Oh, What a Bloody War: Amputations and the Advent of the Prosthesis Industry during the American Civil War.

“At an age when appearances are reality, it becomes important to provide the cripple with a limb which shall be presentable in polite society, where misfortunes of a certain obtrusiveness may be pitied, but are never tolerated under the chandeliers.” Oliver Wendell Holmes in 1863.

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Veterans John J. Long, Walter H. French, E. P. Robinson, and an unidentified companion, 1860s Courtesy Library of Congress

The Civil War was one of the bloodiest engagements in American history, with approximately 620,000 soldiers dying from combat, accident, starvation, and disease. Some studies even put the number as high as 850,000. Nearly 500,000 men were injured in the conflict, many later dying from medical procedures that were meant to save their lives. One such procedure undertaken with shocking frequency was the amputation of limbs, which accounted for approximately three-quarters of the surgeries performed during the war.

One of the key reasons for the upsurge in amputations was the advancements in military weaponry at the time. Prior this period in history, the rifles used in fighting were predominantly smoothbore. It wasn’t until the 1830s that a man named Captain John Norton observed how a certain tribe in India used a softer wood for the lower part of their blowguns, allowing greater range of fire because the wood compacted around the projectile. Based on this concept, he designed a cylindrical bullet with a flat base, that trapped the gasses behind it. The idea was later improved upon by a man named William Greener. However, the true bane of Civil War soldiers was created by Claude-Étienne Minié and Henri-Gustave Delvigne in 1849.

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Minie Ball

Commonly known as the minié (min-YAY or Minnie) ball, this conical projectile was smaller, longer, and easier to load. When coupled with the new grooved barrels of the rifles Minié and Delvigne designed, it was deadly. It made its way to the United States after being observed in use by several American officers in the Crimean War from 1853 to 1855, most notably by General George B. McClellan. James Burton, an armorer in Harpersferry, Virginia improved upon the design (again), and a form of the minié ball was adopted by both sides of the American Civil War—Union and Confederate.

To begin with, smoothbore muskets were still the weapon of choice for battle, but as the war raged on, rifled muskets soon replaced smoothbore, with the industrialized North being able to produce these weapons at an alarming rate. They outshot their earlier cousins by approximately 200 yards, and with deadly accuracy.

What made the minié ball so devastating was how it compacted and then expanded upon hitting a target. Where a round ball would break bone and damage tissue, a minié ball tore violently through arteries and skin, shattering bone underneath, often leading to the injured soldier requiring amputation of the affected limb. If the soldier was shot in the main part of his body or his head, he wasn’t expected to survive.

A medical textbook published a decade after the Civil War, A System of Surgery by William Todd Helmuth, went into detail about the damage caused by the minié ball:

“The effects are truly terrible; bones are ground almost to powder, muscles, ligaments, and tendons torn away, and the parts otherwise so mutilated, that loss of life, certainly of limb, is almost an inevitable consequence.

None but those who have had occasion to witness the effects produced upon the body by these missiles, projected from the appropriate gun, can have any idea of the horrible laceration that ensues. The wound is often from four to eight times as large as the diameter of the base of the ball, and the laceration so terrible that mortification [gangrene] almost inevitably results.”

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A surgeon’s kit from the American Civil War

Amputations often took place in battlefield tents, fear of infection prompting the procedure. The doctors on either side were ill-prepared for such surgeries, however medical texts at the time do document how to perform amputations. The conditions were far from ideal for such a drastic medical procedure. The patients would lay on planks or removed doors, given chloroform or whiskey. Hollywood has been known to exaggerate these procedures, showing men screaming in agony, but the use of pain medication was widespread. Limbs, hands, and feet were removed by cutting in a circular motion, surprisingly resulting in little blood loss. Some surgeons even cut flaps of skin to create a covering for the wound, stitching them together after the injured limb was removed. A good surgeon could amputate a limb in ten minutes. Surgical tools were often unwashed between patients, leading to the spread of infection and subsequent death of many soldiers after the amputation. Many soldiers begged not to have the doctors remove limbs, leading to the nickname of ‘Butcher’ for many of the surgeons at the time.

If a patient managed to survive the operation—mortality rate for a primary amputation was around forty-eight percent—he would be left with questions about his future: how would make a living, continue his hobbies, or even marry? To many people in the late nineteenth century, amputation was also sign of character, where the general populous would assume the subject had been morally degenerate or involved in a physical altercation. Approximately 30,000 Union soldiers lost limbs during the war, with just about 21,000 surviving the procedure. Confederate records are unknown, as when the government fled Richmond at Grant’s Army advancing, they burned all paperwork, but it is estimated the number of amputees was approximately 40,000.

