Snakeroot Extract, Number 26, Autumn 1993
Physicians during the Civil War viewed the amputations as the medical procedure most likely to save a wounded soldier’s life.
The second volume of The Medical and Surgical History of the War of the Rebellion – Part III (1883) documents that 29,980 amputations occurred among the Union forces during the Civil War. However, the volume notes that, since few reports were made during the first 18 months of the conflict, “the whole number of amputations performed for injuries received…would undoubtedly exceed that number.”
Of the number reported, 20,802 cases (69.3 percent) resulted in the survival of the solider whereas 7,459 cases (24.8 percent) resulted in death either from the procedure or from a resulting infection. The volume also indicates that the outcome of the remaining 1,719 cases (5.7 percent) was not known.
Physicians performed amputations in cases when a gunshot wound or another injury almost had severed the limb, when attempts to save an injured limb would not succeed and when a wound contained bone spicule and other foreign bodies that the physician could not remove with forceps. Typically, most physicians desired to perform amputations as soon as possible after the wound occurred.
“In army practice, on the field, amputations, when necessary ought to be primary [performed within 24 hours after the wound occurs],” recommended The Sanitary Commission Report on the Subject of Amputations (1861). “Patients, in most cases, cannot bear removal from the field without increased danger, neither can they have afterwards the hygienic attentions which secondary amputations most necessarily require.”
The physician could select one of three different techniques for amputation, according to A System of Operative Surgery (1856) by Henry H. Smith. Those techniques consisted of the circular operation, the oval operation and the flap operation.
To perform the circular operation, the physician incised the skin and muscles by drawing the knife in a circular fashion around the limb’s girth. The physician then drew back the soft tissue with a retractor and cut across the bone transversely.
The oval operation was performed in the same manner as the circular operation. However, the physician made the cut a little higher on one side of the limb than on the other side, thus creating an oval wound instead of a circular wound.
To perform the flap operation, the physician made a v-shaped cut in one of two manners. The physician either could cut obliquely inward to the bone and then transfix the limb and cut outward, or could cut inward to obtain one flap and then outward to form a second flap.
Of these three techniques, many physicians preferred the flap operation. According to the Principles and Practice of Surgery (1858) by James Syne, F.R.S.E., “The great advantages of this method are: 1. That it is much more quickly performed, and consequently much less painful to the patient…; 2. That it cuts the parts smoothly, and leaves them in a state favorable to union; and, 3. That it afford a much better covering for the bones.”
Whether employing the circular, oval or flap operation, the physician attempted to perform the operation as quickly as possible. Typically, a physician could complete an amputation of the arm or leg within fifteen minutes.
In order to perform any amputation, the physician had the soldier placed on an operating table. After applying chloroform, ether or another general anesthetic to the patient, the physician reduced the flow blood to the operation site by either applying a tourniquet or by having a competent assistant use his hands.
The physician then incised the skin with a large amputation knife (if the physician used the circular or oval technique) or with a catlin knife (if the physician used the flap technique). Next, the physician retracted the skin and incised the underlying muscle.
After exposing the bone, the physician used a raspatory to scrape the bone and, then, an amputation saw to cut the bone. Using a tenaculum or an artery forceps to grasp the arteries, the physician next used silk thread to tie off the major blood vessels.
After stopping the bleeding in this manner, the physician applied a gnawing forceps or bone file to smooth the stump of the bone, thereby eliminating any fragmenting of bone which might hinder the healing process. To complete the operation, the physician used curved needles and silk thread to secure the flap over the wound.
Sources: Pictorial Encyclopedia of Civil War Medical Instruments and Equipment (1983) by Dr. Gordon Dammann; The Medical and Surgical History of the War of the Rebellion – Part III, Volume II (1883) by George A. Otis and D.L. Huntington; and Principles and Practice of Surgery (1858) by James Syme, F.R.S.E.