RUTHFULLY YOURS

In this three-page, handwritten document, Baltimorean P.J. Horwitz, who served as surgeon general of the Navy for the Union during the Civil War, tries to get his fellow medical officers up to speed on the presentation and treatment of gunshot wounds.

The basic information in Horwitz’s treatise, written in January 1862, reflects physicians’ need for rudimentary advice, at this early stage of the war. “One of the first things to be done is to stop the hemorrhage, if there be any, and then carefully examine the wound to see that no foreign body is lodged there in, and then after bathing the flesh in cold water, apply to the wound a piece of lint on which may be spread a little cerate [an ointment],” Horwitz writes.

While the medical corps may have started the war laughably unready for the types and volume of wounds it would see, it would make many improvements in the next four years. “Each side was woefully unprepared, in all aspects, for the extent of the war,” argues Robert F. Reilly, M.D., in an assessment of the performance of physicians and surgeons during the conflict. “Despite this, many medical advances and discoveries occurred as a result of the work of dedicated physicians on both sides”—advances including the safer use of anesthetics, the organization of large hospitals, and the performance of rudimentary neurosurgery.

A transcript follows the document images.

Transcript, by the Shapell Manuscript Foundation:

Gun Shot Wounds

Gun shot wounds include all injuries produced by firearms, and partake of the nature both of contused and lacerated wounds. The symptoms of a gun shot wound vary with the parts injured. When the wound is merely fleshy, and the mind of the individual wounded is not directed to the injury, the  pain and inconvenience may be so inconsiderable as not too attract his notice, till his attention is called to his condition by the bystanders, or by some circumstances not connected with his injury.

If the wound is produced by a musket ball, the patient will generally first feel a slight tingling in the part, and on looking at the seat of injury perceive a hole smaller than the projected ball, generally smooth lined, inverted and the part more or less swelled, and on examining further, if the ball has made its exit there would be found another opening, which unlike the other will have its margin everted and ragged.

The nervous system of the patient may or may not sympathize with the local injury, if it showed not then the symptoms will be little other than those above described, but on the other hand should it do so, on reaching the patient he will be found very much prostrated, this surface of the body cold, and probably bathed in a clammy perspiration, his countenance will be anxious and depressed, pulse frequent, quick and small, and such other symptoms of collapse.

Should the patient present radical symptoms of injury, one of the first things to be done is to stop the hemorrhage, if there be any, and then carefully examine the wound to see that no foreign body is lodged there in, and then after bathing the flesh in cold water, apply to the wound a piece of lint on which may be spread a little cerate, and attach it to the parts by adhesive or if the surgeon prefers it he can dip a little lint in the patient’s blood and in the same manner apply it to the part, and then put the part at rest, and treat the local and general symptoms as they arrive.

If on first seeing a patient who is wounded he is found to be much prostrated, the best thing to do is to try and sooth him by an encouraging manner, and assurances of his speedy recovery, and at the same to administer such stimulus as he requires, such as brandy and water, a little wine water and ammonia if necessary. Should he complain of much pain a little laudanum would be serviceable;  […] also and external warmth may be required.

If a wound of the kind above described be complicated with an injury of a nerve, an artery  or a bone, both symptoms and treatments will vary, for instances. If a nerve be injured there  will be great pain and tingling in part, as was in that portion of the body to which the nerve is distributed. If an artery be wounded there will be more or less hemorrhage depending upon it’s size and also upon the manner in which it is  wounded , or without having much external hemorrhage the parts may be found stuffed and gorged with blood. If a bone is fractured there will, in all probability, be a compound, communicated fracture, with its attendant symptoms.

Time and space will not allow me to do more than sincerely allude to the different local or particular wound with their attending symptoms. If a person has a wound on the head which penetrates the brain various phenomenon may present themselves. The patient may or may not be prostrated at once, he may have all the symptoms, if collapse, or on the contrary his symptoms may be entirely local or the symptoms may be these of confusion of the brain, or one or all the organs of special senses may be interfered with, depending upon the situation and character of the wound.

What we have to do in a case of this kind is not to meddle too much by endeavoring to extract the foreign substances, which may be lodged in or in the brains, to keep the parts cool use very light dressings and to look out for and guard against inflammation by using […] &c.

When a ball penetrates the chest and wounds the lung, it will be known by extreme collapse of the patient by bleeding at the orifices of the wounds, by the great  dyspnea , by his coughing up large arterial mouthfuls l which are frothy.

Time prevents my saying more than I already have, and the above remarks are therefore respectively submitted.

P.J. HORWITZ