James Edward Hanger served in the Confederate Army for less than two days. His military experience was cut short after the first land battle of the Civil War, and Hanger holds the “honor” of being the first known amputee of the conflict. Devastated with the loss of his limb, Hanger turned his emotional trauma into ingenuity, creating an artificial limb that revolutionized prostheses and a business that continues to innovate and advance the field of prosthetic limbs.
Born in Churchville, Virginia in 1843, an eighteen-year-old Hanger dropped out of Washington College (now Washington and Lee) and enlisted in the Confederate Army on June 1, 1861.[1] That same evening, two thousand Union soldiers arrived in Grafton, Virginia (now West Virginia), precipitating the first land battle of the Civil War. Northwest Virginia was heavily contested during the critical early phase of the war, with Confederate troops, including Hanger, under the command of Colonel George Porterfield, headquartered in the strongly secessionist town of Philippi. Disorganized and undisciplined, these fresh troops still held the romantic beliefs that the war would be a grand adventure; one soldier would later call it “a holiday.”[2] However, the reality of war would soon arrive in Philippi.
Union forces under the command of General Thomas Morris, the ranking officer in Western Virginia, approached the Confederate camp, undertaking their first march of the war. Two Federal columns, one led by Colonel Benjamin Kelley and the other led by Colonel Ebenezer Dumont, arrived at the outskirts of Philippi on the morning of June 3. Taking the Confederates by surprise and waking many with the unfamiliar sound of artillery fire, the Union attack caused Porterfield’s men to run in retreat, pursued by Kelley’s regiment, the First Virginia Volunteer Infantry. While this symbolic chase of “loyal” Virginians after the retreating “rebel” Virginians ultimately ended in failure, with many of Porterfield’s 775 men withdrawing to Beverly, about thirty miles away, nevertheless, the “Philippi Races” (as called by Kelley’s troops to mock the cowardice of the Confederate soldiers) marked a Union victory.[3]
The Battle of Philippi was only a small skirmish relative to later Civil War battles, and indeed, is largely forgotten as the first land battle of the conflict. During the action, only six artillery rounds were fired, as well as a volley and a few sporadic shots of muskets. The only death was an Indiana volunteer who tripped during the night march and accidentally shot himself. Only five Union soldiers, including Kelley, were wounded, two Confederates wounded, and several others taken prisoner.[4] However, for Hanger, the events of Philippi changed his life. Indiana Private (and later, noted writer) Ambrose Bierce, in his account, noted almost off-handedly that they had “shot off a Confederate leg.”[5] A Wheeling reporter wrote, in more detail, that the leg, “which had been torn off by a cannonball, was picked up in the camp.”[6]
Hanger, camping in the hayloft of a barn at the outset of the battle, was hit by the third artillery round fired. A six-pound solid shot ricocheted into his left leg, shattering the bone and leaving him immobile until Union soldiers found him. Hanger was taken to the Philippi Methodist Episcopal Church, where Dr. James Robison of the 16th Ohio Infantry amputated the limb without any anesthesia.[7] While Hanger might have been the first soldier to lose a limb during the Civil War, the National Archives estimated that about sixty thousand soldiers on both sides followed in the next four years.[8]
Mostly due to advances in weaponry, amputations became commonplace during the Civil War. When soldiers were wounded, the two most common causes of death were severe blood loss and infection. The use of antiseptics did not become routine until after Joseph Lister’s landmark 1867 work, and in most cases during the Civil War, surgery was considered the best way to clean the wound. Furthermore, the newly-designed Minié ball was rifled, thus increasing the accuracy, range, and lethality compared to a smooth-bore musket. This type of bullet could cause severe damage to the body, resulting in the high casualty rates during the Civil War.[9] Artillery rounds, as in the case of Hanger and Union General Dan Sickles, whose leg was amputated at Gettysburg after being crushed by a twelve-pound cannonball, could also be extraordinarily damaging and completely mangle limbs beyond treatment.
