During the fall semester, 1969, archaeological excavation at the Royal Presidio of San Diego yielded a burial which is unusual in the annals of archaeology and which enables us to draw some inferences regarding early-day health problems and medical procedures in San Diego. At the same time, as has so often been the case at the Presidio, it has provided still another example of how archaeology can compensate for the inadequacies of history. In our attempts to recover the forgotten past, this particular instance also lends itself well to a demonstration of the uses of logic to interpret the always incomplete archaeological and historical data by first identifying the problems and then formulating and testing hypotheses in solving them.
What record we have1 shows only that the cemetery for the Presidio had been on one side of the chapel. Mr. Simon Mannassee2 stated that he remembered crosses in that area to the south and downhill from the chapel. He had been a member of the road-building crew which uncovered skeletons nearby. Although stray bits of human bone had been found repeatedly during excavations to the south of the chapel, the archaeological crew had found no intact burials. Evidently during the past there had been considerable disturbance in the area which had scattered a number of burials. We will probably never be able to learn all the reasons for the digging but we do know of two. Some years before the Mesa College class, under Professor Mike Axford’s supervision, began excavation in the area adjacent to the chapel on the south, San Diego State students tracing the outside of the south wall of the chapel uncovered two skeletons close to the base of the wall. The first burial was incomplete. The intrusion of the grave for the second skeleton had destroyed the upper half of the earlier skeleton. Archaeology had thus confirmed and clarified the record as to the location of the cemetery for the Presidio of San Diego, knowledge of which had long been forgotten. The second known cause of disturbance of the area was the digging of holes after 1930 for planting trees.
When finally uncovered, the burial turned out to be that of a right foot and leg—it had been amputated six inches above the knee. Owing to the evidence of disturbance and their failure to locate any undisturbed burials, the Mesa College students were understandably excited as Mike Banta’s trowel and brush uncovered first the bones of the foot and ankle, then of the lower leg, still lying in the position of articulation which denotes an undisturbed burial. Their surprise and disappointment were correspondingly great when, as Mike cleared away the earth from around the femur (the thigh bone), it was found to end abruptly. Careful exploration of the surrounding soil failed to reveal any of the rest of the skeleton.
An additional surprise came when it was observed that the end of the bone, instead of appearing irregular or jagged as would be the case had it been broken by postburial digging, appeared quite smooth and even. As the leg lay under the roots of one of the trees it was impossible to inspect the end of the femur visually. However, when it was explored by touch, it felt so smooth that it appeared probable that it had been sawn. This, together with the articulated position of the bones in the earth and the absence of the rest of the skeleton could mean only that we had, in fact, recovered the burial of an amputation in that longforgotten cemetery unused since 1870.
It is difficult to find plausible explanations for the rarity of such finds in archaeological excavation. One possibility lies in the concentration by archaeologists until recent years on the sites of peoples whose technology and surgical skills were inadequate to the performance of such an operation. The discovery of the skeleton of a Neanderthal man who had survived the amputation of his right arm above the elbow more than 45,000 years ago3 makes that explanation suspect. Certainly the life circumstances of any group at any time are such that causes for amputation are never lacking.
Six questions immediately spring to mind regarding this burial—who, why, when, how and by whom? (I am saving the sixth). At the moment we can answer the fifth as well as we are ever likely to; we can provide some reasonable hypotheses for the second but the first, third and sixth must wait on some time-consuming research.
Dr. Spencer L. Rogers, physical anthropologist at San Diego State whose specialty is bone pathology, has not yet completed his examinations but has been able to offer some suggestions as to the identity of the patient. He states that the individual was a physically mature but young female, who had been about five feet two inches tall, in all probability, who was apparently crippled in some way which caused her to drag her right foot and to heave her right leg around and forward in walking. The small bone of the lower leg (the fibula) is excessively bowed in comparison with a normal fibula, a condition which could have been caused either by rickets or by that leg having had to support the body’s weight while in an unnatural position such as that caused by a deformed foot. Dr. Rogers feels, however, that it would be unlikely for rickets to affect only one bone of a limb and that as the tibia (the larger bone in the lower leg) appears quite normal, a deformation is a more probable cause of the bowing of the fibula than rickets.
