Definitely a gory medical history question, but hey maybe people wanna know. In the American Civil War, weapons advances like the rifling Minié Ball made muskets much more accurate and deadly from longer distances; hence, the unprecedented carnage on the battlefields that medicine was not prepared to handle at that time. Most historians and resources say the only way doctors could handle the sheer mass of injuries was to amputate serious wounds to the extremities. You hear the stories about doctors being able to saw off a limb every 5 minutes and see the terrible pictures of arms and legs just stacked up in hospital tents. It seems like the surgeons finished the "operation" and just tossed the poor guy into a barn or some hospital bed. The question is, how did these heal without further surgery or attention? I feel like blood loss and infection from a leg cut off with a dirty saw would be just as likely as that from a gun shot wound, especially if they were re-using bandages and just covering up the bone and flesh. So, was the human body capable of healing these brutal amputations on its own with little further attention, and if so how?
I will try to answer your questions without going into a whole tangent regarding battlefield surgery in the 19th century. Always happy to expand on the topic if needed.
Q1: How did amputations performed in the battlefield heal without further surgery or attention?
Short explanation:
Humans are hard to kill.
Longer explanation:
The American civil war occurred in the years between some of the most critical advances in surgical history: anesthesia (1842), the germ theory of disease (1864) and the development of antiseptic techniques (1867). Thus, civil war era surgeons had access to anesthesia but did not know of the importance of antisepsis. Although modern surgeons would easily recognise the surgical techniques used for amputation, the lack of antisepsis is shocking when seen through a 21st-century lens. Surgeons did not scrub their hands and seldom changed clothes for, on the battlefield, access to water is a luxury[1]. Instruments and sutures were also not sterilised [2]. Infection remained the most common (non-immediate) cause of death [3]. Infection was so common that wounds without pus were seen as abnormal for pus was considered a physiological response needed for wound healing [4].
When the war began, amputations were not the treatment of choice for gunshot wounds in the extremities. Surgeons, the US Sanitary Commission and patients alike showed a strong dislike for amputation [5]. Instead, the preferred treatment was "conservative", meaning manipulation of the wound. Again, this wound manipulation (touching the wound, extracting the bullet, dressing the injury) was done barehanded with non-sterile instruments. As you can imagine, these patients fared worse than those amputated. In response, the Sanitary Commission issued a statement: "avoid exploratory procedures except when vital. If amputation is to be avoided, the wound is best left alone" [6]. Throughout the war years, other advances regarding amputation were made. It was noted that mortality was higher if the amputation was delayed for more than 24 hours after receiving the wound [4].
Q2: How was the human body capable of healing these brutal amputations on its own with little further attention?
Human bodies work the same way now as they did then. I feel like the explanation of the immune response is beyond the scope of r/askhistorians . Basically, the body has a way to prevent blood loss and fight infection. As an extra bit of knowledge, most patients in an ICU unit are there because there is an improper regulation of those defence mechanisms. We know the generalities, but there is still a lot to be discovered in that area. Full disclosure: currently doing a PhD on that.
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