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 next case is reported by Assistant Surgeon J. S. Billings, U. S. A., who saw the patient in his inspection of the 18th Army Corps Hospital,: * Case XXI.—An unknown soldier of the 18th Army Corps was wounded in the assault on the enemy's intrenched lines at Cold Harbor, June 3d, 1864, by a fragment of shell, which completely comminuted the trochanter and neck of the right femur. Shortly after the reception of the injury, he was conveyed to the field hospital of the 18th Corps, and immediately anaesthetized and examined. Excision of the head, neck, and trochanters of the right femur was then practised. Assistant Surgeon Billings, U. S. A., saw the patient soon after the operation, and observed that he had rallied encouragingly, and was in a comparatively comfortable condition. On June 7th, the wounded of the 18th Corps were placed in wagons and sent to the rear. Dr. Billings visited the hospital with a view of preventing the removal of this patient; but was informed by the director of transportation that the man had died in the previous night. June 6th, 1864, three days after the operation. The next case is reported in the eighteenth volume of the Transactions of the American Medical Association, p. 263, in Dr. Eve's paper, by Dr. Charles James OHagan, of Green- ville/] North Carolina. Dr. John D. Jackson, of Danville, Kentucky, has communicated some additional facts: Case XXII.—Private , 56th North Carolina Regiment, Ransom's Brigade, was wounded on the night of the 17th of June, 1864, in front of Petersburg, by a conoidal ball probably, in the right thigh. The ball entered on the inner aspect of the limb, and passed obliquely upwards and outwards, producing a comminuted fracture of the neck of the femur, and driving the fragments of bone into the surrounding tissues. The shaft of the bone was not shattered, and. as the man was very much worn and exhausted, as most of the Confederate troops were at that time, it was considered advisable to perform resection of the head and neck of the femur, as offering a better chance of recovery than amputation. The operation was peifonned on June 18th, twelve hours after the reception of the wound, and the bone was sawn through the trochanters. He bore the operation well, and. although weak, was hopeful. He was sent to the Fair Grounds Hospital, from which he was removed in a few days, placed in a tent, and attended by Surgeon Ladd, 56th Xorth Carolina Regiment, and Dr. C. J. O'Hagan. He survived the operation two months, and succumbed at last to suppuration, caused by the want of proper food and stimulants, and the general prevalence of pyaemic infection, which at that period intervened in nearly all the surgical cases in the neighborhood of that hospital. To this account, Dr. J. D. Jackson adds: I recollect very distinctly of being present at the operation of Dr. Ladd. being then of the same division with him, but not of the same brigade. It was on the 18th or 19th of June, 1864, that it was done, the place being an unfinished brick church in the centre of Petersburg, which we were then occupying as an hospital. There were also present some four or five other surgeons, among whom I recollect Surgeon C. J. O'Hagan, Dr. Wilson, of Vir- ginia, then the senior Surgeon of Ransom's Brigade, Dr. Luckie, of the same Brigade; and, if I mistake not, Dr. R. L. Brodie, then Medical Director of General Beauregard's army, was among the number. The man operated upon was of Dr. Ladd's own regiment; his age, and any other personal peculiarities, I have forgotten, though I think he was young and comparatively robust. The wound had apparently been done by a musket ball, and the range of the wound was, I think, from the inner and upper aspect of the thigh, and nearly transversely through, ranging slightly upwards, the aperture of exit being over the trochanter major. If I recollect aright, the trochanter was torn off, and most of the neck of the femur shattered to fragments, the shaft of the femur being entirely separated from the head. Chloroform was given, and Dr. Ladd operated by making a slightly curvilinear incision over the acetabulum and trochanter—the aperture of the wound being in its line—cut down upon the head of the femur, exarticulated and removed it, and cut off a sharp fragment of the remaining end of the femur. The diffi- culty of performing the operation seemed to be small. The haemorrhage was trifling. I do not recollect that I saw the patient again, he being sent off to the General Hospital at what was then known as the Fair Grounds Hospital, situated in the suburbs of Petersburg. But I further remember distinctly of hearing Dr. Ladd, Dr. O'Hagan, and probably others of Ransom's Brigade speaking of his death, which was on the sixtieth day after the operation, and which all agreed at the time in ascribing to want of good food in proper quantity. Owing to the scarcity of our supplies, and the immense number of wounded men then crowding the city in consequence of the battles fought in front of Petersburg on the 17th, 18th, and 19th of June, food really proper for wounded men was not to be obtained, and anything like delicacies were out of the question. The facts in the next case were communicated by the operator, now a practitioner of Pulaski, Tennessee: J * It is hardly necessary to state that every effort has been made to identify this case. Besides searching the records of the 18th Corps, letters of inquiry have been addressed to the Medical Director of the Corps, Dr. George Suckley, Surgeon J. M. Rice, 25th Massachusetts Volunteers, Surgeon S. A. Richardson, 13th New Hampshire Volunteers, and Surgeon A. W. Woodhull, 9th New Jersey Volunteers, senior medical officers of the Corps. The 18th Corps, belonging to the Army of the James, arrived by a forced march from White House in season to participate in the sanguinary battle of Cold Harbor, and five days after the battle was hurried back to Petersburg. The hospital arrangements were necessarily greatly confused, a large number of the wounded being treated in the open air. tNot Glenville, as printed by Dr. Eve. { Letter of Dr. J. F. Grant, dated February 29th, 1868. The case is published also in the Transactions of the American Medical Association, Vol. XVIII, p. 261.