When it comes to the reason for the amputation we can only conjecture at this stage of the study of this burial. A radiologist, Dr. David B. Adams, has carried out X-ray examinations of the bones and Ben E. Esposito, M.D., has also examined them. Neither they nor Dr. Rogers have been able to find anything which might have necessitated the amputation and all three suggest gangrene as a probable cause but, unless more sophisticated examination reveals evidence imperceptible to the eyes and X-rays, we can only speculate as to what may have caused the gangrene. As the amputation was performed some time before 1870 it is quite possible that the concept of antisepsis had not reached San Diego, considering that Lister had only introduced it in surgery in Glasgow in 1868. Consequently any break in the skin of the leg below the point of amputation could have become infected; even an injury such as a bruise which impeded circulation in the lower leg could have resulted in gangrene.
At the moment, a tentative date for the amputation can be set as between about 1850 and 1870, long after the abandonment of the Presidio and the establishment of San Diego as more an anglo-American than an Hispano-American community. The latter date is established on the basis that the last burial recorded as having been made “on Presidio Hill” was as late as 1870 even though another (unnamed) cemetery4 and the Campo Santo5 had been established decades before. The earlier possibility is established by comparison of the condition of the bones with that of the bones of burials interred without coffins there, as was this one. These bones are in about the same state of preservation as those which have been tentatively identified as the remains of “an Indian named Jose, shot and killed near the Bandini House and buried on Presidio Hill” and so recorded in the old burial record. As has been explained elsewhere6 the organic remains at the Presidio have suffered chemical decomposition at a rate faster than would otherwise have been the case as a result of the creation of the park. It is because of that circumstance that a date of no earlier than 1850 is suggested at this time.
When the bones were removed from the earth it could be clearly seen that it had, in fact, been amputated by sawing. The regularity of the saw marks, when contrasted with the marks left by stone saws used by Indians in cutting rings from bones in prehistoric times, attests to the use of a metal saw in this case. Experiments were made with an old surgeon’s bone saw provided by Dr. Rogers and with an ordinary carpenter’s saw. They were used to cut sections from cow leg bones provided by a local butcher. The marks produced by the surgeon’s saw on the cow bone, where they can be seen at the start of the cut, are virtually identical with those on the sawed end of the femur. The marks produced by the carpenter’s saw were broader—a function of the larger teeth—and less frequently parallel, a function of the greater saw length making it more difficult to keep the hand moving in a straight line. Although this is not conclusive, it is a reasonable inference that a surgical saw was used to perform the operation. Both Dr. Adams and Dr. Esposito state, however, that the cut was made higher on the leg than is the case nowdays, even though the injury had to have been below the knee.
At least three further inferences can be drawn from the nature of the sawed surface of the femur. The location of the small “whisker” of unsawed bone where the amputated portion broke free from the rest makes it possible to determine almost certainly that the patient was lying on her back, which would have been the most probable position anyway. This being so, the position of the “whisker” is such that the surgeon was working from the left side of the patient, leaning across her left leg—unless the patient was elevated to above the surgeon’s shoulder height, which seems highly improbable in view of the fact that the surgeon could not have seen what he was doing very well in such a position. A difference between the sawed surfaces of the cow and of the human bone provides ground for the inference that it had not been possible to immobilize the leg of the patient completely during the operation. On the human femur the saw marks are apparent completely across the cut, whereas on the cow bones they are only perceptible for the starting strokes of the saw. The cow bone had been clamped in a vise, thus achieving complete immobility and only the variations in the strokes of the saw in the hands of the non-surgeon as he started the cut produced marks visible to the unaided eye. Thus it is possible that the operation might have been carried out under such circumstances that a proper operating table was not available to keep the limb from being moved, however little, by the action of the saw—there might not even have been such a thing in the San Diego of the time.
