Civil War Medicine: “I Should Have Had The Hand Taken Off”
“If I had known it was so bad and was likely to be so long and tedious a wound, I should have had the hand taken off that afternoon, without a thought to the contrary.”[i] Wrote twenty-three-year-old Colonel William Francis Bartlett approximately three weeks after his wounding at Port Hudson. Bartlett’s commentary on fear of wounding and treatment of his injury is a contrast, and one that he made with some knowledge that other officers lacked.
The young officer had already lost his left leg above the knee joint when he had been wounded on the Virginia Peninsula in April 1862. His recovery had been painful, but his determination conquered. Undeterred by his amputation, Bartlett had taken command of the 49th Massachusetts, drilled the new regiment, and then actively led the unit on campaign in the deep South.
On May 27, 1863, Bartlett faced Confederate guns as the Union army prepared for the first attacks on the fortifications at Port Hudson, Louisiana. He worried about the ground and the defensive obstructions blocking the attack route, knowing that if he was going to lead his green regiment in the assault, he had to ride his horse. “I knew being the only officer mounted, I should be much more conspicuous. I knew that my chances for life were very small. But I had to go horseback, or not at all. So prayed that life and limb might be spared, and went in….”[ii] He made it “two-thirds across the slaughter-field when, just as I was shouting to the men to keep closed on the color, pop I went off my horse like a rocket…. I was spared life, and most probably limb.”[iii] Wounded three times, losing his balance, and tumbling off his horse, Bartlett lay on the battlefield waiting for aid. Around him, his soldiers fell also until the regiment retreated in defeat with the other Union attackers. His life had been spared, but the painful journey with his wounded arm had just started, and Bartlett’s opinions on the treatments changed as the weeks passed.
At the field hospital, Dr. Winsor and other medical staff took care of the wounded. The surgeon later wrote about when Bartlett was carried to the field hospital:
“His clear blue eye met mine steadily, his strong right hand grasped mine firmly, and the voice that could ring along the line like a trumpet had no waver in it as it said, “How are you, doctor? We’ve had a rough time of it. Now you must do your best for me. I can’t lose another limb, you know.” I saw that the hurt in the head could be nothing serious; a buckshot had scored the scalp to the bone, and another had done the same for the heel of his one foot. I undid the bandage that bound his left wrist, and examined it. A ball had entered on the one side, and lay near the surface on the other. His eyes questioned me, and I replied, “I can soon take that ball out, when you are under ether. That’s a very tender place.” “But you won’t take off the hand?” “I will do nothing without letting you know and having your consent, colonel.” So he drank of oblivion and ceased to suffer, but his dream was not of home. “Doctor,” he muttered (talking in ether sleep), that’s my bridle hand, you know. Never can ride at the head of my regiment again if you take that off.” In a moment I held the bullet in my hand, and saw with joy that it was round and rather small, giving reason to hope that it had not shattered the bones badly in coming through, which could hardly have been the case had it been conical. No loose bone was to be felt, and I had the great pleasure of telling him, as he returned to consciousness, that there was good reason to hope that his “bridle hand” would by and by hold the rein again. A smile of satisfaction and relief lit up the face which had till then been set in the resolve to bear the worst, and with the simple, hearty thanks which we surgeons had from the hundreds of men that night he was borne off to his blanket side by side with his officers.”[iv]
Next, Bartlett endured a nine-mile ambulance journey and then boarded a steamboat which took him to a hospital in Baton Rouge. A veteran biographer criticized the medical care at this hospital, saying, “everything seems to have been mismanaged or neglected in that department.“ For example, one evening, Bartlett stayed awake until after ten o’clock, anticipating that the doctors would examine his wound. He wrote in his journal: “waiting for the doctors, who were to come, but didn’t. Learned this morning one was very drunk, the other taking care of him. Good medical attendance!”[v]
Civil War surgeons—even the ones not intoxicated—struggled with standardizing or developing a proper treatment for wrist wounds like Bartlett’s. Was it better to allow healing time or simply amputate quickly to avoid deadly infection? Descriptions in The Medical and Surgical History of the War of the Rebellion explained the physical damages and complications of this type of wound:
The joint is so surrounded by dense ligaments with layers of superimposed tendons, the whole bound down by the annular ligament, that the resistance to the inflammatory swelling is intense, and the reaction is attended by excessive pain, and, unless tension is promptly relieved, the extension of suppuration is great, involving not only the compilated articular surfaces, but the cancellous structures of the bones. Great risk of pyaemic infection then arises, and operative interference becomes necessary at least to the extent of free incisions into the joint, and extraction of all detached splinters. How far it may be advisable to attempt to avert these dangers by primary resection is a question yet undetermined…”[vi]
At first, healing looked good for Bartlett’s wound. He wrote to his mother on June 13, saying that he felt well and was able to eat. All the doctors told him the wound looked fine, and he had no pain when the arm was kept motionless. His foot and head wounds had nearly healed. However, mid-19th Century medicine missed something important in the scenario through the lack of understanding about germs. Bartlett wrote: “My arm is suppurating very freely under the applications of warm woolen cloths, which act like a mild poultice.”[vii]
“Suppuration” seemed like a healing sign to the doctors’ eyes. In reality, the bodily fluids oozing from the wound was the body fighting infection and trying to flush foreign fragments out of the wound. Left untreated since it was seen as a positive sign, infection often spread or lead to recognized disease that would force an amputation.
