Amputation

[DesertFox]

Watching the History Channel's Battlefield Detectives.

The host states that amputation was the only choice for rounds to limbs then and now.

What I am curious is if they are correct, especially about today?

[John Dudek]

Watching the History Channel's Battlefield Detectives.

The host states that amputation was the only choice for rounds to limbs then and now.

What I am curious is if they are correct, especially about today?

 

 

Different times, different weapons, different medical knowledge. If you were struck in the arm or leg by a Minie Ball, the bone was splintered and carried away by the heavy, slow moving ball. There were no anti-biotics to ward off infection and gangarene usually set in. The only way of treating the bullet wound was amputation of the affected limb.

[DesertFox]

Different times, different weapons, different medical knowledge. If you were struck in the arm or leg by a Minie Ball, the bone was splintered and carried away by the heavy, slow moving ball. There were no anti-biotics to ward off infection and gangarene usually set in. The only way of treating the bullet wound was amputation of the affected limb.

 

If it happened by accident today...could the limb be saved?

[KingSargent]

If it happened by accident today...could the limb be saved?

Very likely, given modern surgery and medicines. We saved the arm of a guy at Prudhoe who backed into a propeller at Deadhorse Airport and whacked his arm off. We "re-attached" it by using an airsplint pumped up real tight as a tourniquet and to provide at least some blood to the arm. He was medevaced and surgeons re-attaced the arm. I don't know how much use he got out of it.

 

I had gun blow up once, almost completely severed my thumb (among other things). I made the doc reattach it, and I have about 95% use of it. And a very interesting scar....

 

I met a guy who had been shot through both lungs and his upper right arm point blank with a 7mm Magnum by accident. The arm was almost severed, but he has it. Not whole lot of tricep left but he got by. Luckily the bullet missed the heart and aorta and they got him to hospital in time for surgeons to repair his lungs. Now THERE is a guy with some interesting scars.

[Rubberneck]

If anyone ever goes to the rustic burb of Frederick, MD, there is a nice little Museum of Civil War Medicine there.

 

Took my wife who is a medical professional, and asked our guide about gangrene infections during the war.

 

He said that the majority of gangrene infections took place on battlefields that had cattle nearby or that used the ground for grazing. Apparently the gangrene bacteria like cow shit and that's how most of the gangrene was passed on. Interesting if true.

 

Modern medical advances can save many limbs. Vein, skin, and nerve transplants occur. Infection is rare today. Gangrene is non-existant. Skin grafts are common.

[KingSargent]

He said that the majority of gangrene infections took place on battlefields that had cattle nearby or that used the ground for grazing. Apparently the gangrene bacteria like cow shit and that's how most of the gangrene was passed on. Interesting if true.

 

Aha! Willie and Joe were performing a public health service! The Mauldin cartoon where there is a smoking M1919A4 MG and Willie says: I coulda swore there was krauts behind that cow, Joe. Go wake up tha cooks.....

[Bob B]

I know a fellow who got hit by a partial Mini ball in his lower arm. He was at an American Civil War re-enactment back in the late 1970's, during a live firing, the hollow base sectioned had separated from head of the projectile and become lodged in the rifling. When a blank was fired at a later date it blew the lodged set of rings out of the rifle striking this fellow.

 

It left a really nasty looking scar, but his arm still had full function thanks to modern surgery, If this had happened a hundred years earlier, I think he would have lost it.

[BP]

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QUOTE(Bob B @ Thu 13 Mar 2008 0457) 549542[/snapback]

I know a fellow who got hit by a partial Mini ball in his lower arm. He was at an American Civil War re-enactment back in the late 1970's, during a live firing, the hollow base sectioned had separated from head of the projectile and become lodged in the rifling. When a blank was fired at a later date it blew the lodged set of rings out of the rifle striking this fellow.

 

Well that would make a good bar story, and would certainly earn a free beer at an I&I. "I was the last guy shot bu a Civil War minie ball. . . "

 

Rubberneck is right about that museum- interesting place. A good trip for DC area folks is to go up to Fredneck, check that out, have a beer and wood-fired pizza at the brew pub downtown, then check out a Frederick Keys minor league baseball game. If you come from NOVA you can take the Jubal Early from White's Ferry across the Potomac as well. Nice day out of town.

[shep854]

The pathogen for gangrene is Clostridium perfrengens, which is a spore-forming obligate anaerobe. What this means is that it forms spores which can survive in an oxygen environment, but cannot grow in the presence of oxygen. The spores are pretty much everywhere. C. perfrengens is also in decaying meat, which gives it the distinctive smell. Botulism is caused by a Clostridium species as well (C. botulinum).

 

Gangrene is essentially the decaying of dead tissue still attached to a living organism. High amputation is the classical treatment. A recent treatment has been to get a victim into a hypobaric chamber and raising air pressure has helped by forcing oxygen into damaged tissue, giving the tissue a chance to recover.

