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Myth 4: Every Surgeon Had Authority to Amputate
During the first year of the war, and especially during the Peninsula Campaign in 1862, army surgeons performed all operations. Soon the overwhelming numbers of battle wounded forced the army to contract civilian surgeons to perform operations in the field alongside their army counterparts. Their ability ranged from poor to excellent.

Accusations soon arose that surgeons were doing unnecessary amputations just to gain experience. This was undoubtedly true in some cases, but it was rare. After the Battle of Antietam in September 1862, Letterman was so disturbed by public criticism of the army surgeons that he reported:


The surgery of these battle-fields has been pronounced butchery. Gross misrepresentations of the conduct of medical officers have been made and scattered broadcast over the country, causing deep and heart-rending anxiety to those who had friends or relatives in the army, who might at any moment require the services of a surgeon. It is not to be supposed that there were no incompetent surgeons in the army. It is certainly true that there were; but these sweeping denunciations against a class of men who will favorably compare with the military surgeons of any country, because of the incompetency and short-comings of a few, are wrong, and do injustice to a body of men who have labored faithfully and well.

Motivated at least in part by a desire to improve the public perception of the medical department, Letterman issued an order on October 30, 1862, requiring that "in all doubtful cases" involving Union soldiers, a board of three of the most experienced surgeons in the division or corps hospital would decide by majority vote whether an amputation was necessary. Then, a fourth surgeon, the available doctor with the most relevant skills, would perform the procedure. This system remained in effect for the rest of the war.

After the war, Surgeon George T. Stevens, historian of the the Army of the Potomac's VI Corps, described how the operating surgeon was chosen:


One or more surgeons of well known skill and experience were detailed from the medical force of the division, who were known as "operating surgeons"; to each of whom was assigned three assistants, also known to be skillful men.... The wounded men had the benefit of the very best talent and experience in the division, in the decision of the question whether he should be submitted to the use of the knife, and in the performance of the operation in case one was required. It was a mistaken impression among those at home, that each medical officer was the operating surgeon for his own men. Only about one in fifteen of the medical officers was entrusted with operations.

The Confederate army had a similar problem with excessively zealous surgeons, and it instituted a similar solution. In the 1863 edition of his Manual of Military Surgery, Professor J.J. Chisolm of Charleston, South Carolina, bluntly addressed the issue of unnecessary surgery:


Among a certain class of surgeons ...amputations have often been performed when limbs could have been saved, and the amputating knife has often been brandished, by inexperienced surgeons, over simple flesh wounds. In the beginning of the war the desire for operating was so great among the large number of medical officers recently from the schools, who were for the first time in a position to indulge this extravagant propensity, that the limbs of soldiers were in as much danger from the ardor of young surgeons as from the missiles of the enemy....


It was for this reason that, in the distribution of labor in the field infirmaries, it was recommended that the surgeon who had the greatest experience, and upon whose judgment the greatest reliance could be placed, should officiate as examiner, and his decision be carried out by those who may possess a greater facility or desire for the operative manual.

The new procedures helped the patients, but they hardly changed public opinion. In the end, despite advances in surgical practices and their results, Civil War physicians were unsuccessful in improving their public perception.