Evolution of plastic surgery during the Civil War

- Nyrah Humayun

According to Stark’s article (see References below), there was not a lot of consistent advancement in the field of plastic surgery before the Civil War (1). However, advancement in this field was crucial during this time in history. Stark presents that 10 percent of Civil War wounds were due to head and neck injuries (1). The head and neck region is quite a sensitive area with a lot of nerves and muscles, as we have learned in Anatomy. To be able to reconstruct this region could not only prove important to the physical and mental health of Civil War soldiers but also important for survival of those wounded in the Civil War.

According to Rogers, “During the Civil War a few surgeons started to think of achieving better results for their reconstructive procedures that were pleasing, acceptable, or at the very least, provided a better appearance or function” (2). This was important in helping the soldiers try to get back to as normal of a life as they could despite the injuries they suffered. Rogers presents the injuries that some of the Civil War soldiers faced, such as that of Carleton Burgan who had a slough on the gum that evolved into sloughing that “nearly reached the orbit and the entire upper maxilla was exposed. The parts were gradually able to heal healthfully, but the entire right superior maxilla, the vertical plate of the palate bone, and a narrow strip of the left maxilla, all of which quite separated from the healthy bone, were removed” (2).

There are some pictures of Burgan in the article, and the extent of his injuries is quite intense to the point where I am not sure how he was able to eat or even breathe. Therefore, wounds like this could definitely affect the physical and mental health of someone injured in war. According to Rogers, Burgan’s wounds caused problems with both speaking as well as chewing; however, Dr. Gurdon Buck’s plastic surgery operations were able to ameliorate his condition (2). Rogers in this article uses language such as “Despite his very severe facial and palate deformities, Burgan married Elizabeth Meyers,” to indicate how severe some of these facial wounds were (2). Based on this, facial wounds had the potential to take a toll on a soldier’s physical as well as mental health.

In a different article, Rogers discusses Dr. Reed B. Bontecou’s photography of wounded soldiers during the Civil War (3). This article contains several intense images of the different kinds of wounds people faced during this time (3). Rogers also discusses Dr. Buck in this article, saying that he was “accepted as the first American in medical history to have ordered photographs to be taken of several wounded soldiers in the Civil War, demonstrating their pre-operative facial defects and the ultimate results of his skillful plastic surgery—“skillful” being a word that one can certainly apply to Buck’s surgery” (3). Therefore, plastic surgery was a way of reducing the physical and mental burden of peoples’ wounds during the Civil War.

Facial plastic surgery proved to be essential for survival of soldiers in the Civil War. According to Stark, most people who had a fatal facial wound also had fractures of the facial bones, and treatment involved a combination of removing bone fragments, stopping bleeding, and using adhesives to bring tissue together (1). Furthermore, according to Stark, some of the procedures they were able to do back then were excision of part of the mandible and maxilla, bone debridement, and ligation of the common carotid, external carotid, facial artery, lingual artery, and internal jugular vein (1).

It is quite remarkable that they were able to do all this back then, especially being able to stop bleeding and being able to ligate these vessels. They used all the tools available to them at the time to do quite a bit of reconstructive work in a sensitive area with lots of structures and blood vessels, which is even more remarkable considering that there hadn’t been that many advancements in the field of plastic surgery.

To summarize, the evolution of plastic surgery during the Civil War was remarkable. It transformed peoples’ lives by improving their physical and mental health as well as increasing survival. Furthermore, the kinds of methods used to salvage the head and neck area after a wound were highly advanced given the tools and resources they had. It was an exciting opportunity to explore this topic, especially also since we are currently learning about the head and neck region in class and in Anatomy lab.

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References

1. Stark, Richard B. Plastic surgery during the Civil War. Plastic and Reconstructive Surgery 16(2):p 103-120, August 1955.

2. Rogers, B. O. (2002). Rehabilitation of wounded civil war veterans. Aesthetic Plastic Surgery, 26(6), 498-519. doi:https://doi.org/10.1007/s00266-002-1518-8

3. Rogers, B. Reed B. Bontecou, M.D.—His Role in Civil War Surgery and Medical Photography. Aesth. Plast. Surg. 24, 114–129 (2000). https://doi.org/10.1007/s002660010020