University of California (rl FT < THE MEDICAL AND SURGICAL HISTORY OF THE WAR OF THE REBELLION PART III. VOLUME II. SURGICAL HISTORY. Prepared, under the direction of JOSEPH K. BARNES, Surgeon General United States Army. BY GEORGE A. OTIS, SURGEON UNITED STATES ARMY, AND D. L. HUNTINGTON, SURGEON UNITED STATES ARMY. SIEOOHSTID ISSTJIE. WASHINGTON: GOVERNMENT PRINTING OFFICE. 1883. u 2-2, WAR DEPARTMENT, SURGEON GENERAL S OFFICE, WASHINGTON, D. 0., January 2, 1883. Brigadier General CHARLES H. CRANE, Surgeon General, U. S. Army. SIR: With the present volume, which I have the honor to submit to you, the surgical series of the Medical and Surgical History of the War of the Rebellion is complete. The treatment of regional injuries of gunshot origin is continued, and those of the Lower Extremities are taken up and thoroughly discussed in Chapter X. Miscellaneous Injuries not strictly gunshot in character, but incident to the military status, form the sub ject of Chapter XI. Chapter XII, on Wounds and Complications, includes facts of general interest and of statistical value relative to wounds; to the nature, peculiarities, and effects of missiles and projectiles; to conditions affecting the course and results of wounds, with especial reference to the graver complications of secondary haemorrhage, erysipelas, pyaemia, gangrene, and tetanus; and, finally, a condensed summary of operations and treatment. Anaesthetics, with reference to their use in the Army, are treated of in Chapter XIII. A brief historical sketch of the Medical Staff, and a description of the Materia Chirurgica will be found in Chapter XIV. The methods of field, railway, and water transportation of the wounded are detailed in the concluding Chapter (XV). It was attempted, from the inception of the work, to give, in the beginning of each chapter, the number of cases to be treated therein. But, as the work progressed, new cases had to be added, duplicates had to be eliminated, or additional information changed the nature of a case, so as to transfer it to a group different from the one to which it had been originally assigned. Thus the total number of cases given in the beginning of a chapter was frequently found to be incorrect at its close, and as the preceding pages had been stereotyped, it was not practicable to make the necessary corrections. The percentages and general deductions, however, were not materially affected by these discrepancies, which have been corrected in the summary of cases given in Chapter XII, in this volume. In undertaking the completion of this work, interrupted by the untimely death of its distinguished author, it may be proper to say that no change in, or deviation from, the m PREFATORY. original plan has been attempted; that, so far as known, his wishes and intentions with regard to the arrangement and development of the History have been scrupulously regarded. The work was entered upon, not without serious misgivings as to the wisdom of the choice of successor, and with a full appreciation of the delicate nature of the task and the difficulties involved in its satisfactory solution ; its prosecution has been a source of pleasure, while the labor has been materially lessened by the valuable assistance afforded by Mr. G. J. MYERS, who has been associated with the work as colaborer since its inception, and to whose faithful and assiduous care the reliability and accuracy of the History is largely due. The completed volume now awaits your approval and the judgment of the profession. It is hoped that its short-comings may not seriously impair or detract from the beauty and harmony of the masterpiece, which must remain a living monument to the intelligent industry, perseverance, and professional learning of the late Surgeon GEORGE A. OTIS. I am, sir, Very respectfully, Your obedient servant, D. L. HUMTNGTON, Surgeon, U. S. Army. IV TABLE OF CONTENTS OF PART III OF VOLUME II OF THK MEDICAL AND SURGICAL HISTORY OF THE REBELLION, BEING THE THIRD SURGICAL VOLUME. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES. Page. INTRODUCTION 1 TABLE I. Collated returns, indicating the relative fre quency of shot wounds of the lower extremity in aggregates of wounded men who came under treatment 2 TABLE II. Partial numerical statement of shot wounds of the lower extremities in the field or primary hospitals in various campaigns during the last year of the war, 1864- C5 3 SECTION I. Flesh Wounds of the Lower Extremities . . . 5 Punctured and. Incised wounds 5 Bayonet wounds 5 Abstracts of four cases 6 Sabre wounds 7 Other Punctured and Incised wounds 7 Legations 7 Abstracts of three cases 7 Amputations 8 Abstracts of four cases 8 Shot Flesh wounds 8 Flesh wounds of the Lower Limbs with injury of the Nerves 9 Abstracts of seven cases 10 Flesh wounds of the Lower Limbs with injury of the Larger Blood-vessels 13 Wounds of Blood-vessels treated without operation 13 Abstracts of six cases 13 Wounds of Blood-vessels treated by ligation 16 Abstract of one case 16 Wounds of Blood-vessels treated by amputation .... 17 Abstracts of two cases 17 PLATE XXVIII. Gangrene following a shot lacera tion of the Femoral Artery, facing 18 Wounds of Blood-vessels treated by ligation and subsequent amputation 18 Abstract of one case 18 Flesh wounds of the Lower Limbs unattended by Primary injury of the Large Nerves and Blood vessels IS Shot Lacerations 19 Abstracts of five cases 19 Lodgement of Missiles 21 Abstracts of six cases 21 Peri-articular wounds. Hij>, Knee, and Ankle 24 Abstracts of twenty-nine cases 25 PLATE LVI. Dry Traumatic Arthritis of the Right Hip, facing 27 Pet SECTION I. SHOT FLK.SII WOUNDS [Continued. Complications of Shot Flesh wounds of the Lower Extremities ............................. Pyaemia ........................................ Abstracts of three cases ....................... Hospital ungrene ................................ Abstracts of three cases ....................... Tetanus ......................................... Abstracts of three cases ....................... Erysipelas ....................................... Abstracts of two cases ........................ Haemorrhage ..................................... Abstracts of two cases ..................... Ligations of Blood-vessels of the Lower Limbs after Flesh wounds .......................... Ligations of the Common Iliac Artery .......... Abstract of one case ...... ................. Ligations of the External Iliac Artery .......... Abstracts of eleven cases .................. Ligations of the Femoral Artery ............... Abstracts of seven cases ................... TABLE III. Summary of one hundred and twenty -seven cases of ligations of the Femoral Artery ..... ................... Ligations of the Profunda Artery .............. Abstracts of six cases ..................... Ligations of large branches of the Profunda Artery ..................................... Abstracts of three cases .................. Ligations of the Popliteal Artery .............. TABLE IV. Summary of seventeen cases of ligations of the Popliteal Artery .......... A bstract of one case .................. Ligations of the Posterior Tibial Artery ........ TABLE V. Summary of seventeen cases of ligations of the Posterior Tibial Artery. ... Ligations of the Anterior Tibial Artery ........ Abstracts of ten cases .................... Ligations of the Anterior and Posterior Tibial Arteries .................................... Abstracts of two cases ..................... Ligations of Veins ............................ Abstract of one case ..................... Amputations in the Lower Limbs after Shot Flesh wounds ................................... Amputations in the Thigh ......................... Abstracts o( tivo cases ........................ 32 32 32 33 33 35 36 37 37 37 i!8 38 39 39 39 39 43 43 47 49 49 50 50 50 50 51 51 51 51 51 52 52 TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES CONTINUED i age. SECTION I. FLESH WOUNDS, ETC. [Continued. PLATE XXVII. Effects of Hospital Grangrene, facing 53 TABLE VI. Summary of one hundred and thirty- one amputations in the Thigh 54 Amputations at the Knee 56 TABLE VII. Summary of six cases of amputa tions at the Knee 50 Amputations in the Leg 57 Abstracts of two cases 57 TABLE VIII. Summary of sixty-three amputa tions in the Leg 57 Amputations of the Toes 51) Abstract of one case 59 Tenotomy 59 Abstracts of three cases 59 SECTION II. Wounds and Injuries of the Hip Joint. . 61 Shot fractures at the Hip Joint 61 TABLE IX. Tabular statement of three hundred and eighty-six shot fractures of the Hip Joint 65 Shot fractures at the Hip treated by conservation ... 66 Recoveries 67 Abstracts of twenty-one cases 67 PLATE LVII. G unshot fracture of the Right Ace- tabulum and the Head of the Femur, facing. . . 68 PLATE XXXIII. Consolidated gunshot fracture of the Femur, facing 74 Fatal cases 77 Abstracts of fifty-two cases - . 77 Excision at the Hip Joint after shot injury 89 TABLE X. Numerical statement of sixty-six cases of excision at the Hip Joint for shot injury. ... 89 Primary excisions at the Hip Joint 92 Abstracts of thirty-three cases 92 TABLE XI. Summary of thirty-three cases. 99 Intermediary excisions at the Hip Joint 101 Abstracts of twenty-two cases 101 TABLE XII. Summary of twenty-two cases. Ill Secondary excisions at the Hip Joint 113 Abstracts of eleven cases ) 1 ) TABLE XIII. Summary of eleven cases ... 119 Excisions at the Hip Joint for shot injury in the United States service since the war 120 Abstracts of six cases 120 Amputations at the Hip Joint . . . 127 TABLE XIV. Numerical statement of sixty-six cases of amputation at the Hip Joint 127 Primary amputations at the Hip Joint 131 Abstracts of twenty-five cases 13L TABLE XV. Summary of twenty-five cases 138 Intermediary amputations at the Hip Joint J39 Abstracts of twenty-three cases 139 TABLE XVI. Summary of twenty-three cases 144 Secondary amputations at the Hip Joint 145 Abstracts of nine cases 145 TABLE XVII. Summary of nine cases 151 Ke amputations at the Hip Joint !52 Abstracts of nine cases 152 TABLE XVIII. Summary of nine cases . ... 159 SECTION III. Injuries in the Shaft of the Femur . . icy Shot contusions of the Shaft of the Femur . . 169 TABLE XIX. Numerical statement of one hundred and sixty-two cases of shot contusions of the Shaft of tins Femur 170 Abstracts of four cases 170 Legations after shot contusions of the Femur 172 Abstracts of eight cases 172 Amputations consequent on shot contusions of the Femur .... 172 Abstracts of nine oases 17:) Shot fractures of the Shaft of the Femur ... 174 TABLE XX. Numerical statement of sixty -five hun dred and seventy-six shot fractures of the Shaft of the Femur 175 VI Page. SECTION III. INJURIES OF FEMUK [Continued. Partial shot fractures of the Shaft of the Femur 175 Abstracts of two cases 176 Shot fractures of the Shaft of the Femur treated by conservation 176 Shot fractures of the upper third of the Shaft of the Femur 177 Recoveries (abstracts of thirteen cases) 178 PLATE LIX. Consolidated gunshot fractures of the Femur, facing 178 PLATE LVIII. Consolidated gunshot fractures of the Femur, facing 180 PLATE LV. Two views of a united shot fracture of the Right Femur over eleven years after injury, facing 182 Fatal cases (abstracts of seven cases) 184 PLATE XXV. Secondary inflammation of the Knee Joint, facing 184 Shot fractures of the middle third of the Femur treated by conservation 1 87 Recoveries (abstracts of eleven cases) 187 PLATE LX. Consolidated gunshot fractures of the Femur, facing 188 PLATE LXI. Consolidated gunshot fractures of the Femur, facing 190 Fatal cases (abstracts of five cases) 191 PLATE LXII. Consolidated gunshot fractures of the Femur, facing 192 PLATE XXIV. Osteomyelitis in a fractured Fe mur, facing 194 Shot fractures of the lower third of the Femur treated by conservation 1 94 Recoveries (abstracts of eight cases) 194 PLATE LXIII. Consolidated gunshot fractures of the Femur, facing 19(> Fatal cases (abstracts of three cases) 197 PLATE LX1V. Consolidated gunshot fractures of the Femur, facing 1 98 Shot fractures of the Femur, without indication of the seat of injury, treated by conservation I Jtf Pseudarthrosis after shot fractures of the Fe mur 1 1:8 Abstracts of two cases 1 98 Excisions in the continuity of the Femur for .shot injury l J9 TABLE XXI. Numerical statement of one hundred and seventy-five excisions in the Shaft of the Fe mur for shot injury 2UU Primary excisions in the Shaft of the Femur 2CO Recoveries (abstracts of four cases) 200 TABLE XXII. Summary of twenty cases of re covery 20:1 PLATE XXX. Obstructed femoral vein, facing.. 2U4 Fatal cases (abstracts of five cases) 204 TABLE XX1I1. Summary of sixty-five fatal cases 200 Undetermined cases 207 TABLE XXIV. Summary of six cases with un known results ~07 Intermediary excisions in tlie Shaft of the Femur 207 Recoveries (abstracts of two cases) . - 07 TABLE XXV. Summary of nine cases of re covery 208 Fat:.! i ;ises (abstracts of three cases) 209 TABLE XXVI. Summary of thirty-nine fatal cases 210 Secondary excisions in the Shaft of the Femur 210 Recoveries (abstracts of two cases) 210 Fatal cases (abstract of one case) 211 TABLE XXVII. Summary of nineteen cases 212 Excisions in the Shaft of the Femur at an unknown period 212 TABLE XXVIII. Summary of seventeen cases 212 Amputations in the Shaft of the Femur. . 213 TABLE XXIX. Numerical statement of sixty-two hundred and twenty-nine amputations of the Thigh for shot injury 213 TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES-CONTINUED Page SECTION III. INJURIES OF FEMUR [Continued. Primary amputations in the Shaft of the Femur .... 214 Primary amputations in the upper third of the Femur 214 Successful cases (abstracts of four cases) .... 215 Fatal cases (abstracts of three cases) 216 TABLE XXX. Summary of five hundred and thirty-three cases Primary amputations in the middle third of the Femur 223 Successful cases (abstracts of five cases) 223 PLATE LXIX. Tubular sequestra from am putations of the Femur, facing Fatal cases (abstracts of five cases) PLATE XXXII. Diseased stump of Femur, facing 226 TABLE XXXI. Summary of eleven hun dred and fifty -seven cases 227 PLATE XXXI. Gangrene of the Medulla . . 228 Primary amputations in the lower third of the Femur 241 Successful cases (abstracts of seven cases) . . 241 PLATK LXX. Involucra of the Femur, facing 242 Fatal cases (abstracts of two cases) 244 TABLE XXXII. Summary of nineteen hun dred and fourteen cases 245 Primary amputations in the Femur without in dication of the seat of incision : TABLE XXXIII. Summary of three hun dred and forty-five cases 268 Intermediary amputations in the Shaft of the Femur. 272 Intermediary amputations in the upper third of the Femur 272 Successful cases (abstracts of four cases) 272 Fatal cases (abstract of one case) 274 TABLE XXXIV. Summary of one hundred and forty-seven cases 275 Intermediary amputations in the middle third of the Femur 277 Successful cases (abstracts of four cases) 277 PLATE XXVI. Osteomyelitis of Femur, facing. 278 Fatal cases (abstracts of two cases) 279 TABLE XXXV. Summary of four hundred and seventy-one cases 280 PLATE XLII. Round musket ball in the medul lary cavity of the Femur, facing 280 Intermediary amputations in the lower third of the Femur 287 Successful cases (abstracts of five cases) 287 Fatal cases (abstracts of five cases) 289 PLATE XLIII. Results of Osteomyelitis, facing . 290 PLATE XXI. Gangrene of a Thigh Stump, facing 292 TABLE XXXVI. Summary of six hundred and seventy-six cases 293 PLATE XX. Femoral artery and Femoral rein after amputation, facing 294 Intermediary amputations in the Femur without in dication of the seat of incision 303 TABLE XXXVII. Summary of twenty-six cases. 304 Secondary amputations in the Shaft of the Femur. . . 304 Secondary amputations in the upper third of the Fe mur 304 Successful cases (abstracts of four cases) 304 Fatal cases (abstracts of three cases) 306 PLATK LXVI. Shot fracture of the middle third of the Femur, facing 306 TABLE XXXVIII. Summary of fifty-five cases. 308 Secondary amputations in the middle third of the Fe mur 3C9 Successful cases (abstracts of five cases) 309 Fatal cases (abstracts of three cases) 311 PLATE XXIII. Separation of Periosteum in Os teomyelitis, facing 312 Page. SECTION III. INJURIES OF FEMUR (Continued. TABLE XXXIX. Summary of one hundred and sixty-eight cases 313 PLATE XLIX. Medullary abscesses of the Fe mur, facing 314 Secondary amputations in the lower third of the Femur 316 Successful eases (abstracts of four cases) 316 PLATE LXXII. Involucra of bones of the Leg, facing 317 Fatal cases (abstracts of two cases) 318 TABLE XL. Summary of two hundred and seven cases 320 Secondary amputations of Thigh, point of ablation not specified 323 Abstract of one fatal case 323 TABLE XLI. Summary of twelve cases 323 Amputations in the continuity of the Femur of uncer t ain date 324 Amputations in the upper third of the Femur of uncertain date 324 TABLE XLII. Summary of thirty-three cases.. 324 Amputations in the middle third of the Femur of uncertain date 324 TABLE XLIII. Summary of seventy cases 325 Amputations in the lower third of the Femur of un certain date 326 TABLE XLIV. Summary of one hundred and four cases 326 Amputations in the Femur of uncertain date, and seat of operation 327 TABLE XLV. Summary of three hundred and eleven cases 327 Recapitulation 331 TABLE XLVI. Tabular statement indicating the seats of injury in six thousand two hundred and twenty-nine amputations in the Thigh 332 TABLE X LVII. Results of amputations of the Thigh on the occasions named and from the authorities quoted 334 Concluding observations on shot injuries of the Femur 335 TABLE XLVIII. Results of shot fractures of the Fe mur treated by conservation on the occasions named and from the authorities quoted 336 TABLE XLIX. Summary of twenty-one ligations of the Femoral artery in cases of shot fractures of the Femur treated by conservation 353 TABLE L. Numerical statement of Union and Confederate soldiers treated by conservation after shot fracture of the Femur 355 Excisions in the Shaft of the Femur 355 Amputations in the Thigh 355 PLATE LXX III. Thigh stumps, facing 356 TABLE LI. Statement of the ages of six thousand two hundred and nine patients who submitted to amputation of the Thigh for shot injury 358 SECTION IV. Wounds and Injuries of the Knee Joint .. 359 Punctured and incised wounds 359 Punctured wounds (abstracts of ten cases) 360 Incised wounds 361 Incised wounds treated without operative inter ference 3<>1 Abstracts of ten cases 361 Amputations in tho Thigh after incised wounds. . 362 Abstracts of six cases 362 Shot injuries of the Knee Joint 363 Shot contusions of the Knee Joint 363 Treated by conservation 364 Recoveries (abstracts of ten cases) 364 Fatal cases (abstracts of six cases) 365 Treated by amputation 367 Shot fractures of the Knee Joint 367 TABLE LII. Numerical statement of thirty-three hundred and fifty-five cases of shot fractures of tho bones of the Knee Joint 3C7 VII TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES CONTINUED. Page. SECTION IV. INJURIES OF KNEE JOINT [Continued. Shot fractures of the Knee Joint treated by con servation 3(>8 Recoveries (abstracts of twenty-three cases). 369 PLATE LXVIII. Results of shot injuries of the Knee Joint, facing 1 .!70 PLATE LXVII. Hall lodged in outer con- dyle of Left Femur over 15 years, facing. . . 1(72 Fatal oases abstracts of fifteen cases) 380 Excisions at the Iviiee Joint for shot injury . . 384 TABLE LIU. Classified statement of fifty- seven cases of excisions at the Knee Joint for shut fracture 335 Primary excisions at the Knee Joint 1)86 Abstracts of thirty-two cases 386 PLATE LXV. Successful excisions of the Knee Joint after shut injury, facing 386 Intermediary excisions at the Knee Joint . . . 391 Abstracts of thirteen cases 391 Secondary excisions at the Knee Joint 394 Abstracts of seven cases 394 . Excisions at the Knee Joint of uncertain date 397 Abstracts of five cases 397 Amputation at the Knee Joint 397 TABLE LIV. Summary of one hundred and eighty-nine amputations at the Knee Joint for shot fracture 398 Primary amputations at the Knee Joint .... 398 Abstracts of five cases 399 TABLE LV. Summary of one hundred and eight cases 401 Intermediary amputations at the Knee Joint 404 Abstracts of five cases 404 TABLE LVI. Summary of fifty -one cases 405 Secondary amputations at the Knee Joint . . 407 Abstracts of four cases 407 TABLE LVII. Summary of twenty-six cases 409 Amputations at the Knee Joint of uncertain date 410 TABLE LVIII. Summary of four cases 410 Concluding observations on shot injuries of the Knee Joint 411 TABLE LIX. Shot wounds of the Knee Joint treated by conservation on the occasions named and from the authorities quoted 417 Excisions at the Knee Joint 419 TABLE LX. Excisions at the Knee Joint for shot injury on the occasions named and from the authorities quoted 422 Amputations at the Knee Joint 423 SECTION V. Wounds and Operations in the Leg 427 Shot contusions of the bones of the Leg. 427 Treated by conservation 427 Recoveries (abstracts of six cases) 427 PLATE LXXI. Tubular sequestra and pieces of necrosed bone from tibia, facing 428 Deaths (abstracts of three cases) 430 Followed by amputation 430 Abstracts of eight cases 431 Shot fractures of the Bones of the Leg 432 TABLE LXI. Descriptive numerical statement of the nature and treatment of eight thousand nine hundred and eighty-eight shot fractures of the bones of the Log 433 Shot fractures of the bones of the Log treated by con servation 432 Shot fractures of the Tibia treated by conservation 433 Recoveries (abstracts of nine cases) 433 PLATE LXXIV. Upper portion of right Tibia sawn longitudinally, facing 434 Deaths (abstracts of three cases) 436 Shot fractures of the Fibula treated by con servation . 437 SECTION V. WOUNDS OF LEG [Continued. Recoveries (abstracts of two cases) 437 Deaths (abstract of one case) 437 Shot fractures of both bones treated by con servation 438 Recoveries (abstracts of eight cases) 438 Deaths (abstracts of three cases) 441 Excisions in the continuity of the bones of the Leg for shot injury 444 TABLE LXII. Numerical statement of three hundred and eighty-seven excisions in the bones of the Leg for shot fracture 445 Primary excisions in the bones of the Leg 445 Abstracts of nine cases 445 TABLE LXIII. Summary of two hundred and fifteen cases 449 Intermediary excisions in the bones of the Leg. . 453 Abstracts of six cases 453 TABLE LX1V. Summary of eighty-seven cases 455 Secondary excisions in the bones of the Leg. . . . 456 Abstracts of four cases 456 TABLE LXV. Summary of fifty cases 458 Excisions in the bones of the Leg of uncertain date 459 TABLE LXVI. Summary of thirty-five cases 460 Amputations in the continuity of the Leg for shot fracture 4liO TABLE LXVII. Numerical statement of fifty- four hundred and fifty-two amputations of the Leg for shot injury 461 Primary amputations in the continuity of the Leg for shot injury 46] Primary amputations in the upper third of the Leg 461 Abstracts of ten cases 461 TABLE LXVIII. Summary of one thou sand and twenty-nine cases 466 Primary amputations in the middle third of the Leg 478 Abstracts of eight cases 478 PLATE LXXVI. Laceration of right Leg by solid shot, facing 478 TABLE LXIX. Summary of eight hun dred and ninety-two cases 480 Primary amputations in the lower third of the Leg 491 Abstracts of eight cases 491 TABLE LXX. Summary of nine hun dred cases 494 Primary amputations in the Leg seat of operation not indicated 505 Successful cases (abstracts of four cases) 505 Fatal cases (abstracts of two cases) .... 506 TABLE LXX1. Summary of five hun dred and seventy-one cases 506 Intermediary amputations in the continuity of the Leg for shot injury 512 Intermediary amputations in the upper third of the Leg 513 Successful cases (abstracts of six cases) . 513 Fatal cases (abstracts of three cases) . . . 514 TABLE LXX1I. Summary of two hun dred and ninety-six cases 515 Intermediary amputations in the middle third of the Leg 519 Successful cases (abstracts of five cases) 520 Fatal cases (abstracts of throe cases) . . TABLE LXXIII. Summary of three hundred and sixty-eight cases. Intermediary amputations in the lower third of the Leg. 508 Successful cases (abstracts of six cases) 528 Fatal cases (abstracts of four cases) .... 529 TABLE LXXIV. Summary of three hundred and thirty-five cases 531 VIII TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES CoxTrxuED. Page. SECTION V. WOUNDS OF LEG [Continued. Intermediary amputations in the Log point of operation not specified 536 Abstracts of two examples 536 TABLE LXXV. Summary of forty-seven cases 536 Secondary amputations in the continuity of the Leg for shot injury 537 Secondary amputations in the upper third of the Leg 537 Examples of recovery (abstracts of five cases) 537 Fatal cases (abstracts of four cases) 539 TABLE LXXVI. Summary of one hundred and thirty-three cases 541 Secondary amputations in the middle third of the Leg 544 Recoveries (abstracts of five cases) 544 Fatal cases (abstracts of three cases) 546 TABLE LXXVII. Summary of one hundred and seventy-four cases 547 Secondary amputations in the lower third of the Leg 550 Recoveries (abstracts of three cases) 550 Fatal cases (abstracts of three cases) 551 TABLE LXXVIII. Summary of one hun dred and twenty-one cases 552 Secondary amputations in the Leg third not indicated 554 Recoveries (abstract of one case) 554 Fatal cases (abstract of one case) 554 TABLE LXXIX. Summary of sixteen cases 555 Amputations in the continuity of the Leg of uncer tain date 555 Amputations in the upper third of the Leg of uncertain date 555 TABLE LXXX. Summary of fifty-one cases 555 Amputations in the middle third of the Leg of uncertain date 556 TABLE LXXXI. Summary of forty-seven cases 556 Amputations in the lower third of the Leg of uncertain date 557 TABLE LXXXII. Summary of fifty-one cases 557 Amputations in the Leg of uncertain date and seat of operation 558 TABLE LXXXIII. Summary of four hun dred and twenty-one cases 558 Recapitulation 563 Concluding observations on shot fractures of the Bones of the L.eg 563 TABLE LXXXIV. Results of shot fractures of the bones of the Leg treated by conservation on the occasions named and from the authorities quoted. . 564 Excisions in the continuity of the bones of the Leg. . 569 TABLE LXXXV. Results of shot fractures of the bones of the Leg treated by excision on the occasions named and from the authorities quoted 570 Amputations in the Leg 572 TABLE LXXXVI. Summary of seven thousand six hundred and thirty-seven amputations in the Leg for shot injuries on the occasions named and from the authorities quoted 573 SECTION VI. Wounds and Operations at the Ankle Joint 577 Shot contusions of the Ankle Joint 577 Shot contusions of the bones of the Ankle Joint treated by conservation 577 Abstracts of seven cases 577 Shot fractures of the Bones of the Ankle Joint 578 TABLE LXXXVII. Summary of one thousand seven hundred and eleven shot fractures of the Tibio- tarsal Articulation - 578 Shot fractures of the bones of the Ankle Joint treated by conservation 579 Abstracts of twenty cases 579 9* Pnj-o. SECTION VI. WOUNDS OK AXKLE JOINT [Continued. Excisions at the Ankle Joint for shot ir\jury. .. 585 TABLE LXXXVIII. Numerical statement of thirty-three excisions at the Ankle Joint for shot injury 535 Primary excisions at the Ankle Joint 5S6 Abstracts of eleven cases 580 Intermediary excisions at the Ankle Joint 588 Abstracts of eight cases 588 Secondary excisions at the Ankle Joint 531 Abstracts of nine cases 501 Excisions at the Ankle Joint time between the injury and operation unknown 594 Abstracts of five cases 594 Amputations at the Ankle Joint 595 TABLE LXXXIX. Numerical table of one hun dred and sixty-one amputations at the Ankle Joint for shot injury 595 Primary amputations at the Ankle Joint 595 PLATE LXXV. Amputations at the Ankle Joint, facing 59R Successful cases (abstracts of eight cases) . . 596 Fatal cases (abstracts of four cases) 598 TABLE XC. Summary of one hundred and three cases 599 Intermediary amputations at the Ankle Joint 603 Successful cases (abstracts of five cases) . . . 603 Fatal cases (abstracts of two cases) 604 TABLE XCI. Summary of thirty -nine cases 605 Secondary amputations at the Ankle Joint 006 Abstracts of two cases 606 TABLE XCII. Summary of thirteen cases. 607 Amputations at the Ankle Joint of uncertain date fi08 TABLE XCIII. Summary of six cases 608 Concluding observations on shot injuries of the Ankle Joint 608 Excisions at the Ankle Joint for shot injury 610 TABLE XCIV. Results of excisions at the Ankle Joint on the occasions named and from the authorities quoted 610 Amputations at the Ankle Joint 612 TABLE XCIV. Results of amputations at the Ankle Joint on the occasions named and from the authorities quoted 614 SECTION VII. Wounds and Operations in the Foot err Bayonet wounds of the Bones of the Foot... 617 Shot wounds of the Bones of the Foot 617 Shot contusions of the bones of the Foot 617 Abstracts of two cases 617 Shot fractures of the bones of the Foot 618 TABLE XCV. Summary of five thousand eight hundred and thirty-two shot fractures of the bones of the Foot 618 Shot fractures of the bones of the Foot treated by conservation 618 Abstracts of sixteen cases 61 !) Excisions in the Bones of the Foot 622 TABLE XCVI. Numerical statement of ninety-seven cases of excisions in the bones of the Foot Primary excisions in the bones of the Foot. . Abstracts of seven cases Intermediary excisions in the bones of the Foot 624 Abstracts of four cases 624 Secondary excisions in the bones of the Foot 625 Abstracts of two cases C25 TABLE XCVII. Summary of ninety-seven cases of excisions in the bones of the Foot 626 Amputations in the Foot TABLE XCV1II. Numerical statement of one thousand five htimlrcd and eighteen cases of amputations in the Foot 628 Primary amputations in the Foot 628 Abstracts of ten cases C28 IX TABLE OF CONTENTS. CHAPTER X. WOUNDS AND INJURIES OF THE LOWER EXTREMITIES CONTINUED. Page. SECTION VII. WOUNDS OF FOOT [Continued. TABLE XCIX. Summary of one hundred and sixty-one cases 630 Intermediary amputations in the Foot C33 Abstracts of three cases 633 TABLE C. Summary of fifty-two cases. 633 Secondary amputations in the Foot 604 Abstracts of two cases . . . 634 Tage. SECTION VII. WOUNDS OF FOOT [Continued. TABLE CI. Summary of eighteen cases 635 Amputations in the Foot of uncertain date. . 635 Abstract of one case 636 TABLE CH. Summary of sixty cases. 636 Concluding observations 637 Excisions in the bones of the Foot 637 Amputations in the Foot 639 CHAPTER XL MISCELLANEOUS INJURIES. Page. SECTION I. TABLE CIII. Summary of one hundred ami seventy- one thousand five hundred and sixty-five miscel laneous injuries 640 TABLE CIV. Summary of one thousand three hun dred and thirty-six deaths from various causes .... 641 Burns and scalds 641 Abstracts of four cases 641 Contusions and sprains 642 Abstracts of six cases 642 Concussion and compression of the Brain 644 Dislocations 644 Abstracts of fourteen cases 644 Simple and compound fractures 649 Abstracts of fifteen cases 649 Punctured, incised, and lacerated wounds 652 Abstracts of nine cases 652 Other accidents and injuries 654 Abstracts of six cases 654 SECTION II. Operations for Miscellaneous Injuries.... 657 Excisions 657 TABLE CV. Numerical statement of forty-five cases of excisions following miscellaneous injuries or diseases 657 Abstracts of two cases 657 TABLE CVI. Summary of twenty cases 658 Amputations 659 Amputations in the Upper Extremities 659 TABLE CVII. Numerical statement of one hun dred and ninety -five cases of amputations in the Upper Extremities for disease or for injury not inflicted by weapons of war 659 Page. SECTION II. OPERATIONS FOR MISCEL. INJURIES [Continued. Abstracts of three cases 660 TABLE CVIII. Summary of one hundred and two cases (561 Amputations in the Lower Extremities 664 TABLE CIX. Table of five hundred and eighty- three cases of amputations in the Lower Ex tremities for disease or for injury not inflicted by weapons of war 664 Abstracts of four cases 665 TABLE CX. Summary of one hundred and forty- nine amputations in the Thigh for miscel laneous injuries or diseases 666 Exarticulations at the Knee Joint 670 Abstracts of four cases 670 Amputations in the Leg 670 Abstract of one case 671 TABLE CXI. Summary of two hundred and fifty-nine cases 671 Amputations in the Foot 677 TABLE CXII. Summary of fifty-one cases 677 Amputations of the Toes 678 Abstract of one case 678 legations 679 Abstracts of ten cases 680 Operations on the Eye or its appendages 68 1 TABLE CXIII. Summary of seventy-six cases 681 Operations on the Mouth and its appendages 684 Operations on the Air Passages 684 Operations on the Chest and Abdomen 684 Operations on the Genito-Urinary organs 684 CHAPTER XII. WOUNDS AND COMPLICATIONS. Page. TABLE CXIV. Frequency of sabre and bayonet and shot wounds on occasions named and from authorities quoted . 685 Sabre and Bayonet Wounds 686 TABLE CXV. Summary of nine hundred and twenty- two sabre and bayonet wounds recorded during the American civil war, 1861- 65 686 Shot Wounds . 687 TABLE CXVI. Tabular statement of the shot wounds of the Head, Face, and Neck recorded during the American civil war 688 TABLE CXVII. Tabular statement of the shot wounds of the Spine, Chest, Abdomen, Pelvis, aud Back re corded during the American civil war 689 TABLE CXVIII. Tabular statement of the shot wounds of the Upper and Lower Extremities recorded during the American civil war 690 TABLE CXIX. Table indicating percentage of fa tality and relative frequency of shot wounds re corded during the War of the Rebellion 691 TABLE CXX. Tabular statement of the relative fre quency of shot wounds of the different regions of the body 693 Definition of shot injuries 694 Fire-arms and their projectiles 695 TABLE CXXI. Table indicating the seat of the injury and nature of the projectile in the cases of shot wounds reported during the war 696 Explosive balls . 701 Abstracts of sixteen cases Effects of large projectiles Abstracts of five cases Effects of missiles and projectiles from small arms.. . Abstracts of two cases PLATE LXXVlIt. Distorted bullets, facing Entrance and exit wounds PLATE XXXIX. Early appearance of entrance and exit wounds, facing Effects of projectiles on muscular tissue and tendons Effects of missiles and projectiles on bony structure Abstracts of eleven cases PLATE XL. Early appearances of entrance und exit wounds, facing TABLE CXXII. Numerical statement of shot contu sions of the bones of the Head, Trunk, and Ex tremities Simple fractures (abstract of one case) Partial fractures (abstract of one case) Penetrations of bone (abstract of one case) Perforations of bone (abstracts of three cases) Complete fractures (abstracts of two cases) Effects of missiles and projectiles on nerves Abstracts of thirty cases PLATE XXXVIII. Facial Paralysis consequent on shot injury, facing Effects of missiles and projectiles on Blood-vessels. . . Abstracts of eleven cases age. 702 704 704 708 709 710 711 712 712 713 714 714 716 718 719 719 721 YOO 725 726 74! 750 750 TABLE OF CONTENTS. CHAPTER XII. WOUNDS AND COMPLICATIONS CONTTCUED. Page. TABLE CXXIII. Summary of one hundred and eighteen cases of complete division of the larger Blood-vessels, indicating the number of cases in which primary bleeding occurred 752 Lodgement of missiles and projectiles 757 Primary symptoms common to gunshot wounds 759 Shock (one case) 759 Pain (abstract of one case) 760 Primary haemorrhage 761 Haemorrhages and Legations 762 Arteries 763 TABLE CXXIV. Summary of two thousand two hun dred and thirty-five cases of arterial haemorrhages of the Head, Neck, Chest, Trunk, and Upper and Lower Extremities in which the bleeding vessels were indicated by name 763 TABLE CXXV. Tabular statement of one thousand one hundred and fifty-five ligations for shot injuries . 765 Ligations of the Common Carotid artery 766 Abstracts of two cases 766 TABLE CXXVI. Condensed summary of eighty-two cases of ligalions of the Com mon Carotid for shot injuries 767 Ligations of the Internal Carotid artery 770 Ligations of the External Carotid artery ... 770 TABLE CXXVII. Condensed summary of seven cases of ligations of the External Carotid artery for shot injuries 770 Ligations of minor branches of the External Ca rotid artery (abstracts of eight cases) 770 Ligations of the Temporal artery 771 TABLE CXXVIII. Condensed summary of eighteen cases of ligations of the Temporal artery for shot injuries 771 Ligations of the Facial artery (one example) .... 772 TABLE CXX1X. Condensed summary of eight ligations of the Facial artery for shot injuries 772 Ligations of the Subclavian artery (one abstract) 772 TABLE CXXX. Condensed summary of fifty- one cases of ligations of the Subclavian artery for shot injuries 773 Ligations of branches of the Subcliivian artery. . 774 Abstracts of twelve cases 774 Ligations of the Axillary artery 775 TABLE CXXXI. Condensed summary of forty-nine cases of ligations of the Axillary artery for shot injuries 775 Ligations of brandies of the Axillary artery. . . . 776 Abstracts of four cases 77fi Ligations of the Circumflex artery TABLE CXXX1I. Condensed summary of eighteen ligations of the Circumflex artery for shot injury 777 Ligations of the Brachial artery 777 TABLE CXXXIII. Summary of one hun dred and seventy cases of ligations of the Brachial artery 777 Ligations of branches of the Brachial artery. . . . 782 Abstracts of eleven cases 782 Ligations of the Radial artery 782 TABLE CXXXIV. Condensed summary of fifty-nine ligations of the Radial artery for shot injury 783 Ligations of the Ulnar nrtery 784 TABLE CXXXV. Condensed summary of twenty-two ligations of the Ulnar artery for shot injuries 784 Ligations of the Interosseous artery of Forearm. 785 Abstracts of nine cases 785 Ligations of arteries of the Hand 785 TABLE CXXXVI. Condensed summary of twelve cases of ligations of arteries of the Hand 786 Ligations of the Common Iliac artery 780 Page. TABLE CXXXVII. Summary of five unsuc cessful cases of ligations of the Common Iliac artery 786 Ligations of the Internal Iliac artery 786 TABLE CXXXVIII. Condensed summary of three ligations of the Internal Iliac artery 787 Ligations of the Gluteal artery 787 TABLE CXXXIX. Summary of six ligations of the Gluteal artery 787 Ligations of the Sciatic artery 787 Abstracts of two cases 787 Ligations of the External Iliac artery 787 TABLE CXL. Summary of twenty -six liga tions of the External Iliac artery 788 Ligations of the Spermatic artery (one abstract) 788 Ligations of the Femoral artery 788 TABLE CXLI. Summary of three hundred and seventy-four ligations of the Femoral artery 789 Ligation of the External Pudic artery 798 Ligation of the Profunda Femoris 798 Abstract of one case 798 TABLE CXLII. Summary of twenty-two cases of ligations of the Profunda Femoris. 798 Ligations of the Perforating arteries 799 Abstracts of six instances 799 TABLE CXLIII. Summary of twenty- four ligations of muscular and other small branches of the Femoral artery 799 Ligations of the Popliteal artery 800 TABLE CXLIV. Summary of thirty-six li gations of the Popliteal artery 800 Ligations of the Articular branches of the Popliteal artery 801 Abstracts of three cases 801 Ligations of the Anterior Tibial artery 801 TABLE CXLV. Summary of forty-seven li gations of the Anterior Tibial artery 802 Ligations of branches of the Anterior Tibial ar tery 803 Abstracts of three cases 803 Ligations of the Posterior Tibial artery 803 TABLE CXLVI. Summary of forty-eight li gations of the Posterior Tibial artery 803 Ligations of Plantar arteries 805 Abstracts of three cases 805 Ligations of the Peroneal artery 805 Abstracts of four cases 805 Remarks on haemorrhages and ligations 805 Abstracts of five cases 806 TABLE CXLVII. Table indicating the days on which the first haemorrhage occurred 805 Traumatic aneurism (abstract of one case) 808 TABLE CXLVIII. Summary of seventy-four cases of Traumatic aneurism 808 PLATE LXXVII. Traumatic aneurism 808 Causes of haemorrhage (abstracts of three cases) .... 809 Treatment (abstract of four cases) 810 TABLE CXLIX. Summary of two thousand two hundred and thirty-five cases of haemorrhage, indicating mode of treatment 810 Ligations (abstracts of three cases) 813 TABLE CL. Table indicating the various Modes of Ligations and their fatality 814 Veins (abstracts of three cases) 81G TABLE CLI. Summary of one hundred and six cases of hncmorrhago from veins fi lfi PLATK LXXIX. Fig. 1. The left Femoral vein after death from pyaemia. Fig. 2. Gangrene of Foot after shot wound of Leg, upper third, facing 818 Tetanus (abstracts of ten cases) 8)8 TABLE CLII. Summary of five hundred and five cases of tetanus, indicating seat of injury and result. 819 TABLE CLIII. Statement indicating the day after injury or amputation on which tetanus appeared. . . 819 XI TABLE OF CONTENTS. CHAPTER XII. WOUNDS AND COMPLICATIONS CONTINUED. Page. TABLE CLIV. Numerical statement of results of three hundred and fifty-eight cases of tetanus in which the duration of the disease was reported . . . 820 Gangrene (abstracts of nine cases) 823 TAUI.E CLV. Summary of two thousand six hun dred and forty-two cases of gangrene, indicating the result and frequency 824 TABLE CLVI. Indicating the years in which the gangrene occurred 825 TABLE CLVII. Summary of cases of hospital gan grene, giving treatment and results 836 TABLE CLVIII. Summary of nine cases of hospital gangrene, showing date and grade of disease 842 PLATE XXIX. Dry gangrene of the Feet, facing ... 850 Dry gangrene (abstracts of seven cases) 850 Traumatic Erysipelas (abstracts of eight cases) 851 TABLE CL1X. Numerical statement of one thousand and ninety-seven cases of traumatic erysipelas .... 852 TABLE CLX. Numerical statement of one thousand and ninety-seven cases of traumatic erysipelas, in dicating causes of death 854 Pyaemia (abstracts of seven cases) 857 TABLE CLXI. Summary of cases of pyaemia, indi cating location of injury and result 859 TABLE CLXII. Indicating day of appearance of pyaemia after injury and after operation 860 Condensed summary of forty-eight pnst-mortem ex aminations in cases of pyaemia 862 Concluding observations on Sliot wounds .... 860 Climatic, hygienic, aud moral influences 867 Multiple wounds (abstracts of two cases) 868 Conservation, Excision, Amputation 869 TABLE CLXIII. Tabular statement of eighty-seven thousand seven hundred and ninety-three cases of shot injuries of the Upper Extremities, indicating seat of injury, mode of treatment, and final results. 870 i Page. TABLE CLXIV. Tabular statement of eighty-six thousand four hundred and thirteen cases of shot injuries of the Lower Extremities, indicating seat of injury, mode of treatment, and final results . . 870 TABLE CLXV. Summary of sixty thousand two hun dred and sixty -six.shot fractures ot the Extremities. showing treatment and results 87:i Excisions , 874 TABLE CLXVI. Numerical statement of four thou sand six hundred and fifty-six excisions in the Ex tremities 87f> TABLE CLXVII. Tabular statement of excis ions, indicating the months in which the opera tions were performed : 87(1 Amputations 877 TABLE CLXVIII. Tabular statement of twenty- nine thousand nine hundred and eightyamputa- tions. indicating seat of operation and results. . 877 TABLE CLXIX. Table indicating the rate of mortality after amputations and excisions in the Extremities 878 TABLE CLXX. Summary of twenty-three thou sand seven hundred and sixty-two amputations, indicating the period of the operation 87 .) TABLE CLXXI. Summary of eighteen thousand seven hundred and eighteen cases of amputa tions in the Extremities, indicating the side upon which the operation was performed 880 TABLE CLXXII. Numerical statement of on* hundred and seventy-two cases of double am putations for shot injuries 881 TABLE CLXXIII. Condensed summary of one hundred and seventy-two double amputations after shot injury 881 CHAPTER XIII. AN/ESTHETICS. Prolegomena Deaths from chloroform Abstracts of thirty -seven cases Deaths from chloroform and ether Abstracts of two cases Deaths from ether 894 Abstracts of four cases ... .894 Page. . 887 . 890 . 890 . 894 . 894 Page. TABLE CLXXIV. Statement of five hundred and ninety- seven cases of the employment of anaesthetics, showing quantities used, time to induce anaesthesia, and period during which it was maintained R9fi TABLE CLXXV. Statement showing the frequency of vomiting, excitement, and prostration in five hundred and ninetv-seven cases of anaesthesia . . . . 897 CHAPTER XIV. THE MEDICAL STAFF AND MATERIA CHIRURGICA. Page. Prolegomena 899 An Act to Reorganize and Increase the Efficiency of the Medical Department of the Army 900 Duties of the Medical Director of a Corps 903 Duties of the Medical Inspector of a Corps 906 Duties of the Surgeon-in-Chief of a Division 906 Duties of a Surgeon-in-Chief of a P.rigade 907 Duties of the Surgeon in Charge of a Division Hospital . . 908 Duties of the Mediool Recorder of a Division Hospital 909 Duties of the Attending Surgeon of a Division Hospital . . 909 Page. Duties of the Operating Surgeon 909 Duties of the Regimental Surgeon 910 Duties of the Assistant Regimental Surgeon . 912 Duties of the Commissary of Subsistence of a Division Hospital 912 Duties of the Chief Ambulance Officer of a Corps 913 Duties of the Chief Ambulance Officer of a Division 913 Duties of the Chief Ambulance Officer of a Brigade 914 Matoria Chirurgica 914 CHAPTER XV. TRANSPORTATION OF THE WOUNDED. Page. Hand Litters 923 Wheel Litters 926 Mule Litters 926 Cacolets 927 Ambulance Corps 931 Ambulance Wagons 944 Railway Transportation 957 Water Transportation 971 Steamer City of Memphis 974 TABLE. Tabular statement of trips of Steamer City of Pnge. Steamer Louisiana and R. C. Wood 975 TABLE. Tabular statement of trips of Steamer Louisiana 976 TABLE. Statement of trips of Steamer H. C. Wood 976 Steamer D. A. January 977 TABLE. Statement of trips of Steamer D. A. January 979 Steamer Empress . 981 Steamer .1. K. Barnes . 982 INDICES. List of Plates I List of Operators and Reporters Ill Memphis. . . XII 975 ! Subject-Matter Index. XVTT THE MEDICAL AND SURGICAL HISTORY OF THE WAR OF THE REBELLION (1861-651 PART III, VOLUME II. BEINO THE THIRD SURGICAL VOLUME. ON SPECIAL WOUNQIJ[URIES CONTINUED, CHAPTER X. WOUNDS AND INJURIES OP THE LOWER EXTREMITIES. In attempting to furnish a description, as adequate as practicable, of the various classes of injuries inflicted by war- weapons that were reported during the late war in this country, I have reviewed and analyzed at great length, in two preceding volumes, histories of cases of wounds of the head, neck, trunk, and upper extremities. It remains, to complete this branch of the subject, to discuss, in like manner, Wounds of the Lower Extremities, a very important group, comprising not only a larger number of those cases that come under the treatment of the military surgeon than any other group, but a greater proportion of cases demanding operative interference than is observed in other regions, and presenting to the field surgeon, especially in connection with lesions of the hip and thigh, some of the most difficult practical problems he has to encounter. Of the 253,142 cases of wounds returned during the War that have been examined and classified and entered on the permanent registers of the Surgeon-General s Office, 89,528 are cases of Wounds of the Lower Extremities. Of these, 59,376 are entered as Plefli Wounds, of which 674 were punctured or incised wounds, and the rest shot wounds. The remaining 30,152 cases were all returned as shot fractures, and were distributed as Ill 1 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. follows: Sliot Fractures of the Femur, including fractures penetrating the hip joint, 7,776; Fractures involving the Knee Joint, 3,557; Fractures of the Shafts of the Tibia or Fibula, or- of both, 10,026; Fractures implicating the Tarsus, Metatarsus, and Phalanges, 8,793. It must be borne in mind that this total of 89,528 cases of wounds of the lower extrem ities represents only, those cases that have been accurately determined and entered on the registers, and by no means all the cases belonging to this group that were reported during the War, and hence as the work progresses the figures will need to be modified. Besides the 253,142 registered cases, quite a number, reported with insufficient details for class ification, have been noted for investigation ; and, by searching the Pension Records, and through Union and Confederate reports which continue to be sent in, even at this late date, and by special reports from surgeons who kept note-books, and who, since the publication of the First Surgical Volume, have been led to transmit particulars of their cases, it will be possible, as each successive subject is taken up for analysis, to sensibly augment the aggregates of each group. This was observed in the discussion of the Wounds of the Upper Extremities. In TABLE XII, on page 454 of the Second Surgical Volume, but 84,718 cases of such wounds are recorded as registered, but in examining CHAPTER IX it will be found, as mentioned in the MEMORANDUM at page III of that Volume, that 88,741 oases are actually specified, the particulars of 4,023 additional cases having been obtained through information derived from various sources. Such additions may be expected in this Volume also; but they will not invalidate the approximate correctness of the figures above given, so far as relates to the relative frequency of wounds of the lower extremities. For such a purpose, the numbers 89,528 : 253,142 are ample, and the ratio is perhaps quite as reliable as it could be made by larger aggregates. The relative frequency of wounds of the lower extremities received in battle, com pared with the total number that came under treatment, appears from the above returns to be represented by a ratio of 35.3 per cent., or a little over one-third. There is good reason to believe that this is a very near approximation to the precise facts. Note, for example, its correspondence with returns from other campaigns: TABLE I. Collated Returns, indicating the Relative Frequency of Shot Wounds of the Lower Extremity in Aggregates of Wounded Men who came under Treatment. WARS, CAMPAIGNS, AND OTHEH OCCASIONS. AGGREGATE WOUNDED. WOUNDS OF LOWER EX TREMITY. RATIO. July 1830 days in Paris and Lyons (SERRlEn s table 1 ) . . 784 185 Crimean War (MATTHEW S return ) . . 7,660 2,396 31.2 Crimean War (CHENU s return 3 ) . 34, 306 11 873 34.6 Italian War of 1839 (CHENU s return 4 ) . . . 19, 672 7,704 39.1 Italian War of 1859 (DEMME 8 estimates 6 ) . . 17, 095 5, 248 30. G Danish War of 1864 (HEINE 6 ) . 1, 907 553 28.9 24, 788 7,560 30.5 Totals 106, 212 35, 519 33.4 1 SERULER (L.), Traite des plaies d armes a feu, Paris, 1844, p. 30. The insurgents fighting behind barricades, the proportion of injuries of tho lower extremities is less than usual. * MATTHEW (T. P.), Med. and Surg. Hist, of the Brit. Army in the years 1854-55-56, London, 1858, Vol. II, p. 355. a CHE.\U (J. C.), Rapport, etc., de Campagne d Orient en 1854-55-56, Paris, 1865, p. 6-27. "CHENU (J. C.j, Statistique Med. Chir. de la Campagne d ltalie en 185!) et 1860, Vol.11, p. 850. B DEMME (H.), Studien, Wiirzburg, 1861, B.I, p. 20. 6 HEINK (C.), Die Schwsverletzunge.n der Untercn Extrem- Uaten, Berlin, 1866. I much regret that, in regard to the statistics of the Danish War of 1864, I cannot refer to the conclusions of the lamented Gen- eralarzt F, LcEFFLER, from whose excellent General- Bcric.ht iibcr den Gcsundheitsdienst im Feldzuge gcgen Diinemarli 18C4, Berlin, 1867, the statistics INTRODUCTION.] WOUNDS OF THE LOWER EXTREMITIES. It will be observed, by comparing the tabular statement on page 434 of the Surgical Volume of Part II, that the relative frequency of shot wounds of the lower extremities does, not exceed that of wounds of the upper limbs to the extent that might be anticipated from the greater size of the lower limbs. This is doubtless due to the fact that, in all fighting in entrenched positions, the lower part of the person is partially screened from injury. In the last year of the War, the field casualties of the Union armies were reported with much completeness and accuracy, as has been already noticed (supra, Part I, Vol. II, p.. 600, Part II, Vol. II, pp. 6, 917), and over a hundred thousand cases of wounds were recorded with careful discrimination of their nature and position. In the engagements during this period, the combatants had learned to cover their positions with hastily improvised earthworks; and this may partly account for the smaller ratio of wounds in the lower limbs presented in these returns. Notice, for example, in the following tabular statement, the very small proportion of wounds of the lower limbs in the siege operations before Mobile. Another probable cause why the proportion of wounds of limbs was smaller in the field than in the general hospital returns, is that a large number of rapidly mortal wounds of the head and trunk appear on the field casualty lists, representing patients who never reached the base hospitals. TABLE II. Partial Numerical /Statement of Shot Wounds of the Lower Extremities in the Field or Primary Hospitals in various Campaigns during the last year of the War, 1864-65. CAMPAIGNS. FLESH WOUNDS. FRACTURES. FOOT. MISSILE. a - O A THIGH. LEG. THIGH. LEG. Large projec- Small projec- tilei. musket, b o Q < f~ S NAPLES AND DATES. .3 Ja . J3 J3 alul boinb Irag- pistul I mlK and small mis. H) <; *> o CO I 5 B | i 1 OS <o a munu, grape, ami canister. site, from s s o Q o Q e o o o G canister. H Army of Potomac, from May 4 to August 31, 1864 . . 4,037 10 3,843 6 812 104 938 21 2, 209 1 978 10, 828 38,944 30.5 Campaign to Atlanta, from May 4 to Sept. 8, 1804 . . 3,312 1C 2,058 573 73 581 31 1,044 543 5, 720 23,308 32.4 Geu.G II.Thomas s Army, from Oct. 25 to Dec.31, 64. 376 450 81 106 1 93 74 1,025 3,610 30.6 Gen.W. T. Sherman s Army through Carolinas in 05. 225 3 148 46 3 47 62 1 10 4!)8 1, 533 34.4 From Fort Fisher to Goldsborough, N. 0., 1865 110 12-1 1 32 2 32 i 35 43 178 1,075 31.5 Siege of Mobile, from March 26 tu April 19, 1805 100 84 40 8 32 48 57 137 2,111 14.4 Army of James, from May 4, 1864, to April !>, 1805. 1,091 6 1,850 390 7 436 11 718 504 3, 899 16, 120 27.8 Shenandoah Valley, from May 4 to August 20, 1861. 253 205 fi9 4 23 1 16 32 554 2, 196 26. 7 Shenandoah Valley, from Aug. 21 to Dec. 30, 1804. . 829 1 949 273 18 3:20 5 403 226 2,540 7,542 26.6 Army of Potomac, from Sept. 1, 1864, to Ap l 9, 1805. 1,017 1 1, 120 269 32 27 , 10 555 170 2, 581 10, 407 31.1 Aggregates 11, 356 39 10, 903 13 2, 545 271 2, 787 81 5,243 2, 649 27, 900 106, 846 30.7 of wounds of the upper extremity in this campaign were cited in the Second Surgical Volume (Chap. IX, p. 434). This eminent surgeon died in 1874; and I have been unable to procure the second volume of his most painstaking and accurate treatise : or to learn that it lias been published. Fortunately, Dr. HEINE S statistics cover the ground, if not as thoroughly, at least with commendable precision. These 24,788 cases are collected from the following authors: McCOKMAC (W.) (Notes and Recollections of an Ambulance. Surgeon, London, 1871, p. 129; total number of cases, 610, lower extremities, 257); BlLUtoni and CZEKNY (Chirurgische liriefe, Berlin, 1872, p. 180 ; 277 135); RUPPKECHT (MilitardrMiclie Erfahrungen, 1871, S. 10 ; 361 128); MtfHUiAUEU (Erfa.hru.ngen aus dem Feldzuye, etc., in BayeriscUes drtzliches Intelligenzblatt, 1871, S. 374; 1899 849); STEINBERG (Die Kriegslaz- arethe und Baracken von Berlin, Berlin, 1871, S. 140; 8531 974); GOLTDAMMER (Bcricht iiber die Thatigkeit des Keserve-Lazarethes des Berliner Hulfscereins, in Berliner Klin. Wochenschr., 1871; 639 67); HKYFELDKU (O.) (BericM iiber meine Wirksamkeit am Rhein, in Petersburg Metl. Zeitschrift, 1871 ; f?26 81); Socix (A.) (Kriegschirurgische Erfahrungen, Leipzig, 1872, p. 8; 643 328); MUXDY and MOSETIG (Service Med. chir. de Vambulance du Corps legislatif, in Gaz. des Hop., 1871, No. 149 ; 136 58) ; BECK (B.) (Chir. der Sc/iussD.,1872, S. 160; 4344 1787); FISCHER (II.) (Krieyschir. Erfahrungen, Erlangen, 1870, S. 28; 875 356): KmcHNER (C.) (^rtzlicher Bericht u. s. w. im Palast zu I ersailles, Erlangen, 1872; 2099751); GUAF (E.) (Die Konigl. Reservdazare .he, :u Diissetdorf, 1872; 298 101); SCHOu.EK (Kriegs. chir. Skizzen, Hanuover, 1871 ; 491 160); GllOS (F.) (Notice sur I hopital cii il. ttc.,de Strasbourg, in Gaz. Med. de Strasbourg, 1872, No. 17; 140 55): BEIITHOLU (Deutuche Mil.-ii.r:t Zeitschrift, 1872, B. I, S. 429 ; 1804 723); aud MOSSAKOWSKY (l>.) (Deutsche Zcitschrift fiir Chir., 1872, B. I, S. 320 ; 1415 744), 4 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Examining carefully several series of a thousand each of the 89,528 registered cases of wounds of the lower extremities, 1 including only those in which the seat of injury was noted with precision, a predominance of wounds of the left lower extremity is found in the following proportion: Both limbs, 3.4 per cent.; left limb, 53.1; right limb, 43. 5. 2 A word may be added regarding the recorded instances of evulsion of one or other of the lower limbs by solid shot, fragments of shell, torpedoes, or other large projectiles. Of 164 such instances 93 recovered, 62 or 40 per cent, were fatal, while in 9 instances the results were not ascertained. In 129 of the 164 cases it is noticed that ablations, many of them doubtless resembling merely the paring and regularization of the soft tissues with removal of splinters or sharp projections of bone, rather than legitimate amputations, were performed. Two of these, however, were successful formal disarticulations at the ankle joint, 2 successful amputations at the knee joint, 1 a fatal exarticulation at the hip. Seventy-six, with 56 recoveries, 14 deaths, and 6 unknown terminations, were opera tions in the continuity of the leg; forty cases, 26 successful, 13 fatal, 1 doubtful, were amputations in the thigh. In 4 cases, both legs were removed in the continuity with 2 recoveries, 1 fatal and 1 unknown result. In 1 fatal case the left thigh and right leg were simultaneously removed; in 1 case of recovery amputation was performed in the right thigh and through the left knee joint; in 1 fatal case simultaneous amputation of both thighs in the continuity was practised; and in one instance disarticulation of the left hip and ablation of the right leg was performed, the case terminating fatally. In 35 of the aggregate of 164 cases there is no record of operative interference. Of these, 1 was a fatal instance of evulsion of both limbs in the continuity of the thigh; in 6 fatal cases both limbs were torn off in the leg; in 4 fatal cases the right or left limb was torn off in the thigh, and in 24 the mutilation took place in the continuity of the leg with 4 recoveries, 19 deaths, and 1 with unknown result. An additional proof that of the shot wounds received in action those inflicted upon the lower extremities ordinarily constitute about one-third of the aggregate, is found in the carefully prepared statistical researches of Councillor G. Fischer. 3 The lamented L<EFFLER, one of the soundest of modern Prussian military surgeons, set* forth (General-Bericht iiber den Gesundheitsdienst irn Feldzuge gegen Danemark, 1864, Berlin, 1867, p. 48) that of 2,388 Prussians killed and wounded in the Danish War of 1804, about 31 per cent, were struck in the lower extremities, and remarks (S. 49): "The comparatively small proportion of wounds of the lower extremities mny appear strange. One is accustomed to regard the preponderance of such injuries us considerable. The protections above referred to (trenches, and, in Schleswig, brush- hedges \ Knicks]) would undoubtedly partially protect the lower limbs. But statistics that omit the killed are defective ; they give to the shot wounds of the extremities an undue preponderance, because their immediate fatality is much more limited than is observed in wounds of the head and trunk." Professor H. FISCHER (Lehrbuch der Allgemeinen Kriegschir., Erlangen, 1808, S. 25) observes : " In later wars, in which the fighting was mainly in the open field, the remarkable fact has almost uniformly appeared, that among shot injuries those of the lower extremities far exceed those of the upper limbs. Dr. MACLEOD S statistics refer 68 per cent, of wounds in action to wounds of the lower extremities. [This is an oversight. Di\ MACLEOD (Notes o? fJie Surgery of the War in the Crimea, 1858, p. 414) gives the proportion of wounds of the lower extremities among the men as 31.7; among officers 35.2. Professor FISCHEU seems to have added these ratios together.] DJOERUP reports the proportion of wounds of the lower limbs in the Danish army, in the war of 1848-50, as 40.5 per cent. In Paris in 1848, and in Italy in 1859, the wounds of the lower extremities constituted a third, and those of the upper limbs nearly another third. When it is considered that the remaining third was made up of cases of injuries of the head, chest, abdomen, and pelvis, it is apparent how enormously large is the number in modern wars that have to be transported with the utmost care and skill. Hence, perhaps, the most difficult problem for the modern military surgeon is the management of the ambulance trains. LCEFFLF.R, it is true, has said that the preponderance of wounds of the lower limbs in modern wars is seeming rather than real, and is conditioned on the less proportion of immediate fatality in wounds of the limbs. This assumption, though assuredly founded on facts, might explain the conspicuous fact that the shot injuries of the limbs predominate greatly over those of the bead and trunk ; but does not explain the extraordinary disproportion between the shot injuries of the upper and lower limbs." I may remark that the statistics I have examined do not show any greater disparity in the frequency of wounds in the upper and lower limbs than is warranted by the relative size and position of the extremities. 2 HEINE (C.) (Die Schussvrrletzungen der unttren Extremitaten, Berlin, T866, p. 30) remarks that in the Schleswig-Holsteiu War, I860, 27 of the 562 cases of injuries of the lower extremities both limbs were injured, or a percentage of 4.8, and FISCHER (G.) (Statistic der in dem Kriege 1870- 71, d-c., vorgekommenen Verwundungen und Todtungen, Berlin, 1876) tabulates 780 cases of injuries of both limbs in a total of 20,lfiO cases of injuries of the lower extremities, or 3.8 per cent. 3 The Statistik der in dm Kriege 1870-1871 im Preussischen Heere, vorgekommenen Verwundungen und Todtungen von G. FISCHER comes to hand as these pages are going to press. Tabelle C (loc. cit., p. 59) contains a recapitulation of the seat of injury in 64,897 cases (7,735 killed and 57,100 wounded). In 18,905 instances, or 29. 14 per cent., the upper extremity was injured, and in 20,160, or 31. 06 per cent., the lower extremity was involved, The latter percentage varies but little from that given on page 2 (ante 30. 5), which was consolidated from a number of publications by various authors that have appeared since the late Franco- Prussian War. SKCT. I.) FLESH WOUNDS. SECTION I. FLESH WOUNDS OF THE LOWER EXTREMITIES. The reader is respectfully referred to the introductory observations to the first section of the Ninth Chapter, in Part II, Volume II, page 435, for many remarks on the Flesh Wounds of the Upper Extremities, which are equally applicable to the cases of the cate gory now to be considered. The gravity of flesh wounds in the lower extremities greatly exceeds, however, that of analogous injuries in the upper limbs. The dangers arising from lesions of the great blood-vessels and nerves of the lower extremities, from peri-articular wounds, and especially from deep seton wounds and lacerations of the massive muscles of the thigh, are great. Many perforations of the thigh that are lightly regarded at the outset, present ultimately formidable complications. Dr. H. Fischer remarked, 1 in the late Franco-German War, that "many a wounded man sent to the rear with the diagnosis slight shot wound of the thigh, succumbed to burrowing of pus, detected too late and treated with too little vigor. We had five such cases, and succeeded in all in controlling this terrible complication by early and deep incisions, absolute rest, and disinfecting band ages. When the first stage is neglected, the surgeon loses the mastery, pyaemia delighting to develop in deep phlegmonous cavities." It was impossible, with the clerical force available, to make more than a superficial examination of the individual cases of the immense series of nearly sixty-thousand flesh wounds of the lower extremities. 2 All that has been attempted has been to sift out dupli cated cases and those that ultimately proved to be complicated by contusion of bone or by fracture, and to scrutinize the series sufficiently to select instances illustrating the different varieties of injuries of this group, to determine the average distribution of the wounds in the several regions of the limb, and to ascertain approximatively the mortality. Of the series of flesh wounds of the lower extremities, six hundred and seventy-four were punctured or incised, and fifty-eight thousand seven hundred and two were shot wounds. PUNCTURED AND INCISED WOUNDS--There were reported six hundred and seventy-four cases of punctured or incised wounds of the lower extremities, including a hundred and seventy-six bayonet wounds, twenty-two sabre wounds, and four hundred and seventy-six wounds from daggers, knives, axes, or other pointed or cutting weapons. Bayonet Wounds. The series of bayonet wounds included sixty-two stabs in the thigh, with two deaths; seventy-seven penetrations of the leg, with two deaths; and thirty- 1 FISCHER (H.), Kriegschirurg. Erfahrungen, for Metz, Erlangen, 1872, S. 164. Dr. Fischer, professor of surgery at Breslaa, was a volunteer Burgeon in the Prussian army during the campaign from Saarbrticken to Metz, August 10 to October 27, 1870. "Of the 89,528 registered cases of wounds of the lower extremities, 30,152, or 33.6 per cent., were returned as fractures, so that, as in the upper limbs, the wounds of the soft parts alone constitute very nearly two-thirds of the aggregate 59,376 in 89,528 cases. D INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. seven wounds of the soft parts of the foot, with one death, the series of a hundred and seventy-six cases thus presenting a mortality of 2.8 per cent. Several of the cases present particulars of interest: CASE 1. Private P. Dietrich, Co. E, 151st New York, aged 34 years, was wounded at Spottsylvania, May 12, 1864, and admitted to the field hospital of the 3d division, Sixth Corps. Surgeon R. Barr, 67th Pennsylvania, recorded : "A bayonet thrust through the right leg." The patient was transferred to Douglas Hospital, Washington, subsequently to Summit House, and lastly to the Satterlee Hospital, Philadelphia, whence he was discharged April 27, 1865, because of "lameness of the right leg, caused by chronic eczema," following a bayonet injury. Examiner H. N. Loomis, of Buffalo, New York, May 8, 1855, certified : "A bayonet was thrust through the right leg between the tibia and fibula, about six inches below the knee. The wound healed; but is followed by chronic eczema, extending from the knee to the ankle, much inflamed, with some ulceration, and producing so much lameness as to unfit him for any kind of labor." In August, 1868, the pension examiner states that the eczematous eruption occupies about half the space between the knee and the ankle, and that the limb is still inflamed, ulcerated, and swollen. This pensioner was paid to March 4, 1870, since when he has not been heard from. Iii two cases the femoral artery was reported severed by a bayonet. One of these is related by Surgeon J. A. Lidell, 1 U. S. V.: A soldier of the 106th Pennsylvania received a thrust in the upper inner part of the thigh from a sabre-bayonet, in a picket skirmish near Fair Oaks, in June, 1862, and perished from haemorrhage before assistance could reach him. The result of the second case suggests the probability that a minor branch, rather than the main femoral trunk, was injured by the weapon: CASE 2. Corporal E. Hacket, Co. A, 1st Pennsylvania Chasseurs, was accidentally wounded near Camp Whipple, Philadelphia, in August, 1863. Acting Assistant Surgeon L. D. Radzinsky reported: "While at bayonet exercise he received a punctured wound of the right femoral artery, below Poupart s ligament. The wound was received a short distance from the camp. When brought to the hospital tent the man was considerably exhausted from loss of blood. Judging from the clots found in his clothes he must have lost at least twelve ounces. The haemorrhage was immediately controlled by manual pressure upon the external iliac artery, a compress and spica bandage applied, and pressure continued with a tourniquet for three clays, at which time the tourniquet was removed, a new dressing applied, and pressure continued with the spica bandage. He was returned to duty five days afterwards, and has not had any untoward symptoms since." Hacket is not a pensioner. Surgeon T. H. Squire, 89th New York, reports a case in which the synovial cavity of the knee was penetrated by a bayonet without bad results, remarking that Dr. James Allen, of Marathon, New York, examined the recent wound and concurred in the diagnosis: CASE 3. "Private C. A. Ball, Co. K, 89th New York, aged 16 years, in the spring of 1862, at Roanoke Island, while jumping for exercise, accidentally sprang against the point of a bayonet. At a moment when the joint was partially flexed, the point of the bayonet penetrated the cavity of the knee joint, the wound being immediately above the centre of the patella. The patient was immediately received into the regimental hospital, and Assistant Surgeon W. A. Smith, 89th New York, enjoined perfect rest in bed and low diet, with cold applications to the joint. The wound was from the first regarded as a dangerous one. Some days after the accident occurred, Dr. Squire saw the case with Dr. Smith. There was then synovial swelling of the joint, and other conclusive evidences that the joint had been penetrated. The boy was kept in hospital till the recovery was complete, when he again entered the ranks for duty. The recovery was complete, and no bad effects followed. The wound was not very extensive. The point of the bayonet may have gone through the synovial membrane half an inch or so, and in such a glancing direction as not to injure the cartilage or bone. Dr. Squire did not know exactly how long the boy was kept in hospital, but thought about four weeks." The field registers show that this Private Ball received a gunshot wound of the right side of the thorax at the battle of Chapin s Farm, September 29, 1834, which fact is corroborated by the examining surgeons. For this injury he is a pensioner, but the Pension Records make no mention of a bayonet injury of the knee. Of the five fatal cases in this subdivision of bayonet wounds in the lower limbs, three succumbed from gangrene, one from pyaemia, and one from primary haemorrhage. The following is one of the cases complicated by gangrene : CASE 4. Private S. Dick, Co. E, 79th Indiana, was wounded at Chickamauga, September 19, 1863, and sent to hospital No. 13, Nashville, October 1st. Assistant Surgeon J. K. Bauduy, U. S. V., reported : " He was admitted with a flesh wound of the calf of the left leg, caused by a bayonet. The wound was superficial and slight, and did well for several days ; treated with cold-water dressings. On October 20th, hospital gangrene manifested itself; the disease was then prevailing endemically in the hospital. This patient was immediately transferred to the gangrene ward, and applications of pure bromine were made. Tincture of iron and fluid extract of cinchona were freely administered. Milk-punch and beef-tea were also given at stated intervals. His bowels, which were inclined to be costive, were kept open with enemeta of salt, molasses, and tepid water. The disease steadily progressed, and large sinuses formed in all directions in the intermuscular spaces. One immense sinus ran >LIDKLL (J. A.), Bayonet Wounds, with casts, in Am. Med. Times, 1866, Vol. VII, p. 153. SECT. I.] PUNCTURED AND INCISED WOUNDS. 7 along the course of the tendo-achilles. The sinuses were freely opened and injected with chlorinated soda solution, and bromine was thoroughly applied, taking great care to get it well into the intermuscular spaces. Disinfecting poultices were used in the removal of the sloughs. November 4th, the gangrene at this date was entirely arrested, but symptoms of pyaemia arose. The pulse became frequent and weak, ranging between 140 to 150. Rigors; skin cold and clammy; breathing oppressed and labored. Patient complained of pain in chest. The conjunctiva assumed an icteroid hue, and the whole surface of the body became tinged with a pale yellow appearance. The knee and ankle joints commenced to swell and cause great pain. The following treatment was then resorted to: Carbonate of ammonia in large and frequent doses; stimulants every half hour; iron and cinchona continued; tincture of iodine and blisters to swollen joints; surface of body washed with whiskey and water. Patient continued to sink, and died on the afternoon of November 7, 1863. Post-mortem : Lungs healthy ; no metas- tatic foci could be found in either of them or in the liver; but microscopical examination of the latter revealed a fatty infiltra tion. The liver was also greatly hypertrophied. The heart, spleen, pancreas, bowels, and kidneys were all healthy. There was an accumulation of pus in the left knee joint. Sabre Wounds. None of the twenty-two reported sabre-cuts of the lower limbs 1 were of a sufficiently grave character to prove fatal. Seventeen of the patients returned to duty, and five were discharged for slight disabilities. Six cases were flesh wounds of the thigh, ten of the leg, and six of the foot. One of the patients, Corporal Rice, 1st Vermont Cavalry, whose case is recorded on page 22 of the First Surgical Volume, suffered also from a sword-cut of the frontal; but he, with the rest, recovered without serious trouble. Other Punctured and Incised Wounds Besides wounds caused by legitimate weapons of war, a considerable number were reported as inflicted by daggers, dirks, or bowie-knives, arrows, picks, and other pointed implements, and by knives, scythe-blades, hatchets, axes, and other cutting instruments. There were seventy-two of these serious punctured wounds of the lower limbs, and four hundred and four cases of severe incised wounds. There were eight deaths in this series of four hundred and seventy-six cases, a mortality-rate of 1.6 per cent., and disability leading to discharge from service resulted in a hundred and two of the cases. Twenty-eight cases were wounds of the thigh, a hundred and seventeen wounds of the leg, three hundred and thirty-one wounds of the foot. Ligations. In four instances, at least, of this series, ligations of arteries were practised on account of haemorrhage or aneurism. One of these, an instance of aneurismal varix from puncture of the femoral artery and vein, by a pocket-knife, has been narrated, with a figure of the specimen, at page 336 of the Surgical Volume of Part II. 2 The three other cases were ligations of the tibial arteries: CASES 5, 6, 7. Assistant Surgeon J. C. G. Happersett, U. S. A., reports that Private T. J. Moore, Co. B, 82d Ohio, aged 29 years, received, July 14, 1865, a punctured wound near the right ankle. The haemorrhage was so uncontrollable that, on July 22d, Assistant Surgeon H. M. Lilly, U. S. V., ligated the posterior tibial artery, placing a single proximal ligature. July 24th, unhealthy gangrene attacked parts, and bromine dressings were applied. The patient recovered, and was transferred to Jeffersonville October 19th, and to Post Hospital, Louisville, December 16, 1855. 6. Surgeon C. A. Covvgill reports that Lieutenant T. Linder, Co. E, 158th New York, aged 30 years, received, May 11, 1864, a punctured wound by a sharp knife on the inner side of the right leg at the juncture of the lower and middle thirds, dividing the posterior tibial artery through one half its diameter and causing a diffused traumatic aneurism. He was admitted into the Foster Hospital, New Berne, May 20th; the cellular tissue and iutermuscular spaces were filled with coagula, which had temporarily arrested hsemorrhage. There was great tension and considerable sloughing of the soft parts. May 22d, Surgeon C. A. Cowgill, U. S. V., made an incision five inches long over the wound, through the integuments down to the posterior tibial artery, and, ligating it above and below the wound, the coagula were removed and the wound closed by adhesive straps. A good recovery ensued, and the officer returned to duty June 29, 1864. 7. Surgeon G. A. Otis, 27th Massachusetts, reports that Private C. D , Co. B, 27th Massachusetts, in December, 1863, at Newport News, Virginia, received a severe wound in the left leg from an axe, about three inches above the annular ligament. The tendons of the tibialis anticus, the common and proper extensors, and the anterior In old times, and in the combats of the trained European Cavalry, sabre cuts of the lower limbs were not uncommon. RAVATOX (Chirurgic d armee., 17C8, Chap. IX, p. 518) gives many examples, in which not only the soft parts but the bones were hacked by sword-cuts. M LEOOUEST also (Chirurgie d armee, Seme ed., 187;!, p. 461 ) details several such examples, and refers to illustrations in the Museum of HUTIM at the Hotel des Invalides. Abstracts of interesting incised wounds of the lower limbs may be found also in fiE DlJA.V (Obsenmt. de Chir., 1731, T. II, p. 332) and in LA MO lTE (Traitt compute de Chirurgie, 1771, T. Ill, p. 143 ct seq.). 2 First the femoral, then the external iliac, and finally and fatally the common iliac were ligated by Dr. J. B. CUTTEU. The operator has published abstracts of these ligations in the Am. Jour. Med. Sci., 18G4, Vol. XLVIII, p. 36, Ibid., 1865. Vol. L, p. 391. The pathological specimen, showing the communication between the artery and vein and the huge sacculation of the latter, is numbered 3507 in Sect. I of the Army Medical Museum. INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. tibial artery veins and nerve were divided, and the periosteum. The wound gaped widely, and the artery gave freely per saltv.m. The vessel was completely severed. Ligatures were at once placed by Dr. Otis about the upper and lower orifices of the arterv, and the wound was united by sutures. Recovery was rapid and uncomplicated, and the soldier returned to duty. Amputations. In four instances, after deep incised wounds by axes, complications arose, and recourse was had to amputation. Two were thigh amputations: CASES 8, 9. Private Christian Webber, 8th Co., New York Independent Volunteers, received, September 24, 1863, a severe wound from an axe, severing the quadriceps of the left thigh two inches above the patella. He was sent to Fairfax Seminary Hospital, September 26th, and deep-seated suppuration having appeared, burrowed, and finally penetrated the knee joint, Surgeon D. P. Smith thereupon decided to amputate the limb. The operation was practised, October 4th, at the junction of Ihe lower and middle thirds of the femur. The patient was transferred, convalescent, to York, Pennsylvania, October 30th, and subsequently discharged. The portion of the femur amputated has been catalogued in the Army Medical Museum, 1 but exhibits nothing abnormal. 9. Private T. H. Breckridge, Co. C, 6th New York Artillery, received a wound by an axe in March, 1864, and was sent to Armory Square Hospital. Surgeon D. W. Bliss, U. S. V., reported that the wound involved the right tarsus and metatarsus, and presently became erysipelatous, and that gangrene then supervened. On this account, on May 27th, Dr. Bliss amputated the limb, at the junction of the middle and lower thirds of the femur, by antero-posterior flaps formed bv transfixion. Recovery was satisfactory. On December 28, 1864, he was supplied with an artificial limb at Ladies Home, New York, by Dr. E. D. Hudson, at Government expense. The stump was then soundly healed, and "creditable" in shape. This soldier was discharged July 12, 1865, and pensioned. His pension was paid March 4, 1876. In two instances the leg was amputated for incised wounds of the ankle or foot: CASES 10, 11. Private M. Dunham, Co. D, Engineer Battalion, aged 23 years, received a severe incised wound of the left ankle January 24, 1864. He was sent to hospital at Alexandria. Surgeon E. Bentley, U. S. V., reports that long-con tinued suppuration had ended in necrosis of the tibia-tarsal articulation, the patient being of a strumous habit. Dr. Bentley practised a circular amputation in the lower third of the leg May 5, 1864. Pyaemia supervened, and death ensued June 18, 1864. 11. Private A. Stacy, Co. H, 12th Kansas, received a severe wound of the left leg by an axe on March 17, 1864. He was sent to hospital at Fort Leavenvvorth. In September, 1864, the limb was amputated by short anterior and long posterior flaps by Dr. Clark. The patient recovered with a good stump, and was fitted with an artificial limb by B. Frank Palmer, at New York, June 23, 1866. He is a pensioner, and was paid March 4, 1876. The foregoing instances comprise nearly all the seriously complicated cases reported of punctured and incised wounds of the lower extremities. There was a case (Private Wherry, 115th New York) where half the small blade of a pocket-knife broke off against the femur after perforating the quadriceps two inches above the knee joint; attempts at extraction of the foreign body failed; the patient recovered with partial false anchylosis at the knee. Except those noted, the examples of sloughing or consecutive bleeding were trivial, and no case of tetanus was observed. SHOT FLESH WOUNDS. In the vast series of fifty-eight thousand seven hundred and two cases of shot wounds of the soft parts of the lower limbs placed on the registers, it is difficult in many cases to determine, from the hasty field notes or brief hospital entries, the exact positions and extent of the wounds. As nearly as can be approximated, how ever, it would appear that about twenty-six thousand of these wounds were in the thigh, about twenty-one thousand in the leg, and about ten thousand in the foot, a certain number of reports presenting no indication of the precise seat of injury. These wounds were of every grade of severity, from trivial skin-scratches to huge lacerations by large projectiles; long furroughed wounds with tortuous tracks, deep seton perforations, superficial or deep penetrations with lodgement of the missile, filling up the gamut. In reviewing the great series, two small groups especially claim attention the wounds attended by lesion of the principal nerves, and those with injury of the main blood-vessels. We shall consider these first , and then typical examples of shot injuries of the soft parts, selecting for illustration those cases remarkable for extent of lacerations, those in which foreign bodies were lodged in the limb, those ultimately complicated by extension of inflammation to the joints, or by disease of the arteries, or by gangrene, tetanus, and other complications. 1 See No. 2004, Section I, p. 3(14, of Catalogue of the Surgical Section of the Army Medical Museum, Washington, 18C6. Si-CT. i.l SHOT FLESH WOUNDS. 9 Flesh Wounds of the Lower Limbs, with Injury of the larger Nerves. Instances in which wounds of the larger nerves were sufficiently distinct and uncomplicated to be returned under this head were comparatively few ; they were less frequent, indeed, than in the upper limbs. 1 The relations of the large nerve trunks of the lower extremities to the blood-vessels, bones, and joints are such that they are more liable to share in the injuries of these parts than in wounds mainly involving the muscular tissues. Moreover, it is probable that in many flesh wounds, nervous branches of magnitude were implicated with out manifestation of any very serious results, and that such cases were not returned as injuries of nerves. 2 Presenting less urgency in relation to immediate treatment than lesions of the arteries and bones, these accidents nevertheless were frequently very grave, entail ing a vast amount of protracted misery, and sometimes fatal consequences. Of fifty-nine cases referred to this category, thirty-one were reported as wounds of the sciatic, two of tiie crural, five of the long saphenous, one of the middle cutaneous, nine of the popliteal, five of the anterior tibial, three of the posterior tibial, and three of unspecified large nerve trunks. Eleven cases proved fatal, of which six succumbed from tetanus. Amputation was resorted to in four cases, briefly noted in succeeding tables. Two amputations in the thigh were successful; one through the knee joint, and one in the leg proved fatal. Of thirty-one cases of wounds of the sciatic nerve, twenty-five recovered, including one in which amputation in the thigh was practised, and six were fatal. Four died of tetanus. 3 One succumbed, long after the injury, from secondary traumatic coxitis. 4 Erysipelatous inflammation with sloughing, extending to the hip joint, and resulting in ulceration of the cartilages and caries of the head of the femur and acetabulum. The fourth fatal case 5 was an example of exhaustion from protracted suffering. Of the 1 As indicated in Part II, Vol, II, p. 461, there were 96 cases distinguished as nerve lesions of the upper extremities, contrasted with 59 instances in the lower extremities. Professor A. SOCIN (Kriegschir. Erf., Leipzig, 187:2, p. 64) remarks a similar disproportion in the Franco-German War. Relating 16 cases of shot injuries of the nerves, he observes that: " more than five-eighths of these concerned the upper extremities." 2 In their treatise on Gunshot Wounds and other Injuries of Nerves. By S. WEIR MITCHELL, M. D., GEORGE R. MOItKHOUSE, M. D., and WILLIAM W. KEEN, M. D., Philadelphia, 1864, the authors detail (pp. 93, 93) two cases of shot injury of the sciatic nerve : Private K. Grim, Co. B, 121st Pennsylvania, who received at Fredericksburg, December 13, 1863, a shot perforation of the left thigh, the ball entering externally four inches above the upper border of the patella, and emerging on the inside of the thigh, two inches lower down, slightly injuring the sciatic nerve. He had, July, 18G3, severe burning on the dorsum of the left foot, and eczema, with ulceration about the nails, complete paralysis of the flexors of the fo<;t and partial paralysis of the flexor communis and calf muscles. The other patient entered the hospital about the same time, a ball wound passing close to the sciatic. He had complete loss of power in the flexors of the foot, defective sensation on the outside of the leg and foot, and eczema with burning pain. Both patients were treated with electricity, with gradual gain of motion and relief of pain, and were regarded as fair types of partial wound or commotion of a nerve. At page 128, of the same work, the case of Private J. S. L. Scott, Co. F, 121st New York, aged 31 years, is related: lie had a shot wound of the calf of the right leg. at Chancellorsville, May 3, 1863. The ball passed between the fibula and tibia about mid-leg. Total less of motion below knee, slightly tactile insensibility, foot extended and powerless. September, 1863, rapid improvement followed alternated cold and hot douches, with faradization, and a splint to correct the malposition of the foot. Discharged, improved, February 12, 1864. The reports of Pension Kxaminers Maun and Lanning, of Manchester, Ohio, where this pensioner now resides, recapitulate the foregoing facts, and describe the paralysis as in all probability perma nent. The latest report by Dr. Lanning, February 4, 1874, states that "paralysis of the foot and toes is nearly complete," and recommends that the pensioner be excused from further biennial examinations, as his disability is considered irremediable. This recommendation was opposed, and the pen sioner s condition was unchanged when he was last paid, March 4, 1876. In Circular 6, S. G. O., 1864: On It Jlex Paralysis resulting from shot wounds, the sumo authors narrate two examples of reflex paralysis of the upper extremity induced by shot flesh wounds implicating the nerves of the lower limbs : Private W. W. Armlin, Co. D, 134th New York, aged 23 years, was shot at Gettysburg, July 1, 1863, the ball entering anteriorly about midway on the inner part of the right thigh and emerging outside and below the tuberosity of the ischinm, just above the fold of the nates. The sciatic nerve was probably injured. There was partial paralysis of the right leg, and reflex paralysis of the right arm. The latter speedily recovered. Private D. Kent, Co. 15, 145th Pennsylvania, aged 24 years, was struck, at Gettysburg, July 2, 1863, over the upper third of the right rectus femoris, by a musket ball, which passed through the thigh, emerging at the inner side a little below the fold of the nates. There was loss of motion and sensation in the thigh and leg, and reflex motor paralysis in the right arm. The patient was discharged January 20, 1864, for tuberculosis. The paralysis had amended under the use of hot and cold douches, active motor, and faradization. In his work, entitled Gunshot Wounds of the Nerves and their Consequences, Philadelphia, 1872, Dr. S. WEIIJ MITCHELL cites the case of Sergeant C. Beatty, 26th Pennsylvania, shot through the calf, at Chancellorsville, May 3, 1863, who suffered intensely from causalgia. The foot, a few days after injury, was prickling and burning intensely. After a fortnight the prickling ceased; but the burning persisted. He recovered in about five months, without treatment. In this valuable work, abounding in illustrations of the effects of shot lesions of the nerves of the trunk and upper limbs, I find no other example of shot wound of the nerves of the lower extremities. 8 Privates Albro, 27th Michigan; Fry, 3d New Jersey; Riley, 10th New York; and Smith, 46th New York. 4 Case of Private T. J. Dame, Co. E, 18th Mississippi, wounded at Antietam, September 17, 1862. Died June 1!), 1863. See Spec. 3849, A. M. M., Cat. Surg. Sect., 1866, p. 243. 6 Case of Private E. M. McGregor, Co. C, 76*.h New York, shot through the left sciatic nerve September 6, 1863. The missile lodged and could not be detected during life. He had motor paralysis of the leg muscles, and intense pain in the upper part of the track of the perineal and anterior tibia, and used hypodermic injections of morphia. He died February 1, 1863. Suim. Ill 2 10 INJUKTES OF THE LOWER EXTREMITIES. [CHAP. X. twenty-five survivors, one fully recovered and returned to duty, three entered the Veteran Reserve Corps, and twenty-one were discharged. With few exceptions, they suffered from neuralgia or from partial motor paralysis. One (Private Armlin, 134th New York) had reflex paralysis of the arm on the side corresponding with the injury to the sciatic nerve. 1 Notes of two of the cases of persistent neuralgia are appended: CASE 12. Private W. T. Burk, Co. F, 151st New York, aged 24 years, was wounded at Monocacy, July 9, 1864, and admitted to hospital at Frederick the following day. Acting Assistant Surgeon E. R. Ould reported: "Gunshot flesh wound of both thighs, perforating upper third and injuring the sciatic nerve of the right thigh. The patient is of a nervous and irritable temperament. Simple dressings were applied, and opiates given at night; wound healing. July 20th, great pain complained of in the course of the sciatic nerve and increasing in the region of the foot and ankle; pulse accelerated, 100 per minute; pain increasing; general appearance moderately good ; appetite poor. Applied pounded ice to foot and gave two drachms of solution of morphia four times a day. August 1st, the ice moderated the amount of pain ; treatment continued. Patient slept half the night. August 12th, patient much improved; ice discontinued; prescribed morphia, iron, and quinine four times a day. September 1st, pain more severe; the wounds have entirely healed ; treatment continued. September 20th, walking about with crutches, but very lame; stimulating and anodyne liniment used night and morning. September 25th, patient finds great relief by keeping his hands wet with water; bowels regular; pulse natural. October 1st, but slight improvement; continued the quinine and iron mixture, also one drachm of fluid extract of cimicifuga. October 30th, still walks lame, the leg being very painful on motion. October 31st, furloughed this day; patient has but little prospect of a speedy recovery." He subsequently returned to the hospital, aud was mustered out of service May 31, 1865, and pensioned. Examiner J. H. Helmer, of Lockport, New York, February 9, 1863, certified: "Ball entered right thigh, upper third, passed through in front of the bone, and through the left thigh back of the bone, destroying the femoral nerve. Left leg two inches smaller than the right; muscles flabby; no voluntary motion of the left foot. He can walk, but walks like a paralytic." At a subsequent examination it was additionally reported that " the temperature of the left leg and foot is reduced," etc. The pensioner was paid June 4, 1876. CASE 13. Private C. J. Keegan, Co H, 80th New York, aged 40 years, was wounded at Gettysburg, July 1, 1863, and entered the York Hospital on July 19th. Acting Assistant Surgeon G. Byers reported: "Gunshot flesh wound of right thigh; ball entered the middle third below the edge of the sartorius muscle, passing upward and outward, made its exit two inches below and behind the trochanter, injuring the great sciatic nerve in its course. The wound closed kindly; the leg and foot, however, continued cedematous, and the man has suffered very greatly with pains of a darting character. He has at no time been able to use the limb since the receipt of the injury. Liniment of aconite was applied to the leg, and opiates were given internally. May 23, 1864, the pain has much diminished in intensity within the last two months." The patient was discharged from service June 28, 1864, and pensioned. Examiner H. B. Day, of Utica, New York, certified, February 16, 1865: "The great ischiatic nerve must have been injured, as he has constant pain, numbness, and partial paralysis of the parts supplied by this nerve and its branches, rendering him unable to stand for any length of time," etc. Examiner I. Spencer, of De Ruyter, certified, October 19, 1865: "Permanent lameness of the thigh. The foot is also deformed by an unnatural action of the muscles contracting the toes obliquely, and there is an unnatural fixedness of the arch of the foot," etc. Subsequent examiners reported substantially the same, and all concur in their belief as to the nerve injury. This pensioner was paid June 4, 1876. The two patients wounded in the anterior crural nerve, were discharged without relief of the persistent pain that followed their injuries. Surgeon I. I. Hayes, U. S. V., has furnished a detailed report of one of the cases : CASE 14. Private W. H. Cookson, Co. E, 42d New York, aged 23 years, was wounded at Antietam, September 17, 1882, and entered the Satterlee Hospital, Philadelphia, nine days afterwards. Four months after his admission Surgeon I. I. Hayes, U. S. V., reported: "He was wounded b}- a mini6 ball entering on the outer side of the right thigh, about midway between the anterior superior spinous process of the ilium and the trochanter major, and, passing obliquely upward, made its exit near the middle of Poupart s ligament, wounding, I infer, the anterior crural nerve, from the intense pain he has suffered iff the course of that nerve. The wound has long since healed. The suffering experienced over the front and side of the thigh, parts supplied by the anterior crural nerve, is instructive as showing the effect of an injury in the course of a nerve manifesting itself in the extremities of that nerve. The pain has not abated by the use of the most powerful anodynes, and sleep is only procured through the influence of sulphate of morphia. A question, which is still subjudice, arises: Shall we excise that portion of the nerve which is wounded, hoping thereby to relieve his almost intolerable suffering?" The patient was discharged from service February 28, 1863, and pensioned. Drs. T. S. Johnston and R. H. Hope, of Rock Hill, S. C., in certifying to the results of the wound, May 9, 1874, stated that "from this cause he is now suffering witli neuralgia and partial paralysis of the extensor muscles of the thigh." The pensioner was paid June 4, 1876. Of the five cases of wounds of the long saphenous, one resulted in complete recovery, 1 J. MASON WAKREN, in an interesting article on Neuralgic Affections following Injuries of Nerves, in Am. Jour. Me.il. Sci., N. S., 18fi4, Vol. XLVII, p. 316 (which is reproduced in his excellent Surgical Observations, Boston, 1867, p. 465), details the case of a soldier with wound of the sciatic nerve, who was probably Private D. Callahan, <!o. E, 19th Massachusetts, aged 2J years, whose history on the registers of this Office closely corresponds to the graphi- description given by Dr. Warren, to which the reader is referred. His Pension Report for 187G may be added : There was atrophy of the injured thigh and leg, with diminished temperature and grea ly diminished motor power in the muscles of tlie leg and foot. SECT. M SHOT FLESH WOUNDS IMPLICATING NERVES. 11 four in more or less paralysis and atrophy. 1 The case of wound of the middle cutaneous nerve was attended with severe neuralgia, which yielded to blistering and other remedies, and the patient returned to duty. The series of nine cases of wounds of the popliteal nerve comprises a fatal case of tetanus. 2 The other patients recovered, and three entered the Veteran Reserves, while five were discharged, one after recovery from amputation in the thigh, and one with excruciating neuralgia. The category of five cases of wounds of the anterior tibial included one death from tetanus. 3 The four survivors had partial paralysis of the extensor muscles. An instance is detailed : CASE 15. Private D. S. Pierce, Co. B, 1st Michigan, aged 22 years, was wounded at Bull Run, August 30, 1862, and admitted to Ryland Chapel Hospital, Washington, three days afterwards. Surgeon J. A. Lidell, U. S. V., reported: "The patient was admitted to Stanton Hospital from Eyland Chapel, December 5th, with wound in the right leg. The bullet entered the outer part of the front of the middle third of said leg, about midway between the tibia and fibula. The bullet did not go through the limb. It, however, went in so deep that it could not be reached by exploration. The wound has been healed since the middle of October. The missile has gravitated through between the tibia and fibula, and can now be felt deeply seated in the muscles of the calf. It gives him no trouble. The anterior tibial nerve was divided by the bullet, in consequence of which the muscles of the front of the leg are paralyzed. The end of the foot points downward from activity of those on the back of the leg, and the case resembles talipes equinus. The patient walks haltingly, but without a cane, by the aid of a high-heeled shoe. He has suffered but little pain since the wound healed, and considers himself to be slowly improving. He was discharged December 16, 1862." Examiner D. Hudson, of Lansing, Michigan, reported, May 8, 1863: "Ball passed through both peroneal muscles, dividing the tibial nerve d * and lodging deep in the soleus muscle. Ankle joint became stiff at an obtuse angle, requiring a heel more than an inch higher on the right shoe than on the left one. Neuralgic pain in foot and ankle daily and hourly." Drs. J. B. Hull and I. H. Bartholomew, of the Lansing Examining Board, certified, December 7, 1870: "The ball passed down, and now lies under the skin above the inner malleolus. He cannot stand on his leg but a short time, and is getting worse," etc. They also stated that they excised the ball, and reported, September, 1872: "The nerve is diseased, and he suffers great pain through the whole leg; is emaciated and feeble, and growing worse." This pensioner died of "consumption," November 22, 1872, superinduced, in the opinion of the attending physicians, by "the continually depressing effects of the pain and tenderness of his limb." The three cases of wounds of the posterior tibial nerve were fatal. Two involved unsuccessful amputations, one at the knee joint and one in the leg, and the third was fatal from gangrene. 4 The two amputations were practised after tetanus had supervened: 5 CASE 16. Corporal B. Prather, Co. D, 103d Ohio, aged 18 years, was wounded at the battle of Nashville, December 15, 1864, and Avas admitted to the Cumberland Hospital on the following day. Surgeon B. Clark, U. S. V., reported: "Gun shot wound of right foot, ball entering immediately under the metatarsal bone of the great toe and burying itself in the plantar fascia. The soft parts were remarkably sensitive in the vicinity of the wound, showing a great degree of muscular and nervous irritability. The foot was not swollen, the bones were not fraqtured, nor the tissues severely lacerated. December 26th, the ball was removed by Acting Assistant Surgeon S. G. Ayres; second operation, exsection of a half inch of the posterior tibial nerve, behind the inner malleolus, by Assistant Surgeon W. B. Trull, U. S. V.; third operation, amputation of the toe, with removal of the first metatarsal bone, by Acting Assistant Surgeon L. E. Tracy. The patient complained, on December 26th, saying that a feeling of stiffness had been coming on for three days, especially in the shoulders, neck, and jaws. The latter gradually closed until it was impossible to introduce food into his mouth. There was a tetanic spasm of the muscles of deglutition, so that the patient was dying from inability to swallow. Chloroform alone seemed to afford temporary relief from his intense sufferings. Relaxation of the jaws was effected by division of the nerve, but the spasms of the muscles immediately returned. At midnight of the 27th, amputation at the lower third of the leg was performed by Acting Assistant Surgeon S. G. Ayres, but without effect. Large opiate injections were afterward given, and the patient obtained sleep. A copious warm perspiration breaking out upon the face and the improved pulse were considered favorable symptoms. Died December 28, 1864." The three cases of shot wounds of unspecified nerves were probably examples of 1 Cases of Lieutenant A. Rodman, 2d Wisconsin, wounded in I860, and who recovered. Also of Private W. Lette, Co. F. 09th New York, wounded at Bull Run, August 29, 1862; Corporal A. McNeal, Co. A, 121st New York, wounded October 19, 1862; Sergeant C E. Clark, Co. H. 32d Virginia, wounded at Spottsylvania, May 12, 1864 ; and Private P. J. Vimont, Co. C, 7th Kentucky Cavalry, who were discharged for disability. 2 Caseof Private J. G. Grissetta, Co. D, 2d Alabama; wounded at Fort Blakely, April 9, 1864; died April 21st. It is stated that the popliteal nerve was "dark and disorganized." 3 Private James Rollins, Co. H, 28th North Carolina, aged 30 years ; wounded at Gettysburg, July 3, 1863; tetanus July 20th ; death, July 22, 1863. 4 Case of Private G. Richmoud, Co. D, lllth New York, wounded at Bristow Station, October 14, 1863, in the upper third of the left calf by a carbine ball. He was sent to the Third Division Hospital at Alexandria. The wound was dilated by an incision. Gangrene appeared and spread very rapidly, and death took place October 23, 1863. S CASE 16, and the case of Private J. Leonard, Co. G, 5th Ohio, aged 22 years, wounded at Gettysburg, July 3, 1863 ; tetanic symptoms July 14th. amputation at knee joint July 16th, and death three hours after. 12 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. injuries of the sciatic in one instance, of the anterior and posterior tibials in the others. Abstracts of two of the cases are subjoined; the third case has been published, and has been noticed in the foot-note on page 9 (case of Private J. S. L. Scott, 121st New York). CASE 17. Sergeant J. W. Crane, Co. A, ?9th New York, aged 27 years, was wounded at Bull Run, August 30, 1862, and admitted to Judiciary Square Hospital, Washington, one Aveek afterward. On May 9, 1863, he was transferred to DeCamp Hospital, David s Island, whence Acting Assistant Surgeon J. W. Dickie reported: "A ball passed through right thigh at about the junction of the upper and middle thirds. The wound closed about the first of March, and a small abscess formed, about that tin\e, a little below the wound. When the abscess healed a pain commenced in the left hip joint, extending to the foot. This pain was constant. No pain was felt in the right leg except when pressure was made on the wound. The pain was most severe in the hip and calf of the leg. It would at times ascend and affect the respiratory muscles, causing great distress and difficulty in breathing. Appetite poor when admitted, yet the patient is quite fleshy. Had taken considerable quantity of morphia, so much as to be free from pain. May 13th, had recurrence of pain and dyspnoaa, and spasm of upper extremities. Gave chloro form, twenty drops, and repeated the dose in fifteen minutes. May 17th, had another spasm ; same treatment. Has slighter attacks more frequently, which are relieved by exposure to cold. May 19th, had another spasm; two grains of sulphate of morphia given ; pain checked. May 24th, another spasm ; gave chloroform one drachm, and sulphate of morphia one grain ; pain relieved. On the next day cauterization was performed along the course of the great ischiatic and peroueal nerves. May 28th, gave nine grains of sulphate of quinine and a half grain of sulphate of morphia, and repeated every evening. May 29th, had a recurrence, but not much spasm. June 12th, the cauterized surface is healed; patient improving and has but little pain. June 22d, walked out, supporting himself by means of canes." The patient was subsequently transferred to McDougall Hospital, where he was recorded as having been "returned to duty December 28, 1863." The records, however, do not show that he resumed active duty in the field. He was mustered out October 6, 1864, and pensioned. The Hartford Examining Board certified, May 3, 1871: * * "The muscles and skin are bound down to the bone and are much impaired in. action. Partial paralysis of both limbs, owing to the injury to the nerves." The same Board reported, September 15, 1873, that "owing to the injury to some nerve he suffers excruciating pain on slight exercise or change of temperature," and, at a subsequent examination, they stated that "pain extends to the spine and down the other leg, and the limb at such times is drawn up spasmodically ;" also that " he is confined to bed from one to three months every year," etc. The pensioner was paid June 4, 1876. CASE 18. Private J. W. Young, Co. E, 137th New York, aged 27 years, was wounded at Gettysburg, July 2, 1863, and, admitted to Harewood Hospital, Washington, three weeks afterward. Acting Assistant Surgeon T. H. Elliott reported: "Gunshot wound of right leg. Ball entered through upper portion of gastrocnemius muscle and emerged near the head of the fibula. The foot, immediately after the injury, dropped to full extension ; all of the muscles of the leg paralyzed from division of nerves; flexors of thigh contracted, causing the heel to be raised from the floor three inches in the erect posture. Patient is unable to bear any weight on the limb. August 6th, wound unhealed ; paralysis of extensor muscles complete. Patient discharged from service August 16, 1863." Examiner J. G. Orton, of Binghamton, New York, September 15, 1866, certified : "The power of flexion of the foot upon the leg is impossible in consequence of injury to flexor muscles; walking is performed with much difficulty and not without assistance." On February 29, 1876, he reported : * * "The power of flexion of the foot is entirely gone. It is at present almost worthless, the foot being swollen, and drags when he walks; he cannot walk without assistance." The pensioner was paid March 4, 1876. In addition to the cases of reflex paralysis cited from Dr. Keen in foot-note 2 on page 9, a report of an instance of this rare affection is given below. 1 Special reports of operations on this subject are infrequent. 2 1 Private C. Sullivan, Co. K, 69th New Y< rk, aged 36, was wounded at Spottsylvania, May 10, 1864. From a field hospital of the Second Corps he passed to Douglas Hospital at Washington, and thence to South Street at Philadelphia, from all of which places "a shell wound of the left leg" was reported. Assistant Surgeon S. A. STORHOW, U. S. A., in charge of the Filbert Street Hospital, described the injury as a shot wound of the gastro cnemius muscle, involving the posterior tibial nerve." Acting Assistant Surgeon L. Tosier reported the patient s admission to the Ladies Home Hospital, New York City, November 7th, and the following history: "A shell wound of the posterior portion of the leg, severing the lower portion of the gastro cnemius muscle. The wound has healed with considerable contraction of the parts, flexing the foot strongly and leaving the ankle joint exceedingly tender and painful almost immovable. On the morning of July llth the patient awoke with almost complete paralysis of each forearm and hand, in which condition they yet remain." The patient was discharged December 9, 1864, and pensioned. Examiner E. Bradley, of New York, on February 10, 1866, certified to atrophy of the wounded limb and an open ulcer occupying the lower and posterior surface; also to partial paralysis of the right hand. The New York Examining Board reported, September 11, 1872: "A shell wound, etc., leaving a tender cicatrix which is constantly breaking open. Locomotion is interfered with. The limb is very tender, and it is painful for him to walk. He cannot move his right hand on account of total paralysis of it, nor close the fingers. He states that both hands became paralyzed after he was wounded, and that he recovered the use of the left hand, but the other hand remained useless. We cannot discover any connection between the wound of the leg and the paralysis of the hand. Dr. A. B. MOTT, of New York City, who was surgeon in charge of Ladies Home Hospital at the time of the pensioner s discharge from service, certified, February 22, 1873: At the time of his admission to the hospital the patient had lost the use of both arms, but he recovered the use of the left arm. As far as my memory serves me, it was my opinion at that time that the paralysis was due to shock at the time of receiving the wound . The pensioner was paid June 4, 1877. 2 On wounds of the nerves of the lower extremities the reader can consult, in addition to the works already cited, and the researches of CllUJK- 8HANK, KOXTANA, J. F. MECKEL, RETZIUS, TIEDEMAXX, and other experimenters in surgical physiology on the results of division of the nerves, the following authors: DESCOT, Diu. sur Us affections locales des nerfs, Paris, 1822, No. 21(3; SWAX (J.), A Treatise on Diseases and Injuries of the Nerves, 2d ed., London, 1834 ; HAMILTON (J.), On some effects resulting from Wounds of Nerves, in Dublin Jour, of Med. Sci., 1834, Vol. XIII, p. 38; WALLER, Nouv. meth. anat. pour V investigation du systeme nerveux, Bonn, 1852 ; PHILLU EAUX and VULPIAN, Recherches sur la regeneration des nerfs, in Mem. de la Societe de Bioloyie, 1859 ; DfCHEXXE, De electrisation localisee, etc., 2d ed., 1860 ; LOXDE, Recherches sur les nevralgies, consecutives aux lesions des nerfs, Paris. 1860, No. 199; TlLLAUX (P.), Det Affection* Chirurgicales des Nerfs, Paris, 1866; PAULET, Les Suites immediates et eloignees des lesions traumatiques des nerfs, in Gaz. Hebdom. de Paris, 1868, T. V, p. 283; FOLLIX (E.), Traiti iUm. de path, ext., Paris, 1867, T. II. p. 23& SECT. I.] SHOT FLESH WOUNDS IMPLICATING BLOOD-VESSELS. 13 Flesh Wounds of the Lower Limbs with Injury of the larger Blood-vessels. As indicated in my preliminary surgical report in Circular 6, S. G. 0., 1865, p. 38, shot wounds of the larger arteries of the lower extremity, the femoral, profunda, peroneal, and tibials, uncomplicated by fracture of the adjacent bones, or by extended disorganization or complete removal of the limb by the impact of large projectiles, that come under the treat ment of the military surgeon, are comparatively infrequent. It is difficult to convince surgeons who have had little field practice of the rarity of this form of accident. 1 It is strikingly illustrated by the fact that, in the series of fifty-eight thousand seven hundred and two cases of shot flesh wounds of the lower extremities we are now discussing, only a hundred and fifty-six instances of this particular lesion, or 2.6 per thousand, were reported. Of one hundred and fifty-six cases, thirty-three were treated without operative inter ference, eighty-seven by ligation, twenty-three by amputation, and eight by ligation followed by amputation. These four groups will be separately considered. Wounds of Blood-vessels treated without Operation- This group comprises eighteen cases of wounds of the femoral artery, in two of which the femoral vein was likewise implicated. Of these fifteen terminated fatally. There were three fatal cases in which the femoral vein alone was involved. There were four cases of wounds of the popliteal, with two recoveries. Of two cases of wounds of the posterior tibial, one complicated by wound of the peroneal was fatal. Of two cases of wounds of the peroneal one was fatal, and the result in the other case cannot be ascertained. Two cases of wounds of the internal saphenous vein resulted favorably, as did a case of wound of the dorsalis pollicis. A case of wound of an unspecified artery of the lower extremity had a fatal result. Twenty-three of the thirty-three cases terminated fatally, a mortality of 71.8 per cent. A few examples of these injuries will be detailed, commencing with a case of occlusion of the femoral artery from contusion, and two instances of direct lesion of that vessel: 2 CASE 19. Private S. T. Newell, Co. B, 1st U. S. Artillery, aged 21 years, was wounded at Gettysburg, July 2, 1863, and entered the Satterlee Hospital, Philadelphia, July llth. Acting Assistant Surgeon W. C. Dixon reported: "The missile, a piece of shell, struck the inner side of the left thigh, middle third, producing a severe flesh wound. Simple dressings were applied. On the 19th the wound assumed a gangrenous appearance; a mixture of equal parts of creasote, alcohol, and water was applied. Under that treatment it remained about the same until JuJy 28th, when the sloughing commenced to spread i/ipidly and nitric acid was applied. On the 29th the femoral artery was exposed at the upper and lower edges of the wound, ivith a large amount of sloughing tissue occupying the intermediate space. Two days later the slough was removed from around the artery, which was found to have been converted into a fibrous cord bearing no resemblance to an artery. It was watched closely to guard against haemorrhage. At 2 o clock P. M. on August 1st the artery separated, and the proximate and distal extremities of the vessel were found to be perfectly occluded. The wound healed rapidly, and in September the patient was transferred to Fort Hamilton." He was discharged, at Fort Independence, December 7, 1863, and pensioned. Examiner J. H. Crombie, of Derry, N. H., certified, May 6, 1874: * * "Was struck by a piece of shell, * * making a wound six inches in length and three in width, penetrating nearly to the bone. The limb is weakened very much. The muscular power is considerably limited. He is unable to walk or labor on the limb for any length of time by reason of weakness." The pensioner was paid June 4, 1876. HEINE (C.) (Die SchussverMzungen der tinteren Extremitaten, Berlin, 1866, p. 127) remarks that: "The rarity with which shot injuries compli cated by serious arterial haemorrhages present themselves to surgeons at the stations for first dressings (erste Vtrbandplatz) is an experience that repeats itself in every campaign. Hence operative interference on account of wounded blood-vessels is seldom necessary at this stage. From the last war [the Danish war of 1864J I cannot recall a single case in which ligation or amputation was performed for primary bleeding at the field ambulance stations." The first chapter of GUTHRIE s Commentaries on the Surgery of the Peninsular War, that excellent vade-mecum of the military surgeon, and the chap ter on gunshot wounds of the extremities by MATTHEW, the historian of the surgery of the British army in the Crimea, have already established the doctrine above enunciated. The misconceptions which such an authority as VALENTINE MOTT adopted in his paper On Haemorrhage from Wounds, a paper contributed to the publications of the SANITARY COMMISSION, can only be explained by his comparatively slight acquaintance with the effects of shot injuries. 2 Of the remaining fifteen cases of shot wounds of the femoral artery treated on the expectant plan, one resulted successfully case of Wammack, 5th North Carolina and fourteen fatally, viz: Dinguid, Griffin s Battery; Ledbetter, 9th Alabama; Sylvester, 9th New Hampshire; Uiming, 8 1st Penn sylvania; Corris, 17th Illinois; Collins, Ordnance Corps; Blaisdell, 17th Massachusetts; Lawrence, 9th New York Cavalry; Masser, 143d Pennsyl vania; Craft, 144th New York; Stephen, 147th New York; Geary, 4th Georgia; Bailey, 8th Illinois Cavalry, and Clarendon, 26th Massachusetts. In the last two cases the femoral vein was also implicated. It is impracticable to give the details of these cases, but the names are mentioned in order that students of this special subject may be enabled to refer to them in the MS. records of the Surgeon General s Office. 14 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Of the cases of wounds of the femoral artery treated without operation, a case of recovery and a fatal case will be detailed : CASK 20. Lieutenant L. Hallman, Co. D, 51st Pennsylvania, aged 04 years, was wounded at South Mills, April 19, 1862, and admitted to Hygeia Hospital, Fort Monroe, h ve days afterwards. Surgeon R. B. Bontecou, U. S. V., reported: " Gunshot wound of femoral artery, a bullet traversing the middle of the left thigh, entering anteriorly, and escaping on the posterior aspect just opposite. Pulsation could indistinctly be felt in the pedal and posterior tibial arteries. About one week after admission a smart arterial haemorrhage came from the anterior wound. Compression by a bandage and cold wet applica tions were made, and the haemorrhage was controlled, but returned the next day. We proceeded to his room to tie the femoral ; on consultation, however, it was decided to wait, and, if it should bleed again, to operate. He continued doing well. Treat ment: Absolute rest and cold wet applications, ice in small portions being allowed to melt on the bandage which surrounded the thigh. May 20th, abscess of the skin appeared, and discoloration of the great toe, which eventually sloughed to the first pha lanx; temperature of the foot all the while good. He was sent to Philadelphia, in June, quite well." Lieutenant Hallman was transferred to the Veteran Reserve Corps on March 14, 1854, and ultimately mustered out of service June 30, 1866, and pensioned. Examiner W. Carson, of Norristown, Pennsylvania, March 3, 1867, certified: "Ball passed through left thigh, * * wounding the sciatic nerve; has lost first joint of great toe, with immobility of all the toes. Atrophy of limb equal to one inch in circumference; foot cold." Examiner H. E. Goodman, of Philadelphia, certified, September 18, 1869: * * "Limb much weakened and painful all the time." The pensioner died, of consumption, November 24, 1871. CASE 21. Sergeant H. Booth, Co. E, 7th Indiana Cavalry, aged 24 years, was admitted to the Gayoso Hospital, Memphis, April 18, 1864, having been wounded on the previous day by the accidental discharge of a revolver held in the hands of one of his comrades. Surgeon F. N. Burke, U. S. V., made the following report : "The ball entered the left thigh directly over the course of the femoral vessels, two inches below Poupart s ligament, and escaped at the crease of the nate and median line of the left thigh. There was copious haemorrhage at the time the wound was received, but it was arrested by application of the tourniquet. As a precautionary measure it was left on at the time of admission, but not tightened. The wound became unhealthy and had a gangrenous smell on the fourth day. Charcoal cataplasms were then applied, and Labarraque s solution used to the wound. On the sixth day haemorrhage again occurred, amounting to about six ounces, but pressure again arrested it. For the twenty-four hours preceding this the whole limb had become swollen and ccdematous, especially the upper portion of the thigh. The patient had become very much prostrated and his pulse quite weak. He was naturally of a weak constitu tion. It was thought that to tie the artery there would result in gangrane of the limb, as its vitality was evidently quite low, and, the wound being unhealthy, secondary haemorrhage from the sloughing of the vessel would be imminent. Amputation was then thought of, but it was obvious that the patient was too much prostrated to hope for a successful result. Oozing of blood occurred a couple of times during the ensuing few days, but the formation of a small clot was sufficient to arrest it. He died on April 28, 1864. The post-mortem, examination discovered the femoral artery to have been perforated so as to admit the passage of a duckshot through the wound about half an inch below the origin of the profunda. The femoral vein was found to have sloughed for a distance of about one and a half inches, gangrene having extended along the fascia and cellular planes from one to one and a half inches at different parts along the course of the wound. The ball had passed between the femoral vessels and the femur." Of the four casss of injury of the popliteal artery, a fatal instance and one that eventually resulted in fatal aneurism are selected for illustration : x CASE 22. Private J. C. Mapes, Co. K, 103d Pennsylvania, aged 22 years, was wounded in the left leg at Kinston, December 14, 1862, and entered the Stanley Hospital, New Berne, six days afterwards. Acting Assistant Surgeon J. B. Upham reported : "A mini6 ball entered three inches above the knee joint, on the inside, over the track of the femoral artery, and passing downward and backward emerged in the popliteal space near the insertion of the biceps, lacerating, in its course, the popliteal artery. His condition at the time of his admission was one of great mental and bodily depression. He was treated by stimulants, warm applications, and generous diet. Three days afterwards, secondary haemorrhage coming on, attempt was made to ligate the femoral artery by dilating the wound, which failed. Amputation was not resorted to on account of the con dition of the patient. Gangrene below the point of the injury came on rapidly, and the patient died December 29, 1862, fifteen days after the reception of the wound. The post-mortem examination revealed the injury of the artery already alluded to, which extended for a considerable distance, the track of the ball being almost in a direct line with the course of the vessel itself." The other case referred to is a remarkable example of aneurism developed after fourteen years, as the remote result probably of a shot contusion of the popliteal artery: CASE 23. Private W. Young, Co. K, 4th New York, aged 19 years, was wounded at Fredericksburg, December 13, 1862, and admitted to Campbell Hospital, Washington, four days afterwards. Surgeon J. H. Baxter, U. S. V., recorded: "Gunshot wound of leg; patient transferred to Baltimore January 8, 1863 " Surgeon L. Quick, U. S. V., reported that the patient was discharged from McKim s Mansion Hospital, March 18, 1863, for "gunshot wound of left leg, ball entering near the head of the tibia and emerging through the internal belly of the gastrocnemius muscle, producing lameness." The Boston Examining Board certified, October 27, 1865 : " Has had wound of leg below knee, * * ball emerging one inch below and behind the internal condyle of the femur, evidently passing across the internal saphenous vein. Cicatrices not adherent, but there is some loss of substance of muscle, and the veins of the leg are varicose, probably in consequence of the wound. Mo tions of joint good. He says he has pain in leg on walking or standing, and much pain in popliteal space while sitting." On August 25, ] ]>;!, this pensioner came under the care of Dr. J. Collins Warren, at the Massachusetts General Hospital, who 1 The other two cases of shot wounds of the popliteal artery are those of Pogue, 110th Ohio, who recovered and was discharged, and of Thompson, 120th New York, who died sixteen days after the reception of the injury. SECT. i.J SHOT FLESH WOUNDS IMPLICATING BLOOD-VESSELS. 15 reported the further progress of the case to the Boston Society for Medical Improvement, in the Boston Medical and Surgical Journal, Vol. XCV, No. 18, as follows : "Was wounded fourteen years ago, at the battle of Fredericksburg, by a musket ball, which entered the calf of the left leg a little to the inside, and came out opposite the inner aspect of the knee joint. There was no unusual amount of haemorrhage at the time, and the wound healed well, but on recovery a smull bunch remained in the popliteal space, growing larger at times, and again almost wholly disappearing. One year ago it grew larger than before and began to pulsate. It soon filled the hollow of the knee, and during the last two months lias spread rapidly on the inside of the thigh. The skin over the popliteal space is made tense by an ill-defined pulsating mass, which spreads along the course of the femoral artery to within eleven inches of the anterior superior spinous process of the ilium. The left knee is nineteen inches in circumference, while the right knee measures but thirteen and one-fourth inches. The patient suffers severely from pain in the calf and foot, which is relieved only by frequent subcutaneous injections of morphine. A pound cannon-ball applied to the femoral diminishes but does not arrest pulsation in the vessel. Heavy pressure with the hand arrests pulsation entirely. August 30th: The patient was etherized and pulsation in the femoral was arrested by two hospital tourniquets applied, near the apex of Scarpa s triangle, alternately every fifteen minutes for twelve hours. During this period the patient was kept profoundly etherized, about a pound and a half of ether having been consumed for that purpose, with the exception of a few minutes during the afternoon, when some beef- tea and brandy were administered. The pulse during this time gradually rose from the normal rate to about 120, but subsided somewhat after nourishment had been taken. On removing the tourniquets pulsation had ceased, although on auscultation a slight murmur was heard beneath the tumor. At midnight there was no return of the pulsation, but the next morning a slight pulsation was observed, which gradually increased to its previous force. September 10th: Pressure was applied as before by tourniquet without ether, the patient preferring to bear the pain, and .was continued for twenty hours, but had no effect upon the pulsations, which reappeared after it was removed. September 19th : The patient was etherized, the sac laid open, the clots, which were numerous, everted, and the artery tied at each end. It was found that the sac extended to the point of bifurcation of the popliteal artery. Two ligatures were therefore necessary at this point. The patient rallied well from the operation, and for the first week the wound healed rapidly. An attack of erysipelas arrested the healing process and reduced the patient greatly. On October 3d, haemorrhage occurred from the upper end of the wound during the afternoon, and although digital pressure was immediately resorted to by an attendant, and in a few minutes the tourniquet was applied, the patient sank, and died the same evening. Dr. Fitz showed the specimen, which consisted of the aorta from its origin, the left femoral, and a portion of the aneurism in continuity. The fatal haemorrhage had resulted from the sloughing of the walls of the artery at the upper end of the aneurismal sac, where the ligature had been applied. There was no alteration of the inner surface of the femoral artery, but the fibrous tissue was indurated around it, corresponding with the region where compression had been applied. The entire inner coat of the thoracic aorta was thickened, wrinkled, elevated in patches of an opaque grayish-white color, and the canal was dilated, especially that of the arch. Just above the cceliac axis these alterations ceased abruptly, the interior of the abdominal aorta being smooth and yellow, its walls evidently in a normal condition. The specimen was particularly interesting from the absence of changes at the point of compression and the presence of chronic inflammatory conditions of the thoracic aorta, such as are associated with the formation of aneurisms in a young man in whom a popliteal anuerism had arisen directly or indirectly from a traumatic cause." Of five cases in which large veins were wounded, three in which the Jemoral vein was separately injured proved fatal, and two, in which the internal or long saphenous was believed to be lacerated, recovered. One of these is detailed: 1 CASE 24. Lieutenant L. D. Martin, Co. A, 29th Illinois, aged 32 years, was wounded through the left thigh at the siege of Fort Donelson, February 15, 1862. Dr. Madden, of Nashville, noted the following history of the case, which was forwarded by Surgeon E. Swift, U. S. A., Medical Director: "A rifle ball entered the limb at a point directly over the eaphenous opening and glanced around upon the fascia lata to the outer aspect of the thigh, where it emerged one inch below the trochanter major. There was a copious flow of blood from the wounded veins at the time of the injury, but this was readily checked with lint. The patient was conveyed to the Academy Hospital at Nashville. On the eighth day there was a recur rence of venous haemorrhage from the inguinal wound. This was again arrested by pressure, and the patient continued to improve till the evening of the 5th of March, when the bleeding was suddenly renewed to such a degree that the coats of the femoral artery were supposed to have yielded. Surgeon E. Swift, Medical Director in this city, having been consulted, he directed that the artery should not be ligated but judiciously compressed, and it was decided to postpone till the next morning any attempt to place a ligature upon the vessel. Pressure with the fingers upon the artery at the point of its emergence from beneath Poupart s ligament was maintained during the whole night by relays of assistants. Next morning, on intermission of the pressure, there was no haemorrhage, nor was there any pulsation distinguished below the wound. A compress was placed over the artery, and a bandage applied from the toes to the groin. This was removed at the expiration of twelve hours, and the limb was wrapped in flannels. Pulsation below the groin was not perceptible for several days. The limb, however, retained its temperature and its vitality, and the circulation gradually became re-established. There was no recurrence of haemorrhage. The patient recovered his strength rapidly, and returned to his home April 5, 1862, at which time he was able to walk with the assistance of a cane." Lieutenant Martin resigned the service September 17, 1862, and was pensioned. Examiner J. W. Redden, of Shawneetown, Illinois, March 1, 1864, certified: The ball entered the front of the left thigh near the femoral artery, which seems to have been wounded; there is general derangement of the nerves affecting the joints, and muscular activity and strength of the limb." Examiner H. \V. McCoy, of Golconda, Illinois, September 16, 1873, reported the pensioner as having received a "flesh wound of the left shoulder" in addition to the above injury, but no mention is made of this in any previous reports. The pensioner was paid June 4, 1876 1 The three cases 01 injury cf the femoral vein are : Scullen, 25th Ohio, who died of pyaemia ou the 16th day ; Cambridge, iMth New York, fatal on the SKd day (for autopsy see Lincoln Hospital Case Book No. 17); and Schumaker, 2d New York Cavalry, who died on the eighth day after the reception of the injury. The i-thcr case U injury of the internal saphenous vein is that of Johnson, 7th Connecticut, who recovered and was discharged. 16 INJURIES OF THE LOWER EXTREMITIES. fCHAp. x. The result of this series of thirty-three shot wounds of the larger arteries and veins of the lower limb sufficiently prove that compression, styptics, or a let-alone practice cannot be safely adopted in such grave accidents. The histories of three fatal cases of wound of the femoral vein corroborates the argument of Surgeon S. W. Gross, U. S. V., in favor of the ligation of wounded venous trunks. 1 Surgeon J. A. Lidell, U. S. V., in his excellent memoir on traumatic haemorrhage, 2 has cited two or three other instances of shot lesions of the great vessels of the thigh, reported by Surgeon W. Clendenin, U. S. V., of which I am unable to find any mention in the official returns. The comparative rarity of profuse primary bleeding from shot wounds of the large blood-vessels of the extremities can hardly be seriously contested. 3 Wounds of Blood-vessels treated by Ligation. Eighty-seven cases were reported of shot flesh wounds of the lower extremities with lesions of the larger blood-vessels, treated by .primary or intermediary ligation of arteries. Only twenty-six of these resulted favorably, leaving the formidable mortality-rate of 70.1 per cent. Six rases in which the external iliac artery was tied for wound of the femoral or profunda, or of these vessels and their accompanying veins, were fatal. Of sixty-two ligations of the femoral but seventeen, or 27.4 per cent., were successful. One of two ligations of the profunda was successful. In seven ligations of the popliteal, two patients survived. There were two ligations of the anterior tibial with one recovery, five of the posterior tibial with four recoveries, two of both tibials with one recovery, arid one fatal case of ligation of the peroneal artery. All of these cases will be hereafter enumerated in brief abstracts or in tabular form; but, as there are many other cases of delegation of the same vessels in shot flesh wounds without primary arterial lesion, it will be most convenient to classify the analogous cases further on, and there will be presented here only a single abstract of a remarkable recovery after ligation of the femoral artery for shot injury: 3 CASE 25. Assistant Surgeon R. S. Vickery, 2d Michigan, aged 33 years, was wounded at Petersburg, July 30, 1864, and admitted to the field hospital of the 3d division, Ninth Corps. Surgeon P. A. O Connell, U. S. V., reported: "Gunshot wound of upper third of left thigh by mini6 ball; ligation of femoral artery performed by Surgeon W. B. Fox, 8th Michigan." From the field hospital the patient was moved to City Point, and subsequently to New York. Assistant Surgeon J. E. Semple, U. S. V.. reported his admission to the Officers Hospital, Bedloe s Island, August 25th, with "flesh wound involving direct injury to the large artery of the thigh." In January following, the invalid was transferred to Armory Square Hospital, Wash ington, where he was discharged from service March 11, 1865. Examiner J. Nichols, of Washington, certified, March 24, 1865 : " Gunshot wound of left thigh, inner aspect, upper third, ball severing femoral artery. Limb much atrophied and shrunk away almost to the bone; leg partially flexed upon the thigh; inability to extend it. Great danger of secondary haemorrhage from the artery, which requires a long time for restoration. Limb perfectly useless; prognosis doubtful may yet have to be amputated." Dr. Vickery was a pensioner until May 14, 1867, when he was appointed Assistant Surgeon in the regular army. GROSS (S. W.), Remarks upon the General Applicability of Ligation as a Venous Hemostatic Agent, in Am. Jour. Med. Sci., 1867, Vol. LIII, pp. 17, 305. *In his paper on the Wounds of Blood-vessels, Traumatic Hemorrhage, Traumatic Aneurism, and Traumatic Gangrene, in the Surgical Memoirs of the Sanitary Commission, 1870, Vol. I, p. 51, etc., Dr. JOHN A. LIDELL published several abstracts, contributed by Surgeon W. CLENDENIN, U. S.V., purporting to be descriptions of examples of "complete division of arteries by gunshot projectiles. Although these abstracts aptly illustrate the subject in hand, it has been found impracticable to verify the cases on the regimental and hospital returns ; but in the confusion of the battle-field it is probable that not a few important surgical accidents failed to get recorded In the case of James Brown, 3d Tennessee Mounted Infantry (loc. cit., p. 51), it appears that this regiment was never in action, and the patient s name is not on the hospital registers, nor does it appear on the death records. In the case of James O Neal (loc. cit., p. 55), it is left to conjecture whether the man belonged to the 10th Tennessee Mounted Infantry or to Wheeler s Cavalry. No reference to such a case is found on the flies of the War Department. In the case of Sergeant French, 4th U. S. Cavalry (loc. cit., p. 56), neither the date of the injury nor the engagement in which it was received are given, and on inquiry of the Adjutant General it has been ascertained that "there is no record of the enlistment of any soldier by the name of French in the 4th U. S. Cavalry, from 1856 to 1865, inclusive." 3 BlLLUOTH (Til.) (Chirurgische Brief c, etc., Berlin. 1872, p. 113) remarks : " Of the immediate results of injuries of the larger blood-vessels, of profuse haemorrhages on the field of battle, 1 have as little to relate as other surgeons that have served in the field. None of the colleagues with whom I conversed had observed such bleedings. Nowhere did I find a case of primary ligation of a large blood-vessel. It has been asserted that injuries of this kind prove fatal so rapidly on the battle-field that any assistance comes too late. There is no valid proof of this assertion. * * Observations are accumulating that arteries, even of the size of the aorta, when perforated by some modern shot projectiles, do not invariably bleed. In Carlsruhe, I have learned of a case a priori incredible, but attended by u careful autopsy, in which a shot through the aorta caused no bleeding until several days after the injury; the patient was therefore transported from Worth to Carlsruhe with a hole in his aorta without any bleeding. I have, myself, seen three cases of shot wounds of the external iliac and femoral artery in which n-j bleeding occurred." 1 roiessor BILLROTH then details the cases. SECT. I ] SHOT FLESH WOUNDS IMPLICATING BLOOD-VESSELS. Dr. F. H. Hamilton states (Appendix to Treatise on Military Surgery and Hygiene, 1865, p. G40) th.it in this case "the bleeding was arrested temporarily by a tourniquet, and three hours afterwards Surgeon Fox, of the 8th Michigan, enlarged the wound and tied the femoral loth above and below the seat of injury." No military surgeon now disputes the propriety of tying both ends of a bleeding artery at the wounded point, 1 and it is probable that if the judicious practice of Surgeon Fox had been more generally followed, and the precepts of Guthrie better appreciated, the deplorable fatality of this series of cases might have been largely averted. Wounds of Blood-vessels treated by Amputation. There were twenty-eight cases in which amputation was practised on account of uncontrollable bleeding from shot wounds of the larger blood-vessels of the lower extremity, and eight cases mentioned in the next subsection, in which recourse was had to amputation after proximal ligation of main arterial trunks had proved ineffectual. The series of twenty-eight cases includes twenty- six thigh amputations with only seven recoveries, a fatal amputation at the knee, and a fatal amputation in the leg. In this series the femoral artery was wounded in eleven instances, the profunda in one, the popliteal in nine, one of the tibials in six, and the long saphenous vein in one. All of these cases are tabulated further on. Details of two are inserted here: . CASE 26. Corporal H. Schatt, Co. H, 64th New York, aged 30 years, was wounded at Hatcher s Run, March 25, 1865, and was admitted to the field hospital of the 1st division, Second Corps, where Surgeon F. M. Hammond, 126th New York, noted "a shot wound of the leg." On the following day the man was sent to City Point and thence to Washington. Assistant Surgeon H. Allen, U. S. A., reported his admission to Mount Pleasant Hospital April 2d, and contributed the follow ing history: "Gunshot wound of left lower extremity, ball passing through popliteal space from without inward, injuring the popliteal artery. When admitted the patient s pulse was small, sharp, and fast; face pale and tongue coated. His toes were of a bluish tint, and the foot was covered with bluish and yellowish purple spots. The entire leg was greatly swollen and the super ficial veins enlarged; the small veins of the lower third of the thigh, on the external surface, were somewhat discolored, and the integument was assuming a yellowish color. The limb was amputated at the lower third of the thigh, on the day of admission, by Acting Assistant Surgeon H. Craft. The operation was performed by the circular method, very little blood being lost. Two double ligatures were applied to the femoral and four to the branches. The anaesthetic consisted of equal parts of aether and chloro form. After the oper ation, cold- water dress ings were applied, and a stimulating course FIG. 3. Stump after intermediary amputa- adopted. Thehgaturea tion of thigh. Spec. 2283. came away Qn thg g j xtlj and seventh clays. On May 10th, there were symptoms of the femur exfoliating. The stump was nearly healed, when a collection of pus formed around the bone, and to give exit to it an incision was made just above the end of the stump. This was kept open by a tent and the stump encouraged to heal. Simple dressings were continued, and the tonic and stimulating course was persevered in. The exfoliating process steadily progressed up to June 19th, when a sequestrum was removed which proved to be nine inches long and was nearly a perfect shaft, extending nearly or quite to the trochanter major. It had only been partially destroyed on its under surface, and a new shaft of bone had formed around it. The stimulants and tonics were now increased, with nourishing diet, and by June 30th the patient was progressing favorably." The sequestrum was forwarded to the Army Medical Museum by Dr. Allen, and is represented in the annexed cut (FlG. 1). The patient was subsequently transferred to Rochester, and ultimately discharged from Ira Harris Hospital, Albany, September 25, 1865. Assistant Surgeon J. II. Armsby, U. S. V., contributed a cast of the stump (Cat. Surg. Sect., 1866, p. 554), which shows the inferior portion to be baggy, and a deep and poorly healed cicatrix at that point, caused by loss of substance over the bone (FlG. 2). Examiner G. W. Cook, of Syracuse, N. Y., July 9, 1873, certified: "Tenderness of stump and slight covering over end of bone. He does not, nor can he, wear an artificial limb." The pensioner was paid June 4, 1876. Another case of this category is selected for illustration because it affords quite a typical example of what is likely to occur after a shot wound of the popliteal artery 1 HK.IXE (C.) (Die Schussverlctzungen der unteren Extremildten, Berlin, 1866, p. 133). speaking of shot flesh wounds with injury of the arteries, remarks: " The ligation of the femoral artery was practised eight times [in the Danish War of 1664] and the external iliac was tied twice. In one of the latter cases, the femoral artery had been previously ligated ; but as bleeding recurred, the external iliac was tied. This is the only case of the ten ligations that proved successful. * * The bleeding was primary in two cases only. * * In two other cases, no bleeding at all occurred, although tho artery was completely severed in the wound ; in the rest of the cases the bleeding was secondary, from the seventh to the seventeenth day after the injury. SURG. Ill 3 FIG. 1. Cylindrical sequestrum from stump of left femur. Spec. 171. J. 18 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. unless the proximal and distal ends of the vessel are promptly secured by ligature, and the formation of traumatic aneurism in the ham and consequent gangrene of the leg prevented. Moreover, in this instance, the patient having been brought to Washington, a very conscientious artist was able to depict the appearance of the gangrenous limb, in a water-color drawing, which is reproduced with tolerable accuracy in the chromolithograph opposite : CASE 27. Sergeant G. W. Gardner, Co. A. 12th Illinois Cavalry, aged 29 years, was wounded at Mitchell s Ford, on the Rappahannock, October 11, 1863. Surgeon S. B. Wylie Mitchell, 8th Pennsylvania Cavalry, reported that he was struck by a conoidal carbine ball, which entered four inches above the right knee, passed through the inner hamstring muscles and the adductor magnus, outward and downward, and lodged under the integument on the outer side of the thigh. Upon extracting the ball through an incision there was a profuse haemorrhage, which ceased spontaneously. The patient was sent by railway ij Washington, and entered Emory Hospital on October 13th. Acting Assistant Surgeon J. Walsh reported that "he was feeble and pallid; no pulsation could be detected in the tibial arteries of the injured limb. There was loss of sensibility and slight discoloration of the skin of the right foot. The leg was packed in raw cotton, and the temperature was kept up by bottles of hot water. Frictions with a stimulating liniment were occasionally employed. After October 18th, the leg was daily immersed in a bath of oxygen gas. On October 25th, two bits of blue cloth and a small piece of white cotton cloth were extracted from the wound. The foot was decidedly gangrenous, and gangrene began to advance rapidly up the leg." At this time a sketch of the appearances of the limb was made, under Surgeon J. H. Brinton s direction, by Hospital Steward E. Stauch. This drawing was elaborated, after the lamented death of Mr. Stauch, by Hospital Steward S^hultze, and has been reproduced by chromolithography in the plate opposite (PLATE I, 28). On October 29th, Acting Assistant Surgeon W. H. Ensign amputated the limb at the lower third of the thigh. On exam ination of the amputated member it was found that the artery had been completely divided by the ball near the point at which it passes through the opening in the great adductor. The divided extremities of the artery were occluded by dark grumous clots. After the operation the patient was attacked by diarrhoea, and, on December 5, 1863, the case terminated fatally. A wet prepa ration of the lower half of the right femur, with a portion of the soft tissues, including the popliteal I If!. 3. Preparation of lower _ half of the right thigh, showing artery and vein, was contributed to the Army Medical Museum by Acting Assistant Surgeon J. arto^ laC S. i0 i7CO. the popWeal AValsh (Cat. Surg. Sect., 1866, p. 521), and is represented in the adjacent wood-cut (FiG. 3). Wounds of Blood-vessels treated by Ligation and subsequent Amputation. Of the eight instances in which consecutive amputation was had recourse to after the failure of proximal ligation of large arteries for primary bleeding, six succeeded ligation of the femoral, one ligation of the popliteal, and one ligation of the posterior tibial. Five were amputations in the thigh, and three of the leg. Only one of the eight patients recovered, a case of wound of the popliteal artery treated by tying the femoral and subsequently amputating at middle thigh. One of the fatal cases is detailed: CASE 28. Corporal J. M. Harris, Co. E, 14th Iowa, aged 20 years, was wounded in the right thigh at the battle of Tupelo, July 15, 1864, and entered the Adams Hospital, Memphis, five days afterwards. Assistant Surgeon J. M. Study, U. S.V., made the following report: "A minie" ball entered the lower portion of the middle of the thigh and passed beneath the bone without fracturing it. Aneurism of the femoral artery resulted. On July 27th, Surgeon J. G. Keenon, U. S. V., probed the sac with the finger, when excessive haemorrhage ensued, and, after great difficulty in finding the ends of the artery, the vessel was ligated above and below the sac. Acting Assistant Surgeon S. S. Jessup assisted at the operation. Sphacelus of the foot and leg afterward necessitated amputation, which was performed, just below the knee joint, by Acting Assistant Surgeon R. W. Coale. The patient died of pyaemia August 3, 1864." Eecurrent haemorrhage from the lower end of the wounded vessel was what com monly necessitated amputation in these cases. Flesh Wounds of the Lower Limbs unattended by Primary Injury of the Large Nerves or Blood-vessels. While in the two hundred and fifteen cases discussed in the two foregoing subsections, direct shot injury of the larger blood-vessels or nerves was regarded as the paramount lesion distinctively characterizing them, there were many other instances in the immense category of recorded shot flesh wounds of the lower extremities where the nerves and vessels shared in the laceration of the muscular and other soft parts by large projectiles, or were indirectly involved in the morbid processes following penetra- XXVIII w w CANCRENE FOLLOWING A SHOT LACERATION OF THE FEMORAL ARTERY SECT. I.] SHOT LACEEATIONS OF THE SOFT PARTS. 19 ting or perforating wounds by small missiles. These are included in this third subsection of shot flesh wounds of the lower extremities, a group of fifty-eight thousand four hundred and eighty-seven reported cases, which (as stated on page 8) it is difficult to classify. Some instances remarkable for the extent of laceration of the soft parts will be cited, some of lodgement of foreign bodies, and some distinguished by the complications of pyaemia, tetanus, gangrene, erysipelas, haemorrhage, secondary involvement of joints, etc., will be adverted to. In a hundred cases, ligation of the larger arterial trunks was resorted to, and in a hundred and sixty-one recourse was had to amputation. It will be recollected that in the two preceding subsections ninety-five examples of ligations and forty of amputations have been alluded to, as connected with primary injury of the nerves or vessels. All of these cases of ligations and amputations will be cited in consolidated tabulations at the close of this section. Some cases of shot wounds of the lower limbs, in which no operative interference was undertaken, will now be detailed. Shot Lacerations. After extensive destruction of the fleshy parts of the thigh and leg, reparation was usually slow and imperfect, sometimes as much so as in the remarkable case of laceration of the buttocks, narrated at page 430 of the Second Surgical Volume. Practitioners accustomed to regard mere flesh wounds as of little moment were not always happy in their prognoses of shot injuries of the soft parts in the lower limbs. 1 CASE 29. Sergeant J. W. White, Co. F, 14th New Jersey, aged 24 years, was wounded at Monocacy, July 9, 1864, and admitted to hospital at Frederick on the following day. Acting Assistant Surgeon J. H. Bartholf reported : " The patient was wounded by a cannon ball, or, as he says, by an uuexploded shell, which tore through the back of his left thigh and killed a man close by him. It produced a very extensive lacerated wound, extending on the back of his thigh from near his knee to the fold of his buttock a huge flap hanging downward and a shorter one attached at the upper end of the wound. He was admitted here the next day, without then suffering from any shock. Free suppuration followed, but not any sloughing, and simple measures only were required, viz : poultices, dilute solution of permanganate of potash, balsam of peru, water dress ings, oakum, simple cerate. It granulated, contracted, and healed till, on November 25th, the raw surface was only four inches square. No loss of motion at the knee joint, strange to say, resulted from this extensive involvement of the muscles. Decem ber 22d, he is transferred to hospital at Beverly this day. The wound is very nearly healed, and the patient in good health." Subsequently the man was transferred to the Whitehall Hospital, whence he was discharged June 17, 1865, and pensioned. The Trenton Examining Board certified, September 4, 1873: "The muscles of the posterior portion of the left thigh were very badly lacerated by a fragment of a shell; all the flexor muscles were torn through and a most persistent and gangrenous sore followed the wound, and the cicatrix is very large and tender, the leg weakened, so that he cannot walk far or stand long on it." The pensioner was paid June 4, 1876. Even in young and healthy subjects the progress of repair was slow after large solutions of continuity: CASE 30. Corporal A. W. McCausland, Co. B, 16th Maine, aged 18 years, was wounded at Gettysburg, July 2, 1863, and admitted to the field hospital of the First Corps. On August 24th he was transferred to Camp Letterman, where he came under the care of Assistant Surgeon W. F. Richardson, C. S. A., who recorded: "A shell struck the outer side of the left thigh, inflicting a terrible flesh wound eight inches long by four in width, with ragged edges. When admitted the patient was in good health, the wound looking well and filling up with healthy granulations. Up to date the treatment has been cold- water dressings. Stimulants are given and simple cerate dressings now used. The patient improved rapidly, and the wound closed." In October the man was transferred to Satterlee Hospital, Philadelphia, and on January 10, 1864, he was discharged from service by reason of "lameness of left leg resulting from the wound." Examiner T. Hildreth certified, September 4, 1873 : " Was wounded by a shell in the posterior part of the thigh, carrying away a very large part of the muscles and integument, resulting in a tender cicatrix. He now suffers from numbness of the limb." The pensioner was paid June 4, 1876. Sometimes small projectiles produced extended lacerations by driving into the soft parts coins, 2 knives, or other hard objects carried in the pockets of the soldiers: CASE 31. Private J. C. Haggerty, Co. I, 124th New York, aged 21 years, was wounded at Chancellorsville, May 3, 1833. Surgeon J. S. Jamison, 86th New York, noted a " shot wound of the right thigh. The patient passed from a Third 1 Dr. C. HEINE (Die Schussrerletzungen der unteren Extremitiiten, Berlin, 1866, p. 65) thinks that large shot lacerations of the fleshy parts of the lower extremities are peculiarly liable to be followed by tetanus ; but I find in the records under discussion little to corroborate this view. 1 will revert to the subject in treating of Tetanus. 2 SOCLN (A.) (Kriegschir. Erf., Leipzig, 1872, p. 16) gives a drawing of a flattened Langblei (the missile of the needle-gun), together with three bent French copper sous pieces and two vest buttons, all of which wei j extracted from the thigh of a French soldier at the Swiss ambulance at Lure. The ball and the large copper coins were detected and removed soon after the reception cf the injury, but the buttons were not extracted until three months afterwards. 20 INJURIES OF THE LOWER, EXTEEMITIES. [CHAP. x. Corps hospital to Fairfax Seminary, and thence to Satterlee Hospital, when Acting Assistant Surgeon I. Roberts reported the case as interesting, inasmuch as the ball struck a silver coin in the right pocket of the man s trousers and was thus deflected from the track of the femoral vessels; but passed through the soft parts, driving fragments of the pocket-book into the tissues, and escaping at the gluteal fold. The wound progressed favorably for a time, but, about July 20th, deep abscesses formed, and there was some sloughing at the aperture of entrance and exit. The abscesses were incised, and several fragments of the pocket-book came away with the pus. There was so much constitutional irritation that quiuia and stimulants were freely exhibited. The wound healed about the middle of December, and the man was transferred to the Veteran Reserves. He was quite lame, and the right foot was much everted. He was discharged October 7, 1834, and pensioned. Examiner J. Nichols, of Washington, certified: "Ball entered anterior aspect of upper third of right thigh, passing directly through, and inflicting a frightful flesh-wound. Bone uninjured; cicatrix very deep and adherent to all the soft parts below, nearly to the bone, render ing free motion of the limb impossible, and, if much used, very painful." Examiner J. Gordon, of Newburgh, New York, reported, February 28, 1876: * * There remains a large umbilicated cavity, with adhesions of skin, fascia, and muscles. He suffers more particularly from distress in the leg, extending in part to the foot, accompanied, before atmospheric changes, with shooting, darting pains, * * so severe at times as to unfit him for manual labor." This pensioner was paid June 4, 1876. Extensive lacerations of the calf were very slow in healing, and usually resulted in adherent cicatrices with atrophy of the remaining muscular tissues, greatly disabling the functions of the leg and foot: CASE 32. Sergeant F. A. Ingerson, Co. K, 27th Massachusetts, was wounded at New Berne, March 14, 1862. Surgeon G. A. Otis, 27th Massachusetts, reported that "a large fragment of shell striking the calf of the left leg carried away the greater portion of the bellies of the gastrocnemius and soleus muscles. There was inconsiderable bleeding. The laceration was so very extensive that it was difficult to coaptate or adjust the wound, and much of it had to be dressed open." The patient was sent to Academy Green Hospital. After the separation of sloughs, there remained a huge granulating sur face. On April 19th, the patient was sent to a northern hospital, and discharged December 19, 1862. Examiner A. Lambert, of Springfield, reported, March 11, 1863, the wound " unhealed and discharging constantly." The Boston Examining Boai-d stated, March 23, 1870: "A fragment of shell engaged the left calf. During the suppurating process that ensued a considerable portion of the belly of the calf was lost. The wound has not entirely closed, and the injured leg is notably larger than the other." In October, 1875, Examiner A. W. Nelson, of New London, reported: "There is a large cicatrix of left calf, with loss of most of the substance of the gastrocnemius ; * * patient unable to walk a long distance." In a similar case, amputation was contemplated; but the patient ultimately made a satisfactory recovery without operative interference: CASE 33. Private P. C. Whidden, Co. B, 13th Massachusetts, aged 22 years, was wounded at Antietam, September 17, 1862, and entered the Mason Hospital, Boston, January 22, 1863. Acting Assistant Surgeon W. E. Townsend noted: "Shot wound of left leg. Patient returned to duty November 1, 1863." The following detailed account of his injury and its result was forwarded by the man in July, 1866, through Dr. H. I. Bowditch, of Boston: "Was struck by a piece of shell on the posterior aspect of the left leg, causing extensive laceration and loss of the soft tissues, without injury to the bone. The wound extended from just above the ankle joint about eight inches up the back of the leg, from which, within these bounds, the soft parts, integuments, tendons, muscles, both arteries, and the posterior tibial nerve were entirely carried away, exposing the bones through nearly the whole length of the wound. On the front of the leg, corresponding to the middle of the wound, hut about an inch of sound skin was left. A rounded flap, about an inch and a half long, containing the lower portion of the tendo- achilles, w r as torn up and laid back over the heel. The upper part of the wound was ragged and contused, and the middle portion cleanly cut away. There was but little haemorrhage. He walked with great difficulty to the rear, and was then carried to a house a short distance from the field, where a consultation as to the propriety of amputation was held, six surgeons being present. Four decided that amputation was necessary to preserve life; one assented to this under existing circumstances, but thought that under more favorable conditions there was a possibility of recovery without the operation ; the other that amputa tion was uncalled for. The patient decided to retain the limb. The wound was dressed with lint and was not disturbed for five days. On the fifth day, he was carried in an ambulance a distance of twelve miles to the hospital in Hagerstown. Upon examination the wound was suppurating profusely and full of maggots, and it was dressed with yeast poultice and powdered charcoal. It was then determined to amputate, but the operation was postponed for three days, and nourishing diet and stim ulants were ordered. On the fourth day an examination preliminary to the operation was made, when healthy granulations appeared along the edges of the bones, and the operation was abandoned. The patient was then carried to a private house, where he received proper nourishment and good nursing, and at the end of a month, no bleeding having at any time occurred, went to his home in Boston Granulations had been going on rapidly; the wound had been filling up without a sign of inflam mation, and a pellicle was spreading out from, the sound skin all around the borders of the wound. After the journey the parts became irritated and inflamed, and the process of cicatrization went on much more slowly. By the first of March following the parts were perfectly healed, and the patient walked about with the aid of a cane. But the pellicle covering the surface being excessively thin was easily abraded, and the newly formed tissues possessing but little vitality, it healed slowly, new portions being rubbed off before the old were renewed, so that at no time since the wound was first closed has it been entirely free from slight superficial ulceration. At the present time the gap is partially filled up with cicatricial tissue, which has undergone con traction, making the wound appear much smaller than it originally was. It is covered with a thin layer of epithelium which constantly desquamates. The flap torn up and laid over the heel, as referred to above, instead of presenting the narrow outline of the tendo-achilles, has, in healing, become a thick flabby mass beneath the cicatrix, and after long walking becomes cedema- tous. The length of the cicatrix from top to bottom, on each side of the flap, is seven inches in the median line; from the top SECT. I.] LODGEMENT OF MISSILES IN SOFT PARTS. 21 of the cicntrix to the edge of the flap five inches; across the widest part at top and bottom, three and a half inches; in the middle, the narrowest part, three inches. Four inches and a half above the malleoli the leg measures in circumference six and a half inches; the sound leg at the corresponding part, nine inches. The integument on the front of the leg, at its narrowest part, is three and a half inches in breadth. The muscles of the calf contract but exert no influence over the foot, the tendons being absent, and extension cannot be performed, but the foot drops with its own weight. Owing to contraction of the cicatrix the foot can be flexed to but little less than a right angle with the leg. Sensation, which was lost in the external border of the foot and heel, has gradually returned. There is slight obstruction to the circulation from the slow return of venous blood. The patient walks Avith ease, unaided by a cane, and without the slightest perceptible limp." The report of the Adjutant General of Massachusetts shows that Private Whidden was discharged from service, by order of the War Department, December 11, 1863. He is not a pensioner. In extensive lacerations of the soft tissues of the thigh and leg by shell fragments, or other large projectiles, it was often difficult to make out the exact extent of the injuries inflicted, and the field returns of the surgeons who examined the primary wounds, and the later reports of the hospital surgeons and pension examiners were often, of necessity, wanting in precision regarding such lesions. 1 Lodgement of Missiles. A few cases of lodgement of projectiles or of foreign bodies driven by them into the soft parts of the lower limbs will be cited : 2 CASE 34. Private W. H. King, Co. E, 17th Maine, aged 24 years, was wounded at Bartlett s Mill, November 27, 18C3, and admitted to Prince Street Hospital, Alexandria, one week afterwards. Acting Assistant Surgeon J. Cass contributed the specimen (FlG. 4), with the following history: "He was wounded by a musket ball which struck two pocket knives, breaking them and driving the fragments with the ball into the anterior side of the middle third of the left thigh. A hundred fragments of the knives and four of the ball ware removed on the field. Lime-water dressings applied to the wound, and fifteen drops of tincture of iron given before meals. On December 13th, he suffered considerable pain in the wound, and on the following day an incision was made two and a half inches from the wound, and a jagged piece of ball an inch long and three- fourths of an inch wide was extracted. IGth, complained of strangury and some pain in the limb. A teaspoonful of spirits of nitre given three times a day. 17th, was restless during the night; sweats profusely, and had a chill this morning. Gave morphia and whiskey, also half an ounce of castor-oil. Has had no stool for forty-eight hours; pulse 115 and feeble; tongue coated ; very thirsty ; some soreness in inguinal glands. Prescribed extract of ginger and turpentine ten drops each, to be repeated in six hours if it does not operate, and gave tonics and stimulants. 18th, pulse 100, tongue moist and coated. Sweats all the time, and vomited in the night. Bowels moved freely and urinates more fruely; appetite better. There is a greater discharge of pus from the wound. 19th, pulse 115 and feeble; vomited considerable during the day. Ordered two quinine pills to be taken before meals, and an anodyne injection at bedtime. 20th, about the same; had a chill yesterday; granulations are pale and flabby. 21st, pulse 140 and very feeble; great prostration ; had a chill this morning and is delirious. Takes stimulants every hour. 22d, rested well, but is more prostrated and shows tendency to coma. Died at 4.30 P. M. Autopsy eighteen hours after death : On cutting through the muscles of the thigh, an inch and a half from the surface and an inch from the main channel of the wound, a sliver of horn from a knife- handle was found, half an inch long and one-sixteenth of an inch wide; also a brass rivet one-sixteenth of an inch in diameter and one-fourth of an inch long. In another place two pieces of horn from the other knife-handle, one three-eighths of an inch long and one-fourth wide, and the other one-eighth each way, were found ; also a piece of a blade one-fourth of an inch long and one-eighth wide ; and two pieces of brass, one being three-eighths of an inch long and one-sixteenth wide at one end and tapering to a sharp point at the other, and the other piece measuring one-eighth of an inch each way. Opposite the external wound the periosteum was found in places thickened, inflamed, jagged, discolored, slightly ossified, and separated from the bone for the space of two and a quarter inches longitudinally, and one inch transversely, with some pus beneath it." Dr. Cass 1 CllEXU (J. C.) (Aper<;u, hist. stat. et din., etc., pendant la guerre de 1870-71, T. I, p. 283) observes: " U eclat de bombe ou dobus cause le plus gouvent de larges plates avec perl?, de substance. Nous connaissons quatre faits dans lesquels la partie antero-interne des teguments de la cuisse fut enlevee d un seul coup sans lesion de I artere femorale; on voyait les battements du vaisseau an fond de la plaie." The same surgical annalist cites a case, in which disartieulation at the hip j jint was performed in extremis by M. MAUUICK RAYNAUD on a soldier of the National Guard, aged 19, with a terrible flesh wound of the thigh. 2 Among interesting published cases of lodgement of shot projectiles in the thigh is that of Major R. H. Stephenson, 24th Massachusetts, described by the late J. MASON WARRKX (Surgical Observations, with Cases and Operations, 1867, p. 546): A musket ball, entering the front of the left thigh, about two inches below Poupart s ligament, was concealed somewhere beneath the rectus, and eluded the researches of a number of experienced surgeons. WARREX, after ineffectually searching for the ball a month after the injury, advised that the patient should use (he limb with a view that muscular action would bring the ball from its hiding place. This prevision was justified, and a fortnight afterwards the position of the ball was recognized, and WARREN cut down and extracted it, and the officer speedily rejoined his regiment. The same writer has related (Boston Med. and Sitrg. Jour., 1862, Vol. tiXVI, p. 473) the case of Lieutenant C , 2d Massachusetts, wounded in the retreat from Winchester, a musket ball making a long track in the gastrocnemius, and carrying before it, like a glove-finger, a patch of trousers and flannel underclothing, making a huge plug, which could only be removed the following day by free incisions. Dr. M. GOLDSMITH, of Rutland, Vermont, formerly Surgeon U. S. V., has described (The Search for Balls in old Gunshot Wounds, in New York Med. Jour., 1868, Vol. VI, p. 42G) the case of a color-bearer of a Vermont regiment, in which a ball deeply buried in the thigh was reached by dilating the sinus leading to it by sponge-tents. FlG. 4. Fragments of ball and pocket knife extracted from thigh. Spec. 3236. INJURIES OF THE LOWER EXTREMITIES. fCHAp. x. also contributed five inches of the shaft of the femur of the injured thigh, which constitutes specimen 1985 of the Surgical Section of the Army Medical Museum. It is sawn longitudinally, and shows the shaft to be denser than usual and apparently somewhat hypertrophied. (See Cat. Surg. Sect., 1866, pp. 258, 617.) There were several cases in which large missiles buried in the fleshy parts escaped recognition; but none have been observed in which such concealed foreign bodies equalled in magnitude the projectiles that have been cited in some works on military surgery as embedded in the great muscles of the lower limb : l CASE 35. Lieutenant L. Soistman, Co. H, 98th Pennsylvania, aged 23 years, was wounded at Salem Heights, May 3, 1863. Three days afterwards he entered the Campbell Hospital, Washington, where he obtained a leave of absence on May 19th. On July 8th, he was admitted to the Officers Hospital, Philadelphia, where Acting Assistant Surgeon W. Cammac recorded the following history : "A piece of shell entered the right thigh at the most depending inner part of the middle of the upper third, went under the deep fascia, and upward under the femoral artery and buried itself. The missile appears not to have been noticed at first, as the wound was sewed up. After going to his home in Philadelphia he was attended by a private physician, but the missile remained still undiscovered. On July 8th, Acting Assistant Surgeon W. Hunt was called in, who was struck by the peculiar feel, and on introducing a probe immediately found the foreign body, and ordered the patient to the hospital to have it removed. On July 9th, Dr. Hunt enlarged the wound, and, after considerable trouble from the proximity of the large vessels, removed, with the assistance of the forceps, a piece of shell weighing nine ounces, which had lodged in the thigh sixty- six days. Its presence had given rise to no great disorganization, but he complained, he says, of a weight in the part during the whole time. After recovery from the effects of the ether, a half grain of sulphate of morphia was given. Cerate dressings and light pressure were applied, and the wound drawn together with adhesive straps. The patient s general health was excellent. He did remarkably well and felt greatly relieved by the operation. On July 13th, cataplasms were ordered, the wound looking well and suppurating moderately, and the patient having better appetite than any time since wounded. On September 5th he was attacked with intermittent fever, which was checked after several days by quinine. By October 1st the wound had nearly healed, but the leg was still weak from extensive disorganization of the great muscles of the thigh. On November 9, 1863, he was returned to duty." This officer was again wounded, at the battle of the Wilderness, May 5, 18(54, in the right side, for which injury he was treated in hospitals at Philadelphia and Annapolis. On August 2, 1864, he was again returned to duty, and on October 13, 1864, he was mustered out of service. The Philadelphia Examining Board certified, October 19, 1870: "A deep flesh wound, which, in healing, caused a cicatrix about five inches long and four inches wide, with loss of portion of muscular tissue, causing partial loss of power in the limb upon making much exertion," etc. The pen sioner was paid March 4, 1876. Sometimes musket balls buried themselves in the muscular parts of the lower limbs after ricochetting from stony or metallic surfaces: CASE 36. Private A. Wegner, Co. A, 16th Michigan, aged 25 years, was wounded at Gaines s Mill, June 27, 1862. Surgeon P. B. Goddard, U. S. V., contributed the specimen (FlG. 5), and reported: "He was wounded in the right hip by a shell and ball, taken prisoner June 30th, and carried to Richmond ; paroled July 25th, and arrived at Sixth and Master Streets Hospital, .Philadelphia, July 30th. This ball ricochetted from a stone or some hard substance, entered the front of the thigh near the femoral artery, and was cut out at the glutens maxim us muscle four inches higher up than the orifice of entrance. It did not touch the bone, but carried in with it a long strip of trousers." The patient was discharged January 26, 1863, and pensioned. In the certificate of disability Surgeon Goddard stated that "the ball wounded the sciatic nerve." Examiner R. G. Jennings, of Little Rock, certified, Septembers, 1873: * * "One ball entered the right hip near the joint, glanced, and was cut out from the gluteal muscles. The wound occasionally discharges pns. Suffers from frequent pain in the joint. The leg remains weak and of comparatively little service to him, as he is unable to walk or stan( ^ ^ on o u P on **" * n January, 1876, the same examiner reported : "Has periodical discharges of pus moved from the and spiculffi of bone. The sensation of the right leg is much impaired and the motion impeded by partial paralysis," etc. The pensioner was paid June 4, 1876. 1 HENXEX (Principles of Mil. Surgery, 3d ed., 1829, p. 79) has recorded several examples of the lodgement of large projectiles in the thigh. He remarks that : Masses of very extraordinary and almost incredible sizes are found. . . I have frequently seen them, he says, " of one and sometimes two pounds weight." He then cites the case of Lieutenant F , 12th Regiment, wounded at Scringapatam. A cannon shot rolled over the banquet behind which this officer was lying down, and buried itself in the muscles of the hip. The bearers who conveyed him on a dooley to the tent of the chief medical officer, Dr. ALEXANDER ANDERSON, complained of the difficulty of carrying him from the trenches, owing to the litter "having been unusually heavy on one side." The officer was moribund on his arrival ; but, after his death, Dr. ANDERSON cut out what he told Dr. IlEXNEN was "unequivocally a thirty-two pound shot." GUTIIRIE (Treatise on Gunshot. Wounds, 1871, p. 72) relates the case of a soldier at Badiijos, with a large piece of shell Ijdgsd \:\ the thigh and buttock. HENNEN says (loc. cit., p. 79) that the projectile weighed eight pounds. It was removed, and the man recovered. LARREY (Mem., de Chir. Mil., 1812, T. Ill, p. 582) describes a case in -which he removed a ball -weighing five pounds from the thigh of a soldier. It had caused him little inconvenience, except a feeling of weight in the limb. PAlT.T,Aiu> (Relation chir. du siege d anvers) mentions that BterilX told him of a case in which a nine-pound shot was embedded in the muscles of the thigh. Dr. G. M. B. MACLEOD (Notes on the Surgery of the War in the Crimea, ?th ed., p. 108) states that he "saw a case at Scutari, in which a piece of shell weighing nearly three pounds was extracted from the hip of a man wounded at the Alma, which had been overlooked for two months, and to which but a small opening led." He further relates that BAUDENS describes the case of a French soldier in the Crimea, in which a shell fragment weighing 2 kilog. 150 grammes, or about five and three-quarters pounds avoirdupois, buried itself in the thigh so as to be invisible. I have not found this case in the Guerre de Crimee of BAUDKXS, or in his letters of that date to the Gaze.tte Medicale. A surgeon of a Maine regiment told me of a twelve-pound solid shot, that he had extracted from the muscles of the thigh of a volunteer soldier at Portland, which he should send to the Museum; but the missile never arrived, nor could the injury referred to be identified on the surgical rpconls. . I.] LODGEMENT OF MISSILES IN SOFT PARTS. 23 The small iron balls from spherical case-shot, having only a slight velocity at a little distance from the point of explosion, often lodged : CASE 37. Private E. E. Middleton, Co. C, 12th Now Jersey, aged 24 years, was wounded at Gettysburg, July 3, 18G3, and admitted to Newton University Hospital, Baltimore, several days afterwards. Surgeon C. W. Jones, U. S. V., reported "The patient was in good condition when -admitted. A ball entered near the posterior border of the tibialis anticus, a little above the middle third of the left leg, and, passing downward and backward, was removed July 13th, from the posterior portion of the leg by a counter-opening about four inches below the point of entrance. The missile on being removed proved to be a round ball from a spherical case shot. The wound has healed well and rapidly, but the contraction of the muscles makes the man look as if he had talipes equinus. However, the contraction is growing less by passive motion, and there is reason to hope that he will soon have perfect use of the limb. Simple dressings were used all the time." The missile was contributed to the Museum by Surgeon Jones, and is represented in the cut (FlG. 6). On February 2, 1864, the patient was transferred to Patterson Park Hospital, and one week afterwards he was returned to his command for duty. On June 4, 1865, he was mustered out of service. In his application for pension he alleged that "the wound healed, but broke out afresh in the spring of 1865, FlG - Iron and discharged pieces of bone." Examiner B. H. Stratton, of Masonville, N. J., September 4, 1873, reported eTfromthe*Wgh N the leg as being in an ulcerated condition from necrosis of bone. Examiner F. Ashurst, of Mount Holly, Spec - 3199 - certified, September 18, 1875: "The cicatrices are healed, and the pensioner enjoys very good health." This pensioner was paid June 4, 1876. In the next case, a musket ball had remained, innocuously, for more than two years, encysted near the outer hamstring tendons, and was not removed until the patient under went amputation in the thigh on account of a complicated fracture of the leg. The cyst is of dense connective tissue. 1 CASE 38. Sergeant H. M. Lambert, Co. D, 12th Illinois Cavalry, aged 29 years, sustained a contusion of the right leg by the falling of his horse during a charge on the enemy near Germanna Ford, October 10, 1863. Three days after the accident he was admitted to Emory Hospital, Washington, whence Surgeon N. R. Moseley, U. S. V., contributed the specimen (FlG. 7), with the following report: "Slightly comminuted fracture of both bones of right leg at middle third, followed by copious discharge of sanious pus. The patient having become weak and debilitated, tonics and stimulants were resorted to with the desired effect. On October 25th, double-flap amputation at the upper third of the leg was performed by Acting Assistant Surgeon W. H. Ensign. Simple dressings and adhesive straps were used. The patient did well, and the stump had almost entirely healed, when, on November 8th, haemorrhage supervened. Graduated compresses were resorted to without avail, and on November 10th the limb was reamputated at the lower third of the thigh by the double-flap method. The stump was again well-nigh healed, when, on November 26th, haemorrhage again set in, and Dr. Mott s tourniquet was applied with perfect success. On December 10th the tourniquet was removed, and no return of the haemorrhage followed. By January 18, 1864, the patient was up and about the ward, and doing well. The specimen, a conical ball enclosed in a sac, was removed from the amputated leg at the second operation. The patient had received this ball in a skirmish with the _ enemy in Kentucky, in October, 1861, and the missile had remained in the popliteal space beneath the outer i ve tissue. S/>. 1879. hamstring tendons, without inconvenience, for two years and one month." The amputated tibia and fibula, showing no attempt at union, were contributed by the operator (See Cat. Surg. Sect., 1866, p. 511), and constitute specimen 1744 of the Surgical Section of the Army Medical Museum. The patient was subsequently transferred to Judiciary Square Hospital, and discharged from service July 30, 1864. He is a pensioner, and was paid June 4, 1876. There were cases in which missiles gravitated for considerable distances from the point at which they at first lodged : CASE 39. Private A. J. Dougherty, Co. 1, 13th Indiana, aged 19 years, was wounded in the thighs at Turkey Bone Bridge, November 2, 1861. After being treated for a time at the regimental hospital he was returned to his company for duty, and subsequently he received a furlough to visit his home in Philadelphia. Acting Assistant Surgeon H. M. Bellows reported the following history: "He was admitted to Broad and Cherry Streets Hospital, April 13, 1863, at which time a foreign body was discovered beneath the skin on the front of the right thigh, five inches above the patella, which gave rise to considerable pain whenever the patient walked. On the next day it was removed by Surgeon J. Neill, U. S. V., and proved to be the half of a round leaden ball. He stated that the missile entered the left thigh just below and in front of the trochanter, where the only visible scar was found. After the injury he had some pain and tenderness on pressure over the lower part of the abdomen, with difficult micturition for a few days. On examination the presumption was that the fragment must have crossed from left to right, either in front or just above the pubes, and thence gradually downward into the thigh. The wound healed by granula tions and by the 5th of May had completely cicatrized." The missile was contributed to the Museum by the operator, and constitutes specimen 1776 of the Surgical Section. The patient was subsequently transferred to Indiana, and mustered out at the expiration of his term of service, June 19, 1864. He afterward again enlisted, and was finally discharged June 21, 1865, 1 At the points a a the ball is uncovered by the cyst ; but the cellular envelope was probably nicked by the scalpel in cutting out the ball. This is one of the few good examples the Museum possesses of the " Kyste. defmitif" surrounding balls as defined by BAUDEXS (La Guerre de Crimee, Seme 6d., 1858, p. 110). This " Kyste primitif," which he claimed to have "peremptorily demonstrated" to always invest balls embedded in the muscular tissues, even when extracted immediately after the infliction of injury, has not been observed by others (See MACLEOD, Kates, etc., op. cit., p. 109), and doubtless means nothing more than that missiles sometimes get an investment from the intramuscular areolur tissue. 24 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. and pensioned. Examiner E. A. Smith, of Philadelphia, August 28, 1865, certified: * * "Pain in right testicle, and left leg feels perfectly dead at times; walks with difficulty." The Philadelphia Examining Board reported, February, 18, 1874: * * "Complains of pain in both limbs. Alleges that he has difficulty in passing water at times from irritable condition 01 bladder, and pain in the whole course of the ball. Cicatrices are without adhesions to the bone, and there is no atrophy of the limb. Slight stiffness about the left hip joint." This pensioner was paid June 4, 1876. As in Chapter XI the peculiarities of shot wounds in general will be discussed, it would be superfluous here to dwell longer on the particular instances of missiles lodged in the fleshy parts of the lower limbs. 1 While not wishing to be rudely incredulous in regard to the almost marvellous accounts that some authors have given of large projectiles embedded in the soft parts of the thigh and leg, I may say that analogous authenticated examples are not to be found in the experience of the American War, and that in most of the remarkable heretofore recorded cases there is reason to believe that they were probably associated with fractures. Peri-articular Wounds. After the shot wounds of the soft parts of the lower extremity implicating the larger vessels and nerves, or producing great lacerations, or complicated by the lodgement of foreign bodies, cases are to be considered in which mis siles, without immediately injuring the osseous articular surfaces, so injure the surrounding ligaments and other soft parts, in some instances even the synovial membrane, as to light up immediate or consecutive inflammation in the capsular cavity, or to induce, through the formation of cicatricial bridles or by other deformities, a diminution or even abolition of the movements of the joint. These injuries have been discriminated by M. Legouest under the title of Peri-articular Wounds? He apparently includes in this group only cases in which the capsular cavity is not primarily opened; but I prefer to adhere to the definition proposed in my monograph on Excision of the Head of the Femur? and have not felt at liberty to exclude from this category the rare instances in which evidence indicates the probability of a primary lesion of the synovial membrane without direct implication of the bones of the articulation, and I observe that Drs. Beck and Fischer adopt a similar view- 4 After a careful analysis of the reports of cases liable to belong to this group, four hundred and thirty-seven have been classified as instances of peri-articular shot wounds of 1 The Army Medical Museum is rich in specimens of projectiles extracted from the soft parts of the lower limbs. Besides those described in the text, there are twenty examples of small missiles extracted from the soft parts of the thigh. These specimens are numbered 176, 1095, 1368, 2559, 2C54, 2971. 44CO, 4476, 4480, 4501, 4502, 4507, 4520, 4521, 4552, 4553, 4501, 4574, 4624, 4693. Brief notes of the particulars regarding these cases may be found in the Catalogue, of the Surgical Section of 166, from pages 593 to 597. Two of the most remarkable are illustrated in the annexed wood-cuts. That represented in FIGUKE 8 was extracted by Assistant Surgeon J. T. CALHOUN, U. S. A., from the thigh of a private cf the 12Qth New York, at the battle of the Wilderness, May 7, 18G4, and was regarded as an explosive ball. Specimen 4553 (FIG. 9) was remarkable for having entered the left thigh below and in front of the great trochanter, and having passed subcutaneous]}- around the pubic region and lodged in the right high five inches above the patella. The case is that of Private A. G. D , 13th Indiana, wounded at Gauley River, November 2, 1862 ; the ball was extracted by Surgeon JOHN NEILL, U. S. V., April 14, 18G3. There are seven specimens of missiles extracted from the fleshy parts of the leg in the Museum, viz : Numbers 1586. 2326, 3199, 4462, 4500, 4514, 4695, and two specimens extracted from the soft parts of the foot, viz: 1580 and 4523. All of these specimens are described, with notes of the cases to which they belong, in the 27th Chapter of the Surgical Catalogue already referred to. These specimens are neatly mounted on brass rods. Dr. A. SCHINZIN GEH (Das Keservilazareth Schwetzingen im Krie.ge, 1870-71, Freiburg, i. B., 1873, p. 37) relates that he has a small collection of q _ Distorted extracted bullets remarkable for their deformation, and that those extracted from German soldiers have ro , ln( ^ {, a u extracted tht/jh ^pec 4561 r m ^ een mounted in silver, and on the setting the name of the wounded man and the date of the battle from thigh. 5pc.4553. engraved, at the thoughtful suggestion of the princess of that province. 2 LEGOUEST (L.) (Traite de Chirurgie d Armee, 26me Gd., Paris, 1872, p. 442). Some citations from his remarks on this subject may be found in the Surgical Volume of Part II of this work, footnote 1, p. 503. His further observation on this point is worthy of consideration, that " when shot wounds and notably even slight contused wounds are situated on the side of extension of joints, where they are exposed to continual attritions and tractions, they readily inflame and sometimes give rise to circumscribed abscesses or diffused phlegmous of more or less gravity." 3 OTIS (G. A.), A Report on Excisions of the Ilead of the Femur for Gunshot Injury. Circular No. 2, War Department, Surgeon General s Office, Washington, D. C., 1869, pp. 63, 90, 92. * BECK (B.) (Chirurgie der Schussverletzungen, 1872, p. 609) details 25 cases, in which the soft parts of the knee joint were either primarily or secondarily involved. Four, or 16.0 per cent., terminated fatally. He also gives 7 cases of flesh wounds of the ankle joint; no deaths. FISCHER (H.) (Kriegschir. Erfahr., Ister Theil, For Metz, Erlangen, 1872, p. 102) gives an account of 7 cases in which the knee joint was injured without lesion of the bony structure. Two, or 28.5 per cent., had a fatal termination. SECT. I.I FEET-ARTICULAR WOUNDS. 25 the lower limb, of which forty-nine are referred to the hip joint, three hundred and fifty- one to the knee joint, and thirty-seven to the ankle joint. Each of these subdivisions will be concisely discussed. In peri-articular shot wounds of the Hip Joint, the difficulties of diagnosis are almost insurmountable in the present state of our knowledge. In the cases of recovery, the exact extent of the lesions can only be surmised, and in the fatal cases necroscopic examination will scarcely determine with absolute precision whether the articular capsule was primarily or secondarily opened. Memoranda of forty-nine cases of shot wounds, which the reporters believed to have led to the opening of the coxo-femoral articulation without direct injury of the bones, are found on the registers. Thirty-five instances are adduced in which it was supposed that there was primary lesion of the joint capsule; twenty-one of them are reported as recoveries. Abstracts of seven of these have been already published. 1 Of the remaining fourteen recoveries, such scanty information as can be found in the reports is condensed in the appended abstracts: CASES 40-48. Lieutenant D. H. Miller, Co. H, 75th Ohio, aged 28 years, was wounded and captured at Gettysburg, July 1, 1863. After remaining a prisoner for a few days, he was admitted to the Eleventh Corps Hospital. Several weeks later he proceeded to his home in Logan, Ohio, where he was attended by Drs. G. W. Pullen and J. Sharp, who reported his case as follows: "The ball entered the posterier and inferior part of the glutei muscles of the left hip, passed over the neck of the femur, and came out on the inner side of the trochanter major. February 15, 1864, the wound has closed, but the motions of the hip joint are diminished to a great extent, and the leg is so weakened that he is unable to walk without the use of crutches." The patient was discharged from service January 22, 1864, Surgeon A. M. Speer, U. S. V., certifying to "shot wound of hip joint without fracture." Examiner T. O. Edwards, of Lancaster, Ohio, in February, 1871, stated that "the wound had opened and discharged a portion of his blouse," etc. Examiner W. C. Hyde certified, September 10, 1873: "There is flattening of muscles of the hip, the cavity of the joint injured by the missile, and the joint partially anchylosed." The pensioner was paid March 4, 1877. Corporal L. Bertram, Co. A, 6th Louisiana, entered a Confederate hospital at Richmond with "shot wound of right hip, involving the joint," received May 4, 1863, and was furloughed April 15, 1864. T. J. Brandon, a member of Co. F, 14th Alabama, was treated in the Confederate hospital at Farmville for "shot wound in the buttock with injury to hip joint," and was .furloughed October 22, 1862. Private 77. KiniberUn, Co. G, 48th Virginia, received a gunshot injury of the right hip joint, producing lameness, and was furloughed from the Confederate hospital at Farmville. Private C. C. McMurray, Co. H, 15th North Carolina, was admitted to hospital No. 24, Ricbmond, with "shot wound of hip joint," and was discharged Septem ber 13, 1862. Private G. W. Williams, Co. F. 3d North Carolina, appears on a Confederate hospital case-book as having received a "shot wound of the hip joint, May 3. 1833, the ball being extracted near the knee." Furloughed. Private J. Hilk, Co. B, 112th Pennsylvania, was wounded in June, 1862. Surgeon E. Griswold, of the regiment, reported, "an injury to hip joint by a pistol ball. The man was discharged from service October 16, 1832. He is not a pensioner. Private I. J. Brown, Co. A, 18th Infantry, was wounded at Stone River, December 31, 1862. He was treated at various hospitals, and lastly at Camp Thomas, Ohio. Acting Assistant Surgeon C. R. Reed reported that he was discharged March 17, 1864, by reason of "shot wound of left hip joint." He is not a pensioner. Private M. Ahern, Co. E, 183d Pennsylvania, aged 24 years, was wounded at Spottsylvania, May 14, 1864. Surgeon L. A. Edwards, U. S. A., reported his admission to Lovell Hospital with "shot wound of right hip joint." The man was mustered out July 13, 1835, and is not a pensioner. Spontaneous luxation after traumatic coxitis from shot injury of the hip joint with out fracture, was reported in three instances: CASES 49-51. Sergeant I. Murdick, Co. I, 134th Pennsylvania, aged 23 years, wounded at Fredericksburg, December 13, 1862. He was admitted to Stone Hospital, Washington, December 20th, with "gunshot wound of left thigh." Assistant Surgeon C. A. McCall, U. S. A., reported that the man was discharged from Mount Pleasant Hospital, April 16, 1863, because of "gunshot Avound over left trochanter, passing in the direction of the hip joint ; ball undiscovered and interfering with the free use of the joint." Examiner G. McCook, of Pittsburg, June 22, 1834, certified : * * "Inflammation and suppuration have ensued and have progressed until the round and capsular ligaments of the left hip joint have been destroyed and the femur drawn at least two inches above the acetabulum. The left leg is thrown across the right at least two inches or more above the right knee, resembling the position of a dislocated femur. The heel is elevated, and it is with extreme difficulty that he can walk with the aid of crutches. The toes of the left foot rest on the dorsum of the right." On November 22, 1837, the pensioner was furnished 1 OTIS (GEORGE A.) (A Report on Excisions of the Head of the Femur for Gunshot Injury. Circular No. 2, War Department, S. G. O., Washington, 1869, pp. 90-92): CASE 166, Corporal II. C. Boyd, 3Plh 111.; CASE 169, Lieut. C. Duncan, 18th Ind.j CASE 176, Pt. G. W. Mir.nick, 7th Md.; CASK 177, Pt W. M. Moore, 3d Ohio; CASK 178, Pt. W. N. Morgan, 9th Penn a Reserves ; CASE 1.~>, I t. Jacob Widmann, 97th Xew York; CASE 186, Pt. Henry Witzleben, 28th Ohio. In all seven cases the evidence of direct lesion of the articulation was inconclusive, and the opinions of the several surgical attendants were conflicting in each instance. Two cases (Witzleben, Morgan) terminated in false anchylosis. In the latter the adhesions were forcibly and successfully broken up by Professor S. D. GROSS. In one case (Widmann), after suppuration of the joint, the head of the femur was apparently luxated. Professor B. von LANGENBECK holds (Ueber die Schussutrletzungen des Uiiftgtlenks, in Archiv fur Klin. Chir., B. XVI, p. 286) that, "the most usual result (constanteste Ausgang) of healing shot injuries of the hip joint is in anchylosis. " SURG. Ill 4 26 INJUEIES OF THE LOWEE EXTREMITIES. [CHAP. X. with an apparatus for dislocated hip joint, by Dr. E. D. Hudson, of New York City. Examiner J. K. Reinholdt, February 7, 1871, certified: The downward momentum caused the ball to imbed itself securely in the hip joint. * * Parts swollen and tender; wound discharging; more or less injury to great sciatic nerve; limb deficient in temperature; more or less constant pain; confined to bed months at a time," etc. This pensioner died May 7, 1874, of convulsions superinduced by the results of his wound, his attending physician and others stating that the serious attacks of inflammation, resulting in the formation of abscesses, proved a severe tax upon his vitality and prepared the way for his sudden demise. Private R. Emerick, Co. D, 82d Pennsylvania, aged 28 years, was wounded at Cold Harbor, June 1, 1864, and admitted to hospital at Alexandria, and subse quently to Pittsburg. Surgeon J. Bryan, U. S. V., reported that he was transferred to the Veteran Reserve Corps, October 8, 1864, by reason of "a grapeshot wound, dislocating the right femur." Not a pensioner. Lieutenant F. Heck, Co. I, 74th Penn sylvania, aged 37 years, was wounded in the right thigh at Rappahannock Ford, August 22, 18G2, and was discharged from service October 9, 1863. In 1874, the Examining Surgeons report : "Firm anchylosis, with head of femur thrown out of socket; knee and ankle joints entirely stiff; foot in an extended position, arid limb shortened two inches." Two cases are reported as injuries of the hip joint by large projectiles: CASES 52-53. Private J. Teeters, Co. A, 84th Pennsylvania, aged 34 years, was wounded at Bull Run, August 30, 1862, and discharged from service March 29, 1863. Assistant Surgeon J. D. McClure, of the regiment, certifying to an injury in the right hip joint by a piece of shell, producing paralysis of the whole leg." This man was a pensioner, but has not been heard from since September 4, 1864. Private W. S. Gardiner, Co. A, 14th South Carolina; injury to hip joint from bomb; furloughed. The entire subject of traumatic lesions of the hip joint is of such importance that it is deemed proper to adduce or to refer to the previous publication of all the information that can be found on the registers, with the warning that, in many instances, the facts are derived from reports suggestive of superficial examination, and sometimes of diagnoses that must be regarded as little more than conjectures. 1 Of the fourteen fatal Cases in the series of thirty-five shot injuries believed to have been attended with primary lesion of the hip joint without fracture, the details of all are published in Circular 2, S. Gr. 0., 1869, already cited. 2 In the reports of many of these cases it is stated that the character of the lesions was verified by necroscopic examination, and in others it may be inferred that autopsies were made, so that the series is, as a whole, more reliable than the preceding. 3 Of the series of forty-nine cases of reported peri-articular shot wounds of the hip joint, fourteen may be classified as examples of secondary traumatic coxitis. 4 Seven were 1 VON LANGENBECK (B.) (Uber die Shussverletzungen des Huftgelenks, in Archivfur Klinische Chirurgie, Berlin, 1874, B. XVI, p. 280) remarks: "It may be taken for granted that a gunshot injury of the hip joint may heal under favorable circumstances without traumatic coxitis beginning. Coxitis may certainly be avoided in simple capsule wounds, which are kept perfectly quiet from the commencement, as well as in gunshot injury of the knee joint, as I have seen the recovery of several cases without any inflammation arising. As, however, in most cases (Pott s) side splint was recommended by the surgeon or adopted by the patient, and as during the last war not a few of the men were subjected to distant transport, and, injury of the hip joint not having been discovered, were allowed to go about, it was difficult In such cases to avoid inflammation. It appears to me that we must admit that in all those cases in which coxitis suddenly appears a considerable time after the injury, recovery is certain under favorable external circumstances without any further trouble occurring." [The translation is the version of JAMES F. WEST, F. R. C. S.] 2 Circular No. 2, S. G. O., 18G9, op. cit., pp. 90, 91, 9?. The names of the patients, the duration of life after injury, and the names of the reporters are noted: CASE 1C5, W. Blair, survived injury 23 days ; extent of injury demonstrated by autopsy ; McKEE, reporter. CASE 167, A. D. Bradshaw, survived 19 days; verified by autopsy; BUUXE, reporter. CASE 168, P. Cornell, survived 3 days; WOLFE, reporter. CASE 170, J. W. Falconer, survived 15 days; autopsy; MOROXG, reporter. CASE 171, S. Finnegan, survived 1 day; COLE, reporter. CASE 172, G. Green, survived 14 days; GRAHAM, reporter. CASE 173, F. M. Hate, survived 102 days; HATCHITT, reporter. CASE 174, J. E. Leedy, survived 7 days ; LEAVITT, reporter. CASE 175, J. McMahon, survived 19 days; BLISS, reporter. CASE 179, B. F. Pittman, survived 73 days; JANES, reporter. CASE 180, W. R. Reeves, survived 16 days; autopsy; HARRINGTON, reporter. CASE 181, T. Smith, survived 28 days; autopsy; VANDERKIEFT, reporter. CASE 182, R. Taylor, survived 4 days; autopsy; SEABUOOK, reporter. CASE 183, B. K. Wagoner, survived 265 days; HATCIUTT, reporter. CASE 184, of J. Wells, was also reported in Circular 2 as belonging to this group; but the carbine ball inflicting the injury, much deformed, with large bone fragments embedded in it (Specimen 2994, Cat. Surg. Sect., 1866, p. 603), has since been discovered, and the case has been transferred to the category of shot fractures of the neck of the femur. In three cases, in which the patients died within a few days after the infliction of the injury, it is probable that there were grave concom itant lesions. In those in which they survived two months, three months, and eight months, respectively, there were no autopsies held, and the lesions were not accurately determined. In the eight remaining cases, the parents lived from one to four weeks ; the mean was 16 days. 3 BlLLROTH (TH.) (Chir. Briefe, u. s. w., Berlin, 1872, p. 238) observes: "I am of opinion, that neither the direct injury of the joint capsule and bone, nor the secondary necrosis, can always be early diagnosticated. In cases resulting favorably, the diagnosis can generally only be made ex post, from the total anchylosis of the hip joint, and in many cases only after the discharging of some necrosed bone. . . Nevertheless I had not imagined the diagnosis to be so difficult ; I had thought that there must be, under all circumstances, symptoms of acute coxitis ; but I was mistaken therein. . . But gradually we arrive at a correct diagnosis in the majority of these cases from the slow progress after the injury, the copious suppuration, rapid debilitation, and speedy decubitus." 4 Circular No. 2, S. G. O., 1869, op. cit., pp. 93, 94. The cases of five of the seven patients who partially recovered have been enumerated in the Circular above cited: CASE 190, of Capt. H. C. Mason, 20th Massachusetts, is more extensively reported by J. MASON WARREN in his excellent Surgical Observations with Cases and Operations, Boston, 1867, p. 565. A fortnight after the accident, acute inflammation of the hip joint came on, and WARREN cut down and removed the ball from directly over the capsule of the joint. He ultimately recovered with stiff joint. The next case, No. 191, A. McGce, will be noticed on the next page. In CASE 193, Private S. Schafer, 81st Ohio, was struck in the left hip at Resaca, May 14, 1864, and recovered with a Stiff joint, according to Surgeon W. THRELKELD, U. S. V., and others. CASE 196, Private W. A. Shingledecker, 101st Pennsylvania, Gettysburg, July OH E H O 2 - DC H O j h u SECT. I.I PERT-ARTICULAR WOUNDS. 27 fatal, and seven resulted in recovery. Abstracts of five of the latter have been published in Circular 2, and two others are here noted: CASES 54-55. Sergeant J. A. Heady, Co. B, 15th Kentucky, .igcd 22 years, was wounded at Chickamauga, September 20, 1863, and was discharged from Camp Chase July 18, 18G4. Surgeon J. T. Carpenter, U. S. V., certified to "shot wound of left hip, the ball entering three inches above and posterior to the trochanter major and remaining; function of hip joint inter fered with, and marching impossible." This man is an applicant for pension. The Louisville Examining Board reported, in 1875, that the missile was still unextracted. Private E. D. Bates, Co. B, 24th New York Cavalry, aged 21 years, was wounded in the left hip at Petersburg, June 17, 1864, and was treated at various hospitals. Surgeon R. B. Bontecou, U. S. V., reported his discharge from Harewood Hospital, Washington, May 5, 1885, by reason of "shot wound resulting in necrosis of head of left femur." The various Examining Surgeons certify to more or less injury of the bone, also that the missile remains in the limb. Of the seven examples of secondary coxitis from shot wounds which recovered, the most interesting is the one numbered 191 of Circular 2, in which the nature of the injuries was observed more than seven years after reparation had taken place. CASE 56. Albert McGee, a negro refugee, aged about 30 years, is reported to have been struck at the first battle of Bull Run, July 21, 1861, by a musket ball, which probably entered the right hip at the level of the trochanter major, and, passing downward and forward, made its exit from the inner surface of the thigh just below the perineum. He made a complete recovery with the right lower limb shortened two and a half inches. About seven years subsequently McGee entered the Howard Grove Hospital, at Rich mond. Assistant Surgeon J. H. Janeway, U. S. A., then stationed at Richmond, learned from Dr. D. R. Brower that the man came to Howard Grove Hos pital in the latter part of October from the settlement of refugees at Hampton, Virginia, and was then suffering with Bright s disease. Professor Hunter McGuire, of Richmond, and Dr. J. N. Upshur, at the time resident physician at the Howard Grove Hos pital, have kindly contributed their recollection of the case. 1 An autopsy was made by Dr. J. N. Upshur, and the surgeons who examined the injury of the hip were of the opinion that the head of the femur had been grooved by the ball at its lower part. The pathological specimen 2 was sent to the Army Medical Museum, and there a vertical section of the epiphyses and upper portion of the femur was made, and it clearly appeared that there had never been a fracture of the head, and that the groove, supposed to have been made by the ball, was a depression resulting from a former abscess. The appearances closely resembled those sometimes observed in cases of chronic rheumatic arthritis. They are represented in the wood-cut above (FlG. 10), and yet more satisfactorily in the heliotype opposite (PLATE LVI). 2, 1863, after a gunshot wound disordering the functions of the right hip joint, recovered with a stiff joint, according to the testimony of Examiner of Pensioners G. McCOOK. CASE 197, Private T. Swartwood, 25th Ohio, was wounded May 8, 1862, by a musket ball which injured the right hip joint. Pension Examiner C. Hurr testified that the limb was shortened two inches and all movements of the articulation caused severe pain. Dr. HUNTER MCGUIUE writes, Richmond, Va., October 17, 1877 : " I have received your letter of the 12th inst., and am sorry to be able to give you so little information about the case you speak of (CASE 101 of your report on excisions at the hip joint). I think I gave you at different times two specimens of shot wounds of th head of the femur. One of these cases you saw in the College Hospital here, before I operated. [Reference is made to Specimen No. 6217, Surg. Sect., A. M. M., an excised head an-t upper extremity of the right femur with osteomyelitis.] The other is the specimen Dr. UPSHUR speaks of, the one you here refer to. My recollection of this case is not very distinct, but I am quite certain that I looked upon it at the time as a case of peri-articular gunshot wound of the hip, and that the changes about the head and neck of the femur were due to the resulting coxitis. Dr. D. R. Brower was in charge of the Howard Grove Hospital when this specimen was obtained. He was, afterwards, superintendent of the Insane Asylum at Williamsburg, Virginia, and I think is now in Chicago and holds some office there under the government. He may be able to give you further information about the case, but I do not think it probable that he will remember anything about it." Dr. J. N. Ul SllUK in a letter to Dr. HUM McGuiUE, dated Richmond, October 16. 1877, remarks: "In compliance with your request, I would state in regard to the history of the negro man coi corning whom you have received a letter from the surgeon in charge of the Medical Muser.m at Washington. He came to Howard Grove Hospital, then a hospital for freedmen suffering with Bright s disease of the kidneys. Having noticed considerable shortening of the right leg, with in of the foot, I enquired if he had had fracture of the thigh ; he replied that he had been in the army, and was shot by a Confederate sharpshooter stationed in an apple tree, the ball passing just below and through the hip joint. The wound had healed perfectly, and he possessed some motion in the joint. There was no reason for surgical interference at that time. After his death, which occurred a few weeks subsequently, I made a post-mortem exam ination, removing the head of the femur, which I found had been fractured within the capsule, and recovered with perfect bony union. As well as I remember, the bone bore plainly on its surface the track of the ball. The specimen was removed and given to you, and sent by you to the Medical Museum. I could not obtain from the man. who was an ignorant negro, a clinical history of the case." pl(j _ 10 ._ Cbronic trauma ti c artlrritis of the right hip joint following a shot injury, with secondary suppurative transformations which ultimately eventuated in recovery. pec * the anterior part of the neck a considerable projection is seen, a true exostosis of irregular surface, perfectly isolated by a line of demarcation fr< rest of the Done. This tissue was at that point very red and vascular. On the surface of the head of the femur is found a mult: aginous vegetations, some of which, narrow at their base, might have ultimately detached themselves and fallen as foreign be cavity. In spots the diartnrodial cartilage is ossified abnormally. On the specimen a condensation or kind of concentric hypa^rophy of femur is observed in the section, while the lower part of the head of the bone presents, on the contrary, an atrophic rarefaction of therefore, an unequally distributed process of osteo-cartilaginous new formation, of atrophic absorption, and of ossification of the norma 28 INJURIES OF THE LOWEK EXTREMITIES. [CHAP. X. Abstracts of six of the seven fatal cases of secondary arthritis from peri-articular shot wounds of the hip are published 1 in the oft-cited Circular 2. The following is the seventh: CASE 57. Private C. M. BlacTcweldcr, Co. A, 52d North Carolina, was wounded at Gettysburg, July 2, 1863, and admitted to hospital at Chester about three weeks afterwards. Surgeon E. Swift, U. S. A., reported: Gunshot wound, followed by a dissecting abscess involving the head of the femur and its ligaments. The patient died of pyaemia, September 21, 1863. 1\\epjst- mortem showed inflammation of the arachnoid membrane with serous effusion, also effusion of serum in the other serous membranes, and twelve ounces of pus in the left pleura." Of peri-articular shot wounds of the Knee Joint, three hundred and fifty-one cases were reported. It would appear that of two hundred and fifty-five of these cases, accord ing to the evidence available, the articular capsule of the knee joint was directly involved without fracture, and that in ninety-six cases the projectiles did not injure the joint, which was opened by secondary traumatic arthritis. 2 Of the aggregate of the three hundred and fifty-one cases, ninety-eight or 27.9 per cent, had a fatal termination. Three hundred and thirteen cases were treated without. operative interference and thirty-eight were followed by amputation. The latter will be enumerated in the tabular statements of amputations fallowing shot flesh wounds of the lower extremities. Of the three hundred and thirteen cases treated without operative interference, two hundred and forty-four recovered and sixty-nine or 22 per cent, proved fatal. In the following two cases of recovery the joint appeared to be directly injured. The patients recovered with considerable use of the limbs : CASE 58. Private A. Parker, Co. K, 5th Maine, aged 18 years, was reported by Surgeon C. S. Tripler, U. S. A., as having received a "bullet wound of the left knee" at the battle of West Point, May 7, 1862. Surgeon A. B. Mott, U. S. V., in charge of the Ladies Home Hospital, New York City, recorded the following description and result of the injury: "A musket ball entered the left knee joint at the junction of the tibia and fibula, passed through the joint, and emerged at the inner edge of the internal hamstring. Bleeding occurred freely for about forty-five minutes and then ceased spontaneously. The pain after the wound was very severe. On the day following a consultation of surgeons was held, when it was thought amputation would bo necessary; but the operation was postponed. Two days after he went to Fort Monroe, where he remained until May 25th, when he came to this hospital. While at Fort Monroe he suffered considerable pain for six days after the receipt of the injury, and cold-water dressings constituted the entire treatment, with perfect quiet of the limb. When admitted here the leg and foot were badly swollen; discharge slight and watery; orifice of exit closed. The external wound was attacked with gangrene, and a deep slough came away. Charcoal poultices were used, and creasote, and the wound stuffed with pulverized cinchona. After the slough came away there was some synovitis, and tincture of iodine was applied for several weeks. The general treatment was tonic and sustaining ; porter and ale were taken occasionally but not regularly. September 5th, wound has healed with a good cicatrix. There is stiffness in the knee which is gradually improving. Treatment : cold douche, passive motion and careful uso of the limb. Patient has used crutches and afterwards a cane, but now uses neither. December 30th, the knee can be flexed to but little more than a right angle and is very straight. Patient walks without a limp, and there is very little weak ness in the limb. He has been on guard duty for more than two months." This man was assigned to the Veteran Reserve Corps November 27, 1883. He is not a pensioner. cit,, p. 603. In many respects this specimen closely resembles that of McGee, which is represented in FlGUUE 10, and in the heliotype print, PLATE LVI, Med. and Surg. Hist, of the War of the Rebellion, Part III, Vol. II, op. page 27. In the specimen in the Army Medical Museum there is more extensive ossification of the cartilage at the rim of the acetabulum, and the neighboring osseous surfaces are more densely studded with osteophytes. The atrophic rarefaction and absorption are more pronounced at the inferior portion of the head, giving rise to the appearance which was mistaken for a groove made by a ball. On such lesions consult further CAUL ROKITAXSKY, Lehrbuch der Patliologisclien Anatotnie, Dritte Umgearbeitete Auflage, Wien, 1836, B. II, S. 205. 1 Circular No. 2, S. G. O., 18C9, op. cit., pp. 92, 94. The six published cases are: CASE 187. Pt. J. Delaney, 51st New York, wounded at Antietam, Sept. 17, 1862; matter burrowed about the left hip joint, and the thin part of the acetabulum was perforated. Dr. WILLIAM M. NOTSOX reported his case and death, Dec. 24, 18J2. CASK 198. Pt. O. J. Dunn, 18th Mississippi, was struck at Antietam, Sept. 17, 1862. Secondary involvement of the head of the left femur, from which he died June 19, 1803. A wood-cut of the specimen is reproduced in the Circular. CASE 189. Pt. A. Hall, 1st Cavalry, was wounded in Louisiana, Sept. 27, 1865, the ball penetrating ultimately into the hip joint of the left side. Death, January 12, 1860, Asst. Surgeon A. HAUTSUFF, U. S. A., having reported the case. CASE 194. Serg t C. M. Scovil, 14th Connecticut, wounded May 12, 18IJ4, received a musket contusion of the left hip joint. He died July 14, 1864, as reported by Surgeon T. R. SPEXCER, U. S. V. CASE 195. Lieut. J. G. Seldon, 2d Cavalry, received July 3, 1863, at Gettysburg, a wound of the left thigh in the vicinity of the hip. The hip joint became involved secondarily. He died Sept. 17, 1863. Asst. Surgeon R. F. WEIR reported the case. CASE 198. Serg t C. B. Wheeler, 81st Indiana, received a shot wound of the left hip joint, near Atlanta, August 8, 1864. The injury soon affected the articulation, and Surgeon M. S. SlIEHMAX, 9th Indiana, reports that he had profuse suppuration, and died October 7, 1864. 2 HKINE (C) (Die ScUussverletzungen der unleren Extremitdten, Berlin, 1866, p. 58) observes: "Shot wounds of the soft parts, in which, secondarily, suppuration of the .joint resulted from the breaking down of the tissues surrounding the shot channel, especially at the knee joint, were not very rare, while at the hip joint we only observed a solitary but very remarkable case of this kind." KlRCIIXKR (C.) (Aerztlicher Dericltt iiber das KiJniglich Frev ?ische Feld-Lazareth im Palast zu Versailles, Erlangen, 187.. , p. 86) tabulates 27 injuries of the soft parts of the knee joint ; but does not give the results. ARNOLD (J.) (Anatomische Beitrdge zu der Lehre von den Scfiussiounden, Heidelberg, 1873, pp. 123, 124) gives details of 2 cases of shot wounds of the knee joint, in which, at the autopsies, the bones of the joint were found uninjured. SECT. I.] PERI-ARTICULAR WOUNDS. 29 CASE 59. Private G. Deacon, Co. G, 14th Virginia Cavalry, aged 25 years, was wounded at Boonesboro , July 8, 1863, and admitted to the Cavalry Corps Hospital. Surgeon S. B. W. Mitchell, 8th Pennsylvania Cavalry, noted a "flesh wound at the knee joint." One week after the reception of the injury the wounded man was transferred to hospital at Frederick, whence Acting Assistant Surgeon W. S. Adams reported the following history: "He was wounded by a spent bull, which entered on the outer lateral surface of the right knee, passing inward and forward, striking the patella and lodging. The patient worked the ball out with his finger on the field. By examination I find no evidence of the ball having entered the cavity; the joint can be moved without pain, and there is no evidence of effusion. Simple dressings were ordered to the wound. On July 25th the external opening had closed and an abscess was forming at the point of lodgement of the ball. Enlarged the external opening so as to communicate with the abscess, whea about a half ounce of pus escaped, but no synovial fluid, although there was evidence of the joint being involved, but perhaps not communicating with the opening. On the following day the swelling of the joint was more extensive and fluctuation well marked. Tincture of iodine was then ordered to be applied to the joint twice a day, and the limb was placed in Smith s anterior splint. On August 10th the wound had nearly healed, effusion within the joint had almost entirely subsided, and the patient was comfortable. By August 20th the wound was entirely healed; appearance of joint jiatural. Considerable anchylosis existed, partly owing perhaps to deposit and partly to long continuance in one position. About a week later the splint was removed, and afterwards passive motion was resorted to without producing much pain or tenderness. On September 5th the patient was transferred to Baltimore, having considerable and daily increasing motion of the knee." He was paroled from West s Buildings Hospital on September 25, 1863. Then follow three fatal cases of direct shot injury involving the cavity of the knee without lesion of the osseous surfaces: CASE 60. Private J. Wagoner, Co. F, 116th Pennsylvania, aged 23 years, was wounded at Petersburg, June 22, 1864, and admitted to the field hospital of the 1st division, Second Corps, where Surgeon D. II. Houston, 2d Delaware, recorded: "Flesh wound of left thigh by a minid ball." Surgeon G. L. Pancoast, U. S. V., contributed the pathological specimen (Cat. Sury. Sect., 1866, p. 333, Spec. 3260) with the following notes of the case: "The patient entered Finley Hospital, Washington, July 1st, with shot wound through left knee joint. The bone was not injured. He died July 17, 1864. Two days before death signs of pneumonia presented themselves. An autopsy was made by Acting Assistant Surgeon G. H. Hopkins, who found extensive inflammation extending all around the joint and its neighboring parts. The femur and tibia were denuded of cartilage around the edges. In the cavity of the thorax there was considerable pleuritic adhesion, with effusion of thick pus, the lungs themselves being very much congested and hepatized in fact, the lungs were diseased throughout their entire extent. There was also effusion both in the pleura and pericardium." The specimen consists of the bones of the injured knee joint. CASK 61. Private E. Dolan, Co. D, 5th U. S. Cavalry, aged 21 years, was wounded at Gaines s Hill, June 27, 1862. Acting Assistant Sui-geon R P. Thomas contributed the pathological specimen (Cat. Sury. Sect., 18G6, p. 333, Spec. 227), with the following description: "The patient was wounded by a bullet, which entered on the outside of the left knee joint opposite its lower portion, and made its exit at the inside of the popliteal region, nearly on a horizontal line with the wound of entrance. He was admitted to the Episcopal Hospital, Philadelphia, July 30th, and died on September 30, 1862. During this period he was in a very low condition, the wounds and abscesses in the neighborhood of the joint discharging profusely the greater part of the time; he also suffered from diarrhoea. An autopsy, performed a few hours after death by Acting Assistant Surgeon R. P. Thomas, showed "loss of cartilage, and ulceration of the heads of the femur, tibia, and fibula, with extension of the disease on the posterior aspect of the femur and between the heads of the tibia and fibula. There was also ulceration of the posterior face of the patella and abscesses in the soft parts." The specimen (FlG. 11) consists of the bones of the knee. The age of the patient is perhaps overstated. The epiphyses, both in the tibia and fibula, were not united, and the real age was, probably, under 20; possibly did y lf; n Bones of not exceed 19 years of age. left knee. Sp.227. CASE 62. Private U. Conn, Co. M, 12th Pennsylvania Cavalry, aged 28 years, was wounded during a cavalry skirmish at Frederick, July 10, 1864, and was admitted to hospital the same day. Acting Assistant Surgeon J. II. Bartholf reported: "He was wounded in the right knee joint by a pistol ball. The missile entered at the knver inner edge of the patella, and I removed it from the joint, having put in my finger between the femur and tibia after enlarging the wound to feel the ball. There was no fracture of any bone. On consultation, it was determined to try to save the i mb. The joint was freely opened and local antiphlogistic treatment was employed. Great pain and swelling, for a few days only, ensued, with but slight irritative fever at any time, and the pulse for weeks ranged from 85 to 95. Sometimes for a fortnight at a time he had a really good appetite; this notwithstanding that extra capsular abscesses appeared early and continued throughout to discharge much; at other times he was in a precarious condition. He \vas placed on a water-bed, being thin in flesh on admission and soon troubled with bed-sores. About a month before, his death there was some cough. He sank very gently, and died October 14, 1864. The post-mortem examination revealed the recovery from the joint wound by obliteration of its cavity and bony anchylosis, which was not so firm, however, but that accidental violence partly broke it. The crucial ligaments were still undestroyed. There was one vast abscess from the knee to the groin encircling the femur, and another four inches long from the knee downward neither of them com municating with the joint. He had gray hepatization (pneumonic) of two-thirds of the middle lobe of the right lung, all the rest of the lungs being healthy. The heart was very small and its weight six ounces. All the other organs were healthy." In the three following cases the projectile did not open or enter the knee joint, and the involvement of the articulation was secondary in its nature: CASE 63. Private E. Williams, Co. E, 5th Michigan Cavalry, aged 26 years, was wounded during the engagement at Shepherdstown, August 26, 1864. Acting Staff Surgeon N. F. Graham reported his admission on the day of the injury to 30 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the field hospital at Sandy Hook with "shot wound of right thigh," and his transfer to Frederick two days afterwards. Acting Assistant Surgeon J. C. Shinier, from the latter hospital, made the following report of the case : " He was wounded by a fragment of a shell, which lodged in the external muscles of the lower third of the thigh in close proximity to the bone. It was extracted on the field through the opening. Upon admission the patient s general condition was good. He experienced no pain whatever from the injury. Suppuration was going on finely and everything indicated a speedy recovery. The wound was thoroughly examined with the finger and a sinus found leading in the direction of the knee, but not into the joint. Sep tember 15th, patient complains of slight pain and tenderness in knee. The discharge has nearly subsided and the wound is healing. I enlarged the opening so as to allow free vent for the pus. Tincture of iodine is directed to be applied every other day. September 25th, for the last few days there has been some general derangement of the whole system ; appetite somewhat impaired ; pulse excited; bowels irregular. The knee is still painful, especially upon pressure, and the discharge is the same in quantity. Ordered fifteen drops of tincture of iron three times a day, with a half pint of milk-punch, a poultice of flaxseed meal to be applied around the joint, and the limb to be kept at rest. September 30th, no change in the general condition. The discharge of pus has ceased, but a thin oily looking material, resembling synovia, constantly exudes from the small opening that remains at the entrance of the wound. October 10th, patient has been doing well until to-day; is very restless; pulse accelerated to 128; appetite very moderate; complains of excruciating pain in the knee. The wound has healed externally. Tonics, stimu lants, and generous diet are continued; one pill of opium is given four times a day, and blisters are applied over the joint. October 20th, patient has received considerable relief from the blisters. The blistered surface having healed on October 25th, I directed them to be reapplied and the surface to be kept excoriated by an ointment of Goulard s cerate and powdered cantharides. The other treatment was continued. 28th, pulse 113 ; suffers but little pain in knee, and feels quite encouraged. An opium pill is given at bedtime. 30th, pulse 110; appetite improving; bowels regular; tongue clean; knee of its original size and no pain on pressure. November 10th, general health rapidly improving; the ointment is discontinued. November 18th, walks about the ward with a splint adjusted to favor the knee and keep it at rest; general health excellent. On Decem ber 1st the tonics and stimulants were discontinued and the splint removed from the limb ; the knee is anchylosed, and no passive motion is made for fear of exciting inflammation. On December 21st the patient received a fall, the entire weight of the body resting for the time on the injured limb. He was directed to be confined to bed, the limb to be kept at rest, and iodine to be applied over the knee; parts painful. December 24th, doing well; no constitutional disturbance. December 29th, pain and swelling subsided; patient on crutches again. January 10, 1865, patient transferred to Michigan." Assistant Surgeon D. O. Farrand, U. S. A., reported that the man was discharged from Harper Hospital, Detroit, May 26, 1865, by reason of "anchylosis of the knee joint, produced by the wound." Williams is a pensioner, and has been reported by various examiners as suffering from "complete anchylosis of the right knee joint." He was paid June 4, 1876. CASE 64. Private T. G. Scott, Co. 13, 54th North Carolina, aged 45 years, was wounded at Harper s Farm, April 6, 1865, and admitted to the field hospital of the 3d division, Second Corps. Surgeon O. Everts, 20th Indiana, noted, "shot flesh wound of left knee." From the field hospital the wounded man was transferred to City Point, and thence, on April 22d, to the West s Buildings Hospital, Baltimore. Acting Assistant Surgeon A. Kess- ler contributed the specimen, represented in the annexed wood-cut (FlG. 12), with the following descrip tion : "A mini6 ball passed through the left leg just below the knee joint, implicating the joint but not laying it open. The leg became much swollen and discolored, and from the openings flowed a quantity of what appeared to be arterial blood. Soon after the patient s admission there appeared severe constitutional symptoms : rigors followed by high and continued fever, delirium, extreme nervousness, much prostration, constant vomiting, and sleeplessness. Amputation, which, at an earlier period, might have saved his life, was then pronounced impracticable, and the patient died with symptoms of pyzemia, May 4, 1865. A post-mortem examination of the limb revealed the fact that the tissues above and below the joint, the muscles, fascia, etc., were a gangrenous mass, and that the greater portion of the joint itself was divested FIG. 12. Caries of left f ^ ts periosteum and rapidly assuming the character of caries. Otherwise the joint was found to be intact, knee joint. Spec. 4205. exhibiting no fracture." CASE 65. Private W. P. Werden, Co. K, 34th Massachusetts, aged 20 years, was wounded at New Market, May 15, 1864. Surgeon J. V. Z. Blaney, U. S. V., reported his injury as "a shot wound of the knee." Acting Assistant Surgeon J. H. Bartholf contributed the following history from the General Hospital at Frederick : " The patient was ad mitted here May 25th, from the post hospital at Martinsbui-g, with a flesh wound ol the left leg near the knee, caused by a mini6 ball. The missile entered a half inch below the patella, between it and the tuberosity of the tibia, directly over the quadriceps extensor tendon, and lodged superficially just under the skin, whence it was extracted the same day. lie was removed in an ambulance sixty miles to Martinsburg. The joint soon became inflamed and swollen, and remained so until his admission here. Water dressings had been applied. I found the joint inflamed and very much distended, probably with synovia or a collection of pus, over the tendon of the quadriceps. A counter-opening was made at the lowest part of this, and evaporating lotions applied, on the 29th of May. On the 1st of June the patient was somewhat better. June 4th, ice applied to the knee. June llth, patient has made very rapid and great improvement, so that the synovitis is nearly gone and the abscess is almost healed; but there is communication with the knee joint from the abscess, a minute orifice having been made by ulccration apparently, through which healthy-looking synovia has been flowing in small quantities for a couple of days. There is no constitutional trouble. June 12th, no more synovia comes out. June 17th, patient is permitted to get out of bed and walk a little. July 4th, has gone on very favorably to this time, walking with a cane. Is now transferred to Baltimore." After this date the patient was treated in hospital at Annapolis until September 13, 1864, when he was returned to duty. The Adjutant General of Massachusetts reports that the man was mustered out June 30, 1865. He is not a pensioner. Of thirty-eight recorded instances of lesions of the knee joint without injury to the SECT. i.j PERI-ARTICULAR WOUNDS. 31 articular surfaces, followed by amputation, twenty-nine or 76.3 per cent, were fatal. Two of the cases will be detailed, and all will be enumerated in the tables of amputation at the end of this section: CASE 66. Lieutenant J. A. Boies, Co. H, 13th Infantry, aged 22 years, was wounded in the assault on Vicksburg, May 22, 1863. He was admitted on a hospital transport and conveyed to Memphis, whence he was admitted to the Marine Hospital at Chicago on June 8th. Acting Assistant Surgeon R. N. Isham reported: "He was struck upon the outer side of the left knee by a cannon shot from a distance of about two miles. The ball probably only glanced over the surface, for there was the merest trifling appearance of a redness, but no wound or bruise upon the surface. Amputation at the upper third of the thigh was performed on June 18th, and death resulted June 28, 18G3, from pyaemia. A frequent pulse, brown tongue, anxious expression of the face, and diarrhoea indicated the existence of the poison on admission. The strongest symptom, that of profuse discharges from the bowels, almost involuntary, and of a color, smell, and consistency of the discharge from the stump, together with the sickening sweetish odor of the perspiration and chills, indicated the invasion of the disease in a marked manner on the night of the 18th. The treatment was by iron, quinine, and stimulants. Scrupulous attention was given to the stump, removing all soiled dressings three times a day and injecting the wound with a solution of bromine and occasionally with tincture of myrrh and balsam pern. This pai tially succeeded in correcting its unhealthy appearance and producing the secretion, for a short time, of good-looking pus. There never was any attempt at healing in th wound, the edges of which looked like cut edges of pork. The discharge from the wound was of a dark-colored thin offensive character. There was no sloughing or gangrene. The system seemed to make great efforts to eliminate the poison, as evidenced by the profuse per spiration and diarrhoea. The blood seemed to part with its serum easily. No clot was formed in the stump, and late in the progress of the dis-ease the discharge consisted of altered blood. The pulse during the case was from 130 to 150. No post mortem was allowed by his friends, but the sudden invasion of pain in the joints, a swelling of the knee and fluctuation, satisfied me that pus had formed in the synovial cavity." CASE 67. Sergeant G. A. Dyer, Co. G, 6th Maine, aged 21 years, was wounded at Rappahannock Station, November 7, 1863, and was admitted to Armory Square Hospital, Washington, two days afterwards. Surgeon D. W. Bliss, U. S. V., reported: "A mini6 ball entered four inches below and in .line with the trochanter major of the right thigh, took a down ward and inward course, and could not be found on admission to the hospital. On November 29th, the missile was extracted from the popliteal space; suppuration continued free and of good char acter. Two weeks subsequent to the extraction of the ball a bit of woolen cloth came from the lower wound. December 10th, patient was allowed to get up and move about, using crutches. December 25th, knee joint became painful and continued to swell from this date. Under iodine the swelling subsided to a considerable extent, but the pain continued; suppuration still free and at times thin and poor in character. On February 1, 1864, synovial fluid was observed from the upper point in the discharge; pain in knee joint still considerable at night, and leg enlarged. On February 19th. the thigh was amputated above the coudyles by Hap operation; four arteries tied; loss of blood small ; patient in fair condition constitutionally. On opening the knee joint after the operation, erosion of the cartilages was discovered, and an abscess below the knee joint communicating with it. February 22d, patient doing well." The specimen represented in the adjacent cut (FlG. 13) was contributed by Surgeon Bliss, and consists of the bones of the knee of the amputated limb, showing a slight deposit of callus on the posterior aspect of the shaft, apparently due to the irritation set up by contact with the ball in position. The patient was discharged from service April 18, 1864, and pensioned, and subsequently furnished with an artificial limb. In his application for commutation, dated 1870, he described the stump as being in a sound condition. The pensioner was paid June 4, 1876. In the cut only a portion of the specimen, which consists of the four bones entering into the f emu r studded with osteo- articulation, is represented. The amputation was done at the middle of the femur, and not through ^ byte | 4? er shot contusicra - the lower third as represented in the cut. Of peri-articular shot wounds of the Ankle Joint, thirty-seven cases are indicated on the records; 1 but the evidence in regard to the precise nature of the injury may be termed unsatisfactory. In fifteen cases, of which one proved fatal, no operative interference was deemed necessary. In the remaining twenty-two cases the limb was amputated at the leg, with fatal results in twelve instances. One case may here be detailed; all the cases of amputations of leg for peri-articular shot wounds of the ankle joint will be enumerated in the tables of amputations following shot flesh wounds of the lower extremities: CASE 68. Corporal E. D. Goodell, Co. D, 25th Massachusetts, aged 21 years, was wounded at Cold Harbor, June 3, 1864. Surgeon S. A. Richardson, 13th New Hampshire, recorded his admission to the Eighteenth Corps field hospital with "shot wound of right ankle." Surgeon R. B. Bontecou, U. S. V., reported the result of the injury ao follows: "The patient entered the Harewood Hospital, Washington, June 10th, with shot wound of right foot near os cak-is, the ball severing the 1 The records of shot flesh wounds of the ankle joint without injury to the bones are very meagre. KlRCHNER (C.) (Aerztlfcher Bericht iiber dot Koniglich Preussische FM-Lazareth im Palast zu Versailles. Erlangen, 1872, S. 86) tabulates 8 cases of flesh wounds of the tibio-tarsal articulation but gives no results. HELNE (C.) (Die Schussverlelzungen der unteren Extremitdten, Berlin, 1860, S. 5) thinks it very remarkable that not a single case of secondary arthritis following "shot wound of the ankle joint without lesion to the bjiie " was observed. 32 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. tendo-achilles. On admission, he was very weak. The parts were swollen and suppurating freely, and became subsequently gangrenous, the tarsal and metatarsal bones denuded. An operation was deemed necessary, and performed on July 22d by Acting Assistant Surgeon 13. F. Butcher, who amputated the leg at the lower third by the circular method. Sulphuric ether was used. The patient improved after the operation, and was furloughed August 17th, the stump looking well." The bones of the amputated ankle were contributed to the Museum by the operator, and constitute specimen 3332 of the Surgical Section. In December following the man was admitted to Dale Hospital, Worcester, whence Surgeon C. H. Chamberlain, U. S. V., reported that the stump assumed a large suppurating surface with several sinuses leading to diseased bone, and that on February 20, 18J5, lie removed a sequestrum eight inches in length by a longitudinal incision. After this the patient was reported as having made excellent progress, and the stump as being nearly healed on March 31st. He was ultimately discharged from the Soldiers Rest, at Boston, October 31, 1803, and pensioned. The pensioner was paid March 4, 1877. Peri-articular shot wounds of the joints should be treated at the outset by complete immobilization of the articulation, by wire-cloth splints, or plaster bandages, the wound being covered with simple dressings of thick compresses saturated with cold lotions. The complications are to be cornbatted as they arise. Complications of Shot Flesh Wounds of the Lower Extremities. In the great series of 58,702 shot flesh wounds of the lower limbs, besides the groups characterized by lesions to the principal blood-vessels and nerves, by extensive lacerations, by lodgement of foreign bodies or extension of inflammation to the joints, there were many examples of compli cations of Pyaemia, Gangrene, Tetanus, Erysipelas, and Haemorrhage. A certain number of cases have been classified in each of these categories. The reader, however, must guard against the belief that this class of cases is complete, for, as explained heretofore, there was neither time nor clerical assistance for an exhaustive search. The cases, however, have been impartially selected, and the results probably present a fair average. Pycemia. Three hundred and twenty-eight cases, of which three hundred and twenty, or 97.5 percent., resulted fatally, were found recorded. One of the eight cases of recovery will be detailed: CASE 69. Private S. S. Chase, Co. L, 1st Maine Cavalry, aged 43 years, was wounded at Stony Creek, October 27, 1864, and admitted to the field hospital of the 2d division, Cavalry Corps, where Surgeon F. LeMoyne, 16th Pennsylvania Cavalry, noted: " Shot flesh wound of both legs." The patient was moved to City Point on the following day, and on November 14th he was transferred to Washington. Surgeon D. W. Bliss, U. S. V., made the following report: "He was admitted to Armory Square Hospital with wounds of the right thigh and left leg. The first ball entered the thigh posteriorly, about the junction of the middle and upper thirds, passing inward and a little downward, and emerging on the inner side of the thigh; the second ball entered the left leg on the posterior aspect, about the middle, and passed directly forward, emerging on the inner side, one and a half or two inches from point of entrance. The patient had an unhealthy appearance and was considerably emaciated when admitted, the wounds discharging a very thin and offensive matter, not very profusely. On November 26th, pyaemia became developed ; patient had several violent chills, which were repeated on the following days, when his wounds became dark colored and dry and ceased to discharge, and he grew delirious. From this period quinine, iron, and chlorate of potassa were prescribed, with stimulants and the most nourishing diet, together with applications of creasote, tannin, and solu tion of chlorate of patassa to the wounds, under which treatment ho gradually improved. At present (December 31st) his wounds are about healed and he is able to leave his bed, being greatly improved in every respect, and convalescent." The man was discharged from service March 24, 1805, because of "permanent contraction of the gastrocnemius muscle of the left leg, resulting from the wound." Examiner J. O. Perry, of Portland, Maine, certified, April 30, 1868, that "both wounds are very tender;" and that "the wound in the leg so far involved the nerves that the leg below it and the foot are quite numb." The Portland Examining Board reported, in ls-73 and 1875, that they find deep, and, on the left leg, adherent scars, with considerable loss of tissues in both wounds. The pensioner was paid June 4, 1876. In the greater proportion of the fatal cases, although the ratio of mortality was so large, necroscopic appearances were not recorded : CASE 70. Sergeant M. Armstrong, Co. M, 6th Cavalry, was wounded at Williamsburg, May 4, 1862, and admitted to the Hygeia Hospital, Fort Monroe, five days afterwards, when Surgeon R. B. Bontecou, U. S. V.. noted a "shot wound of left thigh." Acting Assistant Surgeon S. J. Radcliffe contributed the following history, from Hospital No. 1, Annapolis : " The ball entered the external aspect and posterior of the upper third of the thigh, passing inward and downward, and emerged about the centre of the middle third. The patient was in hospital at Fort Monroe about ten weeks, when he rejoined his regiment. He went through most of the great battles and skirmishes until Gettysburg, in July, 1863, when he was taken prisoner at Fairfield, Penn., and went to Richmond via Staunton, arriving there on July 20th. He was paroled and left the enemy s lines on the 23d, arrived at Annapolis on the 24th and at Camp Parole on August 2d, and entered this hospital September 20th. He states that the leg has not been painful except in cloudy weather, and has not swelled, and that his health SECT, i.] COMPLICATED SHOT FLESH WOUNDS. 33 lias been good. Prescribed pills consisting of quinine one and a half grains, and blue mass and capsicum one hnlf grain each, to be given every four hours. September 25th: Had a chill yesterday; tongue coated; skin dry; pulse quick; conjunctiva yellow; countenance dejected and of painful expression; great lancinating pain in leg; nervousness; bowels irregular. Stopped the pills and gave quinine in solution, five grains every six hours. September 27th : Has lost flesh during last week. Has had continued fever, and the leg has been swelling for two or three days and is very painful, the least motion being painful; abscess forming between the former orifices of the wound on the posterior aspect ; general condition unfavorable. A large flax seed poultice was applied to envelope the whole thigh, and the quinine was continued. Patient objects to taking stimulants, find takes but little. October 1st, A. M.: The thigh, from the groin to the knee, has continued to enlarge to this date, with sharp throbbing pain, sleeplessness, depressed nervous condition, deafness, fever of a low type, diarrhoea and loss of appetite; patient quite hectic, pulse quick, and cheeks flushed; abscess pointing at the eschar or orifice of wound of exit. Made an in cision from one to five inches long, and a full stream of dark, thin, offensive matter followed, amounting to nearly two pints; bathed with warm water and vinegar, and continued the stimulants, beef-tea and quinine, with an occasional dose of compound mixture of catechu. 5 P. M.: Patient feels better; pulse quick and feeble; skin in good condition; tongue cleaner; bowels better. Ordered spirits of mindereri, one half ounce, to be given alternately with the other medicine. October 3d: Abscess still discharging very dark, thin, and fetid matter; patient very prostrate; emaciation very rapid and distinct. Gave stimu lants freely and often. October 3, A. M.: Patient very feeble, pale and thirsty; pulse quick and sharp ; bowels worse ; delirium most of the night, and nausea 5 abscess still discharging; leg very much swollen and highly sensitive; sloughing about the wound. Applied charcoal and yeast poultices, and gave tincture of chloride of iron, twenty-five drops, with quinine every four hours. 3 P. M.: Pupils contracted; stupor; pulse 120, feeble, sharp, and quick; very sensitive to touch; bowels more invol untary; leg largely infiltrated, red and swollen, and pits at the knee; very little discharge of bloody serum; patient sinking. Died at 5.oO A. M. on October 4, 1883." An example of the series of fatal cases in which autopsies were made is subjoined. This series constitutes seventy-three of the three hundred and twenty cases. CASE 71. Sergeant D. A. Lent, Co. A, 6th New York Heavy Artillery, aged 24 years, was wounded at Cedar Creek, October 19, 18G4. Surgeon W. A. Barry, 98th Pennsylvania, noted his admission to the Sheridan Field Hospital with "shot flesh wound of right leg." Several days after being wounded the man was transferred to the Camdeu Street Hospital, Baltimore, and subsequently to Rulison, Annapolis Junction, whence Acting Assistant Surgeon A. Marion reported the following history: "The patient was admitted to this hospital January 4, 1865, with a wound of the right leg, middle third, a minic ball entering on the anterior aspect one inch outside of the tibia, lodging between the tibialis anticus, tibialis posticus, and the anterior tibial artery. When admitted the wound was completely healed up, but the leg was much swollen and no ball could be detected. During the first week after his admission the patient had his leg rolled up with a bandage, and the swelling completely disap peared. He became able to walk about until January 18th, when he again complained, and on examination I found the leg again much swollen, with a dark spot located where the wound first healed up. After this fiaxseed poultices were constantly applied until February 2d, when, on opening the wound, the ball was carefully removed from its place of lodgement. On the two days following the operation the patient had a severe fever and chills, with extreme pain and great depression. I ordered eight grains of calomel with ten grains of rhubarb to be taken at once, followed by a saline aperient. On the morning after the 4th, I ordered strong beef-tea, with brandy, to be taken freely. This treatment was continued until February 7th, with some saline draughts, according to the condition of the bowels. On the morning of the 8th, I found the patient greatly depressed and complaining of extreme pain in the joints, and on examining the wrists and the left shoulder joint T discovered them to be very much swollen, with a peculiar boggy feel to the touch. All these symptoms were attended with rigors, drowsiness, yellowness of the skin, and offensive perspiration, sometimes accompanied with delirium. Poultices were applied over the joints, with warm fomentations, and opium was given to relieve the pains every night. The treatment was continued, but no amelioration whatever of the symptoms took place, the patient gradually sinking until the morning of February 15, 1865, when he died. At the post-mortem, an abscess was found in the upper lobe of the right lung, about two and a half inches long and two inches in width and depth, filled with thick pus. Both lungs were much congested. The right ventricle of the heart was filled with a semi-organized clot. Kidneys about six inches long and four inches wide; small abscesses were found in the cortical portion of each one. Pus was also found in the urethra. Liver, spleen, pancreas, stomach, and intestines normal. About one teaspoouful of thick fetid pus was found in the right knee joint, and about half as much in the right wrist joint. There was no pus in the ankle joints." It is to be regretted that autopsies were not more generally practised in cases of this group, and that in the exceptional cases the necroscopical records were so imperfect. Hospital Gangrene. The shot flesh wounds of the lower extremity that were distinguished by the supervention of hospital gangrene 1 numbered two hundred and eighty-three, with one hundred and fifty-eight deaths, or 55.8 per cent. Details of three cases of recovery are appended: CASE 72. Private W. J. Briggs, Co. A, 102d Pennsylvania, aged 27 years, was wounded at Chancellorsville, May 3, 1863. Assistant Surgeon J. C. McKee, U. S. A., in charge of the General Hospital at Pittsburgh, reported the following In Investigations upon the. Nature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies. ]8Gl-186. i, by JosEni JONES, M. D., published in the Surgical Memoirs of the War of the Rebellion collected and. published by the U. S. Sanitary Commission, the author details many illustrations of gangrenous wounds resulting from shot wounds of the lower extremities. Instances may be found in the San. Comm. Memoir, Surg. Vol. 11, pp. 234, 250, 310, 311, 315, 318, 3.J9, 331, 334, 337, 347, 375, 380, 388, 394, 399, 406, 411, 437. SURG. HI 5 34 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. history: "The ball passed between the tibia and fibula, about the middle of the leg, escaping through the calf opposite the point of entrance. The patient was four days at Falmouth Hospital, seven days at Douglas, Washington, and was then removed to Sutterlee, Philadelphia. Seventeen days after his admission to the latter he was furloughed and came to Pittsburgh. The wound had healed at its entrance and was still discharging at its exit, but was considered fit to travel with. He had several slight chills before leaving Philadelphia, and one of i\ more severe character after his arrival home, followed by haemor rhage from the posterior wound, which was arrested. The next day he came to the hospital. The wound presented the unmistakable evidence of gangrene. He was isolated, and nitric acid was freely applied to all parts. The disease was found very extensive, involving the greater part of the calf of the leg. Poultices of charcoal and pyroligneous acid, etc., were applied. The constitutional remedies were quinia, muriated tincture of iron, stimulants, beef-tea, etc. The disease was checked, and the patient is (July 31st) recovering rapidly. The interest in this case is the distance the man carried the contagion, the great rapidity and destructiveness of its attack, apparently uninfluenced by the comforts of a good home and the best of food and nursing/ 7 The patient remained in the hospital until September 3, 1864, when he was mustered out, his term of service having expired. The Pittsburgh Examining Boarxl certified, in 1873 and 1875, that there was wasting of the gastrocnemius muscle from gangrene, and that the resulting adhesions have impaired the action of that muscle and cause pain in the ankle. The pensioner was paid June 4, 1876. CASE 73. Private A. W. Bretz, Co. D, 49th Ohio, aged 23 years, was wounded in the right thigh, at Murfreesboro , December 31, 1862. Surgeon J. R. McClurg, U. S. V., in charge of the General Hospital at Cleveland, contributed the follow ing history: The ball entered upon the outer and posterior aspect of the limb, passed through the biceps, semi-membra- nosus and semi-tendinosus muscles, and out upon the inner side of the thigh. The patient was in Hospital No. 21, Nashville, about ten days, after which he was sent to the West-End Hospital, Cincinnati, where he remained over three months. He says his limb was at one time almost healed, but it soon manifested symptoms for the worse, and afterward discharged consid erably for several days. He was forwarded to and ai-rived at this hospital upon the evening of the 29th of April, and on the 30th his wound was examined and dressed. At this time we found a ragged, foul ulcer upon the back part of the limb, where the ball entered, about one and a half inches in diameter, surrounded by an erysipelatous or a halo of dusky red inflamma tion, hard and painful to the touch. The patient was feverish, restless, unable to sleep; had poor appetite, and appeared much prostrated. He complained of severe shooting pain in the limb and of the disagreeable odor of the wound. We dressed the wound with the creasote ointment and prescribed a tonic treatment. Some three days afterwards the whole integument and cellular tissue, previously inflamed and diseased, became one putrid mass and dropped out, leaving a large cavity, large enough to admit the whole hand. The haemorrhage at this time was considerable, and was arrested at the time by applying the pure creasote to the whole bleeding cavity, together with compresses, adhesive strips, and a roller from the foot to the groin. Tin; haemorrhage was by this process arrested, and for two or three days afterwards my assistant surgeons reported the caso favor ably. But I Avas again called upon to visit the patient, who was reported to be sinking very fast, and that the wound was bleeding very much. I found to my surprise the whole bandage and bed saturated with blood, and the patient truly in a dangerous condition. Upon removing the bandages and compresses a large mass of coagulated blood and dead tissue dropped out, having the most intolerable stench imaginable. The haemorrhage was still very great, and I was almost at a loss to know how-to stop it. The whole back part of the thigh appeared to be one bleeding cavity. I introduced my hand into the wound and found I could pass my fingers almost up to the tuber ischii. At the bottom of the cavity, entirely exposed to view, were the belly of the biceps, the semi-membranosus and semi-tendinosus muscles. We used cold water, which succeeded in a measure to stop the haemorrhage temporarily. Immediately afterward, or as soon as the patient had recovered from the shock produced by the loss of blood, I put him under the influence of equal parts of sulphuric ether and chloroform; then commencing imme diately below the tuber ischii and cutting through the parts down to the muscles, I brought the knife down and out at the upper part of the cavity, turning the flaps outward and exposing the whole cavity; with a pledget of lint tied to a probang I cauterized every part of this cavity the flaps and even the muscles with pure nitric acid until they became perfectly charred and all haemorrhage entirely ceased. The flaps were now brought together and fixed with wide adhesive strips around the thigh. A compress saturated with a lotion of nitric acid was applied, and over this a roller from foot to groin. The patient was ordered sulphate of quinine one grain, and tincture of chloride of iron fifteen drops, every two hours; also, eggnog, brandy-punch, and essence of beef. From this moment he began to improve rapidly and complained of no more severe stinging pain in the limb. Not the least haemorrhage ensued afterward, and that most offensive fetid discharge subsided at once. We dressed the sore twice per day afterward, still using a weak lotion of nitric acid. It has progressed and is still (June 1st) progressing most favorably." The patient was assigned to the Veteran Reserve Corps December 11, 1863. There is no record of his ever having applied for pension. In addition to the history of the case, Surgeon McClurg submits the following remarks in relation to the treatment of gangrene: "There is not a doubt in my mind but that the nitric acid is one of the most, if not the most, efficient remedy in use for sloughing phagedaena and hospital gangrene. I am aware that of late bromine 1 and its compounds are exciting considerable interest in the medical profession as curative agents in hospital gangrene, but I must acknowledge that my expe rience with these agents will not allow me to call them specific, and I certainly regard them as secondary remedies to nitric acid. The acid is an old and common remedy, and I believe the reason it has not often er proved its superiority over all other remedies in hospital gangrene has been on account of the cautious manner in which it has been used. This is a serious disease, and the remedy should be freely applied. In the above case, I placed one ounce of acid in a tumbler, dipped my pledget of lint in again and again until the whole diseased part was effectually cauterized. All danger was at once over, and the disease that moment arrested." 1 Among published papers on the local application of bromine in hospital gangrene may be mentioned Bromine in Hospital Gangrene, by R. L. 8TANFOU1), M. D., Surgeon U. S. V., in Am. Med. Times, 18C3, Vol. VII, p. 24, and Remarks on Hospital Gangrene, by Surgeon O. R. WEEKS, U. S. V., in Am. Med. Times, 1863, Vol. VII, p. 4fi. GOLDSMITH (M ), A Report on Hospital Gangrene, etc., Louisville, 1863. THOMSON (WM.), JKeport of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, D. C., in Am. Jour. Med. Sci., 18(54, Vol. XLVII, p. 378. SECT. I.] COMPLICATED SHOT FLESH WOUNDS. 35 CASE 74. Private H. Barr, Co. I, 21st Iowa, aged 43 years, was wounded at the Black River Bridge, May 17, 18G3, and was transferred from a field hospital to Memphis, two weeks after the injury. Acting Assistant Surgeon W. M. Dorran contributed the following history: "He received a flesh wound of the right leg, the ball entering about two inches below the head of the fibula, external aspect, passing inward and downward behind the bones of the leg, and escaping three inches below the head of the tibia, internal aspect. On June 4th, he was admitted into the Jackson Hospital, in this city. The wounds were then small, the external one nearly healed; both wounds were suppurating, and the pus was darkish, the patient stated. Either pus burrowed or a diffuse abscess formed six inches below the internal wound on the calf of the leg, pointed and broke there, discharging a considerable quantity of pus. The tissues all around this new sore began to slough, and a destructive process extended doAvn to within two inches of the ankle, up to the internal wound, forward to the spine of the tibia, and backward to the median line of the muscles of the calf. A consultation was held over the case, and it was decided to ampu tate, the patient states; but the superintendent of the hospitals happened to be present and overruled the decision, arid had the patient transferred to the gangrene section of this, the Union Hospital, on June 30th. On admission, a large portion of black dead tissue surrounded the breach of the surface, which, when cut away by the scissors, made the ulcer to be about eight inches long and four inches in width at the middle of the leg. The tibia was denuded of periosteum to the extent of four inches in its middle third. The internal saphenous vein was a black cord for about six inches. The gastrocnemius and soleus muscles had sloughed to the median line, and the fascia between these two muscles, and also under the soleus, had sloughed away much farther in extent than the muscles. After it was cleaned as well as possible by cutting and washing, fuming nitric acid was applied, or almost poured on the dead and dying tissues still remaining, and with a piece of wood it was worked into their structure, and the semifluid slush or mud was cleaned away, as it formed, by the application of the acid. Then the whole leg was enveloped with a poultice of charcoal and linseed-meal, covered by an oilcloth, and bandaged from the toes to the knee. After the cauterization, when the patient was under the influence of some stimulants and morphia given to him during the operation, he expressed himself as feeling better than he had for two weeks past, and the leg easier. July 1st, Sloughing by acid not ready to be removed yet; acid again applied where gangrenous ulceration still proceeded, also the poultice and tight bandage. July 4th, The patient rests well at night, and his appetite is rather improved. He is cheerful and hopeful, and of the opinion now that there is a chance of his leg being saved, whereas before he had made up his mind that it was to be lost. The slough by the acid was removed to-day, and the sore is fresher in appearance anteriorly, but posteriorly the fascia is still sloughing. The strong acid was again applied in this region, causing the formation of a mass to be cleaned away to the amount of two or three ounces. Lint saturated with a solution of bromine and bromide of potassium is now introduced into every crevice and sinus and over every sloughing part, and over this a poultice and bandage. Stimulants are given four times a day, also tonics of quinine and tincture of chloride of iron. July 8th, By assiduous attention to ti-eatment, after the manner already described, the sore has been brought to present a fresh and rather healthy base, and some granulations are springing up on the anterior part. Nitric acid has still to be applied under the muscles of the calf, and at the lowest margin of the ulcer some dead tissue remains. July 12th, The ulcer is quite clean and has quite a healthy appearance; granulations are springing up very beautifully, except at the lower margin. The patient s general condition has improved. Resin cerate is used to dress the parts where granulations are springing up, but solution of bromine or Labarraque s solution where any unhealthy appear ance presents itself. July 16th, The sore appears quite healthy and granulating all over. The muscles that were separated from each other by destruction of tissue between them are beginning to grow together. The tibia, which was bare for some distance, is again being covered by granulations. The edges of the ulcer are becoming depressed and rather inverted instead of being indurated and everted. The internal saphena vein has been destroyed for eight inches of its length and cut away. There was no haemorrhage at any time. September 1st, Ulcer very much reduced in size. Nitrate of silver is used at times to depress exuberant granulations. October 1st, Wound almost completely healed, and patient able to walk about," He was discharged April 6, 1864, and pensioned. Examiner R. S. Lewis, of Dubuque, Iowa, certified, June 16, 1864: "The right leg has been pierced by a ball about three inches below the knee, * * * followed by gangrene ; is still discharging, leaving the limb useless." This pensioner was last paid September 4, 1868, since when he has not been heard from. The pathology and treatment of gangrene of the lower extremities will be considered in the chapter on the general subject. In the lower limbs traumatic gangrene is usually of the humid variety and commonly progresses with great rapidity. Tetanus. Among cases of shot wounds of the lower extremities not attended by lesions of the bones, joints, great vessels or nerves, 1 there were one hundred and seventeen 1 Surgeon J. JULIAN CHISOLM, C. S. A., in his Manual of Military Surgery for the use of Surgeons in the Confederate States Army (Columbia, S. C., 3d ed., 1864, p. 257), observes that the results described by LAKKEY in his campaigns in Egypt and Germany (Memoires de Chir. Mil. et Cam- pagnes, Paris, 1812, T. Ill, p. 280), in the frequent appearance of tetanus in wounded soldiers upon exposure on battle-fields to cold and damp night air, never followed the leaving of wounded soldiers upon the battle-fields of the Confederacy. Dr. EDWARD WAIJUEN. Surgeon General of the State of North Carolina, declares (An Epitome of Practical Surgery for Field and Hospital, Richmond, 18(53, p. 132) that "the experience of all surgeons establishes the fact that changes of temperature are prolific sources of this disease;" and Professor SAMUEL D. C.UOSS (A System of Surgery, etc., 5th ed., 1872, Vol. I, Chap. X, p. 238) remarks that gunshot wounds are peculiarly liable to be followed by tetanus only when the sufferers are neglected, or permitted to lie upon damp, cold ground, or in currents of cold air, after an engagement. Dr. CHISOLM says (1. c., p. 258) that "a trifling puncture or scratch is, at times, sufficient to cause an attack ; and it has been noticed by military surgeons that the scraping of the skin by a ball, with bruising of the nerves, is more liable to this complication than the more severe wounds." " Wounds in certain situations/ Dr. CHISOLM adds, "are thought to favor its appearance, viz : injury to the hands, feet, joints, etc." . . "Its common period for appearing is between the fifth and fifteenth days." Professor Jos. JONES, Surgeon P. A. C. S., in an article on Traumatic Tetanus, in Confed. States Sled, and Surg. Jour., 1864. p. 1, dwells upon the good effects of chloroform mixture, administered by the stomach, in shot flesh wounds. The compilers of A Manual of Military Surgery prepared for the use of the Confederate States Army, Richmond, 1863 [Surgeons A. TALLEV, W. F. CAMPHELL, ST. GEOUOK PEACHEY, A. E. PETICOLIS, and J. DUNN are reported to have constituted the commission that prepared this work], in the chapter on Tetanus, on page 9, refer to the effect of draughts of cold air in determining violent exacerbations of muscular rigidity. 36 INJURIES OF THE LOWER EXTREMITIES. iCHAP. x cases of tetanus noticed, with one hundred and six deaths, or 90.5 per cent. An example of one of the eleven instances of recovery is appended: CASE 75. Private G. C. Nichol, Co. C, 22d Iowa, aged 20 years, was wounded at Vicksburg, May 22, 18(33. Surgeon T. F. Azpell, U. S. V., noted his admission to the Steamer E. C. Wood, from a field hospital, June 4th, with "shot wound of right thigh." Assistant Surgeon J. M. Study, U. S. V., reported the following history from Union Hospital, Memphis, where the patient was admitted June 8th: "The injury for which this man was admitted was.au ordinary llesh wound, the hall passing transversely from without inward, through the posterior aspect of the right thigh. At the time of his admission the wound showed no indication of having made any progress toward reparation, but presented an extremely irritable margin. Warm-water dressing was applied, and on the following day there were marked symptoms of tetanus, chiefly confined to the jaws, which, however, soon became more general, and in addition to the trismus there was that frightful condition of the body intermediate between opisthotonos and pleurothotonos. Sufficient quantity of chloroform was administered by inhalation, to produce complete anaesthesia, twice regularly in twenty-four hours. Sulphate of morphia, in half-grain doses, was given each evening at bed-time, and brandy ad libitum. June llth, no notable change in the case ; patient is stupid, and there is an absence of muscular rigidity as long as the combined effects of the chloroform and morphia continue. June 14th, patient much in the same condition as when last noted, excepting an extensive tumefaction of the left limb, which tumefaction, so far as the most careful scrutiny would show, is entirely idiopathic in its nature. A roller was applied to this limb from the toes to the groin; otherwise the treatment of the case is the same. June 18th, tetanic symptoms subsiding somewhat; the wound has changed in appearance but little since first noted ; tumefaction in left leg still present. Chloroform is given less freely than before; morphia continued the same, also the brandy. June 21st, patient is now able to separate the jaws to the width of half an inch; his general condition is improving rapidly ; appetite is ravenous; the bowels are regular; swelling in left leg disappeared ; wound beginning to suppurate. Morphia, in one-third doses, is given at bed-time; brandy, one ounce every two hours. June 28th, the wound has been suppurating freely, a large amount of the adjacent tissues having sloughed away. The warm-water dress ing, which has been continued until now, is stopped, and scraped lint moistened with glycerine is applied. Patient takes one pint of ale daily. July 15th, the wound is quite healed, and the patient walks with the aid of a cane. On August 19th, he was f urloughed." The registers of the Union Hospital show that this man returned from furlough, and was sent to his regiment for duty September 30, 1863. Two examples of fatal cases are subjoined. It has been impracticable to discover any details of autopsies throwing any light on the subject. 1 Apparently there were no instances recorded in this group in which microscopical examinations of sections of the spinal cord were undertaken : CASE 76. Private P. Brown, Co. A, 169th New York, aged 36 years, was wounded at Cold Harbor, June 3, 1834, and admitted to Harewood Hospital, Washington, five days afterwards. Surgeon R. B. Bontecou, U. S. V., reported : "Shot flesh wound of left leg. Patient furloughed July 29th." Assistant Surgeon M. F. Coggswell, U. S. V., in charge of the Albany Hospital, reported the following result of the case: "The patient was admitted August 1st, having a large ulcer, measuring six by five and a half inches, on the calf of the leg, the result of a gunshot wound. His general health was very poor, and he was anaemic and debilitated. Gangrene had appeared previous to his admission to this hospital, and the ulcer was indolent, foul, and unhealthy. Nitrate of silver was applied and solution of chlorinate of soda, also poultices of flaxseed-meal mingled with pulverized charcoal. This treatment was followed in twenty-four hours by a healthy discharge of pus and a general improve ment of the ulcer. Beef-tea, milk-punch, and extra diet were ordered. On the 2d of August his tongue was red and dry, his appetite failed, and he manifested great uneasiness and appeared to labor under an impression of impending evil. That nijht (August 2d) the weather, which had been very hot and dry for several days, suddenly became damp and chilly, and on the morning of August 3d, at 4 o clock, symptoms of trismus appeared, and were followed in two hours by a general spasm of all the voluntary muscles. The rlsus sardonicus was marked, and the patient was in great distress; deglutition was impossible. Beef-essence and milk-punch were administered by enemata, and half a grain of sulphate of morphia was injected hypodermic- ally over the epigastrium. The latter acted so speedily and powerfully that in two hours all the muscles were relaxed. The patient s strength, however, was completely exhausted, and at 8 o clock P. M. he expired, there being no recurrence of the tetanic symptoms. No general post-mortem was made; a local examination did not reveal anything. The trunk of the posterior tibial nerve was intact, but its muscular and cutaneous branches were involved." CASE 77. Sergeant W. Walters, Co. B, 87th Pennsylvania, aged 29 years, was wounded at the Wilderness, May 8, 1864. Surgeon N. R. Moseley, U. S. V., reported his admission to Emory Hospital, Washington, May 16th, with "shot wound of foot." Surgeon J. II. Taylor, U. S. V., reported the following result of the injury: "The patient was admitted to Summit House Hospital, Philadelphia, May 20th, having been wounded by a ball striking the plantar surface of the left foot at the first interosseous space, one and a half inches from the metatarso-phalangeal joints, going directly through on the dorsum and producing a flesh wound. Cold-water dressings were applied. The patient is of strumous diathesis, having scars on the side of his neck, the remains of scrofulous abscesses. May 30th, at 8 A. M, he was in excellent health; at 1"2 M. he com plained of stiffness and pains in the jaws and neck; great pain, referred to articulation of left inferior maxilla with temporal bone, together with constant fixed pains at the epigastrium, shooting around to the spine; jaws seemingly tied, as the patient expressed; mouth gradually closing; twitching of facial muscles; some difficulty of respiration, but none of deglutition. 1 CIIISOLM (J. Jvi.lAX), M. D., (in his Manual of Military Surgery, 3d ed., Columbia, 18(54, p. 259) states: "That fruitful source of information, pathology, gives us no instruction in this disease. An autopsy reveals to the eye nothing commensurate with the intensity of the symptoms. A slight congestion of the spinal cord and medulla oblonguta is all that can be discerned. 1 SECT. T.j COMPLICATED SHOT FLESH WOUNDS. 37 Treatment: Bowels unloaded by injections; brandy and quinine given in large quantities, milk-punch and beef-tea by mouth and rectum. Liquor of morphia, one half ounce, was given every two hours for eight or ten hours, but with no effect. Injected one grain of sulphate of morphia, dissolved in one drachm of water, hypodermically just over the temporal region; but even this failed to produce any narcotic effect. Counter-irritation was used at the spine with chloroform and covered with oiled silk, but so severe was the burning pain that it soon had to be discontinued. On May 31st, the patient was attacked with severe cramps in the abdomen, the muscles here becoming hard and tense, the muscles of the back rigid and prominent; great pain, referred to chest in inspiration; pupils contracted. There was profuse perspiration over the entire body from the commence ment of the disease; pulse natural. A solution of sulphate of atropia, one grain to an ounce of water, was now injected, in quantities of one drachm, a little to the left of the median line of the neck at first, and subsequently on each side of the spine, below the scapula, at intervals of one half, one, and two hours, in all seven or eight times. The pupils were now dilated, but there was not the slightest relaxation of muscular spasm; perspiration still profuse. An effort to rouse him from this state with cold douche had but little effect. The spasms continued to increase in frequency and violence until 3 A. M. on June 1, 1864, when he died." Extraction of foreign bodies, removal of all causes of irritation to the wound, avoid ing cold and currents of air, were the prophylactic measures advised. Anaesthetics and narcotics were generally employed, but in grave and confirmed cases the therapeutical results were most discouraging. Erysipelas. In forty-five cases, of which thirty-four proved fatal, extended erysipe- latous inflammation was the most characteristic feature. An example of recovery from this complication is detailed: CASE 78. Private W. Bowling, Co. B, 1st Maryland Cavalry, aged 22 years, was wounded at Gettysburg, July 4, 1863, and entered the Frederick Hospital two days afterwards. Acting Assistant Surgeon W. S. Adams reported : " The patient was wounded by a minie ball which entered two inches above the right patella, passing downward, striking that bone and glancing, and came out at its lower border, without causing fracture or involving the joint. The patient s general health was good. Cold- water dressings were ordered, and rest. July 20th, evidence of erysipelas appeared this morning; bowels constipated; pulse quick. Ordered lead and opium wash to the knee joint, and gave three compound rhubarb pills. 21st, bowels open freely ; pulse less frequent ; tongue furred, with red edges and tip; skin dry; loss of appetite; erysipelas extending above and below the wound. Applied tincture of iodine around the limb beyond the disease. 23d, erysipelas extending rapidly; considerable gastric irrita tion; pulse quick but feeble. Ordered one pint of milk-punch a day, and three grains of quinine three times a day. 24th, erysipelas still extending and now occupying the entire right leg and thigh, and the pelvic region down the left thigh as far as the knee; right limb very cedematous and assuming a decided phlegmonous character. Evaporating lotions of ether were ordered to the worst points, and the other treatment continued. 30th, erysipelas still extending up the body and now occupies the entire left limb. It has subsided in its original seat, and desquamation has taken place. Numerous longitudinal incisions, extending from the instep to the toes of the left foot, were made to relieve the tension. Stimulants were increased to one pint of whiskey per day, and beef-tea and generous diet pushed as far as possible. August 2d, general condition much better, but erysipelas still continues on the feet and ankles, and there is some sloughing of the integuments over the metatarsus of the left foot owing to the incisions not having been made in due time. August 6th, condition still improving; erysipelas has nearly disappeared. 9th. decidedly convalescent; ulcer of left foot granulating finely; appetite good. 30th, ulcer entirely healed; wound of knee nearly so. October 13th, wounds entirely healed, and patient this day transferred to Baltimore." Surgeon T. H. Bache, U. S. V., reported that the patient was paroled from West s Buildings Hospital November 12, 1863. The graver cases of erysipelas complicating flesh wounds were pernicious and contagious : CASE 70. Private L. Brittin, Co. M, 1st Pennsylvania Cavalry, aged 35 years, was wounded at Hanoverton, May 28, 1864, and admitted to the field hospital of the 3d division, Fifth Corps, where Surgeon L. W. Read, U. S. V., noted "a shot wound of leg." From the field hospital the patient passed to Washington and thence to Philadelphia, entering the Summit House June 28th, and subsequently the Satterlee Hospital. Surgeon I. I. Hayes, U. S. V., recorded the following history: "The injury was caused by a minie ball passing transversely and producing a slight flesh wound of the upper third of the right leg. The wound healed, when it was attacked by gangrene, and after again becoming healthy the whole limb was seized with erysip elas. On March 24, 1865, the whole external lateral surface of the knee presented two sloughing wounds, one on a line with the head of the tibia, the other just above the tendon of the muscle. The whole limb was swollen, red, and painful. General condition poor, with headache, fever, dry tongue, and dry hot skin. On March 26th, a large collection of pus, amounting to about six ounces, was evacuated immediately below the patella. The patient s bed was moved, the old splint removed and a Smith s anterior applied. On rinsing the limb a sloughing wound involving nearly the whole popliteal space was found. On the following day the patient was slightly more comfortable, but there was not much change in his general condition. On March 31st, there was no change in the appearance of the wound, but the patient s strength was evidently becoming exhausted. There were symptoms of pyaemia, and he was delirious during the afternoon, but better toward evening. His pulse was 120 and very small ; countenance sunken, with hectic spots on the cheeks. He complained of no pain, but was evidently partially unconscious. He died April 6, 1865." Hcemorrhage. In addition to the group of cases of shot flesh wounds of the lower limbs with primary lesion of the large blood-vessels, as discussed on pp. 13, 18, ante, one 38 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. hundred and fifty cases have been noted and this is probably an imperfect summary of consecutive bleeding from the large vessels, among which were sixty-four examples of recovery, eighty deaths, and six cases with unknown results, a mortality rate of 55.5. Consecutive bleeding was from vessels varying in magnitude. 1 Tabulations have been made showing the time from the reception of the injury to the onset of the bleeding, the amount of blood lost, and the treatment, but there is not space to reproduce this analysis. Two illustrative cases are appended: CASK 80. Private J. C. Corliss, Co. G, 17th Illinois, aged 21 years, was wounded before Vicksburg, May 19, 1803, and entered the Jackson Hospital at Memphis eight days afterwards. Acting Assistant Surgeon II. D. Garrison recorded the follow ing description of the injury and its result: A conical ball entered the left thigh anteriorly, about five inches below Poupart s ligament, passing upward and slightly inward in its course. The wound was examined at the time by a surgr-on, who was unable to extract the ball. When admitted to this hospital the man was in good health, and his wound gave him but very little pain. Water dressings were applied and all went well until about noon on the 28th, when, from some slight motion, copious haemorrhage commenced suddenly. The femoral artery was almost instantly compressed over the pubic arch, but not until much blood was lost. A consultation being called, it was believed that the profunda femoris was probably severed, and that a tourni quet with a small roller for a pad placed over the track of the ball would probably be sufficient to prevent the recurrence of haemorrhage until nature had time to permanently close the vessel. This plan was accordingly adopted and proved successful for twenty-four hours, when while Surgeon E. M. Powers, ?th Missouri, in charge of the hospital, was looking at the appliance and congratulating the patient on his safety the haemorrhage again set in with all its former force. On consultation it was then agreed to inject the wound with solution of persulphate of iron, which was accordingly done, and the tourniquet was re-applied. Xo further haemorrhage occurred afterwards, but in spite of stimulants freely administered the patient expired fourteen hours after the last attack. The post-mortem examination revealed the fact that the femoral artery was opened about an inch below the origin of the profunda. The opening was about the size of a small pea and seemed to have been caused by the sloughing of the coats. In this case the pulsation of the tibial and popliteal arteries demonstrated that the flow of blood through the femoral was uninterrupted and led to the adoption of an erroneous diagnosis." Surgeon Powers in his report stated that tin; loss of blood in tins case amounted to four and a half pints, also that the bullet was extracted from its place of lodgement after the patient s admission to Jackson Hospital. CASK HI. Private A. Kunkle, Co. IJ. 62d Pennsylvania, aged 18 years, was wounded at Gettysburg, July 2, 1863, and remained at a field hospital for two weeks, when he was transferred to Baltimore. Acting Assistant Surgeon* J. Dickson made the following report from Jarvis Hospital: " He was wounded through the right thigh, the missile entering near the tuberosity of the i^chium, and, passing about fourteen inches through the deep muscles, emerged outside of the femur four inches from the knee. lie stateil that he bled very freely on the field, and after being taken to a neighboring house there was a recur rence, lasting all night. Xo further haemorrhage occurred until the patient was brought to this hospital. At that time he w T as very anaemic and feeble. Generous diet and iron were ordered. On July 17th, an alarming haemorrhage occurred from both wounds, which was arrested by compression and the local application of persulphate of iron. Two days afterwards there was another haemorrhage as profuse as before, and the same treatment was resorted to with the same result. On July 28th, there was a recurrence nearly as profuse as the last. Amputation and ligatiou of the femoral artery was thought of; but it was concluded he would die after either, and compression upon the femoral and along the course of the wound was resorted to. On July 30th, tbe patient was rallying. On August 6th, another slight haemorrhage came on, followed by a discharge of sanious pus, the contents of an aneiirismal sac. By August 29th the wounds had almost healed and the patient quite built up and walking on crutches, his leg being considerably contracted but straightening gradually." In October following the patient was trans ferred to the Sattcrlee Hospital, Philadelphia, and subsequently to Pittsburg, whence he was returned to his regiment for duty February 12, 1861. The Adjutant General of Pennsylvania reports that the man was mustered out with his command July 13, 1864. He is not a pensioner. Ligations of Blood-vessels of the Lower Limbs after Flesh Wounds. At page 16 it will be recollected that attention was called to a considerable number of cases of direct injury of blood-vessels treated by primary or consecutive ligation, and that it was promised that further on such examples would be enumerated, together with cases of deligation of the same vessels for flesh wounds without primary arterial lesion. The series which will be here presented numbers one hundred and ninety-five instances, one hundred and ninety-four ligations of arteries and one of the saphenous vein. It will be noticed, how ever, that among the hundred and ninety-four cases of arterial ligations there were six instances in which the femoral vein was simultaneously tied with the artery it accompanied. An analysis (if the series shows 1 fatal case of bleeding from the external iliac; thero were 23 cases of hscmorrhage from the femoral, with 18 fatal results, 3 recoveries, and 2 unknown. The haemorrhages from the profunda, Circumflex, and other branches were 111 with "> deaths. There were 13 coses of secondary bleeding from the popliteal with 8 deaths; 6. of bleeding from the anterior tibial with 1 death, and 15 of the posterior tibial with 9 deaths. It is hardly necessary to follow out the statistics of the smaller vessels. There were 13 cases of profuse venous hsemorrhage of which 10 were fatal. This includes -1 cases (if bleeding from the femoral veins, all of which were fatal. SECT. j.i LIGATJONS AFTER SHOT FLESH WOUNDS. 39 A fatal instance of delegation of the common iliac artery is first detailed, constituting one of the six instances in which this operation was practised during the American civil war. This operation now (1877) foots up sixty-one cases with forty-eight deaths: CASE 82. Private J. Bouer, Co. I, 48th Pennsylvania, aged 19 years, was wounded at Tolopotomy Creek, May 31, 18G4, and admitted to the field hospital of the 2d division, Ninth Corps. Surgeon J. Harris, 7th Khodc Island, noted, "shot flesh wound of both thighs by a minie" ball." Four days after being wounded the man entered Judiciary Square Hospital, Washington. Assistant Surgeon A. Ingram, U. S. A., corroborated the above description of the injury, and reported the result as follows: "Disorganization of tissue from a deep flesh wound; haemorrhage took place on June 10th, from the small vessels, and was controlled by pressure, but recurred on June loth, when the femoral artery was taken up at Scarpa s triangle. This vessel was again ligated, on June 18th, at Poupart s ligament ; haemorrhage again occurred on the morning of June 22d, when the common iliac was ligated. The patient died during the day. 1 The report does not show which of the two limbs was operated on, and diligent search has revealed no additional record of the particulars of the case. The reader may compare, on page 333 et seq. of Volume II of Part II, the details and comments on four other examples of ligation of the common iliac artery practised during the War, two for shot wounds of the pelvis and two on account of aneurisms arising from punctured wounds. Yet another instance of unsuccessful ligation of the common iliac artery for consecutive haemorrhage after a shot wound of the pelvis has been recorded by Medical Inspector F. H. Hamilton, U. S. A. The particulars, so far as they can be ascertained, are stated in the foot-note. 1 Ligatwns of the External Iliac Artery. In four of these examples ligatures were placed at first on this trunk, but in the seven remaining cases after the femoral had been tied. CASE 83. Private G. W. Husk, Co. F, 1st Maryland Cavalry, aged 47 years, was wounded at Deep Bottom, August 16 ; 1884. Assistant Surgeon C. Wagner, U. S. A., reported, 2 from the hospital at Beverly, New Jersey: "Admitted from City Point with a gunshot flesh wound of the upper third of the right thigh. Bleeding occurred from the femoral artery on Novem ber 10th, fifteen ounces of blood being lost. The patient was feverish, pulse 130, appetite wanting. Acting Assistant Surgeon J. C. Morton administered chloroform and ligated the external iliac artery. The patient died November 17, 1864, from recurrent haemorrhage." CASE 84. Private J. H. Gatewood, Co. F, 21st Georgia, aged 32 years, wounded at Manassas, August 28, 1862, Surgeon J. Chambliss, P. A. C. S., reported : 3 "Small ball entered just behind the left trochanter, passed out below the perineum, entered the right thigh opposite, and emerged at the external aspect at middle of upper third of the thigh ; bleeding was profuse for several minutes. Aneurism of the femoral artery; digital compression repeatedly used without avail. January 31, 1864, liga tion of the external iliac artery, pretty much after Cooper s method, by Surgeon Jackson Chambliss, P. A. C. S. February 3d, erysipelatous inflammation subsided. February 15th, the wound presented a healthy granulated appearance and discharged healthy pus. He continued to improve until February 17, 1864, when violent arterial haemorrhage occurred, from which he died in a few minutes." 1 Professor FRANK HASTINGS HAMILTON, A. M., M. D., LL. I)., in The Principles and Practice of Surgery, New York, 1872, in treating of liga tions of the common iliac, states, at page 232, that : " On the 15th of May, 3804, after the battle of the Wilderness, 1 tied the same vessel in the presence of Dr. WALSEK and my student Mr. HOYN. The patient, John E. Preston, of the 19th Pennsylvania Vols., had been wounded by a rifle-ball which had traversed the pelvis, and the operation was made to arrest a haemorrhage which had already nearly proved fatal. He died on the following day, but without a recurrence of the bleeding. In editing the surgical report in Circular No. (i, S. G. O., 1865, p. 78, I cited from the records but three cases of ligation of the common iliac practised during the American civil war, the operation on the left common trunk by Surgeon J. COOPEH McKEE, U. S. A., for haemorrhage after shot wound of the pelvis (which afforded the specimen 3464, Sect. I, A. M. M.), and the operations by Acting Assistant Surgeon K. N. ISHAM of Chicago, and J. B. CUTTER of Newark, for aneurisms consequent on stabs. In the seventh chapter of Volume II, of Part II, of the Medical and Surgical History of the War, pp. 233-6, these three cases of ligation of the common iliac artery were detailed, and a fourth operation of ligation of this trunk for haemorrhage following shot injury, in the case of Colonel J. K. Scott, 19th Illinois, was quoted from the report of the operator, Professor D. BRAINARD, in the Chicago Medical Journal, 1864, Vol. XXI, p. 97, and reprinted in the Am. Jour. Med. Sci., 1864, Vol. XL VI I, p. 065. The operation of ligation of the common iliac for haemorrhage after shot flesh wound of the lower extremity reported above (CASE 82) by Assistant Surgeon A. INGRAM. U. S. A., is the fifth, and the case adduced by Professor F. H. HAMILTON is the sixth, example of the war-series of this important procedure. From Professor HAMILTON S printed report of the case of Preston I was unable to trace the injury upon the records, as there is no mention made of it either in the 19th or 1 19th Pennsylvania Volunteers ; but after repeated diligent search the original manuscript entry of the case was found on the field register of the 3d division of the Sixth Army Corps hospital, at the Baptist Church, Fredericksburg, Virginia. It is there stated that Corporal John E. Preston, of Co. G. 1 1 9th Pennsylvania, was wounded at the battle of the Wilderness, receiving a "gunshot injury of the anterior superior spinous process of the left ilium. The precise date and extent of the injury is not noticed, nor the disposition made of the patient ; but, in a list of deaths in the 3d division hospital, Sixth Corps, at the Baptist Church, Fredericksburg, the death of Corporal John E. Preston, on May 14, 1864, is recorded. In another part of the register, signed by Dr. J. W. WALSKR, is a list of operations performed at Baptist Church Hospital after the battle of the Wilderness, by Drs. HAM ILTON and BUCK, which comprises: ; One ligation of the common iliac, death in twenty-four hours." The data are very imperfect, but the probabilities are. from the documentary evidence accessible, that Corporal Preston, 119th Pennsylvania, was struck, on May 7th, at the Wilderness, by a musket ball which fractured the anterior superior spinous process of the left ilium, and that he was sent to Fredericksburg by the hospital trains that reached that town on May lltli. Further, that uncontrollable haemorrhage arose, and that Medical Inspector F. H. HAMILTON. U. S. A., ligated the left common iliac artery on May J3th, and that the fatal termination of the case took place twenty-four hours afterwards, May 14, 1864. 2 See Report on Interesting Surgical Operations performed at the Hospital at Beverly, N. J., by Assistant Surgeon C. WAGNER, U. S. A., 1864, p. 13. 3 CHAMIJLISS (J.), Case of Traumatic femoral Aneurism Treated l>y Digital Compression Ligation afterwards of the External Hiac Artery, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 97. 40 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 83. Private J. R. Spaulding, 1 Co. F, 112th New York, aged 23 years, was wounded at Fort Fisher, January 15, 1865. Assistant Surgeon S. H. Orton, U. S. A., reported, from McDougall Hospital, New York Harbor: "A mini6 ball entered the upper and inner aspect of the left thigh, and, passing a little downward and outward, emerged near the knee, apparently avoiding the bone and all important vessels. Simple dressings were applied for about three weeks, when the wound began to look unhealthy and had a tendency to slough. Solution of the permanganate of potash was freely used and tonics given. On March 23d, haemorrhage occurred from the posterior wound and was arrested by sulphate of iron and pressure. On March IJlst, bleeding commenced from the anterior wound. Dr. Orton applied a ligature to the external iliac artery. On April 21st, the haemorrhage recurred from the anterior wound, probably through the collateral circulation, which in the meantime had become established. The bleeding was successfully restrained by the application of the horse-shoe tourniquet, which was kept con stantly retained for the space of two weeks, when it was omitted without any subsequent recurrence of the haemorrhage. At this time the patient was greatly afflicted with bed-sores, which were a source of great annoyance and sufficient to exhaust his strength. The wounds, however, were healing kindly. On May 31st, the patient was attacked with dysentery, which, in his enfeebled condition, resisted all efforts at once. The patient continued to sink under this complication, and died June 15, 1805, five months after the receipt of the original injury and about two and a half months after the operation of ligating the artery. At the time of his death the wounds were nearly healed." The fourth case of this group is that of Private J. Langford, printed in full in the American Medical Times, 1863, Volume VI, page 256. A somewhat extended abstract of this interesting case is here appended: CASE 88. Private J. R. Lanyford, Co. F, 10th Georgia, was wounded at Antietam, September 17, 1862. Assistant Surgeon R. F. Weir, U. S. A., reported from the hospital No. 1, Frederick, that the patient entered that hospital October 27th. He had been struck by a musket ball which entered half an inch below Poupart s ligament, below the right groin, just over the vessels, and made its exit on a line with the right tuber ischii, about two inches and a half behind it. Profuse immediate haemorrhage of arterial color produced syncope, and there was recurrent bleeding when the fainting was over. The patient was confined to his bed only about a week, and, by September 27th, both orifices had cicatrized. When he left his bed the thigh was flexed on the pelvis, extension causing pain. On October 27th, an examination revealed an aneurismal pyriform tumor in the right groin, its apex directed toward the scrotum and the greatest transverse diameter corresponding with Poupart s ligament. At the base its diameter extended to the vessels about four and a half inches; at the apex, internal to the vessels, and about three inches external to the vessels. Starting from Poupart s ligament, the tumor extended in its outer portion three fingers breadth toward the anterior superior spine, and in the iliac fascia it extended a similar distance. Near the cicatrix of the wound of entrance the aneurismal thrill was very distinct. The patient said he perceived this thrill since he had been able to go about. The prominence of the tumor was moderate. The limb was flexed on the pelvis at an angle of about 45. Neuralgic pains affected the anterior surface of the thigh and bitterly increased in its intensity. Pressure on the aorta or external iliac completely arrested pulsation. The pulsation of the posterior tibeal at the ankle was feeble. The patient was of fine physique, and reported himself as in excellent health prior to injury. By November 5th the tumor had rapidly aug mented in bulk, and, after consultation, it was determined to operate by Syme s method on the following day. The measures proposed contemplated compression on the right common iliac, an incision through the cicatrix of the wound of entrance sufficient to introduce the left index, and feel and plug the original opening into the artery, then to freely lay open the sac and ligate the vessel above and below the point of injury. November 6th, at noon, patient was placed under ether. A straight incision two inches long, starting from just within the middle of Poupart s ligament and running obliquely downward along the thigh, was made. The upper end of this opening was prolonged by a curved incision one and a half inches long, running upward and outward as far as the ligature of the external iliac artery. This incision was deepened through .,. ,,,*> , i t t < i , the superficial fascia, and the knife being then laid aside, the dissection was carried on by means of the handle of the scalpel and the finger nails. The lymphatic of the saphenous opening was thus brought into view, immensely enlarged, congested, and pushed upward. The aneurismal tumor was found to have partially forced its way through this opening, overlapping its upper edge like a femoral hernia. Commencing at the inner margin of this opening the dissection was carried on without much difficulty to Poupart s ligament, which was found very tense, and the artery could be felt beating just beyond. The upper end of the incision was then prolonged one inch toward the umbil icus, and after dividing the tendons of the external oblique on a director, the ligament was divided directly over the artery by blunt-pointed scissors. The sheath of the artery was soon brought plainly into view and its covering pushed up to one-half inch beyond the epigastric and circumflex arteries, at which point a ligature was placed around from within outward by means of a Mott s aneurismal needle. The effect of ligation was to arrest pulsation in the tumor. The curved wound was closed by means of silver interrupted sutures. One small artery, the superficial epigastiic, required ligation. Not more than one ounce of blood was lost during the operation. The limb was enveloped in cotton batting. An anodyne was given after recovery from the amcsthetic, and repeated at midnight. At 4 o clock P. M. the patient was quiet; pulse 120, temperature of sound limb 93, of limb operated upon 95 in popliteal space. November 7th, patient passed a quiet night, though sleeping but little, and states that the neuralgic pains have ceased. In a paper on Hospital Ganyrcnc, by Acting Assistant Surgeon A. North, printed in the Fio. 14. Liantion of right ex- ternal iliac for shot injury. Sj>. :to80. 1 The case is briefly noted by Surgeon J. A. LlDF.LF,, U. S. V., Gunshot Wound of Thigh, etc., in Surgical Memoirs of the \Var of the Rebellion, coll. and pub. by the U. S. San. Comm., 1870, Surgical Vol. I. p. 231. SECT. 1. 1 LTGATIONS AFTER SHOT FLESH WOUNDS. 41 American Medical Times, 1833, Volume VI, p. 257, the sequel of the history is given: "The operation was successful, and in two weeks the wound was nearly healed, when it took on an unhealthy action, and patient then complained of a burning pain in it. Anticipating what was coming, he was immediately moved to a stone building where there had previously been no gan grene; and here, November 21st, he came under my care. He remained here for four days before the disease became sufficiently developed to justify his removal to the gangrene tent. November 25th, patient is very desponding, and is growing weaker day by day ; has considerable headache ; pulse 120 and almost imperceptible ; tongue furred, brown, tip and edges red and dry. The ulcer, which is three inches in width, extends from the pubes up nearly to the anterior spine of the ilium; has an unhealthy and sloughy appearance. Patient complains of a slight burning pain in wound, the edges of which are everted, jagged, and undermined for about two inches; the integument is indurated and tumefied, and extremely sensitive to the touch or the least movement of the limb; characteristic odor not well marked. The sinuses extending under the integument were freely laid open and the surface of the ulcer scraped with a spatula, to which the acid was first applied with a mop, and then worked in with a stick so as to get it down to the comparatively healthy tissue, and was also applied in a similar manner to the tissue surround ing the ulcer, to destroy, in this way, both the cuticle and cutis vera and thus to limit the extension of the disease. Superficially antiseptic poultices were applied, and opiates given to relieve pain ; takes half an ounce of brandy and beef-tea every half hour. November 26th, although the pain following the application of the acid was so severe as to cause slight convulsions for a time, patient is feeling better to-day; pulse 108 and gaining in strength. Fearing that the progress of the disease has not been entirely arrested, the acid was again thoroughly applied. Takes stimulants and tonics, with fifteen grains of tartrate of iron and potass three times a day. November 28th, the black, charred slough has separated, revealing a healthy, granulating surface beneath. The extreme sensitiveness to the touch, together with the induration and swelling of the surrounding parts, has almost entirely disappeared; applied oakum saturated with acid wash to the ulcer. December 5th, patient represents himself as feeling much better; mind hopeful and cheerful ; appetite good; ulcer is cicatrizing rapidly; continue stimulants and tonics. December 15th, all unfavorable symptoms have disappeared and patient is regarded as convalescent. For two months after this date patient Avas up and about the ward, when secondary haemorrhage, following sloughing of the sac, supervened, arid in four days resulted fatally," March 15, 1863. Assistant Surgeon R. F. Weir s notes state that a sudden change occurred on February 25th, when, in the evening, the patient had high fever; pulse 140 and almost imperceptible. On February 27th, considerable pain over the right tuber ischii and knee joint. A consultation failed to discover the cause of this change for the worse. On March 2d, an opening formed at the upper portion of the cicatrix and discharged twelve ounces of ill- conditioned pus. The opening was enlarged and examined digitally and with a probe; the cavity was syringed out. March 9th, the patient s condition had improved since the opening of the sac. March 13th, about the same, discharge increasing in quantity. It was decided to make a counter opening at the lower extremity of the sac, on the inside of the thigh, and seven ounces of fetid pus escaped, which was soon succeeded by a jet of arterial blood. The sac was laid freely open and a compress of sheet-lead was held over the sac by an assistant provided with relays of assistants. About seven ounces of blood was lost during the operation. On March 14th, at 9 o clock A. M., pressure was removed and bleeding occurred, five ounces being lost. Pressure was again applied. On March 15th, the patient was much brighter, and it was decided to keep up pressure until bleeding recurred, and then to enlarge the lower opening, search for the bleeding point, and, if it could not be found, to freely lay open the sac. At 7 o clock P. M., seven ounces of blood were lost. Chloroform was given and the opening enlarged; clots were turned out, the entire cavity was exposed, and nothing more than a general oozing could be found. The cavity was thoroughly cleansed, and the slight oozing of blood was stopped by cold water. The patient sank soon afterwards, from the antecedent haemorrhages and the shock of operation. An autopsy was made four hours after death : "Body much emaciated; rigor mortis well marked; right thigh flexed on pelvis and everted. The incision, made for the purpose of opening the suppu rating cavity to arrest the haemorrhage which occasioned death, was seven inches long, commencing about one and a half inches to the inner side and on a level with the anterior superior spinous process, and terminating on the inner side of the thigh. The thickness of the tissue divided, part of which was cicatricial, was about three and a quarter inches, in which ran the femoral vessels. These were found to have been divided by this incision but did not otherwise directly communicate with the aneur- ismal cavity. This cavity occupied the iliac fossa of the right side and was situated between the fibres of the iliac muscles, and had crowded the caput coli toward the median line. It extended from a level with the fourth lumbar vertebra to four and a half inches below Poupart s ligament. The sac or abscess in the thigh was about four inches in diameter and of a size nearly to contain a foetal head. It had dissected up the tissues with the exception of the tendons, psoas, and iliacus from lesser trochanter, and anterior and inner surfaces of the femur. Below this point, at the bottom of the cavity, a track extended to the inside of the lesser trochanter and approached to within an inch of the surface of the tuberosity of the ischium. Another track extended in front of the pubes toward the root of the pubis. This extensive cavity contained about four ounces of coagulum mixed with blood, which gave to the smooth wall a sloughy appearance. At the inferior, beneath the femoral artery, a small quantity of fresh coagulum was found in the cellular tissue, suggesting the idea that the haemorrhage had proceeded from this point, but the vessels causing it could not be found. An attempt had been made to inject the artery, but had failed for the want of proper instruments. On dissection of the abdominal walls the peritoneal cavity and its contents were found in a healthy condition. The external iliac artery of the right side, from its origin to the point of ligation, had diminished to a small cord about one-eighth of an inch in diameter, firm to the touch, and of a dark color from its containing clot. The principal branch of the external iliac, the epigastric, and circumflex were found larger than the corresponding arteries of the left side. The sacral artery was also enlarged. The chain of lymphatic ganglia along the inside of the iliac artery was much enlarged and indurated, and the tissue in the region of Poupart s ligament had been much altered and firmly matted together by inflamma tory Action. The femoral artery, as it passed under the ligament, was nearly three-fourths of an inch nearer the pubis than usual. The femoral vein was in a normal condition. The artery below the point of ligature to the point of division, in the operation immediately preceding death, was about three and one-fourth inches in length. This portion was laid open, together with the upper portion of the femoral artery, in order to ascertain, if possible, the locality of the original injury. About one and a half inches below the origin of the epigastric and its inner margin there was a faint permanent discoloration, which also SURG. Ill 6 42 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. presented a slight linear appearance; elsewhere the artery presented no peculiar appearance." The specimen is represented in the wood-cut (FlG. 14), drawn from the preparation 3986, Section I, A. M. M., and presented by Dr. Weir to the Museum. In the other seven cases of ligation of the external iliac the femoral artery had previously been ligated. Successful results were finally attained in two instances: CASES 87-93. Private J. S. Degolia, Co. A, 76th Pennsylvania, aged 32 years, wounded at Drury s Bluff, May 16, 1864. Surgeon A. Heger, U. S. A., described the injury and its result as follows: "The patient was admitted to the Point Lookout Hospital May 19th, having been wounded by a musket ball entering the right hip at the external and posterior aspect, passing across, over the pubes, to the left thigh, and downward toward the knee, wounding the great vessels of the left side, and making its exit one inch above the knee, on the external surface. On May 24th, the femoral artery was ligated above the wound two inches below Poupart s ligament. The patient was much prostrated from the severity of the wound and loss of blood. Stimulants were used, and warm applications to the limb. Repeated haemorrhage required the ligation of the external iliac on May 29th. The patient died, of gangrene, June 1, 1864. The first operation was performed by Surgeon A. Heger, U. S. A., and the second by Surgeon J. H. Thompson, U. S. V." Private W. S. Marshall, Co. E, llth Pennsylvania Reserves, aged 26, wounded at Gaines Hill, June 27, 1862. Assistant Surgeon C. Wagner, U. S. A., reported that the patient was admitted into Hammond Hospital with a "gunshot wound of the right thigh and false aneurism of the femoral artery. The aneurism measured six and a quarter inches in its longest diameter. Dr. \Vagner ligated the femoral near Poupart s ligament. On September 6th, haemorrhage to the extent of forty ounces occurred from the femoral artery. Dr. Wagner then tied the external iliac. The bleeding did not recur. The patient died September 16, 1862, from exhaustion." Private H. Locke, Co. H, 6th Vermont, aged 23 years, wounded at the Wilderness, May 5, 1864. Surgeon Henry Janes, U. S. V., reported, from Sloan Hospital, Montpelier: "Gunshot wound, right thigh; ligation of femoral and iliac arteries for secondary haemorrhage. Trans ferred to Veteran Reserve Corps December 5, 1864." Sergeant-Major L. C. Sears, 5th New Hampshire, aged 22 years, wounded at Fredericksburg, December 13, 1862. Surgeon T. Antisell, U. S. V., reported from Harewood Hospital, Wash ington : "A conical ball entered the right thigh two inches below Poupart s ligament. On the morning of December 19th there was a slight haemorrhage from the wound. Search was made for the ball without result. A counter opening was made and a seton inserted. He remained very comfortable until the 22d instant, when a severe haemorrhage occurred, which necessitated the tying of the femoral in the ward, by Dr. Antisell. On Sunday, January 4, 1863, there occurred a haemorrhage which was arrested by means of styptics and compression. Another haemorrhage followed on the evening of January 7th, which could not be controlled by styptics. Search was made for the bleeding vessel without result. The patient lost much blood. On the following morning, January 8th, the patient was again brought into the operating room and the wound was carefully explored, but the bleeding vessel was not found. The operation of tying the external iliac artery was then performed by Dr. Antisell, in the hope of arresting the haemorrhage permanently. The operation was no sooner completed than there was a welling up of blood from the point from which the previous haemorrhage had proceeded. Styptics and compression were applied, and the patient was returned to the barrack. Stimulants and beef-tea were freely given, and warmth was applied to the extremities to restore reaction. He revived toward evening, and remained sensible and quite comfortable until the evening of the 10th instant. He died January 11, 1863, from exhaustion." Lieutenant J. A. McQuillan, Co. I, 38th Ohio, aged 25 years, wounded near Atlanta, July 29, 1864. Surgeon J. H. Phillips, U. S. V., reported, from Hospital No. 1, Chattanooga: "Gunshot wound of right thigh. Haemorrhage occurred on September 20th, thirty ounces of blood being lost. The femoral artery was ligated Sep tember 20th, in the wound, which was gangrenous. On the 26th. the haemorrhage again returned, and it being found impossible to ligate it again in the wound, the external iliac was ligated just above Poupart s ligament, after which the haemorrhage did not recur, but the gangrene continued, and the patient sank, and died October 2, 1864." Private R. B. Corn- well, Co. A, 23d Ohio, aged 23 years, wounded at South Mountain, September 14, 1862. Assistant Surgeon W. E. Waters, U. S. A., reported from Caspari Hospital that the patient died November 3, 1862, of peritonitis. Acting Assistant Surgeon L. Heard reported: 1 "The shot had entered some four inches below Poupart s ligament, over the track of the femoral artery. An examination gave evidence that the femoral artery had been wounded and that a traumatic aneurism was forming. Water dressing was applied till the 29th, when compression by means of a horse-shoe tourniquet was made, and continued until Octo ber 4th. On October 10th, Drs. J. F. May and Shippen, assisted by Drs. Hall and Seeley, ligated the femoral artery. Ligatures were placed on the cardiac and distal sides, and the vessel was divided between the two ligatures. (Jn the sixth or seventh day bleeding occurred, which was soon arrested and a tourniquent placed upon the h mb. In about a fortnight after the oper ation the proximal ligature came away of itself, with knot and loop at the end. On October 30th, profuse secondary haemor rhage took place, which greatly reduced the strength of the patient. Dr. May ligated the external iliac artery. The patient gradually sank, and died November 3, 1862." Sergeant J. K. Zeiders, Co. I, 53d Pennsylvania, aged 19 years, wounded near Gettysburg, July 3, 1863. Acting Assistant Surgeon W. V. Keating reported, from Broad Street Hospital, Philadelphia: " Gunshot flesh wound of the right thigh by a conical ball. The wound sloughed, and secondary haemorrhage occurred from the femoral artery on July 28th. The haemorrhage recurring on August 4th, Acting Assistant Surgeon A. Hewson ligated the femoral artery just above Scarpa s triangle, and on August llth again ligated the vessel higher up. The thigh became some what cedematous; by October 28th the wounds of the previous ligations had nearly healed externally. A sinus extended into the tissues below, which were found to be in a softened broken-down condition ; ligature separated. On October 8th, Dr. Hewson administered ether and ligated the external iliac artery through a curved incision about three inches long; about six ounces of blood lost. October 25th, slight haemorrhage from point of ligature, and another in the afternoon, amounting in all to about six ounces; controlled by styptics to wound and oil of turpentine and veratrnm viride internally. Pulse 130 and weak." The patient was discharged from service May 14, 1864. 1 HEARD (L.), Wound of the Femoral Artery Ligation of both Cardiac and Distal Sides of Severed Vessel Secondary Hamorrhage Lirjature of External Iliac Peritonitis Death ; in Am. Med. Times, 1862, Vol. A T , p. 337; and Boston Wed. and Surg. Jour., 1862, Vol. LXVII, p. 369. SECT. 1. 1 LIGATIONS AFTER SHOT WOUNDS. 43 Professor John Ashhurst, jr., has lately remarked 1 that a study of the statistics of the operations of tying some of the larger arteries impresses the fact that "as cases have accumulated, the percentage of mortality has greatly increased." 2 This comment, however, is less applicable to the series of ligations of the external iliac artery. 3 In studying the statistics the operations for disease and for traumatic cause must be discriminated. The war cases have a fatality more than twice as great as those in civil practice. 4 ^Ligation of the Femoral Artery. In a previous portion of this section, commencing at page 16, reference is made to sixty-two ligations of the femoral artery for direct shot injury of the vessel, with the large mortality of 72.6 per cent. An interesting example of a well-managed successful case is adduced, and the great importance of ligating the distal as well as proximal extremities of the vessel is urgently enjoined. In addition to these sixty-two cases there were sixty-five instances in which the femoral artery was tied for consecutive bleeding unattended by primary injury to the vessel. The hundred and twenty-seven examples are enumerated in the summary entitled TABLE III. This series presents the same grave mortality as when the cases of direct lesion of the vessels were separately considered. References to publications of detailed cases are given; a few abstracts will be presented of cases which furnished pathological material for the Museum : CASE 94. Private B. Ayres, Co. A, 5th Iowa, aged 40 years, was wounded at Vicksburg, May 19, 1863, transferred by hospital steamer to Memphis, and admitted into Gayoso Hospital on the 27th. On the Medical Descriptive List appear the following notes by Acting Assistant Surgeon A. W. Nelson : "A minie" ball entered the left thigh through the centre of Scarpa s triangle, passing to the inside of the vein and out at the lower part of the left nates. At the time of admission the wound was in a very dirty and sloughing condition and the skin had a dark tinge. There was considerable diarrhoea, with free perspiration ; he was dozing a good deal of the time without any opiate ; pulse 100. Water dressings were applied, and he was ordered to lie on the abdomen occasionally to allow the discharge to escape. Ale was given daily. He had a severe rigor on the evening of the 30th, and on the 31st, at 7 o clock p. M., had haemorrhage from the anterior wound, which was checked by a compress. Fifteen grains of quinine were divided into four powders, one powder to be given every four hours. At 2 o clock p. M. on June 1st the wound was opened to the sheath of the femoral vessels and a darning needle removed from the sheath; there was no haemorrhage, and all compression was removed. The wound was thoroughly cleansed, and the patient removed to bed. About 8 o clock P. M. blood, in large quantities, burst forth in a jet, apparently from below ; it was quite dark, but the exact shade was not observed. The femoral artery was immediately ligated, but with difficulty owing to the thickened and diseased condition of the parts. There was no haemorrhage after ligation, but patient did not rally under the use of stimulants, and he died at 11 o clock P. M. Chloric ether was used during the operation. The autopsy disclosed great sloughing in the course of the wound. There was a slough of the femoral vein of the size of a three-cent piece. The vein was pierced by the large needle alluded to above, two small holes existing opposite each other; the artery was healthy. It was observed that well marked symptoms of pyaemia existed several days before his death ; however, the autopsy was not carried far enough to verify this diagnosis." The specimens (FiG. 15) consist of wet preparations of the left femoral artery ligated below the origin of the profunda, and of the femoral vein, showing the point of perforation by the needle, which were contributed by Dr. Nelson. 1 Transactions of the International Medical Congress of Philadelphia, 1877, p. 572. 2 Thus Professor AsmiuusT observes that when Dr. G. W. NOURIS published liis classical paper in 1847 (Am. Jour. Afed. Sei., Vol. XIJI, p. 24), he had collected sixteen eases of ligation of the common iliac artery with eight recoveries and eight deaths, a mortality of fifty per cent., while there are now recorded sixty-one cases with only thirteen recoveries and forty-eight deaths, a mortality of seventy-nine per cent. 3 Thus HODGSON (Treatise on Diseases of Arteries, etc., 1815, p. 416) enumerated twenty-one instances of ligations of the external iliac following the first operation by AUEUXETHY, in 1796, and fifteen of the twenty-two patients completely recovered, or 68.2 per cent. In 1875, Dr. RABE collected (Deutsche Zeitschrift fur Chir.. Leipzig. 1875, B. V, p. 213) two hundred and seven cases of ligations of the external iliac, of which one hundred and thirty-five recovered, or C5.2 per cont., advancing the death rate but 3 per cent., though the number of cases is decupled. 4 Among American Surgeons two principal methods of ligating the external iliac artery are taught and practised. ABEKXETHY, who first ligated this vessel on the living subject in l"9(i (TJie. Medical and Physical Journal, London, 1802, Vol. VII. p. 97. and The Surgical and Physiological works of JOHN ABEKXETHY, London, ]830, Vol. I, p. 292), made a perpendicular incision about three inches in length, through the integuments of the abdomen in the direction of the artery, and thus laid bare the aponeurosis of the external oblique muscle, which was next divided from Poupart s liga ment, in the direction cf the external wound, for the extent of nearly two inches. The margins of the internal oblique and transversalis being thus exposed, the finger was introduced beneath them for the protection of the peritonaeum, and they were divided. Next, the peritonaeum and its contents were pushed upward and inward, and the external iliac artery taken hold of with the finger and thumb. It now only remained to pass a ligature round the artery and tic it ; but this required caution on account of the contiguity of the vein." In his second case. ABERNETHY made his incision in a line a little external to the artery to avoid the epigastric. Both of these operations failed, but ABERXETHY s third and fourth attempts were completely suc cessful. Sir ASTLKY (JOOl Eu s operation is generally preferred as endangering the peritoneum less, and less weakening the abdominal parietes so as to give a tendency to hernia. Sir A. COOPER saved four of his six patients. His method of operating is described in HODGSOX (op. cit., p. 42), by HARRISON Fie. 15. Femoral artery and vein. Ligation of artery. Specs. 2085, 2020. 44 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 16. Ligation of femoral. FIG. 17. -Left femoral artery tied four and a half inches be- lowtheprofun- da. Spcc.y.ft-3. CASK U5. Private S. Brown, Co. G, 134th New York, aged 16 years, was accidentally wounded on August 30, 1862, and entered the Mansion House Hospital, Alexandria, six days afterwards. Assistant Surgeon W. A. Conover, U. S. V., contributed the following report of the injury : " The ball entered the left leg at the posterior middle third, penetrated the tibialis posticus muscle, and was extracted at the same opening. At first there was free discharge of laudable pus, but suppuration increased rapidly, and by September 26th infiltration of the tissues had nearly reached the popliteal space. Under a supporting treatment the patient seemed to gain rapidly until November 14th, when, during his sleep, a profuse haemorrhage occurred from the sloughing of the posterior tibial artery and a great quantity of blood was lost before it was discovered. His condition not admitting an operation, the wound was plugged with styptics and a bandage was applied from the toes to the hip. This treat ment controlled the haemorrhage for eight days, stimulants being given freely in the mean time in order to prepare the system for an operation, if necessary. On November 28th another attack of bleeding was promptly controlled by the attendant, and, upon consultation, ligation of the femoral artery at the lower third was agreed upon as giving the patient a chance for his life. The operation was performed with some difficulty, owing to the abnormal structure of a branch artery which had to be carefully avoided. The patient bore the operation very well considering his condition, and, on the following day, his extremities were perfectly warm and remained so, showing that circulation had been re-established. The discharge, however, continued excessive, and although stimulants and tonics Avere used very freely, the patient sank steadily, and died of pyaemia on December 7, 1862. The autopsy confirmed the extensive disorganization from infiltration of pus, the artery being in an unhealthy condition up to within an inch of the ligature. The tying of the artery was a success, the clot having been perfectly formed and the circulation re-established by the profunda, which was sufficiently enlarged for the purpose. The ligated artery was contributed by Dr. Conover, a wet preparation of which is shown in the cut (FlG. 16). CASE 93. Private W. Colgan, Co. C, 2d Massachusetts Cavalry, aged 21 years, was wounded at Berry- ville, September 14, 1884. On the following day he was admitted to hospital at Sandy Hook, and three days afterwards he was transferred to Frederick. Assistant Surgeon R. F. Weir, U. S. A., reported : The wound was caused by a conoidal ball, which entered on the outer border of the popliteal space of the left limb, took a diagonal course up behind the femur, and emerged on the inner aspect at the lower portion of the upper third. The patient was very anaemic when admitted, and stated that he lost a considerable amount of blood on the field. Stimulants and generous diet were ordered. On September 24th there was an attack of haemorrhage to the amount of twelve ounces, which was checked by compression. On the following day another haemorrhage occurred, when the femoral artery was ligated four and a half inches below the profunda by Acting Assistant Surgeon J. C. Shimer. On the morn ing of September 28th there was slight oozing of arterial blood, when the openings were enlarged and the source of bleeding searched for ineffectually. Recourse was had to digital compression. Death ensued at 10 o clock, September 23, 1864. At the post-mortem (see the adjoining wood-cut, FlG. 17) the femoral and profunda arteries were found to be intact. (See the Catalogue of the Surgical Section of the Army Medical Museum, I860, p. 433.) CASE 97. Private I. Curler, Co. G, 5th Michigan, was wounded at Fair Oaks, May 31, 1862, and admitted to Ilygeia Hospital, Fort Monroe, four days afterwards. Surgeon R. B. Bontecou, U. S. V., reported: "Gunshot wound of femoral artery, the ball entering the anterior and middle portion of the right thigh and passing out opposite posteriorly, going close to the inside of the femur. The temparature of the limb was good, although the artery at the ankle beat feebly. Haemorrhage from both Avounds occurred on June 10th, and returned in a few hours. An unsuccessful attempt to find the artery below the wound was made, and I tied the femoral, as I supposed, above the profunda; but pulsation being so strong in the artery exposed below the ligature, further search was made and the profunda was found unusually high up. This was also tied, and no haemorrhage returned. The foot, before the operation warm, now became cold; but by the aid of external heat its temperature returned on the following day. The patient was a fine healthy looking young fellow. He was transferred to New York by steamer on June 12th." Surgeon S. W. Gross, U. S. V., contributed the specimen shown in the annexed cut (FlG. 18) and reported the result of the case as follows : "The patient was admitted to DeCamp Hospital, David s Island, New York, June 15th, and was placed under the charge of Acting Assistant Surgeon W. K. Cleveland. At the time of his admis sion the ligature had come away but the wound had not united. On June 17th, profuse haemorrhage occurred from the profunda femoris, around which a ligature was cast. The patient, however, had lost so much blood that he succumbed two hours after the operation." The specimen (FlG. 18) consists of a small section of the femoral and profunda arteries, and shows the femoral blocked up with a clot at the seat of the ligature, also the ligature around the profunda, Avhere another clot was formed. CASE 98. Private D. Rapp, C<>. K, 7th Indiana, aged 20 years, was Avounded at Robinson s Creek, November 30, 1863. He was admitted to the field hospital of the 1st division, First Corps, Avhere Surgeon G. W. Metcalf, 76th New York, noted: "Gunshot wound of left thigh." On December 6th, the wounded man Avas transferred to Douglas Hospital, Washington. Three days aftenvards he was operated on by Assistant Surgeon W. Thomson, U. S. A., Avho furnished the following detailed (Surg. Anat. of the Arteries, 4th cd., 183!), p. 351), and most of the text-books. Dr. STEPHEN SMITH has published a good account of thirty-two dcliga- tions of the primitive iliac artery (Am. Jour Med. Sci., I860, Vol. XL, p. 17). I have mentioned many of the more recent cases in a foot-note to Part II, Vol. II, p. 333, of the Med. and Surg. Hist, of the War. But by far the most comprehensive analytical summary furnished is given by Dr. L. RAISK. \Zur Unterbindung der grosser! Gffdssstiimme in der Continuitdt by Erkran-Kungen und Verlet:vngen dcr itntcren Extremitatcrt , in Deutsche Zeitscliriftflir Chir.. Leipzig, 1875, B. V, p. 213). who tabulates 207 cases of ligationsof the external iliac, of which 7:. , or 34.7 percent., proved fatal. Of these 207 cases the author distinguishes H4 with 22 deaths (G4.7 %) as war cases, and 173 with 50 deaths (28.0) as cases from civil practice. In four of the cases from civil life the common iliac was afterwards ligated (twice successfully), and in one of the cases from war practice the same vessel was tied with temporary success. This was Dr. BRAINARD 8 case, published in the Chicago Med. Jour.. Igfi4, Vol. XXI, p. 97, which Dr. RABE quotes from Professor GtiRLT 8 Jahresbericht for 1864. Fio. 18. Sec tion of right fem oral and profun da. Ligature on the former has cut its way out. Spec. 1004. SECT. I.J LIGATIONS AFTER SHOT FLESH WOUNDS. 45 report of the case: He was a well developed and very muscular man and had been apparently in good health. At the moment of injury he was retreating, and was struck by a bullet on the posterior aspect of the left thigh a short distance below the gluteal fold, which passed through the limb to the inside of the bone, divided both femoral artery and vein, and made its exit three and a half inches below Poupart s ligament, at the point of election in ligating the femoral in Scarpa s space. There was profuse haemorrhage at the time of injury, and an immediate want of sensibility in the leg and foot. When examined on the 7th of December, the whole limb was found warm and the collateral circulation had been established ; but there was no pulsa tion in either of the tibial arteries. At the superior margin of the wound of exit there was a small tense swelling, which pulsated synchronously with the systole of the heart. An aneurismal thrill, resembling the loud purring of a cat, was distinctly felt, extending along the course of the vessels into the pelvis, but not communicating laterally. The little finger was intro duced into the wound at the time of the operation, and the pulsation and thrill were found to be closely localized and confined lo the divided ends of the femoral vessels. There was no extensive effusion of blood into the tissues of the thi^h, and hence this was not in the strict surgical sense of the word a traumatic aneurism. It was concluded that the sac was composed only of the sheath, which had been united by inflammation after the division and retraction of its vessels, and had then been some what distended after the heart had regained its force. It was also suggested by Surgeon Lidell, who kindly saw the case with me, that there was a free communication between the divided artery and vein in this sac which permitted the arterial blood to return freely by the vein, as evinced by the pulsation communicating with such force backward toward the heart in the line of the vessels. It was unmistakable that there existed a wound of the femoral artery sufficient to cause its obliteration, that an aneurism was being developed at the divided proximal extremity, and that the proper surgical procedure would be to secure the ends of the vessel at the point of the injury. It was determined to emulate the example of Mr. Syme, to lay open boldly the sac by a free incision and search for and secure the bleeding orifices. It was hoped that the profunda had escaped injury and every precaution was to be used to secure the femoral below its origin. A small haemorrhage on December 9th rendered immediate interference necessary, and the following operation was then done with the assistance of Surgeon Lidell and the medical officers of the hospital. After the patient had been fully etherized and the femoral artery thoroughly compressed on the pubes by the thumb of a reliable assistant, as evinced by the loss of pulsation in the tumor, an incision four inches in length was made through the skin and fasciae, immediately over the tumor and including the gunshot wound, in a line parallel with the sartorius. A second incision was now made into the tumor, which was dilated instantly by the finger to the siz of the first. Distal haemorrhage was anticipated, and it caused but little surprise when a most profuse dark colored torrent poured out from the incision. The lower angle of the incision was rapidly searched in vain for the source of the haemorrhage, and it was feared that it might come from the dark softened depth of the track of the ball. No pressure on the artery had the least controlling effect upon it. The removal of the sponge was followed instantly by a boiling dark torrent of venous blood, which so quickly filled the cavity as to prevent any examination. So profuse and uncontrollable was the flow that visions of ligating the external iliac were vividly presented to the mind. When the flow was found to arise from the superior angle of the incision numerous and ineffectual efforts -were made to secure the vessel, but the parts were so hardened by local inflammation that the forceps glided over them as it would over a cartilaginous surface. This point, from whence the dark blood seemed to flow, was finally compressed by the point of the left index finger, and by means of the nail of the small finger of the right hand a vessel was isolated, a ligature passed around it with an aneurism needle, and this haemorrhage, most embarrassing because uncontrolled by pressure, was finally suppressed. The first ligature was applied at the superior angle of the ,. FIG 1 f 9 T Liffa ; incision to the proximal extremity of the divided femoral vein, from which this unexpected and most annoying artery and vein, hajmorrhage escaped by regurgitation from the saphena. The blood found its way into the limb by means of Spec>> arteries arising from the iliac above the point compressed, was finding its Avay back by the sapheiia, enlarged to compensate for the occlusion of the femoral, was poured into the femoral a short distance above its divided proximal extremity, and then regur gitated through the stump of the femoral into the superior angle of the incision. The proximal end of the femoral artery, from which a crimson tide escaped on relieving the pressure slightly, was now easily found, and this was ligated. The wound was now thoroughly cleansed of all clots of blood. The femoral artery and vein, denuded of their sheath for a distance of two inches, were clearly seen at the bottom of the wound, their divided extremities having become adherent to the neighboring tissues during the inflammatory action of the previous ten days. As a precautionary measure a ligature was cast around the femoral artery at the lower angle of the wound, and some little difficulty was experienced in discriminating between the artery and vein, owing to the fact that from ten days disuse the vein in becoming an impervious cord had become similar in size, color, and consistency to the artery. A small orifice was observed in the vein near its distal extremity, and from this occurred a free black How on moving the limb. This was also included in a ligature. The wound was now closed by one or two sutures and the patient placed in his bed. A brief recapitulation may give clearness to the above account. The first vessel tied was, therefore, the proximal extremity of the femoral vein near the entrance of the saphena; the second, the femoral artery a short distance below the origin of the profunda, both at the superior angle of the incision ; the third, the femoral artery at the lower angle of the incision and two inches from its distal extremity; the fourth, the femoral vein near its distal extremity at the centre of the incision, and to control a flow from an incision through its coats, which may have been made accidentally. The profunda had not been seen, and it was hoped that it would suffice to keep up the circulation. No important arterial channels had been interfered with by the operation, and a successful issue might be expected. The man was stimulated, took morphia, and his leg was covered closely in bed with blankets to preserve the animal warmth. This man had lost blood freely at the time of the injury; he had been subjected to a very long and fatiguing transport in ambulances and cars before reaching the hospital, and for seven days his food had not been as good or sufficient as might have been desired for one about to undergo such an operation. He was pallid and haggard looking, and iron, nutrients, and stimulants were freely ordered. There was great pain and restless ness during the ensuing night, and large quantities of morphia were required to procure sleep. December 10th, no interference with the circulation; leg and foot both warm. The whole limb is swollen, and bloody serum escapes freely at the point of 46 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. the injury. December l^tli, the restlessness has been the most marked symptom, caused seemingly by constant and severe l-ut indescribable pain in the limb. The pnlse is 120, the countenance pale and haggard, the tongue dry and coated, and the general symptoms indicate great nervous prostration. Large quantities of morphia have been found requisite. The whole limb and foot are much swollen and oedematous. On the evening unmistakable signs of sphacelus appeared, the foot became cold, and a hue of purple discoloration was observed as high up as the ankle. The neuralgic pain and restlessness still con tinued. On December 13th, all the symptoms were worse. The discoloration, the dark purple hue of gangrene, extended rapidly upward, particularly on the inside of the limb. The whole thigh became crepitant, the pulse more rapid and feeble. He became more and more depressed, and finally died at 12 o clock at night. These final scenes all surgeons can imagine. The post-mortem revealed nothing interesting in the great cavities. The whole thigh and leg were found gangrenous as far as the point of the injury. The vessels were dissected, spread upon a board, and a most faithful picture was made of them by the artist under Dr. Brinton s direction. Only the proximal extremities of the vessels were found in the softened gangrenous mass; but they threw light upon the history of the case. The artery was divided below the origin of the profunda, which was uninjured, but not enlarged, as one would expect if the whole force of the circulation had been directed toward it by the oblit eration of the main artery. In ten days the profunda should here have been as large as the femoral, if all the blood brought to the divided femoral had been seeking a passage through its calibre. Its undilated condition gives color to the idea that most of the blood brought to the divided femoral extremity found its way quickly back by the divided femoral vein ; that the pressure was thus relieved, and that the profunda received only its usual supply of blood. That the limb was nourished by a collateral circulation, arising above the brim of the pelvis, is clear from the fact that no pressure on the external iliac would restrain the flow xf blood from the saphena through the femoral vein. The saphena vein is normal, and its relation with the femoral indicates how easily the regurgitating haemorrhage was caused, as no valves are there to prevent it. For several days from the 9th to the 12th there were no signs of an interference with the circulation, but at that time gangrene appeared and spread with great rapidity. This may have been due to the recent phlebitis of the profunda vein, which is now filled with a pink firm coagulum. The irritation caused by the operation, or due to the passage of the ball, may have induced the inflammation of this vein, now so vital to the support of the circulation. This seems to have been a wound of an artery, resulting in an aneurism the sac of which was composed of the re-united sheaths and enlarged probably by some dissection upward, in which a free passage of blood took place from the artery to the vein. No question as to the propriety of the operation now exists in my mind, since, as the sequel shows, no digital com pression over the femoral would have sufficed to prevent or control a secondary haemorrhage." The two speci mens were contributed by the operator, Dr. William Thomson (see FlG. 19). The case is cited by Dr. Lidell. 