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.

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.

Prosthetics:
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.

Mindset:
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.

Welcome to Tiny Histories which aren’t as tiny as I expected them to be. The end of August brings us some thoughts and notes on early modern bodies and our modern day diet culture. Each Tiny History will come towards the end of the month and will vary in length and seriousness. If you have any questions or topics you’d like me to explore drop a line and I’ll see what I can do.

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NB on Dates: When I say “early modern” I’m referring to the period running from roughly 1400-1800. I know some medievalists would like to claim the first fifty years of the 15th-century but I won’t let them have it. They can fight me for 1400-1450. I’ll win. I would personally argue that the early modern period ends in 1820/30 but it’s more traditional to have it end in the late 18th-century (late 1700s).

In Devotions upon Emergent Occasions John Donne writes, “man consists of more pieces, more parts, than the world.”

Today we distinguish between theological understandings of the human body and medical; the early modern period saw no need for delineation. That said, one can parse between the two but in doing so we are creating an arbitrary distinction that would not have existed in the minds of the average person from 1400-1800. (And before, I believe the Medieval period also had a similar approach wherein the spiritual and medical were bound up in one another.)

Theologically, the body was believed to be an imperfect representation of God. The body, however imperfect, housed the soul and these two things were both separate and discrete from one another while, simultaneously, being intimately bound up in each other.

Donne’s poem, “The Extasie,” addresses the fraught union of body and soul:

“Our bodies why doe wee forbeare?
They are not ours, though they are not wee, Wee are
The intelligences, they the spheare.
[…]
So must pure lovers soules descend
T’affections, and to faculties,
Which sense may reach and apprehend,
Else a great prince in prison lies.
To’our bodies turne wee then, that so
Weake men on love reveal’d may looks;
Loves mysteries in soules doe grow,
But yet the body in his booke.”

Donne’s union between body and soul is ecstatic but rather a necessary, yet fraught, marriage. For Donne the body has a dual identity – it is negative in that it is a prison and it is positive in that the soul’s experience in the body is necessary to ascend to heaven.

The tension between the body as necessary prison and the body as a representation of God complicates the understanding of physicality. If we are like God, and God is a cosmic whole, our physical forms then necessarily must represent a cosmic whole. Yet, we know from the Original Sin, the human form is corrupted and incomplete. The human body is corrupt yet at the same time it represents God since we were made in his likeness.

There is no gentleness in this duality.

Our body is a fraught place upon which to read identity, relation to space, spirituality and community. It’s even a difficult space to read understandings of sexuality and gender, two aspects of our modern concept of identity we think would be intimately tied to the physical being. And they are and they are not.

The body as a space to achieve perfection is not new in Donne’s lifetime. His poem was merely expressing a common theme wherein we are understood to be imperfect yet were made in the image of perfection. Donne’s poetry long struggles with the marriage of the spiritual and physical and what this means for life-after-death. The need to render perfection when humans by our nature are imperfect is a phenomenal amount of stress to hold within ourselves.

In modernity it’s more often physical perfection we seek rather than spiritual. Although the two – physical and spiritual perfection – have historically been linked. The belief that someone’s physiology reflected their spiritual and moral self has a long and sordid history. The better looking you are the more moral and spiritually correct you must be. This approach, where morality is expected to be represented in our physical being, is what lead to the Cult of Monstrous where people born with differently shaped bodies were thought to be representations of God’s ability to create evil. Thus “ugliness” is “monstrous” which is “evil.”

This concept of outward beauty equating spiritual perfection would later inform racist scientific practices which sought to explain “white superiority” by seeking to show how the white body was more perfect than non-white bodies. This would then give birth to the horror that is eugenics and so on and so forth.

Currently, Western society’s view of perfection most often seeks to conform bodies to a model that is white, thin, able-bodied (not handicapped), “unblemished,” “whole,” and youthful looking. This is what it means to be “good.” Diet literature is the most egregious when it comes to linking self-worth and goodness to the physical form. Especially diets that marry any form of faith to eating habits. We remain like John Donne, reading a desire for purity and perfection into and onto the physical being.

To achieve perfection we have stuffed our bodies into girdles, corsets, stomachers, and compressors of all types. We have worn hair shirts, flagellated ourselves, starved ourselves, gorged ourselves, cut off chunks of ourselves, deposited our body onto hospital floors because we think it undesirable. We think of our body incessantly. We inflict pain on ourselves in order to be more like God, whatever God looks like to you. There’s a strong chance God resembles some unattainable, Western, white beauty standard with no room or acceptance for diverse bodies.

In doing all of this, we become monstrous to our bodies and each other. How often are we taught to compare ourselves to one another, itemizing how we are less or more perfect than the person next to us. This undermines friendships, family relationships, and causes untold amounts of harm – most often to the people we care about the most.

Like their Classical and Medieval predecessors, early modern medical professionals (such as they were) subscribed to the humour theory, which informed and was informed-by the theological view of the body.

The humour theory states that there are four humours that make up the human body and in order to achieve perfection one must balance all four. On top of that, and borrowing from the Platonic notion of Ideal Forms, early modern medicine believed there to be only one human body. However, the one human body could exist in two possible forms which were differentiated according to their supposed degrees of perfection (which was informed by the balance of their humours).

In On the Nature of Man, a treatise believed to have been written by Hippocrates, he describes the human body in the following terms:

“The Human body contains blood, phlegm, yellow bile and black bile. These are the things that make up its constitution and cause its pains and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with others.”