Besides the direct damage caused by the Minié ball or artillery shot, entry wounds were not sterile. Oftentimes, debris such as shards of clothing, dirt, and even gun oil were carried into the body, creating the perfect environment for bacteria to grow and create infection.[10] To avoid this, amputation of the injured limb was considered to be the best way to save the life of the wounded soldier. This surgery did two things: tie the damaged blood vessels to staunch bleeding and prevent death from blood loss, and remove the damaged tissue, bone, and any extraneous material that could cause an infection. In other words, cleaning the wound via surgical removal would often prevent a generalized infection from developing.[11]
During large battles where thousands of men were wounded, frequent amputations were necessary. According to the National Archives, a skilled surgeon could amputate a limb in approximately five minutes, resulting in rapid and efficient surgeries that removed limbs en masse.[12] This led to gruesome imagery such as the infamous “pile of limbs” written about in many accounts of Civil War battles, most famously Walt Whitman’s description of his experiences at Fredericksburg.[13]
Losing a limb had a severe emotional effect on many veterans. In nineteenth-century American society, a physical disability was often viewed as a moral flaw. Losing a part of the body also meant that amputees lost a part of their manhood, which was strongly valued in 1860s society. As such, many veterans who lost limbs feared that society would cast them out.[14] This sentiment of isolation must have been extremely strong for Hanger as the first, and for a time, only amputee of the war. From his account, it is evident that he suffered from some psychological damage; as he said, “no one can know what such a loss means unless he has suffered a similar catastrophe. In the twinkling of an eye, life’s fondest hopes seemed dead. I was the prey of despair. What could the world hold for a maimed, crippled man!”[15]
With the cultural perception of physical disabilities, prosthetics were important not just for mobility, but also to help amputees fit into society. As Civil War soldier and future Supreme Court Justice Oliver Wendell Holmes wrote in 1863, “At an age when appearances are reality, it becomes important to provide the cripple with a limb which shall be presentable in polite society, where misfortunes of a certain obtrusiveness may be pitied, but are never tolerated under the chandeliers.”[16] Hanger likely related to this sentiment, as he refused to live with the “traditional” stiff peg that was a common prosthetic of the era. Rather, in November 1861, after four months of solitude in his upstairs bedroom, Hanger walked down the steps in his home, using a new prosthetic.[17] Created from barrel staves and rubber tendons, Hanger’s new leg was hinged around the knee and ankle, giving him a more natural gait.[18] While, of course, this gave him added mobility, it also had the benefit of behaving more like a real leg, and thus, a limb that was more “presentable in polite society.” As of early 1864, Hanger held the only two Confederate patents for a prosthetic, marking the beginning of his burgeoning company, which he established in partnership with his brother, John.[19]
Hanger was not the only inventor of a new prosthetic during the Civil War era. During the immediate period before the war (1845-61), only 34 patents for prosthetic limbs were issued, while, during and after the war (1861-73), 133 patents for prosthetics were issued, an almost 300% increase.[20] Multiple manufacturers began a prosthetics business during this period, including Hanger. As amputation rates grew, both the federal government and Confederate organizations contracted them to supply prosthetics for veterans. Particularly in the Confederacy, veterans found difficulty attaining prosthetics, since most antebellum limb manufacturers were in northern states. Before the Civil War, most recipients of prosthetics were Northern industrial workers who suffered factory accidents, and thus, the prosthetics industry was centered in the urban north. As such, during the war, Confederate amputees often found themselves having to pay far more than their Union counterparts for legs of lesser quality.[21] Given this intense demand for limbs in the South, manufacturers like Hanger were of vital importance to the Confederacy. In early 1864, through the Association for the Relief of Maimed Soldiers (ARMS), a nongovernmental association created to help Confederate veterans obtain and afford prostheses, Hanger was contracted to produce ten to fifteen legs a month.[22]
Shortly after this, however, Hanger’s business met some difficulty. Surgeon William Hay, stationed at Staunton to ensure the quality of the legs produced, wrote in March 1864 that the Hanger legs he had seen were “very indifferent in fact if they were a fair sample of their work… I think the Association would be throwing its money away to purchase them as the men who have them have been obliged to throw them aside & go back to their pegs.”[23] In January 1865, Surgeon William A. Carrington, chief administrator of all general hospitals in Virginia and the corresponding secretary of ARMS (and its de facto leader) complained to Surgeon Archibald Magill Fauntleroy, Hay’s successor as Staunton’s limb inspector, about the poor workmanship and quality in Hanger legs. Carrington angrily wrote that
