The Story of the Pile of Limbs
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Robert G. Slawson, MD, FACR
Originally published in 2017 in the Surgeon’s Call, Volume 22, No.1
Battlefield wounds during the Civil War were a significant problem regardless of the body part involved.1 Death frequently followed, regardless of location of the wound. The principle causes of death from wounds were: exsanguination (severe blood loss) and infection. Existing surgical techniques were not adequate to treat wounds in the head, chest, and abdomen; and the majority of men who received such wounds would die. Wounds to the extremities could be better dealt with.
Treatment and cleaning of the wound within forty-eight hours was necessary to decrease the risk of dying from infection, but it must be remembered that all this happened before the widespread recognition of bacteria as a cause of disease. Unfortunately, the use of antiseptics in wound debridement was not yet routine and would not be until after 1867. For most wounds, surgery was indicated to clean out the wound, removing fragmented bullets and other foreign materials, as well as all damaged bone and soft tissue.1,2 Parts of the body where debridement could most easily be done were the extremities and the edges of the trunk. Accordingly, soldiers with such wounds were the ones most often removed from the battlefields to the field hospitals for urgent medical care as the first step in the exercise of triage.
Wounds were caused by many different types of weapons. Cannon fire with the associated shrapnel and grape shot was deadly, as was the concussive force of the cannon ball passing close to an individual. Edged weapons such as swords and bayonets caused severe wounds, often with marked internal bleeding which were frequently fatal. It is not possible to state the percentage of the deaths caused by any type of weapon because only the living, potentially treatable, and hopefully salvageable, wounded were removed from the battlefields and ultimately sent to the field hospitals, where the initial medical records were recorded. Therefore, there is no record of cause of death for most of the dead left on the battlefield.
Musket balls were responsible for many of the dead and a larger part of the wounded. While the smooth-bore musket ball, when fired from an appropriate range, could cause severe damage, the greater part of musket ball damage came from the new rifled musket, which fired the newly-designed Minié ball. This ball was elongated and hollow at the base so that it could expand to engage the rifling grooves in the musket barrel. This increased the accuracy and effective range of firing and resulted in many more casualties than with the smooth-bore musket.
The Minié ball was made of soft lead and, weighing more than an ounce, was more than one-half inch in diameter. When it hit bone, the bone was shattered for several inches and the bullet often fragmented as well. A tremendous energy was also deposited in the muscle and soft tissue, which cause severe nerve and muscle damage. Unfortunately, the bullet had a relatively slow velocity compared to modern weapons and the entry wound was not sterile. In fact, a lot of surface debris was carried into the wound including bits of clothing, dirt, and even oil and packing from the musket. In effect, the wound created an excellent tissue culture medium and then filled it with bacteria to make certain that it became infected.
When wounds were in the extremities, they could be surgically cleaned more easily. When the nerves and vessels were damaged, amputation gave the best chance of survival.3 The surgery actually accomplished two things: the damaged blood vessels were tied to stop the bleeding; and the damaged tissue and bone were removed, as well as any other material in the wound. When the arterial blood supply to the extremity was completely destroyed, all tissue distal to it would die, thus making amputation necessary. The further the wound was from the shoulder or the hip, the greater the chance of survival and the better the chance to save a portion of the limb. When major nerves were destroyed, as they often were, amputation was called for since any remaining part would not be able to function; and the denervated extremity would wither and become stiff. Certainly the most important reason for surgery was adequate cleansing of the wound. Leaving damaged and contaminated tissue or doing an inadequate amputation would make further surgery necessary and significantly decrease chances for survival. It is true that local infection in the wound usually followed anyway, but this was often without the development of generalized systemic infection.
