GRAPHIC Civil War Surgery: Primary vs. Secondary Amputation

lelliott19

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1574635874046.png

This thread will examine primary and secondary amputation and review some illustrative examples of each.

PRIMARY AMPUTATION - surgery occurs within the first 48 hours of the injury.
Ideally, an extremity that required amputation was removed within 48 hours, reducing the chance of life-threatening complications like gangrene, erysipelas, bone infection, and blood poisoning. The sooner a damaged extremity could be removed, the lower the chance of infection; the better the stump healed; and the better the soldier's chance of survival.

Civil War surgeons did not know about bacteria or the role germs played in infection. There were no antibiotics. Some antibacterials, like sulfur, and some antiseptics, like iodine and bromine, were used; but surgeons did not know how or why they worked. Civil War surgeons knew that survival rates were highest when amputations were performed quickly - but they didn't know exactly why.
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wikimedia commons
CASE: PRIMARY AMPUTATION - MAJOR GENERAL JOHN BELL HOOD
For our purposes, Confederate Major General John Bell Hood is a good example of a quickly executed amputation, with rapid healing, and a positive outcome. Just after 2:00 pm on September 20, 1863, Hood was wounded by a minié ball in the upper thigh of the right leg, resulting in a comminuted fracture of five inches length. He 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.)
1574634881095.png

As illustrated above, Dr. Richardson employed the circular method, amputating Hood's leg at the upper third of the femur. General 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, p.28.] As is well known, Hood returned to field service in the Spring of 1864, in time to participate in the Atlanta Campaign, and served through the rest of the war. He surrendered and was paroled at Natchez, MS May 31, 1865.
Image of Hood on crutches after his amputation

SECONDARY AMPUTATION* - surgery occurs after 48 hours of the injury.
As discussed above, the more time that elapsed between the injury and amputation, the more time bacteria had to multiply. Gunshot wounds from minié balls were filthy - teaming with all kinds of nasty bacteria. The projectile was transported by soldiers in a leather pouch with a flap that did little to keep out dirt and dust. With thousands of horses travelling the roads, the "dirt" wasn't just dirt. It was layered with dried and ground up excrement from animals that were ridden and used to pull the wagons and artillery, and that was kicked up as dust.

Additionally, when the projectile entered the body, it carried along with it anything it had impacted beforehand - tree limbs, leaves, pieces of the soldier's clothing, or worse. So it's not really a question of IF a Civil War gunshot wound would become infected; it's a question of WHEN.

Even though Civil War surgeons knew that survival rates were highest when amputations were performed quickly, sometimes, it just wasn't possible. The number of surgeons, the number of wounded, the location, the need to leave the area, whether or not your side "held the field" or "fell back" - all factors which could prevent an amputation from taking place within 48 hours.
1574631749078.png

CASE: SECONDARY AMPUTATION - PRIVATE JOSEPH McCABE (F/69 NYSNG aka 182 NY)
New member @NYCLAA3 recently inquired about her ancestor, Pvt. Joseph McCabe. McCabe was wounded in the left arm at Petersburg necessitating amputation in the lower third. Luckily, his case was recorded in The Medical and Surgical History of the War of the Rebellion [Volume 2, page 790] so we know some of the details.
1574633159172.png

Pvt. McCabe's surgery was a secondary amputation, performed on June 22, 1864 by Assistant Surgeon Dr. Samuel H. Orton (of New Jersey; buried CT), using the circular method - as illustrated above. Unfortunately, we don't know exactly when he was wounded. Joseph was discharged 14 October 1865; pensioned; and died 27 December 1867.
1574631118527.png

Pictured above is Pvt. John Murphy (K/37 MA) He was wounded April 6, 1865 and his arm was amputated in the field, at the lower third. The date of his surgery is not stated, but the arm became infected. Pvt. McCabe's ordeal was likely very similar. Due to the delay in surgery, McCabe's arm most likely became infected too. This is further indicated by the length of time he was hospitalized. His wound occurred on or prior to June 22, 1864 and he was not discharged until October 1865. He died less than a year later.

