HOW TO DO CIVIL WAR-ERA
AMPUTATION SURGERY

Some of the most haunting images of the Civil War are of fallen soldiers undergoing leg amputations in field hospitals. Doctors had little to work with—saws, scalpels, and old rags… and no antiseptics. So let’s pretend you’re a time traveler going back to be a Civil War surgeon (or “operator” as they were called). Here’s your game plan.

WHAT YOU’LL NEED

A soldier with a bullet wound

A flat surface (upon which the soldier may lay)

A cloth

Bowl full of cold water

Surgical probe (optional)

Chloroform

Scalpel

Bonesaw

Silk, cotton, or horsehair threads

Needle

Isinglass plaster (a gelatinous preparation made from fish bladders)

Bandages

HOW TO DO IT

1. Perform triage. Briefly examine (with your eyes—time is of the essence) the soldiers whose cries of pain and pain-induced delirium fill the crude field hospital tent. Using what little energy you have left after performing somewhere around 50 surgeries in the last 12 hours, determine which patient is most likely to die soonest. Does he have an injury to the head, stomach, or chest? These are the soldiers most likely to die, so move them off to one side and let them die because they can’t be saved.

2. Now, find the person who needs treatment due to a bullet wound in an extremity—the farther from the torso it is, the more likely it is that he can be saved. (Not the leg, but his life. Although he’ll still probably die of sepsis in a few months.) Operate on this person.

3. Wash out the inside and outside of the wound with a cloth. Don’t worry about germs—germ theory is still considered cutting-edge nonsense from Europe. Simply take a rag, any rag, be it covered in soldier blood or not, and rinse it in a bowl of cold, likely bloody water, and dig around inside of the wound, wiping off the blood so you know what you’re working with.

4. Probe the wound, with either a surgical probe or, because it’s highly unlikely that you even have one of those, your finger. (Didn’t have time to wash your hands? Oh well.) Dig around and remove any stray bits of uniform cloth, bone, gristle, and, finally, the bullet. If it’s one of those gigantic, bone-splitting, muscle-flaying .58-caliber Minié bullets used in the Civil War, there’s nothing you can do to treat the tremendous damage to the body. Diagnosis: immediate amputation.

What’s an oubliette? A prison cell entered from the ceiling.

5.Administer the Civil War–era’s most common form of anesthesia: chloroform. Knock the patient right on out with it because they are not going to want to be awake for what comes next. Also, they won’t kick and scream to resist the horrific surgery you’re about to perform.

6.As soon as the soldier has passed out from a combination of pain and chloroform, take a scalpel (that you’ve “cleaned” by rinsing off the last guy’s blood in cold water) and make a cut on the leg above the bullet wound. Keep cutting (or sawing—that scalpel is probably pretty dull) through every layer of the skin, and keep cutting through any and all muscles until you get all the way down to the bone.

7.Now, do that on the other side of the leg, cutting through skin and muscle so that the bone is all the way exposed on two sides.

8.Here’s the part that earned Civil War army surgeons the nickname “Sawbones.” Take your bonesaw, and at the cut you’ve already started with the scalpel, just saw through the bone. Just go back and forth, back and forth as you would if you were cutting down a tree. Keep going until you’ve completely severed the bone.

9.Throw the bloody, severed leg (or arm) onto the pile with the others, over in the corner of the tent, near the poor fellows who you decided aren’t going to pull through.

10.But wait—you’re not done yet! There’s far more to a leg (or arm) than just skin, muscle, and bone. There are also many arteries, and they’re all full of blood. The operation just severed them, and the patient will immediately bleed out and die if you don’t do something. So tie them off, using threads made of silk, cotton, or horsehair.

11.Without any random blood spraying all over your face, you can get back to work on that amputated bone…or what’s left of it. Using a scraping tool, scrape the ends of the bone until they’re smooth, not unlike using sandpaper on wood. This will decrease discomfort for the solider later on—he’s not going to want a sharp edge of a bone poking out through his skin.

12.Take the flaps of skin surrounding the amputation, pull them together, and with the needle and thread, close the incision. (Don’t forget to leave a small drainage hole!)

13.Cover the stump with several applications of isinglass plaster to form a protective seal. Thoroughly wrap in bandages.

14.Move on to the next patient. Repeat steps 1 through 13.

In the local language, the name Astana—the capital city of Kazakhstan—means “the capital.”