Authors: Christopher David Petersen
“Ok, I need you to pull back the first layer as I cut down to the bone. Just be careful of your fingers though. I'm moving pretty fast here and we don't want an accidental amputation of any of your digits, ok?” Dr. Morgan asked.
Asst. Fowler nervously nodded his head, placed his unwashed fingers into the incision, and began to pull back on the skin, opening it wider for Dr. Morgan. As he did this, he asked a question. “Sir, why don't we cut right down to the bone on the first pass? Wouldn't it be faster?”
Looking up at his assistant, Dr. Morgan replied, “Good question, lad. We could do this in one pass, but we lose the precision as we slice deep into the muscle. The remaining stump usually ends up grossly disfigured, more so than is acceptable, frequently leaving the appendage quite painful for use. The accepted practice is the double incision, as we are doing now. We will produce a stump that will retain more muscle tissue covering the bone, making it a less painful, as well as a more useful appendage.”
Asst. Fowler nodded, then turned his attention to his fingers as he pulled the incision open.
Dr. Morgan reached for a longer-bladed scalpel. He inserted it into the bloody tissue at the top, then angled the blade so that he would be cutting several inches up and underneath his assistant’s hand, effectively cutting out a cone shaped piece of muscle down to the bone. The first pass, the doctor sliced deeply into the flesh, slicing though vein, muscle and tendons, hitting the bone and increasing blood flow onto the table. As he was instructed, Asst. Fowler pulled back the freshly sliced muscle as the doctor worked quickly.
Reaching over the leg once more, the doctor continued his conical-shaped incision from the bottom and worked his way to the top. With his hands saturated in blood, he reached for a long strip of cloth a few inches wide. He worked around the bone, then pulled up on each end of the strip, lightly suspending the leg for a moment. He then pulled the cloth up the leg, which pulled the muscles higher up the bone.
“Ok, we've pulled the muscles higher up the bone. I'll cut through the bone as close to the cloth as I can without cutting through it – the cloth, that is. When we release the cloth, the muscle will spring back to its original position, covering the bone by a couple of inches, allowing for greater cushioning after healing,” Dr. Morgan elaborated.
He reached for his saw and placed his thumb on the bone as a guide. Resting the saw against his thumb, he pulled two times toward himself, leaving a small pilot slot to start the cut. He then began to saw aggressively through the bone. In seconds, he was nearly through the bone, as he began to slow. At the end, he only pulled the saw toward himself, insuring that the bone would not splinter. With the last pull of the saw, the lower leg completely detached from the upper leg. At the end of the table, the top-heavy foot rolled to one side under its own weight, and fell from the table into the grass below. The blood pooled around the end of the stump as the assistant released the cloth holding the muscle. Quickly reaching for a pre-threaded needle, the doctor began to tie off the various blood vessels, starting with the femoral artery.
“Right then. See those strands that look like tiny pieces of twine? They are the various blood vessels that supplied the lower leg with blood. Those all need to be tied off or he'll bleed to death,” the doctor said as he worked.
With the bleeding completely stopped, he slowly released the tourniquet and watched for leakages at the end of the stump. Seeing none, he then began to sew up the exposed wound. He quickly pulled the extra skin over the muscle and began to stitch across them.
“The ligatures should not be too close, as there needs to be room for drainage of any excess blood and pus while the appendage heals,” the doctor said as he stitched. His assistant looked on in fascination. When he was done suturing, the doctor allowed Asst. Fowler to bandage the end while he rinsed off his tools and threw the bloody foot into a basket to be carried away later. Turning to his assistant, he said dryly, “Let's hope there won't be too many of these today.”
Asst. Fowler just nodded. The whole bloody experience was almost too graphic for him as he tried to process the procedure in his mind.
“Right, let's have a look at the other fellow, shall we?” the doctor asked rhetorically.
Bandaging the corporal’s amputated leg, he looked up to see that Dr. Morgan was already cutting away the other soldier’s pant leg, presaging the next operative process. Moments later, the sound of distant gallops could be heard as more teams of horses began to arrive, pulling their wooden ambulances as they rushed the wounded to safety.
Faster than they could operate, the privates carried more wounded Union soldiers to the operating wagon. The basket of amputated limbs mounded over as the doctor disposed of the useless appendages, throwing them unceremoniously onto the bloody pile of flesh and bone that had already began to rot in the heat of the day. As each mangled limb landed on the bloody mound, swarms of flies darted away, escaping the falling limb. They quickly returned and continued their forage of filth and disease on their newly found real estate.
As the wounded flowed in, they were helped to the shady edges of the grassy clearing to wait their turn under the knife.
Disheartening moans of agony could be heard everywhere as the injured men left one horrific world and entered another. Working quickly to overcome the numbers, Dr. Morgan set up another operating wagon for Asst. Fowler. Working side by side, Dr. Morgan monitored his assistant’s work. At first, the doctor assigned simple amputations to Dr. Fowler, but as the number of wounded mounted and Dr. Fowler began to grow into his newly acquired skills, Dr. Morgan allowed him to take on more complex surgeries. With two doctors working, the basket used to dispose of the limbs had long since disappeared under the carnage.
The stench of iron hung heavy in the air from the blood that spewed from the wounded. Through blank and pallor faces, some stared out into nothingness as shock deadened reality. Others winced and grimaced with each breath they took, and still others cried out in agony, each time dying a thousand deaths.
Hearing the suffering of their countrymen only served to stiffen both doctors’ resolve to save more men. Throughout the day and into the night, the two surgeons worked frantically to save the injured and the dying. As their exhaustion set in, and hysteria and despair overwhelmed them, they searched within themselves for the strength to continue. Eventually, their own bodies and minds began to fail them. They had pushed themselves to the limits of human endurance. With the battle not yet complete, they both knew that tomorrow would bring further death and pain. If they were going to be of service to the young men risking their lives for their country, they both would need some much deserved rest.
With the last flicker of light from the nearly spent oil lamps, the blood-soaked surgeons made their way across the other side of the clearing to their two canvas tents. With a quick change of clothing, they lay down on their cots and fell quickly asleep.