an illustration of a hip joint operation

Disarticulation at the hip joint (author’s collection).

In his latest medical blog, Mick Crumplin discusses one of the most difficult and dangerous medical procedures of the Napoleonic wars

Sometimes we must marvel at how far human endurance can be stretched. This operation is an extremely stressful one, performed 200 years ago, 31 years before the discovery of anaesthesia. It entailed removal of the whole leg, by cutting into the hip joint and taking the thigh bone’s head out of its ball-and-socket joint. The hip-joint is the largest and strongest joint in the body. It is surrounded by powerful muscles. Removal of a whole limb at a joint is called a disarticulation.

“a choice between death, or a big operation with only a 5-10% chance of survival”

When the hip joint was damaged by a bullet or grape (or case) shot during the long wars against France, survival was unlikely and if the patient did live, his or her health would be severely compromised by lack of mobility and life-threatening infection. So when a serious wound of the hip joint occurred all that time ago, it was a choice, either between death, or a big operation with only a 5-10% chance of survival. This was assuming you, as an otherwise reasonably healthy patient, had the best surgeon operating on you. We would shudder at such a choice, but, although some patients refused surgery, a few did not. There was no pain relief, blood transfusion or good post-operative care for these victims.

A French surgeon named Monsieur Bourgery reported that the operation had been done three times in 1794, at the beginning of the French Republican wars. It was rumoured that there was a single survivor. The notable French surgeon, Baron Dominique Jean Larrey reputedly carried out this enormous procedure seven times in various campaigns in Russia and Europe, in which he served his Emperor, Napoleon. He thought that one or two survivors had been seen in Poland, yet none had returned to France. The first successful disarticulation at the hip joint by a British surgeon was performed by a Mr David Brownrigg, surgeon to the forces near Merida in December 1811, during the Peninsular War. His two previous attempts had failed. Unfortunately there were no case records for this operation.

“De Gay survived as a tribute to the patient’s stoicism and the British surgeon’s skill”

However, the first properly recorded case of successful amputation at the hip was performed by British surgeon George Guthrie after the Battle of Waterloo, on a French prisoner-of-war. François de Gay, of the 45th infantry regiment had lain for several days out on the battlefield. A musket ball entered his right buttock and shattered his right hip joint. Guthrie was one of the few British surgeons capable of doing this operation. The exhausted de Gay at first refused, then relented and agreed to surgery. In Brussels Guthrie operated on his patient on the 7 July – 19 days after the injury. Assisted by two very experienced surgeons, this large operation (see image above) only took about half an hour. The patient lost roughly a pint and a half of blood (about 720 mls.) He was then put to bed, given some lemonade and a dose of laudanum.

His wound became infected (a usual course of events in those days), but by the 12 July he was taking chicken broth, wine and tea. Surgeon Larrey, now a prisoner-of-war after Waterloo, visited de Gay on 19 July. After transfer to England, de Gay was seen by the Duke of York at the York Hospital in Chelsea, after which he was transferred to a military hospital in Paris. He survived as a tribute to the patient’s stoicism and the British surgeon’s skill.