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Medical History: Amputations In The Battlefield — Transcript · YTtoTranscript

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Medical History: Amputations In The Battlefield

History Hit · 3,374 words · 17 min read · EN-ORIG

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Below is the complete, readable transcript of Medical History: Amputations In The Battlefield by History Hit on YouTube. Read the full text, copy any part you need, or generate a transcript for any video with our free tool.

Okay, here we go. Maggots. That bone is tough. Open a vein. Let the blood flow. We can now say that was a catastrophic mistake.

Through the 18th and 19th centuries, war was transformed. The scale of it was vastly increased. Huge armies fighting right the way around the globe. And technology changed, too. It became ever more lethal, ever more destructive. And there was one weapon that really started dominate the battlefield in this period. And that was cannon.

During the Napoleonic War, during the American Civil War, everything just grew to an enormous scale. This was industrial warfare. Exploding rounds, rifled barrels. War was becoming ever more lethal. And the wounds more terrible. I've come to the Commandery in Worcester. Now, this was once a military headquarters during the English Civil Wars. They would have been no stranger

to the boom of cannon. And I've come here to find out how medical science, how surgery tried to keep up with the transformation in military technology. How did surgeons deal with the horrifying wounds that ever more impressive cannon and other weapons could inflict? All right, Kev. The last time I talked to you, we were talking about English

Civil War in the 17th century. We're now coming forward what, 100 years or so? What's What's the state of play? How are things changing? We're still in the realm of the four humors. However, we're getting a better understanding of what the human body does and how it works. We've had the work of

people like the Hunter brothers. They have medical schools. They've been demonstrating to students. There's been dissections going on. Medical education has taken a massive step forward. So, we're getting a better sense of the the mechanics of the body, but not not what underlies it all. Not not the essential biology that makes us tick.

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Exactly. One thing that did come out of the English Civil War with Wiseman was the belief in that the heat of the blood was important. They didn't understand about the blood carrying oxygen, but they did understand about the blood retaining its heat. And that was so important. So, they could recognize gangrene. They could

recognize a lot of different illnesses. But, their understanding at the beginning of the 19th century is way off. A good example is cholera. Today, we know it's caused by the cholera vibrio, spread through dirty water, but to the 19th century mind, it was still caused by a miasma. Bad smells. Bad air, yeah, which basically imbalance

the humors. But yet, we're still seeing some really interesting developments. 1850s, we've got Pasteur discovering germs. We've got the work of Lister, Joseph Lister, and his work with carbolic acids. So, things starting to look up by the mid 1800s, but one good thing for surgeons is there were plenty of wars. No shortage of people to experiment on,

right? Because human beings are fighting all over the planet in ever bigger wars in this period. So, if I'm fighting Napoleon outside the gates of Moscow or I'm at the Battle of Waterloo, I'm injured. What chance do I have, first of all, of just getting in front of a doctor or surgeon? Because we've got these, how do you say,

massive kind of battles, industrial scale, you have to take a different approach with them. And a new approach was taken by the French surgeon, Larrey. He developed triage system. The people are being stacked in seriousness of their wounds. It's a good reminder that for armies, it's not just about new technology and tools, it's about building systems.

Exactly. a big impact. And this is also on the British side, we had George Guthrie, who was a brilliant surgeon. He was a war surgeon. He was very big on collecting statistics. So, that would inform the best way to treat and the best way you could apply resources. And that laid the foundations

for what we have today. Right, so we got triage, we got ambulances, we got people collecting data, working out why people are dying, what wounds are survivable. What about the treatment itself? Okay, the treatment really hasn't changed all that much. Oh, okay, that's disappointing. You're still, anything that goes in could disrupt a humor. If you are being

treated for a bullet wound, uh then we may have to purge you. So, we're going to have to bleed you. So, if you get a a bullet wound, Yeah. one of the ways they could treat you is to just take some of your blood out. Yes. To get everything back in balance. Balance of humors, yes.

