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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    and neck of the femur, ami producing fissures which extended to the head of the bone. The wounded man was taken to a pri- vate house in the neighborhood, at a place called Big Spring, or in another report Burke's Spring, a place ten miles north- west of Dalton, where, shortly after the reception of the injury, it was decided, on the recommendation of the surgeon-in-chief of General Craft's Division, Surgeon S. G. Menzies, 1st Kentucky Volunteers, that excision of the injured extremity of the femur should be performed. Chloroform having been administered, Surgeon Nathan W. Abbott, 86th Illinois Volunteers, made a longitudinal incision, five inches in length, commencing two inches above the trochanter major. After dissecting aside the mus- cular attachments, and removing many fragments of the neck and trochanteric portions of the femur, the shaft of the bone was smoothly divided by the chain saw, at a point an inch or a little more below the lesser trochanter. Then, with a straight bis- toury, the capsular and round ligaments were divided, and the fractured head of the femur was exarticulated. The wound was then approximated by sutures and adhesive strips. The patient rallied satisfactorily from the shock of the injury and operation, and his condition was encouraging on the following morning, when the Union forces retired, sending all the wounded who could be moved to the hospitals at Chattanooga. Private Dempsey alone was left at Big Spring. On the evening of February 26th, Surgeon Menzies sent Assistant Surgeon P. F. Ravenot, 75th Illinois Volunteers, with a cavalry escort, from General Cruft's camp to Big Spring, a distance of five miles, to learn of Private Dempsey's condition, and, if possible, to bring him off. The escort was dispersed and Dr. Ravenot was captured. The fate of Dempsey could not be definitely ascertained. He is dropped from the rolls of his company as missing in action at Buzzard Roost Gap. Dr. Abbott afterwards heard, indirectly, that Dempsey survived the operation four or five weeks ; but was not satisfied that this information was reliable. That the case had a fatal termination there can be no doubt. The excised portions of bono were preserved by Dr. Barnes, of Centralia, Illinois, who was present at the operation. Dr. Barnes proposes, Dr. Abbott writes, to send the specimen to the Army Medical Museum. As this report is passing through the press, a statement has been received from Bvt. Major E. B. Atwood, 16th IJ. S. Infantry, that he had learned from parties who attended Private Dempsey after he was wounded, that he died on February 28th, 1864, at the house of a Mr. Rogers, ten miles northwest of Dalton, Georgia. The particulars of the following case have been communicated by Dr. Claude H. Mastin, of Mobile, formerly Inspector of Hospitals in the Confederate service, by the oper- ator, Surgeon J. J. Dement, P. A. C. 8., now a leading practitioner in Huntsville, Alabama, and by Dr. J. B. Duggan, of Toombsborough, Georgia, who attended the patient in a fatal illness long subsequent to the operation. The case is of peculiar interest as the second instance hitherto reported of a successful primary excision of the upper extremity of the femur for gunshot injury, and one of the two examples of the successful result of such operations during the late war. The history of the case has not been published heretofore: Case XIV.—Private Cannon, Co. A, 49th Georgia Regiment, Thomas's Brigade, aged about 24 years, was wounded at the battle of the Wilderness, Virginia, on the morning of May 5th, 1864, by a conoidal musket ball, which entered the left hip one inch below the trochanter major, extensively comminuting the femur and lodging in the muscles of the inside of the thigh. Just after he was wounded the Confederate line was forced back a short distance, and the wounded man laid upon the disputed ground, swept by the fires of the contending armies, until the following morning, when the Confederates recovered their position and carried off their wounded. Cannon was taken to a Field Infirmary, and, after a consultation by Surgeons J. J. Dement, Holt, J. J. Winn, and F. B. Henderson, it was determined to enlarge the wound and to remove the detached fragments of bone. Accordingly, the patient having been chloroformed, Surgeon Dement made an incision two inches upward from the entrance wound, and extending from the wound downwards four inches. On ascertaining the condition of the injured parts, it was decided to exarticulate the head of the femur. This was readily accomplished, and then the neck and upper extremity of the shaft were removed. The fragments of the upper extremity of the femur, when put together, measured four and a half inches. The haemorrhage during the operation was trivial. All the medical gentlemen present remarked upon the slight degree of shock that was induced by the operation. The depression was less than commonly follows an ordinary amputation low down. The limb and body were confined by a roller bandage to a straight splint extending from the axilla to the foot. A full dose of sul- phate of morphia was.then administered. In a few hours the patient was placed in an ambulance wagon, and was conveyed to Orange Court House, twenty-five miles distant, and thence by railway to Staunton, Virginia, about seventy miles farther. The after-treatment was conducted at the general hospital at that place. Little can be learned of the after-treatment save that the patient was supplied with rich diet, with a liberal allowance of wine, and that no untoward complication occurred except the formation of abscesses attendant on an exfoliation of a ring of bone from the upper end of the shaft. When this was eliminated, the wound rapidly healed. At the end of nine months the cicatrix was firm. The limb was shortened three inches, and was useless for purposes of locomotion. The patient was in fine health, and moved ahout on crutches. He went to his home, in Toombsborough, Georgia, in February, 1865, and earned a livelihood by his trade of shoemaking. He enjoyed good health until November 12th, 1865, when he had an attack of diphtheria, which terminated fatally on November 23d, 1865. The facts concerning the next case were furnished by Dr. Hunter McGuire, Professor of Surgery in the Medical College of Virginia, and have not been previously published: Case XV.—A Confederate private soldier of Ewell's Corps was wounded at the battle of the Wilderness, May 5th, 1864, by a conoidal musket ball, which broke the neck of the left femur into several fragments, and lodged in the bone at the junction of