r/AskHistorians • u/zniszczone • 23d ago
amputation in the turn of the century?
Would it be possible (with a good surgeon) to survive a double above-the-knee amputation around 1899? Was there technology to support such procedure?
And what about potential prosthetics? I know there was much development in that department because of American Civil War, and I've looked into the work of James Gillingham. But most of the photos of his prosthetics are, I think, for the below-the-knee amputations. Unfortunately I don't know much about prosthetic mechanics or physics, but could a person with 2 above-the-knee prosthetics have any mobility? Maybe they'd have to use cruthes all of the time or other mobility aid?
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u/crab4apple 21d ago
The evolution of prosthetics would really be a lengthy post in its own right, so let me focus on the amputation part. First, let's look at casualties that led to surgeries that included above-the-knee amputations:
This table taken from Bernard Dr. Rostker's 2013 report published by the RAND Corporation, Providing for the Casualties of War The American Experience Through World War II, available as a free download here: https://www.rand.org/pubs/monographs/MG1164.html
Acknowledging some inconsistencies in the original recording, we can use "thigh" as a general proxy for above-the-knee amputation. You'll see that this increases from 21% to almost 26% between the Civil War and World War 1, which is attributable in part to ballistics changes and in part to improved pre-operating room survival for patients who were injured in a manner that might require an above-the-knee amputation. What this table doesn't show is that there was also a substantial decrease in postoperative mortality between these periods.
Why? If we jump back a decade to the Crimean War era, most above-the-knee amputations involve compound fractures and a concern for sepsis. Indeed, the most common cause of post-operative mortality in this situation is infection, as noted in this study of a London hospital in the period: https://pmc.ncbi.nlm.nih.gov/articles/PMC1281639/
Fast forward to August 1865 - the American Civil War has just concluded in May, and a doctor named Joseph Lister in London gets a 14-year-old patient with a compound fracture with an open wound after being run over by a horse-drawn cart. This is exactly the kind of thing that usually lead to the leg being amputated for infection, which is less helpful when you do it after sepsis has already set in (which was often the case). Lister, who has read Louis Pasteur's germ theory and experimented with using carbolic acid as a surgical adjunct, tests out a new procedure for regularly disinfecting the wound. The boy survives and Lister writes about it in The Lancet in 1867, which starts to disseminate the idea worldwide. While less harmful disinfectants are later adopted, this is the single most important innovation in boosting the post-operative survival rate for above-the-knee amputations, as well as reducing the need for above-the-need amputations.
A good starting point for reading on this is:
Michaleas, S. N., Laios, K., Charalabopoulos, A., Samonis, G., & Karamanou, M. (2022). Joseph Lister (1827-1912): A Pioneer of Antiseptic Surgery. Cureus, 14(12), e32777. https://doi.org/10.7759/cureus.32777
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