A demand was launched for ways to help the returning soldiers regain some normality—and comfort—and the great race was on to design the best prosthesis. Prosthetic limbs have been around since the Egyptians and Romans, with the earliest example of a prosthesis being a big toe, found in the tomb of a noblewoman. As with most things, though, the need for prosthetics usually circled around war. Between the 1500s and 1800s, there were not many advances in the area, with many of the limbs similar to things that were used during Roman times. In the early sixteenth century, Ambroise Paré, a doctor in France, came up with a locking knee joint and a hinged prosthetic hand. However, his ways of attaching these limbs are still commonly used to this day. Needless to say, there wasn’t much going on in the way of technological advancements when it came to prosthetics for nearly 300 years.

With the vast number of amputees, the government made a vow to provide assistance, unveiling ‘the Great Civil War benefaction,’ a commitment to provide prosthetics to all disabled war veterans. With the lure of government aid, many entrepreneurs took to the challenge of creating something physically appealing and functional. However, with the most common supplies being wood and steel, comfort—despite the claims of the manufacturers—was a great issue, and many soldiers preferred continuing to use crutches, or pin up the sleeves of their coats.

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James Edward Hanger

Interestingly, it was a Confederate amputee, James Edward Hanger, who made the greatest stride in developing a prosthesis. Fed up with the peg given to him by Union surgeons after the amputation of his leg, Hanger developed a substitute leg with a flexible knee and ankle joint, allowing for greater range of movement. He was awarded several patents by the Confederate government at the time, and later, in 1891, awarded a US patent for his design. The company he founded is still active today, providing prosthetics and orthotics to many disabled peoples and veterans.

Unfortunately, prosthetics were not the solution for all amputees. Soldiers who had their arms removed often were faced with clunky appliances that did not lend themselves well to daily life. Often, they opted to learn to use their non-amputated arm, or in the case of double amputees, learn other ways to get on with their day-to-day living. Some struggled with learning to walk with their new legs, thinking they would be able to jump up straight away. One soldier described it as if he was a baby, walking for the first time.

The United States government created a stipend programs to make sure all veterans could afford to buy a prosthetic limb. In 1862, the Federal government allotted Union veterans $75 to buy an artificial leg and $50 to buy an artificial arm. By 1864, the Confederacy was also allocating funds for their injured veterans. However, some of the soldiers refused to take the charity, believing their amputated limbs were marks of bravery in a hard-fought battle.

In addition to funding for artificial limbs, the government looked for ways to employ injured soldiers, creating the invalid corps where the men could work as cooks, nurses, and prison guards. Those with less grievous injuries were sent back to the front. Unfortunately, these men were the subject of much mockery, being dubbed the ‘cripple brigade’ and unable to claim the reenlistment bonus given to men serving their second time with the military forces or the bonus afforded to new recruits. Eventually, the unit was renamed to the Veteran Reserve Corps to avoid further mockery.

War in any context is a horrific event. Eventually, the call for the minié ball along with other soft lead bullets to be banned was made in 1870s, stating that it was comparable to an exploding bullet. Still, the technology advanced, rendering muzzle loading weapons obsolete as manufacturers progressed to breach loading weapons, which could be reloaded much faster than their earlier cousins. However, the rifled barrel and conical bullet changed the face of warfare forever. Yet, today, we can grateful to men like Hanger for his advances made in artificial legs, as his initial designs were the model for many prosthetics to follow.

As Harvard historian Catherine Drew Gilpin Faust said, “The American Civil War produced carnage that has often been thought reserved for the combination of technological proficiency and inhumanity characteristic of a later time.” And still, the advances made during the time, thanks to the need to help disabled soldiers, could almost be described as monumental.

Still, it is a fair question to ask if the minié ball, with its unique shape and ability to maim and kill from a greater distance and with greater accuracy than its predecessors, had not been invented, would there have been the need for the prosthesis industry to advance as it did during after the American Civil War? With more powerful weapons comes the need for new medical technology to keep up with the level of destruction and harm inflicted on the bodies of those fighting the battles. With this in mind, it is no wonder the American Civil War has been known as the deadliest conflict in the country’s history.

Consulted Sources:

After the Amputation: National Museum of Civil War Medicine. Retrieved from http://www.civilwarmed.org/prosthetics/

A History of Wartime Advancements in the Prosthetic Industry. Retrieved from https://history.libraries.wsu.edu/fall2016-unangst/2016/12/16/a-history-of-wartime-advancements-in-the-prosthetic-industry/

Minié Ball: HistoryNet. Retrieved from http://www.historynet.com/minie-ball

Statistics on the Civil War and Medicine. Retrieved from https://ehistory.osu.edu/exhibitions/cwsurgeon/cwsurgeon/statistics

The History of Prosthetics. Retrieved from http://unyq.com/the-history-of-prosthetics/

Wegner, Ansley Herring. Amputations in the Civil War. Tar Heel Junior Historian. Fall 2008. Retrieved from https://www.ncpedia.org/history/cw-1900/amputations

Check out Simple Blessings, the short story prequel to The Soldier’s Secret, available on Amazon via my books section!

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