"Of the varieties of gunshot wounds, none are more terrible in their effects than those that are produced by the peculiar bullet invented by M. Etienne Minié, of Paris….the effects are truly terrible; bones are ground almost to powder, muscles, ligaments, and tendons torn away, and parts otherwise so mutilated, that loss of life, certainly of limb, is almost an inevitable consequence."
The .58 caliber conical minié ball weighed just one ounce and had a circumference of about ½ inch. It might have been small, but it caused major destruction. It was made of soft lead and designed to spread or flatten, on impact. As a result, the minié ball caused profound damage to soft tissue and often shattered bones 3 or more inches either side of the actual impact site.
Proximal portion of a right humerus with a comminuted fracture held together with wires and springs; from an unidentified man shot during the Civil War.
Because of the number of amputation being performed, Civil War surgeons faced harsh criticism from all sides. Citizens and the press condemned the practice of amputation, without understanding its necessity. Medical officers on both sides tried to change perceptions of medical services by initiating more conservative approaches instead of amputation. One alternative to amputation was “excision.” If a damaged joint was excised, Confederate surgeons called the procedure a “resection,” but the terms were often used interchangeably.
Surgeons were much more likely to consider excision instead of amputation when operating at general hospitals located in the rear. They had fewer emergency patients and more time. At field hospitals located near the battlefields, amputations were preferable because of the relative speed with which they could be performed – about 10 minutes. With so many wounded men to attend to, surgeons at field hospitals could treat and save many more lives through amputation. Waiting to operate often resulted in infection, and infection often resulted in death. It is no wonder then, that three of every four surgical procedures performed during the Civil War was an amputation.
If the surgeon had the benefit of time, excision was deemed appropriate when one of the long bones of the leg (femur, tibia, fibula) or arm (humerus, ulna, radius) was comminuted, without damage to nerves or blood vessels. The ends of the fractured bone were cut proximal and distal to the comminuted section and all the fragments were excised. Rigid wooden splints secured and immobilized the shortened extremity, allowing the bone ends to unite.
After recovery, the results were varied. Some excisions resulted in a limb that was slightly shortened but near normal. Other soldiers might have little or no use of the extremity at all. Results were dependent upon the severity of the injury; the elapsed time between wounding and surgery; and the skill of the surgeon in avoiding collateral damage during surgery.
- "The Flexible Chain Saw During the Civil War," Robert Scott Johnson, JD Dorothy A Sippo, MD, et al.,The Journal of Trauma Injury, Infection, and Critical Care, Volume 69, Number 2, Lippincott Williams & Wilkins, Inc., 2010, page 455. https://journals.lww.com/jtrauma/Ci...e_Chain_Saw_During_the_American_Civil.32.aspx
- Medical and surgical care during the American Civil War, 1861–1865, Robert F. Reilly, MD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790547/
- Civil War Battlefield Surgery, A Description of Civil War Field Surgery,Jenny Goellnitz https://ehistory.osu.edu/exhibitions/cwsurgeon/cwsurgeon/amputations
- The Truth About Civil War Surgery, Alfred J Bollet. https://www.historynet.com/the-truth-about-civil-war-surgery-2.htm
Image 2: Excision. Private Francis Furber had the lower third of his humerus bone removed after it was shattered by a minié ball.
Images 1 & 2 from https://www.dailymail.co.uk/news/ar...orrifically-maimed-American-battlefields.html
Image 3: Fractured Right Humerus- Proximal Portion, due to Gunshot Wound, Warren Anatomical Museum, Harvard Medical Library https://collections.countway.harvard.edu/onview/items/show/6128
Image 4: Forearm after excision in the lower third of the radius for shot injury. The Medical and Surgical History of the War of the Rebellion. (1861-65.), Part 2, Volume 2 (Washington, DC: Government Printing Office, 1876), page 938.
Image 5: Double Incline Leg Splint; Illustration from Civil War Medicine by C. Keith Wilbur. http://www.archivingwheeling.org/blog/founding-physician-and-civil-war-surgeon/scan0002