1 CASE 99. Lieutenant R. W. Smith, Co. I, 5th Pennsylvania Reserve Corps, was wounded at the battle of Bull Run, Virginia, August 30, 1862, in the right thigh. He was conveyed to Alexandria in a rough wagon, and thence brought to Washington, and admitted to Douglas Hospital, September 5, 1862, with a circumscribed false aneurism of the femoral artery. The vessel was ligated in the continuity on September 7th. Secondary haemorrhage followed-, and the patient died September 8, 1862. At the autopsy it was ascertained that the haemorrhage had been temporarily restrained by the direction of the wound and coagula in the large aneurismal sac. Recurrent haemorrhage had led to the fatal result. The preparation is well represented in the accompanying wood-cut (FlG. 20) reduced to one-half. CASE 100. Private J. Hiibner, Co. K, 5th Michigan, aged 29 years, was wounded at Fair Oaks, May T^TC ^0 T T n successful prox- 31, 1862, and conveyed to New York City one week afterwards. Dr. F. T. foster, of the New York (Civil) tinal ligation of Hospital, reported the following history: "He was admitted on June 8th, having been wounded by a musket the right femo- . ral artery for ball, which entered the posterior fleshy part of the right thigh and had not been removed. The case presented rism^/Snec 509 nothing peculiar, and under simple treatment progressed well until June 27th, when there occurred from the wound a copious arterial haemorrhage, controlled with difficulty by the application of lint and pressure. On the same day he was etherized and the wound opened; but the source of the haemorrhage was not discovered. The wound was again stuffed with lint and the limb bandaged, after which Dr. T. M. Markoe tied the femoral artery a short distance below the origin of the profunda. The ligature came away on the 8th of July, and the incision and the original wound soon began to close by granulation. On the 29th the ball could be felt encysted beneath the integument on the anterior aspect of the thigh, but he declined to have it removed. On September 3d he was discharged from the hospital with the wound Entirely healed and the limb in good condition." The man was discharged from service, at Fort Hamilton, New York Harbor, October 1, 1862, and pensioned. Examiner H. F. Montgomery, of Rochester, New York, certified, February 2, 1863: "A ball entered the right thigh in middle third, over the femoral artery, and was not abstracted. There is a long cicatrix in this region, and another behind, on the inside of the bone. His foot is benumbed, and, on exercise, swells and is painful. He is apparently in good health. He has a buckshot in the right leg below the knee." Examiner J. J. Lutze, of East Saginaw, Michigan, reported, March 4, 1874: "Large tender cicatrices on outer and inner posterior thigh, points of entrance and incision. Adductor brevis and longus muscles impaired and injured." This pensioner s rate of compensation was reduced from five-eighths to one-fourth on March 4, 1873, since which date he has not drawn any pension. Besides the cases of ligation of the femoral artery above detailed, numerous other cases have been narrated at length in journals or elsewhere, to which references are given further on. In TABLE III, the entire series of thirty-six recoveries and ninety-one fatal cases are noted alphabetically, and the principal facts regarding them are soncisely recorded. 1 L,IDEU, (J. A.). On the. Wounds of Blood- Vessels, Traumatic Exmorrhage, Traumatic Aneurism, and Traumatic Gangrene, in Surgical Memoirs of the War of the Rebellion, collected and published by the United States Sanitary Commission, 1870, Vol. I (Surgical), p. 143. SECT. I.] LIGATIONS AFTER, SHOT FLESH WOUNDS. 47 TABLE III. Summary of One hundred and Twenty-seven Cases of Ligation of the Femoral Artery for Haemorrhage from Shot Injuries unattended by Fractures. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. I.NJUUT, OPERATOR, AND RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. 1 Ambrose. T. L., Chap July 2."), Right thigh : htom.; femoral lig.; 25 Crowdtr, D. J., Pt., Dec. 16, Right thigh; ligation of femoral. lain, 12th New Hamp Aug. 15, haam. from branch of profunda Stamford s Bat ry, age 64, Jan. by A. A. Surg. D. D. Talbot. shire, age 35. 1864. large branch tied. Died Aug. 23. 9, 65. Died Feb. 3. 1865, gangrene. 20, 1864. 26 Cummings, J. M., Pt., Dec. 28, Shot wound right femoral artery; 2 Archibald, T., Ft., G, April 2, Right femoral artery wounded and D, 49th Indiana. 1862. vessel ligated. Died Jan. 29, 63. 24 tli Mass., age 18. 12, 65. ligated; one end tied. Died 27 Cummins. H., Pt., A, 7th May 8, Right thigh ; femoral tied above April 26, 1865. pyjemia. West Virginia, age 21. 25, 64. profunda. Died May 29, 1864. 3 At wood. L. IX. Pt.. B, Sept. 30, Left thigh, middle third; ligation 28 Curler, L, P., G, 6th May 31, Right thigh ; fern, and profunda Ii2d Mass.. age 31. Oct. 31, of femoral, both ends tied. Died Michigan. June 10, lig.; haem. recurred; profunda 1864. November 9, 1864. 17-, 62. relig. Died June 17, 1862. Spec. 4 "Ayres. B., Pt., A, 5th May 22, Left thigh; ha>m.; wound opened 1004, A. M. M Iowa, age 40. June 1, and a darning needle removed 29 Darling, S. G., Pt., D, May 12, Fern, artery severed: vessel lig.; 1863. from sheath of vein ; artery lig * 32d Maine, age 19. 1864, May 26th, thigh amp., by Surg. ated. Died June 1, 63, pyaemia. On field. R. B. Bontecou, U. S. V. Died Specs. 2020, 2085, A. M. M. May 26, 1864, hemorrhage. 5 Bailey, J.. Pt., I, 55th June 18. Left thigh ; ligation of femoral. 30 Delamatev, M., Corp l. May 28. Right thigh ; lig. of femoral, by Perm., age 26. Jul. 9, 64. Died July 10, 1864. G, 7th Michigan Cav July 10, A. Surg. H. M. Sprague, U.S.A. (. Banfill. T., Serg t. C, May 12, Left thigh; femoral ligated, by alry, age 20. 1864. July 12th. thigh amputated. 19th Indiana, age 20. June 12, Surg. T. R. Crosby, U. S. V. Died Aug. 7, 1864, pyaemia. 1864. Died June 12, 1864, pyaemia. 31 Dier,W., Corp l. A, 129th Dec. 13, Left popliteal space ; femoral lig. 7 Barkeloo. J., Pt.. M, 2d July 19, Right popliteal artery severed ; Pennsylvania, age 23. 62, Feb. Died Mar. 4, 1863, pyaemia. Ohio Cav., age 28. 1863. primary lig. of femoral artery; 22, 63. amp. thigh. Disch d Mar. 17. 65. 32 Doyle, L., Pt.. K. 8th May 20, Right thigh : femoral and several 8 Bedingfield, J. T., Capt., Mar. 25. Both thighs; left femoral ligated, Maine, age 34. June 1, branches ligated above and be G. 60th Georgia,age25. April 15, by A. A. Surg. N. A. Robbing. 1864. low wound, by Surg. A. Heger, 1865. Died April 25, 1865, exhaustion. U. S. A. June 6th. thigh amp. 9 Bell, J. C., Pt., E. 34th April 6, Left leg, cutting post. tib. artery; Died June ti, 1864, exhaustion. Iowa, age 23. 17, 65. fern. lig. , by Surg. A . McMahon, 33 Dunn, G. R.. Serg t, E, Mar 16, Right thigh ; femoral ligated. U. S.V.; amp. thigh forrecurrent 25th S.Carolina.age20. 29, 64. Recovery. hsem. Died Ap. 23/65, exhaus n. 34 Edwards, J. W., Pt., B, Mar. 26, Right leg ; femoral ligated, by A. 10 Bills. C., Pt., K, 17th Aug. 30, Wound of thigh, involv. profunda 26th Illinois, age 18. April 20, A. Surg. H. B. Cole. Recovery. New York, age 20. Sept. 26, artery ; both ends femoral tied ; 1865. 1862. sloughing. Died Oct. 4, 1862. 35 Edwards, R., Pt., G, June 25. Both thighs; femoral ligated. 11 Blake, G., Pt., I, 3d Aug. 26, Shot wound of left femoral artery; 98th Illinois. Jul. 6. 63. Died July 11, 1863. West Virginia. Sept. 9, vessel tied, by Surgeon W. D. 36 Elliott, E., Pt., H, 118th June 3, Right thigh ; femoral ligated. by 1863. Stewart, U. S. V. Furloughed Pennsylvania, age 21. 13, 64. Asst. Surg. H. Allen, U. S. A. Nov. 12, 1863. Wounds healed. Died June 21, 1864. gangrene. 12 Brown. S.. Pt., G, 134th Aug. 30, Left leg ; fern. lig. in lower third, 37 Freeman, C. A., Serg t, April 6, Left thigh : femoral art y ligated, New York, age 16. Nov. 28, by Asst. Surg. W. A. Connor, B, 37th Mass., age 22. 15, 65. by Surg. B. A., Vande rkieft, U. 1862. U. S. V. Died Dec. 7, 1862, S.V. Died April 18, 65, anaemia. pyaemia. Spec. 1024, A. M. M. 38 Gardner, R. T., Pt., A, July 2, Both thighs ; left femoral ligated. Hi Brown. W., Serg t, 1st Dec. 10, Left thigh ; femoral ligated. Re IstMd. Battal n.agelK. 23. 63. Doing well November 30, 1863. Maryland Artillery. . 63. covered. 39 Gillev, M., Pt., I. 9th May 5, Right thigh, involving femoral 14 *Check, M., Pt.. I, 6Ist July 30, Femoral artery severed ; femoral N. York State Militia, , 64. artery ; femoral ligated. Died North Carolina. A uer. 3, artery ligated, by Surg. D. F. age 37. May 27, 1864, of pyajmia. 1864. Wright. P. A. C. S. Recovered. 40 Goodwin, A., Pt., B, 2d July 2. Left thigh ; femoral ligatedabove L5 Clark, W. L., Pt.. H, April ], Shot wound lower third right fem New Hampshire. 20, 63. and below. Died Aug. 8, 1863. 25th North Carolina, 10, 65. oral artery; artery tied, by A. A. 41 Graham. J. A., Serg t, June 1 , Right thigh; lurm.; profundalig.; age 20. Surg. J. Morris. Died April 19, H, 116th Penn., age 21. 10, 64. lisem. recurred: fern. lig. Died 1865, gangrene. June 13, 1864. 16 Claypole, S.. Pt., I), G2d May 30, Right leg; femoral lig.. by Asst. 42 Gray, ,T.,Pt.,D.2d Penn June 1 8, Left thigh : femoral tied in con Penn., age 27. June 8, Surg. W. P. Norris, U.S.A. Died sylvania Heavy Art y, 30, 64. tinuity, by Surg. N. R. Mosely, 1864. Aug. 4, 64, asthenia and pleuro- age 17. U. S. V. Died July 12, 1864! pneumonia. 43 4 Gross, C., Pt., K, 6th May 30, Left femoral artery divided; liga 17 Clelland, W.. Pt., A. 8th June 1. Left thigh ; one end of femoral Pennsylvania Cavalry, 31, 64. tures placed above and below. New York Heavy Art., July 24, tied. Died July 24, 64, typhoid age 26. Died June 8. 1864. exhaustion. age 18. 1863. fever. 44 5 Hagan. J., P., G, 76th July 17, Right thigh : fern, tied at proximal 18 Clover, B.. Civilian, age Aug. 23, Left fern, artery injured; aneur Pennsylvania. 23, 64. extrem. and accompanying vein 16. Sept. 1, ism ; femoral tied. Recovered. at prox. and distal ends ; gang. 1864. Died July 27, 1864. 19 Clymer. J., Pt., B, 104th May 31, Left popliteal space : femoral lig., 45 Hamilton, E., Capt., G, May 6, Right femoral vein and branch of Pennsylvania. June 16, by A. A. Surg. M. K. Cleveland. 15th New Jersey, age 15, " 64. profunda divided: femoral tied. 1862. Died June 16, 1862. 19. by Surg.H.W.Ducachet.U.S.V. 20 3 Coble..T.A.. Pt., F.45tb Nov. 27, Left thigh ; diffused trau. fem l Died May 16. 1864 ; exhaustion. North Carolina, age 20. 63, Jan. aneurism; fern. lig. above and 46 Ilarbaugh, H.. Serg t, K, July 2, Left thigh" femoral ligated. Pis- 23, T>4. below ; femoral vein also tied. 7th Wisconsin, age 22. Sept. 13, charged July 21, 1864, atrophy Recovered. 1863. of thigh and leg. 21 Colgau, W., Pt., C, 2d Sept. 14, Left thigh ; fern. lig. in continuity, 47 Harrington, W. J., Pt., July 5, Left thigh ; both ends of femoral Mass. Cavalry, age 21. 25, 64. by A. A. Surg. J. C. Shrimer. C, 16th Wisconsin. 16, " 64. tied, by Surg. G. F. French, U. liied Sept. 28. 64. loss of blood S. V. Died July 20. 1864. and exhaust. Spec. 3972. A.M. M. 48 Harris, J. M., Corp l, C ; July 15, Right fern. art. injured : aneurism ; 22 Connell. M., Pt., K. 2d April 7. Right thigh ; one end of fern, tied, 14th Iowa, age 20. 27, 64. art. ligated above and below sac. New York Heavy Art., June 15, by A. Surg. O. P. Sweet, U.S.V. by Surg. J. G. Kcenon, U. S.V.; age 34. 1865. liied June 16, 1865, exhaustion. amp. leg, by A. A. Surg. R.W. ~3 Coultes, W. H., Lieut., June 1, Middle of thigh; both ends femoral Coale. Died Aug. 3, "64. pyaemia. C, Gist New York. 18, 62. tied, by A. A. Surg. W. Hunt. 49 Harrison, E.. Serg t, 1 , May , Right thigh: ligation of femoral. Died June 23, 1862. shock. 10th New York. 1864. by Surg. M. Rizer, 72d Penn. 24 Coy, J. II., Serg t, K, Nov. 7, Left thigh; femoral lig., by A. A. Died .May 22. 1864. tith Maine, age 28. 24, 63. Surg. J.C.W. Keunon ; haem. re 50 Hickey, T.. Pt., G, 73d Aug. 30, Right thigh : common femoral tied curred ; religated. by A. A. Surg. Pennsylvania, age 53. Se.27. ! 62. in continuity. Died Sept. 27, 62. T. O. Bannister. Dec. 1 ; again 51 Horn, S.. Pt., H, 53d Mar. 25, Left thigh; femoral ligated. by on Dec. 23, by Surg. D.W. Bliss. North Carolina, age 21. July 9, A. A. Surg. J. Morris. Died U. S. V. Died Deo. 23, 1863. 1865. July 14, 1865, haemorrhage. 48 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPEUATOIJ, AND RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOB, AND RESULT. 52 Honser. P., Serg t, H, Aug. 16, Left thigh; femoral ligated in 77 Moscrip, W. 8., Serg t, Aug. 22, Left fem. artory injured; femoral 76th Pennsylvania, age 26. Sept. 10, 1864. continuity, by A. A. Surg. J. II. Packard. Disch d May ^0, 1865, 78 K, l<;th\Vis., age3J. 2 O Keefe, J., Major, 2d 87, 64. Mar. 51, ligated. Died Sept. 14, 64, haem. Right fem. art y injured; femoral and pensioned. Lameness. New York Cavalry, , 65. tied, and, haem. recurring, vessel 53 HUbner, J., Pt., K, 5th May 31, Right thigh; femoral ligated. by age 24. religated. Died May 31, 1865. Michigan, age 29. June 27, Dr. T. M. Markce. Discharged 79 Pack. J. R.,Pt., D, 39th April 8, Right fem. artery wounded ; lig 1862. Oct. 1, 1862: pensioned. North Carolina, age 17. 27, 65. ated, by A. A. Surg. H. B. Cole. 54 Hugging, W., Serg t, G, Mar. 16, Right thigh ; hapm.; profundalig., Died April 27, 1865, cong. chill. 50th Illinois, age 25. April 3, by A. A. Surgeon II. Sanders; 80 Paden, W., Corp l, G, May 23, Great laceration right thigh ; fem. 5, 63. baem. recur.; fern, tied, by A.A. 10th Pennsylvania Re June 1, tied in continuity, by Surg. G. Surg. E. DeWitt. Died April serves, age 22. 1864. L. Pancoast, U.S.V.: leg gang.; 8, 1865. amp. leg by same operator. Died 55 Hunt, J. L., Pt.. G. 57th May 5, Left thigh ; femoral ligated ; dry June 26, 1864, gangrene. New York, age 41. July 9, gangrene of toes ; Sept. 5th, amp. 81 Palmer, J. C., Pt., G, April 2, Right thigh : femora) tied at both 1864. toes. Disch d June 6, 1865. 10th Conn., age 18. 10, 65. ends. Uisch d July 5, 65; pen d. 56 Hurlbut, G. Q., Pt., G, May 17, Both thighs: haem.; fern. lig. in 82 3 Pasclial. J., Pt.. I, 2d Aug. 16, Right thigh; femoral ligated, by 109th N. York, age 37. June 8, continuity; hiem.; profundalig.; N. Carolina Cavalry. 27, 64. Surg. D. F. Wrigat, P. A. C. S. 1864. hasm.: vessel religated. Died Retired February -:2, 1865. June 8, 1864. 83 Pennsyl, E., Pt., H, 93d May 31, fem. artery wounded: vessel 57 Jones, W. H., Pt., C, June 9, Right thigh ; fern, tied in wound, Pennsylvania. J el 6, 62. tied. Died J uly 5, 62, py a?mhi. 14th New York Heavy July 5, by Surg. II. Palmer, U. S. V. 84 Perry, i .. Serg t,D, 16th Sept. 3D, Right thigh; femoral tied at both Artillery. 1864. Died Sept. 25, 1864, chronic Michigan, age 30. Nov. 19, ends, by A.A. Surg.G.H.R. Rob diarrhoea. 1864. inson. Died Nov. 21. 64, exh n. 58 Jones, IV. W., Ensign, Sept. 19, thigh, involving fern, artery; 85 Peters, W. C., Pt., C, July 2, Left thigh ; artery secured. Died Thomas s Legion, acre Oct. 2, ligation of femoral artery. Died 6^th Penn., age 19. 15, 63. July 15, 1863, haemorrhage. 2.->. 1864. Oct. 5, 1864, haemorrhage. 86 Pickett, J., Pt., F, 8th June 20, Right fem. artery severed : artery 59 Judd. I. E., Lieut., K, May 25, Right thigh ; fern. art. tied at both Illinois Cavalry, age 21 . 20, 63. secured. Disch d June !>, 64. 49th Mass., age 25. June 12, ends, by Med. Insp. P. 1 ineo. 87 Pope, P. P.. Pt., M, 67ih May 9, Right thigh ; fem. tied in continu 1863. U. S. A.; fern, vein included in Ohio, age 22. 21, 5 64. ity. Died May 22, 64, exh n. a ligature. Died June 13, 1863. 88 Pope, W., Pt., I, 2d N. June 3, Left thigh ; one end < if artery tied. CO Karlmyer, F., Pt., K, June 1, Right thigh; femoral ligated, by York Artillery, age 1!). 20, 64. Died June 24, 04, hemorrhage. 48th New York, age 37. 9, 64. Surgeon E. Bentley, U. S. V. 89 4 Rapp, D., Pt., K, 7th Nov. 30, Left thigh; fem. art. and vein di Discharged May 20, 1865. Indiana, age 20. 1863. vided: double lig. placed upon Cl Kimber, W., Pt., D, 36th Nov. 29, Left thigh ; both ends of femoral fem. art and vein. Died Dec. 13, Illinois, age 33. 64, Jan. tied. Died January 26, 18.65. 1863. Specs. 2249, 2250, A. M. M. 20, 65. 90 Heed, J. P., Pt., 19th April 6, Right thigh ; fem. artery ligated, 62 Landon, L., Lieut., H, Sept. 29, Left thigh ; also fract. left radius : Alabama, age 20. May 29, by Surg. J. T. Hudgen, U. S. V. tith Colored Troops, Oct. 9, both ends of fern, tied in wound. 1862. Died June 30, 1862. age 20. 1864. Died Oct. 28, 64, pyaemia. 91 Ringer, O., Pt., C, 60th July 6, Right thigh : femoral ligated, by 63 Lang. W. M.. Pt., C, April 2, Right leg ; femoral ligated. Died Ohio, age 21 . Aug. 22, A. A. Surg. J. F. Holt. Died 4()th New York, age 34. 13, 65. April 16, 1865, mortification. 1864. Aug. 25. 1864, haemorrhage. 64 Lapp, C., Pt., I, 22d July 28, Left fem. art y wounded ; vessel 92 Roberts, A. F., Pt., I, May 19, Left popliteal space : fem. artery Wisconsin, age 21. Aug. 11, liff.. by A.A. Surg. J. M. Brown. 127th Illinois, age 20. I e 5, 63. tied. Died June 7, 1863. 1861. Died Aug. 11, 64, haemorrhage. 93 Rodgers, S. J., Pt., A, June 17, Right thigh. July 22d, aneurism ; 65 Layne. J. H., Pt., B, April 6, Right thigh : fem. vein rupt.: fem. 2d Michigan, age 21. Julv 26, fem. tied, tivo ligatures, by A.A. 19th Virginia, age 18. 25, 65. lig. at middle portion, and vein 1864. Surg. 0. W. Peck. Died July above and below rupt., by A.A. 3J, 1864, haemorrhage. Surg. J. Morris: haam. recurred 94 Ross, A. G., Corp l, I, Oct. 19, R t and leftthighs: fern, wounded May 6. fem. relig. abo. profunda. 13th Mississippi, age 21. , 64. and lig.: Nov. 8, amp. right leg Die d May 7, 1865. aboveank. Retired Mar. 14/65. 66 Lei-. J. A., Pt., I, 17th July 2, Left leg; femoral artery ligated. 95 Howe, J. B., Pt., G, 12th May 14, Right thigh ; gang.: fem artery Mississippi, age 25. 21, " 63. Transferred to prison at Fort N. Hampshire, age 22. June 12, lig. in wound, both ends tied, by Mcllenry, Md., March 2. 1864. J864. Surg. A. Heger, U. S. A., anil 67 Leline, G., Serg t. C, 8th Nov. 28, Right fem. art y injured; ligature A.A.Surg. T. Liebold. Diseh d Michigan, age 27. Dec. 5, applied, by A. A. Surg. S. T. June 5, 1865 ; pensioned. 1864. Williams. Died Dec. 5, 1864, 96 * S W , , 1, 17th Sept. 1, Right thigh; proximal endof fem. shock and haemorrhage. New York. 12, 64. artery tied, by Surg. E. Bat well, 68 Lenneghan. P., Serg t, April 6, Right thigh; femoral ligated in 14th Michigan. Sent to rear ten B, 88th New York, age 20, 65. continuity, by Surg. J. Aiken, weeks after injury. 30. 71st Pcnn. D isch d July 26, 65 ; 97 Sager, W., Serg t, E, April 1, Right thigh ; both ends of femoral pensioned. Died Nov. , 1875. 188th N. York, age 19. 22, 65. tied, by Asst. Surg.W. F.Norris, 69 Lesler, J., Pt., K, 148th June 6, Left leg; both ends femoral tied, U.S.A. DiedAp 12;>, 65, pyaem. New York, age 28. Julv 28, by A. A. Surg. W. P. Moore. 98 Sassaman, L. II., Pt., E, May 8, Right leg, wounding ant. tibial 1864. Disch d January 11, 1865. 12th Penn. Reserves, June 4, artery; femoral tied, by A. A. 70 Lund, E. T., Pt., C, 4th June 30, Left thigh, and fract. right knee age 24. 1864. Surg. J. S. Cohen. Disch d July New Hampshire, age Aug. 12, joint ; left fem. tied above and 21, 1865; pensioned. 20. 1864. below, by Asst. Surg. W. Thom 99 Sf.if. J., PC,, H, llth , July thigh; femoral ligated. Died son, U. S. A. Died Aug. 23, Alabama. 11, 62. July 11, 1862. 64, pyaemia. Spec. 3592. A.M.M. 100 Sharpe, A., Pt., D, llth June 21, Both thighs : both ends of 71 McXally, J., Pt,, G, C9th June 16, Right thigh; femoral tied in con Pennsylvania. 21, 64. femoral tied. Died June 26, 64. New York, age 24. July 4, tinuity, by A. A. Surg. O. P. 101 Sheaffer, C., Pt., D, 1st June 5, Right fem. artery injured; vessel 1864. Sweet. Furloug d Nov. 1, 64. New York Cavalry. July 8, secured, by Surg.R.F. Baldwin, 72 MoRevnolds, J., Corp l, Aug. 19, Both thighs ; femoral tied, by A. 1864. P.A.C.S. Died J y 21, 64, gang. 60th Ohio S. S., age 20. Sept. 5, A. Surg. H. B. Maben; haem. 102 Sheffer, G. W., Pt., C, May 24, Left fem. artery severed; ligated, 1864. recur. Sept. llth; artery relig., 5th U. S. Art., age 22. 24, 64. by Surg. N. Hay ward, 20th by A. A. Surg. E. Do Witt. Mass. Disch d Jan. 30, 1865. Died Sept. 17, 64, haemorrhage. 103 Simmons, T.,Pt., F, 97th June 18, Loft thigh; femoral ligated in 73 Mason, J.W., Pt.,1, 12th Aug. 30, Right femoral artery; ligature New York, age 26. July 27, continuity and wound. Died New York, age 21. , 62. applied. Died Sept. 28, 1862. 1864. August 3, 1864, gangrene. 74 Miller, G. H., Pt., F, 3d May 18, Both thighs, dividing right pro 104 Smith, H., Pt., F, 21st Oct. 19, Both thighs, scrotum, right fem. Iowa, age 23. June 3, funda artery: right fem. ligated. Virginia, age 41. Nov. 10, artery severed ; vessel tied, by 1863. Died June lO, 63, haemorrhage. 1864. Surg. W.W.Wilkerson, C. S.A. Spec. 2086, A. M. M. Retired from service Mar. 14/65. 75 Mills, J.. Pt., D, 4th Jan. 16, Left fem. artery wounded-: liga 105 Smith, J., Pt., D, 97th May 18, Both thighs ; haem. from circum Missouri Cavalry. Feb. 7, ture applied. Died February Pennsylvania, age 22. June 2, flex; right femoral tied. Died 1864. 17. 1864. 1864. June 5. 1864, haemorrhage. 76 Moore, W., Pt., G, 5th Oct. 19, Right fem. artery wounded ; lig. 106 Smith. R. W., Lieut., Aug. 30, Right thigh : fem. art y wouaded ; North Carolina, age 27. 20, 64. applied, by Surg. J. F. Pearson, G, 5th Penu. Reserves, Sept. 7, lig. in contin y. Died Sept. 7, "62, 5th N. C. Exch d Feb. 16, 65. uge 24. 1862. loss of blood. Spec. 509, A.M.M. 1 LIDELL (J. A.), op. cit., p. 262. 2 Ibid., p. 233. 3 BLACKMAN (G. C.), On the Treatment of Inflammation of the Limbs by thf. Compression, or Ligature, of their Main Arterial Trunk, in Cincinnati Lancet and Observer, 1858, Vol. XI, p. 77, and Richmond Med. Jour., 1866, Vol. I, p. 307. 4 LIDELL (J. A.), On the Wounds of Blood-vessels, etc., in Surgical Memoirs of the War of the Rebellion, collected and published by the U. S. San itary Commission, 1870, Vol. I, p. 143. "BATWELL (E.), Surgeon, 14th Michigan, in Med. and Surg. Reporter, 1865, Vol. XIII, p. 50. Probably the case of M. Shaw, Pt., I, 17th New York, ago 19. Died Nov. 16, 1864, LIGATIONS AFTER SHOT FLESH WOUNDS 49 No NAMK. Mi UTAH Y DESCnirTlOX, AND AGE. DATES. INJURY, OPEUATOU, AND RESULT. 1 NO. NAME, MILITARY DESCRIPTION, AT;D AGH. DATKS. I.VJUKY, Ol EHATOR, AND RESULT. 107 Smith, W. F., Major, 1st Oct. 27, Hight thigh ; fern. lig. above and 118 Wilder. E., Corp l, A, Aug. 10, Left leg; haem. from post, tibial Delaware. 27, 64. bclow,vein also tied; amp. thigh, 100th N. York, age 19. Sept. 21, artery ; fein. lied in continuity, Surg. A. N. Dougherty, U.S.V. 1664. by A. A. Surg. J. C. Morton. Died Nov. 0, 1804. Deserted March 23, 1805. 10? Sookwcll. C. L., Pt., K, Mav 6, Right thigh : femoral secured. nn Williams, C., Pt., F, 5th Sept. 29, Laceration left thigh ; both ends ICth N. Jersey, age 2;!. C, 64. Disch d June 30, 05; pensioned. Colored Troops, age 23. Oct. 15, of fern, tied in wound, by A. A. 109 Spicey, D., Pt., C, 5th , July Loft thigh, also right leg; aneur- 1804. Surg. O. Warner; haemorrhage Is . Carolina, age 40. 8, 03. ismul tumor of left fern, art.; fern. recurred. Died October 21, 1804, tied, by Surg. E. B. Haywood, phlebitis. C. S. A. Recovered Jan. 10, 04. 120 Williams, G., Pt., E, 9th July 9, Left thigh ; art y tied below origin 110 Story, F., Pt., E, 38th July 23, Right thigh ; gangrene ; both ends N. York, Heavy Art., Aug. 3, cf profunda. by A. A. Surg. J.C. Ohio, age 22. Sep. 9, 64. of fern. tied. Died Sept. K), 04. age 31. 1804. Shimer. Died August 4, 18ti4, 111 Sweeney, .1. L.. Serg t, May 1."), Right fern, artery injured and lig exhaustion. D, 12th Mass., age 25. 30, 04. Disch d from hospital Oct. 15, 121 Willis, jr., A., Pt., 1, 7th Dec, 13, Right femoral artery injured and 1804 ; pensioned. Rhode Island, age 25. 25, 62. ligated. Died Dec. 28, 1862, 112 Thorn, II. C., Pt., I. 14th July 20, Right thigh; fein. ligated; haem. from previous lileedin ". West Virginia, age 19. Aug. 7. recurred from proi iinda: thigh 122 3 Wilson, J., Pt., 27th N. May 26. Left thigh: ball passed close to 1864. amp., by Surg. J. B. Lewis. U. York Battery, age 20. July 10, femoral vessels ; large aneurism S. V. Died Aug. 12, 1804. 1863. of fern, artery; fern, tied above 113 Tompkins. . substitute, July 28, Right leg and lett arm ; femoral and below, by A. A. Surg. G. B. age 21. 29, 03. ligated ; gang. Aug.tid, trismus. Hammond. Duty July 31. 1803. Died Aug. 4, 1803, tetanus. 123 Winchell. C. I)., Pt., K. Apr: 12, Left thigh ; fein. lig. in continuity, 114 Unknown . . Sept. 17, Wound of fern, art.; proximulcnd 38th Wisconsin, age 19. 12, 05. by Surg. J. C. McKee, U. S.A. 22, 02. tied in wound. Died Sept. 22. 02. Disch d July 3, 1805; pensioned. 115 Vearing, W., Pt., G, May 22. Right thigh ; small aneurism cf 124 Winchester, I). W.. Pt., May 19, Left thigh: sloughing : femoral 12th Missouri, age 30. June 22, femoral artery; femoral tied. I, 1st Mass. H vy Ar y, 28, 04. tied in continuity, by Surg. T.R. 1863. Returned to duty Dec. 10, 1863. age 21. Crosby, U. S. V. Duty Febru 116 Vickery, R. S., Asst. July 30. Left thigh ; femoral tied, by Siirg. ary 10, 1805. Surgeon, 2d Michigan. 30, 04. W. B. Fox. 8th Mich. Diseh d 125 Witham, A., Pt,, A, 1st May 19, Left thigh: fern, ligated. by A. A. Mar. 14, G5 ; pens d. Appointed Maine Heavy Art y, June 29, Surg. J. Newcombe. Died July Asst, Surg. U.S.A.. May 14, 67. age 20. 1864. 2, 1804. loss of blood. 117 Wakeham, J. E., Corp l, Mar. 31 , .Left fern, artery involved ; lig. of 126 Wood, W. R., Pt., II, Dec. 31, Right thigh ; femoral tied. Duty E. 18th Virginia, age April 10, artery above profunda, by A. A. 81st Indiana. 62. Jan. June 22, 1863; pensioned. 7 1805. Surg. J. Morris. Ha?m. recur d ; 17, 63. relig. just below Poupart s lig. 127 Worley, S., Pt,, A, 139th May 5, Right thigh ; fern, ligated. Died Died April 28, 05, exhaustion. Pennsylvania, age 2J. 20, 64. June 2, 1804. Of this series of one hundred and twenty-seven cases with ninety-one deaths, the mortality rate of 71.7 per cent, of the aggregate scarcely varies from that of the smaller series of ligations for direct shot injury of the femoral adverted to on page 16. Ligations of the Profunda Artery. Six instances were reported of ligation of the profunda in addition to the cases in which that vessel was tied in connection with ligations of the femoral. Brief abstracts of the two successful and four fatal cases are subjoined: CASES 101-106. Sergeant 11. W. Bcdingfidd, Co. G, COth Georgia, age 18 years, wounded at Monocacy, July 9, 1864; admitted into hospital at Frederick ; conoidal ball passed through upper third of left thigh and lodged near the inner side of right femur, wounding the right profunda artery; traumatic aneurism, sac five inches in length, containing at least a pint of clotted blood. August 15th, Acting Assistant Surgeon J. H. Bartholf laid open the aneurismal sac. Bleeding came from the profunda artery; a ligature was applied above and below the wound of the artery by an incision four inches along the sartorius muscle; the patient was in good condition though irritable and depressed; brandy was given every hour during the day after the operation; haemorrhage did not recur. August 25th, ligature came away; the wound healed, and the patient was trans ferred to Point Lookout, October 25th, for exchange. Private J. H. Beun, Co. E, 45th Pennsylvania, aged 18 years, wounded at the Wilderness, May 6, 1864. Admitted into Campbell Hospital, Washington; shot wound of thigh. May 28th, bleeding to amount of forty-eight ounces from profunda artery; profunda ligated at one end in wound; haemorrhage recurred June 14th, and death on the same day. Lieutenant J. T. Lowe, Co. D, 12th New Jersey, wounded at Bristoe Station, October 14, 1863; admitted into Third Division Hospital, Alexandria; gunshot wound of left thigh by conoidal ball; haemorrhage to extent of twenty-four ounces from profunda artery; both ends of profunda femoris tied in the wound. Patient died October 30, 1863. Corporal T. Machelent, Co. B. 140th New York, aged 27 years, wounded at the Wilderness, May 8, 1864 ; admitted into Mower Hospital, Philadelphia; missile entered middle of posterior surface of upper third of right thigh, passed in a direct line and emerged from inner surface; slight wound. July 4th, haemorrhage to the extent of thirty ounces from the profunda artery; the proximal end of the artery was ligated in the wound. Patient was discharged May 31, 1865. Private M. Murphy, Co. G, 5th Kentucky ; wounded at Mission Ridge, November 25, 1863; admitted into hospital No. 4, Chattanooga; contused shell wound of left thigh. On January 1, 1864, gangrene appeared, which was checked, but reappeared on the 17th and 20th, and spread. On January 26th, the profunda gave way and was ligated by Surgeon A. H. Stephens, 6th Ohio. The patient died January 27, 1864. Corporal T. Patterson, Co. D, 5th Michigan, aged 32 years, wounded at the Wilderness, May 5, 1864 ; admitted into the hospital at Chester, Pennsylvania; shot flesh wound of upper third of both thighs. On July 13th, bleeding occurred from a branch of the left profunda; one end of the artery was tied in the wound; haemorrhage recurred on July 16th, and death ensued July 20, 1864, from pyaemia. 1 HAYWOOD (E. B.), Aneurism of Femoral Artery cured by Ligature, in Confederate States Med. and Surg. Jour., 1804. Vol. I, p. 36. * HAMILTON (F. H.), A Treatise on Military Surgery and Hygiene, 1805, p. 639. 3 LlDELL (J. A.), On Gunshot Wounds of Arteries, Traumatic Hxmorrhage and Traumatic Aneurism, in Am. Jour. Mcd. Sci., 1864, Vol. XIA H, p. 110. and San. Comm. Mem,., Vol. I, p. 119. SURG. Ill 7 50 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. There were also a few examples of ligations of large branches of the profunda involv ing very difficult and troublesome dissections; instances in which the external circumflex, posterior perforating, and anastomotica arteries were tied are here briefly noted. In several cases it was impracticable to determine what particular branch was severed: CASE 107. Private S. Michaels, Co. E, 9th Maine, aged 35 years, wounded at Petersburg, June 2ii, 1864. Surgeon J. J. Craven, U. S. V., reported his admission into the 3d division hospital of the Tenth Corps with a "gunshot wound of both thighs." Assistant Surgeon E. McClellan, U. S. A., reported from Hampton Hospital, Fort Monroe: "On July 30th, bleeding occurred from the descending branch of the external circumflex artery: six ounces of blood were lost. Assistant Surgeon E. Curtis, U. S. A., applied ligatures at both ends of the bleeding vessel in the wound the injury was about the middle of the thigh. On August 4th, a haemorrhage occurred from the femoral artery of the left thigh of about one pint; it was arrested by pressure, but the patient died from exhaustion a short time after. CASK 108. Private Theodore B. Benedict, Co. D, 7th Connecticut, age 32 years, wounded at Drury s Bluff, May 10, 1864. Assistant Surgeon E. McClellan reported from Hampton Hospital, Fort Monroe: "Gunshot wound of right thigh, flesh. On June 9th, haemorrhage to the extent of eight ounces occurred from one of the posterior perforating arteries.- The bleeding vessel was ligated in the wound at one end. The hemorrhage did not recur." On July 25th, the patient was sent north. He was subsequently treated in McDougall Hospital, New York, and Knight Hospital, New Haven. Surgeon P. A. Jewitt, U. S.V., reported from the latter hospital that the patient died May 3, 1865, of pneumonia. CASE 109. Corporal Thomas Haglemeyer, Co. D, 41st Ohio, aged 49 years, was wounded at Nashville, December 16, 1864. Surgeon C. N. Hoagland, 71st Ohio, reported from the 3d division, Fourth Corps: "Gunshot wound of hip; simple dressings." Surgeon J. E. Herbst, U. S. V., reported that the patient was admitted into hospital No. 2, Nashville, December 22, 1864, with a "gunshot wound of the upper third of the right thigh. Wound gangrenous from Scarpa s triangle to the popliteal space. December 29th, separation of the slough caused haemorrhage from the superior perforating and anastomotica arteries oozing surface. The patient was much exhausted from repeated haemorrhage blood deh brinated. Acting Assistant Surgeon S. Blackwood applied proximal ligatures to the bleeding arteries in the Avound and lint to the ooziug surface. Simple dressings were applied, and iron and ale ordered. The patient died January 15, 1864." legations of the Popliteal Artery. Of seventeen cases of ligation of the popliteal for shot flesh wounds of the leg, thirteen were fatal, or 76.5 per cent. Five patients succumbed after amputation of the thigh following ligation of the popliteal. The series is enumerated in TABLE IV, and a case is detailed: TABLE IV. Summary of Seventeen Cases of Ligation of the Popliteal Artery for Haemorrhage from Shot Injuries unattended by Fractures. No. NAME, MILITARY DESCKLPTIOX, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. 1 Dittos, W., Pt., H, 42d May 14, Right popliteal region; sloughing; 10 Smith, A. M., Serg t, F, May 15, Wound of popliteal artery; art y Illinois, age 27. June C, both ends of popliteal art ry tied 20th Maine. 15, 64. tied. Died May 22, 1864. 1864. in wound, by Ass t Surg. B. E. 11 Smith, F., Pt., B, 1st May 23, Rt. and 1 ft thighs; ha?m. from post. Fryer, U. S. A. Disch d Aug. Mass. Heavy Artillery. June 2!), tib.; rt. post. tib. lig. in continu 16, 1865; pensioned. 1861. ity; haem. recurred; poplit l lig. 2 Elliot, J. E., Corp l, E, April 1, In rside left leg; poplit l art. lig., Died June 29, 1864. 2d Pennsylvania Cav 29, 63. lower portion ; haem. recurred ; 12 Smith, P. D.,Pt., C, 8th Mar. 19, Right ankle ; gang.; hami. from alry, age 24. thigh amp. May 5th. Died from Iowa Cavalry, age 20. Mav 0, post. tib. art y; poplit l art y lig. shock two hours after operation. 1864. in continuity, by A. A. Surg. I). 3 Fletcher, J. M., Corp l, June 18, Flesh wound up. third right leg; McLean. Disch d Mar. 21,1865. C, 39th Massachusetts, Aug. 14, sloughing ; both ends artery tied 13 Taber, J. A., Serg t, E, Mar. 31, Right leg ; poplit l art y lig. in age - 8. 1864. in wound, by A. A. Surg. J. M. 5th Michigan, age 2:i. April 12, contin ty, by Surg. J. C. McKee, McGrath. Died Aug. 24, 1864, 1865. U.S.A. Died April, 18/65, htem. typhoid fever. 14 Vann, D., Pt,, B, 8th June 3, Left poplit l art y injured; art y 4 Gray, W., Pt., E, 18th Dec. 31, Near popliteal region ; both ends New York Artillery, 16, 64. lig., by Surg. H. 15. Bontecou, Infantry, age 20. (10, Jan. artery tied in wound. Died Jan. age 18. U. S. V.; haem. recurred; new 12, 63. 22, 1863, gangrene. i lig. applied June 20; same day 5 Kausche, G.,Pt.,D, 20th Sept. 17, Laceration of right poplit l space; amp. thigh. Died June 22, 1864, New York, age 35. 17, (. up. end art. tied in wound ; haem. gangrene. recurred. Disch d Aug. 13, 63. 15 Walker, M.. col d serv June 3, Right poplit l art y injured: vessel 6 Kraher, J. P., Pt., D, June 1, Left thigh near knee; gang.; one ant, K, 58th Penn., age 26, 64. tied above bleeding point, by Cth New York Heavy July 24, end of artery tied in wound. 13. Surg. R. 15. Bontecou. U. S. V. Artillery, age 35. 1804. Disch d Mar. 15, 65; pensioned. Died July 3, 64, diarrhoea. [See 7 Leonard, J., Pt., L, 7th May 30, Left leg; art. tiedbeh. knee; hteni. CASE 107.] New York Heavy Ar July 3, recur d; thigh amp. just above 16 Wick. J.C.,Pt.,C, 155th Mar. 25, Both thighs; left poplit l art y tied tillery, age 21. 18(i4. knee JulyS. Died July 23, 64. Pennsylvania, ago 22. Mav 23, above and below, by Ass t Surg. 8 Lynch, J., Corp l, K, May 10. Left popliteal region ; lig. poplit l, 165. A. Delany, U. S. V.; June 14, 14lith N. York, age 34. 17, 64. by Ass t Surg. C. A. McUall, U. amp. thigh. Died June 20, 65. S. A. DiedMay 23, 64. pyaemia. 17 Wild, C. B., Corp l, E, Sept. 10, Right thigh thro poplit l space; 9 SfMen, B., Pt., 11, Oth July 8, Left post. tib. art. wounded ; pop 114th New York. Oct. 1, lig. of poplit l; haem. recurred; Virginia Cav., age 23. - 7, 63. liteal tied, by A. A. Surg. W.S. 1864. Oct. 12. amp. thigh. Died Oct. Adams. DiedAug.2, 63, pyasin. 13, 1864, of exhaustion. 1 This is probably the case referred to by Prof. A. C. POST, in the Addendum to Section I of the Surg. Mem. of the War of the Rebellion, pub. by the. V. S. San. Comm., 1870, Vol. I, p. 262. SECT. I.] LIGATIONS AFTER SHOT FLESH WOUNDS. 51 CASE 110. M. Walker, a colored servant of the 58th Pennsylvania Volunteers, aged 13 years, was wounded at Cold Harbor, June .3, 1864, by a minie ball, which entered on the inner side of the lower third of the right thigh, passed through the popliteal space, injuring the popliteal artery, and making its exit latterly. Twelve days after the reception of the injury he was admitted to Harewood Hospital, Washington. Haemorrhage to the amount of from three to five ounces took place on June 25th, and was controlled by pressure. On the following day haemorrhage recurred, and the popliteal artery was ligated by Surgeon II. 13. Bontecou, U. S. V., by enlarging the wound of entrance, the patient being under the influence of sulphuric ether. The leg was placed in Smith s anterior splint with a fcnestra opposite the Avound to facilitate dressing, and a supporting treatment was ordered. The patient exhibited typhoid symptoms with very profuse diarrhoea until death, which occurred July 3, 1864. An autopsy showed that the coats of the artery had been injured by the ball, causing sloughing and the subsequent haemorrhage. The history was reported by the operator. Legations of the Posterior Tibial Artery separately. ID a series of seventeen liga- tions of the posterior tibial artery for shot wounds of the soft parts of the leg and foot, thirteen recovered, or 76.5 per cent. Three patients submitted to consecutive amputation, of whom one died. The cases are enumerated in TABLE V: TABLE V. Summary of Seventeen Cases of Ligation of the Posterior Tibial Artery for Hcemorrhage from Shot Injuries unattended by Fractures. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. NO. NAME, MILITARY DESCKTPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. i Ball, J. D., Corp l, A, May 12, Right post. tib. artery wounded ; 9 Ingalls, H. B., Pt., L, Mar. 31, Right leg; post. tib. artery lig., 125th New York, age 28, 64. artery tied in wound, by Ass t 1st Maine Cavalry, age April 9, by Surg. E. Griswold, U. S. V. 24. Surg. A. Ingram, U. S. A. Dis 25. 1865. Diseh d Aug. 12, 18(55; pens d. charged Dec. 29, 64 ; pens d. 10 Maran, M., Pt., A, 2d Feb. U, Right lejr; gang.; posterior tibial o Brown, W. H., Bugler, May 24, Left leg ; posterior tibial art. tied. New Jersey Cavalry, 27, 64. art. ligated on ulcerated surface. 5th New Jersey Batte June 10, Died July 7, 1864, pyaemia. age 20. by A. A. Surgeon S. S. Jessop. ry, age 23. 1864. Disch d Oct. 21, 1865; pens d. 3 Bi:cker, J. F.. Pt., B, 1st April 6, Right leg ; posterior tibial artery 11 Oaklev, C. N., Pt., A, March 8, Left leg ; lig. post. tib. and pero- Confederate, age 01. 16, 62. tied. Recovered. 85th "New York, age 32. 8, 1865. neal arteries. Died Mar. 23, (i5. 4 Dow, J. A.. Pt.,E, 136 th June 20, Right posterior tibial art. severed ; 12 Rigbey, T., Pt., C, 9th June 20, Left leg ; post. tib. artery tied at New York, age 20. 20, 64. vessel tied, by Surgeon I. N. N. Hampshire, age 23. J y3/64. wound. Furl d Aug. 11, 1864. Himes, 73d Ohio. Disch d June 13 Ritter, D. T., Corp l, P, Mar. 25, Left post. tib. art. wounded ; both 13, 1865; pensioned. 208th Pennsylvania, April 7, ends of vessel ligated, bv Surg- 5 Emery, R., Pt., D, 5th May 5, Left leg ; gang.; ends of art y tied age 19. 1865. G. L. Pancoast, U. S. V. Dis Vermont, age 133. Aug. 4, in wound, bv A. A. Surg. J. B. charged June 27, 18(i5 ; pens d. 1864. Crandall. Disch d Dec. 16, 64 ; 14 Sherdan, J., Pt., D, 68th July 3, Right leg ; posterior tibial artery 6 Flannagan, H. A., Ser April 7, pens d ; Aug. 28, 6.3, amp. leg. Left posterior tib. art y wounded ; Pennsylvaniagge 31. 25, V 63. tied at both ends. Discharged Feb. 6. 1865; pensioned. geant, H, 16th Penn. May 14, vessel tied at its middle third. 15 Thompson, S., Pt., E, Sept. 22, Right leg ; both onds of posterior Cav., age 25. 1865. Died June 13, 1865, erysipelas. 4th N. Jersey, age 23. Oct. 19, tibial artery ligated in wound, 7 Gihnore, M., Pt., B, 96th Aug. 3, Left leg, involving posterior tib. 1864. by A. A. Surg. J. W. Kerr. Illinois, age 22. 3, *64. artery ; vessel tied, by Surgeon Duty March 30. 1865. S. II. Kersev, 36th Indiana. 16 Trowbridge, D. A., Cor July 8, Right leg; artery ligated in Disch d Jan. 10, 1863; pens d. poral. L, 5th Illinois Sept. 23, wound. Disoh dNov. 17, 1863. 8 Hagey, J. D.. Pt., I, April 2, Left posterior tibial art. opened ; Cavalry. 1863. 138th Pennsylvania, May 8, one end of artery tied in wound, 17 Wright, E., Pt., F, 119th May 5, Ball cutting right post, tibial art.; age 24. 1865. by A. A. Surg. H. M. Bellows; Peunsylvania, age 18. 23, 64. gang.; art. tied in wound, by sloughing; May 10, amp. leg, by Surg. E.Bentley, U. S. V.; May A. A. Surg. H. A. Drane. Dis 25, haem. recur d ; leg amp. Died charged July 26, 1865 ; pens d. May 28, 64, asthenia and pysem. legations of the Anterior Tibial Artery. Of ten cases of ligation in which the anterior tibial was separately tied, seven were successful, one after consecutive amputation. The cases are here briefly noted: CASES 111-120. Captain C. C. Brewster, Co. D, 10th Connecticut, aged 45 years; wounded at Bermuda Hundred, May 16, 1864; shot flesh wound of left leg. Admitted into Chesapeake Hospital, Fort Monroe, May 21st. Bleeding from the anterior tibial artery to the amount of eight ounces occurred. The vessel was ligated in the wound at the cardial end. Haemorrhage did not recur. Discharged September 19, 1864, and pensioned. Examiner 6. C. Jarvis, of Hartford, reported, August 24, 1869: "The wound is now an open, deep ulcer; occasionally pieces of bone come out from some part of the sore." Pensioner died June 17, 1873, of phthisis pulmonalis. Private W. Brommel, Co. E, 15th New York Artillery, aged 30 years; wounded at Boydton Plank Eoad, March 31, 1865; shot wound of left leg, lower third. Admitted into Columbian Hospital, Washington. Haemorrhage from anterior tibial artery; vessel ligated by Acting Assistant Surgeon S. W. Briggs. Died May 2, 1865, from exhaustion from loss of blood. Corporal T. Condon, Co. C, 2d New York Artillery, aged 21 years; wounded at Deep Bottom. August 16, 1864 ; shot flesh wound of the middle third of the right leg ; the ball entered the posterior portion of the leg and made its exit at a corresponding point anteriorly. Admitted into Satterlee Hospital, Philadelphia. Haemorrhage. August 26th, Ligation of anterior tibial artery above and below bleeding orifice by Acting Assistant Surgeon W. F. Atlee. Collateral circulation re-established in twenty-four hours. Discharged July 26, 1865, and pensioned. The New York Examining Board reported, March 4, 1876 : " There is a cicatrix three and a half inches in length on anterior surface of right leg ; the ball emerged through 1 The case numbered 13 in TABLE V is detailed by Professor A. C. POST in the Surg. Memoirs of the U. S. San. Comm., Surgical Vol. I, p. 862. 52 TNJUEIES OF THE LOWER EXTREMITIES. [CHAP. x. the calf. Both cicatrices are adherent and interfere with locomotion and the strength of the limb." Sergeant M. C. Glass, Co. F, 16th Michigan, aged 24 years; wounded at Hatcher s Run, February 7, 1865; shot wound of right anterior tibial artery. Admitted into Jarvis Hospital, Baltimore. Ulceration and haemorrhage; six ounces of blood lost. Ligation of anterior tibial artery in continuity, February 20, 1865. Died February 28, 1865, of haemorrhage. Private J. L. Renshaw, Co. H. 191st Pennsyl vania, aged 28; wounded at Petersburg, June 24, 1864; shot flesh wound of left leg by a conoidal ball; sloughing and haemorrhage from anterior tibial artery to extent of eight ounces. Ligation of artery above and below wound. The patient recovered, and was discharged May 18, 1865. Private S. Riley, Co. H, 92d New York, aged 24; wounded at Cold Harbor, June 1, 1864 ; conoidal ball passed through the integument of the left leg one inch below the knee. June 25th, sloughing and erysip elas. July 8th, recurrent haemorrhage to the extent of six ounces from the anterior tibial artery. The artery was tied in the wound. The patient was discharged February 9, 1865, and pensioned. Examiner H. O. Hitchcock, of Kalamazoo, reported, June 8, 1867: Ball passed below the patella and under the ligament, The wound was followed by gangrene and large sloughing, and now there is an extensive cicatrix, causing lameness and great weakness of the knee." Examiner J. A. Brown, of Detroit, reported, September 28, 1869 : "Gunshot wound of left knee, the ball striking the inner condyle of the tibia and the patella, causing weakness and impaired motion of the knee, mostly from contraction of the cicatrix." Examiner D. F. Wooley, of Big Rapids, reported, April 1, 1875 : "Ball entered at upper and inner third of the tibia, passing directly in front and under the patella and out, severing the attachment of the lower end of the patella and fracturing the upper end of the tibia; resulting in loss of part of upper portion of the tibia and weakening of knee joint to a serious extent, with slight adhesions of the muscles ; on the whole seriously impeding locomotion and requiring care to maintain a standing position upon it." The pensioner was paid March 4. 1876. Corporal I. Sampson, Co. F, 1st Massachusetts Cavalry, aged 35, was wounded during Sheridan s raid, May 11, 1864; shot wound of right leg, middle third, outside. Admitted into Hammond Hospital, Point Lookout. Gangrenous sloughing set in, destroying the coats of the anterior tibial artery. June 28th, haemorrhage to the extent of four ounces from the anterior tibial artery. Both ends of artery tied in the wound by Acting Assistant Surgeon T. Liebold. The bleeding did not recur. The patient re^vered, and was mustered out October 16, 1864. Examiner \V. H. Page, of Boston, reported, April 11, 1865 : " Ball struck about the middle of the left leg, fracturing and splintering the tibia, a large part of which, at seat of injury, has been removed, and there is a deep cicatrix three inches by one and a half. The whole leg is much swollen and cedematous, and there is probably more dead bone to be removed." The Boston Examining Board reported, Decem ber 2, 1874 : " Ball entered middle third of leg anteriorly and passed directly through. The tibia was shattered, and necrosis has resulted therefrom. The leg is weak and the wound is still open, an ulcer at the time of examination existing the size of a five-cent piece, surrounded by an areola four inches in diameter and somewhat eczematous. His leg is painful and weak upon long standing, and this interferes with the performance of manual labor." In September, 1875, the Board reported: "Large adherent cicatrix, inflamed and very tender; anchylosis of ankle." Pensioner paid June 4, 1876. Private W. Sauls- bury, Co. K, 39th U. S. C. T., aged 36; wounded at Petersburg, July 30, 1864; flesh wound of lower third of right leg. He was admitted into Summit House Hospital, Philadelphia. Secondary haemorrhage ; ligation of anterior tibial artery January 19, 1865. Amputation of right leg at lower third by double-flap method. Transferred to hospital at Beverly, and discharged May 26, 1865. He died July 16, 1871. Private J. Skiffington, Co. I, 2d New York Heavy Artillery, aged 28; wounded at Petersburg, June 16, 1864; flesh wound of l^er third, right leg. Admitted into Satterlee Hospital, Philadelphia; wound sloughing. Acting Assistant Surgeon W. F. Atlee ligated both ends of the anterior tibial artery in the wound, on account of haemorrhage, July 28, 1864. The patient died August 29, 1864, of pyaamia. Private L. Weaver, Co. G, 4th Virginia, aged 23 ; wounded at Gettysburg, July 3, 1863. Admitted into Twelfth Corps Hospital. Shot flesh wound of both legs and face. July 13th, bleeding of eight ounces from the anterior tibial artery, which recurred on the 14th, sixteen ounces of blood being lost. The anterior tibial artery was tied above and below the point of division. The patient was paroled November 12, 1863. legations of the Anterior and Posterior Tibial Arteries. There were two instances in which the posterior and anterior tibial arteries were conjointly tied for shot flesh wounds: CASES 121-122. Private J. Hoar, Co. G, 144th New York, aged 22 years, wounded at White Plains, July 24, 1863. Shot wound of right foot; admitted into Douglas Hospital, Washington; haemorrhage to the extent of six ounces occurred from the metatarsal artery on August 1st. Assistant Surgeon W. Thomson, U. S. A., ligated the anterior tibial artery in the continuity at the instep and the posterior tibial behind the malleolus. The wounds healed well, and the patient was returned to duty from Central Park Hospital, New York, April 11, 1834. He is not a pensioner. Private J. Kercher, Co. D, 7th Michigan Cavalry, wounded at Gettysburg, July 2, 1863. Shot wound of right leg and of anterior and posterior tibia] arteries ; admitted into McDougall Hospital, New York Harbor. July 29th, ligation of anterior and posterior tibial arteries. August 10th, haemorrhage, amounting to thirty-two ounces of blood. Died August 10, 1863. Ligation of Veins. Six cases in which the femoral vein was tied simultaneously with the artery are noted on page 38. Specimens from two of the cases are shown in Figures 15 and 19. A case of ligation of the saphenous vein is detailed: CASE 123. Private A. Kendig, Co. B, 97th Pennsylvania, aged 31 years, wounded at Bermuda Hundred, May 18, 1864. Assistant Surgeon E. McClellan, U. S. A., reported from Hampton Hospital, Fort Monroe: "Gunshot wound of left thigh, inner surface, upper third; the ball entered near the apex of Scarpa s space, passed through the adductor longus muscle, und made its exit over the upper third. Gracilis muscle wounded; phagedaeua. On May 24th, haemorrhage to the extent of xix ounces occurred from the saphenous vein. Both extremities of the vein were ligated in the wound. The haemorrhage did not recur, but the patient sank and died of exhaustion June 4, 1864." Amputations following shot flesh wounds will next be considered. u z u DC CD Z < CD D. CO O X U- O CO I- o u u. u. u SECT. 1. 1 / AMPUTATIONS AFTER SHOT FLESH WOUNDS. 53 Amputations in the Lower Limbs after Shot Flesh Wounds. Two hundred and one cases were reported of amputations in the lower extremity for shot wounds involving only the soft parts, comprising one hundred and thirty-one amputations in the thigh, six disarticulations at the knee, sixty-three amputations at the leg, and one of the toes. Amputations in the Thigh. In the hundred and thirty-one cases of this series, ninety- four or 71.7 per cent, were fatal. The cases are enumerated in TABLE VI. Ten of the operations were primary, with only two recoveries. Fifty-seven intermediary operations, with forty-eight deaths, gave a mortality rate of 84.2 per cent.; sixty-four secondary operations, with thirty-eight deaths, had a death-rate of 59.4 per cent. The amputations were necessitated for the most part by complications of consecutive haemorrhage, gangrene, or secondary disease of the bone or joints, and in some instances were resorted to after ligations, removals of sequestra, or other interference had been unavailingly employed : CASE 124. Private H. Root, Co. B, 104th New York, aged 26 years, was wounded at Petersburg, June 22, 1864, and admitted to the field hospital of the 3d division, Fifth Corps. Surgeon L. W. Read, U. S. V., noted, "buckshot flesh wound of right leg, slight." On June 30th, the patient entered the Harewood Hospital, Washington, whence Surgeon R. B. Bontecou, U. S. V., contributed the specimen (FiG. 21), with the following brief history: "Gunshot wound of right leg, middle third, injuring soft parts. On admission the constitutional state of the patient was very poor; condition of injured parts tolerably good, but wound very painful. The parts subsequently became gangrenous, with rapid sloughing of soft parts; about one half of the lower third, and three-fourths of the upper third, and all of the middle third of the tibia exposed and denuded of periosteum. The tibia became necrosed throughout its whole extent, and at this time the patient became jaundiced. On October 29th, about ten inches of necrosed bone was extracted by Acting Assistant Surgeon D. I. Evans. The general condition of the patient improved soon afterwards, under a supporting treatment throughout, and was doing tolerably well, parts improving, when transferred to hospital at Elmira, January 4, 1865." Two weeks after his transfer the patient obtained a furlough and proceeded to his home in Tioga County, New York, where his limb was subsequently amputated at the middle third of the thigh. Dr. S. Knapp, his attending physician, certified that "he found him suffering from a badly cared for and neglected wound," etc., and that "on February 28, 1865, it became necessary to ampu tate the leg," which operation he performed, being assisted by Dr. E. Daniels. About two months afterwards the patient returned to the hospital, and on July 21, 1885, he was discharged from service and pensioned. He died July 25, 1870, of consumption, resulting from the wound and its effects, more than five years after the ampu tation. The parts removed by the amputation at mid-thigh by Dr. Knapp were not transmitted to the Museum; but the large sequestrum comprising the greater part of the diaphysis of the tibia is represented in the wood-cut FIG. 21. Se- (FiG. 21), and, as mounted, is nine inches in length (see Catalogue of the Surgical Section of the Army Medical J^?],^ Muesum, Washington, 1866, p. 405). Isjec. 3601.* In a grave case of hospital gangrene following a shot wound at the ankle, the lamented artist, Hospital Steward E. Stauch, made a colored drawing of the appearances after the sloughing surfaces had cleaned off under the applications of fermented cataplasms. The drawing is copied in the chromolithograph opposite, PLATE XXVII. CASE 125. Corporal C. H. Dudley, llth Indiana Battery, received at Chicamauga, September 20, 1863, a wound of the right foot, a conoidal ball entering the under portion just below ankle joint. He was taken prisoner, conveyed to Richmond, and on October 29, 1863, was admitted to Division No. 1 hospital, Annapolis, from the steamer New York. The wound had sloughed extensively. On October 30th and 31st there was haemorrhages from the dorsalis pedal artery, Avhich was promptly arrested by the use of styptics. Soon after admission a phagedenic ulcer made its appearance on the posterior face of the right leg, immediately below knee joint, and an examination, made November 19, 1863, revealed a deeply excavated sloughing wound. Yeast poultices were applied to the sloughing tissues, and when the gangrenous masses had cleaned off a colored drawing was made of the parts by Hospital Steward E. Stauch. November 23d, haemorrhage amounting to eight ounces occurred from this wound, and was restrained by finger compression on the femoral artery; tourniquet was loosely applied on limb, and stimulating draughts given. On November 24th, Assistant Surgeon W. S. Ely, U. S. V., who had charge of the case,^ reports that the "wound from which the haemorrhage proceeded was thoroughly examined and the diseased tissues found more extensive than had been supposed ; the finger could be passed beneath superficial border of ulcer to a considerable extent, and the popliteal artery was found to be divided by the extent of the ulcerative process, and the ligamentous structures of the knee joint were found extensively destroyed. Amputation was determined on as the only rational treatment. It was imme diately performed, after the circular method, directly above the knee joint, by Surgeon T. A. McParlin, U. S. A., assisted by Surgeon B. A. Vanderkieft, U. S. V. Patient bore the operation well, and the tissues at seat of amputation appeared healthy. No sutures were used to approximate the flaps, wet straps being the only retentive treatment employed." The case progressed favorably until December 2d. Acting Assistant Surgeon C. Hayes kept the further record of the case. On December 8, 1863, haemorrhage, amounting to eight ounces, occurred from the stump. He failed rapidly after this, and died December 11, 1863. Surgical Series of Drawings, Nos. 59, 60, S. G. O., PLATE XXVII. 54 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TABLE VI. Numerical Statement of One Hundred and Thirty-one Amputations in the Thigh for Shot Injury unattended by Fracture. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. 1 Atwood, H., Pt., K, 14th Sept. 1 9. night fern. art. injured ; circulat n 24 Chescltine, W. C., Pt., May 27, Right thigh, severing fern, vein ; New Hampshire. 23, 04. destroyed; gang.; circ. amp. at C, 1st Maryland Cav June 4, gang.; circ. amp. thigh, by Asst. low. third thigh, by A. Surar.W. alry, age 22. 1804. Surg. W. F. Norris, U. S. A. Fritz, 12th Mo. Died Sept.30, 64. Died June 9, 1804, exhaustion. 2 Baker, J., Pt., A, llth June 15, Sheath of right fern. art. wounded ; 25 Christ, J., Corp l, M., Mar. 25, Right thigh ; circ. amp. thigh, by Com ccticut. age 3-. 26, M. haem. from branch of prnfunda ; 198th Penn., age 27. April 7, A. A. Surg. J. H.Gillman. Died tlap amp. thigh, by A. A. Surg. 1805. April 25, 1805, pyaemia. J. S. Hill. Died June 29. 1804. 20 Cook, L., Serg t, C, 26th June 18, Right thigh. Aug. 9, Ini in.; amp. 3 Barkeloo. J., Pt., M. 2d July 19. Right popliteal artery severed ; Ohio, age 25. Aug. 10, post. Hap, mid. third, by A. A. Ohio Cavalry, age 28. 2(i, 03. tern. art. ligatcd: flapnmp. thigh 1804. Surg. E. H. Sands. Died Aug. at up. third. Disch d Mar. 17, 05. 11, 1804. 4 Barnum, C. F., Pt., E, June 18. Left leg; amp.bel. tubcrc. of tibia ; 27 Cooper, T., Pt., C, 4th June 22, Left thigh and leg ; contraction of 167th Penn., age 30. Sept, 7, haem.; amp. thigh, eirc., lo. third, Penn. Reserves, age 18. 04, May muscles ; Dec. 31, hamstring teu- 1804. bv A. A. Surg. J. Morris. Died 3, 70. dons divided. Disch d June 23, Oct. 13, 04. A}M!C. 3133, A.M. M. 65 ; leg deform d and paralyz d ; 5 Barry, E., Pt., A, S2d June 3, Left k-g ; flap amp. at mid. third, amp. above knee, by Surg. O. Perm., age 24. Aug. 11, by Dr. J. Shields. Discharged Pemberton, F. R. C. S., of Birm 1804. Sept. 2, 1805. ingham, England. 6 Blaker.J. P..Pt.,E, 15th Aug. 7, Left leg ; gang.; ant. post., lower 28 Curtis, J. A., Pt., D, June 27, Right thigh; gang.: flaps of skin, Inl antrv, age 18. Sept. l(i, third thigh, by A. A. Surg. 11. 101st Ohio, age 25. Aug. 7, cir. of muscles, by Surg. S. E. 1804. \V. Forrest. Died Sept.18, 1804, 1804. Fuller, U. S. V. Died Aug. 15, exhaustion. 1804, pyaemia. 7 Brastcd,A.A., Serg t, H, June 1, Right knee joint; gang.; joint 29 Curtis, G., Pt., A, 1st Oct 27, Shell contusion of right thigh and %th New York, age 22. Nov. 7, opened; circ., low. third thigh, Colored Troops, age 23. Nov. 19, leg ; gang.; amp. thigh, by Asst. 18C4. by A. A. Surg. A. J. Smith. 1804. Surg. J. H. Frantz, U. S. A. Died Nov. 30, 1804, exhaustion. Died Jan. 13. 1805, pyaemia. 8 Bell, J. C.. Pt., E, 34tli April 0, Left posterior tibial artery cut by 30 Daniclson, H. A., Pt., Dec. 16, Left thigh ; gang.: amp. thigh, by Iowa, age 23. 18, b 5. ball; gang.; haem.; lig. of fern. G, 7th Minnesota, age 64, Feb. A. A. Siirg. S. W. Thompson. artery; amp. at low. third thigh, 01 23. Dirlinc" S G Pt D 11, 65. M1V l-T Disch d August 10, 1805. Died April 23, 05, exhaustion. oJ. 32d Maine, age 19. **J l i 26, 04. tied on field : gang.; thigh amp. 9 Belt. W. H. II.. Pt., A. Feb. 10, Shot perforation left thigh ; ery by Surg. R. B. Bontecou.U.S.V. 10th Ohio Cavalry, age April 21, sipelas: (lap amp. at mid. third, Died May 20, 04, haemorrhage. 21. 1863. by Surg. J. It. McClurg, U.S.V. 32 Decker, E., Pt., H, 81st July 22, fern. art. wounded ; primary Disch d Sept. 2, 1803. Ohio. 1864. amputation of thigh. Died Aug. 10 Bishop, J., Pt., M, 22d Aug. 25. Right leg, destroying post, tibial 3,1864. New York Cavalry, Sept. C, artery, vein, and nerve; hrem.: 23 Deinlein, D., Pt., C. 5th May 25, Right popliteal space, producing age 20. 18C4. thigh amp. at low. third, by A. Ohio, age 43. July 10, aneurism : amp. thigh, by A . A. A. Sura: . \V. .T. Mcllench. Died 1864. Surg. O. D. Norton. Died Aug. Sept. 15, 1804, pyaemia. 1, 1804, in low typhoid condition. 11 Black. J. M.. Corp l, D. July 20. Right Irsr; gang.: llapamp. thigh, 34 Delamater, M., Corp l, May 28, Right thigh; gang.: haem.: July 35th Ohio, age 21. Aug. 15, low. third, by A. A. Surg. J. E. G, 7th Mich. Cavalry, July 12, 10, femoral ligatcd ; amp. thigh, 1804. Crowo. Died Aug. 18, 04, exh n. age 20. 1864. by Asst. Surg. II. M. Sprague, 12 Blaisdell. II.. Pt., II, April 20, Right leg near knee; no fracture; U.S.A. Died Aug 7. 04. py mia. 58th Pennsylvania. June 28, thigh amp. at middle third, by 35 Deniker, D. H., Pt., E, Sept. 20, Right leg ; thigh amp. at lower 1803. Surg. J. F. Galhv-pe. 17th Mass. 2d Maryland, age 20. 28, 04. third, by A. A. Surgeon M. M. Died July !.(), 18u3. Townsend. Died Sept. 29, 04. 13 Boies, J. A.. Lieut., II, May 22, Loft knee. by spent shot ; pyaemia ; 30 Dodge, W. M., Serg t, July 2, Right leg; gang.; lupin.; amp. 13th Infantry, age 22. June 18, amp. of thigh at upper third. F, 137th New York, 10, 03. thigh, by Surg. II. E. Goodman, 1803. Died June 28, 1803. age 45. 28th Penn. Died July 13, 63. 14 Brockman, 11., Pt., I, April 0, Right femoral artery cut : double 37 Doyle, L., Pt., K, 8th May 20, Right thigh perforated! June 1, Oth Kentucky. June 20, (lap amp. thigh. Disch d Aug. Maine, age 34. June C, haem : fern, ligated : recurred ; 1802. i>, 1803. 1804. amp. thigh, by Asst. Surer. W. 15 inurl-f. IF., Pt., B, 24th Sept. 19, thigh : gangrene : thigh amp. II. Gardner, u". S. A. Died June Alabama. 23, 03. Died Sept 23, 1803. 0, 1864, exhaustion. 16 Burroughs. //. C., C, April 1, Poplit l space, r t leg ; gang.: circ. 38 Drilling, H.,Pt.,C, 124th Oct. 26, Right fern, vein and art ry wound 7th C. S. Cavalry. May 15, amp. thigh, by Surg. W. Hayes, New York, age 30. Nov. 1, ed; haem.; amp. thigh, by Surg. 1805. U.S.V. Died May 17, 05. gang. 1804. D. W. Bliss, U.S.Y: Die d Nov. 17 Butler, II., Pt., TI. 1st June 1 . Left le*" 1 just below poplit l space 21, 1804, pyaemia. New York Artillery. Aug. 5, gang ; amp. thigh, by A. A. Surg. 3 J Dudley, C. H., Corp l, Sept. 20, Right foot ; gang., involving pop age 21. 1804. \V. C. Way. Died Aug. 0. 04. 1 1th Indiana Battery. Nov. 24, liteal artery; lurm.: amp. thigh, 18 Cameron. .!., Serg t, 1C, June 20, Risfht thigh : ch. arthritis ; double 1803. by Surg. T. A. MoParlin.U.S.A. 31st Maine, age 21. 04, July flap, thigh, by Ass t Surg. H. E. Died Dec. 11, 63. haem.. debility. 5, 00. Brown, U. S. A. Recovery. 40 2 Dutcher, J. H., Pt., M, May 31, Left popliteal artery divided near 10 Carroll, R. A., Pt.. F, July 3, Right leg; doub. flap amp. thigh, 2d New York Heavy June 5, end ; gang.; thigh amp., by Surg. 3d Alabama, age 19. Nov. 29, by A. A. Surg. J. E. Steele; Artillery. 1864. J. A. Lidell, U. S.V. Die d June 1803. haemorrhage: fern, art ry li<rated. 8, 04. exhaustion. 20 Case. E. F., Pt.. O, 13th Sept. 19, Died Feb. 17, 1804, pyasmia. Left fern, artery severed; gang.; 41 Dyer, G. A., Serg t, G, 6th Maine, age 21. Nov. 7, 03, Feb. Right thigh ; amp. thigh, by Surg. D. W. Bliss, U. S. V. Disch d Michigan. 26, 03. Sept. 24. amp. leg four inches 19, 04. April 19, 04. Spec. 2047.A.M.M. below knee ; 20th. thigh amp. at 42 Edwards. C. S., Pt., G, Dec. 31, Left leg; amp. thigh, by A. A. upper third. Died Sept. 27, 03. 57th Indiana. 02, May Surgeon J. B. Burns. Disch d 21 Chapmnn. C. II.. Serg t, Sept. 30, Right thigh: gang., destroying 26, 03. Aug. 23, 1863. 10, 13th Ne\r Hamp 04, Apr. profundaart yjhaem.; circ. amp. 43 Elliot, J., Corp l, E, 2d April 2, Left leg ;hsem.: April 29, popliteal shire, age 26. 7, 05. up. third, by Surg. 11. I. P. flood- Pennsylvania Cavalry, May 5, artery ligated: hjpm. recurred : win. Died iive hours after ope n. age 24. 1863. amp. thigh. Died May 5, 1863, 22 Chapmnn. J. S.. Pt.. E. June 18, Left knee ; amp. post. flap, thigh, from shock, 2 hours after amp. 4th Maine, age 33. July 5, by Surg. E. Bentlev, V. S. V. 44 Farder, J., Pt.. 1st N. June 20, Right thigh and left leg: amp. left 23 Chawgo. M. \V., Pt.. II, 40th New York, age 21. 18(54. May 13, 17, 64. Died July 0, 1804, exhaustion. Right leg; gang.; hsem.: amp. at low. third, by Asst. Surg. C. A. 45 Carolina Cavalry, age 25. Feary, G. M., Pt., B, Sept. 1, 1804. July 2, thitrh, by Surg. II. L. W. Bur- ritt, U. S. V. Died Sept. 2, 64. Right thigh, severing fern, artery; McCall, U. S. A. Died May 19, 108th New York. 14, 03. hnnm.; gangrene; amp. of thigh. 1804, pyaemia. Died July 24, 1863. 1 FERRY (C.), Report of Wounded treated in Field Hospital of llindman s Division, etc., in Confederate States Med. and Surg. Jour., 1804, Vol. I, p. 77. 2 Lir>KLT, (J. A.), Wounds of the Arteries, in Surg. Mem. of the. War of the Rebellion, by the U. S. Sanitary Commission, 1870, Vol. I, p. 59. SECT. I.] AMPUTATIONS OF THE THIGH AFTER SHOT FLESH WOUKDS. 55 No. NAME, MILITARY DESCRIPTION 1 , AND AGE. DATES. INJURY, OPERATOR, AND RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. 46 Fenton, C. ( Serg t, E, May 6, Left thigh, wound g profunda art.; 72 Lauch, H., Pt., Bras- Sept. 19, Left thigh, severing fern. art. and 1st Penn., age 25. 22, r 64. frequent luems.; amp. thigh, by Surg. K. B. Bontecou, U. S. V. ton s Artillery, age 34. 28, 64. vein; hiem : amp. thigh, by Surg. G. M. Uurditt, P. A. C. S. Died Died May 22, 64, exhaustion. Sept. 28, shock opcr n and gang. 47 Foss, A. J., Pt., F, loth April 27, Right leg ; gang.; amp. thigh. 73 Lee, W. II., Corp l, F, Feb. 10, Right thigh ; exten. suppu n, knee N. Hampshire, age - I. M y8, G3. Died May S, 1863. 32d Colored Troops, .Mar. 14, joint inv.; circ., lower third, by 48 Foust, J., Pt., , North Mar. 27, Left knee, not in volv g. joint ; ex age 6. 1865. Surg. A. H. Thurston, U. S. V. Carolina Artillery, age June 17, tensive suppurat n involv g joint; Died March 14, 1865, irritative 37. 1865. amp. thigh, by A. A. Surg. J.Gil- fever, shock. man ; hajin.; artery lig.; July 10, 74 Leonard, J., Pt., L, 7th Mav 30, Left leg; July 3, haem.; ligation pyaemia. Died J y 25, 65, exh n. New York H vy Art y, July 8, of posterior tibial artery; amp. 49 Gardner, G. W., Serg t, Oct. 11, Right fern, artery injured; gang.; age 21. 1864. thigh. Died July 23, 1864. H, 12th Illinois Cav 29, 03. amp. thigh, by A. A. Surg. W. 75 Lloyd, R., Pt., B, 1st Dec. 31, Left thigh ; amp. thigh at lower alry, age 29. H. Ensign. Died Dec. 5, 1863, Kentucky. 62, Ap l third. Disch d Aug. 26, 1863. debility. Spec. 1760, A. M. M. 4. 63. 50 Goldsborough. H. J., June 26, Left knee; ulcerat ion of articular 76 Lyon, II. J., Serg t, H, July 21, Left popliteal space ; gang.; amp. Pt., B, 3 1st Illinois. Dec. 1G, surface of bone ; amp. thigh, by 40th Illinois, age 24. 28, 64. of thigh, by Surg. E. J. Buck, 1863. A. A. Surg. J. D. Davis. Died 18th Wis. Disch d April 26, 65. April 15, 1H64. 77 McCarthy, D., Pt., C, Aug. 9, Right popliteal space; amp. right 51 Gooding, H. P., Pt., H, Jan. 30, Left knee; extensive suppurat n, 2d Mass., age 22. Sept. 15, thigh, by A. A. Surg. T. B. 10th Michigan Cav ry. Feb. 27, joint disorg zed; flap. low. third, 1862. Townsend. Disch d June 17, 64. 1865. by A. A. Surg. T. \V. Branch. 78 McClure, R., Pt., L, 15th Jan. 21, Right leg, severing ant. tibial art. Died March 4. 1865 ; pyaemia. Kansas, age 18. 24, 64. and nerve ; mortification ; amp. 53 Hasey,W. H. H., Serg t, July 1, Right leg; gang, and luetn.: amp. thigh, by Surg.A.C. Van Duzen, E 20th Maine, age 23. 30, 64. thigh, by A. A. Surg. 11. B. Ma- U. S. V. Disch d Nov. 14. 64. ben. Died Sept. 2y, 64, exh n. : McMahon, E., Lieut., D, Aug. 30, Left knee ; circ., lower third, by 53 Haskell, A. M., Corp l, Oct. 19, Right knee ; amp. post, flap, June. 80th New York, age 21. 62, Feb. Asst. Surg. E. J. Marsh, l/.S.A. K, 12th Maine, age 23. Nov. 15, lower third, by A. A. Surg. W. 7, 63. Jul. Re-amp., by Prof. W. Parker. 1864. Kempster. Nov. 21, haem.: lig. , 1864. Recovery. Spec. 1054. fern.; hajm. 27th and 30th. Died 80 Maher, L., Pt., C, 69th Sept. 17, Right knee ; amp. post flap, up. Dec. 1, 1864, exhaustion. New York. Nov. 24, third, by Surg. II. S. Hewif, U. 54 tfai/nes, A., Major, 29th May , Right fern. art. injured: single flap V 1862. S. V.; necrosis. Disch d April Virginia. 27. 64. amp. of thigh. Died May 30, 64. 12. 1864. Spec. 754. 55 Bembery, A. J., , K, Sept. 19, Lower portion popliteal space; 81 Martin, J. H., Pt., E, May 12, Left leg. injuring saphenous vein ; 4th Alabama. Oct. 1, haam. from poplit l art.; amp. just 100th Pennsylvania. 12, 64. gangrene : amp. thigh at lower 18(i3. above knee. Died end third day. third. Died May 18, 64. 56 Rickey, J., Pt,, C, 22d July 2, Right leg, follow d by trau. aneur. 82 Martin, M., Pt,, H, 1st June 24, Left knee : circ., mid. third, by Massachusetts, age 19. Aug. 5, of ant.^and post, tibial arteries; Artillery, age 24. Aug. 14, Surg. E. Bentlev, U. S. V. To 1863. haem.; gang.; amp. thigh, by 1864. duty Dec. 9, 18:>4. Surg. C.W. Jones, U.S.V. Died 83 3 McCreary, S.C., Pt.,F, Sept. 1, Right leg.pertbrat gant. tib.art y; Aug. 16, 63. Spec. 1698, A. M. M. 100th Pennsylvania. 14. 62. amp. thigh. Disch d Dec. 4, 62. 57 Hogstead, P., Corp l, A, Feb. 7, Left leg; amp. thigh, by A. A. 84 Mather, H. G., Pt., H, June 17, Left leg; gang.; amp. thigh, by 187th New York, age 26, 65. Surgeon R. Westerling. Died 90th Penn., age 20. July 20, A. A. Surg. G. Badger. Died }. March 8, 1865. 1864. July 20, 1SG4. 58 Hopper, B., Pt.. F, 64th May 12, Left knee; destructive inflamma 85 Mathers, W. D., Pt.. I, Oct. 19, Left leg ; gang, and haem.; amp. New York, age 28. June 1C. tion in joint; amp. thigh, by A. Cth Vermont, age 28. Nov. 13, thigh, by A. A. Surg. F. F. Mur- 1864. A. Surg. J. E. Dexter. Died ltjG4. dock. Died Dec. 16. 64. pyaemia. June 21, 1864, pyaemia. 86 Mej-er, M., Pt., L, 15th Aug. 18, Left leg: gang.: amp. thigh, by 59 Hubbach, H., Corp l, F, Ang. 30, Left thigh. Disoh d Nov. 20, 63. New York Artillery, Oft. 6, A. A. Surg. J. P. Arthur. Died 68th Xew York, age 42. 62, Oct. Contract n of flex, of thigh, and age 44. 1864. Oct. 7, 64. Spec. 3?80, A. M. M. 6, 65. atrophy: flap amp. thigh seven 87 Miller, P , Pt., A, 64th Dec. 16, Left leg: gang.: thigh amp., by inches from body, by Dr. L. Ohio, age 40. Jan. 22, Surg. R. H. Gilbert. U. S. V. Bauer, of Brooklyn. Recovered. 1865. Died Feb. 9, 65, pyaemia. CO Hyatt, J. B., Pt., E, 7th July 9; Loft popliteal art. in.i.: gang.; amp. 88 Monre, T., Pt., E, 51st Sept. 19, Right knee; abscess: ciro,, lower Indiana Cavalry, age 19, V C4. thigh, by Surg. J. G. Keeuon, Virginia, age 19. Nov. 14, third, by Surg. B. M. Cromwell, 18. U.S. V.: gang, of stump and loft 1864. C. S. A. Died Nov. 14, 1864. King. DiedA ig. 11. 64, pya?mia. 89 Moss. B. F., Corp l, B, July 25, Left leg: gang.: amp. leg, by A. 61 Jenkins, W. II., Pt., C, Oct. 13, Right thigh. Disch d. May If, 65, 101st Illinois, age 43. Nov. 1 1, Surg. W.H.Trull, U.S.V. Nov.9, 39th Illinois. 1864. three large exost^scs rem., bone 1864. diffused aneur. in poplit l region; Mav 5, scraped ; Oot. 21. rcm. large se lutms.: amp. thigh, by Dr.Trull: 1863. questrum: May 5, 68. thigh amp. hiems. from and ligation i.f fern. at base of troclmnter, bv Surg. artery. Disch d .lime 25. 65. C. M. Clark, late 3:)th ill. Re 90 Nichols, M. S., Pt., G, Sept. 19, Loft leg: knee joint opened by covered, Got. 2, 1869. 91st Ohio, age 23. Nov. 14, uloeration: amp. thigh, by Asst. 62 Johnson, P., Pt., E, 2d June 27, ! Right knee; sloughing: amp. 1864. Surg. N. F. Graham, tf. S. V. Penn., age 27. Oct. 19, thigh, bv A. A. Surg. W. P. Died Dec. 7, 64. pyaemia. 1864. Moon. Died Oct. 21, 18G4. 91 Nobler, B., Pt,, F, 85th June 30. Right log : sloughing ;md h;pm.; 63 Johnson, W., Pt.,G, 34st June n. Left gnstrocnemius; amp. thigh. . Illinois, age 21. Aug. 4, amp. thigh at lower third, by A. Alabama, age 22. J v 1, < <)4. Died July 12, 1HG4, pyaemia. 1864. A. Surg. S. C. Ayres. Died 64 Jones, J. T., Pt., H, 8th Dec. 10, Loft log ; gang.; amp. thigh. byA. Aug. 14. 64, anaemia. Wisconsin, age 21. 64, Feb. A. Surg. C. V. Barnard. Trans- 1| 92 4 Nottingham, G. M., Pt., May 1, Left popliteal region secondarily 26, 65. fcr d Sept. 20. 65, for musterout. I, 56th Ohio. 20, 63. involv g popliteal artery: luem.; 65 Keep, M.. Pt., E, 3Gth May 19, Left pnpliteal space; knee joint amp. thigh, by A. A. Surg. L. Massachusetts, age 23. June 4. ope d by suppurat n: amp. thigh. Dyer. Died May 29. 63. 1864. by Surg. D. P. Smith, IT. S. V, 93 opaue, A. C., Capt, D, Sept, 16, Post. tib. art. cut by ball : incip. Died June !\ 1864, pyaemia. 21st Virginia. 16, 62. tnort.: amp. thigh, by If. T. Cole- 66 Keller, B., Pt.. T, 1st Mav 11, Right thigh; circ. amp. of thigh, man, chief surg. Gen. Stonewall Mich. Cavalry, age 36. Jtilv 2, bv Surgeon A. Ileger, U. R. A. Jackson s Corps. Recovered. 1864. liiod July 3. 1804. exhaustion. 94 Pcrcel, J., Pt., , 148th Mav 3, Thigh : aneurism : amp. up. third. 67 Kenvon. B. G.. Corp l, Je.16, 64, Left leg: amp. thigh, by Prof. A. Pennsylvania. 21, 63. by Surg. C. S. Wood. 6<;th New H, llth New Hamp. Jnn.3. 67. II. Crosby. Discli d Sept. 27, 6.">. York. Died May 21. 1863. 68 Kintnor, S. L., Corp l, Julv 12. R t thigh : amp , f-ure. J. L. Dick- 95 Pittoe. R.. Corp l, F, 50th Dec. 11, Popliteal space, destroying popli A. 24th Iowa. , 63. ey, 47th I ml. Died July 16. 63. New York. 11, 62. teal vessels and nerves: ha in.: 6!) 2 Kogcl. C.. Pt., D. 1.1th May 30, Right leg ; gangrene : amp. thiffh, amp. thigh. Died Dec. 12, (12. New York H vy Art y, June 6, by A. A. Sur<r. C. II. Osborne. 96 Ports, I. A., Pt., D, 27th Oct. 3, Perfor. riglit poplit l space: gang.; age 39. 1864. Died June 16 18G4, pyo?mia. Ohio. 12. R2. amp. thigh. Disch d April 7. 63. 70 Lane, D., Pt., K, 14th June 14, Left knee : sloughing : amp. thigh. 97 Price, G., Pt., C, 2d July 2, 2, Left foot and log : gang.: primary Ohio, age 34. Aug. 7, by Asst. Surgeon B. E. Fryer. Delaware. 1863. amp. thigh, by Sure-. C.S.Wood, 1864. Died Aug. U>. !P64, pyaemia. 66th X. Y. Died July , 63. 71 Larkin, T., Pt., K, 4th June 23. Left thigh and wrist. Di sc d Aug. 98 Rayser,.I.J.. Pt.. B. 14th Oct. 19, Right knee: joint opened by in- Mass., age 18. 63, June 20, (!:). Atrophvand exo. pain ; ij Penn. Cav., age 40. Nov. 8, flam.: amp. post. flap. mid. third, 15, 64. amp. at up. third thigh, bv Dr. 1864. bv A. A. Surg. A. W. Emory. C. H. Stedman, Boston. Ree d. Died Nov. 8, 1864. 1 EVE (P. F.), Casts of Secondary Hemorrhage, etc., in Sury. Mem. of the U ar of the Kebe.Uinn, U. S. San. Comm., 1870, Vol. I (Surgical) p. 210. 2 Lll>ELL (J. A.),op.cit., p. 61. 3 Ibid., p. 57. 4 BuYAN (J). Amputation of Left Thigh, upper third, in Am. Med. Times, Vol. VII, p. 5. COLEMAN (R. T.), Hems of Army Experience, in Virginia Clinical Record, 1872, Vol. II, p. 141. 56 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME. MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR. AND RESULT. NO. NAME. MILITARY DESCRIPTION, AND AGE. DATES. INJUKY, OPERATOR, AND RESULT. 9!) Uennick, L., Pt., I, 26th Missouri. Sept. 19, Dec. 30, 1862. liight thigh : pr ifuso suppurat n : amp. thigh. Died Dec. 31, 02. pyaemia. 116 Spencer, C., Capt., 1, 1st Michigan. Julv 2, Dee 28, 1863. Right thigh, injnr g sciatic nerve ; amp. thigh, by A. A. Surg.D.O. Farrand. Disch d May 16, 64. 100 Rickard, .T. II., Ft.. D, 1st Alabama Cavalry. Jan. 27, Feb. 28, 1804. Right thiirh : ulceration popliteal art.: basin. : thigh amp., by Surg. J. G.Keenon.l .s.V. Died Feb. 117 Stark, (). II., Scrg t, H, 13tli New Hampshire, age 36. Sept. an, 64. Jan. 3, 05. Right leg ; sloughing : "Dec. 25, amp. leg; reamp. in thigh, by A. A. Surg. II. H.James; haem.; 29. 64. exhaustion from haem. art y lig. Died Jan. 13, 05,pyaem. 101 Uobericlit. C.. It.. B. Julv 18, Extcns. lace, right leg. Disch d 118 Suit/, S. A., Pt.. B, 1st Nov. 30, Right thigh ; gang.; popliteal art. 48th New York, age 44. <;:!. Mar. 15. . 65. Autr. 2J, C4 : flap amp. thigh, by Dr. L. Bauer, c.f Brooklvn. Died Missouri, age 25. 64, Feb. 7, 65. sloughed ; amp. thigh, bv Surg. B. B. Breed. 1 . S. V. Died Feb. Aug. 23. 1871. 16, 1865, exhaustion. 102 Rolf, L. F., Pt., M, 1st Maine Artillery. June 18. l>4. June Left leg : necrosis ; thigh nt mid. third, by Dr. J. C. Manson. tin Taylor. James. Pt., K. 7th New York Heavy June 16, 64. Jan. Left leg; thigh amp., by A. A. Surg. E. J. Farwelt. Disch d 30, "06. Recovery. Artillery, age 22. 17, 65. July 6, 1865. 103 Roork, E. P.. Pt., F. 3d Nov. 27. Right popliteal nerve and artery 120 Thorn, 11. C., Pt., 1, 14th July 20, Right thigh ; Aug. 7, haem.; lig. Pennsylvania Cavalry, utrp <>> Dee. (i, 1863. severed ; thigh amp., bv Surg. K. Bcntlev. r. S. V. Disch d West Virginia, age 19. Aug. 7, 1864. fern.: amp. thigh, by Surg. J. B. Lewis, U S.V. Died Aug. 12, 64. "& e June 18, 1864. 121 Townsend, E., Pt., F, June 2, Left knee ; joint ope. by ulcerat n; 104 Root, 11. V.. Pt., B. 104th June 20. Right leg: gang.: necrosis ; Oct. 5th New Hampshire, 31, 64. amp. post, flap, upper third, bv Xew York, age 26. 64. Feb. 29, remov. of 10 inches neen sed age 35. Surg. E. Bentley.U.S.V.; haem"; 29, 05. tibia: thigh amp. Disch d Julv lig n. Died July 1. 64, asthenia. 21. 65. Sj>cc. 3601, A. M. M. 122 Trees. .L, Corporal, D, June 2, Right knee. June 20, haem.; pop 105 Kowe, G., Pt., B, Cist July 0, Right knee: gangrene, involving 188th Penn.. age 21. 28, 64. liteal flaps, mid. third. Disch d Georgia, ago 32. Aug. 5, 1864. joint; thigh amp., by A. A. Surg. J. II. Coover. Died Aug. 7, 04. 123 Vann, D., Pt., B, 8th N. June 3, Dec. 8, 1864. Left thigh, injuring popliteal art.; Spec. 3809. A. M. M. York Artillery, age 18. 20, 64. hsem.; June J6, popliteal lig.; IOC Royster, J. M., l>t.. C. Julvl. Lett thisrh: amp. thigh, bv A. A. haem. recurred ; amp. thigh, bv 47th North Carolina, 2(i, <;:!. Surg. (1. M. Paullin. Died July . A. A. Surg. E. Vogel. Died age 29. 20. 1863. Spec. 3961, A. M. M. June 22. 64, gangrene. 107 Schatt, II., Corp l, II. Mar. 25. Left thigh, dividing popliteal art.; 124 Waller, J. R., Corp l, A, July 30, Right knee: gang.; thigh amp., 04th New York, age 30. April 2. amp. thigh, bv A. A. Surg. 11. 19th Infantry, age 17. Oct. 25, by A. A. Surgeon M. L. Herr. 186-5. Craft. Disch d Sept. 26. 18G5. 1864. Died Nov. 5. 64. pyaemia. ,v/-<-.. 171. 228:!. A. M. M. 125 Watson, J. II.. Pt., B, June 4, Left knee ; joint ope. by suppu n ; 108 Shugert. J. L., Corp l, B, April 1. Right knee: second, disease joint ; ICth N. Jersey, age 36. 24, ( A. muscular flaps, mid. third, by 49tli Penn.. age 20. Mav 20. amp. thigh at low. third, by A. Surg. E.Bentley, U.S.V. Died 1865. A. Surg.W.B Chambers: liirm.: June 28, 1864, exhaustion. May 24. lig. femoral. Died May 126 White, J. L., Guerilla, May , Both legs perforated; left post. 25. 65. exh n from haemorrhage. age 38. 1863, tibial art. and nerve completely 109 Shupe, J., Pt.. E, 40th Dec. 15, Left leg, amp. thigh. Died Jan. Primary. sev d: gang.: amp. thi. Recov d. Ohio. 15, 64. 1. 181)5. gangrene. 127 Wick, J. C.,Pt.,C, 155th Mar. 25, Both thighs: May 23, luvm from 110 Simpson. P.. Pt.. F, 3Cth Sept. 00. Left thigh : amp. thigh. Died 1 enu., age 22. June 14. left popliteal ; lig n ; amp. thigh, Colored Troops, age 23. 1864. (M. 22. ( 4, exhaustion. 1865. by A. Surg. A. Delanev. I*. S.V. 111 Slanker, J., Pt., C, IGQd Juno 19. Left thigh, injuring poplit l art y; Died June 20. 65. exhaustion. Ohio N. G. Julv 2. gang.: amp. thigh. bv A. A. Surg. 128 Wild, C. B.. Corp l, E, Sept. 19, Right popliteal space : Oct. 1. 1864. W. 11. Drnry. Died July 2, 64. 114th Ne\v York. (Jet. 12, haem. from popliteal artery: iig.; 12 hours after opcr n, from shock. 1864. amp. thierh. bv Asst. Surg- B. A. 112 Sloss, A., Pt., A, 5th Dec. 10, Left knee: drstruc. cf tissue; amp. Fordyce, 160th N.York. Died Penn.. age 35. (14, June junct. low. thirds. bv Asst. Surg. Oct. 13. 3864, exhaustion. 10, ti5. J. 11. Frant/. Dis. Nov.2J, 65. 129 Wing, J. W.,Pt.,TI,27th Mar. 14. Right leg; gangrene; amp. thigh. 111! Smith. J. A., Pt..C,4th Mav 14, Right ki;ec; second, involv. ji.int: Mass.. age 45. April 7, by Surg. (1. A. Otis, 27th Mass. Maryland, age 18. June 9, amp. of thigh, by A. Surg. A. In 1862. liicd April 17, 1862. exhaustion. 1804. gram. I . S. A. Disc d Mar. 23. 65. 1GO Wolf. J.. Corp l, D, 4th Oct. 12. Left thigh : gang.: amp. thigh, by 114 Smith, W. F., Major, 1st Oct. 27, R lit thigh; lig. fern. art. and vein; New York Cavalry. Nov. 26. A. A. Surgeon J. F. Thompson. Delaware. 27, ( A. amp.th.,l>v Surg. A. N.Dougher 1803. Disch d Oct. 11. 1864. ty, r. S.V. Died Nov. 6. 1864. 131 Wright. D.,l t.,A.57th Sept. 17, Right thigh : gang.; amp. thigh. 115 Spalding. J. K., Pt., C. Aug. 30, Left popliteal artery severed; New York, age 23. Dee. 2, by A. A. Surg. A. V. Cherbon 35th New York, age 30. Sept. 12. amp n thigh. Died same day, 1862. nier. Died Dec. 20, 02. gang. 1862. from haemorrhage. Spec. 688, A. M. M. Amputations at the Knee. But one of the six disarticulations at the knee for com plications involving; shot flesh wounds of the leg had a favorable result. Three of the 1 ( * O operations were intermediary, three secondary: TABLE VIT. Numerical Statement of Six Disarticulations at the Knee Joint for Complicated Shot Injuries unattended by Fracture. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. x NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPKRATOR, AND RESULT. 1 Cole. D. D., Corp l. A. 2d New York Cavalry. April 7, Aug. 1, Left leg ; gang.; amp at the knee joint, patella retained, bv Ass t 4 i Huntington. I.. Pt., B, 92d New York, age 29. June 3. Aug. 2. Left leg; slough g: rccur t liicin.: amp. at knee joint, bv Surg. R. age 23. 1865. Surg. G. M. Mcfiill, U. S. A. 1804. B. Bontecou, U. S. V. Died Diseh d Nov. 22. 1865. Aug. 8. 1864. exhaustion. Card o Dempsey. M..Pt., I. 17th Oct. 5, Left leg : obliteration of fern. art.. I hot., Vol. Ill, p. 23. \ ermont. age 18. DC.:. 27. sloughing, and recurrent haem.; 5 Leonard. J.. Pt.. (1. 5th Julv 3. Right leg, injur g post. tib. nerve : 1864. amp. at knee joint, by Ass t Sur Ohio, age 22. 16, 63. tetanus; amp. at knee joint, bv geon W. A. llarvev, U. S. V. Ass t Surg. 11. C. May. 115th N. Died March 26, 1865. Y. Died July 16, 63. tetanus. 3 Grimes. F. A., I t.. C. April 16, Right leg. injuring popliteal art.: 6 Taggart. S. D.. Serg t. Feb. 6. Left leg; ganff.: recurrent ha in.: 4th \ ermont, !ige 2~ . 22, 62. haem.: amp. at knee joint, by G, 150th Pennsylvania, 20, 65. amp. at knee joint, by Ass t Surg. Surg. R. B. Bontecou. U. S. V.: i age 25. J. Vansant. T . S. A. Died Feb gang. Died April 8, 1862. i ruary 20, 1865. 1 LIIIELI. (J A.), op.cit., p. 47. SECT. J.I AMPUTATIONS IN THE LEG FOR SHOT FLESH WOUNDS. 57 Amputations in the Leg. Of sixty-three operations in this category thirty-three proved fatal, or 52.3 per cent Two primary cases were successful; of twenty-four inter mediary operations, seventeen, or 70.8 per cent., proved fatal; of thirty-seven secondary amputations, sixteen, or 43.2 per cent., proved fatal. The Museum possesses pathological specimens from some of the cases. Two of the cases are detailed, and all are enumerated in TABLE VIII: CASE 126. The late Dr. Bodisco Williams, of Georgetown, D. C.. who served in the Confederate Army, presented Acting Assistant Surgeon F. Schafhirt, of the Army Medical Museum, with the specimen figured below, with the accompanying history : " Rev. J. L , a young priest from New Orleans, acting voluntarily as field chaplain, tried to persuade a company of Irish railway laborers to take up arms to fight against the Yankees in front of Fredericksburg, December 12, 1862; but during his speech a large shell exploded close in front of the group and killed three and wounded eight, including the priest, who received a small skin wound over the inner surface of the left tibia, about five inches above the tarsal articulation. Rev. L did not take much notice of the wound until the leg was in full inflammation up to the knee. He had returned to Lynchburg, where he applied bread and milk poultices for several weeks, but afterwards he sent for a physician, who exerted all his knowledge to ?avc the leg. But nothing would avail, and caries of the bone having supervened, gangrene at last reminded the attendant of amputation, which was performed by Dr. Pearson, of Virginia, who took the leg off one inch below the tuberosity of the tibia, August 25, 1863. But even this remedy did not improve the physical health of the patient; and his soul left Lynchburg, September 2, 1863, for that great and blissful haven, it may be hoped, which he had promised to those Irishmen in front of Fredericksburg." The specimen represented in the adjacent wood-cut (FlG. 22) presents great erosion, as though from caustic j nc j,e8 of shaft applications made to arrest the progress of gangrene, and there are neighboring evidences of extensive periosteal ^ ! 1|C left tibia, thickening with osseous exudations and deposits. See Cat. Sunj. Sect., Army Medical Museum, 1863, p. 394. ded. Spec. 858. CASK 127. Private G. Brown, Co. C, 97th Pennsylvania, aged 18 years, was wounded at Petersburg, June 17, 1864, and was admitted to hospital at Fort Monroe two days afterwards. Assistant Surgeon E. McClellan, U. S. A., reported : "Gunshot wound of right foot, flesh." From Fort Monroe the wounded man was transferred to Knight Hospital, New Haven. where amputation was performed but not recorded. Subsequently the patient was transferred to McDougall Hospital, and lastly, on January 19, 1865, to Central Park, New York City, whence Surgeon B. A. Clements, U. S. A., reported: "Gunshot wound of right foot; a minie ball passed through the metatarsus, entering on the dorsiun of the foot. Mortification supervened and the condition of the injured parts became very bad; constitutional condition of patient feeble; loss of appetite ; unable to sleep from pain in wound. On July llth, amputation (apparently circular) of the leg just above the ankle joint was performed at the Knight Hospital, New Haven, by Acting Assistant Surgeon C. Lindsley. Two ligatures were applied, and ether was used as the anaesthetic. Healing progressed well for three Aveeks, when the stump sloughed, which was arrested in four or five days." The specimen represented in the annexed wood-cut (FlG. 23) was contributed by Acting Assistant Surgeon S. Teats, who performed re-amputation on April 1G, 1865, on account of " a sloughing ulcer and a cold and blue condition of the stump." The stump healed at the end of five weeks after the last operation, and the patient was supplied with an artificial leg about two months afterwards. He- was discharged from service August 17, 1835, and pensioned. In his application for commutation, Spec 43 ~ 9 dated 1875, the pensioner described the stump as being in good condition. He was paid his pension June 4, 1876. FIG. 23. Two and a half inches of stump of right leg. TABLE VIII. Summary of Sirtij-three Cases of Amputations of the Ley for Complicated Shot Injuries unattended by Fracture. No. NAME. MILITARY DESCKIPTIOX, AXD AGE. DATES. INJURY, OPEUATOU. AXD RESULT. :co. NAME, MILITARY DESCRIPTION, AXD A GE. DATES. INJURY, OPEUATOH. ASH RESULT. 1 Addington, .T.,Serg t, A, Juno 20. Right ankle : gangrene: amputa G Batherie. N. T.. Corp l. June 6, Left leg; gang.; amp. leg. by A. 84th Indiana, ago 25. Julv 2J. tion leg. by Surg U. 51. S. Jack A, 15th Mass., age 34. 24. 64. A. Surgeon M. F. Price: haMn. 18G4. son, I . S.V. Died Sept. 2. 1864. Died June 30. 64. asthenia from pyaemia. wound, and diarrhoea. 2 Ainswerth.W.H.,.Serg t. May 6, Right leg ; amp. leg. by Surg. 7 Becker. II.. Pt.. F, 50th May <). Right leg: sloughing: amp. leg. K. 4::d Now York, age Juno 2.), W. 1). Stewart. 11. S.V. Disch d Penn.. asre 23. Aug. 10, by A. A. Surgeon (4. E. (ialen. 2 - . 1864. Nov. 3. 1865. 1864. Disch d May 22. 1865. :! Alexander. E. J.. Corp l, June 1 4. Right leg; aaip. of leg. Died t! Bell. J., Corp l. C,, (ii th Dec. 13, Left leg ; sloughing; harm.: amp. B. 11 Oth Now York. . (S3. July 2, 1863. Penn., age 40. 62. Mar. leg. by A. A. Surg. F. II. (let- 4 Barnum. C. F., I t.. E, June 18. Left leg .- amp. leg, bv A. A. Surg. in, <;:. chell. " Disch il Dec. 14. U63. 187th Pcnn.. age 30. j Aug. 2~! J. P. Arthur: hsein.; Sept. 7, 9 Biokley. II.. Serg t. F, May 14, Left; slough : amp. leg, by A. A. 186 J. amp. thigh. Died Oct. 13. 18G4. ! lOtli New Jersey, age Aug. 13. Surg. G. W.Webb : ha>;n. I >i<-d S/Kie.313,!, A. M. M. 21. 1864. Aug. 23. 64. Spec. 3665. A.M. 51. 5 Ban-on, C., Pt., D, 14th May 12. Left f.)ot : gang.: amp. leg. by A. 10 Bloomer. A. S., Pt., G, May 15, Right foot ; gang.; amp. leg. by Connecticut, age 43. Sept. 10, 1864. A. Surgeon S. Smith. Disch d Juno 18. 186."). 5Jth Ohio, age 20. July 21. 1864. Ass t Surg. J. A. Freeman. I . S. V. Disch d Feb. 10. 1865. Sr-KG. Ill H 58 INJURIES OF THE LOWER EXTREMITIES. [CHAP. :;o NAME, MILITARY DESCRIPTION*, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATOR, AND RESULT. n Drown, G., Pt., C, 97th June 17, Right fool; gang.; amp. just aboye 39 Mangan, J.. Pt., F, 82d Julv 20, Left leg; amp. leg, by Surg. H. Penn., ago 18. Julv 11, ankle, by A. A Surg. Lindsley; Ohio, age C8. 22, 64. K. Spooner, 61st Ohio; haem.; 64, Ap l sloughing; ream p. leg. Disch d lig. ot anterior tibial artery Aug. 16, 65. Aug. )8, 65. Spec. 4329, A. M.M. 15, 64. Disch d May 23, 65. 12 Burke, M., Serg t, C, June 3, Right leg; sloughing; amp. leg, 39 Mendenhall, J., Pt., B, May 20. Right leg; sloughing; amp. leg, lC5th N. York, age 51. Aug. 2G, by A. A. Surgeon M. Lampen. !)7th Penn., age 30. Julv 22. by A. A. Surgeon A. D. Hall. 186-1. Died Aug. 27, 1864, pyaemia. 1864. Died July 29, 18G4, pyaemia. 13 Burley. M. D., Pt.. G, May 6, Right leg; amp. log, by A. A. 40 Moser, C., Pt., K, 5th June 18, Left ankle and thigh ; gang.; amp. 45th Penn., age 17. Sept. 13, Surg. 1J. Wilson, gang.; hoem. Michigan, age 43. July 19, leg, by A. A. Surg. F.D \Veisse. 1864. Diseh d Jan. 2- . 18i>5. 18~64. Died July 26, 1864, pyaemia. 14 nunis. T., Pt., D, 8th N. June 17, Right leg; amp. leg. Discharged 41 Moss, B. F.. Corp l, B, July 25, Left leg; gang.; amp. leg, by A. Vcrk II. Art ry. age 34. 17, 64. June 20. 1865. 101st Illinois, age 43. Aug. 2-1, Surg. W. B. Trull, U. S.V.; dif 15 Case, E. F., Pt., G, 13th Sept. 19. Left thigh, sevc g fern, art.; gang.; 1864. fused aneurism ; haem.; Nov. 11, Michigan. 24, 63. amp below knee; gang, extend amp. thigh ; haem.; Dec. 15, lig. ing; Sept. 26, amp. at up. third fem. Disch d June 25. 1865. thigh. Died Sept. i.7, 63, gang. 43 Mott, J., Pt., E, 105th June 26, Left log; slough, ant. tibial; haem.; 16 Cous:ns. J. A., Corp l, May 19, Left foot; slougliing and erysipe- Illinois, age 37. July 26, amp. leg, by Ass t Surg. B. E. I. 1st Maine H vy Art., June 16, lous : flap amp. at up. third, by 1864. Fryer. U. S. A.; July 27, trans ago 24. 1864. Dr. McConnor. Diseh d July fusion. Died Aug. 5, 64, haem. 10. 1865. 43 Paden, W., Corp l, G, May 23, Right thigh; May 29, 31, haem.; 17 Cross, G. P., Pt.. P, 1st ^ine l(i, Right leg: gang.; haem.: amp. leg, ll.th Peun. Reserves, June , June 1, femoral tied; amp. leg, Mass. Heavy Artillery. Aug. 18, by Surg. E. Bentley, U. S. V.: age 22. 1864. by Surg. G. L. Pancoast, U.S V. age 19. 1864. two ounces of blood injected into - Died June 26, 1864. gangrene. veins. Diseh d June 9, 65. 44 Parmenter, J. D., Pt., April fi, Left foot ; gangrene and necrosis ; 18 Dixon, J. #.,Pt.,F, 24th Mar. 23, Right leg; gang.; amp. leg. by G, 67th Penn., age 16. June 21, amp. leg, by Surg. R. B. Bonte- N. Carolina, age 24. April 12, A. A. Surg. J. P. Arthur. Died 1865. cou, U.S.V. Disch d Nov. 23, 65. 1863. May 4, 1865. exhaustion. 45 Prather, B., Corp l, D, Dec. 15, Right foot : exc nhalf in. post. tib. 19 Downey, J., Pt., F, 29th May 15, Left leg; caries; amp. leg, by 103d Ohio, age 18. 27, 64. nerve ; Dec. 26, amp. great toe ; Penn.", age 30. July 13. Ass t Surg. II. T. Legler.U.S.V. amp. leg, by A. A. Surg. S. G. 18,i4. Diseh d Sept 1, 1864. Ay res. Died Dec. 29, 64, tetanus. 20 Emery, R., Pt., D. 5th M y5, 64. Loft leg; gang-.; ha?m.; Aug. 4, 4G Reed, J.. Corp l, F, 101st June, 62. Shot flesh w nd of ank. joint ; circ. Vermont, age 33. Aug. 23, 1834, post, tibial lig n. Diseh d New York. Interme amp. at junct. of low. third leg, 13(55. Dec. 16, 64 ; leg amp. diary. by Ass t Surg. P. S. Connor, U. 21 Gilbert, G. H., Lieut., B, Nov. 8, Both feet contused by spent ball ; S. A. Died July 29, 1862. 122d New York. Dec. 7, gang, left foot ; amp. left leg. by 47 Ross, A. G., Corp l, I, Oct. 19, Right fem. art. injured; also w d 1863. Surg. II. W. Ducaohet, U. S.V. 13th Mississippi, age 21. Nov. 8, of left thigh: gang.; lig. of fem.; Diseh d May 23, 1864. 1864. amp. right leg three ins. above 22 Gooch, A. B., Pt., F, May 9, Left ankle; caries inv. ank. joint; ankle. Retired March 14, 1865. 12th Ohio, age 21. Nov. 19, flap amp. mid. third, by Surg. 48 Saulsbury, W., Pt., K, July 30, Right leg; sloughing; hasm.ant. 1864. N. Gay. U. S. V. Disch d Feb. Stlth Colored Troops, 1864. tibial art.; art. lig. in w nd ; ha?m. 33. 1865. age 36. Jan. 19, recur d; art. relig.: amp. log, by 23 Goodell. E D., Corp l, June 3, Right foot ; gangrene ; amp. leg, 1865. A. A. Surg. O. Shittler. Disch d D, 25th Massachusetts, July 22. by A. A. Surg. B. F. Butcher. May 26. 65. Died July 16, 71. age 21 . 1864. Disch d Oct. 31, 65. Spec. 333J, 49 Smith, \V., Pt,. D, 17th May 12, Right ankle joint ; suppurative in- A.M. M. Infantry, age 22. July 8, flam n, caries; amp. leg, by A. 24 Goodrich, J., Pt., G. May 9, Both ankles ; gang.; amp. right 1864. Surg A. Ingram, U. S.A. Died 1-JSth N. York, age 40. June 5, leg. by Ass t Surg.H.C. Roberts. July 20, 64. Spec. 2865, A. M. M. 1864. U. S.V. Died June 5, "64. exh n. 53 Stark, O. H., Serg t, II, Sept. 29, Right ; slough.; amp. leg. by A. A. 23 Green, J. A., Serg t. E, June 7, Left foot; circ.amp. up. third leg, l"th New Hampshire, Dec. 25, Surg.H.IT James; sloug g; Jan. 2d Connecticut Art ry, 28, 64. by A. A. Surg. 1 . Wilson. Died age 36. 1864. 3. 1865, amp. thigh; haem.; lig. age 23. July 7, 1864, pyaemia. Died Jan. 13, 65, pyaemia. 2fi Gutting, A., Pt., D, llth Oct. 2, Right leg ; amp. leg, by Surg. J. 51 Stebbius. E., Serg t, L, Sept. 6, Left leg; haem.; amp. leg. Dis Mich. Cavalry, age 26. Nov. 9, B. Murphy. C. S. A. Diseh d 3d New York Cavalry, Oct. 12, charged June 15, 1863. 1864. Sept. 14, 1865. ago 26. 1862. 27 Hagey, J. D., Pt., I, April 2, Left leg; artery opened; hoem. 5J Stultz, G., Serg t, K, June 16, Left leg; gang, and necrosis: amp. 138th Penn., age 24. May 19, from post, tibial artery; art. tied; 5th New Jersey, age 26. 64, Jan. leg. by Surg. E. Bcntlev.U.S.V. 1865. amp. leg, by A. A. Surg. IT. A. 9, 65. Left hospital April 18, 1865. Drane. Disch d July 26, 65. 53 Sullivan, D., Pt., F, 1st Dec. 13, Left foot ; extensive inflammat n ; 28 Harris, J. M., Corp l, C, July 15, Right thigh; aneurism; sphacelus: Penn. Rifles, age 23. 29, 62. amp. leg, by A. A. Surg. C. II. 14th Iowa, age 20. 27, 64 ati mal sac probed; exces. hiem ; Bowen. Discharged. fern, tied; amp. leg, by A. A. 54 Tawncy, A.,Pt., D, 74th Sept. 19, Left leg; haem.; amp. leg, by Surg. Surg. R. W. Coale. Died Aug. Indiana, age 38. Nov. 29, G. Grant, U. S. V.; gang. Died 3, 1864, pyaemia. 1863. Dec. 6, 1863, gangrene. 29 Hays, A., Corp l. F, 3d June 18, Right foot ; slough g ulcer : amp. 55 Tewksbury. D., Pt., F, July 2, Left leg.; gang.; amp. leg, bv Delaware, age 29. Aug. 10, leg, by A. A. Surgeon W. W. 73d Ohio, age 22. 63, Ap l Surg. A. M. Speer, U.S.V. Died 1864. Sharplev. Disch d Mayl8, 65. 8, 64. May 8, 1864, pyaemia. Spec. 3668. A. M. M. 56 Thompson, J. A., Corp l, Aug. 3, Left leg ; gang.; amp leg. by A. 30 James, A., Pt. 1, 2d Ten Dec. 17, Left ankle; ball removed: gang.; K, 10th Indiana, age Sept, 3, A. Surg. A. L. Rice; haem. from nessee Cavalry, age 20. 64, Feb. circ. amp. lower third leg. bv 27. 1864. popliteal artery; artery tied. 4, 65. Ass t Surg. W. B. Trull, U. S.V. Died Oct. 4, 1864. * Died May 16, 1865. 57 Thornton, R. M., Serg t, July 30, Left leg; haem.; amp. leg. by A. 31 Kane, H., Pt., A, 24th Sept. 19, Left leg ; gangrene : amp. leg. by K, 4th Rhode Island, Sept. 28, Surgeon S. A. Orton. V. S. A. Iowa, age 25. Deo. 30, A.A.Surg.J.W.H.Baker. Dis age 26. 1864. Disch d January 28, 1865. 18G4. charged May 29, 1865. 58 Tillotson, C. A., Pt., E, Oct. 5, Right ankle ; slough g ar.dliaem.; 32 Knoble, H.,Pt.,D, 149th Nov. 27, Both thighs, ball impinging on 39th Iowa, age 32. Dec. 25, ant. post, flap amp. at mid. third, New York, age 27. Dec. 14, sheath of left fem. artery; gang.; 1864. by Ass t Surg. B. E. Fryer, U. 1863. amp. left thigh. Died Jan. 14, S. A. Died Jan. 6, 65, pyremia. 64. pyaemia. Spec. 2114, A.M.M. 59 Tryan, N., Pt., E, 4th May 5, Left foot ; gang.; amp. leg, by A. 33 Kuentzler, J., Pt., II, June 18, Right leg : sloughing: amp. leg, Ohio, age 26. July 3, A. Surg. A. McLetchie. Died 56th Penn., age 24. Julv 2.3. by A. A. Surg. E. K. Tell. Died 1864. Aug. 10, 1864, asthenia. 1864. Aug. G, 1864, pyaemia. GO Wares, D., Corp l, 22d May 5, Right leg ; amp. leg. by Surg. D. 34 Leasure, J.. Pt., F. 62d May 12, Left leg: haem.: amp. leg, by A. Massachusetts, age 31. 20, 64. W. Bliss, U. S. V. Discharged Penn., age 23. June 2, A. Surg. John Priestley. Died October 23, 1864. 1864. June 15, 64, haem. and pyaemia. 61 Williams, G., Pt., II, Sept. 27, Left leg ; haem.; amp. log, by A. 33 L J , Chaplain Dec. 11, Left leg; gang.: amp. leg. by Dr. 29th Colored Troops, Oct. 22, A. Surgeon J. II. Buchanan. (field). 62, Aug. Pearson. Died Sept. 2, 1863. age 37. 1864. Died Oct. 23, "64, exhaustion. 25, 63 Spec. 858. A. M. M. 62 Wolf, C., Corp l, D, 5th Dec. 16, Left leg, also wound of right leg ; 36 McCnrley, H., Pt., D, June 21, Right ankle: gang.; circ. amp. Minnesota, age 31. 64, Jan. amp. left leg. bv A. A. Surg. L. J st Maine, age 18. July 23. mid. third, by A. A. Surg. G. E. 5, 65. E. Tracy. Died Jan. 19, 1863, 1864. Brickett. Died Aug. 28, 1864, gangrene. pyaemia. 63 Wright, E.,Pt.,F, 119th Mav 5, Right leg, cutting post, tibial art.; 37 Maguire, E., Pt.. I, 8th Sept. 29. Right leg: gang.; uleeration of Penn., age 18. 25, 64. gang.; haem.; May 2:. , lig.: haern. Conn., age 26. 1864. ante, tibial art.; amp. leg, by A. recur d; amp. leg, by Surg. F. Mar. 22, A. Surg. W. B. Casey. Disch d Bentley, U. S. V. Died May28, 1863. Nov. 28, 1863. 1864, asthenia and pyaemia. 1 LlDELL (J. A.). Wounds of the Arteries, in Surg. Mem. of the War of the Rebellion, coll. and pub. by the U. S. San. Comm., 1870, Vol. I, pp. 27, 551. SECT. I.] DEFORMITIES AFTER SHOT FLESH WOUNDS. 59 Amputations of the Toes. There was a single example of amputation of the great and second toes for gangrene following ligation of the femoral artery for a shot wound of the thigh. (CASE 55 of TABLE III, p. 48.) CASE 128. Private J. L. Hunt, Co. G, 57th New York, aged 42 years, was wounded at the Wilderness, May 5, 18G4. Assistant Surgeon J. C. McKee, U. S. A., reported his admission to Lincoln Hospital, Washington, May 26th, with "gunshot wound of left thigh." Two weeks afterwards the patient was transferred to Camden Street Hospital, Baltimore, and on October 23d he entered Mower Hospital, Philadelphia, where Acting Assistant Surgeon F. W. Saunders recorded the following: "A minie ball entered the thigh at the inner side, upper third, and, passing backward and outward behind the femur, emerged just below the tuberosity of the ischium. Deficient circulation from ligature or otherwise of the great trunks occasioned mortification in the foot, rendering necessary the amputation, previous to admission, on September 5th, of the first and second toes at the second joints." The patient was subsequently transferred to McDougall Hospital, New York Harbor, whence he was discharged June 5, 18G5, Assistant Surgeon S. H. Orton, U. S. A., certifying, " the wound has been gangrenous ; extensive cicatrix remaining, causing great contraction of muscles; little use of leg." On June 1, 1866, the pensioner was supplied with a supporting and extensor apparatus by Dr. E. D. Hudson, of New York, \vlio in his statement reports the ligation as having been performed on "July 9." The New York City Examining Board certified, December 8. 1875: "There is a cicatrix five inches by four on inner side of left thigh, middle third, which is adherent and radiated. The femoral artery has been cut and tied. There is great loss of muscular substance. The great and second toes have sloughed away ; foot poorly nourished. Has to wear an artificial appliance to enable him to walk. There is considerable atrophy of muscles of the limb. The disability is equal to the loss of the limb." The pensioner was paid March 4, 1876. Tcnotomy. There were five examples of tenotomy for the relief of deformities result ing from shot wounds of the lower extremities. The case of Sergeant Louis Morell (CASE 243, Med. and Surg. Hist, of the War, Part II, Vol. II, Chap. VI, p. 80, and PLATE V, Fig. I) has been detailed. In the case of Private H. B. Franklin, Co. E, 52d Indiana, aged 21, Surgeon A. Hammer, U. S. V., divided the tendo Achillis at the Marine Hospital, St. Louis, November 5, 1864, and relieved talipes of several months standing. He was returned to duty January 24, 1865. CASE 129. Private J. H. Armidon, Co. I, 49th New York, aged 19 years, was admitted to Satterlee Hospital, Phil adelphia, June 21, 1863. Acting Assistant Surgeon M. J. Perry reported: "The patient was received from hospital at Washington, suffering from diarrhoea. He had previously received a gunshot wound of the leg at the battle of Antietam. Leg bent almost on to thigh. The hamstring tendons were cut by Acting Assistant Surgeon T. G. Morton, formerly in charge of the ward. October 30th, leg much straighter; is obliged to walk with crutches. November 20th, is able to walk about with a cane; leg still a little bent. December 13th, wound nearly healed; general health good. January 1, 1834, patient returned to duty, cured." Several weeks afterwards the man entered Augur Hospital, whence he was discharged for disability, February 10, 1864, Surgeon S. B. Hunt, U. S. V., certifying to "Shell wound of popliteal space of right leg, received at Chancellorsville, May 3, 1863, causing permanent lameness; still discharging." The Washington hospital records show that Armidon was "admitted to Lincoln Hospital on February 27, 1833, with intermittent fever," and that he "deserted June 20, 1863," but no note was made of the wound. He is not a pensioner. CASE 130. Private T. Caswell, Co. C, 6th New Hampshire, aged 30 years, was wounded in the right leg, at Bull Run, August 29, 1852. He was admitted to the Georgetown College Hospital, subsequently transferred to Satterlee, Philadel phia, and lastly to Lovell, Portsmouth Grove. Assistant Surgeon W. F. Cormick, U. S. A., in charge of the latter, reported : "Wound healed with severe contraction of the tendo-achilles, resulting from extensive and repeated sloughing. On October 5, 1863, tenotomy was pel-formed, by dividing the tendo-achilles, by Acting Assistant Surgeon J. W. Gushing. The wound caused by the operation healed by November 23th, and the splints, etc., were removed, the foot and ankle resuming their former positions and functions. On December 15th the patient was able to walk without crutch or cane. He was discharged from service December 30, 1833." Examiner W. G. Perry, of Exeter, N. H., February 17, 1864, certified: "Ball entered the out side about midway between the knee and ankle joints, passing directly across the leg. * * There is contraction of the tendo- achilles, which has been partially relieved by division, but he cannot bring his heel entirely down. Standing causes pain." In October, 1889, he reported that contraction in the use of the leg had produced irritation of the eschar, resulting in ulceration. Examiner E. B. Hammond stated, September 11, 1875: "The foot is reduced in size, the leg is weak, etc." The pensioner was paid June 4, 1876. The fifth case in which tenotomy was practised has been already noted as 27 of TABLE VI, on page 54, amputation being resorted to twelve years after the reception of the injury on account of the uselessness of the limb. CASE 131. Private T. Cooper, Co. C, 4th Pennsylvania Reserves, aged 18 years, was wounded near White Sulphur Springs, June 22, 1864. He was admitted to the Post Hospital at Beverly, and, on August 8th, transferred to the Grafton Hospital. Surgeon S. N. Sherman reported: "Gunshot wound of left thigh; ball entered two inches above knee, on outer side, exit near tuberosity of the ischium; also flesh wound of middle of leg. December 31st, leg flexed at nearly right angle to the thigh, caused principally by contraction of the semhnembranosus and semiteudiuosus ; motion of knee joint perfect; consid- 60 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. erable talipes varus, though without anchylosis. Subcutaneous division of the hamstring tendons performed by Surgeon S. N. Sherman, U. S. V.; chloroform used. Patient reacted promptly, being in good health, though of rather delicate constitution. After division of the tendons the leg was forcibly extended and secured to a straight splint, extending from nates to heel. Twenty-four hours after operation patient rested quite easy and entirely free from pain." The patient was furloughed on April 11, 1865, and admitted to the Emory Hospital, Washington, several weeks afterwards. On June 23, 1865. he was discharged by reason of "paralysis and deformity of the left leg caused by the wound," and pensioned. The man subsequently removed to Birmingham, England, where, in December, 1870, he was seen by Mr. J. B. Gould, the U. S. Consul, who described his condition as follows: His left leg and foot are withered, the foot icy cold and curled up like a bird s claw, and the leg with ered and dead to the hip joint," etc. About this time the pensioner was also examined by Surgeon Jos. Morris, M. R. C. S., who certified : "I find him suffering from the effects of a gunshot wound of the left thigh. The sciatic nerve has been injured, and the entire limb rendered permanently and entirely useless. He suffers great pain in the injured limb," etc. This certificate was corroborated by Surgeon Jordan, F. R. C. S., and Professor of Surgery at Queen s College, at a subsequent examination on March 4, 1871 . Surgeon Oliver Pemberton, F. R. C. S., in charge of the General Hospital at Birmingham, certified, on June 6, 1876: "On the third day of May, 1876, I amputated the left leg of Thomas Cooper above the knee, the said limb having become useless on account of a gunshot wound," etc. The pensioner was paid June 4, 1876. A case of shot injury of the foot in a distinguished general officer may conclude the illustrations selected for this section: CASE 132. Major-General J. Hooker, U. S. V., was wounded at the battle of Antietam, September 17, 1862. The injury was reported by Assistant Surgeon B. Howard, U. S. A., as follows: " He was wounded in the right foot by a mini6 ball while leading his command, being on horseback at the time, and standing in the stirrups with his weight thrown on his right foot, which was turned outward. The ball struck the inner side of the foot inferiorly to the middle of the scaphoid bone, passing between the first and second layers of the plantar muscles, almost transversely across the plantar portion of the foot, and emerg ing inferiorly to the anterior border of the cuboid bone. The bones of the foot were uninjured. On the morning of September 18th, I was sent by the Medical Director of the Army of the Potomac to attend General Hooker, then lying in a farm house near the battle-field. Warm-water dressings had been applied previous to my visit. There was no constitutional disturbance, but the foot was hot and inflamed. By means of a syringe I thoroughly washed out the wound with warm water, and finding it most agreeable to the patient, substituted cold- for warm-water dressings. The next day I found the patient very comfortable; the appearance of the foot had greatly improved and the inflammatory symptoms had disappeared. I then ordered a lotion of plumbi instead of cold-water dressings as being more likely to allay any irritation that might arise in the parts. Before the General left that evening, for Washington, I advised him to resume the use of tepid water as soon as all tendency to active inflammation should cease. On October 25th, I heard that tetanic symptoms had manifested themselves, but received a letter from the General a few days afterwards stating to the contrary. On November 25th the General, who had returned to duty in the field, requested me to look at his wound, which still troubled him somewhat. I found the newly formed cicatrices somewhat tumefied; they were painful on pressure, and the General was still unable to mount hia horse unaided, though he persisted in being on active duty. On November 30th, I found there had been a steady improvement, and, although the step had not its former elasticity, the wound had left no serious inconvenience behind." General Hooker remained in active service until the close of the war, and was ultimately retired October 15, 1868. Wounds of the soft parts of the lower extremities, though constituting the largest group of injuries received in action, have seldom been much commented on by authors. 1 In addition to the bibliographical references cited in previous pages of this section the following may be consulted with interest: PAKE (A.) ( (EuvreS completes, ed. MALGAIGNE, Paris, 1840. T. II, Chap. XXXVII, p. 110) remarks : " Les plaies faites au dedans des Cuisses sont souvent cause de mort subite, quand clles penetrent en la grosse veine Saphene, on grosse artere. et aux nerfs qui les accompagnent : ce que j ay veu souvent advenir" . . and "Mais quand elles penetrent profondement, souvent advient grands accidens. comme inflammation, aposteme, et pourriture anx membranes qui couvrent les muscles, qui causeutquerulcerejette une tres-grandequantitede matiere. defacon quele malade meurt en atrophie, et tout desseicheV . . . RAVATON (Chir. d armee, on Traite des plaies d armes a feu, Paris, 1768, p. 321 et seq.) dwells on the importance of flesh wounds of the lower extrem ities, and cites many and exceedingly interesting examples of extensive lacerations, lodgement of missiles and other foreign substances. He details six cases of shot flesh wounds of the thigh (06s. 81, 83, 84, 85, 86, 87), an instance (Obs. 90) of shot wound of the knee, the missile opening the joint without lesion (sans toucher) of bone, and four cases of shot flesh wounds in the leg {Obs. 91. 93, 94, 95), one of which (Obs. 94) was followed by amputation of the leg. . . . LE UUAN (H. F.) (Obs. de Cliir., Paris, 1731, T. I, p. 347) records a case of shot flesh wound of the thigh followed by repeated hasmorrhages. . . . WILLIAMSON (G.) (Military Surgery, London, 1863, p. 133), in a subsection on Simple Flesh Contusions and Wounds of the Lower Extremities, records 130 cases of this kind from the mutiny in India, 1857-58 ; 117 were slight. 13 severe. Of the 130 cases, 90 were returned to duty, 15 to modified duty, and 25 were invalided. . . . THOMPSON (JOHN) (Report of Obs., etc., after the Rattle of Waterloo, Edinburg, 1816, p. 125) refers to several cases of extensive lacerations of the soft parts by large missiles. . . . NEALE(JOHX) (Chirurgical Institute, London, 1805, p. 247 et seq.). . . . GORDON (C. A.) (Lessons on Hygiene and Surgery, London, 1873, pp. 152, 153) cites several examples of flesh wounds of the thigh, and on page 157 gives three cases of recovery after periarticular wounds of the knee joint. . . . KLEIJS (E.) (Beitrdf/e zur Path. Anatom.it der Schiisswunden, Leipzig, 1872, pp. 42, 58) cites six obductions in cases of shot flesh wounds of the lower extremities 3 of the thigh and 3 of the leg. . . . CHENU (J. C.) (Aper<;u hist. slat, et din. pendant la guerre de 1870-71, Paris, 1874, T. T, p. 278) very briefly adverts to two cases of flesh wounds of the thigh, one of the leg and a penetrating flesh wound of the knee joint, followed by traumatic arthritis. . . . FISCHEU (H.) (Kriegschir. Erf.. 172, p. 1C4) says : " The wounds of the soft parts of the leg, as a rule, progressed very favorably. . . Much worse proved the wounds of the soft parts of the foot. Nearly always circumscribed or diffuse plilogmonous abscesses developed necessitating repeated incisions. . . . MACCOHMAC (W.) (Notes and Jtecollections of an Ambulance Surgeon, London, 1871. p. 129) tabulates 63 cases of wounds of the soft parts of the thigh without fracture, with 6 deaths, and3(i cases of wounds of the soft parts of the leg, with 1 death. . . . LOcKK (ALDEKT) (Kriegschir. Fragen und liemerlc.. Bern, 1871, pp. 6-9) details six cases of shot flesh wounds of the lower extremities compli cated by secondary bleeding, among them three cases of ligation of the crural artery, and remarks: "In recent injuries we yet ligate now and then successfully the crural artery, but we will more and more come to the conclusion rather to tie the external iliac than the crural artery." . . . ScnfJu.EU (M.) Kriegschir. Skizzen, Hannover, 1671, p. 18) tabulates 13(i cases of shot flesh wounds of the lower extremities. All recovered. . . . SCHINZINT.EU (A.) (Das Reserve- Lazareth Schwetzingen, Freiburg i. Br., 1873, p. 68) notes the gravity of shot wounds of the soft parts of the thigh after the battle of Weissenburg. SKCT. n.j WOUNDS AND INJURIES OF THE HIP JOINT. 61 SECTION II. WOUNDS AND INJURIES OF THE HIP JOINT. In the important class of injuries of the joints, those of the hip joint are preeminently hazardous to life, obscure in diagnosis, and difficult in treatment. In the Surgical History of the War of the Rebellion, a comprehensive and systematic classification of this group of wounds and injuries should include the contusions and sprains and dislocations and simple fractures at the articulation, shot wounds involving the tendinous and ligamentous structures about the joint, or laying open the capsule, and shot fractures implicating the acetabulun> or head, neck, and trochanters of the femur, examples of secondary coxitis from extension of inflammation, or septic infection from injuries of the upper part of the shaft, and lastly, cases in which operative interference at the hip is imperative from the extension of lesions of the upper part of the shaft to the articulation. Yet, in this Section, it is proposed to treat mainly of shot fractures involving the hip joint, 1 and of operations at the hip following shot injuries, except in a single instance. 2 There appear on the records notes of about thirty-five examples of luxations at the hip, fifteen simple fractures believed to implicate the hip joint, and forty-four cases returned as contusions or sprains at the hip; but these cases will be referred to in subsequent chapters of this volume, as more in accordance with the classification heretofore adopted. Examples of coxitis from periartic- ular wounds, in which the primary lesions were believed to be confined to the membranous or ligamentous or other adjacent soft tissues, were discussed in the last Section, and of instances of secondary coxitis from extension of lesions of the shaft we shall find many in the following Section on shot fractures of the shaft of the femur. In the preceding Section (pp. 26, 28) all pains has been taken to collect the obser vations that were recorded of periarticular shot wounds at the hip, and details are referred to of all the facts that could be collected of forty-nine cases that were reported. Professor H. H. Smith 3 and other systematic authors believe that shot wounds of the hip joint, unattended by injury of the bone, are very rare; but there seems to be a growing convic tion among military surgeons that, owing to the extreme difficulties of diagnosis, many such cases may escape observation, or be misinterpreted until late in their progress. The early recognition of the precise extent of wounds of the hip joint is of the utmost practical JOHN HEXXEX, in his classical treatise, remarks: "The injuries occasioned by balls lodging near or about the joint of the hip are among the most serious of military s some of these cases the c balls lodged in almost e discovery of their situat u rgery. The fever, the profuse discharges, the tedious exfoliations, all tend to sink the patient, and are but too often fatal. In urse of the ball is so obscure, and its place of lodgement so uncertain, that it can only be detected after death. I have seen cry part of the trochanters, neck, and head of the bone, and yet the most accurate examination during life did not lead to a n." Principles of Military Surgery, 2d ed., Edinburgh, IS -JO, p. 155. 2 Among the coxo-femoral disarticulations one example will be cited where the operation was a re-amputation following an amputation in the continuity of the thigh fora bayonet stab in the knee joint, the only case to be adverted to not connected with shot wounds. 3 Professor H. II. SMITH (J rinc. and Pract. of Surgery, 1863, Vol. I, p. 52(i) remarks that "wounds of the hip joint, uncomplicated by injuries of the bone, arc seldom seen. The joint lies quite deep, and is protected by the shelving outward of the ilium and by the prominence of the great trochanter. An injury reaching it is almost necessarily associated with some fracture of the bones. 1 62 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. importance, and demands a careful and prompt examination to determine whether conserv ative measures are admissible or if operative interference is advisable. Yet here the greatest obstacles present themselves. It must still be admitted, and cannot be too much impressed on the minds of surgeons, that far greater attention and care and trouble are requisite in these than in the injuries of other joints. Until comparatively recent years shot injuries of the hip were regarded as almost inevitably hopeless, and military surgeons enquired into them but little; 1 but now it is agreed that recoveries may be obtained in this group of cases, either under conservative measures or by operative interference, and the 1 In the section on the surgical literature of shot wounds of the hip joint with which Professor B. von LAXGEXBECK prefaces his essay Ueber die Schussverletzungen des Huftgelenks, read before the second session of the German Surgical Congress, April 19, 1873, and printed in the Archiv, B. XVI, S. 264, the learned professor observes that in ancient military surgical literature we find wounds of this joint seldom mentioned. This is emphatically true. Not only in SCHENCKIUS, of Graeffenburg, who laboriously summarized the labors of his predecessors in chronicling rare cases, in PLATER, in FABRICIUS HILDANUS, in the monumental BOXETUS, and in other collectors of curious pathological observations, one searches in vain for instances of wounds of the hip; but we scan the writings of the early teachers who treated specially of shot injuries with as little success. MAGGIUS, FERKIUS, ROTA, and the excellent BOTALLUS, Vioo, FELIX WUUTZ, HIEROXYMUS of Braunsweig, GERSDORF, and even the so-called father of modern army surgery, AMiiROlSE PARE, are silent on this subject. At last, toward the end of the seventeenth century, we find a detailed example of recovery from a shot wound of the hip. MATTHIAS GOTTFRIED PURMAXX (Funfftzig Sander- und Wunderbahre Schusswundcn Curen, Frankfurt, 1721, Obs. XLIII, p. 324) relates the case of Pt. S. Kirsky, of the regiment Gotz, wounded at the siege of Stettin, 1677, in the right hip by a falconet ball, injuring ilium and upper portion of femur. Recovery in twenty weeks, with complete anchylosis of hip. In the writings of English surgeons of the time, in GALE, WlSE- MAA", BROWX, and RAXBY ; among the Germans who were then eminent for treating of shot wounds, HEISTER, THEUEX, and SCHMUCKER; and of French authors who refer particularly to shot wounds of the joints, like LEDUAX, GAREXGEOT, and FAUDACQ, we look in vain for instances of shot injuries implicating the hip. MORAXD and RAVATOX, it is true, in the middle of the eight eenth century, advocated coxo-femoral amputation for shot fractures high up in the femur, but do not allude to any fractures at or above the trochanters. BILGUER, who cites ( Chirurgische Wahrnehmungen, Berlin, 1763, p. 398 et seq.) 117 cases of shot injuries of the lower extremities during the years 1756-02, among them cases of wounds of knee and ankle joints, gives not a single instance of a shot injury of the hip joint. JEAN MEHEE (Traite des plaics d armes A feu, Paris, An. VIII 1800), who systematically divides the wounds of the joints into three classes, those of the lower joints (ankle and wrist), middle joints (knee and elbow), and upper joints (hip and shoulder), and who cites numerous examples, only gives examples of wounds of the shoulder joint in the last-named class, and entirely omits wounxls of the hip joint. The next definite instance of shot injury of the hip joint found in surgical annals is remark able on several accounts. The case is recorded by Dr. JAMES JOIIXSTOXE, of Worcester, in the London Medical Journal, 1786, Vol. VIII, pp. 135-140. Dr. JOHXSTOXE took pains to have prepared a drawing the size of nature, representing the exfoliated fragment of the head of the femur, which is accurately copied in the annexed wood-cut, FIGURE 24. The case was attended by Mr. JOSEPH BRAX- DISH, a " deserving surgeon and apothecary, at Alcester," and has been sometimes cited as an early example of excision at the hip for shot injury. Mr. BRAXDISH treated a lad aged 12, who had accidentally shot himself December 23, 1783. The contents of the gun "passed into the upper part of the thigh, adjoining to the middle of the groin, and came out about the middle of the glutaeus maximus." Several successive abscesses were formed, and several exfoliations came away; one, in particular, which appeared to be a considerable portion of the head of the thigh bone with a shot sticking in it. Much as Baron LAHREY has to say of oper ations at the hip joint, he only once describes a case of shot fracture involving the hip. It appears in the Clinique Chirurgicale (1836, T. V, p. 242): A young officer of the 9th demi-brigade of Infantry of the army of Egypt, at the siege of FIG. 24. Carious fragment of , , , ... , . , . , .. the head of the femur: 1. Outer Alexandria, was wounded at the outer and upper part of the leit thigh, the ball urface of exfoliation ; 2, same embedding itself in the neck of the femur. The officer recovered with anchylosis presence of the missile was not recognized until after the death ixelles, twenty years after the injury. The specimen was LEG*OUEST l" presented to Baron LARREY by Dr. SEUTIN, and ultimately was deposited in the Museum at Val-de-grace. Professor LEGOUEST had a drawing made of it, which is copied in the adjacent wood-cut (FlG. 25). The chief British surgical authorities in the great Napoleonic wars, HEXXEX, GUTHRIE, and BALLIXGALL, cite no cases of shot wounds of the hip. HEXXEN, in his classical Observations, dwells (3d ed., 1829, p. 158) on the extreme difficulties of detecting the course of balls lodged in this region. "I have seen," he remarks, " balls lodged in almost every part of the trochanters, neck and head of the bone, and yet the most accurate examination during life did not lead to a discovery of their situation." Dr. JOHN THOMSON (in his Report of Observations made in the British Military Hospitals in Belgium after the Battle of Waterloo, 1816, p. 123) refers to a case of wound of the hip joint, in which the ball lodged; paralysis was produced, and great swelling of the foot and leg supervened ; and to another case, in which the head and neck of the thigh bone together with the acetabulum were, at the autopsy, found in a diseased state ; and to one or two other cases which seem to have progressed favorably but were not followed up to the final issue ; and to other instances where the ball, without penetrating the capsule of the joint had injured the parts around it, inducing abscesses in the joint and ulceration of the articular cartilages, with softening and absorption of the head and neck of the femur. Writers on more recent wars have cited but few cases and very few of recovery. M^XIEUU (P.) (/, Hotel- TJieude Paris en Juilletet Aout, 1830, Paris, 1830, p. 16) gives the case of M. Firer, aged 23, shot fracture of head of femur. Death August 30, 1830. JOBERT (A. J.) (Plaies d armes a feu, Paris, 1833, p. 247) cites two cases of recovery after shot wounds of the hip joint received in the Paris Revolution of 1830. BAUDEXS (M. L.) (Clinique des Plaies, etc., Paris, 1836, p. 445) relates a fatal case, in which the ball had perforated the head of the femur, in Algiers, November 15,1835, and adds: " Had I remained at the Algiers Hospital I should have practised disarticulation or resection." ALCOCK (J.) (06s. on Injuries of the Joints, in Med.-Chir. Transact., 1840, Vol. XXIII, p. 261) tabulates four cases of shot wounds of the hip ; but in two only the joint was primarily involved; both were fatal. MACLEOr (G. H. B.) (Notes on the Surgery of the War in the Crimea, London, 1858, p. 309) relates the case of A. McPhail, aged 33, wounded at Dubba, March 24, 1843, by a matchlock ball, which entered anteriorly above the great trochanter of the right limb. The wound in the skin cicatrized; but the patient died of tetanus, May 9, 1843. The ball was found embedded in the head of the femur, having fractured the brim of the acetabulum. The specimen is preserved in the Fort Pitt Museum, and numbered 2604. IIYRTL (J.) (Handbuch der topog. Anatomie, Wien, 1865, p. 534) relates the case of a member of the national guard, wounded in 1848 ; the neck of the femur was fractured ; the Bunauu 01 UA.KUIUIIOII ; , BUIIIO ouiuuuuuijg iweu tu uua bone, showing cancellous surface o f the hip. The presen with (A) lead shot sticking in it. [After JOHXSTONE, op. cit.} of the P atient at Brus FIG. 25. Musket ball lodged in the neck of the left femur. [After SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 63 credit of surgery, and still more the interests of humanity, imperatively require that the most favorable periods and conditions of treatment should be diligently sought. Drs. H. H. Smith, 1 H. Fischer, 2 E. Klebs, 3 B. Langenbeck, and other modern writers on military surgery, have dwelt on the inaccessibility of the parts to exploration through the long narrow shot tracks produced by missiles of comparatively small calibre, on the frequent absence of shortening or displacement, or escape of synovia, or indeed with scarcely any serious disturbance of the functions of the joint, until the inflammatory and infiltration patient recovered. STROMEYER (L.) (Maximen, u. s. w., Hannover, 3855, p. 756) tabulates five cases of shot fractures of the neck of the femur from the Danish War, 1848-1850; all were fatal. Two of these five cases are detailed by Dr. H. SCHWARTZ (Beitrage zur Lehre von den Schuss. wunden, Schleswig, 1854, p. 143). J. J. COLE (Military Surgery, etc., London, 1852, p. 13C) cites a case of fracture of the neck of the feuiur during the war in India, 1848-49, but the result is not recorded. BERTHERAND (A.) (Campagnes de Kabylie, Paris, 1862, p. 301) relates the case of Mohammed ben Achtned, shot in the right hip joint at Icheriden, June 25, 1857; death, August 31st. MATTHEW (T. P.) (lied, and Surg. Hist, of Brit. Army, London, 1858, Vol. II, p. 351) refers to three cases of wounds of the hip joint in the Crimean War, which proved fatal in a few hours. CHEXU (J. C.) (Rapport au Conseil de. Santt des Armees de Campagne d Orient, Paris, 1865, p. 372) tabulates 30 cases of shot wound of the hip joint, of which two recovered. The same author (in Rapport, etc., de Campagne d ltalie, Paris, 1809, T. II, p. 690) groups 26 cases of shot wounds of the coxo- femoral region, of which 1C recovered, but it is not even indicated whether the wounds were fractures or simple flesh wounds. DEMME (H.) (Mil. Chir. Studien, Wilrzburg, 1861, p. 252) details two cases of recovery after shot fractures of the bones of the hip joint. HEINE (C.) (Die Schussverletzungen der Unteren Extremitaten, Berlin, 1866, p. 365) records four cases of shot wounds of the hip joint from the Schleswig-Holstein War of 1864 ; all proved fatal. STROMEYER (L.) (Erfahrungen iibcr Schusswunden im Jahre 1866, Hannover, 1867, p. 8) tabulates four fatal shot fractures of the hip joint treated at Langensalza. LAXGEXBECK (B. v.) (Ober die Schussverletzungen der EiiftgeUnke, in Arch, fur Klin. Chir., 1874, B. XVI, p. 270) relates the case of Major J. Preuss, wounded in the hip joint at MUnchengratz, June 28, 1806. The patient died September 13, 1867 ; and another fatal case of a soldier wounded in 1864. In the latter instance, the autopsy showed that the ball had entered the outer point of the left trochanter major and passed through the neck of the femur in its length into the acetabulum. BRUCE (A.) (Observations in the Military Hospitals of Dresden, London, 1866, p. 24) describes the case of a Prussian wounded at Sadowa, July 3, 1866, which terminated fatally. BlEFEL (R.) (Im Reserve- Lazareth, in LANGEXBECK 8 Arcliiv, B. XI, p. 441-2) treated a case of shot fracture of the hip joint at Landeshut, in 1866, which proved fatal on the 171h day. In the Archiv fur Klinische Chirurgie, Berlin, 1874, B. XVI, p. 309, B. v. LAXGEXBECK tabulates 25 cases of recovery and 63 fatal cases after shot wounds of the hip joint, during the Franco-Prussiau War, 1870, collected from various sources. Among the cases of recovery he cites the case of R. Rousseau (CASE 12, p. 313), observed by Dr. SCHIXZIXGER, although the latter (Das Reservdazareth Schwetzingen, Freiburg, i. Br. 1873, p, 56) distinctly states "hip joint intact" (Huftgelenk intact); also the case of Schaefer (CASE 19, p. 315), observed by SOCIN (Kriegschir. Erf., Leipzig, 1872, p. 135), who remarks that the patient died, on the 188th day, of exhaustion. Of the ten cases treated by himself, Professor LANGENBECK had the satisfaction of recording eight recoveries. Stabsarzt DEDONGEU, of the Hallway Battalion (Beitrage zur den Schussfracturen des BiiftgeUnks unter besondercr Berilcksichtiyung der Erfahrungen aus dem Fcldzuge 1870-71, und Benutzung der Acten des Koniglichen Kriegsministeriums, in Deutsche Militairarztliche Zeitsclirift, 1874, B. Ill, p. 314), in his statistics describes 66 cases of shot wounds of the hip joint, of which 13 recovered. All but 15 of these cases are contained in von LAXGEXBECK S enumeration. Of the 15 cases not contained therein (CASES 5, 6. 7, 8, 31, 32, 33, 37 [Recovery], 38 [Recovery!, 49, 50, 51, 54 [Recovery], 50, 58), 12 were fatal while only 3 recovered. Besides the cases collected by Professor von LANGENBECK and Dr. DEININGER I have found the following from the Franco-Prussian War of 1870-71, not contained in the tables of either. Assistant Surgeon EVERS, Saxon train battalion No. 12 (Gelenkwunden und ihr Ausgang, in Deutsche mil-u.rztl. Zeitcshrift, 1874, B. Ill, p. 381), gives the case of Frode, wounded August 29, 1870; ball penetrated the right hip joint ; patient recovered but is totally disabled. LOSSEN (H.) (Kriegschir. Erf. etc., in Deutsche Zeitschrift fur Chir., 1873, B. II, p. 64), case of Th. Margaillon, 22d French Infantry, shot wound of neck and trochanter of left femur, August 18, 1870; died September 4, 1870. MAYER (L.) (Kriegschir. Mitth., etc., in Deutsche Zeitschrift fur Chir., 1873, B. Ill, p. 47), case of Sommerfeld, 3d Prussian Jaegers, shot fracture of head and neck of fernur ; fatal. The cases referred to in this note give a total of 173 cases with 38 recoveries, 134 deaths (a fatality of 77.9 per cent.), and one result unknown. 1 SMITH (H. H.) (The, Principles and Practice of Surgery, 1863, Vol. I, p. 526) says: " The diagnosis is difficult, as the joint lies so very deep as to be almost beyond the reach of the finger. There may be neither shortening of the limb nor eversion, and at first the patient may be able to move the limb without very much pain." 2 Professor H. FISCHER, of Breslau, in his Kriegschirurgische Erfahrungen Vor 3tetz (Erlangen, 1872, p. 201), remarks on the difficulties encoun tered in diagnosticating wounds of the hip joint: " The deep position of the hip joint, strongly protected by thick layers of muscles ; the generally long wound-canal, the termination of which is so difficult to determine ; the absence of all severe disturbance of the functions of the joint, and the very trivial subjective complaints of the patient, render it often impossible to determine precisely the lesion soon after the injury. All authorities, from LARKEY and GUTHRIE to contemporary surgeons, agree in this. LEGOUEST relates (Chirurgie d Armee, 2 e 6d., 1872, p. 449) that a zouave, who, at the Alma, received a shot in the hip, traversing from the groin to the buttock, and completely fracturing the upper rim of the cotyloid cavity, yet still walked about for ten days, escaping all our explorations," and adds that this apparent innocuity or benignity led into error our young surgeous and the patients themselves ; the foimer not daring to propose, and the latter utterly rejecting, the sole means of averting the almost inevitably-fatal termination. "In the case of our patient Emmerich, Dr. FISCHER continues, "the ball had lodged in the shattered head in the hip joint. He moved about for some time after the injury and even from one bed to another a short time before his death, from syncope. The wounded man, Henkel, also reported that he had walked a consid erable time on his injured limb. This remarkable insensibility in the hip joint immediately after shot injury, if one reflects on the ordinary painfulness at the head of the femur in coxitis, appears to be explained only by the supposition of a contusion-paralysis, or direct severing of the sensory nerves of the hip joint. In the course of time a view of the injury generally becomes clearer and the diagnosis easier. In Henkel s case, the characteristic pains at the knee joint set in, and the local pains at the hip joint were also present; but with other patients these highly important diagnostic symptoms remained entirely absent. In Henkel s case the head of the femur was intact and its sensibility therefore undisturbed. Profuse suppuration, early septic infetion and prostration, and the necessity of making counter openings, always led us, unfortunately too late, to the diagnosis. But here the question may be asked of what use is an accurate diagnosis if no help can be rendered when attained. It is for this reason that I deplore the difticulty, nay, impossibility, of the same so much, because I believe that primary excision at the hip would be the best method of treatment for shot fractures at the hip, no matter ho\v difficult the operation might be. All later operative interference is frustrated by the exhaustion and septic infection <:f the patients, by extensive and profuse suppuration, and by phlegmonous and gangrenous processes in deep tissues about the pelvis. 1 3 Kl.EBS (E.) (Beitrdge zur Pathologischm Anatomie der Schusswunden. Leipzig, 1872, p. 29) observes: "The shot injuries of the hip joint that 1 uad occasion to observe had this in common, that they proved fatal at a comparatively early date, viz: at from thirteen to twenty-four days; and also .hat even in the more protracted cases no vestige of a healing process was apparent. " And, on page 34, he adds: "As you may surely depend upon the fact, that in all cases where the ball does not perpendicularly strike the spongy substance of the neck considerable fracture, generally into the joint, exists, and that these fissures, even after four weeks, show no inclination towards reparation ; but that they offer the most favorable conditions for infec tion, namely thrombus of the veins ; a cure without operation, according to my judgment, is absolutely not to be expected, and the dictum of the American Circular No. 6, 1865, S. 61, in which, on account of the absolute incurability of these fractures when abandoned to the resources of nature, the excisiou of the head of the femur was recommended, has again been sadly confirmed by the experience of this war." 64 " INJUEIES OF THE LOWER EXTREMITIES. [CHAP. x. period arrived. The dictum of Hennen, cited at the outset of this Section, 1 that the diffi culties of early precise diagnosis in shot injuries of the hip joint are sometimes insuperable, is corroborated by Dr. F. H. Hamilton 2 in reviewing the surgical experiences of the American civil war, and by Drs. Billroth 3 and Deininger 4 in recording their personal observa tions and the contemporaneous surgical literature of the Franco-German War of 1870-71. The evidence regarding shot injuries of the hip joint presented in the annals of the protracted American civil war is numerically very imposing;, yet attempts to analyze it with a view to learn the principles that should govern the treatment of these grave injuries are beset with difficulties. The abstracts of the individual cases are for the most part wanting in precision, still the material must be classified and consolidated as systematically as practicable, and permitted by the character of the reports. In the preliminary surgical report made by me in 1865, in Circular 6, 8. G. O., 5 at page 31, ninety-seven cases of shot fractures involving the hip joint were tabulated, and some of the more remarkable cases were detailed and several were illustrated by drawings. In 1867, in a monograph on amputations at the hip joint, 6 fifty-three examples of that operation practised during the civil war in America were described, and seven cases were narrated that resulted favorably under conservative measures, although it was alleged, though not absolutely demonstrated, that the shot lesions described involved the articulation at the hip. In 1869, in a report of excisions of the head of the femur for shot injury. 7 I detailed sixty-three instances of this operation performed during the American civil war, with minutes of a number of doubtful or not well authenticated cases; and narrated the facts collected respecting two hundred and seventy-four examples of shot wounds believed to implicate the hip joint and treated either by extracting fragments or by strictly expectant measures. In 1871, in a report on surgical cases treated in the army of the United States from 1865 to 1871, 8 the histories of four examples of shot fractures mvolv- 1 HEXXEN (JOHN) (Principles of Military Surgery, 2d ed., 1820, p. 155, cited in foot-note 1, p. 61, ante.). He asserts emphatically: " In some of these cases the course of the ball is so obscure, and its place of lodgement so uncertain, that it can only be detected after death. I have seen balls lodged in almost every part of the trochanters, neck, and head of the bone, and yet the most accurate examination during Hie did not lead to a discovery of their situation." * Professor FliANK H. HAMILTOX (Princ. and Pract. of Surgery, 1872, p. 407), while regarding the results of excisions at the hip as favorable in comparison with those obtained in amputations at the hip joint, and possibly when compared with the results of the expectant plan, concludes: "I see, in the probable inaccuracy of diagnosis, in both classes of cases many sources of error. Indeed, in my opinion, the surgeon is still justifiable in exercis ing a considerable amount of discretion as to the course to be pursued. If, for example, he has reasons to believe that the comminution is not extensive, and the patient is in a favorable condition as to health ; if he is neither very fat nor very muscular ; if the limb can be kept at rest and moderate extension continuously applied, 1 believe an attempt may be properly made to save the limb without excision." 3 BlLl.ROTH (Tit.) (Chirurgische Brief e aus den Kriegx-Lazarethen, u. s. w., Berlin, 1872, S.238). In the foot-note No. 3, on page 20, of the preceding Section, some of Professor l!lU,ROTH s emphatic declarations on the occasional impossibility of diagnosticating direct shot injury of the capsule or bones of the hip joint have been cited. The length of the shot canals and the great variety of direction in shot perforations of the muscular masses about the coxo-femoral articulation, greatly modified by the changing postures of the soldier, are great obstacles to satisfactory explorations, and, owing to the form of the pelvic bones and ligaments, the course of the missile is very liable to be deflected. The index finger is generally too short to reach the projectile or fracture, and a sound or catheter is but a poor substitute. Moreover, the surgeon is puzzled by the absence of symptoms he has been taught were pathognomonic. In none of the cases examined by BILLUOTH and C/ERNY was found the displacement and peculiarity of position usually ascribed to fractures implicating the hip; and the characteristic intense pain in the hip and knee, aggravated on motion, was missing in many instances. Space forbids further citations, but the reader may profitably consult the comments of the Viennese professor on this difficult subject. 4 DEIXIXGEIC (lieitrdge zu (Jen Scliusffracturen des Huftgelenks, u. s. w., in Deutsche MiL-drztl. Zeitschrift, 1874, Jahrg. Ill, p. 237): The diffi culty of diagnosing a hip joint fracture in its first stages is very great, and frequently it can only be ascertained in the subsequent course whether the joint is really injured, and, sometimes, the fracture is not ascertained until after death. For instance, in the preparation exhibited by TKENIIELKNHUUG in the Second Congress of the Deutsche Gesellschuft fur Chirurgie, the Langblei ball had comminuted the head and neck of the left femur and lodged among the fragments of the head of the bone; a slight fissure existed in the acetabulum. The patient died in consequence of purulent infiltration; during life it was not possible to determine with certainty an injury of the joint. The fragments had been held together by the periosteum, and a dislocation was not indicated. Even walking on the injured limb is no proof that the hip joint has not been fractured." Dr. DEINLXCKU (I. c., pp. 238 and 245) refers to 12 cases in which the injured limbs could be used for some time after the injury, although the autopsy subsequently proved fracture of the joint. 5 Surgical Report of " Reports on the Extent and Nature of the Materials available for the Vre.pa.ra.tion of a Medical and Surgical History of the Rebellion. Printed at Philadelphia, 1865. CIRCULAR No. 6, War Department, Surgeon General s Oflice, Washington, November 1, 18fi5, 4to, pp. 88. " A Report on Amputations at the Hip Joint in Military Surgery. CIRCULAR No. 7, War Department. Surgeon General s Oflice, July 1, 1867, 4to, pp. 88, PLATES 9. A Report on Excisions of the Bead of the Femur for Gunshot Injury. CIRCULAR No. 2, War Department, Surgeon General s Office, Wash ington, January 2, 1869, 4to, pp. 142. *A Report of Surgical Cntes treated in the. Army of the United States from 1865 to 1871. CIRCULAR No. 3, War Department, Surgeon General s Office, Washington, August, 1871, 4to, pp. 296. SECT. II.J WOUNDS AND INJURIES OF THE HIP JOINT. 65 ing the hip joint were detailed, one resulting fatally under expectant measures, and three treated by formal excision, of which two recovered and one had a fatal result. Three hundred and eighty-six cases of shot fracture directly involving the articular sill-faces at the hip are found recorded in the returns of the Union and Confederate armies. Though the reports are, in many instances, very imperfect, they permit an approximate analysis of the cases in TABLE IX following, according to the particular portion of the articulation injured, and also with reference to the treatment of the cases, either by rest and suitable position, with splints and extension and other expectant measures, or by freely incising the joint and removing, if necessary, fragments of bone, projectiles, or other foreign bodies, cases numbering three hundred and four, 1 and grouped as treated by conservation; and then follow two groups treated by formal operative interference, a series of fifty-five cases of excisions at the hip, and a series of twenty-seven cases of amputations at the hip. TABLE IX. Tabular Statement of Three Hundred and Eighty-six Shot Fractures of the Hip Joint. PARTS INJURED. CO M 00 < O TREATED BY CONSER VATION. FOLLOWED BY EXCIS ION AT HIP JOINT. FOLLOWED BY AMPU TATION AT HIP JOINT. Cases. Recov. Died. Cases. Recov. Died. Cases. Recov. Died. Acetabulum without fracture of the Femur 11 :!5 19 3 4 34 23 5 9 1 108 35 37 2 11 o 5 40 11 33 14 1 3 34 12 1 1 10 32 14 o 1 3 23 11 2 4 1 1 1 o Aoetabulum, Head, and Nock of Femur 4 1 I 1 1 1 Acetabulum, Head, Neck, and Trochanter Major of Femur Acetabulum Head, Neck, and Shaft of Femur A cetabulum and Neck of Femur 11 1 Head and Neck of Femur 10 o 1 9 o 1 10 9 9 1 3 1 1 3 1 Head, Neck, and Trochanter Major of Femur 6 6 o 1 10 10 9 96 16 27 o 8 2 a 70 14 25 9 1 8 1 Neck and both Trochanters of Fern ur . . 1 1? Neck and Trochanter Major of Femur Nock and Trochanter Minor of Femur 1 7 1 1 o 1? 1 Trochanter Major, involving the Hip Joint. - 5 5 37 10 27 1 1 2 386 304 55 249 55 53 07 2? 25 In discussing the two series of excisions and of amputations at the hip, eleven instances must be added to the first, and thirty-nine to the second, in which the operations were practised for shot fractures of the shaft of the femur that did not primarily implicate the hip, or for injuries of -the knee joint, thus giving a total of four hundred and thirty-six 1 In Circular No. 2, S. G. O., 1869, from pages 65 to 106, two hundred and seventy-four abstracts of shot wounds at the hip joint were recorded as treated on the expectant or conservative plan, with forty-nine recoveries. Of these, forty-seven, with fifteen recoveries, are omitted from TABLE IX. Of this category of forty-seven, 22, with 7 recoveries (CASES 165-186, inclusive, of Circular 2, pp. 90-92), and 12 cases, with 2 recoveries (CASES 187-198, inclusive, of Circular 2, pp. 92-94), are discarded, the former as uncomplicated by fracture, and the latter as examples of secondary traumatic arthritis. These thirty-four cases have already been referred to in SECTION" I, at page 26, ante., under the head of Peri-articular Wounds. Twelve cases, with two recoveries (CASES 216-227, inclusive, of Circular 2, pp. 96-98), are postponed for consideration in SKCTION HI, as instances of fractures of the trochan- terio region, in which the hip joint became secondarily involved. One case of recovery (CASE 224, Circular 2, p. 100) has been transferred to a future chapter, later information having proved that the injury was not inflicted by shot. On the other hand there were added to the cases summed up in Circu lar 2, 66 cases, with 18 recoveries, since discovered and not heretofore published; 4 cases, withl recovery, already published in the Second Surgical Volume (CASES 859, p. 295, 920, p. 317, 922, p. 318, and 935, p. 324); 5 cases, with 1 recovery, referred to in Circular 2, but not included in the enumerated list (CASES of Swanson, Greenwood, p. 113, Scott, p. 114, and CASES of Drs. AVENT and BRUNS, p. 57); 1 case of recovery (CASE of Sweeney, noted in Circular 7, S. G. O., 1867, p. 73); and 1 fatal case (Circular 2, p. 92, CASE 184), reported in Circular 2 as a case in which the hip joint was involved but uncomplicated by fracture. The specimen, since received (Specimen 2994, A. M. M.), conclusively proves the fracture. SUKG. Ill 9 66 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. cases to be considered in the three following subsections. If the conclusions deducible from these numerous examples are in many respects unsatisfactory, it may be borne in mind that the surgical experiences of the Six Weeks Prusso- Austrian War of 1866, of the Franco-German War of 1870-71, and of the Russo-Turkish War of 1876-77, have not so far proved more fruitful in results tending to solve the difficulties that beset the subject. SHOT FRACTURES AT THE HIP TREATED BY CONSERVATION.-Three hundred and four cases in which shot wounds at the hip were believed to have been attended with fracture of the articular surfaces were treated on the expectant plan, 1 or with such incisions and removals of fragments or foreign bodies as was consistent with a true conservative treatment. Five modern writers on military surgery, 2 the late Dr. H. Demme, of Berne, Professor 1 Professor B. VON LANGEXBECK, in seeking for examples of recoveries after shot wounds of the hip joint ( Ueber die Schussverletzungen des Iliift- gf.lenks, in Archiv fur Klin. C7i.tr., 1874, B. XVI, p. 265) finds none recorded prior to recent wars, "apart from a case communicated by HEXNEX, in his classical work (Observations on Some Important Points of Military Surgery, Edinburgh, 1818, p. 17 ,!), and several eases mentioned by THOMSON (Report of Observations made in the British Military Hospitals in Belgium, Edinburgh, 1810, p. 123) of hip joint wounds which seemed to have pro gressed favorably, but were not followed up to the final issue ;" but it can hardly have escaped Professor LAXGENISECK S notice, in HEXNEX s account of his CASE XXVII, of Spontaneous Luxation of the Hip Joint, that HEXXEX says: " Whether the luxation in this case was produced from a primary injury of the bone, or of the cartilages, and sebaceous glands of the joints, or from a secondary scrofulous affection, it is impossible to say with certainty," and by no means cites this instance of the mounted officer, wounded July 22, 1812, as an instance of recovery from shot wounds of the hip joint. In a later portion of his work, Dr. JOHN THOMSON (Report of Observations * * after Waterloo, Edinburgh, 1816, p. 275) observes: "The proportion of cures which has been obtained from amputation at the hip joint is, I believe, much greater than of cures from gunshot fractures of the head or neck of the thigh bone. Indeed, of recoveries from these injuries I know of none which have been recorded. Those who, for a time, seem to do well, in the end sink under the hectic which supervenes. This has been the fate, I believe, of the two cases which I have mentioned in the account of injuries of the hip joint as having put on a favorable appearance." With such examples, the propriety of caution in admitting recoveries after shot wounds at the hip as incontestable is apparent. Dr. RICHARD M. HODGES ( The Excision of Joints, Boston, 1861, p. 94) observed : " The extent of injury, and the condition of the parts after a gunshot wound of the hip joint, are as notoriously difficult to determine as the cases are certain to terminate fatally. Even when the upper part of the femur has been shot through, shortening, rotation outwards, and crepitus are not always present, and sometimes a very considerable power of flexion and extension remains." After citing GUTHUIE s famous picture (Commentaries, etc., 6th London ed., 185.5, p. 77) of "a man lying with a small hole cither before or behind in the thigh, with no bleeding, no pain, nothing but an inability to move the limb, to stand upon if, and think that he must inevitably die in a few weeks, worn out by the continued pain and suffering attendant on the repeated formation of matter burrowing in every direction, unless his thigh be amputated at the hip joint, or he be relieved by the operation of excision, which, I insist upon it, ought first to be performed," Dr. HODGES declared that: " By following an expectant course and trusting to the resources of nature, an almost invariable mortality will ensue. A case occurring at the battle of Solferiuo, diagnosticated as fracture of the neck of the femur, and another seen at Nantes, in 1830, by M. BOINET, are the only recoveries I am aware of which have followed gunshot wounds of the hip joint." Dr. HODGES refers to the two exceptional recoveries after Solferino and Nantes in L Union Medicale. 28 Juin, 1860. The discussion of the Sociite de Chirurgie here given, from p. 605 of L Union Medicale, is, in that journal, errone ously attributed to May 30, 1860. The discussion was on June 6, 1860, and is correctly reported in the Bulletin de la Societe de Chirurgie de Paris, 1861, ome s (i r _ T. i t p. 32f>. The Solferino case refers to a soldier, wounded June 24, 1859, and presented before the Societe de Chirurgie June 6, 1860, by M. LEGOUEST. This soldier, after receiving shot wounds of the left shoulder and of the neck of the left femur, the latter ball entering anteriorly and passing out through the sciatic notch, entered the hospital at Cremona. Numerous and largo splinters were extracted. The neck of the femur perfectly consoli dated, with three centimetres shortening. M. BOIXET mentioned "a man wounded at Nantes, in 1830, by a shot fracture of the neck of the femur with grave complications, now perfectly cured, and able to take long walks notwithstanding the anchylosis that had followed the accident." (See Circular 2, S. G. O., 1869. p. 65.) Professor RICHARD VOLKMAXX (Die Resectionen der GelenJce, in UsSammlung Klinischer Vortrdge, Leipzig, 1873, No. 51, p. 301), speaking of the American statistics of excision and exarticulation at the hip for shot injury, declares that they "demonstrate that after both operations only exceptionally a patient survives; but that also, under a purely conservative treatment, the result is invariably none better, on the contrary, rather still somewhat worse. The wounded with shot fractures of the hip joint about nearly all perish. This is also the experiences which we, who participated in the two last great wars, the Austro-Prussian and Franco-German, alas, could only confirm. I myself saw only fifteen instances of this injury. Three timrs I performed resection, twice after the battles of Beaumont and Sedan, once in Dijon. All three patients died ; two, as I believe, chiefly from the con sequences of a coexisting decubitus ; in a third an extensive comminution of the pelvis was found at the resection ; but the remaining, about twelve cases treated conservatively, also perished. Among them also one in which the head of the femur, separated by the ball and sp it in two halves, was extracted by an incision opening the joint. Only one patient I see still now and then, who, at Toul. received an undoubted intracapsular shot fracture of the nock of the femur, but which had not been diagnosticated, and who recovered, after exfoliation of several pieces of bone with relatively little shortening, and with anchylosis of the joint." LOHMEYEIt (C. F.) (Die Schusswunden und Hire Behandlung, Gottingeu, 1859, S. 198) remarks: "An operation for tho simplification of the wound, in cases where the acetabulum has been crushed, is naturally out of the question ; but, in cases of comminution of the head or neck of the femur with injury of the capsule, one is called upon to operate, as such injuries, without artificial help, uniformly prove fatal after the patients have undergone terrible suffering." LOFFLKR (F.) (Grundsiitze und Regeln fiir die Behandlung der Schusswunden im Kriege, Berlin, 1859, Erste Abthciliing, p. 66), speaking of shot injuries of the hip joint, remarks: " The conservative treatment of this injury, according to the experience hitherto acquired, gives no prospect of saving life. Even if pyaemia does not supervene, death ensues sooner or later from exhaustion following endless suppuration." With such testimony as the foregoing, together with that of Drs. H. FISCHER and E. KLEBS, in the foot-note to page 63, ante, we are indisposed to concur in the declaration of Dr. SAMTEL W. Glioss (Military Surgery, in Am. Jour. Med. Sci., 1867, Vol. LIV, p. 447) that "those surgeons who pointedly condemn all efforts to save the limb after gunshot fracture of the surgical or anatomical neck of the thigh bone, exercise, in our judgment, but little discrimination, when they declare, as does the surgical historian of tho late American War, that experience has demonstrated the uniform fatality of gunshot fractures of the head or neck of the femur when abandoned to the resources of nature. and that "no statement can be farther from the trutli." The compiler of the surgical report in Circular No. 6, S. (i. O.. 1S6.">, might have said "alum*! uniform fatality," but his statement, if lacking qualifica tion, was assuredly not widely apart from the truth. Z DEMMK (H.), Spec. Chir. der Schusswunden, \VUrzburg, 1864. S. 348. Pn:o<;oi-T (X.), <lrund:uge der Allg. Krieyschir., Leipzig, 1864, p. 814. GROSS (S. W.), Military Surgery, in Am. Jour. Med. Sci., 1867, Vol. LIV, p. 447. Sl lU.MAXX, Elude Anal, et Crit. d un Rapport sur la Resection de la Te.te.du Femur, Paris. 1870, Extrait du Rcc. de Mem. de Med. de Chir. i;t do Fharm. Mil.. 3"" : s6r., T. XXVIII, 1870, p. 48. LANGENBECK (B. vox), Ueber die Schussverletzungen des Huftgelenkf. in his Archives fur Klin. Chir.. Berlin, 1874, B. XVI. p. ~ 63. and translated as Surgical Obs. on Gun-shot Wounds of the Hip-Joint, by JAMES F. WEST, F. R. C. S., in Birmingham Med. Review, Vol. V, 1876, pp. 29, 88, 167. SECT, ii.j SHOT FRACTURES AT THE HIP TREATED BY CONSERVATION. 71 Hospital on May 10, 1862. A conoidal musket ball had entered the right groin, passed slightly downward, traversed the line of union between thigh and trunk, fractured the neck of the femur in its transit, and emerged posteriorly at the fold of the but tock. On flexing or rotating the thigh crepitus was plainly distinguished. His limb was suspended by Smith s anterior splint, and this treatment was continued for two months. The case progressed without a single untoward symptom, and in the middle of July, 1862, consolidation of the fracture was sufficiently firm to permit the patient s removal to the house of a friend. The limb was shortened one and a half inches. In October Captain Bugh was able to move about on crutches, and the wounds were entirely healed. About this time he took a journey to Washington, and was promoted to a lieutenant colonelcy in the 32d Wis consin and placed on recruiting service. He served until April 25, 1863. His recovery was so rapid and uninterrupted that he reluctantly assented to the opinion of his surgeon, Dr. Edmund G. Waters, that he would be incapable of active duty in the field. A letter was received from Lieutenant Colonel Bugh, dated June 12, 1867, more than five years subsequent to his injury, in which he stated that he had partial anchylosis of the hip joint and was unable to perform any labor in a stooping posture. Otherwise his condition was satisfactory, though he was more readily fatigued and debilitated than before he was wounded. He suffered no inconvenience from the slight shortening of the femur. His death occurred eight years afterwards, on August 19, 1875, of phthisis pulmonalis. Examining Surgeon N. M. Dodson, of Berlin, Wisconsin, informed this office on December 13, 1878, that " no post-mortem was had in the case of Captain Bugh. The wound healed in 1866, and the limb remained sound afterwards. Bugh tilled the position of postmaster, was much upon his feet, and residing for some years three-quarters of a mile from the post office, he walked to and fro three times a day with very little inconvenience, using only a cane. The joint was firmly anchylosed. He suffered from pain of a neuralgic character in the whole limb, and at night frequently with cramps in leg and foot." CASE 138. Private J. T. Elliott, Co. H, 22d Georgia, of Sorrell s Brigade, aged 24 years, received, at the engagement at Deep Bottom, Virginia, August 16, 1864, a gunshot fracture of the neck of the left femur. He was conveyed to Richmond and admitted to the Jackson Hospital. He recovered with three inches shortening of the limb, and being permanently disabled and totally disqualified for any military duty, he was retired from the Confederate States service on February 17, 1865. The case is reported by Surgeons A. J. Semmes, Thomas F. Maury, and W. D. Hoyt, members of the medical examining board of the Jackson Confederate Hospital, at Richmond, Virginia, in February, 1865. CASE 139. Private Charles Miller, Co. A, 9th Illinois, aged 26 years, was wounded at the battle of Shiloh, Tennessee, April 6, 1862, apparently by a small rifle ball entering at a point midway between the left trochanter major and the tuberosity of the ischium and fracturing the neck of the left femur. He was conveyed to the general hospital at Savannah, and a month afterward was transferred by steamer to Quincy, Illinois, and admitted to hospital on May 7th. An unsuccessful search for the missile was made, and Buck s apparatus was applied. The bone united and the wound healed. He was discharged from service on October 14, 1862, having limited motion at the hip joint. The case is reported by Surgeon R. Niccolls, U. S. V. On April 7, 1864, Dr. John C. Hupp, Pension Examining Surgeon at Wheeling, West Virginia, stated that the limb was shortened by about two inches, a partial luxation of the head of the femur upward apparently having been produced. Any movement of the thigh created severe pain. The cicatrices were firm and there were no fistulous orifices. In December, 1870, Examining Surgeon C. Griswold, of Fulton, Illinois, reported : " The ball entered posteriorly through the glutei muscles, and fracturing the femur near the socket, resulted in partially stiffened joints both at hip and knee of left leg. The hip joint will admit of only a little forward motion and rotation outward. The knee joint allows only partial flexion, and cannot be crossed over the right leg in a sitting posture. The leg is shortened about one-quarter of an inch. He cannot walk without limping." In August, 1873, Examiner P. J. Farnsworth, of Clinton, Iowa, stated : " The bullet remained in for four years, and was found under the superficial fasciae three inches below the wound. Motion of hip joint impaired. Contraction of abductor muscles, causing stiffening and retraction of knee joint. Constant neuralgic pain of thigh and leg, and considerable atrophy of muscles. Thigh two inches less in circum ference than right at upper third. The original disability has increased." On May 1, 1878, the Davenport, Iowa, Examining Board reported : "There is shortening of the thigh to the extent of three-quarters of an inch, whence it is inferred that fracture of the upper portion of the acetabulum, or neck of femur, occurred; there is partial anchylosis of the knee joint. The patient walks with a cane with considerable impairment of motion." CASE 140. Private T. L. Lomax, Co. K, 30th Virginia, wounded at Antietam, September 17, 1862, and admitted to hospital No. 5, Frederick, on October 20th. Dr. A. V. Cherbonnier communicated, in June, 1869, that "it was supposed, when Lomax was admitted to hospital, he was merely suffering with a fracture of the thigh, high up, with no accurate knowledge of the extent. He was removed to a private residence, and after removal his limb was explored and a full knowledge and extent of the injury was ascertained. The injury was found to be serious, involving the upper portion, the trochanter, and, if I remember correctly, the neck. In the presence and with the assistance of Surgeon H. S. Hewit, U. S. V., and Assistant Surgeon J. H. Bill, U. S. A., I removed all the fragments of bone, and with the gouging forceps removed a considerable portion of dead and rough bone. The operation was repeated a couple of weeks after. The whole of the trochauter major was removed, going deep into the shaft, and leaving, if I remember correctly, but a shell of bone. When I left Frederick I had the satisfaction of seeing young Lomax on crutches. I cannot, with no notes, do justice to what I consider a most interesting case," etc. Surgeon Hewit, in a note dated July 26, 1869, stated: "It was a case of comminution of the hip. Three secondary operations by gouging were performed by myself, in which nearly all the head, neck, and trochanteric portion of the femur were removed. He subsequently made a good recovery." Dr. G. Johnson, of Frederick, subsequently, on October 21, 1869, furnished the following details of the case: " Mr. Lomax was wounded in the left hip. The ball struck the femur, shattering it by his account, but producing no solution of the continuity. He remained in the temporary hospital near the battle-field for weeks, was then brought to Frederick, and on October 31st was transferred to a private residence and came under my charge. His strength at this time was gradually succumbing to profuse suppuration and pain, and although he rallied somewhat at first by the change of circumstances and improved hygiene, it soon became apparent that surgical interference was demanded to arrest the downward tendency. Until this time his only treatment had been the abstraction of detached pieces of bone, detergent washes to the wound, and anodynes and tonics. Carious bone in considerable extent being evident to the probe, it was determined to attempt its removal, and on 72 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. November 15th Drs. Hewit and Charbonnier operated for that purpose, under chloroform. A large quantity of diseased bone was removed from the outer part of the upper third of the femur. There was but trifling haemorrhage, but ranch depression and irritability of stomach succeeded the operation, yielding, however, in a few days, to stimulants and effervescing draughts. For a fortnight the patient steadily improved under nourishing diet and tonics. He then again began to deteriorate under increasing suppuration, and On December 15th it was determined to again operate for the removal of diseased bone. This was accordingly done on that day by Dr. Hewit, the patient being under chloroform. The great trochanter and about two-thirds in circumference of the shaft of the femur were removed for several inches. The depression consequent was not so great as before, but on December 17th congestion of the right lung occurred, with expectoration of a quantity of typhoid pneumonic sputa. I painted the chest thoroughly with iodine tincture, and gave hydrochlorate of ammonia, with milk punch and animal soup. No consolidation of the lung occurred, and after a few days his chest gave no further trouble. I will not weary you with a detailed account of his symptoms and treatment during the four months ensuing. There was at no time any inflammation of the hip joint. Erysip elas twice gave much trouble, as also the usual disposition in such cases to form purulent sinuses. On January 23, 1863, I noted hard and excessive swelling of the limb, with grave constitutional disturbance attributed to lymphatic inflammation, and after this subsided much oedematous infiltration. Pieces of carious bone became from time to time detached, and were removed as soon as detected; the feeble circulation was supported by careful bandaging; the wound was kept thoroughly clean and his hygiene perfect. He took exercise in the open air in carriage and on crutches as soon as strength permitted, and in May was quite convalescent. June 8th, he left Frederick for exchange, still on crutches and wound discharging slightly, but looking healthy almost robust. A year after, he wrote that he was perfectly well and walked comfortably with a cane. In mentally reviewing this case some points of interest occur to me : As to the cause of so extensive a caries this was a true bone ulcer. The several operations did not consist of merely removing sequestra or detached portions of dead bone, but in paring and pinching off the diseased bone from that which was still sound. The ulceration was progressive. The second operation was more extensive than the first and at a month s interval. These facts are consistent with the theory (suggested, I think, by Dr. Hewit) that the caries depended upon osteitis, and this probably caused by the peculiar velocity with which the minie ball strikes. The amount of callus effused after the final operation was immense, fully equalling the new bone of a prolonged case of necrosis, and soon allaying the fear at first felt of fracture of the continuity of the bone through muscular action or otherwise. As regards the statistical value of the case it ended well ; but after an illness in which his life was in extreme jeopardy several times, and under circumstances rarely attainable in private practice, and I should think impossible in military life. The patient had full advantage of every circumstance that affection could prompt and pecuniary means procure. He was in the prime of life and entirely free from constitutional taint. He was free from depressing influences of every kind, while in his medical and surgical treatment I had the counsel and assistance of scientific and thoroughly experienced men. Among them, both he and I are under lasting obligations to Dr. Hewit, to whose operative skill, no less than to his humanity in permitting his removal from hospital, is due whatever credit may pertain to the issue of the case." The bone removed at the two operations referred to consists of a number of fragments, and was subsequently contributed to the Museum by Dr. Johnson, and constitutes Spec. 5652 of the Surgical Section. CASE 141. Private M. M. Phillips, Co. F, 42d Mississippi, aged 23 years, was wounded at the battle of Gettysburg, Pennsylvania, July 3, 1863, by a musket ball, which entered the posterior and outer aspect of the left buttock, fractured the neck of the femur, and emerged in the left groin. He was captured and removed to the hospital for Confederates, and was treated by the expectant plan. On July 22d he was transferred by rail to the De Camp Hospital, in New York Harbor. The wounds of entrance and exit had healed. He was able to walk by the aid of a crutch or cane and suffered no pain. The limb was shortened one and three-quarter inches. By flexing and rotating the limb true osseous crepitus was obtained. There was no inversion or eversion. The patient, much against his will, was placed upon a fracture-bed, where extension was produced for six weeks by a twelve-pound weight acting over a pulley. He was then permitted to rise and directed to use passive motion and friction. On September 20, 1863, he was paroled, being able to walk without assistance of any kind. The limb was short ened one and a quarter inches. The case is reported by Acting Assistant Surgeon George Edwards. Iii the next case, as in the case of Private Charles Miller (CASE 139, page 71), partial anchylosis of the knee joint had supervened many years after the injury: CASE 142. Private James Vanderbeck, Co. F, 145th New York, aged 21 years, was wounded at the battle of Chancellors- ville, May 3, 1863, by a conoidal musket ball, which entered the left thigh above and behind the trochanter major, passed forward and inward, fractured the neck of the femur, and made its exit at the groin. He was made a prisoner and remained in the hands of the enemy eleven days. He was then exchanged and conveyed to the Twelfth Corps Hospital, at Aquia Creek. The injured limb was simply placed in a comfortable position without any attempt at extension. On June 14th the patient was removed on a hospital transport to Alexandria and placed in the First Division Hospital. He was in good condition. The suppuration was comparatively slight, and no bone splinters were found loose and none had come away. Three days subsequently he was trans ferred to Philadelphia, and thence, on October 12th, to New York, where he was admitted to the Ladies Home Hospital. The wounds were closed at this date. The patient was discharged from the hospital and from the service of the United States on November 19, 1863. On that date he walked with crutches. His limb was shortened two inches, with eversion. He was allowed a pension. On August 2, 1866, Dr. E. Bradley, Examining Surgeon of the Pension Bureau, reported that Vanderbeck s general health was good, but that there was much lameness. The fracture was firmly consolidated. Commissioner C. C. Cox reports that Vanderbeck received his pension at the agency in New York City on March 4, 1868, and that his disability was then rated by the examining surgeon as total. On September 9, 1873, Examining Surgeon T. F. Smith, of New York City, states: "Ball entered left nates and emerged beneath left popliteal ligament, fracturing the femur; there is union with deformity and three inches shortening." On September 7, 1875, the New York Examining Board, Surgeons T. F. Smith, J. F. Ferguson, and M. K. Hogan, report "that the knee is anchylosed and the patient is obliged to wear a sole on his shoe three inches thick, and to walk with a cane ; the leg is useless for purposes of labor." SECT. II.] SHOT FRACTURES AT THE HIP TREATED BY CONSERVATION. 73 CASE 143. Private T. C. Garvin, Co. H, 94th New York, aged 43 years, was wounded at Hatcher s Run, February 7, 1865, and admitted to the field hospital of the 3d division, Fifth Corps. Surgeon D. C. Chamberlain, 94th New York, noted : "Gunshot wound of genitals." Four days after the reception of the injury the man was admitted to the Newton University Hospital, Baltimore, whence Surgeon R. W. Pease, U. S. V., reported: " Gunshot wound of penis and right testicle, ball emerging from right gluteal region, fracturing the femur." In a case book it is recorded that Buck s apparatus and counter- extension were used, also that there was free suppuration from the wound, and that evidence of union of the bone set in about March 10th. Assistant Surgeon D. C. Peters, U. S. A., reported that the patient was admitted to Jarvis Hospital May 23d, and described the injury as follows: "Gunshot wound of penis, right testicle, and fracture of femur involving the neck. Urine escapes through the lower opening of the penis. He had some union of limb, with about three inches shortening." The patient was discharged from service June 11, 1865, and pensioned. Examiner G. \V. Cook, of Syracuse, New York, certified, April 25, 1866: "Bullet struck the glans penis, passing downward and backward through the urethra, producing hypospadia, through which the urine is voided, thence into the right testicle, which is destroyed, thence into the right thigh, fracturing the same." The pensioner died January 3, 1869. Dr. A. Welch, his attending physician, certified that "to the time of his death Garvin was laboring under severe pain and difficulty from a wound which he received in the hip of the right side, passing through the joint and through the testicle, destroying the hip joint, and producing shortening of the limb, and an open wound from which pus and portions of the joint, consisting of splinters of bone, were discharged to the time of his death." CASE 144. Corporal Daniel Bachler, Co. G, 82d Illinois, aged 23 years, was wounded in the battle of Chancellorsville, Virginia, May 2, 1863, by a round ball, which, entering just above the right trochanter major, fractured the neck of the femur, and emerged beneath Poupart s ligament about two inches from the symphysis pubis. He stated that he lay thirteen days on the plank road unattended. He was admitted May 15th to the field hospital of the 3d division, Eleventh Corps, and was transferred thence, by steamer, to Alexandria, and admitted May 25th into the First Division Hospital. The patient had been informed that the wound involved the soft parts only; cold-water dressings had been applied. The limb was shortened about three inches. A fracture through the neck was discovered. Partial union had taken place. There was little suppuration and the pus was healthy ; the parts were but little swollen. Smith s anterior splint was applied and moderate extension made by weight and pulley. He was furloughed on July 14th for sixty days, and went to Chicago, Illinois. On September 10th Bachler was received into the City General Hospital in Chicago. A gunshot wound of the right hip joint was recorded. He was transferred to the 2d bat talion of the Veteran Reserve Corps on August 7, 1864. The case is reported by Surgeon Norman S. Barnes, U. S. V. The patient was discharged on July 15, 1865. The Chicago Examining Board, Drs. Wm. C. Lyman, E. D. F. Roler, and F. A. Emmons, report on September 10, 1873 : " The pensioner was shot through the hip close to the joint; there was loss of some small pieces of bone, and half an inch shortening of the limb." On April 3, 1878, the Board state: "There is partial loss of flexion and of power of leg, with neuralgic pains; the neuralgia is increasing." CASE 145. Private James McCabe, Co. A, 12th Massachusetts, was wounded on September 17, 1862, at the battle of Antietam, by a musket ball, which entered just below the right groin and made its exit at the buttock, fracturing the neck of the femur in its passage. He was conveyed to hospital No. 5, at Frederick, Mai-yland, and was treated with the limb in an extended position. On November 9th he was transferred to Frederick Hospital No. 1. In December a large metastatic abscess formed about the right shoulder, which was laid open by Assistant Surgeon R. F. Weir, U. S. A., a large quantity of pus escaping. After the healing of the abscess there was much Aveakness of the muscles of the acromial and humeral region, and the patient could not raise his hand above his chin. On June 16th he was sent in good condition to the Jarvis Hospital at Baltimore, and thence to Point Lookout Hospital, where he remained until July 25, 1864, when, the wound being healed, he was discharged. He was mustered out of service August 5, 1864. On June 10, 1887, he was examined at the office of Surgeon General Dale, of Massa chusetts. The fracture was firmly consolidated. There was but a slight limp in walking. His general health was excellent. He received a pension and was employed in the Soldiers Messenger Corps. He experienced no pain, except on change of weather or when his walk was extended beyond two miles. He considered his injury but a slight disability in his business, since he had free passes on all the lines of horse cars in Boston. CASE 146. Sergeant Edward G-. Gilliam, Co. C, llth Virginia, aged 24 years, was wounded in the engagement at Drury s Bluff, Virginia, May 16, 1864, by a rifle ball, which, entering the upper portion of the right thigh in front, fractured the neck of the femur, and lodged. He was conveyed the same day to Richmond and admitted into Chimborazo Hospital. There was ever- sion of the limb, but no shortening. On placing the finger upon the seat of fracture and rotating the thigh it was observed that the trochanter major moved with the shaft. There appeared to be but little comminution, and there was no escape of synovial fluid. The parts were but little tumefied. The limb was comfortably adjusted on pillows. The patient complained of severe pain in the thigh, especially along its inner aspect, and had frequent twitchings of the muscles. The pulse was 80, the tongue clean, the appetite poor. Half an ounce of whiskey was directed every fourth hour, and a nourishing diet, with one-third of a grain of morphine given at bedtime. During the latter part of May there was severe local pain, with rapid emaciation, and a bed-sore formed over the sacrum. On June 15th the limb was swung in a Smith s anterior splint. The patient s appetite soon began to improve, the pulse about 96. On June 27th he yet suffered severe pain in the hip and along the inner part of the thigh. On July 1st synovial fluid in large amount issued from the wound, after which the pain subsided. His appetite continued to improve, and he now slept well at night. One or two small spiculae of bone were eliminated in the discharges. On July 10th he was stronger and had no pain ; the bed-sore was healing; the discharge from the wound was small in quantity, and the oedema was disappearing. For several days, about July 20th, lie suffered pain at the knee, and the splint was removed. On July 30th the bed-sore was healed and his health was greatly improved; but any movement of the hip joint continued to create severe pain. By August 10th he had become stout and fleshy and could suffer the limb to be moved, and August 22d it could be moved freely without producing pain. At this date a small spicula of bone was removed. There was only a slight discharge from the wound. On September 5th he was able to raise the limb a short distance from the bed, and September 14th he sat up in a chair. There was limited motion of the hip joint. He was furloughed for sixty days on September 20, 1864. The case is reported by Surgeon E. M. Seabrook, C. S. A. SURG. Ill 10 74 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. CASE 147. Surgeon B. W. Avent reports that au officer received a gunshot fracture of the ueck of the femur; two fingers at entrance and exit fully explored the wound; date of injury unknown. The wound was dilated at entrance and spiculse was removed with saw and forceps. He lingered for months, but finally recovered with a limb four inches short, but able to walk with the assistance of a cane. CASE 148. Private R. Yerger, Co. I, llth Pennsylvania, aged 31 years, was wounded at Antietam, September 17, 1862, and entered the Broad and Cherry Streets Hospital, Philadelphia, on December 12th. Surgeon J. Neill, U. S. V., reported: "He was admitted to this hospital with an undetected fracture of the neck of the right femur. A minie ball entered on the front of the thigh on a vertical line with the anterior superior spinous process of the ilium and four inches below it, and, passing obliquely upward and backward, was cut out on a line with and about two inches below the posterior superior spinous process by the surgeon of the regiment on the field. At the time of his admission the wound had entirely healed, but the patient was unable to bear weight on the limb without pain. The tissues over and above the trochanter were flattened, and the fold in t&<i buttock was absent. Rotation was imperfect, and when an attempt was made to bear weight on the limb distinct crepitus could be felt in the neck of the bone, and he complained of pain at that point. Measurement from the xiphoid cartilage revealed two and a half inches shortening of the injured side, and from the anterior superior spinous process of the ilium it was three-fourths of an inch. The fracture appeared to be impacted, and the whole of the right innominate bone was considerably elevated above its normal position. The posterior superior spinous process of that side was also more prominent than that on the other side, giving the idea that the sacro-iliac symphysis had been injured and in that way accounting for the marked amount of shortening by measurement from the xiphoid cartilage. He stated that when shot he fell, the right hip striking the ground, and any attempt to move the limb gave rise to severe pain in the hip joint; also that the surgeon told him it was only a flesh wound and would soon be well. He remained in a field hospital for nine days, when he was removed to Chambersburg and treated for nine weeks, during which time he was allowed to get up to go to stool. The wound healed about two weeks before admission to this hospital. No fragments of bone were removed; crepitis is not so distinct, and his general condition is good. The amount of shortening from the anterior superior spinous process has increased from three-fourths to a full inch since admission." The patient was dis charged from service April 27, 1863, and pensioned. Examiner J. J. McCormick, of Irwin Station, Pennsylvania, certified, September 5, 1873: "Ball entered right thigh in front of trochanter major and came out one inch from lower end of sacrum, fracturing the neck of the femur. The limb is two and one-half inches shorter than the other; strength so much impaired that he cannot walk without a cane. Muscles of limb are atrophied." In an examination for increase of pension, in April, 1880, Examiner McCormick reports: "There is great impairment, of the strength and usefulness of the limb. The pensioner cannot work at all, nor can he set on a chair except a little on the left hip. The injury is nearly equivalent to the loss of the limb." In five instances of recovery after alleged shot fracture of the hip joint the "neck and trochanters" or "the neck and shaft" of the femur were reported to have been frac tured. Three of the cases 1 are here given in detail: CASE 149. C. F. Beyland, Q. M. D., aged 26 years, was wounded December 8, 1861, by a conoidal musket ball, which fractured the great trochanter and neck of the right femur. Excision was proposed and refused. The fracture was treated by Hagedorn s apparatus. After protracted and profuse suppuration the patient recovered with a limb shortened two inches. In July, 1863, he had dispensed with crutches and walked quite well. Assistant Surgeon C. K. Winne, U. S. A., reported the case. CASE 150. Corporal Luke English, Co. E, 2d Wisconsin, aged 21 years, was wounded at the battle of Gettysburg, Penn sylvania, July 1, 1863, by a conoidal musket ball, which entered at a point between the left trochanter major and the tuberosity of the ischium, emerging near the anus, penetrated the right thigh and fractured its trochanters, and lodged. He was admitted the next day into the Seminary Hospital at Gettysburg. Search for the missile was unsuccessful. Two fragments of bone were extracted. Cold-water dressings were applied. On July 17th he was transferred by railroad to York Hospital. Early in August the average discharge of pus was about four ounces. The wound of entrance had nearly closed. On November 4th he could walk a little, the wound, however, discharged considerably. He was discharged from the service of the United States on June 23, 1864. Surgeon Henry Palmer, U. S. V., reports the case. His attorney, John Hancock, of Oshkosh. Wisconsin, reports that English died in 1867. CASE 151. Private Philip Sweeney, Co. C, 3d New York, was wounded in the affair at Big Bethel, June 10, 1861, by a conoidal musket ball, which shattered the trochanters of the right femur. He was admitted to Hygeia Hospital, Fort Monroe, on June 13th, and was treated by Surgeon R. B. Bontecou, U. S. V., by moderate extension and dilatation of the wound by sponge tents in order to facilitate the extraction of primary sequestrse, of which many were removed. Suppuration and exfolia tion persisted until March, 1862. In April there were two severe attacks of erysipelas, involving the entire limb, which greatly reduced the patient, but he quickly rallied, and in May was able to run a race on crutches with his wounded companions. He was transferred to Albany in June, 1862; but his name does not appear upon the hospital reports until March, 1863. when he was admitted to the Ladies Home, in New York City, where a number of necrosed fragments were removed. On May 25, 1863, 1 The remaining two cases were: 1. Serg t P. Casserleigh, A, 38th Illinois; Chickamauga, Sept. 19, 1863: eonoidal ball entered behind the right great trochanter, passed inward and forward, fractured the apophysis, and, it was believed, injured the anterior crural nerve. It was considered possible, though not probable, that the joint was injured. He was discharged July 11, 1863. Examiner T. S. HEXING, of Springfield, reported, in May, 1865, that a ball entered the right hip a little posterior to the great trochanter, passed into the hip and remained concealed in the tissues ; limb one and a half inches shortened ; motion and power of joint destroyed ; and in November, 1866, that " the ball fractured the head and neck of the femur." The Springfield Examining Board reported, in August, 1874: "Thelimbisanchylosed in a semiflexed position and shortened four inches (Circ.%, p. 94, CASE 201). 2. Pt. T. Purcell, F, 96th Pennsylvania, aged 22; Chancellorsville, May 3, 1863; a conoidal ball was stated to have produced a fracture of left femur in upper third, extending into hip joint. From a field hospital of the Sixth Corps he was transferred to Armory Square Hospital, Washington, and subsequently to Cuyler Hospital, Gerrnantown, Pennsylvania. No mention was made at either of the latter hospitals of the involvement of the hip joint. At Mower Hospital, Philadelphia, the injury was noted as a "gunshot wound of upper third of left thigh with loss of four inches of bone." He was discharged July 8, 1865. Examiner J. T. CARPENTER, of Pottsville, reported, in September, 1873 : " Entrance of wound about four inches below anterior superior spinous process of ilium, upper third of femur shattered ; five inches shortening; no power; wasting of limb." (Circ. 2, p. 95, CASE 211.) .H- Surg. UieU.uf the War oT the Rebellion, Part ill Vol.11. PLATE XXXIII. CONSOLIDATED GUNSHOT FRACTURE OF THE FEMUR Case of Private Pltilip Sweeny, 3 r< ? X*wYork Volunlrers . SECT. II! SHOT FRACTURES AT THE HIP TREATED BY CONSERVATION. 75 he was discharged, being able to walk without a crutch and the limb being but slightly shortened. He soon afterwards engaged himself as a laborer at an iron foundry in Troy, New York, where he has since worked without intermission. On July 20, 186G. he was examined by Brevet-Colonel R. B. Bontecou, who found him in perfect health, the injured limb a trifle shortened, and the knee rather stiff, owing to the destruction of connective tissue about the extensor muscles of the thigh during the suppura tion following the erysipelatous attacks, and, doubtless, the formation of adhesions. The knee joint was in good condition and had sufficient motion to allow a firm, good gait. In a letter dated November 23, 1868, Dr. Bontecou states that Sweeney is at work at Troy in a spike factory, and was able to sit at and run a machine. His knee was stiff from agglutination of the sheath of the extensor muscles of the thigh, otherwise the limb was useful. The Albany Examining Board, Drs. W. Craig, R. B. Bon tecou, and C. H. Porter, record, in September, 1873: " Gunshot wound through the trochanters, fracturing the femur at the neck, leaving adhesions of all the muscles of the thigh from deep-seated sloughing, the result of erysipelas, making knee joint stiff in the extended posture." In September, 1875, Examining Surgeon R. B. Bontecou certified that "adhesions have rendered the knee immovable and the limb comparatively useless." The parts injured were not particularly specified in ten instances of recovery after alleged shot fracture of the hip joint. Two are here detailed, and eight are briefly recorded in the foot-note. 1 CASE 152. "Private William C. Watson, Co. A, 4th Michigan, was struck in the left hip, at the battle of Malvern Hill, Virginia, July 1, 1862, by a conoidal musket ball. A fracture through the trochanteric region, with fissures probably extending to the joint, was reported. He was conveyed to Philadelphia and admitted into the Episcopal Hospital July 30th, transferred to Master Street Hospital on March 18th, and to South Street Hospital May llth. The patient stated that for weeks his life was despaired of in consequence of the excessive suppuration which took place. Abscesses formed in the upper third of the thigh. Spiculae of bone escaped at intervals for months from the wound and through the incisions made for the evacuation of the abscesses. On January 1, 1864, suppuration had nearly ceased. The limb was shortened several inches and there was much deformity. On March 24th he was admitted into Christian Street Hospital, where he was discharged from service May 5, 1864. He received a pension in September, 1868, and his disability was rated as total and permanent." Surgeon Paul B. Goddard, U. S. V., reports the case. CASE 153. Private Samuel Hensel, Co. H, 114th Pennsylvania, aged 31 years, was wounded at the battle of Chancellors- ville, Virginia, May 3, 1863, by a musket ball, which entered the central portion of the left buttock. The soldier was conveyed by steamer to Washington, where, on May 8th, he was received into Armory Square Hospital. The wound was probed daily in search of the missile, which, at the end of two weeks, presented itself at the point of entrance and was extracted by the patient. He states that it was a round ball, but was flattened on one side, and had, in this surface, a clean cut filled with osseous matter. The treatment consisted of rest, position, and the application of cold-water dressings. On June 16th the patient was transferred to McKim s Mansion Hospital, in Baltimore. About the middle of July the nurse, while dressing the wound, discovered in it a foreign substance, Avhich, upon removal, proved to be a portion of the haversack. The patient was soon afterwards transferred to Mower Hospital, Philadelphia, Early in September a spicula of bone, nearly two inches in length by one in width in its 1 Cases of: Corp l J. J. Atkenson, B, 1st Tennessee ; wounded at Murfreesboro ; he was examined at Lauderdale, Mississippi, by Surgeons J. T. KEXXEDY, D. W. WHIMPER, and H. YAKDELL, P. A. C. S., who certified that he was suffering from a shot wound of left hip, fracturing bone, and wound of left hand, loss of use of two fingers; shortening and deformity of leg; retired to Confederate Invalid Corps (Circ. 2, p. 98, CASE 228). 2. Sergeant Albert G. Beebe, A, 85th Illinois, received, in the engagement near Perryville, Kentucky, October 8, 1862, a gunshot wound of the right hip, which was believed to involve a fracture of the joint. He was conveyed to hospital No. 7, in Perryville. He was discharged from service on February 15, 1863. His disability was rated as total. He is a pensioner. Examiner P. I,. DlFFEXBECHER. of Havana, Illinois, reported, May 29, 1876 : " Wound of right leg ; ball entered on the anterior aspect about three and a half inches below the groin, passed posteriorly and wounded trochanter major, superior aspect. Exit just posterior to the thigh joint; bones and muscles destroyed; also large cicatrix at point of ingress. Hip joint and leg affected by rheumatism aggra vated by fatigue and exposure." The case is reported by Assistant Surgeon H. S. WOLFE, 81st Indiana. 3. Pt. D. J. C. Campbell, E. 3d Virginia, aged 36 ; Payne s Farm, November 27, 1863 ; shot wound left hip, ball entering near the trochanter major and lodging in the bone in the vicinity of the hip joint; retired from service, unfitted for any duty (Circ. 2, p. 98, CASE 229). 4. Corp l H. Koch, F, 7th Missouri, aged 26; Chickamauga, September 20, 1863; conoidal ball splintered left femur above the shaft; discharged May 16, 1864. The St. Louis Examining Board reported, June 3, 1874: "Ball struck left thigh near trochanter major, shattering the bone" (Circ. 2, p. 100, CASE 245). 5. Pt. A. C. Woodall, G, 55th Pennsylvania, aged 17 ; Drury s Bluff, May 16, 1864 ; fracture left hip, involving the articulation ; mustered out June 8, 1865, and pensioned ( Circ. 2, p. 101, CASE 254). 6. Corp l T. Gal lagher, F, 165th New York, aged 30; Port Hudson, May 27, 1863; canister ball entered two and a half inches below great trochanter, passed backward and upward, and lodged three inches from place of entrance ; projectile and several fragments of bone removed : discharged December 19, 1863, and pen sioned. The New York Examining Board reported in October, 1872: Ball struck outer aspect upper third left hip, fracturing or splintering the femur, and leaving two well-marked cicatrices; interferes with locomotion" (Circ. 2, p. 103, CASE 261). 7. Pt. R. F. Carter, B, 20th North Carolina, aged 21 years, was wounded at Gettysburg. July 1, 1863. His injury is entered on the register of the Gettysburg field hospital as a "gunshot wound of thigh and hip, with compound comminuted fracture of hip joint." On September 4th the patient was admitted to Camp Letterman, where Surgeon H. JAXES, V. S. V., recorded : " A minie ball entered outer side of upper third of left thigh, lodging in the left groin and fracturing the femur in its course. When admitted the general health of the patient was good; leg a little swollen. On September 12th a small piece of bone was removed. October 10th, wound discharging freely, and fracture united with firm callus thrown out. November 8th. improving slowly. Patient can bear about one-tenth of the weight of his body on the limb. November 10th, transferred convalescent." Surgeon A. CHAPEL, U. S. V., reported that the man was admitted to West s Build ings Hospital, Baltimore, with "gunshot wound of left hip," and that he was paroled November 12, 1863. 8. Pt. H. Marlatt, G, 12th Illinois Cavalry, aged 19 years, was wounded at Upperville, June 21, 1863. He was admitted to a Cavalry field hospital, where Surgeon J. B. W. MITCHELL, 8th Penn- sylvania Cavalry, noted : "Wound of left thigh by a pistol ball." Surgeon J. A. LIDELL, U. S. V., recorded his admission to Stanton Hospital, Wash ington. June 23d, with "wound of thigh," and his "return to duty on November 25, 1863." It is believed, however, that the man did not return to active field service, but was discharged from the hospital only to accompany his command when changing station from the Army of the Potomac to the Western armies. He was subsequently admitted to Camp Gamble, whence he was transferred to the Lawson Hospital, St. Louis, on February 15, 1864. Surgeon C. T. ALEXANDER, U. S. A., reported: "Gunshot wound of left thigh two inches below Poupart s ligament; ball passing downward, inward, and lodging. Wound healed when admitted. General condition good ; uses crutches. Patient discharged from service February 27, 1864." Examiner C. HAY, of Warsaw, Illinois, certified, December 20, 1865: "A pistol ball entered the anterior upper third of the thigh, ranging towards the hip joint. The joint was in all probability injured, as he has not been able to move the limb upward since the casualty. The ball was lodged in or near the hip joint, upon the thigh bone, and still rests there. The bones composing the hip joint are now carious. The urinary organs are much deranged iu their functions." 76 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. central portion, was extracted from the wound. Flaxseed poultices were applied. Subsequently ten other pieces, varying in size from one-fourth to one inch in length, were eliminated. The wound soon closed and the patient was able to get about on crutches. On September 24th he was transferred to McClellan Hospital, Philadelphia, where, on May 13, 1864, he was dis charged from service "because of a compound fracture of the left thigh, upper third, incapacitating him for duty." Pension Examining Surgeon H. L. Hodge, of Philadelphia, reported, May 26, 1864 : "On account of a gunshot fracture, probably of the os innominatum (left), there is a luxation of the head of the femur, which destroys the usefulness of the whole limb." On November 1, I860, an apparatus was fitted to the disabled limb by Gemrig, of Philadelphia. Examining Surgeon James Cum- miskey reported, April 6, 1867 : "Was wounded by a ball entering the left buttock and lodging for a time in the left groin, frac turing the head of the femur badly, and resulting in shortening of the limb about three and a half inches and much wasting and feebleness of the limb. He is obliged to wear constantly an iron instrument to support the limb in walking. He suifers much pain at night." In a communication to this office dated Philadelphia, February 13, 1868, Mr. Hensel states that he is unable to walk without the use of the apparatus and a cane, but by the aid of these he can walk from a half to three-quarters of a mile, being obliged, however, to rest for two or three minutes once or twice by the way on account of pain and weakness in the limb. The Philadelphia Examining Board, Drs. H. E. Goodman, T. C. Rich, and James Collins, reported, September 4, 1875: "Has had a ball enter the left buttock, which was extracted from the wound of entrance. Has lost bone from head of femur, and the limb is nearly three and a half inches shortened. He has to wear a support with a high heel and sole shoe. Motion of hip joint limited to one-eighth degree. Spine curved from short limb." Details of twenty-one of the reported cases of recovery after alleged shot fractures of the hip joint have been cited in the preceding pages, and the remaining thirty-four cases have been briefly alluded to in the foot-notes. The hip joint was undoubtedly involved in three of the fifty-five cases, viz: CASE 134, of Lieutenant Colonel H. 0. Strong, 38th New York Volunteers; CASE 140, of Private T. L. Lomax, 30th Virginia; and CASE 143, of Private T. C. Garvin, 94th New York Volunteers. The latter died four years after the injury, but the opportunity was not improved of ascertaining unequivocally the precise nature of the injury to the articulation. Twelve cases 1 were probably examples of fractures of the trochanteric region or base of the neck of the femur, without the capsule. In thirteen cases the evidence is, to say the least, contradictory as to the seat of injury. 2 In five cases the evidence adduced is compatible with the supposition that the fractures were extracapsular. 3 In five other cases it is not proven that the articulation was directly injured. 4 The case of Private A. C. Woodall (Note 1, page 75) seems to have been a periarticular injury only. In the case of Private J. W. Galyean, 10th Indiana Volunteers (Note 1, page 70), the Pension Examining Surgeon, years after the injury, diagnosticated an injury to the joint. In the case of Private J. Hughes, 1st Alabama Cavalry, the evi dence consists of an affidavit of an unknown surgeon before an "Association for the relief of maimed soldiers." In thirteen cases 5 the evidence is entirely insufficient to prove that the injuries were intracapsular shot fractures of the joint. In the case of Private W. C. Watson (CASE 152, page 75), 4th Michigan Volunteers, there remains room for argument, but the weight of evidence is adverse to the supposition that the hip was implicated. Of the fifty-five cases of alleged recoveries after shot fractures of the hip joint treated without operative interference, eighteen were Confederate and thirty-seven Union soldiers. In the cases of the Confederate soldiers no information subsequent to the close of the war could be obtained. Of the thirty-seven Union soldiers four had died previous to 1880, one had not been heard from since 1866, and thirty-two were pensioners. "Cases of: Pt. Philip Sweeney (CASE 151, p. 74. ante); Pt. Charles Miller (CASE 139, p. 71); Pt. M. M. Phillips (CASE 141, p. 72); Pt. James Vanderbeck (CASE 142, p. 72); Pt. J. Doody (Note. 1, p. 70); Corp l D. Bachler (CASE 144, p. 73); Serg t E. G. Gilliam (CASE 146, p. 73); Pt. J. W right (CASE 13 ), p. 69); Corp. L,. English (CASE 150, p. 74); Serg t A. G. Beebe (Note 1, p. 75); Corp. T. Gallagher (Note 1, p. 75); Pt. S. Hensel (CASE 153, p. 75). 2 Casesof: Pt. J. Kivel, Pt. W. Swank, and Pt, O. Wilson (Note 1, p. 69); Pt. J. W. Britton, Pt. A. G. Cotton, Pt. F. Kimball, Pt. R. P. McCutchen, Lieut. C. P. Stoneroad, Pt. D. Strickler, and Pt. J. Weber (Note 1, p. 70); Serg t P. Casserleigh and Pt. T. Purcell (Note. 1, p. 74); and of Pt. H. Marlatt (Note 1, p. 75). 3 Cases of: Capt. W. A. Hugh (CASE 137, p. 70); Pt. J. T. Elliott (CASE 138, p. 71); Surgeon B. W. Avent s case of an unknown officer (CASE 147, p. 74); Pt. R. Yerger (CASE 148, p. 74) ; and C. F. Beyland (CASE 149, p. 74). 4 Cases of: Pt. J. McCabe (CASE 145, p. 73); Pt. S. T. Hook, Pt. W. Miles, and Pt. T. Winans (Note 1, p. 70); and Corp l H. Koch (Note 1, p. 75). B Cases of: Pt. J. L. Harvey (CASE 133, p. G7, ante); Pt. G. A. Crymes, Serg t F. M. Hunter, Colonel L. S. Slaughter, Pt. I. S. Smith, Pt. R Finkle, and Pt. C. Wilson (Note 1, p. 69); Serg t J. M. Adams (CASE 136, p. 69); Pt, W. V. Trail and Pt. W. B. Reynolds (Note 1, p. 70); Corp l J. J Atkenson, Pt. D. J. C. Campbell, and Pt. R. F. Carter (Note 1, p. 75). WOUNDS AND INJURIES OF THE HIP JOINT. 77 Shot Fractures at the Hip Joint unsuccessfully treated by Conservation. Two hun dred and forty-nine fatal cases of shot fractures of the bones of the hip joint treated by conservation were found on the various reports and hospital registers. In ten instances the aeetabulum was recorded to have been fractured: CASE 154. Private G. W. Gentle, Co. E, 5th Ohio, was wounded at Antietam, September 17, 1862, and admitted to hospital No. 3, Frederick, October 1st. Assistant Surgeon J. H. Bill, U. S. A., reported: "The ball entered to the outside of the right pyramidalis muscle, passed outward and downward in front of the femur, and emerged at a spot in the integument corresponding to the insertion of the gluteus maximus. Nothing happened in this case, and no injury of a grave character was suspected. On the 23d of October, however, a haemorrhage from both wounds took place. It was dark in color and readily checked by a tampon. Accordingly no action was taken, and, on the 25th, it recurred. It was now found that the thigh and hip were much swollen, an abscess present, seated in the track of the wound, and haemorrhage evidently due to the ulceration of some vessel. In consultation with Surgeon PI. S. Hewit, U. S. V., ligation of the external iliac was determined on. The man, however, refused the operation, and as the haemorrhage* externally had ceased, it was considered proper to wait. On October 27th, the hemorrhage returned and the man wanted the artery tied. He was nearly moribund, and the case otherwise being unprom ising still, the operation was undertaken by an incision parallel to but outside of the epigastric artery. The external iliac was found and tied without any difficulty. Previous to tying the ligature it was intended to lay open the abscess and search for the bleeding vessel, knowing that the circu lation could be controlled. But at this stage of the operation the shock to the patient was so severe that it was necessary to finish all operative interference as soon as possible. The patient survived the operation only twenty-four hours. The autopsy showed the external iliac tied a quarter of an inch below the internal iliac, and the vein and peritoneum uninjured. A syringe was introduced into the femoral artery below the origin of the profunda and water thrown upward, but the bleeding os innominatunfand healf < .f vessel was not discovered, notwithstanding a careful dissection and prolonged search. The syringe mur 7 5o fter Shot contllsi " n - was now introduced into the internal iliac and the water thrown downward, but with no better result. Failing thus to discover an ulcerated vessel on the cadaver, what likelihood would there have been of a successful seai-ch for the bleeding point on the living patient? The operation performed was unquestionably the proper one, as it checked the hsenior- rhage, and was the only feasible method of doing this." The specimen represented in FIG. 26 was contributed by Assistant Surgeon J. H. Bill, and consists of "the right os innominatum and head of the femur. The joint was opened and the ischium at the lower border of the aeetabulum contused by a musket ball which escaped through the glutaeus maximus. The articular surfaces are eroded, but the implication of the joint was not suspected during life." (Cat. Surg. Sect., A. M. M., 1866, p. 235.) The remaining nine cases of fatal shot fracture of the aeetabulum have been detailed; seven in Circular Wo. 2, 1 and two in the Second Surgical Volume? The ten patients belonging to this group survived the injury 10, 11, 28, 31, 31, 32, 41, 46, 85, and 160 days respectively, and in two instances frag ments of bone were removed. 3 Autopsies verifying the injury to the hip joint were made and recorded in nine of the ten cases, and in seven instances the specimens are preserved in the Army Medical Museum. Specimen 1285 (FiG. 27) is from the case of Private Joseph D , Co. E, 129th Pennsylvania, aged 20 (Circular No. 2, S. G-. 0., 1869, p. 90, CASE 161). A conoidal ball had chipped the upper edge of the coty- Fio.27.-i5.mes of left hip joint loidcavitv, causing slight exfoliation. The FIG. 28.-canous bones of ie hip ith conoidal ball. Spec. 1285. . , - ., . Jomt *" 694 head ot the temur and the aeetabulum were deprived of periosteum. The injury to the bone was very trivial. The patient survived the injury thirty-one days. Specimen 694 (FiG. 28) is from the case of Private C. H. 1 Circular No. Z, p. 88 : CASE 150, Pt. Wm. P. F , 121st New York, Spec. 3525, A. 51. M. CASE 160, p. 89, Pt. J. Brandon, 119th New York, Spec. 1843. CASE 161, p. 90, Pt. J. Donegan, 129th Pennsylvania, Spec. 1085. CASE 162, p. 90, Pt. T. McGowan, 121st New York. (See Boston Med. and Surg. Jour. 1863, Vol. 68, p. 439.) CASE 163, p. 90, Pt. C. H. Roberts, 1st New Jersey, Spec. 694. CASE 164, p. 90, Pt. Wm. H W , G, 4th New York. CASE 2o7, p. 102, Capt. S. J. Alexander, B, 9th New Hampshire. *Med. and Surg. History of the War of the Rebellion, Part II, Vol. II, p. 317: CASE 920, Pt. L. M. B , I, 1st Massachusetts, Spec. 116; CASK 922, p. 318, Serg t T. A , C, 119th New York, Spec. 1183. 3 OASE of J. Brandon, F, 119th New York, Circular 2, p. 89, and CASE of Capt. S. J. Alexander, B, 9th New Hampshire, Circular 2, p. 102. with 78 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Roberts, Co. C, 1st New Jersey Volunteers, aged 19 (Circular No. 2, p. 90, CASE 163). The point of impact of the missile appears to have been at the lowest margin of the acetabulum, where a square inch of the ischium is necrosed and nearly separated. The acetabulum and head of femur were recorded as having been fractured in thirty- two of the two hundred and forty-nine fatal cases of shot fractures of the hip joint. Autop sies are recorded in twenty instances, and in thirteen cases the specimens are preserved in the Army Medical Museum. /Specimen 1908 (FiG. 29) is from the case of Private Joseph W- -, K, 6th Maryland, aged 45 (Circular 2, p. 89, CASE 154). Death occurred in thirteen days. The lower margin of the acetabulum was chipped by the ball, which lodged in the summit of the head of the right femur, splitting it perpendic ularly. Specimen 1248 (FiG. 30) is from the case of Corporal G. Greenwood, D, 13th Massachusetts . FIG. 29. Bones of right hipjomt. Ball (Circular 2, p. 113). injury thirteen days. The patient survived the The ball had shattered the FIG. 30. Shattered head of the left femur. impacted in head of femur, 1908. of the left femur and lodged in the pelvis. Spec - Twenty-five of the cases have been published in detail in Circular No. 2, 1 and seven will here be recorded: CASE 155. Lieutenant C. F. Bailey, Co. D, 6th Vermont, aged 40 years, was wounded at Lee s Mills, April 16, 1862. Surgeon J. B. Brown, U. S. A., described the injury as a "wound of the groin." Surgeon R. B. Bontecou, U. S. V., reported : "He was admitted into the Hygeia Hospital, Fort Monroe, on April 22d, having been wounded by a round ball, which entered the left groin, passing between the femoral artery and anterior crural nerve, then entering the ramus of pubis and acetabulum, furrowing deeply the head of the femur, and passing through the acetabulum into the pelvis and resting by the left side of the rectum, about four inches above its termination. On admission, he was suffering much pain when the limb was moved. Wet applications and soothing treatment, with perfect rest, made him for some days comfortable. Fever of a low form occurred, and a yellow condition of the skin followed, with delirium, and death on May 1, 1862." CASE 156. Private H. U. Cady, Co. K, 207th Pennsylvania, was wounded at Peters burg, April 2, 1865, by a conoidal ball. He was carried to the field hospital of the Ninth Corps, and remained there until April 5th, when he was taken on board the hospital steamer State of Maine. He died April 6th, during the trip to Alexandria, and was buried from the Third Division Hospital. Surgeon E. Bentley, U. S. V., who presented the injured upper extremity of the left femur, with portions of the ilium and ischium, to the Museum, furnishes the following description of the specimen, No. 3205, A. M. M., represented in the adjoining wood-cut (FiG. 31): "The bullet entered one inch above the symphisis and to the left of the median line, shattered the ramus of the pubes, left the obturator vessels untouched, passed through the acetabulum, grooving the head of the femur, and lodged in the loose tissue beyond. The ramus of the ischium appears to have been fractured by Spec. 3205. indirect violence. The bony fragments in the track of the ball are thoroughly necrosed." CASE 157. Private W. Hobbs, Co. C, 22d Indiana, was wounded at Mission Ridge, November 25, 1863, and entered the General Field Hospital at Chattanooga, December 4th. Acting Assistant Surgeon C. E. Ball reported: "He was wounded by a minie ball in the right inguinal region just above Poupart s ligament, the missile passing downward, toward and into the thigh apparently. The patient has double pneumonia. The bullet was in the wound, and the surgeons could not find it. The wound granulated well. Patient was in a recumbent position from the first. December 30th, has pneumonic symptoms still; wound granulating finely. Gangrene appeared in the wound January 3d. Bromine was applied and scissors used, also stim ulants on poultice. Most of the wound granulated healthily again, but in spite of stimulants and iron, carefully given, the patient died January 23, 1864." Acting Assistant Surgeon G. E. Stubbs contributed the specimen (Cat. Sury. Sect., 1866, p. 240, Spec. 2103), with the following account of the autopsy: "A sloughing wound, circular in form, and five and a half inches 1 Circular No. 2, 1869: CASE 40, p. 70, Corp l Wm. Francks, G, 24th Iowa (Boston Med. and Surg. Jour., 1865, Vol. 72, p. 29), Spec. 3793. CASK 1.23, p. 85. Corp l II. Achlcy, G, 2d New York H. A. CASE 125, p. 85, Pt, J. H. Brown, A, 19th Mass. CASE 126, p. 85, Pt. C. H. Calhoun, H, 7th North Carolina. CASE 127, p. 85, Pt. J. H. Carlon, D, 184th Pennsylvania. CASE 128, p. 85, Pt. G. II. C , F, 59th Mass., Spec. 3582. CASE 131, p. 86, Pt. //. De Coux, Depeak s Confederate Battery. CASE 133, p. 86, Pt, J. S. Fabus, 1, 169th New York. CASE 134, p. 86, Pt. David F , G, lllth New York, Spec. 1616. CASE 135, p. 86, Sergeant S. Carver, K, 89th Indiana. CASE 136, p. 86, Pt. F. Geyser, F, 1st Minnesota. CASE 138, p. 86, Serg t W. N. Hinds, D, IS . d New York. CASE 141, p. 87, Pt. W. D. Little, G, 100th Indiana. CASE 144, p. 87, Pt. Royal S. N , A, 26th Mass., Spec. 3726. CASE 146, p. 88, Pt. C. Robinson, C, 2d District Columbia, CASE 147, p. 88. Pt. C. R , 49th New York, Spec. 1247. CASK 148, p. 88, Pt. Z. S , K, 2d Ohio Cavalry, Spec. 3904. CASE 149, p. 88, Pt. H. II. Sturdivant, A, 179th New York. CASK 157, p. 89, Corp l J. P. White, II, 115th Illinois. CASK 151, p. 89, Pt. Joseph W , K, Gth Maryland, Spec. 1908. CASE 155, p. 89, Pt. J. Wiley, A, 155th Now York. CASE 156, p. 89, Pt. J. B. Wilson, E, 20th Mass. CASE 157, p. 89, Pt. L. Winslow, A, 67th Ohio. CASE 239, p. 100, Pt. D. A. Brewer, E, 37th Kentucky. CASE 275a, p. 113, Corporal G. Greenwood, D, 13th Mass., Spec. 1248. FIG. 31. -Grooved head of left femur, with portion of ilium and ischium. SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 79 in diameter, occupies the right inguinal region. The ball entered two inches from the anterior superior spinous process of the ilium, descended behind the caecum, one and a half inches from the ramns of the pubis, passing through the bone and laying open the acetabulum, and fractured the tuberosity of the ischium, where it lodged. The head of the femur is denuded. The left lower extremity is much larger than the right and pits under the finger. The femoral glands are enlarged and prominent; the tissues about them infiltrated with serum. The right femoral vein is filled with a thrombus more or less attached to its wall, which may be detached without impairing the integrity of the lining of the vein. This thrombus consists in the main of greyish granular matter with portions of black coagulum, and extends to the junction of the iliac veins. A similar thrombus is found in the left iliac and femoral veins." 1 The specimen consists of the bones of the right hip joint. Much of the head of the femur is eroded, but a small circular portion of sound bone remains on the anterior aspect, surrounded by diseased tissue. CASE 158. Sergeant M. B. Pendley, Co. E, 6th North Carolina, aged 36 years, was wounded at Gettysburg, July 1, 1863. He remained at a field hospital until August 7th, when he was admitted to Camp Lettermau. Acting Assistant Surgeon D. R. Good reported: "Gunshot wound of right hip joint. A minie" ball passed through his pocket book, and entered the right iliac region one and a half inches inside of the anterior superior spinous process of the ilium, passed directly in the region of the joint and remained. The patient s general health has been very good, though he has suffered constant and severe pain from the injury and cannot endure the least motion of the limb. There has been comparatively very little inflammation and swelling of the surrounding parts. Simple dressings were applied and generous diet given. August loth, for some time the limb has been flexed and drawn over and in front of the other leg. Administered chloroform and straightened the limb, and applied splint to keep the leg at rest. 22d, patient is comfortable so long as his limb is not moved, and is doing well. The general treatment is continued. 27th, general health not so good; limb more swollen. Administered tonics and some stimulants. 30th, has slight diarrhoea; opiates prescribed. September 4th, diarrhoea continues; ordered opiates and astringents. 10th, considerably better ; treatment continued, with tonics and stimulants. 12th, diarrhoea still troublesome at times; his strength foiling considerably. 16th, greatly prostrated; evidence of pyaemia. 17th, gangrene in the parts about the wound. Died September 17, 1863, at 10 o clock P. M. Post-mortem : The ball had passed directly into the joint, slightly fracturing the head of the femur, and was buried in the acetabulum. The cavity was filled up with bone, and a large quantity of pus was found to have accumulated in and about the joint." The os innominatum and the upper portion of the femur were forwarded to the Museum by Acting Assistant Surgeon E. P. Townsend. The specimen shows a fracture extending through the acetabu- Inm at the point of impact, which is necrosed, nearly the entire remainder of the articular surface being carious. A large portion of the head of the femur has been absorbed. Slight osseous deposits exist on the outer margin of the acetabulum. (Cat. Surg. Sect. 1866, p. 242, Spec. 1942.) CASE 159. Corporal G. W. Stepps, Co. C. 20th North Carolina, aged 20 years, was wounded at Spottsylvania, May 12, 1864, and entered Lincoln Hospital, Washington, on May 22d. Assistant Surgeon J. C. McKee, U. S. A., reported: Gunshot wound of right groin, a minie" ball entering half an inch below and exterior to the middle of Poupart s ligament, fracturing the head of the femur and the acetabulum, and escaping at the middle of the right nates. Death occurred on June 10, 1864." A portion of the os innominatum, represented in the wood-cut (FlG. 32), was contributed by Acting Assistant Surgeon H. M. Dean. (Cat. Surg. Sect., 1866, p. 236, Spec. 2488.) Fir.. 32. Portion of right m- CASE 160. Private G. S. Turner, Co. I, 19th Maine, aged 18 years, Avas wounded at Gettys- nomiuatum, with fracture of burg, July 3, 1863. He remained at the field hospital of the 2d division, Second Corps, until July ^l fi 14th, when he was transferred to the Jarvis Hospital at Baltimore. Assistant Surgeon D. C. Peters, U. S. A., reported: "Gunshot wound of left hip joint. The anterior wound was about the middle, and above Poupart s ligament; the posterior near the tuberosity of the ischium. Blood oozed almost continuously from the wound in front, and twice alarming haemorrhages occurred. He had a bad and colliquative diarrhoea, and was nearly pulseless when admitted. No reaction came on such as would warrant so formidable an operation as tying the common iliac. Constant pressure by com presses was made. Death occurred on July 19, 1863. The post-mortem revealed an immense traumatic aneurism and abscess about the hip joint. The femoral artery was lacerated and a mass of decomposed tissue. The musket ball struck the acetabu- lunf and the head of the femur, gouging them, and subsequent disorganization denuded them of periosteum. The structures around were in an advanced state of decomposition, and it is a wonder the patient lived so long as he did." CASE 161. Private H. West, Co. A, 3d North Carolina, aged 20 years, was wounded at Antietam, September 17, 1862, and admitted to the hospital at Locust Springs, November 22d, where Surgeon T. H. Squire, 89th New York, recorded: "The patient came to this hospital from Sharpsburg. He was wounded by a musket ball, which entered the right gluteal region midway between the summit of the trochanter and the crest of the ilium and lodged in some unknown part of the body. There is a general fullness, and some hai dness and redness in the groin and region of Poupart s ligament, and possibly the ball may be in that neighborhood. The patient s general health is tolerable." On January 19th he was transferred to the Smoketown Hospital, and, on May llth, to hospital No. 1, at Frederick. Assistant Surgeon R. F. Weir, U. S. A., reported that he died, July 6, 1863, of gunshot wound of hip, involving the joint." Acting Assistant Surgeon G. M. Paulin contributed the os innominatum and the head of the femur of this case to the Museum. The specimen shows that a round bullet entered obliquely from the right front, fractured the superior portion of the head of the femur, perforated the acetabulum, and lodged in the body of the ilium without derangement to its own form. One half of the head of the femur has been absorbed; the anterior superior third of the acetabulum is carious and partially detached; near the fundus of the acetabulum ulceratiou has perforated the bone, and the bullet communicates with the head of the femur by a carious channel. The missile is encircled with a wall of new- bone thrown out from the irritation of its presence; there is also considerable deposit of callus on the ilio-pubic region, which caused, during life, a prominence in the region of Poupart s ligament. The dorsum ilii and the posterior surface of the body of the ischium show evidence of periosteal inflammation. (Cat. Sury. Sect., 1866, p. 242, Spec. 3865.) LlDELL (J. A.), in Memoirs of U. S. Sanitary Commission, New York, 1870, Surgical Vol. I, p. 551, describes the thrombosis with pyaemia. 80 INJUEIES OF THE LOWER EXTREMITIES. [CHAP. X. In twenty of the two hundred and forty-nine cases with fatal terminations after shot fractures of the hip joint, the acetabulum with the head and neck or trochanters and shaft were injured. Post-mortem examinations are recorded in seventeen instances, and the Army Medical Museum possesses eight specimens belonging to cases of this group. Fifteen of the cases have been detailed in Circular No. 2; 1 five will here be given in full: CASE 162. Private E. Snyder, Co. K, 13th Illinois, was wounded at Ringgold, November 27, 1863, and admitted to the general field hospital at Chattanooga on the following day, where Surgeon J. Perkins, U. S. V., recorded: "Gunshot wound of left hip." Two weeks afterwards the patient was transferred to Nashville, where he was admitted to hospital No. 19. Surgeon W. Foye, U. S. V., described the case as follows: "Admitted December 15th, with gunshot fracture of left femur; the ball, which proved to be a large mini<, entered about one and a half inches to the left and below the anterior superior spinous process of the ilium and had not emerged. The wound was quite small, and discharging a small quantity of pus of a somewhat serous character ; pulse weak, about 90, and feverish. Simple dressings, supporting diet, and tonics were ordered. The following day the discharge was of a fair character and the patient feeling better. As the ball had been searched for twice without success, it was deemed best not to disturb the parts unless rendered necessary. On December 18th the discharge was very profuse, amounting to nearly a quart of sanious and watery matter of very fetid odor. The wound was laid open and probed; the path of the ball was apparently along the inner side of the femur, yet that was not sufficiently large for so profuse a discharge; but no other path or sac was found, though the neck of the femur was ascertained to be much comminuted. He seemed more feverish during the day, and had some dyspnoea and cough ; pulse 100. Treat- Fio. 33. Bones of the left hip ment continued. On December 19th the patient was evidently failing ; pulse 110, and weak ; junction wfth the "neck. S Spec^ZlTA. discharge more profuse and of the same character. On the 20th the symptoms were all aggra vated. He died on December 21, 1863. The autopsy showed that the ball had entered at the point above described and struck the neck of the femur, completely severing it and partially dividing the head, comminuting the lower part of the acetabulum and passing through the ilium, and lay about an inch within the cavity of the pelvis. It was surrounded by coagula, but had done no injury to the intestines. A smaller track was made along the inner side of the femur. No piece of ball was found in this path. Intestines normal ; liver and spleen considerably enlarged and friable. The right lobe of the lungs Avas inflamed but not hepatized. There were no abscesses in any of these organs. The heart and other organs were in good condition." The bones of the injured hip joint were contributed to the Museum by Surgeon Foye. (Cat. Sury. Sect., 1865, p. 242, Spec. 2174.) The specimen (FlG. 33) shows the borders of the bony wound to be necrosed. CASE 163. Private A. Kibble, Co. C, 81st New York, aged 26 years, was struck in the right hip by a cannon ball during the engagement near Petersburg, May 19, 1864. He was admitted to the General Hospital at Fort Monroe, where he died May 25, 1864. Assistant Surgeon E. McClellan, U. S. A., reported: "Both the os innominatum and the femur were frac tured and much comminuted, all the bones entering into the formation of the joint being literally crushed by a solid shot." CASE 164. Private C. Cook, Co. F, 18th Illinois, aged 41 years, is reported by Surgeon J. Simons, U. S. A., as having died of "gunshot wound," at the General Hospital at Cairo, December 4, 1861. In a report of surgical cases transmitted in April, 1873, by Dr. J. H. Brinton, late Surgeon U. S. V., the injury is described as follows: "Cook was shot while drunk, by a guard, on December 1st, at 6 o clock p. M., at a distance of thirty yards. The missile, a Maynard rifle ball, entered in left side on a line with the crest of the ilium, passed outward and downward, and emerged at the posterior part of the left buttock. I saw him shortly after the injury in a state of collapse from the shock, pulse 132, feeble and thready; skin cold, white and waxy; cold sweat on forehead; constant venous dribbling from both openings. December 2d, no discharge from his bowels since being shot ; passes his urine; is in a very prostrate condition; has reacted but very little. Stimulants have been freely given. A few spiculse were extracted from near the exit orifice. December 3d, patient failing fast; pulse feeble and not to be counted; urine scanty; pulse imperceptible; skin hot and dry; urine voided involuntarily; bowels have not been moved. Died at 9 o clock A. M., on December 4th. Post-mortem two hours after death : Tissues around wound o, entrance dissected up all around for an inch. Ball had passed obliquely outward and downward, grazing the anterior lip of acetabulum, passing through head of femur, splintering it and the neck, and destroying the posterior lip of the acetabulum. The extravasation of blood had passed down from wound of entrance, along and superficial to tendon of external oblique muscle as far as the external ring, then up the inguinal canal through the internal ring, and was collected in a clot of three or four drachms around the internal ring. Both rings were enlarged; a hernia came down after injury, which was reduced; no wound of the peritoneum. The tissues were loosened around the wound of entrance in a circumference of one and a half inches." In addition to this case Dr. Brinton makes the following remarks: "This loosening of tissues around the entrance wound of a conoidal ball I have since observed in hundreds of cases. It is undoubtedly peculiar. Usually the point of a finger passed through the wound can be hooked under the skin and swept around without encountering resistance suflicient to impede its motion. The earlier the wound is examined the more perfectly will this phenomenon be observed, as clots, etc., afterwards block up the disintegrated zone." 1 Circular No. 2, 1869 : CASE 80, p. 77, Pt. Wm. O. M , C, 24th Iowa, Spec. 3792. CASE 124, p. 85, Pt. F. Baker, I, 3d Vermont. CASE 129, p. 80, Pt. D. Combe, K, 209th Penn. CASE 130, p. 86, Pt, Ch. Cushion, 179th New York. CASE 132, p. 86, Pt. S. N. E , G, 40th Indiana, Spec. 3390. CASE 137, p. 86, Corp l J. T. Glancy, F, 2d Rhode Island. CASE 139, p. 86, Pt. D. M. Johnson, 1, 13th Alabama. CASE 140, p. 86, Pt. George L , D, 5th Louisiana, Spec. 3946. CASE 142, p. 87, Pt. L. L. Lowe, E, 101st Ohio. CASE 143, p. 87, Pt. Peter M , A, 28th Mass., Spec. 4227. CASE 145, p. 87, Serg t Charles G. P , G, 13th Penn., Spec. 3632. CASE 151, p. 88, Pt. G. F. Tilton, E, 1st Mass. Cav. CASE 153, p. 89, Serg t William Whitney, K, 147th New York. CASE 158, p. 89, Pt. A. Wormack, G, 48th North Carolina. CASE 159, p. 89, Corp l M. F. Yoder, G, 51st Ohio. SECT. II.l WOUNDS AND INJURIES OF THE HIP JOINT. 81 FIG. 34. Bones of the left hip joint. Spec. 1659. CASE 165. Private M. C. Lcsncur, Co. C, 3d Georgia, was wounded at Liberty Gap, June 25, 1863, and admitted to hospital at Murfreesboro two days afterwards. Assistant Surgeon W. P. McCullogh, 78th Pennsylvania, recorded: "Gunshot wound of right thigh, ball entering trochanter and passing inward and backward. The missile was traced through the trochanter but could not be found." The treatment is noted as having consisted of water dressings, morphia, stimulants, and tonics, and, in the latter stage, astringents were given to control the diarrhoea. On July 8th, the wound was suppurating freely and the leg was bandaged. On August 1st, an incision was made anil some spicula? of bone removed, a discharge of pus to the amount of eight ounces taking place. On August 9th the patient was slowly sinking, and, on the 16th, he was failing rapidly. He died August 19, 1863. An autopsy was held eight hours after death, and is recorded as follows: "The ball entered the trochanter major, passing through it and entering the capsule of the joint, carrying away a portion of the head of the ftmur and ligament um teres, and posterior portion of acetabulum, and was found lodging in the lower attachment of the latissimus dorsi. A large abscess was found in the locality of the iliacus internus and psoas muscle, the cartilage and bone of the joint much absorbed, and the cancellated structure infiltrated with sanious pus." CASE 166. Private M. J. H. Perkins, Co. K, 6th Maine, aged 21 years, was wounded at Chancellorsville, May 3, 1833. He was admitted to Judiciary Square Hospital, Washington, May 7th, and transferred to McDougall Hospital, Fort Schuyler, New York Harbor, one month after wards. Assistant Surgeon R. Bartholow, U. S. A., contributed the specimen (Cat. Surg. Sect,, 1866, p. 235, Spec. 1659), represented in the adjacent wood-cut (FlG. 34), with the following descrip tion: "A minic ball entered the left hip, striking the neck of the femur within the capsule, passing through the obturator foramen and between the rectum and urethra without injuring either, and escaped behind the ramus of the right ischium. Inflammation of the prostate gland, and priapism set in. The patient died June 13, 1863." The specimen consists of the bones of the hip joint, the articular surfaces being entirely eroded. Of the two hundred and forty-nine fatal cases of shot fractures of the hip joint, twenty-three were limited to the head of the femur alone. In ten instances autopsies were performed, and six specimens are preserved in the Army Medical Museum. Two are represented in the adjoining wood-cuts. /Specimen 1968 (FiG. 35) was obtained from Corporal J. E. G , Co. I, 2d South Carolina, aged 22 years, wounded at Gettysburg, July 2, 1863. The head of the femur was slightly fractured; the acetabulum became cari ous, and the patient died from exhaustion on Oct. 12, 1863, one hundred and two days after the injury (Circular 2, TIG. 35. Bones of the right hip joint. Head of femur nearly absorbed. Spec, page 71, CASE 42). /Specimen 2198 (FiG. 36) shows the bone of the left hip joint. The head of the femur is carious and the articular surface has been roughened by ulceration. The history of the case from which the specimen was obtained is given in detail in Circular No. 2, page 82, CASE 104. Besides the specimen cases here referred to, fifteen have been detailed in Circular No. 2. 2 The histories of the remaining six cases will here be recorded: CASE 167. Private I. Conduri, Co. D, 1st Michigan Cavalry, aged 22 years, was shot in the right thigh while on scout near Cnlpepcr, April 24, 1864. He was admitted to the Third Division Hospital, Alexandria, whence Surgeon E. Bentley, 1 MOSES (J.), Surgical Notes, etc., in Am. Jour. lied. Sci., 1864, Vol. XLVII, p. 337. 2 Circular No. 2, 1869 : CASE 9, p. 66, Pt. C. Benjamin, 1 18th Pennsylvania. CASE 1 4, p. 67, Pt. F. Bowman, F, 1st U. S. Sharpshooters. CASE 25, p. 69, Pt. J. A. Deyo, B, 20th Indiana, CASE 53, p. 73, Pt. J. Harrigan, K, 36th Mass. CASE 57, p. 73, Pt. Robt. N. II , D, 1st New Jersey Cav., Spec. 3636. CASE 70, p. 76, Pt. J. Lawler, B, 12th New York Cav. CASE 74, p. 76, Pt Chas. II. M , G, L d Maryland, Spec. 3U23. CASE 85, p. 78, Pt. Tohn M , 1, 61st New York, Spec. 1602. CASE 101, p. 82, Pt. H. Sault, 1, 5th New York. CASE 1C8, p. 83, Pt. J. Spangler, A, 38th Ohio. CASE 111, p. 83, Sergeant H. Stulter, D, Slid Pennsylvania. CASE 113, p. 83, Pt. Peter L. Swank, I, 38th Ohio. CASK 115, p. 83, Serg t V. Tidball, H, 122d Ohio. CASE 246, p. 100, Pt. F. Kreegor, B, 18th Georgia. CASE 251, p. 101, Pt S. Sellers, 1, 168th Ohio. SURG. Ill 11 FiG. 36. Bones of the left hip joint with carious head of femur. Spec. 2198. 82 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. U. S. V., reported: "The treatment consisted of water dressings, tonics, stimulants, and extra diet. The patient died June 11, 1864. The post-mortem showed that the ball entered the thigh at its middle third, on its anterior aspect, passed upward and entirely through the articulation of the hip joint, and lodged in the body of the sacrum." CASE 168. Sergeant M. D. Ensor, Co. C, 20th North Carolina, aged 26 years, was wounded and captured at Winchester, September 19, 1864. On the following day he was admitted to the Prisoners Hospital, where Assistant Surgeon II. B. Noble, 2d Ohio Cavalry, recorded: "Gunshot compound comminuted fracture of upper third of right femur; Desault s long splint? applied and simple dressings." Surgeon A. Chapel, U. S. V., reported the man s admission to West s Buildings Hospital, Baltimore, January 19, 1865, from Winchester, with "gunshot wound, the ball entering near the trochanter of the tfiigh bone, producing fracture." On May 9th the prisoner was transferred to Fort McHenry. Surgeon W. Hays, U. S. V., in charge of the Post Hospital at the latter place, reported that the man "died from exhaustion, resulting from excessive suppuration caused by gunshot fracture of head of femur, June 3, 1865." CASE 169. Private A. Farm, Co. C, 18th Tennessee, was wounded at Stone s River, December 31, 1862, and admitted to hospital No. 4, Nashville, January 27th. Acting Assistant Surgeon F. L. Tower reported: "Gunshot fracture of head of left femur and wound of abdomen. Death on January 31, 1863." CASE 170. Private S. Irwin, Co. C, 10th Massachusetts, aged 25 years, was wounded at the Po River, May 12, 1864. Surgeon S. F. Chapin, 139th Pennsylvania, noted his admission to the field hospital of the 2d division, Sixth Corps, with "gunshot wound of left thigh." On May 24th the wounded man was admitted to Prince Street Hospital, Alexandria, whence Acting Assistant Surgeon J. Cass con tributed the specimen (Cat. Surg. Sect., 1866, p. 234, Spec. 2374) and the following report: "The patient suffered considerable pain, had chills, was very uneasy and anxious, had no appetite, hic cough, and great prostration, and died May 28, 1864. At the autopsy the left groin was found considerably discolored, and, on examination, it was discovered that the wound commenced just below the middle of Poupart s ligament, extending doAvmvard and inward, and terminating at the ischium, which was fractured. The ball was found near that bone, between it and the head of the femur, which was also fractured. The ligaments of the hip joint, the soft parts in the groin, and the upper part of the thigh were gangrenous." The specimen (FlG. 37) consists of a portion of the FIG. 37. Portion of left ischi- . ,, . , . ., ,. .-, ,. rrl ,. , ,. ,. ,, , , , urn and upper part of femur. e ischmm and tiie upper extremity 01 the lemur. Inere is a partial fracture of the head ot the Spec. 2374. femur at its articular border and of the ischium by a, battered round bull, which is attached. CASE 171. Lieutenant J. Snyder, Co. K, 83d Ohio, aged 33 years, was wounded at Fort Blakely, April 9, 1865, and admitted to the St. Louis Hospital, New Orleans, five days afterwards. Surgeon A. McMahon, U. S. V., reported: Gunshot wound of right thigh and nates, fracturing the ischium and the femur at its neck. Death resulted from peritonitis following inflammation of the pelvic fascia." CASK 172. Private A. Underbill, Co. C, 10th New York, was wounded at the Wilderness, May 6, 1864, and admitted to the field hospital of the 2d division, Second Corps. Surgeon J. F. Dyer, 19th Massachusetts, reported: "Gunshot fracture of head of femur." The wounded man was conveyed to Fredericksburg, where he died May 15, 1864. In seventeen of the fatal cases after shot fracture of the hip joint treated by conserva tion the head and neck, or head, neck, and trochanters of the femur were injured. Full details of fifteen of the cases, with illustrations of eight specimens, have been given in Circular 2. 1 Meager details of two cases will here be added : CASE 173. Private H. P,eters, Co. D, 18th U. S. Infantry, was wounded at Chickamauga, September 19, 1863. He was admitted to hospital at Chattanooga ten days after the injury. Surgeon J. S. Woods, 99th Ohio, reported: "Fracture of head and neck of right femur. Patient in bad condition; several pieces of bone were removed." The man died October 11, 1863. On the list of casualties at the battle of Chickamauga, furnished by Surgeon G. Perin, U. S. A., Medical Director of the Army of the Cumberland, the injury in this case is reported as a " wound of privates and right side." CASE 174. Private F. Benda, Co. F, 26th Wisconsin, aged 19 years, was wounded at Gettysburg, July 1, 1863, and admitted to the field hospital of the 2d division, Eleventh Corps, where Surgeon W. II. Thorn, U. S. V., recorded: "Gunshot wound of left hip ; ball extracted." On August 6th the patient entered Camp Letterman Hospital, where Surgeon H. Janes, U. S. V., recorded: "The patient suffers from a compound comminuted fracture of femur. The ball entered from the outside of the hip, crushing the bone from the trochanter major upward, then passing obliquely upward entered the pelvis near the sacrum. No history of this case could be procured previous to his admission to this hospital. August 12th, the patient suffers from diarrhoea and hectic fever and is sinking rapidly. He died from exhaustion, August 20, 1863. Treatment: Exhibition of tonics, stimulants, and anodynes." 1 Circular 2, 1869: CASE 6, p. 66, Pt. J. Barnes, B, 52d Indiana. CASE 8, p. 56, Pt. Anthony B , C, 12th Illinois, Spec. 46G. CASK 10, p. 66, Pt. Charles R. B , E, 16th Maine, Spec. 598. CASE 17, p. 67, Pt. W. C , 159th New York, Spec. 1291. CASE 21, p. 68, Pt, D. Curran, A, 5th Kentucky. CASE 45, p. 72, Major John J. G- -, G, 47th Pennsylvania, Spec. 3789. CASE 52, p. 73, Corporal Benjamin H , C, 9th West Virginia, Spec. 4267. CASE 76, p. 77, Corporal Donald McD , E, 12th New York Cav., Spec. 2170. CASE 89, p. 79, Serg t 8. W. N , E, 15th Now Jersey, Spec. 1253. CASE 91, p. 80, Captain Samuel Oakley, 77th New York. CASK 102, p. 82, Pt. C. Saunders, C, Cth Louisiana Cavalry. CASE 106, p. 82, Pt. G. IT. S , H, 2d North Carolina, Spec.. 1967. CASE 118, p. 84, Pt. H. A. Walker, E, 2d New Hampshire. CASE 275, p. 113, Pt, A. Swanson, II, 3d Michigan. In the case reported by Dr. J. DlCKSOX BltUXS (Circ. 2, S. G. O., 1869, p. 57), a first attempt to remedy the injury by an operation was suspended, as the haemorrhage was very great. Some ten days or two weeks after, an excision of the head of the femur was attempted, as an examination had shown that the neck was extensively split. After the primary incisjons had been made, and several fragments of the neck had been removed, the operation was discontinued, as it became apparent that death was inevitable. SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 83 Seventy instances are recorded, among the two hundred and forty-nine fatal cases of shot fractures of the hip joint treated by conservation, in which the neck of the femur was stated to have been fractured. Fifty-six of the cases have been recorded in Circular 2; 1 fourteen will be recorded here. Autopsies were made in twenty-one of the cases, and eleven specimens are preserved in the Army Medical Museum. A specimen belonging to this group, represented in the adjoining wood-cut (FiG. 38), was received without history. It consists of the upper fourth of the femur, with a fragment of a round ball embedded in the neck within the capsule. There is no evidence of chronic articular disease. FIG. 38.-Shot fracture m, f Ml C 1, FIG. 39.-Shot fracture of neck _ f left femur. The specimen is a tair illustration ol injury to bone by s f e e i6 61 g round balls at low velocities. A similar specimen is rep resented in FIG. 39, showing a round ball embedded in the neck of the femur near the trochanter major, fracturing the neck within the capsule. The history of this case has been detailed in Circular No. 2, p. 81, CASE 98. CASE 175. Private J. Boaz, Co. A, 1st Confederate States Cavalry, was wounded at Stone s River, December 31, 1862. He was admitted into No. 19 Hospital, Nashville, January 20, 1863. Surgeon J. Shrady, 2d East Tennessee, noted: "Gun shot compound fracture of the neck of the right femur." Ho died February 4, 1863. CASK 170. Private J. W. Connor, Co. D, 81st Pennsylvania, was wounded at Fredericks- burg, December 13, 1862. Surgeon J. E. McDonald, 79th New York, recorded his entrance into the field hospital of the 1st division, Ninth Corps, with "Gunshot wound of left thigh." Surgeon J. A. Lidell, U. S. V., contributed the specimen represented in the adjoining wood-cut (FiG. 40) (Cat. Surri. Sect., 1866, p. 243, Spec. 622), and reported the following history: "Admitted to Stanton Hospital, Washington, December 26th, with gunshot, fracture of left thigh in upper third; ball not extracted. The injured limb was a good deal swelled; pus flowing from the wound. Exploration did not discover the ball; thigh found fractured high up; amount of displacement small. The case did pretty well till December 31st, when symptoms of pyaemia showed themselves. He grew rapidly worse, and died January 2, 1863. The necropsy showed inflammation of the femoral vein, pus in the femoral and iliac veins, a comminuted fracture in the neighborhood of the trochanters, and the ball firmly impacted in the ischium. The specimen consists of the bones of the hip joint with a. portion of the ligaments, the head of the femur being FK , 4o._Bones of the left hip dislocated. The track of the ball is necrosed, but a small quantity of callus has been thrown .iint with dislocation of head of . . femur. Spec. 622. out on ilie anterior surface of the femur. CASE 177. Private A. E. Davis, Co. E, 1st Maine Cavalry, aged 22 years, was wounded during the Richmond raid, March 2, 1864, and admitted to the General Hospital at Fort Monroe five days afterwards. Assistant Surgeon E. McClellan, U. S. A., reported: "Gunshot wound of right hip. The patient was admitted in good condition; wound healthy. Pyaemia was developed on March 12th, and death occurred within twenty-four hours. The autopsy discovered that the ball had pierced the neck of the femur. There were symptoms of inflammation of the femoral vein ; six ounces of dark bloody fluid in left 1 Circular 2, S. G. O., 1869: CASE 1, p. 65, Pt. A. Baker, 5th Maine Battery. CASE 3, p. 65, Pt. J. Balines, C, 26th Wisconsin. CASE 4, p. 60, Pt. W. Bancho, II, 3d New Hampshire. CASE 5, Corp l M. Barden, K, 10th Mass. CASE 12, p. 67, Serg t (i. Bond, A, 137th Illinois. CASE 18, p. 68, Pt. 1 . C . G, 24th Alabama (sec also Confed. States Med. Jour., Vol. I, p. 76). CASE 19, p. 68, Pt. J. Connelly, C, 1st Louisiana (Colored) Cavalry. CASE 23, p. 68, Pt. It. Damback, 1, 17th Ohio. CASE 26, p. 69, Pt. J. Dice, 43d Missouri. CASE 27, p. 69, Pt. C. < 1. Dodson, C, 13th West Virginia. CASE 29, p. 69, Pt. E. II. Dimklebcrg, F, 11 th Infantry. CASE 30, p. 69, Pt. N. II. Eisenhower, F, 103d Ohio. CASE 33, p. 70, Pt. D. Elmer, M, 14th New York H. A. CASE 35, p. 70, Pt. A. E. Fields, B, 6th Maine, Spec. 2932. CASE 36, p. 70, Pt. S. Fleig, E, 45th New York. CASE 38, p. 70, Pt. J. Foreman, E, 5th Alabama. CASE 4J, p. 71, Pt. S. F , E, lllth New York, Spec. 14G2. CASE 44, p. 71, Pt. J. G , B, New Hampshire II. A., Spec. 3540. CASE 47, p. 72, Pt. B. F. Green, E, 125th New York. CASE 48, p. 72, Pt. T. Green, L, 12th Tennessee Cav. CASE 50, p. 72, Pt. D. Haley, 15, 57th Mass. CASE 54, p. 73, Pt. L. P. Harvey, B, ,11th Now Hampshire. CASE 58, p. 74, Pt. W. linger, D, 7th Virginia. CASE 62, p. 74, Pt. P. C. Johnson, H, 15th Ohio. CASE 65, p. 74, Pt. U. A. Kimble. G, 3d Minnesota. CASE 72, p. 76, Corp l J. G. Mallory, C, 31st Indiana. CASE 75, p. 76, Pt. J. Matthews, A, llth Louisiana (Colored). CASE 77, p. 77, E. McGce, Secret Service. CASE 78, p. 77, Lieut. T. H. McKiuley, B, 29th U. S. C. T. CASE 81, p. 77, Pt. J. W. Moore, II, Oth Penn. Cav. CASE 82, p. 78, Pt. J. M , F, 63d New York, Spec. 782. CASE 83, p. 78, Pt. J. R. Merrill, D, 184th Penn. CASE 84, p. 78, Pt. P. M , H, 1st Virginia, Spec. 33. CASE 86, p. 79, Pt. J. B. Mullen, G, 13th Indiana. CASE 95, p. 81, Pt. J. L. Riley, 1, 21st Mississippi. CASE 98, p. 81, Pt. L. 11 , F, 48th New York, Spec. 1661. CASE 100, p. 81, Serg t F. Sailyards, A, 70th Ohio. CASE 107, p. 82, Corp l H. F. Smith, B, 1st Wisconsin. CASE 109, p. 83, Corp l J. A. Staunton, II, 1st Florida. CASE 110, p. 83, Pt. J. Stewart, B, 26th Ohio. CASE 112, p. 83, Pt. J. S , B, 43d Ohio, Spec. 465. CASE 117, p. 84, Pt. J. Wagoner, F, 81st Illinois. CASE 1 19, p. 81, Pt. I. W. Winans, C, 3d Wisconsin. CASE 120, p. 84, Corp l G. W. Wright, Blonnf s Virginia Battery. CASE 1 21, p. 84, Pt. U* / . Ycargin, E, 22d Georgia. CASE 212, p. 96, Pt. S. Randall, G, 118th New York. CASE 236, p. 99, Serg t S. R. Arrison, A, 118th Illinois. CASE 240, p. 100, Pt. J. T. Cmie, 7th Virginia (see Am. Mcd. Times, 1864, Vol. VIII, p. 13). CASE 241, p. 100, Pt. W. A. Dibble, C, 106th Pcnn. CASE 249, Pt. B. Page, I, 51st North Carolii CASE 255, p. 102, Corp l G. W. W , Virginia Battery. CASE 259, p. 102, Pt. H. T. Elam, A, llth Virginia, Spec. 9. CASE 268, p. 104, Pt. E. Longyear, D, 72d Penn. CASE 269, p. 104, Pt. L. N. P. Rodenbough, D, 55th Illinois. CASE 271, p. 105, Pt. L. Schmidt, H, 8th Kansas. CASE 276, p. 114, Serg t E. Scott, A, 1st New Jersey Cavalry, Spec. 3520. 84 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. thorax, with an oily fluid floating on it; two ounces of light colored bloody fluid in pericardium; an oily substance collected on the blood from all parts of the body. Liver engorged and soft. No formation of pus discovered." CASE 178. Private G. W. Fierstine, Co. K, 93d Pennsylvania, was wounded at Fair Oaks, June 1, 1862, and admitted to the Fifth and Buttomvood Streets Hospital, Philadelphia, six days afterwards. Acting Assistant Surgeon A. C. Bournonville reported: "Fracture of neck -of femur, tuberosity of ischium shot off and pelvic bones shattered; no wound of bladder or rectum. Prognosis fatal. Patient was most comfortable by having the limb elevated and supported by pillows. He died June 12, 1862." CASE 179. Private J. M. Hayse, Co. K, 14th Kansas Cavalry, was accidentally wounded May 19, 1864, and admitted to hospital at Fort Smith. Surgeon C. E. Swasey, U. S. V., reported: "Gunshot wound of left thigh into abdomen, with fracture of neck of femur. Death resulted, from perforation of the bowels, on May 20, 1864." CASE 180. Private F. M. Hayes, Co. A, 211th Pennsylvania, aged 21 years, was wounded at Fort Steadman, March 25, 1865. He was admitted to the field hospital of the 3d division, Ninth Corps, where Surgeon M. F. Bowes, 211th Pennsyl vania, recorded: "Wound of right hip by conoidal ball." Two days afterwards the man was moved to the Depot Hospital at City Point, and ten days later he was conveyed on a hospital steamer to Alexandria, Avhere he entered the Third Division Hospital. Surgeon E. Bentley, U. S. V., reported: "Gunshot fracture of right hip. Light cold-water dressings and a bandage were applied over the thigh to facilitate the discharge of pus from the wound. The limb was retained in position by means of an inclined plane, with slight extension and counter-extension. Alcoholic stimulants and nourishing diet were freely admin istered. He died April 14, 1865. Autopsy thirteen hours after death: Tissues of thigh very much disorganized by the extent of suppuration, involving the entire limb. The femur was fractured at the neck. The ball had passed under the pubis and was found in the pelvis, external to the peritoneum." CASE 181. Private C. Hambrecht, Co. E, 4th New Jersey, was wounded at South Mountain, September 14, 1862, and admitted to the field hospital at Burkettsville. Assistant Surgeon H. A. DuBois, U. S. A., reported: "Gunshot wound through os pubis and neck of femur. Secondary haemorrhage occurred on October 18th. A ligature was applied to the external iliac and the femoral arteries. But little blood was lost, the surgeon being in the ward at the time the haemorrhage commenced. The operation was difficult, it being necessary in order to stop the hemorrhage to compress the artery on each side and close to the wound, which was directly below Poupart s ligament. The patient rallied after the operation and was able to read a letter, but died six hours after." CASE 182. Private W. J. Little, Co. I, 57th Pennsylvania, aged 22 years, was wounded at the Wilderness, May 5, 18G4, and admitted to the field hospital of the 3d division, Second Corps. Surgeon O. Lvarts, 20th Indiana, noted: "Gunshot wound of left hip." Surgeon D. W. Bliss, U. S. V., forwarded the specimen (Cat. Surg. Sect., 1866, p. 241, Spec. 2398) and reported: "The patient entered Armory Square Hospital, Washington, May 28th. He was wounded by a conoidal ball, which entered the right gluteal region on a line with the coccyx, two inches above the anus, passing under the fascia in a direct line and through the ramus of the ischium, comminuting the left femur at its neck, and making its exit over the great trochanter. Powerful stimulants were given but with no effect. The patient died from the effects of the injury, May 30, 1864." The specimen shown in the wood-cut (FlG. 41) FIG. 41. Hones of left hip joint, consists of the bones of the left hip joint, and shows the head of the femur, with the exception Neck of femur shattered. Spec. 2398. o f a slight fissure on its articular surface, to be uninjured. CASE 183. Private J. McAlpine, Co. C, 7th Illinois, was wounded at Allatoona, October, 5, 1864. Surgeon J. R. Zearing, 57th Illinois, reported his admission to the field hospital of the 4th division, Fifteenth Corps, with "gunshot fracture of neck of femur," and his death on October 8, 1864. CASE 184. Musician F. McNeil, Co. B, 17th Illinois, was wounded at Shiloh, April 6, 1862, and admitted to hospital at Quincy twelve days afterwards. Surgeon R. Niccolls, U. S. V., reported: "Compound comminuted fracture of right femuu at the neck and transverse fracture of left femur at the middle third. Dr. Buck s weight and pulley were employed. Death took place on April 27, 1862. At the post-mortem a mini6 ball, split longitudinally, was removed from the neck of the femur." CASE 185. Private U. T. Palmer, Co. I, 1st Maine, aged 33 years, was wounded at Cedar Creek, October 19, 1864, and admitted to the field hospital of the 2d division, Sixth Corps. Surgeon S. F. Chapin, 139th Pennsylvania, noted : "Gunshot fracture of left thigh." On October 27th the wounded man was admitted to Camden Street Hospital, Baltimore, whence Surgeon Z. E. Bliss, U. S. V., reported as follows: "Gunshot wound of left gluteal region, with fracture of neck of femur. Smith s anterior splints were applied, and quinine and carbonate of ammonia, etc., were resorted to, but unsuccessfully. The patient died of pyaemia, November 3, 1864. At the post-mortem pus was found in the synovial cavities near the hip joint." CASE 186. Sergeant W. Peabody, Co. C, 10th Vermont, aged 22 years, was wounded at Monocacy, July 9, 1864, and admitted to hospital at Frederick the following day. Assistant Surgeon R. F. Weir, U. S. A., reported: "Gunshot fracture of neck of left femur and flesh wound of thigh and scrotum. Ball removed July llth. Tonics, opiates, and stimulants administered; Buck s extension apparatus applied. Death, from exhaustion, July 23, 1864." CASE 187. Private J. H. Smith, Co. H, 12th South Carolina, appears on a report from the Confederate Hospital al Charlottesville as having died June 1, 1864, of "gunshot wound of left thigh; missile found in neck of femur." CASE 188. Captain R. Ward, Co. B, 33d Alabama, was wounded at Perry ville, October 8, 1862. On a report of " Sick and Wounded Confederates left behind after the battle," signed by Surgeon C. Longenbecker, 13th Louisiana Regiment, C. S. A., his injury is described as a "gunshot fracture of left thigh through neck of femur into the joint and os ischii, ball in pelvis," and his death is stated to have occurred on October 27, 1862 . SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT. 85 FIG. 42.-Comminuted frac ture of upper third of left fe mur, with fissure extending into the neck. Spec. 49:30. FIG. 43. Upper portion of left femur, with fragments of bone removed after shot fracture of the neck. Specs. 3143 and 67. Of the two hundred and forty-nine fatal shot wounds of the hip joint treated by conser vation fifty were instances of shot injuries of the neck and trochanters, or neck, trochanters and shaft of femur. Autopsies were performed in thirty-two instances, and twenty-five specimens are deposited in the Army Medical Museum. All of the cases have been reported in Circular No. 2, 1 and only a few of those in which interesting specimens are preserved will be here briefly noticed. CASE 189. Private C. H. Elliott, Co. D, 61st Pennsylvania, was wounded at the battle of Fair Oaks, May 31, 1862, by several musket balls. One entered near the right acromion process and emerged at the insertion of the deltoid muscle ; another at the gluteal fold; a third passed through the tipper part of the thigh; a finger was also shot away. He was conveyed to Portsmouth, and on June 5th was admitted into the Balfour General Hospital. A fracture of the head of the humerus was recognized, and, on June 14th, Assistant Surgeon Sheldon, U. S. A., excised the head and about three inches of the shaft (see Second Surgical Volume, p. 586, CASE 23). Abscesses formed in the left thigh. Pyaemia super vened, and the patient died on June 17, 1862. At the autopsy the upper third of the femur was found to be shattered. There was a collection of pus near the wound in the hip. Assistant Surgeon II. f!v V ^ ) \j ( L. Sheldon, U. S. A., reports the case. The specimen, 4930, repre sented in FlG. 42, was contributed by Assistant Surgeon W. Thorn- son, U. S. A.. (Circular No. 2, p. 69, CASE 31.) CASE 190. Private Philo Wilbur, Co. 1, 185th New York, aged 19 years, was wounded in action at the Southside Railroad, Virginia, March 25, 1865. A conoidal ball entered over the left trochanter major, produced a comminuted fracture of the process, and emerged at the lower and inner border of the left buttock. He was taken to City Point and Washington and admitted, on April 2d, into the Mount Pleasant Hospital. On April 7th there was febrile action and anorexia. On April 9th, Assistant Surgeon H. Allen, U. S. A., removed several detached fragments of bone. Irritative fever and anorexia continued. On April 14th he had a rigor; pyffimia appeared, with vomiting and diarrhoea. On April 18th secondary haemorrhage of from six to eight ounces occurred from branches of the external circumflex, and was arrested by compression of the femoral. He died April 20, 1865. The history, with the specimens 3143 and 67 (FlG. 43), were contributed by Assistant Surgeon H. Allen, U. S. A. (Circular No. 2, p. 106, CASE 274.) CASE 191. "Alfred G. R , Adjutant 134th Pennsylvania, aged 24 years, was wounded in the upper part of the left femur by a round ball, which partially fractured the trochanter major, at the battle of Fredericksburg, December 13, 1862. The wound received no attention for some days, and was then dressed with side splints firmly bound by a roller, a plug of lint being tightly inserted in the wound. On the 20th of December he was admitted to E Street Infirmary, Washington. He stated that for some days he had experienced occasional twitchings in the limb, and had taken large doses of opium. The wound was a little behind the trochanter major. Upon removing the plug of lint about half a pint of blood and pus was discharged. There was no crepitus upon rotation, nor shortening. Owing to his weakened condition, no extended search was made for the missile. Simple dressings were applied, and half grain doses of sulphate of morphia were given. For the two succeeding days he seemed to improve. The twitchings of the limb occurred every few minutes, with occasional intermissions of a few hours. On the 23d the spasms became more violent and frequent, and it was deemed advisable to extract the missile. He was etherized, and the wound was enlarged two inches downward and backward. A gum catheter was made to follow the course of the missile behind and beneath the neck of the femur to the body of the pubis, where the ball was found in the scrotum near the spermatic cord. A flattened round musket ball was extracted through an incision at the base of the scrotum. A portion of it had 1 Circular No. 2, 1869 : CASE 15, p. 67, Pt. T. B , 14th North Carolina, Spec. 548. CASE 20, p. 68, Pt. J. C ,*I, 10th New Jersey, Spec. 3806. CASK 22, p. 08, Pt. J. C , C, 5th New York Cav., Spec. 3189. CASE 24, p. 68, Pt. M. D , H, 14th New York H. A., Spec. 3261. CASE 28, p. 69, Pt. A. D , B, 43d New York, Spec. 3797. CASE 31, p. 69, Pt. C. H. E , D, 61st Penn., Spec. 4930. CASE 34, p. 70, Pt. J. F , H, 1st Mass. Cav., Spec. 2704. CASE 46, p. 72, Pt. F. G , 1st Louisiana, Spec. 1300. CASK 49, p. 72, Pt. G. H , D, 26th Michigan, Spec. 2839. CASE 51, p. 72, Serg t W. D. H , A, 6th Iowa, -Spec. 3488. CASE 55, p. 73, Pt. W. Herold, B, 6th Alabama. CASE 56, p. 73, Musician J. B. H , A, 41st Ohio, Spec. 2178. CASE 61, p. 74, Pt. H. J , F, 14th K. York, Spec.. 2309. CASE 64, p. 74, Pt, M. K , D, 65th N. York, Spec. 3419. CASE 66, p. 74, Pt, A. J. K , E, 8th Florida, Spec. 1932. CASE 67, p. 75, Pt. L. P. L, , K, 91st Penn., Spec. 1343. Case 68, p. 75, Pt. J. Laner, F, 39th N. Jersey. CASE 69, p. 75, Capt J. M. L , 1, 20th Indiana, Spec. 565. CASE 71, p. 76, J. McCarthy, E, 76th New York. CASE 73, p. 76, Capt. H. D. M , K, 79th Illinois, Spec. 1747 (Am. Jour. Med. Sci., 1864, Vol. XLVII, p. 337). CASE 88, p. 79, Pt. T. M , C, 14th Maine, Spec. 1728. CASE 90, p. 79, Serg t W. Norton, 1, 5th Wisconsin ( V. S. Sanitary Commission Memoirs, Vol. I, p. 5^6). CASE 92, p. 80, Pt. W. O , K, 2d U. S. Cav., Spec. 2528. CASE 94, p. 80, Adj t A. G. R , 134th Penn., Spec. 545. CASE 96, p. 81, Pt. J. R , C, 69th New York, Spec. 86. CASE 99, p. 81, Pt. T. R , K, 210th Penn., Spec. 4168. CASE 103, p. 82, Capt. E. F. S , K, 1st New York Cav., Spec. 4213. CASE 114, p. 83, Corp l J. M. Thompson, B, 29th Mass. CASK 122, p. 84, Serg t D. Y , H, 106th New York, Spec. 3931. CASE 199, p. 94, Serg t J. H. Bridwell, B, 87th Illinois Mounted Infantry. CASE 200, p. 94, Pt, W. Campbell, A, 23d Missouri. CASE 203, p. 95, Serg t W. G. Davis, H, 19th Ohio. CASE 205, p. 95, Pt. C. Falk, E, 26th New York. CASE 206, p. 95, Pt. W. T. Fostner, F, 28th Virginia. CASE 207, p. 95, Pt. H. B. Gardner, F, 38th Illinois. C.V8E 208, Pt. M. Haehl, A, 3Jd Indiana. CASE 209, p. 95, Capt. J. D. Irwin, C, 124th Ohio. CASE 213, p. 96, Pt. J. Scheets, T, lllth Ohio. CASE 214, p. Hi, Pt. D. Schamill, H, 50th Penn. CASE 215, p. 96, Corp l G. Williams, D, llth Missouri. CASE 242, p. 100, Corp l M. J. Fitzharris, E, 42d N. York. CASH 258, Pt. F. Beck, F, 115th Penn. CASE 263, p. 103, Pt. T. Hay ward, F, 5th Penn., Spec. 592. CASE 265, p. 104, Corp l W. Hermka, D, 1st Maryland Cav. CASK 2fi6, p. 104, Pt. J. Leehart, C, 16th Mississippi. CASE 270, p. 104, Capt. H. A. Sand, 10"d New York. CASE 273, p. 105, J. T. Tindell, K, 18th Mississippi Cav. (Confed. States Med. and Sitrff. Jour., January, 1865). CASE 274, p. 106, Pt. P. Wilbur, 1, 185th New York, Spec. 3143. Second Surgical Volume : CASE 859, p. 295, Serg t W. Spendlovn, E, 1st New York Cav., and CASE 935, p. 324, Serg t C. Moulton, D, 2d Maryland. INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. FIG. 44. Fracture FIG. 45. Fissure of right femur, caused by a conoidal ball lodging in the neck . Svec. 393 1 . been chipped off. The patient rested well that night, but on the following day the spasms were increased in intensity, commencing in the injured limb and extending over the body. Cloths saturated with chloroform and olive oil were applied to the limb, and an antispasmodic and anodyne mixture was prescribed. He rested quietly until the following morning, when clonic spasms returned and persistently increased. The patient s countenance became pinched, wan, and haggard, and expressive of fright. There was no pain nor trismus, and he partook freely of nouishment. At times there was complete opisthotonos. On December 25th he took four dozen pills of assafrctida of four grains each, and one half ounce of fluid extract of Cannabis Indica in divided doses, without any benefit. Sulphate of morphia in doses of one grain was then prescribed, to be administered every two hours, and a poultice of powdered opium and cinchona applied to the wound, but, as before, without apparent benefit. The mind, up to this time, continued clear and undisturbed, his pulse moderately full and strong, ranging at about 100. He now became drowsy, and at times lay in a semi-comatose condition. His pulse ran up to 150. Respiration was free, but at times hurried, from 25 to 28 per minute. The skin became bathed in sweat, which exhaled a peculiar pungent odor. The bowels were regular; the urine was scantily secreted and high colored, though voided without difficulty. The discharge from the wound was thin, bloody, and offensive. On December 27th opisthotonos recurred, and was temporarily relieved by the application of chloroform to the entire extent of the spine. Subsequently, violent epileptifonn convulsions set in, and death resulted from exhaustion, on December 28, 1862." The pathological specimen is figured in the Avood-cut (FlG. 44). and shows a fracture of the great trochanter of the left femur and a piece of a leaden ball embedded in the neck. The specinien and history were con tributed by Surgeon C. L. Allen, IT. S. V. (Circular 2, S. G. O., 1869, p.80. CASE 94.) CASE 192. "Sergeant David Y , Co. H, 106th New York, aged 29 years, Avas Avounded at the battle of Monocacy Junction, July 9, 1864, by a conoidal musket ball, Avhich entered tAvo inches posterior to and one inch above the right trochanter major, passed forward and imvard, and lodged in the neck of the femur at its middle portion. of trochanter and nock He Avas admitted to General Hospital at Frederick, Maryland, on the same day, and of the left femur by a , , ,. . ,. .. . . ,. _ . . . * round musket ball. A the wound did well until the 12th of July, when it assumed an unhealthy appearance. trag-meutof lead isim- ^ careful examination Avas made with the finger and by the probe, and the integu- pacted in the neck. _ ... . . , Spec. 545. ments and fascia were divided, giA ingf ree exit to sanious and fetid pus. Large quan tities of stimulants and beef tea Avere given. On July 19th symptoms of pyremia made their appearance, such as rigors folloAved by profuse perspiration and acceleration of the pulse and respiration, dryness of the tongue, and anorexia. Another examination of the wound Avas made, and the ball Avas found embedded in the femur, but, OAving to the patient s condition, its removal was deemed inadvisable. On July 20th another rigor occurred, and gradual aggravation of all the symptoms folloAved. He died at 3 o clock P. M., July 22, 1864." The pathological specimen and history (FlG. 45) Avere contributed to the Army Medical Museum by Assistant Surgeon R. F. Weir, IT. S. A. (Circular 2, p. 84, CASE 122.) CASE 193. "Captain James M. L , Co. I, 20th Indiana, Avas tAvice Avounded in an engagement in front of Richmond, on June 27, 1862. The first wound Avas through the lumbar muscles, and, while lying on the field, he Avas again struck by a conoidal musket ball, Avhich entered on the outer side of the left thigh a little beloAV the great trochanter, and, passing upAvard and inward, lodged. He Avas conveyed to Washington, and on June 29th was admitted to the Columbia College Hospital. A finger could be readily passed into the perforation of the femur, but the ball could not be reached. There Avas no shortening or eversion of the limb, interfering with the motion of the joint. Three formal attempts to ascertain the position of the ball and accomplish its removal were unsuccessfully made. The patient died from exhaustion, August 19, 1862." The speci men is represented in the adjoining Avood-cut (FlG. 46). It shoAvs the upper portion of the left femur perforated betAveen the trochanters on the posterior surface. The track of the ball is carious. The great trochanter has been split off, but is reunited by callus. The space betAveen the trochanters is bridged over by a displaced fragment of bone, attached in its neAV position by slight osseous deposits. The missile Avas found resting against the capsular ligament. Assistant Surgeon W. M. Notson, U. S. A., FIG. 46. Perforation wno ^tended and reported the case, is confident that the ball Avas external to the joint; but as the of the neck of left femur byaconoidal musket ball, grooving of the neck extends upAvard nearly to the articular surface of the fenrtir, it is hardly possible that the .joint escaped. ( Circular 2, p. 75, CASE 69.) In twenty-seven of the two hundred and forty-nine shot fractures of the hip joint with fatal terminations the parts of the joint involved were not indicated. The details in the cases are very meagre, and no autopsies were made. Fifteen have been recorded in Circular No. 2; 1 such information as was obtainable of the remaining twelve will here be given: CASE 194. Private J. Cilley, Co. E, 19th Maine, aged 22 years, was Avounded at Petersburg, June 22, 1864, by a conoidal ball. He Avas taken to the field hospital of the 2d division, Second Corps, Avhere Surgeon J. F. Dyer, 19th Massachusetts, noted : "Shot fracture of the left hip joint." On July 1, 1864, he Avas admitted into the Carver Hospital, Washington, and he died August 30, 1864. Surgeon O. A. Judson, U. S. V., reports cause of death : "Exhaustion folloAving shot fracture left ilium." SECT. II.] WOUNDS AND INJURIES OF THE HIP JOINT! 87 CASE 195. Private J. Farrel], Co. ]}, I4tli U. S Infantry, aged 35 yours, was wounded at Spottsylvania, May 12, 1804, and admitted to the field hospital of the 2d division. Fifth Corps. Surgeon W. K. DeWitt, jr., recorded: Gunshot wound of left thigh; severe. On May 18th the wounded man was received into Douglas Hospital, Washington. Assistant Surgeon W. Thomson, U. S. A., reported : "Gunshot wound of left hip; fracture of pelvis and femur. Haemorrhage to the amount of two ounces occurred from a muscular branch on May 28th. and ceased spontaneously. The patient died of asthenia May 28, 18G4. CASE 196". Colonel C. Knoderer, 167th Pennsylvania, was wounded at Suffolk, January 30, 18G3. Surgeon D. M. Marshall, of the regiment, reported: "Wound of left hip produced by a piece of shell, completely shattering the hip joint and causing immediate prostration. Stimulants were given internally, and cold applications, combined with styptics, were used. Death occurred on February 15, 1863." CASE 197. Corporal E. W. Mulford, Co , E, 74th Illinois, was wounded at Chattanooga, November 25, 1863, by a conoidal ball, which fractured the right hip. He died December 10, 1863, in the 2d division, Fourth Corps, field hospital. Surgeon F. W. Lytli, 36th Illinois, records the case. CASE 198. Private M. Murphy, Co. D, 8th New York Heavy Artillery, was wounded at Cold Harbor, June 3, 1864, by a conoidal ball. He was taken to the field hospital of the 2d division, Second Corps, where Surgeon J. F. Dyer, 19th Massachusetts, records : "Shot fracture of the right hip joint and wound of both shoulders." He died June 6, 1864. The cause of death is given on the burial records as "shot wound of bowels." CASE 199. Private A. Olds, Co. F, 8th New York Heavy Artillery, was wounded at Cold Harbor, June 3, 1864, and admitted to the field hospital of the 2d division, Second Corps. Surgeon J. F. Dyer, 19th Massachusetts, reported: "Gunshot fracture of left hip joint. Died June 5, 1864." CASE 200. Private C. Pease, Co. C, 4th Michigan, was wounded in the left hip at Gettysburg, July 2, 1863. He was treated at a Fifth Corps field hospital until July 24th, when he was admitted to Camp Letterman. Surgeon H. Janes, U. S. V., reported that the man "died August 7, 1863, of gunshot fracture of left hip joint." CASE 201. Private H. Stratton, Co. B, 99th Pennsylvania, was wounded at Gettysburg, July 2, 1863, by a conoidal ball, lie was taken to the field hospital of the 1st division, Third Corps, where Surgeon G. W. Lyman noted: "Gunshot compound comminuted fracture of the right thigh implicating the hip joint." He died July 4, 1863. CASE 202. Private J. J. Stumple, Co. A, 7th West A r irginia, was wounded at Cold Harbor, June 3, 1864, by a conoidal bull. lie was taken to the field hospital of the 2d division, Second Corps, where Surgeon J. F. Dyer, 19th Massachusetts, noted: "Shot fracture of the right hip." He was admitted into the Second Division Hospital, Alexandria, June 7th, where Surgeon T. R. Spencer, U. S. V., records "shot wound, right thigh." He died June 25, 1864. CASE 203. Private T. O. Tucker, Co. D, (51st Pennsylvania, aged 39 years, was wounded at Spottsylvania, May 15, 18G4, by a shell. He was taken to the field hospital of the 2d division, Sixth Corps, where Surgeon S. J. Allen, 4th Vermont, noted: "Wound of the right groin." On May 2H, 1864, he was admitted into the Second Division Hospital at Alexandria. He died the following day. Surgeon T. R. Spencer, U. S. V., reported the cause of death "shot wound of the right hip joint." CASE 204. Private J. Volkommer, Co. C, 46th New York, aged 19 years, was wounded at Petersburg, July 30, 1864, and admitted to the field hospital of the 3d division, Ninth Corps. Surgeon P. A. O Conuell, U. S. V., reported: "Gunshot wound of left hip; ball entered one and a half inches from the trochanter major, wounding the capsular joint." Three days after the reception of the injury the wounded man was transferred to the Depot Hospital at City Point, whence he was sent to De Camp Hospital, David s Island, New York Harbor, August 7th. Assistant Surgeon W. Webster, U. S. A., in charge of the latter, reported that the patient died November 19, 1884, of "gunshot wound of left hip, with fracture of femur. CASE 205: Private S. Waisner, Co. E, 28th North Carolina, was w T ounded and captured at Gettysburg, July 3, 1863, and entered Camp Letterman on July 23d. Surgeon H. Janes, U. S. V., reported : "Gunshot fracture of right hip joint. Death on August 18, 18G3." Of the series of two hundred and forty-nine cases of shot fractures of the hip joint unsuccessfully treated by conservation, fifty-two have been detailed in the preceding pages and one hundred and ninety-seven cases have been briefly noted, the details of the cases having been cited in Circular No. 2. O In one hundred and eighty-four cases the injuries were caused by small, and in fifteen cases by large projectiles, while in fifty instances the nature of the missile was not indi cated. Fragments of bone were removed in twenty-one of the two hundred and forty- nine fatal cases of shot fracture of the hip joint treated by conservation. Pya?rnia was indicated in thirty-eight instances, gangrene in thirteen, tetanus in one case, erysipelas in one case, peritonitis in five cases, and secondary haemorrhage in fourteen cases. In one instance (CASK of John McCarthy, Co. E, 76th New York, Circular No. 2, p. 76, CASE 71, and foot-note 1, p. 85) the femoral artery was tied, and in two instances (CASES ot: Cor poral J. F. Smith, Co. B, 1st Wisconsin, Circular No. 2, p. 82, and 107, of Private C. Hambrecht, Co. E, 4th New Jersey, CASE 181, p. 84, ante] the external iliac artery was 88 SHOT INJURIES OF THE LOWER EXTREMITIES. ICHAP. x. ligated. In four instances the missile penetrated the abdomen ; in nine cases the pelvic cavity was pierced, but apparently without injury to the viscera. In fifteen cases a shot fracture of either the ilium, ischium, or os pubis was reported; in two instances the blad der was involved, 1 and in twenty-two cases the injury to the hip joint was complicated by various other injuries of less gravity. Eleven patients died on the day of the reception of the injury; fifty-three survived the injury from one to ten days; seventy, from eleven to twenty days; thirty-two, from twenty-one to thirty days; twenty-one, from thirty-one to forty-days; the remaining sixty-two patients lived from forty-one to two hundred and sixty-three days, and one patient lingered for nearly two years and a half. 2 In eighty- three instances it was reported that the missile had lodged, in nineteen of which it was stated to have been extracted. In seventy-eight of the two hundred and forty-nine fatal cases of shot fracture of the hip joint treated by conservation, the specimens indicating the bony lesion at the hip are preserved in the Army Medical Museum. Illustrations of forty of these seventy-eight specimens were given in Circular No. 2, pp. 66-114, and twenty-one have been repre sented by wood-cuts in the preceding pages. In tabular statement IX, on page 65, ante, the total number of alleged shot fractures at the hip joint treated by the conservative expectant mode was given as three hundred and four, of which fifty-five were reported to have recovered; but, from an analysis of the cases, it becomes clearly evident that it would be impossible to arrive at just conclusions regarding the mortality of injuries of this nature from the total number of cases tabulated. It has already been stated on pp. 76, 77, ante, that in fourteen of the fifty-five cases of recovery after alleged shot fractures at the hip joint the evidence is contradictory, or adverse to the supposition that the hip was implicated; that in nineteen instances the evidence is vague and insufficient, and that in two cases the testimony consists solely of the statements of examining surgeons based upon examinations made long after the injury had healed. Deducting these thirty-five cases, there remain two hundred and sixty-nine cases with twenty recoveries, giving a mortality of 92.5 per cent. But it was further stated on pages 76 and 77, ante, that in twelve instances the evidence is compatible with the sup position that the fractures were probably in the trochanteric region, and that in five instances the fractures were extracapsular. Eliminating these seventeen cases, there remain only two hundred and fifty-two cases with three recoveries, or a mortality rate of 98.8 per cent. Of the three patients that recovered after undoubted intracapsular shot fracture of the hip joint, one, Private T. 0. Garvin, Co. H, 94th New York (CASE 143, ante), died nearly four years after the reception of the injury, from which pus and portions of the joint, consisting of splinters of bone, were discharged to the time of his death. In the case of T. L. Lomax (CASE 140, ante], in which it remains a disputed point whether it should be regarded as an example of treatment by excision or by conservation, it was impracticable to ascertain whether the patient is still living. The third patient, Colonel J. C. Strong (CASE 134, ante), was in tolerably good health in December, 1878. From the evidence recorded on the registers of this Office in the alleged examples of recovery after shot fractures of the hip joint treated by temporization, I must continue to share the unfavorable impression of the results in this class of injuries of Guthrie, and 1 The details of these cases have been published with Injuries of the Parts Contained in the Pelvis, Section II, Chapter VII, Second Surgical Volume, viz: Sergeant T. A , Co. C, 119th New York, CASK 922, p. 318; see also Note 2, p. 77, ante; and Sergeant W. Spendlove, Co. E, 1st New York Cavalry, CASE 859, p. 295, and Note 1, p. 85, ante. Case of Private Louis Schmidt, 8th Kansas, wounded at Chickamauga, Sept. 19, 1863, died Jan. 3, 18GG. Circular Xo. 0, 18(19, CASE 271, p. 105. SI:CT. ri.) EXCISION AT THE HIP FOR SHOT INJURY. 89 many of the older as well as more modern writers on military surgery, and can only reiterate the conclusion that I have already expressed in Circular No. 6, at page 61, and in Circular No. 2, at page 117, that shot injuries of the hip joint, when abandoned to the resources of nature, prove almost uniformly fatal. 1 With regard to the twenty-five cases of recovery after shot injuries of the hip joint under conservative treatment in the Franco-German War, 1870-71, tabulated by Professor von Langenbeck, and alluded to on page 67, ante, it may be hoped, in the interest of sur gical science, that the future histories of these patients will be noted, and that when death ensues it may be found practicable to have the extent of the injury to the hip. joint pre cisely ascertained by post-mortem examination. The difficulties of such a task are apparent and have hitherto proved insurmountable. In five of the fifty-five cases of recovery after alleged shot fracture at the hip joint cited from the American civil war, the patients have since died; but so far the opportunity to verify the diagnosis by an autopsy has not been improved. EXCISION AT THE HIP AFTER SHOT INJURY. A large addition to our statistical information on this subject was afforded by the experience of the American civil war as indicated by the accompanying tabular statement: TABLE X. Numerical Statement of Sixty-six Cases of Excision at the Hip Joint for Shot Injury. CASES. PEK CENT. Recovery. Fatal. Total. MOUTALITV. 1 3-2 33 96 9 2 20 oo 00 9 3 8 11 72 7 6 60 66 00 9 "Twelve cases of excision of the head of the femur for gunshot injury are all that are recorded in print, prior to 1861," is correctly asserted at page 17 of the report from this Office 2 published in 1869; but it is now known 3 that in the Italian Campaign of 1859 Dr. J. Neudorfer excised at the hip for shot injury four times, at least, which gives a total 1 In note 1, of page 62, ante, it was attempted to give, in chronological order, the earliest references to cases of shot wounds of the hip in military surgical literature, and the first case adverted to was that of Private S. Kirsky, in 1677, related by PUUMAXX (M. G.) (Funfftzig Sonder-und WumJcr- bahre Scliuxswunden Citren, Frankfurt, 1721, Obs. XLI1I, p. 324). After page 62 had gone to press, the following case, cited by Dr. JOSEPH SCHMIDT (Speculum Chirurgicum oder Spiegel der Artzney, Augspurg, 1656, p. 144), which antedates the case of PURMAXX by 33 years, came to the editor s notice : In the month of May, 1634, while the here-stationed Swedish regiment was being mustered in the castle-yard, a sergeant, whose quarters were with Mr. Peter Rehlinger, was accidentally shot tftrough the hip. He was conveyed in a trough to his quarters. I was called upon to see the case, but found that there was great difficulty in the way of bandaging and that the thigh was greatly swollen, the wound of entrance being as large as a hen-egg. On probing the wound I readily discovered the bare bone, with every indication that the shaft must have been split. Great haemorrhage bad also taken place ; his system was in a bad condition, unfavorable for a cure. The symptoms hourly grew more aggravated and became so severe as to terminate his life on the sixth day. After his death, I endeavored to obtain the consent of the officers to let him be opened, which was readily granted. When I did open him I discovered that the upper part of the femur, the head which enters the hip bone, was comminuted, as if it had been done with a hammer upon an anvil. There was also a long fissure in the shaft running down towards the knee ; the great trunk of the artery was torn, and the condition of the soft parts, inwardly near the bone, was so offensive that I can hardly describe it. It was no wonder that he lost his life from so severe an injury. Should he have recovered he would have done so with a bad walk." An instance from the Turco-Russian War of 1877, is related by KADE (E.) (Das tempordre Kriegslazareth der Anstalten der Kaiserin Maria im Kloslcr Marialiimmclfalirt by Sistowa, in St. Petersburger Medicinische Wochenschrift, 1877, No. 45, p. 383): A soldier, on August 31, 1877, received a shot wound of the right coxo-femoral joint without separation of continuity of bone. The ball lodged with its point in the neck of the femur. On September 12th, the wound was enlarged and the missile extracted. The patient died September 17th, of septicaemia following suppuration of the joint. Oxis (G. A.), A Report on Excisions of the Head of the Femur for Gunshot Injuries. Circular No. 2, War Department, Surgeon General s Office, January G, 1869, 4to, pp. 141. 3 LOXGMOUE (T.J, Gunshot Wounds, in T. HOLMES s System of Surgery, 2d ed., London. 1870, Vol. II, p. 230. SURG. 111-12 90 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. of sixteen examples of this operation iu military surgery prior to our war. Of these, a primary excision by Mr. T. 0. O Leary, in the Crimea, in 1855, was successful. The patient died ten years afterwards of phthisis. A secondary excision, by Dr. Neudorfer, in 1859, was followed by amputation at the hip, which the patient happily survived. In the foot-note 1 instances of excision at the hip for shot injury are enumerated, in addition to those practised in the United States service. At the date of the publication of Circular No. 2, S. Gr. 0., January, 1869, the records of this Office contained sixty-three, as was then believed, authenticated cases of excision of the head, or of the head and neck, or head and neck and portion of the shaft of the 1. OPPENHEIM (F. W.) (Die. Extirpation des Sclienkelkopffs atis <ltr Gelenkhohle, in Ze.itsclirift fur die gesammte Medicin, Hamburg, ]83(i, B. I, S. 137); a Russian chasseur wounded May 5, 1829, at the battle of Eski-Arna-Utlar; fracture of neck of left femur and rim of aeetabuhim. Primary excision May 5, 1829 ; death from plague May 23, 1829. 2. SF.UTIK (Resection de la partie snperieitre du femur, in Bulletin General de Tltfr- apeulique, Paris, 1833, T. IV, p. 371); Private Lisieux, 25th Infantry: fracture of neck, trochanters, and upper fourth of right femur. Primary excision December 8, 1832; death on the fourth day, from gangrene.:!. C. TEXTOll (K.vui, TEXTOU, Der Zweite Fall row Aussaf/ting des Schenl-elknpfes mit volkommenem Erfolg, Wurzburg, 1858, S. 15, No. 12); Kaspar Artes, aged 44 ; caries of head of right femur consequent upon gunshot fracture. Secondary operation on November 8, 1847; death on November 18, 1847. 4. Dr. H. SCHWARTZ (Beitriigc zur Lehrc von den Scliusswunden, Schleswig, 1854, p. 142); O , Danish soldier; shot fracture of trochanters of left femur. Intermediary excision May 13, 1849; death, May 20. ISO. 5. Dr. G. Ross (Deutsche Klinik, 1850, B. II, p. 451); Karl Engelking, aged 23, received, at Fredericia, May 8, 1848, a shot fracture of the left trochanter. Secondary excision, June 10, 1850; death, June 13, 1850. G. Professor BAUM (LOHMEYKU, Die Xchusswunden , 1859, p. !!>); a subaltern officer ; shot comminu tion of neck of femur. Primary excision in 1854 ; death in twenty-two hours. 7. G. E. BLEXKIXS (G. H. B. MACLEOD, J\ otcs on the Surgery, etc.. London, 1858, p. 341, and G. J. GUTHIUE, Commentaries, London, 1855, p. 621); Private C. Monsterey, 3d Batt. Grenadier Guards; shell fracture of neck and trochanters of right femur. Primary excision in June, 1855; death in five weeks. 8. G. H. B. MACLEOD (!\~otes on the Surgery nf the War in tltr. Crimea, 1858, p. 338); Private Couch, of the Rifle Brigade; fracture of the neck of left femur, June 18, 1855. Intermediary excision July 5 ; death fiv.m cholera July 10, 1855. 9. Surgeon J. CREHAU (G. J. GUTHKIE, Commentaries, 6th ed., London, 1855, p. 622); Private W. Smith, 1st Royals; grenade fracture of trochanter and neck of left femur. Primary excision August 6, 1855; died August 21, 1855. 10. T. C. O LEAKY (T. P. MATTHEW. Medical and Surgical History, etc., during the War against Russia, 1854- 55-"56, London, 1858, Vol. II, p. 378); Private T. McKevena, 68th Regiment: shell fracture of trochanter and neck of left femur. Primary excision August 20, 1855; recovery. 11. Dr. GEORGE HYPE (MATTHEW. 7. c.. Vol. II. p. 378;; Corporal B. Sheehan, 41st Regiment ; grapeshot comminution of trochanter and neck of femur. Primary excision Septembers, 1855; death September 14, 1855. 12. Dr. COOSIBE (MACLEOD, loc. cit., p. 344); British artillery soldier; shot fracture of neck of feinnr. Intermediary excision in 1855; death in a fortnight. 13-19. J. NEl DORFER (Das EndresnUat der Geknkresectionen, in Wiener Med. Presse, 1871, B. XII, p. 407) remarks : I have performed the hip joint resection for shot wounds seven times; six died from the eighth to the eleventh day, and the seventh I exarticulated at the hip after a few- days on account of purulent infiltration of the excised joint. The patient recoj^red after the exarticulation, and lives here in Vienna." J. Schranz, 7th Jaeger Bat., wounded at Palestro, May 30, 1859. Excision at left hip joint November 27th. Purulent infiltration followed, and. on December 1, 1859, amputation at the hip joint was performed by Professor NEUDORFER. The patient recovered, and lived in Vienna in 1868. During the Schleswig- Holstein War, 1864, Dr. NEUDORFEU twice excised the hip joint, on Austrian soldiers, for shot fracture of the upper extremity of the femur. Inter mediary operations. Both cases proved fatal (C. HEINE, Die SchussverUtzungen, etc., 1866, p. 369). Of the remaining four operations by NEUHORFKR I have been unable to find any details. 20. A successful secondary excision of the hip joint for shot wound received in the Austro-Prussiaii War, 18(i6, was performed by Dr. WAGNER in Konigsberg. NEUDORFER (Handbuch der Kriegschir., Leipzig, 1872, Zweite Halfte, Ahth. 2, p. 1458) states that he saw the patient in November, 1866, at Gorlitz, when his recovery was yet doubtful, but that in 1872 the patient was living a,t Graz, entirely recovered. He could walk without a cane, and could ascend and descend stairs. , 1-23. B. von LAXGEXBECK (Uber die Schussfracturen der Geleuke. 18C8. p. 16); Kucharsky, aged 18. fracture of left trochanter, March 22, 1863. Secondary excision July, 1863; death in fourteen days. Austrian soldier, wounded July 3, 1866; shot fracture of the neck of the right femur. Intermediary resection August 5, 1866: death August 12, 1866. Emil Bauer, ICth Saxon Infantry, wounded June 29, 1866; shot fracture of the neck of right femur. Secondary excision August 20th; death in September, 1866. 24. Dr. SCHOXBORX (B. v. LAXGKXBECK, loc. cit., p. 16); Maxim Glutschak. aged 24; wounded July 3, 1866, fracture of head of the right femur. Secondary resection August 22, 1866; recovery. 25. B. BECK (Kriegschir. Erf., 1867, p. 351); A. F. S , Wiirtemberg drummer, wounded July 24, 18(>6 : shot fracture of neck of femur and trochanter major. Intermediary resection August 5th; died August 7, 1866. 26. L. STUOMEYEK (Erfakrungen iiber Sc.husswunden, 1867, S. 52); a debilitated subject; intracapsular shot fracture of the neck of the femur. Intermediary resection in 1866; death in two days. Stabsarzt Dr. DEIXIXGER, of the Railway Battalion (Beitrdge zu den Schussfracturen des Hiiftgelenks unter besonderer Berucksichtigimg der Erfahrungen aus dem Fcldzuge 1870-71, und Benutzung der Acten des Koniglichen Kriegsministeriiims, in Deutsche Mil.-arM. Zeitschnft, 1874. Jahrgang III, pp. 237-335), gives a tabular statement of forty-five cases of resection of the head of the femur for shot injury, from the Franco- 1 russian War, 1870-71. The cases are: 1 primary case fatal, 26 intermediary cases (all fatal), and 17 secondary (with 5 recoveries and 12 deaths), and I case in which the time of operation was not recorded. Brief details are given : 27. A. Stephan, 3d Pioneer Bat.; shot fracture of neck and tn-clmnter major of left femur, September 20, 1870; excision same day, by Dr. B. BECK; died September 29, 1870. 28. Piurko, 22d Infantry; shot fracture of trochanter and neck of right femur, September 23, 1870; excision October 25, 1870, by SzMULA ; recovered, with useless limb. 29. A soldier wounded at Orleans; comminution of head of femur; intermediary excision, by Dr. METZLER; died 4 days after operation. 30. J. B. Mtiller. 85th French Line; shot fracture of head of right femur and rim of acetabulum at Beaune la Rolande, November 28, 1870; excision, by Dr. RtirPEL, December 2d; died December 7, 1870. 31. Corporal Heinartz, 75th Prussian, wounded at Orleans, December 9, 1870; ball fractured acetabulum and opened joint; excision, December 14th, by Dr. LAXGEXBECK; died of septicaemia, December 20, 1870. 32. A. Eichner, 2d Prussian Lancers; shot fracture < f head of right femur, Orleans, December 4, 1870; excision, by Dr. LAXGEXBECK, December 12th ; died December 18, 1870. 33. J. Schone, wounded at Weissen- berg, August 4, 1870. splintering trochanter and head of femur; excision, by Dr. C ZERNY, August 13th; died August 16, 1870. 34. M. Echteibruch, Corporal, 78th Infantry ; shot fracture of left femur below the greater trochanter, August 16, 1870; excision, by Dr. Mfn.LER, August 26th ; died Sept. 7, 1870. 35. J. Pakowsky, 14th Inf., wounded Decembers, 1870, in left hip joint; excision, December 14th, by Dr. NEWHAUS; died December 20, 1870. !) ;. J. Unterherg. Oldenberg Infantry No. 91 ; shot fracture of left trochanter, August 16, 1870; excision, August 27th, by Dr. A. EWAI.D; died Sept. 9, 1870. 37. J. Wiedener, 52d Infantry, shot wound in right hip joint, August 16, 1870; excision, by Dr. TRENPELEXBEUG, August 28th : died September 2 ( 1870. 38. F. Kopzinsky, 5th Artillery, shot fracture of left hip joint, Sept. 19, 1870; excision, October 2d, by Dr. WEGXER ; died October 28, 1870. 3!. J. Busse, 24th Infantry, shot fracture of the left femur, August 16, 1870; excision of hip joint, August 29th, by Dr. MARCU8E; died Sept. 7, 1870. 40. F. Patzwald, 9th Infantry, shot wound of left hip joint, December 2, 1870; excision, by Dr. BRA8CH, December 16th ; died December 21, 1870. 41. V. Vaillant, 42<1 French Line, shot fracture head of left femur, September 30, 1870 ; excision, October 14th, by Dr. GRAXDIES ; died October 17, 1870. 42. A. Dettki, 41st Infantry, shot comminution of neck of left femur, August 31, 1870; excision, by Dr. SACHS, Sept. 15th; died October 11, 1870. 43. P. Congacz, French Guards No. 3, shot fracture of head of left femur. August 18, 1870; excised, by Dr. LAXGEXBECK, September 1st ; died Sept. 2, 1870. 44. C. C. Petit, French Infantry No. 67, comminution of left hip joint, August 16, 1870; excision, by Dr. LAXGEXBECK, September 1st; died September SECT. ILJ EXCISION AT THE HIP FOB, SHOT INJURY. 91 femur, for shot injury. It has since been ascertained that in one of these cases the head of the femur was not removed; 1 but records of four additional cases 2 have since been obtained and added to the list of this operation, making a total of sixty-six cases of excision at the hip joint done for shot injuries received during the American civil war. As indicated in TABLE IX, at page 65, ante, fifty-five of these operations were performed for shot injuries of the hip joint, while in eleven instances the excision was practised for fracture of the shaft of the femur that did not primarily implicate the hip. 4, 1870. 45. C. Pacot, 50th French Infantry, shot fracture of neck of right femur, Weissenburg, August 4, 1870; excision, by Dr. BlLl.KOTH, Aug. 20th; died August 20, 1870. 46. W. Liesegang, 24th Infantry, shot fracture of neck of left femur, Vionville, August 16, 1870; excision, September L d, by Dr. GAEIIPE; died September 3, 1870. 47. E. W. Hoffman, of the Prussian Guards, shot fracture of hip joint, St. Privat, August 18, L870; excision, by Dr. LiJCKE, September 5th; died September 13, 1870. 48. A. Weinert, Corporal, 10th Dragoons, wounded in trochanter major, August 14, 1870; excision, by Dr. FISCHER, September 1st; died September 13, 1870. 49. B. Payant, 32d French Infantry, shot fracture of upper third of right femur, August 16, 1870 ; excision, September 4th, by Dr. NEUHAUS ; died September 8. 1870. 50. A. Piasecki, 5th Infantry, comminution of neck of left femur, September 9, 1870; excision, by Dr. WAGNEK, September 29th ; died October 11, 1870. 51. P. Perrot, 13th French Infantry, comminution of right femur into joint, Gravelotte. August 8, 1870; excision, by Dr. P.USCH, September 12th ; died September 23, 1870. 52. J. Pitzer, 83d Infantry, comminution of trochanter major and neck of left femur, Worth, August C, 1870; excision, by Dr. I AGEXSTECHEH, September 1st; died September 10, 1870. 53. Sergeant-major B , 3d French Infantry, shot fracture of trochanter and neck of right femur, Worth, August 6, 1870; excision, by Dr. BECK, at the end of August ; died in the latter part of September. 54. C. Schmock, of the Guard Sharpshooters, shot wound in left hip joint, St. Privat, August 18, 1870; excised, by Dr. BEXSBERG, September 14th ; died September 19, 1870. 55. P , 61st Infantry, comminution of neck of left femur, January 21, 1871 ; excision, by Dr. VOLKMANN, February 20th; died February 22, 1871. 56. J. Blanche*, French Garde Mobilier, shot fracture of head of left femur, November 28. 1870 ; excision, by Dr. HEIXEMANN, December 29th ; died January 12, 1871. 57. E. Paschke, 58th Infantry, comminution of neck and trochanter of right femur, October 2, 1870; excision, by Dr. BORETIUS, November Oth ; died November 16, 1870. 58. A. Schoblock, 7th Wiirtemberg Infantry, shot frac ture of femur high up, Champigny, December 2, 1870 ; excision, by Dr. HUETER, January (i, 1871 ; died January 13, 1871. 59. Bartsch. 2d Guards, shot fracture below trochanter, with fissuring of neck of left femur, August 4, 1870; excision, September 13th, by Dr. SCHILLBACH ; died in a few hours. 60. D. Blennemann, 7th Infantry, shot wound of hip joint, Gravelotte, August 18, 1870 ; excision, about six weeks later, by Dr. WINDSCHEIDT ; recovery, with good use of limb and one and a half inch shortening. 61. E. Geier, 9th Infantry, shot through left hip joint, Worth, August G, 1870; excision, by Dr. BiLLUOTH, September 28th ; died October 27, 1870. 62. Sciiaal, 10th French Infantry, shot wound in right hip, August 16, 1870; excision, by Dr. JOSErHSON, October 24th; death October 25, 1870. 63. F. John. 8th Infantry, shot wound of right hip, fracture of acetabulum, Saarbriicken, August 6. 1870 ; excision, by Dr. HUI EDEX, November 4, 1870; recovery, with moderately free use of limb and one inch shortening. 64. B , 2d Zouaves, shot fracture of upper third of femur, Worth, August 6, 1870 ; excision six mouths after injury, by Dr. WELKKR ; recovery. 65. French soldier, shot fracture of hip joint September 30, 1870; secondary excision ; recovery, with comparatively good use of limb. 66. J. Pieper, 21st Infantry, shot wound of left hip; secondary excision of head of femur, February 19, 1871, by Dr. JACOHY; died Feb. 23, 1871. 67. G. Rossmanieck, 4th Infantry, shot in left hip in August, 1870; secondary excision of hip joint; died Sept. 7, 1870. 68. P , 17th Infantry, shot wound of right hip joint ; secondary excision of joint; died. CD. Unknown soldier ; secondary excision, by Dr. BATTLEHXKK ; fatal. 70. Unknown soldier ; shot fracture of neck of femur ; secondary excision, three months after injury, by Dr. HKPI NER ; death in two weeks. 71. Unknown soldier, shot fracture of neck and trochanter ; resection three and a half months after injury ; died a week afterwards. In a tabular statement of cases of resection of the hip joint performed during the same period, arid collected by Professor B. v. LANGENBECK (fiber die Schussverletzimgen des Hiifigelenkg, in Archiv fur Klinisclie Chirurgie, Berlin, 1874, B. XVI, p. 263), I find 7 cases (2 intermediary fatal cases, CASES Nos. 2, 5, pp. 329, 330,)! secondary fatal (CASE No. 14, p. 334) and 4 fatal cases, period of operation not stated (CASES 12, 20, 21, and 27, pp. 333, 335, 336), not contained in Dr. DElNIXGER s tables. They are: 72. Lieut. Roma, 9th French Infantry, shot frac ture of left hip joint, August 18, 1870; excision, by Dr. LAXGEXBECK, August 31st; died September 4, 1870. 73. Petit, 67th French Infantry, shot fracture of right hip joint, Mars la Tour, August 16, 1870 ; excision, August 30th, by Dr. LANGEXBECK ; died December 10, 1870. 74. Unknown soldier, shot fracture of hip joint; excision, by Dr. BlLLROTll; died 24 hours after operation. 75. Unknown soldier, shot fracture of pelvis; secondary involve ment of hip joint ; secondary excision of head and neck, by Dr. KUSTEK ; death eight days after the operation. 76, 77. Unknown soldiers ; excisions, by Dr. VOLKMAXN ; fatal. 78. Unknown soldier ; excision of head of femur, by Dt. GRAF ; fatal. 79. Another intermediary case of excision of head of femur for shot injury during the late Franco-Prussian War, 1870-71, not reported by either Dr. DEININGER or Professor B. v. LANGEXBECK, is reported by Dr. GEORGE FISCHER (Dorf Floing und Schloss Versailles, in Deutsche Zeitschrift fur Chirurgie, Leipzig, 1872, B. I, S. 227); unknown, fracture of head of left femur. September 30, 1870 ; wound of exit and entrance on a level with the trochanter major. October 20th, resection; October 28th, death from pyffimia. An operation ascribed to Dr. LUTTER, in Lancet, 1870, Vol. II, p. 452, is identical with the case described by Dr. H. FISCHER (Kriegschir. Erf. vor Mdz, Erlangen, 1872, p. 200), and included in cases collected by Drs. DEIXIXGER and v. LANGENBECK (No. 48, ante). 80-97. CHEXU (J. C.) (Apery u hist. stat. et din., etc., pendant la guerre de 1870-71 , Paris, 1874, T. I, p. 493) tabulates eighteen cases of excisions of the hip joint for shot frac tures, in the Franco-Prussian War, 1870-71, with three recoveries. The same author (loc. cit., T. II, pp. 1-150) records, by name, the cases of recovery after amputations, disarticulations, and excisions ; but, after a careful search, I have been able to find only one of the (3) successful cases of excisions at the hip joint among them. The case is detailed on p. 85: " Lande (P. F.), born June 6, 1849, at Valognes (Manche), 109th line. Fracture of head of femur for shot wound. Resection of heitd of femur. 1 The case is duplicated and again appears, on p. 86, as Laude, giving same details in every res peet. I find no record of the two other cases. There is nothing to indicate whether the cases are primary, intermediary, or secondary operations. The cases reported by Dr. DUBUEIL (Gaz. mid. de Paris, 1871, T. XVI, p. 314) and Dr. ARXAUD (GRELLOIS, Hist. med. de blocus de Metz, 1872, pp. 351-353) are undoubtedly included in CHENU s (loc. cit., p. 493) statistics. 98. ROBERTSON (J. B.) (Resection at the Hip joint Removal of the Head with Four Inches of the Femur Tetanus Cure by Physostigma, in Pacific Med. and Surg. Jour., 1878, Vol. XX, p. 500), excised, on April 8, 1876, the head and four inches of the shaft of the femur in the case of George Miller, aged 45, who had suffered for over a year from a sinus, evidently resulting from a rifle shot received two years previously. The wound healed by first intention. Tetanus, which supervened about three weeks after the operation, was successfully treated with physostigma. In February, 1878, Miller was "well and able to ride on horseback and herd cattle in the mountains." 99. Dr. UunttUCK (Sf AUXOI:I:I, Rapport sur le mouvement de lambulance A o. 5 du Croissant Rouge a Orchanie, du 17 Octobre au 8 Norembre 1877, in Le Progres Medical, 1878, No. 1, p. 6) excised, on October 21, 1876, the head of the left femur in the case of Mehemet-Osman, for shot wound received in the Turro-Russiaii War; secondary operation ; pneumonia; death. Summing up the cases of resection of the hip joint referred to in this note we have a total of 99 oases with 86 deaths, a fatality of 86.8 per cent. Of these 99 cases 8 were primary operations with 7 deaths (87.5 per cent.); 37 were intermediary, all fatal; 27 were secondary with 18 deaths (66.6 per cent.); and in 27 instances with 24 deaths the time of operation was not specified. 1 The case of Lieutenant Dwight Beebe, 3d New York, cited in Circular 2, at page 32. Information received since the publication of the case proves it to be an example of removal of three and a half inches of the upper portion of the femur just without the capsule. The case will be detailed with excisions in the continuity of the femur in the third section of this chapter. CASKS of: 1. Private J. W. Epton. Co. I, 5th South Carolina, referred to in Circular 2, at p. 120, but not included in the tabular statements on pp. 59 and 137; 2. Private C. Raines, Co. E, 25th North Carolina; 3. Private G. W. Tilliston, 1st Ohio Light Artillery; and 4. Private T. W. Pease, Co. H, 19th Indiana. 92 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Primary Excisions. Of thirty-three well authenticated primary excisions at the hip practised during the War, twenty were performed upon Union and thirteen upon Confed erate soldiers. The only successful result was in the case of Private Cannon, a young soldier of a Georgia regiment, on whom Dr. J. J. Dement, of Huntsville, Alabama, operated. The particulars of the case were communicated by Dr. Claude H. Mastin, of Mobile, formerly Inspector of Hospitals in the Confederate service, and by Dr. J. B. Duggan, of Toombsborough : CASE 208. Private Cannon, Co. A, 49th Georgia, aged 24 years, was wounded at the battle of the Wilderness, May 5, 1864, by a conoidal musket ball, which struck an inch below the left trochanter major, extensively comminuting the femur and lodging in the adductor muscles. The Confederate line being forced back, the wounded man lay on the ground all night until the early morning, when the Confederates recovered their wounded. In Cannon s case, the consultation at the field infirmary by Surgeons J. J. Dement, Holt, J. J. Wynne, and F. P. Henderson, it was determined to enlarge the wound and 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 downward four inches. On ascertaining the condition of the 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 induced by the operation. The limb and body were confined by roller bandage to a straight splint extending from the axilla to the foot. A full dose of sulphate of morphia was then administered. In a few hours the patient was placed in an ambulance wagon and conveyed to Orange Court House, twenty-five miles distant, and thence by rail to Staunton, about seventy miles farther, where the after treatment was conducted at the general hospital. Little can be learned of the after treat ment, save that the patient was supplied with rich diet, 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 about on crutches. He went to his home, in Toombsborough, Georgia, in February, 1835, and earned a livelihood by his trade of shoemaking. He enjoyed good health until November 12, 1865, when he had an attack of diphtheria which terminated fatally on November 23, 1865. The thirty-two unsuccessful primary excisions at the hip may be arranged in three categories. The first comprises thirteen instances where the circumstances were favorable, the patients of mature and robust organization, the lesions of bone limited to the upper extremity of the femur, the important vessels and nerves intact; the injuries to the soft parts were not excessive; there were no complications of wounds in other regions, and the patients were not subjected to hazardous removals; yet all thirteen succumbed within two or three days, or in one case as late as the fourth day, from the conjoined shock of the injury and the operation. CASE 207. Captain Frederick M. Barber, Co. H, 16th Connecticut, aged 32 years, was wounded at Antietam, Septem ber 17, 1862, by, a musket ball, which entered behind the right trochanter major and shattered the trochanters and neck of femur. He was conveyed to the field hospital of the 3d division of the Ninth Corps. His general health was good, and there was but little shock. There was no swelling of the soft parts; the fracture was accessible to exploration, and appeared limited to the epiphysis. The case was one in which excision seemed peculiarly applicable, and, after a consultation of several surgeons of the division, that operation was decided upon. On the morning of September 18th, the patient being anaesthetised by chlo roform, Surgeon Melancthon Storrs, 8th Connecticut, made a straight incision four inches long, passing through the wound of entrance. The comminuted fragments of the neck and trochanter were extracted, the round ligament divided, the head of the femur removed, and the fractured upper extremity of the shaft was sawn off by the chain saw. The edges of the wound were then approximated by adhesive straps, and simple dressings were applied. Little blood was lost, and the patient rallied promptly from the operation, and appeared quite comfortable during the day. Surgical fever soon set in, however; the patient sank rapidly under the constitutional irritation, and died on September 20, 1862. CASE 208. Sergeant Edwin T. Brown, Co. C, 21st Massachusetts, aged about 30 years, was wounded in front of Peters burg, on July 23, 1864, by a ragged fragment of a mortar bomb, which struck the left thigh over the trochanter major and comminuted the upper extremity of the femur. The wounded man was immediately conveyed to the hospital of the 1st division of the Ninth Corps. Surgeon Whitman V. White, 57th Massachusetts, and Surgeon James Oliver, 21st Massachusetts, saw the patient a short time after his admission to the hospital. He was a strong, healthy man, five feet ten inches in height, weighing about one hundred and sixty pounds, with a constitution of iron, and was in perfect health when injured. The soft parts about the seat of injury were lacerated and torn, and the upper extremity of the femur, to an extent of five inches, was crushed to fragments. No important arteries or nerves were wounded. Excision of the fractured bone was decided upon. On the afternoon of the day on which the injury was received chloroform was administered, and Dr. White made a longitudinal incision and removed the shattered fragments. The ligamentum teres was divided and the head of the bone turned out. The broken extremity of the shaft of the femur was evened off with a chain saw. The patient reacted promptly from the shock of SECT. II.] EXCISION AT THE HIP AFTER SHOT INJURY. 93 the operation. The limb was placed in proper position, and stimulants were freely used. Dr. Oliver states that he saw the man several times on the following day, who was in excellent spirits, and talked and laughed, and did not complain of any pain. On the 26th his appetite failed and he began to sink. He died July 27, 1864. CASE 209. Private Charles Beard, 12th Mississippi, was wounded and made a prisoner in the engagement on the Weldon Railroad, August 23, 1864. With nearly two hundred other Wounded Confederates he was received at the field hospital of the 1st division of the Fifth Corps at Reams s Station, where it was found that a conoidal musket ball had entered the front of the right thigh a little to the outside of the course of the great vessels, and had comminuted the neck of the femur and fractured the head, and lodged in the acetabulum, of which the lower portion of the rim was broken oif. A few hours after the reception of the wound the patient was placed under the influence of chloroform, and, after a thorough examination, it was deemed expedient to excise the upper extremity of the femur. The operation was performed by Surgeon A. A. White, 8th Maryland. An incision, commencing a little below the anterior superior spine of the ilium, was carried downwards below and behind the prominence of the trochanter major. From the lower extremity of the h rst, another incision, Dr. McGill states, was carried backwards. The muscular attachments were then dissected aside, and the chain saw was passed around the bone, which was divided just above the lesser trochauter. The head of the femur was then readily exarticulated, and the ball and splintered fragments were removed. The wound was then approx- FIG 47^Sh tf imated by sutures and adhesive strips, and the limb was suspended by Smith s anterior splint. The of bead of right femur, patient reacted favorably; but very soon after the operation there was a marked rigor, and on the follow- *~ pe ing day there was extreme irritability of stomach and retention of urine. The case terminated fatally on August 25, 1864, two days after the reception of the injury. At the autopsy, it was found that the fracture of the acetabulum did not communicate with the interior of the pelvis; but the articular surfac^vas intensely injected; its cavity was filled with offensive sanious pus. The sawn extremity of the femur was black. One report states that the patient s appearance was of one who had undergone great privations and was not in a favorable condition to undergo any severe operation. The excised portions of bone, repre sented in the accompanying wood-cut (FlG. 47), were sent to the Army Medical Museum without a memorandum ; but were ultimately identified, and numbered 1410 in the Surgical Section. CASE 210. Private Bartholomew Dempsey, Battery I, 4th Artillery, was wounded February 25, 1864, at Buzzard s Roost, Georgia, by a piece of shell, which passed through the upper portion of the right thigh, crushing the trochanter and neck of the femur, and producing fissures which extended to the head of the bone. The wounded man was taken to a private house in the neighborhood, at a place called "Big Spring," or in another report "Burke s Spring," a place ten miles northwest of Dalton, where, shortly after the reception of the injury, it was decided, on the recommendation of Surgeon S. G. Menzies, 1st Kentucky, that excision should be performed. Chloroform having been administered, Surgeon Nathan W. Abbott, 86th Illinois, made an incision five inches in length, commencing two inches above the trochanter major. After dissecting aside the muscular 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 bistoury, 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, 7Cth Illinois, 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 bone were preserved by Dr. Barnes, of Centralia, Illinois, who was present at the operation. A statement has been received from Brevet-Major E. B. Atwood, 16th Infantry, that he had learned from parties who attended Private Dempsey after he was wounded that he died on February 28, 1864, at the house of a Mr. Rogers, ten miles northwest of Dalton, Georgia. CASE 211. Private T. J. Holson, Co. H, 32d Tennessee, aged 23 years, was wounded at Kenesaw Mountain, June 24, 1864, by a conoidal musket ball, which struck the femur and comminuted the neck and trochanters. The fracture extended within the capsular ligament. The shock was very great. The patient was seen by Surgeon J. F. Grant, P. A. C. S., who found that amputation was not practicable except at the hip joint, and deemed it expedient to undertake the operation of excision, as giving, in his judgment, the best chance for recovery. The army was then retreating, and if the patient was removed to the rear it was doubtful if surgical relief could be had. Accordingly, about twelve hours after the reception of the injury, the patient being placed under the influence of chloroform, Dr. Grant proceeded to operate, by making a linear incision ten inches long on the outside of the thigh over the trochauters. The articulation was exposed, the capsular ligament divided, and the head of the bone enucleated. The shattered fragments were then removed, and the shaft of the femur was divided by a straight saw just below the trochanter. The loss of blood was slight. Immediately after the completion of the operation the patient was placed upon a box-car and transported forty, miles over a very rough road to the rear. Reaction was never complete, though the patient lingered three days, and died on June S7, 1864. CASE 212. Lieutenant John A. McGuire, Co. I, 148th Pennsylvania, was wounded on May 12, 1864, at Spottsylvania, by a musket ball, which smashed the trochanters and neck of the right femur. He was carried to the hospital of the 3d division of the Ninth Corps, where, after an exploration of the wound under chloroform and a consultation of the senior surgeons of the division, it was determined to excise the injured bone. The head, neck, and trochanters were accordingly removed through a longitudinal incision by Surgeon George W. Snow, 35th Massachusetts. The patient died on May 15, 1864. 94 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 213. Private O EourJce, 18th Mississippi, aged 24 years, healthy and of flue constitution, was wounded at the Wilderness, May 6, 1864, by a musket ball, which entered the right thigh a little behind the trochanter, shattered the neck of the femur, and lodged. There was little injury to the soft parts, and the important vessels and nerves were unharmed. He was taken to a field hospital, and his injury was examined under chloroform, by Surgeon J. T. Gilmore, Chief Surgeon, 1st division, Longstreet s Corps. The limb was everted and shortened, the fracture appeared to be confined to the epiphysis, and there was no bleeding. Believing that removal of the injured bone offered the best chance of preserving life, Surgeon Gilmore proceeded to excise the head and neck of the femur. A curvilinear incision four or five inches long, with its convexity back ward, was carried downward from a point a little above and behind the trochanter, and was made to pass through the entrance wound. The muscles inserted in the trochanter were then divided, the head was readily disarticulated, and the femur was then smoothly divided through the trochanters by a chain saw. The operation was accomplished with the loss of but little blood. Yet the patient did not react, but gradually sank, and died May 9, 1864. CASE 214. Private Thomas G. Pease, Co. B, 117th New York, was wounded October 28, 1864, near Fair Oaks Station. The trochanters and neck of the right femur were shattered by a musket ball, which lodged against the head in the cotyloid cavity. The soft parts were not injured badly, and it was determined by surgeons on duty at the field hospital of the Tenth Corps that excision of the upper extremity of the femur was expedient. The operation was performed, a few hours after the reception of the injury, by Surgeon N. Y. Leet, 76th Pennsylvania. The patient died on October 29, 1864. CASE 215. Sergeant James M. Tolman, Co. H, 18th Wisconsin, aged 30 years, was wounded May 14, 1863, near Jack son, Mississippi, by a conoidal ,musket ball, which comminuted the head and neck of the left femur, lodging, 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 cachectic subject, debilitated by malarial disorders. It was deemed that the gravity of the injuries of the upper extremity 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. V., exarticulated the head of the femur. The incision commenced a little above and anterior to the trochanter major and extended downward in a curved direction with the convexity backward, 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 a 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, 1863. CASE 216. An unknown private soldier of the Fifth Corps, Army of the Potomac, was wounded in the engagement at Laurel Hill, near Spottsylvania Court House, on May 10, 1864, by a musket ball, which fractured the trochanteric portion of the left femur. He was conveyed to the field hospital of the Fifth Corps, at Cassin s, on the Block House road. He was placed under the influence of chloroform, and the head, neck, and trochanters of the left femur were excised. Assistant Surgeon J. S. Billings, U. S. A., saw him on the following morning, when he appeared to be in a comfortable condition. Dr. Billings recollects that he was a young and healthy looking man. The attendants mentioned the character of the operaticn and the name of the operator, but Dr. Billings cannot recall these particulars. On revisiting the hospital three days subsequently, Dr. Billir.gs learned that the patient had died on that morning, May 13, 1864. CASE 217. An unknown soldier of the Eighteenth Corps was wounded, in the assault on the enemy s intrenched lines at Cold Harbor, June 3, 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 Eighteenth Corps, and immediately anaes thetized 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 com paratively comfortable condition. On June 7th the wounded of the Eighteenth 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 the previous night, June 6, 1834. CASE 218. A Confederate private soldier was wounded at the battle of Fredericksburg, December 13, 1862, by a frag ment of shell, which struck the trochanter of the right femur and fractured it and the neck of the bone, and lacerated the soft parts, but without injuring any of the important vessels or nerves. He was conveyed to a field infirmary, where, a few hours after the reception of the wound, he was placed under the influence of chloroform, and Surgeon Hunter McGuire, Medical Director of Jackson s Corps, having ascertained the extent of the injury, decided that although the lesions of the soft parts rendered the case an unpromising one, yet excision was the only 1 esource that offered any hope, and proceeded to excise the head, neck, and trochanters, dividing the shaft just below the trochanter minor with a chain saw. The wound was left open; the limb placed in a comfortable position by means of pillows, without splints, and the patient was treated at the temporary hospital at which the operation was performed. Notwithstanding the most careful attention to the after-treatment, he succumbed two or three days after the operation. CASE 219. A Confederate soldier of Kershaw s South Carolina Brigade was wounded at the battle of Chancellorsville, May 3, 1863, by a musket ball which 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, Kith South Carolina, on the day after the reception of the wound. The patient died May 6, 1863. In a second category are placed nine cases of primary excision at the hip which resemble each other in that in each the operations were fairly indicated and offered favor- SECT. ii. | EXCISION AT THE HIP AFTER SHOT INJURY. 05 able prospects of success. The patients, for the most part, were robust soldiers, and the lesions were limited to shot fracture of the upper extremity of the femur. All made a struggle for existence, several lived three or four weeks and one for sixty days, and the fatal results were due, in several instances, to the imperative military exigencies that necessitated the removal and inopportune and disastrous transportation of the patients. CASE 220. Private Robert Cole, Co. B, 29th Connecticut (colored troops), was wounded near Fair Oaks, October 27, 1864, by a musket ball, which shattered the upper extremity of the right femur without injury to any important vessels or nerves. He was conveyed to the hospital of the Tenth Corps, where the wound was explored, and it was decided to excise th head, neck, and trochanters of the femur. The operation was performed by Surgeon C. M. Clark, 39th Illinois, a few hours after the reception of the injury, by a longitudinal incision over the trochanter major, and division of the superior portion of the shaft by a chain saw. Dressings to secure the immobility of the limb were applied, and the patient was removed to the base hospital of the Army of the James, at Point of Rocks, where he was received on October 26th, and died on October 29, 1864. CASE 221. Private John Coon, Co. C, 60th Indiana, aged 20 years, a robust man, was wounded at Arkansas Post, Jan uary 11, 1883, by a conoidal musket ball, which entered the right buttock and passed forward and outward, striking the femur on the inter-trochanteric line and comminuting the neck and upper pai t of the shaft of the bone. A few hours after the recep tion of the injury the patient was conveyed to a hospital steamer, and a consultation was held, at which it was determined to excise the injured portions of bone. The loss of blood which had taken place and the patient s exposure to inclement weather were regarded as very unfavorable circumstances, but it was considered that on the whole an excision was the best thing to be done. An ounce of brandy and other restoratives were administered, and half an hour subsequently the wounded man was placed under the influence of chloroform, and Surgeon Milton T. Carey, 48th Ohio, made a semi-circular incision, beginning two inches above the prominence of the great trochanter downward in the direction of the shaft of the femur. The muscular attachments were then divided, and the capsular ligament freely incised. Some difficulty was then experienced in dividing the ligameiitum teres; but this was finally accomplished, and the head of the femur removed. The extent of splintering having been determined, the shaft was sawn below the trochanter minor by means of a chain saw. The edges of the wound were then brought together, and a retentive apparatus was applied. After the operation the patient seemed much prostrated, but he rallied after a few hours, and was conveyed on the hospital transport D. A. January to Memphis, Tennessee, and placed in the military general hospital at that place, where he died ten days subsequently, January 21, 1863. CASE 222. Private J. W. Epton, Co. I, 5th South Carolina, was wounded at Deep Bottom, August 16, 1864, and was conveyed to the third division of the Jackson Hospital at Richmond. Surgeon J. G. Cabell, in charge, entered on the hospital register, page 214: "A minie" ball penetrated the right hip joint, on account of which a primary resection of the head and neck , of the femur was practised. The patient sank, and died September 2. 1864." CASE 223. Private Timothy Greely, Co. C, 74th New York, aged 20 years, was wounded October 5, 1861, by a round musket ball, which entered near the fold of the left natis, struck the left femur at the digital fossa, splintered the neck into the articulation, and made its exit outside the vessels anteriorly. He was conveyed to the E street Infirmary, Washington, on the same day. A stream of blood and another of clear and pellucid synovia issued from the wound of exit. There was but little constitutional irritation, the pulse was but slightly depressed, and the patient congratulated himself on having escaped with what he regarded as a slight injury. On the morning of October 6th Assistant Surgeon John W. S. Gouley, U. S. A., assisted by Surgeon C. H. Laub, U. S. A., Assistant Surgeon C. B. White, U. S. A., Surgeon T. Sim, and Assistant Surgeon H. E. Brown, proceeded to operate. Insensibility having been induced by chloroform, Dr. Gouley made an incision seven inches long, commencing above and behind the trochanter major and continued downward in the axis of the limb. The neck of the bone was found to be badly shattered, but the fracture did not extend to the shaft. A section through the great trochanter and base of the neck was made with the chain saw. The head of the bone was then disarticulated and removed, and the fragments of the neck were extracted. There was very little loss of blood. The wound having been approximated and dressed simply, the patient was put to bed, and the limb was kept in position by pads and cushions. Surgical fever set in soon after the operation ; pyaemia was developed, and the patient gradually sank, and died on October 12, 1861. His friends would not permit an autopsy. The pathological specimen and Dr. Gouley s notes of the case were destroyed in the conflagration which shortly afterwards consumed the Infirmary. CASE 224. Sergeant Samuel Grimshaw, Co. H, 6th New York Cavalry, aged 31 years, was wounded at Cedar Creek, October 19, 1864, by a fragment of shell, which, after lacerating the scrotum, entered at the upper inner part of the left thigh near the femoral artery, making a wound one and a half inches in length, and passing upward and backward, shattered the head and neck of the femur and produced fissures extending four and a half inches in the shaft, and lodged in the acetabulurn. The shock to the nervous system was great. The patient was desponding, and he complained of severe pain. He was con veyed to a field hospital, and two hours after the reception of the injury he was placed under chloroform, and Surgeon A. P. Clark, 6th New York Cavalry, made a straight incision seven inches in length over the trochanter major, and excised the head and four and a half inches of the shaft of the femur. The wound was then dressed, and the limb was supported by pasteboard splints. On the following day no bad symptoms were observed. Beef essence and stimulants were freely given, and afterwards sulphate of morphia was administered. He was removed to the Sheridan Field Hospital at Winchester on October 20th, and there died on November 5, 1864. CASE 225. Private B. C. Johnston, Co. B, 56th North Carolina, 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 upward and outward, 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 96 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 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 performed on June 18th, twelve hours after the reception of the wound, and the bone was sawn through the trochanters. He bore the opera tion 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 North Carolina, 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 Virginia, then the senior Surgeon of Kansom 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 upward, the aperture of exit being over the trochantcr 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 aperature of the wound being in its line cut down upon the head of the femur, exartic ulated and removed it, and cut off a sharp fragment of the remaining end of the femur. The difficulty of performing the opera tion 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 obtained, and anything like delicacies were out of the question." CASE 226. Private Edward A. McDonald, Co. F, 149th Pennsylvania, aged 31 years, a robust, athletic man, was wounded on August 20, 1864, on the Weldon Railroad. A conoidal musket ball entered the upper anterior part of the right thigh and lodged in the head of the femur, after splintering its neck. He was carried to the hospital of the 1st division of the Fifth Corps, and placed under the influence of chloroform a few hours after the reception of the injury, and Surgeon F. C. Reamer, 143d Pennsylvania, assisted by Surgeon Thomas, 119th Pennsylvania, and others, proceeded with the operation. A V-shaped incision, arranged to traverse the entrance wound, exposed the muscular attachments of the neck and trochanter. These being divided, with the capsular and round ligaments, the head of the femur was exarticulated. Fragments of the neck were extracted, and then the femur was sawn through the trochanteric ridge by the chain saw. The wound was then partly closed by sutures and adhesive plasters, a pledget of lint being inserted at the lower end, and the limb was bandaged and suspended by a Smith s anterior splint. Little loss of blood had been incurred, and the patient reacted and his condition appeared hopeful. Two days afterwards it was deemed necessary to remove the severely wounded from the advanced position of the Fifth Corps, and McDonald was sent in an ambulance wagon several miles, over a rough road, to the railroad to the hospital at City Point. There he remained three days, and was placed on a hospital transport and sent to Philadelphia, entering Broad and Cherry Streets Hospital August 27th. The injured limb was extended by means of a weight and pulley, concentrated nourishment and stimulants were administered, with quinia and opium. August 31st, symptoms of pyaamia were noted and the complication made rapid progress. Death took place September 4, 1864. At the autopsy large metastatic foci were observed in both lungs. CASE 227. Private Charles Morrison, Co. C, 185th New York, was wounded on the Quaker Road, south of Petersburg, on March 29, 1865. A conoidal musket ball struck the outside of the left thigh, fractured the trochanter, and separated the neck from the shaft. In less than two hours after the reception of the injury he was placed on the operating table at the field hospital of the 1st division of the Fifth Corps, and his wound was examined while he was under the influence of chloroform. He was a robust man, in the best health. In the judgment of the operating staff, the case was a very favorable one for the operation of excision. Surgeon William Fuller, 1st Michigan, was requested to perform the operation, and proceeded with it without delay. He entered his knife an inch above the great trochanter and made an incision three and a half inches in length, divided the muscular attachments, and readily exarticulated the head of the femur. A fissure was found to extend downwards half an inch below the trochanter minor. The shaft was divided by a chain saw at this point. The ball could not be found, but, from the direction of its track, it was the opinion of the operator and his colleagues that it had entered the pelvis through the obturator foramen. There was scarcely any hemorrhage during the operation, no artery requiring ligation or torsion. A tent was introduced into the wound, which was then approximated by two sutures and covered by a compress dipped in cold water. A full dose of morphia was then administered, and the patient was made as comfortable as possible in a bed in a hospital tent. In the middle of the night Surgeon Fuller returned to the hospital to visit his patient, but found that he had been removed to City Point, in compliance with orders from a superior authority. Dr. Fuller was subsequently informed by Surgeon Joseph Thomas, 118th Pennsylvania, that the man died on the way to the base hospital, about twelve hours after the operation. There was some haemorrhage a few hours after the operation, but it was not considerable. The report of the patient s death was premature. The records of the City Point Hospital show that he was received there, and survived until April 26, 1865. CASE 228. A Confederate private soldier of Ewell s Corps was wounded at the battle of the Wilderness, May 5, 18b 4, by a colloidal musket ball, which broke the neck of the left femur into several fragments and lodged in the bone at the junction SECT. ii.J EXCISION AT THE HIP AFTER SHOT INJURY. 97 of the head and neck. A few hours after receiving his wound he was placed under the influence of chloroform at a field hospital, and was examined by Surgeon Hunter McGuire, the Medical Director of the Corps, who decided that the case was well adapted for the operation of excision of the head of the femur, and proceeded to remove, through a longitudinal incision, the head and shattered fragments of the neck, and to smooth off with a saw the jagged upper extremity of the shaft. The operation was accomplished with but trilling haemorrhage. It is Dr. McGuire s impression, but, owing to the loss of his notes he cannot state positively, that in the subsequent rapid movements of the army it was necessary to send the patient to the rear, and besides the disadvantages of removal, he failed to receive such nourishment and careful treatment as his case demanded. He died of pyaemia, May 22, 1864. As in the majority of the primary field excisions the shattered epiphysis removed was not preserved. Ten fatal cases of primary excision at the hip are placed in a third category. These ten might almost be set aside in estimating the value of the operation, inasmuch as the interference would hardly have been undertaken, had the extent of the lesion been fully ascertained. Four of the cases were complicated by penetration of the pelvic cavity, inducing hopeless peritonitis; four were prostrated from excessive loss of blood; in two instances extensive longitudinal splintering of the shaft of the femur forbade the anticipa tion of a favorable result. CASE 229. Private J. T. Goode, Co. K, 6th Virginia, aged 21 years, was wounded before Petersburg, July 31, 1864, by a conoidal musket ball, which fractured the upper extremity of the left femur. A few hours after the reception of the injury he was anaesthetized by a mixture of chloroform and ether, and the wound being explored excision was decided upon. Surgeon G. S. West, C. S. A., proceeded to perform the operation, assisted by Dr. W. L. Baylor and others. Upon making a linear incision in the axis of the limb and exposing the fracture, it was found that it extended longitudinally much lower on the shaft than was anticipated. Dr. Baylor reports that one of the surgeons present thinks that fully one-third of the femur was excised. The patient never fairly rallied from the shock of the operation, but he lingered until August 2, 1864, when he died. Dr. Baylor adds that the circumstances were very unfavorable, the patient being fully nourished and nosocomial gangrene at the time pervading the surgical wards. CASE 230. Private John McCullo.h, aged 35 years, a recruit at the depot for volunteers at Camp Dennison, Ohio, was wounded on August 30, 1881, by the accidental discharge of a musket. The ball, taking effect at the distance of a few yards only, severely shattered the upper part of iL* femur and lacerated the soft parts extensively. The patient was conveyed to St. John s Hospital, in Cincinnati, and on arrivii^ \\as greatly depressed by loss of blood. Professor George C. Blackman deter mined that removal of the shattered bone offered the best resource for the preservation of life, and, the patient having been rendered iusensible by chloroform, excision of the head, neck, and trochanters was practised without delay, through a vertical incision on the exterior of the thigh. The patJent died August 30, 1861, four hours after the completion of the operation. This was the first excision at the hip for shot injury in this country. CASE 231. Private G. W. Mayo, Co. B, 25th Battalion Virginia Reserves, was wounded at the affair between Yellow Tavern and the outer defences of Richmond, Virginia, May 12, 1864, by a conoidal musket ball, at short range, which entered the right buttock and passed forward and outward through the thigh, striking the femur between the trochanters, and producing very extensive splintering of the neck and shaft. He was admitted to the Receiving and Wayside Hospital, at Richmond, early the next day, and his wound being examined under chloroform, Surgeon Charles Bell Gibson, C. S. A., determined to proceed at once with the operation of excision of the head and upper extremity of the femur. The injured bone being exposed by a long straight incision, the muscular and ligamentous attachments were divided, and the head of the femur was disarticulated. Numerous detached fragments were then removed, and the shaft of the femur was sawn at a point five or six inches below the trochanter minor. The operation was rapidly accomplished, but the shock, added to the depression already existing from the injury, was such that the patient did not react. He FiG.48.