If the amputation was in fact performed with a surgeon’s saw, then another inference can be made as to the kind of person who might have carried out the operation. Such surgery was performed, of course, long before any special training for it was instituted so that on that score the evidence of the operation alone offers no clue as to whether it was performed by one trained in surgery or not. Unlike the kit used by James Ohio Pattie to vaccinate Californians against smallpox after his release from confinement in the Presidio of San Diego7, however, a surgeon’s bone saw is a special tool designed for a limited purpose. It would be surprising, therefore, to find that implement in the possession of anyone not a surgeon, hence the hypothesis that the amputation was in fact performed by one trained in surgery can be advanced. As doctors in that period, and especially in new communities, were often general practitioners by necessity, and as there were a number of doctors in San Diego by the early 1850’s8 it becomes virtually a certainty that a doctor performed that operation.
From the general history of anaesthetics it is possible to infer that the patient may not have had to resort to the old frontier device of “biting on a bullet” while undergoing the operation. If nothing else, there would have been alcohol available to deaden going the operation. If nothing else, there the senses at least, if not to render the patient completely unconscious. The soporific effects of opium, either straight or in the form of laudanum (tincture of opium) had been known since early in the century and, in view of the wide-ranging shipping between San Diego and the rest of the world, either might well have been available. The anaesthetic properties of nitrous oxide (“laughing gas”), ether and chloroform were all known by that time and if a surgeon was present in San Diego then it also seems quite possible that he would have had a supply of at least one of them.
From the circumstances of this particular burial plus some general history it is thus possible to reconstruct quite a bit about one incident in San Diego history which took place a century or more in the past. A young woman underwent the amputation of her crippled right leg, the operation most probably having been performed by someone with surgical training. Although it is unlikely that anything approaching even early antiseptic practice was used, some form of anaesthetic was very likely used. Even though some surgical equipment was available, a proper operating table may not have been, as only partial immobilization of the limb was achieved, perhaps merely by helpers holding it. The patient was placed on her back and the surgeon worked from the left side, leaning across the left leg.
Logic can be used to formulate possible explanations but they can only be tested by applying them to additional information. Another product of the exercise of logic is the perception of potentially fruitful lines of inquiry. For example it is possible that, in the small San Diego of 1850-1870, an operation of that magnitude might have been reported in a newspaper, thus providing us with a date and names and perhaps even the cause. Logic cannot be used, however, to provide a possible answer to the sixth question; archaeology might provide a probable answer if we were to find the right kind of burial, but the historical record may be the only place to seek the answer to the question, “did the patient recover?”
1. Engelhardt, 1920, page 146.
2. Mannassee, 1969, personal communication.
3. Coon, 1962, pages 103, 563.
4. Zink, 1969, pages 16-17.
5. Mills, 1969, page 13.
6. Anonymous, 1968, page 28.
7. Pattie, 1962, pages 185, 192-201.
8. Stanford, 1970, pages 5-6.
Anonymous, 1968. A Landscape of the Past—The Story of the Royal Presdio Excavations. The Journal of San Diego History, Vol. XIV, No. 4, October. Junipero Serra Memorial Museum, San Diego.
Coon, Carleton S. The Origin of Races. Alfred A. Knopf, 1962, New York.
Engelhardt, Fr. Zephyrin, O.F.M. San Diego Mission, 1920. The James H. Barry Company, San Francisco.
Mannassee, Simon, 1968. Personal Communication. Excavation notes, Presidio Archaeological Program.
Mills, James R, 1968. Historic Landmarks of San Diego County. The Journal of San Diego History, Vol. XIV, No. 3, July. Junipero Serra Memorial Museum, San Diego.
Pattie, James Ohio, 1962. The Personal Narrative of James Ohio Pattie. J. B. Lippincott Company, Philadelphia and New York.
Sanford, Leland, 1970. San Diego’s Medico-Legal History, 1850-1900. The Journal of San Diego History, Vol. XVII, No. 2, Spring. Junipero Serra Memorial Museum, San Diego.
Zink, Orion M., 1969. Places and People in Old Town. The Journal of San Diego History, Vol. XV, No. 1, Winter. The Junipero Serra Memorial Museum, San Diego.
Paul H. Ezell is Professor of Anthropology at San Diego State College. He has been involved in anthropology and archaeology for over thirty-five years. His work on the Royal Presidio Excavations and the Bancroft Excavations have shed much light on San Diego’s early history.