Wartime amputations, while extreme, saved thousands of lives and helped spur the development of modern prosthetics.
In four years of brutal Civil War combat, thousands of soldiers on both sides of the struggle suffered wounds that required amputations. In fact, as many as 75 percent of all serious surgeries included such a procedure.
Official records show more than 30,000 amputations probably were performed on Union soldiers alone. And while Confederate battlefield records are particularly incomplete, historians calculate that an equal number of Rebel soldiers might have suffered the same fate. Some experts believe the total could have been as high as 70,000, a stunning figure compared with the 4,000 total amputations among American soldiers during World War I, and 16,000 in World War II.
Risking life and limb while serving was daunting enough. But the prospect that a permanent disability would make the remainder of a soldier’s life practically unbearable was in many ways worse. Soldiers and sailors who returned from the war disabled faced many challenges finding work and supporting their families. Their lobbying and litigation efforts would lay the groundwork for the 20th-century disability rights movement.
Medical amputations on or near the battlefield were performed as far back as 2000 BC in Mesopotamia, and archeologists have recovered Roman surgical tools and procedures. But the sheer volume of casualties during the American Civil War first created a unique crisis of battlefield care. Never before had battlefield surgeons dealt with the overwhelming number of violent, bone-shattering, flesh-tearing wounds created by the lethal marriage of new weapons technology and outdated modes of closed-rank, stand-up Napoleonic combat.
Frantic Civil War battlefield surgeons were forced to consider immediate amputation for any serious wound in the extremities that would not stop bleeding, or exhibited compound fractures or traumatic tissue damage that could not be stabilized by ordinary means. Not only were most of these surgeries rushed, many doctors were ill-prepared to perform them—and, out of necessity, some were even performed by nonmedical personnel.
Although amputations seemed to be a radical option, many Civil War physicians argued otherwise. “An amputation is necessarily conservative,” one surgeon wrote in 1864.“Life is better than limb;…mutilation is the only alternative to…death.”
Coupled with the battlefield medical crisis was a lack of knowledge about germs and bacteria. Flies and other insect vectors often swarmed around the wounded in field hospitals. Less traumatic wounds were often infected several days later, and ultimately resulted in amputation simply as a means of checking the infection’s progress into other parts of the body.
As surgeons studied the ravaging effects of the infections that complicated most serious wounds, the tendency to amputate sooner rather than later steadily grew. Union statistics confirmed that immediate surgery resulted in higher survival rates than waiting and monitoring infections.
Many soldiers, however, were convinced that doctors were simply “knife happy” with their instruments. By the second year of the war, most seriously wounded soldiers actively resisted a potential amputation if they could. In February 1865, an artilleryman wounded in the knee at Hatcher’s Run went so far as to keep a pistol in the folds of his clothing. Surrounded by medical attendants and doctors, he declared, “The man who puts his hand on me dies.” The soldier maintained that he had to keep the leg so he could return to duty or civilian life. The doctor was equally adamant. If the leg stayed, the man would likely die, he insisted. After arguing fruitlessly for some time, however, the doctor finally exploded. “Let the damned fool keep it and die!” he said. Ironically, the man lived. As many as 75 percent of all amputees survived as well, according to official Union records, although precise numbers are impossible to calculate. While Civil War surgeons had the reputation of being “butchers,” or “old saw bones,” they were in fact more successful than surgeons in previous wars. Some types of amputation, such as amputation at the hip, resulted in low survival rates (approximately 15 to 20 percent), but the figures were still significantly higher than in previous wars (less than 1 percent in the Crimean War, for example).
Civil War doctors “deserve a better reputation than the lowly one they have received,” Alfred Jay Bollet wrote recently in Civil War Medicine: Challenges and Triumphs. As the war progressed, “the percentage of the wounded that died after treatment dropped dramatically.”
Notes Ira M. Rutkow in his 2005 book Bleeding Blue and Gray, “What physicians did medically during the Civil War was as modern to them as anything doctors do today.”
Procedures for amputation had been part of medical training for hundreds of years. The operation was so unusual in peacetime, however, that many ordinary doctors had never performed one. Potential amputation cases were usually referred to hospitals or specialists who could perform various types of surgeries, usually at institutions in larger cities in the Northeast.
The war quickly changed that.
Because of the desperate need for doctors and medical attendants, nearly all who were available were accepted. About 11,000 doctors served in the Union Army; one account cited the Confederate total at 4,000, though it was probably a little bit higher. Union hospital “admissions” during the war were estimated at approximately 6 million, which meant an average of three trips to the hospital for every man who served in the Army. According to one source, less than 5 percent of Union doctors had performed any type of surgery before the war, and less than 1 percent on the Confederate side. Doctors had to learn their trade by doing.
Detailed manuals, published to aid surgeons, usually included detailed diagrams. For example, once anesthesia was administered (which, contrary to popular myth, happened in most cases) the surgeon was generally supposed to begin the procedure by making incisions both above and below the area of the wound, cutting so that a flap of skin would be left on the “good” side of the limb. After the arteries were tied with horsehair or similar material, a saw would be used to cut through any bones. Finally, the flap of skin would be sewn up, leaving an opening through which fluids could drain.
A variation on this process—considered more conservative by some—involved a single circular cut. Under ideal conditions, a talented surgeon could perform an amputation in five to 10 minutes.
The war had the unintended but fortunate effect of rapidly advancing medical technology and techniques. Doctors shared information, exchanged letters and met together when they could. By the sheer number of operations involved, they even learned through trial and error. In the area of surgery, contemporary observer George Otis noted that the Civil War led to important advances in dealing with head injuries, stabilizing traumatic wounds, litigating arteries and treating spinal and chest wounds.