-Shot com- died at 9 o clock A. M. on May 15, 1864, about forty-five hours after the operation. The pathological speci- "nd^rochan^o f men was preserved, and has lately been contributed to the Army Medical Museum by Dr. W. F. Richardson, left femur. Spec. It is represented in the annexed wood-cut (FlG. 48). CASE 232. At the assault on Knoxville, Tennessee, on November 16, 1863, a soldier of a Michigan cavalry regiment was wounded and made a prisoner. He was a man about eighteen years of age, five feet eight inches in height, with light hair and blue eyes, and was in robust health when he received the injury. A mini6 ball entering about the centre of the nates, passed forward, shattering the head and upper part of the neck of the femur, but did not injure the acetabulum. No hemor rhage of importance followed the wound. It was considered that the case demanded excision of the head of the femur, and the operation was performed on the day of the reception of the injury by Surgeon J. S. D. Cullen, P. A. C. S. "The operator made his incision posteriorly, directly through the thickest part of the gluteal muscles, on a line parallel with the os femoris, instead of laterally. In making his incision, which, at the least calculation, was ten inches in length, he cut the gluteal artery near its point of exit from the pelvis." The artery was ligated finally, though not until there had been much loss of blood. The head and neck of the femur were then excised. "When the siege was abandoned," another report states, "General Long- street retired to Russellville, and this patient was left behind. I am positive that he could not have recovered, for the suppura tion that followed the operation was immense, and he was suffering from hectic fever when I last saw him, some six days after the operation." There can be but little doubt that the patient referred to in this account was Private Isaac Melcar, Co. A, 8th Michigan Cavalry, aged 18 years, who was found abandoned on the retirement of the Confederate army from Knoxville, and SURG. Ill 13 98 INJUEIES OF THE LOWER EXTREMITIES. [CHAP. * was taken to hospital No. 2, in that city, and entered as a case of gunshot fracture of left hip." No other Michigan cavalry soldier is reported at the perfod referred to with this or any similar wound. This man died on December 2, 1863. The register of the Knoxville Hospital gives no particulars of the case. CASE 233. Private J. J. Phillips, Co. G, 61st Virginia, was wounded on the second day of the battle of the Wilderness, May 6, 1864, by a conoidal musket ball, which entered at the posterior upper portion of the left thigh, fractured the femur, and lodged. He was immediately conveyed to Richmond by rail, and was admitted to the Receiving and Wayside Hospital on May 7th. The wound was at ouce thoroughly explored under chloroform, and excision of the shattered bone was decided on. Surgeon Charles Bell Gibson, C. S. A., performed the operation. A long vertical incision over the trochanter major exposed the injured bone. It was found that the ball had produced extensive longitudinal splintering and had itself split, a small fragment lodging in the medullary canal, while a larger portion had buried itself in the gluteal muscles about two inches from the point of impact upon the bone. The muscles inserted into the trochanter having been divided, the head of the femur was exarticulated, and the upper extremity of the shaft was smoothed off with a saw. The operation was accomplished without much hemorrhage, and the patient rallied promptly from the shock. He had an anodyne, and passed a good night, and, on the following day, May 8th, he appeared to be doing well. On the 9th, however, there was much constitutional irritation, and on the morning of the 10th it was apparent that the man was sink- FIG. 49. Fissuringof ing. He died at 4 o clock A. M., May 11, 1864. The pathological preparation was contributed by Dr. righl r fe e imi r r! m ^c5499 e Richardson to the Army Medical Museum, and is a fine illustration of the characteristic longitudinal fissuring produced in the femur by conoidal balls. It is represented in the adjoining wood-cut (FiG. 49). In a letter dated Chicago, September 18, 1869, Dr. C. M. Clark, late Surgeon 89th Illinois Volunteers, reports the following case of excision at the hip: CASE 234. " Private C. Raines, Co. E, 25th North Carolina, was wounded June 2, 1864, by a conoidal ball, which entered the right thigh at the upper and outer third, near the great trochanter, passing obliquely downward and inward, and making its exit near the junction of the middle with the upper third of the femur. This man was not seen until eight hours after the wound was received, being among the last to be brought from the field. When he reached the operating table he was almost exsanguinated and pulseless, having lost a large amount of blood. After free administration of milk punch and beef tea, with comfortable rest for two hours time, he was placed on the operating table at 7 o clock P. M., and the following operation performed: Chloroform was given (which added greatly to the stimulation of the system pulse 80 and full), and a longitudinal incision made from the great trochanter down to the extent of six inches. The femur was found to be extensively comminuted, and some sixteen fragments were removed, leaving the periosteum behind. There was diffused ecchymosis with clots through out the extent of the fracture. The lower fragment was turned out and smoothly sawn off, and then attention paid to the upper portion, which Avas found comminuted within the capsule to such a degree as warranted the removal of the head of the bone, which was done by extending the incision upward one inch, opening the capsular ligament, turning head of bone out and dividing the ligamentum teres. The parts were then thoroughly cleansed and brought together with eight interrupted sutures. Applied strip of lint to the wound, wet with solution of tannic acid and collodion, then bandaged with spica turns about hip and splint, etc. He rallied well from the operation and passed a comfortable night at the hospital. In the morning he was taken, per hospital transport, to the Chesapeake Hospital, and I have no knowledge of the case sinc^e that time, but presume the records of that hospital will furnish the result. The bone removed below the trochanter major measured three and a half inches." This case has been identified as that of " U. C. Eaines, a rebel prisoner," aged 23 years, who was reported by Assistant Surgeon E. McClellan, U. S. A., as having been admitted to hospital at Fort Monroe, June 4, 1864, with "shell wound of right side and abdomen," and as having died the same day of "exhaustion." CASE 235. Captain Thomas R. Robeson, 2d Massachusetts, aged 24 years, an athletic man, was wounded July 3, 1863, at Gettysburg, his regiment having become warmly engaged under a musketry fire at short range. A rifled musket ball struck him over the right trochanter major, shattering the neck and head of the femur, and, as was subsequently ascertained, fractured the pelvis and penetrated its cavity. He was carried a short distance to the rear, where the stretcher-bearers became exhausted and laid him down. Sergeant Francis O Doherty, of his regiment, coming shortly afterwards wounded to the rear, impressed some stragglers and had the wounded man conveyed to a field station of medical officers of the Twelfth Corps. In the after noon he was brought into the Twelfth Corps hospital, and was examined by Surgeon John McNulty, U. S. V. The sufferings of the patient were intense, and he urgently demanded some operative interference for his relief. Although the prospect was very discouraging, it was decided to comply with his request. An exploration of the wound indicated that there was some injury of the pelvic wall. The patient was placed under the influence of chloroform very soon after his admission to the hospital, and a few hours subsequent to the reception of the injury Dr. McNulty made an incision over the trochanter major six inches long, passing through the wound of entrance and continued downward in the axis of the limb, turned out the shattered superior extremity of the femur and sawed the bone just below the trochanters. The fragments of the head and neck were then removed. There was more bleeding in this than in Dr. McNulty s other operations of excision of the head of the femur, yet the haemor rhage could not be called profuse. The patient survived the operation fourteen hours. During this interval he appeared to be unconscious. CASE 236. It has not been possible to learn the name and military description of the subject of this operation. He was a private soldier of the First Corps, and a Frenchman, for the operator recalls the broken English in which he begged for the operation, and expressed his relief and thanks after it was performed. He had a terrible comminution of the upper extremity of the left femur, inflicted by a fragment of shell at the battle of Antietam, September 17, 1862. Surgeon John McNulty, U. S. V., excised the head and neck of the femur, five hours after the reception of the injury, through a vertical incision six inches long, SECT. II. | EXCISION AT THE HIP AFTER SHOT INJURY. 99 under chloroform. As in two other operations performed by Dr. McNulty, it was found that the lesions extended into the pelvis. Consequently there could be little or no hope of a successful result. This patient survived the operation only ten hours. CASE 237. Private , of the First Corps, was wounded at the second battle of Bull Run, August 30, 1862, by a conoidal musket ball, which entered the left hip below and in front of the trochanters, and fractured the femur at the junc tion of the head and neck. He was conveyed to the hospital of General King s division of the First Corps in the brick house which had been occupied as the rebel headquarters at the first battle of Bull Run. The prostration from shock was great, yet it was thought that exarticulation of the femur was the only resource, and that excision would be less hazardous than amputa tion. Accordingly, fifteen hours after the reception of the injury, Surgeon John McNulty, U. S. V., proceeded to excise the head and neck of the left femur through a vertical incision on the exterior of the limb about six inches in length, the patient being under chloroform. On dividing the round ligament to enucleate the head of the bone, it was discovered that the ball had pene trated the pelvic cavity through the lower portion of the acetabulum. The femur was sawn through at the junction of the shaft and neck by a narrow-bladed saw. After the removal of the shattered fragments of bone, the patient suffered much less pain. There were no symptoms of peritonseal inflammation at the date of the operation, but they were subsequently developed. The patient died August 31, 1862. CASE 238. Private , was wounded on August 28, 1862, in the engagement between General Rufus King s division of the First Corps and the advance of General Jackson s column on the Washington turnpike, near Gainesville. A couoidal musket ball had splintered the neck and trochanters of the left femur, and was supposed to have lodged about the acetabulum, though the operator discovered in the sequel that it had penetrated into the cavity of the pelvis. The symptoms of shock were very grave and the prognosis very unfavorable ; but the chief medical officer of the division, Surgeon Peter Pineo, U. S. V., determined to remove the upper extremity of the femur. The upper fourth of the femur was excised a few hours after the reception of the injury. The excision was done under chloroform, with little apparent loss of blood, through a vertical incision on the outside of the limb. The femur was sawn about two inches below the lesser trochauter. It was now discovered that the ball had passed through the innominatum, and that internal haemorrhage was going on. During the night of August 28th General King s division was driven back to Manassas, and this patient with other wounded fell into the hands of the enemy. It is probable that he survived but a very short time. Dr. Pineo secured the specimen, and it is preserved in the Surgical Section of the Army Medical Museum as No. 71. It is figured at page 233 of the Catalogue of the Surgical Section, and another view is given in the accompanying wood-cut (FlG. 50). The trochanter major is separated into five fragments, and a long oblique fissure produces a complete solution of continuity in the shaft of the femur. (Circ. 6, S. G. O., 1865, p. 62, CASE 5, and Circ. 2, S. G. O., 1869, pp. 21, 132.) The successful primary excision at the hip and thirty-two unsuccessful operations will now be concisely tabulated in alphabetical order for convenience of comparison and reference: TABLE XI. Summary of Thirty-three Cases of Primary Excision at the Hip after Shot Injury. FIG. 50. Perforation of trochanter and fissur- ing of the shaft of left femur. Spec. 71. NO. NAME, AGE, AND MILITAKY DESCRIPTION. DATE OF INJUKY. NATLUE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AXD REMARKS. 1 Cannon, , Pt., A, 49th May 5, Conoidal ball comminuted left May 6, Head. neck, and upper extrem Recovered, February. 1865, short Georgia, age 24. 1864. femur one inch below trochan 1864. ity of shaft, through incision ening three inches ; limb useless ter major and lodged. in wound six inches long, by for locomotion. Died Novem Surg. J. J. Dement, P.A.C.S. ber 23, 1865, diphtheria. Circ. 2 Barber, F.M., Capt.,H, 16th Sept. 17, Shot shattering trochanters and Sept. 18. Head, neck, trochanters, and No. 2, pp. 26, 133. Surgical fever. Died September Connecticut, age 32. 1862. neck of right femur. 1862. tract, upper extremity, thro 20, 1862. Circ. 2, pp. 22, 133. straight incision four ins. long, by Surg. M. Storrs. 8th Conn. 3 Beard, C., Pt., 12th Missis Aug. 23, Conoidal ball fractured head Aug. 23, Head and femur, just above Died Aug. 25, 1864. Spec. 1410, sippi. 1804. and neck of right femur and 18o4. lesser troch., thro angular in A. M. M. Circ. 2, pp. 31, 134, lodged in acetabulum. cision, by Surg. A. A. White, and Circ. 6, p. 70. 8th Maryland. 4 Brown, E. T., Sergeant, C, July 23, Fragment of bomb fractured July 23, Head and broken extremity of Died July 27, 1864. Circ. 2, pp. 21st Massachusetts, age :!0. 1864. \ipper extremity of left femur, 1864. shaft, thro longitudinal in 30, 134. five inches. cision, by Surg. W.V.White, 57th Massachusetts. 5 Cole, R., Pt., B, 29th Con Oct. 27, Musket ball shattering upper Oct. 27, Head, neck, troohanters, and Died October 29, 1864. Circ. 2, necticut. 1864. extremity of right femur. 1864. portion of shaft by longitudinal pp. 33, 134. incision over troch. major, by Surg. C. M. Clark, 39th 111. 6 Coon, J., Pt., C, 60th Indiana, Jan. 11, Conoidal ball comminut g neck Jan. 11, Head and shaft below troch. Died January 21, 1863. Circ. 2, age 20. 1863. and upper part of shaft of 1863. minor, through semi -circular pp. 23, 133. right femur. incis n. by Surg. M. T. Carey, 48th Ohio. 7 1 Dempsey, B., Pt., Battery Feb. 25, Fragment of shell crushing Feb. 25, Head, neck, and shaft au inch Died February 28, 1864. Circ. 2, I, 4th Artillery. 1864. trochanters and neck of right 1864. below trochanter minor, thro pp. 25, 133. femur. longitudinal incis. five ins., by Surg. N. W. Abbott, 80th III 8 Epton, J. W., Pt., I, 5th S. Aug. 16, Conoidal musket ball wound of Prim ry. Head and neck of right femur. Died September 2, 1864. Circ. Carolina. 1864. right hip. 2, p. 120. 9 Goode, J. T., Pt., K, 6th July 31, Conoidal ball fracture upper July 31, Head.neck.and nearly one-third Died August 2, 18G4, from shock Virginia, age 21. 1864. extremity of left femur. 1864. of shaft, thro linear incision, of operation. Circ. 2, pp. 30, 134 . by Surg. G. S. West, C. S.A., and others. 1 AliliOTT (N. W.;, Cases of Resection, in Chicago Medical Examiner, 1864, Vol. V, p. 612. 100 INJURIES OF THE LOWEE EXTREMITIES. [CIIAV. X. NO. NAME, AGE, AND MILITARY DEBCKIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 10 1 Greely, T., Pt., C, 74th New Oct. 5, Round ball splintering neck of Oct. 6, Head and fragments of neck, Surgical fever, pyaemia. Died York, age 20. 1861. left femur into articulation. 1861. through incision seven inches Oct. 12, 1861. Circ. 6, p. 62, and long.sect. thro troch. inaj. and Circ. 2, pp. 21, 132. base of neck, by Ass t Surg. J. W. S. Gouley, U. S. A., and others. 11 Grimshaw, S., .Sergeant, H. Oct. 19, Fragm nt of shell shat ing head Oct. 19, Head and four and a half ins. Died November 5, 1864. Circ. 2, 6th N. Y. Cavalry, age 31. 1864. and neck of left femur, fissures 1864. of shaft, through straight in pp. 32, 134. extending four and a half ins. cision seven inches long, by in shaft, lodged in acetabul m. Surg. A. P. Clark, 6th New York Cavalry. 12 *Bobson, T.J., Pt., H, 32d June 24, Conoidal ball fract. neck and June 24, Head and shaft just below tro Reaction never complete. Died Tennessee, ago 23. 18G4. trochanters of femur, extend- 1864. chanters, through linear in June 27, 1864. Circ, 2, pp. 30, into capsular ligament. cision ten inches long, by 134. Surg. J.F. Grant, P. A.C S. 13 Johnston, 11. C.,.Pt., B, 56th June 17, Conoidal ball severing head June 17, Head and fragments, through Died August 16, 1864, from ex North Carolina, age 26. 1864. and portion trochanter major, 1864. curvilinear incision five ins. haustion, probably the result of right femur. long, roughened projection of shaft cut off, by Surg. C. H. caries and ill-judged diet. Circ. 2, pp. 29, 134. EVE (I. c., p. 263) . Ladd, 56th N. C. 14 McCulloch, J., Recruit, age Aug. 30, Shot shattering upper part of Aug. 30, Head, neck, and trochanters, Died August 30, 1861, four hours 35. 1861. femur. 1861. through vertical incision, bv after operation. Circ. 2, pp. Prof. G. C. Blackman. 20, 132. 15 McDonald, E. A., Pt., F, Aug. 20, Conoidal ball splintered neck Aug. 20, Head, fragments of neck, and Died September 4, 1864, of pyae 149th Pennsylvania, age 31. 1664. and lodged in head of right 1864. shaft, thro trochanteric ridge, mia. Circ. 6, p. 70, and Circ. femur. V-incision, by Surg. F. C. 2, pp. 30, 134. Reamer, 143d Penn. 16 McGuire, J. A., Lieut., I, May 12, Musket ball smashed trochant MavlS, Head, neck, and trochanters. Died May 15, 1864. Circ. 2, pp. 148th Pennsylvania. 1864. ers and neck of right femur. 1664. thro" longitudinal incision, by 28, 134. Surg. G.W. Snow, 35th Mass. 17 Mayo, G. W., Pt., B, 25th May 12, Conoidal ball fractured neck Mav 13. Head and shaft, five inches be Died May 15, 1864, from shock. Virginia Reserves. 1864. and shaft of right femur. 1864. low troch. minor, through Spec. 5498, A. M. M. Circ. 2, straight incision, by Surg. C. pp. 28 134. B. Gibson, P. A. C. S. 18 Melcar, I., Pt., A, 8th Mich Nov 16, Conoidal ball shattered head Nov. 16, Head and neck, thro incision Died December 2, 1863. Circ. 2, igan Cavalry, age 18. 1863. and upper part neck of left 1863. ten inches long, by Surg. J. pp. 25, 133. EVE (I. c., p. 257). femur. S. D. Cullen, C. S. A. 19 Morrison, C., Pt., C, 185th Mar. 29, Conoidal ball separated neck Mar. 29, Head and shaft, half inch be Haemorrhage. Died April 26, New York, age 21. 1863. from shaft of left femur and 1865. low trochanter minor, thro 1865, irritation and profuse sup track trochanter major, and longitudinal incis n, by Surg. puration. Circ. 2, pp. 33, 134. probably lodged in pelvis. W. Fuller, 1st Mich. 20 O Rourke, , Pt., 18th Mis May 6, Musket ball shattered neck of Mav 6, Head, neck, and shaft, through Did not react. Died May 9, 1864. sissippi, age 24. 1864. right femur and lodged. 1864. trochanters, curvilinear incis. Circ. 2, pp. 27, 133, and EVE four inches long, by Surg. J. (I. c., p. 257). T. Gilmore, C. S. A. 21 Pease, T. G., Pt., B, 117th Oct. 28, Musket ball shattered trochant Oct. 28, Upper extremity of femur, bv Died Oct. 29, 1864. Circ. 2, pp. New York. 1864. ers and neck of right femur 1864. Surg. N. Y. Leet, 76th Penn. 32, 134. and lodged in cotyloid cavity. 22 Phillips, J. J., Pt., G, 61st May 6, Conoidal ball, extensive longi May 7, Head and up. extremity, thro Died May 11. 1864. ftpec. 5499, Virginia. 1864. tudinal splintering of shaft of 1864. long vertical incis n, by Surg. A. M. M. Circ. 2, pp. 27, 133. right femur. C. B. Gibson, C. S. A. 23 Raines, C., Pt., E, 25th N. June 2, Conoidal ball, extensive com June 2, Head, neck, trochanter major, Died June 4, 1864, exhaustion. - Carolina, age 23. 1864. minution of shaft and upper 1864. and three and a half ins. of portion of right femur within shaft, thro longitudinal incis the capsule. ion six inches long, by Surg. 1. M. Clark, 39th 111. 24 Robeson, T. R., Capt., 2d July 3, Conoidal ball shattered head July 3, Head, neck, and shaft just be Didnotrally. Died July 3, 1863. Massachusetts, age 24. 1863. and neck of right femur, frac 1863. low trochanters, thro incis n Circ. 2, pp. 25, 133. tured the pelvis, and pene six inches long, by Surg. J. trated its cavity. McNulty, U. S. V. 25 Talman. J. M., Sergeant, H, May 14, Conoidal ball comminuted head May 15, Head, neck, and shaft, two and Died May 19. 1863. Circ. 6, p. 18th Wisconsin, age 30. 1863. and neck of left femur, and 1863. a half inches below lesser 66, and Circ. 2, pp. 24, 133. lodged in neck ; fissures ex trochanter, curved incision, tending down shaft. by Surgeon H. S. Hewit, U. S. V. 26 Unknown, Pt., 1st Army Sept. 17, Fragment of shell comminut g Sept. 17, Head and neck, thro vertical Survived the operation ten hours. Corps (a Frenchman). 1862. upper extremity of left femur, 1862. incision six inches long, by Circ. 2, pp. 22, 133. lesions extending into pelvis. Surg. J. McNulty, U. S. V. 27 Unknown, Pt., First Army Aug. 30, Conoidal ball fractured the left Aug. 30, Head and shaft, at junct n with Died August 31, 1862, from shock Corps. 1863. femur at junction of head and 1862. neck, vertical incision six ins. of injury and operation. Circ. neck, pen. pelvic cavity. long, by Surg. J. McNulty, 2, pp. 22, 132. U. S. V. 28 Unknown, Pt., General R. Aug. 28, Conoidal ball splintering neck Aug. 28, Head and shaft, about two ins. Patient fell into the hands of the King s division, First Army 1862. and trochanters of left femur, 1862. below trochanter minor, vert enemy, probably survived but Corps. and pen. pelvic cavity. ical incision, by Surgeon P. a short time. Spec. 71, A.M . M. Pineo, U. S. V. Phot. Ser., Vol. 1, p. 13, S. G. O. Circ. 6, p. 62; Circ. 2, pp. 21, 132. 29 Unknown, Pt., Fifth Army May 10, Musket ball fracturing trochan- May 10, Head, neck, and trochanters. . . Died May 13, 1864. Circ. 2, pp. Corps. 1864. teric portion of left femur. 1864. 28, 133. 30. Unknown, Pt., Eighteenth June 3, Fragment of shell comminuted June 3, Head, neck, and trochanters. . . Died June 6, 1864. Circ. 2, pp. Army Corps. 1864. trochanter major and neck of 1864. 29, 134. right femur. 31 Unknown, Pt., C. S. A Dec. 13, Fragment of shell fractured Dec. 13, Head. neck, and trochanters, by Died two or three days after 1862. trochanter major and neck of 1802. Surg. II. McGuire, P.A. C. S. operation, from shock. Circ. 2, right femur. pp. 23, 133. 32 Unknown, Pt., Swell s Corps. May 5, Conoidal ball fractured neck of Mav 5, Head and shat d fragments of Died May 22, 1864, pyipmia. Circ. 1864. left femur, lodging. 1864. neck and shaft, longitudinal 2, pp. 26, 133. incis n, bvSurg. II. McGuire, P. A. C. S. 33 Unknown, Pt., Kershaw s May 3, Musket ball shattered neck of May 4. Head and neck, by Surgeon Died May 6, 1863. Circ. 2. pp. S. C. Brigade. 1863. femur. 1863. James, 16th South Carolina. 24, 133, and EVE (I. c., p. 2o7). CALHOUN (J. T.), Army Correspondence, in Med. and Surg. Reporter, 1862, Vol. VIII, p. 76. 2 EVE (P. F.), Contribution to the History of the Hip Joint Operations, etc.. rn Trans, of Am. Med. Ass., 1867. Vol. XVIII, p. 261. SECT. II.J EXCISION AT THE HIP AFTEK SHOT Ii\ T TURY. 101 Of the thirty-three primary excisions at the hip seventeen were on the right side, thirteen on the left, and in three cases the side of the injury was not indicated. In twenty-two instances the straight, vertical longitudinal or linear incision, as variously termed by the different operators, was employed; in four instances the curvilinear; in one the V-shaped, and, in six cases the mode of incision was not indicated. In five instances the missile, either whole or in part, was excised with the injured bone. Intermediary Excisions. Of twenty-two excisions classified as intermediary, two resulted successfully, a mortality rate of 90.9. Sixteen* of the operations were practised on Union and six on Confederate soldiers. The shortest interval between the dates of reception of injury and operation was two days, the longest twenty-eight, the average interval being about thirteen days. Details of the two successful intermediary excisions will be first noticed : CASE 239. Lieutenant James M. Jarrett, Co. C, 15th North Carolina, a spare man ; 28 years of age, of medium size, of fair complexion, of temperate habits, and good general health, was wounded at the affair at Bristow Station, Virginia, October 14, 1863, by a conoidal musket ball, which entered in front and a little to the outside of the median line of the left thigh, two inches below Poupart s ligament, shattered the femur, and made its exit posteriorly at the outer part of the limb, the wound of exit being on a rather higher level than that of entrance. The fracture was dressed with a straight splint, and the wounded officer was placed in an ambulance wagon and transported over rough roads to Richmond, a distance of one hundred and sixty miles. On October 20th, he. was admitted to hospital No. 4, at Richmond, in an exhausted state, and was placed in charge of Surgeon James B. Read, P. A. C. S. He complained of extreme pain upon any movement of the limb, and was unwilling to submit to an examination of the injury unless insensibility was induced. Chloroform having been administered, the splints and soiled bandages were removed, and the limb was placed in an easy position on pillows. Water dressings were applied to the wounds, and an opiate was administered. For the next three weeks, the progress of the case was very unfavorable. The wound of exit discharged copiously unwhole some thin pus, mixed with blood and bubbles of fetid gas and small bits of dead bone. The pulse was quick and small, the tongue red and dry. There was a tendency to diarrhoea, and night sweats frequently recurred. On November 9th, as the patient was steadily growing worse, a" consultation was asked for, and Surgeons C. B. Gibson and M. Michel saw the case with Dr. Read. It was decided that the circumstances called for operative interference, and that an excision of the head of the femur offered the best prospect of recovery. On November 9th the patient was anaesthetized, and then placed on his right side on the operating table. A straight incision was commenced two inches below the posterior or exit wound, and was carried through this to the great trochanter, and thence upward for two inches further, thus making a wound about seven inches in length. This incision being earned down to the bone, the upper end of the shaft of the femur was examined and was found to be jagged and pointed, thin layers of bone about three inches long being broken off from its anterior aspect. The lower fragment was projected through the incision by adducting the limb and pushing the knee upward, and it was sawn about two inches below its upper sharp extremity. The trochanteric portion of the femur was then sought for, and was found drawn upward by the psoas and iliacus internus. Its extremity was seized by the lion forceps and drawn downward, and the attachments of these muscles to the lesser trochanter were divided. To luxate the head of the femur so as to admit of the division of the round ligament was a work of great difficulty. It was finally accomplished, partially by twisting the neck of the bone, and the head was exarticulated. The appearance of the principal portion of this excised bone is shown in the annexed wood-cut (FiG. 51). Several large detached fragments and splinters were then extracted, and other closely attached bits of bone were enucleated by the finger-nail. The wound was cleansed and then closed by sutures and adhesive strips. Dry dressings were applied, and the thigh was fixed by a large straight splint. The patient was ordered two grains of opium and a drachm and a quarter of brandy every two hours. At bed-time the patient was quite comfortable, and could shift his position slightly without pain; his pulse was 120. On the following day, anodynes were given at greater inter vals. On November llth, they were omitted, except at bed-time, and nutritious diet was ordered. The next day the sutures were removed ; the wound began to discharge laudable pus in small quantity. The case progressed without any untoward complication. On December 9th the wound was healed, except at two points, connected by sinuses leading to the cotyloid cavity and the upper end of the shaft. The patient had gained flesh and strength; his pulse was full and strong at 76; his FIG. 51. Shattered upper portion of the left femur. [From a wood cut after READ.] FIG. 52. Appearance of limb seven months after operation. [From a photograph.] 102 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X appotito and digestion were natural; he slept well, was cheerful, and did not complain of pain. The limb was shortened five inches. The daily discharge of pus was less than half an ounce. Two weeks subsequently the wound was entirely united; the cicatrix was firm ; the patient could move about his bed without inconvenience ; there was no pain on pressure about the muscles of the injured part. The patient was now removed to his home in North Carolina, and was soon able to move about on crutches. In September, 1864, ten months after the operation, he reported that he was able to bear considerable weight on the limb, and that he had discarded his crutches and walked about in a high-heeled boot with the aid of a cane. The appearance of the patient, seven months after the operation, is exhibited in the wood-cut on the preceding page (FlG. 52). copied from a photo graph presented to the compiler by Assistant Surgeon Latimer, C. S. A. CASE 240. Private Hugh Wright, Co. G, 87th New York, aged 28 years, a robust, healthy man, was wounded on May 5, 1864, at the battle of the Wilderness, by a conoidal musket ball, which entered the right thigh an inch within the track of the femoral vessels and two inches below Poupar^ s ligament, passed backward and outward, shattering the neck and trochanters of the femur, and, having been greatly flattened and distorted by the impact, it lodged amid the fragments of bone. The precise direction of the fracture is indicated in the accompanying wood-cut (FlG. 54). 1 He stated that after being wounded, he was carried to the rear by a number of his companions, and, in the evening, was taken to the field hospital of the 2d division of the Second Corps. Here he remained for three days. He was then sent in an ambulance wagon to Fredericks- burg, and placed in a temporary hospital. He stated that his wound was repeatedly examined by different surgeons, but that no treatment was instituted beyond the applica tion of a compress dipped in cold water to the wound. He was transferred, after a fort night, on a hospital steamer, to Washington, and on May 25th he was admitted to Stanton Hospital, then under the charge of Surgeon B. B. Wilson, U. S. V. He was placed in Ward 6, under the care of Acting Assistant Surgeon J. B. Garland, who communicated a special report of the case. The injured limb was swollen, everted, and shortened. Pus had accumulated in the tissues about the hip. Notwithstanding the gravity of the injury, the patient s constitutional condition is said to have been hopeful. On exploring the wound with the finger, the patient "being under the influence of chloroform, detached fragments of bone could be felt. On consultation with Acting Assistant Surgeon George A. Mursick, 2 an operation was decided upon, for the purpose of removing these loose fragments, and the missile, if it could be found. On May 2?th, the patient was rendered insensible by sulphuric ether, and Dr. Mursick, assisted by Dr. Garland and others, made a straight incision, commencing above and behind the trochanter major and carried downward in the axis of the thigh. It was not in contemplation, at the beginning of the operation, Dr. Garland states, to exarticulate the head of the femur; but when the muscular attachments were divided, and the full extent of the frac ture was revealed, and the joint was found distended with pus, it was at once determined to make a formal excision. The fragments of the neck were extracted piecemeal. The ball was found lying behind the neck, and was exti-acted. The capsular ligament being freely incised, a bistoury was inserted into the cotyloid cavity and the round ligament was severed, and the head of the femur was removed without difficulty. The jagged upper extremity of the shaft of the femur was then turned out of the wound by carrying the limb over the opposite knee, and was smoothed off by a chain saw. There was but trifling haemorrhage, and no ligatures were required. The wound was carefully cleansed, dressed with dry lint, and left to heal by granulation. To keep the limb in position, long sand bags were laid on either side of it, and moderate extension was made by means of a weight attached to the leg and suspended from the foot of the bed. At night he took a grain of sulphate of morphia in a draught. The operation seemed to depress him very much, and reaction was slow. He passed a restless night, manifesting much nervous excitement. In the morning his pulse was feeble and frequent; his tongue dry and furred. He was ordered an ounce of brandy every three hours, a grain of opium every four hours, and as much beef tea and concentrated nourishment as he could take. On May 29th his general condition had much improved; the pulse was less frequent and stronger. There was free suppuration. The wound was dressed with a weak solution of permanganate of potassa. On June 1st he continued to improve, the wound looked well, and the character of the suppuration was good. The amount of brandy was reduced to four ounces daily. On August 1st he was still doing well. The wound was filled up with granulations from the bottom, with the exception of a sinus leading to the bone. It continued to suppurate quite freely, and some small pieces of dead bone had come away with the discharges. He had gained in flesh, and his health and spirits were good. On August 22d, he attempted, for the first time, to sit up in bed, but, owing to the rigidity of the parts and the agglutination of the muscles, the pain caused by the sitting posture was so severe that he was compelled to lie down again. Cold evaporating lotions were applied to the thigh. On August 23d the upper part of the thigh swelled and was painful, and the discharge was increased in quantity. On August 27th the swelling of the thigh had increased, the discharge from the wound was very free, thin, and flaky, and the surrounding surface was glazed and doughy to the touch. The wound of entrance had re-opened and discharged thin pus. An abscess formed on the inner side of the thigh, and about four ounces of thin flaky 1 An anterior view of this specimen is printed in the surgical report in Circular Xo. G, S. G. O., 1865, p. 74, and in the Catalogue of the Surgica Section of the Arm;/ Metl. Museum, 1866. p. 24G. 2 MUUSICK (G. A.), A successful Case of Excision of the Head of the Femur for Gunshot Fracture, in New York Med. Jour., 1865, Vol. I, p. 424. See also Circular Xo. G, S. G. O., 1865, p. 68, Circular Xo. 2, S. G. O., 18G9, pp. 41, 135, Photographic Series, A. M. M., Vol. IV, p. 38. FIG. 53. Appearance of limb two years and five months after operation. [From a photograph.] FlG. 54. Shot commi nution of neck and tro chanters of right femur. Spec. 3375. SECT, ii.] EXCISION AT THE HIP FOR SHOT INJURY. 103 pus was discharged. The patient was restless. He was ordered twenty drops of the tincture of the sesquichloride of iron every six hours, with stimulants and nutritious diet. On September 1st the swelling and inflammation of the thigh continued. He complained of nausea and want of appetite. An abscess formed on the outer side of the thigh. On September 5th the abscess was incised, and a large quantity of thin, flaky, and offensive pus was evacuated. He had an irritable stomach, and Hoffman s anodyne was administered. On September Gth the edges of the incision in the abscess were beginning to slough, and nitric acid was freely applied. On September 9th he had diarrhoea; ten grains of subnitrate of bismuth and a grain of opium were given every six hours. On September 13th the diarrhoea had nearly ceased. The patient s general condition had improved, and the wound looked well, though the suppuration was still copious, and had improved in quality. On September 25th a large ring-shaped exfoliation from the upper end of the femur was removed through the wound of operation. On September 26th another exfoliation was removed. On October Gth, 1864, Private Wright was discharged from the military service on account of the expiration of his enlistment. On October 7th the swelling of the thigh had subsided; the discharge from the wounds had much diminished in quantity, and presented the appearance of laudable pus; the diarrhoea had ceased, and his general condition was much improved, he being able to sit up in bed. On October 30th. a sinus communicating with necrosed bone opened on the outside of the thigh. In the latter part of December, another abscess formed on the outer side of the thigh. When this was opened the swelling and inflammation subsided. He continued to do well until February 6, 1865, when another abscess formed in the lower third of the thigh, on the outer side. This was incised and the pus evacuated. Several pieces of dead bone came away with the discharges from the wound of operation. About the middle of March, 1865, he was able to get out of bed, and to walk about the ward on crutches. Soon after, in getting out of bed, "he let his leg fall and hurt it." This accident was followed by inflammation and swelling of the thigh, and an abscess in the lower third of it, on the inner side. This was incised, and a small quantity of pus was evacuated. He was now attacked with erysipelas, which extended from the knee to the hip. This was combated with tonics and stimulants, such as iron and quinine, and rapidly disappeared. From this time he did well, taking daily exercise about the hospital on crutches. On April 17th, he was transferred to the Ward Hospital, at Newark, New Jersey. His general health was tolerably good. He could not bear much weight on his limb, and inflamma tion and abscesses followed any unusual exertion. He remained at this hospital until May 6, 1865, when it was reported that he "eloped." As a discharged soldier, he was no longer under military authority, and was at liberty to go. For many months, though diligent inquiries were made, he could not be traced; but, in July, 1866, Surgeon General L. W. Oakley, of New Jersey, transmitted a letter from Dr. W. Pierson, of Orange, New Jersey, which stated that Wright had entered the almshouse at that place in June, 1865, and had remained there until the following spring, under Dr. Pierson s professional care. At first, the mutilated limb had been enormously swollen from oedema, and there was an ichorous discharge from a sinus near the hip joint. With careful bandaging, tile oedema gradually disappeared. In the spring of 1866, Wright left the almshouse, and engaged himself as a laborer on a farm. He wore, Dr. Pierson reported, a cork-soled shoe of his own manufacture. The limb was shortened precisely five inches. The circumference of the injured thigh at the highest part was one inch less than that of its fellow. He walked well without crutch or cane, bearing his full weight on the mutilated limb. There was quite free motion at the hip, but little at the knee. There were no open iistules, and no tenderness about any of the cicatrices. Dr. Stephen Wickes, of Orange, reported, in the summer of 1866, that Wright was in good health, though somewhat intemperate; that he worked daily at light tasks, and was even able to mow grass. He commonly walked with a cane. According to the measurement of Dr. Wickes, the limb was shortened four and tln-ee-quarter inches. About this period, Dr. Mursick, the operator in the case, discovered his former patient, and examined him. He found the resected end of the femur firmly attached to the pelvis by ligamentous tissue an inch and a half long. The agglutination of the muscular sheaths had nearly disappeared. The limb was quite under control. The man could Hex and extend it slightly, and adduct to a limited extent; the power of rotating and abducting was lost. Motion at the knee was quite restricted, on account of the thickening and consolidation of the surrounding tissues resulting from inflammation. He stated that latterly the improvement in his limb had been very decided; that when he first commenced to walk, the limb felt like a weight attached to the body; this sensation had entirely disappeared. January 15, 1837, Hugh Wright was found duly established at his residence in North Orange, Essex, New Jersey, receiving a pension dating from October, 1864, the date of his injury. The Pension Examiner, Dr. A. W. Woodhull, of Newark, reported "that at that date there was about six inches shortening, with no power of flexion or extension at the hip and the power of rotation to a very limited degree. All motion of the injured limb for progression was imparted by lateral swing of the body itself. I may add that the knee joint of the injured limb is stiffened." On October 19, 1867, Dr. Mursick again examined Wright, and took him to New York, and had his photograph taken. The negative is preserved at the Army Medical Museum, and is No. 183 of the Surgical Series of Photographs, a reduced copy of the lower limbs as shown, in the photograph, is presented in the wood-cut (FlG. 53). At this period, Wright reported that his limb had given him no trouble since the sinuses healed, in May/ 1865, and that it sufficed for all purposes of locomotion. He stood on it very firmly, and could move it in any direction with an easy, swinging motion. He had been engaged for a year and a half as a farm hand, and was employed at that time as a wood-chopper. He had for a short time earned larger wages as a hod bearer, and had climbed high ladders with a heavy hod of bricks on his shoulders ; but he found this avocation too fatiguing. His general health and physical condition were good. The knee joint continued quite stiff. It could be flexed to about quarter, perhaps, of the normal extent. When he walked, the rounded upper extremity of the femur played up and down on the dorsum of the ilium over a space of an inch and a half. In November, 1888, Dr. Mursick again examined Wright, and reported on his condition. The utility of his limb had augmented during the twelve months that had elapsed since the last examination. The attachment of the femur to the pelvis was strong; the cicatrices were firm and healthy. All the movements of the thigh were performed with almost as much facility as in the normal state; rotation, even, as well as flexion, extension, adduction, and abduction. His general health was good. On August 3, 1872, Wright s pension was increased to $18 per month on account of increasing disability and because additional legislation permitted larger payment to the more gravely mutilated. In September, 1873, Pension Examiner A. W. Woodhull reported the local disability unchanged, and, on October 26, 1874, the sudden death of the pensioner, Hugh Wright, from supposed cardiac disease was reported. Unfortunately no autopsy was made and the valuable opportunity of examining the relations of the resected joint was unimproved. 104 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. In the twenty unsuccessful intermediary excisions the average duration of life after operation was twelve and a half days. One patient (CASE 248) survived seventy-five days, and apparently succumbed to climatic influences rather than to the effects of the injury and operation; another (CASE 251) died at the end of three weeks with colliquative diarrhoea and malarial complications. Four cases where the lesions seemed to indicate the operation, made little or no recuperative effort, and form the first category. The first was a solitary instance of fracture by a shell fragment: CASE 241. Private Cornelius Callaghan, Co. G, 2d Delaware, was wounded in the left hip by a fragment of shell, at the battle of Antietam, September 17, 1862. On September 19th, he was admitted to hospital No. 3, at Frederick, Maryland". He was placed under the influence of chloroform, and an examination of the wound was made by Assistant Surgeons Bill and Colton, U. S. A. The wound being enlarged sufficiently to admit of free exploration, the trochanteric region of the femur was found to be badly comminuted, the great trochanter entirely detached and drawn backward by the action of the glutens, while fissures extended up the neck within the capsular ligament. No fissures extended below the trochanter minor. The patient s general condition was good, and all the circumstances being favorable to such an attempt, it was determined, in a consultation of the medical staff, and with the approval of Medical Inspector Coolidge and Surgeon Milhau, U. S. A., that the injured portions of bone should be excised. On September 29th, Assistant Surgeon J. H. Bill made an incision from the wound three inches downward in the course of the shaft, and another three inches long curving upward and inward from the wound to a point a little below the anterior superior spinous process of the ilium. The muscular attachments being dissected aside, a chain saw was passed around the shaft of the femur and made to divide it just below the trochanter minor. The head of the bone was then disarticu lated. The edges of the wound were united by six sutures, and adhesive plasters and water dressings were applied. The limb was kept in position by pillows, without the use of splints. A full dose of morphia was given, and light but nourishing food was directed. On the following day the patient was quite com- FiG.55. Neck and tro- f or t a ble. His pulse, which was 100 before the operation, now beat 120. He was ordered a diet of beef chanters of right femur shattered by a fragment tea, eggs, and oysters, with a small amount of wine. At midnight he was sleeping quietly. On October Spec 840 Sec I A^oi 1 st ^ ie was st ^ cheerful. His pulse was very compressible at 120, and he was sweating profusely. The thigh was swollen and painful. A draught of aromatic sulphuric acid with a little quiuia was added to his prescriptions, and the allowance of wine was increased. The prognosis was now very unfavorable. On October 2d the sweating was checked, but diarrhoea had supervened. The pulse was still softer and more frequent, and suppuration had commenced. At midnight the patient was attacked with vomiting and hiccough. On October 3d the vomiting persisted, and the sweating was renewed. This state continued through the day and night, the patient sinking gradually. He died at 3 o clock P. M. of October 4, 1832. The pathological preparation is deposited in the Army Medical Museum, and is numbered 840 of the Surgical Section. An anterior view of it is presented at page 247 of the Catalogue of the Surgical Section, and a posterior view in the accompanying wood-cut (FiG. 55). CASE 242. Private D. M. Noe, Co. C, 4Gth Ohio, aged 22 years, was wounded at the battle of Shiloh, Tennessee, April 6, 1852, by a conoidal musket ball, which shattered the neck of the left femur. The patient was placed on board the hospital transport steamer Lancaster, under the charge of Surgeon George C. Blackman, U. S. V. On April 16, 1862, chloroform having been administered, Dr. Blackman made a longitudinal incision four inches in length over the trochanter, and excised the head, neck, and trochanters, together with three inches of the shaft of the femur, the diaphysis being divided by a common amputa ting saw. The patient reacted well after the operation, and for five days the symploms progressed favorably. Pyasmia was subsequently developed, and death ensued on April 24, 1862, eight days after the operation. CASE 243. Private Marsella Smith, Co. F, 38th Virginia, a robust middle-aged man, was wounded near Spottsylvania, early in the morning of May 10, 18G4, by a conoidal musket ball, which entered at the upper posterior part of the left thigh, passed through the perinscum without injuring the urethra, and through the soft parts of the right hip. He was sent to Rich mond by rail, and was admitted to hospital No. 9, otherwise known as the Receiving and Wayside Hospital, on the following morning. On May 12th he was placed under chloroform and the wound was thoroughly explored. The limb was everted and shortened and swollen; there was crepitus on rotation. The fracture appeared to be limited to the great trochanter and neck. It was supposed that the urethra was divided; but this was afterwards proved not to be the case. Surgeon Charles Bell Gibson, C. S. A., decided to excise the injured bone, and the operation was performed forty-eight hours after the reception of the injury, the head, neck, and two inches of the shaft being removed. It is stated that the effects of the chloroform were unfavorable. On the following day "patient commenced sinking at an early hour, and continued growing FIG. 53. Oblique more and more feeble until 3 o clock P M., when death ended his sufferings," May 13, 18G4. The excised upper^irTion of sMft portion of the femur was preserved by Dr. Richardson, and has been presented by him to the Army Medical of left femur. Speg. Museum. It is represented in the accompanying drawing (FiG. 5G), and shows that the injury to the bone 5500. Sect. I, A.M.M. , . ., , . . was altogether external to the hip joint. CASE 244. A soldier of General Buell s army was wounded in a picket skirmish, about seven miles from Nashville, in March, 1832, by a conoidal musket ball, which shattered the neck and trochanters of the femur. He was immediately conveyed to Nashville, and placed in the College Hospital, under the care of Surgeon A. H. Thnrston, U. S. V. Surgeon M. Goldsmith, U. S. V., saw him in two days after the reception of the injury, and deemed the case peculiarly well adapted for the operation of excision. The surgeon in charge concurring in this opinion, the patient was anesthetized, and Dr. Thurston proceeded to excise the head and splintered upper extremity of the femur, through a long straight incision. The operation was accom- SECT. n.j EXCISION AT THE HFP AFTER SHOT INJURY. 105 plished with but little haemorrhage, and although the patient was much prostrated by the shock of the injury and of the opera tion, he reacted and was in a comfortable condition for several days. But surgical fever and suppuration soon set in, and he gradually sank, and died one week after the operation. There can be little doubt that the subject of this operation was Corporal Henry F. Smith, Co. B, 1st Wisconsin, who, according to the records of the Nashville Hospital, was admitted for a gunshot wound of the hip, and was the only patient who died from wounds in Dr. Thurston s wards, at the period referred to. 1 Corporal Smith died on March 15, 1832. The operation was probably done on March 10th. 2 In the second category of intermediary excisions are grouped eight cases well adapted from the local lesions for the operation in which all the patients made a struggle for .recovery, and two survived respectively five and eleven weeks: CASE 245. Private T. C. Christopher, Co. D, 18th South Carolina, aged 21 years, a robust man, was wounded at Williamsburg, Virginia, May 5, 1832, by a conoidal musket ball, which entered about two inches below and behind the left trochanter major, and passed forward, upward, and inward. He was stooping at the time he received the injury. He was made prisoner, and sent to York River, and thence on a hospital steamer to Washington, and placed in Cliffburne Hospital, May 17th. His pulse was 100, and he complained of severe pain in the hip and knee. The tissues about the hip were much swollen ; the limb was everted, and shortened one and a half inches. The opening made by the bullet was very small, and discharged a thin sanious pus. There was no orifice of exit. The patient was etherized, and careful exploration of the wound revealed a fracture of the inner portion of the neck and probably of the head of the femur. It was decided that excision should be performed, and the patient was placed upon a soothing and supporting regimen preparatory to the operation. May 20th, Assistant Surgeon J. S. Billings, U. S. A., made a curvilinear incision, four inches in length, one inch behind the great trochanter, that revealed the condition of the parts. Fragments of the inner extremity of the neck were removed piecemeal. The head was then removed from the cotyloid cavity, except a small fragment which was extracted from an iutermuscular space. The ball was now discovered lying in the obturator externus muscle, and extracted. Little blood was lost, and reaction took place. Water dressing was applied, and a grain of sulphate of morphia administered. Eversion of the foot was corrected by fastening the limb by straps of adhesive plaster to an upright piece of wood screwed to the foot of the bedstead, and, the latter being raised, adequate extension and counter-extension were secured. On May 21st, the patient reported a comfortable night, but now had a very irritable stomach, with frequent vomiting. His skin was cool and clammy ; his pulse small and feeble at 115. He was ordered aromatic spirits of ammonia in small doses, brand} , egg-nog, and beef essence, with sinapisms to the epigastrium. On May 23d, the irritability of the stomach had subsided. The j,-. IG 57 Transverse shot fracture of the patient was weaker; stimulants and concentrated nourishment were given. On May anatomical neck of the left femur, with caries. 24th, the patient rapidly grew weaker. Capillary haemorrhage took place from the surfaces of the incision, but was readily checked by the application of a solution of persulphate of iron. Enemata of beef essence and brandy were administered, and these articles also by the mouth. The patient sank rapidly, and died May 24th, five days after the operation. At the autopsy, twelve hours after death, the soft parts about the seat of injury were found dark in color and softened. The acetabulum was eroded. A clot of blood of three ounces was found between the peritoneum and iliacus externus muscle. The innominatum and superior portion of the femur were removed, and, together with the excised fragments, forwai ded to the Army Medical Museum, and numbered 19 of the Surgical Section, having been mounted among its earliest specimens, and it is represented in the wood-cut (FlG. 57). (Circ. 6, S. G. O., 1865, p. 62, and Circ. 2, S. G. O., 1869, pp. 35, 135.) CASE 24G. Private T. E. Foulke, Co. D, 2d Alabama, aged 17 years, was wounded and captured at Fort Blakely, Alabama, April 9, 18G5. A conoidal musket ball entered posteriorly at the middle third of the left thigh, fractured the upper third of the femur, including the trochanters and neck, and was removed from above the anterior supei ior spinous process of the left ilium. The patient was then transferred to New Orleans, and, on April 15th, he was admitted to the St. Louis Hospital. On admission he was very much exhausted by profuse suppuration, the soft parts about the hip-joint being filled with unhealthy pus. On April 27th Surgeon A. McMahon, U. S V., excised the head, neck, trochanters, and two inches of the shaft of the left femur, the patient being under the influence of chloroform. He was placed on nourishing diet, with two bottles of porter daily, eggs, beef tea, and everything he desired. On May 2f>th he was transferred to the Marine Hospital at New Orleans. He was then doing well; but he gradually failed, and died June 5, 1835, of exhaustion, thirty-nine days after the operation. CASE 247. Private Charles E. Marston, Co. F, 1st Massachusetts, aged 19 years, a pale and delicate boy, was wounded at the second battle of Bull Run, August 30, 1832. He was admitted to the College Hospital, Georgetown, D. C., on Septem ber Gth, having laid on the battle-field several days, and then moved in an ambulance wagon thirty miles over very rough roads. An examination revealed a large bullet wound an inch anterior to and on a line with the right trochanter major, with great comminution of the head and neck of the femur. The limb was shortened, and the foot was everted. The circumference of the 1 The above account has been submitted to Dr. M. GOLDSMITH, who states that ho thinks that the identification of the case is complete. Surgeon TnunsTOX died during the war. 2 The report of the Adjutant General of Wisconsin for 18C5, p. 33, states that on March 8, 18G2, five companies of the 1st Wisconsin Volunteers were sent out beyond Nashville on picket duty. They were attacked by a cavalry force, and Private Willett Greenly was killed" the first Union soldier killed in Tennessee" while Corporal H. F. Smith and one other were wounded, and were sent to Nashville. SURG. Ill 14 106 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 58. Shot commi- limb exceeded that of its fellow by half. The pulse was 11-2, and of moderate volume. The tongue was rather dry. The patient suffered little pain. The general condition was not promising, and yet not very bad. Excision of the fractured bone was decided upon, and, on the 27th of September, Assistant Surgeon B. A. Clements, U. S. A., assisted by Assistant Surgeon Charles H. Alden, U. S. A., and the surgical staff of the hospital, proceeded to perform the operation. Chloroform was administered, and a slightly curved incision five inches in length was made on the outside of the thigh, the shot hole in the middle of the incision, and the trochanters and neck were thus exposed. The neck was crushed into about forty fragments, which were extracted. The head was also much broken, and the round ligament was absorbed or destroyed, so that exarticula- tion was easy. The roughened portion of the neck, at its attachment with the trochantcr, was sawn off with a small chain saw. The missile, a conoidal musket ball, was found on the inner side of the thigh at the bottom of a large cavity, and was removed with difficulty. After thoroughly syringing the wound and removing the pow dered bone, the wound was closed by silver sutures, except at the bullet hole, and sand bags were placed to keep the limb in position. Slight extension was made by a weight to the foot. The patient expressed himself as relieved by the operation, and he slept well that night. On the following day his pulse had risen to 128, and the discharge from the wound was very copious, thin, and brown. On September 29th, his pulse was still quick and feeble, and his tongue dry, and, though he took nourishment well, and was free from distress, he gradually sank. He died on September 30, 1862, at half past 8 o clock A. M., three days after the operation. At the autopsy, on October 1st, made by Acting Assistant Surgeon G. K. Smith, the wound made by the operation was found to be filled with very offensive pus. The upper end of the shaft of the femur was found to be diseased on its posterior surface near the trochanter minor, and the nation of head ami neck periosteum was loosened from the bone for some distance above and below this point. The fracture of the ischium, which was noticed at the operation, extended obliquely upward and backward from the lower border of the acetabulum, terminating in the sciatic notch, about an inch and a quarter above the spine of the ischium. The lower half of the acetabulum had been broken into several fragments, which were held in position by the cotyloid ligament. The excised portions of the femur were forwarded to the Army Medical Museum, and are numbered 328 in the Surgical Section. They are represented in the adjoining wood-cut (FlG. 58). CASE 248. Private John Miller, Co. E, lG2d New York, aged about 38 years, a robust, phlegmatic German, in good health, was wounded on June 14, 1833, in the assault on Port Hudson, Louisiana, by a conoidal musket ball, which passed through the upper portion of the thigh, breaking the neck of the left femur transversely, and splitting it longitudinally, but without great comminution. The pelvis was uninjured, and there was no serious damage to the soft tissues. The patient was conveyed to New Orleans on a hospital transport, and was placed in the St. Louis Hospital, on June 16th. It was determined that excision of the injured bone was advisable, and the officer in charge of the hospital, Surgeon F. Bacon, U. S. V., being confined to his bed by illness, the operation was performed on July 8th, by Assistant Surgeon George W. A very, 9th Connecticut. The head, neck, and great trochanter were removed in the usual way, through a single straight incision of moderate extent over the trochanter and in a line with the axis of the femur. There was an immaterial loss of blood. The state of the tissues involved and the constitutional condition of the patient were as good as might be. Dr. Bacon remarked that the operation was well and rapidly performed. The patient rallied from it promptly, and afterwards received the most assiduous care. His progress was very favorable until the early part of September. The wound had nearly healed, and Surgeon Bacon and his assistants were very hopeful of the patient s recovery. But in September the weather became most oppressively hot, and the patient steadily declined. The wound assumed a bad appearance, discharging copiously, and despite sustaining measures, the patient sank and died from exhaustion on September 21, 1832, seventy-five days after the operation. Dr. Bacon examined the fragments of bone removed, and found the periosteum adherent throughout the larger pieces. CASE 249. Private Henry Phillips, Co. I, 146th New York, a robust man, aged 34 years, was wounded at the South Side Railroad, near Petersburg, on April 1, 1835, by a conoidal musket ball, which entered the left thigh and lodged against the anterior surface of the neck of the femur. The patient was conveyed to the field hospital of the 2d division of the Fifth Corps, and thence by ambulance and rail to City Point, where he arrived on April 4th, and was transferred by steamer to Washington, and, on April 6th, was admitted into Douglas Hospital. He was much exhausted and had considerable fever, though in frequency the pulse and respiration were nearly normal. The wound was painful, and the beginning of its grave constitutional aspect was becoming man ifest. There was no shortening or deformity of the limb. At a preliminary exploration the ball was found impacted near the anatomical neck, and was extracted. The limited nature of the fracture was also ascertained, and excision was decided on. On April 8th the patient was placed under the influence of ether, and Assistant Surgeon William F. Norris, U. S. A., excised the head, neck, and trochanter major through a curved incision six or seven inches in length with its convexity forward. About twelve or sixteen ounces of blood were lost during the operation. One small artery required a ligature. The ball had crushed in the laminated structure of the anterior face of the neck, and from this cup-shnped cavity a small fissure ran up the articular surfr.ee and a deep fissure nearly around the neck; but the separation between the head and neck was incomplete. During the opera tion this fracture was converted into a complete one in rotating the bone to facilitate the exarticulation. The operation concluded, the limb was supported by pillows, and the patient was ordered beef tea and milk punch every three hours, and a full dose of opium at midnight. He had another dose of laudanum at four o clock the next morning. On the 9th, 10th, and llth. there was little pain, and anodynes were not required, but concentrated nourishment and stimulants were assiduously administered. It was thought the nurse exceeded his instructions in the amount of whiskey given, for on April 12th, the patient had hiccough and nausea, and his breath was redolent of alcoholic fumes. He was now transferred to the immediate charge of Acting Assistant Surgeon C. Carvallo. A laxative enema was administered, and, when the bowels were unloaded, a sinapism at the epigastrium, and small doses of creasote allayed the irritability of stomach. On April 13th the stomach was quiet, pulse 120, rather weak, FIG. 59. Fracture of head and neck of left femur by a conoidal musket ball. Spec. 3235, Sect. I, A. 51. M. * SECT. II. 1 EXCISION AT THE HIP AFTER SHOT INJURY. 107 and there was profuse perspiration. The patient was ordered a cupful of beef tea every two hours, one of milk punch every four hours, milk toast and soft boiled eggs at breakfast and dinner. No change the next day. On the 14th the wound looked well. Some shreds of disorganized connective tissue were removed by the dressing forceps. There was some pain and difficulty in micturition. Small doses of tincture of the sesquichloride of iron were directed thrice daily, and chicken broth was added to his dietary. No entry of importance appears on the 16th. On the 17th the pulse was 120, respiration 32. Slight pain on right side, and signs of pleurisy on auscultation. There was an erythematous blush about the wound, and, in the evening, there was diarrhoea, which was cheated by pills of opium and nitrate of silver. On the 18th the pleurisy was worse, the breathing more rapid, and there was retention of urine, so that it was necessary after this to use a catheter. April 19th tin- countenance was sunken, and the wound was flabby. There was a sore on the sacrum. The patient was moved to a Crosby Invalid Bed. He had a draught containing ammonia and sugar, and a blister on his side. April 20th the nurse reported a chill during the night. The breathing was labored. There were sordes on the teeth. At the next morning visit the patient was very low. He died before noon, April 21, 1865, eleven days after the operation. The autopsy revealed dry pleurisy on either side; lungs healthy, somewhat congested posteriorly; heart and liver not abnormal. A large sub-peritoneal abscess in the course of psoas and internal iliac muscles, which appeared to originate in the obturator foreamen and ascend along the left iliac fossa, denuding the bone of its periosteum. No evidences of pyaemia were found, though it was strongly suspected after the occurrence of the chill on April 20th. The pathological specimen, contributed by the operator to the Army Medical Museum, is represented at pnge 24G of the Catalogue of the Surgical Section of 18o6, and by the Avood-cut (FlG. 59). CASE 250. Captain John Phelan, Co. A, 73d New York, aged 22 years, received a compound comminuted fracture of the neck and upper extremity of the left femur at the battle of Spottsylvania Court House, on May 14, 1864. On May 16th, he was admitted to Mount Pleasant Hospital. Washington. The rapid and incessant influx of wounded was such that the attention of the overworked hospital staff was not especially drawn to his case for some time after his admission, and the delay in minutely examining the case was extended by the uncomplaining fortitude of the sufferer, who expressed his wish that the more serious cases should first be attended to, and declared that his own sufferings were comparatively slight. When, however, Acting Assistant Surgeon Mulford, the ward surgeon, proceeded, on June 3d, to adapt apparatus to what he supposed to be an ordinary gunshot fracture of the upper third of the thigh, he was led to apprehend that the injury extended to the coxo-femoral articulation, and requested the opinion of the surgeon in charge of the hospital, Assistant Surgeon C. A. McCall, U. S. A., as to the diagnosis and treatment. Dr. McCall immediately visited the patient, and found him to be a large, muscular, finely formed man, whose previous health had been excellent. When lying quietly in bed, he suffered but little. His appetite was good ; and his strength, so far, had diminished but little. Altogether, his general condition was extraordinarily good, in view of the gravity of the injury he had sustained. The ball had entered in front, just over the point at which the profunda is given off from the left femoral artery. The aperture of entrance was small and characteristic as an entrance wound of a conoidal musket ball. The missile had passed toward the great trochanter and shattered it. Further, its course could not be ascertained t the time. Any movement of the limb caused extreme pain. Though the femur was much comminuted, Dr. McCall was not positive that the hip joint was implicated, and, with a view to a full exploration of the injury, he directed Dr. Mulford to make a longitudinal incision three inches in length over the trochanter, to explore the parts thoroughly, and to ascertain by digital examination the condition of the articulation. If it was uninjured, Dr. Mulford was instructed to extract detached fragments of bone and foreign matters, to close the upper part of the wound, and to avail of the lower portion for drainage. In the afternoon the patient was ether ized, and the exploratory incision was made, and it was found that the fracture extended to the head of the femur. It was then decided to excise the head. The patient was again rendered insensible by the inhalation of sulphuric ether, and Dr. McCall extended Dr. Multbrd s incision upward an inch or more, and then made an oblique incision across its upper extremity, as represented in the accom panying figure (FlG. 61). The two flaps thus marked out were reflected, and the joint was read ily exposed, the round ligament divided, and the head of the femur exarticulated. The acetabulum was carefully examined and found to be uninjured. Seven large and numerous small fragments of the neck and trochanter major were then removed, a task requiring much time and patience, many fragments being driven into the gluteal muscles, or deeply retracted by the muscles attached to the great trochanter. The fractured upper extremity of the femur was then brought out at the wound, by adducting and pushing upward the knee of the injured limb, and all diseased tissue was removed. The periosteum was in a healthy condition quite up to the end of the bone. The wound was now thoroughly washed out, and approximated by three stitches, and by adhesive strips. A grain of sulphate of morphia was administered, and the patient was put to bed. The operation lasted three-quarters of an hour. Dr. McCall thinks that the ball was removed during the operation; but is not positive on this point. The hospital report, which is quoted at page 69 of Circular No. 6, S. G. O., 1865, states that the patient s pulse was quick and irritable at the time of the operation, that he had a furred tongue and diarrhoea, and was reduced by suppuration. But Dr. McCall (letter of February 11, 1868) thinks that this report exaggerates the gravity of the constitutional symptoms, and is quite sure that the general condition was favorable. The patient rallied well from the operation. For two days the wound was dressed 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 FIG. CO. Excised head and fragments of neck of left femur. ,Sp<?c.2G18. FIG. 61. Direction of the incisions in case of excision of the head of the femur. [From a drawing by Dr. MCCALL.] 108 INJURIES OF THE LOWER EXTREMITIES. fCHAP. X. and stimulants. For a week or ten days subsequently, the case progressed favorably. Suppuration was moderate in amount, and of a healthy character. 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 21, 1834. 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 (FlG. 60). CASE 251. A private soldier of General Pope s Army of Virginia, was admitted on September 2, 1862, to the Cliffburne Hospital at Washington, D. C., with a gunshot fracture of the neck of the left femur, received at the second Bull Run battle, on August 29, 18G2. A conoidal musket ball had entered the left hip directly over the trochanter major and embedded itself in the neck of the femur. The trochanter major and the neck of the femur were split and comminuted, but the head was uninjured. The patient had suffered greatly from the journey from the battle-field to the hospital, and was prostrated by diarrhoea and malarial complications. The tissues about the hip joint were but slightly swollen, and the wound discharged healthy pus. It was decided that excision was the most hopeful resource, and on September 4, 18G2, Assistant Surgeon John S. Billings,!!. S. A v proceeded to operate. Chloroform was administered, and a straight incision was made over the trochanter major, and the head and fragments of the neck were removed. The shaft of the femur was then divided by a chain saw at the level of the trochanter minor. The patient reacted well from the operation. He was placed on a fracture bed, and extension by means of a weight was made on the injured limb. The diarrhoea increased in severity despite all treatment, and the patient succumbed, exhausted, on September 24, 1862, twenty days after the operation. CASE 252. "Private Michael Welsh, Co. II, 10th Kentucky, aged 40 years, was struck by a conoidal ball in the region of the left great trochanter, at the battle of Chickamauga, September 20, 1863, and at once conveyed to a field hospital, which soon after fell into the hands of the enemy. Ten days subsequently, he was brought to Chattanooga; and during the period of his captivity the only nourishment that he received was a small portion of corn-meal gruel daily. Having lost his blankets, he also suffered much from cold, and had contracted a rather severe bronchial inflammation. On the 1st of October, he was admitted into the general field hospital of the Fourteenth Corps, when a conoidal musket ball was removed from among a mass of small fragments of the neck of the femur, the ball having entered just anteriorly to the great trochanter. Two days subsequently, Surgeon F. H. Gross, U. S. V., carried a curvilinear incision, with its con vexity presenting forwaid, and including the opening made by the ball, from above downward, and excised the head of the femur along with the attached greater portion of the lower surface of the neck of the bone. Many FIG. G~. Shct . . . . . fracture of neck fragments were removed with the forceps; but as the trochanters were not involved m the injury, the remaining s^ ec C 344^ mUr snai P portions of the neck were trimmed off close to the inter-trochanteric lines, which completed the procedure. No ligatures were required. The man bore the operation well, and the limb was placed in a comfortable position. From the date of the operation up to October 20th, the man did very well, in spite of his enfeebled condition and bronchial trouble, when the discharge from the wound became sanions. On the same night he had a chill and was delirious, and the pulse was very feeble and frequent. On the 25th of October his condition is thus described : Pulse 125 and very feeble; tongue dry and red ; had a natural alvine evacuation. At 9 o clock A. M. haemorrhage recurred from the wound, which was arrested by injecting a solution of sulphate of iron. Stimulants freely administered, but the man grew more and more feeble, and expired at 2 o clock p. M. No post-mortem examination was held, but death was evidently due to pyaemia. The specimen shows that about one-fifth of the head at its upper aspect has been shot away, together with the entire upper surface of the neck, about one-half of the anterior and posterior surfaces and the lower border of the neck remaining." The pathological specimen, illus trated by the accompanying wood-cut (FlG. 62), was forwarded to the Army Medical Museum, June 3, 1868, by the operator. The third category of intermediary excisions includes eight cases in which the con ditions revealed on exploration offered little prospect of success. All of the patients were subjected to rough transportation. The first case was complicated with shot perforation of the elbow, the second was a man of sixty in poor health, the third a lad, rudely exposed in a wagon without springs; two others had wounds penetrating the pelvic cavity, and, in one of these cases, a splinter of the left innominate bone opened the internal iliac vein, and led to uncontrollable haemorrhage, while, in the other, hyperacute peritonitis supervened. CASE 253. Private G. W. Brantley, Co. C, 2d Alabama, aged 18 years, was wounded and taken prisoner at Fort Blakely, Alabama, April 9, 1865. A conoidal musket ball had passed through the left groin, fractured the neck of the femur, and emerged posteriorly at the apex of the left buttock. lie also received a gunshot fracture of the external condyle of the right humerus. He was conveyed to New Orleans, and, on April 15th, he was admitted to the St. Louis Hospital. The thigh, groin, and surrounding parts were infiltrated with unhealthy pus, and the patient was very much exhausted. On April 28th, the patient was anesthetized by chloroform, and Surgeon A. McMahon, U. S. V., proceeded to excise the head, neck, and trochanters of the left femur. No arteries required ligation. The patient did not rally very well. Stimulants were freely administered; but the patient sank, and died on May 2, 1865, of capillary hremorrhage. The condition of the patient did not admit of any operation on the elbow joint. CASE 254. Private Peter Boyle, Co. D, 59th Massachusetts, aged 60 years, was wounded at Petersburg, July 30, 1864. A conoidal musket ball entered the left hip and passed antero-posteriorly through the soft parts and surgical neck of the femur, SECT. II. | EXCISION AT THE HIP AFTER SHOT INJURY. 109 FIG. H3. Siiot per foration of neck of loft femur. Spec. 3593. 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. Assistant Surgeon William Thomson, U. S. A., decided that an excision of the injured bone 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 moment. 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 he 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 7, 1834. The pathological preparation, presented by Dr. Thomson to the Army Medical Museum, is figured by the accompanying wood-cut (FlG. 63). CASE 255. Private Charles C. Cleaver, Co. C, 2d Infantry, aged 18 years, was wounded at the battle of Spottsylvania, on May 12, 18G4, by a conoidal musket ball, which fractured the neck and trochanters of the right femur. He was transferred to Fredericksburg and thence to Belle Plain in a wagon, and thence on a steam hospital transport to Washington. On May 18th he arrived at Washington, and was admitted to Judiciary Square Hospital. The soft parts of the upper and outer part of the thigh were extensively lacerated, and pus of an ill-conditioned character was burrowing in every direction around the wound. The patient s condition was unfavorable; but it was decided that excision of the fractured portion of the femur afforded the only prospect of relief. Accordingly, on the 19th, Assistant Surgeon Alexander Ingram, U. S. A., proceeded to make a curved incision six inches in length, through which the head, neck, and four and a quarter inches of the shaft of the femur were removed. Carpie soaked with permanganate of potash was applied to the wound, and tonics and stimulants were freely given. Pyaemia supervened, and the patient died on May 23, 1864, four days after the operation. The pathological specimen, figured in the accompanying wood-cut (FlG. 64), is in the Surgical Section of the Army Medical Museum. CASE 256. Private Alexander Ewing, Co. A, 140th Pennsylvania, aged 30 years, was wounded at the battle of Spottsylvania, on May 12, 1864, by a conoidal musket ball, which comminuted the upper part of the left femur. He was taken to the hospital of the 1st division of the Second Corps, and on the follow ing day was sent to the rear in a wagon. Arriving at Belle Plain after a three-days journey over rough roads, he was conveyed on an hospital steamer to Washington, and, on May 18th, he was admitted to Judiciary Square Hospital. There was considerable inflammation and swelling of the soft parts, and the patient was in poor health. On the following day he was anaesthetized, and Acting Assistant Surgeon J. F. Thompson made an incision five inches in length over the great trochanter, including in it the wound of entrance. The muscular attachments being divided, it was found that the neck was splintered, that fissures extended within the capsule, that the great trochanter was separated from the shaft, and the upper part of the shaft much comminuted. The head and fragments of the neck and trochanters were removed, and the shaft was sawn just below the trochanter minor. Ice was applied to the wound, and stimulants were freely administered. The wound assumed an unhealthy action, and the patient gradually sank and died from exhaustion on May 24. 1864, five days after the operation. The pathological specimen was not received at the Army Medical Museum. > CASE 257. Corporal Henry C. Sennett, Co. F, 122d New York, aged 27 years, was wounded in front of Petersburg, March 27, 1835, by a conoidal musket ball, which entered midway between the anterior superior spinous process of the ilium and the trochanter major, and lodged in the head of the left femur. The patient was removed to Washington, and, on April 2d, was admitted to Mount Pleasant Hospital. He was feverish and fretful, and his tongue was furred; but the wound had a healthy aspect, and there was but little swelling or deformity of the limb. But explo ration with the finger proved that the ball had penetrated the hip joint. On April 4th the patient being anaesthetized by an equal mixture of chloroform arid ether, Assistant Surgeon H. Allen, U. S. A., made a T-shaped incision, four inches by six inches, over the trochanter major, and excised the head and neck of the femur. The head was fractured into three pieces, and the ball was embedded in it. Violent hiccough came on immediately after the operation and continued through the night, but was finally arrested by the persistent use of antispasmodics. On April 5th and 6th there was great tympanitis, the bowels being obstinately constipated. An enema of castor oil was administered without effect, and in two hours another of molasses and water and salt, which induced a slight evacuation. Singultus again recurred. On April 7th the bowels moved freely. A chill occurred, lasting half an hour. There was great abdominal tenderness on pressure, and other well marked symptoms of peritonitis. On the 8th the hiccough continued; the abdomen became greatly distended; the countenance became pinched and ghastly, and the patient died at ten at night. At the autopsy, made twelve hours after death, the lungs were found healthy; the liver greatly hypertrophied; the lower fifth of the ilium inflamed and injected. The tissues surrounding the hip joint were in a sloughing condition, and were infiltrated with fetid pus, which had burrowed several inches under the gluteal muscles and two inches below the trochanter minor. The acetabulum was denuded and slightly FIG. 64. Shot frac ture of the neck and trochunter of right fe mur. Spec. 2819. FIG. C5. Upperextrem- ity of the left femur, from vrhirh the head, with a conoidal ball in it, has boon excised. Spec. 103. no INJUEIES OF THE LOWER EXTREMITIES. [CHAP. X. fractured at its upper and posterior border. Two inches of the upper extremity of the shaft of the femur was denuded of peri osteum. The specimen was presented by Dr. Allen to the Army Medical Museum, and is represented in the adjoining wood cut (FlG. 05). The innominate bone was not removed ; but the upper fourth of the femur was sawn oft after death, and mounted with the excised head to show how completely the injury to the femur was limited to the epiphysis. Had it not been for the fracture of the pelvis, it would have been difficult to have found a case better adapted for the operation of primary excision. CASE 258. Private F. Machlin, 1 llth Pennsylvania, a robust man, was wounded at the second battle of Bull Run, August 30, 1862. He laid on the field several days, and was then transported thirty miles in a wagon to the Warehouse Hos pital, Georgetown, D. C., where he was received on September 8th. A musket ball had entered the right buttock and emerged an inch and a half below and within the anterior superior spinous process of the ilium. The limb was shortened, and the foot was everted ; any movement gave excessive pain. A thorough examination was made under the influence of chloroform, and showed that the neck of the bone was comminuted and the shaft uninjured. The case was considered to be a particularly favorable one far the operation of excision of the broken fragments, and the general condition of the patient was such as to oft er some hopes of its success, and it was determined to do the operation on the following day. But the surgeon in charge of the hospital was confined to his bed by illness, and was unable to see the patient for five days. On September 13th the general condition of the latter was less favorable. His pulse was 130, quick and weak, and his tongue was dry. He was placed under very careful nursing, and beef essence, brandy, eggs, and milk, and other concentrated nourishment and stimulants were administered ad libitum. By September 20th this treatment had produced slight improvement, and though he was still in a very unfavorable condition for an operation, it was determined, on consultation, that an excision might afford the patient relief from the constant pain he suffered, and that it could not greatly depress him. At noon on September 20th, accordingly Assistant Surgeon B. A. Clements, U. S. A., assisted by Dr. George K. Smith, of Brooklyn, and the surgical staff of the hospital, performed the operation. An incision five inches in length was made from a point two inches behind and an inch below the anterior superior process of the ilium, downward over the prominence of the trochanter major. The incision exposed the parts freely, and the muscular insertions being divided, and several gmall loose fragments of bone removed, the irregular broken extremity of the shaft, at its junction with the neck and the tip of the great trochanter, were excised by a chain saw. The remnant of the capsular ligament and the round ligament were now cut, the joint being opened from belojv and in front with a probe-pointed bistoury. A blade of a long bullet forceps was then introduced as a lever and the head was disarticulated by gently prying it out of the cotyloid cavity. These steps in the operation were facilitated by rotating the trochanter outward, and by lifting the extensor muscles by a metallic retractor. A small vessel was tied at the upper end and another at the lower end of the wound. The wound was well washed out by means of a syringe and a few stitches were applied, the middle portion of the wound being left open. The limb was suspended in a Smith s anterior wire splint. The patient appeared to rally from the operation satisfactorily. At 9 o clock P. M. he was free from pain ; his pulse was 136, and the skin was cool and natural. He had slept tranquilly. On the following day, September 21st, his pulse was 120 and very feeble. The discharge from the wound was dark and thin, and copious. His countenance was placid, the pinched, distressed expression it had worn having disappeared. But in the afternoon he sank rapidly, and died in the evening, thirty-six hours after the operation, September 21, 1862. The specimen is No. 329 of the Surgical Section of the Army Medical Museum, and is represented in the accompanying wood-cut (FlG. 66). (Circular 6, S. G. O., 1865, p. 64; Circular 2, S. G. O., 1869, pp. 37, 135.) CASE 259. Lieutenant D. N. Patterson, 46th Virginia, aged 31 years, was wounded at an engagement on the Boydton Plank Road, near Petersburg, 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 inward and forward, fracturing the trochan ter, neck, and head of the femur, and the anterior border of the acetabulum. On the day after the patient s admission, five days subsequent to the reception of the injury, Surgeon D. W. Bliss, U. S. V., in charge of the hospital, decided that the case was one in which excision of the upper extrem ity of the femur was applicable. The wounded man was anxious thai an operation should be performed, and his general condition was very satisfactory. On April 3d he was placed under the influence of chloroform, and Surgeon Bliss exposed the fractured bone by a curvilinear incision with its convexity forward. The shattered fragments of the neck were extracted, the rent in the capsular ligament was enlarged and the round ligament was divided, and the head of the femur was exarticulated. It was found that the ball had not only comminuted the head, neck, and great trochanter, but that fissures extended down the shaft of the femur. The bone was divided by the chain saw two inches below the trochanter minor. The deep wound was now washed out, and small fragments of bone were removed, and search was made for the ball. It was finally detected by means of a N<laton probe deeply buried in the obturator muscle near the posterior margin of the obturator foramen. The operation was accomplished with little loss of blood, and the patient reacted satisfactorily. The wound was lightly dressed, sufficient outlet for discharges being left, and the limb was extended and supported by pillows. Careful nursing was provided, and such stimulants and concentrated nourishment as seemed best adapted to the patient s condition. For three days he progressed very satisfactorily. Notwithstanding the extensive lesions of the pelvis, which were not detected until after death, there was no indication of peritonitis or disturbance of the urinary organs. On April 7th, however, profuse haemorrhage Flii. 67. Extensive fractures of the shaft, tro- rhunters, head, and nock of the left femur, and of the os innominatum. Spec. 4048. BATES (S. P.) (History of Pennsylvania Volunteers, 1861-5, Harrisburg, 1869, Vol. I, p. 30) records the name of this patient as Philip Mechling, Co. I, Uth Pennsylvania Volunteers. SECT. II. EXCISION AT THE HIP AFTER SHOT INJURY. Ill took place, which could not be controlled, and the patient died on the morning of that day. At the autopsy it was found that the bleeding had proceeded from the internal iliac vein, gradually worn away by a sharp bit of bone forced inward by the ball. The pathological specimen, represented in the adjoining wood-cut (FlG. 67), is also figured at page 240 of the Catalogue of the Surgical Section of the Army Medical Museum, where another view is given. CASE 260. "I have the honor to report," writes Dr. Hooton, "that I did not take charge of hospital 21 until March 10, 18o 3, and did not treat the case referred to. I was somewhat conversant with its history, however, and will give it to you as I received it from Surgeon Sennet, 94th Ohio, whom I relieved. The wound was received at the battle of Stone River or Muifreesboro , the last of December, 1862, or January 1, 1863. Resection of the upper part of the shaft, including the shattered trochanters, was performed on the field. The head of the bone was left in the cotyloid cavity. A few days subsequently the patient was sent by rail to Nashville, a distance of twenty miles. Notwithstanding the fatigue of the long journey, his general condition was very satisfactory, and the wound looked well. Part of the incision healed; but there was a profuse discharge from the lower part, and gradually this discharge became thin and ichorous. About January 21st it was determined to reopen the wound. It was found that the head of the bone was carious throughout its whole extent. It was therefore removed After this operation, which was accomplished without haemorrhage or other untoward circumstance, the limb swelled very much, irritative fever set in, and the patient died exhausted in a few days." [The records of the hospital identify this patient as Sergeant Dallas W. Hade, Co. H, 101st Ohio, wounded at Stone River, December 31, 1862; died January 31, 1863.] Of the twenty-two intermediary excisions at the hip, four were on the right side, sixteen on the left; in two cases the side of the injury was not reported. A straight longitudinal incision was made in nine instances, a curvilinear in seven, a crucial in one, a T-shaped in one, and in four operations the mode of incision was not stated. In five instances the missile was removed at the time of the operation. Twenty excisions were performed by Union surgeons and two by Confederate surgeons. Pathological specimens illustrating thirteen of the excisions are preserved in the Army Medical Museum, with photographs of the two survivors of intermediary excisions at the hip. TABLE XII. Summary of Twenty-two Cases of Intermediary Excision at the Hip Joint for Shot Injury. NO. NAMK, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 l Jarret, J. M., Lieut., C, Oct. 14, Left femur shattered at upper Nov. 9, Excis nof head, neck, trochant September, 1864. Recovered. 15th North Carolina, age 28. 1863. third by a conoidal ball. 1863. ers, and a port n of shaft of left femur; several largedetached fragments and spiculse rem d, by Surgeon J. B. Read, P. A. C. S.; chloroform ; straight incision seven inches long. 2 2 Wright, H., Pt., O, 8th N. May 5, Conoidal ball shattered the 1 May 27, Head, neck, and both trochant Disch d October C, 1864. and pen Jersey, age 28. 1864. neck and trochanters of right , 1664. ers of right femur removed sioned. Spec. 3375, A. M. M. femur and lodged, greatly flat tened and distorted, amid the thro straight incision ; missile extracted ; jagged upper ex Sept. 4, 1673, "Six and a half inches shortening." Pensioner fragments of bones. tremity of shaft turned out died October 26, 1874, of heart and smoothed off, by Ass t disease. Surg. G. A. Mursick, U. S.V. 3 Boyle, P., Pt., D, 59th Mas July 30, Conoidal ball perforated surgi Aug. 5, Head, neck, and shaft of left Died August 7, 1864, from ex sachusetts, age 60. 1864. cal neck of the left femur and 1864. femur at level of troch minor, haustion. Spec. ; 593, A. M. M. fractured trochanter major. excised through straight in Circ. 6, S. G. O., 1865, p. 70. cision, by Ass t Surgeon W. Circ. 2, S. G. O.. 1869, pp. 45, Thomson, U. S. A.; ether. 136. 4 Brantley, G. W., Pt., C, 2d April 9, Conoidal ball fractured neck of April 28, Head, neck, and trochanters of Died May 2, 1865, of capillary Alabama, age 18. I860. left femur ; also fract. of extl. 1865. femur excised, by Snrg. A. haemorrhage. Circ. 6. S. G. O.. condyle hum. M. McMahon, U. S. V. 18G5, p. 74. Circ. 2, S. G. O., 1869, pp. 47, 13C. r> Callaghan, C., Pt., G. 2d Sept. 17. Comminut n of left trochanteric Sept. 29, Head, neck, and portion of shaft Died October 4, 1862. Spec. 840, Delaware. 1862. region, fissures extending up 1862. of left femur excised, by Ass t A. M. M. Circ. 6. S. G. O.,18t!5. neck of femur, by a fragment Surgeon J. H. Bill. U. S. A.; p. C4. Circ. 2, S. G. O., 1SG9. of shell. curved incision : shaft divided pp. 37, 135. just below trochanter minor. 6 Christopher, T. C., Pt., D, Mav 5, Conoidal ball fractured head Mav 20, Shattered fragments of head Died May 24, 1862. Spec. 19, 18th South Carolina, age 18fJ2. and neck of left femur and 1862. and neck of left femur remo d A. M. M. Circ. 6, S. G. O., 1865. 21. lodged in obturator externus through a curvilinear incision p. 62. Circ. 2, S. G. O., 1869, i muscle. four inches long, by Assistant pp 35, 135. Surg. J. S. Billings, U. S. A. 7 Cleaver. C. C.. Pt., C, 2d Mav 12, Neck and trochanters of right Mav 19. Head, neck, and four and a Died May 23, 1864, of pyaemia. Infantry, age 18. 1864. femur fractured by a conoidal 1864. quarter inches of shaft of right Spec. 2819, A. M. M. Circ. 6, ball. femur removed thro a curved S. G. O., 1865, p. 66. Circ. 2, incision, by Ass t Surgeon A. S. G. O., 1869, pp. 43, 135. Jngram, U. S. A. 1 RKAD (J. B.), Resections of the Hip Joint, in Confederate States Medical and Surgical Jour., 1864, Vol. I, p. 5. Phot. Ser.. A. M. M., Vol. I, p. 41 . Circular No. 0, S. G. O., 1865, p. 66. Circular No. 2, S. G. O., 1869, pp. 39, 135. EVE (P. F.), A Contribution to the History of the Hip Joint Opera tions, etc., in Trans, of the, Am. Med. Association, 1867, Vol. XVIII, p. 256. 2 MuusiCK (G. A.), A Successful Case of Excision of the Head of tlie Femur for Gunshot Fracture, in New York Med. Jour., 1865, Vol. I, p. 424. Circular No. 6, S. G. O., 1865, p. 68. Circular No. 2, S. G. O., 1869, pp. 41, 135. Surgical Photograph Series, A. M. M., Vol. IV, p. 38. 112 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 8 Ewing, A., Pt., A, 140th Mav 12, Conoidal ball splintered neck, May 19, Removal of the head and i rug- Died May 24, 1864, from exhaus Pennsylvania, age 30. 1864. separated the great trochanter 1864. ments of the neck and tro- tion. Circ. 6, S. G. O., 1865, p. from shaft, and comminuted chantors through an incision 68. Circ. 2, S. G. O., 1869, pp. upper part of the left femur. five inches long, by A. A. 43, 135. The fissure extended within Surgeon J. F. Thompson. the capsule. 9 Fovlke, T. E.. Pt.. 1), 2d April 9, Neck, trochanters, and upper April 27, Excision of the head, neck, Died June 5, 1865, from exhaus Alabama, age 17. 1865. third of left femur fractured 1865. trochanters, and two inches of tion. Circ. 6, S. G. O.. 1865, p. by a conoidal ball, which the shaft of femur, by Surg. 74. Circ. 2, S. G. O., 1869, pp. lodged above the ant. sup. A. M. McMahon, U. S. V. 47, 136. spinous process of the left ilium. Missile removed. 10 Hade, D. W., Sergeant, H, Dec. 31, Shot fracture of the trochanters Jan. 21, On reopening the wound the Died January 31 , 1863. from ex 101st Ohio. 1862. of femur; resection of the 1863. head of the femur was found haustion. Circ. 2, S. G. O., 1869, upper part of the shaft and the carious throughout its entire pp. 38, 135. shattered trochanters on the extent; it was therefore re field; head of bone left in moved, by Surg. E. Sennet, cotyloid cavity. 94th Ohio. 11 Marston, C. E., Pt., F, 1st Aug. 30. Neck of right femur crushed, Sept. 27, Fragments of neck removed, Died Sept. 30, 1862. Spec. 328, Massachusetts, age 19. 1862. and the head of the bone com 1862. head of bone exartieulated, A.M.M. Circ. 6, S.G. O., 1865, minuted by a conoidal ball, the roughened portion of the p. 64. Circ. 2, S. G. O., 1869, which lodged in the inner side neck at its attachment with pp. 36, 135. of the thigh. the trochanter sawn off with a small chain saw. and the mis sile removed with difficulty at the bottom of a large cavity; slightly curved incision, by Ass t Surgs. B. A. Clements and C. H. Alden, U.S.A. 12 Machlin, F., Pt., I, llth Aug. 30, Comminution of neck of right Sept. 20, Loose fragm ts removed, irreg Died Sept. 21, 1862. Spec. 329, Pennsylvania. 1862. femur by a musket ball ; fis 1862. ular broken extremity of shaft A . M. M. Circ. 6, S.G. O., 1865, sure extending into the head excised, and head of bone dis p. 64. Circ. 2, S. G. O., 1869, of the bone. articulated ; incis n five inches pp. 37, 135. long; Ass t Surg. B. A. Clem ents, U. S. A., assisted by Dr. G. K. Smith, of Brooklyn. 13 Miller, J., Pt., E, 162d N. June 14, Conoidal ball perforated upper July 8, Ass t Surg. G. W. A very, 9th Died Sept. 21, 1863, from exhaus York, age 38. 1863. portion of left thigh, breaking 1863. Conn., excised the head, neck, tion. Circ. 2, S. G. O., 1869, the neckoffemurtransversely and great trochanter through pp. 38, 135. and splittingit longitudinally. a single straight incision. but without great comminutV : Noe, D. M., Pt., C, 46th Ohio, April 6, Neck of left femur shattered April 16, Excision of the head, neck, and Died April 24, 1862, of pyaemia. age 22. 1862. by a conoidal ball. 1862. trochanters, and three inches Circ. 2, S. G. O., 1869, pp. 34, of the shaft of femur ; incision 135. four inches long, by Surg. G. C. Blackman, U. S. V. 15 Patterson, D. N., Lieut., Mar. 29. Conoidal ball fractured the tro April 3, Shattered fragm ts of the neck Died April 7, 1865, from haemor 46th Virginia, age 31. 1863. chanter major, neck, and head 1865. extracted, head of femur ex- rhage. Spec. 4048, A. M. M. of the left temur, and anterior articulated, and shaft divided Circ. 6, S. G. O., 1865, p. 72. border of the acetabulum ; two inches below the trochan Circ. 2, S. G. O., 1869, pp. 45, fissures extended down shaft. ter minor, through curvilinear 136. Missile lodged. incision; missile removed, by Surg. D. W. Bliss, U. S. V. Died.Tune21, 1864, from diarrhoea. 16 Phelan, J., Capt., A, 73d May 14, Left trochanter major shattered June 3, Head of femur exartieulated Spec. 2618, A. M. M. Circ. 6, ^6w York sisfo 22. 1864 and neck of lemur fractured 1864. and the fragments of the neck S. G. O., 1865, p. 68. Circ. 2, to the head by a conoidal ball, and trochanter major rcmov d, S. G. O., 1869, pp. 44, 136. which lodged ; many fragm ts thro crural incision, by Ass t driven into gluteal muscle. Surg. C. A. McCall, U. S. A. 17 Phillips, H., Pt., I, 146th April!, Conoidal ball crushed in the April 8, Head, neck, and trochanter Died April 21, 1865. Autopsy: New York, age 34. 1865. laminated structure of the an 1865. major removed through a Pleurisy on either side ; large terior surface of neck of left curved incision six or seven subperiosteal abscesses. Spec. femur, where it lodged. Mis inches long, by Ass t Surg. 3235, A.M.M. Circ. 6, S. U.O., sile extracted. W. F. Norris, U. S. A. 1865, p. 72. Circ. 2, S. G. O., 1869, pp. 47, 136. 18 Sennett. H. C., Corp l. F, Mar. 27, Left acetabulum fract d slight April 4, Head and neck excised thro Died April 8, 1865, from peri 122d New York, age 27. 18(i5. ly at its up. and post, border 1865. a T-shaped incision, by Ass t tonitis. Spec. 153, A. M. M. by a conoidal ball, which also Surgeon H. Allen, U. S. A. Circ. 6, S. G. O., 1865, p. 72. fractured the head of the bone Circ. 2, S. G. O., 1869, pp. 46, and lodged in the same. 136. 19 Smith, M., Pt., F, 38th May 10, Conoidal ball fractured the May 12, Head, neck, and two inches of Died May 13, 1864. Spec. 5500, Virginia. 1864. upper portion of the shaft of 1864. the shaft of femur excised, by A. M. M. Circ. 2, S. G. O., 1869, left femur, passed throt-gh the Surg. C. B. Gibson, C. S. A. pp. 43, 135. perinaDum without injuring the urethra, and through the 20 Unknown soldier of General Mar. , soft parts of the right hip. Neck and trochanters of Two Head and splintered upper ex Died one week afteroperat n.from Buell s Army. [Probably Corporal II. F. Smith, 12th 1862. femur shattered by a conoidal ball. days after in tremity of femur remov d thro a long straight incision, by surgical fever and suppuration. Circ. 6,S.G.O., 1865, p.62. Circ. Wisconsin. | jury. Surg. A. H. Thurston.U. 8.V. 2, S. G. O., 1869, pp. 34, 135. 21 Unknown soldier, private of Aug. 29. Conoidal ball split and commi Sept. 4, Head and fragments of neck of Died Sept. 24, 1862, from exhaus Gen l Pope s Army. 1862. nuted the left trochanter ma 1862. the femur removed: the shaft tion. Circ. 6, S. G. O., 1865, p. jor and neck of the femur and of femur was then divided at 64. Circ. 2, S. G. O., 1869, pp. lodged in the latter. the level of trochanter minor. 36, 135. straight incision, by Assistant Surg. J. S. Billings, U. S. A. Couoidal ball fractured the Oct. 3, Head of femur excised, together Died October 25, 1863. Spec. 22 Welsh, M., Pt., H. 10th Sept. 20, neck and head of left femur 1863. with the attached greater por 5442, A. M. M. Kentucky, age 40. 1863. and lodged. Oct. 1st, ball tion of the lower surface of removed. the neck of the bone, fragments removed and remaining sharp portions of neck trimmed off; Surg. F. H. Gross, U. S. V. 1 GROSS (S. W.), Head of the Thigh Bone removed by Excision on account of Gunshot Injury, in Am. Jimr. Med. Sci., 1868, Vol. LV, p. 410. OTIS (G. A.), Observations on some Recent Contributions to the Statistics of Excisions and Amputations at the Hip for Injury, in Am. Jour. Med. Sci., 1868, Vol. LVI, p. 130. Circular No. 2, S. G. O., 1869, pp. 39, 135. SECT. II.] EXCISION AT THE HIP AFTER SHOT INJURY. 113 Secondary Excisions. There were reported eleven secondary excisions at the hip practised on nine Union and two Confederate soldiers, resulting in three recoveries and eight deaths, a mortality rate of 72.7 per cent. 1 The shortest interval between the recep tion of the injury and the operation was thirty-one days, and the longest eight years and four months. Two of the survivors of secondary excision at the hip are still pensioners in comparatively good health, at a period remote from the date of operation. CASE 261. Private Joseph Brown, Co. I, 3d Michigan, aged 33 years, was wounded at the second battle of Bull Run, August 29, 1832, by a musket ball, which passed through the left thigh, fracturing the femur just below the trochanter minor. He laid on the battle field three days, and was then removed to Centreville. On September 11, 18G2, he was admitted to Fairfax Seminary Hospital, near Alexandria. The limb was kept in position by appropriate apparatus; but suppuration was profuse, and, on two occasions, fragments of bone were removed from the wound. Early in March, 1833, there was great swelling of the thigh, the discharge became scanty and fetid, and pus burrowed amid the muscles. On March iilst, an explo ratory incision was made from three inches above to five inches below the prominence of the great trochanter. The neck and upper extremity of the shaft of the femur were found to be extensively diseased, and excision was decided on. Surgeon D. P. Smith, U. S. V., performed the operation. Difficulty was experienced in separating the mus cular attachments from the trochanters, on account of the foliaceous masses of callus that had been thrown out. When this dissection was accomplished, many necrosed fragments were extracted, and the periosteum and new bone were separated by the handle of the scalpel and preserved as far as practicable. The shaft of the femur was then divided by powerful cutting bone forceps, about six inches below the tip of the great trochanter. A screw was driven into the mass of callus, below the trochanters, to be used as a lever in disarticulating the head, but it would not hold, and the bone was seized with large forceps and rotated, so as to facilitate the division of the capsular and round ligaments. The head, neck, and trochanters, and the masses of callus adhering to the trochanters, were then removed. The operation was accom plished with but very trifling haemorrhage, yet great prostration followed, and the patient rallied slowly. As the anesthesia passed off, he had much nausea and vomiting. As soon as this subsided, he was given a very full allowance of concentrated nourishment, such as strong beef-tea, eggs, milk, etc, with half an ounce of brandy every two hours. The wound was par tially closed; the limb was supported on pillows until the third day, when it was dressed in a Smith s anterior splint. About forty-eight hours after the operation, an erysipelatous blush pervaded the limb, and the constitutional symptoms assumed a typhoid character. A female catheter was passed through the middle of the wound and another at its lower extremity, through which much offensive decomposed serum and grumous blood escaped. The wound was thoroughly washed out through the catheters with warm water impreg nated with chlorinated soda. On the fifth day there was a rigor, and hemorrhage to the extent of six ounces. As the anterior splint did not permit convenient access to the limb, it was removed, and the leg and thigh were suspended in a canvas hammock, the leg being horizontal and the thigh in an almost vertical position. A piece of soft toweling extending from the perineum to the popliteal space, and, connected by cords with an upright post at the head of the bed, supported the muscles on the sides and under surface of the thigh. The wound freely discharged synovia, bloody serum, and thin pus, until the seventh day, when healthy suppuration was fairly established. During April, 1863, the patient s progress was satisfactory. He was supplied with very nutritious diet, with porter, and cod-liver oil. He took for a time as much as a half a pint of oil daily. During May, the case continued to progress favorably. It was necessary to keep a tube in the wound until June 1st. Pre viously, whenever it was removed pus would accumulate and burrow. A mesh of suture wire was finally substituted for the tube. This was retained until June 20th, when the patient began to get about on crutches. In the latter part of July the wounds closed. In August, Brown was reported as "well," and on August 23, 1803, he was discharged from the hospital and from the military service of the United States. On March 21, 1834, he wrote from his home in Coopersville, Michigan, that his health was good; that he could get about and attend to home business ; could saw and split a little wood for fuel, though his knee was stiff and his leg painful. On the whole, there had been steady improvement. In September, 1835, he again wrote, and stated that his general health was good; that he had some control over the movements of the thigh, being able, when standing on the right foot, to swing the left backward and forward, and to adduct the thigh enough to carry the injured limb across the other. He could bear some weight on the limb, and use but one crutch, with a stirrup for the foot. There had been no fistulous orifices since March 1834, and there was no soreness about the cicatrices. In November, 1835, in accordance with a request from the Surgeon General s Office, Mr. Brown had a photograph (FlG. 69) taken to represent the amount of deformity in his limb. This picture is numbered 110 in the Photograph Series of the Army Medical Museum. It is carefully copied in the accompanying wood-cut. The excised bone is preserved at the Museum, and is numbered 1192. Section I. It is represented in the adjacent wood-cut (FlG. 68). On February 12, 1868, he wrote to the compiler of this report : I take pleasure in informing you that my 1 Besides the nine cases recorded in the Report on Excisions of the He.ad of the Femur for Gunxhot Injury, S. G. O., 1869, a successful example has been reported by Dr. E. STKULINQ, of Cleveland, Ohio, and another successful operation was performed in 1871, by Dr. J. K. BlGELOW of Indianapolis. SURG. Ill 15 Fia. 68. Head, neck, and trochanters of left femur, with foliaceous callus. Spec. 11S2. FIG. CO. Appearance of limb three years after the operation. [From a photograph.] 114 INJURIES OF THE LOWER EXTREMITIES. ICHAP. x. limb is in as good 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 ] cannot see that there is any 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 liinb measures at the same place 19^- inches. The knee of the well limb measures around the centre of the knee-pan 154- 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 19, 1863, 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 has 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 stepping 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 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 oifice over a year, and have attended to all the business of the office almost entirely without assistance, and it gives me pretty good exercise." On Septem ber 6, 1875, the date of his last examination for pension, the Grand Rapids Examining Board stated: "There is now a false joint with shortening of the limb." Since then this pensioner has been exempted from further surgical examinations. He was paid September 4, 1877, remaining in comparatively good health more than fourteen years after the operation. The next successful secondary excision at the hip after shot injury was not identified at the Surgeon General s Office until after the publication of Circular 2, in 1869. CASE 262. G. W. Tilliston, Co. D, 1st Ohio Artillery, aged 44 years, was wounded at Laurel Hill, July 7, 18(31, by a rifle ball, which entered the right groin, passing backward through the neck of the femur and lodging in the large muscles of the buttock. Two weeks after the reception of the injury he was mustered out by reason of expiration of service, and subse quently he was admitted on the Pension Rolls. Dr. E. Sterling, of Cleveland, who was the regimental surgeon and treated the wounded man in the field, subsequently certified to x the nature of the injury and reported the following: "Extraction of the ball was impossible. The wound was dressed, and within a few days the patient was removed to his home in Cleveland. On or about the 20th of September following it became necessary to remove that portion of the bone traversed by the ball, and I performed the operation of excision at the hip joint." Examiner J. Laisy, of Cleveland, on July 17, 1867, certified to resection of the head and part of the neck of the femur, and stated: "A fistulous opening has formed six inches below the anterior superior spinous process of the ilium, which is keeping up a constant and profuse discharge of purulent matter. The right leg, in consequence of the operation, is short- 70. Shat- ene( l about three inches. He is unable to bear any weight on the injured limb, and obliged to walk on crutches." tered head of right Two years later, in August, 1869, the excised head of the femur, represented in the wood-cut (FiG. 70), was transmitted to the Museum by the operator, who deplored the loss of the other portion of the resected bone, and described the case as being attended with "perfect recovery and a good limb, the pensioner being able to go up and down stairs with ease." Dr. N. M. Jones, attending physician of the pensioner, certified that he died September 6, 1871, and added that a post-mortem examination, held by himself, revealed extensive necrosis of the upper third of the femur * * * and of the ilium, having entirely destroyed the acetabulum and penetrated the pelvis." He also stated that he found an enormous abscess covering the entire right ilium and sacrum. The third successful secondary excision at the hip was practised, in 1871, for ostitis and coxitis, eight years arid four months subsequent to the reception of the shot injury. CASE 283. Private T. W. Pease, Co. H, 19th Indiana, aged 26 years, was wounded at Gettysburg, July 1, 1883, by a conical musket ball, which entered the anterior aspect of the right thigh three inches below Poupart s ligament, passed back ward and outward, and lodged just behind the trochanter major, having fractured the upper third of the femur and passed through the trochanter. The wounded man remained for several months at a Corps hospital at Gettysburg, where merely a "shot wound of right thigh" was noted, but no progress of the case recorded. According to his statement, the missile was extracted by incision three days after the injury, and on July 9th, while under the influence of ether, nearly three inches of bone was removed in fragments. Extension and counter-extension were applied, but the latter caused so much pain that it was discon- 1 Professor H. CULBERTSOX, M. D. (Excision of the Larger Joints of the Extremities, Prize Essay, Trans. Am. Med. Assoc., Vol. XXVII, Supple ment, 107G, pp. 5 and 50), reports this operation as practised "August 20, 1861," which would make it the first excision at the hip after shot injury performed in the United States, the primary excision practised by Professor BLACKMAN, on Private J. McCulloch (CASE 230, p. 97, ante) having been done August 30, 1861. Dr. E. STERLING in his letter transmitting the specimen (3590) also asserts that his excision of the head of the femur in Tilliston s case was the first during the war. Pension Examiner LAIST also states that the patient was wounded July 7, 1861, and that resection was performed six weeks afterwards j but, in his official report to the Pension Office, Dr. STERLING states that the operation was performed " on or about the 20th of September." SECT. II.] EXCISION AT THE HIP AFTER SHOT INJURY. 115 tinued at the end of twenty-four hours. Smith s anterior splints were applied on July 20th, and cold-water dressings were used. The patient also stated that the limb was swollen and painful, the discharge of pus profuse, and his general health bad. For the first two weeks he suffered from constipation, after which, having taken a laxative, diarrhoea set in and troubled him, with short intermissions, for about three months. The records of Camp Letterman Hospital show that the patient was admitted there on September 5th, also that Acting Assistant Surgeon E. A. Koerper took charge of the case on October 8th, who opened a large abscess on the inner side of the thigh on November 3d, and removed the splints several days afterwards, the fracture having become united and the patient s health improved. The subsequent progress of the case was recorded by Acting Assistant Surgeon H. L. Smyscr, at the York Hospital, where the patient was transferred on November 14th. The wound of entrance aud exit at that time had closed, but there was still discharge from an opening on the middle and external part of the thigh, and the limb was swollen and curved outward, with three inches shortening. After this a steady improvement followed until January 12, 186 4, when the patient was seized with a chill, followed by fever, and a deep seated abscess began to form on the anterior part of the thigh, which was opened four days afterwards. Abscesses continued to form at intervals and suppuration was more or less constant, causing the cicatrices of the wound to be reopened. On February 29th, symptoms of tetanus appeared, being exhibited by stiffness of the muscles of the neck and inability of the patient to open his mouth more than half an inch. This attack was subdued, by the administration of pills of camphor aud opium, after several days duration, and during the succeed ing night and morning it was followed by an almost constant hiccough, after which another attack of diarrhoea came on. In April following the wound had again healed, and the patient had so far amended as not to require any more medicine. On July 3d, he was able to walk about on crutches for the first time. His term of service having expired, he was mustered out August 8, 1834, and pensioned. Examiner G. W. Clippinger, of Indianapolis, certified, October 17, 1833: * * * "Almost total anchylosis of knee joint, with foot turned inward at the toes; extensive necrosis of entire shaft of bone, with discharge at three points. * Discharge offensive and exhaustive. Is feeble and emaciated, has frequent night sweats, aud requires constant aid and attendance." Dr. A. L. Lowell, of the Pension Office, who made a special examination of the pen sioner on July 20, 1838, reported the following: * * * "The wound is still discharging from its anterior opening and the process of exfoliation is still progressive. The coxofemoral articulation is firmly fixed and immovable. * * * The subject travels with the assistance of crutches. His general health is good." Dr. J. K. Bigelow, attending physician of the pensioner aud late Surgeon of the 8th Indiana, reported that he, being aided by Surgeon J. S. Bobbs, "on September 2, 1888, removed ten and a half inches of the necrosed shaft of the femur, said necrosed bone having kept up a constant and exhaustive discharge from three or four large sinuses at various places along the inner and posterior part of the thigh," etc. The Indianapolis Examining Board certified, February 8, 1870: "The pensioner is very obnoxious to erysipelas, which frequently causes largo inguinal and popliteal abscesses," etc. Two years afterwards the same Board reported that "the operation for removal of necrosed bone two years ago, apparently resulted in good recovery. * One year after said operation erysipelas of the limb, with ulceration, etc,, again ensued, and on October 20, 1871, he was again attacked with large abscesses, and several sinuses made their appearance. Upon careful examination it was found that the new bone was necrosed and necessitated coxo-femoral exsection, which was performed on the 8th of November, 1871. There is ten inches shortening. He requires the con stant attention of a nurse," etc. In a report recapitulating the history of this case, transmitted by Dr. Bigelow, in September, 1877, he describes the operation of exsection as follows: "While under the influence of chloroform, an incision was made from the middle of the dorsum of the right ilium down the outer aspect of the thigh to within two inches of the knee joint. The femur was exposed and divided five inches below the trochanter with Hey s saw, and on account of the extensive perfora tions of the muscles surrounding the bone by osteophytes (FlG. 71) the cpiphysis was with difficulty and considerable haemorrhage, enucleated and unjointed from the acetabulum. It was found to consist of a very large dead involucrum, filled in all its aspects with sharp projecting spiculsB. A portion of the leaden ball was found embedded in the cancellous structure near the trochanter. The wound healed kindly, and was entirely closed in twenty-eight days. In three mouths a cartilaginous union had taken place, and now in September, 1877 with the assistance of a six-inch lift on the right boot the man can walk quite well with a cane, having nearly a perfect arthrodial joint at the hip, and being able to attend to the ordinary duties of a Deputy United States Marshal." In 1873, in visiting the Surgeon General s Office, Dr. J. K. Bigelow contributed a photograph of the excised epiphysis, which is copied in the wood-cut (FlG. 71). In 1877, Dr. Bigelow contributed to the Museum another photograph representing the cicatrix and appearance of the injured limb, which is copied in the right hand wood-cut (FlG. 72). This pensioner was paid September 4, 1877. The number of patients who servive shot injuries involving the hip joint until the secondary period without operative interference is small ; but such cases may be regarded in reference to their ability to sustain excisions as becoming analogous to the subjects of excisions at the hip for pathological causes. Now we learn from the experience of civil practitioners that excisions at the hip for disease have a mortality rate in children aver aging perhaps below 45 per cent., yet in adults of the military age rising to an average FlG. 71. Shot fracture of tro chanter major of right femur. [From a photograph furnished by Dr. BIGELOW.] FlG. 72. Appearance of the limb six years after the opera tion. [From a photograph.] 116 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. of over 60 per cent. It is found on examination, that, as might be anticipated, the second ary excisions at the hip for traumatic cause attain a mortality rate approximating that of excisions for disease in adults of about the same age. The three survivors of secondary excisions at the hip after shot injury were robust mature men of 26, 34, and 44 years of age. In the eight unsuccessful cases the ages varied from 18 to 43 years. In seven of the eight unsuccessful operations the patients succumbed in from one to eight days from the dates of operation, a mean of a, little over four days, while the eighth lived over a hundred clays after the operation, and succumbed apparently to unfavorable climatic influ ences and only in part to traumatic causes. CASE 264. Private Hugh Frain, Co. G, 31st Massachusetts, aged 22 years, was wounded February 1, 1865, by a conoidal musket ball, which entered the anterior surface of the middle third of the left thigh, ranging upward, and making its exit above the left glutens, fracturing the neck of the femur in its course. He was on horseback, his regiment serving at the time as mounted infantry. He was treated in the regimental hospital for several days, and then, on February loth, he was admitted to the St. Louis Hospital, at New Orleans. When admitted, he stated that the surgeon of his regiment had given him chloroform, and examined the wound, and that the bone was not touched. He had walked upon the limb, and there was then no evidence of fracture. His general health became poor. He; had night sweats. His tongue was clean and moist, and his appetite was good. The whole thigh gradually became dissected with pus of an unhealthy character. Abscesses discharged through fistulous openings in the groin. The limb was inverted and shortened, and was drawn over to the right. It was decided that an excision of the head of the femur was expedient. On March 24th, Surgeon A. McMahon, U. S. V., proceeded to perform the operation. An incision four inches in length was made over the great troclianter, the soft parU were dissected up, and the femur was divided by the chain saw just below the trochantur minor. The ligamentum teres was softened, and the head of the femur was removed without difficulty. The wound was filled with lint, and the patient was ordered porter, chicken broth, eggs, stimulants, and everything necessary to sustain the drain upon his system. He felt easier for a few days after the operation, but he gradually sank, becoming very much emaciated, and died March 30, 1885, six days after the operation. The ball had injured the neck of the femur, and the subsequent caries had caused the destruction of the head and the disorganization of the surrounding tissues. CASE 235. Private Edward Hunt, Co. D, 71st Pennsylvania, aged 24 years, was wounded at the battle of Antietam, September 17, 186J, by a conoidal musket ball, which entered about two and a half inches above the troclianter major, and grazing the neck of the right femur, passed out at the nates. Shortening and eversion were not present, and it was thought that there was not a complete fracture. After the battle, he was removed to a barn near the battle-field, where he was treated with cold-water dressings for eleven days. He was then removed to the City Hotel at Frederick, Maryland, and the cold applications were continued up to November 19th. During this period the wound was discharging healthy pus profusely. As pus was burrowing in the muscles, a seton was run through the wound and six inches down the thigh. On November 19th, he was removed to Jail Street Hospital, and about the last of December he w r as transferred to the U. S. Hotel Hospital, and thence, on January 20, 1833, to hospital No. 5, at Frederick, Maryland. On January 31st, an abscess formed on the anterior internal aspect of the thigh, which was opened, and discharged nearly a quart of laudable pus in twenty-four hours. On February 2d, the opening on the posterior aspect of the thigh was enlarged and the wound syringed out with warm water. Erysipelas attacked the wound, but it was not of an intense character, and by February 10th, it had subsided, and the patient was in good condition comparatively. On February 23d, he had become more emaciated and had night sweats, but his strength continued good. On exploring for the ball with the finger, in the opening on the inner side of the thigh, a round, smooth surface was felt, which was thought at first FIG. 73. Caries of the ace- to be a piece of a conoidal ball, but was ascertained to be the head of the femur just outside of the tabulum, neck, and trochanters ,, . . , , . . . i -i i i A * i. o TT of the right femur, following acetabulum. Excision of the hip joint was now decided upon, and Assistant burgeon Henry A. n ex ^ i n f l shot { racture - Dubois, U. S. A., operated, the patient being under chloroform, by enlarging the opening on the inner side of the thigh, cutting the capsular ligament, and removing the head of the femur. The neck was divided by the lion-jawed cutting forceps. A small quantity of pus was found behind the head of the bone. But very little blood was lost during the operation, and the patient rallied partially, but he never fully recovered from the shock, and died February 25, 1853, two days after the operation. At the autopsy the neck of the femur was found rounded off, and formed a false centre of motion on the inner side of the acetabulum. The rounded extremity of the neck and the acetabulum were carious. The cut (FlG. 73) imperfectly represents the specimen, which was sent to the Army Medical Museum. CASE 266. Ensign W. J. Henry, 21st Mississippi, aged 22 years, was wounded near Petersburg, on June 21, 1864, by a conoidal musket ball, which entered the upper third of the left thigh anteriorly and made its exit at the opposite side of the limb, having badly comminuted the femur, without injuring the principal vessels or nerves. The wounded man was conveyed to Richmond, and was admitted to hospital No. 4, on June 28th. The injured limb was suspended by Smith s anterior splint, th e wound was dressed with water dressings, a nourishing diet was ordered, with an opiate at bed-time. Under this treatment the case progressed satisfactorily until August 2d, when the copious suppuration and wasting of the patient excited so much anxiety that a consultation was held, at which Surgeons C. B. Gibson, M. Michel, and J. B. Read assisted. After a careful exploration of the injury under chloroform, it was decided that an excision of the upper extremity of the femur was expedient, and the operation was at once performed by Surgeon J. B. Read, P. A. C. S. An incision seven inches in length was made, SECT. H.J EXCISION AT THE HIP AFTER SHOT INJURY. 117 commencing above the troclmnter and carried downward in the axis of the thigh. The joint was opened and the head of the bone exarticulated. The shaft was sawn below the trochanter minor, about six inches of the bone being removed. The wound being thoroughly cleansed, was approximated and kept in position by sutures and adhesive strips. A long straight splint was then applied on the outside of the limb. An ounce of brandy and thirty drops of tincture of opium was ordered to be admin istered every hour until reaction should be fully established. August 3d, the patient had reacted and had passed a comfortable night. The pulse was at* 136; there was no pain, except in the left knee, which was swollen, but without increased heat or redness. The appetite was poor but improving. A nourishing diet was directed, and half an ounce of brandy every two hours with a grain of opium every three hours. 4th, the patient had rested well, had a good appetite, the tongue was clean, the skin moist, the bowels had been moved naturally, the pulse was at 129, the countenance was cheerful. The treatment was continued with the addition of porter thrice daily. 5th, the pulse was stronger at 120, the countenance was cheerful ; the treatment was continued. 6th, the patient was reported to have passed a bad night. He complained of acute pain in his left knee and in the right side of his chest. The pulse was 135 and weak. Incipient pneumonia was detected in the right lung. He had vomited the porter, and it was discontinued; the brandy and opium were continued as before. The wound was suppurating profusely. The sutures were clipped, and the wound was kept together by adhesive strips. The bowels were constipated. An enema of warm soap and water was administered, which procured a normal dejection in a few hours. Sinapisms were applied to the chest. 7th, he had rested tolerably well, but breathed badly. He was sweating profusely, and complained of much pain in the chest. The pulse was at 140, and was very weak. He was ordered an ounce of brandy every hour and a grain of opium ever} four hours. 8th, he was reported as having passed a very restless night. He was too weak to expectorate; the pulse was very feeble at 148. He was evidently sinking. He died at 3 o clock P. M., August 8, 1834, six days after the operation, and forty- nine days from the reception of the injury. The report gives no account of the post-mortem appearances. CASE 267. Private John W. Nelling, Co. K, 1st Massachusetts, aged 23 years, was wounded on June 30, 1862, at the engagement at White Oak Swamp, by a musket ball, which entered his right groin, passed horizontally backward, comminuted the neck of the femur, and emerged posteriorly. He was abandoned with other wounded in the retreat of General McClellan s army. Being made a prisoner, he was confined in Richmond for three weeks, and was then released and sent by water to Baltimore, where he was admitted to the National Hospital, on July 25th, in a very depressed condition. There was copious suppuration, and through the large orifices of entrance and exit it was easy to explore the extent of the injury to the bone, and to determine that the comminution was limited to the epiphysis. It was deemed advisable to excise the shattered extremity of the bone as soon as the patient could acquire, by a tonic treatment, strength to undergo such an operation. In a few weeks his general condition was much improved, though he was still anaemic and feeble. On August 21st, Assistant Surgeon Roberts Bartholow, U. S. A., in charge of the hospital, proceeded to perform the operation. The patient being placed under chloroform, Dr. Bartholow made a vertical incision, commencing a little above and behind the great trochauter, continued downward into the axis of the limb four inches, and carried it down to the bone. The head of the femur was found to be entirely separated from the neck, and was retained in the acetabulum only by the round ligament. This was divided, and the head was removed. Several necrosed fragments were then extracted, and the jagged extremity of the neck was smoothed by an osteo- tome. But little blood was lost in the operation, and the patient rallied promptly from the effects of the anaesthetic. After he was put to bed, the limb was suspended by Smith s anterior splint, and the patient s condition was rendered comparatively comfortable. The case progressed favorably and without an untoward symptom till the afternoon of August 25th, when a sudden and very FIG. 74. Head and fragments of the neck of right profuse gush of dark blood from the wound of incision and the entrance bullet femur, excised for gunshot fracture. Spec. 400, Sect. wound took place, and the patient expired before the haemorrhage could be con- *" ** M JI- * trolled. At the post-mortem examination, the soft parts in the vicinity of the wound were found to be in a softened and semi- gangrenous condition. The end of the excised neck was denuded of periosteum and was necrosed. The external iliac and femoral arteries were traced some distance above and below Poupart s ligament, and were found to be in a normal condition. The femoral vein was softened, and near the track of the ball appeared to be broken down so as not to be distinguished from the surrounding tissues. A quantity of dark fluid blood was found under the integuments. The excised head and neck were deposited in the Army Medical Museum by the operator, and are represented in the cut (FlG. 74). CASE 268. Private Joseph Roth, Co. B, 188th New York, aged 25 years, a large robust man, was wounded in the engagement at Hatcher s Run, near Petersburg, on February 6, 1865, by a round musket ball, which entered a little below Poupart s ligament, an inch external to the course of the vessels, and lodged in the neighborhood of the hip joint. He was received at the field hospital of the 1st division of the Fifth Corps, and thence conveyed to the base hospital at City Point, and, as there was no pain or deformity, the case was regarded and treated as a flesh wound, and a week subsequently the patient was sent in the hospital transport steamer State of Maine to the General Hospital at Point Lookout; After a short time, Roth began to complain of great pain in the knee and leg of the wounded limb, which aroused suspicion that the hip joint was impli cated. The symptoms becoming aggravated, and pointing clearly to some injury of the joint, Surgeon John Vansant, U. S. A., in charge of the hospital, determined to make an exploratory incision, and to ascertain the true condition of things. The patient being anaesthetized by a mixture of chlorofonn and ether on March 9th, an incision was made, commencing at the wound of entrance, and continued downward three inches or more. The ball was now found impacted in the head of the femur, the anterior part of Avhich was shattered, while the posterior two-thirds of the head was intact. The muscular attachments being divided, and the capsular ligament freely opened, the round ligament was severed, and the head was exarticulated. A chain saw was then passed around the neck, which was divided near to the head, and the latter, with the ball inserted in it, was removed. Some sharp projecting portions of the neck were smoothed off with bone forceps. There was very little haemorrhage. The wound was drawn together and treated by water dressings, and the limb was kept in suitable position by pads and pillows. The patient seemed to do well for several weeks, but gradually became feeble and emaciated, losing all appetite. There was 118 INJURIES OF THE LOWER EXTREMITIES. fCIlAP. X. but a slight discharge. In May, the patient became quite yellow, and apparently suffered from malarial complications. In spite of a careful tonic and sustaining regimen, and the bracing, wholesome salt air of Point Lookout, he gradually declined, and died June 17, 1885. The pathological specimen was not forwarded to the Museum, and no account of an autopsy was rendered, an annoying omission, since it would have been interesting to have learned what reparative action had taken place during the three months after the operation which this patient survived. CASE 269. Private Alfred Toney, Co. A, 16th North Carolina, aged 43 years, a farmer by profession, was wounded June 30, 1863, and admitted to hospital No. 4, Richmond, on the same day. A conoidal 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 llth, however, he complained of great pain in the knee and ankle; the slightest touch caused great anguish. The foot was oedematous. 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 deprived of its cartilage. Excision of the head of the femur was decided upon, and on August 12th, Surgeon James B. Head, 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 downward 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 during the after-treatment. He died August 19, 1833, eight days after the operation, exhausted by hectic fever. There is no account of any abdominal disturbance or pyaemia symptoms resulting from the fracture of the acetabulum. CASE 270. Private Henry Woodworth, Co. A, 4th Vermont, aged 18 years, was wounded at the battle of Spottsylvania Court House, on May 11, 1864, by a conoidal musket ball, which entered the left thigh, just below the trochanter major, passed inward and forward, grooving the femur anteriorly at the level of the lesser trochanter, and lodging under the sartorius muscle. The patient was conveyed to the field hospital of the 2d division of the Sixth Corps, where the ball was removed through an incision at the edge of the sartorius. A week subsequently, he was placed on one of the trains for the Rappahannock, and was transferred from Fredericksburg to Washington, where, on May 25th, he was admitted to Harewood Hospital. His condition on admission was very unpromising; his pulse was quick and feeble; he was anaemic, and without appetite. He was placed upon a tonic regimen, but he did not improve. The wound discharged profusely; there was much pain in the joint, pain aggravated by the slightest movement, and pus had burrowed in every direction about the articulation. Surgeon R. B. Bontecou, U. S. V., in charge of Harewood Hospital, decided that an excision of the head of the femur per extremity of loft offered the only possible chance of saving life, and, on July 1st, the patient having been anaesthetized by lemur with a conoidal sulphuric ether, Dr. Bontecou proceeded to peiform the operation. A curved incision, with its concavity ball. &pec. MW. J * . forward, embracing the trochanter, readily exposed the joint. The muscular attachments were divided, and the head was easily disarticulated, the joint being disorganized and the round ligament destroyed. The continuity of the bone being uninterrupted, the upper extremity was readily turned out and sawn just below the point of impact of the ball. On examination of the portion of bone removed, it was found that much of the head had been absorbed, and that the remainder was carious. The specimen is represented in the accompanying wood-cut (FlG. 75). The neck and trochanters are covered with traces of the effects of periostitis. The cotyloid cavity was ulcerated. The wound was drawn together by adhesive strips, and the limb was dressed in a fracture apparatus with moderate extension. Every means of supporting the patient s strength was adopted, but he did not rally from the operation, and, sinking gradually, expired on July 2, 1864. CASE 271. Private John Zaborowski, Co. II, 7th Connecticut, aged 33 years, was wounded at the engagement at Deep Bottom, Virginia, August 16, 1884, by a conoidal musket ball, which entered just below the right trochanter major, and passing upward and inward, fractured the neck and slightly injared the head of the femur. The patient was conveyed to the field hospital of the Tenth Corps, where his wound was dressed, and he was then sent to City Point and transferred to the hospital transport steamer De Molay, and conveyed to the U. S. Hospital, at Beverly, New Jersey, where he was admitted on August 22d". His condition at this period is not described, and it is not stated whether the ball had been extracted. From the subsequent history, it would appear that there was profuse suppuration about the joint, since a free transverse incision was practised to give free escape to the discharge. On September 27th it was determined to excise the head of the femur. The patient had greatly lost in flesh and strength since his admission, and seemed to be rapidly failing from the exhaustive suppuration; extensive slough ing of the soft parts had supervened, and, upon the whole, the case was unfavorable and unpromising. Chloroform having been administered, and the patient being placed on his sound side, Assistant Surgeon C. Wagner, U. S. A., made an incision four and a half inches in length, extending from just below the FIG. ?6.-Heail of ri"-M anterior superior spinous process of the ilium toward the tuberosity of the ischium, crossing the trans- femur excised lor caries fol- verse incision previously made over the trochanter major to permit free exit of pus. The thigh was lowing a gunshot fracture. . Spec. b7i6, Sect. I, A. M. M. flexed and rotated inward, the tendons of the muscles were divided, and a chain saw was passed under ^ and between the head of the femur and the trochanter major, and the bone was sawn through the neck, the soft parts being protected by spatulas. About one inch of the trochanter major was found to be necrosed, and was removed by a small saw. No blood was lost during the operation. The patient sank rapidly, and died September 28, 1834, of exhaus tion. A. post-mortem examination revealed nothing of note, except slight caries of the acetabulum. The carious head of the femur was sent to the Army Medical Museum, and is represented in the adjacent wood-cut (FlG. 76). The fragments of the neck and the necrosed trochanter major were lost. SECT. IL) EXCISION AT THE HIP AFTER SHOT INJURY. 119 Of the eleven secondary excisions at the hip five were on the right and six on the left side. The pathological specimens were preserved in six instances. TABLE XIII. Summary of Eleven Cases of Secondary Excision of tlic Head of the Femur for Shot Injury. No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY NATURE OF I::JI:RY. DATE OK OPERA TION. OrF.RATio:; AND OPERATOR. RESULT AND REMARKS. 1 1 Brown, J., Pt., I, 3d Mich Aug. 29 Musket ball perforated the loft Mar. 01. Necrosed fragments extracted ; Disch d Aug. 23, 1863, and pen igan, age 38. 1862. thigh, fracturing femur just 1863. shaft of lemur divided six ins. sioned. Appointed postmaster below the trochanter miner. below tip oftroch. minor. The in 1867, at Coopersville, Mich. head, neck, and trochanters, and the masses of callus ad Able to attend almost entirely without assistance to the busi - hering to the trochanters were ness of the office. Paid pen then removed, straight incis. sion March 4, 1876. Spec. 1192, eight ins. long, by Surgeon A.M.M. Pliot. Ser. 110.A.M.M. D. P. Smith, U. S. V. 2 Tilliston, G. W., Pt., D, 1st July 7, Rifle ball enter d the right groin. Sept. CO, Head and neck of femur ex (Disch d July 21, 1861.) July, Ohio Light Artillery, age 44. 1861. passed backward, fractured the head and neck of femur. 1861. cised, by Dr. E. Sterling. 1867, fistulousopeningdischarg- ing purulent matter. Three ins. and lodged in large muscles shortening. Pens ner died Sept. of buttock. 6, 1871, of as henia. Autopsy. Spec, f.590, A. M. M. 3 Pease, T. W.. Pt., H, 19th July 1, Conoidal ball fractured upper Nov. 8. Fomur divided five ins. below Portions of fomur had been pre Indiana, age 26. 1863. third of right femur, passed 1871. the trochauter and unjointcd viously removed. Patient had thro trochanter and lodged from acetabulum, by Dr. J. been disoh d Aug. 8, 1864. In behind trochanter major, fol lowed by chronic ostitis and K. Bigelow, late Surgeon 8lh Indiana. Sept., 18^, the pensioner had "nearly a perfect art hrodial joint coxitis. at hip. and was able to attend to the ordinary duties of a deputy marshal. 4 Frain, H., Pt., G, 31st Mas Feb. 1, Left thigh perforated by a co Mar. 24, The femur was divided by the Died March 30, 1865. Circ. 6, sachusetts, age 22. 1865. noidal ball ; the neck of the 1865. chain saw just below the tro S. G. O., 1865, p. 72. Circ. 2, femur was fractured. chanter minor; the head of S. G. O., 1869, pp. 54, 137. the femur was removed with out difficulty; Surg. A. M. McMahon, U. S. V. Incision four ins. long. 5 Henry, W. J., Ensign, 21st Tune 21, Comminuted shot fracture of Aug. 2, Head of femur exarticulated, Died August 8. 1864. Circ. 2, S. Mississippi, age 22. 1864. upper third of left femer by a 1864. shaft sawn below trochanter G. O., 1869, pp. 52, 137. conoidal musket ball. minor, six inches of bone re moved, by Surg. J. B. Read, C. S.A. Incis. seven ins. long. 6 Hunt, E., Pt., D, 71st Penn Sept. 17, Conoidal ball grazed the neck Feb. 23, Opening on inner side of thigh Died Feb. 25, 1863. Spec. 3907, sylvania, age 24. 1862. of the right femur und passed 1863. enlarged, neck of the femur A. M. M. Circ. 6, S. G. O., 1865, out at the nates. divided with lion-jawed for p. 66. Circ. 2, 1869, S. G. O., ceps and head of bone re pp. 49. 137. moved, by Ass t Surg. II. A. DuBois, U. S. A. 7 Netting, J. W., Pt., K, 1st June 30, Musket ball comminuted neck Aug. 21, Head of bone removed, several Died August 25. 1862, of hemor Massachusetts, age 25. 1862. of right femur; head of bone 1&J2. fragments extracted, and the rhage. Spec. 400, A. M. M. Circ. entirely separated. jagged extremity of the neck 6, S. G. O.. 1865, p. 62. Circ. 2, smoothed by an osteotome. S. G. O., 1869, pp. 48, 137. by Ass t Surg. R. Bartholow, U. S. A., thro vertical incis 8 Roth, J., Pt., B, 188th N. Feb. 6, Anterior part of head of left Mar. 9, The neck of the femur was Died June 17, 1865. Circ. 6, S. York, age 25. 1865. femur shattered by a round 186"). divided near the head of the G. O., 1865, p. 74. Circ. 2, S. ball, which lodged in same. bone by a ch ain saw; the head G. O., 1869, pp. 53, 137. of the bone with the ball in serted was then removed, straight incision, by Assistant Surg. J. Vansunt.U. S. A. 9 2 Toney, A., Pt,, A, 16th N. Tune 30, Head of the left femur slightly Aug. 12, Head of femur sawn off and Died August 19, 1863, from ex Carolina, age 43. 18b3. fractured by a conoidal bail 1863. the ball removed from the haustion, of hectic fever. that lodged in acetabulum. cotvloid cavity, by Surg. J. B. head, P. A, C. S.; straight incision. 10 Woodworth, H., Pt., A, 4th May 1 1 , A conoidal ball grooved the July 1, Head of femur disarticulated Died July 2, 1864. Spec. "049, Vermont, age 18. 1864. left femur anteriorly at the 1864. arid upper extremity of bone A. M. M. Circ. 6, S. G. O., 1865, level of the lesser trochanter rca dily turned out and sawn p. 70. Circ. 2, S. G. O., 1869, and lodged underthe sartorius just below the point of impact pp. 52, 137. muscle and was removed. of the ball, by Surg. R. B. Bmtecou, U. S. V.; carved incision. 11 Zaborowski, J., Pt., H, 7th Vug. 16. Conoidal ball fractured the Sept. 27. Chain saw passed under and Died September 28. 1864, from Connecticut, age 33. 1864. neck and slightly injured the 1864. between the head cf femur exhaustion. Spec. 3716, A. M.M. head of the right femur. and trochanter majcr and the bun o sawn through the neck; an inch of trochanter major, found to be necrosed, removed by small saw, by Ass t Surg. C. Wagner, U. S. A.; crucial incision. SMITH (D. P.), Gunshot Wounds of the Great Trochanter, in Am. Med. Times, 18G3, Vol. VII. p. 12. Circular No. 6, S. G. O.. 1865, p. 65. Circular No. 2, S. G. O., 1869, pp. 50, 137. 2 READ (J. B.), Resections of the Hip Joint, in Confederate States Med. and Surg. Jour., 1864, Vol. I, p. 6. Evu (P. F.). A Contribution to the History of tlie Hip Joint Operations performed during the late Civil War, in Transactions of the American Medical Association, Vol. XVill. p. 256. Circular No. 2, S. G. O., 1869, pp. 51, 137. 3 WAGNER (C.), Report of Interesting Surgical Operations performed at the U. S. Gen. Hasp., Beverly, N. J., 1864, pp. 14, 15. Circular No. 6, ST G. O., 18C5, p. 70. Circular No. 2, S. G. O., 1869, pp. 53, 137. 120 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Since the termination of the civil war the operation of excision at the hip for shot injury has been practised five times in the service of the United States Army and once in the service of the United States Navy, and this aggregate of six excisions 1 gives the 1 Four of the operations are described at length in A Report of Surgical Cases treated in the Army of the United States from 1865 to 1871, Circular No. 3, War Department, Surgeon General s Office, Washington, 1871, pp. 228-234, and the facts regarding them will be here briefly recorded, two of the cases are hitherto unpublished, and will be narrated more in detail. Two of the excisions were primary, one intermediary, and three secondary opera tions. The first case was that of Private Hubert Erne, Co. D, 4th Infantry, aged 48 years, wounded December 2, 1869, while acting as one of a corpo ral s guard of the mail wagon from Fort Laramie to Fort Fetterman, in an attack by a band of Indians. He was struck in the left buttock by a round carbine ball (cal. 45, weight 225 grains), and fell to the ground. Ills comrades placed him in a wagon and drove rapidly to Laramie, over a very rough road ; he was struck at two in the afternoon and was placed in bed in the hospital at half-past seven, much exhausted, having driven thirty -two miles in five and a half hours. He had lost blood copiously. His extremities were cold, pulse almost imperceptible, and his countenance was pallid and covered with clammy sweat. The left lower limb showed shortening with eversion, the thigh arched with an anterior convexity. The entrance wound was an inch and a half behind the trochanter major on a slightly higher plane ; the exit aperture was near the centre of the groin just below Poupart s ligament, directly over the axis of the femoral artery. The diagnosis of Assistant Surgeon P. MEACIIA&I, post surgeon, was that there was fracture of the shaft, neck, and trochanters of the left femur. As he had not rallied from the shock, it was thought best to defer surgical interference until morning, and the limb was placed in a comfortable position, and the patient allowed half an ounce of brandy every half hour, while external applications of heat were made by hot blankets, heated sad-irons, and bottles of hot water. At midnight the patient had fairly reacted ; but complained of great pain in the middle of the injured thigh. He was ordered a fourth of a grain of morphia to be repeated in two hours if needed. At 7.30 A. si., December 3d, the patient was comfortable ; pulse at 90. No appetite and little sleep during the night. Temperature in axilla 99 F. Cold-water dressings to wound were applied, milk punch given freely, and an eighth of a grain of sulphate of morphia every two hours. At 1 P. si. Dr. MEACHAM, assisted by Assistant Surgeon J. B. GlKARP, U. S. A., placed the patient under chloroform and thoroughly explored the injury, after enlarging the entrance wound to admit the finger to ascertain the extent of shattering of the neck, trochanters, and shaft. No important vessels or nerves were involved. The patient was an old soldier; he had been a hard drinker; during the civil war had been more than once wounded, having on one occasion suffered a shot fracture of the lower jaw. After careful consideration of the Iccal and constitutional conditions it was determined that excision of the upper extremity of the femur would afford the patient the best chance of life. Dr. MEACHAM made a curvilinear incision seven inches in length, beginning an inch and a half above the trochanter major, traversing the entrance wound and extending downward in the axis of the shaft. Exposing the bone by rapid division of the muscular attachments, the fragments of the shaft were first removed and the pointed upper extremity of the shaft was then divided by the chain saw; then, with some difficulty, the head of the bone was exarticulated, and the operation completed. The exploratory incisions, consultation, and final excision occupied nearly an hour. Little blood was lost, and the patient promptly rallied, with little sign of shock. The upper part of the incision was united by sutures and adhesive strips. The man was put to bed with the injured limb extended, and a weight of four pounds attached by Buck s method. The wound had cold- water dressings, and the patient had an ounce Of brandy every hour when awake, and a quarter of a grain of sulphate of morphia every two hours. December 4th, the patient had passed a good night, and had a full pulse at 90. During the day he had nutritious diet, a half ounce of brandy hourly if awake, and two grains of quinia and an eighth of a grain of sulphate of morphia every four hours. Excised fragments of bone were cleaned and sent to the Army Medical Museum and preserved as Specimen 5658, of the Surgical Section, which are represented one-fourth the size of nature (FIG. 78). On December 5th, in the early morning, there was little change in the constitutional symptoms. The patient had slept four hours during the night. He was troubled with hiccough. He had partaken freely of freshly prepared essence of beef. At the surgeon s morning visit, at half past seven, twenty-grain doses of bromide of potassium were substi tuted for the morphia, and the other treatment and diet were continued, with the addition of canned oyster soup. At the evening visit, at nine, the hiccough had nearly ceased, the wound had begun to suppurate, the pulse was 100, the tongue was moist, and the thirst diminished. The dose of bromide of potassium was reduced one-half; the other treatment was con tinued. On the morning of December 6th he was found to have passed a restless night, annoyed by hiccough when awake. He complained of the extension, and the weight attached to his ** ".n..hod one-halt Whiskey was substituted for the left hip. [From a photograph.] brandy which he disliked, and a tincture of sesquichloride of gp ec 5(553 A. M. M. iron was given in twenty -drop doses, with two grains of sul phate of quinia every four hours. One-fourth of a grain of sulphate of morphia was ordered to be given when the pain demanded it. The patient was removed to a water-bed. On December 7th the patient was more comfortable and had slept well. He was annoyed by flatulence, the bowels not having moved since the reception of the injury. He was ordered a tablespoonful of castor oil and twenty drops of turpentine, and an enema of soap and water. The suppuration from the wound was quite copious. On the following day it was practicable to omit the anodyne, and the patient had a free evacuation of the bowels, with great relief. Tlio patient was allowed a small piece of beef-steak for his breakfast, and chicken for dinner. The discharge from the wound was profuse, and the integument over the hips and nates was somewhat abraded from heat and moisture. The weight attached to the foot was removed altogether. The patient was transferred from the water-bed to a mattress, in the middle of which was a movable portion corresponding with the pelvic region. This arrangement greatly facilitated the application of dressings and the use of a bed-pan. The patient was ordered three ounces of beef essence thrice daily and as much mill; as he should relish. On the 9th, he was found to have slept well without taking an anodyne. The suppuration was profuse. The pulse was at 100. The appetite was abundant. Hiccough was again quite troublesome. The bowels had not been moved since the 7th, and an enema of castile soap and warm water was ordered to be given daily, unless there should be an alvine evacuation before nine in the morning. During the next fortnight there were no symptoms of especial interest. The wound continued to suppurate, but less copiously, and was rapidly filling up with granulations. On December 2Cd the patient passed a very restless night. The surface was hot, and the pulse at 100; the appetite was gone; the abdomen was tympanitic. On December 2:id, he had several dejections, and had slept soundly during the previous night, and was in every respect much better. On January 1, 1870, his bowels were again obstinately constipated. Cicatrization of the wound was rapidly g"ing on. Citrate of iron and quinine was substituted for the sesquichloride of iron. Laxative enemata were required daily, and whiskey was still given. The obstinate hiccough ceased about the middle of January, at which date the pulse had fallen to an average of 90, and the wound had far advanced toward healing. For the next six weeks there was very little change in the daily record. The patient s convalescence progressed favorably, and by February 28th the wound was open at two points only. Constipation was still a troublesome complication ; the patient being annoyed by injections he was ordered to take a three-grain compound cathartic pill nightly. By the end of March the patient was able to sit up. There were still two fistulous sinuses leading SECT. II. | EXCISION AT THE HIP FOR SHOT INJURY. 121 gratifying result of four recoveries. Adding to the sixty-six cases of excision at the hip for shot injury performed during the War of the Rebellion the ninety-nine cases referred to in Note 1 on page 90 ante, and the six cases detailed in Note 1 commencing on page toward the cotyloid cavity. About an ounce of pus was discharged daily. The limb was about five inches shorter than the other. On April 10th the patient got on crutches, but could not walk far without fatigue. For the next twenty days he seemed disinclined to exert himself but was taken out every day in a wheeled litter. One of the sinuses had closed. By July 8th the patient had gained in flesh and strength, and the purulent discharge hud diminished to a few drops daily. The limb was swollen considerably and there was an erysipelatous blush extending below the knee. At this date Dr. MEACHAJI was ordered to Omaha, and the patient passed into the hands of Acting Assistant Surgeon L. S. TESSON, who, on July 20th, wrote to Dr. MEACIIAM that quite a large abscess formed in the muscles of the thigh. On August 9th, Dr. TESSON again wrote that it had been necessary twice t<> make incisions to evacuate abscesses in the thigh. Again, on March 9, 1871, Acting Assistant Surgeon A. J. HOGG writes that the man is entirely well, the cicatrix being perfectly sound; but the man persisted in lying in bed. On April 1, 1871, Dr. MEACIIAM reports that he had succeeded in getting his patient again under his personal observation, previous to which he had borne transportation in an ambulance for ninety miles, and appeared in better spirits at the end of the journey than when he set out. The wound had entirely healed, leaving a firm and sound cicatrix three inches in length. The patient was able to walk comfortably on crutches and had slight control over the limb, which admitted of a to-and-fro motion, with rotation inward. The upper end of the femur rested on the dorsum of the ilium, about one inch above the acetabulutn, and was movable in that position. There was six and a half inches shortening. The patient was somewhat hypochondriacal, being greatly troubled with indigestion and irregular bowels. A photograph of the patient, taken at Omaha, March 30, 1871, is copied in the wood-cut (FIG. 77). Private Hubert Erne was discharged from service May 18, 1871, and by an order dated A. G O., June 9, 1871, was sent to the Soldier s Home, near Washington. In answer to an enquiry from this Office, Surgeon C. H. LAUI; reported : Hubert Erne, late of the 4th Infantry, was received in hospital at Soldier s Home on July 16, 1871, in a very emaciated and feeble condition, the result of chronic diarrhrea. Having during his residence here exhibited symptoms of partial insanity, and having no facilities for the proper care of such cases, he was transferred to the Government Insane Asylum, near Washington, August 20, 1871, at which place it is reported that he died a short time after his admission." Then Dr. C. H. NICHOLS, Superintendent of the Government Hospital for the Insane, reported that the patient " was admitted August 19, 1871, to be treated for acute insanity, and that he died Nov. 7, 1871, from exhaustion, of acute mania. No autopsy was made in the case. 1 Another primary excision at the hip for shot fracture of the upper extremit.y of the femur was practised at Fort Concho, Texas, in 1874, by Assistant Surgeon W. F. BUCHANAN, U. S. A. The fracture was attended with very extensive longitudinal splintering, and it would appear that such conditions involve incisions of such perilous magnitude as to afford the slightest prospects of success even under the most favorable attendant circum stances. The abstract of this case has not, at this date, (June 1, 1878), been published in print. Sergeant T. Duncan, Co. K, 25th Infantry (Colored), aged 27, was shot in the left hip while a prisoner and attempting to escape from his guard at Fort Concho, Texas, on the morning of November 24, 1874. On receiving the injury, which was produced by a conical rifle ball at a distance of about sixty yards, he fell to the ground, when he was placed on a wheeled litter and was conveyed to the Post Hospital. At 9.20 A. M. an ounce of brandy with half a grain of morphia was administered. An examination externally exhibited a wound of entrance in the gluteal region, on a line with the lower border of the great trochanter, and about mid way between the trochanter and the tuberosity of the ischium ; the wound of exit existed in the anterior part of the thigh, same side, about an inch and a half below Poupart s ligament and one inch external to the femoral vessels. The mobility, crepitus, probing, etc., proved that the upper part of the shaft of the femur had been shattered ; a compound comminuted fracture, doubtless extending within the capsule. Venous haemorrhage was taking place from the wound in the gluteal region, and great pain was felt in touching the great trochanter and in the knee. There was also great nervousness, and quick and feeble pulse. He was placed on his right side, the injured leg supported, the body bolstered, and the haemorrhage controlled by pledgets of lint saturated with a solution of persulphate of iron. Cold-water dressing was applied, a tin warmer filled with hot water applied to the feet, and a quarter of a grain of sulphate of morphia together with an ounce of brandy was given every two or three hours. On the following day, at 11.30 A. Ji., the patient was quite nervous, suffering great pain, and only relieved by the full effects of the anodyne, having slept little during the night and eaten nothing but a little beef essence ; pulse 120 and small ; tem perature normal. It was decided that resection offered him the only chance to survive. He was therefore placed on the operating table and brought under the influence of the anaesthetic, consist ing of one part of chloroform and two of ether, when a longitudinal incision about eight inches in length was made, commencing just above the trochanter and extending in the axis of the head and neck of the bone, and the soft parts were dissected away. The upper end of the shaft being found much shattered and the fracture extending within the neck, the head of the bone was exurticulated and the fractured extremity removed with the chain saw. About five inches of the shaft, with the head and neck, were exsected. No arteries were cut, and but one small vein was ligated. All the p ~ () si *t i fragments of bone, about forty, were removed, the parts washed out and a weak solution of per- upper extremity of the manganate of potassa applied, the sides of the wound being united with interrupted sutures sup- left femur. Spec. 6313. ported by adhesive straps. The patient was then placed in bed, position maintained by sand bags, of the same specimen. and cold-water dressings instituted. As soon as he had recovered consciousness, brandy and morphia were given and repeated frequently. Warmth was applied to the feet. The patient was of great muscular development, and the incision required to be lengthened an inch or so to allow of necessary retraction. His pulse was about the same as before the operation, rather full. Although relieved of the pain he had suffered previous to the operation, he continued restless, constantly trying to change his position, groaning, etc., and died on the morning of November 26th, about fourteen hours after the operation." The excised portion of the fractured femur, represented in the wood-cuts (FIGS. 79, 80), with the history, was contributed to the Museum by the operator, Assistant Surgeon W. F. BUCHANAN, U. S. A. Of the excisions at the hip after shot injury, practised since the close of the civil war in the United States Army, one was an intermediary operation performed by Surgeon GLOVE:: PEUIN, U. S. A., at Newport Barracks, Kentucky, in August, 18G7 : CASE. Private Francis Ahearn, aged 30 years, U. S. General Service, was wounded at Newport Barracks, Louisville, on July 31, 1867. He was a prisoner in the guard-house, and was shot by a sentinel while attempting to escape. The ball entered behind and below the prominence of the right trochanter major and passed inward and upward, emerging on the anterior part of the thigh, two inches below Poupart s ligament, a little to the outside of the course of the femoral artery, having shattered the upper part of the femur, the fissures extending within the joint. The wounded man was immediately taken to the Post Hospital, and was examined by Colonel PEUtX, the surgeon in charge. The patient had been an habitual drunkard for years and had mania apotu when shot. The shock of the injury was so great that an operation was not considered advisable. It was determined to adopt a supporting treatment, and to endeavor to build up the general health, with a view of operating at the first favorable moment when a good result could be reasonably anticipated. On August 26, 1867, the patient was in a better condition than at any time subsequent to the reception of the injury. The pulse was at 90 : there had been troublesome diarrhoea, but it was some what abated; the injured limb was much wasted, except at the upper part of the thigh, where it was greatly swollen ; the discharge from the wound was very copious, and there was extreme pain on the slightest movement. There were abscesses about the joint communicating with its cavity. Excision having been decided upon, Surgeon PEBIN, assisted by Assistant Surgeon T. E. WlLCOX, U. S. A., proceeded with the operation. The patient being rendered insensible by a mixture of chloroform and ether, the entrance wound was enlarged by a straight incision downward and three SURG. Ill 16 FIG. 80. Posterior view 122 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 120, wo have a total of one hundred and seventy-one instances of excision at the hip for shot injury, of which one hundred and forty-eight, or 86.5 per cent, proved fatal. Forty- three _of the operations were primary, with forty deaths, or 93 per cent.; sixty were inter- inches in length. The head of the bone was disarticulated, and the shaft was sawn several inches below the lesser trochanter. The wound was then cleansed and approximated. Scarcely any haemorrhage took place, no ligatures being required. On recovering from the anaesthetic, the patient com plained of great pain and nausea. Brandy was administered, and half a grain of sulphate of morphia ; but there was such irritability of stomach that everything was rejected. A quarter of a grain of sulphate of morphia was then administered hypodermically, and this relieved the pain. But there was no decided reaction, and, sinking gradually, the patient died from the shock of the operation twenty hours after its completion. No autopsy was made. The shattered excised bones were sent to the Army Medical Museum, and are represented in the adjoining wood-cuts (Fics. 81 , 80). Many of the fragments were carious. Of the six cases of excision at the hip joint practised on account of shot injury in the United States since the civil war, three were successful secondary operations. Two occurred in the United States Army and one in the United States Navy. The first of the operations was performed by Assistant Surgeon J. R. GIBSON , in August, 1868. Tlio patient recovered with a very satisfactory control of the functions of the articulation and limb. A detailed report of the case was published in Circular No. 2, S. G. O., 1869, pp. 117-120, and in Circular No. 3. S. G. O., 1871, p. 228, an account of the pensioner s progress was given, with a lithograph plate showing the appearance of the injured limb three years subsequent to the operation. The following is the condensed abstract of the case as published in Circular No. 3: " Private Charles F. Read, Co. I, 37th Infantry, while in a stooping posture, and distant about one hundred feet, was shot by a sentinel at Missouri Bottom, New Mexico, on June C, 18G8. The ball struck about the middle of the posterior aspect of the left- thigh, causing an injury to the bone, the nature of which is shown in the accompanying wood-cut (Vic,. 84), illustrating the specimen contributed to the Army Medical Museum by the operator, Assistant Surgeon J. FIG. 81. Shattered upper R GIBSON, U. S. A. The case being fully detailed in Circular No. 2, S. G. ()., 18G9, page Fin. 80. ?xeised for caries following ^^ reference will only be made to the more salient points, and to information received since f * ne sam Posterior view me specimen. shot fracture. Spec. 5489. the publication of that report. After weeks of temporization, during which the patient, a young man in the prime of life, had become much exhausted from numerous and futile searches after the missile, from bedsores, profuse suppuration, an irritable diarrhoea, and pain so intense as to require the administration of an anaesthetic previous to dressing the wound, the choice lay between a lingering death or excision of the head of the femur, or the more fearful and precarious alternative of amputation at the joint. On August 14th the patient expressed willingness to submit to any operation that would afford relief, when he was anaesthetized for the purpose of again freel}- examining the parts, and performing such operation as should be considered necessary. Upon explorations of the wound with the probe and finger, the ball was discovered in the head of the femur, a T-shaped incision was made over the joint, the head of the bone was turned out of the acetabulum, and was sawn through the neck, just within the greater trochanter. The incisions were closed with metf.llio sutures, and the limb was temporarily placed between splints, with a pillow under the knee. A Smith s anterior splint not being on hand, nor the material procurable for making one, a long external splint, made in two parts, and connected by iron braces, was devised and put in course of construction. The after treatment consisted in oarbolized dressings to the wound, the administra tion of antiperiodics to control a fever of a remittent type (at one time supposed to be the precursor of erysipelas or pyaemia), and a plain nutritious diet. Notwithstanding frequent displacement of the limb from occasional attacks of diarrhoaa, and the absence of a proper apparatus to secure immobility, the performance of this formidable opera tion seemed to have imparted a new tenure of life. By November 20th the patient was able to walk about the hospital, and the further progress of the case was as rapid as it was favorable. On May 10, 1SG9, this soldier was discharged the service and pensioned for total and permanent disability, the injured member being shortened one inch and three-quarters. He came across the plains by the next train, and, in September, 18G9, reported at the Surgeon General s Office, where a photograph was taken. At that time the patient s general health was excellent ; the cicatrix was perfectly firm and sound, and the strength of the ligamcntous attachments and the amount of control over the movements of the limb were very remarkable. He could bear much weight on the limb. He was supplied with a prothetic apparatus and advised not to use it straightway, but to continue exercising the limb continuously for some months, thereby increasing the strength of the muscles and ligamentons attachments, and the freedom of the newly-formed joint. The next week Read went to New York, where the pro posed apparatus was ingeniously applied by Dr. E. D. HUDSON . In the summer of 1870, it WHS reported that this man could walk very comfortably with a cane either with or without appa ratus. The appearance of the patient is shown in the accompanying wood-cut (FIG. 83.) In June 1871, three years after the operation, the man was in very good health, and could walk almost as well as ever." He was last paid on September 4, 1877. The next secondary operation was performed by Surgeon W. E. TAYLOR, U. S. Navy. A report of the case was published FIG. 84. -Excised in Circular No. 3, S. G. O., 1871, p. 232: Charles B. Scott, a seaman of the U. S. Navy, aged head of left femur the limb 34 > f f a r general health, was wounded in an attack on a piratical vessel in Tecapan River, west ^Jlgj-ctJj^iV <O coast of Mexico, June 17, 1870, by a rifle ball, fired at a distance of about eighty yards. He 5575. was conveyed a distance of seventy miles to the U. S. ship Mohican, on board of which lie was treated for several days, and finally transferred on July 12th to the Naval Hospital, Mare Island, California. The wound of entrance was small, and situated a little below and about two inches posterior to the top of the left great trochanter. He rested entirely on the right side, with the Injured limb partially flexed and resting on the sound one, the whole limb being inverted and shortened about one inch. Cold-water dressings had been applied to the wound and anodynes administered when required. His general condition was decidedly below par. The least movement in the injured joint caused severe pain ; he did not sleep well, and his appetite was poor. Full diet, with milk and an anodyne at night, were ordered. .On July 14th an examination of the wound was made. No anaesthetic was used, and the result was unsatisfactory. However, appearances led to the belief that the neck and probably the head of the femur were fractured; the ball could not be felt. The joint was not swollen but was very sensitive, and there was a scanty sanious and fetid discharge from the wound. On July 25th the patient was chloroformed, and Surgeon \V. E. TAYLOR, U. S. Navy, made a single straight incision, seven or eight inches long, and found the neck and head extensively comminuted; he then sawed off the bone just below the trochanter minor, and removed the fragments, some twelve or fourteen in number, as also the ball, which seemed to have struck the neck obliquely, breaking it into three pieces, and then passed into the head, shattering it into nearly a dozen pieces. Very little blood was lost, two small arteries only requiring to be secured. After syringing the wound with a weak solution of permanganate of potash, it was partially approximated by four sutures, and the limb was placed in an ordinary fracture box, and dressed with oakum. The operation was well borne, and reaction prompt. Stimulants, with nutritious diet, were ordered, and rigid cleanliness was enforced. On the 27th the patient began to suffer from decubitus. On the evening of the 29th he became delirious ; pulse 130 J,I IG 3 _ Appearanc fifteen months after the operation. SECT. II.] EXCISION AT THE HIP FOR SHOT INJURY. 123 mediary, with fifty-eight deaths, or 96.6 per cent.; forty-one, with twenty-six deaths, or 63.4 per cent., were secondary; and, in twenty-seven instances, with twenty-four deaths, and irritable. Hydrate of chloral being substituted for morphia, he went to sleep in a few minutes, and next morning awoke refrethed and feeling better than at any time since the accident. The pulse fell to 100. On the 31st, the sutures were removed. The good effect of the chloral was very marked, but, by August Cth, it seemed to have lost some of its effect ; whereupon morphia was combined with the usual dose, and he slept well. The discharge from the wound was small in quantity and laudable. On August 8th, some exten sion of the limb was made, but was badly borne. By the 14th, the patient was doing well in every respect. On the 21st, all dressings being removed from the limb, it was thoroughly bated and rubbed, after which it was replaced in the fracture box, when extension and counter-extension were made by means of the ordinary perineal band and screw. This was discontinued on the 2Gth, owing to enlargement of the inguinal glands and the general malaise and discom fort experienced by the patient. On the 30th, the use of anodynes was discontinued, as he could sleep without them. September 1st, found the patient improving, the discharge from the wound being moderate, with an entire absence of inguinal trouble, bedsores, and excoriations. Slight passive motion was commenced in the limb, and it was allowed to rest lightly on a pillow for several hours. On the 7th, he was able, for the first time, with assistance, to leave his bed. After this he continued to sit up several hours daily, and, gaining in flesh, was able, by the 18th, to walk on crutches. He continued to take daily a moderate amount of out-door exercise, the limb meanwhile being supported and steadied by means of a wire splint, and his general condition became excellent. On December 27th, he went by steamer to San Francisco, a distance of fifty miles, and returned in the evening, having borne the journey well. On January 20, 1871, a prothetic apparatus was adjusted to the limb, which, at the beginning, proved highly useful. On February 1st, the patient was transferred to the new Naval Hospital. At this time his general health was excellent. The left buttock was somewhat flattened, and there was a small opening about the centre of the line of incision, which discharged a small quantity of pus; the limb was about three and a half inches shorter than its fellow, the knee being quite stiff and foot everted (FIG. 8(>)- The patient had gained about thirty pounds since the operation of excision, and there was a probability of his being able to walk quite well without the aid of crutches. Scott was discharged April 18, 1871, at Mare Island, California, and pensioned. Drs. R. V. WAI.SII and J. S. GUNNING, of Enniskillen, Ireland, certified, Sep tember 4. 1875: "There is a fistulary opening connected with the -_ , . , ... bone. The leg is greatly wasted, being one-third the size of the sound FIG. 80. Anterior and posterior views of the >per extremity of the left femur. Spec. 5884. le S- Dr. JOHN ST. Cl,AIR GUNNING certified, October, 17, 1877: upper FIG. 86. Appearance of limb "Charles B. Scott, who died at Omagh, Tyrone County, Ireland, on seven months after P eration - the 1st day of July, 1877, was under my professional care, and his death was caused by chronic cystitis, the result of a very extensive and severe injury to his hip joint." The specimen 5884 is preserved in the Museum and shown in the accompanying wood-cut (FIG. 85). The third of the secondary operations of excision at the hip joint for shot injury was practised at Fort Fetterman, Wyoming Territory, in September, 1877, by Assistant Surgeon JOHN V. K. HOFF, U. S. A., who has furnished a detailed report of the case, from which a condensed abstract is made: Sergeant William J. Linn, Co. M, 4th Cavalry, aged 22 years, was wounded in a fight with Cheyenne Indians during the Powder River Expedition, November 25, 1876. The bullet (probably conoidal, calibre .50 inch, weighing 412 grains) entered the right groin three inches below and slightly internal to the anterior superior spinous process of ilium and two and three-fourth inches external to the symphysis pubis, passed obliquely backward through the hip joint, fractured the neck of the femur, notched the posterior segment of the rim of the acetabulum, and emerged at a point about one inch posterior and exterior to the notch in the acetabulum. The wound was received while the soldier was resting on his right knee and left foot in the act of discharging his carbine. The patient was immediately earned to the rear and a plaster of Paris badge applied. He was moved on a travois over an almost impassable country, during weather so cold that mercury froze, and reached Supply Camp on the third day. Here the plaster bandage was reapplied and the patient was placed in an ambulance and carried to Cantonment Reno, reaching the latter place after a five days jour ney over a country where roads are unknown, in weather of the utmost severity, and under circumstances of hardship which skillful care and unremitting attention could but little alleviate. A week after his arrival at Reno, the plaster bandage was removed, the limb was elevated, and the wounds of entrance and exit, which were discharging pus freely, were treated with simple dressings. The wound of entrance closed in four weeks, and, though the wound of exit was still discharging, an immense abscess formed in and about the joint, which pointed in anterior cicatrix, finally opened spontaneously, and remained so for several months. A light extending weight was used fur a short time, no medicine given except morphia occasionally fur pain and physic for constipation. On March 24, 1877, the patient was transferred to the post hospital at Fort Fetterman. The journey was accomplished in five days on a stretcher slung in an arm} wagon. When admitted he was very emaciated, pale and pain-worn, and weighed about 100 pounds, having lost 80 pounds since the recep tion of the injury. Two suppurating sinuses led into the articulation and there was fibrous anchylosis of both hip and knee joints. The patient had not moved from a recumbent ._ position since he received the injury, and could not even be raised upon a bed-pan without great pain. Tonics anda generous diet wereordered, the wounds were dressed with carbolic acid solution. The bowels were freely opened and kept regular. When the patient had fairly recovered from the exhausting effects of the journey a side splint was applied which enabled him to be moved without pain. Notwithstanding the most careful attention the patient Y\r, ffj \pncarance of gradually failed, and grew so feeble and complained so much of pain that it seemed but a limb ten months after oper- question of weeks between an operation or death. On September 28th, Assistant Surgeon ation. Side view. j y R HOFF, U. S. A., excised the hip joint after SEDII.LOTT S method. A circular incision was made to include the great trochanter and opening into the joint, the capsular ligament was severed, the head of the femur was thrown out and removed by the chain saw at a point just below great trochanter. The head of the femur (proper), which had been severed by the bullet at its neck, was found lying loosely in the acetabulum partially absorbed, and was easily removed by forceps. Ether was used; insensibility induced in seventeen minutes and maintained one hour and ten minutes; reaction was rapid and satisfactory. Antiseptic dressings were used. A double splint to fit both legs, made of light iron, reaching to the waist and there secured by a belt, was applied. This proved most useful in enabling the patient to be moved with comparative ease, and, at the same time, keeping the wounded parts measurably immovable. Extension was applied by means of tin plates FIG. 88. Anterior view of the s;une. 124 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. or 88.8 per cent., the period of the operation was not stated. Grouping the one hundred and seventy-one cases of excision at the hip, according to the time or the occasions on which the injuries were received, we find that of sixteen operations performed before the American war, 1860-65, one proved successful, and that in a second the patient survived after con secutive amputation; that four fatal operations were performed during the insurrection in Poland, 1863, and the campaign in Schleswig-Holstein, 1864; that six excisions at the hip with two successes were performed during the Austro-Prussian War of 1866; that of seventy-one operations done in the Franco-Prussian AVar of 1870-71, eight were success ful; that once, at least, excision at the hip was unsuccessfully performed during the Russo- Turkish War, 1876-77, and that in one instance the hip joint was successfully excised for shot injury in 1876, in California; that of the sixty-six cases of excisions at the hip per formed for shot injury received during the American civil war, six proved successful; and that finally, of the six cases performed in the service of the United States since the close of the American war in 1865 to the present time (1879), four were attended with success. Of the six survivors of excision at the hip performed on patients wounded during the American civil war, two only were living in the early part of 1879: Brown, of Grand Rapids, Michigan (CASE 261, ante), and Pease, of Indianapolis, Indiana, (CASE 263, ante); both were examples of recovery from secondary excision. Brown can bear his weight upon the injured limb, can walk across a room without the aid of crutches or cane, but ordinarily uses a support. Pease, with the assistance of a "six-inch lift," can walk quite well with a cane. Tilliston, the third survivor of secondary excision, lived until Septem ber 6, 1871, ten years after the operation. He was unable to bear any weight on his limb, and was obliged to wear crutches. He succumbed to most extensive necrosis of the pelvic bones and femur, with huge recurring abscesses. In the case of Cannon, the sur vivor of primary excision (CASE 206, ante), the limb was useless for purposes of locomo tion. He died of diphtheria, in 1865, eighteen months after the injury and operation. Of the two survivors of intermediary excision, Lieutenant /. M. Jarrett (CASE 239, ante) went to his home in North Carolina, and was reported as doing well in September, 1864, ten months after the operation; walking about with a high-heeled boot and the aid of a cane. Persevering attempts to obtain further information regarding the ulterior history of three inches wide by twelve inches long 1 , secured to the log by adhesive straps and connected through eyes, at their extremities, by elastic tubing, to a twenty-one pound weight, playing over a pulley. The tubing passed through a piece of board twelve inches long, secured below the foot piece, thereby preventing pressure on the malle<;li. This arrangement answered the purposes of extension admirably, while counter-extension was effected by elevating the foot of the bed. The patient s convalescence was very tedious. lie suffered from bed-sores and almost continuous pain, requiring the constant administration of opiates nnd anodynes; but gradually improved, and, on December 9th, Dr. llOFF notes: "From this date there was scarcely an untoward symptom. Convalescence progressed slowly but surely; stiirncss of the muscles disappeared entirely about the 15th instant. Tympanitis lasted three days. Spasm persisted, but with greatly reduced violence, nearly two weeks after the extension-weight was removed, December 27th. The patient had daily exercise, FIG. 88a. Excised upper ex- and, on Januarv 10, 1878, took his first walk in the open air. The discharge grew less in vir M, T 3., ct , ,., tremi tv of riffht femur- anterior """ * OBtenot \ ie\\ 01 view Spec C787 amount, and, on January 15th, the dressings were entirely removed. February 17th, the the same. partial anchylosis of the right knee joint not having been fully overcome by passive motion and mechanical appliance, ether was administered and the adhesions thoroughly broken up. There was partial bony anchylosis, the patella at portion of superior external border was firmly joined to femur, and in the breaking down suffered fracture. The limb was placed in a straight splint, and on the third day passive motion was instituted. March 18, 1878, the patient was ordered to join his regiment. The false joint at the hip had all the motions of its predecessor in a somewhat limited degree, and, though capable of sustaining the patient s weight while walking, was not yet equal to any great exer tion, but daily gained in strength. In other respects the patient s health was in admirable condition. Apparent shortening of the limb one inch. The resected upper extremity of the femur was contributed to the Army Medical Museum by the operator, and is numbered 0787 of the Surgical Section. It is shown in the wood-cuts (FIGS. 88a, 8S&). In a letter to Dr. HOFF, dated Fort Clark, Texas, April 3C, 1878, Sergeant Linn writes : " Dear Sir: I write to you according to promise to let you know how 1 am getting along. I am feeling just as well as ever I did. My leg is improving in size and strength, but the hip joint is just about the same as when I left you. 1 weigh one hundred and fifty pounds now and am still improving." On July 10, 1878, Surgeon JOHN MoOKE, U. S. A., Medical Director Department of Texas, forwarded to the Surgeon General two photographs showing the appearance of the limb ten months after the operation. They are copied in the wood-cuts (Fir;s. 87, 88) on the preceding page. In a letter from Fort Clark, Texas, October, 1 878, Linn states that he " don t use a crutch at all, and only uses a cane when he goes to walk a long distance." SECT, n.] EXCISION AT THE HIP FOR SHOT INJURY. 125 this officer were unavailing. The second survivor of the intermediary operation, Hugh Wright (CASE 240, ante), excised May 27, 1864, walked well without crutch or cane, bearing his full weight on the mutilated limb. He lived until October 26, 1874; his death was ascribed to cardiac trouble. Of the six patients submitted to excision at the hip in the United States Army and Navy since 1865, four recovered. Assistant Surgeon F. Meacham s primary case of Erne, 4th Infantry, aged 48 (Note 1, p. 120, ante), operated on December 3, 1869, lived until November, 1871. The patient walked comfortably on crutches and had slight control of his limb. Recovering thoroughly from the coxo-femoral lesions, he became a great sufferer from chronic diarrhoea, and, at last, was attacked with acute mania. The other three cases were examples of successful secondary excision. In the case of Charles F. Read, 37th Infantry (Note to p. 122, ante), wounded June 6, 1868, and successfully excised by Assist ant Surgeon J. R. Gibson, August 14, 1868, the result was exceptionally gratifying. In a letter from his home at Thornton s Ferry, New Hampshire, dated July 1, 1878, nearly ten years after the operation, Read was able to write that he thought he had a very good leg under the circumstances, and used no artificial appliance. His crutches he had laid aside since 1871, relying altogether on his cane, with which he "could get along very handily." He adds a minute account of the condition of the injured limb, showing indis putably an extraordinary restoration of the functions of the articulation. "I can use it so well," says Read, "that some think me falsifying when I tell them that the head of the bone is lost." In the secondary case of the seaman, Charles B. Scott, wounded June 17, 1870, on whom Surgeon W. E. Taylor, U. S. N., successfully excised the head of the femur, July 25, 1870, there was temporary relief. The patient regained comparative health and flesh, and partial use of the limb, exchanging his crutches for a cane; but necrosis invaded the articulation, and the patient succumbed July 1, 1877, while on a visit to his friends in Tyrone County, Ireland. In the case of Sergeant W. J. Linn, 4th Cavalry, wounded November 25, 1876, who underwent excision at the right hip by Assistant Surgeon J. V. R. Hoff, U. S. A., September 28, 1877; a year after the operation the patient s health was in admirable condition, and there was every prospect that the mutilated limb would regain as great a measure of utility as can be hoped for, under such circumstances. In October, 1878, he had discarded the crutch, and only used a cane when he walked long distances. Of the sixty-six excisions at the hip performed during the American civil war, forty- five were practised on Union and twenty-one on Confederate soldiers. Of the forty-five Union soldiers, four recovered, a mortality rate of 91.1 per cent.; of the twenty-one Confederates, two recovered, a fatality of 90.5 per cent. The side on which the excision was practised was recorded in sixty-one of the sixty- six cases, twenty-six being on the right and thirty-five on the left side. Three of the former, or 88.4 per cent., and also three of the latter, or 91.4 per cent., proved fatal. Six operations, viz: one primary, four intermediary, and one secondary, performed on patients under the age of 20 years, terminated fatally; twenty excisions, viz: nine primary, six intermediary, and five secondary, on patients, between 20 and 29 years, inclusive, presented three recoveries, one after a primary, and two after intermediary operations; of thirteen operations on men between 30 and 39, six were primary, four intermediary, and three, with two recoveries, were secondary; four excisions were per formed on patients over 40 years, two being fatal intermediary, and two, with one recovery, 126 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. secondary operations. In twenty-three of the sixty-six excisions the ages of the patients were not ascertained. According to the statistical arrangement of the cases of excision at the hip for shot wounds in the American civil war, as given in TABLE. X, p. 89, ante, the mortality of the primary operations was 96.9 per cent., that of the intermediary 90.9 per cent., while the fatality of the secondary operations was only 72.7 per cent. The results of the six e xcisions at the hip in the American Army and Navy since the civil war gave a mortality of 50.0 per cent, for the primary operations, of 100.0 per cent, for the intermediary, while the three secondary operations were all successful. Of the ninety-nine other cases of excision at the hip after shot injury, cited in Note 1, page 90, ante, of primary cases, 87.5 per cent, proved fatal; of the intermediary all perished, while, of the secondary, only 66.6 per cent, had a fatal termination. Aggregating all cases of excision at the hip for shot injury in which the results have been ascertained, we have a mortality rate of 93.0 per cent, for the primary, of 96.6 per cent, for the intermediary, and of 63.4 per cent, for the secondary operations. This result confirms what we have already stated on page 610 of the Second Surgical Volume, that the "excisions and amputations practised during the intermediary or inflammatory stage are by far the most dangerous, and should never be performed except as compulsory operations." The ratio of mortality in the secondary or ulterior operations is considerably less than that in the primary operations. But this fact should not lead to the conclusion that the primary operation is to be avoided. The dis astrous results attending cases of indubitable shot fracture at the hip treated by tempor- ization, as pointed out on page 88, ante, must induce the surgeon to desist from such an experiment, and to excise primarily rather 1 than submit the patient to the danger of the inflammatory period. 2 In nine 3 of the sixty-six cases of excision of the head of the femur performed for shot injuries received during the American civil war, the acetabulum was involved, and, although these nine cases terminated fatally, the successful operations of Assistant Surgeon J. V. R. Hoff, U. S. A., in the case of Linn (Note on page 123, ante], and of Drs. Schon- 1 Dr. JOHN* AsilHUUSl , jr. (Princ. and Pract. of Surgery, 1671, p. 165), declares that: "Gunshot injuries of the hip joint are universally regarded as among the gravest injuries met with in military practice," and, after reviewing the statistical and other evidence on the comparative advantages of expectant treatment, excision, and amputation, asserts that : " From these facts the conclusion is fairly drawn, that in any case of gunshot injury of the hip joint, primary excision should be preferred to any other mode of treatment, and this simply to increase the chance of life, without reference to the utility of the preserved limb. Of course there may be such extensive destruction of parts as to put excision out of the question, and in such cases the surgeon must still have recourse to what HEXXEX calls the tremendous alternative of hip joint amputation, an operation which may also be required secondarily, after an unsuccessful attempt to save the limb." Dr. WILLIAM THOMSON, formerly Brevet Major and Assistant Surgeon, U. S. A., who, as Acting Med ical Inspector of the Army of the Potomac and Surgeon-in-charge of Douglas Hospital, Washington, had excellent opportunities to investigate the subject of shot fractures at the hip joint, wrote to the compiler in 1868 : * * From a study of these cases, and others similar in character, it would appear that the fatal terminations, under expectant treatment, are due to the following causes : the joint becomes inflamed primarily or secondarily ; the capsule becomes distended by the products i.f inflammation, gives way, and the contents escape into the neighboring parts, and give rise to those extensive dissecting abscesses which are found at the autopsies, and which account so entirely for the fatal results. If these views should be accepted, a full and free incision into the joint, at an early period, would be the proper surgical procedure, and this is accomplished by its excision. The removal of the head of the bone severs, to that extent, the connection between the body and the lower extremity, prevents that constant disturbance at the joint that follows every motion of the body, and thus places the seat of injury at comparative rest. The division of the bone through its cancellated structure may increase the risk of osteomyelitis with its purulent infection, and experience may yet demonstrate that a full and free incision alone, in the primary stage, may be the best resource of surgery." (Circular No. 2, S. G. O., 1869, p. 114.) 2 LOSSEN (I.) (Kritgschir. Erf. aus Mannheim, Heidelberg und Carlsruhe, in Deutsche Zeitschr. fur Chir., 1873, B. II, p. 64) cites a fatal case of shot fracture of the neck of the femur and great trochauter, and remarks : "A primary resection of the joint, with removal or gouging of the trochanter major, might in this case have offered a chance for recovery. But it was probably difficult to ascertain immediately after the injury how far the joint was involved. -A secondary excision, from the general appearances (post-mortem) cited, gave very little prospect of success." FisCHEll (II.) (Kriegschirur- gische Erfahrungen, Erlangen, 1872, p. 201) remarks of shot fractures of the hip joint: " AH well-timed operative interference miscarries on account of the difficulty of the diagm>sis. . . I lament this difficulty and impossibility of exact diagnosis, because I believe that the best mode of treatment of* shot fractures of the hip joint is the primary resection of the joint , however difficult the execution of the operation might be." 3 CASE 209, p. 93, Private Charles Beard, 10th Miss.; CASE 224, p. 95, Sergeant S. Grimshaw ; CASE 235, p. 98, Captain T. R. Robeson ; CASK 236, p. 98, Unknown private of the First Army Corps ; CASE 237, p. 99, Unknown ; CASE 247, p. 105, Private C. E. Marston, 1st Massachusetts ; CASH 257, p. 109, Corporal H. C. Sennett, 122d New York : CASE 259, p. 110, Lieutenant D. N. Patterson, 46th Virginia; CASE 269, p. 118, Private A. Toney, 16th North Carolina. SECT. U.| AMPUTATIONS AT THE HIP JOINT. 127 born 1 arid Hupeden, 2 prove conclusively that an injury of the margin of the acetabulum does not preclude the operation of excision at the hip. When we consider the evidence adduced in the foregoing pages, and especially the fact that of one hundred and seventy-one patients on whom excision at the hip for shot injury is known to have been performed to the present date, twenty-three survived the operation, although in one instance the excision was followed by amputation at the hip (Neudorfer s case of Schranz, Note 1, on page 90, ante), and that the remaining twenty- two survivors had more or less use of the injured limbs, it must be admitted that the results of this operation, so far, have been encouraging, in an almost hopeless class of cases. AMPUTATIONS AT THE HIP JOINT.-In 1867, in a monograph on amputa tions at the hip joint, 3 it was stated that "fifty-three authenticated instances of amputations at the hip joint, performed on account of injuries inflicted by weapons or of lesions con secutive thereto," had occurred during the American civil war. Since that time, data of thirteen additional cases of this operation have been obtained, making, at the present time, a total of sixty-six cases of coxo-femoral amputations to be considered here: TABLE XIV. Numerical Statement of Sixty-Six Cases of Amputation at the Hip Joint. AMPUTATIONS. TOTAL CASES. RECOVERIES. DEATHS. RATIO OF MORTALITY. Primary "5 3 00 88 Intermediary *3 23 100 Secondary 9 77 7 Reampututions 9 6 3 33. 3 Aggregate 66 11 55 83 3 I have continued to divide these sixty-six operations into primary, intermediary, secondary, and reamputations, according to the plan adopted in the monograph of 1867, and the relative percentage of fatality of the secondary operations and of reamputations confirm me in the opinion expressed at that time, that the reamputations "should be sep arated into a distinct class, because they are quite numerous and widely differ in ttie risk attendant upon them from other secondary operations." Of nine cases of reamputations at the hip three only, or 33.3 per cent., were fatal; of nine secondary operations six, or 77.7 per cent., terminated in death. The subjects of the twenty-three intermediary exarticulations at the hip all perished, and of twenty-five primary amputations probably three were successful. As indicated in TABLE IX, page 65, an$e, in twenty-seven of the sixty-six exarticu lations the injury directly involved the hip joint. In thirty-two instances, the operations followed shot fractures which did riot extend beyond the diaphysis of the femur. In two of this scries and in seven examples in which the primary lesion implicated the knee joint, amputations in the continuity of the thigh had preceded the exarticulations at the hip. 1 See L AXGFABECK (B. von), Ucber die Schussfracturen der Geknlce und Hire Behandlung, Berlin, 1868, p. 16, and CASE 2-1 of Note 1, on page 00, ante. 2 See DEINIXGKR, Beitrdge zu den Scliustfracturen des HiJftgeknks untcr besonderer BeriicksicJitigung der Erfahrungen aits dent Fcldzuge 1870-71 und Benutzung der Acten des Koniglichen Kriegsministeriums, in Deutsche Militairdrztlichc Zcitschrift, 1874, B, III, p. 300, CASE No. 37; and CASE No. 63, in Note on page 91, ante. 3 OTIS (G. A.), A Report on Amputations at the Hip Joint in Military Surgery, Circular No. 7, War Department, Surgeon General s Office, July 1, 1867, Washington, p. 20. 128 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. In the subjoined foot-note 1 an endeavor is made to compile a correct record, in chrono logical order, of the published authentic examples of amputation at the hip joint in military LARREY (D. J.) (Men. de Chir. mi!, et Camp., Paris, 1812, T. II, p. 180), A soldier of the French army of the Rhine, in 1793. Primary operation; died within a week. 2. WEXDELSTADT (Reminiscen:en, in IIUFELAXD s Neues Journal tier Practischen Arzneykunde, Berlin, 1811, B. XXVI, StUok 11, p. 110) relates: "I have seen and examined an Englishman, who served as a sailor in the British Navy, and who had lost at the bloody battle of Aboukir, August 1, 1798, the thigh from a cannon ball, and who had undergone the amputation of the probably splintered stump out of the acetabulum, and who survived the operation many years." 3. LARREY (D. .T.) (Rel. chir. de. I Armee. d Orient, Paris, 1803. p. 329), Bonhomme, officer of the 16th Demi-Brigade, Army of Egypt, 1799. Primary exarticulation at right hip; died of the plague on the eighth day. 4. LARKEY (D. J.) (Rel.cliir. de I Armee d Orient, 1803, p. 332), Drummer of 2d Light Demi-Brigade, Army of Egypt, in 1799, aged 20. Primary amputation at right hip; died in a few days. 5. LARREY (D. J.) (Mem. de Cliir., etc., 1812, T. Ill, p. 350), A French soldier at Wagram, July 6, 1809. Primary operation; died in three hours. 6. LAUUEY (D. J.) (Mim. de Chir., etc., T. Ill, p. 351), A French soldier at Wagram, July 6, 1809. Primary operation ; died within twenty-four hours. 7. BROWXRIGG (GUTHUIE s Commentaries, 6th ed., 1855, p. 62), A soldier at Elvas, 1811. Secondary operation ; died in eight days. 8. L.vUREY (D. J.) (Hem. de Chir., etc., 1817, T. IV, p. 26), A Russian soldier, in 1812. Primary amputation at left hip ; died on the twenty-ninth day from dysen tery. 9. LARREY (D. J.) (Mem. de Chir., etc., 1817, T. IV, p. 50), Lieutenant of Dragoons, Borodino, September 7, 1812. Primary; alive and well at Orcha three months after. 10. BROWXRIGG (AVEHILL (C.) (A Short Treatise on Operative Surgery, London, 1825, p. 217), Private 13th British Light Dragoons, December 29, 1811. Secondary operation December 12, 1812; recovery. 11. BROWXRIGG (A VERILL, loc. cit.), Particulars not recorded ; fatal. 12. G UTHIUE (G. J.) ( Treatise on Gunshot Wounds, 1827, p. 332), Private Mason, 23d British Infantry, in 1 812. Secondary re-amputation ; death in seven hours. 13. COOPER (SAMUEL) (Diet. Pract. Surg., 8th London ed., 1861, Vol. I, p. 116), A British soldier at Oudenbosch, in Holland, in 1814. Inter mediary operation; died in a few minutes. 14. COLK (Or. J. GUTHRIE, loc. cit., p. 351), A soldier at Bergen-op-Zoom, 1814. Secondary operation; died in twenty hours. 15. EMERY (GUTHRIG, loc. cit., p. 334), Sebastian de 1 Amour, Corp. Chass. Britt., Spain, August, 1813. Secondary operation July 21, 1814; death in thirty days. 16. GUTHRIE (G. J.) (A Treatise on Gunshot Wounds, London, 1827, p. 342), Duguet, 45th French Regiment, aged 25, Waterloo, June 18, 1815. Intermediary operation July 7th; recovered. Dugnet died in 1840 (GUYOX, Stat. da amputations pratiqutes a I Armee d Afrique, etc., pendant les anndes 1837, 1838, et 1839, in Gaz. Med. de Paris, 1841, T. IX, p. 106). 17. Mr. BUCKE (J. THOMSON, 06s. after the Battle of Waterloo, Edinb., 1816, p. 270), A British soldier, Waterloo, 1815. Secondary operation ; died in eight days. 18. B. BRODIE (G. J. GUTHKIE, On Gunshot Wounds of the Extremities, London, 1815, p. 116) operated, in 1814, unsuccessfully in a case of accidental shot wound. 19. QUARRIER (D.) (Med. Chir. Trans., 1820, Vol. VIII, p. 3), Seaman T. Sullivan, Algiers, 1816. Primary operation ; death in fifteen minutes. 20. KRIMEU (Exarticulution de Oberschenkels aus dem Huftgelenke, in Journal der Chirurgie, von C. F. von Gli.VEFE und Ph. v. WALTHKR, Berlin, 1828, B. XII, p. 121), J. S. C , aged 38, Waterloo, 1815. Exarticulated in 1822; died on the tenth day. 21. Er. Sl ER (ROUX (J.), Desarticulation de la cuisse d apres des observations rec. a Saint Mandrier, Paris, 1860, p. 4), A galley prisoner at Toulon, in 1825; fatal. 22. DlEFFEXUACH (J. F.) (Mag. fur die. gesammte Heilkunde, B. XXIV, II, S. 335), A Baron, aged 22. Secondary operation in 1826 ; died in ten hours. 23. Dr. BRYCE (Glasgow Med. Jour., 1831, p. 262), Soldier, aged 23, at the siege of Athens, May, 1827. Recovery in six weeks. 24. ROUX (P. J.) (Gaz. des Hop., 1830, p. 392), A Swiss subaltern, in 1830. Primary operation; died the same day. 25. CLOT BEY (Gaz. des Bop., 1830, T. IV, p. 96), All Homer, an Arab, aged 26. Secondary operation in 1830; died November 17, 1830. 26. SED1LI.OT (C.) (Ann. de la Chir. Fran?, et Et., 1841, T. II, p. 27!>), A Russian prisoner; Poland, 1831. Primary; died soon after the operation. 27. The elder DEMME (VERDAT, These inaug., Berne, 1846, and A. LtfNJNG, Vber die Blutung bei der Exarticulation des Ober- schenkels, Zurich, 1877, p. 69), Polish solder, in 1831. Intermediary operation ; death in thirteen days. 8. Surgeon ARXOU) (A.LUXIXG, loc. cit., p. 69, and VERDAT, These inaug., Berne, 1846), Russian soldier in Polish War, 1831. Ligation of common iliac by Dr. DEMME. Intermediary exarticulathm at hip; death on the third day. CD. Dr. FRAXCKE (A. LUXIXG, loc. cit., p. 69, and FRAXCKE, Diss., Leipzig, 1835), Russian soldier, A. Pasgezuk, aged 22, Warsaw, Sept. 7, 1831. Operation Sept. 22, 1831 ; death in two days. 30. The elder DEMME (A. LUXIXG, loc. cit., p. 68, and VEUDAT, These inaug., Berne, 1846), Polish soldier, in 1831. Intermediary operation; death from gangrene on fifth day. 31. LF.TULLE (H. LAUREY, Hist. chir. du siege de la Cit. d Anvers, 1803, p. 307), A French cannonier of the llth regiment of Artillery. Siege of Antwerp, 1832. Primary operation December 13th ; died Decem ber 22, 1832. "32, 33. During the campaign in Syria, in 1832, two exarticulations at the hip were performed, one by VOX WELZ, the other by CliRUUlilM. Both were fatal (M. JAEGER in Dr. W. WALTHEK S Handwiirterbuch der Gesammten Chirurgie, Leipzig, 1836, B. I, p. 409). 34, 35. ALCOCK (R.) (Notes on the Sled. Hist, and Stat. of the British Legion in Spain, London, 1838, p. 78) relates that he was informed by Dr. BEI.MUXT that an accom plished Spanish surgeon had twice amputated at the hip joint during the Peninsular War of 1835 once with success. 36. HUT1X (F.) (Rec. de Mem. de Med. de. Chir., etc., I" s6rie, T. XLIV, p. 219), M , a soldier of the 1st Light Battalion, Constantine, 1836. Primary amputation ; Manec s method ; died December 13, 1836 37. HUTIX (F.) (Rec. de Mem. de Med. de Chir., etc., T. XLIV, p. 220), L , 2d Regiment of Engineers, Constantine, 1836. Primary operation ; died December 4, 1836. 38. BAUDEXS (L.) (Clin. des plaies d armes a feu, Paris, 1836, p. 517), C . a soldier in the Dattalion d Afrique, 24 years old, Algiers, 1836. Intermediary operation; recovered, and was an inmate of the Hotel des Invalides in 1840 (SEDILI.OT. Amp. coxo- fenwrale, in Rec. de Mem. de Med., 1840, T. 49, p. 276). 39^1. From the tabular statement of Dr. GUYOX (Statistique des amputations pratiques d Varmee d Afrique, etc., pendant les annees, 1837, 1838, et 1839, in Gaz. Med., 1841, T. IX, p. 105) it appears that no exarticulations at the hip were per- formed during these years ; but Dr. GUYOX states (loc. cit., p. 106) that three unsuccessful amputations at the hip were performed in 1841. 42. BAUDEXS (L.) (Rec. de Mem. de Med. de Chir., etc., 1853, 2" s6r., T. X, p. 130), X , a soldier of the 18th Light Infantry, Paris. 1848. Primary operation; death on the second day. 43. VlDAL (AUG.) (Traite de Path. ext. et de Med. op., 5" ed., Paris, 1861, T. V, p. 731), A French student of medicine, insurrection in Paris in 1848. Secondary exarticulation ; fatal. 44-46. During the same revolution RlCHET (M. E. HERVIEUX, Compte rendu des blessCs recvs a I ambulance des Tuileries, in Gaz. Med. de Paris, 1848, p. 712) performed a primary operation which proved fatal ; and P. GUEliSAXT and ROBERT (L. LEGOUEST, TraiU de Chir. d Armfe, 1863, p. 700) had each an unsuccessful intermediary operation. 47. RESTELLI (F. BAROFF1O, Delle Ferite d arma da fuoco, Torino, 1862, p. 284) performed a successful exarticulation in 1848, after the insurrection in Lombardy. 48. TliEZZI (GRITTI ROCCO, Delle Fratture del Femore par arma da fuoco, Milano, 1866, p. 80) operated unsuccessfully on an insurgent at Milan in March, 1848. 49. C. TEXTOU (G. B. GUEXTHER, Die Blutigen Operationen, Leipzig, 1859, Abschmitt VIII, p. 180), Exarticulation for shot fracture of the neck of the femur in a patient aged 32, in 1848; death from pytBmia. 50. TEXTOU, the younger (GDxTHEli, loc. cit., p. 180), performed an intermediary operation in 1848; death on the fourth day. 51. ROUX (R J.) (Des plaies d armes a Jeu, Communications fa ites, etc., par BAUDEXS, ROUX, etc., Paris, 1849, p. 38, and Gaz. des Hop., 1848, p. 513) had, in June, 1848, a secondary fatal operation. 52. LlXHAUT (W.) (A. LUXIXG, loc. cit, p. 75, and ESCHE, Diss. inaug., Wtlraburg, 1863, p. 11), in 1848, in a case of shot comminution of the trochanter, ligated the femoral, and afterwards exarticulatcd at the hip. The patient died shortly after the operation. 53-59. During the Schlesxvig-Holstein War, 1848-50. seven exarticulations at the hip were made. Prof. B. von LANGEXI .ECK (Vber die Schussfracturen der Gdenke, Berlin, 1868, p. 19) performed four of the sevon operations: J. Seibold, drummer in Tann s corps, aged 18, wounded at Hoptrup, June 7, 1848; operation June 8th; patient hale and hearty in 18.56. Anders Nielson, 2d Danish Jaegers, aged 2fi, Schleswig, April 23, 1848; operation April 24th ; death May 21st. Niels Andersen, 4th Danish Infantry, Schleswig, April 23, 1848; operation May 14th ; death May 20, 1848. Danish soldier, wounded at Ban, April 9, 1848 ; operation June 20th ; death June 21, 1848. The other three operations of this campaign proved fatal; no further data are noted (L. STROMEYER, Maximem, 1861, p. 53 , ). 60. LEXTE (F. D.) (Transactions Am. Med. Association, 1848, Vol. IV. p. 316), J. Dalzell, aged 23. Astor Place Riots, New York, 1849. Primary operation; died May 12, 1849. 61-63. In the War in the Punjaub, 1848-4!), three primary operations were performed. Dr. McRAE (Indian Annals of Med. Sci., 1857, p. 663) states that the patients died one in six, one in twelve, and one in thirty-six hours, from shock. 64. BKCK (B.) (Die Schusswunden, Heidelberg, 1850, p. 315), Soldier of the 2d Baden Infantry, wounded June 29, 1849, in battle, at the Murg. Secondary operation: death six days after operation. 65. FAYRER (J.) (Clinical Surgery in India, London, 1866, p. 630), Moung Schwe-Mo, a Burraan, aged 30. Rangoon, Bengal, February 15, 1853. Primary amputation at left hip February 16th ; deatli March 17, 1853. fi6. Dr. BEATSON (ttAXKIXG s Abstract, 1855, No. 21, p. 182), Thomas Lisbey, aged 61. Conductor in the Ordnance Department, Doimabevv, March 19, 1853. Exarticulation of left hip March 25th; died March 25, 1853. 67-110. Of the forty-four exarticulations at the hip performed during the SECT. ii. j AMPUTATIONS AT THE HTP JOINT. 129 surgery apart from the sixty-six cases that pertain to the "American civil war. This cate gory comprises one hundred and eighty-four cases, of which the results are ascertained in Crimean War, two were done in the Sardinian army, eight by Professor N. PlUOGOFF (Grundziige der Allgtmeinen Kriegsch., Leipzig, 1864, p. 1137), in the Russian army, fourteen in the British army (MATTHEW, loc. cit., p. 374), and twenty in the French army (J. C. CHEXU, Rapport med. chir. de Camp, d Orient, 18G5, p. C58). PORTA states that the two cases in the Piedmontese army were fatal. Of PlROGOFF B eight cases two survived five days and the others perished within two or three days. The operations in the English army were all primary and resulted fatally. The results of the operations in the French army were equally unfortunate ; all the patients died. Of twenty-two of the forty-four cases it is only recorded that they had a fatal termination. The particulars of the other twenty-two will here be cited: ALEXAXDER (T.) (GUTHKIF. s Comment., 6th ed., p. C- O) disarticulated at the hip, in the case of Peter Cleary, 23d Fusileers, for gunshot fracture of femur, Alma, Sept. 20, 1854. Operation Sept. 21st ; patient died on the passage to Scutari. ALEXANDER (T.) (G. J. GUTHUIE, Commentaries, 6th ed., 1855, p. 620), A Russian prisoner, Alma, Sept. 20, 1854. Primary operation Sept. 22d, died Oct. 22, 1854. ALEXANDER (T.) (G. J. GUTHUIE, loc. cit., p. 620), Peter Sullivan, 33d British Infantry, Alma, Sept. 20, 1854. Primary opera tion Sept. 21st; died Oct. 11, 1854. McKEXZIE (R.) (MACLEOD, Notes on Surgery in the Crimea, London, 1858, p. 369), Soldier, Alma, Sept. 20, 1854. Primary operation ; died. Assistant Surgeon W YATT (T. P. MATTHEW, Med. and Surg. Hist, of the British Army in the Crimea, London, 1858, Vol. I, p. Ill), An offleerof the Coldstream Guards, Inkermann, Nov. 5, 1854. Primary operation ; died immediately after the operation. MOU.MEU (in CllENU s Rapp. med. chir. sur. la Camp, d Orient, 18C5, p. 6CO), Garassimoff, a Russian prisoner, Alma, Sept. 20, 1854. Intermediate operation Sept. 27th ; died Sept. 29, 1854, two days after the operation. LEGOUEST (L.) (M6m. de la Soc. de Chir., 1863, T. V, p. 157), Ignatius Wolokenski, 5th Russian Infantry, aged 30, Alma, Sept. 20, 1854. intermediary amputation at left hip October 3d; died Feb. 9, 1855. MOUNIEK (CHENU, loc. cit., p. 660), Chiffttzoff, a Russian prisoner, Inkermann, Nov. 5, 1854. Intermediary operation November 5th; died December 2, 1854, one week after the operation. PAUI.ET (CHENU, loc. cit., p. 661), Soldier. Primary operation in 1855; died one hour after the operation. LUSTREMAN (CHENU, loc. cit., p. 661), Soldier. Primary operation in 1855 ; died five hours after the operation. THOMAS (CHENU, loc. cit., p. 661), Soldier, gunshot fracture of the femur, 1853. Primary operation ; died five hours after the operation. THOMAS (CHENU, loc. cit., p. 661), Soldier, 1855. Primary operation ; died eleven hours after operation. PEKRIN (CllEXU, loc. cit., p. 660), A private of the 32d French Infantry. Fracture of left femur July 5, 1855. Primary operation a few hours after injury; died in one or two days. FRANKLYN (T. P. MATTHEW, lac. cit., Vol. I, p. 377), A private of the 77th British Infantry, Sevastopol, August, 1855. Primary operation ; died twenty-two hours after the operation, from exhaustion. DUNI.OP (T. P. MATTHEW, loc. cit., Vol. I, p. 403), A soldier of the 88th Regiment Connaught Rangers. Primary operation ; died soon after the operation, in November, 1855. Surgeon-Major TROUSDELL (R. DUUITT, Surgeon s Vade Mecum, 1865, 9th ed., p. 160), A private of the 50th British Regiment, Sevastopol, 1855. Primary operation ; died the day after the operation. MOCNIER (CHENU, loc. cit., p. 6(iO), Pietrow, a Russian prisoner. Inkermann, Nov. 5, 1855. Secondary operation Dec. 19th; died Dec. 29, 1854. LARIVIEUE (CHENU, loc. cit., p. 660), Kerigla, a Russian prisoner, Traktir Bridge, Aug. 16, 1855. Intermediary operation Aug. 2od; died August 23, 1865, during the operation. MAUGEIl (CHENU, loc. cit., p. 661), A Russian prisoner, Traktir Bridge, Aug. 16, 1865. Intermediary operation; died soon after the operation. SALLERON (Mem. de Med., de C hir. et de Phar. Mil., 2 me s6r., T. XXI, p. 317), A soldier, Sevastopol, 1855. Intermediary operation (?); died twenty hours after the operation. SALLERON (Mem. de Med., de Chir. et de Phar. Mil., 2 rae s6r., T. XXI, p. 317), A soldier, Sevasto pol, 1855. Intermediary operation (?); died sixty hours after the operation. Chief Surgeon MARROIN, of the French Navy (J. ROUX, Desarticulation de la cuisse, Paris, I860, p. 4), disarticulated, in the case of a soldier of the Crimean army, for fracture of the greater trochanter. The patient died shortly after the operation. 11 1-112. Professor J. F. HEYFELUER, chief surgeon of the Russian army in Finland, in 1855 (Die Verwundungen und Openitionen in Folge des Bombardements von Sveaborg vom 9-11 Aug., in Deutsche Klinik, 1855, B. 7, pp. 530-532) exarticulated twice at the hip. A Finnish soldier, wounded at Sveaborg, August, 1855; primary amputation at left hip ; died in two hours. Stanislaus Maletzki, 8th Finnish Bat., shot fracture of neck of left femur, Svaborg, Aug. 9-11, 1855; primary operation; patient died in less than an hour. 113-115. BERTHERAND (Camp, de Kabijlie, Paris, 1862, pp. 145, 238, and 280) gives three examples of disarticulation at the hip: A , 60th Line, wounded June 20, 1854 ; fracture of neck of femur, disartic- ulation, by Dr. GlLGENCRANTZ, July 14, 1854 ; death on the same day, before recovering from the effects of the chloroform. C , 90th Line, shot frac ture of neck of femur, Algiers, May 24, 1857 ; secondary disarticulation ; died on the day of the operation. W , 2d Legion etrangere, shot fracture of neck of right femur; disarticulation by Dr. TABOUHET; fatal. 116. BERTHERAND (A.) (Camp, d ltalie, de 1859, Paris, 1860, p. 37), An Austrian soldier, a prisoner after the battle of Palestro, June 4, 1859. Intermediary operation ; died three hours after the operation. 117. ARLAUD (J. C. CHEXU, Camp, d ltalie en 1859 et 1860, T. II, p. 697), Louis Legallo, Fusileer, 84th French Regiment, age 25, Montebello, Kay 20, 1859. Secondary exarticulation at right hip; recovered. 118. ISNARD (J. C. CHENU, loc. cit., p. 694), Captain Deshayes, 73d Regiment, Solferino, June 24, 1859. Secondary exarticula tion at left hip; recovery. 119. Roux (JULES) (CHENU, Camp, d ltalie, en 1859 et 1860, T. II, p. 697), Lieutenant Joseph Vitarel, 65th French Infantry, aged 24, Magenta, June 4, 1850. Secondary amputation at left hip; recovered. 120. NEUDORFKR (J.) (Handbuch der Kriegschir., 1872, B. II, Abth. II, S. 1468), Johann Schranz, 7th Jaeger. Neck of femur. Palestro, May 30, 1859. November 27th, excision at left hip joint. December 1st, amputation at hip joint. NEUDORFER saw the patient in 1868. 121. NEUDORFER (J.) (toe. cit., p. 1467), Jurko Katsch, of Inf. regiment E. H. Stephan, Solferino, June 24, 1859. Right trochanter. Operation, August 8th, seventy-six days after the injury; died August 25, 1859. 12;!. NEUDORFER (J.) (toe. cit., p. 1468), Walland Waskaneder, Co. 13, of Baron Rossbach s Regiment, Solferino, June 24, 1859. Fracture of upper third of femur. Disarticulation Dec. 31st (one hundred and ninety days after injury); died four months later. 123. SCOTTT(G. B.) (GRITTI ROCCO, Frat. del fern, per arma dafuoco, Milano, 1866, p. 80), An Italian soldier. Gunshot fracture of femur, Solferino, June 24, 1859. Intermediary exarticulation in July, at Ospitale San Francesco, Brescia; died. 124. TASSAXI (GRITTI ROCCO, loc. cit., p. 80), An Italian soldier. Shot fracture of femur, Solferino, June 24, 1859. Intermediary ampu tation at hip at Ospitale Maggiore, Milan, July, 1859; died. 125. GlIERINI (GRITTI ROCCO, loc. cit., p. 80), An Italian soldier. Gunshot fracture of the femur, Solferino, June 24, 1859. Disarticulation about July 26th, at Ospitale San Filippo, Brescia; died. 126. JOHNSON (T. D.) (Amputation at the Hip Joint, Recovery, in Pacific Med. and Surg. Jour., N. S., Vol. II, 1808-69, p. 305), A man of San Juan, Monterey Co., received a shot from a Colt s revol ver, in July, 1862; ball shattered the entire shaft of femur. Dr. JOHNSON exarticulated two days after the injury. The patient recovered, and was still living, in 1868, at the New Almaden mine, in Santa Clara County. 127. VlLLAGRAX (J. M. B. de) (Observacion de una herida de arma defuego situada en el muslo izquierdo complicada con fractura comminutiva del femur: desarticulacion coxa-femoral a los 180 dias, y muerte del enfernw a los 259, in Gaceta Medica de Mexico, 1865, Vol. I, p. 164), Roman Medina, age 26, shot Nov. 2, 1863, in the left thigh, and admitted to hospital at San Pablo, Nov. 8, 1863. Disarticulated May 11, 1864 ; death July 29, 1864. 128-129. LANGENBECK (B. von) (Schussfracturen der Gelenke, Berlin, 1868, p. 20), Danish soldier, wounded at Alseu, June 29, 1864 ; disarticulation July 1st; died July 8, 1864, of septicaemia; and Danish soldier, wounded at Alsen, June 29, 1864 : disarticulated at right hip June 30th; death July 5, 1864. 130-131. LAXGENBECK (B. von) (Die Schussfracturen der Gelenke, Berlin, 1868, p. 21), Austrian soldier, wounded at Koenigsgratz, July 3, 1866; exarticulated at left hip July 10th; death July 14, 1866, of septicajmia. Austrian soldier, wounded at Koenigsgratz, July 3, 1866 ; amputation at right hip July 17th ; death July 24, 1866. 132. LlNHART (W.) (BECK. B., Kriegschir. Erf., 1867, p. 340) performed secondary disarticulation at the hip in 1866, at Wlirzburg, for comminution of upper part of femur. Patient died a few hours after the operation. 133. FISCHER (K.) (MilitairdrMiche, Skizzen, Arau, 1867, p. 78) mentions a case in which disarticulation at the hip was performed unsuc cessfully for hsemorrhage, in the Austro- Prussian campaign of 1866. 134. HEYFELDER (J.) (Gaz. med. de Paris, 1867, p. 541) states that an unsuccessful disarticulation at the hip was performed at the hospital at Nedelischt, in charge of Dr. WILDE, after the battle of Koenigsgratz, July 3, 1866. 135. MAXNEL (OTTO) (Kriegschirurgische Beobachtungen im Cadetenhaus Kriegslazareth zu Dresden, in Allgemeine Wiener Med. Zeitung, 1867. Jahrg, XII, p. 403), Musquetier B , 1st Thiiringian Infantry, No. 31, wounded July 3, 1866, near Hradeck, in the left femur. Exarticulation October 4, 1866, by Stabsarzt Dr. KUHXE ; died October 8, 1866. 136. Dr. J. HEYFELUER ( Gaz. Med. de Paris, 1867, p. 540) reports that a second amputation at the hip was performed at the hospital at Hradeck, in 1866, which proved fatal in about forty-eight hours. 137. FAYRER (J.) (Gunshot Wound; Amputation at the Hip Joint, in Edinburgh Med. Journal, 1868, Vol. XHI, II, p. 793), Lieutenant H , shot accidentally, on the Island of Ceylon, Sept. 12, 1867, over the left tuber ischii, ball lodged ; fracture of neck of femur not detected. Exarticulation at left hip Sept. 25th ; died three hours after the operation. 138. ASHHURST (JOHN, jr.) ( Case of Amputation at the Hip Joint for Gunshot Fracture of the Head and Neck of the Femur, in Am. Jour. Med. Sci., 1869, SURG. Ill 17 130 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. one hundred and eighty-three, presenting sixteen recoveries. We thus arrive at an aggre gate of two hundred and fifty cases of exarticulation at the hip as the present status of this grave mutilation in military surgery, with twenty-seven recoveries, two hundred and twenty-two deaths, and one example with unknown result, or a mortality rate of 89.1 per cent. We will next notice the details of the sixty-six cases of hip joint amputations of the American civil war as classified in TABLE XIV. Vol. LVII, p. 94), E. B , Irish woman, aged 23, shot in the right hip, in Aug., 1867, at Tacony, Pennsylvania. Exarticulation on Jan. 14, 1868; death in three hours. 139. CAROTHER8 (A. E.) (Amputation at the Hip Joint, in Am. Jour. lied. Sci., 1873, Vol. LXV, p. 92), Juan Blanco, aged 14 ; Saltillo, Mexico, Dec. 5, 1871. Intermediary operation Dec. 15th; recovery. At least forty-four exarticulations at the hip were performed during the Franco- Prussian War, 1870-71. 140. Dr. RtiPFEL (DEININGER, Bcitrage zu den Schussfracturen des Hiiftgelenks, etc., in Deut. Mil.-drztl. Zeitschr, 1874, B. Ill, p. 304), Cbr. Lucia. 3d Brandenburg Field Art., shell laceration, received at Artenay, Dec. 3, 1870. Exarticulation at right hip Dec. 4th : died shortly after the operation, Dec. 4,1870. 141-143. Generalarzt Dr.BUBCH (Zweiter Congress der Deutsch. Gesellschaftfur Chir., in Berlin Klin. Wochenschrift, 1873, B. X, p. 273, and DEINIXGER, Inc. cit., p. 306) performed three exarticulations at the hip : Aug. Hensel, 2d Pomm. Grenadier Reg t ; fracture of right femur, Metz, Oct. 14, 1870; operation Oct. 15th ; death immediately after operation. No particulars of the other two unsuccessful cases are recorded. 144-147. MAC- CORHAC (W.) (Notesand Recollections of an Ambulance Surgeon, etc., London, 1871, pp. 78, 79), Guerieri, 4th Marines, wounded at Sedan, Sept. 1, 1870. Left tibia and upper part of left femur smashed. Admitted to Asfeld hospital Sept. 10th ; operation Sept. 18th ; death shortly after the operation. Liprencle. wound of back part of left thigh by explosion of shell. Admitted to Asfeld hospital Sept. 10th ; operation Sept. 15th; death in six days. Dr. MACCOHMAC (toe. cit., p. 80) states that Mr. BLEwnr disarticulated the hip at Balan, "but with no better result than our two cases," and. on page 123, enumerates among the operations at the field hospital at Floing, under Generalstabsarzt STROMEYER, another hip joint exarticulation with unknown result. Dr. DEIXINOER also refers to two exarticulations by Dr. FRANK, and cites MACCORMAC as authority. The latter (loc.cit., p. 46), however, only states that "he (Dr. FRANK) afterwards told me there were two cases where operations should have been performed at the hip joint, but this had to be left undone for want of assistance/ 148. Ober-Stabs-arzt NEUBER (DEIXLNGER, loc. cit., p. 308) exarticulated in the case of August Schmidt, 70th French Line ; shot fracture of femur, Aug. 18, 1870 ; died Sept. 7, 1870. 149. Ober-Stabs-arzt Dr. LlPPEL (DEININGER, toe. cit., p. 308), at the 8th field hospital of the Tenth Army Corps, at Pont d Mousson, exarticulated for gangrene in the case of Louis Lecoque, shot in the soft parts of the leg; death four hours after the operation. 150. Dr. KOCH (DE1NINGER, loc. cit., p. 308), at the hospital at Maizery, Private Andreas Wilczynski, 44th Infantry, shot fracture of the right femur immediately below the trochanter, August 31, 1870. Exarticulation October 23, 1870; died of dysentery October 31, 1870. 151. Dr. SACHS (DEININGER, loc. cit.. p. 306), at the 9th field hospital of the First Army Corps, at Les Etanges, case of J. Nikelski, private, 12th Co., 43d Infantry; shot fracture of right femur : ball lodged. Metz, Aug. 14, 1870. Exarticulation Sept. 20, 1870; death, from pyaemia, Sept. 25, 1870. 152. Dr. BRAMSII, at the hospital at Neudorf (DEIXIXGER, loc. cit., p. 306), disarticulated in the case of Private H. Malton, 66th French line, shot in the left femur August 6, 1870. Operation Sept. 7th ; death on day of operation. 153. Generalarzt Dr. WAGNER (DEININGER, loc. cit., p. 30C), at the 8th field hospital, First Army Corps, at Gras, Private M. Buddrus, Co. 2, East Prus. Gren., No. 1; shot fracture of right femur near trochanter major, with extensive injury of the soft parts, received at Met/ Sept. 1, 1870. Exarticulation Sept. 17th ; died upon the operating table. 154. Assistant Surgeon TRENDELEXBERG (DEININGER, loc. cit., p. 306), of the 8th field hospital, Third Army Corps, at Vionville, case of Adolpb Marschall, private, 52d Infantry. Shot fracture of left knee joint August 16, 1870; extensive suppuration. Exarticulation August 28, 1870; death on the same day. 155. Dr. METZLER (DEININGER, loc. cit., p. 30C), at the Hessian field hospital No. 1, Anoux la Grange, exarticulated at the hip in the case of L. Nouveau, 73d French line, wounded August 18, 1870. Operation Aug. 19th : death two hours after operation. 156. Dr. RAYNAUD (GILLETTE, Remarques sur les blessurespar armcs A feu observces pendant la siege de Metz (1870), e.t cclui de Paris (1871), in Arch. gen. de Med., 1872, T. XX, p. 571, and CH. PlLLET, De la suppression de la compression digitale preliminaire, etc., Paris, 1873, p. 64) exarticulated at the left hip in a young garde nationale, aged 19; death in a few hours. 157. Dr. WlESEMES (B. BECK, Chir. der Schussverlet- zungen, Freiburg, 1872, p. 855), W , 67th Infantry, wounded before Paris, December 21, 1870, by ashell, fracturing femur to neck. Primary operation ; death in twenty-four hours. 158. HUETER (Berlin, Klin. Wochenschrift, 1873, p. 250) operated on a French soldier for extensive fracture of femur. The patient died suddenly on the following day from venous ha?morrhage. 159, 160. BCEHME ( Verhandl. der mil.-drztl. Gesellschaft zu Orleans 1870-71, in Deut. Mil.-arztl. Zeitschrift, 1872, B, I, p. 66), Fracture of femur just below trochanter, arterial bleeding ; ligation of femoral ; secondary haemorrhage ; exarticulation ; died during the operation. Another case proved fatal in a few days. 161. OTT ( Kriegschir. Mittheil. aus dem Reserve Laz. Ludwigsburg, 1871, p. 52), Harles, a French soldier, wounded at Vionville, Aug. 16. 1870, in right femur close to trochanter. Exarticulation Sept. 24, 1870; death a few hours after the operation. 162. SIMON (G.) ( Verhandl. des Zweiten Congress der Deut. Gesellshaft fur Chir.. in Berl. Klin. Wochenschr., 1873, B. X, p. 261), French officer; fracture of femur osteomyelitis. Secondary exarticulation ; fatal in three days. 163-167. RUPPRECHT (L.) (Mil. drztl. Erf., f.lc., im Jahre 1870-71, WUrzbnrg, 1871, p. 75) states that four unsuccessful exarticulations at the hip three primary, one intermediary were performed at the Bavarian field hospital No. 8, during September and October, 1870, and that a later operation at Verne 1 res also resulted fatally. 108. MUNDY (Rapport sur I ambulance de I ancien corps legislat. du 19 Sept., 1870, an 31 Janv., 1871) exarticulated on December 2, 1870, in the case of Deschamp, 2d Zouaves, for shot fracture of the right femur with injury of the large veins and of the hip joint; fatal. 169. Dr. J. ARNOLD (Anat. Beitrage -it rlrn Schusswunden, Heidelberg, 1873, p. 97) gives the case of H. Moulin, wounded at Worth, August 6, 1870 ; shot wound of right femur, with fissure ; osteo myelitis and necrosis extending to neck of femur. Exarticulation at the hip ; death Sept. 22, 1870. 170. Dr. JCESSEL (SfJDILLOT, Du traitement drs fractures des membres, etc., in Archives gen. de mid., 1871, VI" serie, T. 17,p.421) performed a secondary fatal exarticulation at the hip. 171-183. Cn.^M (J. C.) (Apergu hist. stat. et din., etc., pendant la guerre de 1870-71, Paris, 1874, T. I, p. 493) tabulates twenty-three exarticulations at the hip performed on French soldiers. Some details of ten of these cases have just been noticed; of the remaining thirteen cases it is only recorded that all the patients perished. 184. MORTON (T. G.) (The Cincinnati Lancet and Clinic, Cincinnati, Jan. 4, 1879, N. S., Vol. II, p. 9), Dominico Ludovcss, aged 24, wounded at Sedan, September 1, 1870; amputation of thigh; admitted to Pennsylvania Hospital Nov. 24, 1878; reamputation at hip December 14, 1878. In a letter dated February 19, 1879, Dr. MORTON reports that the "patient is up and about, and would be discharged, but he has no home to go to." Of the 184 rases of exarticulation at the hip here cited, one (STROMEYER s case, reported by MACCOKMAC) must be set aside, since its result was unknown. Of the remaining 183 cases, 16 recovered and 167 proved fatal, a mortality of 91.2 per cent. Of the 53 primary operations, 50, or 94.3 per cent., were fatal. The three recoveries were: LARREY S sub-lieutenant of dragoons, wounded September 7, 1812, and seen at Orcha three months afterwards; LAXGENBECK S operation on J. Siebold, June 8, 1848 ; T. D. JOHXSOX S operation on the California miner, July, 1862. Of the 32 intermediary cases, 29, or 90.fi per cent.. were fatal. The three successful instances were: G. J. GUTHRIE s Waterloo case of Duguet, in 1815; L. BAUDEXS s Algerian case in 1836; and CAROTHEU S case of the Mexican lad, in December, 1871. Of the 31 secondary operations, 26, or 83.8 per cent., had a fatal termination. The five success ful cases were : BROWNRIGG S British dragoon, wounded at Merida, December, 1811, and amputated in 1812, who was living, long afterwards, at Spalding, in Lincolnshire. England; ArtLAUD s case of the fusileer, in the Italian War of 1859; ISXARB 8 case of the officer wounded at Solferino; Dr. JULES Koux 8 case of the Magenta soldier, in 1859; and NEUDORFER S case of the soldier wounded at Palestro, May 30. 1859, who underwent secondary excision and amputation in December following. Of two re-amputations at the hip (CASES 12 and 184), T. G. MORTON S operation, in 1878, on a French soldier wounded in 1870, had a successful issue. Of the 66 exarticulations in which the period of operation was unknown, 4 recovered, giving a mortality of 93.8 per cent. The operators in the four successful cases were : The unknown operator, who, in 1798, operated on the English sailor who was examined by Dr. WENDELSTADT ; Dr. CHARLES BRYCE, in the case of the British soldier wounded at Athens, in 1827; the Spanish surgeon reported by Dr. BELMUNT to Mr. ALCOCK, who successfully disarticulated in 1835; and RESTELLI, in the Italian revolution in 1848. Of the 16 successful operations, 5 were performed by French surgeons, 4 probably by English, 3 by American, 2 by German, 1 by an Italian, and 1 by a Spanish surgeon. SECT. II.) PRIMARY AMPUTATIONS AT THE HIP JOINT. 131 Primary Operations. Of twenty-five well authenticated primary amputations at the hip joint practised during the American civil war, one was completely successful. The pensioner, Kelly, whose left lower limb Surgeon Edward Shippen disarticulated more than fifteen years ago, still survives in comfortable health. A brief review of the case will be given, with references to a few of the numerous accounts of it that have been published: 1 CASE.272. Private James E. Kelly, Co. B, 5Gth Pennsylvania, aged 28 years, was wounded, about 9 o clock of the morning of April 29, 18G3, in a skirmish of the 1st division, First Corps, on the Rappahannock, nearly opposite the "Pratte House," below Fredericksburg. A conoidal musket ball, fired from a distance of about three hundred yards, shattered his left femur. A consultation of the senior surgeons of brigades decided that exarticulation of the femur was expedient, and the operation was performed, at four in the afternoon, at the " Fitzhugh House," by Surgeon Edward Shippen, U. S. V., surgeon-in-chief of the 1st division. The single flap method was adopted, and the amputation was accomplished with slight loss of blood. The patient was at first placed in a hospital tent, and was transferred, May 22d, to the Corps Hospital, progressing favorably. By May 28th, all the liga tures had been removed. On June 15, 1863, the patient was captured by the enemy, and was removed to the Libby Prison, in Richmond. Up to this date there had been no bad symp toms. On July 14th, Kelly was exchanged, and was sent to the Annapolis U. S. A. General Hospital. On his admission he was much exhausted by profuse diarrhoea. The internal portion of the wound had united, but the external portion was gangrenous. Applications of bromine were made to the sloughing surface without amelioration. A chlorinated soda lotion was substituted, and in the latter part of July there was a healthy granulating surface. On December 23, 1863, the wound had entirely healed, and Kelly visited Washing ton, and obtained an honorable discharge from service, and a pension. Kelly then went to his home, near Black Lick P. O.. Indiana County, Pennsylvania. A letter, dated January 12, 18155, was received from him at this Office, and represented him as in excellent health and spirits at that time. In the spring of 1863, Kelly went to New York and had an artificial limb adapted by Dr. E. D. Hudson. At that time a photo graph was taken representing the appearance of the cicatrix and of the prothetic appliance. A reduced copy of this pic ture is presented in the accompanying wood-cut (FlG. 89). Front and posterior views of the upper half of the shattered exarticulated femur are introduced among the accessories in the picture. In a pamphlet on Mechanical Surgery, New York, 1878, page 31, Dr. E. D. Hudson prints an excellent wood-cut displaying the appearance of the cicatrix and the artificial stump. By this simple and excellent expedient of a padded gutta-percha artificial stump secured to the pelvis by a broad chamois-lined canvas band, Dr. Hudson succeeded in applying satisfactorily and comfortably the ordinary artificial limb for thigh amputations, not only in Kelly s case but in the case of Pt. George W. Lemon, Co. C, 6th Maryland. The specimen of the fractured exarticulated femur is preserved at the Army Medical Museum, as No. 1148 of the Surgical Section. Kelly s disability was rated, March 4, 1874, as total. His pension of $24.00 monthly, was paid in March, 1878, and he was then in tolerably good health, nearly fifteen years after his terrible mutilation. He remains an irrefragable demonstration of a successful primary amputation at the hip after shot injury. There was nothing additional recorded at the Pension Office at the above date. Although in the next two instances of primary amputation at the hip it was found impracticable to trace the ulterior histories of the patients, it is known that Surgeon W. M. Gompton s patient, Hobinson, aged 35, was alive and well six months after the exarticula tion, and that Private Williamson, the subject of Dr. J. T. Gilmore s operation, reached his home in Mississippi, after two months, with his stump fairly cicatrized. "HAMILTON" (F. II.), A Treatise on Mil. Surg., 1865, p. 482. SORREL (F.), Gunshot Wounds Army of Northern Virginia, in Confcd. States Med. and Surg. Jour., 1864, Vol. I, p. 153. BUTCHER (R. G.), On amputations at the hip joint, in Dublin Quar. Jour, of Med. Sci., 18C6. No. LXXXIV, p. 301. LKGOUEST (M. L.), Le Service de Sante des Armies Americaines, etc., in Annales D Hygiene Publique, 18fi6, Deuxieme s6rie, T. XXVI, p. 270. Circular No. 6, S. G. O., ISGj, p. 48. Circular No. 7, S. G. O., 1867, pp. 26, 58. LOxrxG (A.), Ueber die Blutung bei der Exarticulation des Ober- schenkds, Zurich, 1877, p. 93. HUDSON (E. D.), Mechanical Surgery: Prothetic Appliances and Apparatus. New York, 1878, p. 31. FIG. 89. Appearance photograph.) f stump five years after the operation. [From a 132 INJUEIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 273. Private Robinson, of a Louisiana Regiment, aged 35 years, was wounded at Battery Pemberton, at the con fluence of the Tallahatchie and Yalabusha Rivers, on March 13, 1863, by a fragment of a twenty-four pounder shell, fired from one of the United States gunboats attacking the work. Surgeon William M. Compton, 2d Texas, was standirg near the wounded man when he fell, and ran to his assistance. Hastily exposing the wound, Dr. Compton found that the immense projectile, consisting of nearly half of an elongated shell, had buried itself in the upper part of the left thigh, smashing the trochanters and neck of the femur and wounding the femoral artery. An assistant compressed the artery at the crural arch, while the necessary preparations for an amputation were made on the spot. Chloroform was administered, and then Dr. Comp ton made an irregular circular incision through the integuments just above the margin of the huge lacerated wound, dissected up and retracted the skin, trimmed away the lacerated muscles and divided those that were intact, and exarticulated the head of the femur, making, as Dr. Compton described it, an awkward circular amputation. The arteries were now rapidly secured and the wound dressed. Strange to say, the patient reacted with scarcely a symptom of shock. When the influence of the anaesthetic passed away, he was cheerful and even jocular. He was moved to a field hospital, and was treated under Dr. Compton s immediate supervision until March 17th. The febrile reaction was very slight; the appetite never failed; the wound had as healthy an appearance as could be desired. On the fifth day, the patient was sent on a steamer to the large general hospital at Yazoo City. The surgeon in charge of that hospital, Dr. J. M. Greene, writes that the case presented a most extraordinary example of union by the first intention throughout almost the entire extent of the vast wound. The patient left the hospital on April 20, 1863, in fine health and excellent spirits. Dr. Greene received direct intelligence from him near the close of the ensuing September, more than six months subsequent to the operation, and he then reported himself in good condition. CASE 274. Private Williamson, 13th Mississippi, was wounded at an advanced picket station near Seven Pines, on June 4, 1862. A conoidal musket ball entered the posterior part of the right thigh about two inches below the trochauter major, and, passing forward and downward, made its exit at the middle third of the thigh in front, having badly shattered the femur in its course. The wounded man was carried to the field hospital in charge of Surgeon J. T. Gilmore, C. S. A., in a church building on the road to Richmond, and there placed under the influence of chloroform about two hours after the reception of the injury. After an exploration of the wound, it was decided that amputation should be performed. Dr. Gilmore began the operation with the belief that the comminution of the femur was mainly below the entrance wound, and that by making a long anterior flap the bone might be sawn at least through the trochauters; but when the anterior flap was reflected and the fracture exposed, it was found that fissures extended upward into the neck quite within the capsular ligament, and that disarticulation must be resorted to. A ligature was first placed upon the femoral artery, and the incisions were then extended upward, the joint opened, the round ligament divided, and a short posterior flap formed by cutting downward and outward. Assistants compressed the bleeding orifices of the arteries, which were then rapidly picked up and tied. The amount of blood lost was small. The wound was dressed, and the patient was comfortably in bed within three hours after the reception of the injury. He was put upon a very nutritious regimen, a messenger being sent daily to Richmond for eggs, milk, and other delicacies which could not be procured in camp. Dr. Gilmore attended him for two weeks, during which suppuration was not excessive, and the healing of the wound progressed favorably. He was then placed under the charge of Acting Assistant Surgeon Spinks. Early in July, he was carried to Richmond upon a hand-litter to a private house, at which he received every attention. In the middle of July, six weeks subsequent to the amputation, the wound had entirely healed, and he was allowed to start for his home in Mississippi. Dr. Gilmore learned that he arrived there in safety; but no intelligence was subsequently received from him. Of twenty-two primary coxo-femoral amputations that resulted fatally soon after operation, the following series of thirteen cases is composed of instances in which the wounds were inflicted by cannon shot, shell fragments, or other large projectiles: CASE 275. Private Jacob Barger, Co. B, 26th Pennsylvania, aged 22 years, of robust constitution and sanguine temper ament, was wounded on the morning of May 18, 1864, in the attack of Birney s division of the Second Corps upon the intrench- ments before Spottsylvania Court House. He was struck by a fragment of shell, which shattered the femur from a little above the trochanter minor for nine inches downward, and tore and mangled the soft parts on the anterior and lateral aspects of the 1 "Mississippi State Lunatic Asylum. Jackson, Mississippi, January 1, 1878. MY DEAR DOCTOR: I herewith enclose a letter from Dr. GREENE, of Aberdeen, Mississippi, the surgeon who treated the case of amputation at the hip joint in the Yazoo City hospital. To explain to you what may appear to be my want of attention in keeping the track of so interesting a case, I will remind you that the operation was performed in the field. The patient was at once conveyed to a steamboat, and as soon as it was full of sick and wounded (a few days) the boat was sent to Yazoo City. Soon after the date of the operation, I was ordered to Vicksburg, where I remained until after the surrender of that citj , and for a long time was shut up by the siege from all communication with the outside world. The fall of Vicksburg, in July, was succeeded by the rapid evacuation of Yazoo City, and it was nearly a year before I met Dr. GREEXE, in Alabama, who informed me of the recovery of my patient. I had not heard of him after the departure of the steam boat from Fort Pemberton, and did not know that he had fallen into the hands of Dr. GREEXE until the doctor informed me himself. I lost my note-book and other papers at Vicksburg and have never had any means of tracing the patient. I will say, however, for Dr. J. M. GREENE, that he stands at the head of hW profession in Mississippi, and is in every respect a highly esteemed Christian gentleman, and his word in any statement of fact where he is known is received as solid truth. Very respectfully, your obedient servant, (signed) Wsi. M. COMPTON." "Aberdeen, Mississippi, December 29, 1877. DEAR DOCTOR: At the request of Dr. WM. M. COMPTON, of Jackson, Mississippi, I again write to you in regard to the hip joint amputation which he performed at Fort Pemberton, in 1863. I greatly regret my inability to furnish any facts in addition to those contained in a letter which I wrote to you in 1867. I oelieve I therein told you that the subject of the amputation was received by me in hospital at Yazoo City, Mississippi, in a few days after the operation. So skilfully were the flaps made and so perfect was the coaptation throughout the vast extent of cut surface, that the fibrinous agglutination followed at once, and resulted in union by first intention in all parts except the tracks of ligatures and sutures. I am positive in my recollection that within six weeks from the time of the operation the patient was dismissed from the hospital with the stump healed. Information of him reached me some months I believe about five afterwards, which I then regarded as entirely authentic. It was probably in the form of an application for Certificate of Disability upon which to be retired or discharged from service. At any rate, I am certain that it thoroughly satisfied me of the life and well-doing of the patient. It is to be deplored that in a matter of so much interest to the profession, complete documentary evidence cannot be obtained ; but yet I feel assured, from my point of view, that the cause of surgical history can sustain no detriment from placing Dr. COMPTON s case In the same catalogue as that of Dr. SHIPPEN. Very sincerely, your obedient servant, (signed) J. M. GREENE." SECT. II.] PRIMARY AMPUTATION AT THE HIP JOINT. 133 thigh, leaving uninjured a V-shaped portion of integument and subjacent tissue on the antero-internal femoral region, seven inches wide at the base and ten inches in vertical length. He was carried to a field hospital of the Second Corps and examined about two hours after the injury. There was no apparent shock, and there had been very little hemorrhage. The pulse was full and calm, and the surface of the body was of a natural temperature. The senior surgeons of the division concurred in the opinion that this was one of the few cases of extensive gunshot injury of the femur in which a successful result might reasonably be anticipated from an amputation at the hip joint. The patient was desirous that an operation should be practised. He was of a hopeful, buoyant nature, and was sanguine of a favorable issue. Amputation having been decided upon, chloroform was administered by Surgeon John Wiley, 6th New Jersey, a medical officer of great experience and caution in this duty. Only two drachms of the anaes thetic was used, given from a napkin, with great regard to a due admixture of atmospheric air. Surgeon C. C. Jewett, 16th Massachusetts, performed the amputation by making a single antero-internal flap. Assistant Surgeon J. T. Calhoun, U. S. A., and others present on the occasion, have described the admirable dexterity and skill manifested in the operative procedure. The disarticulation was completed in less than forty seconds. Surgeon C. K. Irwine, 72d New York, compressed the crural artery at the groin ; Surgeon F. Prentice, 73d New York, grasped the flap and secured the cut end of the femoral; Surgeon James Ashe, 70th New York, had charge of the limb; Surgeon Everts, 20th Indiana, Surgeon E. A. Winston, 1st Massa chusetts, and Assistant Surgeon J. T. Calhoun, U. S. A., also aided in the operation. The flap, the form and location of which were determined by the wound, was made by cutting from without inward. Imme diately after the head of the bone was freed from the acetabulum a spasmodic catch was heard in the patient s respiration, and an assistant exclaimed : "Stop the chloroform !" Surgeon Wiley promptly responded : "He is not taking any." The next instant an assistant at the wrist reported that the pulse was failing. The arteries were now rapidly secured. The loss of blood was estimated not to exceed a single ounce. But the patient was insensible, the respiration labored, the pulse very slow and feeble. The usual restoratives were employed without effect. The patient did not rally; he lingered for about two hours, and died a little after noon, May 18, 1864. In consequence of an advance of Rhodes s Division of Swell s Corps the field hospital p lGf gy Commi- was hastily broken up. Surgeon Jewett was under the impression that the specimen was lost. This, nation O f femur by a J , shell. Spec. 3080. however, was not the case. Some one fastened a label with the names of the patient and operator to the mangled limb, and it was forwarded, with other pathological specimens, from Spottsylvania to the Army Medical Museum, where it arrived safely, and furnished the preparation represented in the adjoining wood-cut (FlG. 90). CASE 276. On March 9, 1862, in the engagement between the U. S. frigate Congress and the rebel iron-clad Merrimac, Private J. Bushmil, 99th New York, or Union Coast Guard, detailed as a seaman on the Congress, was wounded by a piece of shell, which tore away the muscles on the outer side of the left thigh so as to expose the bone, and comminuted the neck and trochanters of the femur. He was immediately conveyed to the military post hospital at Newport News, Virginia, which was distant but a few hundred yards from the anchorage of the Congress, and restoratives and stimulants were administered. Eight hours after the injury, reaction having taken place to a considerable degree, the patient was placed under the influence of chlo roform by Surgeon R. K. Browne, U. S. V., and Surgeon Leroy McLean, 2d New York, amputated at the hip joint by the lateral double-flap method of Larrey. His principal assistants were Dr. Everts, Dr. R. K. Browne, and Surgeon J. Curtis, U. S. V. The operation was rapidly accomplished, with the loss of but little blood. Six arteries required ligature. The patient did not rally from the shock of the operation, and died in less than two hours after its completion. 2 The details of the next primary amputation at the hip (CASE 277), communicated by Dr. F. J. Bancroft, of Denver, Colorado, have not been heretofore published : 3 CASE 277. "Captain Ralph Carlton, Co. I, 3d New Hampshire, received a severe wound in the left hip and thigh from a cannon ball or a fragment of a shell at the battle of Secession ville, on James s Island, June 16, 1862. The trochanters were fractured and the femur was shattered and laid bare for several inches below. The gluteus maximus muscle was severed from its insertion, and the biceps and semi-membranosus were torn asunder. Amputation at the hip joint was performed about two hours after the reception of the injury by some surgeon whose name I have forgotten, assisted by myself. The anterior flap was made by transfixion and carried well down the limb. The posterior one was short and made by paring the torn ends of muscles and the skin. The patient did not rally, and died about two hours thereafter, although he possessed, apparently, a strong will and a good constitution, and was suffering but moderately from shock at the time of the operation. When told of the dangers 1 The abstract of this case is compiled from a full report by Surgeon C. C. JEWETT, 16th Massachusetts, of Holliston, and from communications by Assistant Surgeon J. C. CALHOUN, Surgeon II. F. I/Y6TE1S, U. S. V., Assistant Surgeon J. D. STEWART, 74th New York, Major SAMUEL BKECK, A. A. G. See Catalogue of Surg. Sect, of A. M. M. of 1806, p. 234, Spec. 3080 of SECT. I. See Circular 7, S. G. O., 18G7, pp. 30 and 59, and LtelNG (A.), Vber die Blutung bei der Exarticulation des Obcrsclienkels, Zurich, 1877, CASE 324, p. 96. 2 The imperfect abstract of CASE 27C is com piled- from letters from Surgeon G. C. HARLAN, llth Pennsylvania Cavalry, Surgeon R. B. BOXTKCOU, U. S. V., Dr. llUFUS KING BROWNE, and Dr. LEROY MCLEAN, 2d New York. See Circular 7, S. G. O., 1867, pp. 24 and 57, and L,t)NING (A.), Vbtr die Blutung bei der Exarticulation des Obcrschenkels, Zurich, 1877, p. 90, CASE 281. 3 The particulars of this case were first communicated to the Surgeon General s Office by Dr. F. J. BANCROFT, of Denver, Colorado, formerly Surgeon of the 3d Pennsylvania Artillery, November 26, 1875. Captain CARLTON S regimental surgeon, Dr. A. A. MOULTON, 3d New Hampshire, wrote to the Surgeon General s Office from Tilton, New Hampshire, December 9, 1875, that he "did not see Captain CARLTON, but heard that his limb was amputated at or near the hip joint." A search at the Pension Office corroborates the dates of the injury as reported by Dr. BANCROFT. On June 16th, the 3d New Hampshire was in a brigade comprising the 97th Pennsylvania, 7th Connecticut, and 3d Rhode Island Artillery. Enquiries regarding the case were addressed to Surgeon J. R. EVERHART, 97th Pennsylvania, to Assistant Surgeon H. P. PORTER, 7th Connecticut, and Surgeon H. G. STICKNET, 3d Rhode Island Artillery, medical officers of the brigade of General I. I. STEPHENS, and also to Surgeon E. L. DIBBLE, 6th Connecticut, and Surgeon P. A. O CONNELL, 28th Massachusetts, New England medical officers who were present at the engagement on James Island, on June 16, 1862; but no further information could bo elicited from any surgeon present at this operation in addition to the details recorded by Dr. F. J. BANCROFT, formerly surgeon 3d Pennsylvania Artillery. 134 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. attending and following the amputation, I well remember how earnestly and energetically he said : I desire it. I must live. I will live. I have a wife and five children to provide for. Yet in two short hours all earthly ties were severed." Surgeon A. A. Moulton, 3d New Hampshire, reported that Captain Carlton died on June 16, 1862, of "gunshot wound," and in the military history of the regiment, published by the Adjutant General of the State in 1866, he is mentioned as "a gallant and promising officer," who during said engagement " was hit in both legs by a solid shot, and died the same day." CASE 278. Private Cooper, of an Alabama Regiment, aged 20 years, was wounded at the siege of Vicksburg, on May 22, 1863, by a fragment of shell, which inflicted a terrible laceration of the upper exterior part of the right thigh, comminuted the upper third of the femur, and fractured the tuberosity of the ischium. There was profuse haemorrhage. Surgeon W. M. Compton, 2d Texas, decided to operate, because the wounded man most earnestly begged that an attempt should be made by amputation to save his life. A few hours after the reception of the injury he was placed under chloroform, and amputation at the right hip joint was rapidly performed by making a large anterior flap and dividing the soft parts posteriorly by a circular sweep of the knife. The stump was dressed and the patient actively stimulated, but he never rallied from the shock of the operation, and died in less than an hour after its accomplishment. 1 CASE 279. Private Isaac C. Fulton, Co. I, 4th New York Heavy Artillery, was wounded, on October 1, 1864, in the trenches before Petersburg, by a fragment of shell, which shattered the upper extremity of his left femur and lacerated the soft tissues on the outside of the thigh, without, however, implicating any important vessels or nerves. He was immediately carried to the Second Corps field hospital, under the charge of Surgeon F. F. Burmeister, 69th Pennsylvania, and a consultation was held, at which it was determined that an amputation at the hip joint was the only resource that could possibly preserve life. The wounded man was, therefore, immediately placed under the influence of chloroform, and Surgeon J. W. Wishart, 140th Pennsylvania, did the operation. The ordinary method by antero-posterior flaps formed by transfixion was employed. The operation was rapidly performed and but a trifling quantity of blood was lost. The patient survived the shock of the injury and operation but a few hours, and died at City Point, October 1, 1864. CASE 280. Private Richard Gordon, Co. H, 7th Rhode Island, a stout and apparently healthy man, aged 28 years, was wounded May 18, 1864, in one of the assaults on the lines at Spottsylvania, and was carried on a stretcher, two or three miles to the rear, to a field hospital of the Ninth Corps. A fragment of shell had completely shattered the left thigh, leaving the lower part of the limb attached to the upper by shreds of integument and muscles only. There had been but slight primary haemorrhage. He was conscious and his pulse was perceptible; but he was in extreme collapse. A consultation was held, at which the Surgeon-in-chief of the division, Surgeon P. A. O Connell, Surgeon James Harris, 7th Rhode Island, and others, assisted, and it was determined to give the man the chance of an operation rather than to allow him to die without an effort to save him, and Dr. J. M. Carnochan, who had volunteered his services at the hospital, was selected to operate. Chloroform was carefully administered by Surgeon Harris, and Dr. Carnochan, as a preliminary step, tied the femoral artery three-quarters of an inch below Poupart s ligament, and then proceeded to amputate at the hip joint by a modification of the oblique method of Guthrie. A vertical incision three inches long, commencing an inch above the great trochanter, was made, the soft parts being divided down to the bone. From the lower third of this incision, two oblique incisions, one before and one behind, were made to diverge and then to reunite about two and a half inches below the level of the ischiatic tuberosity. The head of the femur was then disarticulated, and the knife being earned to the inner side of the neck the operation was finished by dividing the soft parts on that side by a single sweep of the instrument. The operation, including the ligation of the femoral, was completed in two minutes. The patient recovered kindly from the influence of the anaesthetic. He was placed in a shelter tent and took a dose of opium. He died ten hours after the operation, no reaction having taken place. 2 CASE 281. Brevet Lieutenant-Colonel J. H. Janeway, Assistant Surgeon, U. S. A., learned that Dr. Hunter McGuire, Surgeon-in-chief of Swell s Division, performed a primary amputation at the hip after the engagement at Ball s Bluff, October 21, 1861, upon a Union prisoner of war, with a frightful injury of the upper part of the femur, caused by a large projectile, and that the patient succumbed to the combined shock of the injury and operation soon after the completion of the latter. CASE 282. A lieutenant in an Arkansas Regiment in Cabell s Brigade, aged 28 years, was wounded at the attack on Corinth, Mississippi, October 3, 1862. A solid cannon ball struck the right hip and made a formidable wound, tearing up the soft parts of the buttock and shattering the upper extremity of the femur. The trochanters and about five inches of the shaft of the femur were comminuted; the head of the femur was exposed and was split across. It was decided that amputation at the hip presented the only possible surgical resource, and the operation was undertaken, two hours after the injury, by Surgeon W. M. Compton, 2d Texas. The operation consisted in paring into shape the lacerated soft parts at the posterior part of the thigh, completing the disarticulation already partly effected by the projectile, and forming a large and long antero-internal flap. The patient was under the influence of chloroform. There was but little hemorrhage. The flap covered the immense wound and was adjusted with tolerable accuracy to meet the incision at the gluteal region. The combined shock of the injury and operation was very great, and the patient reacted slowly and with difficulty. But he rallied finally, and progressed very favorably for several days. The inflammation was not intense, appetite returned, and strong hopes of the patient s recovery were entertained. But, on the seventh day, erysipelas invaded the stump and extended rapidly, in spite of the use of tincture of iron and such other treatment as it was thought proper to institute. The case terminated fatally on October 12, 1862. 3 CASE 283. A private in General A. S. Johnston s army was wounded on the morning of Sunday, April 7, 1862, at the battle of Shiloh, by a fragment of shell, which shattered the upper extremity of the left femur. The comminution extended to the neck and head of the bone, and .the soft parts at the upper third of the thigh were torn into shreds. Notwithstanding the 1 EVE (P. F.), A Contribution to the History of Hip Joint Operations performed during the late civil war, in Transactions of the Am. Med. Ass n, 1867, Vol. XVIII, pp. 255, 263. Circular No. 7, S. G. O., 1867, pp. 27, 58. 2 HAMILTON (F. H.), A Treatise on Mil. Surgery, 1865, pp. 485, 637. Circular No. 6, S. G. O., ISti.j, p. 50. Circ. Xo. 7, S. G. O. 1S67, pp. 30, 5U. 3 E\ E (P. F.), A Contribution to the History of the Hip Joint Operations performed, etc., in Transactions of the Am. Med. Ass n, 1867, Vol. XV1I1 pp. 255, 262. Circular No. 7. 8. G. O.. 1867. pp. 25, 58. SECT. n. | PRIMARY AMPUTATIONS AT THE HIP JOINT. 135 terrible nature of the injury the patient reacted, and it was thought, in the evening, that his condition justified amputation. At seven in the evening disarticulation at the hip joint was performed by Dr. D. W. Yandell, Medical Director. The operation was well borne; but about three hours after its completion symptoms of exhaustion were manifested, and the case terminated fatally seven hours after the operation, at two o clock of the morning of April 8, 1862. 1 CASE 284. A private of the 3d Missouri Regiment was wounded at the siege of Vicksburg, in June, 1863, by a large fragment of shell. The projectile produced a frightful laceration of the tissues on the inner and posterior parts of the right thigh, completely divided the femoral artery, and comminuted the femur through an extent of eight or nine inches. A surgeon in the trenches put a ligature on the femoral artery, d"nd the wounded man was conveyed to the City Hospital and was plied with cordials. The sufferer had but recently recovered from an attack of illness ; the primary haemorrhage had been copious, and reaction was very imperfect. A consultation of surgeons decided that amputation at the hip joint should be practised, and the wounded man expressed a desire to have the benefit of this forlorn chance. Surgeon B. D. Lay undertook the operation with great reluctance, fearing that the patient might die under the knife, he was so very feeble. Stimulants were freely administered and morphia; but it was decided that the operation should be done without anaesthetics. The nature of the wound determined the direction of the incisions. There was a rent in the soft parts laying bare the tuberosity of the ischium, and another extend ing nearly to Poupart s ligament, in which the ligated femoral artery was hanging. Dr. Lay commenced the operation, in the presence of Surgeons Britts, McDowell , Nidelet, and others, by making a clean circular cut through the inner and posterior parts of the thigh, dividing all the soft parts down to the articulation ; a semilunar flap was then obtained from the outer and anterior part by cutting from without inward; the head of the femur was then disarticulated. Eight ligatures were required. The flap fitted well. The operation, which occupied about twenty minutes, was wall supported, and the patient said that he felt more comfortable after than before it. However, reaction was never fully established. Dr. Nidelet relates that the patient died upon the table within an hour and a half after the completion of the dressing. Dr. Lay s recollection is that he survived the opera tion some fourteen or sixteen hours. 3 CASE 285. A private of the 27th Tennessee Regiment was wounded at Jonesboro , Georgia, August 31, 1864, by a cannon shot, which frightfully lacerated the soft parts on the upper and outer part of the thigh and shattered the femur, the splintering extending quite to the neck of the bone. Six hours after the injury, Surgeon J. R. Buist, 1st Tennessee, of Cheat- ham s Division, removed the limb at the hip joint by the antero-posterior flap method by transfixion. The patient was rendered insensible by chloroform. He rallied promptly from the anaesthetic and from the shock of the operation. Cold-water dressings were applied to the stump, and stimulants and concentrated nourishment were administered. After about eight hours the patient began to sink, and he died thirty-six hours after the operation, September 2, 1864. 3 In a letter, dated Nashville, Tennessee, March 25, 1867, Dr. Buist states: "I am sorry to say that the exsected head of the femur was not preserved, nor a photographic drawing taken." CASE 286. Private William Waters, Co. K, 123d New York, was wounded at Resaca, Georgia, on May 15, 1864, by a large fragment of shell, which completely carried away his left thigh and fractured both the tibia and fibula of the right leg. He was carried to a field hospital of the Twentieth Corps, and as soon as he had partially rallied from the shock of his frightful injuries chloroform was administered, and Surgeon J. W. Brock, 66th Ohio, amputated at the left hip joint: and then removed the right leg at the place of election. The patient survived the double operation but a short period. The exact length of time is not stated; but he died in the afternoon of the day on which he was wounded, May 15, 1864. 4 CASE 287. Private Elisha Waylancl, Co. E, 34th Iowa, had his right thigh almost completely torn off at the hip joint, at the siege of Vicksbnrg, July 3, 1863, by an unexploded shrapnel shell. He was hurriedly conveyed to a field hospital, but bled very profusely during the short transit, and is represented as almost exsanguineous upon reaching the hospital. His regi mental surgeon, Charles W. Davis, 34th Iowa, having mastered the haemorrhage, had the patient placed under chloroform, ligated the femoral artery, divided the lacerated soft parts which still connected the mutilated limb with the trunk, and then formed a single large anterior flap, and exarticulated the femur. The patient survived the operation two hours, and died July 3, 1863. 5 In five of the foregoing examples (CASES 273, 280, 284, 286, 287) and in CASE 289, to be cited presently, primary disarticulation at the hip appeared to be of absolute urgency, since the graver injuries of -the femur were, in each case, conjoined with lesions of the femoral artery. 1 The particulars of this case were communicated to the Surgeon General by Professor P. F. EVE in a letter dated Nashville, March 5, 1867. See also EVE (P. F.), foe. cit., p. 253, and Circular No. 7, S. G. O., 1867, pp. 24 and 57 ; LttxiXG (A.), op. tit., p. 90. 2 The abstract of this case was compiled from data furnished by the operator, Dr. BENJAMIN D. LAY, in charge of the City Hospital, at Vicksburg, during the siege, in a letter to the editor, dated Paducah, July 26, 1867. Dr. LAY, who reluctantly undertook the operation, closes his account with the following remark : "I saw nothing in it to diminish the horror with which I approach such cases, of which I have had the misfortune to have three. I have been present at three others. All were fatal." See Circular No. 7, S. G. O., 1867, pp. 27, 58 ; EVE (P. P.), toe. cit., pp. 253. 258; LttxiXG (A.), op. cit., p. 94. 3 The facts in this case were furnished by Professor PAUL F. EVE, from a carefully written account by the operator, Surgeon J. K. BUIST, 1st Ten nessee. See Circular No. 7, S. G. O., 1867, pp. 31, 59; EVE (P. P.), toe. cit., pp. 253, 258; LOxrxo (A.), op. cit., 97. 4 The abstract of this case was made from field returns signed by Surgeon G. E. COOPER, TJ. S. A., Medical Director, Surgeon A. L. Cox, If. S.V., and Surgeon A. BALL, 5th Ohio. See Cireular No. 6, S. G. ().. 1865, p. 50 ; Circular No. 7, S. G. O., 1867, pp. 29, 58 ; LXG (A.), op. cit., p. 96. 8 This abstract was compiled from notes of the case on the Monthly Report of Sick and Wounded of the 34th Iowa, for July, 1863. In a letter to the editor, dated Indianola, Iowa, June 1, 1869, the operator, Dr. C. W. DAVIS, writes: "In reply to yours of May 1st, I will say, after examining my Army surgical notes, I notice the case of E. M. Wayland, Co. E, 34th Iowa Volunteers. Disarticulation of hip joint, on the right side. The femur was fractured at upper third; also laceration of the tissues, muscles, and vessels of the posterior part of the leg ns far upas the insertion of the glutens marimus. I performed the amputation by the single anterior flap operation, ligating the artery before disarticulating the head of the femur. The operation was neat and made a perfect stump, but the patient lived only forty-seven hours." See Circular No. 2, S. G. O., 1869, p. 108. 136 INJUEIES OF THE LOWER EXTREMITIES. ICHAP. x. PIG. 91. Shot fracture through the trochanters of the left femur. [From a drawing by Surgeon H. Z. GILL, U. S. V.] The following nine fatal cases of primary amputations at the hip were for wounds inflicted by small projectiles. In one instance (CASE 294), the patient survived the opera tion at least eleven days; in another (CASE 293), the patient had rallied so far that it was considered safe to move him, but he succumbed on the road, forty-eight hours after the operation. The remaining seven patients died within a few hours. CASE 288. Private James A. Ailing, Co. D, 3d Wisconsin, was wounded on March, 16, 1865, at tlie battle of Averysboro , North Carolina, by a conoidal musket ball, which entered the upper part of the left thigh in front, and produced a comminuted fracture of the femur through the trochanters, with longitudinal splintering extending a short distance down the shaft and upward within the capsular liga ment. The wounded man was conveyed to a field hospital of the Twentieth Corps. Chloroform was administered and the wound was thoroughly explored, and it was determined to amputate at the hip joint, because it was imperative to move the wounded on the following day over rough roads, and either an excision of the head of the femur, or an attempt at conservation of the limb, offered, under the circumstances, less chance of a favorable result than the removal of the limb. Five hours after the reception of the injury, Surgeon H. Z. Gill, U. S. V., amputated by double flap. The patient reacted well after the operation, but the amendment was of brief duration. He died seven hours after the com pletion of the amputation, March 17, 1865. A drawing of the shattered extremity of the femur, contrib uted by the operator, is presented in the adjacent wood-cut (FiG. 91). CASE 289. Corporal Wad Brookins, Co. C, 49th U. S. Colored Troops, 2 was accidentally shot, in the regimental camp, near Transylvania Landing, Louisiana, on September 3, 1863. He was struck in the upper third of the left thigh, at close range, by a musket ball, which divided the femoral artery and badly comminuted the thigh bone. Assistance was immediately rendered, and the copious hasmorrhage was controlled by compression. Prompt preparations having been made, the thigh was amputated at the hip by Surgeon Sylvester Lanning, 49th U. S. C. T. The patient died from the haemorrhage and shock, four hours after the completion of the operation, September 3, 1863. CASE 290. Private J. M. Brown, Co. H, 63d Indiana, was wounded on June 16, 1864, in the attack of the Twenty-third Corps upon the earthworks at Lost Mountain, near Marietta, Georgia. A conoidal musket ball struck his right thigh and shat tered the upper extremity of the femur, fissures extending through the trochanter major. He was conveyed to the field hospital of the Twenty-third Corps, and on June 17th, about fourteen hours after the reception of the injury, he was placed under the influence of chloroform, and after a careful examination of the injury, it was decided to amputate at the hip joint. The oper ation was performed by Surgeon Edward Shippen, U. S. V. The operative method was similar to that adopted by Dr. Shippen in his successful operation (CASE 272). Comparatively little blood was lost, but the patient succumbed to the shock of the operation and died upon the operating table very soon after the completion of the disarticulation. 3 CASE 291. Seaman George Cook, aged 21 years, an Englishman, was wounded on February 1, 1834, in an engagement of a gunboat with a battery supported by sharpshooters, at Smithfield, Virginia. A rifle ball grazed his right thigh, passed through both testicles and entered the left thigh, fractured the femur, and passed out at the posterior and outer portion of the limb. The wounded man was taken to the Naval Hospital, at Portsmouth, Virginia, not many miles distant, and Surgeons Solomon Sharp, A. C. Gorgas, John Paul Quinn, and Assistant Surgeon G. S. Franklin, U. S. N., held a consultation, at which it was decided that the femur was extensively shattered, and that an amputation at the hip joint presented the only chance of saving the patient s life. On the morning of February 2d, the patient was placed under the influence of chloroform, the femoral artery was compressed at the groin, and Surgeon Gorgas, assisted by his colleagues, proceeded to remove the limb. The operation was performed by transfixing and forming an anterior flap, disarticulating, and then making a posterior flap by cutting from within outward. Very little blood was lost; yet the patient never reacted, but succumbed about two hours after the completion of the operation. The shattered femur was forwarded by Surgeon Gorgas to the Army Medical Museum. It is represented in the adjacent wood-cut (FiG. 92). It is a very strong and compact bone. The ball has separated five large fragments, and has produced fissures extending from above the level of the trochanter minor a little over four inches down the shaft. 4 CASE 292. " Private John W. Dadds, Co. B, 4th Maryland, was wounded on the morning of May 12, 1864, at the battle of Spottsylvania, by two musket balls, one of which shattered his left tibia and fibula, while the other passed through the left 1 The notes in this case were furnished by the operator, Surgeon H. Z. GILL, U. S. V. See Circular No. 7, S. G. O., 1867, pp. 31, 59 ; LOxiXG (A), Ober die Slutung bei dcr Exarticulation des ObersclienJcels, etc., Zttrich, 1877, S. 102. 2 The regiment was styled at the period " llth Louisiana Regiment of African Descent." Its designation was changed, March 11, 1864. to "49th United States Colored Troops." The case was reported on the Monthly Report of Sick and Wounded of the llth Louisiana Regiment of African Descent, signed by the operator, Surgeon SYLVESTER LANSING. See Circular No. 2, S. G. O., 1869, p. 108 ; Lt)NDr. (A.), op. cit., p. 93. 3 A Report of Surgical Operations during the Atlanta Campaign in 1864, collected by Surgeon A. M. WILDER, TJ. 8. V., furnished the data in this case. This is one of the two fatal cases referred to by Dr. EDWARD SHIPPEN, the operator, in connection with an account of his successful amputation at the hip (CASE 270, ante.), published in Professor FRAKK H. HAMILTON S Treatise on Military Surgery, New York, 18G5, p. 485. A special report from Dr. Smri EX, dated January 13, 1866, contains no further particulars. See Circular No. 6, S. G. O., 1865, p. 50; Circular No. 7, S. G. O., 1867, pp. 31, 59; LtJxrso (A.), op. cit., p. 97. 4 An account of this case was forwarded to the Surgeon General s Office by the operator, Surgeon ALHEKT C. GORGA8, U. S. N., together with the pathological preparation. See Circular No. 6, S. G. O,, 1865, p. 50 ; Circular No. 7, S. G. O., 1867, pp. 28, 58 ; Catalogue of the Surg. Sect, of the Army Medical Museum, 18C6, p. 233; LINING (A.), op. cit., p. 96. FIG. 92. Comminution of femur by a rifle ball. Spec. 2273. SECT, n.] PRIMARY AMPUTATIONS AT THE HIP JOINT. 137 thigh, comminuting the femur at the trochanters. He was carried to the field hospital of the 2d division of the Fifth Corps, where a consultation was held by the senior surgeons present. After a careful exploration, under chloroform, it was determined that the thigh wound involved the hip joint. It was decided that an excision of the head of the femur, or a resort to expectant treatment, were alike forbidden by the grave compound fracture of both bones of the leg, which complicated the thigh fracture, and that there was no alternative but coxo-femoral amputation. Accordingly, stimulants were administered, and every means were employed to bring about reaction, and, three hours after the reception of the injury, Surgeon Enos G. Chase, 104th New York, proceeded to remove the limb. He performed the double-flap operation, sometimes described as Bdclard s, transfixing the thigh and forming a large flap in front, disarticulating and then cutting from within outward to make a posterior flap. The vessels were then rapidly secured. The patient survived the operation twelve hours." 1 CASE 293. Private James Martin, Co. I, 146th New York, aged 20 years, was wounded on July 13, 1863, in one of the reconnoissances of General Lee s position near Williamsport. He was carried to the rear and placed in a barn by the roadside not far from Williamsport. On the following morning a consultation was held in the case, at which Assistant Surgeons Howard, C. Wagner, and Colton, U. S. A., and Drs. Stearns, Lord, Dean, and others assisted. It was found that a couoidal musket ball had passed through the upper part of the left thigh from before backward, and had struck the femur a little below the great trochanter and produced a comminuted fracture. It was believed that the fracture extended into the coxo-femoral articulation, and it was decided that no operative procedure could be advantageously practised except an amputation at the hip joint. Dr. Howard was invited to operate. Chloroform having been administered, he removed the limb by a double-flap operation. He describes the operation as performed by "entering the knife about four or five inches below the anterior superior spinous process of the ilium, and causing it to emerge by transfixion an inch and a half to the inside of the course of the femoral vessels. The operation was completed in the ordinary manner of flap amputations. By transfixing at the points described, the mouths of the divided vessels were so near the margin of the anterior flap as to be readily seized immediately after division, and by the external obliquity of the plane of incision drainage of pus was facilitated more than by the ordinary horizontal antero-posterior flaps." It appears that the disarticulation Avas rapidly accomplished, and that very little blood was lost. The shock FIG. 93. -Comminuted . . . x i i iv j * ii. A * -j j f ^ T-- ,r> 8hot fracture of femur, was great, but the patient is reported to have rallied so far that it was considered sate to move him. On gp^. 1379. July 16, 1863, he died on the road to Sharpsburg, about forty-eight hours subsequent to the operation. An examination of the specimen from this case, which was forwarded by Assistant Surgeon Howard to the Army Medical Museum, and is represented in the wood-cut (FlG. 93), justified the opinion formed before the operation, that an excision of the head of the femur was impracticable ; for besides the comminution about the lesser trochanter and the fissures towards the neck, fissures ran down the shaft of the bone for a long distance. 2 CASE 294. A private soldier of Major Douglass s Cavalry was accidentally wounded by a comrade near Lavergne, Tennessee, on October 19, 1862. The injury was inflicted by a round ball, with buckshot, fired from a fowling-piece, the muzzle being within a few inches of the person of the man who was wounded. The charge passed directly through the thigh just below the trochanters, comminuted the femur, and extensively lacerated the soft parts. The operation was performed eight hours after the reception of the injury. Chloroform was administei-ed until anaesthesia was complete. Then an assistant controlled the femoral at the groin, and the operator, Dr. J. F. Grant, P. A. C. S., entered the point of a knife twelve inches long an inch below the anterior superior spinous process of the ilium and transfixed, according to Lisfranc s method, on the outer side of the femur, bringing the point out near the tuberosity of the ischium, and cutting an external and posterior flap five inches long. The gluteal and sciatic arteries were then tied; then an antero-internal flap was cut and the head of the bone was disarticulated. He was taken to the neighboring house of a widowed lady on the Murfreesboro pike, between Lavergne and Nashville. Here he was seen by Dr. Grant on October 22d, and seemed in every respect to be doing well. On this day that locality was occupied by United States troops and Dr. Grant did not see his patient again. He received a message from him on October 30th, but no subsequent information. It is altogether probable, therefore, that the patient died. 3 CASE 295. A private of the 18th Mississippi Regiment, of Barksdale s Brigade, a robust man, under thirty years of age, received a shot fracture of the upper extremity of the left femur, at Malvern Hill, July 1, 1862. The injury was probably caused by a conoidal musket ball, and there was great splintering of bone, extending to the neck. Eai ly on the morning of July 2d the patient inhaled chloroform, and amputation at the hip joint was performed by Surgeon J. T. Gilmore, P. A. C. S., by forming anterior and posterior flaps by transfixion. There was no reaction, and the patient died from the shock of the operation an hour or two after its completion. 4 CASE 298. A private of the 21st Mississippi Regiment, a young healthy man, was wounded at Malvern Hill, July 1, 1862, by a conoidal musket ball, which fractured the left femur through the trochanters and neck. Twelve hours after the reception of the injury he underwent amputation at the hip joint. The operation was performed under chloroform, by Surgeon J. T. Gilmore, by the antero-posterior flap method, the flaps being formed by transfixion. The patient only partially reacted after the operation, and, though he lingered until the morning of July 4th, he died apparently from the shock of the operation. 5 1 At the date of the publication of Circular No. 7, in 18C7, various reports regarding this case led to the belief that the head of the femur had been excised. A report of the case, by Surgeon EXOS G. CHASE, 104th New York, the operator, was finally discovered in time for publication in Circular No. 2, 18C9, at page 107; LINING (A.), op. cil., p. 96. 2 Assistant Surgeon BENJAMIN HOWAUD, U. S. A., the operator, and Surgeon T. M. FLANDRAU, 146th New York, communicated the facts in this case. See Circ. No. G, S. G. O., 1865, p. 50 ; Circ. No. 7, S. G. O., 1867, pp. 28, 58 ; Cat. Surg. Sect. A. M. M., 18C6, p. - 33 ; LlJNING (A.), op. cit., p. 94. 3 The abstract of this case was compiled from data furnished by Professor PAUL F. EVE. See Circular No. 7, S. G. O., 1867, pp. 25, 28; EVE (P. F.), Joe. cit., pp. 234, 260; LuNING (A.), loc. cit., p. 91. "EVE (P. F.), Joe. cit., pp. 254, 259; Circular No. 7, S. G. O., 1865, pp. 25, 57; LterNG (A.), op. cit., p. 91. 8 SOUUEL (F.), Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 155; EVE (P. P.), loc. cit., p. 254; Circular No. 7, S. G. O., 1867, pp. 25, 58; LOxiXG (A.), op. cit., p. 91. SURG. Ill 18. 138 INJURIES OF THK .LOWER EXTREMITIES. [CHAP. X. TABLE XV. Summary of Twenty-five Cases of Primary Amputation at the Hip Joint. NO. NAME, AGE, AXD MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Kelly, J. E., Pt, B, 56th April 29, Conoidal ball fractured upper April 29, Single anterior flap, by Surg. Gangrene, diarrhoea. Disch d Pennsylvania, age 28. 1863. extremity of left femur. 1863. E. Shippen, U. S. V. December 23, 1 863. Spec. 1148. 2 Robinson, Pt., Louisiana reg Mar. 13, Frag.of 24 -pounder shell crush Mar. 13, Antero-internal flap amputat n, Healed by first intent n ; left hos iment, age 35. 1863. ing trochanters and neck of 1863. by Surg. W. M. Compton, 2d pital April 20, 63, in fine health. left femur and wounding fem Texas. EVE (P.F.). ?oe.ci/..pp.254, 262. oral artery. Circ. 7, S. G.O., 1867, pp. 26, 58. 3 Williamson, Pt., 13tb Mis June 4, Conoidal ball fract. right femur, June 4. Long anterior and short poste Six weeks after operation wound sissippi, age 20. 1862. fissures extending into neck 1862. rior flaps, by Surg. J. T. Gil- healed and patient allowed to quite within capsular ligam t. more, C. S. A. leave hospital. EVE (P. F.), loc. cit., pp. 254, 259. Circ. 7, S. G. 0., 1867, pp. 24, 57. 4 Ailing, J. A., Pt., D, 3d Mar. 16, Conoidal ball fract d left femur Mar. 16, Double flap, by Surg. H. 7,. Died, March 17, 18t>5, seven hours Wisconsin. 1865. thro troch s, with longitud l 1865. Gill, U. S. V. after operation. Circ. 7, S. G. splintcr gextend g down shaft and upw d within capsul. lig. O., 1867, pp. 31, 59. 5 Barger, J., Pt., B, 26th May 18, Fragment of shell shattering May 18, Single antero-interual flap, by Died, May 18, 1864, two hours Pennsylvania, age 22. 1864. right femur from just above 1864. Surg. C. C. Jewett, 16th Mass. after operation. iSpcc.3080. Circ. tro. minornine ins. downward. 7, S. G. O.. 1867, pp. 30, 5!). li Brookins, W., Corp l, C, 49th Sept. 3, Musket ball eomminut g upper Sept, 3, Amputation, by Surg. S. Lan- Died, Sept. 3, 1863, from hemor Colored Troops. 1863. third left thigh and dividing 1863. ing, 49th Colored Troops. rhage and shock, four hours femoral artery. after operation. Circ. 2, S. G. O., 1869, p. 109. 7 Brown, J. M., Pt,, H, 63d June 16. Conoidal ball shattered upper June 17, Single anterior flap, by Surg Died June 17, 1864; shock of Indiana. 1864. extremity right femur,fissures 1864. E. Shippen, U. S. V. operation. Circ. 6, S. G. O., extending through trochauter 1865, p. 50. Circ. 7, S. G. O., major. 1867, pp. 31, 59. 8 Bushmil. J.. Pt., 99th New- Mar. 9, Piece of shell comminuted neck Mar. 9, Lateral double flap, method of Did not rally; died two hours York (detailed as a seaman 1862. and trochanters of left femur. 1862. Baron Larrey, the elder, by after operation. Circ. 7, S. G. on U. S. frigate Congress). Surg. L. McLean, 2d N. Y. O., 1867, pp. 24, 57. 9 Carlton. R., Captain, 1, 3d June 16. Large missile fractured tro June 16. Anterior posterior flap, by a Did not rally ; died. June 16, New Hampshire. 1862. chanters and shattered left fe 1862. New England surgeon ; assist 1862, less than two hours after mur for several inches below. ed by Ass t Surg. F. J. Ban operation. croft, 76th Penn. 10 Cook, G., seaman, age 21 ... Feb. 1, Rifle ball fractured left femur, Feb 2, Anterior posterior flap.bv Surg Never reacted : died two hours 1864. wounded both testes and right 1864. A. C. Gorgas, U. S. N. after operat n. Spec. 2273. Circ. thigh. 6, S. G. O., 18G5, p. 50. Circ. 7, S. G. O., 1867, pp. 28. 58. 11 Cooper, , Pt., Alabama May 22. Fragment of shell comminuted Mav 22, Large anterior flap, by Surg. Never rallied ; died in less than regiment, age 20. 1863. upper third right femur, frac 1863. W. M. Compton, 2d Texas. an hour. turing tuberosity of ischium. 13 Dadds, J. W., Pt., 15, 4th May 12. Musket ball comminuting left May 12, Double flap, Beclard s method, Died, May 12, 1864, twelve hours Maryland. 1864. femur at trochanters, involv. 1864. by Surg. E. G. Chase, 104th after operation. Circ. 2, S. G. hip joint (also fract. left leg). New York. O., 1869, p. 107. 13 Fulton, I. C., Pt., I. 4th New Oct. 1. Fragment of shell shattered up Oct. 1, Anterior post, flaps, by Surg. Died, Oct. 1, 1864, from shock, York Heavy Artillery. 1864. per extremity of left femur. 1864. J. W. Wishart, 140th Penn. in a few hours. Circ. 2, S. G. O., 1869, p. 108. 1-1 Gordon, R., Pt., H, 7th May 18, Fragment of shell completely May 18, Method of Guthrie, by Dr. J. No reaction ; died ten hours after Rhode Island, age 28. 1864. shattered left femur. 1864. M. Carnochan : femoral tied operation. before amputation. 15 Martin, J., Pt., 1, 146th New July 13, Conoidal ball comminu d frac July 14, Double flap, by Ass t Surgeon Shock great ; rallied somewhat. York, age 20. 1863. ture of left femur a little below 1863. B. Howard, U. S. A. Died July 16, 1863. Spec. 1379. trochanter major. Circ. 6, S. G. O.. 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 28, 8. Hi Unknown, Union soldier, Oct. 21, Large missile fractured upper Oct. 21, Amputation, by Surgeon H. Died soon after operation ; com taken prisoner. 1861. part of femur. 1861. McGuire, C. S". A. bined shook of injury and oper n. Circ. 2, S. G. O., 1869, p. 108. 17 Unknown, Lieut.. Arkansas Oct. 3, Cannon ball wound of right Oct. 3, Soft parts of post, part of thigh Rallied ; favorable progress : Oct. regiment, age 28. 1862. hip, five inches of the shaft of 1862. pared into shape, large and 10th. erysipelas extended rapid femur comminuted, head split long antero-internal flap, by ly. Died October 12, 1862. and exposed. Surg W.M.Compton, 2d Tex. 18 Unknown, Pt., Maj. Doug Oct. 19. Round ball and buck com Oct. 19, External posterior flap, antero- Oct. 22d, doing well ; last heard lass s Cavalry. 1862 minuted femur just below 1862. internal flap, by Surg. J. F. from Oct. 30th ; probably died. trochanters. Grant, P. A. C. S. EVE (P. F.), loc. cit., pp. 254, 260. Circ. 7, S. G. O., 1867, pp. 25. 58. 19 Unknown, Pt., Gen. A. S. April?, Frag, shell shatt d up. extrem April 7, Amputation, by Surg. D. W. Died, from cxhaust n, seven h rs Johnston s army. 1862. ity left femur, com. extended 1862. Yandell, C. S. A. after operation. EVE (P. F.), to head and neck of bone. loc. cit . p. 253. Circ. 7, S. G. O., 1867, pp. 24, 57. 20 Unknown, Pt., 18th Miss., July 1, Conoidal ball fractured upper July 2, Anterior and posterior flaps, by Died, an hour or two after oper Barksdale s brigade, age 1862. extremity of left femur, splint 1862. Surg. J. T. Gilmore, C. S. A. ation, from shock of operation. under 30. ering extending to neck. EVE (P. F.), loc. cit.. p. 254. Circ. 7, S. G. O., 1 867, pp. 25, 57. 21 Unknown, Pt., 21st Miss.... July 1, Conoidal ball fract d left fumur July 1, Anterior posterior flap, by Sur Died, July 4, 1862, apparently 1862. through trochanters and neck. 1862. geon J. T. Gilmore, C. S. A. from shock of operation. oo Unknown, Pt.. 3d Missouri. June , Large frag, of shell comminu Day of Semi-lunar flap from outer and Reaction never completely estab 1863. ting right femur extent of injury. anterior part, by Surg. B. D. lished ; died samo dav. EVE eight inches; femoral artery Lay, P. A. C. S. (P. F.), loc. cit., pp. 253, 261. divided. Circ. 7, S. G. O., 18<i7. pp. 27, 58 :; Unknown, Pt.. 27th Tenn Aug. 31, Cannon shot shat d right femur, Aug. 31, Antero-posterior flaps, by Surg. Rallied promptly ; died. Sept. 2, 1864. splintering extending to neck. 1864. J. R. Buist, 1st Tennessee. 1864, thirty-six hours after oper ation. EVE (P. F.), Inc. cit. , pi>. 253, 258. Circ. 7. S. G. O., 1 867, pp. 31. 59. 24 Waters, W., Pt., K, 123d May 15, Large fragment of shell carried MaylS, Amputation of the left hip and Died May 15, 1864. Circ. 6. S. New York. 1864. away left thigh, fracturing 1864. right leg. by Surgeon J. W. G. O., 1865, p. 50. Circ. 7, S. right leg. Brock, 66th Ohio. G. O., 1867, pp. 29, 58. 25 Wayland, E., Pt., E, 34th July 3, Unexploded shrapnel shell al July 3, Single large anterior flap, by Died two hours after operation. Iowa. 1863. most completely tearing off 1863. Surgeon C. W. Davis, 34th Circ. 2, S. G. O., 1869, p. 108. right thigh at hip joint. Iowa. SECT. II.] INTERMEDIARY AMPUTATIONS AT THE HIP JOINT. 139 Intermediary Amputations. Twenty-three instances of amputations at the hip joint during the inflammatory period after shot injury are included in this category,, and refer to cases of fifteen Union and eight Confederate soldiers, each case having a fatal result. Brief details of the cases are given in alphabetical order, with foot-note references to the sources of information. 1 CASE 297. Private James Garden, of the army of Major General Rosecrans, was wounded at the battle of Chickamauga, in the second day s fight, September 20, 1863, by a fragment of shell, which caused great laceration of the soft parts at the upper part of the thigh, with comminuted fracture of the femur. He was left upon the field and was made a prisoner. On the even ing of September 21st, Surgeon R. P. Bateman, C. S. A., amputated his thigh at the hip joint. The patient died on September 27, 1863, six days after the operation. 2 CASE 298. Sergeant Lewis Carroll, Co. H, 1st Delaware, aged 23 years, was wounded on October 22, 1864, near the Weldou Railroad. 3 A conoidal musket ball entered the right thigh in front, and, striking the femur at the junction of the upper thirds, produced a remarkable longitudinal splintering of the bone, extending from an inch below the lesser trochanter downward for ten inches, together with several oblique fissures. The wounded man was conveyed in an ambulance to one of the field hospitals of the Fifth Corps, where the ball was extracted and the sharp extremity of the upper fragment of the femur was sawn off. Tie fractured limb was then dressed, and the patient sent to City Point, and thence on a hospital steamer to Alexandria, where he was admitted to the Third Division Hospital on November 2d. The thigh was swollen to three times the size of its fellow. An incision six inches long on the outer side presented inflamed everted edges, between which fasciculi of muscles protruded. There was much febrile irritation, but the patient s strength was maintained to a remark able degree. On November llth, there was quite free haemorrhage from a small artery, and the patient was etherized and the vessel secured, and afterward a thorough exploration of the wound was made. The very extensive longitudinal splintering was recognized ; the bone was found denuded in several places; the soft tissues of the thigh were infiltrated with pus of a very offensive character. In view of this condition of things, it was determined to remove the limb at the hip joint. The patient was placed under the influence of chloroform, and the operation was performed by Surgeon Edwin Bentley, U. S. V. An external flap was made by cutting from without inward; then the head of the femur was disarticulated, and au internal flap was cut from within out ward. The loss of blood was slight and the patient reacted promptly. The progress of the case for two or three days after the operation was very favorable. Then a chill occurred, followed by a cold clammy sweat. The wound looked badly and the discharge was unhealthy ; the stump was kept covered with yeast poultices. Beef essence, stimulants, and anodynes were administered. Six days after the operation there was yellowness of the surface and of the conjunctival membranes; then delirium and coma, and death on November 19th, eight days from the date of the operation. At the autopsy, pus was found in the external iliac vein, metastatic foci in the lungs, and a gangrenous abscess in the enlarged spleen. The preparation of the femur was sent to the Army Medical Museum, and is figured in the adjacent wood-cut (FlG. 94). CASE 299. Private John Chamberlain, of one of the United States regiments engaged at the battle of Chickamauga, was wounded on September 20, 1863. A conoidal musket ball passed through the upper part of the thigh and produced great comminution of the upper extremity of the femur, the fissures extending to the neck of the bone. The wounded man was left upon the field when the United States forces were driven back and fell into the hands of the enemy. On September 21st lie underwent amputation at the hip joint, the operation being performed by Surgeon R. P. Bateman, P. A. C. S. The man survived the operation thirty-six hours, and died September 23, 1863. 4 CASE 300. Private Levi Eckley, Co. A, 67jh Ohio, was wounded May 20, 1864, in the assault upon the entrenchments near Bermuda Hundred. A conoidal musket ball passed through the left thigh, shattering the upper extremity of the femur and wounding the sciatic nerve. The patient was conveyed on a hospital transport to Fort Monroe, and was admitted to Chesapeake Hospital on May 22d. A consultation was held, at which it was decided that amputation at the hip joint presented the only chance of preserving life. The patient s condition was unfavorable; he was greatly prostrated. On May 24th the operation was performed by Assistant Surgeon H. C. Roberts, U. S. V., by forming antero-posterior flaps by transfixion. The femoral artery was compressed at the groin by Surgeon D. G. Rush, 101st Pennsylvania, and Acting Assistant Surgeons Bayles, Frick, and others aided in the operation. The haemorrhage was excessive. Though the patient reacted fairly, and partook of nutritious food and stimulants, he died from exhaustion four days after the operation, May 24, 1864. 5 1 Of the twenty-three intermediary coxo-feraoral amputations, details of eighteen were published in A Report on Amputations at the Hip Joint in Military Surr/fry, War Department, S. G. O.. July 1, 18G7, pp. 30-39 and pp. Cl-62, four were noted on pages 107-8, of A Report on Excisions of Hie Head of the Femur for Gunshot Injury, Circular No. 2, War Department, S. G. O., 1869, and one (CASE 308, p. 141, ultra, of Martin, a soldier of the 20th Confederate Arkansas regiment) was communicated personally by Dr. WILLIAM BLACKWELL WKLCI1, of Boonsboro , Arkansas, who served three and a half years in the Confederate service. Eleven of the operations were practised by Confederate surgeons, seven upon their own men and four upon prisoners. twelve of the operations were by Union surgeons, upon eleven Union and one of the Confederate wounded. 2 EVE(P. F.), A Contribution to the History of the Rip Joint Operations performed during the late Civil War, in Trans. Am. Med. Assoc., 18C7, Vol. XVIII, p. 255. Circular No. 7, S. G. O., 18G7, pp. 36, C2. 3 See Circ. No. 6, S. G. O., 1805, p. 50, CASE 18, and Circ. 7, S. G. O., 1867, CASE XXXVI, pp. 38 and 62, and Cat. of Surg. Sect., of 1866, p. 247. 4 This case was communicated to Dr. P. F. EVE (loc. cit. p. 255) by Dr. R. P. BATKMAX, of Memphis, Tennessee. A request for further details of the case, from the Surgeon General s Office, of May, 1867, received no response. 5 The data in this case are noted in Circular 6, S. G. O., 1865, p. 50, CASE XII, and in Circular 7, S. G. O., 1867, at pp. 37 and 62, with additional details from letters by Assistant Surgeon E. McCLELLAN", U. S. A., and Acting Assistant Surgeon G. BAYLES. Fir.. 94. -Right fern, fissured by a musket ball. Spec. 1020. 140 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 301. Private Sullivan Gaines, Co. M, 2d Michigan Cavalry, was wounded on January 31, 1864, near Knoxville, Tennessee, by a conoidal musket ball, which shattered the neck and head of the right femur. On the following day the patient was admitted to hospital No. 4, at Knoxville. He was greatly prostrated, and his constitutional condition was considered unfavorable. On February 3d, Surgeon Edward Shippen, U. S. V., amputated at the hip joint in the presence of Surgeon Henry S. Hewit, U. S. V., and others. The patient being placed under the influence of chloroform, a long double-edged knife was introduced about an inch above the trochanter major ; the point was first directed inward and slightly upward so as to divide the capsule freely,*and was then depressed and brought out near the tuberosity of the ischium ; a large antero-internal flap was then formed, an assistant having passed his hands into the incision and compressed the femoral artery in the flap before it was cut. The flap was now raised, and the heel of the knife was placed at the inner angle of the wound, and a straight incision was made connecting this point with that at which the knife first entered, and dividing the tissues on the back of the thigh down the bone. Disarticulation was then effected. The patient never rallied from the shock of the operation. He died in about one hour. 1 CASE 302. Frank G ; a private in a Texan regiment, was wounded at the battle of Gettysburg, in the left thigh, by a grapeshot, which entered two inches below the trochanter major, shattered the bone up into the neck, and lacerated the soft parts terribly between the place of entrance and the knee. He remained on the battle-field from the 2d until the 4th day of July, with very little attention, until he was brought to the hospital of the Fifth Corps. After a consultation with a number of surgeons, and the conclusion being in favor of amputation at the hip, the patient was placed upon the table, and, when fully under the influence of chloroform, Surgeon B. Rohrer, 2 10th Pennsylvania Reserves, performed the antero-posterior operation, assisted by Dr. Joseph A. Philips, and Henry Grimm, Surgeon 12th Pennsylvania Reserves. Surgeon Philips controlled the femoral artery, and not over three ounces of blood were lost. Death followed in thirty-six hours. CASE 303. Private Henry H. Hale, Co. G, 14th Illinois, aged 21 years, was wounded at the battle of Shiloh, April 6, 1862. A fragment of shell shattered the upper portion of his left femur so that fissures extended to the neck and far down the shaft. The soft parts on the outer aspect of the thigh were extensively lacerated and contused; the femoral vessels and nerves were uninjured. On April 9th he was placed on the hospital transport steamer Crescent City to be conveyed to St. Louis. On April 12th, Surgeon D. P. Smith, U. S. V., assisted by Surgeons Thomas W. Fry and H. P. Stearns, U. S. V., and Assistant Surgeon M. C. Tolman, 2d Minnesota, performed amputation at the hip joint. The patient being made insensible by chloroform, a long anterior flap was made by transfixion. Surgeon Stearns, following the knife with his fingers, compressed the vessels in the flap and completely controlled the haemorrhage. The head of the femur was rapidly disarticulated and the soft parts poste riorly were divided by a straight incision. On April 14th the hospital transport steamer arrived at St. Louis, and the wounded were transferred to hospitals in that city. Shortly after Bale s admission to hospital his stump began to look badly, the vast wound suppurated profusely, gangrene supervened, and he sank and died on April 20, 1862. 3 CASE 304. Private C. Hamilton, Co. H, 3d U. S. C. T., while employed as a stretcher bearer, in carrying a wounded man from the field, during the assault on Port Hudson, Louisiana, June 14, 1863, was struck by a musket ball, which passed through the upper part of his left thigh. The missile entered behind, near the gluteal fold, and, having fractured the upper part of the femur badly, passed out in front in close proximity to the track of the femoral artery. He was taken to his regimental hospital. The limb was shortened and rotated inward, and great swelling and inflammatory mischief speedily supervened. It was ascertained that fragments of bone were detached and driven into the soft tissues, and there was excessive pain in the limb. It was resolved to make an exploratory incision and to remove the displaced splinters. Chloroform was administered for this purpose, and the patient was then removed to an operating table. While being moved from his bed to the table arterial hemor rhage of an alarming character took place, and was so copious as to threaten a speedy dissolution. The bleeding was controlled by digital compression of the femoral at the crural arch, and a hasty consultation was held by Surgeon E. P. Gray, 3d U. S. C. T., Surgeon Pierce, U. S. C. T., and Assistant Surgeon George P. Percival, 3d U. S. C. T., and it was determined that amputation at the hip joint afforded the only chance of preserving the man s life. The operation was immediately performed by Surgeon Gray, assisted by his colleagues. He disarticulated the thigh by the antero-posterior flap method, the operation being quickly accomplished without much haemorrhage. Although the patient was reduced by the irritation and pain caused by his wound, and prostrated by the sudden profuse haemorrhage, his constitution was robust, and he bore the operation remarkably well. The wound being approximated by sutures and adhesive strips, he was put to bed and carefully nourished and watched. He expressed great gratitude for the operation, declaring that it had entirely relieved him of his excessive suffering. He rallied and appeared, for forty-eight hours after the operation, to be in a very hopeful condition. Then the vital powers seemed to flag. He sank gradually, and died from exhaustion, June 29, 1863, four days after the operation. 1 * CASE 305. Private Jackson, of Colonel Tappan s Brigade, aged 21 years, was wounded at the battle of Belmont, Mis souri, November 7, 1861, and was conveyed on a steamer to Memphis and admitted to the Marine Hospital. He had a badly comminuted fracture of the upper extremity of the femur. On November 15th, Dr. Richard Potts proceeded to amputate at the hip joint by antero-posterior flap method. The patient succumbed promptly to the shock of the operation; dying, indeed, befoi e its completion, according to Dr. Mastin, or, according to Dr. Saunders, ten hours after its completion. 6 > HAMILTON (F. H.), Treatise on Mil. Surgery, 1865, p. 485. Circular No. 6, S. G. O., 1865, p. 50. Circular No. 7, S. G. O., 1867, pp. 37, G2. 2 ROHRER (B.), Original Communications, in Am&r. Jour. Med. Sci., 1869, Vol. LVII, N. S., p. 085. Circular No. 2, S. G. O., 1869, p. 108. 3 SMITH (D. P.), Experiences in the Practice of Mil. Surg., in Am. Med. Times, 1862, Vol. IV, p. 332, Circular No. 6, S. G. O., 1865, p. 50. Circular No. 7, S. G. O., 1867, pp. 34, 61. 4 The details of the coxo-femoral amputation by Surgeon E. P. GRAY, 3d U. S. C. T., were not received in season for publication in Circular 7, S. G. O., 1867, but were printed in Circular 2, S. G. O., 1869, p. 109. See also LtiNING (A.), (Jber die Blutung bei der Exarticulation des Oberschenkels und deren Vermcidung, Zurich, 1877, CASE 301, p. 93. 6 The facts in this case were furnished by Dr. CLAUDE H. MASTIN and Dr. D. D. SAUNDERS, of Memphis. See Professor P. F. EVE S Contribution to the History of the Hip Joint Operation performed during the late. Civil War, in Trans. Am. Med. Assoc., 1867, Vol. XV1H, pp. 255 and 264, and Circular 7, S. G. O., 1867, pp. 33 and 61, and LttMNG (A.), Vber die Blutung bei der Exarticulation des Oberschenkels, Zurich, 1877, p. 89, CABK 272. SECT. If.J INTERMEDIARY AMPUTATIONS AT THE HIP JOINT. 14] CASE 306. Private P. Johnson, Co. C, 2d Delaware, was wounded at the battle of Fredericksburg, December 14, 1862 by a conoidal musket ball, which entered the upper part of the right thigh in front and passed out at the nates, haviii"- in its course divided the femoral artery and perforated the great trochanter. Except that the primary liEemor- rhage was slight, little is known of the early history of the case. On December 25th the wounded man was conveyed to Washington and placed in the Douglas Hospital. On admission, nearly the entire injured limb was gangrenous, and it was believed that the fracture extended into the hip joint. Surgeon P. Pineo, U. S. V., decided to amputate at the hip joint, "with no hope of a favorable result, but to mitigate patient s distress in the last moments of life." On December 27th, anaesthesia being induced by ether, the operation was performed. The patient survived it only a few hours. The pathological speci men was sent to the Army Medical Museum. It presents an oblique shot perforation through the great trochanter, with radiating fissures which separate the trochanter and neck in four large fragments and run obliquely down the shaft. Traces of the results of periostitis are visible along the outer aspect of the shaft. 1 CASE 307. Private Charles Lackey, Co. E, 7th Wisconsin, aged 30 years, was struck, at Spott- sylvania, May 12, 1864, by a conoidal musket ball, which entered in front at the upper part of the right thigh and produced a comminuted fracture of the femur through the trochanters, and extending down ward nearly half the length of the shaft of the bone, and then lodged in the muscles at the posterior part of the thigh. After a fatiguing journey to Belle Plain, to which most of the wounded from Spott- FIG. 95. Shot perfora- sylvania were unavoidably subjected, Lackey was conveyed on a hospital steamer to Washington, and 1 ^ * trochanter of right was received at Judiciary Square Hospital on May 18th. The wounded limb was much swollen. The sharp extremity of the lower fragment of the femur had lacerated the muscles, and there was profuse suppuration with burrow ing of pus throughout the thigh. The fracture was believed to extend into the joint. The patient earnestly demanded that an operation should be performed for his relief. His condition was unpromising, for he was suffering from surgical fever of an intense character. A consultation of surgeons decided, however, that, without operative interference, the case would prove inevitably and speedily fatal ; and as the extensive fracture of the shaft of the femur and the purulent infiltration of the thigh precluded excision, amputation at the hip joint was determined on. On May 21st anaesthesia was induced by sulphuric ether, and Assistant Surgeon Alexander Ingram, U. S. A., performed ihe operation by the antero-posterior ttap method. After the operation the patient reacted but partially. After removal to the ward he was plied with beef-tea and stimulants and restora tives ; but he continued to sink, and died on the following day, May 22, 1864, twenty hours after the operation. 2 The details of the next intermediary amputation at the hip (CASE 308) were person ally communicated to the Surgeon General s Office by the operator, Dr. W. B. Welch, of Boonsboro , Arkansas, on June 10, 1875, arid have not been heretofore published: 3 CASE 308. Private Martin, of the 26th (Brooks s) Arkansas Regiment, aged 25 years, was wounded at Prairie Grove, December 7, 1862, by a cannon shot, which shattered his left thigh so dreadfully as to leave the limb attached to the trunk only by the soft parts on the anterior aspect. His case had been regarded as hopeless, but after the surgeons had finished all the other operations he was observed to have rallied somewhat, though greatly exsanguined and prostrated. Wkh the assistance of Drs. Duvall and Keller, Surgeon W. B. Welch, P. A. C. S., of Gunter s Arkansas Regiment, performed exarticulation, making a large anterior flap. The operation was performed twenty -four hours after the injury, and the patient survived four days, when he succumbed from exhaustion. CASE 309. Private Joseph Minott, Co. A, 4th Vermont, was wounded early on June 23, 1864. Minott had his right femur fractured in the upper portion of the shaft by a conoidal musket ball, and lay where he fell, beyond the reach of succor. On the morning of the third day, June 25th, having been without food or drink for forty-eight hours, he crawled into our lines, a distance of over half a mile. He was carried to the field hospital of the 2d division of the Sixth Corps, greatly exhausted. After he had received nourishment and cordials his injuries were examined, and it was found that, besides the extensive com minution of the femur, rapidly spreading gangrene had supervened. In front, mortification already extended to within a few inches of Poupart s ligament. A consultation of the surgeons of the division decided that coxo-femoral amputation offered the only chance of recovery, and that the operation could not be delayed. On the afternoon of June 25th, therefore, the patient was rendered insensible by chloroform, and the amputation was performed by Surgeon D. A. Goodwin. But little blood was lost, yet the patient soon began to sink, and expired on June 25, 1864. 4 1 See Circular 6, S. G. O., 1 865, p. 50. CASE 10 ; Catalogue of the Surg. Sect, of the Army Medical Museum, 4to, I860, p. 248 ; Circular 7, S. G. O., 1867, pp. 35 and 62. 2 The abstract of this case is compiled from register and Report of Surgical Operations of the Judiciary Square Hospital, Washington. The case is noted at p. 50 of Circular 6, S. G. O., 1865, as CASE 11. The age is correctly stated at "19" years, while in Circular No. 7, S. G. O, 1867, pp. 37, 62, by a clerical inadvertence the age is given at "30" years. See also LiJXIXG (A.), Ueber die Blutung bci der Exarticulation des Oberschenkcls, Zurich, 1877, Fall 328, S. 97. 3 After the publication of Circular 7, S. G. O. (A Report on Amputations at the Hip Joint in Military Surgery, Washington, 1807, 4to, p. 88). Dr. JAMES M. KELLKK, of Kentucky, Vice President of the American Medical Association, in 1874, informed the compiler of that report that of several excisions or amputations at the hip that he had observed during his service in the Confederate Army, one was a coxo-femoral amputation practised by Dr. WELCH, after the battle of Prairie Grove, December 7, 1862; and that he had notes of this and of several other amputations and excisions at the hip, which "in the conflagration caused by the explosion in the ordnance depot, at Alobile, Alabama, just after the surrender (April 9, 18.15), with notes on field and hospital Surgery, were destroyed." In the absence of any particulars, it was impossible to classify this case of amputation at the hip; but years subsequently, June 10, 1876, Dr. WILLIAM BLACKWELL WELCH called at the Army Medical Museum with Colonel THOMAS MOXTICUE GUNTEK, M. C. of the IVth Arkansas district, and formerly colonel of the 13th Arkansas regiment, and furnished the details of the case above cited. 4 Surgeon S. J. ALLEN, 4th Vermont, and the operator. Surgeon DAVID M. GOODWIN, reported this case. See Circular No. 7, S. G. O., 1867, pp. 38, 62, and LtiNlNG (A.) (op. cit., Zurich, 1877, p. 97, CASE 330). 142 INJURIES OF THE LOWER EXTREMITIES. (CHAP. X. CASE 310. Private Peter Pausbeck, Co. K, 43d Illinois, was admitted on April 20, 1862, from the battle-field of Shiloh, to hospital No. 2, at Evansville. He had been wounded on April 7th, probably by a conoidal musket ball. The projectile bad entered the front of the left thigh, about an inch below the level of the trochanter major, and ranging a little upward had emerged from the gluteal region opposite. The upper portion of the femur was crushed and the injury to the soft parts was most extensive. A consultation was held on April 21st, and the opinion that amputation at the hip afforded the only possible chance of preserving life was unanimous. Dr. DeI3ruler operated, assisted by Dr. T. N. Myers and others. The loss of blood was very trifling. After the completion of the operation, the pulse, which had been carefully watched, was observed to fail rapidly. Unavailing attempts were made to give brandy and other restoratives. In a few moments the man was dead. There was no reason to believe that the use of chloroform had any connection with the fatal result, which was apparently due solely to the shock of the operation. Such was the opinion of the eminent professor of surgery of Jefferson College, Dr. S. D. Gross, who happened to visit the hospital half an hour after the operation. Professor Gross expressed his approbation of the course that had been adopted, since, although it had resulted unfortunately, it afforded the only hope of saving the patient s life. 1 CASE 311. Private George M. Spencer, Co. B, 2d New York Mounted Kifles, aged 17 years, was wounded on March 31, 1865, at Dinwiddie Court House, Virginia, by a conoidal musket ball, which entered the right gluteal region, and striking the great trochanter, produced a fracture through the trochanters, with very remarkable longitudinal splintering, extending nine inches down the shaft (FlG. 96). The projectile then lodged. The wounded man was sent to City Point, and thence by steamer to Washington, and entered Judiciary Square Hospital on April 4th. There was already a good deal of inflammatory swelling and sup puration, but the constitutional condition was encouraging. Upon examination of the wound, it was thought that the fracture did not extend below the trochanter and that the joint was probably involved, and it was determined to excise the head of the femur. The patient having stated that he w r as anxious to avail of the benefit of any operation that was deemed necessary, he was placed under the influence of chloroform on April 12th, and Surgeon Elisha Griswold, U. S. V., proceeded to disarticulate the head of the femur through a long vertical incision on the outside of the thigh, and to remove the head with an obliquely fractured fragment of the shaft attached to it. The splintering of the shaft was now discovered, and after a hasty consultation with the surgical staff it was decided that amputation at the hip joint was the only procedure which afforded the patient any prospect of recovery. This operation was rapidly executed by Surgeon Griswold, aided by Acting tudinai fissuring^of Assistant Surgeons Hill, McCalla, Colton, and Ahern, by the double-flap method. There was but little haemor- right femur. Spec, rhage; but the shock of the operation was too great. The usual means to promote reaction were diligently employed, but the patient never rallied, and survived the operation less than an hour. 2 CASE 312. A private of Co. C, 54th Massachusetts, a colored man, was wounded and made a prisoner in the assault on Morris Island on July 11, 1863. A fragment of a shell from Fort Wagner struck the upper and outer part of his right thigh, and fractured the neck and head of the femur and the rim of the acetabulum, and extensively lacerated the soft parts in its exit through the posterior part of the thigh. The patient was conveyed to Charleston on the afternoon of July 12th, and was placed in a hospital hastily prepared for the reception of wounded colored prisoners. The contract surgeon in charge of the hospital reports that the patient s condition, in view of the terrible wound he had suffered, was remarkably good, and that the symptoms of shock were unusually slight. On July 13th, the third day after the reception of the injury, Surgeon R. A. Kinloch, P. A. C. S., saw the case, and amputated at the hip joint by Manec s method. The knife being entered midway between the anterior superior spinous process of the ilium and the great trochanter, and carried downward and inward until its point emerged just in front of the ischium, was made to form a large antero-internal flap; the soft parts on the outer and posterior part of the thigh were then divided by a semicircular incision from without inward, and the head of the femur was then disarticulated. The patient bore the operation well, but a few hours subse quently there was extreme depression, and the case terminated fatally on the following morning, July 14th, twenty hours after the operation. 3 CASE 313. A private soldier of an Ohio regiment, aged 35 years, was wounded at the battle of Shiloh, April 6, 1862, by a fragment of shell, which extensively comminuted the shaft, trochanters, and neck of the right femur, as illustrated in the accompanying wood-cut (FlG. 97). The patient was left on the battle-field during the tempestuous night of April 6th, and until late on the following day. He was then removed to a temporary hospital, and thence to the steamer Lancaster, to be transported to Cincin nati. On April 16th, it was decided to remove the limb, and the patient being rendered insensible by chloroform, amputation at the hip joint was performed by Surgeon G. C. Blackman, U. S. V., by the antero-posterior flap. On April 18th, the patient was transferred to St. John s Hospital, Cincinnati, and Dr. C. D. Palmer reported that the flaps began to slough. Death ensued on April 22, 1862. 4 FK;. 07. Comminuted shot fracture of femur. From a drawing furnish ed by Dr. BLACKMAX. 1 Dr. J. P. DEBRULEU, of Evansville, Indiana, communicated the particulars of this case. See Circular No. 7, S. G. O., 1867, pp. 34 and 61, and LO.NING (A.), (jber die Blutung bei der Exarticulation des Oberschenkelt, Zurich, 1877, S. 91, F. 290. 2 This case was first published in Circular No. C, 1865, p. 50, CASE 21, from the Judiciary Square Hospital Surgical Report for the second quarter of 1865. See Catalogue of the irgical Section of the Army Medical Museum, 4to, 1866, p. 248, and Circular No. 7, S. G. O., 1867, pp. 39 and 62, with reference to the report of a board of inquiry in the case, convened April 13, 1865, consisting of Surgeon O. A. .TUDSOX, U. S. V., Assistant Surgeon \V. THOMSON, U. S. A., and Assistant Surgeon W. F. NORKI8, U. S. A. See also LtixiNG (A.) (loc. cit., Zurich, 1877, p. 102, CASE 366). 3 The particulars of this case were communicated to the Surgeon General s Office by Professor R. A. KlNLOCK, of Charleston. See EVE (P. F.) (loc. cit., Vol. XVIII, p. 255, CASE 17, and Circular No. 7, S. G. O., 1867, pp. 36 and 62, and LttxiXG (A.), op. cit., Zurich, 1877, p. 94, CASE 307. 4 Br,ACKMAX (G. C.), Amputation at the Hip joint, in Cincinnati Jour, of Medicine, 1866, Vol. I, p. 101. Circular No. 6, S. G. O., 1865, p. 50. Circular No. 7, S. G. O., 1867, pp. 34, 61. L,tfNINC. (A.), tfler die Blutung bei der Exarticulation des Oberschenlcels, Zurich, 1877, p. 91, CASE 289. SECT. ii. j INTERMEDIARY AMPUTATIONS AT THE HIP JOINT. 143 CASE 314. A private soldier of the U. S. Army was wounded at the first battle of Bull Run, July 21, 1861, by a musket ball, which fractured the lower third of right femur. He fell into the hands of the enemy, and, on the following day, was con veyed in an army wagon to Manassas Junction, and thence by rail to Richmond, where he was admitted to the Alms Ho;is<- Hospital. One week after the reception of the injury there was extensive purulent infiltration in the muscles of the thigh and incipient gangrene of the leg. Under these circumstances Drs. St. George Peachy and Charles Bell Gibson decided to amputate at the hip joint. On July 29th the operation was performed by Dr. Peachy, in the presence of Drs. Gibson, A. E. Peticolas, Richardson, and others. A preliminary ligature was placed upon the femoral artery at the beginning of the operation, which was probably done according to Larrey s method. The patient is believed to have survived the operation two or three days. 1 CASE 315. A private of General Bragg s army, whose name and military description are not recorded, a large man, six feet high, of fair complexion, about 26 years of age, was wounded on December 28, 1852, in a skirmish prior to the battle of Murfreesboro . A conoidal musket ball produced a fracture of the trochanter major and neck of the femur, with fissures extending within the capsular ligament. The wounded man was placed in a field hospital, and his injured limb was supported in a proper position ; but the local inflammation and constitutional disturbance that ensued were intense, and, on January 5, 1863, it was determined to amputate at the hip joint. The patient being placed under chloroform, the operation was performed by the antero-posterior flap method by Assistant Surgeon A. C. Crymes, 39th Alabama. On being removed to his bed the patient manifested extreme prostration, and stimulants were freely administered. After a few hours he was able to take nutriment in a concentrated form, and a supporting and stimulating treatment was perseveringly pursued. In a very few hours after the oper ation, however, the stump evinced a tendency to unhealthy action, and the patient sank into an adynamic condition, and died on the morning of January 8th, three days after the operation.- CASE 316. A private of Colonel Dockeray s Arkansas Regiment of Cabell s Brigade was wounded at the battle of Corinth, Mississippi, October 3, 1862, by a conoidal musket ball, which shattered the neck of the right femur. He was conveyed to a hospital at luka, where, on November 3d, his thigh was amputated at the hip joint by his regimental surgeon, Dr. R. A. Felton. The patient died upon the table before the dressing of the stump was completed. The operation was done under chloroform, and it was the general impression of the surgeons present that the anaesthetic was administered too freely. 3 CASE 317. Besides the instance of primary coxo-femoral amputation for shot injury by Dr. B. D. Lay, P. A. C. S., detailed as CASE 284, p. 135, ante, were two intermediary amputations at the hip joint for comminution of the upper portion of the femur by conoidal musket balls, performed by the same surgeon. One of them, here to be noted, was that of a Confed erate private soldier, who suffered a shot fracture of the femur, in Mississippi, early in 1863, prior to the siege of Vicksburg. Comminution of the femur extended high up through the trochanteric region, and amputation at the hip was practised two days after the injury. The patient sank under the shock of the injury and operation a few hours after the latter, 3 although the oper ation was completed rapidly and vvith slight loss of blood. Dr. Lay observed that "nothing in this case served to diminish the terror with which I approach such cases." 4 CASE 318. A private Confederate soldier, whose name and military description are not identified, received a shot com minution of the femur in one of the engagements in Mississippi, in the early part of 1863, prior to the siege of Vicksburg. A day or two after the injury, amputation at the hip was performed by Dr. B. D. Lay, P. A. C. S. Although the amputation was rapidly accomplished, with little loss of blood, the patient sank and died a few hours after the operation. The detailed memo randa of this and the preceding case were unfortunately lost. 5 CASE 319. Private J. H. Wolf, Co. D, 4th Virginia, had his femur fractured at the battle of Bull Run, July 21, 1861, by a musket ball, which traversed the upper part of the thigh in an antero-posterior direction, and striking the femur four inches below the trochanlers, shattered it quite up to the neck. The patient was removed to Charlottesville, and was received in the general hospital at that place on July 24th. The fracture was treated by Smith s anterior suspensory splint, and this mode of dressing proved very serviceable for a time. The inflammatory phenomena did not abate, however, and after four weeks it was decided that removal of the limb at the coxo-femoral articulation alone afforded a hope of preserving the patient s life. On August 21st the operation was performed by Brigadier General Edward Warren, Surgeon General of North Carolina, and was rapidly executed by the double flap method, with inconsiderable haemorrhage. On the following day there was slight haemor rhage. Death from exhaustion ensued on August 23, 1801, thirty hours after the operation. The constitutional condition of the patient was unfavorable, and he was suffering from colliquative diarrhoea. 6 1 The particulars of this case were supplied by Professor T. G. RlCHARDSOX, of New Orleans, who was present at the operation. See also Circular Vo. 7, S. G. O., 1867, CASE XX, pp. 33, 61, and LfJNlXG (A.), ffber die Slutung, u. s. w., Zurich, 1877, p. 89, CASE 270. 2 Details of this case were communicated to the Surgeon General s Office by the operator, Assistant Surgeon A. C. CRYMES, 39th Alabama, and by Professor R. A. Klxr.OGH, of Charleston, South Carolina. The case has been published in Professor P. F. EVE S contribution (op. cit., Trans. Am. Med. Assoc., 1807, Vol. XVIII, p. 255, CASE 20). See also Circ. 7, S. G. O., 1667, pp. 35, 62, and LiJNING (A.), loc. cit., Zttrich, 1877, p. 92, CASE 293). 3 This case was first published by Professor P. F. EVE (Transact. Am. Med. Assoc., 1867, Vol. XVIII, pp. 253, 261). Further particulars of the case were communicated by Surgeon JAMES D. WALLACE, 1st Missouri. The operator, Surgeon R. A. FELTOX, died in 1863. See Circular No. 7, S.G.O., 1867, pp. 35, 62. See also Dr. AUGUST LUNING (op. cit., Zurich, 1877, S. 92, CASE 291). 4 Dr. B. D. LAV, of Paducah, Kentucky, in a letter of July 26, 1867, to the Surgeon General s Office, refers to this case, and Dr. L. D. NIDELKT, of Mobile, Alabama, in letters of April 21 and May 4, 1867, mentions having assisted at the operation. 5 In a letter to the Surgeon General s Office, dated Paducah, Kentucky, July 25, 1867, Dr. B. 1). LAY regrets his inability to furnish more details respecting this and the preceding case of intermediary amputation at the hip joint, and states that he had kept copious notes of all of his cases of ampu- i.-itions practised during the war, and that these notes, with records and instruments of the Vicksburg hospitals and its branches, were given in charge to Surgeon J. II. BOUCHER, of Major-General J. B. McPllERSOX s corps ; and, if the registers were preserved, they would give the desired information. It was ascertained that Dr. J. H. BOUCHER, formerly Surgeon 13th Iowa, afterwards Surgeon U. S. V., and Medical Director of the Seventeenth Corps, resided in Iowa City after the war, and died in April, 1874. His son, Dr. F. H. BOUCHEU, of Clarksville, Iowa, July 15, 1878, made a careful examina lion in his father s library for papers and notes pertaining to the surgery of the war without finding any trace of the memoranda referred to by Dr. B. D. LAY. EVE (P. F.), loc. cit., p. 254. Circular No. 7, S. G. O., 1867. pp. 33, 61. FAUNTLKROY (A. II.), Hip Joint Amputations, in Richmond Med. Joitr.. 1866, Vol. I, p. 11. LINING (A.), fiber die Blutung bei der Erarticulation des Obcrscliexkels, ZUrich, 1877, p. 89, CASK 271. 144 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Of the twenty -three intermediary amputations at the hip joint, ten were on the right side, six on the left; in seven cases the side of injury was not stated. The Museum possesses pathological specimens from three of the twenty-three cases. TABLE XVI. Summary of Twenty-three Cases of Intermediary Amputation at the Hip Joint. NO. NAME, AGE, AND MILITARY DESCRIPTION. DATK OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Garden, J., Pt., Gen. Rosen- Sept. 20, Fragment of shell comminuted Sept. 21, Amputation, by Surg. R. P. Died September 27, 1863. crans s army. 1863. femur, ex. lac. of soft parts. 1863. Bateman, P. A. C. S. 2 Carroll, L., Sergeant, H, 1st Delaware, age 23. Oct. 22, 1864. Conoidal ball, r t femur splint ered, extending ten ins.; ball Nov. 11, 1864. External flap made by cutting from without inward, internal Progress favorable forthree days; Nov. 17th, pya3mic symptoms. ext.; sharp upper extremity flap by cutting from within Died Nov. 19, 1864, pyasmia. of femur sawn off; Nov. 2, outward, by Surg. E. Bent- Autopsy. Spec. 1020. Circ. G, lurm., lig. small artery. ley, U. S. V. S. G. O., 1 865, p. 50. Circ. 7, S. G. O., 1867, pp. 38, 62. 3 Chamberlain, J., Pt., U. S. Army. Sept, 20, 1863. Conoidal ball, great com. upper extremity of femur, fissures Sept. 21, 1863. Amputation, by Surg. R. P. Bateman, P. A. C. S. Died thirty-six hours after oper n. EVE (P. F.), loc. cit., p. 255. extending to neck. Circ. 7, S. G. O..1PG7, pp. 36, 62. 4 Eckley, L., Pt., A, 67th May 20, Conoidal ball shattering upper May 24, Antero-posterior flap, by Ass t Reacted fairly. Died, May 28, Ohio, age 33. 1864. extremity of left femur and 1864. Surg. H. C. Roberts, U. S. V., 1864, from exhaustion. Circ. 6, wounded sciatic nerve. and others. S. G. O., 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 37, 62. 5 Gaines, S., Pt., M, 2d Mich Jan. 31, Conoidal ball shattered head Feb. 3, Large antero-internal flap, by Never rallied. Died one hour igan Cavalry. 1864. and neck of right femur. 1864. Surg. E. Shippen, U. S. V. after operation, from shock. . C F Pt Tcvac July 2 C* rinpslint sliatt rino* Ipft f pmnr July 4, Antero-postGrior flup by Surff. Died thirty-six hours after oper regiment. 1863. at trochanter major up into 1863. B. Rohrer, 10th Penn. Res., ation. the neck. and others. 7 Hale, H. H., Pt., G, 14th April 6, Frag, of shell shattered upper April 12, Long anterior flap, bv Surg. Reaction fair; April 14th, gan Illinois, age 21. 1862. portion of the left femur, soft 1862. D. P. Smith, U. S.V., and grene. Died April 20, 1862. parts ex. lacerated. others. 8 Hamilton, C., Pt., H, 3d June 14, Musket ball fract. upper part June 25, Antero-posterior flap, by Surg. Sank gradually, and died, June Colored Troops. 1863. of left femur great swelling, 1863. E. P. Gray, 3d Col d Troops, 29, 1863, from exhaustion. Circ. inflammation, and pain co and others. 2, S. G. O., 1869, p. 109. pious hasm., digital pressure. 9 Jackson, , Pt, Col. Tap- Nov. 7, Shot comminuted fracture of Nov. 15, Antero-posterior flap, by Surg. Succumbed to shock of opera pan s brigade, age 21. 1861. upper extremity of femur. 1861. E. Potts, P. A. C. S. tion. EVE (P. F.), loc. cit., pp. 255, 264. Circ. 7, S. G. O., 18G7, pp. 33, 61. 10 Johnson, P., Pt., C, 2d Del Dec. 14, Conoidal ball perforating right Dec. 27, Amputation, by Surgeon P. Died a few hours after operation. aware. 1862. great trochanter ; gangrene 1862. Pineo, U. S. V. Spec. 710. Circ. 6, S.G.O.,1865, entire limb. p. 50. Circ. 7, S. G. O., 1867, pp. 35, 62. 11 Lackey, C., Pt., E, 7th Wis consin, age 30. May 12, 1864. Conoidal ball frac. right femur, thro trochanters, nearly half May 21, 1864. Antero-posterior flap, by Ass t Surg. A. Ingram, U. S. A. But partial reacti n. Died twenty- fourhoursafteroperation. Circ. 1 length of shaft ; surgical fev. 6, S. G. O., 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 37, 62. 12 Martin, , Pt., 26th Arkan Dec. 7, Cannon shot shattering the left Dec. 8, Large anterior flap, by Surg. Rallied somewhat. Died, Dec. sas, age 25. 1862. thigh. 1862. W. B. Welch, of Col. Gun- 12, 1862, from exhaustion. ther s Arkansas regiment. 13 Minott, J., Pt., A, 4th Ver June 23, Conoidal ball fract. upper por June 25, Short anterior, long posterior Rallied, but soon began to fail; mont, age 20. 1864. tion shaft right femur; gan 1864. flap, by Surg. D.M. Goodwin, died two hours after operation. grene, mortification. 3d Vermont. Circ. 7, S. G. O., 1867, pp. 38, 62. 14 Pausbeck, P., Pt., K, 43d April 7, Conoidal ball crushing upper April 21, External and internal flap, after Died, a few moments after oper Illinois. 1862. portion left femur, extensive 1862. Lisfranc s method, by A. A. ation, from shock. Circ. 7, S. injury of soft parts. Surg. J. P. Do Bruler. G. O., 1867, pp. 34, 61. 15 Spencer, G. M., Pt., B, 2d Mar. 31, Conoidal ball fract. thro right April 12, Incision for excision, double Died in less than an hour. Spec. New York Mounted Rifles, 18G5. trochan s, splintering extend 1865. flap amp., by Surg. E. Gris- 4237. Circ. 6, S. G. O., 18G5, age 17. ing nine ins.; lodged. wold, U. S. V., and others. p. 50. Circ. 7, S. G. O., 1867, pp. 39, 62. 16 Unknown, Pt., C, 54th Mas July 11, Fragment of shell fract. neck July 13, Manec s method, large antero- Died twenty-four hours after op sachusetts. 1863. and head of right femur and 1863. internal flap, by Surg. R. A. eration. EVE (P. F.), loc. cit., rim of acetabulum. Kinloch, P. A. C. S. p. 255. Circ. 7, S. G. O., 1867, pp. 36, 62. 17 Unknown, Pt., Ohio regi April 6, Frag, of shell comminuted April 16, Antero-posterior flap, by Surg. Rallied satisfactorily: April 18th, ment, age 35. 1862. shaft, trochanters, and neck 1862. G. C. Blackman, U. S. V. flaps sloughed badly; pyaemic of right femur. symptoms. Died April 22, 1862. 18 Unknown, Pt., U. S. Army. July 21, 1861. Musket ball fract. lower third right femur ; ex. pur. infiltra July 29, 1861. Probably by Larrey s method, by Surg. St. G. Peachy, P. Survived oper n two or three days. EVE (P. F.), toe. cit., p. 253. tion ; incipient gang, of leg. A. C. S. Circ. 7, S. G.O., 1867, pp. 33, 61 . 19 Unknown, Pt., Gen. Bragg s Dec. 28, Conoidal ball fract. troch. maj. Jan. 5, Antero-posterior flap, by Ass t In a few hours stump evinced a army, age 26. 1862. and neck of femur, fissures extending into capsular lig. 1863. Surgeon A. C. Crymes, 39th Alabama.- tendency to unhealthy action, and patient sank into adynamic condition; died Jan. 8, 1863. EVE (P.F.).toc. cit., -p. 255. Circ. 7, S. G. O., 1867, pp. 35, 62. 20 Unknown, Pt., Col. Dock- eray s Arkansas regiment. Oct 3, 1862. Conoidal ball shattering neck of right femur. Nov. 3, 1862. Amputation, by Surg. R. A. Felton, of Col. Dockeray s Died before dressing of stump was completed. EVE (P. F.), regiment. loc. cit., pp. 253, 261. Circ. 7, S. G. O., 1867, pp. 35, 62. 21 Unknown, Confederate sol 1863. Shot fracture of the femur. . . 1863. Amputation, by Surg. B. D. Died. Circ. 2, S. G. O., 1869, dier. Lay, P. A. C. S. p. 108. LUXING (A.), Exart. des OberscJienk., Zurich, 1877, S. 99, CASE 340. 22 Unknown, Confederate sol 1863. Shot fracture of the femur. . . . 1863. Amputation, by Surg. B. D. Died. Circ. 2. S. G. O., 1869, dier. Lay, P. A. C. S. p. 108. LUNING, op. cit., S. 99, CASE 341. 23 Wolf, J. H., Pt., D, 4th July 21 Musket ball shatt g femur from Aug. 21, Double flap, by Surg. E. War Died Aug. 23, 1861, from exhaus Virginia. 1861. four ins. below troch s quite 1861. ren, C. S. A. tion. up to neck ; colliquative diarr. SECT. II.) SECONDARY AMPUTATIONS AT THE HIP JOINT. 145 Secondary Amputations. Of nine instances of secondary amputations at the hip joint, eight were practised on Union soldiers and one on a Confederate soldier, resulting in two recoveries and seven deaths, a mortality rate of 77.7 per cent. The shortest interval between the reception of the injury and the operation was forty-three days; the longest, two years nine months and twenty-one days. Six of the operations were performed on the right side and three on the left. Of the two survivors of secondary amputation at the hip, one is a pensioner in comfortable health at a period nearly fifteen years after the operation. CASE 320 Private George W. Lemon, Co. C, Cth Maryland, aged 30 years, bad liis left femur fractured, at the junction of the middle and upper thirds, by a conoidal musket ball, at the battle of the Wilderness, May 5, 1864. He was left in a shelter tent on the field and fell into the hands of the enemy. On May 13th he was recaptured, and was sent to Fredericksburg, and thence to Alexandria, where he was received at the Third Division Hospital on June 14th. When admitted he had diarrhoea and was greatly emaciated. There was a bed-sore, four inches in diameter, over the sacrum, and smaller sores over the prominences on the spine and scapulae. The lower end of the upper fragment of the femur protruded from the wound, from which there was a profuse offensive ash-colored discharge. To check the diarrhoea, to administer suitable nourishment, and to take pressure from the bed-sores by supporting the body on air cushions, were the first matters attended to. Then moderate extension was applied to the injured limb, and a tolerably good position was maintained by means of pillows and cushions. In three weeks the bed-sores were healed. and there was a slight improvement in the general constitu tional condition. Extension of the limb causing pain, it was discontinued. For the next ten or twelve months the patient clung to life by the slenderest thread. Detached fragments of bone frequently gave rise to inflammatory swelling, abscesses in the thigh, and profuse suppuration. Yet the appetite and digestion continued to be good, and the great drain upon the system was supported unusually well. In May, 1865, it was found that the fracture was quite firmly consolidated. The patient now occasionally sat up in a chair, but every attempt of the sort was followed by acute inflammation of the thigh, with increased suppura tion. It was now decided that the patient must ultimately sink under the profuse suppuration, and that an operation should be performed as soon as it was opportune, and that every effort should be made to put the patient in a condition to support this shock. On October 12, 1865, Surgeon Edwin Bentley, U. S. V., proceeded to ainputate at the hip joint. Chloroform was administered ; the external iliac artery was compressed at the pubis ; anterior and posterior semilunar flaps were formed by transfixion, and the femur was disarticulated. The haemorrhage was inconsiderable, and the patient reacted soon and satisfactorilj r . From the day of the operation he steadily improved, with scarcely On November 15th, Dr. Bentley reported that the ligatures had all come away, and that the wound In December the stump was healed, and the patient began to get about on crutches. The fracture of the exarticulated femur was found to be imperfectly but quite firmly united, with great antero-posterior angular deformity and shortening. The bone was sent to the Army Medical Museum, where it is preserved as Specimen 4386. A posterior view of it is given by the annexed left hand wood-cut (FlG. 98). On January 31, 1866, a photograph of the man was taken, from which the right hand wood-cut (FlG. 99) is copied. Lemon was then transferred to the Harewood Hospital, at Washington. He was then quite well, and able to go where he chose on crutches. The cicatrix was firm and healthy. On February 3, 1866, he was discharged from the hospital, and from the service of the United States, at his own request. He went to his home at Bird Hill, Carroll county, Marj-land, and resumed his trade of shoemaking. He was granted a pension of fifteen dollars a mouth. On April 23, 1867, a letter was received from him in which he stated that bis health was excellent ; that he weighed ninety-nine and a half pounds, an increase of twelve and a half pounds from the date at which he left the hospital ; and that be had been able to walk to the village of Westminster, a distance of seven miles, without fatigue. In a letter dated Westminster, Maryland, July 31, 1870, he states "that the artificial limb is not now or ever has been of the least service to me. * * I have tried to wear it; but it only serves to irritate the stump, and makes it so raw and sore that I cannot bear it to touch anything for days afterwards." The pensioner was paid June 4, 1878. 