And we can now say that was a catastrophic mistake. Yes, without a doubt. I know I'm going to demonstrate how they did it. Great. Which arm would you like? Left arm, please. Okay. This is a genuine antique. Very nice. From the early 19th century. It's a thumb lancet. Oh, no. So, what we're going to do, you'll be

gripping a a pole. We want the veins popping out and what we'll do, we'll just open a vein. And then we'll just let Just let the blood run. Let the blood flow until we think that there's been enough. How much blood would I be letting here? Until they thought you'd been bled enough. Don't forget this isn't just

happening once, it could be happening several times a day. Oh, and these instruments are not properly cleaned or anything. So, you could be getting infections. Well done. There we go. So, it's just this is just wrong on every level. It's basically there's no understanding of germs yet. However, technology has also caught up with bloodletting.

So, they can make it even more efficient to take the blood out of your body. Indeed. Just what you need on a battlefield, more ways of bleeding. Oh, what's that? Scarifier. What you would do is you'd [ __ ] the trigger, place it over the skin, and then you've got 12 blades come out into

the flesh. Just what you don't need if you're fighting off infection or or dealing with some wound or some other part of your body. While this idea of bleeding does really seem a bit horrible. Yes. Some advances were being made. George Guthrie was really at the forefront. One of the things he didn't like doing

was amputating. Now, considering what's gone earlier, that may seem a bit odd, but he believed in preserving limbs. So, if he was going to amputate your hand, rather than amputate the hand totally, he would try and preserve some fingers. So, it's a new way of doing things. It's a more selective way of doing things. One of his biggest

advances, uh biggest beliefs, was his opposition to this. This is the petit tournaquet. So, if you've got a wound, you apply this, you tighten it up, which I'm not going to do because it can cause damage. Mhm. He really didn't like this because it stops the blood reaching parts of the body, and it could cause serious damage. He

really didn't like this at all. Guthrie's approach to stop bleeding, serious bleeding, what he would do, he would instruct to dissect the skin, pull it back, expose the blood vessel, and then just suture that blood vessel. All right. It's a totally different way of doing things. The problem with it is if you're facing a mass of

injured men, how much time have you got? like it's quite time-consuming. It is very time-consuming. Easier to slap a tournaquet on the arm. Exactly. It's revolutionary, is it practical?

Now, there's another thing that Guthrie introduced, especially with dealing with gangrene, wasn't to amputate, but it was to try and debride, get rid of the dead flesh. So, keep keep the limb in place, but just get rid of the Exactly. stuff that was infected, right. And this was achieved using this. Sulfuric acid?

Watered sulfuric acid or nitric acid. Wow, just what, burn, just get the acid to burn off the Yeah. the rotting flesh. Oh, yes. And did that work? Well, it would do, yes, but again, you've got to limit the damage to with the healthy flesh. And would that be an extremely painful way of treating it?

When you've got the dead flesh, no. But when it hit the live flesh, oh yes. Don't forget you're not going to just be shaking this all over the wound. Exactly. You're not going to be pouring it over. You're going to be really administering carefully. Just to the dead flesh. Don't forget these people

are not butchers. They care about the patients. These surgeons did care. They weren't butchers and they cared. But sometimes there's nothing else for it. The limb has got to go. It's got to be amputation. Indeed, it does. Right, what's this? This is a joint of pork doing a brilliant imitation of a person who

needs to have their arm amputated. so imagine that's the torso and the arm stretched out down there. So we've got to get this bit off. How do we do that? Well, first off, in the American Civil War, you've got chloroform. Oh, but we lost. So, that would be placed over the your nose and mouth and the chloroform

would gently be dropped onto the material. You would breathe in the fumes. This isn't You breathe it in and you're out. It could take a minimum of 10 to 15 minutes to work. But it puts you to sleep. It'll put you to sleep. The downside is we have this image of amputations taking

a couple of minutes. In a war situation, it's a lot more difficult. You're going to have to deal with one after the other. For this, I'm using 20th century instruments. They didn't change all that much. Now, the cut, if I could just borrow your arm, would often be right round. We'd have applied a tourniquet at the

top to stop the bleeding. Cut round. You want to get the flesh off. Exactly. Right. You've made the incision to make it easier. There you go. There you go. Okay. So you got Nice smooth cut. Not Sorry. No sawing. You've got to cut through the muscle bundles. That's a good cut. That's a good cut. Okay.

