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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    Case IV.—Private , of the 1st Army Corps, was wounded at the second battle of Hull Run, August 30, 1862, by a conoidal musket ball, which entered the left hip below and in front of the trochanters, and fractured the femur at the junc- tion of the head and neck. He was conveyed to the hospital of General King's Division of the 1st Army Corps in the bric k house which had been occupied as the rebel headquarters at the first battle of Bull Run. The prostration from shock was great, yet it was thought that exarticulation of the femur was the only resource, and that excision would be less hazardous llian ampu- tation. Accordingly, fifteen hours after the reception of the injury, Surgeon John McNulty, U. S. Volunteers, Medical Director 1:2th Army Corps, proceeded to excise the head and neck of the left femur through a vertical incision on the exterior of the limb about six inches in length, the patient being rendered insensible by chloroform. On dividing the round ligament to enucleate the head of the bone, it was discovered that the ball had penetrated the pelvic cavity through the lower portion of the acetabu- lum. The femur was sawn through at the junction of the shaft and neck by a narrow-bladed saw. After the removal of the shattered fragments of bone, the patient suffered much less pain. There were no symptoms of pcritonseal inflammation at the date of the operation, but they were developed subsequently. The patient died August 31st, 1862, eighteen hours after the operation, from the shock of the injury and of the operation. Ill the following case, also, the experienced and accomplished surgeon who performed the operation, and his colleagues who recommended it as the only resource to preserve life, were deceived as to the extent of the injury, and the case offers another illustration of the great difficulties of diagnosis in some gunshot lesions about the hip. Case V.—It has not been possible to learn the name and military description of the subject of this operation. lie was a private soldier of the 1st Army Corps, and a Frenchman, for the operator recalls the broken English in which he begged for the operation, and expressed his relief and thanks after it was performed. He had a terrible comminution of the upper extremity of the left femur, inflicted by a fragment of shell at the battle of Antietam, September 17, 1862. Surgeon John McNulty, U. S. Vols., Medical Director 12th Army Corps, excised the head and neck of the femur, five hours after the reception of the injury, through a vertical incision six inches long. Chloroform was used. As in the two other operations performed by Dr. McNulty, it was found that the lesions extended into the pelvis. Consequently there could be little or no hope of a successful result. This patient survived the operation only ten hours. The next case is a discouraging one, certainly, for the operation was performed under favorable circumstances, on a healthy subject, who, as an officer, received most careful after-treatment, and yet the result was rapidly fatal: Case VI.—Captain Frederick M. Barber, Co. H, 16th Connecticut Volunteers, aged 32 years, was wounded at the battle of Antietam, September 17, 1862, by a musket ball, which entered a little behind the right trochanter major, and shattered the trochanters and neck of the femur. He was conveyed to the field hospital of the Third Division of the Ninth Corps. His gen- eral health was good, and there was but little shock. There was no swelling of the soft parts. The fracture was very accessible to exploration, and appeared to be limited to the epiphysis. The case was one in which excision seemed peculiarly applicable, and, after a consultation of several surgeons of the Division, that operation was decided upon. On the morning of September 18th, the patient being anaesthetized by chloroform, Surgeon Melancthon Storrs, 8th Connecticut Volunteers, proceeded to make a straight incision four inches long passing through the wound of entrance. The comminuted fragments of the neck and trochanter were extracted, the round ligament was divided, the head of the femur was removed,, and the fractured upper extremity of the shaft was sawn off by the chain saw. The edges of the wound were then approximated by adhesive straps and simple dressings were applied. But little blood was lost, and the patient rallied promptly from the operation, and appeared quite comfortable during the day. Surgical fever soon set in, however, the patient sank rapidly under the constitutional irrita- tion, and died on September 20, 1862. The next case is reported by the operator, Professor Hunter McGuire, of the Medical College of Virginia, who has communicated the following observations on excisions of the head of the femur for gunshot injury in connection with this case and of another, (Case XV,) to be related further on:* The results in these two cases has not lessened my conviction of the propriety of this operation in certain cases of gunshot wounds of the hip-joint. When the blood vessels or nerves are injured, or the soft parts badly torn, it would be best to let the patient alone! It would be useless and cruel under such circumstances to * It is much to be regretted that the original notes of these cases, which were minute and complete, were captured with other professional papers of Dr. McGuire, in one of the engagements in the Shenandoah Valley, and were probably destroyed. Diligent but unavailing inquiries have been made for them and for the surgical papers of Dr. Gilmore, lost under similar cir- cumstances.