American Civil War Medicine – Part 2 – Amputations and Plaster Splints

American Civil War medical instruments owned by members of the UK Re-enactment Group, So.Sk.An

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This posting contains some detailed descriptions of medical procedures that a few of my regular followers may find a tad gruesome.  If this topic is not for you, then please check back again in a few days time, when there will be some lovely postings on Victorian actress Lillie Langtry, the 1940s Make Do and Mend Campaign and of course, more cooking with Mrs Beeton.  If you like your history of medicine straight-up, then please read on….

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As you know if you have read my previous posting on American Civil War Medicine, I am researching the career and life of Civil War Surgeon Dr Mary Edwards Walker (1832-1919).   In the course of this research I have come across some great material on medical practices and procedures used by Surgeons during this time which I thought would be of interest to those of you who are keen to find-out more about this fascinating topic.

Amputation was the stock-in-trade of every Civil War Surgeon.   The procedure was used to treat bullet wounds and infections.  The most skilled Surgeon could amputate a leg at the thigh in about 40 seconds.  Reporting on ‘Amputation at the Ankle-Joint’ in The British Medical Journal in August 1869, Prof. George H. B. Macleod, M.D., F.R.S.E., a Professor of Surgery in the Andersonian University, Glasgow, said that ‘..Essentials of any good method of amputation is the removal of the whole disease or injured parts to be removed with as little mutilation as possible and with as great a saving of the body (especially the bone) as can be.’  Macleod’s own research into mortality rates post ankle-amputation in the Crimean War (22.2%) and the American Civil War (8%), demonstrate that even in the few short years that had elapsed between the two campaigns, the Surgeon’s skill at perfecting this procedure had probably reached a high level.   These mortality figures are quite incredible when you think how insanitary the conditions in the Field Hospitals actually were.  The large volume of amputations performed by Surgeons would have ensured that the skill was being practiced on a regular basis.

What is unclear from Macleod’s statistics is whether the amputations were flap or circular.  There were several methods of ankle-amputation available to the Surgeon:   Syme’s, Postero (internal flap), Soupart’s, Sédillot’s and Pirogoff.   Flap method amputations were dangerous in the battlefield as they were particularly prone to gangrene.  However, the flap method was quicker to perform than the circular and would have been popular where speed was of the essence. Macleod believed that the best method was Syme’s flap method which he describes as follows:

• ‘The knife best fitted for amputation at the ankle is a short, strong bladed one. That the covering retained for the ends of the bones should be ample in amount, healthy and firm in quality, so as to make it capable of withstanding pressure and attrition; that the blood-vessels and nerves should be placed out of the way of pressure, and that they should be well-covered and protected; that the flap or flaps should be well supplied with blood, and fall easily together, and be capable of easy retention; that secretions should have easy exit; that the resulting cicatrix should be out of the line of pressure; and, lastly, that the stump should be one to which the mechanist can with greatest facility adjust a substitute for the removed part.’   

Macleod offers plenty of advice on aseptic surgery, which was not practiced during the Civil War.   It wasn’t until 1867 that the benefits of a sterile operating theatre began to be accepted across Europe.    America did not adopt aseptic surgery practices until the end of the 19th century.  Macleod, writing in 1869 advocates its use but the last couple of sentences on dealing with wound dressings would horrify us today:-

• ‘I have employed various disinfectants and antiseptics in the after-treatment of these and other wounds, and am strongly impressed with their advantages in lessening discharge and destroying smell. Carbolic acid dissolved in water (1 to 30) or Condy’s fluid or Chloride of zinc (gr 15 or 20 to the ounce), are very useful indeed, when used to wash over the flaps at the time of the operation; and carbolic acid or Condy’s fluid should always be mingled with the water used for syringing out the stump (which I always do at each dressing, so long as pus lodges in its interior).  I am a strong advocate for dressing as seldom as possible.  Unless the suppuration is very profuse, and the drainage bad, it is not necessary to interfere oftener than every second day; and in fact, if the dressings applied be of the simplest and lightest kind, very little meddling will be required.  I rarely make my first dressing till the third or fourth day.’

Many Surgeons during the Civil War reported on the neurological phenomena known as ‘the phantom limb’.  Contemporary researchers on the topic included physicians, S. Weir Mitchell, W.W. Keen and George Morehouse.  They had all experienced reports of this phenomena amongst their patients.  Many   amputees reported feeling a sensation from the amputated portion of limb.

Conditions in the Civil War field hospitals were basic and grim.  Field hospitals were converted schools, hotels, churches, barns, private homes and even boats.  The injured soldier did not recuperate on sprung mattresses in clean, tidy wards but instead would find himself lying on makeshift beds.  These beds were boards on top of church pews or on the ground and if they were lucky they might be given a mattress made of sacks of straw or corn husks.  The operating table would have been a wooden bench often set-up underneath a tree.  Drugs and medical supplies were in short supply and in emergencies corn husks were sometimes used as a substitute for bandages on patients injured on the frontline.  Suppurating wounds were treated by applying an ointment consisting of 2 parts fresh lard and one part white wax. (For more on this particular topic, see Agatha Young’s, The Women and the Crisis: Women of the North in the Civil War, published by Thomas Yoseloff: New York, 1959).

Apart from amputation skills, the Civil War Surgeon developed relatively sophisticated techniques in the use of plaster splints.  I came across an article, ‘Plaster Splints in the American Civil War’ published 1943 in the December issue of The British Medical Journal by an author just referred to as ‘S.W.’  S.W. had discovered a series of essays, titled ‘A-T’, that had been published between 1862-4 by The United States Sanitary Commissioner and intended for distribution amongst Army Surgeons.  The essays covered a wide ranges of topics on battlefield medicine, including techniques for creating plaster splints which can be found in Volume ‘T’.  The Army Surgeons were recommended to use the Maisonneuve technique and A.W.’s article details this procedure:

• ‘Shave or oil the skin.  Make a paper pattern of the area to be covered and cut to it two thicknesses of Canton flannel or old muslin, devising windows if wounds are present; the sides of the flannel should remain about one inch apart when in position.  Sprinkle plaster into equal quantity of water to a creamy consistence.  Immerse cloth till thoroughly saturated, lay it on a flat surface and smooth with hand.  Apply flannel to limb and put snugly over it a roller bandage.  The limb is then held for a few minutes, extension being made if necessary until the plaster sets, when the roller bandage is removed.  If it is necessary to delay the “setting” of the plaster this maybe achieved by adding a small quantity of carpenters’ glue.’

S.W. goes on to discuss the importance role that the use of plaster splints played in improving survival rates of Civil War soldiers:

• ‘..a patient with a much swollen elbow-joint wounded at the Battle of Cross-Keys.  The joint had been entered by a round bullet, which was removed two weeks later, when free incisions around the joint were found to be necessary.  At this stage a plaster splint was applied to the anterior surface of the arm and retained by a transverse band above the wrist and another at the middle of the humerus, the arm being flexed.  This splint was worn for a month and then renewed.  The head of the radius came away and the patient recovered with some degree of motion in the joint.  Dr Swan employed the plaster splints in several cases of fracture after the seven days’ fighting before Richmond, during M’Clellan’s campaign, and the patients were comfortable transported to Washington.’

I hope that you have found the above interesting.  I will post further on this topic in the future.  For further resources please see my previous posting.