How were chest wounds treated during the American Civil War?

[wedgehed]

I recently saw a soldier’s pension application of a relative who served in the Confederate army. The application states that he suffered a gunshot wound through the lungs. His service records are incomplete, but they do indicate that he spent at least six months at the Medical College Hospital in Atlanta.

I’m somewhat surprised that anyone could survive such a wound in that era. Can anyone shed light on what treatment he might have received?

[engineer_comp_geek]

He’s lucky he lived. Treatment consisted of “removing loose fragments of bone when present, a clean dressing, and quiet”. And that’s apparently it - nothing else is mentioned.

(from “New York State journal of medicine”, April 1904)

Some other texts, like the “Boston medical and surgical journal” mention that other treatments were tried, with very little success. It says that if the ball went int the lungs, it is too difficult to find and remove. It also mentions that death from such wounds can be a very long and drawn out thing (long term infection seems to be the main killer) and that a patient can’t be said to have survived the wound unless he survives for five or ten years.

[wedgehed]

@engineer_comp_geek

Some other texts, like the “Boston medical and surgical journal” mention that other treatments were tried, with very little success. It says that if the ball went int the lungs, it is too difficult to find and remove. It also mentions that death from such wounds can be a very long and drawn out thing (long term infection seems to be the main killer) and that a patient can’t be said to have survived the wound unless he survives for five or ten years.

Well, my relative died in 1910, at age 67.

To a certain extent, I can understand how a “less is more” treatment might have aided his survival, but I don’t understand how punctured lungs could heal themselves before the patient died.

[Qadgop_the_Mercotan]

@wedgehed

I don’t understand how punctured lungs could heal themselves before the patient died.

Not every collapsed or partially collapsed lung is deadly. If airway, breathing, and circulation are not overly compromised, the puncture will heal and the escaped air will be absorbed by the body. Infection becomes the big killer if the air leak/hemorrhage itself is not fatal.

[engineer_comp_geek]

I didn’t have time to post these earlier, but here are some quotes you may find interesting from the Boston medical and surgical journal that I mentioned.

Now, in the gunshot wounds received in the chest, the Civil War gives an enormous number: 8,715 penetrating wounds of the chest are reported and tabulated.
…
The percentage of mortality is very large, as high as 60 to 70 per cent.; and it is not immediate, but subsequent changes that take place in the thorax wliich cause this great mortality.

We all know that we occasionally see at this date, twenty-five years after the war — I know of one or two instances — individuals living who have been shot through the chest, and still go about, and are quite interesting objects to physicians, because they have unhealed sinuses through which air is freely drawn when they breathe, and through which a small amount of pus escapes, giving rise to necrosis of the ribs.

It would seem to be hopeless to hunt for a ball in the thorax; and I believe it is practically abandoned. If the ball enters the pleural cavity and stays there, it drops to the bottom of tbe pleura and may rest upon the diaphragm. If it enters the lung, it is almost or quite impossible to reach it; and unless it happens to have smashed two or three ribs, and made so much destruction that the surgeon makes a large opening, and unless it happens to be partially spent so that it has not penetrated very deeply, it is practically not recovered from the thoracic cavity. It may get into some quiet corner and become encysted. It is more likely to provoke an empyema, or changes in the lung itself, especially pneumonia, or, eventually, tuberculous changes.

[wedgehed]

Thanks for your answers. My relative must have been both lucky & resilient. He also suffered a gunshot wound to the face & was returned to duty with his company where he served until the end of the war.

[VOW]

If it was a through-and-through injury, and hit no major vessels, there’s a good chance the injury could heal.

A natural response by medical personnel would be to cover the wound(s). If enough dressing is applied, the air leak can be stopped.

If the wound bled enough, it could possibly be “cleaned out” and able to heal with minimal infection. Keep in mind, though, in that age, infection and pus were considered part of the normal healing process.

Many survivable wounds from that era left people with horribly debilitating injuries.

A CHEST wound could possibly heal. A GUT wound was fatal. Piercing of the intestines allowed contents to leak into the abdomen, resulting in infection and death. Such death was slow and agonizing.