Julian Kuz, a present-day orthopedist, credits the conflict with being the impetus for the evolution of the field of orthopedics. “The war basically pushed to specialize,” he says.
Medical organization advanced during the war as well. In the fall of 1862, Jonathan Letterman became medical director of the Union Army of the Potomac, and overall conditions in field hospitals and procedures quickly improved. During and after the Battle of Fredericksburg that December, the level of medical care on the Union side immediately proved the effectiveness of Letterman’s reforms. The Union Sanitary Commission, which had no Confederate equivalent, also contributed significantly to improved care. Despite the fierce combat at Gettysburg, hardly a wounded man was left on the field after each of the first two days of fighting.
In fact, the war not only spurred advances in medical technology, organization and surgical techniques, it was the economic catalyst for expanding private enterprises. Between 1861 and 1873, patents for artificial limbs and related devices nearly tripled compared with the previous decade or so, according to Ira Rutkow. A number of businessmen— Augustus Marks, B. Franklin Palmer and even ex-Confederate soldier J.E. Hanger—got involved in manufacturing prosthetics, and some grew rich.
The period of the Civil War is now known as the “Age of Entrepreneurship” in the lengthy and colorful 4,000-year history of prosthetics. These ventures were more than measures of convenience—they presaged a larger cultural shift that would ultimately lead to the disability rights movement 100 years later.
Hanger is reputed to be the first man on either side to undergo an amputation during the war. A Union doctor took off Hanger’s leg after a cannonball mutilated it during the first land battle of the war, June 3, 1861, at Philippi, in what is now West Virginia. A small plaque in Philippi today commemorates the amputation. Hanger’s postwar company became the leading manufacturer of artificial limbs in the world. The company is still in business today.
Despite advances in both care and treatment, Civil War battlefields produced bloody misery—and countless amputations—for the duration of the war. At the Battle of Shiloh in April 1862, Confederate doctors were simply overwhelmed. As one eyewitness in nearby Corinth, Miss., noted, “doctors came from far and near and made their contributions to the pile of amputated limbs that accumulated in the yard of the…Tishomingo Hotel.”
Confederate doctors worked tirelessly, but they were at a distinct disadvantage, in both numbers and equipment, compared with their Union counterparts. Their medicine stocks, for instance, often consisted largely of native herbs and natural materials rather than manufactured medical supplies. Spencer Welch, a surgeon in the 13th South Carolina, described one operation: “Jake Fellers had his arm amputated without chloroform. I held the artery and Dr. Hout cut it off by candlelight. We continued to operate until late at night…”
But surgery on the Union side sometimes hardly seemed less barbaric. At the Battle of Port Hudson in May 1863, one witness wrote, “[There were] 10 or 12 tables just large enough to lay a man on; these were used as dissecting tables and they were covered with blood; near and around the tables stood the surgeons with blood all over them and by the side of the tables was a heap of feet, legs and arms.”
In another instance, Private E.D. Patterson was wounded at the Battle of Glendale (Frayser’s Farm), and operated on with no anesthesia—just brandy. “I watched him while he laid open the flesh and it reminded me of cutting fat pork, it cut so smooth and nice, and it hurt,” Patterson later wrote.
Famous soldiers on both sides suffered amputation— Confederate Generals Thomas J. “Stonewall” Jackson, Richard S. Ewell and John B. Hood (who tried prosthetic limbs from all over the world),and Union Generals Daniel Sickles and Oliver O. Howard, among others. Jackson’s arm has its own famous burial marker not too far from the Chancellorsville battlefield.
Prisoners of war faced additional medical threats. Many of the approximately 600,000 POWs on both sides were wounded or got sick, and ultimately faced amputations. In J. Osborn Coburn describes his time in Confederate Hell on Belle Isle, Union prisoner General Hospital No. 21 in Richmond, where he watched other prisoners from Belle Isle go under the saw.
“Amputations were performed indiscriminately, whether it became necessary or not,” confirmed Sergeant Gribban of the 132nd New York, the wardmaster. “The man [Confederate surgeon Dr. Gibbs] had a perfect mania for amputating limbs. He would scarcely allow a soldier to go from the hospital without he left behind him part of his body.”
Survivors returned to a different kind of life. Most occupations in the postwar era required two hands, and many required two feet as well. Jobs as mundane as standing behind a mule-driven plow, pulling the reins on a horse or maneuvering a boom and winch in a small factory were all but impossible for an amputee.
Despite the open acknowledgement of a soldier’s patriotic service, disabled soldiers had to compete against able-bodied workers for jobs in a still fundamentally discriminatory culture. The cultural views of wholeness, manhood and virility also made social integration difficult for these veterans. Such attitudes did change, but they changed slowly. Many veterans lived hand to mouth, day to day, and never saw any changes at all.
The growth of the prosthetic limb industry, the formation of veterans’ organizations such as the Grand Army of the Republic and the involvement of countless lawyers in litigation on behalf of disabled veterans did mitigate some of the difficulties. But the economy in most areas of the South was wrecked, and no federal pension was available for Confederates, and no stipends for artificial limbs. Southern veterans with disabilities often faced a daunting future; some on both sides chose not to face it at all.
Jack Trammell teaches at Randolph-Macon College in Ashland, Va. He writes a regular Civil War column in The Washington Times.
Originally published in the January 2009 issue of America’s Civil War. To subscribe, click here.
