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On the Duties of the Surgeon in Action Written by Dr. Richard
Swanton Vickery, Regimental Surgeon [Webmaster's Note: This is part of Dr.Vickery's thesis written during the completion of his medical training at the University of Michigan in 1864. It draws on much of his earlier battlefield experiences as a private in the Hospital Corp and as a Surgeon to the 2nd Michigan Infantry. The document describes the duties of the Regimental Field Surgeon as opposed to the duties of the Division Surgeon. Field Surgeons were the first medical person that the wounded would come in contact with. They were armed with little more than a "medical knapsack" which consisted of simple medical instruments, medicines and bandages.]
his war, unprecedented in modern times for the numbers
of men engaged on both sides, the fearful slaughter of its numerous battlefields
and the consequent number of wounded requiring the Surgeon's care, found the
Medical Department like the other Departments of the army, not prepared for demands upon it on such an enlarged scale. As might have been expected in
the first battles there was but little method or system. Each Surgeon attended
to the wounded of his own Regiment as well as he could, generally without much
concert with others, and frequently he found his utmost efforts inadequate to
their proper care.
He wants to have the wounded as they fall, picked up as rapidly as possible
and brought to the Depot which he shall select, there to be cared for and
dressed, and forwarded quickly to the Division Hospital in the rear. Then the stretcher bearers must be looked to, of whom there should be four to each stretcher. After reserving one or two of his Hospital attendants for other duties, he [the surgeon] will have three or four of them to act in this capacity. The Drum corps and the Regimental Band, if there is one, are always on the eve of a battle ordered to report to the Surgeon for duty, but the less he calculates on aid from them the better. With a few exceptions, they are generally worthless as stretcher bearers, many of them being young lads physically incapable of such fatiguing duty. These may be sufficient while the wounded are but few and come in slowly, but more help will soon be required when the combat thickens and some dashing charge or close firing brings them to the rear by dozens. In that case the Surgeon will find the Pioneers the best and most reliable aid. Generally numbering about ten under charge of an experienced sergeant, all able-bodied men accustomed to stand fire, they form a really effective corps of stretcher bearers, and can generally be procured for that purpose if required on application to the Commanding Officer of the Regiment.
The next thing to be considered is his
own field depot for the reception of the wounded as they come in. If he can establish himself where the Ambulances can drive up, it will save his stretcher bearers much work, and ensure that the wounded will be moved speedily to the Division Depot. Other advantages which it would be well to look to in the selection of a site, though they are not indispensable, are water and shelter--such as trees or a building, if a storm or a hot southern sun should beat down on the field. If there is time it would be well also to have something laid on the ground to place the wounded on--such as straw, hay, corn stalks, or even pine tops or brush of any kind. These remarks apply to cases of general engagements where the position of a Regiment may not vary much during the day. If the Regiment advances the Surgeon of course follows it, and locates his Depot anew at each halt. If it is falling back fighting it is more than ever necessary that he should be near, that the wounded may be promptly cared for and carried off to prevent their falling into the hands of the enemy.
Next he should see to the condition of his Hospital Knapsack with its dressings, ligatures [surgical threads], sponges, stimulants & c., also his Instruments--a good pocket-case with perhaps a bullet forceps, being nearly all the Instruments he is likely to need. These things being all considered he is ready for the reception of his wounded--and in coming to the subject of their care it may be well to make a few general remarks. He should bear in mind that anything he does for them is but temporary--he has not instruments, assistants, time, nor any of the facilities to undertake operations not immediately required. Nor if he had would it be well for him to attempt them when a corps of Surgeons is waiting a little to the rear with all the appliances possible to attend to his patients. The dressings he applies in all severe cases will be taken off soon again, the fractured limbs will be re-examined to determine the question of amputation or resection, balls remaining in the wounds will be sought for, and the wounded generally will be looked over anew as they arrive .... It may indeed sometimes happen that there is no Division Hospital near; in that case he must shape his actions to suit altered circumstances, and dress every patient in a more permanent way.
If it should happen to be his first battle there are three things that will be apt to cause him some surprise· 1. The small amount of hemorrhage which requires his attention. He finds in his knapsacks a formidable array of tourniquets and compresses, yet it is very rarely that he will be obliged to use them. Men will be brought in who have bled a great deal--enough perhaps to saturate their clothing and the stretcher or blanket on which they lie--yet by the time they get to the Surgeon it [the bleeding] is generally stopped, or so nearly so as to require nothing more than a light wet compress and a bandage not too tightly applied. Where a large artery is wounded the man generally dies before he can be moved--smaller arteries speedily become blocked up from the amount of bruising and disorganization of tissue caused by a rifle ball. The exception to this are mostly in the case of wounds in the head or face where the vessels contained in bony canals do not retract so readily; or the greater vascularity keeps up the hemorrhage· Then a compress can nearly always be applied so as to check the bleeding until the patient gets to the Division Hospital·
Incised or punctured wounds inflicted by the sabre or bayonet, are also likely to be troublesome in this way, but the proportion of these ·.. wilt be very small. He may dress the wounded through a long engagement and not see an example of either. Bayonet charges though often heard of are very seldom seen.
