Amputation

Amputation is the surgical removal of all or part of a limb. Historically it was done when a limb was crushed, shattered by a weapon, frozen or gangrenous, and the surgeon judged that keeping it would kill the patient. It is one of the oldest operations in the medical record.

The Roman medical writer Celsus, in the first century AD, describes amputating through sound tissue rather than leaving diseased tissue behind, and tying off severed vessels with linen thread and iron clamps in limb amputation. In the sixteenth century the French surgeon Ambroise Paré argued for tying off vessels instead of sealing them with hot iron.

Two later changes altered the odds more than any cutting technique. General anaesthesia, with ether from 1846 and chloroform soon after, ended the need for speed above all else. Antisepsis, from the late 1860s, began to reduce deaths from infection in the days after.

1. The decision. A crushed limb, a fracture with bone through the skin, or spreading gangrene usually meant the limb came off. Waiting could mean losing the patient.
2. Bleeding. A band or tourniquet above the site slowed blood loss, and the cut vessels were tied off.
3. The cut. Skin and muscle were divided, the bone sawn through, and soft tissue drawn over the end to form a stump.
4. The days after. Infection, renewed bleeding and fever killed many patients who had survived the operation itself.

Methods varied by era, by surgeon, and by where the operation was done: a hospital, a tent or a floor.

• Halifax, December 1917. Local hospitals performed 25 amputations after the explosion, according to McAlister and colleagues. In the same disaster 249 eyes were removed. The comparison shows how much of the damage fell on faces and eyes.
• The American Civil War, 1861–1865. The soft lead bullets of the period shattered bone, and amputation was the most common major operation for limb wounds. Most were done under chloroform or ether.