“Old Sawbones”: The Surgeon’s Struggle


Working in the Medical Middle Ages

“Johnny Rebs and Billy Yanks were in the wrong place at the wrong time.  They not only went into the army just when the killing power of weapons was being brought to a new level of efficiency, they also enlisted in the closing years of a period when the science of medicine was woefully imperfect.  Thus, the Civil War soldier got the worst of it in two ways.  When he fought, he was likely to be injured severely.  When he was in camp, he lived in conditions that were apt to make him sick.  In either case, he had no chance of getting the kind of medical treatment that a generation or so later would be routine.”

—— Dr. James I. Robertson, Jr.

“Soldiers Blue and Gray,” Chapter 8: “The Grimmest Reaper”

The nickname “Old Sawbones” was one of many such unflattering names bestowed upon the army doctors of Civil War camps by the unlucky soldiers struck down by wounds or illnesses and left in medical care.  When the most common medical response to a bullet wound in an arm or a leg was amputation, it’s no surprise that soldiers would have expected to lose a limb after sustaining an injury that might, by today’s standard’s, seem minor.

Surgeons’ education during the Civil War Era was inadequate preparation for the large-scale medical emergency that the war brought on.  With no knowledge of the science of antibiotics or of the way communicable diseases spread, doctors distributed “healing” mixtures to soldiers often heavy in lead, mercury, or other poisonous materials that could speed death along rather than ward it off.

More limbs were removed during the Civil War era than at any other point in American history.  Most of a surgeon’s time consisted of amputation procedures — arms and legs were often too mangled to salvage with needle and thread, so the cure for bullet or shrapnel wounds to the outer limbs was most often simple removal.  An injury to the torso or head most often resulted in death.

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Left: Typical surgical kit used largely to perform amputations. Image credit: Burlington Historical Society via The Civil War Monitor.

Right: Illustration of Union soldier Milton E. Wallen suffering gangrene following the amputation of his arm. Image credit: National Museum of Health and Medicine via The Civil War Monitor.

The frequency of amputations as the go-to method of surgery prompted soldiers to bestow nicknames upon surgeons that included “Sawbones,” “Old Quinine,” and “Long John the Shoemaker.”  Soldiers began to label surgeons and physicians as “quacks,” expressing their frustration at the medical men’s apparently lackadaisical attitude toward the injured and ill.  After all, the default response to any sickness was an overdose of quinine or calomel that usually resulted in poisoning, and the slapdash treatment of a wound so often resulted in infection and even death.  Soldiers even accused their physicians of drunkenness and malpractice.

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Left: Diagram of a “flap operation,” a procedure that left flaps of skin and muscle loose in order to cover the remaining stump of the limb following removal.  Unfortunately, this method was especially susceptible to the effects of gangrene and hemorrhaging.  Image credit: Kevin Thompson, “Amputations in Military Surgery During the Civil War.”

Right: An example of an 1860’s “Vinegar Valentine,” a practiced sanctioned and usually anonymous with the intent to insult or criticize their recipient.  This particular card plays upon a common opinion directed towards the surgeons of the Civil War.  Image credit: Collector’s Weekly.

Surgeons were, in fact, generally attentive to the needs of the soldiers; they were simply hindered by lack of medical information, supplies, and space/time in which to work.  The accusations of carelessness and malpractice made by the soldiers were usually contradicted or withdrawn once they experienced battle — in such conditions, soldiers realized the vast number of limitations forced upon surgeons, especially following battles.  The sheer number of diseased and wounded men simply overwhelmed the meager number of surgeons that each side could provide, forcing these surgeons to work in haste in order to at least attempt a treatment for every soldier in need.  Even the most devoted of Civil War surgeons were constrained by the inadequate resources available to them.