It is made in workmanship inefficient and very inferior to the specimens [Hanger] deposited with the Association. The color is unsightly the toes are not fastened by hinges as the specimen was, but by wooden pegs which will soon be worn off. The braces to the knee are too straight and not curved to the convexities of the knee. The sole leather thigh box made of leather much too r ough and too rough entirely. The color with specimen was near flesh color. I am dissatisfied with the leg and hope you will not pass any more such, as these are a discredit to the Association and will soon be of little use to the men.[24]
This decline in quality, Hanger responded, was due to the simultaneous inflation of the Confederate economy and lack of supplies. As he noted, “the cost of the material to finish a limb properly in addition to the present cost of the material of which the legs are made would amount to much more than we get for them after they are made.” To counter this, Carrington and ARMS took measures to obtain cheaper materials from England and lobby the Confederate Congress to exempt limb manufacturers from taxation (this act passed in March 1865, a week after Union troops took Staunton, where Hanger and Brother was based, and Charlottesville, where the Confederacy’s two other main prosthetics manufacturers, Wells and Brother and Spooner and Harris, were based, rendering any governmental assistance pointless).[25] During the war, from late April or early May 1864 to early March 1865, Hanger fulfilled 210 orders, and about 100 were actually fitted to soldiers, according to ARMS records.[26]
Following the war, Hanger’s business continued to grow as both the federal government and former Confederate states expanded benefits to veterans. Already during the Civil War, Congress passed legislation in 1862 authorizing the Army’s Surgeon General to purchase prosthetic legs for disabled soldiers and seamen, and in 1868, they extended that benefit to officers. After the war ended, Congress also authorized the War Department to transport veterans to prostheses manufacturers for fittings at no cost to amputees. By 1870, Congress authorized veterans to receive a new limb every five years, a period which was increased to every three years in 1891. Alternatively, veterans could obtain a one-time commutation payment to compensate their missing limbs, and, starting in 1874, a monthly pension.[27] Confederate veterans, ineligible for these benefits, were supported by the states, many of whom established programs to assist their amputees. Virginia contracted Hanger and Douglas Bly, a New York manufacturer and the leading maker of limbs in the United States (Bly was also contracted by South Carolina and Georgia in their programs), greatly increasing demand for Hanger limbs.[28] In 1872 and 1873 combined, Virginia paid Hanger for furnishing 142 prostheses, more than he had actually fit during his time making limbs for ARMS in 1864-65.[29]
The 1870s also marked Hanger’s first of many patents with the US Government. On February 14, 1871, Hanger filed Patent Number 11,741, entitled an “Improvement in Artificial Legs.” This iteration of Hanger’s prosthetic leg, according to the filing, featured a solid knee with a joint, as well as springs to make walking easier and soften the shock of the step. This patent also had an improved ankle joint, which Hanger claimed to be “permanent and reliable.”[30]
1871 Hanger Leg (from the patent filing)
Twenty years later, in 1891, Hanger patented a new and updated model (Patent Number 465,698), which improved construction of the knee and ankle joints. Most significantly, however, this leg also featured a socket that was shaped to fit the stump and covered with leather, canvas, or another soft and flexible material, allowing it to be pliable and adjust as the remaining limb moved, particularly when the amputee was sitting or riding a horse. This socket, Hanger wrote in the patent filing, would also “not wear out the pants like a hard unyielding socket,” thus not only providing more comfort to the amputee but also ensuring that the prosthetic moved more naturally than competing artificial limbs.[31] Creating a prosthetic that was convenient and acted more like a natural limb was something that Hanger emphasized in his designs. The joints of his 1891 patent legs were built so that the prosthetic had free ankle motion, and when walking, the amputee’s weight was placed on the ball of the foot, just as in a regular stride.[32]
1891 Hanger Leg (from the patent filing)
“No one can know what such a loss means unless he has suffered a similar catastrophe. In the twinkling of an eye, life’s fondest hopes seemed dead. I was the prey of despair. What could the world hold for a maimed, crippled man!" J.E. Hanger
Two Hanger legs, c. 1901-1903 (courtesy of the Library of Congress)
In 1904, Hanger patented a new “fastening device” (prosthetics socket), which improved the attachments of his limbs (Number 762,822). Unlike other prosthetics, which required the socket to be taken on and off to attach or detach the limb, this innovative socket attached to the limb and easily attached or detached from the leg via a hook and lock system. This meant that amputees were able to put on or take of their prosthetics without having to unlace and relace the socket onto their stump, an inconvenient and potentially uncomfortable process if laced poorly.
