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Background
Of all the harrowing facts which lend themselves to explaining how 360,000 Union soldiers died of wounds and disease, there is one, perhaps, that is especially telling: at the outset of the war, the Union medical corps consisted of 83 surgeons and assistant surgeons, few if any of whom had ever treated a gunshot wound. This early wartime treatise on gunshot wounds represents the learning curve. Here J.P. Horwitz, a Baltimore Jew appointed Surgeon General of the Navy, describes in detail the variety of wounds, and their treatment.
Autograph Manuscript Signed (“P.J. Horwitz”), entitled “Gun-Shot Wounds," 4 pages, folio, no place or date [January 1862].
With a Carte-de-Visite from the Surgeon General’s Office Army Medical Museum depicting Civil War amputees, including Jewish Lieutenant Moritz Lowenstein.
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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 will 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 will 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 sympathise [sic] with the local injury, if it should 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, the surface of the body cold, and probably bathed in a clammy perspiration, his countenance will be anxious and depressed, pulse frequent, quick & 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
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carefully examine the wound to see that no foreign body is lodged there in, and then after bathing the part 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 strips, or if the Surgeon prefer it he can dip a little lint in the patients [sic] blood, and in the same manner apply it to the part, & then put the part at rest, & 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 soothe him by an encouraging manner, and assurances of his speedy recovery, and at the same time to administer such stimuli as he may require such as brandy and water, a little wine & water & ammonia if necessary. Should he complain of much pain a little laudanum would be serviceable; Unctions 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 instance, If [sic] a nerve be injured there will be great pain, & tingling in part, as well as 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 its 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 comminuted fracture, with its attendant symptoms.
Time and space will not allow me to do more than merely allude to the different local or particular wounds with their attending symptoms.
If a person has a wound on the head which penetrates the brain various phenomena
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 soothe him by an encouraging manner, and assurances of his speedy recovery, and at the same time to administer such stimuli as he may require such as brandy and water, a little wine & water & ammonia if necessary. Should he complain of much pain a little laudanum would be serviceable; Unctions 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 instance, If [sic] a nerve be injured there will be great pain, & tingling in part, as well as 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 its 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 comminuted fracture, with its attendant symptoms.
Time and space will not allow me to do more than merely allude to the different local or particular wounds with their attending symptoms.
If a person has a wound on the head which penetrates the brain various phenomena
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[text is crossed out] may present themselves. The patient may or may not be prostrated at once, he may have all the symptoms of collapse, or on the contrary his symptoms may be entirely local, or the symptoms may be those 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 on the brains, to keep the parts cool, use very light dressings, and to look out for and guard against inflammation by using depletives, purgatives &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 mouths full, which are frothy.
Time prevents my saying more than I already have, and the above remarks are therefore respectively submitted
P. J. HORWITZ (1862)
Chief Horwitz
Navy Dept. Bureau of Surgery, 1862
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 on the brains, to keep the parts cool, use very light dressings, and to look out for and guard against inflammation by using depletives, purgatives &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 mouths full, which are frothy.
Time prevents my saying more than I already have, and the above remarks are therefore respectively submitted
P. J. HORWITZ (1862)
Chief Horwitz
Navy Dept. Bureau of Surgery, 1862
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Submitted Jan, 1862
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SURGEON GENERAL'S OFFICE.
Army Medical Museum.
PHOTOGRAPHIC SERIES.
Army Medical Museum.
PHOTOGRAPHIC SERIES.