On June 20, Bartlett wrote to Dr. Winsor. His cheerful hopefulness to his mother the previous week had slipped. “I am not in very good spirits. The doctors here differ so about my arm, and the question whether or not to take it off, that I don’t know what to believe. The majority are thus inclined: Don’t take it off yet. It looks healthy; the pus is very healthy. Small pieces of bone have come out, three, I think, not any bigger than half a bean. That was a week ago, since which no more pieces have come out, but the suppuration has continued very freely.” He went on to detail serious swelling and the doctors’ plans to open his wrist and try to remove bone fragments that they suspected caused the pain and suppuration. Clearly frustrated by the circumstances and the constant pain, Bartlett declared he would rather have had an amputation at the field hospital than deal with his bad wound.[viii]
Bartlett’s wound received typical treatment, which according to the medical books:
“To moderate inflammation by cold applications — by ice dressings when available — to support the parts without constricting bandaging upon a padded splint — to relieve inflammatory tension by free incisions as soon as suppuration took place, — to remove all splinters and detached fragments, — and, finally, to institute passive movements of the fingers and hand at the earliest practicable moment, — were the practical indications that were chiefly insisted on in the expectant conservative treatment of shot fractures at the wrist.”[ix]
The purpose of “conservative treatment” was to save a limb and avoid the drastic measures of a resection or amputation. But the process of the treatment hurt excessively. It also left little privacy for enduring the pain. An orderly sat constantly at his bedside holding ice and letting it drip slowly over the wound to help bring down the inflammation. Then, the injury reached the decisive stage. After numerous examinations and uncertainty, the doctors told Bartlett they were going to amputate his lower arm. It was night when the surgeons told him their decision and wanted to operate. Bartlett asked them if it would make a difference if they waited until morning when there would be better light for the surgery. The doctors agreed to delay. In the morning, they re-examined the wound and made a new verdict: the wound did not look better, but it hadn’t gotten worse. They would keep waiting.
The waiting worried Bartlett. At what point would it all be too late? In a letter to his friend from the 20th Massachusetts, Frank Palfrey, Bartlett confessed:
“The wound in my wrist-joint is worse than I knew of at first. If I had been told just how bad the wound was that afternoon on the field, I would have made the surgeon take off the hand without a second thought. The surgeon assured me so positively that I could save the hand, that I didn’t think to ask, “At how great a risk, in how long a time?” I want the surgeons to take it off now, and let me get well, instead of running the risk of inflammation, and losing it above the elbow, or worse. The surgeons say wait….”[x]
In the end, “the wound healed completely in time, but the wrist was permanently stiffened, and the use of some of the fingers of that hand was impaired.”[xi] It may appear at first glance that Bartlett was overly pessimistic about his wound, and it would be easy to praise the surgeons who refused to amputate. However, that is an interpretation with hindsight. In the actual situation, Bartlett knew he and the doctors played with the chances of his life. It could have gone wrong very quickly, ending with an uncontrollable infection which would cause other complications and death.