Pvt. McCabe was lucky to survive and he had a few things working in his favor:
1. The wound was in the lower third of his arm. Distance of the operation site from the trunk of the body impacted survival rates. The further away from the body the amputation was performed, the higher the survival rate. According to the National Museum of Civil War Medicine, amputations at the wrist joint had a 10.4 percent death rate, while amputations at the shoulder joint had a 29.1 percent death rate.​
2. The Assistant Surgeon who performed the amputation was a "real" medical doctor. Dr. Samuel H Orton (1829-April 1892) Find A Grave Memorial I'll edit to add more about him a bit later.​
3. McCabe was evacuated from Petersburg to the hospitals about Washington DC where he was under the care of Dr. Reed Brockway Bontecou, one of the most skilled surgeons in the US Army. [Dr. Bontecou's work to document medical cases via photography was revolutionary! You've probably seen some of the images. Surgeon with a Camera] So even though his arm likely became infected, he was in a clean hospital, with the best care that could be provided.​

*A three-part classification system (Primary, Intermediary, Secondary) was sometimes used, but for the sake of simplicity, and because I'm fairly certain that McCabe's case was treated after 48 hours, I decided to stick to just two for the purposes of this thread. For explanation of the three-part classification system see Museum of Civil War Medicine

It's been a while since our last Civil War surgery thread, Amputation 101, which covered circular and flap amputation methods and the instruments used to perform them. In case you missed it, here's a link

Sources:
OP Image John Murphy amputee: National Museum of Health and Medicine, Otis Historical Archives Rights: No known restrictions upon publication, physical copy retained by National Museum of Health and Medicine. Photo ID: CP 907 Source collection: OHA 75: Contributed Photographs Related material: CP 441
Image of Hood: Hal Jesperson, original composition in Photoshop. Cropped and color adjusted image from Wikimedia Commons. Link
Anatomical Illustration of Leg: 1821 drawing by Charles Bell showing the circular method of amputation
Info about Hood's Amputation:
The Lost Papers of Confederate General John Bell Hood, Stephen Hood, Savas Beatie, Jun 19, 2014, p.28
Anatomical Illustration Arm: Illustrated Manual of Operative Surgery and Surgical Anatomy, Claude Bernard, New York, 1864. Link
Chart: The Medical and Surgical History of the War of the Rebellion, Volume 2, page 790.
Image John Murphy amputee: National Museum of Health and Medicine, Otis Historical Archives Rights: No known restrictions upon publication, physical copy retained by National Museum of Health and Medicine. Photo ID: CP 907 Source collection: OHA 75: Contributed Photographs Related material: CP 441
 
Last edited:

lelliott19

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A clarification: Joseph McCabe served in Company F, 69th New York State National Guard, also known as the 182nd New York Infantry.

Ryan
Got it. Thanks. I edited the OP to reflect the correct unit designation. What brigade and division was that? And were they at Petersburg?
 
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rpkennedy

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Got it. Thanks. I edited the OP to reflect the correct unit designation. What brigade and division was that? And were they at Petersburg?

They were there. They were in the Fourth Brigade (Colonel John Ramsey, wounded on June 16), Second Division (Brigadier General John Gibbon), Second Corps. They suffered 104 casualties from June 16-June 23.

Ryan
 
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View attachment 335808
This thread will examine primary and secondary amputation and review some illustrative examples of each.

PRIMARY AMPUTATION - surgery occurs within the first 48 hours of the injury.
Ideally, an extremity that required amputation was removed within 48 hours, reducing the chance of life-threatening complications like gangrene, erysipelas, bone infection, and blood poisoning. The sooner a damaged extremity could be removed, the lower the chance of infection; the better the stump healed; and the better the soldier's chance of survival.

Civil War surgeons did not know about bacteria or the role germs played in infection. There were no antibiotics. Some antibacterials, like sulfur, and some antiseptics, like iodine and bromine, were used; but surgeons did not know how or why they worked. Civil War surgeons knew that survival rates were highest when amputations were performed quickly - but they didn't know exactly why.
View attachment 335799wikimedia commons
CASE: PRIMARY AMPUTATION - MAJOR GENERAL JOHN BELL HOOD
For our purposes, Confederate Major General John Bell Hood is a good example of a quickly executed amputation, with rapid healing, and a positive outcome. Just after 2:00 pm on September 20, 1863, Hood was wounded by a minié ball in the upper thigh of the right leg, resulting in a comminuted fracture of five inches length. He 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.)
View attachment 335800
As illustrated above, Dr. Richardson employed the circular method, amputating Hood's leg at the upper third of the femur. General 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, p.28.] As is well known, Hood returned to field service in the Spring of 1864, in time to participate in the Atlanta Campaign, and served through the rest of the war. He surrendered and was paroled at Natchez, MS May 31, 1865.
Image of Hood on crutches after his amputation

