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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    The following case was reported by Dr. J. T. Gilmore, of Mobile, Alabama, formerly Surgeon 0. S. A., and chief surgeon of the Division of General McLaws, in General Long- street's Corps. Dr. Gilmore's experience of field surgery in the late war was great, and this Office is under many obligations to him for careful and conscientious reports of his observations. Dr. Gilmore had full notes of this and two other cases of resection of the head of the femur, of which brief descriptions will be inserted farther on. Unfortunately these notes, with all of Dr. Gilmore's professional papers, were captured on the occasion of General Early's defeat at Fisher's Hill, and it is to be feared were destroyed, since the most diligent inquiries by this Office have failed to recover them :* Cask IX. A Confederate soldier of Kershaw's South Carolina Brigade, was wounded at the hattle of Chancellorsville, Virginia, May 3d, 1863, by a musket ball whicli shattered the neck of the femur. It having been decided, after an examination of the wound under chloroform, that the case was a favorable one for the operation of excision, the important nerves and vessels being intact, and the injury limited mainly to the neck of the bone, the operation was performed by Surgeon James, 16th South Carolina Regiment, on the day after the reception of the wound. The patient sank from the shock of the injury and operation and died, May 6th, 1863. The particulars of the next case were communicated by the operator, Colonel Henry S. Hewit, senior surgeon of the volunteer staff, and Medical Director of the Army of the Ohio, who remarks of it that, notwithstanding its fatal issue, it was one of the cases that came under his observation which had much weight in convincing him of the superiority of excision over coxo-femoral amputation in severe gunshot injuries of the upper extremity of the femur, uncomplicated by grave lesions of the vessels or other soft parts. At any rate, Colonel Hewit continues, the less degree of severity of the opera- tion and the greater average success are arguments in its favor. The probable prolongation of life in unsuccessful cases is also a point worthy of consideration. Dr. Hewit adds that he believed at the time, and still adheres'to the opinion, that under more favorable circum- stances this patient would have recovered. He considered the death due to vital and constitutional exhaustion, with the additional burthen of wounds and operation. He adds that the pathological specimen was placed in his saddle-bags, and unfortunately lost with his horse in attempting to send the latter through the enemy's lines, for Dr. Hewit voluntarily remained a prisoner with his wounded: j Case X.—Sergeant James M. Tolman, Co. H, 18th Wisconsin Volunteers, aged 30 years, was wounded on the 14th of May, 1863, at the engagement near Jackson, Mississippi, by a conoidal musket ball, whicli comminuted the head and neck of the left femur, lodging in the latter, and producing fissures which extended about two inches below the lesser trochanter. The important nerves and vessels of the region and the walls of the pelvis had escaped injury. The patient was a somewhat cachetic subject, debilitated by malarial disorders. It was deemed that the gravity of the injuries of the upper extrem ty of the femur rendered operative interference imperative. About twenty-four hours after the reception of the injury, the patient was placed under the influence of chloroform, and Surgeon Henry S. Hewit, U. S. Volunteers, proceeded to exarticulate the head of the femur. The incision commenced a little above and anterior to the trochanter major and extended downwards in a curved direc- tion with the convexity backwards, and passed through the wound of entrance. The splintered fragments of the head and neck and the ball were removed, and then the fissured upper extremity of the shaft was sawn two and a half inches below the lesser trochanter. The operation was well borne, and the patient was removed the same day to an hospital in the city of Jackson, where he was supplied with every comfort and provided with the most careful attendance. He did apparently well until the third day, when he began to sink, the wound from this time forward exhaling a faint cadaveric odor. He died four days after the operation, May 19, 18634 * This case is referred to in A Contribution to the History of Hip-joint Operations performed during the late Civil War, by Taul F. Eve, M. D., p. 8. Dr. Gilmore is incorrectly reported as the operator, t This case is recorded in Circular No. 6, S. G. 0., 1865, p. 66. t The printed report of the Adjutant General of Wisconsin, for 1865, p. 300, gives the date of death as May 16, 1863; but Dr. Hewit states that this is incorrect, an assertion sustained by the entry in the hospital register.