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Battlefield injuries to the upper and lower extremities were common during the American Civil War. Many of these wounds included fractured bone and badly torn, often contaminated muscle and blood vessels. It was quickly appreciated that the survival rate of soldiers sustaining such injuries was better in those who underwent amputation, particularly early on [i.e., within 48 hours of injury ("primary" amputation)]. Because transport of the wounded was often difficult and sometimes poorly organized, surgery was frequently performed on or near the battlefield, often in hastily constructed "field hospitals". The operation itself was associated with a high mortality rate, and was occasionally performed by individuals poorly trained in the procedure and with limited understanding of anatomy.

Although ether/chloroform anesthesia had been introduced in America in 1846, limited supplies and the chaos of battle were such that anesthesia was not always available, particularly in the early part of the war. In some cases, an unfortunate soldier would be held firmly on a table by a number of assistants while the soft tissue was cut, the large vessels ligated and the bone sawn through. In the vast majority, however, chloroform administration made the procedure tolerable. Skilled and experienced surgeons were able to perform an amputation in a few minutes. Such experience often came quickly--over the whole war, 29,980 amputations were performed on Union soldiers alone.

Post-operative wound infection ("erysepalis" or gangrene) was common in those who survived the amputation procedure. In many patients, this led directly and rapidly to sepsis (blood infection) and death. In others, the infection was more indolent and affected the residual stump, often resulting in osteomyelitis (infection of the bone). The latter was also common in patients who did not undergo amputation, as a result of wound contamination at or shortly after the time of injury. Such infection often resulted in the formation of dead bone (the sequestrum), which could be quite extensive. In patients who did not succumb to the infection at this time, a process of healing often began in the viable bone surrounding the necrotic tissue, manifested by an irregular sleeve of new bone enfolding the sequestrum (the involucrum). In more prolonged disease, sinuses sometimes formed between the skin and the sequestrum, draining pus from abscesses that persisted in the dead bone. Although wound care (including surgical debridement or the pouring or injecting acid onto or into the wound in an attempt to 鈥渄issolve鈥� away the infected tissue) sometimes controlled such local infection, amputation or revised stump amputation was frequently necessary if the patient was to have any hope of survival. The complications of such long term disease (including pain, foul odor and physical disability) greatly affected the post-war lives of many veterans.

Additional Reading

• Freemon, Frank R. Gangrene and Glory: Medical Care During the American Civil War. Cranbury, NY: Fairleigh Dickinson University Press, 1998.
• Rutkow, I. R. Bleeding Blue and Grey: Civil War Surgery and the Evolution of American Meidcine. New York, NY: Random House, 2005.

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