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ORIGINS OF CONTEMPORARY CIVILIZATION The letters ofa pioneer andpatriot who, butfor the grace ofGod, might have invented surgery; who, instead, advanced himselfin wisdom and became rich CHARLES E. GOSHEN, M.D.* Gettysburg, Pennsylvania July 29, 1863 Office ofthe Surgeon General Department ofthe Army Washington, D.C. Dear General: I am a local physician who was commandeered by the surgeon of General Meade's army to help care for the battle casualties during and after the skirmish between his army and General Lee's at the beginning ofthis month. Several ofthe wounded are still under my care. I have them housed in a schoolhouse here in Gettysburg, and I am hoping the army will make other arrangements for them so that I can return to my medical practice. Meanwhile, however, I think I have discovered something that you might find useful in the management of other battle casualties. As you well know, it has been the custom to amputate extremities when bullet wounds have caused compound fractures; otherwise the patient develops gangrene and usually dies. During the battle here, and for several days afterward, we did not have enough surgeons to perform all the amputations that seemed to be necessary, so that a sizable number of cases of compound fractures remained unamputated. I have been using three or four ofthe local housewives as nurses to help me. One of these women thought of a way to eliminate the odor from the wounds, and we tried her suggestion on ten of the men who had not had amputations. She took some strong smelling liquid which her husband had made out of coal tar, cleaned out and opened the wounds, and poured in this liquid every day. In none of these cases did any of the usual foul smelling pus appear, even after two weeks, so we covered the wounds with dressings and they all healed up. This peculiar woman also insisted on boiling the dressings before we applied them, and maybe that helped, also, but I cannot see why it would. AU ten of these cases are doing fine now, and it looks as ifthey will all be hale and hearty in another few weeks. I have developed a theory about these cases, which I would like to pass on to you. It seems to me that in the usual compound fracture the penetration of the flesh by the * Department of Psychiatry, School of Medicine, West Virginia University, Morgantown. Present address, RFD 3, Waynesboro, Pennsylvania. 226 Charles E. Goshen · Contemporary Civilization Perspectives in Biology and Medicine · Winter 1967 bullet causes to be trapped inside the wound something like a mold, which, we know, grows only in damp, dark places. This mold grows, then, on the surrounding tissues, destroying them and creating poisons that kill the patient. This would be, then, a kind ofsepsis. By keeping the wound open and applying the woman's coal-tar liquid, I speculate that we managed to kill this mold and therefore prevent the sepsis. I am calling this treatment antisepsis because it is one that attacks the poison. Also, by boiling the dressings, maybe we killed any other mold that might have been on the material and prevented any new sepsis. In any event, the treatment certainly worked so far. If you think the army would be interested in my studying this method further, I would be glad to do so but would need some money to carry it out. I figure that I could get a good supply ofthe coal-tar stuff for about $25; I would need about $10 a month to rent a building to keep the patients in and about $30 a month to hire a nurse. For my own services, I could do this work in conjunction with my regular medical practice and would be satisfied with about $25 a month. Altogether, about $300 would enable me to carry on this search for about three months. Yours truly, Grant Proposal, M.D. * * * August 22, 1863 To: Grant Proposal, M.D. Gettysburg, Pennsylvania From: Major GeneralJohn B. Practice Surgeon General, Department ofthe Army Washington, D.C. Re: Procurement ofMedical Services The surgeon general has transmitted your request for payment of services to...

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