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.

    51/156 (page 45)
    with lint. Suppuration then commencing, the limb was placed in Fergusson's apparatus for excision of the head of the femur, the counter extension straps being left off. The wound was freely syringed with cold water containing a little permanganate of potassa. A nourishing diet was ordered, with tonics and stimulants. For a week or ten days subsequently, the case progressed favorably. Suppuration was moderate in amount, and of a healthy charac- ter. About the middle of June, the weather became intensely hot. The atmosphere of the wards, in which nearly every bed was occupied by a patient with suppurating wounds, became intensely oppressive. About this time, the patient began to grow worse. The cheerful resolution and hopefulness he had hitherto evinced, gave way. Diarrhoea supervened, and he lost strength rapidly. The fatal event was thought to have been delayed by the plan which was pursued of daily removing the patient in his bed at nine in the morning to a spot beneath the shade trees near the hospital, where he had pure air and escaped the distressing scenes of the ward; he remained each day until five in the afternoon. He died on June 21st, 18(54. The portion of bone excised was forwarded at the time of the operation to the Army Medical Museum. The preparation is No. 2618 of the Surgical Series. It is represented in the adjacent wood-cut. (Fig. 17.) Flo. 17.—Head and fragments of tin' neck of the left femur, excised on account of gun shot injury.—Spec. 2u18. Sect. I, A. M. M. The abstract of the next case is derived from the returns of the field hospitals, and the report of the operator, Assistant Surgeon W. Thomson, U. S. A. The patient was the oldest of any of the wounded men subjected to the operation, and incurred the further disadvantage of prolonged transportation: Case XLIX.—Private Peter Boyle, Co. D, 59th Massachusetts Volunteers, aged 60 years, was wounded in front of Petersburg, Virginia, July 30th, 1864. A conoidal musket ball entered the left hip and passed antero-posteriorly through the soft parts and surgical neck of the femur, and fractured the trochanter major. His entry at the base hospital at City Point and transfer to Washington are recorded on August 1st. He was conveyed to Washington on an hospital steamer, and on August 3d was admitted to Douglas Hospital. His constitutional condition, on admission, was poor. The wound, however, had an healthy aspect, and a thorough exploration showed that the injury to the soft tissues involved no important part, and that the fracture, at the junction of the neck and trochanter major, was not accompanied by much longitudinal splintering in either direction. Accordingly, Assistant Surgeon William Thomson, U. S. A., in charge of Douglas Hos- pital, decided that an excision of the injured hone was expedient, and that the operation should be done as soon as the patient had rallied from the fatigue and irritability induced by his long journey. On August 5th, ether having been administered, Assistant Surgeon Thomson proceeded to excise the head, neck, and trochanters of the left femur, through a straight incision of sufficient length made over the trochanter major. The rotator muscles and the tendons of the psoas and iliacus being divided, the round ligament was readily cut and the head exarticulated. The section of the shaft was made by a chain saw at the level of the trochanter minor. The operation was rapidly accomplished, and there was no haemorrhage of mument. The wound was dressed with an antiseptic solution of one drop of creasote to each ounce of water on charpie, and the limb was supported by a sand bag on either side. The patient reacted well after the operation ; but at night there was profuse sweating and some nausea. On the following morning lie ate a good breakfast. He still had a cool, sweating skin, and his pulse was at 128. He gradually sank, and died from exhaustion on August 7th, 1864. The pathological preparation presented by Dr. Thomson to the Army Medical Museum, is No. 3593, Sect. I, and is figured at page 245 of the Surgical Catalogue of the Museum, and also in the accompanying wood-cut. (Fig. 18.) The very extensive fractures of the pelvis, which existed in the case next to be described, would probably have prevented any operative interference, had they been recog- nized. The history of the case is compiled from the reports of Armory Square Hospital, and from a special report by Acting Assistant Surgeon George K. Smith. It is one of the very few cases complicated by secondary haemorrhage. Unavoidable venous haemorrhage was here the cause of death: Case L.—Lieutenant D. N. Patterson, 46th Virginia Regiment, aged 31 years, was wounded at an engagement on the Boydton Plank Road, near Petersburg, Virginia, March 29, 1865, and was captured and sent to City Point, and immediately conveyed on an hospital transport to Washington, and placed in Armory Square Hospital on April 2d. On examination, it was found that a conoidal ball had entered the left thigh behind the trochanter major, and had passed inwards and forwards, fracturing the trochanter, neck, and head of the femur, and the anterior border of the acetabulum. On the day after the patient's admission! Fio. ] 8.—Perforation of the base of the neck of the left femur by a musket hall. Spec. 35'J3, Sect. I, A. SI. M.