WOUNDS OF THE thoracic cavity and mediastinum proved a formidable surgical problem during the Civil War. With surgeons having no technical know-how regarding operative intervention, penetrating injuries were fatal in 65% of cases. Treatment usually involved little more than the attempted removal of foreign bodies by a surgeon's unwashed and filth encrusted fingers and placement of a simple lint dressing topped with a broad chest bandage intended to maintain the chest immobile. Difficulty with respiration, secondary to either flail chest or pneumothorax, was not easily resolved and it was usually a pragmatic matter of the patient either improving on his own or dying. Suprisingly, pneumonia was an infrequent complication of penetrating chest trauma and in this preantibiotic era there were remarkably few cases of erysipelas or tetanus. The overwhelming surgical complication was empyema, which was treated by the insertion of drainage tubes.
Rutkow IM. A Civil War Miracle. Arch Surg. 2000;135(5):608. doi:10.1001/archsurg.135.5.608