Many physicians who performed surgery during the American Civil War had no prior surgical experience at all, still less had training or experience in military surgery. However, the nature of Civil War injuries meant surgery was often necessary if soldiers were to have a chance of surviving their wounds. The devastating injuries caused by advances in artillery, combined with field surgeons’ lack of training and experience, meant a high rate of surgical mortality, especially in the war’s early years….
The incidence of eye injury in general is 20 to 50 times higher than would be expected by ocular surface area alone. The human eye makes up just 0.27% of the body’s surface area and less than 4% of facial surface area. Because Civil War soldiers firing muskets from the standing or prone position needed to sight in their arms, their heads, faces, necks, and eyes were frequently exposed during combat. The eye and orbital areas were usually unprotected. (While eye shields were available to protect against the force of exploding gun caps, they were not always effective even when worn.) Soldiers’ eyes were thus exceptionally vulnerable to injury from small arms, fragments of shrapnel, rock, battlefield debris, and dirt. Because of the Minié ball’s explosiveness and tendency to destroy all tissue near the entry wound, the eyelids of Civil War soldiers rarely escaped injury from gunshot wounds to the face, neck, or head. In addition, missiles seldom penetrated or destroyed the eyeball without injuring the bones of the orbit. A study of eye injuries in Civil War solders reported that the loss of one eye occurred in two-thirds of 1,190 soldiers with isolated eye injuries, while only 5% of these soldiers lost sight in both eyes or died from their wounds.