“The Foot That Is Gone Pains Me The Most”

May 8, 1862

My leg has given me a good deal of pain since yesterday, owing to its being too tightly bandaged. The last ligature is away, and it ought to heal rapidly now. The foot that is gone pains me most. It would seem that somebody made it their amusement playing “stick-knife” on it a greater part of the time. I am much better able to bear it now than when I was weak…. Do you know it is just two weeks to-day since I “stopped” so neatly that pretty little bullet at just about this hour? [i] (emphasis added)

Just two weeks earlier, William Francis Bartlett—called “Frank” by family and friends—had been crouching behind a tree, peering through field glasses at Confederate snipers near Yorktown on the Virginia Peninsula. The twenty-one-year-old captain, acting as commander of the 20th Massachusetts Regiment, had left Harvard University the year before and started rising through the ranks. He had been in the advanced position for about ten minutes when a bullet ploughed through his left knee and down into his leg, shattering at least six inches of bone. Conscious and suffering only at “intervals,” he was carried by stretcher and turned over to the surgeons of his own regiment. Later, a friend recalled him making one particular comment during the ordeal, “It’s rough…isn’t it?”[ii]

After administering chloroform, the surgeons amputated his left leg four inches above the knee. “He suffered a good deal after he returned to consciousness, but not to the point of faintness. His sufferings arose mostly from the necessary dressings. He bore the announcement of what had been done [the amputation] very firmly, and told me that he had expected it.”[iii] As soon as he was physically stable, Bartlett started on his journey northward and after a couple of weeks in Baltimore returned to his family’s home in Massachusetts.

His recovered was not as simple and straight forward as his wounding and field hospital care, and Bartlett’s letters through the following weeks and years offer a glimpse of a lesser-considered effect of the traumatic wounds and medical operations. Bartlett did not offer a term for his continued suffering, but modern medicine has called it “phantom limb pain.”

The May 8th letter—dictated just two weeks after his wounding and operation—is the first published reference to this mysterious pain seeming to radiate from Bartlett’s missing limb. Three days later, his mother added a post-script to another letter, explaining:

“He is, I have no doubt, doing remarkably well; so the surgeon assures me every day. Still, he suffers intensely, at times, and this has been a very hard day for him. He has scarcely been free from pain a moment, and the worst is in the poor shattered foot and leg which is gone. He says, “Ask the Colonel if they gave my leg Christian burial, for my foot torments me as if it were ill at rest. “ [iv]

Many amputees during the Civil War suffered from phantom limb pain, a scenario now believed to be created by injured (cut) nerve endings sending signals to the brain which are misinterpreted and manifested as pain in the missing limb. In the book Phantom Pain: North Carolina’s Artificial Limbs Program for Confederate Veterans by Ansley Herring Wegner, this example tries to explain the current understanding: “A good example of how the brain can misinterpret signals is the headache that occasionally follows the eating of cold foods. The nerves in the roof of the mouth are along the same pathway as those in the forehead; the brain sometimes misreads signals from the roof of the mouth and transmits the pain to the forehead. Similarly, pain in the stump may be assigned to the amputated region by the brain, as the pathway of the nerves has been interrupted.”[v]

Civil War wounded felt the phantom pains. Some—like Bartlett—wrote about their experiences and others’ sufferings undoubtedly went unrecorded. They felt the painful sensations and could not understand why. Many came to the conclusion from their doctors that it had something to do with nerves and there wasn’t much that could be done.

In recent decades, more scientific research and medical therapies have been explored. According to one documentary film, at least 80% of amputees in the modern era experience phantom limb pain at some point after the operation.[vi] One researcher, Dr. Peter Halligan, has observed: “In those patients that describe painful experiences with a phantom [limb], it has often the case that the last moment of their actual tragic accident is the one that they retain as the experience. So in the case of the individual who lost their as the result of the firework accident, the experience of the firework going off in the hand is the retained experience which is relived…” [vii]

This modern observation raises an interesting consideration for the types of phantom pain described in Civil War veterans’ writings: did it stem from and mimic the final sensations that they felt in that limb? In Bartlett’s isolated case, it seems possible. Though it is recorded that he was chloroformed for the actual operation, could he have been conscious of—or at least part of his brain was “recording”—a probing touch or instrumental, the first cuts of a surgical knife, or something else that imprinted that “stick-knife” sensation into the nerves and mind?

