Wednesday, February 8, 2017

Civil War Amputation: How Lives Were Saved


“I noticed a heap of amputated feet, legs, arms, hands, etc. –about a full load for a one-horse cart. Several dead bodies lie near, each covered with its brown woolen blanket”
-Walt Whitman
Poet and Civil War nurse,   Falmouth, VA   1862

In the winter of 1862 the poet Walt Whitman traveled to Falmouth, Virginia in hopes of finding his wounded brother. The recently fought battle of Fredericksburg had left in its wakes thousands of freezing, bloody, casualties for Union medical staff to attend to. Unprepared for the sight of a field hospital with its attendant blood and gore,Whitman described it by conjuring scenes associated with a butcher shop or slaughter house - a sight and smell which many 19th century Americans would have been familiar with. Often described as butchery, Civil War surgery, especially amputations, deserve a second look. The exact number will never be known but approximately 60,000 surgeries, or 75% of all the operations done during the Civil War were amputations. From our modern perspective this seems drastic. However, the frequency of this invasive and disfiguring procedure was one of the few ways to combat deadly infections such as sepsis, pyemia and gangrene.

The weaponry and tactics used during the American Civil War caused damage beyond the capabilities of known medical procedures. The soft lead minie ball (bullet) used in the Civil War was very heavy and rather large close to the size of a present day .58 caliber bullet. When a fired minie ball struck a soldier’s bone it smashed or shattered it.

A broken bone protruding through the skin was termed a compound fracture, while a bone shattered by a bullet or a piece of shrapnel, it was called a comminuted fracture. Compound and comminuted fractures almost always resulted in an infection to the bone, a condition known as osteomyelitis. The bone marrow, along with the bone itself, usually became infected. If the infection spread through the bloodstream, death would eventually result. The best way to prevent this was the removal of the shattered limb within 48 hours of being shot. Doctors usually had no choice but to amputate the limb because of the extensive bone damage and the subsequent infection risk.

The process of amputation was not quite as crude as common imagery has us believe. Blood loss was always a major concern when performing an amputation. Often, especially in the middle ages, soldiers were left to try to survive infection rather than risk the probable death from blood loss. In 1674, French surgeon Etienne Morel invented a light and simple tourniquet that could easily be used on battlefields and in hospitals to stop blood flow. Thus, the practice of surgical amputations became a more common means of dealing with wounds of this nature.

The use of surgical anesthetics including chloroform and ether, had been established in the late 1840’s. Anesthetics were in use at almost all Civil War field hospitals and Union army records show 80,000 surgeries being performed using anesthesia over the course of the war. Confederate numbers, though not available, were probably comparable. The phrase “bite the bullet” – or the practice of having a bullet placed between the teeth of a surgery patient who didn’t have the benefits of anesthesia - is often linked to the Civil War. In fact, the phrase doesn’t appear until 1891 when Rudyard Kipling uses it in his novel entitled The Light that Failed, and virtually no surgeons or nurses comment on the practice during the American Civil War.

The medical theory of the time stated that the further from the heart, or body trunk, the amputation could be performed, the better the chances of survival of the patient. Approximately 75% of Civil War amputees survived and recovered from the procedure. Union Surgeon Dr. Jonathan Letterman (the namesake of Camp Letterman at Gettysburg) created a battlefield evacuation system which included the formation of a new ambulance corps. This decreased the time between wounding and arrival at a field hospital. Letterman was keenly aware that speed improved patient outcomes.

As the Civil War progressed surgeons gained vast amounts of knowledge about how to make an amputation successful and became deft at performing them at times for hours in field hospitals situated close to heavy fighting. Such was the case at the George Spangler Farm. The Spangler’s farm was commandeered as the 11th Corps field hospital on the first day of the battle of Gettysburg. Dr. Daniel Brinton, engaged as division surgeon-in-chief at the Spangler Farm’s Eleventh Corps field hospital, wrote in his diary on July 5: “...Four operating tables were going night and day…We worked with little intermission, & with a minimum amount of sleep.” Division Commander General Carl Schurz toured the 11th Corps Hospital during heavy rains that followed on July 4, 1863 and noted that he: “saw long rows of men lying under the eaves of the buildings, the water pouring down upon their bodies in streams. Most of the operating tables were placed in the open…partially protected by the rain…There stood the surgeons, their sleeves rolled up…their bare arms as well as their linen aprons smeared with blood…around them pools of blood and amputated arms or legs in heaps…a surgeon, having been long at work…put down his knife, exclaiming that his hand had grown unsteady, and that this was too much for human endurance, hysterical tears running down his face.”

In April of 1863 the U.S. War Department issued General Order #105 which called for the organization of the Invalid Corps, also known as the Veteran Reserve Corps. This organization was formed to make suitable use in a military or semi military capacity of soldiers who had been rendered unfit for active field service on account of wounds or disease contracted in the line of duty.

In March of 1864, General Order No. 111 stated that the title of the Invalid Corps would be changed to The Veteran Reserve Corps. The Veteran Reserve Corps was divided into two battalions; the First Battalion was composed of men whose disabilities still allowed them to use a musket and do minimal marching. The Second Battalion was made up of soldiers whose disabilities were of a much more serious nature, such as amputees. These men were used as guards, nurses, orderlies and cooks. During the course of the war, over 60,000 soldiers served in the Invalid and Veteran Reserve Corps.

Image: Walt Whitman, circa 1863. Photo Credit: The Library of Congress


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