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5 Medical Innovations of the Civil War

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by Chip Rowe

As it turns out, the bloodiest war in American history was also one of the most influential in battlefield medicine. Civil War surgeons learned fast, and many of their MacGyver-like solutions have had a lasting impact. Here are some of the advances and the people behind them.

1. Life-Saving Amputation

The General Who Visited His Leg

The old battlefield technique of trying to save limbs with doses of TLC (aided by wound-cleaning rats and maggots) quickly fell out of favor during the Civil War, even for top officers. The sheer number of injured was too high, and war surgeons quickly discovered that the best way to stave deadly infections was simply to lop off the area—quickly.

Among those saved by the saw was Daniel E. Sickles, the eccentric commander of the 3rd Army Corps. In 1863, at the Battle of Gettysburg, the major general’s right leg was shattered by a Confederate shell. Within the hour, the leg was amputated just above the knee. His procedure, publicized in the military press, paved the way for many more. Since the new Army Medical Museum in Washington, D.C., had requested battle-field donations, Sickles sent the limb to them in a box labeled “With the compliments of Major General D.E.S.” Sickles visited his leg yearly on the anniversary of its emancipation.

Amputation saved more lives than any other wartime medical procedure by instantly turning complex injuries into simple ones. Battlefield surgeons eventually took no more than six minutes to get each moaning man on the table, apply a handkerchief soaked in chloroform or ether, and make the deep cut. Union surgeons became the most skilled limb hackers in history. Even in deplorable conditions, they lost only about 25 percent of their patients—compared to a 75 percent mortality rate among similarly injured civilians at the time. The techniques invented by wartime surgeons—including cutting as far from the heart as possible and never slicing through joints—became the standard.

As for the nutty-sounding behavior of the leg-visiting commander, Sickles can be justifiably accused. In 1859, while serving in Congress, he shot and killed U.S. Attorney Philip Barton Key, the son of Francis Scott Key, for sleeping with Sickles’s wife. Charged with murder, Sickles became the first person in the United States to be found not guilty by reason of temporary insanity.

2. The Anesthesia Inhaler

A Knockout Breakthrough

In 1863, Stonewall Jackson’s surgeon recommended the removal of his left arm, which had been badly damaged by friendly fire. When a chloroform-soaked cloth was placed over his nose, the Confederate general, in great pain, muttered, “What an infinite blessing,” before going limp.

But such blessings were in short supply. The Confederate Army had a tough time securing enough anesthesia because of the Northern blockade. The standard method of soaking a handkerchief with chloroform wasted the liquid as it evaporated. Dr. Julian John Chisolm solved the dilemma by inventing a 2.5-inch inhaler, the first of its type. Chloroform was dripped through a perforated circle on the side onto a sponge in the interior; as the patient inhaled through tubes, the vapors mixed with air. This new method required only one-eighth of an ounce of chloroform, compared to the old 2-ounce dose. So while Union surgeons knocked out their patients 80,000 times during the war, rebels treated nearly as many with a fraction of the supplies.

3. Closing Chest Wounds

The Cub Doctor Who Kept Lungs From Collapsing

In the early part of the war, Benjamin Howard, a lowly young assistant surgeon, was shuttled to the sidelines with medical grunt work: changing bandages, suturing wounds, and grabbing grub for the docs. But when the other surgeons decided there was no point in treating chest wounds, Howard experimented with a new life-saving procedure.

At the onset of the war, a sucking chest wound was almost certainly a death sentence. Among French soldiers shot in the chest during the Crimean War (1853–1856), only 8 percent survived. The problem, as Howard came to realize, wasn’t the wound itself, but the sucking. The negative pressure in the thorax was created by the opening in the chest cavity. The effect often caused the lungs to collapse, leading to suffocation.

The cub doctor found that if he closed the wound with metal sutures, followed by alternating layers of lint or linen bandages and a few drops of collodion (a syrupy solution that forms an adhesive film when it dries), he could create an airtight seal. Survival rates quadrupled, and Howard’s innovation soon became standard treatment.

4. Facial Reconstruction

The Plastic Surgery Revolution

Carleton Burgan of Maryland was in terrible shape. The 20-year-old private had survived pneumonia, but the mercury pills he took as a treatment led to gangrene, which quickly spread from his mouth to his eye and led to the removal of his right cheekbone. He was willing to try anything. In a pioneering series of operations in 1862, a surgeon from City Hospital in New York used dental and facial fixtures to fill in the missing bone until Burgan’s face regained its shape.

The doctor was Gurdon Buck, now considered the father of modern plastic surgery. During the war, he and other Union surgeons completed 32 revolutionary “plastic operations” on disfigured soldiers. Buck was the first to photograph the progress of his repairs and the first to make gradual changes over several operations. He also pioneered the use of tiny sutures to minimize scarring.

To some, it seemed pretty wacky, like sci-fi for the 19th century. An Illinois newspaper enthusiastically and erroneously described the new treatments: “Such is the progress of the medical department in these parts that half of a man’s face demolished by a ball or piece of shell is replaced by a cork face!”

5. The Ambulance-to-ER System

The End of Drunks and Cowards

President Abraham Lincoln and General George B. McClellan at Antietam

The Union went into the First Battle of Bull Run on July 21, 1861, expecting a mere skirmish. The rebels brought a war. Although 1,011 Union soldiers were wounded, empty ambulances led the retreat to Washington, D.C. Most of the civilian drivers at the time were untrained and “of the lowest character,” according to Dr. Henry Ingersoll Bowditch, an activist whose son died after lying wounded for hours following a charge. Many were cowards or drunkards, he added.

