A report on excisions of the head of the femur for gunshot injury.

Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: A report on excisions of the head of the femur for gunshot injury. Source: Wellcome Collection.

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    Dr. John D. Jackson, Inspector of Hospitals; Dr. J. T. Gilmore, of General Longstreet's corps; Dr. Claude H. Mastin, Medical Inspector of General A. S. Johnston's army; Dr. Julian J. Chisolm, Professor of Military Surgery; and Dr. J. J. Dement, Inspector of Hospitals. Of the sixty-three excisions, thirty-two were primary, twenty-two were intermediate, and nine were secondary operations. In each category the cases are related in chronological order. In twenty-three cases the operation was performed on the right side, in thirty-six cases on the left side, and in four cases the particular site of the operation is not recorded. In forty-three cases the injuries for which excisions were performed were inflicted by conoidal musket balls; in twelve cases by musket balls the form of which is not desig- nated; in one case the nature of the missile was unknown; in one it was a fragment of a mortar bomb, and in six the femur was shattered by fragments of shell. PRIMARY EXCISIONS. There were thirty-two primary excisions, the operations being performed in every case within twenty-four hours of the reception of the injury, and in most instances within two or three hours. Two of the operations succeeded. This gives the high mortality rate of 93.75 for this particular series of primary cases. Too much importance must not be attached, however, to this naked percentage, as will be shown hereafter. In the thirty unsuccessful cases, the mean duration of life after the operation was a little over seven days. This average is increased by the protracted struggle for life of one patient, who survived sixty days. The majority died in two or three days from the combined shock of the injury and of the operation. The account of the first case was communicated to the compiler by Professor G. C. Blackman, in 1868. It was not reported from Camp Dennison, or registered at St. John's Hospital. A brief notice of it, written at the time of the operation by Dr. T. McMillin, now Assistant Surgeon, U. S. A., has alone preserved a record of it. The case is interest- ing as having been the first instance in which excision at the hip for gunshot injury was resorted to in this country. The operation was not undertaken under very hopeful circum- stances, copious haemorrhage having taken place, and the patient being greatly prostrated: Case I.—Private John McCulloch, aged 35 years, a recruit at the depot for volunteers at Camp Dennison, Ohio, was wounded on August 30, 1861, by the accidental discharge of a musket. The ball, taking effect at the distance of a few yards only, severely shattered the upper part of the femur, and lacerated the soft parts extensively. The patient was conveyed to St. John's Hospital, in Cincinnati, and on arriving was greatly depressed by loss of blood. Professor George C. Blackman deter- mined that removal of the shattered bone offered the best resource for the preservation of life, and, the patient having been ren- dered insensible by chloroform, excision of the head, neck, and trochanters was practised without delay, through a vertical incision on the exterior of the thigh. The patient died August 30, 1861, four hours after the completion of the operation. In the next case, also, the operation was performed on account of an accidental gun- shot injury. The abstract is compiled from a report by Surgeon James T. Calhoun, 74th New York Volunteers,* and a letter from Dr. J. W. S. Gouley. The case seems to have been well selected. The subject was healthy, and had to be removed but a short distance * An account of the case was published by Dr. Calhoun, in 1862, in the New Jersey Medical Reporter, Vol. VIII, p. 76, and it is recorded also in Circular No. 6, S. G. O., 1865, p. 62.