Today, doctors can work with amputee patients using a variety of therapies from mirror boxes to open brain operations (with other options in between) to try to help the mind realize, heal, and recover. In the 1860’s, those options weren’t available and phantom limb pain was not well explored or understood. Adding the 19th Century views on men’s character and roles allowed little outward expression of the agonies that many veterans must have suffered.

Bartlett lived with phantom pain and other lingering war illnesses and physical weakness for the rest of his life. Post war letters mention the pain in the “lost foot” which put a damper on his European travels and honeymoon in 1866. Ten years later, on March 23, 1876, Bartlett wrote to a friend: “I am certainly better in some things. I am free from that dreadful pain in my lost foot which had tortured me for two or three months, and that lets me sleep o’ nights, so that I am doing a good deal of that.”[viii] The same friend and later biographer noted at least one of the triggers phantom pains, recording: “He had become very thin. Whenever he lost flesh, the stump of his amputation was one of the first places in which the loss appeared. This caused his artificial leg to chafe, and was almost always attended with pain in his lost foot. Of this the world knew little. The absolute silence of the man as to his own sufferings was a marked characteristic of him, and his patient, cheerful endurance was almost beyond belief.”[ix]

Endurance almost beyond belief is also an accurate way to describe the rest of Bartlett’s Civil War record. Despite the missing leg and pains that would trouble him for the rest of his life, Bartlett decided he wasn’t finished with the war in 1862. Gritting through his recovery in Massachusetts, he found time to finish his Harvard degree that summer. In September 1862, he reported for active volunteer service with the army again and received command of a new regiment: the 49th Massachusetts. Still unable to bear weight on his leg stump and thus unable to wear his prosthetic, Bartlett turned up in camp and took his place as colonel of the regiment. One of his new recruits noted:

“For two hours at a time he will stand on that remaining leg, till half of us believe he never had any need of the one buried at Yorktown, but it was only a superfluous member or mere ornament. If the Colonel needs rest, he takes it as a part of the exercise, so we cannot tell which is manual of arms and which rest. The cords of that right leg must stand out like great whip-lashes. There is will about all this. It is this quiet, intense determination, this fixedness of will, that makes us desire Colonel Bartlett, with but one leg, for our commander, over any other man with the full complement of limbs. Somehow or other, we cannot tell why, we believe that he will not be the mere buffet of circumstances, but will ride over and lead us over all difficulties.” [x]

William Francis Bartlett is one of the handful of Union officers who enlisted as a private and finished the war as a brevet major general. In his four years of service, he was wounded four times, captured once, and nearly died of illness in Confederate prison before his exchange. Though he would silently suffer the effects of his injuries and illnesses for the rest of his short life—dying in 1876 at age 36—Bartlett determined that he would not be defined by his amputation or his hidden pain. His life and military service is remarkable, but the details of his wounding, operation, and amputation recovery also offer a new window on the phantom pains endured by many Civil War amputees and an opportunity to reconsider that sacrifice and endurance went beyond the battlefield and hospital.

Sources:

[i] Palfrey, Francis W. Memoir of William Francis Bartlett. Originally published in 1879. Accessed via Google Books. Page 45.

[ii] Ibid., Page 41.

[iii] Ibid., Page 43.

[iv] Ibid., Page 48.

[v] Wegner, Ansley H. Phantom Pain: North Carolina’s Artificial Limbs Program for Confederate Veterans. Office of Archives and History North Carolina Department of Cultural Resources. Raleigh, NC, 2004. Page 19.

[vi] “Curse of the Phantom Limbs” Medical Science Documentary – accessed via YouTube: https://youtu.be/CARsGUZdO28

[vii] Ibid., Dr. Peter Halligan. Approximately 15 minute mark in the documentary.

[viii] Palfrey, Francis W. Memoir of William Francis Bartlett. Originally published in 1879. Accessed via Google Books. Page 286.

[ix] Ibid, Page 216.

[x] Ibid., Page 52.