Under the Knife

During the Civil War, my great-great-grandfather Elisha Jones served as a private in the 28^th (Gray’s) Louisiana. On April 8, 1864, he and his comrades charged across an open field towards the Union line during the Battle of Mansfield, Louisiana. A Yankee bullet tore through Elisha’s right hand, breaking the bones in the process, and then struck a friend in the leg. Both soldiers were crippled for life.

Elisha’s shattered hand drew up into a useless claw, and he was later awarded an eight dollars per month state pension. He was lucky to have survived at all; thousands of others died from such wounds.

In some ways, Elisha’s Civil War medical experience was typical because approximately two out of three wounds treated by surgeons were to the extremities. Few soldiers hit in the head, chest, or stomach lived long enough to make it back to a field hospital.

Damaged limb bones presented the greatest challenge to surgeons. The war’s most common projectile, the large, oblong minié ball, often tumbled when it hit the body and damaged bone more than smoothbore musket balls. One Confederate surgeon observed, “The shattering, splintering, and splitting of a long bone by the impact of a minié or Enfield ball were, in many instances, both remarkable and frightful.”

When faced with wounds to the limbs, surgeons had to decide quickly on one of three possible treatments. If it was a simple fracture, a wooden or plaster splint was applied, but if the bone was shattered the surgeon performed either a resection or amputation.

Resection involved cutting open the limb, sawing out the damaged bone, and then closing the incision. It was a time-consuming procedure and required considerable surgical skill, but some surgeons became quite proficient. After one battle, a Union surgeon completed twenty-six resections of the shoulder and elbow in a single day. It was said that he ate and drank coffee at the operating table while pieces of bone, muscle and ligaments piled up around him.

Besides being a difficult procedure, resection also carried a high risk of bleeding, infection and postoperative necrosis of the flesh. Successful resections, however, allowed the patient to keep his limb, although it was limp and useful merely to “fill a sleeve.”

Amputation was simpler. After a circular cut was made completely around the limb, the bone was sawed through, and the blood vessels and arteries sewn shut. To prevent future pain, nerves were pulled out as far as possible with forceps, cut and released to retract away from the end of the stump. Finally, clippers and a rasp were used to smooth the end of the exposed bone.

Sometimes the raw and bloody stump was left untreated to heal gradually, and sometimes excess skin was left intact to be pulled down and sewn over the wound. Speed was essential in all amputations to lessen blood loss and prevent shock. An amputation at the knee was expected to take just three minutes.

Despite popular belief, Civil War surgeons almost always had chloroform to anesthetize patients before an amputation. The chloroform was dripped onto a piece of cloth held over the patient’s face until he was unconscious. Although not an exact science, the procedure worked well, and few patients died from overdose. Opium pills, morphine injections and laudanum were also available to control postoperative pain.

The mistaken belief that amputations were routinely performed without anesthetics can probably be attributed to the fact that chloroform did not put patients into a deep unconscious state. They would react to the knife and saw but wouldn’t remember it afterward. Bystanders who saw the moaning, writhing patients being held down on the table assumed no anesthetic was being used.

Early in the war surgeons earned the nickname “Saw-bones” because they seemed eager to amputate. This eagerness stemmed not from overzealousness but from the knowledge that infections developed quickly in mangled flesh, and amputation was the most effective way to prevent it. Amputations were also preferred because it was easier and less painful to transport an amputee than a soldier whose broken bones and inflamed tissue made the slightest jostle sheer torture.

One surgeon admitted that an excessive number of amputations may have been performed during the war, but he added, “I have no hesitation in saying that far more lives were lost from refusal to amputate than by amputation.”

One of the greatest dangers of any surgical procedure was infection because doctors did not yet appreciate the necessity of sterile environments. As one surgeon recalled, “We operated in our blood-stained and often pus-stained coats. . . . We operated with clean hands in a social sense, but they were undisinfected hands. . . . If a sponge or an instrument fell on the floor, it was washed and squeezed in a basin of tap water and used as if it were clean.”

Despite the dangers, it is estimated that about three out of four soldiers survived amputations. Amazingly, some, like Louisiana Gen. Francis T. Nicholls, endured more than one. His lower left arm was amputated after he was shot at the First Battle of Winchester and his left foot was taken off when he was wounded at Chancellorsville. After the war, Nicholls was a popular two-term governor who was said to have asked people to vote for “all that’s left of General Nicholls” and to support him for governor because he was “too one sided to be a judge.”

Amputation was the most common Civil War surgical procedure. Union surgeons performed approximately 30,000 compared to just over 16,000 by American surgeons in World War II. One postwar British traveler noted that amputees could be found in every Southern town and village. In Louisiana, the men who had survived the surgeon’s knife were a visible reminder of the Civil War for decades.

Dr. Terry L. Jones is a professor emeritus of history at the University of Louisiana at Monroe. For an autographed copy of “Louisiana Pastimes,” a collection of the author’s stories, send $25 to Terry L. Jones, P.O Box 1581, West Monroe, LA 71294.