1 1 This secondary amputation at the hip is noted on page 52 of Circular No. 6, S. G. O., 1865, in a foot-note. In the Catalogue of the Surgical Section of the Army Medical Museum, of 1866, p. 248, there is a brief memorandum of the facts of the case, with a wood-cut of the fractured femur, contributed to the Museum by the operator, Surgeon EbWIX I5ENTLEY, U. S. V. A detailed account of the case, compiled from the reports of the Third Division Hospital, Alexandria, and Harewood Hospital, Washington, is printed in Circular No. 7, S, G. O., 1867, p. 42. SURG. Ill 19 FIG. 98. Consolidated gunshot fracture of the left femur. Spec. 436. an untoward symptom, was granulating kindly. FlG. 99. Appearance of cicatrix after secondary coxo-femoral amputation. [From a photograph.] 146 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. The subject of the second successful secondary amputation at the hip was in good health four and a half years subsequent to the operation, but has not replied to letters of inquiry of a later date. CASE 321. Private Woodford W. Lonymour, a rebel soldier, aged 25 years, a robust, healthy 111:111, was wounded at a skirmish at Cynthiana, Kentucky, on June 11, 1864. A ball from a Belgian rifle, at short range, passed through his right thigh, shattering the shaft of the femur. There was profuse haemorrhage and the shock was alarming. He remained almost insensible for three or four days, and for a fortnight there was extreme prostration. He was placed in a rebel field hospital, and the injured limb was put in a fracture box, with which was connected a crutch piece extending to the axilla. On the evening of the recep tion of the wound numerous detached bony splinters, a handful almost, were extracted. For six weeks extension and counter- extension were maintained, but so much suffering arose from this treatment that it was discontinued, and the limb was simply supported in a comfortable position. The patient was confined to his bed for eight and a half months. In the middle of March, 1865, he was removed to Florence, Kentucky, seven miles from Cincinnati, and Dr. George C. Blackman, professor of surgery in the Medical College of Ohio, was consulted in the case. There was a profuse discharge of offensive pus, and the patient s strength seemed to be failing under the protracted irritation and spoliation. There had been frequent recurrences of abscesses in the thigh, attended with excessive pain and swelling, and followed by the elimination of fragments of necrosed bone. Ever since the recep tion of his injury the patient had taken morphia very freely. Evidently there Avere still loose sequestra and diseased bone with which sinuses communicated, and Dr. Blackman proposed to remove these sources of irritation. On April 23d the patient con sented to an operation, and a number of necrosed fragments were extracted, with much relief to the local irritation and benefit to the general health. During the autumn, however, evidences of exten sive destructive inflammation of the shaft of the femur became unmistakable, and in December a second operation for the removal of fragments w r as performed without advantage. The discharge became more offensive and sanious, and the strength of the patient rapidly gave way. In January, 1866, his condition became almost hopeless, and the removal of the diseased limb was determined on. The operation was performed on January 18th. Ether was admin istered, and the lower extremities were kept elevated for a few minutes before the incisions were made. Then the right femoral was compressed at the groin, and the disarticulation was rapidly effected by Lacauchie s method. 1 A circular cut through the skin was made at the junction of the upper third of the thigh ; then the integuments were retracted and the muscles were divided circularly down to the bone. A vertical incision was now made on the outer side of the limb, commencing a little above the trochanter and joining the first incision. The head of the bone was then exarticulated. There was but little haemorrhage, and the patient rallied from the operation remarkably well. The follow ing day he suffered greatly from nausea, which he ascribed to the use of the ether. This distressing complication soon subsided, however, and thenceforward there was no unpleasant symptom, and the patient progressed rapidly toward recovery (FlG. 100). In February, 1867, Longmoor reported himself to Dr. Blackman as in excellent health, and as having recently married. In the latter part of June, 1867, seventeen months after the operation, Dr. Blackman again saw him, and found that his general health was good, and that his stump was sound, though subject to occasional attacks of neuralgia of extreme severity. He was accustomed, in these attacks, to alleviate his suffering by taking large doses of morphia. An examination of the limb after its removal showed that the entire shaft of the femur had been affected by osteomyelitis. The specimen, with its delicately encased sequestra and fragile deposits of new bone, was destroyed by an unskilful preparer. On July 21, 1870, a letter of inquiry was addressed by the reporter to Mr. Longmoor, then at Cynthiana, Kentucky, which elicited the following response: "In answer to your inquiry, have you suffered much from neuralgic pains, I answer there existed, for a long time, contractions of the muscles, in the centre of the stump, attended with considerable pain and tenderness ; the interval between those contractions of the muscles and the pain is much lengthened. I now suffer comparatively little, and my general health is much improved." 2 In the seven fatal cases of secondary amputations at the hip joint the injuries were inflicted by small projectiles. One patient survived the operation nearly four months; one, twenty-three days; one, eleven days; one, three days; and three, one day or less. M. A. E. LACAUCHIE, chirurgien principal, and chief medical officer of the French army of occupation in Rome, gives a description, with illus trations, of his procedure for amputating at the hip joint, in the Gazette Medicale de Paris, Nos. 19, 20, 25, and 26, 1850. 2 The particulars of this case of secondary amputation nt the hip joint were contributed to the Surgeon General s Office by the operator, Professor GKOKGE C. BLACKMAN, of the Medical College of Ohio, in a letter dated February 26, 1867. The operation had been briefly noted in the Cincinnati Jour, of lied., 1866, Vol. I, p. 101, and was more fully detailed in the Report on Amputations at the Hip Joint, Circular No. 7, S. G. 0., 1867, p. 43, with a ohroinolithographic sketch of the patient five months after recovery, from a drawing transmitted by Dr. BLACKMAN. PIG. 100. Cicatrix five mouths after secondary amputation at the hip. [From a drawing by Prof. BLACKMAN.] SECT. II.] SECONDARY AMPUTATIONS AT THE HIP JOINT. 147 FIG. 101. Gunshot frac ture of the femur. Spec. 2288. CASK 322. Private Daniel H. Bowman, Co. C, 110th Pennsylvania, aged 24 years, was wounded on July 27, 1864, at Deep Bottom, on the left bank of James River. A conoidal musket bull entered at the upper posterior part of the right thigh, comminuted the femur from the trochanters downward for several inches and lodged. The wounded man was transported to Washington on a hospital steamer, and was received at Lincoln Hospital on July .30th. The injured limb was shortened two and a half inches; the soft parts were badly lacerated. On August 7th the position of the ball at the anterior part of the thi"h was detected. An incision was made and the ball and several detached fragments of bone were removed. On August 17th the wound looked badly, and there was slight sloughing. For the next few weeks the patient lost ground steadily. There was profuse suppuration, with great constitutional irritation. There appeared to be no attempt at union at the seat of the fracture. The patient had become much emaciated, and his powers of resistance were failing daily. After due consultation it was determined to amputate at the hip joint. On September 15th the operation was performed by Assistant Surgeon J. C. McKee, U. S. A. The patient was rendered insensible by sulphuric ether. The method by antero-posterior flaps formed by transfixion was adopted. The amputation was rapidly completed and very little blood was lost. The patient did not rally, but died one hour after the operation, September 15, 1884. At the autopsy, the lungs were found to be attached to the thoracic walls by firm fibrinous adhesions. In the upper lobe of the right lung there were two small isolated abscesses. Otherwise the lungs were normal. The right weighed 13 and the left 11 ounces. The abdominal viscera were normal, save that the liver and kidneys were unusually small, the former weighing 44-J and the latter 9 ounces. At the seat of the fracture of the femur (FlG. 101) there was no attempt at repair; the fragments were carious: a large one, consisting of nearly half of the cylinder of the shaft, was four inches long and was quite detached. Fissures pene trated the trochanters and extended posteriorly half-way up the neck of the bone. CASE 323. Sergeant Hiram H. Davis, Co. B, IfiGth New York, aged 26 years, was wounded at the battle of Opequan, Virginia, on September 19, 1864, by a conoidal musket ball, which passed through the fleshy part of the left thigh, and, entering the other thigh, fractured the upper third of the right femur. He was sent by his regimental surgeon, Dr. G. C. Smith, to the Sheridan Field Hospital, near Winchester, where the fracture was adjusted upon a double inclined plane. Thence he was transferred, on March 6, 1865, to the General Hospital at Frederick, Maryland, which reports the flesh wound in the left thigh healed, great deformity and shortening of the fractured limb, and copious suppuration from fislulous sinuses communicating with necrosed bone. On April 25th he was transferred, in a somewhat improved condition, to the Cuyler General Hospital at Germantown, Pennsylvania, where no special alteration in his symptoms or treatment is noted. On May 10th he was moved from Cuyler to Mower Hospital, and thence, on October 18th, to the Post Hospital at Philadelphia. The register of the Post Hospital states that the fracture of the femur was consolidated at the date of his admission, and that he was discharged from service on November 8, 1885. In the spring of 1866 Davis was received at the Episcopal (civil) Hospital in Philadelphia. The appear ance of the injured limb at the date of his admission is indicated in the accompanying wood-cut (FlG. 103). The right lower extremity was shortened six and a half inches; there was false anchylosis of the knee and ankle joints on this side; extensive cicatrices on the thigh indicated the location of former sloughing; there were five fistulous canals communicating with diseased bone; apparently the entire upper portion of the femur was necrosed. On May 5, 1886, Dr. Wil liam S. Forbes, surgeon to the hospital, amputated the limb at the hip joint. Ether was employed as an anaesthetic, but it did not act satisfactorily. The vessels were controlled by the abdominal aortic compressor. An anterior flap was made by cutting from without inward, the integument being dissected up to form the longer portion of the flap. Then the femoral artery was tied ; and then the bone was disarticulated and the posterior flap was completed. The haemorrhage was estimated at less than eight ounces. The patient rallied bravely from the shock of the operation. Forty-eight hours after the operation the pulse fell, and for about five hours there was great depression. This was fol lowed by a febrile reaction, accompanied by an erysip- elatous blush, which, commencing at the outer angle of the wound, gradually involved its entire extent. After this the patient sank rapidly, and expired sixty-four hours after the operation, May 8, 1886. On examining the injured femur (FlG. 102) it was found to be imperfectly united by fragile masses of callus, which enclosed large fragments of dead or diseased bone. 1 1 MouTON (T. G.), On Amp. Hip Joint, with the Hist, of the Cases, in A m. Jour. Med. Sci., 1866, Vol. L1I, p. 36 ( Circ. No. 7, S. G. O., 1667, pp. 46, 64. FIG. 102. Partial union of gunshot fracture of the femur. [ From a photo graph by RHOADS.J FIG. 103. Gunshot fracture of the right femur with great shortening and deformity. [From a photograph by NEWELL.] 148 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 324. Corporal Frederick Kelb, Co. G, 7th New York, was wounded at Fredcricksburg, Virginia, December 14, 1862, by a conoidal musket ball, which fractured the right femur at the junction of the upper and middle thirds. After remaining for a fortnight in the field hospital of the 1st division of the Second Corps he was conveyed to Washington and placed, on December Ciith, in the Patent Office Hospital, where the injured limb was placed in a fracture box and the wound was dressed with oakum. The case progressed favorably, and, on April 2, 1863, the patient was transferred to Judiciary Square Hospital, and, on May 9th, was sent to De Camp Hospital, at David s Island, New York. Acting Assistant Surgeon John C. DuBois reported: "The ball entered about one inch below the fold of the right natis, and, passing outward, shattered the femur at its middle, and lodged in the anterior part of the thigh. The ball was extracted two days afterwards. On January 1, 1863, six pieces of bone were removed. The limb was placed on a double inclined plane and cold water applied. Six weeks after, the long straight external and short internal splints of pasteboard were applied. This was removed in a few weeks and merely the short internal pasteboard splint retained. On April 2d and 8th, pieces of bone came away. The splint was then removed, and the limb suffered to lie on a hair mattress. May 6th, several pieces of bone removed. May 12th, firm union has taken place, with great deformity. External angular curvature, with about 4f inches shortening, as near as can be measured. His whole limb is everted, and he is unable to raise it. His general condition is much reduced. As union is firm no treatment can be adopted to relieve the deformity. July 10th, a few more pieces of bone have been removed. The probe reveals rough bone, not loose. Internal wound closed; sinus injected with dilute tincture of iodine. General health pretty good." On July 10th he was removed to McDougall Hospital, at Fort Schuyler; and on January 19, 1864, he was readmitted to De Camp Hospital. On June 8, 1834, he was discharged from the service of the United States. There was evidence of disease of the femur. On June 7, 1865, Kelb was admitted to St. Luke s Hospital, in New York City. There had been a series of recur ring abscesses in the thigh, and it was believed that nearly the entire femur was necrosed. It was determined to amputate at the hip joint, and, on June 7th, the patient being anesthetized by sulphuric ether and the aorta being compressed by Signoroni s clamp tourniquet, the amputation was performed by the attending surgeon, Dr. R. F. Weir, by the method recommended by Dr. Van Buren, an anterior flap being formed by transfixion and a posterior one by section from without inward. The haemorrhage was slight and the shock .was moderate. The case at first progressed very favorably. Three weeks after the operation the healing of the stump was far advanced and the patient was able to leave his bed. After this he began to lose ground very gradually. He died on October 4, 1865, nearly four months after the operation. At the autopsy, the pelvis of the right kidney was found to be blocked up with numerous calculi; there was an abscess in the left kidney, and there was tuberculosis of both lungs at an advanced stage. The stump was still open and the horizontal portion of the os pubis was necrosed. A section of the exarticulated femur presented the characteristic lesions of chronic osteomyelitis. 1 CASE 325. Private James McGeehen, Co. K, 107th Pennsylvania, aged 48 years, was wounded at the battle of Gettys burg, on July 1, 1863, by a conoidal musket ball, which entered at the inner aspect of the middle of the right thigh and traversed the entire thickness of the limb, badly comminuting the shaft of the femur in its progress. He lay upon the field for about five hours and lost a good deal of blood, although none of the larger vessels appeared to have been wounded. He was then conveyed to a temporary field hospital, and his wounds were dressed. On July 6th he was removed to the Seminary Hospital at Gettysburg, where he remained until September 4th, at which date there was profuse suppuration and some slough ing at the wound of entrance, and it was deemed expedient to put the patient under canvas in the Camp Letterman Hospital. On October llth he was moved to the Town Hall Hospital at Chambersburg. Here he was able to move about on crutches, but the injured limb was greatly enlarged and deformed, and numerous fistulous openings successively formed, through which pus was freely discharged and bits of necrosed bone were occasionally eliminated. On April 23, 1864, by order of the Medical Director at Harrisburg, he was discharged from the military service of the United States on account of "permanent lameness resulting from gunshot fracture of the right femur." Nearly two years subsequently, April 9, 1866, McGeehen entered the Pennsylvania Hospital at Philadelphia. His general condition was satisfactory; his spirits were excellent; a careful examina tion failed to detect organic disease of any viscus. His injured thigh remained greatly deformed and enlarged; the original wounds had long since closed, but there were numerous fistulous sinuses, discharging on an average a gill of pus daily, and, at intervals, scales or nodules of necrosed bone; three tracks seemed to ascend to within an inch and a half of the trochanter major. It was thought probable that above this point the femur was healthy. After a careful consultation, it was determined to remove the limb at the hip joint. The patient was placed upon tonic treatment, with nourishing diet; his bowels were also carefully regulated. He complained of nothing except his cough, arising from a slight bronchitis, which, however, gave him very little trouble. On April 21, 1866, Dr. D. H. Agnew, Surgeon to the Pennsylvania Hospital, removed the limb. The abdominal tourniquet was employed, and by this means the circulation of the abdominal aorta was completely controlled. The method of operating was by antero-posterior skin flaps, with circular division of the muscles. The femoral artery was ligated after the anterior flap was dissected up. The femoral vein was not included in the ligature. Twenty-one of the smaller arteries required deligation. The disarticulation was accomplished in a minute and a half. Pressure was maintained by the abdominal tourniquet for twenty-seven minutes while the minor vessels were secured. The hemorrhage during the entire operation did not exceed three ounces, scarcely more than an ounce and a half of which was arterial blood. Ether alone was employed in inducing anesthesia, and about three ounces sufficed, as he inhaled it without effort and soon came under its influence. The stump was packed with lint. The leg, when drained entirely of blood, weighed twenty-two pounds, the entire weight of the body at that time being about one hundred and forty-five pounds. Immediately after his removal to the ward an enema of half a drachm of tincture of opium was administered, and this was repeated at eight in the evening, when the stump was closed by lead sutures and dressed with cerato. On the following day the patient had entirely reacted from the slight amount of shock following the operation. Pulse, which, under agitation from the approaching operation, had been averaging from 100 to 115, had fallen to 98; respiration 20; skin moist and pleasantly warm. No stimulus; moderate diet, and a drachm 1 LlDELL (J. A.), On the Secondary traumatic Lesions of bone, etc., in U. S. San. Cam. Hem., 1870, Surgical, Vol. I, p. 438. W. H. VAN BUKEN, Transactions of New York Academy of Medicine, Vol. I, 1851-57, p. 123, and Contributions to J ractical Surgery, Philadelphia, 1865, p. 9. M. A. GUERIN (Medecint, Oplraloire, p. 220) has suggested the same plan. See also Circular 7, S. G. O., 1867, pp. 41, 64. SECT, n.j SECONDARY AMPUTATIONS AT THE HIP JOINT. 149 of laudanum by enema. On April 23d he was more comfortable. Had passed a quiet night; had a good appetite. A con siderable part of the stump had united by first intention, and there was only a little greasy, watery discharge from the inner angle. Dry dressing continued. On April 24th he was doing well. Discharge thin and small, and flaps were rapidly uniting. He was ordered four ounces of whiskey daily, and half an ounce of Basham s mixture. Dry dressing continued. April 25th, no unpleasant symptom save a rather frequent bronchitic cough. The flaps are united at the middle of the stump; the discharge comes from the angles, and it is evidently due to the breaking down of the subcutaneous fat. Laudanum enemata were now given twice daily; warm-water dressings were substituted for the dry applications. April 26th, he ate and slept well, but was troubled by his cough, which was severe, accompanied by tenacious mucous sputa. The opiate enemata were suspended, and from two to four drachms of solution of sulphate of morphine were given every night; durin* the day, a sedative expectorant mixture every three hours. The stimulus was not increased. April 27th and 28th, steady improvement ; cough less troublesome, discharge more purulent and increased in quantity ; warm-water dressing still applied. April 29th, discharge purulent and quite abundant, amounting, probably, to three or four ounces daily. April 30th, much the same, excepting that the cough was again more troublesome. The union of the flaps was daily becoming more secure, and the discharge now consisted of laudable pus. Four ligatures came away. May 1st, seemed brighter and better than any day heretofore; ate heartily; stump looked perfectly healthy, discharge moderate; two more ligatures came away. May 2d, condition excellent; the stump was rapidly healing; the skin remained as soft and healthy as on the day of operation. Most of the stitches had been cut away. The pulsation of tho external iliac artery, which for several days was very marked, had diminished greatly, and seemed as though propagated through a firm clot. He had been troubled consid erably with cough for two days. At midnight, in the absence of the watchman, haemorrhage occurred, and on the return of the latter the patient was found dead. Upon removing the dressing it was seen that a secondary haemorrhage had taken place. Most of the blood was retained either in the stump or inside the dressing; the little that had escaped had flowed from the inner angle of the stump back under the body. The haemorrhage was found to have proceeded from the femoral artery. The most powerful restorative measures were employed for a long time, but without producing the slightest effect. Upon dissecting the stump, the union was found to be complete over one-half of the entire surface of the flaps, whilst the deeper portions of the stump were covered with healthy granulations. The femoral vein, which was not ligated, was entirely occluded; the femoral artery was patulous, its inner coat projecting somewhat beyond the other two; the inner coat of the artery was deeply stained and roughened for at least one and a quarter inches above the extremity; higher up it appeared perfectly healthy; the ligature which had secured the vessel was still attached to a shred of the outer fibrous coat. It had evidently very recently cut its way through, and still retained in its loop the end of the vessel which had sloughed off. Lying immediately in front of the femoral vessels, embedded in a recent clot, was found the plug which had been driven out of the artery. This was a firm, flesh-colored clot, of the calibre of the vessel, and long enough to reach up to the origin^ of the deep epigastric and circumflex iliac arteries. No positive testimony could be obtained that the patient had suffered from one of his violent spells of coughing immediately before the accident, as all in the ward were asleep excepting the watchman; but all the appearances render it highly probable that directly after the ligature of the femoral became detached the violent succussion of the diaphragm incident to a paroxysm of coughing had expelled the clot from that vessel. All the other vessels appeared completely obliterated. Only the thoracic and abdominal cavities were examined. The lungs were large and free from pleuritic adhesions. They were somewhat emphysematous, and showed a large amount of pigniP .t over their surface. The anterior portions were anaemic, but posteriorly there was marked congestion of the lower lobes. The heart was quite flabby and moder ately dilated. There was no valvular disease or apparent insufficiency, but microscopic examination showed advanced fatty degeneration of the muscular fibres. The liver was also very soft and fatty. Kidneys anaemic and pale. Other viscera healthy. The large vessels and heart contained very little blood. There was a small collection of unhealthy purulcjnt matter in the manubrium of the sternum. The limb, upon dissection, showed very great disease of all the soft parts between the trochanters of the femur and the knee joint. The muscles had undergone fatty degeneration ; their sheaths were very much hypertrophied and of almost cartilaginous density. Toward the bone there was a thick layer of tenacious colloid bone carti lage, apparently resulting from periosteal disease. Through the dense and morbid mass fistulous tracks radiated in every direction, many of them containing small spiculae of bone. The bone itself was diseased from the condyles to within one and a half inches of the lesser trochanter. The shaft had been fractured obliquely, with considerable comminution, and union had taken place by formation of a very large amount of dense bony structure, which projected in spurs and ridges in all directions. The original track of the ball was marked by a deep groove, and one or two small fragments of lead were found embedded in the bone. There was a large anfractuous cavity, bridged over in places by newly formed bone, which still contained several quite large sequestra. There was incipient periosteal disease along the linea aspera up to the trochanters. A section of the bone showed that if osteo-myelitis had existed it had not extended within several inches of the trochanters. 1 In the four foregoing fatal secondary amputations, one succumbed to the shock of operation in an hour; another died on the third day with surgical fever and erysipelas; a third in seventeen weeks with phthisis and lithiasis, the stump nearly healed ; and a fourth An account of this case was published by Dr. THOMAS G. MOUTOX, in The American Journal of Medical Sciences, 1866, Vol. LII, p. 33 (Com pound Comminuted Fracture of Right Femur, from Wound by Minie Ball. Amputation at Hip Joint after Thirty-four Months, by Dr. D. II. AGNEW, Death from Secondary Hxmorrhage on the Twelfth Day), from notes carefully and admirably drawn up by Dr. WILLIAM PKFPEI:, the resident surgeon at the Pennsylvania Hospital, under whose immediate care the patient was. See also List of the More Important Specimens added to the Pathological Museum of the Pennsylvania Hospital during the year 1867, by WILLIAM PEPPER, M. D., Curator, in Penn a Hospital Reports, Vol. I, 18C8, p. 399. FIG. 104. Consoli dated shot fracture of femur, with secondary lesions. [From a pho tograph by WlLLAUD.] 150 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. perished on the eleventh day, from giving way of the femoral at the point of ligation. In two of the following cases the patients sank from shock in a little over twenty-four hours. In the third case, secondary haemorrhage was restrained by ligating the external iliac on the eleventh day, but bleeding recurred fatally on the twenty-third day. CASE 326. Antonio Mutieres, a Mexican, aged 30 years, employed by the depot quartermaster at Fort Union, New Mexico, was wounded, in an altercation with another Mexican, on May 10, 1867, by a conoidal pistol ball, which entered two inches below the anterior superior spiuous process of the left ilium, and passed downward and lodged in the neck of the left femur at its junction with the head. He was admitted to the Post Hospital at Fort Union on May llth, when Assistant Surgeon DuBois, Post Surgeon, enlarged the wound and extracted the ball and wadding with a pair of Tiemamvs bullet forceps. After the removal of the ball the finger could be passed half an inch or more into the substance of the cervix, in which the ball had been embedded. The patient suffered but little pain, but he gradually lost flesh and strength from the surgical fever and sup puration. On June 14th he began to have severe pain, running up the side of the trunk and downward to the knee. Tins became more continuous and distressing on the succeeding day. Surgeon J. C. McKee, U. S. A., saw the patient in consulta tion, at this date, and advised that amputation should be performed in preference to an excision. At noon, on June 22d, Assistant Surgeon DuBois operated, assisted by Dr. Short, of Los Vegas, and Dr. Simpson, of Moro. A rude clamp abdominal compressor had been made at the post under the direction of Dr. DuBois, and this instrument, applied a little above and to the left of the umbilicus, effectually controlled the aorta. A long anterior and short posterior flap were made. The disarticu- lation was completed in fifteen seconds. Eighteen arteries were ligated. The soft parts were much diseased, and there was a large amount of venous haemorrhage. The anaesthetic employed was a mixture of equal parts of chloroform and ether. The patient breathed well notwithstanding the compression of the abdomen. The flaps were left open, a cerate cloth being inter posed. In the evening the patient was free from pain and had slept a little; but he had not reacted satisfactorily, and talked and laughed excitedly. His pulse was at 160 and feeble. It was fuller and less frequent immediately after the operation. Milk punch had been given in small quantities every fifteen minutes. Hypodermic injections of tincture of opium in doses of from ten to thirty drops, repeated every twenty minutes or at longer intervals, were now administered. This remedy appeared to bring the pulse up, and to act as a stimulant and not as a narcotic a therapeutic result observed by Dr. DuBois in other cases of shock. The patient died June 23, 1867. At the autopsy, the acetabulum was found to be extensively diseased. 1 CASE 327. Private Michael O Neil, 2 Co. E, 58th Massachusetts, aged 19 years, was wounded at the battle of Cold Harbor, June 3, 1884, by a conoidal musket ball, which entered the upper anterior part of the right thigh, and passed backward and slightly upwai-d through the limb, comminuting the upper extremity of the femur. The fissures extended about three inches down the shaft, and through the trochanters halfway up the neck. The wounded man was sent in an ambulance to the White House, on the York River, and thence by a hospital steamer to Alex andria, where he was received at the Third Division Hospital on June 7th. On admission his limb was much swollen, yet there was but little pain, and this was not increased by moving the limb. His general condition was satisfactory, though he reported that he was subject to attacks of inter mittent fever. His limb was arranged in a straight position, supported by cushions and pillows ; evaporating lotions were applied to the wound, and a nutritious diet was ordered. On June 10th, several fragments of bone were extracted. On June 12th the patient had a chill, and was ordered to take four grains of sulphate of quinia every four hours. The injured limb was now suspended by means of Smith s anterior splint. On June 24th there was another chill. The wound was now sup purating freely, and the limb was very sensitive when handled. On June 31st there was a slight chill. From this date to August 1st there was little change in the symptoms. It was now decided that there was little hope of consolidation of the fracture. The suppuration was profuse, and it was believed that the patient would inevitably succumb ultimately to the constitutional irritation and the drain upon the system. It was determined, therefore, that amputation should be performed, and the FIG. 10.3. Gunshot fracture character of the fracture admitted only of amputation at the hip joint. On August 10th, the patient . f Jke upper extremity of the was anaesthetised bv sulphuric ether, and amputation at the hip joint was performed by the lateral right lemur, spec. jU9b. l r J flap method by Surgeon Edwin Bentley, U. S. V. There was but little haemorrhage, and the oper ation was borne well. The patient had an anodyne, and was freely stimulated. For forty-eight hours after the operation there was some febrile excitement, with complete anorexia. The fever then subsided and the appetite returned. The wound looked well, and the amount of suppuration was trifling. The case progressed very favorably until August 20th, when secondary haemorrhage supervened from ulceration of the femoral near the ligature. About six ounces of blood were lost. A ligature was promptly placed upon the external iliac just above Poupart s ligament. After the operation the patient was very weak and faint, and stimulants were freely administered. On August 22d there was an excess of febrile excitement, but this abated on the following day and the appetite again became moderately good. On August 28th there was nausea and vomiting, which persisted for forty-eight hours. The wound at this time had assumed a very unhealthy appearance, and the patient had become much emaciated. On the night of September 1st there was delirium. The case terminated fatally on the morning of September 3d, twenty-three days after the operation. At the autopsy the viscera was found to be healthy, except that there was an old cicatrix with cretaceous deposit at the apex of the left lung. The lips of the wound were united in nearly their entire extent. There was a large accumulation of pus within the flap, bathing the acetabulum and the gaping mouth of the femoral artery. The wound left by the incision above Poupart s ligament, through which the external iliac was tied, communicated with an abscess between the iliacus oxternus muscle and the iliac fascia, filled witli pus. The ligature on the external iliac was found to be 1 See DuBois (II. A.), A Case of Amputation at the Hip Joint for Gunshot Wound of the Head of the Femur, in The Medical Record, 18C8, Vol. II, p. 266 ; Circular No. 7, S. G. O., 1867, p. 40; Circular No. 3, S. G. O., 1871, p. 214. 2 The abstract of this case was compiled from a report by the operator, Surgeon E. BEXTLEY, U. S. V. See Circular No. 7, S. G. O., 1867, p. 39. SECT. II.] SECONDARY AMPUTATIONS AT THE HIP JOINT. 151 placed about half an inch below the origin of the epigastric; the circumflex iliac was given off a little below the epigastric. There was a firm conical plug in the external iliac, ending at the origin of the epigastric. Through this plug ran a canal communicating with the mouth of the circumflexa ilii; this canal was closed by a clot colored by included red corpuscles and of more recent formation than the plugging clot. Ulceration of the external iliac just above the ligature had commenced. The femoral vein was collapsed and contracted; the external iliac vein was distended by a dirty fluid, which, when placed under the microscope, was found to abound in pus globules. Higher up, the contents of the vein consisted of a granular detritus. The branches of the external iliac vein was blocked up by dense coagula. The deep-seated abdominal lymphatic glands were enlarged and deeply injected. An examination of the fractured femur showed that it was shattered, with much loss of sub stance, just below the trochanters. The fissures ran up with the capsule, and the fractured extremities of the bone were carious and had lost tissue by absorption. CASE 328. Private John Williams, Co. F, 13th Ohio Cavalry, aged 44 years, was wounded at Peebles Farm, near Petersburg, September 30, 1864, by a conoidal musket ball, which passed through the left thigh and contused or partially fractured the femur. He was conveyed in an ambulance to the field hospital of the first division of the Ninth Corps, and his wounds were dressed, and he was then sent by rail to City Point, and thence to the North in a hospital transport steamer. On October 7th he was received at the General Hospital at Beverly, New Jersey. For over three months the case progressed very favorably under the simplest treatment; but early in February abscesses formed in the thigh, and when they were incised they discharged copiously an offensive pus. About the same time the patient was attacked by an obstinate diarrhoea. On February 17, 1865, an exploratory incision was made, and a careful examination with the finger and the probe indicated that the femur was necrosed as high as the trochanters. It was then considered that amputa tion at the hip joint presented the only chance for preserving life. The operation was performed by Assistant Surgeon Clinton Wagner, U. S. A. The patient inhaled chloroform; anterior and posterior semilunar flaps were made by transfixion; the femoral artery was tied as soon as divided; disarticulation was then effected, and the operation completed by securing the minor vessels. Very little blood was lost. The patient reacted satisfactorily, but sank and died, apparently from shock, twenty-nine hours after the operation. An autopsy revealed a healthy condition of the viscera and no lesion worthy of special mention. The femur displayed an interesting example of necrosis of the entire diaphysis. It is numbered Specimen 84 in the collection of the Army Medical Museum, and is represented in the adjacent wood-cut, FlG. 106. FIG. 106.-Necrosis of the femur follow ing gunshot injury. Spec. 84. TABLE XVII. Summary of Nine Cases of Secondary Amputation at the Hip Joint. No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Lemon, G. W., Pt., C., 6th May 5, Conoidal ball fract. left femur, Oct. 12, Anterior and post r semilunar Steady imp. Dec., 1865, stump Maryland, age 30. 1864. junct. upper thirds ; bedsores ; 1865. flap, by Surgeon E. Bentley, healed. Disch d Feb. 3, 1866. abscesses. May, lt-65, pro U. S. V. Specs. 4386, 4167, 51)40. Pliot. fuse suppuration, bone firmly er. 136, 137. Circ. 6, S. G. O., consolidated. 1865, p. 52. Circ. 7, S. G. O., 1867, pp. 42, 64. 2 Longmoor, W. W., Pt., age June 11. Conoidal ball shattering shaft Jan. 18, Lacanchie g method ; circular Rapid recovery. 1870, general 25. 1864. right femur ; abscesses ; nee. 1866. cut thro skin, integ. retracted, health good. BLACKMA\(G.C.), bone rem d ; protracted irrita muscles div. circularly down Amputations at Hip Joint, in tion and exhaustive suppu to bone ; vertical incision on Cincinnati Jour, of Jled., 1866, ration. outer side, by Prof. G. C. Vol. I, p. 101. Circ. 7, 1867, Blackman. pp. 43, 64. ;j Bowman, D. H., Pt., C, 110th July 27, Conoidal ball com. right femur Sept. 15, Antero-posterior flaps, by Ass t Did not rally. Died one hour af Pennsylvania, age 24. 1864. from trochanters down several 1864. Surgeon J.C.McKee, U.S.A. ter operation. Spec. 2288. Circ. inches. Aug. 17th, ball and 6, S. G. O., 1865, p. 50. Circ. fragm ts bone extracted ; pro 7, S. G. O., 1867, pp. 41. 64. fuse suppuration ; no union. 4 Davis, H. H., Sergeant, B, Sept, 19, Conoidal ball fract. upper third May 5, Anterior posterior flap, by Dr. Rallied well. Died May 8, 1866, 100th New York, age 26. 1864. rightfemur. Mar., 65, healed 1866. W. S. Forbes, Civil Hospital, sixty-four hours after operation. with great deformity. 66, dis Philadelphia. Circ. 7, S.G.O., 1867, pp.46, 64. eased bone; fistulous canals. 5 Kelb, F., Corporal, G, 7th Dec. 14, Conoidal ball fract. right femur, June 7, Anterior flap by transfix n, pos July 1st, able to leave bed ; after New York. 1862. junct. up. thirds. J une 8. 64. 1865. terior flap by sect n from with this failed, and died Oct. 4, 1865. fracture consolidated. June, out, in, by Dr. R. F. Weir, St. Circ. 6, S. G. O., 1865, p. 52. 1865, abscesses, necrosis. Luke s Hosp., N. York City. Circ. 7, S. G. O., 1867, pp. 41. 64. 6 McGeehen, J., Pt., K, 107th July 1, Conoidal ball badly comminu April 21, Anterior post r skin flap, circ. April 23d, heal g by first intent n. Pennsylvania, age 48. 1863. ting right femur. Oct. 11, 65, 1866. division of muscles, by Dr. 26th, bronchial cough trouble able to move on crutches D. H. Agnew, Pennsylvania some. May 2d, hcem. from fem li mb deformed, bone n ecros d. Hospital. oral artery; died. Circ. 7, 1867, April, 66, numerous fistulous pp. 44, 64. openings discharging. 7 Mutieres, A., Mexican, team Mav 11, Revolver ball ent g left thigh. June 22, Long anterior, short posterior Died June 23, 1867. Circ. 7. 1867, ster in Quartermaster s De 1867. lodging in neck of femur; ball 1867. flap, by Ass t Surgeon H. A. pp. 46, 64. Circ. 3, S. G. O., partment, age 33. removed lost strength daily. Dubois, U. S. A. 1871, p. 214. 8 ONeil, M., Pt., E, 58th Mas June 3, Conoidal ball comminuting up. Aug. 10. Lateral flap, by Surgeon E. Ulce,ration of femoral. Aug. 20, sachusetts, age 19. 1864. extremity right femur. June 1864. Bentley, U. 8. V. hasm., lig. of ext. iliac. Died 10, fragments extract d. Aug. Sept. 3, 1864. Spec. 3098. Circ. 1st, profuse suppuration. 6, S. G. O., 1865, p. 50. Circ. 7, S. G. O., 1807, pp. 39, 64. S> Williams, J., Pt., F, 13th Sept. 30, Conoidal ball thro left thigh, Feb. 17, Anterior and posterior semi- Died, twenty-nine h rs after, from Ohio Cavalry, age 44. 1864. partially fract g or contusing 1865. lunar flaps, by Ass t Surgeon shock of operation. Spec. 84. femur. Feb, 65, exam, found C. Warner, U. S. A. Circ. 6, S. G. O , 1865, p. 50. femur necrosed to trochanters. Circ. 7, S.G.O., 1867, pp. 41, 64. 152 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Reamputations at the Hip Joint. The category of exarticulations at the hip for diseased conditions succeeding previous amputations in the continuity of the thigh, per taining to the surgery of the late civil war, includes nine examples with only three deaths. 1 CASE 329. Private \V. Cotter, Co. E, 9th New Hampshire, aged 27 years, was wounded at Petersburg, July 30, 18C4. Surgeon J. Harris, 7th Rhode Island, recorded his admission to the field hospital of the 2d division, Ninth Corps, and noted: "Fracture of thigh, lower third; amputation of thigh at middle third." From the field hospital the patient was transferred to City Point, and thence to Washington, August 3d. Assistant Surgeon W. F. Norris, U. S. A., contributed the pathological specimen, shown in the wood-cut (FlG. 107), with the following history by Acting Assistant Surgeon H. Gibbons: "The patient was admitted to Douglas Hospital with primary amputation of right thigh, lower part of middle third. The operator had made a long posterior skin flap, which was turned up over the muscles and bone, and attached to the integument anteriorly by means of several sutures. When first seen the stump was greatly swollen, partly from a retention of pus by the bag-like flap. A couple of sutures were removed and the pus evacuated. On August 4th, an incision was made in the dependant portion to admit of free drainage, and poultices were ordered. Appetite and sleep were not greatly disturbed, and there was not as much irritative fever as in most similar cases. Ordered stimulants, tonics, and generous diet. August 13th, swelling much reduced ; constitutional irritation less. Ligature of femoral artery separated. The poultices were alternated with flannel dressings till September 1st, when wet cloths were substituted. Flaps mostly united; appetite poor; sleep disturbed; stump painful. Ordered morphia at bed-time. September 13th, patient sits up and walks about with some assistance. Stopped the stimulant. September 28th, stump doing well; swelling gone; dead bone felt with the probe Had an attack of diarrhoea, which lasted but a few days. The irritability of the stomach was a source of continual complaint for two or three months. The various stomachics relieved but temporarily ; nevertheless there was marked improvement, especially during November, the patient being about on his crutches daily. November 29th, divided the cicatrix (but a small fistulous opening was still remaining) and removed a sequestrum nearly six inches long. It was attended with some difficulty, yet not as much as was expe rienced in similar cases. The sequestrum consists of the entire bone at the lower extremity, but tapers to two or three points at the other; the circumference is complete for three inches. In its centre, surrounding the medulla, was found a beautiful transparent flake of new bone. The femur contained, as in like cases, a large amount of new bone. July 16, 1865, the cavity left in the stump has never entirely closed, but continues to discharge, and refuses to heal, though various stimulating injections have been resorted to. It is over three inches deep. The patient is in a promising state of health." On November 2d, the patient was transferred $r i fe 1 2 5 ern i ir to the Harewood Hospital. Surgeon R. B. Bontecou, U. S. V., reported that he was doing well on December 31st, but that there was still a "fistulous discharge from the stump." At the closing of the Harewood Hospital, on May 1, 1866, the patient was transferred to the Washington Post Hospital, where the specimen represented in the adjacent cut (FlG. 108) was removed. Assistant Surgeon W. Thomson, U. S. A., who performed the operation, reported as follows: "Two sinuses lead to the interior of new bone, which have failed to close since the date of the first operation. On June 6, 1866, resection of four inches of femur from the end of the stump, after previously made incisions into the soft parts, was performed. Ether was used, and the incisions were united by silver sutures. June 30th, wound has healed kindly, two-thirds by first intention, leaving a sinus on the under surface of the stump still discharging. September 30th, although mostly healed the stump is still indurated. Two sinuses, evidently leading to necrosed fragments of femur, are still open and keep up an offensive discharge. Small intercellular abscesses form occasionally. Patient in good condition." He was discharged from service October 15, 186f>, and pensioned. In the following year he was reported as having been treated for a time at the Bellevue Hospital, New York City, where Drs. H. B. Sands and F. H. Hamilton are said to have removed several pieces of necrosed bone. On October 5, 1871, the pensioner entered the Providence Hospital 1 Amputation at the hip, after previous amputation in the continuity <,f the thigh, was first performed by G. J. (IL TMRIE, in 1812, in the case of Private Mason, 23d Infantry, or Welsh Fusiliers, wounded at Ciudad Rodrigo. GUTHRIE, On Gunshot Wounds of the Extremities, London, 1815, 8vo, p. 141. Of the nine cases pertaining to the American civil war, the earliest, May 21, 1864, was practised by Dr. A. B. MOTT, on the stump of a prior amputation for bayonet stab of the knee. On September 21, 18C4, Dr. Guunox BUCK and Dr. F. HASSENBUUG disarticulated at the hip unsuccessfully, after prior amputations for shot fracture. In 1865, Dr. J. H. PACKARD had the first successful reamputetion at the hip after previous amputation in the thigh for shot fracture, and Dr. A. M. FAUXTLEROY successfully reamputatcd, under similar conditions, on March llth. In 1806, the successful reampu- tation at the hip by Dr. T. G. MOUTOX, and a like operation, with fatal result, by Dr. J. B. WniTCOMB, were practised. In 1870, and in 1871, Dr. G. A. OTIS and Dr. N. S. LINCOLN performed successful reamputations at the hip, after prior amputations of the thigh, for shot fracture. Professor J. FAYUER (Clin. and Path. Obs. in India, London, 1873, pp. 84, 489), in 1867, unsuccessfully reamputated at the hip after prior thigh amputation for an incised wound of knee. Besides these eleven reamputations at the hip, the records of civil surgery afford .it least twenty-one examples, viz: five following amputations forbad fractures of the femur J. SYME S, in 1848 (The Medical Times, London, 1849, Vol. XIX, p. 252); J. Roux s, in 1859 (Gaz.hebd., 1860, pp. 292, 297), recoveries ; J. F. HEYFELT)ER s, in 1801 (Deutsche Klinik, 1862, S. 275), fatal ; J. FAYREK S, in 1864, recovery ; und J. FAYHEIl s, in 1805, fatal (Clin. and Path. Obs. in India, 1873, p. 489). There were eight exarticulations following prior amputations for ostitis or ill-defined lesions, viz: A. COOPER S, in 1824 (Lond. Lancet, 1824, Vol. II, p. 96); BRADIIURY S, in 1851 (Host. Med. and Surg. Jour., 1852, Vol. LXVI p. 349); B. BECK S, in 1854 (Deutsche Klinik, 1856, No. 47); ROSER S, in 1857 (THIEME s Diss., Leipzig, 1867, p. 9), successful: and TEXTOK S, in 1851 (EscuE S Diss., Wiirz- burg, 1863); CHEUUS S, in 1853 (THIEME s Diss., Leipzig, 1807, p. 8); HEYFELUEIl s, in 1854 (THIEME s Diss., Leipzig. 1867, p. 8); and HANCOCK S, in 1860 (Lond. Lancet, 1860, Vol. I, p. 319). Eight exarticulations followed prior amputations for malignant growths, viz : MAYO s, in 1835 (COSTELLO s Cyclop., 1841, Vol. I, p. 182); BOISSEAU S, in 1841 (METZ s Diss., Wurzburg, 1841, p. 17); W. 8. COXE s, in 1844 (Mem. on Amp. at the Hip Joint, London, 1845); VAN BUREN S, in 1850 (Contrib. to Pract. Surg., 1865, p. 10); GROS CLARK S, in 1866 (Lond. Lancet, 1867, Vol. I, p. 11), successful; and CHELIUS s, in 1845 (BituCH, Die Diagnose der bosartigen Geschwulste, Mainz, 1847, p. 3); VOLKMANN S, in 1868 (Deutsche Klinik, 1868, p. 338); and J. LISTER S, in 1872 (REYUHli. in LAXGENliECK s Archiv, B. XVII, p. 516), fatal cases. FIG. 108. Resected extremity of the right femur from a case of osteomyelitis. Spec. 4954. i SECT. IT.) REAMPUTATION AT THE HIP JOINT. 153 at Washington, with the stump still in a diseased condition; and ten days afterwards Dr. N. S. Lincoln exarticulated the remain ing part of the femur, consisting of the head, neck, and trochanteric portions, which was also contributed to the Museum, and is represented in the annexed cut (FlG. 109). The femoral vessels were respected, go that the disarticulation might be said to have resembled an excision or enucleation rather than a reamputation. The patient was able to be about in a short time; and on April 22, 1872, he visited the Army Medical Museum, and a photograph was made of the stump, which is copied in the adjoining wood-cut (FlG. 110). The pen sioner subsequently entered the Na tional Military Asylum at Hampton, Elizabeth City County, Va., where Examiner C. McDermout certified the following: "The right leg has been amputated at the hip joint. This was the third amputation per formed on the limb. Since the last operation he has been troubled with abscesses in and about the cicatiix, which have not healed, though a year has almost elapsed since the disarticulation was made. It is my belief that the tissues of the wounded limb have been diseased and never free from ulceration since he was wounded. His general health hiss been considerably impaired by the constant irritation and drain upon his svstem." This pensioner died FIG. 109. Exartic ulated head and tro- at Queenstown, Ireland, January 21, 1874, while on furlough from the Asylum. chanters of i-igli t femur after osteomyelitis. Spec. 5346. " $ FIG. 110. Cicatrix six months after cox< tion. [Prom a photograph.] femoral disarticulation and reumputa- CASE 330. Private Julius Fabry, Co. K, 4th Artillery, aged 38 years, was wounded at Deep Bottom, Virginia, August 16, 1864. Surgeon B. Gesner, 10th New York, reported : "Severe shot wound of left knee joint; amputation at lower third of femur. Sent to general hospital at City Point, Virginia, August 17th." He was admitted, on August 20th. into Satterlee Hospital, Phil adelphia, from City Point. Surgeon I. I. Hayes, U. S. V., reported: "Gunshot wound of left leg by round ball, which embedded itself in knee joint; also conical ball, which was extracted high up on outer side of left thigh. August 17, 1864, circular amputation of lower third of left thigh. Improving slow ly; simple dressings, tonics, and stimulants." On an unsigned case book of Ward 3, of Sat terlee Hospital, the progress and treatment of the case are recorded as follows: "Stump looks well ; patient somewhat weak but doing well. August 26th, suppurates very freely. August 28th, conical ball extracted from outer side of thigh two inches below great trochan- ter. Patient states that he saw one other ball extracted from the wound. September 1st, doing well; suffers from a bedsore contracted before he came here. States that he lost much blood during the amputation, which accounts for his weak and anaemic condition. Septem ber 9th, doing well. 21st, improving slowly. FIG. ill. Left femur, November 8th, transferred to Ward A." The from a case of reampu- c ., ,. i ,, tation for osteomyelitis progress of the case is continued on another following shot injury. case } )QO ^ > a l so unsigned: "December 2d. Bone ex- Spec. 5C14, A. M. M. FIG. 112. Cioatrix twelve months after coxo-femoral disarticulation and reamputation. [From a photograph-l wound still discharging copiously, posed about one-eighth of an inch ; general health middling, appetite good, bowels regular. Some difficulty with his urinary apparatus; detected pus in nrine. January 9, 1855, morphia ceases to have any effect except to constipate. Remains much the same, better and worse, alternately, every ten or twelve days. February 4th, made an incision on external side of stump some two inches in length, just cutting the fascia, and removed a small piece of woolen. The muscles were not affected by the SURG. Ill 20 154 INJURIES OF THE LOWER EXTREMITIES. [CtTAP. X. superficial sinus." On May 22, 1863, this soldier was sent to regimental headquarters at Fort Washington, whence he was discharged from service January 1, 13 33, on surgeon s certificate of disability, signed by Surgeon John H. Bayne, U. S. V. In October, 1885, the patient received an artificial limb but could not use it without discomfort. Fabiy was admitted into the Soldiers Home January 31, 1836. The remnant of the femur was affected by osteomyelitis, and Surgeon C. H. Laub, U. S. A., had frequent occasion to have the stump poulticed and abscesses opened. October 27, 1838, Assistant Surgeon J. S. Billings, U. S. A., made an exploratory and palliative operation, cutting down on the outer aspect of the thick involucrum a little below the trochanter major, trephining over one of the cloaca?, and discovering a sequestrum consisting of the shaft of the femur. Fabry was pensioned, and remained at the Soldiers Home for the next three years, suffering acutely, at times, from suppuration in the stump, and again enjoying intervals of comparative comfort, The general health did not give way materially under the protracted suppuration. The patient was exempt from albuminuria, and the viscera generally were in a normal condition. The nervous system seemed shattered, a result ascribed to the inordinate doses of narcotics which the patient consumed. On May 15, 1870, Assistant Surgeon George A. Otis, U. S. A., exarticulated at the hip and removed the stump. The single anterior flap procedure was used, only the flap was cut from without inward, because the great masses of foliaceous callus enveloping the upper third of the femur precluded transfixion. The accompanying wood-cut (FlG. Ill) will indicate the extent of these osseous formations. Fabry had a rather rapid convalescence, being about on crutches in twenty-one days, and soon afterwards able to ride about the grounds at the Soldiers Home. A photograph of the patient, made at the Army Medical Museum a year after the operation, is copied in the Avood-cut, FlG 112. On May 15, 1878, eight years after the operation, Fabry has had no trouble with his stump. He has never been willing to attempt the expedient of an artificial limb. 1 The next case is exceptional inasmuch as the amputation and reamputation followed a bayonet stab in the knee instead of shot injury. CASE 331. Private Lewis Francis, Co. I, 14th New York Militia, aged 42 years, was wounded July 21, 18G1, at the first battle of Bull Run, by a bayonet thrust, which opened the right knee joint. He received not less than fourteen other stabs in different parts of the body, none of them implicating the great cavities. He was taken prisoner, and conveyed to Richmond and placed in hospital. One of his wounds involved the left testis, which was removed on July 24th. On October 28, 1861, his right thigh was amputated at the middle, on account of disease of the knee with abscesses in the thigh. The double-flap method was employed. The stump became inflamed and the femur protruded. An inch of the bone was resected and the flaps were again brought together. In the spring of 1882 the- patient was exchanged and sent to Fort Monroe. Thence he was transferred to a Washington hospital, and thence, in March, 1862, to his home in Brooklyn. There was necrosis of the femur, and in May, 1862, its extremity was again resected by a civil surgeon. On October 28, 1833, Francis was admitted to the Ladies Home Hospital, New York. Necrosis had apparently involved the remain ing portion of the femur. On May 21, 1864, Surgeon A. B. Mott, U. S. V., laid open the flaps and exarticulated the bone. The patient recovered rapidly and had a sound stump. He was discharged August 12, 1864. On October 1, 1865, a photograph, from which the accompanying wood-cut (FlG. 113) was taken, was forwarded by Surgeon A. B. Mott to the Army Medical Museum. Dr. Mott reported that the pathological specimen of the exarticulated femur was stolen from his hospital. For some months after his discharge Francis enjoyed good health ; but then the cicatrix became unhealthy, pus was discharged through several sinuses, and there was bleeding from the slightest irritation. In March, 1837, a messenger was sent to his residence, 54 Hamilton Street, Brooklyn, and found him in very poor health. He had been unable to leave the house since November, 1866. On April 12, 1887, he was visited by Dr. E. D. Hudson, who reported him as then confined to his bed. There was a large ulcer at the upper outer angle of the cicatrix, which communicated with extensive sinuses; there was a fistula-in-ano also. The pus from the different fistulous orifices was thin, oily, and ichorous. There could be little doubt that there was disease of some portion of the innomi- natum. The patient was much emaciated, and had a cough with muco-purulent expectoration. His pulse, however, was not frequent, and he had a good appetite. In May, 1887, it was reported that his general condition had somewhat improved. In March, 1838, Pension Examiner J. C. Burdick, of Brooklyn, reported that this pensioner was permanently helpless and required the constant aid of a nurse." On May 30, 1874 (Decoration Day), and the day prior, at a preparatory parade of the veterans of his regiment, he was particularly active. The day after this unusual exercise, May 31, 1874, he died suddenly while at table. 2 This statement from the Brooklyn Union, June 1, 1874, is corroborated by the records of the Pension Bureau. FlG 113. Cicatrix sixteen months after a reampu tation at the right hip, succeeding- amputation for a bayonet stab through the knee. SECT. II.J REAMPUTATION AT THE HIP JOINT. 155 FIG. 114. Shot perforation of right tibia. Spec. 3709. CASE 332. Private Eben E. Smith, Co. A, llth Maine, aired 19 years, was wounded August 16, 18C4, at Deep Bottom. A musket ball passed through the right leg from within outward, fiacturing the head of the tibia. The wounded man was conveyed to a field hospital of the Tenth Corps, where it was determined that an attempt should be made to preserve the limb. Constant cold applications were made to the wounds. After a few days, the patient was sent to the North on a hospital steamer, and, on August 22d, he was received at the hospital at Beverly, New Jersey. On admission he suffered but little pain, though the knee joint was considerably swollen. On September 14th secondary haemorrhage occurred, and it was deemed advisable to remove the limb. The amputation was performed by Acting Assistant Surgeon J. C. Morton, at the lower third of the thigh, by the circular method, the patient being anaesthetised by chloroform. On examining the seat of the injury, it was found that a fissure ran through the external tuberosity of the tibia and the external articular surface, and that the bone was carious in the vicinity of the fracture. The specimen was forwarded to the Army Medical Museum by Assistant Surgeon C. Wagner, U. S. A., and is represented in the wood-cut (FlG. 114). The case progressed favorably until October 17th, when there was haemorrhage from the stump to the amount of twelve ounces. The stump was in a sloughing condition, and it was therefore determined to tie the femoral artery in Scarpa s space, which was done by Dr. Morton. The ligature came away on November 1st. The wound remained in an unhealthy condition, with a copious fetid suppu ration, and the necrosed extremity of the femur protruded from the upper angle of the wound. On November 5th, the soft parts were retracted, and four inches of the shaft of the femur were resected by the chain saw. After this the stump became much swollen, frequent abscesses formed, and it was finally decided that necrosis involved the femur quite up to the trochanters. This conclusion was verified by an exploratory incision made on Janu ary 19, 1865, when it was determined to proceed at once to amputate at the coxo-femoral articulation. The operation was performed by Acting Assistant Surgeon John H. Packard. The patient being already under the influence of chloroform, the fem oral artery was exposed and tied just below Pou- part s ligament. Anterior and posterior flaps were then formed and disarticulation effected. Some difficulty was experienced in securing an artery supposed to be the comes nervi ischiadici; but the quantity of blood lost in the operation was not con sidered large. There was extreme depression after the operation, and the patient was kept on the am putating table for two or three days, lest an attempt at removal should prove fatal. Large quantities of stimulants and concentrated food were adminis tered, and artificial warmth was applied to the surface of the body. Eight days after the operation haemorrhage to the extent of six ounces occurred, and a ligature was placed upon the external iliac artery by Dr. J. C. Morton. The ligature separated on February 17th. On the 19th. there was pro fuse bleeding from the point of ligation, which was controlled by pressure. Direct compression was maintained for fourteen days. After this the patient rapidly improved, and by the end of March he was quite well. On April 12th, Smith was transferred to the White Hall Hospital, near Bristol, Pennsylvania. On May 27, 18b 5, Assistant Surgeon W. H. Forward, U. S. A., reported his discharge from service with a sound stump and robust health. After his discharge Smith went to his home at Eastbrook. Maine, and was granted a pension. On February 27, 1867, he wrote to this office that his general health was excellent, but that the cicatrix of his stump was painful. In May, 1867, he was admitted to the eastern branch of the U. S. Military Asylum for disabled volunteer soldiers, at Togus Springs, near Augusta, Maine. On May 12th, the surgeon of the asylum, Dr. B. B. Breed, wrote that he "was apparently in perfect health, and complained only of conges tion of the stump after standing for some time." In July, 1887, Dr. Breed forwarded photographic prints representing the condition of the cicatrix two and a half years after the amputation at the hip, from one of which the adjoining photograph (FlG. 115), is copied. An attempt was proposed to adapt an artificial limb to the stump. The exarticulated portion of the femur was forwarded to the Army Medical Museum by Assistant Surgeon C. Wagner, U. S. A. It is represented in the adjacent wood-cut (FlG. 116), and shows a fragile involucrum and sequestrum about to separate extending quite to the epiphysis. Pension Exam ining Surgeon P. H. Harding, of Ellsworth, Maine, reports, in 1837, that the pensioner s health has become poor, and that he is unable to do any manual labor. On December 4, 1874, Dr. G. Parcher, of Ellsworth, certifies "that, in consequence of the extensive and tender cicatrix, the pensioner cannot sit to work at any trade or to write, and as he cannot wear an artificial limb, he can perform no labor in an erect position." June 4, 1878, this pensioner alleged no further disability. 1 1 WAGXEU (C.), Report of interesting Surgical Cases, p. 15. MOUTON (T. G.), Amp. Hip Joint in Philadelphia, etc., in Am. Jour. Med. Sci., 1866, Vol. LII, p. 32. PACKARD (J. H.), On Amputation at the Hip Joint, in New York Jour. Med., 1865, Vol. II, p. 161. Circular No. 6, S. G. O., 1865, pp. 49, 50. Circular No. 7, S. G. 0., 1867, pp. 49, 65. FIG. 115. Appearance <;f cicatrix two and a half years after coxo-femoral exarticulation. [From a photograph.] FIG. 116. The upper half of right femur, disarticulated five months after amputation in lower third. Spec. 81. 156 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. Fir,. 117.-Shot com minution of lower half of left femur. Spec. 3734, A. M. M. J CASE 333. Sergeant E. D. Ulmer, Co. G, 15th New Jersey, aged 21 years, was wounded at Cedar Creek, October 19, 18(54, by a musket ball, which entered the inner face of the left thigh, fractured the bone, and lodged under the skin on the outer side of the limb. The femur was badly comminuted, fissures extending into the knee joint and upward for seven inches (FlG. 117). The ball was extracted at a field hospital of the Sixth Corps, and it was determined to attempt to save the limb. The wounded man was conveyed to Baltimore, to Jarvis Hospital, on October 2411). Intense arthritis supervened, with deep dissecting abscesses in the thigh. On November 14th haemorrhage to the extent of twenty-five ounces took place from both orifices, which were in a sloughing condition. The patient was put under ether, and amputation at the middle of the thigh was performed by Acting Assistant Surgeon Edmund G. Waters. The patient rallied promptly after the operation, and in a few weeks was able to get about on crutches. Yet the stump continued painful, and the extremity of the femur was found to be necrosed. In March, 1865, it was found that a cylindrical sequestrum was loose. This was removed, on March 8th, by Acting Assistant Surgeon B. B. Miles, with forceps (FlG. 118). On May 29, 1865, he was discharged. On the following day he started for Philadelphia, and, unfortunately, on the journey he fell with violence upon the stump. After this there was increased suppuration, with deep-seated pain in the stump. On the 22d of January, 1836, fifteen months after the original injury, while dressing the part as usual, a haemorrhage occurred from one of the fistulous openings at the end of the stump, amounting, according to his statement, to at least a pint. On account of this haemorrhage, he was admitted into the Pennsylvania Hospital. The history of the case and the appearances of the stump clearly indicated the existence of osteo myelitis, with necrosis of the neck, and probably nlceration of the head of the bone. The risk of recurrence of dangerous haemorrhage, and the extensive disease of the femur, obviously demanded operative treatment. On February 17, 1835, in the hospital amphitheater, the patient being etherised, an exploratory operation was made by Dr. Thomas G. Morton, the attending surgeon, and amputation was decided upon by him in consultation with Drs. W. Hunt and D. H. Agnew. The abdominal tourniquet, used the first time in this country by Professor Joseph Pancoast, June, 1860, was applied, and antero-posterior integumentary flaps were dissected up; the femoral artery was then tied, the muscles cut circularly, and the head of the bone was disarticulated. The aorta was so completely controlled by the abdominal tourniquet that no arterial jet was observed during the operation. About six teen ligatures were applied. The flaps were approximated with adhesive plaster, no sutures being deemed necessary. The dressings consisted of lint soaked in pure laudanum. The patient reacted well ; under vigorous stimulating treat ment and the local application of permanganate of potash he rapidly recovered. He left the hospital March 27, 1866, for his home in Philadelphia. The exarticulated portion of the femur presented a characteristic example of necrosis following osteomyelitis. A long loose sequestrum was found en cased in a new deposit of porous bone, and was not limited to the diaphysis, but extended quite into the neck, and then projected through the ulcerated capsular ligament. The head of the femur was ulcerated. The acetabu- lum was healthy. On May 10, 1866, the patient was able to get about on crutches. On the 20th, he left for New Jersey to fill a situation as tele graph operator. On July 24, 1866, he sent a letter to this office from Milford, New Jersey, announcing that his health was excellent, and a FlG. 120. Kxarticnlated few weeks subsequently he corrob- necrosed upper portion of . . . femur. [From a photograph orated this statement by transmit- by WILLAUD.] On FIG. ll!i. Cicatrix five months after reamputation at the left hip by Dr. T. G. MOHTO.V. I From a photograph.] ting his photograph (FlG. 119). October 27, 1868, he was supplied with an artificial limb by Clement, of Philadelphia. On June 28, 1867, Mr. Ulmer wrote to this office that he had never had a day s illness since the hip joint amputation was performed, and had never been in better health than then. He was stouter than ever before, weighing one hundred and seventy-five pounds, or twenty-five more than his average weight when he had both lower extremities. His stump was firm and solid and gave him no pain or inconvenience. He considered his artificial limb an excellent one, but found it inconvenient at his work, which required him to sit all day on a high stool. In a letter addressed to the Surgeon General s Office from the publishing house, 1630 Wellington Street, Philadel phia, October 15, 1878, Mr. Ulmer reported his health as most excellent, his weight at 173 pounds, or 25 pounds more than before exarticulation. He had an artificial limb from Clement, but had to abandon it. 1 MORTON (T. G.), loc. cit., Vol. LII, p. 26. UDELL (J. A.), On Secondary Traumatic Lesion of Bone, etc., in U. S. San. Com. Memoirs, 1870, Surg. Vol. I, p. 440. Circular No. 7, S. G. O., 18G7, pp. 51, 05. SECT. II.] REAMPUTATIONS AT THE HIP JOINT. 157 CASE 334. Private E. A. Viclc, Co. E, 43d North Carolina, aged 37 years, received a shot wound of the knee joint, at Cedar Creek, October 19, 1864, and underwent primary amputation at the lower third of the right thigh. On December 19th, he was sent to the hospital at Staunton. On January 1, 1835, the stump had almost cicatrized, but there were apertures through which pus issued. On February 15, 1865, an exploration with a silver probe revealed bone denuded of periosteum and roughened. Another aperture lyd to a somewhat superficial fistulous track of six or eight inches. It was determined to open the face of the stump, with a view to the removal of the diseased bone. The operation was performed on March 11, 1865, by the surgeon in charge of the hospital. Dr. A. M. Fauntleroy, assisted by Drs. T. W. Glocker and R. K. Carter. Chloroform was administered. A transverse incision was then made over the face of the stump. At the exposed extremity of the femur was a redundant mass of new bone, which was sawn off. It was then found that the carious shaft of the bone was encircled by a soft porous osseous deposit. About six inches of this formation was stript off by the gouge, yet the limits of morbid action had not been reached. An incision on the outer side of the thigh, between the vastus externus and biceps, was extended upward to a point between the great tro- chanter and the anterior iliac spine, and revealed the fact that the entire femur was diseased. It was now decided to disartic ulate at the hip joint. The femoral artery was compressed upon the pubic bone and anterior and posterior flaps were formed, the arteries being secured as they were cut. The loss of blood was trifling. The flaps were brought together by silver sutures, and the stump was dressed with dry lint. As soon as consciousness was restored the patient was freely stimulated, and warmth was applied to the surface of the body; the patient rallied in a few hours. At bed-time the pulse beat 120. On the following morn ing the patient was doing well. Pulse still the same in quick ness and frequency. On March 13th, his condition was satisfac- tory; his appetite was remarkably good ; he ate soft-boiled eggs and drank largely of rich milk. Suppuration having commenced, cold water was directed to be constantly applied to the stump to lessen the secretion of pus. He was ordered twenty drops of the tincture of the sesquichloride of iron thrice daily, and ten grains of Dover s powder at bed time. Suppuration amounted to half a pint during the day. On March 20, 1865, he was still doing well. Suppuration was diminished in quantity and was laudable. JLEUOY.J . . . support the flaps and maintain them in apposition. Ihe patient s bowels had been regular since the operation. His tongue had at no time been furred. The stump was doing well. The discharge had abated to three or four ounces. March 28th, the progress of the patient was highly favorable. March 29th, the patient s condition was comfortable and favorable; his appetite continued good. The stump along the lower surface seemed to have united firmly; on the side, granulations were healthy; the pus discharged was laudable. On April 24th the face of the stump had entirely healed. There was still a granulating sore at the outer angle. On July 18, 1865, the patient started for his home, near Tarborough, in Edgecomb, North Carolina. He was in excellent health, and walked about on crutches with facility. A year subsequently he was in Lyuchburg, Virginia. Since that date no intelligence has been- received from him, and it is not known whether he still survives. 1 Dr. A. M. Fauntleroy, the operator, courteously transmitted to the Surgeon General s Office a photograph of the diseased exarticulated femur, which is copied in the wood-cut (FiG. 121), and the photograph of the patient and of his stump sixteen months after the operation, July, 1866, which is represented in the wood-cut, FiG. 122. CASE 335. Henry Campbell, aged 23 years, received, in March, 1863, at New Orleans, a pistol shot in the left knee. Primary amputation at the junction of the middle and lower thirds of the thigh was performed by Acting Assistant Surgeon Avery. Osteomyelitis supervened and resulted in necrosis. After a few months the patient was removed to his home in Con necticut. In October, 1864, eighteen months subsequent to the injury, he was visited by Dr. Bauer, of New York, who laid open the cicatrix, crowded with fistulous openings, and removed a cylindrical sequestrum five inches in length. For a few months after the removal of this sequestrum the health of the patient improved, and hope was entertained of his recovery without further operative interference; but persistent pain and constitutional disturbance then recurred with augmented intensity. The lower part of the stump was riddled with sinuses and the tissues were much indurated. The probe detected dead bone, or morbid bone formation, in every direction. In October, 1856, the medical attendants resolved that an operation should be performed for the radical removal of the diseased bone. It was hoped that it would be only necessary to remove a portion of the shaft of the femur. On October 22d, the patient was placed under the influence of chloroform, and Dr. James B. Whitcomb, assisted by Dr. Charles Bliss, of Willimantic, and others, proceeded with the operation. An exploratory incision was made on the outside of the thigh, extending quite up to the trochanter. On exposing the new osseous formation at the end of the stump it was found to be more than twice the normal diameter of the shaft of the femur, rough, porous, and fragile. The immensely thickened periosteum was studded with plates and spines of new bone, and in many cases there were foliaceous masses of callus unconnected with the shaft. Toward the upper extremity of the femur the periosteum appeared less diseased, 1 FAUNTI.KKOY (A. M.), Hip Joint Amputations, in Richmond Medical Journal, 18C6, Vol. I, p. 7. EVE (P. F.), Contribution to the Hip Joint operations performed, etc., in Trans. Am. Med. Ass n, 1867, Vol. XVIII, p. 254. Circular No. 7, S. G. O., 1867, pp. 50, 65. LON1XG (A.), loc. tit., p. 10a CASK 368. FIG. 122. Cicatrix sixteen months after reamputatiou futures were removed, and adhesive strips used to at the right hip. [From a photograph.) 158 INJURIES OF THE LOWER EXTREMITIES. ICHAP. x. but the bone was found to be softened and disorganized quite up to the great trochanter. It was therefore decided to amputate at the hip joint. Ether was administered. Pressure with the thumb on the femoral artery served to control the haemorrhage. A large antero-internal flap was formed and disarticulation effected. There was very little loss of blood, but the patient was greatly prostrated by the shock of the operation, which, from the beginning of the exploration to the completion of the ampu tation, lasted fifty minutes. The free administration of ammonia and brandy brought about reaction; but it was temporary, and the case terminated fatally, five hours after the operation, October 22, I860. 1 CASE 336. Private Lewis Larry, Co. A, 1st New Orleans Regiment, aged 23 years, was shot through the left knee by a sentry, July 18, 1864, while attempting to avoid arrest. He was carried to the University Hospital. It was found that the condyles of the femur were badly comminuted. Synovial fluid was dribbling from the wound, with little haemorrhage. Amputation at mid-thigh was promptly performed, under chloroform, by double flaps. The patient did well for about three weeks, when he was attacked with persistent diarrhoea. Erysipelas now attacked the stump. Sloughing phagedaena of the flaps ensued, and purulent sinuses extended upward along the femur, the necrosed extremity of which protruded from the stump. Amputation at the hip joint was performed by Acting Assistant Surgeon F. Hassenburg, on September 21, 1864. The patient was under the influence of chloroform. The artery was controlled at the groin, an anterior flap was formed by transfixion, the capsule divided and disarticulation effected, and a posterior flap cut from within outward. The haemorrhage was inconsiderable, and the patient promptly rallied from the shock of the operation. For a few days his appetite and general health improved; then the wound assumed an unhealthy aspect, and finally sloughed. Symptoms of pyaemic infection set in, and death ensued on September 30, 1864. On dissecting the removed portion of the thigh it was found riddled with abscesses. The periosteum was enormously thickened and contained flaky ossific deposits. The shaft of the femur was necrosed up to the trochanters, the dead bone being included in a redundant friable involucrum. The preparation was forwarded to the Army Medical Museum by Surgeon Samuel Kneeland, U. S. V. 2 FIG. 123. Diseased CASE 337. Charles H. Hawkins, a second lieutenant in Co. C, 4th New York Cavalry, aged 23 ifcase of^oxo- femoral y ears > was wounded in a reconnoissance near Strasburg, Virginia, on the night of June 1, 1882. A conoidal disarticulation. Spec, ball, from a Colt s cavalry pistol, entered the posterior surface of the right thigh, and, passing downward and forward, fractured the femur at the lower part of the middle third, and lodged under the skin about five inches above the knee. The wounded man layout all night in the rain, and in the sun next day until three in the afternoon, when he was brought into camp and had tho ball removed by his regimental surgeon. He was then conveyed in an ambulance to a hospital in Strasburg, where his limb was dressed with a straight splint, moderate extension and counter-extension being maintained. After ten days he was carried on a stretcher to a private house, where he remained seventeen days. Two frag ments of bone were extracted during this period. He was next transferred to a tent hospital, five miles distant, near Middletown, and after a sojourn of nine days was again transferred to a hospital at Winchester. The splints were removed and the limb was bandaged. On July 19th he was conveyed to Baltimore, and admitted to the Camden Street Hospital on July 20th. His con dition was very unpromising; there was much irritative fever, a copious suppuration, and partial union of the fracture, with three inches shortening and much angular deformity. No ap^iratus was applied; but the limb was maintained in an easy position by pillows, and attention was mainly directed to improving the condition by wholesome diet. Two months subse quently the patient had gained ground, and an operation to remove the diseased bone and to break up the faulty union of the fragments was determined on. On October 1st, the posterior orifice was enlarged, a number of denuded fragments of bone were removed by forceps, and the deformed callus was chiseled and gouged away. Temporary improvement ensued. The limb was put in a proper position and the wound was daily-syringed out by iodine injections. After a time, however, it became manifest that the broken extremities of the femur were still diseased. On April 5, 1863, the patient was transferred to the Ladies Home Hospital, New York City, where he was received on April 8th, greatly reduced in strength. The wounds discharged profusely, and he complained of much pain. On April 29th, Surgeon A. B. Mott, U. S. V., amputated the limb at mid-thigh. Evidence that the femur was diseased above the point at which it was sawn soon became apparent, and, after a protracted effort to induce healthy action, the flaps were freely laid open and the femur was resected, four inches of the shaft being removed. After this the patient was put upon a full diet, with an allowance of brandy and of porter daily. The stump still failed to assume a healthy action, but became much enlarged, undergoing apparently a fatty degeneration. On April 4, 1864, Lieutenant Hawkins was mustered out of the military service, and was transferred to St. Luke s civil hospital, and came under the care of Dr. Gurdon Buck. The patient was anaemic, his appetite capricious; he was compelled to keep his bed continually on account of the pain he suffered when the stump was in a dependent position. For over five months every means were used to bring the patient up to a condition in which an operation for the removal of the diseased femur stump might be safely undertaken. On September 21st, he was placed under the influence of sulphuric ether, and Dr. Buck proceeded to disarticulate. It was found necessary to bisect the stump, uncovering the neck of the bone on the inner as well as the outer aspect, by an incision which commenced above the great trochauter and ran around the extremity of the bone to near the tuberosity of the ischium. During the opera tion the administration of ether was suspended on account of the extreme feebleness of the circulation, and brandy was ft-eely given, and warm applications were made to the trunk. The loss of blood was not great, but every possible means had to be called into requisition to bring about a partial reaction after the operation, so great was the prostration and so feeble the recuperative powers. After twenty-four hours of great apparent suffering, the patient died in a syncope, September 22, 1864. The portion of the femur removed consisted of the head, neck, and trochanters, with four inches of the shaft. The head and neck were much softened and the shaft was atrophied and fatty. 3 1 Circular No. 7, S. G. O., 1867, pp. 52, 65. 2 Circular No. 6, S. G. O., 1866, p. 50. Circular No. 7, S. G. O., 1867, pp. 48, 65. 3 \VATEKS (E. G.), Shot Fractures of the thigh, in Am. JUed. Times, 1863, Vol. VI, p. 185. HAMILTON (F. H.), Amp. in Shot Fractures of the femur, in Am. Aled. Timtt, 1864, Vol. VIII, p. 1. Circular No. (i, S. G. O., 1865, p. 50. Circular No. 7, S. G. O., 1867, pp. 47, 65. SECT. II.] EEAMPUTATIONS AT THE HIP JOINT. TABLE XVIII. Summary of Nine Cases of Reamputation at the Hip Joint. 159 NO. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATUUE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Cotter, W., Pt., E, 9th New Hampshire, age 27. July 30, 1864. Musket ball fract. lower third right femur; prim. amp. thigh, mid. third. Nov. 29, 64, seq. Oct. 15, 1871. Reamp. thro extend g incision of later operation upward suf ficiently to allow ready exar- April, 1872, w d cicatriz d firmly. 1873, abscesses unhealed ; con stant irritation. Died Jan. 21, 74. rem.; osteomyelitis. June, 66, ticulation of head, neck, and Specs. 252, 4954, 5946. Photos. exc. four inches end of stump. trochanteric portion of femur, 61, ISO, 324. OTJS (G. A.), in Subsequent operation rem d by Dr. N. S. Lincoln, Wash Boston lied, and Surg. Jour., dead bone. ington, D. C. Feb. 7. 78. Vol. XCVIII. p. 166, and Circular 3, S. G. O., Wash ington, 1871, p. 283. o Fabry, J., Pt., Battery K, 4th Aug. 16, Shrapnel shot wound left knee Mav 15, Long semi-lunar flap; incision Reaction prompt. Mayl6th,w nd Artillery, age 38. 1864. joint ; prim. amp. lower third 1870. from point on tuberosity of united nearly f full extent by thigh. Aug. 28, ball and pc. ischium to point midway be first intention. June 5th, about of fuse ext.; necro.; abscesses tween ant. sup. spin, process on crutches. July 13th, complete opened. 1866, discharge pro of ilium and troch. major, by ly cicatrized. Specs. 5684, 5685, fuse ; exfol. fistulous open gs. Ass t Surg. G.A. Otis, U.S.A. 5687, 5(599, 5702. Photos. 274, Oct. i!7th, dead bone removed. 275, 276. 1867 to 1870, abscesses cont d to form and dead bone to exfo. 3 Francis, L., Pt., 1, 14th New- Jul\-21, Bayonet thrust opening right Mav 21, Antero-posterior flap reampu- Rapid recovery; stump sound. York State Militia, age 42. 1861. knee joint (14 other bayonet 1864. tation at hip joint, bv Surg. 1867, confined to bed ; copiously stabs); gangrene; extensive A. B. Mott, U. S. V. (Bone discharging ulcer, fistula in ano. abscess on thigh. Oct. 28th, found extensively diseased 1870. about on crutches, stump amp. mid. third thigh. Nov. -, close up to head.) apparentlv healed. Died, May femur protruded; exsected. 30, 1874, suddenly. May, 1862, necrosed end of femur exsected. 4 Smith, E. E., Pt., A, llth Aug. Ifi, Musket ball fract. head of right Jan. 19, Anterior and posterior flap Extreme depression. Jan. 27, 65, Maine, age 19. 1864. tibia. Sept. 14th, haem.; amp. 1865. amputation at hip joint, by ha?m.; lig. external iliac artery. low. third thigh. Sept. 17th, A. A. Surg. J. H. Packard. Feb. 19th, hsem.; compression. haem.; lig. fern. Nov. 5th, ne (Femur found necrosed up to Disch d May 27, 1865, sound crosis ; four ins. end of femur trochanters.) stump. Specs. 81, 3709. Photos. resected ; frequent abscesses. 29, 174, 203. 5 Ulmer, E. D., Serg t, G, Oct. 19, Conoidal ball com nuted fract. Feb. 17, Anterior and posterior flap Rapid recovery. Left hospital 15th New Jersey, age 21. 1864. left femur, fissures extending 1866. amputation at hip joint, by March 27, 1866. 1877, continues into kneej t and upw d seven Dr. T. G. Morton, Penn. Hos in good health ; stump in healthy inches; ball ext. Nov. 14th, pital. (Bone diseased as high condition. Specs. 107, 3734. haem.; amp. mid. third. Mar., as neck.) 65, seq. removed. Jan., 66, haem. from endofstump; osteo myelitis. 6 Vick, R. A., Pt., E, 43d N. Oct. 19, Shot wound right knee joint; Mar. 11, Anterior and posterior flap April 24, 1865, stump entirely Carolina, age 37. 1864. prim. amp. lower third thigh. 1865. amputation, by Surg. A. M. healed. Last heard from July, Jan. ] , 65, almost cicatrized. Fauntlerov, C. S. A. .assisted 1866, in excellent health. Feb. 15th. increased disch rge by Drs. T. W. Glocker and of pus. Exploration revealed R. K. Carter. entire femur diseased. 7 Campbell, H., Sutler s Cl k, Mar. , Pistol shot in left knee: prim. Oct. 22, Large anterior internal flap, by Died October 22, 1866, five hours age 23. 1863. amp. junct. low. thirds thigh ; 1866. Dr. J. B. Whitcomb. (New after operation. osteomyelitis ; necrosis. Oct., osseous formation at end of 1864, seq. removed; stump stump was twice the diameter riddled with sinuses. of shaft of femur : bone soft and diseased up to troch.) 8 Hawkins, C. H., Lieut., C, June 1, Conoidal pistol ball fract. mid. Sept. 21, Tissues of stump indurated and Only partial reaction. Died Sep 4th New York Cavalry, ]862. third right femur; ballextr d. 1864. inelastic; stump bisected by tember 22, 1864, in a syncope. age 23. July 20th, bone partially uni an incision commencing above after twenty-four hours of great ted. Oct. 1st, fragments and great troch., running around apparent suffering. calloused bone removed. Apr. end of bone to near tuberosity 29, 63, amp. mid. third ; exc. of ischium : antero-posterior four inches of femur. flap, by Dr. G. Buck. 9 Larry, I,., Pt., A, 1st New July 17, Shot wound left knee comminu Sept. 21, Anterior flap formed by trans Rallied promptly; wound became Orleans, age 23. 1864. ting condyles of femur; prim. 1864. fixion, posterior flap cut from unhealthy and sloughed. Died amp. mid. third thigh ; erysip. within outward, by A. A. Sept. 30, 1864 ; pyaemia. The attack d stump,flapsslough d, Surg. F. Hassenburg. shaft of femur was necrosed up necrosed end bone protruded. to trochanters. Spec. 3738. These nine cases of reamputation at the hip comprise only three deaths, giving the low mortality rate of 33.3 per cent. In three instances the exarticulation had been preceded by amputation in the lower third of the thigh, and, in six cases, the disarticulation was subsequent to amputation in the middle third of the thigh. In two of the cases the prior amputation was done on account of shot fracture of the shaft of the femur, in six for shot fractures involving the knee joint, and, in one, for a bayonet stab of the knee. In six instances extraction of sequestra or resection of the necrosed extremity of the femur had been practised in the interval between the amputation in the continuity and the disarticula tion. In the three fatal cases the prior amputation had been primary in two instances; secondary in the third case. One patient survived the shock of the operation only a few hours; another died in a syncope after twenty-four hours of great apparent suffering, and 160 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the third succumbed to pyaemia eight days after the exarticulation. Of the six patients who survived the operation, three, J. Fabry (CASE 330), E. E. Smith (CASE 332), and E. D. Ulmer (CASE 333), were living in August. 1879. Of the Confederate soldier, Vick (CASE 334), no information has been received since 1866, and it is not known whether he still lives. Two survivors of the operation have since died: Cotter (CASE 329), in 1874, two years and three months after the operation; Francis (CASE 331), in 1874, over ten years after the exarticulation. The nine cases cited in TABLE XVIII, and the operations performed by G. J. Guthrie, 1 in 1812, and by T. G. Morton, 8 in 1878, are, it seems, the only recorded examples of reamputations at the hip in military surgery. From the records of the surgery of civil life twenty-five cases may be collected, making a total of thirty-six 3 exarticulations at the hip after previous amputations in the thigh, with fourteen deaths, a mortality of 38.8 per cent. Of the eleven cases in military surgery, four, or 36.3 per cent., proved fatal, while, of the twenty-five operations in civil practice, ten, or 40.0 per cent., had a fatal termination. Summing up the sixty-six cases of amputation at the hip detailed in the preceding pages, it will be seen that twenty-five were primary, twenty-three intermediary, nine secondary, and nine were reamputations. In each of the twenty-five primary cases the amputation was performed within twenty hours of the infliction of the injury, the average interval between -the reception of the wound and the operation being about four hours. Sixteen died within twelve hours, one survived thirty-six hours, two about forty-eight hours, and one lingered eight days; in two instances the period between the operation and death could not be ascertained; the average period of death being about twenty hours. Of the three survivors after primary amputation at the hip, one was in comfortable health over fifteen years after the operation; the other two patients were heard from two and six months, respectively, after the date of the operation, but the hope expressed in Circular No. 7, at page 23, that the subsequent histories of these men might be traced has not been attained; and there might be some question regarding the justness of citing these cases as well authenticated instances of recovery. In TABLE XIV, on page 127, ante, these cases have been classed among the recoveries, thus arriving at a fatality of 88.0 per cent. Should they be excluded, the fatality of the primary amputations at the hip during the war of the rebellion would be 95.6 per cent. The femoral vessels were torn in six of the primary amputations, to wit: Compton s case (273) of Robinson; Carnochan s case (280) of Gordon; Lay s case (284) of a private of the 3d Missouri, in which the femoral artery was ligated prior to amputation; Brock s case (286) of Waters, in which the opposite leg was also amputated at the point of election; Davis s case (287) of Wayland, and Lanning s case (289) of Brookins. The twenty-three intermediary exarticulations at the hip had fatal results. The inter val between the reception of the injury and the date of the operation varied from twenty- four hours to thirty days, the mean length being a little over nine days. Only two survived 1 See CASE 12 in Note 1 on page 128, ante. * See CASE 184 in Note on page 130. 3 In note 1 on page 152, ante, reference was made to 32 instances of exarticulation at the hip after previous amputation in the continuity of the thigh. The prior operations had been performed in 9 instances for shot injury, in 2 for punctured and incised wounds, in 5 for bad fractures of the femur, in 8 for ostitis or ill denned lesions, and in 8 for malignant growths. Particulars of 4 additional instances have since been ascertained, viz : three exartic ulations at the hip after amputations in the thigh for ill defined lesions: E. S. O GRADY, in 1874 (Dublin Journal of Med. Sciences, 1876, Vol. LXI, p. 78); T. G. MORTOX, in 1877 (Cincinnati Lancet and Clinic, 1879, Vol. II, N. S., p. 9, and letter of Dr. T. G. MORTON to the editor, dated February 19, 1879); D. BECK, in 1878 (Archiv fur Klin. Chir., Berlin, 1879, B. XXITI, p. 654); and a reamputation at the hip by T. G. MORTON, in 1878 : Boasso Dominico (notDominico Ludovess, as indicated in CASE 184 in note on p. 130, ante), aged 24; wounded in the right thigh, by a cannon ball, at Sedan, ip 1870; amputation in middle third; reamputation at hip, December 14, 1878. Recovery (Cincinnati Lancet and Clinic. 1879, Vol. II, N. S., p. 9, and Dr. T. G. MOKTON 8 letters to the editor, dated February 19, March 18, and May 28, 1879). Of the 36 reamputations at the hip, 14 had a fatal termination, a mortality of 38.8 per cent. SECT, n.1 AMPUTATIONS AT THE HIP JOINT. 161 the amputation eight days; nine died within the first twenty-four hours, four on the second day, one on the third, three on the fourth, two on the sixth, and in two, the date of death could not be ascertained; the average duration of life after the operation in the inter mediary series was only about thirty-five hours. In four instances gangrene, and, in two, pyaBmia, supervened. In one case (Surgeon P. Pineo g case of Private P. Johnson, CASE 306, p. 141, ante) it is stated that the femoral artery was divided by the missile, and in one (Surgeon E. Bentley s case of L. Carroll, CASE 298, p. 139, ante) the amputation had been preceded by a primary partial excision in the shaft of the femur. Of the nine secondary amputations at the hip, two resulted successfully. George W. Lemon (CASE 320, p. 145, ante) enjoyed good health in 1879, nearly fifteen years after the operation. In the case of the Confederate soldier W. W. Longmoor (CASE 321, p. 146, ante), the following additional information was received shortly after the case had been sent to press: CASE 321, p. 146 (continued) : Mr. Longmoor, who, at the present writing, is clerk of the court at Cynthiana, Kentucky, writes, under date of April 2, 1879 : " I have had two abscesses form in my stump, * * the first one was very severe indeed, and kept me confined to my bed for several weeks, and discharged copiously for about one week of that time. The next and last abscess was not near so severe, and did not confine me to my bed for more than about two weeks. The discharge was not near so great, and the pain accompanying the formation not near so severe. I have a constant pain in my stump ; an uneasy, restless sort of a pain that never ceases but is always with me at times much worse than others, and often taking the form of neuralgia, especially before or during damp or falling weather. I suffer a great deal from neuralgia acute, very acute, lasting generally four or five days; sometimes compelling me to leave my office, at which times I usually resort to heavy doses of quinine. I use morphine every day. I take about one-fourth of a grain three times a day have been doing this ever since I was wounded. During these times my stump becomes very sore, and hurts me when I walk. I have never been able to wear an artificial limb, in fact have never tried, knowing its utter impossibility, for I could not bear the weight of the limb much less the pressure on the stump." Of the seven fatal cases after secondary amputation at the hip, one patient died from phthisis and lithiasis, one from secondary haemorrhage and phlebitis, one from the giving away of the femoral artery at the point of ligation, one from surgical fever and erysipe- latous inflammation of the stump, and three from the shock of the operation. The shortest interval between the operation and the date of death was one hour, the longest one hun dred and nineteen days, the average duration of life being a little above twenty-two days. The average interval between the date of injury and the date of operation was about four hundred and twenty-nine days, the shortest interval being forty-three days, the longest two years, nine months and twenty-one days. The sixty-six exarticulations at the hip were practised in forty-five instances with seven recoveries on Union soldiers, in twenty instances with four recoveries on Confederate soldiers, and, in a fatal instance, on a citizen employs . In twenty-nine instances with six recoveries, the right limb was removed; in twenty-eight with five recoveries, the left; and, in nine, the side was not stated. Chloroform was the anaesthetic administered in thirty- eight of the sixty-six cases, ether in ten, chloroform and ether in three. In one instance (Dr. B. D. Lay s CASE 284, p. 135, ante), stimulants and morphia only were given, and in fourteen instances this point is not mentioned. Considering the ages of the patients we find that three operations, performed on patients under twenty, were fatal; that of thirteen operations performed on patients between the ages of twenty and twenty-four inclusive, three were successful ; of ten between the ages of twenty-five and twenty-nine inclusive, two had a successful issue; of seven between the ages of thirty and forty, four recovered; and of four above forty, two had a successful termination. In twenty-nine instances the age of the patient was not recorded. Fragments or splinters of bone were removed prior to the exarticulation at the hip SURG. Ill 21 162 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. joint in the cases of W. W. Longmoor (CASE 321, p. 146, ante) and of M. O Neil (CASE 327, p. 150, ante). The ball and detached fragments of bone were extracted in Bowman s case (CASE 322, p. 147, ante), and the ball, with some wadding, in the case of Antonio Mutieres (CASE 326, p. 150, ante). Of the different modes of amputating at the hip joint, the operation by the antero- posterior flap method was most commonly selected. It was used in twenty-nine of the sixty-six cases of exarticulation at the hip described in the preceding pages, and in five of the eleven cases of recovery, viz: in Dr. E. Bentley s case of Lemon (p. 145, ante); in Dr. A. B. Mott s case of Francis (p. 154, ante); in Dr. J. H. Packard s case of E. E. Smith (p. 155, ante); in Dr. T. Gr. Morton s case of Ulmer (p. 156, ante); and in Dr. A. M. Fauntleroy s case of VicJc (p. 157, ante). The single flap method was successfully employed in three instances: by Dr. Shippen in the primary case of Kelly (p. 131, ante), by Dr. J. T. Gilmore in the case of Williamson (p. 132, ante), and by Dr. G. A. Otis in the case of Fabry (p. 153, ante), and unsuccessfully in twelve cases. Drs. William M. Compton and Gr. C. Blackman adapted, with success, the circular method in the cases of Robinson (CASE 273, p. 132, ante) and Longmoor (CASE 321, p. 146, ante). Larrey s method of amputa ting at the hip by two lateral flaps was preferred in eight instances; the oval was employed only once, in Dr. J. M. Carnochan s case of Gordon (CASE 280, p. 134, ante). In Dr. N. 8. Lincoln s successful operation at the hip, in the case of Cotter (CASE 329, p. 152, ante), the disarticulation resembled an excision or enucleation rather than a reamputation. The mode of operation is not indicated in ten instances. Prothetic apparatus, that might in some measure compensate the survivors after hip joint amputation for the loss of the limb, and relieve them of the necessity of continually using crutches, have been devised by Charriere, Foullioy, 1 and others. In 1867, Dr. E. D. Hudson devised a lined and padded gutta-percha bonnet conforming to the entire ilio-lumbar parts, and some eight inches in length, firmly strapped to the pelvis by a broad chamois- lined canvas band. To this artificial stump an ordinary apparatus for thigh stumps could be fitted. This simple apparatus, which is fully described by Dr. E. D. Hudson in his pam phlet: Mechanical Surgery, New York, 1878, p. 29, was tried by Kelly and Lemon; but, although great hopes were entertained that it would answer the purpose for which ii was designed, it seems that this, as well as similar appliances, have now been discarded as use less, even by those survivors who, at the first, were favorably impressed with their utility. Mr. Ulmer, who wrote to this Office in June, 1867, that he considered his "artificial limb an excellent one," in a letter dated October 15, 1878, states that after several attempts to wear the artificial limb he had to abandon it, "as it gave intense pain; the weight of the body pressing the top of the limb too severely against the pelvic bone. Another objection is the absence of motive power in the stump to propel the limb. As this has to be given by a swinging motion of the body, the effort is too fatiguing." James E. Kelly, under date of July 30, 1870, writes: "The leg I got from Dr. Hudson is of no benefit to mo whatever, nor ever will be. I tried it sufficiently to know that I cannot wear it." Lemon advises this Office on July 31, 1870, that: "The artificial limb is not now nor ever has been of the least service to me." Longmoor has never tried an artificial limb as he "knew it would be useless." Fabry never attempted to wear one, and there is no record that 1 See GAUJOT (G.) et SriLLMAXN (E.), Arsenal de la Chirurgie contemporaine, Paris, 1872, T. II, p. 15!J, M. DEUOUT (Appareils destines aux ampules qui ont subi la disarticulation de la cuisse, in Bulletin General de Thfrapeutique Med. et Chir., Paris, 1862, T. 62, p. 283) relates that Cauzeret, a soldier of the Light Infantry, on whom BAUDEXS successfully performed intermediary amputation at the hip, in Africa, in 1836 (CASE 38, Note 1, p. 128, ante), wore the apparatus of Foullioy for 11 years, from March, 1837, to October, 1848. SECT. II.] AMPUTATIONS AT THE HIP JOINT. 163 FIG. 125. Anteriorview Cotter, Williamson, Robinson, Vick, or Francis essayed a trial. In the case of E. E. Smith the cicatrix remained too tender to allow the wearing of an artificial limb. While the preceding pages were in press, a report of an unsuccessful primary ampu tation 1 at the hip by Assistant Surgeon Edward B. Moseley, U. S. A., was received from Fort Robinson, Nebraska. This, with three additional cases given in the foot-note, 2 increases the total number of exarticulations at the hip to two hundred and fifty-four, 1 "Private Bernard Kelley, Co. E, 3d Cavalry, aged 39, while in the field in pursuit of Cheyenne Indians, on January 11, 1879, was struck by a carbine ball (said to have been an accidental shot from one of his own company), which entered at a point just over the centre of the sacrum, half an inch to the left of the median line, passed downward and outward through the gluteal muscles, and struck the left femur just between the two trochan- ters, fractured it, and escaped from the front of the thigh about two inches above its middle, and an inch to the outside of the median line. He was brought to the post hospital at Fort Kobinson the same day, and was found to be suffering from a high degree of shock ; he was pale, cold, and weak from haemorrhage, which had occurred at intervals since the receipt of the wound. He was given one grain of morphia, and hot water was placed to his feet, and small quantities of beef essence given at frequent intervals. During the night he reacted a little from shock, but complained greatly of pain in the wound and of weakness. The thigh was supported in a comfortable position by pillows, and wet compresses were kept over the wounds. About one p. m., a brisk haemorrhage commenced from the posterior wound, which, on examination, was found to be of such a serious nature as to require immediate interference to save the man s life. He was immediately placed under the influence of chloroform, and the posterior wound was freely enlarged, with the idea that the haemor rhage came from the sciatic artery. This was found not to be the case, however, the blood flowing from the deeper portion of the wound, and probably originating from the branches of the profunda femoris. This opening allowing of a free introduction of the finger, the wound was thoroughly explored, and the femur was found to be hopelessly comminuted. The bleeding still continuing, it was decided to amputate the limb at the hip joint, which was done at once by Assistant Surgeon E. B. Moseley, U. S. A., assisted by Acting Assistant Surgeon C. V. Petteys. The femoral artery was compressed against the brim of the pelvis by Dr. Petteys, and the limb was removed by trans fixion from without, joining the incision made previously to explore for the seat of haemorrhage to that forming the anterior flap, which was rather long, and forming the posterior flap from the muscles on the back of the thigh. About four ounces of blood were lost, as well as*could be judged, mostly from a general oozing from the surface of the flaps. The neck of the bone was seized by forceps and the head was removed from the acetabulum with some difficulty, owing to the short leverage obtained. The vessels were tied with silk ligatures and the flaps brought together with silver wire. minution of upper por- ^ ne P a ti en t was then covered with blankets and bottles of warm water placed about him, and, as tion of left femur. Spec, soon as possible after he reacted from the chloroform, he was given teaspoonful doses of brandy and " water. He had taken the anaesthetic well and seemed to come out of it in good condition, recognized those about him, asked i f his leg was off, and complained of pain, etc.; his pulse gradually improved in strength and decreased in rapidity. While in this improving condition, and before he could be stopped by the attendants, he suddenly raised his head and shoulders quite high and looked down at where his leg had been, then instantly fell back ; the eyes rolled up, respiration became irregular, and he was dead inside of three minutes. Death occurred about two hours after the completion of the operation." The specimen of the fractured femur was forwarded to the Army Medical Museum, with the foregoing report, by the operator, Assistant Surgeon E. B. Moseley, and is numbered 6914 of the Surgical Section. Two views of the specimen are shown in the wood-cuts (FIGS. 124, 125). 2 To the examples of amputations at the hip joint for shot injury cited in Note 1 on page 128, ante, should be added the following: 185. A primary operation performed by Assistant Surgeon J. M. STEIXER, U. S. A. Private Hall, Co. K, 14th U. S. Infantry, was struck, at the battle of Chapultepec, September 12, 1847, by a round shot, just below the trochanter major of the left thigh. The femur was fractured and the soft parts lacerated for some inches. The patient survived only until evening. The case is reported by the operator, Dr. J. M. STEIXER, in the Medical Examiner and Record of Medical Science, Philadelphia, 1849, N. S., Vol. V, p. 15. 186. Another primary operation to be added to the examples of exarticulation at the hip, in Note 1, p. 128, ante, is cited by M. CHEXU from a report of Dr. DE POTOR (Stat. Mid.-Chir. de la Camp, d ltalie, en 1859 et I860, Paris, 1869, T. II, p. 693). On June 25th, 1859, an Austrian, wounded at Solferino the night before, was brought to the Cavalry Hospital. The neck of the femur and the cotyloid cavity were comminuted. Coxo-femoral exarticulation was performed by Dr. EHRMAXX. The patient survived only two hours. 187. A third primary operation to be added was performed by Dr. W. A. EAST, of San Antonio, Texas. A negro, aged 25, received, in the latter part of 1864, in Lavaca County, Texas, a shot wound at the outer and upper margin of the trochanter major. The head of the femur was comminuted. About ten hours after the injury Dr. EAST exarticulated at the hip by LARUEY S method. He recovered, and was last heard from in the winter of 1865-66, through Dr. DOUGLASS (W. A. EAST, Gunshot Wound Fracture of the Head of the Os Femoris Amputation at the Hip Joint Recovery, in Southern Jour, of Medical Science, 18(56, Vol. I, p. 232). It will be noticed that I have omitted from the list of examples of amputations at the hip joint for shot injury in Note 1, p. 128, ante, several cases heretofore referred to by writers on this subject as authenticated instances of this exarticulation. I believe, with Dr. A. LtJ NIN G (Ueber die Blutung bei der Exarticulation des Oberschenkels und deren Vermeidung, Zurich, 1877, p. 56), that the three cases ascribed to A. BLAXDIX, of which two are reported to have been successful, and the successful case of PERUET. are apochryphal. Mr. PH. F. BLAXDIX, who cites the successful cases of amputation at the hip in his article Amputation, in Diet, de Mf.d. et de Chir. Prat., Paris, 1829, T. II, p. 280, does not men tion these cases, and they are, as far as I have been able to ascertain, first mentioned by VELPEAU (Nouv. lem. de Medecine Op ratoire, Paris, 1832, T. I, p. 514); but the latter author, who, in the second edition of his Nouv. JZlem. de Med. Opi rat., Paris, 1839, T. II, p. 539, attempts to cite the authorities for his statements, omits to state the sources from which the BLAXDIX and PERRET cases are derived. MALGA1GXE, in the discussions of the National Academy of Medicine at Paris, on August 8, 1848 (Bull, de VAcad. Nat. de Med., Paris, 1847-48, T. XIII, p. 1278), refers to "a very remarkable thesis" on amputations by "ALEXAXDRE BLAXDIX, aide-major " to LARREY. In his Rfjlexions sur plusieurs points de Chirurgie, read to the first class of the Imperial Institute on March 6, 1815, and an extract of which is published in Jour, de Med. de Chir. et de Pltar. Mil., Paris, 1815, T. I, p. 132, LARREY states that " Mr. MlLLEXGEX, Surgeon in Chief of the British Armies in Spain, assured him that he had made, with success, according to his method [of M. LARREY], two amputations" at the hip. I have omitted these cases, as it is probable that Mr. J. G. V. MlLLIXGEX, who was Chief Surgeon of the British Armies in Spain and Portugal, in 1811 and 1812, had reference to the cases of BROWXR1GG. It would, to say the least, appear strange that British writers on military surgery, who cite BROWXRlGG s and GUTHRIE s cases of amputation at the hip, should have failed to record the cases ascribed to MILLIXGEX, who, as late as 1830, was chief surgeon of the British Armies. M. VELPEAU (Noun. lem. de Med. Operat., Paris, 1839, T. II, p. 540) refers to a successful exarticulation at the hip by AVEDE.MEYER, and LEGOUEST in his paper De la disarticulation coxo-fimorale au point de vue de la chir. oVarmle, in Rec. de Mim. de, Mid. de Chir. et de Phar. Mil., Paris, 1855, 2" ser., T. XV, p. 224, and Trait& de Chirurgie d Armce, Paris, 1863, pp. 669, 670, ascribes two fatal cases of amputation at the hip to the same operator. VELPEAU gives as his authority the Bulletin de Ferussac, T. II, p. 1G5 ; LKGOUEST, the same Bulletin, T. Ill, p. 161. In the second volume of the Bulletin des Sciences M&licales, Paris, 1824, "public sous la direction dt. M. It Baron de FKRUSSAC," on p. 161, Obs. Ill, reference has been made to a case of amputation at the hip cited from an nrtirlo by Dr. Wl DKMr.YEU. Amputa- 164 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. with twenty-eight recoveries, two hundred and twenty-five deaths, and one instance in which the result was not ascertained, giving the slightly modified mortality rate of 88.9 per cent., instead of 89.1, as indicated on page 130, ante. Of these two hundred and fifty -four cases there were eighty-two primary, 1 with seventy-five deaths, or 91 .4 per cent, fatality; fifty-five intermediary, with fifty-two deaths (94.5 per cent.); forty secondary, with thirty-three deaths (82.5 per cent.); eleven reamputations, with four deaths (36.3 per cent.); and sixty-six cases with sixty-one deaths, and one unknown result (93.8 per cent.) in which the time of the operation was not ascertained. According to these statistics it would seem that intermediary operations offer the least chance of recovery, that the results of primary operations are more favorable; that secondary exarticulations give one recovery in twelve cases, and that of the instances of reamputation one in about three proves successful ; and I can, therefore, only reiterate what I have already stated on page 78 of Circular No. 7, that the statistics "tend to show that unless the nature of the injury is such that the ope ration can be delayed until the secondary period, it is better that it should be done at once," 2 although it would appear that the dire results of amputations" at the hip, 3 performed for shot injury during the Schleswig-Holstein War of 1864, the Austro-Prussian War of 1866, and the Franco-Prussian War of 1870-71, have had a tendency to raise doubts regarding the expediency of especially the primary exarticulation at the hip. 4 tion nahe am Hiiftgelenke, wegen Osteosteatoma, etc., in Mag. fur die gesammte Heilkunde, B. XIII, Berlin, 1823. The article will be found at page 45 of the Magazin, and it is there stated that the amputation was performed in May, 1821, the width of a hand below the hip joint ("eine Handbreit unter dem Huftgelenke"). The patient, a soldier named Kloppner, recovered. I have vainly searched Baron FEKUSSAC s Bulletin for the fatal cases cited by M. LEGOUEST. The case of fatal secondary exarticulation at the hip by Dr. JOHN WEIGHT, of Illinois, in the case of Private J. W. Spradling, Co. A, 33d Illinois, detailed by the operator in The Cincinnati Lancet and Observer, Vol. XI, No. 5, p. 257, May, 1808, and reported also in Circular No. 2, War Department, S. G. O., Washington, 1869, p. 109, and mentioned by LOxiNG, loc. cit., p. 108, No. 397, I have omitted from the secondary coxo-femoral amputations for shot injury. The records of this Office show that the original shell wound in the right side, received at Black River, May 17, 1863, healed, leaving a large cicatrix ; that a bedsore formed on the left hip, and that the left femur became diseased and was exarticulated on February 20, 1867. It is apparent that the original wound had only a remote connection with the disease for which the operation was performed. Dr. WRIGHT after wards reported to the Pension Office that "soon after the amputation Spradling was taken with diarrhoea and that dropsy followed, which continued off and on until the date of his death, September 28, 1872." 1 LARREY s successful instance of amputation at the hip in the case of the lieutenant of dragoons wounded at Borodino, September 7, 1812, has been cited by M. LEGOUEST (De. la dfsarticulation coxo-femorale, in Rec. de Mem. de Med. de Chir. et de Phar. Mil., 1855, 2 ms s6r., T. XV, p. 234, and Traite de Chir. d Armee, Paris, 1863, p. 699) as an instance of successful intermediary exarticulation at the hip. This was undoubtedly a primary operation, and I have classed it as such. M. LARREY (Mem. de Chir. Mil. et Camp., Paris, 1817, T. IV, p. 51) details the case and remarks of the oper ation : " Que j entrepris, quoique sur le champ de bataille, avec d autant plus de confiance qu il la demandait instamment." 2 Professor B. v. LAXGEXBECK, in his article: Ueber die Schussverletzungen des Huftgelenlts, in Archiv fur Klinische Chirurgie, Berlin, 1874, B. XVI, p. 299 (republished in his Chirurgische Beobachtungen aus dem Kriege, Berlin, 1874), remarks : "As heretofore, I am still quite convinced that dis- articulation of the thigh ought not to disappear from military surgery, and that if we do not regard all very severe shot fractures of the hip joint and thigh from the beginning as lost, in all these cases primary exarticulation ought to be performed if possible during the first 12-24 hours. In this connec tion I can only repeat what I have said in 1868, and what I may again emphasize, that the only two primary exarticulations that I performed in the Schleswig War, 1848, recovered, and that one of the patients operated upon is still alive." I cannot omit here to call attention to the translation of Pro fessor B. v. LANGENBECK S article by Dr. JAMES F. WEST, F. R. C. S. The translation is published in The Birmingham Medical Review, Vol. V, 1876, pp. 29, 88, and 166. At page 100, Professor LAXGEXBECK is made to say: "The results of the American War, with its great numbers, have been suf ficient for settlement of the question of disarticulation of the thigh. We must regard it as an operation which, at the least, ought to be excluded from military practice, and one that ought at the most to be thought of in the light of reamputation." From this Prof. LAXGEXBECK would appear to be in favor of excluding exarticulation at the hip from the field of military surgery. Nothing could be more erroneous. What Prof. LANGEXBECK (Archiv fur Klin. Chir., 1874, B. XVI, pp. 298, 299) really says is : " The results of the American War, with its great numbers, have become decisive as regards the value of hip joint exarticulation. It has been designated as an operation which it would be best to exclude from military practice, and which should at the most be thought of in the light of reamputation," and further on he continues with the remark cited in the beginning of this note. 3 The two exarticulations at the hip for shot injury performed during the Schleswig-Holstein campaign of 1864, and the seven operations performed during the Austro-Frussian War of 1866, proved fatal. Of the forty-four cases of amputation at the hip performed for shot injury received during the Franco- Prussian War, 1870-71, cited in note on page 130, ante, the only successful one, as far as I have been able to ascertain, was the case of reamputa tion at the right hip performed by Professor T. G. MORTOX, of Philadelphia, on a soldier named Boasso Dominico (not Dominico Ludovess, as first erroneously communicated in note on page 130, ante), whose thigh had been amputated after the battle of Sedan, September 1, 1870. "HOLMES (T.) (.4 Treatise on Surgery, its Principles and Practice, Philadelphia, 1876, p. 344): " The following are, I believe, the main maxims of practice in gunshot injuries of the extremities. . . II (p. 345). In the lower extremity gunshot fractures involving the hip joint or the upper third of the femur are usually fatal, however" treated. Primary amputation is so fatal in these cases that it is almost abandoned. Several cases have recovered under strictly conservative treatment; a few cases of successful excision are on record ; and secondary amputation has been decidedly more successful than primary. The surgeon must use his own discretion in each case, but all surgeens nowadays have a well founded horror of primary amputation at the hip, believing that the operation is almost necessarily fatal, while the injury is not so." BECK (B.) (Chir. der Schussverletzungen, Freiburg, 1872, p. 852) remarks : "Exarticulation at the hip . . is only to be performed, as a primary operation, in cases of extensive comminution of the bones with laceration of the soft parts, especially of the large vessels, and where amputation high up is not possible. In injuries which involve the femur in its continuity close to the joint, conservative expectant treatment should be employed, and operative interference should only be had in the further course, as it is known that the secondary operation is more readily tolerated. I have not yet seen in the various campaigns at the places of first dressing a case really adapted to primary exarticulation; either expectation was yet admissible, or resection or high amputation could be performed ; or the lesions were of such a nature that there was no prospect of a cure. The wounded of the last category I left to their fate as incurable, ligating only the larger vessels." SECT. ii. | AMPUTATIONS AT THE HIP JOINT. 165 Generalarzt B. Beck 1 proposes "to let secondary exarticulation at the hip be preceded by resection," and considers this procedure as not unworthy of the consideration of his colleagues. During the Franco-Prussian War, 1870-71, he had selected a patient 2 for this mode of treatment, and had excised the hip and intended to remove the limb fourteen days later; but he was compelled to leave the patient, who died about a month after the excision. Professor J. Neudorfer, 3 in the case of an Austrian soldier, Johann Schranz, during the Italian War of 1859, resected, on November 27. 1859, the head of the femur for shot injury received at Palestro, May 30, 1859, and, on December 1st, removed the limb at the hip. The patient recovered. This seems to be the only case of this kind on record in military surgery. In civil surgery six instances 4 may be cited in which the exarticulation at the hip had been preceded by excision at the hip joint. Five of the six cases had a successful issue, giving the favorable result of a mortality of 16.66 per cent. The evidence set forth in the preceding pages in regard to the three plans of treat ment of gunshot injuries of the hip joint received during the American civil war shows that of the cases of undoubted intracapsular shot fracture of the hip treated by conserva tion, 98.8 per cent, had a fatal termination; that in sixty-six cases treated by excision 5 BECK (B.), Chirurgie der Schussverletzungen, Freiburg, 1872, p. 855. 2 BECK (B.) (loc. cit., p. 854) remarks: "In another case I had performed resection, and intended to disarticulate 14 days later; but I had to leave the patient, who reacted well, and he died of pyaemia afterwards, because my plan was not follo\^d, to wit: to let, at the proper time, when it became evident that recovery could not be achieved in this manner, the resection be followed by exarticulation." The patient he had selected for this manner of operation was Sergeant Major B , of the 3d French Infantry (see BECK, loc. cit., p. 894, and note on page 91, ante, CASE 53), who had survived a shot fracture of the neck and trochanter of the femur at Worth. August 6, 1870. In the latter part of August the head and neck and more than one-third of the shaft of the femur were excised. But Dr. BECK was sent away before the time for the removal of the limb had arrived. Professor BECK continues : In another case, which, to my sorrow, I also had to leave before the proper time for the operation, there was an extreme oblique and longitudinal frac ture extending into the capsule, with considerable infiltration of the soft parts. When I left Dijon I had ordered that, as soon as the swelling would some what go down, the limb should be amputated high up, and that subsequently the remaining bone should be extirpated, provided acute septicaemia should not supervene. Several days after my departure the latter complication appeared; energetic interference was not attempted, and only the projecting end of bone fragment was resected. The patient died shortly afterwards." 3 NEUDORFER (J.), Uandbuch der Kriegschir., 1872, B. II, Abth. II, S. 14C8, and notes on pp. 90 (CASE 13) and 129 (CASE 120), ante. *HRYFKLDER (J. P.) (Ueber Resectionen und Amputationen, Breslau utid Bonn, 1854, p. 155) resected the hip joint on January 11, 1848, in a tailor, Carl Eckstein, aged 20, for caries of the joint, and exarticulated the limb on May 20, 1851. The patient died in two hours. 2. T. CAKR JACKSOX (Trans actions of the Path. Society of London, London, 1872, Vol. XXIII, p. 191), for disease of the hip joint, excised, in 1871, the head of the femur in a young man aged 19, and, in 1872, successfully removed the limb. 3. Dr. TEALE (Medical Times and Gazette, July 26, 1872, Vol. II, p. 93) excised, on Decem ber 28, 1871, the head of the femur for hip disease, in a boy aged 10, and, on July 18, 1872, the limb was successfully removed at the hip. 4. In a girl, aged 7, suffering from hip disease, Mr. HANCOCK performed excision of the head of the femur in the early part of 1871, and, on November 2, 1872, ampu tation at the hip was performed by Dr. RICHARD BARWELL. The girl recovered (London Lancet, April 5, 1873, Vol. I, p. 105). 5. Dr. RUSHTOX PARKEU (London Lancet, 1875, Vol. II, p. 099), on a boy, aged 6, with inflammation of the hip joint, excised the head of the femur on July 31, 1874, and amputated at the hip, November 21, 1874. The boy survived. 6. Professor Sl EXCE (London Lancet, 1875, Vol. II, p. 549), ThomasH , aged 20; hip disease; excision at the hip October 29, 1864. Amputation April 13, 1875, by Prof. Sl EXCE; the patient recovered. *Besides the works referred to on pages 89 to 120, ante, by ABBOTT, AT.COCK, AsimuRST, CHEXU, CALHOUX, CULBERTSOX, DEINIXGER, Du- BREUIL, EVE, H. FISCIIEH, G. FISCHER, GUTIIKIE, GRELI.OIS, GROSS, HEINE, HODGES, KADE, LAXGEXliECK, LOHMEYER, LOXGMORE, LOSSEN, MAT THEW, MACLEOD, Muxx, MAUXOURI, MURSICK, XKUDOKFER, OTIS, OITEXHEIM, OITEXHEIMER, PAILLARD, READ, ROBERTSOX, SEUTIX, SCHWARTZ, D. P. SMITH, STKOMEVER, K. TEXTOI:, and C. WAGXER, the following may be consulted on excision at the hip joint: ADAMS (Z. B.), Excisions of Joints for Traumatic Cause, in Boston Med. and Surg. Jour., 18C7, Vol. 7G, p. 229; BALLARUE (D. P.), Beitrage zur Statistik der Huftgelenks Resec tion, Leipzig, 1808. BECK (B.), Zur Statistik der Amputationen und Resectionen, in LAXGEXBECK s Arch, fur Klin. Cliir., B. V, pp. 245,256, and Kriegs chir. Erfahrungen u-ahrend des Feldzuges, 18CO, in Suddeutschland, pp. 206, 351, and Die Schusswunden, Heidelberg, 1850, p. 332. BEKAltD (A.), Resection de I articulation coxo-femorale, in Diet, de M^d. en 30, 1837, T. XV, p. 82. BlLLROTH (TH.), Ueber die Resectionen, in Deutsche Klinik. B. V, p. 220. BLAXD1X (P. P.), Article Resection, in Diet, de Med. et de Cliir. prat., Paris, 1835, T. XIV, p. 266. BOXIXO (E.), De la n section de la tete du femur, in Annal. de la Cliir. Fran? et Etrang., Paris, 1844, T. X, p. 385. BOWMAX (WM.), Resection of the Hip Joint, in Medical Times and Gazette, London, 1800, Vol. II, p. 210. BRYK (A.), Beitrage zu den Resectionen, in LAXGEXllECK S Archiv filr Klin. Chir., 1873, B. XV, p. 273. ClIAMTIOX (L.), Traite de la Resection, etc., These, Paris, 1815. ClIKEVER (D. W.), Two successful cases of Excision of the Head of the Femur, in Boston Med. and Surg. Jour., Vol. LXXV1I, p. 281. COOTE (H.), Remarks on the operation of Resection of the Head of the Femur, in British Medical Journal January 2, 1858, p. 2. DlltCKS (C. J. M.), Diss. inaug. de resectione capitis femoris, Wirceb, 1846. DECAISXE, Des moyens d eviter les amputations et les resections osseuses, Bruxelles, 1855. EULEXBURG (ALBERT), Beitrage zur Statistik und Wiirdigung der Huftgelenkresection, in Archiv filr Klin. Chir., I860, B. VII, p. 701. FOCK (C.), Bemerkungen und Erfahrungen ueber die Resection im Hiiftgelenk, in Archiv fur Klin. Chir., Berlin, 1861, B. I, p. 172. GERDY (J. V.), De la resection des extremites articulaires des os, Paris, 1839, p. 157. GOOD (R. R.), De la resection de V articulation coxo-fem- oralepour carie, Paris, 1809. GOOD (R. R.), Comparative Mortality after resection of the hip joint in France and in England, in Med. Times and Gaz., London, 1809, Vol. I, p. 355. GOSSELIX, Resection de la hanche, in Bull, de VAcad. de Med., Oct. 15, 1861. GURLT, Resection im Hiiftgelenk, in LAX OEXBECK S Archiv, 1867, B. VIII, p. 903. HAXCOCK (H.), On Excision of the Hip Joint, Lancet, 1857, Vol. II, p. 84. HKYFF.LDER (J. P.), Ueber Resectionen und Amputalionen, Breslau, 1854, p. 154. IlEYFELDER (O.), Lehrbuch der Resectionen, Wien, 1863. HUETKU (C.), Die Resectionen, in LAXGEXBECK s Archiv, B. VIII, p. 94. JACOBSEX (L.), Om Resektion of Hofteleddet i Tilfdlde of caries og suppuration, Kbhvn, 1874. JAEGER (M.), Operatio resectionis conspeclu chronologico adumbrata, Erlangen, 1832. JAEGER, Article Decapitatio, in J. N. RUST S Handbuch der Chirurgie, 1831. B. V, p. 626. KlXLOCH (R. A.), A case of Excision of the Hip Joint for morbus coxarius, with Remarks upon the Propriety of such an Operation, and a Summary Account of the recorded Cases up to the present Time, in Charleston Med. Jour, and Rev., 1857, Vol. XII, p. 307. KRETSCHMAU (G. A.), Ueber BuftgeUnkresection, Jena, 1867. LARGIII (B.), Resection de tete et du col du femur, in Gaz. Med. de Paris, 1857, T. XII, p. 8. LE FORT (LEOX), De la resection de la hanche dans les cos de coxalgie et de plaies par armes d. feu, in Mtm. de VAcad. Imp. de Med., 1861, T. XXV, p. 445. LEISRINK (H.), 166 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the fatality was 90.9 per cent., and that in sixty-six cases treated by exarticulation 1 it was 83.3 per cent.; but from these results it should not be concluded that operative interference was always indicated, and that amputation was preferable to excision. On page 121, of Circular No. 2, I have already pointed out that the question as to the most eligible treat ment of shot injuries of the hip joint is not susceptible of a purely arithmetical solution, and that the variety of the conditions under which the patients are placed, the diversity in the extent of their injuries, and the inevitable imperfection of all surgical records forbid any such rigorous comparison. Not less than nine 2 of the sixty-six cases of excision at the hip were complicated with such lesions of the pelvic walls and viscera as made any Zur Statistik der Huftgelenk Resection, in Archiv fur Klin. Chir., Berlin, 1870, B. XII, p. 134. LEPOLD (F.), Ueber die Resection des HuftgeJenkes, Inaug. Diss., Wttrzburg, 1834. LOCKE (A.), Beitrdge zur Lehrevon den Resectionen, in Archiv fur Klin. Chir., Berlin, 1862, B. Ill, p. 291. LYON (IRVIXG W.), Excision of the. Knee and Hip Joints, in Am. Jour. tied. Sci., 1865, K. S., Vol. XLIX, p. 49. MOHNS (J.), Beitrdge zu den Resectionen der Knochen, Jena, 1866. PAGENSTECHER, Zur Resection des Hiiftgelenkes, in LANGENBECK s Archiv, 1862, B. II, pp. 312-315. PERCY et LAURENT, Article Resection, in Dictionnaire des Sciences Mtdicales, Paris, 1820, T. XLVII, p. 553. RlEU (F.), Die Resectionen der Knochen, Nuremberg, 1860, p. 385. ROUX (P. J.), De la resection ou de retrenchment de portions d os malades, Paris, 1862, p. 49. SAUNDERS (D. D.), Excision or Resection of the Bones and Joints of the Lower Extremity, in Memphis Med. Monthly, April, 1866, Vol. I, p. 77. SAYUE (L. A.), Exsection of the Head of the Femur and Removal of the Upper Rim of the Acetdbulum for morlus coxarius, with perfect recovery, in New York Jour, of Med., 1855, Vol. XIV, p. 70. SCHEDE (M-), De resectione articulationis coxse, Halis Saxonum, 1866. SCHILLBACH (L.), Beitrdge zu den Resectionen der Knochen, Jena, 1861. SEDILLOT (C.), De la resection coxo-fSmorale, in Gaz. Mid. de Paris, 1866, T. XXI, p. 691. SENFTLEBEN (H.), Beobachtungen und Bemerkungen ueber die Indikationen, den Heilungsprocess und die Nachbehandlung der Resectionen grcesserer Gelenlce, in LANGENBECK S Archiv filr Klin. Chir., Berlin, 1862, B. Ill, p. 112. SlEBERT (L.), Statistik der Resectionen, etc., Jena, 1868. STARK (W.), Beitrage zu der Statistik und den Endresultaten der Gelenkresectionen, in Bei trage zur Operativen Chirurgie, von Dr. V. CZERNY, Stuttgart, 1878, p. 183. STEVENS (G. F.), On Excisions in Cases of Gunshot Wounds, in Trans. Med. Society of New York, 1866, p. 132. SWINBURNE (J.), Exsection of the Hip Joint, and Conservative Surgery, in Med. and Surg. Reporter, 1861, Vol. VII, p. 198, and Vol. IX, 1863, p. 377. SYME tf AMES), Treatise on the Excision of Diseased Joints, Edinburgh, 1831, p. 125. SZYMANOWSKY (J.), Ueber die Resection des Hilftgelenkes, in LANGENBECK s Archiv, 1865, B. VI, p. 787. TALLICHET, Dissert, de resecto femore ex articulo, Haloe, 18C8. TEXTOK (CAJETAN), Ueber die Wiedererzeugung der Knochen nach Resectionen, WUrzburg, 1842. TOSTIVINT (A. L. M.), Sur les resections coxo- fi morales dans les cas de coxalgie, These, Paris, 18C8. WAGNEH (A.), Ueber den Heilungsprocess nach Resection und Extirpation der Knochen, Berlin, 1853, p. 14. WAGNEH, Article Decapitatio ossium, in EncyclopddiscJies Worterbuch der Med. Wissenschaften, von W. H. BUSCH, Berlin, 1833, B. IX, p. 188. WlNNE (C. K.), Statistical Inquiry as to the Expediency of Excision of the Head of the Femur, in Am. Jour. Med. Sci., 18C1, Vol. XLII, p. 26. 1 The literature of amputation at the hip joint is copious. In the foot-notes on pages 127 to 159 I have referred to the various sources of information on this subject by AixocK, AsuHUKST, AVERILL, BAUDEN8, BECK, BERTHERAND, CHENU, COSTELLO, W. S. Cox, DEININGER, GUTHRIK, J. F. HEY- FELDER, D. J. LARREY, H. LARREY, LANGENBECK, LEGOUKST, MACCORMAC, MACLEOD, MATTHEW, MORTON, KEUDORFER, OTIS, J. Roux, P. J. ROUX, STUOMK.YER, C. TEXTOK, J. THOMSON, and others. To these may be added: ARMAND (A.), Histoire medico-chirurgicale de la guerre de Crimie d apres les travaux des medecins militaires, Paris, 1858, p. 19. BAKBET, in Prix de I Acad. roy. de Chir., Paris, 1819, T. IV, p. 45, relates the operation by LA CROIX, and defends the exarticulation at the hip. BECK (B.), Zur Auslosuvg des Femur im Huftgelenk, in Archiv fur Klin. Chir., Berlin, 1679, B. XXIII, p. 654. CARPIO (L. H.), Una observation de desarticulacion coxo-femoral, in Gaceta Mddica de Mexico, 1865, T. I. p. 346. DENECHAUD, Observation sur Vextirpation de la cuisse, in Rec. de Mem. de Med., Paris, 1820, T. VIII, p. 190. DOLIGNON, Amputation de la cuisse dans Varticle, in Jour, de M(d, Chir., Paris, 1786, T. LXVI, p. 69. FLAJANI (GlUSEPPO), Osservazione pratiche sopra I amputazione digli articoli, etc., Roma. 1791. GOURAUD (V. O.), Demonstrations des principals operations de Chir., Tours, 1815, p. 85. GURLT (E.), Ampulationen, Exarticulaiionen, Resectionen, in Jahresbericht ueber die Leistungen und Forlschritle in der Gcsammten Medicin, Berlin, 1868, B. II, Abth. 2, S. 411. HAWERKAMP (A.), Ein Fall von Exarticulatio femoris. Inaug. Diss., Berlin, 1678. HEDENUS (A. G.), Cvmmentatio chirurgica de femore in cavitate cotyloidea ampu- tando, Lipsiaj, 1823. IlENOT, Mem. sur la desarticulation coxo-femorale, in Mem. de I Acad. Nat. de. M<.d., Paris, 1852, T. XVI, p. 213. HEYFELDER (O.), Exarticulation des Hiiftgelcnks. Bemerkungcn zu NKUDORFER s Kriegschirurgie, in Deutsche Klinik, 1873, B. XXV, p. 167. JENTY (C. N.) Methodo de hacer la amputacion del muslopor su articulacion con el hueso innominado, etc., Madrid, 1766. JUBIOT, Observations sur Vamputation dans I article coxo-fcmoral, Montpellier, 1840. KERR (WILLIAM), An account of the Operation of Amputating the Thigh at the Upper Exarticulation, in Medical and Philosophical Commentaries, London, 1779, Vol. VI, p. 337. KEliST, Heelkundige Mengelingen, Utrecht, 1836, p. 186. KREMER (H. S. W. L.), Ueber Exarticulation im Huftgelenk, Marburg, 1857. KROENER (C. A.), De exarticulalione femoris et cruris quxdam, Stuttgartiae, 1837. L ALUETTE (PET.), An femur in cavitate cotyloidea aliquando amputandum, Paris, 1748, in HALLKR S Disput. chirurg., Lausannae, 1756, T. V, p. 265. LAND (A. L.), Over the exarticulalio ossis femoris, in BOERHAVE, Tijdschrift, Amsterdam, 1841, Jaarg. Ill, p. 2G5. LlSFRANC (J.), Memoire sur un nouveau procede operatoire pour pratiquer I amputation dans V articulation coxo-femorale, in Archives Generales de Med., 1823, T. II, p. 161. METZ (H.), Ueber die Losing des Oberschenkels aus dem Huftgdenke, WUrzburg, 1841. MOKAND (S. F.), Sur Vamputation de la cuisse dans son articulation avec I os de la hanche, in his Opuscules de Chir., Paris, 1768, T. I, p. 176. MULDER, Overzigt von de voornamste gevallen, welke in het heelen vroekundig akademisch Ziekenhuis to Griiningen, etc., zijn waargenommen, door MULDER, Amsterdam, 1814, p. 144. NEVEKMANN, Vie Exarticulation des Oberschenkels in geschichtlicher Hinsicht dargestellt, in Journal der Chirurgie und Augenheilkunde\on C. F. v. GRAEFE und Ph. WALTHER, Berlin, 1839, p. 95. POHTA (L.), Delia disarticolazione del Cotile, Milano, 1860. PUTHOD, Sur Vamputation de la cuisse dans so-n articulation, in MORAND S Opusc. de Chir., Paris, 1768, T. I, p. 199. RAUSCH (J. J.), Ueber die Amputation grosser Glieder nach Schusswunden, Leipzig, 1807. ROBUCHON (L.), Observations et statis- tiquespour servir a Ihistoire des amputations, Paris, 1872, p. 61. SABATIER (R. B.), De la Medecine Operatoire, Paris, 1824, T. IV, p. 542. SAUVAN, Diss.de extirpatione femoris, Vilnas, 1823. SCHNEIDER (AUGUST), Ueber die Exarticulation des Oberschenkels im Huftgelenk, Inaug. Diss., Landau, 1848. SMITH (STEPHEN), Statistics of the Operation of Amputation at the Hip Joint, in New York Jour, of Med., 1852, Vol. IX, p. 184. SoLGER, Veber die Amputation im Hi iftge lenke, WUrzburg, 1854. S iEMMERMANN (W.), Ueber die Exarticulation des Oberschenkels, Jena, 1866. UNCER, An femur aliquando et quo methodo e cavilate cotyloidea sit amputandum? Halae, 1793. Vo LCKERS (C.), Beitragezur Statistik der Amputalionen und Resectionen, in Archiv fur Klinische Chirurgie, Berlin, 1863, B. IV, p. 574. VOELKNER (LOUIS), Ueber die Exarticulation de.s Oberschenkels im Huftyeie.nl-, Halle, 1868. VOIJ1ER, Sur Vamputation de la cuisse dans son articulation, in MORAND S Opuscules de Chir., Paris, 1768, T. I, p. 189. VOLKMANN (RICHARD), Ueber die Anwendung des ESMARCH s schen blutersparenden Verfahrens by Exarticulationen des Hilftgelenkes, in Centralblatt fur Chirurgie, May 2, 1874, Xo. 5, p. C5. WACHTER (G. H.), Diss. chir.de articulis extirpandis, etc., Groningae, 1810. WAGNER, Ueber die Exarticulation des Oberschenkels aus dem Huftgelenke, in Magazin fur die Gesammte Heilkunde, von J. N. RUST, Berlin, 1823, B. XV, p. 261. WlNNINGHOFF De exarticulatione femoris, Gryphias, 1843. ZANDERS, Ablosung der Glieder in den Gelenken, DUsseldorf, 1831. 2 See CASE 209, p. 93, of Pt. C. Beard, 12th Miss.; CASE 227, p. 96, of Pt. C. Morrison, 185th N. Y.; CASE 235, p. 98, of Capt. T. R. Robeson, 2d Mass.; CASE 23G, p. 98, of an unknown private soldier of the First Corps; CASE 238, p. 99, of an unknown soldier; CASE 247, p. 105, of Pt. C. E. Mars- ton, 1st Mass.; CASE 257, p. 109, of Corp l H. C. Sennett, 122d N. Y. ; CASE 259, p. 110, of Lieut. D. If. Patterson, 46th Va.; and CASE 209, p. 118, of Pt. A. Toney, 16th N. C. SECT. IT.] WOUNDS AND INJURIP;S OF THE HIP JOINT. 167 operative interference useless; among the sixty-six coxo-fernoral amputations probably all successful cases have been recorded, while some fatal cases may remain unpublished; and in the three hundred and four cases treated by conservation, the correctness of the diagnosis may be questioned in many instances. The character of the injury must determine the choice of treatment; but the general rules regarding shot wounds of the hip joint 1 laid down in Circular 2 are uncontro verted: that "expectant treatment is to be condemned in all cases in which the diagnosis of direct injury to the articulation 2 can be clearly established;" that "primary excisions of the head or upper extremity of the femur should be performed in all uncomplicated cases of shot fracture of the head or neck;" that "intermediary excisions are indicated in similar cases where the diagnosis is not made out till late;" that "secondary excisions are demanded by caries of the head of the femur or secondary involvement of the joint;" that amputation should be performed:- "1. When the thigh is torn off, or the upper extremity of the femur comminuted with great laceration of the soft parts, in such prox imity to the trunk that amputation in the continuity is impracticable. 2. When a fracture of the head, neck, or trochanters of the femur is complicated with a wound of the femoral vessels. 3. When a gunshot fracture involving the hip joint is complicated by a severe compound fracture of the limb lower down, or by a wound of the knee joint." A number of authors especially on excision or exarticulation at the hip have already been cited, but many additional facts in regard to injuries of the hip joint may be derived from the works of: BALLIXGALL (Sir GEORGE), Outlines of Military Surgery, London, 5th ed., 1855, p. 397. BARWELL (RICHARD), A Treatise on- Diseases of the Joints, London, 1865. BELL (JOSEPH), A Manual of the Operations of Surgery, London, 1866 , p. 111. Br.EXKIXS (G. E.), Article Gunshot Wounds, in COOPER S Dictionary of Practical Surgery, London, 8th ed., 1861, Vol. I, p. 838. BRINTON (J. H.), Consolidated Statement of Gunsliot Wounds, Circular No. 9, S. G. O., Washington, July 1, 1863, p. 12. BlUOT (M.), Bistoire de VEtat et des Progres de la Chirurgie Militaire en France pendant les Guerres de la Revolution, Besan9on, 1817, p. 177. CHAUSSIER, Pr&is d experiences sur I amputation des extremites articulaires des os longs, in Hem. de la Soc. Mid. d Emulation, an VIII, T. Ill, p. 399. CHELIUS (J. M.), System of Surgery, translated from the German by J. P. SOUTH, Philadelphia, 1847, Vol. III. CHISOLM (J. JULIAN), A Manual of Military Surgery for the use of Surgeons in the Confederate States Army, 3d ed., Columbia, S. C., 1864. CORTKSE, Guida teorica pratica del medico militare in campana Torino, 1862, Vol. I, p. 209, uud Vol. II, p. 308. COUL60N (W.), On Disease of the Hip Joint, London, 1867. EMMERT (CARL), Lehrbuch der Chirurgie, Stuttgart, 1867, B. IV. KRICHSEX (JOHN), The Science and Art of Surgery, London, 1872. FERGU68ON (Sir WM.), A System of Practical Surgery, London, 4th ed., 1867 ; and Clinical Lecture on Hip Disease, in London Lancet, 1849, Vol. I, p. 359. FISCHER (H.), VerUtzungen durch Kriegswaffen, in v. PlTHA and BlLLROTH s Handbuch, 1865, B. I, Abth. II, S. 483, 496. GAXT (F. J.), The Science and Practice of Surgery, London, 1878. GHERLXI (A.), Vade Mecum per le Ferite d Arma da Fuoco, Milano, 1866; aud Relazione chirurgica dell Ospedale militare provisorio di S. Filippo, in Annali Universali di Medicina, Milano, 1860, Vol. CLXXIII, p. 450. HOLMES (T.), Report on Surgery, in Biennial Retrospect of Medicine and Surgery for 1867, pp. 225, 326; A Trea tise on Surgery, its Principles and Practice, Philadelphia, 1876. HUETER (C.), Klinik der Gelenk Krankheiten mil Einschluss der Ortopadie, Leipzig, 1870-71, p. 596. KOCH (W.), Notizen uber Schussverletzungen, in LANGEXBECK s Archio fur Klin. Chir., 1872, B. XIII, p. 510. MALGAIGXE (J. T.), Manuel de Medecine Operatoire, sept, ed., Paris, 1861, p. 250. METZLER, Verhandlungen der Mil. arztl. Gesellschaft zu Orleans, 1870-71, in Mil. Arztl. Zeitschrift, 1872, B. I, p. 63. MILLER (JAMES), A System of Surgery, Edinburgh, 1864. MOXTFALCOX, Memoire sur VEtat Actutl de Chirurgie, Paris, 1816, p. J03. MOTT (V.), VELPEAU s New Elements of Operative Surgery, New York, 1847, Vol. II, pp. 779, 845. OCHWADT (A.), Kriegschirurgiscle Erfahrungen, Berlin, 18G5, S. 53. OLLIER (L.), Traiti experimental et clinique de la Regeneration des Os, Paris, 1867, p. 165. OTIS (G. A.), Observa tions on some Recent Contributions to the Statistics of Excisions and Amputations at the Hip for Injury, in Am. Jour. Med. Sci., 1868, Vol. LVI, p. 128. PAGET and STANLEY, Catalogue of the Pathological Specimens contained in the Museum of the Royal College of Surgeons of England, London, 1847, Vol. II, p. 230. PAXCOAST (J.), A Treatise on Operative Surgery, Philadelphia, 1846, 2d ed., p. 129. PASSAVANT (G.), Bemerkungen aus dem Gebiete der Kriegscliirurgie, in Berliner Klinische WocJienschrift, Berlin, 1871, Jahrg. VIII, p. 115. PAUL (H. J.), Die Conservative Chirurgie der Glieder, Breslau, 1859, S. 38, 193. PlRUIK (WILLIAM), The Principles and Practice of Surgery, London, 1860. PlTHA (F.), Krankheiten der Extremitaten, Krlangen, 1868, S. 203. M. ROCHOUX, Communications sur les platjes d armes afeufaites a V Academic, in Bull, de VAcad. de Med., 1848, T. XIV, p. 127. Rossi (P.), Elemens de Medecine Operatoire, Turin, 1806, T. II, p. 224. SANTESSON (CHARLES), Om Hoflleden och Ledbrosken uti anatomiskt, pathologiskt, och chirurgiskt hanseende, je.mte en Kritish Ofversigt ofver nagra. bland Injlammationlarens vigtigaste, Stockholm, 1849, and Dublin Journal of Medical Sciences, 1861, Vol. XI, p. 432. SEDILLOT (C.), Traite de Medicine Operatoire, Paris, 1865, T. I, p. 515, and De I evidement sous periosti des Os, Paris, 1867, p. 165, and Compte Rendu de VAcad. des Sciences, seance du 15 Oct., 1866. SIMON (GUSTAV), Mittheilungtn aus der Chir- urgischen Klinik, Prag, 1868, S. 98. SKEY (F. C.), Operative Surgery, Philadelphia, 1851, p. 374. SMITH (G. K.), The Insertion of the Capsular Lig ament of the Hip Joint and its relation to intra-capsular fractures of the Neck of the Femur, in Med. and Surg. Reporter, Vol. VII, p. 244, et seq. SMITH (STEPHEN), Handbook of Surgical Operations, New York, 3d ed., 1862, p. 221. SOLLY (S.), Clinical Lectures on Injuries and Diseases of the Joints, delivered at St. Thomas s Hospital, in London Lancet, 1852, Vol. II, pp. 121, 144. SYME (JAMES), The Principles of Surgery, edited by Dr. MACLEAN, Philadelphia, 1866, p. C94. SZYMAXOWSKI (JULIUS), Additamenta ad Ossium Resectionem, Dorpati Livonorum, 1856. TEXTOU (CAJETAX), Grundzuge zur Lf.hr der Chirurgischen Operaliimen, Wtirzbug, 1835. S. 310, 348. VELPEAU (A. L. M.), Nouveau Elements de Medecine Opiraloire, Paris, 1833, T. I, p. 582. VERMAXDOIS, Sur le traitement de quelques maladies chirurgicales de I articulation du femur avec Vos innomine, in Journal de Medicine, Chirurgie, Pharmacie, etc., 1786, T. LXVI, p. 51. VOGEL (A. F.), Observationes quasdam chirurgicas defendit, Kiliae, 1771. WAKREX (EDWARD), An Epitome of Practical Surgery, Richmond, 1863. WHITE (C.), Cases in Surgery, in Philosophical Transactions, Vol. HX for the year 1769, London, 1770, p. 45. WILLIAMSON" (G.), Military Surgery, London, 1863. WOODHULL (A. A.), Catalogue of the Surgical Section of the U. S. Army Med. Museum, Washington, 1866, p. 234. ZANG (C. B.), Darstellung blutiger heilklinstlerischer Operationen, Wien, 1821, Theil 4, pp. 287, 300. 2 Professor II. II. SMITH (Princ. and Pract. of Surgery, 1863, Vol. I, p. 526) pronounces "compound fractures involving the hip joint are exceed ingly dangerous. If left alone death usually results." . . " Some few cases of recovery have resulted after injuries in this locality, but in them the fracture may not have entered the joint, and these few exceptions to the general fatal result certainly offers no encouragement for their repetition. LOr- FLEK (F.), Grundsdtze und Regeln fur die Behandlung der Schusswunden im Kriege, Berlin, 1859, Erste Abtheilung, p. 66), speaking of shot injuries of the hip joint, remarks: "The conservative treatment of this injury, according to the experience hitherto acquired, gives no prospect of saving life. Even if pyaemia does not oupervene, death ensues sooner or later from exhaustion following endless suppuration." 168 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. The preceding portions of this Section were already in print when Professor E. Gurlt s 1 excellent and elaborate work on resections of joints was received. On page 1261 he enumerates one hundred and thirty-seven cases of excision 2 at the hip, of which the results were ascertained in one hundred and thirty-six instances, with sixteen recoveries, a mor tality rate of 88.23 per cent.; and "on page 1319 he states that, considering the severity of wounds of the hip joint and the great mortality that has hitherto followed them, this result must be regarded as favorable. GuilLT (E.), Die Gelenk-Resectionen nach Schussverletzungen. Ihre Geschichle, Statistik, End-Resultate, Berlin, 1879, pp. 1333. Professor GURLT cites the following additional cases ot excision at the hip for shot injury not hitherto published: Dr. BRYK (GURLT, loc. cit., p. 63) excised the head of the right femur in the case of Nagy Lajos, age 27, wounded at Buda, May 21, 1849; excision May 24 ; death June 2, 1849. Dr. ABEL (GUHLT, loc. cit., p. 317), Pt. J. Poulsen, 20th Danish Infantry; Dtippel, April 18, 1864; neck of right femur; intermediary excision May 4; death May 4, 1864. Dr. HAHN (GURLT, loc. cit., p. 317), P. Rasmussen, 5th Danish Infantry, age 25; Alsen, June 29, 1864, in left trochanters; resection July 4, death July 6, 1864. BURCHARDT (GuilLT, loc. cit., p. 483), F. Haberditz, Austrian Infantry, age 42; Koeniggratz, July 3, 1866, through left hip; resection August 6; fatal. BUSCH (GURLT, Inc. cit., p. 395), N. Breidt, Gth Rhenish Infantry, Koeniggratz, July 3, 1866, right hip; excision July 20; death July 21, 186 6. BUSCH (GURLT, loc. cit., p. 483), F. Harlitschek, Austrian Infantry, age 74; Koeniggratz, July 3, 1866; right trochanter major; excision August 9; death August 13, 1866; pyaemia. KLOPSCH (GURLT, loc. cit., p. 484), N. N. Oest, Austrian Infantry, Koeniggratz, July 3, 1866, left hip; excision July 7; death July 9, 1866. C. REYHER (GURLT, loc. cit., p. 1159), W. Jowanowitsch, age 45; Russo-Turkish War, August 24, 1876; excision Sept. 8; death Sept. 12, 1876. On p. 1154 Dr. GURLT tabulates 2 additional cases of excision at the hip during the Russo-Turkish War, 1876-1878, but gives no details. *The operation of excision at the hip was first proposed in 1769, by CHARLES WHITE, F. R. S., Surgeon to the Manchester Infirmary, at the con clusion of an account of a successful excision of the head of the humerus performed by him April 14, 1768. The paper is recorded in the Philosophical Transactions for 1769, Vol. LIX, p. 45, and is republished the following year in CHARLES WHITE S Cases in Surgery. 1770, p. 76. Prior to this a surgeon had, in 1730, according to J. D. SCHLICHTfNG (Obsercationis variee medico-chirurgicx, in Philosophical Transactions, Ldndon, 1744, Vol. XLII, for the years 1742 and 1743, p. 274), extracted the carious head of the femur in a girl, aged 14, by dilating a fistulous opening over the hip. The girl recovered in six weeks. Similar instances in which the diseased head of the femur was spontaneously eliminated or was extracted were reported by A. F. VOGEL (Observationes quasdam chirurgicas defendit, Kiliae, 1771), in 1771; T. KIRKLAND (Thoughts on Amputations, etc., London, 1780), in 1780; HOFMANM (Vom Schaarbocke, Munster, 1782), in 1782 ; OlILE (SCHMIDT S Jahrbucher, 1834, B. II, S. 116), in 1815 or 1816; SCHMALZ (cited by HEDENU8 (A. G.). Commentatio chirurgica de femore in cavitate cotyloidea amputando, Lipsias, 1823, p. 65), in 1817. In the meantime experiments had been made in excising the joints of animals by VERMANDOIS (Jour, de mid. cliir. et phar., Janv,-Mar., 1786, T. LXVI, p. 73), in 1785; G. L. KOELEU (Experimenta circa regenerationem ossium, Gottingen, 1786, experiments 14, 15, 16, pp. 84-98), in 1786 ; CHAUSSIER (Magazin Encycloped., 56me annee, T. VI, No. 24), in 1801 ; F. ROSSI (Elem. de Mcd. Operat., Turin, 1806, T. II, p. 224), in 1806; and G. H. WACHTER (Dissertatio Chirurgica de Articulis Exlirpandis, Groningen, 1810, pp. 91-94), in 1810; but the first excision of the head of the femur upon the living human subject was performed by Mr. ANTHONY WHITE, of Westminster Hospital, London, in April, 1821. The date of this operation has been variously stated. O. HEYFELDER (Lehrbuch der Resec- tionen, Wien, 1H63, p. 78) gives the date as 1815, and, on page 88, as 1818, and refers to an article by LIONEL J. BEALE, in the London Medical Gazette, 1832, Vol. IX, p. 853 ; but Mr. BEALE gives no date for the operation. In COOPER S Dictionary of Practical Surgery, 1872, Vol. II, p. 151, it is also stated that the operation was performed in 1818, and Mr. FERGUSSON speaks of the operation as done in 1818 in his paper in the Medico- Chirurgical Transactions, 1845, Vol. X, p. 578, and in his System of Practical Surgery, 1870, 5th ed., p. 407. FOCK (C.), (Bemerkungen und Erfahrungen iiber die Resection im Huftgelenk, in Arclnv fur Klinische Chirurgie, Berlin, 1861, B. I, S. 172) and GOOD (R. R.), (De la resection de I articulation coxo-femorale pour carie, Paris, 1869) correctly state that the operation was performed in 1821. HODGES (R. M.). (The Excision of Joints, Boston, 1861, p. 91) and CULlJERTSON (II.), (Excision of the. Larger Joints of the Extremities ; Prize Essay, in Transactions of the American Medical Association, 1876, Supplement to Vol. XXVII, p. 40) give 1822, and LEPOLD (F.), (Ueber die Resection des Hiiftgelenkes, Inaugural Thsis, WUrzburg, 1834, p. 15) 1824, as the year of the operation. However, in Mr. FERGUSSON s Lecture on Hip Disease, at King s College Hospital, reported in the Lancet, April 7, 1849, at page 361 , is quoted Mr. ANTHONY WHITE S own account of the operation on the boy John West, a twin : "In April, 1821, we met, and the boy being placed on a table, I proceeded," etc., etc., with the operation. This would seem to be conclusive as to the date of the operation. Mr. ANTHONY WHITE S account states further on in the same page (361) that this boy, five years after the operation, became phthisical, and died of diseased lungs in the Westminster Hospital. The pathological specimen was presented by Mr. A. WHITE to the Museum of the Royal College of Surgeons, and numbered 941, and is described at page 230 of Vol. II. 1847, of the quarto catalogue. The patient was a boy, 14 years old, who had suffered from hip disease following a fall received at the age of nine. The head and neck of the femur were excised. The wound healed quickly and quite a useful joint was obtained. The second excision at the hip was performed in 1828, by Mr. HEWSON, of Dublin. The date of IlEWSON s operation is given as 1823 by BONING (E.), (De la resection de la tele du femur, in Annales de la Chirurgie Fran^aisc et tUtrangere, 1844, T. X, p. 391) ; HODGES (R. M.), (loc. cit., p. 91) ; SAYUE (L. A.), (Exseclion of the Head of the Femur and Removal of the Upper Rim of the, Acetabulum for Morbus Coxarius, with perfect recovery, in the New York Journal of Medicine, 1855, Vol. XIV, p. 81); LE FORT (LEON), (La resection de la hanche, etc., Paris, I860), and others ; but the correct date of the operation seems to be 1828, as given by LEPOLD (F.), (ffeber die Resection des H:iftgelenkes, Inaugural thesis, Wurzburg, 1834); OPPENIIEIM (F. W.), (Die Extirpation des Schenkelkopfes aus der Gelenkltohle, in Zeitsclirift fiir die gesammte Medicin, 1836, B.I, S. 137); FOCK (C.), (Bemerkungen und Erfahrungc.n iiber die Resection im Iliiftgelenk, in Archiv filr Klinische Chirurgie, Berlin. 1861, B. I, S. 172); OTIS (G. A.) (loc. cit., p. 10); GOOD (R. R.), (De la rezection de I articulation coxo-femorale pour carie, Paris, 1869). HAKGRAVS (WILLIAM), (A System of Operative Surgery, Dublin, 1831, p. 514) states that the operation was performed "a short time since." The third FIG. 126. Head, excision of the head of the femur, and the first example of the performance of the operation for shot injury, was done by Dr. neck.andpart of shaft Ol PENHEUI of Hamburg, in 1829. Professor LONGMORE, iu his article on Gunshot Wounds of the Lower Extremity, in the second RIB S successful in- edition of A System of Surgery, of Mr. T. HOLMES, New York, 1870, Vol. II, p. 230. remarks : " It is a curious fact, in a historical termediary amputa- point of view, that Sir CHAULES BELL proposed excision of the upper fragments in 1818 [1815?] at Brussels, in the case of Fran9ois tion at the hip, in the <j e Q aVj wno had b een W0 unded nineteen days before at Waterloo, and on whom Mr. GUTIIUIE successfully practised amputation guet. Spec 2929 in at the hip joint the next day instead. The reasons for his advice are preserved in some manuscript notes made about the time of Army Med. Museum the occurrence, in a diary presented to the Army Medical School by Lady Bell, his widow. The chief points are the following: at Netley. I After i jjy proposal is to extract the head of the bone, and do no more. Mr. GUTHRIE S proposal is to amputate the thigh at the hip joint. If the bone be taken out, there is a great cavity and suppuration certainly; but by this means the shock and violence will be saved. I fear the shock of so great an injury, especially as now the wound cannot be cut off (alluding to its extent and sloughing condition), and its injury must be superadded to that of the incisions. The man will readily allow of my proposal, but not of G. s. However, next day he said he would consent. In the meantime I was forced home by business, etc. The separated head and neck of the femur in GUTHRIE S case is preserved in the Museum of the Army Medical Department at Netley, and, both from its intrinsic interest and because it almost exactly corresponds with the fragment in the Crimean case in which resection was successfully performed, a drawing of it is appended." A reduced copy of this drawing is reproduced iu the wood-cut (FlO. 126). 8ECT.UI.J INJURIES OF THE SHAFT OF THE FEMUE. 1.69 SECTION III. INJURIES OF THE SHAFT OF THE FEMUR. In this Section will be considered only injuries of the shaft of the femur unattended by primary injury of the hip or knee joints, and inflicted by weapons of war. Simple and compound fractures produced by other causes are reserved for consideration in Chapter XII of this volume. No sword or bayonet injuries of the femur are recorded on the registers of this Office, and it is, therefore, only necessary to consider the shot injuries of and the operations performed in the continuity of the femur. There are recorded 6,738 shot inju ries of the femur. Of these, 3,620 were treated by the expectant conservative mode; 11 were followed by excision at the hip; 29 by exarticulation of the hip joint; 1 by excision in the shaft and subsequent disarticulation at the hip; 6 by excision in the shaft and sub sequent amputation of the thigh; 168 by excision in the shaft; 2 by amputation of the thigh and subsequent exarticulation at the hip, 1 and 2,901 by amputation of the thigh. The total number of amputations of the thigh to be recorded in this Section will be 6,238, the discrepancies in numbers being due to the many examples of amputation through the thigh in which the operation was performed for shot lesions of the knee joint or leg. The shot injuries of the femur were accompanied by flesh wounds of the upper or lower extrem ities, of the back, and of the chest. Some were attended by fracture of the pelvic bones, of the bones of the leg, and of the upper extremities; and, in a few instances, by pene trating wounds of the chest or abdomen. These instances will be alluded to in the various- subdivisions of this Section; At page 666 of the Second Surgical Volume the number of shot injuries of the shaft of the humerus is stated as 8,245, and, on page 697 of the same volume, the number of amputations in the arm recorded is 5,456. Comparing these figures with, the injuries and amputations of the thigh, it will be seen that while the shot fractures of the humerus exceed the shot injuries of the shaft of the femur by 1,407, the amputations in the thigh are in excess of the amputations in the humerus by 782. The latter fact is, perhaps, to be attrib uted to the perilous nature of shot injuries of the knee joint. Of the 6,738 cases of shot injuries of the femur, 162 were shot contusions and 6,576 were shot fractures. SHOT CONTUSIONS OF THE SHAFT OF THE FEMUR. In treating of shot injuries of the shaft of the humerus in the Second Surgical Volume, at pages 667 and 817, only twenty-two instances of contusion of the humerus could be cited. The examples of shot contusion of the femur are not rare, one hundred and sixty-two instances of this class being found on the registers of this Office: fifty in the upper, thirty in the middle, and forty-two in the lower third; while in forty instances the precise seat of the injury was not stated. Amputation in the thigh became necessary in nine instances, with seven 1 The cases of excisions and exarticulations at the hip for shot injuries of the shaft of the femur have already been considered in the preceding section of this Chapter. For the 11 instances followed by excision at the hip see CASES 206, 208, 216, 220, 229, 233, 239, 243, 261, 263, 266, ante. The 29 cases followed by exarticulation at the hip are: CASES 272, 275, 277, 278, 280, 284, 285, 286, 289, 290, 291, 293, 294, 295, 297, 299, 303, 305, 308, 309, 311, 314, 319, 320, 321, 323, 324, 325, 328, ante. In CASE 298 excision in the shaft was followed by amputation at the hip, and in CASES 329 and 337 exarticu lation at the hip joint had been preceded by amputation of the thigh. SUUG. Ill 22 170 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. fatal results, a mortality of 77.7 per cent., while of the remaining one hundred and fifty- three cases treated without operative interference, thirty-five, or 22.8 per cent., proved fatal: TABLE XIX. Numerical Statement of One Hundred and Sixty-two Cases of Shot Contusion of the Shaft of the Femur. POINT OF CONTUSION. AGGREGATE. TREATED BY CONSERVATION. TUEATHB BY AMPUTATION OF THE THIGH. a O Recovered. a 0) s Ratio of Mortality. a Recovered. & Ratio of Mortality. 50 30 42 40 49 *,O 36 40 33 32 30 1C 5 4 10 32. G 17.8 11.1 25.0 1 o G 1 1 5 100. 50. 83.3 Middle Third of Femur 1 1 Total 1G2 153 118 35 22. 8 9 o 7 77.7 i It is probable that in many cases in which the periosteum or the external layer of the femur was only slightly bruised the injury to the bone remained unnoticed, and that the wound, treated as a simple flesh wound, healed without complication; but generally, after a few weeks suppuration, the surface of the bone became roughened and sometimes slight exfoliation followed: CASE 338. Private H. H. Coombs, Co. D, 6th Maine, aged 22 years, was wounded at Fredericksburg, May 3, 1863, and entered Douglas Hospital, Washington, five days afterwards. Assistant Surgeon W. Thomson, U. S. A., reported: "He was struck by a bullet on the outer side of the right thigh. The missile was extracted from below the crest of the ilium on May 14th, the operation demanding a very extensive incision, which was kept freely open to permit the discharge to escape. The femur had been denuded of its periosteum for several inches, the ball evidently having been deflected upward after impinging upon that bone. This man recovered, and was transferred to Lovell Hospital, Portsmouth Grove, July 3d." The patient sub sequently entered Cony Hospital, Augusta, Maine, whence he was returned to duty October 24, 1864. On June 28, 1865, he was mustered out of service, and subsequently he was admitted on the Pension Roll. The Bangor Examining Board, October 4, 1873, certified to the injury, and adds: "The scar is three inches long, and deep, permitting the finger to pass through the fascia and feel roughened bone. Slight lameness results." Examiner C. Fuller, of Lincoln, Maine, reported, October 20, 1877 : " The cicatrix is now so depressed that the little finger can be laid in it, and the bone below is a little hollowed, the parts around being very tender on pressure. A disagreeable pricking sensation is also produced there on percussion at the bottom of the heel." The pensioner was paid December 4, 1878. The extracted missile, a conical ball, was contributed to the Museum by Assistant Surgeon W. Thomson, and constitutes Specimen 4277 of the Surgical Section. In two cases of shot contusions of the middle third, and in ten of the lower third of the femur, anchylosis or stiffening of the knee joint resulted. One example 1 will be cited: CASE 339. Private W. A. Currier, Co. B, 22d Massachusetts, aged 33 years, was wounded at Fredericksburg, December 13, 1862, and admitted into Harewood Hospital, Washington, four days afterwards. Surgeon T. Antisell, U. S. V. ; recorded the following history: "A minie" ball entered the outer side of the right thigh at the middle third, striking against the femur. The missile was extracted on December 18th, being found to have moulded itself to the cylindrical form of the shaft of the bone. The patient s general health was good. Simple dressings were applied to the wound. On February 11, 1863, the bone was found to be re-covered with periosteum excepting a very small portion, and the wound was allowed to close. On February 20th it had healed ; but, on this day, erysipelas set in, spreading rapidly, and invading the whole leg and the body to the umbilicus. The leg swelled enormously and vesicated over a large portion of its surface, the cellular tissues being distended with serum. Punctures being made, several quarts of serum were discharged. By April 22d the patient had recovered, though he was still debilitated, and there was yet some enlargement. He was discharged from service May 9, 1863, by reason of an oodematous and stiffened condition of the wounded leg." Examiner A. L. Monroe, of Medway, Massachusetts, certified, January 12, 1864 : "The knee cannot be flexed perfectly; the leg is swollen, and the fascia of the thigh seems to have been destroyed by the ery- sipelatous inflammation. The limb will improve, but it will never be perfectly restored." The Boston Examining Board, in 1873, certified to " varicose condition of the veins of the thigh and leg, phlebit.s, etc." Pensioner was paid March 4, 1879. 1 Partial or complete anchylosis of the knee joint following shot contusion of the femur were noted also in the cases of: Pt. D. Brown, E, 8th Mary land. Pt. S. Clark, B, 14th Infantry, anchylosis of knee, necrosis, exfoliation. Pt. H. B. Baker, A, IGth Maine ; in this instance there was almost complete anchylosis at the hip and knee. Corporal J. C. Noteman, D, 8th Wisconsin, partial anchylosis and paralysis. Pt. R. B. Pierce, F, 7th Wisconsin. Pt. H. Schocker, B, 12th Ohio Cavalry. Lieutenant A. D. Detweiler, C, 116th Pennsylvania. Pt. J. D. Page, K, 57th Illinois. Pt. E. J. Russell, G, 10th Regiment Veteran Reserves, partial anchylosis of knee joint, and false anchylosis of ankle joint. Pt. F. De Braymaii, E. 53d Pennsylvania. Pt. J. W. Bowlinger, M, 4th Cavalry. SECT. 111. SHOT CONTUSIONS OF THE SHAFT OF THE FEMUR. 171 FIG. 127. Shot con tusion of left femur. Spec. 4341. Of the grave complications after shot contusions of the shaft of the femur, pyaemia was the most frequent; it supervened in eighteen instances, of which sixteen proved fatal. There were thirteen cases in which serious secondary haemorrhage followed. Two of the patients recovered, eleven died. Three cases of recovery from gangrene, and three fatal cases were reported: CASE 340. Private J. White, Co. A, 4th New Jersey, aged 19 years, was wounded before Peters burg, April 2, 1865, and admitted to the field hospital of the 1st division, Sixth Corps, where Surgeon R. Sharpe, 15th New Jersey, recorded : "Shot wound of left thigh." On the following day he was conveyed to the Depot Hospital at City Point, and one week afterwards he was transferred to Washington. Surgeon R. B. Bontecou, U. S. V., who removed the missile from the patient s limb, made the following report: "He was admitted to Harewood Hospital April 12th with a wound of the upper third of the thigh, the ball enter ing posteriorly, passing upward and inward, impinging against the femur and denuding it of a small portion of its periosteum, and lodging beneath the vastus externus muscle. On April 17th, the ball was extracted by incision, the patient being under the influence of chloroform. The condition of the injured parts and the constitutional state of the patient at the time of the operation were poor. He was suffering from diarrhoea and his progress was unfavorable. On April 19th, pysemic symptoms were developed. The treatment consisted of alteratives, and was supporting throughout. The patient gradually sank, and died April 27, 1865." The upper third of the injured femur was contributed to the Museum by Surgeon Bontecou, and is represented in the adjacent wood-cut (FlG. 127). In the following fatal instance of shot contusion of the shaft of the femur, gangrenous osteomyelitis 1 was found at the autopsy : CASE 341. Private J. Kagrice, Co. F, 198th Pennsylvania, aged 30 years, was wounded during the engagement at White Oak Road, March 31, 1865. Surgeon W. R. DeWitt, U. S. V., recorded his admission to the field hospital of the 1st division, Fifth Corps, with "shot wound of left thigh," and his transfer to City Point on the following day. Several days afterwards the wounded man was transferred to Douglas Hospital, Wash ington, whence Assistant Surgeon W. F. Norris, U. S. A., contributed the specimen (Cat. Surg. Sect., 1866, p. 258, Spec. 4201), with the following history: "The injury was a severe gunshot contusion of the left femur at its middle third. The patient was in good health and spirits at the time of his admission and doing well. The wound was carefully examined, but the ball could not be traced. On April 23d, a large abscess was opened on the anterior aspect of the thigh near the ti ochanter. On the 29th, another similar incision was required in order to give free exit to pus. The patient, however, continued pretty well until May 5th, when he had a chill. This ream-red on May 7th and 8th, and on the 9th, 12th, 13th, and 14th, he had two chills a day. The thigh became painful, the discharge thin and fetid. On May 16th, the patient became delirious, had another chill, and his tongue became swollen and inflamed. He died on the following day. At the autopsy no pleurisy or effusion was found in either thoracic cavity. The lungs, liver, spleen, kidneys, and brain were carefully examined for pysemic abscesses, but appeared healthy. On examining the femur it was found that the ball had struck it at its middle third, contused the bone without fracturing, and, being deflected from its course, had lodged in the hollow above the acetabulum. The hip joint was healthy and uninjured. A longitudinal section was made of the femur, which exhibited well marked gangrenous osteomyelitis, the medulla being of a dirty greenish color, dry, pulverulent, and excessively fetid. The interspaces between the cancelli contained a dark greenish liquid, a quantity of which escaped in sawing the bone, and was also extremely offensive. The bone where the missile had struck had become necrosed and nearly separated, and around this partial exfoliation a ring of new bone had formed. A portion of the injured femur is illustrated in the adjacent wood-cut (FlG. 128). Besides the specimens referred to in the preceding two cases the Army Medical Museum possesses nine representations of shot contusions of the shaft of the femur, 2 and several missiles flattened by impact with the bone. 3 1 Dr. J. A. LlDELL in his excellent paper on Contusion and Contused Wounds of Bone, with an Account of Thirteen Cases, in Am. Jour. Med. Set.. 1865, Vol. L, p. 17, gives the following as the principal pathological effects of contusions of bone: 1. Ecchymosis of the osseous tissue; 2. Ecchymosis of the medullary tissue ; 3. Osteom yelitis of a simple character; 4. Necrotic osteitis ; 5. Suppurative osteomyelitis ; and C. Gangrenous osteomyelitis. 2 Specimen 291 ( Cat. Surg. Sect. A. M. M., I860, p. 259): The upper third of the right femur, necrosed one inch below the trochanter minor ; the adjacent bone is honeycombed by suppuration. Spec. 759 (Cat., p. 334), showing exfoliation and some periosteal thickening in the lowest third of the right femur. Spec. 1671 (Cat., p. 25!l): Section of right femur, showing an exfoliation about to separate, and some necrosed action. Spec. 2675 (Cat., p. 259): Contusion at the inner surface of the middle third of the right f<?mur; the bone is necrosed and greatly roughened by suppuration. Spec. 3106 (Cat., p. 253): Portion of shaft of middle third of left femur contused by a ball, which split and escaped in two pieces; the bone is necrosed where struck by the ball ; an abscess was found in the medullary canal corresponding with this spot. Spec. 3873 (Cat., p. 258): A section of the upper third of the left femur contused by shot; there is a slight degree of caries with widespread periosteal disturbance. Spec. G716: Part of the left femur slightly contused. The specimen is sawn longitudinally, exhibiting diseased action of the bone. Spec. 2437 (Cat., p. 283): The lowest third of the left femur amputated for contusion above the inner condyle, where it is locally carious. Spec. 1985 (Cat., p. 258), see CASE 34, p. 21, ante. 3 Specimen 4277 (Cat. Surg. Sect. A. M. M., I860, p. 609) has been alluded to in CASE 340. Spec. 2726 (Cat., p. 598): A spherical ball, with a small concave impression caused by contact with the shaft of the femur, in the case of J. C , Co. I, 1st Ohio Artillery. Spec. 3009 (Cat., p. 604): A conoidal riflo ball from which a smooth slice has been removed on one side; case of T. McO , 1st Vermont Cavalry. FlG. 128. Shot contusion of left femur.5pec.420). 172 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Ligations after Shot Contusions of the Femur. At page 47 were tabulated, it will be remembered, one hundred and twenty-seven cases of ligation of the femoral artery for shot flesh wounds of the thigh, with ninety-one deaths, a mortality rate of 71.7 per cent. To this series of operations must be added seven instances of ligations of the femoral following shot contusions of the femur, the patients perishing in every instance: CASES 342-348. Private G. Coleman, Co. F, 94th New York, aged 19 years ; wounded August 29, 1862 ; slight injury of upper third of femur. December, 1862, ligation of femoral artery on account of secondary hemorrhage; pysemia. Died December 3, 1862. Sergeant G , 16th Illinois ; mini6 ball passed through left thigh about three and a half inches above the knee joint, grazing the femur; admitted into the hospital of the 2d division, Fourteenth Corps. Surgeon E. Batwell, 1 14th Michigan, reported that on the eleventh day considerable haemorrhage occurred, eight or ten ounces of blood being lost. The tourniquet was loosely applied. The bleeding recurred on the twelfth and thirteenth days, when Dr. Batwell cut down and tied the main vessel in the middle stage of its course. He seemed comfortable for about thirty-six hours; but notwithstanding all the efforts used to keep up the temperature of the leg and to nourish and support his system, he gradually sank into a comatose condition, and died on the eighteenth day after the reception of the injury. Private A. Kitzing, Co. H, 57th New York, aged 40 years; wounded at Fredericksburg, December 13, 1862, a musket ball passing through the left popliteal space. December 20th, violent haemorrhage from inner orifice of wound. Surgeon J. P. Prince, 2 36th Massachusetts, immediately placed a ligature on the femoral at the angle formed by the sartorius and adductor magmis muscles, which entirely controlled the haemorrhage. The bleeding recurred and continued to increase, notwithstanding the use of styptics and pressure, and, on December 23d, the left thigh was amputated at the upper part of the lower third. Pyaemia developed, and the patient died January 12, 1863. The specimen of the injured knee was forwarded to the Army Medical Museum by the operator, Dr. Prince, and is numbered 535 of the Surgical Section. The femur has been grazed above the condyle and the popliteal artery cut across by a bullet (Cat. Surg. Sect., A. M. M., 1866, p. 457). Private J. Eoberts, Co. A, 9th West Virginia, aged 31 years; wounded at Winchester, July 20, 1864; shot wound of left thigh, denuding upper third of femur of its periosteum; missile lodged, and was extracted July 27th; haemorrhage set in on July 29th, and Surgeon J. B. Lewis, U. S. V., ligated the femoral artery. Typhoid symptoms supervened, and the patient died August 24, 1864. Private J. Scott, Co. D, 69th New York, aged 30 years; \vounded at Petersburg, July 24, 1864; ball entered upper part of left thigh, striking the femur and denuding it of its periosteum for two inches. August 4th, haemorrhage to the extent of one pint; limb bandaged from distal extremity and wound plugged with lint saturated Avith per sulphate of iron. Bleeding recurred on the next day, and Acting Assistant Surgeon 11. M. Dean ligated the femoral artery in Scarpa s space, about three inches below Poupart s ligament. The case progressed favorably until August 20th, when he had a slight chill followed by profuse perspiration. He died August 21, 1864, of pysemia. The pathological specimens in the case, consisting of the femoral artery, the contused portion of the shaft of the femur, and the femoral vein, were forwarded to the Army Medical Museum, and are numbered 3105, 3106, and 3118, respectively, of the Surgical Section. They were contributed by the operator, Dr. Dean. Sergeant S. Van Wie, Co. B, 62d Ohio, aged 25 years, was admitted into the hospital at Beverly, New Jersey, August 21, 1864, with a shot wound of the left thigh, injuring the bone, received at Deep Bottom, August 16, 18{54. Parts in sloughing condition. September 28th, secondary haemorrhage to extent of eight ounces. Acting Assistant Surgeon J. C. Morton ligated the femoral artery. Patient died September 29, 1864, from exhaustion. Private A. Young, Co. F, 1st Mis souri Cavalry, was wounded at Cape Girardeau, April 26, 1863. He was admitted into the post hospital at Cape Girardeau, and Surgeon H. A. Martin, U. S. V., reported that a minie ball entered the lower third of left thigh, struck the femur without frac turing it, and lodged in the perineum. The ball was removed, in a flattened state, May 8th. Profuse haemorrhage occurred on May llth. The femoral artery was ligated above and below the seat of injury on May 17th. The haemorrhage did not recur, but the patient sank, and died May 20, 1863. One fatal instance of ligation of the profunda for secondary haemorrhage following shot contusion of the shaft of the femur is found recorded on the registers of the Office: CASK 349. Corporal James Sturgis, Co. G, 85th Pennsylvania, received at Deep Bottom, Virginia, August Hi, 1864, a shot wound of the left thigh, the missile injuring the femur. He was admitted into the hospital at Beverly, New Jersey, August 21st. The parts began to slough; haemorrhage to the amount of sixteen ounces occurred, and, on November 1st, the profunda was ligated in the continuity by Acting Assistant Surgeon J. C. Morton. Haemorrhage recurred from the point of ligation, and death ensued November 6, 1864. Adding to this the six cases of ligation of the profunda for haemorrhage following shot flesh wounds of the thigh, recorded on page 49, ante, we have seven instances of this operation with five deaths, in shot injuries of the thigh without fracture of the fernur. Amputations consequent on Shot Contusions of the Shaft of the Femur. In nine instances of shot contusions of the shaft of the femur amputation of the thigh was per formed. Four were intermediary,. five secondary operations; the former proved fatal; of 1 BATWELL (E.), Notes of Army Practice Ligation of the Femoral Artery for Secondary Hnsmorrhage, in Med. and Surg. Rep., 1865, Vol. XII, p. 254, and LlDELL (J. A.), United States Sanitary Commission Memoirs, New York, 1870, Surgical Volume I, p. 186. 2 PRL\CE (J. P.) (Surgical Cases Wound in the Popliteal Space Secondary Hamorrhage Amputation in Boston Mcd. and Sury. Jour., 1863, Vol. LXVIII, p. 70) gives a detailed account of the case. SECT. III.] SHOT CONTUSIONS OF THE SHAFT OF THE FEMUR. 173 ti the latter, two recovered. The seat of contusion was in the upper third in one instance, in the middle in two, and in the lower in six instances ; while four amputations, with one recovery, were practised in the upper third; one, fatal in the middle third; and four, with one successful issue, in the lower third. The cases will be briefly detailed : CASES 350-358. Private H. F. Rugg, Co. H, 2d New York Heavy Artillery; wounded at Cold Harbor, June 3, 1864 ; a mini6 ball passed through the middle third of the right thigh, injuring the bone and causing necrosis. Circular amputation of the thigh at the upper third was successfully performed at Blairsville, Pennsylvania, on January 24, 1866, by Drs. St. Clair and T. M. Laney. The pensioner was paid in 1878. Lieutenant W. D. Templin, Co. D, 32d Iowa, aged 26 years; wounded at Bayou de Glaze, Louisiana, May 1?-, 1864; missile entered two inches above knee internally and posteriorly and passed downward and outward, slightly grazing the femur. On July 22d, Surgeon E. Powell, 72d Illinois, amputated the left thigh at the lower third. The> patient recovered and was discharged March 30, 1865, with a sound stump. Private 7?. L. Donald, Co. B, 27th North Carolina, wounded at Anfietatn, September 17, 1862, through the middle of the left thigh, and admitted to the hospital at Ches ter, Pennsylvania, October 2d. Necrosis and hectic supervening, and death being imminent, amputation at the junction of the middle and upper thirds of the thigh was performed by Dr. J. Ashhurst, jr., 1 by circular incision, November 6, 1862. The patient, with great difficulty, rallied from the shock of the operation; but subsequently sank suddenly, and died seven hours afterwards. Dr. Ashhurst contributed the specimen of the injured femur to the Army Medical Museum. It is numbered 863 of the Surgical Section, and consists of "five inches of the shaft of the left femur, showing local necrosis after contusion by a conoidal ball in the upper third. A moderate deposit of callus has occurred adjacent to the seat of injury. The specimen is an interesting illustration of serious injury without complete fracture." (FlG. 129.) (Cat. Surg. Sect., A. M. M., 1866, p. 288.) Private B. A. Elmore, Co. B, 6th Michigan Cavalry, aged 18 years, received, near Old Church, Virginia. May 28, 1864, a shot wound of the left knee joint. "A conical ball entered the joint from the front, and passing backward and upward, impinged against the inferior epiphysis of the femur, glanced, and passing upward, lodged high among the muscles of the thigh, deep. Knee and thigh considerably swelled. Track of bullet emphysematous, filled with thin, dirty looking, offensive pus. The emphysema and suppuration extended as high up as the junction of the middle and superior thirds of the thigh. June 5th, thigh amputated high up in the upper third by the double flap method. The bullet dropped out while cutting the posterior flap. There was but trifling loss of blood during the operation, and the patient reacted promptly. June 6th, feverish and restless, pulse rapid. June 10th, pyaemia developed. Died June 17, 1864." The operator, Surgeon John A. Lidell, U. S. V., contributed the portion of the femur removed, together with the history of the case, to the Army Medical Museum. The specimen is numbered 2437 of the Surgical Section, and consists of the " lowest third of the left femur. It is contused above the inner condyle, where it is locally carious. The specimen is sawn open longitudinally, exhibiting diseased action to the center of the bone." (Cat. Sury. Sect., A. M. M., 1866, p. 283.) Captain G. Grecheneck, Co. A, 72d New York, received, at Williamsburg, Virginia, May 4, 1862, a gunshot wound of the right popliteal space. Surgeon R. B. Boritecou reported that a minie ball transfixed the thigh between the hamstrings and condyles of the femur, grooving that bone slightly at the attachments of the gastrocnemius muscles and injuring the artery and nerve. The foot became gangrenous, and amputation in the lower third of the thigh, by circular operation, was done. Gangrene attacked the stump on the 15th, and he died May 16, 1862. Private Lafayette Hoyan, Co. G, 14th Tennessee, was admitted into Lincoln Hospital, Washington, Decem ber 23, 1862, with a gunshot wound of the right knee. Amputation at the lower third of the thigh was per formed on the day of admission. The patient died January 1, 1863, from haemorrhage. Assistant Surgeon G. M. McGill, U. S. A., forwarded the pathological preparation (Specimen 1891, Section I) to the Army Medical Museum. It consists of "a ligamentous preparation of the bones of the right knee, except the patella, amputated in the lowest fourth, apparently for a contusion just above and behind the outer condyle." ( Cat. Sury Sect., A. M. M., 1866, p. 338.) Private J. L. Hudson, Co. 1, 59th Illinois, aged 18 years, received, at Nashville, December 15, 1864, a shot wound of the right thigh just above the knee joint, the ball grazing the femur and denuding it of its periosteum. The wound progressed favorably until December 30th, when the structures of the joint became implicated. An abscess made its appearance just below the patella. The patient became much debilitated. On January 25, 1865, Acting Assistant Surgeon F. B. Nossinger ampu tated the right thigh at the middle third by the circular method. Great prostration followed. Irritative fever ensued, and the patient died February 1, 1865. The case of Private A. Kitzing, Co. H, 57th New York; wounded at Fredericksburg, December 13, 1862, whose thigh was amputated on account of recurrent bleed ing after ligation of the femoral artery, has been alluded to on page 172, ante, CASE 344. Private M. Shay, Co. B, 61st New York, aged 20 years, received, at Antietam, September 17, 1862, a shot wound of the anterior aspect of the right thigh ; the femur was bruised ; ball lodged. October 20th, ball found lying against the femur, at upper third, and removed. The discharge became profuse and offensive and the patient failed daily. November 15th, flap amputation of right thigh at the upper third by Surgeon H. S. Hewit, U. S. V. The patient died November 24, 1862. Dr. Hewit contributed the specimen shown in the wood-cut (FlG. 130). There is "a large portion of necrosed bone nearly detached, with very little callus." He also forwarded the preparation of the right femoral artery to the Museum. It is numbered 853 of the Surgical Section. 1 Dr. ASHIIURST, in a published account of this case (Surgical Cases, Illustrating some Practical Faints, in Am. Jour. Med. Sci., 1863, Vol. XI/V, p. 343), states that: " The wound, which appeared to be simply a flesh wound, did well, and was nearly healed, when, from some then unknown cause the track reopened, and by the probe and little finger dead bone was detected about the middle of the left femur." - FIG. 129. Shot contusion of shaft of left femur. Spec. 863. FlG. 130. Necrosis of the right femur. Spec. 109(>. INJURIES OF THE LOWER EXTREMITIES. |CHAP. x. The left thigh was amputated in three, the right in six instances; of the latter, two recovered. The modes of operation selected were: The circular amputation five times, the flap operation twice; in two instances the manner of operation was not indicated. Seven amputations were practised on Union, two on Confederate soldiers. Comparing the results of cases of shot contusion in the shaft of the femur with the results of analogous cases in the shaft of the humerus, we find that of one hundred and sixty-two contusions in the femur forty-two, or 25.9 per cent., proved fatal, while of twenty- two patients with contusion of the humerus only four, or 18.1 per cent., succumbed, and that while in not a single instance of contusion of the humerus operative interference was deemed necessary, nine amputations of the thigh were practised for complications following shot contusions of the femur. 1 The serious consequences ascribed to injuries of this nature by Dr. Lidell have been alluded to on page 171, ante. Professor L. Stromeyer, Dr. H. Gibbons, Professor A. Liicke, M- Jobert (de Lamballe), Dr. C. Heine, and Dr. J. Arnold 2 have noted the complications accompanying shot contusions of the femur; but only a few writers on military surgery have cited instances of such injuries. 3 SHOT FRACTURES OF THE SHAFT OF THE FEMUR. Shot fractures of the shaft of the femur were considered as almost universally fatal by the older writers on military surgery, and amputation of the thigh was regarded by many as the only means of saving the patient s life. 4 But the many successful attempts at preservation of the limb in cases of shot fracture of the femur within the last twenty years leave no doubt as to the value of the conservative treatment of such fractures. 5 Six thousand five hundred and 1 SCHWARTZ (H.) (Beitrage zur Lehre von den Schusswunden, Schlesswig, 1854, p. 147), in a very interesting chapter, carefully notes the frequently serious consequences following shot contusions of the femur, and remarks that: "Notwithstanding the most careful treatment, the attempts at conserva tion not rarely necessitate consecutive amputation as a last means of saving the life of the patient." A. J. JOBERT (de LAMBALLE) (Plaies d armes a feu, Paris, 1833, p. 255) refers to contusions with denudation of the femur, and cites a case in which he amputated the thigh unsuccessfully. 2 STROMEYER (L.), Ueberdiebei Schusswunden varlcommenden Knochen verlelzungen, Freiburg, 1870, p. 3. GIBBONS (H.), Contused Wounds of Bone, in the Pacific Med. and Surg. Jour, and Press, San Francisco, 1866, Vol. VIII, p. 284. LtiCKE (A.) (Kriegscliirurgisclte Aphorismen aus dem Zweiten Schleswig Holsteinschen Kriege im Jahre 1864, Berlin, 1865, p. 67) remarks that contusions of the femur by musket balls are very severe injuries, frequently misapprehended, and followed by ostitis, osteomyelitis, and even osteophlebitis, ar.cl cites three cases of which one proved fatal. JOBERT (A. J. de LAMBALLE), Contusion des os, in L Union Medicate,, Paris, 1865, T. XXV, pp. 263. 337. HEIXE (C.), Die Schussverletzungen der unteren Extremitaten, Berlin, I860 , p. 164, etc. ARNOLD (J.) (Analomiiche Beitrage zu der Lehre von den Schusswunden, Heidelberg, 1873) describes the path ological changes following contusions of the femur as observed in his autopsies of six cases of this injury. 3 LARREY (H.) (Hist. Chir. du siege de la Citadelle d Anvers, Paris, 1833, p. 202, etc.) cites three successful instances of shot contusion of the femur, and adds: "Les resultats cons6cutifs de cette blessure, constates & 1 hopital, ont e~t6 raflh6rence dela principale cicatrice, 1 atrophie et 1 ankylose du genou." CHENU (J. C.) (Rapport, etc., pendant la Campagne d Orienl en 1854, 1855, 1856, Paris, 1865, p. 374) tabulates 146 cases of shot contusion of the femur with 22 deaths, a mortality of 15.0 per cent. MATTHEW (T. P.) (Med. and Surg. Hist, of the British Army, etc., London, 1858, p. 355) tabulates 43 cases of shot contusions and partial fractures of the lower extremities, but it is impossible to eliminate from his tabulations the number of shot contusions of the femur. CHEXU (J. C.) (Stat. Med. Chir. de la Camp, d Italic en 1859 et I860, Paris, 1869, p. 715) groups 103 shot contusions of the femur with 13 deaths. SCHIXZINGER (A.) (Das Reserve-Lazareth Schwetzingen im Kriege 1870 und 1871, Freiburg, 1873, p. 69) observed 10 cases of shot contusion of the femur. One of the cases proved fatal from pysemia, another succumbed to ansemia following arterial bleeding. SCIlULLER (MAX.) (Kriegschirurgische Skizzen aus dem Deutsch-Franzosischen Kriege, 1870-71, Hannover, 1871, p. 66) cites 2 cases of shot contusion of the femur, one in the middle, the other in the lower third ; both recovered. BECK (B.) (Chir. der Schussverletzungen, Freiburg, 1872, p. 677) reports 15 cases of shot con tusions of the femur in the Bavarian (XII) Corps during the Franco-Prussian War, 1870-71, of which 3, or 20 per cent., proved fatal, and remarks: " That the shot contusions, although entirely innocuous looking in the beginning, are apt, in the progress of the case, to prove dangerous, and to convince the surgeon how careful ho must be not to overlook the sneaking initiatory processes of inflammation of the periosteum and the interior of the bone." 4 RAVATOX (Chirurgie d Armee ou Traite des Plaies d armes a feu, etc., Paris, 1768, p. 323): Les coups de feu qui fra^ssent 1 os de la cuisse dans son cntier, sont si facheux quo j ai vu pgrir tous ceux qui 1 ont eu fracture." SCHMUCKER (J. L.) ( Vermischte Chir. Schriften, Berlin und Stettin, 1785, p. 42): " If the fracture is in the lower part of the bone, the danger is relatively a great deal less, as the muscles are not very powerful here, and, in such a fracture, amputation should not be at once performed, but all other means should first be tried; and very frequently T have happily cured fractures of this kind; but if the femur is fractured and splintered in the middle or above the middle, I never wait for complications, but perform the operation before they occur, and several times I have cured patients where the operation has been done soon." BAUDENS (L.) (Clinique des plaies d armes a feu, Paris. 1836, p. 460) remarks: " Toute fracture de cet os [femur] par coup de feu exige 1 amputation immediate," and, on page 461, adds, that of 25 cases with fracture of the femur treated by expectation, only two recovered with deformed limbs, incapable of fulfilling their functions. MACLEOD (Notes on the Surgery of the War in the Crimea, London, 1858, p. 296) advises primary amputation in fractures of the middle and lower thirds of the femur ; but where the fracture is in the upper third of the bone he concludes " that slight as the chance of saving life is in any case, it is still our part to attempt con solidation in preference to amputation." LARREY (D. J.) (Mem. de Chir. Mil. et Camp., Paris, 1812, T. II, p. 503) refers to a case of simple shot fracture of the femur without notable lesion of the soft parts for which amputation had been performed on the 40th day, and remarks : "Jo no ddsapprouve point cette operation ; car mon exp6rience m a appris quo toutes les plaies avec fracture de la cuisse sont tres-faehouses, et exigent toutes en g6n6ral 1 amputa tion qu on no peut pas toujours pratiquer dans les premiers momens, et c est un des cas ou ello pout etro faite consdcutivement." S HEINE (C.) (Die Schussverletzungen der unteren Extremitaten, Berlin, 1866, p. 234) declares : " To-day it must be accepted as an axiom that in all cases of shot fractures of the femur by small projectiles, uncomplicated by injury of the femoral artery or by opening of the knee joint, the conserva tive treatment should by all means be tried." SECT. III.] PARTIAL SHOT FRACTURES OF THE SHAFT OF THE FEMUR. 175 seventy-six shot fractures of the diaphysis of the femur were found on the returns, furnish ing examples of every variety of partial fracture, of comminution of bone, of longitudinal fissuring, of oblique or transverse fracture, and of detachment of large fragments. Of these six thousand five hundred and seventy-six shot fractures of the femur three thousand four hundred and sixty-seven were treated by conservation, and three thousand one hun dred and nine were followed by excision either in the shaft of the femur or at the hip joint, or by amputation of the thigh or exarticulation at the hip. TABLE XX. Numerical Statement of Sixty-jive Hundred and Seventy-six Shot Fractures of the Shaft of the femur unattended by Primary Injury of the Hip or Knee Joint. TREATMENT. FRACT. IN UPPER THIRD. FRACT. IN MIDDLE THIRD. FRACT. IN LOWER THIRD. POINT OF FRACTURE UNSPECIFIED. 1 o Recovered. a <u ft Undeter mined. Ratio of Mortality. 3 a o Recovered. d 5 Undeter mined. Ratio of Mortality. 1 Recovered. a V> S Undeter mined. Ratio of Mortality. 3 1 o Recovered. 3 5 5 Undeter mined. Ratio of Mortality. 1,254 11 25 73 1 1 669 4 2 25 572 7 23 47 1 1 13 1 46.0 63.6 92.0 65.2 100.0 100.0 73.3 855 500 342 13 40.6 620 375 232 13 38.2 738 145 538 55 78.7 Excision at the Hip Joint. . Amputation at the Hip Joint. Excision in Shaft of Femur Excision in Shaft of Femur and Amp. at Hip 3 56 1 17 2 38 1 66.6 69.1 1 16 1 100.0 4 10 o 71.4 23 3 16 4 84.2 Excision in Shaft of Femur and Amp. in Thigh 3 355 o 1 156 1 2 195 1 4 66.6 55.5 50.0 2 1,120 1 606 1 496 50.0 92 24 66 2 18 45.0 1,325 461 801 63 63.4 Amputation in Thigh and Consec. Amp. at Hip 986 33 1,457 724 717 16 49.7 1,274 676 580 18 46.1 1,759 740 42.8 2,086 609 1,355 122 68.9 It was found impracticable to eliminate from the large number of cases aggregated in TABLE XX the instances of partial shot fractures of the shaft of the femur, as frequently the diagnosis was too vague to allow a distinction to be made between a complete fracture or a partial fracture. The Army Medical Museum possesses eighteen 1 specimens of partial 1 Specimen 126 (Cat. Surg. Sect. Army Med. Museum, 1866, p. 260), the upper part of the left femur, the great trochanter being carried away by ;i grape shot. Spec. 134 (Cat., page 260), upper half of left femur with a section of the shaft just below the great trochanter gouged out: Pt. A. B , Co. Gr, 152d New York, aged 34 ; wounded June 10, 1864 ; died, of asthenia, August 29, 1864. Spec. 1594 (Cat., p. 261), the upper portion of the left femur, with the great trochanter badly grooved by a musket ball : Corporal J. M , E, 39th Massachusetts, aged 19 ; wounded at Petersburg, April 1, 1865; died, exhausted after pleuro-pneumonia, August 17, 1865. Spec. 2132 (Cat., p. 259), the upper fourth of the right femur, the great trochanter being partly fractured. Spe.c. 2197 (Cat., p. 258), the right femur chipped and contused on anterior and inner face: Pt. G. S , Co. E, 88th Illinois, aged 27; wounded at Mission Ridge, November 27, 1863; died, from exhaustion, February 18, 1864. Spec. 2995 (Cat., p. 260), the upper third of the left femur partially fractured at the level of the trochanter minor: Pt. E. P , Co. A, 38th Mass., aged 19; wounded at Port Hudson, June 14th; died, from exhaustion, July 27, 1863. Spec. 3433 (Cat., p. 259), the upper third of the left femur contused and partially fractured : Pt. W. V , Co. F, 12th Penn. Cavalry, aged 20 ; wounded at Winchester, July 24th ; died, of typhoid fever, September 29, 1864. Spec. 3956 (Cat., p. 261), the shaft of the left femur sawn longitudinally, showing an oblique partial fracture by a conoidal ball, which chipped the shaft in its outer border: Serg t J. O B , Co. F, 42d New York, aged 30; wounded at Antietam, September 17, 1862; died, from pyaemia, February 17, 1863. Spec. 140 (Cat., p. 260), the lowest third of the left femur grooved two inches above the condyles : Serg t H. D , Co. E, 2d X. Y. S. M.; wounded at Bull Run, August 30th ; died October 10, 1862. Spec. 916 (Cat., p. 260). the lower half of the left femur, penetrated in the lowest third, with a slight osseous deposit on the neighboring portion of the shaft: Serg t L. B , Co. A, 7th Wisconsin; wounded at South Mountain, September 14th; died December 29, 1862. Spec. 1104 (Cat., p. 259), tho lower half of the left femur severely contused in the lowest third, with an oblique fissure around the bone. Spec. 1757 (Cat., p. 261), the lowest third of the right femur obliquely perforated above the external condyle: Pt. M. K ,4th Ohio Cavalry; wounded July 10th; ligation of popliteal and femoral arteries on account of recurrent haemorrhage ; died, from exhaustion, August 14, 1863. Spec. 1788 ( Cat., p. 260), the lower half of the right femur partially split, with a longitudinal fragment nearly detached: Pt. O. B. N , Co. K, 3d Michigan Cavalry; wounded near Jackson, July 15th; died October 2, 1863, of pyaemia. Spec. 1924 (Cat., p. 260), the lowest third of the left femur grooved on the outer aspect from before backward: Pt. S. T. C. , Co. E, 17th Kentucky; wounded at Chickamauga, September 19th; died November 5. 1863. Spec. 2370 (Cat., p. 261), the lower half of the right femur chipped by a bullet on the outer side; part of the injury repaired by a deposit of callus : Pt. A. R , Co. A, 2d Penn. Cavalry; wounded at Mine Run, November 29, 1863; taken prisoner, paroled, and admitted into hospital, Baltimore, April 18, 1864 ; died, May 22, 1864, of pyaemia. Spec. 4271 (Cat., p. 261), the lowest third of the left femur, showing partial fracture of the laminated portion of the shaft just above the condyles, with a longitudinal fissure upward: Corp l J. E. T) , Co. O-, r?4th Massachusetts: wounded at Newmarket. May 15th: died, with typhoid symptoms, June 5, 1864. 176 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X PIG. 131. Partial shot fracture of right femur. Spec. 3339. shot fractures of the shaft of the femur. Two instances will here be cited, and then the shot fractures of the femur treated by expectation, according to the seat of the injury in the upper, middle, and lower thirds, will be considered. CASE 359. Private O. C. Higgins, Co. D, 31st Maine, aged 24 years, was wounded before Peters burg, June 23, 1864. Surgeon J. Harris, 7th Khode Island, reported bis admission into tbe field hospital of the 2d division, Ninth Corps, with a "shot wound of thigh caused by a musket ball." From the field hospital the wounded man passed to the Depot Hospital at City Point, and thence, on July 3d, to the Third Division Hospital at Alexandria. Surgeon E. Bentley, U. S. V., in charge of the latter, reported the fol lowing description of the injury and its result : "A conical explosive ball entered the external aspect of the middle third of the right thigh anteriorly, and, exploding, scattered fragments of lead through the thigh and partially fractured the femur, not, however, preventing the patient from using his leg at will. Water dressings were applied. When admitted the patient was not in good condition, having been suffering from diarrhoea for some time, for which astringents were given. On July Cth, he was somewhat improved. The cold-water dressings were changed to warm. By July 10th the diarrhoeal discharges had ceased, but the wound was very much inflamed. On July 15th, a slight discharge of dark and unhealthy pus set in, and flaxseed poultices were applied. Tonics and stimulants were administered. On July 21st, the patient felt better, and his treatment was continued. Two days later there were dark and unhealthy discharges from the wound, but the patient looked bright and his tongue was cleaning. Death occurred suddenly at 4 A. M., 011 July 24, 1864, the patient having been given water to drink about an hour previously by the nurse, and no signs of rapid exhaustion being then apparent. The post-mortem examination, made nine hours after death, showed the thigh filled with fragments of the bullet, and a partial fracture of the femur; there was profuse suppuration above and around the bone, and great emaciation. The viscera were found to be perfectly healthy." The upper two-thirds of the injured femur were contributed to the Army Med ical Museum by Dr. Bentley, and are represented in the wood-cut (FlG. 131). The specimen shows the existence of local necrosis, with trivial osseous deposit near by, and the traces of profuse suppuration following the fragments of lead are seen in the roughening of the shaft. In another instance of partial shot fracture of the shaft of the femur, the ball, at the autopsy, was found lodged in the medullary cavity : CASE 360. Corporal J. Higgins, Co. A, 159th New York, aged 19 years, was wounded at Irish Bend, April 14, 1863. Surgeon T. B. Reed, U. S. V., reported his admission to the field hospital of the 4th division, Nineteenth Corps, with a "shot wound of leg." Assistant Surgeon P. S. Conner, U. S. A., contributed the pathological specimen represented in the annexed wood-cuts (FlGS. 132, 133), with the following history: "The patient entered University Hospital, New Orleans, April 17, 1863. Upon examination he was found to have a wound just below and external to the head of the left fibula, the track of the ball being upward and inward. The missile had not been extracted nor could it be detected. There being no evidence of fracture, the case was regarded as a simple flesh wound and treated accordingly. On the seventh day after admission haemorrhage supervened, but upon cutting down tlii ough the popliteal space no bleeding vessel could be detected, and no further h;emorrhage occurred. On passing the finger along the track of the wound the superior margin of a cavity was felt, which appeared to be a portion of the femur partially split off and thrown backward. There being no displacement or other evidence of fracture extend ing entirely across the shaft, and the man being unable to give any account of his position at the time of receiving the injury, it was concluded that the ball had lodged in the femur. Though much prostrated by the loss of blood the patient was rallied by careful nursing. As a precautionary measure the limb was placed in an anterior splint after a few days, from which time the case progressed quite favorably until May 15th, when rigors came on and the patient failed rapidly. He died on May 18, 1863, thirty-five days after being wounded. At the post-mortem examination no inflammation of the knee joint was discovered, but little pus at the seat of the injury, and no abscesses in the lungs or liver. An inspection of the specimen indicates that the leg must have been strongly flexed on the thigh at the time the man was shot." The specimen shows longitudinal fractures on the anterior surface of the bone, with some periosteal thickening, and the ball lodged in the medullary canal. SHOT FRACTURES OF THE SHAFT OF THE FEMUR TREATED BY CONSERVATION. The shot fractures of the shaft of the femur treated by conserva tion numbered three thousand four hundred and sixty-seven. The result of the injury could not be ascertained in ninety-four instances. Sixteen hundred and eighty-nine patients recovered, and sixteen hundred and eighty-four, or 49.9 per cent., died. The injury was on the right side in fourteen hundred and thirty-one instances, with a mortality rate of 47.0 per cent.; on the left in sixteen hundred and five, of which 47.1 per cent, died; in four hundred and thirty-one cases the side of the injury was not specified. The seat of fracture FIG. 132. Lowest third of right femur, with ball in medullary canal. Spec. 1296. FIG. 133. Anteric view of Spec. 129G. SECT, ni.1 SHOT FRACTURES OF THE UPPER THIRD OF THE FEMUR. 177 was in the upper third in twelve hundred and fifty-four instances; in the middle third, in eight hundred and fifty-five; in the lower third, in six hundred and twenty cases; and in seven hundred and thirty-eight instances the precise seat of fracture was not stated. Shot Fractures of the Upper Third of the Femur treated by Conservation. Very few instances of recovery after shot fractures in the upper third of the femur treated by expectation seem to have been reported by the older authors on military surgery, and I have been unable to find more than eight examples of recovery after this class of injury prior to the beginning of the present century. In the subjoined foot-note 1 an attempt is made to collect the instances of recovery after fractures in the upper third of the femur, to show that in later years these cases have been by no means as rare as has generally been believed, and, indeed, the results obtained in the American Civil War, and, subsequently, 1 The earliest instance of shot fracture of the upper third of the femur that I have been able to trace is a case reported by Dr. JOSEPH SCHMIDT. In his Speculum Chirurgicum oder Spiegel der Artzney, Augspurg, 1656, p. 144. J. von Meda, of Captain Newmann s company, received a shot fracture of the upper third of the femur, August 31, 1648, at Meramingen. He recovered and was able to go about on crutches. PUBMAJfX (M. G.) (Funfftzig Sonder-und Wunderbahre Schusswunden Curen, Franckfurt, 1721 ) reports three cases of recovery after shot fracture of the upper third of the femur, viz : The case of a soldier wounded at Ttlrckshansen, in November, 1671 (Obs. I, p. 32); the case of Corp l C. Endte, wounded before Stettin in 1677 (Obs. XVIII, p. 213), and. the case of M. Leschke, wounded before Wolgarth in October, 1675 (Obs. XXXIII, p. 250). BKLLOSTE (Le Chirurgien d Hopital, 3d ed., Paris, 1716, p. 206) relates the case of Sergeant LeGrand, who received, in 1686, a shot fracture of the upper portion of the right femur, and, after copious suppurations with exfoliations, recovered. The ball and a fragment of the femur were extracted eighteen months after the injury. RAVATOX (Chirurgie d Armie, Paris, 1768, p. 338) relates that at the battle of Dettingen, July 5, 1743, a lieutenant of cavalry received a shot fracture of the right lesser trochanter. On the 55th day five pieces of bone came away, and the wound cicatrized without further accident. MOSCATI (Hem. de VAcad. de Clrir., Paris, 1768, T. IV, p. 625) relates the case of a soldier of 35, who, at the battle of Crevelt, June 23, 1758, received a shot fracture just below the trochanters of the right femur. He recovered, and was sent to the Invalides, at Paris, where he died April 13, 1764. Two copperplates well represent the fracture united by large masses of callus. DE8AULT (Jour, de Chirurgie, Paris, 1792, T. Ill, p. 104) reports the case of Louis Waymet, shot in Paris, Feb. 28, 1791. The ball passed through both thighs and fractured the left femur in the upper third. The patient recovered and walked well. FEXECH (E.) (Obs. recueillics a I Armie d Espagne sur les plaits d armes a feu aux txtrimitls, Paris, Thesis, 1813, p. 10) cites the case of Lieut. Larque, 70th regiment, wounded near the right great trochanter, at Busaco, Portugal, September 27, 1810, and recovered. LEGOUEST (De la Desarticulation Coxo- fimorale, in Mem. de la Soc. de Chir. de Paris, 1863, T. V, p. 166): M. X was shot in the left trochanter in 1812. He recovered with four or five inches shortening, and was piesented by H. LARKEY, in 1854, to the surgical clinic of Val de Grace. FOKGET (Bull.de la Soc. de Chir. de Paris pendant 1853-56, p. 230) reports that a captain at Waterloo, in 1815, received a shot fracture of the femur near the trochanter. Pieces of bone continued to come away, and suppuration and fistulB yet existed in 1852. HEXXEN (J.) (Principles of Military Surgery, London, 1829, p. 131) states that a French prisoner was brought to Brussels after the battle of Waterloo, June, 1815, whose right femur had been struck by three musket balls, splintering the bone from the middle of the upper third to within two inches of the condyles ; enormous suppuration followed, and extensive incisions were made to extract bones and halls, and the patient recovered. Four cases of recovery after shot fractures in the upper thirds of the femur, received in the Paris revolution in 1830, are reported by A. J. JOBEKT (DE LAMBALLE) (Plaies d armes a feu, Paris, 1833, pp. 262, 264). LAUUEY (H.) (Relation chirurg. dts evenemens de Juillet, 1830, Paris, 1831, pp. 1P2, 106) relates two instances of recovery after shot fracture of the upper third of the femur: Cases of M. de Saint C., and H , 7th regiment. AUXAL (Mem. sur quelques peculiarity desplaies par armes a feu, in Jour. Held, de Mid. et de Chir. prat., Paris, 1831, p. 36) reports two cases. A member of the National Guard of Lyon recovered after a shot fracture of the neck of the femur, in 1831 (GEXSOUL, Note sur lei blesses recus a V Hotel- Dieu de Lyon, pendant Its troubles de 1831, in Gaz. Sled, de Paris, 1833, No. 43, p. 300). LAUUEY (H.) (Hist. chir. du siege de la Citad. d Anvers, Paris, 1833, p. 21fi) cites four cases of shot fractures of the upper portion of the femur treated successfully during the siege of Antwerp, in 1832. LEGOUEST (loc. cit., p. 167) gives the successful case of Tanguel of the 2d light infantry, wounded in the right trochanter, at Cherchell, in January, 1841. The same author states that SEDILLOT successfully treated a shot fracture of the right trochanter in a lieutenant of artillery, wounded in a duel in 1843. According to HUGUIEU (Bulletin de la Soc. de Chir. de Paris pendant 1855-56, Paris, 1856, p. 230), Dr. GEUDY successfully treated a shot fracture of the trochanter in 1848. (This is probably the case of Guiton, alluded to in Gaz. des H6p., 1848, p. 98.) BAUDEXS (Des plaies d armes a feu Communica tions faites, etc., Paris, 1849, p. 231) cites a case of shot fracture of the upper third of the femur in 1848 ; the patient recovered. AMUSSAT (Des Plaies d armes a feu Communications, etc., Paris, 1849, p. 55, refers to a case of recovery. During the discussion on disarticulation at the hip at the meetings of the Surgical Society of Paris (Bulletin de la Soc. de Chir. de Paris, 1855-56, pp. 230-234), on October 24 and October 31, 1855, GlliALDES, ROBEUT, and DEXOXVILLJERS gave details of three cases of recovery after shot fractures of the upper third of the femur. SCHWARTZ (H.) (Beitrage zur LeJtre von den Schusswunden, Schleswig, 1854, pp. 154 and 167) cites two cases: J. G , wounded at Altendorf, April 21, 1848, fracture of the great tro chanter ; fragments of bone removed ; recovery. C. B , of the Berlin volunteers ; fracture of trochanter minor ; recovery in four months. HUT1X (Recherches sur le resultat des fractures de la moitie superieure de la cuisse, in Rec. de Mem. de Mid. de Cliir. et de Phar. Mil., 1854, 2 me s6rie, T. XIV, p. 2(i3) found among the inmates of the Hotel des Invalides at Paris, from 1847 to 1853, seventeen patients who had recovered from shot fractures of the upper third of the femur. MATTHEW (loc. cit., Vol. II, pp. 361, 362) relates two cases of recovery after shot fracture of the upper third of the femur: An officer of the 17th regiment, wounded September 8, 1855, by a rifle ball, which fractured the trochanter major of the left femur. On November llth, the bone had united, and there was only slight shortening of the limb. J. Fitzball, 62d regiment, received, September 8, 1855, a shot fracture of the femur at the junction of upper and middle thirds. He recovered, with 11 inches shortening. LOXGMOUE (T.) (HOLMES s System of Surgery, 2d ed., 1870, Vol. II, p. 225) details the case of Lieut. D. M , 19th regiment, who received a shot fracture of the left femur on September 9, 1855. On February 22d, the union of bone was firm. In 1856, "the stiffness of joints gradually disappeared, and the patient was enabled to return to duty. Among the 282 pen sioners after injuries of the thigh, recorded by name by M. CHEXU in his Rapport, etc., pendant la Campagne d Orient en 1854, 1855, 1856, Paris, 1865, pp. 375-397, 37 cases of recovery are found after shot fracture of the upper third of the femur. From the same campaign, L. BAUDEXS (La Guerre de Crimee, Paris, 1858, pp. 3:iO, 331, 336) reports a case of recovery after shot fracture of the upper third of the femur among the French troops, not recorded by CHEXU : J. Albaric, 80th line, upper third of right femur, Sept. 8, 1855 ; and two cases of recoveries among the Russian prisoners : Jusef Testanief, left femur, just below the trochanter major, and S. Zarepa, fracture of right femur at the trochanter major. WlLUAMSOX (G.) (Military Suryery, Lon don, 1863, pp. 141, 142) records six cases of recovery after shot fracture of the upper third of the femur: Private P. Carty, 64th regiment, wounded at Lucknow in 1857. Private J. Ashworth, 53d regiment, wounded November 1, 1857; July 14, 1858, wounds healed. Private J. Hewitt, 52d regiment, wounded July 12, 18.77; wounds healed July 20, 1858 ; and Private E. Collins, 75th regiment, wounded at Delhi, June 8, 1857; September 6, 1858, sent to modified duty; and cases of Williams and Curtis, on p. 151. In the Italian War of 1859, H. DEMME (Militar-Chir. Studien, WUrzburg, 1864, B. II, p. 365) tabulates 43 cases of shot fractures of the upper (bird of the femur treated conservatively among the Austrian troops, of which 18 recovered, giving a fatality of 58.1 per cent. Among the French wounded in the same campaign, named by ClLEXU (Stat, med. chir, de la Campagne d Jtalie en SURG. Ill 23 178 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. in the Franco-Prussian War, 1870-71, have been highly encouraging,. 1 From the statistics O / < > CJ 1 in TABLE XX, ante, it will be seen that of twelve hundred and fifty-four cases of shot fracture of the upper third of the femur treated by expectation, six hundred and sixty-nine recovered, and five hundred and seventy-two proved fatal; while in thirteen instances the result could not be ascertained, giving a mortality of only 46.0 per cent. Recoveries after Shot Fractures of the Upper Third of the Femur treated by Con servation. Of the six hundred and sixty-nine cases of this group, two hundred and ninety- eight were on the right, and three hundred and thirty-four on the left side ; in thirty-seven instances the side was not specified. Five hundred and fifty-one patients were Union, and one hundred and eighteen were Confederate soldiers. CASE 361. Private W. Eigney, Co. G, 21st New York Cavalry, aged 18 years, was shot near Bladensburg, May 27, 1865. Surgeon B. B. Wilson, U. S. V., reported his admission to Stanton Hospital, Washington, May 29th, with "shot wound of right nates and right thigh, fracturing the femur, received while running the guard." The method of treatment, however, was not stated. On September 13th the patient was transferred to Harewood Hospital, whence Surgeon E. B. Bontecou, U. S. V., described his condition as follows : " He was admitted convalescing from a fracture of the upper third of the femur, caused by a revolver ball, the injured bone having firmly united with two inches shortening and very slight deformity. His constitutional condition was good, and he was able to go about on crutches and had good prospects of a useful limb." One month afterwards the man was transferred to De Camp Hospital, David s Island, New York, and on June 26, 1866, he was discharged from service and pensioned. Examiner W. G. Davis, of Lyons, New York, certified, July 1, 1872: "Pistol shot wound of right thigh, the ball entering posteriorly and fracturing the femur just below the trochanter major. There is considerable deformity and two and a half inches shortening. Pieces of bone discharged. Has pain in the limb in damp weather. Cannot rotate the thigh or flex it upon the pelvis, and has pain in it if he works, stands long, or lifts heavy loads." No material changes were 1859 et 1860, Paris, 1809, T. II, p. 715, etc.), 50 cases of recovery are found after shot fracture of the upper third of the femur treated by conservation. ROUX (J.) (D. sarticulation de la cuisse, Paris, 1860) cites 9 cases of recovery after shot fracture of the upper third of the femur in the Italian campaign of 1859-60, not contained in CHENU S list, viz: Barka-ben-Brahim, 3d Turks; G. Barbet, 100th line; B. Girel, 65th line; J. Hyvan, 1st Zouaves; J. Labastoule, 15th line; P. Mignucci, 1st Zouaves; J. Pamary, 85th line: F. Rousselot, 5th Battalion; C. Rossignol, 6th line. GHEUIXI (A.) (Relazione chlrurgica dell Ospedale m.llita.re provisorio di S. Filippo, in Annali Universali di Medicina, Milano, I860, pp. 459, 460) tabulates 9 cases. Mot AT (The New Zealand War of 1863-64-65, in Stat. San. and Med. Reports for the year 1865, London, 1867, Vol. VII, pp. 502-3) tabulates 2 cases of recovery. HKINE (C.) (Die SchussverUtzungen der Unteren Extremitdten, Berlin, 1866, p. 251): J , shot fracture of upper portion of right femur, April 18, 1804 ; recovered, with 1| inches shortening. From the Austro-Prussian campaign of 1866, B. BECK (Kriegschirurgisclie Erfahrungen, 1867, p. 294) reports 4 cases ; STKOMEVEi: (L.) (Erfahrungen iiber Schusswunden im Jahre 1866, Hannover, 1867, p. 53) 3 cases; R. BlEFEL (LANGENHECK s Archiv, 1869, B. XI, p. 445) 1 case; and MA AS (Kriegschirurgisclie Beitrage, Breslau, 1870, p. 40) 3 instances of recovery after shot fracture of the upper third of the femur. GlUTTI (R.) (Nunvi document! infavore della euro, conservativa, etc.. in Annali Universali di Medicina, Milano, 1868, Vol. CCV, p. 518, et. se.q.) gives details of 10 successful cases of fracture of the upper third of the femur. From various sources it has been possible to collect 264 instances of recovery after shot fractures of the upper third of the femur, received during the Franco-German War of 1870-71. Of these cases were reported among the German forces: By B. BKCK (Chirurgie der Schussverletzungen, Freiburg, 1872, p. 694), 28 cases; by W. KOCH (Notizen iiber Schussverletzungen, in LANGENBECK S Archiv, 1872, B. XIII, p. 474, etc.), 5; by A. SOCIN (Kriegschir. Erfahr., Leipzig, 1872, p. 134), 6; by G. FlSCHEK ( Dorf Floing und Schloss Versailles, in Deutsche Zeitsch. fur Chir., Leipzig, 1872, B. I, pp. 185 and 224, etc.), 8; by OTT (Wiirtemburg. Med. Correspondenz-Blatt, 1871, p. 169), 5; by H. FlSCHEtt (Kriegschir. Erfahr., Erlangen, 1872, p. 171, etc.), 4; by CZERXY (Bericht iiber die im College Stanislaus in Weissenburg behandelten verwundeten, in Wiener Medizinische Wochenschrift, 1870, No. 57, p. 1373), 3 ; by A. SCHINZINGER (Das Reserve- Lazareth Schwetzingen, Freiburg, 1873, pp. 70, 71), 3; by H. LOSSES (Kriegschir. Erf., in Deutsche Zeitschrift fiir Chir., 1873, B. II, p. 112), 2; by TH. BlLLKOTH (Chir. Brief t, Berlin, 1872, p. 228), 2; by KUCHLER (Memorabilien, 1871, B. XVI, p. 141), 2; by GUAF (E.) (Die Koniglichen Reserve-Lazarethe zu Dilsseldorf wahrend des Krieges 1870-71, Elberfeld, 1872, p. 62), 2; and by C. KlKCHXEU (Aerztlicher Bericht iiber das K. P. Feldlazareth im 1 alast zu Versailles, Erlangen, 1872, p. 56), by GUTEKUNST (Zeitschrift fiir Wundarzte und Geburtshulfe, 1870-71, p. 146), by GOLIUAMMEK (Berliner Klinische Wochen- schrifl, 1871, B. VIII, p. 150), by STALL (Bericht aus dem K. Wiirttembergischen 4 Feldhospital, in Deutsche Mil. Zeitschrift, 1874, B. Ill, p. 197), 1 each ; a total of 74 cases among the German troops. Of the cases of recovery after shot fracture of the upper third of the femur among the French troops in 3870-71: SEUILLOT (Fractures des membres par armes de guerre, in Arch. Gen. de Med., 1871, 6 m<! s6r., T. XVII, p. 423, etc.) reports 10 cases; A. W. ROALDES (Des fractures compliquees de la cuisse, Paris, 1871, pp. 43, 44, 46), 4; A. CHIPAULT (Fractures par armes a feu, Paris, 1872, pp. 4, 7, 19, et seq.), 3; andWM. MACCOUMAC (Notes and Recollections of an Ambulance Surgeon, London, 1871, pp. 120, 129), 4; CHHISTIAN (J.) (Relation sur tcs plaies de guerre, in Gaz. Mi d. de Strassbourg, 1872, p. 283), 4 ; FELTZ et GEOLLEMUND (Rel. Clin. sur les Ambulances de Hagenait, in Gaz. Med. de Strassbourg, 1871, No. 11, p. 133), 5; JOESSELL (Ambulance du Petit Quartier a Haguenau, in Gaz. MM. de Strassbourg, 1871, p. 8), li; MOYKIEU (E.) (Ambulance de la Rue Saint Lazare, in Gaz. des Hop., 1871, Vol. XLIV, p. 445), 1; PAX AS (F.) (Mem. sur le traitement des blessures, in Gaz. Hebd. de Med. et de Chir., 1872, T. IX, p. 391), 2 ; VASLIN (L.) (Etude sur les plaies par armes a feu, Paris, 1872, pp. 114, 120, etc.), 3 ; and among the pensioners enumerated by M. CIIEKU (Apercu hist. stat. et din., etc., des armies pendant la guerre de 1870-71, Paris, 1874, p. 153, et seq.), 150 cases are found. Five of these are included in the reports of SEUILLOT (1), CHIPAULT (2), ROALUE6 (1), MACCOUMAC (1), ante, leaving 151 additional cases. To these should be added 9 cases of French pensioners reported by MOSSAKOWSKY (Stat. Bericht ueber 1514 Franzosische Invaliden, in Deutsche Zeitschrift fiir Chir., 1872, B. I, p. 342, et seq.), not contained in CHEXU ; and 4 cases of German invalids, detailed by BEKTHOLD (Deutsche Militair-arztl. Zeitschrift, 1872, B. I, p. 522). One case is reported by G. TILING (Bericht ueber die 124 im Serbisch-Tiirkischen Kriege (1876), etc., behandelten Schussverletzungen^ Dorpat, 1877, p. 66). The 489 cases of recovery of shot fractures in the upper third of the femur under conservative treatment, here referred to, must convince the reader that recoveries under such circumstances are not as infrequent as the older writers on military surgery contended. BKCK (B.) (Chir. der Schussverletzungen, Freiburg, 1872, p. 694, etc.) details 37 cases of shot fractures of the lemur in the upper third, of which 28 recovered and 9 proved fatal, and remarks: "Unfortunately, I have not been able to give an entirely precise account regarding the proportion of the seat of the fractures in the various parts of the femur, and the corresponding mortality, as frequently the seat of the fracture was not clearly designated. But I can say this much, that I had reason to be very well satisfied with the results of the fractures in the upper third, providing the lesion was not too extensive and severe. The fractures in the middle third at the junction with the upper always made the most unfavorable impression upon me, on account of the frequent injuries and lesions of the bloodvessels, which, through frequent and even profuse bleedings, etc., easily lead to fatal results, aud which should, therefore, be carefully investigated at the place of first dressing, and, if necessary, at once subjected to the proper operation." Med and Surg. Hist of the Wai- of the Rebellion . Part HI Vol Jl.ChapX Ward phot J.Bien lith. PLATE LIX.- CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR Fig. I. Case of Private W. Rigney 21 .* "N"ew Tork Cavalrv. Fis. 2 Case of Corporal T. Crasslev 69 ^ Nev\-York. SECT. III.] SHOT FRACTURES OF UPPER THIRD OF FEMUR. 179 reported at subsequent examinations. The pensioner was paid June 4. 1879. Photographs taken at the Harewood Hospital in October, 1865, were contributed by Surgeon Bontecou. (Photo s of Suryical Cases, Vol. 8, No. 4, Card Photo s, Vol. 3, p. 32.) A copy, taken at the Army Medical Museum (Photo. Series, No. Ill), is represented in FIG. 1 of PLATE LIX, oppl p. 178. CASE 362. Captain D. Lewis, Co. G, 8th Ohio, aged 26 years, was wounded at the Wilderness, May 6, 1864, by a mini6 ball, which entered the external part of the left thigh about the junction of the upper and middle third, fractured the femur, and made its exit at the left buttock two inches from the anus. He was conveyed to Fredericksburg and treated with a double inclined plane for three weeks. On May 26th he was removed to a private dwelling in Washington, where he was attended by Acting Assistant Surgeon G. K. Smith, who applied Buck s method of treatment. There was but little suppuration or constitutional disturbance, and by July 9th the fracture had so far united as to permit the patient to walk on crutches. On July 13, 1864, Captain Lewis was mustered out by reason of expiration of service, and pensioned. In October following his wound had entirely healed, and soon afterwards he was able to walk on the injured limb. Subsequently he was for some years an employ6 in the Treasury Department. On August 22, 1865, his photograph was taken at the Army Medical Museum (Photo. Series of Surgical Cases, No. 91, A. M. M.), at which time he was in excellent health, and the injured limb showed no other deformity than one and a half inches shortening. The St. Louis Examining Board, in September, 1874, certified to "occasional lameness and soreness." The pensioner was paid March 4, 1879. His photograph is represented in FlG. 1 of PLATE LVIII, opp. p. 180. CASE 363. Private John Durkin, Co. G, llth Infantry, aged 30 } r ears, was wounded at Gettysburg, July 2, 1863, by a conoidal ball, which entered the outer side of the upper third of the left thigh, and, passing obliquely inward and downward, produced a comminuted fracture of the femur. On the 3d he was admitted to the Seminary Hospital at Gettysburg, where, on the 8th, Assistant Surgeon W. R. Ramsey, IT. S. A., made an incision three inches in length a short distance below and opposite the point of entrance, and extracted the ball. On the 31st he was transferred to the Camp Letterman Hospital, where, so far as recorded, expectant treatment only was used. At this hospital a surgeon, who took charge of the case on August 19th, "found the limb lying in bed, without either splints or bandage; wounds discharging freely; considerable shortening of leg; ordered junk bags, placed Barton s handkerchief to foot, and made extension and counter-extension." On the next day the leg was reported the same length as the right one. On Septem ber 10th there was very little suppuration, and the bones were uniting; but, on the 30th, the discharge still continued, and the patient was reported "sinking." On November 8th, he was transferred to the Newton University Hospital at Baltimore, where, on December 2d, Acting Assistant Surgeon W. S. Smiill made an incision, three inches in length, down to the injured part, and removed a small fragment of bone. On February 19, 1864, the wound was still suppurating freely, and presented indications of the presence of necrosed bone. The limb was shortened four inches. The patient was fur- loughed on June 30, 1864, and at its expiration was admitted to the post hospital at Fort Independence, Boston Harbor, the recruiting depot of the llth Infantry, where he was discharged the service April 30, 1865, for disability arising from gunshot fracture and "excision of four inches of the upper third of the femur, performed previous to admittance." The wound was still sup purating, and there was partial anchylosis of knee. Prior to his admission to the latter hospital there is no mention of an excision. The patient became an inmate of Old Soldiers Home ; and on August 3, 1868, he visited the Army Medical Museum and had his photograph (FlG. 134) taken. He states that Dr. Smull excised four inches of the shaft of femur at Newton University Hospital in December, 1863; that, at the time of the operation, there was profuse suppuration from the wound and abscesses in the thigh, and that Smith s anterior splint was used. At the date of his visit to the Museum open fistulous sinuses remained. The patient s statement at Fort Independence undoubtedly led to the above diagnosis ; and, from the treatment pursued prior to his admission to Newton University Hospital, coupled with the report of the operation made the same month, it is most plausible to believe that the great shortening is not to be attributed to excision. The Boston Examining Board in September, 1873, reported the wound of entrance to be still discharging. The pensioner was paid March 4, 1874, since when he has not been heard from. CASE 364. Private A. F. Dinsmore, Co. E, 3d Michigan, aged 19 years, was wounded at Fair Oaks, May 31, 1862, and admitted to Hygeia Hospital, Fort Monroe, four days afterwards. On June 12th the wounded man was transferred on board of the Hospital Steamer Fulton and conveyed to New York. Surgeon J. Simons, U. S. A., reported that he was admitted to De Camp Hospital, David s Island, June 15th, and discharged from service April 9, 1863, by reason of "shot fracture of left thigh." Several months afterwards the man entered the Veteran Reserve Corps, and after serving in that organization for three years he was mustered out and pensioned. Subsequently the pensioner received employment as clerk in the General Land Office, and in December, 1866, he visited the Army Medical Museum, where his photograph was taken (Photo. Series of Surgical Cases, No. 157, A. M. M.). At that time he was in good health, though the missile, a musket ball, which fractured the femur at the upper third, was still lodged in the limb. The bone was firmly united, union having occurred, according to his statement, about, seven months after the injury, and his treatment having been by moderate extension and counter-extension. He also stated that numerous detached fragments were removed. Examiner J. B. Bascom certified, September 4, 1873 : "Gun shot fracture of left femur. The ball remains in the hip. A fistulous opening finally healed, but occasionally breaks out again. There is a large indurated cicatrix over the trochanter major and several smaller ones, caused by the opening of abscesses," The pensioner was paid June 4, 1879. A copy of the photograph is shown in FlG. 2 of PLATE LVIII, opp. p. 180. FIG. 134. Result of shot fracture in the upper third of the femur. [From a photograph.] 180 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 365. Private H. A. Wiggins, Co. K, 37th Massachusetts, age 24 years, was wounded in the left thigh, at the Wilderness, May 5, 1864. Three weeks afterwards he was admitted to hospital in Alexandria, whence Surgeon E. Bentley, U. S. V., reported the injury as a "shot fracture of the upper third of the femur, caused by a musket ball." In April, 1865, the patient was transferred to Dale Hospital, Worcester, and subsequently to DeCamp Hospital, David s Island, where he was ultimately discharged September 21, 1865, Assistant Surgeon W. Webster, tJ. S. A., certifying to "angular union of the frac tured bone, with five inches shortening; wasting and powerlessness of the limb, and anchylosis of the knee joint. Wound not healed." One month after leaving the service the man was supplied with an apparatus for the injured limb by Dr. E. D. Hudson, of New York City. In a communication, received during July, 1866, and corroborated by a statement by Dr. W. J. Sawin, late Surgeon 2d Vermont, the pensioner related the following in regard to his case: "The ball and eight pieces of bone were removed from my leg on the field, and a second operation was performed at the Fredericksburg hospital, where Surgeon Sawin extracted four pieces of bone." He also alleged that a third operation was performed while he was an inmate of the Alexandria hospital, and that he had recently removed a fragment of bone himself, making altogether some fifty-five pieces that were removed from the limb. Three fistulous openings were described as existing in the injured thigh. The pensioner further represented himself as having been able for two months to move about with the aid of a cane and without crutches, and added that since he was wounded his weight had become reduced from one hundred and seventy-four pounds to one hundred and twenty-nine, and was steadily decreasing. Examiner E. Barton, of Orange, Massachu setts, certified, January 2, 1867 : "There is an open ulcer near the hip, from which fragments of bone are frequently discharged ; the knee joint is nearly perfectly anchylosed, and from the loss of bone the limb is five and a half inches shorter than the other. The foot is distorted, and he does oot.know when it is cold. With the aid of an apparatus he walks very comfortably." No new facts were reported at subsequent examinations. The pensioner Avas paid March 4, 1879. His card photograph, taken at his home in July, 1866, was contributed (Card Photos., A. M. M., Vol. II, p. 21), an enlarged copy of which, taken at the Army Med ical Museum (Surg. Phot. Scries, No. 152), is represented in the wood-cut (FiG. 135). CASE 366. Private I. Wetzel, Co. I, 184th Penn sylvania, aged 21 years, was wounded in the left thigh during the siege of Petersburg, October 3, 1864. He was admitted to a field hospital of the Second Corps, and trans ferred to Armory Square, Washington, five days afterwards. In July, 1835, Acting Assistant Surgeon H. A. Bobbins reported the following description of the injury and its re sult : "A conical ball entered the anterior aspect of the limb one inch below Poupart s ligament, passed backward, frac turing the femur near the trochanters, and made its exit at the apex of the left nates. The limb was treated in Hod- gen s splint without extension. The bone is now united with three and a quarter inches shortening ; the foot is everted and the limb slightly turned outward. Incomplete anchylosis of the knee joint exists, and there is still a discharge of healthy pus amounting to about one ounce daily. The patient is not yet able to use crutches, but from present appearances he soon will be." The patient was discharged from service on August 21, 1885, and pensioned. Various Pension Examiners, at successive dates, certified to "shortening of the limb and partial anchylosis of the knee;" and in March, 1877, Dr. J. Y. Shindell reported as follows: "I find the left knee joint quite stiff, also evidences of occasional abscesses in the muscular portions of the leg. He says that about once a year matter does form, and that he continually wears bandages around the thigh as a support." In September, 1877, the Examiner stated: "The pensioner s general physical condition is not good. He is now confined to his bed, and has been for the last two weeks, on account of his wound, which is again suppurating. * * But the greatest trouble now seems to be in the hip joint and its neighborhood. On probing the opening a little above the joint the body of the ilium seems to be of a honey-combed nature, diseased, and, no doubt, the cause of these frequent attacks of suppuration which occur every three or four months. His leg trouble will very likely cause death some time." The pensioner was paid March 4, 1879. The wood-cut (FiG. 13G) represents a photograph taken at the Army Medical Museum on July 6, 1865. (Sure/. Phot Series, No. 67, A. M. M.) In the next case perfect consolidation of the ends of the fractured femur took place in less than. five weeks. The patient recovered with a strong, sound limb, and, in 1879, while engaged in active business, has walked six miles without difficulty, limping but little. CASE 367. Lieutenant J. S. Lowery, Co. D, 146th New York, aged 21 years, was wounded at Bethesda Church, June 3, 1864. Surgeon W. E. DeWitt, jr., U. S. V., recorded his admission to a Fifth Corps field hospital, with a "severe wound of the right thigh caused by a mini6 ball." Surgeon D. W. Bliss, U. S. V., reported that the patient entered Armory Square Hos- FlG. 135. Result of shot frac ture of upper third of left femur. I From a photograph.] FIG. 13". Result of shot fracture of upper third of left femur. [From a photograph.] MiHl.aml Simj. Ilist of Uu- War oi" the Rebellion . Part III , Yol.H,Chap.X. \Vanl phot PLATE LVIII.- CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR Fi-j 1. Case of Captain l).l.\vis l ; rj 1 Case i)l Private A.K Dinsmore 3 ? Mic Ki^an . SECT, m.j SHOT FRACTURES OF UPPER THIRD OF FEMUR. 181 pital, Washington, June 7th, and described his injury as a "shot fracture of the upper third of the femur," but gave no account of any treatment but that of simple dressings. Dr. T. M. Flandrau, late Surgeon 146th New York, who attended Lieutenant Lowery at the field hospital, gives the following details: The patient was wounded by a rifle ball while on picket duty. The missile entered at the middle of the thigh, toward its inner aspect, and was cut out on the field by Assistant Surgeon G. H. Fossard, 146th New York, above the trochanter. The femur was fractured in its upper third. The patient was brought six miles on a stretcher to the field hospital of the 2d division, Fifth Corps, where I determined not to amputate, and supported the limb on folded blankets, so that it was very comfortable. He was then carried by some men belonging to the Quartermaster s Department fifteen miles further to the White House, and placed on a steamboat and sent to Washington. He was left on his stretcher while on board of the transport and was not removed from it until placed on a bed in Armory Square Hospital, four days after receiving the injury. At the latter place, Acting Assistant Surgeon T. O. Bannister had immediate charge of the case. According to the patient s statement the limb was placed in a box, little extension being used and no counter-extension. Three or four small pieces of bone Avere discharged within a short time, and another small piece was cut since from under the skin. An abscess was opened on, the outer side of the thigh, the scar of which is conspicuous in the photograph. When the patient left the hospital he used crutches, the wound having closed in four or five weeks and the bone united firmly. He con tinued to use his crutches until the following April. The limb is shortened two and five-eighths inches; the thigh cannot be fully flexed on the pelvis, but the limb is strong, sound, and freely movable, with the afore-mentioned exception. When wearing a boot slightly thickened in the sole he limps but little. Lately he has walked six miles without difficulty, and is actively engaged in business." In a previous communication Dr. Flandrau stated that the very expeditious recovery of the patient was, no doubt, to be attributed in a large measure to his good fortune of having unusually comfortable transportation. Lieutenant Lowery became a pensioner from the date of his discharge from service, January 13, 1865. Various surgeons have examined liim at regular intervals, and certified to lameness, etc., as resulting from the injury, up to April, 1872, since when he has been exempted from further examinations, owing to the permanent character of his disabilities. He was paid June 4, 1879. A photo graph of the patient was prepared under the direction of Dr. Flandrau, who contributed it to the Army Medical Museum. It is numbered 265 of the Surgical Photographic Series. In the following instance a rifle ball fractured the upper third of the left femur, and passing through the right thigh chipped off a piece of the upper third of the right femur; a second ball shattered the head of the left fibula; a third ball caused a flesh wound of the leg; and a fourth missile struck over the sacrum: CASE 368. Sergeant W. Shakespeare, Co. K, 2d Michigan, aged 18 years, was wounded in both lower limbs at Jackson, July 11, 1863. He was treated at a field hospital of the Ninth Corps for several weeks, and was then transferred by steamer to Cincinnati, where, on August 12th, he entered Washington Park Hospital. On June 1, 1864, the patient was discharged from service and pensioned. Examiner H. O. Hitchcock, of Kalamazoo, Michigan, in March, 1866, furnished the following description of the case: "Shakespeare was struck by a minie" ball, which, after passing through the upper third of the left thigh and fracturing the femur, entered the right thigh and either fractured the right femur or perhaps chipped off a piece of bone, making its exit on the outer side of that limb. A minie ball about the same time shattered the head of the left fibula, and another ball produced a flesh wound of the leg ; and while lying on the field he was severely wounded by some missile over the sacrum. From this last injury he suffered long and severely. Before being taken from the field several corps surgeons advised amputation of the left thigh, which operation was opposed by Surgeon E. J. Bonine of the regiment, on the ground that it would not add to the chances of recovery. When the patient reached Cincinnati, union of the fragments had taken place, with about seven inches shortening, the fragments crossing each other at a considerable angle and one of them protruding from the wound. Acting Assistant Surgeon A. D. Norton, on August 14th, broke up the temporary union of the parts of the left femur and extended the limb. Three months later, when the case was examined by several surgeons, the parts were still ununited. At present there is complete union of bone, the right leg being one and one-fourth inches shortened, and the left leg one and three-fourths inches shorter than the right. The left femur is a little straighter than normal; the left leg can be flexed upon the thigh to an angle of about 30; the foot is contracted, rather stiff, and sometimes painful. He suffers considerably from neuralgia, is not as robust as formerly, and walks with the aid of a cane, his gait being rather slow and halting." Several years afterwards the same Examiner reported that the wound in the left thigh frequently opened and discharged pieces of bone and bits of lead. Drs. E. J. Bonine and H. A. Clelland, late Surgeon and Assistant Surgeon of the 2d Michigan, both testify to the injury of both femurs, as well to the fact of amputation having been advised or ordered to be performed at the field hospital, and that the operation was refused or deferred. The former in his report on October 4, 1874, states: "The present condition of the pensioner, as I find by critical examination, is as follows: An open, suppurating, and discharging wound in the superior third of the left thigh, the bone, having been crushed, lapping in the heal ing, so as to shorten the leg from two to three inches. Bone denuded; partial anchylosis of knee," etc. Examiner Hitchcock, at subsequent dates, lastly in December, 1877, added that "there is a sinus leading down to diseased bone in the left Aigh, which is open and discharging more or less nearly all the time. The left knee is nearly anchylosed and is swollen ; the foot is tender and the toes are stiffened in a deformed position," etc. The pensioner was paid June 4, 1879. Pension Examiner O. H. Hitchcock presented to the Army Medical Museum a card photograph of the patient (Vol. I, p. 2, Card Photographs ). A copy is represented in the wood-cut (FlG. 137). / 3 FIG. 137. Shot fractures of the tipper thirds of both femurs. [Froip a photograph. 1 182 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Forty-six of the five hundred and fifty-one Union soldiers who recovered after shot fracture in the upper third of the femur died during the fourteen years that have passed since the close of the American civil war, a fatality of less than 0.6 per cent, a year. In the following two instances the patients survived the injuries eleven and ten and a half years, respectively: CASE 369. Corporal T. Crassley, Co. E, 69th New York, aged 34 years, was wounded at Fort Steadman, March 25, 1865, and admitted to the field hospital of the 1st division, Second Corps, where Surgeon F. M. Hammond, 126th New York, noted: "Shot wound of hip by mini6 ball." Assistant Surgeon C. A. Leale, U. S. V., reported that the wounded man was admitted to Armory Square Hospital, Washington, April 1st, and discharged from service July 25, 1865, by reason of "shot fracture of upper third of right femur, resulting in one inch shortening." The Albany Examining Board, consisting of Drs. R. B. Bontecou, W. H. Craig, and C. H. Porter, certified, September 11, 1873: "The ball entered near the right trochanter, injuring the bone seriously. Numerous portions of bone were removed. The missile passed deeply through the muscular tissue and escaped near the inner border of the right nates. The limb is greatly weakened, and occasionally ulcers appear near the entrance wound, owing to necrosed bone." The pensioner died at the National Military Asylum at Dayton, Ohio, January 8, 1876. The immediate cause of his death has not been ascertained. A photograph, taken at the Army Medical Museum in July, 1865 (Surg. Phot. Series, No. 76), is copied in FIG 2 of PLATE LIX, opp. p. 178. CASE 370. Private M. Murthra, Co. H, 159th New York, aged 18 years, was wounded in the right thigh, at Irish Bend, April 13, 1863, and admitted to the Marine Hospital, New Orleans, four days afterwards. Surgeon J. Bockee, U. S. V., described the injury as a "compound fracture of the femur at or near the trochanter," and reported that the patient was assigned to the Veteran Reserve Corps March 9, 1864. Surgeon G. Sutton, U. S. V., recorded his entrance into Augur Hospital, Alexandria, with "chronic ulcer," and his transfer to Sickels Hospital several days afterwards. On May 31, 1865, the man was discharged from service, Surgeon E. Bentley, U. S. V., certifying to "great deformity resulting from the fracture." Examiner C. Rowland, of Brooklyn, reported, July 28, 1865: * "Many pieces of bone have been extracted from a large abscess still existing. The leg is three inches shorter than the other and" quite lame. He is obliged to walk with a crutch," etc. The pensioner subsequently entered the National Military Asylum at Augusta, whence Surgeon J. O. Webster contributed his photograph in August, 1869, with the following recapit ulation of his case: "The wound was caused by a minie" ball, which entered the anterior aspect of the thigh in the upper third, emerging posteriorly, nearly opposite, and lodging in the pants. On admission to the hospital the lirnb was treated by sand bags, and by manual extension once a day. The femur united in bad shape, and another Surgeon coming in charge, it was rebroken and a straight splint applied. He was able to bear his weight on the leg eight months after the injury. The wounds have never healed, and the thigh now discharges in four places. Several splinters of bone have come away. He can walk comfortably with a cane." The Augusta Examining Board certified, August 6, 1873: * * * "The parts being thickly invested by muscles, masses of new bone have been thrown out around the fragments from the surrounding inflamed tissues. Owing to the nature of the fracture, it being greatly comminuted, proper apposition could not be maintained. Masses of new bone were deposited as supports and the splinters enveloped with provisional callus, producing an enlargement of the limb at the point of the fracture. We are of the opinion that superficial exfoliation is going on in some part of the bone on account of the nature and quantity of the discharges, the limb having to be dressed several times during the day. The pensioner has, at short intervals, profuse haemorrhage from the posterior opening near the ischium. These bleedings are no doubt produced by sharp spiculse of bone cutting small arteries." The pensioner died December 26, 1873. A copy of FlO. 1.T8. Result of shot fracture , . , n , , , r ,. , ,, , c, -ni * a -KT oo<--\ * j of femur. [From a photograph.] his photograph, taken at the Army Medical Museum (Surg. Phot. Series, No. 236), is represented in the wood-cut (FlG. 138). In the next case the patient died from extensive inflammation and suppuration of the injured limb, caused by a fall, eleven and a half years after the injury: CASE 371. Lieutenant E. L. Postley, 1 Co. D, 176th New York, aged 39 years, was wounded at Winchester, September 19, 1864. Surgeon E. S. Hoffman, 90th New York, reported his admission to the field hospital of the 2d division, Nineteenth Corps, with* "severe wound of the thigh, caused by a minie ball." On September 23d the patient was moved to the Depot Hospital at Winchester, where Surgeon L. P. Wagner, 114th New York, recorded the following description of the injury: "The missile entered the right thigh at the upper third, one and a half inches below Poupart s ligament, passed through the limb outside the femoral vessels, and emerged one and a quarter inches below the trochanter major, fracturing and comminuting the femur. The limb was kept in a splint for ten days, after which some extension was made, and subsequently a sort of a Desault splint was applied for five weeks. No bad symptoms occurred. The wound discharged very freely. Not much bone came out, but some w Js removed at the time of the injury. By November 27th there was firm union of bone, with two and a half inches shortening and some outward curvature at the seat of the fracture, and the patient was able to throw his leg up." On December 1 The case of Lieutenant Postley is noticed by Assistant Surgeon JOHX HOMANS, jr., in his article : Cases of Gunshot Fractures of the Thigh and Wound* of the Cites!, showing tlie, Ke.sults of Conservative Surgery in the Former, in Boston Med. and Surg. Journal, 18G5, Vol. 72, p. 11. Med.fi- Sin--. Hirft.of 11 ic War of the h ebrllioii 1 nrt HI, Vol.11. Ward phot PLATE LV. _ TWO VIEWS OF A UNITED SHOT FRACTURE OF THE UPPER EXTREMITY OF THE RIGHT FEMUR OVER II YEARS AFTER INJURY. Casf of Lipulc>imii( K.L. Po.sllev. I7(i M. N\\- York. -Spec (ir)9(j. Surj*a-Hl Section A.M.M. SECT. III.] SHOT FRACTURES OF UPPER THIRD OF FEMUR. 183 9th lie was transferred to Camden Street Hospital, Baltimore, and in the following month he obtained a leave of absence and proceeded to his home. He was ultimately mustered out April 13, 1865, and pensioned. Examiner J. Neil, of New York City, certified, April 24, 1867: "The thigh is shortened about four inches; the limb is crooked and feeble; he requires the aid of a crutch." The pensioner subsequently entered the National Military Asylum at Hampton, whence Surgeon W. M. Wright reported him, in 1873, as being iu good general health, his wound as well healed, and the fractured bone united, with five inches shortening, also that stiffness of the knee joint resulted from extensive adhesions of the muscles of the thigh. Two years after wards spiculac were reported to have been removed from the wound, and, on March 6, 1876, Dr. Wright communicated that the pensioner had died on the previous day, stating that "he was able to walk well without the aid of a crutch or cane," and that " two weeks ago he fell, while intoxicated, upon his disabled thigh, which resulted in extensive inflammation and suppuration, from which he died." The greater part of the injured femur, comprising the two upper thirds, was contributed to the Museum by Dr. Wright, and constitutes Specimen 6596 of the Surgical Section. Illustrations of the hone are shown in PLATE LV, opp. p. 182. CASE 372. Corporal E. Worthen, Co. B, 2d Vermont, aged 25 years, was wounded in the right thigh, at the Wilderness, May 5, 1864, and admitted to hospital in Alexandria three weeks afterwards. Surgeon E. Bentley, U. S. V., described the wound as a "shot fracture of the upper third of the femur," but the progress of the case was not recorded. On March 17, 1865, the patient was transferred to Sloan Hospital, Montpelier, whence Surgeon H. Janes, U. S. V., contributed the following history: "The wound was caused by a minie" ball, which entered the thigh in front, passed directly through and emerged posteriorly, at the lower border of the glutei muscles, comminuting the femur for about three inches. From the field the wounded man was taken to the hospital of the 2d division, Sixth Corps, at Fredericksburg, and thence by boat to Alexandria, where the limb was first adjusted, and kept in position by sand bags without extension. He stated that no other apparatus was ever used. Sub sequently he had typhoid fever and erysipelas. The first fragment of bone was removed in July. 1864, and since that time about fifty pieces have come away. When admitted to Sloan Hospital the wound was still slightly discharging, but the patient was able to go about on crutches. About three months afterwards the bone had become so firmly united that he could walk a short distance without crutch or cane. When discharged from service, .June 23, 1865, the patient was in good general health, and able to walk a considerable distance on smooth ground without crutch or cane, the injured limb being shortened two and a half inches and considerably deformed. There was also necrosed bone remaining, and the wound still slightly dis charging." Examining Surgeon C. L.Allen, of Rutland, Vt., reported, September 24, 1866: "The right limb is now three inches shorter than the left. An opening (the wound of entrance) still exists in front of the trochanter, into which a probe passes about four inches ; another opening posteriorly (the wound of exit) allows the probe to pass in about three inches. A third opening exists near the middle of the inside of the thigli, having been made by the Surgeon for the dis charge of the burrowing pus." The same examiner subse quently certified that he. was called on to visit the pensioner on October 23, 1870, and found him "suffering from pyaemia, resulting from the wound breaking out anew, from the effects of which he died October 25, 1870." A card photograph of the patient, taken at the Sloan Hospital, was contributed by Surgeon Janes (Card Photos., A. M. M., Vol. II, p. 22), an enlarged copy of which, taken at the Army Medical Museum (Surf/. Phot. Series, No. 129), is shown in wood-cut (FlG. 139). CASE 373. Private G. Ruoss, Co. G, 7th New York, aged 27 years, was wounded near Petersburg, March 31, 1865, and admitted to the field hospital of the 1st division, Second Corps, where Surgeon F. M. Hammond, 126th New York, noted : " Shot fracture of right thigh." On the day following the injury the wounded man was sent to the Depot Hospital at City Point, and several days afterwards he was conveyed to Washington, where he entered Campbell Hospital, and subsequently Stanton Hospital. Surgeon R. B. Bontecou, FIG. 130. Kesultofa shot wound of upper third of femur. [From a photograph.] FlG. 140. Shot fracture of upper third of right femur. [From a photograph.] U. S. V., reported his admission to Harewood Hospital September 12th, and his condition as follows: "The patient was suffer ing from great deformity of the right limb, the result of a shot wound of the upper third of the thigh, fracturing the femur. When admitted he had so far recovered as to be able to sit up, and his constitutional state was tolerably good. The fractured parts had firmly united but with great deformity; the wound of entrance had healed, but there were still some discharges from sinuses in the thigh, and small fragments of necrosed bones were daily removed. The prospects of usefulness of the limb are unfavorable; otherwise the patient is doing tolerably well." At the closing of Hanwood Hospital, May 1, 1866, the patient was transferred to the Post Hospital at Washington, where he was operated on by Assistant Surgeon W. Thomson, U. S. A., who described the injury and operation as follows : "The wound was caused by a minie" ball, which entered on the anterior and outer aspect of the thigh about three inches below the great trochanter, passed inward and a little downward, comminuting portions of the upper and middle thirds of the femur, and escaped posteriorly near the middle of the gluteal fold. On June 8th, the patient was etherized and a triangular incision, three by three and a half inches, was made on the upper and outer side of the thigh, and several pieces of bone were removed. On September 30th the wound had almost healed. Three sinuses, evidently 184 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. leading to necrosed bone, however, still existed, two of which were located on the upper and one on the lower surface. The patient s health was not very good, having suffered from several attacks of diarrhoea, and a severe attack of erysipelas which commenced near the wound and soon spread over the entire surface of the leg and foot. On December 31st, the sinuses were still open and discharging, and there was great deformity, with about five inches shortening, and almost complete anchylosis of the knee joint." Assistant Surgeon J. Brooke, U. S. A., who took charge of the patient in November, 1807, reported the termination of the case: "I found the limb in much the same condition as described by Dr. Thomson, except that a collection of pus, which had formed on the inner aspect of the thigh just above the knee, had been opened and a sinus found to connect with the seat of the fracture. This sinus, as well as those already described by Dr. Thomson, remained open, and the patient continued extremely feeble, became greatly emaciated, and suffered much from diarrhoea and frequent attacks of almost total loss of appetite. These symptoms continued until his death, which occurred on June 27, 1868. At the autopsy the liver was found to be enormously enlarged, weighing ten pounds and ten ounces, and the right lung contained a small mass of calcareous matter." The injured femur, with the os innominatum and patella attached, and portions of the tibia and fibula were contributed to the Museum by Dr. Brooke, and constitute specimen 5450 of the Surgical Section. The femur is imperfectly united, with great displacement and a deposit of foliaceous callus, and shows that extensive periostitis has taken place, and the patella and upper portions of tibia and fibula also show similar pathological changes. The photograph represented in the wood-cut (FlG. 140) was obtained at the Harewood Hospital, and contributed by Surgeon Bontecou. Other photographs of the patient, taken at the same hospital and at the Army Medical Museum, are represented by No. 40, Vol. 8, of Photo s of Surgical Cases, S. G. O.; Card Photo s, Vol. 2, p. 21, and Vol. 3, p. 27, and Surgical Photograph Series, Nos. 139, 178, 179, and 292. Fatal Cases of Shot Fractures of the Upper Third of the Femur treated by Conser vation. Of the twelve hundred and fifty-four cases of shot fractures of the upper third of the femur tabulated in TABLE XX, on page 175, ante, five hundred and seventy-two proved fatal. Four hundred and eighty were Union and ninety-two Confederate soldiers. The side on which the injury was received was noted in four hundred and eighty-one instances, the right side being involved in two hundred and nineteen, the left, in two hundred and sixty-two cases. A few fatal examples will be cited: CASE 374. Private J. Northrnp, Co. K, 77th New York, aged 21 years, was wounded before Yorktown, April 29, 1862, and entered the Douglas Hospital, Washington, May 15th. Assistant Surgeon W. Webster, U. S. A., forwarded the specimen (FlG. 141), and recorded ihe following history: "The wound was caused by a conoidal ball, which entered on the outer side of the lower portion of the upper third of the left thigh, and was extracted through the glutens maximus muscle on a level with and two inches from the anus, same side. The missile produced a compound fracture of the femur at the upper third and shortened the limb to the extent of two inches. On admission, the patient, who was of robust and healthy appearance, had considerable fever and constipation of the bowels. There was extensive swelling of the integuments, and he was suffering acute pain. Vedder s long splint was applied, and extension from the ankle and counter-extension by a perineal band was made. By these means the limb was lengthened one inch and retained in that position. The acute pain rendered any further extension impracticable. The patient was ordered to take one-half ounce of castor oil, and sulphate of morphia at night to relieve the pain. May 18th, the wound has been dressed with poultices of flaxseed meal ; the swelling has some what subsided and there is no fever. The pain continues, and to relieve it and promote sleep a mixture of two drachms of elixir of opium and one ounce of camphor water is given in two doses every evening. June 2d, the discharge has ceased and the external wound is nearly closed. There are some signs of union and of the deposition of abundant provisional callus. June 10th, the splint was removed; the shortening of the limb now amounts to three inches. June 16th, the patient was this morning attacked with chills and the initiatory symptoms of fever, a frequent and very weak pulse and red tongue, also great tenderness in the epigastric region, with frequent vomiting. The above symp toms continued without intermission until terminated in death, at 11 o clock P. M., on June 18, 1862. The autopsy, ten hours after death, confirmed the previous diagnosis of acute gastro-enteritis. The coats of the stomach were found to be intensely congested, with disorganization of the mucous membrane, which appeared to be greatest about the greater curvature of the stomach. The fracture was found firmly consolidated, with abundant deposition of pro visional callus." The specimen consists of the upper half of the fractured femur, showing partial union at right angles and the shaft roughened by the action of pus, also callus somewhat copiously thrown out and entangling the fragments, FIG. 142. Shot frac- , . . ture of left femur. Callus but the inner surfaces being carious. without union. Spec. 1810. CASE 375. Private F. Smith, Co. C, 121st New York, was wounded at Fredericksburg, May 3, 1863. Surgeon E. F. Taylor, 1st New Jersey, noted his admission to the field hospital of the 1st division, Sixth Corps, with "shot wound of thigh," and his transfer to general hospital June 13th. Surgeon A. Heger, U. S. A., con tributed the specimen, shown in the adjoining wood-cut (FlG. 142), with the following description of the case: "The patient was wounded by a round ball, causing fracture of the left femur at the upper third. He was admitted to hospital at Point Lookout, June 14th, very much reduced, abscesses and sinuses extending through the whole thigh from the pelvis to the knee. He Fm. 141. Left femur shat tered below trochanters. Spec. 27. .-(.! t!i< Wiir.TfthrKohpflii.il. I nrl III A oi II .C hnji X PLATE XXV. SECONDARY INFLAMMATION OF THE KNEE JOINT I nsr r IM AVillinin /iliox. F. 2 . !. .\c\v"l < u ]< SECT. III.] SHOT FRACTURES OF UPPER THIRD OF FEMUR. 185 seemed to gain a little strength, but died July 11, 1803, from exhaustion." Tie specimen consists of a portion of the femur with the missile attached. The bone was shattered below the trochanters and shows considerable effusion of callus, but no union seems to have occurred. CASK 376. Private M. Sullivan, Co. K, 6th Louisiana, aged 30 years, was wounded at Antietam, September 17, 1862, and admitted to hospital at Frederick two weeks afterwards. Assistant Surgeon R. F. Weir, U. S. A., recorded the following history: "The patient was wounded by five balls. The first entered about one and a half inches above and a little inside of the left patella, and, passing through, fractured and comminuted the femur, and emerged on the outside about three and a half inches above the knee joint. The second ball entered the left thigh near the junction with the perinaeum, merely making a flesh wound. The third entered about three and a half inches below and a little posterior to the trochanters of the right thigh, fracturing the femur, and, going directly through, emerged at the junction of the thigh with the perinseum. The fourth missile produced a flesh wound, entering just over the junction of the dorsal and lumbar vertebra, and was not found; and the fifth grazed the left thigh posteriorly at the junction of the upper and middle thirds. After the battle he was carried to the White House Hospital, where his limbs were placed in long board splints, and in that condition he was sent to the Seminary Hospital at Frederick, where the splints were removed and Buck s apparatus was substituted, with two bricks on each leg for extension. No bone was extracted. Two abscesses formed, one near the right knee, which was opened and discharged copious quantities of bloody pus. The wounds in the right thigh also discharged considerable quantities of curdy mat ter. The second abscess was opened near the first and the discharge was similar in character. While in the Seminary the patient s treatment con sisted of tonics and stimulants. On January 15, 1863, when admitted to hospital No. 1, both limbs were very much swollen, and tight bandages were ordered to be applied. On the 17th an abscess made its appearance on the posterior part of the right thigh just, below the buttock, and the ball, which had entered the back and could not be discovered at first, was taken out with two pieces of bone, one being about two inches long and one and a half inches wide, and the other a small fragment. 23d, the limbs PJG 143 United shot frao- are S OW ^J improving and are considerably reduced in size, the left leg FIG. 144. United shot fracture ture of lowest third of left measuring thirty-three inches and the right one thirty-two and a half f " p ?R fl r i third f right femun femur. Spec. 3882. * . . Spec. 3881. inches; general health tolerable; treatment consisting of iron and quinine, with generous diet. 28th, opened an abscess on left side of left knee; abscess under right thigh gradually healing. 30th, a bloody sanious pus is being discharged from the abscess in the left knee, and the burrowing includes a space of about eight inches square. Introduced a tent into the opening of both abscesses. The patient s bowels being rather costive, three compound cathartic pills were given. February 1st, abscesses looking well and gradually filling up with healthy granulations; patient slowly improving. 9th, general condition not so good; has some hectic fever at night, also diarrhoea. Abscesses healing and limbs appear to be doing well. 17th. slowly improving; appetite better. Discovered a sinus leading from the external wound of the left thigh posteriorly, at the bottom of which there is some necrosed bone. 21st, abscess on knee cicatrized; small abscess making its appearance on the anterior aspect of the upper third of left thigh; discharge from sinus increased; wound on right thigh discharging considerable healthy pus. Patient had a chill this morning. His bowels being constipated, castor oil was prescribed. March 3d, improving. Abscess on under surface of tipper third of right thigh is closing up, but a portion of the necrosed femur is yet felt by the probe. The left thigh is discharging healthy pus, and from its external wound an abscess opened extending about two inches, from which there is now protruding a large portion of necrosed bone, which will be removed by exsection as soon as the patient s health will permit. 13th, general health improving; sinus discharging as usual. Wound in posterior aspect of thigh probed and found to be very extensive; necrosed bone apparently covered by healthy granulations. April 5th, patient rapidly improving; has an excellent appetite; bowels regular. Wounds on posterior aspect of right thigh entirely closed and the other wounds doing well. 15th, patient has had a severe attack of erysipelas in his left leg, also a high fever aiid attacks of vomiting; leg much inflamed and greatly swollen. It was painted with tincture of iodine and lead and opium wash was applied. Stimulants were also ordered. 20th, considerable swelling of the knee joint. Urine was drawn off, he being unable to pass it. 22d, patient much worse. An incision was made near the right knee joint and a large quantity of pus discharged. The urine was again drawn oif. Death occurred April 22, 1863. Post-mortem, examination five hours after death : On opening the chest pleuritic adhesions were found on both sides; lungs healthy and partially covered with seropurulent lymph; liver highly congested and fatty and weighing fourteen ounces; kidneys weighing eight ounces, of light color, and external surface mottled; heart healthy and weighing eight ounces." The pathological specimens represented hi the wood-cuts were contributed to the Museum by Acting Assistant Surgeon G. M. Paullin. FlGUKE 144 shows the right femur united with two inches shortening after fracture in the tipper third, a large fragment being bound fast, a small sequestrum nearly loose, the ends well rounded, and the lower extremity diseased as far as the condyles. The other specimen (FlG. 143) consists of the lower third of the left femur; showing a fracture firmly united by profuse bone deposits, with lateral deformity and two and a half inches shortening, the lower fragment forming an angle with the shaft of about fifteen degrees forward. CASE 377. Private William Ziliox, Co. F, 29th New York, aged 31 years, was wounded at Chancellorsville, May 3, 1863. He was standing erect and in the act of firing. The missile, a conoidal ball, entered the outer and middle portion of the left thigh, passed upward, fractured the femur, and lodged in the surrounding muscles. He was left on the battle-field and fell into the hands of the enemy, and received no treatment until his return within our lines, May 15, 1863. He was then admitted into the field hospital of the Eleventh Corps, at Brook s Station, where his leg was dressed in splints. On June 14th, he was admitted into the Lincoln Hospital, Washington. Assistant Surgeon H. Allen, U. S. A., reports : " When admitted his affected SuttG. Ill 24 186 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. thirdof left femur. Spec. 17G1. Fit;. ]4(i. Shot fracture of right femur below tro- chanters. Spec. 2. i3. limb looked as though no extension had been employed. The ball had not been extracted, there Avas no union, and there was four and a half inches shortening. Acting Assistant Surgeon D. Weisel, under whose care the patient was placed, removed the splints and applied the anterior splint. This treatment was continued until June 20th, when, suppuration becoming so great, fear was entertained of pus burrowing toward the hip joint, and it was discontinued, and sand bag supports and extension, produced by a bag of stones suspended by a rope run through a pulley and attached to the base of the foot, substituted. The case progressed favorably. August 1st, small abscesses appeared near the knee, not, however, troublesome. There was little burrowing of pus. August 7th, Dr. Weisel opened a small abscess on the posterior portion of the thigh immediately behind the seat of fracture. August 26th, several spiculae of bone were extracted through this opening, together with the bullet, which was flattened and contorted to a very irregular form. Early in September, the pus was observed extending down the inner side of the thigh and opening two inches above the internal condyle of the femur. -By pressure pus could, at any time, be made to pass out of this opening, it, no doubt, communicating with the injury above. The constitutional symp toms were still favorable. October 1st, effusion in the knee joint of the corresponding side was first noticed; the skin over the joint had an erysipelatous hue, and the joint was swollen. It was at first thought that the opening on the inside of the thigh com municated with the joint, and that pyarthrosis was caused thereby; but it was afterwards thought to be a case of suppurative arthritis and in no direct way connected witli the pus-producing surface about the seat of -fracture. From the first appearance of this complication the patient sank rapidly, the tongue became dry and brown, the stomach rejected all aliment; hiccough was a constant and distressing symptom. Severe pain was experienced in the limb. These signs of constitutional exhaustion continued with out relief until the day of his death, October 6, 1863." The secondary inflammation of the knee joint is shown in PLATE XXV, opposite p. 184. The fractured femur, show ing fractures in the upper third, large deposits of callus, but without union, is Spec. 17(il of the Surgical Section, A. M. M. (FlG. 145.) CASE 378. Private W. Eeed, Co. II, 83d Pennsylvania, aged 29 years, was wounded and captured at Gaines s Mills, June 27, 1862. He remained in the hands of the enemy for a month, when he was paroled and conveyed to Philadelphia. Acting fracture of upper Assistant Surgeon II. P. Thomas, in charge of the Episcopal Church Hospital, recorded the following description of the wound and its result: "The ball entered the outer side of the right thigh about five inches below the anterior superior spinous process of the ilium, fractured the femur, and made its exit on a horizontal line with the point of entrance and five inches from it. The man entered this hospital on July 30th in a miserable condition. The thigh was much shortened, and an opening formed in the buttock wiChin four inches of the wound of exit, discharging very freely and resulting from the passage of a piece of bone. The patient was also suffering from diarrhoea and a diphtheritic exudation in the mouth and fauces. He was taking stimulants and chlorate of potassa. Death resulted on September 26, 1862, from pysemia and exhaustion. The post-mortem showed no metas- tatic abscess. The femur was found to be extensively fractured high up and to consist mainly of two fragments, around the free ends of which and adherent to them were several other pieces of large size. The specimen, represented in the cut (FlG. 146), was contributed by Acting Assistant Surgeon A. C. Bournonville, and shows considerable deposit of callus imprisoning the larger fragments and affording partial union. CASE 379. Private E. Vehorn, Co. F, 13th South Carolina, was wounded at Gettysburg, July 3, 1863, and was treated in hospital at Chester. Acting Assistant Surgeon B. Brinton contributed the specimen, shown in the annexed cut (FlG. 147), and described the injury as a "shot wound of the right hip, fracturing the femur near its neck. Patient died of exhaustion October 13, 1883." The specimen consists of the upper portion of the femur, showing oblique fracture through the lesser trochanter, with a moderate deposit of callus, but without union. CASE 380. Private T. Manley, Co. A, 63d New York, aged 26 years, was wounded at Gettysburg, July 2, 1863, and admitted to Camp Letterman one month afterwards. Acting Assistant Surgeon R. S. L. Walsh described the injury as a "compound fracture of the upper third of the right femur," and reported: "There is no history of the case previous to admission. The gen eral health of the patient is good ; the wound discharging profusely. Tonics and stimulants were given, and the limb treated by the double-inclined plane. The patient did tolerably well for some days, but his general condition became worse about August 31st." Acting Assistant Surgeon J. Newcombe, into whose hands the case passed on September 4th, reported the following termina tion : " On taking charge of the patient he was sinking rapidly. The fracture FIG. 147. Shot fracture was disunited and the limb was shortened about five inches. The patient was ^ ]4g _ shot fr!icturc of of left femur through a ] so troubled with profuse night sweats and had a large bed-sore on his back, rurht femur below troelwn- lesser trochanter. Callus ,-,,.,-, ,, tors C -illim without union without union. Spec.2070. He died September 8, 1863, of exhaustion. At the post-mortem examination the _ 1935. fractured ends were found overlapping each other, the lower being, as usual, drawn upward and inward by the adductor muscles, while the upper was carried forward by the psoas and iliacus and outward by the external rotators. The fracture ran obliquely upward and inward, and considerable callus had been thrown out on the inner side only. A false joint had formed between the fragments, the lower playing in a rude socket formed by the upper, and both being covered by a dense, smooth, glistening, and apparently fibrous membrane." The pathological specimen (FlG. 148) consists of the upper portion of the injured femur, and was contributed by Acting Assistant Surgeon E. P. Townseim. SECT. III.l SHOT FRACTUEES OF THE MIDDLE THIRD OF FEMUR. 187 Shot Fractures of the Middle Third of the Femur treated by Conservation. Ei Mi t G hundred and fifty-five cases of shot fracture of the middle third of the femur treated with out operation were collected from the registers in this Office. In thirteen instances the result could not be ascertained; five hundred patients recovered and three hundred and forty-two died, a mortality of 40.6 per cent. Cases of Recovery after Shot Fractures of the Middle Third of the Femur treated by Conservation. The five hundred cases of recovery after shot fracture of the middle third of the femur included four hundred and twenty-one Union, and seventy-nine Confed erate soldiers. In two hundred and eight cases the injury was on the right, and in two hundred and sixty-seven on the left side: CASE 381. Private J. H. Green, Co. E, 14th New York Heavy Artillery, aged 46 years, was wounded at Bethesda Church, June 2, 1864, and admitted to the field hospital of the 1st division, Ninth Corps, where Surgeon M. K. Hogan, U. S. V., recorded: Gunshot fracture of right thigh." Two days afterwards the wounded man was moved to the Depot Hospital of the Ninth Corps, and on June 14th he reached Washington. Acting Assistant Surgeon H. A. Robbins reported: "He was admitted to Armory Square Hospital, having been wounded by a conoidal ball, which entered the anterior aspect of the right thigh at a point above the junction of the middle and lower thirds, producing comminuted fracture, and made its exit at a point on the posterior surface opposite to that of entrance. The limb was treated in Hodgen s splint without extension. During the month of March, 186"), several spiculoe of bone were removed, varying in size, the longest being two and a half inches in length. These were extracted without enlarging the opening. The patient came under my care June 1, 1865. The bone is now united with five and a half inches shortening. The femur is bowed out and the foot is considerably inverted. The knee joint is considerably stiffened, so that it can only be flexed to an angle of about twenty degrees. About one ounce of healthy pus is now discharged during twenty-four hours. The patient s health is very good." On July 6th he was brought to the Army Medical Museum, when the photograph, shown, in the cut (FlG. 149), was taken. On the following day he was transferred to the Ira Harris Hospital at Albany, whence Assistant Surgeon J. H. Armsby, U. S. V., contributed a cast of the injured limb (Cat. Surg. Sect.. 1866, p 535, Spec. 1356). The patient was discharged from service October 3, 1863, and pensioned. Examiner S. L Parmelee, of Gouverneur, New York, certified, September 4, 1873: "The ball entered five inches above the knee, anteriorly, fracturing the femur, and splitting, with two points of emer gence, on the posterior aspect of the thigh. Result : Stiff knee ; femur curved outward at an angle of twenty degrees," etc. At a subsequent examination substantially the same was reported. The pensioner was paid March 4, 1879. CASE 382. Private W. D. Gilbert, Co. C, 6th Vermont, aged CO years, was wounded in the right thigh at the Wilder ness, May 5, 1864. Three weeks afterwards he arrived at Alexandria and entered the Mansion House Hospital, whence Surgeon C. Page, U. S. A., reported the injury as a "shot fracture of the middle third of the femur." Subsequently the patient was transferred to Sickels Hospital, and lastly to Sloan, Montpelier. Surgeon II. Janes, U. S. V., in charge of the latter hospital, contributed the following history: "The patient, a man of strong constitution, was wounded by a minie ball, which passed through the thigh at the junction of the middle and lower thirds, comminuting the femur for several inches. The day after the injury he was sent by ambulance to Fredericks- burg, no retentive apparatus having been applied, and two weeks later he was moved by cars and boat to Alexandria, the limb being kept in a fracture-box during the trip. At Alex andria, it was put upon an anterior splint and extension was made by brick and pulley. In June several pieces of bone ^ were removed. Suppuration was profuse, and about August FIG. 150. Shot fracture of middle third 1st Ins appetite failed and he became so much debilitated that of right femur. [From a photograph.] I l ;. 140. S| 1( ,t fracture of mid dle third of right femur. [From a photograph.] his life was despaired of. After this he gradually but slowly improved, though not without occasional relapses. On January 1, 1865, the splint was removed and the patient allowed to sit at the bedside, and no retentive apparatus was used for more than two or three days after that time. About the last of January he could walk about the ward on crutches, though unable to bear any weight upon the limb. On March 17th the patient was transferred to this hospital, during which journey the limb became considerably inflamed, resulting in his confinement to bed for three days. On May 29th the limb, having again become inflamed and discharging vory offensive pus, was freely opened for 188 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. about four inches, and several large pieces of necrosed bone, one of which measured one by three inches, were removed. The cavity in the callus, which contained these fragments, was found to be large and seemed to extend quite or nearly to the can cellated structure of the condyles. After the operation suppuration became healthy and the wound mended rapidly for four weeks, when the improvement became checked. On September 7th, the limb was again-laid open freely and a small piece of bone was removed, after which there was no further interruption in the progress of the patient up to October 12, 1865, when he was discharged from service. At this time the wound still suppurated to the amount of two ounces per day, and a considerable cavity existed between the ends of the bone, but no necrosis could be detected by the probe. The limb was shortened three inches, and there was ligamentous anchylosis of the knee joint, permitting the patient to move it about ten degrees. He was in general good health, able to bear half his weight on the injured leg for a short time, and seemed to have a fair prospect of obtain ing a useful limb. There had been no haemorrhage, gangrene, or diarrhoea since the injury, and his appetite had been good nearly all the time, having taken nutritious food freely and stimulants moderately." Examiner W. McCollom, of Woodstock, Vermont, November 14, 1866, certified to the injury, and stated: "The bone has united with three inches shortening. Exfolia tions are thrown off occasionally, and the wound in the soft tissues has not entirely healed. He is totally disabled from performing manual labor at present." Examiner O. W. Sherwin stated, September 4, 1873: "There is considerable loss of tissue, and the knee is permanently flexed so as to keep the heel two inches from the floor," and, in September, 1877, he reported the following : "During the present year a large abscess formed at the seat of the injury, Avith exfoliation of bone. I attended him during two months of confinement in bed from the aforesaid cause." A card photograph of the patient, taken at the Sloan Hospital, was contributed by Surgeon Janes (Card Photos, A. M. M., Vol. 2, p. 22), an enlarged copy of which, taken at the Army Medical Museum (Surg. Phot. Series, No. 130). is represented in the cut (FlG. 150). The pensioner was paid March 4, 1879. CASE 383. Lieutenant J. Buckley, Regimental Quartermaster of the 140th New York, aged 22 years, was wounded at Spottsylvania, May 8, 1864, by a mini6 ball, which fractured the right thigh at the middle third. From the field he was, on May 12th, admitted to hospital at Alexandria, and five days afterwards he was transferred to the Seminary Hospital, George town. Surgeon II. W. Ducachet, U. S. V., in charge of the latter, reported the character of the injury and that the patient remained under treatment until November 12th, when he obtained a leave of absence and departed for his home. On January 13, 1865, Lieutenant Buckley was mustered out of service and pensioned. Dr. T. M. Flandrau, formerly Surgeon 146th New York, who saw this officer at the time of the injury, and also after he left the service, communicated his observations in March, 1870, as follows : "I decided to save the limb, and, aided by Surgeon H. C. Dean, 140th New York, dressed it in Smith s anterior splint, suspending it from the bows of an army wagon, in which, with his servant steadying the foot, he was carried to Belle Plain. When he reached the Georgetown Hospital the thigh was found shortened five inches. During the second, third, and fourth months after the injury he was treated by an extension weight of sixteen pounds, a counter-extending band, and lateral sand bags. On August 20th he had three profuse haemorrhages, jeopardizing his life, which were controlled without operation. He used crutches when leaving the hospital, but threw them aside five months afterwards. He has since been employed as a bookkeeper. There is two and a half inches shortening, and the knee is somewhat stiffened. A fistulous opening still exists on the back of the thigh and discharges a little. The limb is very useful, and the limp is not conspicuous." The Utica Examining Board reported, January 3, 1872: * * * "There has been extensive exfoliation of bone, leaving several deep cicatrices, and there is still an open sinus extending to the bone and attended with bloody sanious discharge, indicating that there is still disease of the bone," etc. Examiner C. B. Coventry, September 6, 1873, certified to several pieces of bone having been removed, some of them since the previous examination. The pensioner was paid March 4, 1879. FIG. 1 of PLATE LX, opp., is a representa tion of a photograph of the pensioner, taken in Rome, New York, March, 1870, which was contributed by Dr. Flaudrau, and copied at the Army Medical Museum. (Sury. Phot. Scries, No. 266, A. M. M.) CASE 384. Private J. Hamilton, Co. I, 1st Delaware, aged 19 years, was accidentally shot, while on picket duty at Camp Hamilton, November 24, 1831. On the following day he was admitted to Hygeia Hospital, Fort Monroe, whence Surgeon R. B. Bontecou, U. S. V., reported : " Gunshot fracture of right thigh, above the middle, by a conical ball. The bone, though considerably comminuted, finally united at the expiration of five Aveeks; suppuration and exfoliation kept up Avith occasional intermission until June, 1862. The Avounds Avere, at times, dilated Avith sponge tents to keep them free. Constant slight exten sion Avas used, and some portions of bone Avere removed from time to time. On June 14, 1862, the patient Avas discharged from service, and sent home with limb pound and shortened not more than an inch." Examiner D. W. Maull, of Wilmington, Del- aAvare, certified to "shot fracture of the femur and shortening of the limb, Avith pain and occasional suppuration." A Pension Examining Board reported, in September, 1877: "An inch shortening; deep cicatrices; one of the Avounds has been suppurating within six Aveeks, when a piece of dead bone came out." The pensioner Avas paid June 4, 1879. Photographs of the patient Avere furnished by Surgeon Bontecou (Photos, of Surgical Cases, Vol. 8, No. 54, and Card Photos., Vol. 2, p. 21, and Vol. 3, p- 22), an enlarged copy of Avhich (Surj. Phot. Series, No. 119) is represented in FIG. 2 of PIATE LX, opp. CASE 385. Sergeant A. Ryder, Co. B, 121st New York, aged 22 years, Avas wounded before Petersburg, April 2, 1865, and admitted to the field hospital of the 1st division, Sixth Corps, Avhere Surgeon R. Sharpe, 15th New Jersey, noted: "Shot fracture of left thigh; splints applied." On the day following the injury the wounded man Avas sent to the Depot Hospital at City Point, and, on April 12th, he Avas transferred to Armory Square Hospital, Washington, Avhence Acting Assistant Surgeon G. K. Smith reported the folloAving history: "The Avound Avas caused by a conoidal ball, Avhich struck the femur about six inches above the patella, fracturing the shaft of the bone and lodging. But slight constitutional disturbance took place, and the quantity of discharge from the AVOUIH! Avas A r ery moderate. The position of the ball could not be ascertained. The patient Avas treated on Dr. Gurdon Buck s plan. TAVO weeks after his admission, the injured limb Avas found to be shortened one and one-quarter inches. By June 9th the Avound had healed, but bony union Avas still incomplete and extension by Aveights Avas continued* On July 8th the femur Avas found to be firmly consolidated, and the patient Avas allowed to go about on crutches. He was mustered out of service August 2, 1865, his general health being good and his injured leg shortened less than an inch." Examiner J. C. Tibbets, of WarsaAV, NCAV York, certified, October 14, 1872 : " The ball passed through the rectus muscle, fractured the bone, and lodged in the posterior pan of the thigh among the muscles, where it still remains. The muscles in the M.M! ami Surv Hist of the War of ihe Kebolhoii. Part Ifl, Vol.lU haj) X PLATE LX- CONSOLIDATED Gil NSHOT FRACTUR ES OF THE FEMUR .Case of Lieuieuanl J.BiicJdev I/K) A N e w York . Fig. 2. Case of Private J. Hamilton SECT, in.] SHOT FRACTURES OF THE MIDDLE THIRD OF FEMUR. 189 back of the leg and thigh are contracted, so that walking or even much resting on the limb causes spasms (cramps), etc." The pensioner was paid March 4, 1879. His photograph, taken at the Army Medical Museum on July 25, 1865 (Surg. Phot. Series, No. 72), is represented in FlG. 1 of PLATE LXI. CASE 386. Private J. Friederick, Co. F, 127th New York, aged 19 years, was wounded in the right thigh at Honey Hill, November 30, 1864. Assistant Surgeon J. F. Huber, U. S. V., reported his admission to hospital at Hilton Head, on the day following the injury, with "compound fracture of femur, treated with splints," and his transfer to Washington, May 7, 1865, but gave no account of the progress of the case. The following notes were furnished by Acting Assistant Surgeon G. K. Smith, from Armory Square Hospital, and by Assistant Surgeon W. Webster, U. S. A., in charge of DeCamp Hospital, David s Island, New York. The wound was caused by a round ball, which entered the inner side of the thigh at its middle third, passing obliquely outward and forward, fracturing the femur and lodging. An attempt to stand on the limb after receiving the injury caused the thigh to bend to an obtuse angle at the seat of the fracture. The wounded man was placed on a shelter tent and conveyed to a steamboat, about eight miles distant, no examination of the wound having been made and no local support having been applied to the broken bone. During the night following the injury the ball was removed through an incision on the external aspect of the thigh. Cold-water applications were used, and a partial support was given by an arrange ment of blankets around the parts. On arriving at the Hilton Head Hospital a surgical examination was made under chloroform, but with no operative result, the limb being exceedingly tumefied. Smith s anterior suspensory apparatus was then applied, and the topical applications of cold water were continued. This treatment was kept up until January 7th, when side splints, extending below the foot, were substituted, and the limb was maintained in a straight position. This apparatus was continued for nearly two months, and during this stage of the treatment the swelling.greatly subsided, and about a half dozen pieces of bone were removed by the attending surgeon at various intervals. The largest of these is represented to have been about three inches long, one-half inch wide, and one-eighth inch thick. An abscess also opened, spontaneously, about two inches below Poupart s ligament. In the latter part of March the side splints gave way to a fracture-box, the cold- water dressings being still persevered in. On May 1st all local supports by means of splints were cast aside, bandages and pillows being sufficient from that period in consequence of the advanced stage of bony consolidation. On May 10th, when the patient was admitted to Armory Square Hospital, the fractured femur had firmly united, with seven inches shortening, a marked deformity by an outward curvature of the thigh, and very limited motion of the knee joint. There was still a slight dis charge, and the extremity of the upper fragment lapping by the lower fragment presented itself on the outer aspect of the limb, close to the external condyle, at which point the skin was ulcerated through, exposing the end of the bone. By June 1st the patient s recovery was so far advanced as to enable him to walk about the ward with the aid of crutches. About the last of June, however, he was compelled to resume his bed in consequence of the appear ance of an abscess on the outer side of the thigh, which was opened and gave exit to about eight ounces of sanious and offensive pus. Up to this time the purulent discharges from the wound had been moderate in quantity and healthy in character. On July 5th, however, the several openings were attacked by gangrene, which rapidly extended up the thigh and destroyed the skin and superficial and deep fascia nearly the whole length of its external surface. This disease was, at length, arrested by the appli cation of bromine, and by August 15th the wound had become filled with granulations, and cicatrization was progressive. On August 17th the patient was transferred to Douglas Hospital, where a subsequent exploration of the limb resulted in the removal of six small sequestra from the external wound. Simple dressings were now used, and no further operative interference was required in the case until after the arrival of the patient at DeCamp Hospital, where he was transferred on October 23d. At this date he was strong enough to walk from the steamboat landing to his ward on crutches, and his general health was excellent. There were three apertures, two on the external and one on the posterior surface of the thigh, from which pus of a healthy appearance found exit in small quantities. An examination of the wound by means of a probe revealed secondary splinters, but not sufficiently approachable to warrant an attempt at their removal. The amount of new osseous deposit was considerable, but unfortunately the sequestra were found so intimately embedded in it as to cause their removal to be attended with great difficulty and even impossibility, and involving the sacrifice of so much new growth as to endanger the limb. On February 25, 1866, how ever, the further removal of necrotic pieces was induced by constitutional symptoms, which manifested themselves and indicated local irritation. Portions of the involucrnm were removed by the trephine and chisel, where necessary for the purpose, and small masses of dead bone were extracted from each of the orifices. One of the pieces, deeply situated, measured about two inches in length. As a seeming consequence of the operation the unfavorable constitutional symptoms entirely disappeared, and the condition of the patient and his wounds became highly satisfactory." In June following he was supplied with an apparatus for the injured limb by E. D. Hudson, of New York City, and four months later he left for his home, having been discharged from service November 25, 1865, but re-admitted to the hospital one month afterwards. The Examining Board of Augusta, Maine, certified, in May, 1873, and in December, 1876: "The leg is withered and badly deformed, and there are discharging ulcers all the time. He can perform no manual labor of any kind, and is confined to his bed a large part of the time. The leg, from knee to foot, is nothing but skin and bone." The pensioner was paid June 4, 1879. The wood-cut (FlG. 151) represents a photograph of the patient, taken August 15, 1865. (Photo s of Suryical Cases, Vol. 9, p. 16, and Surg. Phot. Series, No. 90.) FIG. 151. Shot fracture of middle third of right femur. [From a photograph.] 190 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. x. Card photographs, taken at a subsequent date at the DeCamp Hospital, were contributed by Assistant Surgeon Webster. (Card Photo s, Vol. 2, p. 22, A. M. M.) CASE 387. Private T. Miller, Co. G, 116th Pennsylvania, aged 18 years, was wounded at the Wilderness, May 5, 1864, and admitted to Armory Square Hospital, Washington, three weeks afterwards. Surgeon D. W. Bliss, U. S. V., described the injury as a "fracture of the upper third of the left femur, caused by a mini6 ball," but the progress of the case, further than an attack of pleuro-pneumonia, in March, 1865, was not reported. On August 15, 1865, the patient was transferred to Harewood Hospital, whence Surgeon R. B. Bontecou, U. S. V., reported the following history : " When admitted he was convalescent from a wound of the thigh, the missile entering and fracturing the femur at the junction of the upper and middle thirds, passing through and coming out on the inner side, near the tuberosity of the ischium. According to the patient s statement his constitu tional condition at the time of the injury was very good, although the wound was very painful. Severe haemorrhage followed the injury, with great tumefaction of the whole limb. The fracture box was used and counter-extension, and the treatment was suppoi-ting throughout. The patient had so far recovered as to be able to be about on crutches. The thigh had shortened about two inches and three-fourths; but otherwise the man was in good condition and in a fair way of having a useful limb." Two weeks afterwards he was transferred to Mower Hospital, and subsequently to the Post Hospital at Philadelphia, and in October he was finally sent to Harrisburg to be mustered out, his term of service having expired July 14, 1805. An apparatus for the injured limb was furnished on December 6, 1865, by J. M. Gemrig, of Philadelphia. Dr. J. A. McArthur, Surgeon of the Soldiers Home, Philadelphia. October 17, 1866, certified to anchylosis of the knee joint as resulting from the injury, and described the wound as still open and requiring treatment. The Philadelphia Examining Board reported "almost complete anchylosis of the knee," in September, 1873, and two years afterwards the same Board stated: "The femur is curved antero- posteriorly concavity forward. There are several scars on the front of the thigh, where spicula3 were removed, and the muscular structure of the thigh is much wasted. He alleges constant pain in walking." The pensioner was paid June 4, 1871). A photograph of the patient, taken at the Harewood Hospital in October, 1865, was contributed by Surgeon Bontecou, and copied at the Army Medical Museum. (Photos, of Surgical Cases, Vol. 8, No. 142, and Surg. Phot. Scries, No. 114, A. M. M.) A representation is shown in FIG. 2 of PLATE LXI, opp. CASE 388. Private H. Shatter, Co. D, 7th Wisconsin, aged 30 years, was wounded at Gravelly Run, March 31, 1865, and admitted to the field hospital of the 3d division, Fifth Corps, where Surgeon A. S. Coe, 147th New York, recorded: "Frac ture of middle third of right thigh by a minie" ball." On the second day after the injury the wounded man was moved to the Depot Hospital at. City Point, and several days later he was sent to Washington. Acting Assistant Surgeon G. K. Smith reported the following history: "The patient was admitted to Armory Square Hospital April 5th. The missile had entered the external portion of the thigh, producing fracture and lodging. On April 19th, a small opening ulcerated through the skin on the inner side of the thigh, about two inches below the perinaeum, through which the ball was removed by the forceps. Tin 1 limb was bandaged in its whole length and laid upon a mattress, being supported by sand bags and extended by weight and pulley. On July 5th the patient was able to ride about the ward in an invalid chair, and a few days later he walked on crutches. By July 16th the bone had firmly united, with only one inch shortening, though there was still a slight discharge from the wound. The patient s general health was remarkably good." He was subsequently transferred to Harvey Hospital, Madison, and ultimately discharged from Camp Randall November 15, 1865, Acting Assistant Surgeon A. W. Greenleaf certifying to "shortening and total loss of power and strength of the limb." Examiner A. J. Ward, of Madison, Wisconsin, on September 8, 1873, reported over three inches shortening of the limb and anchylosis of the knee joint; and two years later he stated that the pensioner "will never be any better." The pensioner was paid March 4, 1879. FlG. 2 of PLATE LXII, opp. p. 192, is a copy of a photograph of the patient, taken at the Army Medical Museum on July 16, 1865. (Sury. Phot. Scries. No. 71, A. M. M. ) CASE 389. Private H. E. Gumberts, Co. E, 136th Indiana, aged 18 years, was shot in the left thigh, at Camp Carrington, May 13, 18J4. Acting Assistant Surgeon J. M. Kitchen reported his admission to hospital at Indianapolis on the day of the injury, and described the wound as a "fracture of the femur, caused by a musket ball." The patient was discharged by reason of expiration of service September 2, 1834, and subsequently he was placed on the Pension Rolls. In January, 18l>6, Dr. Kitchen communicated that he received a letter from the man stating that he could "run and jump as well as ever," and repre senting "the injured limb, with the exception of a little shortening, just as good and useful as the other." Examiner H. M. Harvey, of Evansville, Indiana, certified, August 12, 1871: "The ball entered the thigh about midway between the knee and hip joints, on its outer aspect, passed inward, backward, and slightly downward, fracturing the shaft of the femur in its course, and emerging on the inner side of the limb. There is a large amount of callus around the seat of the fracture, and the limb is shortened about one and one-quarter inches. He complains of pain in the knee joint, and cannot completely flex the leg upon the thigh." At a subsequent examination the pain in the knee was reported to be increasing. The pensioner was paid June 4, 1879. His photograph was obtained in July, 1866, and contributed by Dr. Kitchen to the Museum, where it was copied. (Surg. Phot. Series, No. 153, A. M. M.) A representation of it appears in FIG. 1 of PLATE LXII, opp. p. 192. Of the four hundred and twenty-one Union soldiers discharged the service on account of shot fracture of the middle third of femur, thirty-three have died in the course of four teen years since the close of the war, and one committed suicide. In the following two instances the patients died nine and twelve years after the reception of the injury: CASE 390. Captain R. T. Shillinglaw, Co. I, 79th New York, aged 32 years, was wounded in the left thigh, both upper extremities, and the right temple, at Bull Run, July 21, 1861. The injury of the thigh was caused by a conoidal ball, which fractured the femur obliquely at the middle third. He was made a prisoner and conveyed to Richmond, where the frac ture was treated at the Alms House Hospital, by a Desault splint for one week, and by Smith s anterior splint for twelve weeks subsequently. Slight suppuration continued for nearly a year after the injury, with occasional elimination of bits of necrosed Mnl and Sunj Hisl of the War of lh- Kebt lliou . l ;u-t HI Vol.11. Chap.X. PLATE LXI.- CONSOLIDATED GU NSHOT FRACTURES OF TH E FEMU R I - 1 ( use of ScrM iUit A RvdfM- ! J1 -. N ^vFYork l iv 1 Case of Private ! Mill.-r 1 l(i ll> l\>nn s vlviiii; . i SECT. III.] SHOT FRACTURES OF MIDDLE THIRD OF FEMUR. 191 FIG. 152. Shot fracture < f middle third of left femur. [From a photograph.] bone. Having been exchanged on December 31, 1861, he proceeded to his home in New York City, where he was treated, for a time, by his family physician. Some months afterwards he returned to the field, and served as Acting Aid-de-Camp to General Wilcox until January 20, 1863, when he resigned the service. In August following, Captain Shillingluw was commissioned in the Veteran Reserve Corps, in which organization he remained until August 2, 1865, when he was finally mustered out and pensioned. After leaving the service he took up his residence in Washington City, and obtained employment in the U. S. Treasury Department. The photograph, represented in the annexed cut (FlG. 152), was obtained in June, 1866, when he visited the Army Medical Museum. At that time the injured limb was shortened nearly three inches, but he could walk briskly and without a limp. He used no cane and experienced little or no inconvenience from his wounds. Examiner J. Phillips certified, February 6, 1869t "Gunshot wound of left thigh, left arm, right hand and arm, and right temple. Compound comminuted fracture of thigh bone. The bone has united crookedly, and is about three inches shorter than its fellow; the muscles are attenuated, and the nerves of the limb so affected that he is constantly suffering. Gunshot wound of left elbow joint; ball lodged near the joint, which is now so weakened as to be unserviceable for labor. Flesh wound of right hand from piece of shell. The right arm was pierced by a piece of shell, scraping the bone. This wound impairs the usefulness of the limb. A ball struck the right parietal bone. He suffers but little from this wound." This pensioner died April 14, 1870, of consumption, superinduced by an attack of pleuro-pneumonia and gunshot wounds. CASE 391. Private J. Moran, Co. K, 25th Ohio, aged 22 years, was wounded "at Bull Run, August 30, 1862, and admitted to hospital at Alexandria four days afterwards. Surgeon E. Bentley, U. S. V., reported : "A ball entered on the anterior side of the left thigh, at the top of the middle third, passed though the limb, fracturing the bone, and emerged on the inner side of the thigh, at the bottom of the middle third. The patient was treated by rest and position, and the bone united with considerable shortening. He was discharged from hospital January 30, 1863." The man subsequently joined the Veteran Reserve Corps, and was ultimately discharged from service March 28, 1865, and pensioned. Examiner S. S. Thorn, of Toledo, Ohio, October 3, 1865, certified to the "shot fracture of the femur, fol lowed by three and a half inches shortening, anchylosis of knee, and impaired power of limb;" also to "the wound being still open and exfoliating bone." Examiner S. M. Smith, of Columbus, one year later reported the injured femur as affected with necrosis, and Exam iner T. A. Reamy, of Cincinnati, in September, 1873, describes the "muscles firmly adherent to the bone at the point of the injury, an open sinus communicating with the bone anteriorly, and great angular deformity at the union of the fractured bone." The attending physician of the pensioner certified that he died November 11, 1874, of debility superinduced by necrosis of the injured femur, which was attended by continued exfoliation and suppuration. fatal Cases of Shot Fractures of the Middle Third of the Femur treated by Con servation. Three hundred and forty-two cases of shot fracture of the middle third of the femur treated by conservation had fatal terminations. Eighty-six were Confederate and two hundred and seventy-four Union soldiers: CASE 392. Private J. Shimrock, Co. A, 55th Ohio, aged 20 years, was wounded at Chancellorsville, May 3, 1863. Surgeon G. Suckley, U. S. V., reported that he was left in the hands of the enemy, and described his injury as "a shot fracture of the femur." Twelve days after being wounded the man was paroled and admitted to the Eleventh Corps field hospital at Brook s Station, and one month later he was transferred to the Stan ton Hospital at Washington. Surgeon J. A. Lidell, U. S. V., contributed the specimen (FlG. 153) and made the following report of the case: "Examination at the time of admission showed that the right femur was broken near the junction of the lower with the middle third, and that union had not yet taken place. There was a copious discharge of thin pus from the wound of the soft parts. The fracture had been treated in a simple straight fracture-box, and the limb was still in it when the patient was brought to this hospital. He stated that the bullet had not yet been extracted from the wound. He was pale, thin, and weak, with a frequent pulse. His tongue was smooth, dry, and red, and he complained of diai rhcea, but said this was an old affair, and that he had also had chills and fever some time back. The prognosis was very unfavorable. The broken limb was placed in Hodgen s splint; pills of camphor and opium were given to control the diarrhoea, and the system was supported with a nourishing diet, using eggs, milk, beef tea, farina, etc., together with milk-punch. Juno 18th, diarrhoea checked; tongue continues red and smooth; has considerable irritability of the stomach. The pills were suspended, but the supporting treatment continued. 22d, secondary haemorrhage from the wound, to the extent of about three ounces, occurred this morning; there was also slight bleeding yesterday, some branch of the profunda being the probable source. Two drachms of solution of persulphate of iron was injected into the bottom of the wound through a catheter, and the haemorrhage did not again occur. 24th, complained of pain in the thigh, was restless, and had some diarrhoea. Gave one-grain opium pills every four hours until the 26th, when the diarrhoea was again checked. Suppuration continued profuse; tongue smooth and red. July 2d, patient appeared to be slowly failing. Fluctuation having been detected above the internal condyle of the femur, an incision was made and about two ounces of pus evacuated. Two grains of quinine was prescribed three times a day, and six ounces of whiskey daily was substituted in place of the milk-punch, which, the patient thought, did not agree with him. 8th, patient began to exhibit night sweats, with increase of pallor and anaemia; suppuration profuse, unhealthy and fetid ; necrosed bone at the bottom of the wound firmly impacted. 18th, had a chill, followed by a hot and sweat ing stage. Administered ten grains of quinine three times a day: chills did not return for four days. 20th, patient very pale 192 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 153. Fracture of right femur at junc tion of middle and low er thirds. Spec. 1536. and feeble, with smooth red tongue; in addition to quinine he takes muriated tincture of iron, and porter two pints daily, with nourishing diet. 21st, diarrhoea returned and was checked by pills of opium. 22d and 23d, chills occurring at irregular inter vals, associated with hot flushes and profuse perspiration. 25th, some unhealthy fetid pus was evacuated from the inner side of the thigh by incision. 27th, had pysemic rigors and sweats again ; is much emaciated and very pale; pulse 120 and feeble; tongue glazed and of bright red color. 29th, continuance of pysemic rigors and sweats, the perspiration being very profuse; left leg and thigh cedematous and blue colored, the superficial veins looking like dark blue knotted cords; all of which denotes obstruction of the left iliac and femoral veins. The patient continued to sink, and died of exhaustion on July 31, 1863. Post mortem twenty hours after death: Fracture of right thigh firmly united; necrosed bone closely surrounded by involucrum ; muscles of right thigh extensively infiltrated with pus. The missile, a conical and much flattened bullet, was found at the lower and inner side of the thigh. The femoral artery opposite the seat of the injury contained an oval-shaped clot of blood (embolus) which completely occluded it; no other abnormity of the artery was noticed. On examination of the left thigh a metastatic abscess was found in the popliteal space containing about an ounce of pus, and the external iliac and femoral veins were dis covered to be distended with coagulated blood. The femoral and iliac veins of the injured limb appeared to be normal. The liver was somewhat enlarged, nutmegged and fatty; kidneys beginning to be granular; spleen enlarged, softened, and reddish brown in color; lungs containing some frothy serum, otherwise natural ; left ventricle of heart containing some coagulated blood." The specimen consists of the lower half of the injured femur with a battered piece of lead attached, and exhibits a fragment four inches long by one and a half w;ide, which preserved the vitality of its periosteal surface. The effusions from this fragment connect, as a bridge, the broken shaft; its internal surface is carious. Besides this, other and smaller fragments are entangled in the newly formed bone, some of which are necrosed and some serve as bonds. A wet preparation of portions of the common and external iliac and femoral arteries of the right side, showing an embolus in the latter near the seat of the fracture of the thigh, was also contributed by Surgeon Lidell, 1 and constitutes Specimen 3454 of the Surgical Section of the Army Medical Museum. CASK 303. Corporal W. Ford, Co. B, 1st Colored Regiment, aged 20 years, received a shot wound at Petersburg, June 1"), 1885, and was conveyed to Baltimore twelve days afterwards. Surgeon L. W. Read, U. S. V., reported his admission to McKim s Mansion Hospital with "shot fracture of left thigh." On July 25th, the patient was transferred to Hick s Hospital, whence Assistant Surgeon G. M. McGill, U. S. A., forwarded the specimen, shown in the annexed cut (FiG. 154), with the fol lowing account of the case: "The patient suffered with a wound of the left thigh. The ball had entered the posterior part of the outer aspect of the middle third, pass ing inward, forward, and slightly upward, and lodged. It was sought for several times but could never be detected. A large detached piece of necrosed bone was taken out of the opening of entrance during the month of September, 1865. The patient complained of continual pain, aggravated by pressure in both lumbar regions, in which regions there was extended flatness on percussion. He continued very weak, had several attacks of erysipelas, and finally sank, after a severe attack, on February 20, 1866. The injured thigh was greatly swollen, its skin shiny and somewhat tuberculated about the sinuses and slow-healing incisions. The diagnosis of fatty degeneration (interstitial formation and proper) was made for the left thigh and leg and inferred for the great organs. Ford was a long time dying : For seventy hours or more his death was expected from hour to hour. Before death the surface of his body, in appearance, was waxen. The left leg and foot were gangrenous. There was a tumor (result of periosteal action) of the diaphysis of the left femur. The ball (much flattened) was found beneath the sartorius muscle and vessels in the middle third of the thigh. There was pus in the left knee joint, in the left hip joint, and in the superficial fascia of the left leg. No disease of the vessels was observed." The specimen consists of the left femur, obliquely fractured in the middle third and partly consolidated by an excessive deposit of new bone on the posterior surface, the adjacent surfaces being carious, with a necrosed fragment remaining at the upper portion. CASE 394. Private C. Hill, Co. K, 7th Michigan, was wounded at Antietam, September 17, 1862. Surgeon G. Chaddock, 7th Michigan, reported his admission to the Stone House Hospital, near the battle-field, with "shot wound of the thigh." Surgeon B. A. Vanderkieft, U. S. V., forwarded the specimen, shown in the wood-cut (FiG. 155), with the following history: "The patient was wounded by a musket ball, which passed through the middle third of the right thigh, fracturing the femur. He came under my care six weeks after the injury, there being no previous history other than his statement that a small piece of bone was extracted a few days after the reception of the wound. On account of the normal appearance and length of the leg, the slight suppuration, the absence of other fragments and of any crepitation whatever, I diagnosed an incomplete compound fracture of the thigh, such as is often the result of an injury by a spherical ball received at short distance. (Patient stated that he distinctly saw the man who shot at him.) His general condition was very satisfactory. The fractured limb presented two fistular openings, one on the inner and the other on the outer side of the thigh at the middle third, and discharging but little pus. There was no shortness whatever, and if there had been a complete Dr. LIDELL, in an article on Thrombosis and Embolism, in the American Journal of Medical Sciences, 1872, Vol. LXIV, N. S., p. 343, gives a minute account of this important case. FIG. 154. Oblique fracture of left femur in middle third. Spec. 255. FIG. 155. Left femur fractured in middle third. Spec. 1043. M. d aiul Sin-. Ilisl of the WHi-oI llieKrbellion. Part III Vol. II, C hap X. PLATE LXII -CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR Fi 1 Case of Private H.K r.HM.h.M-ts l:-5t) 1h Indiana. Fi-j 1 Case of Wivatr H.Shetter / *. h Wisconsin . SECT in.] SHOT FEACTUEES OF MIDDLE TRIED OF FEMUE. 193 division of the bone consolidation had already followed. The limb was placed between two sand bags, acting as splints, and a plain dressing was applied. A very nourishing diet was prescribed. By the 17th of December the patient was doing very well; the inner fistular opening was closed, while the one on the outside was still of the same dimension, but discharging an ichorons pus mixed with small pieces of bone in the form of sand, such as is often noticed in caries of the long bones. On Jan uary 9, 1863. notwithstanding the continuation of the discharge of the aforementioned character, the patient felt well enough to sit up a short time in an arm-chair, but, on returning to his bed, he accidentally fell down, and, owing to the fragility of the injured parts, he fractured the same precisely at the corresponding point of the passage of the ball. Notwithstanding the most careful attendance no consolidation could be obtained, the whole femur seeming to be in a state of molecular disorganization, and having lost its normal firmness even as in rachites. The discharge of ichorous pus increased daily, and the patient died of exhaustion on March 19, 1853, no signs of pyaemia having been noticed. The use of phosphate of lime against the existing osteomalacia did not afford the slightest relief. According to the patient s statement, there was no constitutional predisposition." The specimen consists of the injured femur, and shows the formation of an immense sequestrum in the lower half and disease of the lower two-thirds of the shaft. CASE 395. Sergeant T. Bechtold. Co. C, 93d Pennsylvania, aged 34 years, was wounded at Fair Oaks, June 1, 1862, and entered Hygeia Hospital at Fort Monroe nine days afterwards. Surgeon R. B. Bontecon, U. S. V., reported: "He received a shot while in line of battle, the ball entering the anterior and middle third of the right thigh, and making its exit nearly opposite on the posterior portion of the limb; and while on the ground he was hit again by a conical ball, which entered the back below the inferior angle of the scapula and was cut out in the axilla. On June 12th, secondary haemorrhage from the wound in the axilla set in, which continued from time to time for four days, when it was finally controlled by pressure and plugging. The thigh was swung up in Smith s anterior splint, and imperfect union took place under unfavorable circumstances, the patient being very much emaciated and suffering from bedsores and diarrhoea. He was sent to his home in August, 1832, and I learned that he subsequently died from the exhaust ing suppuration, which, from the first, kept up from the thigh wound. Sequestra were removed whenever discovered, and the fascia of the thigh relieved to prevent burrowing." The patient died at Lebanon, Penn sylvania, on September 24, 18(i2, whence the specimen represented in the wood-cut (FlG. 13b ) was con tributed by Dr. B. F. Schenk. The specimen embraces a portion of the fractured femur, and shows a remarkable instance of reparative effort. The fragments are thoroughly involved with callus, and a large sequestrum is nearly detached. There is also an accidental post-mortem fracture of the specimen one inch below its superior border. CASE 396. Private Tobias Bever, Co. C, 57th North Carolina, aged 30 years, was wounded and taken prisoner at Eappahannock Station, Virginia, November 7, 1863. Surgeon John A. Lidell, U. S. V., reported : "The bullet entered the left limb one and a half inches to the inner side of the inner margin of the patella, passed upward and outward, fractured the femur five or six inches above the knee joint and lodged; its locality could not be ascertained. He was admitted into Stanton Hospital November 9th, his general condition being favorable. The synovia! pouches were apparently unopened. The limb was placed in Hodgen s splint and a of moderate amount of extension applied ; the wound was kept wet with cold water. Some synovial effusion into tured in middle third, the cavity of the joint occurred on November 21st, but no other untoward symptoms were present. November ^ ec 30th, doing well, wound healing, but little effusion in the knee joint ; general health good ; bullet still unextracted. December 1st, the external wound is healed ; there is a hard substance, feeling like a portion of bone, or perhaps the ball, to be felt in the outer and back part of the thigh at a point corresponding with the fracture. December 25th, femur united and quite strong. The ball still remained in the limb, and its location was not surely known. On January 1, 1864, the extension was discontinued. He could move the limb very well; the amount of shortening was two inches, which was occasioned by overlapping at the seat of fracture. His general health was excellent, and he was out of bed almost every day, and appeared to be doing well until February 1, 1864, when the wounded thigh had become swollen (not circumscribed) and painful. Ordered to stay in bed for the purpose of resting the limb and to apply a lotion of lead and opium. The tumefaction of the thigh partially subsided on February 14th, but the lymphatic glands of the groin had become swollen, painful, and tender. March 2d, the swelling about the track of the bullet has increased and is very painful. Fluctuation is also detected. The cicatrix of the wound is tense and puffy ; incised it and evacuated about two ounces of laudable pus. March 3d, the pain has ceased and the swelling has partially subsided. The discharge from the wound is thin, straw colored, and flaky. Directed the tincture of iron to be continued, with the addition of six ounces of whiskey daily. On March 20th, the swelling and soreness of the thigh had again increased. The discharge continued free. There was also diffuse redness of the skin, extending from the wound up the inner side of the thigh. He was pale, anaemic, and felt very weak. Stimulants were directed to be continued, with such articles of diet as he could take. It was now apparent that he would not recover without amputation of the thigh, but we were compelled to await the subsidence of the diffuse inflammation of the soft parts in order to perform that operation with any hope of success. March 22d, the discharge continues copious. It is thin and there is some blood mixed with it. He is somewhat emaciated and slowly failing in strength. March 24th, copious haemorrhage from the wound, apparently parenchymatous in character, occurred this morning, and about half a pint of blood was lost before it could be controlled. Injected about two ounces of solution of persulphate oi iron through a catheter carried deep into the wound, after which there was no more external haemorrhage. The loss of blood reduced him very much. He gradually sank, and died on the morning of March 27, 1864. At the autopsy, in dissection, great oedema of the areolar tissue of the thigh was found. There was a large cavity beneath the fascia lata and surrounding the seat of fracture. It extended from the synovial pouches of the knee joint up to the trochanter major. It was lined with a moderate amount of plastic exudation. It contained about a quart of dark colored blood mixed with some pus. At the bottom of it, and toward the inner side of the femur, a minie" ball was discovered. A piece had been split off from the side of it which could not be found. The medulla of the femur above the fracture was found to be bright red in color and soft in consistence. It presented the appearance described by Virchow as the red inflammatory marrow (osteomyelitis). The fracture was firmly but irregu- SURG. Ill 25 194 LNJUIUES OF THE LOWEK EXTREMITIES. IciiAr. x. larly united. Examination of the specimen showed that the bullet passed upward and outward from the orifice of entrance at the inner side of the knee, but without opening the joint cavity, and impinged against the femur about three and a half inches above the extremity of the condyles, fracturing the bone very obliquely with comminution, so obliquely, indeed, that while the line of fracture commences about three and a half inches above the extremity of the condyles, as already stated, it terminates about seven inches above the extremities of the femoral condyles, so that the lower fragment of the broken femur is, in all, about seven inches long. The fragments of comminution had all united with more or less irregularity of position, but portions of some of them appeared likely to exfoliate. The two principal fragments had united at something of an angle opening forward and a little inward, so that the femur bowed backward and somewhat outward on that account. The marrow at the place of exam ination, a few inches above the fracture, was bright red in color, and presented a striking resemblance to newly formed gran ulations. A few spots appeared to be undergoing the process of conversion into bone." The pathological preparation, Specimen 2167, was contributed to the Army Medical Museum by Dr. Lidell. A colored drawing of the specimen, prepared by Hospital Steward E. Stanch, U. S. A., is copied in the chromo-lithograph (PLATE XXIV) opposite. Shot Fractures of the Lower Third of the Femur treated by Conservation. Six hundred and twenty cases of shot fractures of the lower third of the femur were treated without operative interference. Instances of shot fracture of the lower third of the femur, in which the knee joint was primarily involved, are not included in this series; they will be considered in Section IV of this Chapter, with injuries of the knee joint. Three hun dred and seventy-five of the six hundred and twenty patients recovered; two hundred and thirty-two died, and in thirteen instances the result remained undetermined, giving a ratio of mortality of 38.2 per cent. Five hundred and two were Union, and one hundred and eighteen were Confederate soldiers, and the proportion of deaths among the former was 38.7, among the latter 36.0 per cent. Successful Cases of Shot Fractures of the Lower Third of the Femur treated by Con servation. Three hundred and four of the three hundred and seventy-five survivers of shot fracture of the femur in the lower third were Union soldiers, and an account of the pension record has been obtained in two, hundred and thirty-nine instances: CASE 397. Private C. H. Schellenger, Co. C, 9th New York Heavy Artillery, aged 35 years, was wounded at Petersburg, April 2, 1865, and admitted to the field hospital of the 2d division, Sixth Corps, where Surgeon W. A. Childs, 10th Vermont, recorded : " Shot fracture of right femur; splints applied." Surgeon E. Griswold, U. S. V., reported the patient s entrance into Judiciary Square Hospital April 12th, and the fracture as being located at the "middle third" of the bone. He also stated that the treatment at first con sisted of simple dressings, and afterwards splints and sand bags were used, and that "the progress of the case was favorable throughout, the wound being nearly healed about the middle of June, with one and a half inches shortening of the limb." The patient was discharged from service June 22, 1865, and pensioned. Examiner E. Hall, of Auburn, New York, certified, November 25, 1865, to " shot wound through right thigh above the knee, breaking the femur obliquely, the ball coming out on the inside of the leg near the scrotum. Limb shortened and knee quite stiff from thickened cartilage." The Syracuse Examining Board reported, April 5, 1876: * * * "The limb, he alleges, is lame, weak, and subject to spasms upon fatigue." The pensioner was paid June 4, 1879. His photograph, taken at the Army Medical Museum in June, 1865 (Sury. Phot. Scries, A. M. M., No. 45), is represented in the wood-cut (FiG. 157). In the following instance the patient recovered with such excellent use of the limb that the Pension Examining Board recommended, in 1876, that the pensioner s name be dropped from the Rolls, as the disability had ceased and the injured limb was as well nourished as the other: CASE 398. Private J. Durst, Co. D, 69th New York, aged 21 years, was wounded at Hatcher s Run, March 25, 1865. On the following day he was admitted to the Depot FIG. 157. Result of shot fracture of lower Hospital of the Second Corps, at City Point, and, on March 30th, he reached Washington, lird of riprht femur. [From a photograph.] . . , n T- a vu where he entered Armory Square Hospital. Acting Assistant Surgeon G. K. Smith con tributed the following history : "A minie" ball entered the anterior aspect of the right thigh at the junction of the middle and lower thirds, passing backward and fracturing the femur, and made its exit opposite the wound of entrance. The injury produced very little constitutional disturbance, and the discharge from the wound did not exceed two drachms in twenty-four hours at any time. The limb was treated in Hodgen s splint, without extension, until April 14th, when it was placed on a mattress with a sand bag third < PLATE XXIV. OSTEOMYELITIS IN A FRACTURED FEMUR. iisc (i I I I Tnliiiis I Ic-MVt !.( . i~i , i: N :-lli ( lire! in. SECT. III.] SHOT FRACTURES OF LOWER THIRD OF FEMUR. 195 on each side to keep it in position, and extension was applied by Buck s method. On June 9th the extension was removed and the bone was found to be firmly united, with one and one-fourth inches shortening. The patient was now walking on crutches. The anterior wound had healed for about a week, but the posterior wound was still discharging very slightly. By June 23d he had good movement of the knee and could bend the leg to a right angle with the direction of the thigh. The discharge from the wound at this time did not amount to over one drachm in a week. No fragments of bone were ever removed, and the limb healed almost as kindly as a simple fracture, showing no deformity except the shortening." The patient was subsequently trans ferred to DeCamp Hospital, David s Island, New York, and, on August 19, 1865, he Avas discharged and pensioned. Examiner W. M. Chamberlain, on August 22, 18G6, certified to a " well united fracture of the right femur, with only one inch shortening, and some lameness and debility of the limb." Substantially the same was reported at subsequent examinations until January 19. 