Early Modern Amputation

I get asked a lot about early modern amputation over on my tumblr so I thought I'd share here some bits and pieces on early modern and Napoleonic amputation. 

In terms of amputations, and learning to live with the end result of such a surgery, by the 18th century there were a lot of advancements made. Both in terms of prosthetics and the surgery itself. This is unsurprising considering the ongoing Seven Years War and resulting number of amputees in need of physick (many arms and legs were blown off by canons).  

Amputation was always a last resort. A sort of “you’ll die if we don’t, and you might die if we do, so your call.” That said, given the limited options at the time amputation did serve as a life-saving operation in many cases. 

If you had a good surgeon the amputation would have been relatively quick, although still painful and dangerous, especially without general anesthetic. Field and naval surgeons were well versed in amputations and had it down to a science. As a soldier or sailor you were in good hands. If you were a common labourer and an accident befell you that necessitated amputation it would depend on your proximity to a large enough town that would have an experienced surgeon. Not that the local barber-surgeon wouldn’t be able to do it; they would! But the efficient removal of the limb might uh … not be efficient. For every surgeon who had it down to a minute and a half there is an equivalent horror story. 

According to Joseph Charriere in his 1712 treatise on surgery, it is recommended for surgeons to 'cut quick with a crooked knife [saw] before covering the stump with the remaining skin.’

Post-surgery, they would stitch and bind the wound. The first four to five weeks would be spent with a very swollen leg and phantom limb-pain might begin to occur at this time. Not everyone experienced it; but it was (and is) not uncommon. 

In general, the healing process would vary depending on infection. Many didn’t survive amputation, either due to shock or gangrene. Napoleon's close friend, Jean Lannes, is one of the more famous cases of an amputee dying post-surgery due to gangrene. If the amputation went poorly people would die anywhere from immediately after to upwards of seven to twelve days later.  

An account of Lannes’ amputation: 

Marshall Jean Lannes, a favorite of Napoleon and someone much admired by Larrey, who was hit by a three-pound ball during the battle of Essling on May 22, 1809, which shattered the left knee and also injured the right thigh, and left Lannes in extremis. Larrey was taken aback by the challenge of this situation. “How my situation was so difficult,” he later recorded. He wanted to offer hope to this brave leader, and yet he could see that the eventual outcome was at best questionable. Larrey knew and admired Lannes, who had been his great friend and his patient also in Syria and Egypt. “I swear that this was one of the most difficult circumstances of my life.” All agreed that an amputation was needed, but no one dared to try it, given the precarious state of the patient. Finally, Larrey quickly amputated the leg, taking less than 2 minutes, and this was well tolerated by Lannes. Lannes was to die at daybreak on May 30, 1809.

–David Welling, “The influence of Dominique Jean Larrey on the art and science of amputations,” Journal of Vascular Surgery, 2010. 

Presuming you’re lucky, and have access to clean bandages and no lingering infection, you could begin moving around a month-or-so after surgery. There was no concept of physical therapy in the modern sense of a strict program to retrain muscles after trauma, but people absolutely made up their own version. 

To get back up to full speed it would take anywhere from six months to a year depending on how quickly the wound healed and support from family and medical professionals. Amputation was a collective endeavour guided as much by communal concerns as by medical ones.

If you were wealthy enough to afford a prosthetic you could start practicing with one around three weeks after the amputation, again, provided there’s been no infection. That said, custom  prosthetics took time to make so you might not have one to work with that quickly after surgery. 

Lingering after effects would possibly have included continued phantom limb syndrome, itching scar tissue, numbness from damaged nerve endings, and increased stress on the cardiovascular system. Grief over the loss of a limb was also a common struggle. These are only a few of the long-term effects of limb loss. 

An aside on the cardiovascular stress: if an amputee lost a large enough limb, let's say the leg from the hip down, that would put a lot of stress on the patient's heart which could lead to significantly lowered life expectancy. In contrast, a below-the-knee amputation still leaves the thigh, an important large muscle needed for circulating blood properly. So if you lost your entire leg you'd face risk of not only infection but also cardiovascular shock and a lowered life expectancy than if you had a below-the-knee surgery. 

By the early 19th century prosthetics were advancing nicely. The intricacies, and attempts to make them as multi-functional as possible, continued to be developed. Some names of pioneering designers of prosthetics included, but is not limited to, Kriegseissen, Jen-Frederic Leschot, and Pierre-Joseph Laurent de Villedeuil.

Circa 1800, James Potts invented a prosthetic leg made of wood for the main leg with a steel knee joint. The foot was articulated and controlled by catgut tendons from the knee to the ankle.

(NB: Catguts are cords made from fibres found in animal intestines [usually goat or sheep]. It was most commonly used as string for instruments as well as for early sutures.)

Obviously, the more money you had the greater access to medical advances you had. Average Jean-Pierre made do with crutches and no prosthetic. If an amputee had some money, but not enough for a tailored prosthetic such as what Laurent and Leschot developed, they’d be able to turn to more “mass market” prosthetics.

E.g: 1811 Maelzel began advertising wooden legs and feet that would allow the wearer to climb steps and mount a horse. In 1813 Prevost advertised hands, arms and legs that were light weight, and equally important, silent. (Prosthetics were noisy. Also, how lightweight is lightweight? Not known.)

Further back in time in the 1690s Pieter Verduyn’s invented the first below-the-knee prosthetic that didn’t lock. This meant it could bend as opposed to Ambrose Pare’s famous 16th-century device that locked at the knee when the person stood so when you walked it was the stiff “peg-leg” walk we think of for pirates. Pare did amazing work in advancing the field of prosthetics and is an interesting figure in the history of medicine, worth reading up on if interested.

The idea of wholeness was very important in the early modern period on through the 19th-century. There was a lot of conflation between mental, physical and spiritual selves and so if you’re not physically “whole” can one therefore be mentally or spiritually? 

As Hillman and Mazzio write on the medieval and early modern view, “Because corporeal parts have individuated functions, locations, and differentiated relations to the body as a whole, they can become concentrated sites where meaning is invested and often apparently stabilized.”

A person's faith also informed their relationship with amputation. Catholics venerated saints and martyrs who were often dismembered. Religious relics were made of severed parts and the body of the saint was often that of a broken body – sometimes made whole by God but not always. That conflation of saintliness with a broken body serves to complicate the perception of wholeness of body and spirit mentioned above.

Amputation highlights the body as a space for fragmentations and dissolution which is both holy and unholy; a representation of the fragmenting person and the fragmenting state, church, and the larger civic body.