Now we apply the bone saw. Okay? Different kinds of saws didn't change all that much. So, what you going to do? Hold on and I want you to cut through the bone as quickly as you can. Chloroform isn't about lying there gently out of it. The person will be moving. Okay. So, you're going to have assistants

holding the person down while you're doing this. Absolutely. Oh, that sound. And as quickly as you can. Okay. Why why what's why speed important? Less discomfort.

God, bone is tough. Oh, there we go. Excellent. Isn't that amazing? We haven't finished yet. Well, no, I can tell that. Now we've got to tie off all the major blood vessels. So, all the arteries and all the veins coming got to be tied off. Uh what do you mean tie them off?

Tie them off with a bit of a little bit of cotton twine. And the the severed limb? The severed limb thrown on a fire. Yeah. I found a few of those at the battlefield of Waterloo, so they're still there today. Yeah. The chloroform wear off, they're going to wake up missing an arm. Yeah. And that is going

to be extremely painful. Yeah. Um but don't worry because even in the American Civil War, people were still being bled. So, now you've got to be purged. You know, hopefully infection isn't going to set in. If I'm doing dozens of these operations, am I cleaning the tools in between? them off and that's it. Carry on.

So, if anyone's got a bad infection, I'm just spreading it to all the different Exactly. Right. God, there's bits of meat on the sole. If it doesn't require amputation, what else can you do to a wound to try and heal it? You're dealing with uh dead flesh, gangrenous flesh, and you don't want to amputate. There was

something that was introduced in the American Civil War. Okay, here we go. Maggots. Indeed. Oh. Maggots are excellent for debridement. The eating of dead flesh. Because in the Napoleonic Wars they were using the acid. Yeah. Now they're using maggots. Yeah. Don't try and escape, little fellow. So this was introduced during the American Civil War. Still used today.

What they use today is the maggots of green bottles, which like eating meat, specially bred sterile. Put them into ulcers. And where there's dead flesh, um they do a nice clean job of eating all that horrible dead flesh. So they like dead flesh, they don't like healthy flesh. No. That's handy, isn't it?

It is. So I could put them on my hand? Yeah, go on. There you go. Yeah, go on. And they're not going to eat my hand. No. Cuz it's just too healthy. Exactly. But stick them on some dead Oh, they're quite ticklish, aren't they? But you So you'd have these just crawling at Would you bandage them in?

You bandage them in. Well, that is weird. Yeah, you place them in, bandage them in. And that was first I said, first introduced in American Civil War. Still done today.

What about the weapons? Cuz through this period weapons are getting more and more lethal. Indeed they are. If you look at from the Napoleonic up to the American Civil War, we've got cannons, we've got artillery. They are killing swaths of people. Once you've been taken apart by a cannonball, by an artillery shell,

you're going to have great difficulty putting that person back again. There is an account from the Napoleonic Wars of when a soldier saw a cannonball bouncing along the floor and he decided to stick his foot out and try and stop it like a football. It took his leg off. Just shows Even going relatively slowly, there's so

much mass and momentum, they're just incredibly dangerous. Very dangerous. However, especially during the American Civil War, there was one weapon caused more damage than any other. It's a mini ball, more of a mini shell, used with a rifle that was responsible for the majority of injuries. What's different about that round compared to the the musket balls of a

previous generation? These are a bit more powerful. They're also a lot heavier. They're going to go into you and they might move around a bit once they're in there as well. All musket balls do that, but these are going to bounce around. But if you're if you're lucky enough and one of those has gone into you but

hasn't shredded your internal organs, are you still able to to extract them in the way that you know the previous surgery we've been looking at what they would have done? Oh, yes. Our man has been shot in the shoulder. He has. The treatment actually hasn't changed all that much. So, the first thing we're going to do,

