GRAPHIC Civil War Surgery: Amputation 101

lelliott19

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Do we know whether famous Civil War amputations (Hood, Jackson, Ewell, Sickles, among others) were flap or circular?

HOOD - wounded by a minié ball in the upper thigh, right leg, just after 2pm on September 20, 1863, resulting in a comminuted fracture of five inches length. Hood was conveyed immediately to the field hospital where it was decided that amputation was the only reasonable alternative. At 4pm, Surgeon Tobias Gibson Richardson (Medical Inspector AoT) performed the operation. He was assisted by Surgeon William Oliver Hudson (Act. Chief Surgeon of Hood's Division) and Surgeon J. C. Jones (Robertson's Brigade Surgeon) and employed the circular method, amputating Hood's leg at the upper third of the femur. Hood experienced some nausea from the chloroform, but by 3 pm the next day, was sufficiently recovered to begin transport. He was carried on a litter thirty miles to the residence of Col Francis H Little, 11th Georgia, arriving there on the night of September 22.
[The Lost Papers of Confederate General John Bell Hood, Stephen Hood, Savas Beatie, Jun 19, 2014, p.28.]

JACKSON - In the wee hours of the morning, about five hours after the wounding, Dr. Hunter Holmes McGuire amputated Jackson's left arm two inches below the shoulder using the ordinary circular method. Four surgeons were present: McGuire performed the operation; Dr. R T Coleman served as the anesthesiologist, administering chloroform using the "open drop" technique; Dr Harvey Black watched Jackson's pulse, a Dr. Wall assisted McGuire and ligated blood vessels. Captain James P. Smith, a theology student at Richmond, held a light above the operating table. The actual operation was basically uneventful, with "slight loss of blood." The operation took place about 2 am at the CS corps hospital located at Wilderness Tavern.
If you're interested in learning more about Jackson's wounding and subsequent medical care, there's a really detailed account provided in this video by the History of Medicine Society http://digital.lib.uiowa.edu/cdm/ref/collection/histmed/id/53

SICKLES - wounded on the evening of July 2, 1863 at Gettysburg by a 12-pounder solid shot which shattered his right leg. Sickles dismounted unassisted, and aid arriving promptly, he was removed to a sheltered ravine a short distance to the rear, where the limb was amputated low down in the thigh by Surgeon T. Sim, U S V, Medical Director of the Corps. I can find no source to indicate which procedure was used. The patient was then sent further to the rear, and, on the following day, he was transferred to Washington, DC. The stump "healed with great rapidity" and within two weeks, Sickles was able to ride about in a carriage. By early September, he was able to mount a horse, the stump being completely cicatrized (healed by formation of scar tissue.) [The Medical and Surgical History of the War of the Rebellion. (1861-65),U.S. Government Printing Office, 1883, p. 242.] https://books.google.com/books?id=3do5AQAAMAAJ&pg=PA242&lpg=PA242&dq=Ewell+amputation+circular&source=bl&ots=6MRUXBr_bJ&sig=ACfU3U1EqEUWPHOheQ8laDTMQRngTvRcqA&hl=en&sa=X&ved=2ahUKEwjlvcPjjfnhAhVRXK0KHfqlCj84ChDoATAAegQIBxAB#v=onepage&q=Ewell%20amputation%20circular&f=false

