Surgical saws and tools have been in use since at least 3000 B.C. The first known surgical armamentaria, the equivalent of a Civil War surgeon’s kit, was found in Pompeii, and dates back to 79 A.D. (Kirkup 21). Surgeon’s tools at the time were composed from many materials, including copper, bronze, silver and steel (29). It was typical for surgeons to choose their own material for their tools, as well as help craft them, so there was a lot of variation from country to country. In the 15th century, tools became slightly more standardized, and the first widely used saw was the bow saw. This instrument was often highly ornamental, and was often extremely long, with some models reaching up to 67 cm. Surgeons were advised to keep an extra blade handy when performing surgery, as the blades would often snap during the procedure, due to their length and lack of reinforcement. Though the ornamental saws were quickly done away with, as the decorations often tore the tissue around the amputation site, the lengthy bow saws remained the popular choice for the next two centuries (387).
Surgical Saw Development Leading up to the Civil War:
The 18th century saw the rise of smaller saws with better adapted features. In fact, many of the saws that were used in the Civil War are very similar to those used today. The biggest difference between past and current saws is that while current saws are made from stainless steel, saws from the Civil War era were nickel based (Belferman 1). While the exact number of amputations during the Civil War is unknown, it is estimated to be around 70,000 total and accounted for 75% of all major surgeries performed (Trammell 46). Amputation was the standard treatment for any wound that created a compound fracture. Remarkably, around 75% survived the operations. This is most likely due to several advances made in surgical saws and tools just prior to the Civil War. In his book American Surgical Instruments, James Edmonson states that craftsmanship of surgeon tools in the 19th century was greatly improved and expanded due to new manufacturers, as well as an influx of immigrants who brought their own particular skills and knowledge from their native countries, and the older more established companies mixing together (44). Many advances and changes were also made during the Crimean War by British surgeons. Several major changes included the invention of a frame saw with an adjustable rotating blade in 1850 by the Butcher Company (Kirkup 202). The rotating blade gave surgeons the ability to be more precise in their incisions, as well as allowed them to cut out damaged tissue in such a way that sometimes did away with the need to amputate. A second major change to the saw was the rise in popularity of the pistol handle.
The handle was much easier to grip than the previous t-shaped handles usually featured on saws. Another major shift in saws had to do with the introduction of tenon saws. Tenon saws were smaller, and more accurate than the bow saw, which was still in heavy use. The saws were much less cumbersome, and were reinforced along the back. This allowed for more movement of the blade, as the blade could often pivot on the reinforcement, which helped the surgeon avoid damaging the soft tissue around an amputation site. The reinforcements also did away with the problem of blade breakage, which was the biggest downfall of the bow saw. Tenon saws became the most commonly used in Britain, and were widespread in the U.S. as well, though they were not nearly as popular in continental Europe (203).
Use in the Field
Surgeons were always equipped with a surgeon’s kit, a case that contained around 30 different tools (Trammell 51). The U.S. government purchased large numbers of specially manufactured kits from instrument makers at the time to distribute to field surgeons (Edmondson 50). Several main manufacturers of surgeon kits at this time were Jacob H. Gemrig, Horatio G. Kern, George P. and Henry C. Snowden and Dietrich W. Kolbe (43). These kits were usually made from mahogany and lined with velvet. As many Civil War doctors would later note, this was not particularly conducive to maintaining sanitation, as the tools would often go back into the kits after being hastily wiped off. Most kits consisted of two saws, the capital and metacarpal saw, along with many other forms of amputation knives, scalpels and other tools. These saws would be the capital saw and the metacarpal saw.
The capital saw was used for large bones, whereas the metacarpal saw was used for smaller bones. An amputation could not be made with only these tools alone though. A surgeon’s kit was supplemented with various amputation knives and scalpels, as well as a tourniquet and forceps (Trammell 51).
Edmonson, James M. American Surgical Instruments. San Francisco: Norman Publishing, 1997.
Trammell, Jack “‘Life Is Better Than Limb’.” America‘s Civil War 21.6 (2009): 46-51. Academic Search Complete. EBSCO. Web. 20 Oct. 2009.
Kirkup, John. The Evolution of Surgical Instruments. CA: Norman Publishing, 2003.
Belferman, Mary. “On Surgery’s Cutting Edge in the Civil War.” Washington Post 13 June 1996.