During the Civil War union surgeons performed nearly 30,000 amputations. Surgical manuals, with illustrations, explained the proper way to amputate. Surgeons were taught that an amputation should be performed within the first two days following injury. The death rate from these immediate amputations was lower than the rate for amputations performed after the wound became infected. Practical restrictions on both time and need forced doctors with little or no prior surgical experience to amputate.
1862. Private Patrick Hughes, Co. K, 4th New York Volunteers, was wounded at the battle of Antietam.
Private Hughes survived, but when he sneezed, a cone would protrude from the wound site.