by Kevin Thompson
Medicine on the battlefield during the Civil War was crude at times and good at best. With only a surgeon or two with an assistant surgeon to a regiment there was a good chance the wounded would severely overwhelm the medical personnel. The problem was compounded by the type of injuries suffered on the battlefield: gunshot and explosive wounds. These type wounds carried many types of injuries with them, none more severe than, comminuted fractures, compound fractures, and wounds of the joints. The goal of the surgeon in all cases of amputation was to leave as much of the limb intact as possible while giving the patient the best chance of survival.
Comminuted fractures are those fractures where the bone is either broken, splintered, or crushed into a number of different pieces. It does not take long to understand how a projectile, such as the minie ball, could produce such an injury, The minie ball, and other related projectiles that were fired from a rifle, were relatively slow moving and large. When the human body was struck at the bone the velocity of the projectile did not allow a “clean exit.†This produced a shattering effect at the point of impact. In general when a comminuted fracture occurred with rupturing of the principal artery or nerve of a large limb it demanded amputation. It is interesting that Hamilton states that fractures involving contusions demanded amputations more often than those that created a laceration. Also when a fracture injury occurs with a laceration of a main artery, amputation is not always necessary if the artery can be tied.
Compound Fractures are those fractures that produce the bone protruding from the skin. As in injuries producing a comminuted fracture the compound fracture may require amputation if sustained in a large limb, such as the leg, thigh, the arm, or forearm. Amputation during the Civil War was almost always performed if the large limb had severed principal arterial damage or nervous trunk damage.
Wounds to the joints almost always needed amputation during the Civil War. Those wounds include injuries sustained to the knee joint, elbow joint, shoulder joint, wrist, ankle, and hip joint. Amputations made at these joints are also referred to as disarticulations. When an injury was taken to the arm below the forearm, that required amputation, it was common to amputate through the elbow joint even though it was thought better by some to leave some of the radius and ulna. This was also the line of thinking when an amputation was required of the upper arm, leaving a few inches below the humerus. To prevent exposing the patient to inflammation and spread of trouble upwards the road more traveled was disarticulation. Wounds of the hand and feet are more complicated because of small bones and will not be discussed in this article. I will note however that disarticulations took place at the smallest of joints of the toes and fingers. Amputation at the knee joint was normally carried out rather than at the thigh. Baudens comments on this procedure in the text, On Military and Camp Hospitals, which describes the War in the Crimea. The preference for him was to amputate in the knee joint rather than below the joint or the thigh.
From: civilwarmedicalbooks.com
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