EWELL - A messenger sent to inform Dr. McGuire failed to locate him, and Ewell lay on the field for "several hours" before Dr. McGuire became aware of his injury. Jackson sent his aid-de-camp to tell Dr. McGuire. McGuire stated that Ewell's health, "not very good, was unusually bad at this time" and he was concerned that he would die from shock. When he was sufficiently recovered from shock, according to Dr. H H McGuire, the operation commenced "as rapidly and with as little loss of blood as I could." A postwar newspaper article [The Manassas Journal, (Manassas, VA), February 20, 1914, page 2.] includes this statement: "Though wounded in the knee, the amputation was done at the juncture of the middle and upper third of the thigh, because it was said, he was so thin that proper flaps could not be gotten lower down.*" This seems to indicate that the amputation was a flap procedure but since it's a postwar account, who knows? Regardless of which type of procedure was utilized, about ten days after the operation, Ewell was carried on a litter by soldiers nearly fifty miles to escape capture. McGuire continues:
The motion of the litter caused the bone to protrude and, in consequence of this and his bad health, the wound sloughed. After much suffering and the loss of about an inch of bone, he got well enough to go about, when one day he he was so unlucky as to let his crutches slip from under him, and falling upon an icy pavement, he re-opened the wound and knocked off another piece of bone. After some months he was well enough to go back to the field again, where he performed some very active service, but from the shape of his stump, and an ill-contrived wooden leg he wore, he was frequently troubled with abrasions of the skin, small abscesses, and so on. He now (1866) uses a suitable artificial limb, and with the assistance of a cane, gets along right well, being no longer liable to affections of the stump.
[The Medical and Surgical History of the War of the Rebellion. (1861-65),U.S. Government Printing Office, 1883, p. 242.] https://books.google.com/books?id=3do5AQAAMAAJ&pg=PA242&lpg=PA242&dq=Ewell+amputation+circular&source=bl&ots=6MRUXBr_bJ&sig=ACfU3U1EqEUWPHOheQ8laDTMQRngTvRcqA&hl=en&sa=X&ved=2ahUKEwjlvcPjjfnhAhVRXK0KHfqlCj84ChDoATAAegQIBxAB#v=onepage&q=Ewell amputation circular&f=false
*Link to The Manassas Journal, February 20, 1914, page 2. https://eservice.pwcgov.org/library/digitallibrary/News-Archive/Manassas Journal 1913-1914/the manassas journal_1914 02 20.pdf
 
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OldReliable1862

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HOOD - wounded by a minié ball in the upper thigh just after 2pm on September 20, 1863, resulting in a comminuted fracture of five inches length. Hood was conveyed immediately to the field hospital where it was decided that amputation was the only reasonable alternative. At 4pm, Surgeon Richardson, assisted by Surgeons Hudson and Jones, performed the operation using the circular method and amputating at the upper third of the femur. He experienced some nausea from the chloroform, but by 3 pm the next day, was sufficiently recovered to begin transport. He was carried on a litter thirty miles to the residence of Col Francis H Little, 11th Georgia, arriving there on the night of September 22.
[The Lost Papers of Confederate General John Bell Hood, Stephen Hood, Savas Beatie, Jun 19, 2014, p.28.]

JACKSON - In the wee hours of the morning, about five hours after the wounding, Dr. Hunter Holmes McGuire amputated Jackson's left arm two inches below the shoulder using the ordinary circular method. Four surgeons were present during the operation: McGuire performed the operation; Dr. R T Coleman served as the anesthesiologist, administering chloroform using the "open drop" technique; Dr Harvey Black watched Jackson's pulse, a Dr. Wall assisted McGuire and ligated blood vessels. Captain James P. Smith, a theology student at Richmond, held a light above the operating table. The actual operation was basically uneventful, with "slight loss of blood." The operation took place about 2 am at the CS corps hospital located at Wilderness Tavern.
If you're interested in learning more about Jackson's wounding and subsequent medical care, there's a really detailed account provided in this video by the History of Medicine Society http://digital.lib.uiowa.edu/cdm/ref/collection/histmed/id/53

SICKLES - wounded on the evening of July 2, 1863 at Gettysburg by a 12-pounder solid shot which shattered his right leg. Sickles dismounted unassisted, and aid arriving promptly, he was removed to a sheltered ravine a short distance to the rear, where the limb was amputated low down in the thigh by Surgeon T. Sim, U S V, Medical Director of the Corps. I can find no source to indicate which procedure was used. The patient was then sent further to the rear, and, on the following day, he was transferred to Washington, DC. The stump "healed with great rapidity" and within two weeks, Sickles was able to ride about in a carriage. By early September, he was able to mount a horse, the stump being completely cicatrized (healed by formation of scar tissue.) [The Medical and Surgical History of the War of the Rebellion. (1861-65),U.S. Government Printing Office, 1883, p. 242.] https://books.google.com/books?id=3do5AQAAMAAJ&pg=PA242&lpg=PA242&dq=Ewell+amputation+circular&source=bl&ots=6MRUXBr_bJ&sig=ACfU3U1EqEUWPHOheQ8laDTMQRngTvRcqA&hl=en&sa=X&ved=2ahUKEwjlvcPjjfnhAhVRXK0KHfqlCj84ChDoATAAegQIBxAB#v=onepage&q=Ewell%20amputation%20circular&f=false