It took Jonathan Letterman, the medical director of the Army of the Potomac, just six weeks to implement a brilliant system to evacuate and care for the wounded, becoming the model for the ambulance-to-ER system we know today. On September 17, 1862, the Battle of Antietam left 2,108 Union soldiers dead and nearly 10,000 wounded. Letterman established caravans of 50 ambulances, each with a driver and two stretcher bearers, to ferry the injured to field hospitals. He hired private wagons to carry medical supplies to circumvent enemy damage to railroad lines. He even introduced spring suspensions to ambulances and added a lock box under the driver’s seat to make it harder for soldiers to steal protein, bedsacks, and morphine reserved for the wounded. The rest is history.

This article originally appeared in mental_floss magazine.

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iStock // Ekaterina Minaeva
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Man Buys Two Metric Tons of LEGO Bricks; Sorts Them Via Machine Learning
May 21, 2017
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iStock // Ekaterina Minaeva

Jacques Mattheij made a small, but awesome, mistake. He went on eBay one evening and bid on a bunch of bulk LEGO brick auctions, then went to sleep. Upon waking, he discovered that he was the high bidder on many, and was now the proud owner of two tons of LEGO bricks. (This is about 4400 pounds.) He wrote, "[L]esson 1: if you win almost all bids you are bidding too high."

Mattheij had noticed that bulk, unsorted bricks sell for something like €10/kilogram, whereas sets are roughly €40/kg and rare parts go for up to €100/kg. Much of the value of the bricks is in their sorting. If he could reduce the entropy of these bins of unsorted bricks, he could make a tidy profit. While many people do this work by hand, the problem is enormous—just the kind of challenge for a computer. Mattheij writes:

There are 38000+ shapes and there are 100+ possible shades of color (you can roughly tell how old someone is by asking them what lego colors they remember from their youth).

In the following months, Mattheij built a proof-of-concept sorting system using, of course, LEGO. He broke the problem down into a series of sub-problems (including "feeding LEGO reliably from a hopper is surprisingly hard," one of those facts of nature that will stymie even the best system design). After tinkering with the prototype at length, he expanded the system to a surprisingly complex system of conveyer belts (powered by a home treadmill), various pieces of cabinetry, and "copious quantities of crazy glue."

Here's a video showing the current system running at low speed:

The key part of the system was running the bricks past a camera paired with a computer running a neural net-based image classifier. That allows the computer (when sufficiently trained on brick images) to recognize bricks and thus categorize them by color, shape, or other parameters. Remember that as bricks pass by, they can be in any orientation, can be dirty, can even be stuck to other pieces. So having a flexible software system is key to recognizing—in a fraction of a second—what a given brick is, in order to sort it out. When a match is found, a jet of compressed air pops the piece off the conveyer belt and into a waiting bin.

After much experimentation, Mattheij rewrote the software (several times in fact) to accomplish a variety of basic tasks. At its core, the system takes images from a webcam and feeds them to a neural network to do the classification. Of course, the neural net needs to be "trained" by showing it lots of images, and telling it what those images represent. Mattheij's breakthrough was allowing the machine to effectively train itself, with guidance: Running pieces through allows the system to take its own photos, make a guess, and build on that guess. As long as Mattheij corrects the incorrect guesses, he ends up with a decent (and self-reinforcing) corpus of training data. As the machine continues running, it can rack up more training, allowing it to recognize a broad variety of pieces on the fly.

Here's another video, focusing on how the pieces move on conveyer belts (running at slow speed so puny humans can follow). You can also see the air jets in action:

In an email interview, Mattheij told Mental Floss that the system currently sorts LEGO bricks into more than 50 categories. It can also be run in a color-sorting mode to bin the parts across 12 color groups. (Thus at present you'd likely do a two-pass sort on the bricks: once for shape, then a separate pass for color.) He continues to refine the system, with a focus on making its recognition abilities faster. At some point down the line, he plans to make the software portion open source. You're on your own as far as building conveyer belts, bins, and so forth.

Check out Mattheij's writeup in two parts for more information. It starts with an overview of the story, followed up with a deep dive on the software. He's also tweeting about the project (among other things). And if you look around a bit, you'll find bulk LEGO brick auctions online—it's definitely a thing!

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What Happened to Jamie and Aurelia From Love Actually?
May 26, 2017
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Nick Briggs/Comic Relief

Fans of the romantic-comedy Love Actually recently got a bonus reunion in the form of Red Nose Day Actually, a short charity special that gave audiences a peek at where their favorite characters ended up almost 15 years later.

One of the most improbable pairings from the original film was between Jamie (Colin Firth) and Aurelia (Lúcia Moniz), who fell in love despite almost no shared vocabulary. Jamie is English, and Aurelia is Portuguese, and they know just enough of each other’s native tongues for Jamie to propose and Aurelia to accept.

A decade and a half on, they have both improved their knowledge of each other’s languages—if not perfectly, in Jamie’s case. But apparently, their love is much stronger than his grasp on Portuguese grammar, because they’ve got three bilingual kids and another on the way. (And still enjoy having important romantic moments in the car.)

In 2015, Love Actually script editor Emma Freud revealed via Twitter what happened between Karen and Harry (Emma Thompson and Alan Rickman, who passed away last year). Most of the other couples get happy endings in the short—even if Hugh Grant's character hasn't gotten any better at dancing.

[h/t TV Guide]

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