SECONDARY AMPUTATION* - surgery occurs after 48 hours of the injury.
As discussed above, the more time that elapsed between the injury and amputation, the more time bacteria had to multiply. Gunshot wounds from minié balls were filthy - teaming with all kinds of nasty bacteria. The projectile was transported by soldiers in a leather pouch with a flap that did little to keep out dirt and dust. With thousands of horses travelling the roads, the "dirt" wasn't just dirt. It was layered with dried and ground up excrement from animals that were ridden and used to pull the wagons and artillery, and that was kicked up as dust.

Additionally, when the projectile entered the body, it carried along with it anything it had impacted beforehand - tree limbs, leaves, pieces of the soldier's clothing, or worse. So it's not really a question of IF a Civil War gunshot wound would become infected; it's a question of WHEN.

Even though Civil War surgeons knew that survival rates were highest when amputations were performed quickly, sometimes, it just wasn't possible. The number of surgeons, the number of wounded, the location, the need to leave the area, whether or not your side "held the field" or "fell back" - all factors which could prevent an amputation from taking place within 48 hours.
View attachment 335783
CASE: SECONDARY AMPUTATION - PRIVATE JOSEPH McCABE (F/69 NYSNG aka 182 NY)
New member @NYCLAA3 recently inquired about her ancestor, Pvt. Joseph McCabe. McCabe was wounded in the left arm at Petersburg necessitating amputation in the lower third. Luckily, his case was recorded in The Medical and Surgical History of the War of the Rebellion [Volume 2, page 790] so we know some of the details.
View attachment 335797
Pvt. McCabe's surgery was a secondary amputation, performed on June 22, 1864 by Assistant Surgeon Dr. Samuel H. Orton (of New Jersey; buried CT), using the circular method - as illustrated above. Unfortunately, we don't know exactly when he was wounded. Joseph was discharged 14 October 1865; pensioned; and died 27 December 1867.
View attachment 335782
Pictured above is Pvt. John Murphy (K/37 MA) He was wounded April 6, 1865 and his arm was amputated in the field, at the lower third. The date of his surgery is not stated, but the arm became infected. Pvt. McCabe's ordeal was likely very similar. Due to the delay in surgery, McCabe's arm most likely became infected too. This is further indicated by the length of time he was hospitalized. His wound occurred on or prior to June 22, 1864 and he was not discharged until October 1865. He died less than a year later.

Pvt. McCabe was lucky to survive and he had a few things working in his favor:
1. The wound was in the lower third of his arm. Distance of the operation site from the trunk of the body impacted survival rates. The further away from the body the amputation was performed, the higher the survival rate. According to the National Museum of Civil War Medicine, amputations at the wrist joint had a 10.4 percent death rate, while amputations at the shoulder joint had a 29.1 percent death rate.​
2. The Assistant Surgeon who performed the amputation was a "real" medical doctor. Dr. Samuel H Orton (1829-April 1892) Find A Grave Memorial I'll edit to add more about him a bit later.​
3. McCabe was evacuated from Petersburg to the hospitals about Washington DC where he was under the care of Dr. Reed Brockway Bontecou, one of the most skilled surgeons in the US Army. [Dr. Bontecou's work to document medical cases via photography was revolutionary! You've probably seen some of the images. Surgeon with a Camera] So even though his arm likely became infected, he was in a clean hospital, with the best care that could be provided.​

*A three-part classification system (Primary, Intermediary, Secondary) was sometimes used, but for the sake of simplicity, and because I'm fairly certain that McCabe's case was treated after 48 hours, I decided to stick to just two for the purposes of this thread. For explanation of the three-part classification system see Museum of Civil War Medicine

It's been a while since our last Civil War surgery thread, Amputation 101, which covered circular and flap amputation methods and the instruments used to perform them. In case you missed it, here's a link

