Brutal Facts About Amputation Throughout History

Amputations were often the only lifesaving surgery possible in the ancient past and the most common (and often only) form of treatment available for the presence of advanced infection, dead flesh, and broken bones until the past couple of centuries. During wartime, amputation was often the easiest and fastest way to save a person's life (per The American Battlefield Trust).

Ancient amputations were crude and the chances of surviving one weren't very good. Major advancements came in the 16th century when French surgeon Ambroise Paré invented a technique to ligate blood vessels to replace the old brutal system of cauterizing wounds, according to a study published in Clinical Orthopedics and Related Research. In the 18th century, professor Jean Petit introduced another life-changing innovation: a better tourniquet so patients wouldn't bleed to death during the amputation. Other than that, amputations continued to be quite terrible, painful medical procedures for a very long time.

Things significantly changed in the second half of the 19th century. While the Civil War saw an astonishing number of amputations, it also marked a defining point in amputation surgery, especially towards the end of the war. New innovations that helped the situation were ambulances that helped transport the injured, improved methods of tying off blood vessels to stop patients from bleeding out, and using anesthetics so patients felt less pain during procedures, as reported by Baylor University Medical Center Proceedings.

Not all amputations in ancient history were done for medical reasons. Limb amputation has been carried out through the ages as a punitive method in various parts of the world. Some of the oldest records of this go back to Babylonian times when offenses were often punished with amputation and to Peru, where surprisingly mild offenses like theft, lying, and laziness were punished with amputations as well, according to a 2014 study published in the Clinical Orthopedics and Related Research. 

The Romans started practicing punitive amputation during the time of emperor Constantius Flavius Valerius Aurelius, though it was mostly reserved to punish slaves. By the time emperor Phocas took over power, things were starting to get more and more gruesome, and Phocas added to that by introducing torture, blindness, and amputation as punishment for many crimes (via the Clinical Orthopedics and Related Research journal).

Punitive amputation was rarely used after the Renaissance but it was again introduced during the 1800s, as Europeans embarked on the colonization of Africa. According to a 2016 report published in the Sociological Association, Belgian colonizers were known to cut the hands of Congolese slaves who were not processing rubber at the speed they demanded. Punitive amputation is still practiced in countries like Iran and Afghanistan. In July 2022, Amnesty International condemned the decision of an Iranian court to punish two men convicted of stealing by cutting off their fingers. 

In 2018, scientists digging in a well-known battlefield in Virginia uncovered what turned out to be a major first: a mass grave for limbs. For decades, researchers had known that discarded limbs after amputation were a major issue in field hospitals during the Civil War, but this was the first proof of what happened to them: They ended up in mass graves in fields (via NPR). 

Based on the previous estimate from the American Battlefield Trust of about 60,000 amputations during the Civil War — and assuming each soldier only lost one limb — that left medical personnel with a lot of discarded body parts that needed to be disposed of.

In his book "The Wound Dresser," poet Walt Whitman describes visiting camp hospitals in the Potomac in 1862 and noticing the discarded limbs. "Outdoors, at the foot of a tree, within ten yards of the front of the house, I notice a heap of amputated feet, legs, arms, hands, etc. — about a load for a one-horse cart," Whitman wrote. While there are no records of what exactly happened to all those limbs, the 2018 discovery is an example of what historians have long suspected: Amputated limbs were either buried or potentially burned (via the American Battlefield Trust).  

Not only were there no antibiotics during the Civil War, but there was also no understanding of germ theory and the importance of using sterile techniques during the care of wounded Civil War soldiers (via The American Biology Teacher). Because of a lack of understanding of how diseases spread and what causes bacteria to grow, doctors didn't wash their hands or disinfect medical instruments between patients.

In a 1918 report published in The Annals of the American Academy of Political and Social Science, former Civil War surgeon W.W. Keen looks back at conditions in war hospitals in 1861: "We operated in old blood-stained and often pus-stained coats ... We used undisinfected instruments from undisinfected plush-lined cases, and still worse, used marine sponges which had been used in prior pus cases and had been only washed in tap water." 