1904 Hanger Fastening Device (From the patent filing)
A demonstration of the Hanger Fastening Device, circa 1905-1906 (Library of Congress)
Hanger’s 1910 patent (Number 951,989) made dramatic improvements to the artificial foot. This new model, which featured three pneumatic chambers, allowed the prosthesis to spread like a normal foot does after taking a step, not only making the stride appear more natural but also helping the artificial foot fit better into a shoe, thus creating the image of “normalcy” for amputees.[33]
Hanger’s final patent for an artificial leg, filed in 1913, combined all of his previous innovations into a single limb. Featuring a new flexible socket mechanism to attach the leg more efficiently and comfortably to the stump and comfortably be held in an extended position, this patent also improved on his 1904 fastening mechanism by creating an adjustable frame to connect the leg more comfortably to the stump. It also improved on his older leg models, with two independently connected joints at the knee and ankle to give an even more natural articulation to the leg while giving even more support to the limb than older Hanger legs. Finally, it had a better system of shock absorption and weight distribution, further contributing to a more natural stride that improved mobility and acted more like a natural limb.[34]
As he improved on his design, Hanger also expanded his business. In 1890, Hanger moved to Washington, DC, which likely provided better access to veterans, and thus, a larger customer base than it would have in Staunton. Sixteen years later, in 1906, J. E. Hanger Company was incorporated, and by his death in 1919, had branches across America in Atlanta, Baltimore, Philadelphia, Pittsburgh, and St. Louis.[35] By 1910, Hanger had won multiple awards for his legs, first at the 1881 International Cotton Exposition in Atlanta and later at the 1907 Jamestown Ter-Centennial Exposition.[36] According to the Library of Virginia, Hanger claimed that many amputees preferred his prosthetics to the best limbs made by Northern manufacturers, demonstrating the sectionalism that endured well after the end of the Civil War.[37] While Hanger was likely exaggerating for the sake of emphasizing Southern pride, he certainly did, of course, see great success in the prosthetics industry. Hanger had, indeed, created an artificial limb that competed with companies in the North, which had dominated the industry prior to the Civil War.
A group of patients posing in front of Hanger’s store, likely circa the turn of the twentieth century (courtesy of the National Museum of Civil War Medicine)
The last few years of Hanger’s life coincided with World War One, a conflict of a scale unlike any conflict since the end of the Civil War in 1865. European trench warfare resulted in an estimated 41,000 British amputees and 67,000 German amputees, and thus, a high demand for prosthetic limbs similarly to that in America during the Civil War.[38] Having made a national name for his company Hanger, despite having retired from active management of the Hanger Corporation, travelled across the Atlantic share his expertise with Britain.[39] In 1915, recognizing that the demand for prosthetic legs was too large to rely entirely on American imports, the British government decided to sponsor the manufacturing of prosthetic limbs domestically. They organized the International Exposition of Artificial Limbs, where Hanger and 38 other American manufacturers demonstrated their designs to judges from the Royal College of Surgeons.[40] Following this exhibition, the British invited American prosthetics manufacturers to establish workshops at the Queen Mary’s Hospital at Roehampton, a center for limb fittings during WWI.[41] At the time of the death of its founder in 1919, the J. E. Hanger Corporation had opened branches in London and Paris, becoming an international business.[42]