I love antibiotics, antiseptics, and vaccines!
~VOW

[Gbro]

A GUT wound was fatal. Piercing of the intestines allowed contents to leak into the abdomen, resulting in infection and death. Such death was slow and agonizing.

Is that why the old saying for someone that isn’t liked, “He ought to be Gut Shot” ?

I would believe some of the survivors were left with only one lung, and the bullet of that period were slow and didn’t do the damage a modern high speed one of today will do.
I was lucky to recover a lung shot deer many years ago that went 400 plus yards before bleeding out. The shot was with a 30WCF at 200 yards. The wound was almost like a pencil was pushed through the lung with just a small ring of brusing around the hole. Had that deer bedded instead of running and I not went after it I believe the deer would have had a good chance for survival.
Those soldiers and of course everyone that survived in that day to adult were hardy people.

[T.Slothrop]

I once met a Filipino Doctor who during WWII only had iodine to work with. He said he had a patient with a sucking chest wound survive.

[Derleth]

Reminds me of an old quote:

“The abdomen, the chest and the brain will forever be shut from the intrusion of the wise and humane surgeon.” — Sir John Eric Erichsen, 1st Baronet, Surgeon-Extraordinary to Queen Victoria, 1873 (apparently; not entirely trivial to legitimately source this one. On the plus side, this guy was an expert on railway spine, which just makes me happy for some reason.)

[YoDoc]

I’m an Army Medic. Guys survive crazy injuries all the time. A lung shot isn’t the worst thing ever. Many things, already mentioned, probably contributed. A slow moving projectile, the relative sterility of the chest cavity, the luck of not hitting a major artery, and sheer determination are what saved him.

[engineer_comp_geek]

@Gbro

the bullet of that period were slow and didn’t do the damage a modern high speed one of today will do.

The bullet of the day was the .58 caliber Minie ball. While it is true that they were much slower than a modern bullet , the Minie ball was also just a huge freaking hunk of lead. It had a fearsome reputation in its day for making huge, horrible wounds.

For comparison, the typical Civil War rifled musket (Model 1861 Springfield or Model 1853 Enfield, for example) fired a .58 caliber Minie ball at roughly 1,000 feet per second. The modern M-16 fires a 5.56 mm (.223 caliber) round at roughly 3,000 feet per second. So yes, the M-16’s round is certainly faster, but your typical Minie ball weighed in at around 450 grains, where the M-16’s round is a mere 62 grains or so. The M-16’s round certainly has a lot of advantages. It will penetrate farther, it has less drop at a distance due to the higher speed, it’s a better aerodynamic design so it’s more accurate, and it weighs less so soldiers can carry a lot more of them. And of course there’s the M-16’s fire rate of about 700 rounds per minute, compared to the Springfield’s 3 or 4 rounds per minute (if you’ve been well trained). As far as wounds go, though, if I have a choice between getting shot with an M-16 or an 1861 Springfield, I think I’d choose the M-16. Actually I’d choose not to get shot at all, but you know what I mean.

Now granted, there are higher powered rifles than the M-16 out there today, but let’s be fair here. The 1861 Springfield and the M-16 are both the standard infantry weapon of their time.

[wedgehed]

Can anyone describe what my relative would have experienced during his recovery? What does a collapsed lung feel like? Would he have experienced a constant shortness of breath? Would it have felt like a heavy weight on his chest?

[smiling_bandit]

@wedgehed

Can anyone describe what my relative would have experienced during his recovery? What does a collapsed lung feel like? Would he have experienced a constant shortness of breath? Would it have felt like a heavy weight on his chest?

Well, first he would have had one of the greatest agonies which can be inflicted on a human being. Collapsed lungs are horribly painful, which is not improved by the fact he woulod have been almost entirely helpless. It’s fully possibly to recover, obviously, and the lung can be reinflated quite easily once the hole is sealed up.

Once the wound was treated in the short run (i.e., not bloody much), he’d have had pain but it would have been tolerable as long as he didn’t move around. He probably would have had some shortness of breath until his lungs got back to normal. There’s a good chance he had a nasty infection, but evidently made it alright past that.