Bartlett’s reactions could be interpreted as irrational. He wrote about wanting safety of life and limb before the Port Hudson attack. Then he seemed relieved to keep his arm. Then he wrote on two separate occasions that he wished the arm had been amputated. Was he being rational? Why the change?
Yes, I would argue that Bartlett was rational. The fact that he had already lost a leg and had regular problems with his amputation stump is a reminder that he knew the pain and outcomes of a major surgery. He was willing to go through that with his forearm rather than the risk of waiting. The shift in his hopes and thinking seems to occur at the hospital in Baton Rouge. There, the wound took a turn for the worse. Bartlett worried that infection was setting in and could force a more serious amputation or kill him. He also felt that with the information he now had about the wound it wasn’t worth the risk. It is worth noting that Bartlett trusted only one of his doctors at Baton Rouge. He—like other hospitalized Civil War soldiers—may have felt that he had little control or power over his medical treatment or decisions. He may have felt like an experiment project, but surgeons’ choices could have cost his life.
Finally, on July 19, Bartlett left Baton Rouge, declaring, “I never was so glad to leave any place before. I hope never to see it again.”[xii] His next destination, a hospital in New Orleans, was the next step of his journey home to Massachusetts. Bone fragments and splinters continued to work their way out of the wound on the trip, while the inflammation and swelling eased.
By early August 1863, Bartlett had arrived home to finish his convalescence. A photograph taken at that time shows his arm supported in a box sling. A bunch of flowers appears to hang from the splint/sling. Later, poet Herman Melville wrote about “The College Colonel”, painting a word portrait of the young officer and mentioning the conspicuous arm sling:
He rides at their head:
A crutch by his saddle just slants in view,
One slung arm is in splints, you see,
Yet he guides his strong steed – how coldly too….
He has lived a thousand years
Compressed in battle’s pains and prayers,
Marches and watches slow….
Though somewhat against his will at the time, Bartlett kept his bridle arm. He lived to literally fight another day. In 1864, Bartlett took the 57th Massachusetts into battle during the Overland Campaign. Wounded again at The Wilderness, he returned to the Army of the Potomac with the rank of brigadier general in time to lead in the disastrous attack at The Crater. An imprisonment devastated his already weakened body and healthy. Though Bartlett survived the war, effects of his injuries and wartime sicknesses contributed to his early death in 1876.
[i] Richard A. Sauers and Martin H. Sable, William Francis Bartlett: Biography of a Union General in the Civil War (Jefferson: McFarland, 2009). Pages 88-89.
[ii] Francis W. Palfrey, Memoir of William Francis Bartlett, (1878), Page 82. Accessed through Google Books.
[iii] Ibid, Page 82.
[iv] Atlantic Monthly, “The Surgeon at the Field Hospital” August 1880. Accessed: https://www.theatlantic.com/magazine/archive/1880/08/the-surgeon-at-the-field-hospital/632452/
[v] Francis W. Palfrey, Memoir of William Francis Bartlett, (1878) Page 84. Accessed through Google Books.
[vi] The Medical & Surgical History of the War of the Rebellion, Volume 2, Part 2. Page 995. Accessed: https://collections.nlm.nih.gov/catalog/nlm:nlmuid-14121350R-mvset
[vii] Francis W. Palfrey, Memoir of William Francis Bartlett, (1878) Page 87. Accessed through Google Books.
[viii] Atlantic Monthly, “The Surgeon at the Field Hospital” August 1880. Accessed: https://www.theatlantic.com/magazine/archive/1880/08/the-surgeon-at-the-field-hospital/632452/
[ix] The Medical & Surgical History of the War of the Rebellion, Volume 2, Part 2. Page 997-998. Accessed: https://collections.nlm.nih.gov/catalog/nlm:nlmuid-14121350R-mvset
[x] Francis W. Palfrey, Memoir of William Francis Bartlett, (1878) Page 88-89. Accessed through Google Books.
[xi] Ibid., Page 85.
[xii] Ibid., Page 86.
2 Responses to Civil War Medicine: “I Should Have Had The Hand Taken Off”
“He has lived a thousand years.” How poignant–didn’t they all?
Sarah, Excellent article. This guy was tough.