While Hanger died in 1919, his business continued to grow both at home and abroad. However, after Hanger’s death, the corporation split into four independent regional companies. These companies, despite having different owners, all kept the “Hanger” name and worked together to care for patients and collectively advertise their prosthetics. While Hanger family members still owned the DC and St. Louis operations, L. H. Barghausen and Paul Coleman, both sales representatives, purchased the Pittsburgh and Atlanta offices, respectively. Despite being separate businesses, all four companies’ locations were on the single marketing brochure that was published nationally, which touted that any patient could be cared for at any office with the Hanger name while travelling around America. Indeed, the four offices had made reciprocity agreements to ensure that this arrangement could work. This cooperative approach could also be seen at national events, where, oftentimes, the various companies shared a single trade show booth. For most of the twentieth century, this unusual approach endured, until larger companies bought and reunited the four branches in the 1980s and 1990s.[43] Abroad, in 1926, Hanger became the the largest prosthetics manufacturer in Britain, and, by 1934, was the only contractor to the British Ministry of Pensions. By the outbreak of WWII, Hanger had sixteen branches across the United Kingdom, and during and after the war, cared for British veterans.[44] While the ownership of the business was split amongst several different people, Hanger’s family continued to build upon his spirit of innovation. In 1914, James Hanger, Jr., who had entered the “family business,” patented his first artificial leg, and in 1917, he filed two more patents for improvements on both a complete artificial leg and the knee joint. After WWII, Hanger’s grandson, James E. Hanger III, filed his first patent for a knee structure, which he improved upon in 1951. In the 1960s, specialized educational programs in prosthetics and orthotics were developed, significantly at New York University and Northwestern University. Some of the early graduates of these programs were men who would later become senior managers of Hanger, including Ivan Sabel, a longtime CEO and Chairman of Hanger. As CEO, Sabel reunited the regional Hanger companies via acquisition, in addition to making other decisions to grow the company into the large corporation it is today.[45]
Today, the Hanger Corporation remains significant in the prosthetics industry. A multibillion-dollar company with over 900 Hanger Clinics nationwide, Hanger still aims to improve and innovate in the field of prosthetics and orthotics, helping its patients retain mobility despite their disabilities.[46] Well-known Hanger patients include Paralympians Jeremy Campbell and Mark Barr, rock climber Aron Ralston, NFL Quarterback Alex Smith, and Winter the Dolphin. Many of these noted figures are athletes who could do what they love because of a Hanger limb. Campbell, a below-the-knee amputee, is a four-time gold medalist and one-time silver medalist in the Paralympics. He is mainly a discus thrower, but he also medaled in the Pentathlon and competed in the long jump. Barr, who lost his right leg above the knee, swam in the 2004 and 2008 Paralympics and has competed in triathlons since 2009. Ralston, the rock climber whose arm was crushed by a rock until he self-amputated it to free himself (the film 127 Hours is based on his experience), worked with Hanger to develop an arm specifically designed for rock climbing. Smith, the quarterback for the Washington Commanders, suffered a compound fracture in 2018. After surviving a debilitating compound spiral fracture in his leg and a septic, flesh-eating bacterial infection, Smith made a triumphant return to playing for the Washington Commanders wearing a Hanger leg brace.
The Hanger Corporation has also helped more than just people who have lost limbs. Winter, who lost her tail after being caught in a crab trap line, was featured in the film Dolphin Tale , based on her life. It took approximately eighteen months for Hanger to develop a new tail for her. To fit the prosthetic onto Winter, Hanger developed WintersGel, a prosthetic gel liner that cushions the prosthetic and, more importantly, stuck to Winter’s body using suction without irritating her skin. Hanger began using WintersGel on human patients afterwards, furthering their founder’s mission to create a prosthetic that attached as comfortably as possible.
When making a leg for himself in his room in 1861, James Hanger could never have known what his legacy would be. It is only fitting that the company which he founded still pursues the same goals that he did: creating artificial limbs that not only fit with minimal inconvenience or discomfort, allowing amputees to overcome the devastating losses of their limbs and live their lives.
The William A Neal Museum of the Health Sciences has an 1891 model Hanger Leg on display.