Amputation through the Ages: A Time-Honored Way to Save Lives
I am watching a movie trailer. The scene shows an unseen man’s booted foot caught in the stirrup of a saddle. Another man rides across the field toward the horse and the unseen fallen rider. We see the man is an officer in the Union army. He kneels down to the man on the ground. A short conversation ensues:
Fallen man: Don't... Don't... Don't take off my foot.
Officer: You rest easy, son. You'll keep your foot. As God is my judge, you'll keep it.
Movie buffs might remember this scene from Dances with Wolves. The incidence of amputations during the Civil War was higher than any war fought by the United States. Over many centuries, wars have been the catalyst for great medical advances in amputation surgery and patient survival rates, as you will see below.
Amputation is a chilling subject to research, especially for me. When my physician father informed me as a young child that limbs do not regenerate like a starfish, I was horrified. That emotion is burned in my memory, but I now accept amputation as a life-saving operation that focuses on a patient regaining quality of life. Let’s take a look at the evolution of amputation surgery.
A Checkered Past
Amputation is an ancient surgical operation, used as a last, desperate attempt to save a life. Often, the patient would die from loss of blood or infection; thus it was the surgery of last resort. Unfortunately, amputation was also used as a means of punishment or for religious self mutilation. Cave paintings in both the Old and New Worlds, dating back almost 36,000 years, depict amputations thought to have been performed to “appease the gods.”
The oldest written account of an amputation comes from an Indian poem called the Rigveda, which dates between 3500 and 1800 BC. According to the story, the warrior queen Vishpla was wounded in battle and lost her leg. She was fitted with an iron leg and returned to battle soon after the operation.
Hippocrates, the famous Greek physician who practiced around 460 to 380 BC, performed amputations for the treatment of gangrene (death of soft tissue as a result of lack of blood flow). To control heavy bleeding, he used cautery (basically burning the wound to seal it) or vascular ligatures (tying off blood vessels). Medical contemporaries of Hippocrates also used these techniques as well as tourniquets and antiseptics like wine and vinegar.
In 1st century AD Rome, an encyclopedist and philosopher named Aulus Cornelius Celsus wrote of circular surgical amputation, ligation of blood vessels, creating a flap of skin to cover the stump and packing the wound with lint soaked in vinegar. Surgical instruments used for amputation as early as 79 AD have been found in Pompeii. Albucasis was an Arab physician, also of the 1st century AD. He applied tourniquets to both sides of the amputation site to cause tension in the soft tissue, which was protected from saw injury with linen dressings. Albucasis also developed the “double suture” (suturing successive layers of tissue) procedure, which is still used today.
Amputation surgery continued to evolve until the early Middle Ages. Unfortunately, a decree from the Catholic Church between 1130 and 1247 prohibited surgeons from causing bleeding. To fill the obvious need for surgery, the procedure was taken over by “barber surgeons,” who had only dexterity and skill with a shaving razor. Surgical skills degenerated, and because Europe was made up of isolated kingdoms, there were few surgical innovations until the 14th century. When firearms were invented in the mid 1300s, war casualties escalated, but it would take another 100 years before amputation became a routine way to treat battlefield wounds. So many surgical innovations from ancient times had been forgotten or discarded it was as though medical technology had to start from the ground up.
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