2. The small amount of depression [on the part of the wounded] compared with the extent of injury. So constantly is this the case, that when a man is brought in looking deadly pale, with sunken countenance, cold sweat upon his brow, pulse almost gone and all the symptoms of collapse, the Surgeon at once supposes that he is mortally wounded, and is too frequently right in his supposition. The ardor and fury of the fight stimulating every nerve and fibre of the body, and making every drop of blood flow quicker has not yet quite died away, and it is many hours before its effects altogether pass off.
Wounds of the intestines or any of the abdominal viscera are generally the most depressing--those of the thorax and head next--fractures of the limbs in proportion to their nearness to the trunk, and injuries of the joints in proportion to their size. A little stimulant wilt be found very serviceable in most of the cases as they are brought in, and will be eagerly sought after by the wounded. 3. The patience with which the men bear their sufferings. [The inexperienced surgeon] has probably read accounts of battle fields, describing the shrieks and groans of the wounded, and expects to find the [wounded] are full of lamentations. In place of that, he hears as a general rule only low moans escaping involuntarily, and an occasional expression of an impatient wish that the Doctor would get round quickly to dress the wound--the poor fellow expecting relief from him that he cannot often give. When a large nerve or plexus of nerves has been bruised, or partially divided, we sometimes hear expressions of acute pain, not often otherwise. If the wounded are brought in faster than the Surgeon can attend to them, he should appoint his Hospital Steward or if he is not there, one of the most experienced of his attendants to receive them as they come in, get them placed as comfortably as possible, and cut away the bloody clothing and sponge the wounds--all in readiness for his [the surgeon's] examination. Another of the attendants might accompany him with dressings, adhesive plaster, & c. and still another will be well employed in administering water to the wounded, and stimulants to the cases designated by the Surgeon--taking care not to pour them in too liberally
A sponging of the wound with cold water--especially in warm weather --removing any clotted blood or shreds of clothing, will be most grateful to the patient, and should generally be the first thing attended to. Where the ball remains in the wound it can be sought for and extracted by the bullet-forceps if within reach .... If lodged near the surface it can be readily cut out. If it cannot be easily found, it will be better not to torture the man by a prolonged search, but send him back to the Division Hospital .... Fractures of the thigh, or severe wounds of the chest, or abdomen, should, if possible, be kept on the stretcher in which they were brought in, and thus sent on it to the Division Hospital. This saves them the torture of frequent moving .... When the wounded are coming in fast, it is generally a good rule to attend to all the serious cases in the order in which they are brought in, letting the slighter ones wait; though occasionally a case of unusual severity will require immediate attention and speedy removal to the Division Hospital. Men wounded in the upper extremities, if not very severely, will frequently be able to make their own way to the rear after the wound has been dressed, and the arm supported in a sling. In some cases of acute pain the Surgeon will find it necessary to administer an anodyne [pain reliever] immediately, but as a general rule it will not be required for some time. It is not necessary to say anything of amputations here. It is very rarely, if ever, that they are required to be performed on the field, nor does the Surgeon have with him the instruments necessary for the purpose. If any wounded of the enemy are brought in, they should receive all the care and attention the Surgeon can possibly pay them consistent with his duty to his own men, who have the first claim upon his time. When a man is struck down he ceases to be an enemy and becomes a patient. In conclusion, the Surgeon should bear in mind the good moral effect that a proper performance of his duty has upon the men of his regiment. It encourages them more than he may suppose to know that if struck down in the performance of their duty, they will be promptly removed and receive all the attention that kindness and surgical skill can bestow. It is scarcely necessary to say that he [the surgeon] should be gentle and kind--no hurry or turmoil will excuse a rude or rough-bearing to a wounded man. He should console and comfort as much as possible--have a few words of cheer, if there is any room for life. If asked as he frequently will be in an anxious tone what the prospect is of retaining life, or saving a shattered limb, he should speak as hopefully as he can. Not that he should encourage any one in false hopes where it is c/ear that life is ebbing out--or if a limb must be sacrificed, it is better to say so at once; then the man makes up his mind to the loss--but when there is room for doubt, the sufferer should at least have the benefit of it. It may at some time become necessary to abandon his wounded to the enemy; but it should only be done in the last extremity, and when it is perfectly clear that they cannot be brought off. When many wounded are left, some Surgeons are always detailed to remain with them--and any number more than one or two, should never be left without a Surgeon. Finally, when the smoke and the dust of the battle have cleared away, when the Surgeon, probably wearied and exhausted, has dressed his last wounded man, and seen him carried to the rear, and has pencilled out his Report of Casualties, he has finished, for that day at least, "The Duties of the Surgeon in Action."
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