1876, when the New York Board certified to the injured thigh being as well nourished as the other, and to the disability as having ceased, in accordance with which the pensioner was dropped from the Pension Rolls. A photograph of the patient, taken at the Army Medical Museum in June, 1865 (Surg. Phot. Series, No. 46, A. M. M.), is represented in PLATE LXIII, opp. p. 196. CASE 399. Private E. P. Allen, Co. D, 12th Infantry, aged 19 years, was wounded at Gettysburg, July 2, 1863, and admitted to the field hospital of the 2d division, Fifth Corps. The injury was caused by a minie" ball, which lodged in the anterior portion of the lower third of the left thigh, and was removed on the following day by Assistant Surgeon E. DeW. Brenneman, U. S. A. The missile was contributed to the Museum by the oper ator and is represented in the annexed wood-cut (FlG. 158). It consists of a couoidal ball beaten into nearly a triangular pyramid with very sharp edges. From the field hospital the patient was, on July 25th, transfer red to the Cotton Factory Hospital at Harrisburg, whence Acting Assistant Surgeon W. S. Woods reported that he was discharged from service December 21, 1863, by reason of "compound fracture of left thigh." Examiner C. Hard, of Ottawa, Illinois, certified, May 1, 1869: "There is a compound comminuted fracture of the lower third of the left femur. The bones have united, with three inches shortening, leaving great and incurable deformity, and there is partial anchylosis of the knee joint, making him permanently lame." In FIG. 1 58. Batter- September, 1873, the same Examiner stated that "the heel is drawn up, the fot turned out, and the limb moved from thigh, atrophied from foot to body." The pensioner was paid June 4, 1879. < $P ec - 3028 - CASE 400. Private M. Burns, Co. B, 28th Massachusetts, aged 22 years, was wounded at Hatcher s Run, March 25, 1865. Surgeon F. M. Hammond, 126th New York, noted his entrance into the field hospital of the 1st division, Second Corps, with "shot wound of left thigh." The wounded man reached Washington April 3d, and was admitted to the Armory Square Hospital, whence Acting Assistant Surgeon G. K. Smith reported the following history: "The missile, a mim 6 ball, entered the anterior portion of the thigh at the junction of the middle and lower thirds, and, passing horizontally backward, fractured the femur and made its exit posteriorly. The constitutional disturbance resulting from the injury was very slight, the discharge of pus from the wound amounting to only about half an ounce in twenty-four hours. The limb was shortened two inches. It was placed on a mattrass, between two sand bags, and extension was applied with a sixteen pound weight. Muriated tincture of iron was ordered; but no stimulants were given. By April loth, the discharge amounted to only one drachm daily, and the limb was shortened only one and a quarter inches. On May llth, believing the fragments to be firmly united, I allowed the extension to be removed and the patient to ride on the invalid chair, and, on measuring the limb, I found that it was still shortened three- quarters of an inch. I reapplied the weight ; but this contraction could not be overcome by any amount of extension that the patient could bear. He was now kept in bed until June 9th, at which time the fragments had firmly united and he commenced walking on crutches. No fragments of bone were ever removed from the limb." The patient was transferred to the Readville Hospital July 5th, and subsequently to Dale Hospital, Worcester, where he was discharged and pensioned August 28, 1865, Surgeon C. N. Chamberlain, U. S. V., certifying to "fracture of femur, with moderate deformity and shortening and slight contraction of the flexors of the thigh." The pensioner enlisted in the 43d Infantry on August 21, 1867, and was again discharged June 10, 1869. Examiner I. F. Galloupe, of Lynn, Massachusetts, certified, in 1869: "A musket ball passed through the left thigh, fracturing the femur. The wound is healed and the bone appears to be sound. The limb is shortened and he walks slow and with difficulty," etc. In June, 1874, the same Examiner reported : " In walking he does not touch the heel, but rests on the forward part of the foot, thus making locomotion slow and fatiguing. The limb is painful when much used and in cold weather. The femur is enlarged and the foot is swollen." The pensioner was paid June 4, 1879. FlG. 2 of PLATE LXIII, opp. p. 196, represents a copy of a photograph of the patient taken at the Army Medical Museum on June 25, 1865 (Surg. Phot. Series, No. 47, A. M. M.). CASE 401. Corporal L. Tenney, Co. F, 82d New York, aged 20 years, received a comminuted fracture of the lower third of the right femur, at Gettysburg, July 2, 1863. The following history of the case and its result was obtained from reports of Surgeon Z. E. Bliss, U. S. V., in charge of Camden Street Hospital, Baltimore, and Assistant Surgeon W. Webster, U. S. A., in charge of DeCamp Hospital, David s Island, New York Harbor: "The ball, believed to be cylindro-conoidal, struck the anterior surface of the bone external to the median line, and passed directly backward through the posterior surface of the thigh. The patient stated that the limb bent beneath him, at the point of the fracture, directly the injury was received. Soon afterwards he was borne from the field on a blanket, and was deposited temporarily in a neighboring barn. The following day he was removed in an ambulance about the distance of a mile to a temporary hospital. There he first received professional attendance, and was placed under the influence of chloroform preparatory to amputation of the thigh. The examination, however, to which he was submitted, appears to have decided the attending surgeon in favor of endeavors to preserve the limb. A rough fracture- box was accordingly adopted, in which the limb remained subjected to cold-water dressings for six days, when the disclosure to the surgeon of three inches contraction of the femur induced him to substitute a double-inclined plane. The patient alleged that by this new apparatus the limb was restored to its normal length. About three weeks after the reception of the injury the double- inclined plane gave place to Smith s wire splint, which was employed during a space of five weeks. In the mean time the patient was transferred to the Corps Hospital at Gettysburg, where he remained until October 21st. The fracture appears to have been 196 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. thought sufficiently consolidated on August 20th to warrant the removal of all mechanical support from the limb on that date. Tennev stated that the limb was at that time of primitive length, and that ho could raise the heel from the bed by the unaided muscular power of the leg. The posterior aperture gave constant exit to pus of a healthy character throughout the treatment. The perpendicular direction of the wound, in the recumbent posture of the patient, is believed to have had a beneficial influence in this instance, as it has in several other successful cases whose treatment has come under observation, in protecting the patient from accumulations of pus and securing an otherwise happy result. It will be observed that the fracture of the femur suffered by this patient was one of those typically favorable cases described by Stromeyer, where the femur is struck by the bullet on the outer side, remote from the great vessels, and the limb traversed in an antero-posterior direction, affording free escape to the secretion of the wound during treatment. About the middle of October the patient was able to move about on crutches, and on the 20th of that month he was removed from Gettysburg to Baltimore. On January 1, 1834, he walked a distance of three miles without the aid of cane or crutch. One week afterwards an exploration of the wounds discovered small necrosed portions of the shaft, which were removed by Surgeon Bliss, under chloroform, by making an incision two and a half inches in length anteriorly, and another internally three and a half inches long. On April 25111 the patient was transferred U> DeCamp Hospital, nt which time he was able to walk about freely without cane or crutch. The osseous case of new bone which surrounded the fracture was very large, and an operation performed by Acting Assistant Surgeon E. DeWitt, on February 18, 18( 4, for the further removal of necrosed bone, necessitated the penetration of the involucrum by the trephine to a depth of two inches and a half. Nine spiculas of old bone were removed during the operation, the largest of which was one inch long, a half inch wide, and one-fourth of an inch in thickness. About three weeks afterwards a thin fragment of sequestrum, two inches long and a half inch wide, was removed by the same channel. The patient received his discharge from service October 1, 18(54, after which he was employed for nearly two years, in the capacity of a wardmaster, at DeCamp Hospital. At the date of the report, March 5, I860, he was one of the most accomplished and indefatigable skaters at the hospital, and suffered no inconvenience from the injured limb, although the two wounds had not yet permanently cicatrized." Examining Surgeon T. F. Smith, of New York City, September 17, 1873, certified to the injury, and stated: "There are eight adherent cicatrices, with great loss of bone and muscular substance; movements of knee joint limited one-half," etc. The New York City Examining Board, two years later, reported that "the bone united with great thickening," etc.; also that "the cicatrices on the anterior, . outer, and posterior surfaces of the limb are attached to the bone and at times take on ulceration." Substantially the same was reported at an examination in September, 1878. The pensioner was paid June 4, 1879. CASE 402. Private E. Hanlon, Co. C, 5th Cavalry, aged 21 years, was wounded at Beverly Ford, June 9, 1863. On the following day he was admitted to Lincoln Hospital, Washington, subsequently to Judiciary Square, and lastly to Carlisle Barracks, whence he was discharged May 16, 1864, and pensioned. Acting Assistant Surgeon G. K. Smith contributed the following history: "He was wounded by a mini6 ball, which entered the external aspect of the left thigh near its middle, com minuting the greater portion of the middle third of the femur, and splitting the lower third longitudinally nearly down to the knee joint. The missile lodged and could not be found. Ether was administered and the wound enlarged, and seventeen fragments of bone, comprising three inches of the continuity of the shaft, were removed. On June 23d, an abscess opened on the inner aspect of the thigh, near the perinaeum, through which the ball was extracted. The limb was bandaged in its whole length, placed on a mattrass, and kept in position by a sand bag on either side. Owing to the loss of bone no extension was resorted to until October 1st, at which time the patient was able to roll his injured limb on the mattrass, the fragments having united, though the callus had not yet become firm and hard. I then applied a ten pound weight, suspended by a cord and pulley, and succeeded in reducing the shortening one-half inch. This amount of extension was continued until I left Lincoln Hospital, on November 8tli, but was removed soon afterwards. On December 16th, while moving about on crutches, the patient fell and rcfractured the bone. The surgeon in charge then applied a long splint to the posterior aspect of the limb, retaining it in that position and preventing any motion of the knee joint until the fragments had reunited. The wound healed in the begin ning of March, 1864, but broke open again in the middle of June, and continued to discharge slightly until March, 1865, during which time, however, the man was able to walk about and to serve as a watchman at the Government Repair Shops in Washing- ton. On June 20th, 1865, the limb appeared perfectly sound, and at this period the man could walk all day without feeling tired, though there was fibrous anchylosis of the knee joint." Various pension examiners have certified at different dates to "anchy losis of the knee and about three inches shortening of the limb." The pensioner was paid June 4, 1879. PLATE LXIV, FIG. 1, opp. p. 198, represents his photograph, taken at the Army Medical Museum in June, 1885. (Surg. Phot. Scries, No. 55, A. M. M.) CASE 403. Private J. O Conner, Co. F, 16th Michigan, aged 16 years, was wounded at Cold Harbor, June 2, 1864. He reached the Fifth Corps Hospital at White House three days after the injury, and was thence conveyed to Washington, where he entered the Armory Square Hospital June 10th. Acting Assistant Surgeon G. K. Smith made the following report of the case : "A mini6 ball entered the external aspect of the left thigh three inches above the patella, and, passing obliquely inward and upward, fractured the shaft of the femur through the upper end of the lower third, making its exit posteriorly. The patient was treated by Acting Assistant Surgeon T. O. Banister. Hodgeu s splint was used, and no extension was applied other than the tying of the foot to the foot-board with a bandage. During the treatment eight small fragments of bone were removed. On December 27th the patient, though his wound had not entirely healed, was transferred to the Veteran Keserve Corps and placed on guard duty ; but being unable to perform it, he was readmitted to the hospital for treatment several weeks afterwards. He came under my care on June 22, 1865, at which time he was in good health, but slightly lame and able to walk without a cane. There was still a slight discharge of sero-pimilent fluid from the wound. The limb was shortened one and one-fourth inches, and, at the seat of the fracture, it was a little larger than normal but not otherwise deformed. On July 18, 18(55, the patient was mustered out of service, with his wound still open." Examiner W. G. \Vilkinson, of Farwell, Michigan, May K!, 1876. certified to the wound, and stated: "The fracture lias been followed by necrosis of bone, several pieces having been removed during the year 1875.. The sciatic nerve was injured, and the veins are in a varicose condition. The wound has continued open." The pensioner was paid June 4, 1879. His photograph, taken at the Army Medical Museum in June, 1865 (Svr : /. I lot, Srrirs, No. 49. A. M. M.), is copied in PLATE LXIV, FIG. 2, opp. p. 198. M.-d .uul Sun; Hist oftht- War of th- Rebellion. Part HI. Vol.H.l hap X. PLATE LXIII - CONSOLIDATED GU NSHOT FRACTUR ES OF TH E FEMUR Private ,1 .Durst X t , NV York. 1 VJ - ( asr of Private M.Kuriif J8 *.h Massachusetts SECT. III.J SHOT FRACTURES OF LOWER THIRD OF FEMUR. The records of the Pension Office show that, of the three hundred and four Union soldiers who recovered after shot fracture of the lower third of the femur under conserva tive treatment, twenty-five have died since the termination of the War. In the following instance the patient survived the injury fourteen and a half years: CASE 404. Assistant Surgeon T. S. Stanway, 102d Illinois, aged 33 years, was wounded during a fight with Guerrillas, between Lavergne and Nashville, December 21, 1833, a pistol ball entering the left thigh about four inches above the knee joint, passing downward and out about two inches above the knee, fracturing the feinur in two places. The limb was treated with simple dressings and kept upon a double-inclined plane. About two weeks after the injury an abscess formed, which was evac uated through the lower wound. The wound healed rapidly, without loss of bone, and union took place between the fractured ends. About two months after the reception of the wound the patient obtained a leave of absence and went to his home, and on April 29, 1864, he returned to his regiment with a good limb of proper length. Soon afterwards he started with his command on the Atlanta campaign. In the course of six weeks, however, owing to the want of sufficient nutrition, scurvy set in, and the newly formed callus was gradually absorbed. Although keeping the limb supported by starch bandages, he became almost unable to step upon it, in consequence of which he resigned August 13, 1834. Some months after reaching his home partial union again took place, but the limb remained shortened to the extent of three inches. Dr. Stanway became a pensioner, and was examined on April 17, 18G5, by Examiner J. A. Young, of Moumouth, Illinois, who described his condition as follows: " There is displacement of the upper portion of the femur downward and outward, with consequent shortening of nearly two inches. At present he suffers from pain, particularly during locomotion, owing to the slipping of the tendon of the vastus externus over the projecting end of the femur." The San Francisco Examining Board, in September, 1873, reported "an apparent movement in the bone at the point of the fracture," and several years later, " slight overlapping of the extremities, occasioning deformity, also lameness," etc., was alleged. The pensioner died at Los Angelos, California, prior to May, 1878. Fatal Instances of Shot Fracture of the Lower Third of the Femur treated by Con servation, Two hundred and thirty-two such cases are reported: CASE 405. Sergeant Sewell T. Douglas, Co. G, 1st Maine Heavy Artillery, aged 28 years, was wounded ut the battle of Spottsylvania, May 19, 1804, and was admitted to Emoiy Hospital, at Washington, May 22, 1834. A musket ball entering posteriorly, had fractured the lower third of the left femur and lodged in the medullary cavity. The injured limb was placed on a double-inclined plane and moderate extension was used. Internally, stimulants and tonics were employed. In August, 1834, the patient suffered from severe diarrhoea. There was a copious ill-conditioned discharge from the wound. The patient died September 26, 1864, from exhaustion, and, at the autopsy, a deposition of callus was found at the seat of in jury, enclosing several necrosed splinters and a battered musket-ball. The speci men (FiG. 159) was contributed to the Army Medical Museum by Acting Assistant Surgeon J. M. Downs. CASK 403. Private E. A. Dickerson, Co. C, 5th New Hampshire, was wounded in the right thigh, at Fair Oaks, June 1, 1862, and was admitted to the Fifth and Buttomvood Streets Hospital, Philadelphia, ten days afterwards. Acting Assistant Surgeon A. C. Bournonville reported the nature of the injury and its result as follows : "A compound comminuted fracture of the femur at the junction of the middle and lower thirds. At date of admission the wound was suppurating freely, with no effort at repair, though the patient was doing well. The treatment was by weights and sand bags. Death occurred on September 5, 1862." The specimen represented in the cut (FiG. 160) consists of a portion of the femur, obliquely fractured in the lower third, showing considerable but irregular effusion of callus without union, and the formation of a sequestrum in the upper fragment. It was contributed by Acting Assistant Surgeon W. Hunt. CASE 407. Private O. Rales, Co. F, 61st Georgia, aged 34 years, was wounded at Monocacy, July 9, 1884, and entered the General Hospital, at Frederick, three days afterwards. Acting Assistant Surgeon T. E. Mitchell contributed the pathological specimen (Ca<. Sury. Sect., 183G, p. 468, Spec. 3934) and the following history: "The patient was admitted into this hospital with gunshot fracture of the left femur, lower third. He came under my care on August 29th, Smith s anterior splints having been applied to the injured limb. He complained very much of pain in his leg, which was swollen and discharging freely from the wound. His appetite was good, but his appearance was quite anaemic. I prescribed tincture of iron and quinine, with milk punch three times a day. On September 10th, I removed the splint and substituted Buck s apparatus with sand bags to the outside of the leg. Under this treatment his condition remained much the same as when I first saw him. By October 1st, sup puration was still continuous, and the patient was very much reduced in strength. On November 1st, his appetite was better and his general condition slightly improved, though as yet there was no union of bones. On November 12th, I made counter- openings into the thigh and found sinuses extending nearly to the hip. On November 19th haemorrhage, amounting to about four pints, took place from the femoral artery, from the effects of which he died. The post-mortem examination proved that non-union of the bones was due to a small spicula of loose bone between the broken ends of the femur. The haemorrhage was the result of sloughing of the femoral artery, which, in all probability, was wounded in making the counter-opening." The specimen consists of a wet preparation of portion of the femoral and popliteal arteries, injected with wax, and shows the accidental wound of the vessel, enlarged by nlceration. from which the secondary haemorrhage occurred. FIG. 159. Partially consolidated gunshot fracture of left femur. Spec. 32G7. FIG. 160. Oblique fracture of lower third of right femur. Spec. 240. 198 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Shot Fractures of the Femur without Indication of the Seat of Injury treated by Conservation. Besides the shot fractures in the upper, middle, and lower thirds of the femur treated by conservation, considered in the preceding pages, there were seven hundred and thirty-eight cases in which the precise seat of injury was not indicated. In fifty-five of these cases the result as to fatality is undetermined. Of the six hundred and eighty-three determined cases, five hundred and thirty-eight died principally in the field hospitals a few days after the reception of the injury, giving the large death rate of 78.7 per cent. The histories of these cases are brief, and give little information beyond the mere fact that the femur had been fractured; it is, therefore, not considered necessary to detail examples of this group. In two hundred and eighty-three cases the right femur was involved; in two hundred and eighty-two, the left; and in one hundred and seventy-three the side was not specified. Six hundred and two of the patients were Union and one hundred and thirty- six were Confederate soldiers. Pseudarthrosis after shot fractures of the femur was not frequent. Sixteen instances are reported among the three thousand four hundred and sixty-seven shot fractures of the femur treated by expectant measures. In seven cases the fracture was in the upper third, in three in the middle third, and in six in the lower third. Two examples 1 will be cited: CASK 408. Corporal E. G. Abbott, 4th Indiana Battery, aged 21 years, was wounded at Stone River, December 31, 1862. He remained at a field hospital of the Fourteenth Corps for nine days, when he was conveyed to Murfreesboro . Two months later he was transferred to hospital at Nashville, and subsequently to Louisville, at all of which places his injury was recorded as a "shot wound of left thigh." On April 14, 1863, the patient was discharged from Camp Chase, Acting Assistant Surgeon J. S. Bailey certifying to "Shot fracture of left femur, resulting in nearly two inches shortening." In January, 1871, Dr. A. L. Lowell, Special Examiner of the Pension Office, who saw the man several years previously, furnished the fol lowing description of the injury and its result, which he obtained partly from his own observations and partly from a personal communication of Examiner L. T. Ballou, of Newark, Ohio : "Aconoidal ball struck the left thigh anteriorly, about four inches below the great trochanter, and, fracturing the femur, passed backward and made its exit about one inch below the gluteal fold. He states that neither splints nor extension were ever applied to the limb. About September 1, 1863, the external wound had healed, but there was still some tenderness about the seat of the fracture, and as he further improved and began to use the limb with less care, he observed that it would rotate. At present he is able to shorten the distance between the knee and trochanter six inches by a sudden swinging and extending motion of the limb, which appears to throw the lower fragment to one side and is followed by voluntary contraction of the muscles. While in this position he is able to support his weight (140 pounds) on the limb, and he can then extend the same again to its former position by a little shaking, or, as he describes it, by a wiggle, the thigh in either attitude being firm and inflexible. He can evert the left foot so as to place its heel to the toes of the right foot, thus placing the outer margin of the left foot in apposition with the inner margin of its fellow. These malpositions are com pleted without eversion of the trochanter. The lower part of the shaft of the femur appears to slide up on the anterior and internal surface of the upper fragment. The upper and middle thirds of the injured thigh exceed the corresponding portions of its fellow one inch in circumference. This increased size is doubtless due to a large ensheathing callus which surrounds the lower portion of the upper third of the femur, and which is distinctly perceptible by digital compression. Sometimes, though only with great care, the man is able to walk well, his gait showing only a slight irregularity of step. The limb is often pain- 1 The remaining 14 instances of pseudarthrosis in the femur after fracture treated by conservation are : 1. Pt. J. Kissee, 1st Arkansas Cavalry, aged 29 ; fracture of upper third of right femur ; Arkansas River, May 16, 18G4 ; discharged March 20, 1865 ; recovery, with 1 J inches shortening and a false joint. 2. Pt. Joseph Patterson, G, 40th Indiana, aged 20; shell fracture of upper third of left femur; Stone River, Tennessee, December 31, 1862; dis charged April 21, 1863; there is 3 inches shortening, and the ligamentous union or false joint renders locomotion uncertain. 3. Pt. Franklin Rosenbery, A, 148th Pennsylvania, aged 30; shot fracture of upper third of right femur; Spottsylvania, May 12, 1864; discharged May 15, 1865; 1 inch shortening: there is cartilaginous union the limb can be rotated on the thigh, and the foot is entirely reversed. 4. Pt. H. Meyers, B, 157th New York, aged 30 ; shot fracture of upper third of left femur; Gettysburg, July 1, 1863; discharged December 3, 1863; shortening about 2J inches, with false joint at point of fracture. 5. Lieut. B. Button, B, 76th New York, aged 46; shot fracture of upper third of left femur; Gettysburg, July 1, 1863 ; discharged November 9, 1863; nearly 3 inches shortening and false joint. 6. Corp l Franklin Cusick, H, 108th New York, aged 21 ; shot fracture of upper third of right femur; Wilderness, May 5, 1864 ; discharged March 31 , 1865 ; shortening of 1 J inches, leaving a false joint with eversion of toes. 7. Pt. J. F. Hutchinson, B, 7th Maine, aged 24 ; shot fracture of right femur at middle third; Wilderness, May 5, 1864; discharged July 7, 1865; false joint and 2 inches shortening. 8. Pt. P. S. Chase, I, 2d Vermont, aged 20 ; shot fracture left thigh, middle third ; Wilderness, May 5, 1864 ; discharged May 16, 1865 ; false joint and . shortening of the thigh 2 inches. 9. 1 t. J. L. Hanna, D, 95th Pennsylvania, aged 42; compound fracture of left femur at middle; West Point, Virginia, May 10, 1862; discharged August 29, 1862; false joint at point of fracture, and 3J inches shortening; muscles atrophied. 10. Pt. I,. Paul, C, 12th Wis consin, aged 24; shot fracture of lower third of femur; Kenesaw Mountain, June 15, 1864; discharged September 1, 1865; false joint and 2 inches shortening ; varicose veins covering all the leg and lower thigh. 11. Pt. L. D. Boyd, K, 85th Pennsylvania, aged 24 ; shot fracture left thigh just atwve the condyles ; Ware Bottom Church, May 20, 1864; discharged November 22, 1864; artificial joint and about 3 inches shortening. 12. Corp l E. II. Morrison, F, 35th Illinois, aged 20 ; shot fracture right thigh about 2J inches above knee joint ; Chickamauga, September 19, 1863 ; discharged January 19, 1864 ; false joint and about 2J inches shortening. 13. Pt. H. P. Mayer, A, 1st West Virginia, aged 22; shot fracture left femur, lower third; New Market, May 15, 1864 ; discharged October 10, 1864 ; weak cartilaginous union ; can bring the bottom of his foot against his face. 14. Pt. B. Whiting, C, 9th New York Heavy Artillery, aged 27; shot fracture right femur about 4 inches above knee; Cold Harbor, June 3, 1864; false joint above knee; limb shortened about three inches. M.-.1 ,ml Sin-j Hist <.r the War of the Keb. ll ion Tart HI Vol.11, Chap X. Ward phot PLATE LXIV- CONSOLIDATED GU NSHOT FRACTURES OF THE FEMUR 1. I usc of IVivHte H.Haiiloti "I h I .S. Cuvalrv. Fis. 2. Case of Pi-i\"ate J. O Connor 16 ^ Miclxioan ,UN" r ?-U3ITY SECT. m.J EXCISIONS IN THE CONTINUITY OF THE FEMUR. 199 ful, and frequently he is obliged to suspend his occupation as a laborer. During the winter of 1869 he could not walk without pain, and was unable to put on his boot." Subsequent examiners report no changes in the condition of the limb. The pensioner was paid June 4, 1877. CASE 409. Private E. Gilroy, Co. F, 6th Vermont, aged 22 years, was wounded and captured at Savage Station, June 29, 1862. After remaining in the hands of the enemy for one month, he was exchanged and conveyed to Philadelphia. Acting Assistant Surgeon J. Neill, in charge of Broad and Cherry Streets Hospital, reported the following description of the injury: "A musket ball entered the right thigh anteriorly, three inches above the knee joint, passed backward and fractured the femur, and was removed by a surgeon on the field. The wounded man was admitted to this hospital on July 30th, at which time there was considerable swelling and inflammation of the thigh, also slight sloughing of the edges of the wound, which discharged healthy pus. The foot was everted and there was two inches shortening of the limb. The patient s health was good. A stim ulating poultice was applied to the part and the limb kept in a Dessault apparatus, with side-extension and counter-extension, for six weeks. At the end of this time the wounds had healed, but there was very little, if any, union at the seat of the frac ture. Two moulded splints of binder s board, with bandage, were then applied to the thigh, and Dessault s apparatus continued." Subsequently, on November 18th, "union of bone, with one inch shortening and fair indication of a good cure," was noted in the case; but at the date of the patient s discharge from service, February 23, 1863, the fracture was reported as remaining uuunited. Examiner T. B. Nichols, of Plattsburgh, New York, reported April 15, 1838: "The leg is five inches shorter than its fellow and swings loosely, except when he lets his weight down upon it. In this position it supports him, but in no other is it of any use." In September, 1873, the same examiner described the injured limb as being shortened six inches, and stated that the man " can lift his right foot with his hand up against his breast." The pensioner was paid June 4, 1879. Comments on the various complications of shot fractures of the femur treated by con servation pyeemia, tetanus, gangrene, erysipelas, and haemorrhage and on the different modes of treatment, will be reserved for the concluding pages of this section of Chapter X. EXCISIONS IN THE CONTINUITY OF THE FEMUR FOR SHOT INJURY. The results of excisions in the continuity of the femur performed during the American civil war have been discouraging, and justify the disfavor with which this operation is regarded among American 1 as well as European 2 surgeons. One hundred and seventy-five cases have been reported. 3 In eight instances the terminations could not be ascertained. 1 HAMILTON (F. II.) (A Treatise on Military Surgery and Hygiene, New York, 1865, p. 517) remarks that he has never seen a case of shot fracture of the femur that would justify excision. " The great depth of the bone and the attachment of the muscles to almost every point of the surface of the bone are, perhaps, the chief circumstances which render these operations so unsuccessful." GllOSS (S. W.) (Military Surgery, in Am. Jour. Med. Sci., 18G7, Vol. LIV, p. 478): " Resection of the femur in its continuity has proved to be a more fatal procedure than amputation at the hip, and should, there fore, not be repeated." AsHHUliST (JOHX, jr.,) (The Principles and Practice of Surgery, Philadelphia, 1878, p. 167) asserts that "excision in the con- tinuity of the femur is a bad operation and should be definitely rejected from military practice." 8 SCHWARTZ (H.) (Beitrage zur Lehre von den Schusswunden, etc., Schleswig, 1854, p. 106): "The resection of the splintered ends of the fracture for the purpose of converting the comminuted fracture into a simple fracture, as well as any resection in the continuity, is to be rejected in the femur." DKMSIE (II.) (Militar-Chirurgische Studien, etc., WRrzburg, 1861, B. II, p. 283): "The facts hitherto known justify the total rejection of resection in the continuity of the femur, even more so than the resection in the shaft of the humerus." NEUUORFER (J.) (Handbuch der Kriegschirurgie, etc., Leipzig, 187:3, B. II, Zweite Hiilfte, p. 1521): " Even as an advocate of resection in the continuity of bone, one cannot defend resection in the continuity of the femur, as, in this bone, the indication for the resection is relatively rarely found, and as the risks attending its execution are very great. It is possible that a resection in the continuity for total caries of the injured bone at the point of fracture may prove successful; but, as yet, no such cases have been observed. It is also probable that, even in the most favorable case of recovery after resection for caries, the resected ends of bone would not unite, and that psendarthrosis would be the result of the resection." Instances of excision in the shaft of the femur for shot fracture are not frequent in military surgery: 1. ROSS (G.) (Militairdrztliches aus dem Ersten Schlesivigschen Feldzuge im Sommer, 1848, Altona, 1850, p. 54) excised H- inches of the shaft of the left femur in a Prussian soldier, wounded at Dflppel, June 5, 1848; death from gangrene. 2. SCHWARTZ (H.) (Beitrage zur Lehre von den Schusswunden, Schleswig, 1854, p. 167) relates the case of a Danish volunteer, wounded at Holding, April 23, 1849; fracture at junction of upper and middle thirds of the right femur; excision April 26; death April 28, 1849. 3. STROMEYEIJ (L.) (Maximen, etc., Hannover, 1855, p. 757) tabulates a third fatal instance of excision in the shaft of the femur from the Schleswig-Holstein War, 1848-50. 4-14. CHEXU (J. C.) (Stat. Med. Chir. de la Camp, d ltalic en 1859 et 1860, Paris, 1869, T. II, p. 763) tabulates 6 cases of excisions in the shaft of the femur, with 5 deaths, and, on page 7(i2, gives an extract from a report of Dr. BlMA, of the Sardinian army, who states that of 5 excisions in the shaft of the femur by the subperiosteal method, performed at the hospital at Vercelli, 4 proved fatal : A. Paschit, Regiment Archduke Leopold, admitted into hospital May 31, 1859; shot comminution of femur; excision June 5, after extraction of missile; sent to Verona, Aug. 4, 1859; able to walk with the aid of a cane. E. Rigovich, Regiment Archduke Leopold, admitted into hospital May 31, 1859; shot comminution of lower third of femur; excision June 18 ; death September 13, 1859. E. Opodopic, Regiment Archduke Leopold, admitted May 31, 1859 ; comminuted fracture lower third of femur; excision of three centimeters of bone June 22; death July 6, 1859. L. Gerbitz, Austrian, admitted into hospital May 31, 1859; comminuted fracture lower third of femur; excision June 23; death July 23, 1859. M. Goldschmitt, Regiment Wimpfen, admitted May 31 ; com minuted fracture middle third of femur; excision June 4; death July 17, 1859. 15-16. HEIXE (B.) (Die Schus$oerletzungen der CTnteren Extremitaten, Berlin, 1866, p. 293) reports that in the Schleswig-Holstein War of 18G4, excision in the shaft of the femur was only performed twice by Dr. NEUuOtiFEU ; the result is not indicated. 17. LOT/IJECK. (Zur Resection des Trochanter major, in Aerttliches Intelligent Ulatt, MUnehen, 1870, B. XVII, p. 438) cites the case of Sergeant W. S , 9th Infantry; fracture of left trochanter major, July 4, 1866; excision of trochanter in September; death November 9, 1866. 18-21. BECK (B.) (Chirurgie der Schussverletzungen Freiburg, 1872, p. 912) tabulates 4 cases of excision of the shaft of the femur in the Austro- Prussian War of 1866 ; only one patient survived 22-37. CHEXU (J. C.) (Apercu Hist. Stat. et Clin., etc., pendant la guerre de 1870-71, Paris, 1874, p. 493) tabulates 16 cases of excision of the shaft of the femur, with 14 deaths, from the Franco-Prussian War, 1870-71 ; four cases reported by FELTZ and GEOI.I.KMUND, and two by UOALDES, seem not to be included in M. CHEXU S Statistics. 38-41. FELTZ et GUOLLEHUXD (Relation Chir. sur les Ambu lances de Haguenau, in Gaz. MCd. at Strasbourg, 1871, No. 11, pp. 131-134) relate 4 cases: J. Debat, 47th Line, aged 22, fracture of upper third of left femur, in August, 1870 ; secondary excision September 26 ; death October 2, 1870. Beschia Mohammed, 3d Tirailleurs ; fracture of middle third of right femur; excision September 26; death October 2, 1870. Thomas Ferray, aged 20, 1st Algerian Tirailleurs; shot fracture of middle third of femur, prior to August 8, 1870; excision August 28; recovery. E. Plichon, 3d Zouaves, aged 22; fracture of middle third of right femur, prior to August 9, 1870; 200 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X Fifty-one cases had a successful, and one hundred and sixteen a fatal issue, giving a mortality of 69.4 per cent. TABLE XXI. Numerical Statement of One Hundred and Seventy-five Excisions in the Shaft of Femur for Shot Injury. OPERATIONS. CASES. EXCISION Df THE UPPER THIKD. EXCISION IS THE MIDDLE THIRD. EXCISION IN THE LOWER THIRD. PART EXCISED NOT SPECIFIED. Recovered. a 1 Undeterm d. .2*3 ~t -- o K s Recovered. d 9 s Undeterm d. Ratio of Mortality. Recovered. a fi Undeterm d. Ratio of Mortality. Recovered. d s Undeterm d. Ratio of Mortality. Recovered. o o 3 Undeterm d. s . 3 ! 20 9 15 7 65 39 3 9 6 1 1 76.4 81.2 16.6 56.2 13 1 9 2 30 17 1 1 1 69.7 94.4 10.0 33.3 6 6 4 2 21 14 2 3 1 77.7 70.0 33.3 60.0 2 2 1 4 5 2 100.0 71.4 1 10 3 3 90.9 100.0 00.0 60.0 00.0 66.6 1 2 2 3 51 116 8 69.4 25 49 1 66.2 18 40 1 68.9 5 11 2 68.7 3 16 4 84.2 Primary Excisions in the Shaft of the Femur. Ninety-one, or more than one-half of the total number of cases of excision in the shaft of the femur, belong to the primary group. In six instances the result remains undetermined; twenty proved successful, and sixty-five were fatal, giving a mortality rate of 76.4 per cent. Cases of Recovery after Primary Excision in the /Shaft of the Femur. Of the twenty patients who survived this operation, four were Confederate and sixteen were Union soldiers. The point of excision was in the upper third in twelve instances, in the upper and middle thirds in one, in the middle third in five, in the middle and lower thirds in one, and in one instance the point of excision was not indicated. Thirteen of the sixteen Union soldiers were pensioned and were living in 1879. In the following case four inches of the upper and middle thirds of the shaft of the femur were excised: 1 CASE 410. Lieutenant W. M. Tirtlot, Co. F, 105th Illinois, aged 24 years, was wounded at Resaca, May 15, 1834, by a shell, which fractured the right femur. He was admitted to the field hospital of the 3d division, Twen tieth Corps, where excision was performed but not recorded. On June 22d he was transferred to hospital No. 2, Chattanooga, and several days afterwards to the Officers Hospital at Nashville. Surgeon J. E. Herbst, U. S. V., in charge of the latter, reported: "Shot fracture of femur, middle third. Primary excision of about four inches of the shaft at the middle third w as performed on the field by Surgeon A. W. Reagan, 70th Indiana. The limb was treated in straight splints, and simple dressings were applied. Tonics and a generous diet were prescribed." The patient went on leave of absence July 21st, and on November 28, 18G4, he was mustered out and pensioned, inches <>f right The excised portion of the femur was contributed by Surgeon G. W. McMillin, 5th Tennessee, and is represented for n obiique ( fr S a e c l in the cut (FiG. 1G1). Examiner A. Steele, of Oberlin, Ohio, certified, March 21, 1867 : "Part of the femur is ture. />:.2l5!>. g one an( i the leg is short in proportion. There is exostosis of the femur, and suppuration is nearly constant; also anchylosis of what is left of the knee joint; unimpaired health," etc. Examiner A. II. Steele, of Olympia, W. T., certified, October 4, 1873: * * "There is lateral motion of the knee joint, caused by the proximity of the injury destroying the lateral secondary excision October 25 ; recovery. 42-43. ROALDE8 (A. W.)(Des fractures compliquees de la cuisse par armes de guerre, Paris, 1871, p. 58, etc.) details 2 cases of excision in the shaft of the femur : Ch. Huart, Adjutant 193d Batt. Nat. Guards, aged 32 ; fracture of right femur at union of upper and middle thirds, May 21, 1871 ; excision June 2 ; death January 15, 1871. A. Cavarr6, Lieutenant of Marines ; shot fracture of upper third of right femur, May 21, 1871 ; excision June 10; recovery. 44-46. SOCIN (A.) (Kriegschirurgische Erfahrungen, Leipzig, 1872, pp. 135, 13(5) cites 3 cases of excision in the shaft of (he femur: A. Leonhardt, shot fracture of left femur at juncture of middle and upper thirds, Gravelotte, August 18, 1870; excision of 7 centi meters of lower fragment ; recovery. A. Leroy, shot fracture of right femur near trochanter, at Noisseville, August 31, 1870 ; excision September 24 ; death September 27, 1870. A. Primault, shot fracture of middle third of right femur. Worth, August 6, 1870; excision October 26; recovery, with 12 centimeters shortening. 47. FISCHER (G.) (Dorf Floing und Schloss Versailles, in Deutsche Zeitschrift fiir Ciiirurgie, Leipzig, 1872, B. I, p. 187) tabu lates a fatal instance of secondary excision in the shaft of the femur. 48-50. BECK (B.) (Chir. der Schussverletzungen, Freiburg. 1672, p. 900) reports 3 cases of excision of shaft of the femur in the 14th Corps during the Franco-Prussian War, 1870-71. One recovered, one died; the result in the third instance is not recorded. 51. TRITTON (W. P.) (Excision of a Large Portion of the Femur after Gunshot Wound, in The Lancet, London, 1879, Vol. I, p. 117) resected the shaft of the femur on an Arab of the Turkish army, in December, 1877. The patient recovered, with 1J inches shortening.of the limb. Of the 51 cases here cited, the results could not be ascertained in 3 instances; 12 patients recovered, and 36 died, a mortality rate of 75.0 per cent. 1 The extent of bone excised in the remaining cases was : One inch in 2 cases; two inches in 1 ; two and a half inches in 1 ; three inches in 2 ; three and a half inches in 2; foar inches in 1 ; four and n half inches in 3; five inches in 1 ; six and a half inches in 1 ; trochanter major or a portion thereof in 3; and in 2 cases (his point was not defined. SECT. III.] EXCISIONS IN THE CONTINUITY 01- THE FEMUR. 201 ligaments. There are also extensive cicatrices which are tender and painful. The limb at this time is more of an impediment than an advantage. The pensioner was paid March 4, 1879. In January, 1870, he was furnished with an apparatus for his injured limb by the firm of Marsh & Corliss, of Cincinnati. CASE 411. Lieutenant Dwight Beebe, 1 Adjutant 3d New York Veteran Vols., was wounded on October 27, 1884, while in command of a skirmish line on the Darbytown Road, near Richmond. He was, on the same day, admitted into the Flying Hospital of the Tenth Corps, near Chapin s Farm. Dr. C. M. Clark, late Surgeon 39th Illinois, under date of September 17, 1839, gives the following description of the case: "The wound was made with a conoidal ball, which entered the right thigh, outer surface, at the junction of middle with upper third, passing upward and inward, and making its exit at the upper and inner angle of Scarpa s triangle, slightly abrading the scrotum in its passage. On examination of the wound I found an extensive comminution of the femur, and removed sixteen (10) fragments before the operation was decided upon. * * I made a longitudinal incision from the great trochanter down, to the extent of five inches, and took away the upper fragment with a chain saw at its junc tion with the capsule (the bone above being sound). I then removed all the spiculse attaching to the periosteum (which was preserved) and muscle, cleansing the wound thoroughly ; then turned out the lower portion and removed it smoothly with the common amputating saw. Dr. N. Y. Leet assisted me in the operation." On October 28th, Lieutenant Beebe was taken to the landing near Deep Bottom, and placed on board a hospital transport and conveyed to Fortress Monroe, and admitted into the Chesapeake Hospital on the evening of November 1st. He was placed upon a fracture bed and received the best attention. There was a profuse discharge and the patient soon became exhausted. The upper extremity of the lower fragment necrosed, and a ring of bone seven-eighths of an inch in length exfoliated. This occurred in the middle of January, 1865. After the dead bone was eliminated, Lieutenant Beebe rallied. On May 17, 1865, he was able to be moved comfortably, and obtained a leave of absence and went to his home in New York. He returned to the hospital July 9th, and, in September, 1835, again went to the north with his regi ment to be mustered out at the expiration of its term of service ( Circular 2, p. 33). In a letter dated Havana, October 27, 1888, Mr. Beebe says: "I continued to improve until I was able to get around with a cane and supposed I was as well as I would ever be, until August, 1837, when my wound broke out and discharged terribly for about three weeks. The medical men here thought it was brought on by irritation, being on it too much. Now, Avith the exception of the limb being quite weak, it only troubles me in damp weather, when it has a dull heavy ache. It has all healed. The flesh on the outside of the thigh is quite numb. My knee is stiff. My general health is not good, and my physician cautions me to be very careful of myself. The limb measures 3-J- inches short. Resection, 2J inches ; necrosis of the bone, & inch." Pension Surgeon G. D Baley, of Havana, N. Y., examined Lieutenant Beebe in November, 1867, and reported : "Right leg is three inches shorter and three inches smaller in circumference than the other. There is anchylosis of the knee joint. The patient has repeatedly been confined to his room six weeks at a time. The wound is now discharging, the limb is weak and painful. He is constantly liable to fall in walk ing." In a letter to the editor, dated April 30, 1869, Dr. Baley describes the portion of the femur shown to him by Lieutenant Beebe s father, the upper division of the bone being "just below the greater trochanter obliquely downward from the outer side of the bone, to the middle of the lesser trochanter on the inner side ; the lower division being a transverse cut embracing 1J or 1-J- inches of the upper section of the bone. I think the head of the bone could not have been removed, as there is now, and was at the time of my first examination, the full development of the greater trochanter and neck of the femur. There is at this time great tenderness and pain both above and below the section of excision, with frequent suppurations. There is also evidence of a los? of portion of bone two or three inches below the lower section of the operation." Pension Surgeon F. J. Bancroft, of Denver, Colorado, reported, in September, 1875: "Ball entered anterior portion of thigh, fracturing upper third, and made its exit near the anus. Resection of two inches of the upper third of the femur was performed, causing shortening of three inches. The muscles are softer and smaller in this limb." Since that time the pensioner has been exempted from biennial examination, his disability being considered permanent. A copy of the photograph, furnished by the patient (Contributed Photographs, Vol. XII, p. 17), is represented in FlG. 162. He was paid March 4, 1879. 1 The case of Lieutenant D. Beebe, Adjutant 3d New York, has been cited on page 32 of Circular 2, War Department, S. G. O., 1869, ns an example of excision of the head of the femur. It had been stated by Lieutenant Beebe, in a communication to the editor, dated Havana, N. Y., Novem ber 2, 1868, shortly before the publication of Circular 2, that " the head of the bone was not taken out." A letter of inquiry was thereupon addressed to Dr. N. Y. LKET, late Surgeon 7Gth Pennsylvania, who had been officially reported as the operator on the register of the Tenth Corps field hospital, requesting information in the case of Lieutenant Beebe, and, in an answer dated Scranton, Tenn., March 9, 1869, Dr. LEET stated that " about four inches of the femur, including the head, was removed," and, in a second communication, dated April 20, 1869, Dr. LEET asserted that "the style of the operation was first a longitudinal incision, cutting directly in the direction the ball took until I opened the capsule, thus exposing the head of the bone ; by carry ing the limb over the opposite thigh and pushing the limb upward I removed the head of the bone by sawing through the trochanter with a chain saw." These positive assertions of Dr. LEET led the editor to accept, in such a matter of anatomical detail, the statement of the surgeon rather than the impres sion of the patient. However, in September, 1869, after the publication of Circular 2, a letter dated Chicago, September 17, 18G9, was received from Dr. CHARLES M. CLAHK, late Surgeon 39th Illinois. In this communication Dr. CLARK gave the account of Lieutenant Beebe s case as detailed in CASE 411, above, and added that Dr. N. Y. LEET assisted him in the operation. Immediately upon receipt of this communication, on September 20, 186: , a copy of Dr. CLAKK S letter was forwarded to Dr. N. Y. LEKT, at Scranton, for comment on the issue as to matter of fact between Dr. CLARK and himself; but no answer was ever received. In the meantime a letter had been sent by the editor to Dr. G. D. BALEY, Pension Examining Surgeon, of Havana, where Mr. Beebe then resided, asking whether, in his opinion, the head of the fern ur in the case of Lieut. Beebe had been removed. Dr. BALEY S answer, dated April 30th, is included in the history (CASE 411), and corresponds with the statements of Dr. CLAKK in regard to the extent of the operation. A letter from Lieut. Beebe, dated September 25, 1869, corroborated Dr. CLARK S statement, and gave a description of the excised portion of the femur, then in the possession of his father. In addition to these facts, a letter was received from Dr. D. II. BUOWEU, late Assistant Surgeon U. S. V., dated Chicago, Becenv Suno. Ill 26 FIG. 11)2. Hesult of excision in the upper third of the femur. [From a photograph.] 202 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. In the next case six and one-half inches of the shaft of the femur, from the great trochanter downwards, were excised. By means of a prothetic apparatus and with the aid of a small cane the patient is enabled to make good use of his limb, although it is shortened six and one-half inches: CASE 412. Private J. W. Joslin, Co. I, 7th New York Heavy Artillery, aged 20 years, received a shot fracture of the right thigh at Cold Harbor, June 3, 1864. He was captured, and while in the hands of the enemy underwent the operation of excision of the femur. After being a prisoner for more than two months he was paroled and conveyed by steamer to hospital at Annapolis, where Surgeon B. A. Vanderkieft, U. S. V., recorded his admission, August 28th, with "shot wound of right femur." On November 28th the patient was transferred to Jarvis Hospital, Baltimore, whence Assistant Surgeon D. C. Peters, U. S. A., reported that "the parts were nearly healed on admission, and entirely so on December 31st, when the patient was furloughed, at which time the limb was shortened six inches and could be swung backward and forward, but could not be exercised in lateral or rotary motion." One mouth afterwards the man entered Dale Hospital at Worcester, whence Surgeon C. N. Chamberlain, U. S. V., reported his condition as follows: " He is in perfect health; the parts ai e free from tenderness, and the limb is movable in every direction and perfectly under the control of the muscles. The upper end of the femur is enlarged, apparently by new osseous growth, to almost twice its normal diameter, and it has a good false joint." On August 29th the patient was finally transferred to DeCamp Hospital, David s Island, whence Assistant Surgeon W. Webster, U. S. A., contributed the following history: "The wound was inflicted by a minid ball, which entered the gluteal region about four inches external to the os coccygis, passed downward, and struck the femur a little below the trochanter major, producing a compound comminuted fracture of the upper half of the shaft of the bone. Excision of six and a half inches of the femur, extending downward from a point immediately below the great trochanter, was performed by a surgeon of the Confederate army. This operation was done fifty-four hours after the injury, by a linear incision seven and a half inches long in the axis of the limb, beginning from a point opposite the superior portion of the trochauter major, and on the same day the patient was transferred thirteen miles in an ambulance to Richmond, where he was placed in hospital No. 21. He stated that he was in a very weak and exhausted condition when he reached Richmond. His limb was then placed in a fracture-box, and whiskey was administered twice daily, his diet consisting of corn and wheat bread and inferior soup. Extensive sloughing of the soft parts of the thigh occurred in the third week. On October 26, 1865, the patient was discharged from service, at which time a careful examination of the injured thigh revealed union of the trochanter major with the upper extremity of the lower fragment of the resected femur. There was also extensive deposit of new bone, and the degree of shortening amounted to six and a half inches. He could bear his entire weight upon the injured limb without producing any apparent yielding of the united bone. The flexion of the thigh was natural, and when it was rotated the trochanter major performed its entire and natural circuit. The thigh and leg were very much atrophied, but the knee joint Hexed freely, and the cicatrix, though extensive on account of the sloughing of the parts, was firm and healthy. The gastrocnemius and extensor muscles of the foot were rigidly contracted, and the foot was extended to its utmost capacity." One week before receiving his discharge the patient was furnished by Dr. E. D. Hudson, of New York City, with a prothetic apparatus, 1 consisting of a case of raw hides, laced upon the thigh and leg, and terminating in an artificial foot with ginglymoid articulations at the ankle and toes. 15y means of this appliance he was enabled to walk with ease, requiring only the aid of a light cane. In a communication from the pensioner in March, 1868, he stated that "the apparatus works very well," considering the condition of the limb, and added that he had not had any abscesses about the hip or any part of the injured leg. Various examining surgeons at successive dates certified to the injury and operation resulting in shortening, etc., and the San Francisco Board added, in 1877: "The result is good, and ber 24,1877, in which the following occurs: "CASE XXX, of the same Circular, in my opinion, is not correctly reported. I treated Lieut. Beebe from his admission into the Chesapeake Hospital until he was considered well enough to be sent north. This case, in my judgment, wus not of the magnitude the report represents it. The fractured portions of the femur were removed, and the ends of the bone smoothed off; the head of the femur was not removed from the cotyloid cavity. In this opinion, I am pleased to say, I am sustained by Surgeon D. G. RUSH of this city, who was one of the staff of the Chesapeake Hospital at the time the patient was under my treatment, and who repeatedly saw the case with me. He recollects distinctly to have felt, at the time the man was admitted, the head of the femur in its proper position. Surgeon CLARK, of the 39th Illinois regiment, told me, a year or two afterwards, that he performed the operation, and described it just as I have done above." From a careful examination of all the correspondence and records on file in this Office, it is evident that the head of the femur was not removed from the cotyloid cavity, that an excision in the upper third of the shaft of the femur was performed by Dr. C. M. CLARK, and not by Dr. N. Y. LEET, and that the account of the injury and of the operation as published on page 32 of Circular 2, on the authority of Dr. N. Y. LEET, is erroneous. On July 17, 1879, another letter was addressed to Dr. N. Y. LEET, asking him whether he would deny the correctness of the account of the case as furnished by Dr. C. M. CLARK and the pensioner, Jlr. D. Becbo. To this, as well as to a prior letter of similar tenor, no answer has been received at the date of this writing (September 8, 1879). This case has been published as an excision of the hip joint by Dr. H. CuLliERTSON (Excision of the Larger Joints of the Extremities, Philadelphia, 1870, p. G4), and as a resection of the hip joint by Professor E. GUKLT (Dfe Gelenlc-Iiesectionen nach Schussverletzungen, Berlin, 1879, p. 203), and it is to be regretted that the erroneous version of the operation has misled these reliable authorities on excisions. 1 The apparatus is figured on page 33 of E. D. HUDSON S Mechanical Surgery, Prothe.tic Appliances and Apparatus for Amputations, Resections, Vnunited Fractures, Diseases of Joints, Deformities, Curvatures of Spine and Paralysis, New York, 1878. FIG. 103. Result of primary excision in the shaft of the femur. [From a photograph.] SECT. III.] EXCISIONS IN THE CONTINUITY OF THE FEMUR. 203 the leg, by the use of a mechanical apparatus, is of use to the man." The pensioner was paid March 4, 1879. Photographs of the patient, taken in 1865, and showing his appearance without and with the apparatus, were contributed by Dr. Webster (Contr. Photo s, A. M. M., Vols. 9 and 10, pp. 31, 32, and 33) and copied at the Army Medical Museum (Sim/. Phot. Series, Nos. lOo and 107). The former is represented in the wood-cut (FlG. 163). CASE 413. Captain S. V. Shipman, Co. E, 1st Wisconsin Cavalry, aged 38 years, was wounded in the right thigh during the engagement at Whitewater River, April 24, 1883. Two days after the reception of the injury he was admitted to the Post Hospital at Cape Girardeau, whence Surgeon W. McClellan, 1st Nebraska, reported the wound as "a fracture of the femur, caused by gunshot, for which primary resection of three and a half inches at the upper third was performed, the ends of the bone being clipped off. Patient left the hospital on leave of absence July 17th." Captain Shipman was subsequently promoted to Major, and ultimately mustered out as Brevet Colonel on July 19, 1803. In his application for pension he alleged that the ball was not found nor removed from his thigh until eight months after the reception of the wound. Examiner A. J. Ward, of Madison, Wisconsin, October 23, 1836, certified to the injury and operation resulting in contraction of the leg and stiffness of the knee, and added: "The pensioner has had an abscess form three different times; the last time it laid him on his back some six weeks. It may recur any time, as there is evidently diseased bone in the femur." Dr. H. A. Martin, late Surgeon, U. S. V., in a letter, dated Boston, April 24, 1889, makes reference to this case as follows: "When I was stationed at Cape Girardeau a most interesting case, that of Captain Shipman, was under my care to a perfect successful issue. He lost nearly four inches of the whole shaft of the femur, including portion of the trochanters, and is now living, with a limb shortened some two and a half inches." This pensioner was paid June 4, 1879. TABLE XXII. Summary of Twenty Cases of Recovery after Primary Excision of the Shaft of the Femur for Shot Injury. NO. NAMB, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATION, AND RESULT. NO. NAME, MILITARY DESCRIPTION, AND AOE. DATES. INJURY, OPERATION, AND RESULT. ( I Beebe, D., Adjutant, 3d Oct. 27. Right ; three and a half ins. from 10 Hayes, W. J., Pt., L, June 11, Right ; five ins. middle third, by New York, age 25. 27, 64. junct. with caps, to level of troc. 16th Penn. Cavalry, 11, 64. Surg. F. Le Moyne, 16th Penn. minor, by Surg. C. M. Clark, age 18. Cav.; necrosis. Disch d June 20, 39th 111. Mustered out Sept., 1865; pensioned; three inches 1865. Surg. Phot. 210 ; pens d. shortening ; fistulous opening. o Brewer, J. W., Pt,, C, Aug. 14, Right; four and a half ins., inclu 11 Joslyn, J. W., Pt.. I, June 3. Right ; six and a half ins. from 4th Tenn. Car., age 40. 14, ti4. ding great trochanter, by Surg. 7th New York Heavy 5, 64. great troch. downward, by Conf. Sevenson, 4th Tenn. Cav y. Artillery, age 20. surg. Disch d Oct. 26, 1865; Released June 1 6, 65 ; two and pens d; seven ins. shortening. a half ins.shortn g. Circular %, Surg. Phot. Ser., Nos. 106, 107. 1869, p. 58. Circ. 6, 1865, p. 68. 3 1 Button, F.H., Musician, July 6, Lett ; four ins. upper third, by 12 Keyser, M., Pt., E, 9th June 17, Left; one inch middle third, by I, 14th Mich., age 18. G, M. Surg. E. Batwell, 14th Mich. Kansas Cav., age 40. 20, 63. A. A. Surg. J. Tliorne. Also Disch d May 5, 1865; pens d; exc. r t radius. Disch d March ligamentous union ; three inches 1, 1864 ; compl. union ; two ins. shortening. shortening ; not pensioned. 4 2 B , S.,7th Kentucky April 6, ; two and a half inches from 13 McLaughlin, G. H.. Lt., July 2, Left. Duty Oct. 9, 1864 ; retired Mounted Inf y, age . (i, 62. upper third, by Surgeon S. F. 11, 2d Infantry, age . 3, 63. Dec. 31, 1870. Clardy, C. S. A. Recovered; 14 3 Reynolds, J. C., Pt., E, May 5, Left ; portion of trochanter major. ends of bone united well ; limb 5tb N. Jersey, age 24. 8, 62. Disch d Aug. 18, 64 ; not pens d. of great use. ]5 Shanley, J., Pt., A, 76th May 24, Left ; portion of trochanter major. 5 Cnlhonn, W. F., Sorg t, Mar. 25, Right ; mid. third, by Surg. G. U. New York, age 24. 26," G4. Duty Nov. 15, 1864 ; pensioned ; F, 5th Virginia, age 25. 25, 05. Sullivan. 39th N. J. Erysipelas. hip joint stiffened ; necrosis. Released June 11, 18G5. 16 * Shelley, J. H., Pt., L, June 10, Four and a half ins. middle third, G Conner, S., Colonel, 19th May C, Right ; two ins., fragment, middle 3d Kentucky Cavalry, 10, 64. by Surg. S. F. Clardy, C. S. A. Maine, age 25. G, G4. third, by Surg. J. F. Dyer, 19th age 15. Disch d Dec., 1864 ; union com Mass.; June, liaems.; Sept., bone plete; four and a half ins. short g. extracted. Disch d April 7, 66, 17 Shipman. S. V., Capt., April 24, Right ; three and a half ins. upper as Brig. General ; pensioned ; E, 1st Wisconsin Cav., 24, 63. third and portion of troch. maj. anchylosis of knee joint ; leg age 38. Promoted Maj. Disch d July 19, entirely useless. 1865; pensioned ; two and a half 7 Gebhardt, J.,Pt.,B, 149th July 2, Left ; about two ins. up. third, by ins. shortening ; anch. knee. New York, age 22. 3, 1863. Surg. J. V. Kendall. 149th N. Y. 18 Shock, A., Pt,, A, 4th Mar. 11, Right ; four and a half ins., frag- Disch d March 1, 1865; pens d; Penn. Reserves.age 23. 12, 62. ments, up. third, by Ass t Surg. shortening, ulcerntion, and de J. S. Billings, U. S. A. Disch d formity. C ont. Phot. Series, Vol. Oct. 10, 62 ; pensioned ; five ins. 4, No. 8. short g. Med. and Surg. Hist., 8 IIurris.B.F., Lieut.-Col., Nov. 7, Left; three ins., neck, trochanter, Pt. II, Vol. II, p. 367. Gth Maine, age 33. 7, 63. upper third. Discharged July 19 Thibaut, F. W., Capt., A, Dec. 13, Left ; trochanter major, by Surg. 19, 18G4 ; pensioned ; shortened 7th New York, age 28. 13, 62. C. Gray, 7th N. Y. Also amp. three inches. left ring finger. Disch d May 9 Hartman, L., Pt., E, June 1, Right; three ins., upper third, by 8, 1863 ; pensioned. 24th Mich., age 16. 1, 64. Surg. J. II. Beech, 24th Mich .; 20 Tirtlot, W. M., Lieut., May 15, Right ; four ins. middle third, by gang. Disch d Aug. 23, 18G5; F, 105th 111., age 24. 15, 64. Surg. A. W. Reagan, 70th Ind. pens d; four ins. shortening. Disch d Nov. 28, 1864 ; pens d ; limban impediment. Spec. 2159. The injuries are reported to have been inflicted by shell fragments in two instances, by a fuse plug in one, and by small projectiles in seventeen cases. Sixteen of the twenty operations were performed by Union and four by Confederate surgeons. 1 BATWELL (E.), Notes on Bisection, in Med. and Surg. Reporter, 1865, Vol. XII, p. 221. 2 THOMPSON (J. W.), Resection of the Long Bones, in Med. Record, 1868-9, Vol. Ill, Case VI, p. 29. 3 PllAY (O. M.), Reports of Hospitals, in Am. Med. Times, 18, i3, Vol. V, Case IX, p. 77. 4 MAUGIIS (G. M. B.), Conservative Treatment of Compound Comminuted Fractures of the Femur, in Confederate States Med. and Surg. Jour., 1865, Vol. II, Case 8, p. 8. THOMPSON (J. W.), Cases of Resections, etc., in Nashville Med. Jour., 1868, N. S., Vol. I, p. 340. THOMPSON (J. W.), Resec tion of the Long Bones, in Med. Record, 1868-9, Vol. Ill, Case I, p. 28. INJURIES OF THE LOWER EXTREMITIES. [CHAP x. Fatal Cases of Primary Excision in the Shaft of the Femur. Of the sixty-five cases of this group, the operation was performed on Union soldiers in fifty-three and on Confed erate soldiers in twelve instances. The right femur was involved in thirty, the left in twenty-six cases; in nine the side of the injury was not indicated. CASE 414. Private A. A. Shaw, Co. C, 9th Missouri State Militia Cavalry, was accidentally wounded in the left thigh by a conical ball, April 1, 1863. He was admitted to the general hospital at Eolla, and operated on by Surgeon II. Culbertson, U. S. V., who described the case as follows: "A compound comminuted fracture of the femur at the lower third, the bone being broken into small fragments, and small spiculae being thrown over the internal surface of the wound; orifice of exit two and a half inches in diameter, and located on inner side of thigh. The vasti, biceps, semi-membranosis, and tendinosis, rectus, and adductors (below) were lacerated as high as the middle third and down to the knee joint, which was not involved. The large vessels were uninjured. The patient was vomiting, being cold and prostrated ; pulse 140. Under these circumstances I determined, on consultation, to stimulate and anaesthetize, then remove all loose portions of bone and resect the ends of the femur as far as they were denuded of periosteum, amputation being precluded by the great prostration. In three hours, the pulse having become somewhat fuller and slower and the general surface warmer, I performed the resection. Under the influence of chloroform the patient s pulse grew stronger, and after the operation he seemed better. He recovered from the effects of the anaesthetic in due time, but never rallied fully from the shock of the injury, and his system gradually failed, though supported by full doses of morphia and brandy. He died eighteen hours after the reception of the injury, being conscious of his approaching end." CASE 415. Private Jonathan Wallace, Co. F, 21st Georgia, aged 33 years, was wounded by a conoidal ball, in the charge on Fort Steadman, March 25, 1835. The missile entered on the external surface of the left thigh at the lower portion of the middle third, passed obliquely upward and inward, fractured the femur through the middle third, and emerged on the internal surface an inch above the wound of entrance. He was taken to the field hospital of the 2d division, Ninth Corps, where Surgeon G. W. Snow, 35th Massachusetts, reports that "resection at the middle third of the femur was performed by .Surgeon G. R. Sullivan, 39th New Jersey, and anterior splints applied." On April 10th, he was admitted into the Armory Square Hospital, Washington. Acting Assistant Surgeon George K. Smith reports "that the injured limb was shortened one inch; extension was applied (Buck s method) with a weight of eleven pounds, after which there was no shortening. Patient did remarkably well until June 8th, when he was attacked with diarrhoea, which was arrested at the end of three days. On June 23d, the bone appeared to be firmly united with half an inch shortening, and, on July 2d, extension was removed, and the patient rode about the ward in an invalid chair. July 28th, it was discovered that the limb had shortened two and one-fourth inches; exten sion was reapplied with a weight of sixteen pounds, and, on August 5th, it measured three-fourths of an inch shorter than its fellow. On August 15th, a photograph of the patient was taken [No. 92 of the Surgical Plioto- <jrap\ Series of the Army Medical Museum, a reduced copy of which is represented in the wood-cut, FlG. 164]. On August 17th, the wound had nearly healed, his condition was remarkably good, and the bone had apparently united." On this date he was transferred to the Douglas Hos pital, Washington, to the care of Assistant Surgeon W. F. Norris. U. S. A., who reports: "The wound was still open and discharging a small quantity of matter, but there was firm union of the broken femur, and the patient could without assistance raise his leg from the bed. His general health seemed to be improving, and he daily rode about the ward in a wheeled chair, the limb being supported in an extended position. August 26th* several small loose fragments of bone were removed. August 28th, had a severe chill ; on the 29th, had an attack of erysipelas in the thigh, and, on the following day, a loose piece of necrosed bone, one and a half inches in length, was removed. On September 2d, erysipelas had spread down to ankle joint, llth, erysipelas had disappeared; another small sequestrum was removed from the posterior wound. 16th, had two chills, diarrhoea! passages, and vomiting. 21st, he steadily grew weaker; the wound had almost ceased to discharge. There was slight icterus; the countenance was pinched and anxious and the breathing labored. 22d, he had pain in Fio. 1G4. Appearance five months chest and abdomen, and was unable to pass his urine. These symptoms united six months ;if- after excision in middle third of femur, continued until the evening of the 23d, when death ensued from pysernia. ter shot injury. Spec. [Irom a photograph.] i.J.j4. At the autopsy, fifteen hours after death, the brain appeared healthy; but there was a large amount of serous subarachnoid effusion. Both lungs were adherent and thickly studded with pyremic patches, most of which were dark colored and hardened, a few only having softened, and containing pus. There was considerable serous effusion in the left plenral sac. The spleen was enlarged but not softened; the other thoracic and abdominal viscera appeared healthy. The fractured femur [which is represented in the adjoining wood-cut, FlG. 165] was removed and sawn longitudinally; above the fracture the marrow and interspaces between the cancelli presented a reddish chocolate hue, below, it appeared red dened and inflamed; it had not, in either locality, any gangrenous odor. The femoral vein [represented in PLATE XXX, opposite] was found to contain old and partially disintegrated blood clots, and in some portions also a quantity of healthy look ing creamy pus; its walls were much thickened. It continued to present the same appearance up to about two inches below its 1C5. Ends of fractured left femur \ PLATF XXX. OBSTRUCTED FEMORAL VEIN SECT. III.] EXCISIONS IN THE CONTINUITY OF THE FEMUR. 205 junction with the internal iliac vein ; here the clots ceased, and the coats of the vein, although of reddish hue, did not appear much thickened. The pus was carefully examined Avith the microscope and presented its usual round corpuscles, which under the appli cation of acetic acid exhibited distinctly their characteristic double and triple nuclei. The femoral artery appeared to be healthy." CASE 416. Private W. J. Beck, Co. D, 2d Pennsylvania Heavy Artillery, aged 18 years, was wounded at Petersburg, June 18, 1864. Surgeon M. K. Hogan, U. S. V., recorded his admission to the field hospital of the 1st division, Ninth Corps, with "shot wound of left thigh." Surgeon N. R. Moseley, U. S. V., reported the following: "The patient was admitted to Emory Hospital, Washington, June 24th, with fracture of the middle of the upper third of the left femur, caused by a minie" ball, and resulting in resection, which operation was performed on the field on June 19th. The treatment consisted of cold-water dressings, and stimulants and nutritious diet. Death occurred July 8, 1864." The upper third of the injured fernur was contributed to the Museum by Acting Assistant Surgeon W. H. Ensign, and is represented in the cut (FlG. 167). The specimen shows no bony deposit, and the shaft is stripped of periosteum for some distance below the seat of the injury. CASE 417. Private J. Fearing, Co. G, 21st Massachusetts, aged 23 years, received a gunshot fracture of the right thigh at Cold Harbor, June 3, 1834. He was admitted to the field hospital of the 1st division, Ninth Corps, where the operation of resection was per formed but not recorded, and several days afterwards he was conveyed to Washington. Acting Assistant Surgeon P. O. Williams described the injury and its result, as follows: "The patient was admitted to Emoiy Hospital, June 7th, with compound comminuted frac ture of the femur at the upper third, caused by a minie" ball, which entered anterior to the femoral artery, passed backward and outward, and emerged on the opposite side. Two and a half inches of the bone had been excised the day after the injury, through an incision four inches in length. The general treatment consisted of tonics, stimulants, astringents, and FIG. 166. Upper por- generous diet. Pulley extension, sand bags, and bandages were applied to the limb and in^lxc^i on^ So^^T c 1^- watc r dressings to the wound. Small spiculse of bone and a small piece of lead about the size of a pea were removed on June 30th. The patient died August 3, 1834, of exhaus- Spec - * tion resulting from the excessive discharge of the wound and from severe diarrhoea, which had troubled him the last two weeks. The post-mortem revealed necrosis of both excised extremities, extending from one to one and a half inches. There was abundant deposit of osseous matter on the upper portion, but upon the lower part only a little was found on the posterior aspect." The upper half of the injured femur was contributed by Surgeon N. R. Moseley, U. S. V., and is shown in the cut (FlG. 166). In the following case severe hemorrhage occurred on the twentieth day after the injury, and amputation in the upper third of the thigh was performed: CASE 418. Corporal J. W. Soule, Co. D, 6th Michigan Cavalry, aged 27 years, was wounded in the right thigh at Boonesboro , July 8, 1863. Surgeon S. B. W. Mitchell, 8th Pennsylvania Cavalry, recorded his admission to the Cavalry Corps field hospital, and noted that a resection was performed. On July 21st the wounded man was transferred to the Frederick Hospital, whence Acting Assistant Surgeon J. H. Bartholf contributed the specimen (FlG. 168), with the following history: "The wound was caused by a rifle ball, which entered below the nates and fractured the femur at the lower part of the upper third. A portion of the bone was removed on the evening following the injury, and sand bags were kept to the sides of the limb until the day before the patient was removed to this hospital, when a long outer splint was applied. On admission the limb was in very good condition and shortened only one and three-quarter inches. On July 23d the long splint had become displaced and was doing harm, when I removed it and substituted Buck s extension (pulley, weight, and sand bags). On the following day the patient felt comfortable and the Avound looked well; the short ening now amounted to two and three-quarter inches. On the next day the extension was increased by additional weight. A moderate flow of haemorrhage from the wound took place on July 25th, which could not be controlled by pressure on the common femoral artery, and did not cease until after five minutes continuance, of the pressure. The amount of blood lost was estimated at six ounces. Explora tion showed the sawn end of the upper fragment to be denuded a finger s breadth; but the upper end of the lower fragment could not be felt nor reached. On the 28th a collection of pus was detected, by examination with the finger, in a cavity at the inner side of the upper fragment, and at 8.30 P. M. of this day another haemorrhage, uncontrollable by pressure on the femoral artery, to the amount of eight ounces took place. Stimulants and opiates were then given to procure sleep and time in order to enable the patient to recover, in part at least, from the effects of the haemorrhage and undergo an operation, for which, with a view of having the further advantage of daylight, the following morning was determined upon. At 4 o clock A. M. the next day there was another hemorrhage, estimated at six ounces, and when the patient had pretty well recovered, amputation was performed by transfixion through the site of the wound, making antero-posterior flaps. The patient did not rally well. He died two hours after the operation. At the post-nuirteni examination, the thoracic and abdominal organs were found to be healthy. The hemorrhages were discovered to have occurred from a large orifice plainly to be seen in the upper end of the lower portion of the severed sciatic artery, the ball having evidently found the vessel lying in its course and disrupted it. The blood not coming from any branch of the femoral explains the non-control of the flow by pressure thereon, as was believed at the time. The bleeding and stopping was probably due to the closing of the orifice by the end of the bone, and to its shifting, and perhaps to other causes. The two sawn ends of the bone were necrosed for the space of one- quarter inch to an inch, beyond which a good amount of callus was thrown out." FIG. 168. Upper halfcif rig-lit femur. Spec. 3S.T4. 206 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TABLE XXIII. Summary of Sixty-jive Fatal Cases after Primary Excision of the Shaft of the Femur for Shot Injury. xo. NAME, MILITARY DESCRIPTION , AND AGE. DATES. INJURY, OPERATION, AND RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATION, ANL> RESULT. l 1 Austin, M. G., Pt.. D, July 2, Right ; up. third ; Sept. 26, bony 34 Mcllhany, P., Pt., C, May 5, Left ; three inches mid. third, by 21st Virginia, age 24. 3, 63. union, with lateral curvature. 88th New York. 5, 64. Surg. W. O Meagher, 69th N. Died Dec. 2, 1863, of wounds. York. Died May 5. 1864. o Ball, C. H., Capt., K, Mav 7, Left. Died May 14, 1864. 35 Meeks, W. A., Pt., F, Sept. 19, Right; upper third, by Surg. H. 6th Va. Cav., age 20. 9, 64. 125th Ohio. 19, 63. McHenry, 125th Ohio. Died 3 Becht, J., Pt., 15. 7th Mar. 31, Right ; mid. third, by Surg. R. K. Nov. 3, 1863, exhaustion. Maryland, age 38. 31, 65. Robinson, 7th Md.; April 12, 36 Mehwaldt, H., Pt., B, June 18, Right; six inches mid. third, by amp. up. third. Died April 12, 8th New York Heavy 18, 64. Surg. N. Hayward, 20th Mass. 1865, shock. Artillery. Died June 21, 1864. 4 Beck. W. J., Pt., D, 2(1 June 19, Left; upper third; no attempt at 37 Messenger, I., Pt,, F, A ug. 6, Right; three inches upper third, Peun. Heavy Art ry, iy, 64. union. Died July 8, 1864. Au 1 12th Illinois, age 25. 6, Y 04. by Surg. C. S. Frink, U. S. V. age If. topsy. Spec. 2816. Died, Sept 2, 1864, of wounds. 5 Hittle, M., Pt., K, 3(itli fe. 18/64, Right : mid. third, by Surg. S. 11. 38 Milkie, W., Pt., D, 26th July 20, Left. Died August 7, 1864. Wisconsin. Primary. Plumb. 59th N. Y. Died June Wisconsin. SO, 64. 21, 1864. 31) Mock, A., Pt., K, 55th Mar. 30, Left ; four inches mid. third, by o lions, D. ir., Pt.,K,<;-lth Feb. 6, Right ; three inches upper third. Pennsylvania. 30, 05. Surg. C. M. Clark, 3!>th Illinois. Georgia, ago 20. 7, 65. Died February 9, 1865. Died March 31, 1805. 7 Brown, J. 10., Corp I, ! , July 2, Middlethird. Died July 11, 1863. 40 Moore, H., Pt., H, 36th Nov. 27, Left ; lower third, by Surg. J. C. 80th New York. 2, 63. Alabama. 28, 63. Morgan, 29th Mo. (gang, of foot, 8 Brozier, N. P., Pt., I, June 27, Right ; neck, by Surg. S. H. Ker amp. foot). Died Dec. 6, 1803. 101st Ohio, age 27. 27, 64. sey, 3(ith Ind. Died July 6, 64. 41 Personius, S. W., Pt., May 6, Left ; upper third. Died May 20, !) Burch, ()., Pt.. G. llltli April 2, Left; three ins. mid. and upper G, 109thN. Y., age 21. 6, 64. J804. New Vork, age 17. 5, 65. thirds, by Act. Staff Surg.W. J. 42 Peterson, C. M., Pt., I, June 27, Right: four ins. lower third, by ]?urr, U. S. A.; sloughing. Died 6th Iowa. 27, 64. S urea. W. Graham, 40th 111., and July 18, 65, exhaustion. Autop. W. Lomax, 12th Ind. Died July 10 Burt, E. K., Pt., C, 8th June 17, Right ; four ins. lower third, by 20. 1864. Xew York Heavy Art. 17, 64. Surg. N. Hayward, 20th Mass. 43 Phinney, J. A., Corp I, April 2, Right; upper third, by Surg. J. Died June 20, 18(i4. B, 31st Maine, age 22. 2, 65. A. Hayes, 1 1 th New Hampshire. 11 Carroll, L., Serg t, II, 1st Oof. 22, Right; mid. third: Nov. 11, haein.; Died April 16, 1865. Delaware, age 22. 22, 64. lig.; amp. hip. joint. Died Nov. 44 Potter, R. E., Serg t, II, Mav 12, Right; two ins. middle third, by r.>. 64; proem. Spec. 1020. Circ. 1st N. York Dragoons, 12, 64. Surg. B. T. Kneeland, 1st N. Y. 6, 65, p. 50. Circ. 7, 67, pp. 38, age 26. Drag s. Died J une 1 8, 64 ; p viem. 62. See CASE 298, p. 139, ante. 45 Pugh, J. M., Corp I, F, Sept. 1, Upper third. Died Sept. 14/1864. 12 Chirk, K., Pt., 15, 55th Mav 17, Left, Died May 20, 1862. 38th Ohio. 1, 64. Illinois. 18," 62. * 40 Ramage, E., Pt., I, 15th June 25, Left ; three inches. Died June 13 Conner, S. L., Pt., 10, July 1, Right ; middle third. Died July Ohio. 25, 03. 28, 1863. Spec. 1752. 8~>d Ohio. 1, (53. 16, 1863. 47 Ruokel, D., Pt., I, 14th June 16, Right: upper third, by Surff. C. 14 Cox. R., Serg t, L, 1st S. June 30, ; up. third; bones of pelvis Ohio. 16, 64 N. Fowler, 105th Ohio. Died Carolina Sliarpshoot rs. J y3, 62. also fractured. Died July 11, 62. June 27, 1804. 15 Dawson, J., Pt.. G. 48th Aug. Hi, August 18th, gangrene. Died 48 Shaw, A. A., Pt,, C, 9th April 1, Left; lower third, by Surg. H. New York, age3J. 16, 64. August 19, 1864. Missouri S. M. Cav. 1, 63. Culbertson, U. S.V. Died April 10 Daniel, It., Pt., I- 1 , 1 3th Oct. 19. Left ; six inches upper and middle 2, 1863. Autopsy. West Virginia, age 37. 19, 64. thirds. Died Nov. 7, 64 ; pysem. 49 Small, E., Pt., E, 69th Sept. 17, Left, Died October 2, 1862. Autopsy. Xew York. 17, 62. 17 Delinger, C., Pt., D, Mar. 25, Left; upper third. Died March 50 Smith, C., Serg t, K, 3d May 21. Right: middle third. Died May 200th Pennsylvania. 25. 65. 29, 1865. Ohio Cavalry. 21, 63. 25. 1863. 18 Engle, J., Government Mar. 16, Right ; middle third, by Surg. B. 51 Soule, J. W., Corp I, D, July 8, Right; upper third; ha?ms.: 2!)th, employe, age 19. 18, 64. Woodward, 22d 111. Died Mar. Oth Mich. Cav., age 27. 8, 63. amputat n up. third. Died July 24, 1864. 29, 1863, of haem. Spec. 3854. 1 J 10 vans, J., Pt., I, 57th June 15, Right : upper third, by Surg. E. 53 Sullivan, J., Pt., F, 57th Mav 27, Left; middle third. Died June Indiana. 15, 64. 15. Glick, 40th Ind. Died June Indiana. 27, 64. 17, 1864, of wounds. 29, 1864. 53 Thomas. R. M., Serg t, Mar. 10, Left ; four inches, by Surg. G. W. 20 Fearing, J., Pt., G, 21st June 3, Right ; two and a half ins. upper 10, 129th Ind., age 28. 10, 65. Carr. 129th Ind. Died March Mass., age 2:5. 4, 61. third: June 31, spic. removed; 20, 1805, exhaustion. nee. Died Aug. 3, 64. S)w!c. 2947. 54 2 , Lieut., 118th Sept. 17, Fourinches middle third. by Surg. 21 Foster, F., Serg t, K, 1st April 2, Left; middle third. Died May 5, or 115th Penu., age 30. 17, 62. H. W. Rivers, 4th Rhode Island. New York Dragoons. 2, 65. 1865. Died Sept. 19. 1862. 22 <;il!is, G., Serg t, (;,(ilst June 2, Upper and middle thirds. Died 55 Vining, M. R., Lieut., May 12. Right ; four inches upper third, Georgia, ago 24. 2, 64. Juno 10, 1864 A, 7th Maine. 12, 04. by Surg. F. M. Eveleth, 7th 23 Harris, L. W., Pt., I, Aug. 8, Middle third, by Ass t Surg. W. Maine. Died May 19, 1864. 84th Indiana. 8, 64. H. Matchett, 40th Ohio. Died 50 Wallace, J., Pt., C, 21st Mar. 25, Left: mid. third, by Surg. G. R. Sept. 5, 1864. Georgia, age 37. 25, 65. Sullivan, 39th N. J.: Aug. 20th 24 Hill, J. M., Pt., C, llth May 24, Right ; three ins. middle third. and Sept. 11, rem. frags. Died Alabama, age 21. 24, 64. Died June 9, 1864. Sept. 23, 1865 ; pyaemia. Spec. 25 Holmes, J., Lieutenant, June 17, Right: upper third, by Surg. E. 1354. Photo. Series, No. 92. E, 40th Indiana. 17, 64. B. Glick, 40th Ind. Died June 57 Washburne, E. A. B., April 6, Right: upper third. Died April 25. 1864. Pt., D, 10th New York 6, 65. 19, 1865, exhaustion from harmi. 26 Hood, S., Pt., D, mh Dec. 10, Eight ins. from lesser trochanter Cavalry, age 23. South Carolina. 10, 64. down. Died Dec. 11, 1864. 5S White, J., Lieut., G, 1st May 12, Right ; troch. minor, and frag. 27 Hyatt, J., Pt., F, 57th Mav 27, Left: middle third, by Surg. E. Penn. Reserves, age 30. 12, 64. upper third, by Surg. I/. W. Indiana. 27, 64. B. Glick, 40th Ind. Died June Reed, U. S. V. Died May 18, 24, 1864. 1664 ; pyaemia. 28 Lambert, J. S., Pt., I, Sept. 14, Left; entire middle third, by A. 59 Williams, P. I., Lieut., June 21, Upper third, by Surgs. C. Carle, 30th Wisconsin, age 30. 14, 64. A. Surg. A. Kelly. Died Sept. E, 76th Illinois. 21, 03. 41st 111., and B. F. Stephenson, 14. 1864, shock. 14th 111. Died in three-quarters 29 Lediuell, J., Pt., B, 52d July 14, Right ; three inches up. third, in of an hour. North Carolina. , 63. cluding troc. maj., by Surg. R. 60 Williams, B.,Pt.,C, 76th April 9, Left. Died April 12, 1805. W. Pease, U. S. V. Died on the Colored Troops. 9, 65. eighth day. Spec.. 1476. 61 Wishmire, C. E., Pt., A, July 3, Left: by Surg.W. H. Twiford. 30 Lewis. W. II., Pt., F, June 18, Left; middle third, by Surg. N. 27th Indiana, age 33. 5, 63. 27th Ind.; 12th, htem. Died July 1 1th New Jersey. 18, 64. Hayward, 20th Mass. Died June 15, 1803. 24/1864. 62 Wolf, M. B., Serg t, E, Nov. 24, Right : three inches. Died Dec. 31 Lihbv, J. C., Serg t, I, Dec. 13, Left; middle third. Died Jan. llth Ohio. 25, 63. 9. 1803. 17th Maine. 13, 62. 2, 1863. 63 Wool. C., Pt., M, Oth June 11, Right ; upper third. Died June 32 Matthews. J. S.. Pt., B, May 25, Right : upper third. Died May New York Cavalry. 11, 04. 13, 1864. 3d Iowa Cavalry. 25, 63. 30. 1863. 64 Wrir/ht, H. A., Lieut., July 30, Right ; upper and middle thirds. 33 Mayer, J. 15., Pt., C, Sept. 3, Middle third, by Ass t Surg. W. G, Oth Virginia, age 23. An.1, 64. Died Aug. 5, 1864. 9th Indiana. 3, 64. H. Matchett, 40th Ohio. Died 65 Yancey, T. IT., Serg t. B, Oct. 7, Left : four inches upper third. Sept, 3, 1864, of wounds. 48th Alabama, age 33. 7, 64. Died Oct. 25, 1864. O MEAOHER (TV.), Casualties of the Battle of FredericTesburg, in Am. Med. Times, 1803, Vol. VI, p. 179. 2 Supposed to be Lieutenant R. M. Johnston, Adjutant 125th Pennsylvania. SECT. III. | EXCISIONS IN THE SHAFT OF THE FEMUR. 207 In ten of the sixty-five fatal cases of primary excision 1 in the shaft of the femur the point of resection was not indicated; in twenty-five instances the excision was in the upper third; in five, in the upper and middle thirds; in twenty-one, in the middle third, and in four, in the lower third. Undetermined Cases of Primary JUxcision in the Shaft of the Femur. There are six cases of this group; the data are very meagre, and in five of the six cases not even the names of the patients are recorded: TABLE XXIV. Summary of Six Cases of Primary Excision in the Shaft of the Femur with Unknown Results. No. NAMK, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPKKATOES, RESULT. NO. NAME, MILITAUY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Gosa, J. A., 1 t.. K, 3!!th Nov. 27, Right ; lower third. Surg. J. C. 4 Unknown. July 3, Left ; middle third ; nine inches. Alabama. 28, 63. Morgan, 29th Mo. 3, 63. Spec. 1552. 2 Unknown. May 6, Left ; five and a half inches ex 5 Unknown. May, Left ; six und a half inches lower (i, r (i4. cised. Spec. 2671. , 64. third. Spec. 2410. 3 Unknown. May (i, Left; eight and a half inches. 6 Unknown. May 3, L t; seven and a half ins. Surg. J. 6 , 64. Spec. 2644. 3, 63. Y. Cantwell, 82dOhio.and A. A. Surg. A. D. Kibbee. Spec. 1374. Intermediary Excisions in the Shaft of the Femur. This category comprises forty- eight cases, with nine recoveries and thirty-nine deaths, a fatality of 81.2 per cent. Recoveries after Intermediary Excision in the Femur. Two examples are detailed : CASE 419. Private J. B. Kendall, Co. K, 5th Wisconsin, aged 34 years, was wounded in the right thigh during the assault on the heights of Fredericksburg, May 3, 1863, and entered Campbell Hospital, Washington, five days afterwards. Surgeon A. F. Sheldon, U. S. V., reported his discharge from service May 3, 1864, by reason of "shot fracture of right femur," and at an examination on July 2, 1886, Surgeon J. H. Baxter, U. S. A r ., described the man as " suffering from the effects of an excision of nearly five inches of the femur. 1 On November 6, 1887, the pensioner, who then held the appointment of clerk in the Quartermaster General s Office, visited the Army Medical Museum, when the photograph, represented in the annexed cut (FiG. 169), was taken. The following information in regard to his case was elicited from his statements: "He was wounded by a musket ball, which split upon the shaft of the femur, a portion of the missile lodging in tbe cylinder of the bone and a portion traversing the thigh and making its exit posteriorly. He was conveyed on a stretcher to a house in Fredericksburg, and on the following morning to the Sixth Corps Hospital on Falmouth Heights. On May 10th, he was sent on the cars to Aquia Creek, and thence on a hospital transport to Washington. The injured limb was suspended by Smith s anterior splint. There was intense irritative fever, with copious suppuration. On May 21st, Acting Assistant Surgeon F. W. Kelly made a long incision on the posterior aspect of the thigh, removed a fragment of ball and numerous detached pieces of bone, and turned out and sawed off the sharp extremities of the fractured shaft. The limb was then supported in a wooden trough by cushions. The surgical fever and suppuration gradually abated, and ultimately firm union took place and the wound healed. Abscesses formed several times after his discharge from hospital, and bits of necrosed bone were eliminated. The sinuses did not close definitely until August, 1868." At the time of his visit to the Museum the cicatrices were in a sound condition, and the frac ture appeared firmly consolidated, having resulted in two and a half inches shortening of the limb and false anchylosis of the knee. His general health was excellent, and, notwithstanding the stiffness of his knee, he walked briskly with only a slight limp, injury tliis pensioner has been exempted from examinations. FIG. 169. Result of intermediary excision of the shaft of the femur. [From a photograph.] Owing to the permanent character of the results of the The pensioner was paid December 4, 1878. 1 The portion of bone excised amounted to eight inches in one instance (CASE No. 26 of TABLE XXIII) ; to six inches in two (CASES l(i nnd 36 of TAHLR XXIII) ; to four inches in eight ; to three inches in eight; to two and one-half and to two inches in one each; and in forty-four cases the length of bone excised was not precisely stated. The fractures were caused, in 62 instauues, by small projectiles, twice by shell fragments, and once by a grapeshot. 208 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 420. Private L. M. Baker, Co. B, 2d Wisconsin, aged 29 years, was wounded at Gettysburg, June 1, 18f>3, and admitted to the field hospital of the 1st division, First Corps. Surgeon G. M. Ramsey, 95th New York, recorded: Gunshot fracture of right thigh. July (>th, resection." On September 5th, the patient was trans ferred to Camp Letterman, and subsequently to the General Hospital at York. A photo graph, represented in the annexed cut (FlG. 170), was received from Surgeon H. Palmer, U. S. V., with the following description of the case : "A conical leaden ball entered the anterior aspect of the right thigh six inches below the middle of Poupart s ligament, thence passing backward and slightly upward, making its exit at the posterior aspect, an inch above the point of entrance, fracturing the femur. Two hours after the reception of the injury he was taken to a field hospital, and, he states, on the 3d of July he was placed under the influence of chloroform and fragments of bone to the extent of two inches of shaft were removed by cutting down upon them at the seat of the fracture. Water dressings were used for the first two weeks, when Smith s anterior splint was applied the limb suppurating profusely, and the man s vital power being a good deal depressed. There was a constant tendency to sloughing in the posterior wound, rendering the frequent application of caustic necessary. The splint was removed on the 15th of November, partial bony union having taken place, suppuration still continuing and spiculse of bone being discharged from time to time ; patient, who was upon tonics and nutritious diet, gradually improving. On the 13th of January the posterior wound assumed a sloughing condition, which spread with rapidity, and was attended with considerable constitutional disturbance. It was checked by the free use of bromine, the patient being at the same time upon iron and quinia. Since that time the patient has continued slowly but steadily to improve. April 14th, the wounds have closed; the man is in excellent health and able to walk about on crutches, amount of shortening being two and a half inches. On June 30, 1864, he was discharged from service, although still using crutches, able to bear considerable weight upon the injured limb." Examiner C. D. Cameron, of LaCrosse, Wisconsin, reported, December 23, 1865: "Shot wound of right thigh, shattering the bone. Some four inches of the femur were removed. Limb much crooked and greatly atrophied; is five inches shorter than the other. Wound not yet healed." Examiner W. D. Flinn, of Eedwood Falls, Minnesota, September 26, 1873, certified to "resection of about three inches of bone," and stated "the wound has been open and running during the last two and a half years." The pensioner was paid June 4, 1879. One of the nine survivors after intermediary excision in the shaft of the femur was a Confederate soldier, and eight were Union soldiers. Of the latter, one died nearly a year after the operation, six are pensioners in 1879, and one has not been heard from since 1870. The point of excision was in the upper third of the femur in one instance; in the middle third in five; in the middle and lower in one; and in the lower third in two cases. TABLE XXV. Summary of Nine Cases of Recovery after Intermediary Excision of the Shaft of the Femur for Shot Injury. FIG. 170. Result of intermediary ex cision in the shaft of the femur. [From a photograph.J No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. IXJUEY, OPEHATION, AMD ilKSULT. NO NAME, MILITAUY DKSCRIPTION, AND AGE. DATES. IXJUUY, OPERATION, AND RESULT. 1 Anderson, L. C., Pt., A, Nov. 11, Left; three ins. upper third, by 6 McFarland, R., Pt., K, July 3, Right ; two and a half ins middle 7th Kansas Cavalry, 20, 61. A. A. Surg. J. Thome ; erysip 22d N.Carolina, age 19. 23, 63. third, by A. A. Snrg. J. L.Whit- age 19. elas. Disch d March 1, 1864 ; aker. Sept. 23, leg paralyzed pens d ; four ins. shortening; an and two ins. shorten g. Kxch d chylosis knee joint. April 25, 1864. 2 Baker, L. M., Pt., B, Sd Wisconsin, age 29. July 1, 6, fo. Right; two inches middle third ; two and a half ins. short g ; Oct. 7 Morrison, II. A., Pt., A, 1st Maine Heavy Art., May 19, 23," 64. Right; two and a half ins., and iragm ts amount g to three ins. 14. partial union. Uisch d June age 20. more, middle third, by Surg. N. 30, 1864 ; pens d; Sept., 73, w d R. Mosely, U. S. V. Mustered has been open two years. Surg. out June 6, 186~>; pens d; nut I hot. Scries, Vol. 4, 1865. heard from since March, 1070. 3 Hall, 8. C., Pt., F, 3d Nov. 8, Right ; three and n half ins. up. Spec. 23:i3. Indiana Cav., age 18. 15. 03. third, by Surg. T. R. Crosby, U. 8 Whitesell, J., Pt.,E, 61st Aug. 29, Left: four and a half ins. low. and S. V. April 13, 1864, amp", up Ohio, age 2o. Sept. 8, middle thirds, by Surg. 15. I?. per third. Disch d July 8, 1804 ; 1H6_2. Breed, U. S.V. Disch d Jan. 17, pensioned ; stump healed. 1863; pens d. Died Aug. 1 . , 03. 4 Hazelrigg, W. G., Pt., April 6, Left ; lower third. Disch d Jan. Spec. 1!)9. A, 19th Inf ry, age 31. , 62. 14, 18G3; pens d ; three and a half 9 Wilson, J. E., Pt., F, May 3, Right; fragments, four ins. mid. ins. short g; pieces of bone dis d; 13th N. Jersey, age 37. 17, 63. third, by Surg. W. II. Twiford, anch. knee joint. 27th Ind. Disch d April 8, 64 ; 5 Kendall, J. B., Serg t, May 3, Right ; three ins. low third, by A. pens d ; four and a half inclies K, 5th Wisconsin, age 21, Y C3. A. Surg. F. W. Kelly. Firmly short g; anchy. of knee joint. 34. united. Disch d May 3, 1864 ; Spec. 1277. pens d ; 67. slight limp; two and a half ins. short g ; false anchy. of knee joint. Surg. Phot. 187. SECT. III.] EXCISIONS IN THE SHAFT OF THE FEMUR. 209 FIG. 171. Section of rig-lit femur fractured in lowest third. Spec. The injuries were inflicted by a grape shot in one case, by a slug in one, and by small missiles in seven instances. The length of the excised portion of the femur varied from two to five and one-half inches. Fatal Cases of Intermediary Excision in the Shaft of the Femur. A few illustra tions, showing the nature and extent of the intermediary excisions practised, will precede the tabular statement of the thirty-nine fatal cases: CASK 421. Private T. Fitzgerald, Co. C, 38th New York, aged 27 years, was wounded at Chancellorsville, May 2, 1863, and treated at a field hospital until June 15th, when he was conveyed to Washington. Assistant Surgeon G. A. Mursick, U. S. V., reported: "The patient was admitted to Stanton Hospital with compound fracture of the lower third of tho right femur. Resec tion of a portion of the bone was performed on May 19th, before admission to this hospital. The wound suppurated profusely, and his condition was unfavorable. Water dressings were used, and Hodgen s splint was applied to the limb. Six ounces of whis key were administered daily. There was no attempt at union of the bone and no abatement of the discharge. By July 2d the patient had become pale, anaemic, and emaciated, when muriated tincture of iron was prescribed in doses of twenty drops three times a day. The patient was also troubled with anorexia, and on July 5th diarrhoea came on, for which astringents, consisting of opium and tannin, and subsequently tincture of catechu and opium, were administered. Death occurred on July 10, 1863." A section of the injured femur was contributed by Surgeon J. A. Lidell, U. S. V., and is shown in the wood-cut (FlG. 171). The specimen exhibits considerable deposit of callus, imprisoning the necrosed fragments but not uniting the extremities. CASE 422. Corporal J. White, Co. F, 12th Infantry, aged 16 years, was wounded in the thigh at Gaines s Mills, June 27, 1862. Assistant Surgeon H. S. Schell, U. S. A., reported that the femur was fractured and that the wounded man was captured by the enemy. After remaining a prisoner for three weeks he was exchanged and conveyed to Baltimore. Acting Assistant Surgeon E. G. Waters reported the following history: "The patient was admitted to Camden Street Hospital, July 21st, with the left femur badly shattered at the upper third. No apparatus had been applied. On July 26th, he was placed under the influence of chloroform, and an incision over the seat of injury, six inches in extent and exposing the bone, was made and the broken and unattached fragments removed, after which the ends of the upper and lower extremities were sawn off, leaving a hiatus of some four inches. The wound was then closed by stitches and adhesive strips, and the patient was put upon a supporting treat ment. There was considerable loss of blood during the operation, which was performed by Assistant Surgeon R. Bartholow, U. S. A. On August 5th, the limb was placed in the anterior splint. At this time the discharge had improved in appearance and diminished in quantity, and the external wound looked healthy and was closing rapidly; the patient also maintained his strength and cheerfulness, and but for a troublesome bedsore over the sacrum he was almost free from pain. On August 8th, typhoid symptoms came on, the pulse being quick and irritable; the tongue dry, cracked, and covered with brown epithelium; appetite good but thirst insatiable. Wine, quinine, iron, and concentrated nourishment were now administered liberally. The wound was nearly closed and presented a healthy appearance as well as the discharge. On August 14th, colliquative diarrhoea came on, from which the patient sank and died, having survived the operation nineteen days. At the post-mortem examination both extremities of the resected portion of the femur were found denuded of periosteum and extensively necrosed. There had been no attempt at union, nor was any callus found in the surrounding tissues. The soft parts were gangrenous and intolerably offensive." The specimen, shown in the wood-cut (FlG. 172), was contributed by the operator, and consists of a portion of the shaft of the injured femur, embracing two sections an inch and a half and three inches long respectively, and an irregular portion two inches by three in its greater lengths. The latter is composed of fragments united by new bone. The larger section is obliquely fractured at one end, with thick ened periosteum, and the smaller shows a ring of necrosis at one extremity. GASP: 423. Sergeant M. Smith, Co. I, 73d Pennsylvania, was wounded in the left thigh at Chancellorsville, May, 3, 1863. The injury involved a fracture of the femur at the trochanter major. The wounded man reached the Eleventh Corps hospital at Brook s Station on May 15th, and on the following day five inches of the bone, commencing just below the neck, was resected by Surgeon R. Thomain, 29th New York. The patient died June 8, 1883. The excised bone is represented in the wood-cuts (FlGS. 173, 174), and was contributed, with the history, by the operator. The excision was practised in the upper third in fifteen instances; at the junction of middle and upper thirds in two; in the middle third in fourteen; in the lower third in five instances. In three cases the point of excision was not indicated. SURG. Ill 27 FIG. 172. Two sections and an irregular portion of shaft of femur. Spec. 394. FIG. 173.-E*- cisedfive inches ofshaftofleftfe- mur. Posterior view.5pec.1539. FIG. 174.-Ante- rior view of the same specimen. 210 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TABLE XXVI. Summary of Thirty-nine Fatal Cases of Intermediary Excision of the Shaft of the Femur for Shot Injury. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. IXJUHY, OPERATION, AND RESULT. NO. NAME, MILITAUY DESCRIPTION, AND AGE DATES. IXJUUY, OPERATION, AM> RESULT. 1 Atkinson, H. L., Pt., II, Sept. 30, Kight ; great trochanter and one 22 Horrigan, D., Pt., K, Mav 5, Left; four ins. up. third, by Surg. 2d Maryland, age 32. Oct. 30, inch of shaft. Died Oct. 25, 65 ; 28th Mass., age 32. 30, 64. A. F. SheJdon, U. S. V. Died 1864. traumatic erysipelas. Sept. 2, 1864, of wounds. Baker, J. P., Pt.. D, May 3, Right; two ins., and loose spiculae. 23 Huntley, H. S., Pt., I, May 5, Left; lower third, by Surg. 1. . B. 147th Pcun., age 2 J. 18, S G3. June 10, diarrhoea. Died Aug. 37th New York. 17, 62. Bontecou, U. S. V. Died May 10, 1863. 22, 1862 ; pyaemia. 3 Biddle, A., Pt., E, 6th May 5, Left ; mid. third, by Surg. R. B. 24 Lemberger,F..Pt., 1, 33d July 4, Right ; nineteen fnigm. and sharp New Jersey. 14, 6- . Bontecou, U. S. V. Died May Iowa, age 23. 17, 63. ends, four ins. in all, lower third. 2.3, 1862, of pyaemia. by Snrg. I. Moses. U.S. V. 1 >i<><t 4 Brewer, J.. Pt., K, 130th Aug. 6, Right; three ins. upper third, by July 26, 1863, of inflammatory Indiana, age 18. Sept. 1, Surg. F. Meacham, U. S. V. fever. Spec. 2084. 1864. Died Nov. 18, 18G4. 25 Martin, F., Serg t, F, May 8, Left; middle third, by Surg. A. 5 Brown, E. W., Lieut., May 5, Kight ; three ins. upper third, by 155th Penn., age 22. June 1, F. Sheldon, U. S. V.; gangrene. C, 37th New York. 16, 62. Surg. R. B. Bontecou, U. S. V. 1864. Died June 7, 1864; exhaustion. Died May 23, 1862; pyasmia. 26 May, A. S., Pt., E, 8th April 9, Right ; three ins. up. third. Died 6 Burden, H., Pt., 6th 8. May 5, Left ; by Surg. R. B. Bontecou, Iowa, age 26. May 5, May 6, 1864. Carolina, age 18. 17, 62. U.S.V. Died May 20. 62; pyaem. 1864. 7 Burroughs. J., Serg t, Sept. li>, Right; four ins. low. third; amp. 27 McCormick, R., Serg t, Sept. 20, Left ; frag, and ends, three and a IJ, 3d Kentucky. 28, G3. mid. third. Died Oct. 10, 1863. C, 2d Missouri, age 24. Oct. 1, half ins., mid. third, by Surg. J. 8 Collar, C., Pt., P, 45th Feb. 14, Right ; mid. third, by Surg. G. S. 1863. Moses, U. S. V. Nov. 3, arterial Illinois, age 20.- Mar. 1-!, Kemble, U. S. V. May 1, amp. ham. DiedNov. 11, 1863, of py 1864. thigh, upper third. Died May aemia. Autopsy. Spec. 2131. 9, 64. shock. 28 p Interme Ri^ht ; low. third V>v Sur. B A, 9 Connover, J. C., Corp l, May 25, Left ; four ins. up. third, by Ass t diary, Vanderkieft,102dN.Y. Died in E, 27th Illinois, age 21. June 18, Surg. Ci. W. Burke, 46th Penn. 18G2. three weeks ; pyasmia. Spec. 1 1 . 18G4. Died June 21, 1864; pneumonia. 29 Parker, T., Pt., I, 5th May 5, Right; three ins. mid. third, by 10 Cramer, J., Pt., E, 55th Mav 5, Five ins. mid. third, by Surg. R. New Jersey, age 20. 15, 62. Surg. R. B. Bontecou, U. S. V. New York. 14, G2. B. Bontecou, U. S. V. Died Large bed-sores. Died July 2. May 17, 1862. 1862; diarrhoea. 11 Dickenson, C., Corporal, Sept. 20, Right ; four inches middle third, 30 Paton, T., Pt., E, 72d Mav 7, Left; up. port, protruding femur, G, 88th Indiana. , 63. by Surg. I. Moses, U.S.V. Died New York. 17, 62. bv Surg. R. B. Bontecou,U.S.Y. Oct. 5. 18G3. Spec. 2145. Died May 20, 1862. of pyaemia. 12 Dillon, W., Pt., A, 10th June 3, Kight ; six ins. up. third, by Surg. 31 Polser, J. P., Pt., B, 15th Oct. 4, Left ; upper third. Died Oct. -~7, New York, age 23. 13, 64. A. F. Sheldon, U. S. V. Died Iowa. 25, 62. 1862. June 13, 1864, shock. 32 Redwood. W., Pt,, A , May 5, Left ; five ins. mid. third, by Surg. 13 Eisele, R., Pt., E, 6th May 5, Left; four ins. middle third, by 5th Michigan. 16, 62. R. B. Bontecou. Died Mav 11 , New Jersey. 17, 62. Surg. R. B. Bontecou, U. S. V. 1862. Died May 20, 1862 ; pyaemia. 33 Rose, S. L., Serg t, D, Sept. 20. Right; ends and frag., two and a 14 Fitzgerald, P., Pt., I, May 2, Right; low. third. July 5, diarrh. 113th Ohio. Oct. 17, half ins. in all, middle third, by 38th New York, age 27. 19, G3. Died July 10, 1863, suppuration 1863. Sqrg. L Moses, U. S. V. Died and diarrhoea. Spec. 1522. Oct 20, 1863. Spec. 2130. 15 Friend, J., Pt., H, 7th July 4, Right ; mid. third, by A. A. Surg. 34 Sayre, A., Pt., E, 12th Dec. 11, Left; troch. major. Died Janu Missouri, age 27. 13, 63. A. Sterling. Died July 17, 1863; Ohio. 2G, 63. ary 23, 1804; pyaemia. haemorrhage. Spec. 2091. 35 Smith, I. M., Serg t, I, May 3, Right; five ins. up. third, includ g 16 Goddard, W., , B, June 24, Middle third; erysipelas. Died 73d Pennsylvania. 16, 63. troc. major, by Surg. 11. Tho- Caswell s Georgia S. S. J yl, 63. August 24, 1863. maine, 29th New York. Died 17 Hall, J. W., Pt., I, 92d Dec. 14, Left ; three and a half ins. up. t d, June 8, 63; anaemia. Spec. 1539. New York. 29, 62. by Surg. C. A. Cowgill, U. S. V. 36 Stevens, H., Pt., I, 59th May 6, Right; three ins. upper third, by Died Jan. 22, 1863. Autopsy. Mass., age 16. June 3, Surg. R. B. Bontecou, U. S. V. Spec. 1328. 1864. Died June 5, 64; exhaustion. 18 Hall, S. M., Pt,, E, 7th June 3, Left ; five ins. up. third, by Surg. Spec. 3034. New York, age 29. 13, 64. A. F. Sheldon, U. S. V. Died 37 Taylor, C. H., Pt., E, Feb. 20, Right; mid. third, five ins., by June 17, 1864, exhaustion. 3d Artillery, age 20. Mar. 6, Ass t Surgeon W. R. Ramsay, 19 Hamlin, J. L., Corp l, Dec. 16, Left ; two and a half ins. upper 1864. U. S. A., and others. Died April < r, 7th Minnesota, age 23, 64. third, by A. A. Surg. S. Black- 2, 1864 ; exhaustion from con 21. wood. Died Dec. 24, 64 ; shock tinued haemorrhage. of operation. 38 White, J., Corp l, F, 12th June 27, Left ; three ins. up. third, by Ass t 20 Harper, C. D., Pt., F, Mav 5, Left ; four ins. mid. th d, by Surg. Infantry. July 26, Surg. R. Bartholow, U. S. A. 5th Michigan. 14, 62. R. B. Bontecou, U. S. V. Died 1862. Died Aug. 14, 1862. Autopsy ; May 17, 18<>2 ; pyaemic hsemor. gangrene. Spec. 394. from wounded veins of thigh. 39 Young, W., Serg t, C, Dec. 16, Left ; thre*e and a half ins. upper 21 Heller, J. P., Pt., F, Mav 3, Right ; three ins. Died May 25, 5th Minnesota, age 28. 23, 64. third, by A. A. Surg. S. Black- 147th Pennsylvania. 19, 63. 18G3, tetanus. Spec. 1272. wood. Died Dec. 31, 1864. Three of these thirty-nine soldiers belonged to the Confederate and thirty-six to the Union army. The right femur was injured in nineteen, the left in eighteen of the thirty- seven cases in which this point was recorded. Secondary Excisions in the Shaft of the Femur. Nineteen examples were reported in this category. Fifteen patients recovered, three died, and the result in one instance remains undetermined. Recoveries after Secondary Excision in the Shaft of the Femur. Two examples of the fifteen cases of this group will be given in detail : CASE 424. Private J. Reid, Co. G, 162d New York, aged 35 years, was wounded in the right thigh, at Springfield Lauding, June, 1863. Assistant Surgeon J. Romans, jr., U. S. A., recorded his admission to St. James Hospital, New Orleans, July 3d, and described the injury as follows: "The patient had sustained a compound fracture of the right femur a few days previous to entering the hospital, having been wounded by a bullet, which entered the anterior face of the limb about four and a half inches below Poiipurt s ligament, and emerged about four inches below the great trochanter, having passed just outside SECT. 1II.J EXCISIONS IN THE SHAFT OF THE FEMUR. 211 the femoral artery and shattered the bone in its passage. On admission the thigh was but slightly swollen ; the shortening amounted to about an inch and a half. I determined to make an effort to save the limb, for experience had taught me how much conservative surgery can accomplish in gunshot fractures of the thiglu A Smith s anterior splint was applied, but, proving uncomfortable, it was removed and the limb was placed on a double-inclined plane. The orifice of entrance healed, and pus, which began to be discharged quite freely, flowed out through the lower opening. On July 29th the patient s condition was favorable for an operation, and I determined to remove all the necrosed bone possible, and, if necessary, to resect a portion of the shaft of the femur. The patient was placed under the influence of chloroform, and an incision two and a half inches long was made from either side of the orifice of exit in the direction of the long axis of the limb. Several pieces of necrosed bone were then removed, and the end of each fragment of the fractured femur was turned out and sawn off with a chain saw beyond the point where the bone was bare. The periosteum along the course of linea aspera was carefully preserved and peeled off from the bone, or rather the bone was gently torn away from the periosteum. About three inches of the femur were thus resected. No untoward symptom followed for more than two months, and, in October, the limb could be raised by the heel, union being quite firm. About this time he was attacked with erysipelas, which seemed to be caused by the whitewashing of the ward in which he lay; but the attack was slight and soon passed off. In November he could walk about on crutches and bend his knee slightly. I noticed that union took place first and mainly along the inner side of the bone ; and as the periosteum here was preserved entire, there was not so much shortening as would otherwise have resulted, it being only three and a half inches. On December 12, 1863, the patient was discharged from service and left for New York. How useful a limb he will have cannot yet be determined, but amputation would have killed him." The New York City Examining Board, at different dates, certified to the injury, and to union with deformity, and from four and a half inches to five inches shortening as resulting therefrom, together with complete anchylosis of the knee joint. The pensioner is also reported as wearing an artificial appliance attached to his shoe. The pensioner was paid Match 4, 1879. CASE 425. Private J. F. Williams, Co. H, 26th Pennsylvania, aged 25 years, was wounded in the right shoulder and right thigh, at Gettysburg, July 2, 1833. He entered a field hospital of the Third Corps, and was removed to Camp Letter-man one month afterwards. Surgeon H. Janes, U. S. V., noted the injury as "a compound fracture of the right femur at the upper third, caused by a miuie ball," and recorded the following result: "On September 8th, the upper extremity of the lower frag ment was found to be protruding and to be denuded, and four days later the patient was placed upon the operating table and about two inches of the lower fragment were carefully excised by Acting Assistant Surgeon H. Leaman. The limb was then placed in* an anterior splint. Small pieces of bone were discharged from time to time and steady improvement followed. By November 9th, partial union had taken place, and several days afterwards the patient was transferred to York Hospital." Surgeon H. Palmer, U. S. V., in charge of the latter, on February 15, 1864, made the following note of the condition of the limb: "At this time there is complete bony union of the fracture. There is, however, some dead bone at the upper fourth of the thigh, still causing rather free discharge of pus by three openings. The thigh is shortened about four and a half inches, its circumference increased four inches, and the limb bent outward. The patient s general health is excellent and his constitutional condition good." The patient was ultimately transferred to Mower Hospital, Philadelphia, July 25, 1865, and one month later he was discharged and pensioned. Examiner E. A. Smith, of Philadelphia, on August 28, 1865, certified to "total loss of use of right arm and right leg from wound of shoulder and thigh, to fracture of femur and eight inches shortening," and to "one hundred and twenty-nine pieces of bone having been removed," and added that the pensioner "has a cough and is a sad wreck." The pensioner was paid March 4, 1866, since when he has not been heard from. The excision was practised in the upper third in nine instances, in the middle third in four, and in the lower third in two. In four cases portions of the trochanter major and of the shaft of the femur were excised; in the remaining eleven cases the excised portion of the femur varied in length from two to six inches. Fatal Cases of /Secondary JSxcision in the Shaft of the Femur. The three operations of this group were practised on Union soldiers. In one instance the right femur, and in two the left femur had been fractured. CASE 426. Private J. McElroy, Co. E, 35th Iowa, aged 38 years, was wounded in the right thigh, at Lake Chicot, June 6, 1864, and underwent the operation of resection of the femur at Gayosa Hospital, Memphis. Surgeon F. N. Burke, U. S. V., who performed the operation, made the following report of the case: "The patient was admitted twelve days after the injury, which was caused by a mini6 ball striking the anterior surface of the middle third of the thigh, fracturing the femur, and lodging in the limb. The leg was placed in a double-inclined concave splint. The wound healed readily without suppuration, and in two months the patient was able to walk on crutches, the fragments though not in a straight position having united partly by cartilage and partly by ligament. His constitutional state was very good, he being fat and healthy. The patient was to have been sent to his home on furlough, but on October 25th, having been allowed to go out on the street, he became intox icated, and, by a fall, refractured the femur at the place of union. On the following day he was placed under the influence of chloroform, and three inches of bone was excised through an incision five inches in length, an opening one inch long being made on the posterior surface of the thigh for drainage. Bilious diarrhoea set in five days after the operation and continued for two weeks. Death resulted from pya3mia, November 23, 1864, several violent chills having occurred five or six days before and much prostration during two weeks. Large quantities of stimulants, together with quinine and iron, and nourishing diet wre administered, and solution of chlorinate of soda was applied to the wound. The post-mortem examination revealed a large abscess extending from the wound to the hip joint and containing laudable pus in considerable quantity. There was no sign of any reparative process in the ends of the bone, and no pus was found in the lungs, liver, or spleen." 212 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TABLE XXVII. Summary of Nineteen Cases of Secondary Excision in the Shaft of the Femur for Shot Injury. [Recoveries,! 15; Deaths, 16 18; Result undetermined, 19.] NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJUUY, OPERATION, AND RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. INJURY, OPERATION, AND RESULT. 1 Allen, J. W., Pt., B, 22d Oct. 8, Left ; three ins. lower third, by 11 O Riley, P., Pt., H, 69th Sept. 17, Left: carious and necrosed tro- Indiana, age 28. Dec. 1, Surg. J. G. Hatehitt, U. S. V. New York. Oct. 22, chanter major and shaft. Dis 180-2. Anaemia. Disch it Feb. 13, 1863; 1862. charged Mar. 10, 1863 ; not pen ]>ens d ; six inches shortening. sioned. o Curtin, D., Pt., G, 47lh Feb. 20, Left ; four in. mid. third. Disch d 12 "Reid, J., Pt., G, 162d June 8, Right ; necrosis ; three ins. upper New York, age 25. July 15, June 5, 1865; peus d; lig. union New York, age 35. July 20, third, by Ass t Surg. J. Homans, 1864. only ; knee joint anchylosed ; 1863. jr., U.S.A.; Oct., "63, union firm ; shortening over seven inches. erysip. Disch d Dec. 12, 1863; 3 Dennell, W. I., Serg t, July 20, Left; troch. maj. and two inches pensd; union with deformity; E, 73d Penn., age 23. Aug. 23, necrosed shaft, by A. A. Surg. anchylosis knee joint. 18G4. M. L. Herr. Duty Jan. 10, 1865; 13 Thomas, W. C., Pt., F, May 2, Right: July 11, rein, seq.; ex. of not pensioned. 55th Ohio, age 17. Sept. 11, four ins. up. third. Disch d June 4 Duggan, T.. Corp l, M, Dec. 18, Right ; lower third : gangrene. 1863. 27, 1864; pens d; great deform. llth Illinois Cavalry, (52. Aug. Disch d April 7, 65; pensioned. and short g. Spe.c. 1686. age 19. 23, C3. July 5. 1866, amputation, junct. 14 Watts, S., Serg t, K, May 14, Right ; two ins low. thirds. Dis d lower and middle thirds. 33d Ohio, age 21. 1864. June 6, 65; pens d; shortening 5 Frazee. H. W., Pt.. L, A pi 7, 65, Left; two ins. upper thirds, by six ins., leg useless. 2d New York Heavy April , Dr. Hutchinson; ends wired. 15 Williams, J. F., I t., II, Right ; two inches upper third, Artillery, age 29. 1866. Dis d Jan. 10. 66, befo. operat n ; 26th Penn., age 25. July 2. by A. A. Surgeon H. Leaman. pcns d ; no union, limb no use. Sept. 12, Nov., 63, partial union. Must. (i Hrayson. C., Pt., F, 16th Sept. 17, R t; necro.: portion of troch. maj. 1863. out Aug. 26, 65; pens d; eight Mississippi. Dec. 22, and shaft, by A. A. Surg. A. V. inches shortening. 1862. Cherbonnier. Duty April 27, 63. Chase, J. A., Pt., B, 12th Dec. J 3, Left ; fragm ts and sharp points, 7 Haggerty, D., Pt., L, Oct. 12. Left : necrosis troch.; exc. discas d 16 Mass., age 36. 1862, two ins. in all, by A. A. Surg. 1st New Jersey Cav., 1863, portion, by A. A. Surg. J. H. Jan. 13, R. Reyburn. Jan. ]8, 19, haem age 2:i. Thompson. Must, out Sept. 22, 1863. orrhage from external circum 1864 ; applied for pension Dec., flex artery. Died Jan. 19, 1863. 1864, not heard from since. Spec. 1021. 8 ITosay. J., Pt., B, 9th July 4, Left ; three ins. mid. third, by A. 17 2 McElroy, J., Pt.. E, June 6, Right ; bone united ; refract, by Missouri. 63, Mar. A. Surg. A. Sterling. Prison, 35th Iowa, age 38. Oct. 26, fall; three ius. mid. third, Surg. 8, 64. Nov. 4, 1864. 1864. F. N. Burke. U. S. V. Died Nov. n Houghton.D. F., Corp l, Dec. 13, Left ; caries : six ins. up. third, by 23, 1864, pyamiia. Autopsy. E, Kith Maine, age 21. 62, Aug. Surg. C. Alexander, 16th Maine. 18 3 Unknown, Pt., New June 27, Left; five and a quarter inches 6,. 63. Disch d May 15, 1863, pens d; Jersey, age 22. Aug. 10, mid. third. ~8 pieces, by !>r. shorten g six ins., stiff, open. 1862. Merritt. Died Aug. 10, 1862. 10 Millhousp J., Serff t Iv Sept. 20 T pft two nrirl \ linlt ins mifldle 1!) Unknown . . Excis n of trair t ami small 7:id Illinois, age 31. Dec. , "third. Disch d April 30, 1865; 1862. portion of shaft partly necrosed. 1863. pens d ; bone carious, very lame. Result unknown. Spec. 396. Excisions in the Shaft of the Femur at an Unknown Period after Shot Injury. The seventeen cases of this group are enumerated in the following table: TABLE XXVIII. Seventeen Cases of Excision in the Shaft of the Femur after Shot Injury; time of Operation not known. [Recoveries, 1 7; Deaths, 8 16; Result unknown, 17.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Grauaz, F., Pt., D, 1st Dec. 13, Left ; two ins. mid. third. Dis d 8 Baker, R., Lieut., A, 9th Nov. 25, Left; three ins. and small frag Penn. Rifles, age 38. 62, . Aug. 20, 1863; subsequently en Mississippi, age . 63, . ments middle third; diarrhoea. listed in V. R. C. Dis d June 4, Died Jan. 2, 64 ; pyasm. Autop. 65. and pens d: union complete. 9 Bartholomew, G., Pt., E, May 8, Right : fractured parts mid. third, Not heard from since Mar. 4, 68. 8th Missouri, age . 62, . by Surg. I). W. Hartshorne, U. 2 Hiatt, H. H., Pt., B, Aug. 31, Right ; three ins. Disch d Oct. 20, S. V. Died May 20, 1862. 19th Indiana, age 19. 62, . 63; pens d. Atrophy; three ins. 10 Bowman, W. H., Pt., I, Jfov. 24, Left ; lower third, ends sawn off; short g ; auchy. of knee and hip 78th Illinois, age . 63, . pyicmia. Died Dec. 22, 1863. joints. Died Mar. 21, 71 ; gen 11 Furgerson, N., Pt., G, Nov. 23, Right ; low. third, ends sawn otf. eral debility and prostration. 6th Indiana, age . 63, . Died Jan. 18, 1864; exhaustion. 3 Holbrook, S., Pt., 1st N. Dec. 13, Right; up. third. Disch d Dec. 17, Autopsy. H. Battery, age 22. 6 63; pens d: bone discharging: 12 McHarper, P., l>t., H, Left. Died June 6, 1864. can do light work. 12th Miss., age . 4 Murphy. E. A., Serg t, Mar. 31, Left; two ins. middle third ; ball 13 iMaines, R., I t., F, 70th May 5, Loft. Died May 31, 1862. C, 2d New York Mt d 65, . extracted. Disch d Oct. 11, 65; New York, age 30. 62, . Rifles, age 23. pens d; short g three and a half 14 Thompson, J. S., Pt., H, Nov. 24, Right; middle third, rough ends ins.; anchy. knee joint ; necrosis. llth Tenn., age . 63, . sawn off. Jan. 14, 1864, haein. 5 Nelson, J., Pt., H, 51st Sept. 3, Right ; two ins. one side of upper from profunda art y. Died Jan. Ohio, age 21. 64, . third; gang., car, necro. Uis h 19, 1874. Autopsy. July 29, 65; pens d: bone dis 15 Woolf, T., Pt., A, 125th Sept. 17, Left. Died Jan. 25, 1863. eased; one and a half ins.short g; Pennsylvania, age . go anchy. of knee joint. 16 Yocum, J. P., I t., A, Nov. 24, Left; upper third, ends sawn off. 6 Shannon, A. J., Pt., F, April 20, Left. Retired February 9, ]865; 89th Illinois, age . 63, . Dec. 19, pyaemia. Died Dec. 20, 35th N. C., age 33. 64, . limb entirely useless. 1863. Autopsy. 7 Woolton. A.. Pt. A 15th Aug. 28 T?*^*- ir\n-*.*Vi;./-i !?+;/} Ton 17 Debuck J Pt. C 29th Alabama, age 26. 62, . 4,1865; shortening 2J inches. Tennessee, age . Je. 1, 64. chanter major. Result unknown. 1 HOMANS (J., jr.), Resection of Three Inches of the Upper Third of Femur, in Am. Med. Times, 1864, Vol. VIII, p. 65. 2 DORRAN(W. M.), Tivo Cases of Gunshot Fract. of Upper Third of Femur, Treated Conservatively, in Med. Record, 1866-67, Vol. I, Case II. p. 467- 3 MEKRITT ( ). Compound C lmminntfd Fracture nf FrinitrEmrdimi. in .\ni. Mol. Times, 1863, Vol. VI, p. 247. 4 PRAY (O. M.), Reports of Hospitals, in Am. Med. Times. li?62, Vol. V, Case III, p. 76. SECT. III.] AMPUTATIONS IN THE SHAFT OF THE FEMUR. 213 The seventeen cases in which the time between the reception of the injury and the operation could not be ascertained comprise eleven Union and six Confederate soldiers. In eleven instances the length of the excised portion of the femur wa.s not indicated; in three instances two inches, and in three, three inches of bone were removed. Summing up the one hundred and seventy-five cases of excision in the shaft of the femur, it will be seen that the operations were performed in the upper third in seventy-six instances, including nine cases in which the operation extended into the middle third of the femur. Of these seventy-six cases twenty-five recovered, forty-nine proved fatal, and in two the result remained undetermined, a mortality of 66.2 per cent. Of the fifty-nine excisions in the middle third of the femur, the final issue could not be ascertained in one case; eighteen were followed by recovery, and forty by death, a death rate of 68.9 per cent. The seventeen operations in the lower third include five recoveries, eleven deaths, and one undetermined result, a fatality of 68.7 per cent. The twenty-three operations with undefined seat of fracture include sixteen deaths, three recoveries, and four undetermined cases, a mortality of 84.2 per cent. In six of the one hundred and seventy-five cases of excision in the shaft of the femur recourse was had to subsequent amputation of the thigh, and in one, to exarticulation at the hip. 1 Further observations on excisions in the shaft of the femur will be reserved for the concluding remarks of this section. AMPUTATIONS IN THE SHAFT OF THE FEMUR. On page 169, ante, the total number of cases of amputations of the thigh to be considered in this section was stated as 6.238. Of these, 9 were performed for shot contusions of the femur, 2,900 on account of shot fractures of the shaft of the femur, and 3,329 for immediate or remote results of shot fractures of the knee joint, leg, ankle joint, or foot. The nine operations for complications following shot contusions of the shaft of the femur have been detailed at page 173, and there remain to be noticed 6,229 cases as indicated in the following table: 2 TABLE XXIX. Numerical Statement of Sixty-two Hundred and Twenty-nine Amputations of the Thigh for Shot Injury. OPKUATIOXS. TOTAL. UFPEK THIUD. MIDDLE THIRD. LOWER THIRD. SEAT UNRECORDED. o> s o Recovered. -a D s Undetermined. Ratio of Mor tality. Recovered. 3 o 5 Undetermined. Ratio of Mor tality. Recovered. d 5 Undetermined. Ratio of Mor tality. Recovered. i 3 Undetermined. Ratio of Mor tality. Recovered. d o 3 Undetermined. o S x jl K 3,949 1,320 442 1,958 479 239 1,943 841 203 48 49.8 63.7 45.9 260 50 ^o 268 97 T 5 50.7 66.0 45.4 686 205 102 463 266 fifi 8 40.3 56.4 39.2 46.0 973 217 107 37 927 459 100 61 14 6 48.7 67.9 48.3 62.2 39 7 80 285 19 212 21 19 87.9 73.0 100.0 72.6 Intermediary Time between injury and operation not stated 518 163 323 32 66.4 12 63.6 34 29 7 6,229 2,839 3,310 80 53.8 352 411 5 53.8 1,027 824 15 44.5 1,334 1,547 20 53.6 126 528 40 80.7 1 The oases of XXIII, p. 2()<>) ; Cori Indiana Cavalry, rec Collar, F, 4. r ,th Illino xcision in the shaft of the femur followed by amputation of the thigh are : Private J. Becht, B, 7th Maryland, fatal (CASE 3, TAISLE .nil J. W. Soule, D, 6th Michigan Cavalry, fatal (CASE 418, p. 205, and CASE 51, TA1U.E XXIII, p. 206); Private S. C. Hall, P, 3d >very (CASE 3, TAHLK XXV, p. 208); Sergeant J. Burroughs, B, 3d Kentucky, fatal (CASE 7, TABLE XXVI, p. 210); Private C. s, fatal (CASE 8, TAUI.E XXVI, p. 210); and Corp l T. Duggan, M, llth Illinois Cavalry, recovery (CASE 4, TAULE XXVII, p. 212). In the case of I,. Carroll, H, 1st Delaware (CASE 298, p. 139, and CASE 11, in TAULE XXIII, p. 206), the excision in the shaft of the femur was followed by an unsuccessful exarticulation at the hip. 2 Adding to the 6,229 cases recorded in this Table the 9 cases of amputation in the thigh following shot contusions of the femur, the 2 operations cited at page 8, ante, for complications following deep incised wounds, and the 131 amputations tabulated at page 54, ante, following shot flesh wounds of the lower extremity, we have a total of 6,371 recorded cases of amputation of the thigh performed for injuries Inflicted by weapons of war in the American civil war. 214 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. As indicated in the Table, the result as to fatality remained undetermined in only eighty of the six thousand two hundred and twenty-nine cases; twenty-eight hundred and thirty-nine were followed by recovery, and three thousand three hundred and ten by death, a mortality of 53.8 per cent. This exceeds the fatality in cases of shot fractures of the femur treated by conservation (49.9 per cent., see page 176, ante) by 3.9 per cent., while it is 15.6 per cent, less than the ratio of deaths after excisions in the shaft of the femur (69.4 per cent., see page 200, ante). It will also be observed that of the amputations in which the time between the injury and the operation could be definitely ascertained, the primary are by far the most numerous. The sixty-two hundred and twenty-nine amputa tions were performed on sixty-two hundred and nine patients, twenty being double opera tions. In three cases both thighs were removed at the middle thirds; ten ablations of both thighs were performed in the lower thirds; in one case the point of amputation in tlie right thigh was not stated, while the left thigh was amputated in the lower third, and in six instances of amputation of both thighs the thirds were not indicated. 1 In fourteen of the twenty double thigh amputations both operations were primary; in two, both inter mediary; in one, the operation in the right thigh was a primary, and in the left thigh an intermediary; in one, the amputation in the right thigh was a primary, and in the left thigh a secondary; and in two instances the periods of the operations were not recorded. In twelve cases the ablation in the thigh was accompanied by an amputation of the opposite limb, viz: in three, by amputations at the knee joint; in eight, by amputations in the leg; and in one, by an amputation at the ankle joint. 2 PRIMARY AMPUTATIONS IN THE SHAFT OF THE FEMUR FOR SHOT INJURY. According to the plan indicated on p. 697 of the /Second Surgical Volume, the cases in which the operation was practised within forty-eight hours subsequent to the reception of the injury have been classified as primary amputations. Three thousand nine hundred and forty-nine of the six thousand two hundred and twenty-nine amputations in the shaft of the femur belong to this group. In forty-eight instances the results were not ascertained; nineteen hundred and fifty-eight were successful, and nineteen hundred and forty-three were fatal, a mortality of 49.8 per cent. Primary Amputations in the Upper Third of the Femur. -Five hundred and thirty- three of the thirty-nine hundred and forty-nine primary amputations in the shaft of the The throe instances in which both thighs were removed in the middle thirds are: Sergeant T. Doud, 2d Michigan, primary operations, fatal: Corporal J. W. Woodworth. II, llth Michigan, primary operations, fatal; Private S. Bagley, B, 5th New Hampshire, right, primary, left, secondary operation, fatal (Spec. 4232, A. M. M.). Tlie ten instances of ablations of both thighs in tin; lower thirds are: Corporal M. Dunn, II, 40th Pennsyl vania, primary operations, recovery (Spec. 3193, A. M. M.); Private E. G. Rush, 21st Georgia, primary operations, recovery (see Surg. Phot. Scries, Nos. 132, 133, and Cont d Photo s, Vol. :j. p. 36, and Spec. 3998, A. M. M.): Private S. Allen, G, 59th Massachusetts, primary operations, fatal: Private U. S. Michael, A, 105th Pennsylvania, primary operations, fatal; Private D. Nicholson, II, 23d Massachusetts, primary operations, fatal (Spec. 2966, A.M. M.); Sergeant E. C. Rabbit, 15, 10th Missouri, primary operations, fatal; Private J. Stewart, D, 77th New York, primary operations, fatal ; Lieutenant J. Whelpley, D, 1st Maine, primary operations, fatal; Private D. Wallace, I, 5th Artillery, intermediary operations, fatal (Specs. 1383. 1384, A. M. M.); Pt. J. Moore, E, 46th Pennsylvania, intermediary operations, fatal. In the fatal case of Private W. F. Mills, E, 8th New York Heavy Artillery, the point of the primary amputation in the right thigh was not recorded, the operation in the lower third of the left thigh was an intermediary. The six instances in which the points of ablation were not stated are: Pt. S. Goodwell, G, 29th Illinois, primary operations, fatal ; Pt. If. Kenncr, 4th Virginia, primary operations, fatal; Pt. C. Myer, F, 3()th Missouri, primary operations, fatal; Pt. H. Tieman, 0, 119th New York, primary operations, fatal; Pt. ./. A. Parker, L, Cobb s Legion Cavalry, time of operations not stated, recovery; Pt. G. Nune.nger, A, 58th Virginia, time of operations not stated, fatal. 2 The three cases of amputation of the thigh and of exarticulation at the knee of the opposite limb are : Corporal C. N. Lapham, K, 1st Vermont Cavalry, amputation of right thigh in middle third and of loft leg at the knee joint, primary operations, recovery (see Surf/. Photo s Scries, Nos. 154. 155); Private J. Barker, I, 58th Massachusetts, amputation of right thigh in lower third and of left leg at knee joint, primary operations, fatal; Private II. Smith, I, 14th New Jersey, amputation of right thigh in lower third and of left leg at the knee joint, primary operations, fatal. Tho eight cases of amputations in the thigh and ablations of the opposite leg are: Private S. Banks, C, 43d Colored Troops, primary amputations in middle third of right thigh and lower third of left leg, fatal; Private L. Johnson, B, 1st Tennessee, primary amputations of left thigh in lower, and right log in upper third, fatal; Private L. O. Lamphere, G, 21st Connecticut, Sergeant P. Bradley, C, 16th Michigan, and Private J. K. Lewis. II, 53d Georgia,, primary amputa tions in left thighs in lower thirds and of right legs in lower thirds, fatal ; Sergeant J. Foss, C, 59th New York, primary amputations of thigh and leg, thirds unknown ; II. Housley, F, 33d Wisconsin, amputation of right thigh in lower third and of left leg in upper third, intermediary operations, recov ery; Private H. Brown, K, 2 Jd Colored Troops, primary amputation of right leg in upper third, and secondary amputation of left thigh in lower third, recovery ; Lieut. A. Birmingham, A, 69th New York, primary amputation of right thigh in lower third and of left foot at ankle joint, fatal. SECT, in.] PRIMARY AMPUTATIONS IN THE SHAFT OF THE FEMUR. 215 femur were practised in the upper third of the thigh. The result was determined in all but five cases. Two hundred and sixty patients recovered after the operation, and two hundred and sixty-eight, or 50.7 per cent., died. The right thigh was amputated in two hundred and forty-nine, and the left in two hundred and thirty of the four hundred and seventy-nine instances in which this point was recorded. A few successful and fatal exam ples will be detailed, and all cases of primary amputation in the upper third of the thigh will be enumerated in TABLE XXX. Successful Cases of Primary Amputations in the Upper Third of the Thigh. The two hundred and sixty operations of this category were performed on two hundred Union and on sixty Confederate soldiers. It was impracticable to ascertain the subsequent his tories of the Confederate soldiers. Of the Union soldiers, one officer was retired and one hundred and ninety-nine men were pensioned, and it appears from the records of the Pen sion Office that one hundred and ninety-three of the survivors after primary amputation in the upper third of the femur were living in September, 1879. One had died from chronic diarrhoea, two from consumption, the result of the injury and the operation, and in four cases the cause of death was not reported: CASE 427. Lieutenant-Colonel R. Avery, 102d New York, aged 24 years, received a shot fracture of the upper third of the right thigh, at Lookout Mountain, November 24, 1863. He entered the field hospital of the 2d division, Twelfth Corps, where the injured limb was amputated by Surgeon C. H. Lord, 102d New York, who reported as follows : "This case of ampu tation at the upper third of the thigh is of interest from the fact that the patient had recently returned to duty from hospital, where he had been since receiving a severe wound of the face and neck at Chancellorsville, May 3, 1863. His general health was poor, yet he underwent the operation well, and at the date of this report, December 2d, he is getting along finely. The flap has closed completely for nearly two inches anteriorly, and every indication points to a speedy recovery. Dry dressings have been used entirely." TJie patient was subsequently transferred to hospital at Bridgeport, and afterwards to Nashville, whence he proceeded to his home on leave of absence. Lastly he entered the Annapolis Hospital, and on June 27, 1864, he was discharged from service. In the following year he was re-appointed as an officer of the Veteran Reserve Corps, and on December 31, 1870, he was retired from active service. In a communication from Dr. H. E. Goodman, late surgeon U. S. V., the amputation was described as having been performed "at the great trochanter." During January, 1866, Colonel Avery, who was then serving on duty at the office of the Commissary General of Prisoners, visited the Army Medical Museum, being quite well and in good health, and the stump, though aft ected with neuralgia, having been healed for more than a year previous. This officer s name appears on the retired list in 1879. CASE 428. Private T. E. Gay, Co. H, 9th Ohio Cavalry, aged 19 years, was shot in the left thigh while on guard duty, at Cypress Creek, April 22, 1864. The nature of the injury was reported by Surgeon C. M. Finch, of the regiment, as follows : " The wound was the result of an accident, the missile, a carbine ball, entering the knee joint at the external condyle, passing upward and comminuting the femur to the upper third, at which point the limb was amputated. From present indications (eight days after the accident) the man will recover." One month after the reception of the injury the patient was transferred to hospital at Nashville, subsequently to Louisville, and lastly to Camp Dennison. Surgeon C. McDermont, U. S. V., in charge of the latter hospital, reported that "the patient was admitted June 21st in good general health, but in his transfer he sustained a severe contusion of the stump by a fall. On the following day the stump presented a gangrenous appearance, which was checked by the application of a solution of bromine. Subsequently dressing of basilicon ointment was applied, under which it rapidly improved and threw out healthy granulations." The patient was furnished with an artificial limb, seven months after the recep tion of the injury, by the firm of Douglas Ely, and on November 17, 1864, he was discharged from service and pensioned. In his application for commutation, in 1870, the pensioner mentions that Assistant Surgeon John C. Thorpe, 9th Ohio Cavalry, performed the amputation. Examiner J. W. Long, of Bryan, Ohio, May 7, 1873, certified to "amputation of left leg four inches below the upper point of the trochanter major; muscles very much atrophied, the bone being covered by nothing but the skin and fascia up to the trochanter. He has no power in the stump, etc." The pensioner was paid September 4, 1879. CASE 429. Private J. H. Judd, Co. C, 86th New York, aged 18 years, was wounded in the right thigh, before Petersburg, September 11, 1864. He was admitted to the field hospital of the 3d division, Second Corps, whence Surgeon J. S. Jameson, 86th New York, described the injury as "a compound fracture of the femur at the middle third, caused by a musket ball," and reported that he "amputated the limb at the upper third." The patient was subsequently transferred to City Point, and three weeks after the date of the operation he was moved to hospital at Alexandria, whence Surgeon E. Bentley, U. S. V., described (In- amputation as an "antero-posterior flap operation." The patient was ultimately transferred to Judiciary Square Hospital, Washington, and discharged from service January 13, 1865, and pensioned. Previous to leaving the hospital he was supplied with an artificial limb by the Jewett Patent Leg Company, of Washington, D. C. In his application for commutation, dated 1870, the pensioner represented the stump as being in a sound condition, but reported the artificial leg as having be<Mi unsatisfactory. Examiner F. R. Wagner, of Addison, N. Y., April 15, 1874, certified to " amputation about two inches below the trochanter minor, leaving the stump so short that an artificial limb cannot be worn." The pensioner was paid June 4, 1879. The specimen, No. 410, Army Medical Museum, consists of the middle third of the shaft of the injured femur. It was contributed by the operator. 216 INJURIES OF THE LOWER EXTREMITIES. ICHAP. x. CASE 430. Private A. Tarcott, Co. H, 94th New York, aged 18 years, was wounded at Fredericksburg, December 13, 1862, and admitted to the field hospital of the 2d division. First Corps. Surgeon C. J. Nordquist, 83d New York, noted: "Gun shot wound; right leg amputated ahove knee/ Two weeks after the injury the wounded man was conveyed to Washington, where he entered Trinity Church and subsequently Judiciary Square Hospital. On June 11, 1803, he was transferred to Central Park Hospital, New York City, whence Acting Assistant Surgeon G. F. Shrady contributed to the Army Medical Museum a cast of the stump (Spec, 1:573), taken nine months after the amputation, with the following history: "According to the patient s account the lower portion of his right thigh was almost completely carried away by a grapeshot, and a great deal of haemorrhage fol lowed the injury. Amputation at the upper third by the long posterior tlap was performed, on the day following the injury, by Surgeon G. W. Avery, 94th New York. There was an attack of gangrene of the stump in the latter part of April, and the patient has suffered from necrosis of the femur. When admitted FIG. 175. Stamp of right to this hospital the stump was entirely healed." Two months later the patient was furnished with an putation. Spec. 1373. artificial limb by E. D. Hudson, of New York City, and on Novemter 15, 1863, he was discharged from service and pensioned. Examiner C. M. Johnson, of Watertown, New York, certified, May 7, 1873: "The stump is only three inches in length, tender and painful; the extremity of the femur being covered only by integument. He uses an artificial limb occasionally only." The pensioner was paid September 4, 1879. Fatal Cases of Primary Amputation in the Upper Third of the Thigh. There were two hundred and sixty-eight cases of this group. Two hundred and thirty patients were Union and thirty-eight were Confederate soldiers. Gangrene supervened in eight, pyaemia in -thirty, and tetanus in four instances. In the following case the femur was fractured in its upper third: CASE 431. Private W. H. Croyle, Co. H, 55th Pennsylvania, aged 21 years, was wounded at Petersburg, June 16, 1864, and was admitted to hospital at Fort Monroe four days afterwards. Assistant Surgeon E. McClellan, U. S. A., reported: "Gunshot fracture of right femur, upper third. Amputation was performed in the field on the day of the injury, chloroform being used." On August 27th, the patient was transferred to DeCamp Hospital, David s Island, New York Harbor, whence Assistant Surgeon W. Webster, U. S. A., reported that the stump was still unhealed, and that the patient was a sufferer from chronic diarrhoea, from the effects of which he died September 7, 1864. In the next two cases primary amputation in the upper third of. the femur was per formed for fractures in the middle third: CASE 432. Private M. H. Bartlett, Co. D, 4th Vermont, aged 19 years, was wounded at Funkstown, July 10, 1863, and entered the General Hospital at Frederick two days afterwards. Acting Assistant Surgeon C. M. Martin reported the injury and its result as follows : "A minie" ball entered the outer side of the left thigh about the middle third and passed directly through, breaking the bone. Amputation in the upper third was performed on the field by the circular method. When admitted to this hospital there was partial union of the flaps, and granulation was progressing. Cold-water dressings were used. The patient was in good spirits and seemed to be doing finely until July 29th, when I saw a change for the worse, his pulse being low and quick. I then ordered pills of iron and quinine to be given three times a day, also full diet. Two days afterwards he had a slight chill and appeared rather weaker, the stump not looking healthy and the granulations very pale and flabby. Ten drops of nitric acid diluted in an ounce of water was then ordered to be applied once a day, and the pills were continued, with one ounce of whiskey every three hours. On the next day the patient was gradually sinking, and on August 2d, he had a severe chill in the morning. Death supervened at 9.30 A. M. on August 3, 1863. At the post-mortem examination, three hours after, the lungs, heart, spleen, and kidneys were found to be healthy, but the liver was highly congested. On removing the remaining portion of the femur considerable callus was discovered to have been thrown out, and in dissecting the muscles I found two circumscribed abscesses, each containing about half an ounce of pus." The upper portion of the femur was contributed to the Museum by Dr. Martin, and is numbered 3887 of the Surgical Section. CASE 433. Private F. Ward, Co. G, 45th Colored Infantry, was accidentally shot in the left thigh, near Fort Harrison, February 7, 1865. The nature of the injury and its result were recorded by Dr. N. Folsom, Regimental Surgeon, as follows : "A conical musket ball, fired at a distance of about three hundred yards, entered the outer aspect of the limb about the middle, fractured the femur, and, splitting in two, passed out on the inner aspect lower down. There were two orifices of exit, and two more pieces of the ball were found in the wound. The man was admitted to hospital within six hours after the injury. The loss of blood was estimated at a pint and a half, and the boije was found extensively comminuted, there being twenty-six frag ments. Amputation by the circular method, at the junction of the upper and middle thirds of the bone, was performed under ether, three ligatures being applied and six sutures. Stimulants were freely exhibited, with beef tea, through the night. The case progressed well until forty-eight hours after the operation, when the patient was suddenly attacked with violent pain in the stump, and, the dressing being removed, adhesion was found to be quite extensive. The sutures were then removed and a finger gently introduced at the middle of the wound for one and a half inches, and relief was afforded by giving one-fourth of a grain of morphia. Wet lint covered with oiled silk was now applied, and the adhesions gradually gave way during the week follow ing. Granulations appeared over about one-third of the surface, but were pale and inactive. The patient took tincture of chloride of iron, fifteen drops three times a day, and good diet and stimulants. Poultices were applied after the fourth day, but suppuration was at no time profuse. Considerable pain and tenderness of the other leg was also complained of. The pulse gradually rose from 100 to 130, and fell in strength. After the seventh day the patient s tongue became dry and brownish. He died on the twelfth day, February 19, 1865." SECT. III.) PRIMARY AMPUTATION OP THIGH IN UPPER THIRD. TABLE XXX. Condensed Summary of Five Hundred and Thirty-three Cases of Primary Amputations in the Upper Third of the Femur for Shot Fractures. [Recovery, 1-260; Death, 261-528; Kesult unknown, 529-533.1 NO. NAME, MILITARY DESCRIPTION , AND AGK. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGK. DATES. OPERATIONS, OPERATORS. RESULT. 1 Abey, J., Corporal, B, Oct. 19, Left ; circular; Surg. R. Barr, 67th 41 Cozad, II. J., Pt., A. June 2, Right ; Surgs. G. S. Walker and 67th Penn . age 20. 20, 64. Penn. Disch d May 8. 1865. 6th Missouri. 2, 61. W. F. McChesnev, 6th Missouri. o Allen, \V. G., Capt., F, Mar. 20, Right ; Surg. A. Sabine. 76th Ohio. Disch d June 16, 1862. 20th Iowa, age Ii8. 20, 65. Mustered out June 6, 1865. 42 Congdon, J., Pt., II, June 2!. Left ; circular: Surg. A. K.Fifield, 3 Amos, 1\ .l/..Pt.,D, 45th July 7, Lett. Prison, December 4, 1864. 30th Ohio, age 21. 24, 64. 29th Ohio. Disch d July 19, 65. North Carolina, age 27. 7, 64. 43 Crawford. G. W., Lieut., July 14, Flap. Discharged Feb. 17, 1864. 4 Atchinson, J. N., Pt., F. Aug. 27, Right ; circular; Aug. 31st, haem., F. 6th Michigan Cav. 14, 63. 2d New Jersey, age 28. 27, 62. lig. femoral. Disch d June 3, 63. 44 Cribb, D. W. i"., Pt., F, May 12, Left; Surg. Gelks, 26th Georgia. 5 Atwater. T. J., Pt., C, Nov. 18, Left; flap; Confederate surgeon. 23th Georgia. 13, 64. Recovery. 112th Illinois. 19, 63. Disch d Feb. 17, 1864. 1 45 Criss, S. G.. Pt., A, 7th May 24, Right; flap; Surg. D. W. Maull. 6 Avery, II.. Lt.Col., 102d Nov. 24, Right; flap; Surg. C. II. Lord. West Virginia, age 19. 24, 64. 1st Del. Disch d May 27, 1865. New York. 25, 63. 102d N . Y. Disch d J une 27, 64. 46 Crowley, D.. Pt., F, 25th Sept. 17, Right. Discharged. 7 Babcock, J. P., Pt., D, May 14, Right: circular. Disch d Ma} New York, age 35. 17, 62. 18th Ohio, age 24. 14. 64. 20, 1865. 47 Cue, E., Pt., F, 97th Sept. 17, Right ; flap. Disch d May 15, 63. 8 Barker, D., Serg t, K, April 18, Left; flap. Disch d June 29, 1863. New York. 18, 62. 10th Illinois Cavalry. 18, 03. 48 Curtis, E. I)., Serg t, I, July 2, Right ; flap. Disch d February 9 Barnes, S., Pt., B, 12th Oct. 3, Right. Disch d April 6, 1863. 1st Penn. Res., age 25. 3, 63. 3, 1864. Illinois. 5, 62. 49 Dart, E. S., Pt., G, Sth June 16, Left. Discharged Oct 18. 1862. 10 Barrett, G. W., Serg t, Aug. 9, Right ; circular. Disch d Oct. 27, Michigan. 17, 62. 1, 7th Ohio. 11, 62. 1862. 50 Davis, S. M., Pt., A, July 1, Left; Surg. Mitchell, C. S. A. 11 Barton, G., Lieut., D, Dec. 13, Right; circular. Disch d April 16, 24th Georgia. 1, 64. Recovered. 81st Pennsylvania. 13. 62. 1863. 51 Dailey, P., Pt., G, 140th May 5, Right; flap; Confederate surgeon. 12 Bassett, \V., Pt., A, Sept. 17, Left ; flap. Disch d Dec. 1, 1862. New York, age 29. 6, 64. Disch d June 11, 1865. lllth Pennsylvania. 17, 62. 52 Dana, D. Z., Pt.. B, 60th June 15, Right ; circ.; Surg. H. P.. Whiton, 13 Bauer, A.,Serg t,A,102d June 27, Left; circ.; Surg. A. K. Fifleld, New York, ago 35. 15, 64. 60th N. Y*. Disch d Jiar. 7. 65. New York, age 21. 27, 64. 29th Ohio. Disch d Nov. 22, 64. 53 Dean, U. H., Pt., Pro July 18, Surgeon Gleeves, C. S. A. Re Spec. 2:i28. vost Guard. 20, 63. covered. 14 Bedell. 11. E., Lieut., D, Sept. 13, Left ; Surg. C. B. Park, llth Ver 54 Dell, F., Pt., F, 70th May 1, Right; Ass t Surg. J. Ash. 70th llth Vermont. 13, 64. mont. Disch d Feb. 20, 1865. New York, age 21. 2, 62. N. York. Disch d Oct. 13. 62. 15 Beaver, J. A.. Colonel, Aug. 25, Right ; circ.; Surg. J. W.Wishart, 55 Delcher, P., Pt., K, 3d May 16. Left; flap; Confederate surgeon. 148th Pennsylvania. 26, Ii4. 140th Penn. Disch d Dec. 22, 64. N. Y. Cavalry, age 42. 16, 64. Disch d March 8. 1865 16 Bell, J., Serg t, D, 150th Mar. 19, Right ; flap ; Skey s operation ; 56 Dermock, T.. Pt., B, 7th Oct. 8, Left; flap : Surg. G.C. Jarvis, 7th New York, age 28. 19, 65. Surg. C. M. Campbell. 150th N. Conn., age 27. 8, 63. Conn. Disch d Dec. 24. 1863. York. Disch d Oct. 1 3, 1865. 57 Donohue, J.S.,Capt., A, May 6, Left ; circ.; Surg. VV. B. Fox, 8th 17 Benedrum, C. W., Pt.. G, July 1, Left. Recovered. 8th Michigan, age 27. 7, 64. Mich. Disch d ^ept. 28. 18.i4. 17th Virginia Cavalry. 1, 63. 58" Downs. T., Pt., F. 88th Sept. 17, Right ; Surg. F. Reynolds, 88th 18 Benninghoff, F., Corp l, Nov. 22, Right ; flap ; Surg. A. Sabine, 76th New York, age 38. 17, 62. N. Y. Sept. 29th, ham., fern. B, 1st Mich. Artillery, 22, 64. Ohio. Disch d June 18, 1865. tied. Disch d March 13, 1803. age 28. 59 1 Duncan. M. I , Serg t, Oct. 26, Right: eiro. ; Surgs. Coleman and 19 liine, J., Pt., J, Stuart May 2, Right ; Surg. Randolph, C. S. A. G, 21st Virginia. 27, 63. Fleming, C.S. A. Fur. Jan. 11. 64. Horse Art y. age 43. 2, 63. Furloughed June 11, 1863. 60 Dunlap, I. N., Pt., I, Feb. 15. Left ; flap ; Surg. C. Goodbrake, 20 Birt. W. T.. Corp l, D, May 22, Left; circular; Surg. 11. 7j. Gill, 17th Illinois. 15, 62. 20th 111. Disch d .Mar. 2?, 1862. 47tli IWnois. 22, 63. U. S. V. Disch d Sept. 23, 1863. 61 Dunham, C. R., Pt . II, June 3. Riffht ; circ.; Surg. A. A. White, Died October, 1863; diarrhoea. 1st Maryland, age 30. 3, 64. 8th Md. Disch d Mar. 30. 1865. 21 Boden, E. G., Pt., A, 1st May 5, Right; circular. Disch d August 62 Emmitt. J.. Serg t, C, July 30, Left ; Surg. C. H. Ladd, C. S. A. Vermont, age 19. 5, 64. 30, 1865. 56th North Carolina. 30, 64. Recovery. 22 Brannagan, \V r ., Pt., II, Julys, Left ; flap. Veteran Res. Corps 63 Eveland, J., Pt., E, 7th Oct. 4, Right. Jan. 15, 1863, loose skin 70th New York, age 21 . 4, 63. Dec. 31, 1863. Illinois. 4, 62. cut off. Discharged. 23 Brown, A. P., Serg t, K, June 18, Right; flap; Surgs. W.P. Pierce, 64 Frrguson. S ,Pt., D, 14th Sept. 17, Left; Surg. Tracy. C. S. A. Re 7-lth Illinois, age 2(i. 18, 64. 88th 111., and 11. E. Hasse. 24th N. Carolina, age 28. 18, C2. tired March 1(5. 1865. Wis. Disch d Oct. 28. 1864. 65 Finn. T. Lilut., D, 7th J une 3, Left; circ.; Surg. D. W. Maull. 24 Brown, C. E., Lt. Col., July 22, Left ; flap ; Surg. A. B. Monohan, West Virginia, age 21. 3, 64. 1st Del. Disch d Dec. 19, 1864. 63d Ohio, age 30. 23, 64. 63d Ohio. Disch d July 8. 18 >5. 66 Fisher, II. J., Pt., K, Mar. 16. Left; flap: Surg. W. Hamilton, 25 Bruck, T., Capt., F, Sth June 8, Left : Drs. Allen, Davis, and Her 102d Illinois, age 24. 16, 6."). 102d 111. Disch d June 14, 1865. New York. 10, 62. ald. C. S. A. M. O. Apr. 2:!, ii.3. 67 Fisher, J. A., Serg t, E, Aug. 9, Right: Surg. Waddell, C. S. A. 26 Bryant, E. A., Musician, July 30, Right ; circular. Disch d Oct. 18, 52d Virginia. 10. 62. Disch d Oct. 7, 186, . C, 4thN.Hamp..age24. 30, 64. 1864. 68 2 Fischer. F., Lieut., K, May 19, Right ; circular. Disch d Deo. 27 Butler. G., Pt., 31st Mis July 20. Right ; circular. To Provost Mar 47th Ohio, age 26. 20, 63. 15, 1863. sissippi, age 2d. 20, 64. shal Dec. 1, 1864. 69 Fisher, J., Lieut.. K, 17th Oct. 28, Left; Surg. Fountain. 2d Ala. 28 Bull, H., Pt.. K, 7th Nov. 28, Right: circ.; Surg. G. W. New, Indiana, age 24. 28, 64. Cav. Disch d May 15, 1865. Indiana, age 24. 28, 63. 7th Ind. Disch d April 1.1864. 70 Fitzgerald, P.,rt., A, 7th June 18, Left : circular. Disch d May 25, 29 Campbell, J., Pt.. T,. 2d Sept. 29, Right; flap. Disch d July 10. 65. Wisconsin, age 18. 18, 64. 1865. Penn. Art y, ago 24. 30, 64. 71 Fit:Uufjh, H., Lieut., Antcro-interual large and small 30 Capstran, A., Pt., H, May 13, Left ; circular. Disch d October Purcell s Battery. post, flap at neck of fern.; Surgs. 98th New York, age 18. 13, 64. 18, 1864. G. R.C.Toddand Taney. C.S.A. 31 Carroll, J., Pt., 11. 25th June 1, Right. Disch d June 23, 1863. Recov d. Died two years later. New York, age 19. 2, 6J. Spec. 2400. 72 Flemming, D., Pt., D, Nov. 30, Right ; ant post. flap. To Provost 32 Carpenter, I., Pt., II, Dec. 18, Right; circular. Disch d Oct. Sth C. S.. age 27. 30, 64. Marshal March 7. 18;i5. 10 Jd New York, age 19. 18, 64. 5, 1865. 73 Foote, F. W., Lieut.. I, May 10, Left; flap: Surg Met !uire,C.S.A. 33 Carter, W. W., Pt.. I, April 2. Right ; circular. To Provost Mar 121st N. York, age 22. 11, 64. Disch d Sept. 27. 1864. 2d Tenn. Cav., age 26. 2, Go. shal May 6, 1865. 74 Foster, R., Corporal, B, April 5, Left; circular. Disch d August 34 Carter. A. L., Pt., A, Juno 27, Amp. by Surg. Evans, C. S. A. 16th Penn., age 24. 5, 65. 21, 1865. 5()th Virginia. 27, 62. Recovery. 75 Fox, J., Pt.. K, 1st Cav Aug. 10, Right; ant. post, flap: Confod. 35 Cashine. ./. //., Pt., K, April 3, Left. Released July 10, 18G5. alry, age 20. 10, 64. surgeon. Disch d July 6, 1865. Sth N. Carolina, age 30. 4. 65. Spec. 3224. 36 Cassell. R., Pt., E, 29th April 2, Right: circular. Disch d July 76 French, S. S.,Pt., I, Sth June 17, "Right; flap. Disch d July 26, 65. Col d Troops, age 38. 2, 6,1. 11. 1865. N. Hampshire, age 18. 17. 64. 37 Clarke, II. G., Corp l, A, July 2, Right: circ.; Surg. O. Munson, 77 Fry, W., Serg t, K, 123d April 2, Left; circ.; Surg. H. C. Leven- lllth N. York, age 22. 3, 63. 108th N. Y. Disch d Oct. 15, 63. Ohio, age 26. 2, 65. sacler. Sth Me." Recovery. 38 Cook, D., Pt., F, 118th Dec. 29, Right; circ. Disch d June 23, 78 Gay, T. E., Pt., II, 9th April 22, Left; flap; As t Surg. J.C. Thorpe, Ohio, age 21. 29, 63. 1865. Ohio Cavalry, age 19. 22. 64. 9th Ohio. Disch d Nov. 18. 64. 39 Cookson, R. B., Pt., B, Aug. 5, Left : flap ; Surg. E. Adams. 14th 79 Gilbert. R. r., Serg t. D, July 2, Riffht ; circ.: Asst. Surg. Ramseur, 14th Maine, age 18. 5, %2. Maine. Disch d Sept. 26. 1862. 18th Georgia, age 31. 0, *l>3. C. S. A. Exch d Nov. 12. 1863. 40 Cowger. G. M., Serg t, May 14, Left; circular. Disch d Nov. 23, 80 Golden, J., Pt,, B, 2d July 21, Left; Asst. Surg. C. J. Wilson, E, 17th Iowa. 15, 63. 1863. U. S. Cavalry. 21, 63. U. S. A. Disch d Mar, 16, 1864. 1 DAVIS ( W. A.), Case of Tetanus Recovery, in Confed. States Med. and Surg. Journal, 1864, Vol. I, No. 1, p. 8. 2 BRYAN (J.), Cases of Amputations from the Armies of the Southwest, in Am. Med. Times, 1863, Vol. 7, p. 288. SURG. Ill 28 218 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 81 ! Goodman, J. E., Serg t. Nov. 27, Left; circ.; Surg. H.E. Goodman, 123 Jones, O., Pt., C, 27th May 15, Left ; flap ; Surg. W. II. Rice. 81st D, 147th Perm., age 21. 27, 03. 28th t enn. Disch d Sept. 19, 04. Mass., age 19. 15, 64. N. Y. Disch d July 10, 1805. 82 Goodwin, W.H.,Pt.,B, Aug. 0, Left: flap. Disch d February 19, 124 Jones, S. P., Serg t, D, Dec. 13, Right: flap; Confed. surgeon. yth Missouri S. M. Cav. 0, "OJ. 1803. 121st Pennsylvania. 15, 02. Disch d Dec. 3. 1803. 83 | Grim, F. M., Pt.,F, 140th June 18. Left ; Surg. J. W. Wishart, 140th 125 Judd, J. H., Pt., C, 86th Sept. 11, Right ; ant. post, flap ; Surg. J. S. Pennsylvania, age 18. 19, 04. Penn. Disch d May 10, 1805. New York, age 18. 11, 64. Jamison, 8*ith N. York. Disch d 84 Grims, W., Pt., 1, 49th May 31, Right; circ. To prison Oct. 1, Jan. 13, 18.J5. Spec. 4110. Virginia, age 17. Jo. 1, 04. 1804. 126 Kelly, T. A., Pt.. E, 57th July 20, Left: ant. post, flap; gang. To 85 Hall, J. D., Pt., K, 1st Oct. 27, Left ; flap. Disch d June 22, "05. Alabama, age 19. 22, 04. prison Aug. 21. 1805. Delaware, age 18. 28. 04. 127 Kesslcr, M., Pt., A, 87th Oct. 17, Left; flap. Disch d July 1,1865. 8G Hall, J. W., Serg t, H, July i), Right; circular. Disch d June 7, Penn., age 46. 19, 64. (ith Kentucky, age 24. 9, 04. 18G5. 128 Key, J. J., Pt., E, 8th July 1, Right. Retired Feb. 7, 1805. 87 Hall, A., Serg t, li, 15Cd Aug. 14, Left; flap; Confederate surgeon. South Carolina, age 23. 3, 03. New York, age 26. !.->; 04. Diseh d June 23, 1805. 129 Kilbonrn, G. L., Serg t, July 2, Left; Surg. 11. B. Whiton. G"th 88 Hainos. E., Pt., I, 8th May 0, Right ; ciro.; Surg. C. Bowers, Oth C, 137th N. Y., age 25. 3. 63. N. Y. Disch d July 19, 1864. Penn. Reserves, age 23. 0, 04. Penn. Res. Disch d Jan 18, 05. 130 Kilncr. T. A.. Corp l. E, Aug. 30, Left: (lap; Asst.Surg.J. D.Gatch, 8!) Ilainliak. D. F.. Major, Mar. 31, Right ; flap. Mustered out Sept. Kith Indiana, age 3;!. 30, 62. 16th Ind. Disch d Oct. 24, 02. 4t!iN. Y.H.A., age22. 31, 05. 20. 1805. 131 Kiser, G., Serg t, G, 95th Aug. 30, Right; circ.: Surg. II. Z. Gill, 90 j BamM, S. /)., 1 t.. K, 1st Nov. 30, Right : ant. post, flap : Asst. Surg. Ohio. 31, (>>. S)5th Ohio. Disch d Aug. 20. 03. Mississippi, age 31. Dec. 1, W. E. Whitehcad, U. S. A. 132 Klein, D., Pt., C, 64th July 22, Left; ant. post. flap; Asst. Surg. 1804. Provost Marshal, May 0, 1805. Illinois, age 20. 22, 04. II. A. Mix. 04th 111. lltem.; lig. 91 llankins. D. W., Corp l, June 1, Right; double flap; Surg. J. S. Disch d Feb. 6, 1866. E, 14th New Jersey, 2, 04. Martin. 14th N.Jersey. Disch d 133 Knapp, L.,Pt., B. lllth May 18, Left; flap; Surg. W. S. Cooper, age 24. Jan. 23, 1805. New York, age 21. 18, 61. 1-^Sth N. Y. Disch d Oct. 5. 05. 92 Harrison, S.,Pt.,A,149tb May 25, Left; circ.; Surg. J. V. Kendall, 131 Knapp, D. E.,Pt.,K.05th July IS), Left: circ.; Surg. C. S. Frink, U. New York, age 25. 20. 04. 149th N. York. Reamputation. Illinois, age 21. 19. 04. S. V. Mustered out July 12, 05. Disch d July 15, 1805. 135 Langston. 6. M., Serg t, July 2, Right ; flap. Exchanged March 93 Harrington, H., Pt.. B, June 19, Right; flap; Surg. J. Chapman I, 3dS.( arolina.age37. 3, 03. 17. 1804. 123d New York, age 20. 20, 64. ]-^3dN. York. Disch d Oct. 4, 130 Lawrence, J., Pt., B, July 30. Right ; flap. Disch d April 24, 65. 1805. Spec. 580. 37 th Wisconsin. 30, 04. 94 Hartford. W. H., Serg t, June 2, Right ; circ.; Confed. surgeon. 137 Leich. J., Serg t, A, 27th Sept. 27, Right; Surg. Walker, C. S. A. A, 5th N. York, age 28. 3, 04. Disch d Aug. 7, 1805. North Carolina. 8, 03. Pvocovered. 95 Harvey, E. II., Pt., A, May 28, Right: ant. post, flap; Surg. S. 138 Lewis. W. W., Pt., K, June 10, Right ; flap ; Confederate surgeon. 7th Mich. Cav., age 111. 28, 04. R. \Vooster, 1st Michigan Cav. 95th Ohio. 11. 04. Discharged. Disch d Dec. 25, 1804. 131) Liudslcy, D.,Pt., C, 29th May 8, Right ; Surg. A. K. Fifield, 29th 96 Ilassler, J. A., Pt., II, Feb. 6, Right; circ.; Surg. F .H.LeMoyne, Ohio, age 22. 8, 04. Ohio. Disch d Jan. 9, 1805. IGtb I enn.Cav.. age 23. 7, 05. 10th Penn. Cav. Dis.Aug. G! G5. ! 140 Lock, J., Serg t, I, 2d Sept. , Right. Furloughed April 13, 64. 97 I hives. J. E., Lt. Col., April 30. Left. Mustered out June 30, 05. North Carolina. , 02. ! 12th Kansas. 30, 04. 141 Loftis, W. J., Pt., K, 5th May 27, Left ; ant. post, flap : Surgeon J. 98 Hays, Jl. F., 1 t . F, 3d Sept. 17, Left; Surg. Mayo, C. S. A. Fur- Tenn., age 22. 27, 04. Sympson, 24th Ky. Disch d \ irginia. 17, u 2. loughcd Oct. 30, 18G3. May 0, 1805. 99 II;;flen, Jr. J.. Pt., (. , June 14, Right; Surg. Love, C. S. A. Re 142 Lowe, W., Pt., F, 9th Oct. 18, Right; circ.; Surg. R. R. Clarke. Sill Louisiana. 15, 03. tired Oct. 22. 1834. Maryland, age 17. 18, 03. 31th Mass. M. 0. Feb. 2. 04. 100 Henry, J-, Pt., A, 57th May 5, Right : circ.; Surg.D.Kelsey, G4Hi 143 Lumphrcy, O., Serg t April 0, Left ; Surg. T. S. Gardner, 17th New York. 0, 04. N. Y. Disch d Jan. 18, 1865. Major, 1st N. Y. Cav. 0, 05. Penn. Cav. Disch d July 24, 05. 101 Henry, P.. Pt.. G, 2d Oct. 8, Right ; flap; Surg. C. Spinzig. 2d ,: 144 Maass, L., P., F, 1st In July 13, Right ; flap : Surg. G. P. Ilex, 33d Missouri. 8, 02. Missouri. Disch d Jan. 3, 1853. j diana Batterj-. 13, 03. Illinois. Disch d Dec. 10, 1803. 102 Hill, R. 8., Capt.. B, 2d April 10. Right. Mustered out July 22, 05. 1 145 Mahouev, J.. Pt., A, Indiana Cavalry. 10. 05. llth New York Cav., 15, 04. Gray, llth N. Y. Cav. Diseh d 103 Hill, A. F., Serg t, D, Sept. 17, Left; flap. Diseh d June 21, 63. age 21. March 30, 1805. 8th Pennsylvania. 17, 62. 140 Manning, G.M., Lieut., Nov. 29, ; Surg. Shine, C. S. A. Fur 104 Himes, A., Pt., D, 7th June 3, Right; ant. p--st. flap: Surgs. ( , Phillips s Legion. 29, 63. loughed Oct. 15, 1804. New York Heavy Art., 5, 04. Peel and Snelly, C. S. A. Dis 147 Martin, C. A., Serg t, F, July 20, Right ; ant. post. flap. Disch d age 25. charged Jan. 2:1, 1SG5. 2! th Penn., age 27. 21, 04. July 2, 1805. 105 Hor/.in. F., Sergeant, B, June 1, Left; circ; Surg. C. B. Gibson, 148 Mattock, J. M., Pt., A. 1st Aug. 27, ; Surgs. Mitchell and Ford, Huger s I.atterv. 1, 04. C. S. A. Recovery. Arkansas Battery. 27, 03. C. S. A. Recovered. 10G Ilolbert. J., Pt., E, 20th Mar. 25, Left ; flap. Disch d Aug. 2, 1805. 149 McCabe,J.2*.,$eig*t, F, Oct. 11, Right; Surg. Shackleford.C.S.A. Indiana, age 43. 25, 05. 2d Virg a Cav., age 20. 11, 03. Retired Feb. 28, 1805. 107 Holman, II., Pt., A, 25th June 25, Left : flap. Diseh d June 20, 05. 150 McClaiu, J. S., Pt., K, Deo. 31, Left ; flap ; Surg. L. Manker, 79th Mass., age 35. 20. 04. 79th Indiana. 31, 02. Ind. Disch d March G, 18G3. 108 Hood J. B., Lt. Gen l, Sept. IS), Professor J. G. Richardson, of; 151 McCtmkey, S. /., Pt., G, Sept. 20, ; Surg. Hall. Recovered. 0. S. A. lit, 03. New Orleans. Recovery. 37th Tennessee. 21, 03. 109 Howard, N. J., Pt., II, June 3, Circular. Furloughed. 152 McCord. C. P., Corp l, May 17, Left; Surg. W. II. White, 22d 48th Alabama, age 33. 4, 04. K, 23d Iowa. 17. 03. Iowa. Disch d Aug. 20, 1803. no Hoyer, 15., Pt , G. 107th Sept. 17, Right; flap; Snrg. J. F. Hutchin- 153 McCurlcy, J., Pt, B, 1st Aug. 29, Right. Disch d Oct. 29, 1862. Penn., age 18. 19, 02. son, 10?th Penn. Disch d July Pennsylvania Art y. 2.), 02. 13, 1803. 154 McDan iels, S., Pt.; D, April 11, Left: flap; Surg. C. L. Wilson, 111 Huder, A. L., Pt., H, July 2, Left. Exchanged Sept. 25, 1803. 75th Ohio. 13, 02. 75th Ohio. Disch d June 2, 02. llth Georgia, age 20. 3, 03. 155 McFarland, R. W., Cor May 25, Left; circular. Disch d May 20, 112 Uur/hes, G. W., Pt., B, Mar. 20, Right; Surg. Swann, C. S. A. poral , C . 3d \V i s . , age 23 . 20, 04. 1805. (ith Georgia. 20, 04. Recovery. 156 McKce, S. T., 1 t., E, Mar. 31. Left: circular. Disch d .lime 14. 113 Huston, W. G., Pt., K, May 13, Right ; periosteum flap ; Surg. J. 4th Penn. Cav., age 2 ). Ap. 1, 05. 1805. 8th Indiana. 23, 03. K. Bigclow. 8th Ind. Disch d 157 McLaughlin, M., 1 t., A. Mar. 10, Left: circular. Disch d Oct. 3, October 8, 1803. 2Jth Conn., age 34. 10, 05. 1805. 114 Hutcltinxon, K. B., Pt., D, 7th South Carolina. Sept. 17, 18, 62. Right ; Surg. T. II. Squire, 89th N. Y. Nov. 21th, b;me removed. 158 McMahon, I)., Capt., D, 8Uth New York. July 1, 3. 03. Left; flap. Disch d June 23, 64. femoral opened, lig. Provost 159 McNulty. C., Pt.. A, Sept. 17, Right ; flap ; Surg. B. A. Yander- Marshal, April 27, 1863. 2!>th Massachusetts. 18, 02. kcift,U.S.V. Diseh d Mnr.23, 63. 115 Hyatt, K. F., Pt., C, 3d Sept. 17, Left; sloughing: gangrene. Dis 160 Milling, K. K . Pt., O. Sept. 20, Right ; Surgeon Walker, C. S. A. i Arkansas, ago 18. 19, 02. charged Nov. 24, 1802. 3d S.Carolina Battcrv. 21, 03. Recovered. 116 Ireland, A., Pt., B, 9th Oct. 27, Right; Surg.C.M. Clark, 39th 111. 16) Moore. J. II., Corp l, K, Aug. 25, Right; circular; Surgeon J. W. Maine, age 18. 27, 04. Disch d June 12, 1805. 2d New York Heavy 20. 04. Wishart. 140th Penn. Disch d 117 Inmn, 1. M., 1 t., G. 45th Oct. 19, Right. To Prov. Marshal April i Artillery, age 20. March 22. 1805. North Carolina, age 21. 19, 04. 171805. I"- Moore, I 1 ., Pt., E, 26th Sept. 10, Left ; nnt. post, flap: Surg. J. G. 118 Irving, D., Pt., H, 8th Nov. 27, Right; circular. Exchanged and Mass., age 32. 19, 04. Bradt. 20th Mass. Disch d Oct. Louisiana, age 20. 27, 03. retired February. 1805. 3:i, 05. Died Dec. 5, 1809. 119 Jackson. J., Serg t, A May >, Left: circular. Disch d June 7, 103 Mosher, D. II., Pt., I?. May G, Right; Surg. \V. B. Fox, 8th 00th Illinois, ugc 30 10, 04. 1805. 8th Mich., age 24 8, 04. Michigan. Disch d Jan. 24, 65. 1120 Jarrett, I.. Serg t, A. 1st Alar. 31, Left: circular; Surg. W. W. L. 104 Murphy, E., Lieut., A, Sept. 19. Left: skin flap: Asst. Surg. J. New .Jersey Cavalry, Ap. 1, 05. Phillips, 1st New Jersey Cav. 5th Cavalry, age 20. 20, 04. \f. Williams. U. ,S. A. Retired age 18. Disch d July 5, 18G5. April 25, 1805. 21 Jessup, J., Lieut., B, Juno 18, Right. Mustered out Aug. 7, G4. ,105 Myers, S.. Pt., C. 183d May 2, Lett ; circular; Surg. D. II. Hous 187th Pennsylvania. 18. 04. Pennsylvania, age 18. 2, 04. ton, 2d Del. Disch d June 8, 05. 122 Jones, D. M., Corp l, I. April 2, ! Right: flap; Surg. J. S. Taylor, i 100 Nealis. .T. P., Serg t, E, July 3, Left. Recovered. 199th Penn., age 25. 2, 05. 23d 111. Must, out June 24. 05. , 23d Virginia Cavalry. 5, 03. . : i ;> 1 1 SMITH (STEPHEN), Analyses of 439 amp. -in the contiguity nj the lower extremity, in Memoirs of the U. i>. an. Com., 187], Surg. II, p. 04. SECT. III.] PRIMARY AMPUTATION" OF THIGH IN UPPER THIRD. 219 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 107 Nelson, J., Lieut., K, Feb. 26, Right ; ant. post, flap ; Surg. J. 307 Space, J. D., Pt., 1, 15th Aug. 17, RigTit; circ.: Surg. J. W. Miller, 18th Penn a Cavalry, 26, 63. J. Marks, 18th I enn. Cavalry. New Jersey, age 21. 18, 64. C. S. A. Disced June 24. 65. age 42. Discharged. 208 Springer, J. M., Corp l, April 6, Right ; flap. Disch d July 10, 168 Nnthrnann, A., Pt., D, May fi, Left: ciro.; Surg. G. L. Potter, B, 40th Illinois. 8, 62. 1863. 39th Now York, age 40. 8, 64. 145th Peun. Disch d Dec. 9, 64. 309 Stackhouse, P. J., Pt.,C, July 2. Left; ant. post. flap. Disch d 169 O Brien, E., Pt., A, 63d May 18, Right; circ.; Surg. P. B. Hubon, 3d Penn. Res., age 34. 4, 63. . May 3, 1864. New York, age 24. 18, 64. 28th Mass. Disch d April 9, 66. 210 Steinberger, W., Pt., A, May 1, Left ;flap. Recovered ; disch d. 170 O Connell, T., Pt., H, July 2, Left; circular. Disch d June 15, 23d Indiana. 1, 63. 124th N. York, age 24. 4, 63. 1865. Died June 9, 1872. 211 Stiensberger, M., Pt., H, Mar. 31, Left ; flap. Disch d June 9, 1865. 171 Olive, J. W. A., Corp l, Mav 6, Right ; Surgeon Brown. C. S. A. Uth Penn., age 30. 31, 65. H. 3d Arkansas. 6, 64. Recovered. 212 Stoddard, A.,Pt.,G, 4th Sept. 1 , Left: flap; Surg. S. A. Green, 175 Park, W. B., Corp l, E, July 11, Left [injuring popliteal artery) ; N. Hampshire, age 33. 1, 63. 24th Mass. Disch d June 1 6, 64. 3d Michigan, age 20. 11. 63. circ. ; Surgeon E. J. Bonine, 3d Spec. 4306. Mich. Disch d April 9, 1864. 213 Stoughton, W. L., Col., July 4. Right; Surg. W. N. Elliott, llth 173 Payne, I. A., Pt., K, 1st Oct. 27, Left ; lateral flap ; Confederate llth Michigan. 4, 64. Mich. Disch d Sept. 30, 1864. Colored Troops, ago 18. 28, 64. surgeon. Disch d July 12, 1865. 214 Stocks, G. W., Pt., I. 3d July 12, Left ; flap. Disch d Oct. 1, 1863. 174 Peach, G. S., Serg t, B, April 11, Right; circ.: Surg. S. A. Green, Iowa. 12, 63. 24th Mass., age 29. 11, 63. 24th Mass. Disch d May 10, 1864. 215 Streeter, H. R., Pt.. A, Aug. 9, Right : flap ; Surg. II. R. Payne, 175 Perkins, L. A., Corp l, Sept. 19, Right; circ.: Surg. Buvard.C.S.A. 85th Illinois, age 28. 9, 64. 10th Ills. Disch d Nov. 7, J865 D.lSth Virgim a.age 19. 19. 64. Provost Marshal, April, 1. 1865. 316 Strickland, N., Pt., C, Jan. 15. Right: circ.: Surg. J.W.Mitchell, 176 Peterson, W., Pt., K, 3d June 3, Right; double flap: Surg. D. M. 203d Penn.. age 20. 15, 65. 4th C. T. Mar. 8th, reamp. Vermont, age 30. 3. 64. Goodwin, 3dVi. Dis. June6, 65. 217 Stuekev, J. S., Capt.. D, Sept. 19, Right. Surg. C. E. Cady. 138th 177 Phillips. W. IX, Serg t, April 2, Left ; ant. post, oval flap ; Confed. 138th "Penn.. age 30. 20, 64. Penn. Disch d Feb. 8," 65. I, 10th N. York Heavy 2, 65. surgeon. Necr. bone removed. 218 Sweet, L., Corp l. C, Mar. 19, Left; flap: Confederate surgeon. Artillery, age 28. Disch d Oct. 17, 1865. 88th Indiana, age :i3. 20, 65. Disch d Oct. 4, 1865. 178 Pinknev, J. H., Pt., C, Sept. 29, Right ; flap. Disch d Dec. 20, 65. 219 Taggart, J. X., Pt., G, Aug. 26, Left : ant. post, flap ; Surg. AV. B. 4th Old Troops, age 33. 29, 64. 1st West Virginia L.A., 26, 63. Wynne. 14th I enn. Cavalry. 179 Pluss, W., Pt., E, 23d Mav 14, Left; circ.; Surg. D.L.Heath, 23d age 33. Disch d June 14. 1864. Michigan, age 39. 14, 64. Mich. Disch d July 18, 1865. 220 Tanner, J., Pt., C, 38th Sept. 1, Left ; circular. Disch d June 3, 180 Powell. F., Pt.. A, 10th Aug. 29, Left: Surg. Tanncy, C.S.A. Re New York. 1, 62. 1863. Louisiana. 30, 62. tired Oct. 22, 1864 . 221 Tarcott. A., Pt., A, 94th Dec. 13, Right ; long post, flap ; Surg. G. 181 Purcell, J., Pt., A, 20th Mar. 16, Left : ant. post, skin flap ; Surg. New York, age 18. 14, 62. VV. Avery, 94th N. Y. Disch d Connecticut, age 23. 16, 65. J. W. Terry, 20th Conn. M. O. Nov.12, 1863. Spec. 1373. June 13, 1865. 233 Taylor. M. C.. Pt.. G, 4th June 19, Right. Furloughed Nov. 3, 1863. 183 Pullien, R., Pt., E, 47th July 3, Right. Exch d Oct. 26, 1863. North Carolina Cav. 20, 63. Nofth Carolina. 3, 63. 223 Terry, J.. Pt., B, 7:3d July 3, Left ; flap. Disch d Nov. 29, 64. 183 Pyle, A. J., Corp l, V, April 30, Right. Disch d Sept. 33, 1863. Ohi o, age 23. 4, 63. 51st Indiana, age 25. 1863. Died Jan. 11, 1867. 224 Thompson, W., Signal Nov. 7, Right : flap; Surg. J. T. Kitchen, 184 Quinu, P., Serg t, E, 1st April 7, Right ; circular. Disch d June Quartermaster, U.S.N. 7, 61. U. S. N. Disch d July 22, 62. Louisiana Cavalry. 7, 64. 10, 1864. Died Sept. 12, 1872. 185 Redmond, M.. Serg t, F, Sept. 17, Right; circ.: Surg. G. B. Cogs 225 Thresher, A., Pt., I, 66th June 28, Left ; flap ; Surg. E. Guilick. 9th 63d New York. 18, 62. well, 29th Mass. Disch d May Illinois. 28, 64. Ills. Disch d Aug. 1, 1865. 20, 1863. 236 Tucker, R., Pt., K, 19th July 22, Left ; flap. Recovery. 180 Rennells, A. L., Corp !, May 12, Right; flap: Surg. W. D. Hum Arkansas, age 21. 22, 64. K, 149th Pennsylvania. 13, 64. phrey, 149th Penn. Disch d 237 2 Tucker, J., Serg t, G, May 9. Right; flap. May 14th, reamp. July 18, 1865. 4th Tenn. Cav., age 40. 9, 64. Furloughed. 187 Richmond, J. L., Pt., G, June 27, Right. Retired from service Sept. 238 Uhl, G., Serg t, K, 20th Mar. 25, Left ; flap. Disch d July 6, 1865. 6th South Carolina. 1864. 6, 1864. Indiana, age 22. 25, 65. 188 Riley, J. H., Corp l, K. Sept. 1, Left ; lat. flap : Surg.W. M. Gray. 239 Vangorden, J. S.,Pt.,C, June (i, Left. Disch d Sept. 4, 1862. 78th Illinois, age 31. 1, 64. 60th Ills. Gang. Dis. Feb. 8. 65. 14th Infantry. 7, 62. 189 Rohne, A. AV., Pt., K, June 13, Right : flap. Disch d Oct. 26, 6J. 330 Vaughan, J. F., Lieut., June 1, Left; Surg. G. W. New, 7th Ind. 123d Ohio. 13, 63. K, 7th Indiana, age 32. 1, 64. Disch d Sept. 20, 1864. H>0 Rogers, E., Pt., C, 103d Oct. 3, Right. Disch d March 13, 1863. 331 Vebber. II. II.. Serg t. D, April 2, Right: circ.: Surg. O. S. Cope- Pennsylvania. 3, 63. 10th N. Y. Art., age 33. 4, 65. land, 10th New York Artillery. 191 Royal, J. B., l>t., F, 59th July 3. : Surg. Harris, C. S. A. Pa Disch d Oct. 5. 1865. Georgia. 3. 63. roled Oct. 32, 1863. 333 Vechan, C., Pt., D. 12th May 10, Right: circ.; Stirg. A. Satter- 193 Sandi urd, G. P.. Comis y April 6, Right ; ant. pest. flap. Recovery. New Jersey, age 24. 11, 64. thwaite, Uth N. Jersey. Disch d Serg t, F, 2d West Vir 6, 65. Mustered out June 30, 1863. July 18, 1865. ginia Car., age 24. 233 Vinzant, J., Serg t, A, Dec. 4, Right: ant. post. flap. Paroled 193 Schenkelberger. J., Lt., Aug. 29, Left: circ. inside, flap externally; 1st Florida, age 26. 6. 64. July 15. 18ti5. I, 1st New York Arfy. 29, 62. A. A. Surg. J. B. Greene. Dfs- 234 Wait, A., Corp l, D,127th July 28, Left; flap: Surg.A.C. Messenger. charged Dec. 17, 1863. Illinois, age 31. 28, 64. 57th Ohio. Disch d Mar. 33, 65. 194 Schleier. M., Pt., B, 3d Aug. 14, Right; circular. Disch d Aug. 235 Walker, G., Serg t, K, June 26, Right ; Surgeon Spence, C. S. A. Iowa, age 29. 14, 64. 15. 1865. 40th Virginia. 27, 62. Recovered. 195 Schneider. E., Pt., II, Sept. 19, Left ; flap. Disch d Feb. 24, 64. 236 Wallace, S. F., Pt., D, April 9, Left ; flap. Disch d June 35, 65. 5th Artillery. 21, 63. 178th N. York, age 18. 9, 64. 1870, stump tender. 196 Schwartz, P. J t.F, 46th July 30, Right ; double flap ; Surg. W. B. 237 Wakefield, S., Pt,, K, May 18, Left ; flap ; Surg. J. W. Green, New York, age 20. 30, 64. Fox. 8th Mich. Dis. Apr. 3, 65. 95th Illinois. 19, 63. 95th 111. Disch d Aug. 11. 63. 197 Shea. A., Pt.. C, Pur- June 18. Right: circ.; Surg. J. S. O Don- 238 Warren. G. W., Pt., B, June 25, Left; flap; Surg. M. Gunn. 5th uell s Legion, age ~0. 18, 64. nell. Puniell Legion. Disch d 20th Indiana. 26, 62. Mich. Disch d Aug. 21. 62. Oct. 28, 1864. 239 Waters, P., Pt., C, 4th Sept. 29, Left. Disch d April 10, 1865. 198 Sheldon. D. D., Serg t. May 23, Left: circular. Disch d Nov. 11, Col d Troops, age 45. 30, 64. B, 14th Missouri. 23, G~>. 1862. , -!:> Wathins. J. >.. Serg t. Dec. 17, Left; Surg. Warren, C. S. A. 199 Simmers, P.. Pt., A, June 3, Right ; flap ; Confed. surgeon. I, 52d North Carolina. 17, 62. Recovered. 140th N. York, age 41. 2, 64. Disch d Aug. 11. 1865. 341 Watkins, L. D., Pt,, E, June 18, Left. Disch d Dec. 20, 64. Spec. 200 1 Simpson, W., Courier, Sept. . Left ; ant. post, flap ; Surg. E. 55th Penn.. age 21. 20, 64. 4325. Iowa, age 24. Batwell, 14th Mich. Disch d. 242 Webb, J. M., Lieut., D, April 6, Left: flap; Surg. N. A. Ilersom. Not a pensioner. 17th Maine, age 29. (i. 65. 17th Maine. M. out June 4, 63. 201 Sluder, A. L.. Pt., II. July 3, Left. Exchanged Sept. 25. 1864. 243 Wedeking. J. 11.. Pt., A, July 16, Right: ant. post, flap; Surg. II. llth Georgia, age 20. 3, 63. 114th Illinois, age 20. 16, 63. /,. Gill. U. S. V. Disch d May 203 Small. G. \V.. Pt.. K, June 3, Right: circular. Disch d August 244 20. 1864. 2ist I enn. Cav.,agel9. 3, 64. 2 1865. 3 Weeks, J. D., Pt., G. Nov. 14, Left ; oblique flap ; Surg. S. W. 203 Smith. K. A.Pt., A, 48th June 30, Right; cir. Escaped August 18, 3d Col d Troops, ago 20. 14, 63. Gross. U. S. Y. Also amp. arm. Mississippi, age 49. l.J vl, 62. 1863. 245 Dis. July 2ii. 65, and pensioned. 304 .Smith, .1., Ft., B. 2d Mar. 16, Right ; ant. post. flap. Disch d Welch, W., Pt.. D, 33d May 8, Left; circ.: Confederate surgeon. Massachusetts, age 29. 1 (i, 65. Sept. 12, 1865. 246 New Jersey, ago 19. !, 64. Disch d Aug. 20, 1865. 205 Smith. S. D., Pt., C, 7th July 18, Left: circ.: Con. surg. Disch d Welsh, J., Pt.. A. 4th Aug. 16, Right. Disch d Feb. 9, 1865. N. Hampshire, age 30. 20, 63. April 13, 1864. Spec. 1856. 247 Penn. Cav.. age 37. 16, 64. 200 Snyder, W. E.. Pt., F, May 22, Lett. Disch d Sept. 4, 1863. Westmoreland, M . Pt., July 23, ; Surg. J. Scmple, C. S. A. 7th Kentucky. 22, 63. B, Nelson s Battery. 20, 64. j Recovered. 1 B.vnVKLL (E.), Successful Amputation at the Hip Joint, in Med. and Surrj. Reporter. 1865, Vol. XIII, p. 188. 2 O KKKFE (I). C.), Surgical Cases of Interest treated at Institute Hospital, Atlanta. Ga., May and June, 1864, in Confederate States Med. and Surg. Jour.. 1865, Vol. IT, p. 25. 3 GUOSS (S. W.), Synchronous Amputation of the. Left Thiylt at its Upper Third and of the Left Arm, in Am. Mat. Times, 1864. Vol. VIII. p. 122. 220 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Xo. NAME, MILITAKY DESCRIPTION, AND AGE. DATES. Ol EKATIONS, OPKRATOliS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 248 Wiatt, T., Pt., A, 24th* June 1, Right; flap. Disch d March 22, 295 Breunan, P.,Pt.E, 169th Jan. 16, Right; ant. post, flap; Surg. L. Kentucky, age 32. 1, 64. 1865. New York, age 23. 16, 65. Barney, 6th Col d Troops. Died 249 Wiggins, \V. W., Corp l, Mav 12. Right: flap: Surg. C. R. Crane, Feb. 2", 1865; exhaustion. E, 5ih Wis., ago 34. 12, 64. 5th Wis. Mustered out 1864. 296 Briggs, J., Pt., C, 79th May 25, Right. Died June 11, 1864. 250 Wilbur, D., Serg t, K, Get. 27, Right; ant. post, flap; Confed. Ohio. 25, 64. 1st Maine II. A., age 37. v.9, 64. surgeon. Mustered out 1865. 297 Brine. J. M., Pt., F, 27th July 30. Right; Surg. W. B. Fox, 8th 251 Willey, K., Pt,, E, 40tti April 6, Left ; circ. Disch d Aug. 4, 1862. Michigan. 30, 64. Michigan. Died July 30, 1864. Illinois. 8, 62. 298 Brooks, M., Serg t, 4-1, July 3, Right, Died July 18, 1863. 252 Wilkinson, U.T., Lieut., Nov. 27, Right; circular. Trans. Dec. 3, J6th North Carolina. 3, 63. 0, 22d Virginia, age 25. 28, 03. 1863. 299 Browney, W., Pt., G, July 3, Left. Died July 13, 1863. 253 Winn, J. J., Quarter April 22, Left ; Surg. J.Y. Taylor, U. S. N. 73d New York. 3, 63. master U. S. S. Oneida, 22, 62. Also amp. left arm. Disch d 300 Brown, I., Pt., I, 142d May 5, Left. Died May 7, 1864. age 33. Nov. 17, 1862. Pennsylvania. 5, 64. 254 Wise, G. C., Pt., B, 14th May 6, Left. Surg. Huger, C. S. A. Re 301 Brown, J., Pt, K, 102d May 27, Right; flap; Surg. C. II. Lord, South Carolina, age 20. 6, 64. tired from service Feb. 11, 1865. Neir York, age 27. 27, 64. 102d N. Y. Died Feb. 18. 1865. 255 Wolf, A., Pt., I, 38th April 2, Left ; flap : also amp. finger right 302 Brown, J. P., Pt,, A, June 1, Left; double flap. Died June 9, Wisconsin. 2, 65. hand. Disch d Sept. 6. 1865. 15th South Carolina. 1, 64. 1864. 256 Wormwood, C., Pt., 13, June 4, Right. Disch d. Spec. 1464. 303 Brown, J. W., Pt., F, May 18, Right ; Surg. M. Rizer, 72d Penn. 97th New York, age 19. 4. 64. 152d New York. 18, 64. Died May 18, 1864. 257 Worthy, (J. W., Pt., H, June 22, Right ; circ. Furloughed August 304 Brown, M. A., Pt., II, May 16, Flap. Died May 22, 1864. 15th S. Carolina.age21. 22, 64. 16, 1864. 25th S.Carolina, age 18. 16, 64. 258 Yeagle, J., Pt., C, lllth Mav 25, Left; flap: Surg. G. P. Oliver, 305 Buch, J., Pt., H, 27th June 21, Left: Surg. N. Gay, U. S. V. Penn., age 25. 25, 64. lllth Penn. Disch d Feb. 8, 65. Iowa. 21, 63. Died June 22. 1863. 259 Yerwood, T. L., Pt., 11, Aug. 9, ; Surg. Beckie. Recovered. 306 Burks, J. U., Pt., F, 9th June 24, Died June 26, 1864. 19th Georgia. 10, 62. Alabama. 24, 64. 200 York, D. P., Pt , B, 12th Sept. 19, Left : circ.; Surg. II. Fearn, 175th 307 Burns, A., Pt., F, 66th Sept, 17, Surg. C. S. Wood, 66th N. York. Maine, age 30. 20, 64. N. York. Disch d Dec. 3 J. 64. New York. 17, 62. Died Sept. 25, 1862. 261 Able, P., Pt., A, 49th May 30, Left: ant. post. flap. Died July 308 Butler, A. K., Corp l, F, Mar. 19, Right ; circular. Died March 27, Virginia. 31, 64. 1, 1864; pyaemia. 1st Michigan Cavalry. 20, 62. 1862 ; pvirmia. 262 Aikens, II. N. G., Serg t, June 10, Right; Asst. Surg. J. S. French. 309 Caesar, H., Captain, A, May 1, Right; Surg. C. S. Wood, 66th B, 109th N. Y., age 21. 10, 64. 109th N. York. Irritative fever. 52d New York. 1, 63. N. York. Died May 10, 1863. Died Sept. 17, 64 ; exhaustion. 310 Cairns, J. W., Pt., G, 5th Mav 9, Surg. C. Bowers, 6th Penn. Died 263 Albert, H. C.. Corp l, A, July 27, Right; flap. Died Aug. 19, 1864; Penn. Reserves. 9, 64. May 10, 1864. 1st Cavalry, age 21. 27, 64. exhaustion. 311 Callahan, J., Pt , I, 1st Aug. 10, Died August, 1804. 264 Allison, J. J., Serg t, 15. .Iunel9, Right. Died July 30, 1864. Ne^v York Dragoons. 10. 64. 39th Mass., age 40. 19, 64. 312 Carne, W.W., Serg t, H, Sept. 19. Left; flap : Surg. J. G. itradt. 26th 265 Anderson, 11., L!eut., I, Mav 21, Flap; Surg. J. C. Morgan, 29th 26th Massachusetts. 20, 64. Mass. Died Nov.30, 64. Sp.3796. 31st Iowa. 21, 63. Missouri. Died May 22, 1863. 313 Camp. E. L., Serg t, G, June , Left; Surg. J. T. Woods, 9! th 266 Anderson, S. P., Pt.. D, Sept. 20. Right. Died Sept. 29, 1862. 84th Illinois. -, 64; Ohio. Died June 21, 1864. 118th Pennsylvania. 20, 62. 314 Campbell, M., Pt., C, July 2, Left. Died August 1, 1863. 267 Angle, T., Pt,, D, 100th Dec. 16, Left; circ.; Surg. J. R. Ludlow, llth Penn. Reserves. 2, 63. Colored Troops, age 21 . 17, 64. U.S.V. Died Dec. 30, 64 ; exh n. 315 Campbell, J., Pt., K, 6th May 15, Right. Died May 18, 1864. 268 Arms, A. I., Pt., H, 71st July 2. Also amp. arm. Died July 3, 63. Vermont. 15, 64. New York. 2. ? 63. 316 Carpenter, C., Pt., L. 1st April 30, Right ; Surg. E. Shippen, U.S.V. 269 Armstrong, J.. Pt., I), July 18, Left; circ.; Surg. T. F. Oakes, New York Artillery. 30, 63. Died May 2. 1863. 14th New York H. Art. 18, 64. 56th Mass. Died July 21. 1864. 317 Carson, T. D., Pt., C, May 3, Surg.C. S.\Vood, 66th N.Y. Died 270 Armstrong, .T., Pt., A, June 25. Right. Died July 6, 1862. 4th Ohio. 3, 63. May 3, 1863. 2<1 Rhode Island. 25, 62. 318 Chambers. W., Pt., I, May 5, Right. Died May 7, 1864. 271 Armstrong, S. H., Pt., Deo. 16. Right, Died January 1, 1865. 4th New Jersey. 5, 64. A. 13th C. T., age 24. 17, 64. 319 Chisler, J., Pt.. I, 8th May 6, Left; Surg. C. Bowers, 6th Penn. 272 A shcrwood, J..Pt,, G,7tli June 16. Left ; ant. post. flap. Died June Penn., age 19. 6, 64. Reserves. Died May 13, 1864. N. Y. II. Arfy,age30. 16, 64. 28. 1864; exhaustion. 320 Churchill, A.W., Corp l, Oct. 19, Right ; flap. Died Nov. 8. 1864 ; 273 Aylesworth, E. G^, Pt., July 2, Right, Died July 10, 1863. G, 7th Mich. Cavalry, 19, 64. exhaustion ; anemia. G, 147th New York. 3, 63. age 33. 274 Babcock, W., Lt. Col., Sept. 19, Left : ant. post. flap. Died Oct. 321 Clapp, S. C. B., Lieut., May 12, Right ; Surg. J.W. Wishart, 140th 75th New York. 19, 64. 5, 1864 ; pyaemia. H, 125th N. Y., age 22. 12, 64. Penn. Died June 5, 1864. 275 liailcy, W., Pt., D, 31st May 16, Left; flap. Died June 14, 1864. 322 Clarke, A., Pt., A, 69th Primary. Right. Died November 7, 1862. N. Carolina, age 23. 16, 64. Indiana. 276 Bailey. J., Pt., E, 35th Nov. 30, L^ft; ant. post. flap. Died Jan. 323 Coffing, J. C., Lieut., K, Dec. 14, Right ; Surg. F. G. Snelling, U. Alabama, ago 29. De. 1. 64. ~8. 1865; exhaustion. 10th Connecticut. 14, 6, . S. V. Died Dec. 25. 62 : exh n. 277 Ball, C. A., Corp l, D, Sept. 19, Right: ant. post. Hap: pyaemic. 324 Collier. P.. Pt., K, 3d May 1, Right, Died May 3, 1863. 14th N. Hamp.,age45. 19, 64. Died Oct. 25, 1864. Missouri Cavalry. 1, 63. 278 Barr. S., Serg t, B, 3d Oct. 22, Left: oval flap. Died Nov. 28, 325 Combs, A. J., Pt., II, Dec. 4, Flap; A. A. Surg. W. Appley. Iowa Cavalry, age 23. 22, 64. 18. !4: irritative fever. 39th Georgia, age 27. 4, 64. Died Dec. 5. 64 ; haemorrhage. 279 Jiarnes, It. G., Sergeant July 3, Right. Died July, 1863. 326 Condon, S., Pt., I, 87th June 25. Right: July 7th. Died Sept. 2, Major, 52d N. Carolina. 3, 6:i. New York, age 18. 27, 62. 1862; pyaemia. 280 Bart lett, M. II., Pt., D, July 10, Left; circ. Died August 3, 63; 327 Conlin, W., Pt., H, 140th July 3, Left. Died July 15, 1863. 4th Vermont, age 19. 10, 63. exhaustion. Spec. 3887. Pennsylvania. 3. 63. 281 Barrett, A.. Pt., II, 4th Oct. 4, Left : double flap: Asst, Surg. J. 328 Connor, S. A., Pt., G, Oct. 13, Right. Died Nov. 7, 64 ; tetanus. Indiana Cavalry. 5, 63. K. Link, 21st III. Died Oct. 7, 63. 62d Ohio, age 21. 13, 64 282 Realty, C. L., Capt.. A, Aug. 14, Died August 15, 1864. 329 Connor, P., Pt., D, 53d June 1, Right ; June 26th. reamp. Died Palmetto S. S. 14. 64. Pennsylvania. 1, 62. July 8, 1862; exhaustion. 283 Hell. J. C., Pt., A, 13th July 28, Circ.: Ast. Surg. W.F.Richardson, 330 Constine. L., Pt.,C, 143d May 11, Circ.; Surg. W. T. Humphrey, South Carolina. 28, 64. C.S.A. Died July 30, 64; exh n. Pennsylvania. 13," 63. 149th Penn. Died May 18, 63. 284 Bennett, L., Pt., D, 141st July 3, Died July 10, 1863. 331 Coqitillet, L, Pt., G. 8th Dec. 1, Right : circ.; A. Surg. T.W. Stull, Pennsylvania. 3, fe. 111. Cavalry, age 21. 2, 63. 8th 111. Cav. Died Jan. 17, 1864. 285 Bennett. J. W.. Major, Sept. 27, Left. Died November 15, 1864. Spec. 1893. 10th Missouri Cavalry. 27, 64. 332 Cowman, J., Pt., C, 81st Sept. 3, Left; Surg. J. Pogue, 66th 111 286 Berguist, ( ,.. 1 t., C. 95th June 17, Left : atit. post. flap. Died Aug. Ohio. 3, 64. Died Sept. 10, 1864; pvasmia. New York, age 33. 17, 64. 4, 1864 ; pyaemia. 333 Coxe, L. T., Serg t, D, Sept. 29, Left. Died October 23, 1864. 287 Biltz. G. C., Serg t, E, Mav 14, Right. Died May 24, 1864. 25th South Carolina. 29, 64. 108th Ohio. 14, 64. 334 Crane, J., Pt., K, 100th Sept. 4, Right : Surg.M.S.Kittingor.lOOth 288 Bishop, M. G., Serg t, E, July 20. Right. Died July 28, 1864. New York. 4, 64. New York. Died Sept. 5, 1864. 5th Connecticut. 20." 64. 335 Crawton,W.,Pt., II, 63d Sept. 17, Died September 22, 1862. 289 Bollonbaugh. J.. Pt., E, June 28, Right. Died July 28, 1864. New York. 17, 62. 93d Ohio. 28, 64. 336 Croyle, W. II., Pt., 11, June 16, Right. Died Sept. 6, 64 ; chronic 290 Bowers, .1. C., Capt., D, Juno 2, Right; Surg. J. L. Brinton, 8th 55th Penn., age 21. 16, 64. diarrhcea. 184th Penn.. age 2J. 2, 64. Ohio. Died July 18, 64 : exh n. 3. )? Danner, S., Pt., I, lllth Mav 14. Right : Surg. A. C. Messenger, 291 Boi/cf.S.. Serg t, K, 30th Nov. 8, Left; Surg. 11. F. Lyster, 5th Illinois. 14, 64. 57th Ohio. Died June 7. 1864. North Carolina. 8, 63. Mich. Cav. Died Nov. 11, 63. 338 Davill, J., Pt., U, 10th May 14, Left. Died May 18, 1863. 292 P.oyd. J.. Color Scrg t. July 2, Left. Died. Missouri. 14, 63. 2d Delaware. 2, 63. 339 Davis, E., Pt., C, 18th Dec. 15. Left ; ant. post, flap; A. A. Surg. 21(3 Bragg. J., Pt,, I, 4Qd Sept. 17, Left. Died October 3, 1862. Ohio, age 35. 16, 64. M. L. Herr. Died Dec. 27, 64 ; New York. 17. 62. pyaemia. 294 Brandt, C., Pt., A, 1st July 3, Right. Died July 21 , 1863. 340 Delancy, J., Pt., C, 101st May 25, Right; ex. and int. lateral flaps. Minnesota. 3, 63. Illinois, age 25. 26, 64. Died June 20, 1864 ; pyaemia. SECT. III. PEIMARY AMPUTATION OF THIGH IN UPPER THIRD. 221 No. NAME, MILITARY DESCRIPTION, AXI) Ar.E. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DAT KB. OPERATIONS, OPERATORS, RESULT. 341 Diefenbangh, J., It., H, May 8, Right. Died July 2, 1864 ; gan 387 Hughes, ff., Serg t, Mil July 22, Left ; gang.; circular. Died July J3d Ohio. 6, 64. grene. ler s Mississippi Cav. 24, 64. 24,1864. 342 Dingman, A., I t., F, June 3, Left; Surg. W. B. Fox, 8th Mich. 388 Hyde, W. J., Pt., C, 19th Dec. 17, Left; flap; gangrene. Died Nov. 27th Michigan. 3, 64. Died June 3, 1864. Louisiana, age 24. 18, 64. 20, 1865 ; typh. fever. 343 Dixon, J.. I t., F, 32d May 15, Right. Died May 25, 1864. 389 Hydrick, L., Serg t, I, Aug. 14, Left. Died August 16, 1864. Alabama. 15, 64. 66th New York. 14, 64. 344 Doiz, J. C., It., B, 19th July 22, Right. Died August 4, 1864. 390 Jackson, J., Corp l, K, June 18, Left. Died July 23, 1864; ex Infantry. L 2, 64. llth Conn., age 36. 18, 64. haustion. 345 Donaldson, S.. It., C, June 7, Right. Died June 9, 1864. 391 2 James, J. L., Corp l, C, May 1, Right; double flap. Died Mav ll SJth Pennsylvania. 7, 64. 18th Indiana. 1 . "C3. 27, 1863. 340 Douglass. A. j., I t.. B, Aug. 25, Left; do. flap; A.Surg.C.W.Stin- 392 Jennings, J., Pt., 1, 14th Aug. 25, Left; ant. post, dovib. flap; Surg 14th W. Ya , ago 25. C7, 64. son, 23d 111. Died Aug. 27, 64. Conn., age 17 27, 64. Hunt, C.S.A. Died Sept. -Jli, (i4. 347 Doyle, T., Oorp l, I, 4th July 2, Right. Died July 6, 1863. 393 Jessop. N., Corp l, K, Aug. 18. Right: <-ii-(!. Aug. 31st, pyu iuia. Maine. 3, 63. 97th N. York, age 30. 19, 64. Died Sept. 5, 1864; pyaemia. 348 Dudley, J., Pt., C, 34th Mar. 31, Left; flap; Surg. T. H. Squire, 394 Johnson, J. W. C., It., June 18, Died July 1, 1864. Massachusetts. 31. 65. 8!>th New Y ork. Died. B, 187th Penn. 18, 64. 349 Dudley, W., I t., E, 64th July 2, Left; haemorrhage. Died July 395 Jonex, D. C., It., H,43d Mav 16, Flap. Died May 19, 1864. New York. 2. 63. 23, 1863. Alabama, age 25. 16, 64. 350 Dunham, W. H.. It., K, Oct. 19, Right ; circ. Died Oct. 28, 1864 ; 396 Jones. H., Pt,, F, 36th June 15, Left ; flap. Died August 20, 64 : 114th New York. 19, 64. pyaemia. Col d Troeps, age 33. 35. 64. haemorrhage. 351 Dunn, <)., Corp l, F, 66th Sept. 17, Surg. C. S. Wood, 66th N, Y ork. 397 Jones, J. W., It., A. Dec. 13, Died December 20, 1*62. New Y ork, age 26. 17, 62. Died October 25, 1862. 122d Pennsylvania. 13, 62. 302 Durnan. L., Corp l, G, Mar. 19, Left. Died April 14, 1865. 398 Jones. O. H., Serg t, D, June 2, Left ; flap. Died June , 1864 ; 121st Ohio, age 21. 20, 65. 14 Jth New Y ork. 3, 64. absorption. 303 Eddy, J. C.. It., F, 22d Dec. 13. Died December 20, 1862. 399 Kelty, T., Pt., K, 100th July 30, Left; flap; Surg. T. F. Oakes. ( onnerticut. 13, 62. Pennsylvania. 30, 64. 56th Mass. Died July 31, 1864. 354 Edward, W., It., I, 49th June 26, Left. Died June 26, 1864. 4CO Kenison, A., It., E, 12th Sept. 19, Right : circ.: pvscmic sym. Died Ohio. 26, 64. Maine. ilt, 64. October 16, 1864. 355 Edwards, C., It., K, Mav 25, Left. Died June 2, 1864. 401 Kennedy, C., Pt., F, 71st Mav 18, Right .- Surg. G. L. Potter, 145th J4Uth New Y ork. 25. 64. Penn.. age 27. 18, 64. Penn. Died June 4, 64; pyaemia. 35(i 1 Elder, W. B.,Serg t, B, Dec. 14, Right; circ. Died Jan. 8,. 1863; 402 Kensler, P., Pt., G, 47th July 28, Left; flap: Act. Staff Surg. C. 91st Ponu. 14, 62. tetanus. Ohio, age 36. 29, 64. 15. Richards, U.S.A. Died July 357 Erwin, W. B., It., C, 5th May 14, Left. Died May 16, 1864. 31, 1864. Tennessee. 14, 64. 403 Kerr, S. M., Pt., C. 6th Dec. 16, Right: ant. post. flap. Died Jan. 358 Evans. E. S., Pt., 1, 87th June 15. Left. Died June 26, 1864. Tenn. Cav., age 20. 16, 64. 10, 65; typhoid pneumonia. Indiana. 15, 64. 404 Kief, J., It., B, 66th Dec. 16, Left : Surg C. S. Wood, 6>ith N. 35 J Evans, H., Serg t, E, Mav 5, Right. Died May 6, 1864. New York. 16, 62. York. Died Dec. 19, 1862. 12th Massachusetts. 5. 64. 405 King, T. II., Corp l, C, Oct. 19, Circular. Died; tetanus. 360 Fortna, H. A., It., D, Mar. 19, Left. Died May 4, 1865 ; exhaus 12th N. C., age 19. 19, 64. 16th Illinois, age 20. 19, 65. tion. 406 Kirkpatrick. E., Pt., A, Dec. 16, Left: ant. post, flap: Surg 11. 11. 361 French, J., Pt., C, 53d June 27, Right; Surg. A. C. Messenger, 16th Ohio, age 31. 16, 64. Breed, U. S. V. Died Deo. 17, Ohio. 27, 64. 57th Ohio. Died July 1, 1864. 1864 : exhaustion. 362 French, D., Pt., F, 81st May 16, Left. Died June 8, 1864. 407 Knox, S., Pt., C, 28th July 20, Left. Died August 22, 1864. Ohio. 16, "64. Pennsylvania. 20," 64. 363 Gaston, T., Pt., E, 8Pth June 1, Died June 3, 1864. 408 Lackey, J., Pt., C, 21st May 5, Right ; Surg. P. E. Hubon, 28th Illinois. 1, 64. Mass., age 39. 6, 64. Massachusetts. Died June 1, 364 Geary, C. M., Corp l, M, April 7, Right. Died April 15, 1865. 18(i4 ; pyaemia. 1st Maine Cav., age 23. 7, 65. 409 Lake, C., Pt., A, 102d Sept. 17, Right. Died September 29, 1862. 305 Gillsen, A., I t., F, 7th Feb. 21, Asst. Surg. B. Norris, U. S. A. New York. 17, 62. Infantry. 22, 62. Died Feb. 22, 1862. 410 Lamson, W. H., Pt., C, May 9, Right : skin flap ; circular. Died 366 Gilbert, W., It., D, 23d July, Left. Died August 15, 1863. 6th Maine, age 23. 9, 64. J une (i, 18(54. South Carolina. ," 63. 411 Langelle, L.. It., H,7th June 17, Circular; pyaemia. Died July 367 Girrior, IF., I t.. K, April 2, Died April, 1865. Missouri. 17, 63. 7, 1863. Dawsou s Artillery. 2, 65. 412 Laughner, A., Pt., F, Nov. 12, Right; oval flap; Surg. J. W. 368 Glqver, W., It., A, 16th De.31, 62, Right. Died January 7, 1863. 18th Penn. Cavalry. 12, 64. Smith, 2d Ohio Cavalry. Died or 25th La., age 21. Jan. 1, 63. Dec. 22, 1864 ; pyaemia. 369 Good, F., It., 15, llth May 12, > Right. Died June 19, 1864. 413 Leary, T., Pt., I, 5th Feb. 21, Asst. Surg. B. Norris, U. S. A. New Ilatnp.. age 19. 12, 64. Infantry. 22, 62. Died Feb. 22, 1862. 370 Grice,S.M., I t., A, 27th June 15, Right ; ant. post, flap; Asst. Surg. 414 Leech, j.. It., A, 82d Sept. 21, Right. Died Oct. S, 64 ; shock. South Carolina. 17, 64. W. F. Richardson.C.S.A. Died Penn., age 42. 21, 64. Juno 18, 1864; exhaustion. 415 Leonard, S. H., Pt., A, Sept. 19, Right, Died September 24, 1864. 371 Griffin, T., I t., 15, 6th July 27, Right ; circ.; Surg. C. E. Swezey, 3d Massachusetts. 19, 64. Kansas Cavalrv. 27, 64. U.S.V. Died July 29/64 ; shock. 416 Linerman, H., Pt, G, July 28, Left ; circ,; Act. Staff Surg. C. B. 37:2 Groat, P., It., 11, 14th Mav 18, Right ; flap. Died June 14, 64 ; 37th Ohio, age 33. 28, 64. Richards. Died Aug. 4, 1864. Iowa, ago 25. 18," 04. typho-malarial fever. 417 Long. F. M., Major, 45th July 12, Right. Died July 12, 1863. 373 Gusler, W., Pt.. F, 60th Sept. 1, Left. Died September 3, 1864. Illinois. 12, 63. Illinois. 1, 61. 418 Long, R., Serg t, H, 24th June 16, Left ; circ. Died July 23, 1864. 374 Guilford, II., Corp l, F, Dec. 13, Left. Died December 15, 1862. N. Carolina, age 23. 16, 64. Spec. 1685. Kith Maine. 13, 62. 419 Lothian, J., Capt., C, June 16, Left ; lat. flap ; Surg. J. W. Wis- 370 Iladdike, L., Serg t, I, Aug. 13, Left ; Surg. A. Van Devere, 66th 24th Mich., age 27. 16, 64. hart, 140th Penn. Died July 60th New York. 13. 64. N. Y . Died August, 1864. 12, 1864. 376 Hall, .}. C., It.. A, 20th Sept. 30, Right. Oct. llth, diarrhoea. Died 420 Luderking, R., Corp l, Nov. 29, Right; Surg. G. B. Cogswell, 29th Maine, ago 37. Oct. 1, 64. Oct. 21, 1864. A, 2d Michigan. 29, 63. Mass. Died Dec. 3, 1863. 377 Ilannan, J. H., Serg t, May 18, Left. Died June 6, 1864 ; irrita 421 Lynch, W. M., Serg t, June 3, Right; Surg. J. A. Spencer, 69th K, 9th Maine, age 21. 18, 64. tive fever. A, 69th New Y ork. 3, 64. New Y ork. Died June 8, 1864. 378 Hartland, A., Corp l, A, June , Left; circ.: Surg. J. Wilson. 99th 422 Mace, W. H., Corp l, D, July 22, Left. Died July 23, 1864. S)9th New York. , 63. N. Y . Died June 24, 1863. 3-d Maine. 22," 64. 379 Homphill, D., It., E, July 2, Right; July 20th, gang. Died 423 Maders, W. C.. Pt., G, Mav 8, Right. Died June 3, 1664 ; py 72d I enn., age 26. 4, 63. Aug. 20, 1863; pyaemia. 83d New Y ork, age 30. 9, 64. aemia. 380 Hensey, J. if., It., H, Aug. 31, Left ; Surg. A.C. Messenger, 57th 424 Mahan, M., It., A, 12th Dec. 13. Left ; flap. Died Dec. , 1862. 50th Illinois. 31. 64. Ohio. Died Sept. 6, 18(54. Massachusetts. 13. 62. 381 Hewitt, L. T., I t., M, Muv 14, Left. Died May 22, 1864 ; exhaus 425 Marsh, J., 2d Lieut., I, July 1, Right. Died July 4, 1863. (ith Peiin. Cavalry. 14," 64. tion. 29th Ohio. 1, 63. 382 Hills, W., Pt., D, 2d Nov. 24, Left; Surg. G. B.Cogswell, 20th 426 Martin, A. B.. Capt., H, Mav 5, Left. Died May 5, 1864. Michigan. 24, 63. Mass. Died Dec. 22, 1863. 6th Maryland. 5, 64. 383 Hoffman, A., It., I, 57th Jan. 11, Right; Surg. M. F. Carey, 48th 427 Mason, A . J., Capt., H, Dec. 13, Left. Died Jan. 12, 64 ; pyaemia. Ohio. 11, 63. Ohio. Died Jan. 13, 1863. 145th Penn., age 30. 13, 62. 384 Holmes, J., It., II, 9th May 5, Right. Died May 8, 1864. 428 Mathias. L., It.. C, 107th Mar. 16, Left; flap. Died May 6, 1865. Massachusetts. 5, 64. New York, age 38. 16, 65. 385 Howard, G. J., Serg t, Mar 25, Left. Died April 2, 1865. 429 May, J., Corp 1, H, 6th Mav 14, Died May 14, 1864. G, 5th Vermont. 25, 65. Wisconsin. 14, 64. 386 Howard. W., It , K,55th July 3, Left. Died July 22, 1863. 430 Mayo, J., It., C, 44th Oct. 2. Right; Surg. A. A. White, 8th North Carolina. 3, 63. North Carolina. 2, 64. Md. Died Oct. 4, 1864. 1 BUTLER (W. If.), Kcmarl.-s on tetanus, with histories of nine cases, in Am. Med. Times. 1P63, Vol. 7, p. 108 * BRYAN (J.), Sixteen cases of Amputation treated in hospital at Grand Gulf, Jtiss., in Am. Jlcd. Times, 1863, Vol. 90-7 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OrEK.vnoxs, OPEKATOISS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE. DATKS. OPERATIONS, OPERATORS, RESULT. 431 McDonald, 1 ., 1 t., K, Sept. 19, Right ; circular. Died October 474 Rider, J., Pt., A, 8th Sept. 19, Left ; circ. Died October 22, "63 ; f-th Kansas, age 30. 20, 63. 12, J 863; haemorrhage. Kansas, age 37. 20, 63. pyaemia. 432 McDonald. II.. Corp l, Sept. 1, Right ; ant. post. flap. Died Nov. 475 Riley, J., Pt., B, llth Mar. 29, Left. Died April 1, 1865. 15, 98th Ohio, age 3 .). 1, 64. 24, 1864 ; exhaustion. New Jersey. 29, 65. 433 McFarland, G., Pt., B, Dec. 13, Died December 12, 1862; shock 476 Riley, O., "Pt., M, 2d Sept. 13, Right. Died September 33, 186. . 13th Indiana. 12, 62. and haemorrhage. New York. 13/63. 434 McGany, J. E., 1 t., I?, June 16, Right: ant. post, flap; Surer. D. 477 Rinker, G. W., Pt., B, July 27, Right : circ.; Surg. C. E. Swezev, 105th I J enn., age 21. 16, 64. S. Hays, 110th Penn. Died J uly 6th Kansas Cavalry. 28, 64. U.8.V. Died July 29. 04 ; shook. 17, 1864. 476 Rupert, J. F., Corp l, K, May 12, Died May 13, 1864". 435 McMorris, M., Pt.; B, May 5, Left. Died May 30, 64 ; pyaemia. 2-lth Michigan. 12/64. 124th N. Y., age 18. 5, 64. 479 Ryan. T., Pt., E, 127th June 27, Right ; Surg. A. C. Messenger, 436 Mead, J. P., Pt., I, llth July 21, Died July 23, 1861 ; under opera Illinois, age 23. 27, 64. 57th Ohio. Died Aug. 9, 1864. Massachusetts. 23, 61. tion. 480 Salmoud, K., Pt.,G,74th July 22, Left. Died July 30, 1864. 437 Miller, W., Corp l, B, June 27, Right. Died July 6, 1864. Ohio. 22, 64. 85th Indiana. 27, 64. 481 Sanderson, J. K., Pt., F. May 5, Right ; Surg. G. T. Stevens, 77th 438 Montgomery, J. P., Pt., Aug. 21, Left; ant. post, flap; Surg. J. W. 37th Massachusetts. 5, 64. N. V. Died May 12, 05 ; gang. B, 10th Inia ry, age 18. 21, 64. Anawalt, llth Penn. Died Sept. 482 Schmidt, F.,Pt.,D.118th Sept. 20, Left. Died September, 1802. 10, 1864 ; pyaemia. Pennsylvania. , 62. 439 Moore, J. N., Pt., F, 5th May 14. Left. Died May 17, 1864. 483 Schrafenberger, P., Pt., Sept. 19, Right. Died October 13, 186:!. Tennessee, age 40. 14, 64. A, 9th Ohio. 19, 63. 440 Morgan, G. C., Serg t, July , Asst. Surg. R. L. Von Haiiingen, 484 Seaman, H. J., Pt., E, Nov. 27, Left; Surg. S. C. Phimmer, 13th D. 48th Illinois. , 63. 53d Ohio. Died July 18, 1863. 13th Illinois. 27, 63. 111. Died Nov. 27, 1803. 441 Mulligan. T. H., Pt., A, July 2, Left. Died July 14, 64 ; tetanus. 485 Seevers, R. D., Pt., K, July 25, Right ; lat. flup. Died October 14th Infantrv, age 30. 4, 63. 36th Ohio, age 43. 25, 64. 20, 1864 ; exhaustion. 442 Murray, M., Pt., I, 149th July 20, Left; circ.; Surg. C. H. Lord. 486 Sharp, I)., 1 t., A, 7th Sept. 14, Died September 15, 1862. New York. 20, 64. 102d New York. Died July 21, Penn. Reserves. 15/62. 1864 ; haemorrhage. 487 Shepard, H. B., Pt., F, May 5, Right ; circ. Died June 12, 1804 ; 443 Myers. S. C., Corp l, F, July 2, Left. Died July 28, 1863 ; haem 95th New York, age 21 . 6, *64. pyaemia. 70th N. Y., age 24. 3, ti3. orrhage. 488 Sherman, E., Corporal, July 28, Right ; flap. Died July 29, 1804. 444 A elms. W. F., Pt., B, July 3, Right. Died July 9, 1863. Young s Bat ry, age 43. 28, 64. 5th Texas. 3, 63. 489 Sherman, M.,Pt.,G, 28th Sept. 17, Left. Died October 5, 1 802. 445 Noonan, C., , F, 18th Sept. 14, Amp.; sloughing. Died August Pennsylvania. 17, 62. New York. 15, 62. 8, 1863. 490 Shields! T., Pt., H, 99th July 3, Right. Died July 5, 1863. 440 Nye, G. W., Serg t, H, Aug. 30, Right. Died September 5, 1862. Pennsylvania. 3, 63. 3d Maine. 30, C2. 491 Shrine^J. T..Pt.,G,83d May 27, Died June 10, 1862. 447 O Hagan. M. P., Serg t, Aug. 12, Left ; Surg. E. Bentley, U. S. V. Pennsylvania. 27, 02. C. ItithN. York Heavy 12, 65. Died August 23, 1865; haemor- 492 Slaine, P. S., Pt..H, 10th Feb. 8, Died February 10, 1862. Artillery, ago 22. rhage. Connecticut. 8, 62. 448 Ormsby, U., Pt., G, 64th July 2, Right. Died July 16, 1863. 493 Smith, J., Serg t, K, 7th June 2, Left. Died August 22, 1864 ; ex New York. 2, 63. Connecticut, age 29. 2, 64. haustion. 449 Osborn, L., Pt., G, 3d May 17, Right; circ. May 22d, haemor 494 Smith, J. W., Serg t, H, April 6, Right. Died May 2, 05; pya?mia. New York Cav., age 27. 18, 64. rhage. Died May 27, 18(14. 48th N. C., age 2"-. . 7, 65. 400 Page, J. L., Corp l, H, Sept. 17, Right; Surg. C. S". Wood, (Kith 495 Smith, N., Pt., A, 39th April 2, Right; circ.: Surg. C. M. Ciark, 00th N. York, age 33. 17, 62. N. Y. Died October 10, 1862. Illinois. 2, 65. 39th 111. Died April 4, 1H05. 401 Partridge, P. S-. Pt., D, June 3, Circ.: Surg. Taley. Died June 496 Smith, T., Pt., 34th Cl d Dec. 9, Left. Died December 23, 1 64. 26th Mississippi. 5, 04. 10, 1864. Troops. 9, "64. 452 Parker, W. S., Pt,, C, 1st May3, Right. Died May 3, 1863. 497 Soper, J., Pt., C, 16th Dec. 13, Left. Died December 26, 1862. U. S. Sharpshooters. 3, 63. Maine. 13, 62. 153 Parker, M., Pt., A, 5th Oct. 19, Right, Died October 21, 1864. 4i8 Sperioer, G. E., Pt., A, Nov. 27, Left. Died December 21, 1803. Vermont. 20, 64. 7th Ohio. 27, 63. 454 Paul.W., . C, 7th Wis July 1, Circ. Died July 6, 1863. 499 Stiene.S. P.,Pt.,K, 100th May 12, Right ; Surg. T. F. Oakes, 50th consin. 1, 63. Penn., age 22. 12, 64. Mass. Died May 30. 1864. 455 Pwkins, J. W.. Pt., F, June 5, Left ; Asst. Surg. J. T. Wharton, 500 Stood, M., Pt., C, 14th Mar. 19, Left. Died March 21, 1865. (itli West Virginia. 5, 63. 6th W.Virginia Cav., and others. Michigan. 21, 65. Died June 5, 18C3. 501 Strong, L.. Serg t, A. 9th Sept. 13, Right. Died September 16, 04 ; 450 Perrin, W., Pt., T, 158th April 2, Right: Asst. Surg. C. G. Allen, N. York Cav., age 23. 13, 63. pyaemia. New York, age 26. 2, (i5. 34th Mass. Died April 13, 65 ; 502 Stuart, S., Pt., F, 31st July 30. Right: circ.; Surg. F. M. Weld, pyaemia. Colored Troops. 30/64. 27th C. T. Died Aug. , 1804. 457 Pettigrew, A. J., Pt.. C, July 2, Right. Died July 13, 1863. 503 Sulfrise, C. A., Pt., 6th Aug. 6, Left; Surg. A. M. Wilder, U.S.V. 11 th Penn. Reserves. 3, 63. Tenn.. age 20. 6, 64. Died Sept. 3, 1864. 458 Potter, W., Pt., B, 29th May 8, Left; circ.; Surg. A. K. Fifield. 504 Sullivan, D., Pt., B, 63d Deo. 13, Left. Died January 3, 1863. Ohio, age 22. 8, 64. 29th Ohio. Died July 6, 1864 ; New York. 13, 62. diarrho?a. 505 Slimmer, G., Corp l, K. May 12, Left. Died May 14, 1864. 459 Poust, W. t Pt., K, 51st Aug. 19, Right; circ. Died Sept. 10, 64 ; 20th Michigan. 12, 64. Penn., age 29. 19, 64. erysipelas. 506 Thomas. A., Pt., C, 2d Feb. 5, Left; circ.: Surg.J.G.F.Uolston, 460 Pratt, E. C., Lieut., G. Sept. 29, Right. Died Dec. 15, 64; pyaemia. Tennessee C. T. 6, 04. U. S. V. Died Feb. 29. 1864. 6th Cl d Troops, age 24. 29, 64. 507 Van Buren, M., Pt., II, June 28, Left. Died July 6, 1864. 461 Preston, Y. P., Pt., C, May 15. Died June 8, 1864. 59th Ohio. 28, 64. 42d Alabama. 15, 64. 508 Waffle, W., Pt., F, 14th July 11, Right; flap; Surg. T. F. Oakes, 462 Preston, J. W.. I t., F, June 18, Right; circ.; Surg. J. W. Brook, New York H vy Art., 11/64. 50th Mass. Died Sept. 26, 1864 ; 147th Penn., age 29. 19, 64. (Kith Ohio. Died Aug. 29, 1864 ; nee 30. pyaemia. diarrhoea. 509 Ward, F., Pt., G, 45th Feb. 7, Lei t : circ.; Surg. N. Falsom, 45th 4(i3 Prescott, C., Pt., G, 51st June 2. Left. Died June 4, 1864. Colored Troops. 7 65. Cl d Troops. Died Feb. 19, 05. Pennsylvania. 2, 64. 510 Walters, J. R., Pt., I. July 3, Left. Died. 464 Purdy, H., Pt., C, 2d July 1, Right. Died September 11, 1863; 52d North Carolina. 3, 03. Penn. Battery, age 33. 1, fe. pyaemia. 511 Warren, J. 11., Pt., D, May 15, Died May, 1864. 465 llanner, W., Pt., F, 3d Mar. 19, Right. Died March 25, 1865. 42d Georgia. 15/64. Florida. 19, 65. 512 Watson, G. M., Pt., D. May J4, Right : gangrene. Died May 22, 466 Kalhlone L., Pt., C, Dec. J, Left ; circ. Died Dec. 2, 1864. 63d Indiana. 14/64. 1864. 25th N. C , age 20. 1, 64. 513 Wciler..T., Corp l, K,40th May 24, Right. Died May 31, 1864 ; haem 467 Reaghton. W , I : t., G, Mar. 25, Right. Died March 25, 1865. New York, age SO. 24, 64. orrhage. 67th Pennsylvania. 25, 65. 514 Wheeler.A. R.. Corp l, I, June 16, Left. Died July 20, 1864, 468 Reed, J. M. , Serg t, B, May 12, Left. Died May 12, 1864. 9th N. Hamp., age 21. 16/64. 24th Michigan. 12, 64. 515 Whipple, R. G., Corp l, Aug. 19, Left ; flap. Died August 25, 64 ; 469 Reynolds, J., Pt., C, 1st April 5. Left. Died April 5, 1862; shock. K, 2 lth Mich., age 41. 20, 64. haemorrhage. Rhode Island Artil ry. 5, 62. 516 White, P., Pt., A, 35th June ](), Left; Surg. H. G. Averdiok, 35th 470 Rice, A., Pt., G, lllth June 19, Left ; circ.: Surg. J. W. Wishart, Indiana, age 27. ]()/64. Ind. Died July 12, 1*64. New York, age 21. 19, 64. 140th Penn. Died June 29, "64 ; 517 White,W.,Pt.,I, 3d Wis Mar. 16, Lett: Asst. Surg. G. W. Burke, exhaustion. consin. ](), 65. 46th Penn. Died March 17. 65. 471 Rice, J. C., Brig. Geivl May 10, Died May 10, 1864. 518 Whitehead, F., Pt., I, May 12, Died May, J 864. U. S. V., 5th A. C. 10, 64. 97th New York. 12, 64. 472 Richardson. A. C., Serg t, July 30, Right: flap; Surg. T. F. Oakes, 519 Whitney, G. P., Pt., II, May 5, Left ; Surg. D. W. Maull, 1st Del A, 59th Mass. 30, 64. 56th Mass. Died July 30, 1864. 6th Vermont. 5, 64. aware. Died. 473 Richardson. T.. Pt., II, Mar. 16, Right : cire.: Surg. C. M. Clark, 520 Wicks, A., Pt., G, 14th May 10, Right; Surg. G.W. McCune, 14th llth West Virginia. 16, 64. 39th 111. Died March 18, 1864 ; Indiana. K>, 64. Ind. Died May 12, 1864. shock and exh n. Spec. 5656. SECT. III.J PRIMARY AMPUTATIONS OF THIGH IN MIDDLE THIRD. 223 No. NAME, MILITARY DESCKUTIOX, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 521 522 523 Wiley, J.,Corp l, K, 40th New York. Willey, H., Pt., E, 46th New York, age 28. Williams, E., I t. ,E. 80th May 24, 25, 64. June 17, 17, 04. Oct. 8, 8 6 Right; Surg. H. F. Lyster, 5tb Mich. Died May 31, 1664. Left; eirc.; Surg. W. C. Shnrlock, 61st Pcnn. Died July 12, 1864 ; pyeinia. Died October 10, 1862. 527 528 529 530 Winsket, A., Pt.,G, 123d Indiana. Wright. J. If., Lieut., D, 5th Virginia. Craifi, J. C., Pt., E, 44th Mississippi, age 28. Frayer T J I t I 4 ( lth June 16, 10, 64. Mar. 25, 25, 65. July 28, S8, 64. Right ; Surg. A. M. Wilder, U. S. V. Died June 23, 1864 ; shock. Left. Died March 27, 1865. Right ; ant. post. flap. 524 525 520 Williams, .1. 15.. I t., A, 14th N. Y. II. Art y. Williams, W. II., Serg t, D, l"th Mississippi. Wilson, J., I t., 15, 5th Aug. 5, 5, 04. July 3, 3, 03. July 2, 4 03 Right ; flap : Surg. T. F. Oakes, 50th Mass. Died Aug. 0, 1804. Right. Died. Right: flap. July 15th, haem., ! \\" fern Died July !5 lSf>") 531 532 533 Virginia. Hawkins, G. W., Lieut., TI, 30th Mississippi. Ilennesy, W., Citizen, Confederate. Whitney F. Pt A 44th 2, 64. Aug. 31, , 64. July , , 63. May 19 Left: also wound right ; Surg. A. Sabino, 76th Ohio. Surg. C. H. Richards, 30th Ohio. Georgia. , 64. In two hundred and five of the five hundred and thirty-three cases enumerated in the foregoing table the precise seat of fracture in the femur was not indicated. In the remaining three hundred and twenty-eight cases the fracture was in the upper third of the femur in sixty-six, in the middle third in one hundred and seventy, in the lower third in fifty, at the knee joint in thirty-seven, and in the leg in five instances. Primary Amputations in the Middle Third of the Femur. There were eleven hun dred and fifty-seven of these operations. The results were ascertained in eleven hundred and forty-nine cases; six hundred and eighty-six were successful, and four hundred and sixty-three proved fatal, a mortality of 40.3 per cent. The operations were on the right side in five hundred and forty-four, and on the left in five hundred and thirty-four instances; in seventy-nine cases the side was not specified. Recoveries after Primary Amputation in the Middle Third of the Femur. The six hundred and eighty-six operations of this group were performed on one hundred and forty- five Confederate and five hundred and forty-one Union soldiers. Of the latter, two have become insane, one was retired, and five hundred and thirty-seven were pensioned; in one instance no application for pension seems to have been made. CASE 434. Private J. Kells, Co. I, 113th Ohio, aged 44 years, was wounded at Jonesboro , September 1, 1864. He was admitted to the field hospital of the 2d division, Fourteenth Corps, whence Surgeon W. C. Daniels, U. S. V., reported: "Shot fracture of right thigh at middle third by a mini6 ball ; limb amputated." From the field hospital the patient passed to Chattanooga, thence to Cumberland, Nashville, and afterwards to Brown, Louisville, from which hospitals his case was described as an "antero-posterior flap amputation of the thigh at the middle third." He was discharged from service at Camp Dennison March 21, 1865, and supplied with a Palmer artificial leg four months afterwards. He became a pensioner, and has been paid as such June 4, 1879. In his application for commutation he represented the stump as "healed and sound," and stated that Surgeon T. B. Williams, 121st Ohio, performed the amputation. In the following instance a large sequestrum was removed from the stump of the femur three months after the amputation: CASE 435. Private J. McMahon, Co. I, 6th New York Cavalry, aged 23 years, was. wounded in the left leg, at Todd s Tavern, May 7, 1864. He was admitted to a field hospital of the Cavalry Corps, where amputation was performed but not recorded, and five days afterwards he was transferred to Washington. Assistant Surgeon W. Thomson, U. S. A., made the following report of the case: "The wound was caused by a musket ball, which caused a fracture of the femur extending into knee joint, for which amputation was performed at the middle third, by the circular method, within an hour, chloroform being used. He was admitted to Douglas Hospital May 12th, at which time a large slough existed on the anterior flap, which soon separated, exposing the end of the bone. There was no vigorous effort at repair, the granulations being pale and flabby. The patient s general condition was unfavorable; he was much depressed and very pallid, and had a severe diarrhoea. On June 20th, the cellular tissue of the stump again began to slough, and, on the 22d, it was found requisite to apply pure bromine. On the 23d most of the sloughs separated, and, by the next day, the stump was clean and the granulations more florid and healthy. One inch and a half of the end of the femur was in a state of necrosis and protruding. On August llth, a sequestrum, nine inches in length, was removed by extraction, leaving a deep cavity in the stump, which was bounded externally by a large and firm cylinder of new bone. The patient s improvement was then rapid, and, by November 1st, he was considered convalescent. This man had remained for weeks MS ]:>!<> :< denth and so feeble as to be unable to lift his head from his pillow. He seemed daily on the verge of the chill of pyujmi.i, and his case was recognized and pointed out as one of osteomyelitis of the femur, from which if death did not result a long exfoliation would be removed." On May 18, 1865, the patient was discharged from 224 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. service, and several weeks after he was furnished with an artificial limb by the firm of A. A. Marks, of New York City. In his application for commutation, dated 1870, the pensioner stated that the amputation was performed by Assistant Surgeon S. C. Sanger, 6th New York Cavalry, also that the stump was in a healthy condition. The pensioner was paid June 4, 1879. The sequestrum (Spec. 4281) was contributed to the Museum by Dr. Thomson, and is shown, reduced in size one-third, in FlG. 4 of PLATE LXIX, opposite. Amputation of the right thigh in the middle third and of the left leg at the knee joint was successfully performed in the following instance: CASE 436. Corporal C. N. Lapham, Co. K, 1st Vermont Cavalry, aged 23 years, was wounded during the engagement near Boonsboro , July 8, 1833, by a cannon ball, which carried away botli logs. He was conveyed to the field hospital at Boons- boro , where both limbs were amputated two days after the receipt of the injury. Four months after the operation the patient was deemed well enough to be allowed to go to his home, where he remained until the following year. On May 31, 1834, he was furnished with artificial limbs by Dr. E. D. Hudson, of New York City, who contributed the photographs represented in the annexed cuts (FiGS. 176, 177) and the following description of the operation: "The right thigh was amputated at the middle third, by the antero-posterior flap method, on account of great com minution of the leg involving the knee joint; the stump is healed and in a favor able condition. The left leg was disarticulated at the knee joint. This operation was also performed by antero- posterior flaps, and the stump is healed and in good condi tion, though the supporting cicatrix at the base is not good. The condyles of the femur, us a base, form the most useful. reliable, and comfortable sup port, and constitute his chief dependence, and the benefits of disarticulation, when com pared with amputations of the thigh, are shown to be incal culable." The patient was dis charged from Baxter Hospital, at Burlington, Vermont, Aug. 25, 1864, and pensioned. Five months later, when a student at the Collegiate Institute in Poughkeepsie, N Y., he wrote to Dr. Hudson that "he could walk with ease on level ground, get up and down stairs readily, and was getting along much better than he anticipated in so short a time." Some time afterwards he obtained an appointment as clerk in the U. S. Treasury Department at Washington, in which occupation he is still employed. His pension was paid September 4, 1879. In his application for commutation he reported that Surgeon L. P. Woods, 5th New York Cavdry, was the operator who amputated his limbs. In thirteen instances re-amputation of the thigh became necessary, and in fourteen cases the protruding ends of the femur were removed. In the following, four inches of the extremity of the bone were exsected nearly seven months after the amputation. CASE 437. Private J. Wearing, Co. L, 2d Pennsylvania Heavy Artillery, aged 20 years, was wounded at Petersburg, June 17, 1864, and admitted to the field hospital of the 1st division, Ninth Corps, where Surgeon M. K. Hogan, U. S. V., recorded: "Wound of left knee joint ; amputation at junction of middle and lower third of thigh." One week after the recep tion of the injury the man was transferred to Finley Hospital, Washington, and in October following he entered Broad and Cherry Streets Hospital, Philadelphia, whence Acting Assistant Surgeon T. C. Brainerd made the following report: "At the date of admission the femur protruded about one-fourth of an inch, and the stump was healed to within one inch of the bone. The patient being anaemic, iron and quinine were administered. Simple dressings were applied to the stump. By November 15th his general health had improved and the line of separation was forming around the protruding portion of the bone. On Decem ber 1st, the ulcer upon the stump presented a sloughing tendency, but again cleaned up. On January 6, 1835, about four inches of the extremity of the femur was exsected by cutting down upon it from the outer anterior surface of the stump and sawing through the bone with a chain saw. The bone removed was necrosed and surrounded by a large amount of reparative material. A small artery spouted from the medullary canal of the bone, the haemorrhage from which was promptly controlled by pressing a piece of soft wax into the canal. Three ligatures were applied and ether was used The operation was performed by Acting Assistant Surgeon H. M. Bellows. The patient reacted promptly. Simple dressings were continued to the stump. Two days FIG. 176. Araputati of left leg at knee joint i of right thigh at middle third and [From a photograph.] Fio. 177. Appearance of patient with artificial gs. [From a photograph.) Med.Suro. Hist, of the War of the Rebellion, Part HI.Vol II. Ward phot T .Sinclair ttttm litli PLATE LXIX. _TUBULAR SEQUESTRA FROM AMPUTATIONS OF THE FEMUR. L Spec. l&Vi3._2 Spec 14-1. ._ Spec-,. aiOO. .4 Spco. 4281. SiLTgica.1 Section, Aj-mv Medical Museum. ^^ A ^-^ <^> o {; ^ UN T V^USITy!] SECT. III.] . PRIMARY AMPUTATIONS OF THIGH IN MIDDLP^ THIRD. 225 . FIG - of right femur. s P ec - 412(X later fin attack of erysipelas supervened, extending as for up as the groin, but yielding to treatment, and by January 15th it had entirely disappeared and the general condition had much improved. One mouth later cicatrization was almost complete, and the patient was walking about with the aid of crutches." In April he was transferred to South Street Hospital, and subsequently to Chester, where he was discharged from service July 26, 1865, and pensioned. Some weeks afterwards the man was supplied with an artificial leg, manufactured by K. Clements. In his application for commutation, dated 1870. he represented the stump as being in a sound and healthy condition. The pensioner was paid June 4, 1879. The sequestrum (Spec. 4196) removed from the stump was contributed to the Museum by the operator, and is represented in FlG. 3 of PLATE LXX, opposite p. 242. Thirteen of the pensioners have died since the date of their discharge from the service; one from lung disease, three of debility, and nine of causes not stated : CASE 438. Corporal J. Bidlingmaier, Co. II, 73d New York, aged 46 years, was wounded before Peters burg, September 11, 1864. Surgeon O. Everts, 20th Indiana, noted his admission to the field hospital of the 3d division, Second Corps, with "shot fracture of thigh, followed by amputation." From the field the wounded man was transferred to the depot hospital at City Point, and thence, on October 8th, to Washington. Assistant Surgeon J. C. McKee, U. S. A., reported his entrance into Lincoln Hospital, with "antero-posterior flap ampu tation of the right thigh at the middle third," also that he was furloughed December 9th. The patient subse quently entered Judiciary Square Hospital, and on May 6, 1865, he was discharged from service, having been previously supplied with an artificial limb by the Jewett Patent Leg Co., of Washington, D. C. He was a pensioner until June 16, 1871, when he died of marasmus, his attending physiciau certifying that "it was evi dent that some portion of the splintered bone remained in the stump, as abscesses frequently formed thereon and copious discharges ensued;" also that the disease, as a consequence, first became apparent about the first of April, 1871. The amputated portion of the femur, represented in the wood-cut (FlG. 178), was contributed by Surgeon D. S. Hays, 110th Pennsylvania, who performed the operation. The specimen shows that the shaft was badly comminuted by a conoidal ball, which flattened, in a mushroom shape, against the anterior surface in the lowest third. fatal Cases of Primary Amputation in the Middle Third of the Thigh. The four hundred and sixty-three operations of this group were performed on four hundred and sixty-one patients; in two instances both thighs having been primarily removed at the middle third. Sixty-seven were Confederate and three hundred and ninety-four were Union soldiers: CASE 439. Private G. Cox, Co. K, 1st North Carolina Cavalry, aged 27 years, was wounded at Brandy ^Station, June 9, 1863. He was admitted to a field hospital of the Fifth Corps, whence Assistant Surgeon B. Howard, U. S. A., reported the following history: "The patient was a man of usual good health but had the bloated appearance of a habitual drinker. He was shot in the right thigh, and was brought to Kelly s Ford, a distance of about three miles, in an ambulance. On examination I found a wound of entrance on the outer side of the thigh, a little above its middle, but there was no wound of exit. The wound of entrance was very small, as if made by a pistol ball. The femur was badly shattered. The patient complained of having lost a good deal of blood on his way to Kelly s Ford. I immediately proceeded to amputate near the upper third by the circular mode. The patient suffered considerably from shock, but rallied comfortably, and was transported eight miles the next morning in an ambulance, and thence by cars to Alexandria. On examination of the amputated leg the femur was found to be shattered more than six and a half inches, but not comminuted as finely as often hap pens in fractures by a mini6 rifle ball, this fracture being more vitreous in appearance and furnishing but one small fragment, all the others being large ones. The ball had entered the outer side of the thigh, passed behind and partially around the femur, entering at its inner aspect, and lodging in the medullary canal. The interesting point in the case is the relation of the extensiveness of the fracture to the weight and the dimin ished velocity of the ball; that the bone should have been so extensively shattered by a pistol ball, which, when subsequently weighed, did not exceed five scruples and six grains, and that the mischief was all done, too, after the ball had been so much deflected from its original course." Surgeon T. R. Spencer, U. S. V., reported the patient s admission to Prince Street Hospital, and the result of the case as follows: "On June 19th and 23d, haemorrhage occurred from the external circumflex artery, for which compression and cold applications were made. The loss of blood amounted to six ounces. The patient looked anaemic, and there was considerable sloughing of the stump. Death followed on June 24, 1863." The amputated portion of the femur was contributed to the Museum by the operator, and is numbered 1233, Surg. Section (FlG. 179). CASE 440. Sergeant John Sproul, Co. C, 40th New York, aged 24 years, received at Kelly s Ford, November 7, 1883, a conoidal musket ball wound, causing a compound fracture of the left femur just above the knee. He was taken to the field hospital of the 1st division, Third Corps, Surgeon J. W. Lyman, U. S. V., >"> <>{ "> <ldl , e thi , n l f right femur. 3pec. 1233. in charge, and amputation of the thigh in the middle third, anterior and posterior flap method, was performed by Surgeon A. Campbell, 40th New York, on the day of injury. He was conveyed to Washington, and admitted into the Douglas Hospital on November 9th. His attending medical officer, Assistant Surgeon W. F. Norri*, U. S. A., reports, Novem ber 16th: It was found impossible to support the heavy posterior muscular flap; the sutures sloughed out, and there was a great gaping surface discharging profusely, but normal in appearance. The patient was very pallid. The stump was SUKG. Ill 29 FlO. 179. Comininu- 226 INJURIES OF THE LOWER EXTREMITIES. . [CHAP. x. thoroughly supported l>y adhesive straps, and the best nutrients, with stimulants, were administered. 24th, there was slight tenderness along the femoral artery and slight enlargement of the inguinal glands. There was no vigorous effort at repair in the stump, which remained pale and flabby, and his general condition became worse daily. December 4th, there were well- marked chills with fever in the evening, pulse 120 and feeble, respiration hurried, sweating, and nausea. These symptoms became hourly worse ; his pulse became countless, his respiration sighing and very rapid, his face pinched and anxious; occasional vomits of a green bilous matter: he finally died, on December 7th, at 4 o clock P. M., of pyaemia. Autopsy sixteen hours after death. Assistant Surgeon W. Thomson, U. S. A., records: "The most careful examination failed to find a trace of inflammation or coagulation in the blood-vessels. The soft tissues of the stump were perfectly normal. There were found in the thoracic cavity the usual traces of pya inia. The lungs anteriorly were pale, posteriorly they were both coated over the lower lobes with recent yellow and soft ill-looking lymph. There was no considerable effusion or adhesions; no traces of a frank pleuritis, but of a local asthenic inflammation were found. Both lungs were congested, hardened, and dark in color posteriorly, and in the left there were several small yellowish-white spaces, apparently abscesses. : The other organs, except the cerebro-spinal, were examined and found normal except the spleen, which was slightly hardened and congested. No trace of embolia was found in the lungs, nor was death caused by the secondary changes there produced. The destruction of pulmonary tissue had not progressed sufficiently. There must have been the absorption, by the veins most probably, from this medullary and cancellated portion of the femur, of a material soluble in the fluids of the blood, and produced, in the cadaveric changes that took place in the organic matter dead, but confined in this cancellated bone. This caused the fatal toxicomiia which overpowers the nervous system, and may have also caused those local changes found in the posterior portions of both lungs. It seems strongly probable that.it is due to blood poisoning, introduced by the veins, since all cases of pyaemia exhibit pathological changes in the lungs, where the venous blood becomes distributed to thin delicate structures before being depurated by exposure to the atmosphere. The case was about to be relinquished as incomprehensible, when it was proposed by Dr. Norris to saw the femur from its head to its extremity longitudinally, and thus expose its medullary canal. A small quantity of apparently healthy pus had been found between the periosteum and the shaft two inches from the sawn end, and there were a few osteophytes clinging to the bone at that point. When, however, the bone had been separated in its long diameter, its medullary canal presented the traces of pathological action. This canal and the cancellated structure extending past the trochanters to a point half way through the head were found filled with a yellowish -green substance, intolerably fetid, and resembling, more than anything else, the debris of hospital gangrene. The bone was sent at once to the Museum and portrayed in colors. No pus was found in this bone, and, under the microscope, nothing but debris. The connective tissue seemed to have perished en masse. In PI,ATK XXXII, opposite, the diseased stump of the femur is represented, and PLATE XXXI, opp. j). 228, exhibits the gangrenous condition of the medullary canal. CASE 441. Private William Crawford. Co. B, 2d Pennsylvania Cavalry, aged 40 years, had his right leg shattered near the knee by a fragment of shell, at the battle of Spottsylvania, May 12, 1864. The soft parts were much torn, and the popliteal artery was divided. Amputation was immediately performed near the middle of the thigh by Surgeon Charles Bower, (5th Pennsylvania Reserves. The patient was sent to Washington, and admitted, on July Kith, to Lincoln Hospital. He was in an exhausted condition and had no appetite. He utterly refused to take bark or stimulants of any description. The tongue and fauces were covered with aphthto. There was diarrhoea, from which, in a chronic form, the patient had long suffered. He died on July 27. 1834. There was extreme emaciation. At the autopsy but slight lesions were found in the viscera, except the great intestine, which was studded with ulcers. The necrosed extremity of the femur slightly protruded from the wound. This was the end of a very large, loose sequestrum, invested by a fragile involucrum. The specimen in the Army Medical Museum, No. 2890, Surtfical Section, consists of the stump of the right femur, with a very large sequestrum in process of separation and a partial involucrum formed. The histories of the two cases of primary amputations of both thighs iu the middle third are very brief. The patients died on the day following the operations: CASE 442. Sergeant Theodore Doud, Co. C, 2d Michigan, received, at Petersburg, July W, 18(54. a shell wotinfl of both thighs. He was carried to the field hospital of the M division, Ninth Corps, where, on the same day, Surgeon W. B. Fox, 8th Michigan, amputated both thighs at the middle third. Death resulted July 31, 1864. The case is recorded by Surgeon P. A. O Connell, U. S. V. CASK 44:5. Corporal John W. Woodworth. Co. H, llth Infantry, was wounded at Rappahannock Station, November 7. 1863, a shell fracturing both femurs at the middle third. He was taken to the field hospital of the Fifth Corps, and both thighs were amputated in the middle third. lie died the next day, November 8, 1863. The case is reported by Assistant Surgeon E. DeW. Breneman, 17. S. A. Pyaemia was observed in seventy-six, gangrene in eighteen, tetanus in seven <>t the four hundred and sixty-three fatal primary amputations in the middle third of the thigh, and in forty-four instances haemorrhages occurred subsequent to the operations. In three cases the amputation in the thigh was accompanied by operations in the upper extremities, and in one instance the opposite limb was amputated in the leg. 1 1 In tlie case of Private W. .T. Rand, K, 45th Massachusetts (TAHI.K XXXI, p. -~>39. No. 1,018, and Second Surgical Volume.. TADLK XUV, 1>- o:i4, No. 87), the left arm was removed at the shoulder joint ; the left arm was amputated in the lower third in the ease of Private H. Jackson. E, 4th Colored Troops (T.AHLE XXXI, p. 237. No. 904, and Second Surgical Volume, TAHLK LXXII1. p. 747. No. 40): three inches of the right radius were excised in the case of Sergeant .1. Uolnnson, II, 48th Illinois (TAIU.K XXXI, p. 2:19, No. 1.033. and Secmid Surgical Volume, TAlir.K CXXVII, ]>. 95:2. No. 51). Thf left leg was amputated in the lower third in the case of Private S. Banks, C, 43d Colored Troops (TABLE XXXI, p. 230, No. 706 ). DISEASED STUMP OF FEMUR SECT, in.] PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. TABLE XXXT. Condensed Nummary of Eleven Hundred and Fifty-seven Caws of Primary Amputations in the Middle Third of the Femur for Shot Fracture. [Recoveries, 1 68:; ; Deaths. 6871,149; Results unknown. 1.1501,157.) NAMK, MILITARY Ol-EUATlONS, Ol EUATOllS, NAMK, MILITARY OI KKATIOXS. OL KK.VKJUS. No. DKsuui Tiox, AXD AGE. U Allot. RESULT. Xo. DESCUUTIOX, AXD AGE. D.MT.S. RESULT. 1 Adams, C. B., Pt., G, Sept. 19, Right : circ. A. Surg. J. Homans, 39 Bentley, A. C., Pt., D. May 23, Left; flap. Disch d June 30, 64. 116th X. York, age 37. 20, 64. jr., U.S.A. Dis. Aug. 25, 65. 93d New York, age 27. 23, 64. Adams J. Pt. H 27th Mar. 13 Ri"ht flap. Disch d Aug. 2 62. 40 Br.ntlfij, G., Pt., B, 8th .1 ii IIP 27 Ohio. 13, 62. Louisiana. 28, 62. 3 Alexander, J., Pt.. A, May 4, Right. Surg.W.G. Xugent, 126th 41 Bentley, W. G., Major, June 21, Left ; circ. Surg. W. H. Rulison. 129th Peun., age 25. 4, 63. Penn. Disch d Mar. 16, 1864. 9th N. Y. Cav., age 28. 21, 64. 9th N. Y. Cav. Disc. Oct. 5. l>5 4 Alexander, J , Pt,, P, Sept. 20, Left; flap. Mar. 15, 65, removed 42 Berran. B., Serg t, K, May 27, Left ; circ. Discharged Oct. 26, 22d C. T., age 34. 21, 64. necro d bone. Dis. Mar. 20, 65. 160th New York. 27, 63. 1863. 5 Allaback, E. W.. Pt.,A, May 24, Left ; flap. Surg. W. S. Woods, 43 Best. W. J., Ord y Sea June 27, Left; Surg. X. Pinkney, U. S. N. 52d Pennsylvania. 24, 62. 52d Penn. Disch d Aug. 1, 1862. man. U. S. S. Pawnee. 28, 61. Discharged. 6 Allen, F. A., Pt., I, 8th June 3, Left ; flap. Subseq. operations. 44 Biebel. A., Pt., L, 9th Nov. 2,i, Left ; ant. post. flap. Surg. C. H. X. Y. Cavalry, age 29. 3, 64. Disch d July 13,1865. X. York Cav., age 23. 27, 64. Andrus, 176th N. York. Pisch d 7 Allen, G. W., Serg t, A, Oct. 19, Right; circ. Surg. D. F. Leavitt, Oct. 2 1,1865. 3d Mass. Cav., age 27. 20, 64. 3d Mass. Cav. Dis. May 31, 65. 45 Bidlingmayer, J., Corp l, Sept, 11, Right ; ant. post. flap. Surg. P. S Allen, ,S ., Pt., 11,23d X. July 1, Left ; circular. Exchanged Nov. H, 73d N. York, age 46. 11, 64. S. Hays, 110th Penn. Pisch d Carolina, age 25. 3, 63. 12, 1863. May 6, 1865. Spec. 4120. 9 Allroth, W., Pt., K, 46th July 30, Left; flap. Surg. A. F. Whelan, 46 Bishop, F., Pt., H, 65th Dec. 13, Right; flap. Pisch d Oct. 21/64. New York, age 30. 30, 64. 1st Mich. S. S. Dis. Sept. 11, 65. Indiana, age 21. 14, 63. 10 Altenberger, J., Pt., F, May 19, Left. Surg. S. P. Bonner, 47th 47 Bishop, I, Pt., K, lllth May 14, Left; flap; one and one-half inch 37th Ohio. 19, 63. Ohio. Subsequent operation. Ohio, age 24. 14, 64. boneremo d. Ris d Aug. 29, 65. Disch d Sept. 8, 1863. 48 Bissell, J. B.. Sergeant- Sept. 4, Right; ant. post. flap. Surg. A. 11 Ammermau, R. W.. Pt., May 12, Right; circ. June 24th, removed Major, 26th Iowa. 4, 64. T. Hudson, 26th Iowa. Pisch d B, 148th Penn., age 22. 13, 64. three ins. femur. Disch d May Jan. 6, 1865. 30, 1865. Spec. 2698. 49 Bivens, T. E., Pt., C, May 28, Right; flap. Reg l Surg. C. S. 12 Andrews, P., Pt., I, 62d Penn., age 18. May 6, 6, 64. Left ; ant, post. flap. Discharged July 26, 1865. 50 Bissell s Engin r Reg t. Blair, J., Serg t, A, lOoth 28, 62. Oct. 2, Shelton. Pisch d July 29, 1865. Left; cire. 8urg.D-8.Hays, 110th 13 Andrews, W. A., Pt., E, Nov. 30, Right ; lateral flap. Exchanged Penn., age 26. 2, 64. Penn. Pisch d Jan. 11, 1866. 3d C. S. Inf., age 27. Pec.1, 64. March 7, 1S65. Pied Nov. 8, 1869. Spec. 4125. 14 Arts, J., Capt., K, 2d June 25, Left. Discharged Nov. 10, 1862. 51 Blake, W., Pt.. K, 18th July 3, Left. Sept. 4th, extol, removed. Xevv York. 25, 62. Mississippi, age 18. 3, 63. Exchanged Nov. 12, 1863. 15 Aschman, R., Capt., A, Aug. 15, Right. Surg. H. F. Lyster, 5th 52 Boatwrigltt, It. S., Pt., Jyll, 63. Left ; circ. July 17th. end of bone 1st Sharpshooters. 15, 64. Mich. Disch d Aug. 19, 1864. I, 21st South Carolina. Primary. removed. Exch d July 23, 1863. 16 Austin, W. F.,Capt., K, April 7, Right. Dr. W. W. Goldsmith, 53 Brake, G., Pt., D, 15th June 18, Left ; double flap. Ass t Surg. J. 9th Kentucky. 8, 62. Louisville. Disch d Apr. 19, 62. West Virginia, age 41. 18, 64. J. Johnson, 15th W. Virginia. 17 Azdcll, J., Pt., C, 104th May 27, Left; circ. Surg. F. H. Rodgers, Pisch d Oct. 19, 1864. Ohio, age 29. 27, 64. 104th Ohio. Dis. June 13, 1865. 54 Brandon S S., Pt. C June 2, 18 Bachman, C., Pt., P. Mar. 29. Left : flap. Discharged June 27, 27th S. Carolina.age 19. 2, 64. Oct. 18, 1864. 198th Penn.. age 28. 29, 65. 1865. 55 Brannon, L., Pt., D, 10th Oct. 8, Left ; flap. Surg. C. S. Museroft, 19 Bagley, T. K., Pt., H, May 14, Tfppovprpd Ohio. 10, 62. 10th Ohio. Pisch d Feb. 15, 63. 24th South Carolina. 14, 63. 56 Breen, M., Pt., E, 9th June 3, Right ; double skin flap. Pisch d 20 Bailey, J. C., Pt,, P, 4th Dec. 13, Left; flap. Disch d April 22, 63. Mass., age 40. 5, 64. Oct. 18, 1864. Ohio. 14 62. 57 1 Brett C Pt B llth 21 Ball, L., Serg t, F, 3d Sept. ?!, Right ; flap. One inch fern, rem d. Alabama. 28, 62. July 15, 1862. Kentucky, age 24. 21, 63. Disch d March 22,1864. 58 Brickham, L, Pt,, K, April 3, R t; ant.poet.flap. Surg. E. Pow 22 Barnett, R., Pt., P, 1st Oct. 14, Left: ant, post. flap. Surg. A. P. 14th Wisconsin, age 46. 3, 65. ell, 72d 111. Pisch d Oct. 20, 65. N. Y. Pragoons, age 15, 64. Clark, 6th N. Y. Cav. Disch d 59 Briggs. W. D., Pt., A, Sept. 29, Left ; circ. Surg. P. McFall, 142d 25. Oct. 30, 1865. 147th N. York, age 29. 29, 64. N. Y. Pisch d Sept. 11, 1865. 23 Barnes. J. W., Pt., C, Jan. 28, Left; flap. Surg. T. H. Kearney, 60 Brobst, J., Serg t. A, April 9, Left; ant. post. flap. Surg. J. llth Tennessee Cav. 28, 64. 45th Ohio. Disch d Mar. 28, 65. 107th Ohio, age 22. 10, 65. Knauss, 107th Ohio. Pisch d 24 Barnes, W., Serg t, I, Aug. 3d, Left. Disch d April 23, 1863. Sept. 6, 1865. 13th Mass., age 38. 31, 62. 61 Brock, M. V., Pt., C, July 2, Right. Surgeon Craft, C. S. A. 25 Barnhart, T. P., Pt., F, Mar. 16, Right; circular. Disch d Aug. 48th Mississippi. 3, 63. Recovered. 3d Wisconsin, age 19. 16, 65. 22, 1865. 62 Brown, C., Pt., F, 8th July 28, Right ; flap. Surg. J. K. Bigelow, 26 Barraham, ./. 11., Pt., Aug. 16, Right ; circular. Retired March Indiana, age 23. 28, 64. 8th Ind. Pisch d Nov. 29, 1864, H, 2d North Carolina. 16, 64. 17, 1865. 63 Brown, D. W., Pt., A, Feb. 13, Left. Pisch d July 31, 1862. 27 Barrett, S., Pt.. K, 69th Mar. 19, Left ; flap. Confederate surgeon. 25th Indiana. 13, 62. Ohio, age 17. 20, 65. Disch d Oct. 14, 1865. 64 Brown, G. M., Pt., A, June 15, Left; circ. Surg. J. S. Reeves, 28 Bartlett, \V. F., Capt., April 25, Left ; circ. Surg. N. Hay ward, 31st Illinois, age 22. 15, 64. 78th Ohio. Disch d Feb. 2, 65. I. 20th Mass., age 21. 25, 62. 20th Mass. Disch d July, 1866. 65 Bruce, W. D., Pt., C, Aug. 28, Right. Surg.W. Grimes, C. S. A. 29 Bartling. H.. Pt., L, 9th June 12, Left ; lat. flap. Surg. A. Nash, 9th 13th Virginia. 29, 62. Recovered. Mich. Cavalry, age 22. 12, 64. Mich. Cav. Disch . May 12, 1865. 66 Bruce, V. W., Pt., A, Nov. 16, Right; circ. Confed. surgeon. 30 Barton, M., Pt,, E, 72d May 9, Right Surg. D. B. Rice, 102d 111. 17th Mich., age 20. 17, 63. Disch d April 4, 1864. Indiana. 10, 63. Disch d Sept. 15, 1863. 67 Bryant, W. W., Pt., G, May 31, Left. Surgeon Wright, C. S. A. 31 Batch, P., 1 t., K. 99th June 20, Right; ant. post. flap. Surg. J. 1st Tennessee. Je.l, 62. Recovered. Ohio, age 21. 20, 64. T. Woods, 99th Ohio. Disch d 68 Buckles, A. J., Lieut,, Mar. 25, Right : flaps. Surg. D. S. Hays. Nov. 22, 1865. E, 20th Ind.. age 18. 25 65. 110th Peun. Disch d May 16, 65. 32 Becht, A.. Pt., E, 52d June 1, Left. Disch d Dec. 25, 1862. 69 Bullcnr, A. C., Pt., F, Sept. 14. Left. Disch d Nov. 19, 1862. New York. 3, 62. 18th New York. 15, 62. 33 Beck, (1. H., Corp l. I, May 5, Left ; circ. Ass t Surg. W. F. 70 Bullock, W. S., Pt., G, Oct. 27, Right ; circ. Surg. T. H. Squire. llth Penn., age 18. 6, 64. Osboni, llth Penn. Disch d 89th New York. 28, 64. 8th N.Y. Disch d April 20, 65. June 1, 1865. July, 65, necro. bone remo d. 34 Becker, C., Corp l, B, Mar. 8, Right ; circ. Surg. C. Coot, 12th 71 Burbank. J. H., Pt,, F, May 3, Right ; flap. Disch d Feb. 25, 12th Missouri. 8, 62. Missouri. Discharged. )0th Massachusetts. 3, 63. 1864. 35 Keck with, D.G., Pt., K, Dec. 13, Left. Surg. J. Ebcrsole. 19th 72 Burcliett, J. IV.. Pt.. K, July 3, Left. Exchanged Nov. 12, 1863. 23d New York. 13, 62. Ind. Disch d April 10, 1863. 8th Virginia, age 21. 3, 63. 36 Beckwith W.(r. Ser"* t April 8 Iltii l ]l F Ser" t K Sept. 17, Surg Lindsay S A B, 5th Alichigan Cav., 8, 65. 5th Mich. June 26th, nee. bone 48th North Carolina. 18, 62. age 31. rem. Dis. Sept. 1, 65. flp. 4239. 74 Kiirkf.tt, F. H., Pt.. D, July 2, Right. Surgeon Pierce, C. S. A. 37 Bell, L, Serg t, 15, 81st July 2, Right; flap. Pisch d March 10, 2d S. Carolina, age 24. 4, 63. Furloughed Dec. 4, 18(i3. Penn., age 20. 3, to. 1864. 75 ^Burnett. J. B., Pt., 1st Sept. 17, Left; circular. Recovered. 38 Bellis, R., Serg t, D, 1st July 2, Right ; circ. Ass t Surg. J. A. S. Carolina, age 31. 18, 62. Maryland P. H. B. 4, 63. Freeman, 13th X. Jersey. Pise. 76 Burton. J. O., Pt., B, Feb. 13, Right ; flap. Disch d June 17, Jan. 31, 1864. 48th Illinois. 13, 62. 1862. 1 SMITH (E. H.), Cases of Fracture of Femur, in Confed. States Me.d. and Surg. Jour., 1864, Vol. I, j>. 24. Z FISHKU (G. J.), Cases of Amp. after the Battle of Antietam, Sept. 17, 1862, in Am. Jour, of Med. Sci., 1863, Vol. XLV, p. -17. 228 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AXD AGE. DATES. OPERATIONS, OPERATORS, RESULT. 77 Butler, A.C.,Pt., D, llth Aug. 14, Right ; circ. Ass t Surg. W. W. 120 Cosby, A. W., Corp l, E, May 5. Left. Surg. Young. Recovered. Maine, age 20. 14, 64. Royal, llth Maine. Disch d 4th Georgia. 5, 64. Sept. 20, 1865. 121 Costa, D., Pt., K, 6th C. Sept. 29, Right; ant. post. flap. Disch d 78 Butler, W. H., Serg t, C, Sept. 29, Right ; circ. Ass t Surg. J. W. Troops, age 19. 29, 64. June 20, 1865. 6th C. Troops, age 24. 29, 64. Mitchell, 4tL Colored Troops. 122 Cotter, W., Pt., E, 9th N. July 30, Right; long post, flap ; rem. dead Disch d May 29, 1865. Hampshire, age 27. 30, 64. bone. Oct. 15, 1871, amp. hip j t. 79 Bnzzell, S. P., Corp l, B, Aug. 13, Right: circ. Surg. W. B. Fox, Specs. 252, 4954, 5946. Died Jan. 38th Wisconsin, nge 24. 13, 64. 8th Mich. Discf d Feb. 25, 65. 21, 1874. 80 Catltlell. G. R., Pt., K, Sept. 19, Left. Surg. Hill, 3d N.Carolina. 123 Covey, W. G., Pt., B, Feb. 14, Right ; ant. post, skin flap. Surg. 43d N. Carolina, age 20. 19, 64. Exchanged April 3, I8!i5. 27th Missouri, age 24. 14, 65. B. N. Bond, 27th Mo. Disch d 81 Cammett, W. B., Pt., A, June 14, Right ; eirc. Surg.C. Abbott, 26th July 15, 1865. 26th Maine. 14/63. Maine. Disch d Aug. 29, 1863. 124 Coyne, P., Pt., B, 69th Sept. 17, Right ; aut. post. flap. Surg. J.H. 82 Cannon, J., Pt., D, 7th July 18, Left : flap. Surg. R. II. Robinson, New York. 17, 62. Taylor. U. S. V. Disch d May Maryland, age 24. 18/04. 7th Md. Disch d June 5, 1865. 15/1863. 83 Cappers, A., Pt., A, 4th May 27, Right ; circ. Disch d Feb. 19, : 64. 125 COT, J. W. M., Corp l, A, May 17, Right. Snrg. Wilson, 4th Miss. Wisconsin. 27, 63. 61st Tennessee. 18/63. Recovered. 84 Capper, 11. M., Serg t,G, Mar. M, Right ; flap. Disch d July 1, 62. 126 Cram, W. H., Pt., K, 9th May 12, By Surg. J. S. Ross, llth New 10th < onnecticut. 14, 62. New Hampshire. 12/64. Hauii>sliire. 85 Carlisle, M., Lieut., G, Sept. 19, Right. Recovered. 127 Cramer, A., Serg t, B, Mar. 16, Left; circular. Disch d Aug. 23, 19th South Carolina. 19, 63. 55th Ohio, age 37. 16/65. 1865. 86 Carpenter, H. II., Pt., D, May 15, Left, Ass t Surg. B. L. Hovey, 128 Creager, W. H., Pt., B, June 27, Left ; circ. Surer. T. B. Williams, 136th N. Y., age 27. 16, 64. 146th N.Y. Disch d June 13, 65. 121st Ohio, age 17. 28, 64. 121st Ohio. Dis. June 21 , 1865. 87 Carpenter, J. M., Pt,, Sept. 19, Left ; circ. Surg. W. S. Love and 129 Crist, (F.J/.,Pt..2dRock- April 2, Left : lat. flap. Released June Carpenter s Bat y, age 19, 64. II. McGuire, C. S. A. Exch d bridge(Va.)Bat.,age!9. 3, 65. 29, 1865. 17. April 1, 1865. 130 Crommett, C., Pt., K, Nov. 18, Left ; flap. Confed. Surg. Disch d 88 Carr, P., Pt., F, 73d June 27, Left; circular. Discharged Aug. 112th Illinois. 19, 63. Feb. 16, 1864. Penn., age 18. 27, 64. 2, 1865. 131 Crow, W. T., Serg t, I. Nov. 30, Right; circ. Provost Marshal 89 Carroll, J., Pt., B, 1st N. June 2, Right. Surg. W. W. L. Phillips, 35th Mississippi, age 25. 30, 64. March 7, 1865. Jersey Cavalry. 2, 62. 1st N. J. Cav. Dis. Sept. 27, 62. 132 Growl, J., Pt., F, 100th July 30, Left; cire. Surg. W. V. White, 90 Carroll, S. F., Pt., D, Sept. 23, Right ; flap. Trans, to prison Penn., age 18. 30, 64. 57th Mass. Disch d Feb. 25, 65. 1st N. Carolina Cav. 23, 63. December 7, 1863. 133 Crye, J. D., Pt., D, 34th May 16, Left; flap. Disch d Sept. 21/64. 91 Carrow, J. T., Corp l, F, June 16, Left ; ant. post. flap. Surg. D. S. Indiana, age 22. 16, 63. 4th Delaware, age 33. 16, 64. Hopkins, 4th Delaware. Disc d 134 Curran, J.W., Pt.,G, 5th April 6, Left ; ant. post. flap. Ass t Surg. May 31, 1865. Wisconsin, age 24. 8, 65. W.W.Allen, 5th Wis. July Kith, 92 Carson, A., Pt., H, 42d Dec. 33, Left. Confed. surgeon. Disch d prot. exfol. rem. Disch d Nov. Pennsylvania, 15, 62. March 4, 1863. 30, 1865. Spec. 547. 93 Carter, C. C., Pt., H, 9th July 19, Right ; out. post. flap. Surg. T. 135 Curtis, R.D.,Pt.,K, 18th June 5, Right ; lat. flap. Surg. L. Hoi- Kentucky, age 35. 19, 64. R. W. Jeffray, 19th Ky. Mus Conn., age 40. 5, 64. brook, 18th Conn. Disch d June tered out Dec. 7, 1864. 27, 1865. 94 Gartner, C., Pt., A, 30th Sept. 19, Right ; circ. Released June 28, 136 Dalton, J., Serg t, G, Oct. 19, Left ; ant. post. flap. Surg. J. R. Virginia, age 22. 1!), 64. 1865. 151st N. York, age 33. 20, 64. Cotes, 151st N.Y. Disch d Jan. 95 Carver, J., Pt., E, 18th July 17, Left ; flap. Dr. Pendleton, C. S. 23, 1865. Kentucky. 17, 62. A. Recovered. 137 Dangler, J. H., Pt., B, Sept. 22, Right ; oval skin flap. Ass t Surg. 96 Casey, J., Pt., C, 100th April 2, Right ; circ. Surg. N. M. Carter, 1st N. Y. Cav., age 26. 22, 64. P. Gardner, 1st Vermont Cav. New York, age 19. 2, 65. 100th N. Y. Disch d Nov. 20, 65. Disch d March 16, 1865. 97 Case} , P., Pt., II, 1st July 10, Right ; flaps of skin ; circ. of mus. 138 Danner, J., Pt., A, 39th May 6, Left ; ant. post.flap. Confed. Surg. Cavalry, age 21. 10, 63. Hiem. July 26th, femoral ligat. New York, age 33. 8, 64. Disch d June 26, 1865. Disch d Dec. 9, 1863. 139 Davis, E. J., Serg t, G, Aug. 25, Right ; circ. Furloughed Nov. 98 Casselberry, G., Serg t, Oct. 27, Left ; bilateral flap. Disch d July Cobb s Georgia Leg n, 25, 64. 24, 1864. K, 51st I enn., age 23. 27, 64. 27, I8o5. Sub. operation. age 25. 99 Cltranif, W. W., Lieut., July 4, Right; haem.; femoral lig. Fur- 140 Davis, B., Pt,, I, 17th Oct. 19, Left ; doub. lat. flap. Surg. Pat ]!, 30th Arkansas. 4, 63. loughed Oct. 15, 1864. Mississippi, age 30. 19, 64. terson, C. S. A. To prison Mar. 100 Cheeseboro, J., Pt,, I, May 15, Right ; circ. Surg. C. J. Bellows, 9, 1865. Nov., 65, seq. remov d. 13!ith N. York, age 20. 15, 64. 7th Ohio. Disch d Juno 19, 65. 141 Davis, J., Pt., B, 88th N. Sept. 17, Right ; flap. Surg. F. Reynolds, 101 Clark, E. W., Pt., F, 5th June 16, Left ; flap. Disch d Feb. 7, 1865. York. 18, 62. 88th N. Y. Disch d Nov. 18, 62. " Michigan, age 31. 17, 64. 142 Day, R. M., Pt., B, 54th July 16, Right; circ. A. Surg. L. D. Rail- 102 Clark, G.W., Pt.,E, 12th N. Hampshire, age 25. May 9, 9, 64. Right; flap. Surg.A.C. Benedict, II. S.V. (also amp. right forearm.) Mass. C. T., age 22. 16, 64. zinsky, 54th Mass. Aug,6, ream- putatV Disch d March 29, 65. Disch d J une 2, 1865. 143 Debaugh, A.,Pt.,A, 123d April 6, Right; flap. Surg. T. II. Squire, 103 Clark, J., Pt., H,8thN. June 14, Lett. Discharged Aug. 24, 1863. Ohio, age 28. 7, 65. 89th N. Y. Discharged. Hampshire. 14, 63. 144 Deloe,W. W., Corp l, H, Mar. 31, Right; circ. Surg. C. M. Clark, 104 dart;, R. F., Pt., B, 49tb March, To Provost Marshal May 10, 65. 15th West Va., age 23. 31, 65. 39th 111. Disch d April 16, 1866. North Carolina, 1865. 145 Demers, E., Corp l, D, July 3, Left; lat. flap. Surg.W.S.Cooper, 105 Clineo, N., Pt., H, 28th Aug. 16, Left ; circ. Surg. 28th North Car 125th N. York, age 21. 4, 63. 125th N. Y. Disch d June 7, 64. North Carolina. 16, 64. olina. Recovered. 146 Dennison, J. M., Corp l, Sept. 19, Right ; ant. post. flap. Disch d 106 Clowes, J., Seaman U. Jan. 15, Left. Surg.J. McClellan.U.S.N.; K, 126th Ohio, age 27. 19, 64. Jan. 17, 1865. S. Navy. 15, 65. nee. bone rem. Dis d Feb. 7, 65. 147 Dercourt, A., Pt,, F, 32d May 8, Right. Disch d Oct. 25, 1862. 107 Cli/burn, B. R., Major, Oct. 19, Left: circ. Surg. Gilmore.C.S.A. New York. 8, 62: 2d S. Carolina, age 22. 19, 64. Sent to prison Jan. 10, 1865. 148 Detweiler, C., Pt., B, May 12, Right ; ant. post. flap. Surg. T.F. 108 Cockburn, W., Serg t, H, Dec. 28, Left; flap. Jan. 7th, femoral lig.; 100th Penn., age 37. 12, 64. Oakes, 56th Mass. Discharged 2d N. Jersey Cavalry, 29, 64. religated 18th and 23d. May li, Jan. 13, 1865. age 38. 1865, recovered. 149 Devlin, J., Pt., 1, 91st N. Mar. 31, Left ; Teale s method ; also amp. 109 Coffett, J. B., Pt., B, 7th May 23, Left. Surg. West. Retired Mar. York, age 22. 31, 65. thumb and mid. finger. Disch d Virginia Cav., ago 20. 23, 62. 8, 1865. Sept. 30, 65. Phot. Ser., Vol. 8, 110 Coleman, M. J., Pt., D, Oct. 14, Left ; circular. Disch d May 9, No. 45. Card Pt., Vol. 1, p. 25. 14 63 1865 ?Dew J. H. Pt. A 24th Sept. 19 Sent to hospit il Oct 31 111 Collins, W. T!, Corp l,A, Aug. 23, Left, Surg. J. P. Prince, 36th Alabama. 21, 63. 1863. 2d Sharpshooters. 23, 62. Mass. Disch d Feb. 23, 1863. 151 DeWolf, H., Pt., D, 7th May 31, Right. Surg. G. Chaddock, 7th 112 Coombs, F. M., Pt., B, Aug. 25, Right: circ. Surg. A. C. Messen Michigan, age 17. Je 1, 62. Mich. Rem. of sequest. Disch d. 6th Missouri, age 23. 25, 64. ger, 57th O. Disch d July 5, 65. 152 Dilks, J., Pt., D, 25th N. Dec. 13, Left; flap. Surg. J. Riley, 25th 113 Council, Q., Pt,. 4th Me. Sept. 29, Left ; ant. post. flap. Disch d Jan. Jersey. 13, 62. New Jersey. Recovered. Battery, age 30. Oct. 1/64. 20, 1865. 153 Dillon, J. J., Pt., B, 16th Mar. 20, Right; flap. Surgeon C. S. A. 114 Connor, H., Capt., H, Mar, 31, Right ; circ. Surg. J. Thomas, Illinois. 20, 65. Mustered out July 8, 1865. 118th Penn., age 28. 31 , 65. 1 ! 8th Penn. Disch d Oct. 28, 65. 154 Dixon, L., Pt., H, 17th July 1, Right; circ. Confed. surg. Aug. 115 Coogan, T., Pt., F, 5th Sept. 20, . A. Surg. Roberts, 5th Texas. Connecticut, age 19. 2, 63. 28th and Sept. 3d, spiculas rem. Texas. 21, 63. Disch d Oct. 16, 1863. Disch d Oct. 10, 1864. 116 Coolidge,N., Pt., K, 46th July 7, Right ; flap. Surg. Allen, C.S. A. 155 Dollar, G., Col d Team March, Right. Doing well. Illinois, age 21. 7, 64. Disch d Oct. 5, 1864. ster. 1865. 117 Conk, J. / ., Pt., H, 4th Oct. 11, Right; flap. Transferred to hos 156 Dormyer, J., Pt., G, 93d Oct. 19, Left ; ant. post, skin flaps ; circ. Virginia Cav., age 34. 13, 63. pital April 10, 18(i4. Pennsylvania, age 29. 20, 64. sect, of mus. Disch. April 1, "65. ,118 Cook, J., Corp 1, F, 6th New York. May 7, 8, 62. Left. Surg. F. II. Hamilton, U.S. V. Disch d July 1, 186J. 157 Douglas, A. C., Serg t, G, 97th N.York, age 20. May 10, 10, 64. Left; flap. Surg.W.B Chambers, 97th N. Y. Disch d Dec. 13, 64. 119 Cooper, H.J.Pt.,F, 71st May 12, Right, Surg. J. M. Rizer, 72d 158 Downs, D., Serg t, B, Nov. 29, Left ; circ. Provost Marshal May Peun., age 23. 12, 64. Penn. Disch d July 27, 1865. 35th Alabama, age 24. : De. 1, 64. 20, 1865. 1 TERRY (C.), Report of wounded, Army of Tennessee, after the battle of Cliickamauga, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 76. 1 TKHRY (C.), op. tit., p. 76. GANGRENE OF THE MEDULLA. SECT. III. PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. 229 No. NAME. MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION AND AGE. DATES. OPERATIONS, OPEIIATOUS, RESULT. 159 Downs, T. J., Ft., B, 21st May 3, Left; circ. Surg. N. Hay ward, 200 French, S., Pt., D, 16th Aug. 16, Left; circ.; bone removed. Dis Mississippi. 3, 63. 20th Mass. Kern, three ins. fern. Penn. Cav., age 23. 16, 64. charged July 18, 1865 Exchanged April 11, 1864. 201 French, W., Corp l, D, Aug. 16, Left ; lateral flap. Discharged ICO Doyle, J., Pt., B, 1st Aug. 3, Left ; flap. Veteran Res. Corps. 17th Penn. Cav. .age 17. 16, 64. Jan. 17, 1866. 202 Fristoe It U Captain July 14 161 >V isconsin cavalry. Drain, W. L., Ft., I, 5tli 3, 62. June 2, Left ; flap. Surg. C. S. A. Feb. 8th Kentucky Cavalry. 14, 64. New York, age 19. 2, 64. 16, 1865, sequest. rem. Disch d 203 Fultz, II., Pt., K, 23d Nov. 25, Left ; flap. A. A. Surg. R.Wirth. June 9, 1865. Spec. 113. Kentucky, age 34. 26, 63 Discharged June 22, 1864. 162 Drach, W. S,,Pt.,F,7th Mav 8, Right ; double flap. Dr. Dungan, 204 Fuller, J., Pt. G., 3d May 14, Right; flap. Surg. A. Sabino, Man-laud, age 22. 9, "64. C. S. A. Diseh d July 21, 1865. 5Iissouri, age 28. 14, 64. 76th Ohio. Disch d Slar. 8, 65. -I (?} Nov. 30 205 Gable, J., Pt., B, 155th June 18 Ri^lit ; ant. post. flap. Sur <f . A, lOo B, 3uth Term., age 20. De. 1, 64. Marshal May 4, 1865. Pennsylvania, age 19. 20, 64. E. Reed, 155th Penn. Disch d 164 Duchenes, J., Pt.,C, 71st July 2, Left flap. Surg. J. 51. 5Ierrow, Aug. 7, 1865. New York, age 26. 3, 63. 2dN. II. Disch d June 14, 1864. 206 Gahl,.jr.,W.,Pt., K,57th Oct. 4, Right ; flap. Recovered. 165 Duff, L. B., Lieut.-Col., June 18, Right. Discharged Oct. 25, 1864. Illinois. 4, 62. 105th Pennsylvania. 18, 64. 207 Gallagher, T., Serg t, F, June 14, Left. Surgeon Davis. Retired 16C DulTuny, A. D., Pt., C, April 16, Right ; flap. Surg. C. M. Chand 7th Louisiana, age 30. 15, 63. February 13, 1865. 6th Vermont, age 44. 18, 62. ler, 6th Yt. Disch d July 1, 62. 2C8 2 Gardner, H., ( apt., I, Nov. 24, Right ; (lap. Surg. A. W. Ileise, 167 Dugal, }j., Sergeant, F, Mav 5, Left ; ant. post. doub.flap. Confed. 100th Illinois, age 23. 25, 63. 100th 111. Ila-m.; lig. cf fem l 14.ith N. Y., age 26. 6, 64. surg. Disch d March 22, 1865. art ry. Disch d Aug. 18, 1864. ]68 Dugan, P., Pt., G, 169th Sept. 29, L t ; circ. Surg. J.Knowlson, 169th 209 Gardner, C. II., Pt., C, June 18, Left ; circ. Confed. surg. Dis. New York, age 25. 29, 64. N.Y. Dis.Nov.3, 65. Nov.25. 65, 16th Mass., age 34. 18, 62. July 11, 1863. S]*c. - itf. reamp.,Surg. Thorn, Troy,N.Y. 210 GarrM, W., Pt., I, 15th July 18, Right; Hap; slough.; gangrene. 169 Duncan, L. S., Serg t, I, Aug. 14, Left ; circ. Provost Marshal Nov. Mississippi, age 18. 19, 64. Recovery. 4th Tenn. Cav., age2ti. 14, 64. 16, 1864. 211 Gathers, L.,Pt.,H, 155th Feb. 6, Left ; flap. Disch d Slay 29, 65. 170 Dunlap,L.I.,Pt.,F,119th April 2, Left ; circ. Surg. P. Leidy, 119th Penn., age 30. 6, 65. Penn., age 22. 2, 65. Penn. Disch d June 17, 1865. 2J2 Gay, I. D., Serg t, F, Aug. 6, Left; irc. Surg. E. Batwell, 171 Dunn, J., Pt., I, 2d New Aug. 14, Right ; circ. Disch d June 9, 65. 91st Indiana, age 28. 7, 64. 14th Slich. Disch d June 20. Co. York II. A., age 30. 15, 64. 213 Gear, N. II., Pt., D, 2d June 1, Left; doiib. flap. Surg.ll. Plumb, 172 Duron, L. M., Pt., C, 7th Oct. 8, Left : circ. Furloughed June 16, Connecticut. 2, 64. 2d Conn. Disch d June 3, 64. Arkansas, age 21. 8, 62. 1863. July 7th, re-amputation. 173 Eaton, G. 1,., Pt., F, 16th April 24, Left ; cire. Ass t Surg. J. B.Whit- 214 Geissler. J., Pt., B, 49th July 12, Right ; ant. post. Hap. Surg. G. Conn., age 28. 24, 63. comb, 16th Conn. Disch d. New York, age 49. 12, 64. T. Stevens. 77th X. Y. Disch d 174 Eck, 11., Serg t, F, 14th Dec. 13, Left. Surg. White. Furloughed June 23, 1865. Card Phot. Louisiana. 13, 62. Jan. 26, 1864. 215 Gelsleichter, C., Corp l, July 30, Left ; double flap. Surg. A. F. 175 Englebrecht, H., Pt., E, April 7, Lett. Disch d August 4, 1862. C, Kith Ohio Cavalry, 30," 64. Whelan, 1st Mich. S. S. Sept. 2d Kentucky. 8, 62. age 32. 7, bone rem. Disch d JuneJ , 65. 176 Erenburg, A., Lieut., 1st Sept. 17, Left. Surg.H.E. Smith, 27th Mich. 216 Gibson. G., Pt., C. 63d June 1, Right. Disch d July 21, 1862. Ky. Light Artillery. 17, 62. Dis. May 15, 65. Subs, rem.bone. Pennsylvania. 1, 62. 177 Evans, E. M., Corp l, D, Oct. 19, Right ; circ. A.Surg.J.M.Cowen, 217 Giese, E. F., Pt., D, 82d July 1, Left: flap. Surg. W. C, Stein 28th Iowa, age 19. 20, 64. 77th 111. Disch d June 21, 1865. Illinois, age 20. 1, *63. 58th N. Y. Sub. oper. Disch d 178 Everson, F., Pt., E, 1st Aug. 24, Right ; circ. Insanity. Washing March 14, 1864. Wisconsin, age 40. 24, 64. ton, Oct. 20, 1864. 218 Gibson, IT. B., Pt.. D, July 3, Left; circ. Transferred for ex 17 J Ewald, 11., Pt.,F,43dN. Mav 3, Right ; flap. Surg. M. Case, 43d 2d S. Carolina, age 23. 4, 1863. change Sept. 10, 1863. York, age 18. 5, 63. N. Y. Disch d Sept. 16, 1863. 219 Gildersleeve, A., Lands Jan. 15, Left ; also amp. r t thumb and in 180 Fairgricves, G., Pt., H, June 1, Right ; circ. Surg. J. S. Martin, man, U. S. Steamer 16, 65. dex finger. Re-amp. Disch d 15th X. Jersey, age 23. 2, 64. 14th N. J. Disch d June 30, 65. Montgomery. July (i, 1867. 181 Farmer, M.. Pt., K, 10th June 3, Left; circ. Surg. 11. N. Small, 220 Gill, J. W., Serg t, A, April 2, Left; flap. Surg. E. 1C. Foreman, N. Hampshire, age 24. 3, 64. 10th N. II. Disch d June 14, 65. 6th Maryland, age 27. 2, 65. 6th Sid. Disch d July 21, 65. 182 Faulkner, I., Pt., B, (ith Aug. 25, Right; circ. A. A. Surg. J. F. 221 Godley, L.M., Serg t, E, 51 ay 22. Left ; flap. Discharged Sept. 4, Missouri Cav., age 25. 27, 64. Musgrove. Disch d Mar. 16, 65. 22d Iowa. 23, 63. 18(i3. 183 Feerer, D. A., Pt., A, Mav 27, Left ; flap. Disuh d Dec. 28, 64. 222 Gooch, J. 1)., Pt., B, Mav 5, Left : circ. Surg. Slater, 15th Va. 7 .)th Ohio, age 22. 27, 64. 15th Virginia. 5, 64. Furlonghcd May 25. 1864. 184 Fickel, S. W., Pt., B, Aug. 26, Right ; circ. Surg. J. S. Reeves, 223 Good, P., Pt., B, 33d June 22, Left ; flap. Dis ch d April 14, 78th Ohio, age 17. 26, 64. 78th Ohio. Dec. 4th, re-amp, by Indiana, age 19. 23, 64. 1865. Surg. G. Grant, U. S. V. Dis 224 Gould, T. M.. Serg t, E, July 20, Right; circ.; gang.; bone exc. charged July 24, 1865. 29th Alabama, ago 29. 21, 64. Recovery. 1S5 Fitzgerald, C., Pt, G, Jan. 7, Left. Ass t Surg. F. J. Foster, 225 Goulding. J. F., Serg t, July 2, Right ; tta p. Surg. N. Hayward, lOlith Illinois, age 25. 7, 65. 13th 111. Cav. Dis. Aug. 31, 65. C, 20th Massachusetts, 3, 63. 2Uth Slass. Aug. 30, spicu. ext. 186 Finn, J., Pt., B, llth Oct. 1, Right. Surg. T. M. F landrail, age 29. Sept. 23, nee. bone ext. Disch d Infantry, age 28. 1, 64. 146th N. Y. Duty Mar. 17, 65. Jan. 28, 1864. 187 Fisher, H., Pt., E, 14th July 5, Right ; long. ant. flap. Insanity. 226 3 Gowans, J., Pt., A, 38th Dec. 13, L-ft ; lat. flap. Ass t Surg. R. A. N. York II. A., age 36. 5, 64. Insane asylum Mar 3, 1865. New York. 15, 62. Everett, 5th Mich. Discharged 188 Fisher, L., Corporal, F, June 3, Rijjht. circ. Discharged May April 27, 1863. 184th Penn.. age 18. 3, 64. 30, 1865. 227 Grant, P., Pt., E, 48th June 27, Left; circ. Surg.W.R.D.B .nck- 189 Fisher, T., Corp l, 15, 4th June 14, Right ; flap. Discharged 5Iay Pennsylvania, age 17. 27, 64. wood, 48th Pa. Dis. Jan. 1 3, 6J. Colored Troops, age 1 8. 15, 64. 20, 1865. 228 Grant, 11., Pt., F, 165th July 23, Left ; circ. Discharged Feb. 10, 190 Fordice. J. 11., Pt., B, Sept. 11, Left; circ. A. A. Surg. W. H. New York, age 21. 25, 64. 1865. 3:>th Illinois. 11, 63. Finn. Disch d June 20, 1864. 229 "Gray, W. A., Pt., K, Sept. 19, Right. Discharged Oct. 9, 1863. 191 Folger, I. H., Lieut., II, June 3, Right. Surg. 32d Me. Subseq. 24th Alabama. 19, 63. 58th Mass., age 21. 3, 64. operat n. Disch d Deo. 17, 64. 230 Gra>j, W. 11., Pt., F, 33d Slay 23, Left. Ass t Surg. J. A. Vigal, Dead bone removed. North Carolina. 24, 64. 33d N. Carolina. Recovered. 192 Follard, J., Pt., A, 21st Nov. 30, Left ; circular. Provost Marshal 231 Green. D., Serg t. G, 4th June li), Left; ant. post. Hap: remo. necr. Tennessee, age 18. De. 1, 64. March 18, 1865. Delaware, age 26. 19, 64. bone. Disch d June 23, 1865. 193 Forney, K., Pt., H, 48th Sept. 17, Right : flap. Discharged Jan. 232 Green, J. D., Pt., E, 7th Mav 5, Left ; flap. Surg. Smith, C. S.A. Penn., age 24. 18. 64. 13. 1864. 51aryland, age 22. 6, 64. Disch d Aug. 18, 1865. 194 Forrest. J. J., Pt., K, Sept. 1, Right : flap. Surg. D. S. Young. 233 Green, T. G.. Pt., G, July 1, Left; flap; necr. bone removed. 21st Ohio, age 24. 1, 64. 21st Ohio. Disfh d June 21, 65. 36th New York. 2. 62. Disch d July 15. 6:5. Spec. 1 15. 195 Forrester, P., Pt., G, Dec. 13, Left : ant. post. flap. Surg. \V. 234 Green, W. II., Pt., K, S~ept. 4, Right. Released April 1, 1865. 99th Pennsj-lvania. 13, 62. O Meagher, 69th N. Y. Sub. rem. of bone. Dis. Nov. 26. 63. 235 2d S. Carolina, age 32. Griffin, H. SI., Pt., D, 4, 64. July 6, Left ; circ. Surg.E. Hat well, 14th 196 Fountain, N.,Pt.,B, 18th Oct. 5, Right: circ. Surg. E. J. Buck, 14th Michigan, age 20. 6, 64. Slich. Discharged July If, 65. Wisconsin, age 17. 5, 64. 18th Wis. Disch d May 18, 65. 236 Grogan, A., Lieut., G, June 29, Left ; ant. post. flap. Surg. ! . L. 197 Fonts, S., Pt., G, 2d Feb. 15, Left ; flap. Discharged. 6th Conn., age 21. 29, 64. Dibble. 6th Conn. Discharged Iowa, age 23. 16, 62. Nov. 26, 1864. 198 Fralick, \V. A., Pt. M, April 2, Left ; circ. Confederate surgeon. 237 Groover, P. II., Pt., I, Oct. 20, Right. Surgeon Burton. Recov IDthN.Y. H. A., age 19. 2, 65. Disch d Sept. 22, 1865. 48th Alabama. 20, 63. ered. 199 Frazer, P., Lieut., C, 4th July 30, Right ; flap; haem. Disch d April 238 Gross, J., Corp l, E, 82d Slay 25, Right : circular. Disch d Feb. Colored Troops, age 40. 30," 64. 22, 1865. Illinois, age 24. 26, 64. 12, 1865. O MEAGHKK (W.), Casualties at the Battle of Fredericksburg. in Am. Med. Time.s, 1863, Vol. VI, p. 179. 2 LIHELL (J. A.), On the Surgical Treatment of Traumatic Hemorrhage, etc., in Surg. Mem. of the War of the Rebellion, collected and published by the U. S. Sanitary Commission, 1870, Vol. I, p. 225. 3 O SIKAGUEU (W.), Casualties, etc., op. cit., p. 179, and Surg. Mem. of the War of the Rebellion, Coll. and pub. by the U. S. San. Comm., 1871, Vol. IL p. 20. * TERUY (C.), toe. cit., p. 76. IN.IUKIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME. MII.ITAUV DESCUH TIOX, AND AcK. DATES. ( UT.UATIONS. Ol EKATOKS, RESULT. No. ! NAME, MILITARY DEscnii Tiox. AND ACK. DATES. Ol KKATlONS, ( H EKATOIiS. RESULT. 239 (j rorex. J. li.. Pt.. K, July 1, Left. Recovered. 280 Hunt, M., Serg t. I), 3d June 3, Left; double flap. Surg. D. M. 13th North Carolina. 2, 63. Vermont, age 25. 3, 04. Goodwin, 3d Vermont. Disch d 240 Guy II. W., Pt., F, 14th July 1, Right; ant. post. flap. Surg. G. May 17, 1865. N. York S. M., age 30. 2, ; 63. M. Ramsey, ! 5th N.Y. Disch d 281 Hyndman. J. A., Pt., G, Feb. 23, Left; cire. Surg. D.V. Runnels March 30, 1864. Spec. 4368. 5th Ohio Cavalry. 23, 03. and Ass t Surg. G. Sprague, 5th 24) Gayer. F., Capi. D, 83d Mav 6, Right: circ. Confed. surgeon. Ohio Cav. Disch d June 3, "04. Now York, age 36. 7, 64. Mustered out. 282 Iburg, F.. Pt., E, 2d Oct. 8, Left; flap. Disch d Oct. 3, 1863. 242 Hall, A. A., Pt., E, fith Oct. 11, Right; circ. Surg.B.G. Streeter, Missouri. 8, 02. N. York C av., age 20. 11, C3. 4fh N. Y. Cav. Disch d Aug. 283 Imhoff. F., Pt.,D,2d N. July 3, Left; flap. Disch d March 15. 23, 1804. Spec. 4307. Jersey, age 32. 4, 03. 1804. 243 HalloweU, W. G., Pt., Oct. 14, Left. Furloughcd Dec. 18, 1863. 284 Inman" W., I t., D, 4th May 5, Left; flap. Surg. J. D. Osborne, A, 27th North Carolina. 15. 63. New Jersey. 5, 04. 4th N. J. Disch d Nov. 21, 64. fyAI Sept. 10 C -p., ,. f< ^ A 285 Inman, P., Pt., A, 95th June ^ 7 Left; flap. Surg. G. W. East nfl 1 * Hamilton. *f. R-, Lieut., E, 10th Florida. 10, 64. Recovered. Illinois, age 20. 27, 64. man, Kith Wis. Sub. amputa 245 Hammell, D. F., Serg t, Oct. 19, Right; flap. Snrg.G.T. Stevens, tions. Disch d June 17, 1805. E, 132dN. Y., age 34 19, 64. 77th N. Y. Disch d May 30, 65. 280 Irvine, T., Pt., I, 1st Mav 31, Left ; cire. Confederate surgeon. 246 Hammers, G., Capt., D, July 21, Left: circ. Surg. J. W. Lawton, Pennsylvania, ago 27. J ne l, 64. Disch d May 12, 1865. -7th Kentucky, age :i4. 21, 64. U. S. V. M. o. March 29, 1865. 287 Jackson, A.. Pt., E, 75th Aug. 19, Right ; circ. "(also w d left knee). 247 Hanna, O., Pt,, B, 47th Mar. 21, Right ; circ. Surg. J. II. Hutchin- Ohio, ago 18. 19, 03. Surg. C. L. Wilson, 75th Ohio. Ohio, age 26. 21, 65. son, 15th Mich. Disch d June Disch d Jan. 20, 1865. 17, 1865. 288 James, J., Pt.. H., 19th July 2, Right; flap. Disch d Nov. 12, 24 1- Hannah, A., Pt., I. 1st Aug. 12, Right: flap. Surg. H. II. Lang- Maine, age 29. 3, 03. 1804. Mich. Art y, age 18. 12, 64. don, 7t)th Ohio. Disch d Oct. 3, 289 James, S.E.,Pt.,G. :!0th Oct. 21. Right ; flap. Surg. A. T. Hud 1865. Iowa. 21, 03. son, 20th la. Disc. Feb. 27, t4. 249 Hauerwas, L , Pt., C, May 15, Left; circ. Confederate surgeon. 290 Jarrell, A., Corp l. I, 1st April 7, Left ; circ. A. Surg. E. P. Roche, 18th Connecticut. 16, 64. Disch d May 12, 1865. Delaware, age 23. 8, 65. 35th Mass. Disch d Oct. 18, 65. 550 Harford, T. J., Pt., D, April 8. Right; circ. Ass t Surg. W. F. 291 Jarvis, I.,Pt.,K, lOthN. May 31, Left ; circ. Surg. O. R. Freeman. 161st N. York, age 21. 9, 64. Sigler, 13Cth III. Sub. opera n. Jersey, age 30. 31, 64. 10th N. J. Disch d Dec. 15, 64. Disch d March 8, 1865. .M,.) Jay, I., Pt., 14th In June 10, Right; ant. post. flap. Confed. 231 Harvey, H.G.. Capt.,E, June 12, Right; circ. Surg. G. L. Potter, diana Battery, age 28. 11, 64. surgeon. Disch d July 8, 1865. 145th Pennsylvania. 12, 64. 145th Penn. Disch. Dec, 19/64. 293 Jean R. M., Pt., G, 3d July 8, Left. Surgeon Brown. Recov 252 Haskins, D. , Pt.. 1st Sept. 29, Left; double flap. Ass t Surg. Arkansas. 8, 64. ered. Virginiai Artillery. 29, 64. W. F. Richardson, C. S. A. Fur- 294 Jennings, J. W.. Serg t, Jan. 17, Left. Surgeon Bozeman. Re loughed Nov. 10, 1864. B, Hampton s Legion. 18, 64. covered. 253 Held, P., Pt., C., 40th Mav 23. Right; ant. post. flaps. Nov. 18th, 295 Jerger, S.,Capt., K, 27th Mav 3. Right; circ. Discharged Aug. New York, age 21. 23," 64. bone rem. Disch d Mar. 8, 1805. Indiana, age 40. 3. 63. 19. 1863. 254 Honne, li., Lieut., II, Mar. 8, Left. Surg. C. Cook, 12th Mo. 290 Jess, T., Pt.. F, 125th Aug. 5, Left : flap. Surg. M. AV. Hooton, 12th Missouri, age 40. 8, 62. Disch d Jan. 27, 1863 ; re-amps. Illinois, age 25. 5, T 64. 80th 111. Disch d Feb. 22, 65. 255 Herald, J., Pt., J, 1st Aug. 29, Right. Surg. J. \V. Tunniclitfe, 297 Johnson, V, W., Serg t, June 21, Right. Surg. A. Hard, 8th 111. Michigan. 29, 62. 1st Mich. Disch d Feb. 20, 63. O, 3d Indiana Cavalry. 21, 03. Cavalry. Diseh d Feb. 11. 64. 25G Hill, J., Pt., B, 79th N. Oct. 10, Left; circ. Surg. G. 13. Coggs- 298 Johnson, W. W., Corp l, Julv 1 , Right: ant. post. flap. Disch d York, age :)6. 11, 63. well, 2!)th Mass. Discharged E, 143d Penn., age 31. 2, 03. Jan. 20, 1864. June 4, 1864. Spec. 4377. 299 Jolin.-<ton, J. L., Corp l, July 22, Right : circ. Sept. 5th, gang.. 257 Hill. T. M.. Pt., I, 14th Julv 3, Left. Surg. L. V. Hurt, C. S. A. G, 19th Ala., age 20. 22, 64. slough. Trans d Sept. 22, 64. South Carolina. 4, 63. Paroled Sept. 23, 1803. 300 Johnston, G. S., Pt,, H, May 22, Left. Surgeon Hunt, C. S. A. 258 Hitler, S. J.. Pt., E, 3d Oct. 19, Right ; circ. Surg. Evans, C. S. 27th North Carolina. 22, 63. Recovered. South Carolina, age 23. 19, 64. A. Pro. Marshal April 1, 1865. 301 Johnston. R., Pt., D, July 20, Right. Disch d June 7, 65. Died 259 Hodges, S., Pt., F, 82d May 25, Left ; flap ; gangrene ; re-amp. 70th Indiana. 20, 64. March 15. 1809; pytemia. Ohio, age 20. 26, 64. I .Tune Kith. niseh d .Time 5. 65. 302 Jones J seaman II. S. Jan. 15 Left. Disch d August 4, 1805. 260 Holbrook, C., Pt., II, May 12. Left ; double flap. Confed. surg. Navy. 16, 65. lOUth N. York, age 21. 14, 04. Disch d Nov. 25, 1865. 303 Jones, E. E., Corp l, F, Jan. 15. Left; circ. Ass t Surgeon F. B. 201 Holloit dit J -I Pt F 1 17th N York afre 20 15 65 15th South Carolina. 1, 64. 7,1864. Diseh d Oct. 14. 1865. 2(52 Holloway, F., Corp l, F, June 1, Right : doub. flap. Confed. surg. 304 Jordan. A., Pt., C, 12th Oct. 19. Left : circ. Discharged June 12, 3Gth Wisconsin, age 20. 1, 64. Disch d May 27, 1865. Maine, age 21. 19, 04. 1865. 2G3 Holmes, P., Pt.. D. 8th June 3, Right ; circ. Ass t Surg. W. R. 305 Joyce, E., Pt., A, 1st Mav 27, Left ; ant post. flap. Surg. M. Maine, age 20. 3, "64. Benson, 8th Maine. Discharged Artillery, age 27. 27," 63. Benedict, 75th N. Y. Disch d May 3, 1805. March 30, 04. Spec. 2670. 264 Holmes, W. F., Pt., G, May 9, Left; flap; three-fourths of an 306 Knrn, W.. Pt., G, 118th July 20, Left ; ant. post. flap. Surg. C. D. 4th Tcnn. C av., age 24. 9, 64. inch ot bone remo. Recovered. Ohio, age 24. 20, 64. Moore, 13th Ky. Disch d April 265 Hopwood, A. S.. Corp l, June 28, Left; Surg. R. R. Taylor. U.S.V. 14. 1805. B, 7th Ky. C av., age 27. 28, 63. Disch d June 8, 1804. 307 Karstens. H., Corp l, K, Sept. 19, Right : flap. Surg. J. G. F. Hol- 266 Ilorton, \V. H., Pt., B, July 2, Right ; removal of protruding 16th Iowa. 19, 02. ston, U.S.V. Disch d Ap 18, 63. 8th Alabama age 19. 2, 03. b:inc. Exchanged. : ;i - Kearney, J., Serg t, I, July 2, Right; circ. Surg. G.W.Metcalf. 267 Houghton. C. H., Capt., Mar. 25, Right; circ. Surg. W. Ingalls, 76th New York, age 30. 2, 03. 76thN.Y. Also amp. r tthumb. L, 14th New York II. 25, 65. 5 Jth Mass. Disch d Aug. 26, Disch d.Iulyli, 1864. Spec. 4300. Artillery, age 23. 1865. Spec. 4001. 309 Heeler. D. N., Pt., C, Feb. 15, Right; circ. Diseh d Oct. 11. 268 House, M., Serg t, F, Feb. 1, Left; flap. Surg. A. Sabine, 76th 8th Illinois. 16, 02. 1802. 9th Iowa, age 21. 1, 65. Ohio. Diseh d June 6, 1865. 310 Keller, G. W., Pt., I, Aug. 28, Left: flap. Surg. J. McNulty. 269 Howard, R. C., Pt.. F, Sept. 27, Right : circ. Confed. surgeon. 19th Indiana. 29, 62. U. S. V. Disch d Dec. 23, 62. 5th Penn. C av.. age 22. 27, 04. Disch d July 18, 1805. 311 Hells, J., Pt., I, 113th Sept. 1, Right: ant. post. flap. Surg. T. 270 Howard. \V. H., Pt., K, Aug. 19, Right: circ. Disch d N ov.25, 65. Ohio, age 44. 1, 64. B.Williams.rjlstOhio. Disch d 14th New York II. A., 20, 64. Died Nov. 27, 08. Spec. 391. March 21, 1865. age 18. 312 Kelly, J., Pt., G, 2d Mav 31, Lett; flap. A. A. Surgeon J. II. 271 Howe, F.M.,Pt.. C,30th Aug. 18, Left; circ. Surg. W. B. Fox, Artillery, age 21. 31," 64. Thompson. Julv 31, seq. rem. Michigan, age 23. 18, 64. 8th Mich. Disch d July 26, 65. Disch d Mar. 10, 05. Spec. 2920. 272 Hw.-Jf.tt, H. M., Pt., A, May 6. Left. Surgs. Hancock and Trip- 313 Kelly, M.. Pt., A, 1st Aug. 16. Left ; bilateral flap. Discharged 7th Louisiana. 7, 62. lett. Disch d July 14. 18C2. Vermont Battery. 16, 63. Dec. 10, 1803. 273 Hoyner. J., Pt., A. 153d Oct. 1! , Left: circ. Surg. N. L. Snow, 314 Kelscy. E. E., Pt., B, Dec. 13, Left. Diseh d March 13, 1864. New York, age 30. 20, 64. 153d N. Y. Disch d Jan. 9, 65. 04th New York. 14, 62. 274 Hulbard, W. Jtf., Pt., A, July 2, Left. Surgeon White. C. S. A. 315 Kennedy, J., Serg t, A, Dec, 15, Left; circ. Surg. J. W. Green, 1st Louisiana, age 26. 2, 63. Exchanged March 3, 1864. 95th Illinois, age 28. 15, 04. 95th 111. Disch d June 8, 1805. 275 Huck, J., Pt., A, 72d Avig. 27. Left. Disch d April 7, 63. Died 316 Kennedy, 1 . R.. Pt., C, Oct. 14, Left; circular. Furloug d Feb New York, age 34. 27, 62. Sept. 8, 1865. 27th N. C.. age 21. 15. 03. ruary 13, 1804. 27t ; Hudson, G. H., Pt., L, Sept. 23, Left : circ. Surg. W. S. Love, 317 Killen, A., Pt., K, 14th Sept. 19, Left ; ant. post. flap. Disch d 5th Virginia, age 38. 2:!, 04. C. S. A. Released June 28, 65. Ohio, age 31. 21, 63. July, 17, 1805. 277 Huffman, A., Corp l, C, Dec. 3J. Left; flap. Surg. B. F. Miller, 318 Killian, M., Pt . I, 79th Julv 20. Right: hit. flap. Disch d July 2d Ohio. 62, Jan. 2d Ohio. Disch d April 9, 63. Penn., age 20. 21, 64. 13, 1805. 1, 63. 319 King, A., Pt.. II. 7th Aug. 24, Right: flap. Ass t Surg. C.. R. -. .- Hughes, P. F., Serg t, Mav 18, Left : circ. Surg. W. S. Cooper, Michigan Cavalry. 25, 04. Richards, 7th Mich. Cav. Disch. C, 125th New York, 18, 64. 125th N. Y. Nee. bone rem. 320 Kirly, W. T., Pt , , Sept. 19, . Bono protruded; reampu- age 22. Disch d Aug. 29. 65. Spec. 3^76. 50th Alabama. 19. 03. tation. 279 Hunt. J., Pt., K, 151st June 1, Right ; double flap. Discharged 321 Kirby, \V. II.. Pt., A, July 1, Left; flap. Disch d May 6, 1804. New York. 2, 64. Dec. 26, 1864. 7th N. Jersey, age 24. 2, to. . I O KEEFE (D. C.), Surgical Casi-s of Interest, treated tit Institute Hospital, . urg. Jour.. 1865, Vol. II, p. 25. 2 TERUY (C.). Joe. cit., p. 70. SECT. III. | PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. No XAMK, MILITARY DESCIIU TIOX, AND AfJK Ol KKA TIOX8, OPERATORS, RESULT. NO II NAMK, MILITARY DESCRIPTION, AND AGE. .,.,. Ol KKATIOXS. OlT.KATOIJS RKMI.I. 322 Kline, K., 1 t.. E, 51st June 3. Uight: flap: necrosis. Mustered 365 Lucas, W. V., Sersr t, I, May 1, Right ; flap. Disch d Aug. 27. Penn . age 1!>. 3, ti4. out Jan. 25, 1866. 8th Indiana. 1, 63. 18G3. 323 Kin tli H. < . II- Serg t, Dec. 16, Right; circ. Provost Marshal 366 Lusty, H, Pt.. E. 15th July 2, Left. Surg. S. H. Plumb. 8_ d K, 8th Ark . age 22. 17, 64. Juno 24, 1865. Massachusetts, age 18. 2, 63. X. V. Disch d Jan. 12, Ib64. 324 Kottinger. .1. F.. Pt.. B. Dec. 31. Left ; Hap. Ass t Surgeon J. F. 367 Luttmann, J., Pt., K, Jan. 15, Right ; circ. Disch d May 7, (;.">. 16th Infantry, nge 30. 62. Jan. Woods. K. S. A. Disch d July 203d Penn., age 34. 15, 65. 1. 113. 15, 1863. 368 Li/onx. W., Pt., Wheat s July 21, Left. Surg. Love. Recovered. 323 Konklcman. F.. Pt.. C. Oct. 8, Right ; flap. Disch d July lit, Battery. 21, 61. I 149th Penn., age 19. 8. 64. 164. 369 Maybt. W., Pt.. C, 63d May 16, . Recovered. I 326 Kohlnian. II., Pt.. F, Pec. 13. U t; circ.; also amp. three fingers Tennessee, age 51. Hi, 64. 47th Ohio, age 37. 14, (i4. r t hand. Surg. I. X. Barnes. 370 Madden. T.. Corp l, A, May 27, Left: circ. Surg. X. W. Leigh- lliith 111. Disch d Sept. 20, 65. 173d New York. 29, 63. ton, 173d X. Y. Disch d Sept. 327 Kountz. J . musician, G. Nov. 25. Lett : ant. post. flap. Surg C. P. 12, 1863. 37th Ohio, age 20. 25, 63. Brent. 54th Ohio. Discharged 371 Maguire, D., Serg t. B, June 26, Left ; circ. Dr. Swinburne. Dis April 29. 1864. 2d Penn., age 24. 28, 62. charged Mar. 3, (M. Spr.r. 170. 328 Kramer, C., Pt., E, 191st Mar. 31. Lelt: oval skin Hap: circ. sect. 372 Magill. D. B.. Capt., A, Jan. 15, Left. Surg. J. W. Mitchell. 4th Penn.. age 20. 31, (15. of muse. Disch d June 16, 65. 117th X. York, age 26. 15, 65. C. T. Diseh d June 8, 1865. 329 Kranz.C.. Corp l. B. 15th Aug. 18. i Left : circ. Disch dSept.]-, . 373 Maher, P., Lieut., F, 63d June 22. Left. Discharged June 12, 1865. X. Y. II. A., age 27. 19. <M. 1865. New York, age 42. 22. 64. Not pensioned. 330 Kreig, P., Pt , C. 40th Aug 21, : Left ; amp. left arm. Surg. W. 374 Main, F. F.. Pt.. F, 100th July 18. Left; ciro. Confcd.Surg. Slough New York, age 28. 21. 64. 15. Fox. 8th Michigan. Di.-ch d New York, age 19. 19, 63. ing; necr. liisch d July 30.V1. April 27, 1865. .S jwc. 4298. :i Landolt. W. H., Serg t. April (i. Left: circ. Disch d July 13, 65. 375 Mansfield. C.. Pt., E, May 12, Right ; flap. Disch d March 24. A, 5th Wis.. age 29. . 6, 65. 145th Penn., age 30. 13. 64. 1865. 332 Langshold. A.. 1 t.. I!. May 12. Left : Hap. Pisch d Aug. 8, 63. 376 Manson, S. B., Pt., F, July 24, Right: flap. Surg. C. L. Traf- i 8th Illinois. 12, (13. 3- ( d Maine, age 24. 24, 64. ton, 32d Maine. Disoh d May 333 T.:im> .F M. Sor" t. E Oof 7 TJi.rht- fl:m TkicoliM .Tiili- 9C 6 1865. Kith Penn. Cav.,oge41. 28, 64. 1865. 377 Mapes, W. E., Capt., II, Aug. 14, Right; flap. Disch d Dec. 19. 6-1. SIM Langan, J.. Pt.. B, 2d June 18. Right: ant. post. Hap. Surg. S. 124th X. York, age 21. 14. 64. Michigan, age 22. 18. 64. S. French. 20th Mich. Gang. 378 Marine, S. A., Pt , G, July 21, Right ; Hap. Surg. M.W. Thom Disch d Sept. 11, 1865. loth Iowa, age 21. 21 . 64. as, 13th Iowa. Dis. April 5/65. 335 Lanning. A., Serg t. F, ! Dec. 15. Left; circ.: gang.: necr. Disch d 379 Marr, A. C., Serg t, E, Sept. 19, Right: flap. Surg.T. A. Ilclwi-r, 9:kl Indiana, age 27. j !", 64. Xov. 16, 1865. 14th X. Jersey, age 25. 19. "64. 87th Penn. Disch d July ,". (.">. 336 Lapham. C. X.. Corp l. July 8. Right: ant. post. flap. ( Left : 380 Marsh. A., Serg t, B, May 12, Right: flap. Surg. J. W. Wis K, 1st Vermont Cav., 10, " 63. knee joint.) Surg. A. Wood, 1st 64th X. York, age 32. 12, 64. hart, 140th Penn. Feb., 1865, nye 23. Mass . Cav. Disc d Aug. 25. 64. necrosed hone pulled awav. 337 Lanystone, B. F.. Pt.. C. Nov. 30, Left ; bilateral flap. Prov. Mar Disch d Feb. 24, J865. 5th Arkansas, age 19. Do. 1, 64. shal March 27, 1865. 381 Marsh. T. J., Pt.. I. 2d June 18, Rig-lit ; ant. post. flap. Proves! 338 Larkin. A. 1?.. 1 t.. I), Oct. 21. Right ; lat. flap. Surgeon G. L. Missouri, a<?e 19. 19, 64. Marshal Oct. 21, 1864. 30th Iowa, age 24. 21. 63. Carhart, 31st Iowa. Pisch d 382 Martin, D. D., Pt., C, Sept, 15, Right ; flap. Discharged 1863. Feb. 4. 1864. 12th Maine, age 45. 15, 62. 339 Lawrence, J. K., Pt.. D. May 12. Left ; circ. Pisch d June 16/65. 383 Martin, J.. Corp l, F, June 22, Right : flap. Surg. J. Chapman, 93d New York, ago 33. i 13, 64. 123d X. York, atre 25. 22, 64. 123d X. Y. Disch d July 19, 65. 340 Laurie, C., Pt., F, 2d June 4, : double flap: gang. Fur- 384 Martin, J., Pt., D, 106th Sept. 19, Left: flap. Sursr. T. A/Helwig, Vermont. 4. 64. loughed. Xew York, age 20. 19, 64. 87th Penn. Disch d Mar. 31/05. 341 Learey. J., Pt.. M, 10th Mar. 31, Left : ant. post. flap. Disch d 385 Martin. S.. Pt. . H, 64th July 22, Left: flap. Disch d Feb. 28, 65. N. Y ork Cav.. age 22. A)>. 1/65. July 20, 1865. Illinois, age 22. 22," 64. 342 Leach. E. B., Corp l. K, Sept. 19. Right ; ant. post. flap. Surg. J. 386 Martin, W. J., Corp l, I, July 20, Right: ant. post. flap. Surg. J. 2:>th Mass., age 33. 20. 64. G. Bradt. 2, .th Mass. Pisch d 14th W. Va., age 33. 21, " 64. H. Manown, 14th W. Va. July Oct. 29, 1864. 27. 65, necrosed bone removed. 343 L?.?, r. ,r., PI., i, 38th Aug. 25. Right. Surgeon Wilbur. C. S. A. Pisch d April 16. 1666. Virginia, a^o 32. 26. M. Retired March 13. 1865. 387 Mason, G., Pt., K, 13th Sept. 30, Right ; circ. Prison Jan. 27, 65. 344 L:-::, Z. J ., Pt., C, 23d Sept. 20. Right. Surgeon Plummer. Re- Virginia Cav.. age 24. Oct. 1/64. Tennessee. 20. 63. covered. 388 MeAnany, P., Pt., Bat y April 12, Right: ant. flap. Pisch d from 315 Le Flure. 11., Serg t, (1, July 17, Uight; circ. Pisch d Aug. 29, A, 1st Art ry, age 28. 12, 63. hospital Jan. 29, 1864. 2d Kansas Col d. 17. 63. 1804. 389 McCann. F., Pt.. B, 10th Aug 17, Right: circ. ( unfed. Surgeon. 340 Loggett, W. F., Pt.. F. July 29. Left : Hap. Surg. A I!. Stewart, Xew Jersey, age 22. 18r 64. Pisch d March 17, 1R65. 1st Ala. Cav., age 2 i. 3J. 03. 1st Ala. Cav. Pise. July 5. 64. 390 McCarthy, F., Corp l, G, April 30. Right. Disch d Aug. 14. 1863. 347 Lelar, \V. P.. Corp l, II. Dec. 13. Right. Pisch d May 4, 1863. 1st Wis. Cav., age 27. 3:), 63. Died Feb. 10, 1864. 9Jth Pennsylvania. 14. 62. 391 MoClaskev. J. R.. Serg t, July 6, Left : ant. post. flap. Surg. M.W. :;l- Lemmon. J.. Corp 1, P. May 17. Right: flap. Surg. G. P. Rex. A, 13th Iowa, age 33. 7, 64. Thomas. 131h Iowa. Diseh d 33d Illinois. 17." 63. 33d III. (Jang. Pisch d Xov. Aug. 23, 1865. - 4. 1863. 392 McClintock, J. II.. Pt.. Oct. 19. Left : ant, post. Hap. Surg. F. A. 349 Lennon. W., Pt., A, 8tli Oct. 25. Lett: circ. Pisch d May 26, 64. A, 87th Penn., age 18. 19, 64. llelwig, 87th Penn. Discharged .Michigan Cav., a-, o 17. ; 25. 63. April ](). 1865. 350 Leonard. <>. H.. Pt.. 1!, Julv4. Right : ant. post. flap. Surg. C. 393 McCord. P..Pt .(!, 149th July 3. Left : circ. Surg. J. V. Kendall. 21st Indiana, ago 22. ! 4, 64. J. Walton. 21st Ky. Pisch d Xe\v York, age 24. 3. 63. 149th X. V. May 26th, rein, of June 20. 1865. bone. Pisch d March 3, 1865. 351 Levitt, J.. Serg t. C. 35th June 18. Left; circ. Surg. S P. Ilawley, Spen. 2756. Illinois, age 31. 19, (14. 35th 111. Disch d Feb. 24. 65. 394 McDonald. II.. Corp l. F, Oct. 16. Left: ant. post. flap. Confederate 352 Lewis, M.. Pt.. K. 7th July 3, Right. Pisch d June 3, 1864. 61st C. Troops, age 24. 17. 61. Surg. Disch d July 29. 1865. Mich. Cav.. age 18. 4. C.i. 395 McFarling. J., Pt.. 1), June 22, Left : flap. Disch d May 31. 65. 353 Liesy, J.. Pt.. P.. 17th May 14, Right: circ. Disch d Feb. 18. 154th X. Y., age 20. 2. , 64. Ohio, ago 36. 15. 64. 18(15. 396 Me.Gary, W.. Pt., D, 1st July 12. Lett: circ. Surg. Clark. Dis 354 Lillev. S. O.. I t.. L. 1st May 19. Right : flap. Disch d April 26. Xew jersey, age 29. 13. 63. charged Oct. 5, 1863. Maine H. A., age 2 .). 21. 64. 1865. 397 -Mcllniro, P., Corp l, E, July 3. RiirM : circ. Surg. X. Havward. 355 Lincoln, E . Serg t, I, April 6. Left; flap. Surg. II. Wardnor, 20th Mass., age 32. 5, 63. 20th Mass. Disch d May 14, )M. 12th Illinois. 7, l>2. U. S. V. Disch d May 29. 1862. 398 Mcfiill. L . Pt., 1!. 97th Aug. 16. Right: circ. Surg. J. R. F.ver- 356 Litultaii. \V.. Pt., I. 18th May 2. Right : circ. Surg. Lane. (lang. Penn.. age 16. 16, 64. liart, 97th Penn. Pisch d Jan. .North Carolina. 3. ii3. FiirhmgluMWuly 28. 1863. 17. 1866. SIM. 2399. 357 Listinau. J., dipt., II, Feb. (i, Right ; circ. Surg J. Thomas. 399 Mcliaulley. W.. Pt.. P. Aug. 23, R t : doub Hap. Snrir. R W. Ila/- 185th Now York. 6. 65. 118th Penn. Disch d May 29/65. 2d W. Va., a ire 27. 23. 62. lctt.2d W.Va. Dis. April 27/63. 358 Little. J., Pt., B, 27th Aug. 28, Left. Surg. Gibson. Recovered. 400 Metlindloy. B. . Pt.. C. May 16. Hiyht : Hap. Sursr. B. F. Steven Virginia 28, 62. 22d Kentucky. 17. 63. son. 22d Ky. Dis. Sept. 10. 63. 359 L lfton, It. / .. Pt., P. Sept. 20, Left. Surg. Grant. Recovered. 401 MoGomiglo. C., Corp l, Oct. 19, Ki;rht : ciiv : femoral rel uratod. DM Tennessee. 21. 63. C. 35th Ohio, age 24. 20. 64. Diseh d March 31. 1865. 360 Logan. W. A., Corii l. , Sept. 1, Right: flap. Surg. X. G. Sher 402 Mcr.rew. X. 1!., Pt., F. Sept. 13. Left : flap. Diseh d June 17. 63. D, 110th III.. age 30. 1. Ii4. man. 9th Ind. Disc d Feb. 1/65. 34th Ohio. 13, 62. Died 0<-t. 27. 1864 : shock. 3i;i L ltf., G. \V.. Sorg t, H, July 3, Right. Surgeon Pierce, C.S. A. 403 McKay, R.. Pt., F, 28th May 18. Left: circ. Disch d April 26, 65. 7th South Carolina. 3, 63. Recovered. i Mass.. age 18. 18! 64. 362 Lovely, C., Pt., F, llth June 1. Right: double flap; also amp. 404 McKinney, J., Serg t, A, June 24. Riirlit : circ. Disch d- March 9, Vermont, ajje 38. 1, 64. left arm. Disch d Feb. 6. 1865. 15th Ohio. 24. 63. 18ii4. 303 Loveridge, C., Pt., 1!, May 27, Left; flap: gang. Disch d Jan. 405 McMahon. .).. Pt.. I. 6th Mav 7. Left ; circ. A. Rrirg. R. C. ftang- 1st U. S. S. S. 27, 62. 29, 1863. New York Cav. .auo _>:;. 7. 64. cr. 6th N. Y. Cav. AllfT. 18th, 364 Lowenstein,M.,Lieut.,D, Mar. 31, Right : circ. Surg. A. A. White, remo .8 ins. seq. Disch d May 15thN.Y. II.A.,age21. 31, 65. 8th Md. Disch d Oct. 20. 1865. : 18, 1865. .ST/wr. 4281. : 1 232 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. "Vn NAME, MILITARY OPEUATIO.NS. OPERATORS, Vn NAME, MILITARY DATES OPERATION S, OPERATORS, JNO. DESCRIPTION, AND AGE. RESULT. 11 <j. DESCRIPTION, AND AGE. RESULT. JOG McMann, S., Corp l, C, May 11, Right ; flap. Snrg. J. J. Comfort, 448 Nugent. T., Lieut., II, July 3, Left ; flap. Surg. W. II. Twiford, 1st Peuu. Rifles, age 35. 11, 64. 1st Penn. Rifles. Disch dAug. 27th Indiana, age 26. 3, 03. 27th, lud. Disch d May 25, 1804. 7, 1805. Spec. 221. 449 Nurse, H. H., Pt., II, Mar. 16, Left; ant. post. flap. Surg. A. Wil 407 McMillan, J ., Serg t, G, July 2, Right : eirc. Surg J. H. Beach, 80th Illinois, age 21. 17, 65. son, 113th O. Dis. June 25, 65. 24th Michigan, age 22. 4, 63. 24th Mich. Disch dNov. 30, 03. 450 O Brien. J. D., Capt., A, Sept. 17, Right ; circ. Surg. J. M. Farley, 408 McMillan, W. VF.,Corp l, July3, Left ; flap. Exchanged. 24th New York. 17, 02. 84th N. Y. Disch d Dec. 22, 62. 0, 12th Ala., age2U. 3, f U3. 451 O Connor, C., Pt., G, 8th May 7, Right ; circ. Surg. M. Storrs, 8th 409 McMullan, A.. Pt., 15, July 1, Right; circ.: July 17th, flap amp. Connecticut. 7, r 64. Conn. Disch d Oct. 4, 1804. 3(ith New York, age 23. 2, 02. up. third. Disch dJuly 3, 1803. 452 Ohlinger, F., Pt., D, 13th June 18, Left; flap. Disch d June 10, 05. Spec. 1392. West Virginia, age 18. 18, 64. 410 McNair, G., Corp l, C, Oct. 19, Left ; flap. Disch d Oct. 5, 1865. 453 O Kaue, D., Corp 1, A, May 15, Right; circ. Surg. J. A. Wolf, 6th N.Y. H. A., age 19. HI, 04. 29th Penn.. age 22. 15, 64. 29tli Penn. Diseh d July 4, 65. 411 JtfuA eaf, J., Lieut., C, Sept. J 7, Right; circ. Surg. G.G.Crawford, 454 Oliver, C. E. M., It., F, Mar. 31, Right; fire. Surg.-C. II. I.evan- luth Georgia, age 34. 17, 02. C. S. A. Retired Nov. 11, 63 123d Ohio, age 20. 31, 65. saler, 8th Me. Disc. Aug. 30, 65. 412 McNey, J., Pt., B, loth May 10, Right; flap. Disch d Sept. 2, 65. 455 Oliver, G. W., Pt., H, June 19, Right; circ. Surg. J. W. Brook, New Jersey. 10, 64. 7th Ohio, age 36. 19, 64. Goth Ohio. Gangrene. Disch d 413 McNulty, \ ., Pt., 7th Mar. 27, Right; ant. post. flap. Disch d May 12, 1865. Mass. Bat ry, age 24. 27, G5. June 3, 1805. 456 O Neal, R. H., Pt., K, July 3, Right; circ. Disch d March 14, 414 McOmber, M. J., Pt., H, July 2, Right ; flap. Surg. C. Bowers,6th 29th Penn., age 21. 3, 63. 1804. 6th Penn. Res. Corps, 4, 03. Peun. Res. Disch d May 30, 64. 457 Orbetou, J. H., It., K, May 20, Right; double skin flap. Disch d age 18. 9th Maine, age 33. 20, 64. Jan. 6, 1805. 415 McVeau, D. C., Capt.,E, Sept, 19, Left. Surg. L. I. Dixon, 1st Wis., 458 Osborn, V. B., Pt., A,2d Jan. 17, Right; flap. Surg. J. P. Root, 1st Wisconsin. 20, 03. Capt., V. R. C. Res. May 9, 64. Kansas Cav., age 26. 19, 65. 2d Kan. Cav. Disch. May 8, 05. 416 Means, P. B., Pt., K, July 3, Left. Exchanged Nov. 12, 63. 459 Owens, J. M., Lieut., H, Dec. 13, Right; circ. Surg. T. Jones, 8th 48th Alabama, age 18. 3, 03. 8th Penn. Reserves. 15, 62. Penn. Res. Disch d April 4, 63. 417 Melion, J., Pt., G, 55th June 27, Right, Ass t Surg. J. J. Smith. 460 Oxley, J. H., Pt., K, 86th Jan. 1, Right ; flap. Disch d Mar. 7, 1865. Illinois. 27, 04. Disch d March 1, 1805. Indiana. 2, 03. 418 Mellinger, It., Pt., B, June 18, Left. Disch d April 4, 1865. 461 Page, J. C., Pt., E, 112th Jan. 15, Left: ant. post. flap. A. Surg. F. 55th Penn., age 28. 19, 04. New York, age 25. 16, 65. B. Kimball, 3d N. II. Disch d 419 Mercer, J. Q., Capt., E, June 10, Right; flap. Surg. H. E. Good June 27, 1865. 147th Penn., age 25. 16, 04. man, U. S. V. Two sub. oper. 462 Palmer, W. H., Lieut., Mar. 21, Right ; circ. Surg. F. M. Rose, Disch d Feb. 2, 1865. G, 53d Illinois. 21, 05. 43d Ohio. Disch d June 22, 65. 420 Mess, F., Pt., B, llth April 1, Left; bilateral flap. Disch dJuly 463 Parks, G. W., It., I, 7th Aug. 10, Right : flap. Surg. Raydon, C. S. New Jersey, age 47. 1, 05. 21. 1865. Missouri Cavalry. 17, 62. A. Boneremov. subs. Disch d 421 Messmer, A.", Pt., B, 7th Aug. 15, Right ; oir. Surg. J. W. Wishart, Nov. 8, 1862. N. York H. A., age 33. 15, 04. 140th Penn. Disch d Dec. 10, 04. 464 Paul, J. S., Corp l, H, Oct. 21, Right. Surg. A. B. Crosby, U. S. 422 Miller, D. C., Pt., F, G3d Sept. 20, Left. Surg. McDonough. Re 71st Pennsylvania. 22, 01. V. Disch d, 186J. Tennessee. 21, 03. covered. 465 Parr, J., It., D, 100th Mar. 25, Right; circ. Disch dJuly 16, 65. 423 Miller, G., Pt., E, 15th Aug. 7, Leit ; ant. post. flap. V. R. C. Penn., age 24. 25, 65. Infantrv, age 19. 8, V 04. June 1, 1865. 466 Parry, D. D., Pt., F, 3d Oct. 8, Left; lateral flap. Surg. G. D. 424 Miller, J. K., Pt., D, 1st May 18, Left ; ant. post, flap. Surg. S.W. Ohio. 9, 02. Beebe. Disch d March 21, 63. Conn. H. Art., age 32. 18, 64. Skinner, 1st Conn. II. A. Dis 467 Parsell, L. D., Corp l, A, Aug. 18, Right; flap. Confed. Surgeon. charged May 6, 1805. 5th New York, age 30. 19, 64. Disch d March 8, 1865. 425 Miller, J. P., It., I, 12th May 6, Left ; oval flap. Surg. Gaskill, 408 Patterson, S. N., Corp l, Aug. 28, . Surgeon Grimes, C. S. A. New Jersey, age 24. 7/64. C. S. A. Disch d April 28, 65. A, 52d Virginia. 29, 62. Recovered. 426 Miner, R. F., Pt., F, 3()th Aug. 27, Right ; flap. Surg. O. Hoyt, 30th 469 Faxon, G. H., It. E, 4th June 11, Right ; flap. Disch d July -1, 65. Wisconsin, age 29. 28, 64. Wis. Exfol. removed. Disch d Penn. Cav.. age 22. 11, 64. April 5, 1805. 470 Peeden. J. M, It., H, Oct. 22, Right ; circ. Confed. Surgeon. 427 Moody, D. M., Pt., C, 3d July 1, Left; flap. Confederate Surgeon. 16th Georgia, age 23. 22. 64. Prison Feb. 18, 1865. Maine, age 3<i. 3, 03. Disch d Nov. 28, 1863. 471 Perkins, H. C., It., B, Aug. 0, Right: flap. Surg. A. C. Miller, 428 Moore, S. E., Serg t, L, Aug. 28, Left. Surg. T. A. Evans, P. A. 141h Kentucky. 6, 7 03. 14th Ky. Disch d Dec. 31, 03. 1st S. C. Rifles. 28, 62. C. S. Disch d Oct. 25, 186->. 472 Perkins, G. R., It.. C, Mar. 31, Right; circ. Act. Staff Surg. G. 429 Moran, I K., Pt.,D, 14th May 16, Left. Surg. Doughty. Furl d 1st Maine Cav., age 18. 31, 05. W. Colby. Disch d Aug. 24, 05. Virginia. 10, 04. June 25, 1864. 473 Perry. J., Pt., C, 74th July 2, Right; flap. A. Surg. J.T. Cul- 430 Morgan, H. O., Captain, May 5, Left ; circ. Surg. L. W. Oakley, New York, age 2i>. 3, r 03. houn, U. S. A. Dis. July 19, 04. 12th Infantry. 0, r 04. 2d N. J. Retired Feb. 17, 1808. 474 Phelps, R. S., Pt., B, 1st May 14, Left. Recovered. 431 Morgan, J., Pt., K, 145th Oct. 12. Left ; doub. ant. post. flap. Surg. Georgia Cavalry. 16," G4. New York. 12, 03. R. K. Tuthill, 14Sth N. Y. Dis. 475 Phillips, Z. D., it., H, May 5, Right. Surg. Moft at, C. S. A. Feb. 23, 04. Spe.c. 4317. 49th Va., age 21. 5, 04. Retired Feb. 11, 1865. 432 Morgan, J. M., Pt., Orr s July 28, Left; double flap. Reg t Surg. 470 Pickering, A. II., It., F, June 10, Right ; flap. Disch d Jan. 2, 65. S. C. Rifles. 28, 04. Transfd Sept 16, 1804. 1st Mass. Art., age 29. 17. 04. 433 Morse, J. \V.,Pt.,F, 14th Sept. I .i, Left ; ant. post, flap: one inch of 477 PiMiford, R. T., Rich April 2, Right. Camp Parole June 17, N. Hampshire, age 20. 21, 04. femur rem. Dis. June 15, 05. ard s Miss. Bat n,age 29. 2, 05. 1865. 434 Moses. M. J., Corp l, E, May !), Left: ant, post. flap. Surg. W. 478 Pfemons. Z. T., . E, Nov. 27, Left. Surg. J. Dwinelle, 106th 81st New York, age 28. 9, 04. H. Rice, 81st N. Y. Disch d 60th Georgia. 28, 63. Penn. Prison April 11, 1864. Sept. 14, 18ii4. Spec. 1886. 435 Mowatt, D., Pt., C, 100th Aug. 16, Left ; flap ; spic. remo d. Disch d 479 Pollard, A., Serg t, C, July 20, Right; circular. Recovery. Xew York, age 2(5. 17, 04. Jan. 18, 18!i5. 38th Tennessee. 20, 04. 436 Mulrenen, P., Pt., H, July 13, Right. Disch d Dec. 26, 1863. 480 Porter, li. C., It., A, May 10, Left ; circular. Confed. Surgeon. 30th Mass., age 43. H, 63. Died Sept. 5, 1808: debility. 9th Virginia, age 31. 10. (. 4. Retired Nov. 4, 1864. 437 Murphy, D., 1 t., A, 17th May 13, Left: circ. Surg. . I. F.Galloupe, 481 Porter, J. A., Serg t, B, Oct. 28, Left; circ. Surg. N. Y. Lcct, 76th Mass., age 28. 13, 03. 17th Mass. Disch d Mar. 5, 1804. 76th Penn., age 27. 29, 64. Penn. Disch d Aug. 12, 1865. 438 Murphy, E. (P., Serg t Aug. 10, Right. Surgeon Pope. Recov 482 Powell, R. H., It., E, Mar. 31, Right; flap: sequ. rem d. Disch d Major, 48th Georgia. 10, 04. ered. 7th Wisconsin, age 33. 31, 65. Nov. 28, 05. Spec. 3015. 439 Murphy, 11. A., Pt., E, July 2, Right. Surg. Taney, C. S. A. 483 Powell. J., It,, K, 143d Mar. 19, Left ; skin flap. Surg. II. Z. Gill, 14th Louisiana. 2, 63. Gangrene. Exch d Mar. 3, 04. New York, age 20. 19, 65. U. S. V. Disch d Oct. 21, 65. 440 Myers, A. A., Pt.. B, Dec. 15, Left; circ. Disch d July G, 05. 484 Powell, W., It., K, 66th Sept. 17, Left; circ. Disch d Dec. 4, 1802. 51st Indiana, age 31. 15, 04. Ohio. 17, 02. 441 Myrick, N. W., Pt., A, Aug. 18, Right ; circ. Surg. T. F. Oakes, 485 Powers, P., It., B, 25th Sept. 12, Right; flap. Surg. Buchanan, 27th Georgia, age 27. 1 .), 04. 50th Mass. Prison Mar. 23, 65. Missouri. 13, 01. C. S. A. Discharged. 442 Nelson, E. H., Pt., E, 8th Sept. 4, Left; flap. A. Surg. G. W. 486 Price, T., Pt., G, 5th May 27, Right; ant. post, flap (wound left Vermont. 5, 62. A very, 9th Conn. Disch d Feb. Artillery, age 26. 27, 04. knee). Disch d Sept. 21, 1864. 20, 1803. 487 Prosser, G., It., G, 27th July 30, Right; flap. Disch d May 29, 443 Newland, 1. 1., Serg t, B, Sept. 19, Left ; ant. post. flap. Surg. W. Indiana, age 18. 30, 04. 1865. 34th Ohio, age 28. 20, 64. S. Newton, . 1st Ohio. Disch d 488 Quance, A., Pt., B, 1st July 15, Left ; flap. Subs. oper. Disch d April 6, 1805. Michigan, age 16. 15, 64. Jan. 20, 1805. 444 Newton, J. A., Pt., F, July 1, Left. Surg. A. F. .Miller, C.S.A. 489 Rae, A. 31., It., 11, 2d Aug. 18, Left. To prison Feb. 10. 1865. 34th North Carolina, 2, 03. Necro. bone removed. Exch d Miss., age 26. 19, 64. age 19. March 4, 1864. 490 Ralph, W. R., Pt., I, 8th July 2, Left; flap. Disch d May 30, 64. 445 Nicholson, J., Pt., C, 4th May 19, Left: flap. Disch d August 14, New Jersey, age 35. 2, 63. West Virginia, age 25. 20, 63. 1803. 491 Reed, C., It., F, 4th W. May 19, Left ; circ. Surgs. J. R. Philson, 446 Nixon, J., 1 t., F, 18th Dec. 30, Right ; flap. Surg. G. D.Beebe, Virginia. 20, 63. 4th W. Va., and S. P. lionner, Ohio. 30, 62. U. S. V. Disch d April 2.i. 03. 47th Ohio. Disch d Sept. 1, 03. 447 Norris, H., Pt., F, 7th S. Aug. 21. Left. To prison Feb. 10, 18 i5. 4<>2 Rieder, C., Pt., C, 41st Nov. 23, Right. Surg. Wood. Disch d Carolina Bat r}-, age 44. . 04. Ohio, age 19. 21 63. April 25, 1864. 1 FISHER (*j,. J.), toe. cit., p. 47. SECT. III.] PRIMARY AMPUTATION OF THIGH TN MIDDLE THIRD. 233 No. * NAME, MILITAKY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 493 Reifsnyder, R. L., Pt., Mar. 29, Left : flap ; gangrene. Disch d 534 Schad, C. H., Pt., M, 1st May 1, Right; circ. Ass t Surg. J. S. G, 198th Penn., age 30. 29, 65. July 20, 1865. New York Art., age 19. I, 63. Billings, U. S. A. Discharged 494 Reinhart, J., Serg t, 13th Aug. 29, Right. Disch d March 14, 1863. April 15, .-364. Spec. 2361. New York Dattery. 29, 62. 535 Scharf, A., Pt., I, 1st N. April 8, Left. Surg. W.W.L. Phillips, 1st 495 Repperger, J.. (Jorp l, C, June 9, Right. Surg. E. Bentley.U.S.V. Jersey Cav., age 30. 8, 64. N. J. Cav. Dis. July 20, 1865. 10th N. Y. Art., age 38. 9, 63. Disch d April, 1864. 536 Scheifely, J., Pt., D, 3d Dec. 13, Right. Confed. Surgeon. Dis 496 Reynolds. J., Pt., C, 33d Mav 14, R t ; unt. post. Hap. Surg. J. Ben Pennsylvania. 15, 6J. charged June 2J, 1863. Slass., age 18. 14, 64. nett, 19th Mich. Dis. Feb.27, 65. 537 Scofield, E. D., Pt, F, Sept. 28, Right; ant. post. flap. Surg. II. 497 Reynolds, J., Pt., B, 13th May 3, R t; ant. post. flap. Surg.J.J.lI. 40th N. York, age 26. 28, 64. K. Lyster, 5th Mich. Disch d New Jersey. 5, 63 Lord, 13th N.J. Dis. Oct. 19, 63. May 18, 1865. 498 Rexford, S., Pt., I, 45th June 2, Left; flap. Disch d July 12, 65. 538 Schroeder, F., Pt., B, 7th May 5, Left ; double flap. Disch d July Penn., age 20. 2. 64. New York, age 21. 5, *62. 8, 1863. Spec. 3708, A. M. M. 499 Rhodes, C., Pt., llth Sept. 19, Left : flap. Surg. L. J. Ham, 48th 539 Schweighauser, S.. Pt., March 8, Right. Disch d August 28, 1862. Ohio Battery. 21, 62. Ind. Disch d Mar. 23, 1853. 1st Bat ry Me. Art ry. 8, 62. 500 Rice, D., Pt.. C, 79th Mar. 19, Left ; bilat. flaps. Surgeon J. F. 540 Scott, E., Pt., E, 4th Oct. 9, Left ; circ. Surg. Thomas. To Penn., age 23. 20, 65. Reeve, 21st Wis. Disch d June Virginia, age 28. 10, 64. Prison Feb. 16, 1865. 15, 1865. 541 Scott, P. U., Pt.. A, 13th Sept. 19, Right; ciro. Surg.W. S. Grimes, 501 Rice, G. W., Pt., I, 4th May 5, Left ; ant. post. flap. Surg. G. T. Virginia, age 25. 19, 64. C. S. A. To Prison Jan. 5, 1865. Vermont, age 17. 6, 64. Stevens, 77th N. Y. Disch d 542 Secor, J., Serg t, E. 142d May 1, Right ; circ. A. Surg. J. S. Bill Feb. 23, 1865. New York, age 23. 1 fa. ings, U.S.A. Dis. Sept. 9, 1863. 502 Rice, J., Pt., G, 207th Mar. 25, Right; ant. post. flap. Surg.W. 543 Seiferman, B., Pt., B, May 28, Right. Surg. M. K. Taylor, 26th Penn., age 23. 25, 65. G. Hunter, 21 1th Penn. Disch d 26th Illinois. 28, 62 111. Disch d Oct. 16, 1862. Sept. 23, 1865. Spec. 4008. 544 Selbe, S., Pt, D, 18th June 27, . Recovered. 503 Richard, L. P., Serg t, April 2, Left; circ. Disch d Sept. 3, 65. Virginia. 29, C2. H, 7th X. Y., age4j. 2, 65. 545 Shaffer, F. H., Pt , F, Mav 1, Right ; flap. Ass t Surg. B. How 504 Richards, W. T., Pt., I, Mar. 25, Right; ant. post. flap. Surg. T. 2d Infantry, age 38. 1, *63. ard, U. S. A. Jan. 2d, reamp.; 12th Ala., age 28. 25, 65. F. Oakes. 56th Mass. Recov d gang Disch d Sept. 6, 1864. Nov. 2, 18u5. Spec. 4000. Died Feb. 1, 73. 505 Richmond, J., Pt., 7th Sept. 14, Right ; ant. post. flap. Disch d 546 Shafer, S. J., Pt., E, 66th June 9, Left ; circ. Surg. Tener, C. S. A. Mass. Bat ry, age 24. 14, 64. Feb. 25, 1865. Ohio. 11, 62. Disch d Dec. 22, 1862. 506 Rider, G., Pt., H, llth Oct. 9, Left ; ant. post. flap. Surg. H. F. 547 Shanley, 3t.,Pt ,B, 164th May 18, Left. Disch d August 29, 1865. Mass., age 29. 10, 64. Lyster, 5th Mich. Diseli d Sept. New York, age 27. 18, 64. 29, 65. Died May 3, 1871. 548 Shari,G.,Pt.,L,2dMich. Nov. 5, Left: ant. post. flap. A. Surg. 507 Riley, G. W., Pt., D, May 31, Left; flap Surg. j. Pogue, 66th Cavalry, age 22. 6, 64. W. F. Green, 2d Mich. Cavalry. 6Gth Illinois. 31, 64. 111. Disch d JuiieS, 1860. Disch d Sept. 18, 1865. 508 Rilev, P., Pt., M, 3d R. Sept. 11, Right; flap. Surg. S. W. Gross, 549 Shaw. J. S., Serg t, B, July!, Right ; circ. Nee. bone rem. Sept. I. Art., age 29. 11, 63. U. S. V. Necr d bane removed. 5th Alabama, age 30. 2, 63. 14th. Exch d Dec. 1, 1863. Disch d June 24, 63. Spec. 4320. 550 Shaw, W. K., Pt,, A, May 3, Right ; ant. post. flap. Surg. W. 509 Roach, P., Pt., C, 2d June 11, Left; flap. Ass t Surg. J. W. 5th Connecticut. 4, 63. C. Bennett, 5th Conn. Disch d Cavalry, age 23. 11, 61. Williams, U. S. A. Recov d. Nov. 16, 18J3. Spec. 1838. 510 Roberts, E. G.. Pt-., C, Nov. 30, Left ; circular. Provost Marshal 551 Shawgo, G.,Pt, A, 121st April 1, Right; circ. Surg. T.A.Ramsey, 1st Georgia, age 21. De. 1, 64. Feb. 24, 1865. Penn., age 21. 1, 65. 121st Penn. Hsem. April 7th, 511 Roberts, C. W., Adj t, July 2, Left ; flap. Disch d Dec. 16, 63. lig. prof. Disch d June 17, 65. 17th Maine. 3, 63. 552 Shay, L., Pt., K, 21st Dec. 17, R t ; circ. flap. Surg. J.T. Reeve, 512 Roberts, J., Pt., F, Gist Dec. 13, Left. Surg. Sly. Furlouglied Michigan, ago 20. 17, 64. 21st Wis. Disch d June 8, 65. Georgia. 15, G2. Oct. 31, 1864. 553 Shearm, St., Lieut., I, April 6, Right; flap. Released June 9, 513 Robinson, D., Corp l, A, Mar. 20, Right ; double flap. Surg. A. B. 12th N. C., age 25. 7, 65. 1865. 25th Indiana, age 21. 20, 65. Monahan, 63d Ohio. Disch d 554 Shelley, A., Pt, H, 52d May 12. Right ; double flap. Discharged Oct. 17, 1865. New York, age 21. 12, 64. Dec. 26, 1864. 514 Robinson, R., Pt., C, Nov. 26, Left ; circ. Prot. bone rem. Feb. 555 Shelley, J. M., Pt., H, Aug. 9, Right. Recovered. 29th Penn., age 39. 27, 63. 7. 64. Disch d July 5, 1864. 48th Virginia. 9, ? 62. 515 Rodgers, E., Pt., C, 103d Sept. 3, Right. Disch d March 14, 1863. 556 Sheppard, G., Seaman, April, 63. Lett. Discharged. Pennsylvania. 3, 62. Gunboat Prairie. Primary. 516 Rodgers, E. J., Pt., F, 12th Alabama, age 48. July 1, 1 f 63. Left. Confed. Surgeon. Exch d Sept. 25, 1863. 557 Sheppard, J. M., Capt , K, 21st Conn., age 23. May 16, 16, 64. Left; circ. Surg. J. II. Lee, 21st Conn. Disch d Sept. 14, 1864. 517 Rogers, A., Pt., B, 1st July 2, Left. Disch d Nov. 14, 1864. 558 Sherman, E. M., Serg t, Sept. 19, Right; double flap. Surg. C. B. New York, age 17. 2, 63. C, llth Vt, age 18. 19, 64. Park, llth Vt, Dis. June 28, 05. 518 Rollins, J. W., Pt., H, Sept. 1, Right; circular. Disch d May 559 Sherrill, if. O., Serg t, May 9, Right; circ. Surg. Strong. To 31st Indiana, age 19. 1, 64. 18, 1865. A, 12th N. C., age 22. 10, 64. Prison Oct. 26, 1864. 519 Rone} , II., Sergt, E, Dec. 13, Left; circ. Act. Staff Surg. C. 560 Shiftier, J., Pt., G, 55th Sept, 29, Right ; flap. Disch d June 1, 65. 30th Ohio, age 30. 13, 64. B. Richards. U. S. V. Disch d Penn., age 19. 29, 64. July 6, 1865. 5G1 Shindler, G. F., Pt, E, Sept. 17, Right. Surg. J. F. Hutchinson, 520 Rose, II., 1 t., F, 13th Mar. 19, Left; ant. post. flap. Confed. 107th Penn. 19, 62. 107th Penn. Dis. Nov. 25, 62. Mich., age 35 19, 65. Surgeon. Disch d June 30, 65. 562 Shultz, J. L., Pt., H, 5th Mar. 25, Right; flap. Disch d July 25, 52] Roth, J. II., Pt.,H, 205th April 2, Left ; flap. Disch d July 6, 65. Penn , age 27. 25, 65. 18(15. Penn., age 22. 2, 05. 563 Simms, W., Pt., A, 1st Mav 8, Right, Surg. Coleman. Recov i)^- Rouse, G. A., Serg t, F, Sept. 30, Left ; flap. Disch d Sept. 13, 65. Virginia Battery. 10, 62. ered. 8th Conn., age 22. 30, 64. 564 Singleton, G. W., Pt, Oct. 7, Left. To prison April 13, 1865. 523 Rove. P.. Pt., B, 4th July 1, Left. Disch d Nov. 9, 1863. Palmetto S. S., age 22. 7, 64. Artillery. 1, 63. 565 Sippcy, W., Pt., C, 1st Feb. 20, Right ; flap. Surg. H. C. Merry- 524 Rtidd, X., Pt., E, 32d Sept. 17, Right : circ. Furloughed Nov. Colored Troops. 20, 65. weather, 5th C. T. Disch d Virginia, age 28. 18, 62. 2, 1864. July 14, 1865. 525 Rutherford, J., Pt., E, Jan. 30, . Surg. White. Recovered. 566 Sisco, F. A., Pt., I, 23d Nov. 25, Right ; ciro.: gangrene. Disch d 50th Virginia. 33, 63. Michigan, age 18. 26, 64. June 21, 1865. 52G Runyon, J. M., Pt., 11, Sept. 17, Right ; circ. Surg. J. P. Colgan, 567 Slater. I., Pt., D, 75th Oct. 9, Left ; flap. Surg. G. W. Phillips, 59th New York, age 16. 17, 62. 59th N. Y. Sequestr. extract. Illinois. 9, 62. 75th 111. Disch d Dec. 5, 62. Disch d May 4, 63. Spec. 104 1. 568 ^Slaughter, W. B., Pt., Sept. 19, - -. Removal of six inches of 527 Samples, J. B., Pt., E, Feb. 20, . Recovered. D, 18th Tenn., age 20. 19, 63. necrosed bone. Recovered. 19th Georgia. 20, 64. 569 Smith, C. S., Pt., K, May 10, Left; circ. Confed. Surgeon. 528 Samlford, W. H.,Pt., H, Mar. 16, Left; ciro. Ass t Surg. G. M. 119th Penn., age 20. 11, 64. Disch d June 16, 1865. 19th Mich., age 20. 16, 65. Trowbridge, 19th Mich. Dis 570 Smith, G., Pt., C, 28th May 8, R t ; circ. Surg. H. E Goodman, charged June 30. 1865. Penn., age 27. 8, 64. 28th Penn. Discharged June 529 Saner, G.. Serg t, G, June 1, Right; ant. post, flap,- gangrene 1 . 16, 1865. 169th N. Y., age 37. 1, 64. Disch d March 20, 1865. 571 Smith, H. G., Serg t. A, Oct. 9, Right : flap. Surg. C. M. Clark, 530 Sausser, P., Corp l, A, Mar. 25. Left; ant. post. flap. Surg. W. 33th Illinois, age 24. 9, 63. 39th 111. Disch d June 22, 64. 2L)8th Penn., age 24. 25, 65. O. McDonald, U. S. V, Disch d 572 Smith, J., Pt., D, 6th June 18, Left; ant. post. flap. Disch d July 10, 65. Spec. 4133. Penn. Res., age 29. 18. 64. June 19, 1865. 531 Savage. W. B., Pt., F, July 20, Left ; ant post. flap. Surg. J. B. 573 Smith. J. J.. Corp l, H, April 11, Left ; flap. Surg.J. II. Thompson, 91st Ohio, age 33. 21, 64. Warwick. 9lst Ohio. Disch d 5th Pennsylvania. 11, 63. 139th N.Y. Disch d May 30, 63. Nov. 7, 1865. 574 Smith. S. D., Serg t, D, July 20, Left ; flap. Surg. J. A. Wolf, 2! th 532 Sawyer, T. J., Pt., E. June 20, Left; circ. Surg. C. M. Clark, 29th Penn., age 24. 20, 64. Penn. Gangrene. Disch d July 7th New Hampshire. 21, 63. 33th 111. Disoh d Oct. 33, 63. 10, 1865. 533 Sax, J., Pt., D, 3d New May 16, Right ; ant post. flap. Disch d 575 Smith, W., Corp l, B, 1st , 64, Left Retired Dec. 7, 1864. York, age 2:3. 17, 64. Dec. 10, 1364. Georgia S. S., age 22. Primary. FISHEU (G J.), loc. cit. ttuiiu. 11130 2 O KEEFE (D. C.), loc. cit., p. 25. 234 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, ANU AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITAHY DESCRIPTION, AND AOE. DATES. ^ OPERATIONS, OPE.JATORS, RESULT. 57(i Smock. J. W.. Corp l, I", June 18. Left : lat. flap. Surg. J. Eber- R20 Thomson, H. H., Lieut., Sept. 16, Left. Exchanged Nov. 21, 62. 19tH Ind., age 23. 18. 64. so!e, 19th Ind. Sequest. and K, Palmetto S.S.,age22. 16, 62. frag, remov d. Dis. Nov. 9. 65. 621 Thorpe, R., Pt., B, 10th Sept. 19. L t ; flap. Stirg. J. G. F. Hoist. .n. 577 Sneden, 1?. C., Pt., I. June 22, Right; flap. Surg. J. W. Tunne- Missouri. 19, 62. U. S. V. Diseh d April 4. 1H63. 1st Michigan. 22, 62. clifte. 1st Mich. Discharged. 622 Tixld, J., It., M, 6th July 1, Right. Surg. Hays. C. S. A. 578 Snyder, J.. l>t., T, 3<1 Jan. 11, Left : flap. Surg. W. Dickinson. Alabama, age 35. 2, 63. Paroled Sept. 25, J8G3. Missouri Cavalry. 13, 63. U. S. V. Diseh d July 19, 63. 623 Treadu ell. 1)^, Serg t, F, Dec. 15, Right: ant. post. flap. A. A. 579 Snyder, W. S.. It.. 15, Sept. 17. Right ; circ. Diseh d Nov. 29, 33d Mississippi, age 29. 16, 64. Surgeon S. C. Avers. Provost 28th Pennsylvania. 19, 62. 1862. Marshal March 27, 1865. 580 Solon, II.. Bugler. H, June 12, Left; flap: gangrene. Diseh d 624 Tracy, C. H.. Serg t, A, April 2, Right : flap. Surg. E. .M. White. 1st Mich. Cav., age 19. 12, 64. Jan. 7. 1865. 37th Mass.. age 32. 2. 65. 37th Mass. Recovered. 581 Sjiangler, H. D., Pt., A, Dec. , 64, . Paroled Jan. 16, 1865. 625 Troi/den, S. W., Serg t. July 1, Right. Surg. Me Aden, C. S. A. 54th Virginia, age 33. Primary. M] 22d X. Carolina. 2, f 63. Paroled Oct. 22. 1863. 582 Spellman, J., Pt., 10. Bth June 27, Left. Disch d July 13, 1863. 626 True, R. M., It.. B, 2d June 2."), Left. Diseh d April 1, 1863. Massachusetts. 28, 62. New Hampshire. 25, 62. 58:5 Spencer, W. H., Capt., June 30. Right ; flap. Diseh d December 627 Tryon, M. M.,Pt., I. 14th June 1. Left: cire.: gangrene. Diseh d G, Gist New York. J y-2, 62. 21, 1862. N. Y. H. A., age 26. 2, 64. Oct. 12. 1865. 584 Si ittler. W.. Corp l, A. July 27, Left. Surg. D. S. Hayes, 1 10th 6:28 Tuck, W. H.. Pt., E. Sept. 19. Left: flap. Surg. W. A. Barry, ilOth I enn., age 21. 27," 64. I enn. Diseh d Jan. 28. 1865. 38th Mass., age 29. 20, 64. 98th Penn. Diseh d July 26, 65. 585 Stahlschmidt, 10., Serg t, Mar. 31, Left: circular. Diseh d July 20, C29 Tunney, P., It., E. 24th July 2. Right: ant. post. flap. Diseh d H, 15th New York H. 31, 65. 1865. Mich., age 23. 3. 63. Dee. 20. 1863. A., age 32. 630 Tupper, F. W., Adj tlst Dec. 9. Right: <irc. Sursr. F. M. Rose, 586 Starr, G. II.. Pt., E. llth May 15. Left : ant. post. flap. A. Surg. D. Alabama Cav., age 25. 9, 64. 43d Ohio. Duty Mar. 22, 1865. Conn., age 40. 15, 64. Satterlee, llth Conn. Diseh d 631 Turner, W. H., It., G, July 1, Left. Exchanged Nov. 12, 63. June 23, 18G5. 26th N. C ., age 35. 2. 63. 587 Stebbins. B. I .. Corp l, Feb. 6, Left; ant. post. flap. Surg. F. 632 Updyke, C., It.. B, 2d June 7. Right : cire. Surg. .T. C. Howe, C, 16th Pa.Cav.,age21. (i. 65. LeMoyne, 16th Penn. Cavalry. N. Y. H. A., age 39. 7, 64. 2d N. Y. 11. A. Dis. Nov. 7, 65. Disch d May 31, 1865. 633 Vanalstine, G. P., Serg t, June 3. Right; circ. Surg. G. L. Potter. 588 Stelzer. C.. Pt , K. 37th May 19, L t: circ. A.Surg.C.B. Richards, E, 7thN.Y.Art..age34. 4. 64. 145th Penn. Dis. Mar. 4, 1865. Ohio. 19, 63. 30th Ohio. Diseh d Aug. 24, 63. 634 Van Blareom. L., Capt., May 8. Left: flap. Confed. Surgeon. 589 Stevens, C. I)., Pt., H, May 18. Right: flap. Surg. (i. L. Potter, C, 15th N. J., age 29. 9, 64. Disch d Dec. 19, 1*64. 126th N. York, age 26. 18, 64. 145th Penn. Dis June 12, 65. 635 Van Houten, S. C.. Pt., Aug. 25, Right : cire. Surg. Hunt, C.S.A. 590 Stevens, J. C.. Pt., A. Mar. 16. R t ; flap. A. Surg. < .. W. Burke. E, 4th New York H. A., 27, 64. Rem. of segues. July 13. 1805. 13th N. Jersey, age 29. 16, 65. 4Gth Penn. Diseh d May -*, 65. age 32. Disch d Oct. 14, (15. Spec. 1429. 591 ^Stevenson, H. C., Pt., June 27, : circ. Surg. J.Mc/. Gaston, 636 Viles, W. S., Pt., D, 74th July 23, Left; flap. A. Surg. J. T. Cal- K, Palmetto S. S. 27, 62. C. S. A. Furl d Sept. 4, 62. New York. 23, 63. houn.U.S.A. Dis d Dee.31, 63. 592 Stewart, T., Pt., I, 110th May 2"), Left; flap. A. Surg. H. Bauer, 637 Wade, D. F.. Corp l, D, Aug. 30, Right: circ. Surg. D.W.Voyles, C. Troops, age 22. 25, 65. 97th C. T. Diseh d June x 8, 65. 66th Indiana. 31, 62. 66th Ind. Disch d Nov. 18. 62. :,:: Stierten, C., Pt., A, 7th Mar. 8, Right: circ. A. Surg. B. F. 638 Wadsworth, C.P.,Corp l, June 21, Right : ant. post. flap. Surg. C. New York. 8, 62. Staehly, 7th N. Y. Recovered. B, 16th Maine, age 25. 21, 64. Alexander, IGth Me. Disch d 594 Stiles, J., Pt., 1$, 1st N. April 30, Right; cire. Diseh d July 4, 65. June 9, 1 865. 595 .lersey Cav., age 19. Stoll. J. E,, Pt., K, 1st 30, 64. Mar. 31. Aug. 10, necrosed bone remo d. Right. Diseh d July 12, 1865. 639 Wadsworth, D. G., It., C, 198th Penn., age 23. Mar. 29, 29, 65. R t : ant. post. flap. Surg. T. M. Flandreau, 146th N.Y. Diseh d N. J. Cav , age 26. A p. 1, 65. Feb. 21, 1866. :/<>; Stroud. K.. Pt., H, 8th July 2. Right. Provost Marshal Sept. 640 Wagner, C., Corp !, G, Mar. 31 , Right; ant. post. flap. Disch d Alabama, age 27. 3, r G3. 1, 1863. !!th N. Y. Cav., age 20. Ap. 1, G5. July 24, 1865. 597 ^Stuart, A. J., Lieut. May 19, Left. Recovered. 641 Walker, G. W., 1-t., G, May 9, Right; circ. To prison Oct. 5, Hcskin s Miss. Bat ry, 19, Ii4. i 8th La., age 36. 10, 64. 1864. age 25. 642 Walker, J. A., It., C, July 2, . Surg. Brown. Recovered. 598 Sturgis, W. (i., 1 t., B, June 2, Right ; flap. Surg. W. W. Root, 3d Arkansas. 2, 63. 75th New York. j 2, 63. 75th N. Y. Diseh d Sept. 2, 63. 643 Walsh, J., It., II, 1st June 17, Right: flap. Surg. A. F. Whe- 599 Sullivan,A.O.L,, Corp l, May 5, Left. Surg. S. R. Sayers. C.S.A. Mich. S. S., age 30. 17, 64. lan, 1st Mich. S. S. Disch d G, 4th Virginia. ; 5, 64. Recovered. Oct. 24, 1864. 000 Sullivan, J., It., F. 22d June 16, Col d Troops a""e21. : 18 64 Left; ant. post. flap. Diseh d No v 22 1 864 644 Walter, D. P., It., C, 33d N C age 1*) May 3, 4 63. Left; circ* A. Surg. J. A. Vigel. Sullivan, W., Pt!, 15th Juno 18, Left ; flap. Surg. G. W. Metealf, 645 Warrell. W., Pt.. 1 1, 60th Se pt. i, Left; flap. Surg. W. M. Gray, New York Independent 1 J, (i4. 76th N. Y. Diseh d Jan. 31, 65. Illinois, age 17. 2, 64. 60th 111. Disch d July 31, 65 Battery, age; 22. 1 646 Waters, J. A., Serg t. C, April 2, Right : ant. post, skin flap. Surg. 6ii2 Sutler, F., Pt., 10, 12th | Aug. 29, Left. Diseh d August 1. 1863. | 15th N. C., age 24. 2, 65. H. Churchill, 8th N. Y. II. A. Penn., age 35. 1 30, 62. ]! Released June 14. 1865. G03 Swan, G. B., Pt., B,21st | June 2."), Right; ant. posterior (oval) flap. II 647 Weakly. R., Lieut., G, June 2, . Surg. McMillan, C. S. A. Conn., age 18. .">, Ii4. Diseh d June 11, 1865. 42d Tennessee. 2. 64. Recovered. G04 Swayer, 11., Pt.. B, 93d May (i, Right ; flap. Diseh d Oct. 25, 64. | 648 Wearing, J.. Serg t, A, June 17, Left; circ. Jan. G, 1865, resec. Penn.. age 20. 8, 64. \ 2d I enn. H. A., age 20. 19, 64. of extr. of femur. Disch d Julv 605 Sweeney, J., Pt., I. 24th Aug. 14, Right ; cire. Diseh d May 11. 26, 1865. Spec. 4196. Mass.. ago 22. 14, 64. 1865. 649 Weatherli/. J. M . It.. I. Dec. 11, Right. Furhmghed Feb. 17, 63. 60fi Sweetser. L. ( ., Lieut., June 2, Left. Surg. C. M. Clark. 39th 13th Miss., age 20. 11, 62. B, 39th Illinois, age 26. 2, 64. Illinois. Diseh d Nov. 7, 1865. 650 Wc.ber, A., Corp l, I, 7th June 14, Left. Surg. Davis. Recovered. 607 Switzer, I). M.. Pt., A, April 6, Right. Dr. A. Judkins. Diseh d Louisiana. 15, 63. IGth Iowa, age 33. G, 62. July 16, 1862. ! 651 Weekwith, E., It., K, Sept. 17, Right; circ. Disch d June 2, 65. 608 Tanner, L. H., Corp l. B, May 12, Right; flap. Diseh d Dec. 29, 3d Maryland, age 39. 19, 63. 3d Michigan, age 23. 13," 63. 1864. 652 Weeks, N., It,, B. 10th April 2, Right; flap. Confed. Surgeon. 609 Talbot, A., Pt., A, 14th Mar. 2, Left; ant. post. flap. Disch d : N. Y. Art y, age 26. 2, 65. Diseh d Oct. 21, 65. Sper. .774. N. Y. H. A., age 22. 2, 65. Nov. 27, 1865. 653 Weeman. W. H. H., It., Oct. 19, Left : circ. Surg. C. II. Andrus, 610 Talbott, G. B., It., D, July 9, Left; circ. Surg. L. Slusser, 69th I] 1st Me. Bat ry, age 28. 19, 64. 176th N. Y. Disch d Aug. 2, 65. 38th Indiana, age 24. 9, 64. Ohio. Duty Nov. 17, 1864. 654 Welch, T., It,, B, 9th May 3, Left. Disch d Jan. 20, 1865. 611 Terrell. J. it.. Pt., B, Aug. 16, Left; circ. Surg. 9th Va. Cav. Alabama, age 24. 3, 63. 9th Virginia. 16. 64. Trans. Aug. 30. 1864. 655 Wells, F., It., 1, 99th Oct. 27, Right: circ. Confed. Surgeon. 612 Terhuno, N. D. F., It., July 3, R t; circ. Surg.W. H.Twiford, Penn., age 32. 28, 64. Diseh d Sept. 9, 1865. (1. 27th Ind.. age 19. 4, : 63. 27th Ind. Disch d May 30, 64. 656 Wenhoner, W., Pt., II, Mar. 31, Left; ant. post. flap. Disch d 6i:i Tbacker, B. F., Sg t, K, Aug. 21, Right: flap. Ass t Surg. J. M. 15th N. Y.H.A.,age22. 31, 65. Julv 27, 1865. 61st C. Troops, age21. 23, 64. Study, V. S. V. Discharged. 657 West, B. F., It., A, 59th Dec. 31, Right; flap. Disch d April 5. 63. 614 Theban, T. A., Serg t, June 18, Left ; circ. Surg. H. C. Tomp- Ohio. 31, 62. H, 4th N. York Art y, 18, 64. kius, 4th N. Y. H. A. Diseh d 658 Whaley, E. A., Capt., C, April 1, liight. Mustered out August 4. age 25. May 31. 1865. 6th Wisconsin, age 28. 1, 65. 1865. 615 Thoina, J.. It.. I. 26th Dec. 13. Left; flap. Disch d Mar. 14 , 63. 659 Whitcomb. J., It.. K. .May 31, Left. Disch d Sept. 12, 1862. New York. 14, 62. llth Maine, age 26. Je. 2, 62. June 15, 65, reamp. upper third 016 Thonia, 1 ., It.. D. 10th Sept. 19, Left : flap. Diseh d April 8, 63. by Dr. J. Benson. Missouri. 19. 62. > 660 White, W. M., Pt., D, July 2, Left; ant. post. flap. Surg. A. 617 Thomas, J.. Pt., A. 14th Aug. 7, Right; flap. Surg. O. W. Snow, 11 1th N. Y., age 24. 3, T>3. Satterthwaite, 12th N. Jersey. N. V. II. A., age 20. 7, 64. 3:ith Mass. Diseh d Feb. 27, 65. Diseh d Nov. 3, 64. Sprc. 1417. 618 Thomas, J., It., I, 33d Mar. 19, Left: flap. Diseh d June 24. 65. 661 Wliitehead, J. M., It., July 25, Left. Surg. Boatwright. Re Ohio, age 47. 20, 65. Died Sept. 1. 1866. H, 15th Alabama. 25. 6u. covered. GI9 Thomas. W., Serg t, B, May 5. Left; flap. Diseh d Jan. 17, 65. GC2 Weir, T. I .. Pt., B, 5th Sept. 19, Left. Surg. Griggs. Recovered, i 99th I enn., age 24. G, 64. Georgia. 19. 63. SECT. III.] PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. 235 No. NAME, MILITARY DESCRIPTION. AND AGE. BATES. OPERATIONS, OPERATORS, RESULT. NO NAME. MILITARY DESCRIPTION-, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 063 Wight, G. L., I t., K, J in? 22, Left ; ant. post. flap. Surg. J. 704 Baker, E. S.. Corp l, <;, April 9. Left; sloughing; femoral; ha-iii.; 24th Mich., age 21. 22, 64. H. Beach, 24th Mich. Bisch d 1st Maine Cav., uge 2>>. 9, 65. ant. ]Mist. skin flap: circ. sect. <.f July 13, 1865. muscles; up. third. Died July G64 Wilbur, J., Serg t, D, Aug. 29. Left ; flap. Disch d June 9, 65. 18, 1805. 17th Penn., age 40. 29, 04. Spec. 1514. 705 Ball, C. E., It.. F, 53d June 14, Right; haem.; ligation femoral. 065 Wiley, G. (>., I t., 1), Sept. 19, Right. Disch d March 8, 1865. Mass., age 20. 14, 63. Died June 29, 1803. 34tli Mass., age 20. 20, 64. 706 Banks, S., It., C, 43d July 30, Right: amp. left leg. Surg. D. 666 Wilkinson, G. U., It., K, June 18, Left ; double hit. flap. Surg. G. Colored Troops. 30, 04. Mackav, 29th C. T. Died July 147th X. Y., age 3.1. 18, 64. W. Xew, 7th Iml. Disch d Sept. 31, 1804. 14, 1864. 707 Ban-on. J., Pt., C, Oth Mar. 31, Right; hit. flap. A. A. Surg. S. 667 JPYHtfuson, 5. C ., It., A, Nov. 30. Right: circular. Provost Marshal Illinois Cav., age 42. Ap. 1. 04. S. Jessup. Died April 2, 1864 : 9th Tennessee, age 21. De. 1, 04. March 5, 1805. exhaustion. 668 Williams, B. F., Serg t. June 20, Left ; flap. Surg. J. X. Beach. 7.18 Beils, W. H., It., D, June 1, Left. Died June 0, 18<!4. K, 40th Ohio, age 23. 20, 64. 40th Ohio. Ilasm.; fern, ligateil. 14th New Jersey. 1, 64. Disch d May 29, 1865. 709 Berry, J. R., Corp l, E, July 12, Right. Died November 12, 03. 669 Williams, E., Coal Hea Jan. 15, Right. Disch d June 15. 1865. 41st Illinois. 12, 63. ver, U. S. S. Tristain 15, 65. 710 Bcntley, E., Lieut., 14th June 2. Right. Died June 4, 1864. Shandy, age 33. New York Artillery. 2, 64. 070 Williams, U.. Pt., H, 6th Sept. 28. Left ; flap. Disch d May 1 6, 65. 711 Berry, J., Corp l, F, 10th Sept. 19, Left; circ. Oct. 25, pyaem. chills. Col d Troops, age 22. 28, 64. West Virginia, age 20. 20, 64. Died Nov. 14, 64 : typh. fever. 671 Williams, K., it., A, May 12, . Surgeon Henderson. Re 712 Bidwell, I). M., Serg t. June 3, Right. Died July 13, 1804. 14th Georgia. 12," 64. covered. 20th Mich., age 21. 3, 64. 072 Wills, H., Lieut., G, June 14. Right. Surg. A. II. Van Xorstrand, 713 Bigham, J., It., H, 17th June 25, Right; flap. Died July 21, 03: 173d New York. 14, 03. 4th \Vis. Resigned Aug. 17, 63. Indiana. 26, 63. pyaemia. 673 Wills, J. SI., Pt., I, 21st May 3, Left. Disch d Aug. 20, 1863. 714 Billings, S., Serg t, C, Julyl, Left. Died July 1, 1803. New Jersey, age 15. 3, 63. 19th Maine. 1, fe. 674 Wilson. A., Pt., G. 48th April 1. Left: ant. post, skin flap; circ. 715 Rills, W. J., Pt., G, 32d Muv 13, Rifcht: circ. A. Surg. AV. F. Col d Troops, age 20. 3, 05. sect, of muso. Surg. A. P. Bart- Tennessee, age 35. 13," 64. Smith, 28th Penn. Gang. Aug. lett, 33d Mo. Dis. July 22, 65. 14th, lig. fern. Died Sept. 24), 675 Wilson, A. L., Serg t, K, Dec. 16, Left; circ. Surg. C. J. Walton, 64 ; acute diarrhoea. 84th Indiana, age 23. 16, 64. 21st Ky. Disch d Juno 10, 65. 716 Binson, J., Pt., G, 26th May 5, Right: circ. Surg. J.W.AVisliart, 676 Wilson, E. J., Pt., 15, July 6, Right: circ. Surg. J. Boone, 1st North Carolina. 5, 64. 140th Penn. Died. 21st N. Y. Cav., age 32. 6, 04. Md. P. U. B. Dis. Dec. 0. 64. 717 Bixler, G. W., It., H, April 0, Left; lateral flap: haemorrhage. 677 Wilson. H. T., Pt,, G, Sept. IS), Left; lateral flap. Surg. 1st W. 82d Penn.. age 33. 7, 05. Died April 15, 1865. 10th West Va., age 40. 19, 04. Va. Disch d Jan. 17. 1865. 718 Blystonc, W., Pt., G, June 18, Died June 25. 1864. 678 Wilson, Ij., Corp 1, E, Sept. 1, Right: circ. Disch d June 9, 65. 63d Pennsylvania. 18, 04. 17th N. Y.. age 20. 2, 04. 719 Bone, J., It., E, 147th June 18, Died June 18, 1804. 079 Wine, J., Pt., C, 9th In Dec. 17, Left ; ant. post. flap. A. Surg. J. Xew York. 18, 04. diana Cav., age 44. 17, 04. R. Culbertson, 10th Ind. Cav. 720 Bouton, J. H., It., H, Sept. 29, Left; flap. Oct. 3d, haemorrhage. Disch d May 15, 1865. 4th C I d Troops, age 25. 29, 04. Died Oct. 3, 1804; shock. 680 Winkler, J., Pt., D. 77th Oct. 19, Left; double flap. Surg. G. T. 721 Bowlby, P., It., 11, 27th Nov. 25, Right. Dec.5th,guigrene. Died Xew York, age 33. 19, 64. Stevens, 77th X. York. Disch d 111., age 25. 20, 63. December 25, 1863 Aug. 11, 1805. Spec. 3513. 722 Boyle, J. E., Corp l, E, June 2, Left. Died June 19, 04; py;emia. 681 Winston. D. S., Pt., F, Sept. 29, Right: flap. Confed. Surg. Mar. 81st New York, age 19. 2, 04. 117th X. York, age 23. 29, 64. 10, 65, seq. remov d. Sept. 26th, 723 Bradley, J., It., D, 164th June 3, Left; circ. Diarrhoea. Died Aug. rcamp, A. Surg. J. H. Armsby, New York, age 37. 3, 04. 20, 1864. U. S. V. Spec. 3226. 724 Brannon, T. D., Serg t. May 14, . Surg. G. II. Bane, 115th 682 Wion, J. W., It., F, 3d Aug. 9, Right. Disch d Dec. 26, 1862. F, 115th Illinois. 14, 04. 111. Died May 21, 1864. Wisconsin. 11, 62. 725 Brestler, J.\V.,Corp l,A, June 27. Right. Died July 3, 1864. 683 Wood. E.R.. Pt,, B, 18th June 18. Right. Surg. L. Holbrook, 18th 26th Ohio, age 24. 27, 04. Connecticut, age 30. 18, 64. Conn. July 29th, flap reamp.; 726 Brewer, W. L.. Serg t, July 1. Right. Died August 10, 1863: up. third. Disch d May 4. 05. K, 51st Georgia. 1, 63. exhaustion. 084 Wood, J. E.. Pt., , Nel Sept. 19, Left. Surg. G. W.Simple .C.S. A. 727 Brittaln, F. M., It., I, June 15, Left ; ant. post. flap. Surg. W. son s Batterv, age 21. 19, 64. Provost Marshal April 1, 1805. 66th Ohio, age 21. 15, 04. R. Longshore, 147th Penn. Died 685 Wright, II. J., Pt., C, June 17, Right : flap. Surg. S. S. French. Nov. 20, 04 : chronic diarrhoea. 2d Michigan, age 21. 18, 04. 20ih Mich. Disch d Oct. 19, 05. 728 Brown, A., Pt., D, 60th June 27, Left ; circ. Surg. 11. B. AVhiton, 686 Young, J., Pt., I. 120th May 5. Left: ant. post. flap. Surg. E. Xew York, age 25. 27, 04. 00th N. Y. Died Sept. 21, 04 ; New York, age 18. 0, 04. L. Welling, llth N. J. Feb. 7, diarrhoea. 65, seq. rern. Dis. Sept. 5, 05. 729 Brown. J. W.. Capt., I, Aug. 25, Right ; circ. Died Oct. 5, 1864. 687 Abbott, J., Serg t, A, Aug. 31, Left. Died September 14, 1864. 47th X. C., age 3li. 25, 04. 31st Iowa. 31, 04. 730 Jirongli. J. R., Capt., F, Aug. 31, Left. Surg. A. C. Messenger, 57th 688 Adams, H. T,., It.. K, Oct. ID, Right : oval ; sloughing. Died 27th Mississippi. 31, 04. Ohio. Died Sept. 1. 1804. 18th Penn. Cavalry. 19. 64. Nov. 16, 1804: pyaemia. 731 Brown, \V. C., Sera t, May 11, Right; flap. Ass t Surg. A. G. 689 Adams, J., It., I, 12th May 12, : cire. Surg. J. W. Wishart, G, 51st X. Y., age 21. 11, 64. Sprague, 7th R. I. May 21st, New Jersey. 12," 04. 14()th Penn. Died Dec. 23. 04. ha-in.; lig. Died July 11, 1804. 090 Aherns, I)., "it., B, 3 1st April 2, Right. Surg. W. O. McDonald, 732 Brown, W., It., A, 14th July 9, Right: circ. A. A. Surg. G. M. Maine, ago 2J. 4, 05. U. S. V. Died April 11, 1805; New Jersey. 11, 04. Paullin. Died July 12, 1804; pyaemia. Spec. 4160. exhaustion. Spec. ii857. 691 Aikin, H. H., dipt., D, July :iO. Left ; circ. Surg. D. Muckay, 29th 733 Bruce, A., Pt., H, 91st July 20, Left: ant. post. flap. Died Aug. 2 .)th Colored Troops. Au. l, 64. C. T. Died August 2, 1804. Ohio, age 20. 20, 64. 14, 18ii4 : diarrhoea. 092 A-kam, R. J., It., I, 145th July :!, Died July 24, 1803. 734 Buckingham. M.. Color July 1, Right. Died July 5, 1803. Pennsylvania. 3, "03. Serg t" C, 104th X. Y. 1, 63. 693 Alpen, R., It., F. 20th June 1, Left. Died June 14, 1864 ; hasm- 735 Burneson. W., It., D, June 10. Left ; ant. post. flap. Died July Massachusetts. 1, 04. orrhage. 147th Penn., age 21. 17, 04. 19, 1804: exhaustion. 694 Ambler. W. II., Pt., G, May It!, Right : anterior post. flap. Died 736 Burns, M., It., C. 140th July 2, Left. Died August 4, 1863. 2d Vermont, age 21. 18." 64. June 9, 1864: exhaustion. X. Y.. age 20. 4, 03. 695 AmstPiid, G., Serg t, 15, May 2, Lett. Died May 15, 63; anaemia. 737 Burson, J. J., It., D, 85th July 2i, Left. Died August 20, 1804. 73d Pennsylvania. 2, 63. Indiana. 20, 64. 696 Andf.rsnn. S. W.. It., K, July 20, Left ; circ. Died August 10. 04. 738 Burt. J. T., Pt., D, Sy- Dec. 13, Right. Surgeon E. Hutchinson. 37th Mississippi. 20," 64. mon s Ga. Res., age 18. 14, 64. 137th New York. Died March 697 Ankany, L., It., D, 33th Oct. 19, Right ; circ. Died Nov. 27. 04 ; 2, 181)5; pya inia. Autopsy. Ohio, age 23. 20, 04. pyaemia. 739 Butler, S., Pt., C, 3d June 27. Right : circ. Died July 2ii. 1862.. 698 Arnold, J., It., K, 3d June 3, Right. Died June 23, 1804. Xew Jersey. 28, 02: Vermont, age 15. 3, 64. 740 Butler, W., it., H, 98th June 2 I, Died June 22, 1804. 6!)9 Askenette, P.. It., II, July 21, Left. Surg. H. McKennan, 17th Illinois. 21, 04. 12th Wisconsin. 21, 04. AVis. Died July 23, 1864. 741 Campbell, II., Camp fol Mar. , Left. A. A. Surg. G. W. A very, 700 Ataway. S., It., G. 1st July 3, Right; slough "g, bone protrud g. lower, age 23. . 03. Osteo-myelitis : seq. removed. S. Carolina, age 10. 3, 63. Died Aug. 10, 63; diarrhoea. Oct. 22, " 00, amputa. hip joint. 701 Atwell.O.M., Pt.,I,2(ith Dec. 13, Left; flap. Jan. 5, 1863, ha>m. Died Oct. 23, 18;i; >. New York, age 21. 14. 62. Died Jan. 9, 1863. 742 Campburn, J.. It.. F, Oct. 27, Right; bi-Uitoral flap: diarrhoea. 70-2 Barber, A. J., Lieut., July 2, Left. Died July 28, 03; pyaemia. 51st Penn., age 23. 27. 64. Died Nov. 23, 04: exhaustion. llth Infantry, age 30. 4, 63. 743 iCantrM, F. M., It., , Sept. 17, Right: flap. Died Sept. 25, 62: 703 Baguley, S./Pt., B, 5th April 7, R t ; circ. Surg.W. O Meagher. 1st S. Carolina, age 3:). 18, "02. pyaemia. N. Hampshire, age 21. 8, 05. G9th N. Y. June rid, nmp. left 744 Carabine. D. W., It., G, Dec. 10, Right; circ. A. A. Surg. A. Rolls. thigh. Died July 10, 1805 ; ex Myrick s Miss. Battal 10, 04. Died Dec. 22, 04 ; irrita. fever. haustion. Spec. 4332. ion, age 21. "FlSHHR (G. J.), Casex af Amputations, in Am. Jour. Med. Sci., 1803, A ol. 15. p. 17. 236 INJURIES OF THE LOWER EXTREMITIES. (CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 745 Cardeman, W., Pt, A, Jan. 15, Left ; circ. A. Surg. H. C. Mer- 786 Culliden, D., Pt., I, 83d May 5, Left; ant. post, flap; bed-sores. 203d Penn., age 24. 15, 65. riweather. 5th C. T. Died Jan. Pennsylvania. 6, 64. Died June 16, 64; exhaustion. 29, 1865 ; pyaemia. 787 Culver. H., Pt.. E, 2d 11. June 18, Left ; circ. Dec. 17, reamp. Died 746 Carpenter, L. B., Pt., H, Oct. 19, Right. Ass t Surg. J.Homans, jr., S. S. S., age 30. 19, 64. Jan. 10, 65; gangrene. 90th X. York, age 25. 20, 64. U.S.A. Haem. from wound in 788 Cumber, J. G , Pt., I, May 15, Right; circ. Surg. II. E. Good arm; lig. Died Nov. 14, 1864. 38th Ala., age 30. 15, 64. man, U. S. V. Died July 14, 747 3arver, E., Corp l, H, May 5, Right : ant. post. flap. Died June 1864; exhaustion. 7th Wisconsin. 6, r 64. 16, 1864 ; exhaustion. 769 Cummings, I. S., Pt., F, Aug. 6, Right. Surg. A. M. Wilder, U. 748 Case, C. F., Adj t, 36th Nov. 30, Right; circ. A. A. Surg. J. II. 100th Ohio, age 20. 6, 64. S. V. Died Sept. 5, 64 ; typhoid Illinois, age 27. )ec.l, 64. Green. Died Dec. 18, 64: pyaem. fever. 749 Casey, 1\ J., Lieut., E, Xug. 21, Left. Died October 16. 1864. 790 Curry, J. H., Serg t, D, May 5, Right. Surg. W. O. Meagher, 16th Mississippi, ape 36. , 64. 116th Penn., ago 23. 5, 64. 69th N. Y. Died May 30, 1864. 750 Chamberlain, (Jr., Pt., D, May 12, Left. Surgs. A. F. Whelan, 1st 791 Curtin, F., Pt., A, 28th June 3, Left; circ. Surg. 1". E. Hnbon, 8th Michigan. 12, 64. Mich. S. S., and W.C. Shurloek, Mass., age 26. 3, 64. 28th Mass. Diarrhoea; haem. 51st Penn. Died May, 1864. Died July 1, 1864. 751 Chapman, W., Pt., G, Sept. 1, ; by Surg. G. W. Beach, 141st 792 Curtis, R., Lieut., D, 3d May 6, Died May 19, 1864. 21st Ohio. 1, 64. N. York. Died Sept. 11, 1864. New Jersey. 6, 64. 752 Chase, A., , I, 4th N. Julv 30, Right; circ. Surg.G.P.Greeley, 793 Dafrimont, L., Pt., G, July 28, Right. Died Aug. 31, 1864. Hampshire, age 35. 30, 64. 4th N.H. Died Aug. 23, 1864 ; exhaustion. 794 17th Alabama. Dail, J. H., Pt., K, 79th 29, 64. Mar. 19, Right. Died March 29, 1865. 753 Cherry, S., Pt., A, 34th Aug. 6, Left. Died August 25, 1864. Ohio. 19, 65. Illinois. 6, ? 64. 795 Dangler, D. F., Pt., E, June 18, Right. Died July 20, 1864 ; ex 754 Chestnut, J., Pt., A, 80th May 14, Right. Died July 16, 1864. 55th Penn., age 20. 18, 64. haustion. Indiana, nge 22. 14, 64 796 Davis, G., Pt., B, 2d Oct. 6, Died October 17, 1864 ; pyaemia. 755 Childs, G. W., Pt., D, May 24, Right; diarrhoea. Died June 11, Artillery. 6, 64. 56th Mass., age 27. 24, 64. 1834; asthenia. 797 Davis, W. H., Pt., A, June 23, Right ; circ. Surg. J. W. Wis- 756 Clark, J., Pt,, H, 7th N. June 16, Right ; circ. Surg. P. E. Hubon, 38th N. C., age 21. 23, 64. hart, 140th Penn. Died August York H. A., age 24. 17, 64. 28th Mass. June 27, haem.; lig. 16, 1864. profunda. Died Oct. 9, 64 ; ex 798 Davidson, R. C., Serg t, July 30, Left; circ. Surg. G. W. Snow, haustion. C, 35th Mass. 30, 64. 35th Mass. Died Aug. 19, 1864. 757 Clapp, E., Pt., H, 7th June 2, Right. Died June 10, 1864. 799 Dawson, G. S., Capt., F, June 16, Left. Dr. A. Garcelon. Necro. Conn., age 47. 2, 64. 2d N. Y. H. A., age 26. 17, 64. Died Dec. 6, 64. Sp. 1427, 2828. 75rf Dlapper, F., Serg t, I, April 23, Right. Died April 1-3, 1864. 800 Delaney, D., Pt., B, 1st Dec. 2, Left ; ant. post, flap; ciro. sect, of 2d N. York Vet, Cav. 23, 64. Md. Cav., age 29. 4, 64. muscles. Surg. J. B. Lewis, U. 759 Clough, J., Pt., B, 109th Oct. 20, Left. Died November 10, 1862. S. V. Died Jan. 5, 65; pyaomia. Illinois. 20, 62. Autopsy. 760 Coffin, P., Pt., B, 19th July 3, Died July 9, 1863. 801 Dennerhorn. G. B., S gt, June 1, Left. Died June 9, 1864. Maine. 3, 63. A, 119th Penn. 1, 64. 761 Cor/gins, V. M., Pt., I, , May Right. Died May 22, 1864. 802 Devon, J., Pt., F, 26th July 2, Left. Died July 10, 1863. 13th South Carolina. 22, 64. Pennsylvania. 2, r 63. 762 Colby, J. S., Corp l, I, May 19, Right ; ant. post. flap. Died June 803 Dillon, N., Corp l, K, Deo. 15, Right ; circ. A. Surg. R. J. Hill, 27th Michigan. 19, 64. 21, 1864; exhaustion. 80th 111., age 21. 15, 64. 45th 111. Died Dec. 17, 64 ; haem. 763 Cole, A. E., Pt., 0, 142d Jan. 15 Right ; circ. Surg. J.W. Mitchell, 804 Dinley, J., Pt,, E, 73d Oct. 29, Died November 14, 1 863. New York, age 17. 15, 65. 4th C.T. Died Feb. 4, 65; exh n. Ohio. 29, 63. 764 Cole, S. R., Pt., K, 9th April 2, Right. Died April 16, 1865. 805 Dolan, J,, Pt., I, 74th Sept. 1, Right; circ.; nee. femur; prot. N. Y. H. A., age 48. 2, 65. Ohio, age 26. 2, 64. remov d; gang. Died Nov. 21, 765 Collier, H., Pt., I, 12th Dec. 16, Right ; circ. A. Surg. J. A. Free QHft) 1864; exhaustion. Penn. Cavalry, age 20. 17, 64. man, U. S. V. Died Dec. 27, 64 ; V/Of 1)71 Doud, T., Serg t, C, 2d July 30, Both. Surg. W. B. Fox, 8th exh. and pneumonia. Sprc. 375. . suo Michigan. 30, 64. Mifth. F.iod July 31, 18:i4. 76J Conklin, C., Pt., I., 6th April 29, Right. Surg. J. Ebersole, 19th 80S Dougal, F. L., Pt., H, April 24, Right. Died April 25, 63; shock. Wisconsin. 30, 63. Ind. DiedMav9, 63. Spec. 1120. loth Connecticut. 25, 63. 767 Connell, J., Pt., F, 146th Mar. 31, Left; ant. post. flap. Surg. T. M. 809 Downey, J., Corp l, B, April 1, Right ant. posterior flap. Died New York, age 21. 31, 65. Flandrau, 146th N. Y.; gang. 2d Iowa Cav., a^e 21. 1, 65. April 26, 1865; pyuemia. Died May 27. 65 ; phleb. and exh. 810 Dwyer, W., Pt., E, 27th April , Left; congestive chill. Died 768 Cook, C. C., Lieut., C, June , Left. Died October 6, 1864. Mass., age 1!). , 63. April 27, 1863. 77th Pennsylvania. , 64. 811 Eaton, G. W., Teamster, May 17, R t; circ. A. Surg. J. M. Palmer, 769 Cook, F. S., Serg t, I, May 10, ; ant. post. flap. Surg. C. B. H, 17th Mass., age 36. 17, 64. 80th N.Y. Died May 18, 64. 53d Virginia. 12, 64. Gibson.C.S.A. Died May 14, 64. 812 Eckhart, G. W., Corp l, Sept. 19, Right ; circ. Surg. P. Leidy, 770 Coon, 11., jr., Corp l, H, Nov. 24, Died November 25, 1863. B, 49th Pennsylvania. 19, 64. 119th Penn. Died Oct. 6, 1864 ; 149th New York. 24, 63. peritonitis. 771 Courtnav, J. C., Pt., H, Julv 22, Right. Surg. H. McKennan, 17th 813 Eddy, G., Pt., E, 7th Aug. 30, Right. Sept. 8, 13, haem.; lig. of 30th Illinois, age 18. 22, 64. Wis. Died Aug. 12, 1864. Wisconsin, age 24. 30, 62. femoral. Died Sept. 13, 1862; 772 Courtney, C.,Pt.,F, 89th Sept, 17, Left, Died Sept. 26, 62 ; tetanus. exhaustion. New York, age 20. 19, 62. 814 Elder, M., Lieut., llth July 2, Left. Jply 2!), pyaemia dev. Died 773 Cox, G., It., K, 1st N. June 9, Right ; circ. Ass t Surg. B. How Infantry, age 28. 4, 63. July 2.3, 63 ; pyicmia. Carolina, age 27. 9, 64. ard, U. S. A. Died June 24, 64. 815 Enos, E ., Pt., H, 10th May 10, R t. Surg. B. Robrer, 10th Penn. Spec. 1233. Penn. Res., age 28. 10, 64. Res. Died May 19, 64. Sp.2442. 774 Cox, J., Pt., C, 9th New Oct. 19, Left. Died October, 1864. 816 Evarts, E., Serg t, C, Oct. 27, Right. Nov. 14, sym. of pyiemia. York Heavy Artillery. 19, 64. 8th N. Y. H. A., age 26. 28, 64. Died Nov. 18, 18ii4. 775 Cox, W. F., Pt,, D, 91st Aug. 6, Right; Surg. C. D., Moore, 13th 817 Fakee, N., Pt., C, 6th N. May 19, Right; flap. Died Oct. 2, 1864; Indiana. 6, ? 64. Ky. Died Sept. 2, 1864. Y. H. A. 19, 64. typhoid pneumonia. 776 Coyle, J., Pt., D, 15th Mar. 31, Left. Died May 24, 1865. 818 Farrer, J. W., Pt., E, June 9, Left. Surg. A. Hard, 8th 111. Cav. New York Cavalry. 31, 65. 8th 111. Cav., age 27. 9, 63. Died June 18, 63. Aato./S/J. 1224. 777 Cramer, D., Pt., E, 149th May 8, Left. Died J une 3, 64 ; pyaemia. 819 Ferguson, C. F., Serg t, July 2, Left. July 8, huam. Died Sept. Penn., age 25. 8, 64. I, 1st Mass., age 25. 2, 63. 11, 1863. 778 Crawford, W., Pt., B, 2d May 12, Right, Surg. C. Bower, 6th Penn. 820 Ferguson, D., Pt., G, June 23, Left. Surg. T. L. Magee, 51st 111. Penn. Reserves, age 40. 12, 64. Res. Died July 27, 64 ; chron. 125th Ohio. 23, 64. Died June 26, 1864. diarrhoea. Autopsy. Photo. Ser. 821 Ferguson, J., Pt., K, Dec. 13, Right. Died Dec. 14, 1862. 164. Spec. 2890. 51st Pennsylvania. 13, 62. 779 Crawford, W. S., Pt., D, Dec. 15, Left : lat. flap. A. A. Surg. J. E. 822 Fillingim, A., Pt., E, Dec. 16, Right; circ. Ass t Surg. W. B. 18th Ohio, age 23. 16, 64. Link. Died Dec. 29, 1864. 37th Miss., age 23. 16, 64. Trull, U. S. V. Died Dec. 25, 780 Crosby, A., Serg t, C, July 1, Left. Died July 12, 1863. 1864 ; irritative fever. lOth Maine. 2, 63. 823 Fisher, D., Pt., K, 102d July 20, Right. Died August 30, 1864. 781 Cross, W. H., Pt., G, July 2, Right. Died July 13, 1863. New York. 20, 64. 61st New York. 2, 63. 824 Fisher, S., Corp l, C, May 9, Right ; circ. Died May 30, 1 864 ; 782 Crowthers, J., Serg t, E, May 16 Right ; circ. Died June 8, 1864 ; 90th Penn., age 27. 10, 64. pyaemia. 81st New York, age 26 18, 64. pyaemia. 825 Flamburg, M., Pt., G, Oct. , . Surg. J. E. Pom fret, 7th N. 783 Crowley, J., Corp l, A, April 2 Right; circ. Surg. J. C. How, 52d New York. , 64. Y. II. A. Died Oct. 17, 1864. 7th New York, age 25 2, 65. 2d N. Y. Artillery. Died May -. Flynn, J. F., Pt., E, 1st April 6, Right; circ. Died June 2, 1865; 7, 65; pyae. Autop. Spec. 1487. Maine Cav., age 26. 6, 65. exhaustion. Autopsy. 784 Cruser, P. C., Serg t, A Oct. 19, Left ; lat. skin flap ; circ. section 827 Ford, W., Pt., B, 7th July 1, Left; slough g; (also w nd right 6th New York Heavy 21, 64. muscles. Surg. C. H. Andrus, Louisiana, age 23. 1, 63. thish.) Died Aug. 2 ), 63; haem. Artillery, age 20. 176th N. Y. Died Oct. 27, 64; 828 Frank, E. H., Lieut., A, Aug. 12, Right. Surg. A. T. Hudson, 26th pyaemia. 26th Iowa. 12, 64. Iowa. Died Aug. 14, 1864. 785 Crumpton, F. A., Pt., I, Jan. 17, Left ; circ. Died Jan. 30, 1864. 829 Franklin, G. W., Pt., K, Julv , Left. Died August 10, 1863. 4th Indiana Cavalry. 18, 64. 50th Georgia. , 63. SECT. III.] PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. 237 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 830 Free, A., Pt., K, 26th May 15, Left. Died May, 1864. 874 Henderson, J., Pt., F, July 2, Right. Died July 8, 63; wound, j Pennsylvania. 16, 64. 2d New Hampshire. 2, r 63. 831 Frost, A., Pt., A, 187th June 18, Right. Died Sept. 12, 1864. 875 Hendricks, F. E., Major, Mar. 31, Right. Surg. P. E. Hubi.n, 28th Penn , ago 19. 20, 64. 4th New York H. A. 31, 65. Mass. Died April 1, 1865. 832 Funt, J ., Pt., H, 75th June 24, Right. Surg. C. J. Walton, 21st 876 Bengen, B., Pt., A, 2d Nov. 3, Right. Died Nov. 14, 1863. Illinois. 24, 64. Ky. Died July 15, 1864. Louisiana. 3, 63. 833 Caddie, S. W., Pt., K, May 15, Left. Died May 21, 1864. 877 Henry. J., Pt., B, 103d Nov. 25, . Died December 20, 186;;. 5th Kentucky. 15, 64. Illinois. 25, 63. 834 Gallagher, P.. Pt., B, Oct. 3, Right ; circ. Died Oct. 4, 1864. 878 Henwright, T., Pt., E, Sept. 30. . Died Oct. 4, 64 ; exhaus 157th Pennsylvania. 3, 64. 117th N. Y., age 28. , 64. tion from suppuration. 835 Gardner, J., Pt., D, 15th Oct. 19, Left ; slough g ; protruding bone 879 Herndon, T. 11., Pt.. C. Nov. 27, Left. Surg. J. Dwinelle. 106th New York, age 28. 19, 64. excised. Died Feb. 4, 1865. 60th Georgia. 8, 63. Penn. Died December 3, 1863. 836 Gardner, J.,Pt., K, 27th July 3, Left. Ass t Surg. G. V. Woolen, Spec. 1885. Indiana. 3, G3. 27th Ind. Died JnlyCS, 1863. 880 Hersha, C., Serg t, F, Mar. 19, Right ; circ. Surg. G. F. French, 837 Gay, J., Pt., A, 35th Aug. 18, Left ; cir.; sloughing. Died Sept. 25th Iowa, age 21. 20, 65. U. S. V. April 14, iKfm.j iTg. Massachusetts, age 36. 19, 64. 29, 1864 ; pyaemia. Died April 15. 1865 838 Geiser, 15., Pt., G, 32d June 4, . Died June 13, 1864. 881 Hess, A., Pt., H, 10th June 1, Left, Died June 18, 1 864. Indiana. 4, 64. New Jersey. 1, 64. 839 Cetchell. G. O., Capt., May 5, Right ; muscular flap. Surg. T. 882 Hess, J., Pt., I, 83d N. May 12, Left; circ.; protrud. bone romo d. E, 3d Maine, age 28. 5, 64. Hildreth, 3d Maine. Died May York, age 19. 12, 64. Died Slav 24, 64: exhaustion. 30, 18G4 ; pyaemia. Autopsy. 883 Heacock, N., Serg t, E, Sept. 19, Left. Die dOct. 4, 1864 ; exhaus 840 Getchell, II. D., Pt., C, Sept. 17, Left. Died October 14, 1862. 119th Pen-,. 19, 64. tion. 15th Mass.. age 19. 17, 62. 884 Hickman, I,.. Pt., 1st Sept. 29, Right; circ.; (also other wounds.) 841 Gersingrr, J. H., Pt., H, July 3, Right. Surg. G. P. Oliver, lllth Virginia Artillery. 29, 64. Ass t Slug. W. F. Richardson, 1st North Carolina. 4, 63. Penn. Died July 28, 1863. C. S. A. Died Oct. 23, 1864. 842 Gibbs, L.. Pt., G, 5th July 3, Right ; slough extending nearly 885 Higgins, A . \V., Pt., E, June 17, Lef" ; lat. flap. Surg. J. W. Wis- Mich. Cav., age 33. 4, 63. to groin. Died Sept., 18, 1863; lllth N. York, age 27. 18, 64. hart, 140th Penn. Died July diarrhoea. 11, 1864 ; pyaemia. 843 Gilbert, J. H., Serg t, K, April 1, Left ; ant. post. flap. Died April 886 Hinchcliff . !. H., Pt., E, Feb. 6, Left; flap. Died Feb. 17, 1865; 2d N. Y. Cav.. age 34. 1, 65. 27. 1865; pyaemia. 210th P( i;i., age 39. 6, 65. exhaustion. 844 Gilbert, P., Pt., D, 83d June 18, Left, Died June 28, 1864. 887 Hitchcocl , H., Corp l, May 5, Right ; circ. Surg. J.W.Wishart, Pennsylvania. 18, 64. G, 39th New York. 5, 64. 140th Penn. Died May 6, 64. 845 Gilmore, J.A.,Maj. ,48th May 31, Right ; flap. Died June 9, 1864 ; 888 Hoffman. F., Private, July 20, Right ; cire. Surg. J.V.Kendall, Penn., age 30. 31, 64. exhaustion. Knapp - Penn. Bat ry. 20, 64. 149th N. Y. Died Aug. 11, 64. 846 Gleuson, 0. A., Corp l, Sept. 19, Left; circ. Died Oct. 12, 1864; 889 Hoffman J. W., Pt., B, Oct. 19, Left. Died Oct. 25, G4 ; tetanus. L, 3d Mass. Cavalry. 19, 64. pyasmia. 57th N. Carolina. 19, 64. 847 Godfrey, VV. M., Pt., F, Nov. 7, . Surg. E. C. Franklin,U.S.V. 890 Holley. C., Pt., H, 2d June 18, Right. Surg. S. S. French, 20th 7th Iowa. 9. 61. Died Nov. 19, 18G1 ; tetanus. Michigan. 18, G4. Mich. Died June 18, 1864. 848 Goldtbwaite, J., Capt., Mar. 25, Right. Died April 17, 1865. 891 Howard, F. H., Pt., B, Jan. 30, Right. Died Feb. 1, 63; asthenia. A, 1st Maine. 25, 65. 6th M;;ss. 30, 63. 849 Goodsell, G. B., Serg t, May 14, Left. Died May 20, 1864. 892 Howard, J. S., Capt., Mar. 31, Left. Died April 21, 1865. D, 103d Ohio. 14, 64. G, 8th Penn. Cavalry. 31, 65. 850 Gordon, P., Pt., E, 7th June , Left. Died June 7, 1863. 893 Bowel, J. C., Lt., C, 55th July 20, . Died July 30, 1864. Missouri. , 63. Alabama. 20, 64. 851 Gotwaltz, A., Pt., A, Sept. 19, Left; flap. Died Oct. 11, 1864; 894 Hiibbard, J. D., Corp l, Dec. 15, Left. Died Jan. 22, 63; pyaemia. 138th Pennsylvania. 19, 64. exhaustion. G, 8th Florida, age 32. 15, 62. Autopsy. 852 Gould, E. S , Corp l, I, July 3. Right. Died August 7, 1863. 895 Hubbell, G. P., Corp l, May 14, . Died May 17, 1864. 2Jd .Mass., age 19. 3, 63. C, 24th Michigan. 14, 64. 853 Goxvers, J. A., Pt., B, May 12, Right; circ.; seq. removed. Died 896 Hudnot, M. B., Pt., D, June 16, Left, Surg. S. II. Plumb, 82d 14th X. Y. H.A.,age23. 13/V4. Sept. 18, 1864 ; asthenia. 8th New York H. A. 1G, 64. N. Y. Died June 17, 1864. 854 Graves, J., Pt.. D, lllth July 28, Right. Surg. H. C. Messenger, 897 Hugh, E., Pt., H, 59th June 16, Right ; ciro. Surg. G. L. Potter, Illinois. 28, 64. 56th Ohio. Died Aug. 1, 1864 ; New York, age 22. 17, 64. 145th Penn. Died June 30, 64. wound. 898 Hulce, C., Corp l, H, 2d June 18, Right. Surg. S. S. French, 20th 855 Gray, T. W., Corp l, F, Sept. 19, Left. Died Oct. 29. 1863; haem. Michigan. 18, 64. Mich. Died June 18, 1864. 58th Indiana. 19, 63. and pyaemia. 899 Humel, H. J., Pt.. G, Mav5, Left. Died June 5, 64 ; exhaus 85(5 Green, J., Serg t.D, 88th Dec. 13, Right ; slough ; rein, protr. bone. 155th Penn., age 23. 5, r 64. tion. New York. 13, 62. Died Feb. 23, 18G3. Spec. 655. 900 Husted, W , Pt., I, 142d Oct. 27, Right. Surg. A. M. Clark, U.S.V. 857 Grissel. J., Pt., B, 8th Dec. 16, Loft ; ant. post. flap. A. A. Surg. New York, age 18. 27, 64. Died Nov. 15, 64; pyaemia. Kansas, age 21. 17, 64. R. McMilley; shock. Died Dec. 901 Hutchinson, W. W., Pt., June , Left. Died July 28, 1864. 18, 1864 ; exhaustion. F, 18th Infantry. , 64. 858 Grow, L., F., Lieut., K, July 22, Right. Died July 26, 1864. 902 Hutzel,G. F., Pt.,E, 5th April 2, Right ; circ. Died May 4, 1865 ; 25th Wisconsin. 24, 64. Wisconsin, age 33. 2, 65. pyaemia. 859 Haines, J., Pt., I, 7th May 11, Right; circ. Surg. J. Ebersole, 903 Jackson, E., Adj t. 82d Juno 1, Left. Surg. S. H. Plumb. 82d Indiana, age 29. 11, 64. 19th Ind. Died May 29, 1864. New York. 1, 64. New York. Died June 7, 64. Spec. 2408. 904 Jackson. H., Pt., E, 4th Sept. 20, Left: (alsoamp. arm.) Died Oct. SCO Hance. W.. Corp l, D, 137th N. Y., age 18. Oct. 29, 29, 63. Left. Surg. J. V. Kendall, 149th N. Y. Died Oct. 29. 18G3. 905 Colored Troops, age 23. Jackson, W. , Serg t, C, 20, 64. May 26, 11, 64 ; exhaustion. Left; cire. Died June 8, 1864; 8G1 Hancock, G., Pt., A, 21st Sept. 19, Right ; flap. Died Oct. 4, 1 864 ; 23d Kentucky, ago 41. 27, 64. exhaustion. Virginia. 19, 64. pyaemia. 906 Jeffries, A. S., Pt., I, April 7, Left. Died July 9, 1865 ; exhaus 800 Hancock, J.,Pt., E, 179th June 18, Left. Died June 19, 1864. 17th S. Carolina,nge 23. 7, 65. tion. New York. 18, 64. 907 Johnson, F. B., Pt., C, Dec. 13, Right. Dec. 25, lig. fern. Died 8(J3 Hansard. W., Capt., K, Dec. 16, Right; ant. post. flap. Died Jan. 16th Maine, age 23. 14, 6->. Dec. 25, 62; exhaustion. 4ibt )hio, age 22. 16, 64. 7, 1865. 908 Johnson, I , Corp l, K, July 1, Left. Oct. 10, haem. Died Oct. 804 Harck. M., Corp l, C, May 14, Left. Died May, 1864. 1st Ohio Art ry, age 21. 3, 63. 19, 63 ; asthenia. C.id Indiana. 14, 64. 909 Jones,A., Corp l, K, 15th May 10, . Died Juno 17, 64 ; pyaemia. 8G5 Hardy, E., Pt., F, 36th July 30. Left; flap. Ass t Surg. Th. Wild. Mass., age 21. 10, 64. C. T., age 23. 30," "64. 36th C. T. Died Aug. 29, 64; 910 Jones, W. H., Pt., H, 1st May 19, Right. Died June 19. 1864 ; py pyaemia. Maryland, age 36. 19, 64. aemia. Autopsy. 8(iC Hartinan, E.. Pt., A, Oct. 19, Lei t. Surg. S. H. Plumb, 82d 911 Kane, D.,Pt., H, 1st New June 3, Left ; circ.; slough g. Died Sept. 59th Xew York. 19, 64. N. Y. Died Oct. 19, 1864. Jersey, ago 19. 4, 64. 10, 1804. 8G7 Hartson. P.. Pt., I, GOth June 1C, Right : flap. Surg. H. B. Whiton, 912 Keeling, L. T., Pt,, D, May 27, Died June 3, 1864 ; wounds. New York, age 25. 16, 64. GOth N. Y. Gangrene. Died 17th Kentucky. 27, 64. Aug. 16, 64 ; chronic diarrhoea. 913 Keller, H. H., Pt.. B, May 5, Right. May 20, haem.: 28th, re 8G8 Hatch, W. 1!.. Col.. 4th Dec. 13, Left. Died December, 1862. 7th Mich. Cav., age 34. 6, 64. curred ; ligation. Died Juno 25, New Jersey. 13. 62. 1864 : pva?mia. 8G9 1 Hawksworth. T., Muj., Doc. 14, Left. Died Jan. 6, 1863 ; tetanus. 914 Kennard, P., Pt.,A, 16th May 14, . Died May 14, 1864. 1 (iSth Pennsylvania. 14, 62. .Spec. 112. Kentucky. 14, 64. 870 Ilealcy, T., Pt., E, 157th July 1, Left. Died July 15, 1863. 915 Kerner, C", Pt., D, 26th Mar. 19, Right. Died April 21, 1865. New York. 1, 63. Wisconsin, age 17. 19, 65. 87] Ilealy, J., Pt.. E, 64th April 7, Left. Died June 8, 1865. 916 Kessler. J , Serg t, A, Nov. 25, Left ; gang.; sym. of ichoraemia. i Now York. 8, 65. 44th Illinois, age 26 27, 63. Died Dec. 31, 1863. i: 72 Ilolston. J., Pt., II, 49th Sept. 19, Left ; circ. Died Sept. 29, 1864 ; 917 Kidd.W., Serg t, C, 14th June 16, Right ; anterior post. flap. Died Pennsylvania. 19, 64. exhaustion and debility. N. Y. H. A., age 33. 17, 64. July 7, 18G4. ^-.., Ilcmpletnan, N., Pt., G, Jul^Si, Left ; circ. Surg. R. Morris, 103d 918 Kiddoo, A., Pt., K, 102d July 20, Right. Died November 2G, 1&64. Midi Ohio. 22, 64. 111. Died Aug. 18, 1864. Illinois. 20, 64. 1 O MKAGIIER ( W.), Casualties at the Battle of Freclericksburg, in American Medical Times, 1863, Vol. VI, p. 179. rill ; LOWER EXTRKMITIKS. ICHAP. x. NO. NAMK. MII.ITAKY OI-KKATIONS, OIMCHATOKS, j v DESCRIPTION, AND .\(.K. RKSULT. NAMK. MILITARY DESCRIPTION. AND AUK. u OPERATIONS, OPERATORS, RESl LT. 919 Kilboume, K. A., Pt , H, May 18. Right : ant. post. Hap. Surg. T. 956 Maxsei/. J. W., Pt., A. July 3. Left : slough. Aug. 5. bone rem d. 4.">th Penn., age 19. 18, 64. S Christ, 45th Penn. Died June 14th X. C . age 22. 3, 63. Died Sept. 2, 1863; pyaemia. 15. 1864; exhaustion. 957 2 Mail, IT. / ., Serg t, C, Sept. 19, Right. Died Oct. 16, 1863; py 920 Kincaiil. J. it., ( apt., July 3, Left. Died Aug. 21, 1863. 10th South Carolina. 19. 63. aemia. G. 5-d X. Carolina. : , 63. 958 McCollum. J., Pt., E. May 14, . Died May 14. 1804. 921 Kirkpatrick. J., Pt., G, June 18, Left; circ. flap; gang. Died 16th Kentucky. 14. 64. 4th X. Y. II. A., ago 21. ! 18, 64. Sept. 20, 1864. 959 McCoiiaughy, S. B., Pt., May 19, Lett. Surg. J. 15. Potter, 30th 922 Kline. M., Pt.. H, 2; 3d i Jan. 15, Right; circ. A. Snrg. F. B. Kim- C, 116th Illinois. 19, 63. Ohio. Died May 20. 1863. Penn., age 20. | 15, 65. ball, 3d N. H. Died Feb. 9, 960 McCullough, J. H., Ser May 14. Left. Died May 27, 1863. 1865; exhaustion. Autopsy. geant, K, 17th Iowa. 14. 63. 923 Knight, T., Pt.. F, 7th !>,,. 13. Right. Died December 15. 1862. 961 McElrov. S., Serg t. I, Oct. 1, Left. Died October 25, 1864; Rhode Island. 13, 62. 7th R. Island, ago 33. 1, 64. pyaemia. 924 Knight. W.,Pt., (1. 147th Aug. 18. Left. Surg. A. S. Coe. 147th N. 962 3 MeEvov, J., Pt., II. Dec. 14, Right : ant. post. flap. Surg. T. New York. 18, 64. Y. Died Aug. 21, 1864. 99th Penn. 15, 62. Hildreth. 3d Me. Died Dec. 925 Krani, T., Pt., D, 8th July 20, Left ; flap. Surg. AY. B. Fox, 8th 29. 1862. Michigan, age 20. 21, 64. Mich. Aug. 18, reamp. Died 963 McGowan, W., Pt.. D, Feb. 6. Left. March 27, haemor. Died Sept. 1, 64: pyaemia. Autopsy. 97th N. Y.. age 25. 6, 65. March 28. 1865. 92i ; Lackey, M., Pt., K^Gth July 10, R t : circ. July 21, luem.: lig. fern. 904 McGill, R., Pt., A, 12th May 27, Left. Surg. A. C.Robertson, 159th Vermont, age 18. 10, 63. Died Oct. 22, 1863; exhaustion. Maine, age 44. 27. 63. X. Y. Died June 6, 1863. Spec. 3880. 965 Mclllhaney, R., Pt.. I, July 28, Right. Died July 29, 1864; ex 92? Lamb, H., 1 t., H, 31st May 26, Left ; flap. Surg. A. T. Hudson, 29th Pennsylvania. 28, 64. haustion. Iowa. 26. 64. 26th Iowa. Died June 6, 1864. 966 Melligan. D.. Pt., I, June 14, Left ; haemorrhage. Died Aug. 928 Lambert, X , Pt., II, 32d Feb. 6, Right. Died March 4, 1865: py 110th New York. 14, 63. 18. 1863. Muss., age 34. 6, 60. aemia. Autopsy. 967 Meranvillc, R.E.,Corp l. Aug. 29, . Sept. 5 and 6, haem.; 7, lig. 929 Lamphere, ( , Pt., G, Sept. 29, Left; circ. Surg. T. H. Squire, F, 2d New York Cav. 30, 62. femur : 8, haemorrhage. Died 8th Conneotieiit. 29, 64. 89th N. Y. Died Sept. 30, 1864. ! Sept. 12, ]62. 9:5!) Lani])inan, A., Pt , B, July 18, Right. Died July 26, 1864. ; 968 Miller, F.. Pt., E. 66th Dec. 13, Right. Surg. C. S. Wood. 66th frtli X.Y.II.Art,,agc24. ," 64. New York. 15, 62. N. Y. Died Dec. 20. 1862. 931 Lanier, J .. Pt., C, 17th July 30, Right: eire.; sloughing. Died ,969 Miller, J., 1 t.. H. 134th June 27, . Surg. H. B. Whiton. 00th S. Carolina, age 33. , 64. Aug. 17, 1864. New York. 27, 64. New York. Died June 28, 64. 932 Larkin, W. H., Pt., li, Sept. 19, Right: oval. Surg. . I. W. Smith, 970 Miller, A.. Pt., K. 2d May 3, Left; circ. May 8. sloughing; 22d New York Cav. 19, 64. 2d Ohio Cav. Died Oct. 30, 64 ; Virginia, age 33. 5. 63. haem. from bowels. Died May pyaemia. 9, 1863. 933 Larry, L., Pt , A, 1st July 17, Left : double flaps. A. A. Surg. 971 Milliner, W., Pt., Goss s July 4. Right; nee. bone remo d. Died New Orleans, age 23. 17," 64. F. Hassenburg. Erysip. Sept. Arkansas Reg t.age 30. 5. 63. Sept. 7, 1863. Spec. 2088. 21, amp. hip joint. Died Sept. 972 Mink. M., Pt., E, 28th Oct. 19, Left; flap; sloughing: bone re 30, 64 : pvnemia.ctc. Spec. 3738. Iowa, age 21 . 19, 64. moved ; haemorrh. Died Dec. 934 Lawyer, F. T., Pt., A, May 5, Left. Died May 10, 1864. 7. 1864: pyaemia. 6th Maryland. 5, 64. 973 *Minslett, J. C.. Pt.. , Sept. 19, . Died Sept. 30, 1863; ex 935 Ledbetter, J. W.. Pt., H, May 12, Right; circ. Surg. A. H. Hoff. 39th Alabama, 19. 63. haustion. 131st Illinois, age 28. 12," 63. U. S.V. Died May 27, 1863; 974 Mitchell. F. A., Corp I, July 3. Risrht. Surg. H. F. Lyster. 5th exhaustion. I, 17th Maine. 4, 63. Mich. Died July 29, 63; exh n. 930 Leddy, J., Pt., G, 4th Sept. 30, Left. Died Oct. 18, 64; pyaemia. | 975 Mitchell, J.. Pt., L, 6th Oct. 19, Right; lat. skin flap; circ. sect. Rhode Island, age 21. 