The loss of limbs through trauma, childhood illness and congenital disorders and the subsequent use of artificial devices to restore function has been recorded since ancient times. Workplace accidents and disease were particularly common causes of surgical amputation in heavily industrialised areas like North Lanarkshire. In this article, we take a look at a few accounts relating to the history of amputation and use of prosthetic limbs.
Under the knife
Surgical amputation is known to have occurred in ancient history but until relatively recently it was a very risky business. One of the most dangerous aspects was the inability to control blood loss during surgery. Ancient Greeks and Romans used ligatures to tie off blood vessels but this method appears to have been forgotten for many centuries. It was replaced with cauterisation (sealing the wound by burning it) with boiling oil or hot irons. The (re)discovery of ligatures in the sixteenth century led to a higher survival rate, as did the introduction of the tourniquet in the seventeenth century. Joseph Lister (1827–1912) promoted sterile surgery through the use of antiseptics, which also helped to make surgical procedures safer from the late 1860s, but anaesthesia was the big surgical development of the nineteenth century.
Something in the air
Surgical anaesthesia was not used until the mid-1800s. Some anaesthetising agents, including ether, had been synthesised centuries earlier, and the European Age of Enlightenment led to the study of gases, but clinical use was still unknown. The first anaesthetic, nitrous oxide or ‘laughing gas’ was used by Cornish chemist Humphrey Davy (1778–1829) in 1799. This was followed in 1846 by American dentist William T G Morton (1819–1868) publicly performing a painless tooth extraction on a patient, thus demonstrating ether as a surgical anaesthetic for the first time.
James Simpson (1811–1870) was an obstetrician from Bathgate, West Lothian. In 1847 he conducted the first demonstration of the anaesthetic properties of chloroform on humans. Prior to this, chloroform as anaesthesia had only been tested on animals in the 1930s. Simpson’s initial demonstration was not undertaken as a medical procedure but as a form on entertainment on two (presumably willing) dinner party guests! Just a few days later, the procedure was repeated for surgical purposes by Edinburgh dentist Francis Brodie Imlach (1819–1891). By the 1850s chloroform was being produced commercially. Despite reservations about its dangers, chloroform remained popular until the early to mid-twentieth century, when nitrous oxide began to make a comeback.
Dragged to Light! The British Medical Association and the Analyst Dragged to Light was published in the early twentieth century. Written in support of ‘quack doctors’ and herbalists, the book contains several satirical cartoons attacking the medical profession and modern science. One such cartoon, is titled “HOW TO CURE CORNS – CUT OFF THE TOES. This is the latest scientific remedy. Oh! For shame!” (p.48) suggesting that doctors are too quick to wield the amputation knife.
The latter part of the book is given over to correspondence by patients seeking cures or extolling herbal remedies. It includes a letter from Scotland (pp.142-3) under the heading BARBARISM THAT DUMBS THE TONGUE, in which the unnamed correspondent asks for advice regarding various ailments that appear to stem from wrongful amputation:
About 18½ years ago I had my right arm amputated just at the elbow joint through a sprained wrist being wrongly treated. It was tubercular the surgeon said, and was too long in getting it off, and went through my system.
Trauma and infection
The above example citing tuberculosis (TB) was by no means unusual. A booklet published by the Wishaw Co-operative Society in 1912 as part of its “crusade against consumption” states:
…the public conscience has been awakened to a sense of duty that some efforts must be made to arrest the deadly march of the “white plague” and its ravage on human life.
In many cases, amputation occurs as a surgical measure to control pain and the spread of infection through diseases such as TB and severe cases of frostbite, which can lead to tissue death.
William Murray was born in Baillieston, later moving to Coatbridge when he married. As a youngster, he enjoyed activities like tree climbing. Aged thirteen, William fell from a tree, an accident that changed his life. He had badly injured his arm and subsequently developed gangrene, which resulted in the loss of the arm. Statistics show that a high proportion of upper extremity amputations are related to trauma such as this. William was treated at the Royal Infirmary in Glasgow, receiving 100 stitches. It took a full year to recuperate. Three years later, he was given the prosthetic arm pictured below. Despite the challenges this presented, William went on to live an active life and worked with disabled children, taking them swimming.
James ‘Jim’ Murphy (1961-2008) of Airdrie was born with only one fully developed arm. While carrying him, his mother had been given thalidomide, a drug initially developed as a sedative and first marked in the UK in 1958. Prescribed in 49 countries for a range of conditions, including pneumonia, colds and flu, it was also found to be effective in quelling the nausea experienced by many women during the early stages of pregnancy.
Thalidomide was issued for several years until a link was made between the drug and its impact on foetal development. A Government warning was finally issued in May 1962, just a few months after Jim was born. It is estimated that over 10,000 babies were affected by thalidomide, with the drug affecting the development of limbs, eyesight, hearing and internal organs. The mortality rate was almost 50%. Like many children affected by thalidomide, Jim was fitted with an artificial arm at the age of three or four, and another when he reached his teenage years. Both of these prosthetic limbs are pictured here. As well as facing physical challenges, including ill-fitting, uncomfortable prosthetics and phantom limb pain, thalidomide survivors and amputees commonly have to deal with prejudiced and discriminatory attitudes. You can read, listen to and watch accounts from thalidomide survivors on the Thalidomide Society website.
Life and limb
As is the case with many medical and technological advancements, some of the biggest developments in prostheses were closely connected with warfare. Indeed, the earliest known accounts of artificial limbs include a Persian soldier who fashioned a wooden foot and medieval knights who wore iron hands. Hinged hands and legs with locking knee joints were introduced in the sixteenth century by French barber surgeon Ambroise Paré (c. 1510–1590) but further developments to prosthetic limbs were slow in coming. James Hanger (1843–1919) was a confederate soldier and the first of many amputees created by the American Civil War. In 1871 he patented the Hangar Limb, which featured hinged joints at both the knee and ankle.
Since the millennium, prostheses have become stronger and lighter with the use of carbon fibre and other modern materials. Prosthetic enhancements have enabled athletes such as Oscar Pistorius (the South African “Blade Runner”) and British double-amputee champion marathon runner Richard Whitehead to compete on the world stage and challenge long-held attitudes towards disability. Recent advancements in biometrics, robotics and 3D printing are being used to manufacture personalised prosthetics, giving amputees both choice and a voice. People with disabilities still face many physical, institutional and societal barriers but these barriers are slowly being broken down, one step at a time. UK resources and support: