Forever known in history as the main subject in artist Thomas Eakin’s The Gross Clinic (1875), Dr. Samuel D. Gross of Pennsylvania was one of the country’s most well-known and respected trauma surgeons at the time of the American Civil War. In 1862, Dr. Gross wrote A Manual of Military Surgery, or, Hints on the Emergencies of Field, Camp, and Hospital Practice to be read and used by United States Army surgeons in the field during the war. At that time, he served as the surgical consultant for the Surgeon General of the United States Army, William Alexander Hammond. Although Dr. Gross himself never served as a military surgeon, his experience as a student and professor of surgery helped him in his understanding of operating on the human body. In his 1862 Manual, Dr. Gross laid out a list of “circumstances may be enumerated as justifying, if not imperatively demanding, amputation in cases of wounds, whatever may be their nature.”
“1st. When a limb has been struck by a cannon ball or run over by a railroad car, fracturing the bones, and tearing open the soft parts, amputation should, as a general rule, be performed, even when the injury done to the skin and vessels is apparently very slight, experience having shown that such accidents seldom do well, if an attempt is made to save the limb, the patient soon dying of gangrene, pyemia, or typhoid irritations. The danger of an unfavorable termination in such a case is always greater when the lesion affects the lower extremity than when it involves the superior.
2nd. No attempt should be made to save a limb when, in addition to serious injury done to the integuments, muscles, or bones, its principal artery, vein, or nerve has been extensively lacerated, or violently contused, as the result will be likely to be gangrene, followed by death.
3d. A lacerated or gunshot wound penetrating a large joint, as that of the knee or ankle, and accompanied by comminuted fracture, or extensive laceration of the ligaments of the articulation, will, if left to itself, be very prone to terminate in mortification, and is therefore a proper case for early amputation.
4th. Gunshot wounds attended with severe comminution of the bones, the fragments being sent widely around among the soft parts, lacerating and bruising them severely, generally require amputation, especially in naval and military practice.
5th. Extensive laceration, contusion, and stripping off the integuments, conjoined with fracture, dislocation, or compress and pulpification of the muscles, will, in general, be a proper cause for the removal of a limb.
Amputation is not to be performed, in any case, until sufficient reaction has taken place to enable the patient to bear the additional shock and loss of blood.“
- Samuel D. Gross, A Manual of Military Surgery, or, Hints on the Emergencies of Field, Camp, and Hospital Practice (Philadelphia, PA: JB Lippincott, 1862), 75-76.