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Capital amputating instruments

This kit contains the standard major surgical instruments of the Civil War era. On the left is the capital bone saw, used to saw through the long bones of the femur, humerus, tibia, fibula, radius and ulna. The smaller saws were used to amputate fingers, toes and for small bone resections. The long "catlin" knives were used to cut through skin, soft tissue and muscle. A cloth and brass tourniquet was used to prevent exsanguination during surgery.

The long, porcelain tipped probes were used to locate bullets. The probe made different sounds when tapped against bone as opposed to lead. Once the suspected bullet was located, the white tip was rubbed against the bullet. If the probe tip showed a gray discoloration, it had found its lead quarry.

Once located, the bullet was removed by one of several extractors shown in the next section on the "Bullet Extraction Set".

The curved hooked devices, "tenaculums", were used to hold the ends of severed arteries and veins for ligation. An arterial "director" could be used to repair a blood vessel. Various scalpels were used for incisions and excisions. Tissue scissors, forceps, needle holders and suture completed the set.

Suture in the North was often silk (unsterile - of course). In the poorly supplied South, cotton suture was more commonly used. Catgut was highly prized. Horse hair was used late in the war as a field expedient by the Confederacy. Interestingly, the stiff tail hairs were boiled to make them more pliable and thus, inadvertently, sterilized.

This set was made by Ed Archer & Son, Knoxville, TN.

The following essay is from the Civil War Battlefield Medicine page of the Civil War News website.

Civil War Medicine:Amputation

The slow-moving Minie bullet used during the American Civil War caused catastophic injuries. The two minie bullets, for example, that struck John Bell Hood's leg at Chickamauga destroyed 5 inches of his upper thigh bone. This left surgeons no choice but to amputate shattered limbs.

Hood's leg was removed only 4 and 1/2 inches away from his body. Hip amputations, like Hood's, had mortality rates of around 83%. The closer to the body the amputation was done, the more the increase in the wound being mortal. An upper arm amputation, as was done on Stonewall Jackson or General Oliver O. Howard (who lost his arm at Fair Oaks in 1862) had a mortality rate of about 24%.

This site is, basically, devoted to medicine of the battlefield. Other topics are of course covered, but here you will see a description of a common battlefield amputation. Missing arms and legs were pernemant, very visible reminders of the War. Amputees ranged from the highest ranking officers, like John B. Hood, Stonewall Jackson, and Oliver O. Howard, all the way down to the enlisted men, such as Corproal C.N. Lapham of the 1st Vermont Cavalry who lost both of his legs to a cannon ball. Hood, Jackson, Howard, and Lapham were certainly not alone in their loss, as 3 out of 4 wounds were to the extremities... in the Federal Army this led to 30,000 amputations.

An Example Case

The wait for treatment could be a day, maybe two and that was not out of the ordinary. And when treatment was finally done on the poor soldier, it was not done antiseptically. It would only be in post1865 that Joseph Lister embarked upon the era of antiseptic surgery. Careful hand washing by the surgeon of the Civil War was not even done. The doctors wore blood splattered clothes. When something was dropped, it was simply rinsed in cool, often bloody water. They used sponges that had been used in previous cases and simply dipped in cold water before using them again on the next person.

A surgeon recalled: "We operated in old blood-stained and often pus-stained coats, we used undisinfected instruments from undisinfected plush lined cases. If a sponge (if they had sponges) or instrument fell on the floor it was washed and squeezed in a basin of water and used as if it was clean"
The injuries to be dealt with were dreadful and the fault of the soft lead Minie Ball.

With the capability to kill at over 1,000 yards, this soft lead bullet caused large, gaping holes, splintered bones, and destroyed muscles, arteries and tissues beyond any possible repair.

Those shot with them through the body, or the head, would not be expected to live. Almost all wounds were caused by the bullet, with canister, cannonballs, shells, and edged weapons next down on the list.

The weapons (particularly the rifle) of the 1860s were far ahead of the tactics; i.e. the generals still thought to take a position you needed to go at it with the bayonet. The cynlidrical lead bullet, the Minie ball, was rather large and heavy (.58 caliber usually). When it hit bone, it tended to expand.

When it hit "guts" (i.e. the intestines or other soft tissue) it tended to tear them in ways the old smoothbore musket ball didn't do.
The wounds from a minie bullet were ugly. Since they crushed and smashed bone so badly, the doctors didn't have much choice but to amputate a limb. Wounds to the stomach were almost always a death sentence.

