While trepanation may have had a spiritual significance, amputations were practical and essential in nature. Amputation, or the removal of a limb, was necessary in the case of severe injury or infection to a limb. The first amputations were likely performed in the Neolithic period; however, there’s no evidence of the patient surviving, and there’s a story of amputation told in the Indian Rig-Vega, dating to between 3,500 and 1,800 BCE.
By the time of Classical Greece, in the 5th century, surgeons provided clear explanations and instructions on amputation in cases of gangrene, explaining that the diseased tissue must be fully removed. Up until 100 CE, the operation was solely used to manage gangrene; however, after that time, it was also used to treat injury or other conditions. Hot oil and cauterization were used to prevent excess bleeding and infection; however, the risks were quite significant.
The introduction of gunpowder and firearms increased the need for amputation after the 14th century; however, the basic procedures were largely unchanged until improvements in tourniquets in the late 17th and early 18th centuries. Amputation procedures improved throughout the 19th century; however, mortality rates remained quite high, with deaths totaling around 85 percent during the Napoleonic Wars.
Amputation techniques and survival improved significantly following the introduction of both anesthesia and antiseptic practices in the 19th century. Increased survival also led to the development of improved prostheses. The majority of amputees prior to the Civil War likely had no access to prosthetics.