I can see the entry wound. No exit wound. That means I get to probe in. Oh, that would have been painful. Oh. I hear metal on metal. Indeed. So, it doesn't go too deep, thankfully. Has it lodged in the shoulder? We don't know. Next thing we'll get We get the scalpel and enlarge the

wound. We have bullet forceps. Oh, this is the painful bit. Don't forget we've got anesthesia for this. That allows us to remove the shell. Then stop any bleeding, sew him up, apply any necessary oils, and he's good to go. Also, hopefully the shoulder hasn't been broke. But if there's infection, if the shoulder's broken, if it all goes bad,

it's coming off, is it? Yeah, well, we've got to wait and see what happens if gangrene sets in. If the infection has set in and it does get and it does go bad, yeah, there's every chance it will be amputated. He's been lucky here, that it's just gone into his shoulder, but things get a

bit ugly if it goes deeper into the torso, presumably. Right. If it goes too far into the abdomen, you've got a lot of organs there. A lot of a lot of soft things in there. Yeah, but they're processing food into waste. Any of that gets perforated, you're not going to survive. If it goes into

too deeply into the chest, they're not even going to bother filling around after the shell. It's too dangerous. So, really not good places. So, the triage system is basically designed to to find guys who've been sort of wounded in the extremities. So, if you've been shot in the guts, the triage system is against you.

Yeah. It's fascinating that was you know, people are still being hit by bullets today, so we're still treating these wounds. But obviously the understanding of of health and and the science around it has come on so far. Germs are relatively new discovery. We're in the 1860s, American Civil War. These things haven't caught on, but they did introduce quite

a revolutionary thing, carbolic acid. Carbolic acid comes from coal tar. It's an excellent antiseptic. It kills germs. The problem was they weren't using it for that. They were using it to drive away the bad air, the miasma. So, little do they know, they did actually have a brilliant antiseptic, but they just chose not to use it.

By spraying it around rooms, it probably did some good by uh killing the germs, but they really didn't realize it. Today, you can't really go um wafting around carbolic acid. It can be quite toxic. Carbolic acid did find its way into this stuff later in the 19th century, carbolic soap. If you have a whiff of it,

then you can imagine what it smells like. It smells like a hospital ward today. Very clean. Yeah. Yeah. Carbolic acid was to become a major thing. Joseph Lister, being the surgeon, discovered that if he placed a piece of material on an operating wound, the wound did not become infected. And took to operating in a steam of carbolic

acid and water. So, that gave to the rise of carbolic soap. It was a major move forward. So, he tried to what, to wash down the surfaces, even wash down their tools? Yeah. One of the proponents for the use of carbolic acid for sterilizing wounds was a American Army surgeon called Joseph Bill.

Now, in the 1860s, he's had to deal with arrow wounds. From bows and arrows. Yep. The American Indian wars. Now, he's puzzled because he's never had to deal with arrow wounds. So, he has to go back, and he admits this, to the medieval and Tudor writers to learn how to deal with arrow wounds. The truth

is, his treatment is the same. But, he's also forced to make new tools to remove arrows. And this is one of them. I've just taken a generic arrow head, so it goes down the shaft. down the shaft, down the Then you get to this bit, and then you have to open slightly. Open slightly.

Oh, that must have been painful. And then, close, catch it, and then allows you to then remove the arrow. And this brings us back to the medieval surgeon uh Theodoric, who said that every day surgeons are creating new tools and new techniques. Applied back then, applied in the 19th century, and of course today.

So, Kevin, it really feels that in this period, yes, the technology has advanced, the tools are getting better, but now at last we have this real revolution in understanding disease and pain and cleanliness, and we're entering the modern world. Indeed, we are. We've got now anesthesia, we've got the antiseptics being introduced, we've got

an understanding of germs. We're entering, I'd just say, the modern world.