Civil War doctors were woefully ill-prepared: of 11,000 Northern physicans, 500 had performed surgery. In the Confederacy of 3,000, only 27. Many docs got their first introduction to surgery on the b'field. Doctors usually didn't specialize. Medical school, for many, was just 2 years (some less, few more) Surgeons reacted by adapting. They learned surgery on the job. And people died of course until they learned and became better... Many docs were political appointments too; thier were no liscencing boards in the 1860s... Army exam boards often even let in quacks. Of the wounds recorded in the Civil War, 70%+ were to the extremities. And so, the amputation was the common operation of the Civil War surgeon.

The field hospital was hell on earth. The surgeon would stand over the operating table for hours without a let up.
Men screamed in delirium, calling for loved ones, while others laid pale and quiet with the effect of shock. Only the division's best surgeons did the operating and they were called "operators".

Already, they were performing a crude system of triage. The ones wounded through the head, belly, or chest were left to one side because they would most likely die. This may sound somewhat cruel or heartless, but it allowed the doctors to not waste precious time and to save those that could be saved with prompt attention. This meant that common battlefield surgery was the amputation.

The surgeon would wash out the wound with a cloth (in the Southern Army sponges were long exhausted) and probe the wound with his finger (the finger being usually used), or a probe perhaps, looking for bits of cloth, bone, or the bullet. If the bone was broken or a major blood vessel torn, he would often decide on amputation. Later in the War, surgeons would sometimes experiment with resection, but far more common was amputation.

Deciding upon an amputation, the surgeon would adminster chloroform to the patient. What is portrayed in "Hollywood" and in much "modern" conception of what surgery in the War was like during the war is false; anesthesia was in common and widespread use during the war.... it would make more complicated and longer operations possible as the era of antiseptic surgery was embarked upon (but too late for the poor Civil War soldier). With the patient insensible, the surgeon would take his scapel and make an incision through the muscle and skin down to the bone. He would make incisions both above and below, leaving a flap of skin on one side. Taking his bonesaw (hence Civil War slang for a doctor is a "Sawbones") he would saw through the bone until it was severed. one of the most graphic pictures from the Civil War... Limbs removed from their owners. He would then toss it into the growing pile of limbs. The operator would then tie off the arteries with either horsehair, silk, or cotton threads. The surgeon would scrape the end and edges of the bone smooth, so that they would not work back through the skin. The flap of skin left by the surgeon would be pulled across and sewed close, leaving a drainage hole. The stump would be covered perhaps with isinglass plaster, and bandaged, and the soldier set aside where he would wake up thirsty and in pain, the "Sawbones" already well onto his next case. A good surgeon could amputate a limb in under 10 minutes.

If the soldier was lucky, he would recover without one of the horrible so-called "Surgical Fevers", i.e. deadly pyemia or gangrene.

15 years after the War, surgeon George Otis cited the five prinicpal advances of Civil War surgery: the surgeons had learned "something" about head injuries, how to deal with awful "ghastly wounds" without dismay, they had learned how to litigate arteries, information on injuries to spine and vertebrate had been "augumented", and "theory and practice" in chest wounds had been forwarded.

A little about the "Surgical Fevers". These were infections arising from the septic state of Civil War surgery. As you should have been able to see, the Civil War surgeon was interested not so much in cleanlieness, but speed. As such, and not knowing anything about antiseptic surgery, fevers arose. Of these, the most deadly was probably pyemia. Pyemia means, litterally, pus in the blood. It is a form of blood poisioning. Nothing seemed to halt pyemia, and it had a moratality rate of over 90%. Other surgical diseases included tetanus (with a mortality rate of 87%), erysepilas, which struck John B. Gordon's arm after he was wounded at Antietam, and osteomyelitis which is an inflammation of the bone. Also, there was something called "Hospital Gangrene". A black spot, about the size of a dime or so, would appear on the wound. Before long, it would spread through, leaving the wound an evil smelling awful mess. The Hospital Gangrene of the Civil War is an extinct disease now.

Primary amputation mortality rate: 28%

Secondary amputation rate: 52%

Most of the information from this page came from Coco's "A Strange and Blighted Land" and Adam's "Doctors in Blue"