30, 64. Autopsy. N. York Heavy Art y, 21, 64. muscles. Surg. C. H. Andrews. 937 Lesher, J. M., Pt., G, July 20, Left ; flap. Surg.W. Lomax, 12th age 25. 176th N.Y. Died Nov. 3, 1864 ; 12th Indiana. 20. 64. Ind. Died Oct. 2, 1864. pyaemia. Autopsy 938 Leonard, J., Serg t, D, June 18, Right. Died Aug. 11, 64; exh n. 976 Mohner, J., Pt., F, 15th Dec. 16, Left; circ. Surg. T. L. Magee, 55th Penn., age 27. 18, 64. Missouri, age 24. 16, 64. 51st Ills. Died Dec. 23, 1804; 939 Lindsay, W., Pt., A, June 18, Right. Died June 28, 18C4. irritative fever. llth New Jersey. 18, 64. 977 Montgomery, J.. Corp !, Oct. 5, Right. Ass t Surg. J.J.Whitney, 940 Lintz, 11., Pt., K, 10th April 2, Right. Died April 22, 65 ; typh. C, 93d Illinois. 5, 64. 18th Wis. Died June 22, 180"5. N. Y. II. Art v, age 20. 2, 65. fever. 978 | Moon. J. L.. Pt., E, 44th Oct. 3, Right. Died Oct. 6, 1864. 941 Littlffidd, if. C., Pt,, 15, May I"), Right. Ass t Surg. H. K. Good ! North Carolina. 3, 64. 43d Georgia. 15, 64. man, U. S. V. Died May 21, 64. 919 -" Moral], J., Pt., I. 6th Jan. 1, Right. Surg. P. C. Pease. Gth X. 942 Loetze, H., Pt., G, 9th l>ec. 14, Right ; circ. Surg.G. A.Otis, 27th New York. 3, 62. York. Died Jan. 3, 62; never New Jersey, age 56. 14, 62. rallied. Died Jan. 31, 63; haem. Autop. 980 Morear, J , Pt., 1st Mas Oct. 19. Right. Died Oct. 21, 1864. 943 Long, F , Pt., E, 14th June 2, ; flap; sloughing. Died June sachusetts Batter}-. 19, 64. N. Y. II. A., age 20. 4, 64. 14, 1864 ; exhaustion. 981 Morgan, J. D., Serg t, Mar. 25, Right. Died March 26. 1803. 944 Long, II., Pt., K, 148th July , Left. Died July 21, 1863. F, 22d Wisconsin. 25. 63. Pennsylvania. ," 63. 982 Morse, A. A., Pt., D, Oct. 19, Left; circ. A. Surg. 15. A. For- 945 Lord, U., Pt.. 1, 1st Me. May , Left. Surg. J. W. Lyman, 57th 114th N. York, age 25. 20, 04. dyce. 160th N. Y. Died Nov. Heavy Artillery. ," 64. Penn. Died May. 64. Spec. 3225. 13, 1864: exhaust . Autopsy. 946 l.nvrll, J. D.. 1 t., I, 54th July 2 ,>. Left. Surg. A.C. Messenger, 57th 983 Murphy, P., Pt.,15, lllth Oct. 28, L t; circ.; (alsofract. cran.) Died Ohio. 23, 64. Ohio. Died An?. 3, 1864. Penn., age 22. 30, 63. April 30. 04. Ant. Spec. 2139. 947 Low, S., Corp l, F, 17th Aug. 25, Right; circ. A. Surg. J. D. Wil- 984 Mushiltz. W., Pt., A, May 6, . June 16. nee. bone remo d. Penn. Cav., age 23. 25,~ : G4. lard, 1st Md. P. H. 15. Died llth Penn. 6, 64. Died June 24. 64; exhaustion. Oct. 9, 1864. Spec. 2720. 948 Lowery, J., Pt., 15, 10th Aug. ii, R t ; circ. Surg. II. N. Small, 10th 985 Nash, K. J., Pt., G, 9th July, Right; haemorrhage. Died Aug. N. Hampshire, age 24. 6, r 64. N. II. Died Oct. 4, 64; pytrm. Virginia. , 63. 16, 1863. 949 Lowrey, J., Lieut., C, May 14, . Died May 15. 1864. 986 New, F., Pt., E, 7th N. Dec. 13, . Surg. C. S. Wood, With Kith Kentucky. 14, 64. York. 15, 62. N. Y. Died Dee. 23, 1802. 950 Ludwig. E., Pt., F, Gth Oct. 19, Right. Died Nov. 23, 1864. 987 Newton. J. II., Pt.. B, July 20. Right. Died Aug. 12, 1864. Maryland. 19, 64. 70th Indiana. 20, 64. 951 Lynch, J.. Pt., I, 89th July 9, Right; lat. skin flaps; circ. sect. 988 Nicholas, M. 15., Serg t, Oet 19, Left; circ. Died Nov. 27, 1864; Penn., age 40. 11, 64. mus. A. A.Sur"-. J. H. Bartholf. I, 24th Iowa. 19. 64. pyaemia. Died Feb. 14, 65: soft, of brain. 989 Notestine, W. F.. Capt., Dec. 15, Left; circ. A.. V. Surg. ,1.11. Green. Autopsy. Spec,. 1369. E, llth Mo., age 22. 15. 64. Died Feb. 12, 1865; exhaustion. 952 Mniiii. I)., Pt., D, 39th July 4, Left. May 14. 1865. reamputat n. 990 Nunemacher, I.. Pt.. C. April 6, Left; flap; diarr. Died April 29, Ohio, age 29. 4, 64. Died May SO, 1865; pyicmia. 8th Penn. Cav., age 40. 6. 65. 1805; pya inia. Autopsy. 9:,:: Martin. I- .. Pt., H, llth Nov. 10. Left. Surg. O. J. Evans, 40th N. 991 Oberly, F. A., Pt., D, July 24, Right. Surg. G. S. Palme r. U. S. New Jersey. 10, 64. Y. Died Dec. 3/64. Spec. 4117. 10th N. York, age 23. 24," G4. V. Died July 31, 64; exhaust n. 9.VJ Martin, M. C.. Pt., G, Sept. 19, Left : circ. Surgs. Duval and Wil 992 O Brien. T., Pt., G, 69th Sept. 17, . Sept. 26, bone protruding RW North Carolina. 19, 64. kinson. C. S. A. Died Sept. 26. New York. 17, 62. remo d ; tetan. Died Oct. 3. 62. 1864 ; pass, haemorrhage. 993 ; O Connell, \V., Pt., D, Mar. 10, Left; circ, Died Mar. 17, 1805; 955 Marshall, K., Ft.. G, May 28, Right ; ant. post. flap. Surg. A. 25th Mass., ago 19. 11, 65. exhaustion. 147th N. Y., age 23. 28, 64. S. Coe, 147th N. Y. Died June 994 O Donnell, C., Pt., A, 2d May 19. Left; circ. Died June 28, 1864 ; 18, 18G4 , pytemia. N. York Art y, age 19. 19, 64. pyaemia. 1 Circular No. 6, S. G. O., 1865, p. 50, CASE 10. Circular No. 7, S. G. O., 1867, pp. 48, 65. 2 TEIJUY (C.), Report of Wounded treated in Field Hospital of Hindman s Divis., Army of Tennessee., after the battle of Chickamauga, in Con fed. States .Weil, and Surg. Jour., 1864. Yol. I, p. 70. 3 O MEA<;HER (W.), Casualties at the Battle of Fredericksburg, in Am. Med. Times, 1863, Vol. VI, p. 179. "TKltnv (C.). Confederate States Med. and Surg. Jour., 1864, Vol. I, p. 76. 5 LYNCH (E.). Santa Rosa Isle, Health, of the Gth JV. Y. Vols., in American Medical Times, Vol. IV p. 196. SECT. III. PRIMARY AMPUTATION OF THIGH IN MIDDLE THIRD. No. NAME, MIMTAKY DE.srim TIO.N, ANH A(!K. DATES. ( H KKATIOXR, OrEKATOKti, RESULT. NO NAMK, MIUTAKY DKS< inmox. AXI> AGE. OrKllATlOXS, Ol KKATOIih. KKsri.T. 935 O Harn, J., Pt..C. 12th Dec. 14, Lett ; ant. post. flap. Surg. J. 1034 Robiiiett, J. A.. Pt., ( ,. Julv 2, Left. Died Julv 22. 1803. 1 fiiii. lies. ii (i "o 40. 15, 02. Howe 1st X. Y. Jan. 1 3 63 5!!th Xorth Cnrolinji. 3, 03. lisem. Died Jan. 4, "63: exh n. 1035 Rogers, L. A., ( apt., D, June 2, : Left. Died Julv 10. 1804. 996 Pnlmerton, J. P., I t.. E, June 18, Right. Surg. O.W. Metealf. 76th 9Mh Xew York, age 36. 2, 64. \ 7(ith Now Yi.rk. 18. 64. N. Y. Died June. 1864. 1036 Kogers.XV. JL.Corp l.A. Julv 22, Left; circ. Act. Staff Surg. C. Mav 10 Right ; circ. Died May J9, 1864 ; 110th Illinois, age 35. 22, 64. B. Richards. 1". S. A. Died 24th M ifli., aire - 3. 10, (54. exhaustion. > Sept. 20, 1804. il JS l <trl;tr, J. L., 1 t., G, Oct. 19, Left. Died Xovember 8, 1864. 1037 Rowe, J. B., Corp l, I, May 10. Right. Surg. J. S. Rose, llth N. 12th Georgia. 20, 64. llth New Hampshire. 10, 04. , H. Died May 19, 1864; wounds. ll .i .i Parker, S. K., Serg t, G, Mar. 30, Left. Died March 31, 186"). 1038 , Royxtcr, T , Pt., Prices Oct. 22, : haemorrhage. Died Oct. L 7, 147th New York. 30, 65. Artillery. 22, 63. 1803. 10(10 / ,//.,>, .Y. It.. Corp !, Oct. 3, Left. Died October 24. 1864. 1039 Rannells. A. ./., Pt., D, Aug. 19, Uiglit ; circ. Surg. W. V. White. I, 44th N. Carolina. 3, "64. 27th Georgia. 19, 04. 57th Mass. Died Aug. 22, 1864. KX)1 Fcarsall, K. 11., Pt., E, June 5, Left : circ. Surg. J. \V. Wishart, 1040 Russell, A.R., Serg t, E, Oct. 17,1 Right: oval. Asst. Surir. K. P.. 2d N. Y. H. A., ago 17. 5. 04. 140th Penn. Died June 30, 64 ; 2d Massachusetts. 19, 04. Nims, 1st Vt. Cav. Died Oct. 19, pyaemia. 1804: tetanus. 1002 Peiffer.M., Corp l. V, 83d Mav 8. Left ; flap. Died Oct. 28. 1864. 1041 Sanders. L. C., Pt., K. June 10, Left ; cire. Surg. J. W. Wishart, Penn., age, 37. 8, 64. 2d X. Y. II. A., age 21. 17, 04. 140th Penn. Died July 10, 64. 1003 l en<Jrrffrant,N. t ., Sgt., July 20, Left. Died August 5, 1804. 1042 Savers,.!. \V.. Corp l, C, April 29, Left. Died May 5, 1865; exhaus E, 55th Alabama. 20, 64. 8th X. Y. Cav., age 24. 30. 65. tion. 1004 Perigo, li. T , Corp 1, A, Mav 3, . Ass t Sur<r. 11. Howard, 1043 Scurry, J., Pt., I!. 1st Aug. 14, Right. Died August 21, 1804. 140th New York. 3, 63. U. S. A. Died May 3, 1863. Minn., age 35. 14, 64. 1005 Perry, J. K.. Pt.,A,44th Oct. 14, ; flap. Died Oct. 28, 1863. 1044 Seudder. L, C., Pt., I, June 22, Right. Died July 15, 1864. North Carolina, age 31. 15, 63. 33d Indiana. 22, 64. 100(5 Pierce, T. G.,jr., Pt , D, July 31, Right; cire.: gang. Died Nov. 1045, Scarlet, G., Pt., 1), llth Aug. 24, Left ; eirc. Died August 25, 64 ; Kith Iowa, age 24. 31, 04. 6, 1864; exhaustion. Colored Troops. 25, 64. haemorrhage. 100? I M*, C. C., Pt., K, 1st April 9. Right. Surg. W. 1). Murray. 101st 1040 Scott. A.. Corp l, I. 121st | June 27, Right. Died June 28, 1864. Alabama. 9, 65. N. Y. Died April 9, 1805. Ohio. 27, : 64. 1008 Plankington, J.. Pt., K. June 18, Left: flap. Aug. 6. luem. Died 1047 Seaburn. A.. I t. .G. 97th July 30, Left ; ant. post. flap. Surg. D.W. 2d Penn. Art y, age24. 18, 64. Aug. 6. 1804 : exhaustion. Pennsylvania. 30, 64. Maull, 1st Del.: aneur.: lig. ex. KNi .i Pollard. A., Pt., ( . 4lh June 15, Right: (also w ndlcft knee joint ;) iliac. Died Oct. 9, 64. Sp. 3282. Colored Troops.age 19. , 64. ant. pest. flap. Died Julv 21, 1048 Sergeant. \V. II.. Pt.. G. June 17, Right : flap. Surg. S. S. French. IS M: exhaustion. 24th Xew York, age 28. 18. 64. 20th Mich. Died June 26, 1864. 1010 Ponle. C. ! .. 1 t., G. tli Dec. Hi. Left ; ant. post. flap. A. A. Surg. 1049 Shortsleeve. G.. Pt.. E, May 12, Left. A. Surg.M.Uizer. 72(1 Penn. Illinois Cav., age 35. 17. 64. T. Morrison: py;eiuia. Died 15th Mass.. age 20. 12, 64. Died June 5, 64 : pyaemia. Dec. 30. 1864. 10501 Sheppard. G., Pt., C , 1st Sept. , Right; hsem. Oct. 20, reamputa- 1011 Poole, J.C., l t.,C, 145th ! May !?, Left. Surg. P. E. Hubon. 28th Illinois Cavalry. , 61. tion. Died Oct. 20, 1861. Pennsylvania. 12, (>4. Mass. Died .Mav 2.1. 1864. 1051 Shilling, H. IK.. Pt., Sept. 19, . Died September 28, 1863; 1012 Potter. F. W., Corp l. C , Mav 13, . Surg. L. W. P.liss, 51st N. ! A, 19th Alabama. 19, 03. exhaustion. . 7th Khode Island. 13, - i4. Y. Died .May 18. 1864. 1052 Silliman, W., Col., 20th Dec. 9, Right. Died December 17, 1864. 1013 Prentiss, W. S.. Pt., A. April 2. Right; pyaemia. Died June 23, Colored Troops. 9, 04. 2d Maryland, age 2(i. 2. 65. 1865. 1053 Skillman, F., Pt., E, Sept, 19, Right; eirc. Surnr. L. P. Wagner, 1014 Preston A. A., 1 t.. C, June 2. Right. Died June 7, 18G4. 114th New York. 19. 04. H4thN.Y. DiedOct.7, 64; pyse. 2d X. Y. Mt d Killes. 2. 64. 1054 Skinner, J., Pt.. F, 140th Mav 12, Right : ant. post. flap. Died May 1015 Proctor. K., Serg t. 11, Oct. 19, Right ; cire. A. Surg. J. Ilomans, Xew York, age 34. 12," "64. 31, 1864; pyaemia. Autopsy. 9(>th N. Y., age :i5. 20, 64. li. S. A. Died Nov. 8. 04 : ha?m. 1055 ^Skipper, A. li., Pt.. A, Sept. 19, : haemorrhage. Died Nov. ion; Quarlrs. T. !>., I t., H, June 19, Right: Hap: (uls:> fracture left.) ICth South Carolina. 19, 03. 2, 1863. 53d Virginia, age 32. 19, 64. Died August L , 1864. 1056 Slater, B.. Pt., B. 72d July 23, Right. A. Surg. J. T. Calhoun. 1017 Quinn, J., Pt., 11. 7th X. June 18. Right. Surg. G. L. Potter. 145th Xew York, age 22. 23," 03. II. S. A. Died Julv 3), 18.14. York Art y. age 25. 19, "64. Penn. Died Dec. 18, 04 : cxh n. Spec. 1513. 1018 Kami, W.".l.." 1 t.. K. Dec. 14. Right; (also amputa. left arm at j 1057 Smiley. J.. Pt., B, 10th May 10, Left. Surg. H. Rohrer. 10th Penn. 45th Mas*. a (r e 25. 14, 62. shoul. ioint.l Snnr. 1. F. Gal- Penn. Reserves. 10," 04. Res. Died Mav 11. 1864. loupe, 17th Mass. Died Jan. 24. 1058 Smith, D.. Pt., G, 6th May 12, Left. Surg. W. B. Lyons, llth 1863: pviemia. Penn. Reserves. 12, 64. Penn. Res. Died May 12. 1804 101 it Randolph. \V.. 1 t.. C. April 6. ; slough.: exposed end bone 1059! Smith, F. W., Pt., C, 2d May 25. ; circ.: severe diarrh. Died 25th lii liaiia. 6, 62. removed. Died April 9, 1862. S. C. Rifles, age 16. 25, 64. June 20, 18<4. ID-JO Ranger. K. .].. I t.. 11. Feb. 7, Left: circ. flap. Died Feb. 24, 1060 Smith, H. M., 1 t., G, April 6, Right; lat. (lap : femur prot. one 24th Mich., age 2(i. 7, 65. 1865; pyamiia. 82d Penn., age 28. 6, 65. inch. Died May 7. 65: pyaetn. 1021! Kavuio.i(l.\V. 1).. l t..l). Mav 1-, . Right; eirc.; sloughing. Died 1061 Smith, J. J., Pt., F, llth Oct. 19. Left; circ.: hieiu : lig. perforating 5: id X. V., ago 28. 12, 04. June 21, 1864; pya inia. West Virginia, age 20. 20, 64. artery. Died Nov. 9. 04; pyaem 1022 Redman. U., Corp l, I. May 14. . Surg. D. L. Heath. 23d 1062 Snowbridge, A., Pt., G, Dec. 14, Right- flap. Surg. J.W. Lvman. 2 kl Michigan, i 14. (i4. Mich. Died July 18, 18:i4. 99th Pennsylvania. 15, 62. U. S. V. Died Jan. 0, G3 ; effect 1(,V 3 Reed. \V. H.. I t., 11. 8th (tct. I .l. Kight : oval flaps. Oct. 24, hasm.: of amputation. Vermont, age 31. 21, ii4. lig. fern.; 29th. hami. Died Nov. 1063 Solomon. H., Pt., B, 12th May 14, Right. Surg. G. L. Carhart. 31st 21. 04 : peritonitis and pyaemia. || Missouri. 14, 64. Iowa. Died Mav 17. 1864. 1024 R: iiitrr. Ji. .I/.. I t.. 1. June 1, Right: circ. Died June 15, 1864. ,1064 Spear, J.. Serg t. E, 6th June 1, Left; circ. Died July 17, 1864. 51st N . ( .. aire U-. 1. 14. Maryland, age 32. 2, 64. 10.15 .R>-yii<,l,h. .. 1 t., 42d .July]. . Died July 19. 1803. j 1065 Spear. J. W., Pt., D, May 14, Left; diarrhoea. Died July 6, 64. Mississippi. :i. (i3. 27th Mass.. age 39. 14, 04. 1020 Rich. T. H.. I t., I.. 8th Nov. Id, Right. Surg. A. Churchill, 8th 1066 Sproul, J..Serg t,C, 40th Nov. 7, Left : double ant. post. flap. Surar. N Y 11 \ a"-e 27. 10 64. N. Y. H. A. Died Dec. 20, 64; New York, age 24. 7, 63. A. Campbell, 40th N. Y. Died pytemin. Dec. 7, 1863: pyatmia. Autopsy. 1(1-7 Richard.son.A.C.. I t. .15. Dee. 13, ; flap. Died Jan. 29, 1863; 1067 Sprowl. J. K.. I t., B, Sept. 19, Left. Died Sept. 23, 1863. 1211th Penn., age 30. 13, 62. haemorrhage. 58th Indiana. 20. 63. 1028 Ricketts, I... I t.. A. 123d June 2 .. Right : ciiv." Stiffr. C. \V. Me Mil- 1068 Steele. J., I t., I. 100th Dec. 15, Left; flap. A. A. Surg. J. S. Indiana, a-, !- 2.J. 27. (14. Ian, 1st E. Tenn." Died Aug. 29, Col d Troops, age 22. 10, 04. Giltner. Died Jan. 14. 1865. 1864 ; pytemia. 1009 Stines, H., Corp l. D, June 17. Left : ant. post. flap. Died July 102!) liilev. 1!.. ( oh 1. Vr.tli , Mav 2. Right. Died May 3. 1863; ex 97th New York, age 28. 18, 04. 18. 1804: exhaustion. Autopsy. ( >hio. 3. 63. haustion. 1070 Stokes, S.. Pt., F. 1st Mav 21, Right; erysipelas. Died. June 1. 103:) liilev. .I.. Drummer. C, Julv 3. Left; flap. Died July 29, 1863; Mo. S. M. Cavalry. 22, 64. 1804; tetanus. Hj th N. Y.. age 17. 5, 63. diarrhoea and typhoid fever. 1071 Stonecyphe. S., Pt., G. Deo. 13, Right. Surg. C. S. Wood. (iOth 1031 Risley. S.. 1 t.. H. 4-!th ! Mayo, Right. Died June 1, 1804; ex 131st Pennsylvania. 15, 02. N. Y. Died Jan. 2. 1863. Now York, ago 27. 5. 04. haustion. 1072 Stnwers, .V. "C., Lieut.. Aug. 20, Right. Surg. A. A. White, 8th 1032 3 Roach. S.. I t.. C. 99th Dee. 14, Right : ant. post. flap. Surg. A. K, 6th Georgia. 20, 64. Mil. Died Sept. 17. 1804. Pennsylvania. 15, 02. J. Ilerr. (i8th Penn. Died Jan. 1073 Strong, \V. U.. Pt.. 121st Mav s. Left; flap. Surg. J. A. Ramsey. 13. 1803; pya-mia. Penn., age 20. 10, 64. 121st Penn. Died May 24. 64 : 1033 Robinson, J., Serg t, II. Mav . Right; flap: (also exe. forearm ) exhaustion. 48th Illinois 64 ^urc \ Co"lin l w th 111 l^icd 1071 Stncf ff tf C June 1 "J Ri~ht Died Fulv 1 t l fi J4 June 1, 1864. ago l 8. 15. (i4. 1 O MK.Vi.HKi: (\V.). lac. <:.. : t.. in American Medical Times, Vol. VI. p. 179. "GAl.l.orrE (1. ! .), Army .Medii-al InteUi-jriirr, in 2iost. Med. and Surg. Jou,:, 1803. Vol. 08. p. 205. : <) MKA<.III-:K (\V.), Casualties at the Rattle of Frfdrrii-ktbnnj. in Am. Med. Times, 18ti3, Vol. VI, p. 179. J Ti:;;i:v (( .). l<-.rit., p. 7C.. "TICKKY ((. .). lot-, cit.. p. 7(i. O MEAUllKK (W.), Casualties at the Battle of Frulericksbunj. in American Medical Times, 1863, Vol. VI, p. 179. 240 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITAUY DESCRIPTION , AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITAUY riATwa DESCRIPTION, AND AGE. OPERATIONS, OPERATORS, RESULT. 1075 Stulls, H., Pt., A, 6th Feb. 6, Left; circ. flap. Died Feb. 19, 1117 Washington. G., Pt., A, April 1, . Surg. II. Osborne, 51st C. Wisconsin, age 22. 6, 65. 1865 ; pyaemia. 48th Colored Troops. 1, 65. Troops. Died April 3, 1865. 1076 Sullivan, P., Pt., F, 42d Sept. 17, Right. Died Sept, 29, 1862. 1118 Waters, J., Pt,, B, 26th May 12, Right ; circ. Surg. J.W.Wishart, New York. 17, 62. Michigan, age 44. 12, 64. 140th Penn. Died June 26, 64. 1077 Summers, H., Serg t, M, Sept, 19, ; circ. Surg. Sutton. C. S. A. 1119 Webb, J., Pt.. G.. llth Mar. 31, Right. Surg. C. M. Clarke. 39th 21st N. C., age 30. 19, 64. Died Nov. 4, 1864 : pviemia. West Virginia. 31, 65. Illinois. Died April 10, 1865. 1078 Swarman, J.,Pt.,G, 13th Sept. 19, Right. Died Sept. 27, 1864. 1J20 Webb, J. D., Corp l, D, Oct. 19, Left; ant. post, flap. Surg. H. Connecticut. 19, 64. 5th Alabama, age 26. 20, 64. McGuire, C. S. A. Necrosed. 1079 Tarbell, C. F.,Corp l, D, May 27, Left. Died May 27, 1863 ; effect Died Feb. 26, 1865. Autopsy. 21st Maine, age 19. 27, 63. of chloroform. 1121 Weddle. S., Serg t, L, July 4, Right ; double flap. Surg. W. R. 1080 Tate, H. A., Pt., D, llth July 3, Right. Died August 25, 1863. 1st Md. P. H. B. Cav., 6, 64. Wray, 1st Md. P. H. I!. Cav. N. Carolina, age 31 . 3, 63. age 35. Died July 6, 1864. 1081 Taylor, J., Serg t, K, 2d Oct. 21, Right; oval flap. Anaemic. Died 1122 Wcdman, L. Pt., A, 7th June 16, . Surg. A. M. Dougherty. Colorado Cav., age 33. 21, 64. December 1, 1864; irritative New York Artillery. 16, 64. U. S. V. Died June 23. 1864. fever. 1123 Weeks, A. M., Pt., E, June 2, Right. Died July 9, 1864. 1080 Terrell, L. B., Pt., A, May 14, Left. Died June 25, 1864. 3d N. Hamp., age 21. 2, 64. 2M Michigan. 14, 64. 1124 Weeks, W. II., Pt., E, Aug. 15, Left. Died Sept. 10, 1864; ex 1083 Terry, J. It., Pt., K, 47th Aug. 20, ; flap; gang. Died August 10th Conn., age 36. 15, 64. haustion. Virginia, age 42. 20, 64. 27, 18G4. 1125 Wcndt. C., Pt., E, 153d Oct. 19, Right; oval; sloughing; h:em.; 1084 Thomas, F. G., Pt., D, Oct. 19, . Died October 22, 1864. New York. 20, 64. fem. secured. Died Nov. 5, 64. 8th Vermont, age 20. 19, 64. 1126 West, S. P., Corp l, K, Mav 12, Right. Surg. J. S. Ross, llth 1085 Thomasxen, J. H., Pt.,D, May 16, Left ; circ. Died June 21, 1864 ; llth N. Hampshire. 12, 64. N. H. Died May 19, 1864. 24th Virginia, age 24. 16, 64. pneumonia. 1127 Wheelock, O. R., Serg t, Aug. 30, Left. Died Sept. 9, 1862. 1086 Thompson, A., Pt., D, Oct. 19, Right. Died Oct. 21, 1864; ex K, 8th Michigan. 30, 62. 81 h Vermont, age 22. 21, 64. haustion. 1128 White, C. S., Pt., G, Dec. 13, Left ; bone protruded. Died Jan. 1087 Thompson, W., Pt., A, Sept. 30, Left. A. Surg. J. E. Beattv, 2d 142d Penn., age 25. 13, 62. 19, 1863. Autopsy. Spec. 986. 3d Maryland. 30, 64. Maryland. Died Sept. 30, 64. 1129 White, J. W.. , F, May 18, : circ. June 12, one and a 1088 Thompson, W. H., Pt., Nov. 30, Right ; anterior posterior flap ; 39th Georgia, age 40. 18, 64. half ins. sawn off. Died June K, 15th Tenn., age 29. De. 1, 64. gangrene. Died Dec. 26, 1864 ; 29. 1864 ; irritative fever. exhaustion. 1130 Whipple, E., Pt,, B. 2d Mar. 27, Left ; gang. Died April 5, 1865; 1089 Thurston, I., Corp l, H, Dec. 29, Right, Died January 22, 1863. Rhode Island, age 32. 27, 65. pyaemia. 54th Indiana. 29, 62. 1131 2 Wick, F., Pt., D, 1st Dec. 13, Right ; circular flap : gangrene. 1090 Titus, L. G., .Serg t, E, Dec. 13, Left. Died January 7, 1863 ; py N. Y. Art., age 32. 13, 62. Died March 21, 1863; gangrene. 51st Pennsylvania. 13, 62. aemia. Spec. 1000. 1091 Todd, R. L., Pt,, llth July 3, Right. Died July 10, 1863. 1132 Wildhack, C. W., Pt.,H, June 14, Left; circ. Nov. 11, bone rem d; North Carolina. 3, 63. 1st La., age 27. 15, 63. abscesses. Died Jan. 31, 1864 ; 1092 TrauUvine, J., Pt., A, Aug. 19, Right. Died September21, 1864. exhaustion. ir>thN.Y.H.A.,age37. 20, 64. Il33 Wilkinson, A. J., Pt., G, June 17, Left. Surg. J. Ebersole, 19th Ind. 1093 Tressler, S.. Artificer, K, Aug. 18, Right. Died September 4, 1864 ; 7th Wisconsin, age 20. 17, 64. Died July 7, 1864. 2d Penn. H. A., age 28. 18, 64. pyaemia. 1134 Willman, II.. Serg t, F, July 1, Left. Died July 10, 1863. 1094 Trester, W. B., Pt., K, May 18, Right ; flap ; sloughing. Died 154th New York. 2, 63. 5 , d Indiana, age 31. 18, 64. September 23, 180 4. 1135 Wilson, J., Lieut, Col., May 5, Right. Surg.J.Ebersole,19th Ind. 1) .I5 Tnif. W. S., Ft., D, Oct. 19, Right. Died October 22, 1864 ; 43d New York. 5, 64. Died May 6, 1864. Spec. 2315. :J!>th Maine. 19, 64. shock. 1136 Wilson, C., Pt., K, llth Mar. 31, Left ; bilateral flaps. Died May 1096 Tuft, .1. 1)., Serg t, E, June 19, Right. Died July 22, 1864. Mass.. age 25. Ap. 1, Co. 17, 1865 ; exhaustion. ."Ih Slur viand, age 26. 19, 64. 1137 Winship, N. W., Pt., K, July 2, . Died July , 1863. 105.7 Tr.rncr. S.. 1 t., B, 106th Sept. 19, Left ; circ. Died Oct. 15, 1864 ; 86th New York. 2, 63. New York, age 40. 19, 64. peritonitis. 1138 Wipfelder, F., Pt., C, June 1, Right. June 9, haemorrh ge; liga- 1098 Turhill, D. I.., Serg t, T. May 30, Left; circ. Surg. G. L. Potter, 52d New York. 2, 62. tion femoral artery. Died June 7th N.Y. H. A., age 38. 31, 64. 14oth Penn.; pyaemia. Died 17, 1862. July 9, 1864. 1139 Wolf. D., Pt., A, 23d June 18, Right. Died June 28, 1863. 1099 Ulum, J., Pt., H, 102d July 20, Right. Hsem. from femoral art. Indiana. 18, 63. New York. 20, 64. arrested before death, but never 1140 Wood, L., Pt., B, 65th June 15, Right. Surg. J. F. Kimbly, lltb reacted. Died July 21, 1864. Illinois. 15, 64. Kentucky. Died July 30, 1864. 1100 Van Anken, J.L., Corp l, May 12, . Died May 12, 1864. 1141 Woodward, J., Pt., C. Dec. 16, Left; ant, post. flap. Died Jan. K, 56th Penn. 18, 64. 09th Illinois, age 40. 16, 64. 9, 1865: irritative fever. 1101 Vanausdale, W. B.. Cor Jan. 13, Left; flap. Surg. G. C. Jarvis, 1142 Woodward, W., Pt., C, Nov. 30, Right; circ. Died Dec. 27, 1863 ; poral, C, 203d Penn., 13, 65. 7th Conn. Died Feb. 10, 1865 ; 67th New York, age 31. De.l, 63. pya?mia. Autopsy. age 24. pyaemia and exhaustion. 1 1 A r - i 1102 Vanderburgh. II. .Corp l, July 20, Right; middle third. Died July 1 I4. 1144 >Woodworth, J. W.. Cor- Nov. 7, Both. Died November 8, 1863. B, 129th Illinois. 20/64. 26, 1864. poral, 11,11th Infantry. 7, 63. 1103 Van Pelt, D., Corp l, G, June 10, Right; flap. Died July 3, 1864. 8th Iowa, age 22. 10. 64. 1145 Wottington, B., Corp l, May 15, Left; flap. Asst. Surg. H. G. 1104 Vincent, T. H , Pt., H, Nov. 7, . Died November 19, 1861. 13th Colored H. A. 15, 65. Keefer, li. S. V., and others. 7th Iowa. 7, 61. Died Mav 21 , 1865. 1105 Volner, E., Serg t, 13th July 20, Left. Died September 15, 1864. 1146 Wright, A.. Pt,, C, 5th May 5, Right. Died Aug. 17, 1864; en New York Ballery. 20, C4. N. Y. Cav., age 18. 5, r 64. teric fever. Spec. 3084. 1106 Walker, W., Pt., B, 81st Aug. 31, Left. A. Surg. S. W. Marshall, 1147 Wynn,J. J., Pt., E, 20th Dec. 16, Left ; ant. post. flap. A. A. Surg. Indiana. 31, 64. 84th Illinois. Died Sept. 10, 64. Alabama, age 25. 17, 64. D. D. Talbot, Died Dec. 23, 64 ; 1107 Walker, J. W., Serg t. Mav 6, Left ; circ. Died June 4, 1864 ; exhaustion. G, 105th Penn., age 25. 6, 64. pyaemia. 1148 Tount, E., Pt., A, 23d Sept. 19, Right; circular. Surg. J. W. 1108 Wall, G.. Pt., H, 26th Dec. 13, Left. Died Jan. 23, 1863; ex Virginia. 19, 64. Lawson, C.S.A. Died Oct. 10, New York, age 18. 14, 62. haustion. Autopsy. Spec. 973. 1864 ; pyaemia. 1109 Walsh, E., Lieut , B, May 12, Right; circular; typhoid fever ; 1149 York, H. C., Pt., A, 4th May 5, Left; double flap; gang, extend g 52d New York, age 33. 12, 64. diarrhoea. Died June 13, 1864. Vermont, age 44. 5, 64. to body ; four inches femur ex 1110 Walton, W. H., Pt., B, June 18, Right. Died July 21, 1864 ; ex posed. Died June 7, 1864 3d New Damp., age 23. 18. 64. haustion. 1150 Colladay, C. W., Pt., D, July 2, Right. 1111 Ware, 11. S., Pt..H,38th Mav 5, Right. October 9, removed three Grey s Reserves. -, 63. New York, age 23. 5, 62. inches necrosed bone. Died 1151 Cousin, N. A., Pt., F, 5th Sept. 29, Right. A prisoner, not on Pen October 12, 1862; exhaustion. Col d Troops, aged 24. , 64. sion List. Spec. 1007. 1152 Hart, W., Sergt, G, 6th May 19, 1112 Warner, C. F., Pt,, G, Sept. 19, Right ; flap. Died Sept. 23, 64 ; New York Il vy Art y. , 64. 2d Connecticut. 19, 64. exhaustion. 1153 Kirby.J. 7 ., Pt., E,58th Sept. 1, Right. Surg. A. C. Messenger, 1113 Warner. SI., Pt., 13th July 2. Right. Died. Alabama. 1, 64. 57th Ohio. Mississippi. 3, 63. 1154 Laureford, G. H., Pt., I, May 5, . Surg. J. W. Wishart, 140th 1114 Warner. M., Pt.. II. 70th Aug. 12, . Died August 27, 1864. 8th Georgia. -, 64. Pennsylvania. Indiana. 12, 64. 1155 Pierson, J., in., G, 26th Mav 5, Right. " Surg. J. W. Wishart, ,1115 Warren. G. W., Pt., E, May 26, Right. Surg. A. Goslin, 48th North Carolina. -, 64. 140th Pennsylvania. 100th Indiana. 26, 64. 111. Died June 9, 1864. 1156 Royan, J., Pt., G, 10th Sept. 1, Left ; circ. Surg. J. R. Zearing, 1116 Washington, I)., Pt.. A. Oct. 28. Left. Surg. C.M. Clarke, 39th 111. Tennessee. 1, 64. 57thlll. Leftinhosp. Sept.5, 64. 29th Conn., ago 21. 28, 64. Died Dec. 11, 1864; irritative 1157 Walker, S. T., Pt., F, May 15, Left; and wound of right thigh. fever. 12th North Carolina. , 64. O KEEFE (D. C.), Surgical Cases of interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confed. States lied, and Surrj. Jour., 1865, Vol. a, p. 25. 2 THOMSON (W.), Rejprtof Cases of Hasp. Gangrene treated in Douglas Hospital, Washington, D.C., in Am. Jour. Med. Sci., 1864, Vol. XLVII, p. 382 SECT. III.] PRIMARY AMPUTATIONS OF THIGH IN LOWER THIRD. 241 The seat of injury in these eleven hundred and fifty-seven primary amputations in the middle third of the thigh is reported to have been in the middle third of the femur in ninety-eight, in the lower third in three hundred and fifty-eight, in the femur without indi cation of the third in two hundred and ninety, in the knee joint in three hundred and fifty- three, and in the leg in fifty-eight instances. Primary Amputations in the Lower Third of the Femur. Of nineteen hundred and fourteen primary amputations in the lower third of the femur the result could not be ascer tained in fourteen instances. Nine hundred and seventy-three operations were successful, and nine hundred and twenty-seven were fatal, a mortality of 48.7 per cent. In one hun dred and fifty-eight instances the limb implicated was not indicated ; in eight hundred and forty-five the right, and in nine hundred and eleven the left thigh was amputated. Recoveries after Primary Amputations in the Lower Third of the Femur. The nine hundred and seventy-three operations of this group were performed on nine hundred and seventy-one patients, the discrepancy in numbers being due to the fact that double ampu tations were performed in two instances. Two hundred and twenty-nine were Confederate, and seven hundred and forty-two were Union soldiers. Of the latter, seven hundred and thirty-four were pensioned, and four retired; the names of the remaining four patients are not borne on the rolls of the Pension Office. CASK 444. Corporal J. A. Crawford, Co. K, 6th Wisconsin, aged 24 years, was wounded through the knee joint, at Gettysburg, July 1, 1853. He was admitted to the Seminary Hospital, whence Acting Assistant Surgeon W. M. Welch made the following report: "The limb was amputated at the lower third of the thigh on the day following the injury. The patient, came under my care on August 15th, at which time the stump was granulating slowly and there was a free discharge of healthy pus; but the flaps had sloughed, leaving the end of the femur bare. A roller bandage was applied to prevent retraction of the muscles, and warm-water dressings with disinfectants were used, iron and stimulants being given internally. The patient s general health was disturbed, though his appetite was tolerably fair. He improved gradually, and was transferred to Camp Letterman on September 2d." Assistant Surgeon H. C: May, 145th New York, continued the history as follows: "The patient came under my charge on October 12th, being very feeble and troubled with profuse and obstinate diarrhoea, having no appetite, and suffering from hectic fever and much pain, also an abscess along the course of the lower end of the bone. The stump was conical shaped, with the end of the femur exposed, and the granulations were pale and flabby. Astringents and tonics were administered. On October 30th, the diarrhoea was almost controlled, but great pain and irritation was felt about the stump, and, chloroform having been given, a seques- FIG 180 trum four and a half inches long, and consisting of a complete section of the lower end of the bone, Tubular se- was removed by forcible traction. The surfaces of the bone were found to be very rough and sur- moved"from rounded with a wall of callus. The patient did well after the operation; the abscesses ceased to stump of the discharge, and the cavity in the stump filled with healthy granulations. By November 6th, he had right femur. , * , Spec. ii)7i. regained a good appetite, the diarrhoea was entirely checked, and his general appearance and con dition were rapidly improving." On the next day the patient was transferred to Newton University Hospital, Baltimore, where the following described operation was performed on February 2, 1864, by Surgeon C. W. Jones, U. S. V., in charge: "The end of the femur being necrosed, an incision six inches in length was made on the anterior aspect of the thigh and four inches of bone removed. Thirty-six hours afterwards haemorrhage to the amount of four ounces occurred, when the sutures were removed and a large clot of blood was taken out, after which the bleeding ceased. After this the patient s constitutional condition continued to improve and the flaps approximated. By March 24th, the stump had entirely healed with a good cushion." The patient was discharged from service May 3, 1864, and pensioned. He was paid June 4, 1879. The sequestrum was contributed to the Museum by Acting Assistant Surgeon E. A. Koerper, and is represented in FIGURE 180, and an involucrum of new bone, removed at the last operation, is shown in FIGURE 181. CASE 445. Private J. Miller, Co. C, 18th Kentucky, aged 38 years, received a gunshot injury of the left lower extrem ity, at Richmond, August 30, 1832. Acting Assistant Surgeon J. B. Smith furnished the following history: "The wound was in the left knee and thigh, and amputation was performed on the field at the lower third of the femur. The patient was admitted to Washington Park Hospital October 15th. At the time of his admission he presented evidences) of severe constitutional suffer ing, his skin being pale and yellow, accompanied by general emaciation, night sweats, and constant diarrhoea. The stump showed two or three small openings, and there was free discharge of sero- purulent, fluid. Exposed bone could be distinctly felt with the probe. Astringent medicine was given until the faecal discharges became natural. Warm-water dressings were used to the stump and the flaps supported with adhesive plaster, the wound being syringed every morning with a weak solution of chloride of soda. By December 1st, the patient was doing well, having good appetite and gaining flesh and strength rapidly, and all the constitutional trouble being removed. The end of the bone gradually became more exposed. On January 13, 1863, the patient being considered in a suitable condition for an operation, and having been placed under the influence of chloroform, SURG. Ill 31 FIG. 181.-Invo- lucrum, 4 inches in length, from stump of right fe mur. Spec. 2153. 242 INJURIES OF THE LOWEE EXTREMITIES. [CHAP. X. Acting Assistant Surgeon O. D. Norton cut down to the bone about four inches above its exposed end, dividing all the tissues, and carrying the knife downward to the opening at the end of the stump. The bone, after being dissected from the tissues, was then separated by a saw about three inches above the projecting extremity, the forceps being used for the removal of the spongy bone above the point of the division. Some trouble was experienced from haemorrhage, necessitating the ligating of two or three small vessels. Water dressings were applied. By February 10th, the wound had healed and the patient was apparently doing well. On February 20th, he had a chill, followed by fever and by pain about the stump, when a small incision was made and about half an ounce of healthy pus discharged. From this time there was a gradually lessening quantity of pus until April 20th, when the wound had healed, and the patient, to all appearances, was well, being able to walk about the ward, and all his constitutional symptoms having disappeared." The patient was discharged April 30, 1864, and pensioned. He was paid March 4, 1879. The tubular sequestrum, three inches long and surrounded by a cylindrical involucrum of spongy bone, was contributed by Dr. Smith, and constitutes Spec. 1094 of the Surgical Section, A. M. M. It is represented in FIG. 2 of PLATE LXX, opposite. In the following two instances of amputation in the lower third of the thigh, the officers continued in active service until the close of the war: CASE 446. Major-General D. E. Sickles, U. S. V., while in command of the Third Corps, at Gettysburg, was wounded, on the evening of July 2, 1863, by a twelve-pounder solid shot, which shattered his right leg. He dismounted unassisted, and aid arriving promptly, he was removed to a sheltered ravine a short distance to the rear, where the limb was amputated low down in the thigh by Surgeon T. Sim, U. S. V., Medical Director of the Corps. The patient was then sent farther to the rear, and, on the following day, he was transferred to Washington. The stump healed with great rapidity. Two weeks after the injury the patient was able to ride about in a carriage, and early in September he was well enough to again mount a horse, the stump being completely cicatrized. The bones of the amputated leg (Spec. 1335) were contributed to the Museum by the patient, and the history of the case was obtained from the operator. General Sickles subsequently for several years held command in South Carolina and the Department of the South, but has been retired from active service since April 14, 1869. 1 CASE 447. Major-General It. S. Ewell, while commanding a division of General Jackson s Corps of the Confederate Army, was wounded in the left knee during the night of the engagement at Manassas, August 28, 1862. Dr. Hunter McGuire, Surgeon and Medical Director of the Corps, who amputated the wounded limb, published an account of the case as follows : 3 " He was kneeling on the ground and looking under some pine bushes to get a better view of the field, when he was hit upon the left patella, nearly in the centre of it, and his leg being flexed, the ball passed downward, striking the head of the tibia and splitting it into several fragments. The bullet finally lodged in the muscles of the calf of the leg. He sent for me at once, but the messenger failed to find me, and I did not know he was hurt until General Jackson sent his aid-de-camp to tell me. He was still laboring under the severe shock of the injury when I found him, although several hours had elapsed. In all gunshot wounds of the knee the shock of injury is severe, but it was especially great in this instance. The General s health, naturally not very good, was unusually bad at this time. He had also lost a great deal of sleep, and the night he was hurt was compelled to drink a large quantity of strong tea to keep awake. * * He was so much exhausted when he was shot that his surgeons thought at one time he would die from the shock of the injury. When he had sufficiently recovered from this, Tadvised him to submit to amputation; but he consented to it very reluctantly, partly because some surgeon had assured him that his wound was not dangerous, but one from which he would soon recover. I amputated the thigh just above the knee, performing the operation as rapidly and with as little loss of blood as I could. About ten days after the amputation, to escape capture, he was carried on a litter by some soldiers near fifty miles. The motion on the litter caused the bone to protrude, and in consequence of this and his bad health the wound sloughed. After much suffering and the loss of an inch of bone, he got well enough to go about, when one day he was so unlucky as to let his crutches slip from under him, and falling upon an icy pavement, he re-opened the wound and knocked off another piece of bone. After some months he was well enough to go back to the field again, where he performed some very active service, but from the shape of his stump, and an ill-contrived wooden leg he wore, he was fre quently troubled with abrasions of the skin, small abscesses, and so on. He now (1866) uses a suitable artificial limb, and with the assistance of a cane gets along right well, being no longer liable to affections of the stump." As already stated, amputation in the lower thirds of both thighs was twice success fully performed. One of the survivors died in 1877, over thirteen years after the operation CASE 448. Corporal M. Dunn, Co. H, 46th Pennsylvania, aged 21 years, was wounded at Dallas, May 25, 1864. Surgeon W. C. Bennett, U. S. V., recorded his admission to the field hospital of the 1st division, Twentieth Corps, and noted: "Canister-shot fracture of both legs, followed by excision of the head of the left fibula and amputation of the right thigh. Vessels of left leg destroyed and mortification ensuing, necessitating amputation of left thigh." Three weeks after being wounded the patient was removed to hospital at Chattanooga, where the stumps assumed a gangrenous appearance, which yielded to the application of bromine. One month later the patient was transferred to hospital No. 14, at Nashville, whence he was furloughed and proceeded to his home. He subsequently entered the Post Hospital at Elmira, and lastly, on April 24, 1835, he was admitted to Central Park Hospital, New York City. Surgeon J. J. Milhau, U. S. A., in charge of the latter, reported the following history: "The missile passed through both legs just below the knee joints. The right thigh was amputated by the flap method, just above the knee joint, eighteen hours after the injury, and circular amputation of the left thigh was performed forty hours after the reception of the wound. In August, 1864, the right thigh had to be re-amputated at the middle third, which operation was performed by the circular method, at the patient s home, by Dr. Robison, of Wellsville, New York. The stump of the right thigh closed completely about December 1, 1864, but that of the left never entirely healed, and was still discharging from three 1 Circular No. 6, War Department, Surgeon General s Office, Washington, 1865, p. 38. 2 McGuiUE (HUNTKE), Clinical Remarks on Gunstiot Wounds of Joints, etc., in Richmond MedicalJournal, 1866, Vol. I. p. 262. Prof. P. F. EVE, in a communication published in the V. S. Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, p. 64, states that "Lieutenant-General Ewell survives an amputation through the upper third of the thigh." Hint, of the War of the Kebellion. Vol. II. I jiH 111 AV ard phot . T. Sinclair #011 Uth PLATE LXX INVOLUCRA OF THE FEMUR Fig. I ..Case of Pi . W Vannatta, 4 Pennsylvania Cav Tig. 2._Ca^e of PtJlliller, 18 Kentucky. Spec. 2602 SUP^. Sect A.M.M. Spec. 1094 Surg. Sect.A.M.M KiS _ Case of Ft, J. Wearing. 2 Pennsylvania Art Fig l_Case of Ft L.C Griffin, 8 North Carolina. Spec 4106 Sm-g Sect. A.M. M*. Spec. 3141 Surg. Sect.. A.M.M. SECT. 111.] PRIMARY AMPUTATION OF THIGH IN LOWEK THIRD. 243 openings at the time of the patient s admission. On April 30th, chloroform was administered, and several pieces of necrosed bone were removed with the forceps by Acting Assistant Surgeon S. Teats, who made an incision some three inches in length on tlie face of the stump. The sequestrum being enclosed by a very thick involucrum, it was found necessary to remove a portion of the end of this with the gnawing forceps before the sequestrum could be extracted." The patient was discharged from service August 17, 1835, and pensioned, having been previously supplied with artificial limbs by the firm of A. A. Marks, of New York. The removed necrosed fragments were contributed to the Museum by the operator, and constitute Specimen 3193 of the Surgical Section. The pensioner died October 23, 1877. The cause of his death is alleged to have been the diseased condition of the stump of the left thigh. In the second successful case of primary amputation of both thighs in the lower thirds the patient was a Confederate soldier: CASE 449. Private C. G. Rusk, Co. C, 21st Georgia, aged 22 years, was wounded and captured during the assault on Fort Steadmnn, March 25, 1865. He was conveyed to the Ninth Corps field hos pital, whence Assistant Surgeon S. Adams, U. S. A., contributed the pathological specimen (Cat. Sarg. Sect., 1886, p. 321, Spec. 3998), with the following history: "The injury consisted of a shell wound of the right leg below the knee joint, tear ing open the joint, passing across and smashing the patella of the left leg. Sur geon L. W. Bliss, 51st New York, amputated both thighs at the lower third on the day of the injury. By April 1st the patient s general condition was excel lent, his appetite and pulse good, and his tongue clean." The specimen con sists of the amputated lower extremity of the left femur, with fragments of the patella. From the field hospital the pa tient was sent to City Point, and thence to Washington, where he was admitted to Armory Square, and subsequently to Lincoln Hospital. Surgeon J. C. McKee, U. S. A., in charge of the lat ter, contributed the photographs, repre sented in the annexed wood-cuts (FiGS. 182, 183), and described the amputation as a flap operation. The patient was released and discharged from hospital Aug. 2, 1865. Subsequently he entered and was treated for a time at St. Luke s Hospital, New York City, where, on February 28, 1866, he was provided by Dr. E. D. Hudson with artificial limbs, by means of which he was enabled to walk, requiring the assistance of two canes only. Twenty-seven of the seven hundred and forty-two Union soldiers who survived ampu tation in the middle third of the femur have died during the fourteen years since the close of the war. One case (CASE of Dunn) has already been detailed ; in the following instance the patient survived the operation over fourteen years and died of phthisis : CASE 450. Private C. Briof, Co. C, 39th New York, aged 26 years, was wounded in the left knee, at Bristoe Station, October 14, 1863. He was conveyed to Alexandria on the follow ing day, and admitted to the First Division Hospital, whence Acting Assistant Surgeon C. W. Koechling transmitted the pathological specimen (FlG. 185), with the following history : "The wound was caused by a mini6 ball entering the external aspect of the knee, passing through the joint, and lodging. The missile was extracted from the internal aspect of the leg, on tho field, by the regimental surgeon, and the limb was amputated at the lower third of the thigh, by the circular method, on October 16th, by Acting Assistant Surgeon N. Barnes. The patient came under my care on October 26th, at which time the bone protruded from the stump over an inch. For this gentle attraction of the integuments was made by adhesive strips and kept up for a week, when, the patient suffering too much pain, it was continued no longer, and a roller was FlG 18 5._ applied from above downward and kept on until the bone was nearly covered. The patient Sequestrum . . . from stump improved every day, there being but very little discharge, but occasionally very severe pain in O fl-ft femur. the stump. On February 8, 1864, the accompanying sequestrum was removed. On February SP 60 - -^ 20th, the patient was seized with tetanic pains, which, though relieved by the free administration of opium, recurred every other day for a month. After that period the patient did well, and was able to take exercise on crutches, the stump having healed. On May 9th, the patient left the hospital on furlough." He subsequently passed through different hospitals, and lastly FIG. 182. Amputation of both thighs at lower thirds. [From a photograph.] FIG. 183. Artificial limbs applied in case of double amputation. [From a photograph.] FIG. 184. Upper parts of bones of left leg; tuberosity of tibia split off obliquely. Spec. 2344. 244 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. entered De Camp, David s Island, New York Harbor. On September 19, 1865, the man was discharged from service and pen sioned. The upper portion of the bones of the leg of the amputated limb were forwarded to the Museum by the operator, and are represented in FIGURE 184, and a cast of the stump was contributed by Acting Assistant Surgeon G. F. Shrady. (Cat. Surg. Sect., 1866, p. 548, Spec. 1787.) The New York City Examining Board certified, March 11, 1874: "The pensioner is unable to wear an artificial limb in consequence of excessive tenderness of the stump, rendering him unable to stand the pressure upon it. He has tried one several times, but it was so painful that he could not wear it more than a few hom-s." This pensioner died November 12, 1877, of phthisis pulmonalis. Fatal Cases of Primary Amputation in the Lower Third of Femur. Six of the nine hundred and twenty-seven cases of this group were instances of double amputations; the operations were, therefore, performed on nine hundred and twenty-one patients. Seven hundred and ninety were Union, and one hundred and thirty-one were Confederate soldiers. In the following case both thighs 1 were amputated in the lower third on the day of the injury, the patient surviving the operations eighteen days: CASE 451. Private D. Nicholson, Co. H, 22d Massachusetts, aged 23 years, was wounded in both thighs, at Spottsyl- vania, May 10, 1854. He was admitted to the field hospital of the 1st division, Fifth Corps, where Surgeon J. Thomas, 118th Pennsylvania, amputated both limbs. Surgeon R. B. Bontecou, U. S. V., reported the following termination of the case: "The patient entered Harewood Hospital, Washington, May 25th. He had undergone amputation of both thighs at the lower third the same day he received the wound, the operations being performed by the antero-posterior flap method. When admitted he was in a very weak condition, the stumps being unhealthy and showing a tendency to slough. A supporting treatment was administered. Pro gress, however, continued unfavorable. Death occurred from exhaustion May 28, 1864." The amputated portions of the femurs were contrib uted to the Museum by the operator, and consti tute Specimen 2966 of the Surgical Section (FlGS. 186, 187), showing the right femur to be trans versely perforated, with comminution, two inches above the condyle, by a bullet which passed on, badly grooving the left femur on the anterior face at the same level and producing a severe oblique fracture. CASE 452. Private J. O. Blackburn, Co. E, 138th Pennsylvania, aged 35 years, was wounded at Monocacy Junction, July 9, 1864, and admitted to hospital at Frederick on the following day. Assistant Surgeon R. F. Weir, U. S. A., reported the following history: "The injury was caused by a fragment of a shell, which struck the inner side of the left knee, lacerated the soft parts, and comminuted the joint. On the day after his admission the patient was etherized, and the thigh was removed at the lower third, by Acting Assistant Surgeon W. S. Adams. The integuments in this case being in bad condition on the inner side, a circular incision was made to extend half around the limb, a long lateral flap on the outer side and a circular incision through the muscles, and the parts united by sutures and adhesive straps. The patient s condition at the time of the operation was very poor. July 13th, patient irritable; pulse 120; appetite rather poor; no effort at union by first intention. 16th, some evidence of sloughing of the flap. Ordered yeast poultices, also tartrate of potassa and iron in doses of twenty grains three times a day, and continued the stimulants and generous diet. 20th, line of demarcation well marked. 22d, slough being detached at several points; clipped it off with scissors down to the bleeding surface and thoroughly applied oakum saturated with a strong solution of permanganate of potassa, covering the whole with oiled silk. 25th, slough came away nicely, leaving a clean healthy surface. August 1st, patient doing tolerably well; granulations somewhat abundant but pale and flabby. Has obstinate diarrhoea, and is taking opiates and astringents in addition to other treatment. 10th, diarrhoea partially checked; appetite very poor; sloughing has recommenced, and permanganate of potassa is reapplied. 15th, sloughing about ceased. There is but little discharge, and the end of the stump is dry and refuses to granulate. Applied yeast poultice and continued the other treatment. 21st, patient quite despondent and evidently failing rapidly; pulse 140 and scarcely perceptible. Increased the stimulants. 28th, sloughing still continues and patient sinking. 31st, had a haemorrhage from femoral artery to amount of eight ounces; controlled by tourniquet. Haemorrhage occurred again on the following morning and was arrested by the tourni quet, the patient not being in condition to undergo ligation. He died at 7 o clock P. M., on September 1, 1864. At the autopsy, eight hours after death, the body was found to be much emaciated and the muscles remarkably loose and flabby. On examin ing the stump to the head of the bone and removing the femoral artery and vein, the end of the artery was found to be pervious from the breaking down of the clot, and the vein much thickened and indurated." The amputated extremity of the femur, showing the inner condyle to be superficially fractured (Spec. 3832), and four and a half inches of the stump of the bone, being superficially necrosed (Spec. 3488), together with the femoral artery (Spec. 3980), were contributed to the Army Med. Museum by the operator. >The remaining five fatal cases of amputation of both thighs in the lower third of the femur are: Pt. S. Allen, G, 59th Mass. (No. 984, TAULK XXXII, p. 257); Pt. R. S. Michael, A, 105th Penn. (No. 1551, TABLE XXXII, p. 263); Serg t E. C. Rabbit, B, 10th Missouri (No. 1C52, TABLE XXXII, p. 264); Pt. J. Stewart, D, 77th New York (No. 1769, TABLE XXXII, p. 265); and Lieut. J. Whelpley, D, 1st Maine (No. 1862, TABLE XXXII, p. 267). FIG. 186. Anterior view of lower third of each femur. Spec. 2966. FIG. 187. Posterior view of lower third of each femur. Spec. 2966. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. TABLE" XXXII. 245 Summary of Nineteen Hundred and Fourteen Cases of Primary Amputations in the Lower Third of the Femur for Shot Fracture. Recoveries, 1973 ; Deaths, 974 1900; Result unknown, 1901 1914. Xo. NAME, MIUTAUY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Abbott, O. A., Serg t, A, Oct. 27, Left; circ. fiurg. F. A. Dudley, 38 Ballentine, H.J., Lieut., Nov. 29, Left ; circ. Prov. Marshal June 14th Conn., age 24. 28, 64. 14th Conn. Disch d June !>, 65. B, 42d Tenn., age 29. De. 1, 64. 5, 1865. 2 Adair, U., Serg t, F, 7th Feb. 21, Right; circ. A. Surg. B. Norris, 39 Bangs, L. G., Adj t. 19th Nov. 24, Right ; circ. Surg. F. H. Gross, Infantry. 22, 62. U. S. A. Disch d July 13, 62; Illinois, age 27. 24, 63. U. S. V. Erysipelas. Mustered subsequent operation. out July 9, 1864. 3 Adams, E. H., Pt., C, June 8, Left; flap. Surg. A. H. Hoff, 40 Bappert, M., Pt., G, 47th Aug. 3, Left ; flap. Surg. S. P. Bonner. 12th Iowa. 8, 63. U. S. V. Disch d Sept. 22, 63. Ohio, age 18. 3, 7 64. 47th Ohio. Aug. 18, oper. May 4 Aderhold, E., Pt,, E, Oct. 14. Left. Disch d May 2, 64. Died 30, 65, nee. bone rem d. Disch d 6th Penn. Reserves. 14, 63 Jan. 22, 1869. Aug. 9, 1865. 5 Agren, A., Pt.. C, 7th Mar. 27, Right ; circ. Surg. A. T. Bartlett, 41 Barclay, T., Pt., K, 14th Nov. -27, . Surg. White. Recov Minnesota. 27, 65. 3.JdMo. Dischd June 14, 1865. Louisiana. 28, 63. ery. 6 A Idensen, J. J. , Serg t, K, Nov. 30, Right ; anterior post. flap. Surg. 42 Barker, H., Pt., H, 31st Oct. 19, ; circular. Dr. G. L. Miller. 4(ith Miss., age 32. De. 1, 64. McCormack, C. S. A. Provost Virginia. 20, 64. Transferred. Marshal March 7, 1865. 43 Barnes, J. E., Serg t, A, June 21, Left ; ant. post. flap. Surg. G. T. 7 Aldrich,B.,Pt., A, 155th July 9, Left ; ant. post. flap. A. A. Surg. 77th New York, age 37. 21, 64. Stevens. 77th N. Y. Disch d New York. 11, 64. W. S. Adams. Disch d. Spec. Oct. 26, 18(i4. 3938. 44 1 Barrett, M., Corp l, E, Sept. 19, . Amputation. Transferred 8 Alexander, G.. Pt., A, May 3, Right ; flap. Recovery with good 19th Alabama. 19, 63. to hospital Oct. 3. 1863. 4th Virginia, age 39. 4, 63. stump. 45 Bartle. W., Serg t, H, Nov. 17, Left ; circ. Surg. O. I. Owens, 9 Allen. J., Corp l, I, 22d Sept 19, Right : flap. Surg. T. L. Magee, 86th New York, age 25. 17, 64. 40th N. Y. Disch d June 6, 65. Illinois, age 23. 21, 63. 51st 111. Disch d Feb. 27, 1864. Spec. 4129. 10 Allen, J. G., Pt.. A, 77th June 21, Left ; ant. post. flap. Surg. G. 46 Bastian, J., Pt., A, 31st June 27, Right ; circ. Surg. J. Reeves, New York, age 39. 21, 64. T.Stevens, 77th N.Y. Disch d Illinois. 27. 64. 7Sth Ohio. M. out Mav 31. 65. Sept. 9. 1864. 47 Bauer, J., Pt., F, 100th July 22. Left : ant. flap. Surg. M. S. Kit- 11 Allen, R.,Serg t, A,59th Dec. 15, Right ; circ. Disch d July 1, 65. New York. 22, 63. tinger. 100th N. York. Disch d Illinois, age 34. 15, 64. May 3, 1864. 12 Ammerman, G., Corp l, May 6, Left; ant. post. flap. Surg. C. 48 Baughinan, C., Pt., B, Nov. 22, Right ; ant. pest. flap. Surg. A. C, tith Penn. Reserves, 6, 64. Bowers, 6th Penn. Res. Disch d 1st Mich. Art., age 26. 22, 64. T. Hudson. 26th Iowa. Disch d age 26. May 30, 1865. June 3, 1865. 13 Anderson, J., Pt., I, 21st Jan. 2, Left; flap. Disch d March 13, 49 Beall, T.. Pt., C, 39th Oct. 5, Left. Surg. J. R. Zearing, 57th Ohio. 2, 63. 1863. Iowa, age 28. 7, 64. Illinois. Disch d July 8, 1865. 14 Anderson, J.. Pt., I, 21st June 22, Left ; flap. Surg. C. J. Walton, 50 Bean, C. H., Pt.. E, llth July 21. Left; flap. Surg. N. F. Blunt, Kentucky. 22, 64. 21st Ky. Must, out Jan. 23, 65. Maine, age 19. 21, 64. llth Me. Disch d June 10, 65. 15 Andrews, A, C., Pt., H, Feb. 6, Right; flap. June 10, reamp. 51 Beightal, J., Pt., C, 93d Mar 25, Right ; flap ; erysipelas. Disch d 32(1 Mass., age 21. 6, 65. two and a half ins. A. A. Surg. Penn., age 39. 25, 65. July 12, 1865." E. B. Lyon. Disch d Oct. 20, 65. 52 Beisse, N., Bugler, A, Oct. 8, Left ; circ. Surg. C. S. Muscroft, 1C Angle, II., Pt., F, 5th May 5, Left ; circ. Disch d May 30, 64. 1st Michigan Battery. 10, 62. 10th Ohio. Disch d June 7, 63. Wisconsin, age 31. 5, 64. 53 Bell, G. W., Pt., H, 39th July 22, Right ; flap. Surg. J. R. Zearing, 17 Anthony, A,, Lieut., E, T\l V f nn*o ^1 Mar. 25, C)~ /;K Left ; circ. A. Surg. E. P. Roche, KA Ohio, age 26. ftfllJ T ff Pt V 1 itVi 22, 64. Aug. 16 57th 111. Disced June 17, 65. I eft* circ Sure 15th 18 O.Al A> . \_i,, tlgC o.L. Anthony, II. G., Pt.. C, 3, U*J. Sept. 19, o5th Mass. Ixcleased July 10, 65. Left ; circ. Surg. E. Phillips, 6th O4 />(.((, / . J/-, v| Ju, I..HI1 Alabama. 16. 64. Ala. Diarr. Trans. Aug. 31, 64. 6th Vermont, ago 24. 19, 64. Vt. Disch d June 26, 1865. 55 Bellew, B., Pt,, I, 4th July 25, Right; circ. Surg. D. A. Cham 19 Anthony, R. H., Pt., D, July 1, Left. Surg. McGuire, C. S. A: Delaware, age 45. 25, 64. berlain. 94th N. York. Disch d 1st Tennessee. 2, 63. Exch d March 17, 1864. July 13, 1865. 20 Armsberg, G.,Pt,, L, 62d July 3, Left. Dec. 21, exfol. removed. 56 Bergeoin, P. P., Serg t, Aug. 29, Right ; flap ; abscesses. V. R. C. Penn., age 18. 3, fe. Disch d Oct. 1 J, 64. Spec. 2156. 11, 3d Mich., age 21. 29, 62. June, 1863. 21 Armstrong, A. T., Pt., Mav 12, Right ; double lat. flap. Surg. J. 57 Berry, W. T., Pt., Pur- July 1, Left. Recovery. H, 31st Maine, age 24. 14, 64. S. Ross, llth N. 11. Disch d cell s Battery. 1, 62. Nov. 16, 1864. 58 Bcaverson, D., Pt., H, July 10, Left; circ. Disch d July 11, 65. 20 Ash, J., Pt., G, 25th S. May 16, Left ; circ. Furloughed July , 187th Penn., age 23. 10," 64. Carolina, age 30. 16, 64. 1864. 59 Bickel, J. P., Corp l, G, Sept. 20, . Surg. Sawers, C. S. A. 2J Ash by. D. C., Lieut., H, Deo. 15, Right. Vermale s method. Asst. 20th Virginia Cavalry. 20, 64. Recovery. 80th Indiana, age 24. 17, 64. Surg. W. B. Trull, U. S. V. 60 Billington, S. A., Pt., C, Oct. 27, Left : flap. Surg. X. Y. Leit, 76th Mustered out May 15, 1865. Llth Maine, age 26. 27, 64. Penn. Disch d June 12, 1865. 24 Ashburn, J. C., Coro l, Oct. 19, Left ; circ. Disch d June 5, 65. 61 Billingsley, J. B., Pt.. I, May 16, ; circ. Surg. Hilliard, C.S.A. B. 14thW.Va..age25. 20, 64. 43d Alabama, age 21. 16, 64. Recovery. 25 Atkins, C. S., Serg t, D, July 27, Right ; flap. Surg. C. E. Swasey, 62 Bish, A., Pt., G, 155th Oct. 27, Left: circ . Union by first inten 6th Kans. Cav., age 22. 27, 64. U. S. V. Aug. 2, hasm.; artery Penn., age 25. 28, 64. tion. Disch d March 17, 1865. sec d.. M. out, 1870, bad stump. 63 Bishop, J. H., Serg t. F, Aug. 30, Left : flap. A. Surg. J. D. Gatch, 26 Atwell. W.P., Lieut., G, July 30, Right. Disch d Nov. 25, 1865 18th Kentucky. 30. 62. 16th Indiana. Discharged. 37th Wis., age 19. 30," 64. 1871, not in good condition. 64 Bishop, II., Pt", A, 88th Dec. 13, Left ; flap : gang. May 1 . seq. rem. 27 Auker, II., Serg t, C, May 25, Left. Surg. H. E. Goodman, U. Penn., age 20. 13, 62. Disch d Dec. 17. 63. Spec. 1264. 28th Penn., age 24. 25," 64. S. V. Mustered out July, 1865. 65 Black. W. R., Serg t, G, April 6, Right; ant. post. flap. A. Surg. 28 Ayrcs. D. C., Pt., 1, 102d Mav 5, Left; circ. Disch d Mar. lS, 65. 67th Perm., age 22. 7, 65. T. F. Corson. 67th Penn. Dis Penn., age - 6. 5, 64. charged July 7, 18G5. 29 Bacon. G. F., Pt., A, Mar. 31, Left ; flap. Disch d July 25, 65. 66 Blanchard, C. H.,Pt.,F, Oct. 19, Right; circ. Confed. Surgeon. 20th Maine, age 18. 31, 65. 34th Mass., age 23. 19, 64. Disch d Jan. 9, 1865. 30 Bailey, W. F., Pt., A, A ug. 29, Right ; circular. Discharged. 67 Blanchard, W., Pt., B, Oct. 19, Left ; flap. Disch d July 4, 1865. 2d U. S. Sharpshooters. 30. 62. 90th N. York, age 22. 19, 64. 31 Bakeoven, G. A., Pt., F, Nov. 27, Left ; flap. Surg. M. Rizer, 72d 68 Blackburn. L. G., Pt., Oct. 4, Recovery. 72d Pennsylvania. 28, 63. Penn. Mustered out Aug. 24, D, 3d Missouri. 4. 62. 1864. Spec. 1883. 69 Bliven, C. J., Pt., K, 4th July 30, Left: circ. A. Surg. R. Millar, 32 Bal;er, H. C., Pt., F, June 27. Right. Surg. Gibbon, C. S. A. Rhode Island, age 21. 30," 64. 4th R. I. Sub. operat s. Disch d 4t?th North Carolina. 27, 62. Retired. Jan. 23, 1865. 33 Baker, J. D.. Pt., H, Nov. 24, Left ; circ. Surg. M. W. Robbins, 70 Blossom, W. E., Pt.. G, Deo. 5, Left ; bilat. oval flap. Surg. N. 4th Iowa, age 28. 24, 6:i. 4th Iowa. Disch d July 27, 1864. 184th N. York, age 34. G, 64. R. Barnes, 184th N. Y. Disch d 34 Baker. J. W., Lie.ut., A, Dec. 13, Left. Disch d February 1, 1863. June 15. 1865. 14th Indiana. 13, 62. 71 Boardman, T., Pt., A, June 27, Right. Surg. E. Bentlcy,U. S.V. 35 Baker. S., Pt., K, IGth Oct. 7, Right : flap. Oct. 12, bone cut 2-d Massachusetts. 28, 62. Two sub. op. Dis d May 2, 64. N. Y. H. A., age 18. 7, 64. shorter. Disch d Oct. 3, 1865. 72 Bolton, G. W., Pt., D, Sept. 20, Left. To Provost Marshal March Spec. 2382. 44th Ala., age 39. , 63. 16, 1864. 36 Baldwin, C., Corp l, H, 58th Penn., age 32. June 1, 1, 64. Left ; ant. post. flap. Surg. H. C. Christy. 58th Pa. Disch d Feb. 73 Boland, J. C., Lieut., E, 60th New York, age 32. May 9, 9, 64. Left: ant. post. flap. Surg. W. B. Fox. 8th Mich. Disch d Nov. 4, 18<>5. 27, 1864. 37 Baldwin, P. B., Serg t, June 17, . Surg. Cook, 47th Ala 74 Bonnell, W. D., Pt., G, Aug. 14, Left; flap. Confed. Surg. Neo. D, 48th Alabama. 17, 64. bama. Recovered. 152d N. York, age 23. 14, 64. Disch d May 9, 1865. 1 TERKY (C.), Report of Wounded treated in Field Hospital of llindman s Division, e 246 INJURIES OF THE LOWER EXTREMITIES. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME. MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 75 Boothman,M.M.,Pt.,H, Sept. 1, Right ; flap. Surg. G. E. Sloat, 113 Bush, W., Pt., C, 99th June 18, Left ; flap. Disch d Nov. 15, 64. 38th Ohio, age 18. 2, 61. 14th Ohio. Disch d June 5, 65. Penn., age 41. 19, 64. 76 Boostr, L. B., Pt., F, 2d July 2, Left. Recovery. 114 Butler, J. M., Pt., D, May ] 6, Right ; circ. A. Surg. J. O. Skin S. Carolina, ago 25. 3, 63. 5th Iowa. 16, 63. ner, 10th la., and W". II. Darrow. 77 Boring 1 , \V., Corp l, I, Feb. 15, Right. Disch d July 17, 1862. 5th Iowa. Gang.; nee. Disch d 7th Illinois. 15, 62. Oct. 23, 63 78 Boss, J. M., Pt., A, 3d July 28, Right : circ.; gang. Aug 12. circ. 115 Callahan, T., Pt., I, 9th Aug. 30, . May 15, 63. reamp. upper South Carolina. t:8," 64. reamp. Prison Jan. 27. 1865. Georgia. 30, 62. third. Surg. S. E. Ilabcrsham, 79 Bourns, W. H., Pt., G, Dec. 5, Right; ant. post. flap. Surg.W. P.A.C.S. Disch d Oct. 12. 63. 1st Mich. S. S., age 21. 5, 64. C. Shurlock, 51st Penn. Disch d 116 Campbell, D., Pt., F, Aug. 30, Right ; flap. Disch d Dec. 22, July 18. 1865. 71st Indiana. 30, 62. 1862. Died Feb. 4, 1864. 80 Bowers, A.. Pt., H, 32d Feb. 14, Left: circ. Surg. A. H. Brund- 117 Campbell, J. M., Pt., C, July 2, Left; flap. Disch d August 26, Ohio. , 64. age, 32d Ohio. Not a pensioner. 25th Ohio, age 34. 2, 63. 1864. 81 Bond, E., Pt., I, 69th Aug. 30, Left; flap. Disch d April 2, 63. 118 Cameron, R., Pt., A, April P, Left; flap. Surg. C. M. Clark, Indiana. 31, 02. Died April 6, 1868, of amp. and 62d Ohio. 9, 65. 39th 111. Disch d Sept. 27, 65. chronic diarrhoea. 119 Cardwell, J. E., Pt,, C, Aug. 6, Left ; circ. Surg. S. K. Crawford, 82 Bonde, J. C., Capt., H, May 3, Right ; ant. post. flap. Retired 123d Indiana, age 32. 7. 64. 50th Ohio. Disch d May 23, 65. 27th Virginia, age 28. 3, 63. March 11, 1864. 120 Carl, J. E., Pt., A, 20th June 18, Right; ant. post, skin flap; circ. 83 Bowers, J., Pt., I, 69th Sept. 17, Right. Surg. S. N. Sherman, 34th Michigan, age 2i. 18, 64. of muscles. Surg. S. S. French, Pennsylvania. 19, 62. N. Y. Disch d May 1 5, 1863. 20th Mich. Disch d Nov. 10/64. 84 Bradley, J. H., Pt., H, June 1, Left; flap. Surg. J. A. Ramsay, 121 Carl, W., Pt., G, 14th Aug, 18, Left ; ant. post. flap. Surg. A. A. 121st Penn., age 26. 2, 64. 121st Penn. Sept. 27, ant. post, Infantry, age 44. 18, 64. White, 8th Md. Gang. Duty flap amp.. A. A. Surg. T. T. February 18, 1865. Maury. Disch d June 23, ] 865. 122 Carlyle, T., . D. 2d Aug. 14, Left ; ant. post, flap. Surg. J. W. 85 Bradford, P., Pt., F, 1st June 17, Right; flap. Disch d Dec. 15, N. Y. H. A., age 49. 15, 64. Buckman, 5th X. II. Disch d Maine H. A., age 21. 17, 64. 1864. May 21), 1865. 86 Brady, J., Pt., C, 71st May 30. Left; flap. Surg. M. Rizer, 72d 123 Carroll, J., Pt., D, 10th May 3, Right. Surg. White, 14th La. Penn., age 21. 30, 64. Penn. Disch d Nov. 28, 1864. Louisiana. 4, 63. Recovery. 87 Branoski, J. N., Pt., G, Julv 4. Loft. Surg. W. M. Nash, 61st 124 Carson, D., Pt., I, 86th May 10, Left ; flap . Disch d Nov. 2, 64. 61st Virginia. 4, 63. Virginia. Furl d Jan. 9, 1864. New York, age 26. 11, 64. 88 Breene, I)., Pt., F, 97th June 18. Right; ant. post. flap. Disch d 125 Carter, J. W., Pt., C, June 27. Right; flap. Disch d Nov. 7, 04. New York, age 19. 19. 64. May 17, 1865. 85th Illinois, age 24. 27, 64. 89 Bridges, B. P., Pt., C, Oct. 5, Right ; flap. Disch d March 30, 126 Carter, J. It., Pt,, A, July 1, Left. Surg. Warren. Recovery. 25th Indiana (5, 62. 1S03. 26th North Carolina. 3, (>:!. 90 1 Brings, W. 11.. Serg t Sept. 17, Left: circular. Confed. Surgeon. 127 Cawlhorne, C. F., Pt, E, Nov. 30, Right; ant. post. flap. Provost Major, loth Va., age 30. 17, 62. Furloughed Dec. 28, 1864. 15th Texas, age 39. De.1, 64. Marshal April 6, 1865. 91 Brink, J.,Pt.,C, 2d Penn. Juno 10, Left; ant. post. flap. Disch d 128 Cavanaugh, J., Lieut., May 5, Left; flap. Surg. G. T. Stevens, Art y, age 48. 10, 64. Dec. 4, 1865. B, 43d N. Y., age 25. 5. 64. 77th N. Y. Disch d Nov. 4, 64. 92 Briody, P., Pt., B, 4th June 18, Left; ant. post. flap. Surg. H. li .i Clialkley, G. R., Lieut., July 3, Right; circ. Surg. Doughty, New York H. Art ry, 18, 64. C. Tompkins, 4th N. Y. H. A. B, 14th Va., age 29. 4, 63. C. S. A. Retired Mar. 15. 65. age 25. Disch d Jan. 31, 1865. 130 Chamberlain, A. H., Pt., Aug. 30, Right: circ. Surg. J. C. Wilson, 93 Briot, C., Pt.. C, 39th X. Oct. 14, Right; circ. A. A. Surg. N. S. K, 8th Mich., age 23. 30, 62. 8fh Mich. Disch d Nov. 29, 62. York, age 26. 16, 63. Barnes. Bone rcm d. Disch d 131 Champlain, W. H., Pt., May 3, Right ; flap. Surg. J. V. Kendall, Sept. 20, 1865. Died Nov. 12, E, 149th N. Y., age 29. 3, 63. 149th N. Y. Disch d July 21. 63. 77 ; phthisis pulm. Specs. 1787, 133 Chapman, S. S., Pt., E, May 14, Left. Mustered out Sept. 30, 64. 2344, 3027. 27th Mass., age 34. 14, 64. 94 Bristoff, G., Corp l, A, July 17, Right; double flap. Surg. J. D. 133 Cheeseman, R. C.. Capt,, April 2, Right ; flap. Surg. L. W. Bliss, 2d New York Mounted 17, 64. Mitchell, 31st Maine. Disch d A, 45th Penn., age 25. 2, 65. 51st N. Y. M. out July 17, 65. Kifles, age 28. April 4. 1865. 134 Cherington, D. W., Bu Sept. 22, Right; oval skin flap. Surg. P. 95 Bronson, A. B., Corp l, April 2, Left; circ.; (amp. finger.) Surg. gler, H, 2d West Va. 22, 64. Gardner, 1st West Va. Cavalry. K, 38th Wis., age 23. 2, 65. W. E. Johnson, lOSrth X. York. Cavalry, age 30. Disch d March 29. 1865. Disch d June 22, 1865. 135 Chesebo rough.O. B..Pt,, May 15, Right; flap. Surg. A. W. Reagan, 96 Brookfield, R., Capt., C, May 8, Left. Nov. 3. rem d nccro. end. A, 105th 111., age 21. 15, 64. 70th Ind. Disch d Feb. 24, 65. 5th N. C.. age 19. 10, 64. Released May 30, 1865. L36 Choselc.y, S. E., Serg t, Oct. 7, Left. Prison May 4, 1865. 97 Brooks, J.. Pt., F, 151st July 9, Left; circ. A.A.Surg.A.R.Gray. B, 4th Texas, age 30. 7, 64. New York, age 18. 10, 64. Disch d Nov. 27, 64. Spec. 4034. 137 3 Claridi/, J. B., Pt., C, Sept. 19, Left. Recovery. 98 Brotherton, H. /., Pt.. Mar. 31, Right. Sent to Military Prison 24th Alabama. 19, 63. I, 49th N. C., age 35. 31, 65. May 30, 1865. 138 Clark, A.D.,Pt.,C, 134th July 1, Right; flap. Dec., 63, seq. rem d. 99 Brower. C. A., Pt., D, June 3, Left; circ.; gangrene. Disch d Xew York, age 20. 3. 63. Disch d Feb. 18, 1865. 14th N. Jersey, age 18. 3, 64. June 1. 186.-). 139 Clark, D., Serg t, H, 61st Mar. 27, Right ; flap. Confed. Surgeon. 100 Brown, C., Pt., I, 1st Dec. 13. Left : circ. Discharged Feb. 28, Pennsylvania. 27, 65. Mustered out Juno 28, 1865. Artillery, age 21. 13, 62. 1863. 140 Clarke, J. L., Pt., H, Sept. 17, Right. Surg. H. Taylor, U.S.V. 101 Brown, E., Pt., K, 89th Oct. 27, Right : circ. Surg. I . H. Squire, 57th New York. 18. 62. Disch d Jan. 13, 1863. New York, age 35. 27. 64. 89th N. Y. I )isch d Nov. 30, 65. 141 Clarno, W., Pt., C, 3d June 16, Right; circ. Surg. J W. Brock, L02 Brown, G. W., Pt.. L, July 22, . Surg. Hawkins, C. S. A. Wisconsin, age 22. 16, 64. 66th O. Disch d July 26, 65. 10th South Carolina. 23, 64. Recovery. 142 Clements, G. A. H.,Lt., Aug. 16, Right; circ.; protrusion. Disch d 103 Brown, J., Pt., G, 17th June 17, Right; flap. Disuh d May 27, D, 1st Md. Cav., age 22. 16, 64. March 16, 1865. Vermont, age 17. 17, 64. 1865. 143 Cline, J. H., Pt., K. 4th Dec. 13, Right ; cire. Disch d Aug. 22, 63. 104 Brown, J. W., Pt.. K, June 20, Left ; ant. post. flap. Surg. C. J. New York. 14, 62. 21st Kentucky, age 30. 20, 64. Walton. 21st Ky. Discharged 144 Clouts, A., Pt., F, 32d Mar. 21, Left ; lateral flap. Disch d June March 29, 1865. Missouri, age 20. 21, 65. 26, 1865. 105 Brown, T. C., Pt.. I). June 30. . Surgg. Niblet and Harrison. 145 Cobb, S. W., Pt,, E, 20th May 29, Right ; circ. Surg. C. B. Gibson, 24th Virginia. J ly V62. Disch d Sept. 24, 1862. Georgia, age 39. 30, 64. C. S. A. 106 Brown. W. J.. Pt., I>, Nov. 3, Right ; ant. post. flap. Surg. J. 146 Coder, P. M., Pt., A, May 16, Right ; flap. Disch d April 17, 19th Maine, age 18. 4, 64. T. Myers, 59th N. Y. Disch d 28th Iowa. 17, 63. 1865. August 7, 1865. 147 Coldwell, M. B., Corp l, Sept. 14, Left; gangrene; nee. p n of shaft 107 Brown, W. W., Serg t, Sept. 19, Right ; flap. Surg. Lowe, C. S. A. D. 1st Ga. Leg., age 24. 15, 62. rem d. Retired Feb. 24. 1865. A, 22d Virginia, age 36. 19, 64. Transferred Jan. 8, 1865. 148 <Cole, J. W., , G, 28th June 27, Left ; circ. Furloughed July 19, 108 Browne, T. W., Pt., C, Aug. 29, Left. Discharged Oct. 21. 1862. North Carolina. 28, 62. 1862. 24th New York. 2!), 62. 149 Cole, W., Corp l, H, 6th May 18, Right; circ. Furloughed July 109 2 Bryant, W. R., Pt., . Sept. 17, Left ; flap. Recovered. Mass. Cav., age 23. 20," 64. 10, 1864; healed. 18th Mississippi. 18, C:. 150 Coleman, J., Pt,, A, 14th Aug. 5, Right. Disch d Sept. 22, 1862. 110 Buchanan. J. S., Pt., K, Aug. 21, Left ; iat. flap. Surg. G.W. Met- Maine. 5, 62. Died Jan. 12, 1864 ; gastritis. 13thS. C., age 22. 22 64. calf. 76th N. Y. "Prison Dec. 151 Collins, A., Pt., E, 36th Sept. 29, Left. Surg. J. W. Mitchell. 4th 30, 1864. Col d Troops, age 51. 29, 64. C. T. Disch d June 1, 1865. 111 Buck, J , Pt.. A, 3d N. June 4, Right ; circ. Disch d May 25, 65. 152 Collins, C., Pt., D, 3d June 18. Left; flap. Mustered out June Hampshire, age 25. 4, 64. Delaware, age 23. 18, 64. 6, 1865. 112 Bugbee, S., Corp !, E, Oct. 27, Right : ant post. flap. Surg. F. 153 Collins, J. W., Pt., F, July 20. Right; circ.; gang.; sloughing. 14th Conn., age 24. 28, 64. A. Dudley. 14th Conn. Hsem.; 12th La., age 23. 20, 64. Recovery Sept. 22, 1864. lig. art. Disch d Aug. 23. 65. 154 Collins, S. A., Pt., K, April 1, Right; (hip. Surg. W. 11. True, Dec., 1865, reamp. upper third. 20th Maine. 2, 65. 20th Maine. Disch d , 1865. FISHER (G. J.), Fifty-seven Cases of Amp. after battle of Antietam, in Amer. Jour. Med. Sci., 1863, Vol. 45, p. 47. 3 FISHER (G. J.), loc. dt.. p. 47. 3 TERRY (C.). loc. cit., p. 76. 4 SMITH (E. II.), Report of cases of compound comminuted fracture of fejnur, Chimborazo Ilnsp., T/iird Div., in Confed. States Med. and Suryical Journal, 1864, Vol. 1, p. 24. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 247 NO. NAME. MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION AND AGE. DATES. OPERATIONS, OPEKATOHS, RESULT. 155 Comstock, H., Pt., 12th Sept. 2, Left; flap. Disch d Oct. 16, 63. 195 Davenport, J. M., Cap t, Sept. 1, Right; flap. Surg.G.E.Sloat,14th Wisconsin Battery. 2, 62. G, 10th Kentucky. 2, 04. Ohio. Mustered out Dec. 0, 64. 156 Connell, M., Pt,, E, 2d Aug. 3, Left; circ. Surg. G. A. Otis. 27th 190 Davis, A. A., Pt., K.Cth Mar. 31, Right ; long ant. flap. Surg. J. Penn. Art y. age 36. 4, ? 64. Mass. Disch d Mar. 21, 1865. Wisconsin, age 32. 31, 65. C. Hall, Cth Wis. April 4, haem.; 157 Conner, J., Pt., A, 47th July 1, Left. Surg. J. S. Bruce, C. S. A. lig. femor l. Aug. 18, dead bone Virginia, age 28. 1, 63. Retired Nov. 29, 1864. rem d. Disch d Sept. 14, 1865. 158 Connor, J., Pt., G, llth Sept, 13, Left. Surg. J. B. Whitcomb, llth 197 Davis, D. D., Corp l, C, Nov. 24, Left; circ. Confed. surg. Mar., Conn., age 21. 13, 62. Conn. Disch d Nov. 25, 1805. 2d Mich., age 26. 24, 63. 64, nee. June 1. gang. 11, nee. 159 Conway, P.,Pt., K, 139th Sept. 29, Left; circ. Disch d July 31, 65. bone rem d. Disch d Aug. 3/64. New York, age 29. 30. 64. 1870, stump tender. 160 Coons, G. W., Pt., H. Aug. 29, Left ; circ. Surg. J. Y. Cantwell. 198 Davis, G. S.,Pt.,A,185th Mar. 31, Right ; ant. pest. flap. Surg. C. 82d Ohio. 30, 62. 82d Ohio. Disch d Oct. 25, 02. New York, age 33. April 1, W. Crary, 185th N. Y. Disch d 161 Cooper, J. P., Serg t, G, Aug. 21, Right ; circ. Surg. T. F. Oakos, 1865. July 20, 1805. 7th S. Carolina, age 19. 21, 64. 50th Mass. Prison Mar. 1, 1865. 199 Davis, J., Pt,, F, 61st Aug. 21, Left; flap. Surg. G.T.Stevens, 162 Cooper, S., Pt., A, 17th Oct. 19, Right ; circ. Surg. Patterson. C. Penn., age 40. 21, 64. 77th N. Y. Disch d June 16, 65. Mississippi, age 34. 19, 64. S. A. Prison May 9, 1865. 200 Davis, M., Pt., E, 15th July 5, Right ; lat. flap. Surg.W.lI. Gib- 163 Cooper. \V. K., Pt, E, Oct. 19, Right; flap. Retired March 18, Iowa, age 19. 5, 64. bon, 15th Iowa. Sept. 10, gang. 21st Miss., age 20. 20, 64. 1865. Disch d May 26, 1805. 164 Copeland, D. B., Pt., G, June 4, Right; ant. post, flap. Dec. 6, 201 Day, A., Pt.. H, 31st C. Sept. 15, Right; circ, Jan. 7/65, nee. bone 2d New Hamp., age 25. 5, 64. nee. bone rein d. Disch d May Troops, age 20. 15, 04. rem d. Disch d June 10, 1865. 31, 1865. 202 Day, I., Pt., A. 5th C. Sept. 29, Left; bi-lat. flap. Confed. surg. 165 Corbett, C. A., Pt., B, June 6, Right ; ant. post. flap. Surg. J. Troops, age 24. Oct. 1/04. Disch d Aug. 31, 1865. 8th Wisconsin, age 23. 7. 64. E. Murta, 8th Wis. Disch d 203 Dan, J ^-. Pt., A, 10th Aug. 28, Left. Surgeon Walls. Recovery. Nov. 22, 1865. Virginia. 29, 62. 106 Cortes, L. G., Ptlf G, 7th July 3, Left. Surg. Davis, C. S. A. Dec. 204 Dean, D. W., Pt., 1st la. Aug. 31, Left ; flap. A. Surg. D. Haider- Louisiana, age 21. 3, 63. 15, nee. bone ext. Exch d Mar. Battery, age 17. 31, 64. man, 46th O. Dis. May 9, 65. 4, 1864. 205 Dean, J. M., Pt., K, 3d Sept 22, Left; flap: bone prot. Dec. 30, 167 Costello, T., Corp l, E, June 10, Right; (also forearm.) Confed. West Va., age 22. 22, 64. rem. of bone. Disc d May 30/65. 108 93d Indiana. Coughlin,M.,Pt.,H, 94th 12, 64. June 3, surg. M. out August 10, 1805. Right. Disch d January 25, 1865. 206 Deichley, S., Pt., I, 53d Penn., age 19. Mar. 31, 31, 65. Left ; bi-lat, skin flaps. Surg. W. Vasburgh, lllth N. Y. Disch d New York, age 19. 3, 64. August 2, 1865. 169 Covington, W. J., Pt., E, June 22, Right ; ant, post. flap. Surg.G.L. 207 DMinger, P., I, llth May 5, . Surgeon Wilson, C. S. A. 18th N. C., age 26. 22, 64. Potter, 145th Penn. Released North Carolina. 5, 64. Recovery. July 13, 1865. 208 Delmer, P., Pt., F, 17th July 28, L t ; lat. flap. Surg.H.McKennan, 170 Cox, R. N., Pt., D, 41st July 12, Right ; circ. Diseh d Oct. 9, 63. Wis., age 26. 29, 04. 17th Wis. V. R. C. April 1/65. Illinois. 13, 63. 209 Demond,G.,Pt.,K, 145th Dec. 13, Left, Disch d Feb. 26, 1863. 171 Craig, J. B., Pt., E, 15th Aug. 12, Left; circ.; gangrene. Recovery Penn., age 32. 13, 62. Texas, age 25. 12, 64. Sept. 22, 1864. 210 Dempsey, T., Corp l, A> May 3, Right ; flap. Disch d April 19, 172 Crawford, J. A., Pt., K, July 1, Right ; ant. post. flap. S urg. H . C . 2d Vermont. 3, 63. 1864. Oth Wisconsin, age 24. 2, 63. May, 5th N.Y. Oct. 30, seq. rem. 211 Deptitch, W., Pt., E, 3d Dec. 17, Right ; flap. Surg. A. A. Stocker, Feb. 2, 04, nee.bo.rem. 3d, hasm. Massachusetts. 17, 62. 3d Mass. Mustered out. Dis. May 3/64. Specs.W il, 2153. 212 Dewitt, G. M., Corp l, H, Feb. 6, Left ; flap. Surg.A.S. Coe, 147th 173 Creamer, D., Pt., C, 9th Aug. 23, Right ; cire. Surg. J. Owens, U. 147th N. York, age 26. 6, 65 N. Y. Disch d June 22, 1865. Maryland, age 19. 23, 63. S. V. M. out Feb. 23, 64. Died 213 Dickerson, P. B., Lt., H, Dec. 15. Left ; circ. Surg.F.W.Lytle, 36th June 28, 1870. 13th C. Troops, age 32. 15, 64. Illinois. Furfd Feb. 7, 1865. 174 Crew, M., Pt., E, 156th Mar. 22, Left; circ. A. A. Surg. L. W. 214 Dickinson, I., Pt.,H, 53d July 22, Right ; circ. Confed. surg. Dis. Illinois, age 22. 22, 65. Beckwith. Mustered out. Indiana, age 19. 23, 64. June 26, 65. Reamp. Sept. , 06. 175 Cronkite, J. W., Major, April 6, Left. Mustered out June 25, 65. 215 Digbij, C. T., Pt., D, 19th Aug. 9, Left. Surg. R. Battey, C. S. A. 121st N. Y., age 24. 6, 65. Georgia. 10.^02. Recovery. 170 Crosby, A. C., Corp l, I, Nov. 29, Right; ant. post. flap. March 26, 210 Dignian, E , Pt., B, 5th Mav 16. Left : circ. Surg. L. D. Harlow, 5th Ga., age 30. De. 1/63. 64, reamp. middle third. Pro. Confederate, age 25. 16, 04. U. S.V. Pro. Mar. June 16/65. Marshal Dec. 1, 1804. 217 Dittman, J. H., Lieut.G, Aug. 16, Left ; flap. Surg. R. A. Dodson, 177 Cross, L. M., Pt., E, 58th Sept. 29, Left; circ. Disch d March 29, 1st Md. Cav., age 21. 16, 04. IstMd.Cav. Disch d Jan. 12/65. Penn., age 23. 30, 04. 1865. 218 Dnnthil, S. J., Pt., B, 2d July 1, Left. Surgs. Salmon and Page. 178 Cross, S. F., Pt., D, llth June 6, Left; circ. Surg. L. H. Baker, South Carolina. 1. 02 Recovery. Missouri, age 33. 6, 64. 24th Mo. M. out July 13, 1864. 219 Dole, R. D., Corp l, II, Sept. 1, Right; ant. post. flap. Surg. J. 179 Ci-ouse, J. L., Serg t, C, Oct. 19, Prison February 10, 1865. 38th Ohio, age 25. 2, 64. Haller, 38th O. Dis. May 26/65. 31st Georgia. 19, 64. 220 Dooley, W., Pt., Wash Dec. 7, Left ; ant. post. flap. A. A. Surg. 180 Crowell, B., Pt., I, 20th May 10, Right ; flap. Surg. H. F. Lyster, ington Art y, age 29. 8, 64. J. R. Owens. Provost Marshal Mass., age 24. 10, 64. 5th Michigan. Dis. Mar. 27, "05. March 1, 1805. 181 Crowell, S., Pt., I, 93d June 23, Right; circ. Teal s method. A. 221 Doore, C. F., Pt., K, 31st April?, Left; circ. Surg. Hays. Frag. Ohio, age 19. 24, 64. Surg. J. M. Weaver, 93d Ohio. Maine, age 16. 3, 65. bone rem d. Dis d July 18/05. Disch d May 16, 1865. 222 Doran, M., Lieut., C, Mar. 19, Left : circ. Surg. E. Bat well. 14th 182 Crowley, R., Serg t, C, April 2, Right; bi-lateral flaps. Surg. J. 14th Mich., age 28. 19, 65. Mich. Disch d Oct. 17, 1805. 23d Illinois, age 27. 2, 65. S. Tavlor, 23d 111. Disch d Oct. 223 Dougherty, J. H.. Capt., Nov. 12, Left ; ant. post. flap. Sloughing. 26, 1865. B,llthVa.Cav.,age25. 12, 64. Exchanged Feb. 16, 1805. 183 Crown, G., Pt., H, 2d Sept. 19, Left ; circ. A. Surg. J. J. Meigs, 224 Douglas, G. W., Lieut., Aug. 6, Left. Surg. A. M.Wildcr, U.S.V. Vermont, age 19. 19, 64. llth Vt. Disch d June 6, 1865. G, 8th Tennessee. 6, 64. Mustered out June 30, 1805. 184 Ciillen, D. C., Serg t, E, July 22, Right; flap. Surg. A. H. Brun- 225 Douglass, J. A., Pt., D, June 18, Right ; circ. To Regiment Feb. 32d Ohio, age 30. 23, 64. dage, 32d Ohio. Erysip. Disch. llth Infantry, age 23. 19, 64. 18, 1865. March 30, 1865. 226 Downei/. W. C., Pt., 11, May 16, ; circ. Furloughed August 185 Curtin, T., Pt., G, 147th Jan. 15, Right; double flap. Surg. F. B. 43d Ala., age 32. 16, 64. 23, 1861. New York, age 29. 16, 65. Kimball, 3d N. H. Nee. bone 227 Doyle. J., Pt., F, Phil- Nov. 29, Right. Surg. .1. S. Ross, llth N. rem d. Dis.Oct.21/65. 5pec.3U4. lips s Legion. 29, 63. 11. Sent to Confederate lines. 186 Curtis, A. A.. Capt., I, July 20, Flap. Surg. B. L. Hovev, 136th 228 Downing, ./.,Pt., K, 55th Nov. 30, Left ; ant. post. flap. Provost 136th N. Y., age 22. 20, 64. N. Y. Disch d Jan. 14, 1865. Alabama, age 25. De. 1, 64. Marshal March 17, 1865. 187 Cuthbert. T., Serg t, G, Oct. 27, Left ; ant. post. flap. Surg. F. A. 229 Drane, K., Pt., G, 52d Dec. 13, Right. Doing well. 8th New York Heavy 28, 64. Dudley, 14th Conn. Nov. 19, Virginia, age 23. 13, 62. Artillery, age 44. gangrene. 22, haBm.;lig. femor l. 230 Driver, J.. Pt., H, 3d May 25, Right ; circ. Disch d June 22, Disch d July 18, 1805. Wis., age 18. 25, 64. 1855. 188 Daley, E., Pt., K, 158th Sept. 28, Right. Disch d June 24, 1865. 231 Drumm, G. W.. Pt., I, Aug. 29, Left. Surg. J. Y. Cantwell, 82d New York, age 18. 28. 64. 82d Ohio. 30, 62 Ohio. Disch d Feb. 23, 1863. 189 Damarce, M., Corp l, A, Mar. 20, Right ; ant. post, skin flap. Surg. 232 Druse, E. H., Corp l, A, Dec. 10, Left ; ant. post. flap. Surg. V. B. 25th Iowa, age 23. 20, 65. A. T. Hudson, 26th Iowa. Dis. 5th Minnesota, age 20. 17, 64. Kennedy, 5th Minn. Disch d July 23, 1805. June 5, 1805. 190 Danforth, H. J., Corp l, May 18, Right ; circ.; bone prot. May 26, 233 Duell, C. N., Pt., H, 9th Oct. 19, Right ; (lap. Disch d June 9, 65. A, 8th N.Y. Art., age 18. 19, 64. haem.; lig. fern. Dis.Aug. 11/65. N. Y. II. A., age 35. 19, 04. 191 Daniels. II., Pt., D, 1st June 14, Right ; flap. Disch d Sept. 4, 64. 234 Dugan, W. C., Serg t, May 25, Left ; flap. Disch d Jan. 2, 05. Louisiana, ago 23. 16, 63. Spec. 4361. F, 63d Ohio, age 20. 25," 64. 192 Dantz. W. \V., Pt., F, Aug. 25, Right : circ. Confed. surgeon. 235 Duncan, J. H., Serg t, Oct. 10, Left ; ant. post. flap. Surg. J. P. 36th Wis., age 18. 27, 64. Disch d Jan. 6, 1866. B, 7Cth New York. 10, 03. Prince. 30th Mass. Discharged. 193 Dare, II. C., Serg t, C, Mav 1, Left. Disch d July 16, 1863. 230 Dunlap, W., Pt.. I, 9th July 30, Right ; lat. flap. Nov. 9th. gang.; 50th Ohio. 3, "63. New York, age 24. 30, 64. liiPm. 22, lig.: erysip. Disch d 194 Davage, J., Pt., B, 4th June 15, Right circ. Surg.J. W.Mitchell. MaylS. 65. 1870, stump slou g. Col d Troops, age 22. 15, 64. 4th C. T. Necrosed ; six ins. of 237 Dunn, A., Pt., A, 53d Aug. 30, Right : eirc. Surg. S. P. Homier, shaft rem d. Disc d May 20/65. Ohio, age 21. 30, 64. 47th O. Disch d Mav 3, 1865. 248 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TCn NAME. MILITARY OPERATIONS, OPERATORS, No NAME, MILITARY 1 * \ i i ^ OPERATIONS, OPERATORS, INU. DESCRIPTION, AND AOE. RESULT. DESCRIPTION, AND AGE RESULT. 238 Dunn, J. W., Pt., K, 3d June 9, Right. Disch d February 9, 64. 278 Fisher, E. D., Pt., A, De.30, 62 Left. To Camp Morton March OOQ Wisconsin. 9, 63. Louisiana, age 19. Jan. 1, 63 22, 1803. f,>i\ i OA ("U Dunn, M.,Corp l, H, 46th May 25, Both ; oirc.; (li d of r t fib. exc. on 279 Fisher, N., It., H, 37th Nov. 25, Right ; circ. Surg. A. Weiden- -4U) Penn., age 21. 2(i" 27, 25th;) gang. Aug., 04, reainp. Ohio, age 27. 25, 63. bach, 37th Ohio. Disch d Oct. 1, I64. right mid. third. May, 05, nee. 1804. Spec. 3210. bone rem d from left. Disch d 280 Fitzherbert, A., Pt., E, April 9, Right: ant. post. flap. Surg. H. Aug. 17, 05. Died Oct. 23, 77. llth Maine, age 20. 9, 65. C. Levensaler, 8th Me. Disch d Spec. 3193. June 20, 1805. 241 Dyer, J., Pt., V, 89th N. June 4, Left ; circ. Disch d June 26, 05. 281 Fitzpatrick, J., Pt, F, April 2, Left. Mustered out July 28, 65. York, age 20. 5, 04. 8th N. Jersey, age 23. 2, 65. 242 East, T.J.,Serg t, 1. 13th Aug. 19, Right; circ. A. Surg. A. E. Ar 282 Fleming, J., Pt., D, 2d Nov. 8, Left ; flap. Disch d July 4, 05. Alabama, age 22. 111. 64. nold, C.S.A. Trans. Nov. 29,"04. Artillery, age 21. 8, 63. 243 Eastwood, J. S., Pt., H, July 21. Left ; doub.flap. Surg. W.Lomax, 283 Flood, W., Pt., C, 1st Mar. 1, Right ; skin flap ; ciro. muscles. 48th Illinois, age 19. 21. 04. 12th Ind. Disch d July 2, 1805. Md. P. H. B., age 20. 2, 64. A. A. Surg. W. S. Adams. Dis. 244 Edge, IF. /,., Pt., G, 10th De.31, 62 Left; circ. Furl d June 16, 63. May 27, 04. Died Dec. C, teta. S. Carolina, age 23. Jan. 1, 63. and expos after reamp. <Sp.3930. 245 Edmonds, J. J.. Pt., D, June 19, Left ; circ. Surg. D. A. Chamber 284 Fogerty, M. J., Pt., F, Aug. Id. Right; flap. A.Surg.P.Goddard, 90th Penn., age 38. 19, 64. lain, 94th N. Y. Sub. operat n. 12th Infantry. 19, 04. U.S.A. Disch d March 9, 1865. Dis. Sept. 21, t)4. 70,bad stump. 285 Fogg, H. M., Pt., E, 1st Oct. 19, Left ; gang.; ant. post. flap. Surg-. 246 Edwards, #., Pt., C, 20th July 9, Right. Surg. Bissell, C. S. A. Maine, age 22. 20, 04. G.T.Stevens, 77th N.Y. Gang.; North Carolina, age 19. 9, "04. Exch d Sept. 21, 1804. Retired slough g. Disch d June 8, 65. Jan. 17. 1805. 286 Foote, M. J., Capt., B, June 17, Right. Surg. J. Ash, 70th N. Y. 247 Edwards,G., Pt., F, 30th July 30, Right ; flap. Surg. G. J. Potts, 70th N. York, age 28. 17, 64. Furloughed Sept. 16, 1864. C. Troops, age 21. 30," 04. 23d C. T. Feb., 1805. nee. bone 287 Ford, C., Pt., C, 106th Sept. 17, Right. Surg.S. N.Sherman, 34th rem d. Disch d July 26, 1865. Pennsylvania. 17, 62. N. Y. Dch d Jan. 10, 1863. 248 Ehle, J. N., Pt., D, 2d Sept. 14, Left ; flap. Disch d Mar. 5, 1863. 288 Ford, J. A., Pt., H, 38th April 2, Right ; circ. Surg. W. B. Fox, Wisconsin. 15, 02. Wisconsin, age 30. 2, 65. 8th Mich. DischU June 1, 1865. 249 Ehle, W., Pt., A, 14th July 1, Right ; flap. Discharged. 289 Foreman, A.,Pt..D, 150th July 1, Left ; ant. post. flap. Oct. 11, bone New York. 2, fe. Pennsylvania, age 21. 1, 63. prot. rem. Disch d Dec. 14, 04. 250 Eidson, J. W., T/ient., Sept. 20, Right. Surg. Carlisle. Re Spec. 2397. G, 7th South Carolina. 20, 63. covery. 290 Fox, J., Pt., D, 16th May 17, Right: ant. post, skin flap; circ. 251 Elam, R. S., Corp l, E. July 2, Right. Sept. 23, nee. bone rem d. Michigan, age 24. 18, 65. sect. mus. Disch d Aug. 5, 05. 23d Va. Bat ry, age 32. 2. 03. Provost Marshal Oct. 13, 1653. 291 Franks, J.W.,Pt.,E, 6th Aug. 28, Left ; doub. flap. Surg. O. Hoyt, 252 Elfwing, N. A., Major, Feb. 21, Right ; circ. Surg. A. D. I almer, Iowa Cavalry. 30, 04. 30th Wis. Disch d Mar. 30, 05. 48th N. Y., age 33. 21, 65. 9th Me. M. out Sept. 12, 1805. 292 Franklin, D. M., Pt., A, July 20, Left. Sent to Prison Oct. 31, 04. 253 Elliott, J. J., Pt., L, 1st Aug. 25, Right ; flap. Confed. surgeon. 30th Georgia. 20, 04. Maine Cav., age 20. 26, 64. Disch d June 30, 18 f 5. 293 Frazer, J.K.,Pt., B, 44th Sept. 19, . Surgs. Jackson and Ganna- 254 Ellen, H., Pt., C, 3d Mo., May 28, Left ; flap. Surg. G. L. Carhart, Tennessee. 19, 03. way. Recovery. age 27. 28, 64. 31st Iowa. Disch d Sept. 27/04. 294 Frazier, J. B., Corp l, F, Dec. 13, Left. Disch d June 6, 1863. 255 Ellis, F., Pt., B, 21st Me. May 27, Left ; circ. Surg. G. E. Brickett, 26th New York. 14, 6-3. 28. 63. 21st Maine. M. out Aug. 25. 03. 295 Freeman, A. B., Pt., E, Aug. 30, Left, A. Surg. W. B. Witt, 69th 256 Ellis, R., Pt., C, 81st In June 23, Right : flap. Surg. C. J. Walton, G9th Indiana. 30, 02. Ind. Disch d March 20, 1863. diana, age 21. 23, 64. 21st Ky. Disch d May 22, 1865. 296 Freeman, A. J., Pt., C, May 7, Left; flap. Disch d May 10, 65. 257 Ellsner. C., Pt., B, 20th May 5, Left ; ant. posterior flap. Disch d 115th N. Y., age 19. 7, 64. Mass., age 25. 6, 64. June 9, 186"). 297 Freeman, P.,Pt.,D,139th Sept. 19, Left ; ant. post. flap. Surg. W. A. 258 Ell wood, J., It., I, 2d Mar. 5, Left ; flap. Surg. G. B. Cogswell, Penn., age 46. 20, 64. Barry, 9Sth Penn. Disch d June Mich., age 28. 5, 61. 29th Mass. Disch d Sept. 5, 64. 8, 1805. 259 Erabrce, H. A., Pt., C, July 18, Left ; flap. Confed. surg. Disc d 298 Fnshan, N., Pt., E, 21st May 6, Right. Asst. Surg. G. H. Peets, 5th N.Y. H. A., age 23. 19, 64. June 3, 1805. Mississippi. 7, r 64. 21st Miss. Recovery. 260 Emerson, S., Corp l, C, July 24. Left ; flap. Surg. H. C. Leven- 299 Fuller, C. A., Lieut., C, July 2, Left. Surg.C.S. Woods.OOth N.Y. 8th Maine, age 44. 20, 64. saler, 8th Me. J uly 18, 65, scq. Olst New York. 3, 63. (H dhum.exc.) Dis. Dec.15, 63. seven ins. long rem d. Disch d 300 Fulke, C., Pt., H, llth Dec. 13, Left, Disch d Oct. 24, 1863. October 11, 1805. Penn. Reserves. 14, 6-2. 261 Eschbach,H..Pt.,I.118th June 22, Left ; bi-lat. flap. Surg. W. Hoi- 301 Gallagher, H., Pt., K, May 5, Left; circ. Surg. G. L. Potter, Penn., ago 48. 22, 64. brook, 18th Mass. Exfoliation. 99th Penn., age 22. 6/64. 145th Penn. M. out July 1, 1805. Disch d June 30, 1805. Nee. stump. Died Nov. 20, 69; 262 Estle,J.L.P.,Pt.,H,27th Mar. 13, Right : flap. Surg. W. R. Thrall, consumption. Ohio. 13, 62. 27th O. Disch d Aug. 20, 1802. 302 Galusha, C., Pt., D, 17th Dec. 13, Right. Disch d June 15, 1863. 263 Estes, B. F., Pt., F, 10th Sept. 1, Left; circ. A. Surg. R. W. Var- Infantry. 13, 62. 1870, stump discharging. Kentucky, age 24. 3, 04. ney, 31st O. Duty Nov. 29, 64. 303 Galvin, I., Pt., D, 14th July 6, Left; circ. Surg.E.Batwell, 14th 264 Evans, J. B., Pt.,D,24th April 9, Riglit ; flap. Disch d June 5, 65. Michigan, age 20. 6, 64, Mich. Gang.; exf. Disch d June Ind., age 26. 9, 05. 19, 1865. 265 Ecerhi. A. F., Pt.,A,10th Aug. 28. Left. Surg. Walls. Recovery. 304 Garnett. W. H., Pt., B, Oct. 28. Right. Mustered out Oct. 24, 05. Virginia. 28, 62. 2Jth Conn., age 21. 28, 04. 266 l EwM. R.S.,t,\eut.-Gen- Aug. 30, Left. Surg. H. McGuire, C. S. A. 305 Garrahan, W., Pt., 7th June 3, Right ; circ. Surg. P. E. Hubon, eral. 30, 62. Returned to active service. N. Y. H. A., age 28. 3, 04. 28th Mass. Sept. 30, seq. rem d. 267 Fabry, J., Pt., K, 4th Aug. 16, Left ; circ. Surg. G. W. Jackson, Disch d July 0, 1865. Artillery, age 38. 17, 64. 53d Penn. Ext .il.; abscess. May 300 Garvey, J., Pt., E, 99th April 0, Right : circ. Surg. H. F. Lyster, 15, 70, amp. hip j t. Specs. 5084, Penn., age 34. 0, 65. 5th Mich. Disch d June 20 65. 5(585, 5087, 5H99, 5703. 307 Gatchell, A. A., Pt., A, Oct. 5, Left ; circ. Surg.W. L. Leonard, 268 Fagan. J. B., Lt.-Col., July 3 Left. July 31, rem. of nee. bone. 39th Iowa, age 26. 0, 64. 7th 111. Disch il Dec. 10, 1864. 15th Ala., age 29. 3, 63. Exch d and furloughed. 308 Gates, G. W., Corp l, I, May 5, Right : circ. Surg. J. A. Straith, 21 Fagar, W., Pt., B, 59th Aug. 14, Left; flap. Disch d Nov. 7, 1804. 140th N. Y., age 30. 6, 64. C. S. A. Gang.; car. bone rem. New York, age 19. 15, 64. Dis. Aug. 2, 65. 70, bad stump. 270 Farlev, C. J., Capt., B, Sept. 19, R t: circ. Surg. L. P. Woods, 5th 309 Geer, I. S., Carft., C, 3d May 6, Right ; circ. Confed. surg. Mus .5th N. Y. Cay., age 42. 20, 64. N. Y. Cav. Disch d Jan. 11, 05. Michigan, age 30. 6, 04. tered out Sept. 21, J804. 271 Fasnacht, W. E., Pt., G, May 25, Left ; circular. Recovery. 310 Gentry, T., Pt., F, 27th Sept. 17 Left ; flap. Disch d Nov. 29, 02. 147th Penn., age 20. 20," 64. Indiana. 19, 62. 272 Fawlks, N. G., Pt., D, April 12, Left ; ant. post. flap. A. A. Surg. 311 Gerke, H., Lieut., I, 52d June 3, Right. Surg. J. C. Rappold, 52d 13th Tenn. Cavalry. 13, 64. C. Fitch. Erysipelas. Disch d New York. 3, 62. N.Y. Bone prot.: subs, opera. age 45. October 20, 1864. Disch d May 23, 1805. 273 Fay, J. S., Pt., F, 13th April 30, Right ; circ.; (amp. f. arm.) Surg. 312 Gerald, G.F..PI., E, 19th June 27, . Surg. Chancellor, 19th Va. Massachusetts. 30, 63. A.W.Whitney, Kith Mass. Dis Virginia. 28, 02. Recovery. charged Sept. 19, 1803. 313 Gerrish, W., Pt., H, 20th June 3, Left; double ant. flap. Disch d 274 Ferguson, D., Lieut., A, Jan. 11, Left. Surg.G. S.Walker, 6th Mo. Maine, age 28. 4, 04. Jan. 14, 1805. 113th Illinois, age 27. 11, 63. Bone prot.; haems.; lig. femoral. 314 Gibbs, G. A., Pt., D, 18th June 23, . Surg. Griffin, C. S. A. Re Disch d Sept. 3, 1803. Mississippi. 23, 04. covery. 275 Field, A., Corporal, C, June 22, Left: flap. Surg. A. Wilson, 113th 315 Gibbs, W. S. S., Pt., A, May 12, Right ; circ. Retired Mar. 2, 05. 113th Ohio, age 29. 22, 04. Ohio. Disch d Aug. 17, 1804. 12th Miss., age 22. 12, 04. 276 Finke, F., Corp 1, F, 10th Mar. 21, Right ; flap. Surg.A.B.Monohan. 316 Gifford,J.O..Pt., B, 26th Nov. 30, Left. Disch d June 15, 1864. Illinois, age 26. 21. 65. 63d Ohio. Disch d June 27, 05. Michigan, age 20. 30, 03. 277 Finnegan, T., Pt., F, 72d July 23, R t ; lat. flap. Surg.C.K. Irwine, 317 Gilchrist, D. R., Pt., H, May 5, Left : flap. Surg. G. T. Stevens, New York, age 45. 24, 03. 72d N. Y. June. (M, nee. bone 3d Vermont, age 22. 5, 64. 77th N.Y. July 1, nee. bone rem. extracted. Disch d July 2, 64. Disch d Aug. 12, 65. Spec. 2814. ns m.). Shot Wounds of Joints, in Richmond ifed. Jour.. IPfifi. Vol. I. p. 262. *Ons (G. A.), Mem. of a Cast of Re-amp, at the nip, in Am. Jour. ,Mf<l. Sci i, 1871, Vol. LXI, N. S., p. 141, Circular No. 3, p. 215, S. G. O., 1371. SECT. III. | PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 249 No. NAME, MILITABT DESCRIPTION, AND AOE. DATICS. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 318 Gill, C., Corp l, F, 105th Oct. 27, Right; circ. Surg. Smith, C. 360 Harder, T. J., Capt., H, Nov. 16, Right. Surg. Gilmore, C. 8. A. Penn., ago 22. 29. 64. S. A. Disch d June 28, 1865. 9th Georgia. 16, 63. Recovery. 319 Glass, J., Corp l, G, 48th June 27, Left. Recovery. 361 Harding, J., Pt., A, 86th Nov. 25, Left ; flap. Surg. W. J. Burgess, Mississippi. 27, 64. Indiana, age 28. 26, 63. 17th Ky. Disch d Nov. 12, 64. 320 Gomf.r, A. J ., Lieut., F, July 3, Left ; circ. Surg. Mayo, C. S. A. 362 Harding, U., Ft., I, 13th Dec. 17, Left ; flap. A. A. Surg. J. S. Gilt- 3d Virginia, age 27. 3, 03. Provost Marshal Oct. 15, 1863. Col d Troops, age 22. 17, 64. ner. Disoh d Oct. 12, 1865. 321 Goodex, L., Pt., E, 29tU Mav 15, Left: flap. A. Surg. W. F. Smith, 363 Hardy, A. T., Pt.,A, 8th May 16, Left; double flap. Duty Dec. Penn., age 22. 15,"64. 28th Penn. Abscess : bone prot. Maine, age 25. 16, 04. 14, 1864. Disch d July 4, 1865. 364 Hare, S. P., Lieut., D, May 27, Right; circ. A. Surg.W.H. Park, 322 Gorman, IF. H., Pt., , June 15, . Surg. Hunter. Recovery. 49th Ohio, age 23. 27," 64. 4 .ltli O. Disch d Oct. 25, 1864. 1st Maryland Battery. 15, 63. 365 Harley, U.,Corp J, I, 73d Nov. 25, Left. Discharged May 30, 1864. 323 Gorman, T. J., Pt., , April 8, Left ; flap. Surg. J. F. Hess, 96th Penn., age 30. 25, 03. Died Sept. 14, 1869. 83d Ohio, age 21. 10, 64. Ohio. Disch d Aug. 30, 18ii4. 366 Harold, W.O., Serg t, B, Nov. 30, Left ; ant. posterior flap. Provost 324 Gould, 11. P., Serg t, G, Aug. 6, Right ; circ. Surg.W.H. Mullins, 57th Alabama, age 25. De. 1/04. Marshal March 1, 1865. 12th Kentucky, ago 24. 6, 7 64. 12th Ky. Disch d July 14, 65. 367 Harper, W., Pt., B, llth Jan. 24, . Surg. Tripler, C. S. A. 325 Gould, J., Pt., H, 2d July], Left; circ.: nee. hone discharged. Virginia. 25, 64. Recovered. Col d Troops, age 40. 1, 64. Disch d July 27, 1865. 368 Harris, II. D., Pt., D, 7th July 18, Right; flap. Surg. W.W. Brown, 326 Graeter, C., Pt., K, 7th Sept, 17, Left; circ. Disch d Dec. 18, 62. New Hampshire. 19, 63. 7th N. H. Disch d Mar. 4, 1864. Ohio. 17, 62. 369 Harris, W. C., Pt,, A, 3d Oct. 19, Left; circ. Surg.J.M.G.McGuire, 327 Graham, M. J., Lieut., F, Sept. 17, Right ; circ. Surg. G. H. Hum Alabama. 20, 64. C. S. A. Prov. Mar. April 8/65. 9th New York, age 25. 17, 62. phreys, 9th N. Y. M. out May 370 Harrison, W. H., Pt., E, April 2, Left; circ. Surg. J. H. Kimball, 20, o"3. Spec. 1436. 39th N. Jersey, age 32. 3, 05. 31 st Mo. Disclf d Aug. 18, 1865. 328 Grant, G., Pt., K, 101st April 8. Left ; ant. post. flap. Surg. J. F. 371 Hart, D. F., Pt., C, 55th Dec. 13, Left. Surg. Spence, C. S. A. New York, age 18. 10, 64. Hess, 96th O. July 21, 65, nee. Virginia, age 21. 13, 62. Retired April 1, 1865. bone rem. Disch d Aug. 10, Oj. 372 Harding, E., Pt., K, 93d Sept. 19, Right ; double flap. Subs, opera. 329 Greene, C. T., Capt. and Nov. 27, Right; flap. Surgs. J. L. Dunn, Penn., age 19. 19, 64. Disch d March 23, 1866. A. A. General, U. S.V., 27, -G3. 109th Penn.. and J. A. Wolfe,29th 373 Hartman, J., Pt., A, 37th June 19, Left : flap. Surg. W. B. Fox, 8th age 22. Penn. M. out Sept. 19, 1865. Wisconsin, age 16. 20, 64. Mich. June 27, ha?m.; lig. fern. 330 Green, J., Pt., B, 34th Sept. 17, Right ; flap ; two ins. bone rem d ; D-sch d Aug. 14, 1865. New York, age 24. 19, 62. slough. Disoh d Mar. 10, 1863. 374 Hartler, J., Pt., E, 50th Mav 12, Left ; circ.; gangrene ; bone prot. 331 Green, J.. Pt., B, 6th July 3, Right ; circ. A. Snrg. U. F Weir, Penu., age 20. 13, 64. Disch d Aug. 19, 1865. Penn. Cavalry. 5, 63. U. S. A. Disch d Sept. 1, 1863. 375 Haste.y, N.B.,Pt., E, 20th May 6, Left. Surgeon Secan, C. S. A. Spec. 3897. Georgia. 6. 64. Recovery. 333 Green, P., Pt.,F, 3dVt., May 5, Left ; ant. post. flap. Surg. E. 376 Hatch, M. T., Serg t, B, Oct. 19, Right; ant. post. flap. Surg. E. age 33. 7, 64. Phillips, 6th Vt. Disch d May 3d Vermont, age 25. 19, 64. Phillips, 6th Vermont. Siough- 31, 1865. ing. Disch d July 25, 1805. 333 Greenleaf, R., Seaman, April 22, Right.- Surg Vreeland,U.S.N. 377 Haverfield,G.A., Serg t, Sept. 21, Right; gangrenous. Discharged U. S. S. Iroquois. 22, 62. Discharged. H, 120th Ohio, age 24. 22, 64. May 22, 1865. 334 Greenlief, II., Corp l, G, Dec. 17, Left; flap. Surg. I. F. Galloupe, 378 Hayes, J., Serg t, A, 5th Sept. 19, Right ; circ. Surg. Hicks.C.S.A. 17th Mass., age 25. 17, 62. 17th Mass. Disch d May 31, 63. North Carolina. 19, 64. Released April 1, 1865. 335 Greer, J. S., Pt., I, 43d May 14, Left; circ. Surg. F. M. Rose, 379 Hayes,T., Pt., E,25thN. Feb. 14, Left. Paroled May 11, 1865. Ohio, age 28. 14, 64. 43d Ohio. Disch d July 29, 65. Carolina, age 28. 14, 65. 1870, stump discharging. 380 Haynes, G., Pt., B, 26th Aug. 3, Right ; circ. Surg. J. II. Hutchi 336 Greer, T. I., Lieut., B, Mar. 29, Left; circ. Released June 9, 65. Illinois. 3, P 64. son, 15th Mich. Disch d Aug. 18th S. C.. age 22. 29, 65. 28, 1864. Feb. 28, 1865, flap re- 337 Griffin, J., Pt., B, 9th Oct. 27, Left; circ. Surg. A. M. Clark. U. amp, middle third. Maine, age 27. 27, 64. S.V. Gang. Disch. Jan. 30, 66. 381 Headley, A., Pt., C, 2d May 5, Left ; flap. Sept. 15, necro. bone 338 Griffin, J. J., Pt., I, 50th July 2, Left; flap; haem. recurrent. Ex Rhode Island, age 25. 6, *64. rerao. Disch d May 4, 1865. Georgia, age 27. 3, 63. changed Nov. 12, 1863. 382 Heckert,P.,Pt,F,120th July 10, Left ; flap. Disch d Oct. 7, 1863. 339 Grimes, S. R., Corp l. C, Oct. 7, Left. Recovery Feb. 28, 1865. Ohio. 10, 63. 47th Alabama, age 21. 8, 64. 383 Hearing, J., Lieut., G, April 29, Left ; flap. Disch d Dec. 23, 63. 340 Grim, D. D., Pt., D, 1st Mav 7, Left. Discharged July 22, 1864. 58th Ohio. 29, 03. Cavalry, age 23. 7, 64. 384 Heath, P., Pt., A, 9th N. June 11, Left ; flap. Duty Sept. 1, 1804. 341 Gronoble, I. I , Pt., I, May 10, Left; cire. Surg.W.C. Byington, York Cavalry. 11, 64. 148th Penn., age 18. 11, 61. 183d Penn. Disch d June 8, 65. 385 Hebing,G.A., Pt.,I,23d May 17, Left ; circ. gurg. J. C. Ross, 94th 342 Grouse, B., Pt., B, 13th April 14, Right; flap. Disch d Oct. 10, 63. Iowa. 17, 63. 111. Disch d Aug. 17, 1803. Conn., age 25. 14, 63. 386 Hoizeman,II.,Pt.,D,77th May 14, Right; flap. .Surg. S. 11. Kersey, 343 Grower, J.(F..Pt.,E,29th Nov. 30, Left ; circ. Provost Marshal Mar. Penn., ago 19. 14," 64. 3 uth Ind. Disch d Mar. 28, 05. Georgia, age 20. De. 1, 64. 1, 1865. 387 Helen,G.F.,Pt.,B, 114th July 2, Right ; flap. Healed by first in 344 Guenther, H.,Pt,G,65th Nov. 26, Right ; circ. Surg. Dunn, 58th Penn., age 18. 3, 03. tention. Disch d April 12, 64. Illinois, age 2). 26, 64. N. C. Disch d July 31, 1865. 388 Hcllings, J., Pt., H, 5th April 2, Right; flap. Disch d July 19, 345 Habcrkern, J., Pt., I, 7th Feb. 6, Right; circ. June 1, reamp. flap, Penn. Cav., age 22. 2, 65. 1805. Wisconsin, age 21. 7, 65. mid. third. Disch d Nov. 1 , 65. 389 Henderson, A., Pt., E, Aug. 14, Left ; circ. Disch d April 20, 65. 346 Hagemver, A., Pt., C, ISthN.Y.H.A., age 30. Mar. 31, 31, 65. Right ; flap. Surg. A. A. White. 8th Md. Disch d Sept. 20. 65. 390 8oth N. York, age 22. Henry, M., Pt., I, 69th 14, 04. Nov. 25, Left ; lat. flap. Surg. L. Slusser, 347 Baii; R. A., Pt., E, 5th May 29, Left ; lat. flap. Surg.C. B.Gibson, Ohio, age 19. 20, 03. 09th Ohio. Nee. bone removed. S. Carolina, age 3.J. 30, 64. C. S. A. Recovered. Disch d Feb. 6, 1865. 348 Halfpenny, J., Pt., H, Aug. 20, Left ; flap. Confed. surg. Disch d 391 Hensel, C. W., Pt., D, May 14, Right ; flap. Disch d Jan. 13/05. 90th Penn., age 18. 20, 64. Sept. 8, 1865. 66th Indiana, age 20. 14," 61. 349 Hall, J.W., Capt., K, 4th June 11, Lett; flap. Surg. B. G. Streeter, 392 Henslcy, E., Corp l, I, Oct. 2, Right ; circ. Surg. J.G. Hatchitt, N. Y. Cavalry, age 23. 12, 64. 4th N. Y. C. M. out July 17, 65. 39th Kentucky, age 18. 2, 64. U. S. V. Disch d June 20, 1805. 350 Hall, M. Y., Pt., A, 31st May 5, Left. Surg. Atkinson, C. S. A. 393 Herrin, T. J.,Pt., F, 10th April 6, Left; flap. Released June 14/05. Virginia. 5, 64. Retired Dec. 14, 1864. Georgia, age 21. 6, 65. 351 Hall, W.,Pt.,H, 4th W. May 19, Right ; flap. Surg. E. D. Kittoe, 394 Herron, E. 11., Capt., D, May 27, Right. Disch d Nov. 20, 1863. Virginia. 19," 63. U. S. V. Dtech d Mar. 4, 1864. 4th Wisconsin, age 24. 27, 63. 352 Hamilton, J. F., Pt., G, Oct. 13, Right; flap. Surg.C. M. Clark, 395 Hickey, C. M., Pt., H, 7th July 1, Left. Surg. Davis, C. S. A. 39th Illinois, ago 21. 13, 61. 39th 111. Reamp. upper third. Louisiana. 1, 63. Recovery. Disch d June 5, 1865. 396 Hickey, N., Serg t,C,7th Oct. 12, Lett ; circ. Surg. J. E. Pomfret, 353 Hammer, L., Pt., C, 47th Mav 22, Right ; flap. Surg. S. P. Bonner, N. Y. H. A., age 23. 12, 64. 7th New York Heavy Artillery. Ohio. 22, 03. 47th Ohio. Disch d Oct. 6, 1803. Disch d Aug. 15, 1805. 354 Hampel, A., Corp l, E, Alar. 16, Right; ant. post, flap (Skey s). 397 Hill, J., Corp l, B, 123d July 28, Right ; flap. Surg. A. M. Wilder, 355 82d Illinois, age 28. Hampton, T. E., Pt., I, 16, 65. July 1, Disch d Sept. 7, 1865. Right. Surg. L.V. Huot, C. S. A. 398 Indiana, age 27. Hill, J. W., Pt., I, 10th 28, 64. Oct. 28, U. S. V. Disch d June 24, 1805. Right. Disch d Jan. 15, 1805. 14th South Carolina. 2, 63. Paroled Sept. 5, 1863. Alabama, age 23. 29, 04. 35fi Hamrick,A., Pt., E, 45th Nov. 30, Right ; ant. post. flap. Provost 399 2 Killer, W. P., Pt., A, July 27, Left. Teale s op.; ant. post. flap. Tenn., age 25. De. 1, 64 Marshal March 21, 1865. 2d N. Y. II. A., age 41. 27, 04. Surg.J.W.Wishart, 140th Penn. 357 Hancock, J. W., Pt., H, Jan. 17, Left; flap. Surg. H. Brown, 1st Disch d April 3, 1865. 1st Kentucky Cavalry. 18, 65. Ky. Cav. Disch d Aug. 1, 1865. 400 Bines, J. D. E., Pt., II, May 6, Right. Surg. Hudson, C. S. A. 358 Hancock, W. L., Pt., D, 42d Miss., age 25. July 1, 2, 63. Right; flaps sloughed. July 24, reamp. middle third. Paroled 401 4th Alabama. Hinson, T., Pt., G, 39th 6, 64. April 7, Recovery. Right; flap. Disch d Sept. 25/03. Sept. 5, 1863. Indiana. 8, 62. 359 Hardendorf, A., Pt., D, Aug. 29, Left; circ. Disch d Jan. 13, 1863. 402 Hinson, W. H., Pt., H, Sept. 19, Right; circ. Surg. Bissell, 28th 6th N. York Cavalry. 29, 62. 25th N. C., age 37. 19, 64. N. C. Prisou Jan. 5, 1865. 1 BUY AN (J.), Cases of Amputations from the Armies of the Southwest, in Am. Me.d. Times, 1803, Vol. 7, p. 288, Case XXXI. O MEAGHER (W.), Surgical Cases from Field Hospitals, in lied, and Surg. Rep., 1865, Vol. XII, p. 253. SL-HG. Ill 32 250 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCIIIPTIOX, AMI AC.K. DATKS. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATKS. OPERATIONS, OPERATORS, RESULT. 403 Hitt, JT. L., Pt., F, 3d South Carolina. July 1, 1, 62. Right. Surg. Sammond, C. S. A. Disced October 14, 1862. 448 Keegan, J., Corp l, D, 58th Pennsylvania. Sept. 30, 30, 64. Left; flap. Duty. Jan. 29, 1866, mustered out. 404 Hedging, I. M., Pt., D, July 1, Left; flap. Exchanged Nov. 12, 449 Keep, D. S., Corp l, I, Mav 5, Left ; circ. Discharged Sept. 27, 34th N. C., age 30. 1, 63. 1863. 142d Penn., age 25. 5, r 64. 1864. 405 Hoffman, P., Corp l, B, Julv2, Left ; circular. Surg. Purcell. 450 Keller, C., Pt., B, 43d April 6, Left: reamp. upper third: necro. 40C 107th Ohio, age 21. Hoge, tr. F., Pt., Kirk- 2, 63. June 3, Disch d July 30, 1864. . Surg. Capers, C. S. A. 451 Illinois, age 19. Keller, S. P., Corp l, E, 8, 62. Aug. 18, bone rem d. Disch d Mar. 9, 63. Right; ant. post. flap. Surg.A.A. Patrick s Battery. 3, 64. Hecovery. 1st Maryland, age 23. 19, 64. White, 8th Md. Bis. May 14, 65. 407 Hollingshead, A.,Pt., K, 2d West Virginia. June 8, 9, 62. Left ; flap. Surg. R. W. Hazlett, 2d W. Va. Disch d Aug. 22, 62. 452 Kelley, E.,Corp l,C,25th Indiana, age 26. Mar. 21, 21, 65. Right; ant. post. flap. Surg. A. B. Monohnn, 63d Ohio. Disch d 408 Holt, A., Pt., G, 12th X. Mav 2, Left;circ. Surg. Hicks,C.S.A. July 9, 1865. Carolina, age 20. 2, 63. Furl d Oct. 4, 1864. 453 Kelley, J., Pt.. H, 60th Nov. 3, Right. Disch d March 10, 1864. 409 Hopkins, O., Pt., K, 7th June 1. Right. Surg. A. N. Dougherty, Indiana, age 39. 3, 63. Michigan. 1, 62. U.S.V. Disch d March 5, 1863. 454 Kelley, J.R.,Pt., B,14th Mav 23, Right. Surg. Henderson, 14th 410 Hopkins, W..Pt.,C,lllth Penn., age 21. July 3, 4, 63. Left. Surg. G. P. Oliver, lllth Penn. Discharged. 455 Georgia. Kelly, T. J., Pt., D, 49th 24, 64. Mav 4, Georgia. Recovery. Left ; long ant., short post. flap. 411 Homer, G. W., Pt., G, Mav 14, Right : double flap. Vet. Reserve New York, age 19, 5, 63. Disch d Aug. 23/64. 67, reamp. 17th Ohio, age 22. 14, 64. Corps Jan. 14, 1865. 456 Kelly, T., Pt., G, 183d June 3, Right : flap. Surg. P. E. Hubon, 412 Horton, W. M., Serg t, June 3, Left ; circ. Disch d Jan. 19, 1865. I enn., age 35. 3, 64. ?8th Mass. Disch d Mar. 2, 65. B, 8lst X. Y., age 34. 5, 64. Spec. 2934. 413 Howard, H. 11., Pt., G, Sept. 19, Left; circ.; necrosis. Discharged 457 Kelly, V. B., Corp l, B, May 10, Right ; flap. Surg. F. M. Wafer, 114th N. Y., age 23. 19, 64. Mav 20, 1865. 108th N. York, ago 22. 12, 64. 108th N. Y. Duty Sept. 19, 1864. 414 Howard, T. M. b.,Pt.,L, June 18, Right ; flap. Duty Oct. 26, 1865. 458 Kelly, W., It., I, 100th Nov. 23, Left ; lat. flap. Surg. B. N. Bond. 1st Me. H. Art., age 20. 19. 64. Indiana, age 26. 23, 64. 27th Mo. Disch d June 9, 186.5. 415 Howald. C , Corp 1, K, Sept. 3, Right; flap. Surg. C. H. Mills, 459 Kemp, R., 1 t., K, 6th May 30, Right; flap. Disch d Sept. 21/64. 10th Mich., age 21. 3, 64. 125th 111. Mustered out, 1865. N. Y. H. A., age 33. 31, 64. III Howe, 11. P., Pt ,0.120th July 30, Right ; ant. post. flap. Disch d 460 Kennedy, J., Pt., G,42d May 12, Right ; circ. Surg. S. H. Plumb, New York, age 23. 30, 64. Jan. 7, 1865. New York, age 42. 12, 64. 82d N. Y. Seq. rem. Disch d 417 Efowland, J., , B, 1st Sept. 14, ; flaps sloughed; bone prot. Oct. 5, 1865. Georgia. 14, 62. rem d ; small arts. tied. Recov. 461 Kennedy, J.,Pt.,B, 110th Aug. 16, Right; flap. Surg. D. S. Hays, 418 HoyJe,B.M., Pt., F, 34th June 27, Left. Surg. Ross. Retired Feb. Pennsylvania, age 20. 16, 64. 110th Penn. M. out Jan. 17/66. North Carolina. 29, 62. 23, 1865. 462 Kennedy, J.,Pt.,C, 157th June 19, Right; flap. A.Surg.N.R.Barnea, ll > Huffman, J.. Corp l, M, July 28, Left; circ. Disch d May 20, 65. Pennsylvania, age 19. 19, 64. 76th N. Y. Disch d June 30/65. 1st Pcnn. Cav , age 28. 28, 64. Stump unsound in 1870. 1870, not healed. 420 Hughes, E., Pt., 1, 53th Sept. 29, Right ; flap. Surg. Mitchell, 463 Kennison, A ,Pt.,A,19th July 2, Right; flap. Disch d Sept. 19, Penn., age 22. 30, 64. C.S.A. Nec.;rem. seq. Disch d Maine, ago 39. 2. r 63. 1863. Feb. 28, 1866. 464 Keough, P., Pt., C, <33d Mav 13, Left; circ. Surg.N.Gay, U. S.V. 421 Hume, J.,Lient..F. 140th Mav 5, Left, Disch d Oct. 12, 1864. New Jersey, age 24. 14, 64. Gang. Deo. 2, reamp., circ., mid. New York, age 31. 5, 64. A. Surg. J. T. Calhoun, U. S. A. 422 Humphries. 11.. Pt., I. Nov. 29, Left ; circ. Provost Marshal May Disch d Aug. 20, 65. 45th Alabama, age 31. 29, 64. 6. 1865. 465 Kimball, W. H., Lieut., Aug. 4, Right. Surg. S. P. Bonner, 47th 423 1 Humphrey, W. H., Lt., April 2, Right; flap. Surg. C.B. Park, jr., D, 47th Ohio, ago 21. 4, ? 64. Ohio. Disch d Nov. 1, 1864. G, 4th Vermont, age 2. ). 2, 65. UthVt. Pysemia. Disc d Aug. 166 Kimberly, E. P., It., C, Sept. 19, Left; circ. A. Surg.W. G. Bryant, 3, 1865. 10th Vermont, ago 20. 21, 64. 122d Ohio. Disch d June 12/65. 424 Hunt, C. E., Lieut , r. Mav 9, Left : flap. Surg.W. J. Burr, 426. 467 Kincaid, W. 11., Capt., I, Aug. 16, Left; flap. Surg. S. Smith. 93d 59th N. York, age 21 i. 10, "64. N. Y. Disch d Sept. 3 J, 1864. 93d New York. 1C, 64. N. Y. Disch d Nov. 23, 1864. 425 Hunter, B. F., Pt., 1C, July 7, Right ; (also wound of right arm.) 468 King, J., Pt., D, 124th Dec. 16, Right; circ.: gang. Disch d May 19th Georgia, age 23. 7, 64. Retired January 13, 1865 Ohio, age 18. 16, 64. 16, 65. 1870, stump unhealthy. 426 Hunter,C.,Corp l,G.25th Aug. 10, Right : circ. Surg. F. M. Rose, 469 Kino, J- J; I 3 *-, D , 60th Aug. 21). Right. Surg. Walls, C. S. A. Indiana, age 21. 12, 64. 43d Ohio. Hiem.; gang.; necr. Alabama. 29. 64. Recovery. bone ext d, 1865. Disch d Dec. 470 Kingsbury, A., It., I, Sept. 29, Right ; circ. Surg. D. McFalls. 3. 65. 70, stump open. Sp. 4247. 117th N. York, age 20. 21), 64. 142d N. Y. Disoh d Aug. 15/65. 427 Huiton, H.,Serg t, B,62d Sept. 19, R t; circ. Surg. Love, C.S.A. 471 Kircher, H., Capt., E, Nov. 27, Left ; flap ; (also amp. right arm.) Virginia, age 20. 19, 64. Sloughing. Prison Feb. 16, 65. 12th Missouri. 27, 63. Surg. J. Spiegelhalter, 12th Mo. 428 Ingralium, F., Pt., E, 1st Aug. 23, Loft; flap. Surg. \V. 1!. Rczner, Mustered out Nov. 14 1864. Maine Cav , age 2 *. 23, C4. (ith O. Cav. Disch d June 24, 65. 472 Kirkham, A. W., It., A, Feb. 20, Left ; flap. Confederate surgeon. 429 Irby, A. V., Pt., I), 44th Sept. 17, Right. Furloughed Nov. 21, 64. 115th N. Y., age 32. 20. 64. Disch d May 20, 1865. Virginia. 17, (12. 473 Kirkman, D., Serg t, K, Mav 4, Right. Surg. White, C. S. A. 430 Ivers, J., Pt., K, 10th Mav 16, Left ; flap. Disch d Aug. 14, 63. 10th Louisiana. 4, 63. Furl d July 3, 1863. Iowa. 17, 63. 474 Kirkwood, B. F., Corp l, Aug. 18, Left ; lat, flap. Surg. R. H. Rob 431 Jackson, J., Pt., A, 22d Sept. 29, Right; circ. Disch d April 10, 65. H, 7th Md., age 23. 111, 64. inson, 7th Md. Disch d April Cl d Troops, ago 2.5. 30, 64. 10, 1865. 432 Jacobs, J., Pt., K, 1st Mo. Sept. 2, . Surg. A. H. Ramsie.C.S. A. 475 Kishbauch, A., Pt., I. May 12, Left ; (Tealc s rectangular meth.) 2, 64. Recovery. 143d I enn., age 21. 12, 64. Slough g ; end of bone removed. 433 Janney, J., Pt., B, 14th July 1, Left; circ. Disch d April 12/64. Mustered out Doc. 28. 1865. New York. 2, 63. 476 Kittlein, J., It., D, 8th May 5, Left ; ant. post. flap. Confed. 434 Jan-is, K., It., E, 3d N. Mav 13, Left; double flap. Feb.2J, rearnp. Maryland, age 21. 7, fo. surgeon. Disch d June 2, 1865. Hampshire, age 19. 15, 64. nee. bone. Disch d Oct. 26, 65. 477 Klett, J., Pt., F, 5th N. Aug. 2.-, Left ; circ. A. Surg. T. C. Smith, 435 Jenkins, E., Pt., K, 125th July 19, Right ; ant. post. flap. Disch d YorkH vyArt.,age3G. 27, 64. 116th Ohio. Oct., reamp. Disch. Illinois, age 19. 19, 64. Sept. 9, 1865. July 7, 1865. 436 Johnson, L. D., Pt., F, Aug. 14, Right : circ. Prov. Marshal Nov. 478 Klinegger, F., Pt., I, 41st Dec. 1.5, Right; circ. Disch d June 5, 65. 9th Tenn. Cav., age 44. 14, 64. 16, 1864. Ohio, age 33. 15, 64. 437 Johnson, S., Pt., D, 23d Mar. 14. Left; circ. Surg. G. Derby, 23d 479 Klinger, C , It., E, 33(1 Aug. 5, Right ; flap ; gang. Disch d, 1865. Massachusetts. 14. 62. Mass. Discharged. Ohio, age 19. 5, V 64. 438 Johnston, T., Pt., H, 8th June 3, Right; flap. Surg. M. Rizer, 72d 480 Knight, A. J., Corp l, C. April 2, Left ; ant. post. flap. Discharged New York, age 24. 4, 64. Penn. Disch d May 31, 1865. 37th Mass., ago 26. 2, 65. Sept. 4, 1865. 439 Jones, D. M.,Lieut.-Col., July 2, Left; circ. Surg. D. S. Hays. 481 Knir/ht, D. E., It., 12, Mar. , Right. 1 rovost Marshal May 10, 110th Pennsylvania. 2. 63. 110th Penn. Disch d Oct. 9, 63. 17th South Carolina. , 65. 1865. 440 Jones, E. W., Serg t. H, Mar. 22, Right; flap. Surg. A. Sabinc, 482 Knight, E. O., It., K, Mav 5, Left; eiro. Surg. W. B. Cham 26th Illinois, age 26. 22, 6.5. 7iith Ohio. Disch d June 18/65. 97th New York, age 18. 6, 64. bers. !>7th X. Y. Dis. July 12, 65. 441 Joss, J. C., Lieut., G, 2d Mav 6, Left. Surgeon E. J. Boninc, 2d 483 Knight, F.W., It., E, 9th July 27, Left; circ. Surg. A. D. Palmer, Michigan, age 23. 6, 64. Mich. Disch d Sept. 26, 1864. Maine, age 24. 27, 64. 9th Me. M. out Oct. 4, 1865. 442 Judge, T.. Serg t, H, 62d Oct. 19, Left ; ant. post. flap. Discharged 484 Knight, W. A., It., H, Sept, 17. Right ; don. flap. Surg. M. Storrs, New York, age 32. l!t. 64. April 10, 1865. 4th R. Island, age 25. 17, 62. 8th Conn. Disch d Nov. 7, 1863. 443 Kahl, M., Pt., A, 37th O. Mar. 21, Left ; bi-lateral flaps. Surg. F. N. 485 Krausc, J., It., B, 7th Mar. 31, Right; flap. Disch d July 12, 65. age 37. 22, 65. Barnes,! 16th 111. Dis.Oct.21/65 Wisconsin, age 35. Ap. 1 6.5. 444 Kane, J. J., Lieut., H, July 2, Left. Surg. Whitlield, C. S. A. 486 Kresgie, F., 1 t., I, 81st Aug. 16, Left ; flap. Surg. J. H. Buckman, fith Ala., age 24. 2. 63. Provost Marshal March 17, 64. Penn., age 24. 16, 64. 5th N. II. Disch d April 13. 65. 445 Kaufman, W. H., Pt., A, Dec. 31, Left. Disch d Sept. 18, 1863. 487 Krctzler, A., Corp l, D, June 14, Right ; ant. rcct. flap ; (amp. fore 9th Penn. Cav., age 20. 31. 62. 162d New York. 14, 63. arm.) Surg. W.I?. Eager, jr.,162d 446 Kaylor, A., Corp l, I, 2d Mar. 31, Right; circ. Mustered out June N. Y. Disch d August 29, 1863. Ohio Cav., age 25, Ap. 1, 6.5. 6, 18 i.5. Died July 8/7(1: phthisis pulmo. 447 Kean, J., Pt., K, 42d N. Mav 12, Left ; flap. Surg. W. J. Burr. 42d 488 Kuble, J. U., Ft., K,2d Aug. 28, Right. Disch d October 18, 62. York, age 30. 12, 64. N. Y. Disch d Feb. 16, 1865. Wisconsin. 30, 62. LIDELL (J. A.) On I yxmia, in U. S. San. Con. Mem., 1870, Surg. Vol. 1, Sect. Third, p. 535, Case XII. SECT. III. PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 251 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 489 Kugan, M., Pt., K, 145th Aug 16, Right; circ. Surg. G. L. Potter, 531 Maddox, J, Qorp l, K, July 2, Left. Surg. Strickland.C.S.A. Penn., age 21. 16, 64. 145th Penn. M. out Oct. 30, 65. 5th Louisiana. 2, 63. Paroled Sept. 5, 1863. 490 Kurtner, C., Pt., A, 31st Sept. IS), . Provost Marshal Dec. 17, 532 Magee, J., Pt., G, 2d May 5, Right ; flap. Surg. G. W. Carr, 2d Virginia Battery. 19, ( A. 1864. Rhode Island. 5, 64. R. Island. M. out Oct. 16, 1864. 491 Kyle, U., Pt., D, 6th N. July 1, Right ; flap. Provost Marshal 1870, stump discharging. Carolina, age 40. 2, 63. Oct. 15, 1863. 533 Maher, J., Pt., F, 4th Dec. 14, Right; circ. A. Surg.A. M.Clark, 492 Lake, E.,Pt.,D,8th Penn. Oct. 28, Right: flap. Surg. W. L. Baylor, Infantry, age 27. 14, 62. U. S. V. Gang.; erysip.; renio. Cavalry, age 19. 30, (54. C. S. A. Disch d Aug. 29, 1865. exfol. Disch d July 8, 1863. 493 Lamarsna, J. J., Pt., D, June 19, Left; flap. Surg.A.C. Messenger, 534 Maire. C. L., Corp l, K, June 15, Left; flap. Surg. J. L. Dunn. 127th Illinois, age 18. 19, 64. 57th Ohio. Disch d March 18, 109th Penn., age 37. 16, 64. 109th Penn. Disch d June27, 65. 1865. 535 Malbry, P. S., Pt., K, May 30, Right ; lat. flap. Surg. C. B. Gib 494 Lambert. G., Pt., H, 53d Oct. 5, Left. Discharged April 7, 1863. 3d Alabama. J nel, 64 son, C. S A. Transferred June Indiana. 5, 62. 3, 1864. 495 Lambson, J. F., Pt., A, Mar 14, Left ; flap. Surg. B. N. Bond, 27th 530 Mallort/. D. C., Serg t, Nov. 27, Right. Surg. Holt, C. S. A. 4th Iowa, age 26. 15," 64. Mo. Disch d Oct. 7, ] 865. F, 4tli Virginia. 28, 63. Furloughed Jan. 19. 1864. 496 Land,J.,t.,B,lWhQB. May 24, Right; circular. Recovery. 537 Manning, A. F., Pt., D, June 3, Right; flap. Disch d Sept. 30. 24, 64. 50th New York. 3, 63. 1863. 497 Landis, T. J., Corp l, D, Nov. 30, Left ; ant. post. flap. Prov. Mar 538 Manning, G. W., Pt., A, April 13, Right. Surg. Lewis, C. S. A. 2d Arkansas, age 25. De. 1, 64. shal March 7, 1865. 15th Virginia. 13, 63. Furloughed June 24, 1863. 498 Lansperger, C., Pt., F, Mav 6, Left ; circ. Confed. surg. Ulcer- 539 Marlow, J., Pt.. I, 7th May 16, Right. Surg. W. Berry, 7th Ky. llth Penn., age 34. 6, 64. ation. Disch d March:.*], 1865. Kentucky. 16, 63. Disch d Sept. 21, 1863. 499 Lapoint, V., Pt., A. 81st June 3, Right : ant. post, flap ; nee. seq. 540 Marsh, D. W., Pt., H, June 29, R t ; circ. Surg. C. M. Campbell, New York, age 35. 3, 64. rem d. Disch d June 16, 1865. 150th N. York, age 21. 29, 64. 150th N. Y. Mar.. 65, seq. rem. Specs. 2373, 3765. Disch d Sept. 11, 65. Spec. 476. 500 Larke, W.. Pt., E, 9th Sept. 30, Left; .circ. Disch d April 20, 63. 541 Marshall, C., Pt.,E,llth July 3, Left. Provost Marshal Sept. 25, Wisconsin. 30, 62. Virginia, age 22. 3, 63. 1863. 501 Laton, J. M., Serg t, A, June 14, Left ; circ. Discharged June 17, 542 Martin, H., Pt,,H, 8th N. Mar. 31, Left ; cire. Surg. II. F. Lyster, 8th New Hampshire. 14, 63. 1864. Jersey, age 23. Ap. 1, 65 5th Mich. Disch d Sept. 8J865. 502 Lavr.rtjne, A.. ) t.. Aus Mar. 28, Right; circ. Dr. Miller. June 8, 543 Mashan, R. W., Pt., K, May 27, Left : flap. Surg. J. V. Kendall. tin s Battery, age 22. 28, 65. dise. bone rem d. Aug., 65. left 149th N. Y., age 22. 27, 64. 149th N.Y. Disch. June 13, 65. hospital. Spec. 482. 544 Masters, N , Pt., D, 8th June 13, Right ; circ. Disch d March 25, 503 Lawrence. C., Corp l, E, June 10, L t;circ.; (amp. forearm.) Surg. N. Y. Cavalry, age 26. 13, 64. 1865. 9<)th New York. 10, 63. E. S. Hoffman, 90th N. Y. Sub. 545 Mattox, Al.F.,Vt., H,13th Sept. 19, Left ; circ. Prov. Marshal April operations. Disch d Nov. 21, 63. Virginia, age 34. 19, 64. 1, 1865. 504 Lawrence, J. A.. Corp l, June 21, Left ; ant. post. flap. Surg. G. T. 546 Maynard, M., Pt.,D,36th July 20, Left ; circ. Disch d Feb. 4, 65. A, 77th N. Y.. age 21. 21, 64. Stevens, 77th N. Y. M. out. Mass., age 20. 20, 64. 505 Lawrence, F. J., Pt., B, Sept. 19, Left; circ. Surg. C. H. Andrus, 547 McSride, W. H., Pt., B, Mar. 25, Right ; circ. Surg.W. G. Hunter, 159th N. Y., age 17. 20, 64. 176th N.V. HaBin. July, 1865, 44th Virginia, nge 30. 25, 65. 211th Penn. Provost Marshal seq. rem d. Disch d Mar. 3, 66. July 20, 1865. Spec. 3996. 50.; Lawrence, W. E.. Lieut.. Oct. 14. Left. Surgeon Butt, C. S. A. 548 McBride, P., Pt., D, 1st Sept. 1, Left; sloughing. Disch d April F, 32<l N. Carolina. 14, 63. Furl d February 5, 1865. New York, age 23. 1, 62. 4,1863. 507 Laxton, J. L.. Serg t, F, June 1, Left. Surg. Walker, C. S. A. 549 McCaffrey, P., Pt., C, Sept. 14, Right; ant.post.flap. Surg. H. F. 3d North Carolina. 1, 64. Retired Feb. 1, 1865. 5th N. Jersey, age 29. 14, 64. Lyster, 5th Mich. Disch d Apr. 508 Leach. M., Pt., C, 50th Mar. 21, Loft ; ant. post, skin flap. Disch d 37, 1865. Spec. 4112. Illinois, age 21. 21, 65. June 30, 1865. 550 McCaleb, B., Pt., D, 1st Sept. 22, Right ; ant. post, flap ; bone prot.; 509 Lee. T., Pt., K, 45th Ala.. Nov. 29, Right ; circ. Surg. Ringgold, Tenn. Cav., age 25. 23, 64. gang. Disch d Nov. 23, 1865. age 30. 30, 64. C. S. A. Pro. Mar. April 2, 65. 551 McCann, A. J., Serg t, June 17, Right ; circ. Surg. N. Hay ward, 510 Lennard, J. M., Pt., C, Sept. 21, . Surg. Burton, C. S. A. K, 36th Wis , age 23. 17, 64. 20th Mass. Disch d Sept." 27, 64. 3d Georgia Cavalrv. 23, 63. Recovery. 552 McCann, D., Pt., D,40th Nov. 27, Left: ant.post.flap Discharged 511 Lewin, J., Pt., D,"7th June 3, Right. Surg. G. T. Stevens, 77th New York, age 39. 28, 63. Nov. 8, 1864. Maine, age 34. 4, 64. N.Y. Gang.; fetn. prot. Disch d 553 McCann, H., Serg t, A, April 2, Left: flap. Surg.C.C.McGlaugh- Oct. 17. 64. Re-amp, flap, mid. 95th Penn., age 21. 2, 65. lin, 95th Penn. Disch d , 1865. third, Oct. 21, 1865. 554 McCarthy, B., Pt., K, June 16, Left ; circ. Surg. D.W.Maull, 1st 512 Loyson, J., Pt., D, 20th Dec. 13, Right. Surg. J. Dwinelle, 106th 170th N. Y., age 28. 17, 64. Del. May, 65, seq. rem. Disch. Mass.. age 19. 13, 62. Penn. Disch d June 6, 1863. Oct. 19, 65. Died April 5, 70. 513 Lichstein, L., Lieut., F, June 18, Right. Surg. W. A. Barry, !)8th Spec. 1581. 98th Penn., ago 28. 18, 64. Penn. Duty Nov. 15, 1865. 555 McCarthy, J., Pt., D, June 1, Right ; circ. Dec. 30, dead bone 514 Lilley. M. A., .Serg t, H, Aug. 3, Right ; flap. "A. Surg. D. Haider- 13>Jth N. Y., age 21. 2, 64. remo d. Disch d May 22, 1865. 4(ith Ohio, age 26. 3, ? 64. man, 46th Ohio. Erysipelas. 556 McCarthy, W., Pt., B, Oct. 11, Left. Disch d May 29, 1865. Disch d Juno 9, 1865. 27th Michigan. 11, 63. 515 Lindloy, F. \V., Pt., K, June 19, Left; flap. Surg. J. H. Rodgers, 557 McCaughey, T. M., Pt., May 17, Left. Surg. \V. P. Pierce, 88th 103d Ohio, age 25. 21, 64. 104th Ohio. HsBin.; gangrene. D, 74th 111., age 18. 18," 64. 111. Disch d May 18, 65; never Disch d June 30, 1865. healed. Died Ja n. 20, 1867. 516 Linrtslcv, M.W., Pt., G, April 2, Left ; flap. Disch d Oct. 29, 65. 558 McClellan.W.R., Serg t, Mar. 25, Left; circ. flap. Surg. W. G. 1st N.V. Drag., age 21. 2, 65. A, 209th Penn., age 27. 25, 65. Hunter, 211th Penn. Disch d 517 Lintlinrst, C. W., Corp l, Aug. 30, Right. Disch d Oct. 10, 62. Died July 28, 1865. Spec. 4029. I, 1st Penn. Reserves. 30, 62. May 8, 1670: consumption and 559 McClcskey, Pt., U. S. March 8, Left. Disch d Aug. 21, 62. Died general debility from injury. Marines, age 28. 8, 62. January 14, 1863. 518 Little. W. M., Corp l, I, Feb. 10, . Surg. Momenier.C.S.A. 560 McColloch, W. M., Pt,, June 25, Left ; flap. Confederate surgeon. 8th Louisiana. 11, 64. Recovery. K, 20th Indiana. 26. 62. Disch d August 8, 1862. 519 Long. D. B., Pt., E, 75th Get. 8, Left. Disch d Dec. 9, 62. Sub. 561 MeConnell, A. F.,Corp l, Mar. 16, Right : double flap. Surg. T. B. Illinois. 9, 62. operation 1870. K, 121st Ohio, age 24. 16, 65. Williams, 121st Ohio. Disch d 520 Loomis, D., Pt., I, 38th Sept. 1, Right ; flap. Surg. C. N. Fowler, June 16, 1865. Ohio, age 18. 2 64. 105th Ohio. M. out May 17, 65. 562 MeConnell, J., Capt., F, Mar. 25, Left ; circ. A. Surg. E. M. Smy- 521 Losie. J. M., Capt., A, May 25, Right ; flap. Surg. J. Chapman, 4th Georgia, age 22. 26, 65. ser, 48th Penn. Released June 107th N. York, ago 34. 26, 64 123d N. Y. Diseh d Jan. 31, 65. 14, 1865. Spec. 3993. 522 Lovvrcy, A.,Pt.,G, 104th Sept. 11, Left ; circ. Surg. K. G. Thomas, 563 MeConnell, J. J., Serg t, Oct. 11, Right ; ant. post. flap. Surg. E. Ohio." 11, 62. 104th Ohio. Disch d Sept.28, 62. G,3dInd.Cav.,age25. 12, 63. W. H. Beck, 3d Ind. Cavalry. 523 Lozier, T. H., Pt., P., 2d June 11, Right ; circ. Surg. W. M. Weid- Disch d Sept. 5, 1864. Penn. Cav., age 18. 11, 64. man, 2d Penn. Cav y. Disch d 564 McCord, T.N., Pt., For Aug. 21, Left; ant. post. flap. A. Surg. March 2, 1865. est s Cavalry, age 28. 22, 64. J. C. G. Happersett, U. S. A. 524 Ludaka, A., Pt., L, 102d Sept. 19, L t ; flap. A. Surg. J. Romans, jr., Retired March 16, 1865. Penn., ago 26. 19, 64. U. S. A. Disch d Aug. 21, 65. 565 McCready, J. A., Serg t, Sept. 20, Right: eirc. Confed. surgeon. 52."> Luhinan, E., Seaman, Mar. 15, Left ; flap. Disch d Dec. 14. 63. E, 12th Ala., age 29. 20, 64. Prison Jan. 5, 1665. II. S. Navy, age 28. 15, 63. Died June 12, 69 ; consuinpt n. 566 McCutcheon, G. B., Pt., Sept. 30, Left ; post. flap; (also w d of head, 52 i Lumiitgan. / ., Serg t, Sept. 20, Left. Surg. Vaughn, C. S. A. E. 6th South Carolina. Oct. 2, 64. arm, and foot.) A. Surg. S. P. A, 5th C. S. 20, 63. Recover}-. Brcckinridge.C.S.A. Recovery. 527 Lupton, J. W., Pt., C, July! , Left: circ. A. Surg. R. F. Weir, Spec. 5515. 14th N. Jersey, age 21. 10, " 64. IT. S. A. Disch d April 3, 1865. 567 McDonald, D., Serg t, A, July 21, Right : flap. Surg. G. M. Beaks, Specs. 2306, 3924. 101st New York,age24. 21," 64. 141st N. Y. Dec. 10, gangrene. 528 Liiscombe, F. E., Pt., E, May 19, Left; circ. Disch d Mar. 29, 64. Disch d Sept. 20, 1865. 17th Wis., age 21. 20," 63. 568 McDonald, J.,Pt.,D, 4th April 2, Left ; circ. Surg. H. Plumb, 2d 529 Lynch, J., Serg t, 1, 17th. Sept. 20, Right. Surg. W. H. Gentry, 17th New Jersey, age 23. 2, 65. Conn. Heavy Artillery. Disch d Tennessee. 20, 63. Tenn. Recovery. Sept. 11, 1865. 530 Madden. J. .ST., Capt.,D, Nov. 30, Left ; circular. Provost Marshal 569 McDonald, P., Pt., F, Sept. 19, Left. Surg. Smith, C. S. A. 32d Miss., age 34. De.1, 64. March 1, 1865. 54th Tenn., age 25. 19, 63. Transfd June 16, 1865. 252 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITAUV DESCRIPTION, AND AGE. DATES. OPERATIONS, Ol EKATOKS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 570 McDowell,C..Pt.,I,117th July 4, night; ant. post, flap Surg. H. 613 Moore, P., Pt., E, 1st Vt. June 1 , Left; double flap. Surg. C. B. New York, ajre til. 4. 04. W. Carpenter, 117thNcw York. H. Art., age 19. 2, 64. Park, 1st Vermont H. A.; necro. Disch d Jan. 1;>, 1866. Spec. 390. Disch d August 11, 1865. 571 McElroy, R. P., Pt., A, June 18, Left; eirc. Surg.lI.C.Tompkins, 614 Moore, H. P., Pt., C, 20th April 9, Right ; circ. Disch d April 11, 66. 4th N. Y. H. A., n ffe 33. 18, 64. 4th N.Y.H.A. Dis. Nov. 21, 64. Penn. Cav., age 19. 9, 65. 57:. McFarland, J. 7/.,Capt., May 16, . Surg. Taylor, C. S. A. 615 Morton.H., Serg t, D,23d Nov. 3, Left ; flap. Surg. .T. S. McGrew, G, 1st Missouri. 17," 63. Recovery. Wis., age 25. 4, 63. 83d Ohio. Disch d Mar. 10, 64. 573 Mcdaha, W. H., Pt., A, July 3, Right. .Surg. Strath. C. S. A. 616 Morse, S. L.,Pt.,E, 24th May 16, Right ; double flap ; gangrene. iM Virginia. 3, 63. Exchanged March 3, 18154. Iowa. 16, 63. Disch d Sept. 15, 1863. 574 McGuire.T., Pt., D,21st June 21, Plight ; flap. A. Surg. J. L. Rcat, 617 Moss, E.,Pt.,F.7th Col d Oct. 30, Right; flap. Recovered. Illinois, age 22. 21, 64. 21st 111. Disch d Feb. 27, 1S65. Artillery, age 23. 30, 64. 575 Mclntirc, H., Pt., C, 12th Mar. 28, Left ; ant. post. flap. Surg. S. II. 618 Mothersb augh, S.,Pt.,B, Oct. 27, Right ; ant. post. flap. Disch d New Jersey, age 21. 29, 65. Plumb, 8~ d X. Y. Disclrd June 91st Penn., age 35. 27, 64. July 13, 1865. 6, 1865. 619 Muller, G., Pt., A, 40th July 2, Right ; antero-rectangular. Dis. 576 McKinney, J. F., Pt., F, Dec. 16, Right : ant. post. flap. Provost Now York, age 32. 4, r 63. Feb. 20, 1864. Spec. 1478. 44th Miss., age 26. 16, 64. Marshal March 27, 1865. (120 Murphy, D., It., D, 20th Dec. 13, Left. Surg. J. Dwindle, 106th 577 Mo.Kinstrcy, K., Pt., C, June 25, Right. Surg. T. Sim. U. S. V. Mass., age 23. 13, 62. Penn. Disch d Sept., 1863. 70th New York. 25, 62. Disch d Sept. 29, 1862. 621 Murphy, J. D., Serg t, F, Nov. 30, Left ; circ. A. Surg.A. I.Gustine, 578 McMahon, II. P., Pt., L, June 16, Left; circ. Disch d Nov. 14, 64. 42d Tenn., age 18. De. 1, G4. 48th Tenn. Pro. Mar. May 6. 65. 1st Mass. Artillery. 17. 04. 622 Murphy, P., Corp l, II, May 12, Left ; flap. Surg. A. S. Coe, 147th 579 McMahon, M.,It.,B,15th July 3, Right ; ant. post. flap. Disch d 147t"n"N. York, age 22. 12, 64. N.Y. Disch d Sept. 9, 1i5. Infantry, age 19. 4, 04. Aug. 29, 1WJ5. 623 Murray, R. W., It., F, May 6, Right. Surg. R. M. Terrill, P. A. 580 McMahon, P., Pt., G, 32<1 Mar. 22, Left ; flap. Surg. A. B. Monohan, 4th Texas. 6, 64. C. S. Recovery. Wis., age 27. 22, 65. 63d Ohio. M. out June 20, 60; 624 Murray, M., Pt., A, 4th June 2, Left ; flap. Surg .A. S. Coe, 147th not healed 1870. Delaware, age 19. 3, 64. N. Y. Disch d Mav 16, 1865. 581 Me Mann, J., Pt., F, 48th July 2, Left. Exch d Sept. 25, G3, and 625 Murray, R, Corp l, D, 2d Sept. 30. Left ; double flap. " Surg. R. T. Alabama, age 18. 3, 63. furloughed. N. York M. R., age 18. 30, 64. Paine, ir.. 2d N. Y. M. R. Gang. 582 McManus, J., Serg t, G, May 16, Right; flap. Disch d Nov. 6, 63. Disch d June 15, 1865. 69th Indiana. 16," 63. G2C Myers, C., Pt., 1st Conn., April 5, Right ; circ. Surg. E. Bentley, 583 McMillan, C., Corp l, F, May 19, Left. Disch d Sept. 2 , , 1863. age 32. 6, 65. U. S. V. Disch d July 10, 1865. 4th West Virginia. 20, 63. 627 Naragon, A. C., Pt., F, Sept. 19, Left;oirc. flap. Confed. surgeon. 584 McRea, P., Pt., H, 153d Sept. 19. Right ; circ. Surg. X. L. Snow, 19th Ohio, age 24. 21, 63. Disch d Sept. 25, 1864. New York, ago 24. 19, 64. 153d N. Y. Disch d June 14, C5. 628 Naughton, E., Pt., F, 3d Aug. 25, Left i nnt. post. flap. Surg.W.W. 585 Meaker, W., Pt., G, 5th June 16, Left: circ. Surg. H. F. Lyster, N. Jersey Cav., age 21. 25, 64. Bowlby, 3d N. J . Cav. Disch d Michigan, age 19. 17, C4. 5th Mich. Disch d Nov. 9, (i5. Oct. 2G, 65. April 20, 68, flap Spec. 3318. reamp. mid. third. Spec. 2443. 580 Mettz, T., Corp l, C, 5th Oct. 19, Left ; ant. post. flap. Surg. 629 Neat, W., It., 1, 28th 111. Oct. 4. Right; circular. Rcamputation. Alabama, age 31. 19, C4. Mushett, 5th Ala. Prison Feb. 4, (12. Disch d April 17, 1863. 10, 1865. 630 Neidhart, J., Lieut., D, Mar. 30, Right. Surg. C. M. Clark, 39th 587 Meidam, S., Pt., E, 5th April 2, Left ; Hap. Disch d Sept. 1, 18(15. 10th Conn., age 24. 30, 65. Illinois. M. out Sept. 2, 1865. Wis., age 17. 2, C5. 631 Newell, A., It., F, 14th June 14. Left; circ.; flap. Surg.G.E.Sloat, 588 Meinhart, P., Pt., D, 6th May 4, Right . Surg. W. A. Robertson, Ohio, age 17. 14, 64. 14th Ohio. Disch d June21, G5. Louisiana. 5, 63 6th La. Recovery. 632 Newell, T. L.,Pt.,F, llth May 8, Left; circ. Disch d July 21, 65. 589 Meis, W., Pt., E, 9th N. May 6, Right; flap. Disch d Feb. 12, Penn., age 19. 10, 64. Jersey, age :50. 6, 04. 18G5. 633 Newton, J. M., Serg t, D, Oct. 3, Left ; flap. Disch d May 13, 65. 590 Meissner, D. F., Pt., K, July K 1 , Left ; flap. Disch d Nov. 2, 1864. 12th Illinois. 5, 62. 34th N. Jersey, age 19. 12, M. 634 Nice, W. T., Pt., B, 1st Dec. 13, Right. Disch d June 3, 1863. 591 Merrick, G. W., Major, June 18, Right; circ. Disch d Sept. 30, Penn. Artillery. 13, 62. 187th Penn., age 26! 18, 64. 1864. 635 Nichols, H., It.," K, 138th June 2, Right; circ.; bpne prot. Sept. 27, 592 Merrill, C., It., K, 4th An?. 27, Right ; flap. Surg. S. A. Green, Penn., age 20. 2, 64. reamp.; ant. post, flap, middle New Hampshire. 27, (13. 24th Mass. Disch d Nov. 25, 63. third. Disch d April 19, 1865. 593 Mersheimer, G., Pt., D, June 10, Right; flap. Surg. J. L. Dunn, 636 Nickason, A., Serg t, I, Sept. 19, Left; circ. A. Surg. B. Fordycc, 109th Penn.. age 22. 16, 64. 109th Penn. Disch d Aug. 2, Go. 73th New York, age 35. 19, 64. 1 6()th N.Y. Disch d May 25, 65. 594 Messer. S.L.,Pt.. E, 20th Mar. 31, Left; flap; erysip. Discharged 637 Nickle, J., Serg t, H, Dec. 9, Right ; ant.post.flap. Surg. J.W. Maine, age 33. 31, 65. August 17, 1865. 14Cth Penn., age 24. 10, 64. Wishart, 140th Penn. Disch d 595 Milan, J. K., Lieut., F, June 11, Right. Surg. Mitchell, C.S.A. May 19, 1865. 17th Arkansas. 11. 63. Furloughed Oct. 9, 1864. 638 Nigh, J., Serg t, C, 35th Sept. 1 9, Right ; flap. Surg. S. B. Hawley, 59G Miles, J.,Pt., F,53dlnd., Nov. 24, Right; circ. Disch d June 26, 65. Illinois, age 33. 19, 63. 35th Illinois. M. out July, 1864. age 23. 24, C4. 639 Norman, W. B., Pt., D, Sept. 3. Right : circ. Surg. Barr.C.S. A. 597 Miller, C., Pt., E, 43d May 5, Left : flap. Disch d Dec. 24, 1864. 13th Miss , age 25. 4, 64. Prison Nov. 19, 1864. New York, age JO. 6, r 64. 640 Norris, J. A., Capt., C, July 2(1, Right. Surg.T.B.Williams,121st 598 Miller, C. A., Pt., G, 20th April 27, Left : circ. Surg.O. Peabody, 23d 98th Ohio. 20," 64. Ohio. Disch d Oct. 3, 1864. Wisconsin, age 27. 27, Go. Iowa. Gang. Dis. Aug. 5, G5. 641 Obier, J., It., E, 1st Del Dec. J3, Right. Surg.D.W.Maull, 1st Del. 599 Millf.r,F. M., It., Nelson July 18, . Surg. Love, C. S. A. aware, age 27. 14, 62. Dec. 28, reamp. mid. third. A. Batten r . 18, 64. Recovery. A. Surg. II. Stone. Nee. May 7, 600 Miller, J., Corp l, F, 2d Aug. 11, Right ; (lap. A.A.Surg.Maxwell. 64, reamp. up. third. A. A. Surg. Artillery, age 33. 11, G4. Fort Mcllenry July 2, 1805. U. J. Lewis. Disch. Dec. 3, 64. 601 Miller, J., It., K, 118th Sept. 30, Left ; circ. Mar. 29. <>5, bonerem. 642 O Brien, P., Pt., G, 34th June 18, Left ; flap ; sloughing. Disch d Penn., age 30. Oct. 1, 64. Disch d Sept.9, 1865. Spec. 4349. Mass., age 27. 18, 64. February 4, 1865. 602 Miller, J., Corp l, 15, 73d Mar. 19, Right; circ. Disch d August 22, 643 O Bryan, P., It., F, 7th Sept. 17, Left. Disch d June 29, 63. Died Ohio, age 25. 19, 65. 1865. Maine, age 35. , 62. July 9, G6 ; effects of amp. 603 Miller, J., Pt., C, 18th Aug. 30, Left : flap; bone exp. rem. Disch. 644 Oliver, J., It., L, 72d Sept. 17, Right. Surg. S. G. Lane, 5th Pa. Kentucky, age .58. 30, 62. April 23, 186-1. Spec. 1094. Pennsylvania. 18, 62. Res. Disch d Dec. 1 , 1862. 61 ! Millis, H. C., Lieut., B, Oct. 14, Left. Surgeon Butts, C. S. A. 645 Oliver, J., Pt., A, 2d Oct. 8, Left; flap. Surg.C. L.Henderson, 45th North Carolina. 14, 63. Recovery. Michigan Cavalry. 8, 62. 2d Mich. Cav. Dis. Dec. 17, G2. 605 Mills, S. S., .Serg t, 15,7th Dec. 16, Right; circ. Surg. V.P.Kennedy, 646 Ordway, A., It., L, 1st June 22, Left ; circ. Mustered out. Minnesota, age 39. 17, 64. 5th Minn. Disch d Mar. 28, 65. Maine Cavalry. 23, 64. 606 Minnich, A., Serg t, K, Mar. 25, Right ; ant. post. flap. Surg. W. 647 Osborne, J., Pt., G, 132d May 3, Left ; circ. Disch d Nov. 7, 1863. 200th Penn., age 24. 27, 65. (). McDonald, U. S. V. Disch d Pennsylvania. 3, 63. July 19, 1865. Spec. 4134. 648 Oflin, J. 0., Pt., A, 2d Sept. 20, Left. Surgeon Holt, C. S. A. 607 Minshew, J., Pt., G, 50th July 2, Left ; nee. bone rem d. IVovost Tennessee. 20, 63. Recovery. Georgia, age 29. 3, fa. Marshal Sept. 28, 1863. 649 Otle.w, J. n., Pt., A, 43d Oct. 19, Left. Pro. Marshal April 1 , 1865. 608 Mitchell. S. J., Corp l, A, May 29, Right ; ant. post. flap. Prison N. C., age 26. 19, 64. 58th Virginia, ago 32. 30, 64. Oct. 1, 1864. 650 Ott, C. A., Pt., B, 155th June 18, Left; circ. Surg. J. A. E. Reed, 609 Moffitt, S., Lieut.-Col., Oct. 27, Left; circ. A. Surg. W. Wood Penn., age 19. 19, G4. 155th Penn. Gangrene. Disch d 9Gth X. Y., age 28. 28, 64. ward, 39th III., and Surg. T. H. May 25, 1865. Squire, 89th N. Y. Must. out. 651 Palmer, II. II., Corp l, B, July 3, Right; circular. Confed. surgeon. 010 Molegnn, L. G., Pt., H, Oct. 19, Left ; lat. flap. Dis. Sept. 8, 65. 2d Ohio Cavalry. 3, 63. Discharged. 32d Mass., age 24. 19, 64. Died Oct. 22, 69 ; anaemia and 652 Park, G. A., It., A, 81st Aug. 25, Left ; flap. Surg. W. C. Jacobs, pain resulting from amputation. Ohio, age 29. 25, (14. 81st Ohio. Disch d May 5, 1865. 611 Monroe, E., Pt., H, 59th Dec. 15, Right ; circ. M. out May 27, 65. 653 Park, S. W., Colonel, 2d May 3, Right. Surg.H. McLane,2d N.Y. Illinois, age 24. 15, 64. New York, age 3(i. 3, 63. Mustered out May 26, 1863. 612 Moore, A. M., Pt., Wash April 2, Right. Released June 21, 1865. 654 Parker, M., It., H, 1st May 16, Left ; circ. Surg. C. E. Swasey, ington Bat., age 18. 2, 65. Arkansas, age 20. 17, 64. U. S. V. Disch d July 19, 1865. 1 BRYAN (J), foe cit., p. 287. SECT. HI.J PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 253 NO. NAME, MILITARY DESCRIPTION, AKD AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AM> AGE. DATES. OPERATIONS, OPERATORS, RESULT. 655 Parker, M. F.,Pt..E, 19th May 15, Left : flap. Surg. J. Bennett, 19th 695 Reagan, W. B. L., Lieut., July 24, Right. Surg. Love, P.A.C.S. Michigan, age 25. 16, 64. Mich. Disch d Oct. 16, 1864. 16th Tenn. Bat.,age 25. 24, 64. For exch. Nov. 22, 1864. 656 Parker, W., J t., I, 1st June 16, Right ; circ. Disch d Feb. 27, 65. 696 Rector, C. J., Lieut., C, Mar. 29, Left; double flap. Surg. P. L. Mass. II. Art y, nee 27. 18, 64. 185th N. York, age 21. 29, 65. Sonnick, 187th N. Y. Must, out 657 Parker, W. F., Pt., F, Oct. 21, Left ; circ. Surg.R. J. Mohr, 10th May 29. 1865. 10th Iowa, age 21. 21, 64. Iowa. Disch d Aug. 21, 1865. 697 Reed, G. P., Sergeant, I, June 11, Left ; circ. Skirg. J. H. Rodgers. 658 Parquette, H., Pt., 1, 1st Sept. 14, Right. (Teale s method.) Surg. 104th Ohio, age 32. 11, 64. 104th Ohio. Disch d Oct. 25/64. N. H. H. Art y, age 21. 14, 64. R. B. Bontecou, U.S.V. Gang.; 698 Reeves, J. J., Pt., F, 1st June 18, Left; flap. Disch d Dec. 3, 1864. haem. Dis.Oct. 1. 65. Spec. 3244. Maine H. A., age 27. 19. 64. 659 Parquetti, J., Pt., B, 1st July 29, Left ; circ. A. Surg. H. E. Brown, 699 Regner, M., Pt., E, 6th Feb. 6, Left; circ. Disch d Aug. 21, 65. California Cavalry. 30, 65. U. S. A. Disch d June 25, 1866. Wisconsin, age 25. 7, 65. Spec. 4383. 700 Reitzel, U J., Pt.,A,12th July 20, . Surg. Hinkle, C. S. A. 660 Parsons, \V. D., Pt., 15, April 2, Right ; circ. Surg. C. B. Park, jr., North Carolina. 20, 64. Recovery. 2d Vermont, age 18. 2, 65. llth Vt. Disch d Aug. 11, 65. 701 Renner, A., Pt., K, 26th May 14, Left : flap." Surg. A. Sabine, 76th 661 Patterson, W. H., Lieut., Aug. 2, ; ant. post. flap. A. Surg. Iowa, age 16. 14, 64. Ohio. Sept., 1864. bone exfol. 0, 37th Virginia. 2, ? 64. Anderson, C. S. A. Prov. Mars. Jan., 186.">. reamp.; double flap. Nov. 1, 1864. middle third. A. A. Surg. J. M. 662 Payne, L. D., Serg t, D, Mar. 25, Left. A. Surg. E. P. Roche, 35th Adler. Disch d May 26. 1865. 44th Virginia, age 22. 25, 65. Mass. Released June 14, 1865. 702 Reynolds, E. B., Pt., 3d Mar. 7, Right. Sing. B. J. Newland,22d Spec. 4015. Iowa Battery, age 18. 8, 62. Ind. Disch d July 6, 1863. 663 Peak. R., Pt., E, 66th Aug. 4, Left ; ant. post. flap. Surg. J. 703 Rice, A.V., Colonel, 57th June 27, Right : rirc. Surg. A. C. Messen Illinois, age 19. 4, 7 64. Pogue, 66th 111. Erysip. Feb. Ohio, age 27. 27, 64. ger, 57th Ohio. Recovery. Pro 21, 65, reamp. mid. third; circ. moted. Mustered out. flap. A. A. Surg. S.W. Thomp 704 Rice, A. D., Pt., B, 38th April 3, Left ; circ. Surg W.C. Shurlock, son. Mustered out July 19, 65. Wisconsin, age 17. 3, 65. 51st Peun. Disch d Aug. 12/05. 664 Perkins, G., Pt., A, 64th Mar. 25, Left ; ant. post. flap. Surg. M. H. 705 Rice, E., Pf., F, 113th June 22, R t: flap. Surg.A. Wilson. 113th New York, age 22. 25, 65. Ravmond, 26th Mich. Exfol. Ohio, age 25. 23, 64. Ohio. Disch d May 3. 1865. Disch d Nov. 17, 1865. 706 Rice, L., Pt., K, 16th Sept. 30, Left ; flap. Disch d Mar. 21, 1865. 66S Perkins, H. E., Serg t, Mar. 29, Left ; flap. Surg. C. Winne, 77th Michigan, affe 22. 30, 64. C, 7th Vt., age 22. 29, 65. Illinois. Disch d Nov. 25, 18fi5. 707 nice, W. H., Captain, Oct. 3, Left. Surg. Daily, C. S. A. 666 Perrin, W. 8., Lieut., C, Aug. 25, Right : circ. Disch d Feb. 4, 65. Rice s Battery. 3, 61. Recovery. 1st R.I. Art y, age 24. 26, 64. Lied August 13, 1876. 708 Richards, R., Pt.,C, 51st Aug. 17, Right. Prison Nov. 19, 1864. 667 Peters, J., Pt., K, 203d Jan. 15, Right : circ. Surg. L. Barnes, 6th Virginia, age 27. 18, 64. Penn., age 30. 15, 65. Col d Troops. Bone prot. Disc d 709 Ricker, J. W., Lieut., I, May 27, Right : flap. Surg. Y. G. Kurd, July 18, 1865. 48th Massachusetts. 27. 63. 48th Mass. M. out Sept. 3, 63. 6G8 Philo, E. R., Pt., I, 1st Aug. 15, Left ; ant. post. flap. Discharged 710 Rider, J., Pt., D, 98th Sept. 19, Right. Diseh d May 2, 1864. Sharpshooters, age 24. 15, 64. March 2, 1865. Illinois. 19, 63. 669 Picquel, L. A., Pt., A, May 28, . Surg. Brown, C. S. A. 711 Rider, J. F., Pt., A, 4th May 3, Right; ant. post. flap. Furl d 63d Georgia. 30, 64. Recovery. Virginia, age 37. 5, 63. June 14, 1863. Recovered with 670 Pierce. C. L., Lieut., K, April 1, Right ; flap. Surgs.R.Curran, 9th good stump. 9th N. Y. Cav., age 23. 1, 65. N. Y. Cav., and A. P. Clark, 6th 712 Ried, L. W., Adj., 25th Oct. 8, . Surg. Fleming, C. S. A. N. Y. Cav. M. out Sept. 25, 65. Virginia Cavalry. 9, 64. Recovery. 671 Pierce, T. D., Pt., A, 8th Nov. 28, Left ; circ. Surg. J. Sparks, 8th 713 Riggs, H., Pt., F, 27th Oct. 4, Right ; circ. Disch d Apr. 8, 63. Teun., age 37. 28, 64. Tenn. Disch d March 18, 1865. Ohio. (i, 62. C72 Pine, J. A., Pt., I, 168th June 11, Right ; ant. post. flap. Dr. Mc- 714 Rigsbey, N. L., Pt., A, June 20, Right ; circ. Surg. J. Ebersole, Ohio, age 18. 11, 64. Neese. Disch d Oct. 18, 1864. 19th Indiana, age 20. 20, 64. 19th Ind. Disch d Nov. 14, 64. 673 Pinson, J. V., Pt., K, 31st April 6, Left. Disch d October 7, 1862. 715 Riley, H., Pt., F, 13th Dec. 29, R t. Surg. E.O.F. Roller,55th 111. Indiana. 6, 62. Infantry, age 30. 29, 62. Gang. Feb./64. seq.rem. Disch. .;:! Plunkett, C., Pt., B. 4th July 15, Left ; ant. post. flap. A. Surg. Nov. 19, 64. Died Oct. 10, 68. Rhode Island, age 27. 15, 64. R. Millar, 4th R. I. M. out Oct. Spec. 2676. 15, 1864. 716 Rind, E., Pt., B, 5th June 25, Left. Surg. Carder, C. S. A. 675 Pool, D. E., Pt., D, 5"d July 14, Left; circ. Surg. Hinkley. Two Tennessee. 25, 64. Recovery. Illinois. 16, 63. subs. oper. Disch d Oct. 10/63. 717 Ritchey, D., Pt., K, 208th Mar. 25, Left; ant. post. flap. A. Surg. W. 676 Pope, W., Pt., K, 10th May 3, Left. Surg. Taylor, C. S. A. Penn., age 25. 25, 65. Carroll, U.S.V. Disch d June 28, Alabama. 4, 63. Furloughed July 3, 1863. 1865. Died May 14, 1872 ; lung 677 Pulson, \V. S., Corp l, Oct. 8, Right ; flap. Surg. S. Marks, 10th disease. Spec. 4132. F, !)8th Ohio. 10, 02. \Vis. Disch d Feb. 15, 1863. 718 Roacli, J. F., Lieut., E, Sept. 19, Right ; circ. Surg. Singlet, C. 673 1 Powell, J. W., Pt., A, Sept. 19 . Recovery. 45th N. C., age 20. 19, 64. S. A. Prison Nov. 19, 1864. 19th Alabama. 19, 63. 719 Roberts, C.. Pt., H, 45th June 27, Right : ant. post. flap. Surg. F. H. 679 Powell, S., Corp l, F, 21st Aug. 11, Left; flap. Surg. D. S. Young, Ohio, age 23. 27, 64. Kearney, 45th Ohio. Gnng. : end Ohio, age 20. 11, 64. 21st Ohio. Gang.; necro. bone of bone exp. Disch d June 27/65. rem. Disch d June 5, 1865. 720 Roberts, O. D., Serg t, Sept. 30, Left ; circ. Disch d July 18. 65. 680 Powers, D., Pt., E, 35th Jan. 2, Left. Surg. C. J. Walton, 21st H, 118th Penn. 30, 64. Indiana. 3, 63. Ky. Mustered out Mar. 27/63. 721 Roberts, W. W., Corp l, Oct. 12, Left ; circ. A. Surg. T. W. Stull, 681 Price, E., Pt., B, 35th Nov. 29, Left. Recovery. A, 8th Illinois Cavalry. 12, 63. 8th 111. Cav. Disch d Apr.27/64. Virginia Cavalry. 30, 63. 722 Robertson, J., Pt., I, 18th May 8, . Surg. Griffin, 18th Miss. 682 Prince, S. W., Pt.,I, 24th Nov. 30, L t ; lat. flap. Surg. McKinley, C. Mississippi. 8, 64. Recovery. 683 South Carolina, age 17. Printy, T., Pt,, G, 20th De. 1, 64. June 25, S. A. Gang. Pro.Mar.May 3U/65. Right; doub. flap. Cenfed. sttrg. 723 Robinett, M. P.. Pt., E, 65th Ohio, age 20. Nov. 29, 30, 64. Right ; flap. Confed. surg. Disch. Sept. 6, 1865. Indiana, age 33. 26, 62. Disch d July 8, 63. Spec. 367. 724 Robinson, J. ft., Serg t. Mar. 25, Right ; circ. Surg. W. L. Ba ,-l<;r. 684 Prior, W., l>t., H, 72d Sept. 17, Right : flap. Surg. B. A.Vander- B, 18th South Carolina. 25, 65. C. S. A. Prov. Mar. May 10/65. Pennsylvania. 18, 62. kieft, U. S. V. Dis. Jan. 11, 63. 725 Rodgers, T. J., Pt., E, July 22, Right : flap. Surg. S. P. Bonner, 685 Quinn, .T., Pt., G, 21st Oct. 27, Left : flap. Disch d Oct. 17, 1865. 47th Ohio, age 20. 22, 64. *47th Ohio. Disch d June 30/6.3. Penn. Cav., age 22. 27, 64. 726 Rogers. C. B., Corp l, T, Nov. 27, Right. Surg. Taylor. C. S. A. 686 Quinn, M., Pt., B, 55th June 27. Left. Disch d Feb. 13, 1863. Cobb s Legion Cav. 27, 63. Furloughed Jan. 26, 1864. New York. 27, 62. 727 Rogers, G., Pt., C, 2d July 11, Left ; circ. Disch d June 6, 1864. 687 Quinn, M., Pt., A, 14tb Aug. 28, Left. Surg. White, C. S. A. Michigan, age 24. 11," 63. Louisiana. 28, 62. Gang.; abscess, fistulas. .Recov. 728 Rose, E. E., Pt., F, 47th Mar. 27, Left ; flap. Surg. J. L. Dicken, 688 Raburdy, J., Pt,, K, 12th Sept. 17, Left. Surg. J. McL. Hayward, Indiana, age 34. 27, 65. 47th Ind. Disch d July 26, 65. Massachusetts. 17, 62. 12th Mass. Disch d Dec. 1, 62, 729 Rose, F., Pt., D, 57th X. Oct. 14, Right ; circ.; (amp. arm.) Surg. 689 Ragan, J., Pt., B, 4th Oct. 27, R t. Con. surg. Kebel. Mar. 3/65. York, age 20. 15, 63. W. W. Potter. 57th N. Y. Seq. Mass. Cav., age 19. 27, 64. reamp.; circ. A. A. Surg. F. H. rem. Dis. Oct. 3/64. Spec. 3104. Getchell. Disch d July 27, 65. 730 Rose, H. A., Pt., F, Kith July 30, Left : ant. post. flap. Subs. oper. 690 Raley, C. S., Pt., G, 60th Mar. 5, . Provost Marshal May 10, N. Y. Cavalry, age 16. 30, 64. Disch d Feb. 7, 1863. Georgia. 5, 65. 1865. 731 Ross, H., Pt., A, 16th May 21, Left ; flap. Surg. J. Pomerene, 691 Ramsey, W. R., Serg t, May 6, Left ; flap. Confed. surg. Disch d Iowa. 21 ," 63. 42d Ohio. Disch d Aug. 28/63. F, 150th Penn. 8, 1)4. June 3, 1865. 732 Ross, W. E. W.. Lieut. July 30, Left; circ. Surg. J. P. Prince, 692 Rausher, H., Pt., D, 25th Sept. 1, Left ; ant. post, skin flap ; gang. Col., 31st Col d Troops. 30," 64. 36th Mass. M. out Mar. 11, 65. Iowa, age 24. 2, 64. Nit. acid. Disch d Sept. 12, 65. 733 Roth, J., Pt., B, 12th May 14, Left ; flap. Surg. A. T. Hudson, 6 J3 Raynor, L. II., Pt., F.lst June 4, R t ; lat. flap. Surg. C. B. Park, Missouri, age 23. 14, 64. 26th Iowa. Gang. Discharged Vermont, age 21. 4, 64. jr., 1st Vt. H. A. Gang. Disch d April 18, 1865. Feb 21, 65. 1870, stump bad. 734 Rourke, J., Pt., I, 1st Jan. 30, Left; flap. A. A. Surer. J. Brady. 694 Reason, W., Pt., H, 2d Sept. 14, Right ; skin flaps ; circ. muscle. Louisiana Cav., age 25. 31, 65. Disch d Oct. 19, 1865. Cavalry, age 22. 15, 64. A. A. Surg. W. B. McCausland. 735 Royal, H. S., Serg t, A, May 3, ; circ. Surg. Bridges, C. Duty Apr. 2/65. Sps. 3914, 1574. 30th N. C., age 26. 3, 63. S. A. Furl d June 23, 1863. TERRY (C.), loc. cit., p. 76. 254 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITAUY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATOKS, RESULT. 736 Runyon, J. A., Lieut., A, June 14; Right ; circ. Disch d Nov. 5, 64. 779 Bible;/, J>. H., Pt.,E, 18th May 6, . Surg. Griifin, 18th Miss. 74th Indiana, age 18. 14, 64. Mississippi. 6, 04. Recovery. V*? i 780 Sickles, D. E., Major July 2, Right. Surg. T. Sim, U. S. V. /.)/( - Rush, C. G., Pt., C, 21st Mar. 25, Both ; ant. post. flap. Surg. L.W. General, U. S. V. 2, 03. Recovery. Spec. 1335. /OOJ Georgia, ago 22. 25, 65. Bliss, 51st N. Y. Released Aug. 781 Sieben, J., Serg t, D, 4th Sept. 17, Right. Discharged Feb. 9, 1803. 2. 1865. Spec. 3998. New York. 19, 62. 739 Rust, C. W., Serg t, C, Dec. 15, Right ; circ. Surg. H. B. Tuttle, 782 Sinks, J. F., Q. M. S g t, June 22, Left ; circ. Surg. II. K. Spooner, 8th Kansas, age 22. 15, 64. 8yth 111. Disch d June 14, 1865. 61st Ohio, age 22. 22, 64. 61st Ohio. Erysip. Discharged 740 Ryan, J, A., Lieut., L, May 3, Right : ant. post. Hap. Surg. J. March 31, 1865. 5th Virginia. 3, 63. W. Walls, P. A. C. S. Retired 783 Simmons, P., Pt., I, 60th Aug. 18, Left; flap. Disch d Feb. 7, 1865. Feb. 16, 1864. Ohio, age 46. 18, 64. 741 Ryan, T., Pt., G, 90th Nov. 25, Left ; flap. Surg. H. Strong, 90th 784 Sisco, M., Pt., D, llth Oct. 19, Right; flap. Disch d May 27, 05. Illinois, age 28. 27, 63. Illinois. Disch d March 19, 65. Vermont, ago 19. 20, 64. 742 Saeger, D. L., Pt., A, Sept. 2, Right ; flap. Surg. B. M. Failer, 785 Sivert, C. W., Pt., I, 2d Aug. 23, Right. Surg.R.W.Hazlett,2d W. 19th Ohio, age 24. 3, 64. llithOhio. Gang. Disch d May West Virginia. 23, 62. Va. Disch d Feb. 2, 03. Died 16, 1865. April 7, 1870; consumption. 743 Sage, W., Pt., E, 42d Ohio. Mav 1, 1, 63. Left ; flap. Surg. J. Pomercne, 42d Ohio. Disch d July 23, 03. 786 Skellie, E., Corp l, D, 112th New York. Sept. 29, 29, 64. R t; circ. Surg.C. E.Washburn, 112th N. Y. Dis. June 24, 1865. 744 Saila, A., Corp l, I, 65th June 18, Left; flap: gangrene. Disch d 787 Skidmore, G., Pt., I, 53d June 27, Left : ant. post. flap. Surg. A. C. Ohio, age 24. 19, 64. Aug. 17, 1865. Ohio, age 3:). 27, 64. Messenger, 57th Ohio. Disch d 745 Saladal, L., Pt., E, !!th July 30, Left; anterior post. flap. Disch d Jan. 3, 1865. N. Hampshire, age 23. 30, 64. March 29, 1866. 788 Slack, 0. F., Pt., E, Pur- June 3, Right ; flap. Surg. J. O Donncll, 746 Sanborn, S. F., Pt., E, Sept. 1, Right ; circular. Surg. S. Marks, nell Md. Leg., age 20. 3, 64. Purnell Legion. Disch d Oct. 21st Wisconsin, age 24. 0, 64. 10th Wis. M. out May 25, 1865. 1C, 1864. 747 Sanford. J. R., (. apt., B, May 8, Right ; circ. Surg. J. Kelly. 33d 789 Slater, AV. IL. Capt., G, Dec. 13, Right. A. Surg. W. E. Mattison, aid N. Jersey, ago 40. 9, 64. N. J. Disch d Sept. 12, 1864. I 15th New Jersey. 13, 62. 3d N. J. Disch d April 22, 1865. 748 Santo, C., Pt., V, 60th July 1, Left; ant. post, flap: gang.: nee. 790 Slaughter, J. L., l t., E, Sept. 29, Lett: circ. A.Surg.G.G.Odiorne, New York, age 20. 2, 63. seq. rem. Disch d Sept. 20, ( A. 4th C d Troops, age 18. 29, 64. 4th Col d Troops. Gang. Dis. 749 Santry, J., Pt., I, 14th Oct. 19, Left : circ. Surg.W.W. Root,75th March 27, 1865. N. Hampshire, age 20. 21, C4. N.Y. Boneprot. Dis. June (>, 65. 791 Smathers, H., Pt., E, 53d June 23, Left; flap. A. Staff Surg. C. B. 750 Sounders. B., Serg t, I, May , Right. Surg. J. J. Knott, P. A. Ohio, age 23. 23, 64. Richards, U.S.A. Diseh d June 53d Georgia, age 28. , 64. C. S. Recovery. 17, 1865. 751 Sawyer, J. H., Q. M. May 31, Left; double flap. Surg. J. P. 792 Smith, E., Pt., B, 4th Sept. 29, Right; lat. flap. A. Surg.M. Phil Sufg t, 36th Mass. Je. 1, 63. Prince, 36th Mass. Disch d Jan. Col d Troops, age 18. 29, 64. lips, 22d Col d Troops. Disch d 19, 1804. July 19, 1865. 752 i Sawyer, W. C., Capt., Mar. 14, Left; cire. Surg. G. Derby, 23d 793 Smith, G., rt., A, 14th Octl, Right ; flap. Surg. F. A. Dudley, H, 23d Mass. 14, 02. Mass. Disch d Nov. 17. 1802. Conn., age 19. 1, 64. 14th Conn. Disch d June 10, 05. 753 Saxon, W. T., Serg t, E, Mav 3, Right. Surg. Todd, C. S. A. 794 Smith, H., Pt., A, 149th June 1, Left; ant. post.skin flap; circ.sc.ct. 51st Georgia, age 21. 3, 03. Gang.; bone prot. Retired Dee. Penn., uge 25. 1, 64. muscles. Disch d Dec. 8, 18(J4. 22, 1864. 795 Smith, H.C.,Pt., A, 10th April 2, Left ; long ant. flap. Surg. T. H. 754 Scales, J. S., Pt., H, 43d Sept. 14, . Surg. Luckie, C. S. A. Conn., age 25. 2, 05. Squire, 89th N.Y. Disch d July Alabama. 14, 64. Recovery. 31, 1865. 755 Schriner, L., Pt., K, 81st Sept. 17, Left. Surg. G. B. Cogs we! 1, 29th 796 Smith, J., Serg t, E, 61st April 7, R t; circ. Surg. W. 13. Hartman, Penn., age 18. 1!), 02. Mass. Dis. Dec. 27, (i2. V. R. C. New York, age 23. 8, 65. 110th Penn. Dis. July 20, 1805. 756 Schwartz, F., Pt., B, 1st Aug. 21, Ripht; ant. post, flap ; gangrene. 797 Smith, J., Pt., D, 6th N. June 3, Left ; flap. Disch d Aiig. 2, 18 J5. Maryland, age 49. 22, 04. Mustered c.ut Dec. 24. 1864. Hampshire, age 27. 4, 64. 757 Scott, J., Serg t.A, 126th Oct. 19, Left: lat. flap. Disch d May 20, 798 Smith, J., Corp l, F, 3d May 2, Right; flap. Disch d Sept. 29, 63. Ohio, age 27. 19, 04. 1805. Artillery. 2, 63. 758 Scram, J., Pt., D, 134th Dec. 19, Right; flap. Surg. J. L. Dunn, 799 Smith, J.A.,Pt., E.llSth May 7, Left ; flap. Confed. surg. Disch d New York, age 31. 19, 64. 109th Pcun. Dis. Aug. 18, 05. New York, age 21. 8, 64. July 20, 1865. 759 Sebastian, J. M., Serg t, May 16, Right ; flap. Surgs J. Pomeryne, 800 Smith, J. G., Pt., 13, 61st Mnr 25, Right; circular. Recovery. A, 7th Kentucky. 16, 63. 42d Ohio, and W. Berry, 7th Ky. Alabama, age 42. 25, 65. Disch d Sept. 1, 1863. 801 Smith, J. O., Pt., H, 62d July 6, Right; circ. Excli d Nov. 12, 63. 7(50 Serey, J., Pt., K, 17th July 1, Left ; circ. Confed. surg. Disch d Virginia, age 40. 6, 03. Conn., age 17. 1, 63. May 14, 1864. 802 Smith, J. R., Serg t, E, Mar. 31, Right : circ. Surg . P. E. Ilubon, 701 Shackley,P.H.M.,Corp., June 18, Right ; circ.; slough g : bone prot. 53d Penn.. age 34. Ap.l. fiS. 28th Mass. Disch d July 14, 65. B, 32d Maine, age 1! . 18, 64. Mustered out Dec. 12, 1804. 803 Smith, N. B., Pt.,II, !!8th July 20, Left; flap. Disch d Jan. 2, 1865. 762 Shaeffield, W. J., Pt., H, June 18, Right. Retired March 15, 1865. Ohio, age If. 23, 64. 19th Georgia, age 22. 18, 64. 804 Smith, S., Corp l, K, 22d Sept. 29, Right ; lateral flap. Disch d June 763 Shafer, E., Pt., K, 23d May 15, Right; circ.: gangrene. Disch d Col d Troops, age 22. 29, 64. 13, 1865. Michigan, age 21. 15," 64. June 7, 1865. 805 Smith, S. II., Pt., B, 24th June 30, . Surg. Neblitt, C. S. A. ; Shaffer, J.,Corp l,C, 61st April 7, Left ; circ. Disch d Nov. 6, 1865. Virginia. J yl, 62. Recovery. New York, age 26. 7, Co. -0,: Smith, T. N., Pt., B, 43d Oct. 19, Right; ant. post. flap. Surg.G.T. 760 Shaffer, M. V., Pt., G, May 6, Rifrht ; flap. Surg. W. Watson, New York, age 30. 20, 04. Stevens, 77th N.Y. Discharged 105th Penn., age 25. 8, 64. 105th I enn. Dis. June 17. 05. January 20, 1805. 766 Shaffer, T., Pt., F, 138th Sept. 21, Left. Disch d June 12, 1865. 807 Smith, W. E., Capt., E, June 25, . Surg. WML Philpost, C. S. Penn., age 26. 22, 64. 4th Georgia. 25, 62. A. Recovery. 767 Shane, J. B., Lieut., D, Aug. 6, Left. Surg. J. H. Rodgers, 104th --- Smith, W. U., Serg t, C, Mar. 25, Right ; circ. Surg.VV. L. Baylor, 16th Ky., age 23. 7, 64. Ohio. M. out July 15, 1865. 17th South Carolina. 25, 65. C.S.A. Released May 10, 1865. 768 Shannon, W. M., Pt., G, June 18, Right; circ. Confed. surg. Exfol. 809 Smock, G.W., Corp l, A, April 29, Right ; circ. Surg. R. B. Brown, 14th W.Va., age 23. 18, 64. rem. Dis. June 2. 65. Spec. 108. 14th New York S. M., 30, 63. 31st N. J. Disch d June 15, 64. 769 Shattuck, W. W., Pt., C, 7th Michigan. May 31, Je.2, 62. Left; circ. Disch d July 18, 62. 810 age 18. Smed, J. R., Serg t, K, July 22, Spec. 1144. Right. Surg. Hawkins, C.S.A. 770 Shelly, J., Pt., D, 46th July 20, Left \ tint. post. flup. Disc d. tJune 10th S. C. ajro 23. 2 ., 64. Retired Feb. 24 1865. Penn., age 24. 21, 64. 10,1865. 811 Snoddy, VV., Pt.,D,46th D~ec. 9. Ri^ht ; flap. Surg. II. 7.. Gill, U. 771 Shelly, W. H., Pt., I, 5th Mav 5, Left; flap. A.Surg. ILC.Grover, Penn., age 49. 11, 64. S. V. Disch d June 19, 1865. Michigan, age 26. 6, ! 64. 20th Ind. Uiseh d May 6, 1865. 812 Snowble, J. F.,Serg t,TI, July 23, Right ; circ. Surg. C. K. Irwine. 772 Shepardson, C., Corp l, Sept. 19, Right : flap. A. Surg. J.Homang, 72d New York, age 31. 24, 63. 72d N. V. Bono exfol. Disch d G, 1 14th New York. 19, 64. jr., U. S. A. Disch d June 8, 05. July 27, 1604. 773 Sherwood. H., Serg t, C, June 20. Right : flap. Surg. W. H. Gib 813 Snyder, J. O., Lieut., B, Dec. 13, Left; flap. Surg. C. Bower, 6th 4th Michigan. 22, 64. bon, 15th Iowa. Recovery. 7th Penn. Reserves. 13, 62. Pa. Res. Disch d April 1, 1803. 774 Shields, R., Pt., K, 12th Mar. 21, Right ; circ., with lat. flaps. "Surg. 814 Snyder, VV. P., Pt., H, Nov. 27, Right; flap. Surg. J. E. Pomfret, Wis. Bat ry, age 20. 21, 65. A. T. Hudson, 26th Iowa. Dis 7th N.Y. H. A.,age22. 27, 64. 7th New York Heavy Artillery. charged Sept. 1, 1865. Disch d June 6, 1R65. 775 Shoop, S., Pt., F, 200th Mar. 25, Right ; long ant. short post. flap. 815 Solan. T., Pt., K, 10th July 30, Left ; circ. Disch d Oct. 26, 1865. Penn., age 23. 27, 65. Surg. W. O. McDonald, U. S. V. N. Hamp., age 30. 30, " 64. 776 Short,S.A.,Ser,~ t,A,73d July 20, Disch d July 5, 65. Spec. 41 30. Right : flap. Sursr. W. P. 1 eiroe, 816 Song. P., Pt., H, 47th N. York, age 24. Aug. 10, 18, 64. Left ; flap. Confed. surg. Disch d Oct. 26, 64. 1870, stump always Illinois, age 26. 21, 64. 88th 111. Slough g: hsem.; lig. sore. 777 Shrieve, A. T., Pt.. A, June 1. Disch d Jan. 18, 1605. Left : ant. post. flap. Surg. f!. T. 817 Soper, I, Pt., B, 4th Wis consin. May 27, 27," 03. Left : flap. Surg.W.U. Bronncll, 12th Conn. Disch d July 14, 63. 778 6th Maryland, age 22. Shrum, j", I t.. H, 139th 2, 64. Sept. 19, Simpers.lith Md. Dis.May 14, 05. Left: lat. flap. Surer. W.A.Barrv, 818 Southworth, J. E., S g t. C, 1st U.S.S.S., age 20. Nov. 7, 7, 03. Right. Discharged June 28, 1864. Penn., nyc 1! . 19, 04. 98th Penn. Disch d Mar. 20 65. 819 Spalding, L. G., Pt., B, Nov. 7, Left. Disch d March 28, 1864. __ Died Aug. 10, 1870. 4th Vt., age 29. 7, 63. 1 DERBY (G.), Army Med. Intelligence, in Boston Med. and Surg. Jour., 18G2, Vol. CO, p. 193. OTIS (G. A.),ibid^ p. 239. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 255 NAME, MILITARY OPERATIONS, OPERATORS, Ttfrt NAME, MILITARY OPERATIONS, OPERATORS, NO. DESCRIPTION, AND AGE. DATES. RESULT. IX U. DESCRIPTION, AND AGE. DATKS. RESULT. 820 Specht, J., Tt., A, 49th Mar. 25, Left; flap; gangrene; necrosis. 858 Terry, W., Pt., G, 8th Oct. 7, Left; circ. A. Surg. Johnson, New York, ago 45. 26, 65. Disch d Sept. 18/65. Spec. 4174. New Jersey, age 19. 7, 64. C. S. A. April 14, 65, reamp. 821 Spinnings, T., Pt., F, Julv 2, Right ; circ. A. A. Surg. W. S. mid. third. Disch d June28, 65. 137th N. York, age 19. 3, 63. AVoods. Gang.; necro. Nov. 7, 859 Thair, J., Pt., E, 22d Ky. Mav 22, Left. Surg. B. F. Stevenson, 22d reamp. up. third. Diseh d Sept. 22." T3. Ky. Disch d Aug. 1, 1863. 14, 1864. Spec. 4185. 860 Thompson, H., Pt., A, 2d Sept. 20, . Surg. Bates, C. S. A. 822 *Spivey, W. W., 1 t., K, Sept. 19, . Recovery. Tennessee. 20, 63. Recovery. 27th Alabama. 19, 63. 861 Thompson, II., Pt.,G,7th May 5, Right ; ant. post. flap. Mustered 823 Sprinkle, S. M., Pt., I, Julv 30, Left; flap. Surg. J. C. Denise, Indiana, age 23. 5, 64 . out Sept. 20, 1864. 39th Ohio, age 23. 30, 64. 27th Ohio. Disch d Dec. 2, 65; 862 Thompson, M., Serg t, D, Mar. 19, L t ; do u. flap. Surg.D.S. Young, sub. amputations. 88th Indiana, age 24. 19, 65. 21st Ohio. Disch d Oct. 17, 65. 824 Squires, C. W., Ft., B, April 20, Left ; circ. Surg. N. Mayer, 16th 863 Thompson, J. R., Pt., C, Nov. 25, Left ; flap. Disch d Dec. 1, 1864. 16th Connecticut. 20, 64. Conn. Disch d April 17, 1865. 40th Indiana, age 20. 27, 63. 825 Staples, R. C., Pt., F, Oct. 4, Right ; flap. Surg. R. L. Metcalf, 864 Thompson, J. A., Serg t, May 9, Left; circ. Surg. S. S. French, 7th Illinois. 4, 62. 7th 111. Disch d Nov. 26, 1862. G, 79tb N. Y., age 42. 10, V 64. 20th Mich. Nee. bone removed. 826 Stark, A. E., Serg t, II, Oct. 19, Left; double lat. flap. Surg. J. Disch d Aug. 15, 64. Spec. 2968. 49th Virginia, age 28. 20, 64. M. G. McGuire, C. S. A. Ex 865 Thompson, S. J., Serg t, Nov. 25, Left ; flap. A. A. Surg. R. W irth. changed Feb. 16, 1865. B, 79th Ind., age 22. 26, 63. Gang.; necro. Dec. 4, reamp.; 827 Stark, J. T., Serg t, I, Mav 28, Left ; ant. post. flap. Surg. C. D. circ. Disch d Aug. 25. 1864. 13th Ky,, age 25. 28," 64. Moore, 13th Ky. Disc-.li d June 866 Thanason, T. B., Pt., E, Sept. 3, Lett; double flap. Surg. Pat 10, 1865. 17th Miss., age 27. 3, 64. terson, C. S. A. For exchange 828 Starr, A. T.,Pt., F, 106th June 16, Left; circ. Surg. H.A.Martin, Nov. 22, 1864. Penn., age 23. 16, 64. U. S. V. Disoh d Jan. 17, 65. 867 Thornton, R., Pt., 1, 29th Oct. 27, Left ; flap. Surg. N. Y. Leit, 76th 829 Staton, G. D.,Vt.,V, 48th Aug. 16, Right; circ. Disch d Jan. 15, Conn., age 18. 27, 64. Penn. Disch d Aug. 16, 1865. Alabama, age 28. 17, 64. 1865. 868 Tliurmer, J. W., Capt., Dec. 11, Right. Surgs. Hill and Franklin, 830 Steel, B., Serg t, C, 9th Aug. 14, Left. Surg. W. S. Cooper, 125th D, 13th Mississippi. 11, 62. C. S. A. Retired Oct. 29, Ic64. Georgia, age 22. 14, 4. N. Y. Prison Oct. 26, 1864. 869 Tomlin, J., Pt., A, 21st Dec. 8, Left; bi -lateral flap. Provost 831 Stephens, A. F., Pt., H, Nov. 25. Left ; flap. Surg. J. H. Rodgers, Tenn., age 19. 8, 64. Marshal May 6, 1865. 65th Illinois, age 19. 26, 64. 104th Ohio. Disch d June 13, 65. 870 Tompkins, S. C., Serg t, May 2, Left; ant. post, flap. Surg. C. 832 Stephens, G., Pt., C, 1st Julv 28, Left; ant. post. flap. A. A. Surg. F, 159th New York. 3, 63. Robertson. 159th N. Y. Disch d Cavalry, age 35. 28, 64. C. Rogers. Disch d March 8, Aug. 1, 1863. 1865. Operation Jan., 1866. 871 Torrance, R. A., Pt., H, Dec. 26, Left. Surg Holmes, C. S. A. 833 Stephens, S. B., Pt., G, Oct. 7, Right. Surg. J. S. Jackson, C. 8th Texas Cavalry. 26, 6:!. Recovery. 8th Georgia. 7, 64. S. A. Recovery. 872 Tower, D.W., Lieut., B, May 16. Left : flap. Surg. J. II. Ealy.l7th 834 Stephenson, R., Pt., B, June 23, Left: flap. Surg."D.MacKav,29th 17th Iowa. 16, 63. Iowa. Pieces of bone removed. 19th C. Troops, age 19. 23, 64. C. T. Disch d April 17. 1865. Mustered out May 5, 1865. 835 Stevenson. G, Pt., A, June 18, Right; flap. Surg. G. AY. New, 873 Townsend.A., Lieut., G, Aug. 7, Left: circ. Surg. L. SHisser, 6Cth 7th Indiana, age 23. 18, 64. 7th Ind. Gang. Dis. Oct. 5, 64. 18th Infantry, age 20. 7, T 64. Ohio. Retired Dec., 1864. 836 Stickles. J. R., Pt., M, 2<1 June 11, Left : flap; gang. July 11, flap, 874 Tramell, J. F.,Pt., L, 6th Julv 1, Left. Provost Marshal Sept. 1 0, Mich. Cav., age 18. 11, 64. middle third. A. Surg. R. Rae, Alabama, age 21. 1, 63. 1863. 1st N. Y. Drag. Dis. Mar. 10/65. 875 Treadivay, J. A., Pt., H, Julv 2. Left. Paroled Sept. 25, 1863. 837 Sticknev, J. G., Serg t, Aug. 21, Left ; ant. post. flap. Surg. K. 43d N. Carolina. 2, 63. D, Cth Vt., age 24. 21, 64. Phillips, 6th Vt. Exfol.; gang. 876 Trexler, AY. G., Pt., B, Mav 31, Left: flap: prot. bone removed. Disch d Oct. 12, 1865. 93d Pennsylvania. Je. 2, 62. Disch d Julv 5. 1862. 838 Slinzon, A., Pt., 1, 38th April 2, Right. Trans d for release June 877 Trow. AY.. Pt., A, 8th N. June 3, Left : flap. A."Surg.C.II.Pegg.8th N. Carolina, age 20. 2, 65. 21, 1865. York Art y, age 26. 3, 64. N. Y. H. A. Haem.; nee. bone 839 St. Martz, W., Serg t, F, Dec. 15, Right ; ant. post. flap. A. Surg. removed. Disch d Sept. 20/65. 59th Illinois, age 26. 16, 64. H. P. Jennings, 51st O. Gang. 878 Truckev, G. F., Pt., A. June 17, Right : circ. Surg. C. N. Cham Disch d June 26, 1865. 7th AA is., age 19. 18, 64. berlain, U. S. A r . Disch d Oct. 840 Stone, D., Pt., C, C3d Aug. 29, Left. Discharged Jan. 13, 1863. 17, 1864. Pennsylvania. 29, 62. 879 Truesdell, J. AY.. Pt., L, July 18, Right; circ. Disch d Sept. 14, 841 Strong, R. M., Lt.-Col., Oct. 27, Left; ant. post. flap. A. Surg. 54th Penn , age 21. 19. 64. 1864. 19th YYis., age 34. 29, 64. Gibbs, C. S. A. Discharged 880 Tryon, J. L., Serg t. H. June 11, Right : flap. Surg. E.G. Streeter, April 11, 1865. 9th New York, age 33. 11, 64. 4th N. Y. Cav. Dis. Apr. 28/65. 842 Stubblefield, W. H., Pt,, June 1, Left; circ. June 15, medulla prot. 881 TumUin, S. H., Pt., H, Mav 2, Left. Recovery. C, 2d S. C., age 19. 3, 64. from bone. Released June 14, 65. 22d N. Carolina. 4, 63. 843 Sturgis. AY. H., Pt,, K, Mav 18, Right: flap. Surg. A. D. Palmer, 882 Turnbull, J. M., Lieut., May 26, Left ; flap. Surg. AV. P. Peirce, 9th Maine, age 25. 18," 64. 9th Me. M. out Sept. 27. 1864. C, 36th Illinois. 27, 64. 88th 111. Resigned Nov. 4, 1864. 844 Sturman, J. A., 1 t.. A, Aupf. 3 Left eirc. flaps. Exfol. Disch d 883 Turner, C.II.,Pt., B,38th Dec. 13, Right. Confed.surg. Gang.; haem. 3d Ind. Cav., age 19. 4, 62. April 22, 1863. New York, age 24. 15, 62. Mar. 1/63, amp. up. third ; haem. 845 Suggs, It. R., Pt ., M, 8th Julv 1, Left. Transferred Sept. 28, 63. Disch d Sept. 9, 1863. S. C., age 22. 3, %3. 884 Turner, P. L., Pt,,A,23d Oct. 11, . Furloughed Feb. 6, 1864. 846 Button, J. M., Lieut., E, Mav 10, Left ; circ. Surg. J. \V. Wishart, N. Carolina, age 19. 12. 63. 148th Penn., age 22. 11, 64. 140th Penn. Dis. Nov. 2, 1864. 885 Underwood, C., Serg t, Sept. 30, Left. Discharged July 12, 1865. Nov. 13, 64. reamp. up. third. D, 36th Mass., age 27. Oct. 1, 64. 1865. dis. bone removed. Died 70, stump not healthy. Sp.2280. April 30, 1867. 847 Swartz, J., Pt., K, 3d N. June 1, Right ; ant. post. flap. Disch d 886 Underwood, J., Pt., F, Dec. 15, Right ; ant. post. flap. Disch d Jersey Cav., age 20. 1, 64. April 26, 1865. 41st Ohio, age 23. 16, 64. May 11, 1865. 848 Swayne, W., Col., 43d Feb. 2, Right ; flap. Surg. F. M. Rose. 887 Usher, J., Pt., D, 107th May 25, Left ; ant. post. flap. Surg . AY. C. Ohio, age 30. 2, 65. 43d Ohio. Haem.; lig. small art. New York, age 26. 27, 64. Bennett.U.S.V. Dis.June6/65. Retired. 888 Utter, AY., Pt., K, 8th July 19, Right ; semi-circ. integ.tlaps ; circ. 849 Sweezey, I. T., Serg t, I, Dec. 13, Left ; flap. Surg. H. Z. Gill, U- Iowa, age 21. 20, 63. cutmus. Surg.H.Z.Gill.U.S.V. 150th N. York, age 19. 15, 64. S.V. (Alsoamp.lertsec dfing r.) Exfol. Disch d Oct. 21, 1863. Disch d July 19, 1865. 889 Van Lear. A. G. L., Pt., Mav 3, Right; circ. May 15, haem.; lig. 850 Swisher, J., Corp l, B, Aug. 7, Left: circ. A. Surg. J. C. Simon- K, 5th Virginia. 3, 63. femoral. Recovery. 81st Ohio, age 22. 7, 64. son,66th Ind. Disch d May, 9, 65. 890 * Vick, R. A., Pt., E, 43d Oct. 19, Right : necr. Mar. 11, 65, reamp. 851 Sykes, O., Pt., C, 123d Sept. 19, Left ; circ. Disch d June 3, 1865. N. Carolina, age 37. 19, 64. hip joint. Recovery. Ohio, age 17. 2!), 64. 891 Vickery,D.L.,Pt., I,40th Nov. 25, Left ; circ. Disch d May 20, 1864. 852 Tatom, R. P., Pt., C, Aug. 19, Left, Surg. Matthews.C.S.A. Indiana, age 23. 27, 63. 19th Georgia. 19, 64. Recovery. 892 AValbridge, H.C., Pt., E, June 16, Left; flap. Surg. G. L. Potter, 853 Taylor, F. I.. Pt.,E, 17th April 2, Left; circ. Surg. L. AY. Bliss, 145th Penn., age 18. 17, 64. 145th Penn. Disch d June 8. 65. Vermont, age 22. 2, 65. 51st N. Y. Bone prot. Disch d 893 AVager. M. H., Pt., G. Mar. 31, Ri.Sht : circ. Surg. T. H. Squire, November 4, 1865. 123d Ohio, age 39. 31. 65. 89th N. Y. Recovery. 854 Taylor, J. H., Lieut., F, June 19, . Surg. Cooper, C. S. A. 894 Walker, G. R., Pt, E, Julv 4, Left; flap. A.A.Surg.C.G.Page. Kith South Carolina. 19, 64. Recovery. 7th AVest Virginia. 5, 62. Disch d Oct. 23, 1862. 855 Taylor, J., Pt., A, 19th June 22, Right: flap. Surg. J. Bennett, 895 AValker, H., Pt., K, 6th April 16, Right. Surg. H. Janes, 3d A t. Michigan, age 19. 22, 64. 19th Mich. Disch d Sept. 13. 65. Vermont. 18, 62. Disch d August 22. 1864. 85G Temple, J. B., Pt.,A,8th June 22, Left ; ant post. flap. Surg. M. F. 896 AValker, S., Serg t, F, May 3, Right; ant post. flap. A. Surg. N. York Art y, age 57. 22, 64. Regan. 164th N. Y. Seq. rem. 155th Penn., age 29. 3, 63. D. D. Swift, 126th Penn. Lieut. Disch d Aug. 25. 1865. V. R. C.March 11, 1864. 857 Tennis, S., Pt., F, 24th Dec. 28, Right; haem. Disch d July 15, 897 3 Wallace, D. P., Pt., K, July 12, R t ; circ. Surg. J. Potnerene,42d Missouri, age 28. 28, 62. 1863. 42d Ohio. 12, 63. Ohio. Disch d Oct. 7, 1863. "TERRY (C.), loc. cit., p. 7(5. "FAUNTLEROY (A. M.), Wp Joint Amp.-Rec., in Richmond iM, Jour., 1866, Vol. I, p. 7. Circular No. 7, S. G. O., 1867, pp. 50, 65, etc. 3 BUYAN (J.), loc. cit.. A r ol. 7, p. 288. 256 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 898 Wallace, R. T., Pt., A, Oct. 22, Left ; ant. post. flap. Surg. R. B 942 Wilkinson, J:W.,Pt., A, June 19, Right ; ant. posterior flaps. Surg. 76th Penn., age 33. 24, 62. Bontecou, U. S.V. Disch d Jan. 187th Penn., age 40. 20, 64. W. F. Humphrey, 149th Penn. 8, 1864. Specs. 2031, 3018. Disch d Jan. 19, J865. 899 Walsh, R. L., Pt., E, 8th M&y 10, Left. Surg. J. L. Brenton, 8th O. 943 Wilkinson, S. F., Pt., D, Mar. 16, Right ; circ. Surg. C. M. Camp Ohio, age 24. 10, 64. Disch d Oct. i3, 1864. 150th N. York, age 40. 16, 65. bell, 150th N.Y. Disch d June 900 Wanzer,J.,Pt.,G, 137th Oct. 2 J, R t : ant. flap. Surg. G. P. Oliver, 17, 1865. New York. 30, 63. lllth Penn. Disch d Mar. 1, 64. 944 Wilson, A., Corp l, H, 6th Get 15, Right ; circ. Surgs. A. P. Clark, 901 Ward, F. B., Corp l, F, July 2, Right ; flap ; erysipelas. Disch d New York Cavalry. 15, 63. 6th N. Y. Cav., and W. H. Ruli- 20th Maine, age 22. 3, 63. Nov. 28, 1864. son, 9th N. Y. Cav. Discharged 902 Ward, T. W.. Pt., E, May 30, Right ; dou. flap. Surg. Dixon, April 26, 1864. 14th Alabama. 30," 64. C. S. A. Involucnim removed. 945 Wilson, E. E., Pt., H, July 2, Right ; flap. Surg. II. F. Lyster, Disch d July 17, 1865. 110th Penn , age 20. 4, 63. 5th Mich. Disch d Aug. 7, 64. 903 Wardell. S., Corp l, A, June 2, Left ; circ. Disch d June 23, 65. 946 \Vilson, G., Pt., I, 95th Aug. 30, Left ; circ. Surg. II. Z. Gill, 95th 14thN.Y.H.A.,age23. 3, 64. Ohio. 31, 62. Ohio. Disch d Nov. 28, 1862. 904 Watkins, J. R.. Pt., G, July 12, Left ; lateral flap. Prison Oct. 14, 947 Wilson, H., Pt., I, 45th Oct. 7, Right; bi-lat.flap. Confed. surg. 43d N. C., age 37. 12, 64. 1864. Missouri, age 19. 7, 64. Disch d Jan. 31, 1865. 905 Watson, G. W., Lieut., May 5, Right ; circ. Disch d Nov. 14, 65. 948 Wilson, P. P., Lieut., H, June 22, Right ; (also wound of left leg.) H, 90th Penn., age 35. 7, f 64. 5th Connecticut. 23, 64. Surg. J. Chapman, 123d N.Y. 906 Watson, M. F., Lieut., July 2, Right ; circ. A. Surg. B. Howard, Disch d Dec. 22, 64 ; sub. oper. I, 5th Artillery. 3, 63. 1!. S. A. Promoted. Spec. 1382. 949 Wilson, R., Pt., E, 49th Dec. 29, Right ; flap. Disch d March 16, 907 Webb, W. E., Serg t,K, Aug. 6, Left; circ. Surg.G.A.Collamorc. Indiana. 29, 62. 63. 1670, stump sore. 100th Ohio, age 22. 7, 64. 100th O. Gang. Dis. Mar. 27, 65. 950 Wilson, S., Pt., F, C5th Nov. 30, Left; lat. flap. Provost Marshal 908 Wciler, G. S., Pt., G, Nov. 29, Right ; circ. Confederate surg. Georgia, age 26. De.1, 64. March 2, 1865. 0:,th Illinois, age 29. 29, 64. Disch d June 5, 1865. 951 Wilson, W., Pt., I, 1st June 25 Left; circ. Disch d Sept. 29, 62. ;iO!) Wells, D.,Corp l.E, 121st Oct. 19, Right; circ. Disch d June 12, Massachusetts. 25, 62. New York, age 28. 20, 64. 1865. 93S Winder, J., Pt., E, 43d Oct. 19, Left ; long ant. flap ; sloughing. 910 Wells, G., Serg t, K, 7th Sept. 19, Left ; circ. Surg. Davis,C.S.A. New York, age 39. 20, 64. Disch d July 10. 1865. Louisiana, age 21. lit, 64. Provost .Marshal Feb. 11, 1865. 953 Wing, A. O., Pt., F, 1st June 18, Left; circ. Discharged 1865. 911 Welsh, J., Ft., H, 6th June 23, Left; circ ; nee. bone removed. Maine Art y, age 27. 19, 64. Kentucky, age 26. 23, 64. Disch d April 10, 1865. 954 Winstead, W. D., Pt., H, July 1, Right. Surg. Murphy, C.S. A. 912 Welton. F. G., Pt., B, May 29, Right; circ. Surg. Z. 1*. Hanson, 16th North Carolina. 1, 63. Exchanged March 17, 1864. 42d Illinois, age 21. 29, 64. 4:. d 111. Disch d Mar. 20, 1865. 955 Woodle, R., Pt., F, 21st June 16, . Surg. Mullcr, C. S. A. 913 Werle, M.,Pt.,K,66th N. June 16, Loft : ant. post. flap. Surg. G. L. South Carolina. 16, 64. Recovery. York, age 2: . 16, 64. Potter, 145th Penn. Discharged 956 Wood, L, Corp l, G, 94th May 14, Left ; flap. Disch d Dec. 2, 1864. June 24, 1865. Ohio, age 22. 14, 64. 914 Worth, W., Pt., E, 7th April 7, L t ; dou. flap. Surg. W.Vasburgh, 957 Woods, W., Pt., G, 32d JJuy 7, Right ; (also wound of left leg.) New York, age 32. 7, 65. lllth N. \. Dis. Aug. 18, 1865. New York. 7, ! 62. Disch d Sept. 15, 1862. 915 Westbrook, J. IF., Lieut., Nov. 30, Left : circ. Pro. Marshal Feb. 958 Woolbough, J. R.,Pt.,I, Oct. 1, Left ; flap. Surg.J.Thomas, 118th B. 4th Miss., age 23. Dec. 1, 64. 6, 1865. 118th Penn., age 33. 1, 64. Penn. Nee. bone rem d. Disch d 91 G Wetlcr, IL.Licut., II,8th Aug. 28, Uight. Surg. L.W. Read, 1st Pa. July 25, 1865. Penn. Res., age 20. 28, 62. Reserves. Disch d Sept. 29, 62. 959 Workman, A.J., Pt., I, May 16, Right ; circ. Retired February 917 Whealan, J..I t.,D, 123d Dec. 15, Left ; flap. Surg. O. Ferris, 123d 29th Virginia, age 20. 16, 64. 22, 1865. Ohio, age 23. 16, 63. Ohio. Disch d .May 23, 1864. 960 Wright, A., Pt , I, 68th April 9, Left ; circ. skin flap ; circ. sect. 918 Wliff.ley, 1 .. Pt., K, 61st Sept. 30, Right. Prison April 14. 1865. Colored Troops,age 24. 10, 65. muscles. A. Surg. B. F. Lyford, N. ( ar.)lina, age 23. 30, 64. 68th 0. T. Disch d June 10, 65. White. A. J..l t.,H, 155th June 22, Left; flap; erysip.; gang.; bone 961 Wright. J. C., Serg t, C, Oct. 3, Left; flap. Confed. surg. Disch d Pennsylvania, age 19. 22, 64. remov d. Disch d Nov. 10, 1864. 58th Illinois. 4, 62. April 10, 1803. . White, G.C.,Pt.,F.144th Nov. 30, Right; ant. post. flap. A. Surg. 962 Wylie, R., Pt., D, 23d July], Right. Surg. Neil!, Dickenson New York, age 40. De.2, 64. C. T. Reber, U. S. V. Disch d Penn. Militia. 2, 63. College. M. out Aug. 4, "63. Aug. 11,1865. 963 Wyse, C. F., Pt., F, 69th Sept. 17, Left ; circ. Disch d Mar. 30, 63. 921 White, J., Corp l, E, 6th May 27, Left. Surg. C. W. McMillan, 1st New Y ork. 19, 62. Tennessee, age 28. 27, 64. Tenn. Disch d May 9, 1865. 964 Y T ale, T., Corp l, H, 23d Jan. 11, Right ; flap. Surg. J. B. Sparks, 922 White,,/. M.,Pt.,A, 55th June 27, Right; circ. A. Surg. J.T. Smith, Wisconsin. 11, 63. ]9th Kentucky. Discli d March Illinois. 27, 64. ;5th 111. Disch d June 6, 1865. 7, 1863. 923 WhitfJ . P., Pt., A, 20th July 1, Left. Surg. Bisscll, C. S. A. 965 Yatton, G. W., Pt., D, April 2, Right ; flap. Surg. O. S. Cope- N. Carolina, age 21. 2, 63. Exchanged. 10th N.Y. Heavy Art., 2, 65. land, 10th N. Y. Art y. Discli d 924 Whitlock, R.,Pt.,G, llth Sept. 13, Left. Disch d Dec. 31, 62. Died age 23. Oct. 3, 1865. Connecticut. 13. 62. of apoplexy Dec. 16, 1864. 966 Yeager, B., Pt., A, 9th May 6, Left ; circ.; bone rem d. Discli d 925 Whitner, P. W., Pt., A, Julyl Left. Exchanged Nov. 12, 1863. New Jersey, age 21. 6, r 64. Feb. 25, 1865. Spec. 2972. 12th N. C., age 24. 1, 63. 967 Yeiser, J., Pt., F, lOtb. Nov. 25. Right; circ. Surg. R. J. Mohr, 926 Whitney, J. F., Corp l, Mar. 16, Left; circ. Surg.A. Wilson, 113th Iowa. 25, 63. 10th Iowa. Discli d Nov. 23, 64. C, 14th Mich., age 21. 16, 65. Ohio. Disch d June 25, 1865. 968 Yemmans, F.,Pt., B, 8th Nov. 25, Left. Confed. surg. Gang. Mar. 927 Whitney, W. E., Pt., I, Dec 13, Left: circ. flap. Surg. J. Avcry, Mich. Cavalry, age 32. 25, 64. 26, 65, reamp.; circ.; mid. third. 21st Mich., age 53. 13, 64. 21st Mich. Disch d June 16, 65. Dr. S. L. Norris, Saugatuck. :- \Vhittingham, A. .Serg t, Sept. 17, Left. Disch d December 31, 62. Disch d June 10,1865. E. 28th Penn. 17, 62. 969 Young, A. L., Corp l, F, July 20, Left ; flap. DiscU d July 28, 65. 929 Wicks, B., Pt., A, 89th Sept. 17, Left; flap. Surg. T. H. Squire, 46th Penn., age 24. 21, 64. N. Y., nge 20. 19, 62. 89th N. Y. Disch d Feb. 2.!, 63. 970 Young, G., Serg t.G, 8th June 17, Left ; circ. Surg.W. B. Fox, 8th 130 Wifff/x, J. T.,Pt., 1, 16th April 7, Left; circ. Released June 14, 65. Michigan, ago 23. 17, 64. Mich. Gang. Disch. June 9, 65. N. Carolina, age 23. 7, 65. 971 Young, L., Corp l, F,81st July 22, Right ; flap. Surg. W. C. Jacobs, 931 Wir/inton. J. T., Pt., K, Sept. 1, Left ; circ. Surg. Wilson, 28th Ohio, age 22. 22, 64. 81st Ohio. Disch d Feb. 17, V5 28th Tennessee, age 18. 1, 64. Teun. Pro. Mar. Nov. 16, 1864. 972 Zahnizer, M. B., Pt., B, May 12, Right; circ.; gangrene. Discli d 932 Wiley. W. A., Colonel, Nov. 25. Left. Discli d June 7. 1864. Maj. 140th Penn., age 21. 12," 64. July 4, 1865. 41st Ohio. 25, 63. V. R.C.April 19,1865. 973 Zimmerman, II., Pt., E, Aug. 24, Left; flap. Surg. .T.A.C oiningtcn, 933 Williams, B., Pt., E, 6th Feb. 11, Left ; circ. A. Surg. 11 C. Merry- llth Indiana, age 18. 24, 64. 1 1th Ind. Discli d Mar. 20. 65 Colored Troops. 11, 65. weather. 5th Colored Troops. 974 Abrams, L., P1..D, 158th April 2, R t ; flap. Surg.I LC. Lovensalcr, Disch d July 25, 1865. New York, age 30. 2, 65. 8th Me. Died June 5, 65; irri 934 Williams, E. C., Pt., D, Mar. 16, Kip-lit; circ. (Skey s operation.) tative fever. 3d Wis., age 23. 16, 65. D.sch d Sept. 1, 1865. 975 Aiken, W., Pt., G, 105th May 2, Right. Died June 9, 1663. 935 Williams, E. S., Pt., H, July 1, Right ; circ. Disch d December Pennsylvania. 2, 63. 2d Wis., age 23. 2, 63. 1, 1863. 976 Albert, G., Pt., A, 27th July 30, Left; circ. Surg.W.C. Shurlnek, 9C6 Williams, G. J., Corp l, May], Left ; flap. Surg. J. Pomerene, Michigan, age 30. 30, 64. 51st Penn. Died Aug. 27, 64 ; B, 42d Ohio. 1, 63. 42d Ohio. Disch d Oct. 29, 1 863. exhaustion. 937 Williams, J., Pt., C, 1st Feb. 22, Left; ant. post. flap. Surg. A. J. 977 Alderson, B.,Pt.,E, lllth July 22, Left. Surg. A. C. Messenger, 57th Infantry, age 28. 22, 65. H. Buzzell, 3d N. H. Discli d Illinois. 22, 64. Ohio. Died Aug. 14, 1864. Sept. 22, 186;,. 978 Aldinger, C., Pt., E, 7th Dec. 13, Right. Surg. C. S. Wood, 66th 938 Williams, T. II., Corp l, July 3, Left; double flap. Surg. J. A. New York. 13, 62. N. Y. Died Dec. 28, 1862. E, 13th New Jersey. 3, 63. Freeman. 13th N. J. Discli d 979 Alexander, A. C., Pt., H, Dec. 13, Right; (also other wounds;) flap. Nov. 7, 63. Died May 16. 70. 64l h Ohio, age 20. 13, 64. Surgeon J. II. Hutchison, 15th 939 Williamson,.!. J., Lieut., June 3, Right ; circ. Surg. J.W.Wishart, Mich. Died Dec. 13, 1864. B, 2d New York Art y, 3, 64. 140th Penn. Nee. bone remov d. 980 Alexander, N. A., Pt.,A, Sept. 19, Left. Surg. J.G.F. Holston, U.S. age 30. Disch d Fob 25. 1865. 5th.Iowa, age 23. 19, 62. V. Died Sept. 29, 1862. 940 Wilkersnn. W. U., Lieut., May 10, . Surg. Graves, 44th Va. 981 Allen, D., Serg t, G, 4th May 5, Left ; flap. Died June 0, 1864. G, 44th Virginia. 11, 64. Recovery. Maine, age 21. 5, 64. 941 Wilkins.J.,C rp l,L,14th Aug. 19. Ri.fflit : circ. Surg.W. V. White. 982 Alien, G., Pt, H, 12th June 5, Right. Surg. J. Spvcgelhalter, N. Y. H. A., age 33. 20, 64. 57th Mass. Disch d May 30, 05. I Missouri. 5, 63. 12th Mo. Died June 25, 1863. SECT. III.J PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 257 No-. NAMK. MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, IlESULT. NO NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 983 Allen, E.S.,Serg t,D,3d July 2, Left. Died Aug. 7, 1863; ha?m. 1021. Bebout, L.,S gt,D,140th June 3. Left ; circ. Surg. J. W. Wishart, Maine, age 3ti. 3, 63. Fenn., age 32. 3, 64. 140th Penn. Died Oct. 8, 64 ; 984? Allen, S., 1 t., G, 59th June i7, Both. Died June 27, 1864. disease of stomach. !i8r,J Mass., age 19. 17, 64. 1030 Bechtell, D. R., Ft., B, June 18, Right. Died July 16, 1864. 986 Almon. H . J., Ft., F, 5th May 8, Left ; circ.; slough.; baem. recur 21st Penn., age 23. 18, "64. North Carolina. 8, 64. rent. Died May 24, (i4 ; exh u. 1031 Bechtolt, F., Ft., G, 54th July 3, Left. A. Surg. C. B. Richards, 987 Alpen, H., Ft., F, 20th May :iO, Left. Died June 14, 1864. Ohio. 3, 64. 30th Ohio. Died Aug. :.8. 64. Massachusetts. , 64. 1032 Beck, C., Ft., D, 29th July 28, Left; circ. Surg. A.-K. 1 ifield, 988 Alsop, Vv ., Ft., F, 33d June 25, Right. Surg. J. Bennett, ICth Ohio. 28, 64. 2Cth Ohio. Died Sept. 16, 64. Indiana. 25, 64. Hiich. Died July 3, 1864. 1033 Beck, G. W., Pt., C, 21st June , Left. Surg. A. L. Cox, U. S. V. 989 Alva, J., Corp l, F, 13th Oct. 1, Right. Died Nov. 5, 1864 ; chr. Illinois. , 64. Died June 24, 1864. Ohio Cav., age 21. 1, 64. diarrhoea and wounds. 103-1 Bcckman, W. W., Serg t, June 16, Right : circular. Died June 25, 990 Anderson, J. B., Ft., II, June 20, Lett. Surg C. J. Walton, 21st D, 27th S. C., age 33. 16, 64. 1864 ; pyaemia. 81st Indiana, age 33. 20, ti4. Ky. Died July 1, 1864. 1035 Beckwith, C. J., Ft., C, June 14. Right. Died June 26, 1863. 991 Anderson, .J. 8., 1 t., A, July 18, Right. Died August 11, 1864. 26th Connecticut. 14, 63. 123d Ohio, age 22. , 64. 1036 Becker, J. J.,Pt.,K,89th June 27. Left. Died July 22, 1864. 992 A nder.ton, J. H., Corp l, Nov. 29, Left. Surg. A. M.Wilder.U.S.V. Ohio. 27, 64. 11, 59th Georgia. 2!>, 63. Died December 12, 1863. 1037 Belcher, F., Ft., B, 49th May 27, Right. Died June 10, 63: diph 993 Andrews, J., Pt., D, llth Sept. 1 9, Right ; circ. Died Sept. 28, 64 ; Mass., age 20. 27, 63. theria. Vermont. 19. 64. gen l depress n ol nerv s system. 1038 Bell, H.,Pt.,I, 36thCol d Sept. 29, . Died October 15, 1864. 994 Andrews, J., Capt., D, May 27, ; flap. Surg. W. R. March, Troops. 29, 64. 66th Illinois. 27, 64. 2d Iowa. IliBin. Died June 2:!, 1039 Bell, R. H., Capt,, F, 7th Way 7, Left ; ha^m.; lig. femoral. Died 1864; pyaemia. N. Y. H. A., age 37. -, f 64. June 24, 1864; exhaustion. 995 Anglen, T. R., Pt., D, July 3, . Died October 8, 1863; chr. 1040 Benedict, A., Serg t, A, May 14, Left. Died May 20, 1864. 38th Virginia. 3, 63. diarrhoea. 104th Illinois. 14, 64. 996 Antonio, J., Ft., A, llth June 6, Right : ant. post. flap. Died June 1041 Bennett, T., Ft.,F, 199th April 9, Left: circ. Surg. G. DeLandre, Conn., age 31. 6, 64. 14, 1864 ; exhaustion. Pennsylvania. 9, 65. 158th N. Y. Died May 29, 65. 997 Argo, J E., , H, 1st Sept. 14, . Injured end of stump, caus 1042 Benton, G.M., Lieut., B, Oct. 19. Right. Confed. surg. Died Nov. Georgia. 15, 62. ing slough. Died Oct. 16, 1862. 12th Conn. 19, 64. 4, 1864; general depression. 998 Armond, F., Ft., D, 1st May 18, Right. Died May 30, 1864 ; py- 1043 Berry, E. P., Capt., E, July 2, Left. July 8, haem. Died same Delaware, age 39. 18, 64. aeuila. Sth N. Jersey, age 24. 3, 63. day. 999 Armstrong, F.,.Serg t.A, June 3, Left: flap: ha?m.; lig.; haem. rec d. 1044 Betts, J. S., Pt., F, 40th Nov. 26. Left : ant. post. flap. Surg. H. 58th Mass., age 30. 3. 64. Died July 18, 1864; exhaustion. New York, age 22. 26, 63. F. Lyster, 5th Mich. Died Dec. 1000 Armstrong, J.. Serg t, M, June 18, Right; ciro. Died July 11, 64 ; 17, 1863; pyaemia. 21st Fenn. Cav., age 28. 18, 64. pyasmia. 1045 Bibbs, W. J., Pt., G, 32d May 15, Right ; circ. Ass t Surg. W. F. 1001 Armstrong, S., 1 t., G, 2d June 18, Left. Died June 29, 1864. Tenn., age 35. 16, 64. Smith, 28th Penn. Gang.; lig. Mich., age 45. 18, 64. femoral on face of stump. Died P OS ATmstronn T. H. Pt. D Aug. 18, 7th S. Carolina Cav. l9, 64. SC.Cav. Died Oct. 9, 1864. 1046 Biddle, G. C., Ft., C, April 2, Right : ant. post. flap. Surg. W. 1003 Arnich, M., Ft., K, 2COth Mar. 25, . Died March 29, 1865. 205th Fenn., age 25. 3, 65. O. McDonald, U. S. V. Died Pennsylvania. 25, 65. April 25, 65; pyaem. Spec. 4159. 1004 Atwoori, H. W., Corp l, May 27, Right. Surg. J. W. Hastings, 1047 Biddle, H., Corporal, C, Oct. 27, Right. Died January 28, 1865. C, 105th Illinois. 27, 64. 33d Mass. Died June 4, 1864. 148th Pennsylvania. 27, 64. 1005 Austin, 11. K. N., Serg t, June 1, Left; circ. -Died June 30, 1864; 1048 Bigalow, C., Pt., E, 17th May 5, Left; flap; gastric irritability. E,9thN.Y.H.A.,age35. 3, 64. pyaemia. Infantry, age 16. -, 64. Died May 30, 1864. i006 Bailey, H., Corp l, 13,39th May 20, Right. Died June 11, 64 ; pyaem. 1049 Birmingham. A. .Lieut., Dec. 13, Right; (amputa. left ankle joint.) Illinois, age 27. 20, 64. A, 69th New York. 13, 62. Died December 17, 18(12. 1007 Buines, J. A., Pt.,G, 55th July 22, Left: flap. Act. Staff Surg.C.B. 1050 Bishop, L., Sergeant, C, July 1, Left. Died July 31, 1863. Illinois, age 25. 23, 64. Richards, U. S. A. Died July 154th New York. t, *63. 25, 1864. 1051 Bitter, L., Ft.. B, 180tb Dec. 7, Right. Ass t Surg. J. W. Reed, 1008 Baker, C., Ft., 12th Wis Oct. 5, Left. A. Surg. J. J. Whitney, Ohio. 7, 64. 115th Ohio. Died Dec. 9, 1864. consin Battery. 5, 64. 18th Wis. Died Oct. 15, 1864. 1052 Blackburn, J., Pt., E, July 9, Left; circ. A. A. Surg. W. S. 1009 Bamberker, J., Pt., F, 2d Sept. 19, Left. Died October 25, 1863. 138th Penn., age 35. 11, 64. Adams. Haem. recurrent. Died Missouri. 19, 63. Sept. 1, 1864 : ha?m. and exh n. 1010 Banks, E. M.,Pt.,H, IGth Dec. 13, Left. Died December 16, 1862. Specs. 3882, 3848, 3980. Maine. 13, 62. 1053 Blackwell. E.,Pt.,F,13th Dec. 15, Right; flap. A. A. Surg. J. S. 1011 Banning, L., Ft., A,122d Sept. 19, Left. Died October 12, 1864 ; ex Colored Troops, age 24. 16, 64. Giltner. Died Dec. 27, 1864. New York. 19, 64. haustion. 1054 Blauchard.W., Captain, Nov. 27, Left. Surg. S. C. Plummer, 13th L012 Barbour, S.V., Ft., E. 9th Oct. 19, Left ; ant. post. flap. Surg. G. T. K, 13th Illinois. 27, 63. 111. Died Dec. 4, 1863. N. Y. H. Art ry, age 28. 20, 64. Stevens, 77th N. Y. Haem. fatal 1055 Blaney, J. W., Ft., E, Dec. 13, . Died December , 1862. before discovery, Oct. 27, 1864. 7th West Virginia. 13, 62. 1013 Barclay, W. II., Lieut., June 3, Right ; circ. Surg. G. L. Potter, 1056 Blett, D., Lieut., F, 1st May 8, Right ; circ. Surg. J. J. Comfort, K, 7th N. Y., age 23. 5, 64. ]45th Penn. Oozing of blood; Fenn. Rifles, age 35. 9, 64. 1st Penn. Rifles. Died June 30, diair. Died July 6, 64 ; exh n. 1864; pyaemia. 1014 Barker, J., Ft., I, 58th June 17, Right ; (amputa. left knee joint.) 1057 Bodley, E., Pt., B, 39th Sept. 19, Left; flap. Surg.A.M.McMahon, Mass., age 42. 17, 64. Died June 28, 1864. Indiana, age 28. 19, 63. 64th Ohio. Sept. 28, 63, haem.; 1015 Barnes, C., Pt., D, 40th May 5, Right ; haem. June 17, lig. fein. lig. fem., fatal six hours after. New York, age 21. 6, 64. Died June 19, 1864. 1058 Bohrer, T., Serg t, I, April 13. . Died April 14, 1863. 1016 Barnes, H., Pt., II, 14th Sept. 17, Right. Died October 7, 1862. 159th New York. 13, 63. Indiana. 17, 62. 1059 Bond, R., Ft., A, 24th Aug. 14, Left; circ. A. A. Surg. S. J. 1017 Barnes, J. M., Corp l, A, Aug. 6, Right : circ. Surg. C. S. Frink, Mass., age 28. 16, 64. Holley. Died Sept. 2, 64 ; irri 12th Kentucky, age 31. 6, 64. U.S.V. Died Nov. 14, 64 ; exh n. tative fever. 1018 Barnes, . W-, Pt., H, July . ), Right. Died August 2, 1863. 1060 Bonhauui, A., Pt., F, June 18, Right. Died Aug. 7, 64 ; exh n. 140th Penn. 3, fe. 143d Penn., age 43. 18. 64. 1019 Barnett, P., Ft., F, 3d June 18, Left. Surg. C. N. Chamberlain, 1061 Bonneberg, J., Ft., E, Dec. 29, . Died January 14, 1863. Delaware. 18, 64. U. S. V. Died July 1, 1964. 12th Missouri. 29, 62. 1020 Barringer, F., Ft., E, June 16, Right; lat. flap. Surg. J. W. 1062 Bonyea,R.,Pt.,F. 118th June 3, Left : circ.; haem. Died July 8, 140th Penn., age 18. 18, 64. Wishart, 140th Fenn. Died July New York, age 33. 3, 64. 1864; pyaemia. Spec. 2930. 15, 1864. 1063 Boughton, J. It., Corp l, Sept. 19, Right ; flap. Died Oct. 20, 1864 ; 1021 Bartlett, M., Ft., G, 10th Sept. 17, Right. Died November 6, 1862. E, 2d Conn. H. Art ry. 19, 4. exhaustion. Maine. 17, 62. 1064 Boutwell, R. T., Ft., B, May 12, Left. Died May 12, 1864. 1022 Bass, W. L., Ft., K, 6th May 16, ; flap. Died July 30, 1864. 4th Vermont. 12, 64. Georgia. 17, 64. 1065 Bowman, H. M., Ft., II, Nov. 3, Left, Surg. J. S. McGrew, 83d 1023 Battee, P., Sergeant, B, Sept. 1, Left. Died September 4, 1864. 60th Ind.. age 21. 3, 63. Ohio. Died Feb. 1, 1864. 76th Ohio. 1, 64. 1066 Boyd, W. A.,Maj., 84th May 7, Left. Ass t Surg. H. Kirby. 84th 1024 Battles, T., Pt., , 3Gth Nov. 25, Right ; flap. Surg.A.Sabine, 76th Indiana, age 37. 7, 64. Ind. Died July 11. 1864. Alabama. 25, 63. Ohio. Died Nov. 26, 1863. 1067 Boyle, M., Pt., D, 1st Dec. 13. Right. Died Dec. 31, 1862 ; py 1025 Beach, J. T., Adj t, 5th May 4, ; pneumonia ; pyaemia. Died Delaware. 13, 62. aemia and tetanus. Louisiana. 5. V 63. May 28, 1863. 1068 Boyles, T. R., Ft., D, June 18, Right. Died June 19, 1864. 1026 Beard, H., Ft., F, 46th July 20, Left; (also w nd of face.) Died 187th Pennsylvania. 18, 64. Pennsylvania. 20, 64. October 17, 18C4. 1069 Bradford, J. M., Ft., B, Feb. 6, Left. Died February 17, 1865. 1027 Beaty, "S., Pt., B, 30th June 16, Left ; double flap. A . Surg. C. B. Kith Michigan. 6, 65. Ohio, age 44. 16, 64. Richards, 30th Ohio. Died June 1070 Bradford. W. II., Ft., A, June 17, Left : circ. Surg. W. B. Fox, 8th 16, 64 ; shock and loss of blood. 38th Wisconsin, age 26. 17, 64. Mich. Died June 25, 1864. 1028 Bebout, B., Corp l, D, July 2, . Died August 9, 1863. 1071 Bradley, P., Serg t, C, Aug. 21, Left; (also amp. right leg.) Died 140th Penn. -, 63. 16th Michigan. 21, 64. Sept. 16, 1864. SURG. 11133 258 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. KO. NAME, MILITARY DESCRIPTION, AND AGK. DATES. ( M EUATIOXS, Ol KKATOUS, RESULT. No. NAME, MILITAKV DESCIiU TION, ANP AGE. DATES. OPERATION S, Ol EUATOUS, RESULT. 1072 Brand, A. , Serg t, K, 21st 8. C., age 30. May 10, 18, 64. Left; flap; slough g bone exp d. Died June 1, 1864. 1115 Campbell, B.,Pt., A, 81st Ohio. Aug. 25, 25, 64. Left. Surg. J. Pogue, 66th 111. Died Oct. 19, 1864. 1073 Brandnhaw, H. If., Pt., July 3, Died. 1116 Campbell, S. G., 1 t., F, May 31, Lel t ; circ. June 20. haem ; 21, lig. G, 7th Tennessee. 3, 63. 58th Virginia, age 31. Je. 1, 64. Died June 23, 64 ; pyaemia. 1074 Brause, A. D., Pt., II, Sept. 19. Uight ; circ.; pvii inic symptoms. 1117 Camphor, L., Pt., G,4th Sept. 29, . Died October 27, 1864. 49th Peun., age 20. 19, 64. Died Nov. 19," 1864. I Colored Troops. 29, 64. 1075 Bremer, E., Pt., A, 3i)th Feb. C, Left ; flap. Surg. A. N. Dough 1118 Capen, S. L.,Pt.,B.207th April 2, Right. Died April 14, 1865. New York, age 29. 8, G4. erty, II. S. V. Stump diseased. Penn., age 22. 2, 65. Died June 1, 64. Spec. 2043. 1119 Carey, O., Pt., E, 86th May 24, Left: diarrhoea. Died June 2, 107(i Brewer. J. S., Corp l, A, Oet. 19, . Died November 8, 1804. Xew York, age 21. 24, 64. 1864 ; pyaemia. 20th .South Carolina. 19, M. 1120 Carlin, J., Pt., C, 41st Nov. 25, Left. Died December 9, 1803. 1077 lirickley. P., Pt., B, (itli Mav 14, Uight. Surg. D. L. Heath, 23d Ohio. 25, 63. Tennessee. 14/64. Mich. Died July 28. 1864. 1121 Carlton, R. B., Pt., F, Mav 5, Right ; ant. post. flap. Died May 1076 Brigys, 31. IK., Pt., C, Lel t. Died July 19, 1862. 3d Vermont, age 22. C, 64. 20, 1864 ; pyaemia. 24th Virginia. 1122 Carmer, D., Corp 1, L, Aug. 19, Left. Surg. T. F. Oakcs. 56th 1079 Brihm, J., Recruit, age Aug. 26, Right : circ. Surg. G. L. Sutton, 14th N.Y.H.A., agu!9. 19, 64. Mass. Died Sept. 13, 1864. 38. 26, 64. I). S. V. Gangrene. Died Oct. 1123 Carnahan, J. A., Pt., K, Sept. 1, Left. Died Oct. 4, 1864 ; chronic 8. 1864. 10th Michigan. 1, 64. diarrhoea. 1080 Broomeling. T., Pt., C, July 9, Lett; circ. A.A.Surg.G.M.Paul- 1124 Carney, J.. Pt., F, 155th June 3, Right : lateral flap. Died June 106th N. York, age 24. 10, 64. lin. Gangrene. Died August Xew York, age 35. 3, 64. 13, 1864. 11. 1861; diphtheria. 1125 Carpenter, J. M., Pt., C, July 20, Left. Died July 21, 1864. 1081 Brown, W. II. II., Lt. July 20, Uight. Died .Septembers, 1804. 33d Indiana. 20/04. Col., 61st Ohio. , 64. 1126 Carroll. J., Pt., A, 20th Dec. 13, Right. Died January 1 5, 1863 ; 1082 Brown, H. Z., Pt., F. 1st .June 18, . Died June 20, 1864. Massachusetts. 13, 62. pyaemia. Mass. H. A., age 29. 18, 64. 1127 Carroll, W., Pt., H,66th May 28, . Surg. W. F. Cady, 12th 1083 Brown, J. F., Lieut., F, Mav 12, Right ; flap : erj sipelatous. Died Illinois. 28, 64. 111. Died June 15/64 ; pyannia. 147th N. Y.. nge 29. 12, 64. J uly 14/64 ; exh n. Spec. 3573. 1128 Carter, C.S.,Pt.,D, 50th Mav 12, Right. Mav 20, ha;m.; lig. fern. 1C84 Brown, J. \V., 1 t., K, July 3, Right. Died July , 1863. Penn.. age 22. , 64. Died June 3, 1804. 3d Michigan. 3, 63. 1129 Casey. T., Serg t-Major, Sept. 19, Left. Died Oct. 4, 1863; pyaemia. 1085 Brown, O. S., Serg t, F, July 3, -. Died July 29, 1863. 51st Illinois. 21, 63. 145th Pennsylvania. 3, 63. 1130 Cassidy, M., Pt.,C,90th June 14, Left. A. A. Surg. Kendall, 1086 Bryant, D., Pt., C, 19th Sept. 17, Right. Died October 8, 1862. Xew York. , 63. U. S. N. Died June 22. 1863. Massachusetts. 17, 62. 1131 Causei/, B. F., Pt., F, Nov. 29, Left : lateral flap. Died March 8, 1087 Bryant, J. C., Pt.. B, April 0, Left ; flap. Died April 28, 1865 ; 30th Georgia, age 21. 30, 64. 1865; exhaustion. 18th Georgia, age 29. 7, 65. exhaustion. 1132 Cave, R.. Pt., F, 8th Aug. !, L t ; circ. A. A. Surg. C. Carvallo. 1088 Buchanan, A, Corp l, K, May 12, Left; long ant. flap. Surg. J. F. Illinois Cav.. age 29. 3, 63. Died Aug. 20. 1863. Spec. 1077. 19th Mass.. age 28. 13, 64. Dyer.19th.Mass. DiedJe. 2, 64. 1133 Certain, W. R., Pt., II, June 1, . Surg. C. B. Gibson, C. S. A. 1080 Bump, J., Pt., M, 8th X. June 3, Right ; circ. Surg. S. H. Plumb, 47th North Carolina. I, 64. Died June 12, 1804 ; exhaustion. York Art y, age 18. 3, 64. 8Jd N. Y. Died July 7, 1864 ; 1134 Chancellor. II. C., jr., July 3. Left. Died Aug. 5, 1863. pyaemia. Lieut , B, 150th I enn. 3, 63. 1090 Bunting, J. M., Pt., B, Nov. 29, Left. Surg. X. A. Hursam, 17th 1135 Chandler. W. S. J., Pt., July 3, Right. Died July 9, 1863. 9l>th Pennsylvania. 29, 64. Me. Died Dec. 5, 64. .Spec. 4119. A, 1st Maryland. 4, 63. 1091 Burbank, W. II., Lieut., June , Right. Died June 10, 1864. 1136 Cheever,W.!Pt.,A, 30th Oct. 19, Right ; ant. post flap. Died Xov. 58th Alassachusotts. , 64. Mass.. ago 28. 21, 64. 24, 1864 ; pyaemia. 1092 Burdy, T., Pt., K, 71st June 29, Right ; ulcer, dead bone exp d. 1137 Churchill, W.H., Serg t, Oct. 27, Right ; circ. Died Xov. 7, 1864 ; Pennsylvania. 2! , 62. Nov. 29, reamp. six ins. higher. H, 2d U. S. S. S. , 64. wounds. A. A. Surg. R. P. Thomas. 1138 Clark. G.H., Serg t, I, 2d June 5, Left: ant. post. flap. Surg. G. Died Dec. 12, 1862; pyaemia. N.Y. H.Art ry, age 32. 6, 64. L. Potter, 145th I enn. Typhoid 1093 Biirfell, L.,Pt.,L>, 118th May 14, Right. Died July 30, 1864. fever. Died July 20. 1864. Ohio. 14, 64. 1139 Clark, G. F., Pt., A, May 15, Right. Surg. C. 11. Lord, 102d 1094 Burghart, C. H., Lieut., April 2, Left : flap. Surg. G. B. Parker, 149th Xew York. 15, 64. Xew York. Died May 23, 04. K, 4th New York Il vy 2, 65. U. S. V. Died April 17, 1865; 1140 Clark, J.. Pt., A, 83d April 9, Right ; flap. Died May 4, 1805 ; Artillery, age 20. result of wound. Ohio, age 18. 9, 65. pvasmia. 109:. Biirgin, f. if., Serg t, Oet. 19, ; circ.; bone exposed. Died 1141 Clark, J., Pt., 13th Xew July 20, Left. Died August 22, 18<i4. H. oth Ala., nge 24. 19, 64. November 28, 1864; pyaemia. York Battery. 20, 64. 1090 Hurley, W.. Pt., K, 7:id Oct. 28, Lei t ; circular; gangrene. Died 1142 Clark, J., Pt., , 38th July 3, . Died. Ohio, age 40. 30, 63. November 1, 1863. North Carolina. 3, 63. 1097 Burke, V., It., H, 1st June 17, Left; flap. A. A. Surg. W. S. 1143 Clark. J. L., Serg t, G, May 28, Right; doll, skin flap; sloughed. Mich., age 30. 19. 64. Forbes. Died July 25, 64 ; pyae. 5th S. C. Cav., age 27. 29, 64. Died June 18. 18fi4 ; pyaemia. "-- Burmastcr, J., Pt., 1), Sept. 19, Right. Died October 8, 1863. 1144 Clark. S. F., Serg\ D, Deo. 13, ; flap. Died December 30, 88th Illinois. 19, 63. 1st Massachusetts. 13, 62. 1802. 1099 Bums, P.. Pt., C, 5th Aug. 20, . Died August 25, 1864. 1145 Clark, W. D., Pt., A, 3d Mav 8, Right ; femur, protrud. and cxfol. New York. 20, 64. Xew Jersey, ago 26. 8, 64. Died Juno 25, 04 ; pyaemia. 1100 Burns, P., Pt., E, 15th Aug. 10, Right. Died August 17, 1864. 1146 Cleaveland, J.F.,Pt.,G, Dec. 13, Left; flap. Dec. 30, litcm.; fern. Infantry. , 64. 16th Maine, ago 25. 14, 62. ligated. Died Dec. 31, 18(i2; 1101 Burns, K., Pt., A, 23d April 2, Right ; flap. Surg. J. S. Taylor, exhaustion. Illinois. 2, 65. 23d Illinois. Died April 4" 65. 1147 dough, J. E., Pt.. B, April 1, Left ; oval ant. post. flap. Surg. 1102 Burr, T , PL, K, 112th June 3, Right. Died June 20, 1864. llth Mass., age 50. 2, 65. II. F. Lyster, 5th Mich. Diarr.. New York, age 33. 3, 64. phlebitis, slough. Died April 1103 Bush, J., Corp l, F, 90th June 14, Right. Surg. E. S. Hoffman. 90th 23, 1865; exhaustion. New York. 14, 63. N. Y. Died June 24, 1863. 1148 Cobaugh, J., Pt., A, 10th Mav 6, Right. Surg. B. Rohrer, 10th 1104 Buslinell. O.. I t., A, Juno 4, Right. Died June 14, 1864. Penn. Reserves. 6, 64. Penn. Res/ Died May 19, 1864. 101st Illinois. 4. 64. 1149 Coffee, J., Pt., E, 69th Sept. 17, Right; circ. A. A. Surg. A. V. 1105 Butcher, J., Serg t, F, June 17, Left; oval flap. Surg. W.B. Fox, Xew York. 17, 62. Cherbonm er. Prot. fern, rem d; 37th Wis., age 45. 17, 64. 8th Mich. Died June 25, 1864. necrosed. Died Jan. 28, 18(i3. 1106 Butler, L., Pt.. B, 181st Dec. 7, Right; circ. A. Surg. J.W. Reed, 1150 Cogswell, W. H., Lieut., Sept. 19, Left; circular. Died October 7, Ohio, age 43. 7, 64. 1 15th Ohio. Died Dec. 9, 1864 ; B, 2d Connecticut. 19, 64. 1804 ; exhaustion. exhaustion. 1151 Cole. C., Pt., II, 124th Mar. 10, Right; circ. Died April 19, 65. 1107 Butler, J. N., Pt., C, 1st Dec. , Left. Died January 5, 1865. Indiana, age 20. 10, 65. Georgia, age 41. 64, 1152 Cole, W., Corp l, G, 5th July 2, Left; haemorrhage. Died July 11C8 Byers, J. II., Pt., G, 35th May 14, Right, Surg. J. B. Rice, 72d Michigan. 2, 63. 13, 1803. Iowa. 14, 63. Ohio. Died. 1153 Cone, C. C., Lieut., 1, Sept. 29, Left. Died October 22, 1864 ; 1109 Byrne, W., Corp l, F, Mav 9, Left ; colliquative diarrh. Died SthCol dTr ps, age 21. 29, 64. exhaustion. (iOth Ohio, age 19. 9, 64. May 22. 1864. 1154 Sept. 17, Right. Died October 10, 1862. 1110 Cahill, J.. Ft., K, 170th Mav 24, Left ; phlcg. ervsip. Died July Pennsylvania. 17, 02. Xew York, age 43. , 64. 3, 1864. 1155 Connor. D. C., Pt., C, Dee. 16, Left: flap. A. Surg. It. J. Hill 1111 Cathoun. C. H., Lieut., Mav 3, Right ; ant. post. flap. Died May 9()th Ohio, age 21. 1C, 64. 45th Ohio. Died Jan. 11. 1865. F. 5th Va.. age 21. 4, 63. 8. 1863; hemorrhage. 1J56 Converse. I). B., Pt., G, June 4, Left. A. Surg. G. M. Trowbridge, 1112 Caiman, E F..!Scrg t, E, Aug. 25, R t ; circ. A. Surg. T. C. Smith, 129th Illinois. 4, 64. 19th Mich. Died Sept. 4, 1804. 5th N. Y. H. A., age -J9. _ 7.~ ( A. 110th Ohio. Died Sept. 1, 1864. 1157 Conway. R., Pt., F, 30th Jan. 11, Right. Died February 1H, 1803. 1113 Cameron. D. II.. l j t., C, Mar. 14 Right ; circ. Surg. G. Derby, 23d Iowa, age 18. 11, 63. 4th Rhode Island. 14, 62. Mass. April 5, haein.; lig. fern. 1158 Cook, J. B., Lieut., H, May 5, Right. Died June 1, 1864,. Died April 6, 1862 ; exhaustion. 148th Penn., age 24. 5, 64. 1114 Campbell, A., Lieut.. II. Nov. 27, ; circ. Surg. J. C. Morgan, 1159 C *>k. W. />., Lieut., F, Jan. 15, Left. Died April 29, 1865. 32d Alabama. 27. (i3. 29th Missouri. Died. 21st S. C., age 36. 15, 65. 1 THOMPSON (J. H.), Wounded at the Battle of New Berne, in Am. Jted. Times, 1862, Vol. 5, p. 6. SECT. III. | PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 259 No. NAME, MILITARY DESCRIPTION, AXI> AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME. MILITARY DESCRIPTION, AND AGK. DATES. OPERATIONS, OPERATORS, RESULT. 1160 Coons, II., Pt., K, 100th Sept. 9, Right. Surg. M. S. Kittenger, 1205 Dice, .T., Pt., A, 149th May 25, Right. Died May 27, 1864. New York, uge 42. 9, <i4. 100th N. Y. Died Jan. 25, 65; New York. 25, 04. enteritis, etc. 1206 Dick, J., Pt., K, 7th N. Dec. 13, . Died December 20, 1862. lib] Cooper. 1) , Pt., D, 5ih June 5, Right: sloughing. Died July York. 13, "62. New York Anillery. 5, 04. 26, 1864. 1207 Dickensheet, D., Pt., B, Dee. 7, Right; circ. Surg. I . Harvey, 1162 Cope, W. M.. Serg t, I, July 20, Left. Died August 5, 1864. 71st Illinois, age 26. 8, 62. lyth Iowa. Sloughing: haem. 33d Mississippi. 20, 64. Died Dec. 22, 186. ; exhaustion. 1163 Oppernall, C., Pt., B, June 14, Left. Died June 29, 1863. 1208 Dickcrson, C., Corp l, C, April 1. Right. Surg. T. H. Squire. 89th 75th New York. 14, 63. 48th N. C., age 29. 1, 65. N. Y. Died May 7. 65: exh n. 1164 Corkeran. W. J , Pt., F, Right. Died April 29, 1865. 1209 Dietrich, J., Pt., H, llth Dec. 13, Right ; flap. Died Dec. 13, 1862. 56th Virginia. Pennsylvania. 13, 62. 1165 Corn. J., Pt,, K, 88th July 3, Right. Died July 9, 1863. 1210 Dingman, A. W., Pt., D, Mar. 30, Left: ant. post. flap. Surg. J. C. Pennsylvania. 3, 63. 91st N. Y., age 23. 31, 65. Hall, 6th Wis. Died April 17, 1166 Corpiue. F., Pt., H, llth Mar. 31, Right ; flap. Died April 6, 1 865 ; 1865; exhaustion. Penn. Cav., age 64. 31, 65. exhaustion. 1211 Dix, L /., Pt., D, 4th May 3, Right; ant. post, flap; slough g. 1167 Cosgruve, J. W., Serg t, Aug. 19, Right; circ. Died Sept. 1, 1864; Virginia. 5, 63. Died May 7, 1863. A. 56th Mass., age 21. 20, 64. exhaustion. 1212 Dodge, H N., Corp l, G, May 5, . Surg. G. T. Stevens, 77th 1168 Costello, C., Pt., P, 28th Sept. 17, Right. Died Sept. 23, 1862. 10th Massachusetts. 5, 64. N.Y. Died May 22, 1864. Pennsylvania. 17, T2. 1213 Doman, I , Pt., C, 198th Mar. 29, Left; circ.; erysip. Died April 1169 Comngton, J. A., Serg t, Mar. , Right. Died July 3, 1865. Penn., age 16. 29, 65. 19. 1865; pyaemia. G, 23d South Carolina. , 65. 1214 Dormoy, G., Pt., K, 75th June 27, Right, Surg. T. M. Cook, 101st 1170 Craig. J., Pt., A, 119th Mav 5, Left ; flap ; slough g. Died May Illinois. 27, 64. Ohio. Died June 30, 10C4. Pennsylvania. 5, 64. 26. 1864. 1215 Dougherty, J., Pt., D, Mav 12, . Surg.W. C. Shurliick, 51st 1171 Cramer, H., Pt., I, 21st Mar. 19, Right, Died April 4, 1865. 9th N. Hampshire. 12, 64. Penn. Died May 18, 1864. Michigan. 19, 65. 1216 Douglass, E., Pt., K, 9th Mav 12, . Surg. J. S. Ross, llth N. 1172 Cress, H.,Corp l, K, 95th Mav 6, Right; ant. post, flap; abscesses; N. Hampshire. 12/64. Hampshire. Died May 17, T>4. Penn., age 25. 7, 64. diarrhcea. Died July 8, 1864. 1217 Douglass, D., Pt., E, 9th June 1, Left ; circ.; gangrene. Died July 1173 Crews. M. A., Pt., F, 2d June 1, Right ; ha?m.; lig. femoral. Died N. Y. H. Art., age 40. 3, 64. 31, 1864 ; pyaemia. South Carolina, age 36. 3, 64. Oct. 25. 1864 ; tuberculosis. 1218 Draper, L T., Pt., E, 3d June 17, Left; flap. July 9, 11, 12, haem. 1174 Crisler. W. R.,Corp l, C, Mar. 16, Right. (Skey s operation.) Surg. Delaware, age 37. 19, C4. Died July 12, 1864. 107th New York. 16, 65. J. Chapman, 123d N. Y. Died 1219 Dudley, J.A.,Vt.,E, 58th Sept. 19, Left ; circ.; flap opened, stump ex March 17, 1865. Virginia. 19, 64. posed. Died Oct. 23, 64 : diarr. 1175 Cronan, T.. Pt., C, 149th May 25, Right. Died June 8, 1864. 1220 Dudley, A., Pt., C, 15th Aug. 7, Right. Died September 5, 1864. New York. , 64. Infantry. 7, 64. 1176 Cronin, U.. Pt., F, 59th Dec. 13, Left. Died January 18, 1863. 1221 Dueniscli, T., Pt., F,37th May 17, Left ; gangrenous. Died May 30, New York. 13, 62. Ohio. 17, 62. 1862. 1177 Crow, T., Pt., B, 86th Sept. 19, Left. Died October 29, 1863. 1222 Duncan, W. H., Pt., A, June 1, Right; gangrene. Died June 11, Indiana. 19, 63. 87th New York. 1, 62. 1862. 1178 Crulip, W. B., Pt., F, June 3, Left ; circ. Died July 10, 1864 ; 1223 Dunn, A., Pt.,H, 1st Mis April 4, Left. A. Surg.W. W. Bailey, 1st 53d Penn.. age 18. 4, 64. pyaemia. Spec. 3165. souri Cavalry. 4, 64. Mo. Cav. Died April 5, 1864. 1179 Cummings.G. P., Serg t, June 18, Right; post, flap; pyaemia. Died 1224 Dupple, S, Pt., K, 142d May 12, Right; circ. July 18,. 19, haem. K, 1st Mass Art. .age 26. 18, 64. Sept. 9, 1864. Penn., age 20. 13, 64. Died July 21 ; hoem. Spec. 2885. 1180 Cunningham, J 3 ., Pt.,H, Jan. 27, Right : circ. Surg. C. W. McMil 1225 Durant, C., Pt., D, 32d Feb. 6, Right. Died February 12, 1865. 5th Texas. 28, 64. lan. 1st E. Tenn. Died Feb. 18, Mass.. age 35. 8, 65. 1864; exhaustion. 1226 Dwire.W. J., Pt.,G, 55th May 15, Right ; (also wound of left thigh 1181 Cunningham, S., Pt., D, Dec. 4, Right : circ. Surg. H. B. John Ohio. 15, 64. and testes.) Removal of testes. 13th Indiana Cavalry, 5, 64. son. 115th O. Recurrent haem.; Died May 30, 1864. age 29. lig. fem l. Died Jan. 26, 1865. 1227 Dwyre, J., Pt., K, 176th Sept. 19, Right. Died Sept, 23, 1864. 1182 Cunningham. H. L., Cor Mav 16, Right. Surg. J. Bennett, 19th New York. 19, 64. poral, G, 22d Wis. 16/64. Mich. Died June 26, 1864. 1228 Dykeman,W., Pt,, B,5th May 11, Left; circ. Snrg. H. F. Lyster,5th 1183 Cuppernull, C. E., Pt., June 18, Left; ant. post. flap. Died Aug. Michigan, age 45. 12, 64. Mich. Died July 15, 64 ;pneum. K, 6th Wis., age 29. 19, 64. 13, 1864 ; gang., exhaustion. 1229 Eagan, J., Pt., E, 10th June 17, Left. Surg. D.W. Maull, 1st Del. 1184 Curaeh. C., Pt., D, 10th Oct. 8, Left. Died November 4, 1862. New York. 17, 64. Died July 6, 1864. Ohio. 8, 62. 1230 Eaton, J., Pt., G, 16th June 17, Left. Died July 8, 1864. 1185 Daggett.C. H.,Corp l, B. June 19, Left ; ant. post. mus. flap ; gang. Maine, age 27. 17, 64. 1st Me. II. Art., age 18. 19, 64. Died June 30, 1864 ; severity of 1231 Eaton, L., Pt., 1, 17th In June 21, Right. Surg. B. N.Bond,27th Mo. wound, etc. diana, age 18. 21, 64. Died July 16, 1864 ; haem. 1186 Dailev, B. H.. Pt., A, Dec. 15, Left; lat. flap. A. A. Surg. M. 1232 Eddie, J..Pt..K,3d Mich May 5, Left; circ. Died June 2, 1864; 18th Ohio, age 21. 15, 64. L.Herr. Gang. Died Jan. 8, 65. igan, age 23. 5, 64. pyaemia 1187 Dallsby, J. O., Pt., I, June 27, Right. Died J une 30, 1864. 1233 Edwards.G., Pt., H, 21st July 30, Right; flap. Surg. N. Y. Leet, 22d Indiana. 27, 64. Connecticut, age 20. 30, 64. 76th Penn. Died Sept. 4, 1864. 1188 Daly, J. M.. Pt., H, 40th Nov. 25, Left ; circ.; gangrene. Died Dec. 1234 Egan, J., Pt., G, 2d N.Y. Sept. 17, Right. Surg. S. N. Sherman,34th Indiana, age 22. 27, 63. 7, 1863. State Militia, age 1 8. 17, 62. N. Y. Died Sept. 25, 1862. 1189 Danforth, M., Pt., A, Sept. 13, Left. Died September 20, 1864. 1235 Eiznor, J., Pt., F, 120th Mar. 25, Right, Died April 22, 1865. 116th Ohio, age 18. 13, 64. New York. 25, 65. 1190 Darnels, B. F., Corp l, B, July 28, Left. Died August 3, 1864. 1236 Elam, S. A., Pt., A, 33d Mar. 30, Left; flap. Surg. L. Dyer, 81st 4th Louisiana. 28, 64. Wisconsin, age 26. 30, 65. 111. Died June 6, 1865 ; chronic 1191 Darrow, J.. Corp l, I, Nov. 10, . Surg. D. W. Maull, 1st diarrhosa and erysipelas. 59th New York. 10, 64. Del Died Nov. 12, 1864. 1237 Elkin, C. R., Pt., E, 22d Mav 24, Right ;circ.: missile lodged in left 1192 Daum, L.. Pt., G, 5th Aug. 20, . Died August 23, 1864. Georgia, age 22. 24 , 64. knee. Died June 19, 64; pyaem. New York. 20, 64. 1238 Ellingwood, H., Pt., K, Sept.1, Left. Died September 24, 1864. 1193 Davis, A., Pt., D, 44th May 5, Right, Died June 1, 1864. 79th Indiana. 1, 64. New York, age 23. 5, 64. 1239 Ellisou,R.,Corp l,E,86th Oct. 16, Left. Surg.H.F.Lyster.Sth Mich. 1194 Davis, H. J., Lieut., K, Mav 22, Right ; circ. Ass t Surg. H. M. New York. 16, 64. Died Oct. 25, 64. Spec. 4116. 30th Ohio, age 22. 24 ," 63. Sprague, U. S. A. Died June 1240 Emerson, H., Pt., I, 88th Nov. 30, Left; circ. A. A. Surg. J.C.Tay 5, 1863. .Spec. 1623. Illinois, age 34. De.1, 64. lor. Gang. Died Dec. 13, 1864; 1195 Davis, J. P., Pt., C,27th May 14, Left ; diarrhoea. Died June 19, irritative fever. Mass., age 34. 14, 64. 1864 ; exhaustion. 1241 EnbanJc, J. G., Pt., A, June 3, ; lat. flaps. Surg. Black, 1196 Dawley, E., Pt.,K, 19th June 25, Left. Died July 11, 1864. 51st Alabama. 3, 64. C.S.A. Died June 5, 64; exh n. Michigan. 25. 64. 1242 Estel, A., Corp l, F, 10th June 24, Left; circ. Died July 22, 1864 ; 1197 Day, C. C., Pt., A, 19th May 13, Left ; flap ; recurrent hsem. Died N. Y. Cav., age 21. 24, 64. pyaemia. Wisconsin, age 29. 13, 64. June 16, 1864. 1243 Etters, B. J., Pt., G, 51st May 9, Right ; circ. Died May 30, 1864 ; 1198 Vaii, S. M., Pt.. I, 4th May 3, Left ; circ. Died June 9, 1863. Penn., age 18. 9, 64. exhaustion. Virginia, age 18. 4, ; 63. 1244 Faber, ,1. C., Serg t, G, April 1, Left. Died May 17, 1865 ; pyaem. 1199 Dean, W., Pt., D, 10th Sept. 19, Left. Died September 30, 1862. 210th Penn., age 28. 2, 65. Missouri. 19, 62. 1245 Faehndrich, J., Ft., C, Dec. 13, Left. Supposed to have died. 1200 Dempsey . C., Pt., G, 32d May 12, Left ; circ. Died June 7, 1864 ; 52d New York. , 62. Spec. 1362. Mass., age 38. 12, 64. pyaemia. 1246 Fales, A., Pt,, F, 9th N. July 9, Right; circ. A. A. Surg. J. C. 1201 Derocher. G.. Pt, I, 1st Mav 12, Right ; flap ; femur prot. Died Y. H. A., age 20. 10, 64. Shimer. Gangrene. Died July Maine, age 23. 12, 64. February 20. 1865. 13. 1864. 1202 Det wyler, G., Pt., D. 7th June 22, Right ; flap. Died August 1, 64. 1247 Fales, J.A., Corp l, K, 3d Aug. 21, Left. Died September 21, 1864. New Jersey, age 19. 22, 64. Vermont, age 45. 21, 64. 1203 Devlin, A., Pt., H, 20th June 1, ; bone prot.; removal of bone. 1248 Farrellv,B.,Pt.,K, 100th May-17, Left. Died July 21, 1864 ; exh n. 1204 Massachusetts. Dewey, E.E., Pt.. F, 1st 1, 62. June 1, Died June 18, 1862; pyaemia. Right : circ.; gang. Died Aug. 1249 New York, age 37. Faust, P. L., Pt., A, 79th 17, 64. Aug. 10, Left ; haem.; fern, art y lig d. Died Vermont, age 31. 1, 64. 7, 1864 ; pyaniia. Penu., age 26. 10, 64. October 2. 1864. 1 260 INJURIES OF THE LOWER EXTREMITIES. | CHAP. X. NAME, MILITARY OPERATIONS, OPERATORS, Vr* NAME, MILITAUY DATES. OPERATIONS, OPERATORS, NO. DEscuirnox, AND AGE. DATES. RESULT. 1>U. DESCRIPTION, AND AGE. RESULT. 1250 Fenruson. W.. Corp l, D, Oct. 7, Left. Died December 9, 1864; 1295 Goodson, A. A., Pt., K, Sept. 19, ; circ.; haem. Oct. 20, reamp. 1st Artillery age 20. 7, 64. pyaemia. 22d N. C., age 25. 19, 64. at mid. Died Oct. 27, "64; pya?m. 1251i Ferrer, II , It., 1>, 96th Nov. 3, Left : (also wound of right knee.) 1296 Gordon, J., It., C, 1st Feb. 3, Right. Surg. A. B. Monohan, 63d Ohio, age 21 3, 63. Died Nov. 18, 1863. Michigan Artillery. 3. 65. Ohio. Died Feb. 10, 1865. 1252 Feller, 11., It., C, 9th 111. Dec. 17, Lett: circ. A. A. Surg. 11. G. 1297 Gould, J. P., Col., 59th July 30, Left : circ. Surg.W.lngalls, 59th Cavalry, age 30. 17, 64. Ludlow. Died March 13, 1865. Massachusetts. 30," 64. Mass. Died Aug. 22, 1864. 1253 Fimiughty. M., Serg t, July 2, Right; flap: biem. from femoral. 1298 Gradi/, F., It., 1), 8th N. Feb. 12, Left. Surg.C.A.Cowgill, U.S.V. G, 10th luf v, age M. 3, 63. Died July 7, 1863; exhaustion. C. Battalion. 14, 63. Died Feb. 15, 1863. 1254 Fisher, N., it., F, 22d Sept. 29, Right. Died October 30, 1864. 1299 Graves, E ., Serg t, F,37th May 5, . Surg. ( ,. T. Stevens, 77th Col d Troops, age 2. }. 2 .t, 64. Massachusetts. 5, 64. New York. Died May 26, 1 864. 1255 Fitch, M.. It., A, 14th Mar. 25, Left ; circ.; (also wounds of left 1300 Gray, K. F., Pt., G, 26th May 13, Left; flap. Surg.W. Loinax,12th New York H vy Art y. 25, 05. shoulder and thoracic parietes.) Illinois. 13, 64. Ind. Died July 5, 1864. Died May 2, 1865. 1301 Gray, H. M., Serg t, E, Dec. 7, Right ; ant. post. flap. A. Surg. 1256 Flax. S., Pt., C, 90th July 3, Lefr. Surg.C. J.Walton, 21st Ky. 37th Uinois, age 30. 9, 62. M. A. Mosher, 20th Wis. Died Ohio. 4, 64. Died Sept. 4, 1864. Dec. 17, 1862: haemorrhage. 1257 Flftcher,G.W.,Corp \,K, May 18, Left. Died August 30, 1864 ; 1302 Green, E. B., It., H,55th May 15, Right. Died June 20, 1864. 3d Arizona Cav.. age 32. 18, 64. gangrene. Ohio. 15, 64. 1258, Flood, P., It., II, 28th May 12, . Surg. P. E. Hubon, 28th 1303 Green, H. W., Serg t, D, July 20, Right. Died October 25, 1864. Massachusetts. 12, 64. Mass. Died May 16, 1864. 31st Miss. 20, 64. 1259 Ford, E. T., It., C, 121st Sept. 19, Right ; flap. Died Oct. 8, 1664 ; i:;i)4 Green, J.,Pt., B, IstR. I. July 3, Right. Surg. G. Chaddock, 7th New V ork. 19, 64. exhaustion. Artillery. 3, 63. Mich. Died July 16, 1863. 1260 Forston, W., Pt., F, 53d Oct. 5, . Died October 9, 1862. L305 Green,T.W.,lt.,F,151st July 9, R t;circ. A. A. Surg. J.C. Shimer. Indiana. 5, 62. New York, age 26. 11, %4. Died Aug. 4, 1864. Spec. 3935. i2<;i Fortuey, H., Pt., F, 12th J une 5, Left. Died June 12, 1864. 1306 Greenlee, A. F., Pt., F, July 3, . Died August 3, 1863. West Virginia. 5, 64. 140th Pennsylvania. 3, 63. 1262 Foster, J.,~ It., K, 82d Aug 7, Left Surg. C. S. Arthur, 75th 1307 Griffith, J., it., K, 5th Dec. 20, Left. Died December 24, 1863. Indiana, age 20. 7, 64. Ind. Died Feb.17, 1865: pneum. Connecticut. 20, 63. 1263 Fredcnburgb.W ,Pt., D, Sept. 17, Right. Died November ,1862. 1308 Griffith, B., Corp l, G, Dec. 31, . Died February 6, 1863. lllth 1 enn. 17, 62. 18th Ohio. 31, 62. 1264 Fredericks, D., Pt., G, Sept. 30, Left. Died Oct. 27, 1864 ; pyaem. 1309 Guillery, A., Pt,, A, Left. Died May 23, 1863. 5.*th Penn., age 42. 30, 64. Miles s Legion. 1265 French, G. W., Pt., C, July 20, Right ; lateral flap. Surg. M. W. 1310 Gwytiti, J., Pt., I, 70th Aug. 28, Right ; circ. Surg. R. Morris,103d 13th Iowa, age 26. 21, 64. Thomas, 13th Iowa. Died Nov. Ohio. 28, 64. Illinois. Died Oct. 3, 1864. 24, 1864 ; exhaustion. 1311 Hackathorn, ./., Pt., F, May 12, Left; ant. post. flap. Died June 1266 Frost. W. H., Pt., A, 32d Feb. 3. Left. Surg. A. B. Monohan, 63d 126th Ohio, age 21. 14, 64. 9, 1864 ; exhaustion. Wisconsin. 3, 65. Ohio. Died Feb. 25, 65; pyaem. 1312 Hagan, L, II, Vt, K,2:id July 1, Left. Died September 18, 1863 , 1-J67 Fullerton, A. 1?., Pt., A, Mar. 25, Left. Died April 4, 65; pyaemia. North Carolina, age 18. 2, 63. diarrhoea. 1st Vt. H. Art., age 26. 25, 65. 1313 Haines, J., Pt., E, 50th June 7, Right; circ. Surg. S. S. French, 1268 Garl, W. 0., Pt., G, 3(ith April 4, Right. Surg. S.H.Sawyers, 36th Penn., age 19. 8, 64. 20th Mich. Died June 26, 1864 ; Iowa. 4, 64. Iowa. Died April 7, 1864. exhaustion. 1269 Garland, M. H., Pt., D, June 4, Left. A. Surg. L. W. Kennedy, 1314 Haines, J. C., Pt., B, 52d July 22, Left. Died July 30, 1864. l:lth i\e\v Jersey. 4, 64. 123d N.York. Died J une 24, 64. Ohio. 22, 64. 1270 Ganiish, J., Pt., F, 8th June 3, Left ; circ. Surg. W. B. Fox, 8th 1315 Hall, J. W., Pt., G, 4th May 13, Left : long ant. flap. Died July Michigan, age 46. 3, 64. Mich. Died June 30, 1864. Michigan, age 24. 13, 64. 6, 1864 ; exhaustion. 1271 Gay, J. C., Pt., A, 7th June 1, Right. Surg. G. T. Stevens, 77th 1316 Ham, J. C., Pt., B, 87th Oct. 19, Left : ant. post. flap. Oct. 28, fern. Maine, age 37. 1, 64. N. Y. Gang. Died Dec. 26, 64. Penn., age 24. 20, 64. artery lig. Died Oct. 28, 1864 ; 1272 Gear, W., It., E, 14th Oct. 5, . Died October 7, 1862. hanmorrhage. Illinois. 5, 62. 1317 Hamrick, A., Corp l, H, May 11, Left; ant. post. flap. Died June 1273 Gentry, W. H., Pt., G, Mar. 25, Left. Surg. L.W.Bliss, 51st N. Y. 28th N. C., age 23. 11, 64. 13, 1864 ; exhaustion. 44th Virginia. C5, 65. Died April 5, 65. Spec. 4020. 1318 Hanes, E., Pt., K, 7th N. June 8, Right ; circ. Surg. G. L. Potter, 1274 George, A. 1., It., C, 4th Mar. 29, Left ; flap. Surg. W. G. Keir, 91st Y. H. A., age 20. 8, 64. 145th Penn. Died July 10, 64 ; I enn. Cav., age 29. 29, 60. I enn. Died Apr. 29, 65; pysem. pyasmia. 1275 Gerard, C., It., K, 35th Aug. 19, Left ; circ. Surg.T.F.Oakes, 56th 1319 Hankins, G. S., Pt., B, July 4, Left: (also w nd of wrist.) Died Massachusetts. 19, 64. Mass. Died Aug. 30, 1864. 142d N. York, age 20. 4, 64. July 15, 1864 : exhaustion. 1276 Geringer, J. H., Pt,, H, July , Left. Died July 28, 1863. 1320 Hardy, A., Pt., C, 140th June 16, Right, Died July 7, 1864. 1st North Carolina. , 63. New York, age 33. 16, 64. 1277 Gerry. W.H.,Pt.,H, 7th May 5, Right, Died May 22, 1862; py 1321 Hardy.G. E., It., 1, 13th Sept. 30, Right. Died Oct. 15,1864 ; morti Muss., age 30. 5, 62. aemia. N. Hampshire, age 31. Oct.1, 64. fication following amputation. 1278 Gibbons, P., It., E, 150th Oct. 27, Right : flap. Died Jan. 5, 1865 ; 1322 Harlatid, I). G., Corp l, Dec. 31, . Died January 3. 1863. I eun., age 21). 28, 64. pyaemia. B, 84th Illinois. 31, 62. 1279 Gilibs. A.. It., I, 6th C d Sept. 29, Left. Died March 12, 65; pneu 1323 Harle, B. B., Serg t, E, Sept. 30, Left. Surg. F.L.Ainsworth.U.S. Troops, age 22. 29, 64. monia and amputation. 158th N. York, age 24. 30, 64. V. Died Nov. 16, 64 ; irrita. fev. 1280 Gibney, T., It., A, 69th Sept. 17, Right. Died Dec. 22, 1862. 1324 Harper, J. L., Pt., C, 63d Feb. 18, Right. Died Feb. 28, 1865. New York. 17, 62. Indiana, 18, 65. 1281 Gibson, J. M., Corp l, A, Nov. 25, Right. Died Jan. 11, 64 ; pyaem. 1325 Harrington, T., Serg t, A, May 18, Left : circ. A. Surg.C. II. Andrus, M Kentucky, age :J4. 27, 63. 6th Mass. Cav., age 29. 20, 64. 128th N. Y. Died July 14,1865; 1282 Giddings, J. A., It., G, -May 3, Right ; circ. Died June 9. 1863 ; chronic di;irrhu?a. t!d Wisconsin, age 17 3, 63. pyaemia. Specs. 124 1 , 1 242. 1326 Harrington, W., It., B, June 14, Right. Surg.E. S. Hoffman.HOth 12?3 Gillespie, B. F., It., G, July 28, Right; circ. Act. Staff Surg. C. 90th New York. 14, 63. New York. Died Sept. 2, 1963. 30th Ohio, age 32. 28, 64. 15. Richards, U.S. A. Died Aug. 1327 Harris, H. B., Serg t, G, July 20, Right. Died July 27, 1864. It, 1864 ; empyema. 4(ith Pennsylvania. , 64. 1284 Gillespie, J. D., Serg t, April 6, Right ; circ.; luem.; diarrh. Died 1328 Harris.J. Z,.,Pt., F, 56th July 3, Left. Died July 16, 1863. K, 4Uth Penn., age 21. 7, 65. May 12, 1865; exhaustion. Virginia. 3, 63. 1285 Gi ley,C.U., It., K, 60th Dec. 13, Left. Died December 18, 1862. 1329 Ilarrison, F., Pt., M, 1st Dec. 24, . Died December 31, 1862. Georgia. 13, 62. Texas Legion. 25, 62. 1236 Gillmore, R., Pt., F, 91st Mar. 31, Right ; ant. post, flaps. Died May 1330 Harry, L., Pt., I, 147th Dec. 19, Right. Died Dec. 20, 1864. New York, age 20. 31, 65. 25. 1865; exhaustion. Penn., age 23. 19, 64. 1287 Gilrnan, W., Corp l, K, July 2, Left. Died July 28/63 ; pyaemia. 1331 Hartman, C., Pt., I, 1st July 13, Right. A. Surg. J. T. Myers. 91st 32d Mass., age 31. 3, 63. Louisiana. 13, 63. New York. Died July 13, 63. 1288 Gilt, J.A.,Corp l.G,l 30th Dec. 16, Left; (Vermale s method.) Ass t 1332 Haskell, C., Pt., F, 2d Mar. 10, Left; circ. Died Mar. 30, 1865; Indiana, age 33. 16, 64. Surg.W. B.Trull.U. S.V. Died Mass. Art y, age 22. 11, 65. shock of wound and operation. Jan. 2, 1865; typhoid fever. 1333 Haskill, C., It., F, 82d July], Right. Died July , 1863. 1289 Ginither, J. A., Pt , B, May 10, Right. Died Juue4, 64; pyaemia. Ohio. 1, 63. 49th Pcnr.., age 22. 12, 64. , 1334 Hawk, C., Pt., H, 210th Mar. 31, Right : ant. post, flap : (also flesh 1290 Glasgow, A. /., Pt., H, July 2, i Right. Died October 18, 1863. Penn., age 26. 31, 65. w nd r t thigh.) Died May 9, 65. 21st N. C., age 26. 3, V>3. 1335 Hawks, E., Corp l, G, May 12, Right: flap. Died June 8, 1864. 1291 Gleason, T. E.,Corp l, D, July 22, Left. Surg. W. R. Marsh, 2d la. 115th Penn., ago 37. 12, 64. ,S>cc. 4547. 6lith Illinois. 22, 64. Died Nov. 2, 1864 ; wounds. 1336 Hays, G. W., Corp l, K, June 17, Left : circ.: (and cxc n right knee 1292 Gliddeu, G., Pt., K, 40th Mass., age 2.J. May 15, 15/64. Left. Died June 13, 1864 ; exh n. 2d Michigan, age 19. 17, 64. joint.) Died July 2, 64; exh n. Spec. 3046. 1293 Goff, C,, Pt., G, 22d Va. Sept. 19, ; circ. Died October t, 1864 ; 1337 Heistand. B.,Pt.,E, llth Dec. 15, Left ; circ. Died Jan. 7, 1865. 19, 64. pvamia. Missouri, age 17. 16. 64. 1234 GV*:,P..Corp l,O,26th May 15, Right; flap. Died June 27, 64 ; 1338 Henderson, N.W.,Pt.,E, Sept. 19, Right : circ.; (and excis n of ulna.) Tennessee, age 22. 15, 64. asthenia. 123d Ohio, age 16. 20, 64. Died Nov. 4, 1864 ; pyaemia. O KKEFE (D. C.), Surgical Canes of Interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confederate Stales Aled. and Surg. Jour., 1665, Vol. II, p. 29. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 261 No. NAME. MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1339 Hendricks, M.,Corp l, C, June 17, Left : don. flap. Surg. A. R. Coe, 1381 Huett, L. A., Pt., E, 51st Dec. 30, . Died February 27, 1863. 4th Delaware, age 40. 19, 64. 147th N. Y. Died July 2, 1864. Indiana. 30, 62. 1340 Henry, W., Pt., 1, 30tb May 7, . Surg.C. J.Walton,21stKy. 1382 liuff.W. F., Pt.,G, 119th May 5, L t ; circ. Surg.P.Leidy, 119th Pa. Indiana, 7, 64. Died June 26. 1804. Penn., age 22. . 6/64. Died June 6, 1804; pyaemia. 1341 Herman, I., Pt., B, 27th May 12, Right ; circ. Died June 3, 1864. 1383 Humphreys.C.J., Corp l, June 3, Right. Surg.J.H. Lee,21st Conn. Michigan, age 19. 12," 64. H, 81st N. Y., age 25. 3, 64. Died Aug. 17, 1H64 ; diarrhoea. 1342 Herron, G. S., Pt., F,7th Aug. 19, Right ; circ. Surg. J. F. Hutchin 1384 Humphries, J., Pt., B, July 21, R t. Surg. J. \V. Lawton, U.S.V. S. Carolina, age 21. 20, 64. son, 107th Penn. Died Sept. 18, 50th Ohio, age 47. 21, 64. Gang. Died August 24, 1864. 1864; pyaemia. Spec. 4155. 1385 Hunker, J. C., Pt., D, 2d July 17, R t; circ. A. Surg. E. M. Smyser, 1343 Hickman, R., Corp l, E, Oct. 17, Left ; ant. pos*. flap. Confed. surg. N.Y. Mt d Rift., age 30. 1V64. 48th Penn. Died Aug. 29, 1864 ; 1st Del. Cav., age 23. 18, 64. Died Feb. 27, 65 : typhoid pneu pyaemia. monia and chronic diarrhoea. 1386 Hunnewell, J., Pt., H, June 25, Left; flap. Died July 21, 1864; 1344 Hicks, J., Pt., D, 56th N. Mar. 25. Right; flap. Surg. T. F. Oakes, 3lst Maine, age 30. 25, 64. exhaustion. Carolina, age 20. 25, 65. 50th Mass. Died April 15, 1805. 1387 Hunter, J., Serg t, B,57th July 3, Left. Died July 22, 1863. Spec. 3995. Pennsylvania. 3, ti3. 1345 Hicks, J.W., Pt., A, 37th May 31, Left. Died June 13, 1864. 1388 Hurley, J., Pt., B, 8th May 5, Left. Died June 5, 1864. Indiana. 31, 64. Maryland, age 33. 5, f 04. 1346 Higgins, J., Pt., I, 6th July 9, ; circ. Surg. C. H. Todd, 1389 Hutchinson, G., Pt., K, July 21, Right. Died July 29, 1864. Louisiana. 11, 64. C. S. A. Died July 25, 1864. luth Iowa, 21/64. 1347 Hitrgins, N., Pt., M, 1st June 21, Right. Died October 2, 1864. 1390 Hutchinson, R. D..Pt..G, April 9, Right ; circ. Died April 24, 65; Me. H. A., age 44. 22, 64. 89th Indiana, age 21. 9, 65. haemorrhage. 1348 Highland, W., Pt., E, Nov. 25, Right. Died December 26, 1863. 1391 Hyctt, C. P., Capt., 6th Aug. 21, Left. Died Sept 22, 1864. 41st Ohio. 25, 63. Miss., age 25. 21, 64. 1349 H igley, A ., Serg t, E, 68th July 21, Left. Surg. E. M. Rogers, 12th 1392 Ingraham, G.,Pt.,K,15th July 3, Right. Died August 3, 1863. Ohio. 21, 64. Wis. Died July 25, 1864. Alabama, age 22. 3, 63. 1350 Hildreth, N., Corp l, B, Feb. 7, Left. Surg. C. N. Chamberlain, 1393 Jackson, E. D., Pt., G, Nov. 25, Right ; semi-circ. skin flaps : circ. 94th N. York, age 21. 8, 65. U. S. V. Died Mar. 4, 65 ; py llth New York, age 24. 26, 64. incis u muscles. A. A. Surg. J. aemia. Specs. 1504, 1595. F. Musgrove. Died Mar. 6, 05 ; 1351 Hill, D. S.,Lieut.,G, 10th Sept. 19, Left. Died October 26, 1864. consumption. Vermont. 19, 64. 1394 Jackson, G. W., Pt., H, Sept. 14. . Died Oct. 17, 1862 ; exh n. 1352 Hill, E., Pt., C, 114th May 22, Right. Died August 14, 1863; 16th Georgia, 15, 62. Illinois. 22, 63. gangrene and chronic diarrhoea. 1395 Jackson, P., Pt., E, 31st Oct. 28, Left; (also wound right thigh.) 1353 Hill, H. W., Pt., A, 24th June 18, Right; (also flesh w nd left thigh.) Colored Troops. 28, 64. Surg. E. Jackson, 30th Colored New York Cavalry. 18, 64. Surg. W.B.Fox,8th Mich. Died at Andersonville, Nov. 8, 1864. 1396 Jackson, W. H., Pt., E, Dec. 13, Troops. Died Nov. 20, 1864. Left ; (also wound of right knee.) 1354 Hill,W., Pt., A, 32d Col Dec. 7, Right. Died December 16, 1864 ; 1st Penn. Rifles. 13, 62. Died December 14, 1862. ored Troops, age 21. 7, 64. pyaemia. 1397 Jackson, W.,Pt.,G, 107th May 25, R t ; circ. A. Surg. L.W. Kenne 1355 Hillman, J., Pt., C, 31st June 14, Left. Died July 8 1863. New York. 25, 64. dy, 123d N. Y. Died June 4, 04. Massachusetts. 14, 63. 1398 Jacobs, J., Serg t, G, 90th June 14, . Surg. W. Y. Provost, 159th 1356 Hiukley, A. P., Corp l, June 18, Left. Died Aug. 1, 64 ; pyaemia New York. 14, 63. N. Y. Died June 23, 1803. C, 1st Me. H.A.,age 19. 18/64. and osteomyelitis. Spec. 2918. 1399 Jacquith, A. J., Capt., I, June 16, Right : flap. Died July U , 1864 ; 1357 Hinton, A. B., Serg t, H, Sept, 29, Right. Died October 21, 1864 ; 1st Me. H. A., age 32. 18, 64. prostration. 4th C. Troops, age 26. 29, 64. exhaustion. 1400 Johns, J. A., Pt., G, 5th Sept. 17, Left; haem.: femoral artery lig d. 1358 Hipp, A., Pt., F, 15th June 26, Left Died July 16, 1864. Florida, 17, 62. Died October 5, 1862. Missouri. , 64. 1401 Johnson, A. A., Pt., F, May 25, Right. Surg. P. II. Flood, 107th 1359 Hockley, E. J.,Serg t.B, Dec. 13, Right ; flap. Died Dec. . 1862. 107th New York. 25, 64. N. Y. Died June 1, 1804. 12th Mass., age 23. 13, 62. 1402 Johnson, C. L.,Pt.,B, 1st Aug. 6, Left; (also amp. right leg.) Died L; Holden, G. W., Pt., 1, July 20, Left. Died August 16, 1864. Tennessee. 6, 64. August 21, 1864. 33d Indiana. 20, 64. 1403 Johnson. P.C., Corp l, C, April 1, Right : circ. Surg. C. M. Clark, 1361 Holden, T.,Pt., I, 42d N. May 19, Left ; circ.; gangrene. Died July 48th N. Carolina. 1, 65. 39th 111. Died April 3, 1865. Carolina. 19, 64. 29, 1864. 1404 Johnson, S., Pt.,C, 110th May 5, . Died May 11, 1864. 1362 Holman, J., Pt., F, llth Dec. 16, Right ; circ. Died Feb. 6, 1865. Pennsylvania. 6, 64. Missouri, age 22. 17. 64. 1405 Johnston, T., Pt., I, 42d July 3, Left. Died Aug. 14, 64 ; pyaem. 1363 Holmes. D. H.,Pt.,D,7th May 12, Left ; ant. post, flap. Surg. F. M. Mississippi. 3, 63. Mlinp ifrp * )r l 12 64. Everleth, 7th Me. Died June 1406 Jones, A. A., , K, 7th ; circular. Died. 2. 1864 ; exhaustion. North Carolina. 1364 Holmes, G. E., Serg t, I, May 12, Left. Surg.W. J. Burr, 42d N.Y. 1407 Jones, J. 0., Pt., I, llth July 3, Right. Died July 15, 1863. 19th Maine, age 21. 12, 64. Died June 1 5/64 ; . pyaemia. Virginia. 3, 63. 1305 Romans, S.C.,Pt.,E, 91st Oct. 27, Left. Died November 6, 1864. 1408 Jones, M., Pt., K, 16th Dec. 13, Left; flap. Died Jan. 16, 1863; Pennsylvania. 27, 04. Maine, age 24. 13, 62. pyaemia. 1366 Hoogland, E., Pt., A, 2d June 17 Right ; circ.; (also w nd left leg.) 1409 Jones, S. W., Pt., B, 1st May 19, Left: flap; (alsofract. of forearm.) N.Y. Mt d Rifl., age 19. 17, 64. Died July 5, 1864 ; pyaemia. Mass. H. A., age 29. 19," 64. Died of haem. from radial artery 1367 Hoover, J., Pt., K, 55th June 19, Right. Died J une 22," 1864. June 1, 1804. Spec. 2202. Ohio. 19, 04. 1410 Jones, W., Pt., B, 23d July 30, Right: flap. Died August 19/64 : 1368 Hopper, W., Serg t, A, May 3, Left. Died May 5, 1863. Colored Troops. 31, 64. pyaemia. 40th Pennsylvania. 3, 63. 1411 Jones, W. A., Pt., A, 6th Nov. 24, Right. Surg. R. L. Von Harlin- 1369 Horth, M.F.>t.,DJ79th July 10, Right ; circ. Surg. G. W. Snow, Iowa. 25, 63. gen, 70th Ohio. Died Dec. 24, New York. 10, 64. 35th Mass. Died Sept. 6, 1864 ; 1803 ; pneumonia. chronic diarrhoea. 1412 Justin, J. H., Corp l, E, , 62. Left. Died November 2, 1862. 1370 Horton, A., Pt., B, 48th June 3, Right ; lat. flap. June 16, fem l 57th Illinois. New York, age 19. 3, 04. ligated on face of stump. Died 1413 Justis, E., Pt., A, 90th June 27, Right. Died August 3, 1864. June 23, 1864: exhaustion. Ohio, age 29. 28, 64. 1371 Horton, I., Pt., G, 150th July , Right. Died August 10, 1864. 1414 Kaser, J.,Serg t,B, 107th Jjme 21, Right. Died August 5. 1864; New York. , 64. Penn., age 24. 21, 6-1. gangrene and exhaustion. 1372 Houck, \V. F., Pt., D, June 21, Left. Surg.T.M.Cook, 101st Ohio. 1415 Karr, M., Pt.,II, 1st New May 7, Left: circ. Surg. 1$. G. Streeter, 138th Illinois, age 26. 21, 64. Died June 23, 1864. York Dragoons, age 21. 7, 64. 4th N.Y.Cav. Died May 27/64 ; 1373 Hough. A.,Serg t,H, 15th Nov. 25, Left : circ.; gangrene. Died Jan. pyaemia. Indiana, age 31. 27, 63. 6. 1804. 1416 Keating, P., Pt.,F, Phil. Dec. 13, -. Died March 6, 63; slough 1374 Houston, l.\V.,Serg t,C, 7th 111. Cav., age 23. Dec. 15. 17, 04. Left ; circ. A. A. Surg. J. N. Van Meter. Died Dec, 31, 04 ; irrita. 1417 Legion. Keaton, J.M.,Pt..D,19th 13, 62. May 12, ing of stump. Left : hK>in.: lig. of fern, artery. fever andcolliquative diarrhoea. Indiana, age 24. 12." 64. Died June 12, 1804. 1375 Howard, F. II.,Lieut.,F, June 1, Left: circ. Surg. G. L. Potter. 1418 Keese.W., Corp l. G,74th July 23, Left ; lupin.: lig. of fern, artery. 2d N. Y. Art y, age 25. 1, 04. 145th Ptmn. Died Aug. 17, 04. New York, age 31. 24, "03. Died .May 8, 1804. Spec. 1397. 1419 Keilliolz.D. P.,Corp l,K, May, 64, . Died May 10, 1864. 1370 Howe, II. A., Corp l, I, June 19, Left. Surg. G. tt r . Metcalf, 76th 6oth New York. Primary. !)5th Now York, age 40. 19, 64. New York. Died July 25, 1864. 1420 Kelly, D. F., Pt., C, 67th June 8, Left. Died June 19, 1864. 1377 Hubbard, W., Serg t, A, Oct. 19, Right. Died October 21, 1864. New York, a.?e 25. 8, 64. 12th Connecticut. 19, 64. 1421 Kelly, T.,Pt., G, 51st N. May 12, Right. Snirg. J. S. Ross, 1 1 th N. 1378 Hudson, F., Serg t, B, Mar. 7, Lett ; flap. A. Surg. E. F. Hen- York, age 34. 12, 64. Hampshire. Died May 29, 64; 13-!d N. York, age 24. 9, 65. dricks, 15th Conn. Died March pyaemia. 23, 1805; haemorrhage. 1422 Kelly, W. B , Pt.,F, 39th Aug. 18, . Died August 18, 1864. 1379 Hudson, H., Pt.. I), 7th May 5, Right. Died May 31, 1864. Mass., nge 23. 18, 04. Mass., age 25. -, 64. 1423 Kelly, W. 11., Pt., A, 7th May 12, Left ; ant. post. flap. Died July 1380 Hudson, T. F.,Pt.,\, 4th Louisiana, age 23. Dec. 10, 17, 64. Right; ant. post. flap. A. A. Surg. R. L. McCture. Died Dec. 24, 1424 Maine, age 43. Kemp, I. M., Pt., L, 2d 12, 64. June 17, 9, 1804. Left. Died July 6, 1864. IP. il : px i.iKntion. N.Y. ?.!t dKifl., ago 21. , 01. 262 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MIMTAKY DESCRIPTION, AM> AGE. DATES. Ol ERATiONS, OPERATORS, . RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS. Ol EHATOKS, RESULT. 142: Kf.nnaman. W,. 1 t., G. Mav 12, Left; ant. post. flap. Died June 1466 Lesley, J., Pt., A, HCth June 27, Left. Surg. A. C. Messenger, 57th 12th Alabama, age 32. 12, 64. 14,1864; exhaustion. Illinois. 27, 64. Ohio. Died Sept. 20, 1864. 1426 Kent, 1 . A., 1 t., B, 14th Nov. 25, Left ; circ. Died Dec. 5, 1863. 1467 Letner.D., Lieut., B, 30th Mav 22, Right ; circ. Ass t Surg. 11. M. Mississippi. 25, 63. Iowa. 24, 63. Sprague, T T . S. A. Gang. Died 1427 Kerr.T.,Pt.,L,83dNew Mav 10, Left. Died May 23, 1864. May 29, 1863. Spec. 1621. York, age 2li. 10, 64. 14C8 Lewis, J.,Pt..K, 8th Vt., Oct. 19, Right ; flap : erysip.: gang. Died 1408 Kester, F. M.. Pt., I, 71st Dec. 16. Left; lat. flap. A.A. Surg. M. L. age 18. 21, 64. Nov. 11, 1864 exhaustion. Ohio, age 22. 17, 64. JIoiT. Died Dec. 29, 64; pya?m. 1469 Lewis, J. It, Pt., H, 53d July, 63, Left; (also right leg at point of HOQ Kiclcr M L It. 15 Gth Primary. 1 enn. lies., age 33. 10, 64. Penn . Res. Died June 26, 1864 ; b . A. C. S. Died July 10, 1863. pyaemia. 1470 Lewis, J.W.,Pt.,D,14Cth June 7, Right: circ. Surg. jiW.Wishurt, 1430 Kimball, D. C., Pt., B, July 2, Left. Died July 6, 1863; trau Penn., age 18. 7, 64, 140th Penn. Died June 11,1864. 4th Midi., age 21. 3, 63. matic tetanus. 1471 Lienthardt, E.. Serg t, K. June 23, Right ; double- lat. flap. Died 1431 Kimborly, D., 1 t., E, 7th June 2, Left. Died July 5, 1864 ; irrita 52d New York, age 42. 23. 64. August 14, 1864. Connecticut, age 27. 2, 64. tive fever. 1472 Lilly, A., Pt., A, 85th In May 25, Left. Died July 2, 1864. 1432 King, P., Pt., E, 97th N. June 18, Left. Surg. J. \\. Ana wait, llth diana. , 64. York, age 33. 19, 64. Pa. DiedOct.19, 64. Spec.4145. 1473 Linaweaver, C., Corp l. Oct. 12, Right. Died October 16, 1864; 14:i3 Kinsey, W. S., Private, June 17, Left; circ. Died July 12, 1864 ; K, 5<th Illinois. 12, 64. haemorrhage. Hlounfs Ya. Battery. 17, 64. jaundice. 1474 Lindsay, J., Pt., A, 134th Dec. 13, Right. Died January 15, 1863. 1434 Kinsley, .1., Corp l, 1C, Sept. 30, Right. Died Oct. 17, C4 ; exhaus Pennsylvania. 13, 62. 58th Penti., age 27. 30, 64. tion and diarrhoea. 1475 Lindsey, S., Pt., A, 73d Mar. 19, Right ; (also fract. left leg.) Died 143.1 Kirk, E., Pt., A, 98th June 27, Left. Died August 5, 1864. Ohio, age 22. 19, 65. April 30, 1865; exhaustion. Ohio. 27, 64. 1476 Link, G., Pt., F, 9th La., Julv 9, Left; circ. Died July 10, 1864. 1436 Kirkendall,D.,Pt.,B,73d May 25, Right. Died July 7, 1864. age 27. 10, 64. Ohio. 25, 64. 1477 Liston, W., Pt., D, 21st Sept. 19, Left. Died October 8, 1863. 1437 Klinkhart, C., Pt., B, June 16, : circ. Surg. J. V. Kendall. Illinois. 19, 63. 149th N. York, age 25. 16, 64. 149th N. Y. Died July 11, 1864 ; 1478 Lock, J. L., Pt., I, 59th Dec. 15, Left ; ant. post. flap. Died Jan. pyaemia. Illinois, age 23. 16, 64. 31, 1865. 14:58 Knight, A. B., Pt., B, May 11, Right ; circ. Surg. H. F. Lyster, 1479 Locy, M., 1 t., A, 13Sth Dec. 13, Left. Died December 13, 1862. 86th New York. 11, 64. 5th Mich. Died May 20, 1864 ; Pennsylvania. 13, 62. exhaustion. 1480 Long, T., Pt., B, 56th My 18. 64, Right. Died May 20, 1864. 1439 Knoll, J., Pt., C, 26th May 10, . Surg. J. W.Wishart, 140th Massachusetts. Primary. Michigan. 10, 64. Penn. Died May 12, 1864. 1481 Lonymei/er, J., 1 t., Capt. Oct. 13, Right. Died October 21, 1863. 1440 Krir.n, L>.,Capt., 15,139th Sept. 21, Right. Surg. S. F. Chapin, 139th Brown s Co.,(. ) age 18. 15, 63. Pennsylvania, age 50. 2->, 64. Penn. Oct. 15. one inch of bone 1482 Loss, J. E., Pt., 1, 184th Oct. 1, Left; ant. post. flap. Surgeon G. rem d. Died Nov. 25, 64 ; exh n. Penn., age 28. 2, 64. Chaddock, 7th Michigan. Died 1441 Kunkle, D., Pt., E. 5?tli Oct. 2, Left. Surg. O. Evertj, 20th Ind. Nov. 23, 1864. 1 euu., age 19. 2, 64. Nov. 26, ant. post.flap.mid.third. 1483 Loucks, D., Pt., C, 106th Oct. 19, Right ; circ. Died Nov. 16, 164 ; A. A. Surg. J. H. Packard. Died New York, age 17. 19, 64. typhoid fever. Dec. 16. 64 ; exhaustion. Specs. 1484 Louison, W., Pt., G, 81st Sept. 17, Left. Died. 3715, 4122. Pennsylvania. 17, - 62. 1442 Kunkle, J., Pt., E, 148th Julv 3, Left. Surg.C. S.Wood,66th N.Y. 1 i-:. Love, T.W., Pt., D, 74th June, 64, Right, Died July 12, 1864. Pennsylvania. 3, 63. Died July?24, 1863. Illinois. Primary. 1443 Ladd, C., Serg t, E, 25th Julv 1, Right. Died J uly 14, 1863. M-.; Love, W., Pt., G, 16th Mav 12, Right. Died May 26, 1864; py Ohio. 1. 63 Maine, age 19. 12," 64. aemia. 1444 Lamb, T., Citizen. Primary, ; double flap. Surg. E. C. 1487 Lovctt, G. G., Lieut., G, May 6, Left. Died May 31/64 ; pyaemia. 1862. Franklin, U.S.V. Died , 1862. 119th Penn., age 22. 8, 64. 144.1 Lampliere. L. O., Pt., G, June 30, Left ; (also amp. of right leg.) 1488 Lowe, J., Pt., B, 54th April 2, Left, Surg. R. R. Clark, 34th 21st Connecticut. 30, 64. Died July 22, 186] ; tetanus. Pennsylvania. 2, 65. Mass. Died May 6, 1865. 1440 Lane. A. 11., Pt.,D, 104th Aug. 7. Right. Sept. 21, circ. re-amp, at 1489 Lowery, W. J., Pt., D, Mar. 25, Right. Surg. M. II. Raymond, Illinois, age 26. 7, ? 64. middle third. Died Oct. 4, 1864. 64th New York, age 18. 25, 65. 26th Mich. Died June 14, 1865; 1447 Lane, J., Pt , A, 37th June 17, Left. Surg.W.B. Fox, 8th Mich. exhaustion and diarrhoea. Wisconsin, age 25. 18, 64. Died July 7, 1864. 1490 LowtJirop, J., , K, 43d Julv 12, Left, Surg. G. T. Stevens, 77th 1448 Lanicr. W. B., Capt., H, Mav 15. Right; lat. flap. Died May 19, 64. North Carolina, age 23. 13," 64. N.Y. Gang. Died July 13, 64. (ilst North Carolina. 15. 64 1491 Lunn, J., Pt., D, 5th N. July 17, Right ; ant. post. flap. Confed. ! Lankow, ! ., Pt., E, 26th May 25, Right. Died June 4, 1864. York H vy Artiller}-. 17," 64. surg. Died Dec. 13, 64 ; exh n. Wisconsin. 25. 64. 1492 Lunt, C. W., Serg t., F, May 10, Right. Died May 12, 1864. 1450 Laury, J., 1 t., B, 56th Mav 8, . Died May 9, 1864. 22d Massachusetts. 10, 64. Pennsylvania. 8, "64. 493 2 Lurchin, R. W., Pt., F, May 3, Right ; circ. Died June 1 , 1863 ; 1451 Lawrence, D.W., Pt., C, Sept. 17, Right. Died September , 62. 6th Maine, age 28. 3, 63. pyaemia. 7th Michigan. 17, 62. 1494 Lyle, W. II., Pt., I, llth Julv 3, . Died August 1, 1863. ! Lawrence, T. J., Pt., B, Mav 27, Right. Died June 30, 1863. Mississippi. 3, 63. 8th X. Hampshire. 27," 63. 1495 Lynch, H. fr.,Pt.,F,13th Julv 9, ; circ. Surg. C. II. Todd, C. 1453 Lawson, E., Pt., V, 30th Dec. 16, Rifflit fint. post, flfip. A.A.Suny. GoorirujL 11, " 64. S.A. Died Aug. 12, 64. .Sp.3824. Alabama, age 22. 18, 64. H. L. McClure. Died Feb. 9, 65. 1496 Lynch, J. A., Serg t, B, May 14, . Died ^la y 17, 1864. 1454 Laydon, D., Pt., G, 54th Dec. 28, Left. Died February 24, 18G3 ; 24th Michigan. 14, 64. Indiana. 28. 62. pyaemia. 1497 Lyons, J. N., 1 t., I, 42d Dec. 29, Right. Died January 3, 1863. Leather, E., Pt., B, 55th Mar. 16, Right ; circ. Died April 23, 1865 ; Ohio. 29, 62. Ohio, age 43. 16, 65. fatty degeneration of the heart. 1498 Mackey, J., Pt., B, 9th June, 64, Right. Surg. J. N. Beach, 40th 1456 Lee, D., Pt.,G,57th Mas Aug. 19, Left; circ. Surg. F. F. Oakes, Indiana. Primary. Ohio. Died July 4, 1864. sachusetts, age 30. 20, 64. 56th Mass. Died Sept. 27, 1864 ; 1499 Maddock, C. II., Pt , F, Oct. 1, Left; (also exc. of metacarpus.) pyaemia. 1st Maine, age 22. 1, 64. Surg. J. S. Jemison, 8(ith N. Y. 1457 Lee, F. G., Pt., B, 120th Mar. 9, Right : ant. post. flap. Died Mar. Died < )ct.27, 64 ; exh n. ftp. 4 121. Indiana, age 20. 10. 65. Ifi, 1865; exhaustion. 1500 Maguire, C. F., Pt., F, June 17, Left. Died June 23, 1864. 1458 Lee, J. H., Pt., I, 29th July 4, Ri"ht. Died July 31 1863. 14tli Xcw Vork Art v 17 64. Iowa. 4, 63. 1501 Malone, J., Pt.,E, 9th N. Dec. 13, . Died January 1, 1863. 1459 Leech, C., Pt., A, 63d Oct. 3, Right. Died October 4, 1862. York State Militia. 13, 62. Ohio. 4, 62. 1502 Mann, E., Pt., C, 52d O., Mar. 21, Left. Died May 1, 1865; typhoid 14(30 Lefller, J., Pt., D, 82d Juno 18, Right. Died August 10, 1864; age 22. 21, 65. fever. Olno, aw 21. 18, 64. pyaemia. 1503 Mann, J. L, Pt., B, 26th June 7, Right; circular. Died Aug. 19, 1461 Lpgott. A. S., 1 t., I). Jan. 1, Left. Died January 2, 1863. Michigan, age 24. 7, 64. 1864. . HI Kentucky. 1, 63. 1504 Markliam, \V. D., Pt., July 3, . Died July 16, 1863. 1462 Leghtback, II. .Pt., E, 2d May 5, Right ; ciro. Died July 23, 1864 ; , 47th N. Carolina. 3, 63. 1403 Now Jersey, age 21. l Lence. R., it., , 18th 6, 64. Sopt. 17, diarrhoea. : circ. Confcd. surg. Died 1505 Marshall, G. W., Pt., D, 64th New York. July, 63, Primary. . Died July 16, 1863. .Mississippi, age 35. 17. 62. Sept. 21, 1862; pyaemia. 1506 Marshal!, L., Pt., F, 27th Mar. 14, Right. Died March 14, 1862. 1464 Leonard, ,f. II . Pt.,E,9th Oct. 19, Right. Died October 28, 1864. Mass , age 24. 14. 62. N. Y. H vy Artillery. 20, u 4. 1507 Marshbrun, S. IT., Ma.j., Oot. 19, Right : (also wound through left Leonard, J. 1)., I t., I, July 4, Left. Died July 8, 1864. 53d Georgia. 19. 64. knee.) Surg.J.J.KnottJ .A.C.S. 1st Michigan Artillery. 4, (J4. 1 Died Nov. 18, 1864. 1 FI8HEK (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals mar Sharpsbury, Md.. after the battle of Antictam, Sept. 17, 1862, in Am. Jour. Med. Sci., 1863, Vol. XLV, p. 47. 2 LIUEI.L (J. A.), Suppurative Osteomyelitis (acute) following Primary Amputation of the Right Thigh, in Surgical Memoirs of the War of the Rebellion, Collected and Published by the U. S. Sanitary Commission, Surgical Volume I, p. 350. Ibid. On Thrombosis and embolism, in Am. Jour. Med. Sci., 1872. New Series. Vol. LXIV, p. 353. PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 263 NO. NAME, MILITARY DESCIUI TIOX, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE., DATES. OPEHATIOX.S, OPERATORS, RESULT. 1508 Martin, R., Corp l, F, 93d May 5, . Died May 7, 1864. 1553 Miller, B., Pt., B, 185th Mar. 25, Right. Died May 22, 1865. New York. 6, 64. New York. 25, 65. 1509 Martin, A. J., Pt, F, 82d July 2 ), Right. Died September 5, 1864. 1554 Miller, J., Pt., F, 88th May 10, Right; flap. Died May 33, 1864. Ohio. 20, 64. Penn., age 39. 10, 64. 1510 Mason, D., Pt., K, 32d Mar. 21, Right. Surg. A. B. Monohan,63d 1555 Miller, J., It., G, 6th In May 14, Right. Died May 28, 18C4. Wisconsin. 21, 65. Ohio. Died March 29, 1865. diana. 14, 64. 1511 Mason, H.W.,Pt.,B,24th Nov. 30, Right ; circ. Surg. J. R. Ludlow, 1556 Miller, J., Pt.,E, 57th N. April 6, Right ; flap. Died May 6, 1865 ; Wisconsin, age 21. Dec.1, 64. U.S.V. DiedDec.23, 64; pyaem. Carolina. (i, 65. exhaustion. 1512 Massie, J. W., J t.,G,19th July 2, Left. Died. 1557 Milter, J. E., Pt., II, 33d May 3, ; circular ; sloughing. Died Virginia. 3, 63. Virginia, age 22. 5, 63. May 14, 1863. 1513 Matthews, B., , H, 16th Sept. 14, . Died Sept. 28, 62 ; exhaus 1558 Miller, S. K., Serg t, K, Sept. 19, Left; circ. Died Dec. 20, 1864; Georgia. 15, 62. tion. 2d Ohio Cav., age 23. 19, C4. pyaemia. 1514 Matthews, W., Corp l, B, Jan. 2, Right. Surg. C. J. Walton, 21st 1559 Miller, W. S., Pt., K, 8th Aug. 28, Right. Died October 32, 3864; 78th Pennsylvania. 4, 63. Ky. Died Jan. 16, 1863. Indiana Cavalry. 28, 64. remittent fever. 1515 May, P.,l t.,A, 5th Mich. May 5, . Died May 19, 1864. 1560 Mills, A. B., Pt., E, 16th July 3, Right. Died October 7, 1863. 6, 64. Maine, age 19. 3, r 63. 1516 Mazerva, G., Pt., A, 86th May 5, Left. Died May 7, 1864. 1561 Minoque, J., Pt., G, 12th May 12, Left ; flap. A. Surg. P.Adolphus, New York. 6, %4. Infantry, age 24. 12, 64. U.S.A. Died June 21, 64; exh n. 1517 Mcliride.J. A., Pt., , Oct. 27, ; cire. Surg. J. T. Kelbv, C. 1562 Mitchell, G., Pt,, D, 2d June 19, Left; circ. Died July 12, 3864; 7th C. S. Cav., age 26. 27, 64. S. A. Died Oct. 28, 1864. Maryland, age 42. 19, 64. pyaemia. 1518 McBride. M. C., Lieut., July 9, : circ. Surg. C. H. Todd, C. 1563 Mitchell, J., Citizen em- Oct. 10, Left; ant. post. flap. A. A. Surg. G, 9th Louisiana. 9, "64. S. A. Died July 22, 1864. ploy6, age 25. . 10, 64. M. H. Hend. Died Oct. 15, 64 ; 1519 McCandless.W.W., Pt., Dec. 31, Right. Died. double pneumonia. H, 84th Illinois. 31, 62. 1564 Mitchell, B. J., Lieut., B, Oct. 19, Right. Died Nov. 12, 64; second 1520 McCarthy, D.,Pt..B,39th Sept. 19, . Died Oct. 8, 1863. 1st Maine. 19, 64. ary haemorrhage. Indiana. 19, 63. 1565 Monroe, M., Pt.,E, 109th June 17, Left. Died June 27, 3865. 1521 McCarthy, J., Pt., Car Sept. 19, : circ. Surg. G. W. Burdett, New York, age 28. 17, 64. penter s Battery. 20, 64. C.S.A. Died Sept.21, 64 ; shock. 156C Moody, J., Pt., H, 17th April 2, Right. A. Surg.E. P.Roche,35th 1522 McCartney, J., Corp l, H, June 18, ; flap. Died Feb. 11, 1865, Vermont, age 45. 2, 65. Mass. Died April 24, 1 865. 149th Penn., age 24. 38. 64. while on furlough. 1567 Moore, J. T., Pt,, G, 45th July 12, Left ; circ. A. Surg. J.C. McKee, 1523 McClarence, F., It., F, July 3, Left. Surg. N. Hayward, 20th North Carolina, age 20. 14, 64. U. S. A. Died August 9, 1864. 20th Massachusetts. 3, 63. Mass. Died July 20, 1863. Spec. 2856. 1524 McComb, J., Captain, D, June 3, Left, Surg.A.Satterthwaite, 12th 1568 Moore, L. M., Lieut., , July 3, Left. Died August 2, 18C3. 12th N. Jersey, age 25. 3, 64. N. J. Died July 2, 1864. 17th Mississippi. 3, 63. 1525 McCometrm,A. J., Pt., F, July 20, Left. Died July 29, 1864. 1569 Moore, W. B.,Pt.,E, llth May 25, Right; circ.: (also w d left thigh.) 55th Alabama. 20, 64. N. Hampshire, age 34. 26, 64. Surg. J.S.Ross,llth N.H. Died 1526 McC ormick, N., Corp l, June 17, . Surg. D. S. Hopkins, 4th June 24, 1864 ; pyaemia. E, 4th Delaware. 17, 64. Delaware. Died June 22, 1864. 1570 Moran, H., Pt., K, 155th June 3, Left. Died June 18, 3864. 1527 McCulIougb,S.E.,Corp., May 22. R t: circ. A.Surg.H.M.Sprague. New York, age 25. -, fi4. A, 47th Illinois. 24, 63. U.S.A. Died J yl2. 63. ^.1622. 1571 Morey, D. D., Serg t, C, May 20, Left. Died July 22, 3 864 ; opera 1528 McCullough, W., Pt., D, llth Pennsylvania. May 5, 5, 64. Right. Died May 16, 1864. 1572 9th Maine, age 28. Morill, D. H., Corp l, C, 30, 64. May 18, tion and chronic diarrhoea. Left. Surg. J. S. Ross, llth N. 1529 McCurdy,T.,Pt.,H, 38th Aug. 31, Right. Died Sept. 3, 1864. 31st Maine, age 22. 38, 64. Hampshire. Died Mav 20, 1864. Indiana. 3ir 64. 1573 Morris, J., Pt., F, 39th June 1, Left. Died July 8, 1864. 1530 McDill, K., Pt., I, 81st Mar. 19, Left ; circ. Surg. W. C. Jacobs, Illinois, age 40. 2, 64. Ohio, age 25. 19, 65. 81st O. Died May 7, 65; diphth. 1574 Morris, W. C., Pt., E, 4th May 19, Right; flap. June 1, basm.: lig. 1531 McDonald, H ..Corp l, D, June 19, Left. Died August 2, 1864. Alabama, age 24. 19, 64. femoral. Died June 2, 64 ; hsem. 35th Ohio. 19, 64. 1575 Morris, W., , C, 44th July 2, Left. Died July 22, 63 ; pyaemia. 1532 McDonald, P., Pt., P., May 18, Right. Surg. M. Rizer,72d Penn. New York, age 30. 3. 63. 170th New York. 18, 64. Died May 18, 1864. 1576 Morrison, J. H., Pt., B, Dec. 13, . Died December 16, 1862. 1533 McDougal, A. L., Col.. 123d New York. June 4, 4, 64. Right. A. Surg. L.W. Kennedy, 12:!d N. Y. Died June 23, 64. 1577 19th Massachusetts. Morse, W. E., Pt., B, 2d 13, 62. Dec. 13, Left. Died December 18, 3862. 1534 McFadrlen, J. L., Tt., C, June 23, Right ; ant. post. flap. Surg. J.H. New Hainpshire. 13, 62. 34th N. C., age 18. 23, 64. Buckman, 5th New Hampshire. 1578 Morse, R., Pt,, C, 100th Aug. 6, Right ; circ. Surg. C. S. Frink, Died July 22, 1864. Ohio, age 20. 6, Y 64. U.S.V. Died Nov. 22, 1864. 1535 McFarJand, .7..4.,Ccrp l, E, 18th Tennessee. Myl5. 64. Primary. . Died May 27, 1864. 1579 Morton, B. T., Pt., H, 2d Ohio Cav., age 24. June 18, 20, 64. Right; circ. Surg.J.II.Wliitford, 36th O. Hasm. Died July 2, 64. 1536 MeGarvey, M., Corp l, C, June 2, Left. Died Dec. 3, 1864. 1580 Morton, D. H., Pt., D, May 23. Right; short ant. and long post. 4th Infantry. 2, 64. 149th Penn., age 20. 24, 64. flaps. Surg. W. F. Humphrey, 1537 McUenty, E.",Pt., E. 68th July3, Left. Died July 23, 18C3. 149th Penn. Died June 6, 1864 : Pennsylvania. 3, fe. pyaemia. Spec. 2795. 1538 McUrat h, J , Pt., E, 88th June 16, Left. A. Surg. J.S. Smith,U.S.A. 1581 Morton, J. IF., Pt., E, July 3, . Died July 23, 1863. New York, age 3ii. 17, 64. Died June 29, 64. Spec. 3766. 18th Virginia. 3, 63. 1539 McGraw, 11., Lieut., K, July 1. . Died July 8, 1863. 1582 Morton, P., Pt., I, 83d May 10, Right ; circ. Died May 20, 1864 ; 140th New York. 3, 63. Penn., age 35. 10, 64. ha?morrhage. 1540 McKonzie, A., Corp l, M, June 3, Right; ant. post.flap. Snrg.G.W. 1583 Mullen, W. W., Pt., D, June 4, Right. Died June 38, 1864. 8th N. Y. H. A., age 21. 4, 64. McCune, 14th Ind. Died July 57th Indiana. 4, 64. 11,1864. 1584 Mullen, C.. Serg t, M., April 7, Left. Died May 18, 1865; amp. 1541 McKnight, L. \P., Pt., C, 2d Tenn. Cav., age 22. Mar. 25, 27, 64. Right ; flap. Surg. H. P. Stearns. U. S. V. Died April 16, 1864. 1585 7th Penn. Cavalry. Murphy. P., Pt.. D, 28th 7, 65. June 15. and pneumonia. . Died June 17, 1864. 1542 McLeod, J., Pt., F, 16th May 27, Right. Died June 11, 1864. Pennsylvania. 15, 64. Infantry. 27," 64. 1586 Myers, R. P., Pt., K, July 3, Left. Surg. H. M. McAbee, 4th O. 1543 McNew. C., Pt., E, 34th Jan. 11, Right. Died February 17, 1863 ; lllth New York. 3, 63. Died August 31, 1863. Iowa, ago 25. 11, 63. wound. 1587 Nash, J. A., Pt., H, 1st June 21, Right ; ant. post. flap. Died June 1544 McXutt, J., Lieut., , Sept. 37, ; flap. Died Sept. 19, 1862; Mass. II. A., age 19. 21, 64. 30, 1864; exhaustion. 17th Miss., age 26. 18, 62. shock and exhaustion. 1588 Nason, S. H., Pt., F, 1st June 18, Left ; ant. post. flap. Surg. H. F. 1545 Melane,. K. B., Pt., L, 1st Oct.9, 63 . Died October 27, 1863. Maine H. A., age 28. 18, 64. Lyster, 5th Mich. Died July 4, Tenn. Cavalry. Primary. 18 (i4 ; pyaemia. 154C Menich, J., Pt., F, 10th May (i, Left. Died May 28, 1864. 1589 Nanss, J., Pt., C, 82d July 20, Right. Died October 19, 1864. New Jersey. 6, 64. Ohio, age 24. 20, 64. 1547 Meniott, E., Pt., D, 6th May 3, Left ; flap. S urg. F. G. Porter. U. 1590 Neal, F., Pt., M, 21st Pa. June 18, Right. Died June 19, 1864. Mo. S. M. Cav., age 23. 4, 65. S.V. Lig. fern. Died May 29, 1865; exhaustion. 1591 Cavalry. Neal, L.,Corp l, I,2dKy. 18, 64. Dec. 15, . Died December 17, 1861 ; 154E Menzie, J. R., Pt., I, 9th Oct. 19, Right. Died October , 1864. Cavalry. 17, 61. shock. N. Y. H vy Artillery. 19, 64. 1592 Neilson, G., Corp l, Tar- Dec. 16, Right ; circ. Died Jan. 14, 1865. 154C Messinger, W., Pt., A, 3d Vermont. June 7, 7, 64. Right. Died June 8, 1864. 1593 rant s Battery. Nelson, 0., Pt., F, 40th 16, 64. July 20. Left. Died July 26, 1864. 155( Meyer, J., Pt., K, 2d N. April 7, Right ; circ. Surg. P. E. Hubon, Mississippi. 20, 64. Y. H. A., age 23. 8, 65. 28th Mass. Died May 25, 1865 ; 1594 Nelson, R., Pt., E, 26th De-. 13, . ; circ. Died Doc. 15, 1862. pyaemia. Pennsylvania. 13, 62. 1551 ) Michael, R. S., Pt., A, July 3, Right and left. Died July 16, 63. 1595 ^Newman, W. G., Pt., II, Aug. 9, ; flap. Died Sept. 27, 1862. 155x ) 105th Pennsyvania. 3, 63. 58th Virginia, age 34. 10, 62. FISHER, (G. J.), Amp. after Battle of Antietam, in Am. Jour. Med. Sci., 1863, Vol. XLV, p. 47. 2 CHALMERS (H. S.), Keport of Three Cases illustrating the Correlation existing between Erysipelas, Diphtheria (and Hospital Gangrene?), In Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 86. 264 INJURIES OK THE LOWER EXTREMITIES. [CHAP. X. XO. NAME, MILITAUV DESCRIPTION, AXI> ACE. DATKS. OPERATIONS, OPERATORS, RESULT. xo. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1596 Newton. W., Capt., E,2d Mar. 31, Left. Died April 8, 1865. 1641 Post, J. K., Pt., B, 112th June 1, Right; circ. Died June 21, 1864 ; Ohio Cavalry. 31, 65. New York, age 21 . 3, 64. exhaustion. 1597 Nicholas, I., Corp l, G, Oct. 28, Right. Died Nov. 28, 1864 ; irrita 1642 Potter, W.M.,Pt.,E, 84th May 3, Left. Died May 20, 1863. 7th C. Troops, age 21. 28, 64. tive fever. Pennsylvania. 3, 63. 1598 Nichols, D., 1 t., 1C, 31st May 12, . Surg. P. O M. Edson, 17th 1643 Pratt, A., Pt., D, 34th Sept. 19, . Died September 20, 1864, Maine. 12, 64. Yt. Died May 22, 1864. Massachusetts. 20, 64. on operating table. 1599 (Nicholson, D.,Pt.,H,2, d May 10, Both thighs; ant. post. flap. Surg. 1644 Price, J., Pt., C, 78th Sept 28, Right ; lat. flap. Died Oct. 18, 64 ; 1600 5 Mass., ago 23. 10, 04. .J. Thomas, llbth Penn. Died Penn., age 53. 28, 64. surgical pneumonia. May 28, 64 ; exh n. Spec. 2966. 1645 Priest, J., Corp l, D,129th July 20, Right. Died August 24, 1864. 1001 Nickerson, J., Pt., D, 3d Nov. 10, Right! ant. post. flap. Surg.S.W. Illinois. 20, 64. R.I. Artillery, age 38. 10, (i3. Gross, U. S. V. Died Nov. 20, 1646 Pritehett, J. L., Pt , A, April 9, Right; circ. Died April 30, 64. 1863; erysipelas. 87th Illinois. 9, 64. 1602 Nolton,A.W., Pt.,F,93d May 12, Left ; circ. Died June 4, 1864 ; 1647 Pryor, W., Pt, F, 21st Dec. 12, . Died December 18, 1862. New York, age 22. 14, 61. pysemia. Mississippi. 12, 62. 1603 Norton, M., Pt., I, 117th May 13, Right. Died May 28, 1864. 1648 Pulley, D. W., Pt., E, Dec. 15, Right ; lat. flap. A. A. Surg. L. New York. 13, 64. 60th Illinois, age 20. 16, 64. Sinclair. Erys. Died Feb. 4, 65. 1604 Nunamaker, \V., Pt., A, Aug. 5, Right. Surg. J. N. McCandless, 1649 Pune, D. S., Pt., A, 79th July 20, Left. Died A ugust 4, 1864. 77th Pennsylvania. r>, vi. 77th Penn. Died Aug. 15, 1864. Ohio. 20, 64. 1605 O Connor,P.,Pt.,B,147th May 2.1, Left : ant. post. flap. Died June 1650 Putnam, C., Corp l, E, Mar. 31, Left ; circ. Died J une 22, 1865 ; New York, age 3:). 26, 64. 14, 1864 : pyaemia. 64th New York, age 27. 31. 65. pyaemia. Spec. 4238. 1606 Ogden.T.W., Pt.,F,94th Oct. 19, Right. Died October 29, 1864. 1651 Quinn, F., Pt., K, 147th July 30, Right; circ. A. A. Surg. S. J. New York, age 16. 19, 64. New York, age 40. Au. 1, 64. Ilolley. Died August 2, 1664. 1607 Osgood.G. H., Serg t., K, June 27, Right. Died July 25,1864. 1652 ^Rabbit, E. C., Serg t, B, Nov. 24, Both. Surg. E. J. Buck, 18th VVis. lllth Pennsylvania. 27, 64. 1653 i 10th Missouri. 25, 63. Died Dec. 26, 1863. 1608 Otley, J. K., Adj t, 32d Mar. 25, Left. Surg. J. T. Kilby, C. S. A. North Carolina. 25, 65. Died April 25, 1665. 1654 iRainwater,J. G., Pt., , Sept. 17, Left ; circ.; (hasm. fr. ant. tib. art.; 1609 Owen, E. F., Pt., B, 29th Dec. 17, Right ; circ. Died Feb. 5, 1865 ; 18th Miss., age 28. 19, 62. gang.) Died Sept. 22, 62; pyae. Penn., age 4?. 17, 64. exhaustion. 1655 Rapp, J., Pt., C, llth June 19, Right. Died July 13, 1864. 1610 Owens. B. E., Pt., C, 30th Mar. 65, Right. Died May 10, 1865. Conn., age 31. 19, 64. Yirginia. Primary. 1656 *Rate, J. B., Pt., , 45th Sept. 17, Left ; circ. Confederate surgeon. 1611 Page. B. M., Pt., 1, 126th May 12, Left ; circ. Died May 26, 1864. Virginia, age 23. 17, 62. Died Sept. 30, 1862; pyaemia. Ohio, age 21. 12, 64. 1657 Rayburn, S. Y., Serg t, July 3, Left : circ. Surg.W. H. Twitord, 161 ,> Paine, B., Musician, E, Dec. 15, Right ; ant. post. flap. Died Dec. D, 27th Indiana. 3, 63. 27th Indiana. Died Aug. 1, 63. 1st Alabama, age 22. 15, 64. 24, 1864. 1658 Reardon, J., Pt., D, 52d June 27, Left. Died July 4, 1864. 16l:i Patterson, J., Corp l, K, Oct. 18, Left. Died Jan. 20, 1864 ; chronic Ohio. 27, 64. 10th Missouri, age 22. 18. 63. dyspepsia and diarrhoea. 1659 Ream, C., Pt., I, 26th N. Dec. 13, Right. Died January 6, 1863; 1614 Parker, L. II., .Serg t, D, July 2, . Died July 24, 1863 ; haemor York, age 60. 14, 62. pyaemia. 1-Jth X. II., age 26. 3, 63. rhage. 1660 Reeolder.G., Pt., A, 79th June 16, Left; circ. Died July 24, 1864 ; 1615 Parncll, E., Pt., A, lllth July 2, Right. Surg. H. M. Me A bee, 4th Penn., age 18. 16, 64. pyaemia. New York. 3, 63. Ohio. Died July 13, 1863. Kim Reddick, G. H., Serg t, July 2, Left. Died July 6, 1863. 1616 Parsons, W., Serg t, K, May 5, Right. Died July 3, 1864. F, 20th Indiana. 2, 63. 124th X. York, age 20. 6, 64. 1662 Reece, E., Pt., I, 36th May 15, Left. Asst. Surg. C. 11. Burbeck, 1617 Pas^hall, A. O., Pt., G, Mar. 10, Right; ant. post. flap. Died Mar Alabama. 15, 64. 60th N. Y. Died May 17, leG4. 124th Indiana, age 23. 10, 65. 16,1865; exhaustion. 1663 Reed, J., Pt.,C, 15th Va., June 18, Left. Confed. surgeon. Nov. 1, 1618 Patten, H. L., Maj., 20th Aug. 16, Lett; anterior post. Hap. Surg. age 26. 20, 64. fern. lig. Nov. 8, re-amp, at up. Mass., age 28. 17, 64. N. Haywarcl, 20th Mass. Died third. Surg.G. S. Palmer, U.S.V. Sept. 10, 1864 ; pyasmia. Ha?m. Died Nov. 14/64 ; exh n. 161!) Paul, J., .Serg t, B, 152d May 30, Left ; flap. Surg. M. Rizer, 72d 1664 Reed, J., Pt., G, 123d May 15, Right. Died July 10, 1864. New York, age 24. 31, 64. Penn. Died June 30/64: pyacin. Ohio. 1.1, 64. 1620 Perk, VV. H., Pt., I, 1st July 3, Right: haein.; ligat n. Died July 1665 Reedy.C. T., Pt.,G,40<h June 20, Right. Surg. J. N. Beach, 40th Minnesota. 5, 63. 21,1863. Ohio. 20, 64. Ohio. Died July 19, 64 ; pyaem. 1621 Peclen,J..Corp l,A, 140th May 8, : circ. Surg. .T. W.Wishart, 1666 Reeves, A., Pt., C, 36th Nov. 23, Right. Died December 18/1863. Pennsylvania. 8, 64. 140th Penn. Died May 1.1,1864. Ohio. 23, 63. 1622 Pel key, J., Pt., II, 2d Nov. 25, . Died Nov. 28, 1863. 1667 Reeves, W. J., Pt., C, May 14, Loft. Died Aug. 3, 1863 ; chronic Minnesota. 25, 63. 10th Missouri. 14, 63. diarrhoea. 1023 Perkins, M., Pt., D, 18th Dec. 12, Left : (also wound of right side 1668 Reidman, G., Pt., I. 15th Sept. 17, Left. Died September 30, 1862. Massachusetts. 13, 62. and lung.) Died Dec. 20, 1862. Massachusetts, age 44. 17, 62. 1624 Perry, II. 11., Corp l, K, Mar. 25. Right ; ant. post. flap. Died April 1669 Remele. D., Pt., E, 10!)th May 6, Left: circ. Died Aug. 8, 1864; ">7th .Mass., age 20. 25, 65. 9, 186." ; apoplexy. New York, age 19. -, 64. diarrhoea. 162-1 Peters, K., Pt., C, 29th Oct. 27, Left. Surg. A. C. Barlow, 62d 1670 Renerson.W. It., Pt., E, June 16, Left : ant. post. flap. Died A ug. Conn. (Col d.) 27, 64. Ohio. Died Nov. 17, 1864. 1st Maine, age 27. 16, 64. 9, 1864. 1626 Peterson, O. C., Pt., A, Dec. 16, Left; eirc. Surg. V. B. Kennedy, 1671 Reynolds, W. T., Pt., A, April 5, Right ; circ. Died April 30, 1865. T>th Minnesota, age ."]. 16. 64. 5th Minn. Died Jan. 13, 1865. 4t h Delaware. 5, 6.1. 1627 Peterson, I . 15., Adj t, Sept. 17, Left. Died October 13, 1862. 1672 Rhea, J. M., Pt., I, 8th June 20, Right; circ. Surg. II. /,. Gill, 78th Xcw York. 17, 62. Iowa. 20, 63. 9.1th Ohio. Died July 25, 1863. 1628 Petersnn. O., Pt.,O, 39th Nov. 30, Left ; lat. flap. Died May 18, 65; 1673 Richards, A. J., Pt., K, May 30, Left; circ. Died June 20, 1864; Norlh Carolina, age 2.1. De. 1, 64. exhaustion. 9th N. 11., age 25. 3:), 64. exhaustion. 162!) Phelps, II. E., Corp l, K, May 27, Right. Died August 9, 186:!. 1674 Richardson, W. A., Pt., Nov. 25, Right ; circ. A. Surg.W. S. Lam 4 : Jth Massachusetts. 27, 63. G, 6th Iowa. 2.1, 63. bert. 6th Iowa. Died December 1630 Phelps. C. B., Pt., H, May 15, Left; circ. Died June 11, 1864. 24, 1863; pneumonia. 38th Virginia. 16, 64. 1675 Riley, P., Pt.,G,42d Mas Aug. 27, Left. Died October 4, 1864 ; py 1631 Phipps, J., Pt., A, 187th June 2.1, Left. Died July 4, 1864 ; exh n sachusetts, age 19. 28, 64. asmia. Pennsylvania, age 19. 25, 64. and irritative fever. 1676 Riling, J., Pt., C, 159th April 13, Left. Died Oct. 6, 1863; chronic 1632 Phyfe,\V.F.,Pt., E, 10th Sept. 27, Left; anterior post. flap. Surg.G. New York. -, 63. diarrhoea. New York, age 22. 28, 64. Chaddock, 7th Mich. Died Oct. 1677 Ripley, C. A., Pt., E, 2d July 4, . A. Surg. A. F. Marsh, 56th 18, 1864: exhaustion. Iowa. 4, 64. 111. Died July 15, 1864. 1633 Pickens, P., Serg t, F, July 3, Left ; (also wound of right leg.) 1678 Ripley, L. D.,Pt.,E.10th Sept. 19, Left. Died October 17, 1864. 141st Pennsylvania. 3. 63. Died July 10, 1863. West Va., age 29. 19, 64. 1634 Pike, S., Serg t, 1, 10th Aug. 28, Right. D ied October 9, 1864. 1679 Ritka, A., Pt,, M, 4th Sept. 19, Right ; circ. Died Feb. 26, 1865 ; Ohio Cavalry. 28, 64. N. Y. Cav., age 32. 19, 64. typhoid fever. 163.5 Platts.N., Serg t, D,100th July 22, Left. Died September 16, 1864. 680 Robarge, L. J., Corp l, I, Mar. 1, Left; ciro. A. Surg. J. W. Wil Illinois. 2->, 64. 5th Cavalry, age 30. 2, 64. liams, U. S. A. Died March 14, 1636 Pollsys, T. A., Serg tJI, June 18, Right; posterior flap. Surg. J. II. 1864; tetanus. Spec. 2151. 6th Wisconsin, age 25. 19, 64. Beech, 2 lth Mich. Gang. Died 1681 Roberts, W. H., Pt., E, May 14, Left. Died May 23, 1864. June 30, 1864 ; ha?morriiage. 33d Ohio. 14. 64. 1637 Pomeroy, W., Pt., B, 1st June 18, Right ; circ. Died June 27, 1864 ; 1682 Robinson, F., Pt., D, 3d Mar. 5, Left. A. Surg. B.Durham, .jr.,72d Maine II. A., age 30. 18, 64. pyaemia. Cavalry. 5, 64. 111. Died June 22, 64 ; diarrhoea. II 38 Pool, E. G., Pt., A, 12th Sept. 17, Right. Died October 14, 1862. 1683 Robinson, D. W., Pt. F, May 27, Left. Died June 6, 1863. Massachusetts. 17. 62. 53d Mass., age 43. 27, 63. 1639 Poppleton, B. 11., Pt., B, July 22, Left. Surg. W. C. Jacobs, 81st 1684 Robinson, II., Capt., G, May 3, Left; circ. Died May 11, 1863; 7th Iowa, aged 21. 22, 64. Ohio. Died Sept. 7, 1864. 55th Ohio. 5, 63. exhaustion. 1640 Posey, E., Pt., A, 39th Oct. 28, Right. Surg.M.Tucker,39th Cl d 1685 Robinson, J., Pt.,K,123d Sept. 3, Left; flap. A. A. Surg. J. R. Colored Troops. 28, 64. Troops. Died Nov. 9, 64 ; hajm. Ohio, age 24. 4, 61. Uhler. Died Sept. 10, 1804. 1 FISHER (G. J.), Report of Fifty-Seven Casfs of Amputations, in the. Hospitals near SJiarpsburg, Md., after the Battle, of Antielam, Kept. 17, 1862, in Am. Jour. He.d. Sci., 1863, Vol. XLV, p. 47. 2 FlSHER (G. J.), op. ciL, p. 47. PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 265 No. NAUR, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AKD AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1686 Robinson, J. T., Pt., A, June 4, Left. Surg. E. B. Glick, 40th 1730 Shipper, R., Corp l, C, Oct. 5, Right : circ. Surg. P. N. Woods, 1st Ohio Artillery. 4, 64. Ind. Died June 26, 1864. 12th Illinois, age 19. 5, 64. Sijth Iowa. Died Dec. 26, 1864. 1687 Robinson, P. P., (Jorp l, May 5, . Died May 6, 1864. 1731 Shoemaker, G., Pt., B. July 2, . Surg. F. Wolf, 39th New A, 57th Penn. 6. 64. 39th New York. 3, 63. York. Died July 25, 1863. 1688 Kodgers, J. A.,Pt.,G, 1st Aug. 25, Left; flap. A. A. Surg. J. R. 1732 Shorey, R., Pt., I, 17th Nov. 27, Right ; ant. post. flap. Died Dec. Cavalry, age 19. 26, 04. Uhler. Died Oct. 2, 1864. Maine, age 45. 29, 63. 10, 1863: gangrene. 1689 Rodgers, W. B., Pt., D, Sept. 17, Left. Died Oct. 17, 1862. 1733 Showalter, J., Pt.,C, 53d June 3, Right. Surg. G. L. Potter, 145th 88th Penn. 17, 62. Penn., age 20. 3, 64. Penn. Died Junc24, 64. Sp 665. 1690 Roff, W. H., Lieut., II, June 6, Left. Surg. P. E. Hubon, 28th 1734 Shuster, G., Serg t, G, June 27, Right. Surg. A. C. Messenger, 2d N. Y. H. A., age 35. -, 04. Mass. Died June 30, 1864. 30th Ohio. 27, 64. 57th Ohio. Died July 26, 1864. 1G91 Roarers, G., Pt.,K, 104th July 8, Right. Died July 8, 1864. 1735 Silman.W. L., Corp l, K, July 3, Left. Died July 28, 1863. Ohio, age 19. 8, 64. 32d Mass. 3. 63. 1692 Rogers, S., Pt., F, 1st June 18, Left. Died August 6, 1864. 1736 Simmons, J. K., Pt., D, April 1, Left; (also wound of right leg.) Maine, age 21. 18, 64. 21i;th Penn., age 38. 1, 65. Surgeon A. A. White, 8th Md. 1693 Rolfe, G.,Pt.,H, 2d N.Y. April 1, Left ; circ. Died April 21, 1865 ; Died April 12, 1865; pyaemia. Cavalry, age 36. 1, 65. pyaemia. 1737 Simmons, D. F.,Pt.,G, April 30, Left, Died May 10, 1863. 1694 Rolls, D. B., Pt., D, 6th June 1, Right. Died June 26, 1864. 38th Mass. , 63. N. V. H. A., age 42. 1, 64. 1738 Simmons, S. S., Sergt., Nov. 27, Right. Died December 9, 1863. 1695 Roper, S., Pt., A, 140th June 16, Left; circ. Surg. J.W.Wishart. D, 84th Penn. 28, 63. Penn., age 43. 17, 64. 140th Penn. Hasm.; lig. fem l 1739 Simmons, T. JV., Corp l, July 3, Right. Died July 16. 1863. art. Died Aug. 10, 64 j exh n. C, 14th Tenn. 3, 63. 1696 Rose, W.H.,Pt.,C, 105th May 27, Right. A.Surg.G.M.Trowbridge, 1740 Singer, L., Pt., F, 174th July 11, Left; haem.; fern, ligated. Died Illinois. 27, 64. lythMich. Supposed to be dead. New York. 13, 63. July 17, 1863. 1697 Ross, E., Serg t, G, 52d Dec. 13, . Died December 19, 1862. 1741 Sisey, J., Pt., K, 21st June 27, Left. Surg C. J. Walton, 21st New York. 13, 62. Kentucky. 27, 64. Ky. Died July 6, 1864. 1698 Ross, R. E., Corp l, H, Sept. 19, Left. Died Sept. 30, 1863. 1742 Sloan, M., Pt , H, 47th May 5, Left. Died May 7, 1864. 3(ith Indiana. 20, 63. Indiana. 5, 64. 1699 Rouark, T. H..Pt.,F, 1st Aug. 3, Left. Surg A. A.White,8th Md. 1743 Smith, A. C., Corp l, C, Mar. 19, Right. Died March 28, 1865. Maryland, age 25. 3/64- Died Oct. 6, 64. Spec. 4855. 20th Connecticut. 21, 65. 1700 Roussel, E. G., Capt., G, Sept, 17, . Died October 11, 1862. 1744 Smith, E., Pt., C, 18th May 4, Right: circ. Surg. C. Powers, 7-, d Penn. 17. 62. N. Y. Cavalry, age 38. 4, 64. 160th N.Y. Died June 19. 1864. 1701 Rowe, A. P., Pt., A, 1st June 1(5, Right; (also am p. finger.) Haem, 1745 Smith, H., Pt., l, 14th N. June 7, Right ; flap : (also left leg at knee Maine II. A., age 3D. 16, 64. Died July 2il, 64 ; gangrene and Jersey, age 24. 7, 64. joint.) Died June 17, 1864. pyaemia. Spec. 29U7. 1746 Smith, H., Pt., A, 88th June 18, Right. Died July 3, 1864. 1702 Rumbell, J. F.,Corp l,F, Feb. 21, -. A. Surg. B. Norris.U. S. A. Pennsylvania. 18, 64. 7th Infantry. 22, 62. Died March 25, 1862. 1747 Smith, il.D.,Pt.,H, 18th May 31, Right. Died June 19, 1864. 1703 Rumsev, J. W., Pt., A, June 2, Left. Died July 11, 1865; fatty Infantry. 31, 64. 3d Md , age 43. 4, 64. degenerat n of heart. Spec. 4290. 1748 Smith, J. F., Pt., C, 61st April 8, Right. A. Surg. W. B. Hartman, 1704 Rupert, H., Pt., M, 2d June 24, Left ; circ. Died July 8, 1864. New York, age 17. 9, 65. 116th Penn. Died May 24, 65 ; Penn. Cav., age 21. 25, 64. pyaemia. 1705 Russell, A. P., Capt., 1st Sept. 20, Left ; circular. A. A. Surg. A. A. 1749 Smith, J. N., Pt., E, 7th May 10, Left. Died July 3, 1864 ; pya?m. Maine, a<je 28. 22, 64. Younglove. Died Oct. 2, 1864. Wisconsin, age 17. 10, 64. 1706 Russell, W., Pt., B, 90th Dec. 13, Left. Died Jan. 1, 1863 ; pysemia. 1750 Smith, J. W., Corp l, E, June 27, Right. Died July 18, 1864. Pennsylvania. 13, 62. 42d Indiana. 27, 64. 1707 Ryan, W. J., Pt., E, 2d Sept. 17, Right. Died October 2, 1862. 1751 Smith, T., Serg t, G, 4th June 18, Right ; ant. post. flap. Died June N. Y. State Militia. 17, 62. N. Y. H. A., age 22. 18, 64. 29, 1864 ; exhaustion. 1708 Sargent.O. II. P., Pt., G, May 1, . Died May 30, 1862 ; py 1752 Smith, W., Pt., B, 17th Sept. 19, Left. Died Oct. 11, 1863. 22d Mass, age 30. 1, 62. aemia. Kentucky. 19, 63. 1709 Sclmefler, T., Pt.,C,26th May 25, Right. Died June 20, 1864. 1753 Snodgrass, N., Pt., F, 3d May 14, Right. Died July 29, 1864. Wisconsin. 25, 64. Tennessee, age 24. 14, 64. 1710 Schlechter, J., Pt., ,5th I y 18, 64, Right ; (also fracture of left leg.) 1754 Snvder.W. H., Musician, Nov. 25, Right. Died December 23, 18C3. Cuvalrv, age 27. Primary. Died July 25, 1864. G, 23d Kentucky. 25, 63. 1711 Schmidt, J., Pt., A, 60th July 10, Left. Died July 11, 1863. 1755 Sockwell, B. F., Pt., D, Dec. 13, Laft. Died February 5, 1863. Indiana. 11, " 63. 25th New Jersey. 13, 62. 1712 Schnapp, C., Pt., I; 76th June 20, Left; double flap. Surg. J. H. 1756 Sow, J. L., Serg t, B, May 15, Right. Died July 16, 1864. New York. 21, 64. Beech, 24th Mich. Gang. Died 124th Ohio. 15, 64. July 24, 1864 ; exhaustion. 1757 Sparry, J. E., Corp l, L, July 3, Right. Died July 15, 1863. 1713 Schemer, W., Pt., E, 82d May 3, Right. Died June 5, 1863. 1st Vermont Cavalry. 3, "fi:5. Illinois. 3, 63. 1758 Spaulding, D., Pt., K, May 10, Left ; circ. Died May 20, 1864 ; 1714 Sch wart/ waelder, A.,Pt., Nov. 25, Right. Died Dec. 27, 1863. 16th Maine, age 29. 10, 64. exhaustion. D, 32d Indiana. 25, 63. 1759 Sporleder, L., Pt., B, June 18, Left, Died June 19, 1864. 1715 Soott, C. L., Fife Maior. June 27, Left. Surg. S. H. Kersey, 36th 187th Penn. 18, 64. 3.Jth Indiana. 27, 64. Ind. Died July 28, 1864." 1760 Sprague, T. M., Pt., C, Oct. 19, Left; oval skin and circ. muscles. 1710 Scott, W., Pt., C, 39th Oct. 13, Right ; circ. D ied Nov. 10, 64. 1st Maine. 20, 64. Surg. G. T. Stevens, 77Ui N.Y. Illinois, age ID. 13. 61. Died Oct. 26, 64; toxicoluemia. 1717 Scarcey, D., Pt., E, 19th Deo. 20, Right. Died Feb. 5, 63; pyaemia. 1761 Springer, S., Pt., A, 37th June 18, Left ; circ.: (also w d right thigh.) Kentucky. 20, 62. Wisconsin, age 15. 19, 64. Surg. S. S. French, 20th Mich. 1718 Scidolph, I.. Pt., P,, 39th June 16, Left ; circ. Surg. J. \V. Wishart, Died Sept. 4, 64 ; ch. diarrhoea. New York, age 19. 16. 64. 140th Penn. Died Sept. 27, 64. 1762 Stanislaus, J., Pt., 1, 1st Mar. 25, Right ; ant. post. flap. Died May 1719 Sevoy, W., Pt., A, 27th May 18, Right ; (also wound of left heel ) Maine, age 46. 25, 65. 16. 1865; pyaemic intoxication. Iowa. 18, 64. Died May 21, 1864. 1763 Steel, L. T., Pt., F, llth May 5, Right. Died May 19, 1864. 1700 Shank, A., Pt., C, 1st Oct. 14, Right: ant. post. flap. Surg. E. Pennsylvania. 5, *64. Peun. Cavalry, age 23. 16, 64. Bentley, U. S. V. Died Oct. 24, 1764 Steele.G. S.,Pt.,D.126th June 22, Left ; circ. Surg. A. Van Devere, 1 863 ; haemorrhage. New York, age 23. 23, 64. 66th N. Y. July 23, haem.; fern. 1721! Shanks, J., Pt. t D, 21st June 20, Left. Surg.C. J. Walton,21st Ky. lig. Died July" 29, 64 ; exh n. Kentucky, age 29. 20, 64. Died July 17, 1864. 1765 Sterling, E.E., Corp l, E, May 9, Rijrht ; flap : hapm.; lig. small art. 1722 Shannon, R. G.,C:ipt., F, Mar. 21, RiffJit. Surg. A. B. Monohan,63d 143d Penn., aue 32. 10, 64. Died August 12, (>4 ; pyaemia. 25th Indiana. 21, 65. Ohio. Died March 23, 1865. 1766 Stetson, J.M., Pt., H,57th May 13, Right ; ant. post. flap. Died May 1723 Slui p, C. D., Serg t, D, July 2, Left : (also wound of right thigh.) Mass., age 17. 13, 64. 29, 1864 ; pyaemia. 14; th Penn. 3, 63. Died August 1U, 186:). 1767 Stevens, D. H., Pt., D, May 6, Right. Died June 19, 1864. 1724 Sharp, J., Pt., E, 14th N. July 30. Right : circ. Surg. J. Oliver, 21st 5Cth 1 enn., age 24. 6, 64. Y. H. A., age 20. 33, 64. Mass. Died Sept. 8, 64; pyaem. 1768 Steward, C. A., Pt., 5th May 3, . Died May 11, 1863. 1725 Shattuok, A. B., Capt., Dec. 13, Right. Died December 17, 1832. Maine Battery. 3, 63. 10, llth N. Hampshire. 13, C2. 1769 > Stewart. J., Pt.. D, 77th Mar. 25, Right and left. Died April 17, ]726 Sha\v.A. J.,Pt., 11, 113th June -7, Left. Died July 19, 1864. 1 770 $ New York, ajre 38. 25, 65. 1865; pyaemic intoxication. Ohio. 27, 64. 1771 Stiles, J., Pt., A, 2d Del- July 2, Right. Died July , 1863. 1727 S/<e//on, J. A. J., Lieut., Aug. 30, . Gang. Died Oct. 23, 64; aware. -, 63. G, 50th Tennessee. 30; 64. pyaemia. 1772 Stoner, W. K., Pt,, A, July 3, Right. Surg. A. C. Messenger, 1728 Shelvin, W., Colored Aug. 31, Right. Surg. A. T. Hudson, 26th 53d Ohio. 3, 64. 57th Ohio. Died Sept. 15, 64. Pioneer. 31, 64. Iowa. Died Aug. 31, 1864. 1773 Stooksbury, R., Serg t, F, May 14, Right. Surg. D. L. Heath, 23d 1729 Shields, P., Pt , D, 6th April 29, Left. A. Surg. J. T. Duffiold, 7th 6th Tennessee. 14, " 64. Mich. Died May 26. 1864. Wisconsin. 29, 63. Ind. Bone rem d : hueni.; litr. of 1774 Stout, S., Pt., I, 143d May, 63, Right: double flap. Surg.W. F. fern. June 9, lig. of exter. iliac. Pennsylvania. Primary. Humphrey. 149th Penn. Died Died June 19, 64. Spec. 1143. July 11, 1863. JONES (J ), Incestiyations upon the Mature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies, in United States Sanitary Commission Memoirs, 1871, Surgical Volume II, p. 403. SURG. 111^4 266 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MIUTAKY DESCRIPTION, AXD ACE. DATES. Ol KKATlOXS, Ol EKATOKS, RESULT. {NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, Ol EKATOKS, RESULT. J1775 Stubblebein, H., Pt., C, May 3, Left; circ. Died June 2. 1863; 1817 Trint, J. M., Pt., I, 29th July 4, Left. Gang. Died July 20, 0;! ; 9(ith Penn. 3, 63. pyaemia. Iowa, age 22. 4 63. exhaustion. 1776 Sullivan, M., Corp l, E, Aug. 20, Left. Died September 20, 1864. 1818 Tudar, S.. Pt., G, 61st July 30. Right ; circ. H:em. Died Sept. 17th Wisconsin. 20, 04. Virginia, age 40. 31," 64. 21, 1804. 1777 Snmmcrvillo, .J. H., Pt., Dec. 15, . Feb. 15, 03, reamp. in mid. 1819 Turnball, E., Corp l, K, June 3, Left; circ. Died July 21, 1864; D.llth Pa.Kes.,agel9. 15, 62. third. Died Feb. 28, 03 : pyaBin. 48th N. York, age 19. 3, 64. abscess of brain. 1778 Sumner, F. H., Pt., H, Feb. 7, Left ; ant. post. flap. Died Feb. 1820 Turnbaugh, J., Pt., E, April 2, Loft. Died April 14, 65; exhaus 3.ith Mass., age 29. 7, 65. 25, 1865; pyaemia. 208th Penn., age 21. 2, 65. tion. my Silt ton, S. S., Pt.,K,12th June 3, Right. Surg. F. F. Burmeister, 1821 Turner, T. C., Corp l, C, July 12, Left; circ. A. Surg. J. C. McKee, New Jersey. 3, 64. 69th Penn. Died June 7, 1804. 12th Georgia, age 29 14, 64. U.S.A. Died Dec. 20, 1804; Spec. 3304. exhaustion. Specs. 2842, 3518. 1780 Swain, J. G., Pt., I, 20th Dec. 13, Left; ant. post, flap.; seq. rem d. Photo. Set:, Vol. IV, No. 105. Mass., age 19. 13, 62. Oct. 8. reamp. mid. third. Died !822 Turney, E., Serg t, D, July 3, Right. Surg.W. H.Twiford,27th Oct. 1 0, 03 ; pvaem. Spec. 1265. 27th Indiana. 3. 63. Ind. Died JulyO, 03; second 1781 Sweinhart, P.,Pt.,C,47th Oct. 19, Left; circ. Died Nov. 18, 1864; ary haimnrrhuge. Pen n., age 23. 19. 04. diphtheria. 182: Upton, A., Pt., D, 59th Jan. 11, Left. Died January 22, 1805. 1782 Swisher, C., Pt., T!, 3d A ug. 20, Right. Died in the hands of the Massachusetts. 11, 65. Ya. Mounted Infantry. 20, 63. enemy. 1824 Unknown, 85th N. York. My30, 62 ; (liEem.) Died. 1783 S \vycr, W., Pt., C, 143d May 10. Right : flap. Died June 18. 1864 ; Primary. Pcnn., ago 24. 10, 64. exhaustion. 1825 Unknown, 50th Pennsyl May 6, Left. Died May 27, 1804 ; ex 1784 Tack, G. !>., Pt., E, 77th May 12, Left. Died May 18, 1864. vania. 7, 64. haustion. New York. 12, 64. 1826 Usher, S., Lieut., G, 17th April 5, Left. Died April 7, 1865. 1785 Taggart, C. F., Maj.,2d Oct. 22, Left ; circ. Surg.W.M.Weidman, Maine. 5, 65. Penn. Cav., age 32. 23, 63. 2d Penn. Cav. Died Oct. 24, 03. 1827 Vache, H. W., Pt , K June 3, Left ; flap. Died June 9, 1864. Spec. 1765. 45th Penn., age 20. 3, 64. 1780 Tanner, L. M., Corp l, E, April 2, Right. Died May 18, 1865 : py 1828 Van Blarcome,A.H.,Pt., May 10, Right ; circ. Died June 3, 1864. 37th Mass., age 21. 2, 65. aemia. D, 05th N. Y., age 21. 10, 64. 1787 Tanner, H. J., Serg t, C, July 28, Right. Died August 21, 1864. 1829 Vance, W. H., Pt., G, May 25, Left. Died Juno 3, 1804. 103d Illinois. 28, 64. 33d Ohio. 25/64. 1788 Taylor, A., Pt., A, 1st May 5, . Died May 6, 1864. 1830 Vandamark, D., Pt., B, Aug. 31, . Surg. T. M. Cook, 101st Vermont Cavalry. 5, 61. 30th Indiana. 31, 04. Ohio. Died Sept. 21,1804. 1789 Taylor, D. W., Pt., D, June 27, Left. Surg. T. M. Cook, 101st O. 1831 Van Gordon, J., Pt., F, Sept. 29, Left ; cire. Surg. T. II. Squire, 81st Indiana. 27. 64. Died July 3, 1804. 58th Penn. 30, 64. 89th New York. Died October 1790 Taylor, K., Pt., G, 5th July 3. . Died July 11, 1863. 30, 1804. New Hampshire. 3, 63. 1832 Van Ingen.G., Adjutant, Sept. 17, . Died Oct. 20, 62 ; diarrhrca. 1791 Taylor, W., Pt , E, 188th Mar. 31, Left. Died April 12, 1865. 89th N. Y., age 9. 19, 62. New York. 31, 05. 1833 Van Vliet, J., 1 t., H, May 25, Right: (also excision of right ra 17.42 Terry, W. B., Pt., B, 6th Oct. 7, Left. Died Nov. 1, 1864. 107th New York. 25," 64. dius.) Died June 24, 1864. Connecticut. 7, 64. 1834 Vaughan, J., Pt., F, 6th Jan. 2, Right. A. A. Surg. W. B. Cary. 1703 Theurer, P., Pt., D, 82d May 25, Right ; circ. Surg. G. M. Beaks. Kentucky. 4, 63. Died January 11, 1863. Ohio, age 3. . 25, 64. 141st N. Y. Died July 14, 64 ; 1835 Viele, M., Pt., D, lllth June 16, Left; circ. Surg. J. W. Wishart, exhaustion. New York. 16, 64. 140th Penn. Died June 27. 04. 17!)4 Thomas, B., Pt., G, 70th May 15, Right. A. Surg D.L. Je\vett,20th 1836 Violet, J.,Corp l, A, 13th Sept. 29, Left ; (also wound of right thigh.) Indiana. 15, 64. Conn. Died June 21, 1864. Penn. Cav., age 22. 29, 64. Died Jan. 20, 1865. 179. ) Thomas, J. L., Pt., 15, 2d May 27, . Died June 19. 1862. 1837 Wager, J. A., 1 t., C, May 17, Left. May 19, rem. of bone. Died Maine. 27. 62. 115th N. Y., age 19. 17," 64. June 6, 1804 ; irritative fever. 17% Tlitrmasrm. .7..Pt.,B.49th July 14, Left : circ. Died July 20, 1864 ; 1838 Walby, M., Pt., D, 114th Sept. 19, Left; circ. Surg. L. P. Wagner. North Carolina, age 28. 14," 04. gangrene. New York. 19, 64. 114th N. Y. Died Oct. 7, 1804 ; 1797 Thompson, G., Pt., A, June 3, Left; circ. Surg. F. F. Burmeis- pyainin. 71st Pcnn., age 50. 3, 04. ter, 69th Penn. Died Aug. 23, 1839 Walker, A. H., Pt., K, June 21, Right. Surg. R. H. Tipton, 90th 1804 ; ch. diarrhoea. Spec. 3489. 31st Indiana, age 24. 21, 64. Ohio. Died JulylS, 04; pywm. 1798 Thompson, T. Ji., 1 t., G, July 2, Left. Surg. H. M. MoAbce, 4th 1840 Walker, L. M., Pt., A, June 22, Right. Died June 30, 1804. 52d North Carolina. 3, 03. Ohio. Dred Aug. 9, 1803. 39th Mass., age 22. 22, 04. 179!) Thompson, K.W.,Pt.,G, July 22. Left. Surg. F. N. Barnes, 110th 1841 Walker, S., Lieut., D, Dec. 13. Right. Surg. C. Gray, 7th N. Y. 53d Ohio, age 23. 22, 64. Illinois. Died Nov 2,1864. 133d Penn. 13, 62. Died Dec. 18, 1802. 1800 Thompson, Tr.,Pt.,I, 12th May 15, Right. Died June 27, 1804. 1842 Wallace, W. C., Capt., Aug. 19, Left; cire. Surg. W. V. White, Virginia. 15,"04. A, Olst Virginia. 19, 04. 57th Mass. Died Aug. 22, 1804. 1801 Thorp, E., Pt., G, 1st Aug. 4, L t :circ. A.A.Surg.W.S.Adams. 1843 2 Ward.D., Corp l, H,13th Oct. 19, R t. Surg. G. T. Stevens, 77th N. Penn. Art y, age 20. 5, 04. Haam.; fern. art. tied. Died Aug. West Va., age 19. 20, 04. Y. Dec. 30, rein, of bone. Died 12, 64: hsem. Specs. 3929, 3900. Jan. 10, 65. Spe.cs. 4219, 4223. 1802 Tickner, W., Pt., D,9Cth Sept. 17, Left. Died Nov. 10, 1862. 1844 IFard, GMT., Pt.,K, 13th July 3, Left; (also wound of right leg.) Pennsylvania. 17, 02. North Carolina. 3, fe. Died July 12, 1863. 180:i Tiller, G. M., Lieut.. C. Dec. 15, Right; circ.; (also w nd left leg.) 1845 Ward, J., Pt., C, 98th N. May 16, Right. Died August 29, 1804 ; 04th Miss., age 20. 15, 64. A.A^Surg.F.B.Nossinger. Died York, age 21. 16, 64. exhaustion. Jan l, 1865; tetanus. 1846 Ward, J. H., Pt., D, 27th May 12, . Surg. L. W. Bliss, 51st N. 1804 Tillinger, C., Lieut., K, Aug. 10, . Died Sept. 5, 1861. Massachusetts. 12, 04. Y. Died May , 1804. 3d Missouri. 10. 01. 1847 Warner. J.. Serg t, F, 28th June 17, Right. Surg. E. B. Glick, 40th 1805 Tindall, J., Pt., E, 1st Feb. 8, Left. Died Feb. 13,1804. Spec*. Kentucky. 17, 04. Indiana. Died June 20, 1864. Delaware, age 38. 8, 04. 2115,2087,2041. 18-18 Watsoti, J. T,Pt.,T, 26th June 3, . Died June 11,1864; diar 1806 Tinker.G.. Corp l, I, 27th Nov. 25, Left; circ. Died Jan. 25, 1864. North Carolina. 3, 64. rhea. Illinois, age 19. 27. 03. 1849 Watts, T., Pt., F, 26th Nov. 27, Right. Died Dec. 9, 1863. 1807 Tipton, S., Pt., II, 97th June 27, Left. Surg. J.H. Hutchison, 15th Pennsylvania. 27, 63. Indiana. 27, 64. Mich. Died July 20, 180-1. 1850 Wearer, A., Pt., G, 63d June 29, Right. Died June 29, 1864. 1808 Todd.O.W., Major, 91st Dec. 13, . Died Dec. 1 9, 1802. Georgia. 29, 64. Pennsylvania. 13, 62. 1851 Webster, /?. L., Pt., A, May4, 63, Left; cirn. Died June 17, 1863; 1809 Tomilson, A., Pt., I, 39th Aug. 10, Right; circ. Haem. Died Sept. 21st North Carolina. Primary. debility. Illinois, age 21. 16, 04. 14, 04 ; syncope. 1852 Week, I..Pt., D, 1st New Dec. 13, Right. Died March 21, 1863. 1810 Tomlinson, A., Pt., E, June 1 , Right ; circ. Surg. P. E. Hubon, York Artillery. 13, 62. 110th Penn., age 30. 1, 04. 28th Mass. Died June 18. 1804. 1853 Weir,J. A., Pt., K, 3d July , . Died July 8, 1863 ; erysip 1811 Tompkins.G., Pt.,G,84th Dec. 31, Left. Died Jan. 19, 1863. Virffinia. , : 63. elas ; tetanus. 1812 Illinois. Tourtelotte.C. A., Serg t, 31, 62. June 18, Left. Died August 15, 1864. 1854 Welin, P., Pt..E, 1st Min nesota. July 3, 3, 63. Left. Died July 26, 1863. II, 18th Conn. 18, 64. 1855 Weller.G. A.,Pt.,C, 54th May 15, Left. Died June 14, 1864. 1813 Toy, J., Pt., E, 7th Mis June 25, Left ; circ. Surg. J. S. Reeves, Pennsylvania. 15, 64. 1814 souri. Trauseht, N., Pt.,F, 14th Oct. 19, 78th O. Died July 9, 63 ; pyiem. Right ; ant. post, flap ; (also w nd 1850 Wells, E., Pt., I. 12th Iowa, age 21. Dec. 16, 16, 64. Right ; ant. post. flap. Surg. S. W. Huff, 12th Iowa. Profunda lig. Maine, age 28. 19, 64. left arm.) Sphacelus; phlebitis. Died Dec. 21, 64-; haemorrhage. 1815 Tremlett, II. M., Lieut. Mar. 30, Died Nov. 15, 64 ; pyaemia. Left. Died June 6, 1865. 1857 W elman, W. F., Pt., I, 1st Minnesota. July 3, 3, ^S. Left. Died August 2, 1 863. Col., 39th Mass. 30, 05. 1-..- Wesley, D. F., Corp l, Oct. 19, Right. A. Surg. W. H. B. Past, 1816 Trimmer, Adam, Pt., H, 143d Penn., age 21. June 18, 19, 64. Left. Died August 14, 04 ; irri tative fever. K, 128th New York. 20, 64. 128th N. Y. Femoral lig. Died Nov. 1,1864; exhaustion. LIUELT, (J. A.), Suppuratire Osteo- Myelitis (Acute) following Primary Amputation of Left Thigh for Gunshot Injury, in United States Sanitary Commission. Memoirs, 1870, Surgical Volume I, p. 280. *M(T.n.I. (G. M.), in rHwrratiort Ttool-. Ante-Mortnns a,J Pnst-.Vortemx, Baltimore, 1805-66, page 3. SECT. III.] PRIMARY AMPUTATION OF THIGH IN LOWER THIRD. 267 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1859 Weymouth, C., Pt., B, Feb. 11, Right ; circ. Died A pril 20, 1865 ; 1889 irinw,J"..7.,Pt.,Clynch s Dec. 13, Right ; flap. Surg. E. Hutchinson, 3d K. H., age 19. 11, 65. pyaemia. Ga. Battery, age 18. 14, 64. 137th N. Y. Died Jan. 20, 65; J860 Wheeland, \V. J.. Pt., April 1, Left ; ant. post, flap. Died April pysemia. E, 207th Penn., age 32. 1, 65. 16, 1865; pyaemia. L89I Wood, C., Pt.,A, 8th N. June 5, Right; cire. Dr. A. Garcelon. 1861 AVheeler, S. P., Pr., H, May 15, Left. Died June 14, 1864. Y. H. A., age 20. 5, 64. Died Aug. 1, 1864. Spec. 2380. 33d Mass. 15, 64. 1891 Woodcock, H.. Pt., H, June 17, Right. Died July 13, 64 ; shock 1862 1863 (Whelpley, J., Lieut., D, Mar. 25, 25 65. Both. Died March 25, 1865. 1892 109th N. York, age 36. Woolford, J., Pt.,G,19th 18, 64. July 30, and irritative fever. Left; flap. Surg. F. M. Weld, > ist Maine. Col d Troops, age 27. 30, 64. 27th C. T. Died Aug. 10, 1864 ; 1864 Whitaker, D., Serg t, A, April 1, R t; circ.; (fract. left tibia;) fem l exhaustion. 88th Penn., age 20. 1, 65. lig. Died April 20, 65 ; pyaemia. 1893 Woolford. W. H., Pt., A, May 3, Right : ant, post, flap ; sloughing 186"i Whituker, M.,Corp l, 3d Feb. 5, Right; circ. Surg. M. Brucker, 4th Virginia, age 24. 3, %3. Died July 13, 1863. Ohio Batterv. 5, C4. 23d Indiana. Died Mar. 26, 64. 1894 Wray, T. S., Corp l, F, May8, Right ; double flnp. Died Sept. 186(i White, S., Pt., I, 33d Julv 20, ; (also wound of other leg.) 10th Penn. Res.,age 33. 8, 64. 3, 1864. Indiana. , 64. Died July 30. 1864. 1895 Wright, G. W., Serg t, May 5, Right. Died May 11, 1864. 1867 White, B. W., Pt., D, May 15, Right. Died June 12, 1864. G,3d Vermont, 5, 64. 118th Ohio. 15, Vi4. 1896 Wright, W., Pt., B, 8th May 7, Lfift. Died June 26, 1864; ex 1868 White, C. D., , 4th Deo. 16, Right; flap. Surg. J. R. Ludlow, Connecticut, age 47. 7, 64. haustion. Louisiana, age 36. 17, 64. U. S.V. Died Jan. 21, 1865. 1897 Yeagher, F., Corp l, C, June 17, Right ; circ. Surg. J. W. Wishart, 1869 White, If. C., Pt, H, 1st Julv 3, Right, Surg. J. L. Dunn, 109th 26th Mich., age 44. 17, 64. 140th Penn. Haeni.; lig.; gang. North Carolina. 3, 63. Penn. Died July 5, 1863. Died July 5, 64; sec. haem. 1870 White, J. S.,Pt.,D, 55th May 14, Right. Died June 14,1864; ex 1898 Yockey, P., Pt., D, 29th July 22, Right. Sept., 1864, reamp. mid. Penn., age 40. 14, 64. haustion. Ohio, age 29. 22. 64. third. Haem.; fern, and external 1871 Whiteley, J., Pt.,G, 97th June 19, Right ; circ. Died July 1, 1864. iliac art cs ligated. (Also w nd New York, age 40. 19, 64. right arm.) Died April 23, 65; 1872 Whitman, J. ., Pt., I, June 26, Right. Died July 4, 1864. chronic diarrhoea. 58th Mass. 27, 64. 1899 Young, M. G., Pt., D, May 17, Left. Gangrene; diarrhoea. Died 1873 Whitney, H. D., Pt,, D, Dec. 13, . Surg. C. S. Wood, 66th N. 23d Iowa. 17, 63. August 6, 1863. 145th Penn. 13, 62. York. Died Jan. 11, 1863. 1900 Young, W. F., Pt., A, Oct. 19, Left ; lat. flap. Hsem.; inferior 1874 Wilcox. D., Serg t, K, Nov. 25, Right. Surg. E. J. Buck, 18th 114 thN. York, age 26. 19. 64. perforating artery ligated. Died 103d Illinois. 25. 63. Wis. Died Dec. 19, 1863. Nov. 27, 1864; exhaustion. 1875 Wild, W. H., Corp l, C, Sept. 30, Left, Died Oct. 29, 64 ; pyaemia. 1901 Anderson, H., Pt., D, Sept. 1, Right; (alsow ndlefthip.) Surg. 118th Penn., age 31. Oct. 1, 64. 39th Georgia. -, 64. A. C. Messenger, 57th Ohio. 1876 Wiley, A. J., Pt,, H, June I, Left ; circ. Surg.D.F.McKinney, 1902 Barnum, J. C.. Corp l, Aug. 31, Left. Surg. J. A. Lair, 53d Ohio. 87th Penn., age 26. 2, 64. 87th Penn. Gang. Died June D, 29th Mississippi. 31, 64. 9, 1864: asthenia. 1903 Brockley, W., Pt., D, 8th April 20, Right; semi-lunar flaps. Surg. 1877 Wilhelm, E., Pt., F, 81st Mar. 25, Left. Died April 8, 1865. North Carolina. 20, 64. C. H. Ladd, C. S. A. Penn., age 16. 26, 65. 1904 Casner, D., Pt,, E, 122d June 1, Left. 1878 Wilkes.J., Corp l, I,170th June 22, Left. Surg. J. A. Douglass, llth Ohio. -, 64. New York, use 31. 22, 64. Mass. Died July 12, 1864. 1905 Eggleston. A., Pt., D, May 15, Right. 1879 Wilkon, R.,Serg t,C,lst June 14, Right, Died Aug. 10, 63 ; wound lllth Penn. , 64. Louisiana. 14, 63. and diarrhoea. 1906 Fender, F. D., Pt,, G.lst Sept, 30, Left ; circular. 1880 Will, T., Pt., G,21st Pa. June 16, Right ; ant. post. flap. Died July South Carolina. 30, 64. Cavalry, age 39. 16, 64. 31, 1864. 1907 Fierhaut, R., Pt., B, 2d June!?, Right. Not a pensioner. 1881 Willard, A., Pt., G, 97th Sept, 17, Right. Died October 14, 1862. P. H. B. Md. , 64. New York, age 26. 17, 62. 1908 Gnlledge, J., Pt., D, 21st May 16, ; posterior flap ; sloughing. 1882 Willard, G. W., Corp l, Aug. 19, R t; circ. Surg.W.V.White,57th S. Carolina, age 51. 17, 64. H, 57th Mass., age 35. 20, 64. Mass. Died Sept. 16, 6 4 ; pyaem. 1909 Harlien, T., Pt., A, 12th June 2, 1883 1 Williams, A., Pt., , Sept. 17, Left; flap. Confed. surg. Died Georgia. 2, 64. 13th Miss., age 25. is, 62. Sept, 21, 1862; pyaemia. 1910 McSparrain, J. W., Pt., May 27, Right. Not on the Pension List. 1884 Williamson" I . G., Pt,, July 3, Right. Died Sept. 5, 1863; haem I, 62d Penn. , 62. D, 5th Texas, age 24. 3. 63. orrhage. 1911 Nelson, R., Pt., G, 7th Sept. 29, Left. Not a pensioner. 188.5 Willis, J., Pt., K, 2d In July 3, Right. Died July 26, 1863. Col d Troops, age 20. , 64. fantry. 4, 63. 1912 Powell, T. F., Adj t, 23d May . . Surgeon W. B. Fox, 8th 1886 Wilson, J., Pt., A, 27th Nov. 24, Right ; circ. Surg. B. N. Bond, North Carolina. , 64. Michigan. Missouri. 24, 63. 27th Missouri. Died. 1913 Price, J. W., Pt., I, 30th Sept. ], Right ; flap. Surgeon J. Pogue, 1887 Wilson, T. A.. Capt., B, April 1, . Died April 25, 1865. Georgia. 1, 64. 66th Illinois. 146th New York. 1, 65. 1914 White, J. K., Corp l, B, April 20, Right; Semi-lunar flaps. Surg. 1888 Wimberlij, W., Pt., D, Dec. 16, Left ; lateral flap. Died Dec. 18, 24th N. C. 20, 64. C. H. Ladd, C. S. A. 4(>th Tennessee, age 22. 17, 64. 1864 ; haemorrhage. In two of the nineteen hundred and fourteen cases the amputation of the thigh was followed by successful re-amputation at the hip; 2 in five, the opposite limb was amputated either in the leg or in the ankle joint; 3 and in nine, the amputation in the thigh was accom panied by operations in the upper extremities. 4 The seat of fracture was, in the lower third of femur, in four hundred and twenty-six; in the knee joint, in eleven hundred and thirty-three; 1 FISHER (G. J.), Report of Fifty-sei-en Casts of Amputations in the Hospitals near Sharpsburg, Md., after the Battle of Antietam, Sept. 17, 1862, in Am. Jour. Me,d. Sci., 1863, Vol. XLV, p. 47. 2 Case of Private J. Fabry, K, 4th Artillery (TABLE XXXII, No. 267, p. 248; CASE 330, p. 153; and TABLE XVIII, No. 2, p. 159, ante), and rase of Private R. A. Vide, E, 43d North Carolina (TABLE XXXII, No. 890, p. 255; CASE 334, p. 157; and TABLE XVIII. No. 6, p. 150). 3 Sergeant P. Bradley, 16th Michigan (TABLE XXXII, No. 1071, p. 257), amputation of left thigh and right leg, fatal Pt. C. L. Johnson, B. 1st Tennessee (TABLE XXXII, No. 1402, p. 261), amputation left thigh and right leg, fatal; Pt. L. O. Lamphere, G, 21st Connecticut (TABLE XXXII, No. 1445, p. 262), amputation left thigh and right leg, fatal ; Pt. J. R. Lewis, II. 53d Georgia (TABLE XXXII, No. 1469, p. 262), amputation of left thigh and right leg, fatal; Lieut, A. Birmingham. A, 69th New York (TABLE XXXII, No. 1049, p. 257). amputation of right thigh and left leg at ankle joint, fatal. 4 Private F. Rose, D, 57th N. Y. (TABLE XXXII, No. 729, p. 2j.i, ante, and Second Surg. Vol., TABLE LXVIII, No. 892, p. 71 J). amputation of thigh and arm, recovery ; Capt. II. Kircher, E, 12th Mo. (TABLE XXXII, No. 471, p. 250, and Second Surg. Vol.. TABLE LXX, No. 481, p. 727), amputation of left thigh and right arm, recovery; Pt. J. S. Fay, F, 13th Mass. (TABLE XXXII, No. 273, p. 248, and Second Surg. Vol., TABLE CXXXIII, No. 378, p. 972), amputation thigh and forearm, recovery; Corp l C. Lawrence, E, 90th N. Y. (TABLE XXXII, No. 503, p. 251. ante, and Second Surg. Vol., TABLE CXXXIII, No. 463, p. 973), amputation of thigh and forearm, recovery; Corp l T. Costello, E, 93d Ind. (TABLE XXXII, No. 167, p. 247, ante, and Second Surg. Vol. TABLE CXXXIII, No. 679, p. 975), amputation of thigh and forearm, recovery; Corp l A. Kretzler, D, 162d N. Y. (TABLE XXXII, No. 487, p. 250, ante, and Second Surg. Vol., TABLE CXXXIII, No. 756, p. 976), amputation of thigh and forearm, recovery; Corp l G. W. Hays, K, 2d Mich. (TABLE XXXII, No. 1336, p. 260, ante), amputation of left thigh and excision of right knee joint, fatal; Pt. N. W. Henderson, E, 123d Ohio (TABLE XXXII, No. 1338, p. 260, ante, and Second Surg. Vol., TABLE CXXVII, No. 27, p. 952). amputation of thigh and excision of ulna, fatal; Pt. J. Van Vliet, II, 107th N. Y. (TABLE XXXII, No. 1833, p. 266, antf, and Second Surg. Vol., TABLE CXXVII, No. 66, p. 952). amputation of thigh and excision of radius, fatal. 268 INJURIES OF THE LOWER EXTREMITIES. IOHAP. X. in the leg, in three hundred and fifty-three; and in the foot, in two instances. Pyaemia was noted in one hundred and twenty-eight, gangrene in one hundred and twelve, and tetanus in seven instances. Primary Amputations in the Shaft of the Femur without Indication of the Seat of Incision. Three hundred and forty-five primary amputations in the thigh were recorded in which the precise seat of the operation was not specified. The cases are well authen ticated, but the histories are frequently deficient in detail. In twenty-one the issue as to fatality could not be ascertained. Thirty-nine were successful and two hundred and eighty- five fatal, a mortality of 87.9 per cent. The thirty-nine successful operations were per formed on Confederate soldiers; the two hundred and eighty -five fatal operations were performed on two hundred and eighty-one patients, of whom two hundred and thirty-six were Union and forty-five were Confederate soldiers. The operations were on the right side in one hundred and five, on the left in one hundred and -seven, and in one hundred and thirty-three instances the side was not indicated. Brief abstracts of the cases will be found in the following table : TABLE XXXIII. Summary of Three Hundred and Forty-Jive Cases of Primary Amputations in the Thigh for Shot Frac ture, the Point of Ablation unspecified. Recoveries, 139 ; Deaths, 40324 ; Results unknown, 325 345. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPKRATOHS, RESULT. 1 Allen, J. T., Pt., F, 2d Aug. 20, . Surg. Thomas, C. S. A. 27 Mullin, T. Q., Serg t, E, May 31, . Surg. J. T. Gilmore.C.S.A. Florida. 21, 62. Recovery. llth Mississippi. 31 , 62. Disch d July 7, 1862. 2 Ard, G. W., Pt., K, 2d Sept. 17, Right. Surgs. G. H. Humphreys, 28 Pascoe, C. F., Pt., D, May 6, . Surg. D. G. Peats, C. S. A. Georgia, age 29. 17, 62. 9th N. Y., and T. H. Squire, 89th 21st Mississippi. 7, 64. Recovery. 3 Ashby, D. D., Pt., Jeff. July 3, N. Y. Disch d May 16, 63. . Surg. Stone, C. S. A. 29 Pitman, W. E., Lieut., E, 10th Virginia. Aug. 9, 11, 62. . Su rg.W.Campbell.C.S.A. Recovery. 4 Davis Legion. Bennett, R.ll., Serg t.G, 3, 63. May 6, Recovery. . Surg. P. Griffin, C. S. A. 30 Powe, T. E., Captain, C, 8th South Carolina. July , , 63. Left. Transferred Sept. 14, 1863. 18th Mississippi. 7, 64. Recovery. 31 Raftray, P., Pt., C, 21st May 6, Left. Surg. D. G. Peats, C. S. A. 5 Bones, T. M., Serg t, A, Sept. 19, . Surg. Griggs, C. S. A. Mississippi. 6, 64. Recovery. 6 5th Georgia. Booker, J. F., Serg t, E, 19, 63. May 20, Recovery. . Surg. Headley, C. S. A. 32 Rogers, W., Pt., D, 33d Alabama. Sept. 20, 20, 63. . Recovery. 7th Arkansas. 20, 62. Recovery. 33 Smith, G. T., Corp l, D, June 24, . Surg. J. B. Fontaine, C. 7 Brown, H. C., 1st Georgia. Sept. 14, Left. Point Lookout for exch nge. 35th Mississippi. 24, 63. S. A. Recovery. 15, 62. Dec. 13,1862. 34 Smith, S. P., Pt., F, 16th Dec. 13, . Surgeon Snell, C. S. A. 8 Caldwell, J., Pt., H, 45th July 18, . Recovery. Mississippi. 13, 62. Recovery. 9 Virginia. Carter. H., Pt., A, 6th 18, 64. June 21, . Surgeon E. M. Seabrook, 35 Stewart, J. W., Pt., F, 44th Alabama. May 25, 25, 64. Left. Furloughed July 24, 1864. Virginia. 2:3, 62. C. S. A. Recovery. 36 Walker, L. A., Corp l, April 14, . Sure:. Foulks, C. S. A. 10 Clifttm. T. B.. Pt., I, 1st North Carolina. July 2, 2, fe. . Surg. J. B. M. Cromwell, P. A. C. S. Recovery. 37 Rogue s Battalion. Wayne, J. J., Pt., A, 14, 63. July 10, Recovery. Left. Nov. 19, extr. nee. bone. 11 Dukes, A., Pt., C, 17th Mississippi. July , , 63. . Transferred Oct. 21, 1863. llth Georgia, age 33. 11, 63. Gangrene. Exchanged March 3, J864. 12 Eden, C. At., Serg t, H, June 27, . Recovery. 38 White, D. A., Pt., H, Sept. 19, . Surg. Brown, 3d Ark. 14th Alabama. 27, 62. 3d Arkansas. 30. 63. Recovery. 13 Eller, S.. Pt., H, Slid N. July 1, . Surg. Parson, C. S. A. 39 Williams, E. G., Serg t, May 16, . Recovery. 14 Carolina. Ether idge, J. D., Pt., G, 1, 63. Dec. 13, Recovery. . Surg. Huit, C. S. A. 40 E, llth Virginia. Ackerly, H. E., Pt., C, 16, 64. Dec. 13, . Died Dec. 24, 1862. 14th South Carolina. 13, 62. Recovery. 12th New York. 13, 62. 15 Garner, F. M., Pt., C, July 14, . Surg. J. W. McGee, 51st 41 Alfred, L. S., Corp l, B, Sept. 19, Left. Died October 8, 1863. 51st North Carolina. 14, 63. N. C. Recovery. 22d Illinois. 19, 63. 16 Golladaij, J. T., Pt., I, 52d Virginia. Aug. 29, 29, 62. . Surg. Lewis, C. S. A. Recovery. 42 Allman, H., Pt. , H, 38th Ohio. Sept. 1, 1, 64. Left. Died Sept. 8, 1864. 17 Grimes, G. C., Pt., C, 14th Alabama. May 24, 25, 64. Left. Furloughed July 20, 1864. 43 Anderson, W., Serg t, D, 118th Pennsylvania. Sept. 17, , 62. . Died September 19, 1862. 18 Hartley, J., Pt., K, 7th Texas. Sept. 19, 19, 63. . Surg. G. G. Roy, C. S. A. Recovery. I 44 Armspoker, J., Pt., H, 96th Ohio. Jan. 11, 11, 63. Left. Surg.D. W.Henderson, 9Cth Ohio. Died Jan. 22, 1863. 19 Herring, J. F., Pt., F, 8th N.Carolina, age 42. Sept, 30, Got. 1, 64. Left. Prison Feb. 1, 1865. 45 Austin, A., Lieut., 1st New Jersey Cavalry. Aug. 9, 9, ? 62. Right. Died August 9, 1862. 20 Hurst, M., Pt., C, 12th Tennessee Cavalry. July 13, 13, 64. Left. Recovery. 46 Austin, C., Pt , F, 18th Mass., age 26. Sept. 17, 62. . Died September 24, 1862. 21 Jackson, J. T., Pt., 1, 1st Georgia, age 18. Right. Exchanged Jan. 16, 65. 47 Bachelor, A., Pt., D, 5th Michigan. May 5, 5, 62. . Died May 5, 1862. 22 Kiser, J. F., Pt., E, 25th Virginia. June 8, 8, 62. Left. Surgeon Opie, C. S. A. Disch d August 29, 1862. 48 Baker, E., Pt, A, 6th Missouri. May 15, 15, 64. Right. Surg. S. P. Bonner, 47th Ohio. Died May 26, 1864. 23 Kissenger, H. H., Pt., F, 24th Virginia. Sept. 29, 29. 64. . Surg. Hope, C. S. A. Recovery. 49 Baird, R., Pt., C, 3d Tow&. July 12, ) 63. Left. Died July 15, 1863. 24 LeRoy, J., Pt., D, 8th Alabama. Aug. 16, 16, 64. . Surg. Royston, C. S. A. Recovery. 50 Barger, J. E., Pt., G, 2(1 Virginia flfiTC 40. May 30, , 64. Right. Died Junel4, 64; pyaem. 25 26 AlcCray, J. 11., Pt., F, Sept 30, Oct. 1, 64. April 16, 16, 62. Left. Prison February 18, 1865. . Surg. White, C. S. A. Recovery. 51 52 Baxter, C., Corp l, C, 9th New York Cavalry. Benson, A.J.,Pt.,l, 5th Alabama. Aug. 29, 29, 64. May 5, 5, 64. Right. Died Sept. 1. 1864. Right. Died May 28, 1864. 28th Georgia, age 30. Mealor, JF.P.,Pt., Troup Artillery. 1 li i SECT. III.] PRIMARY AMPUTATIONS OF THE THIGH. 269 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPKKATOUS, RESULT. 53 Bernard, O., Lieut., G, Deo. 17, . Surg. H. P. Ritter, 8th N. 99 Dubindach, C., Pt., C, July 14, Left. Died July 15, 1864. 10th North Carolina. 17, 62. Carolina. Died Dec. 17, 1862. 33d Missouri. 14, 64. 54 Beverly, G. H., Pt., C, Dec. 13, . Died December 26, 1862. 100 Eddy, A. R., Pt,, H, 1st Oct. 8, . Died October 10, 1862. 3U Cavalry. 13, 62. Mich. Engineers. 8, 62. 55 Bishop, G. T., Pt., I, July 3, Left. Died July 12, 1863. 101 Edwards, L>., Pt., B, 61st Sept. 30, Left. Died October 25, 1864 ; py 141st Pennsylvania. 3, r (i3. North Carolina, age 44. 30, 64. aemia. 56 Blackburn, i ., Pt., E, Aug. 30, . Died September 19, 1862. 102 Eikley, G., Serg t, E, Nov. 27, Right. Died December 11, 1863. 73(1 Pennsylvania. 30, 62. 7th Ohio. 27, 63. 57 Blaisdell, J. H. D., Pt., May 27, Right. Died May 30, 1863. 103 Ellis, A. C., Pt., B, 2d July 1, Right. Dr. Crawford. Died July H, 15th New Hani p. 27, 63. Florida. 3, 62. 4, 1862. 58 Blaxhaui, R., Corp l, E, Sept. 17, . Died September 28, 1862. 104 Ershman, F., Pt., G, July 1, . Died July 2, 1863. 9th New York. 17, 62. 147th N. Y., age 40. 2. r 63. 59 Bohor, A , Pt., H, 100th June 1, Left; (also wound right thigh;) 105 Estergreen. F., Pt., H, June 20, Left. Died July 3, 1864. New York. 1, 62. gangrene. Died Juno 9, 1862. 89th Illinois. 20, 64. CO Bousner, M., Pt., A, 5th May 31, . Died June 9. 1862. 106 Farley.-J., Lieut., G, 8th July 4, Left. Died December 5, 1863. Michigan. , 62. Missouri Cavalry. 4, 63. 61 Bower, A.. Pt., E, lllth Mar. 31, Right. Surg.W.Vasburgh, lllth 107 Fichell, A., Pt., B, 27th May 10, Right ; circ. Died May 18, 1864. New York. 31. 65. N. Y. Died March 31 , 1865. Michigan, age 20. 10, 64. 62 Boyles, B., Pt., I, 28th July 12, Left. Died July 15, 1863. 108 Finlay, J., Pt., C, 52d Dec. 13, . Died December 20, 1862. Illinois. , 63. New York. 13. 62. 63 Broad, L., Pt., C, 5th May 5, . Died May 7, 1862. 109 Finley, M. K., Lieut., F, April 8, . Died April 21, 1864. Michigan. 5, 62. 162d New York. 8, 64. f>4 Brown, B. F., Pt., C, 22d May 7, ; (also w nds leg and neck.) 110 Fish, E. A., Capt., A, Sept. 29, Left. Died October 1, 1864 ; ex Massachusetts, age 23. 7, 64. Died May 17, 64 ; ulceration of 81st New York, age 42. 29, 64. haustion. jugular vein. Autopsy. 111 Fitzpatrick, J., Corp l, April 8, Left. Died April , 1864. 65 Brown, W. M., Pt., G, May 14, Right. Died May 14, 1864. F, 173d New York. 8, 64. 12th Illinois. 14, 64. 112 Flomerfield, P., Pt., F, Sept. 17, Left. Died Sept. 18, 1862. 66 Burke, T. A., Lieut,, E, June 15, Right. Died Sept. 1, 64 ; pyaem. 69th New York. 18, 62. 67 16th Iowa, age 23. Buslinel). 11. 8., Corp l, 15, 64. May 12, Right. Died May 21, 1864. 113 Flowers, M.,Pt., H. 101st New York, age 26. Aug. 30, 30, 62. . Sept. 19, haem., 40 oz.; lig. femoral. Died Sept. 24, 1862; I, 17th Michigan. 12, 64. exhaustion. 68 Cautrell, A. D., Pt., D, Dec. 31, Left. Died January 2, 1863. 114 Folk, J. S., Pt., B, 141st July 3, Left; (also wound of right hip.) 18th Infantry. 31, 62. Pennsylvania. 3, fe. Died July 27, 1863. 69 Cartwriarlit, H. C., Pt., April 8, Left. Died June 8, 1864. 115 Fosket,O.,Pt.,F.34thN. Dec. 13, Left. Died December 31, 1862; 11. 13Uth Illinois. 8, 64. York, age 19. 13, 62. pyaemia. 70 Castar, S., Pt., B, 2d July 2, Right. Died July 30, 63 ; pyaem. 116 Foss, J., Serg t, C, 59th Sept. 17. Thigh and leg amputated. Died Wisconsin. 3, 63. New York. 17, 62. Sept. 21, 18(j-3. 71 Chapman, B , Corp l, A, Feb. 14, Right. Died February 19, 1865. 117 Fouts, M.N., Pt., G, 4th Oct. 23, Right. Died October 25, 1864. 14th N. Y. H vy Art. 14, 65. Missouri S. M. C. 23, 64. 72 Chasteen. M., Pt., D, Dec. 15, . A. Surg. R. J. Hill, 45th O. 118 Freeman, A., Pt., A, May 15, Left; stump alive with maggots; 81st Indiana. 15, 64. Died December 16, 1864. 155th Penn.. age 31. 15, 64. bled to death May 26, 1864. 73 Cherrington. C. H., Pt., Oct. 19, . Died October 20, 1864. 119 Gartland, J.. Color Bear Sept. 17, Right. Died September 25, 1 862. K. 36th Oliio. 19, 64. er, A, 72d Penn. 17, 62. 74 Clark, D. C., Pt., K, June 29. Right. Died July 1, 1864. 120 Gates, J., Pt,, F, 8th Sept. 17, Left. Died October 14, 1862. 188th Penn. 29, 64. Pennsylvania. 17, 62. 75 Clarke, J., Serg t, H, Mar. 13, . Died April 7, 1862. 121 Gillen, N., Pt., I, 69th Sept. 17, Left. Died September 27, 1862. 27th Ohio. 13, 62. Pennsylvania. 17, 62. 76 Coleman, D. G., Pt., A, May 3, Right. Died May 26, 1863. 122 Gillespie, K. G., Pt., F, July , . Died July 8, 1863. 30th North Carolina. 3, r 63. Phillips Legion. , 63. 77 Collins, II., Lieut., D. May 27, Left. Surg. A. T. Hudson, 26th 123 Gleasman. C., Pt., H, Sept. 29, Left. Died Oct. 1, 1864 ; haem. 29th Missouri. 27, 64. Iowa. Died June 3, 1864. 117th New York. 29, 64. 78 Collins, It. J., Pt., F, Dec. 13, Left. Died December 30, 1862. 124 Glover, W. E., Pt., D, July , Left. Died July 24, 1864. 108th New York. 13, 62. 118th New York. , 64. 79 Connell, P., Corp l, E, Jan. 2, . Died Januarys, 1863. 125 Godbold, H. L., Lieut., Aug. 23, Left. Died Sept. 27, 62 ; pysem. 35th Indiana. 3, 63. F, 1st Pa. Art., age 23. 23, 62. 80 Couteil, M. K., Pt., A, Oct. 4, . Died. 126 Golding, J. J., Corp l, A, July , . Died July 17, 1863. 13th Missouri. 4, 62. 3d Battalion S. C. , 63. 8L Cook, C. S., Corp l, I, April 13, Left. Died May 29, 1863; chr. 127 Goodling, G., Pt., F, 2d Sept. 17, Right. Died October 21 , 1862. 2."ith Connecticut. 13, 63. diarrhoea. Delaware. 17, 62. 82 Cooper, H. M., Pt., H, AprilS, . Died April 28, 1864. 128? Goodwell, S., Pt., G, Mar. 30, Both. Surgs.W. D. Murray, 161st 2!)th Wisconsin. 8, 64. 129$ 29th Illinois. 30, 65. N. Y., and J. W. Angell, 23d 83 Cramer, A., Ft., F, 31st June 5, Left. Surg.B.N. Bond, 27th Mo. Wis. Died March 31, 1865. Missouri. 5, 63. June 12, artery sloughed; nee.; 130 Gordon, J. B., Lieut., C, June 18, Left. Died June 19, 1864. reamp. Surg. C. G. Strother, 1st West Virginia. 18, 64. 31st Mo. Died June 22, 1863. 131 Goukl,J.M.,Pt.,G,81st Aug. 6, Left: circ. Surg. W. H. Rice, 81st 84 Cramer. S., Pt., B, H2d July 1, Left: (also amp. arm.) Died July New Y ork. age 21. 6, 64. N. Y. Died Sept. 3. 1864. Pennsylvania. 1, 63. 9, 1863. 132 Gould, P. II., Pt., H, Oct. 4, Right. Died October 20, 1862. 85 Cronstein, M., Pt., F. 3d July 3, Right. Died July 6, 1863. 8th Wisconsin. 4. 62. Infantry. 3, f 63. 133 Gregg, J. H., Capt., I, July 3, . Died July 3, 1863; shock. 86 Cuff, W., Pt., D, llth June 7, Right. Died June 10, 1863. 137th New York. 3, 63. Louisiana C. T. -, 63. 134 Grunbine, C., Pt., F, 93d May 5, Right. Died May 5, 1864. 87 Danfortli, H., Pt., H, July 20, Left ; rearap. Died July 31, 64. Pennsylvania. 5, 64. 123<1 New York. 21, 64. 135 Guy, A., Pt., G, 51st N. Oct. 1, Right. Died October 19, 1864 88 Davis, J., Pt., F, 40th April 6, . Died. Carolina, age 44. 1, 64. pvasmia. Illinois. - 62. 136 Gwinn. F., Pt., F, 30th July 28, Left. Died September 6, 1864. 8 J Davis, M., Pt., E, 2d N. July , . Died July 7, 1863. Louisiana. 28, 64. Carolina Batt. , 63. 137 Hair, J., Pt.. K, 61st June 1, Left. Died June 11, 1862. 90 Davis, T.J., Pt., D, 40th April 30, Left. Died June 9, 1864. Pennsylvania. 1, 62. Iowa. , 64. 138 Hale, W. H., Pt., F, May 10, Left. Died May 12, 1864. 91 Dawson, W. R . Pt., E, May 14, Left. Died May 23, 1864. I52d New York. 10, 64. 139th Pennsylvania. 14, 64. 139 Halstead, S. F., Pt., K, July 3, Left. Surg. H. M. McAbee, 4tU 92 Dean, W. C.. Serg t, G, June 12, Right. Died June 15, 1864. lllth New York. 3, 63. Ohio. Died August 2, 1863. 4(!th Kentucky. 12, 64. 140 Hamilton, J. S., Serg t, Oct. 19. . Died October 20, 1864. 93 Deckftt, J. M., Lieut., H, July , . Died July 7, 1863. A, 5th West Virginia. 19, 64. 2d N. Carolina Battery. . 63. 141 Harris, S., Pt,. H, 90th Dec. 15, Left. Died December 16, 1864. 94 Deivnger, 10., Corp l, E, Aug. 30, ; circ. A. Surg. J. A. Arm Ohio. 15, 64. 73d Pennsylvania. 30, 62. strong, 73d Penn. Died Sept, 142 Haslette, F. A., Pt., C, May 6, Right. Died May 17, 1864. 22, 1862. 45th Pennsylvania. 6, 64. 05 Dessart. G., Corp l, B, June 25, . Died July 18, 1862. 143 Hastings. O., Pt.,B, 16th July 22, Left. Surg. II. McKennan, 17tb 74th New York, age 21. 25. 62. Wisconsin. 22," 6-1. Wis. Died July 22, 1864. 96 Devus, P., Pt., E. lllth July 2, . Surg. H. M. McAbee, 4th 144 Hawley, R., Pt., K, 2d Oct. 27, . Died October 31, 1864. New York. 3, 63. Ohio. Died July 12, 1863. South Carolina. 27, 64. 97 Dooley. J., Corp l, I, June 1.4, . Died June~30, 18(53. 145 Hewlett, G.,Pt.,H, llth May 5, Left. Died May 10, 1862. 38th Massachusetts. 14. 63. Mass., age 19. 5, 62. 98 Doty, W. F., Pt., E, Aug. 5, ; (also wound of arm.) Died 146 Hoffadin, J., Pt., F, 7th Dec. 13, Right. Died January 4, 1863; 21st Indiana. 5, V 62. August 6, 1862. New York. 13, 62. pyaemia. 270 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME. MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 147 Holmes, G., Pt., D, 6th New Jersey. May 5, -, fe. . Died May 10, 1862. 195 Martin, J., Pt., I 2d Rhode Island. May 14, 14, 64. . Died May 15, 1864. 148 Hopson, A., Pt., B, 4th Dec. 13, Left. Died December 15, 1862. 196 Maxwell, R., Lieut., H, Mav 8, Left. Surg. J. J. Comfort, 1 st Pa. Vermont. 13, 62. 1st Penn. Rifles. 8, 64. Rifles. Died Mav 12, 1864. 149 Hubbell, W. W., Major, June 7, Right. Died June 7, 1864. 197 McCright, C. M., Corp 1, April 9, . Died April 10, 1865. 62d New York. 7, 64. C, 52d Indiana. 9. 65. 150 Hudson, A., Pt.. B, 43d Nov. 5, . Died November 5, 1864. 198 McFall, H.,Pt., H, 76th .Dec. 13, . Died December 13, 1862. Wisconsin. 5, 64. New York. 13, 62. 151 Hughes. E., Pt., E, 6th Sept. 28, Left : (also wound right thigh.) 199 McMiller,C.,Pt.,C,85th Aug. 16, Left ; sloughing; bfem. Aug. 28, Colored Troops. , 64. Died Oct. 12, 1864. Pennsylvania. 16, 64. re-amp, up. third. A. Surg. C. |l52 Hughes, G . Serg t, B, July 3, Left. Died July 7, 1863. Wagner, U. S. A. Died Sept. 4, lOoth Pennsylvania. 3, 63. 1864 ; haemorrhage. 153 Hughes. J.. Pt., G, 15th Sept. 17, Left. Died September 28, 1862. 200 MsNaughton, J. B., Pt., Dec. 13. Right. Died December 26, 1862. Massachusetts. , 62. F, 108th New York. 13, 62. 154 Hunter. M., Pt., C, 21st July 14, . Died July 1864. 201 Merrill, W. R., Pt., A, Dec. 13, . Died December 20, 1862. Missouri. 14, 64. 6th New Hampshire. 13, 62. 155 Irish, A. J., Pt., G, 9th May 20, Right. Died May 22, 1864 ; ex 202 Men-lit, H, Pt., 1, 33d May 3, Left. Died May 29, 1863. Maine, age 24. 20, 64. haustion and shock. New York. 3, 63. 156 James, W., Pt., I, 122d May 6, Right. June 24, pyaemia. Died 203 Mertins, H., Pt., H, 17th Nov. 25, Right. Surg. E. J. Buck, 18th Ohio, age 29. 6, 64. July 2, 1864; pyaemia. Iowa. 25, 63. Wis. Died Nov. 27, 1863. J57 Jasper, A. F., Pt., E, May 15, Left, Died July 24, 1864. 204 Miller, H., Pt., B, 147th July 2, Right. Died August 3, 1863. 12th Virginia. 15, 64. New York. 4, 63. 158 Johnson, J., Pt., A, lllth April 2, Right. Died May 15, 1865. 205 Mills. W. F., Pt., E, 8th June 16, Right ; (also int. amp. left thigh.) New Y ork. 2, 65. N. Y. H. A., age 42. 16, 64. Surg. S. H. Plumb, 82d N. Y. 159 Johnson, J. E., Pt., A, July 3, Right. July 22, hasmorrh. Died Died June 23, 1864. 153d Penn., age 22. 4, "63. July 22, 1863 : exhaustion. 206 Mills, W., Pt., A, 130th Mar. 9, Left. Surg. V. H. Gregg, 124th 160 Jones. B. M., Pt., H, 5th May , . Erysipelas. Died June 3, Indiana. 9, 65. Indiana. Died March 9, 1865. North Carolina. -, 62. 1862; pyaemia and haemorrhage. 207 Montague, L., Serg t, G, Oct. 2, Right. Died December 1, 1864. 161 Jones, R. J., Pt., F, 18th Dec. 31, . Died January 10, 1863. 12th Ohio Cav., age 19. -, 64. Infantry. 31, 62. 2C8 Moore, S., Pt., G, 51st Mav 12, Left. Surg. J. S. Ross, llth N. H. 162 iJoyne, Z>., , , 1st , . Re-amp. Died of varioli. Pennsylvania. 12, 64. Died May 18, 1864. Louisiana. , 63. 209 Morrow. E. G., Capt., G, July , . Died July 27, 1863. Keevitt, F., Pt., I, 68th Julv 22, Left. Surg. H. McKennan, 17th 28th North Carolina. , 63. Ohio. 22, " 64. Wisconsin. Died. 210 Morton, H., Pt., H, 81st May 17, Right ; (also wound of cranium.) 164 Kehoe. T., Pt., C, 107th Sept. 17, Right, Died September 29, 1862. New York, age 21. 17, 64. Died May 26, 1864. Pennsylvania. 17, 62. 211 Moses, J., Pt., K, 80th Oct. 8, Right. D ied October 14, 1862. Kelley, J., Pt., A, 1st Sept. 17, . Died September 21, 1862. Indiana. 8, 62. 166 Delaware. Kelso. M. C., Pt.. A, , 62. Dec. 13, 13, 62. Right. Died December 29, 1862. 212; .Myer, C., Pt., F, 30th Missouri. June 4, 4, 63. Both. Surg. M. W. Robbins, 4th Iowa. Died June 5, 1863. 134th Pennsylvania. 167 Kelton, I. J., Capt., 21st Sept. 1, . Dr. Miller. C. S. A. Died 214 Nailor, N. A., Pt., B, 4th June , Left. Surg.W.S. Tremaine, 31st Massachusetts. -, 62. September 24, 1862. Colored Troops. , 64. Col d Troops. Died J uly 8, 64. 168 Kennedy, J. B., Capt., Dec. 13, Left. Died December 15, 1862 ; 215 Needick, A., Serg t, B, Sept. 17, . Died September 27, 1862. D, 1st "Michigan. 13, 62. wounds. 89th New York. , 62. 701 Kenner. H., Pt., , 4th July , Both. Died July 6, 1863. 216 Neice, T. F., Pt., K, 5th July , . Died July 10, 1863. 1 1 w; Virginia. , 63. Texas. 63. 171 King, J., Pt., A, 7th In Julv 3, Right. Died July 15, 1863. 217 Newsum, W. , Lieut., May , Left. Died May 20, 1864. fantry. 3, 63. H, 4th Alabama. , 64. 172 King, P., Pt., B, 5th May 3, Left. Died May 12, 1863. 218 Nicholas, C., Pt,, D, 98th May 3, Left. Died May 12, 1863. Vermont. -, 63. Pennsylvania. 3, 6.3. 173 Kinkle, C., Pt., I. 23d Sept. 19, Right; (also wound left thigh.) 219 O Connor, M., Pt., F, Sept. 19, Left. Died September 25; 1863. Ohio. 19, 64. Died October , 1864. 16th Infantry. , 63. 174 Kline, C. A., Pt., E, 26th Sept. 19, Right. Died Sept. 20, 1863. 321 Odom, J. C., Pt., G, 18th July , . Died July 12, 1863. Ohio. 19, 63. Georgia. -, 63. 175 Knight, B. F., Pt.,I, 9th May 22, Right ; flap. Surg. E. J. McGoo- 221 Orr, J. A., Pt., G, 41st July 12, . Died July 15. 1863. Iowa. 22, 63. risk, 9tb Iowa. Died June 20, 63. Illinois. , 63. 176 Koff, J., Pt., D, 46th May 25, Left. Surg. W.C.Bennett, U. S. 222 Ostar, P., Pt, I, 7th N. Dec. 13, Left. Died December 30, 1862. Pennsylvania. 25, 64. V. Died July 25, 1864. York. 13, 62. 177 Kohl, J., Pt., E, 26th May 27, Right, Died June 7, 1863. 223 Owen, A., Serg t, G, 1st Aug. , Right. Died August 24, 1864. Connecticut. 27, 63. Confed. Cavalry. , 64. 178 Lalone, A., Pt,. B, 27th May 6, Right. Died May 11, 1864. 224 Oxley, B. W., Pt., B, May , Right. Died May 31, 1862. Michigan. -, 64. * 24th Virginia. , 62. 179 Lanfair. S. P., Pt., A, Mav 5, Right. May 25, 26, haem.; lig. 225 Palmer, G., Pt., B, 7th Sept. 17, . Died September 2o, 18(i2. 37th Mass., age 40. 5, 64. Died May "26. 1864; exhaustion. Michigan. 19, 62. 180 Lawrence, G., Pt.,C, 5th July 3, Left. Died July 15, 1863. 226 Peebles, H. T., Capt., C, April 9, . Died April 25, 1864. Michigan. 3, 63. 32d Iowa. 9, 64. 181 Lawrence, J. W., Pt., C, Aug. , Right. Died August 26; 1864. 227 Perry, D., , , 7th May , Right. Died May 14, 1864. 9th Kentucky. , 64. Michigan, ," 64. 182 Lewin, J., Pt., H, 142d June 3, Right. Died June 15, 64; hajm. 228 Petrey, J., Corp l, K. Oct. 19, . Died October 20, 1664. New. York, age 20. 3, 64. 8th Vermont. 19, 64. 183 Lilly, S. W.. Pt., E, 6tb May5, Right. Died June 12, 1862. 229 Phillips, J., Pt., H, 21st Dec. 31, . Died January 10, 1863. New Jersey, age 19. 5, 62. Illinois. 31, 62. 184 Livingston, A., Pt., A, Sept. 17, Right. Died Nov. 25, 1862. 230 Pierce, J., Serg t, E, 43d Mar. 13, . Died March 21, 1862. 2d Sharpshooters. 17, 62. Ohio. 13, 62. 185 Loury, M.F., Pt.,A, 6th July 28, Left. Died September 3, 164. 231 Pierce, F. M., Pt., A, Sept. 17, . Died September , 1862. Kentucky. 28, 64. lllth Pennsylvania. 17, 62. 186 Lumbard.H.,Pt., D,46th April 8, . Died April 16, 1864. 232 Pleasure, O., Pt, F, 12th Sept. 3 Right. Surg. E. M. Rogers, 12th Indiana. 8, 64. Wisconsin. 3, 64. Wis. Died Sept. 29, 1864. 187 Lumpkin, J. W., Pt., H, Oct. 7, Right. Died October 9, 1864. 233 Pool, I). J., Pt., E, 18th Oct. , . Died October 16, 1862. 1st Texas. 7, 64. South Carolina. , 62. 188 Lynch, P.. Pt., D, 73d Julv 2, Left. Died July 13, 1863. 234 Porter, J. A., Serg t, K, Sept. 1, Right. Died September 14, 1864. New York. -, 63. 74th Indiana. 1, 64. 189 Mahaffey, D. D., Pt., E, June 18, . Died June 19, 1864. 235 Prentice, H., Pt, B, 21st May 3, Right. Died May 27, 1863. 6:id Pennsylvania. 18, 64. New Jersey. -, 63. 190 Maloney, R., Pt., E, 69th Sept. 17, Right. Died September , 1862. 236 Price, J. U., Serg t, A, Oct. 3, Left. Died October 4, 1861. New York. 17, 62. 14th Indiana. 3, 61. 191 Manley, N. F., Pt., D, May 16, Left. Died June 3, 1864. 237 Prouty, L., Pt., D, 105th Oct. 8. . Died October 12, 1862. 27th Mass., age 39. 16, 64. Ohio. , 62. 192 Mansir, W. H., Pt., B, May 5, Right. Died May 82, 1864. 238 Pugh.W. C.,Pt.,D,37th Oct. 8, . Died October 19, 1862. 37th Mass., age 19. 5, "64. Mississippi. 8, 62. 193 Manyfold, J. H., Pt., K, July 12, Right, Died July 28, 1863. 239 Rainer, S., Pt., F, 61st July -, . Died July 30, 1863. 97th Illinois. 12, 63. Georgia. , 63. 194 Martial, J., Pt., C, 8th Jan. 11, Died January 14, 1863. 240 Randolph, R., Pt, B, July , . Died July 6, 1863. Missouri. > 11, 63. 16th Georgia. , 63. 1 FORMENTO (F.), jr., Notes and Observations on Army Surgery, 1863, p. 17. SECT. II. I PRIMARY AMPUTATIONS OF THE THIGH. 271 NO. NAME, MILITARY DKSCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND Act. DATES. OPERATIONS, OPERATORS, RESULT. 241 Ray-bum, L. C., Lieut., Sept. 19, . Died September 20, 1864. 289 Trone A , Pt., H, 3d Jan. 7, Left. Died January 18, 1864. 242 B, 13th West Virginia. Redman, T. C., Lieut., 1!, 64. July , Left . Died A ugust 2, 1 863. 290 Penn. Cavalry. Tucker, R., Pt., D, 14th -, 64. Oct. 1, Left ; hsemorrh. recurred. Died C. 4th Virginia. -, 63. Tennessee, age 34. 1, 64 November 4, 1864. 243 Reed, L. P.. Pt., H, 36th May 6, Right. Died May 12, 1864. 291 Turants, L., Pt., C,76th July 3, Left. Died July 22, 1863. Massachusetts. 6, fo. New York. 5, to. 244 Reifsnyder, \V.. Ft., B, July , Right. Died July 30, 1864. 292 Turner, J K., Pt., H, Oct. 8, Right. Died October 11, 1862. 55th Pennsylvania. , 64. 33d Alabama. -, 62. 245 Uenninger, A., Pt., F, Dec. 13, . Died January 29, 1863. 293 Turway, J., Pt., F, 6th May 6, Left. Died June 4. 1864. 131st Pennsylvania. 13, 62. Maryland, age 24. 6, 64. 246 Reynolds, E., Capt., D, Dec. 13, Left. Died December 24, 1862. 294 Unknown. July 3, Left. Died JulyS, 1863. 59th New York. 13, 6~>. 3, to. 247 Roberts, H., Pt., H, 5th Sept. 19, . Surg. J. G. F. Holston, U. 295 Uttley, W., Serg t, B, Sept. 17, Right. Died September 30, 1862. Iowa. 19, 62. S. V. Died Sept. 23, 1862. 59th N. Y., age 29. 19, 62. 248 Roberts, W. G., Pt., B, April 9, . Died April 14, 1865. 296 Vanalstein, A., Corp l, A, Dec. 13, . Died December 14, 1862. 1 2 ~ d Illinois. 9, 65. 105th New York. 13, 62. 249 Robinson, S. R., Pt., I, Feb. 15, Left. Died March 18, 1862. 297 Van Outerstorp.J., Corp., June 18, . Died June 23, 1864. llth Illinois. , 62. F. 4th N. Y. H. A. 18, 64. v.v i Rowe, J. L., Serg t, E, May 27, . Died June 6, 1862. 298 Voellinger, J., Lieut., A, Sept. 19, Right, Died October 18, 1863. 2d Maine. , 62. 27th Illinois. 19, 63. 251 Ruby, 1. W., Pt., C, 66th June 9, Right. Surg. J. H. Grove, U.S.V. 299 Walker, J., Pt., G, 35th Sept, 19, . Died October 10, 1863. Indiana. 9, 64. Died June 14, 1864. Illinois. 19, 63. 25J Jtudf.r,N.,Capt., H, 16th Sept, 14. . Sept. 26, hijeui. Died Sept. 300 Walters. D. N., Pt., C, May 15, Right. Died June 3, 1864. Georgia. 15, 62. 27, 1862 ; exhaustion. 42d Indiana. 15, 64. 253 Ryan, J., Pt., D, 5th Sept. 19, . Died September 24, 1863. 301 Ward, C. W., Pt., H, Oct. 7, Right. Died October 9, 1864. Kentucky. , 63. 6th South Carolina. 7, 64. 254 Scott, L. S., Lieut., B, Julv 1, Right; (also wound of left thigh.) 302 Ward, R. F., Serg t, B, May 16. . Died May 19, 1864. 19th Maine. 2, 63. Surg. G. Chaddock, 7th Mich. 39th Iowa. 16, 64. Died Julv 13, 1863. 303 Watson, C., , , 1st Sept. 17, ; (also wound of arm.) Died 255 Scott, C. 1 ., Pt., F, An July 4, Left. Died July 6, 1863. Texas. , 62. September , 1862. thony s Regiment. 4, 63. 304 Watson, H., Pt., B, 4th Sept. 29, Right. Died November 9, 1864. 256 Sears, W. A., Pt., H, June 18, Right. Died June 20, 1864. Colored Troops, age 23. 30, 64. 34th Mass., age 33. 18, 64. 305 Webb, A. H., Serg t, E, July 28, Right. Died August 4, 1864. 257 Sliac, J., Pt., I, 15th July , . Died August 12, 1863. 7th Mississippi. 28, 64. Louisiana. , 63. 306 Weber, W., Pt., B, 73d May 5, . Died May 13, 1862. 258 Shellhart, C., Pt.,G, 68th Julv 28, Left. Surg. E. M. Rogers, 12th New York. -, 62. Ohio. 58, 64. Wis. Died July 30, 1864. 307 Weir, J., Corp l, K, 73d Sept. 19, Right. Died October 8, 1863. 259 Shurman, J. E., Pt., C, May 5, . Died May 5, 1864. Illinois. 19, 63. lllth New York. 5, *k 308 Welch, J. W., Pt., B, Sept. 19, Right. Died October 14, 1863. 260 Sink, A. J., Pt., A, 33d Julv 20, Left. Died July 21, 1864. 125th Ohio. 19, 63. 20, 64. 309 Wells, G. E., Pt., B, 35th Left. Died December 29, 1862. 261 Smith, H., Pt., F, 8th June 26, Right. Died July 21, 1862. Georgia. Alabama. , 62. 310 Westcott, O.,Pt.,C, 121st May 3, Right. Died May 14, 1663. 262 Smith, I., Pt., C, 15th May 27, Left. Died May 27, 1863. New York. -, 63. New Hampshire. 27, 63. 311 Weston, J., , B, 2d June 27, . Died July 24, 1862. 263 Smith, J., Pt., C, 44th Dec. 31, . Died. Infantry. 37, 62. Indiana. 31, 62. 312 White, W. A., Pt., C, Oct. 4, . Died Nov. 19, 1862. 264 Smith, L., Pt., B, 118th Sept. 17, . Died September 17, 1862. 43d Ohio. 4. 62. Pennsylvania. 17, 62. 313 Whitman, G. W., Pt.,K, May 31, . Surg. A. N. Dougherty, 265 Sorrells, W., Pt., H, Nov. 7, . Died November 14, 1861. 7th Michigan. 31/62. U. S. V. Died June 1, 1862. 27th Illinois. 7, 61. 314 Williams. F. K., Serg t, June 26, Right. Died July 8, 1862. 2S6 Spencer, S. E., Pt., G, May 8, Left. Surg. J. R. Bailev, 8th Mo. A, 8th Alabama. 26. 62. 8th Missouri. 9, 62. Died May 24, 1R62. 315 Wilson, J., Pt., 21st N. Mar. 27, Left; (also amp. arm.) Surg. C. 21 i" Spoth, A., Pt., F, 7th Sept. 17, Left. Died February 16, 1863. York Batterv. 27, 65. Winne,77thlll. DiedMar.27, 65. Michigan. 17, 62. 316 Wilson, J. F. , Capt., G, Mar. 25, . Surg. J. W. Wisharf. 140th 268 Springer, J., Pt., G, 53d July , Right. Died July 31, 1863. 140th Pennsylvania. 25, 65. Penn. Died April 14, 1865. Illinois. , 63. 317 Witty, T.T., Pt,, E, 29th July 4, Right: ha?morrh.; pyasmia. Died 269 Stafford, L. Pt., H, 43d Dec. 13, Right. Died December 26, 1 862 ; Iowa, age 28. 4, to. September 7, 1863. New York. J3, 62. gangrene. 318 Wood, P., Lieut,, F,27th May 9, Left. Died May 13, 1864; ex 270 Stamm,W., Pt., G, 151st Julyl, Right. Died August 1, 186& Mass., age 29. 9, 64. haustion. Pennsylvania. 1, to. 319 Wooden, J. W., Serg t, May 5, Left. Died. 271 Steele, G. H., Serg t, 1C, Oct. 9, Right. Died November 12, 1864. D, 27th N. Carolina. 5, 64. 1st New Hamp. (Jav. 9, 64. 320* Wooll, G., Pt., A, 26th Dec. 13, Left. Died January 23, 1863. 272 Stephens, E., Pt.,P., 14th Julv 3, Left. Died July 6, 1863. New York. 13, 62. Infantry. 5, 63. 321 Wright, R., Pt., E, 93d Nov. 24, Left. Died November 24, 1863. 273 Stevens, R., Pt., A, llth Nov. 27, Right. Died December 8, 1863. Ohio. 24, 63. New Jersev. 27, 63. 322 Yates, W. H., Pt., B, Sept. 17, . Died September 28, 1862. 274 Stine, J., Pt., B, 14th Julv , . Died July 30, 1863. 5th New Hampshire. 17, 62. Louisiana. , 6;>. 323 Young, E. C., Pt., H, Mav 6, Right. Died May , 1864. 275 Stowe, J. P., Pt,, G, 15th Sept. 17, Right. Died October 1, 1862. 36th Massachusetts. -, 64. Massachusetts. 17, 62. 324 Zoller, J., Serg t, F, 16th Oct. 7, Left, Died October 23, 1964. 276 Strayhome, T. A., Pt., Dec. 31, . Died January 25, 1863. New York H. Art y. -, 64. E, 21st Illinois. 31, 62. 325 Breij, W. H., Lieut., E, July 3, 277 Sullender, 11. G., Pt., B, May 2, . Died May 13, 1863. 53d Virginia. -, 63. 143d Pennsylvania. -, to. 326 Case, A., Pt., C, 8th N. June 3, Right. Surg. J. L. Brenton, 8th 278 Summers, J~. G., Pt., B, Dec. 13, Left. Died December 29, 1862. York H vy Art y. -, 64. Ohio. Not a pensioner. 13th Mississippi. 13, 62. 327 Uiggin, D., Pt., A, 12th June 2, Right. 279 Swart. A. XV., Corp !, I, July 3, Right. Died July 25, 1863. Georgia. 3, 64. 20th N. Y. S. M. 3, to. 328 Elrod, W. B., Pt., G, Julv , 280 Swinnford, R. M., Pt., May 22, Right; flap. Surg. M. W. Rob- 16th Georgia. , 63. B, 25th Iowa. 22, 63. bins, 4th Iowa. IJied.Hily 5, 63. 329 Foran, J., Serg t, C, 63d Mav 8, . Surg. P. E. Hubon, 28th 281 Taft, E., Pt., E, 42d N. Sept. 17, Right. Died October 7, 1862. New York. 8, 64. Mass. Not a pensioner. York. 17, 62. 330 Gaskin, H., , 18th N. May 27, 282 Terrell, J., Corp l, K, June 2, Left. Died June 17, 1864. Carolina. , 62. 55th Penn., age 22. 2, 64. 331 Glendi/, R. J., Lieut,, C, July , 283 Thorn, T. J., Lieut., D, July 3, Right; (also amp. arm.) Died 4th Virginia. , 63. 16tb X. C., age 30. 4, 63. Julv 30. 1863; pymia. 332 Hagler, C., Pt., F, 7th Dec. 13, Right. 284 Tibbetts, E. G., Pt., H, May 27, Right. Died July 14, 1863. North Carolina. 62. 12th Maine. 27, 63. 333 Hambrich, J., Pt., A, July , 28")) Tieman. II., Pt.,C, 119th June 21, Both. Surg. G. P. Oliver, lllth 24th Georgia. , 63. 286) New York. 21, 64. Penn., and J. V. Kendall, 149th 334 Jones, G. W.. Pt., A, 43d June 2, Left. N. Y. Died June , 1864. North Carolina. 3, 64. 287 Tiltou, G. A., Pt., C, May 12, . Surg.W. C. Shurlock, 51st 335 Kirkland, W. L., Pt.,K, May 28, . Surg. Taylor, C. S. A. llth New Hampshire. 12, 64. Penn. Died May 29, 1864. 4th South Carolina. 28, 64. 288 Trimble, A., Corp l, E, Oct,8, . Died October 11, 1862. 336 Kroupe, T., Pt., St. M. April 23, 10th Wisconsin. -, 62. 23d C. S. A. , 62. 272 INJUEIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 337 McCauley, T., Pt., G, 2d July 14, Right. Not a pensioner. 342 Orender, L., Pt., I, 2d July , Illinois Lt. Art y. , 64. South Carolina. , 63. 338 McGthee, W. B., Pt., C, July 3, 343 Overton, H. T., Pt., A, Nov. 25, Right. 17th Mississippi. -, 63. 17th Alabama. 25, 63. 339 Meadows, H. M , Pt., A, July 28, Left. 344 Williams, J., Serg t, D, May 31, Left on field. Not a pensioner. 34th Alabama. 28, 64. Od Ohio Cavalry. , G4. 340 Morris, J. r.,Pt., B,34th Aug. 31, Left. Surg. A. C. Messenger, 345 Wina, E., Pt., P, 5th Sept. 29, Left ; not doing well. Not a pen Alabama. 31, 64. 57th Ohio. Colored Troops, age 30. , 64. sioner. 341 O Keefe, P., Serg t, C. July 28, Right. 30th Louisiana. 28, 64. In three hundred and forty-one of the cases enumerated in this table the seat of frac ture was in the femur; in two, in the knee joint; and in two, in the leg. In four fatal instances both thighs were primarily amputated; and in one, primary amputation of the thigh was performed on the right, and intermediary amputation in the lower third on the left limb. 1 In three cases, an arm, and in one, a leg were simultaneously removed. 2 INTERMEDIARY AMPUTATIONS IN THE SHAFT OF THE FEMUR FOR SHOT INJURY. This category comprises thirteen hundred and twenty cases. Four hundred and seventy-nine proved successful and eight hundred and forty-one were fatal. Intermediary Amputations in the Upper Third of the Femur. There were one hun dred and forty-seven intermediary amputations in the upper third of the femur, with fifty recoveries and ninety-seven deaths. The right limb was implicated in seventy-seven cases, the left in fifty-four, and in sixteen this point was not recorded. The modes of operation are reported as: circular, forty-six; flap, thirty-nine; not stated, sixty-two. Successful Cases of Intermediary Amputations in the Upper Third of the Femur. The fifty operations of this group were performed on forty Union and ten Confederate soldiers. Thirty-five of the thirty-eight pensioned Union soldiers were living in 1879. The injuries were caused by shell in five, by grapeshot in one, by solid shot in one, and by small missiles in forty-three instances. In the following case the patient, an employe of -the Pension Office, was in excellent health in October, 1879: CASE 453. Private Lorenzo E. Dickey, Co. A, 4th Maine, aged 21 years, received a gunshot wound of the right thigh, at Chantilly, September 1, 1862. He was taken to a field hospital in the vicinity of the battle ground, where the limb was amputated at the upper third, on the fourth day after the reception of the injury. On September 8th, the patient arrived at Washington and was admitted to Douglas Hospital. A haemorrhage from the femoral artery, to the amount of tsventy ounces, occurred on October 16th, and was controlled by pressure. After this the case progressed favorably and the wound healed about January 1, 1863. About two months later the patient was transferred to Lincoln Hospital, and sub sequently he was sent to St. Elizabeth Hospital, whence he was discharged June 16, 1863, and pensioned. Mr. Dickey was subsequently appointed a clerk at the Pension Office. On January 14, 1873, he visited the Army Medical Museum, being in as good general health as he had been previous to the time of receiving the injury, and suffering no pain from the sturnp. He stated that his weight then was 194 pounds, while before he was wounded and lost his leg he only weighed 1/0 pounds. Owing to the shortness of the stump, being only three inches long from the hip joint, he is unable to wear an artificial limb and is obliged to use crutches in walking. A copy of the photograph, taken in 1873, is represented in the wood-cut (FlG. 188). His pension was paid September 4, 1879. 1 Cases of Pt. S. Goodwell, G, 29th Illinois (No. 128, p. 269), fatal; Pt. H. Kenner, 4th Virginia (No. 169, p. 270), fatal ; Pt. C. Myer, F, 30th Mis- 212, p. 270), fatal; Pt. H. Tieman, C, 119th New York (No. 285, p. 271), fatal. In the case of Pt. W. F. Mills, E, 8th New York H. A. (No. 205, p. 270), primary amputation in the right thigh, and subsequently intermediary amputation in the left thigh was performed. An arm was simultaneously removed in the cases of Pt. S. Cramer, B, 142d Pennsylvania (No. 84, p. 209, and Second Surg. Vol., TABLE LXXV, No. 39, p. 751); Lieut. T. J. Thorn, D, 16th North Carolina (No. 283, p. 271, and Second Surg. Vol., TABLE LXXV, No. 15:i, p. 752); and Pt. J. Wilson, t New York Battery (No. 315, p. 271, and Second Surg. Vol., TABLE LXXV, No. 167, p. 752). In the case of Serg t J. Foss, C, 59th New York (No. 116, p. 269), the opposite leg was amputated. SECT, ill.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 273 The femur was fractured in its upper third in four of the fifty examples of this group, necessitating amputation close to the trochanters : CASE 454. Captain John C. Hilton, Co. K, 145th Pennsylvania, aged 22 years, was wounded at Gettysburg, July 2, 1863, by a conoidal ball, which fractured the right femur in its upper third. He was carried to the field hospital of the 1st division of the Second Corps, where Surgeon C. S. Wood, 66th New York, reports: "The bone was extensively comminuted. I amputated the thigh about one inch below the trochanter major. The operation was not performed until eleven days after the receipt of the injury, yet the patient at this date, August 2d, is rapidly improving." The patient entered Camp Letterman hospital August 5th, where Acting Assistant Surgeon B. F. Butcher notes: "He is doing very well; the treatment consists of stimulants and nourishing diet, with water dressings to the stump. August 20th, still improving, all ligatures were removed, the stump healing rapidly. On the 25th, the stump had entirely healed, and on September 1st, he left the hospital on leave of absence." This officer was discharged December 19, 1863, entered the Veteran Reserve Corps February 5, 1864, was mustered out of service June 30, 1866, and pensioned. His pension was paid June 4, 1879. CASE 455. Private Alvin Hubbard, Battery M, 5th Artillery, aged 20 years, was wounded at Spottsylvania Court House, May 12, 1864, by a solid shot or a large fragment of shell, which struck both knees, fracturing the patella and opening the joint of the right knee, and inflicting a large flesh wound on the inner side of the left knee. He was taken to the field hos pital of the Artillery Brigade, Sixth Corps, and on the 14th sent to Fredericksburg. On May 24th, he was admitted into the Third Division Hospital, Alexandria, from which Surgeon E. Bentley, U. S. V., reports: "The right leg and knee were badly swollen, painful and cedematous, and the soft parts ecchymosed; there was an unhealthy discharge from the wound; the left knee was black and swollen, but the joint was not seriously injured. His constitutional condition was much disturbed, pulse quick aud frequent, appetite poor. On the 25th, it was decided to amputate, and, after placing the patient under the influence of chloroform, Surgeon Bentley removed the right thigh just below the trochanter by the circular operation; free incisions were made in the integuments of the left knee. He rallied well from the operation, and the after treatment consisted of stimulants, opiates, and nourishing diet. On October 7th, he was transferred to the First Division Hospital, Alexandria; on February 25, 1865, to the hospital at Fairfax Seminary; and finally discharged at the Judiciary Square Hospital, Washington, May 19, 1865." Examining Surgeon E. H. Wood, of Hersey, Michigan, September 5, 1877, reports: "The stump of the amputated limb is sound. The wound on left knee healed, leaving a large scar, and the patella so dislocated upward that this leg can be only semi- flexed." His pension was paid June 4, 1879. In the next case the patient died, nearly nine years after the operation, of tubercular disease of the lungs complicated with necrosis of the stump of several years standing : CASE 456. Private J. Frederick, Co. D, 15th Massachusetts, aged 35 years, was wounded and captured at Bristoe Station, October 14, 1863. After remaining a prisoner for a month he was paroled and brought to Annapolis, where he entered the First Division Hospital on November 18th. Assistant Surgeon W. S. Ely, U. S. V., contributed the pathological specimen (FlG. 189), with the following description of the injury: "A fragment of a shell entered the left thigh in its middle third pos teriorly, and passing directly forward, produced an extensive comminution of the femur and great destruction of muscular tissue. He laid upon the battle field without medical attendance until the afternoon of the following day, when he was conveyed by the enemy to Gordonsville, where he suffered amputation of the injured limb at the junc tion of the upper and middle third, by the circular method, on October 26lh. When admitted here, this soldier gave evidence of having endured a full share of the exposure and neglect to which our captured men, as a general rule, were subjected. His system was found to be excessively reduced : his pulse rapid and feeble; anorexia exist ing, and an exhausting diarrhoea complained of. At the seat of the operation the parts gave evidence of unhealthy reparation, the wound was open, the skin retracted, and the sawn extremity of the femur protruding beyond the tissues to the extent of one and a half inches. It was thought advisable to leave to nature the removal of the pro truding bone, and therefore no operative interference was determined upon. The patient s body was thoroughly cleansed, and an equable temperature maintained in his room, the stump washed twice with alcohol, and lint moist ened with diluted alcohol kept applied. Generous diet was enjoined, and six ounces of spiritus ferment! was given daily. For the diarrhoea a prescription was ordered consisting of one grain of sulphate of morphia, ten grains of quinine, one and a half drachms of diluted sulphuric acid, and one ounce of water, to be given in doses of a tea- FlG 189 _ spoonful three times a day. By December 1st, the patient was slowly improving, the diarrhoea being no longer Tubular se- troublesome, and his appetite good, though his pulse still continued rapid. The stump under the action of the nearlvTins. alcohol applied locally, combined with the constitutional measures employed, now presented a granulating surface, removedistx and the granulations were slowly extending towards the extremity of the bone, one inch of which was still exposed, amputation. His treatment was yet continued with the exception of th# prescription for the diarrhoea, for which a mixture of s P ee - twenty grains of quinine, one and a half drachms of muriated tincture of iron, and ten drachms of simple syrup was substi tuted, to be given in teaspoonfuls one hour before meals. On January 6th, the applications of alcohol to the stump were discon tinued ; the patient still doing well and no marked change having occurred. January 29th, by seizing the protruding extremity of the femur between the fingers it became perceptible that a slight movement of rotation could be made. February 4th, necrosis going on certain but slow; considerable movement now attainable, causing great pain to the patient; muscles of affected limb apparently becoming hypertrophied ; general health of patient continuing good. February 26th, protruding bone a little more mobile; discharge increasing in amount and becoming offensive. It was not yet deemed advisable to interfere with the natural process going on, a portion of the fragment not being sufficiently separated and liable to break off if extraction was attempted, thus retarding the subsequent reparative process. On April 1st, interference was deemed proper, the fragment appearing to be very free. Sensibility being too great to operate without the use of anaesthetics, chloroform was administered, the extremity SUKG. Ill 35 274 INJURIES OF THE LOWER EXTREMITIES. ICHAP x. seized with a large forceps by Surgeon B. A. Vanderkieft, U. S..V., and by a combined motion of traction and rotation the sep arated portion, measuring five inches in length, was removed entire. The patient recovered rapidly from the anaesthetic and felt great relief. He progressed finely and the stump closed rapidly, and the result of waiting upon nature in this case proved very satisfactory, though it would be interesting to know whether a second operation performed at the time of the patient s admission would have prevented necrosis to the depth at which it was found to exist." The patient was discharged from service May 24, 1864, and supplied with an artificial limb by B. F. Palmer, of Philadelphia, five months afterwards. He died March 13, 1872, Dr. J. Hyndman, of Boston, certifying that his death was caused by "tubercular disease of the lungs, complicated with necrosis of the bone of the amputated limb" of several years standing, etc. Fatal Cases of Intermediary Amputation in the Upper Third of the Thigh. The ninety-seven operations of this category were performed on eighty-one Union and sixteen Confederate soldiers. A case, in which the amputation had been preceded by primary excision in the upper third of the femur, has been detailed on page 205, ante (CASE 418, Corporal J. W. Soule, D, 6th Michigan Cavalry); a second case will here be cited: CASE 457. Private J. Kelly, Co. F, 1st New York Cavalry, aged 21 years, was wounded near Hagerstown, July 7, 1863, and admitted to hospital at Frederick on the following day. Acting Assistant Surgeon J. H. Bartholf contributed the specimen (No. 3875, Surgical Section, A. M. M.), with the following history: "While acting as a scout the man had his left thigh fractured by a cavalry pistol conoidal shot, at a point a little above the junction of the middle and lower thirds. The ball, much battered, was removed from under the skin on the inner side of the limb, three inches above the edge of the condyle. When admitted into hospital, Smith s anterior splints were applied and continued till July 16th, when Buck s extension apparatus was substituted, with sand bags to the side of the limb. Much fcetid pus was found to be confined in the limb, which was let out by enlarging the opening. The patient having all the signs of pneumonia of the left lung, an oiled silk jacket was applied around the thorax. July 18th, patient more comfortable with the change of appliance to the limb; six ounces of milk punch given daily, and nourishing diet. 19th, rusty colored sputa continuing, with but little cough; double friction sound over heart; heart s action somewhat turbulent. 21st, pulse 120 ; brown, moist fur on tongue ; feeling of great oppression in chest, but friction sound over heart nearly gone ; some diarrhoea; suppuration from limb very free and somewhat offensive. Applied oakum dressings and gave pills of camphor and opium. 22d, pulse smaller; cough increasing; pain and tenderness to pressure of limb now extending up to groin and becoming more acute from pus burrowing up among the muscles; diarrhoea continuing at intervals. Increased the milk punch to one pint per day. 23d, patient very feeble and in a very critical state; thoracic symptoms dimin ishing. 27th, all chest symptoms gone; thigh in bad condition; pus burrowed among the muscles in front nearly to groin; has two troublesome bedsores. 29th, sleeps tolerably well now; vomited once after tea, but has no chills. 31st, pulse still 120; erysipelatous inflammation about the wound. The best of diet and half a pint of milk punch is given daily. August 5th, the patient s general condition, strength, and appetite has somewhat improved during the last few days. The diarrhoea continues, however, the bedsores are very troublesome, and the fractured bone is a good deal necrosed, and abscesses are extensive in the thigh. 6th, amputation was performed by Assistant Surgeon E. F. Weir, U. S. A., at 4 P. M., as low down as the wound would permit ; method : Flaps of skin and circular of muscles. Two and a half inches of the upper fragment of the bone were removed, when, the medullary canal and periosteum being still found dead, one and a half inches more of the shaft were taken off, thus getting a line or two above the necrosis. Four fragments were found, all being more or less attached by periosteum or muscle, but all partially denuded of periosteum and necrosed. One large lower fragment embraced the greater part of the lower third of the femur and was considerably denuded and necrosing, showing scarcely any effort at repair. A sinus on the outer and front aspect of the thigh, found at the amputation to reach nearly up to Poupart s ligament, had a counter opening then made in its upper extremity. Reaction did not take place, in spite of all efforts, until 11 P. M., and not decidedly then, vomiting occurring at intervals and some delirium. Patient was placed on a water-bed at 11 P. M. 7th, pulse 150 and a mere thread; condition very precarious indeed. At 9 A. M., patient rallied somewhat, then fell asleep and slept the greater part of the day. Adminis tered beef tea and milk punch alternately throughout the day. 8th, pulse 116 and much fuller; flaps sloughy and fcetid. Applied the strong nitric acid, and after that injected a mixture of hydrochloric acid, one ounce; laudanum, two ounces; and water, fourteen ounces, between the flaps and into the sinus, after which oakum dressing, wet with the same wash, was applied. All the sutures were removed but one, and extension was applied to flaps, to prevent retraction, by adhesive strips, string, pully, and weight. Patient has considerable diarrhoea, and takes camphor and opium pills; is also ordered ten grains of tartrate of iron and potassa three times a day. 9th, pulse 136; suppuration from stump healthy and not foetid; diarrhoea ceased during night but recurred this morning. Patient has aphthse on the tongue and lips; has some little relish for food. Opium is con tinued, and tincture of chloride of iron is substituted for the tartrate of iron and potassa. 10th, pulse 120; diarrhoea a little better; ordered Hope s mixture for it, also ten grains of chlorate of potassg, four limes a day for stomatitis. Stump not sloughy; good flaps. Patient has some little appetite and is ordered good fo6*d, with one pint of milk punch daily, llth, stump in good condition ; diarrhoea worse. Gave one grain of opium every two hours and continued other medicine. 12th, stomatitis and diarrhoea ceased. 13th, stomatitis and diarrhoea returned. Patient losing strength and wasting in flesh ; pulse 126; pus from stump healthy. 14th, pulse 128 ; had nausea last evening and vomiting this morning; no chill; diarrhoea slight; granulations weak and pale. Discontinued the tincture of iron, and prescribed extract of nux vomica, four grains, and pulverized iron, twenty grains, to be made into sixteen pills, and administered one three times a day. 15th, pulse 130; some nausea; stomatitis very bad; diarrhoea troublesome; bedsores painful. Treatment continued and brandy mixture ordered. 17th, subsultus ten- dinum. 18th, patient died. Sectio cadaveris seventeen hours after death: Body much emaciated. On examining the stump found sinuses up the thigh in various directions, and just behind the trochanter major a circumscribed abscess containing about an ounce of pus; another similar one near the trochanter minor; hip joint intact; tissues of stump very unhealthy, and wound of stump pale and flabby and presenting scarcely any granulations. On opening the chest found the right lung healthy and INTERMEDIARY AMPUTATIONS OF THE THIGH. 275 weighing twelve ounces; left lung, upper lobe healthy; lower lobe in a state of red hepitization through nearly its entire extent, and permeable to air here and there ; weight one pound and two ounces. Pleura healthy. The heart was contracted and firm, clots in both sides of it, especially in the left; valves healthy; no evidence of endocarditis; recent pericarditis well marked; pericardium throughout adherent by new false membrane becoming organized, susceptible of being torn off by little force; weight of heart ten ounces. Liver moderately contracted, with cirrhosis and a little hobnailed; weight three pounds and two ounces." TABLE XXXIV. Summary of One Hundred and Forty-seven Cases of Intermediary Amputations in the Upper Third of the Femur for Shot Injury. [ Recoveries, 150 ; Deaths, 51147. | NO. NAME, MILITARY DESCRIPTION", AND AGE. DATES. OPERATION S, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Anderson, S., Pt., B, Sept. 19, ; erysipelas ; gangrene. Re 35 Nehemiah, C. S., Pt., K, Dec. 7, Right, Surg. B. O. Reynolds, 3d 20th Alabama. 22, 63. covery. 26th Indiana, age 32. 31, 62. Wis. Cav. Disch d J une 9, 63. 2 Beckart, A., Pt., A, 74th Aug. 29, Left; circ. A. Surg. G. M. Mc- 36 Ochs, H. G., Pt., H, 54th May 15, Right ; circ. Disch d Jan. 31 , 65. New York, age 22. Sep.8. 62. Gill, U. S. A. Dis d May 22, 63. Penn., age 26. 23, 64. 3 Bray, J. A., Pt., K, 3d June 27, Left. Surg. A. Y. P. Garnett, P. 37 O Connor, J., Pt., G, Sept. 17, Right; flap. Disch d June 27, 63. Virginia. 30, 62. A. C. S. Recovery. 28th Pennsylvania. Oct. 9, 62. Died April 13, 1867. 4 Briscoc, L. N., Pt., K, July 21, Left. Surg. Jennings, C. S. A. 38 Page, G. L., Corp l, B, Sept. 19, Right. Surg. Bakeman, C. S. A. 7th South Carolina. 29, 61. Recovery. 18th Texas. 26, 63. Retired Feb. 10, 1865. 5 Cain, J., Corp l, I, 104th July 1, Left; circ. Surg. E. G. Chase, 39 Perkins, G., Pt., G, 2d Jan. 1, Left ; flap. A. Surg. W. T. Men- New York. 5, 63. 104th N. Y. Disch d Nov. 3, Kentucky. 5, 63. denhall, 57th Ind. Discharged 1864. Spec. 3022. March 30, 1863. 6 Calder, J., Lieut., G, 2d Sept. 20, Right. Surg. W. Varian, U. S.V. 40 Peters, J.,Pt., A, 6Bth N. July 21, Right. Surg. Walker, C.S.A. Kentucky Cav., age 28. 27, 63. Disch d March 1, 1864. York, age 28. Aug. 12, Disch d Jan. 25, 1862. Died 7 Cunningham, E.H., Sgt, Aug. 9, Right. Surg. Davis, C. S. A. 1861. April 8, 1871. E, 9th Louisiana. 14, 62. Recovery. 41 Porter, C.,Citizen of Rus July 11, Right (gang.; aneurism): lateral 8 Dalton. T.W.,Pt.,G,83d Dec. 13, Left ; ant. post, flap ; gangrene. sell ville, Ky., age 17. 21, 64. flaps. Dr. J. R. Bailey, of Rus- New York, age 18. 16, 62. V. R. C. June 21, 1863. sellville. Recovery. 9 Darlington, W. B., Maj ., Mav 5, Right ; circ. Confed. surgeon. 42 Roberts, T., Guerilla, age Feb. 10, Left ; ant. post, flap. A. A. Surg. 18th Penn. Cav., age 35. 9, 64. Disch d October 30, 1864. 31. Mar.4, 64. P. Gilroy. Prison June 26, 64. 10 Dickey, L. E., Ft., A, 4th Sept. 1, Right ; haem. from femoral artery. 43 Rovstou, W. H., Pt., C, Feb. 15, Left ; flap. Disch d Nov. 8, 62. Maine, age 25. 5, 62. Disch d April 27, 1863. 2d Iowa, age 24. Mar.6, 62. 11 Dun lap, J. H., Pt., F, 3d De.14, 62, Right ; circ. Surg. C. A. Cowgill, 44 Schmidt, H., Pt., G, 57th Oct. 4, Right: flap. Surg. J. R. Zear- X. Y. Artillery. Ja. 11, 63. II. S. V. Disch d April 15, 1863. Illinois. 28, 62. ing, 57th Illinois. (Amp. arm.) 12 *Dwyer, L., Pt., F, 14th June 30, Right ; circ. Surg. F. Formento, Disch d Dec. 18, 1863. Louisiana. J y 8, 62. jr , C. S. A. Recover v. 45 Seiter, J., Serg t, I, 7th Sept. 17, Right. Disch d Dec. 15, 1862. 13 Eagan, L. W., Pt., , Aug. 30, Right. Ass t Surg. B." Howard, New York. 27, 62. 22d New York. .Sep.3, 62. U. S. A. 46 Spear, W. A.,Pt.,1, 112th Sept, 29, Right; Confed. surgeon. Disch d 14 Frederick, J.,Pt.,D,15th Oct. 14, Left; flap. Confed. surg. Five New York, age 35. Oct. 2, 64. June 13, 1865. Massachusetts, age 35. 26, 63. ins. nee. seq. removed. Disch d 47 Velzy, G., Corp l, K, 94th July 1, Left ; circ. Surg. R. Loughran, May 24. 1864. .JJpec.2232. Died New York, age 21. 8, 63. 20th N. Y. S. M. Disch d July March 13, 1872 ; tuberculosis. 19, 1864. 15 Hanilin, W. H., Corp l, Oct. 18, Left ; flap. Surg. N. S. Hamlin, 48 Vick, E. R., Pt., I, 30th July 1, . Surg. Sacherell, C.S.A. L, 7th Missouri Cav. No.18, 61. 7th Mo. Cav. Disch d Mav 5, 62. North Carolina. 17, r 62. Recovery. 16 Hervey, R., Pt., C, 82d July 1, Left. Surg. C. Page, U. S. A. 49 Whitacre, J. R., Pt, E, Aug. 30, Left: circ. A. Surg.D.W.Voyles, Pennsylvania. -, 62. Disch d Oct. 6, 1863. 69th Indiana. Sep. 6, 62. 66th Ind. Disch d Nov. 22, 62. 17 Hilton, J. C., Capt., K, July 2, Right. Surg. C. S. Wood, 66th 50 Woodhouse, J., Pt., I, Dec. 7, Right ; circ. Surg.P.Harvey, 19th 145th Penn., age 22. 12, ^63. N. Y. Disch d Dec. 19, 1863. 20th Wisconsin, age 28. 11, 62. Iowa. Bone remo d. Recovery. 18 Hobbs.L. H., Pt., H, 27th Aug. 27, Right; circ. Transferred Sept. 51 Acker, D., Pt., D, 148th May 3, Right. Died June 3, 1863. Georgia, age 33. Se. 17, 64. 22, 1864. Pennsylvania. 18, 63. 19 Hnbbard, A., Pt., Bat ry Muy 32, Right ; circ. Surg. E. Bentley, 52 Allen, H. H.,Pt.,F,100th May 12, Right; circ. Surg. A. F. Sheldon, M, 5th U.S.Art.,age20. 25, 04. U. S. V. Disch d May 19, 1865. Penn., age 35. 28, 64. U.S.V. Died June 4, 64 : exh n. 20 Hugot, J., Pt., H, 5th N. Mav 5, Left; circ.; hyperostosis. Disch d 53 Allen, L. M., Pt., E, 10th April 6, (erysipelas; haem.) Died Jcrsev, age 30. 8, 62. July 7, 1863. Spec. 1256. Arkansas. M y6, 62. May 6, 1862. 21 Iffla, A. G., Pt., C, 83d Sept. 17, Right. Surg. W. T. Thurston, 54 Anderson, W. G., Pt , G, Dec. 13, Right ; flap. Jan. 13, 15, 17, hasm.; New York. Oct.7, 62. U. S. V. Disch d Dec. 12, 1862. 114th Penn., age 16. 1862, lig. mus. branch. Died Jan. 17, 22 James, T.. Pt , E, 147th Feb. 6, Left; flap. Disch d Sept. 6, 65. Ja. 11, 63. 1863; exhaustion. New York, age 37. 10, 65. 55 Balcom, M. S., Pt., B, May 17, Right (pyaemia ; diarrhoea) ; circ. 23 Jennings, T., Pt., ,24th Aug. 30, Right. Ass t Surg. B. Howard, 12th Conn. Je. , 64. A. A. Surg. W. S. Ward. Died New York. Sep.5, 62. U. S. A. June 23, 1864 ; shock. 24 Kane, J., Serg t, D, 2d May 6, Left, Disch d March 27, 1865. 56 Barr, R.G.,Capt.,B,49th May 10, Right (gang.); circ. A. A. Surg. Michigan, age 23. 12, 64. Penn., age 24. 24, 64. M. C. Mulford; slough. Died 25 Keeuan, J., Pt., B, 3Gth Nov. 30, Right (gang.); ant. post. flap. Dr. July 27, 1864 ; diarrhoea. Illinois, age 34. De.5, 64. Rainey, Franklin, Tenn. Disch d 57 Becht, J., Pt., B, 7th Mar. 31, Right (prim. exc. fern.); ant. post. June 12, 1865. Maryland, age 38. Ap.12, 65. flap. A. A. Surg. J. Tyson. Died 26 King, E. S., Pt., E, 23d Julv 30, Left; flap. Surg. E. Bentlev, April 12, 1865; shock. Colored Troops. Au. l2, 64 U. S. V. Disch d June 8, 1865. 58 Belden, H., Pt., H, 171st June 12, Right (hasm.);circ. Surg. A.M. 27 Kim, P., Pt., A, 69th In Aug. 30, Right ; circ. Disch d Nov. 23, 62. Ohio, age 18. 26, 64. Speer, U. S. V. Died June 27, diana. Sep.4, 62. 1864; shock. 28 Kniffeus, C., Serg t, D, July 1, Right; circ. Surg.R. Loughran, 59 Blantin, A., Pt., K, 15th Sept. 14, (frag s removed) ; oval flap; 20th New York S. M., 7, 63. 20th N. Y. S. M. Neo. Dissh d South Carolina, age 37. 26, 62. slough. Died Oct. 1, 62; pyaem. age 29. August 9, 1864. Spec. 4300. 60 Brinklev, J. If., Pt., A, June , Left. Surg. Eads, C. 8. A. 29 Kreger, J., Pt., C, 142d Dec. 13, Right. Disch d April 22, 1864. 28th N. Carolina. J y 12, 62. Died August 4, 1862. Pennsylvania. 21, 62. 61 Bryan, E. G., Pt., E, 3d Oct. 19, Left (mortification). Died Nov. 9, 30 Linehan, T., Pt., D, 37th Mav 31. Right ; flap. A. A. Surg. G. H. Mass., age 22. 24, 64. 1864 ; exhaustion. New York, age 19. Je.27, 62. Dare. Haetn.; lig. fcm. artery. 62 Bueson, T., Pt., A, 142d Jan. 15, . Surg. J. W. Mitchell, 4th Disch d Sept. 26, 1862. Died New York. 19, 65. C. T. Died Jan. 19, 1865. Julv 15, 1876. 63 Bnshnell, E., Serg t, G, De.31, 62, Left. Died Jan. 28, 63 ; shock. 31 Manghermar. J. G., Pt., Sept. 1 9, Right ; flap. Surg. H. J. Herrick, 29th Indiana. Ja.28, 63. K, 87th Indiana. 24, 63. 17th Ohio. Disch d May 7, 64. 64 Carney, J., Pt., B, 66th Sept. 17, . Surg. C. S. Wood. 66th 32 Masterson, J., Pt., B, Sept. 17, Right ; circ. Disch d Jan. 13/63. New York, age 20. 27, 62. N. Y. Died Sept. 30, 1862. 106th Penn. 21, 65. 65 Chase,G. L., Pt., D, 36th May 5, Right; ant. post. flap. Surg. A. 33 Miller, J. II., Pt., E, 33d April 30, Right ; flap. Confed. surgeon. Mass., age 25. 29, %4. F. Sheldon, II. S.V. Died June Iowa. M y3, 64. Discharged, 1865. 10, 1864 ; exhaustion. 34 Neal, W. H., Pt., H, 9th Mav 27, Right ; circ. Disch d Feb. 5, 64. 