Mending Broken Soldiers: The Union and Confederate Programs to Supply Artificial Limbs by Guy R. Hasegawa (review)

One of the iconic images of Civil War medicine is titled Field Day. This shadowy photograph depicts eight tagged amputated feet and legs lying in a neat but ignominious interlocking pile on the ground; its title, while an obvious allusion to the trauma of the battlefield, could equally describe the numerous capital operations performed daily by army surgeons in the field. For those soldiers who survived such major amputations, it meant that they would be in need of a prosthesis enabling them to function somewhat normally when they returned to civilian life. In Mending Broken Soldiers: The Union and Confederate Programs to Supply Artificial Limbs, Guy R. Hasegawa, pharmacist, journal editor, and avid contributor to Civil War medical history, describes how thousands of disabled soldiers along with some sailors from both the North and the South were supplied with prosthetic legs (mostly) as well as arms and hands. It is a poignant story.

If a Civil War soldier survived being struck by a bulky .58 caliber Minié musket ball or a six-pound canon ball, more than likely his still life-threatening wounds included shattered bones in his extremities. In the latter circumstances, fingers, toes, arms, feet, or legs were amputated; Hasegawa relates that about sixty thousand such operations, with a survival rate in the region of 75 percent, were undertaken during the war. But of those forty-five thousand probable survivors, only men missing limbs would be in need of a prosthetic—even just after the commencement of this conflict it was obvious that demand was going to far exceed normal supply of these items. In the North, the resourceful and capable surgeon general William A. Hammond allocated $15,000 at the beginning of the war to buy artificial limbs for his maimed troops; by 1865 this budget item was $300,000. Hammond also formed a select surgical advisory panel to evaluate and recommend devices suitable for soldiers and to assist in approving manufacturers for supplying the government, established a standardized price scheme for prosthetics based on bids, and devised an army hospital network for the distribution and fitting of artificial limbs for eligible soldiers. According to Hasegawa by May 1867 in excess of 6,700 limbs had been supplied to men, and “[a]lthough not all recipients were satisfied with their prostheses, the program was a remarkable logistical accomplishment and an important milestone in the government’s commitment to care for its wounded soldiers and sailors” (p. 45).

The North’s system for mending broken soldiers seems to have enjoyed some success; this was also an early American venture into federally government-funded healthcare. In contrast, the model deployed in the South and its results were totally different. The antebellum South relied heavily on northern suppliers for artificial limbs, so that avenue was severed after the onset of war. As hostilities continued, materials to support a faltering southern prosthetic industry soon dwindled, resulting in both a poorly manufactured product and limited numbers. By 1864 perhaps as many as eleven thousand men needed some kind of prosthetic, a situation that the Association for the Relief of Maimed Soldiers (ARMS), formed in Richmond, Virginia, that year, hoped to address. Despite the dedication and effort of key ARMS personnel, this group was entirely dependent on voluntary civilian financial donations, not government funding, thus it could not fulfill its mandate and mission due to insufficient backing; between 1864 and 1865 the association ordered only 768 artificial legs, with fewer than half that number actually delivered. Despite this overarching story of failure in the South, embedded in it is another of southern industrial success vis-à-vis artificial limbs: James E. Hangar, an engineer and perhaps the Civil War’s first recorded amputee, at the time established a fledging artificial limb company in Virginia that eventually prospered to its current status as a national $800+ million company (it...