00:01 - Ok I'm Alan Fleckner. I'm a real

00:04 - physician.

00:06 - I'm retired military of 37 years

00:08 - and I have private practice as

00:09 - an emergency physician for 27 of

00:12 - my 47 years.

00:14 - I was asked today to portray a

00:15 - Civil War surgeon. No one in

00:17 - particular. Just to give

00:18 - everybody a demonstration of

00:20 - what actually went on in a civil

00:22 - war field hospital. At that

00:25 - stage of 1863 was used as a

00:27 - Confederate field hospital.

00:30 - So they have real casualties

00:32 - here and some of the

00:33 - armamentarium that I have is

00:35 - down here.

00:37 - This is the surgical side of it.

00:39 - The knives that were used to

00:40 - start an amputation. Don't run

00:46 - through.

00:46 - When you got down and cut the

00:47 - bone you can chip off the end of

00:49 - it so that's smooth. Saw it cuts

00:55 - to the bone to various different

00:57 - types.

00:59 - I have pictures that you can see

01:07 - you had broadswords, hacksaws,

01:11 - your wounds.

01:16 - Over here you cut circularly

01:19 - around down to the bone. Then

01:27 - you had flap incisions over

01:29 - here.

01:30 - Bleek incision over here. You

01:32 - just use these big knives to cut

01:34 - down, cut off a former flap and

01:39 - move down here.

01:41 - This is what caused all the

01:43 - damage.

01:44 - These are replicas of bullets.

01:47 - This is a smooth ball. Musket

01:49 - ball.

01:51 - It causes very little bone

01:53 - damage, but a lot of tissue

01:54 - damage.

01:55 - This is a mini bowl.

01:57 - This is a, I don't know if you

01:59 - can see it.

02:00 - This is a mini ball off the

02:02 - battlefield.

02:03 - This came out of a rifle then

02:05 - feel the range on the musket

02:07 - ball was maybe 100 yards.

02:09 - This could go out from anywhere

02:10 - to 400 and 500 yards. It spun so

02:15 - very fairly accurate.

02:18 - The tactics that they use in

02:21 - those days was to line up a

02:23 - column of troops in line and

02:27 - marched to each other and fire

02:29 - with a mini ball.

02:31 - It was very dangerous.

02:32 - More accurate took you out on a

02:35 - longer range of tactics and did

02:38 - not fit the weaponry of the

02:40 - civil war.

02:42 - And it took a while for them to

02:43 - learn that the used

02:44 - intrenchments to protect

02:46 - themselves.

02:46 - That didn't happen until later

02:48 - on in the war, 64, 65.

02:51 - Here are some of the instruments

02:54 - that you would use for minor

02:56 - injuries.

02:57 - This is a bullet for us.

02:59 - If you go down, grasp the

03:02 - bullet, and take it out.

03:05 - This is a probe.

03:06 - You go into the wound site,

03:09 - touch whatever is at the end.

03:11 - There's a little hot wax. It's a

03:13 - little porcelain at the end of

03:16 - it, you touch the bullet and

03:19 - scrape it off and you can see

03:20 - it's metal not bone that you've

03:22 - hit.

03:22 - But the best thing that we had

03:24 - to use to probe a wound was my

03:26 - finger. Unclean. Dirty. Into the

03:29 - wound to see what was down

03:32 - there.

03:34 - This is a unique instrument.

03:35 - It's called a trefine.

03:37 - It's used to cut into the skull.

03:40 - You could see a little point out

03:42 - pull it back and slowly turn and

03:47 - it will cut a piece of bone out

03:48 - of the skull so you can put an

03:50 - elevator and and lift it up and

03:52 - take it out.

03:54 - And this relieves pressure

03:55 - that's on there or if you have a

03:58 - fracture that's a depressed

03:59 - fracture that does not want to

04:01 - come out easily and you can't

04:03 - get the spatula underneath it.

04:06 - This will make a hole for you to

04:07 - get close to.

04:12 - This is an arterial hook or as

04:16 - we call it a tanaquilum. Grab

04:23 - the end of the vessel pull it

04:25 - out and you can tie your

04:26 - ligature around it, cut off any

04:29 - bleeding that would occur.

04:30 - Usually after a amputation seems

04:40 - high level weight and balance

04:42 - doesn't want to work.

04:45 - In case you hadn't dispensed

04:46 - medication I could use the

04:49 - weights here and measure out my

04:57 - morphine or opium and give it to

04:59 - somebody.

05:00 - This was also used to put in

05:03 - rooms is stringent.

05:06 - It will constrict blood vessels

05:07 - to stop small bleeding, but the

05:09 - unfortunate thing is you're

05:10 - putting opium into a place that

05:12 - can be absorbed.

05:13 - You don't know how much the

05:15 - patient got back. This is my

05:19 - anesthesia.

05:20 - They've one surgeon doing the

05:22 - surgery and another surgeon

05:26 - giving the anesthesia.

05:27 - This is a nice call. It went

05:29 - over the mouth and you pour

05:32 - ether onto it.

05:34 - So I'd be lying flat till the

05:37 - patient was anesthesized enough

05:40 - to do the surgery.

05:44 - This is the chloroform. Same

05:47 - thing, you used chloroform to do

05:49 - it.

05:50 - Most of the anesthetic was

05:51 - chloroform rather than ether.