 

I was working in a micro lab once when another tech asked me, "Have you ever smelled gangrene?" He had a sealed test tube. When I answered "no," he opened the cap. There was a hiss of escaping gas, and the stench of rotting meat filled the lab.

[DougRichards]

Isn't the other problem, even if a bone isn't hit and broken, that the impact of a projectile kills the muscle around the impact point by shock effect? That is a large area of mucle must be removed, modern techniques can deal with thses, but 19th century medicine didn't have the capability.

 

This is an interesting site, dealing with an 1849 treatise on the treatment of gunshot woulds:

 

http://books.google.com.au/books?id=gM8DAA...hl=en#PPA195,M1

 

Where a modern surgical text states as follows:

 

Soft-tissue wounds. A projectile produces a permanent

cavity containing fragments of necrotic muscle and clot.

Other tissues are stretched as they are thrown aside from

the path of the bullet, creating a temporary cavity8-10 with

zones of contusion and concussion, some devitalised tissue,

and haemorrhage within and between muscle fibres.11 The

extent and shape of this temporary cavity are related to the

local transfer of energy (dE/dx). There is a transient low

pressure as this temporary cavity collapses, which may

draw contamination into the wound.12

 

http://www.jbjs.org.uk/cgi/reprint/79-B/6/1031.pdf

[shep854]

Isn't the other problem, even if a bone isn't hit and broken, that the impact of a projectile kills the muscle around the impact point by shock effect? That is a large area of mucle must be removed, modern techniques can deal with thses, but 19th century medicine didn't have the capability.

 

AIUI, that is why immediate high amputation (well above the actual injury) was the preferred treatment for badly wounded limbs. Coupled with the press of large numbers of casualties, amputation was pretty much automatic.* There were probably a lot of amputations that weren't necessary.

 

*"Meatball" surgery defined.

[nitflegal]

AIUI, that is why immediate high amputation (well above the actual injury) was the preferred treatment for badly wounded limbs. Coupled with the press of large numbers of casualties, amputation was pretty much automatic.* There were probably a lot of amputations that weren't necessary.

 

*"Meatball" surgery defined.

 

It makes sense, as the current treatment requires some extensive and fairly careful debridement to clean out the wound before closure. Before sterilizing instruments (Hell, before even cleaning them between uses) the more debridement the surgeon tries the more microorganisms they will introduce. It would be pretty self-defeating.

 

What is interesting to me is going through Napoleonic and US Civil War surgical texts. In the absence of germ theory, antibiotics, and sterilization practices they actually had a fair number of rules of thumb that were good ideas. Several of them mention releasing the tourniquet slightly to "flush" with blood prior to closure, which isn't a bad idea to at least dilute the microorganisms. Some even mentioned soaking wound in boiling water prior to debridement, which does a great job leaching ions from the cells and giving you an easily scrapable pulpy tissue interface. Heck, these guys were cutting a limb off, ligating the arteries and veins (without Gelpis, weitlaners, lights, or even good tissue handling forceps) preserving a flap to cover, and closing in under 3 minutes. That's some mad skillz right there! From a 3-T standpoint (trash, trauma, time) they forcibly remove the trash, apparently did fairly minimal tissue handling (trauma) and had the wound closed very quickly. Put a modern surgeon under the same constraints (no antibiotics, anesthetics, antiseptics, sterilants or disinfectants) and they'd probably do a terrible job in comparison.

 

Matt

[DesertFox]

One interesting item I have been told is that the North used new wrappings for wounds and that they were contaminated due to the factories producing them. In the South, they had to reuse wrappings and they boiled them to clean out the blood which just happened to sterilize them as well.

 

Anybody else hear that or is it myth?

[John Dudek]

I also wonder when they discovered the positive effects of introducing maggots directly into open wounds to clean out the dead, rotting flesh?

[KingSargent]

I also wonder when they discovered the positive effects of introducing maggots directly into open wounds to clean out the dead, rotting flesh?

That practice has cropped up several times in the history of medicine.

[KingSargent]

I was working in a micro lab once when another tech asked me, "Have you ever smelled gangrene?" He had a sealed test tube. When I answered "no," he opened the cap. There was a hiss of escaping gas, and the stench of rotting meat filled the lab.

I trust you chastised him severely in a pysical manner?

[shep854]

I trust you chastised him severely in a pysical manner?

 

Nope. After appropriate gagging noises, I thanked him for the lesson. Believe me, it's something I have not forgotten.

[KingSargent]

Nope. After appropriate gagging noises, I thanked him for the lesson. Believe me, it's something I have not forgotten.

What, you didn't even pour Liquid Nitrogen down the front of his trousers?!!