The controversy over saving limbs

In addition to arguing against the routine amputation of limbs – which, in his day, was practiced with alarming regularity – Albany’s Dr. John Swinburne fought the medical establishment on the subject of “resection” “extension” of broken limbs. For major fractures of the arm and leg, it was established practice to apply a splint and let the fracture heal in place, almost no matter what angle the bone had come to, or to amputate. This resulted in people with shortened and crooked limbs who were hobbled for the remainder of the lives by a simple broken bone. Dr. Swinburne adopted and proselytized for a new technique, known as resection, extension and counter-extension, by which the bone was set back in place as it should have been, the bone and muscles allowed to heal in their natural position. He had ample opportunity to practice his method on the battlefields of the Civil War, where bullet frequently shattered bone, and where amputation was applied like Band-aids. The results were nothing short of phenomenal. One would think the medical community would have been anxious to adopt a technique that not only didn’t kill the patient (as amputation did with, again, alarming regularity), but allowed him to go through life without the nickname “Gimpy.” Dr. Swinburne’s papers on the subject, and his instruction of others in the technique, brought vehement opposition.

The “Medical and Surgical Reporter” in 1862 praised Dr. Swinburne’s technique:

“We have seen limbs that were badly wounded, in which amputation seemed almost unavoidable, but which were saved in spit of all the disadvantageous circumstances that followed their dressing. A few days ago we met one man belong to a New-York regiment, who had the upper portion of the humerus shattered by a minie-ball. How few surgeons on the battle-field would have thought of any thing but amputation in this case! Yet exsection of the humerus was performed [by Dr. Swinburne], several inches of bone removed, and dressing applied; and the man passed through all the ordeals mentioned above, and now has an arm that is useful for many purposes. He does not even ask his discharge from the army, but intends going home on a short furlough, and then entering the cavalry service, where he says he can manage his horse with the injured arm, and wield a sword with the sound one. How much better that than amputation at the shoulder-joint!”

His advances brought highly critical correspondence his way, which is well-chronicled in “A Typical American.” Their tone, particularly with regard to his practice of doing away with splints and allowing the muscle to support the bone, made it seem as if he had angered the splint lobby, as doctor after doctor wrote to assert that his results were impossible or dangerous. One wrote of Swinburne, “His honest efforts to prove the opposite state of things only shows how skilfully he can ride his ‘hobby.’ . . . Dr. Swinburne must pardon me when I give it as my conviction that he is indeed a bold surgeon to advocate a plan of treatment which is so universally acknowledged to result in non-union. In reference to the good results obtained by this practice as applied to this bone, I can only express my astonishment.” The letter was signed “Splints.”

But others did support him, and the numbers showed why. Dr. W. Van Steinburgh of the 55th New York Volunteers adopted Swinburne’s method on the battlefield. He reported that of 21 cases of compound fractures he treated with Swinburne’s method, 19 recovered with tolerably useful limbs. Of twelve amputations he performed, ten died; of thirteen “excisions of the shaft, all but one resulted fatally.”

Our other mentions of Dr. Swinburne:
Champion of the Limbs
Who put the Swinburne in Swinburne Park
Mayor Swinburne