Orthopaedic Injuries of the Civil War: An Atlas of Orthopaedic Injuries and Treatments during the Civil War, and: Photographic Atlas of Civil War Injuries: Photographs of Surgical Cases and Specimens, Otis Historical Archives (review)

These books show historically dedicated clinicians usefully addressing aspects of medical history. Kuz, now an orthopedic resident, and Bengtson, newly in the practice of plastic surgery, founded their own Medical Staff Press and published these labors of love with skill, knowledge, and dedication.

Orthopaedic Injuries is an atlas of trauma surgery by anatomic region, excluding the head. The twenty patients presented were selected from the Otis collection (see below). There is a brief overview of Civil War medicine, of the overwhelming impact of disease, and of the improvement in wound management as the war progressed. Chest, head, and abdominal wounds had very high mortality rates—hence, the focus of operative care was on extremity wounds, some 70 percent of the wounded treated by surgeons. Over time, surgeons learned the indications for early operations and for conservative management—postoperative infection in this pre-germ theory era was common. Minor errors in the text (vessel ligature, maggot use, Dakin’s solution, débridement), but they do not detract significantly from its value.

Beginning with the spine, each anatomical area is presented using the case of an actual patient, Union Army statistical data from The Medical and Surgical History of the War of the Rebellion (1861–1865) (published by the U. S. Government Printing Office between 1870 and 1888, and hereafter referred to as MSH), and a concise description and discussion of the management of the wound. There are drawings of many of the operations. Succinct descriptions of limb amputation and of “your day in the operating room” neatly outline the surgeon’s work. Prosthetic development is touched upon, and the development of orthopedic surgery as a specialty in 1887 is properly credited to the surgical experiences of the war.

This is a nice, inexpensive, attractive volume, useful for its nonpresentist approach, its compilations of data, and its capsule summaries of the operative approaches to the wounds of each area. It is a splendid gift for any surgeon, especially for those in training.

However, Bengtson and Kuz have earned their spurs as historians in returning to print, in their Photographic Atlas, the exceedingly rare Otis collection of Civil War surgical cases and specimens. Michael Rhode, archivist of the Otis Historical Archives at the National Museum of Health and Medicine (founded as the Army Medical Museum in 1862), opens the book with a superb discussion of this first reprinting of the Photographic Series since 1881. Rhode describes the early work of the Museum during the war and the contributions of Major George Alexander Otis, its curator from 1864 to 1881. Otis received his M.D. from the University of Pennsylvania, studied in Paris, founded a medical journal, and served with distinction in the Union Army as a medical officer in various postings until his appointment to the Museum. He published surgical monographs and studies of the transport of the wounded as “Circulars from the Surgeon General’s Office.” He edited the first two massive surgical volumes of the MSH, and had partially completed the last before his death.

The volume reviewed here is the compilation in 1881 of eight separately published volumes, many of whose photographs and etchings were published in various volumes of the MSH. There were four hundred photographs of patients and anatomical specimens in the original photographic series; to these are added nearly one hundred more from Otis’s Photographs Contributed to...