Question: Why were amputations so common in the Civil War?
The most common surgical procedure used in the Civil War was amputation. Was it really because of a new type of bullet used in the war?
Yes, a new bullet led to the large number of amputated limbs among wounded soldiers in the Civil War.
Amputations Defined Civil War Hospitals
The poet Walt Whitman, who had been working as a journalist in New York City, traveled from his home in Brooklyn to the battlefront in Virginia in December 1862, following the Battle of Fredericksburg. He was shocked by a gruesome sight he recorded in his diary:
“Spent a good part of the day in a large brick mansion on the banks of the Rappahannock, used as a hospital since the battle – seems to have received only the worst cases. Outdoors, at the foot of a tree, I notice a heap of amputated feet, legs, arms, hands, &c., a full load for a one-horse cart.”
What Whitman saw in Virginia was a common sight at Civil War hospitals. If a soldier had been struck in the arm or leg, the bullet tended to shatter the bone, creating horrendous wounds. The wounds were certain to become infected, and often the only way to save the patient's life was to amputate the limb.
And a new type of bullet was largely responsible.
The Minié Ball Was Invented in the 1840s
In the 1840s an officer in the French Army, Claude-Etienne Minié, invented a new bullet. It was different than the traditional round musket ball as it had a conical shape.
Minié’s new bullet had a hollow base at the bottom, which would be forced to expand by gases released by the igniting gunpowder when the rifle was fired. While expanding, the lead bullet would fit snugly into the rifled grooves in the gun’s barrel, and would thus be more accurate.
The bullet would be rotating when it came from the barrel of the rifle, and the spinning action gave it increased accuracy.
The new bullet, which was commonly called the Minié ball by the time of the Civil War, was extremely destructive. The version which was commonly used throughout the Civil War was cast in lead and was .58 caliber, which would be larger than most bullets used today.
The Minié Ball Was Feared For Its Destructive Power
When the Minié ball struck a human body it did enormous damage. Doctors who had to treat wounds were perplexed by the damage caused.
A medical textbook published a decade after the Civil War, A System of Surgery by William Todd Helmuth, went into considerable detail describing the effects of Minié balls:
"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."
Civil War Surgery Was Performed Under Crude Conditions
Civil War amputations were performed with medical knives and saws, on operating tables which were often simply wooden planks or doors which had been taken off their hinges.
And while the operations may seem crude by today’s standards, the surgeons tended to follow accepted procedures spelled out in the medical textbooks of the day. And surgeons generally used anesthesia, which would be applied by holding a sponge soaked in chloroform over the patient’s face.
Many soldiers who underwent amputations did eventually die due to infections. Doctors at the time had little understanding of bacteria and how it is transmitted. The same surgical tools might be used, without being cleaned, on many patients. And the improvised hospitals were commonly set up in barns or stables.
There are numerous stories of wounded Civil War soldiers begging doctors not to amputate arms or legs. As doctors had a reputation for being quick to resort to amputation, soldiers often referred to the Army surgeons as "butchers."
In fairness to the doctors, when they were dealing with dozens or even hundreds of patients, and when faced with the gruesome damage of the Minié ball, amputation often seemed like the only practical option.