66 Clinch, T., Lieut., A, May 31, ; flap. Died June 8, 1862; Illinois, age 20. 30, 63. Palmetto S. S. Je. 5, 62. shock. HiXKLEY (H.), Treatment of Hospital Gangrene, in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 132. 2 FORMENTO (F.), Notes and Observations on Army Surgery, New Orleans, 1863, p. 20. 276 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AJ*U AGE DATES. OPERATIONS, OPERATORS, RESULT. 67 Clayborne, J. B., Pt., H, July 3, Right (slough.; haem ): circ. A. 99 Labrie, O., Pt., H, 126th July 9, Left ; circ. A. A. Surg. J. C. Shi- 22d N. Carolina, age 23. 19, 63. Surg. B. Stone. U. S. V. Died Ohio, age 23. 12, 64. mer. Haem. from branch of prof. July 22/63 ; exh n. Spec. 2056. art.: lig. Died July 23, 1864. 68 Clodius, C., Pt., A, 125th Mav 3, Left. A. Surg. C. H. Lord, 102d Autopsy. Pennsylvania. 17, "63. N. Y. Spec, 1153. 100 Laughery, J., Pt.,C,26th Ju .y 2, Left ; hy?m. from femoral artery. 69 Conrud, F., It., E, 26th Dec. 13, Right. Died January 12, 1863 ; Pennsylvania, age 27. 7, 63. Died July 19, 1863; exhaustion. New York, age 43. 25, 62. pysemia. 101 Lochner, J., Pt., I, 13th Nov. 27, Lef-.. Died November 30, 1863. 70 Con way, A., Pt., G, 34th Sept. 10, Right. Died Sept. 16, 1862; te Illinois. 30, 63. Ohio. 14, 62. tanus. 102 4 Lochterhand,E.,Pt, H, June 17, Left; circ. A. Surg. G. A. Mur- 71 Cowan, J., Pt., H, 155th June 26, Left ; ant. post flap. A. A. Surg. 37th Wisconsin, age 34. J y 3/64. sick, U. S. V. Died July 9/64 ; Penn., age 32. J yll/64. A. W. R. Andrews. Died July pyaemia. Spec. 2738. Autopsy. 11, 1864 ; syncope. Spec. 3345. 103 Lounsbeck, G., Pt., G, May 12, Right (haem.). flap. A. A. Surg. Autopsy. 64th New York, age 28. 18, "64. H. D. Vosburg Died May 18, 72 1 Curtis, G. F., Corp l, C, May 31, Right ; circ. A. Surg. G. A. Mur- 1864 ; exhaustion from haem. 10th N. Jersey, age 22. Je. 5/64. sick, U. S. V. Died June 7, 64; 104 Lutz, J.,Pt.,B., 1st Penn. Dec. 13, Left; haemorrhage, ig. femoral exhaustion. Autopsy. Reserves. 20, 62. artery. Died Dec. 22, 1862; 73 z Davis, II. C., Pt., I, 46th May 1, Right (haem.); circ. A. A. Surg. exhaustion. Indiana. 10. *63. L. Dyer. Died May 18, 1863. 105 Mackay, M., Pt., D, 26th Aug. 29, Left. Surg. O. A. Judson.U.S.V. 74 Dawson, B,Pt.,D, 100th May 30, Left ; circ. A. Surg. W. Thom New York. Sept. 12, Died Sept. 17, 1862; haemor Penn., age 18. Je. 5/64. son, U. S. A. Died June 7/64 ; 1862. rhage. Spec. 4280. shock. Spec. 3547. 106 Macon, J. M., Capt., A, May 5, . Surg. D. Prince, U. S. V. 75 Deal, J., Pt., K, 81st May 8, Right ; circ. A. A. Surg. J. New- 19th Miss., age 30. 8, 1)2. Died May 8, 1862. Penn., age 35. 27/64. combe. Died June 6, 1864. 107 Mapes, E. A., Pt.,C,10th June 11, Right (slough.); circ A. A. Surg. 76 De Frend, J., Pt., M, 4th Nov. 30, Right ; circ. Surg. S. E. Fuller, N. Y. Cavalry, age 22. 23, "64. J. P. Nagle. Died June 30/64. Artillery, age 21. De.3/64. U. S. V. Died Dec. 4, 1864 ; 108 Markins, G., Pt., H, 2d Sept. 24, Right. Died September 29, 1863. haemorrhage and shock. W. Virginia M. I. 29, 63. 77 Dibble, H., Pt., F, 198th Mar. 31, Right (ball extr.); flap. Surg. N. 109 McAllister, D.,Pt..G, 3d July 9, Right; flap; skin circ. muscles. Penn., age 20. Ap. 6, 65. R. Moseley.U.S.V. Died April Maryland, age 57. 12, 64. Died July 13, 1864 ; shock. 12, 65 : nerv. exh n. Spec. 4067. 110 McAtee, G., Pt., E, 12th July 18, Right ; double flap. A. Surg. J. 78 Doane, H. H., Pt., 1,1st May 21, Right (mortification); circ. A. A. Virginia, age 19. 28, 64. Willard, 1st Md. P. H. B. Died Maine H. Art y, age 23. 29, 64. Surg. J. H. Thompson. Died July 29, 1864. June 1, 1864 ; pyaemia. 111 *McLaughlin,G., Pt.,A, Aug. 27, ; ant. post. flap. A. Surg. C. 79 Dougherty, J. J., Pt., C, May 18, Right. A. A. Surg. W. C. Dixon. 84th New York, age 25. Sept. 2, A. McCall, U. S. A. Died before 1st Me. H. Art., age 32. 22, 64. Died May 25, 1864. 1862. operation was completed. Ellsworth, J., Pt., C, 1st July 3, Left. Surg. C. S. Wood, 66th N. 112 McMullen, M., Pt., G, Feb. 25, Rigut. Dr. P. II. Johnson, Rich Minnesota. -, 63. Y. Died July 20, 1863. Virginia Grays. , 63. mond. Died eight days after 81 Fellows, C. B., Serg t, Sept. 29, Right ; anterior post, double flap. operation. Spec. 3016. H, 115th N. Y., age 26. Oct. 2/64. Confed. surgeon. Died Nov. 1 1, 113 McNiece, S., Pt., C, 19th Aug. 30, Right; circ. A. A. Surg. B. F. 1 864 ; congestion of lungs. Indiana. Sept. 22, Bowles. Died Sept. 25, 1862. 82 Fenner, T., Pt., G, 142d Dec. 13, Left; circ. Surg. J. A. Phillips, 1862. Spec. 15. Pennsylvania. 16, 62. 9th Penn. Res. Died Jan. 12, 114 Merritt, C. S., Corp l, D, April 6, ; double flap. Surg. E. C. 1863; wound. 40th Illinois. -, 62. Franklin, U. S. V. Died April 83 Fisher, H., Serg t, A, Oct. 19, Right ; lat. skin flap ; circ. muse. 28, 1862. 10th N. Jersey, age 21. 22, "64. Surg. C. II. Andrus, 176th N. Y. 115 Murit, B., Pt., H, 17th Aug. 30, . Died September 14, 1862. Died Nov. 12/64 ; exh n. Autop. New York. , 62. 84 Frazier, J. H.,Pt., A,56th Dec. 6, Left; ant. post. flap. A. A. Surg 116 Murphy, J. M., Pt., E, Sept, 17, R t ; circ. A. A. Surg. A. North, New York, age 25. 11, 64. W. Balser. Died Dec. 13, 1864 ; 27th Georgia, age 22. Oct. 10, Died Oct. 21, 1862; exhaustion. exhaustion. 1862. Specs. 779, 871. 85 Gaw, R. P., Pt., B, 23d June 1, Left. A. Surg. B. Stone, U.S.V. 117 Musser, J., Capt,, A, 46th April , Left. Died April 24, 62 ; shock. Penn., age 52. 9, 64. Died June 13, 1864. Spec. 1407. Illinois. , 62. 86 Hite, n. S., Pt., A, 17th May 5, ; flap. Surg. D. Prince. U. 118 Noonan, F., Pt., F, 18th Sept. 17. Right. A. Surg. H. A. Dubois, Virginia. 8, 62. S. V. Died May 9, 62 ; shock. New York. Oct. 1/62. U. S. A. Died Aug. 8, 1863; 87 Hoffman, C., Pt., A, 1st Aug. 1, Right (haem.); dou. oval skin flap. tuberculous disease. Spec. 3886. Cavalry, age 24. 8, 63. A. Surg. W. Thomson, U. S. A. 119 Nugent, P., Pt., I, 5th July 2, Left ; circ. A. Surg. B. Howard, Died Ang. 8, 63 ; shock. Spec. Artillery. 5, 63. U. S. A. Died July 8, 1863. 1679. Autopsy. Spec. 1380. 88 Hostetter, A., Corp l, K, 45th Penn., age 23. May 9, 26, 64. Right ; ant. post. flap. Surg.A.F. Sheldon, U. S. V. Died May 28, 120 Parrish, P. B., Serg t, D, 31st N. C., age 22. Sept. 29, Oct. 7/64. Right. A.A.Surg. E. K. Deemy. Died October 9, 1864. 1864 : exhaustion. 121 Patten, J., Pt., I, 3d Wis May 25, Right; circ. A. A. Surg. II. S. 89 Howell, J., Serg t, K, July 9, Left ; amp. mid. third ; reamp. up. consin, age 21. Je.7/64. Kilbourne. Died July 22, 1864 ; 110th Ohio, age 37. 12, 64. third while on table. A. A. Surg. exhaustion. Spec. 3396. W. S. Adams. Died July 12, 122 Pierce, T. M., Pt., B, 1st May 19, Right ; circ. Died May 31, 64 ; 1864; shock. Maine Art y, age 16. 25, 64. asthenia. Spec. 2617. 90 3 Hutchings, J. B.,Pt.,G, 6th New York H. Art., May 30, Je. 5/64. Left; circ. Surg. J. A. Lidell, U. S. V. Died June 10, 1864 ; 123 Province, S., Pt., I, 90th Pennsylvania. Aug. 31, Se. , 62. . Died September 21, 1862. age 22. exhaustion. Autopsy. 124 Radford, V., Pt., K, 71st May 12, Left; circ. A. A. Surg. J. H. 91 Jarkson, C., Corp l, G, 2d Michigan. June 25, 28, 64. Left. (June 25, exc. fib.) Surg. A. F. Whelan, 1st Mich. S. S. Penn., age 29. 19, 64. Thompson. Died May 25, 1864 ; pyaemia. Died July 2, 1864. 125 Razette, V., Corp l, G, Mav 5, Right. Died June 1, 1864 ; py- 92 Johnson, J., Pt., A, 153d Oct. 19, Right (haem.); circ. A. A. Surg. J. 57th Mass, ajre 33 9 64 New York, age 21. No. 9, 64. Neff. Died Nov. 17/64 ; pyaemia. 126 Robbins, A., Pt., G, 48th July 4, Left. Died July 9, 1864. 93 Jones, T., Pt., H, llth June . Right. Surg. Ward, C. S. A. Colored Troops. 7, 64. 94 Virginia. Jourman, R., Pt., E, 35th J ylO/62. Feb. 20, Died July 16, 1862. R t ; flap. Surg. Hallyfield, C. 127 Rowell, A., Pt., F, 94th New York. Aug. 31, Se.-/62. . Died September 10, 1862. Colored Troops. 26, 64. S.A. Died June 5/65; consump. 128 Rowland, R., Pt., 1st N. June 19, Left; ciro. A. A. Surg. W. C. 95 Kelly, J., Pt , F, 1st N. York Cavalry, age 21. July 7, Au. 6/63. Left (ball extr.> A. Surg. R. F. Weir, U.S.A. Erysipelas. Died 129 York Ind. Bat., age 31. Ryder, S., Pt., F, 1st 27, 64. Mav 31, Pryer. Died June 27/64 ; exh n. Left. A. Surg.A. Ingram, U.S.A. 96 Kerr, R. D., Pt., F, 5th May 6, Aug. 18/63. Spec. 3895. Autop. (haem ); ant. post. flap. A. Mass. H. Art y, age 39. Je. 5/64. Died June 12, 18(i4; exhaustion. Spec. 2824. N. Carolina Cavalry. 23, 64. Surg. W. F. Hichardson, C. S.A. 130 Smith, , , 14th New July 21, . Surg. >Darby, Hampton s Died May 23, 1864. York S. M. 27, 61. Legion. Died July 27, 1861. 97 98 Kisnt.r, G. W., Pt., E, 19th Mississippi. Knox, T. T., Pt., B, 1st June , J y 13/62. Oct. 19, Right. Surg. _ Ward, C. S. A. Died July 14, 1862. Left (mortification); lat. skin flap; 131 Soule, J. W., Corp l, D, 6th Michigan Cavalry, age 27. July 8, 29, ^63. Right (July S, exc.; baam. from sciatic artery) ; ant. post. flap. Died July 29, 18G3. Spec. 3854. Maine, age 40. 22, 64. circ. sect. muse. Surg. C. H. Autopsy. Andrus. 176th N. Y. Died Nov. 132 Stanford, G., Pt.,A,12th July 9, Left ; circular. Died same day; 10, 1864; pyaemia. Georgia, age 30. 13, 64. never rallied. 1 LIDKLL (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in U. S. San. Com. Memoirs, Surg. Vol. I, 1870, p. 383. 2 BttYAX, i J.), Brief Description of Sixteen Cases of Amputations Treated in the Mary Ann Hospital, Grand Gulf, Miss., in Am. Med. Time* Vol. VH, 1863, page 5, case XIII. 3 LIDELL (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in U. S. San. Com. Memoirs, Surg. Vol. I, 1870, p. 413. 4 LIDELL (J. A.), On the SecorVary Traumatic Lesions of Bone, etc., in U. S. San. Com. Memoirs, Surg. Vol. I, 1870, p. 409. COUES (E.), Report of some Cases of Amputations and Resections, from Gunshot Wounds, performed at the Mount Pleasant U. S. A. General Hospital, by C. A. McCall, M. D., U. S. A., in Med. find Surg. Reporter, 1862-3, Vol. 9, p. 194. SECT, in.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 277 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 133 Stiff, D. D., Serg t, A, 2d June 10, Right (ball and bone extracted). 140 Vose, E., Pt., I, 5th New Dec. 13, Left. Surg. C. 8. Wood, 66th Michigan Cavalry. 13, 63. Died one hour after. Spec. 659. Hampshire. 22/62. N. Y. Died Dec. 23, 1862. Autopsy. 141 Warren, C., Serg t, I, Sept. 17, Left (gang.); flap. Surg. A. N. 134 Still, C. B., Pt., B, 22d Sept. 1, Left. Died September 13, 1864. 15th Massachusetts. Oct.2, 62. Dougherty, U. S. V. Died Oct. Indiana. -, 64. 2, 1862 ; shock. Spec. 379. 135 Tetard, J., Serg t, F, Gth Infantry. July 1, 4, 63. Left ; double skin flap. A. Surg. B. Howard, U.S.A. Died July 142 Wheedon, K. A., Corp l, K, 47th N. C., age 24. July 3, 7, 63. Left ; liaem. from muscul. branch. Died July 23, 1863; pyaemia. 13, 1863. Hsem. Spec. 1381. 143 Whitbeck, W., Pt., E, July , Right. Surg. C. S. Wood, With 136 Thomas. W. C., Pt., G, Oct. 22, Right ; circ. Died Nov. 9, 1862. lllth New York. , 63. N. Y. Died July 14, 1863. 7tli Connecticut. No. 9, 62. 144 Williams, W.,Pt.,B, 24th July 1, Left. Died July 20, 1863. 137 Tompkins, G., Pt., G, 1st July 3, Right (July 4, amp. leg.; gang.); Michigan. 6, 63. New York Bat y, age 17, 63. amp. thigh to get rid of putrid 145 Winchell, G., Pt., D, May 12, Right; circ. Surg. A. Delaney, 40. mass; haem.; lig. fem l artery. 14th New York Art y, 29, 64. U. S. V. Died June 2, 1864; Died July 26, 1863; pyjemia. age 18. congestion of lungs. 138 Underwood, T., Pt., G, June 27, Right. Surg. W. Faulkner, 83d 146 Woodward, J. T., Pt., June 3, ; circ. Surg. C. B. Herndon, 1st Mich., age 30. J y9, 62. Penn. Erysipelas ; gang. Died D, 26th Mississippi. 23, 64. C. S. A. Anorexia ; bed sores ; August 11, 1862. diarr. Died July 15/64 ; exh n. 139 Verner, J., Pt., I, 99th Aug. 28, Left. Died September 21, 1862 ; 147 Worchester, S. W., Pt., Sept. 19, Left ; flap. Surg. W. A. Barry, New York. Se.18, 62. pyaemia. B, 9th N.-Y.H. Art y. 23, 64. 98th Penn. Died; exhaustion. In one hundred and thirteen of the above cases the femur had been fractured in eighteen, in the upper; in fifty, in the middle; in fifteen, in the lower third; and in thirty, without indication of the precise location. In twenty-nine instances the seat of fracture was in the knee joint, and in five in the leg. In one case, primary amputation in the upper third of right arm, in three instances excision in the thigh or bones of the leg, and in one, amputation in the upper third of the same leg had preceded the amputation in the thigh. 1 Intermediary Amputations in the Middle Third of the Thigh. The four hundred and seventy-one intermediary amputations in the middle third of the thigh furnished two hundred and sixty-six deaths, a mortality rate of 56.4, or nearly 10 per cent, less than the intermediary upper third amputations. Seventy-two of the four hundred and seventy-one operations were performed on Confederate soldiers. The right limb was removed in two hundred and nine, and the left in two hundred and thirty-five instances, and in twenty- seven the side was not indicated. The circular and the flap methods were each employed in one hundred and sixty-three cases; in one hundred and forty-five the mode of operation was not stated. Successful Cases of Intermediary Amputations in the Middle Third. One hundred and sixty-seven of the two hundred and five operations of this group were performed on Union soldiers. All but seven were living in October, 1879. Two had undergone ante cedent operations; one an excision at the knee joint, and one an amputation in the upper third of the leg. 2 Sequestra were removed in twelve, and fragments or protrusions of bone in thirty-one instances: CASE 458. Sergeant H. Clark, Co. E, 125th New York, aged 22 years, was wounded at the Wilderness, May 6, 1864, and entered the Third Division Hospital, Alexandria, eight days afterwards. Surgeon E. Bentley, U. S. V., reported: "The patient was admitted with a shot injury of the left knee joint, caused by a conical ball. His physical state was good, but the condition of the wounded limb was such as to give no hope of recovery without resorting to amputation. The operation was performed by antero- posterior Haps, at the junction of the middle and lower thirds, on May 17th, chloroform being used as the anaesthetic. The patient did not rally well, and fears were entertained of his immediate death. He had chills at intervals for a week or ten days. By June 10th, the stump was doing well and parti} closed by first intention, though there was profuse suppuration. The treatment consisted of stimulants, beef tea, iron, and quinine, and cold-water dressings. With the exception of the excessive suppuration the patient did well until June 20th, when he had a severe chill, and stimulants were ordered to Private H. Schmidt, O, 57th Illinois (TABLE XXXIV, No. 44, p. 275. and Second Surg. roL, TABLE LXVI1I, No. 920, p 711), amputation right thigh and right arm in upper thirds, recovery; Corp l J. W. Soule, D, 6th Miohifr.m Cavalry (TARI.E XXXIV, No. 131, p. 27fi, anil TABLE XXIII, No. 51, p. 206, ante), primary excision of femur in upper third and amputation of thigh, fatal; Pt. J. Becht, B, 7th Maryland (TAlil.E XXXIV, No. 57, p. 275, and TADI.E XXIII, No. 3, p. 20fi, ante), primary excision in middle third of femur and amputation of thigh, fatal ; Corp l C. Jackson, 2d Michigan (TAHLE XXXIV, No. 91, p. 27(5), excision of upper part of fibula and subsequent amputation of thigh, fatal ; Pt. G. Tompkius, G, 1st New York Battery (TABLE XXXI.V. No. 137, p. 277), amputation of upper third of leg followed by amputation in thigh, fatal. Private W. M. Constable, H, 1st Cavalry, wounded March 31, 1865; primary excision of knee joint March 31, 1865, amputation of thigh April 5, 1865 (TA1U.E XXXV, No. 43, p. 280); Pt. A. J. Cheever, H, 16th Massachusetts, wounded July 2, 1863, amputation of leg July 4th, and amputation of thigh July 18, 1803 (TABLE XXXV, No. 35, p. 280). 278 INJUEIES OF THE LOWER EXTREMITIES. (CHAP. X. FIG. 190. Sequestrum, 4J ins. long, remov dnine months aff? r amputation. Spec. 666. FIG. 191. Cast of stump of left thigh, nineteen months after am putation. Spec. 294. be used freely, and quinine was given in large doses. The secretion having become watery and offensive, the dressings were changed frequently. No repetition of the chill occurred, and by June 25th the patient s countenance had changed very much for the better, being now clear instead of the yellow hue. The treatment was continued, and the patient steadily improved, his appetite being good and his bowels regular. On July 1st, the stump had closed with the exception of one opening, which was still discharging a large quantity of pus, healthy in color and odor, however. On July 7th, the patient complained of pain just below the great trochanter, caused by tumefaction and great heat of the skin, for which tincture of iodine was applied, fol lowed by a tight bandage, and morphia was administered. On July 10th, an abscess was opened in the region of the great trochanter and followed by a thin watery discharge. A tent was then introduced, and the whole stump being much swollen, it was painted with tincture of iodine, and a bandage was applied tightly. On July 15th, another abscess was forming on the posterior aspect ; the stump, though much reduced in size, was still discharging quite freely. On July 20th, the patient was suffering from a severe diarrhoea, and his diet was restricted, and lead and opium prescribed. By July 30th, the diarrhooa was checked; the abscess on the posterior aspect of the thigh, having formed a track and opened at the end of the stump, evacuated half a pint of healthy pus. The stump still continuing to discharge large amounts of pus, the bandage was kept tightly applied. Diluted creasote was also used locally, and iron and quinine was continued internally. On August 7th, a new abscess was opened just below the great trochanter. On August 13th, the stump still suppurating freely, an injection of solution of chloride of zinc was commenced, the bandage being continued, and the patient freely stimulated by the use of whiskey. After this date several abscesses formed on different parts of the thigh, which were opened and discharged large quantities of pus. By proper bandaging the limb was finally reduced to near its natural size, but one opening remaining at the end of the stump and discharging a limited quantity of pus. By the use of stimulants and nourish ing diet the patient s general health improved so as to enable him to be transferred to hospital at Albany, near his home, on November llth." The description of two sub sequent operations was contributed by Assistant Surgeon J. H. Armsby, U. S. V., in charge of Ira Harris Hospital : "At the time of the patient s admission his constitutional condition was bad, being pale, weak, and emaciated. The stump was swollen and inflamed, and there were several small fistulous ulcers. On February 6, 1865, a sequestrum (FlG. 190) was removed through an incision about five inches in length by Acting Assistant Surgeon H. Pearce. After this operation the stump began to heal, and continued to do well up to September 4, 1865, when the patient was discharged from service. On December 9th, following, he applied for admission into the Albany City Hospital. The stump was then healed with the exception of a small fistulous ulcer, which was discharging moderately. There was but little swelling and pain, but, on examination with the probe, naked and carious bone could be discovered. The patient having been placed under the influence of chloroform, two elliptical incisions were made on the extremity of the stump, including the ulcer, and the tissues were removed down to the bone, thus leaving lateral flaps. A chain saw was then introduced and the boue cut through an inch and a half higher up, after which the flaps were brought together and secured by sutures. Cold-water dressings were applied after the operation." A cast of the stump (FlG. 191) was also contributed to the Museum by Dr. Armsby, and constitutes Specimen 294 of the Surgical Section. Fourteen months after the last operation the patient was supplied with an artificial limb by E. D. Hudson, of New York City. Examiner A. P. Cook reported, May 14, 1873: "He is unable to wear an artificial limb. The femur is about three inches shorter than the fleshy stump. The stump is atrophied, the muscles are soft, and there is a deep cica trization at the end, which is very tender." The pensioner was paid June 4, 1879. CASE 459. Lieutenant-Colonel George R. Maxwell, 1st Michigan Cavalry, aged 22 years, was wounded at Five Forks, Virginia, April 1, 1865. He was taken to the field hospital of the Cavalry Corps and remained there until April 15th, when he was sent to Washington on the hospital steamer Connecticut, and admitted to the Armory Square Hospital on the 16th. Acting Assistant Surgeon C. A. Leale, 1 in a special report of the case, furnishes the following particulars: " The left knee joint was opened by a conoidal ball, which had entered opposite the head of the fibula and was extracted at point of entrance. He was very ana3inic and in a generally unfavorable condition; extensive suppuration had taken place, the leg had become infiltrated with serum, the knee joint was filled with pus, and the muscles of the thigh had been separated by extensive abscesses extending as high as the apex of Scarpa s triangle. April 17th, no change in his condition; he was placed under the influence of ether, and the thigh amputated by the circular operation, at the middle third, by Surgeon D.W. Bliss, U. S.V.; the stump was dressed with water, and the patient placed in bed. April 18th, although twelve ligatures had been applied, haemorrhage continued to take place (he being apparently of a hamorrhagic diathesis), and altogether about eight ounces of blood was lost. Applied liquor ferri persulphas by a camel s hair brush to the whole of the surface of the wound, which had been left open and exposed to the air for about fifteen minutes ; this, with the styptic, entirely checked all oozing. April COth, the granulations had become healthy; about two drachms of pus discharged daily. On the 30th the stump had nearly closed. June 23d, a piece of necrosed femur of a conical shape, and about four inches in ength, was removed. August Hth, he was mustered out of service; his stump (FlG. 19.!) was solid and in good condition." The pensioner was paid June 4, 1879. LEALE j. A ), Intermediary [Ixmnrrhage, Parenchymatmis in Cliaracter, following Secondary Amputation of Thigh; Recovery, in United States Sanitary Coinmitsifm Memoirs, Surgical Volume 1, p. 176. Fin. i9-j. Amputating <>f left thigh at mid dl third. [From a photograph.] SECT. III.] INTEKMEDIARY AMPUTATIONS OF THE THIGH. 279 FIG. 193. Upper portion of rigfht tibia with eccentric splin tering. Spec. 3558. FIG. 194. Tubular se questrum, 6 ins. long, re moved from right femur four months after ampu tation. Spec. 3599. CASE 460. Private O. Vezina, Co. B, 9th New Hampshire, aged 24 years, was wounded at Tolopotomy Creek, May 31, 1864, and admitted to the field hospital of the 2d division, Ninth Corps, where Surgeon J. Harris, 7th Rhode Island, noted: "Shot wound of right leg by mini6 ball." Four days after the reception of the injury the man was transferred to Douglas Hospital, Washington, where the limb was amputated. Assistant Surgeon W. Thomson, U. S. A., who performed the operation, described the case as follows: "The missile entered over the anterior surface of the tibia at about the junction of the lower thirds, passed obliquely upward and inward, fracturing the bone in several pieces and lodging beneath the integuments, whence it was extracted on the field. The fibula was not injured. On admission, the leg was erysipelatous and abscesses were bur rowing above and below, one of which was opened below the internal malleolus. Poultices were applied, and several sloughs of the integuments came away, leaving the muscles and tendons exposed. The patient suffered constitutional irritation from continual pain and was anxious for amputation, which was performed on June llth, by the antero-posterior flap method, at the lower part of the middle third. The stump was dressed with equal parts of tincture of opium and tincture of camphor, and poultices were applied until June 18th, when the sloughs had entirely separated. After this, cold-water dressings were used and the stump progressed finely. By September 1st, it had been healed for some time, with the exception of a fistulous opening lead ing to necrosed bone. On October 13th, the patient having for some days suffered from great pain and consequent inability to rest, a sequestrum, six inches long and of a nearly entire circum ference, was, with great difficulty, removed by Acting Assistant Surgeon H. Gibbons. A large formation of new bone was discovered around the cavity thus left in the stump. After the operation the pain ceased, and the patient again became cheerful and his appetite good. On December 25th, the opening had almost entirely closed." The upper portion of the tibia of the amputated limb, showing eccentric splintering by the missile, and necrosis adjacent to the seat of the fracture, was contributed by the operator, and is represented in the wood-cut (FlG. 193). The sequestrum, shown opposite (FlG. 194), was contributed by Assistant Surgeon W. F. Norris, U. S. A. The patient was discharged from service June 14, 1865, and furnished with an artificial limb one month afterwards by B. F. Palmer, of Phila delphia. The pensioner was paid June 4, 1878. In the following instance the officer remained in active service until 1870, when he was retired. He died in 1879: CASE 461. Brigadier-General T. W. Sherman, U. S. V., Colonel 3d U. S. Artillery, was wounded, during the assault on Port Hudson, May 27, 1863, by a conoidal musket ball passing through his right leg and causing a fracture of the tibia and fibula at the upper third. When conveyed to New Orleans, three or four days after the injury, the wound, which was extensive and greatly lacerated, was found to have been very tightly sewed up with one continuous suture, the cutting out of which gave exit to a large discharge of decomposing coagula, pus, and bone splinters. His constitutional symptoms had assumed a most aggravated character, and the patient remained in a very discouraging condition for nearly two weeks, when amputation through the middle third of the thigh, though only offering the slightest hope of success, was performed by Professor Warren Stone with favorable result. The injured tibia and fibula (Spec. 3804), many of the missing fragments of which were discharged from day to day before the amputation, were contributed to the Army Medical Museum by Professor F. Bacon, of New Haven, late Surgeon U. S. V. General Sherman was mustered out of the volunteer service April 30, 1866, and retired from active service December 31, 1870. He died at his home in Newport, R. I., March 16, 1879. (See Circular No. 6, War Department, S. G. O., 1865, p. 38.) Fifteen of the patients survived ulterior operations one a re-amputation at the hip joint, 1 ten, re-amputation of the thigh, one an amputation of the opposite arm and leg in consequence of an accident, and three, ligations of the femoral artery. Consecutive bleeding was observed in nine, pyaemia in two, and gangrene in fourteen of the cases of this group. Fatal Cases of Intermediary Amputation in the Middle Third of the Thigh. Two hundred and sixty-six cases belong to this group. Thirty-four of the operations were practised on Confederate, and two hundred and thirty-two on Union soldiers. Pyaemia was noted in forty-two, gangrene in thirty-three, tetanus in four, erysipelas in four, and haemorrhage in sixty-nine instances. The Museum possesses specimens in eighty-nine of the two hundred and sixty-six cases: CASE 462. Corporal Clark Chase, Co. B, 120th New York, aged 23 years, was wounded at Cold Harbor, Virginia, May 31, 1864. Surgeon O. Evarts, 20th Indiana, reported the admission of the patient into the hospital of the 3d division, Second Corps, with a "shot wound of the left thigh, flesh; simple dressings." He was transferred to Washington, and admitted into Douglas Hospital on June 4th. Assistant Surgeon William Thomson, U. S. A., reported : " Shot fracture of right femur, lower part of middle third. The patient s condition was apparently good, his pulse full and strong. The bone was much comminuted. There was no inflammatory action. June 5th, Assistant Surgeon W. Thomson administered ether, and amputated the left thigh m the upper part of the middle third by the circular method. 8th, pyasmia developed, ushered in by a chill. 10th, chill; conjunc- 1 Sergeant E. D. Ulmer, G, 15th New Jersey. (See CA6E 333, p. 156, and TABLE XVIII, No. 5, p. 159, ante, and TABLE XXXV, No. 183, p. 282.) 280 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. tiva slightly yellow, llth, haemorrhage, to the extent of four ounces, from a muscular branch, which ceased spontaneously and did not recur. The discharge from the stump was very dirty and offensive, and breath sweetish. He died June 12, 1864. The autopsy revealed pyaemic patches in the lungs, phlebitis of femoral veins, and osteomyelitis of the femur." Dr. Thomson con tributed the pathological preparation of the femoral artery to the Army Medical Museum, numbered 2509, and the lower two- thirds of the femur, numbered 3548, of the Surgical Section. He also forwarded the upper extremity of the femur (Spec. 6715, Surg. Sect."), removed post-mortem. A longitudinal section of the specimen, showing osteomyelitis, was drawn by Hospital Steward E. Stauch, and is copied in the chromo-lithograph (PLATE XXVI) opposite p. 278. CASE 463. Brigadier-General E. Kirby, U. S. V., First Lieutenant, U. S. Artillery, was wounded at Chancellorsville, May 3, 1863. He was admitted to the Artillery Brigade Hospital, Second Corps, whence Surgeon J. H. Merrill, 1st Rhode Island Artillery, reported : " Wound in lower third of left thigh by two bullets from a spherical case shot. Patient sent immedi ately to Washington." Surgeon B. Norris, U. S. A., under whose care the patient came to Washington, reported the following description and result of the injury: "Two round balls entered the thigh about two inches above the condyles, producing a com minuted fracture of the lower third of the femur. The case came under my treatment on May 5th, and amputation at the middle third by the circular method was performed on May 10th. The tourniquet was used, and chloroform employed as the anaesthetic. One ball was found embedded in the medullary canal of the femur, and the other in the vastus externus muscle. The operation was followed by increase of fever, which rapidly assumed the typhoid type. This brave young officer survived the operation eighteen days, and died of pyaemia May 28, 1863." The amputated portion of the femur was contributed to the Museum by the operator (Cat. Surg. Sect., 1866, p. 290, Spec. 1076), and is represented in PLATE XLII, opposite. TABLE XXXV. Summary of Four Hundred and Seventy-one Cases of Intermediary Amputation in the Middle Third of the Femur for Shot Injury. [Cases of recovery, 1205 ; fatal cases, 206 471.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Albert, J., Pt., D, 46th Aug. 9, Left. Surg. D. O. Perry, 10th 24 Burgess, D. M., Pt., Mas- Nov. 3, Right. Surg. Browne, C. S. A. Penn., age 26. 14, 6-2. Me. Necrosed. Disc d Jan.4, 64. sier s Battery. 7, 63. Recovery. 2 Alexander, J. D., Pt., A, May 8, Right ; circ. Confed. surgeon. 25 Campbell, W., Pt., C, Sept. 17, Right ; circ. Nee. bone excised. 8th Maryland, age 20. 12, V)4. Disch d June 20, 1865. 69tb Penn. 21, 62. Disch d July 29. 63. Spec. 3822. 3 Allhouse, L., Pt., H, 63d May 5, Left; circ. A. A. Surg. M. F. 26 Campbell, W. P., Capt., De.31, 62, Right. Surg. J. Avents, C. S. A. Peun., age 20. 27, 64. Price. Seq. removed. Disch d D, 1st Arkansas. Ja.27, : 63. Furloughed Oct. 1, 1863. May 24, 1865. Spec. 2908. 27 Campbell, W. B., Pt., C, May 9, Left; circ. Surg. D. W. Bliss, 4 Baker, G., Teamster. Aug. Right; flap. Recovery. 1st Me. H. Art., age 20. Je. 1, 64. U. S. V. Disch d Feb. 16, 1865. , 64. 28 Carey, J.G.,Pt., D,106th May 14, Right ; circ. A. A. Surg. J. H. 5 Baker, J. T., Pt., B, 72d July 1, Lett. Surg. Russell, C. S. A. Pennsylvania. 26, 64. Thompson. Disch d May 27, 65. New York. 5, 62. Disch d Aug. 2J, 1865. 29 Carey, W., Pt,, B, 13th April 7, Right. Surg. C. H. Mast in, C. S. 6 1 Barker, C. R., Pt., D, July 21, Right. Snrg. Ford, C. S. A. Arkansas. 24, 62. A. Recovery. 7th Louisiana, age 23. Aug. 9, Necro.; dead bone, seven and a 30 Carl, M., Pt., G, 107th Sept. 17, Left ; flap. Disch d Feb. 17, 63. 1861. half ins. in length, extracted. Pennsylvania. , 62. Retired Jan. 5, 1865. 31 Case, J. E., Pt., E, 16th Sept. 17, Left ; circ. Dr. P. W. Ellsworth, 7 Barleon, G., Pt., C, 33d Jan. 3, Left; flap. Disch d April 27, 63. Conn., age 22. Oc. , 62. Hartford, Conn. Seq. remov d. Ohio. 10, 63. Disch d Oct. 16, 63. Spec. 2859. 8 Bartmess, G. J., Serg t, Sept. 14, Left i flap. Disch d Jan. 5, 1863. 32 Castor, T., Pt., I, 5th May 6, Left ; circular. Confed. surgeon. G, 3(3th Ohio. 17, 62. Died Aug. 9, 1866; ccmsumpt n. Mich., age 26. 11, 64. Disch d Jan. 27, 1865. 9 Bell, C. E., Serg t, C, Aug. 27, Right ; duub. flap. .A. A. Surg. 33 Champens, W., Corp l, July 11, Left; flap. Confederate surgeon. 74th New York. Sept. 4, U. lleyburn. Six anda half ins. C, 76th Penn., age 20. 15, 63. Disch d Aug. 24, 1864. 1862. bone removed. Disoh d Jan. 23, 34 Chase, P. E., Pt., C, 7th Aug. 14, Right ; circ. A. A. Surg. II. B. 1863. Spec. 323. Col d Troops, age 25. 19, 64. White. Fragments removed. 10 Bennett, D., Pt., K, 1st Mar. 23, Left; flap. Disch d June 18/62. Disch d May 26, 1865. W. Virginia, age 19. 27, 62. 35 Cheever, A. J., Pt., H, July 2, Left (July 14, amp. leg). Disch d 11 Blazier, T. f ., Pt., C, 1st July 7, Left. Recovery. 16th Mass., age 35. 18, m January 27, 1864. Texas. 15, 63. 36 Christ, A. L., Corp l, A, Jan. 30, Right ; circ. Surg. E. Bentley, U. 12 Blodgett, E. F., Pt., D, May 5, Right ; flap. Disch d August 22, 5th Penn., age 21. Fe.4, 64. S.V. Gangrene. Mustered out 4th Vermont, age 34. 12, 64. 1864. Dec. 23, 1864. 13 Bodge, G. E., Pt., A, 5th Sept. 19, Right; ant. post. flap. A. Surg. 37 Clark, F., Corp l, F, 4th July 2, Left ; flap. Surgs. Ramsour and Louisiana, age 25. Oct. 10, Dorsev. 1st Md. Cav. C. S.A. Michigan, age 21. 16, *63. Patterson, C. S.A. Carious bone 1864. Exchanged Feb. 16, 1865. rem d. Disch d June 14, 1864. 14 Boscroe, S., Pt., M, 4th Feb. 22, Right ; circ. Confed. surgeon. 3S Clark.H., Serg t,E,125th May 6, Left; ant. post. flap. Surg. E. Cavalry, age 21. 25, 64. Disch d July 15, 1865. New York, age 22. 17, 64. Bentley, U. S.V. Seq. four and 15 Boss, E. P., Pt., K, 44th June 27, Right. Disch d Feb. 28, 1863. a half ins. long rem d. Disch d New York. 30, 62. Sept. 4, 65. Specs. 294, 602, 666. 16 Boucher, G., Pt., A, 76th July 1, Right ; circ. Surg. J. M. Farley, 39 Clark, M. D., Pt., D, 6th Mar. 31, Left; circ. Surg. D. W. Bliss, New York. 6, 63. 84th N. Y. Disch d Feb. 23, 64. Ohio Cav., age 18. Ap.5, 65. U. S.V. Disch d July 18, 1865. 17 Bowen, J. H., Corp l, C, July 1, Left (gang.); circ. Disch d Dec. Spec. 4058. 10th Indiana, age 23. 18, 63. 19, 1863. 40 Clune, J.,Pt., F, 14th In Aug. 30, Right (haem.); flap. Disch d Jan. 18 Boyle, M., Pt., F, 5th Aug. 9, Left ; flap. Disch d Nov. 21, 62. fantry. Se. 5, 62. 2, 1863. Ohio. 13, 62. 41 Collins, M., Pt., K, 13th Dec. 7, Left ; flap. Surg. A. J. Ritchie, 19 Brassell, \V., Pt., M, 72d Sept. 17, Left; lat. flap. A. A.Surg. J.H. Kansas, age 26. 10, 62. 2d Kansas. Dec. 25, haem.: lig. Penn., age 18. Oct7, 62. Bartholf. Disch d Dec. 29. 62. fem. art. Disch d May 13, 1864. Spec. 771. Died Jan. 20, 1865; 42 Conners, W. B., Pt., C, Oct. 5, Right ; circ. Snrg. W. F. West, consumption. 28th Illinois. 19, 62. 28th 111. Disch d April 4, 1863. 20 Brown, J., Pt., H, 100th July 27, Right ; circ. A. A. Surg. W. L. 43 Constable, W.M.,Pt.,H, Mar. 31, Right (Mar. 31, exc. knee j t); circ. New York, age 21. Au. 1, 64. Welles. M. O. Feb. 9, 1865. 1st Cavalry, age 26. Ap.5, 65. A. A. Surg. F. H. Colton. Seq. 21 Bruce, J., Pt., B, 49th May 10, Right; circ. Confed. surgeon. rem d. Disch d Nov. 18, 1865. Penn., age 21. 14, 64. Seq. rein d. Prison (sentence G. 44 Cook, J. M., Lieut., E, May 3, Left. A. A. Surg. H. W. Duca- C. M.) July 3, 1865. 119th Penn., age 30. 11, 63. chet. Disch d Aug. 19, 1863. 22 Bufllngton, J. D., Pt., A, Sept. 17, Right. Surg. Gray, C. S. A. Died July 28, 1865 ; sunstroke. Huger s Battery. 21, 62. Fnrloughed. Spec. 1119. 23 Biiffum, T. J., Corp l, K, July 18, Right (mortificat n); ant.post.flap. 45 Cooper, A., Corp l, F, Aug. 30, Left ; flap. Disch d Dee. 11 , 62. 100th Now York. 23, 63. Disch d Feb. 14, 64. Spec. 37. 101st New York. Se.8, 62. JONES (J.), Investigations upon tlie Nature, Causes, and Treatment of Hospital Gangrene at it prevailed in the Confederate Armies, 1861-1865, in U. S. San. Com. Memoirs, 1871, Surgical Volume II, p. 267. SECT. III.] INTERMEDIARY AMPUTATIONS OE THE THIGH. 281 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 46 Cortelyou,W.,Pt., B,9th April 19, Right. Two Confed. surgeons. 85 Heffner, J., Pt., C, 31st Sept. 19, Right ; circ. Surg. S. J. Young New York. 23, 62. Bone taken away. Recovery. Ohio, age 24. 24, 63. 7!!th 111. Disch d July 5, 18641 47 Cronk, E., It., F, 21st April 6, Left ; flap. Surg. E. C. Franklin. 86 . Henderson. N. G. B.,Pt., Oct. 2, Left. Recovery. Missouri. 15, 62. U. S. V. Disch d Aug. 29, 62. > ! H, 3d Texas. 8, 62. 48 Crosson, Ji. F., Pt., E, June 29, Left. Surg. R. A. Lewis, P. A. C. 87 , Hill, J., Pt., I, 3d Wis- Sept. 17, Right ; flap. Disch d Jan. 13, 03. 28th Georgia. J y 5, 64. S. Recover}-. cousin. 20, 62. 49 Cunningham, J. H., Pt., Oct. 4, Left. Surg. Palmer, C. S. A. 88 Hinsev, A., Pt.. F, 85th July 19, Left; flap. Surg. E. Bntwell, I, 2d Missouri. 8, 02. Recovery. Illinois, age 17. 25," 04. 14th .Mich. Disch d June 15, 05. 50 Cutsinger, S., Pt.,C, 27th Sept. 17, Right. D isch d Jan. 10, 1863. 89 Hoffacker, W., Corp l, Mav 11, Right ; ant. post. flap. Surg. R.B. Indiana. 21, 62. II, 3d Maryland, age 27," 64. Bontecou. U. S. V. Furlough d 51 Daverio, C., Pt., E, 3d Aug. 9, Left. Sept. 2, re-amp.: gang.: 22. July 19, 64. Spec. 3003. Maryland, age 26. 12, 62. nee. bone rem d; large vessels 90 Howard, W. H., Corp l, June 18, Left : circ. A. Surg. A. Delaney, secured. Disch d April 16, 03. E, 147th N. Y., age 23. J y 6, 64. U. S. V. Disch d June 23. 05. 52 Davis, D. D., Pt.,K, 28th Julv 3, Left. Exchanged March 17, 64. Spec. 2805. North Carolina, age 21. 8, 63. 91 1 Irens, J. S., Pt., I, 61st Dec. 13, Right; circ. Surg. C. S. Wood, 53 Denton, E., Serg t, H, Sept. 29, Left ; short ant., long post, flap ; New York. 16, 62. 60th N.Y. Nee.: resec. of stump; 112th N. Y.. age 42. Oct. 2, 64. nee Disch d Oct. 17, 1865. bone and necro. bone removed; 54 Dodge, B. C., Serg t, M, Aug. 22, Left ; flap. Dr. Haggarty. Dis osteomyelitis. Dis d July 7, 63. 2d Indiana Cavalrv. 31, 62. charged Feb. , Ie63. 92 Ivens, T. S., Confederate Oct. 23, Left. A". A. Surg. F. A. Bushey. 55 Donahee, P., Pt., C, 9th Jan. 11. Right; circ. Surg. W. Dicken- conscript. No.11, 64. Prison March 3, 1805. Illinois, age If. Fe. 2, 63. son, U. S. V. Dis d Julv 19, 63. 93 James. J., Pt., I, 2d Iowa Nov. 19, Left; circ. A. Surg. J. A. Free 56 Donahue, A., Pt., O Har- April 6, Right. Surg.C. H. Mastin.C.S.A. Cavalry, age 20. 28, 64. man, U.S. V. Haemorrhage: lig. ris s Battery. 18, 62. Recovered. Disch d April 20, G5. .Spec. 3753. 57 Donovan, F., Serg t, I, Nov. 25, Left; ant. post. flap. Surg. H. 94 Jordan, J., Pt., H, 1st Julv 6, Right ; end of bone rem d. Duty 90th Illinois, age 40. De.13, 63. Strong, SJOth Illinois. Disch d Feb. 24, 1805. 95 Maryland, age 19. Keever, J. L., Pt., E. 12, V,3. May 12, Nov. 29, 1864. Left; circ. Surg. D. W. Bliss, 58 Dumass, M. A., Pt., C, May 27, Right ; circ. Disch d Oct. 16, 62. 91st Penn., age 19. 19, 64. U. S.V. April 6. 05, seq. rem d. 44th New York. Je. 17, 02. M. O. Nov. 17, 1805. 59 Dunlap, J., Pt., A, 14th Mav 5, Left: circ. A. Surg. J. S. Billings, . 96 Kelly, P., Pt., E, 37th Mav 3, Left. M.O. June 22, 1863. Died Louisiana, age 29. 30, " 62. U. S. A. Prison May 1, 1803. New York. 18, 63. June 13, 04; general debility, Spec. 32. result of injury. 60 Dwyer, J. M., Corp l, B, May 5, Left; flap. Surg. I. H. Thomp 97 Kenny, D., Pt., A, 16th De.31, 62, Left ; ant. post. "flap. Duty Nov. 2Uth Indiana. 9, 64. son, 124th N. Y. Disch d Sept. Infantry, age 40. Jan. 3, 63. 28. 1804. 1, 1804. 98 Kerrigan. J., Pt., K, 5th Aug. 30, Right: flap. Surg. J. C. Dorr. 61 Easterly, A. N., f>\., B, April 6, Right (gang.); circ. Surg. W. J. | New York, age 20. Sep.7, 62. U. S.V. Hsprn.; exfol. Disch d 24th Iowa, age 20. 10, 64. McKim, 15th 111. Disch d Oct. July 20, 1803. 5. 1864. 99 2 Kimm, J., Pt., E, 152d May 31. Left : double flap. Surg. J. A. 62 Farnum, G. W., Pt., E, June 1, Right; flap. Surg. D. W. Bliss, New York, age 21 . J ue6, 64. Lidell. U. S. V. Disch d Jan. llth Vermont, age 20. 13, 64. U. S. V. Disch d Aug. 15, 1805. 16. 1805. a3 Fan-ell, J., Pt., I, 119th July 1, Right; flap. Disch d -March 21, 100 Kinnie, A., Pt., H, 14th June 27, Left: flap. Disch d December New York, age 35. 9. 63. 1804. New York. J y 1, 62. 13. 1802. 64 Fellsburg, C., Corp l, D, July 1, Left; flap. July 16, re-amp, up. 101 Knott, E., Pt., D, 3d June 27. Right; ant. post. flap. Disch d 119th N. Y., age 23. 5, 63. third. A. Surg. W. H. H. Gin- j New Jersey. 30, 62. Sept. 3D, 1802. kinger. 27th Penn. Disch d Dec. 102 Lanthrup. J. E., Pt., C, Feb. 9, Left. Recovery. 9, 1864. 59th Virginia. 12, 64. 65 Fifield, L. B., Pt.,A.16th Aug. 30, Right; circ. A.Surg.M.F.Bowes, , 103 La Page, J., Pt., 1. 147th July 2, Right; fl:ip. Disch d March 4, Mass., age 24. Sept. 20, 12th Penn. Cav. Exfol. Disch d New York, age 40. 6, 63. 1864. 1862. Sept. 16, 1803- 104 Lehr, W., Corp l, K, 7th Mar. 23, Left: flap. A. Surg. C. H. Dcuig, 65 Fletcher, W.,Pt.,H, llth July 21, Left ; flap. Surg. Walker, C. Ohio, age 25. 26, 62. 7th Ohio. Disch d July 3. 1862. Massachusetts. Au.15, 61. S. A. Disch d March 28, 1862. 105 Les, J.. Pt., D, 6th Con Mav 10, Right: circ. Julv 15. 1^05. seq. 67 Flippo, J., Unassigned Afar. 26, Right; circ. A. A. Surg. I). S. necticut, age 34. J ne l, l 4. rem d. Disch d" Oct. 2 Recruit, age 25. Ap. 4, 64. Booth. Returned to his home Spec. 1557. June 3, 1804. 106 Linn, M., Pt., A, 122d Mav 6, Left: circ. Surg.C. Page. U.S.A. 68 Flockhart, D. S., Corp l, Nov. 7, Right ; circ. A. Surg. P.C. Davis. Ohio. 27, " 64. Disch d March 4. 1865. D, 119th Penu., age 31. 15, 63. U. S. A. Jan. 13. 64, protrud g 107 Locke, J.C.,Pt.,E, 100th Aug. 30, Left ; circ. Disch d June 29. 03. bone sawn off. Disch d June Pennsylvania. Se. - 0, 02. 15, 1865. 108 Loeb, L., Pt., I, 3d New June 27, Left. Surg. W. H. White. U.S.V. 69 Foreman, J. W., Pt., II, Oct 9, Left; circ. A. A. Surg. C. II. Jersey. J y 2, 02. Disch d Oct. 1, 1802. 13th Infantry, age 20. 13, 63. Wade. Nov. 25. 63. three ins. of 109 Lofton, E., Pt., F, 23d Julv 2, Left (erysipelas). Exch d April bone rem d. Disc dSept. 20, 64. N. Carolina, age 22. 5, 63. 27. 1804. 70 Givens, J. F., Pt.,C, 24th May 5, Right. Recovery. 110 Lynch, T., Pt., D, 40th Sept. 1, Right : circ. July 3, 04, two ins. Virginia. 30, " 62. New York, age 22. 5, 62. of femur sawn off and seq. rem d. 71 Goebel, J., Pt., E, 151st June 3, Left; circ. Disch d Oct. 7, 1804. Duty Oct. 25. 1804. New York, age 39. 8, 64. Ill Lyon. A. E., Pt., E. 37th Aug. 8, Right : flap. A. A. Surg. J. Prieto. 72 Gordon, W. Y., Serg t, July 22, . Surg. T. E. Chaille, C.S.A. Iowa, age 23. 12, 64. Ha?m.: lig. fern. art. Diseh d A, loth Texas. 27. 64. Recovery. Aug. 15, 1805. 73 Gowan, J.. Corp l, B, 82d De.l7. 64. Left: flap. A. Surg. J. T. Brown, ! 112 Lyons, R.. Pt., D, 176th Sept. 22, Right (gangrene): ant. post. flap. Colored Troops. Ja. 12/65. U. S. V. Disch d June 24. 65. New York, age 42. 27, 04. Disch d April 2. 1^00. 74 Graham, F., Pt., A, 2d Oct. 19, Left; circ. Furloughed March 10, 113 Machamer, D., Pt., G, May 10, Left; circ. Surg. G. W. Thorn- S. Carolina, age 37. 23, 64. 1805. 90th Penn., age 22. 14," 64. hill, P. A. C. S. Sept. 15, [64, 75 Gray, W., Serg t, G, 1st Mar. 25. Left ; circ.. A. Surg. H. Pinknpy. seq. rem d. Disch d Dec. 5, l>4. West Virginia. Ap. 4, G2. 83d N. Y. Disch d Oct. 2. 02". 114 Mackin. J., Pt., H, 24th Dec. 13. Right: circ. Surg. F. G. Snell- 76 Gunokl, ./., Serg t, E. Oct. 19, Right : flap. Dr. Duball. Released Massachusetts. , 62. ing, U. S. V. Disch d June 25, 4">th Virginia, age 22. 23, 04. April 1, 1865. 1863. Spec. 1620. 77 | Hafierman, J. T., I t.. K. July 3, Left ; flap. Furloughed Nov. 21. 115 Madden, F.. Pt., H. 40th July 2, Left: flap. Jan. 2: , 1804. large 18th Virginia, age 21. 6, ; 63. 1803. New York, age 18. 7, 63. bulbous mass of bone removed. 78 Hamilton, J. H., Pt., M, \ug. 6, Left ; flap; slough. Discharged Disch d April 23. 1804. 15thN.Y.U.A.,age21. 9, 64. May 17. 1805. 110 Malloy, M., Pt.. H. 69th : Sept. 17, Right ; ant. post. flap. Surg. M. 79 Harnev, F. W., Pt., B, Oct. 27. Right ; circ. Surg. Pope, C.S. New York. 27, 62. C. Rowland, Gist N. Y. Oct. 4. 8th N. Jersey, age li 8 . 30, 64. A. Disch d June 18. 1805. lupm.: lig. fern. art. Jan. 15, C3. 80 Harnnock, J. V\., A, 8th Mav 5, Right; circ. A. Surg.J.S. Billings, j rem d soq. Di-h d .March 4, Alabama. 19," 62. U. S. A. Prison June 27, 1802! 1803. Spec. 3! 57. Spec. 30. 117 Maroney, P., Pt.. G, G3d ; Sept. 17, Left; (lap". . rem d 81 Halting, L., Lieut., B, Julv 1, Left ; flap. A. A. Surg. J. Swine- New York. 27, 62. seq. Disch d March 6, 18 7th New York. 5. 62. burne. M. O. May 8. 1863. 118 Marsh. S., Corp l. B. 1st Nov. 27, Right; circ. Surg. E. Bentlev, 82 Hays, J., Pt., A, 1st Sept. 1, Left (extravasation, mortification. Mass. Cav., age 27. De.10, 63. U. S.V. Pyarmia. Dec. 20. 04, Texas Cav., age 22. 10, 63. and synovitis) : circ. Surg. J. 5 ins. seq. rem d. Disch d July Boekee. U. S. V. Discharged < 12. 1865. | Nov. 3. 1804. Spec. 4(iO. 119 Martin, P., Pt..H, 39th N. Feb. 6, Left : circ. flap. Surg. J. Aiken, ! 83 Haywood, J., Pt., D, 8th Feb. 20, 1 Left: circ. Surg. Holmes, C. York, age 45. 11, 04. 71st Penn. Exf. Disch d Dec. Colored Troops. Ma. 1, 04. S. A. Disch d Oct. 3. 1865. 5. 1864. Spec. 2039. 84 Hoarier, B., Pt., G, 42d De.31, 62, Right; flap. Disch d August 9, 120 Mason, J. H., Corp l, E, Julv 1, Right: circ. flap. Disch d Jan. Illinois. Jan. 4, 63. 1864. 149th Penn.. age 31. 8, 03. 29, 1804. 1 LIDELL (J. A.), On the Secondary Traumatic Lesions of Bone, etc.. in U. S. San. Com. Memoirs, 1870, Surgical Volume I, p. 385. LIDELL (J. A.), On Contusion and Contused Wounds of Bone, with an Account of Thirteen Cases, in Am. Jour. Med. Sci., N. S., 1865, Vol. L, p. 20. SURG. Ill 36 282 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 121 Maxwell. G. II., Lieut. April 1, Left; circ. Surg. D. W. Bliss, 157 Rice, T. H., Pt., I, 31st June 5, Left. Surg. Dorsey, C. S. A. Col., 1st Mich. Cavalry, 17, 65. U. S. V. Hsem.; nee. bone re Tennessee. J y 1, 64. Recovery. age 2J. moved. M. O. Aug. 8, 1865. 158 Rich, H. C., Seaman. U. Mar. 22, Left. Surg. S. Moody, C. S. A. 12. Mc Jambridge, ,S.,Pt., F, May 3, Left; flap. A.A.Surg. F. Hinkle, S. N., age 22. Ap. 8, 62. Piece of bone rem d. Disch d 95th Penn., age 17. 28, 03. Gangrene. Disch d July 4, 64. Dec. 1, 1862. 123 McCoy. J., Pt., B, 3d May 10, Right ; flap. Confed. surgeon. 159 Richards. J. F., Pt., D, Sept. 11, Right ; flap. Surg. R. C. Bond, New Jersey, age 3?. 13, 64. Slough g. Disch d Sept. 2, 65. 15th Indiana. 16, 61. 15th Ind. Disch d May 24, 62. 124 2 McCreary, S. C., Pt., Sept. 1, Right ; flap. Disch d Dec. 4, 62. 160 Rickard, H. C., Pt., M, Sept, 19, Left ; circ. A. Surg. J.G. Thomp- F, lOOth Penn. 14, 62. llth Vermont, age 23. Oc.19, 64. son, 77th N. Y. Hsem. Disch d 125 McDonald, J., Fireman, Mar. 9, Right. Surgs. Macomber and June 19, 1865. V. S. Steamer Dragon. 12, 62. Bragg, U. S. N. Disch d Jan. 161 Robbins, O. P., Pt., H, June 27, Right ; ant. post. flap. Surg. D. 13, 1863. 10th Pennsylvania. J y23/62. Mc.Ruer, U. S. V. Disch d Feb. 126 McFarland, W. H., Pt., May 4, Right. Confed. surgeon. May 27, 1864. Died April 15, 1867. B, Oth Wis., age 19. 7, 6a 14, amp. upper third. Disch d Specs. 1129, 2377. March 21, 1804. 162 Ross, J., Pt., C, 123d Oct. 7, R t: flap. Dr. D. Swain, Shelby- 127 McGary, E., Pt., B, 17th Dec. 20, Left; flap. A.A.Surg. II. T. Sill. Illinois. 18, 63. ville, Tenn. Disch d Feb. 4/04. Illinois Cav., age 20. 23 64. M. O. Dec. 15/65. Subsequently 163 Rudy, P. H., Lieut., B, Sept. 30, . Surg. Montague, C. S. lost the other leg and one arm 2d Kentucky Battery. Oc.13, 04. A. Recovery. by accident. Died Jan. 15, 69. 164 Sackett, V. B., Pt., G, Aug. 9, Right, Disch d Nov. 12, 1802. 128 McGrath, J.. Pt., I, 4th April 16, Left; ant. post. flap. Surg. 42d Pennsylvania. 12, 62. Artillery, age 33. May 9, 65. Board, C.S.A. Nee. bone retn d. 165 Sadler, J., Pt,, M, 100th Aug. 29, Left ; circ. flap. Surg. E. Bent- Disch d Nov. 11, 65. Spec. 1408. Pennsylvania. Se.15, 62. ley, IT. S.V. Disch d June 0/63. 129 McKenzio, J.. Serg t, I, July 21, Right; flap. Surgs. Peachy and 166 Schlotterback, J., Pt., I, Aug. 30, Lett ; flap. Disch d Dec. 27, 62. 79th New York. 30, 61. Gibson, C. S. A. Disch d Oct. 75th Ohio. Se.25, 62. Spec. 83. 22, 1861. 167 Scott, J., Serg t, D, 34th May 10, Right; circ.; two ins. bone rem d. 130 McLaughlin, J., Pt., A, May 2, Right ; circ. Surgs. Black and Ohio, age 27. 20, 64. Disch d May 3, 1805. 3d Alabama, age 35. 7, (J3. Wilkerson, C. S. A. Recovery. 168 Scraggs, J. A., Pt., G, May 9, Left; ant. post. flap. Surg. E. 131 AfcVairy, T. m, Pt., B, Oct. 14, Left. Furloughed Jan. 22, 1864. llth Virginia Cavalry, 15, 64. Beutley, U. S. V. Gangrene. 27th North Carolina. 24, 63. age 32. Prison March 1, 1665. 132 tic Vey, W., Pt., F, 5th Sept. 19, Left. Surg. Roberts, C. S. A. 169 Shepherd, E., Pt., F, 1st July 21, Right ; flap. Confed. surgeon. Texas. 23, 63. Disch d Oct. 16, 1863. Michigan. Au. 1, 61. Discharged. 133 Merrifield, W., Pt., H, Aug. 22, Left; circ.; nee. bone removed. 170 Sherman, T. W., Brig May 27, Right. Prof. W. Stone. Retired. 14th W. Va., age 18. 28, 64. Disch d July 19, 1865. adier General, U. S. V. J e-, 63. Spec. 3604. Died March 16/79 ; 134 Miller, E., Pt., D. 61st June 3, Right: circ. Disch d July 21, pneumonia. New York, age 27. 8, 64. 1865. 171 Shubert, P., Pt., G, 15th Oct. 21, Right ; circ. Surg. T. R. Crosby, 135 Miller, J. H., Pt., A, Dec. 13, Left ; ant. post. flap. A. A. Surg. Massachusetts. No. , 61. U. S. V. Disch d Feb. 14, 62. 118th Penn., age 21. 18, 62. A. E. Carothers. Nee. Disclrd 172 Smith, B., Pt., C, 88th May 8, Left ; ant. post. flap. Surgeon J. March 21, 1864. Pennsylvania, age 21. 26, 64. Carroll, C. S. A. Necrosed bone 13:; MUller. E.. Pt., F, 29th Aug. 29, Left; circ. Disch d June 9, 63. rem d. M. O. Jan. 15, 1806. Ne-.v York, age 31. Se.5, 62. 173 Smith, J., Pt., G, 73d June 15, Left ; flap. Disch d Sept. 3, 1802. 137 Mullins. P., Pt., K, 2d Aug. 28, Right; circ. A. A. Surg. S. R. New York. 25, 62. Wisconsin, age 20. Se.12, 62. Skillern. Nee. bone sawn off. 174 Snackenberg, H., Pt., A, June 19, Right ; flap. Dr. E. Evans. Mus May, 1863, reamp. upper third. Mo. Home Guards. 22, 61. tered out 1861 . Disch d July 2, 64. Spec. 1227. 175 Spielman, S., Pt., D, Sept. 19, Left; circ.; flaps. Disch d Aug. 138 Munn, I). A., Pt., K, June 27, Right. Surg. Hoyt, C. S. A. 24th Iowa, age 28. 22, 64. 23, 1865. Spec. 4220. 31th North Carolina. I y 13,T,2. Disch d Sept. 28, 1862. 176 Stone, C. H., Pt., F, 5th June 3, Left; circ. Surg. C. Page, II. S. 13.1 Nicholas, G. J., Corp l, May 3, Left. Oct. 20, 1863, flap re-amp. New Hamp., age 21. 22, 64. A. Gang. Dec. 18, re-amp mid. 11, 73d Pennsylvania. 18, V 63. up. third. Disch d Feb. 10, 65. third. Disch d June 9, 18C5. 140 Norris, J., Pt., I, 37th Aug. 21, Left ; ant. post. flap. Surg. Z. E. 177 Sweatt, W., Pt., K, 6th Aug. 29, Left ; ciro. A. Surg. B. A. Clem Mass., age 36. 26, 64. Bliss, U.S. V. Sloughing; hasm. New Hampshire. Se. 15/62. ents, U. S. A. Disclf d May 19, Sept. 24, re-amp.; nee. Disch d 1863. Aug. 7, 1 865. 178 Taylor, W., Pt., H, 42d Nov. 30, Left (gang.); circ. Dr. Raney, 141 Oatis, J., Pt., H, 24th Aug. 30, Right ; dou. flap. A. A. Surg. C. Illinois, age 24. De. 4/64. Franklin, Tenn. Disch d June Xe\v York, age 20. Sep.9, 62. M. Ford. Disch d Mar. 24, 65. 29, 1865. 14^ Paddnck, J., Corp l, D, April 25, Right; flap. Surg. Keller, C. 179 Tomy, E. H., Pt.,C, 27th Sept, 17, Right; flap. Disch d Dec. 19, 43d Indiana. My 15, 64. S. A. Disch d Aug. 23, 1864. Indiana. 20, 62. 1802. 14!! Page. C. W.. Serg t, D, Sept. 17, Left. Disch d Feb. 9. 1863. 180 Tonsing, F. H., Pt,, B, July 1, Right; flap. Disch d July 15, 3d Wisconsin. 20, 62. 107th Ohio, age 21. 6, 63. 1804. 141 Perkins, N. B., Pt.,.5th May 3, Right. A.Surg.A.Ingram.U.S.A. 181 Trainer, J., Pt., C, 4th June 27, Left. Disch d Oct. 15, 1862. Maine Battery. 23, 63. Disch d Dec. 7, 1863. Spec. 1156. New Jersey. 30, 62. M5 Pitcher. J., Pt., K, 94th Aug. 30, Right ; lat. flap ; mortification. I--: Tricketts, E!, Pt.,C, 14th Oct. 19, Right; circ. Disch d Feb. 13, New York. Sep.6, 62. Sept. 13, re-amp.; exfol. Disch d W. Va., age 20. 22, 64. 1805. Aug. 16, 03. Spec. 1225. 183 3 Ulmer, E. D., Serg t, G, Oct. 19, Left. (Hsem., gang.) A.A.Surg. 140 Pollock, J.. Pt., K, 84th Sept, 2, Right ; ant. post, flap. Sept. 12, 15th N. Jersey, age 22. No.14/64. E. G. Waters. March 8, 18G5, Illinois, age 42. 6, 64. hsem. Disch d May 6, 1865. exfoliation rem d. Disch d May 147 Postles, W: R., Corp l, Dec. 13, Left: circ. Surg. T. Antisell, 29, 1865. Feb. 17, 60, amp. hip A, 1st Del., age 24. 25, 62. U. S. V. Disch d Dec. 24, 1863. j nt. Recovery. Specs. 107, 3734. Spec. 990. 184 Vezina, O., Pt., B, 9th May 31. Right (erysipelatousit]fi;ui).);ant. 148 Potter, L., Pt., A, 5Cth July 1, Left ; flap. Surg. J. H. Brinton. New Hamp., age 24. J e 11/64. post. flap. A. Surg. W. Thom Penn., ago 26. 4, 63. U.S.V. July26, re-amp. Disc d son, U. S. A. Oct. 15, 1864, nee. June 18, 1865. Spec. 1495. seq. rem d. Disch d June 14, 149 Power. J. H., Pt., B, Sept. 20, Right; circ. Disch d Jan. 24, 1805. Specs. 3558, 3599. 36th Indiana. 27, 63. 1864. 185 Vogelsang, D.,Pt.,A, 1st Sept. 17, Left; flap. Disch d Nov. 25/02. 150 Preitling, C., Hospital May 10, Right (gangrene); ant. post. flap. Minnesota. 20, 62. Steward, 39th N. York, 17, 64. Surgeon E. Bentley, U. S. V. 186 Walker, G. W., Pt., D, Aug. 30, Right, Surg. E. Bentley,U.S.V. age 24. Duty Sept, 19, 1864. 12th Pennsylvania. Se. 21/62. Disch d June 18, 1804. 151 Pyle. J.. Serg t, B, 105th July 14, Left. Ass t Surg. W. B. Witt, 187 Warren, J. A., Pt., C, Oct. 5, Right: flap. Surg. W. F. West, Indiana, age 36. 24, 03. 69th Ind. (M. O. July 18, 63.) 28th Illinois. 28, 62. 28th 111. Disch d Mar. 20, 03. 152 Qnatc., It.. Pt., C, 45th July -, Left. Provost Marshal Septem 188 Waux, J., Pt., E, 1st July 2, Right. Surg. P. F.Whitohead, P. N. Carolina, age 31. 6, 63. ber 10, 1863. Louisiana, age 21. 5, 63. A.C. S. Retired Jan. 30. 1805. 153 Kadley, A., Pt., B, 44th New York, age 21. May 8, 15, 64. Left ; ant. post. flap. Ass t Surg. S. B. Ward, U. S. V. Diseh ? d 189 Wmtherhj, L. T.,Corp l, F, 10th Ala., age 20. May 12, J e 3/04. Right ; flap. Retired Dec. 9, 64. Nov. 8, 1864. 190 Wheeler, J.,Pt.,F, 16th Oct. 28, Right; flap. Surg. J. P. Eriok- 154 Ray, J., Pt., B, 57th July 3, Left (gangrene). Exch d March Kansas Cav., age 30. Nov. 1, son, 10th Kansas Cav. Disch d Virginia, age 29. 6, 63. 7, 1864. 1804. April 25, 1865. 155 Redding. J. 31., Pt., A, Sept. 19, Left. Surg. H. M. Lawson, C. S. 191 Wilckens,H.,Pt.,K, 17th May 10, Left ; ant. post. flap. A. A. Surg. 5th Georgia. Oct. 2, 03. A. Recovery. Infantry, age 25. J e 8/64. S. D. J. Evans. May 1 , 05, nee. 150 Reveur, J., Pt., E, 47th Feb. 20, Left; flap. Surg. Harrington, bone rem d. Disch d Aug. 26, New York, age 36. 25, 64. C. S. A. Disch d May 1, 1865. 1866. Spec. 4347. 1 LIDHLL (J. A.), On the Wounds of Blood-vessels, Traumatic Hemorrhage, Traumatic Aneurism, and Traumatic Gangrene, in U. S. San. Com. Memoirs, 1870, Surgical Volume I, p. 176. 2 Lll)ELL (J. A.). On the Wounds of Blood-vessels, Traumatic Hemorrhage, Traumatic Aneurism, and Traumatic Gangrene, in U. S. San. Com. Memoirs, 1870, Surgical Volume T, p. 57. 3 LIDELL (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in U. S. San. Com. Memoirs, 1870, Surgical Volume I, p. 440. MORTON (T.G.), On Amputation at the Hip Joint, etc., in Am. Jour. Med. Sci., N. S., 1866, Vol. LIT, p. 17. Circular 7, S. G. O., 1867, pp. 51, 65. SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 283 No. NAME, MILITARY DESCUIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 192 Willard, L. C., Pt., A, July 28, Right (gang.); circ. flap. Surg. 226 Bodman, C., Pt., G, llth July , Right. Died August 15, 1863. 64th Illinois, age 20. Aug. 23, J. C. Denise, 27th Ohio. Disch ? d Infantry, age 24. 10, 63. 1864. July 6, 1865. 227 Bovard, F., Pt., K, 1st June 25, (gangrane). Died July 3, 193 Williams, L., Serg t, C, Aug. 16, Right ; flap. Dr. Raylin. Bis- Massachusetts. J y 2, 62. 1862 2d Batt. Cav. Mo. S. M. 19, 62. charged. 228 Boyd, J., Pt., C, 19th Jan. 2, Left. Died January 13, 1863. 194 Williams, W. S., Pt., Left. Dr. V. B. Thornton. Re Ohio. -, 63. Morgan s Cavalry. covery. Spec. 406. 229 Bradley, J., Pt., F, 48th June 3, Right (mortification: haem.); circ. 195 Williamson, W. H , Pt., Oct. 19, Right ; circ. A. Surg. J. Homans, Pennsylvania, age 21. 8, 64. A. Surg. H. Allen.U.S.A. Died D, 114th N. Y., age 24. 23, 64. jr., U. S. A. Disch d May 13, 65. J une 9, 64; shock, etc. Spec. 2931 . 196 Willis, N. P., Pt., U. S. Feb. 3, Left; circ. Surg. B. N . Bond, 230 Brannagan, J.. Pt., I, June 3, Left ; flap. Surg. F. F. Kurmeig- Signal Corps, age 23. 10, 65. 27th Mo. Seq. rem d. Disch d 69th Pennsylvania. -, 64. ter, 69th Penn. Died June 14, Sept. 3, 1865. 1864. Spec. 1501. 197 Willson, J. P., Pt., K, Oct. 7, Right ; circ. Disch d Feb. 2, 64. 231 Britton, C., Pt., C, 12th Nov. 30, Left (carious); lat, flap. A. A. 12:id Illinois. 11, 63. Kentucky, age 40. De.30, 64. Surg.J. E.Patterson. Died Jan. L9 Wilson, G., Serg t, D,7th Sept. 17, Left. Retired September 22, 64. 6, 1865. Louisiana, age 26. 28, 62. 232 Brizzee, W. J., Pt., G, June 22, Right. Died July 4, 1864. 199 Wilson, W., Pt., B, 2d Nov. 21, Right ; flap. A. A. Surg. W. P. 46th Pennsylvania. , 64. Colored Troops. De.15, 63. Powell. Disch d June 16, 1864. 233 Brown, T., Pt., K, 5th Sept. 29, Left : circ. A. A. Surgeon H. B. 200 Wingn, T., 8th Ky. Mt d July 19, Left; circ. Surg.W. H.Gobrecht, Col d Troops, age 21. Oc.18, 64. White. Died Oct. 26. 1864. Infantry, age 20. An. 4, 63. U. S. V. Pro. Mar. Dee. 19, 63. 234 Bryant, N. B., Pt., K, May 5, Left ; ant. post, flap? A. Surg. J. 201 Wooden," L. W., Corp l, Oct. 2, Right. Nov. 1, re-amp. Surg. S. 19th Miss., age 25. 19, V32. S. Billings. IT. S. A. Gangrene. K, 3d New York Cav. 14, 62. A. Green, 24th Mass. Disch d Died May 26, 62. Aut. Spec. 31. Feb. 17, 1803. 235 Buckey, J. E., Pt., E, June 5, Left; ant. post. flap. Died June 202 Woodward, O. S., Col., May 5, Right. Surg. D.W. Bliss, U.S.V. 7th Maryland, age 30. 10, 64. 20, 1864. 83d Penn., age 27. 15, 64. M. O. Sept. 20. 1864. Spec. 2269. 236 Burditt, W. C., Pt., I, Mav 19, Left; circ. A. A. Surg. L. Dar 203 Worthington, A. S., Pt., June 27. Left (gang.); circ. A. A. Surg. 4th West Virginia. 26, 63. ling, jr. Died May 31. 1863. D, Ubth Ohio, age 21. J yl6, 64. T. H. Hammond. Discharged." Spec. 1625. 204 1 Young, J. W., Pt., D, Sept. 17, Left ; circ. Furloughed Novem 237 Burke, W., Pt., G, G9th Sept. 17, Right. Died September 27, 1862. 13th Miss , age 22. 20, 62. ber 20, 1862. New York. 24, 62. 205 Zahns, J.,Pt.,A, 3d Wis Aug. y, Left; flap. Disch d Dec. 21, 62. 238 Burroughs, J., Serg t, B, Sept. 20, Right. (Sept. 28, excis. femur.) consin. 14, S 62. 3d Kentucky. -, 63. Died October 10, 1863. 206 Ackerman, G., Pt., L, May 19, Left ; flap. Surg. E. Bentley, U. 239 Cadv, T. P. "T., Pt., C, Oct. 3, Right. Surg. J. F. Hogden, U. S. 6th N. Y. H vv Art y, 25, 64. S. V. Died June 9, 64; pyaemia. 12t h Illinois, age 22. No. 1, 62. V. Died Nov. 8, 1862 ; pyaemia. age 33. Spec. 2659. Fpec. 469. 207 Addy, G., Pt., C, 7th Nov. 7, Right. Surg. E. C. Franklin, U. 240 Carpenter, H. W., Pt,,K, Nov. 27, Right ; circ. Surg. E. Bentley, Iowa. -, 61. S.V. Died Dec. 12, 61 ; pneurn. 3d Michigan, age 33. De.13, 63. U. S. V. Died Jan. 11. 64 ; py 208 Allen, E. H., Pt., A, 2d July 12, Left; circ. A. A. Surg. W. H. aemia. Autop. Specs. 2011,2012. Massachusetts Cav lry, 31," 64. Randolph. Died Aug. 16, 1864 ; 241 Carpenter, J. H., Pt., E, June 22, Left (exc. fib.); circ. A. A. Surg. age 24. exhaustion. 110th Ohio, age 40. J y 5, 64. J. F. Thompson. Died July 16, 20!) Anderson, G.W., Corp l, July 2, ; haemorrhage. Died July 64 ; pyaemia. Spec. 2759. B, 73d N. York, age 23. 6, 63. 19, 1863. 242 Carr, G. W., Serg t, G, June 18, Right: circ. Surg. A. F. Sheldon, 210 Anderson. W., Pt., l-\6th June 18, Right; ant. post. flap. Surg. E. 1st Maine H. Artillery, J y 3, 64. U.S.V. Died July 10, 1864; New York H. Artillery, J y5, 64. Bentley, U. S. V. Died July 17, age 42. exhaustion. Spec. 764. age 24. 1864; exhaustion. Spec. 2831. 243 Casey, M., Pt., K, 108th Sept. 17, Left. Died Oct. 3, 62. Spec. 380. 211 Atkins, W.H.,Pt., 1, 10th July 1, Right : flap. July 26, bone rem d; New York. 27, 62. Massachusetts, age 20. 6, 62. slough.; hasm.; lig. fern, art ry. 244 Chamberlain, R., Serg t, Sept. 17, Right. A. Surg. J. Oliver, 21st Died Aug. 12, 62; exhaustion. I, 16th Conn., age 43. Oc.15, 62. Mass. Died October 29, 1862. 212 Atkinson, J. M., Pt., A, May 12, Right. (Haem.; Mav 25, lig. fern. Spec. 274. 3d Indiana Cav., age J e2, 64. art ry.) A. A. Surg. T. Liebold. 245 Chandoin, B. P., Pt., A, Sept. 17, Left. Surg. A. N. Dougherty, U. 23. Died June 7, 1864 ; pyaemia. 4th Texas, age 20. 24, 62. S.V. DiedSept.29, 62. Spcc.127. 213 Baily, J. E., Lieut., A, July 12, Right: skin flap; circ. sect. mus. 246 Chase, C., Corporal, B, Juue 1, Right ; circ. A. Surg. W. Thom 7th Maine, age 38. 29, 64. Surg. H. W. Ducachet, U. S. V. 120th N. York, age 23. 5, 64. son, U. S. A. Haem. Died July Died July 31, 64 ; prostration. 12, 1864 ; pvasmia. Autopsy. 214 Bailv, W., Pt., E, 7th N. June 2, Left ; ant. post. flap. Surg. R. B. Specs. 3548, 2509, 6715. York, age 23. 25, 64. Bontecou. U. S. V. Haem. from 247 Christy, W. J., Pt., E, Aug. 16, Right; circ. A. A. Surg. D. Ken fern. art. Died July (i, 64 ; ex 19th Mass., age 23. Sep.8, 64. nedy. Died Sept. 22. 1864; ex haustion. Spec. 3037. haustion. Spec. 3643. 215 Baker, L. D., Pt., G, 4th De.29, 62, Left. Died January 25, 63; ex 248 Coe, W. W., Serg t, H, July 2, Right ; circ.: slough. Died Sept. Iowa. Ja.20, 63. haustion. 23d X. Carolina, age 23. 15, 63. 19, 1863. 216 Barnes, L., Pt., I, 34th June 30, Right (July 3. ball ext); circ. 249 Cole, C. M., Pt., B, 48th July 19, Left. Died August 3, 1863. New York, age 19. J y21, 62. Surg. R. B. Bontecou, U. S.V. New York. Au. 1, 63. Died July 2, 62; deeply jaun 250 Coleman. C., Pt., G, 1st Sept. 14, Right. Surg. H. S. Hewit.U.S.V. diced. Penn. Reserves. 23, 62. Died, Sept. 23, 62, on operating 217 2 Barrett, G. Y., Pt., F, Dec. 13, Right. (Dec. 16, osteo-plast. oper. table. 5th New Hampshire. 25, 62. at knee joint. A. Surg. J. W. S. 251 Collins, J. F., Pt., F, 2d Sept. 20, Right, Surg. A. W. Heise, 100th age 20. Goulev,U. S.A. Slough ; gang.; Kentucky. 23, 63. 111. Died Oct. 5, 63 ; exh n. hsem.) Surg. J. P. Prince, 3:>th 252 Connors. J., Pt., H, 7th June 16, Right ; circ. Died June 26, 64. Mass. DiedDec.28, 62. Spef.536. N.Y. H vyArt.,age37. 26, 64. 218 3 Bause, J., Pt., B, 42d De.31, 62, ; lat. flap. Surg. J. Shrady. 253 Conrad, H., Pt., I, 24th May 6, Left (May 19, excis. fib.; gang.); Indiana, age 24. Jan.8, 63. jr., U. S. V. Diarrhoea. Died Michigan, age 21. 22, 64. circ. Surg. O. A. Judson, U.S.V. January 15, 1863. Died May 27, 1864 ; pyaemia. 219 Bell, L. H., Lieut., B, Sept. 20, Left. Surgeon I. Moses, U. S. V. Spec. 3653. 1 1 3th Ohio. 30, 63. Died October 10, 1863. 254 Conway, P., Pt., M, 1st Nov. 14, Left (gang.); circ* A. A. Surg. 220 Benton, H. S., Serg t, C, May 6, Left : dou. flap. Surg. E. Bentley, New Hampshire Cav. 22, 64. M. Darrach. Died Dec. 18, 64 ; 7th Mass., age 21. 25, 64. U. S. V. Died June 17, 1864 ; pyaemia. pyaemia. Spec. 2657. 255 Cooke. A. E., Serg t, G, July 2, Left : flaps sloughed. Died Aug. 221 Berkey. C.. Pt., A, Kith Aug. 30, Left (Sep. 11, haem.; 13, 14, haem.: 1 1th Infantry, age 20. Au. 1, 63. 6, 18G3. Penn. Reserves, age 24. Se. 18/62. lig. fern.; Sept. 17. haem.): circ. 256 Creighton, M., Serg t, B, May 12, Left; circ. A. A. Surg. T. W. Died Sept. 18, 1862. Autopsy. 9th Mass., age 20. 26, 64. Miller. Died June 9. 1864 : py 222 Berns, J. F.. Pt., F, 5th June 9, Left : ant. post. flap. A. Surg. J. aemia and tetanus. Spec. 2818. Ohio, age 19. 23, 62. S. Billings,U.S.A. Hiem. Died 257 Culbertson.D. J., Serg t, June 1. Right (nee.); circ. A. A. Surg. July 2, 62. Autopsy. Spec. 23. A, 69th Ohio, age 25. 16, 64. J. W. Digbey. Died June 18, 223 Biehl, N., Pt., I, 155th Pennsylvania, age 27. June 19, J yl9, 64. Right (June 21, -exc. tibia; gang.); circ. Surg. E. Bentley, U. S. V. Gang.: ulcer n of artery. Died 258 Dareey.W. H.,Pt.,D,6th Maryland, age 23. May 31, J ne9, 64. 1864. Spec. 3399. Left; circ. A. A. Surg. J.Phil lips. Died June 24, 64: exh n. July 21. 64; exh n. Autopsy. 259 Dai-is, H. A., Pt.,D, 12th April 7, Right : lat. flap. A. Staff Surg. Spec. 3337. N. Carolina, age 30. 14, 65. W. J. Burr, U. S. A. Died April 224 Blanchard, A., Serg t,E, 92d New York. Mav 31, J e 11, 62. Right; flap. A. A. Surg. W. K. Cleveland. Died June 13, 1862 : 260 Day, J. W., Corp l, H, July 20, 24, 1865. Right. Surg. J. B.Warwick, 91st pvlniujti 91st Ohio. 23, 64. Ohio. Died July 23, 64; exh n. 225 Blockle, M.. Pt., A,4iith Iowa, age 20. June 30, J y6, 64. Right ; lat. flap. Surg. J. G. Kee- non, U. S. V. Died July 17, 64. 261 Dean, S., Pt., I, lllth New York. July 3, -, 63. Left. Surg. O. Munson, 108th N. Y. Died August 9, 1863. "FISHER (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Sharpsburg, Md., etc., in Am. Jour. tied. Set., N. S., 1863, Vol. XLV, p. 47. 2 PRINCE (J. P.), Surgical Cases, in Boston Med. and Surg. Jour., 1863, Vol. LXV11I, p. 69. 3 SHRADY, jr. (J.), Cases in Military Surgery, in American Medical Times, 1863, Vol. VI, p. 113. 284 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 262 Delaney, J., Pt., G, 67th May 6, Left ; ant. post. flap. A. A. Surg. 300 Hall, J., Pt., A, 12th May 10, Left; ant. post. flap. Surg. R. B. New York, age 20. 27, r 64. J.A. Bates. Haem.; lig. fern. art. Pennsylvania, age 22. 28, 64. Bontecou, U. S. V. Died May Died July 10, 1864 ; pyaemia. 31, 1864 ; exhaustion. 263 Demastf.rs,A., Pt., F, 7th Dec. 7, Right (gang.); circ. Surg. S. D. 301 Hall, P., Pt., D, 42d July 3, . Died July 15, 1863. Florida, age 24. 11, 64. Turney, U. S.V. Died Dec. 14, Virginia. 8, 63. 1864 ; gangrene. 302 Hammond, C., Pt., H, Aug. 29, Right; circ. A. Surg. J. C. Mc- 264 Dennison, II., Pt.,E,123d June 15, Right. Died June 26, 1663. 1 1th Massachusetts. Se. 18, 62. Kee, U. S. A. Died Sept. 28, Ohio. , 63. 1862. Spec. 63. 265 Dick, T., Pt., B, 6th N. Mav 8, Left ; circ.; sloughing. Died June 303 Hankins, J., Pt., D, 4th Sept. 19, Right ; modified flap. A. Surg. Hamp., age 23. 11, 64. 12, 18(>4 : pyaemia. New Jersey. 23, 64. J.G.Thompson, 77th New York. 266 Dillon, J., Pt., D. 34th June 1, Left ; flap. A. A. Surg. G. W. Slough. Died Oct. 10, 1864; New York, age 19. 13, 62. Edwards. Died July 13, 1862; typhoid fever. exhaustion. 304 ffargrow, J. H., Pt., D, Sept. 17, Right. Surg. H. S.Hewit, U. S.V. 267 Dobey, E., Pt., D, 14th Sept. 19, ; circ. Surg. J. W. Lawson, 12th North Carolina. Oct. 7, 62. Died October 9, 1862. Spec. 365. North Carolina. Oct.4, 64. C. S. A. Haem. Died October 305 Harman, B., Pt., A, 50th Sept. 30, Left; circ. Surg. G. S. Palmer, 18, 1864 ; exhaustion. Penn., age 24. Oc.14, 64. U.S.V. Died Oct. 17/64 ; exh n. 268 Donnelly, J.,Pt.,B,198th Mar. 29, Right ; ant. post. flap. Surg. N. 306 Harris, D., Pt., F, 59th July 15, Right ; flap. A. A. Surg. J. Prieto. Penn., age 22. Ap. 7, 65. R. Moseley.U. S.V. Died April Col d Troops, age 22. 24, 64. Died July 25, 1864 ; tetanus. 11, 1865; exliaust n. Spec. 4069. 307 Harris, J., Pt., A, 38th Sept. 29, Left: flap, A.A.Surg. A. B. Cha- Douglas, A. J., Pt., M, 1st Maine H vy Art y, May 19, 31, 64. Right (haem.); lat. flap. A. A. Surg.W. H. Ensign. Died May 308 Col d Troops, age 21. Harris, K. E. U., Pt., F, Oc.22, 64. Mav 4, pin. Died October 24, 1864. Left ; circ. Surg.C.D.Rice.C.S. A. age 21. 31, 1864. Spec. 2388. 57th N. C., age 27. 30, 63. Gang. Died June 7, 1863. 270 Dovers, C., Pt., D, 148th May 3, Left (gang.). Surg. C. S. Wood, 309 Hartley, W., , C, 6th Sept. 17, Right. A. Surg. R. F.Weir, U.S. Pennsylvania. 17, "63. 66th N. Y. Died May 19, 1863. Georgia. Oct. 3, 62. A. Pyaemia. Died Oct. 24, 62. Spec. 1171. Spec. 872. 271 Drake, J. B., Pt., H, 62d July 1, Right ; circ. A. A. Surg. W. K. 310 Hayden,G.,Corp l, B,lst July 3, Left (haem.); lig. femoral artery. Penn., age 22. 27, ^62. Cleveland. Died Augusts, 62 ; Md. Battery, age 22. 8, 63. Died Sept. 25, 1863; exliaust n. exhaustion. 311 Hayer, G., Pt., K, 6th N. May 19, Left ; circ. A. Surg.W. F. Norris, 272 Durgin, P. G*Pt.,H,6th Aug 30, Left. A. A. Surg. W. K. Cleve Y. H. Art y, age 27. Je. 16/64. U. S. A. Haem.; lig. Died June New Hamp., age 19. Se. 19, G4. land. Died Sept. 20, 1864. 29, 1864 ; pyaemia. Autopsy. 273 Eaton, J. A., Lieut., D, May 10, Left (sloughing). A. A. Surg. J. 312 Hedder, W., Pt., C, 56th June 1, (amp. knee j t, June 1); haem. 10th N. Hamp., age 24. 21, 64. Coloosdian. Died May 27, 64. New York. 13, 62. Died July 3, 1862. Spec. 4933. 274 Edson, W., Pt., I, 5th N. May 12, Left; circ. A. A. Surg. J. Phil 313 Henery, J. F., Adjutant, July 2, Right. Died July 24, 1863; py Carolina, age 22. 20, 64. lips. Haem.; lig. fern, artery. 157th N. Y., age 24. 20, 63. aemia. Died May 25, 64 ; haemorrhage. 314 Hennely, P., Pt., K, 48th Aug. 29, Right. Surg.O.A. Judson.U.S.V. 275 Elliott, P., Pt., B, 18th April 6, Left ; ant. post. flap. A. Surg. W. Pennsylvania. Se. 12/62. Died October 25, 1862; pyaemia. Georgia Bat ry, age 24. 16, 65. Carroll, U. S. V. Died May 20, Spec. 184. 1865; exhaustion. Spec. 4163. 315 Hezeltine, L.,Pt..D,86th May 8, Left: circ. Surg. O. A. Judson, 276 Elliott, P. M., Pt.,G,96th Nov. 3, Right (yen. haem.; diarr.); circ. New York, age 19. 17, 64. U.S.V. Haem. Died June 9, 64 ; Ohio, age 20. 30, 63. A. Surg. P. S. Conner, U. S. A. pyaemia. Died Nov. 30, 1863. 316 Bighsmith, D., Pt., D, Sept. 19, Left; circ. Died Oct. 20, 1864; 277 Evans, S. B., Corf 1, D, June 2, Left ; circ. Surg. J. W. Wishart, 24th Georgia. 23, 64. exhaustion. 140th Penn. 9, 64. 140th Penn. Died June 13, 64. 317 Hill, S. W., Corp l, H, May 26, Right ; circ. A. A. Surg. IT. M. 278 Evans, W. E.. Pt.,G,37th Dec. 16, Right (haem.); lat. flap. A. A. 36th Wis., age 36. J ne9/64. Dean. Died June in, 1864 ; ex Georgia, age 28. 20, 64. Surg.B.L. McClure. Died Dec. ^ haustion. Spec. 2490. 24, 1864; exhaustion. 318 Hollenback, H. W., Pt.. April 6, . Surg. E. C. Franklin, U.S. 279 Fanning, H. C., Pt., D, Sept. 17, Right. A. Surg. J. Oliver, 21st A, 46th Illinois. -, 62. V. Died April 27, 1862. 8th Conn., age 18. Oc.17, 62. Mass. Died October 29, 1862. : Honan, M., Pt., B, 10th April 2, Right ; ant. post. flap. Surg. E. Spec. 287. Vermont, age 24. 7, 65. Bentley, U. S.V. Died April 280 Fitzpatrick, T., Pt., A, May 6, Left ; ant. post. flap. Died June 10, 1865; exhaustion. 10th Infantry. 14, 64. 3, 1864; exhaustion. 320 Hoysington, A., Pt., A, June 26, Left; circ. A. A. Surg. J. H. 281 Frakes, W., Pt., B, 26th Dec. 7, ; circ. Surg. T. W. Florer, 8th Michigan, age 25. J y 4, 64. Thompson. Died July 29, 64; Indiana, age 19. 12, 62. 26th Ind. Died Dec. 26, 1862; pyaemia. Spec. 2760. pyaemia and pneumonia. 321 Hughes, J.O.,Pt., A, 1st Mav 19, Right ; oval flap ; ciro. of muscles. 282 Furlong, P., , E, 4th Sept. 17, - ; flap. Died October 1, 62 ; Maine H. Art y, age 29. 22, 64. Surg. N. R. Moseley, IT. S.V. New York. Oct. 1, 62. exhaustion and shock. Died Mav 27, 1 864. Spec. 2308. 283 Galiger, M., Serg t, G, July 2, Left (haem.); lig. prof. art. Died 322 Irwin. F. H., Corp l, E, Mar. 25, Left; circ*. Surg. D. W. Bliss, 73d New York, age 22. 5, 63. July 8, 1863; exhaustion. 93d Penn., age 22. Ap.l4. 65. U. S. V. Died May 2, 65 ; py 284 Gibbs, C. E., Pt., E, 19th Dec. 7, Left ; ant. post. flap. A. Surg. J. aemia. Spec. 4077. Iowa, age 21. 30, 62. J. Sanders, 1st Iowa Cav. Died 323 Janvrin, G. A., Pt., B, June 3, Right ; ant. post. flap. Surg. R. B. Jan. 22, 1863. 12th N. H., age 20. 8, 64. Bontecou, U. S.V. Haem. Died 285 Gilbert, J., Pt.. G, 119th July 2, Right; flap; haem.; gang. Died June 11, 64 ; exh n. Spec. 3070. New York, age 38. 6, 63. August 13, 1863; pyaemia. 324 Jenkins, F., Pt., D, 1st Aug. 31, . Died October 2, 1862. 286 Gittens, T., Pt., G, 12th Dec. 13, Left; circ. Surg. E. Bentley, U. New York. -, 62. Mass. , age 48. 21, 62. S.V. Hapm. Died Jan. 1, 1863. 325 Jenkins, J., Pt., D, 20th Dec. 7, ; circ. Surg. T. W. Florer, Autopsy. Spec. 595. Wisconsin, age 22. 22 62 26th Ind. Died Dec. 26, 1862; 287 Glenn, J. R., Pt., E, 32d Nov. 27, . Surg. J. C. Morgan, 29th haemorrhage. Alabama. De. 1, 63. Mo. Gang. Died Dec. 5, 1863. 326 Johnson, L, Pt., C, 57th Nov. 30, Left ; lat. flap. A. A. Surg. H. C. 288 Goddard, W. A., Pt., F, May 20, Left ; flap. A. Surg. A. P. Frick, Indiana, age 27. De.28/64. May. Died Jan. 1. 1865; exh n. 9th Maine, age 35. J ne5/G4. 103d Penn. Died June 5, 1864. Spe c. 3757. 289 Godwin, C., Pt., E, 48th Dec. 13, Left (gang ns); circ. Died Jan. 327 Jones, A., Lieut., Texas Feb. 15, Right ; circ. 18th. h;em. from fern. North Carolina, age 33. 17, 62. 13, 1863. Regiment. Mar .7/62. Died March 18, 1862; ha in. 290 Going, J. K., It., G, 60th Sept, 19, Left ; circ. Surg. D. Orsay, C. S. 328 Jones, A. D., Pt., B, 12th June 3, Right ; ant. post. flap. Surg. R. Georgia. 22, 64. A. Gangrene. Died Oct. 6, 64; New Hamp., age 20. 8, 64. B. Bontecou, U. S.V. 91h, htrm. exhaustion. Died June 11, 1864; exliaust n. 291 Gordon, S. I., Serg t, B, Nov. 25, Right. Died December 27, 1864. Spec. 3062. 1st Alabama Cavalry. , 64. 329 Jones, W. R., Pt., H, 32d June 27, Right ; ciro. Surg. E. M. Powers, 292 Gray, N., Pt., II, 33d N. May 3, Left (gang.); circ. May 14, haem. Ohio, age 25. J ylO/64. 7th Mo. Died July 13, 64; shock. Carolina, age 26. 10, 63. Died May 15, 1863. 330 Keefe, J. A., Pt., H, 63d Sept. 17, Right. A. Surg. L. H. Searle, 293 Gray.W. A., Pt., K,13th June 1, Right ; ant. post. flap. A. Surg. New York. Oc.10/62. 26th N. Y. Died Oct. IP, 1862; New Hamp., age 25. 13, 64. S.B. Ward.U-S.V. Gang. Died exh n. Spec. 813. June 25, 64. Autop. Spec. 2709. 331 Keeley, E., Serg t, A, Aug. 7, Left; circ. Died Nov. 28, 1864; 294 Greene, A., Pt., E, 93d May 9, Right; circ. Surg. E. Bentley, 15th Infantry, age 21. 12, 64. chronic diarrhoea. Penn., age 34. 29, 64. U. S. V. Died June 2, 1864; 332 Kelly, W. D., Pt., I, 13th Jan. 2, . Surg. C. J. Walton, 21st haemorrhage. Spec. 2661. Ohio. 6, 63. Ky. Died Jan. 9, 1863. 295 Grey.C. C., Lieut., I, 4th Mav 6, Left ; circ. Prof. F. H. Hamilton. 333 Kielt, J., Serg t, C, 69th Sept. 17, Left ; lat. flap. Died Oct. 25/62; Maine, age 28. 20, 64. Died May 29, 1864 ; pyaemia. New York, age 20. Oc. 10/62. pvaem. Autop. Specs, i 90, 873. 296 Grovendyke, A., Lieut., Nov. 30, Right: ant. post. flap. A. Surg. 334 Kirby, E.,13rig.-General, May 3, Left. Surg. B. Norris, U. S. A. F, 124tli Ind., age 34. De.25/64 W. B. Trull, U. S.V. Died Dec. U.S.V. 10, 63. Died May 28, 1863; pyaemia. 27, 1864 ; exhaustion. Spec. 1076. 297 Gump, II., Pt., D, 61st May 5, Left; circ. Died June 9, 1864; 335 Koerner, J., Corp l, E, April 2, Right ; circ. Surg. E. Griswold, Penn., age 45. 15, 64. pyaemia. Autopsy. 10th N.Y.H.A.,nge28. 15, 65. U. S. V. Died April 24. 1865. 298 Hack, C., Pt., D, 15th Mar. S, Left. Died April 18, 1865. 336 Kopp, S. S., Pt., E, 10th Aug. 28, Right. Surg. C. Page, U. S. A. Connecticut, age 21. -, 65. Penn. Res., age 21. -ie. 20/62. Died Sept. 22, 1862. Spec. 76. 299 Hale, J. L., Pt., C, 31st Nov. 24, Left ; lat. flap. Surg. J. C. Mor 337 Ladd, G. W., Pt., B, 2d Aug. 29, Right. A. A. Surg.H.C.Heilner. Iowa. De. 3, 63. gan, 29th Mo. Died Dec. 3, 63. New Hamp., age 21. Se. 19/62. Died Sept. 25, 1862. Spec. 118. SECT. III.J INTERMEDIARY AMPUTATIONS OF THE THIGH. 285 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 338 Landman, J., Ft., , Sept. 17, Left (ulcer n of post. tib. artery; 374 McPherson, D., Pt., E, June 2, Right; circ. A. A. Surg. P. C. 6th Georgia. Oct. 6, 62. haem.); flap. Ass t Surg. H. F. 5th Mich., age 24. 14, 64. Porter. Died June 20. 64; exh n Weir, U. S.A. Died Oct. 14/62; and pyaemia. Spec. 2555. pneumonia. Specs. 789, 875. 375 McPherson, W. H., Pt., Sept. 14, Right. Surg. Boyle, C. S. A. 339 Lane, T., Pt., F, 6th N. May 19. Right ; circ. Surg. E. I>entley, D, 50th Georgia. 24, (52. Died Oct. 27/62. Specs. e:M, 874. Y. H vy Art y, age 50. 25, 64. U. S. V. Died May 28, 1864; 376 McVeay, J., Pt., E, 23d May 31, Right ; dou. flap. Surg.R.B.Bon- gangrene. Spec. 2658. I enn., age 25. J ne7/62. tecou, U. S. V. Died June 8, 62. 340 Langford, J".,Pt., E, 60th July 1, Left ; (lapof skin andcirc. of muse. 377 Medgley, A. W., Lieut., Mav 5, Left (gang.). Surg G.T.Stevens, Georgia, age 36. 18, 63. Died August 10, 1863; pyaemia. H, 10th Massachusetts. 10, " 64. 77th N.Y. Died May 11,1864. Specs. 3856, 3968, 3987, 3988. 378 Meeker, A., Pt., D, loth Oct. 19, Left (gang.); oval flap. A. Surg. 341 Lasley, L. C., Pt., H, Mar. 19, Right ; circ. A. A. Surg. 1). Shep- New Jersey. 24, 64. E. B. Nims, 1st Vt. Cavalry. 124th Ind., age 19. Ap. 1, 65. pard. Died April 4, 65 ; shock Died Nov. 6, 1864; exhaustion. and exhaustion. ;r.:i Melhan, W., Lieut., C, Mar. 31, Left ; circ. Surg. D. W. Bliss, U. 342 Lawson, L. B., Pt., F, Sept. 19, Left ; modified Hup. A. Surg. J. 188th N. Y., age 21. Ap.17, 65. 8. V. Died April 18/65; exh n. 128th New York. 26, 64. G. Thompson, 77th N.Y. Haem.; 380 Melman, C., Pt,, B, 1st Sept. 17, Right. A. Surg. W. M. Notson, lig. fern. art. Died Oct. 4, 1864 ; New Jersey, age 17. Oc. 16/62. U. S. A. Died Oct. 28 I860 exhaustion. Spec. 936. 343 Lobroke. II. F., Pt., A, May 3, Left. (haem.). Died May 29, 1863; 381 Mensh, C., Pt, IT, 33d Mav 5, ; dou. flap. Surg. A. B. Mott, fith Maine, age 24. 17, 63. exhaustion. New York. 31, 62. U.S.V. Died June 7/62 ; gang. 344 Lehman, C., Lieut, D, Sept. 13, Right. Died Oct. 9, 1862; pros 382 Metzer, W., Serg t, E, April 23, Left. A. Surg. G. F. Thompson, 20th New York S. M. Oct. 4/62. tration. Spec. 141. 1st Louisiana, age 26. 29, 64. 38th Mass. Haem.; lig. fern. art. 345 Libbey, J., Pt., G, 69th Sept. 17, Left. Dr. Green. Died Dec. 11, Died May 15, "64 ; exhaustion. New York. Oct. 8. 62. 1862; exh n. Autop. Spec. 1099. 383 Mires, E., Pt., A, 23d Nov. 30, ; circ. Surg. J. R. Ludlow, 34(3 Long, J., Pt., E, 148th Mav 10, Right ; circ. A. A. Surg. F. H. Michigan, age 23. De.19/64. U.S.V. Died Dec. 20/64 ; haem. Penn., age 29. J ne 4, 64. Colton. Died June 4, 64 ; shock. 384 Mohre, A., Pt., K, 104th June 1, Left. Haem.; lig. fern. art. Died 347 Loomis, J., Pt., G, 109th Mav 12, Right; circ. Surg. A. F. Sheldon, Pennsylvania. 9, 62. June 19, 1862. Autopsy. New York, age 31. J ne 2/64. U. S. V. Gang.; diarrh. Died 385 Moore, W., Serg t, I, 33d July 14, Left ; lat. flap. Surg.J.G.Keenon, June 19, 1864 ; exhaustion. Missouri, age 44. 22, 64. U.S.V. Died July 27/64; exh n. 348 Loutz, J., Pt., D, 94th April 2, Left. A.A.Surg.J.Tyson. llsem.; 386 Morgan, W. E., Corp l, April 6, . Surg. E. C. Franklin, U. S. New York, age 17. -, 65. slough.; lig. fern. art. Died May B, 57th Illinois. -, 62. V. Died April 26, 1H62. 26, 1865: exhaustion. 387 Morris,C., Corp l, F, 19th Dec. 7, Right ; ant. post. flap. Surg. H. S. 349 Loveland, J., Pt.,C, 16th Sept. 17, Left. Surg. T. H. Squire, 89th Iowa, age 48. 26, 62. Churchman, U. S. V. Died Dec. Connecticut. Oct. 7, 62. N.Y. Died Oct. 16, 1862 ; haem. 26, 1862 ; shock. Spec. 3576. 388 Morrison, W. E. L., Pt., Oct. 27, Left (Oct. 27, exc. knee j t); circ. 350 Luce, D. A., Pt., C, 17th Sept. 30, Left; circ. Surg. J. T. Kilby, 1, 29th Conn., age 21. Nov. 10, A.A.Surg. J. Pitkin. Died Nov. Vermont, age 42. Oc.17, 64. P. A. C. S. Died Dec. 9, 1864. 1864. 12, 1864; exhaustion. 351 Luherman, C.,Corp l, D, Sept. 19, Right ; circ. Surg. F. Irish, 77th 389 Morriton, T. P., Pt., E, Nov. 30, Left ; ant. post. flap. A. Surg. J. 9th Ohio. Oct. 7/63. Penn. Died Oct. 7, 1863. 1st Miss., age 26. Dec. 28, H. Cruthers, 88th Ohio. Died 352 Lunceford. T. J., Serg t, Dec. 21, Left; oval flap; circ. sect. muse. 1864. Jan. 2, 1865; haem. E, 2d West Virginia 1864, A. Surg. R. F. Weir, U. S. A. 390 Morse, L. O., Pt,, 1,17th Mav 9, Left (slough g); circ. A.A.Surg. Cavalry, age 24. Jan. 9, 65. Died Jan. 17, 1865; pyaemia. Vermont, age 17. 27. 64. T. W. Carroll. Flaps slough g ; Autopsy. Spec. 3811. gang. Died May 31, 1864. 353 Lynch, C., Pt., A, 95th Mar. 31. Left ; lat. flap. Surg. N. R. Mose- 391 Murphy, D., Pt., F, 62d Dec. 13, Right ; circ. Surg. O. A. Judson, New York, age 22. Apr.7, 65. ley, U. S.V. Died June 24, 65 ; Penn., age 18. 27, 62. U. S. V. Jan. 4, 63, haem. ; lig. exhaustion. Spec. 4071. fern. art. Died Jan. 4/63 ; exh n. 354 Lyon, S., Pt., C, 84th In Sept. 19, Right (erysip.; rec t haem.; lig,; Spec. 637. diana, age 23. Oct. 6, 63. gangrene). Died Oct. 8, 1863. 392 Noble, S., Pt., I, 71st Sept. 17, Left. A. Surg. W. M. Notson, U. 355 Mallet, J. H.,Pt.,E, 19th Dec. 7, Left; ant. post. flap. A. Surg. J. Pennsylvania. Oct. 9/62. S. A. Died Oct. 28, 1862. Iowa, age 30. 28. 62. J. Sanders, 1st Iowa Cavalry. 393 Nolf, J., Pt., A, 155th Mar. 25, Left; circ. A. A. Surg. L. J. Dra Died Dec. 30, 62 ; haemorrhage. Penn., age 23. Ap. 7, 65. per. Haem. Died April 22, 65. 35G Mallott, F., Pt., A, 92d Sept. 29, Left. A.A.Surg. B. N. McCleery. Autopsy. Spec. 186. New York, age 21. Oc.15, 64. Died October 27, 1864. 394 O Brien, J., Pt., F, 1st Nov. 25, Left. D ied December 16, 1863. 357 Marquardt, J., Pt,, G, Mav 22. Right. Surg. E. M. Powers, 7th Ohio. , 63. llth Wisconsin, age 22. J ue"8, 03. Mo. Died June 16, 1863 ; phle 395 Osborne, W. P., Serg t, April 6, Right. Haemorrhage. Died April bitis and pyaemia. A, 31st Ind., age 26. 13, 62. 15, 1862. 358 Marquis, H. M., Corp l, Sept. 17, Left. Surg. H. S. Hewit, U. S.V. 396 Page, J. M., Pt., B, 27th Aug. 19, Right ; circ. Surg. T. F. Oakes, 15, 23d N. Carolina. Oct. 8, 62. Died Oct. 18, 62. Spec. 369. Georgia, age :i7. 22, 64. 56th Mass. Diarrhoea. Died 359 Marston, G., Pt,, H, 4th Aug. 29, Right (mortification); circ. A. A. Sept. 16, 64: exh n. Autopsy. Vermont, age 29. Se. 15/64. Surg. J. C. Shinier. Died Sept. 397 Patterson, T. A., Serg t, May 10, ; ant. post. flap. Surg. C. B. 15/64 ; shock. Autop. Spec. 3831. A, 43d Alabama. 13, 64. Gibson, C. S. A. Died May 16, 360 Martin, H., Pt., H, 26th Sept. 19, Right. Died Sept. 30, 1863. 1864 ; exhaustion. Ohio. 25, 63. 398 Pearl, S., Pt., F, 97th N. May 6, Right. A. A. Surg. P. C. Porter. 361 Mask, M., Pt., A, 23d N. Sept. 14, Right. Oct. 6, 8, 9, ham.; lig. fern. York, age 34. 23. 64. Died May 31, 1864 ; exhaust n. Carolina, age 24. 20, 62. art.; slough. Died Oct. 9, 1862; 399 Peasly,J.E.,Com.Serg t, May 31, Left (gang.); circ. A. A. Surg. J. exhaustion. F, 6th N. Y. H. ArtY June 16, H. Thompson. Died July, 18, 362 Maurer, H., Corp l, K,7th Mar. 31, Left ; flap. Surg. N. R. Moseley, age 38". 1864. 1864 ; exhaustion. Maryland, age 24. A p. 6/65. U. S. V. Died April 9, 1865; 400 Peters, J., Pt., H, 8th Sept. 17, Right. Surg. H. S. Hewit.U.S.V. nerv. exh n and haem. Spec. 4070. Penn. Reserves. 27, 62. Died October 2, 1862. 363 Mayer, J., Pt., II, 44th I>ec. 13, Left. Died Dec. 20, 1862. Spec. 401 Piersol, C., Pt., G, 145th June 3, Left (gang.; diarrhoea). A. Surg. New York. 24, 62. 4154. Penn., age 19. J y2/64. W. F. Norris, U. S. A. Died 364 Mayo, G. W., Serg t, A, May 10, ; ant. post. flap. Surg. C. B. July 12, 1864 ; pyaemia. 43d Alabama. 13, 64. Gibson, C. S. A. Died May 16, 402 Pinckney, J. C., Pt., I, July 19, Left (gang.); circ. A. A. Surg.W. 1864 ; exhaustion. 7th Minnesota, age 31. 23, 64. M. Dowan. Died July 24,1864, 365 McAvory,W., Pt., G,73d July 2, Left (haem.). Died July 11/63; while chloroformed. Autopsy. New York, age 20. 8. 63. exhaustion. 403 Pitcher, DeW., Pt., K, April 7, ; ant. post. flap. A. Staff 366 McCarty. J., Pt,, I, 61st June 1, Left ; flap ; pyaemia. Died June 2d N.Y. H. A., age 20. 13, 65. Snrg.W.J. Burr, U.S.A. Died Pennsylvania. 7, 62. 11, 1862. Mav 4, 1865. 367 McOormick, J.E., Pt.,E, Dec. 7, Right ; ant. post. flap. A. Surg. 404 Platt, F., Pt,, E, 72d N. July 2, Left (hem.). Died July 8, 1863 ; 26th Indiana, age 22. 12, 62. E. A. Clark, 37th 111. Died Dec. York, age 40. 5, 63. exhaustion. 24, 1862 ; haemorrhage. 405 Pool, S., Pt., H, 23d N. Dec. 13, Left. Died December 29, 1862. 368 McCoy, J., Pt., B. 140th Mav 12. Riffht ; ant. post. flap. Surg.R. B. Jersey. 25, 62. Feuu., age 17. J ne"3/C4. Bontecou.U. S.V. Haem. Died 406 Porter, W., Pt., H, 16th Sept. 17, Left. Surg. T. H. Squire, 89th June 8, 64 ; exh n. Spec. 3058. Connecticut. Oct. 8/62. N.Y. Died Oct. 10, 18U2. 369 McKee, T., Pt., I, 123d June 15, . Died July 15, 1863. 407 Potter, C. II., Pt., C, 31st Mav 18, Right; ant. post. flap. A.A.Surg. Ohio. , "63. Maine, age 16. 29, 64. C. T. Trautman. Huem. Died 370 MoKenna, P., Pt., I, 67th June 1, . Died June 18, 1862; exh n. June 3, 1864; exhaustion. New York, age 30. 16, 62. 408 Raynor, O. W., Pt., G, April 6, Right ; ant. post. flap. A. Surg. 371 McLanghlin, 11., Pt,, H, Mav 10, Left ; ant.post.flap. Surg.E. Bent- 12th Alabama, age 18. 17, 65. W. Carroll, U.S. V. Haem.; fern. 142d 1 enn., age 21. 23, 64. ley, U. S.V. Gang.; pyae. Died art. lig. DiedMav6, 05; exh n. June 7/64; asthenia. Autopsy. Spec. 4164. Spec. 2553. 409 Reigle, J., Pt., H, 88th May 8, Right ; ant. post. flap. Surg. R.B. 372 MoMahon, J., Pt., A, 61st Sept. 17, Left (haem.). Oct. 2, fern. art. lig. Penn., age Qii. 28, 64. Bontecou, U. S. V. June 8, 12, New York. , 62. Died Oct. 16, 1862. haem.: lig. fern. art. 16, 24, recur 373 Me Mick en, N., Pt., A, July 2, Right (sloughing) . Died August rent ha?m.; re-lig. Died June 24, 151st Penn., age 24. Au. I, 63. 12, 1863. 1864; haemorrhage. PURDY (E. M.), Cases of Gunshot Wound, in American Medical Times, 1863, Vol. VI, p. 66. 286 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS. OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 410 Reed, AV., Ft., G, 39th Feb. 6, Right. Surg. J.Aiken, 71st Penn. 440 Stewart, E., Pt., B, 13th July 24, Left ; flap. A . Surg. J. Willard, New York, age 30. 11, 04. Died March 1, 1864 ; tetanus. W. Virginia, age 25. 28, 6-1. IstMd. P.H.B. Died Aug. 5/64. 411 Rentz, J. W., Lieut., 13th Sept. 17, Right ; flap. A. Surg. C. P. Rus 441 Stewart, J., Pt., C, 26th Dec. 7, Left (gang.); circ. Surg. T. W. Alabama, age 21. Oct. 7, 62. sell, U. S. A. Diarrhoea. Died Indiana, age 22. 11, 62. Florer, 26th Ind. Died Dec. 24, Oct. 11, 1862. Spec. 800. 1862; haemorrhage. 412 Rice, S.H.,Corp l,E,50th May 13. Right ; circ. Died June 7, 1864 ; 442 Stone, B., Capt.,, llth Aug. 30, Right. A. Surg. B. Howard, U. Penn., age 29. 19, 64. pyaemia. Massachusetts. Sep.4, 62. S. A. Died Sept. K), 1862. 413 Ricker, J., Pt., K, 2d N. May 5, Right; circ. Surg.R.B.Bontecou, 443 Stroup, W., Seaman. Feb. 12, ; double flap. Surg. E. C. Hampshire, age 24. 8, 62. U. S. V. Died Sept. 21 , 1862. , 62. Franklin, U. S. V. Died March 414 Riggs, I.,Pt., I,8th Penn. Dec. 13, Left. Surg.J.E.Summers.U.S.A. 5, 1862. Reserves. 29, 62. Died Jan. 10/63 ; pyae. Spec. 661. 444 Strunk,AV.C.,Pt.,G,56th July 30, Left (slough.); circ. A. A. Surg. 415 Roberts, W. P., Pt., I, July 1, Right ; circ. A. A. Surg. J. L. Mass., age 26. Au.l2, C4. E. Sevffarth. Died Aug. 12/64. 42d Mississippi. 24, \!3. Whitaker. Diarr. Died Aug. 445 Sturdevant, J. H.,Pt.,C, May 12, Left, A. Surg. M. J. Hyde, 2d 5, 1863; exhaust n. Spec. 2057. 5th Vermont, age 20. 24, 64. Vt. Necrosed. Aug. 20. liaem.; 416 Robertson, G., Pt., A, 63d Sept. 17, Right ; flap. A. A. Surg. A. V. re-amp. Died Aug. 21, 1864. New York, age 42. Oc.i7, 62. Cherbonnier. Died October 21, 446 Swink, J., Pt., K, 5th May 3, Right ; circ. Died June, 1863. 1862. -Spec. 360. Virginia, age 18. 12, 63. 417 Robiuson, Mary, wife of April 12, Right ; ant. post. flap. Surg. H. 447 Taylor, T.L., Pt.,C, 82d Aug. 31, . Died October 9, 1862. Colored soldier. 21, 64. Wardner, U. S. V. Died April Ohio. , 62. 26, 1864; exh n. Spec. 3315. 448 Thompson, A., Corp l, A, April 2, Right (erysip.; haem.). Surg. D. 418 Robinson, W. B., Pt., B, Nov. 6, Left (haem.). Died Nov. 12, 63. 98th Penn., age 29. 25, 65. W. Bliss, U.S.V. Died May 23, 2d E. Tennessee. -, 63. 1865. Spec. 4096. 1 Robison, W. R., Pt., D, May 15, Left; circ. A. A. Surg. R. L. 449 Thornbury, L., Pt., C, July 25, Right ; circ. A. A. Surg. W. L. 29th Alabama, age 23. J ne 7, 64. McClure. Died June 22, 1864 ; 97th Penn., age 20. Au. 1, 64. Welles. Died Sept. 13, 1864; exhaustion. Spec. 3372. irritative fever. 420 Rodden.M. L., Serg t, D, May 31, Left ; flap. A. A. Surg. W. K. 450 Tournier, L, Pt., A,147th May 5, Left ; ant. post. flap. Died Aug. 96th New York, age 25. J e 12/62 Cleveland. Died June 17, 1862. New York, age 42. 9, 64. 15, 1864. 421 Holland, J.G., Serg t. F, May 19, Right; circ. A. A. Surg. W. C. 451 Unknown. Dec. 7, Left. Surg. J. P. Root, 2d Kansas 7th New York Artil ry. 26, 64. Mulford. Gang. Died June 2, 11, 62. Cavalry. Died Dec. 13, 1862. age 21. 1864; pyaemia. Spec. 2381. 452 Vanderhoof, N. P., S g t, May 1, Left (hajm.); circ. Died May 16, 422 Sargent, C. H., Pt., 1, 6th Dec. 13, Right, Died Jan. 7, 1863 ; shock B, 146th N. Y., age 21. 5, 63. 1863. Autopsy. N. Hampshire, age 25. 1862, and suppuration. 453 Walker, J., Serg t, F, 2d June 16, Left (J y 2, haem. recur d; gang.); Jan. 1, 63. Maryland, age 21. J y 6, 64. circ. A. A. Surg. J. Winslow. 423 Scanlan, P., Pt., G, 63d Dec. 14, Right. A. Surg. G. M. McGill, Died July 6, 1864 ; asthenia. New York, age 34. 26, 62. U.S.A. Haem.; lig. fern, art.; 454 Walker, P., Pt.,C, 3 th June 3, Right ; circ. Surg. S. S. French, hjem. rec d. Died Jan. 1 4, 1863 ; Wisconsin, age 38. 20, 64. 20th Mich. Kxf. bone extracted. haein. Autopsy. Died Aug. 22, 1864. Spec. 3128. 424 Scanlon, J., Pt., A, 3d Aug. 9, Left ; circ. A. Surg. P.Adolphus. 455 Watts, J. H., Serg t, K, Mar. 26, Left; ciro. Diarrhoea. Died April Maryland. 15, 62. U. S. A. Died Aug. 20, 1862. 110th Penu., age 24. Ap. 2, 65. 22, 1865; exhaustion. Spec. 42. 456 Weaver, J., Pt., G, 103d May 31, Left ; flap. Died June, 1862. 425 Schadot, J., , G, 30th Sept. 17, Right. Died October 12, 1862. Penn., age 31. J ne4/62. Ohio, age 40. Oct. 8, 62. 457 Welch, E., Pt., I, 14th July 3, Right ; ant. post. flap. Surg. H. 426 Schock, W., Corp l, K, Aug. 9, Left ; ant. post, flap. A. Surg. J. Indiana. -, 63. M. McAbee, 4th Ohio. Died 46th Pennsylvania. 16, 62. B. Brinton, U. S. A. Haem.; lig. July _, 1863. Died Sept. 2, 1862. Spec. 50. 458 Wells, F. M., Lieut , D, May 2, Left, Died June 2, 1863. Spec. 407 Sohuyler.W. S.,A.D. C. June 3, Left ; circ. A. Surg. \V. Thom 132d Pennsylvania. 6, 63. 1064. and Capt., 155th N. Y., 16, 64. son, U. S. A. Died June 20, 64 ; 459 Westlake.W.W., Corp l, July 2, Right. Died July 25, 1863; teta age 24. exhaustion. Spec. 3560. A, 17th Conn., age 18. 14, 63. nus. 428 Secord, J., Pt., B, 43d May 5, Left (gangrene). Surg. G. T. Ste 460 Whitcher, O. B., Corp l, June 1, Left; ant. post. flap. Surg. E. New York. 10, 64. vens, 77th N. Y. Died May, M,8th New York H vy 13, 64. Beutley, U. S. V. Haem. Died 1864; gangrene. Artillery. June 18, 1864 ; haemorrhage. 429 Sharon, P., Pt., I, 153d Sept. 19, Right (nearly moribund from bsem. 461 Wilber, N., Pt., C, 185th Mar. 29, Left ; eirc. Surg. D.W. Miss, U. New York. Oc.18, 64. Oct. 12, lig. pop l art,); lat. flap. New York, age 31. Apr.2, 65. S. V. Died April 18, 65 ; fract, Ass t Surg. C. II. Allen, 8th Vt. of cranium. Spec. 4041. Died Oct. 18, 1864; exhaustion. 462 Wilbur, W. F.,Corp l, I, May 3, Left; circ. May 15, haem., lig. 430 Shields, H., Pt., C, 61st May 31, Right. Died July 3, 1862; py 29th Ohio, age 24. 8, M33. fern, art., recur d, prof, ligated. Pennsylvania. J e , 62. aemia. Spec. 4940. Died May 17, 1863. 431 Shire, J., Pt., B, 5th 111. Feb. 11, ; ant. post. flap. A. Surg. J. 463 Williams, H. P., Pt., G, May 5, Right ; ant. post. flap. Surg. R. Cavalry, age 25. Mar. 6, B. Ensey, 5th Illinois Cavalry. 53d Penn., age 17. 20, 64. B. Bontecou,U.S.V. Died June 1863. Died March 6, 1863. 14, 1864 ; pyaemia. Spec. 3059. 432 Shultz, B., Pt., H, 1st May 31, ; flap. Died June 15, 1862 ; 464 Williams, R., Pt., C, Sept. 16, Right; flap. A. Surg. C. A. Me- Penn. Artillerv, age 21. J ne 9, 62. pyaemia. 28th Penn. 30, 62. Call, U. S. A. Died October 2, 433 Singer, W. H.. Pt., C,7th Nov. 27, Left; circ. A. A. Surg. J. Cass. 1862. Spec. 59. Virginia, age 22. De.15, 63. Dec. 22. haem. Died Jan. 6. 64. 465 Wilson, W., Pt., I, 2d April 9, Right ; circ. Surg. F. Bacon, U. Specs. 2006, 2007, 2008. New York Cavalry. 16, 64. S. V. Died April 28, 1864. 434 Smith, H. E.,Pt., E, 80th May 12, Right (re nt hasm.); eirc. Surg. 466 Witman, J., Pt., A, 16th May 10, Left; ant, post, in us. flap. Surg. New York, age 17. 28," 64. D. W.Bliss. U. S.V. Died June Michigan, age 23. 25, 64. A. F. Sheldon, U. S. V. Died 2. 1864. Spec. 2371. May 27, 1864 ; exhaustion. 435 Smith, W., Corp l, I, 1st June 11. Left; circ. A.A.Surg.D.H.King. 467 Wolford, J. R., Serg t, B, Sept. 19, Right, (haem.). Died Nov. 13/63. N.Y. Dragoons, age 28. J y 6, 64. Died July 17, 1864 ; asthenia. 30th Indiana. Oc.19, 63. 436 Spencer, J., Pt., G, 48th May 9, Right ; oval flap. Surg. E. Bent- 468 Wynne, W. G., Pt., F, Sept 17, Left ; flap. A. Surg. P.Adolphus, Penn., age 19. 16, 64. ley, U. S. V. Haem.; lig. Died 66th New York. Oc.16, 62. U. S.A. Oct. 25, haem.; lig. fern. May 31, 1864: exhaustion. art. Died Nov. 3, 62. Autopsy. 437 Sproule, L.. Pt,, E, 37th De. 7, 62, Right; lateral flap. Surg. H. S. Spec. 746. Illinois, age 23. Jan. 3, 63. Churchman, U. S.V. Died Jan. 469 Wyznski, C., Pt,, B, 3d May 18, Left ; circ. A. A. Surg. R.W.W. 9, 1863; pysamia. Md, Cavalry, age 26. 29, 64. Carroll. Died May 31, 1864; 438 Squires, L., Pt., D, 29th Aug. 9, Left ; ant. post, double flap. A. | pyaemia. Ohio. 15, 62. A. Surg. J. B. Bellanger. Died I 470 Yearby, J., Waiter, C, Aug. 7, Left; flap. A.A.Surg.H.B.White. Sept. 5, 1862 ; exh n. Spec. 52. 12th N. Hamp., age 25. 12/64. Died August 20, 1864 ; exh n. 439 Stevens, J., Pt., E, 3d April 4, Left, Surg. J. E. Lynch, 1st Mo. 471 Young, G. W., Pt., F, May 3, . A.Surg.B. Howard,U.S.A. Missouri Cavalry. 12, 64. Cav. Died one hour after. 114th Pennsylvania. 8, 63. Died May , 1863. The seat of fracture in the cases enumerated in the foregoing table was in the middle third of the femur in seventeen; in the lower third, in ninety-four; in the femur, without specification of third, in sixty-six; in the knee joint, in two hundred. and thirty-four; in the leg, in fifty-six; and in the ankle joint or foot in four instances. COUE8 (E.), Cases of Amputation* and Resections, from Gunshot Wounds, performed by Assistant Surg. C. A. McCa.ll, V. S. A., in Medical and Surg. Reporter, 1862-3, Vol. IX, p. 195. SECT, in.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 287 Intermediary Amputations in the Lower Third of the Thigh. There were six hundred and seventy-six of these operations. Two hundred and seventeen were successful and four hundred and fifty-nine terminated in death a mortality of 67.9 per cent., exceeding the fatality of the intermediary amputations in the upper third by 1.9 per cent, and the same operations in the middle third by 11.5 per cent. Successful Cases of Intermediary Amputations in the Lower Third of the Thigh. Of the series of six hundred and seventy-six intermediary amputations in the lower third two hundred and seventeen had favorable results, comprising thirty-one Confederate and one hundred and eighty-six Union soldiers. Of the latter, one hundred and eighty-four were pensioned and one retired, and eight have died since the close of the war in 1865. Of fifty-three of these cases pathological specimens are preserved in the Army Medical Museum. CASE 4G4. Private W. Vanuatta, Co. D, 4th Pennsylvania Cavalry, aged 24 years, was wounded at Upperville, June 21, 1863, and entered Stanton Hospital, Washington, three days afterwards. Surgeon J. A. Lidell, U. S. V., reported: "The patient, a man of sound constitution, had received a wound of the right knee by a carbine ball. The missile entered the limb on its anterior inner face a short distance below the joint, passed backward and upward, and escaped through the popliteal space, apparently without opening the joint. From the course and direction of the wound the upper part of the tibia was supposed to be injured. At the time of admission the patient s condition was good, there being no pain, heat, or swelling about the injured knee. He was directed to refrain from using it by remaining quietly in bed, to have ice applied to the wound constantly so as to lessen the danger of inflammatory action, and to be supported by nutritious diet. Under this treatment his case progressed without an untoward symptom until July 5th. At inspection, on this day, I especially noticed his condition as very promising, the anterior orifice of the wound being nearly healed. But, about the middle of the following night, he was seized with great pain and distress in the injured knee, and full doses of morphia were administered without producing much relief. On the following morning the knee was found to be greatly swollen, hot, and exceedingly tender, the patient complaining of intense gnawing pain in it, and crying out from agony occasioned by it. Although his pupils were markedly contracted from the large quantities of anodynes taken, his countenance was expressive of great distress; pulse frequent, quick, and irritable; skin hot and dry: he was also thirsty, had a coated tongue, and had had a slight chill. Free abstraction of blood from the neighborhood of the knee by cups was ordered, also ten grains of calomel, and anodynes as required. On July 7th, the patient s condition had not materially changed. Seeing that the arthritis was secondary to the wound, and believing that it was associated with fracture and comminution of the upper end of the tibia, amputation appeared to be the proper remedy. The operation was accordingly performed by Assistant Surgeon P. C. Davis, U. S. A., in the lower third of the thigh, by the circular method, about midday thirty-six hours after the attack. Anaesthesia was produced by sulphuric ether. The patient bore the operation well. On examining the amputated limb the inner part of the head of the tibia was found to be extensively injured by the bullet, a deep groove having been made in the bone, associated with much comminution, and some of the broken fragments connected directly with the joint. The cavity of the knee joint was found to contain about four ounces of dirty-brown colored viscid liquid, in which yellowish shining globules (synovia), looking like oil, floated. The lining membrane of the joint was stained with a dull red hue throughout its whole extent and had entirely lost its polished and shining appearance. The internal semilunar cartilage com pletely covered the opening in the head of the tibia. On July 10th, the patient was progressing pretty well." On October 2d, he was transferred to Turner s Lane Hospital, Philadelphia, where a second operation was performed by Acting Assistant Surgeon C. B. King, who described it as follows : "When admitted, the femur was protruding about half an inch, and appeared to be dead as far up as could be felt with the probe, a ring of new bone being thrown around it. The discharge was very pro fuse. On October 5th, the patient having been placed under the influence of ether, an oval incision was made around the end of the bone and through the cicatrix and some unhealthy granulations, when, after dissecting the muscles for a short distance, the vitality of the new bone was found to be small, and lateral incisions were made and the flaps dissected up for about four inches, where the new bone seemed to be more healthy, and was sawn off. About four inches of the remaining dead bone, which I judged as reaching up as far as the great trochanter, was extracted with the forceps. The femoral artery was avoided by making the internal lateral incision below the vessel, and the patient lost but little blood. Three or four small arteries were ligated, and the wound was closed with iron wire and adhesive straps. The patient, being very weak from suppuration and the shock of the operation, was rallied with difficulty. Cold-water dressings were applied and stimulants administered. On the following day the patient was still very weak, had a slight fever and coated tongue, and the stump was very much inflamed and swollen. The sutures were removed and the straps loosened, and milk punch, beef tea, and generous diet were ordered. On October 12th, the inflammation was somewhat reduced, the discharge free but very offensive, and the patient was gaining strength slowly and his appetite improving. The ligatures were now removed. On October 18th, the bands were removed, union having taken place in the stump. On November 4th, the wound had closed with an abundance of flap, and the patient was going about on crutches. On November 16th, he was transferred to Haddington Hospital for the purpose of getting an artificial limb." Acting Assistant Surgeon J. R. Levis, in charge of the latter hospital, recorded the following result of the case: "At date of admission a fistulous opening existed in the stump, and on examination by the probe the whole wall of this sinus was found to have an osseous fell leading directly to the end of the femur, where loose spiculse of bone were clearly perceived. A small pledget of sponge tent was applied, and on November, 20th the orifice was well dilated, and, with the dressing forceps, several pieces of bony formation were removed, which crumbled readily under pressure; also a good sized spicula from the sawed surface of the femur. Some inflammation followed this operation, for which lead and opium lotion was applied ; perfect quiet INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. was enjoined, and anodynes given at bedtime. On November 23d, the inflammation was still continuing and the patient suffer ing intense pain in the stump, but two days afterwards both were subsiding. On December 1st, another examination was made by the probe and another small piece of bone was extracted. By December 10th, his health had improved, the discharge had much lessened, and the stump was doing well, the patient stating that it felt better than at any previous time. In January, 1864, the patient went to his home on furlough, and in the following month, when he returned, the discharge had almost ceased. On March 1st, the sinus had closed and the stump was apparently sound." The patient was subsequently transferred to Christian Street Hospital, and was discharged from service June 7, 1864, and pensioned. Examiner J. Walker, of Bethany, Missouri, certified, May 2, 1874 : "I find him unable to wear an artificial limb on account of tenderness and shortness of the stump. HP is unable to raise the stump in walking, and wears a wooden peg with a leather socket, buckled around his waist. He is also unable to raise the peg, but moves it by moving the side of his body. The stump chafes so easily that he can wear the socket but a short time, and then has to use a crutch." The pensioner was paid June 4, 1879. The bones comprising the knee of the amputated limb were transmitted to the Museum by Surgeon Lidell, and the involucrum and sequestrum, removed at the second operation, together with a cast of the stump, were contributed by the operator. (Cat. Sury. Sect., 1866, pp. 341, 309, and 555, Specs. 1306, 2602, and 1529.) Specimen 2602 is represented in FIG. 1 of PLATE LXX, opposite p. 242. CASE 465. Corporal H. H. Ellis, Co. I, 16th New York, aged 23 years, was wounded in the left knee, at Fredericksburg, May 3, 1863. Five days after the injury he was admitted into Douglas Hospital, Washington, whence the following history was received : " On examining the wound it was found that a conical ball had fractured the patella so extensively as to involve the joint. On May 13th, there were symptoms of synovitis, and the thigh was amputated at the lower third, by the circular method, by Acting Assistant Surgeon J. E. Smith. Portions of clothing were removed from the amputated knee, and an examination showed that the patella had been broken into numerous fragments, that a fissure extended through the inner cartilaginous face of the bone, and that synovitis had been developed. The patient was broken down with diarrhoea. The stump was dressed with alcohol, and stimulants, quinine, and nutrients were given as largely as possible. The general condition of the patient was so unfavorable that no effort at repair was perceptible in the stump for many days. On May 20th, a haemorrhage of several ounces occurred and was controlled by pressure. During the following night the bleeding recurred so freely as to render a liga- tion of the femoral artery necessary, which was performed below the profunda on May 21st. The patient was so prostrated from the loss of blood that he almost died from the effects of the ether. The most careful administration of whiskey, ammonia, valerian, and morphia alone sustained his life during the next forty-eight hours. There was no recurrence of hemorrhage after the ligation, nor did this ligature of the main artery produce the slightest perceptible effect upon the appearance of the stump. The usual changes were resorted to in the various astringents given for the diarrhoea, nitrate of silver, opium, tannin, and sul phuric acid, all proving at first beneficial and then losing their effect. Lemon juice was given, as the patient s stomach would bear it. with evident benefit as an antiscorbutic. For weeks the patient hung between life and death. His whole thigh was much swollen and very tender on pressure; the incisions were healthy in appearance, the discharge moderate, and the granula tions very tedious. Under a careful treatment he gradually grew stronger, his diarrhoea ceased, and the stump, though yet greatly swollen, became closed excepting at the inner extremity, where the end of the femur protruded, the flaps from the first having been insufficient. On August 9th, Dr. Smith was ordered to remove the exfoliating end of the bone, which was loose, and, to his surprise, proved to be a very extensive sequestrum ten inches in length. Considerable haemorrhage supervened, but after the operation convalescence was very rapid, and the stump, no shorter than before, soon closed entirely, being firm and in every Avay satisfactory. A formation of new bone could be plainly felt in it. The patient regained his flesh and strength, and left the hospital October 26, 1863, his term of service having expired May 22d." The history, with the sequestrum, represented in FIG. 1 of PLATE LXIX, opposite p. 224, and the bones of the amputated knee, were contributed to the Museum by Assistant Surgeon W. Thomson, U. S. A., in charge of Douglas Hospital. A ligamentous preparation of the latter specimen constitutes No. 1852 of the Surgical Section. The patient was subsequently an inmate of the Post Hospital at Albany, and afterwards entered Central Park Hospital, New York City, to be fitted with an artificial limb by Dr. E. D. Hudson. He left for his home June 6, 1864. His pension was paid June 4, 1879. (See wood-cut 64, p. 63, Circular 6, S. G. O., Washington, Nov. 1, 1865.) CASE 466. Private J. Nash, Co. G, 143d Pennsylvania, aged 21 years, was wounded at North Anna, May 22, 1864. He was admitted to the field hospital of the 4th division, Fifth Corps, where Surgeon C. W. Chamberlain, U. S. V., recorded: "Severe shot wound of right knee joint by musket ball." From the field hospital the wounded man was conveyed to Port Royal, and thence by steamer to Washington. Surgeon D. W. Bliss, U. S. V., reported that " the patient entered Armory Square Hospital May 29th, having undergone circular amputation of wounded limb at the lower third of the thigh the day previous to his admission, while on board of the hospital transport." On July 22d, the patient left for his home on furlough, whence he returned several months afterwards, and subsequently he was transferred to Judiciary Square Hospital. Surgeon E. Griswold, U. S. V., in charge of the latter, reported that the presence of necrosed bone in the stump having been indicated by suppuration, a tubular sequestrum, eight and three-fourths inches long, was removed on April 9, 1865, by Acting Assistant Surgeon F. H. Hill. On June 22, 1865, the patient was discharged from service and pensioned, having been previously supplied with an artificial limb by the Jewett Patent Leg Company of Washington, D. C. His pension was paid March 4, 1879. The sequestrum (Cat, Sim,. Sect., 1866, p. 308, Spec. 144) is shown in FIG. 2 of PLATE LXIX, opposite p. 224. Eight of the patients who recovered after intermediary amputation in the lower third have died since the close of the war. In the following instances the pensioners survived the operation three and nine years respectively: CASE 467. Private J. Glassie, Co. B, 63d New York, aged 22 years, was wounded at Cold Harbor, June 3, 1864, and admitted to the field hospital of the 1st division, Second Corps. Surgeon W. S. Cooper, 125th New York, noted : " Shot wound of left leg; amputation at lower third by Surgeon P. E. Hubon, 28th Massachusetts." One week after the reception of the injury the man was admitted to Emory Hospital, Washington, where Surgeon N. R. Moseley, U. S. V., recorded that the limb was SECT. III.] INTEEMEDIAEY AMPUTATIONS OF THE THIGH. 289 FIG. 195. Appearance of thigh stump after lateral flap operation. [From a photograph.] re-amputated above the knee on June 20th, also that abscesses formed subsequently, and that the stump of the femur became hypertrophied. On March 10, 1865, the patient was transferred to Central Park Hospital, New York City, whence Surgeon B. A. Clements, U. S. A., reported the following: When admitted, the end of the stump was red and inflamed, and there were three sinuses leading to necrosed bone. On March 19th, chloroform was administered, and a sequestrum about eight inches long was removed by Acting Assistant Surgeon S. Teats. The patient did well after the operation. By July 15th, the stump had entirely healed, and one month later he was discharged from service." The man subsequently became a pensioner. He died at Brooklyn, New York, November 12, 1867. The removed fragment was contributed to the Museum by the operator, and constitutes Specimen 3100 of the Surgical Section. A representation of it appears in FlG. 3 of PLATE LXIX, opposite p. 224. CASE 468. Private Alexander McConkey, Co. D. 63d Pennsylvania, aged 48 years, was wounded at the Wilderness, May 5, 1864, by a conoidal ball, which entered on the inner condyle of the left knee, passed through the joint, and made its exit on the opposite side. He was conveyed to Washington, and admitted into the Hare- wood Hospital on May 14th. Surgeon E. B. Bontecou, U. S. V., furnishes the follow ing notes of the case : "An examination of the injury was immediately made; the soft parts around the wound were found much inflamed and the joint cedematous. His general condition being good, it was decided to amputate without delay, and the patient being chloroformed, Surgeon Bontecou removed the thigh in the lower third by the lateral flap operation. The stump healed favorably, the ligatures came away on the eighth day, and the patient progressed well on a supporting diet until, July 29th, he had so far recovered as to be about on crutches, when he accidentally fell, injuring the stump, which became inflamed; alcohol and water dressings were applied. On August 4th, an abscess was opened, which discharged about four ounces of pus. 5th, he had a severe attack of diarrhoea, which was checked by proper treatment. 30th, condition very good; a small sinus still exists, owing to some necrosed bone." He was trans ferred to Pittsburg, April 3, 1865, and admitted into hospital there. The wound had entirely healed, and he was discharged May 19, 1865. He was pensioned, and died May 15, 1873; the cause of death is not satisfactorily given. The pathological speci men, showing the bones of the left knee, with the articular extremity of the femur shattered (No. 3066, Sect. I, A. M. M., Cat., 1866, p. 338), was contributed by the operator, who also furnished a photograph of the stump, which is copied in the adjoin ing wood-cut, FIG. 195. Fatal Cases of Intermediary Amputation in the Lower Third of the Femur. This group comprises four hundred and fifty-nine operations performed on four hundred and fifty- seven patients, in two instances intermediary amputations in the lower thirds of both thighs having been performed: CASE 469. Private W. Sailor, Co. E, 119th Pennsylvania, aged 40 years, was wounded in the left leg by a conical bullet, at Kappahannock Station, November 7, 1863. Two days -afterwards he was admitted to Stan ton Hospital, Washington, whence Surgeon J. A. Lidell, U. S. V., made the following report: "On examination, it was found that the injured leg was much swollen and dark colored on its anterior surface, that there was no pulsation in the anterior tibial artery, and that both the tibia and fibula were extensively comminuted, with much laceration of the soft parts. His pulse was frequent and irritable, and he had a good deal of constitutional disturbance and fever of an irritative type. On November 14th, the fever had abated, and the general condition much improved; pulse fuller and less irritable; appetite better; wound suppurating; discharge thin, dark colored, and offensive ; leg not improved. There being manifestly no hope of saving, it, the bones being broken and the soft parts inflamed nearly up to the knee joint, and comminution very extensive, the limb was amputated in the lower third of the thigh. The operation was performed by the circular method by Assistant Surgeon G. A. Mursick, U. S. V., under sulphuric ether. A dissection of the amputated limb showed that the bones were extensively comminuted as high up as the head of the fibula. The anterior tibial artery was found to be divided by the bullet a little below where it passes through the interosseous membrane, the ends being separated from each other about one inch and retracted within the sheath, also closely contracted. The cardiac end was plugged up by a firm coagulum about an inch in length. The distal end was also plugged up by a small coagulum. The anterior tibial muscles were pale yellow in color, soft and greasy to the touch (fatty degeneration). The patient bore the operation well. The stump was dressed with lead sutures and adhesive plaster, and a full dose of morphine was administered. He had a good night s rest after the operation, and, on the following day, expressed a desire for food, his pulse being full, frequent, and quick ; bowels confined, for which a dose of rochelle salts was ordered. On November 17th, suppura tion commenced, but little of the stump being united by adhesion ; general condition good. Prescribed moderate stimulation, with whiskey. 18th, edge of posterior flap looked sloughy; ordered diluted Labarraque s solution to the stump, and twenty drops of muriated tincture of iron every six hours internally. 20th, had a chill in the morning, followed by fever and sweat; skin sallow looking; granulations in stump looking well, except on the posterior flap, a small portion of which was sloughing. Ordered five grains of quinine every six hours, twenty drops of muriated tincture of iron every four hours, and one ounce of whiskey every three hours. 21st, had a chill in the afternoon; sallow appearance of skin deepened ; pulse irritable; slight sub- sultus; bowels not moved for two days. Ordered ten grains of aloes and twenty grains of rhubarb to be given at once, and continued other treatment. 22d, had chills again in the afternoon, Avith slight delirium. Ordered one-twelfth of a grain of cor rosive sublimate, with three grains of iodide of potassa, every four hours, and continued the whiskey. 23d, patient vomited in the morning, had also a good deal of fever. Applied sinapism to epigastrium. 24th, rigors, etc., in the morning; treatment SURG. Ill 37 590 INJUKIES OF THE LOWEK EXTREMITIES. [CHAP. X. continued. 25th, rigors, fever, and delirium; skin very yellow. 28th, rigors, etc.; urine passed involuntary; bedsores on sacrum. Ordered a water bed. Patient died, exhausted, on December 1, 1863, the seventeenth day after the amputation and the eleventh day after the advent of the purulent infection. Autopsy twelve hours after death: Rigor mortis well marked; skin yellow; some emaciation; stump swollen and cedematous; femoral artery well plugged up in stump; end of femoral vein well sealed up in stump; femoral vein empty and collapsed from the end up to the valve at the first anastomosing branch, a distance of about six inches; the vein in this situation about as large as the artery; the walls of the vein also much thickened, being about as thick as those of the artery; the lining membrane looking velvety, wrinkled, and dirty gray in color; no pus in vein. From the valve above mentioned up to the mouth of the vena profunda, a distance of about two and a half inches, the femoral vein was filled to distension with fetid broken down liquefied blood, its lining membrane dirty gray colored in this situation, and its walls somewhat thicker than natural ; no pus revealed in this locality by the microscope. At the mouth of the vena profunda the femoral vein was plugged up with yellowish white fibrine ; vena profunda and many of its branches filled and knotted with recent coagulum ; femoral vein also filled with recent coagulum above the mouth of the profunda to a distance of about two and a half inches; the lining membrane of the profunda and part of the femoral vein last mentioned stained dark red, and the walls of the vessels somewhat thickened in same locality. A thin dark colored recent coagulum, not filling the calibre of the vein, extended the whole length of the external iliac. The end of the femur in the stump (FiG. 2, PLATE XLIII, opposite) was necrosed to the extent of nearly half an inch, and here the periosteum was thickened, varying from a line to one-third of an inch, detached and gangrenous; underlying bone white in color; medullary membrane at end of bone gangrenous and dirty grayish green in color to the depth of about one-third of an inch; medullary membrane elsewhere more vascular tfian natural, which was well shown by splitting the bone lengthwise with a saw (FiG. 1 of PLATE XLIII, opposite). Three or four small superficial abscesses were formed about the right extremity of the spleen; the rest of that organ was contracted and indurated. Five or six small superficial abscesses were discovered in the lungs, the pulmonary tissue surrounding each of them being con solidated by inflammatory action. The other organs were natural, and the blood did not exhibit any abnormity." The femoral artery (Spec. 1887) and the femoral vein (Spec. 1888), together with three inches of bone from the stump (Spec. 1890), and the section of the spleen containing the metastatic abscesses (Spec. 1889, shown in FiG. 3, PLATE XLIII, opposite), were contributed to the Museum by Dr. Lidell. In the following instance a shot injury of the inner condyle of the right femur was followed by severe secondary arthritis, which necessitated amputation. The autopsy revealed suppurative osteo-myelitis : CASE 470. Private J. N. Saxon, 1 Co. D, 9th Louisiana, aged 27 years, was wounded in the right knee, at Rappahannock Station, November 7, 1863, and suffered amputation at the Stanton Hospital, Washington. Surgeon J. A. Lidell, U. S. V., who performed the operation, described the case as follows: "A conical bullet entered the knee about three inches above the patella, on a line with its inner margin, passed backward, dowmvard, and a little inward, and escaped at the inner posterior side, about six inches below the joint. The inner condyle of the femur was fractured by the missile passing through it, but without opening the cavity of the joint. The patient stated that his knee was bent at the time of the infliction of the wound. He was admitted two days after the injury and did well, having good spirits, good appetite, and but little pain or swelling of the parts until the night of November 16th, when he had a severe chill, accompanied with great pain in and about the knee, and the injured parts became hot and swollen. On the following morning he-exhibited great constitutional disturbances: skin hot; tongue coated white; pulse very rapid, gaseous, and weak. The injured knee was much swollen and exquisitely tender, and he complained of intense pain in it ; the anterior orifice of the wound presented a gelatinous appearance, with elevated and everted edges. The patient appeared so feeble that I thought he would not then bear the shock of an amputation, and ordered him to take whiskey freely with anodynes. The next day, November 18th, his general condition appeared unchanged with the exception of his pulse, which was stronger and not gaseous, being 120 by the watch. He had not slept during the night, and complained of great pain in the knee, which was rather more swelled, and the tumefaction was extending up the thigh. The wound presented the same gelatinous appearance as the day before, and the skin over the saphenous veins looked purple colored, but the veins did not exhibit any induration. The thigh was amputated at the lower third, by the flap method, at 1 P. M., about thirty-six hours subsequent to the accession of the secondary arthritis. The patient was under sulphuric ether and bore the operation well. Examination of the amputated member showed the inner condyle of the femur to be extensively comminuted. There was a layer of yellowish gray colored plastic exudation on the articulating surfaces of the fragments in the joint, and the cavity of the joint contained about three ounces of reddish brown colored liquid, in which shining globules floated resembling oil in appear ance. The synovial membrane was reddened, especially the pouches of it in relation with the quadriceps extensor cruris. The subcutaneous areolar tissue was infiltrated with a yellowish serum. The bullet was ascertained to have passed behind the joint. On the day following the operation the patient s tongue was coated and his appetite poor; he had also moderate diarrhoea, the evacuations being very offensive. Five grains of blue mass was given at night, and free stimulation with whiskey. On the 20th, the patient was comfortable and the stump looked well. The diarrhoea was unchanged, but during the following several days it gradually abated and the patient progressed well in every respect. 28th, patient cheerful; tongue clean; appetite good; bowels regular; stump but little swollen; granulations healthy; suppuration moderate in quantity and laudable in quality. 30th, patient appeared to be doing well, but complained a good deal of pain in and about the stump. December 1st, patient restless and complaining of increased pain in the stump, especially about the end of the bone ; no preternatural swelling, redness or heat in the stump. Prescribed one-fourth of a grain of sulphate of morphia and one drachm of Hoffman s anodyne every four hours. 2d, patient more restless, appearing much agitated and very nervous, having slept but little, and complaining of agonizing pain about end of bone and end of femoral artery. There were exacerbations in the pain and sometimes the whole stump ached, but there was no febrile excitement and nothing untoward in the appearance or feel of the stump ; neither was it 1 LIDELL (J. A.), in Surgical Memoirs, * * by the United States Sanitary Commission, New York, 1870, Vol. I, p. 358, gives a detailed account of this case, Kip. 2. Fig. 3. PLATE XL!II_ RESULT OF CSTEOMYEL! i IS SECT. m.J INTERMEDIARY AMPUTATIONS OF THE THIGH. 291 swelled, red, or hot. 3d, patient had a bad night, and complained much of sickening pain in end of stump and in bowels. About 7 A. M. the ligature separated and a most profuse haemorrhage occurred, the blood pouring out in a stream as lar^e as the calibre of the artery. It was finally stopped by digital compression, but, in the meantime, he had lost more than six pounds of blood, which brought him very low. He was stimulated as freely as possible with whiskey and carbonate of ammonia, but did not rally, and died about 3 P. M. Autopsy twenty-three hours after death : Surface of body very pale and waxy (exsanguinated); rigor mortis strong ; superficial lymphatic ganglia lying along the vena saphena magna of amputated thigh all enlarged and exhibiting a faint reddish hue on section; deep ganglia riot affected; stump not cedematous and no part sloughy; stump healed throughout except in the track of the ligatures and at the end of the bone. The femoral ligature had come away and the end of the vessel was patulous, uncontracted, and unobstructed. The c ats of the artery were infiltrated with blood (recent) at its end and for about half an inch above it. A branch of considerable sine was given off from the artery about three-fourths of an inch above its end, which had apparently interfered with the formation of a suitable clot for the permanent plugging up of the vessel ; there had been but little effort towards occlusion. No other abnormity existed in the artery. The end of the femoral vein was well sealed up, the vein itself diminished in size up to the nearest valve, a distance of about an inch, and its walls thickened in same locality so as to equal those of the femoral artei-y; lining membrane not stained with blood; no emboli and no thrombi found anywhere, and no vein presenting any abnormity, the vena profunda not being overlooked. A remarkable osteophyte was found in relation with the femoral artery and vein at their respective ends in the stump. It was developed from (connected with) the linea aspera, a little above the end of the femur, and thence passed horizontally inward, separating or fork ing into distinct plates, toward the ends of which the one laid in front of and was closely adherent to that side of the artery at and near its end ; the other laid behind and was adherent to the vein at and near its end. This osteophyte was about seven- eighths of an inch wide where broadest, and about one-fourth of an inch thick. It was of recent formation. The lower part of the femur in the stump was moderately enlarged by deposit (laminated) of new bone beneath the periosteum (hyper-nutrition); this membrane was detached for about one-fourth of an inch above the line of the saw all the way round the bone, which pre sented a dull white color in that locality. The medullary membrane was noticed to bulge out a good deal at the end of the bone and to present a dark red or reddish brown color. It was also strong and tough (flesh like). On sawing through the lower part of the femur lengthwise and cleaning off the bone dust the medullary membrane was seen to be more vascular than natural ; the medullary tissue exhibited about a dozen small milk-colored abscesses on the surface of the section, showing pus under the microscope, and varying in size from that of a split pea to a mustard seed. The osseous tissue outside of the medullary canal was more compact and heavier than natural in the same locality. The periosteum was thickened to the extent of from one to three lines and more vascular than natural, the thickening being greatest where it had been detached from the bone. There was also a small abscess, flattened in shape, and holding about an ounce of cream-like pus, in the quadriceps extensor cruris muscle, and the red muscular tissue in immediate relation with it was changed to a dark brown color, which, however, did not extend to any depth. The spleen was enlarged, and the other organs all exsanguinated but presenting no other abnormity." The bones of the knee of the amputated limb (Spec. 1819), the femoral vein and artery (Spec. 1892), with portion of the osteophyte attached, and a longitudinal half section of the lower end of the stump of the femur (Spec. 1860, shown in FIG. 4 of PLATE XLIII, opposite p. 290) four and one-fourth inches long, were contributed to the Museum by the operator. Gangrene of the thigh stump was reported in forty-seven instances, and, in the follow ing instance, tetanus, which appeared on the tenth day after the amputation, hastened the fatal issue: CASE 471. Captain IV. E. Davis, Co. B, 30th North Carolina, aged 25 years, was wounded in the skirmish at Kelly s Ford, Virginia, November 7, 18G3. He was conveyed to the hospital of the Third Corps, and, November 10th, was transferred to Washington and admitted into Douglas Hospital. Acting Assistant Surgeon Carlos Carvallo reported that the ball entered the anterior external aspect of the right leg about two and a half inches below the inferior edge of the patella, one and a half inches external to the median line of the leg, and one and a quarter inches below the head of the fibula, where it fractured the bone, and descending downward, inward, and backward, emerged in the posterior internal aspect of the leg, midway between the inferior edge of the patella and the internal malleolus, internal to the bulk of the gastrocnemius muscle. The right foot was cold, of a purple hue, and entirely senseless; the leg, from knee to upper portion of lower third, was swollen and emphysematous, and the middle third was of a yellow and dark green, intermixed with a brown-purple hue. Diagnosis: Gangrene of the foot and leg from gunshot wound of leg, with, most probably, injury and obliteration of the main arteries. Amputation was the sole treat ment indicated, the foot and lower portion of the leg being completely mortified. Assistant Surgeon W. Thomson amputated the thigh at the lower third by the circular method. The femoral was secured by digital compression and the tourniquet. Very little arterial blood was lost. A grain of morphia was administered in a half ounce of whiskey immediately after the operation, he having readily revived from the ether narcosis, and he stated that he had slept undisturbed during the operation, without dreaming, and was now entirely free of pain. The cut surface of the stump showed the tissues infiltrated and of an unhealthy appearance. Stimulants were administered. The stump was dressed with dry charpie. At night the pulse was 130, tongue moist, skin dry. The stump was boggy and crepitant to pressure, and a dark discoloration was visible on the external aspect extending to the tensor fascia lata. November 12th, towards evening a line of demarcation was visible of a large slough in external side of skin flap, no discharge from stump; tension of the skin caused by three sutures, which were removed, followed by gaping of the flap. About 9 P. M., the pulse became frequent (145), and there was great paleness of the conjunctiva and skin. The extensive sloughing, weak pulse, and anagmic appearance presented a hopeless prognosis. Late in the evening, a strong solution of bromine was directly applied to the surface of the stump by means of charpie. The application was at first painless, but, after penetrating the mortified tissues and coming in contact with sensitive parts, it caused such pain that the patient was fortified during the operation by a half ounce of sherry wine in powdered ice and one-half grain morphia. 13th, Dr. Holly touched the line of demarcation (which was very well marked, and extended to the whole circumference of the stump) with pure bromine, by means of a flattened stick, in order to facilitate and hasten the efforts of nature. He also applied Dr. 292 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Thomson s solution of bromine (composed of one drachm of pure bromine, three drachms of bromide of potassium, and three ounces of water), by means of a glass pipette, to all the sinuses beneath the mortified integuments and the sinuses near the arteries; besides this application, after carefully washing the stump with "blue wash" (solution of permanganate of potassa), and protecting the integuments outside with castor oil and the surface of the stump with a thin muslin rag, the vapor of bromine was administered by pouring an ounce of solution of bromine on charpie; this was applied to the face of the stump and covered with simple cerate spread on sheet lint and inclosed by oil-cloth and a bandage. The application of bromine was repeated at 1 and 7 P. M., and the nourishing food and stimulants continued. An injection of soap and water caused the first passage since the date of the injury and gave great relief. 14th, the effects of the bromine yesterday had hermetically sealed the surface of the stump, covering it with a yellowish gray matter, which was removed as much as possible, a large amount of mortified integ uments being cut away and three loose ligatures removed. Decubitus of gluteal region, somewhat to right of sacral bone ; bedsore the size of the palm of the hand, with a yellow greenish slough, which was partly removed with the assistance of a scissors. India-rubber rings employed, and ointment of cinchona bark. Bromine was freely applied four times during the day. There was an abundant discharge of thin unhealthy pus, and the removal of a great quantity of slough discovered a red gran ulating surface. 15th, wound dressed with bromine at 9 A. M. and 4 P. M. Doing very well ; slough removed in large pieces. 17th. large quantity of sphacelated integuments removed and vapor of bromine applied. The stump was exposed for an hour to a painter s view. 18th, the decubitus is becoming the most painful and prominent feature of his complaint. For the first time he had a free passage without adjuvants; slept on his belly. On the 19th, he was put on a water bed, on which he lay much easier. An extensive slough was removed from the inferior portion of the flap, as also from the decubitus, which discharges health v pus in large quantity; could see an artery pulsating. Bromine applied to bedsore. Patient felt bright, and eat a hearty dinner. In the evening, he complained of a little pain in his throat resembling tonsilitis. 20th, on examining the patient s throat, it was found that he could only open his jaws enough to show the tip of his tongue. Tetanus diagnosticated. Nutritious diet and stimulants were given as usual. At 4 P. M., a laxative was administered. The decubitus was dressed with pulverized cinchona. The stump, which had a beautiful red granulating surface, with one single ligature, was dressed at night with castor oil. He had had contractions and jerking of the stump once in the morning, but had not paid any attention to it until 6 P. M., at which time it became more frequent, recurring nearly every half hour; three ounces of brandy and a half grain of morphia were ordered at 10 and 12 P. M. and 2 and 4 A. M. 21st, trismus well confirmed. Contractions of glottis muscles and fits of suffocation after taking fluids, though administered in small quantities and through a pipette. There was rigidity of the mas- seters and sterno-cleido-mastoid muscles, and of the muscles of the back of the neck, which were quite hard. The head inclined backward and to the left side; diificulty of articulation. The difficulty of swallowing increased and only fluid nourishment could be taken. He gradually sank, and died November 22, 1863, of asthenia. A. post-mortem examination of the stump was made November 24th. There was a natural clot of blood at the distal end of the femoral artery. The neurilemma of the sciatic- nerve appeared thickened, and the fibres of the nerve more gross and coarse than usual. The ends of several nerves were strongly attached to the external surface of the stump. The body and spine were not opened. A drawing, by Hospital Steward E. Stauch, of the gangrenous stump, is copied in the chromo-lithograph, PLATE XXI, opposite. CASE 472. Sergeant D. A. Barnett, Co. B, 99th Pennsylvania, aged 22 years, was wounded at Kelly s Ford, November 7, 1863. Surgeon J. W. Lyman, U. S. V., recorded his admission to the field hospital of the 1st division, Third Corps, with "shot wound of left knee joint." Two days after the reception of the injury the wounded man Avas transferred to Douglas Hospital, Washington, whence Assistant Surgeon W. Thomson, U. S. A., reported the following history: "The patient was anaemic when admitted, and stated that very free haemorrhage took place the moment he was wounded. He was struck by a bullet, which entered the leg at the lower border of the patella, and was removed through an incision at the median line poste riorly, four inches above the joint. An examination showed the probable obliteration of the main vessel, since there Avas no circulation in the foot, which, with the leg half way to the knee, was cold and purple or tallow colored, and in the early stages of traumatic sphacelus. This, added to the direct wound of the knee joint, rendered an operation necessary, which was performed on November 10th. Ether was given, and the limb was removed by Acting Assistant Surgeon P. R. Holly, at the lower third of the thigh, by the circular method, with a straight cut from the wound of exit to the point of the circular incision. The opera tion was well borne and there was no serious loss of blood. On examining the amputated leg, I found that the ball had com minuted the patella and passed through the femur, entering at the outer margin of the inner condyle and dividing the popliteal artery. The popliteal space contained a large quantity of coagulated blood, and the ends of the vessel were surrounded by a mass of pink-colored and semi-organized clot, sufficiently firm to prevent haemorrhage. The patient s tongue was very pallid and his whole appearance anaemic. His leg soon became swollen though perfectly white, resembling a case of phlegmasia alba dolens. The skin was smooth and blanched; there was tenderness along the line of the bone and no vigorous effort at repair, the edges of the incision being pale. The discharge consisted of dark colored ill-looking pus, and the whole appearance of the stump was unfavorable; the edges gaped widely apart. On November 20th, a slight slough appeared on the posterior lip of the stump, and two days afterwards the patient had a severe chill, followed by profuse perspiration in the night and succeeded by a light cough. During the night of the 23d there was another severe chill, and the next day respiration was increased in fre quency and accompanied by pain in the right side. There was no perceptible dullness on percussion, but on auscultation it was found that inspiration was deep and a little labored, while the expiration over both lungs anteriorly was prolonged almost as in phthisis. There was no rale, but the expiratory sound seemed to indicate that the whole lung had lost some of its elasticity and returned upon itself after dilatation with apparent difficulty. Expectoration was slight, very tough and viscid; the pulse rapid and feeble; the skin relaxed. The pulse became still weaker, and the respiration more hurried until almost sighing; the nervous depression increased. The breath had the sweet sickening smell resembling the odor of fermentation, which denotes pyaemia. Death occurred at 8 A. M. on November 26, 1863. The post-mortem examination was made six hours afterwards. On opening the right pleural cavity we found the lung coated with soft greenish colored lymph, and there was an effusion amounting to six ounces of yellow pus and serum, separating into two strata, the upper serum, the lower pus, and having (under the micro scope) the usual pus corpuscles floating in a fluid with an abundance of unrecognizable debris. There seemed to be also a thin SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 293 layer of pus beneath the pleura anteriorly, giving that portion of the lung a yellowish color. The upper lobe was apparently normal; the lower lobe posteriorly was congested, dark in color, and, on division, revealed nodules of tissue of various sizes in all stages of pathological changes from acute congestion to thorough hepatization and yellow softening. The diseased spots were in dimension from the size of half an English walnut to that of a split pea, the large ones having in the center a space white or yellow in color, and probably breaking down rapidly. The outline of these solidified portions, on section, suggested the idea of embolism, since they were somewhat triangular in shape, with the base at the pleural surface and the apex at the deepest portion of the lung, giving the impression that a circumscribed area of lung nourished by a single vessel had been destroyed by its occlusion. There was no recent effusion in the left pleural cavity, but changes in the parenchyma similar to those on the right side were discovered. An examination of the vessels of the stump revealed the existence of inflammation of the artery and veins. Both the femoral artery and vein at the point of their escape from the pelvis were normal. The femoral vein at the entrance of the saphena was filled with a semi-organized clot, which extended through the saphena and femoral to a point two inches from the cut ends of these vessels, where they had been divided on the face of the stump. (See left-hand figure of PLATE XX, opposite p. 294.) These vessels, as will be seen, are now hard and firm dark-red cords, of course entirely impervious. The artery from the origin of the profunda to a point two inches from its cut termination was also reddened, and its inner coat softened and easily removable. The phlebitis, with its occlusion of the main venous trunks, accounted for the swollen and white condition of the stump, compared above to the condition known as phlegmasia alba dolens. In making this dissection it was observed that the inflammation, apparent in the artery and to some extent circumscribed (since its lower extremity yet contained the clot formed on the application of the ligature and was normal both in color and firmness, as well as that which occluded the veins), had extended through the coats of these vessels from without. No pus was found in the veins, and no evidence of inflammation except the marked redness of the coats and the firm and clotted coagulation of the blood within." Wet preparations of the femoral and profunda arteries (Spec. 2246), the femoral and saphena veins (Spec. 3991), and the pop liteal artery and vein (Spec. 2247), saved from the stump, were contributed to the Museum by Assistant Surgeon Thomson. Drawings of the specimens 3991 and 2246 were prepared by Hospital Steward Stauch, and are represented, the former on the left and the latter on the right side of PLATE XX, opposite p. 294. CASE 473. Corporal L. C. Griffin, Co. D, 8th North Carolina, was wounded in the left knee by a piece of shell, at Winchester, July 19, 1864. He was conveyed to hospital at Richmond, where the limb was amputated at the lower third of the femur by Dr. Joseph Jones. The patient died in February, 1865. The specimen, a portion of the stump four and a half inches long, was contributed to the Museum by Acting Assistant Surgeon F. Schafhirt. It constitutes number 3141 of the Surgical Section, and exhibits a prodigious involucrum. The bone is exceedingly hyperostosed, measuring three and a half inches in diameter at the extremity. The extremity and central portions are carious, and a slight sequestrum is contained. A representa tion of the specimen will be found in FIG. 4 of PLATE LXX, opposite p. 242. TABLE XXXVI. Summary of Six Hundred and Seventy-six Cases of Intermediary Amputations in the Lower Third of the Femur for Shot Fracture. [ Recoveries, 1217 ; Deaths, 218676.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Anderson, J., Serg t, I, July 3, Left; ant. post, flap; slough.; nee. 13 Boebel, H., Lieut.-Col., July 1, Right. Disch d May 28, 1864. 54th New York, age 32. 8, 63. Aug. 2, flap, mid. third. Surg. 26th Wisconsin. 4, 63. C.W. Hagen, 54th N.Y. Haem.; 14 Bonhomme, E., Pt., E, April 10, Left (April 10, amp.leg.; slough.); necro. bone removed. Disch d 73d Col d Troops, age 24, 65. circ. Surg. F. E. Piquette, 86th Aug. 25, 1864. Spec. 4358. 27. C. T. Disch d June 17, 1865. o Askey, J., Pt., F, 200th Mar. 25, Right ; circ. Surg. W. G. Hunter, Died June 3, 1867 ; marasmus. Pennsylvania, age 18. 28, 65. 211th Penn. April 11, hsem.; 15 Bosworth, C. W., Pt., I, May 19, Left; flap. Surg. D. W. Bliss, lig. fern. art. Disch d July 28, 1st Maine H vy Art., 24, 64. U. S.V. Nee. Disch d April 10, 1865. Spec. 3987. age 23. 1865. Jan. 9, 68, flap, mid. third. 3 Austin, G. II., Pt., D, April 29, Left (erysipelas). A. A. Surg. R. 16 Brown, J. T., Corp l, C, June 27, Left (gang.); circ. A. Surg.C.W. 106th New York. May 22, W. Hazlett. Hsem.; lig. femoral 10th Illinois, age 21. J y2, 64. Burke, 46th Penn. Gangrene; 1863. art.; rec d. Disch d Aug. 23, 63. end of bone rem d. Mustered 4 Bassett, W., Pt., E, 4th June 27, Right ; flap. Disch d January 7, out August 31, 1864. New Jersey, age 20. J yl, 62. 1863. 17 Buehler, J., Pt., C, 41st May 2, Right thigh ; circular operation. 5 Bathurst, J. B., Pt., D, June 4, Left ; circ. A. A. Surg. J. C. Nel New York. 8, 63. Disch d Nov. 28,1864. 45th Penn., age 19. 16, 64. son. June 28, nee. bone rem d. 18 Buhner. B., Pt., A, 71st Sept. 17, Right. Discharged Dec. 12, 62. Disch d Nov. 20. 65. Spec. 2584. Pennsylvania. 2(1, 62. 6 Bailors, P., Musician, D, April 1, Left ; circ. Surg. J. McL. Hay- 19 Bflrle, J., Corp l, K, 61st Aug. 25, Right; double flap. Surg. W. 74th Pennsylvania. 6, 62. ward, 12th Mass. Erysipelas. New York, age 52. Sept. 15, O Meagher, 3?th N.Y. Re-amp. Disch d Aug. 23, 1862. 1864. upper third. Disch d May 30, 7 Becker, A., Pt., F, 3d May 10, Right ; flap. Drs. Fellerer and 1865. Died July 16, 18C8. Missouri. 19, 61. Comstock, St. Louis. Disch d. 20 Bunvell, T. J., Pt., H, Mar. 21, Right; circ. Surg. A. F. Marsh, 8 Beers, L. R., Corp l, E, Sept. 29, Right (gangrenous slough.); circ. 81st Ohio, age 23. A p. 2, 65. 5tith 111. Disch d Sept. 11, 65. 188th Penn., age 1!>. Oc.29, 64. A. Surg. S. H. Orton, U. S. A. 21 Butler, C. H., Pt., H, 2d , Oct. 19, Right; flap. A.Surg. J. J. Meigs, Gang. Disch d Nov. 9, 1865. Conn. H. Art y, age 20. 22. 64. llth Vt. Disch d Aug. 17, 65. Spec. 3682. 22 Carlin, J., Pt., I, 3d Vt,, May 5, Left ; flap. Surg. E. Phillips, 6th 9 Bennett, P. L..Pt.,F, 1st Aug. 23, Left ; lat. flap. Surg. N. R. Mose- age 20. 9, 64. Vt. M.O.March 18, 18ti5. Maine Cavalry, age 24. 30, 04. ley,TJ. S.V. Nee. Disch d Aug. 23 Carpenter, H., Pt., A, May 3, Left. Confed. surgeon. Disch d 12, 1865. 121st N. York, age 24. 6, 63. June 15, 1864. 10 Beverlin, G., Pt., B, llth \ June 17, Right ; circ. Surg. L. R. Stone, 24 Casebolt, T. D., Pt., E, April 6, Left; flap. Disch d Oct. 19, 62. West Virginia. |J yo, 64. U. S. V. M. O. Nov. 11, 1864. 3d Iowa, age 21. 9, 62. 11 Biddle, W. B., Pt., K, Oct. 19, Left; circ. A.A.Surg.B.B. Miles. 25 Causdell, J. A.. Corp l, B, Dec. 15, Left; flap. A. A. Surg. J. H. Mc- 138th Penn., age 27. 27, 64. Exfol. rem d. Disch d July 18, 10th Minnesota, age 27. 19, 64. Intire. Slough g. Disch d May 1865. Specs. 109, 3425. 29, 1865. 12 Bloomer, S., Serg t, B, Sept. 17, Right. A. Surg. E. G. Pugsley, | 26 Claden, M., Pt., I, 108th May 14, Right ; circ. A.Surg.J.M.Brown, 1st Minnesota, age 24. 20, 62. 1st Minn. Disch d Dec. 6, 62. Ohio, age 31. 22, 64. U. S. A. Disch d May 11, 65. 294 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITAUY DESCRIPTION", AND AGE. DATES. OPEHATIONS, OPERATOBS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 27 Clarey, P., Pt., I, 24th Michigan, age 18. July 2, 10, 63. Left (mortification); circ. Surg. A. J. Ward, 2d Wis. Rem v d 63 Gardener, J., Co rp l, I, 72d Penn., age 21. Sept. 17, 21, 62. Left; flap. Surg. M. Rizer, 72d Penn. Gang. Disch d August nee. bone ; gang. Disch d Feb. 4. 1863. 26, 1864. 64 Gardner, J., Pt., , 73d Aug. 30, Right. Ass t Surg. B. Howard, 28 29 Clark, S. A., Pt., E, 1st Sharpshooters. Cleggett, T., Pt.,D, 76th Colored Troops, age 45. Aug. 30, Se.22, 62 April 2, 24, 65. Right ; flap. Surg. D. W. Bliss, U. S. V. Disch d Jan. 29. 1863. Right ; ant. post, skin flap ; circ. of muse. Surg. F. E. Piquette, 65 66 Ohio. Gayman, S., Pt., B, 69th Indiana. George, E. L., Serg t, G, Sep.5, 62. Aug. 30, Sep.:!, 62. April 10, U. S. A. Left; flap. A. Surg. W.B.Witt, C9th Ind. Disch d April 29, 63. Right ; circ. Surg.F. E. Piquette, 86th C. T. Hffirn.; lig. femoral 73d Col. Troops.age 30. 23, 65. 86th O. T. Disch d June 17, 65. art. Disch d July 22, 1865. 67 Gibson, G. S., Pt., H, Oct. 12, Right (necrosis: gang.); circ. A. 30 Cliff, H., Serg t, F, 76th July 1, Left ; circ. Disch d Nov. 28, 63. 10th Missouri, age 19. No.10, 64. A. Surg. J. J. Bell. Disch d New York, age 34. 5, 63. June 1(), 1865. 31 Cocheran, F., Pt., G, 9th July 9, Right : circ. Fort Monroe, Sept. 68 Classic, J., Pt., B, 63d June 3, Left (June 3, amp. leg; gang.); Louisiana, age 1 J. 14, 64. 20, 1864. New York, age 22. 20, 64. bilat. flap. Surg. N. R. Moseley, 32 Cochran, P., Serg t, A, Dec. 1 6, Left; ant. post. flap. Ass t Surg. U. S. V. Necrosed bone rem d. 19th Tennessee, age 25. 29, 64. J. H. Cruthers, 88th Ohio. Pro Disch d Aug. 15, C5. Died Nov. vost Marshal May 6, 1865. 12, 67. Spec. 3100. 33 Cooley, G. W., Corp l, E, "5th Ohio. May 2, 12. 63. Right. May 27, a mp. mid. third. Disch d Jan. 22, 1864. 69 Golden, P., Pt., H, 28th Massachusetts, age 38. Aug. 30, Sep.9, 62. Left ; dou. flap. A. A. Surg. J. O. French. June 30, 1863, re-amp. 14 Corcoran, P..Pt..C, 100th July 18, Right; flap. Disch d Aug. 25, mid. third. Disch d Jan. 5, 64. New York. 21. 63. 1864. Died Jan. 28, 1868. Spec. 147. 35 Crawford, jt.Jf., Corp l, Mav 16, Left ; circ. A. Surg. H. E. Good 70 Green, H., Pt., K, 17th May 23, Right ; flap. Surg. D. W. Bliss, G, 33d Tenn., age 28. 19," 64. man, U. S. V. Provost Marshal Maine, age 24. Je. 10, 64. U. S. V. July 4, haem. Disch d October 21, 1864. Nov. 21,1864. Spec. 2498. 36 Critse, 1 . L., Serg t, C, Aug. 21, Right. Surg. Edwards, C.S. A. 71 Greene, A. H., Serg t, B, June 27, Left. Surg. A. D. Palmer, 9th 21st Georgia, age 44. 29, 64. Prison Nov. 22, 1864. 12th New York. 30, 62. Maine. Disch d Feb. 24, 1863. 37 Curie, H., Pt., F, 7th Aug. 16, Left (August 17, amp. leg); circ. 72 Grubbs, H. B., Pt., Car Sept. 14, Right. Surg. Roberson.C.S.A. Connecticut. 19, 64. Disch d June 10, 1865. ter s Battery. 18, 62. FurloughedSept.21, 1864. 38 Curren, T. S., Pt., E, 7th Aug. 2G, Right ; flap. Surgs. Gleaves, Mc 73 Halderman, C., Pt., H, July 2, Right; flap. Surg. H. Palmer, Ohio. Sept. 1, Donald, and Searout, C. S. A. llth Penn., age 28. 25, 63. U. S. V. Rem d bone. Disch d 1861. Disch d July 17, 1862. October 6, 1863. 39 Darling. R. A., Pt., H, May 31, Right ; flap. Surg. D. Prince, U. 74 Hamilton, J.,Pt.,C, 45th Sept. 14, Right. Disch d Dec. 30, 1862. 67th New York. Je. 3, 62. S. V. Hiem.; lig. fern, artery. Pennsylvania. 17, 62. Disch d August 9, 1862. 75 Hand, C., Pt., B, 15th N. May 12, Right ; circ. Disch d June 17, ; Darraugh,J.C..Lieut.,D, Oct. 1, Right ; lat. flap. Surg. A. Nash, Jersey, age 33. 16, 64. 1865. 9th Mich. Cav., age ]!). 17, 64. 9th Mich. Cav. Mustered out. 76 Hannon, M., Pt., K, 76th Sept. 14, Right ; circ. Gang.; bone rem d. 41 Davis, L., Pt., A,9th W. Aug. 26, Left ; circ. A. A. Surg. T. J. Du- New York, age 24. 18, 62. Sept. 12, 63. re-amp., circ , mid. Virginia, age 18. 29, 64. nott. Sept. 3, hsem. Disch d third ;baem. Disch d June24, 64. Oct. 26, 65. Spe.cs. 1423, ] 072. Died June 22, 1870. Spec. 4324. 42 Debold.C.A., Pt., H,21st July 24, Left; circ. A. A. Surg. W. S. 77 Barris, C. W., Pt., G, July 3, Left: circ. Surg. Clark, C.S. A. N. Y. Cavalry, age 21. 28, 64. Adams. Disch d Dec. 17, 1864. llth Miss., age 20. 15, 63. Necrosed bone rem d. Exch d 43 Deery, P., Pt., C, 170th Aug. 26, Left; ant. post. flap. Surg. A. Nov. 12, 1863. New York, age 55. Sep.7, 64. Heger, U. S. A. Disch d Aug. 78 Hart, B. B., Scout, H, Aug. 28, Right, Surg.A.Wynkoop,U.S.V. 15, 1865. 24th New York, age 33. Se.16, 62. Disch d Nov. 15, 1863. 44 De La Barr, G., Pt., C, Mar. 19, Left; double flap. Surg. D. S. 79 Hawkins, W. W., Serg t, May 5, Right (May 6, amp. leg, Teale s 13th Mich., age 16. 27, 65. Young, 21st Ohio. Disch d Oct. I, 93d N. York, age 20. 16, 64. method). April, 1865, carious 21, 1865. bone rem d. Disch d July 12, 45 Devine, J., Lieut., F,32d April 8, Left ; flap. Disch d August 30, 1865. Spec. 4497. Iowa, age 43. 12, 64. 1864. 80 Hayes, J. W., Corp l, D, May 9, Rght; circ. A. A. Surg. T. W, 46 Dil!ey,J.L., Musician, Q, April 2, Right : circ. Surg. J. S. Taylor, 60th Ohio, age 19. 27, 64. Carroll. Disch d April 17, 65. 62d Ohio, age 24. 6, 65. 23d 111. Disch d July 15, 1865. 81 Henning, B. D., Lieut., May 9, Right. Surg. N. F. Graham, 12th 47 Dillon, G., Pt., F, 40th Sept. 1, Left. Disch d March 14, 1863. F,3dPenn. Res., age 29. 14, 64. Ohio. M. O. Sept. 26, 1864. New York. 10, 62. Died May 25, 1870. 82 Henderson, J., Serg t, A, May 10, Right : circ. A. A. Surg. F.G.H. 48 Dimmick, L. L., Pt., G, Oct. 8, Left ; circ. A. A. Surg. J. Sloan. 126th N. York, age 29. 30, 64. Bradford. Disch d Aug. 1, 65. 10th Wisconsin. 24, 62. Rem d end of bone. Disch d 83 Herron, J., Pt., I, 8th Mar. 31, Right; ant. post. flap. A. A. Surg. April 16, 1863. Penn. Cav., age 18. Ap.5, 65. F. H. Hill. Disch d Sept. 30, 65. 49 Dunlap.R.K., Pt., I.4th Mav 3, . Surgeons Stroth and Saw Spec. 4044. Virginia. 7, 63. yer, C. S. A. Recovered. 84 Hess, R., Pt., G, 153d July 1, Left ; ant. post. flap. Mustered 50 Ellis, A., Pt., F, 114th Oct. 19, Left. A. A. Surg. E. G. Waters. Pennsylvania. 5, 63. out July 24. 1863. New York, age 21. No. 7, 64. Disch d May 31, 6."). Spec. 3423. 85 Hewitt, W. E., Pt., I, 8th Oct. 3, Left. Surg. J. E. Murta, 8th Wis. 51 Ellis.H.H..Corp l,I,16th May 3, Left; circ. A. A. Surg. J. E. Wisconsin. 8, 62. Disch d Nov. 24, 1862. New York, age 23. 13, 63. Smith. Haem.; lig. feui. artery. 86 Hodgman, O., Pt., K, 1st Sept. 5, Right; flap. A. A. Surg. C. C. Removed exfol. bone. Disch d Wis. Cav., age 19. 25, 64. Joslin. Disch d July 4, 1865. from hospital June 6, 64. Specs. 87 Hoon, E. L., Pt., H, 102d Sept. 19, Right : lat. flap. A. A. Surg.W. 1852. 1853. Pennsylvania, age 23. 28, 64. S. Adams. Tub. seq. removed. 52 Emigh, B. F., Lieut., F, June 17, Left ; circ. A. A. Surg. F. H.Col- Disch d Mar. 18, 65. Spec. 3860. 2dPenn. H vy Artil ry. 25, 64. ton. Sloughing : seq. extracted. 88 Hope. G. W., Serg t, A, Nov. 24, Right; circ. flap. A. Surg. A. age 24. Disch d May 10, 65. Spec. 3598. 6th New York Cavalry, De.3, 63. Ingram, U. S. A. Mar. 4, 1864, 53 Emmert, G. S..Corp l,H, Dec. 7, Right: flap. Surg. P. Harvey, age 30. rem d nee. end. Duty Nov. 11, 64. :<7th Illinois, age 23. 14, 62. 19th Iowa. Bonerem d. Disch d. 89 Horner, D. J., Pt. C,142d Dec. 13, Left. Subsequent operat n. Dis 54 Everett, D., Pt., L, 15th June 15, Right (mortification; 17th, amp. Pennsylvania. 21, 62. charged Feb. 19, 1864. Kansas Cav., age 16. 20, 64. leg; gangrene); ant. post. flap. 90 Hosmer, O. M., Pt., F, Sept. 19. Left. A. A. Surg. E. G. Waters. Disch d Aug. 19, 1864. 106th N. Y., age 20. Oc.l6. 64. Disch d May 3(). 65. Spc.3424. 55 Falconer, D. G., Lieut., Sept. 17, Right : ant. post. flap. A. Surg. 91 Honsley, H., Cook. F, April 2, Right : ant. post, flap : circ. of mus. B, 79th N. Y., age 25. Oct. 9. 62. J. B. Brinton, U. S. A. V. R. C. 33d Wis., age 20. 11, 65. (amp. left leg). Surg. F. E. Pi July 20, 1863. Spec. 453. quette, 86th C. T. Recovered. 56 Farthing, G. W., Pt., D, .Iiilv 2, Left. Recovery. 92 Howell, A.,Corp l, K.lst April 1, Right: flap, skin ; circ. muscles 5th Tennessee. 7, r 63. N. Y. Cavalry, age 21. 7, 64. A. A. Surg. A. R. Gray. Slough. 57 Fish, R. M., Pt., I, 24th July 1, Right ; circ. Nov. 4, 2J inches end Disch d June 20, 64. Spec. 3947. Michigan, age 22. 6, 63. of bone rem d; erysip. Disch d 93 1 Huber, J., Pt., A, 1st Oct. 8, Left; circ.; gangrene. Disch d April 19, 65. Specs. 1589, 2624. Kv. Battery, age 25. 12, 62. June 23. 1864. 58 Fitzmorris,E.,Pt..K,12th Aug. 30, Right: circ. Oct. , seq. rem d. 94 Huffman, F. M., Pt., D, Aug. 29, Loft; circ. A. A. Snrg. H. C. New York, age 24. Sep.8, 62. Mustered out. Spec. 1051. 3d W.Virginia, age 26. Sept. 15, Ilcilncr. Ilsem. Diseh d Feb. 59 Fletcher, D. C., Serg t, Sept. 1, Right; circ. Surg. H. Bryant, 1862. 13, 1863. Spec. 120. H, 40th New York. 18, 63. IT. S. V. Recovery. 95 Hutchings, S., Lieut., G, May 10, Right; double flap. Surg. G. E. 60 Frum, P., Corp l, F, 3d Aug. 29, Left (Aug. 29, amp. leg; gang.); 5th Maine, age 22. 18, 64. Brickett, 21st Maine. M. O. July West Virginia, age 28. So. 21, 62. gang. Aug. 6, 63, seq. rem d. 27, 1864. Disch d July 7, 64. Spec. 1665. 96 Johnson, G. H., Pt., F, Feb. 20, Left (gangrene); circ. Surg. 61 Fuller, P., Serg t, G. 1st Aug. 5, Right. Surg. O. B. Payne, 10th 8th Colored Troops. 25, 64. Holmes, C. S. A. Disch d Oct. Missouri H. G., age 41. 19, 61. Mo. Two subsequent amput ns. 3, 1865. Disch d Oct. 25, 1865. 97 Jones, J. P., Pt., K, 52d July 1, Right. Gangrene. Exchanged 62 Gallana, P., Pt., C, llth April 1, Left (gang.); circ. A. A. Surg. N. Carolina, age 21. 14, 63. March 17, 1864. Penn. Cav., age 35. 7, 65. Z. P. Dennler. M. O. Jan. 17, 98 Joy, A., Serg t, C, 24th July 1, Left ; circ. Surg. ,1. II. Beech, 1866. Spec. 4045. Michigan. 7, fo. 24th Mich. Disch d Oct. 18, 63. "STANFORD (R. L.), Bromine in Hospital Gangrene, in American Medical Times, 1863, Vol. VII, p. 24. PLATE XX. FEMORAL ARTERY AND FEMORAL VEIN AFTER AMPUTATION SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 295 No. NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPKUATOUB, RESULT. NO. NAMK, MILITARY DESCKUTION, AND AGE DATES. OPERATIONS, OI-EUATOUB, RESULT. 99 Keefer, C., Pt., E, Kith Aug. 30, Left ; flap. Surg. J. C. Dorr, U. 136 JUilJican, G. F., Corp l, Aug. 19, Right ; ant. post. flap. Surg. Mich., age 46. Sept. 12, S. V. Disch d October 5, 1865. H, 26th Miss., age 35. 29, 64. Clark.C.S.A. Trans. Nov. 2, 65. 1862. Spec. 4546. 137 Minehan, A., Corp l, F, Aug. 21, Right ; circ. Surg.O. A. JiuUon, 100 Kemp, S. P., Pt., 1, 7th Aug. 9, Right ; double flap. A. Surg. T. 27th Mich., age 31. Se. 10, 64 U. S. V. Haeni.; lig. fem. artery. Ohio. i4,m G. Mackenzie, U. S. A. Disch d Oct. 19, re-amp. Disch d May Oct. 20, 1862. Specs. 51, 4477. 19, 1865. Spec. 3272. 101 Kent, W. E., Pt., C, Oth Oct. 1, Left (pyaem. symptoms); flap. A. 138 Mitchell, W..Pt., A, 122d Sept, 19, Left, Teale s method. A. Surg. J. Ohio Cavalry, age 22. 15, 64. Surg. P. C. Davis, U. S. A. Ohio, age 21. 23, 64. G. Thompson, 77th N. Y. Bony Disch d May 4, 1865. tumor, and seq. rem d. Disch d 102 Krider, G. C., Lieut., C, Mar. 25, Left ; circ. Surg. J. H. Kimball, Jan. 19, 1865. 49th N. C., age 38. 28, 65. 31st Me. Released June 15, 65. 139 Moore, J. L., Lieut., K, June 27. Left (aneurism); dou. flap. Surg. 103 Kuhns, J.W.,Pt.,C, llth Dec. 13, Left; circ. Disch d Nov. 14, 63. 10th Penn. Res., age 26. J y24, 62 R. B. Bontecou, U. S.V. Hajm.; Pennsylvania. 16, 62. lig.fem.art. Res d Jan. 21 , 63. 104 Kuoni, 0., Serg t, C, 9th April 30, Right; flap. Disch d March 16, 140 Morton, W. G., Pt., F, Nov. 27, Right ; flap. Surg. A. N. Dough Wisconsin. M vlO, 64. 1865. 4th Ohio, age 20. Dec. 3, erty, U. S. V. Disch d July 8, 105 Larck, J., Pt,, A, 5th W. July 24, Left; lateral flap. Disch d Jan. 1863. 1864. Spec. 182. 106 Virginia, age 22. Large.W.G., Pt.,K, 90th 27, 64. April 29, 10, 1865. Right ; flap. Surg. A. \V. Whit 141 Mulligan, P.,Pt.,A,125th New York, age 44. June 17, J yl3, 64 Left ; circ. Ass t Surg. A. Ingram, U. S. A. Necrosed bone rem d. Pennsylvania, age 21. May 15, ney, 13th Mass. Mustered out Spec. 2866. 1863. Dec. 13, 1864. 142 Musselman, W., Pt., H, Sept. 19, Left ; circ. Surg. Blair, C.S.A. 107 Lauer, J. S., Pt., B, 5th New Jersey. May 3, 7, 63. Left ; circ. Surg. J. Dwindle, 106th Peun. Disch d Mar. 28. 64. 143 49th Virginia, age 40. Myers, G., Pt., 1, 24th N. Oc.25, 64 Mar. 31, To Fort McHenry Feb. 10, 1865. Left ; circ. Dr. J. H. Thompson. 108 Leonard, J., Pt., E, 2d July 2, Left ; circ. Nov. 7, seven inches York, age 19. A p. 6, 65 Disch d July 6, 65. Spec. 4063. N. Y. S. M., age 30. 5, 63. end of bone rem d. Sent to In 144 Nash, J., Pt., G, 143d May 22, Right; flap. April 9, 1665, seq. sane Asylum June 6, 64. Spec. Penn., age 21. 28, 64. removed. Disch d June 22, 65. 2152. Spec. 144. 109 Lewis, J., Pt., K, 47th April 3, Right (gang.); ant. post, skin flap; 145 Peabody. A., Pt., G, 43d Feb. 21, Lett; flap. A. A. Surg. J. F. Colored Troops, age 20. 18, 65. circ. mus. Surg. F. E. Piquette, Missouri. March 15, Bruner. Disch d June 30, 1865. 86th C. T. Disch d July 22/65. 1865. 110 Little, T., Pt., I, 19th July 2, Right; lateral flap. Discharged 146 Perrott, G.W., Corp l.G, May 3, Right ; circular. Confed. surgeon. Maine, age 28. 6, 63. August 1, 1864. 21st New Jersey. 10, 63. Nee. Dec. 3, re-amp. Dr. Olcott, 111 Lothrop, J. H., Pt., P, Sept, 19, Left ; circ. Confed. surgeon. Re- Jersey City. Recovery. Kith Infantry, age 21. 24, 63. amput n middle third. Disch d 147 Fetters, T. T., Capt., B, April 6, Left; ant. post. flap. Released Nov. 18, 1864. 34th Virginia, age 33. 11, 65. August 10, 1865. 112 Lowe, II. B., Serg t, F, May 3, Left. Ass t Surg. J. S. Ewing, 148 Phillips, W. M., Corp l, Oct. 19, Right ; circ. Surg. R. W. Pease, 5th Wisconsin, age 34. 6, 63. 5th Wis. Disch d June 21, 64. D, 121st N.Y., age 28. Nov. 18, U. S. V. Haem. Disch d Jan. 113 Lynch, J , Pt,, C, 47th July 30, Right; circ. A. A. Surg. S. J. 1864. 12, 1865. New York, age 30. Au. 3, 64. Holley. Necrosed bone rem d. 149 Pitts, E. W., Pt., B, 69th Jan. 30, Left. Surg. J. Dwyer, 69th N.Y. Disch d May 25, 1865. New York, age 19. Feb.2, 63 Disch d Jan. 12, 1664. 114 Maedel, C., Pt.,C,9th 111. Oct. 3, Left ; flap. Surg. E. Guelick, 9th 150 Pixley, P., Pt., A, 55th May 2, Left ; circ. Disch d December 9, 13, 62. 111. Disch d Sept. 22, 1863. Ohio. 7, 63. 1864. 115 Maron, P., Pt., E, 2d May 3, Right ; circ. Disch d August 21, 151 Place, S. W., Pt., G, 1st Oct. 19, Left ; ant. post. flap. A. A. Surg. Mass., age 27. 9, 63. 1863. Rhode Island Artil ry, Nov. 10, B. B. Miles. Exfol n removed. 116 Martz, C., Pt., G, 64th Mar. 25, Right (mort n); circ.; nee. Sept. age 28. 1864. Disch d May 7, 65. Spec. 106. New York, age 26. 30, 65. 26, re-amp, mid. third A. Surg. 152 Powell, J , Pt,, B, 29th April 30, Left ; circ. Feb. 28, 65, necrosed J. H. Armsby, U.S. V. Disch d Iowa, age 21. May 4, bone came away. Disch d May Oct. 4, 65. Specs. 2853, 3195. 1864. 22, 1865. Spec. 228. 117 Matthews, I. W., Pt., K, July 24, Right. Ass t Surg. L. D. Miller, 153 Priest, C., Pt., H, 8th N. Oct. 27, Right; circ. Disch d April 9, 23d Ohio, age 24. Au. 4, 64. IstN. J. Disch d Aug. 18, 1865. Hampshire, age 20. Nov. 26, 1863. 118 Maurer.A.J., Pt., B, 53d May 2, Left; flap. Disch d July 27, 64. 1862. Ohio. Je. 1, 63. 154 Pullen, W. H., Serg t, I, July 2, Left; flap. Disch d September 119 Mayes, S., Pt., F, 1st Oct. 1, Right; flap. A. Surg. P. C.Davis, 5th Michigan, age 24. 7, fo. 14, 1864. Penn. Cavalry, age 20. 12, 64. U.S.A. Disch d May 6, 1865. 155 Rial, J., Pt., B, 4th Ohio, June 3, Right : ant. post. flap. A. Surg. 120 McAllister, W. H. H., Dec. 13, Right; circ. A. A. Surg. C. W. age 22. 15, 64. W. Thomson, U. S. A. Haem. Serg t, G, 4th Vermont, 23, 62. Filmore. Bone extracted. Dis. Disch d July 8, 1865. Specs. age 27. Sept. 19, 1864. Spec. 200. 3562, 3570. 121 McCombs,S.,Pt., A, 28th April 6, Right ; double flap. Surg. E. C. 156 Rice, A. D., Pt., F, 45th Sept, 17, Left; circ. A. Surg. J. A. Bige- Illinois, nge 18. -, 62. Franklin, U. S. V. Discharged Penn., age 23. Oct. 15, low, 8th Conn. Erysip. Disch d April 7, 1863. 1862. April 2, 1863. 122 McConky.A., Pt., D,63d May 5, Left ; lat. flap. Surg. R. B. Bonte- 157 Roberts, C., Pt,, E, 1st April 28, Left ; flap. Surg. N. Gay, U.S.V. Pennsylvania, age 48. 14, 64. cou, U.S.V. Disch d May 19, 65. W. Tenn. Cavalry. Myl2, 63. Discharged. Died May 15, 73. Spec. 3066. 158 Koberts. C. W., Pt,, B, June 4, Left, Surg. Craft, C. S. A. 123 McCormick, M., Serg t, Sept. 19, Left; flap. A. A. Surg. J. R. 12th Mississippi. 7, 64. Disch d Jan. 15, 1865. F, 2d Cavalry, age 36. 26, 64. Uhler. Disch d June 15, 1865. 159 Robinson, E. P., Pt., H, May 3, Left. Surg. G. P. Oliver, lllth 124 McCray,A.F.,"Pt., E,6th Aug. 16, Left; flap. A. Surg. W. H. II. I2Cd Penn., age 18. 8, 63. Penn. Nee. bone rem d. M. O. Missouri Cavalry. 19, 62. Cundiff, 2dMo.S.M.C. Disch d. 160 Robinson, J. C., Brig. May 8, Left; circ. Surg.B.Norris.U.S.A. 125 McGarraghan, H..Pt.,E, De.31/62, Right; circ. A. A. Surg. J. M. General U. S. V. 15/64. Retired May 6, 69. Spec. 2268. 24th Ohio, age 20. Jan.4, 63. Henderson. Disch d May 14/63. 161 Robisho, J., Pt., D, 76th April 9, Right (sloug h g); dtmb. hit. flap. 126 McGinley, E., Corp l, I, Nov. 3, Right (Nov. 11, hffim.); circular. Illinois, age 23. M y8, 65. A. Surg. A. Hartsuff, U. S. A. 23d Wisconsin, age 30. 13, 63. Ass t Snrg. S. McClellan, 13th Disch d Aug. 9, 1865. Re-amp. Conn. Disch d March 10, 64. 162 Rose. P. B., Ass t Surg. Oct. 27, Left; circ. Surg. D. W. Bliss, 127 MeGlone, H. W., Pt., F, May 3, Right; circ. Surg. II. S. Potter, 5th Michigan, age 30. Nov.6, 64. U. S. V. Disch d Mar. 28, 1865. 55th Ohio. 12, 63. 105th 111. Disch d Aug. 5, 63. 163 Russell. Z. B., Serg t, B, Sept. 14, Right ; flap. Discharged. 128 McGrognn, J.,Pt., H,62d July 1, Left; flap. Disch d September 7th Wisconsin. 17, 62. Pennsylvania. 5, fe. 15, 1862. 164 Sansom, S. B., Pt., I, May 3, Right; sloughing. Rem d end of 129 Me Mullen, H. 1\,~P\.,G, July 9, Left; circ. Surg. Todd, 6th 14th Indiana. 15, V 63. bone. Disch d Feb. 11. 1864. 61st Georgia, age 23. 25, 64. Va. (C. S. A.). Exch d. Specs. 165 Schondan, J., Pt.,IC,95th July 1, Left ; flap. Surg. G. M. Ramsay, 2692. 3871. New York. 15, 63. 95th N.Y. Bone rem d. Disch d 130 McMullen, R. J., Pt., I, May 3, (May 4, amput n knee joint.) Feb. 9, 1864. 4th Georgia, age 20. 23, 63. Surg. Philpot, C.S.A. Htem.; 166 Schrabaskie, M., Pt., B, April 1, Right; circ. A. A. Surg. D. L. lig. fern. art. Furl d Aug. 4, 63. 183d Penn., age 46. 8, 65. Haight. Seq. rem d. June7, 66, 131 McWhinnie, J., Serg t, May 3, Left ; circ. Surg. 11. E.Goodman, nee. bone rem d : muse. art. lig. A, 20th Conn., ago 24. 26, 63. 28th Penn. Necro. bone rem d. Disch d Oct. 15/66. Specs. 2452, Disoh d May 4, 64. Spec. 1284. 14H4, 4956. 132 Mickle, C., Pt., E, 83d July 1, Right. Re-amp, by Dr. Waters. 167 Scrotjrjs, A., Pt., C, 48th Sept. 17, Right. (Dec. 10, end bone rom d.) Penn., age 19. So, 62. April, 63, seq. rem d. Disch d North Carolina, nge 19. 20, 62. Disch d from hosp l Feb. 9/63. June 27, 1863. 168 Sedgewick, P., Pt., E, July 2, Right ; circ. Surg. W. S. Cooper, 133 Miller, C., Pt., B, 8th April 6, . Surg. E.C. Franklin.U.S.V. 125th N. York, age 23. 6, 63. 125th N. York. Bone extracted. Illinois. -, 62. Hastn. Recovery. Disch d Sept. , 1864. 134 Milltr, G.W., Pt., I, 61st July 1, Right ; flap, skin : circ. muscles. 169 Seiders, J. Y., Serg t, K, July 1, Left (gang.). A. Surg.C. A. Ham Georgia, age 19. 15, 63. A. Surg. R. F. Weir, U. S. A. 151st Penn., age 30. 8, 63. ilton, 76th N. Y. Recovery. Necrosis. Paroled Nov. 12, 63. 170 Shackelford, F. W., Ft., De.31, 62, Right ; flap. Disch d April 11, Spec. 3908. E, 15th Ohio. Ja.26, 63. 1863. 135 Miller, J., Pt., 1st Ky. Nov. 30, Right (gang.; caries); circ. A. A. 171 Shea, J. A., Pt., 1st Me. Oct. 19, Right; nnt. post. flap. A. A. Surg. Battery, age 22. De.7, 64. Surg. S. T. Williams. Disch d Battery, age 21. 25, 64. E. G. Waters. Disch d April 3, March 11,1865. 1865. Spec. 3427. 296 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 172 Shea, J., Pt, C, 5th N. Oct. 11, Left. Amp. near ankle j t ; tissue 206 Ware. J. W., Pt, H, 2d July 1, ; circ. Furloughed October York Cavalry, age M. 16, G3. unhealthy; re-amp., flap. Surf. D. W. Bliss, I*. S. V. Disch d 207 Mississippi, age 23. Waters, A. S., Pt., E, 9, 63. July 1, 7, 1863. Right; circ.: sloughing; exfol. July 27, ti4. Spec. 1736. 157th N. York, age 36. 6, 63. Disch d June 12, 1865. 173 Shepherd, R.,Pt..F, 89th May 18, Left ; nap. A. Surg. J. A. Meeks, 208 Weaver, L.. Pt, K, 153d July 1, Left ; circ.; sloughing. Mustered *" Indiana, age 21. 21, 64. 8Hth Ind. Disch d Mar. 17/65. Pennsylvania, age 20. 7, 63. out May 16. 1864. 174 Sheward, H., Pt.,F, 65th Oct. 19, Right (gang.): flap. A. A. Surg. 209 Weir, T. P., Pt . B, 5th Sept. 20. Right : ant. post. flap. Recovery. New York, age 20. No. 1/64. C.1I. Jones. Disch d Apr. 22/65. Georgia. 23, (13. 175 Shonio. A. B.. 1 t., G, Cth May 4, Left ; circ. Diseh d Oct. 17, 1863. 210 Welch, J., Pt., D, 13th Nov. 7, Right. Surg. Ferraer, C. S. A. Vermont. 9, 63. Arkansas. 24, 61. Recovery. 17li Simeon, E. A., Serg t, Oct. 19. Left (Oct. 21, amp. leg); ant. post. 211 Werneck, F. J., Capt., Aug. 29, Right; flap. A. A. Surg. W. B. B, 30th Mass., age 34. 26, 64. flap. A. A. Surg. G. W. Fay D. 54th New York. Se. 3/62. Crain. To V. R. C. Necrosed ; re-amput s. Disch d 212 Whitehead, W. J., S g t. May 5, Left. Retired Feb. 20, 1865. Oct. 16, 1865. C. 44th Georgia. 8, 64. 177 Sisson, J., Pt., H, 3th N. June 16, Kight ; circ. Disch d May 30, 65. 213 Wickline, J.. Serg t, D, May 5, Left ; ant. post. flap. Surg. E. Hampshire, age 17. 21, 64. 63d Penn., age 25. 15, "64. Bentley, U. S.V. Disch d June 178 Sladd, A. A., 1 t., D, 42d Sept. 19, Right; ciro. Surg. Orsay, C. 4, 1865". Virginia, age 23. 23, 64. S. A. Provost Mar. April 8/65. 214 Winkler, J., Pt., C, 4th Aug. 30, Right. A. Surg. B. Howard. U. 179 Smith, E. E., Pt., A, Aug. 16, Right : circ. A. A. Surg. J. C. Penn. Reserves. Sep.5/62. S. A. Disch d Feb. 22, ] 863. llth Maine, age 19. Sept. 14, 1864. Morton. Haem.; lig. fern, art ry. Nov. 10, bone rem d; nee. Jan. 215 Worden, W. II.. Pt., F, Purnell s Legion, age May 30, Je. 9/64. Left; circ. A. Surg. J. B. Baxter, 16th Maine. Disch d May 9/65. 19. 65. amp. hip .i t.: haem.; lig. 27. Spec. 3176. ex. iliac art. Disch d May 27, 216 Worley. R. M., Serg t, Aug. 5, Lett. Disch d Nov. 27, 62. Jan. 1865. Specs. 81, 3709. E, 22d Kentucky. 26, 62. , 1863, re-amp., flap, middle - Smith, W., Corp l, Bat y Sept. 6, Right ; nirc. Surg. G. Derby, 23d third. Surg.H.Manfred, 22cl Ky. H, 3d N. Y. Artillerv. 9, 62. Mass. Disch d Feb. 1, 1863. 217 Youlls, G. W., Pt., F, July 1, Left; circ. flap; exfol. Disch d 181 Snyder, W. J., Pt., I, 42d Dec. 13, Left. Surg. II. Bryant, U. S. V. 149th Penn., age 22. 8, 63. Jan. 30. 1864. Pennsylvania, age 25. 28, 62. Ihem. Disch d Aug. 27, 1863. Died O< t. 25, 1865; general an 218 Adams. A. J., Corp l, A, 4th Batt. Georgia S. S., Dec. 18, 22, 64. Left. (Vermale s method.) A. Surg.W. B. Trull, U. S.V. Died aemia. Spec 585 age 25. Dec. 25/64 ; irritative fever. 182 Stanly, J., , A, 4th Jan. 2, Left. Surg. C. J. Walton, 21st 219 Adams, J. W., Pt., I, 2d June 1, Left; ant. post. flap. Surg.E Bent- Florida. 5, 63. Ky. Erysipelas. Recovery. Vermont, age 23. 10. 64. ley,U. S.V. (Gang.) Died June 183 Stewart. J.E., Serg t, H, July 2, Right. A ug. 28, spic. removed. 1 0", 64 ; asthenia. Spec. 2547. 4th Texus, age 21. 5, 63. Exch d Nov. 12, 1863. 220 Akeman, M., Serg t, I. Dec. 4, Right ; flap. Surg.H. B. Johnson, 184 Stevens, F. L., Serg t, E, 12l)th X. York, age 19. Oct. 27, 30, 64. Right : ant. post. flap. Confed. surgeon. Disch d May 25/65. 13th Ind. Cav., age 32. 14, 64. 1 1 5th Ohio. Died Dec. 19, 1864 ; ichorhaemia. Autopsy. 185 Surface, W. J., 1 t., F, Aug. 9, Left ; ant. post. flap. Surg. J. E. 221 Albright. G. M.. Capt., July 3, Right ; flap, skin ; cir. mus. Died 7th Indtfiiifi. 15, 62. F, 53d N. C., age 36. 11, " 63. July 16, 1863. Spfcs.3966, 3977. Nov. 18. Inem.; lig. fern, artery. 222 Allen, Lieut., 13th April 6, . A. Surg. B.Howard,U.S.A. Disc d Oct. 27/63. Specs. 40, 706. Louisiana. 18, 62. Died April 26, 1862. 186 Su>tften,R. J 1 ., Pt., E, 1st Julv21, Right: ant. post, flap; gangrene; 223 Allen, A., Pt., H, 5th April 6, . Surg. E.C.Franklin,U.S.V. Arkansas, age 26. 25, 64. sloughing. Recovery. Artillery. -, 62. (April 9, excis. tib. and fib.; mor 187 Taylor. M.II.,Pt.,U, 47th May 12, Left. Surg. J. G. Dudley, P. A. tification.) Died May 11, 1862. Alabama. 23, M. C. S. Recovery. 224 Allen, A. T., Capt., H, June 3, Left ; circ. A. A. Surg. F. H.Col- 188 Tedrow, D. W., Pt., D, May 2, Right ; circ. Surg. L. G. Meyers. llth Conn., age 24. 15, 64. ton. Died July 6, 64 j pyaemia. 75th Ohio. 14, 63. 25th Ohio. Disch d June 6, 64. Autopsy. Spec. 3561. 189 Thrasher, G. M., Pt., C, Sept. 17, Left; circ. Surg. A. Ball, 5th 225 Allen, W., Pt., G, 8th July 14, Right; circ. A. A. Surg. T. E. 5th Ohio. 20, 62. Ohio. October, 1862, re-amp. Va. Cavalry, age 23. 27, 64. Mitchell. Died Aug. 10, 1864; Disch d Dec. 20, 1862. pyaemia. Autopsy. Spec. 3817. 190 Tonrtellotte, T. I., Pt., H, 57th Mass., age 27. Mar. 25, 28, 65. Left : cire. Surg. W. O. McDon ald, U.S.V. Disch d Oct. 20/65. 226 Applegate, H., Pt., K. 64th Ohio. De.31/62, Ja. 21/63. Lr-i t thigh. Died January 29, 1863. Spec. 4135. 227 Arkwith. J., Pt.. D, 83d Dec. 13, Right thigh. Died January 4, 191 Tract/, M. , Capt ., A, De.31, 62 Right. Surg. R. P. Bateman, P. New York. 28, 62. 1863. 13th Louisiana. Ja.11/63. A. C. S. Recovery. 228 Ashley, II. ,1., Pt., K, Sept. 19, Left; circ. Died Oct. 21, 1863; 192 Trumbaurer, P. S., Pt., Mar. 10. Left: circ.; flap. Ass t Surg. W. 87th Indiana. , 63. pyaemia. H, 205th Penn., age 20. 15, 65. Carroll, U. S. V. Disch d June 229 Ashton, T. G.. Pt., F, May 6, Left ; diarrhoea. Died June 10, 9, 1865. 51st Penn., age 34. Je. 1/64. 1864 ; pyaemia. 193 Tully, M., Pt., C, 10th June 3, Left: ciro. Surg.D.F.McKinney, 230 Atwood, N. 11., Pt., C, April 2, Right : circ. A. A. Surg. F. H. Now Jersey, age 35. 8, 64. 87th Penn. Necro. bone rem d. 6th Vermont, age 22. 13, 65. Colton. (Excis. fibula.) Died Disch d June 9, 1865. May 23, 65 ; pyaemia. 194 Turner. J., Pt.. E, 5th Sept. 29, Lett: flap. A. A. Surg. H. B. 231 Badger, O., Pt., E, 126th July 9. Left: circ. A.A. Surg.A.R.Gray. Colored Troops, age 24. Oc.l8. 64 White. Disch d April 14. 1865. Ohio, age 23. 12. " 64. Died July 20, 1864 /exhaustion. 195 Urquhart, M. J.. Cap*.. Sept. 20, Right (gang.): circ. A. Surg. S. 232 Baldwin, D. IT., Pt , G, Sept. 19, ; circ. Surg. E. A. Brevard, D, 98th Ohio. Oc.20/63 M. McClure, 37th Ind. (Also 2d North Carolina. Oc.19/64. P. A. C. S. Gang. Died Oct. wound of breast and eye.) Dis 2:>, 1 864 . exhaustion. charged March 1. 1864. 233 Barnett, D. A.. Serg t, Nov. 7, Left; circ. A. A. Surg. P.R.Holly. 196 Vaden.W.B., Pt.,C, 09th May 7, Right. Surg. McNutt, U. S. N. B, 99th Penn., age 22. 10, 63. (Gang.) Died Nov. 26, 1863; Illinois, age lit. 27, 63. Re-amp.; ciro.: exfol. bone ext. pyaemia. Specs. 2246, 2247, 3991. Disch d Nov. 15, 18ti4. 234 Barnhersel. M. J.. Pt..C, Aug. 28, Right. Surg. C. Page, U. S. A. 197 Vanderhoof, W. M., Pt.. May 4, Right ; circ. Haem. Disch d Feb. 2d Wisconsin, age 21. Se. 21/62. Died Oct. 7, 1862. Spc.c. 77. I), 2<ith New Jersey. 9, 63. 4, 1864. 235 Barry. J.. Pt., I). 2d N. May 16, Right: flap. A. A. Surg. J. S. 198 Vannetta, W., Pt., D, 4th June 21, Right ; circ. A. Surg.P.C. Davis, Hampshire, age 20. 25, 64. Hill. (May 16. amp. leg: slough.: Penn. Cavalry, age 24. J y 7/63 U. S. A. Oct. 5, re-amp, middle haem.) Died May 30, 64 ; exh n. third. Disch dJune7/64. Sprc*. 236 Bassheart, W.. Pt., C, May 22, Loft; circ. A. Surg.H. M.Sprague. 2602. 1336, 1529. 116th Pennsylvania. 26," 63. U.S.A. Died . I une 1. 63. Spec. 199 Voorhees, J. K., Pt., G, May 3. Left; flap. Haem. Disch d Oct. 1624. 107th N. York, age 18. 10, 63. 7. 1863. 237 Baxter. S.. Serg t, I. 68th April 1, i Right; circ. skin flap and circ. of 200 Walker. N. J., Pt., C, July 12, Right : circ. Surg. A. F. Sheldon, Col d Troops , age 23. 12, 65. miis. Sursr. F. E. Piquette, 86th 43d N. Carolina, age 30. 16, 64. U. S. V. Released July 5, 1865. C. T. Hasm.; lig. fern, artery. Spec. 2879. Died June 2, 65; exhaustion. 201 Walls. D., Pt., , 18th Jan. 3, Left. Surg. C. J. Walton, 21st 238 Bearlev, J. 11.. Serg t. I. Sept. 1, Right. Surg. W. 11. Matchett. Florida. 6, 63. Kentucky. Recovered. 101st "Ohio. 8, 64. 4(Mh Ohio. ~ H;em. : lig. femoral 202 Walsh, P., Pt., A, 69th June 3, Left (June 3, exc. tib.); ant. post. artery. Died Oct. 31. 1864. New York, age 29. 9, 64. flap. A. A. Surg. Riter. Nee. 239 Bechtel.W.H., Corp l. A. Oct. ID. Ri^hti double flap. Surg. R.W. bone rem d. Disc d Sept. 20. 65. 22d Iowa, age 23. Nov.3, i;-l. Pease, U. S.V. Died Nov. 12/64. 203 Waman, G. W., Pt., E, Mar. 26, Right ; circ. Disch d July 15, 240 Bennett, H., Corp l, G, May 7, Right: flap. Surg. D. W. Bliss, 47th Ohio, age 23. 29, 65. 1865. 6th Maine, age 20. 14,64. 1 . S. V. Pvrrmia. Died June 204 Ward, G. 15.. Capt., K, May 3, Left. Surg. H. W. Ducachet, II. 4. 1864. Spec. 2272. 14th Indiana. 30, <<>3. S. V. Disch d Aug. 17, 1863. 241 Bettler, P.. Pt., II. 9th April 30, Left. May 22 re-amp Died June Spec. 1191. Wisconsin. iM y3/64. 21, 1864. 205 Ward, J.H., .B,Gobb s Sept. 14, Left ; flap. Transferred Decem 242 Bishop. C. C.,Pt., M, 8th June 3. Left : ant. post. flap. Died June Georgia Legion. Oc.14/62 ber 5, 1862. N. Y. H. Art y, age 17. 6. 64. 26, 1864; exhaustion. WAGNER (C.), Report of Interesting Surgical Operation.*, etc., p. 15. MORTON (T. G.), On Amputation at the Hip Joint, etc., in Am. Jour, of the Med. Sciences, A r . S., 1866, Vol. LII, p. 32. PACKARD (J. H.), On Amputation at the Hip Jnint, in Xew York Med. Journal, 1866, Vol. II, p. 161. Circular 6, S. G. O., 1865, pp. 49, 50. Circular 7, S. G. O., 1867, pp. 49, 65 SECT. JII.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 297 No. NAME, MILITARY DESCRIPTION, AND AOE. DATES. OPERATION S, OPEHATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGK. DATES. OPERATIONS, OPERATORS, RESULT. 243 Bissell, A. E., Corp l, I, July 23, Right. (Spiculae rem d.) Died 278 Clutz, G. W.. Pt., G, 83d May5, Left; circ. A.A.Surg.C.T.Traut- 9th N. Hnmp.. age 23. 26, 64. October 8, 64 ; amputation Penn., age 23. 19, 64. man. Died Mav 25, 64 ; exh n. 244 Blackburn, J., Corp l. K. Dec. 7, Right; ant. post. flap. A. Surg. Spec. 3044. 20th VVis., age 22. 11, 62. J. F. Bruner, 7th Mo. Cavalry. ;279 Clyde, C., Pt., I, 150th July l, Right. Surg. P. A.Quinan, 1 ">0th Died Dec. 18, 62; haemorrhage. I Pennsylvania. 15/63. Pa. Died July 17. 63. Spec.1481. 245 Blackmer. C. 11., Pt., A, June 16, Left; circ. A. A. Sr.rg M F. 280 Cole. B. W., Corp l, K, Dec. 13, Left ; circ. Surg. E. Bentlev, U. 21st Mass.. age 20. 22, 64. Prince. Died July 1, U4 asihen. 16th Maine. 21, 62. S. V. Died Dec. 27/62; pyaem. 24r, Bloomer, J., Pt., K, 170th Aug. 25, Right; flap. Surg. N. R.Moseley, Spec. 609. New York, age 44. Se. 18,V>4. U. S. V. (Gang. Sept. 12 ex. 281 CoJUns, A. D.. , H, Sept. 14, Left. Dr. Halsey. Died Oct. 2, fib.; lig. post, tib.; haem. lig. !| 17th South Carolina 27, 62. 1662. Spec. 816. femoral.) Died Sept 2i .1864; 282 Conner, W., Pt., B, llth Dec. 13, Left ; flap. Surg. J. S. DeBenne- cons lirritab y. S/)cc*.T2:iH 3269. Pennsylvania Res. 19, 62. ville, 1 1th Penn. Reserves. Died 247 Bowers, J.A., Pt..C.15th Sept. 14. : circ.; gang.; flaps sloiiif led. Jan. 2, 1863. S. Carolina, age 18. 20, 62. Died Nov. l>. 1862 pypniia. 283 Conroy. D., Pt., D, 62d June 1, Right ; circ. (mortification). A. 248 Bowker. J., Pt., B, 45th June 3, Right: ant. post. fl*p. Surg. R. New York, age 23. 6, 64. A. Surg. J. H. Thompson. Died Penn., age 25. 8, 64. B. Bontecou, 1 . S. V. Died June 22, 1864; pyaemia. June 12, 1864; exhaustvm. 284 Coinvay, T., Pt., I, 33d May 3, Left. Died June 4, 1863. 249 Bowser, J. F., Pt., B. Mar. 30, Right : circ. A. A. Surg. Geo. I . New York. -, r 63. llth Penn., age 18. | April 11, llanawalt. Haem. recurred ; lig. 285 Coot, J., Lieut., F, 10th Mav 5, Left ; flap. Ass t Surg. J. S. Bill 1865. fern. art. Died May 21 , 65 py Alabama, age 26. 20, 62. ings, 1 . S. A. Diarrh.; haem.; aemia. Autopsy. Spec. 1426. lig. Died May 25, 62 ; diarrh. 250 Bowyer, H.L.,Capt., H, May 16, Right (abscesses). Died Jiuie 13, 286 Corey. O- M., Pt., H, Oct. 19, Right ; ant. post. flap. A. A. Snrg. 31st Illinois. 23, 63. lHt>3. Haemorrhage. Sprc. 1486. 114th N. Y., age 21. 29, 64. W. Kempster. (Oct. 19, amp. 251 Brandon, E. C.. Pt., K. May 10, Right; circ.; haem.: lig tem. art. leg.; haem.): sloughing. Died 14th Virginia, age 23. 19 64. Died June 24, 64 ; exhaustion. Nov. 11. 1864. 252 Brasier, J. P., Pt., C!75th Avig. 30, Right. A.A.Surg.H. J. Bigelow. 287 Correll, L., Pt., G, 67th Sept. 19, Left: modified flaps. A. Surg. J. Ohio. Se. , 02. Necro. Died Dec. 12, 62: exh n. Penn., age 19. 27, 64. G. Thompson, 77th N.Y. (Gan 253 Brassington, J., Pt., H, May 13, Left ; circ. A. Surg.W. F. Norris, grenous.) Died Sept. 27, 1864; 9(ith Penn., age 33. ; 30, 64. U.S.A. Recurrent ham. Died exhaustion. June 7. 64; exh n. Spec. 3539. 288 Cox, W. T., Pt., G, 8th April 9, Right ; circ. A.Surg. A.Hartsuff, 254 Brennan, J., Capt., A, Oct. 27 Right, Teale s method. A. A. Illinois, age 40. 14, 65. U.S.A. (Gang.) Died May 5, Kith Virginia, age 29. Nov. 25, Surg. C. Eberhardt. Died Nov. 1865 ; profuse haemorrhage. 1*64. 25, 64. Autopsy. Spec. . A . S. 289 Crassen. L. M., Pt., L, June 6, Left ; circ. Died August 15, 64. 255 Brenning, C. F., Corp l, Oct. 14, Left ; bi-lat. flap. A.A. Surg. F. 7th N.Y. H. A., age 22. 10, 64. F, 49th Ind , age 25. 21, 64. llassenburg. (Erysip.) Died 290 Crawford, J. J. S.,Pt..D, April 1, Right ; circ. A. Surg.W. F. Nor three hours after; exhaustion. 91st New York, age 23. 8, 65. ris, U. S.A. Died April 14, 65 ; Autopsy. Spec. 3740. exhaustion. l?pr.c. 2963. 256 Briscoe. M., Pt.,G, 155th June 3, Left. Surg. Gen. A. Garcelon, of 291 Crawford, W. E., Pt., I, Mav 12, Left ; circ. Surg. N. R. Moseley, New York, age 42. 8, 64. Maine. Haem.: lig. fern, artery. 5th N. Carolina, age 32. 23, 64. U.S.V. Three ins. of fern, rem d. Died June 16, 1864: haemorrh. Died June 17, 64. Specs. 2563, 257 Brooks, E., Pt., B, 188th June 3, Right : circ. Surg. O. A. Judson, 4761. Penn., age 21. 13, 64. U. S. V. Died June 23, 1864; 292 Crocraft. S., Pt., B, 121st Mar. 13, Right ; flap. Surg. N. Gray, U. pyaemia. Autopsy. Spec. 2941. |l Col d Troops, age 18. 24, 65. S. V. Died April 6, 1865. 258 Brown, JV., Pt., E, 56th JulyS, -. July 10, lia-in. Died July 293 Cronin, P., Pt., K, 20th June 30, ; lat. flap. Surg. R. B. Bon- Virginia. 9, 63. 11, 1863; loss of blood. Massachusetts. J y22, 62. tccou.U.S.V. Died July 24. "62. 259 Bruen, L. B., Major, 12th May 13, Left : circ. A. Surg.W. Thomson. 294 Crossan, A., Pt., E, 34th July 24, Left; circ. A.A.Surg.G.M.Paul- Infantry, age 42. 22, 64. 11. S. A. May 25. erysip. Died Ohio, age 32. Aug. 3, lin. Died Aug. 24, 64 : pyaemia. June 21, 64: pyaem. Spec. 3594. 1864. A utopsy. 260 Bubier, F., Pt., G, llth Aug. 14, Left; circ. A.A. Surg. R. O. Sid- 295 Crowley, P.,Serg t,G,lst June 20, Left; flap A. A. Surg. F. H. Maine, age 20. 21, 64. ney. Died Sept. 13, 64 ; irrita Mass. Heavy Artillery, July 11, Getchell. (Erysipelas.) Died tive fever. age 23. 1864. July 11. 1864. Spec. 3662. 261 Bunnell, J., Pt., D, i tli June 16, i Right. Died June 30, 1864. 296 Cummins, A. H., Pt., K, Dec. 13, Right. Surg. H. Bryant, U. S.V. Indiana, age 20. , 64. ! 34th N. York, age 25. 26, 62. Ha?m.; lig. fern. art. Died Jan. 262 Burdick, W. ( ., Pt., G, Dec. 13, Left. Surg. C. S. Wood, 66th N. 25, 63: exh n. Autop. Spec. 589. 7th Rhode Island. 21. 62. Y. Died Dec. 26, 1869. 297 Cunningham, J., Pt , I, Mav 12. Left : ant. post, flap ; haemorrhage. 263 Burke, P., Pt., G, 10th Aug. 30, Right : haem.; lig. femoral artery. 13th Georgia, age 26. 15, 64. Died June 14, 1864 ; exhaust n. Infantry. iSe.ll. 62. Died Sept. 14, 62; exhaustion. 298 Cupp, W., Pt., A, 44th Aug. 31, . Died September 30, 1862. 264 Burnett, C.. Pt., C, 6(!th July 2, . Surg. . . S. Wood, 66th N. New York. Se. , 62. New York. 7, 63. York. Died July 10. 1863. 299 Daggett, S.W..Capt., B, June 18, Right: ant. post, flap; circ. sect. 265 Burnliam, II ., Serg t. G, Oct. 19, Right; flap. Surg. A. Chapel, 1st Me. H. A., age 32. 27, 64. muscles. A. Surg. W.Webster. 8th Louisiana, age 35. Nov. 5, IT.S.V. (Gang.; h;em : lig. pop U. S. A. Died July 1, 1864; 1864. liteal art.) Died Nov. 14, 1864 ; exhaustion. Spec. 2261. exhaustion. 300 Daily, T., Serg t, A, 63d Sept. 17, Left. Surg. H. S. Hewit, U. S.V. 266 Burrell, J., Captain. A, Oct. 19, Right ; circ. A.Surg.J.G. Thomp New York. Oct. 3. 62. Died Oct. 8. 1862. Spec. 448. 121st New York. 22, 64. son, 77th N.Y. Hsem. Died Oct. 301 Dall, J. H.,Pt., H, 77th Sept. 1, Right; circ. A. A. Surg. D. H. 30. 64: exhaustion. Spec. 3V84 . Penn., age 23. 15, 64. Bell. Recurrent haemorrhage. 267 Butcher, J. S., Pt., F, Dec. 15, Left thigh. Died January 9, 65. Died Sept. 26, 1864. 100th Illinois, age :!0. 20, 64. 302 Davidson, J., Pt., G, 1st Mar. 31, Left. Surg. E. Griswold, U. S.V. 268 Butler, P., Pt., I, 7th Oct. 27, Left. A. Surg. J. H. Kinsman, Mich. Cavalry, age 21. Apr.7, 65. Died April 8, 1865. Col d Troops. age, 23. No.ll, 64. 1 . S. A. Died Nov. 15, 1864. 303 Davis. L. T., Pt., B. 3d Aug. 19, Right : double flap. A. A. Surg. 26!) Call, J., Pt., !:, 3d Mich Aug. 30, Left; ant. post. don. flap. Ass t W. Virginia Cavalry, 29, 64. E. K. Deemy. (Necrosis.) Died igan. Sep.2, 62. Surg. T. G. Mackenzie, U. S. A. age 21. October 4, 1864 : exhaustion. Died Sept. 8, 1862. 304 Davis, T., Pt., F, 25th Jan. 15, Right; post. flap. A. Surg. J. 270 Carlton.C. C..Pt., B, 1st May 7, Left: circ. Surg. N. R. Moseley. South Carolina. Feb. 2. Vansant, U. S. A. Died Feb. 9, Massachusetts, age 35. 22, Y>4. U. S. V. Haem.; lig. prof, art y; 1865. 1865; pyaemia. recurrent lupm. Died May 30, 305 Davis, W. E., Capt., B, Nov. 7, Right : circ. A. Surg. W. Thom 1864; haemorrhage. 30th North Carolina, 10, 63. son. U.S. A. (Gang.) Died Nov. 271 Carney, C., Pt., C, 1st Sept. 14, Right. Surg. II. S. Hewit.U.S.V. age 25. 22. 63;trism. Autop. Spec. 2236. Pennsylvania Res. 26, (12. Died Oct. 17. 62. Spec. 376. 306 Dawson, F., Bugler, I, Oct. 19, Left ; flap, skin ; circ. muscles. 272 Carrier, M. II.. Serg t, E, May 27. Left. (June 8, excis. humerus.) 1st Cavalry, age 24. 22, 64. Surg. W. A. Barry, 98th Penn. 25th Connecticut. Je. 12, 63. Died June 15, 63. Spec. 1311. Ho?m. recur d : slough g. Died 273 Carter, J., Pt., H, 1st W. June 18. Tiight; circ. A.A. Snrg. W. H. Nov. 9, 64 ; exh n from haem. Virginia Cav., age 20. J y4, 64. Phillips. Died July 9, 1864; 307 Decker, N., Pt., C, 125th Sept. 17, Right. Died October 17, 1862. exhaustion. Penn., age 45. Oct. 6, 62. Spec. 4827. 274 Christian, S. J., Pt., I, Dec. 7. Left: ant: post. flap. A. Surg. J. 308 DeCoureey, G., Pt., F. Mar. 20, Right (gangrene). Died April 26th Indiana, age 20. 12, 62. F. Bruner, 7th Missouri Cav ry. 101st Indiana. , 63. 24, 1863. Died Dec. 16, 1862. 309 Dener, C., Pt., D, 6th June 3, Right (June 12, haem.: lig. ant. 275 Claflin, W. X., Pt., G, May 3. Right, Died May 20, 1863. Conn., age 32. 14, 64. tib. art.; 13, ex. piece shell): circ. 6th Vermont. 18, 63. A.A. Surg. S. Coloosdian. Died 276 ; Cleaver. A. R., Pt., A, June 1, Right : ant. post. flap. Surg.R.B. June 18, 1864: exhaustion. 188th Penn., age 18. 19, 64. Bontecou, U. S. V. Died June 310 Dickey, L. W., Pt., G, June 21, Right; circ. Surg. A. F. Sheldon, 26, 1 864 : typ. fever, Spec. 3060. 40th N. Y., age 28. 29, 64. U. S. V. Died July 8, 1864 ; 277 Clinton, O., Pt., O, 2d Sept. 19. Right: skin flap: circ. muscles. pyaemia. Conn. Artillery, age 111. 24, 64. Surg. \V. A. Harry, 98th Penn. 311 Donnelly, R.,Pt., A, 25th Aug. 30, Right; flap. Surg. J. E. Summers, | (Erysipelas); sloughing. Died Ohio. Sept. 5, U.S.A. Died Oct. 20, 62; osteo Nov. 15, 1864. Autopsy. 1862. myelitis. Spec. 319. SURG. 11138 298 INJURIES OF THE LOV/KR EXTREMITIES. ICIIAP. x. NO NAMK, MILITABY DESCRIPTION AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. 312 Doty, N., Pt., E, 102d Sept. 19, Left ; oval flap. A. A. Surg. T. 343 I Flammer, T., Pt.,A,12th July 9, Right ; circ. A. A. Surg. W. S. Penn., age 23. 28, 64. J. Dunott. Pytemic chills. Died Penn. Cav., age 50. 24, 64. Adams. Hasm. recur d. Died Nov. 7, 1864. Autopsy. Specs. Aug. 3, 1864; exh n. Autopsy. 1562, 3944. Specs. 3812, 3958. 313 Dougherty, J.H.,Pt.,G, June 6, Right. Surg. W. Watson, 105th 344 Flanders, A., Pt., 4th Aug. 16, Left (slough g; necrosis). A. A. 66th N. York, age 35. 9, 64. Penn. June 20, luem.; 21st, re New Jersey Artillery, Sept. 12, Surg.G.A.Chesley. Died Sept. curred ; lig. fem. art. Died June age 43. 1864. 15, 1864 ; luemorrhage. 29, 1864 ; pyaemia. 345 Fliegi, H., Corp l, F, 7th Sept. 17, Right. Hsem. Oct. 11. lig. fem. 314 Dougherty, M., Pt., E, Sept. 19, Left ; ant. post. flap. A. Snrg. J. Michigan. Oct. 9, 62. art. Died Oct. 18, 1862. 49th Penn., age 35. 26, 64. G. Thompson, 77th N. Y. Nov. 1346 Flynn, M., Pt., L, 21st July 16, Right; circ, A. A. Surg. A. R. 4, bone reui d; hiem.; lig. fem. N. York Cav., age 19. Aug. 2, Gray. Sloughing. Died Aug. art. March 19/65. lig. fem. art.; 1864. 18, 1864; pyiemia. Autopsy. 25, lig. ex. iliac art. Died April Specs. 3835, 3967. 8, 18t>5. Autopsy. 347 Folunsbee, C. M., Pt., B, Dec. 6, Right ; ant. post. flap. A. A. Surg. 315 Douw, J. D. P.,Capt.,K, Oct. 19, Right ; semi-lunar Haps. A. Surg. 157th N. York, age 16. 9, 64. W. Balser. Sloughed : haein. 121st New York. 22, 64. W. G. Bryant, 122d Ohio. Died Died Dec. 26, 64 ; hectic fever. Oct. 26, 1864; exhaustion. 348 Foorhee. W. F.. Pt.. I, May 19, Left (gangrene); circ. A. A. Surg. 316 Doverspike, H., Pt., I, June 1, Right. A. A. Snrg. C. Curvullo. 14th North Carolina, Je. l. 64. : II. M. Dean. Died June 17, 64 ; 82d Penn., age 33. 8, 64. Died June i:t, I86-). N/w-c. C01. age 22. fxlimistion. 317 Dow, J. M., Pt., E, 12th Juno 3, Right: lat. flaps. Surg. N. R. , :j.]9 Forrester, S., Corp l, E, S<>pi. 19, Lett: modified flaps. A. Surg. J. New Hamp., age 20. 20, 64. Moseley, 1 . S. V. Died July 67th New York, age 37. 24. 64. G. Thompson, 77th N.Y. Phle 7, 1864. bitis. Died Oct. 13/64; pyaem. 318 Doyle, E., Pt., F, 3d Vt, May 10, Right ; ant. post, flaps. A. Surg. Autopsy. Spec. 3273. age 28. 15, 64. A. Delaney, U.S.V. Died May 350 Foster, R., Capt., E, 1st May 12, Left ; circ. A. A. Surg. F. H. Col- 17, 1864; exhaustion. New Jersey, age 39. 27, 64. ton. Haem.; lig.; slough g. Died 319 Driseoll.C., Bugler, 14th Mar. 12, Right (sloughing; luem.); bi-lut. June 14, 64: exh n. Spec. 3956. N. Y. Cavalry, age 17. 22, bo. flaps. A. A. Surg. F. Banies. 351 France, J.,Serg t,A,20th Dec. 7, Left: flap. A. Surg. J. J.Sanders, Died April 3, 1865; pyaemia. Wisconsin, age 25. 10, 62. | 1st Iowa Cav. Sloughed. Died 320 Duffin, M., Sergeant, D, July 30, Right ; oval flap. Surg. C. Page, Dec. 21, 1862; haemorrhage. 29th Col d Troops. Aug. 21, U.S.A. Died Aug. 31, 64; loss 352 Galawa//. E., Pt., B, 2d May 16, (gangrene); circ. Diedjune 1864. of blood and disc, of lung. Auto. South Carolina, age 22. 23, 64. 15,1864; pyaemia. Autopsy. 321 Dunn, J., Pt., Georgia Sept. 20, ; circ. Died Nov. 1, 1863; 353 Gallaher, E.,Pt.,A,l 19th May 3, Right; ciro. Surg. R. Reyburn, Sharpshooters. 23, 63. exhaustion. New York, age 17. 27, 63. U.S.V. Died June 20, 1863; 322 Dunsmore, D. F., Serg t, May 5, Right ; circ. Died Oct. 1, 1864. pyaemia. Spec. 1601. G, 147th N. Y., age 20. 31, 64. 354 Gans, E., Serg t, E, 46th Aug. 19, Left; circ. A. A. Surg. E. P. 323 Durkee, M. B.,Curp l, E, Mar. 29, Left; circ. A. A. Surg. J. Wins- New York, age 20. 31, 64. Fitch. Died Oct. 1, 64; hectic 185th N. York, age 22. April 3, low. Died May 5, 1865; pyaem. fever. 1865. Autopsy. Spec. 162. 355 Garble, C., Pt.. G, 3d June 17, Right ; oval flap. A. A. Surg. W. 324 Eaton, C. A., Pt., K, 39th May 9, Right (May 12, exe. fibula ; 17th, Maryland, age 21. 24. 64. H. Ensign. Died June 25, 1864. Mass., age 40. 17, 64. hu?m.); ant. post. flap. Surg. A. Spec. 2392. F. Sheldon, U. S.V. Died May 356 Gardiner, P., Serg t, K, Oct. 27, i Right thigh. Died December 4, 29, 1864; exhaustion. 21st Penn., age 21. No.26/64. 1 1864. 325 Edwards, B., Pt., D,17th May 5, Left; ant. post. flap. A. A. Surg. 357 Gay, E., CorpM, H, 18th April 6, (excision); dou. flop. Surg. Vermont, age 22. 30, 64. C. Eberhardt. Gang.; slough g. Wisconsin. -, 62. E. C. Franklin, U. S. V. Died Died June 13. 64 ; pyaemia. April 22, 1862 ; pyaemia. 326 Edwards, C. H., Pt., C, May 16, Right ; double flap. Surg. C. B. 358 Geist, L., Pt., E, 3d Md., May 13, Left. A. A. Surg. F. G. 1 1. Brad 24th Virginia, age 25. 20, 64. Gibson, C. S. A. Died May 31, age 21 . Je. 5/64. ford. Died June 22. 64 ; exh n. 1864 ; gangrene. Spec. 2504. 327 Eldred, H., Pt., E, 2d June 18, Left (June 18, amp. leg.; gang.); 359 Geller, M., Pt.. D, 48th June 30, Left : ant. post. flap. A. A. Surg. Sharpshooters, age 27. J yl, 64. ant. post. flap. Surg. R. B. Bon- New York, age 37. J y4/64. T. Liebold. Sloughing; haem.; tecou, U. S. V. Died July 6, lig. Died Aug. 29/64 : diarrhoea. 1864; tetanus. 360 } Gibsnn, J. ,1., , F, 7th June 27. : circular. Died. 328 Ells, J., Pt,, C, 5lst Illi Nov. 30, Left; circ. Surg. J. R. Ludlow, Virginia. J .v3/62. nois, age 19. Dec. 19, U.S.V. Hasm. Died Dec, 19, 361 Gilbert. N.I/., Serg t, F, July 20, Left : ant. post. flap. A. A. Surg. ! 1864. 1864: synovitis and pneumonia. 58th Virginia, age 21. 23, 64. C. FI. Ohr. Died Aug. 8, 1864. 329 Ellsworth. C.W., Serg t, April 2, Left ; circ. Died May 18, 1865 ; Spec. 4272. B, 17th Vt., age 33. 6, 65. exhaustion. 362 Gilkerson, H r ., Pt., B, Sept. 19, Left ; circ. Surg. E.A. Brevard, 330 Emerson, H. S., Corp l, May 19, Left ; circ. A. A. Surg. J.C. Nel 60th Virginia. Oct. 18, P. A. C. S. Died Oct. 18, 1864 ; M, 1st Maine H vy Ar 31, 64. son. Died May 31, 64 ; exh n. . 1864. shock of operation. tillery, age 32. Spec. 2469. 363 Gill, B. F., Pt., E, 7th Aug. 9, Left; double flap. Surg. J. E. 331 Evans] W., Pt., I, 10th July 27, Left ; circ. A. A. Surg C.T. Bul- Ohio. 15/62. Bummers, IT. S. A. Died Aug. Connecticut, age 21. Au. 1, 64. len. Died Aug. 18, 64; exh n. 29. 1862. Spec. 39. J2 Evy, R., Pt.,B, 1st Mich. May 12, Right (haem.); circ. A. A. Surg. 364 Gillinger. J., Pt., K, 46th Aug. 9, Right ; ant. post. flap. Surg. J. E. Sharpshooters, age 28. 27, 64. L. C. Dodge. Died June 6, 64 ; Penn., age 29. 15, 62. Summers. U. S. A. Died Sept, pyaemia. Spec. 2357. 15, 1862. Spec. 48. 333 Ewing, T.C., Pt., E, 31st June 22, Right (bone rem d ; haem.): circ. 365 Gilmore, M.. Pt., D, 54th July 18, Left. (23d. excision til). ;md fib.; Ohio, age 18. July 18, 1864. A. Surg. J. M. Brown, U. S. A. Died Au. 1, 64 ; exh n. Jppcc.3389. ;i,;t; Massachusetts. Glazier, A., Corp l, B, 27," 63. Aug. 25, mortificat n.) Died July 27/63. Left (Aug. 25, patella rem d): circ. 334 Exnor, C., , C, 1st New Sept. 14, ; ciro.; flaps sloughed. Died 1st Minnesota, age 29. 29, 64. A. A. Surg. D. C. Van Slyck. Jersey. 17, 62. October 17, 1862. Died Sept. 2, 1864; gangrene. 335 F , E., Private. Feb. 16. ; circ.; erysipelas three ins. 367 Glinney, J., Pt., H, 81st De.13, 62, Right. (Dec. 13, amp. leg.) Died 26, 62. stump rem d. Died March 5, Pennsylvania. Ja. 1/63. Jan. 2, 1863; shock and exh n. 1862; exhaustion. 368 Golden , 0. P.,, 0. 1st Sept. 20, Right. (Haemorrhage.) Died in 336 Fairchilds, J. O., Corp l, Sept. 19, Left; flap. Surg. W. A.Barry, South Carolina Cav. Oc.19/63. ten hours. K, 77th New York. 23, 64. 98th Penn. Died Sept. , 1864. 369 Gowan, N. P., Pt., C, July 1, Right, Died Sept. 25, 1863 ; diar 337 Farrar, G. P., Pt., K, Mar. 29, Right ; ant. post. flap. Surg. N. 150th Penn., age 26. 15, 63. rhoea. 185th N. Y., age 20. April 5, It. Moseley, U.S.V. Died April 370 Graves, L. W., Pt., D, Oct. 29, Right. A. A. Surg. E. G. Waters. 1865. 10. 65; exhaustion. Spec. 4040. 1st R. Island, age 19. Nov. 7, Died Dec. 22, 1864 ; exhaustion. 338 Farron, A. W., Lieut., July 3, Left. Died July 21, 1863 : shock 1864. Spec. 3430. 8th Georgia. 21, ! 63. of operation. Spec. 2048. 371 Green, J., Pt., H, 82d June 1, Left. Died June 23, 1864. 339 Fayshon, J., Pt., A, 57th May 5, Right; circ. Surg. E. Bentley, Ohio. -, 64. Mass., age 23. 25, 64. U. S. V. Died May 30, 1864 ; 372 Green, J. P., Corp l, D, Mav 6. Right (haem.: tourniquet obstruct exhaustion. 14th Infantry, age 25. . 26, 64. ing yen s ciroulat n); ant. post. 340 Firth, R.E., Pt., A, 157th Dec. 6, Left; ant. post. flap. A. A. Surg. flap. Surg. A. F. Sheldon, U.S.V. New York, age 23. 10, 64. II. Leaman. Flaps sloughed ; Died May 20, 1864 ; exhaustion. haam Died Dec. 29, 1P64 ; py- 373 Green, W. H., Serg t, E, Sept. 20, Left. Died October 21, 1863. semia. Autopsy. 26th Ohio. , 63. 341 Fisher, G. A., Pt., K, 8th June 2, Right ; circ. A.Surg.W.F.Norris, 374 Griffin, L. C., Corp l, D, July 19, Left. Dr. J. Jones, of Richmond. New York H vy Art., 15, 64. U.S.A. Haem.: lig. Died June 8th North Carolina. 22, 64. Died Feb., 1865. Autopsy. age 19. 23/64 : pye. Autop. Spec. 3563. Spec. 3141. 342 Fitch, P., Pt., E, 61st April 7, Left ; ant. oval skin flap. A. Surg. 375 Grubbs, D. A., Serg t, May 3, Left. A. Surg.E.J. Marsh, U.S.A. New York, age 34. 18, 65. W. S. Ely, U. S. V. Slough g ; H, 95th Penn. -, 1;3. i Died Mav 31, 1863. Spec. 1078. pyaemia. Died April 26, 1865. 376 Gujnn, E., Pt., B, 138th July 9, Left ; circ. ; hapm.; poplit l artery Spec. 4099. Penn., age 21. : 12, 64. lig. Died July 22, 64 ; pyuem. 1 SMITH (E. H.), Report of Gates of Compound Comminuted Fracture of Femur, etc., in Confed. States Afed, and Surg. Jour., 1864, Vol. I, p. 24. SECT. III.] INTERMEDIARY AMPUTATIONS OF THE THIGH. 299 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 377 Hadm, E. R., Pt., F, May 10, Left ; circ. A. A. Surg. C. P. Big- 410 Hynes, J., Pt., F, 18th May 25, Right. (Gang.) A. Surg. C.W. 4th Virginia Cavalry, 18, 64. elow. Died May 25, 64. Spec. Infantry. June 16, Lawrence, 22d Mich. June 19, age 22. 2289. 1864. gang.; bone rem d. Died June 378 Haggerty, F., Pt., G, Dec. 13, Right ; flap. Died Dec. 30, 1 862 ; 22, 1864. 14th Indiana, age 35. 27, 62. exhaustion. 411 Irvin, R., Capt., B, 77th Jan. 11, Left. Surg. A. H. Hoff, U. S. V. 379 Haldron, J. W., Pt., A, Nov. 9, ; circ. Died Nov. 21, 1864 ; Illinois. 15, 63. Died Jan. 17, 1863. Spec. 1490. 17th Va. Cavalry, 13, 64. gangrene. 412 Jay, J. C.. Pt., K, 19th Dec. 7, Left ; circ. Surg. T. W. Florer, 380 Hammond, A., Pt., H, April 2, Left ; circ. A. Surg. W. F. Norris, Iowa, age 18. 11, 60. 26th Ind. Flap sloughed. Died lllth N. York, ago 47. 6, 65. U. S.A. Haem.; lig. Died April June 11, 1663; pyaemia. 16, 65; pyaem. Autop. Spec.2652. 413 Jenkins. J. H., Serg t, B, Feb. 25, Left ; circ. Surg. F. Salter, U. S. 381 2 Hang, G., Pt., G, 2d May 31, Right ; circ. A. A. Surg. C. H. 89th Ohio, age 24. 29, 64. V. Sloughed. Mar. 12, ham.; Artillery, age 27. June 14, Osborne. Haem. Died June 21, lig. profunda artery. Died Mar. 1864. 1864 ; pyaemia. 16, 1864 ; pyaemia. 382 Harding. W.,Pt., B, 58th Sept. 29, Right ; flap. A. A. Surg.T. Hop 414 Johnson, A., Pt., G, 91st April 1, Left : circ. A. A. Surg. T. O. Ban Pennsylvania, age 22. Oct. 6, 64 kins. Died Oct. 6, 1864 ; shock New York, age 27. 9, 65. nister. Died April 27, 1865; of operation. pyaemia. Spec. 4050. 383 Harouff, J., Pt.. D, 56th Mar. 30, Right; circ. Died April 29, 65; 415 Johnson, F., Pt., A, 10th Aug. 25, Right : lat. flap. Surg.N.R.Mose- Penn., age 27. Ap.25, 65. exhaustion. Spec. 4106. New York, age 45. 30, 64. ley, U. S. V. Died Jan. 23, 65 ; 384 Harris, W. H., Pt., A, Mav 3, Left. Died May 14, 1863. exhaustion. Spec. 1991. 12th New Jersev. 8, 63. 416 Johnson, L., Pt., B, 99th May 12, Left ; circ. A. A. Surg. F. G. H. 385 Harvey, B., Pt.," A, 3d Sept. 20, Right ; circ. Died Oct. 21, 1863. Penn., age 21. SO, 64. Bradford. Died May 25, 1864. Kentucky. Oct. -, 63. 417 Johnson, P. L., Pt., D, May 3, Right (abscesses); circ.; slough g; 386 Haskell, J. L., Pt., D, Mav 3, Left. A.Surg.E.J.Marsh, U.S.A. 25th Virginia, age 22. 23, m femoral art. lig. May 27, bone 7th Maine. -, 63. Died June 3, 1863. Spec. 1077. rem d. Died June 2, 1863. 387 Haskins, W. H., Pt., K, May 10, Left (Mav 14, 16, haein.); circ. 418 Johnston. D., Pt.,B, 40th June 1, Right; circ. A. A. Surg. T. F. 39th Mass., age 23. 18, 64. A. Surg. W. Thomson, U. S. A. Mass., age 21. 30, 64. Belton. Died July 1, 1864. May 24, haem.; lig. May 31, 419 Johnston, J., Pt., B, 27th Dec. 13. Right. Haem.; lig. fem. artery; haem.; lig. fern. art. Died May Connecticut. 23, 62. anaemi. Died Jan.5, 63.Spec.982. 31, 1864 ; exh n. Spec. 3522. 420 Johnston, T. H., Corp l, May 16, Right. (Gangrene.) Died May 388 Hays, A. H., Pt., B, 142d Dec. 13, Left. Surg. H. Bryant, U. S. V. D, 34th Ohio. 28. 62. 28, 1862. Penn., age 23. 25, 62. Hsm.; lig. Died Jan. 10, 1863; 421 Jones, G. W., Pt., C, 14th Oct. 19, Right ; double flap. A. A. Surg. exhaustion. Spec. 2558. New York, age 26. 30, 64. J. R. Uhler. Died Nov. 9, 64. 389 Heafey, J., Pt,, F, 24th Aug. 14, Right; circ. A. A. Surg. W. L. 422 Jones, H., Pt., C, 1st N. May 19, Right (gangrene); ant. post flap. Mass., age 30. 22, 64. Welles. Died Sept. 14, 1864 ; York Dragoons, age 20. June 7, Surg, A. F. Sheldon, U. S. V. irritative fever. 1864. Died June 7, 64; shock andhaem. 390 Heath, L., Serg t, D, 2d June 18, Right (excision tibia); circ. A. A. 423 Jones, J., Serg t, I, 65th Sept. 20, Right. Died October 18, 1863; Michigan, age 22. July 7, Surg. J. H. Thompson. Haem. Ohio. Oc. , 63. hemorrhage. 1864. Julv 12, lig. fern. art. Died July 424 4 Jones, L., Pt,, E, 25th July 11, Right : double flap. Died Sept. 28, ^64 ; pyaemia. Spec. 2867. Indiana, age 20. 23, 63. 16, 1863. 391 Hector, O., Pt., K, 56th Mav 31, . Died June 13, 1862; py 425 Kane, G. H., Pt., E, 1st Oct. 27, Left (slough g); circ. A. A. Surg. New York. J e 8, 62. aemia. Col d Troops, age 17. Nov. 10, J. Pitkin. Died Nov. 10, 1864 ; 392 Hendrix, J., Pt.,C, 110th July 9, Right; circ. A. A. Surg. G. M. 1864. exhaustion. Ohio, age 27. 14/64. Paullin. Died Aug. 11, 1864; 426 Keeth, C. B., Pt.,G, 26th Sept, 19, Left. Died Sept. 24, 1864. 4 pyaemia. Autopsy. Spec. 3842. Massachusetts. 23, 64. 393 Henefin, G., Pt., F, 5th May 2, Left. Surg. G. P. Oliver, lllth 427 Kelly, J., Pt., B, 2d In Sept. 17, Left. Died Oct. 21, 1862. Spec. New Hampshire. 8, 63. Penn. Died May 13, 1863. fantry. Oc.l6. 62. 2496. 394 Henry, J., Serg t, E, llth May 12, Left ; ant. post, double flap. A. 428 Kelly, J., Pt., D, llth Mav 6, Right ; circ ; diarrhoea ; slough g. Infantry, age 24. 21, 64. Surg. G. A. Mursick, U. S. V. Virginia, age 24. J e 15, 64. Died June 27, 1864 ; exhaust ii. Died May 25 64 ; exh n. Autop. 429 Kelly, P.. Pt., D, 102d June 1, Right. (Haemorr.) Died June 395 Hess. D., Pt., K, 56th May 8, Left (gang.); circ. Surg. E. Bent- Pennsylvania. 7, 64. 8, 1864. Penn., age 30. 16, 64. ley, U. S.V. Gang.; sloughing. 430 Kelly, T., Pt., F, 20th Dec. 13, Left, Died January 5, 1863. Died June 19, 1864 ; asthenia. Massachusetts. 26, 62. Autopsv. 431 Keniston, S. E., Pt.. H, May 23, Right (necrosis); lat. flap. A. A. 396 Hill, J. J., Pt., G, 47th Oct. 22, Left; cir e. Died Nov. 2, 1862. 4th Maine, age 36. June 17, Surg. H. M. Dean. Died June Pennsylvania. 25, 62. Spec. 731. 1864. 22, 64; exh n. Spec. 2575. 397 Hindman, McC., Pt., B, May 27, Left: flap. Died July 29, 1864 ; 432 Kennedy. M., Pt.,G,24th June 1, Left ; ant. post. flap. A. A. Surg. 78th Penn., age 19. J e 1, 64. pyaemia. Autopsy. New York. 10, 62. W. Hunt. Died June 16, 1862 ; 398 Hine. F. T., Lieut., I, Nov. 30, Left, Surg. A. P. Dalrymple, U. exhaustion. 144th N. York, age 34. De.20, 64. S. V. Did Dec. 20. 18(i4. 433 Kent, R. H., Serg t, F, Mav 3, Right. Surg.G. P. Oliver.lllth 399 Hoffman, M.,Pt.,F, 39th Mar. 31, Right ; circ. A.Surg.W. B. Hart- 141st Penn. 8, 63. Penn. Died Mav 15, 1863. New York, age 35. Apr.3, 65. man, 116th Penn. Abscesses; 434 Kerr, H., Pt., E, 139th Julv 12, Left: circ. A. A. Surg. F. S. Bar- diarrli. Died May 24, 65; pyaein. Penn., age 33. Aug. 11, barin. DiedSept.20, 64;pva?m. 400 Holmes, G., Pt., F, 2d June 30, Left. (Spieulae removed.) Died 1864. Spec. 3004. Penn. Art }-, age 20. , 64. July 12, 1864; exhaustion. 435 Kimball, F., Pt., E, 5th Aug. 30, Right. Died Oct. 7, 62 ; pyaemia. 401 Holmes. G. J., Pt., A, Mav 5, Left ; lat. flap. A. A. Surg. M. New York, age 20. Se.20, 62. 26th Georgia, age 24. 30, 64. Sheffield. Died June 6, 1864; 436 5 King, T., Corp l, H, 2d Mav 7. Right (aneurism); ciro. A. Surg. exhaustion. Cavalry, age 24. 14, 64. \V. Thomson, U. S. A. Slough. 402 Horton, E., Pt., A, 9th May 9, Left ; ant. post. flap. Surg. A. F. Died June 4, 64 : pyaemia. Au New York H vy Art.. 30, 64. Sheldon, U. S. V. Died June 3, topsy. Spe.cs. 3545", 3529, 3579. age 31. 1864; shock. 437 King. W. S., , K, 28th Mav 5, Left : circ. A. Surg. J.S. Billings, 403 3 Howell, T. R., , C, June 27, Left ; circ. Died July 4, 1862 ; Virginia, age 32. 17, 62. U. S. A. Died May 18, 1862. 4th Alabama. Jy2. 62. tetanus. 438 Kinney, B., Pt., G, 2d Oct. 19, Left ; ant. post. flap. A. A. Surg. KM Hubbard, J. H., Lieut., Dec. 13, Left. Died December 19, 1862. Connecticut, age 43. Nov. 7, J. J. Cockrell. Died Nov. 12, D, 145th Penn. 17, 62. 1864. 1864 ; haemorrhage. 405 Hubbs, J. B., Pt., B, Dec. 13, Right. (Haem,,recur d; lig. fern. 439 Kinnev, J. H., Serg t, F, Sept. 19, Left. Died October 21, 1863. 142d Penn.. age 20. 26, 62. art.) Died Jan. 12, 1863; ex 84th Illinois. Oc. , 63. haustion. Spec. 652. 440 Kirby, R., Pt., H, 12th Mav 3, Right. Died May 18, 1863. 406 Hug, G., Drum Major, Mav 21, Left. A. A. Surg. L. Darling. New Jersey. 16. 63. 30th Missouri. 26, 63. Gangrene. Died May 31, 1863. 441 Kirsherman, J. J.,Pt.,K, Sept. 20, . Surg. T. H. Squire, 89th Spec. 1626. 118th Penu. Oc.10, 62. N.Y. Ham. Died Oct. 18, 62. 407 Hnghbiinks.J.H.,Corp ], Nov. 20, Left. Died Nov. 26, 1 864, during 442 Kitt, J., Corp l, F, 54th April 6, . Surg. E. C. Franklin, U.S. E. 17th 111. Cav., age 20. 26, 64. operation. Ohio. -, 62. V. Died May 18, 1862. 408 Huntingdon. S., Serg t, Dec. 31, Right. Died January 19, 1803. 443 6 Klumpeter, H., Pt., I, Aus-. 29, . Surg. D." P. Smith, U. S. V. B, 101st Ohio. la. , 63. 8th New York. Se. 17, 62. Died Sept. 21, 18C2. Autopsy. 409 Ilyam, D., Pt., C, 5th April 7, Right (hnom.); circ. Surg. O. A. 444 Knapp, C. A., Pt., B, 6th Mav 10, Lett; ant. post. flap. Surg. R. B. New Hamp., age 21. 27, 65. Judson, U. S.V. Died May 14, Vermont, age 20. 29, 64. Rontecou, U. S. V. Haem.; lig. 1865; pyaem. Autop. Spec. 4228. fem. art. Died June 4, 64; exh n. 1 LIDELL (J. A.), On the Major Amputations, for Injuries in both Civil and Mil ry Practice, in Am. Jour. Med. Sci s, N. S., 1864, Vol. XLVII, p. 367. 2 LlDELL (J. A.), Ot^the Wounds of Blood-vessels, Traumatic Haemorrhage, Traumatic Aneurism, and Traumatic Gangrene, in V. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, p. 198. 8 SMITH (E. H.), Report of Cases of Compound Comminuted Fracture of Femur, etc., in Confed. States Med. and Surg. Jour., 1864, Vol. I, p. 24. 4 BRYAN (J.), Amputations from the Armies of the Southwest, in Am. Med. Kmes, 1863, Vol. VII, p. 288. 8 LlDELL (J. A.), U. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, p 141. "DUCACUET H. W.), Cases of Military Surgery, in Am. Med. Times, 1863, Vol. VI, p. 137. 300 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 445 Knight, B.,Pt.,E, 110th May 25, Right : circ. A. A. Surg. R. H. 481 McConnell, D. W., Pt., April 6, . (April 10, amp. knee joint ; Col d Troops, age 24. J e 1, 65. Blandry. Died June 15, 1865; H, 46th Ohio. -, 62. slough g ; necrosis.) Surg. E. C. pyaemia. Franklin, U. S. V. Died April 446 KnigM, W. T., Corp l, Mar. 25, Right ; circ. Surg. W. L. Baylor, 25, 1862. C, 54th N. Carolina. Ap. 7, 65. C. S. A. Died April 18. 1865. 482 McDonald, J., Corp l, B, April 1, Left ; circ. A. A- Surg. H. Gib 447 Langenderser, M., Pt., Mar. 11, Right ; oblique anterior post. flap. 94th New York, age 20. 8, 65. bons, jr. Haem. Died April 20, A, 189th Ohio, age 18. 14, 65. A. A. Surg. J. J. Cockrell. Bone 1865;pyaem. Autop. Spec. 3200. rem d. Died April 15, 1865. 483 McGee, J., Pt., C, 6th De.29, 62. Left. Died February 2, 1863. 448 Laurier, T., Lieut., K, June 1, Right. (Gangrene.) Died in two Missouri. Jan. 8, 63. 71st New York. 8. 62. hours after operation. 484 McHarvard, T., Pt., C, July 2, . Died July . 1863. 449 Lawton, C. M., Pt., H, June 3, ; ant. post. flap. Surg. R. B. 28th North Carolina. 15, ^63. 58th Penn., age 30. 8, 64. Bontecou, U. S.V. Haem. Died 485 McKittrick, L., Pt.. A, Jan. 1. Left. Died February 13, 1863; June 11, 64 ; shock. Spec. 3057. 37th Indiana. 10, 63. pyaemia. Autopsy. 450 Leach, W. B., Pt., K, 2d June 1, Left ; ant. post. flap. Surg. R. B. 486 McLean, P., Pt., E, 86th April 10, Left ; circ. skin flaps ; cire. sect. Conn. H. A., age 37. 16, 64. Bontecou, U. S. V. Died June Col d Troops, age 23. 29, 65. muscles. Surg. F. E. Piquette, 19, 1864; pyaemia. Spec. 3032. 86th Col d Troops. Died May 451 Lee, P., Pt., C, 142d May 12, Right ; ant, post. flap. A. Surg. 8, 1865; ac. diarrhoea. Penn., age 20. 24, 64. A. Ingram, U.S.A. Sloughing. 487 Mellick, M., Pt., F, llth Aug. P, Right ; ant. post. dou. flap. Surg. Died May 27, 1864. Pennsylvania. 15, 62. J. E. Summers, U. S. A. Haem. 452 Leedy, D., Pt., F, 26th Aug. 8. ; flap. Surg. J.H. Hutchison, from w d in axilla. Died Aug. Illinois. 14, 64. 15th Mich. Died Aug. 14, 1864. 26, 1862. Spec. 41. 453 Leslie, W., Pt., B, 16th De.31, 62, Right (gang.; mortificat n); gan 488 Merron, J., Pt., D, 12th May 9, Left; circ. A. A. Surg. J. O. Infantry. Jan.4, 63. grene. Died Jan. 9, 1863. Mass., age 31. 16, 64. French. Died May 25, 1864; 454 Lindsay, F.. Pt., C, llth Dec. 13, Left. Surg. H. Bryant, U. S. V. pyae mia. Autopsy. Spec. 2286. Penn., age 22. 29, 62. Died January 4, 1863; pyaemia. 489 Metitel, F., Corp l, F, Nov. 27, Right ; ant. post, flap. Surg. C. Spec. 570. 26th Penn., age 20. De.23, 63. Page, U.S.A. Haem. Died Jan. 455 Linsenberger.W.R., Pt., May5, Left; ant. post. flap. Surg. R. B. 19, 1864. Specs. 1433, 2019. B, 139th Penn., age 22. 29, V 64. Bontecou, U. S. V. Died June 490 Miller, A., Pt., E, 95th May 3, Right ; circ. Haem.; lig. fern. art. 7, 1864; exhaustion. Spec. 3041. Penn., age 18. 14, " 63 Died June 6, 1863. Autopsy. 456 Livingston, L. A., Capt., July 2, Left. (July 3, amp. leg ; erysip.) Spec. 1243. F,8th Alabama, age 23. 14, 63. Haem. Aug. 4, bone excised. 491 Miller, C., Corp l, K, 5th April 7, Left. Surg. B. A. Vanderkieft, Died Sept. 27, 63; exhaustion. N. Hampshire, age 33. 23, 65. U.S.V. Died April 29, 65. Spec. 457 Llewellyn, J. T., Corp l, Mar. 31, Left; circ. A.A.Surg.Z.P.Derm- 4104. C, 13th Ohio Cavalry, April 11, ler. Died May 6, 65 ; pyaemia. 492 Miller, L., Pt., D, 100th May 15, Left; circ.; necrosis. Died April age 21. 1865. Spec. 40b2. Ohio, age 25. 18, 64. 4, 1865; gangrene. 458 Lobden, S., Pt., I, 2d Oct. 19, Right ; ant. post. flap. A. A. Surg. 493 Miller, L. S., Pt., E, 12th Aug. 30, Right ; flap. Surg. B.A.Clements, Conn. H vy Artillery, No. 2, 64. C. H. Jones. Died Nov. 16, 64 ; Massachusetts. Sept. 18, U.S.A. Died October 3, 1862 ; age 22. exhaustion. 1862. pyaemia. Spec. 3493. 459 Lohr, E. J., Pt., B, 54th Julv 18, Left , eirc. A.A.Surg.J.H.Coover. 494 Miller, S. C., Pt., K, 8th April 9, Left ; bi-lat. flap. Ass t Surg. A. Penn., age 24. 29, 64. Died Aug.8, 64 ; pi. -pneumonia. Illinois, age 38. M y8, 65. Hartsuff, U. S. A. Died May 9, 460 Loid, W. H., Pt., B, 2d April 6, Right ; circ. Surg. O. A. Judson, 1865. New York H vy Art., 25, 65. U. S.V. Phagedaen. Died May 495 Mills, W. F., Pt., E,8th June 16, Left. (Prim. amp. right thigh.) age 26. 6, 1865; exhaustion. N. Y. H. A., age 42. , 64. Died June 23, 1864. 461 Lave, H. T., Pt., C, 41st July 20, Left ; circ. Died Aug. 1, 1864. 496 Moan, F. H., Corp l, F, May 3, Right; circ.; haem.; lig. fen. art. Alabama, ago 30. 31, " 64. 6th Maine, age 22. 14, 63. Died May 23, 63. Spec. 1255. 462 Loveland, W. H., Capt., May 5, Left ; circ. Med. Ins. F. H. Ham ^Q71 B, 4th Mich., age 35. 20, 64. ilton, U. S. A. Haem. Died May 4y /i ^iOfl Moore, J., Pt., E, 46th Aug. 9, Both; double flap. Surg. J. E. 31, 64; exh n. Spec. 2287. 4yoj Pennsylvania. 15,^62. Summers, U. S. A. Died Aug. 46 1 Luedick,W.,Pt.,C,37th Nov. 24, Right. Died January 4, 1864. 26, 1862. Specs. 46, 47. Ohio. De.16, 63. 499 Moorehouse, O. J., Pt., Nov. 24, Right (ball extr d); circ. Surg. 464 Lynch, A. D., Pt., B, 2d June 2, Left ; circ. Surg. J. W. Wishart, H, 31st Iowa. 30, 63. J. C. Morgan, 29th Mo. Died New York H vy Art., 8, 64. 140th Penn. Died July 4, 1864 ; Dec. 18, 1863. age 41. pyaemia. 500 More, J., Pt., 1, 76th Col April 9, Right ; circ. Surg F. E. Piquette, 465 Lyons, C. H., Pt., K, 5th May 3, Right. Surg. G. P. Oliver, lllth ored Troops, age 30. 25, 65. 86th Col d Troops. Died May 1, Ohio. -, 63. Penn. Died May 13, 1863. 1865 ; exhanst n and diarrhoea. 466 Madden, C., Pt.. 3d S. Carolina Art y, age 17. Sept. 17, Oct. 2, 62. Right; circ. A.Surg.A.H. Smith, U.S.A. Haem.; lig. fern. Died 501 Moriarty, C., Pt., K, 8th New Hampshire. April 13, M yl, 63. Left. Died May 3, 1863. Oct. 8, 1862; exh n. Autopsy. 502 Morse, J., Pt., B, 2d June 16, Right. (Amp. leg.) A. A. Surg. Specs. 777. 833. Penn. Art y, age 22. 25, 64. E. T. Caswell. Haemorrh. Died 467 Mallett, C., Serg t, F, Dec. 13, Left. Died Jan. 2, 1863. Hasm. August 10, 1864 ; pyaemia. 57th New York. 28, 62. Spec. 2451. 503 Murray, H. T.. Serg t, I, [NOV. 27, Right; circ. Surg. E. Bentley, 468 Marion, G. S., Pt., C, May 6. Left ; lat. flap. Surg. R. B. Bonte 6th Maryland, age 24. Dec. 10, U. S. V. Died Dec. 19, 63; py 45th Penn., age 21. 15, 64. cou, U. S. V. Died May 19, 64 ; 1863. aemia. Autopsy. pyaBinia. Spec. 3055. 504 Murray, W., Pt., C, 20th Deo. 7, Left ; lat. flap. Surg. P. Harvey, 469 Mark, J., Pt., K, 110th Mar. 25, Left ; circ. A. Surg. H. Allen, Iowa, age 25. 20, 62. 19th Iowa. Died Dec. 29, 1862; Ohio, age 42. Ap. 3. 65. U.S.A. Died April 23, 1865; pya?mia. pyaemia. Autopsy. Spec. 158. 505 Myers, E., Pt., A, 154th May 3, . Died May 22, 1863. 470 Markle, II.. Pt., C, 148th May 3, . Surg. C. S. Wood, 66th N. New York. 16, %3. Pennsylvania. -. 63. Y. Died June 7, 63. Spec. 1172. 506 Myers, H.. Pt., E, 93d May 12, Left ; ant. post. flap. Surg. R. B. 471 Mars, H., Pt., O. 5th Mar. 31, Right ; circ. A. Surg.W. F. Nor- Penn., age 23. 31, 64. Bontecou, U. S.V. Haem. Died New York, age 24. Ap. 9, 65. ris, U. S. A. Died April 22, 65; June 11, 1864 ; typhoid fever. pyaemia. Autopsy. Spec. 3237. 507 Nance, T. J.. Pt.. H,30th April 4, Right (April 4, amp. leg); circ. 472 Marsh. H. F.. Pt., City June 13, Right ; circ. A. A. Surg. J. Money- Texas Cavalry. Mayl, 64. Surg. C. E. Sxvascy, U. S. V.; Batt n, Petersburg, Va. 20. 64. penny. Died June 24, 1864. pyaemia. Died May 8, "64 ; ex 473 Martin, C., Pt., C, 16th July 2, Right. Haem. July 14, re-amp. haustion, etc. Michigan, age 19. 5 T 63. mid. third; hasm. DiedJuly21, 508 Nelson, C., Pt,, A, 129th Mar. 8, Right (abscess); skin flap. Ass t 1863; pyaemia. Autopsy. Indiana, age 18. 29, 65. Surgeon E. F. Hendricks, 15th 474 Marx, J., Pt., F, 24th Sept. 20, Left. Sufg.I. Moses.U.S.V. Died Conn. Died April 13, 1865; ex Illinois. 30, 63. Oct. 6, 1863. Spec. 2127. haustion, etc. 475 Marys, D., Pt., C, 90th May 5, Right. (Gang.; May 10, amp. knee 509 Nelson, D , Pt., E, 13th Dec. 15, Right. Died Dec. 22, 1864. Pennsylvania. 20, 64. j t; art. sloughed; haem.) Surg. Colored Troops. , "64. J. Ebersole, 19th Ind. Died May 510 Nicely, M., Pt., E, 79th Sept. 19, Left thigh. Died October 17, 63. 20. 1864. Spec. 2340. Indiana. , 63. 476 Mather, Z. H., Serg t. M, July 8, Left (hasm.); flap, skin; circ. mus. 511 Dickinson, A., Pt., G, July 3, . Surg. C. S. Wood, 66th N. 5th Mich. Cav., age 27. 26, Y 63. Died Aug. 19, 1863; pyaemia. 52d North Carolina. , 63. York. Gang. (prim. amp. arm). Autopsy. Spec. 3963. Died July 19, 1863. 477 McAnnay, L., Corp l, L, Mar. 25, Left (humid gang.); circ. A. A. 512 Noye, C.. Pt., C, 63d June 7, Right. Died July 14, 1863. 20th Penn. Cav..age 21. Ap. 1, 65. Surg. W. B. McCuusland. Died Colored Troops. : 21, 63. April 15, 1865; pneumonia. 513 Ocker, T., Capt., A, 6th April 2, Left. Died May 3, 1865. 478 McCallum, M.. Serg t.D, May3, Left. A. Surg. W. Thomson, U. Maryland. . 65. 140th Penn., age 32. 9, 63. S. A. Erysipelas. Died May 514 O Ha ra, H., Pt., I. 19th De. 7/62, Right ; 4at. flap. Surg.P. Harvey, - 17, 1863; pyaemia. Spec. 1081. Iowa, age 23. Jan. 1, C3. 19th Iowa. Died Jan. 9, 1863; 479 Me Cloud, M., Pt., E, 32d Nov. 25, Left ; circ. Surg. J. C. Morgan, pyaemia. Alabama. De.3, 63 29th Mo. Died Dec. , 1863. 515 O Reillv, P., Pt., E,42il Sept. 17, Left ; lat. flap. A. A. Surg.W.W. 480 McCormick, C., Pt:, A, 57th Penn., age 22. July 2, 5/63. Left. Haem. Died July 12, 63; exhaustion. New York, age 20. Oct. 1, KB. Keen, jr. Died Oct. 6, 62; exh n. Spec. 793. SECT, m.] INTERMEDIAKY AMPUTATIONS OF THE THIGH. 301 NO. NAME, MILITARY DESCRIPTION, AXD AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AXU AGE. DATES. OPERATIONS, OPERATORS, RESULT. 516 Osborn, E., Pt., D, 91st Mar. 31 , Left ; semi-circ. Surg.T. R. Cros 549 Reynolds, H. H., Pt., F, Sept. 4, Left. A. A. Surg. J. H. Bartholf. New York, age 20. Ap. 6, 65. by, U.S.V. Died April 18, 1865; 1st Mich. Cav., age 28. 18, 64. Haem.; lig. popliteal art. Died pyaemia. Sept. 30. 18C4; pyaem. Autop. 517 Osborne, S., Pt., M, 2d May 31, Right (gang.); double flap. A. A. Spec. 3930. Conn. H. Art y, age 44. Je.27, 64. Surg. W. C. Earle. Died June 550 Rice, S., Pt., A, 142d Sept. 29, Left; circ. A.Surg D.R.Brower, 31), 1 864 ; pyaemia. New York, age 27. Oc.14, 64. U.S.V. Died Oct. 21, 64; pyaem. 518 Osgood, T. J., Pt., A, Aug. 16, Right (sloughing); circ. A. A. 551 Richards, E., Pt., H, 8th June 3, Left (haem.); ant. post. flap. Surg. 39th Illinois, age 20. Sept. 15, Surg. J. C. Martin. Hsem.; lig. Maine, age 20. 9, 64. R. B.Bontecou.U.S.V. Slough. : 1864. fem. art. Died Sept. 28, 1864 ; haem.: re-amp, mid. third. Died exhaustion. June l:i, 64 ; exh n. Spec. 3064. 519 Paddock, D. G., It., G, May8, Right ; lat. flap. Surg. R. B. Bon- 552 Ridy, J., Pt., I, 9th N. Oct. 19, Left ; circ. A.A. Surg.W.B. Mor 83d Penn., age 23. 16, 64. tecou, U. S.V. Hsem.; lig. fem. Y. H vy Art v, age 41. 25, 64. rison. Died Nov. 11, 1864. art. Died May 24, 64 ; exh n. 553 Ripley, F., Pt. , G, 10th May 5, . (Gangrene.) Surg. G. T. 520 Page, A., Pt., B, 161st April 7, Right; circ. A.Surg.S.H.Orton, Massachusetts. 10, 64. Stevens, 77th N. Y. Died May New York. 15, 64. U. S. A. Died April 27, 1864. 13, 1864. 521 Parker, N., Corp l, B, May 10, Left. (Hm.; lig. post. tib. art.; 554 Robbins, E. H., Serg t, May 6, Right (haem.; May 30. lig. fern. 51st Georgia, age 40. June 2, hsem. recurred ; lig. fem. art y.) F, 15th Mass., age 29. June 2, art.; slough.; haem.); double lat. 1864. Died June 2, 1864 ; shock. 1864. flap. A. A. Surg. J. Ransom. 522 Parsons, T. H., Capt., C, May 3, Left; circ. A. A. Surg. J. O. Died July 15, 1864. 91st Penn., age 29. 11, " 63. Stanton. Abscess ; exostosis. 555 Robinson, F. B , Pt., H. July 11, Left (haem.): circ. Died Aug. 10, Died June 26, 1863; pyaemia. 7th New Hampshire. An. 1, 63. 1863. Spec. 1062. Spec. 1324. 556 Robinson, J., Pt., D,12th Oct. 19, Right : ant. post. flap. A. A. Surg. 523 Payne, D., Pt., H, 2d Oct. 19, Left; double flap. Surg. R. W. Conn., age 34. Nov. 4, C.H.Jones. Nov. 11, haem.; fem. Conn. H. Art y, age 25. Nov. 2, Pease, U. S. V. Haem.; lig. fem. 1864. art. lig. Died Nov. 23, 64; haem. 1864. art. Died Nov. 17, 1864. Spec. 3443. 524 Payne, G. H.,Pt., K,64th Oct. 12, Left (Oct. 21, haem.; lig. pop. art. 557 Rogers, D., Pt., E, 1st S. July 28, Left : double flap. A. A. Surg.W. New York, age 18. 29, 64. Oct.28, haem.; lig.fern.art.); flap. Carolina, age 22. Au21, 64. L.Hammond. Died Aug. 22, 64. A. A. Surg. J. C. Norton. Died 558 Rombaugh; I., Pt., B, Sept. 17, Left. Surg.C. Page.U.S.A. Died Dec. 4, 1864 ; exhaustion. 28th Pennsylvania. Oc.13, 62. Jan. 5, 63 ; col. diarr. Spec. 1745. 525 Peck, N. A., Serg t, D, May 3, Left. (Gang.) Died June 2, 63. 559 Rosenfelt, N., Serg t, D, July 2, Right. Surg.C.W. Jones, U.S.V. 2d Rhode Island. 29, " 63. Spec. 1181. 26th Penn., age 22. 19, 63. Slough.; exc.endofbone; haem.; 526 Perkins, W. J., Pt., A, June 18, Left. Surg.F. F. Burmeister,69th lig. fem. art. Died Oct. 2, 1863. 7th C. S. Cav., age 24. , 64. Penn. Died June 28, 64. Spec. Spec. 1699. 4512. 560 Ross, B. W., Pt., C, 26th Dec. 13, Right, Died Jan. 9, 1863. Spec. 527 Perry, A., Pt., C, 6th N. Aug. 16. Left (art. sloughed ; haern.); circ. New York, age 22. 29, 62. 577. York Cav., age 24. Sept. 3, A. A. Surg. B. B. Miles. Died 561 Rowe, J. A., Pt., I, 3d Aug. 16, Left ; circ. A.A.Surg.E.B. Wool- 1864. July 8, 65; osteo-inyelitis. Spec. Maryland Cavalry. 28, 64. ston. Sloughing. Died Oct. 18, 2965. 1864; exhaustion. 528 Perry, W., Pt., A, 34th June , Left. (Irrita. fever.) Died July 562 Royal, R. B., Pt., B, 6th June 3, Left ; circ. Died June 23, 1864. North Carolina. J y 8, 62. 16, 1862. Maine, age 25. -, 64. 529 Peters, F., Pt., A, 49th June 1, Left; circ. A. A. Surg. J. Cass. 563 Ruhling, F.J., Serg t, E, June 1, Left ; lat. flap. Surg. R. B. Bonte- Penn., age 24. 7, 64. Died June 8, 1864; exhaustion. 112th N. Y., age 29. 11, 64. cou, U. S. V. Hsem.; lig. fem. 530 Philbrick, II., Pt., D, June 15, Left ; circ. A. A. Surg. J. Money- art. Died June 18, 1864 ; gang. 117thN. Y., age 25. 24, 64. penny. Died June 27, 64; exh n. Spec. 3050. 531 Phillips, J., Pt., I, 37th June , Right. Surg. Eads, C. S. A. 564 Sackner, J. C., Pt., E, May 31, Left; ciro. A. A. Snrg. F. H. North Carolina. J y 3, 62 Died July 7, 1802. 2d Michigan. June 24, Brown. Died June 24, 1862; 532 Pippin. A. P., Pt., D, April 9, Left; flap. Surg. A. McMahon, 1862. shock. 2d Alabama, age 18. 26, 65. U. S. V. Died May 11, 1865; 565 Sailor, J., Serg t, E, 45th Sept. , Right. Died Oct. 1, 1863. suppuration and exhaustion. Ohio. 30, 63. 533 Polhemus, J., Pt., F, May 3, Left ; circ. Died May 15, 1863 ; 566 Sailor, W., Pt., E, 119th Nov. 7, Left ; circ. A. Surg. G. A. Mur- 137th New York. 8, 63. haemorrhage. Penn., age 40. 14, 63. sick, U. S. V. Died Dec. 1, 63 ; 534 Potter, P. B., Pt., D, May 6, Right. Died June 5, 1864. pyaemia. Autopsy. Specs. 1887, 12th Mass., age 24. 27, 64. 1888, 1889, 1890. 535 Powers, J., Pt., H, 74th Aug. 30, . Died Sept. 1 1, 62 ; tetanus. 567 Salzman, C., Pt., K, 2d De.27, 65, Left (gang.), ant. post. flap. A. New York. 8ep.-, 63. Infantry, age 31. Jan. 3, 66. Surg. C. C.Gray.U.S.A. Hsem.; 536 Prescott, C. R., Corp l, July 21, ; circ. Drs. Darby and Con lig. fem. art. Died Jan. 13, 66. F., 14th New York S. 24, 61. rad. Exc. end of fetnur. Died Autopsy. M., age 27. Augusts, 1861. 568 Saltzman.W.C., Bugler, Oct. 19, Left : ant. post. flap. A. A. Surg. 537 Preston, T., .Serg t, E, July 9, Left ; circ. A. A. Surgeon T. J. 1st N. Y. Ind. Battery, Nov. 16, E.G. Waters. Died Nov. 22, 64; 14th W. Virginia Cav., 25, 64. Dunott. Died August 2, 1864. age 21. 1864. diphtheria. Spec. 3731. age 21. Spec. 3911. 569 Sampson, D. B.. Pt., C, May 31, Left. (Pyaemia.) Died June 26, 538 Price, A. H.,Pt ,H, 188th May 30, Right ; circ. Surg. O. A. Judsou, 6?th New York, age 34. J e , 62. 1862. Penn., age 25. J ne8, 64. U. S. V. Died June 13, 1864 ; 570 Saunders, S., Pt., K, 52d June 16, Left. A. Surg.T.O. Cornish, 15th shock. .Spec. 2942. New York. , 64. Mass. Died J e 25, 64. Spfc. 204. 539 Pulhemus, J., Pt., E, 1st Dec. 13, Left. (Haem.) Dec. 30, haem.; 571 2 Saxon, J. iV., Pt.. D, 9th Nov. 7, Right ; flap. Surg. J. A. Lidell, Mich., age 20. 26, 62. lig. fem. art. Died Jan. 15, 63 ; Louisiana, age 27. 18, 63. U. S.V. Osteo-myelitis. Died exhaustion. Dec. 3, 1863; hasm. Autopsy. 540 Putnam, G. R., Pt., 10th Aug. 25, Right (sloughing); ant. post. flap. Specs. 1819, 1860, 1892. Mass. Batter} , age 32. Sept. 23, Surg. G. S. Palmer, U. S. V. 572 3 Schaffer, C., Corp l, D, Aug. 24, Left ; ant. post. flap. A. A. Surg. 1864. IlEein. Died Nov. 2, 1864. 9th Illinois Cavalry. 27, 63. S. R. Coale. Died Sept. 12, 63 ; 541 Rainier, M. G., Pt., G, Mar. 10, Left (gang.); flap. Surg. C. A. pyaemia. Spec. 2101 . 124th Indiana, age 20. 13, 65. Cowgill, U.S.V. Died March 573 Schaup, H., Pt,, K.lOOth May 14, Left; circ. A. A. Surg. J. S. Hill, 22, 1865 ; shock. New York, age 29. J e 11, 64. Died June 15, 1864; shock. 542 Rairdon, W.. Pt., I, 40th June 27, Right (gang.); circ. A. Surg. C. 574 Schlaf, A., Pt., B. 2d Nov. 30, Right ; ant. post. flap. A. A.Surg. Indiana, age 3(5. July 9, C. Byrne, U. S. A. Haem.; lig. Penn. Art y, age 42. Dec. 7, C. W. Harper. Dec. 15, haem. 1864. Died July 23. 64 ; haemorrhage. 1864. Died Dec. 16, 1864 ; pyaemia. 543 Ramsey. W., Pt., H, 6th April 1, Right; circ. A. Surg. W. Thom 575 Schneider, F., Pt., E, Dec. 7, Right; lat. flap. Surg.P .Harvey, Virginia Cav., age 19. 8, 65. son, U. S. A. Sloughing. Died 20th Wis., age 25. 11, 62. 19th Iowa. Slough. Died Dec. April 18, 65: pyaemia. Autop. 18, 1862; haemorrhage. 544 Ransom, F. H., Corp l, May 16, Left. (Gangrene.) Died May 576 Schweitzer, S., Pt., A, July 7, Left. A. A. Surg. J. C. Shimer. D, 34th Ohio. 27, 62. 30, 1862. 161st Ohio, age 18. 21, 64. Slough. Died July 29, 1864. 545 Reeves, G. T., Pt., E, April 30, Left. Died May 5, 1864. Spec. 3920. 29th Iowa. M y3, 64. 577 Seber, J.W.,Pt., A, 76th July 1, Left. July 20. haem.; August 3, 546 Reeves, W., Pt., K, llth May 24, Right. Died May 31, 64; tetanus. New York, age 27. 4, 63. re amp.; 15, slough. Died Aug. Mass., age 45. 28, 64. 29, 1863; diarrhoea. 547 Reinliart. L., Pt., F, 23d May 12, Left. Surg. O. A. Judson.U.S.V. 578 Sehman, C., Pt., F, 28tb May 16, Left. Died June 1, 186- . N. Carolina, age 3!). 19, 64. Ilaem. Died May 30/64 ; pyaem. Ohio. 30, 62. 548 Kevin, IK., Pt., D, 8th Feb. 20, Autopsy. Spec. 2276. Left. (Haem.) Surg. H. L. W. 579 Senior. T. H..Pt.,C, 10th Maine. July 2, 18, *63. Right; circ. Hasm.; slough. Died July24, 63; pytemia. Autopsy. Tenn. Cavalry, ago 21. Mar.5/64. Burritt, U.S.V. Gang. Died 580 Sheridan. N. B., Pt., A, Dec. 13, Right. Died February 4, 1863. March 11, 1864. Sp:.~2228. 90th Pennsylvania. 17, 62. Autopsy. 1 HOLLOWAY (J. M.), Consecutive and Indeterminate Hxmorrhage from, Large. Arteries after Gunshot Wounds, etc., in Am. Jour, filed. Sciencet t JV. S., 1865, Vol. L, p. 344. LIDELL (J. A.), V. S. Sanitary Commission Memoirs, 1870, Surgical Volume I, p. 188. 2 LIDELL (J. A.), On the Secondary Iraumatic Lesions of Bone, etc., in V. S. San. Com. Memoirs. 1870, Surgical Volume I, p. 358. "BRYAN (J.), loc cit., p. 288. 302 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 581 Sherron, L., , I, 12th Sept. 17, Right. Asst. Surg. J. A. Bigelow, 615 Taylor, C. W., Pt., C, Dec. 13, Left. (Hsem.; gangrene.) Died Ohio, age 22. Oct. 14, 8th Conn. Haem. Died Oct. 60th Georgia, age 20. 26, 62. Dee. 28, 1862. Spec. 638. 1862. 25, 1862. 616 Taylor, J., Pt., H, 91st July 20, Left (gang.); ant. post. flap. A. A. 582 Shields, J. J., Pt., K, June 1, Left (gang.); flap. A. A. Surg. Ohio, age 32. Aug. 6, Surg. M. M. Townsend. Died 105th Penu., age 19. 10, 62. G.W.Edwards. Died June 30, 1864. August 10, 64. Spec. 4273. 1862. Autopsy. 617 Taylor, J. G., Pt., G, Dec. 13, ; circ. Surg. E. Bentley, U. 583 Shuey, A. B., Corp l, C, Sept. 19, Right ; flap. Surg. W. A. Barry, 12th Mass., age 37. * 1 , 62. S. V. Dec. 28, htemorrh. Died 93d Pennsylvania. 22, 64. 9th Penn. Died Sept. 27, 64 ; Dec. 28, 1862. exhaustion. 618 Teagles. B. A., Pt., G, Feb. 6, Right. Surg. J. Dwinelle, 106th 584 Six, I., Pt,, K, 14th W. July 20, Left ; ant. post. flap. Surg. J. B. 126th N. York, age 20. 11, 64. Penn. Died Feb. 19, 1864; py Virginia, age 16. 26, 64. Lewis, U. S. V. Aug. 3, haem.; aemia. Spec. 2045. lig. fern. art. Died Aug. 14/64 ; 619 Thompson, J. M., Pt., H, June 3, Left ; lat. flap. Surg.R.B.Bonte- haemorrhage. Spec. 4270. 12th N.Hamp., age 20. 9, 64. cou, U.S.V. Died June 15, 64. 58 Smith, A. M., Pt., 1, 10th July 9, Right; circ. A. A. Surg. A. R. 620 Thompson, W., Pt., H, Mar. 25, Right. (Dry gangrene.) Surg. Vermont, age 20. Aug. 3, Gray. Died Aug. 8, 64 ; exh n. 69th N. York, age 19. April 2, D. W. Bliss. Pyaemia. Died 1864. Autopsy. Spec. 3814. 1865. April 15, 1865; exhaustion. 586 Smith, C. D.,Pt.,H, 15th Sept. 17, Right. Died Sept. 27, 1862. 621 Thompson, W. H., Pt., June 3, Right ; flap. Surg.A. F.Sheldon, Massachusetts. 24, 62. C, IstTJ.S.S.S., age 20. 16, 64. U.S.V. Died June 16, 64 ; shock. 587 Smith, E. W., Capt., D, Sept. 19, Right. Died October 16, 1863. 622 Thormsley, J., Pt., I, Nov. 25, Right; circ.; gang. Died Dec. 21st Michigan. 22. C3. 9?th Ohio, age 18. De. 9, 63. 13, 1863. 588 Smith, G., Pt., B, 2d j Aug. 10, . Died September 15, 1861. 623 Thorn, S. R., Pt., A, May 3. Left. Surg. G. P. Oliver, lllth Infantry. ISep.l. Gl. 124th Pennsylvania. 7, r 63. Penn. Died May 8, 1863. 589 Smith, J., Pt., B, 16~\1 July 26, Right ; flap. A. A. Surg. C. T. 624 Tibbetts, W. B., Serg t, Mar. 31, Left; lat. flap. Surg. E.tlriswold, New York, age 18. Au. 1, 64. Bullen. Died August 23, 18G4; K, 1st Me. Cav., age 28. Ap.13, 65. U. S. V. Died April 19, 1865. exhaustion. 625 Tibbs, L., Serg t, 5th Sept. 29, Right ; circ. A. A. Surg. B. T. 590 Smith, J., Pt., V, 6th Sept. 29, Left ; circ. A. A. Surg. C. C. Ela. Col d Troops, age 21 . Oct. 7, 64. Crooker. Haem. Died Oct. 19, Col d Troops, age 27. Oct. C, 64. Hiem. Died Oct. 14, G4 ; haem. 64; pyaem. Autop. Spec. 1049. 591 Smith, J., Pt., B, 98th Nov. 25, Left. Died Dec. 4, 1863. 626 Timberlake, T., Corp l, Nov. 30, Right ; ant. post. flap. A. A. Surg. Ohio. , 63. H, 25th Ohio, age 20. De. 5, 64. 11. Seaman. Dec. 12, hasm. Died 592 Smith, J. H., Lieut., G, Dec. 1C, Left (gang.); bi -lateral skin flaps ; Dec. 19, 64 ; pyaemia. Autopsy. 34th Georgia, age 32. 29, 64. circ. muse. Surg. J. R. Brust, 627 Tracy, A. L., Pt., K, July 2, Right. Haem.; lig. fern, artery. 1st Tenn. Died May 28, 1865; 141st Penn., age 35. 5, r 63. Died July 22, 63 ; exhaustion. exhaustion. 628 Tresonthick.S.H.,Capt, June 15, Left; circ. Surg. A. P. Frick, 593 Smith, It. K.,Pt., K,l3th Oct. 25, Left (Nov. 10, pyaemia); ant. post. E, 18th Penn. Cavalry, 23, 64. 103d Penn. Gang. Died July Missouri Cav., age 21. Nov. 13, flap. A. Surg. W. H. Warner, age 22. 26, 1864. 1864. 3d Wisconsin Cavalry. Died 629 Trimblv, J. E., Pt., D, Sept. 20, Left ; circ. Died Oct. 22, 1863. Nov. 13, 1864 ; pyaemia. 68th Indiana. Got. 1, 63. 594 Smith, W. L., Pt., I, 5th May 9, Left ; ant. post. flap. A. Surg. G. 630 Truex, J. P., Corp l, F, May 31, Right. A. A. Surg. J. H. Thomp North Carolina, age 24. 18, 64. A. Mursick, U. S. V. Died May 14th N. Jersey, age 22. June 14, son. Haem.; fern. art. secured. 31. 1 864; pyaemia. Autopsy. 1864. Died June 20, 18C4; pyaemia. 595 Snider, D., Pt., G, 4th May 6, Right (slough.); circ. Surg. R. B. 631 Truitt, H. W., Pt., E, Aug. 21, Left ; ant. post. flap. A. A. Surg. Maine, age 47. 20, 64. Bontecou, U. S. V. Died May 137th Illinois, age 22. 24, 64. C. H. Wade. Died Sept. 26, 64 ; 23, 1864 ; haemorrhage. typhoid fever. 596 Somers, J., Pt., E, C4th April 1, Left ; ant. post. flap. A. Surg.W. 632 Uhland, F., Pt., G, 47th Oct. 22, Left, Died Oct. 30, 1862; hsem. New York, age 21. 10, 6.3. F. Norris, U. S.A. Died May 1, Pennsylvania. 25, 62. Spec. 732. 18(55 ; pysem. Autop. Spec. 2629. 633 Unknown, Pt., 23d Ky. De31, 62, . Died January 5, 1863. 597 Sponholtz, F., Pt., A, 5th May 3, Left, Surg. G. P. Oliver, lllth Jan. 5, 63. New Jersey. 7, 63. Penn. Died May 24, 1863. 634 Unks, G., Corp l, L, 62d May 12, Left. Gangrene. Died June 5, 598 Spring, W., Pt., K, 19th Dec. 7, Left ; circ. Surg. G.tl. Hubbard. Pennsylvania. 30, 64. 1864 ; pyaemia. Iowa, age 20. 11, 62. U. S.V. Slough g. Died Dec. 635 Valley, J.R.,Pt,, I, 20th Feb. 7, Right; circ. A. Surg. J.Vansant, 30, 1862. Maine, age 20. 23, 65. U.S.A. Died Mar. 3, 65; pyaem. 599 Steadman, W., Pt., A, May 16, Right. Surg. D. P. Smith, U.S. V. 636 Vunderslice.A. H.,Corp, July], Left. (Haem.) Died August 20, 1st Mass. H vy Art ry, 25," 04. Died June 8, 1864 ; pyremia. E, 27th Penn., age 30. 16, 63. 1863; colliquative diarrhoea. age 21. Spfc. 3296. 637 Vermillye, J. C., Pt., K, May 12, Left (haem.); skin flaps; circ. mus. : .1 Steele, W., Pt., H. 2d Oct. 17, Left. Died November 9, 1864. 124th N. York, age 24. 20, 64. Surgeon T. R. Crosby, U. S. V. New York H vy Art v. , 64. Haem.; lig. fern. art. IJied May Steinhofer, A., Pt., D, May 18, Left. Died May 30, 1864; py 28, 1864 ; exhaustion. 20th Mass., age 24. 27, 64. aemia. Spec. 822. 638 Vest, C., Pt., B, 42d Vir May 12, Left : ant. post. (lap. A. Surg. T. 602 Stephens, E., Pt., I, 1st June 18, Left (spic. rem d); lat. flap. Surg. ginia, age 23. 19, 64. McMillin, U. S. A. Died June Pennsylvania Ilifles. July 15, N. R. Moseley, U. S. V. Died 10, 1864 ; pyaemia. Spec. 2820. 1864. April 11, 1865; debility. Spec. 639 Vincent, R., Corp l, H, May 3, . Surg. G. P. Oliver, lllth 2874. 149th New York. 9, fe. Penn. Died May 15, 63; haem. 603 Sterling, G., Pt., I, 20th Sept. 30, Left (Oct. 11, amp. leg; gang.); 640 Vittman, G. L., Pt., K, Oct. 19, Right; circ. Surg. R. W. Pease, Maine, age 29. Oct. 15, bi-lat. flap. Died Oct. 20, 1864 ; 14th N.Hamp., age 27. No. 2, 64. U. S.V. Died "Nov. 9, 1864; 1864. exhaustion. Spec. 3285. exhaustion. 604 Stoldt, G., Capt., 58th July 3, Left. Died July 21,"63 ; tetanus. 641 Walker, T. S., Pt., D, May 3, Left. Surg. A. N. Dougherty.U. New York. 6, 63. 116th Pennsylvania. 15, 63. S. V. Died May 23, 1863. 605 Stone, G. E., Pt., M, 1st Mass. Art y, age 29. May 19, 29. 64. Right ; ant. post. flap. A. Surg.W. Thomson, U. S. A. Died June 18, 1864; pyaemia. Autopsy. 642 ( 643) Wallace, D., Pt., I, 5th Artillery. July 1, 4, 63. Both; circ. Died Aug. 2, 1863. Specs. 1383, 1384. 606 Story, J. C.,Pt.,D, 114th Sept. 19, Right ; circ. Surg. L. P.Wagner, 644 Wallace, W., Pt., E, 63d June 3, Right ; circ. A.Surg. S. B. Ward, New York. 24, 64. 114th N. Y. Died Oct. 7, 1864 ; New York, age 34. 19, 64. U. S.V. Died July 14, 64 ; py pyaemia. Autopsy. aemia. Spec. 2713. 607 Stover, A. W., Serg t, I, June 20, Right: circ. A. A. Surg. A. N. 645 Walters, C., Pt., H, 42d Sept. 30, Left; circ. Surg. Whitman. 20th Maine, age a3. 28, 64. Brockway. Died June 30, 64 ; New York, age 21. Oc.17, 64. Died October 30, 186-1. shock. 646 Wannamaker, D., Pt.,F, Aug. 28, . (Sept. 7, gang.) Sept. 17, 608 Stowell, P. M., Pt., D, July 2, Left; haem.; lig. Died August 3, 5th New York. Sep.9, 62. haem. Died Sept. 27, 18G2. 70th N. York, age 28. 31, 63. 1863. 647 Ward, J., Pt., I, 170th May 25, Right ; circ. A.A.Surg.R.Ottman. 609 Strader, F. P., Capt., H, Nov. 2.3. Left. A.Surg.C.C.Byrne.U.S.A. New York, age 30. 30, 64. Died July 12, 64. Spec. 2471. fith Indiana, age 26. De. 9, 63. Died Dec. 16, 1863; pyaemia. 648 Watkins, F. M., Serg t, May 1 5, Right (four inches tibia rem d ; 610 Stringer, T. J., Pt., C, , Left. Died November 4, 1862. F, 57th Indiana, ago 24. 30, 64. caries); ciro. A. Surg. R. Mc- 98th Ohio. Oc. , 62. Neilly, 19th Ohio. Died June 611 Stubbs, J.P., Pt.,F,13th Sept. 19, ; circ. A. Surg. D Orsay, 22, 1864; exh n. Spec. 3368. Georgia. 22, 64. P. A. C. S. Died Oct. 10, 1864 ; 649 Weatherell, J. H.,Capt., May 5, Right. Surg. H. W. Ducachet, pyaemia. C, 10th Mass., age 39. 19, 64. U. S. V. Haem.; lig. fern, art y. 612 Stuckey, J. E., Corp l.B, Dec. 13, Right. Died November 17, 1863. Died June 20, 1864 ; pyaemia. 42d Pennsylvania. 24, 62. 650 Weaver, A., Pt., C, 2d June 8, Left; circ. Surg. J. Shrady, 2d 613 Sullivan, J. W., Pt., C, Oct. 19, Left ; ant. post. flap. A. A. Surg. Tenn., age 35. 19, 63. Tenn. Venous hasm. Died June fith Maryland, age 18. Nov. 9, T. F. Murdock. Died Nov. 22, 25, 1863. 1864. 1864; exhaustion. Spec. 3414. 651 Weaver, J. E., Pt., A, July 1, Left. Surg. W. 11. Rulison, 9th G14 *Tate, J. G., Pt., , 53d Sept. 17, Left; circ. Died Sept. 30, 1862; 3d Indiana Cavalry. 17, 63. N. Y. Cavalry. Died Aug. 30, Georgia, ago 20. 29, 62. pyaemia. 1863. Spec. 1482. 1 LIUELL (J. A.), On the Secondary Traumatic Lesions of Bone, etc., in U. S. San. Com. Memoirs, 1870, Surgical Volume I, p. 380. LlDELL (J.A.), On Thrombosis and Embolism, in Am. Jour, of the Med. Sciences, JV. S., 1872, Vol. LXIV, p. 356. 2 FISHER (G. J.), Report of Fifty-seven Cases of Amputations, etc., in Am. Jour, of the Med. Sciences, If. S., 1863, Vol. XLV, p. 47. SECT. III.] INTERMED1AKY AMPUTATIONS OF THE THIGH. 303 NO. NAME, MILITARY DEbCUIl lIO.V, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DEsciumoN, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 652 Wearer, J., Pt., K, 59th June 17, : post. flap. Died July 2, 665 Wilkint, T. E., Corp l, Oct. 19, ; circ. (Haem.; lig. ant. tib. Alabama, age 36. 23, 64. 1864. A, 49th Virginia. 31, 64. and pop. arteries.) Surg. J. M. 653 Weiser, A., Pt.. I, 73d May 3, Left. Died June 3, 63 ; pyaemia. G. McGuire, C.S.A. Slough g; Pennsylvania. -, 63. Spec. 1545. gaug. Died Nov. 12, 64 ; haein. 654 Weiss, C., Pt., F, 29th Aug. 28, . Died September 23, 1862. 666 Wilson, C. M., Pt., F, May 5, Left ; ant. post. flap. Surg. R. B. New York, age 30. Se. , 6-2. 4th New York, age 35. June 2, liontecou. U. S. V. Haem.; lig. 655 Wells, A. A., Sergt, I, May 3, Left. Surg. G. P. Oliver, lllth 1864. fern. art. Died June 5, 1864 ; 5th New Hampshire. 8, 63. Penn. Died Mav 15, 1863. exhaustion. Spec. 3043. 656 Wenger, W., Pt., E, 1st Nov. 25, Left. Died December 15, 1863. 667 Wilson, G., Pt., F, 1st June 3, Right. A. A. Surg. W. C. Minor. Ohio. , 63. New Jersey, age 21. 13, 64. Diarrlio?a. Died June 2.), 64. 657 Werber, G.. Pt., K, 39th May 6. Left ; circ. Surg. E. Bentley, U. 668 Wilson, G. S., Adjutant, De.13, 62, Right. Haeui. Jan. 12, lig. fern. New York, age 31. 25, 64. S. V. Died June 7, G4; asthenia. 17th New York, age 24. Ja. 12, 63. art. Haem. recurred 17 ; 21. lig. 658 Whaley, C. H., Pt., G, Aug. 29 Left. (Gang.) A. A. Surg. J. fern, iirtery. Died Feb. 7, 1863; 14th New York. Sept. 2, Nichols. Died Sept. 6, 1862. pyaema. 1862. Spec. 138. 669 Wilson, T. C., Pt., C, Sept. 19, Right. Died September 22, 1863. 659 Whallon, W. M., Pt., C, Dec. 13, Left. (Dec. 14, lig. fern, artery.) 2fith Ohio. 22. 63. 129th Penn., age 21. 18, 62. Dec. 24, haem.; lig. fein. artery. 670 Wilson, W. C., Pt., C, Aug. 16, Left. Died September 16, 1864; Died June 4. 1863; pyaemia. 105th Penn., age 21. Se.14, 64. pyaemia. 660 Wheeler, H. S., Serg t, Oct. 19, Right ; ant. post. flap. A. A. Surg. 671 Wilson, W., Sergt, F, De.29, 63,! Right ; circ. Died May 27, 1864. B, 2d Conn. H vyArt., 26, 64. B. B. Miles. Haem.; lig. Died 9tb Penn. Cav., age 22. Ja.19, 64. age 29. Nov. 11/64 ; ch. diar. Spec. 3434. 672 Wimer, A., Pt., A, 139th May 5, Left. Died June 3, 1864. 661 Wiesmiller, C., Pt., B, Dec. 13, Left. A. A. Surgeon D. Weisel. Penn., age 21. 13, 64. 1 2th Penn. Reserves, 25, 62. Haem.; lig. Died Dec. 27, 62; 673 Wolf, W., Pt., H, 91st June 18, Left ; ant. post. flap. Surg. E. age 22. exhaustion. Spec. 569. Pennsylvania, age 35. July 5, Bentley, U. S. V. Died July 9, 662 Wilcox, B. F., Pt., B, July 3, Right ; ant. post. flap. Surg. J. B. 1864. 1864 ; exh n. Autop. Spec. 2832. ]35th Ohio, age 21. 14, Ii4. Lewis 1 S V Haem Died 674 Wollenweber, L., Pt.,K, Dec. ]3, Right. Died January 7, 1863. Aug. 5, 1864. 90th Pennsylvania. 27, 62. 663 Will, J., Pt., A, 10th Aug. 30, . A. Surg.B.Howard,U.S.A. 675 Woodward, J. A., Lieut., May 3, Right ; circ. Died June 1, 1863 ; New York. Sep.5, 62. Died Sept. , 1862. I, 86th N. Y., age 20. 11, 63. pyffimia. Autopsy. 664 Wilkie, T., Pt., D, 14th Sept. 17, : ; ant. post. flap. A. Surg. C. 676 Wright, J., Pt., D, 7th June 4, Right ; ant. post. flap. Surg. R. Conn., age 40. Oct. 2, 62. A. McCall, U. S. A. Died O^t. New York H vy Art y, 19, 64. B. Bontecou, U. S. V. Haem. 23, 1862; pyaemia. Autopsy. age 19. Died June 29, 1864 ; exhaustion. In two instances intermediary amputations in the lower third of both thighs were unsuccessfully performed. One of these cases is detailed: 2 CASE 474. Private D. Wallace, Co. I, 5th Artillery, aged 37 years, was wounded in both legs, at Gettysburg, July 1, 1863, and suffered amputation at the field hospital of the 2d division, Fifth Corps. Assistant Surgeon B. Howard, U. S. A., reported: "The patient was struck by a rnini6 ball, which passed through one knee joint and shattered the patella of the other. A flesh wound was also received by another shot in the upper third of the left thigh. Both thighs were amputated by the circu lar method in the lower third, in immediate succession, on the third day after the wound was received. Very little blood was lost at the operation, and no appreciable oozing had occurred by the next day, at which time the patient was in such good spirits as to create frequent merriment among iiis wounded comrades by his funny witticism. His pulse and appetite had both improved." The patient was subsequently transferred to Camp Letterman, where he was received on August 1st, in a very exhausted con dition, the stumps not having been dressed for two days; he died on the following day, August 2, 1863. The bones of the knee joints of the amputated limbs were contributed to the Museum by Dr. Howard, and constitute specimens 1383 and 1384 of the Surgical Section. The former consists of a ligamentous preparation of the right knee, from which the patella was shot away; the latter embraces the bones of the left knee, the condyles of the femur being completely shattered. The amputations in the foregoing table were performed, for shot injuries of the lower third of the thigh, in forty-one; of the knee joint, in four hundred and thirteen; of the leg, in two hundred and two; and of the ankle joint or foot, in twenty instances. The Museum possesses specimens in two hundred and three of the six hundred and seventy-six cases of intermediary amputations in the lower third of the thigh. Intermediary Amputation in the Shaft of the Femur without Indication of the Seat of Incision. In twenty-six only of the thirteen hundred and twenty intermediary opera tions the seat of operation was not specified. Seven had successful and nineteen fatal terminations; a mortality of 73.0 per cent. Eighteen operations were performed on Union and eight on Confederate soldiers. The seat of fracture in the twenty-six cases was in the lower third of the femur in two; in the knee joint, in three; and in the leg, in three cases; in eighteen instances the fracture was recorded to have been in the femur, but the precise point was not indicated. Such meagre details as are reported on the records of this office will be found in the table on the next page. COUES (E.), Report of some Cases of Amputations and Resections from Gunshot wounds, performed by Ast t Surgeon C. A. HcCall, V. S. A., in Medical and Surgical Reporter, 1862-3, Vol. IX, p. 195. 2 The other instance of intermediary amputation <>t Uuth thighs in the lower thirds is that of Private J. Moore, E, 46th Pennsylvania (TABLB XXXVI, p. 300, Nog. 497, 498, ante), wounded Aug. 9, 18(2; double flap amputations at lower thirds of both thighs, Aug. 15, 1862; death Aug. 26, 1862. 304 INJURIES OF THE LOWER EXTREMITIES. TABLE XXXVII. LCHAK X, Summary of Twenty-six Cases of Intermediary Amputation in the Thigh for Shot Fracture, the Point of Ablation unspecified. [Recoveries, 17; Deaths, 8 26.] NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 o 3" Grim, P., Pt., F, 25th Virginia. Read, J. it., Pt., H, 48th Alabama. Siblei/, R. W., Pt., A, Aug. 9, 29, 62. Oct. 29, No. 13. 63. June 13, Left. Surgs. Bland and Miller C. S. A. Recovery. . Surg. Westmoreland, C. S. A. Recovery. Left. Surg. J. N. K. Monmonier, 14 15 16 Lohnes, A., Pt., K. 104th New York, age 27. McDonald, A. O., Serg t, D, 7th Mich., age 25. Peck, M. A., Pt., H,33d July 1, 9, 63. Dec. 13, 28, 62. April 30, Right. July 22, re-amp. Died August 20, 1863. Left. Died January 2, 1863; py aemia. . Died June 5, 1864. 4 6th Louisiana. Stevens, , Pt., , 13th 17, 62. Aug. 30, 8th La. Recovery. Right. Ass t Surg. B. Howard, 17 Iowa. Rankin, W. H., Pt., C, June*27, . Died July 21, 1862. 5 Massachusetts. Terry, W., Pt., , 76th Sep.4, 62. Aug. 30, U.S.A. Left. Ass t Surg. B. Howard, 18 95th Pennsylvania. Rhoads, D. W., , llth J ylO, 62. April 7, . (Erysipelas; haem.) Died 6 .- 9 10 11 Pennsylvania. Vogt. F. E ., Serg t, F, 1st Maryland. Williams, G. H, Pt., B, 7th South Carolina. Anderson, A., Pt., B, "l. d Illinois. Dixon, W., Pt., D, 14th N. Carolina, age 21. Fox, M., Pt., B, 1st Michigan. Freyer, W., Pt., K, 1st Michigan. Sep.3, 62. June 8. 19, 62. Sept. 19. 27, 63. April 6, 22, 62. May 12, 19, 64. Aug. 30, Sep.4, 62. Aug. 30, Sep. 2, 62. U. S. A. Left. Disch d June 28, 1864. . Surg. Carlisle, C. S. A. Recovery. Left. Died April 28, 1862 ; haem orrhage. . Died May 21, 1864; py aemia. Right. Ass t Surg. B. Howard, U. S. A. Died Sept. 10, 1862. Right. Ass t Surg. B. Howard, U.S.A. Died Sept. , 1862. 19 20 21 22 23 04 Kentucky. Rodgers. E. F., Serg t, C, 1st Michigan. Ross, C., Pt.. E, 5th N. York, age 17. Shields, J. A., Pt., K, 105th Penn., age 19. Sonderman, C., Pt., K, 17th Illinois. Thornburg, G., Pt., C. 70th Ohio. Waller, D. ./., , E, 23d M y3, 62. Aug. 30, Sept. 6, 1862. Aug. 30, So. 23, 62. May 31, Je. 10, 62. April 6, 25, 62. April 6, 20, 62. Sept. 14, May 3, 1862; haemorrhage. Right. Ass t Surg. B. Howard, U. S. A. Died Sept. 16, 1802; pyaemia. Right; circ. Died Oct. 7, 1862; pyaemia. . June 17, pyaemia. Died June 30, 1862. Autopsy. . (Erysipelas; haem.) Died April 25, 1862. . Died May 2, 18o2; haemor rhage. . Sept. 15, amp. leg; 25, 1- 13 Harney, R., Serg t, A, 29th Mass., age 28. Legler, G., Pt., K, 9th Wisconsin. J une 2, 14, 64. April 30, M y25, 64. Left ; circ. A. A. Surg. F. G. H. Bradford. Died June 26, 1864; exhaustion. Right, Died June 3, 1864. 25 26 South Carolina. Warren, H. M., Corp l, D, 18th Mass. Weston, H., Pt,, K. 15th Illinois. 25. 62. Dec. 13, 20, 62. April 6, 25, 62. haem. Died Oct. 13, 1862. Right. Died December 20, 1862. Right. Died May 13, 1862. SECONDARY AMPUTATIONS IN THE SHAFT OF THE FEMUR. There were four hundred and forty-two cases in which the amputation in the thigh was practised sub sequent to the thirtieth day after the reception of the injury. Two hundred and thirty-nine recovered and two hundred and three died, a fatality of 45.9 per cent., or 3.9 per cent, less than in the series of primary, and 17.8 per cent, less than in the series of intermediary operations. Secondary Amputations in the Upper Third of the Shaft of the Femur. Fifty-five operations of this nature were reported, with twenty-five deaths, or a mortality of 45.4 per cent. The operations were performed on forty-five Union and ten Confederate soldiers. In thirty the right limb, and in twenty-one the left limb, was involved, and in four this point was not indicated. Recoveries after Secondary Amputations in the Upper Third of the Femur. Thirty of the secondary amputations in the upper third of the femur resulted favorably, six on Confederate and twenty-four on Union soldiers. Twenty-three of the latter were pensioned, and all but one were living in October, 1879. In two cases the lesions were consequent on injuries inflicted by shell, in one by grape shot; in twenty-seven, the injuries were believed to have been caused by small projectiles. Two of the patients had undergone prior operations, one, an amputation of the same leg, and one, an excision of three and a half inches of the upper third of the femur. 1 The convalescence was retarded by pyaemia in one, by gangrene in two, and by haemorrhage in three instances. In the following case bleeding occurred on the thirteenth day, but was readily controlled by the tourniquet and ice: CASE 475. Captain J. A. Bates, Co. D, 12th New York, was wounded in the right leg at Gaines s Mill, June 27, 1862, and underwent amputation nineteen months afterwards. Surgeon A. B. Mott, U. S. V., who performed the operation, made the following report of it: "The wound was caused by a shell which splintered the tibia about midway between the knee and the foot without completely fracturing it. The patient entered Ladies Home Hospital, New York City, December 25, 1863, and 1 The amputation of the thigh had l>een preceded by amputation in the leg in the case of C. I5asim, Pt., II, 8th Pennsylvania Reserves (TAI)LE XXXVIII, No. 2, ]>. 308), by excision in the shaft of the femur in the case of Pt. S. C. Hall, K, 3d Indiana Cavalry (TAliLE XXV, No. 3, p. 208, ante, aud TAliLK XXXVIII, No. 9, p. 308). SECT. III.] SECONDARY AMPUTATIONS OF THE THIGH. 305 thirty days afterwards the limb was amputated. At the time of the operation the leg had become greatly swollen from enlarge ment of the bone, the skin was discolored with numerous ulcerations, and there was an immense discharge of matter from the ulcers and from an abscess about the knee joint. The patient was in a very low and emaciated condition, had no appetite, and was unable to sleep without taking anodynes. The amputation was performed at the upper third of the thigh by the circular method, and was attended with little haemorrhage, chloroform being used, and followed by prompt reaction. Ligatures were applied to every bleeding vessel. The patient did well from the time the operation was performed. He was ordered to have two pints of porter and six ounces of brandy daily, together with nourishing diet. Some haemorrhage took place on the thirteenth day, which was easily controlled with the tourniquet and ice, but recurred one week afterwards. On June 12, 1864, the patient was discharged from the hospital cured." Captain Bates re-entered the Army as an officer of the 43d Infantry, July 28, 1866, and four years later he was retired from active service. He was furnished with an artificial limb by B. F. Palmer, of Philadelphia, July 14, 1869. In the next case the amputation was not performed until seven years after the date of the reception of the injury: CASE 476. Private Jesse M. Jones, 1 Co. K, 21st Indiana, aged 29 years, was wounded at Baton Rouge, August 5, 1862, by a musket ball, which fractured the right femur at the junction of the middle and upper thirds. He was taken to the regimental hospital, remained there one day, and was then sent on a hospital transport to New Orleans, the limb meanwhile being supported by bandages and pillows. On arrival, August 7th, he was admitted to the St. James Hospital, where a long splint was applied, seventeen days after the reception of the wound. Ho was discharged April 15, 1863, and pensioned. On No vember 14, 1866, Examining Surgeon W. J. Hoadley, of Danville, Indiana, reports : "The wound still unhealed, fracture had united by large deposits of bone; limb shortened four and three-fourths inches." In January, 1869, he entered Providence Hospital, Washington; and, on the 23d, Dr. D. W. Bliss, late Surgeon U. S. V., amputated the thigh in the upper third by the antero-posterior flap method. The patho logical specimen was presented to the Army Medical Museum by the operator. It is No. 5558 of the Surgical Section (FiG. 196), and shows great deformity, with exfoliations on posterior aspect, and a fragment of lead imbedded in the callus. On March 9, 1869, Jones visited the Museum, when his photograph (A. M. M. Card Photographs, Vol. I, p. 27) was taken, a copy of which is shown in the wood-cut (FiG. 197). His pension was paid December 4, 1879. Of four of this series of thirty cases of secondary amputation in the upper third of the femur the specimens are preserved in the Army Medical Museum: CASE 477. Sergeant J. Hammill, Co. D, 8th New Jersey, aged 23 years, was wounded in the right knee, at Chancellorsville, May 3, 1863. From the field he was conveyed to Potomac Creek Hospital, and thence, six weeks afterwards, to Washington, where the injured limb was amputated. Surgeon D. W. Bliss, U. S. V., who performed the operation, reported : "The wound was caused by a mini6 ball, which struck the external condyle of the femur and passed directly through, comminuting the condyles and lower part of the femur and opening the joint. The patient was admitted to Armory Square Hospital, June 14th. He was then suffering from profuse suppuration from the joint, and had a large abscess attended with disintegration of the tissues of the calf of the leg, in consequence of which he was in a very reduced condition. There were no symptoms of pyaemia, however. As there was no possible chance of life for the patient without an operation, it was decided to amputate, which was done on June 16th, by the circular method, at the junction of the middle and upper thirds. The soft parts were found in a very diseased condition. The patient stood the operation well and progressed favorably. Three months afterwards he was transferred to St. Elizabeth Hospital." The man was ultimately discharged from Ward Hospital, Newark, May 4, 1864, having been previously furnished with an artificial limb by E. D. Hudson, of New York City. He is a pensioner, and was paid June 4, 1878. The amputated part of the femur, together with the bones of the knee, were contributed to the Museum by the operator, and are shown in the cut (FiG. 198). The specimen shows a slight deposit of callus on the border of the fracture, and much disorganization of the articulation by suppuration. As already remarked, one of the twenty-three pensioners of this of lower third of right fe- J J L mur, with slight deposit of group died nearly fifteen years after the operation : CASE 478. Private M. Hartigan, Co. H, 108th New York, aged 18 years, was wounded in the left knee, at Antietam, September 17, 1862. He was moved from a field hospital to Frederick twelve days after the injury, and two days later to Ches ter, where the injured limb was amputated. Acting Assistant Surgeon C. J. Morton, who performed the operation, contributed An account of the case has been published in Circular No. 3, Surgeon General s Office, Washington, 1871, p. 209. SUKG. Ill 39 FIG. 196. Rig-lit lemur fractured at junction of upper and middle thirds. Spec. 5558. FIG. 197. Appearance of the weeks after operation. [From a phi ;t mil p six tograph.J FIG. 198. Shot fracture 306 INJURIES OF THE LOWER EXTREMITIES. the pathological specimen (Cat. Sury. Sect., 1866, p. 337, Spec. 262), with the following details of the case: "The wound was produced by a ball, which entered near the centre of the popliteal space and emerged at outer side of the knee. The man walked from the battle field to the field hospital. After his admission to Chester Hospital, on October 2d, the wound did well for u few days, when syuovitis ensued, and the knee joint became highly inflamed and painful on motion. The patient was also suffering from diarrhoea, poor appetite, and .was much emaciated. About a week afterwards large dissecting abscesses formed above and below the knee, which were freely opened, and compresses were then applied to prevent the upward tendency of the abscesses. On October 29th, the muscles were completely dissected with pus to above the middle of the thigh, and the least movement of the limb would cause the most agonizing pain; the patient s appetite now being completely gone and his emaciation very great. On consultation, it was then decided that, as the only means of preserving life, amputation should be resorted to, which was performed about four and a half inches below the great trochanter. The patient spent a wakeful night after the operation, his pulse being 160; but after several days he began to rest better and regained some appetite, and by November 6th his general condition was much improved, the stump healing nicely and showing every prospect of recovery. By December llth, the stump was nearly healed and the patient had almost recovered. Dissection of the amputated limb showed that the ball had passed through the joint and struck the outer condyle of the femur. The cartilage of the femur and tibia was very much roughened." The specimen consists of a ligamentous preparation of the bones of the injured knee. The patient was discharged from service May 19, 1863, and pensioned. He was subsequently supplied with an artificial limb by the Palmer Arm and Leg Co., by whom the operation was described as having been performed by the flap method. The pensioner died April 1, 1877. Fatal Cases of Secondary Amputations in the Upper Third of the Thigh. The twenty-five operations of this group were performed on four Confederate and twenty-one Union soldiers. In one instance excision in the middle third of the femur had preceded the secondary amputation. 1 Four patients perished from pyaemia, two from gangrene, ten from exhaustion, three from shock. In one instance it was believed that chloroform con tributed to the unfortunate result, 2 and in five the cause of death was not recorded. CASE 479. Private John Pool, Co. H, 119th Pennsylvania, aged 23 years, was wounded by a conoidal ball, at Rappa- hannock Station, November 7, 1863. He was admitted into the Stanton Hospital, Washington, November 9th. Surgeon John A. Lidell, 3 U. S. V., furnished the following history, with the specimen (.No. 2229, Sect I), to the Army Medical Museum : "The bullet had entered the lateral and external part of the left thigh near the junction of the middle and upper thirds, and passing downward, inward, and somewhat forward, had fractured the femur at its middle. The missile appears to have been split, by contact with the bone, into two pieces, which made their escape through separate openings in the popliteal space. When admitted the knee was much swollen and hot; the patella floated some distance above the femoral condyles. He did not complain of pain, and his general condition was favorable. The wounded limb was propped up with long sand bags placed on either side of it, and moderate extension was applied by a weight hanging over the foot of the bed and attached to the foot and leg by strips of adhesive plaster. Counter extension was effected by elevating the foot of the bed. He was put upon supporting diet, and simple dressings applied. The inflammation and swelling at the knee gradually subsided, and, on December 1st, had entirely disappeared, the wounds in the popliteal space closed; the wound of entrance, however, w;is still open and discharging. On the 20th, there was a slight hemorrhage of arterial blood from the wound of entrance, which was readily checked. On the 28th, the limb was placed in Hodgen s splint to facilitate the outflow of pus. January 8, 1864, the wound in the popliteal space reopened and the wounds, both of entrance and exit, discharged freely. 24th, pulse 110; he was daily becoming more feeble. On exploring the wound through the orifice of exit with N41aton s probe detached fragments were found at the seat of fracture. The patient was etherized, and through an incision about four inches long, made in the back part of the thigh, six detached fragments of considerable size, the largest about two inches long by three-fourths of an inch wide, were extracted. The supe rior and inferior part of the fractured femur were found to be held in proper position by strong splints of provisional callus, which had been thrown out on the inner and outer sides of the bone. The finger could be readily passed between the broken extremities of the bone, both ends of which were necrosed but not yet detached. On the 25th, the thigh had swelled a good deal and was emphysematous, but, on the 28th, the emphysema had disappeared and the swelling was subsiding; the limb was again placed in Hodgen s splint. On the 31st, he was improving in every respect. On February 14th, he was doing finely; no night sweats; slept well; appetite good; pulse 80; discharge of pus moderate. 24th, two fragments of bone were extracted. March 1st, a diffuse inflammation, accompanied with redness and much swelling, attacked the thigh and spread rapidly through the limb; there was also great constitutional disturbance. After a time this inflammation subsided in a great measure but left him much weakened. About April 1st, another attack of diffuse inflammation brought him still lower. 18th, the whole limb was greatly swollen from the groin to the toes; a small slough on the instep separated; the knee joint was extended with effusion, the patella floating some distance above the femoral condyles. There was a profuse discharge of thin pus from the wound of operation in the back part of the thigh. He was much emaciated, pale, and weak ; pulse frequent and feeble; tongue red and inclined to be dry; appetite capricious and poor, and he was subject to frequent attacks of diarrhoea. He was steadily Case of Private C. Collar, F, 45th Illinois (TABLE XXVI, No. 8, p. 210, ante, and TABLE XXXVIII, No. 34, p. 308). *Case of Private J. Bradley, D, 25th North Carolina (TABLE XXXVIII, No. 32, p. 308), admitted to Chimborazo Hospital, Richmond, June 25, 1862, with a slight wound of patella and integuments covering it, not penetrating joint. July llth, patella partially necrosed; gangrene appeared on inner and outer aspect of knee joint, showing tendency to spread. July 18th, amputation of thigh at junction of middle and upper thirds. Death July 18, 1862, a few minutes after the operation. A remark on the hospital register explains : " The wound was deemed of trifling importance until the llth, when the patella was discovered to be necrosed. The chloroform may have contributed to the unfavorable result, for it caused him to vomit freely, and he was unable to retain any stimulants on his stomach." 3 LIDELL (J. A.), On Secondary Traumatic Lesions of Bone, viz: Osteo-myelitis, Periostitis, Ostitis, Caries, and Necrosis, in U. S. Sanitary Commitsion Memoirs, 1870, Surgical Volume I, p. 414. - o z_ H - c _ 3 -- en - O SECT. HI.] SECONDAKY AMPUTATIONS OF THE THIGH. 307 failing, and, there being no hope of saving his life without amputation, he was placed under the influence of sulphuric ether, digital compression applied to the femoral artery, and the thigh amputated in the upper third, by the double flap method, bv Surgeon .1. A. Lidell, U. S. V. The femur was sawn off about one and a half inches below the trochanter minor. The soft parts of the thigh were so much diseased as not to admit the performance of the operation at any point below. But little blood was lost during the operation. There was a good deal of shock, but he reacted promptly afterward. In a short time the stump became sloughy; he gradually failed, and died of exhaustion April 26, 1863. On examining the amputated member, extensive burrowing of pus was found among the muscles of the thigh, and numerous small pieces of the bullet and fragments of bone sticking into the soft part around the seat of fracture. The ends of the broken femur were not in apposition, but separated from each other by the space which had formerly been occupied by the fragments of bone extracted by operation. Pretty firm union had, however, taken place by means of a bridge of new bone which arched over the chasm in front. On splitting the femur open lengthwise with a saw the marrow presented a coppery-red color, and there were abundant, deposits of new reddish colored osseous tissue both within the medullary canal, endostosis, and, external to the bone, periostosis, for a considerable distance above the fracture. In the marrow below the fracture there was a large-sized chocolate-colored spot, the result, apparently, of an old extravasation of blood. The substance of the marrow was decidedly tougher than normal. There was a considerable deposit of new osseous tissue lying between the periosteum and the bone. The periosteum itself "as thicker and redder than natural in that locality, and from it these laminae of new osseous tissue had been developed. Th knee joint was swelled out with a straw-colored jelly-like substance; the synovial fringes were reddened, but the articular cartilage presented no abnormity." A drawing of the specimen, No. 2229, by Hospital Stewart E. Stauch, is copied in PLATE LXVI, opposite p. 306. In the following instance amputation was performed twenty-two months after ike injury. The patient had been discharged and pensioned, but the wound reopened, allowing the end of the lower portion of the femur to protrude through a fistulous passage : CASE 480. Private P. Eiley, Co. A, 10th New York, aged 24 years, was wounded at Cold Harbor, June 3, 1864, and admitted to the field hospital of the 2d division, Second Corps. Surgeon J. F. Dyer, 19th Massachusetts, recorded : " Gunshot fracture of left thigh, upper third." Surgeon J. C. McKee, U. S. A., contributed a photograph, which is shown in the wood-cut (FiG. 199), and reported as follows : "Admitted to Lincoln Hospital, Washington, June llth, with a gunshot fracture of the left femur, the ball entering the anterior surface of the thigh four inches below the anterior superior spinous process of ilium, passing directly backward, producing a compound comminuted fracture of the upper third of the femur, and lodging in the muscular substance of the thigh posteriorly. Extension and counter-extension were used, but re moved on account of the inflammation of the parts and the severe pain produced. Three weeks after admission free incisions were made for the discharge of pus. The patient slowly recovered, with four and a half inches shortening of the limb." He was mustered out of service August 1, 1865, and pensioned. A cast of the injured limb in this case was also contributed by Dr. McKee, and constitutes specimen 4051 of the Surgical Section of the Museum. (See Cat. Surg. Sect., 1866, p. 535.) Examiner W. H. Thomson, of New York City, certified, January 22, 1866: "A ball entered the inner aspect of the left thigh and fractured the femur opposite the great trochanter. The limb is now much distorted and marked with fistulous passages, from one of which, at the anterior upper third of the limb, the end of the lower portion of the femur protrudes. He should not have been discharged from hospital in that condition." Dr. M. M. Marsh, Surgeon at the Lincoln Hospital, New York City, certified : "That in the month of April, 1866, Peter Eiley came into the hospital for an operation on a shattered femur in its upper third, the lower fragment of bone protruding. Amputation was performed, and the patient died of pyaemia May 7, 1866, and in consequence of the injury received in the service as the remote cause." (See Photo. Series, A. M. M., No. 117.) FIG. 199. Appearance of limb a year after injury, photograph.] [From a Consecutive bleeding was observed in three instances, two of which necessitated liga- tion of the femoral artery. One of the cases is detailed: 1 CASE 481. Private J. B. Lynn, Co. B, 83d Ohio, aged 19 years, was wounded in the right leg, at Fort Blakely, April 9, 1865, and was admitted to Sedgewick Hospital, Greenville, four days afterwards. Assistant Surgeon A. Hartsuff, U. S. A., who amputated the injured limb, furnished the following report of the operation: "The wound consisted of a longitudinal frac ture of the upper portion of the tibia, involving the knee joint. The ball passed through the bone downward and emerged opposite the tendon of the gastrocnemius. On May 30th, the limb being infiltrated with serum and there being extensive bur- 1 The other instance of ligation of the femoral artery is that of Private H. Griffith, E, 8th New York Cavalry ; wounded at Autietam, September 17, 1802 ; shot fracture of left knee joint. Amputation at upper third of thigh, November, 1862 ; ulceration of branch of femoral nrtery, haemorrhage ; ligation of femoral at Scarpa s triangle, November 19, 1862 ; death November 19, 18(i2. Specimens 768 and 8o3, Sect. I, A. M. M. 308 INJURIES OF THE LOWER EXTREMITIES. (CHAP. X. rowing of pus from phlegiuouous erysipelas, amputation was performed at the upper third of the thigh by the circular method. No sutures were introduced on account of the condition of the parts, thereby favoring the draining of the serum. Though the patient was debilitated and much emaciated, he finally rallied under stimulants and nourishing diet. On Jure 5th, haemorrhage occurred, amounting to over twenty ounces, when the femoral artery was immediately cut down upon, expo ed in its continuity, and ligated about an inch above the face of the stump. Death occurred two days later, from exhaustion. The ligatures were found to, have ulcerated through, the arteries being patulous and showing no attempt at closing." TABLE XXXVIII. Summary of Fifty-Jive Cases of Secondary Amputation in ike Upper Third of \he Femur for Shot, Fracture. [Recoveries, 130; deaths, 31 55.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Babson,C.L.,Pt.,K,16th De.13, 62, Left ; ciro. A. A. Snrg. A. Cool- 29 Smith, P., Pt., F, 5th In. Feb. 22, Right ; flap. A. Surg. B. Norris, Maine, age 21. Mar. 28, idge. Disch d Oct. 16, 1863. fentry. M y4, 62. U. S. A. Disch d J uly 13. 1 862. 1863. 30 Walsh, H., Landsman, July 16. Left; circ. Surg. \V. Johnson, 2 Basim, C., Pt., H, 8th Sept. 17, Right. (Sept. 17, amp. leg; gang.) U. S. S. Mendota, age Sept. 2, U. S. N. Diseh d April 11 , 1865. Penn. Reserves, age 20. Dec. , Drs. Jones, Stewart,and Thomp 18. 1804. Spec. 3213. 1862. son, Strattonville, Pa. Disch d 31 Bosse, E.. Pt., F, 8th June 8, Left; lat. flap ; hectic fev.; diarr. Dec. 6, 1862. New York. J yl5, 62. Died Sept. 1, 62; pyaem. Autop. 3 Bates, J. A., Capt., D, Je.27, 62, Right; circ. Surg. A. B. Mott, 32 Bradley, J., Pt., D, 25th 1 . (Necrosis; gang.) Died 12th New York. Jan. 24, U. S.V. Feb. 6, haem. recurred. North Carolina. J yl8, 62. fi;w minutes after operation. 1864. Disch d June 12, 1864. 33 Byram, W., Pt., K, 3d May 6, Right. (July 150, bone rem d.) 4 Brinker J. H., Pt., E, De.13, 62, Right (necrosis); flap. A. A. Surg. Michigan Cav., age 20. Aug. 7, Surg. A. Hammer, U.S.V. Died llth Penn., age ss3. Mar. 21, J. H. Thompson. Discharged 1864. August 10, 1864. 1864. March 3, 1865. 34 Collar, C., Pt., F, 45th Feb. 14, Right. (March 12, exc.) Rurg. 5 Crede, F., Pt., C, 178th April 9, Left ; ant. post. flap. Surg. J. F. Illinois, age 20. M yl, 64 \V. J. McKim, 15th 111. Died New York, age 29. Sept. 1, Randolph, U. S.A. Discharged May 9, 1864 ; shock. 1864. Oct. 21, 1865. 35 Cowperthwaite,C.,Corp., ; Oc.l2, G3, Left; circ, A. Surg. A. Ingram, 6 Drew, D., Pt., F, Phil- Au.31, 62, Left. Surg. Owens, C. S. A. L, lstN.J.Cav.,age22. |jan.5. G4. U.S.A. Died Jan. 6, 64; shock. lips Legion. Ja.31, 63. Recovery. 36 Cunningham, O. H., Pt., May2, 63, Right (ball ext.; erysip.); double 7 Eltett, L., Pt., D, 16th May 3, ; circular. Recovery. I, 82d Ohio, age 35. May3, <!4. flap. Surg. D.W. Bliss, U. S.V. Mississippi, age 20. J ne6, 63. Died June 5, 64. Spec. 2254. 8 Glenn, J., Pt., 1C, 42d De.20, 61, Right ; circ. Surg. E. Shippen, 37 Ellithorpe, P. G., Pt., I, July 2, Left; slough.; iliar.; haem.; tourn. Pennsylvania. Fe.9, 62. U. S. V. Disch d May 16, 1862. 1st Penn., age 20. Au.10, 63. Died Oct. 5, 1863; exhaustion. 9 Hall, S. C., Pt., F, 3d Nov.8, 63, Right. (Exc. femur.) Surg. T. 38 Fair, F.B., Serg t, H,2d April 7, Right (frag s bone and two pieces Indiana Cavalry. April 13, R. Crosby, U. S. V. Disch d New York H vy Artil Aug. 2, of ball rem d ; hffim.); ant. post. 1864. July 8, 1864. lery, age 22. 1865. flap. A. A. Surg. B. B. Miles. 10 Hammill, J., Serg t, D, May 3, Right ; circ. Surg. D. W. Bliss, Died same day. .Specs. 1505, 2797. 8th New Jersey. June 16, U. S. V. Disch d May 5, 1864. 39 Goodsell, A., Pt., H, 1st No.29, 64, Right. Died one hour after oper 1863. Spec. 1263. Colorado Cavalry. Ja.14, 65. ation. 11 IIartigan,M.,Pt.,H,108th Sept. 17, Left (synovitis); flap. A. A. Surg. 40 Griffith, H., Pt., E, 8th Sept. 17, Left. Surg. H. S. Hewit, U. S. V. New York, age 18. Oc.30, 62. C. J. Morton. Disch d May 19, 1863. Spec. 262. New York Cavalry. Nov. , 1862. Haem ; Nov. 19, lig. fern, artery. Died Nov. 19, 62. Sptcs.WF, 855. 12 Henry, D.P.,Pt.,H, llth Oct. 4, Left. Discharged April 7, 1863. 41 Hughes, S. D., Pt., D, J y 2, 63, Right ; circ. Surg. A. Heger, U. Missouri, age 29. De.26, 62. 14th South Carolina, Feb. G, S.A. Died Feb. 16, 1864; py 13 Hervey, R., Pt., C, 82d July 1, Left ; flap. Surg. C. Page, U. S. age 38. 1864. aemia. Autopsy. Pennsylvania, age 2D. Aug. 1, A. Aug. 12, lig. femoral artery. 42 Humma, L., Pt., H, 88th Au.30, 62, Left, (Erysipelas.) Surg. D. P. 1862. March 28, 63, gen. hsem.; gang.; Pennsylvania. Jan. 20, Smith, U. S. V. Died Jan. 20, pyaemia. Disch d Oct. 6, 1863. 1863. 1863. Spec. 1 186. 14 Jarvis, H., Pt., K, 55th No.30, 64, Right (disch d Nov. 25, 65); flap. 43 Icanbeny, A., Pt.,K, Gth Nov. , Left thigh. Died December 30, Massachusetts. jM y8, G7. Dr. A. R. Carey. Recovery. Kansas Cav., age 18. De.22, 63. 1863. 15 Johnson, C ., Pt., H, 13th Oc.20, 63, . Surg. " Friend, C. S. A. 44 Ivery, N., Pt., B, 12th April 7, . Died three hours after oper Louisiana. |J yl4, 64. Recovery. Michigan. M yl5, C2. ation; exhaustion. 16 Jones, J. M., Pt., K, 21st Au. 5, G2, Right (necrosis ; exfol.); ant. post. 45 Kreps, J., Pt., C, 29th April 30, Right (carious); ant. post. flap. Indian!!, age 29. Jan. 23, flap. Disch d April 15, 1863. Iowa, age 16. July 9, A. Surg. E. A. Clark, U. S. V. 1869. Surgeon D. W. Bliss, U.S.V. 1864. Died Aug. 8, 1864 ; pyaemia. Recovery. Spec. 5558. 46 Luxford, G., Pt,, A, 50th Oct. 5, Right (necrosis): circ. Surg. S. S. 17 Knox, A.G.,Pt.,D, 18th Sept. 14, Right; fla p. Act. Ass t Surg. A. Illinois, age 16. Nov. 20, Boyd, 8-lth Ind. Died Nov. 28, New York, age 19. De.12, 62. North. Disch d Jan. 14, 1863. 1864. 1804: exhaustion. 18 Kuhns, W. H., Serg t, C, May 31, Right ; flap. Discharged July 6, 47 Lynn, J. B., Pt., B, 83d April 9, Right (erysip.); circ. A. Surg. A. 102d Pennsylvania. J y2, G2. 1862. Ohio, age 19. May 30, Ilartsuff, U. S. A. Ilaem.; lig. 19 Loggins, W., Pi., E, 6th De.21, 62, i Right ; circular. To Prison Nov. 1865. fern. art. Died June 7, 186:">. Texas Cavalry, age 21. <Feb.-, 63. 9, 1863. 48 O Brien, D., Pt., H, 69th Sept. 17, Right ; flap. Surg. H. S. Hewit, 20 Morris, T. H., Pt., D, 6th A p. 6, 62, Right (discharged April 29, 1863. New York. Dec. 5, U. S.V. Died Dec. 16. 1862; Iowa, age 21. Ap.5, 67. Suppuration, erysip., etc.); flap. 1862. exh n. Autop. Specs. 755, 1101. Dr. H. S. Sawyer, Ceuterville. 49 ^easlee, A., Pt., I, 22d June 27, Left. Dr. Halsted. Died Aug. Iowa. 1870, stump healthy. Mass., age 23. Au.14, 62. 15, 1862. 21 Oal-u, E., Pt,, E, 14th May 5. Right thigh. Recovery. 50 2 Pool, J., Pt., H, 119th No. 7, 63, Left (frag s bone rem d); double 22 Louisiana. J .y 9, 62. Page, W. A., Pt., F, 21st May 25, Left. Surg. Brundidge, C.S.A. Penn., age 23. April 18, 1864. flap. Surg. J. A. Lidell, U.S.V. Sloughing. Died April 26, 64 ; North Carolina. J yl9, 62. Recovery. exhaustion. &pe,c. 2229. 23 Perry, H. D..Pt.. H, 19th De.l3. 62, Left. (Portion of ball and spiculae 51 Riley, P., Pt., A, 10th J e3, G4, Left. (Deformity; fistulous pas Mass., age 17. May 2!), removed ; necrosis ; deformity. New York, age 24. A p. -, 66. sage.) Died May 7, G6 ; pym. 1866. Disch d Sept. , 1863.) 52 Seville, W. S., Pt., G. Sept. 17, Right (deformity); flap, skin ; circ. 24 Plack, J. H., Corp l, F, De. 29,61, Right. Surg.W. R. S.Clark, 34th 1st Delaware. 1862, muscles. A. Surg. R. F. Weir, 34th Ohio. ; Feb.-, 62. Ohio. Disch d May 24, 1862. Jan. 5, U. S. A. Died Jan. 10, 1863; 25 Rufus, C., Pt., 1st Col d Jan.. Left ; flap. Surg. D". O. McCord, 1863. shock. Spec. 3866. Artillery, age 25. M hl, 64. 9thLa.C.T. Duty Feb. 10, 6G. 53 ShoffeM, J. IT., Pt., E, July 3, Right (thrombo.; gang.; erysip.); 20 Sears, J., Pt., E, 43d N. July 1, Left (sloughing); flap. Surg. A. 13th Alabama, age 20. Nov. 1, circ. Surg. A. Ileger, U. S. A. York, age 26. Aug. 19, B. Shipman, U. S. V. Disch d : 1863. Died Nov. 2, 1863. Autopsy. 1862. Sept. 14, 1864. M Sims, T. B., Pt., F, 12th Sept. 22, Right; ant. post. flap. A. A. Surg. 27 Shanen, J., Pt., E, 170th May 24, Right ; lateral flap. Surg. T. R. Tenn. Cav., age 20. Nov. 7, M. L. Herr. Died November 22, New York, age 40. Oct.], 64. Crosby, U. S. V. Oct. 6, haem.; 1864. 1864; exhaustion. lig. fern. art. Disc h Aug. 15, 65. 55 Smith, C. A., Pt., C, 51st Nov. 30, Right ; ciro. Surg. J. R. Ludlow, 28 Sherwood, G. A., Corp l, Sept. 17, Left ; flap. A. A. Surg. W. M. Illinois, age 41. 1864, U.S.V. Died Jan. 8, 65; exh n. G, 14th Indiana. Oc.25, 62. Hines. Disch d Dec. 13, 1862. Jan.8, 65. STURCis (F. D.), Reports nf Hospital*, in American Medical Times, 1862, Vol. V, p. 174. *LlDELL (J. A.), Onthe Secondary Traumatic Lesions of Done, etc., in U. 8. Sanitary Commission Memoirs, 1870, Surgical Volume I, p. 414. SECONDARY AMPUTATIONS OF THE THIGH. 309 In tim-o of the fifty-five cases enumerated in the foregoing table the seat of injury was in the upper third; in twelve, in the middle third; in eleven, in the lower third; in seven, in the femur without precise indication; in fifteen, in the knee joint; and in seven cases in the leg. Secondary Amputations in the Middle Third of the Femur. The one hundred and sixty-eight cases of this group comprise one hundred and two recoveries and sixty-six deaths, a mortality of only 39.2 per cent., or 6.2 per cent, less than the mortality of the secondary upper third amputations. Twenty-seven of the one hundred and sixty-eight operations were practised on Confederate, and one hundred and forty-one on Union soldiers. Of one hundred and sixty-two cases in which this point was indicated, the injuries were on the left in eighty-nine and on the right side in seventy-three instances. Cases of Recovery after Secondary Amputation in the Middle Third of the femur. One hundred and two cases belong to this category. The injuries were caused by shell in one, by solid shot in two, by canister shot in one, and by small projectiles in ninety-eight cases. Nine patients were Confederate, and ninety-three Union soldiers; five of the latter have died since the termination of the War, while eighty-eight remained pensioners in January, 1880. CASE 482. Private Andrew Van Vorst, Co. A, 134th New York, age 18 years, was wounded at Gettysburg, July 1, 1863, by a conoidal ball passing through the right knee joint, causing a comminuted fracture. He was admitted into the Camp Letterman Hospital on August 21st. Acting Assistant Surgeon W. M. Welch, under whose care he was placed October 28, 1863, records : " Thigh was amputated at the middle third August 1st ; the stump is healing finely and his health is good." He was sent to Balti more November 8th, where he remained in the Newton University Hospital until April 23, 1864, when he was sent to New York and admitted into the DeCamp Hospital. His stump had entirely healed. On October 16th, he was transferred to Albany and admitted into the Ira Harris Hospital, from whence Assistant Surgeon J. H. Armsby, U. S. V., reported his recovery and discharge from service August 11, 1865, and contributed a plaster cast of the stump (A. M. M., Spec. No. 417, Sect. I, Cat. 1866, p. 554), a drawing of which is given in the wood-cut (FlG. 200). His pension was paid January 4, 1880. CASE 483. Private J. Scheuermann, Co. K, 9th Ohio, aged 28 years, was wounded at Chickamauga, September 19, 1863, and admitted to the field hospital of the 3d division, Fourteenth Corps, where Surgeon J. E. Arter, 31st Ohio, noted: " Shot fracture of right thigh." Several weeks after the reception of the injury the wounded man was transferred to hospital at Chattanooga, subsequently to Bridgeport, and, on December llth, to Murfreesboro , whence Assistant Surgeon G. V. Woolen, 27th Indiana, reported the case as follows: "The ball entered the limb anteriorly, about four inches above the knee joint, passing backward and upward, fracturing the femur at the junction of the middle and lower third, and lodging in the gluteus maximus muscle. The fracture was oblique and lateral, and remained ununited, the limb being shortened about three inches. The ends of the bone were necrosed, and suppuration profuse. About three months after his admission the patient had an attack of erysipelas, which subsided, but left the limb in an cedematous condition. At this time his constitutional condition had become very feeble, his appetite was wanting, and he was unable to sleep from pain in the wound, which was discharging considerable quantities of ichorous pus. It was then deemed proper to remove the limb, and amputation was performed by Assistant Surgeon J. E. Link, 21st Illinois, on March 18, 1864. The operation was done by the circular method at the junction of the upper and middle thirds, but little haemorrhage taking place. The ligatures were applied and chloroform was used. The patient rallied well from the operation, and immediately began to improve in general health. In the course of a month the stump had closed." The patient was subsequently transferred to Washington Park Hospital, Cincinnati, mustered out of service July 14, 1864, and supplied with an artificial limb of Dr. Ely s pattern one year afterwards. He is a pensioner, and was paid September 4, 1879. The amputated femur was con tributed by Surgeon I. Moses, U. S. V., and is represented in the cut (FlG. 201), showing a moderate deposit of callus but no union of the fracture. CASE 484. Private F. Luck, Co. C, 21st Wisconsin, aged 21 years, was wounded in the right knee, at Chaplin Hills, October 8, 1862. He was admitted to hospital No. 7, Perryville, and discharged from turo (if middle third service February 15, 1863, Surgeon J. G. Hatchett, U. S. V., certifying to "complete destruction of the use of rijjht femur. S;*c. of the knee," as resulting from the injury. On the 2d day of the following December the man entered Harvey Hospital, at Madison, whence Surgeon H. Culbertson, U. S. V., contributed the pathological specimen (No. Suryical Section, A. M. M.), with the following report: "This soldier received a penetrating wound of the knee j< was unfortunately discharged at the breaking up of the Perryville Hospital, when the knee was still running and not FIG. 200. Appearance of stump three months after am putation. Spec. 417. 310 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. progress of cure. The injury was caused by a mini6 ball, which entered posteriorly and to the iuside of the tuberosity of the external condyle of the femur, passed obliquely forward and slightly inward, fracturing the external condyle and also the upper and outer margin of the patella, and came out opposite that point of the bone. True and false anchylosis resulted, the former between the inner condyle and head of tibia, and necrosis of the inner condyle ensued. At the time of the patient s admission the state of the parts was as follows: The joint was enlarged and the wound open over the external condyle, and some three inches higher up the thigh another opening existed, both of which discharged unhealthy pus. There was also periostitis extend ing up as high as the lower fourth of the femur, and the soft parts about the joint were swollen and indurated up to the middle third of the thigh. Circulation below the knee was extremely feeble, and the leg, bent upon the thigh at right angle, was extremely emaciated. The patient s constitution showed marked evidence of scrofulous diathesis. At first I determined to treat the case by resection of the joint, but on reflecting, and with the advice of Dr. E. B. Wolcott, Surgeon General of Wisconsin, I decided upon amputation as affording the best and safest means for the removal of the disease. Just before the operation, which was done on January 3, 1864, the patient fell upon the floor and broke the union between the tibia and inner condyle of femur; yet from the inflammatory exudations thrown out about the joint it was found impossible to straighten the limb, though efforts were made to effect this object while he was under the influence of chloroform. I performed the amputation at the middle third of the thigh, by the circular method, in the presence of Dr. Wolcott, Acting Assistant Surgeons J. J. Brown and J. Favill, and Medical Cadet W. B. Buckley. Nothing unfavorable occurred, and the wound healed by first intention, though the ligature applied to the femoral artery has not yet (February 7th) come away. The stump now certainly demonstrates the superiority of the circular over the flap operation of this member, being one of the most perfect in form I have yet seen. This case illustrates the efforts of nature to diminish the capacity of the joint by anchylosis and the exudation into it of plastic organizable material ; also the fact that penetrating gunshot wounds of the knee joint will require amputation, even though nature be given fifteen months in which to effect a cure. On examination of the morbid specimen, it will be seen that the ball^passed through the can cellated structure of the external condyle, entering the cavity of the joint only at two opposite points, thus inflicting upon the synovial membrane but a slight wound so far as extent is concerned. Unquestionably great inflammation must have followed the wound, as is proved by the effects observable. But nature could not have been as successful had the external condyle been broken into fragments. It was in fact a penetrating wound of a portion of the joint which inflicted great injury to it, and yet it was singularly and uncommonly local, the wound of the bone appearing as though it might have been made with a circular punch. The fact that the bones entering into the formation of the joint were injured in so limited a manner would seem to be the reason why amputation was not required long since." Dr. Culbertson appends the following remark to this history: "This case is cited not because of the amputation performed, but to illustrate the great efforts of nature in the cure of penetrating gunshot wounds of knee joints, and also her failure in the attempt." Three months after the operation the patient was well enough to proceed to Chicago for the purpose of being fitted with an artificial limb, and on May 28, 1864, he left the hospital for his home. The pensioner was paid June 4, 1879. CASK 485. Private E. Green, Co. K, 119th Pennsylvania, aged 35 years, was wounded in the right thigh, at Rappahau- nock Station, November 7, 1863, and was admitted to Armory Square Hospital, Washington, two days afterwards. Surgeon D. W. Bliss, U. S. V., furnished the following description of the injury, and of the operation which he per formed: "The missile, a conical ball, entered one and a half inches above and to the right of the patella, passing across the limb, fracturing the femur in the lower third, and lodging on the inner and posterior side, nearly opposite the point of entrance. The limb was treated in a skeleton fracture-box, and water dressings were used. On November 18th, the ball was extracted. Haemorrhage occurred on the following day, and again three days afterwards. The discharge of pus became copious about December 1st, and dry gangrene of the toes and dorsum of foot appeared. The upper fragment of the femur protruded one and a half inches, and at every effort to extend the limb so as to retract the protruding bone violent haemorrhage ensued. The patient s system was greatly reduced, and careful attention was paid to retain his digestive powers by a rotation of stimulants and nourishing diet. A slight change in the position of the limb, on December 28th, brought on a haemorrhage to the amount of twenty ounces in three minutes time evidently from the femoral artery, which was then controlled by pressure. By January 20, 1864, sloughing of the heel and dorsum of foot had commenced, and the patient s system was still so much debilitated that a decision to operate, which had been retarded as calculated to prove fatal, was now arrived at as a last chance to pi-eserve life. On the following day the thigh was amputated at the middle third by antero-posterior flaps, four arteries being tied and but little blood lost. Ether was used as the anaesthetic. At the operation an abscess was discovered in the anterior flap extending upward for three inches, and the femoral artery was found to be destroyed in the upper part of the popliteal space, evidently by the missile. Above the point of the amputation the vessel was healthy; but no clot was found. The vessels of the leg were much constricted. The lower fragment of the femur was flexed at an angle of thirty degrees with the leg, and, by contraction of the muscles of the thigh, was pressed firmly against the wounded extremity of the femoral artery, thereby preventing fatal haemorrhage. The flaps of the stump presented an unhealthy appearance, being much indurated and infil trated with serum. Tincture of chloride of iron was applied to the entire surface with a view of sthnulalin. obtaining its haemostatic effect upon the capillary vessels which failed to contract from cold and exposure to the air. A large tent was placed through the fourchette of the stump so as to prevent the accumulation of pus, the flaps being gently brought together and tepid \\ater dressing applied. The patient improved daily, and was in a fair way of recovery one week after the operation." The amputated portion of the femur was contributed to the Museum by the operator, and is shown in the wood-cut (FlG. 202). The specimen shows the parts about the fracture to be dead and stripped, and its upper half to be covered with an involucrum of foliaceous callus tolerably donse posteriorly, also some periosteal deposit above the condyles. The patient sub sequently entered Judiciary Square Hospital, and was discharged July 7, 1864. He was furnished with an artificial leg by B. F. Palmer, August 26, 1865, and was paid as a pensioner until September 4, 1867, since when he has not been heard from. Fio. 202. Shot comminution of the lower third of right femur. Spec. 2033. the parts and of SECT, in.] SECONDARY AMPUTATIONS OF THE THIGH. 311 FIG. 203. Appearance of stump two mo after amputation. [From a photograph.] In the next case the amputation was performed five years after the reception of the injury, owing to the continual recurrence of abscesses. The patient died eleven years after the operation, of pulmonary disease: CASE 486. Private Charles M. Bowen, 1 Co. A, 27th Indiana, aged 19 years, was wounded at Antietam, September 17, 1862. He was taken to Frederick and admitted to No. 1 hospital on September 24th. Acting Assistant Surgeon J. C. Shimer records the following: "A conoidal ball had entered the outer aspect of the left thigh about five inches above the knee, fractured the femur, and passed out directly opposite. Buck s apparatus was applied. On Octo ber 19th, considerable amount of callus had been thrown out, and there was some union ; his appetite and general condition were good. October 23d, a deep but circumscribed abscess on the outer side of middle third of thigh was opened and evacuated. 30th, both the wounds of entrance and exit were enlarged to evacuate pus more freely. December 5th, he has improved greatly; passive motion has been employed to overcome stiffness of the knee." On March 18, 1863, he was able to walk with the aid of crutches, and the wounds had nearly healed. A slight attack of erysipelas yielded readily to treatment. May 21st, the wound took on a gangrenous condition, for which strong nitric acid was applied. On June 15th, he was transferred to Baltimore. The wounds looked healthy and his general condition was excellent. He entered the Jarvis Hospital on the 16th, and was discharged September 7, 1863. The femur had only partially united; the sciatic nerve was injured; his leg was partially and his foot entirely para lysed. He received a pension, and was employed as a clerk in the Interior Department. Owing to a recurrence of abscesses he entered the Providence Hospital, Washington, in the autumn of 1867, and, on November llth, the limb was amputated in the middle third by Dr. D. W. Bliss, late Surgeon U. S. V. The wound healed well, and a photo graph was taken at the Army Medical Museum on January 9, 1868, at which time the stump was firm and healthy. The specimen was contributed to the Museum by the operator, and is No. 4914, Surgical Section. The fragments are considerably over lapped, having undergone unusual disturbance, and the amount of callus exceeds what is necessary for complete union. On March 10, 1871, the patient was a clerk in the Pension Office ; the stump was healthy but his general health poor. He died March 17, 1878, of phthisis pulmoualis. The amputation in the thigh in the one hundred and two cases of this group had been preceded by other operations in thirteen instances, viz: by amputation at the knee joint in two, by amputation in the leg and subsequent amputation at the knee in one, by ablation in the leg in six, by excision in the shaft of the femur in one, and by excision in the bones of the leg in three instances. 2 Fatal Cases of Secondary Amputation in the Middle Third of the Femur. The sixty-six operations of this category were practised on forty-eight Union and eighteen Confederate soldiers. Eight autopsies are recorded in this series, and twenty-five path ological specimens are preserved. Pyaemia was observed in ten, gangrene in fourteen, and erysipelas in seven cases. In nine instances copious haemorrhages preceded the amputation, and in eleven haemorrhages occurred after the operation. CASK 487. Private L. Williams, Co. C, 26th Michigan, aged 23 years, was wounded at Spottsylvania, May 12, 1864. Surgeon J. E. Pomfret, 7th New York Artillery, recorded his admission to the field hospital of the 1st divjsion, Second Corps, with "shot wound of left knee, caused by a mini6 ball." Assistant Surgeon J. C. McKee, U. S. A., who contributed the path ological specimen of the case (Cat, Surg. Sect., 1866, p. 343, Spec. 2538), reported the result of the injury as follows: "The wounded man entered Lincoln Hospital, Washington, May 30th. He was a man of nervous and irritable tempei-ament. When admitted he suffered from much constitutional derangement, and the tissues in the neighborhood of the injured joint were much enlarged, tender, and painful. Cold-water dressings were used, and tonics and stimulants were administered. On June 13th, the parts above and below the knee joint being infiltrated with pus and discharging copiously through several openings, ampu- 1 Circular No. 3, Surgeon General s Office, Washington, 1871, p. 205, CASE DLXXXV. 2 The limb had been removed at the knee in the cafce of Corp l F. Hare, B, Cth Wisconsin (TABLE XXXIX, No. 39, p. 314), and of Pt. L. C. Young, A, 3d Virginia (TABLE XXXIX, No. 100, p. 315). In the case of Pt. A. Bronchard, 5th New Hampshire (TABLE XXXIX, No. 11, p. 313), the fracture in the foot had been followed by excision of the 3d and 4th metatarsal bones, then by amputation in the lower third of the let, , then by amputation through the knee .joint, and finally by amputation in the thigh. The patients who had undergone amputation in the leg were Corp l II. W. Hughes, I, 133d New York (TABLE XXXIX, No. 43, p. 314); Pt. W. Stifle, A, 29th Ohio (TABLE XXXIX, No. 86, p. 314); Pt. J. Bowen, C, 4Cd Illinois (TABLE XXXIX, No. 8, p. 313;; Pt. B. Nussbaumer, B, 67th Ohio (TAISLE XXXIX, No. 67, p. 314); Corp l G. Dewey. M, llth Illinois Cavalry (TAI)U! XXXIX, No. 24, p. 314); and Lieut. J. II. Bell, D, (ilst Ohio (TAHLE XXXIX, No. 5, p. 313). In the case of Corp l T. Duggan, M, llth Illinois Cavalry (TABLE XXVII, No. -I, p. 212, ante, and TABLE XXXIX, No. 26, p. 314), an excision in the shaft of the femur had been performed, and excisions in the bones of the leg in the oases of Pt. S. Montgomery, I, 139th Pennsylvania (TABLE XXXIX, No. 63, p. 314); Pt. W. Stockdnle, D, 48th Indiana (TAULK XXXIX, No. 87, p. 314); and Pt. C. Murphy, D. GPth New York (TABLE XXXIX, No. 65, p. 314). 312 INJURIES OF THE LOWER EXTREMITIES. fCHAP. X. tation waa decided upon, and performed at the middle third of the femur by Acting Assistant Surgeon A. Ansell, as the only chance of saving the patient s life. On examining the injured parts after the operation the missile was found to have passed through the joint, comminuting the patella and knocking away the head of the tibia on its inner side. The subsequent treat ment consisted of cold-water dressings to the stump and the administration of six ounces of brandy per diem ; one grain of sulphate of morphia was given at bedtime after the operation. Iron and quinine were prescribed some days afterwards. The patient did exceedingly well, and the stump healed kindly, the cicatrix forming perfectly with the exception of one small open ing, which served as an outlet for a small abscess about the size of a pigeon s egg. Hemorrhage took place from this part of the stump on July 18th, when the tourniquet was applied to the femoral artery, which had the effect of arresting the flow of blood. A plug of lint saturated witli a solution of persulphate of iron was then introduced into the wound and the tourniquet removed. Haemorrhage occurred again on the morning of the following day, when, on consultation, it was decided to open the stump and ligate the bleeding vessel. This was also done by Dr. Ansell, who tied the femoral as well as two muscular arteries, which had been opened by the incision. The operation was performed at 11.30 A. M., and the patient died at 6 P. M. on the same day, July 19, 1864, not having rallied, and having lost altogether about twenty ounces of blood. The interior of the Btump was found to be perfectly healthy, with the exception of the small abscess before mentioned." The specimen consists of the bones of the amputated knee, showing the articular surface to be carious, and a longitudinal incomplete fracture extending between the condyles two and a half inches up the femur, on the shaft of which two trivial points of periosteal thickening appear. The stump of the femur, showing a partially detached sequestrum and handsome but useless foliaceous deposit, together with a wet preparation of the ligated femoral artery, were also contributed to the Museum by Acting Assistant Surgeon H. M. Dean, and constitute specimens 2882 and 2883 of the Surgical Section. CASE 488. Captain E. W. Capps, Co. C, 15th Virginia Cavalry, aged 35 years, was wounded at Brandy Station, Virginia. October 11, 1863. He was admitted, on October 21st, into Lincoln Hospital, Washington. Assistant Surgeon H. Allen, U. S. A., reported : "A conoidal ball entered the right leg, from without inward, about one and a half inches below the patella, passed through the anterior portion of the leg, fractured the spine of the tibia, and emerged on the inner side of the limb. On admission a bandage was found applied tightly to the affected part. Upon its removal the joint was discovered to be greatly swollen from effusion, and the wounds presented an inflamed appearance. Cold-water dressings were applied. No constitutional symptoms were present. After the effusion in the joint had subsided a thorough examination of the wound was made. The head of the tibia was found pierced by the ball. No stellation existed, nor was the joint involved. A seton of tow was thrust through the wound and withdrawn, bringing away several small fragments of bone. On October 21st, a small abscess was opened in the popliteal space. The patient, from this time, did remarkably well, and all thought him to be out of danger. On January 26, 1864, however, when he was walking, with the assistance of crutches, from one ward to another, he stumbled, and, in order to preserve his balance, bore his weight upon the injured limb. The following day an erysipelatous inflammation set in about the joint, which became enormously swollen. He was restless and uneasy, his skin hot and dry, tongue coated with a thick whitish fur; he had severe pain in the head; pulse 140; anorexia and constipation present. On January 29th, a sense of decided fluctuation was felt in the joint, and it was thought at the time that pyarthrosis of the knee joint was present. He had little or no fever. His pulse averaged 120 beats per minute, soft, compressible. Face very pale, mind clear. The swelling in the course of a week had gone down completely from the limb below and above the joint; but around the seat of injury and joint a dull purplish red color lingered. By judicious pressure pus could readily be made to exude through the internal wound. Pus had burrowed a very little distance in the parts connected with the popliteal abscess above mentioned. No sinus of any extent existed. It was now evident that the case was one demanding amputation, and, the patient s condition being favorable, the circular operation was performed by Assistant Surgeon J. C. McKee, U. S. A., in charge, on February 8th. The joint, which gave evidence of the presence of pus of long standing, the cartilages being denuded and partially destroyed, was sent to the Army Medical Museum (Specimen 2036 of the Surgical Section). The patient did well until February 12th, when he had a severe chill which lasted forty minutes. This was followed by a profuse diaphoresis. The skin became cold and clammy, the pulse 120 and feeble. On the following day he had another chill, and, on the 15th, two more, one in the morning at six, the other at four o clock in the afternoon. Another exacerbation occurred on the morning of the 16th. In other respects the con stitutional symptoms of what was evident to all to be pyaemia were remarkably slight. His tongue remained clean. His appetite continued the same. There was no vomiting, no fever of any consequence followed the chills; his pulse varied from 120 to 140, rapid and weak. His appearance at this time was that of a man who was suffering from a severe haemorrhage; his anaamic condition was startling; his sclerotica were pearly white, his lips and gums pale, his finger nails blue. He had a slight cough, though no expectoration. His most distressing symptom was the colliquative sweatings, which came on during the night, and which were not apparently connected with the chills. The limb looked well, and there was no unusual amount of pain in it. The flaps were granulating finely. On February 18th the sixth chill took place, and, on the next day, the seventh, followed by vomiting. He now rapidly sank, and died on February 20th, at four o clock A. M. Autopsy: Rigor mortis marked. Adipose tissue abundant. Limb much swollen and of a tallow color. Upon dissecting out the vessels the tissues of the thigh were found greatly indurated, especially along the course of the Hunterian tract. The interior of the femoral vein was filled with a solid black clot, which was firmly adherent to the walls of the vein. No disintegration noticed. The lower third of the vessel, that which had lain in contact with the suppurating surface of the stump, was stained by a purulent fluid for about two inches from the patulous opening. A curious appearance was observed in one of the small branches of the prof unda vein in the upper third of the thigh. It presented the same general aspect seen in the patulous end of the femoral, and was filled with pseudo- pus." A drawing (made by Hospital Steward E. Stauch, and copied in PLATE XXIII, opposite) of the upper two-thirds of the femur, removed at the post-mortem, shows the separation of the periosteum in osteomyelitis. Upon a longitudinal section of the femur (PLATE XLIX, opposite p. 314) the medulla throughout was found to be of a grayish-yellow color, which was more intense at the region of the trochanter than elsewhere. Numerous small abscesses, more or less elliptical, were arranged lineally 1 A condensed abstract of this case was published by Dr. ALLKN in the American Journal of Medical Scir.nre.s, 1865, Vol. XLIX, p. 39, in connec tion with his Remarks on the I athological Anatomy of Osteomyelitis, with Cases. SEPARATION OF PERIOSTEUM I IN OSTEOMYELITIS SECT. III.] SECONDARY AMPUTATIONS OF THE THIGH. 313 down the central portion of the medulla. The bone was not thickened or vascular. The periosteum, however, was inflamed, and, at the lower two-thirds of the specimen, was readily stripped from the bone, where it presented the appearance of having been pulled away from the femur by the fibres of the muscles inserted upon it. CASE 489. Lieutenant-Colonel G. F. Lamon, 32d New York, was wounded in the left thigh, at Crampton s Pass, Sep tember 14, 1862. He was conveyed to hospital at Burkittsville, whence Assistant Surgeon H. A. DuBois, U. S. A., contributed the pathological specimen (Cat. Surg. Sect., 1866, p. 287, Spec. 792), with the following history: "The injury was caused by a minie" ball, producing a compound comminuted fracture of the femur in the lower third, which was treated with Smith s anterior splints. The wound suppurated freely, and at the end of the second week all inflammatory symptoms had subsided. There was no pain from the first. On November 3d, I found recorded in the case book : A speedy recovery beyond doubt; shortening about an inch. Several days after this bleeding took place, whirh was thought to be from the femoral. The artery was then compressed with the finger at Poupart s ligament for about fifty hours. Up to the time of the haemorrhage the patient had an excellent appetite; but he now sank speedily and did not rally for two days, though strongly stimulated and receiving the most nourishing diet. On November 9th, the thigh was removed by the flap method by Surgeon L. W. Oakley, 2d New Jersey, it being decided inexpedient to secure the artery. The patient did not completely recover from the shock. Eight hours after the operation he commenced to sink with great rapidity, and three hours later he died. The specimen illustrates well the nature of a wound in the bone caused by a minie" ball, also the amount of union after two months rest. On examining the removed limb it was found that the ball had brushed the artery, and that the artery had ulcerated to the extent of about one-third of an inch. During the last month the case was under the care of Surgeon Oakley." The pathological specimen consists of the amputated lower half of the femur, and exhibits shortening, with slight union and some deformity, the fractured extremities being necrosed and spanned at points by new bone. Of the sixty fatal secondary operations in the middle third of the thigh, ten had been preceded by other major operations, viz: one by a primary amputation in the middle third of the opposite thigh, two by exarti dilations at the knee joint; and seven by amputations in the leg. 1 In one instance the amputation in the thigh was followed by exarticulation at the hip joint. 2 TABLE XXXIX. Summary of One Hundred and Sixty-eight Cases of Secondary Amputation in the Middle Third of the Femur for Shot Fracture. [Recoveries, 1102; Deaths, 103168.] NO. NAME, MIUTAUY DESCRIPTION, AXI> A(;E. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Abbott, T., Pt., E, 7th Sept. 14, Left (abscesses); flap. Surg. H. 11 Bronchard, A., Pt.. A, April 7, Left. (Disch d April 12, 1865; Perm. Reserves. Nov. 14, S. Hewit, U. S. V. Discharged 5th New Hampshire, 1865, 17, exc. met.; May 15, amp, leg; 18G2. Jan. 27, 1863. age 31. _. Feb. 18/66, amp. kn.jt.) Reo y. 2 Barger, W. M., Pt., H, April 7, Right; flap. Surg. O. Martin, 12 Brunemer, J. H., Corp l, Sept. 14, Left (gang.); circ. A. A. Surg. 34th Illinois. J e 1, 62. U. S.V. Disch d July 22, 18G2. H, 7th Wisconsin. De. 8, 62. Q. W. Carey. Disch d April 1, 3 Barnes, B. C., Pt., C, Mav 5, Left; ant. post. flap. Surg. E. 1863. Spec. 917. 146th N. York, age 20. J ne9, P4. Donnelly, 2d Penn. Reserves. 13 Buckley, J., Pt., A, 15th Aug. 7, Right (haem. post, tib.); circ. A. Disch d Jan. 26, 1865. Infantry, age 24. Sept. 12, A. Surg. P. L. Rice. To regi 4 Barnett, W. M., Pt., F, Nov.6, 63, Right ; flap. Dr. J. W. Ramsey, 1864. ment Dec. 7, 1864. 10th West Va., age 18. Mav 25, Wilsonburg, W. Va. Mustered 14 Burgenson, S., Pt., F, De.31/fi2, Right; flap. Disch d July 13, 18 65. out May , 1865. 15th Wis., age 22. Mar. 17, 1864. 5 Bell, J. 11., Lieut., D, July 20, Left. (July 20, 1864, amp. leg. 1863. 61st Ohio, age 52. 1864, Disch d Dec. 15, 1864. Neuralff. 15 Burnes, W., Pt., A, 14th Sept. 19, Right; flap. Disch d Sept. 8, Oct. 27, aff n of stump.) Dr. D. A. Hart, Ohio, age 36. No.24, 63. 1864. 1870. Cleveland, Ohio. Recovery. 16 Cain, J. II., Pt., I, 17th Oct. 21. Right; flap. Snrg. I.Casselberry, C Besley, S. B., Corp l. H, Mav 5, Right (gang.; bonedis.); circular. Illinois. No.30, 61. 1st Ind. Cavalry. Discharged. 147th N. York, age 30. Oct. 3/64. A. A. Surg. C. E. Lee. Disch d 17 Capp, A., Serg t, B, 2d April 2, Right (nee.); circ. Surg. E. Bent- August 17, 1865. Maryland, age 24. Oct. 11, ley, U. S. V. Disch d Jan. 15, 7 Bowen, C. M., Pt., A, Sept. 17, Left. (June, 63, nee. bone rem d. 1865. 1866. Spec. 4387. 27th Indiana, age 19. 1862, Disoh d Dec. 7/63.) Dr. D. W. 18 Carey, C., Pt., F, 5th Feb. 21, Left ; circ. A. Surg. B. Norris, Nov. 1], Bliss. Spec. 4914. Died March Infantry. Ap.15, 62. U. S. A. Discharged. 1867. 17, 78; phthisis pulmonalis. 19 Coleman. O. A., Pt., B, No.18, 63, . Surg. C. L. Dunkley, C. S. 8 Bowen, J., Pt., C, 42d Dec. 30, Right (Dec. 31, 1862. amp. leg; 3d South Carolina. Mar.4, 64. A. Recovery. Illinois, age 21. 1862, June 17, 1863, hsem.); circular. 20 Conlon, J. II., Pt., B, 5th Mav 5, Left ; double flap. A. A. Surg. J. June 21, Surg. T. D. Fitch. 42d Illinois. Wisconsin. J e2"0/62. W.Dickie. Disch d July 8/63. 1863. Disch d April 28, 1864. 21 Crispin, J. A., Pt., A, Feb. 21, Right. A. Surg. B. Norris, U.S.A. 9 Brader, S., Pt., M, 4th June 12, Left (carious): circ. A. Surg. C. 3d New Mexico. Mar.-, 62. Disch d Feb. 28, 1863. N. Y. Cavalry, age 25. Aug. 15, A. McCall, U. S. A. Disch d 22 Culley, J., Pt., K, 7th May 18, Right (caries: erysip.); circ. A. 1864. July 5, I860. Spec. 2927. Missouri, age 23. 1863, Surg. II. R. Tilton,U.S.A. Disc. 10 Bristcr, J. J., Pt.,G, 19th Se. 1!), 63. Left. (Diseb d ; anch. knee, Julv Ap.10, 64. July 14, 1864. Spec. 2677. Ohio, age 23. Sept. , 22, 64.) Drs. Smith and Hati- 23 Daniels, S., Pt., K, 1st Aug. 10, Right; circ. Dr. J. P. Coulter, 1864. nan, Huntington, O. Recovery. Iowa. Oc. , 61. Marion, Iowa. Discharged. XXXI 1 Primary amputation in the middle third of the opposite thigh had been performed in the case of Pt. S. Baguley, B, 5th New Hampshire (TAlil.E :, No. 703, p. 235, ante, and TABLE XXXIX, No. 105, p. 315). In the cases of Pt. George T. Skilton, I, 36th Wisconsin, at Case of Lieut. C. H. Hawkins. C, 4th New York Calvary (CASE 337, p. 158, and No. 8 of TABLE XVIII, p. 159, ante SURG. Ill 40 314 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 24 Dewey, G., Pt, D, 51st De.13, 62, Left (Dec. H, amp. leg; 28, re- 58 Martin, JR. ., Lieut., K, Sept. 19, . Surgeon Hall, C. S. A. New York. Jan. -, 63. amp, leg; slough.); double flap. 25th Arkansas. Oc.20, 63. Recovery. A. A. Surg.W.V. White. Disc. f\nl OQ 1 ftT 59 McDonald, S. H., Re- De.25, 64, Right. (Gangrene.) Recovery Sept. 22 18b5. 25 Draper, L. G., Lieut., Oc.19, 64, UCu ;o, looo. Left. (M. O. Feb. 15, 6G, deform 60 McDougall, R., Corp l, April 1, Left; flap. Disch d July 13, "(J5. P, 75th N. Y., age 27. M y 2, 67. ity of limb.) Dr.M.U.Bennedict, G, 2d Mich., age 21. Je. 1, 64. late Surgeon 75th N. Y. 61 McFarland, D., Corp l, June 16, Right; circ. A. A. Surg. W. L. 26 Dnggan, T., Corp l, M, De.18, 62, Right (disch d April 7, 65); flap. A, 22d C. T., age 22. Au.2, 64. Wells. Disch d Sept. 7, 18G5. llth Illinois Cavalry. J y5, 66. Surg. E. Andrews, late 1st 111. 62 McWhinney, F., Pt., A, April 2, Left ; circ. Surg. J. B. Larkin, Light Artillery. 123d Illinois, age 21. M yll, 65. 17th Ind. Disch d July 22. Ii5. 27 Durkee, E. W., Pt., G, April 6, Right; circ. Disch d July 16, 63 Montgomery, S., Pt., I, May 12, Left (May 12. exc. tibia); flap. 18th Wisconsin. M y20, 62. 1862. 139th Penn., age 23. July 29, Surg. E. Bentley, U.S.V. Disch. 28 Dwyer, J., Pt., G, 69th Sept. 17, Right. Disch d April 27, 1863. 1864. August 2, 1865. New York, age 33. Oc.20, 62. Died April 9, 70 ; consumption. 64 Moore, D. A., Corp l, TI, J el, 64, Right (disch d Nov. 18, 64); bilat. Spec. 756. 92d New York, age 27. Jan. 13, flap. Dr. O. F. Parker, Parish- 29 Eastman, W.,Pt.,1, 114th Oct. 19, Right ; ant. post. flap. Surg. T. 1865. ville, N. Y. Recovery. New York, age 35. No.29, 64. Sim, U. S.V. Disch d April 10, 65 Murphy, C., Pt., D, 69th Sept. 17, Right (March 18, 63, dead bone 1865. Spec. 3474. New York, age 24. 1862. exc.); circ. A.A.Surg.A.North, 30 Ekstrand, J. H., Lieut., Aug. 30, Left. (Nov. 24, 63, shell injury Mar. 23, Disch d Sept. 12, - (i4. Died Dec. H, 13th Col d Troops, 1864, of left tibia. Disch d Jan. 12, 1803. 28, 64; pneumonia. Spec. 38G7. age 33. July 17, 65. 1868, constant pain in site of 66 Nickerson, C., Corp l, K, May 31, Right (gangren s); lat. flap. Surg. 1868. first wound; cancerous tumors 1st Maine H vy Art y, Oct. 27, N. R. Moseley, U. S.V. Disch d inv. entire knee joint.) Recov y. age 23. 1864. April 12, 1865. Stump dis d, re- Specs. 5479, 5480. amp. Died April 2 ., t 8 ; tuber 31 English, J., Pt., D, 23d Sept. 17, Right; flap. A. Surg. A. Mass, culosis. iSpee. 28D8. Ohio. Oc.23. 62. 100th Penn . Disch d Mar. 6, 63. 67 Nnssbaumer, B., Pt., B, Ma.22, 62, Left. (April J2. 1862, nmp. leg; 3-2 Everett, P., Pt., K, 53d June 1, Left; flap. Surg. P. A. Jewett, 67th Ohio, age 27. , 63. caries. Disch d July 28, 1862.) Pennsylvania. Au. 1, G2. U. S. V. Disch d April 2, 1863. 68 Nutting, J., Pt., F, 19th May 5, Right ; flap. Surg. Manson, 33 Pisk, J., Pt., C, 4th K. J y 1, 62, Left (hsem.); circ. Surg. J. Neill, Maine, age 21. Aug. 22, Hartland, Maine. Disch d Jan. Island Bat ry, age 25. Ja. 17, 63. U. S. V. Disch d Aug. 6, 1863. 1864. 26. 1865. 34 Galway, R., Pt., E, 54th April 20, Right (Dec. 15, 65, frag s nee. 69 Page, E., Corp l, 11, 17th Sept. 20, Left (gang.; bone diseased); ant. New York, age 36. 1865, bone rem d; disch d June 22, 66); Kentucky, age 21. 1863, post. flap. A. A. Surg. P. Peter. Sept. 8, flap. A. Surg. G. M. McGill, U. Jan. 24. Erysip. March 2f>, (>4. exc. end 1866. S. A. Recovery. 1864. fern.; Oct. 20, seq. rem d. Duty 35 Gibson, J. W., Corp l, F, June 15, Right ; circ. A. Surg. W. G. Bry Jan. 21,1865. Spec. 21 96. 123d Ohio. July 26, ant, 122d Ohio. Disch d Feb. 70 Painter, G. W., Serg t, May 5, Left : flap. A. A. Surgeon J. L. 1863. 13, 1864. H, 139th Penn., age 24. J e5, C4. Stewart. Disch d April 19, 65. 36 Green, E., Pt., K, 119th No. 7, 63 Right (haem s ; dry gang.); ant. 71 Porter, E., Pt., G, 2d June 1. Right ; circ. A. A. Surg. S. N. Penn., age 35. Jan. 21, post. flap. Surg. D. W. Bliss, Vermont, age 37. Au.22, 64. floss. Disch d June 12, 1865. 1864. U. S. V. Disch d July 7, 1864. 72 Powell, J. E., Serg t, A, May 10, Right ; circ. Surg. C. E. Swasey, Spec. 2033. 6th Kans. Cav., age 28. J ell, 64. U. S. V. Disch d Jan. 23. 65. 37 Griffin, W., Pt., A, 69th June 3, Right ; flap. Surgeon Gibbs, 73 Rand, K., Corp l, C, 2d May 5, Left (May 26, hsem.: gang:.); circ. New York, age 20. Au. 2, 64. C. S. A. Recovery. Vermont, age 23. J e23, 64. A. Surg . J. C. McKee, U. S. A. 38 Griggt, W. I., Serg t, A, Au. 9, 62, . Surg. Douglass, C.S.A. Nee. bone rem d. Disch d Oct. 42d Virginia. J e20, 63. Recovery. 28, 1865. 39 Hare, F., Corp l, B, 6th May 5, Left (May 6, amp. kn. j t ; gang.); 74 Reed, J., Pt.. K, llth Feb. 5, Right ; circ. Surg. G. S. Kcmble, Wisconsin, age 23. Au. 6, 64. circ. Confed. surgeon. Disch d Illinois, age 37. Ma.24, 64. U. S. V. DischM June 22, 64. May 22, 1865. 75 Rich, R. E., Pt., B, 19th Sept. 17, Left; circ. A. A. Surg. P. Mid- 40 Harvie, W. E., Pt., A,2d Oct.4, 63, Left (symptoms of gang.); flap. Massachusetts. No.lO, G2. dleton. Disch d Jan. 17, 1863. Kentucky. Jan. 10, Surg. S. J. W. Mintzcr, U. S. V. 76 Robb, B. F., Pt,, K, 26th May 3, Rig-lit. (Gangrene.) Surg. D. W. 1864. Disch d March 21, 1864. Pennsylvania, age 25. Aug. 6, Bliss, U. S.V. Disch d Dec. 1 9, 41 Haycock, H. H., Pt., K, Oc.28, 63, Right; circ. A. A. Snrg. H. C. 1863. 1863. Spec. 1582. 137th New York, age Mar.8, 64. May. Disch d June 18, 1864. 77 Robertson. W.B., Pt., H, J e27, 62, Left (erysip.); flap. Surg. J. Neill, 21. Spec. 2201. 27th N. York, age 20. May 14, U. S. V. Disch d Jan. 27, 18G4. 42 Howard, W. H., Pt., A, July 2, Left. Discharged June 3, 1864. ieG3. Spec. 1330. 7th Infantry, age 24. An. 4, 63. 78 Sauer, C., Pt., I, 88th Nov. 25, Left; flap. Disch d Jan. 10, 65. 43 Hughes, H.W.,Corp l, I, J el4, 63, Right (amp. leg June 14, 63; dis. Illinois. De.30, 63. 133d New York. Jan. 21, Oct. 12, 63); circ. Dr. Olcott, 79 Scheuerman, J., Pt., K, Se. 19/63, Right (erysip.); circ. A. Surg. J. 1864. Williamsburg, N.Y. Recovery. 9th Ohio, age 28. Mar. 18, E. Link^ 21st 111. Disch d July 44 Husband, J., Serg t, K, Mar. 18, Right ; circ. Snrg. A. Hard. 8th 1864. 14. 1864. Spec. 2802. 5th Penn.Art y, age 21. Ap 22, 65. 111. Cav. Disch d Aug. 5, 1865. 80 Scott, J., Pt., K, 18th June 18, Left; circ. A. A. Surg. J. C. La- 45 Jefferson, E., Pt., K, 1st July 2, Left (gang.; erysip.); ant. post. Massachusetts. Au.12, 64. mont. Disch d Feb. 17, 1865. Minnesota, age 19. Sept. 14, flap. A. A. Surg. B. B. Miles. 81 Schneider.M.,Pt.,F.26th July 1, Right: ant. post. flap. Disch d 1863. Disch d Dec. 9, 63. Spec. 17:i2. Wisconsin, age 26. Aug. 13, Jan. 29, 1864. 46 Jones, J., Pt., K, 13th No.13, 64, Right; circ. A. A. Surg. T. W. 18G3. Tenn. Cav., age 26. M ylO, 65. Baugh. Disch d Aug. 22, 1865. 82 Shaw, J.W.,Pt., I, lllth J y 3, 63, Right (M. O. June 16, 1865; 66, 47 Keigan, P., Pt., D, 1st Mar. 26, Right; flap. A. Surg. J. C. Bailv, New York. June 1, bonecame away): ant. post. flap. Colorado. Ap.26, 62. U.S.A. Disch d Aug. 23, 1862. 1872. II. K. Spooner, late Surg. 61st 48 Kelly, B., Pt., G, 83d Sept. 17, Right ; circ. A. A. Snrg. W. 11. Ohio. Recovery. Spec. G670. New York. Oc.20, 62. Matlock. Disch d March 7, 63. 83 Stierrer, J. M., Pt., C, May 16, Left ; circ. Furlonghcd October Spec. 4826. 2?th S. C.. age 38. J el 6, 64. 10. 1864. 49 Kelly, M., Pt., B, 106th July 2, Left ; ant. post. flap. A . A . Surg. 84 Steel, J.L., Corp l, C,2d Nov. 3, i Left; lat. flap. A.A.Surg.W. P. Penn., age 23. Nov. 10, F. Hinkle. M. O. Sept. 10, 64. Iowa Cavalry, age 26. De 9D (>3 Kw<w>flnnH.~ niutfiM Onf. 1 fi4 1863. Spec. 1994. 85 Stinson, J., Pt., B, 99th July 2. Left : flap. Surgeon H. Palmer, 50 King, J. M., Capt., C, Jan. 1, Right. (Nee. bone rem d.) Surg. Penn., age 18. Sep.2, G3. U. S. V. Erysipelas; abscesses. 13th Louisiana, age 25. Sept. 15, A. H. Thurston, U. S.V. Furl d Mustered out Sept. 8, 1864. 1863. Nov. 7. 1864. Spec. 1918. 86 S title, W., Pt., A. 29th May8, 64, Riffht (May 9, 64, amp. Icjr : disc. 51 Kreidler, C. W., Pt., A, Apr.7, 62, Right (disch d May 16, 63; bone Ohio, age 21. March 15, Aug. 16, 1865, gangrene); flap. 15th Infantry. May 21, diseased); flap. Dr. G. C. Black- 1866. Recovery. 1863. man, late Surg.U. S.V. Recov y. 87 Stocdale,W.,Pt., D,48th May 14, Rig-lit; flap. Confed. surgeon. 52 LaMarsh, J., Pt., I, 3d Sept. 19, Left; flap. A. A. Surg. C. W. Indiana, age 28. ,7 v (";. <;:). Mustered out July 15. 18G5. Vermont, age 20. No. 1, 64. Stinson. Caries. Disch d Aug. 88 Sullivan, J., Pt.,H,15th No. 25, 63,; Right : (lap. A. Surg. R. Bartho- 4, 1865. Indiana, age 37. Jan. 22, low,U.S.A. Carious bone rem d. 53 Litzinger, R. A., Corp l, Feb. 21, Right ; circ. A. Surg. B. Norris, 1864. Disch d April 20. 65. Spec. 21 05. G, 2d Cavalrv. .I ne4, 62. U. S. A. Discharged. 89 Surer, J., Pt., H, 19th Jan. 2. i Right : flap. Surg. F. Seymour, 54 Luck, F., Pt.", C, 21st Oct. 8, 62, Right (caries; periostitis: disch d Illinois. M h4, 63. T. S.V. Disch d June 18, 1863. Wisconsin, age 21. Jan.3, 64. Feb. 15, 1863); oirc. Surg. II. 90 Thayer. A., Pt., F. 48th May 7, Itijrht ; flap. Dr. C. Freiot, Troy, Culbertson, U. S.V. Spec. 2074. New York, ago 18. Sep.6, 64. New York. Disch d January 4, 55 Lndis, M., Pt., A, 2d Oct. 8, 62, Right ; circ. Surg. J.G. IT.itchitt, 1865. Missouri, age 37. Fe.11, 63. U. S. V. Recovery. 91 Todd. M. A., Pt., E, i<lth Aug. 29, Left ; circ. Retired March 30, 56 Mangan, J., Pt., H, 1st June 24, Left (gang.; haem.; nee.); circ. Alabama, nge22. Oc.10, 64. 18G5. Artillery, age 23. Oct. 24 Surg. E. Bentley, U.S.V. Reg l 92 Vanvourst. A. K., Pt.,A, July 1, Right. Disch d Aug. 11, 18G5. 1864. Headquarters Jan. 27, 1865. 134th N. Y., ago 18. Au. 1, G3. Spec. 417. 57 Marshall, J., Pt., 1, 69th Mar. 19. Left; flap. Surg. C. O Leary, 93 Ward, F., Pt., D, 49th April 6, Lei t. (Gangrene.) Dr. White. Ohio, age 20. 8ep.5, 65. U. S. V. Disch d Feb. 6, 1 866. New York. Myl2, 62. Disch d October 28, 1862. HOMANS (J., jr.). Cases of Gunshot Fracture of tJir Tliigli, Results of Cfmse.rrative Surgery, in Jiostim Med. and Surg.Jtnirnal, 1865, Vol. 72, p. 29 Mel K- Sun>. !li.-t.of llic M ;ir ol tho Rebellion, P;-I III Vol ILC linp X i f PLATE XLIX.MEDULLARY ABSCESSES OF THE FEMUR I iisr nf Ciml K \V ( .-II.I.K l."t th \ il"Jlii!. i SECT. III.l SECONDARY AMPUTATIONS OF THE THIGH. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND ACE. DATKS. OPERATIONS, OPERATORS, RESULT. 94 Wellman.J. G., Serg t, I, July 21, Right (slough.; necrosis); long 124 2 Hawkins, C. H., Lieut., J e8, 62, Right. (Oct., 62, dis. bone rem d.) 27th New York, age 25. Nov. 5, int., short ext. flap. Dr. R. Steb- C,4th New York Cav., April 29, Surg. A. B. Mott. 1 . S.V. Sept., 1861. bins, AlleganjiCo., N.Y. Disc h age 23. 1863. 63, exc. four ins. Amp. hip jt., Dec. 15, 1862. Spec. 1067. Sept. 21, <i4. Died Sept. 22, (M ; 95 West, W., Pt., V, 2d Jan. 17, Left ; flap. A. A. Surg.W. Dick syncope from shock. Ohio Cavalry. Mar. 29, inson. Disch d April 24, 1862. 125 Hindman, W. L., Pt., E, May 23, Left (May 23. amp. leg; gang.); 1862. 155th Penn., age 20. June 24, circ. A. A. Surg. M.C. Mulford. 96 Whiting, C., Pt., C, 17th Aug. 30, Left ; ant. post. flap. A. Surg.W. 1864. Died June 24, (i4 : inflammation New York. Oct. , E.Waters, U. S.A. Discharged and suppuration of stump. 1862. March 25, 1863. 126 ^Holland, W., Pt., I, 6th June 1, Left (erysip.; gang.; bone rem d; 97 Whortenbcrry,J.M.,Pt., De.31, 62, Left. Surg. F. Seymour, U. S.V. N. Carolina, age 45. Aug. 4, haem.); circ. A. A. Surg. T. I.. B, 15th Kentucky. Au. -, 63. Disch d Feb. 15, 1864. 1864. Leavitt. Died August 4, 18<t4. 98 Winning, J., Pt., A, 125th May 14, Left (gang.; rupt. pop. art.); ant. Spec. 2924. Ohio, age 27. Oct. 12, post. flap. Surg. H. P. Stearns, 127 Holmes, J., Pt., D, 1st June 30, Left. A. A. Surg. S. D. Gross; 1864. U. S.V. Heem. Dec. 5, re-amp. New York, age 26. Aug. 7, pyaem. Died August 19, 1862. upper third. Ilicms. Disch d 1862. Autopsy. Spec. 256. May 20, 1665. 128 Horey, G., Pt., D, 10th Mar. 21, Right (sloughing); circ. A. A. 99 Wood, W. W., Pt., D, Sept. 20, Right. Surg. Agnes, C. S. A. Illinois, age 20. June 24, Surg. E. P. Fitch. Died June 4Cth Georgia. De.27, 63. Recovery. 1865. 24, 65. one hour after. 100 Young, L. C., Pt., A, 3d May 12, Eight. (May 12, ainp. knee joint.) 129 Ingram, W. A.. Serg t, Aug. 30, . Died October 4, 1862. Virginia. July 27, Surg. W. F. Richardson, C.S.A. B, 20th N. Y. S. M. , 62. 1864. Gang. Furl d Sept. 17, 1864. 130 Jackson, H. A., Lieut.. D, No.29, 64, Left ; ant. post. flap. A. A. Surg. Spec. 5514. 45th Alabama, age 29. Jan. 1, R. McNeilly. Died Jan. 20, 65 ; 101 Young, M., Pt., F, 25th May 27, Right ; flap. Dr. J. R. Brouson. 1865. exhaustion. New York, age 25. July 28, Nee.; ervsip. Jan. 3, 63, circ., 131 Jell, F., Serg t, I, 95th July 3, Right; gang.; haem Died Sept. 1862. up. third. Disch d May 26, 63. New York, age 35. Au.26, 63 25, 1863 ; exhaust n and diarr. 102 Zweifel, J., Corp l, F, J y3, 63, Right ; circ. A. A. Surg. B. B. 132 Johnson, E. F., Pt., I, Julv 3, Left. Died Sept. 7, 63 ; exh n 6th Wisconsin, age 23. April 14, Miles. Disch d Nov. 10, 1864. 8th Georgia, age 18. Au.l2, G3. Spec. 1947. 1864. Sjsec. 2256. 133 Kirke, S. H.,Pt.,K, 200th April 2, Left (bone carious); ant. post. flap. 103 Allman, G. W., Pt., I, May 7, Left. Died August 7, 1864; ex Pennsylvania, age 19. May 22, Surg. E. Bentley, U. S. V. Dic.l 8th Iowa Cavalry. , 64. haustion. 1865. May 29, 65 ; prostration. A utop. 104 Ambrose, B. J., Corp l, I, No.22, 63, Left. (Gang.; diarr.) Feb. 10, 134 Lafferty, J. C., Capt., C, Oct. 5, Left ; circ. A. A. Surg. P. L. Rico. 105th Ohio, age 24. Jan. 29, gang.: 14, 15, haem. Died Feb. 12th Illinois, age 21. Nov.9, 64. Died Nov. 25, 64; exhaustion. 1864. 18, 64 ; exh n. Spec. 2199. 135 Lamon, G. F., Lieut. Sept. 14. Left (ulc. fern, art.; haem.); flap. 105 Baguley, S., Pt., B, 5th April 7, Left (April 8, amp. right middle Col., 32d-New York. Nov.9, G2. Surg. L. W. Oaklev. 2d N. J. New Hamp., age 21. June 3, third); ant. post. flap. Surg. O. Died Nov. 9, 62. Spec 792. 1865. A. Jndson, U. S. V. Died July 136 Lemar, J. C., Pt., B, Jan. 11, Left. (Synovitis.) Died June 10, 1865; exh n. Spec. 4232. 97th Illinois, age 21 . My2f>, 63. 23, 1863; pyaemia. 106 Bauer, P., Pt., B, 9th Feb. 14, Right ; double flap. Dr. Briggs, 137 Linn, H., Pt., A, 6th Pa. Sept. 17, Left (Dec. 4, amp. leg; gang.: Illinois. Mar. 15, Nashville. Mar. 23, haem.; lig. Reserves, age 25. 1862, nee.); flap. Surg. J. 15. Lewis. 1862. fern. art. Died May 5, 62; exh n. Jan. 15, U.S.V. Haem. Feb. 4, 63, lig. 107 Baling, J., Serg t, B, No.30, 61, Right (carious); oval skin flap. 1863. fern, art.; March 5, bone rem d. 28th Tenn., age 27. Feb. 1.8, Surg. B. B. Breed, U.S.V. Died Died March 31, 1863. Autopsy. 1865. April 26, 1865. Specs. 3818, 3983, 74H. 108 Brown, H. G., Corp l, B, June 17, Right (Junel7,amp.leg; slough.); 138 Long, J., Pt., B, 47th May 1, Right. Surg. G. Grant, U. S. V. 37th Wisconsin, age 21. July 21, flap. Surg.N.R.Moseley.U.S.V; Indiana. J e 10/63. Died Jan. 15, 1864. Spec. 1351 . 1864. July 31, bone retn d. Died Aug. 139 Matthews, T., Pt., D,8th May 6, Right; circ. Surg. D. W. Bliss. 3, 1864. Specs. 2897, 2945. Ohio, age 32. June 10, U. S.V. Died June 12, 64 ; amp. 109 Bryant, E. K.,Pt., H, 1st May 19, J c20 64 Right ; circ. A. A. Surg. C. W. TAf) MoTloiTi \V Qnrrr i T 1 1864. Spec. 2499. 110 *Capps,E. W., Capt.,.C, Oct. 11, Carrier. Died July o, 64 ; pyaem. Right (erysip.; pyarthrosis); circ. ITV cixun, w ., oerg i, xj, 23d Illinois, age 31. Sept. 24, Surg. A. M. McLetchie. Gang. 15th Virginia Cavalry, 1863, A. Surg. J. C. McKee, U. S. A. 1864. Died Sept. 25. 1864. age 30. Feb. 8, Died Feb. 20, 1864; pyaemia. 141 McCann, R. H., Corp l, May 3, Right. Surg. C.Witsell, C.S.A. 1864. Autopsy. Spec. 2036. G, 13th Miss., age 19. J e7, 63. Died July 2, 63; typ. fever. 111 Carr, W. E., Pt,, D, 27tli June 3, Left ; circ. A. A. Surg. J. Morris. 142 McCure, A., Pt,, F, 3d Sept. 19, Right; oval flap. Surg. A. At Mass , age 21. Sc.8, 64. Died October 7, 1864. Alabama, age 19. Oct. 31, kinson, C. S. A. Died Oct. 31, 112 Christiana, G., Pt., A, July 2, Right. (August 10, amp. leg.) 1864. 1864 ; pneumouia. 120th N. Y., age 36. Sept. 2, A. A. Surg. H. Leaman. Died 143 4 McGowan, P., Pt., A, May 31, Left (prof, discharges; erysip.); 1863. Sept. 26, 1863 ; exhaustion. 61st New York, age 32. J yl5, 62. cire. Dr. W. Parker. Diarrh. 113 Cobb, C. P., Pt., F, 1st Mar. 31, Left; ciro. Surg. A. F. Sheldon, and gastric irritability. Died in Michigan, nge 20. June 3. U. S. V. Died July 1, 1865; the course of twenty-four hours 186o. osteomyelitis. Spec. 4215. 144 Meadows. J. W.. Pt., C, Xo.30, (>4. Right; bi-lat. skin flap; circ. sect. 114 Curly, J., Pt., 1C, G9th fciopt. 17, Left; flap. Died Oct. 27. 1862. 16th Tennessee, age CO. Jan. 24, mus. A. A. Surg. It. McNeilly. New York. Oc.20, 02. Spec. 4828. 1865. Died Jan. 31, 65 ; exhaustion. 115 Debar, J., Pt., T, 88th Sept, 17, Left; flap. A. Surg. P.Adolphus, 145 Meyer, S.,Pt.,H, 110th July 2, Left (nee.; bone rem d); ant. post. New York. Oc.21, 62. U.S.A. Nee. bone rem d. Died Pennsylvania, age 25. Nov. 9, flap. A. A. Surg. W. P. Moon. Nov. 27, 62. Specs. 446, 447. 1864. Died Nov. 9, 1864. 116 Drain, J. F., Pt., A, 53d July 2, Left. (July 4th, amp. leg, nee. 146 Meyres, D. C., Serg t, C, No.30, 64, Left ; ant. post. flap. A. A. Surg. Virginia, age 26. Oct. 9, bone rem d.) Died Nov. 5, 63; 7th Mississippi Battery, Jan. 1, W. J. R. Holmes. Died Jan. 1 , 1863. exhaustion. Specs. 1963, 1975. ago 24. 1865. 1865; exhaustion; shock. 117 Eastman, H. J., Pt., F, Mar. 2, Left (extracted splinters of bone); 147 Patton, S., Pt., G, 31st July 9, Left; circ. A. A. Surg. J. H. 1st Vt. Cav., age 23. J e6, 64. slough. Died Sept. 19, 64; exh n. Georgia, age 42. Aug. 10, Coover. Died August 27, 1864 ; 118 Edwards, J. W., Pt., G, May 8, Left (si. ven.; haem.); circ. A. A. 1864. exhaustion. Spec. 3836. 44th Alabama, age 26. Julv 11, Sun?. T. L. Loavitt. Died Oct. 148 Pitcher, A., Pt., G, 122d May 6, Left; circ. Surer. D.W. Bliss, U. 18U4. 26, 64 ; dysentery. Spec. 2837. New York, age 25. June 7, S. V. Died July 13, 64. Spec. 119 Ewing, W. E., Pt., C, July 2, . (Gang.; slough.; haemorr.) 1864. 2449. 2d Wisconsin, age 32. Au.13, 63. Died Aug. 13, 1863 ; shock. 149 Poucher, A., Pt., A, 14th Aug. 29, Left, A. S. J. B. Brinton, U. S. A . 120 Farley, H., Pt., H, 61st May 5, Left; cire. A. A. Surg.W. W. New York. Oct. 4, 62. Died Oct. 21, 1862 ; pyaemia. Pennsylvania, age 27. J yl5, C4. Volk. Died Sept. 2, 1864. 150 Roe, J., Pt., B, 42d N. Sept. 17, Left. A. A. Surg. N.Webb. Oct. 121 Flippin, A. 11., Corp l, July 20, Left (tib. carious); circ. A. A. York. Oct. 27, 29, hasm.; 30, rcc rd, lig. femoral C, 33d Miss., age 34. Nov. 14, Surg. D. D. Talbot. Died Dec. 1862. art. Died Oct. 30, 1862; exh n. 1864. 28, 1864 ; exhaustion. Spec. 436. 122 Frost, A. C., Pt., C, 15th July 2. Left. (Prim. amp. leg.) Died 151 Roth, J., Pt., K, 2d Au.30, 62, Left. Died Oct. 19, 1862. Spec. Qo 10 f?Q 4014. 123 Goode, W. F., Pt., H, 2d OC. l*i, Oo. Sept. 17, oept. 10, louo ; gangrene. Left; flap, skin; circ. mus. A. 152 Roxbury, C. F., Pt., F, Sept. 17, Left (erysip.); flap of skin; circ. Mississippi, age 18. Dec. 22, Surg. R.F. Weir, U. S.A. Dec. 124th Penn., age 29. 1862, of mus. A. Surg. R. F. Weir, 1862. 27, haem.; gang. Died Jan. 15, Feb. 24, U. S. A. Erysip. Died March 63 ; pysem. tepees. 3858, 3893. 1863. 11, 63 ; exh n. Specs. 3855, :303. 1 ALLEN (H.), Remarks on the Pathological Anatomy of Osteomyelitis, with Cases, in American Jour. Med. Sciences, 1865, N. S., Vol. XLIX, p. 3! 2 WATERS (E. G.), A Report of Twelve Gunshot Fractures of the Thigh, in Am. Med. Times, 1863, Vol. VI, p. 185. HAMILTON (F. H.), Amputa tions in Gunshot Fractures of the Femur, in Am. Med. Times, 1864, Vol. VIII, p. 1. Circ. 6, S. G. O., 1865, p. 50. Circ. 7, S. G. O., 1867, pp. 47, 65. LEAVTTT (T. L.), Tenacity of Human Life as seen in Cases of Gunshot Injuries, in Medical and Surgical Reporter, 1865, Vol. XHI, p. 205. KENNEDY (J. T.), Reports of Hospitals, in American Medical Times, 1862, Vol. V, p. 105. 8 MOON (W. P.), Case of Gunshot Wound of the Thigh, in American Journal Medical Sciences, N. S., 1868, Vol. LV, p. 62. 316 INJURIES OF THE LOWER EXTREMITIES. (CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 153 151 155 Ryall, W. C., Corp l, E, 121st Penn. Scott, M. E.. Pt., B, 17th Indiana, age 25. Shindler M. Pt H 43d De.13, 62, Feb. 4, 1863. April 2, J e2:t, 65. May 5, Left (necrosis); circ. A. Surg. A. Hartsuff, U. S.A. Died Feb. 14, 1863; exh n. Spec. 1053. Left (necrosis); circ. Surg. H. Wardner, U. S. V. Died July, 19, 1865; exhaustion. Left (gang.); ant. post. flap. Surg. 161 162 Ifffi Tafft, F. H., Pt.,K, 3d Rhode Island Artillery. Thomas, J., *Pt., K, 30th Indiana, age 26. Travicke. W. U., Pt., A, June 16. July 23, 1862. Sept, 19, Dec. 18, 1863. July 2, Left; circ. A. A. Surg. W. K. Cleveland. Died July 27, 62; exhaustion. Left. (Gang.) Teal s method. Dec. 31, rupture fern. art. Died Dec. 31, 63; haem. Spec. 2172. Left. Sloughing; Aug. 18, hsem.; 156 l, r >7 New York, age 16. Skilton, G.T.,Pt., 1, 36th Wisconsin, age 31. Storej-,J.M.,Pt.,II,37th June IP, 1864. June 3, Aug. 30, 1864. J y30, G4, E. Bentley, U. S.V. Slough g ; ha m. Died June 27, 64 ; hsem. Right (gang.; ho?m.; Aug. 8, amp. knee; gang.; hcem.); circ. A. A. Surg. N. F. Martin. Died Sept. 19, 1864; exhaustion. Left. (July 31, amp. knee ; hrcm.; 164 165 8tb Alabama, age 46. Warner, S. N., Pt., H, 83d Penn., age 21. Williams, L.,l t..C, 26th Michigan, age 23. Au.6, 63. July 1, Au. 3, 63. May 12, June 13, 1864. gang. Died Sept. 4, 1863. Left. Died August 14, 1863; diarrhoaa. Left. A. A. Surgeon A. Ansell. Htem.; lig. fern. art. Died July 19, 64 ; hoem. Autopsy. Specs. 2882, 2883, 2538. 158 159 160 Wisconsin, age 30. Stratton, A.,Pt.,D,110lh Ohio, age 21. Stuart, S. H., Pt., I), 2d Arkansas Cavalry. Sullins, W., Texan Le- geon, age JO. April 14, 1865. May 5, June 24, 1864. Sept. 27, , 64. De.21, 62, Fe.18, 63. gang.) A. Surg. S. H. Orton.U. S.A. Died July 3, 65; gang. Left (nee.; pya?m.);ant. post. flap. A. A. Surg. J. Priestly. Died June 29, 1864 ; pysem. Autopsy. Right. Died November 10, 1864. Left. Died March 2, 1863; ery sipelas. 166 167 168 Winters, L., Pt., K, 50th Georgia. Woolsey.A., Pt., II, 20th New York. Zody, A. E., Capt., D, 102d Ohio, age 28. July 3, Sept. 11, 1863. Aug. 30, Oct. 1, 62. Se.24, 64, Jan. 26, 1865. Right (July 3, amp. leg; slough.; bsem.); circ. A. Surg. B. Stone, U. S.V. Died Sept. 30, 1863; pytemia. Left. Hsem.; lig. fem. art. Died Oct. 5, 1862 ; exhaustion. Left ; (erysip.); flap. Surg. R. II. Gilbert, U. S. V. Diarr. Died Feb. 21, 1865 ; pytemia. The seat of fracture in the foregoing one hundred and sixty-eight cases was in the middle third of the femur in seven ; in the lower third in twenty-three ; in the femur, pre cise seat not indicated, in twelve; in the knee joint, in sixty-eight; in the bones of the leg, in forty-eight; and in the ankle joint or foot, in ten cases. Secondary Amputations in the Lower Third of the Femur. Two hundred and seven operations of this group were reported. One hundred and seven were successful and one hundred proved fatal, a fatality of 48.3 per cent. /Successful Cases of ^Secondary Amputation in the Lower Third of the Femur. Four teen of the one hundred and seven successful secondary operations were practised on Union and ninety-three on Confederate soldiers. Eighty-nine of the former were pensioned, but seven have died since the close of the War. The side of operation was not indicated in seven instances; in forty-four the right, and in fifty-six the left side was implicated. Major operations had preceded the amputation in the thigh in thirty-one cases, viz: amputation at the knee joint in four, in the leg in twenty; excision in the bones of the leg in six, and amputation of the opposite leg in one instance. 1 In the following instance the amputation was performed by the subperiosteal flap, advocated by Assistant Surgeon George M. McGill, U. S. A. CASE 490. J. H. Allison, a farrier of Co. I, 21st Pennsylvania Cavalry, aged 19 years, was wounded in the left thigh, at Amelia Court House, April 5, 1865. From a field hospital he passed to the Cavalry Corps Hospital at City Point, thence to Annapolis, and afterwards to Baltimore, where he entered Jarvis Hospital, and subsequently, on July 24th, Hicks Hospital. Assistant Surgeon G. M. McGill, U. S. A., in charge of the latter, reported the following history: "The wound was caused by a mini6 ball, which entered the inner aspect of the lower third of the thigh and made its exit posteriorly, having passed down ward, outward, and backward behind the femur, and clipped a piece from the posterior surface of the bone. The femoral artery was cut by the bullet, and profuse primary haemorrhage occurred on the field, followed by a secondary attack on May 19th, and two recurrences since. Each secondary haemorrhage ceased spontaneously and did not amount to more than a teacupful. About 1 The four cases in which the amputation in the thigh was preceded by exarticulation at the knee are : Pt. J. M. Brooks, A, 17th Pennsylvania Cavalry (TABLE XL, No. 14, page 320); Pt. H. Desmond, 1, 28th Massachusetts (TABLE XL, 3o. 25, p. 320); Pt. C. H. Rist, A, 36th Wisconsin (TABLE XL, No. 82, p. 321); and Pt. H. Sholes, D, 26th New York (TABLE XL, No. 84, p. 321). Antecedent amputations in the leg had been performed in the following cases, enumerated in TABLE XL: Pt. D. M. Fletcher, 10th Indiana Battery (No. 36, p. 320); Pt. G. Mclntire, I, 7th Maine (No. 61, p. 320); Pt. J. Morrin, G, 126th New York (No. 69, p. 321); Pt. J. B. Bronson, I, 14th Ohio (No. 13, p. 320); Lieut. M. A. Cobb, A, 23d Alabama (No. 20, p. 320); Pt. E. Crawford, F, 105th Ohio (No. 23, p. 320); Pt. H. S. Dickens, H, 126th New York (No. 26, p. 320); Pt. W. F. Dudley, F, 1st Maine Cavalry (No. 28, p. 320); Corp l D. C. Eaton, H, 5th New Hampshire (No. 31, p. 320); Pt. H. Hadlow, H, 81st New York (No. 42, p. 320); Pt. F. Hoffman, H, 2d Pennsylvania Heavy Artillery (No. 47, p. 320); Pt. I. M. Welsh, B, 8th Maine (No. 101, p. 321); Pt. B. Thompson, C, 28th Pennsylvania (No. 93, p. 321); Pt. W. Bacon, I, 7th Maine (No. 4, p. 320); Corp l A. Bisbee, B, 7th Maine (No. 9, p. 320); Corp l J. Duran, C, 17th Maine (No. 29, p. 320); Pt. W. II- Miller, I, 72d Pennsylvania (No. 67, p. 321); Pt. L. N. Kimball, H, 22d Massachusetts (No. 53, p. 320); Pt. J. Kerrin, G, 19th Infantry (No. 52, p. 320); and Pt. H. Pust, K, 104th Illinois (No. 78, p. 321). Excision in the bones of the leg had been performed in the cases of: Pt. J. A. Angell, D, 1st Wis consin Cavalry (No. 2, p. 320); Pt. W. H. Bnrdick, B, 82d Pennsylvania (No. 17, p. 320); Corp l T. Odell, H, 5th Michigan (No. 73, p. 321); Pt. J. Fergus, A, 70th Indiana (No. :i4, p. 320); Serg t J. Lowth, M, 4th Wisconsin Cavalry (No. 57, p. 320); and Pt. E A. Bennett, F, 44th New York (No. 7, p. 320). In the case of Pt. II. Brown (No. 15, p. 320), K, 22d Colored Troops, the opposite leg had been previously removed. UNIVERSITY Med.fi Surg. Hist, of the War of the Rebellion. Part ni.Vol.n.Chnp X Op. pag a 17. mvmssm tfm&SM &4^3*M Ward phot PLATE LXXII. . INVOLUCRA OF BONES OF THE LEG. Fil. 1 i-ivntc Olivfi- I jiyii 1). ll\ I .S. f oloi-od Troops Specinit-ii 47-10. A.M.M. Fij^. 2. .Private W Milli-r 1.7*2 PerniKylvmiin Vols. Specimen 4172. A.M.M. SECT. III.J SECONDARY AMPUTATIONS OF THE THIGH. 317 FIG. 204. Appearance of stamp of left thigh four weeks after operation. Spec. 403. FIG. 205. Upper portion of left tibia and fibula and lower portion of femur. Spec. 477. April 20th, the wound, was attacked with gangrene. The knee joint at first, and at different periods since, became severely inflamed, and was opened eight times, discharging a serous purulent fluid on each occasion. The leg became bent at right angle with the thigh and firmly anchylosed, and several attempts were made to straighten the limb by means of anterior splints, which, however, gave the patient great pain, and were followed on each occasion by erysipelas. One attack of this disease supervened about December 13th, leaving the limb in a flabby and oedematous condition, and with several indolent ulcers, which obstinately refused to heal and were a source of great anxiety and annoyance to the patient. On February 16, 1866 the limb being found in a sloughing condition and the patient seeming to sink gradually, being very nervous, sallow, and anaemic, and his pulse very weak, quick, and irritable, Acting Assistant Surgeon H. McElderry amputated the leg by my direction. The operation was performed in the lower third of the femur through the diaphysis, by forming an ample anterior flap and a short and somewhat thick posterior one, and raising a very long and wide periosteum flap. The periosteum flap was raised with the greatest ease, and, after the operation was completed, was folded over every part of the cut surface of the bone. Great prostration followed the operation, from which the patient reacted rather slowly. He was kept under the influence of morphia the first several days. The bandages were removed and the stump dressed for the first time on the third day. Fever and attacks of vomiting appeared on February 19th, but after the next day the patient improved steadily and speedily. The last ligatures came away on February 24th. During the progress of his cure his blood presented the remarkable phenomenon of a change of the white corpuscles into red. At his own request the patient was discharged from service March 20, 1866, at which time he was able to sit in a chair all day, the stump being perfectly well with the exception of a surface granulation in the cicatrix. The end of the bone in this case was beautifully rounded." Dr. McGill further reported that an examination of the amputated limb fully corroborated the previous diagnosis of extensive fatty degeneration, and contributed two specimens of the case, one of which, embracing the amputated femur and upper portion of tibia, is shown in the cut (FiG. 205). The other specimen consists of a lig- amentous preparation of the tarsus and metatarsus and lower portion of the bones of the leg, and shows anchylosis of the ankle joint as well as a trans verse fracture in the astragalus, believed to have been inflicted after the operation. (Cat. Sury. Sect., 1866, p. 440, Spec. 483.) A cast of the stump, made four weeks after the amputation, was also contributed by the same donor, and constitutes Specimen 403 of the Surgical Section (FiG. 204). The patient, after being discharged, was admitted on the Pension Rolls, and furnished with an artificial limb two years afterwards. The Muscatine, Iowa, Examining Board, on June 4, 1873, reported that "on account of contraction of the anterior muscles of the thigh, pre venting the limb from being carried backward, he is unable to wear an artificial leg." This pensioner was paid June 4, 1879. Necrosis of the tibia and fibula following amputation in the lower third of the leg, and unhealthy condition of the soft parts of the stump, rendered secondary amputation in the lower third of the thigh unavoidable in the following instance : CASE 491. Private W. H. Miller, Co. I, 72d Pennsylvania, aged 21 years, received a shot fracture of the tarsal and metatarsal bones of the left foot, at Antietam, September 17, 1862. Assistant Surgeon J. J. Woodward, U. S. A., recorded his admission, six days after the injury, to the Patent Oflice Hospital, Washington, where the injured limb was amputated on September 28th, by Acting Assistant Surgeon P. Middleton, the operation being performed by the circular method at the lower third of the leg. Several months afterwards the patient was transferred to Armory Square Hospital, and subsequently he passed through several hospitals in Philadelphia, entering Christian Street on March 21, 1864. Acting Assistant Surgeon R. J. Levis, in charge of the latter, reported that he found the patient s general health feeble, both bones of the stump necrosed in nearly their whole length, and the soft parts in a very unhealthy condition, necessitating a re-amputation at the lower third of the thigh, which he performed by the antero-posterior flap method on April 28, 1864. He also reported that the patient reacted promptly, and that his general health improved greatly after the second amputation, and that the stump healed readily. On September 3, 1864, the patient was discharged from service and became a pensioner. He was paid as such March 4, 1879. The amputated bones of the foot and the soft tissues, as well as the bones removed at the second operation, were contributed to the Museum by the respective operators (Cat. Surg. Sect., 1866, pp. 440, 503, and 402, Specs. 