It can be supposed disagreements at a personal level and between various opposing groups ending in violence, have a long history, at least as far back as the Old Stone Age, although we have no clear prehistoric facts. Today's newspapers and televi sion programmes confirm such disputes are part and parcel of "civilisation," which is not to say the participants concerned are aiming to achieve amputations, for other forms of maiming and mayhem are much easier to attain. Manually inflicted injuries with stones and clubs were unlikely to sever limbs, although doubtless crushed fingers complicated by infection and gangrene sometimes separated from living tissues. The appearance of stone axes and other cutting tools increased the possibility of limb severance, although the writer considers clean section through the tibia, humerus and femur would have been difficult if not impossible to attain with a single blow. Apart from fingers and hands severed during sword fights, major limb amputations must have been rare before the Iron Age: a heavy bronze axe might amputate an arm but an iron or steel axe would have proved more efficient.
At the Battle of Hastings as depicted in the Bayeux Tapestry, scrutiny shows many axe-men and several decapitated military figures in the lower margin but only one dismembered limb, apparently at the level of the elbow joint (see Fig. 4.4), perhaps inflicted on a wounded or dead soldier. Complete transection through major bones was not easily obtained, as described in Chapter 4 by a 12th-century Arabic writer reporting on the treatment of a crusading knight with a chronic leg ulcer. If "guillotine" amputations were encouraged by some surgical authors during the 17th century, Woodall restricted chisel and mallet amputation to fingers and toes,4 although Scultetus was prepared to section as high as the lower forearm and ankle joint with a very heavy chisel or massive bone nippers (Fig. 5.1).5 Fabry (Hildanus), who considered these actions unworthy of rational surgeons, as nerves and tendons were contused rather than sectioned cleanly, nevertheless had faith in a massive machine with weighted blades intended to 'guillotine' arms and legs, although he presented no actual case obser-vations.6 Purmannus, one of the last authors to illustrate an amputation chisel for fingers and toes, in 1706, did provide witness accounts of two guillotine sections through the shin, between weighted blades: the first required two drops of the upper blade ending with badly splintered bone and the other needed completion with knife and saw. He concluded:
"So that, all things considered, the Ancient way in cutting through the Flesh with a Knife, and through the Bone with a Saw, is more practicable, safe and certain then (sic) any of the new Inventions.""
Notwithstanding these conclusions, in 1835,11 years before the introduction of general anaesthesia, Mayor raised the possibility of instantaneous cutting once more, having concluded pain was inversely proportional to the time taken to amputate, that is, less pain was experienced if the section was swift. He recalled earlier attempts with chisels and admitted this resulted in profuse haemorrhage and the impossibility of closing the wound immediately, and at best resulting in paper-thin scars. Despite this, Mayor pursued the concept of instantaneous cutting, which he termed 'tachytomie,' putting forward an imaginary and entirely theoretical solution, in the form of giant secateurs whose precise mechanism he left to scientists and mechanics to resolve, a challenge never mastered.8 Guillotine section of limbs inevitably resulted in shortage of skin and soft tissues to cover bone ends, resulting in prolonged healing and painful stumps, and the practice disappeared in the early 18th century. However, in 1941 Harley reported the Masai of Lake Victoria, Kenya, were noteworthy for cutting off a damaged limb with a single stroke of a large sword, although neither the level of amputation nor the postamputation progress is recorded.9
If we examine reports of cold steel injuries sustained in battle, it is astonishing how soldiers survived multiple wounds which rarely involved division of limb bones. Wiseman stated:
"I shall now consider of Wounds with loss of Substance made by Bill, Pole-axe, Sword, etc., some cutting twice or thrice in one or near one place, whereby the Wound is large, transverse, yea and oblique,... These kinds of Wounds are often seen in times ofPeace, but in the Wars
they are frequent, especially when the Horse-men fall in amongst the Infantry, and cruelly hack them; the poor Soldiers the while sheltring their Heads with their Arms, sometimes with the one, then the other, until they be both most cruelly mangled... And if they fly, and the Enemy pursue, his Hinder parts meet with great Wounds, as over the Thighs, Back, Shoulders, and Neck."10
Here Wiseman speaks about survivors, for many others received severe open wounds of the skull from which they died; he does not mention limb severance but again such victims may have perished before receiving medical assistance.
In an important study of military surgery published in 1768, Ravaton devoted a significant section to cold steel wounding and observed that if weapons, especially sabres, divided limb bones, they also divided main vessels and nerves, causing rapid collapse due to haemorrhage. When brachial or femoral vessels were divided and soldiers survived, the only course was a formal amputation. Overall, Ravaton considered sabre wounds of the upper limbs were less troublesome than those of the lower limbs. In describing case histories of several survivors with severe wounds, he offered no details of any amputations.11 Ravaton divided cold steel injuries into those caused by pointed weapons, that is, stab wounds, and those due to cutting weapons, that is, open wounds.12 In his experience, the former were caused by rapiers, bayonets and sabres, and because of their depth, were much more troublesome and dangerous than the latter, caused mostly by slashing sabres, when the wounds although extensive were less deep, easily inspected and open to surgical remedy. Ravaton illustrated his work with large numbers of personal observations,including the history of a soldier who sustained a puncture wound of his upper arm in 1740 and bled a great deal; Ravaton ligatured the brachial artery, only for the wound to become infected, necessitating an amputation.13 He also described a number of penetrating wounds of the brachial and femoral arteries which produced recurrent haemorrhages and severe infections, some ending in death.14 Ravaton concluded wounds of the main arterial trunks of the arm and thigh caused either early death from blood loss or, in fortunate cases, a life-saving amputation.
