Deep wounds of the arm, leg, chest, and abdomen presented often-impossible problems for Civil War Surgeons. One of the only instruments available for seizing and holding displaced or severed arteries was the sharp, slender hook called a tenaculum.
The word was borrowed from Medieval Latin tenāculum (usually in plural tenācula) “forceps, pincers,” going back to Latin, “instrument for gripping,” from tenēre “to hold, occupy, possess” + -āculum, probably after retināculum “rope, cable” The first known use of a tenaculum was in 1693.
A tenaculum is a surgical instrument, usually classified as a type of forceps.
It consists of a slender sharp-pointed hook attached to a handle and is used mainly in surgery for seizing and holding parts, such as blood vessels.
The original, Civil War era medical instrument was called a ‘tenaculum’, used by Surgeons in performing operations after amputations. It was used to pull out the arteries from the stump in order to tie them off.
Silk suture material was placed around the instrument and after the artery was extruded, the suture was slid from the tenaculum over the artery or vein and tied. The well-known instrument maker Gemrig or Tiemann made many of these.
The tool measures 6 ¾” total length and has a checkered, 4” long gutta-perch handle with a 2¾” long steel tip with a pronounced curved hook at the end. Maker’s name was usually stamped on the steel shank.
The surgeon would hook and hold the blood vessels with the instrument as an assistant or second surgeon tied them off to control the bleeding.
Union Surgeon William Williams Keen explained this process when he said,
“The surgery of the chest lagged far behind that of the head and the abdomen because when the chest was opened the lung collapsed and breathing became embarrassed, or impossible, if both sides were opened.
“In the depths of a wound, the tissues could not be seized and drawn up to the light and the bleeding vessel quickly clamped. Our only resource was to try to pass a tenaculum through the vessel and tie it with silk. Usually we were only successful after several attempts.
“Meanwhile that vessel and others were all bleeding; the others had to wait their turn. We had no retractors by which we could get a good view of the depth of such a wound.”
The hook-like tip of the tenaculum helped pull back tissue so that the surgeon could better observe what he was cutting with a scalpel. He further stated,
“In the application of the ligature we may have occasion for the following instruments. For securing arteries, in amputations, the forceps and tenaculum have been spoken of, by many, as being equally useful.
“We have a decided preference for the tenaculum, and have to remark, that very often, there is not sufficient attention paid to the pointing of this instrument; a dull or clumsy tenaculum will greatly hinder the most dexterous surgeon,, in taking up arteries of small size. We also prefer the small hooks, found in common pocket cases, to those, more straight, put into amputation cases.
“The former are more convenient, because a ligature looped about its shaft can be slipped most easily over the point — the latter is generally, in large arteries, passed too far through the vessel. The difficulty occurs in slipping the noose or loop over its point.
“To avoid the unseemly appearance of the blood spurting over the surgeon, and his assistants, in arteries that cannot be obstructed by the tourniquet, the surgeon should hold the forefinger of the left hand over the mouth of the bleeding vessel, a little above the point of the tenaculum, which he holds in the right hand.
“The assistant should learn to pass the loop of the ligature over, and below the point of the tenaculum, and direct it to its proper situation around the artery, which, in all cases, must be as close to the divided parts as possible. He should do this without seeing either the mouth of the vessel, or the point of the book, which is readily done by the sense of feeling, after a little practice.”
A spring tenaculum is designed to enable the surgeon to tie an artery without assistance. The instrument was be found extremely limited in its use. It was found that the Surgeon could hold the artery better with it than the commonly used tenaculum.
When an artery in a healthy condition was to be ligated, the surgeon seized the open end of the vessel with a tenaculum by inserting the point of the instrument into its coats, drawing it out of its sheath and separating it as much as possible from the surrounding tissues, especially from the accompanying nerves.
If done incorrectly, it could produce violent neuralgic pains, or tumors. This might result in preventing the wound from healing for a long time by the retention of the ligature.
A very different version of the tenaculum was commonly used in gynecology for over the last 100 years.
This different version with the same name may confuse modern medical staff observing a reenactor conducting an amputation.
While this instrument bears the same name as the Civil War instrument, it is radically different.
The predecessor of cervical tenaculum was a forceps bullet extractor – a common surgeon’s tool used to extract bullets on the battlefields.
During the Civil War in the United States, this tool was used to remove bullets from the patient’s body or to pull out arteries to tie them off.
Inspired by the shape of the bullet extractor, French doctor Samuel Jean Pozzi, a pioneer of modern gynecology, developed, at the end of 1800’s, a gynecological tool called the Pozzi forceps, also known as the tenaculum. Since then, its shape has hardly changed.
Until next time….
Your Obt. Servant,
Surgeon Trevor Steinbach
17th Corps Field Hospital