Necessary amputations had been done for some time. During the Napoleonic wars, amputation was practiced even though effective anesthesia was not available. It was the fastest way to treat the largest number of wounded in a very short window of time. They had found that forty-eight hours after the injury was the magic time. After that, the probability of dying from infection was very high. During the Crimean War in the mid-1850s, it had been demonstrated again that primary amputation was the best way to save the most lives.4 They also found that amputations done days later were seldom as effective in preventing death.3,5 Because of this fact, early amputation became the recommended treatment in the Civil War. Resistance to this was frequent among surgeons at the beginning of their service and many conservative approaches were tried. Most of these ended fatally. Many surgeons who initially opposed amputation came to see the benefits of this procedure in survival.6
Because of the devastating effects of amputation on the lives of most of the survivors, the public objected to this treatment. The term “invalid” actually meant that the person was an incomplete person and not a valid person. Certainly it was difficult for a laborer or a farmer to function well afterwards, especially if the limb was an arm. A huge public outcry arose. Many both in and out of the army complained that surgeons were too quick to amputate. In the early part of the war, some unnecessary amputations may have been done by inexperienced surgeons or by some who simply wanted the experience of learning to do amputations. The army responded to this and developed criteria for amputation to limit the procedure to those in whom it was medically necessary. Military surgeons came to be called “sawbones,” a nickname that is still applied to surgeons, although most people don’t realize the origin of the term.
After a battle, surgeons at the field hospitals spent hours treating the wounded that arrived at their doors. There were few skilled operators and many patients who needed their care. Surgery was performed expeditiously and amputation was the usual operation when the extremity had been injured.1 An amputation took only a few minutes. When the surgery for one patient was completed, another patient was waiting for the operating table. The amputated limbs, at times, accumulated in piles near the operating table before they could be disposed of. This was a gruesome sight and caused comments by uninvolved observers. Such piles of limbs were known to have existed as early as 1811, described by a British officer at a British hospital in France during the Napoleonic wars, at a time when surgery was being done without anesthesia.7,8
Certainly the piles of limbs at the field hospitals is described in most secondary sources and in general accounts of the war.2 Several questions arise from these mentions. How frequently were these piles accumulated? Was this a universal phenomenon or only an occasional occurrence? What happened to the limbs after surgery? To where were they removed? To find answers to these questions, a large number of hospital descriptions, letters, memoirs, and diaries have been reviewed. Most of these reports were not published until many years after the war and the question always arises whether the observation of piles of limbs was personal knowledge or was added later because of the popular belief.
The question of the frequency of these piles is easy to answer, although not with any precision. The majority of letters, diaries, and memoirs of accounts of field hospitals do not mention piles of limbs.9-78 Of the individuals writing on the subject, six were surgeons in the war21,24,27,52,54,71 and six were nurses.53,55,56,63,65,72 Many reports do not even mention military hospitals, although they were certainly aware of them and often in them. Clearly they only discuss things that concerned them and the accumulating piles of limbs were part of everyday work at field hospitals. There are, however, a number of accounts that do describe piles of limbs either by the operating table or on the ground outside the window closest to an operating table.79-92 Some of these descriptions are by surgeons.82 Two accounts are descriptions of medical care at a battlefield.87,93 Many of the descriptions are clear enough to demonstrate that after battles with large numbers of wounded and many operations, such piles of amputated limbs did appear.
The question of disposal of the limbs is much more difficult to answer, since very little information is available. It would be reasonable to believe that most physicians would regard the patients and their parts with humanity, and because of this, burial would subsequently be performed. Many hospitals were near or in churches and a cemetery would be nearby. In addition, burial details were constantly at work to bury those who were killed on the battlefield or died soon after. The amputated arms and legs would simply have been buried as part of the routine. Five of the sources specifically address this issue of burial.80,82,86,89,91 One writer, who was a surgeon at Williamsburg, describes limbs piled as high as the window sills by the end of the day and pits dug each day to bury the dozens of limbs collected.82 He did not, however, state where the limb burial occurred.
Another account is in a history of Keedysville, MD, where the hospital was on the second floor of the church.80 In this case, it is stated that the limbs were buried in the churchyard next to the church, subsequently resulting in damage to the church walls. In only one other account was a specific burial location mentioned. An account by an observant young man from Shepherdstown, VA, (now WV) states that the limbs were carelessly buried when the first rush of surgical work was over,86 although he does not state where the limbs were buried. In 1887 in Frederick, MD, while breaking ground for a new building behind the Frederick Female Seminary, a number of arm and leg bones were found with saw marks on them.94 The article explained that these were undoubtedly from arms and legs buried there while the building was used as a hospital after the Battle of Antietam. It was not thought necessary to re-bury them so they were carted away with the dirt.