He describes Civil War hospitals as having "no sterilized gauze dressing, no gauze sponges" and often dressing wounds using anything from shirts to tablecloths when operating in makeshift hospitals. By his own estimations, "amputations averaged over 50 percent mortality" because of these conditions. By WWI, things had improved significantly regarding disinfection — so much, in fact, that Keen was able to point out that the "victory over infection is the reason for the greatly diminished number of amputations in the present war. Moreover, the mortality of amputations in our armies is low." 

The first-ever surgery performed under anesthesia dates back to 1846, and it was performed by a dentist in Boston, according to the Journal of Investigative Surgery. This was a major breakthrough in the surgery field. According to University of Alabama at Birmingham professor Dr. Maurice S. Albin, chloroform was first used just a year later. But it wasn't until the start of the Civil War that these agents were first used on a massive scale. Albin believes (via Newswire) the "firsthand exposure to anesthetic agents and techniques, as well as to their side effects and complications" that Civil War doctors experienced forever change the history of anesthesia.

So what happened before ether and chloroform came into play? "Prior to the war, alcoholic drinks, physical restraints, opioid drugs and bite blocks were the most typically employed methods of keeping a patient under control during surgery," Albin explains. Long before that, ancient civilizations used the mandrake plant to somewhat sedate patients, while the Romans and late Medieval English surgeons sometimes used a special mix known as "dwale." Although dwale's recipe varied, it usually consisted of a mix of alcohol and a number of strong ingredients like hemlock, bryony or mandrake, opium, and henbane — a dangerous and not always effective mix, according to a report published in BMJ.

Medical school and training in the 1800s were nothing like they are today and becoming a doctor at the time required just 32 weeks of schooling spread across two years, followed by three years of guided practice called preceptorship. Lessons included pathology, botany, and anatomy. During the 19th century, students didn't actually participate in things like dissection or actual anatomy practice. Instead, they would attend a lecture where a professor will conduct the actual dissection and the students would just observe, as reported in the Journal of Evidence-Based Integrative Medicine.

Because of poor refrigeration systems, some schools couldn't access bodies all the time, which meant that many medical schools did not require anatomy laboratories to graduate or only had observation classes when possible. This also impacted surgery practice. Less than 1% of graduating students had performed any kind of surgery during their time at school. When bodies were available, students could observe surgeries performed by doctors, but even then, the surgeries were usually minor things like bloodletting. This meant a lot of what doctors knew was learned through years of practice after graduation. 

But the Civil War seemed to inspire more people to become doctors. According to Baylor University Medical Center Proceedings, there were only 113 army doctors before the war but the number had grown to 15,000 by the war's end. Many of those doctors were using the battlefield as their learning ground.

Historically, the horror of primitive amputation didn't end with the war. Amputees returned home unable to work, often in pain or addicted to painkillers, and with very few options for the future (per History). Though prosthetics were available at the time, they were primitive — legs had to be strapped on and prosthetic arms often ended in a hook rather than a fingered hand, according to The National Museum of Civil War Medicine. While Congress dedicated a significant amount of money to provide Union soldiers with the best artificial limbs available at the time (per U.S. Department of Veteran Affairs), Confederate soldiers did not qualify for help as they had fought against the country. 

Ironically, it was an amputee Confederate soldier that had the biggest impact on the future of prosthetics. As detailed by American Battlefield Trust, James E. Hanger was just 18 years old when he was hit by a cannonball and his leg was seriously injured. A Union surgeon amputated the leg close to the hip and Hanger's case was one of the first documented cases of amputation in the war. After returning home, Hanger struggled with pain and day-to-day difficulties because of the precarious artificial limb he had been given, so the young ex-soldier designed his own version using rubber bumpers and oak barrel staves. He eventually received a patent for it and developed his own business producing prosthetics.