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Moments in Surgical History
May 2000

A Civil War Miracle

Arch Surg. 2000;135(5):608. doi:10.1001/archsurg.135.5.608

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.

Despite such grim statistics, the story of 29-year-old Pvt Charles P. Betts, of Company. I, 26th New Jersey Volunteers and his surviving what should have been a lethal penetrating chest injury can be considered a Civil War miracle. On the morning of May 3, 1863, in a ferocious charge on the heights of Fredericksburg, Fredericksburg, Va, Betts was struck by 3-oz "grapeshot." The ball comminuted his sternum at the level of the left third rib, and proceeded inward to injure Betts' costal pleura. With the ball remaining "in the wound," Betts is related to have somehow removed the metal object himself. It was not until the next day that he entered the hospital of the 2nd Division of the Sixth Corps, where through his gaping wound, the "arch of the aorta was distinctly visible, and its pulsations could be counted." Even though Betts had a left pneumothorax, "when sitting up there was but slight dyspnea." Surgeons were able to remove several fragments of the fractured sternum but, otherwise, no consequential surgical care was given. Much to everyone's surprise the "wound soon granulated kindly." Almost 2 months to the day after his injury, Betts was transferred to a convalescent center in Washington, DC, where he "ultimately recovered perfectly." Eleven months later, he was honorably discharged from the US Army, receiving a monthly pension with his "disability being rated three-fourths and permanent." In April 1864, a pension examiner reported that the injured lung "still continues defective somewhat, causing dyspnea."

This drawing of Pvt Charles P. Betts was completed by Edward Stauch at the Potomac Creek Hospital 1 week after the private's injury. Published in The Medical and Surgical History of the War of the Rebellion, 1861-1865 (Vol II. Washington, DC: Government Printing Office: I:486), so faithful was the likeness of the patient, as well as the features of the wound, that 3 years later, surgeon S. A. Holman, medical director of the Sixth Corps, in unexpectedly viewing the illustration exclaimed, "I know that man; that's Betts."

This drawing of Pvt Charles P. Betts was completed by Edward Stauch at the Potomac Creek Hospital 1 week after the private's injury. Published in The Medical and Surgical History of the War of the Rebellion, 1861-1865 (Vol II. Washington, DC: Government Printing Office: I:486), so faithful was the likeness of the patient, as well as the features of the wound, that 3 years later, surgeon S. A. Holman, medical director of the Sixth Corps, in unexpectedly viewing the illustration exclaimed, "I know that man; that's Betts."

In an era when "home health care" and any meaningful type of medical and/or surgical follow-up did not exist, Betts lived a somewhat disquieting life in Newark, NJ. It was 8 years later in April 1872, writing about his wound, that he told of his daily struggles and continuing health-related difficulties:

My wound is not what you would call a running sore exactly, but still there is all the while a kind of dry scab forming and coming off one after the other, and it is very tender. I have spoken to several doctors about it, and they say that it will always be so on account of the bone being broken in such a way that it is ragged and does not heal solid. My health is as good as I ever expect it to be again. My left lung is a very delicate thing, and the least cold seems to go right to it, and the weather we have here at this season of the year is very rough on me; but I suppose there is no use of crying over spilt milk, but must only try to make the best of a bad job.

What became of Betts and how much longer he lived is uncertain. However, his surgical story is cause to reflect on the miraculous healing capacity of the human body without the presence of a surgeon's guiding hand.

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