Sources:
OP Image John Murphy amputee: National Museum of Health and Medicine, Otis Historical Archives Rights: No known restrictions upon publication, physical copy retained by National Museum of Health and Medicine. Photo ID: CP 907 Source collection: OHA 75: Contributed Photographs Related material: CP 441
Image of Hood: Hal Jesperson, original composition in Photoshop. Cropped and color adjusted image from Wikimedia Commons. Link
Anatomical Illustration of Leg: 1821 drawing by Charles Bell showing the circular method of amputation
Info about Hood's Amputation:
The Lost Papers of Confederate General John Bell Hood, Stephen Hood, Savas Beatie, Jun 19, 2014, p.28
Anatomical Illustration Arm: Illustrated Manual of Operative Surgery and Surgical Anatomy, Claude Bernard, New York, 1864. Link
Chart: The Medical and Surgical History of the War of the Rebellion, Volume 2, page 790.
Image John Murphy amputee: National Museum of Health and Medicine, Otis Historical Archives Rights: No known restrictions upon publication, physical copy retained by National Museum of Health and Medicine. Photo ID: CP 907 Source collection: OHA 75: Contributed Photographs Related material: CP 441
If that doesn't remove the "Glory of War" attitude among anyone, I don't know what would.
 

Seduzal

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Joined
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Location
Canton, North Carolina
Thanks for sharing this awesome article. As a retired Emergency Medical TechnicIan (EMT), was alway ready to aid a patient with sometimes the first medical treatment that they received! As with other injuries; fall, sickness, accidents of all kinds, gun shots, and many others to much to list all of them.. The first contact was to maintain breathing, stop the bleeding and transport the patient to a hospital as soon as possible.
Medical treat has come a long way since to Civil War...
 

JPK Huson 1863

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Joined
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Location
Central Pennsylvania
Thanks for sharing this awesome article. As a retired Emergency Medical TechnicIan (EMT), was alway ready to aid a patient with sometimes the first medical treatment that they received! As with other injuries; fall, sickness, accidents of all kinds, gun shots, and many others to much to list all of them.. The first contact was to maintain breathing, stop the bleeding and transport the patient to a hospital as soon as possible.
Medical treat has come a long way since to Civil War...


EMT. I know it's respectful when encountering our military to say thank you for their service, EMT's always make me want to go shake their hands too. And thank you. Seriously do not know how you people do what you do- glad you're all there anyway. ( sorry to distract from your OP, @lelliott19 ) Friend lost her daughter when she apparently froze on tracks, stalled car. You know the rest. Friend was on the scene in minutes- to this day says the only thing she remembers is the EMT's compassion that awful day.
 

scone

2nd Lieutenant
Honored Fallen Comrade
EMT. I know it's respectful when encountering our military to say thank you for their service, EMT's always make me want to go shake their hands too. And thank you. Seriously do not know how you people do what you do- glad you're all there anyway. ( sorry to distract from your OP, @lelliott19 ) Friend lost her daughter when she apparently froze on tracks, stalled car. You know the rest. Friend was on the scene in minutes- to this day says the only thing she remembers is the EMT's compassion that awful day.

 

Seduzal

Major
Retired Moderator
Joined
Jun 19, 2013
Location
Canton, North Carolina
EMT. I know it's respectful when encountering our military to say thank you for their service, EMT's always make me want to go shake their hands too. And thank you. Seriously do not know how you people do what you do- glad you're all there anyway. ( sorry to distract from your OP, @lelliott19 ) Friend lost her daughter when she apparently froze on tracks, stalled car. You know the rest. Friend was on the scene in minutes- to this day says the only thing she remembers is the EMT's compassion that awful day.

Thank you for the kind words! I really enjoyed helping others in their time of need. I retired after 26 years of service as both an EMT and a volunteer firefighter for the fire department.
 

lelliott19

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Whenever I run across additional information related to a previous post, I like to add it. In this case, I had mentioned the names of all the surgeons I knew of who performed and/or assisted with the amputation of Hood's leg. What I didn't know was that John Bell Hood was initially treated on the field by "Dr. W L West."
1594514870259.png

Reminiscences of Pvt William T Shumate, "Gettysburg to Chattanooga: Kershaw's Ragged Brigade," Yorkville Enquirer. (Yorkville, SC), April 12, 1883, page 1.

There was no W L West in Co B 2nd SC - there was a W S West, but he died of pneumonia in 1861. I believe there was a mis-transcription of the "W" where an "M" should be in this newspaper article, and that the doctor who treated Hood was actually Marcus Lafayette West. Dr. West was, at the time, serving as a 2nd Corporal in Company B aka Butler Guards of the 2nd South Carolina Infantry and was recorded as "present" on the Company Muster Roll for Sept/Oct 1863.
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