05:52 - Ether was flammable or the

05:54 - chloroform caused more noise.

05:56 - You put Vaseline around the

05:58 - mouth here so you didn't burn

05:59 - them or pull over forward into

06:02 - that.

06:02 - And the patient would be

06:04 - anesthetized. For how to use the

06:09 - last resort good old Kentucky

06:15 - bourbon and you give this to a

06:17 - patient as a sort of a pre

06:19 - anesthetic like they did a lot

06:21 - where you can use them alone and

06:22 - you didn't have anesthesia.

06:24 - Now most people have a myth that

06:26 - we didn't use enough anesthesia.

06:28 - That's not true.

06:29 - We took people down to an

06:31 - excitement phase. They would

06:32 - move around.

06:33 - They would cry out but they did

06:36 - not remember anything and could

06:37 - not feel anything.

06:39 - We didn't get taken down to a

06:40 - deep anaesthetic phase as they

06:42 - do today.

06:43 - We didn't have the implements to

06:44 - measure and monitor if we took

06:46 - them to the Woodside these

06:50 - instruments or use the phone

06:52 - goes through here and wraps

06:54 - around. When you're cutting it

06:56 - pulls up the soft tissue so you

06:58 - can get it a deeper cut at the

07:00 - bone.

07:00 - You should cut the bone about an

07:01 - inch deeper into the tissue so

07:04 - that you can make a flap over it

07:07 - and make a better cut.

07:09 - This is used if you have two

07:10 - bones. It goes between the bone.

07:13 - The other goes around the

07:15 - outside.

07:17 - This is a tourniquet.

07:18 - You used that while you're

07:20 - stopping before you start your

07:22 - anesthesia, before you start

07:25 - cutting this controls bleeding.

07:27 - When you finish amputating

07:29 - through the bone.

07:30 - You would use the that limb that

07:32 - I showed you grab out the blood

07:34 - vessel tie it off the veins of

07:37 - the left strict.

07:38 - By themselves it was just minor

07:40 - bleeding.

07:41 - You went to control that if

07:42 - there were any nerves alongside

07:45 - the blood vessels you separated

07:47 - the nerves so you did not get

07:48 - any pain afterwards.

07:50 - And there were all more or

07:51 - neuropathy of the bone each

07:56 - surgeon or doctor was given a

07:58 - chest. If I am a Confederate and

08:00 - I haven't got captured this from

08:02 - the union slows a lot of

08:07 - Glindemann's most of which were

08:10 - of no value to cure anything.

08:13 - So we closed the lid on this

08:15 - note using this is a list of

08:19 - what was in the average doctors

08:21 - traveling kit. This is a pocket

08:29 - surgical kit.

08:32 - Put your instruments in there

08:37 - and carry it around with you to

08:40 - tie off wounds.

08:41 - We use silk, real surgical silk

08:49 - or cotton linen to tie off the

08:51 - road.

08:53 - Now the trick that they use in

08:56 - those days was to thread the

08:58 - needle as any woman who sold

09:01 - them can tell you when you can't

09:03 - get the thread into the hole of

09:05 - a needle.

09:06 - What do you do you put it in

09:07 - your mouth and you put it in the

09:09 - needle.

09:09 - Well they did that the same way

09:11 - and then put that into you to

09:13 - tell you if you ligature. The

09:16 - environment that we worked in

09:18 - was entirely on steroids yet

09:22 - after 30000 amputations in the

09:25 - Union army because the

09:27 - Confederate mystics were burned

09:30 - in Richmond during the war we

09:33 - have no statistics like

09:34 - confederate surgery that's

09:35 - reliable. Least that I've found

09:38 - other people may disagree with

09:40 - that but fatality rate was only

09:42 - 25 percent, which is very good

09:45 - for the time period.

09:46 - Remembering that the germ theory

09:48 - was not invented found by Pastor

09:52 - until 1870 or so.

09:55 - So they work in the dark.

09:57 - They didn't know that there was

09:58 - little killers out there that

10:00 - would take you out.

10:02 - Everyone that was wounded died

10:04 - of disease.

10:06 - Six hundred twenty four thousand

10:08 - deaths.

10:08 - If you have any reliable

10:11 - statistics that they vary and

10:12 - what book you read.

10:16 - Two to one with disease with two

10:19 - disease death for every one

10:22 - battle death.

10:25 - The camps were dirty. The young

10:28 - soldiers coming in did not have

10:31 - real physicals. They were off

10:33 - the farms. They got measles,

10:34 - they died of measles.

10:36 - You put a lot of people into a

10:37 - close area.

10:39 - The sanitary facilities were not

10:41 - good.

10:42 - You didn't learn that till about

10:43 - two years into the war and they

10:45 - saw to clean things up.

10:47 - But again they were working.

10:48 - What they knew they didn't know

10:50 - about, but they didn't know

10:51 - about mosquitoes causing malaria

10:54 - or yellow fever.

10:56 - We did the best we can with what

10:57 - we got.

10:58 - We've got to remember we did

10:59 - very well and as one of our

11:03 - esteemed physicians in his last

11:07 - speech in 1911 said if you go to

11:09 - any small town you will find

11:11 - many monuments of the civil war

11:13 - on the veterans that you will

11:15 - not find one monument to a civil

11:18 - war physician.

11:18 - Except at mass general hospital.