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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    sented in the preceding wood-cut. (See Fig. 24.) The reports of the Pension Office for I860 and 1867 indicated that Mr. Brown con- tinued to enjoy tolerable health. On February 12th, 1868, he wrote to the compiler of this report as follows : I take pleasure in informing y°u tnat my l'imb is in as g°°d condition as when I last wrote you ; but think there is no improvement, except that it is not as tender. There have been no abscesses, nor any pain in the limb, excepting slight pains about the knee, just before storms. About two years ago, I slipped and fell upon the ice, injuring the limb severely about the knee, and was thereby confined to the house for about three weeks. In March last I had a severe attack of ague. The limb swelled quite badly at this time, and was much inflamed for about ten days. I applied cold water and a bandage to reduce the swelling. I had to keep it bandaged about two weeks after the inflammation was removed. Since that time the limb has given me no more trouble than usual. Since I was discharged I cannot see that there is airy lengthening of the limb. I have to use a crutch and cane all the time when moving about, and I think I shall always have to do this. The injured limb has wasted away somewhat since I last wrote. The circumference of the well limb at the upper extremity is 22 inches, and the injured limb measures at the same place 19t} inches. The knee of the well limb measures around the centre of the knee-pan 15i inches; the injured limb measures at the same place 17 inches. The above measurements were, made in the evening; I think that in the morning the measurements of the injured limb would be less. The knee still remains quite stiff, and gives me about all the pain there is anywhere in the limb. I have.been troubled during cold weather by coldness of the outer side of the leg, and I have to warm it by the fire before going to bed nearly every night when I have been out. On November 19th, 1868, another letter was received from Mr. Brown, from which the following extract is made : I take pleasure in informing you that my limb is in as good condition as it lias been at any time since it was entirely healed, and, if anything, in better condition. It does not pain me about the knee as much as it did one year ago. It does not have any spell of swelling at the knee as it did for the first two years after my discharge, and there is less soreness about the limb than there was even one year ago. I can get around without hurting it as much as formerly. I can bear some weight upon it. I have walked across a room without the aid of crutch or cane, by step- ping very quick with the well limb ; but it is more like hopping than walking. There have been no abscesses in the limb. I think that it is gradually improving, and hope that I may yet see the day that I can go without a crutch. My general health is good. I have not been sick a day for a year and a half, and then only a few days with ague. My weight now is 167 A pounds. Before I entered the army my weight was never quite up to those figures, but within a few pounds of it. I have been postmaster at this office over a year, and have attended to all the business of the office almost entirely without assistance, and it gives me pretty good exercise.'' The following case, remarkable for the delay in the apparition of grave symptoms after a fracture of the acetabulum, is recorded in the Confederate Btates Medical and Sur- gical Journal,] and in one of the Confederate hospital registers deposited in this office: Cash LVIII.—Private Alfred Toney, Co. A, 16th North Carolina Regiment, aged 43 years, a farmer by profession, was wounded June 30th, 1863, and admitted to Hospital No. 4, Richmond, Virginia, on the same day. A eonoidal musket ball had entered the left buttock and lodged. No particular attention was called to this case for some time. The patient seemed to be doing well. On August 11th, however, he complained of great pain in the knee and ankle; the slightest touch caused great anguish. The foot was cedematous. Chloroform was administered, and digital examination of the wound was made. The finger could pass but half an inch into the wound until the limb was carried forward; it then could be passed into the cotyloid cavity, and the ball was found in the acetabulum. The round ligament was severed and the head of the femur was ascertained to be slightly fractured and dejirived of its cartilage. Excision of the head of the femur was decided upon, and on August 12th, Surgeon James B. Read, P. A. C. S., proceeded to operate. The patient was laid on his face, and his buttocks were brought to the edge of the table. A straight incision was commenced two inches below the anterior superior crest of the ilium and carried downwards to one inch below the trochanter major. The muscles were then separated, and the joint exposed. The head was then dislocated by forcibly bringing the leg under the table. The soft parts were protected by a spatula and the head was sawn off. The ball was removed from the cotyloid cavity, which was found to be broken across and the cartilage loosened. The wound was then closed by sutures and the patient was removed to his bed. He suffered no pain, and in twenty-four hours the swelling had subsided. His general condition was very feeble, and he was freely stimulated dining the after-treatment. He died oil August 19th, 1863, eight days after the operation, exhausted by hectic fever. There is no .account of any abdominal disturbance or pyaemic symptoms resulting from the fracture of the acetabulum. The particulars of the fifty-ninth case are derived from the casualty lists of the Sixth Army Corps, and from the quarterly surgical report from Harewood Hospital. The patient was young and slender, and was one of those who had made the exhausting journey in (lie ambulance trains through the Wilderness. There was nothing like a complete fracture in the case. The ball flattened its apex against the shaft in front of the lesser trochanter, grooving the bone, but without any splintering. The joint was involved secondarily. It was a case for primary debridement of the entrance wound: * Another view of the specimen is given at p. 246 of the Catalogue of the Surgical Section of the Army Medical Museum, and in Circular No. 6, S. G. O., 1865, p. 75. t Read, Confederate States Med. and Surg. Journal, 1864, Vol. I, p. 6.