Against common belief, Civil War surgeons were not heartless, nor were they totally incompetent. There were certainly those who were not competent, but to lump all surgeons into that category was an injustice. In the battle of Antietam, devotion to duty caused some medical officers to lose their lives. If any objection were to be made against surgery in the field it would be the efforts on the part of surgeons to practice conservative surgery to too great an extent.
The slow moving mini bullet used during the Civil War caused catastrophic injuries. The mini ball that struck John Hoods leg at Chickamauga destroyed 5 inches of his upper thigh bone. This left surgeons with no choice but to amputate, his leg was removed only four and one half inches away from his body. Injuries like Hoods had an 83% mortality rate. The closer to the body the amputation was done, the more chance there was that the wound would be mortal.
The most common Civil War surgery was amputation. Missing arms and legs were permanent, very visible reminders of the war. Amputees ranged from the highest ranking officers like John B. Hood and Stonewall Jackson all the way down to enlisted men like Corporal C.N. Lapham of the 1st Vermont cavalry who lost both of his legs to a cannon ball.
With three out of four wounds being to extremities, the Federal Army had 30,000 amputations. It would not be out of the ordinary for the wait for treatment to be up to two days. When treatment was finally done it was not done antiseptically, surgeons did not perform careful hand washing before operating. The doctors wore blood spattered clothes and when something was dropped it was simply rinsed in cool, often bloody water. They used sponges and instruments that had been used in previous cases and simply dipped them in water before using them again.
The injuries to be dealt with were dreadful. The mini ball bullet left large gaping holes, splintered bones and destroyed muscle, arteries and tissue beyond any possible repair. Those shot through the body or the head would not be expected to live.
The problem was that on the whole, Civil War doctors were not incompetent as doctors, but as surgeons. Of the 11,000 Northern physicians, only 500 had performed surgery. In the confederacy it was worse. Of 3,000, only 27 had done surgery. Many got their first introduction to surgery on the battlefield.
The field hospital was hell on earth. Surgeons would stand over the operating table for hours without a let-up. Men screamed in delirium, calling for loved ones. They worked under a crude system of triage. Wounds through the head, belly or chest were left to one side, because they would most likely die. As cruel and crude as it sounds, it allowed doctors to save previous time to operate on the ones that could be saved.
The surgeon would wash out the wound with a cloth, probe for cloth, bone splinters, or the bullet. If the bone was broken or a major blood vessel torn, he would often decide on amputation. He would then administer chloroform (which was in widespread use, contrary to opinion). Then he would take his scalpel and make an incision through the skin and muscle and down to the bone, making incisions above and below the wound, leaving a flap of skin on one side, then saw through the bone until it was severed, tie off the arteries, scrap the bone smooth, and pull the flap of skin across and sew closed, leaving a drainage hole.
A good surgeon could amputate a leg in less than 10 minutes. If the soldier was lucky he would recover without surgical fever (pyemia or gangrene). Pyemia was the most deadly; it was a form of blood poisoning and had a mortality rate of ninety percent.