EWELL - A messenger sent to inform Dr. McGuire failed to locate him, and Ewell lay on the field for "several hours" before Dr. McGuire became aware of his injury. Jackson sent his aid-de-camp to tell Dr. McGuire. McGuire stated that Ewell's health, "not very good, was unusually bad at this time" and he was concerned that he would die from shock. When he was sufficiently recovered from shock, according to McGuire, the operation commenced "as rapidly and with as little loss of blood as I could." A postwar newspaper article [The Manassas Journal, (Manassas, VA), February 20, 1914, page 2.] includes this statement: "Though wounded in the knee, the amputation was done at the juncture of the middle and upper third of the thigh, because it was said, he was so thin that proper flaps could not be gotten lower down.*" This seems to indicate that the amputation was a flap procedure but since it's a postwar account, who knows? Regardless of which type of procedure was utilized, about ten days after the operation, Ewell was carried on a litter by soldiers nearly fifty miles to escape capture. McGuire continues:
The motion of the litter caused the bone to protrude and, in consequence of this and his bad health, the wound sloughed. After much suffering and the loss of about an inch of bone, he got well enough to go about, when one day he he was so unlucky as to let his crutches slip from under him, and falling upon an icy pavement, he re-opened the wound and knocked off another piece of bone. After some months he was well enough to go back to the field again, where he performed some very active service, but from the shape of his stump, and an ill-contrived wooden leg he wore, he was frequently troubled with abrasions of the skin, small abscesses, and so on. He now (1866) uses a suitable artificial limb, and with the assistance of a cane, gets along right well, being no longer liable to affections of the stump.
[The Medical and Surgical History of the War of the Rebellion. (1861-65),U.S. Government Printing Office, 1883, p. 242.] https://books.google.com/books?id=3do5AQAAMAAJ&pg=PA242&lpg=PA242&dq=Ewell+amputation+circular&source=bl&ots=6MRUXBr_bJ&sig=ACfU3U1EqEUWPHOheQ8laDTMQRngTvRcqA&hl=en&sa=X&ved=2ahUKEwjlvcPjjfnhAhVRXK0KHfqlCj84ChDoATAAegQIBxAB#v=onepage&q=Ewell amputation circular&f=false
*Link to The Manassas Journal, February 20, 1914, page 2. https://eservice.pwcgov.org/library/digitallibrary/News-Archive/Manassas Journal 1913-1914/the manassas journal_1914 02 20.pdf
Thanks Laura, this is great!

Also good to know no pigs were unduly harmed in the making of this article.
 

John Hartwell

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For more on post-amputation treatment, see:
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From the Boston Medical and Surgical Journal, vol. 70, pp 211-16 (1864)
 

NH Civil War Gal

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Definitely following this thread. Main character in my book has his arm amputated after a battle.
Question: was morphine ever used?
Absolutely it was. And when they had time, they would do pre-op morphine too. They measured it out by the grain and it could be given orally or by injection. Personally, I would have wanted it orally, because I can only imagine they had a big bore needle (no standardized 18 gauge needles or butterfly needles in those days!). Morphine can be mixed into a liquid and their favorite liquid of choice was alcohol. Only a tiny fraction of doctors were starting to look askance at alcohol as the cure-all and delivery method for everything - that was still about 50 years away.
 
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Absolutely it was. And when they had time, they would do pre-op morphine too. They measured it out by the grain and it could be given orally or by injection. Personally, I would have wanted it orally, because I can only imagine they had a big bore needle (no standardized 18 gauge needles or butterfly needles in those days!). Morphine can be mixed into a liquid and their favorite liquid of choice was alcohol. Only a tiny fraction of doctors were starting to look askance at alcohol as the cure-all and delivery method for everything - that was still about 50 years away.
I’ve done a little bit of research on morphine in the Civil War and it looks like there’s varied opinions on the frequency of morphine addiction in CW vets after the war. Do you have an opinion on this?
 

NH Civil War Gal

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My own opinion is there was a lot of addiction in the whole population - male and female - period. Certainly some from CW wounds, but up until about 1910 (I’m just doing off-the-cuff right now) there was no FDA and no prohibition about what was sold. Mother’s Little Helper, Peragoric and stuff like that had opium in them and it really helped colicky babies by stopping spasms in smooth muscle tissue lining of the intestine. BUT I’ve always suspected it helped Mother too - and she probably took a swig too when she felt a need.

There were lots and lots of products on the market that had opium or laudanaum in them, never mind all the alcohol out there and a number of combinations of all the above.

The CW created an expanded market but the market was already there and growing.

Interestingly, Prohibition that came along later, wasn’t limited to just the US. Sweden and Norway had forms of it too in the 1930s so other countries, without Civil Wars had addiction problems leading up to WWII.
 
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