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Wednesday, October 19, 2016

Amputations

From: medicine-during-the-civilwar.leadr.msu.edu


Amputations were the most common surgical procedure of the war.  Many lives were saved by these operations even though there was public criticism for performing too many amputations.  A British surgeon who visited the Union Army in the middle of the war wrote that American surgeons were too cautious about performing amputations, losing many lives that he though could have been saved.

Data showed that wounded soldiers treated by Union or Confederate surgeons had lower mortality in all situations including amputations than the British and French in the Crimean War.

Civil War Amputation Tools
Three-fourths of a surgeon's time was spent amputating the limbs of wounded soldiers. Amputations were the chief mode of major surgery before and during the Civil War. Of the 174,000 extremity wounds that the Union recorded, almost 30,000 of them resulted in amputations. Although their records are incomplete, Confederates most likely performed around the same number of amputations.

While both armies received a lot of criticism for the number of amputations performed, they saved many lives and there could have been way more casualties than there were. The badly torn tissues where bullets had entered virtually always became infected. And the main danger and cause of casualties during the Civil War were infections and disease. The missiles would break through the skin carrying with them dirty material into the fractures. The fractures were defined as “compound” and the bones broken into many fragments were called “comminuted”, both of which are terms that are still used today. These types of fractures provided perfect breeding grounds for bacteria and bone infections called osteomyelitis that would inevitably cause death if limbs were not amputated. Even today the only way to treat this is with prolonged use of antibiotics that Civil War surgeons did not have. When looked back upon the Civil War surgeons did the right thing.

Amputation Techniques
There were two basic procedures for performing amputations during the Civil War and surgeons argued long and hard about ensuring that these were the best techniques to use.

1. Circular Method: This method left a raw, open stump that healed gradually. This method was the simplest and fastest. It withstood travel better, healed satisfactorily, and accommodated a prosthetic limb. It also required less dressing and discharges were less.

2. Flap Method: This method was a more elegant procedure. It created a flap of skin close to the raw stump, which allowed quicker healing but took longer to perform. This method forced the neglect of other men and required the prolonged use of anesthesia, increasing the danger of death from the chloroform. Also the ambulances that were used often ran into bumpy roads and men would often fall off onto the roadside. Under these conditions flap amputations often broke open, increasing infection.

Primary V. Secondary Amputations
Primary: These were amputations performed during the first 48 hours after the injury. This type of amputation is considered the best option and decreases the likely hood of death or infection.(1)

Secondary: Amputations that were performed 48 or more hours after the injury. Surgeons didn’t know that the higher mortality rate of secondary amputations as to primary amputations was due to the notion that infection had more time to gain a foothold on the body and spread. This type of amputation was preferred to not have to occur.

Image: Circular method of amputation: leaving an open wound


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