The humour theory was popularized by Galen, a 2nd century Roman physician, who laid out the foundations of the theory in his work, On the Temperaments. Medieval and early modern writers built out from there.

The nut-shell version is that there are four humours: black bile, yellow bile, phlegm, and blood. Each of these then corresponds to a temperament.

Black bile = melancholia
Yellow bile = choleric
Phlegm = phlegmatic
Blood = sanguine.

Alongside temperaments, the humours correspond to elements, qualities, age, and organs.

A rough breakdown is below:
Black bile = earth & cold and dry & adulthood & gallbladder
Yellow bile = fire & warm and dry & youth & spleen
Phlegm = water & cold and moist & old age & brain and lungs
Blood = air & warm and moist & infancy & liver

If you were ill it was thought that there was an imbalance of the humours and so treatment focused on restoring balance. Much of the early modern person’s understanding of the world was based on the four humours. It informed what they ate, how they understood gender, medical advice provided, pregnancy, animal taxonomy, and more. Food and rank were also bound up in each other so if you ate above or below your station it was believed that you were increasing your possibility of becoming ill.

An example comes from the late 14th-century diarist Gregorio Dati who wrote his son advice on how to best avoid the plague. One of his strictures was to encourage the young man not to eat melon. His logic was that melon grows close to the ground and is therefore cold and wet which could cause an imbalance to the man’s natural hot and dry humours making him susceptible to illness. If he must eat melon let him have it with either a dry red wine (which corresponded with hot and dry qualities) or with prosciutto (also hot and dry) to counter balance the negative effect of the melon.

This is, coincidentally, possibly why we eat prosciutto with melon today.

For health diet advice from the early modern period included eating within your rank so as to not become ill. If you’re poor eat food that grows closer to the ground such as turnips, lentils, cabbage. If you’re wealthy eat food that is further from the ground – apples, swans, anything that flies, and so on. Your humours will be better balanced if you eat according to your rank which means your body will be closer to perfection. If you’re ill remedies will depend on your malady – so if you’re feverish you might be advised to eat fish which is cool and wet, if you’re faint you might be advised to drink a warm, dry wine. Weight was rarely a consideration for the early modern person, rather the balancing of your body.

Although we might think it odd, early modern diet advice reads as little different from our modern approach to perfection. The variance is in the end purpose. They sought spiritual purity and to avoiding illness; ours is to perfect the physical aesthetics of our body based on some arbitrary standard imposed upon us by some higher being (HBO’s bad sex scenes; Laguna Beach; Biggest Loser; “Body positive” Instagram accounts run by very tiny white girls). Altering what you intake is key to both approaches.

One common cure for illness from the medieval period through to the 19th-century was purging. This could come in the form of bleedings, inducing vomiting, cuppings and enemas. It was believed that doing so would rid you of the excess humours that were causing an imbalance. Later, as the humour theory went out of fashion, it was believe you were removing general “impurities” that made you susceptible to illness. To purge was to make yourself more balanced, more pure, more perfect.

This is little different than modern “cleanses.” The “juice cleanse’ is perhaps the most ubiquitous. Juice cleanses can range in extremity from drinking only hot water with a little honey and hot pepper flakes in it to having a complex, intense schedule of juices you drink throughout the day. In the end, almost all dieting is about “purging” yourself of “toxins” or fats or carbs in order to make your body more balanced. This form of thinking is right in line with our early modern and medieval ancestors. Both exhibit the belief that purging is a form of perfection and both also exhibit a lack of understanding of how the human body works.

“Ideal” health attained through kale smoothies or leeches. Perfection to be attained through controlled eating whether it’s to balance your humours or to fit arbitrary beauty standards.

Hilary Mantel calls our obsession with extreme dieting a “Holy Disorder” equating our quest to disappear our bodies with the spiritual quests starving nuns went on in the early modern period. Indeed, the length to which we push ourselves in order to achieve spiritual, physical, moral perfection is often unhealthy. This is the case for ourselves and our ancestors. For John Donne and his spiritual counterparts across Christianity – from Protestant to Catholic – hurting yourself physically was a way to become more like Christ. To achieve some piece of God by sharing in the pain of the crucifixion. Suffering in such a way was also a means to alleviate the sins of others. Saint Margaret of Cortona once said, "I want to die of starvation to satiate the poor."

The spiritual and humoural purification through achieving balance is no different in its rituals as our diet culture. We seek to conform in 1418 the same as we seek to conform today. We look at bodies and judge them for their failings. I’ve sat in rooms with women flipping through Facebook pages judging the bodies of relatives saying “I can’t look at her she’s so fat.” I’ve sat in rooms with women lamenting girls who are anorexic, or have other disordered eating, staring at their bodies which are now too skinny.

Hilary Mantel asks us, “Are we threatened by flesh or its opposite?”

“Our bodies why doe wee forbeare? They are not ours, though they are not wee […]” Bodies are not ours, Donne means to speak of God, but we in modernity can look at those lines and understand that our bodies are not ours in that we cannot control them. Our bodies are also not us (though they are not wee). They need not be our only sense of worth and definition. We remain entangled in that fraught relationship between physical and the not-physical; our flesh and our morality.

There will be no perfection.

After all, man consists of more pieces, more parts, than the world. How can anyone think to contain that?

Early Modern Amputation

Some notes on Early Modern Bodies and Modern Diet Culture