Descriptions of many field hospital sites after the battle of Gettysburg, PA, contain seven additional descriptions of piles of limbs, and two of these accounts mention burials of amputated limbs.89 It is stated that the pile of limbs at the Lutheran Theological Seminary field hospital had accumulated for several days before being taken away and buried.89 In the account concerning the Gettysburg Warehouse Hospital, it is stated that men came with horses and carts, collected the amputated parts, and buried them in long trenches.89 However the sites of the trenches are not stated. A new corollary appeared on this subject when, in 1906, while remodeling and enlarging the Adams County Courthouse in Gettysburg, workers discovered a collection of bones of amputated arms and legs apparently buried there while the building was used as the Courthouse Hospital by the Union Army in 1863.95
Perhaps the most unusual account is in a narrative about Ellwood House near Chancellorsville, VA.91 Major General Thomas (Stonewall) Jackson was wounded at Chancellorsville and his arm was amputated at a field hospital near that battlefield. After surgery, the arm was placed on a pile of amputated limbs near the field hospital but was rescued from the pile by Chaplain Beverly Lacy, who carried it to Ellwood House. It was buried in the family cemetery in a marked location. This is the only amputated limb for which a definite burial site is known. Another example of a known destination for an amputated part is General Sickles’ leg. Sickles’ leg was damaged at Gettysburg when he was hit by a cannon ball. After amputation the specimen was prepared and presented to the Army Medical Museum in the Surgeon General’s Office. It is well known that General Sickles organized annual parties to visit his limb on the anniversary of the amputation. This specimen is still on display at the National Museum of Health and Medicine.
One other note needs to be added. A booklet published in 1964 on military hospitals in Richmond, VA, states that recent digging in the yard at General Hospital #18 revealed leg and arm bones, presumably from amputation burials.96 A later book on the same subject published in 2005 fails to mention such a finding.76
Three weeks after the Battle of Antietam, a farmer found an intact, detached arm while plowing a field.97 Legend has it that he initially placed this souvenir in brine but later passed it to a local physician who put it in formaldehyde. After a period of time the arm reappeared in a small museum near the battlefield. A pathologist examined the arm and stated it was from a 19 year-old man. When the museum closed, the specimen was passed to the NMCWM in Frederick, MD. It is clear that the arm was not surgically removed, but was probably was blown off by a cannon. The fate of the original owner of the arm is not known.
In summary, one must conclude that after the bigger battles when the number of amputations was large, the amputated arms and legs would have accumulated, often not being removed from the vicinity of the surgery until the end of the day or completion of the surgeries. When the clean-up began, these accumulated extremities would be removed to be buried in a convenient location near the operating hospital. Except for Jackson’s arm and Sickles’ leg, none of the burial plots for these extremities have been documented. It would appear that these burial sites were not routinely marked and burial locations were not recorded in the hospital records. Although deliberate searches have been made for the burial sites of the amputated limbs, no such sites have yet been located except as mentioned at Richmond Hospital #18. Most sites of limb burial known today were incidentally discovered years later and no organized effort has been made to identify any bones found.
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About the Author
Dr. Robert Slawson is a 1962 graduate of the University of Iowa School of Medicine. He spent eight years as a medical officer in the United States Army, and had training in Radiology and Radiation Oncology, ultimately serving as Director of Radiation Oncology at Walter Reed General Hospital. In 1971 he joined the faculty of the University of Maryland School of Medicine in Baltimore, MD, and remained there until his retirement in 1998, although he still has a faculty position and works there part-time. He is currently a Master Docent at the NMCWM in Frederick, MD. Dr. Slawson also is actively involved in researching new topics on Civil War medicine and life in the nineteenth century. He has presented and published on several topics both for the Museum and for articles in other publications. He has had a book published on African American physicians in the Civil War: Prologue to Change” African American Physicians in the Civil War Era. Dr. Slawson is a member of the NMCWM and the Society of Civil War Surgeons.