Amputation saw

By Dr Bob Weston
Amputation saw held in the Victoria and Albert Museum, metalwork and ceramic collection

This saw, little different from one which could be found in a carpenter’s shop or blacksmiths’ forge, would have been used to amputate the limbs of patients requiring surgery around 1660-1670. Historically, amputations were ordered when a limb had been severely damaged, often in war, or when infected with gangrene. Yet the excision of an arm, a hand, a foot or a leg, was not undertaken lightly. The procedures were painful and dangerous, with a high risk of further infection leading to death. There were no antiseptics in use and hygiene was almost non-existent. Before the nineteenth century there were no anaesthetics – at best, the patient would be given laudanum, an opium based narcotic, or perhaps strong liquor.

Emotionally, patients contemplating amputation surgery would have been extremely fearful. Only the prospect of pain relief from the removal of the injured or diseased limb may have countered their dread. The English surgeon William Cheselden (1688–1752), remarking on surgical operations in general, wrote that ‘no one ever endured more anxiety and sickness before an operation, yet by the time I began to operate, all uneasiness ceased’. [1] Edward Alanson (1747–1823) noted that: ‘The mental Sufferings of the Diseased [undergoing an amputation] will ever be considered, by the humane Practitioner … after the Tourniquet is applied, every Moment’s Delay detains the patient in a most painful State of Mind’. [2] Surgeons were clearly aware of the emotional stress imposed on practitioner and patient when an amputation was to proceed.

Amputation surgery, as can be seen in Image 1 below, started by tying a tourniquet above the section to be cut off; then a knife was used to cut right around the flesh before the bone was sawn through.

image-1-1
Image One: Hans Von Gersdorff, Feldtbuch der Wundartzney (Strasbourg, 1540), 164, Bibliotheque-interuniversitaire-de-sante, (Cote 021654, Image 01090) Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0.

In the seventeenth century, amputations were often carried out in hospitals. In 1577, William Storey, surgeon, was paid By St Bartholomew’s Hospital 13s. 4d in relation to the cutting off a woman’s leg ‘which otherwise would have rotted off’ (Later in 1699, a surgeon’s fee was set at 6s. 8d. for each amputation). [3] Amputations were also performed on the battlefield or aboard a ship — conditions hardly conducive to cleanliness. Joanna Burke cites the case of a British soldier, Sergeant Thomas Jackson who had his foot amputated in 1814:

‘A pint of red wine … which Jackson “eagerly drank, rejoicing that, in an instant it wrought a wonderful effect, and raised up my spirits to an invincible courage”. … Wielding a knife “much like that of a shoemaker”, the surgeon tightened the tourniquet and, ‘setting the edge of the knife on the shin bone, at one heavy stroke, drew it around until it met with shin bone again’. Blood flowed downwards “like a beautiful red fan” frightening the witnesses, who screamed as though they were being cut”. The surgeon then “forced up the flesh towards the knee, to make way for the saw” … When the surgeon began sawing through the bone, Jackson’s tone became less hearty. It was “extremely painful”, Jackson remembered because the saw was “worn out” and got stuck. … The operation lasted an agonising half hour. [4]

Jackson complained that the hospital staff were not very nice to him, and described the suffering of another soldier in the next bed who “Went mad … with his pain” and died in his agonies”. [5]

The American surgeon William Beaumont (1785–1853) described the conditions in a battlefield hospital during the American War of Independence as follows:

A most distressing scene ensues in the Hospital — nothing but the Groans of the wounded and agonies of the Dying are to be heard. The Surgeons wading in blood, cutting off arms, legs, and trepanning heads to rescue their fellow creatures from untimely deaths. To hear the poor creatures crying, “Oh, Dear! … Oh, my God, … Doctor! Do cut off my leg, my arm, my head, to relieve me from misery!” would have rent the heart of steel… It awoke my liveliest sympathy … My God! Who can think of the shocking scene when his fellow-creatures lie mashed and mangled in every part … with-out having his very heart pained with the acutest sensibility and his blood chill in his veins. [6]

Clearly the emotions of surgical practitioners and onlookers ‘wading in blood’ were stirred by the suffering of their wounded patients begging and crying out for surgical treatment.

The elaborate handle of the amputation saw in the Emotions3D collection is made of ebony inlaid with ivory and amber — all exotic and expensive materials — carved in the shape of a goose head. This suggests that parts of the instrument were made by a talented craftsman. The V&A catalogue outlines that the head of the saw may have originated in India, even though the rest of the saw was possibly made in the commune of Brescia in Italy.

The blade of the saw is made of steel, like its chiselled and engraved frame. The masks and floral ornamentation on the frame of the saw are complemented by hand grips at each end, which would have aided the movements of the surgeon to saw quickly and cleanly through bone. The use of ebony and ivory for surgical instruments was not unusual, but the composite nature of the saw, with its decorative handle from India, suggests that it belonged to a wealthy surgeon who sought to impress his patients.

The saw was an instrument which the surgeon used only when there was no other option. John Woodall (1570–1643), a renowned military surgeon, described this instrument as ‘great and terrible’ and that though a surgeon should have two blades, ‘one good blade well used will serve an Artist for his whole life.’ [7] For the surgeon its use called on his courage and belief in his capabilities. For the terrified patient it represented extreme pain; small wonder he or she were often blindfolded before it was used.

Material objects are often sites of conflicted and competing emotions, yet the fear experienced by patients undergoing amputation would have infused most if not all emotional responses to this object throughout its history. Although akin to the tools of craftsmen and builders, the amputation saw is an instrument of terror — from its carefully crafted head to the shape of the handle at its other end, ergonomically designed to fit in the hand of the surgeon to expedite amputation procedures as horrified witnesses looked on.

Do you feel a sense of terror when you look at the 3-D replica of the saw? Tell us in the comments below.

About the author

Dr Robert Weston is an Honorary Research Fellow at the University of Western Australia. His interests are focussed on early modern European medical history.

References

1.  William Cheseldon, The Anatomy of the Human Body (London, 1711), 334.

2. Edward Alanson, Practical observations upon amputation, and the after-treatment. By Edward Alanson, Surgeon to the Liverpool Infirmary (London, 1779) 2nd edn, 5.

3. Norman Moore, The History of St. Bartholomew’s Hospital, London 2 vols. (London, 1918), II, 350, 387.

4. Joanna Burke, The Story of Pain: from Prayer to Painkillers (Oxford, 2014), 271.

5. Ibid.

6. William Beaumont, ‘Letter of 27 October 1812’, in Life and letters of Dr. William Beaumont, including hitherto unpublished data concerning the case of Alexis St. Martin, ed. Jesse S. Myer (St Louis, 1912).

7. John Woodall, The Surgeons Mate, (London, 1627), 7.

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