No sooner have you opened the door than you are assailed without warning by the sight and smell of about forty or fifty amputees and critically wounded, some of them on camp beds, but most of them lying on the floor … Now, if you have strong nerves, go through the doorway on the left: that is the room in which wounds are bandaged and operations performed. There you will see surgeons with pale, gloomy physiognomies, their arms soaked in blood up to the elbows, deep in concentration over a bed on which a wounded man is lying under the influence of chloroform, open-eyed as in a delirium, and uttering meaningless words which are occasionally simple and affecting. The surgeons are going about the repugnant but beneficial task of amputation. You will see the sharp, curved knife enter the white, healthy body; you will see the wounded man suddenly regain consciousness with a terrible, harrowing shrieked cursing; you will see the apothecary assistant fling the severed arm into a corner; you will see another wounded man who is lying on a stretcher in the same room and watching the operation on his companion, writhing and groaning less with physical pain than with the psychological agony of apprehension; you will see fearsome sights that will shake you to the roots of your being; you will see war not as a beautiful, orderly, and gleaming formation, with music and beaten drums, streaming banners and generals on prancing horses, but war in its authentic expression – as blood, suffering and death.23
The use of anaesthetics enabled Pirogov and his team of surgeons to work extremely quickly, completing over a hundred amputations in a seven-hour day by operating simultaneously on three tables (critics said he ran a ‘factory system’). He developed a new type of foot amputation at the ankle, leaving part of the heel bone to give added support to the leg bone, and generally, in his amputations, cut much lower than most other doctors to minimize the trauma and loss of blood, which he understood posed the greatest threat. Above all, Pirogov was aware of the dangers of infection (which he thought came from contaminated vapours) and made a point of separating post-operative patients with clean wounds from those whose wounds were discharging pus and showing signs of developing gangrene. Through all these pioneering measures, Pirogov achieved much higher rates of survival than the British or the French – up to 65 per cent for amputations of the arm. For thigh amputations, the most dangerous and common in the armies of the Crimean War, Pirogov had survival rates of around 25 per cent, whereas only one in ten survived the operation in British and French hospitals.24
The British were much less enthusiastic about the use of anaesthetic than the Russians or the French. Shortly before the British army left Varna for the Crimea, the principal medical officer, Dr John Hall, issued a memorandum in which he cautioned the army’s surgeons ‘against the use of chloroform in the severe shock of serious gunshot wounds … for however barbarous it may appear, the smart of the knife is a powerful stimulant; and it is much better to hear a man bawl lustily than to see him sink silently into the grave’. British medical opinion was divided on the new science of anaesthesia. Some feared the use of chloroform would weaken the patient’s ability to rally, and others thought it was impractical to use it in battefield surgery because of the shortage of qualified doctors to administer it. Such attitudes were closely linked to ideas about withstanding pain that were perhaps peculiar to the British sense of manliness (keeping ‘a stiff upper lip’). The notion that the British soldier was immune to pain was commonplace. As one doctor wrote from the Crimea:
The pluck of the soldier no one has yet truly described. They laugh at pain, and will scarcely submit to die. It is perfectly marvellous, this triumph of mind over body. If a limb were torn off or crushed at home, you would have them brought in fainting, and in a state of dreadful collapse. Here they come with a dangling arm or a riddled elbow, and it’s ‘Now doctor, be quick, if you please; I’m not done for so bad, but I can get away back and see!’ And many of these brave fellows, with a lump of towel wrung out in cold water, wrapped around their stumps, crawled to the rear of the fight, and, with shells bursting round them, and balls tearing up the sods at their feet, watched the progress of the battle. I tell you, as a solemn truth, that I took off the foot of an officer, Captain –, who insisted on being helped on his horse again, and declared that he could fight, now that his ‘foot was dressed.’25