After the battle of Waterloo in 1815, Thomson visited the surviving wounded evacuated from the field and noted:
"The incised wounds which we saw had been inflicted by the sabre. They were chiefly among the French prisoners at Antwerp, and were for the most part upon the upper region of the head, or upon the temples, face, back part of the neck, and shoulders."15
Again, no clear evidence of cold steel limb severance is mentioned, and we conclude any such wounded rarely survived, except for the fingers of the sword arm which, it is probable, were considered unworthy of note as nonfatal minor amputations. Based on wide experience of military surgery, Hennen wrote about cold steel injuries in 1820, as follows:
"The gigantic blows by which long bones are divided and limbs severed are not a frequent occurrence in modern days. Most serious incised wounds are, however, inflicted by the sabre; the cavities of the joints are laid open, their appendages injured, the tendons divided, and the bones so deeply wounded, that, without the greatest attention, the preservation of the power of the limb becomes questionable."16
Apart from penetrating wounds caused by bayonets, cold steel injuries diminished during the 19th century whereas gunshot injuries became much more dominant. Penetrating bayonet wounds which did not kill could introduce infection and precipitate life-saving amputation. In 1897,Worsnop recounted an extraordinary amputation involving an Australian aborigine injured by a spear penetrating his shin about 1850, who was interviewed by Wollaston, Assistant Colonial Surgeon in Western Australia:
"At King George's Sound, Mr Wollaston had a native visitor with only one leg: he had travelled 96 miles in that maimed state. On examination, the limb had been severed just below the knee, and charred by fire, while about 5 cms of calcined bone protruded through the flesh. This bone was at once removed by saw, and a presentable stump was made ... On enquiry the native told him that in a tribal fight a spear had struck his leg and penetrated the bone below the knee... He and his companions made a fire and dug a hole in the earth sufficiently large to admit his leg, and deep enough to allow the wounded part to be level with the surface of the ground. The limb was then surrounded with live coals or charcoal, and kept replenished until the leg was literally burnt off"'17
This report seems hardly credible, and yet the stoicism of Australian aboriginals is well known; perhaps the victim thought the spear was poisoned? In any event, this method of amputation ensured uncomplicated control of haemorrhage by heat cauterisation and complete asepsis of the wound by thermal sterilisation, factors which raise the question of dipping stumps in boiling oil or tar.
Despite widespread scrutiny of surgical texts illustrated by case observations, the writer has found no case under the direct management of surgical authors which authenticates plunging stumps in boiling liquids. All allusions to this horrendous practice stem from second-hand accounts without direct witness by a physician or surgeon. For example, in 1679, Yonge when complaining about a physician who asserted he had used oleum terebinthnae (turpentine oil) before him, was supposed to have told Yonge:
"Some Chirurgeons using the Levant, had told him, That the Turks, as soon as they have amputated, use to dip the stump in hot Tar, and that they thereby securely restrained the Flux, and laid the foundations of a very good digestion: The way seeming too brutish and terrible to be imitated, he considered how to contrive it more neatly... none seeming more like it than Turpentine;"18
In 1875 Syme wrote that before the ligature some surgeons used the summary method of applying hot pitch or tar over the face of the stump and gave this account of a sailor he met who had been injured on a whaling vessel:
"... for lack of other aid, the ship's carpenter amputated. Whether from his acquaintance with ancient surgical authorities, or simply acting on the rules of his craft, he "paid" the stump with hot pitch. The man recovered well..."19
Although Yonge used hot turpentine, this was applied on pledgets to the bleeding points or trickled into penetrating wounds, which he then held in place with his finger, suggesting it was not boiling. As a naval surgeon, Yonge added it was difficult if not impossible to use heated volatile turpentine in great sea fights due to the danger of fire and the difficulty in keeping it hot. In 1861, Boyes witnessed (see Chapter 4) a legal amputee's stump being dipped in a pot of boiling fat in Ethiopia, perhaps as a part of the punishment? In any event, this and any other stump dipped in hot liquids would prove a difficult physical manoeuvre with the victim surely fighting and screaming, causing the skin and much muscle to retract well away from other soft tissues which, apart from the nerves, would be less sensitive. In holding the patient down the "helpers" were also in danger of scalding as the vessel could easily be tipped by the struggling victim. I suggest that any hot oil used by Paré and others was applied on small pledgets or wisps of wool to the mouths of the vessels, just as the hot iron cautery was applied, the problem for the patient being the inadvertent application to nerve stumps. Unless concrete case histories can be traced, considerable mythology surrounds tales of dipping stumps in boiling oil or tar. Any exposure of the skin to scalding and burning would be completely counterproductive to wound healing, which was difficult enough after a guillotine section.
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