Kaufman H H
Department of Neurosurgery, West Virginia University School of Medicine, Morgantown.
J Neurosurg. 1993 May;78(5):838-45. doi: 10.3171/jns.1993.78.5.0838.
At the time of the American Civil War (1861-1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. Failure to understand how to prevent infection discouraged physicians from aggressive surgery. Manuals written to educate inexperienced doctors at the onset of the war provide an overview of the advice given by senior surgeons. The Union experiences in the treatment of head injury in the Civil War were discussed in the three surgical volumes of The Medical and Surgical History of the War of the Rebellion. Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.
在美国内战（1861 - 1865年）时期，人们对闭合性颅脑损伤和头部枪伤已经有了很多了解。压迫性损伤与脑震荡得以区分，但损伤部位的定位并不精确。乙醚尤其是氯仿被用于提供麻醉。由于不了解如何预防感染，医生们不愿进行积极的手术。战争初期为教育缺乏经验的医生而编写的手册概述了资深外科医生给出的建议。《叛乱战争的医学与外科史》的三个外科卷册讨论了联邦在内战中治疗头部损伤的经验。伤口被分为切割伤、刺伤、钝器伤和枪伤，并分别进行了分析。由于患者没有按损伤严重程度进行分层，且没有神经影像学检查，所以很难了解临床问题以及手术的有效性。战后几乎立即，关于脑定位的知识增加以及防腐（随后是无菌）技术的发展推动了现代神经外科的发展。
