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Battlefield orthopaedics: Civil War style

By Elaine Fiedler

John M. Rathgeb, MD, brings history alive

Imagine being a doctor in the midst of the American Civil War. You might find yourself at a field station near the battlefield or at a general hospital treating the men in your charge. You are overwhelmed with shocking numbers of casualties, but you do your best to help others survive.

John M. Rathgeb, MD, dons the garb of a Civil War surgeon to give visitors to the National Museum of Civil War Medicine a sense of what surgeons faced during the conflict.

Although many of the soldiers die from disease, an endless array of battle injuries confront you. Soldiers hit in the head, chest, or abdomen have little or no chance of survival. Those with extremity injuries might survive, even though some may be crippled for the rest of their lives.

You put all your knowledge and experience into practice. Each day, you learn something new from your observations and from listening to the other doctors. Some things seem to work, but other attempts fail, and you are not sure why. Although you are not called an orthopaedic surgeon, more often than not, you are practicing as one—treating extremity injuries.

This is the world that AAOS fellow John M. Rathgeb, MD, strives to bring alive for audiences and visitors to the National Museum of Civil War Medicine (NMCWM) in Frederick, Md. A student of the Civil War for most of his life, Dr. Rathgeb’s interest in Civil War medicine may be his true passion.

“At the start, I got interested in the Civil War because my great-grandfather was in the 4th Pennsylvania Cavalry. So there was that connection and of course my own medical interest. Several years ago, I toured the NMCWM and was hooked,” recalls Dr. Rathgeb. “I started volunteering at the museum and did more research on Civil War medicine.”

A turning point in medicine
From a medical perspective, the conflict proved to be a major turning point, according to Dr. Rathgeb. “The Civil War is really the beginning of modern medicine in the United States. Before the war, German and French surgeons were considered the best in the world, but afterward, American surgeons were considered on a par with their European counterparts.”

Just as today’s wars in Iraq and Afghanistan are revolutionizing the treatment of extremity injuries with advances in combat casualty care, the American Civil War introduced a host of orthopaedic and surgical advances. Even though the dire consequences of bacteria and infection were not realized until after the war’s end, many modern medical practices originated on the battlefields and in the hospitals, including the use of pulleys and weights to realign lower extremity fractures (Buck’s traction).

Dr. Rathgeb points out that Jonathan Letterman, known as the “Father of Battlefield Medicine,” organized the Union Army’s medical service and first used triage. He established field hospitals and an ambulance corps. The huge Union medical encampment that served Union and Confederate soldiers at Gettysburg after the battle was even named Camp Letterman.

“The war was a turning point for medicine,” Dr. Rathgeb says. “Many of the surgeons who came out of the war were the movers and shakers of the late nineteenth and early twentieth centuries.”

Bringing the past to life
Since he first became involved with the museum 5 years ago, Dr. Rathgeb has developed into an engaging public speaker, who appears in period costume. “I give presentations on Civil War medicine on a regular basis. One talk focused on orthopaedic surgery during the war; another one featured a profile of a Civil War soldier, with a review of his medical history. My next talk will focus on four soldiers and compare their wounds.

“Civil War researchers are lucky,” he continues. “We have voluminous records of the soldiers, their injuries, and their treatment. When Richmond burned, Confederate records were lost, but we can still rely on the diaries of the Confederate surgeons. During the war, doctors from both sides exchanged ideas and medical information. They treated many cases of orthopaedic injuries, and tried different things, and did a lot of observation and saw what worked, even if they didn’t know why it worked. In many instances, they even published their findings.”

The period is filled with revelations for researchers, says Dr. Rathgeb. The term 4F, for example, came about as a shorthand description of men who were missing four front teeth. Without teeth, the men couldn’t bite off the powder cartridge needed to load a rifle and were rejected as unfit to serve.

“We’ve also learned that anywhere from 400 to 1,000 women enlisted in the war,” notes Dr. Rathgeb. “Information about the military hospitals is also plentiful. The museum’s annual conference in October 2009 will include a presentation on Civil War hospitals that will provide a lot of information on how they were set up.”

From surgeon to innkeeper
As rich as he finds Civil War history, Dr. Rathgeb also inhabits another rewarding world—the Victorian-style bed-and-breakfast (B&B) he and his wife run in Oakland, Md.

“It’s a wonderful place not far from Baltimore, Washington D.C., and Pittsburgh,” he says. “We can enjoy downhill skiing, cross country skiing, hunting, fishing, and whitewater rafting.”

The Rathgebs moved to Oakland in 2006, and he works in the office of a local orthopaedist two days a week. This is the third year they have operated their B & B, The Oak & Apple. “My wife and I dreamed of having a B & B for as long as we can remember,” says Dr. Rathgeb. “It’s similar to medicine because it’s people oriented. I’ve always liked talking to my patients and it’s the same with the B&B. I enjoy talking to the diverse guests we have.”

Although open year-round, “it’s busiest in the summer, of course,” says Dr. Rathgeb. “But the Oakland fall color festival—the Autumn Glory Festival, which MSN.com voted the top fall festival in the world—also brings lots of visitors. After the holidays, people come for the snow.”

About your host
Born in Greensburg, Pa., Dr. Rathgeb graduated from Georgetown University School of Medicine, did his internship and a year of general surgery residence at Mercy Hospital in Pittsburgh, and an orthopaedic residency at the Geisinger Medical Center and The Alfred I. duPont Institute.

Dr. Rathgeb was in solo practice before becoming chief of surgery for Kaiser Permanente and chief of orthopaedics at the Greater Baltimore Medical Center. He retired from Kaiser in 2004, and worked with Johns Hopkins Orthopaedics at the Good Samaritan Hospital. He has volunteered at The Hospital Albert Schweitzer in Haiti and Volunteers in Medicine on Hilton Head Island.

For most of his life, Dr. Rathgeb has done just what he wants to do. His professional life, interests, personality, and family (5 children and 10 grandchildren) make him a happy man. He chuckles as he says, “In my other life I probably would have been a history teacher.”

Elaine Fiedler is a freelance writer. She can be reached at aaoscomm@aaos.org

Additional Links:

The Oak & Apple Bed & Breakfast

National Museum of Civil War Medicine

AAOS Now
August 2009 Issue
http://www.aaos.org/news/aaosnow/aug09/youraaos5.asp