97, 2748, and 4172). The last of these specimens is represented in FiG. 2 of PLATE LXXII, opposite, showing the dead shafts of the tibia and fibula surrounded by a quite complete involucrum, which, in size, approaches hypertrophy. The extremity of the fibula is roughened, but softened as if carious. The tibia approaches roundness, but its extremity is incomplete, exhibiting the end of the sequestrum. The late Dr. G. M. McGlLL in a letter to the Surgeon General, U.S.A., dated April 12, 1866, says: "When a bone is cut in amputations, two conditions, I believe, must result from the action of its distal living bone tissues. First, metamorphosis into such transitional forms as will connect with ordinary fibrous tissue. Second, change of medullary tissue into such transitional tissue and into bone proper. If, then, we a<lapt living transitional tissue we substitute the mere action of union the cohesion of homologous formed material, the easiest in nature apparently, for the action of change that reproduces bone out of medullary tissue and forms a connective tissue, certainly by means of the germinal matter that lives in fully formed bone, and that has already performed the work of development and growth. Again, it might bo reasoned, a priori, that in changes one and two, made, of course, feebly by substance of exhausted (?) formative energy, the least injury of the general health and the most trifling local injury are calculated to kill or set the germinal matter free (in the form of pus), and so throw the labor of formation, and, it may be, an added one of separation, upon more proximal forms. Thus we have sequestra, thus often osteomyelitis and pyaomia. With periosteum over the cut end of a bone, we have a tissue there whose office is to form, to connect, and to resist. So promising have the results of amputations with a periosteal flap been in my hands, that I am constrained, most respectfully, to call your attention again to the subject." The case of Allison and the preceding extract from Dr. McGlLr. B letter have been noted in Circular No. 3, S. G. O., War Department, Washington, 1871, p. 280, CASK 4. 31 K INJURIES <SF THE LOWER EXTREMITIES. ICHAP. X. KlG. 206. Appearance of stump after amputation in lower third of thigh. Amputation at the knee joint had preceded amputation of the thigh in the next case: CASE 492. Private Cutler H. Rist, Co. A, 36th Wisconsin, aged 18 years, was wounded at Cold Harbor, June 1, 1864, by u conoidal ball, which entered on the inner and posterior portion of the left leg and caused a fracture of the tibia, which extended into the knee joint. He was immediately conveyed to the field hospital of the 2d division, Second Corps, where amputation at the knee joint was performed by Surgeon J. M. Burr, 42d New York. On June llth, he was admitted into Lincoln Hospital, Washington, where Acting Assistant Surgeon C. H. Bowen reported : "Date of operation. June 3d; amputation at knee joint, leaving patella and condyles of femur." Dr. Bowen adds: "Having seen several of these operations performed, they have all died in periods varying from six to twenty days, from pyarnia, tetanus, etc., I totally discard the operation : 1st, from the extensive suppuration from the condyles of the femur and from the patella, from the duration of the suppuration, which will continue until the entire cartilaginous substance from condyles and patella is either cut away or has sloughed off by the work of nature, after which comes the continuous discharge of the synovial fluid from ihe wound. In the case of Eist, in which the limb was amputated on June 3, 1864, the synovia still exudes, in December, 1864, in quantities varying from a teaspoonful to a tablespoonful, and. more especially, after the least exertion, such as walking by means of crutches; besides, the cicati ix is of a slough ing character, tending to gangrene. December 14th, amputation not healed; continuous discharge of synovial fluid, more especially when walking; tendency to slough ; patient otherwise in a healthy condition, and desires a re-amputation, and, in my opinion, the stump will never heal while remaining in its present condition." On December 15, 1864. Assistant Surgeon J. C. McKee, U. S. A., amputated the thigh at the lower third; skin flap and circular section of muscles. Simple dressings were applied. The patient recovered, rapidly. He was transferred to Harvey Hospital, Madison, Wisconsin, on March 23d, and discharged from service May 20, 1865. His pension was paid March 4, 1879. Dr. McKee contributed a photograph of the patient (Contributed Photographs, Vol. II, p. 25), which is reproduced in the wood-cut (FlG. 206), and the pathological specimen which consists of "the extremity of the left femur and the soft tissues forming the stump i after amputation through the knee joint." (Catalogue of Surgical Section, A. M. M., 1866, p. 502, Spec. 3514.) Primary amputation of the right leg at the upper third and secondary ablation at the lower third of the left thigh were performed in the next case. The patient survived the operations eight years: CASE 493. Private H. Brown, Co. K, 22d Colored Troops, aged 19 years, was wounded in both legs, at Petersburg, July 30, 1864. He was admitted to the Eighteenth Corps Field Hospital, where Surgeon S. A. Richardson, 13th New Hamp shire, recorded "amputation of right leg." Surgeon J. H. Taylor, U. S. V., reported the following history: "The patient was admitted to Summit House Hospital, Philadelphia, August 17th, with shell wound of both legs, the right leg having been amputated at the upper third by flap method on the field. The stump of the right leg healed entirely, but the wound of the left tibia, which was injured in the upper third, resulted in necrosis of the bone extending into the knee joint, and was attended by extensive sloughing of the soft parts. The left limb was amputated on March 19, 1835, above the knee joint, by Acting Assistant Surgeon O. Shittler, the double flap method being employed and chloroform used. The treatment consisted of simple dressings, tonics, and stimulants. The stump healed kindly and the patient progressed well." Several months after the operation lie w:is supplied with artificial limbs by the Palmer Arm and Leg Company. At the closing of Summit House Hospital the patient was transferred to Mower Hospital, and subsequently to the Post Hospital at Philadelphia. On September 11, 1886, he left for his home, cured, having been discharged from service to date from March 20, 1865. His name appeared on the Pension Rolls until July 14, 1872, when he died. The cause of his death has not been ascertained. Fatal Secondary Amputations in the Lower Third of the Thigh.- One hundred secondary operations in the lower third of the femur proved fatal. Twenty-four were practised on Confederate and seventy-six on Union soldiers. In three the injuries had been caused by shell, in two by grapeshot, and in ninety-five by small projectiles. Pyaemia was noted in twelve, tetanus in one, and gangrene in twenty-one instances: CASE 494. Private W. H. Powell, Co. I, 3d South Carolina, aged 20 years, was wounded at Antietam, September 17, 1862, and entered hospital No. 5, Frederick, November 25th. Surgeon H. S. Hewit, U. S. V., recorded the following history : "The patient had been wounded by a grapeshot in the right leg and through the ankle joint, for which amputation had been performed at the middle third of the leg. The stump was doing badly, having commenced sloughing on the outer side. There was also much swelling. The granulations on the inner side of the stump were very exuberant. Pain in the knee joint indicated carti laginous inflammation. Reamputation was deemed necessary, and was performed by Acting Assistant Surgeon A. V. Cherbon- nier, above the knee, on No%"ember 30th. At the operation, the track of an old abscess wns discovered, extending some distance up the thigh. Two days afterwards the stump showed some fungous granulations and the dressing was supplemented with a weak solution of nitric acid, with which the sinus was also injected. This treatment was kept up until December 10th, when SECT, ill.] SECONDARY AMPUTATIONS OF THE THIGH. 319 the stump had assumed a healthy appearance, but a large quantity of laudable pus was being discharged from the si HUB. The injection was then increased and a tight bandage applied, and the dressing of the stump was changed to a solution of tannin. On the 20th, the stump was still doing well, and the sinus seemed to have closed, pus having ceased to come from it. On the 24th, the stump grew painful and the discharge ceased. Poultices were now applied and tincture of iodine used to the hip. Iodide of. potassa was also prescribed in doses of five grains three times a day, and the same quantity of quinine, and one half ounce of cod-liver oil every four hours. On the 26th, the patient s condition had improved. The discharge of pus having become offensive, the stump was washed with a dilution of chlorinate of soda, the poultice discontinued, and wet strips applied." The patient was transferred to hospital No. 6 on December 29th, and to hospital No. 1 six weeks later. Assistant Surgeon R. F. Weir, U. S. A., in charge of the latter, recorded the termination of the case as follows : "At the time of admission the stump looked healthy and was suppurating, and the patient was in tolerable good health, but had quite a large bedsore above the sacrum, which was healing. He was taking tonics and stimulants, also iron mixture and cod-liver oil, and the stump was dressed with oakum saturated with acid wash. On February 29th, fluctuation w r as detected in the stump, and an opening was made on the anterior aspect one inch long, through which pus escaped. On March 17th, the patient complained of pain in the stump and more pus was discovered by the probe, necessitating another incision, one and one half inches long, to be made to allow it to escape, after which poultices were applied. Two days afterwards an abscess was discovered on the anterior aspect of the stump and just opposite the point of the previous incision, which on being opened evacuated two ounces of pus. For some days after this the patient was much better and the stump was improving slowly. One month later, however, he was noticed to be failing, and looking very pale and anaemic. Erysipelas was discovered in the stump on April 24th, for which lead and opium lotion was applied. At the same time the patient was suffering from considerable irritability of the stomach, being unable to retain any food or medicine for any length of time. Hydrocyanic acid having been administered for this without any good effect, lime water was given, which appeared to relieve the patient to some extent. On the following day the erysipelas was found to be extending to the opposite side and body, and, on April 28th, it was leaving the stump and was spreading still farther upon the body, the patient s condition being quite feeble, having no appetite, his tongue coated, skin dry, and pulse weak. During the two following days he was in a critical condition and unable to retain anything on his stomach, nourishment being given by the rectum. Hydrocyanic acid and lime water were now used without benefit, and tincture of opium was sub stituted with apparent relief. On the morning of May 1st, the patient appeared brigliter, having rested well and being able to retain his nourishment. The erysipelatous inflammation had left the stump, but had extended across the body and was spread ing down the other thigh. In addition to his treatment egg-mixture and tincture of iron was now prescribed for the patient. He failed rapidly on the next day, and died on the morning of May 3, 1863. At the post-mortem examination four ounces of purulent serum was discovered in each side of the chest, and the lungs were found to be partly congested, with small calcareous deposits in the upper lobe of the right side. The heart was of normal size, the cavity of the stomach very much congested, the liver having the appearance of fatty degeneration, the gall bladder very much distended, and the kidneys moderately congested. The tissues about the stump were healthy, but on opening the capsular ligament about two ounces of pus was found around the hip joint. The cartilage lining the acetabulum was softened, and in some places entirely gone. On dissecting out the nerves the bulbous expansions of their ends were shown to be well marked. Above the saphenous a wire ligature was found, which seemed to have given rise to little or no irritation. The patient had frequently complained of pain in the stump, but it is impos sible to say whether it was caused by this ligature or by the abscesses that were forming from time to time. The end of the stump of the femur was found to be surrounded by an involucrum, exposing a small sequestrum running up the shaft." The amputated stumps of the tibia and fibula were forwarded to the Museum by the operator, and the stump of the femur was contributed by Acting Assistant Surgeon A. North. (Cat. Surg. Sect., 18(i6, p. 400, Spec. 795, and p. 300, Spec. 3837.) In the following instance Byrne s amputation at the ankle joint had been performed on the clay of the injury, but continuous sloughing and abscesses followed, and amputation at the upper third of the leg and subsequently at the lower third of the femur were practised: CASE 49.">. Private F. M. Bland, Co. D, 23d Iowa, received a shot wound in the left foot, during the engagement at the Black Kiver, May 19, 1863. " Syme s amputation at the ankle was performed the same evening at a field hospital. On June 13th, the patient was admitted into Adams Hospital, at Memphis, at which time nearly the entire flaps had sloughed off the stump and the bones were exposed to view. An abscess had also formed at about the middle of the lower third of the leg, and periostitis of the tibia and fibula existed at the same point. The general condition of the patient was low; he having suffered from diarrhoea for four months. He was put upon iron, quinine, stimulants, and astringents. On June 17th, his general con dition being somewhat improved and the diarrhoea checked, it was decided to amputate, which was accordingly done at the junction of the upper and middle thirds of the leg by Acting Assistant Surgeon J. Thompson. I saw the patient for the first time on the following clay, when, though in a low condition, he seemed to be rallying from the shock of the operation. I admin istered iron, quinine, stimulants, and beef tea, and had water dressings applied to the stump, under which course the general condition of the patient gradually improved. The stump at first appeared to do well, but before many days began to discharge thin ichorous looking pus. This was the condition of the patient when his ward was transferred to the charge of Acting Assistant Surgeon W. P. Sweetland. On June 26th, the wound gaped open, no adhesions having formed in any part of the stump, and the Haps soon commenced sloughing. It was then decided that the only chance for the patient rested in another operation, and accordingly, on July 2d, the thigh was amputated at the middle of the lower third. The patient seemed to bear up well under the operation, and, as before, seemed at first to be doing well. But soon the stump became gangrenous: an abscess also formed on the patient s shoulder below the clavicle, the edges of which sloughed, laying bare the thyroid axis and destroying its branches. On July 13th, the patient was removed to my ward in a rapidly sinking condition. He died on July 16, 18G3." The foregoing history was transmitted by Acting Assistant Surgeon B. J. Bristol, and the bones removed at the second amputa tion were contributed to the Museum by Surgeon J. G. Keenon, U. S. V. (Cat. Surg. Sect., 1866, p. 441, Spec. 1706.) The specimen shows the extremities to be necrosed, no reparativc action having occurred. 320 INJURIES OF THE LOWER EXTREMITIES. (CHAP. X. TABLE XL. Summary of Two Hundred and Seven Cases of Secondary Amputation in the Lowe) Third of the Femur for Shot Fracture. I Recoveries, 1107; Deaths, 108207.] NO. NAMK, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPEHATIONS, OPERATORS, RESULT. 1 Allison, J., Farrier, I, Ap. 5, 65, Left (hsem s; erysip.); ant. post. 31 Eaton, D. C., CorpM, H, Sept. 17, Left. (Sept. 17, amp. leg.) Disc d 21st Pennsylvania Cav Feb. 16, flap. A. A. Surg. H. McEldery, 5th New Hamp., age 30. De.29, 62. March 13, 03. Died July 1. 63. alry, age 19. 1866. Disch d March 20, 1866. Specs. 32 Elliott, T. A., Corp l, Shu- Jan. 4, . Surg. H. McGuire, C. S.A. 477, 403, 483. maker s Battery. Fe.18, 62. Recovered. 2 Angell, J. A., Pt., D, 1st July 23, Right (gang.; Aug. 1, 64, excis. 33 EustisJ. B.,Pt.,E,149th Oc.28, 63, Left (haem.); circ. Surg. W. Va- Wisconsin Cav., age 23. Sept. 18, tibia; haem.); circ. A. A. Surg. New York, age 23. Jan. 21. rian, U. S. V. Disch d April 3, 1864. J. C. Thorpe. June 16, 65, re- 1864. 1864. Spec. 2097. Died Feb. amp. Recovery. Spec. 5549. 18, 1875; consumption. 3 Arendt, J., Pt., E, 5th Jan. 1, Left ; flap. A. Surg. J.W.Pearce, 34 Fergus, J., Pt,, A, 70th May 14, Left (June 24, exc. fib.; gang.; lib. Kentucky. Mar.1, 63. 51st Ind. Disch d Nov. 17, 63. Indiana, age 34. Aug 15, art. sloughed; haem.); circular. 4 Bacon, W., Pt., I, 7th JV12, 64, Left (amp. leg; nee.; disch d June 1864. Surgeon R. I,. Stanford, U. S. V. Maine, age 21. , 66. 16, 65); flap. 1870, good stump. Disch d Jan. 20, 1865. Spec. 2841. 35 Fisher, A., Pt., C, 7th N. June 17. Left ; circ. Surg. J. W. Merriam, 5 Bass, J. B., Pt., K, 59th M h7, 62, Left (disch d Sept. 20, 62); circ. Y. H vy Art y, age 26. Oc.19, 64. U. S. V. Disch d June 24, 1865. Illinois. Jan. 16, Dr. S. Cabbot, Mass. Hospital. 36 Fletcher, D. M.,Pt., 10th Oc.27, 64, Right (Oct. 28, amp. leg); flap. IQfiQ Mustered out July 10, J865. 6 Bassett.J. P., Pt., 1, 114th ioOo. Oct. 19, Left; ant. post. flap. A. A. Surg. 37 Fulwiler, L. is., Pt, A, June 25, Left ; flap. A . Surg. P. Goddard, New York, age 22. Nov. 29, A.W.Emory. Disch d April 10, 20th Indiana. J y26, 62. U. S. V. Disch d Aug. 22, 1 862. 1864. 1865. Spec. 3476. 38 Garlick, J., Pt., I, 26th May 3, Rifiht; flap. Disch d June 27, 7 Bennett, E. A., Pt., F, May 22, Left. (M. O. Oct. 11, 64; Dec.. G4, Pennsylvania, age 21 . J yll. G3. 1864. 44th New York, age 41. 1864, nee. bone rem d ; Jan., 69, exc. 39 Glavin. D., Pt., E, 87th June 1, Left (frag, of bone rem d); double Mar.2, 69. up. frag, fibula.) Dr. T. Becket, New York. July 2, flap. A. Surg. W. Thomson, Albany. Re-amputation. 1862. U. S. A. Disch d Feb. 28, 1863. 8 Biddle, D., Corp l, A, July 1, Left; circ.; gang.; exfol. Disch d Spec. 4931. 107th Ohio, age 23. Au.13, 63. June 24, 1864. 40 Graham, R. P., Pt., II, Oct. 5, Right ; circ. A. A. Surg. D. C. 9 Bisbee, A.. Oorp l, B, 7th Ap.16, 62, Right (May 12, 1862, amp. leg; 7th Illinois, age 23. Nov. 9, Bell. Haem.; lig. fern, artery. Maine, age 25. Ap. 8, 63. disch d Feb. 10, 1863); circular. 1864. Disch d May 22, 1865. 10 Bishoff, D.D.,Pt. ,15,14th May9, 64, Left (nee.); circ. A. A. Surg. J. 41 Grant, W., Pt., G, 9th N. Oct. 19, | Right; ant. post. flap. A. A. Surg. West Va., age 25. Mar. 13, H. Butler. Disch d May 20, 65. York Artillery, age 36. No.26, 64. C. H. Jones. Disch d Feb. 2, 65. 1865. 42 Hadlow, H., Pi., H, 81st May 31, Right (prim. amp. leg: July 24, 11 Blakeley, J. W., Pt., F, J y21, 61, Right (disch d Sept. 29, 62); flap. New York, age 21. Aug.], gang.); circ. Aug. 15, re-amp. llth Massachusetts. ^No. , 62. Died Jan. 30, 1870 ; phthisis. 1862. mid. third. Necrosed. Disch d 12 Boyd, H., Pt., D, 51st May 25, Left ; lat. flap. A. A. Surg. R, H. May 2, 1863. Colored Troops, ngc 42. Je.25, 65. Blandry. Recovered. 43 Hagadone,A., Serg t, M, Aug. 25, Right (gang.; nee.); flap. A. A. 13 Branson, J. B.,Pt.,I,14th Aug. 5, Right. (Pr. amp. leg.) Disch d 2d New York Heavy Nov. 21, Surg. "\V. II. Ensign. Disch d Ohio, age 18. , 64. June 21, 1865. Artillery, age 29. 1864. July 12, 1865. Spe.c. 3436. 14 Brooks, J. M..Pt.,A.17th June 21, Left (June 21, amp. knee joint; 44 Ham, W., Pt., G. 42d Sept. 20, Left : . circ. A.Surg.N.Teal, 88th 1 enn. (, av., age 28. Sept. 10, fang.); ant. post. flap. Disch d Indiana, age 20. De. 6, 63. Indiana. Disch d Sept. 30, 1864. 1863. uly 28, 1865. 45 Hanley, M., Pt., A, 18th June 13, Left; circ. A. A. Surg. C. II. 15 Brown, H., Pt., K, 22d July 30, Left "(July 30. amp. right leg); Connecticut, ;ige 19. Dec. 23, Jones. Disch d June 15, 1864. Colored Troops, ago 19. 1864. dou. flap. A.A.Snrg.O.Shittler. 1863. Died March 2, 1866. Spec. 1993. Mar. 19. Disch d March 20, 1865. Died 46 Hill, G. N., Corp l, A,: 5th Sept. 29, Left ; lateral flap. Recovery. 1865. July 14, 1872. Colored Troops, age 21. De.29, 64. 16 Brown, W.C., Pt., K, 93d Se.20, 63, Left (erysip.); ant. post. flap. A. 47 Hoffman, F., Pt., H, 2d June 18,. Left (July 11, amp. leg); flap. A. Ohio, age 215. April 12, Surg.B.E.Fryer.U.S.A. Disc d Penn. Heavy Artillery. Dec. 6, 64 A. Surg. J.S. Waggoner. Disch d 1864. Oct. 7, 1864. Spec. 117. age 21. August 15, 1865. Spec. 3714. 17 Burdick, W. II., Pt., B, Ap. 6, 65, Right (exc. tibia; disch d Oct. 12, 48 Hogg, W., Pt., I, 76th May 5, Right ; ant. post. flap. Surg. E. 82d Penn., age 24. Mar. 27, 1865); flap. Dr. B. E. Phelps. New York, age 34. J ne7, G4. Donnelly, 2d Penn. Reserves. I860. Corry, Pa. 1870, stump healthy. Disch d May 6, 1865. 18 Chase,H.\V.,Pt., H, 96th Sept. 29, Left ; flap. A. A. Surg. E. Vogel. 49 Hubbard, A., Pt., D, 6th July 22, Left (inter, amp. leg; ext. nee.); New York, age 21. De. 1, 64. Disch d April 14, 1865. New York Cav., age 31. 1864, circ. A.Surg.S.H.Orton.U.S.A. 19 Clapp, F., Pt., K.2d Mass. J y 13/63, ; circular. A. A. Surg. J. F. Jan. 1, 65. Disch d Nov. 7, 1805. Spec. 278. Cavalry, age 21. !Mh 18, 64. Thompson. Disch d Sept. 13, 64. 50 Inman, A. W., Pt., B, May 27, Left; circular. Disch d June 15, 20 Cobb, M. A., Lieut., A, De.15, 64, Right (Dec. 17, amp. leg: gang.); 124th Ohio, age 30. J y 5, 64. 1865. 23d Alabama, age 39. Jan. 19, bi-lat. skin flap ; circ. sect. muse. 51 Jinne.lt, J., Pt., D, 67th De.29, 63, . Surg. Turner, C. S. A. 1865. A. A. Surg. W. I. R. Holmes. North Carolina. J e22, 64. Recovery. Provost Marshal June 3, 1865. 52 Kerrin, J., Pt., G, I Jth Aug. 13, Right (Aug. 13, amp. leg; gang.); 21 Oomer, C. Serg t F 13th Right. Surg. 1. 1*. Smith, C. S. A. Virginia Cavalry. Oc.20, 63. Recovery. * 1804. U. S. V. Bone rem d. Disch d 22 Costello, P., Pt., K, 88th No.25, 63, Right ; circ. Surg. G. Grant, U. June 4, 1865. Illinois, age 26. July 18, S. V. Gang. Disch d June 17, 53 Kimball, L. N., Pt,, II, May 10, Right. (May 10, 64, arnp. leg; 1864. 1865. Spec. 3006. 22d Mass., age 19. 18"04, ham.; lig. Disch d Oct. 17, 04.) 23 Crawford,E.,Pt.,F,105th Sept. 19, Right (Oct. 4, 63, amp. leg); circ. Jan. , Dr. W. 11. Thorndike, Boston, Ohio, age 20. 1863, A.Surg.G. M. Sternberg.U.S.A. 1867. Mass. Recovery. Aug. 5, Haem s; lig. prof. art. Disch d 54 Kirk, W. II., Capt., D, De.2!), 04, Right : circular. Resigned May 1864. March 18, 1865. Spec. 3108. 3d N. C. MTd Infantry. Feb.4, C5. 15, 1805. 24 Deny, J. M.,Pt.,B,126th Sept. 21, Right ; nee.; sect, skin flap. A. A. 55 Klammer, A., Pt., E, nth De.16, 64, Right (nee. fragm ts rem d); circ. Ohio, age 23. Oct. 30, Surg. B. B. Miles. Disch d June Minnesota, age 26. Feb. 10, A.A.Surg.H.M. Lilly. Disch d 1864. 28, 1865. Spec. 3417. 1805. June 1, 1865. Spec. 4245. 25 Desmond, H.,Pt, I, 28th De.13, 62, Right (Dec. 21, 62, amp. knee j t); 56 Love, J. W., Pt., D, 25th De. 7, 64, Left ; oval flap. A. A. Surg. G. 6? post flip Disch d Dec 22 63 An. 31 05 E Sloat Disch d Jan. 14 1866. 26 Dickens, II. S., P*., H, J v2, 63, Left (July 11, amp. leg); ant. post. 57 Lowth, J., Serg t, M, Aug. 24, Right (gang.; May 27, 65, exc. 120th N. Y., age 30. April 24, flap. A. A. Surg. R. J. Lewis. 4th Wisconsin Cavalry, 1864, fib.; lig. post. tib. art y); at con- 1864. Disch d April 28/65. Spec. 2740. age 26. June 2, dyles. Surer. H. Culbcrtson, U. 27 1 Doerllinger, C. H , Lt., May 2, Left ; oirc. Surg. J. A. Lidell, 1865. S. V. Disch d July 17, 1865. B, 2(ith \Vis., age 20. Je.27, 63. U. S. V. Disch d Feb. 25, 1864. 58 Mason, D., Corp l, G, May 14, Right ; circ. A. Surg. C.W. Law 28 Dudley, W. F., Pt., F, Mar. 1, Left (March 2, amp. leg; gang.); 104th Illinois, age 23. July 6, rence, 22d Mich. Disch d Jan. 1st Maine Cav., age 24. June 14, circular. A. Surg. W.Webster, 1864. 6, 1865. 1864. U. S.A. Disch d Aug. 14, 1865. 59 McClelland, W. II., Pt., De 18, 04. Right; circ. Confed. surgeon. 29 Dnran, J.,Corp l, C, 17th ;M y C, 64, Left (gang.; Aug. 28, amp. leg); A, 12th Ohio Cavalry. Feb.7, 65.| Disch d Sept. 11, 1865. Maine, age 23. May 18, circ. Surg. G. Derby, U. S. V. 60 McCue, A., Pt., G, 21st Sep. 1, 62, Left (disch d June 23/63); circ, , 1865. Disch d August?, 1865. Massachusetts. Feb. 27, Dr. B. S. Shaw, Mass. Hospital. 30 Eastman, J., Pt., E, 1st Sept. 19, Right (gang.); circ. A. A. Surg. 1864. Recovery. Wisconsin. Dec. 25, W.E.Whitehead. Disch d Nov. 61 Mclntire, G., Pt., I, 7th May 10, R t (May 11, amp. leg); ant. post. 1863. 29, 1864. Died April 10, 1870. Maine, age 24. Oct. 16, flap. A. A. Surg. G. E. Brickett. Spec. 2035. 1864. Hsem. Disc.h a June 16, 1865. 1 LIDELL (J. A.), On the Major Amputations for Injuries in both Civil and Military Practice, in Am. Jour. Mtd. Kci., N. S., 1864, Vol. XLVII, p. 368. SECT. 1 11.1 SECONDARY AMPUTATIONS OF THE THIGH. 321 xo. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. XAMK, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 62 McLeppy. J., Corp l, C, June 28, Right; circ. A. A. Surg. J. E. 95 Vogt, M., Pt., I, 15th N. May 19, Left (gang.; nee.); ant. post. flap. 20th Indiana, age 31. De. 6/62. Steel. Disch d June 8, 1863. York Artillery, age 23. June 28, Surg. R. B. Bontecou, U. S. V. Specs. 1836, 4760. 1864. Disch d Oct. 21/65. Spec. 3C53. 03 McLin, V., Pt., H, 7th July 3, Right ; ant. post. flap. Surg. C. 96 Wagenknight, W., Pt., Sept. 20, Left (gang.; haem.); circ. A. A. Wisconsin, age 20. Aug. 3, W. Jones, U. S. V. (August 6, G, 118th Penn., age 38. Nov. 23, Surg. J. Cass. Discharged July 1863. haem.; lig. fern, artery: disch d 1864. 26, 1865. Sept. 6, 6<l . ) Spec.?. 1 697, 2154 . 97 Wager, G. H., Pt., H, Aug. 30, Right thigh. Discharged March 64 McMahon, A., Pt.,G. 9th Sept. 17, Left. Surg. J. B. Lewis, U. S. V. 22d New York. L, 62. 11, 1863. New York S. Militia. Oc.22/62. Disch d Jan. 9, 63. Spec. 449. 98 Wandel, G., Pt., K, 7th Xo.27/63, Left (gang.); circ. A. A. Surg. 65 McMurray. J. T., Serg t, July 2. Right : circ.; end of fern, rem d. Ohio, age 25. Mar. 15, M. L. Herr. Duty June 28, 64. D,9th Alabama,age ^4. A u.3, 63. Exchanged March 3, 1864. 1864. Spec. 2202. 66 Miller, J. M., Pt., D, 6th May 27, Left : flap. A. A. Surg. R. Koeler. 99 Waters, W. W., Serg t, Mar. 30, Right (Disch d July 6, 65) ; circ. Michigan Artillery. J y IP/63. Disch d Sept. 22, 1863. K, 6th Cavalry, age 23. 1865, Dr. N. S. Lincoln, Washington, 67 Miller, W. H., Pt., I, Sept. 17, Left (Sept. 28/62, amp. leg; nee.); Mar. 19, D. C. Recovery. Spec. 4047. 72d Pennsylvania, age 1862, ant. post. flap. A. A. Surg. R. J. 1866. 24. April 28, Levis. Disch d Sept. 3, 1864. 100 Weiderecht, M., Pt., D, No.25/63, Right ; circ. A. Surg. R. Bartho- 1864. Specs. 97, 2748, 4172. 6th Ohio. Oc.19/64. low.U.S.A. Disch d May 17/65. 68 Montana, J. R., Surgeon April (i, Left. (Ulceration.) Langenbeek s 101 Welsh, I. M., Pt., B, 8th M y 20, 64, Right. (Amp. leg; nee.; hoem.) from Mexico. 1862, method. Dr. Sutherland, S. C. Maine, age 21. April 12, Surg. G. Derby, U. S. V. Dis- 1865. 69 Morrin, J., Pt., G, 126th July 3, Left (July 4, amp. leg: gang.; 102 Wey mouth, H. G. O., De.13/62. Lett (ball extr d); circ.; flap. A. New York, age 21. Nov. 3, hsem.); ant. post. flap. A. Surg. Capt., K, 19th Mass. Jan 17 A. Surg. D. R. Good. Disch d 1863. T. C. Brainerd, U. S. A. Seq. 1863. April 8, 1863. Spec. 701. and fragments rem d. Disch d 103 White, E. S., Pt,, F, 54tb Jan. 30, Right thigh. Recovery. June 18, 1865. Specs. 2604, 1416. Virginia. Ap. 1/63. 70 Newman, E. B., Serg t, Feb. 20, Left (disch d June 19, 1865, limb 104 Wilder, F. W., Pt., A, July 2, Right ; ant. posterior flap. A. A. F, 48th New York, age J864, distorted; knee i t anchy.): flap. 59th Georgia, age 22. Oc.24/63. Surg. J. E. Steel,U.S.A. Prison 23. June 18, Dr. S. Shove, Katonah, N. Y. April 19, 1864. 1868. Recovery. 105 Wood, M. P., Pt., G, 43d May 16, . Surgeon Burk, C. S. A. 71 Nichols, L., Pt.. F, 157th July 1, Right ; haem. A. A. Surg. C. H. Georgia. J y26/63. Recovery. New York, age 18. Aug. 14, Jones. Disch d May 31, 1864. 106 Wren, R. L., Pt., C, 15th No. 8/63, Left ; circ. A. A. Surg. P. Peter. 1863. Spec. 1670. Ohio, age 26. Feb.1/64. Disch d July 28, 64. Spec. 2195. 72 O Boyle, M.,Pt,,E, 156th Oc.l J/64, Left; ant. post, flap; skin, circ. 107 Yearkes, G., Pt., A, 3d Sept. 26, Left : ant. post. flap. A. A. Surg. New York, age 17. Jan. 13, sect, muscles. A. A. Surg. B. B. Mary land Cav., age 30. No.22/64. J. N. Snively. Spec. 3721. 1 865. Miles. M. O. 1865. Spec. 3728. 108 Anthony, C.,Pt. H 55th Right : flap. A. A. Sur". W. L. 73 Odell. T., Corp l, H, 5th J e 18/64, Left (slough.; excis. tibia); flap. Penn., age 34. J e 25, 64. Welles. Died July 12/64 ; exh n. Michigan, age 20. Jan. 13, A. A. Surg. G. C. Harlan. Dis 109 Asliford, W. H., Pt., I, Oct. 19, . Profuse suppuration. Surg. 1865. charged May 22, 1865. 18th Georgia. No. , 64 Love, C. S. A. Sloughing. 74 Ferryman, J. L., Pt., D, Sept. 19, Left. Surgeon A. M. Spalding, Died Nov. 30, 1864 ; gangrene. 20th Georgia. Oc.30/63. C. S. A. Recovery. 110 Baesier, J. P.,Pt.,C,75th Aug. 29, ; thigh. Died December 12, 75 Potter, II. G., Serg t, A, Se.20/64, Right. (Synovia; nee.) A. A. Ohio. , 62. 1862. 74th Indiana, age 20. May 13, Surg. J. W. Taylor. Re-amp. 111 Ballinger,R.,Pt.,A,113th June 27, Left (gang.) ; oval flap. A. A. 1865. mid. third. Disoii d June 20/65. Ohio, age 29. Aug. 10, Surg. J. C. Thorpe. Died Aug. 76 Potts, N. H., Serg t, B, May 3, Left (hoein. recur nt); circ. Surg. 1864. 12, 64 ; gang, and irrit. fever. 95th Penn., age 22. J ne5/63. R. S. Kemlerdine, U. S. V. Dis 112 Barrett, G., Pt., C, 13th July 21, Left (slough g); flap. A. Surg. charged August 24, 1864. Indiana, age 22. Au.23/64. H. M. Sprague, U.S.A. Slough. 77 Powell. S. H., Oorp 1, C, J ly9/64, Right (gang.; nee.); ant. post. flap. Died Aug. 31, 1864 ; exhaustion. 14th New Jersey, age Sept. 15, Surg. T. Sim, U. S. V. Disch d 113 Beebe, C., Serg t, B, 3d May 28, Right ; circ. Surg. S. E. Fuller, 24. 1864. Jan. 3, 1865. Spec. 3468. Wisconsin, age 26. J y 7/64. U. S.V. Died Jiily7/64 ; shock. 78 Pust, H., Pt., K, 104th De.7/62, f,eft (Dec. 11, amp. leg); conical. 114 Bertsch, W., Corp l, G, Aug. 29, ; thigh. Died October 7, Illinois, age 25. Oct. 24, A. A. Surg. R. N. Isham. Dis 58th New York. , 62. 1862. 1863. charged March 4, 1861. 115 Binns. E. D., Pt., K, 53d July 3, Right; hsem. Died October 3, 79 Reid. W. F., Pt., A, 1st May 23, . Surg. Miller, C. S. A. Virginia, age 19. Se. 30/63. 1863. Spec. 1943. N. C. Battery. Se. l 5/62. Recovery. 116 Black, B. F., Pt., A, 6th Sept. 19, Right; circ. Died October 30, 80 Rice, R., Pt.. I, 1st Mis May 26, Right (gang.); circ. A. A. Surg. Kentucky. Oc.30/63. 1863; haemorrhage. Autopsy. souri Cavalry, age 23. Oc.27/63. A.L.Allen. Disch d July 29/64. 117 Bland, F.M.,Pt.,D, 23d Alay 19, Left. (May 19, Syme s nmp.; 81 Ringold, W. H., Pt., I, June 1, Right ; flap. A. A. Surg. R. J. Iowa. July 2, slough.; June 17, amp. leg.) A. 188th New York, age July 13, Levis. Disch d Feb. 11, 1865. 1863. A.Surg.W.P.Sweetland. Gang. 19. 1864. Spec. 3680. Died July 16, 1863. Spec. 1706. 82 Rist, C. H., Pt., A, 36th June 1, Left. (June 1, amp. knee joint.) 118 Brady, B., Pt., C, 4th May 24, Right; circular. A. A. Surg. A. Wisconsin, age 19. Dec. 15, Surg. J. C. McKee.U. S.A. Dis. Infantry, age 34. J e 25/64. Ansell. Died Xov. 2, 1864. 1864. May 20, 1865. Spec. 3514. 119 Brooks, J. H., Pt., E, 1st Aug. 16, Left (slough.; haom.; lig. femoral 83 Shafer, A., Pt., B, 13th Sept. 30, Left;" circ. A. A. Surg. W. II. Maryland Cav., age 39. Sept. 28, art.); circ. A.A.Surg.J.C. Mor Ohio Cavalry, age 18. Xov. 15, Coverton. Seq. rem d. Disch d 1864. ton. Died Oct. 17, 64 ; exh n. 1864. Aug. 5, 1865. Spec. 3723. 120 Bullen, B. W., Lieut., No.30/64, Right. (Dec. 31, amp. leg; teta.) 84 Sholes, H., Pt., D, 26th New York, age 20. De.13/62, Feb. , 1863. Right (Dec. 15, amp. knee joint; gang.); ant. post. flap. Surg. D. W. IJliss, U. S.V. Disch d June 121 Darden s Bat y, age 25. Callahan, M., Corp l, K, 1st New Jersey, age 17. Jan. 6/65. June 11, Aug 3, Died Jan. 7, 1865; trismus. Left: circ. A. A. Surg.W.C.Mul- ford. Died August 5/64 ; haem. 4, 1863. 1864. and asthenia. Spec. 2922. 85 Silsbee, J. H., Pt., C, 8th May 3. Left ; circ. A. A. Surg. W. S. 122 Camp, W. II..Pt.,B, 203d Jan. 15, Left ; circ. A. Surg. S. H. Orton, New Jersey, age 27. June 18, Ward. Aug. 5, re-amp. Disch d Penn., age 35. Mar. 5, U. S. A. Died March 15, 1865; 1863. May 6, 1864. 1865. haemorrhage. 86 Sloppy, P., Pt., E, 148th May 10, . Confed. surgeon. Necrosed 123 Cannivau, C. C., Pt., G, Aug. 30, (nee.; aneurism); ant. post. Pennsylvania, age 20. J y<J.V64. end femur removed. Recovery. 88th Pennsylvania. Oc.31/62. flap. Died Nov. 14, 1862. 87 Smith. M., Pt., G, 16th Au.30/62, . Ass t Surg. M. P. Shelton, 124 Cogby, H. J., Corp l, B, May 3, Left. (Bone and ball removed. Virginia. May4/64. C. S. A. Recovery. 139th Penn., age 25. J ne9/63. Surg. J. H.Baxter,U.S.V. Died 88 Sollers, J. II., Lieut., B, May 2, Right ; ant. oval flap. A. A. Surg. June 17, 63. Specs. 1229, 1230. 73d Pennsylvania. July 28, T. Liebold. Exfol. Disch d Oct. 125 Colby, II. A., Serg t, G, June 18, Left (nee.; gang.); nnt. post. flap. 1863. 9, 63. Died Mar. 14, 64 ; fatty 2dU. S. Sharpshooters, Oct. 20, Surg. N. R. Moselev, U. S. V. degenerat n. Autop. Spec. 1808. age 23. 1864. Died Nov. 1, 1864. Spec. 3319. 89 Stout, A. H., Pt., H, 13th Sept. 29, Left (nee.): flap. A. A. Surg. J. 126 Crocker. W., Pt.. II, 42d Oct. 2, Right (slough.); Teale s method. Pennsylvania Cavalry, Dec. 3, II. Thompson. Disch d July 8, Virginia. Xov. 4, A. Surg. C.W. P. Brock, C.S.A. age 25. 1864. 1865. Spec. 3477. 1863. Died Xov. 9, 18tf3; exhaustion. 90 Street, B., Pt., E, 27th Auo-. 2, Left ; ant. post. flap. Ass t Surg. 127 Detloff, E., Pt., H, 38th Aug. 7, Left (Aug. 7, amp. leg; gang.>: Indiana, age 20. Sept. 7, G. W. Burke, 46th Penn. Mus Ohio, age 26. Dec. 5, lat. flap. Surgeon B. B. Creed. 1864. tered out Feb. 7. 1805. 1864. U. S.V. Died January 16, 1865. 91 Sullivan, E., Pt., D, 5th Infantry, age 39. Feb. 21, M yl4/G2. Left ; circ. Ass t Surg. B. Norris, U. S. A. Disch rt Aug. 23, 1862. 128 Derr, J. W., Pt., E, 7th Maryland, age 18. Mar. 31. May 15, Right (March 31, rem d patella); circ. A. A. Surg. F. Hall. Died 92 Taylor, W., Serg t, B, 106th X. York, age 26. Sept. 19, Nov. 25, Left (nee.): ant. pest. flap. A. A. Surg. J. Xeff. Disch d Aug. 6, 129 Doub1edav,W.O.,Corp.. 1865. July], June 23, 65; exh n. Spec. 41! 9. Left. Snrg.L.W.Oakley, 2d X .1. 1864. 1865. Specs. 5, 4856. H,14th Vt., age 41. Au.10, 63. Diarr.;dysen. Died Aug. 12/63. 93 Thompson, B., Pt., C, Se. 17/62, Right (Oct. 3, amp. leg ; erysip.; 130 Drake, J. H.. Pt.,I,71st June 1, Left. (Knee ulcerated.) Dr. II. 28th Penn., age 33. April 14, gang.); flap of skin; circ. muse. Pennsylvania, age 23. July 10. Marsh, Albany, N. Y. Died 1863. Dis. May 6/63. Specs. 3883, 3965. 1862. July 14, 1862. " 94 Vannoy, J., Pt., E, 3(ith Aug. 17, Left thigh. For exchange April 131 Efner, J. B., Pt., F, 4th June 14, Left thigh. Died July 18, 1863. Virginia, age 33. Oo.27/64. 8, 1865. Texas Cavalry. , 63. SURG. Ill 41 322 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 132 Eline, J. A., Pt., D, 76th July 18, Left. August 31, haem. Died 163 Maxfleld, D. E., Pt., E, Sept. 17, Lett; circ. A. A. Surgeon A. V. Pennsylvania. Au.20, 63. August 31, 1863; exhaustion. 97th New York, age 20. Oc.22, 62. Cherbonnier. Oct. 23, 25, haem.; 133 Fenuimore, H., Pt., E, Sept. 19, Left thigh. L)ied November 2, lig. femoral artery. Died Oct. 101st Indiana. , 63. 1863. 27, 1862; exhaustion. 134 Gates, A.E., Pt,, C, 18th June 5, Left thigh. Died July 26, 1864. 164 McCreary, G. L.,Pt.,F, May 12. Right ; circ. A. A. Surg. F. G. H. Connecticut. J y22, 64. 100th Penn., age 19. J el 2, 64. Bradford. Died June 25, 1864 ; 135 George, H., Captain, A, Dec.8, 64, Left; circ. Surg. C. H. Lord, 102d exhaustion. Louisiana Zouaves.age J y 7, 65. 1 N. Y. J uly 2T, ligature torn oft ; 165 McDerbit, W., Pt., D, June 34, Right. (Amp. right second and 25. hasrn.; fatal. 17:kl New York, age 27. , 63. third fingers.) Died July 29, 63. 136 Hull, W. H., Pt., I, lirth May 24. Left (slough.): ant. post. flap. A. 166 McGir, E., Pt,, F, 5th Aug. 30, . Died October 3, 1862. Maine, age 18. Aug. 12, A. Surg. W. H. Randolph. Died New York. , (12. 1864. Sept. 5, 64 ; pyaem. Spec. 3025. 167 McHe.mii, A., Pt.,15, llth July 3, Right. Died August 23, 1863. 137 Hannans, J., Pt., K, 97th May 20, Right. (Ha>m.: diarr.; June 11, Mississippi, age 26. Au. -, 63. Pennsylvania, age 23. July 10, amputation leg.) A. A. Sorg. W. 168 Miller, A. J., Pt., D, 5th Sept. 20, Right (sloughing); circ. Died 1864. Stillman. Died Sept. 20, 1864 ; Kentucky. No. 1, (i3. November 15, 1863. pytemia. 169 Millsap, M.. Pt., I, 31st May 22, Right. Died July 6, 1863; py 138 Harrimau, R. C., Pt., F, Aug. 16, Left; circ. A. A.Surg.J. C.Morton. Iowa, age 23. J o29, 63. aemia. llth Maine, age 39. Sept. 16, Sept. 23, haemorrhage ; lig. fem 170 Morgan, J., Pt., E, llth July 2, Right. A. Surg. W.A. Hammond, 1864. oral artery. Died Sept. 2li, 64. Penn. Reserves. Oct. 2. 6L U.S.A. Died October 4, 1861; Spec. 3711. exhaustion. 139 Harrington, W., Pt., A, May 9, Left, Teale s method. Surg. R. 171 Munn, W., Pt., I, 27th May 10, Right (May 10, amp. leg; gang.); 106th N. York, age 20. Sept. 11, 15. Bontecou, U.S.V. Died Sept, Michigan, age 31. Sept. 20, Teale s method. A. A. Surg. C. 1864. 19, 64; exhaustion. Spec. 3328. 1864. F. Trautman. Died Oct. 4, 64 ; 140 Hartraan, L., Pt., B, 2d July 2, Right; ant. post. flap. A. Surg. exhaustion. Spec. 2330. Infantry, age 24. Oct. 19, H. E. Brown, U.S. A. Died Oct. 172 Nevins, T., Pt., F, 63d Sept, 17, Lett, (Joint eroded.) Surgeon 1863. 24, 63; exhaustion. Autopsy. New York. Oc.24, 62. H. S. Hewit, U. S.V. Died Oct* 141 Henderson, E., Pt., 13, De.16, 64, Left (gang.); bi-!at. flap. Surg. 24, 1862 ; shock. Spec. 489. 16th N. C., age 32. Jan. 24, B. B. Breed, U. S. V. Died 173 Ogden, D., Pt., E, 2d Sept. 25, Left (slough.; ant. (ib. art.; haem.); 1865. April 3, 1865. Illinois Cav., age 21. Nov.1, 64. semi-circ. flap of skin ; circ. inc. 142 Hines, T. I., Pt., D, 1st July 1, Rin-ht. Died September 17. 1863: thro. mus. Surg-. C.Winne,77th Maryland, age 32. Au.27, 63.; hectic fever. Illinois. DiedNov. 6, 64 ; cxh n. 143 Holbrook, E., Corp l, 15, June 3 Left (gang.); circ. Surg. R. B. 174 Otto, B. G., Serg t, A, Aug. 30, . Died October 35, 38(i2. 40th Mass., age 25. July 12, Bontecou, U. S. V. Sloughing. 48th Pennsylvania. , 62. 1864. Died July 30, 64; exhaustion. 173 Oi^en, A., Serg t.G, 19th Sept. 17, Right; circ. A. Surg. C. Bacon, 144 Holland, A., Pt., B, (ith May 6, Left ; ant. post, flap. Surg. E. Georgia. Oc.21, 62. U. S. A. Died October 28, 3862. New Jersey, age 2G. June 15, Beutlcy, U. S.V. Died July 21, Spec. 926. 1864. 3864. Autopsy. Spec. 3342. 176 J atten, W. F., Pt., C, Nov. 30. Right (Mar. 19, amp. leg; gnng.; 145 1 House, J.,Vi., K, 2d Mis Aug. 1, Right. (Gang.; erysip.; exfol.; 9th Mississippi, age 24. 1864, haem.); ant. post. flap. A. Surg. sissippi, age Hi. Oc.29, 64. nee.) Stump swollen greatly. Mar. 24, J. C. Thorpe, U. S. V. Died 146 Ingerson, A., Pt,, A, 123d May 15, Left ; ant. post. flap. Surg. J. B. 1865. April 20, 1865; pyaemia. Ohio, age 18. June 19, Lewis, U. S. V. Died June 26, 177 Perry, O., Pt., F, 41st July 12, Right. (Prim. amp. leg; gang.) 1864. 1864 ; pyaemia. Illinois. , 63. Died September 12, 1863. 147 Jacobson, F., Pt.,C, llth June 18, Right (June 18, amp. leg; gang.); 178 3 Pettigrcw, J. A., Capt., J e24, 63, Right ; circ. A. Surg. J. E. Link, Connecticut, age 18. Aug 90 circ. A. A. Surg. W. B. Casey. C, 20th Tennessee. Jan.4, 64. 21st 111. Died Jan. 7, 1864; 1864. Died August 26, 1864. shock. Spec. 2136. 148 Johnson, D. A., Pt., E, No. 7, 63, Right (Nov. 7, exc. tib.); circular. 179 *Powell, W. H., Pt., I, Sept. 17, Right. (Sept. 18, amputut n leg.) 43d New York, age 37. July 2, A. A. Surgeon T. B. Townsend. 3d South Carolina, age Nov. 30, A. A. Surg. A. V. Cherbonnier. 1864. Gangrene. Died Aug. 6, 1864. 20. 1862. Erysip. Died May 2, 63: cxh n. 149 Jones, T., Pt., E, 70th July 3, Left (haem.); flap. Surg. C. W. Autopsy. Specs. 795, 3837, 3%2. New York, age 26. Au. 7, 63. Jones, U. S. V. Died Aug. 18, 180 Prentice, S. B., Pt.,C, 1st June 35, Left (necrosis); flap. A. Surg. K. 1863. Spec. 1695. District Columbia Cav. J y23, G4. Curtis, U. S. A. Died August", 150 Kenned;/, / ., Pt.,C, 59th July . Left thigh. Died August 23, 1864; exhaustion. Georgia, age 46. Au. -, 63. 1863. 181 Rader, J., Pt., F, 59th Aug. 19, Left (Aug. 39, exc. tib.; caries); 151 Kewley, \V. C., Pt., G, May 22, Right ; extensive burrowing of Illinois, age 21. Dec.7, 64. circ. A. A. Surg. M. L. Ilerr. 68th Ohio, age 46. J e24, 63. pus. A. A. Snrg. J. Thompson. Gang. Died Jan. 4, 65 : cxh n. Died July 11, 6:S. Spec. 1702. 182 Richard, J., Corp l, E, 1 Left. Died September 27, 1863. 152 Kightlinger, J., Pt., F, Aug. 14, Left (eedeniatous);circ. Surg. A. 9th Wisconsin. Se.23, 63. 145th Penn., age 23. Oct. 1, G4. F. Sheldon, U. S. V. Died Oct. 183 Roberts, J. F., Pt., K, May 5, Left; ant. post. flap. Surg. E. 8. 1864; exhaustion. 147th New York, age J ne8, 64. Donnelly, 2d Peun. Reserves. 153 Lane, W., Pt., I, 1st E. De.31, 62, Left: lig. torn off; luem.; re-lig. 33. Died Aug. 2, 1864 ; chr. diarr. Tennessee, age 20. Mar.2, 63. Died March 6, 1863. 184 Robinson, A.. Pt., D, 8th May 8, Left ; ant. post. flap. A. A. Surg. 154 Langfield,W. E., Pt., K, May 14, Right (haem.); flap. A. A. Surg. Wisconsin, age 30. J ne-, 64. J. N. Sharpe. Died July 1, 64 ; 7th New Hampshire. J y2, 64. F. H. Getchell. Died July 5, exhaustion. 1864 ; exhaustion. 185 Rodrigues, A., Corp l, C, May 15, ; circ. A. A. Surg. R. C. C. 155 Langworthy, S., Pt., 15, May 14, Left ; flap. A. A. Surgeon F. H. 101st Illinois, age 23. J y28, 64. Jones. Gangrene. Died Aug. 3, 117th New York, age J yl2, 64. Getchell. Died July 12, 1864 ; 1864 ; exhaustion. Autopsy. 28. exhaustion. 186 Schultz, C., Pt., K, 5th De.16, 64, Left (nee. tib.); circ. A. A. Surg. 156 Lawrence, T. K., Pt.. G, July 3, Left thigh. Died Aug. 19, 1863. Minnesota, ago 44. Jan. 27, J. G. Harvey. Died Feb. 9, 65 ; 24th Georgia, age 31. Au. 6, 63. 1865. chronic dysentery. 157 Lininger, ,S., Pt., H, 74th Sept, 19, Right. (Exc. int. condyle.) Died 187 Scott, L., Pt., F, 2d New Sept. 20, Right (Nov. 1, giing.); flap. Surg. Indiana, age 32. No.39, 63. December 7, 1863. York Mounted Rifles, Nov. 39, E. Beniioy, II. S. V. Died Nov. 153 Locket/, A., Pt.,1- 1 , 3d Mis No.30, 64, liight (gang.; carious): oval flap. age 17. 1864. 30, 38(i4; exhaustion. sissippi, age 29. Fe.24, 65. A. A. Surg. D. D. Talbot. Died 188 Seiberlieh, J., Corp l, F, May 16, Right (erysip.); circ. A. Surg. D. April 27, 1865: pyaemia. 19th Wisconsin, age 23. June 28, R. Brower, U. S. V. Died July 159 2 Lootnis, I. A., Pt., G, Apr.6, 62, Right (sloughing; necro.); ant. 1864. 13, 1864; exhaustion. 16th Wisconsin, age 23. Jan. 25, post. flap. Dr. F. II. Milligan. 189 Sharp, 0. D., Pt., II, 1st Sept. 17, Left ; gangrene. Died Nov. 21, 1866. Died February 18, 3866. North Carolina. No.35, 62. 1862. 160 Lovell, P., Pt., C, loth No.25, 63, Left (exc. tibia; Jan. 10, 64, amp. 190 Shelly, J. J., Pt., B, 2d Ja.30, 62, Right. Dr. G. II. Higgins. Died Feb.2 64. Surgeon^R. Bnrtholow, U. S. A. Spec. 405. Died Feb. 3, 3864. Spec. 2108. 191 Staggs, A., Pt., K, 10th July 3, Left. Died Sept. 1, 18(13; pyxm. 161 Lumley, F. S., Pt., 1 1, Xov. 24, - ; eirc. A. Surg. J. H. Wilson, Kentucky Cavalry. Au. 5, 63. Autopsy. 29th Mississippi, age 26. De.31, 63. 73d Penn. Died Jan. 5, 1864 ; 192 Stanley, F. E., Serg t, A, April 13, Left. (Haemorrhage.) Died May shock and gangrene. 13th Connecticut. . , 03. 29, 1863. 162 Lyons, G. W., Pt., I, 43d Oct. 4, 62, Left. (Necrosed bone removed.) 193 Sfcinton, J., Pt., H, 2d July 3, Left. (Chronic diarrhoea.) Died Ohio. Feb.2, 63. Died Aug. 14, 1863. Spec. 968. Infantry, age 40. Au. 8, 64. August 11, 1863. JONES (J.), Investigation g upon the Nature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies, 1861-1865, in United States Sanitary Commission Memoirs, 1871, Surgical Volume II, p. 291. 2 MILLIGAN (F. H.), Amputation of the Thigh resulting from Injury received nearly four years prior lo the operation, in Cincinnati Lancet and Observer, 1869, Vo3. XII, p. 590. 3 MOSKS (I.), Surgical Notes of Cases of Gunshot Injuries occurring durina the advance of the Army nf the Cumberland, Summer of 1863, in American Journal of the Medical Sciences, 1864, N. S., Vol. XLVII, p. 340. 4 FlSHER (G. J.), Amputations after the Battle of Antietam, in American Journal of the Medical Sciences, 1863, N. S., Vol. XLV, p. 48. SECT. III.J SECONDARY AMPUTATIONS OF THE THIGH. 323 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OI EKATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 194 Teefle, S., Pt., H, 9th Mar. 21 , Left; circ. A. A. Surg. D. Shep- 202 Wileman. L. G., Pt., C, Oct. 8, ; circular. Surgeon J. G. Ap.21, 65 6 ll ltchitt Tf ^ V Died T tn 195 Thomas, G. M., Black Oct. 13, Right; circ. A. Surg. A. Ingrarn, PI 16, 1863. smith, I, 3d Peim. Cav. Nov. 23, U.S.A. Died Jan. 28, 1864; 203 Wilson, S., Pt., I, 6th N. May 10, Right ; circ. Surgeon G. L. I an- 1863. pyaemia. Spec. 2821. Hampshire, age 24. June 13, coast, K. S. V. Died June 21, 196 Touhey, J. D.,Corp l, B, Aug. 30, Left. (Haemorrhage.) Died Oct. 1864. 1864; exhaustion. Spr.c.2&Sl. 14th New York. Oc.10, 62. 13, 1862; pyaemia. 204 Wingate, B., Capt., D, Feb. 21, Right (nee.); circ. A. Surg. 15. 197 Turner, J. P.,Serg t, I, Aug. 30, Left. Died October 18, 1862; 5th Infantry. May 19, Norris, U. S. A. Died June 1. 16th Massachusetts. Oct. 9, 62. pyaemia. 1862. 1862; operation and diseased 198 Twining, P. E., Serg t, June 1, Left. (June 1, amp. leg.) A. A. stomach. P, 36th Wisconsin, age Sept. 14, Surg. M. Rizer. Slough g. Died 205 Wnrmsley, L. W., Pt.. July 2, Right (July 6, amp. leg; necr); 26. 1864. October 16, 1864. K, 8th Florida, age 35. Dec. 29, circ. A. Surg. C. W. I . Brook, 199 Veasey, J. W., Pt., C, 3d Sept. 19, Right ; circ. Surg. Weatherby, 1863. P. A. C. S. Died Dec. 30, 1863 ; Alabama. Oc.25, 64. C.S.A. Died Nov. 14, 64; exh n. exhaustion. 200 Waters, B. G., Pt., H, Oct. 15, Left (Oct. 15, amp. leg); circular. 206 Wright, J. E., Pt., K, April 9, Left; flap. A. Surg. W. H. For- 19th Maine, age 19. Nov. 27, Surg. E. Bentley, U. R. V. Died llth Wisconsin, age 23. June 18, wood, U. S. A. Died June 26, 1864. April 28, 65. Specs. 3445, 3446, 1865. 1865 ; pyaemia. 3447, 3448. 207 Wyatt, /., Capt., 10th Sept. 27, Left. Died November 25, 1864. 201 Wenzell,A.,Pt.,E, 121st J y 1, 63, Right (fragra ts nee. bone rem d); Missouri Cavalry. No.23, 64. Pennsylvania, age 21. Sept. 9, oval skin flap ; circ. muscles. 1864. A. A: Surg. J. H. Jamar. Died Sept. 28, 1864 ; pyaemia. The seat of fracture in the foregoing two hundred and seven cases was in the lower third in seventeen; in the knee joint, in seventy-three; in the leg, in ninety-one; and in the ankle joint or foot in twenty-six instances. Secondary Amputations of the Thigh, Point of Ablation not specified. Of twelve secondary amputations in which the seat of operation was not indicated, nine were per formed on Union and three on Confederate soldiers ; all resulted fatally. Seven operations were on the right, two on the left side ; in three cases this point was not recorded. In two instances total excision of the knee joint and in two other cases amputation in the leg had preceded the ablation of the thigh. One of the latter cases is here detailed: 1 CASE 496. Private G. R. Hathaway, Co. A, 125th Illinois, aged 24 years, received a shot fracture of the tarsal bones of the left foot, at Kenesaw Mountain, June 27, 1864. Five days after the reception of the injury he entered the field hospital at Chattanooga, where amputation was performed, but not recorded. Surgeon B. Cloak, U. S. V., reported the termination of the case as follows: "The patient was admitted to Cumberland Hospital, Nashville, July llth, having undergone amputation of the leg below the knee previous to his admission. On August llth, a second amputation was performed above the knee, by the antero-posterior flap method, by Acting Assistant Surgeon J. C. Thorpe. The flaps at the time of the second operation had become indolent and slightly gangrenous and could not be brought to cover the protruding bones ; the patient s condition being weak and anaemic and his tongue whitish. Stimulating dressings were applied to the stump of the thigh, which looked clean but failed to close by first intention, though it became covered with healthy granulations. The patient died of irritative fever September 9, 1864." TABLE XLI. Summary of Twelve Fatal Cases of Secondary Amputations in the Thigh for Shot Fracture of the Femur, tlie point of Ablation not specified. No. 1 2 3 4 5 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPKRATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. Dowd, J., Farrier, M, 10th Missouri Cavalry, age 24. Edmondson, W.W., Pt., C, llth Iowa, age 20. Hathaway, G. R., Pt.,A, 125th Illinois, age 24. Hawkins, W., Pt.,C, 17th Ohio. Kellum, T. H., Pt., B, 89th Indiana, age 18. April 18, 1863, Right. (April 19, 63, amp. leg, lower third; 1865, gang.) Nov., 1867, necrosis ; re-amp, of thigh. Died Nov. 15, 1867. Right. Died September 3, 1864. Left (int. amp. leg; gang.); ant. post. flap. A. A. Surgeon J. C. Thorpe. Died Sept. 9, 1864; irritative fever. Right ; circ. Surg. S. E. Fuller, U. S. V. Died March 21, 1864 ; pyaemia. Right ; circ. Surg. E. Powell,72d 111. Died Aug. 3, 64 ; septasmia. 6 7 8 9 10 11 Kiefer, M., Pt., C, 31st Pennsylvania, age 33. Turpen, J., Pt., B, 2d Missouri, age 36. Traube, A., Corp l, E, 2d Missouri, age 34. J Unknown. 3 Unknown. ra-ughn, W., Pt., B, 13th South Carolina. Whitbeck, O.. Pt., D, 109th N. York, age 29. June 29, Au. 1, 62. Oct. 8, No. -, 62. Oct. 8, 62, Mar. 25, 1864. May , , 64. May , , 64. . Diarrhoea. Died August 18, 1862 ; exhaustion. Right. Died November 14, 1862. Left: ant. post. flap. A. A. Surg. P. Gilroy. Died May 5, 1864. . (Total excision knee joint.) Fatal. . (Total excision knee joint.) Fatal. Right thigh. Died June 26, 1864. Right. (Typ. fev.) Dr. G. Burr, Binghamton. Died July 10/64. July 22, , 64. June 27, Aug. 11, 1864. Se.20, 63, Feb. 28, 1864. May 18, J y 18, 64. May 6, J y 9, 64. 3 CULBERT8ON (H.), loc. tit. M(5GUIIiE (H.), loc. Clt. 324 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. AMPUTATIONS IN THE CONTINUITY OF THE FEMUR, OF UNCERTAIN DATE. In five hundred and eighteen cases of amputations in the thigh for shot injury the intervals between the injuries and operations are unknown, one or the other or some times both dates having been omitted in the reports. The ablations were practised in the upper third in thirty-three, in the middle third in seventy, in the lower third in one hun dred and four, and at an unspecified portion of the thigh in three hundred and eleven cases. Although the recorded data are generally meagre, the results have been ascertained in all but thirty-two cases. One hundred and sixty- three had successful, and three hundred and twenty-three fatal terminations, a mortality rate of 66.4 per cent. Amputations in the Upper Third of the Thigh, of Uncertain Date. There were thirty-three amputations in the upper third of the thigh, in which the length of interval between the injury and operation could not be ascertained. Twenty-eight of the patients were Confederate, and five were Union soldiers; twelve recovered and twenty-one died. Successful Cases of Amputation in the Upper Third of the Thigh, of Uncertain Date. The twelve operations of this group were all performed on Confederate soldiers on the right side in four, on the left in three, unspecified in five cases. The nature of the missiles and the methods of operating are not recorded. Fatal Cases of Amputation in the Upper Third of the Thigh, of Uncertain Date. There were twenty-one operations of this class, five performed on Union and sixteen on Confederate soldiers; eight on the right and nine on the left limb; in four cases the side was not specified. No antecedent operations were recorded. TABLE XLII. Summary of Thirty-three Cases of Amputation in the Upper Third of the Femur, time of Ablation not specified. No. NAME, MILITARY DESCRIPTION", AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 2 3 4 5 6 7 8 9 10 11 12 13 H 15 16 17 Anderson, J. E., Pt., F, Holcoinb sS.C. Legion. Brown, S., Pt., C, 53d South Carolina. Carroll, J., , 2d South Carolina. Chambers, D. W., Pt., D, 37th North Carolina. Freeman.R., Pt., P, 14th North Carolina. Long, J. D., Pt., I, 1st Texas. O liri/ant, W. H., Pt., F, 2d A. Carolina Hides. files, J. J/., Pt., I, 12th Mississippi, age 23. Ward. J., Pt., D, 8th Louisiana. White, A. C., Serg t, H, 5th South Carolina. Williamson, G. A., Col., 2d Arkansas. Wimmer, J. W., Pt., K, 48th North Carolina. Anderson, G. B., Pt., F, 41st Alabama. Blankenship, E. P., Pt., E, 57th Virginia. Boii en, J., Pt., E, 7th Virginia. Suforil, P. If., Pt., G, llih Miss., age 20. Bnrley,lI.lI.,It.,G,4f>th Pennsylvania, age 21. Furloughed May 7 1864 Cleland, D., Pt., D, 1st South Carolina Rifles. Dillings, I., Pt., A, 5th Artillery, age 34. Garreth, \V. A., Pt., B, 45th Penn., age 21. Kinsley, J\, Pt., G, 31st Virginia. Lofton, J., Pt., G, 8th Louisiana. McWhorttr,J.B.,Pt.,-E, 2d S. Carolina Rifles. Neighbours, W., Pt., K, 3d Georgia. Neil, W., Pt., K, 14th S. Carolina. Peterson, L., Pt., K, 36th Wisconsin, age 37. Sfyrist, W. D., It., I, 5th South Carolina, age 30. Snider.J.A., Pt., D, 12th Virginia Cavalry. Troll, J. H., Serg t, K, 57th North Carolina. Underhill, J., Pt., C, 1st N. Carolina Battery. Wlntn<ort>t.R.A.,Vorp l, K, 64th Georgia, age 40. AVilkinson, \V.,I t., 1, 22d Col d Troops, age 38. Wooddlt, I . 11., Corp l, F, 19th Virginia Cav., age 25. Right. Died May 25, 1864. Left. Died January 9, 1865. Left. Died October 22, 1864. Right. Died June 7, 1864. Left. Released July 8, 1865. Right. Provost Marshal May 31 , 1865. Right. Furloughed September 12, 1864. Left. Furloughed November 30, 1864. Right. Furloughed September 2, 1863. Dec. 3, , 64. Sept. 30, 61 June 3, , 64. May 2, April 26, , 63. Died July 17, 63; haemorrhage. Right. Died October 7, 1864. Left. Died September 22, 1864. Left. Died June 16, 1864. Right. Died June 11, 1864. Left. Died July 16, 1864; py aemia. Right. Died June 30, 1864 ; py aemia. Left. Died December 17, 1862. Nov. 1, , 64. July 6, , 64. Aug. 16, , 64. 1863. Right. Retired January 23, 1865. . Surgeon Momer, C. S. A. Recoverj . Left. Furloughed September 7, 1864. June 3, (54 May 28, De.13, 62. N. C. Recovery. Left. Died September 21, 1864. . Died July 23, 1863. Left. Died August 15, 1863. Left. Died August 15, 1863. Right. Extensive bedsore over sacrum. Died June 6, 1864. De.17, 62. July , 63 Aug. 16, 61 Right. Died September 7, 1864; exhaustion. Right; ant. posterior flap. Died July 15, 1864. July , 63 June 15, July 6T circ. Surg.W.S. Love.I .A.C.S. Died Nov. 8, 1864 ; exhaustion. May 12, , 64. Amputations in the Middle Third of the Thigh, of Uncertain Date In this group are recorded seventy cases, of which thirty-four were successful, twenty-nine proved fatal, SECT, m.] AMPUTATIONS IN THE THIGH OF UNCERTAIN DATE. 325 while the result in seven cases could not be ascertained. Fifty-three of the patients were Confederate, and seventeen Union soldiers. The amputations were on the right side in twenty-eight, on the left in thirty-one, not reported in eleven instances. The seat of frac ture in these cases was in the middle third of the femur in one, in the lower third in six teen; in the femur, precise seat not recorded in forty-two; in the knee joint in seven, and in the leg in four instances. TABLE XLIII. Condensed Summary of Seventy Cases of Amputation in the Middle Third of the Femur, of Uncertain Date. [ Recoveries, 1-34 ; Deaths, 35-63 ; Results unknown, 64-70.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 C9 30 31 33 34 35 36 Baldwin, J., Pt., A, 26th North Carolina. Boykin, P., Pt., C, 19th Louisiana, age 18. Clark, J., Pt., D, 1st Louisiana N. G. Comer, T., Capt., H, 5th South Carolina. Cribb, J., Pt., C, 49th Georgia, age 32. Croft, J., Pt., L, 50th Georgia. Dell, P., Pt., C, 20th Louisiana. Edmonson, J. C., Pt., K, 13th Georgia. Evans, W. S., Lieut., B, 4th Georgia. Farr, J. B., Pt., I, 18th Tennessee. Fechner, C., Pt., , 3d Alabama, age 28. Ferguson, J. G., Pt., A, 12th 1 ennessee, age 24. Foster, P., Pt., I, 57th Virginia, age 21. Gales, P. V., Musician.E, 30th Tenn., age 31. Hearn, B. L., Pt., H, 6th Georgia. Helms, C. A., Pt., B, 43d North Carolina, age 33. Hunt, S. J., Pt., D, 18th Virginia. Ingraham,L.,Pt., D, 42d Mississippi. Johnston, W. S., Pt., I, 20th North Carolina. Kennedy, T. J., Pt., E, 16th Ark. Car., age Oo. May ne, J. J., Pt.,A, llth Georgia. Passons, IP"., Pt., F, 5th Kentucky Cav., age 44 . Powell, J. K. !>.,, C, 31st Georgia. Praft J U. Pt F 7th July 2, (J3 Left ; gangrenous. Paroled Nov. 12, 1863. Right. Retired Dec. 22, 1864. Left thigh. Duty July 31, 1863. Left. Furloughed September 23, 1864. Right. Retired October 31, 1864. . Furloughed July 3, 1863. Left ; flap. Discharged July 17, 1865. Right. Furloughed November 8, 1864. Right. Furloughed October 9, 1864. Left. Surg. H. W. Brown, P. A. C. S. Recovery Dec. 20, 1864. Right. Retired January 19, 1865. Left. Retired January 23, 1865. 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 Beiden, R., Pt., H, 116th Pennsylvania, age 24. Boswell, J., Pt., B, 63d Georgia, age 31. Butler, W. C., Serg t, F, 2d Florida, age 26. Chinn, F. E., Pt., H, 7th North Carolina. Cobb, J., Pt., G, 9th Vir ginia, age 22. Cobb, L. G., Pt., H, 45th North Carolina. Conway, J., Pt., F, llth Infantry, age 23. Davis, J. D., Corp l, D, 8th Virginia. Gohegan, T. O., Pt., D, 19th Mississippi. Goodman,E.,Pt.,D, 27th Pennsylvania. Hall, J. H., Pt., E, 43d Tennessee. Heath, G. E., Pt., I, 12th Massachusetts. Jones, J. C., Pt., F, 122d New York, age 26. Mallory,!. r.,Pt.,E,45th North Carolina, age 24. Metz, J., Pt., A, 68th Pennsylvania. M ilroy, J. T., Pt., E, 45th North Carolina. Robinson, J., Pt., B,45th North Carolina. Shtperd, IT. B., Pt., E, 45th Georgia, age 30. Simons. L., Pt., F, 7th N.Y. H vy Art., age 27. Spiess, H., Pt., 1, 67th Ohio, age 23. Suggett, T., Pt., G, 24th Michigan. Sutton.O. />.,Pt., D,45th Georgia. Thomas, H. L., Pt., F, 45th Penn., age 18. Walrnm.J. P., Lieut., D. 28th Virginia. White, T. II., Pt., I, Oth Wisconsin, age 19. Williams,C..Contrab nd, Government employe. Winrjfield jr. L. Pt. D June 5, 61 Left. Died June 23, 1864. Right; circ. Gang.; diarrhoea. Died July 21, 1864 ; exhaustion. Left. Died August 15, 1863. Left. Died September 12, 1864. ; flap; diarr.; slough g; haem. Died Sept. 22, 64 ; pyae. Autop. Right. Died August 16, 1863. Left. Re-amputation upper third. August 11, 1863, bone cut off. Died Aug. 18, 1863; exhaustion. Right. Died May 5, 1865. Right. Died August 18, 1863. Right. June 18, haem.; lig. of fern. art. Died August 9, 1863. Left thigh. Died July 2, 1864. Left. Died Sept. 12, 1863 ; diar rhoea. Left thigh. Died May 30, 1864. Right. Died August 12, 1863. Left. Died August 18, 1863. Right. Died August 12, 1863. Left. Died August 14, 1863. Aug. 31, 61 June 19, 61 May 27, , 63. Aug. 16, , 64. July , , 63. 1864. Aug. 28, , 64. July , , 63. July , , 63. April , , 65 May 3, , 63. Jan. 2, , 63. May 12, , 64. July 9, M Sept. 19, , 63. May 2, 63 1863. 1863. July 20, , 64. July 12, 64 July , 63 Left ; ant. posterior flap. Provost Marshal March 7, 1865. Right. Furloughed December 6, 1864. Right. Retired January 20, 1865. Right. Paroled May 31, 1865. Right. Exchanged Mar. 3, 1864. . Furloughed October 13, isea Right. Retired March 18, 1865. Left. Exchanged March 3, 1864. Right ; circ. Prison April 28, 1865. ; circ. Furloughed August 26, 1862. Right ; flap. Released June 28, 1665. Left : flap. Discharged July 17, 1865. Right. Exchanged October 13, 1803. Right. Retired March 11, 1865. May 6, , 64. July , , 63. July , , 63. July , Nov. 30, 64 Sept. 30, 64 July 18, July 2, 6*5 July , , 63. May 3, Sept. 27, , 64. Aug. 9, June 3. , 64. May 10, aemia. Left. Diarrhoea. Died July 9, 1864 ; exhaustion. Left. June 5, erysipelas. Died August 13, 1864; exhaustion. . Died August 3, 1863. Left thigh. Died May 30, 1864. Left thigh. Died July 29, 1864. Right thigh. Died July 30, 1863. Right. Died September 14, 1864 ; wound. July 1, June 26, 6 June 16, 64 Tennessee, age 41. Satterwhite,D.S., I t.,G, 7th Georjria. Scott, G. W., Serg t, H, 7th South Carolina. Sharp, W. T., .Serg t, G, 22d Georgia. Stegen, J. W , Serg t, D, 5<!th Virginia. Stout, T. N., Pt., C, 6th Louisiana. Sioicfgnotl, J. H., Pt., A, 54th X. C., age 20. Z7n</crwno</../.,Corp l, K, Ifith Georgia. WatsonJ. B., Pt.,Cobb s Georgia Cavalry. Wilkinson, S. !{., Pt., I, 14th Alabama. Williamson. A., Seaman, St r Savannah, age 55. Bag\)]i,A. P , Pt., E, 23d North Carolina. Barker, E., Pt., A, 2(ith North Carolina, age 21. 18C5. Oct. 7, 61 July , , 63. Aug. 18, , 64. July , Feb. 6, Feb. 22, 1865. U. S. V. Died l- eb. 22, 1865; prostration. Right. Died of pyaemia and pneumonia within ten days. ; circular. Left thigh ; circular. Not a pen sioner. Right thigh. Left thigh. Left thigh. . Not a pensioner. Left thigh. June 27. 6 . Furloughed September 9, 1863. Left. Retired March 3, 1865. . Furloughed September 17, 1863. Left. Exchanged November 12, 1863. Right. Furloughed September 16, 1863. Left. Recovered. Right. Died October 3, 1864. Left. Died August 12, 1863. 58th Virginia, age 19. Bennett, W., Pt., B, 13th South Carolina, age 1!>. Carmonay, D., Pt., K, 5th Michigan. Coleman, J. L., Pt., B, 9th Virginia Cavalry. Daniels, W., Pt., K, 6th A lahama. Edwards, W. H., Pt., G, 41st Virginia. Fullerton,W.,Pt.,G,GOth Ohio, age 44. Phelix, , Colored serv ant, age 25. An n July 2, (>3 May 3, 63. June 7, 61 May 3, 03 , 63. Se. 30, 64, 1864. July _. , 63. 1 SMITH (E. H.), Keport of Cases of Compound Comminuted Fracture of Femur, in Confed. States 31d. and Surg. Jour., 1864, Vol. I, p. 24. 326 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Amputations in the Lower Third of the Thigh, of Uncertain Date. This group com prises one hundred and four cases, with thirty-seven recoveries, sixty-one deaths, and six cases in which the final result could not be ascertained. The operations were performed on thirty-two Union and seventy-two Confederate soldiers; thirty-seven amputations being on the right and forty-six on the left side, while in twenty-one this point was not recorded. The seat of the injury was in the lower third of the femur in fifty-two, in the knee joint in twenty seven, in the leg in twenty-four, and in the foot in one instance. In one of the fatal cases the patient had undergone amputation of the arm, and, in a second, haemorrhage from the femoral artery was followed by ligation of that vessel. TABLE XLIV. Condensed Summary of One Hundred and Four Cases of Amputations in the Lower Third of the Thigh, of Uncertain Date. [Recoveries, 1-37; Deaths, 38-98; Result unknown, 99-104.] NO. NAMK, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 NAME, MILITARY DESCRIPTION, AXD AGE. DATES. OPERATIONS, OPERATORS, RESULT. I 2 3 4 5 6 7 8 9 10 11 13 14 15 16 17 18 19 20 23 24 25 26 27 C8 30 31 33 Adams.R.T., It., H, 21st Virginia, age 19. Allen, W. S., Captain, E, 2d Mississippi. Bowtn, /?.. Ft., G, 1st South Carolina. Burns, G., Pt., D, 50th Virginia. Chamberlain. W.A., Pt., A, 61st Georgia. Clarke, S., Pt., E, 23d North Carolina. Coffee., L., Pt., E, 22d Alabama, age 19. Craft, J. II., Pt., F, 7th Tennessee, age 20. Fields, L., Pt., Latham s Batterr. Foster, ~S., Pt., A, 33d Alabama. Fountain, A. G. C., Pt., E, 6th S. C., age 29. Faust, E. B., Pt., 13, 13th Mississippi, age 21. Gonton, A., Pt., F, 25th North Carolina. Hoye,B. H., Serg t, Fall ing Battery, age 23. King, W. A., Corp l, L, 1st South Carolina. King, W. JJ., Pt., F, 2d Mississippi, age 23. Klfckley, J. F., Pt., A, 10th Georgia. Lane.;/, S. L., Pt., B, 26tb North Carolina. Maddox, M., Corp l, F, 7th S. Carolina, age 19. Mahoney, D. A., Corp l, A, 60th Alabama. lfaud,J.P.,Yl., F, 10th Virginia Cavalry. Mcrey,W.J.,Pt.,F,yb Virginia, age 24. Nowtand, J., Serg t, B, IstGa., Cobb s Legion. Painter, S. B., Pt., H, 65th N. C., age 19. Parks, J. D., Pt., A, 2d Mississippi. Phillips, E., Serg t, C, Gth Miss., a.se 23. Prong, A., Pt., 11, 2d Louisiana. Reed, A., Pt., B, 5th S. Carolina. R?/an,E., Pt..B, 5th Con federate, age 35. Stnne, S. M., Pt., I, 55th North Carolina. Strnud, E. D., Pt., H, 8th Alabama. Talley. W. O , Pt.,G, 23d Virginia, age 22. Thurman, M. P., Pt., K, June 2, , 64. Sept. 17, , 62. Sept. 30, , 64. July , , 63. June 27, g4 May 3, , 63. Left. Retired February 10, 1865. Left. Surg. A. Y. P. Garnett, P. A. C. S. Recovered. Right. Furloughed December 9, 1864. Right; bi-lateral flaps. Paroled August 24, 1863. Left ; flap. Discharged July 17, 1865. Right. Furloughed June 16, 63. Left ; flap. Prison July 4, 1865. Tunstall, P. A., Serg t, B, 34th Virginia. Whitaker, J., Capt., E, 47th Alabama. Witlter spoon, J. C., Lt., D, 1st S. Carolina. Young, J. E., Pt., H, 7th Maine, age 17. Ames, E. T., Pt., I, 1st N.Y. Dragoons, age 26. Asliwood, T. W., Pt., C, 12th Virginia Cavalry. Becker, C., Pt,, C, 2d Tennessee, age 25. Blackivood, J., Pt., H, 49th North Carolina. Boorman, E., Pt., C, 6th New Jersey. Bostwick, D"., Pt., C, 2d Michigan. Bradlty, T. C., Pt., K, 22d North Carolina. Burgny, H. C., Pt., F, 44th Georgia. Byles, M., Pt,, F, 55th North Carolina. Collins, J. C., Pt., C, 2d N. York M. R., age 29. Connelly, J. A., Pt., G, 100th Pennsylvania. Duffy, S. K., Pt., D,48tb New York. Evins,N., Pt., H, Cobb s Georgia Legion. Faircloth, J.,Pt.,A, 59th Georgia. Fowler, IV. S., Pt.,B,10th N. Carolina Artillery. Freeland J. A Pt. G Left. Furloughed December 16, 1864. Left; circular. Prison October 22, 1864. Left. Furloughed November 9, 1864. Left. Furloughed June 29, 1864. Not a pensioner. Left thigh. Died June 25, 1864. 1864. July 2, , 63. Sept. 30, , 64. May 14, , 64. Mav 7, - , 64. 1, 1863 ; pyaemia. Left ; circular. Died May 19, 1865. Left. Died September 14, 1864. . Died May 14, 1862. Right. Died December 10, 1863. Right. Died September 1, 1864. Left. Died October 31, 1862. Left. Died September 13, 1864. Left thigh. Died June 6, 1864. Right, Surg. G.B.Cogswell. 29th Mass. Died Dec. 6. 1863. Right thigh. Died July 31, 1863. 1864. M y31, 62. J e2, 64. Right. Furloughed October 5, 1864. ; circular. Transferred. Uight. Provost Marshal May 31, 1865. Left. Retired March 15, 1865. May 5, , 62. Nov. 24, , 63. 1865. Nov. 29, 1863. Sept. 307 , 64. Aug. 16, , 64. Sept, 17, , 62. Aug. , , 64. Left. Prison April 14, 1865. Right. Furloughed September 2, 1864. Right, Dr. Bads. Transferred March 3, 1863. Right. Furloughed October 21, 1864. Right. Furloughed October 6, 1864. Righ t. Exchanged March 1 7, 64. Right. Discharged October 9, 65. Left. Surg. Douglas, C. S. A. Recovered. Right. Retired March 27, 1865. Left thigh. Recovered. Left. Discharged from hospital July 2, 1865. . Discharged October 4, Gl. Left ; ant. posterior flap. Provost Marshal March 7, 1865. Left. Duty August 17, 1863. Left. Furloughed December 16, 1864. Left. Retired December 31, 64. : Right. Exchanged November 12, 1863. Right. Furloughed October 1, 63. Left. Retired January 20, 1865. Right. Furloughed October 21, 1864. 1864. May 31, , 64. Nov. 21, , 63. July 18, , li3. 1864. Sept. 30, , 64. Right. Died January 26, 1865. Left thigh. Died March 29, 1865. Left thigh. Died May 20, 1862. Right. Died September 16, 1864. Right thigh. Died June 16, 1863. . Died November 2, 1862. Right : double flap. Died Aug. 11, 1862. . Died July 31, 1863. Right ; circ. Died May 28, 1864 ; exhaustion. . Died May 16, 1862 ; hem orrhage. Left. Died November 4, 1862. Right thigh. Died June 17, 64. . Died July 26, 1863. . Died July 9, 1862. Left. Died October 8, 1862; py- spmia. Left thigh. Died June 10. 1862. July 1, , 63. May 5, , 62. Mav 22, -, 64. Mar. 23, 1862. Sept. 17, , 62. April 2. , 65. July 21, *gl_ Nov. 30, 4 May 27, , 63. 5th New Jersey. GHsson, J., Pt., A, llth Florida. Hamilton, W., Pt., 124th New York, age 44. Harmon, J. E., Pt., G, 79th Pennsylvania. Ingalls.A. S., Major,40th New York. Johnson, D.R.,Pt.,T,82d New York. Knapp, E., Pt., A, 4th Vermont, age 34. Knox, J. F., Pt., H, 13th Mav 3, 1. 63. Oct. 8, , 62. 1862. July , , 63. May 5, , 64. May 5, (]0_ Oct! 8, , 62. May 16, g4_ July 2, " 63. June 27, , 62. North Carolina. Kuraeh, C., Pt., D, 10th Ohio. Lovell, D.O., Pt.. n,25th Massachusetts, ago 25. Lovell, W. H., Pt., B. 72d New York. Maloy, P., Pt., D, 5th Cavalry. Martin, C., Pt., I, 38th Illinois. Martin, G. C., Pt., G, 2d Maine. June 25, , 64. July , , 63. July 2, , 63. May 5, , 64. June 12, , 64. 1862. April , , 62. 6th South Carolina. SECT. III.] AMPUTATIONS IN THE THIGH OF UNCERTAIN DATE. 327 NO NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 Maxey, D. M., Serg t, C, 3d Maine. May, G., Pt., I, 55th X. Carolina. May, J., Pt., K, 9th Ala bama, age 2U. McDonald, J. M., Pt., G, 21st Georgia. itcElree.n, ..Pt.,E, 20th Georgia, age 18. McGovern, J., Pt.,H, 9th Massachusetts. McKenzie, J. R., Pt., E, 1st Minnesota. McKerroll.J.M., Ensign, C. 1st S. C. Cavalry. Mil!er.M.S..Pt.,E, 116th Ohio. Minple, E., Serg t, A, 148th Pennsylvania. Myers, A. Jt., Pt., I, 48th Virginia. Myers, G. K., Pt., E, 6th Virginia Cavalry. Kettle.-!, W., Pt., C, llth South Carolina. Peele, J. J., Pt., C, 3d N. C. Artillery, age 19. Pegram, S. , Pt., E. 22d North Carolina. Pellett, S. S., Pt.. D, 4th Louisiana, age 24. Petersrm, S., Pt.. I, 56th North Carolina. Pilney, G. H., Pt., C, 2d N. Y. II. A., age 25. Poole. J., Pt., G, 13th Mississippi. July 2. , 63. Right. Died August 14, 1863. Right. Died September 10, 1864. . Surg. Thorn, C. S. A. Died Sept, 3, 1862. 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 Powers, E. 6., Pt., K, 40th N. C., age 27. Pridmore, F., Serg t, K, 41st Alabama. Reed, F., Pt., A, 53d Illinois. Left; flap. Died February 12, 1865; pyaemia. Right thigh. Died April 6, 1865. Left. (Amputation arm.) Died August 12, 1863. Left. Died September 9, 1864. J y30, 62. July 12, , 63. May 28, (54 J y30, 62. July 3, , 63. 26, 1863. Left. Died August 14, 1864. . Died August 5, 1862; ex haustion. Left thigh. Died August 7, 1863. Right. Died August 22, 1864. Right. Died September 11, 1864. Right. Died August 1, 1863. Right. Died May 17, 64 ; morti fication of stump. Left ; slough ; haem.; lig. fern, art.; haem. recur d. Died Oct. 10, 64. Left. Died September 14, 1864. Left. Died February 12, 1865; pyaemia. Left. Died September 20, 1864. ; circular. Died August 20, 1864. Right. Died January 2, 1865. Left thigh. Died June 12, 1864. Died August 28 1861 South Carolina. SeJoy, A,, Corp l, 1C, 15th Louisiana. Smith, W. H. H., Pt., G, 55th Penn., age 22. Smoot, D. J., Lieut., G, 4th North Carolina. Snyder, J., Pt., L, 2d Mich. Cavalry, age 33. Spain. II. P., It., D, 21st South Carolina. Templin, W. C., Corp l, C, 73d Ohio. Thompson, G. T., Pt., F, 56th North Carolina. Walker, II., Pt., F, 27th Massachusetts, age 35. Webb, J., Pt., C, 5th Ar kansas. Barrett, J. L., Pt., H, 21st Virginia. Pewell,J. 17., Pt., A, 4th Virginia Cavalry. Prather,J., Pt., H, 41st Alabama. Racer, W., Pt., Fry s Battery, Orange Art. Thomas, C., Pt., G, 5th Col d Troops, age 22. Tibbs, J. A., Pt., F, 50th Alabama. Sept. 29, , 64. Right. Died October 23, 1864. 1864. Dec. 25, , 63. Right. Died April 12, 1864 ; con gestion of the brain. Left thigh. Died June 9, 1864. Left thigh. Died August 9, 1863. Left thigh. Died April 12, 1865. Right. Died August 3, 1864; exhaustion. Left. Died November 2, 1862. Right thigh. Right thigh. Left thigh. Left thigh. Left thigh. Left thigh. June 5, , 64. July 3, ., 63. May 6, , 64. July , , <>3. July 14, -, 64. Oct. 8, . 02. 1864. 1865. 1864. June 3, -g4 July 21, , 61. Sept. 29, , 64. 1865. Amputations in the Continuity of the Femur, of Uncertain Date, and without Indica tion of the Seat of Operation. In three hundred and eleven cases of amputations of the thigh the interval between the injury and the operation and also the precise seat of the operation were not recorded. The operations were performed on three hundred and nine patients, in two instances both thighs having been amputated; seventy-nine, among them one with an amputation of both thighs, recovered, and two hundred and eleven perished, while the fate of nineteen could not be ascertained, giving a death-rate of 72.7 per cent, for the determined cases. Eighty-nine were Union, and two hundred and twenty were Confederate soldiers. The three hundred and eleven operations were on the right side in eighty-nine instances, on the left in one hundred, and not stated in one hundred and twenty- two. Such meagre details as ace entered on the records of this Office will be found in the following table: TABLE XLV. Condensed Summary of Three Hundred and Eleven Oases of Amputations of the Thigh, of Uncertain Date and Seat. [Recoveries, 1-80; Deaths, 81-292; Result unknown, 293-311.] No. 1 o 3 4 5 6 7 NAME, MILITARY DESCRIPTION-, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. 8 9 10 11 12 13 14 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. Barclay, R. G., Lieut., G, 5th Louisiana. Bass. J., Pt., F, 2d South Carolina. Host. H. M., Pt., F, 1st North Carolina, uge 18. Bowie. H. L., Capt., H, 6th Alabama. Boyle,, J. R., Lieut., C, 12th South Carolina. Bristnw, J. C., Pt., E, 5th Texas. Drown, E. Z., Pt., D, 1st South Carolina. May 3, -", 63. July , , 63. June 1, . 64. May 12, -, 64. July 1, , 63. Right. Furloughed October 26, 1863. . Transferred Oct. 1, 1863. Right, Retired January 24, 1865. Left. On leave July 4, 1864. Right. Furloughed March 12, 1864. Brownfield, T. A*., Pt., G, 9th Georgia. Bullard, J. N., Pt., G, 12Jh Georgia. Carlisle, V., It., F, 40th Alabama. Carter. J. P., Pt., K, 2d Va. Cavalry, age 81. Christian, J. O., Serg t, D, 8th Georgia. Daniels, J.A., Pt., K,9th Georgia. Dunkin, G. W., Pt., D, 33d North Carolina. Oct. 7, , 64. May 3, , 63. Left. Furloughed December 24, 1864. Left. Furloughed June 24, 1863. Left thigh. Recovery. Right. Retired February 16, 1865. Right. Furloughed December 27, 1864. Right. Retired December 16, 64. . Surg. Hickerson, C.S.A. Recovery. Sept. 30, Get . 7, , 64. June 30, , 62. Sept. 30, 64. Right. Furloughed November 17, 1864. 328 INJURIES OF THE LOWER EXTREMITIES. fCHAP. X. No. 15 16 17 18 19 20 21 22 23 24 26 27 28 29 30 31 32 33 34 35 36 37 36 39 40 41 42 43 44 45 46 47 48 49? 505 51 52 53 54 55 56 57 58 59 60 61 62 NAME, MILITARY DESCRIPTION, AND AOE. DATFS. OPERATIONS, OPERATORS, RESULT. NO. 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. Dunn, S. M., Lieut., A, Cabell s Art v Batt n. EargU, W. K.,Corp l, H, 13th South Carolina. Edens, W. M., Pt., B, 9th Louisiana. Ennis, H., Pt., F, 26th North Carolina, age 38. Evans, C., Pt., I, 47th North Carolina. Fadeley, I. P., Pt., K, 33d Virginia. Fears, E. B., Serg t, E, 3d Georgia. Foster, J. A., Serg t, F, 52d North Carolina. Fowler, E. \V., Lieut., C, 18th North Carolina. Frangan, A., Corp l, C, 2d Missouri. Gammon. O. D., Pt., D, 44th Virginia. Gleadon, G. W., Pt., G, 19th Georgia. Haymon$,A., Pt., F, 12th Georgia. Hays, B. W., Pt., G, 17th Georgia. Hfderick, H. J., Pt., E, 25th Virginia. He.nde.mon, D. J., Pt., A, 3.~>th North Carolina. Holmes, M.C., Lieut., H, 4th Texas. Huffman, \V., Pt., I, 1st Kv. Cavalry, age 19. Hughes J Pt. F 54th June 4, , 64. July 3, , 63. , 65. May 5, , 64. Oct. 14, , 63. July 21, , 61. , 64. Right. On leave August 12, 1864. Left. Paroled September 12, 1863. Left. Discharged September 26, 1865. Right. Retired February 23/65. Left thigh. Fnrloughed. . Recovery. Left. Furloughed January 17, 1865. Right. Released June 14, 1865. Left. Transferred September 30, 1664. Left. Transferred March 10, 63. . Furloughed July 2, 1863. Shippey. J., Pt., C, 5th South Carolina. Singleton, R. L., Serg t, C, 17th Tenn., age 22. Smith, J., Pt., 1, 1st Mis souri L. A., age 22. Smith, J. C., Pt., G, llth South Carolina. Spainhond, P., Pt., D, 53d North Carolina. Spears, A. D., Pt., H, 15th South Carolina. Stevens, J. G., Lieut., E, 4th Georgia. Stone, J. L., Pt., B, 37th Virginia. Stovall J E Pt B 21st Dec. 31, , 62. June 18, 61. Oct. 27, , 64. July , , 63. July 28, , 64. Oct. 12. , 63. May 3, , 63. Left. Retired March 18, 1865. Right. Discharged November 30, 1861. Right. Furloughed January 21, 1865. . Exchanged October 22, 1863. Left. Furloughed September 6, 1864. Left. Furloughed November 11, 1863. , 64. Oct. 8, , 62. May 2, , 63. Sept. 17, ;>_ Sept. Georgia. Weeks, W., Pt., C, 34th North Carolina. Welch, J., Pt., D, 3d Ar kansas. Whitly, D., Pt., H, 27th North Carolina. Whitman, R. F. Pt. A Mav 3, , 63. Sept. 19, , 63. Right. Furloughed July 6, 1863. Right. Retired December 31/64. Right. Transferred September 30, 1864. Left. Discharged November 5, 1862. Left. Furloughed November 12, 1863. Right. Furloughed June 25, 63. Right. On leave August 15, 64. Left. Furloughed February 21, 1863. Left. Furloughed March 14, 65. Right. Died May 27, 1864; py. asmia. Left. Died August 26, 1864. . Died October , 1863; wound. Right. Died July 28, 1862. . Died January 1, 1864. March 4, 1863. Right. Discharged from hospital May 28, 1863. 44th Alabama. Willis,H.C., Pt., B, 45th North Carolina. Winslow, E. G., Pt., G, 29th Mississippi. Woodbridge, \V. B., Lt. Col., 4tb Va. Cavalry. Youngblood, fF.S.,Corp., A, 45th Georgia. Zoble, J., Pt., E, 3d S. Carolina. Abernathy, S. M., Pt., B, 28th North Carolina. Adicks, H., Pt., I, 27th South Carolina. Allen, C. A., Pt., E, 1st Michigan Cavalry. Allen, R., jr., Lieut., F, 1st Cavalry. Amos, D. J., Serg t, 1, 5th Georgia. Oct. 14, , 63. Right. Discharged August 29, 1862. Left. Furloughed July 26, 1864. Right. On leave September 26, 1863. Left Discharged December 1, 1864. Right. Furloughed June 11, 63. Right. Furloughed June 25, 63. . On leave February 11/64. Right. Retired February 3, 1865. Left. Furloughed April 1, 1864. Right. Retired October 10, 1864. May 20, , 64. Aug. 30, , 62. Aug. 15, , 63. May 4, , 63. Mav 2, -", 63. Nov. 14, , 03. Sept. 30, , ti4. Nov. 27, , 63. Nov. , , 63. North Carolina. Ime, L. C., Pt., F, 60th Georgia. James, J, W., Lieut., A, 21st Georgia. Jones, O. T., Pt., H, 2d S. C. Uifles. age 21. Lawrence, J. H., Serg t, B, 4th Virginia. Lawrence, P.,Pt.,B,19th Louisiana, age 2">. Lutz, C.. Serg t, Marine Corps, U.S. N., age 29. Mathews, J., Pt., F, 32d North Carolina. McDnniel. J. J., Serg t, F, 35th Georgia. Miller, S., Pt., A, 1st Mo. .S. M. Cavalry. Minx, It., Pt., H, 6th Georgia. Mook, L. A., Pt., G, 2d North Carolina ISat ry. Morgan, E. C , Serg t, E, 2d S. Carolina Hides. Moss, W., Pt., H, 4th Alabama. HalUn, W., Pt., D, 45th Alabama. Nunnery, J. 31., Pt., A, 41st Louisiana. Parker, J. A., Pt., L, Cobb s Ga. Leg. Cav. Patterson, P. B., Pt., Adam s Co. Hampton s S. Carolina Legion. Patterson, W., Pt., G. 27th North Carolina. Perkins, C., Pt., B, 1st Louisiana. Pierce, r.M.,Pt.. B.Brad ford s Battery, age 22. Reid, A. J., Pt., I, 37th North Carolina. Rhoades,C.A , Serg t, B, 10th Georgia. Roberts. C. M., Lieut., B, 1st N. C. Cavalry. Robertson G. 7 .JV.,Corp., H, Kith N. Carolina. Robertson, J.A., Serg t, B, 12th Georgia, age 21. Robinson, E. is. />.,Pt,,B, 1st South Carolina. RtMedge, R. S., Corp l, C, 1st South Carolina. Segrist, D. F., Pt., B, 4th Alabama. , 64. July 14, , 63. June 28, , 62. Dec. 5, , C3. De. 9, 64. Texas. Axhbi/, W., Pt., F, 8th North Carolina. Atridge, R., Corp l, A, . 6th Wisconsin. Ballentine, J. L., Serg t, A, 6th South Carolina. Barbor, A., Pt., D, 3d Michigan. Barlow, M., , D, 109th New York, nge 41. Baughan, R. E., Pt., D, 21st Virginia. Beaman, C. C., Pt., G, 3d Arkansas. Bellflower, H., Pt., II, 14lh Georgia. Blair, S. F., Pt.,B, 38th Virginia. Bonncll \V. W. Pt I Discharged Nov. 17. 1865. Right. Transferred April 9, 65. Left. Furloughed February 9, 1863. Sept. 17, , 62. Right, Died November 28, 1862. Right. Died March 28, 1865. . Died September 22, 1862 ; diarrhoea. Left. Died May 29, 1864. Left. Died June 4, 1865. Died July 10 1863 Aug. 30, , 62. , 64. , C3. July 3, . 63. Right. Transferred August 3, 1863. Left. Furloughed March 17, 65. . Discharged September 9, 1861. Left. Transferred February 11, 1863. Right. Parolsd June 21, 1865. Both. Furloughed Aug. 2, 1864. . Discharged August 29, 61. Jul y July 21, -, 61. Oct. 8, , 62. , 63. July , , 63. May 3, , 63. , 63. June 14, , 03. Sept. 17, , 62. Right. Died December 24, 1862. . Died July 15, 1863. Left. Died June 7, 1863. Left. Died December 9, 1863. . Died July 15, 1863. Right. Died November 1 , 1862. Left. Died June 15, 1864 ; py- a?mia. June 24, , 64. , 61. Sept. 17, , 62. 26th New Jersey. Bowen,A. P., Lieut., F, 4th Virginia. Brayman, G.. Pt., E, 52d Massachusetts, age 18. Bresuer, J., Pt., H, 9th New York. Brewer, J. C .,Pt., D, 13th Mississippi. Bristor, P., Pt., C, 16th Tennessee. Brown, J., Pt., L, 1st Texas. Bryant, J.S.,Pt., 1, 100th Ohio. Bryant, T. D., Capt., A, 27th North Carolina. Burrows. P. A., Pt., I, 57th Massachusetts. Burwenick, A., Pt., A, 1st Kansas. Butler, L. P., Pt., H, 2d Ohio Cav., age 18. Butler, W.B., Pt., I, 50th Georgia. Campbell, G. J., Corp l, D, 10th Maine. Chadman, J. H., Colored Teamster. April 27, 1863. Oct. 8, , 62. Left ; circular. Released July 13, 1865. Died July 10 1863 /63. May 8, , 64. Right. Died June 1, 1864. Right. Died October 30. 1863. Left. Died June 1, 1864 ; ex haustion. . Died August 24, 1861. Right. Died August 7, 1864. Left. Died August 7, 1863. . Died September 20, 1862. Left. Died August 13, 1863. May 3, , 63. Aug. 15, , 64. July 3, , 63. Feb. 6, , 65. Right. Furloughed June 23, 63. Right. Furloughed September 9, 1864. . Paroled September 5, 1863. Left. Retired March 17, 1865. . Discharged October 24, 1862. Right. Furloughed November 17, 1864. Right. Discharged June 26, 186-. May 6, , 64. Aug. 10, , 61. July 2, , 64. Tiilv Sept. 30, , 64. , 63. Aug. 9, . 62. July 3, , 63. SECT. III.] AMPUTATIONS IN THE THIGH OF UNCERTAIN DATE. 329 No. Ill 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 1C8 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 NAME, MILITAKY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. Chappel, B. J., Lieut., I, 21st South Carolina. Chappie, J. A., Capt., E, 3d Virginia Cavalry. Cheevers, K., Pt., F, 34th Georgia. Church, W., Pt., K, 5th Vermont, age 23. Clark, J. R., Serg t, K, 115th New York. Comer, W. E., Pt., C., 34th North Carolina. Cone, T. J., Lieut., G, 18th Georgia. Conklin, J.W.,Lieut., K, 152d New York. Connor, J. B., Pt., F, 3d South Carolina. Cook, G. M., in., B, 28th New York. Cooper, J., Pt., C, 73d Illinois. Copage, W, F., Pt., A, 8th N. Carolina, age 17. Crews, B., Pt.,E,2dN. Carolina Battery. Crowley, T., Pt., A, 1st Minnesota. Cunningham, P., Pt., E, 5th North Carolina. Dumpert Pt H 4th Died July 8 1864 Hamlin, J., Pt., D, 1st Penn. Rifles, age 28. Hancock, T., Pt., I, 5th North Carolina. Hannah, E. Ji., Pt., G, 45th Georgia. Hardsaw, D.,Pt.,B, 17th Iowa. Harner, W. T., Serg t, E, 98th Ohio, age 39. Hartneady, P., Pt., B, 69th New York, age 26. Hatley, D., Pt., K, 21st North Carolina. Hawes, J. E., Lieut., G, 2d Virginia Battery. Hedriclc, TF., Pt., C, 1st N. Carolina Jun. Res. Henderson, J. M., Pt., F, 2d South Carolina. Hera, E. A. W., Pt., D, 7th Tennessee. Hernandez, I.,Pt.,C,39th New York. Hill, L. N., Pt., G, 14tb Georgia. Binds, L. A., Pt., H, 1st South Carolina. Hoffman, A., Pt., C, 30th New York. Holder. G. A., Pt., H, 6th Alabama. Holmes, B., Pt., F, 57th North Carolina. Right. Died June 28, 1864. . Died July 12, 1863. . Died July 27, 1863. Left. Died August 15, 1863. . Died November 9, 1862. . Died June 11, 1864. . Died July 24, 1863. Left. Died December 24, 1862. Left. Died March 25, 1865; ery sipelas and tetanus. Right. Died June 1, 1863. , 64. Left. Died September 24, 1864. Right. Died March 27, 1865. Right. Died August 19, 1862; chronic diarrhoea. Right, Died August 15, 1864. Left. Died April 8, 1865. Left. Died July 7, 1862. Left. Supposed to be dead. July , , 63. July , , 63. May 14, , 63. Oct. 8, , 62. , 64. July , , 63. , 62. g4 May 6, , 64. go Aug. 9, , 62. Oct. 8. , 62 June 3, , 64. July Right. Died October 30, 1862. Right. Died June 15, 1864. Died July 16 1863 May 6, , 64. Left. Died June 13, 1864. . Died January 9, 1863. Right. Died October 15, 1864; pneumonia. Right. Died November 17, 1862. Left. Died May 27, 1864; py aemia. . Died July 17, 1863. Left. Died August 4, 1863. Right. Died October 1, 1863. . Died July 19, 1863. , 63. July 3, , 63. July 6, , 63. Right. Died July 27, 1863. Left. Died July 17, 1863. , 64. Sept. 17, , 62. Alabama. Damsoe, C. S., Serg t, D, 14th South Carolina. Dew, J., Pt., B, 44th N. Carolina. Donohoe, F., Pt., B, 15th Louisiana. Dowdy, J., Pt., B, llth Virginia. Dufiield,W., Pt., D, 86th Illinois. Dtmbar, A.B., Pt., 1, 33d Massachusetts. Everett, D., Pt., E, 7th Ohio. Fallen, J. S., Corp l, K, 1 Ith Georgia. Font, L. T., Pt., A, llth Mississippi. Farris, R. E., Corp l, G, 10th Maine. Fieldsend, H., Pt., I, 5th Connecticut. Fleming, J., Pt, K, 7th Louisiana. Frank, A., Pt., I, 5th Louisiana. Freeman B Pt 5th July , , 63. Right. Died July 23, 1863. Left. Died October 23, 1863. July , , 63. tery. Holt, R. S., Pt,, A, Mor ris s Artillery. Howard, T., Pt., , 28th North Carolina. Bowse, A. J., Pt., C, Cobb s Legion. Irwin, J. C., Pt.,E, 37th Mississippi. Jackson, F., Pt., G, 27th North Carolina. Jenkins, S., Serg t, B, 6th Louisiana. Johns, , Corp l, E, 2d Infantry. Johnson, W., Pt., F, 1st Tennessee. Johnston, A., Pt., D,80th Ohio. Keith, A. B., Corp l, I. 7th Massachusetts. Kelly, M., Pt., H, 43d North Carolina. Kendrick, T. L., Pt., A, 10th Maine. King, D. K., Capt., B, 48th Alabama. Lair, A., Serg t, C, 1st Penn. Cavalry. Letellier, J. C., Pt., E, 19th Virginia. Loyd, B. F., Pt., G, 22d Georgia. Mahon, S. B., Pt , D, 7th Penn. Reserves. Mathews, J., Pt., I, 48th Georgia. McBride, B., Pt., B, 42d Mississippi. McClendon,R. L., Pt.,G, 61st Alabama. McCrae, F., Serg t, K, 8th South Carolina. McCullough IF. Pt. K , 63. , 64. June 27 >g4 May 15 , 64 Sept. 17 , 62 Left. Died May 22, 1864. Right. Died August 8, 1864. Left. (Also fracture right femur.) Died June 25, 1864. July , , 63. Oct. 8, , 62. . Died October 21, 1862; pyaemia. Right. Pyaemia. Died March 21, 1865. Right. Died April 11, 1865. . Died August 20, 1861. . Died October 26, 1862. Right. Died December 13, 1862. Left. Died June 2, 1863. Right. Died May 22, 1864. Right. Died September 31, 1862. Left. Sloughing; pyaamia. Died December 26, 1862. Died September 5, 1862. . Died August 19, 1862. Left. Died October 12, 1863; pyajmia. , 62. Aug. 9, , 62. Aug. 9, , 62. Aug. 10, , 61. Oct. 2, , 62. Oct. 3, , 62. May 3, , 63. Aug. 9. , 62. Texas. Freeman, G., Pt.,H, 26th Michigan, age 22. Funderbunk, F., Pt., E, 8th Georgia. Gamage, T. B., Pt., E, !Hh Georgia. Geron AD Pt. C 84th 6-1 Left. Died June 17, 1864. . Died August 28, 1861. . Died January 1, 1864. July 21, , 61. Dec. 5, , 63. July 21, , 61. Aug 9, , ! 62. , 65. . Died September 23, 1862. Left. Died April 19, 1865. New York, age 22. Gilbert S P Pt D Aug. 31. 28th North Carolina. Gillespie, P., Pt., K, 2d Michigan. Gluve, F., Pt., A, 1st Minnesota. Goldxticker, J. A., Pt., A, 4th Texas. Goodin, H., Pt., I, 39th July 11, , 63. July Left, Died July , 1863. . Died September 4, 1862. Right. Died June 3, 1864. Right. Died April 11, 1865. Died December 5 1864. , 63. July , , 63. 64 Left. Died July 15, 1863. Left. Died August 10, 1864. Right. Died January 29, 1864 ; anaemia. . Died July 14, 1863. , 65. Illinois, age 47. Goodman, E., Serg t, D, 27rh North Carolina. Goodson, J. H., Pt., B, - - 64 Left. Died November 3, 1864. . Died September 9, 1861. Left. Died May 22, 1864. July , -, 63- 6th S. C. Cavalry. McDaniel, J. TF.,"Pt.,B, 2d.Mississippi. McDonald, J. T., Pt., B, llth Georgia. McElhany, J., Pt., C, 42d Pennsylvania. McGuire, M., Pt, G, 4th Infantry. McMillen, A., Pt., A, 12th Infantry. McNaughton,J. B., 108th New York. Merrill,, \J.,-pt.,Y,l9t\i Georgia. Miles, J. E., Pt., H, 18th Georgia. -V61- 18th North Carolina. Gow. E. J., Pt., F, 1st South Carolina Cav. Goynes, D., Pt., B, 14th Louisiana. Gradij, J. W., Pt., E, 30th North Carolina. Greer, J. AT., Pt., C, 9th Georgia. Baines, F., Pt., A, 8th Virginia. Hall, H., Pt., H, 18th North Carolina. Hamlet, B. O., Pt., A, 2d U. S. S. S. J ue6, 62. Sept. 17, , 62. Aug. 9, , 62. Dec. 13, , 62. Left. Died September 29, 1862. Oct. 21, , 61. July , , 63. July . Died November 5, 1861. Left . Died December 26, 1862. Died September 25 1862 Left, Died July CO, 1863. Died September 18 1862 , 63 . SURG. Ill 4-2 330 INJUEIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. 207 208 209 210 211 212 213 214 215 216 217 218 219) 220/ 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME. MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. Miller, O. O., Pt., B, 145th Penn., age 23. Millirons, A. B., Pt., Jordon s Battery. Minrieck, S., Corp l, B, 10th Wisconsin. Mitchel, A. S., Pt.,H, 7th Ohio Cavalry, age 21. Moss, T., Pt., C, 10th Georgia. Moulton, A., Pt., G, 3d New Hamp., age 24. Mullen, J. H., Pt., G, 37th North Carolina. Myers, G. Jf., Pt., A, 2d Virginia. Nail, *P.^.,Pt.,F,68th North Carolina. Nelms, W.M.,Pt., D, 5th Texas. Nelson, W., Pt., A, Low- ther s Battaliou. Nicholls, W., Pt., 1, 27th Alabama, age 22. Nunenger, G., Pt., A, 58th Virginia. O Neil, H., Pt., C, 1st Kansas. Otto, F.,Pt.,H, 1st Iowa, age 31. Padgett, T., Pt., I, 1st Artillery. Park, L. "H., Pt., G, 21st Connecticut, age 34. Parker, S. M., Pt., A,32d Mississippi. Parrish, J.A.,Pt.,B, 12th Infantry. Parvin, L., Pt., B, 7th Tennessee. Penno, A. B., Pt., B, 1st Rhode Island. Perry, C., Pt., F, 15th Massachusetts, age 18. Peterson, J. H., Pt., H, 33d Alabama. Pierce, W. F., Pt., G, 27th Mississippi. Piper, L. R., Corp l, F, 8th Penn. Reserves. Powell, C., Pt., E, 9th Virginia. Pritchet, J., Pt., G, 50th Indiana. Prilchett, T. R., Pt., K, 55th Virginia. Quinn, W., Pt., , 2d Vermont Battery. Radford, G., Corp l, B, 26th New Jersey. Rawls, J. T., Pt., C, 3d South Carolina Cav. Reaser, U., Pt., B, 151st Pennsylvania. Reed, F., Pt., A, 53d Illi nois. Reese, J., Pt., E, 8th Georgia. Rhinebast, J., , 62d N. York, age 32. Roberts, A.J., Pt., I, 48th Alabama. Robins, W. F., Pt., M, 22d North Carolina. Rogers, R., Corp l, K, 2d N. Y. Artillery, age 21. Sann, J., Pt., A, 7th N. York Heavy Artillery. Saunders, W., Pt., F, 47th Alabama. Sax, , Capt., K, 37th Mississippi. Sensabauglin, W., Pt., E, 5th Texas. Sheldon, H., Pt., C, 8th Michigan. Simpson, R. H., Major, 17th Virginia. Sink, J., Pt., F, 15th N. Carolina. Smoke, J., Pt., K, llth South Carolina. Spencer, S. G., Pt., D, , 64. , 63. Oct. 8, , 62. April 28, , 64. Left. Died May 23, ] 864. Left. Died August 4, 1 863. . Died October 14, 1862. . Died October 14, 1864; chronic diarrhoea. Right. Died June 20, 1863. Left. Died September 26, 1864. Died July 13 1863 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 - ,,, 293 294 295 296 297 298 299 :>() 301 Stackhouse, S. W., Pt., G, 104th Penn. Stanley, G., Pt., H, 63d Pennsylvania. Stephens, G. W., Pt., F, 3d Vermont, age 40. Sturtevant, E., Serg t,E, llth New Jersey. Sullivan D. C. Pt., E, June 1, , 62. May 5, , 64. . Died June IP, 1862. Right. Died. Right. Died June 11, 1864. Left. Died July 13, 1863. July , -, 63. 64. Aug. 13, , 64. Tulv llth Mississippi. Sullivan, W. U., Pt., A, 49th Virginia. Tabor, J., Pt., C, 4th Vir ginia. Taylor, W. L., Pt., E, 27th North Carolina. Terrell, C., Pt., E, 15th Virginia. Thornton, J. W., Corp l, B, 40th Alabama. Tolin, E. S., Pt., I, 8th Alabama. Tyler, E., Pt., E, 4th Rhode Island. Tyrrell, J., Pt., 1, 8th N. York H. Art y, age 46. Van Aman, J., Pt., A, 57th New York, age 20. Vanpell, J. S., Pt., H, 1st North Carolina. Vaughn, G. W., Pt., H, , 64. 26, 1864. Right. Died June 12, 1864. , 63. July 21, , 61. . Attempted to tie fem l art.; had to amp. Died Aug. 13, 61. 1863. ous shock. Left, Died March 29, 1865. Right. Died February 12, 1864 ; pyaemia. Right. Died October 13, 1862; haemorrhage. Left. Died November 21, 1864. . Died June 9, 1862. Right. Died August 27, 1864. Right. Died under operation, March 31, 1865. Right, Died June 25, 1863. . Died July 23, 1863. Left. Died July 25, 18G3. Left. Died November 1, 1863; tetanus. . Died July 29, ] 862. Right, Died February 4, 1 865. Left. Gangrene. Died August 19, 1863. Right. (W ndofleftliiTig.) Died June 5. 1864 ; pyaemia. . Died January 7, 1864. Left. Died June 17, 1864. Left. Died November 1 , 1862. Left. Died June 5, 1863. Right. Died August 29, 1864. Left. Died August 23, 1864. Left. Died June 17, 1864. . Died September 23, 1862. . Died August 17, 1862. . Died October 28, 1861. . Died June 1,1863. Died July 186 py Oct. 22, , 64. Dec. 7, , 64. , 62. Aug. 10, , 61. Aug. 10, -, 61. July , 63 1864. Left. Died December 19, 1864 ; gangrene. Both. Died August 17, 1862. . Died August 21, 1861. . Died August 25, 1861 . . Died July 26, 1863. Left. Died June 1 1, 1864. Left. Died November 3, 1862. . Died August 23, 1862. Left. Gangrene. Died Septem ber 24, 1864. . Died September , 1861. . Died eight days after am putation. Right, Died October 26, 1862. Right. Died February 16, 1863. Right. Died January 1, 1863. . Died July 21, 1863. Left. Died November 26, 1862. Sept.^17, Oct. 27, , 64. June 1, , 62. *g4 Mar. 31, 1865. 40th North Carolina. Wade, H., Pt,, C, Cobb s Georgia Legion. Wadkins, C.. Serg t, H, 45th North Carolina. Wakefield, L., Pt,, C, 3d Iowa. Walker, J. M., Pt., F, 48th North Carolina. Wallron, W., Corp l, E, 52d Pennsylvania. Walls, J., Scout. Ward. J. D., Serg t, A, 4th Mississippi. Ward, W. F., Corp l, D, 57th Massachusetts. Wardlaiv, J. S., Serg t, G, 9th Georgia. Weiand, J., Pt., F, 148th Penn., age 30. Welch, J., Pt., K, 98th Ohio. Whitcher, J. S.. Pt., I, 116th New York. White, B. Y., Pt., 1, 25th North Carolina. Wilkcrson, J., Pt., E, 1st Georgia Cavalry. Williamson, W. if., Pt.. II. 57th Alabama. Willis, W. W., Pt,, I. 21st Virginia. Wilson, C., Corp l, B, 7th Ohio. Wilson, T., Pt., D, 18th Mississippi. Wingo, M. S., Pt., F, J 8th Georgia. Wood. I\ S., Lieut., C, 4th Texas. Wood, W. B., Serg t, I, 16th Tennessee. 1 Woods, J., Pt., C, 14th Louisiana. Salman, J. W., Pt., G, 2d South Carolina. Bonnell, G. B., Pt., C, 2d Florida. Campbell, W. G., Pt., D, 45th Alabama. Carnolf, J., Pt., B, 1st New Jersey Cavalry. Champion, J. A., Pt., G, 60th Georgia. Collins, B. R., Pt., F, 13th Georgia. Cousins, W. T., Capt., C, 17th Georgia. Earhcart, R.. Lieut., C, 54th Virginia. Freret, J., Pt., , Wash ington Artillery. May 16, , 64. Oct. 8, , 62. Aug. 9, ? 62. July , !J-j July 12, , 63. May 31, July 21, 61 Sept. 17, , 62. Oct. 8, , 62. July , , 63. May 6, Dec. 13, , 62. July , , 63. Sept. 14, , 62. Dec. 5, , 63. May 12. , 64. Oct. 8, , 62. May 27, June 14, , 63. May 3, 63 December 9, 1863. Left. Died August 20, 1863. Left. Died May 31, 1863. , 64. , 64. Aug. 9, -, 62. Aug. 9, , 62. Oct. 21, , 61. , 63. July 1, , 63. July 12, , 63. July 21, -, 61. May 31, , 62. . Died July 23, 1863. thigh and left arm amputat il. Died August 12, 1863. . Died August 18, 1861. . Died August 14, 1863 ; py aemia. Oct. 8, , 62. aemia. Left. Died November 14, 1862; typhoid fever. , 63. May 19, , 64. , 64. . Died July 23, 1863. Left. Died June 13, 1864. Left. Died June 19, 1864. Oct. 7, , 64. July . cide. Left thigh. Left thigh. Left thigh. thigh. Right thigh. Right thigh. Left thigh. Left thigh. Left thigh. Oct. 8, . 62. July , 63 1, 1864; diarrhoea. . Died October _16, 1862; gangrene. Left. Died July 21, 1863. Right. Died May 20, 1864. Oct. 8, , 62. June 2, , 62. May 12, J 6i , 64. Left. Died October 23, 1863. Right. Died June 5, 1864. . Died. , 64. July , , 63. July , , 63. 76th New York. HITCHCOCK (A.). Army Medical Intelligence, in fiaslim Medical and SurgicalJournal, 1862, Vol. LXVI, p. 361. SECT. III.] AMPUTATIONS IN THE THIGH. 331 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. 307 308 309 310 311 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 302 303 304 305 306 Gcrdin, W. J., Pt.. H, 5th Georgia. Hagler, J. G., Pt., D, 20th Alabama. Benclrick, W. D., Pt., D, 55th North Carolina. Bumant, J. A.. Capt., C, 12th South Carolina. Jones, H. E., A. A. G., Grade s Brigade. Right thigh. Right thigh. Left thigh. Left thigh. Right thigh. Mass, M., Pt., C, 49th North Carolina. Norlow, J. R., Pt.,JD, 41st Georgia. Odam, J. J., Pt., F, 1st South Carolina. Tucker, D., Pt., F, 9th Arkansas. Williams, J., Pt., C, 1st Texas. Right thigh. Right thigh. Left thigh. Left thigh. Right thigh. Oct. 8. , 62. Sept. 30, , 64. Ul The seat of fracture was recorded to have been in the lower third of the femur in two; in the femur, precise location not specified, in three hundred and four; in the knee joint in one; and in the leg in four instances. The two patients with amputations of both thighs were Confederate soldiers; one recovered and was furloughed, and has not been heard from since; the other died shortly after the operation. RECAPITULATION. Six thousand two hundred and twenty-nine cases of amputation in the shaft of the femur have been enumerated in TABLES XXX to XLV, inclusive, and the results ascertained in all but eighty cases. Two thousand eight hundred and thirty-nine had successful and three thousand three hundred and ten fatal terminations, a mortality rate of 53.8 per cent. Had it been practicable to determine the issues in the eighty cases with unknown results the fatality rate would only be slightly modified. Assuming that all these eighty cases had proved fatal the mortality would be 54.4 per cent., an increase of only 0.6 per cent.; or, supposing all the eighty cases terminated successfully the decrease in the rate of mortality would be 0.7 per cent., leaving a fatality of 53.1 per cent., a deviation of only a little over one half of one per cent, from the percentage of fatality obtained in the determined cases. In five thousand seven hundred and eleven of the six thousand two hundred and twenty-nine amputations in the femur the precise length of time between the injury and the operation was recorded. Three thousand nine hundred and forty-nine, or over two- thirds, were primary operations; one thousand three hundred and twenty intermediary, and four hundred and forty-two, only, secondary operations. In the three thousand nine hundred and forty-nine primary operations the results were not ascertained in forty-eight instances; one thousand nine hundred and fifty-eight were successful, and one thousand nine hundred and forty-three fatal, a mortality rate of 49.8 per cent. One thousand three hundred and twenty intermediary operations were followed by four hundred and seventy- nine recoveries and eight hundred and forty-one deaths, a fatality of 63.7 per cent. Four hundred and forty-two secondary operations comprise two hundred and thirty-nine recov eries and two hundred and three deaths, a mortality of 45.9 per cent. Of the remaining five hundred and eighteen cases in which the time between the injury and operation could not be ascertained, thirty-two were recorded as without result, one hundred and sixty- three as recoveries, and three hundred and twenty-three as fatal, a death rate of 66.4 per cent. The foregoing results differ somewhat from those obtained in the series of amputa tions of the arm (Second Surgical Volume, p. 805). In the latter, the primary operations gave a mortality of 18.4 per cent.; the intermediary, of 33.4; and the secondary, of 27.7 per cent., the fatality of the secondary operations exceeding that of the primary, while in the femur the mortality of the primary amputations exceeds that of the secondary. 332 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Considering the series of amputations in the continuity of the thigh according to the seat of the original injury (TABLE XLVI) it will be seen that the femur had been fractured in twenty-nine hundred, 1 or in 46.6 per cent, of the total number of amputations; the TABLE XLVI. Tabular Statement indicating the Seats of Injury in Six Thousand Two Hundred and Twenty-nine Cases of Amputation of the Thigh after Shot Fractures. POINT AND PERIOD OF OPERATION. 1 o SEAT OF INJURY. FEMUR. KNEE JOINT. LEO. ANKLE JOINT OR FOOT. UHPKB THIKD. MIDDLI THIRD. LOWEK Turai). THIKD Nor INDICATED. Recovery. J5 a Undeter mined. Recovery. 1 r-t Undeter mined. Recovery. 3 1 Undeter mined. Recovery. 3 "5 t- Undeter mined. Recovery. 5 5 ^ Recovery. 5 S ^ Recovery. "a * fa SKAT NOT LOWER MIDDLE UPPER SPECIFIED. THIRD. THIRD. THIRD. 533 147 55 33 1 157 19 4 1 45 14 2 6 o 92 16 7 1 ?ft 76 34 5 3 6(1 29 5 3 21 10 8 2 92 14 6 11 155 35 11 28 112 16 1 10 127 31 1 7 1 27 8 7 10 21 8 1 3 6 4 o 1 0-|0 146 8 7 248 96 42 2 581 121 33 8 105 138 26 5 552 292 40 19 2 3 4 1 33 29 25 1 157 73 45 5 25 27 23 3 196 129 46 19 9 471 1G8 70 1,914 670 207 3 3 14 4 1 41 15 3 233 18 13 24 8 1 53 8 13 179 23 4 22 6 1 I 14 \ 6 3 4 2 5 16 15 10 1 104 345 6 31 6 275 12 1 21 20 3 12 :n i 1 1 2 3 485 / 4 .... 3 o 77 208 19 tl Aggregates 6,229 24 1 67 o 160 198 2 607 497 20 466 801 56 1,173 , 2, 1,226 599 379 > , ee 30 * , 36 , 6 2, 900 knee joint in twenty-three hundred and ninety-nine, or 38.5 per cent.; the bones of the leg in eight hundred and sixty-four, or 13.8 per cent.; and the ankle joint or foot in sixty-six, or 1.1 per cent. Of the twenty-nine hundred amputations for shot fractures of the femur twelve hundred and fifty-seven were successful, fifteen hundred and sixty-three fatal, and eighty results could not be ascertained, a mortality of 55.4 per cent.; of these the amputa tions following fractures of the upper third had a fatality of 7^.6 per cent.; those following fractures of the middle third a mortality of 55.3 per cent.; and those following fractures of the lower third a death rate of 45.0 per cent. The ratio of mortality of the twenty-three hundred and ninety-nine amputations following shot injuries of the knee was 51.1 per cent., eleven hundred and seventy-three patients having recovered, and twelve hundred and twenty-six having died. The mortality of the eight hundred and sixty-four amputations of the thigh for shot injuries of the leg was 56.1 per cent., four hundred and eighty-five of the eight hundred and sixty-four operations having proved fatal. Finally, the sixty-six 1 While the total number of amputations following shot fractures of the femur as cited in this table, viz : 2,900, agrees with the total number of amputations as indicated in TABLE XX, page 175, ante, the figures in several of the subdivisions have been slightly modified, as, in the progress of the work, the results as well as the seats of fracture in several cases classified in TAHLK XX as "undetermined" or "unspecified" were ascertained. Thus, the number of amputations for fractures of the upper third remains the same, 93 cases with 24 recoveries, 67 deaths, and 2 undetermined results. The amputations for fractures in the middle third are 360, as in TABLE XX, but the number of recoveries is increased by 2, while the undetermined oases number 2 less. Similarly the total number of amputations for fractures in the lower third is increased by 2, and those for fractures with unspecified seat decreased by 2, the seats of fracture in these cases having been determined since the publication of TABLE XX. Finally, the results have since been ascertained in 5 cases recorded in TABLE XX as undetermined with unspecified seat of injury, thus giving, in this group, 46 6 recoveries and 56 undeter mined results instead of 401 recoveries and 63 unknown results. SECT, m.] AMPUTATIONS IN THE THIGH. 333 operations for shot injuries of the ankle joint or foot were followed by thirty-six deaths, a fatality of 54.6 per cent. Thus it would seem that of the amputations in the thigh per formed for shot fractures, those for fractures of the lower third of the femur offered the best chance for life. The point of section or ablation in the thigh was in the upper third in seven hundred and sixty-eight, in the middle third in one thousand eight hundred and sixty-six, in the lower third in two thousand nine hundred and one, ?"d in the femur, point not specified, in six hundred and ninety-four instances. The mortality rate of the first group was 53.8 per cent., of the second, 44.5, of the third, 53.6, and of the last, 80.7 per cent., the death rate being the largest in amputations in the upper third, next in the amputations of the lower third, and lowest in those of the middle third, a result differing from that obtained in the different thirds of the arm, where the operations in the upper third were less fatal than those in the lower third (Second Surgical Volume, pp. 805, 806), the percentage of fatality after amputation in the upper third being 18.4, in the middle third 16.4, and in the lower third 26.0 per cent. Of the six thousand two hundred and twenty-nine amputations in the continuity of the femur the side was not indicated in seven hundred and nine cases. The right side was involved in two thousand six hundred and ninety-eight, the left in two thousand eight hun dred and twenty-two. Of the former, one thousand two hundred and ninety-six recovered, one thousand three hundred and seventy-three died, and in twenty-nine cases the results were unknown, a death rate of 51.4; of the latter, one thousand three hundred and seventy- seven recovered, one thousand four hundred and sixteen died, and in twenty-nine cases the results were undetermined, a mortality of 50.7 per cent. This would point to the fact already noticed in the discussion on the amputations of the shoulder joint and arm (Second Surgical Volume, pp. 655, 806), that the left extremity, although most frequently inter ested, had a less proportionate fatality than the right; but the difference in the mortality rates of the two sides is too insignificant to allow conclusions to be drawn, especially as the number of undetermined cases is sufficiently large to materially modify the result. As already stated on page 214, ante, the six thousand two hundred and twenty-nine operations were performed on six thousand two hundred and nine patients, twenty having submitted to amputations of both thighs. 1 Four thousand seven hundred and seventy-one were Union, and one thousand four hundred and thirty-eight were Confederate soldiers. Of the Union soldiers, two thousand and ninety-six recovered and two thousand six hundred and fifty-seven died, while the results in eighteen cases were undetermined, a mortality of 55.9 per cent. Of the Confederates, seven hundred and forty survived, six hundred and thirty- six died, and the fate of sixty-two remained undecided, a fatality of 46.2 per cent. 1 Of the twenty cases of amputations of both thighs, three were successful, viz: Corporal M. Dunn, H, 46th Pennsylvania (CASE 448, p. 242, and Nos. 239, 240, TABLE XXXII, p. 248); Private C. G. Rush, C, 21st Georgia (CASE 449, p. 243, and Kos. 737, 738, TABLE XXXII, p. 254); Private J. A. 1 arker, L, Cobb s Legion Cavalry (Nos. 49, 50, TABLE XLV, p. 328). The seventeen fatal cases are: Pt. S. Baguley, B, 5th New Hampshire (No. 703, TABLE XXXI, p. 235, and No. 105, TABLE XXXIX, p. 105); Serg t T. Doud, C, 2d Michigan (CASE 442, p. 226, and Nos. 800, 807, TABLE XXXI. p. 236); Corp l J. W. Woodworth, H, llth Infantry (CASE 443, p. 226, and Nos. 1143, 1144, TABLE XXXI, p. 240); Pt. S. Allen, G, 59th Massachusetts, Nos. 984, 985, TABLE XXXII, p. 257); Pt. R. S. Michael, A, 105th Pennsylvania (Nos. 1551, 1552, TABLE XXXII, p. 2G3); Pt. D. Nicholson, H, 22d Massachusetts (Nos. 1599, 1600, TABLE XXXII, p. 264); Serg t E. C. Rabbit, B, 10th Missouri (Nos. 1652, 1653, TABLE XXXII, p. 2G4); Pt. J. Stewart, D, 77th New York (Nos. 1769, 1770, TABLE XXXII, p. 265); Lieut. J. Whelpley, D, 1st Maine (Nos. 1862, 18C3, TABLE XXXII, p. 267); Pt. S. Goodwell, G, 29th Illinois (Nos. 128, 129, TABLE XXXIII, p. 269); Pt. H. Kenntr, 4th Virginia (Nos. 169, 170, TABLE XXXIII, p. 270); Pt. C. Meyer, 30th Missouri (Xos. 212, 213, TABLE XXXIII, p. 270); Pt. W. F. Mills, E, 6th New York H. A. (No. 205, TABLE XXXIII, p. 270, and No. 495, TABLE XXXVI, p. 300); I t. II. Tieman, C, 119th New York (Nos. 285, 286, TABLE XXXIII, p. 271); Pt. J. Moore, E, 46th Pennsylvania (Nos. 497, 498. TABLE XXXVI, p. 300); I t. D. Wallace, I, 5th Artillery (Nos. 642, 643, TABLE XXXVI, p. 302); Pt. G. Nunenger, A, 58th Virginia (Nos. 219, 220, TABLE XLV, p. 330). Of the 20 cases, 2 were primary operations in the middle thirds ; 8, primary operations in the lower thirds ; 4, primary operations, the seat not recorded ; ~, intermediary operations of both thighs in the lower thirds; 2, amputations of both thighs, time and operation not stated; 1, primary amputation of the right and intermediary of the left thigh, and 1, primary amputation of right and secondary operation in left thigh. 334 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. The following tabular statement will enable the reader to compare the results of the amputations in the thigh of the American civil war with those of other wars : TABLE XLVII. Results of Amputations of the Thigh on the Occasions named and from the Authorities quoted. ACTION, ETC. AMPUTATIONS. PRIMARY OPER ATIONS. INTERMEDIARY OPERATIONS. SECONDARY j OPERATIONS OF OPERATIONS. ( i UNKNOWN DATE. 8 3 o Recoveries. Deaths. Result Unknown. Recoveries. Deaths. Result Unknown. Recoveries. 1 Result. 1 Unknown. Recoveries. Deaths. Result Unknown. Recoveries. Deaths. Result Unknown. Siege of Spires 1689 (Diovis 1 ) l 1 1 i \ 1 1 Battle of Dettingen 1743 (HOME 3 ) 1 1 Battle of Fontenoy, 1745 (FAURE, 4 BOUCHER, 5 4 1 2 o 1 1 1 1 j 1 Germany, 1756-17G3 (MEHEE, 8 MURSIXXA 9 ) Napoleonic Ware, 1791-1815 (LARUEY, 10 HEX- NEN," GUTHRIE, 12 EUDE8, 13 CARRE, 14 Mi- 3 198 4 23 15 35 37 8 5 18 20 218 13 7 2,748 16 806 6 33 166 19 12 798 3,794 7 2 112 _ 9 I ll 12 1 1 8 7 90 7 1 77 o 14 o 18 23 7 4 10 12 128 6 7 1 2 9 3 9 49 21 4 54 53 5 War of 1812-14 (MAXN 18 ) 2 1 2 7 Revolution in Paris, 1830 (ARNAL.WMEXrERE, 20 1) J LARREV 21 H LARREY ** Roux 23 ) 4 4 2 o o 1 Siege of Antwerp 1832 (H LARREY 24 ) 12 o .... 1 French in Algiers, 1830-1836 (BAUDEXS 25 ) Spanish Peninsular War, 1836-37 (ALCOCK 26 ) .. Campaign of Constantine, 1837 (SEDILLOT 27 ). .. Campaign in Mexico, 1847 (PORTER, 28 JARVIS 29 ) . Revolution in Milan 1848 (RESTELLI 30 ) 17 18 2 5 11 1 7 1 13 7 1 1 1 7 2 4 4 3 1 3 6 3 Paris, 1848 (HUGUIER, 31 AMUSSAT.^BAUDEXS, 33 TORFRT 34 MATOAinNK *5 Tinnx 36 ) 3 1 2 90 3 128 Sleswick-Holstein, 1848-1850 (STROMEYER, 37 DJORUF 38 ) Revolution in Baden 1849 (BECK 31 ) 5 1 2 5 7 Bombardment of Sv6aborg, 1855 (HEYFELDER 40 ) Crimean War, 1854-57 (MATTHEW, 41 CHEXU, 42 HUliBEXET 43 ) 227 14 195 3 3 87 13 6 243 342 o 2,033 o 611 3 29 72 6 6 514 3,452 5 488 165 1,424 24 197 .... 38 14 171 412 1 480 488 British in India, 1857-58 (WlLLIAMSOX, 44 GOR DON 48 ) 1 Italy, 1859-60 (CHEJJU, 46 DEMME, 47 GHERLM 48 ) . . New Zealand War 1 863-65 (MOUAT 49 ) 1 7 41 8 1 27 7 6 106 58 16 o 1 19 4 73 3 3 35 4 Danish War, 1864 (HEINE, 80 LUCKE, 81 OCH- WADT 62 NEUDORFER 83 ) .... 3 12 1 9 2 18 15 2 .... Germany, I860 (STROMEYER^FisCHER.^MAX- NEL, 86 BECK, 67 BlEFEL, 88 MAA8 59 ) Kb 10 7 Austro-Italian War 1866 (GRITTI 60 ) United States Army 1865-70 (OTIS 61 ) 4 149 Franco-German War, 1870-71, Germans (HE1N- ZEL 62 ) . ... 8 121 359 26 16 342 6 3,452 7 Franco-German War, 1870-71, French (CHEXU 63 ) Russo-Turkish War, 1876 (TILING, 64 STF.IXER 68 ) 5 502 549 Totals 9,017 1,419 7,049 406 1,701 14 17 53 259 771 33 737 4,524 Of the aggregate of nine thousand and seventeen amputations in the thigh here adduced, five hundred and forty-nine were undetermined, one thousand four hundred and 1 DIOXIS (P.), Cours d opCrations de Chirurgie, ed. par G. DE LA FAYE, Paris, 4 me 6d., 1750, p. 740. 2 SCHMUCKER (J. L.), Vermischte Chirurgische Schriften, Berlin und Stettin, 1785, B. I, p. 43. 3 HOME (FRANCIS), Itedical Facts and Experiments, London, 17G3, p. 115. 4 FAUUE, L amputation Ua.nl absolument nf.cessaire, etc., in Prix de VAcad. Royale de Chir., 1819, T. Ill, p. 337 (2 recoveries). "BOUCHKU, Obs. sur dcs playes d armes & feu com- pliqu es sur tout de fracas des os, in Stem, de VAcad. Roy. de Chir., Paris, 1753, T. II, p. 470 (1 fatal). G BAGIEU, Examen de Plusieurs Parties de la Chirurgie, Paris, 1756, T. I, p. 153 (1 fatal). BOUCHER, in Mem. de VAcad. Roy. de Chir., Paris, 1753, T. II, p. 477. "MEHEK (JEAN), Traite des plains d armes a feu, Paris, An. VIII (1799), p. 215 (1 fatal). "MURSIXNA (C. L.), Neue Med. Chir. Ceobachtungen, Berlin, 179G, pp. 177, 181 (2 recoveries). IO LARRKY (D. J.), Clin. Chir., Paris, 1829, T. Ill, p. 623 (7 recoveries); and Mem. de Chir. Mil. et Camp., Paris, 1817, T. IV, p. 53 (1 recovery); and Relation Hist, et Chir. de V Expedition de VArm.ee, d Orient, Paris, 1803, pp. 300, 432-433 (10 recoveries, 1 fatal). HKXXEX (JOHN), Principles of Mil itary Surgery, London, 1829, pp. 27C, 278 (2 fatal). "GUTHRIE (G. J.), Gunshot Wounds, London, 1827, pp. 260, 375 (5 recoveries, 8 fatal); and Com- SECT. HI.] SHOT INJURIES OF THE FEMUR. 335 nineteen had successful, and seven thousand and forty-nine fatal terminations, a death rate of 83.2 per cent. CONCLUDING OBSERVATIONS ON SHOT INJURIES OF THE FEMUR. Until the middle of the present century the majority of the writers on military surgery insisted upon immediate amputation as the only means of saving life in comminuted shot fractures of the femur, 1 while there were a few only who questioned the necessity of the operation, and who declared 2 that not only life but also a more or less useful limb might be mentaries, London, 1855, Cth ed., p. 158 (77 recoveries, 62 fatal, 9 results unknown). I3 EUDES (P. J.), Sur les wantages de pratiquer Vamputation sur IP, champ de bataille, etc., Paris, 1815, These, p. 1C (1 recovery). u CARRE (A. C.), De Vamputation considert e comme moyen curatif dans les accidens de dubiliti. , etc., Paris, 1815, Thfise, No. 9, p. 13 et seq. (2 recoveries, 2 fatal). 1S MIREAU (H. L. M.), Sur les inconveniens de Vamputation du moignon de la cuisse devenu conique, Paris, 1815, pp. 15, 16, Thfise (1 recovery, 2 fatal). 16 ARXAL, item, sur quelques peculiarity des plaies par armes a feu, in Jour. Hebd. de M^ d. et de Ckir.pral., Paris, 1831, T. Ill, p. 36 (1 recovery). " KLEIN (D. C.), Practische Ansichten der bedeutendsten chirurgischen Opera- lionen, Stuttgart, 1815, p. 35 (7 recoveries). 18 MAXX (J.), Medical Sketches of the Campaign of 1812-13-14, Dedham, 181C, p. 213 et seq. 19 ARNAL, in Jour. Held, de Mid. et de Chir. prat., Paris, 1831, T. Ill, p. 36 (2 recoveries). ^MEXIERE (P.), L Hotel Dieu de Paris, en Juillet et Aout, 1830, Paris, 1830, p. 323 et seq. (-2 recoveries, 9 fatal). Z LARREY (D. J.), din. Chir., Paris, 1832, T. IV, p. 282 (1 fatal). LARREY (H.), Relation chirur- gicale des evi nements de Juillet, 1830, Paris, 1831, p. Ill (4 recoveries, 1 fatal). ^Roux (PHIL. J.), Des plaies d armes dfeu; Communications, etc., Paris, 1849, p. 37 (1 recovery, 3 fatal). 24 LARREY (H.), Histoire chirurg. du siege de la citadelU d Anvers, 1833, p. 311 et seq. (13 recoveries, 2 fatal). 25 BAUDEXS (L.), Clinique des Plaies d Armes d feu, Paris, 1836, p. 460. x ALCOCK (R.), Notes on the lied. Hist, and Stat. of the British Legion in Spain, London, 1838, pp. 92, 95. 27 SEDILLOT (G.), Campagne de Constantine de 1837, Paris, 1838, p. 266. 28 PORTER (J. B.), Med. and Surg. Notes of Camp, etc., in Mexico, 1845-46-47-48, in Am. Jour. Med. Sci., 1852, Vol. XXIII, N. S., pp. 32, 37, and Vol. XXIV, p. 28 (1 recovery, 2 fatal). JARVIS (N. S.), Surgical Cases at Monterey, in New YorJc Jour, of Medicine, 1847, Vol. VIII, p. 158 (2 fatal). ^RESTELLI (A.), Note ed Osservazioni cliniche di chirurgia mil., in Annal. Univers. di Medicina, 1849, Vol. CXXX, p. 243. ^-^Des plaies d armes dfeu, Paris, 1849, Communications, par HUGUIER, p. 142 (5 recoveries); AMUSSAT, p. 57 (1 fatal); BAUDEXS, p. 224 (5 fatal); JOBERT DE LAMBALLE, p. 155 (1 recovery, 3 fatal); MALGAIGXE (1 unde termined); Roux, p. 38 (1 recovery, 3 fatal). 37 STROMEYEH (L.), Maximen, Hannover, 1855, pp. 756, 757 (51 recoveries, 77 fatal). ^DJOUUP, Semxr- kninger over de i Krigen 1848-50 fnrctagne Amputationer, in Hospitals-Meddelelser, 1852, B. V, p. 106 (39 recoveries, 51 fatal). * BECK (B.), Die Schuss- wundcn, Heidelberg, 1850, p. 347 (7 recoveries, 6 fatal). ^HEYFELDER (J. F.), Die Verwundungen und Operationen in Folge des Bombardements von Sveaborg, in Deutsche Klinik, 1855, B. VII, p. 584-5. 41 MATTHEW (T. P.), Med. and Surg. Hist, of the British Army, etc., in the years 1854-55-56, London, 1858, Vol. II, p. 368 (62 recoveries, 119 fatal). 42 CHEXU (J. C.), Rapport, etc., pendant la Campagne d Orient en 1854-55-56, Paris, 1856, p. 662 (126 recoveries, 1,545 fatal). 43 HOBBEXET (C. V.), Die Sanitdts- Verhdltnisse der Russischen Verwundeten, etc., in den Jahren 1854-1)6, Berlin, J871, p. 182 (89 recoveries, 269 fatal, 488 undetermined). * WILLIAMSON (G.), Military Surgery, London, 1863, p. XXVII (14 recoveries, 1 fatal). ^GORDON (C. A.), Experiences of an Army Surgeon in India, London, 1872, p. 26 (1 fatal). 46 CHENU (J. C.), Stat. Mid. Chir. de la Campagne d ltalie en 1859 et 1860, Paris, 1869, T. II, p. 754 (79 recoveries, 257 fatal). 47 DEMME (H.), Militdr-Chirurgische Studien, WUrzburg, 1861, Zweite Abth., p. 264 (110 recoveries, 321 fatal). 48 GHERIXI (A.), Rdazione chirurgica dell Ospedale militdre provisorio di S. Filippo, in Ann. Universali di Med., Milano, 1860, Vol. CLXXIII, pp. 459, 460; 39 cases (6 recoveries, 33 fatal). 49 MOUAT, The New Zealand War of 1863-64-65, in Stat. San. and Med. Reports for the Year 1865, London, 1867, Vol. VII, p. 513. M HEIXE (C.), Die Schussverletzungen der Unteren Extremitdten, Berlin, 1866, p. 275 et seq. (3 fatal, 1 unde termined). 61 LucKE (A.), Kriegschir. Aphorismen, in LAXGEXBECK S Archiv, 1866, B. VII, p. 25 (1 fatal). 52 OCHWADT (A.), Kriegschir. Erfahrun- gen, Berlin, 1865, Appendix (Table of Operations) (3 recoveries, 20 fatal). M NEL DO RFER (J.), Aus demfelddrztlichen Berichte ubtr die Verwundeten in Xchkswig, in LAXGENBECK S Archiv, 1865, B. VI, pp. 531, 532 (5 fatal). M STROMEYER (L.), Erfahrungen uber Schusswunden im Jahre 1866, Han nover, 1867, pp. 16, 17 (27 recoveries, 23 fatal). & FISCHER (K.), Militairdrztliche Skizzen aus Siiddeutschland, Aarau, 1867, p. 90 (32 recoveries, 9 fatal, 7 undetermined). M MAXXEL(O.), Kriegschir. Beobachtungen, in Allg. Wiener Med. Zeitung, Jahrgang, XII, 1867, No. 48, p. 403 (1 fatal). 57 BECK (B.), Kriegschir. Erfahrungen wdlirend des Fcldzuges 1866, Freiburg i. B, 1867, p. 333 (25 recoveries, 26 fatal). ^BlEFEL (R.), Kriegschir. Aphorismen von 18(36, in LANGENBECK S Archiv, Berlin, 1869, B. XI, p. 475 (7 fatal). 69 MAA8 (II.), Kriegschirurgische Beitrage, Breslau, 1870, p. 73 (3 recoveries, 6 fatal). 60 GRITTI (R.), Nuovi documenti in favore della cura conservativa, etc., in Ann. Unicersali di Med., Milano, 1868, Vol. CCV, p. 518 et seq. 61 OTIS (G. A.), Circular No. 3, War Department, S. G. O., Washington, 1871, p. 205 et seq. (6 recoveries, 6 fatal); 17 amputations following shot wounds are reported in Circular 3, but 5 of these cases arc from the American civil war, 1861-65, and are included in the preceding tables of amputations. ra HEIX- ZEL, Ueber die conservirende Behandlung der Kniegelenkschiisse, in Deutsche Militairdrzt. Ztitschrift, 1875, Jahrgang IV, pp. 358-59. ^CHEXU (J. C.), Aper<;u hist. Stat. et Clin. sur le service des ambulances et des Hopitaux, etc., Paris, 1874, T. I, p. 493. M TILING (G.), Bericht iiber 124 im serbisch- liirkischen Kriege, etc., be.handelte Schussverletzungen, Dorpat, 1877, pp. 66-69 (2 fatal). 65 Sl"EIXER (F.), Aus dem Tagebuche eines deutschen Arztes u dhrend der Zc.it des Krieges im Oriente 1876, in Wiener Med. Wochenschrift, 1877, p. 657 (2 recoveries, 3 fatal). Of these 9,017 operations 366 were in the upper third of the femur, 503 in the middle third, 436 in the lower third, and in 7,712 the seat of ablation was not specified. The results in the upper third amputations were 133 recoveries, 232 deaths, and 1 unknown result, a fatality of 63.5 per cent.; in the middle third, 213 recoveries, 290 deaths, or 57.6 per cent, fatality; in the lower third, 211 recoveries and 225 deaths, a mortality of 51.6 per cent.; andln the femur, seat not specified, 862 recoveries and 6,302 deaths, with 548 undetermined results, a fatality of 87.9 per cent. 1 GUTHUIE (G. J.) (Treatise on Gunshot Wounds, London, 1827, p. 373) remarks: "Injuries of the femur from musket balls are the more common wounds that render amputation necessary," and, on p. 375, "Upon a review of the many cases I have seen I do not believe that more than one-sixth recovered so as to have useful limbs; two-thirds of the whole died, either with or without amputation ; and the limbs of the remaining sixth were not only nearly useless, but a cause of much uneasiness to them for the remainder of their lives." LARREY (D. J.) (Clinique Chirurgicale, Paris, 1829, T. Ill, p. 636): "Lorsque les coups sont regus au centre ou d la partie sup6rieure de la cuisse, de manifire que le projectile la traverse d avant en arriere, en fracturant lo femur, 1 amputation dcvient indispensable." KEUVEGUEN (II. G.) (-Des cas d amputation dans les plaies d armes d feu, Paris, 1847, p. 33) notices one or two recoveries from pistol shot ; but remarks that " these fortunate results must be regarded as exceptions which must not be set up in opposition to the regular rule, viz: that we must amputate whenever the femur is fractured by shot." SCHWARTZ (H.) (Beitrage zur Lehre von den Fchussiuunden. Gesammelt in den Feldzugen der Jahre 1848, 1849 und 1850, Schlcswig, 1854, pp. 155, 168) cites cases of shot fractures of the shaft of the fc inur of the Schleswig-Holstein War, 1848-1850, and advises primary amputation in all cases of extensive comminuted fractures, whether in the upper, middle, or lower thirds of the femur. BLEXKINS (G. E.) (in his article Gunshot Wounds, in COOPER S Diet, of Practical Surgery, London, 1861, Vol. I, p. 817) remarks: "Were I to judge, then, from iny own personal observations in the army, and from some other cases which I saw under my colleagues, I should, without hesitation, recommend immediate amputation in all cases of compound fracture of the thigh caused by grapeshot, musket balls, etc." 2 LE DRAX (H. F.) (Traite ou reflexions tir. es de la pratique sur les plaies d armes d feu, Paris, 1737, p. 221) evidently believed that a useful limb might bo preserved after comminuted fracture of the femur : "Sans parler des pansemens qui sont enonc6s dans la premiere partie, je dirai seulement, que supposant le fcemer fractur6 en 6clats, et qu il y eut lieu d esp6rer de conserver la cuisse, on doit aprSs avoir fait ce que 1 art present, faire ensorte de fixir lo reste des pieces fracturges, de mani6re qu elles ne jouent pas 1 une contre 1 autre, comme je 1 ai dit en parlant ties playes au bras." Hurix (Recherches sur le resultat des fractures de la moitic supcrieure de la cuisse, etc., in Rec. de Mem. de Med. de Chir. et de Phar. Mil., 1854, T. XIV, p. 253), on page 272, believes that the facts cited by him "demontrent que Ton ne doit pas adopter exclusivement le pr6cepte de recourir toujours a 1 amputation dans les cas dont il s agit, et qu il est de ces fractures dont on peut espfercr une gu6rison bonne et durable, quoiqu elle ne laisse qu un membre difforme." 336 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. preserved to the patient by an expectant conservative mode of treatment. From the fol lowing statistical summary of fractures of the femur treated by conservation, recorded in other wars, it will be seen that of a total of three thousand four hundred and seventy-four cases only about two hundred and fifty antedated the year 1850. But with improvements TABLE XLVTII. Results of Shot Fractures of the Femur treated by Conservation on the Occasions named and from the Authorities quoted. ACTION, ETC. CASES. UPPER THIRD. MIDDLE THIRD. LOWEK THIRD. SEAT NOT INDICATED. 1 H Recovery. j3 t. Result Unknown. Recovery. "a a Pw Result Unknown. Recovery. "3 a Result Unknown. Recovery, "a a fe Result Unknown. Recovery. 3 a PM Result Unknown. Battle of Moncontour 1569 (PARE 1 ) 1 1 2 3 1 1 3 2 9 1 1 1 82 2 27 3 9 25 9 3 22 28 17 63 555 1* 542 11 18 29 236 26 9 811 896 11 1 1 1 3 1 1 3 2 9 1 1 1 36 18 3 6 2 3 12 14 3 63 1 II Accidentally, 1608 (FAUBICIUS HlLDAXUS 2 ) Thirty-Years War 1618-1648 (SCHMIDT 3 ) 1 1 1 3 1 1 Franco-German War 1C71 78 (PURMAXX 4 ) Vaudois War, 1686 (BELI.OSTE 8 ) Siege of Milan, 1733 (DESPORT 6 ) 1 2 2 3 Battle of Dettingen, 1743 (RAVATOX 7 ) 1 Fontenoy and Tournay,1745(FAURE, 8 BOUCHER 9 ) Seven- Years War, 1756- 63 (Bn.GUER, "MEHEE," MURSIXXA 12 ) 5 1 Battle of Crevelt 1758 (MOSCATI 13 ) 1 Battle of Prince Town, 1777 (XEALE 14 ) 1 Revolution in Paris, 1791 (DESAULT 15 ) 1 4 Napoleonic Wars 1792 1815 16 . 45 1 11 2 2 20 1 1 2 20 23 War of 1812-14 (TROWBRIDGE, 17 HAMILTON, 18 ). Revolution in Paris, 1830 10 9 8 1 4 2 1 4 1 4 5 Revolution in Lyons. 1831 (G ENSOUL 10 ) 2 Siege of Antwerp, 1832 (H. LARREY 21 ) . . 3 23 8 1 2 1 I French in Algeria, 1830-1836 (BAUDENS 22 ) 2 23 8 1 Spanish Peninsular War, 1836-37 (ALCOCK 28 ) African Campaigns, 1841-42, and accident, 1843 (LEGOUEST 24 LE CLERC 26 ) 1 2 6 2 1 Revolution in Paris, 1848 26 9 14 14 1 1 2 1 6 12 3 8 12 14 War in Sleswick-Holstein, 1848-50 (STROMEYEK 27 ) Revolution in Baden, 1849 (BECK - 8 ) PensiouersattheInvalides,Paris,1847-53(HuTlN w ) Bombardment of Sveaborg, 1855 (HEYFELDER 30 ) Crimean War,1854-57(MATTHEW, 31 LOXGMORE, 32 CHEX U H BAUDEXS 34 ) 17 28 18 1 i 153 12 231 6 9 29 128 25 4 530 811 7 402 1 311 3 9 2 43 6 86 2 1 1 1 128 1 2 20 5 19 1 68 71 401 British in India 1857-58 (WILLIAMSON 3 *) Italian War.lPSg-eOfCHEXU^ROUX.s DRMME, 38 GHERIN I 30 ) . o 37 4 5 44 1 5 60 1 40 79 New Zealand War, 1863-65 (MOUAT 40 ) Danish War 1864 (HEIXE 4I LOCKE 42 ) 3 2 Danish Invalids of War of 1864 (HAXXOVFR 43 ). . . Six Weeks War, Germany, 1866 44 29 61 1 5 233 85 4 47 11 10 12 11 9 1 55 97 5 1 o 47 20 1 6 3 3 44 127 18 100 3 26 47 Austro Italian War 1866 (R. Gltrrn 48 ) United States Army, 1865-70 (OTIS 46 ) 3 T Franco-German War, 1870-71 Germans 47 48 78 199 1 56 20 1 o 26 14 353 388 6 104 31 ;{ 42 Russo. Turkish War, 1876 40 Totals 3,474 2,132 1,242 100 489 230 4 296 148 3 307 125 3 1,040 73!) 90 PARE (A.), Oeuvres Completes, 6d. MALGAIGXE, Paris, 1840, T. II, p. 170. 2 FABRICIU8 HlLDAXUS, Wund-Artzney, Franckfurth, 1652, p. 1207. 3 SCHMIDT (JOSEPH), Speculum Chirurgicum oder Spiegel der Artzney, Augspurg, 1656, pp. 148, 150. 4 PURMAXX (M. G.), Funfftzig Sonder-und Wun- derbahre Schusswunden-Curen, Franckfiirt und Leipzig, 1721, pp. 32,213, 250. 6 BELLOSTE, Le Chirurr/ien d Hopital, Paris, 1716, p. 206. "DEBPORT, Traite des Plaits d Armes a feu, Paris, 1740, p. 222. 7 RAVATOX, Chirurgie d Armt e ou TraM des Plaies d Armes d. Feu, Paris, 1768, pp. 338, 347, 350. "FAURE, L amputation etant absolumcnt necessaire, etc., in Prix de VAcad. Royale de Chir., 1819, T. Ill, pp. 351 (1 recovery). 9 BOUCHER, 06.?. svr des Playes d Armes a feu compliquees surtout de fracas des os, in M m. de VAcad. Roy. de Chir., Paris, 1753, T. II, p. 470 (1 recovery). 10 BlLGUER (J. U.), Chirurgische Wahrnehmungen, Berlin, 1763, pp. 458, 475, 476, 481, 482, 483 (6 recoveries). " MEHEE (JEAN), Traite des plaies d armes a feu, Paris, SECT. m.J SHOT INJURIES OF THE FEMUR. 337 in the manner of securing immobility of the limb, in facilitating the requisite dressings and in the means of transportation, the views of military surgeons experienced a change, and the field of conservative treatment of shot fractures of the femur became enlarged o Baudens, who (as indicated \u Note 4, on page 174, ante), in 1836, strenuously advocated An. VIII (17!)9), p. 134 et seq. (-, recoveries). "MUKSIXNA (C. L.), Neue Med. Chir. Beobachtungeu, Berlin, 1790, p. 138 (1 recovery.) "MOSCATI, in Mem. de I Acad. Roy. de Chir., Paris, 1768, T. IV, p. 625. 14 NEAL (H. ST. JOHX), Chirurgical Institutes, London, 1805, p. 251. "DESAULT, Plait d arme a feu tracersant les deux cuisses, in Jour, de Chir., Paris, 1792, T. HI, p. KM. 10 LAIWKY (1). J.), Clin. Chir., 1636, T. V, p. 328 (1 recovery). HEXNEX (JOHX), Principles of Military Surgery, London, 1829, pp. 113, 131 (1 recovery, 1 result unknown). GUTHlilE (G. J.), Gunshot Wounds, London, 1827, p. 375 (18 recoveries, J3 deaths). EUDKS (P. J.), Sur les wantages de pratiquer Vamputation sur le cluimp de bataille, Paris,, 1S15 ThSse, p. 17 (2 fatal cases). FEXECH (E.), Sur les pieties d armes a feu aux extremites, Paris, 1813, Thdse, pp. 10, 16 (2 recoveries, 5 fatal). ElIHl.ICH (J. A.;, Chirurgische Beobachtungen, Leipzig, Ifelo, B. II, p. 156 (1 recovery). FORGET, Bull de la Soc. de Chir. de Paris, pendant 1855-56, p. 230 (1 recovery). RlBES (F.), Mem. sur la fracture du tiers moyen du femur, etc., in Gaz. Mid. de Paris, 1831, T. II, pp. l(!2-10(i (7 recoveries, 15 fatal). HUTIX (M. F.), Mem. sur la necessite d extraire les corps itrangers et les esquilUs, etc., in Mem. de I Acad. Nat. de Med., 185i.>, T. XVI, pp. 444-448 (3 recoveries). BALLINGALL (G.), Outlines of Military Surgery, Edinburgh, 1855, pp. 388-390 (I recovery, 10 fatal). LEGOUEST (L.), Mem. de la Soc. de Chir., Paris, 1863, T. V, p. 166 (1 recovery). 17 TKOWBKIDGE, Gunshot Wounds, in Boston Medical and SurgicalJournal, 1838, Vol. XVIII, p. 343 (1 recovery). "HAMILTON (F. H.), A Practical Treatise on Fractures and Dislocations, Philadelphia, 1875, p. 518 (1 recovery). "AUNAI., Mini, sur quelques peculiaritts des plaies par armes a feu, in Jour. Ilebd. de Mid. et de Chir. prat., Paris, 1831, p. 36 (4 recoveries). MENIERE (P.), L Uotel Dieu Paris, en Juillet et Aout, 1830, Paris, 1830, p. 312 (4 recoveries, 7 fatal). LAKKEY (H.), Relation Chirurgicale des ivinements de Juillet, 1830, Paris, 1831, pp. 102, 106 (2 recoveries). ROUX (PHIL. J.), Considerations Cliniques sur les blesses a. la Charite, Paris, 1830. p. 50 (2 fatal). JOBEUT 1>E LAMBALLE (A. J.), Plaies d armes a feu, Paris, 1833, p. 262 (8 recoveries.) 20 GEXSOUL, Note sur les blesses recus a I Hotel-Dieu de Lyon, pendant les troubles de 1831, in Gaz. Med. de Paris, 1833, T. IV, p. 300. S1 LAKKEY (H.), Histoire chirurg. du siege de la citadelle d Anvers, 1833, p. 215. BAU- UEXS (L.), Clinique des Plaies d Armes a Feu, Paris, 1836, p. 460. * 3 ALCOCK (R.), Notes on the Med. Ifist. and Stat. of the British Legion in Spain, London, 1838, pp. 52, 95. ** LEGOUEST, in Mem. de la Soc. de Chir. de Paris, 1863, T. V, p. 167 (2 recoveries). 25 LE CLERC, Quelques observations par- ticulieres de plaies d armes a feu, Strasbourg, 18-">2 (1 recovery). 26 Communications, Des Plaies d armes d feu, Paris, 1849: HUGUIER, p. 131 (3 recoveries, 2 fatal); AMUSSAT, p. 55 (1 recovery); BAUDENS, p. 231 (1 recovery, 1 fatal, 1 undetermined); JoiiEKT (UE LAMBALLE), p. 153 (2 recoveries, 4 fatal); MALGAIGNE, p. 45 (2 recoveries, 2 fatal). Bulletin de la Hoc. de Chir. de Paris, 1855-56, pp. 230-214: GKKALUES (1 recovery), ROBERT (I recovery), DEXOXVILI.IEKS (1 recovery). "STROMEYER (L.), Maximen der Kriegsheilkunst, Hannover, 1855, pp. 756-57. >BECK ( B -), Die Schuss- wunden, Heidelburg, ia50, p. 266. HUTIN, Recherches sur le risultat des fractures de la moitii superieure de la cuisse, Paris, 1854, pp. 10, 14, and Rfc. de Mi m. de Med. de Chir. et de Phar. Mil., Paris, 1854, 2"" ser., T. XIV, pp. 261, 263 (63 cases, all pensioners). 3U HEYFELUEK (J. F.), Die Verwundun- gen und Operationen in Folge des Bombardments von Sveaborg, in Deutsche Klinik, 1855, B. VII, p. 554. 31 MATTHEW (T. P.), Med. and Surg. Hist, of the British Army, etc., in the years 1854-55-56, London, 1858, Vol. II, pp. 355-56 and 361 (19 recoveries, 69 fatal). 3J LOXGMORE (T.). in HOLMEs S System of Surgery, 1870, 2d ed., Vol. II, p. 225 (I recovery). ^CHEXU (J. C.), Rapport, etc., pendant la Campagne d Orient en 1854-55-56, Paris, 1856, p. 374 (126 recoveries, 333 fatal). M BAUI)EXS (L.), La Guerre de Crimte, Paris, 1858, p. 328 et seq. (7 recoveries). K WILLIAMSON (G.), Mil. Surgery, London, 1863, p. XXVI. ^CHENU (J. C.), Stat. Mid. Chir. de la Campagne d ltalie en 1859-60, Paris, 1869, T. II, p. 715 (118 recoveries, 190 fatal). 37 ROUX (J.), Dcsarticulation de la cuisse, Paris, 1860, p. 16 (9 recoveries not in CHEXU). ^DEMME (H.), Militdr- Chirurgische Studien, Wurzburg, 1801, Zweite Abth., p. 232 (79 recoveries, 86 fatal). ^GHERIXI (A.), Relazione chirurgica dell Ospedale Militare provisorio di is. Filippo, iu Annali ffniver- sali di Medicina, Milano, 1860, Vol. CLXXIII, pp. 459, 460 (60 cases 25 recoveries, 35 fatal). 40 MOUAT, The New Zealand War of 1863-64-65, in Stat. San. and Med. Reports for the year 1865, London, 1867, Vol. VII, pp. 502-3. 41 HELVE (C.), Die Schussverletzungen der Unteren Extremitdten, Berlin, 1866, p. 238 et seq. (9 recoveries, 7 fatal). 42 L(JCKE (A.), Kriegschirurgische Aphorismen, in LANGENBECK s Archiv, B. VII, pp. 13, 21 (2 fatal). 43 HAX- NOVER (A.), Die Ddnischen Invaliden aus dem Kriege 1864, Berlin, 1864, p. 26 (29 cases, all pensioners). 44 STUOMEYER (L.), Erfahrungen i,ber Schuss- wunden im Jahre 1866, Hannover, 1867, p. 53 (10 recoveries, 15 fatal). FISCHER (K.), Militdrdrztliche Skizzen aus Siiddeutschland und Bohmen, Aarau, 1867, p. 83 (98 recoveries, 17 fatal, 47 result unknown). MAXXEL (O.), Kriegschirurgische Beobachtungen, in Allg. Wiener Med. Zeitung, Jahrg, XII, 1867, No. 48, p. 403 (1 fatal). BECK (B.), Kriegschirurgische Erfahrungen wdhrend des Feldzuges 18U6, Freiburg i. B. 1867, p. 294 (8 recoveries, 9 fatal). BIEFEL (R.), Kriegschirurgische Aphorismen von 1866, in LAXGENBECK s Archiv, Berlin, 1869, B. XI, p. 445 (5 recoveries, 6 fatal). MAAS (II.), Kriegschirurgische Beitrdge, Breslau, 1870, p. 40 (7 recoveries, 13 fatal). ^GRITTI (R.), Nuovi documents in favore della cura conservativa nelle fratture del femore par arma da fuoco, in Annali Universali di Medicina, Milano, 1868, Vol. CCV, p. 518 et-seq. 4G OTIS (G. A.), Circular No. 3, War Department, S. G. O., Washington, 1871, p. 70 et seq. 47 BECK (B.), Chirurgie der Schussverletzungen, Freiburg, 1872, p. 677 (87 recoveries, 44 fatal). BILLKOTH (TH.), Chirurgische Briefe, etc., Berlin, 1872, p. 228 (9 recoveries, 12 fatal). FISCHER (G.), Dorf Floing, etc., in Deutsche Zeitschrift fur Chirurgie, 1872, B. I, p. 185 (26 recoveries, 17 fatal, 4 undetermined). FISCHER (H.), Kriegschirurgische Erfahrungen, Erlangen, 1872, p. 177 (9 recov eries. 11 fatal). GOLTDAMMER, Bericht iiber die Thdtigkeit des Reserve-Lazareths des Berliner Hiilfsvereins, in Berliner Klin. Wochenschrift, 1871, No. 13, p. 151 (4 recoveries, 2 fatal). GRAF (E.), Die Kdniglichen Reserve- Lazarethe zu Dusseldorf wdhrend des Krieges 1870-71, Elberfeld, 1872, p. 62 (4 recoveries, 5 fatal). GUTEKUNST. Bericht ueber die wdhrend des vorigen Jahres indem Vereinspital Ludivigsburg aufgenommenen ScJtussverletz- ungen, in Zeitschrift fur Wunddrzte, Stuttgart, 1876, B. XXIII, pp. 140, 146 (1 recovery, 2 fatal). HEYFELUEU (O.), Berichte, etc., in Petersburg. Medizinische Zeitschrift, 1871, No. 1, p. 57 (1 recovery). KlRCHNER (C.), Aerztlicher Bericht ueber das K. P. Feld-Lazareth im Palast zu Versailles, Erlangen, p. 54 (3 recoveries, 12 fatal). KOCH (W.), Notizen, etc., in LANOEXBECK S Archiv, 1872, B. XIII, p. 500 (7 recoveries, 11 fatal, 2 unde termined). KUCHLEK (H.), Analecten aus der Kriegsgeschichte, in Memorabilien, B. XVI, 1871, p. 141 (2 recoveries, 9 fatal). LOSSEN (H.), Kriegs chirurgische Erfahrungen, in Deutsche Zeitschrift fur Chir., 1873, B. II, p. 112 (9 recoveries, 6 fatal). MAYER (L.), Kriegschir. Mittheilungen, in Deutsche Zeitschrift fur Chir., 1873, B. Ill, pp. 49-52 (2 recoveries, 4 fatal). MOSETIG (V.), Erinnerungen aus dem Deutsch-Framosischen Kriege, in Der Militdrarzt, 1872, Jahrg. VI, p. 21 (1 recovery). OTT, OESTEKLEN, und ROMBERG, Kriegschir. Mittheilungen, etc., Stuttgart, 1871, p. 49 (8 recov eries, 5 fatal). RurriiECHT (L.), Militdrdrztliche Erfahrungen, WUrzburg, 1871, p. 74 (4 recoveries, 2 fatal). SALZMANX, Mittheilungen aus dem Vereinsspital in Esslingen, in Med. Correspondenz-Blatt des Wi/rttemberg. A"rztl. Vereins, 1871, B. XLI, pp. 148, 153 (1 recovery, 1 fatal). ScilIX- ZINGER (A.), Das Reserve- Lazareth Schwetzingen, Freiburg, 1873, pp. 70, 71 (7 recoveries, 2 fatal). SOCIN (A.), Kriegschirurgische Erfahrungen. Leipzig, 1872, p. 134 (16 recoveries, 6 fatal). STEINBERG, Die Kriegslazarethe und Baracken von Berlin, Berlin, 1872, p. 147 (233 recoveries, 55 fatal, 40 undetermined). STOLL, Bericht aus dem K. Wiirttembergischen 4 Feldhospital, in Deutsche Mil. Zeitschrift, 1874, B. Ill, p. 197 (11 recoveries. 15 fatal, 2 undetermined). SruMl F (L.), Bericht iiber das Kriegsspital, etc., Neuberghausen, in Bayerisches Aerztl. Intelligenz-Blalt, 1872, p. 656 (9 recov eries, 3 fatal). CZERXY (VlNCEXZ), Bericht ueber die in College Stanislaus in Weissenburg behandelten Verwundeten, in Wiener Medizinische Wochen schrift, 1870, No. 57, p. 1373 (11 recoveries, 9 fatal). BERTHOLD, Statistik, etc., in Deutsche Militdrarztliche Zeitschrift, 1872, B. I, p. 522 (65 recov eries 4 in upper, 2 in middle, 4 in lower third, and 55 in which the seat is not recorded; all pensioners). 48 Cini AL LT (A.), Fractures par armes a feu, Paris, 1872, p. 4 et seq. (10 recoveries, 2 fatal). CHRISTIAN (J.), Relation sur les plaies de guerre, in Gaz. Med. de Strassbourg, 1872, p. 283 (10 recov eries, 12 fatal). COUSIN, Ambulances de la Presse Frangaise, in L Union Mtdicale, 1872, T. XIII, p. 148 (7 fatal). DESPRES (A.), Rapport sur les travaux de la 7> Ambulance a VArm.ee. du Rhin, etc., Paris, 1871, pp. 44, 46, 48 (5 recoveries, 12 fatal). FEI.TX et GuOLLEMUXD, Rel. Clin. sur Ir* Ambulances de Haguenau, in Gaz. Med. de Strasbourg, 1871, No. 11, p. 133 (11 recoveries, 3 fatal). JOESSELL, Ambulance du Petit- Quartier a Hariue- nau, in Gaz. Med. de Strasbourg, 1871, p. 8 (7 recoveries, 6 fatal). MACCORMAC (W.), Notes and Recollections, etc., London, 1871, p. 109 (8 recoveries, 20 fatal). MOYXIER (EUGENE), Ambulance de la Rue Saint Lazare, in Gaz. des Hopitaux, 1871, Vol. XLIV, p. 44.-) (J recoveries, 1 fatal). PAXAS (F.), Mem. sur le trailcmrnt des blessures, etc., iu Gaz. hebdomadaire de Med. et de Chir., 1872, T. IX, p. 391 (2 recoveries, 4 fatal). POXCET (F.), Contribu- SUKG. Ill 43 338 INJUKIES OF THE LOWEE EXTREMITIES. [CHAP. x. immediate amputation, and who yet, in 1849, l insisted that "les fractures du corps du fe"mur demandent impe rieusement 1 amputation immediate," acknowledged, in 1858, after his experience in the Crimean War, "cette sentence trop absolue."- The successful attempts at conservation in shot fractures of the femur recorded from the Danish War of 1864, by Heine, from the Six Weeks War of 1866, by K. Fischer, Beck, and E. Gritti, and from the Franco-German War of 1870-71, by Beck, H. Fischer, Lossen, Rupprecht, and Socin among the Germans, and Chipault, Feltz, Grollemund, Roaldes, Se dillot and others among the French (TABLE XLVIII and notes on p. 336), stimulated the propensity towards con servative opinions in war surgery. B. Beck, who, in 1850, insisted upon immediate ampu tation, 3 "be it in the field or in cities in well conducted hospitals, in all shot fractures of the femur, even if there be only the slightest splintering or displacement of the ends of the femur in oblique fractures," conceded, in 1872, after the Franco-Prussian War, 4 that "we have, in the field hospitals, by expectative therapy and by the use of the simplest band ages, saved a considerable number of shot fractures of the femur." Se dillot 5 declared that "the extreme mortality of amputations of the thigh in war surgery, and the annoyances and accidents to which the apparatus destined to replace the limb are liable, have led us to renounce this operation in all cases in which the most positive necessity does not require it." Socin 6 considers it "inexcusable to perform in a case of shot fracture of the femur for splintering of bone alone, the primary amputation as yet advocated by the first authorities of French military surgery. Only when we are assured that the vessels, artery and vein, are shot through, is the operation justifiable." Already in the early part of the War of the Rebellion many American surgeons were tions, etc., in Montpellier Midical, 1872, T. XXVIII, pp. 41-43 (1 recovery, 4 fatal). ROALUES (A. W. DE), Des fractures compliquees de la cuisse, Paris, 1871, p. 43, etc. (11 recoveries, 10 fatal). SEDILLOT, Du traitement des fractures des membres par armies de guerre, in Archives Gentrales de Mcd- tcine, 1871. 4 rae ser., T. XVII, p. 423, etc. (25 recoveries). TACHAUD (E.), Reflexions pour servir d I histoire de la Chirurgie, iu Gaz. des Hopitaux, 1871, p. 238 (1 fetal). VASLIM (L.), Htude sur les plaies par armes it feu, Paris, 1872, pp. 102, 244 (7 recoveries, 3 fatal). CHENU (J. C.) (Apercu hist, ttat. tt clinique, etc., Paris, 1874, T. II, pp. 153-1038) names 705 pensioners who recovered after shot fractures of the femur; 12 of them have been recorded by the authors just quoted, Y!Z: CHIPAL LT (2), CHRISTIAN (2), MACCORMAC (1), FELTZ et GROLLEMUND (2), ROALDES (3), and SEDILLOT (2), leaving fi .l3 cases to be added to this series, viz: 151 in upper third, 58 in middle third, 110 in lower third, and 374 in which the location of the injury was not specified. MOS8AKOWSKY (P.) (Stat. Bericht ueber 1415 Franzbsische Invaliden, in Deutsche Zeitschrift fur Chirurgie, 1872, B. I, p. 342) cites 19 cases of pensioners after shot fracture of the femur not reported by CHENU, viz: 9 in the upper third, 9 in the middle third, and 1 in the lower third of the femur. * TILING (G.), Bericht ueber 124 im Serbisch-Tiirkischen Kriege im Baracken Lazareth des Dorpater Sanitdts- Train Zu Swilainatz behandelle Schussverletzurtgeri, Dorpat, 1877, pp. 66-69 (1 recovery, 2 fatal). KADE (E.), Das Tempordre Kriegslazareth des Kessoris der Anstalten der Kaiserin Maria, in St. Petersburger Med. \\~ochenschrift, 1877, No. 45, p. 384 (4 recoveries, 2 fatal). STEINEU (F.), Aus dem Tagebuche tines Deittschen Arztes wahrend der Zeit des Krieas im Orient, 1876, in Wiener Med. Wochenscrift, 1877, No. 28, p. 681 (2 recoveries). Of the 3,474 cases of shot fractures of the femur treated by conservation here referred to, ,2,132 were successful and 1,242 were fatal, while in 100 instances the result could not be ascertained. But it would obviously be unfair to make a deduction regarding the percentage of mortality from the numbers here adduced. Among the oases of recovery enumerated are 63 pensioners observed by HUTIN (No. 29, ante) at the Hotel des Invalides at Paris during the years 1847-1853 ; 29 pensioners recorded among the Danes after the Schleswig-Holstein War, 1864, by HANNOVER (No. 43, ante); 65 pensioners observed by BKKTHOLD (No. 47. ante); 693 pensioners tabulated by CHE\U (No. 48, ante): and 19 pensioners observed by MOSSAKOWSKY (No. 48, ante). These cases, numbering 869, should be deducted from the total number of recoveries, leaving 1,263 successful to 1,242 fatal cases, a mortality of 49.5 per cent. Of the 869 pen sioners thus deducted, 181 recovered after shot fractures in the upper third of the femur, 97 in the middle, 133 in the lower third, and 458 in the femur, third not specified. Deducting these from their respective categories in TABLE XXXVI there remain 489181308 recoveries in the upper third to 230 deaths, a mortality of 43.7 per cent.; 296 97=199 recoveries to 148 deaths in the middle third, a death rate of 42.6 per cent.; 307 133^^174 recoveries to 125 deaths in the lower third, a fatality of 41.8 per cent., and 1040 458=582 recoveries in the femur, scat unspecified, to 704 deaths, or a mortality of 54.7. 1 BAUDEXS (L.), Des 1 laies d armes a feu. Communications, etc., Paris, 1849, p. 218. *BAL DKNS (I...) (La Guerre de Crimt e, Paris, 1858, p. 131): "Avant la guerre de Crim6e, c 6tait un principe g6n6ralement accepte qu tine fracture du f6mur d6termin6e par un coup de feu n^cessite 1 amputation. II y a lieu de penser que, grace d mes nouveaux appareils d fractures, on pent en appeler de oette sentence trop absolue; and, on p. 333, " Us prouvent, contrairement a 1 opinion re^ue, que les fractures eomminutives du femur avec pluie nc gont pas fatalement vonfees d 1 amputation, si on a le soin d extraire les esquillcs et les corps 6trangers pour faire d une plaie cnmpliquee line plaie simple, et si d 1 aule d un appareil a fracture convenable, on parvient d placer le membre dans une immobility complete, sans 1 ebranler meme pendant les pansements. et d donner uux humiditds pimilentes un facile 6culement." 3 BECK (B.). Die ScltujtswurKhn, Heidelberg, 1650, p 283. 4 BECK (B.), Cliirurgie der Schussverlet~unyen, Freiburg, 1872, p. 691. *S|ilLLOT (Du traitrment des fractures des membres par armes de guerre, in Arch. Gin. de Mid., 1871, 6 me serie, T. XVII, p. 422) remarks: "I/ extreme mortalite.de 1 aroputation de la cuisse dans la chirurgie de guerre, et les ennuis et les accidents que causent leg moyens de prothese destines d remplacer ce membre. nous ont conduit d renoncer d cette operation dans tous les cas ou la nficessite, la plus 6vidente ne 1 imposait pas. Les ablations partielles ou totales par un boulet, un 6clat d obus; des fracas osseux trds-etendus avec division de I art6re, de la veine crurale et du nerf sciatique; la gangrene, les fractures avec large ouverture du genou et fragmentation des condyles du fiSinnr et du tibia, sont les seules complications qtii semblent empdcher absolument la conservation de la cnisse." SOCIN (A.) (Krirgschirurgische Krfahrungen, Leipzig, 1872. p. 128) believes that the experiences of the late campaigns confirm on the one hand the previous reports of the enormous mortality of primary amputations of the femur, and. on the other hand, prove that the conservative treatment is not only enabled to save many useful extremities but gives far better results in regard to mortality. SECT, in.] SHOT INJUKIES OF THE FEMUR. 339 led to similar conclusions. Assistant Surgeon Philip 0. Davis, U. S. Army, in a report to the Surgeon General of his services from June 1, 1861, to June 19, 1863. remarked that: "The mortality was very great in cases of amputations for compound comminuted fracture of the femur; better success being met with by using splints and other appliances adapted to the nature of the cases." (See Appendix to Part I of the Med. and Surg. Hist, of the War of the Rebellion, p. 15.) Surgeon A. J. Phelps, U. S. V., in his observations after the battle of Chickamauga, September 19, 1863, stated: "As a rule a gunshot .fracture of the femur should not be amputated, but should be treated with the expectation of saving the limb. Such appliances should be used as to secure drainage from the wound and com fort to the patient, and the case then be left to nature supported by good air and generous diet." Surgeon J. S. Woods, 99th Ohio Volunteers, in a report from the hospital at Chat tanooga, declared: "Amputation is almost never warrantable; but the prospect of success warrants the effort to save the life with the limb." Surgeon Henry J. Churchman, U. S. V., detailed eleven cases of shot fractures of the femur treated at the hospital at Fayetteville, Arkansas, and arrived at the following conclusions: "The results, so far, of the cases given, force me to believe, Guthrie and others to the contrary, that: 1, Gunshot fractures of the femur, as a rule, do not require amputation to save life; 2, As a rule, none should be ampu tated save those where, in addition to comminution, there is extensive laceration of soft parts or serious injury done to principal artery or nerve or both." Surgeon A. W. Heise, 100th Illinois, who had observed twelve cases of commiuuted fractures of the thigh at the first division, Twenty-first Corps, field hospital, "of which six had recovered, two would probably recover, and four had terminated fatally," concludes that "the results of these few cases, so much at variance with the experience of all military surgeons, will be one more reason to encourage a hope for a favorable result from conservative treatment of these unfortunate cases." Like views were entertained by Surgeon I. Moses, U. S. V., Assistant Surgeons A. H. Hoff and DeWitt 0. Peters, U. S. A., Assistant Surgeon A. E. Carothers, U. S. V., Acting Assistant Surgeons B. B. Miles, J. Swinburne, E. G. Waters, and the Confederate Surgeon G. M. B. Maughs. 1 That the conservative mode of treating fractures of the femur gave the best results and was most zealously advocated by surgeons in charge of general hospitals remote from the scene of conflict 2 is readily understood when it is considered that 1 MOSES (I.) (Surgical Notes of Cases of Gunshot Injuries occurring during the Advance of the Army of the Cumberland, in Am. Jour. JJed. Sci., 54, Veil. XLVII, p. 338): With our ambulances, " easy and abundant, and the hospitals amply supplied with everything essential . . we ~ere pre- 1804 pound fractures of the femur received by Confederate soldiers at the battle of Gettysburg, and remarks: " The general condition of all the men was f above my expectations of finding them, considering they were prisoners of war and liable more or less to nostalgia. . . The treatment they hi received was, in my opinion, in conformity with the laws of conservative surgery, yet it seemed to me had a little more care been given to extension __ counter-extension, there would have been less shortening and deformity." CAHOTIIEUS (A. E.) (On Compound Comminuted Fracture of the Femur from Slinie Balls, in Am. Jour. Med. Sci., 18C3, Vol. XLV, p. 330, et seq.) concludes: " That the operation of resection is not advisable, but that it offers a more favorable prognosis as a primary than as a secondary operation," and advises moderate and regular extension and counter-extension and the use of the anterior wire splint. JlJLES (B. B.) (Conservative Treatment of Gunshot Fractures of the Knee-Joint, in Am. Med.-Timcs, 18C4, Vol. VIII, p. 50): "In he limb in place and the patient from sleep. The wounds were carefully examined, and all foreign bodies, including spicula of bone immediately in the rack of the ball, removed. . . As a general rule, ordinary fractures above the knee from rifle, balls should never carse primary amputation. Surgeon J. T. IIODGEN, U. S. V., on October 17, 180- , reported from the City General Hospital, St. Louis, of shot fractures of the femur, that he " succeeded in saving 37 out of 53 cases admitted, " and, in a letter dated April 30, 1803, suggests that " amputation for these fractures should seldom be performed." Surgeon Joux II. liBBTTOX, U. S. V., ou Jlay 19, 1803, in a report to the Surgeon General U. S. A., on Dr. IlODGE.x s cradle splint, take* 340 INJUKIES OF THE LOWER EXTREMITIES. [CHAP.X. cases reaching these hospitals had been generally selected by the surgeons in the field as cases in which there existed some chance of saving the limb. But while many of the American surgeons advocated and practised conservative meas ures in shot fractures of the thigh, there were those who deprecated the frequent attempts at conservation, and who were of the opinion expressed by Surgeon S. Hart, U. S. V., 1 that "more amputations would have saved more lives." Surgeon T. H. Squire, 89th New York Volunteers, wrote in 1862, after the battle of Antietam: "A badly shattered femur by a ball through the thigh should always be amputated, and the quicker the better." Surgeon G. D. Beebe, U. S. V., in his report of the centre division of the Fourteenth Corps, at the battle of Murfreesboro , remarked: "In the shaft of the femur I believe amputation is the true conservative course." Surgeon Gr. A. Collamore, 100th Ohio Volunteers, declares: "In fractures affecting the lower two-thirds of the limb, I should amputate so as to remove the fractured portion;" and Surgeon H. S. Hewit, 2 U. S. V., Medical Director of the Army of the Ohio, reported, in September, 1864: "Compound comminuted fractures of the thigh were almost invariably amputated primarily when reaction took place." Surgeon F. Sorrel, 3 Inspector of Hospitals of the Confederate States Army, also favored primary amputation on the field as "the greater readiness with which the patient can be transported from the field; the greater ease and comfort realized under these circumstances, when the limb has been removed ; the lesser time required in hospital for recovery, would all seem to point to its adoption as the wiser policy." Reviewing the cases of injuries and operations in the shaft of the femur recorded during the American civil war, it cannot be denied that the results of the conservative mode of treatment as well as of the amputations have been very gratifying. The three thousand four hundred and sixty-seven cases of the former group gave a mortality of 49.9 per cent., while, of the six thousand two hundred and twenty-nine cases of the latter group, 53.8 per cent, were fatal. Less favorable were the results of excisions in the shaft of the femur, which exhibited a mortality of 69.4 per cent, in the one hundred and seventy- five cases of this operation recorded on the registers of this Office. Of the six thousand two hundred and twenty-nine amputations of the thigh it is true only two thousand nine hundred were performed for shot fractures of the femur, while the remaining three thousand three hundred and twenty-nine were done for shot fractures of the knee joint, leg, or foot, and the objection may be made that it would be unfair to compare the results of six thousand two hundred and twenty-nine amputations in the thigh with the results of shot fractures of the femur treated by either conservation or excision, the injuries in all these cases being in the femur; but the mortality of the two thousand nine hundred amputations in the thigh for fractures of the femur, with one thousand two hundred and fifty-seven issue with the latter suggestion : " I think that neither an examination of gunshot iujuries of the thigh made on the battle-field, nor of the study of the pathological specimens in the Army Medical Museum, will sustain this view of Dr. HODGEN. It must, moreover, be remembered that the cases sub mitted to the treatment of this surgeon are cases which have reached him at advanced periods after the reception of the injuries; that they. have been selected by the surgeons at the scene of conflict as cases in which there existed some chance of saving the limb. They were forwarded to St. Louis for that purpose, and not for amputation. Were the worst eases sent him, I doubt much if his results would be as encouraging. 1 From his experience, based upon the cases treated by him at the Stewart Mansion Hospital, Baltimore, Assistant Surgeon DE WITT C. PETEKS, U. 8. A., reported, in 18(i:i: "My experience in the treatment of compound fractures of the thigh caused by gunshot wounds and by other kinds of violence has inclined me to favor the most conservative course of action. In cases where the large and important blood-vessels and nerves have escaped injury, and where there is not any extensive laceration and destruction of the soft parts, when the constitutional symptoms are not alarming, the true indications are, it appears to me, to try and save the limb. Instances where, by chance or accident, the surgeon has not seen the case in time to perform primary amputation, and has left nature to her own powerful efforts, which have been finally crowned with success, are by no means infrequent, and these instructive cases should not, in my judgment, be overlooked in forming our opinions in deciding whether a limb should be sacrificed or not." Appendix to Part I of the Medical and Surgical History of the War of the Rebellion, p. 118. 2 Appendix to Part I of the Medical and Surgical History of the War of the Rebellion, p. ail. SoilKEL (F.), Gunshot Wounds Army of Northern Virginia. [An Extract from a Report on the Sickness and Mortality in tlie Armies of the Confederate States, for 1863 , in Confederate States Medical and Surgical Journal, Richmond, 18G4, Vol. I, p. 154. SECT. III.] SHOT INJURIES OF THE FEMUR. 341 recoveries, one thousand five hundred and sixty-three deaths, and eighty unknown results, or 55.4 per cent., exceeds that of the total number of amputations (53.8) only 1.6 per cent., leaving the relative results nearly the same the percentage of fatality of the total number of amputations, and that of the amputations for fractures of the femur, exceeding the fatal ity of the conservatively treated cases 3.9 per cent, and 5.5 per cent, respectively. But it is obvious that in comparative statements of cases treated by conservation and by amputa tion the majority of intermediary and secondary operations should be considered only an abandonment of the conservative treatment made necessary by subsequent complications. To arrive, therefore, at a correct estimate of the value of conservation, we must contrast the latter with the primary operations; and here it will be noticed that while the conserv ative cases presented a fatality of 49.9 per cent., the mortality of the primary amputations was 49.8 per cent., the latter offering a slightly better chance for the preservation of life. 1 In comminuted fractures of the upper third of the femur surgeons generally consid ered conservation preferable to amputation. Professor F. H. Hamilton 2 gave it as his impression that "in compound gunshot wounds of the upper third of the femur amputation should never be performed." Surgeon Charles O Leary. 3 U. S. V., found, during the Peninsular campaign in 1862, that "amputations at the upper third of the thigh proved fatal within a short time in all cases. The results of this operation were such as to dis suade us from resorting to it in subsequent battles, except when a limb was in such a con dition as to make its removal a relief to the patient." Surgeon G. A. Oollamore, 4 100th Ohio Volunteers, who advised primary amputation in shot fractures of the middle and lower thirds of the femur, declares that "if the fracture occur in the upper third, I should prefer to trust the case to nature, with such aid from position, splints, etc., as could be obtained." Surgeon J. J. Chisolm, 5 Confederate States Army, declares that "A compound fracture in the upper third of the thigh should be treated, in every respect, as if in the arm. Unless the leg is so mangled that an amputation is an act of necessity, it should not be thought of." That these views largely prevailed among the surgeons of the War of the Rebellion is apparent from a comparison of the number of cases of shot fractures of the upper third of the femur treated by amputation with those treated by conservation. In fifteen hundred and seventy-seven of the twenty-nine hundred amputations for shot frac tures of the femur the precise seat of the injury was recorded. Of these fifteen hundred and seventy-seven cases the injury was in the upper third in only ninety-three instances, or 5.8 per cent., while in two thousand seven hundred and twenty-nine of the three thou- 1 Professor TH. BlLLROTH (Chirurgisclic Brief e aus den Kriegslazarelhen in Weissenburg und Mannheim, 1870, Berlin, 1872, p. 239) contends that the intermediary and secondary operations should be grouped with the conservation cases, and this result compared with that of the primary operations: MODE OF TREATMENT. CASES. RECOVERY. FATAL. UNKNOWN. MORTALITY. Conservation 3,467 1,689 1,684 94 49.9 Excisions (Intermediary and Secondary) 67 24 42 1 63.0 Amputations (Intermediary and Secondary) 1,762 718 1,044 59.2 Aggregate 5,296 2,431 2,770 95 53.2 .. . .. or a fatality oi 5:i.2 per cent, for conservation against 49.8 for primary amputation. 2 HAMILTON (F. H.), Amputations in Gunshot Fractures of the Femur, in American Medical Times, 1864, Vol. VIII, p. I. 3 O LEAKY (CllAUt.ES), Surgeon U. S. V. "Extract from a Narrative of his Services in the Volunteer Medical Staff," in Appendix to Part I of the Medical and Surgical History of the War of the Rebellion, p. 70. 4 SMITH (STEl HEX), Analysis of Four Hundred and Thirty-nine Recorded Amputations in the Continuity of tlie Lower Extremity, in United States Sanitary Commission Memoirs, 1871, Vol. II, p. 62. 5 CHlSOLM (J. J.), A Manual of Military Surgery, Columbia, 1864, p. 394. 342 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. sand four hundred and sixty-seven cases treated by conservation, in which the locality of the injury was ascertained, twelve hundred and fifty-four, or 46 per cent., or nearly one-half, were for fractures in the upper third of the femur. The number of amputations for frac tures in the middle third of the femur was three hundred and sixty, and for fractures in the lower third eleven hundred and twenty-four, while of the cases treated by conserva tion those for fractures in the middle third numbered eight hundred and fifty-five, and those for fractures in the lower third only six hundred and twenty. Ribes, 1 Demme, 2 Pirogoff, 3 . and others 4 have called attention to the great fatality fol lowing shot fractures in the middle third of the femur, and Surgeon E. Andrews, 5 1st Illinois Artillery, reports to have had a similar experience. But neither the results of the cases treated in the American civil war (TABLE XX, p. 175, ante) nor of the cases collected in TABLE XLVIII, on p. 336, appear to confirm this opinion. In the former the percent age of fatality is 46 per cent, for fractures in the upper third, 40.6 per cent, for fractures in the middle third, and 38.2 per cent, for fractures in the lower third. In the latter the fatality is 43.4 per cent, for the upper third, 43.1 per cent, for the middle, and 42.3 per cent. for the lower third, thus affirming, in shot fractures of the femur at least, the old axiom that the gravity of injuries of the extremities steadily augments in proportion as the seat of the injury approaches the trunk. When it had been decided in a shot fracture of the femur to attempt preservation of the limb, all loose spiculse and foreign bodies were carefully removed, 6 the limb was then brought as near as possible to its normal position, and there held by the use of splints. The extraction of splinters retaining any connection by the periosteum, and also the practice of cutting off the broken ends of the bone, was generally deprecated. 7 * 1 RlBES (F.) (Memoire sur la fracture du tiers moyen du femur compliquee de plait, et produite par arme & feu, in Gazette JUedicale de Paris, 1831, T. II, No. 12, p. 101) asserts: "Toutes les fractures du fSmur compliques de plaie, produites par un corps pousse par la poudre a canon sont des maladies graves; mais celles qui arrivent au tiers moyen de cet os sout extremement dangereuses et presque toujours mortelles." 2 DEMME S (H.) (Mililar CJiirurgische Studiert, Wiirzburg, 1861, p. 3612) tabulations show a similar result in the Italian War of 1859 ; the mortality of fractures in the middle third of the femur being 60.87 per cent, to 58.14 of the upper and 43.42 of the lower thirds. 3 PlUOGOFF (N.) (Grundziige der Allgemtinen Kricgschirurgie, Leipzig, 1864, pp. 783, 784) remarks that in the hospitals in the Caucasus and after the Crimean War he saw 20 cases of recovery after shot fractures of the upper third of the femur, but no cases of recovery after fractures of the middle third, and adds: "Our own efforts comparatively few in comparison to the number of amputations to cure shot fractures of the middle third of the femur, miscarried." 4 FISCHER (II.) (Kriegsclnrurgische Erfahrungen, Erlangen, 1872, p. 178) analyses twenty cases of fracture of the femur that were treated by him during the Franco- Prussian War, 1870-71: 10, with 6 deaths, or 60 per cent, mortality, were in the upper, 5, all fatal, were in the middle, and 5, all recoveries, were in the lower third ; and reaches the conclusion: "That shot fractures in the middle third are the most dangerous, and are least adapted to conservative treatment. I believe, therefore, that it would be best to amputate primarily in extensive comminuted fractures of the middle third, and to attempt conservative treatment only in shot fractures with little splintering. Stress should be laid upon this rule, as especially to-day, too little primary amputating is done. Primary amputation for shot fracture of the femur is considered almost a crime. . . It is altogether different in shot fractures of the lower third of the femur ; here the conservative treatment promises the best results. Between the two stand the results of shot fractures in the upper third. There the amputation or exarticulation is, under all circumstances, a dangerous proceeding, and we may, therefore, allow the conservative treatment a larger field." BECK (B.) (Chir. der Schussverletzunrjen, 1872, p. 694) remarks : " Fractures of the middle third of the femur near the junc tion with the upper third always impressed me most unfavorably, on account of the frequently co-existing injuries of the blood-vessels." "ANDREWS (E.) (Complete Record of the Surgery of the Batiks fought near Vicksburg. December 27, 28, 29, 30, 1862, Chicago, 1863, p. 37): "It would seem that shots through the cancellar tissue, at the superior fifth of the femur, are much less dangerous than those in the compact bone of the shaft below ; the reason is, that when a ball bores its way through spongy bone, it produces only a moderate amount of shattering, owing to the yielding character of that tissue; but the impact of a mini6 bullet upon the brittle ivory of the shaft shatters it for several inches, and disperses the fragments with the force of an explosion among all the surrounding tissues, producing immense disorganization. These cases nearly all die within the first five days, no matter what treatment is adopted." 6 The records show that fragments of bone were dislodged in 288 instances at least, of which 170 had successful terminations. Surgeon A. W. IlEISE, 100th Illinois, who observed twelve cases of comminuted fractures of the thigh at the 1st division, Twenty-first Corps, field hospital, of whom six had recovered with union, two would probably recover, and four had terminated fatally, remarks, in a communication to the Medical Director of the Twenty-first Corps, dated February 4, 1863: "In all these cases the principal vessels had escaped injury. Primary sequestra, or those directly and completely separated by the force of the projectile, were carefully removed by making a liberal incision over the parts. But sequestra retaining connection by periostea!, muscular, or other attachment, I did not interfere with. In only two cases I found that during the process of suppura tion sequestra were thrown off. In the majority of these comminuted compound fractures I find that the removal of splinters retaining any connection with periosteum is unnecessary and often injurious, as is also, in my opinion, the practice of sawing off the broken ends of the bones projecting from the comminuted parts. I am strengthened in the belief, from observation made here, that by proper treatment, and under favorable circumstances, splinters become impacted in callus, and. in time, unite with the other fragments of the bone, and, in this manner, a cure is completed without operative inter ference. Whether the splinters which have thus become impacted in callus will lead to mischief, or are subsequently discharged as if they were so many foreign bodies, the future will determine." Surgeon A. J. PHELrs, U. S. V., in his observations after the battle of Chickamauga, recommends that "loose spicula only should be removed, and resections of the shaft be eschewed." Surgeon H. S. IlEWIT, U. S. V., in his Report on the Military Med- SECT. I.I1.J SHOT INJURIES OF THE FEMUR. 343 FIG. 207. DESAULT S splint. The plans adopted for the mechanical support of the fractured thigh bone, for main taining proper extension, for retaining the fractured ends in accurate apposition, and for facilitating the necessary dressings, during transport as well as in hospitals, were manifold and ingenious, and doubtless contributed to the success achieved in the saving of useful limbs. The extended position, which may be traced back to Hippocrates, 1 but for the systematic and rational application of which we are indebted to Desault, 2 as well as the icine. Surgery, and General Conduct of the Medical Department of the Army of the Ohio, from May, 1, 1864, to September 8, 1864 (Appendix to Part I, lied, and Surg. Hist, of the War of the Rebellion, p. 311), declares "(he principle of removing fragments primarily when detached is obvious and has been recommended to the surgeons of the department." Surgeon W. W. BLAIK, 58th Indiana, in "Report of the Medical Staff of the 1st division of the Twenty-first Corps, at the Battle of Stone s River (Appendix to Part I, Med. and Surg. Hist, of the War of the Rebellion, p. 203), states that "all frag ments of bone completely separated by the force of the projectile were carefully removed by making an incision if necessary ; but fragments retaining connection by the periosteum were not removed, and in only two cases were sequestra thrown off during the process of suppuration." Surgeon HEXUY J. CHURCHMAN, U. S. V., in charge of the hospital at Fayetteville, Arkansas, insists that "the comminuted fragments, if small and detached, should in all cases be removed at once under chloroform, and the thigh put in splints so as to keep parts in proper apposition and invite callus the amount of exten sion or counter-extension to be regulated by the amount of comminution or loss of substance. It seems to me that the inflammation and suppuration necessitated by an unreduced compound comminuted fracture detach the periosteum from fragments, and not from fragments alone but from bone gen erally, while the system wastes from suppurative exhaustion and pyaemia. Should even a useless limb result from effort to save, amputation could subsequently be performed under far more favorable circumstances than are generally found in the crowded wards of a general hospital." 1 HIPPOCRATES, Oeuvres completes par fi. LlTTRE, Paris, 1841, T. Ill, Des Fractures, Par. 19, p. 483. 2 DESAULT (P. J.) (Oeuvres chirurgicales, ed. par XAVIER BlCHAT, Paris, 1813, T. I, p. 249, and PLATE II) employed a straight outer splint to reach from the hip to some distance beyond the foot ; an inner splint extending from the periuaeum and terminating opposite the end of the outer splint ; an anterior splint reaching from the abdomen to the knee ; and an extending and counter-extending band, the former secured to the foot and lower extrem ity of the long splint, the latter to its upper extremity after being passed under the perinseum. Junkbags and the SCULTKTU8 bandage completed the apparatus (see FIG. 207). H. J. BRtfxxiXGHAUSEX (Ueber den Bruch des Schenkelbeinhalses iiberhaupt, und insbesondere eine neue method*., denselben ohne Hinlten zu heile.n, Wiirzburg, 1789) fastened the broken thigh to the sound one, a principle followed by HAGEDORN (M.) (Abhandlung von dem Bruch des SchenkelbeinUalses, nebst einer ntuen Methode, denselben leicht und sicker zu heilen, Leipzig, 1808) in his apparatus, which makes the sound limb the extending power, both feet being secured to the foot-board, and the splint to the sound thigh. The apparatus was extensively used on the continent of Europe as well as in England, and was considered a most simple and effectual apparatus. To obviate the principal objection to DESAULT s splint, that it does not act in the line of the axis of the broken limb, but obliquely, drawing the upper fragment outwards, PHILIP SYXG PHTSICK (JOHN SYNO DORSEY, Elements of Surgery, Philadelphia, 1813, Vol. I, p. 1G3) lengthened the outer splint (see Flo. 208) until it reached nearly to the axilla, and attached to its inner side, at about two inches above its lower end, a block grooved on its inner margin, and broad enough to reach the line of the middle of the foot. Counter-extension was thus made more in the line of the body. If the patient experienced any difficulty in bearing pressure upon the top of the foot, Dr. PlIYSICK used a buckskin gaiter laced around the ankle, with straps for extension. Dr. HUTCHINSOX added a notched block, over which the extending band is stretched, throwing the direction of the extension in the line of the limb. The apparatus of ButtXNIXGH AU6EX as well as of HAGEDORN prevented the lateral movements of the pelvis. This defect was partially overcome by WILLIAM GIBSON, of Philadelphia (Reflexions on the Treatment of Fractures of the Thigh, with an Account of a New Apparatus, in the Philadelphia Jour, of the Med. and Phys. Sciences, 1821, Vol. Ill, p. 230, etc.), who, in a case of oblique fracture of the femur, had applied DESAULT S splint; but, owing to the obesity of the patient, found it impossible to keep up extension and counter- extension sufficient to prevent the overlapping of the fractured ends of the bone, and tried the method of HAGEDORX : " I soon found, how ever, that simple and ingenious as it was, and calculated to effect extension and counter-extension to a much greater degree than that of DESAULT, that it was still imperfect, but susceptible of such changes as would make it a most valuable acquisition." Dr. GlttSOX constructed two splints five and a half feet in length, reaching from the axilla beyond the feet. Both feet were confined by gaiters to a foot-board, which was firmly supported upon the ends of the long splints through mortises near its edges. But as both feet are imprisoned, the confinement is apt to become irksome to the patient, and it is difficult to prevent bedsores, to give the patient a stool, or to use a urinal. Subsequently, Dr. GIBSON recommended (Philadelphia Journal of Med. and Physical Sci., 1822, Vol. V, p. 372) a triangular frame presenting a single inclined plane, on which both extremities were extended ; the feet were confined to a foot-board, and counter-extension was made by the weight of the body. In a similar manner Dr. E. MlCHEXER (Remarks on the Treatment of Fractures of the Femur, in the American Medical Recorder, 1822, Vol. V, p. 430) raised the limb on a single-inclined plane to receive counter extension by the weight of the body. A further modification of DESAULT s splint was that of LUKE HOWE (Observations on the various methods of treating the fractures of the Os Femoris, with Cases, in which a new apparatus was successfully used, in The New England Journal of Medicine and Surgery. 1824, Third Series, Vol. Ill, p". 234). The extension was made at the foot with weight and pulley ; counter-extension by a band over the groin and ischiurn, connected by a strap with the headboard of the bed, and a waist band was buttoned or sewed on the pelvis and fastened to the side pieces of the bedstead by bandages or tape. The pulley and weight was also employed by WILLIAM C. DAXIELL (Method of Treating Fracture of the Thigh Bone, in Am. Jour. Med. Sci., 1829, Vol. IV, p. 330) attached to a handkerchief passed around the ankle. BOVEU 8 splint (Traite des Maladies Chirurgicales et des Operations qui leur conviennent, Paris, 1831, T. Ill, p. 305, and PL III, opposite p. 640) is composed of a long splint for the external side of the limb, with a foot-board, which was moved up and down by means of a screw for the purpose of making extension ; of an inside splint from the perinaeum to the foot, and of an anterior splint reaching from the groin to the ankle. A padded leather band through the perina?um and buckled into the upper end of the outer splint made the counter-extension. A modification of BOYEK S DESAULT was used by Dr. JOSEPH E. HARTSHORNE, of Philadelphia. The counter-extension was made against the perinaeum at the upper end of the inside splint, and both splints were connected at the lower end by a transverse piece through which a long wooden screw passed having a foot-board attached to it. By this arrangement the outer splint could be detached from the inner one without disturbing either the extending or counter-extending force. The splint is figured, after nature, by H. H. SMITH (The Princip es and Practice of Surgery, Philadelphia, 1863. Vol. I, p. 625). LlSTOX s modification of DESAULT (R. LISTOX. Practical Surgery, London, 1840, p. 88) consists of a straight splint from the axilla to about six inches below the foot, perforated with two holes at the upper extremity and with two deep notches in the lower end, and an opening to receive the external malleolus. The periueal band is tied to the upper end of the splint ; the foot is secured to the processes at the lower end of the splint by a roller passing from one to the other, and then junkbag, FIG. 2CP. -FHYBICK S modification of DESAULT S splint. 344 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X seiniflexed position, which was brought into practice chiefly by Percival Pott, found their advocates, although the former was perhaps better known to American surgeons through its modifications by Physick, Gibson, and others. An apparatus on the plan of the double- splint and thigh are all bound together by continuing the roller up the limb. The apparatus keeps up a moderate extension and counter-extension. The splint employed by W. E. HORXEU, of Philadelphia (H. H. SMITH, The Principles and Practice of Surgery, Philadelphia, 1863, Vol. I, p. 627) is similar to PIITSICK S, but the upper extremity of the inside splint is slightly carved out like a crutch head, and has stretched across it a soft leather strap. On the inside of the upper portion of the splint two leather loops are nailed to serve for the attachment of the counter-extending band. Extension was made by adhesive strips. The mode of making extension by adhesive strips and weight is said to have been first employed by Dr. JOSEPH SWIFT, of Easton, Pennsylvania. It was suggested, in 1843, by Dr. EXNIS, a pupil of Dr. SWIFT, to Dr. E. WALLACE, of Philadelphia, and was by the latter successfully employed in a case of simple fracture of the thigh (Wif. HUNT, Extracts from Clinical Lectures, in Pennsylvania Hospital Reports, 1869, Vol. II, p. 273). The same mode was employed by Dr. FREDERICK D. LENTE in 1851, in the New York Hospital (F. D. LENTE. A statistical and critical Account of the Fractures occurring in the New York Hospital, etc., in New York Jour, of JUed., 1851, Vol. VII, p. 179). It consisted in the employment of broad strips of adhesive plaster (2J or 3 inches), which were applied to the limb previously shaved, on either side of it, from a little above the knee to below the foot, where it was secured to the ring at the end of the screw. The straps are confined by a single roller bandage. To prevent slipping of the plaster the extension is not applied until some hours after the application of the strips to the limb. In 1853, Dr. JOSIAH CHOSIIY (New Mode of Extension in fractures, in Am. Jour. Med. Sci., 1854, Vol. XXVII, p. 76) published a description of his mode of procuring extension by adhesive strips, which he " used, for the first time, in 1849," and which he believed had never been suggested to the profession in a manner to attract the attention of surgeons until it appeared in Professor MUSSEY S Surgical Report to the American Medical Association at their session in 1850 (Transactions of the Am. Med. Associa tion, 1850, Vol. Ill, p. 382). Dr. D. GILBERT ( Cases in Surgery, in Am. Jour Med. Sci., 1851, N. S., Vol. XXI, p. 70) substituted a movable for HUTCHIN- SON s permanent block, which he attached to the straps of a common tourniquet, close to the sole of the foot, placing the instrument upon the distal side of the block and regulating the extension by the screw of the tourniquet, using adhesive plaster as a counter-extending bandage. Similarly, JOHN NEILL (New Means for making Extension and Counter- Extension in Fractures of the Leg and Thigh, Philadelphia, 1855, p. 4) made counter-extension by means of adhesive plaster. The ends of the extending and counter-extending strips were carried through their respective holes at the upper and lower ends of the splint and secured to each other about the middle of the outer splint. By twisting these united bands by a small stick the extension could be increased and maintained. J. McF. GASTON (Counter- Extension with Adhesive Plaster, in Sout)iern Med. and Surg. Jour., 1859, N. S., Vol. XV, p. 672) adapts adhesive plaster to counter-extension in the manner of GILBERT, but claims superiority in this, that he makes the attachment of the strips over the spinous process of the ilium and the trochanter, thus giving more fixed resistance to the force of extension. Dr. L. A. DUGAS (On the Best Plan of Treating Fractures in Country Practice, in Southern Med. and Surg. Jour., 1854, Vol. X, p. 69) employs 4 wooden splints, a little shorter than the femur, secured around the thigh with many -tailed bandages, a long splint from the side of the thorax to a little below the foot secured by separate ties around the abdomen, pelvis, thigh, leg, and foot, a weight fixed to the ankle and hung over the foot-board, and an arch of crossed hoops to protect the toes from the bed clothes. Dr. H. LENOX HODGE (Counter Extension in Fractures of the Femur, in Am. Jour. Med. Sci., 1860, N. S., Vol. XXXIX, p. 505) devised a modification of PHYSICK, with adhesive strip extension and counter-extension. He dispenses with the perineal band, and prevents the patient from rising or sitting during treatment by a piece of iron attached to the long splint which extends over the patient s shoulder, terminating in a blunt hook. A broad piece of adhesive plaster placed on the front and back of the chest, and secured by strips around the body, is looped over a small block of wood which is attached to the hook at the end of the metal bar, thus making counter-extension. To prevent excoriation or sloughing in parts under pressure, the groin, or the perineum and the ankle, Dr. B. E. COTTING (Simple Apparatus for Fractures of the Thigh, in the Boston Med. and Surg. Jour., 1861, Vol. LXV, p. 129, etc.) recommends a band of stout cotton or linen cloth made to fit the pelvis and upper part of the hips closely, and a stocking on the leg, with side straps of strong cotton cloth, which should hang free for a few inches below the foot. By these straps extension is made on the DESAULT splint, the whole leg being brought down with great steadiness, and without the slightest danger from undue pressure on any particular portion. Dr. J. II. PACK ARD (On the Employment of India-Rubber in obtaining Continuous Extension in the Treatment of Fractures of the Femur, in Am. Jour. Med. Sci., 18fi2, Vol. XLIV, p. 90) added to the inner and lower end of PHYSICK S long outer splint a pulley, through the groove of which he ran an India-rubber cord, secured to the leg and ankle by adhesive plaster. The rubber cord was drawn until a sufficient degree of tenseness had been obtained, when the end was tacked to the outer side of the long splint. Two or three inches of the India-rubber cord should be free between the adhesive plaster and the pulley in order to make the elastic force operative. A similar apparatus is figured by R. BARWELL (A Treatise on Diseases of the Joints, London, 1865, p. 266, etc.). Dr. T. H. BACHE (F. W. SARGENT, On Jlandaging and other Operations of Minor Surgery, Philadelphia, 1862, p. 179) cut a long narrow fenes- trum in PHYSICK S outer splint, extending upwards from near its lower extremity ; in this fenestrum slides an iron arm, capable of being firmly fixed by screw clamps at any point, so as virtually to lengthen or shorten the splint in adaptation to limbs of different lengths. An ingenious apparatus is described and figured by Dr. HENRY X. HEWIT (Original Adaptation of Received Principles of Treatment in Fracture of the Thigh, in The Medical Record, 1808-69, Vol. Ill, p. 217): "It consists of two light flat lateral bars of steel connected by a cross-bar below the sole of the foot. The exterior bar or splint extends from its angle with the cross-bar, six or eight inches below the foot, to the side of the chest opposite the nipple. Two flat bands of steel well padded secure it to the chest and body. The inner bar reaches nearly to the perinaeum, but does not impinge, and the floor of the splint is of flexible metal, carefully padded by a continuation of the bands, which secure it to the limb and buckle in front. The two lateral bars opposite the thigh are fenes- trated, and nuts are inserted capable of sliding longitudinally, through which play the screws, which can be used for the exact application of detached moulded metallic splints of coaptation. " 1 POTT (PERCIVAL) (Chirurgical Works, Dublin, 1778, Vol. II, p. 304) ascribed the cause of the retraction of the bone in fractures of long bones to the tension of the muscles: "In the thigh, the case is still more obvious, as the muscles are more numerous and stronger. The straight posture puts the majority of them into action, by which action that part of the broken bone which is next to the knee is pulled upward, and by passing more or less underneath that part which is next to the hip, makes an inequality or rising in the broken part, and produces a shortness of the limb." He discarded all machinery for extension in use, and relied on the relaxation of the muscles by placing the knee "in a middle state, between perfect flexion and extension," supporting the leg and foot by smooth pillows, and inclining the patient s whole body to the outside of the fractured femur. The same position was recommended by ROKEHT WHITE (The Present Practice of Surgery, London, 1786, p. 147) in fractures toward the middle or lower part of the thigh bone, in "order to moderate the subsequent tension; but as soon as the swelling and tightness of the muscles are subsided, the limb should be carefully and gradually brought down, and the toe, knee, and groin kept in a direct line with each other." A double-inclined plane suspended by ropes and cross bar from a ring was advised by J. N. SAUTER (Anweisung, die Beinbriiche der Gliedmassen, vorzuglich der complicirten, und den Schenkelhalsbruch nach einer neuen, Uichten, einfachen und wohlfeilen Melhode ohne Schienen sicher und bequem zu heilen, Konstanz, 1812). The apparatus is figured by MATTHIAS MAYOR (Bandages et AppareiU a Pansements ou Nouveau Systeme de Obligation Chirurgicale, Paris, 1838, 3" 1 " d., PL. 11, FIG. 72). Sir ABTLEY COOPER (Surgical Essays by ASTLKT COOPER and BENJAMIN TRAVERS, London, 1819, Part II, p. 49, and Fio. 5 of PLATE VIII) placed the patient on his back, brought the thigh over a double-inclined plane composed of three boards, one below to reach from the tuberosity of the ischium to the patient s heel, and the two others above, with a joint in the middle by which the knee may be raised or depressed. Sir ASTLEY COOPER, who had employed this double-inclined plane for near twenty years, ascribed its construction to Mr. WHITE, of Manchester, " who had one made of iron, and hollowed to adapt it to the form of the leg and thigh, but this machine was too heavy and too complicated for use. Mr. JAMES, of Hoddesdon, improved upon Mr. WHITE S idea, by having the instrument made of wood, with movable splints upon the sides." CHARLES BELL (Observations on Injuries of the Spine and of the Thigh Bone, London, 1824, p. 45) also placed the patient on his back instead of the side as advised bv POTT : " It is now about eighteen years since I have been accustomed to show the application of the double-inclined plane to fractures of the thigh bone, that it relaxes the muscle* inserted into the inner trochanter, and at the same time relaxes all the muscles on the back part of the thigh by the bending of the knee; in short, that it SECT. IIt.| SECT INJURIES OF THE FEMUR. 345 inclined plane of Pott, introduced, in 1854, by Professor N. R. Smith, 1 and known as Smith s anterior splint, was largely employed in shot fractures of the femur in the early part of the war, the reports indicating that it was used in at least two hundred and eighty-eight instances. Surgeon J. T. Hodgen, U. S. V., in charge of the City General Hospital, St. Louis, forwarded, humours the natural position of the limb ; and that instead of having to restrain and bring down the upper portion, the lower part is raised to correspond with it." The apparatus is figured on p. 346 of Vol. II of C. BELL S System of Surgery, London, 1841, and is copied in the adjoining wood-cut (FIG. 209). A modification of BELL S apparatus by J. AMESBUUY (Observations on the Nature and Treatment of Fractures of the Upper Third of the Thigh Bone, London, 1628, p. 132) was found objectionable on account of its cost and complicated character. It consists of three parts, exclusive of straight splints and straps : one part for the thigh, one for the leg, and the third for the foot. The thigh plane again consists of two pieces arranged to make the upper part of the plane conformable to that of the thigh. Hinge joints connect the thigh and leg pieces, and the foot-board is fitted upon the leg plane by means of a screw, allowing it to be moved at a greater or less distance from the angle of the two planes. A steel rod connects the two planes underneath, by which the angle of the plane may be altered at pleasure. The apparatus can only be prepared by the manufacturer. The apparatus of MATTHIAS MAYOU (foe. cit., p. 6, and PL. 10, FIGS. 66, 67, and 68) consists of two planes made of wire and connected by a hinge, with cords to suspend the limb from the bed or ceiling. In 1828, NATHAN SMITH FlG 209Double-inclined plane of C. BELL. [After BELL.] ( Observations on Fractures of the Femur, with an Account of a New Splint, in The Philadelphia Monthly Journal of Medicine and Surgery, 1828, Vol. II, p. 51) perfected an apparatus similar in principle to AMESBL RY s but of simple construction and material. It consisted of two thin broad pieces of bass wood, so warped that the concavity of one corresponded to the convexity of the under surface of the thigh, and the other to that of the leg. Both were joined by hinge-like rivets. A strap passing from the upper extremity of the thigh-piece to the lower extremity of that of the leg, allowed the limb to be fixed at any angle. His son, NATHAN R. SMITH (Description of an Apparatus for the Treatment of Fractures of the Thigh and Leg, in The Baltimore Monthly Journal of Medicine and Surgery, 1830, Vol. I, p. 305), substituted for bass wood thick binder s board, which he slightly moistened with wetted sponge and shaped into a semi-cylindrical form with the hand. To meet certain requirements, which N. R. SMITH deemed indispensably necessary in the treat ment of fractures of the femur (Observations on Fractures of the Thigh and Leg; with a Description of an Apparatus applicable to the treatment of such injuries, in Baltimore Medical and Surgical Journal, 1833, Vol. I, p. 13), he devised, in 1833, a new apparatus, consisting of four pieces, viz : two concave planes, the one adapted to the inferior surface of the thigh, the other to that of the leg. These are united by a hinge corresponding to the knee. The third piece is for the foot, and the fourth is connected with the thigh piece, and extends upward beside the body. To allow the patient to change his position, Dr. SMITH suspended the limb by means of a cord attached to some fixed point, as already indicated by SAUTER and MAYOR. In LONSDALE B apparatus (E. F. LOXSDALE, A Practical Treatise on Fractures, London, 1838, p. 295) the thigh and leg planes were joined at a point corresponding to the knee by a hinge. A horizontal plane, joined also by a hinge to the upper part of the thigh plane, was serrated at the foot end, allowing the leg plane to be fixed at any angle. This simple apparatus was very generally used in the Middlesex Hospital, London. JOSIAH C. NOTT (Description of a Mod ification of the Double Inclined Plane, with an exposition of its advantages over other apparatus for fractures of the lower extremity, in Am. Jour. Med. Sci., 1839, Vol. XXIII. p. 21) describes and figures an apparatus similar to LONSDALE s, with the addition of a foot-board. Three narrow slits are cut through on each side of the thigh plane, two inches from the edges. Through these are drawn leather straps, long enough to pass around the limb after the pads and splints are applied. By means of buckles at the end of the leather straps the limb is firmly secured to the plane. The apparatus of MclNTYRE, of Newcastle (WM. FERGUSSON, A System of Practical Surgery, London, 1842, p. 282), is better known in its simplified form by R. LlSTON (Practical Surgery, London, 1840, p. 96). It consists of a foot-board of wood, and a thigh and a leg piece of sheet-iron made to fit the limb, and capable of being elongated, by means of screws, to suit any limb, or of being* adjusted to any angle. A cross plate of iron is attached to the foot end of the apparatus, which is so arranged that it will always rest flat on the bed, whether the limb be raised or depressed. SMITH (N. R.), A New Instrument for the Treatment of Fractures of the Lower Extremities, in the Maryland and Virginia Medical Journal, January, 1860, Vol. XIV, p. 1, and The Anterior Suspensory Apparatus for the Treatment of Fractures of the Lower Extremity, in Am. Jour. Med. Sci., April, 1861, N. S., Vol. XLI, p. 346, and Treatment of Fractures of the Lower Extremity by the Use of the Anterior Suspensory Apparatus, Baltimore, 1867. On page 11, etc., of the latter work, Professor SMITH describes the apparatus as follows: "A single splint constitutes the whole of the rigid, or supporting, part of the apparatus. It may be made of wood or wire (FIG. 210). The first employed by me was of wood. It was three inches broad half an inch thick, and long enough to extend from above the spine of the ilium to the toes. It had an angle corresponding to that of the ankle, another at the knee more obtuse, allowing the leg to be very slightly flexed, and a third corresponding to the hip, still more obtuse, slightly flexing the thigh on the pelvis. Two staples, by which to suspend it, were attached to the upper surface, one a little above the knee and the other about the middle of the leg. The splint may be sawed, in one piece, out of thick pine plank, or may be made of three pieces united at the angles by nails or screws. I now employ a splint of tinned wire. The size of the wire should be that of a No. 10 bougie. If lighter than this it is apt to spring too much. It is constructed of one piece of wire bent twice at right angles, at each extremity, in the form of a long parallelogram (FIG. 210). being, however, three inches and a half wide at its upper extremity and two and three-fourths at its lower. It must be long enough to extend from a point a little above the anterior spinous process of the ilium to an inch beyond the toes when the leg, foot, and thigh are extended. Three feet eight inches will be sufficiently long for most adults. A little excess of length, above or below, is unimportant. The side pieces are to be sustained by curved cross-pieces at distances of about five inches, firmly clinched and soldered upon them, and having loops in their centres for the attachment of the hooks. The wire frame is then to be bent by the surgeon to suit the case. The lower angle corresponds to the ankle, and is one of aoout 120, to secure an easy posture of the foot. The angle at the knee is very obtuse, about 160. The angle at the hip should be of about the same degree. The angle at the ankle should be about five inches from the extremity ; that of the hip seven. The middle bend corresponds to the knee. The angles are easily made by bending the splint over the margin of a strong chair or table. It will often be necessary to vary these angles to suit particular fractures. The wire frame is now to be tightly wrapped with a muslin bandage, and it is ready for application. The suspensory apparatus SURG. Ill 44 FIG. 210. SMITH S anterior splint. 346 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. in October, 1862, to the Surgeon General a description of a cradle splint, 1 which had been successfully employed by him in the hospital under his charge. "By this arrangement," he writes, "we have succeeded in saving thirty-seven out of fifty-three cases admitted, or is simple and easy of application. A small iron pulley is to be screwed into the ceiling, over the bed of the patient, perpendicularly over the middle of the shin, or nearly so. A cord, about as thick as the wire of the splint, passes over the pulley, and is reeved through a small tent-block, by which, slipping it upward or downward, we elevate or depress the limb. The eccentric pressure prevents the weight of the limb from causing it to slip; If not, rub the cord with chalk. This single cord, which depends from the block, has a loop at its end, about two feet or more above the limb. Through this another cord, about five feet long, passes and hangs double from the loop, by its centre. Each end has a hook attached to it of the form represented in the cut (FIG. 211). It is made of much smaller wire. When everything is ready for suspension, these hooks are to be attached to the loops in the cross-bars. The application of the apparatus is extremely simple. The limb (we are now supposing a fracture of the thigh) is to be carefully adjusted and laid on pillows still supported by the hands of assist ants. The splint is now to be laid along the upper surface of the limb, the foot portion an inch remote from the instep, the middle angle nearly corre sponding to the knee. I formerly placed a long narrow compress under the splint, but it is generally superfluous. One may, however, be placed on the instep, and one under the hip extremity of the splint. I now pass a piece of wet bandage, long enough to embrace the limb and overlap, under the foot and over the splint, so as to embrace both, not tightly. I pass another, also wet, around the ankle, another beneath the knee, a fourth above the knee, and a fifth around the thigh near the hip. Button-hole slits may be made near the end of each sling, and these be buttoned on to the loops in the cross wires of the splint. The limb being still kept extended by the hands of FIG. 211 -Shows suspension apparatus and the member attached to the assistants, the hooks are now to be applied. It is very important to select splint by the slings at four points, preparatory to the application of the bandage [After SMITH 1 properly their points of attachment so as to adjust well the centre of gravity of the limb. In fractures of the middle of the thigh, f attach the upper hook nearly over the seat of the fracture; the other a little above the middle of the leg. By pulling upon the tent-block the limb is now gently raised from the pillows and hangs suspended in the slings. Observe now whether the upper portion of the splint presses down too much upon the thigh, or springs up too much from it. If the former occurs, then attach the upper hook higher; if the latter, attach the lower one lower. But this may be cor rected, if slight, by slipping the cord, with the hooks attached, through the loop of the single cord so as to correct the bearings, and securing it with a piece of twine just below the loop to keep it thus. The limb being now raised, so that one may pass his hand under every part of it, the application of the roller is made. The surgeon commences with the foot, the splint being held steady. Three or four turns are to be. made loosely around the foot, care being taken not to press it upward against the splint, which it must never touch. Then figure-of 8 turns are made around the ankle and foot, and the roller is carried upward along the leg and thigh, reversing, where necessary to make perfect adaptation, and great care being taken not to crowd the limb too firmly against the splint. On reaching the hip with the roller, a few spica turns are to be made obliquely through the groin and around the pelvis, concluding with two direct turns around the pelvis (Flo. 212). I often besmear the whole under surface of the bandage thus applied with starch. This prevents the slipping of the bandage, and preserves a uniform and accurately adapted surface of support." Fleet Surgeon JAMES C. PALMER, U. S. N., applied, in a case of fracture of both thighs (HERBERT SMITH, Assistant Surgeon, U. S. N., Case of Fracture of Both Thighs, in Am. Jour. Mcd. Sci., 1W>5, Vol. L, p. 58), a modification FIG. 212. Represents the member as completely dressed and suspended. . _ , . . , ,. . [After SMITH 1 f SMITH 8 anterior splint. It consisted of two continuous parallel rods of No. 9 iron wire, passing over the anterior surfaces of both limbs, from the toes upward, arching over the pubes clear of the anterior spinous processes, and bent at the groins at an angle of about 30 degrees. The abdominal arch was well padded. Holler bandages were employed as usual, and the limbs, slung separately, were suspended by a single cord passing over a pulley at the ceiling, and making extension at an angle of about 30 degrees. Dr. HODGEX published a description of the cradle splint in the American Medical Times, New York, January to July, 1803, Vol. VI, p. 245: "Having experienced great difficulty in dressing compound fractures of the femur when the wound was on the posterior part of the limb, I at length devised the apparatus to meet this difficulty. The wood-cut (FlG. 213) shows the construction of the cradle, so that I need only give the measurements and mode of application. The foot-board is four inches and a half wide, one inch thick, and fourteen inches high (or long), supported on a base fifteen inches long and one inch square. The centre support is seven inches high, eight inches on the base, and one inch thick. The uprights of this portion are one inch wide at the top and one inch and a half wide at the base ; this piece is placed twenty-one inches from the foot-board. The longitudinal strips are forty-two inches long, one inch and a quarter wide, and half an inch thick ; one end of each of the four is fastened by screws to the foot-piece, two at the base, the remaining two above them, leaving spaces of four and a half inches between the lower and upper pieces. The lower strips are fastened to the outside of the centre support at its base, the upper at the inner side of the upright portion, thus forming the frame represented in the cut (FIG. 213). This may bo adapted to either limb by binding the ends of the pieces designed for the porinaBum and pubes, the lower one from C FIG. 213. HODGEX B cradle splint for fractures of the femur. above and the upper from below, and shortening them so that the foot will come near the foot-board the upper strip passing in front of the pubes and the lower a short distance from the perineum. Strips of cotton or linen cloth, two and a half inches wide, are now placed on the upper longitudinal bars, and pinned, so that they form a double-inclined plane on which the limb may rest. These suspension strips lire placed in contact with each other, and, being distinct, any one may be removed and replaced to insure cleanliness, when necessary, without disturbing the limb. The limb is then prepared by placing broad strips of adhesive plaster on either side of the leg and securing them in the usual manner by a roller. It is then placed on the suspension SECT. III.] SHOT INJURIES OF THE FEMUR. 347 FIG. S214. - HODGEN 8 splint applied. oi 66 per cent." Surgeon J. H. Brinton, 1 U. S. V., to whom Dr. Hodgen s paper was referred by the Surgeon General for examination and report, recommended that a "certain number of these cradles be issued to the surgeons in charge of the Washington hospitals, in order that this mode of treatment be fairly tested. I do not anticipate for it a failure." In the campaign before Richmond, in 1862, Acting Assistant Surgeon J. Swinburne 2 pro posed apian for counter-extension available on the field, whereby the stretcher becomes the splint, and the system of extension can be carried into effect immediately after the receipt of the injury. In 1863, Dr. Hodgen 3 proposed a second apparatus, "a combination of the strips, and the free ends of the adhesive plasters placed around the foot board and secured to it. A strong cord is fastened to the middle of the foot board at a proper height, and passed over a pulley which is to be screwed into the foot-board of the bedstead. A bag containing from five to twenty pounds of s:md is attached to the cord, and this weight serves as an extend ing force. Two or more bricks are placed under each of the legs of the bedstead at the foot, thus elevating it four or six inches and allowing the weight of the body to serve as the counter-extending force. Thus the limb is suspended so that the air circulates freely under and about it." 1 Surgeon J. H. BRINTON, U. S. V., to whom the paper of Dr. HOD- GEN was referred by the Surgeon General for examination, reports : " The essential portions of this treatment seems to be that the fractured limb is suspended in a cradle formed by strips of bandages attached laterally to a framework. These strips are so arranged as to form a double-inclined plane. Extension is obtained by the attachment to the foot of a sand bag of from five to twenty pounds weight. By raising the foot of the bed from six to eight inches, the weight of the body is made the counter-extending force. Surgeon HODGEN also suggests that the same result may be obtained by the use of SMITH S anterior splint, widened at its upper end, with an oblique suspension for procuring counter-extension. In other words, this latter modification is almost identical with this apparatus as it is applied in our eastern hospitals in the treatment of compound fractures. The only difference in the application, according to the views of Dr. HODGEN, is the absence of redundant band ages. The advantages which Surgeon HODGEN claims for his cradle splint is the increased ventilation, the cleanliness, and the ease with which portions of the dressings may be changed; all of these ends are, however, attained by the use of SMITH S anterior splint, judiciously applied, and suited to the exigencies of each individual case. From a careful study of very many cases of gunshot fractures of the thigh, both in our western and eastern hospitals, I have come to the conclusion that the treatment by suspension, in some form or other, is preferable to the use of the DESAULT or other immobile appa ratus. I believe that the methods of Surgeon HODGEN and Dr. SMITH will alike be productive of good results, when properly applied and carefully attended to. The success which has been obtained by Dr. HODGEN I do not attribute so much to the new form of dressing employed as to the care, time, and attention which he personally bestows upon the cases under his charge. . . I would state, that when it is decided to try and save the limb, I should be inclined to regard the treatment suggested by Dr. HODGEN as a valuable one. It possesses, I think, all the advantages of the anterior splint, and, in the hands of a young and inexperienced surgeon, is, perhaps, more manageable. The extension can be more readily graduated, and the limb of the patient is equally open to the inspection of the surgeon. The chief objection to its employment is the mobility of the counter-extending point. This fact, which would lessen its value in the treatment of a simple fracture of the thigh, is of little moment in the class of cases resulting from gunshot injuries. In the latter, the life of the patient and the consolidation of the fracture are the chief points at stake ; shortening or deformity matter but little. I would, therefore, respectfully suggest that a certain number of these cradles be issued to the surgeons in charge of the Washington hospitals, in order that this mode of treatment may be fairly tested. I do not anticipate for it a failure." 2 The plan was explained in a paper read before the Xew York State Medical Society, in February, 1864 (Transactions of the Medical Society of the State of New York, 1864, p. 159), and a MS. copy thereof was sent to the Surgeon General U. S. A., by Dr. J. V. P. QUACKKSBUSH : Surgeon Gen eral of the State of Xew York, on April 11, 1864 : "As soon after the injury as practicable, to place the patient on a bed or stretcher, extend the limb as near as possible to its normal length, without giving too great pain, retain it in that posi tion by fastening the patient s foot to the foot of the bed or stretcher by means of adhesive plaster, as I am in the habit of doing in ordinary fractures of the thigh (FIG. 1!15). Of course there should be no bandaging of the leg or thigh. Make the counter-extension by the use of a large perineal belt fastened to the head of the bed or stretcher. In order more fully to make the stretcher a splint, I propose to place" two sliding iron rods, 4, 4, the length of which should be from 8 to 12 inches, and placed upon the handles of the i<lu - 215SwiNBUKNK s plan of applying early extern. [After SWINBURNE. | stretcher, which are to be provided with thumb screws, 3, 3, to keep them in any desirable position, and allow of their being depressed, elevated or extended, as the case may require. The foot-strap or cord can be fastened to the sliding iron rod, 4, 4, at the foot of the stretcher, while the perineal belt, 2, can be fastened to the sliding iron rod or arm, 4, 4, at the opposite end. Thus making an apparatus for the treatment of this fracture as complete and perfect as can possibly be produced in private practice ; and since the majority of these fractured bones suffer no loss of substance, why should we not then succeed in effecting as good results by this method in army practice as in private practice?" 3 HODOKX (J. T.) (0?! the Treatment of Gunshot Fractures of the Femur and Tibia, in American Medical Times, 1863, Vol. VII, p. 160, and in The St. Louis Medical and Surgical Journal, January and February, 1864, Vol. 1, p. 20): " The body of the splint is made of No, 2 iron wire, which is suflicient to support the limb, all of one piece, bent as seen in the cut (FIG. 216). The dimensions are as follows: Four inches across the bottom of the foot : twenty two inches from the foot to the bend at the knee ; twenty inches from the bend of the knee to the upper ends of the wire (corresponding to the pubes and hip when applied). These upper ends are eight or nine inches apart, being separated by a bow of thick wire; another similar bow is placed at the knee, having a span of six inches. These two bows are made so as that they can be put on or taken off without disturbing the dressings, and are put in position after all else is arranged the one at the hip having a loop at each end to receive the upper end of the splint wires, the other simply hooks, to be looped on at the knee. A roller bandage may be placed around the hips and upper end of the external limb, the splint to keep the latter in place, if required. How applied : A bandage is applied to the foot : an adhesive strap, three inches wide, is applied to each side of the leg, extending four or five inches below the foot, and up to the knee in case of fracture of the femur ; or to the fracture, in case the tibia is the injured part. The roller is then extended smoothly over the adhesive plasters. That limb of the splint designed to pass next the pubes is bent upward, at a point 348 INJURIES OF THE LOWER EXTREMITIES. (CHAP. X. principles of Smith s anterior splint, Swinburne s extension, and the strip bandage supports used in the cradle splints," which he had found in some respects more desirable than the cradle splint. Dr. Gurdon Buck s apparatus, 1 a modification of Physick s Desault, in which the long splint was dispensed with, and constant and uninterrupted extension was kept up from the bend of the knee in the splint, corresponding to the distance from the bend of the knee to the pubes on the sound side of the body. Strips of bandages three inches wide are now looped over one limb of the splint, continuously from the upper to the lower end, and allowed to belly downward a distance equal to two-thirds of the diameter of that part of the extrem ity designed to rest upon each one : the other ends of these strips are pinned over the other limb of the splint, thus forming a double-inclined trough in which the extremity is now to be placed on these strips of muslin. The free ends of the adhesive strips are next fastened to the cross-piece at the foot, three inches apart, and the whole suspended from a pulley fixed to the ceiling or a frame ; the pulley should be almost over the foot if the ceiling be eight or ten feet high, giving the suspend ing cords an oblique direction, that in this way we may have sufficient extension. If the patient is disposed to slide toward the foot of the bed, this must be elevated on two bricks under each of the legs at the foot of the bedstead." The apparatus used in the New York hospitals since 1859 (G. F. SCHRADY. Report of the Proceedings of the Medical Society, in New York Journal of Medicine, 18. r >9, Vol. VI, 3d series, p. 239) is ex plained in the Am. Med. Times, 1861, Vol. II, p. 214. The following description is taken from BUCK (GUKDOX), (Description of an Improved Extension apparatus for the Treatment of Fractures of the Thigh, in The Medical Record, 1867-68, Vol. II, p. 49): "Articles composing the apparatus : Two bands of adhesive plaster spread on Canton flannel or thick twilled cotton ; each band being two inches and a half wide and two feet long. At the end of one of the bands a piece of elastic rubber webbing, two inches wide and ten long, is attached. At one end of the other band a buckle of corresponding width is fastened. A thin block of wood three inches and a half wide transversely and three inches verti cally. The perineal portion consists of rubber tubing of one inch calibre, having inside of it a tube of muslin stuffed with bran and left an inch longer than the rubber tube at both ends. At each end of the muslin tube a metallic ring is first fastened, and then shoved within the rubber tube, to the end of which it is also fastened. This arrangement prevents FIG. 216. J. T. HODGEX S suspension apparatus. the rubber tube from being over-stretched. Two straps fastened to the rings at the ends of the perineal portion serve to lengthen it and allow it to be made fast to the head of the bedstead. A belt that passes around the opposite side of the body, and maintains the bearing of the perineal band in a line with the axis of the body and limb. The perineal portion should be wound with a narrow strip of Canton flannel or other soft material, and this should be changed as often as soiled. Four guttered coaptation splints, covered with flannel, are intended to surround the fracture and be secured in place by three elastic bands, each having a buckle at one end. An upright support ing a pulley wheel, to be fastened to the floor by three screws, opposite the foot of the bed. Jlode of application : The bands of adhesive plaster are first to be applied, one on either side of the limb from a point above the ankle up\vards as high as the seat of fracture. The limb is then to be bandaged in the usual manner, beginning at the toes and covering the plasters, but leaving their lower ends free. The band of elastic webbing is next passed around the sole of the foot and fastened to the buckle on the other side of the foot. The block of wood should then be interposed between the loop of webbing and the foot. A cord fastened to the block thus adjusted is passed over the pulley, and has a weight suspended from it. This arrange ment combines elasticity with the extending force, keeps the bands stretched out smooth, and pre vents pressure upon the ankles. The amount of weight required must be proportioned to the resist ance to be overcome and the toleration of the pa tient. Sometimes five or six pounds only can be borne at the outset, and an increased weight sub sequently. After a fracture has taken place the sooner the limb is put up and subjected to treat ment the better. Spasmodic twitchings of the muscles are controlled, and the patient made com fortable from the outset. To permit the applica- FIG. 217. GUBDOX BUCK S apparatus. tion of lotions to the seat of injury during the first few days, the bandage should not be carried above the knee, and the ends of the plaster should be rolled up and kept in reserve. At the end of six or eight days the plasters may be extended up on the thigh and the bandage continued over them. The coaptation splints are now to be applied around the thigh and secured by the three elastic bands. To complete the apparatus the perineal band should be adjusted and its ends fastened to the head of the bedstead so as to be in a line with the axis of the body and limb. The limb should be raised on a hair cushion sufficiently to keep the heel from pressure. In the employment of this method of treatment, experience has shown that in a large majority of cases the use of the perineal band may be dispensed with, the weight of the body being sufficient to resist the extending force. This resistance may be further increased by raising the foot of the bedstead five or six inches above the floor. The advantages claimed for this method over others hereto fore in use are its great simplicity of arrangement, facility of management, and especially the comfort it affords the patient during a long confinement in bed. The efficiency with which uninterrupted extension of the limb can safely be kept up secures, it is believed, better results than have been obtained SECT. III.] SHOT INJUEIES OF THE FEMUK. 349 by means of a weight and pulley, was frequently employed during the war. 1 Dr. Vedder, 2 in 1862, recommended a long straight splint, which by a mechanical arrangement may be folded in the middle when not in use, and securely straightened when desired. Extension is made by a rachet pulley, a drawing of which has already been given in FIGURE 570, on page 812 of the Second Surgical Volume. During the last year of the war a combined splint and fracture bed, constructed by Dr. I. Langer, 3 was used with favorable results by by any other method. The sitting posture may be allowed without disturbing the action of the apparatus ; an indulgence for which patients are always very grateful, and one which greatly alleviates the irksomeness of their condition. The materials required for employing this treatment are obtainable under almost any circumstances, the only indispensable article being adhesive plaster. If this is of the ordinary description it is better to use it of double thickness. All the other articles requisite may be improvised. The elastic band may be dispensed with, and a round stick properly placed across the foot of the bedstead may serve instead of a pulley." In a report to the Surgeon General, in February, 18H3, Surgeon H. J. CHUKCHMAX, U. S. V., speaks favorably of BUCK S pulley: In regard to mechanical appliances I much prefer BUCK S pulley with side splints rolled in muslin, which may be so tacked to splints as to permit their being easily thrinvn down for dressing w inspection. Of course when there is a discharging wound the splint must be so shaped as to leave wound readily accessible. In lieu of the usual counter-extending adhesive strips or the galling periueal baud, I propose to substitute, when attainable, the old-fashioned ribbed corset, lacing up in front with side buckles, by which, with strong tapes, the body may be secured to the bunk or bedstead. The tape might be tightened or loosened as deemed necessary. This apparatus would relieve materially the vexation of spirit to both surgeon and patient necessarily incident to the old plan. I propose this in connection with BUCK S pulley, while the side splints, arranged as I have stated, give uniform support to the limb in its whole extent and keep it in proper line. In the absence of the corset, I have heretofore advantageously employed in several instances BUCK S pulley, with side splints as described, and elevation of foot of bed, as described in case 5. The corset will relieve a position found more or less uncomfortable to patient. The only objection in theory is the difficulty of defecation when bound down by the side straps. In practice there is uo serious difficulty when using the bed-pan. If deemed necessary, however, the men can readily unbuckle the straps for the time." 2 VEDDEK (JOSEI H H.), New Apparatus for the Treatment of Fractures of the Long Bones, in American Medical Times, 1862, Vol. IV, p. 254. 3 Under the direction of the Medical Director of the Army of the Potomac, Colonel T. A. McPAUI.lx, Dr. LANGKK S apparatus was tried by Sur geon W. L. FAXON, 32d Massachusetts, who reports, on March 28, 1865: "I have the honor to report that on the 7th and 8th days of March. 18(i.~>, I witnessed the application of Dr. I. LAXGEK S combined splint and fracture bed, in two cases of compound fracture of the thigh, one near the trochanter major, the other at the middle third, in consequence of gunshot injuries. Each of the patients were transferred and located comfortably, in ten minutes, from the beds on which they were lying to Dr. LAXGEK S beds, with the aid of two assistants. Extension and counter-extension were applied from the beginning. No anaesthetics were given, and the patients have evinced no suffering. The changing of the sheets lying under the patients and the evac uations from the bowels during their confinement were effected without the necessity of lifting the patients from the beds they were first put on. The discharge of the matter from three wounds in the first case the bullet entering at the edge of the nates on the left side, penetrating the left thigh, and entering the right limb one inch below the tuberosity of the ischium as well as from the two wounds in the second case, has not at any time made the patients uncomfortable, as the matter and the water used for cleansing ran off freely. The position as well as the axis of the limbs are nearly straight, and the shortening in neither case exceeds one inch. I consider Dr. LAXGEK S combined splint and fracture bed as I have seen it in opera tion at this hospital as the best appliance I have used, or seen used in the army. The patient can always be made comfortable ; he seldom requires opiates to procure sleep (in neither of the cases above quoted were any bed-sores); the patients can always be kept clean, the bed clothing is not at all soiled, one nurse can take care of as many cases as of simple wounds, and the operation of lifting and shifting the patient in dressing of the wound is entirely avoided, an object of great im portance to all concerned; and I respectfully request that fifty of Dr. LAXGKR S beds be furnished for use of this hospital, if possible." This report received the favorable endorsement of the Acting Chief Medical Officer of the Depot Field Hospital at City Point, Surgeon G. B. PAHKEU, U. S. V., and was for warded to the Surgeon General of the Army for favorable consideration by the Medical Director, Colonel T. A. McPAULIX. Dr. LAXGEli s apparatus consists of a triple-inclined plane, on which extension and counter-extension of the fractured femur is kept up by the weight of the body and the leg: "It is constructed of iron and covered with duck-cloth ; its weight is twenty-six (2(i) pounds, including the straps to swing the apparatus in an ambulance wagon or anywhere else. It consists of : a. One head piece, b. Two trunk bars. c. One cross piece, d. Two thigh pieces, e. Two leg pieces. /. Two bows under the knees. The thigh as well as the leg piece, for the injured limb, has pins to support the straps on which the limb rests, a. Head piece connected with the trunk bars, arranged to change its relative position, when vertical, to form a shelter to the head, when horizontal, to make an elongation to the trunk part for the head to rest on, or sen-ing instead of legs, when set down, with a strip of wood at its opening to keep it spread; it is covered with double cloth, which is to be stuffed if chosen, b. Two trunk bars, connected with the head piece by bolts and thumb-nuts ; to the necks of the bolts straps arc fastened to swing the apparatus. On each of the bars is a loop for an additional strap, to support the arm, or if the wounded man is exposed to the weather, to attach there a storm hood. Between these bars cloth is stretched for the patient to rest on. A blanket and a sheet doubled up and spread over the cloth before the patient is laid on it will enhance the comfort. These trunk pieces are connected with the cross piece in a manner as to allow the change of their relative position from a level with the thigh pieces to an angle of 45. c. Cross bar, with a bend nine inches, opening to receive a bed-pan with a neck on each end, to rest on a fulcrum having a head to secure against slipping. Near the angles of the bend are two holes to receive the screws of d. d. Two thigh pieces, rotating in a loop connected, movable, with a screw and thumb-nut, with the cross-piece so as to allow either of the two thigh pieces to elevate or lower nearly three-fourths of a circle; also to allow to separate one from the other; but if wanted stationary they are fastened together by a FIG. 218. Dr. I. LANGEH S apparatus. 350 INJUEIES OF THE LOWER EXTREMITIES. [CHAP. X. surgeons of the Army of the Potomac. In a few instances the single long splint of Dr. Kimball 1 was preferred. Assistant Surgeon W. Thomson, U. S. A., substituted the "bran box for Hodgen s splint, which had become uncomfortable and difficult to adjust." 2 Surgeon J. T. Woods, 99th Ohio, employed the double-inclined plane in fractures of the femur near the trochanters, and Desault s splint, or some modification thereof, in fractures of the middle third of the femur. 3 Surgeon E. McDonnell, U. S. V., advised that in fractures of the upper third of the femur all extension apparatus be dispensed with as liable to produce a hiatus between the fractured ends, leaving, on account of the absence of periosteum and nourishing vessels, no chance for repair, and that the limb be simply placed in an easy position regardless alike of deformity and shortening. 4 The danger of producing such a separation of the ends of bone as might delay if not interfere with the union of bone was pointed out by Dr. J. R. Lothrop, at the Buffalo General Hospital, 5 and other surgeons. The method of wiring together the fractured ends of long bones proposed by Assistant Surgeon B. Howard, 6 already referred to in the Second Surgical Volume, at page 819, found key; four holes on eacb end, to adjust the length and to connect with the spreading bows under the knee and the leg pieces. On each end of the thigh pieces are slats for the straps to swing the apparatus ; when the two thigh pieces are connected by key there is still a place left for defecation, e. Two leg pieces, with four holes on each end, to be adjusted and connected outside of the end of the thigh pieces ; the cross bars of each have a hole for a cord to pass through, to fasten a weight to the foot if required ; to the cross bar is a strap fastened to swing the apparatus. The inner comer to be connected with a cord. One of the thigh as well as one of the leg pieces has pins to fasten the straps stretched across for receiving the injured limb to rest on. The other is covered with cloth ; both of them have a well padded cushion secured at the end near the cross piece, f. Bows under each knee, to connect by a bolt and thumb-nut, inside of the ends of the thigh pieces, to keep the thigh and leg piece from drawing together by the weight of the limb resting on them. To these two bows a strap is attached, which fastens to the floor, preventing side motions or raising the whole apparatus." SARGENT (F. W.), On Bandaging and other Operations of Minor Surgery, Philadelphia, 1862, p. 182. Dr. KlMBALL S splint extends from the axilla to below the foot, but is so contrived as to be capable of being lengthened at each extremity by sliding bars. The upper sliding bar terminates in the manner of a crutch ; to the lower is secured at right angles a transverse bar, which is moved up and down by screw, thus regulating extension at will. The perineal band is used, but may be discontinued with safety by moving the upper crutch-like sliding bar into the axilla. 2 Report of Assistant Surgeon Wll. THOMSON, U. S. A., in charge of Douglas Hospital, Washington, for June, 1863 (File A, No. 103): "It is difficult to conceive of a more suitable apparatus for compound gunshot fractures of the thigh than the Bran Box, properly arranged. The limb is sup ported at every point ; the skin is kept cool and dry, and the profuse discharge easily removed at each dressing. Where extension is desired, it can readily be made by fastening the adhesive strips attached to either side of the leg to the box and then adding a sufficient weight to a cord fastened to the foot-board." 3 In his report from the hospitals at Chattanooga, Surgeon WOODS remarKS: " The limbs were placed in positions most comfortable to the patient for some time, when, suppuration having at last become much reduced in quantity and the reparative callus was being thrown out, they were (usually under chloroform) placed in some form of splint with moderate extension and counter-extension. My observation led me to conclude that the double-inclined plane is inferior save where the fracture is within a short distance of the trochanter, and the tilting of the upper fragment requires the adaptation of the lower fragment to it by changing the position of the leg from the straight line, and possibly when the fracture is so low down that the condyles are drawn backward and downward. SMITH S anterior splint failed to meet my expectations in every particular. If it be applied as Dr. SMITH directs, the parts are hidden from view, sacculation of pus occurs, drainage is imperfect, and filth accumulates in the bandage. If the leg be simply suspended in the wire frame, sufficient quietude of the parts is not maintained, and the extension is neither sufficient nor reliable, and, if the fracture be in the upper third, the motions of the body produce movement in the fractured extremities just what a splint is designed to prevent. The splint of DESAULT, modified in various ways to suit particular cases, can be so applied as to secure the desired immobility, extension, drainage, exposure, and cleanliness. My impression from observing these cases leads me to conclusions briefly summed up thus. . . The proper dressing of a limb is really of great importance and very much underrated. That supporting diet in the early stages of these injuries is over-estimated. That an object of the first importance is to secure an abundance of fresh air, cleanliness, and perfect drainage. A very great error consists in excessive bandaging a limb is better off without bandaging or splints until reparation has commenced. The covering of gunshot wounds with lint, either picked or patent, is objectionable ; the pus drying at the edges glues it fast and is not permitted to drain away. The best splint for fracture at the trochanter major or immediately above the condyles is some form of the double-inclined plane, and, for fractures in the middle of the femur, some modification of the DESAULT splint." 4 Surgeon E. MCDONNELL, U. S. V., who had charge of a field hospital after the battle of Antietam, remarks, in a special report, transmitted in Feb ruary, 1863, of a fatal case of fracture of the upper third of the femur treated by BUCK S apparatus: "It appears to me the lessons most practically deducible from the foregoing ease are two, viz : 1st, that there was such a destruction of bone that when the limb was extended by BUCK S plan a hiatus was produced between the fractured ends, as left by the absence of periosteum and any nutrient vessels no chance for repair hence I think this or any apparatus separating the fractured bones destructive of our hopes of a good result. This case, with many others in the hospitals of Sharpsburg, gave ample scope for contemplation on the different methods devised by distinguished members of our profession to advance conservative surgery. The result of my observation is that, should 1 ever have charge of as many wounded men as those in the Sharpsburg hospitals, over which I had control, I should in all cases of badly compound comminuted fractures of the femur in the upper third dispense with all extension apparatus, and simply place the limb in an easy position regardless alike of deformity and shortening (amputation being out of the question). This I am persuaded is the treatment to save most lives." LOTHROP (J. R.)_, A Case of Gunshot Wound of the Femur, in liuffalo Med. and Surg. Jour., 1866, Vol. V, p. 470. 6 In his article (The Application of Sutures to Bone in Recent Gunshot Fractures, in the Medico- Chirurgical Transactions, London, 1865, Vol. XLVIII, p. 252) Dr. HOWARD defends this expedient: "The shock of the operation involved in this plan of treatment, superadded to that of the original wound, immediately suggests itself, of course, as an objection to its adoption. Over against this, however, we must weigh the immediate dangers pre viously enumerated from the pressure and constriction of tight dressings attending the use of simple splints. Those from the enclosed fragments and spiculae during transportation being in continual motion, and afterwards awaiting tedious extrusion by the slow processes of nature, keeping the patient in a condition which renders him continually susceptible to various intercurrent diseases, and, should union be ultimately effected, the degree of effort called forth for its accomplishment has left behind such a surplus of provisional callus, and other pathological changes in the parts adjacent, as seriously to diminish the usefulness of the limb for a long period, with a still further danger that after apparent recovery tertiary sequestrse, as mentioned by Duruv- TUEN, may continue to be extruded for ten, fifteen, or even twenty years thereafter. In the operation described the chief causes of the evils above enumer ated are removed. Its advantages consists mainly in this : 1st. Negatively : In the absence of everything which may aet as a foreign body and dangerous SECT, ill.] SHOT INJURIES OF THE FEMUE. 351 even less favor in shot fractures of the femur than in those of the humerus, and it seems that in one instance only this plan was attempted : CASE 497. Private H. Ingalls, Co. B, 6th Ohio Cavalry, was wounded during the engagement near the Pamunkey River, May 28, 1864. He was admitted to the field hospital of the 3d division, Fifth Corps, whence Surgeon L. W. Reed, U. S. V., reported the injury as a "severe shell wound of the left thigh." From the field hospital the patient was moved to White House Landing, where he died from the effects of his injury on June 2, 1864. This case has been identified as one published by Dr. Benjamin Howard, late Assistant Surgeon, U. S. A. (Medico- Chirurgical Transactions, London, 1865, Vol. XLVIII, p. 251), as follows: "On May 29, 1864, 1 was called in consultation on the field to see the patient, who was sixty years of age and of broken down constitution ; he had received a severe fracture of the femur from a large fragment of shell, which I found firmly wedged into the botie about three inches above the knee. From this point there proceeded a long oblique fracture, running upwards and outwards, with some comminution of the inner aspect of the bone in the vicinity of the piece of shell. The sharp pointed lower fragment was overriding the upper, causing a shortening of about three inches, reduction of which, with such a wound, could not possibly be maintained with splints alone during transportation. Having made the requisite incision and extracted the impacted piece of shell, I proceeded to remove the looser fragments; then causing steady extension to be kept up while I kept my finger and thumb in the wound, I guided the fractured ends so that the corresponding serrations were accurately refitted to their original position for about two thirds of the circumference of the bone. Having somewhat enlarged the incision, I directed the limb to be so bent upon itself as to slightly reopen the fracture, while I drilled the requisite holes and passed a suture, which firmly secured the interlocked fragments, rendering shortening or shifting impossible. A straight splint was then applied, the wound being left exposed for the repetition of cold-water dressings. After the operation the patient ceased to com plain of pain and seemed very comfortable. The next morning he was hurried away in an ambulance train, and I saw no more of the case. In consideration of his age, the nature of the wound, and his broken-down constitution, I was not surprised when subsequently I incidentally heard that he died on the road three days afterwards." The amount of shortening 1 of the injured limb was indicated in seven hundred and thirty-two 2 of the sixteen hundred and eighty-nine cases of recovery after shot fractures of the femur treated by conservation, varying from one-quarter of an inch to eight inches, and averaging 2.31 inches. 3 In fifty-two cases the reports indicated shortening, but the precise amounts were not stated. In twelve instances it was recorded that there was no shortening whatever, and in eight hundred and ninety-two this point was not noted. One instance is reported in which the limb was found lengthened: 4 source of irritation. 2d. Positively: In securing complete coaptation and perfect rest. This plan of treatment is new only in its application. Substan tially the same operation, including the use of the wire suture, has for a long time been practised, and still meets with general approval, as a secondary operation for uuunited fracture. Other things being equal, why should it be less advisable as a primary one, where, in the absence of all pathological changes, we have a healthy condition of all the parts, with sound bone in apposition and at rest. These considerations led me to hope for a healthy pro cess of uninterrupted repair, with speedy use of the limb after union. The selection of the cases (which at most must be quite limited in number, either on the field or in civil practice), the amount of bone which may be with propriety removed, etc., must, of course, be a matter of careful judgment. 1 The exact amounts of shortening in the 732 cases in which this point was ascertained are : J of an inch in 1 instance ; J in 1 ; J in 20 ; f in 17 ; 1 in 77; IJ in 19; li in 1; H in 80; 1| in 13 ; 2 inches in 179; 2J in 2 ; 2Jin5; 2J in 82; 2J in 14 ; 2f in 1; 3 in 111; SJiuS; 3iin23; 3f in 3; 4 in 42; 4Jin6; 4J in 1 ; 5 in 16 ; 5J in 3 ; 6 in 5; CJ in 1 ; 7 in 2; 7J in 1 ; 8 in 1. 2 Assistant Surgeon DliWlTT C. PETEUS, U. S. A., in a letter to Medical Inspector JOHN M. CUTLER, U. S. A., dated Jarvis U. S. A. General Hospital, Baltimore, January 11, 1804, remarks : "Recently I had the opportunity of hurriedly examining twenty-five rebel prisoners who were wounded at Gettysburg, and had, up to a late period, been treated in hospitals near the field. They were lying side by side and had compound gunshot fractures of the femur. M} 1 time was limited, as they were under orders to embark for exchange ; but I measured their injured limbs and found the greatest amount of shortening to be four inches, and the least about one inch. Average near two and a quarter inches. I believe you were instrumental in having these bad cases retained near the battle field, also many others, and the happy results prove your wise forethought. I have long argued that many of these cases were killed by transportation employed too early. The cases I saw fully show how much nature can do; but I cannot say so much about the treatment, for some of them were strangely crooked, bowing every way. I think with proper extension and counter-extension they might have been greatly improved. I thought the mention of them might be interesting, as they were prisoners and depressed in spirits; it further adds to our knowledge of nature s reparative powers when aided." 3 The instances in which the shortening of the limb after recoveries from shot fractures of the femur has been recorded in military surgery are few : SxitOMEVER (L.) (Maximen der KriegsJieilkunst, Hannover, 1855, p. 724) remarks that he has notes regarding the length of the limb in 12 of the 15 cases of shot fractures of the femur that he observed. In one of these the shortening was 5 inches ; in 1, 4 inches ; in 4, 3 inches ; in 5, 2 inches ; and in 1, 1 inch, averaging 2J inches. ClIKNU (J. C.) (Rapport, etc., pendant la Campagne d Orient en 1854-55-56, Paris, 1805, p. 375 et seq.) cites 126 cases of recovery after shot fractures of the femur. The amount of shortening is ascertained in 32 cases, varying from 3 to 11 centimetres, and averaging 5.7 centimetres, or about 2 inches. WILLIAMSON (GEOKGE) (Military Surgery, London, 1863, p. 138) reports, from the mutiny in India, in 1857-58, 13 cases, viz: "Limb 3 inches shorter in 3; Si inches shorter in 1 ; li inch shorter in 4 ; and 1 inch shorter in 5 instances;" an average of 1.7 inch. CllENU (J. C.) (Stat. il&d. Chir. de da Camp, d ltalie en 1859 et I860, Paris, 1869, p. 715 et seq.) reports, among 118 cases of recovery, 25 cases with shortening varying from 2 to 15 centi metres, the average being 7 centimetres, or 2J inches. BECK (B.) (Chirurgie der Schussverletzungen, Freiburg, i. B., 1872, p. 694 et seq.) ascertained the shortening in 23 instances varying from 1 to 4J inches, averaging 2.25 inches. CHENU (J. C.) (Aperyu Hist. Stat. et. Clin., Paris, 1874, p. 453 el seq.) records 705 invalids after shot fractures of the femur treated by conservation. Shortening is stated to have existed in 426 instances ; in 201 cases the amount of shortening is definitely stated, and varies from 3 to 23 centimetres, averaging 7.4 centimetres, or very nearly 3 inches. According to these limited statistics the average shortening in shot fractures of the femur is 2.7 inches. Professor F. II. HAMILTON (A Practical Treatise on Fractures and Dislocations, Philadelphia, 1875, p. 516) relates the following case as an example of lengthening of the limb after shot fracture of the femur: "Melchior BriStel, Private, 12th N. Y. V., was wounded in June, 1862, at the battle of White Oak Swamp, Virginia, by the fragment of u shell, which struck the left leg three inches above the eondyles. He was taken to Richmond as a prisoner, and about a month later he was. exchanged and sent within our lines. January 1, 1864, I found him in the United States General Hospital^at Newark, under the charge of Surgeon Taylor. The wound was still discharging matter occasionally, and several fragments of bone had been removed. Splints were not applied until alter his exchange. No extension was ever employed. At the end of four months he begau to walk about with crutches. 352 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 498. Lieutenant J. Davis, Co. G, 73d Ohio, aged 35 years, was wounded at New Hope Church, May 25, 1864, and admitted to the field hospital of the 2d division, Twentieth Corps. One week after receiving the injury the patient was moved to Chattanooga, where the wound is described as an "injury to the trochanter major." He was subsequently sent to the Officers Hospital at Nashville, whence he proceeded to his home on leave of absence, August 10th. He was mustered out of service May 5, 1865, and pensioned. Examiner O. J. Phelps, of Piketon, Ohio, certified, July 25, 1865: "The ball entered at the groin, passed through, shattering the trochanter major, and as yet rendering the limb entirely useless. It is still unhealed." Examiner J. Arnold, of Waverly, December 12, 1871, stated: "The hip joint is rendered entirely useless. There are two ulcerating sores that discharge very much all the time, and small pieces of bone are taken out. Has to use crutches to get about." Examiner W. Scat-lock found no improvement in the pensioner s condition in September, 1873, and reported, two years later: "One running sore still exists on the outer side, over the great trochanter. There are four tender cicatrices that have recently healed, two on the inner and two on the posterior side, ranging from four to six inches below the original wound. The limb is lengthened some three inches, and its movements are painful and limited. The wound still requires dressing once or twice a day." At a subsequent examination, in 1877, the limb was still found to be in the same condition, lengthened, etc., and the pensioner was reported as wholly unfit for any occupation requiring manual labor. The pensioner was paid Sept. 4, 1879. The side of the injury was recorded in three thousand and thirty-six instances; four teen hundred and thirty-one were on the right, and sixteen hundred and five on the left side. Of the former, six hundred and sixty-one, or 46.1 per cent., and of the latter seven hundred and forty-three, or 46.2 per cent., -were fatal. Here, as well as in the cases of shot injuries of the shoulder joint and arm (Second Surgical Volume, pp. 610, 806), the left extremity seemed to have been most frequently interested; but here, also, the number of cases in which this point could not be ascertained (four hundred and thirty-one) prohibited definite conclusions on this subject. In two hundred and eighty-four cases the fractures of the femur were accompanied by lesions of other portions of the body: fractures of the bones of the head in nine instances, penetrating wounds of the chest in five, penetrating wounds of the abdomen in three, fractures of the pelvic bones in thirteen, fractures of the upper extremities in thirty-three, fractures of the opposite lower extremity in twenty-five, and in one hundred and ninety-six instances the fractures of the femur were accompanied by shot flesh wounds of the upper or lower extremities. Pyaemia was noted in one hundred and fifty- one instances with one hundred and forty-seven deaths; tetanus in eighteen with seventeen deaths; gangrene in fifty-three with thirty-two deaths; erysipelas in forty-six with twenty- six deaths; and haemorrhage in one hundred and thirty-three with one hundred and eighteen deaths. The external iliac artery was unsuccessfully ligated in one instance: CASE 499. Private M. Teel, Co. C, 73d Indiana, was wounded through the upper third of the right thigh, at Stone River, December 31, 1862. Assistant Surgeon F. L. Town, U. S. A., reported that the wounded man was admitted into hospital No. 4, Nashville, six days after receiving the injury, where, by reason of secondary haemorrhage, the external iliac had to be ligated, resulting fatally on January 19, 1863; also that the severity of the original injury was sufficient to produce death. The femoral artery was ligated in twenty-one instances, of which two proved success ful. Socin 1 has remarked that in a shot fracture of the femur "accompanied by an injury of the artery alone, conservation might yet be attempted after an utmost early ligation;" but a most careful examination of all the cases of shot fractures of the femur treated by conservation during the American civil war has failed to disclose a single instance of recov ery after fracture of the femur accompanied by an unquestionable primary lesion of the femoral artery. In the following instance the femur had been fractured and the femoral artery severed by a mini^ ball; the artery was promptly ligated. The patient survived nine months and eleven days, but finally perished from the effects of the "injury: On measuring I found this limb lengthened half an inch, and this measurement was confirmed by Surgeon TAYLOR and others. There was no anchylosis at the knee joint." Professor HAMILTON must have been mistaken as to the name of the patient. The name of Melchior Bridtel is not borne on the rolls of the 12th New York Volunteers. A private, Melchior Breitel, I, 12th New Jersey Volunteers, wounded at Chancellorevillo, Virginia, May :!, 1803, was admitted to the Newark U. S. A. General Hospital with a gunshot wound of the thorax and the left arm, September !), 18b :i. lit: was discharged March . 8, 1864, and has been a pensioner since. The records of the Newark hospital, as well as the soldier s certificate of disability, and the certificates of two pension examining surgeons, agree in the diagnosis: "Gunshot wound of chest and left arm," but no mention is made of a shot fracture of the femur or its treatment, and Professor HAMILTON himself, in his Lectures on Gunshot Injuries of the Chest, in American Medical Times, 1864, Vol. VIII, p. 182, cites the case as an example of perforating wound of the lung followed by empyema, without mentioning an injury of the femur. 1 SOCIN (A.), Kriegschirvryischc Frfahrunyen, Leipzig, 187v>, p. lv!8. SECT. III.] SHOT INJUR1KS OF THK FEMUR. 353 CASE HOO. Private B. M. Dunn. Co. D, 1st Louisiana, was wounded in the right thigh, at Gettysburg, July 2, 1863, and admitted into Camp Letterman four weeks after the injury. Assistant Surgeon W. F. Richardson, C. S. A., reported: "He was wounded by a minie ball, which entered at the inner anterior portion of the thigh about the middle third, and made its exit at the posterior and outer portion, severing the femoral artery and fracturing the femur in its course. The femoral artery was ligated in Scarpa s space on the day of the injury. When admitted in my ward the patient was suffering intolerable pain, occasioned by moving him four miles in an ambulance over a rough road, without splints, sand-bags, bandages, or any other appliance to the limb, and with the ends of the bones overlapping each other. I administered chloroform and placed the bones in apposition, attaching a twenty-pound weight to the leg. Three days afterwards I reduced the weight to ten pounds, and on August 8th Smith s anterior splints were applied. One ounce of whiskey was given three times a day. The patient improved under the treatment adopted. On August Kith, the splint was readjusted, and again on September 1st, when the wound was found to look well and healthy and to be still discharging laudable pus. After this, tincture of iron in doses of fifteen drops was given in addition to the whiskey, and on September 6th the ligature was removed. On September 8th, the patient complained of sharp shooting pains around the wound, extending downward to the knee; he was placed under chloroform, and an incision one and a half inches long was made behind the exit wound, through which four or five small pieces and one large piece of bone were removed. Considerable haemorrhage ensuing, persulphate of iron was injected in the wound, after which the leg Avas again placed in a splint. By September l 2th. the patient was again improving. On October 10th, the wound was still discharging freely, and the thigh was much swollen and very painful. The patient was also suffering from a rather troublesome diarrhoea. On November 10th, when he was transferred to Baltimore, his wound was still suppurating freely, but his general health was improving and union of the fractured bone was firm, so that he could bear about one-twelfth of his weight on the injured limb." In Baltimore, the patient was admitted to West s Buildings Hospital, and two months later he was transferred to Point Look out. Surgeon A. Heger. V. S. A., in charge of the latter hospital, reported that the man died, from the effects of the fracture of the femur, April 13, 1864. TABLE XLIX. Nummary of Twenty-one legations of the Femoral Artery in Cases of Shot Fractures of the Femur treated by Conservation. No. NAME. MILITARY DESCRIPTION, AND AI;K. DATE AND DESCRIPTION OF INJURY. iJEW LIGATION AND OPERATOR. RESULT AND REMARKS. 1 Union Lieutenant. Comminuted fracture upper Femoral artery sloughed. Ligation of femoral artery. Complete recovery. Exch d. third of fem ur. Harrisburg. C.S.A.Med.and Surg.Jour., Miss., July 14, 18C4 Jan., 1865, Vol. II, p. 9. 2 Smith F. A. Pt. G 4th Conoidal ball fract re of lower Ligation of femoral . Exchanged April 27, 1864. Alabama, age 24. third of left femur. Gettys burg, July 2. 1863. 3 Wright, M., Pt.. F. 25th Conoidal ball fractured por- : Suppuration fetid; severe January 2, 1865, ligation of Incision healed : ligatures Indiana, age 18. tion of external condyle of haemorrhage from vessels in femoral artery ; Scarpa s came away on January 14. right femur and passed thro neighborhood of popliteal triangle, by Acting Ass t Discharged July 8, 1865. popliteal space. Savannah. (-pace ; controlled tempora- Surgeon E. L. Mola. V. S. San. Com. Memoirs, Dec. 11. 1864. rily by plugging. Surg. Vol. I. p. 263. 4 Urixjl. s. A. M., Lieut.. A. Pistol ball fracture of lower April 17, haemorrhage caused April 17, ligation of femoral Died April 20. 65. Post-mor- 26th Virginia. third right femur. Burks- by a sharp spicula of bone artery below origin of pro- tern. : ant. wall of artery had ville, April 6. 1865. piercingthe popliteal art "ry. funda. sloughed ths of an inch. A.M.M.. Specs. 4084. 4085. 5 Campbell. J. W., Pt.. A. Conoidal ball fracture of up August 13, haem. amounting Augnst 13, ligation of fem Haem. did not recur, but pa- 17th Virginia, age 23. per middle and lower thirds to 60 ounces from femoral. oral artery in continuity in tient died of exhaustion from <;f femur. August 4, 1864. Scarpa s space. loss of blood, Aug. 13, 64. 6 Campbell, S., Pt., H. Conoidal ball fractured up J une 10. haem. 8 oz.; profunda June 13, ligature around the Died June 13, 1864 ; asthenia. 140th Penn.. age 30. per third right femur, also ligated and ligature placed femoral artery by Assistant A. 31. M., Spec. 3557. wound of the left thigh, etc. under the femoral. June Surg. W. Thomson, U.S.A. May 29, 1864. 13. hapm. recurred, 2 oz. 7 Cox, T. C.. Pt., G. 88th Conoidal ball comminuted January 9. 1863, severe hm- January 10, ligation of fem Died Jan. 10, 1863; autopsy; New York. fracture of upper third of orrhage. controlled by cold oral artery by Acting Ass t arten- torn for an inch or left femur. Fredericksburg, water and compress. Jan Surgeon R. Carroll. more, apparently by slough Dec. 13, IE 32. uary 10, recurred. ing. 8 Coder, D..Corp l, F, 16th Shot entering immediately June 8, haemorrhage amount June 9, ligation of femoral Died June 10, 1864; exhaus- Pennsylvania Cavalry, over femoral artery, right ing to 5 oz. from femoral. artery below profunda by tion and gangrene; autopsy. age 23 . thigh, splintering trochan- June 9, haemorrhage recur- Ass t Surgeon W. Thorn- ter minor. Hanover C. H., red, 8 ounces. son, U. S. A. May 28. 1864. !l Detweiler, C.. Pt.. A,47th Conoidal ball wound of left Extensive sloughing March March 10, 1865, ligation of Died March 10, 65; exhaus Pennsylvania, age 24. thigh, injuring femur in the 5, 1865- haem. 8 ounces from femoral artery in continuity tion. A. M. M., Spec. 1357. middle third. Cedar Creek, branch ot ext. circumflex: in Scarpa s triangle, one Oct. 19, 1864. < lig. of profunda. March 9, inch below origin of pro- femoral sloughed ; haemor funda, by A. A. Surgeon rhage 20 oz. W. P. Moon. 10 Dunn, B. M., Pt., D, 1st Conoidal ball severing fem- I July 2 libation of the fem- Sept. 6, ligature rem d ; con- Louisiana. oral artery and fracturing oriil in Scarpa s triangle. siderable haem., arrested by middle third of right femur. persulp. iron. Died April Gettysburg. July 2, 1863. 13, 1864. 11 Floyd, J., Serg t Major, Conoidal ball comminuted June 19, neighborhood of June 19, ligation of femoral June 20, 21, bleeding recur d. 13th PennsvvaniaCav.. fracture upper third of left wound much disorganized; j in continuity just below Died June 25. 1864 ; hasm- age 32. femur. May 28. 1864. : haemorrhage from profunda, 1 Poupart s ligament by Act. orrhage. 30 ounces. Ass t Surg. J. Newcombe. 1 12 Freeman, A., Pt., II, 61st Partial fracture in the upper j Nov. 3. profuse haemorrhage Novembers, ligation of fem- Died November 24. 1862; ex- New York, age 19. third of the left femur by from femoral artery. oral artery. haustive suppuration. A. conoidal hall. Antictam. M. M., Spec. 740. Sept. 17, 1862. 13 Geitz, H., Pt., C, 15th Conoidal ball fracture right May 29, haemorrhage from May 30, ligation of femoral June 7, hajm. recurred. Died New York Heavy Artil thigh. May 18. 1864. profunda artery. artery in continuity bv Sur- June 8, 1864. lery, age 26. geon D. W. Bliss. U/S. V. 14 Harper, J.. Pt., H, Kith Shot fracture of right thigh. Ligation of femoral artery. Died February 14, 1863. Infantry. Stone River, Dec. 31, 1862. SUKG. Ill 45 354 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE AND DESCRIPTION OF INJURY. H^MOKRHAUK. LlGATTON AND OPERATOR. RESULT AND REMARKS. 15 16 17 1R Johnson, V., Pt., I. 13th Indiana, age 22. Kelly, J. A., I.ienl.. C.. 9th Missouri. Parker. J., Corp l. H. 58th Mass.. age 38. Root, J. L.. Pt.. H. 77th Conoidal ball fracture upper third of left thigh (also wound right). Petersburg. May 9, 1864. Shot fracture upper third left femur. July 4, 1863. Conoidal ball fracture of mid dle third of the left femur. Conoidal ball fracturo, splin May 19. haemorrhage from profunda ; ligated in contin uity; hsem. recurred May 22; 26 ounces. July 12, 13, haemorrhage, 7 ounces, from profunda. Haemorrhage. May 2V 1 , ligation of femoral artery above profunda. July 13, ligation of the fem oral artery. June 27, ligation of femoral artery. October 19. ligation of the May 24. haemorrhage recur red. Died May 26, 1864. Died July 13, 1863. Died July 2, 1864. Died November 1, 1864. 19 90 New York, ago . Sexton, J. 31., Pt., A, 4th Virginia Cavalry, age 22. Smith, D. R. Pt. I. 93d tering left thigh. Cedar Creek. Oct. 19, 1864. Conoidal ball comminuted fracture mid. thirdjof right femur. Monocacv, July 9, 1864. August 5. femoral artery sloughed ; haemorrhage 10 ounces. femoral artery. August 5, ligation femoral in continuity below profunda, above wound, by Act. Ass t Surgeon J. H. Coover. November, 1863. ligation of Aug. 6, haem.recur d, 12 oz.; ligation of profunda. Died from exhaustion and loss of blood. .4.JO/.,.Vpec.3971. Died December 5, 1863. 21 Illinois. Walter, V., Pt.. E, 8th Ohio, age 24. femur. Mission Ridge, No vember 25, 1863. Conoidal ball fracture upper third of right femur. Spott- sylvania. May 10, 1864. June 7. hemorrhage, 16 07. , from femoral artery. femoral art y bv Ass t Surg. J. S. Prout, 26th Missouri. June 9, ligation of femoral artery above profunda. Died June 17, 1864. The profunda was successfully tied in one case, and the circumflex of profunda and the popliteal arteries 1 were unsuccessfully ligated in one instance each. In one case it is stated that the femoral vein was successfully ligated on the day of the injury; but unfortu nately neither the records of the field hospital nor of the Columbian Hospital at Washing ton, where the patient was treated during the first five months after the injury, allude to the ligation of the femoral vein, and not until the soldier reached the hospital at Madison, Wisconsin, is the operation, said to have been performed on the field, mentioned, probably upon the patient s own statement. A brief account of the case is appended : CASE 501. Corporal G. Bulman, Co. G, 36th Wisconsin, aged 22 years, was wounded through the upper third of the left thigh, at Hatcher s Run, October 27, 1864. He was sent from the field to Columbian Hospital, Washington, several days after the injury, and five months later he was transferred to Harvey Hospital, Madison. Surgeon H. Culbertson, U. S. V., in charge of the latter, reported that the femur was fractured by the missile, and that the femoral vein had been ligated on the day of the injury. The patient was discharged from service May 22, 1865, and pensioned. Examiner W. II. Walker, of Fond du Lac, certified, August 11, 1865 : " He was woimded by a ball through the upper third of the thigh from without inward, frac turing the femur. The muscles are adherent and the thigh is diminished in circumference two and a half inches. The circula tion of the limb is much impeded from extensive loss and induration of the soft parts from hospital gangrene." Several years after the same examiner reported "deep and extensive varices and ulceration on the outer aspect of the calf from the obstruc tion of the circulation of the limb. The pensioner was paid December 4, 1879. A fatal instance of ligation of the femoral vein and the profunda artery for secondary haemorrhage is reported by Acting Assistant Surgeon T. J. Dunott: CASE 502. Private E. Gilkey, Co. C, 17th Maine, age 27 years, was wounded at Petersburg, June 18, 1864, and admitted into Campbell Hospital, Washington, ten days afterwards. Surgeon A. F. Sheldon, U. S. V., reported : "Shot fracture of upper third of right femur. Haemorrhage to the amount of twelve ounces occurred on July 5th, when the femoral vein and the pro funda artery were ligated, the ligature of the former being applied at the seat of the injury. Haemorrhage recurred on July 7, 1864, when the case resulted fatally." Among the three thousand four hundred and sixty-seven cases of shot fracture of the femur treated by conservation referred to in this Section, were two thousand eight hundred and thirty-nine Union and six hundred and twenty-eight Confederate cases. The ratio of 1 Surgeon G. M. B. MAUGHS, P. A. C. S. (Conservative Treatment of Compound Comminuted Fracture of the Femur, with Cases, in Confederate States Sled, and urg. Jour., 1865, Vol. II, p. 9), reports that Private W. T. Ivy, 19th Mississippi Cavalry, aged 40, was wounded at Harrisburg, July M, 1864; compound comminuted fracture of femur, upper third; ligation of arteria profunda; treated by position; union complete; shortened one inch. Acting Assistant Surgeon T. J. DUNOTT reports that Private E. H. Gibson, Co. A, 14th New Jersey, aged 15, was wounded at Monocaoy, July 9, 1864. A conical ball perforated the right thigh in the upper third, on the anterior aspect, fractured the femur without producing much comminution, and emerged near the anus. The patient was admitted into the hospital at Frederick, and, on July 13th, the limb was placed upon a double-inclined plane. On July 19th, haemorrhage set in, a large and continuous stream flowing out of the anterior wound. Dr. Dl NOTT immediately enlarged the wound and tied the circumflex of the profunda above and below; on July 20th, violent ha?morrhage occurred from the wound. Compression was made at once, and a plug of lint introduced. A hot-air bath was ordered and stimulants given, but the patient died July 19, 1864, two hours after the recurrence of the haemorrhage. Surgeon R. NlCOl.1,6. U. S. V.. reports that Private C. A. Knight, Co. L. 2d Illinois Cavalry, aged 24, was accidentally wounded at Sikeston, Missouri, May 4, 1862, by a pistol ball, which fractured the left femur three inches above its lower extremity. He was admitted into the hospital at Quincy on May 10th, and the popliteal artery, which was wounded, was ligated above and below the wound. BUCK S apparatus was applied. The ligatures came away on the fourteenth day. The wound of operation had nearly closed by the latter part of August, but the patient was reduced by diarrhoaa and died September 29, 1862. SECT. III.] SHOT INJURIES OF THE FEMUR. 355 mortality of the completed cases was 51.1 per cent, on the Union, and 44.0 per cent, on the Confederate side, as exhibited in the following table: TABLE L. Numerical Statement of Union and Confederate Soldiers treated by Conservation after Shot Fracture of the Femur. POINT OF FRACTURE. TOTAL CASES. UXION SOLDIERS. CONFEDERATE SOLDIERS. Cases. Recoveries. Deaths. Unde termined. Ratio of Mortality of Determined Cases. Cases. Recoveries. Deaths. Unde termined. Ratio of Mortality of Determined Cases. Fracture of Upper Third 1,254 855 620 738 1,036 699 502 002 531 421 304 85 480 274 192 480 5 4 b 37 46.5 39.4 38.7 84.9- 218 156 118 136 118 79 71 60 92 68 40 58 8 9 7 18 43.8 46.2 36.0 49.1 Fracture of Middle Third Fracture of Lower Third 3,467 2, 839 1, 361 1,426 52 51.1 628 328 258 4-2 44.0 The rate of fatality among the Confederates as exhibited in this table is remarkably low; but it must be taken into consideration that in the enumeration of the Union cases, made up to a large extent from the casualty lists of the various corps, are included even those patients who died within the first, few hours after the reception of the injury, before means of transportation could reach them, while the Confederate cases of a similar nature do not appear in these statistics. 1 Excisions in the /Shaft of the Femur. Although the number of excisions in the shaft of the femur practised was comparatively large, little need be said about the operation, which, as already stated, was generally considered with disfavor by the American surgeons, and frequently those who had practised it became its strongest opponents. 2 Amputations in the Thigh. While the experience acquired during the War of the Rebellion indicates that the attempts to save the limb after shot fractures of the femur have, in many instances, met with favorable results, there are a large number of cases in which primary amputation remains the only alternative. When the fracture of the femur is accompanied by great comminution, or by extensive longitudinal fissuring, or by grave laceration of the soft parts, or by primary injury of the femoral artery or vein, the limb should be removed at once. Furthermore, the crowded condition of the field hospitals after large engagements, the infectious diseases likely to arise, the scarcity, and sometimes 1 In the Confederate Sttites Medical and Surgical Journal, Richmond, June, 1864, Vol. I, p. 89, wiil be found a consolidated statement of compound fractures of the femur treated without operation, compiled from the records of the Confederate .Surgeon General s Office from June, 1862, to February 1, 1864, inclusive. The total number of cases treated was 221, of which 116 recovered, and 105 or 47.5 per cent., had a fatal termination. 2 Surgeon C. A. COWGILL, U. S. V., who excised a portion of the shaft of the femur in the case of Private I. W. Hall, 92d New York (TABLE XXVI, No. 17, p. 2iO, ante), writes, in a letter to the editor dated Dover, Delaware, July 12, 1866: "The result of this case determined me never to attempt again to save a femur fractured by a gunshot wound by excising any portion of its continuity. The extraction of fragments almost entirely detached and displaced is all that I would do in a similar case. In severe injuries where there is no hope of saving the limb, the fracture involving the \ipper third, I would prefer waiting for some weeks until all primary irritation had subsided, and a degree of tolerance acquired by the system, and then amputate, believing that secondary amputations are more frequently followed by successful results when performed in the upper third of the femur than excisions of the contin- an inuiana, wno excised in me cases 01 i-nvaio \\isninirc. ~ /m inaiana (i AISLE AAiv, r<o. ui, p. xvo, aniei, aim i-nvaie 115011, 1.0111 ^>e uciai^ (TAiiLE XXV, No. 9, p. 208, ante), in a letter to the Surgeon General dated July 27, 1866, advises primary amputation rather than excision, providing the patient is able to bear up under the shock of the amputation, and remarks: I am therefore opposed to excision of the shaft of the femur unless the exigencies of the case demand it." Surgeon A. .1. I UKI.rs, U. S. V., in his Report of the Operations of the Medical Department of the Left Wing of the Fourteenth Corps at the Battle of Murfrcesboro , in Appended Documents to Part /, Vol. I, Med. and Sury. History of the War of the Rebellion. Wash ington, 1870, p. 260, says: "I consider exsectious in the case of the shaft of the femur should very generally give way to amputation. 1 356 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. entire want, of surgical appliances to make the patient with a fractured thigh bone com fortable, the rough transportation to which the wounded man is liable to be exposed, are circumstances which will sometimes urge the military surgeon to forego all conservative inclination and prefer to sacrifice the limb rather than to expose the; patient to the risks attending the attempts at preservation. Here, as well as in all questions of surgical inter ference, medical officers in the field will always be guided by the circumstances surrounding each case. The modes of operating employed were the flap method 1 and its various modifications the anterior, posterior, aritero-posterior, and lateral flaps in one thousand one hundred and forty-one, the circular method in eight hundred and sixty-three, the oval flap with circular division of muscles in one hundred and eight instances; but it is difficult to draw correct conclusions from the recorded cases regarding the value of the modes practised. Surgeon E. Batwell, 2 14th Michigan Volunteers, observes: "The sort of operations per formed is worthy of comment, and has been very closely watched, to try and give a prefer ence to either circular or flap operations, based on observations as to their relative merits as far as healing was concerned; but no difference was discernible, except in lateral flaps, where the protrusion of the bone through the incision prevented the rapid union that took place in the antero-posterior ones. The only cases in which the healing process seemed retarded were those in which the operation urged by Malgaigne was performed oval flaps with circular division of muscular tissue. The chief points in which they seemed to be deficient was the small anterior flap being unable to support the weight of the posterior- larger one. This again granulated very freely, and thereby prevented approximation of the edges, and a large granulating surface was the result, instead of the nicely adjusted linear mark observable in either the flap or circular operations. From the observations made on the subject, I would urge that no modifications are worthy of being noticed by surgeons, and that the circular or flap operations amply fulfil all the requirements necessary." The Army Medical Museum possesses seventy-nine casts of stumps after amputations in the femur, six of which are shown in the accompanying plate (PLATE LXXIIi). FIGURES 1, 2, 3, and 5 represent stumps after the anterior, posterior, antero-posterior, and lateral flap methods, FIGURE 4, after the circular method, and FIGURE 6, after an operation by the flap of skin and circular division of muscles method. An amputation after the method of Gritti, 3 of Milan, is reported by Surgeon W. Child, 4 5th New Hampshire Volunteers, to Surgeon A. J. 1 HELPS, U. S. V., in his Report of the Operations of the Medical Department of the Left Wing of the Fourteenth Corps, at the Battle of Murfreesboro , remarks: The method of amputation employed was, very generally, the flap. Those eases of flap operation, however, that approached nearest to the circular method f .id best, and I have thought that our success would be greater if the circular method was adopted more gen erally. The only hope we have of an entire success is union by the first intention in the flap operation, and this depends upon the subsequent attention of the surgeon. We can seldom expect to realize it while we have to depend upon inexperienced nurses for dressers. The weight of an unsupported flap will invariably break those tender bonds of union that nature so readily attempts. (Appended Documents to Part I, Vol. I, of the. If ml. and Surg. llist. of the War, Washington, 1870, p. 262.) Extract from a Report on the Surgical Operations performed after the Engagement at Jonesboro , Georgia, in Appended Documents to 1 art I, Vol. I, of the Med. and Knrg. Hist, of the War, Washington. 187(1, p. :i04. 3 K. GlUTTI (Dell ainputazione del femore al terzo inferiore e della disarticolazione del ginocchio. Valore retativo di cadanna coll indicazione di tin nuovo metodo tlenominato amputazione del femore ai condili con tzmbo patellare, in Annali Universali di Mediciiia, Milano, 1857, Vol. CLXI, p. 5. This operation will be referred to in the succeeding section. 4 CHILD (W.), (iUITTI S Sitpra-condyloid Amputation of the Thigh, in the Huston, Med. and S-urg. Jour., 1879, Vol. CI, p. 78:!. J)r. CllIM) says: " After the battle of Antietam (September 17. 18P2) it was determined to establish upon that battle-field a hospital for such severe cases as could not bo conveniently removed to the general hospitals. Dr. BKllNAUli VAXHKUKIEFI . I nited States volunteer surgeon, was detailed surgeon in charge of this hospital. Among the patients was a soldier with an amputation of the right leg. After some weeks it was found that the leg must be amputated at or above tho knee joint. ])r. VAXnEKKIKFT decided to amputate at the knee joint by "a new operation" (as lie said), and the operation was certainly new to his associates and assistants. He made a circular incision from the internal tuberosity of the tibia across the leg below the patella to the head of the fibula, dissected this flap up to about the middle of the patella, cut through the ligamentum patella close to the lower border of the bone, arid turned back the flap. He then made the posterior flap by passing tho knife beneath the femur and cutting outward and downward. lie then sawed through the femur just above (lie condyles, and removed a section from the posterior or internal surface of the patella by the saw. Next he adjusted the sawn surface of the patella to the sawn extremity of the femur and adjusted the Haps in the usual manner. The patient died in about sixteen hours, on account of previous exhaustion." in- - Hi-! << ihc WarofthchV-hcllinji ] ;ii-l III.Vol II.Cliop * Slump jiCtcr ;un| >n t ,i 1 ti c. i liv iiiili-ri) )>DSli ricir Hiips SJ-M-I-. IHI7 -. Stiintp .illcr .)ni|)ut.il ion I>v posii l-ior Clap. SJHM- 117 }. Stump Jil lci 1 :un|)ii tnlioM by rm-ular l!a|>. Sjiec-. . V2^ C>. Slump ;il tfi- ;iniputution liy f]np of skin ;ui(1 cifculrir ol iniis< U .S Spec 2. U)( SKCT. III.] SHOT INJURIES OF THE FEMUR. 357 half <>f nutated dyles. FIG. 220. The same have been performed by Surgeon B. A. Vanderkieft, U. S. V., who was in charge of the Smoketown Hospital after the battle of Antietam, September 17 ; 1862. Another operation of this character was performed by Assistant Surgeon J. W. S. Gouley, U. S. A., December 16, 1862, three days after the battle of Fredericksburg: 1 CASE 503. Private Grey Y. Barrett, Co. F, 5th New Hampshire, aged 20 years, was wounded at Fredericksburg, December 13, 1862, by a musket ball, which entered at the outer condyle of the femur, passed inward and upward, and, escaping posteriorly in the middle of the lower third of thigh, left the bone much comminuted at its exit. He was admitted to the hospital of the 1st division, Ninth Corps, where, on December 16th, Assistant Surgeon J. W. S. Gouley, U. S. A., amputated the femur a short distance above the wound of entrance, the patella being included in the anterior Hap; the line of section not having escaped the wound, another third of an inch was removed (FiG. 219); the femoral surface of the patella was then sawn off, and the two cut surfaces of the bone were brought in apposition (FiG. 220). The laminated portion of the femur, however, was fractured half an inch above this point, and fissures extended two inches further. The operation was well borne, and the case continued to do well until the sixth day, when sloughing commenced ; on the eighth, signs of gangrene were noticed ; and, on the ninth, December 25th, Surgeon J. P. Prince, 3Cth Massachusetts Volunteers, amputated the femur in the middle third, on account of the burrowing of pus, for secondary haemorrhage from the pop liteal. No plastic deposit could be observed immediately after the operation. On the next day he was transferred to Washington, and admitted to the Douglas Hos- The lower pital, where he died on December 27, 1862. The pathological specimen, which was right femur am- contributed to the Army Medical Museum by Dr. Prince, with a history of the case, with the sawn surfaces auove me con- . _ of the patella and femur Spec. 536. is numbered o.iu ot the Surgical Section. in apposition. Extension as a means of covering protruding bones after amputation of the thigh was successfully employed at the City General Hospital, St. Louis, after a plan 2 devised by Acting Assistant Surgeon A. S. Barnes. How far the size of the thigh presented for amputation influences the result of the operation cannot be ascertained from the cases recorded in the preceding pages. M. Bras- dor, 3 in 1774, observed that plus la plaie de 1 amputation a de surface, plus, toutes choses, egales, le danger que court le malade est grand," and Surgeon M. Goldsmith, U. S. V., 4 in a letter to this Office notices the influence of the size of the limb upon the mortality of 1 An account of this case by Surgeon JAMES 1 . PKIXCE, 36th Massachusetts Volunteers, has been published in the Boston Medical and Surgical Journal 1863, Vol. LXV1II, No. 4, p. 69, and by Dr. ROBERT P. WEIR in his excellent paper On GRITTl S Supra- Condyloid Amputation of the Thigh, in The Medical Record, New York, 1879, Vol. XV, p. 338. 2 HO1>GEX (J. T.). Letter to the Surgeon General, dated April 30, 1863: "The accompanying drawing (FIG. 22J) shows its application to the thigh. The same is also applied to the arms, forearms, or legs. From three to six adhesive strips are applied, extending from the end of the stump up the limb to near the next joint; this is then covered by a smoothly applied bandage. The free ends of plaster are brought together several inches below the end of the stump and fastened by a cord, to which is attached a bag of sand weighing from 1 to 3 or 4 pounds; the cord, passed over a pulley placed at a proper point on the bedstead, the bag is suspended, thus making gradual constant extension on the flaps, which soon elongate and cover the protruding bone. Great numbers of such stumps have been brought to this hospital, in many the bone protruding three inches or more, and in but one case have we thought it best to saw off the end of the bone; and that was done before this method of treatment was practised. There have been very few cases in which the ends of bones have exfoliated, and then only a small part of what would have been lost if the usual course had been pursued. The credit of introducing this new method of covering protruding bones is due to Acting Assistant Surgeon A. S. I5AUXES of this city. Dr. W. \V. IvKEX, jr., in a letter to the Surgeon General s Office, dated V. S. A. General Hospital, West Philadelphia, May 26, 1863, 3 FIG. 2U1. Dr. A. S. I5ARNKS S method ot treating amputations with ascribes this plan to Assistant Surgeon A. H. SMITH. U. S. A : "Assistant re t ra cted flaps. .Surgeon A. II. SMITH. U. S. A., who was with me at Frederick, and after wards here and now at Nashville, while at Frederick devised a very ingenious apparatus, which was afterwards adopted at hospitals nearer the battle fields, and there claimed as original, and now, I learn, is claimed by J. T. HODOEX, Surgeon U. S. V., of St. Louis. The apparatus is the application of adhesive strips to the flaps after amputation (especially in the thigh), and the attaching to them of a weight running over a pulley, very much after the plan of BUCK S apparatus for the thigh, the object being to prevent retraction of the flaps, and to overcome it if already established. 3 BKASDOK, Essai sur Ics amputations dans les Articles, in Mem. de VAcad. Roy. de Chir., Paris, 1774, T. V, p. 757. 4 GOLUSMITII (At.). Letter to the Surgeon General, dated Jeffersonville, Indiana, October 18, 1865: "It has been a subject of general remark in the Army that a much larger proportion of the lean, lithe, active men hardy men, without a particle of encumbering fat. recovered from amputation, than equally hardy men men oftentimes of much more muscular development and strength, with a larger accumulation of fat. Or, in other words, that small, light, active men, bore amputation of the thigh better than larger, stronger, and stouter men did. That other things being equal, the general 358 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. amputations, especially in the thigh, a subject which seems to him of "importance enough to challenge the attention of medical men." Considering the results of the amputations according to the ages of the patients, as represented in TABLE LI, the mortality rate of four hundred and seventy-six patients under twenty years of age was 41.0 per cent.; of thirteen hundred and fifty-one patients TABLE LI. Statement of the Ages of Six Thousand Two Hundred and Nine Patients who submitted to Amputation of the Thigh for Shot Injury. AMPUTATION OF THIGH. UNDER 20. 20-1-2-3-4. 25-6-7-8-9. 30-1-2-3-4. 35-6-7-8-9. 40 A 1 0) > o g K S D OVER. AGE UNKNOWN. Recovery. 3 Result Unknown. Recovery. "5 a |JH Result Unknown. Recovery. "3 "3 fc< Result Unknown. > o 1 K a <n Result Unknown. Recovery. d S fe 3 CQ fe Result Unknown. Recovery. "3 S fe Result Unknown. C Upper Third 2 9 GO 179 276 35 84 160 11 1 1 39 110 155 1 6 19 25 19 56 93 6 8 30 49 3 1 23 67 77 2 5 11 18 16 31 57 4 8 16 35 1 9 28 41 8 20 35 1 6 9 24 10 25 32 1 7 11 7 16 46 6 5 14 21 1 90 205 279 34 26 90 67 7 13 34 26 174 226 470 245 44 90 154 13 8 16 33 4 4 7 12 20 " I Middle Third 70 R - 1 Lower Third 111 1 2 12 60 5 6 21 7 58 64 20 86 140 1 4 8 7 g * I Middle Third 25 34 2 " I Third not specified 4 6 10 4 6 10 1 32 39 10 16 21 T i 2 3 5 1 2 1 1 2 1 3 6 >; Middle Third 16 16 13 15 1 4 10 8 10 o 9 4 O jj / S < I Lower Third 1 2 7 6 3 6 3 9 1 g T 1 1 11 0] 23 68 12 10 46 187 4 5 19 o $ Middle Third . 1 5 o 3 2 4 1 1 4 1 o 3 6 2 1 3 2 K < a o 1 Lower Third 1 1 1 1 1 4 ^1 Z I 4 280 193 1 738 610 3 399 305 2 220 197 1 112 118 93 131 2 994 ],737 71 between twenty and twenty-five, 45.2 per cent.; of seven hundred and six between twenty- five and thirty, 43.3 per cent.; of four hundred and eighteen between thirty and thirty-five, 47.2 per cent.; of two hundred and thirty betweejn thirty-five and forty, 51.3 per cent.; and of two hundred and twenty-six above forty years of age, 58.4 per cent. health of the two classes being alike, the injuries and subsequent exposures being the same, the mere size of the limb, controlling as it does the area of the traumatic surfaces, came to be the ruling element in the determination of the question of amputation in line cases. Professor BUSH, of the Transylvania University, was sent by the Governor of Kentucky to the succor of the wounded at the bottle of Shiloh. He tells me that among those with amputated thighs, very few large fleshy men recovered, while much the larger proportion of those having small, lean, muscular limbs, arrived at Louisville in good condition. He was so much struck with this observation, that out of it he has drawn for himself a clinical rule, in determining the question of amputation, not a dominating rule, but one having much to do with the question. Dr. BUSH S observation is all the more pertinent that it was an independent one. All of the leading surgeons with whom I have conversed upon the subject have made concurrent observations. For myself. I have been so impressed with the influence of the mere size, volume, or thickness of the limb presented for amputation, that in cases where the question was debatable the decision in the wavering balance was determined by the extent of traumatic surface necessarily incident to the operative procedure required. This consideration had all the more weight as the line of the contemplated division approached the trunk. 7 SECT. IV.] WOUNDS AND INJURIES OF THE KNEE JOINT. 359 SECTION IV. WOUNDS AND INJURIES OF THE KNEE JOINT. The injuries of the knee joint to be considered in this Section number three thousand four hundred and forty-nine. Twelve were punctured, thirty-nine incised, and three thou sand three hundred and ninety-eight shot wounds. Of the latter, forty-three were shot contusions and three thousand three hundred and fifty-five shot fractures. The injuries of the knee from blows, falls, or railroad accidents are reserved for a future chapter. The number of cases of injuries of the knee joint followed by amputations of the thigh is very large. Of the thirty-nine patients with incised wounds, six submitted to amputation; of the forty-three shot contusions, ten, and of the three thousand three hundred and fifty-five shot fractures, two thousand three hundred and eighty-nine were succeeded by amputation in the thigh. The two thousand three hundred and ninety-nine cases of amputation in the thigh for shot contusion or shot fractures of the bones of the knee joint have already been cited in the amputation tables of the preceding section, and will therefore be only briefly alluded to in the concluding remarks of this Section. PUNCTURED AND INCISED WOUNDS OF THE KNEE JOINT. The instances of punctured and incised 1 wounds of the knee joint reported on the records num ber fifty-one twelve punctured wounds and thirty-nine incised wounds. In some of the cases, undoubtedly, the cavity of the joint was directly implicated, but the meagre evidence tranchcnis, Paris, Thdse Xo. 84, 1811, p. 20) records two cases of sabre wounds of the knee joint : Maker, 84th line, who received. 7iear Utrecht, in 1804, a sabre wound which cut the upper ligament of the right patella and penetrated the articulation. The parts were brought together and cataplasms employed. Abscesses formed on the interior and exterior sides of the knee, which were opened, and a seton was introduced to allow the escape of pus. The wounds healed and the patient recovered, but with complete anchylosis of the knee joint. A grenadier of the 54th regiment received, in a duel, a ,-ithout benefit. The soldier demanded amputation, which was performed on the fifth day. The paticnl at he saw several patients with similar wounds, who perished because amputation had not been risked. died on the fifteenth day. I-AUliEY adds tli 360 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. and the fact that the injuries in several of the cases healed with very slight inflammatory action render it possible that they were periarticular wounds only. Punctured Wounds of the Knee Joint. The twelve punctured wounds of the knee joint terminated in recovery. Seven were caused by bayonets, two by knives, two by falls on nails, and one by a fall on a pair of scissors. The seven cases of bayonet wounds are: CASE 504. Private C. Smith, Co. H, 30th Iowa, aged 17 years, received, September 20, 1862, a bayonet puncture of the left knee joint. He was discharged from service at Beuton Barracks Hospital, October 5, 1863, Surgeon J. H. Grove, U. S. V., certifying to "anchylosis and chronic synovitis" resulting from the wound. His claim for pension was rejected. CASK 505. Private J. S. Oldscamp, Co. K, 16th Maine, aged 22 years, was wounded and captured at Spottsylvania, May S, 1864. He was subsequently exchanged, and ultimately discharged for disability June 22, 1865. Examiner C. Rowland, of Brooklyn, New York, reported: "A bayonet wound penetrated the vight knee; also a shot wound of right thigh, and of right foot injuring the little toe. The result is lameness and inability to labor." The man was a pensioner until March 4, 1866, when he was dropped, his disabilities, in the opinion of the examiner, having ceased. CASE 506. Surgeon W. O Meagher, 1 37th New York, reports: "Private received an accidental wound of the knee joint between the border of the patella and the internal condyle of the femur. At first little was thought of it, a few adhesive straps and a roller bandage being applied, and the patient returned to duty. In a few days, owing, doubtless, to impru dence and over exercise, inflammation, accompanied by pain, fever, swelling, and effusion, set in, while the wound assumed an angry fungoid appearance; but by means of rest in the recumbent position, elevation of the extremity, and water dressing, the pain and other symptoms slowly abated at the end of three weeks, leaving the patient, however, lame and stiff at the joint. CASE 507. Musician J. H. Getman, Co. E, 115th New York, aged 19 years, was wounded at Fort Fisher, January 16, 1865. He was conveyed to McDougall Hospital, New York, and subsequently to Troy. Surgeon George H. Hubbard, U. S. V., in charge of the latter hospital, reported that the patient s injuries consisted of "a bayonet wound of the posterior portion of the right knee joint. 1 Getman was furloughed April 28lh, and was mustered out of service May 19, 1865; he is a pensioner. CASE 508. Sergeant S. M. Ingraham, Co. K, 64th New York, aged 34 years, received a bayonet wound of the left knee, at Spottsylvania, May 12, 1864. He was mustered out and pensioned October 13, 1864. Examining surgeons represent him as suffering from permanent weakness of the knee as a result of a bayonet wound of the patella followed by suppuration. The remaining two cases of bayonet wounds of the knee joint have already been cited, viz: cases of Private C. A. Ball, Co. K, 89th New York (CASE 3, page 6, ante), and Private Lewis Francis, Co. I, 14th New York (CASE 331, page 154, ante). The former recovered without any bad results; the latter after amputation in the middle third of the thigh and subsequent disarticulation at the hip. Amputation above tlie knee was advised, but refused by the patient. The arteries were ligated and the edges of the wound drawn together by sutures, care being taken that synovia and blood were allowed to escape. August Gth, inflammation, swelling, and pain. Synovia continued to escape until August 10th. Death from exhaustion August 23, 1813. A soldier of the 7th line, aged 27, received, on August 16, 1813, near Dresden, a sabre cut through the left patella. He secured the wound with bandages, and was received into the military hospital on August 24th. very much exhausted. An examination revealed a cut about 4 inches in length, splitting the patella and opening the joint ; blood and synovia escaped freely and symptoms of tetanus appeared. August 28th, escape of synovia diminished. September 1 Jth, cut edges i.f patella were united and the escape of synovia had ceased. The patient recovered. LEFKANCOIS (JEAN) (Dissertation sur les plaies jiem trantcs de / articulation du genou, Paris. 18C-0, These No. :>, pp. 17, 18) cites ttvo cases: A soldier of the 7th chasseurs u cheval received, in December, 1814, a sabre wound across the anterior part of the right knee, extending from the internal to the external part of the knee and opening the joint. Simple dressings were applied. The limb was painful during the first eight days; tetanus appeared on the fifteenth day and death resulted. A soldier of the 18th line received a sabre wound on January 15, 1815. The cut was transversely across the upper part of the knee joint and opened the cavity of the joint about an inch. There was copious haemorrhage. The edges were brought together and simple dressings applied. There was little pain during the first three days ; but on the fourth there was some fever and gastric disturbance. Numerous abscesses appeared, which were incised. The patient recovered in 27 days. FociiMEIt (JULES) (Euai sur les plaies des artic ulations, Paris. 1823, These No. 150, pp. 11, 14) : Bottari, 8th guards, received, November 6, 1822, a sabre puncture over the left patella and two others on the anterior and upper portion. Considerable swelling ensued and synovia escaped through the small wound. By November 15th the wound.had cica trized and the patient was able to walk; there was very little stiffness in the articulation. A young chasseur received, in 1815, a sabre wound of the external portion of the right knee. The \voundgn-as three inches long and penetrated the synovia! capsule, from which there was considerable effusion. The wounded surfaces were brought together and the limb permanently extended. On the tenth day cicatrization was complete. MAI.I.E (P.) (Clin. Cliir. de I hopital Mil. d instruction de Strasbourg, Paris, 18"8, p. 022): V , fusilier, 20th line ; entered hospital at Strasbourg March 25, 1830, with a sabre wound of the right knee. The tendons of the extensor muscles if the leg were divided near the insertion at the upper border of the patella. The wound was about three inches long. Clots were removed by the finger, the wounded surfaces brought together, and immobility secured by splints. Inflammation and suppuration ensued and the patient suffered from nausea and insomnia, but his condition improved ; he had recovered on June 12, 1830. OiiEXU (J. C.) (Rapport, etc., pendant la Campagne d Orient en 1854, 1855, 1850, Paris, 18(J5, p. 410) tabulates 5 cases of recovery after sabre, bayonet, and lance wounds of the knee, but gives no details. GARDEN (A. M.) (Conservative Surgery Treatment of Sicierd Wound of the Knee, in The Lancet, 1859, Vol. I, p. 631): On September 13, 1857, a woman received sword cuts of both knees ; the left was only slightly injured ; the right knee was opened and a portion of the head of the tibia severed ; the muscles and ligaments attached to the patella were cut through, leaving the patella itself attached by a very small piece of integument. Limb placed in position; patella replaced; union with anchylosis in about four months. WILLIAMSON (GEOUGE) (.Military Surgery, London, 18(J3, p. 173): Private John (Umnell, West York Rifle 1 egiment, was stabbed in the left knee by a bayonet on February 5, 1858. The wound was small and deep and just beneath the level of the patella; the pus was excessive; delirium and great agony followed ; knee became swollen ; abscesses formed outside of the joint and were opened. Profuse purulent discharge continued. April (ith, amputation of thigh ; patient .recovered. The specimen is preserved in the Museum of the Army Medical Department, at Netley, and is numbered 3G33. VOLKMANX (R.) (I enetri- rende Kniegdenkstvunde, Zweimalige Gelenkpunction, Heilung ohne Ankylose, in Deutsche Klinik, \\. XIII, 1801 . p. 411): A mason, on June 23, 1861, received a sabre wound of the left knee joint ; escape of synovia, fever, and extensive bun-owing of pus ; incisions, ice ; recovery. 1 O MEAGHEH (WILLIAM), Cases in Military Surgery Bayonet Wound of Knee Joint Synovitis, in Am. Med. Times, 1802. Vol. IV, p. 7. SECT. IV.J INCISED WOUNDS OF THE KNEE JOINT. 361 The instances in which the penetrations of the knee joint were caused by falls on nails or scissors or by knife stabs are: CASE 509. Private S. Galliway, Co. B, 32d Ohio, was injured March 18, 18(53, at Lake Providence, by falling on a nail, which entered the right knee joint at the external and inferior border of the patella, and penetrated downward and inward about an inch. Surgeon J. T. Hodgen, U. S. V., reported the case, and that the man entered the City Hospital at St. Louis three weeks after the reception of the injury. HeAvas transferred to the Veteran Reserve Corps July 15, 1863; he is not a pensioner. CASK 510. Musician B. Williams, Co. C, 1st New York, aged 17 years, is reported by Acting Assistant Surgeon P. B. Goddard as having been treated at the Master Street Hospital, Philadelphia, from August 12 to November 26, 1862, for " syno- vitis of the knee joint from puncture by a nail of a cracker box on which he fell." There is no record of his ever having applied for a pension. CASE 511. Private T. A. Jackson, Co. H, 1st Rhode Island Cavalry, aged 23 years, entered Satterlee Hospital, Phila delphia, May 7, 1863. Acting Assistant Surgeon W. W. Keen, jr., reported : "The case is one of punctured wound of the knee joint followed by partial anchylosis. The patient states that in December, 1862, he fell from his horse, and that a pair of scissors in his knapsack punctured the right knee joint and broke off; that the points were removed three days after the accident, being three inches deep, and that severe inflammation followed, and a large number of abscesses formed about the joint. When admitted the injured joint was smaller than the sound one, the hamstrings were contracted, and motion was limited from com plete flexion to an angle of 135 with the thigh. On motion there was marked crepitation, the movement of the patella being much restricted. The cicatrix of the wound is located just to the inside and above the tubercle of the tibia, and all about the joint are old cicatrices from abscesses. The evidence of penetration of the joint is manifest, both by the position of the cicatvix as well as the escape of synovia, which took place according to the patient s statement. The patient walks about on crutches, and is unable to bear weight on the limb." He was discharged from service June 1, 1863. There is no record of his ever having applied for pension. CASE 512. Private E. Rice, Co. E, 100th Indiana, was discharged from service February 28, 1863, by reason of anchy losis of the right knee joint. Medical Inspector G. T. Allen, U. S. A., reported that the disability arose from a wound inflicted, September 16, 1862, by a pointed knife entering beneath the patella and penetrating the knee joint. The man is not a pensioner. CASE 513. Private D. R. Ewell, Co. G, 39th Massachusetts, received a knife wound of the left knee in April, 1864. He was successively admitted to the regimental, Harewood, and Portsmouth Grove hospitals, and returned to duty May 26, 1864. He is not a pensioner. Incised Wounds of the Knee Joint. The thirty-nine cases of this group were axe or hatchet wounds with the exception of perhaps one, in which the instrument with which the injury was inflicted is not named. Thirty-three cases were treated without operative interference and six were followed by amputations in the thigh. Incised Wounds of the Knee Joint treated without Operative Interference. Thirty- three cases, of which four proved fatal, are included in this category. In the majority of the cases the reports are brief, and the evidence regarding the penetration of the joint is very vague. A few cases of recovery are cited: CASK 514. Private N. Bacon, Co. C, llth Michigan, aged 17 years, entered Cumberland Hospital, Nashville, May 17, 1864, with an incised wound of the left knee joint, caused accidentally by an axe two weeks previously. Surgeon B. Cloak, U. S. V., reported the case and that the patient was returned to duty June 4, 1864. The man is not a pensioner. CASK 515. Private J. H. Fuller, Co. K. 3d Massachusetts, age 28 years, received, October 20, 1862, an injury of the left knee joint by a hatchet, which penetrated outside of the patella and made quite a deep cut, causing much arterial haemor rhage. The patient recovered, and was discharged April 1. 1863. He was pensioned on account of lameness and anchylosis of the joint. The case is reported by Surgeon Z. B. Adams. 32d Massachusetts. CASK 516. Private L. H. Hudson, Co. K, 1st Missouri Engineers, received an accidental blow from an axe in the left knee joint, at Waverly, June 3, 1864. The patella, half the capsular, and all the lateral ligaments were severed, allowing the synovia to escape from the joint. The patient passed through various hospitals, and was discharged January 11, 1865, and pensioned. Examining surgeons describe him as very badly disabled and suffering from looseness of the joint, the consequence of loss of parts of the outer side of the knee. CASK 517. Private W. Trahey, Co. H, 71st New York, was discharged from service May 31, 1862, by reason of lame ness and partial anchylosis of the knee joint. Surgeon A. J. McKelway, 8th New Jersey, certified that the disability was caused by a wound made with an axe in February, 1862, which laid open the joint. The man is not a pensioner. CASE 518. Sergeant A. E. Waterman, Co. H, 1st Michigan Light Artillery, is reported by Acting Assistant Surgeon U. O. Farrand as having been admitted into St. Mary s Hospital, Detroit, August 20, 1864, with an accidental incised wound of the right knee, penetrating the joint, and that he was returned to duty October 3, 1864. He is not a pensioner. CASE 519. Private J. Williams, Co. H, 2d Sharpshooters, aged 32, received an accidental wound of the right knee by an axe, April 3, 1864. Assistant Surgeon W. Webster, U. S. A., in charge of De Camp Hospital, reported that the joint was penetrated and that the patient was returned to duty May 27, 1864. He is not a pensioner. SUKG. Ill 46 362 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. The evidence in the remaining twenty-three cases 1 of recovery after incised wounds of the knee is of a similar nature. The fatal cases are : CASE 520. Private G. M. Sadler, Co. B, 22d Michigan, was admitted into hospital No. 3, Nashville, where lie died February 8, 1864 Surgeon S. D. Turney, U. S. V., reported that the cause of death was "an accidental incised wound of the left knee joint, caused by an axe, and inflicted during the previous month. CASE 521. Sergeant J. A. Wynkoop, Co. E, 39th Iowa, aged 26 years, was accidentally wounded at Athens, Georgia, April 30, 1864. He was admitted into hospital No 19, Nashville, whence Surgeon W. H. Thorn, U. S. V., reported: "An axe wound of the left knee, penetrating the joint. Death on May 26, 18b 4." CASE 522. Private A. Hatfield, Co. I, 129th Illinois, aged 25 years, was admitted into the hospital of the 3d division, Twentieth Corps, October 7, 1864, with an accidental incised wound of the right knee, inflicted with an axe. On October 31st, he was transferred to hospital No. 1, Chattanooga, whence Surgeon J. H. Phillips, U. S. V., reports that he died on December 7, 1864, " of incised wound of right knee." CASE 523. Private A. G. Hill, Co. G, 43d New York, aged 25 years, was admitted into Finley Hospital, Washington, March 25, 1864, with an incised wound of the right knee, inflicted with an axe, accidentally, at Brandy Station, Virginia, Feb ruary 19, 1854. Surgeon G. L. Pancoast, U. S. V., reports that he died May 21, 1864, from the effects of the wound. Amputations in the Thigh after Incised Wounds of the Knee Jomtf. -Burrowing of pus, extensive sinuses above or below the knee, and sloughing, necessitated amputation in the thigh in six cases of incised wounds of the knee joint. Only one of the patients survived the operation: CASE 524. Private F. O Brien, Co. A, 4th New York, aged 24 years, was cut in the left knee by an axe during a fight iu a private house near Baltimore, February, 1862. He was admitted to hospital in Baltimore, where, on account of the diseased condition of the injured joint and adjacent parts, the limb was subsequently amputated about the middle of the thigh by Surgeon G. Taylor, U. S. A. The patient was discharged from service April 28, 1863, and supplied with an artificial limb. A cast of the stump was contributed to the Army Medical Museum by Assistant Surgeon J. W. S. Gouley, U. S. A., and constitutes specimen 919 of the Surgical Section. The man subsequently served in the Veteran Reserve Corps, and was discharged December 15, 1864. His application for pension was rejected. CASE 525. Corporal M. J. Allen, Co. I, 33d Indiana, aged 22 years, while putting up a tent on June 17, 1865, received an axe wound of the right knee joint. He was admitted to Brown Hospital, Louisville, several days afterwards, and on July 27th to Crittenden Hospital. Assistant Surgeon J. C. G. Happersett, U. S. A., in charge of the latter, reported that the injured knee was affected with synovitis; also that pus had penetrated the joint and was burrowing in the tissues above and below, necessitating amputation of the thigh, which was performed July 31st, by Acting Assistant Surgeon D. J. Griffiths, at the middle third. The patient died of diarrhoea August 11, 1865. CASE 526. Private H. C. Frazer, Co. A, 40th Ne\v York, while cutting wood, on June 20, 1862, accidentally struck the left knee. He entered Ascension Hospital, Washington, July 4th, whence Acting Assistant Surgeon J. W. Bulkley reported that the cut ran obliquely across the outside of the joint and had nearly healed when the patient was admitted. About ten or eleven days afterwards, however, the leg and joint became greatly swollen and inflamed, the skin rapidly assuming a bright red color. This was attended with excessive pain in the joint upon motion. Ice, cold irrigations, and tincture of iodine were applied, and salines, small doses of tartar emetic, and sweet spirits of nitre were administered. Bandages were applied from the foot to the knee joint with good effect. On July 20th. a small incision was made inside the ligamentum patella and gave exit to a large amount of sanious and highly offensive pus. About July 27th, the pus was noticed to be accumulating in the joint and burrowing above it in the muscles of the thigh. The bandage was still used, and cold, alternated with warm, applications were continued. Quinine and tincture of iron was now given, and beef tea and brandy punch freely. About the beginning of August an incision, made in the calf of the leg, gave exit to still more offensive pus. After August 5th the patient was slowly sinking. A small blackish discoloration was then seen on the inside of the leg, midway between the knee and the ankle: the foot, which from the first had remained cedematous, was puffed and pitting on pressure. On August 13th the black spot was noticed to be rapidly increasing and was recognized as gangrene, when a lotion of nitric acid was applied. On the following day, the necessity of amputation becoming manifest, two doses of one-half grain of morphia each were administered, after which the limb was removed about six inches below the trochanters by the antero-posterior flap method. The operation was performed by Surgeon J. C. Dorr, U. S. V., assisted by others, the patient being under the influence of chloroform, and losing but a slight amount of blood. Dead and disorganized tissues were found in the flaps and dissected out, after which the lips of the wound were closed by silver sutures and adhesive plaster. Stimulants were freely given, but the patient sank rapidly, and died at 5 P. M. on the same day. An examination showed that the soft parts were extensively disorganized nearly to the trochanters; also that the original wound had communicated with the knee joint. CASE 527. Private R. B. Swift, Co. H, 1st Regiment Michigan Engineers and Mechanics, aged 23 years, was accident ally cut in the right knee joint by an axe, while engaged on duty on the Northwestern Railroad in Tennessee, November 24, 1863. The cases are: 1. Pt. D. Bird, Co. G, 107th New York; 2. Pt. G. Blucher, Co. C, 119th New York; 3. C. Bradley, Government employe; 4. Pt. A. Capp, Co. II, 13th Illinois; 5. Pt. J. M. Condon, Co. B, 3d New York Cavalry; (i. Pt. H. Coon, Co. F, 14M New York; 7. Pt. T. Decker, Co. D, 15th New Jersey; 8. Pt. J. Elliott, Co. E, 4th California; 9. Pt. D. Geigheimer, Co. B, ]31st New York; 10. Corp I J. Howard, Co. D, 78th Illinois; 11. Pt. M. Kelley, Co. B, 59th Illinois; 12. Pt. J. Kimball, Co. A, 1st Wisconsin Cavalry; 13. Pt. L. B. Lewis, Co. C, llth New Hampshire; 14. Pt. H. T. Marsh, Co. I, 8th Ohio; 15. Pt. J. Martin, Co. D, Iu9th New York; 16. Pt. K. M. Morris, Co. C, 84th Indiana; 37. Serg t J. L. Morse, Co. D, 21st N. York Cavalry; 18. Pt. G. AV. Proctor, Co. D, IGth Illinois; 19. Pt. H. A. Smith, Co. G, 141st New York; 20. Pt. E. S. Spangler, Co. F, 145th Penn sylvania; 21. Pt. D. A. Stephens, Co. B, 2d Penn. Cavalry; 22. Pt. A. M. .Sutton, Co. L, 4th New York Artilley; 23. Pt. J. Wood, Co. G, 79th Ohio. SECT, iv.1 SHOT INJURIES OP THE KNEE JOINT. 363 On the following day lie was admitted to hospital No. 3, Nashville, where the limb was amputated on January 5, 1864, by Sur geon S. D. Turney, U. S. V., at the lower end of the middle third of the thigh. The operation was performed by the circular method with little loss of blood, chloroform and ether being used and four ligatures applied. At the time of the operation the knee was greatly swollen and very painful, the internal condyle was laid bare by sloughing, and the joint had opened exten sively, the discharges being very offensive. There were also extensive sinuses above the joint, and below it free incisions had been made to effect drainage. The patient had become quite reduced and was unable to sleep without opiates. He slept some during the night following the operation. Milk punch and beef tea were freely given, but the patient died from exhaustion January 7, 1864. The case was reported by the operator. CASE 528. Private E. H. Turner, Co. E, 1st Maryland, aged 23 years, was admitted to hospital at Frederick, October 3, 1864, having received an axe wound of the left knee joint. Acting Assistant Surgeon P. O. Cornish reported that the patient was not a very strong man and apprehensive of a fatal result from the first. Two and a half hours after the injury the wound was firmly closed with a stitch and adhesive plaster, after which cold lotions were used. Two days afterwards the joint became swollen and painful, and, on October 12th, synovia was flowing from the wound, the patient s tongue was coated, and his appetite poor. On October 15th, pus having formed in the joint, it was freely opened on both sides, also an abscess located above the knee but not communicating with the joint. Diarrhoea now set in and indications of pyaemia came on, and all the symptoms growing worse, amputation of the thigh at the middle third, by the circular method, was performed by Assistant Surgeon R. F. Weir, U. S. A., on October 18th. An examination of the amputated limb disclosed abscesses above and below the knee and in the popliteal space, and showed that the cartilages of the joint had commenced to break down. The treatment consisted of tonics, opiates, and stimulants. The stump having commenced to discharge unhealthy pus, it was opened on October 21st, and washed with bromine solution. Subsequently iodide of starch was administered, and iodine was applied to the stump. The patient died October 25, 1864. The post-mortem examination confirmed the existence of the pyaemic infection. The stump showed no reparative process around the bone, numerous small abscesses being present in the cellular tissues nearly to the hip joint. The fascia surrounding the femoral vein was closely adherent from inflammatory action, the coats of the vein being much thickened and filled with broken down clots. The valves of the vein and the coats of the femoral artery were also thickened and very friable. No pus was found in the hip joint. In the next case the external wound had partly healed by first intention so that a probe could not be made to enter the joint, but insidious burrowing of pus and disorgan ization of the tissues finally rendered amputation unavoidable: CASE 529. Private O. F. Reams, Co. B, United States Engineers, aged 23 years, accidentally cut his right knee joint open with an axe while in the act of chopping down a tree in camp, on March 12, 1864. He was admitted to hospital in Alex andria, March 21st. at which time there was but little suppuration, the external wound having partly healed by first intention, so that a probe could not be made to enter the joint. The patient was doing very well and had a good appetite, and hopes were entertained that the joint might be saved. On April 12th, the limb was somewhat swollen and painful, and his appetite began to fail. On April 22d. fluctuation was distinctly detected, when an opening was made and two ounces of pus escaped On April 24th, the thigh was amputated in the upper third by lateral flaps, by Surgeon E. Bentley, U. S. V. The tissues below the point of amputation were found to be infiltrated with pus and badly disorganized. The patient reacted well, though not very promptly. Pyaemic chills began two days afterwards, and secondary haemorrhage set in on April 28th, when the femoral artery was ligated just below Poupart s ligament. The patient died from the effects of pyaemia, May 1, 1864. At the autopsy large quantities of serous fluid were found in the pleural cavities and a number of pyaemic abscesses in the left lung. One abscess was also dis covered in the spleen. The latter organ, together with the bones of the amputated knee, were contributed to the Museum, with the history, by the operator, and constitute specimens 2253 and 2234 of the Surgical Section. SHOT INJURIES OF THE KNEE JOINT. Of the three thousand three hun dred and ninety-eight cases of shot wounds involving one or more bones of the knee joint, forty-three were designated on the reports as shot contusions, and three thousand three hundred and fifty-five as shot fractures. SHOT CONTUSIONS OF THE KNEE JOINT. Contusions of the knee joint 1 involving the condyles of the femur, the patella, or the head of the tibia by small projec tiles or fragments of shell, were noted in forty-three instances. Thirty-three were treated without operative interference, and ten were followed by amputation. Examples of shot contusions of the knee joint are reported by JOliEKT 1>E LAMltAU.E (Plaits d armes it feu, Paris, 1833. p. 065), who cites two successful cases. CHENU (J. C.) (Rapport, etc., pendant la Campagnt d Orient, Paris. 18<>5, p. 410) tabulates 70 cases of shot contusions of the knee joint, of which 4 proved fatal. ClIKXU (J. ( .) (Slat. Med. Cltir. de la Campagne-d Italic en 183!) et 1800, Paris, 18(W, T. II, p. 7(it>) records 21 cases of shot contusions of the knee joint ; 17 patients recovered and 4 died. HEINE (C.) (Die ScJitusvcrletzungen dtr Untercn Extremitiiten. Berlin, 18(J<>, p. 57) cites a case in which a bullet struck the lower third of the thigh on the inside just above the knee, passed over the knee, hugging the bone closely, and escaped on the outer side of the knee. On the third day after the injury a viscid fluid escaped from the wound of entrance. During the first days the symptoms were slight, and the wounds looked well, but they soon assumed an angry appearance. Immense infiltration and pyaemia supervened, and death occurred 14 days after the injury. At the post-mortem examination the bone was found entirely intact ; no roughening was noticeable, the peri osteum only being partially destroyed where the ball had passed along the bone. . . The synovial sac was opened at its inner and upper circumfer ence and was filled with pus. STKOMEYEK (L.) (Erfaltruiigrn iiber Schitsswunden im Jahre 18Wi, Hannover, 1867, p. 55) tabulates 8 shot contusions of the knee joint, but gives no results. Uui I llECHT (L.) (Militdriirztliclte Erfaltrungen wdhrcnd des Deutsch-t ra.mijsisdi<n Krieges im Jahre 1810-71, WUrzburg, 1871. p. 10) tabulates 8 cases of shot contusions of the knee joint and patella but does not indicate the results in the cases. 364 INJURIES OF THE LOWER EXTREMITIES. fCHAP. X. Shot Contusions of the Knee Joint treated by Conservation. Of the thirty-three cases of this group, eleven, or 33.3 per cent., were fatal. More or less swelling, extensive inflammation often involving the synovial membranes, necrosis, and exfoliations of small pieces of bone, abscesses, and effusions into the joint were the most prominent symptoms following shot contusions of the bones of the joint, and the cases of recovery were followed by wasting of the limb, partial or complete anchylosis, and, in a few instances, by perma nent enlargement of the joint and exacerbations of pain and swelling during damp seasons. Recoveries after Shot Coiitusions of the Knee Joint treated by Conservation. Twenty- two cases of this group are reported. The patella was the seat of the contusion in nine, the condyles of the femur in seven, the patella and condyles of the femur in two, and the head of the tibia in one instance; in three cases the parts injured are not specified. Four were Confederate and eighteen were Union soldiers. Of the latter, one was returned to duty and afterwards killed in battle; fifteen became pensioners, of whom one died of phthisis four years after the injury; two have not applied for pensions. CASE 5:?0. Private C. Bowers, Co. D, 84th Pennsylvania, aged 23 years, was wounded in the left knee, at Winchester, March 23, 1862, a ball striking the patella, passing upward one and a half inches, and lodging. He was admitted to St. Joseph s Hospital, Philadelphia, April 2d, where the missile was extracted by an incision. Considerable pain and inflammation ensued, and an abscess formed above the wound, discharging itself through the opening made for the removal of the ball. The patient was discharged July 16, 1862, and pensioned. Examining surgeons report him suffering from weakness in walking. CASK 531. Private G. W. Clark, Co. G, 126th Ohio, aged 27 years, was wounded at Winchester, September 19, 1864, by a musket ball, which passed through the right knee, grazing the patella. He was treated at various hospitals, and was ultimately mustered out June 25, 1865, and pensioned. Examining surgeons report partial anchylosis of the knee, difficulty in walking up and down hill, and considerable wasting of the limb. CASE 532. Private G. Deacon, Co. G, 14th Virginia Cavalry, aged 25 years, was wounded at Boorisboro , July 8, 1863, by a spent ball, which entered the outer and lateral surface of the right knee, passed inward and forward, striking the patella and lodging. He entered Frederick Hospital one week afterwards. The patient stated that he worked the ball out with his fingers on the field. About July 25th, an abscess formed at the point where the ball had lodged, when the external opening was enlarged, allowing the escape of about half an ounce of pus. Though no synovial fluid escaped, marked evidence of the joint being involved existed, the swelling being more extensive on the following day and fluctuation well marked. Tincture of iodine was then freely applied and the limb was placed in Smith s anterior splint. By August 10th the wound was nearly closed, the effusion within the joint had almost entirely subsided, and the patient was comfortable. On August 20th the wound was entirely healed, the appearance of the joint being natural, though considerable anchylosis existed, partly perhaps from deposit and partly owing to long continuance in one position. About a week later the splint was removed, and, on September 1st, passive motion was exercised without producing much puiu or tenderness. On September 5th, the patient was transferred to Baltimore, having considerable and daily increasing motion of the knee. The man was paroled for exchange September 25, 1863. CASE 533. Private J. Hammond, Co. 15. 98th Ohio, aged 25 years, was wounded in the left knee by a musket ball, at Chickamauga, September 20, 1863. lie was admitted to hospital at Chattanooga, whence Surgeon J. T. Woods, 99th Ohio, reported: "The missile entered at the inner hamstring precisely opposite the centre of the patella, and emerged an inch from the inner border of the patella." The patient was transferred to hospital No. 1, Nashville, where he was discharged from service March 3, 1864, by reason of "chronic synovitis and anchylosis of the knee joint." His name was subsequently admitted on the Pension Rolls, examining surgeons certifying to his disabilities, and reporting some enlargement of the bone and also swelling of the leg. CASE 534. Sergeant J. Hendricks, Co. F, 105th Pennsylvania, aged 32 years, was wounded in the right knee, at Gettys burg, July 2, 1863. He was admitted to hospital at Annapolis two weeks after the injury, and several months later he was transferred to Philadelphia. Surgeon I. I. Hayes, U. S. V., in charge of Satterlee Hospital, reported that the wound was caused by "a rifle ball striking the inner portion of the patella and involving the knee joint. The patient recovered with an ancliylosed joint. He was assigned to the Veteran Reserve Corps December 11, 1863." On September 16, 1865, the man was discharged from service, and subsequently he became a pensioner. In 1878, the examining surgeons reported: "The power to extend and flex the injured knee is still slightly impaired." CASE 535. Private G. Hodges, Co. B, 7th Michigan, aged 25 years, was wounded at Gettysburg, July 2, 1863, and entered Satterlee Hospital, Philadelphia, one week afterwards. Acting Assistant Surgeon M. J. Grier noted: "A shot wound of left knee by a mini6 ball passing over the patella, cutting through the outer laminae of the ligamentum patella and scratching the surface of the bone." A portion of the patella became necrosed during the progress of the case. The wound closed about October 1st, but reopened some ten days later, when a small piece of bone exfoliated. The wound healed about November 1st. Some days afterwards, however, the patient, while wrestling, fell on his injured knee, breaking open the tissues down to the ten don over the patella for an inch and a half in length. After this rupture reclosed the patient had an attack of facial erysipelas, which was cured, and subsequently he suffered with otorrhoea. On March 24, 1864, the patient was returned to his regiment for duty. He was killed at the battle of the Wilderness, May 6, 1864. SECT. IV.] SHOT CONTUSIONS OF THE KNEE JOINT. 365 CASE 536. Corporal L. P. Miller, Co. G, 124th New York, aged 27 years, was wounded at Chancellorsville, May 3, 1863, by a rninie ball, which entered the left knee one-half inch external to the inner condyle of the femur and emerged two inches anteriorly, bruising the bone. Surgeon D. W. Bliss, U. 8. V., reported his admission to Armory Square Hospital, Wash ington, May 8th, with the knee joint in a swollen condition. Irrigation was made by water dressings, and subsequently tincture of iodine was applied to the knee. By June 6th the wound had nearly healed, but there was considerable effusion in the joint and contraction of the flexor tendons. The patient subsequently passed through several hospitals, was assigned to the Veteran Reserve Corps March 2, 1864, and ultimately discharged August 13, 18(55, and pensioned. Examining surgeons report swelling of the knee, owing partly to enlargement of bone and partly to ocdematous condition of the tissues; also anchylosis from injury of the bony structures and from contraction of the tendons and ligaments. CASE f>37. Private M. Piggott, Co. K, 8Sth New York, aged 19 years, was wounded at Savage Station, June 29, 1862, by a mini6 ball, which grazed the right knee joint between the patella and the inner condyle of the femur. He was captured and remained a prisoner for nearly a month, when he was exchanged and conveyed to Philadelphia. Acting Assistant Surgeon J. B. Bowen reported that the patient was admitted to Fourth and George Streets Hospital, suffering from synovitis and a very painful wound as well as a much swollen knee. The treatment consisted of cold-water dressings, and afterwards fly blister and solution of lead and opium was used. On August 24th, the adhesions were broken up by Acting Assistant Surgeon S. D. Gross, and splints were applied. This was followed by more severe painfulness and enlargement of the knee. The patient was discharged from service and pensioned February 10, 1883, Assistant Surgeon L. D. Harlow, U. S. V., certifying to the " wound causing an external communication with the knee joint and resulting in permanent anchylosis. Surgeon E. P. Vollum, U. S. A., reported that the pensioner subsequently served in the 43d Infantry (Invalid Regiment), his injured knee being free of pain, but perfectly anchylosed and considerably bent inward, and flexed so that the heel did not reach the ground by about four inches. On May 10, 1869. the man was again discharged and re-admitted on the Pension Rolls. CASE 538. Brigadier General T. G. Pitcher, U. S. V., was wounded at Cednr Mountain, August 9. 1862, by a musket ball, which entered the right knee at the internal condyle of the femur, striking the bone perpendicularly upon its anterior face. The result of the injury, as apparent nine months after its reception, was recorded by Surgeon R. S. Satterlee, U. S. A., before whom the patient appeared for examination in April, 1863, as follows: "There is an unusual accumulation of fluid in the joint, enlargement of and more or less painfulness generally of the knee, and inability to extend the leg completely. The knee is sub ject to pain and swelling during cloudy weather, and the General is, at all times, required to use a crutch and cane. It would be exceedingly imprudent for him to travel. It is not known whether the missile remains in the knee or came out." General Pitcher was mustered out of the Volunteer service April 30, 1863, returned to the Regular Army, and was ultimately retired June 28, 1878. CASE 539. Adjutant J. E. Toure. Caswell s Georgia Sharpshooters, was wounded at Liberty Gap, June 25, 1863, and admitted to hospital at Murfreesboro the following day. Assistant Surgeon W. P. McCullough, 78th Pennsylvania, in charge, recorded the following history: "A gunshot wound of left knee by a mini6 ball. The missile struck the outer condyle of the femur, glancing downward and opening the capsular ligament of the joint, and making its exit at the middle of the fibula. The wound looked healthy and there was no inflammation. Ice was applied to the knee. One-half ounce of whiskey was given three times a day, and anodynes at bedtime. On July 27, 1833, the patient was sent to the prison at Nashville, his wound being entirely well, and there being but partial anchylosis of the joint." 1 Fatal Cases of Shot Contusions of the Knee Joint treated by Conservation. Ten cases of shot contusions of the knee joint terminated fatally. The patients survived the injury from twenty to seventy days, experiencing extensive burrowing of pus and ulceration of the joint, erysipelatous swelling, arterial bleeding, and, in one instance, gangrene. A few cases are detailed: CASE 540. Private G. W. Perkins, Co. G, 1st Massachusetts Cavalry, aged 22, was wounded at Beverly Ford, June 9, 18o 3, by a pistol ball, which entered the left knee at the lower outer edge of the patella, passed downward, and came out over the head of the fibula. Three days after the reception of the injury he was admitted to Douglas Hospital, Washington, where he was etherized and an incision made to examine the wound, when the head of the tibia was found to be grazed and the joint opened, allowing synovia to escape on motion of the limb. Ice- water dressings were applied for a couple of days. It was then resolved by Assistant Surgeon W. Thomson, U. S. A., in charge of the hospital, to lay the knee joint freely open by means of liberal incisions on either side of the patella and through the original track of the wound. By this means it was hoped to give free exit to pus, which was already filling the joint, and to save the limb with anchylosis, the operation being adopted as the only alternative to amputating the thigh. A large quantity of bloody pus and synovia escaped when the lateral incisions were made; two or three cutaneous vessels were tied, and by means of a syphon the limb was kept constantly under the effect of ice water. The patient, though having some fever and retention of urine, had very little pain in the knee and felt comfortable. Morphia and sweet spirits of nitre were prescribed. On June 17th, there was some fluctuation along the base of the internal condyle, for which a free horizontal incision was made, and tlaxseed poultices were applied. All the incisions about the knee continued to discharge freely. About one week later an crysipelatous swelling was noticed, a deep-seated abscess having appar ently formed and fluctuation being detected below the head of the tibia. A large quantity of pus was then liberated by a careful dissection, and the painful tension of the leg was thereby relieved. On June 26th, the patient had a severe chill for the first time, and his stimulants were at once increased and quinine and capsicum added to the prescription of morphia. On the follow ing day the fever had disappeared, but pneumonic symptoms were detected, and a mustard plaster was applied over the left chest. 1 This case has been noted by Surgeon I. MOSKS (Surgical Notes of Cases of Gunshot Injuries, etc., in the American Journal of Medical Sciences, 1864, Vol. XLVII, p. H40). 366 INJURIES OF THE LOWER EXTREMITIES. ICHAP. x. Suppuration .still continued freely from all the openings. On the morning of July 1st, a large amount of arterial blood was found to have escaped through the incision along the gastrocnemius muscle, and compression was at once made in the groin and the wound was cleaned out carefully, the source of the hleeding being apparently the anterior or posterior tibial artery near the bifurcation, and too deeply seated to be reached without careful dissection. Meanwhile the patient, already moribund, was stimulated, but without avail. He died within a half hour, from the immediate effects of the haemorrhage. At the autopsy a diffused abscess was found following the course of the vessels in the popliteal space into Hunter s canal but not otherwise involving the thigh; all the connecting tissue in the ham was iw a sloughing condition. When the artery was dissected out the perforation was found in the anterior tibial, about three-fourths of an inch from its origin, the vessel being much thickened, soft, and tough, though not materially diseased. The left lung was- found firmly adherent and much congested. The bones com prising the injured knee joint were contributed by Dr. Thomson (Cat. Surg. Sect., 1866, p. 323, Spec. 1339), and the history of the case was furnished by Assistant Surgeon C. C. Lee, U. S. A. CASE 541. Private J. McAllister, Co. C, 72d Pennsylvania, was wounded in the right knee, at the Wilderness, May 6, 1864, by a mini ball, which entered four inches above the external condyle and lodged on the outside of the patella, without perforating the capsular ligament. Surgeon D. Prince, U. S. V., reports that the following treatment was resorted to in the case: "The bone was cut down upon and the missile pulled out. No inflammation of the joint ensued until the eleventh day after the injury, when the joint swelled and became excruciatingly painful, attended with free discharge of synovia from the wound in front, on the outer side of the patella. On May 18th, this opening was enlarged and a counter-opening was made behind the external lateral ligament and tendon of the biceps, the patient being under the influence of ether. The limb was subjected to moderate extension for the following purposes: 1st, to separate the opposing joint surfaces and obviate the ulcera- tion attending contact and pressure, at the same time lessening the amount of irritation; 2d, to obviate the caries and necrosis of bone apt to follow, and making bony anchylosis impossible; 3d, to preserve the limb in a position to be afterwards useful. The patient was relieved of suffering by the incision and experienced a feeling of comfort from the moderate extension." The records in this case show that the patient was admitted to the field hospital of the 2d division, Second Corps, with "shot wound of knee," and Surgeon T. R. Crosby, U. S. V., reported that the man entered Columbian Hospital, Washington, May 28th, with "shot wound of right knee joint," of which he died on the following day, May 29, 1864. CASK 542. Private A. D. Seelye, Co. A, 136th Pennsylvania, was wounded at Fredericksburg, December 13, 1862, by a musket ball, which entered the right knee over the external condyle of the femur and passed out in the popliteal space. He was admitted to Lincoln Hospital, Washington, ten days after the injury. Cold-water dressings and afterwards iodine tincture were applied at first; subsequently warm dressings. The wound did badly; the joint became inflamed, and unhealthy pus was secreted in large amounts. On January 16, 1863, an incision was made extending six inches from the wound of entrance up the thigh. Considerable bleeding followed and several small vessels were tied, after which the wound was packed with cotton bandages soaked in persulphate of iron. Another lateral incision, two and a half inches long, was made below the popliteal, opening an abscess. On January 25th, an opening was made opposite the large one for the purpose of better drainage. Up to this time his appetite had been good, but now it failed, and the patient became delirious and had a troublesome diarrhoea. The wound remained open and exposed the blackened surface of the femur for the space of three inches. Death supervened on February 3, 1863. At the post-mortem examination the internal condyle was found to be injured in its posterior aspect. The cartilages of the joint were destroyed and the surfaces of most of the bones roughened and honey-combed. An abscess in the thigh had dissected the femur half way up the limb. The history of the case was recorded by Acting Assistant Surgeon T. H. Dearing. CASE 543. Private J. Tetlow, Co. F, 23d New Jersey, was wounded at Fredericksburg, December 13, 1862, by a ball entering the outer side of the popliteal space of the right leg. The patient, a strong healthy man, was admitted to hospital at Alexandria six days after receiving his wound. The knee was tender and the inflammation slight at first, but soon grew worse. On December 23d, the patient had a chill and there was high constitutional fever, with great swelling and pain in the knee. On the following day the ball was discovered lying loose in the wound and was removed. On December 29th, pus was detected and let out by free incision, giving much relief. Subsequently the patient became delirious at times, and on December 31st he again had a chill, with pain in the stomach. He died January 2, 1863. At the autopsy it was ascertained that the ball had impinged upon the under side of the internal condyle, killing the periosteum for over a space -of half a dime. The other articu lating bones were also found bare of periosteum, and pus had filled the knee joint and dissected up the lower third of the femur. The case was reported by Acting Assistant Surgeon G. F. French. 1 CASK 544. Private L. D. Wells, Co. D, 74th Indiana, aged 22 years, was wounded at Chickamauga, September 20, 1863, by a musket ball, which entered about two inches above the inner condyle of the right femur, passed obliquely under the bone between the two condyles, grazing the inner, and emerged about three inches below the head of the fibula. He was admitted to hospital at Chattanooga, and thence transferred to hospital No. 8, Nashville, on October 30th. There was little swelling of the parts, and the relative constitutional condition of the patient was good until he became greatly prostrated from haemorrhage, the precise seat of which could not be determined. On November 17th, the femoral artery was ligated at Scarpa s space by Surgeon W. C. Otterson, U. S. V. Reaction was perfect by the following day. The limb was wrapped in cotton bat ting. No particular change occurred until November 24th, when the wound suppurated excessively and injections of solution of sulphate of iron were ordered. The leg and foot were cedematous. On the next day the wound made by the operation broke open and suppurated freely. On November 27th, the patient was worse in every respect and marks of gangrene appeared. Remittent haemorrhage from the anterior tibial artery caused death on December 1, 1863. The autopsy showed that the ligature had not yet cut away. The femoral was obliterated on the cardiac side for about one inch ; the profunda was greatly enlarged. The femoral vein was discolored and contained a clot three or four inches long and not entirely obstructing the circulation. The structures at the seat of the haemorrhage were greatly disintegrated. Tl.e hie -ry of the case was reported by the operator. BELLANGER (J. B.), Report of Wve Cases of Gunshot Injury of the Knee Joint treated at Mansion House Hospital, Alexandria, Virginia, Slay Iti, 18(i3, in American Journal Medical Sciences, 1863, Vol. XLVI, p. 44. SECT. IV.] SHOT FKACTURES OF THE KNEE JOINT. 367 CASK ."45. Private C. Wertli, Co. K, 1st New York, aged 22 years, was wounded in the left knee and right ankle, near Richmond. June 30, 1862. Acting Assistant Surgeon J. B. Bowen reported: A ball entered one inch above the knee, and eiu.rged at the inner portion of the leg one inch below the patella, grazing that bone and the head of the tibia; the other ball entered at the external nialleolus and comminuted the tarsul bones. The wounded man was taken prisoner and sent to Rich mond. He was received at the Fourth and George Streets Hospital, Philadelphia. July 23th, in a debilitated state and with both wounds in a very bad and painful condition, there being synovitis of the knee and purulent discharges. Linseed poultices and solution of sulphate of copper were applied to the ankle, and cold-water dressing and subsequently blister, followed by solution of lead and opium, were used to the knee. The patient gradually sank, and died from exhaustion August 8, 1862. Amputations after Shot Contusions of the Knee Joint. The ten instances comprising this group have already been cited in the tables of amputations in the thigh in the pre ceding section of this Chapter. Five were intermediary and five secondary operations. 1 Eight of the ten operations terminated fatally. SHOT FRACTURES OF THE KNEE JOINT. The cases to be considered in this group are those involving primarily the bones composing the knee joint. They number three thousand three hundred and fifty-five, atid are classified in the subjoined table: TABLE LII. Numerical Statement of Thirty-three Hundred and Fifty-jive Cases of Shot Fractures of the Bones of the Knee Joint. PARTS INJURED. MODE OF TREATMENT. CONSERVATION. Excis. OF KNEE EXCISION OF KNEE :, J T FOLLOWED AMPUTATION AT KNEE JOINT. : BY AMPUTAT N JOINT. or THIGH. AMP. AT KNEE j BY AMPUTAT N 1 OF THIGH. AMPUTATIO> THIGH. OF | s o ill o o 69 9 7 1 84 22 6 56 84 Death. Undetermined. Mortality Rate of Determined Cases. _" Recovery. | Undetermined. a Recoverj . 1 ! G 5 ? V 1 Death. Undetermined. W Recovery. i : . 3 " 1 5 o a o $ 159 17 22 4 117 47 10 137 89 8 15 30 25 4 80 1 1 4 56. 3 47.0 68.1 75.0 26.3 53.1 40.0 58.8 76.0 10 4 2 8 2 1 5 14 1 1 7 3 2 2 7 Q .... 2 o 4 1 3 419 178 68 26 59 23 20 9 21 9 85 55 17 j 7 285 H5 1,403 744 241 36 11 12 30 10 170 659 Patella and Condyles of Femur .. Cond. of Femur and Head of Tibia Cond. of Femur, Patella, and Head of Tibia . . .... 1 1 1 1 1 1 Patella, not opening-joint primarily Patella, opening the joint primarily Patella and Head of Tibia .... 1 1 1 1 4 12 1 1 1 7 13 1 2 13 1 1 1 2 1 1 Head of Tibia 2 1 11 2 3 3 868 338 521 9 60.6 49 8 38 3 7 1 6 49 25 23 1 5 1 2,377 1,166 1,211 It will be seen that the table embraces a great variety of injuries. In two hundred and eighty-three instances the bony lesion interested the patella only; in five hundred and ninety-four the condyles of the femur were fractured; in eighty-nine the condyles of the femur and the patella; in eighty-six the condyles of the femur and the head of the tibia; in twenty-seven the condyles of the femur, the patella, and the head of the tibia: in thirty-three the patella and the head of the tibia; in four hundred and forty the head ot The cases of intermediary operations are: Pt. J. Kimm, E, li)2d New York, recovery (No. 99, TABLIC XXXV, i>. 281); Pt. C. Kerkey, A. 10th Pennsylvania Reserves, fatal (No. 221, TABLE XXXV, p. 283); Serg t J. Walker, F, 2d Maryland, fatal (No. 453, TABLE XXXV, p. 28(5); Serg t M. Akeman, I, 13th Indiana, fatal (No. 220, TABLE XXXVI, p. 296); Pt, J. Wright, D, 7th New York Heavy Artillery, fatal (No. H7(i, TAIILK XXXVI. |>. 303). The secondary operations are: Pt. 7. Bradley, D, 25th North Carolina (No. 32, TABLE XXXVIII, p. 308); Pt. J. Jones. 1C, 13th Tennessee Cav alry, recovery (No. 40. TABLE XXXIX, p. 314); Corp l R. H. McCann, Q, 13th Mississippi, fatal (No. 141, TAIILK XXXIX, i>. :u: ; I t. T. Nevins. K, G3d New York, fatal (No. 172. TABLE XL, p. 322); Corp l J. D. Touhey, B, 14th New York, fatal (No. 196, TABLE XL, p. 323). 368 INJURIES OF THE I.OWI1R EXTREMITIES. fCHAP. x. the tibia was involved; and in one thousand eight hundred and three the fractured portion of the articulation was not specified. Eight hundred and sixty-eight were treated on the expectant conservative plan ; forty-nine by excision; seven by excision and subsequent ampu tation of the thigh; forty-nine by amputation through the articulation; rive by amputation at the knee joint and subsequent amputation of the thigh; two thousand three hundred and seventy-seven 1 by amputation of the thigh, six of which were followed by amputation at the hip. 2 SHOT FRACTURES OF THE BONES OF THE KNEE JOINT TREATED BY CONSERVATION. Of the three thousand three hundred and fifty-five cases of shot fractures of the bones of the knee joint, eight hundred and sixty-eight, or about one-fourth, were treated throughout without operative interference. 3 The results in nine instances 1 There are noted in this table 2,3S . amputations of the thigh f..r sh<,t fractures of tlie bones of the knee joint, of which 11! had been preceded by excisions or amputations at the knee joint, and (i had been followed by disarticulatiou at the hip. To these J.:*9 amputations should be added 10 opera tions for shot contusions of the knee joint, making the total of 2.399 cases of thigh amputations for shot injuries of the knee joint, as indicated in TAltLK XI, VI, on page 332, ante. "Cases of Pt. Julius Fabry, Co. 1C, 4th Artillery (CASE 330, p. 153. and No. 2 of TAIJI.E XVII, p. 15!>): 1 t. Eben K. Smith, Co. A. llth Maine (CASK 3:)2, p. 155, and No. 4 of TABLE XVII, p. 159); Serg t E. I). Ulrner, Co. G, 15th New Jersey (CASE 333, p. 15(i. and No. 5 of TAIU.K XVII, p. 159); Pt. It. A. Vick, Co. 10, 43d North Carolina (CASE 334, p. 157, and No. C of TABLE XVII, p. 159); Henry Campbell, sutler s clerk (CASE 335, p. 157, and No. 7 of TAUI.E XVJI. p. 159), and Pt. Lewis Larry, Co. A, 1st New Orleans Regiment (CASE 33(i, p. 158, and No. 9 of TABLE XVII, p. 159). a Examples of shot wounds of the knee joint treated without operative interference have been cited by FRAMBESAKIUS (N. A.) (Canonum et Con- sultationum, Librilll. quibus aphoristica metlwdus medendi omnibus affectibus corporis continetur, Paris, 15i:5): A ball lodged in the knee joint appeared afterwards on the surface and was cut out. SCHMIDT (J.) (Speculum Chirurgicum oder Spiegel der Arztne.i. Augspurg. 1(>56, pp. 153 et, se</.): On Decem ber 12, 1032. a Swedish dragoon was shot through both knees; both patellas were fractured; the patient recovered, but could walk only poorly on crutches. In October, Ki47, a Bavarian soldier was shot through the right knee; he remained for three days without assistance; a "jury of six" recommended ampu tation ; Dr. SCHMIDT refused to operate, dressed the wounds, and placed the limb in a straight position ; pieces of bone came away ; recovery in six weeks. G. ISasch, shot through the left knee joint, May 18, 1648; fracture of bones; recovery. Th. Rosen, shot through right knee: recovery. Z. Neschin. shot through right knee, May 20, 1648; swelling; suppuration relieved by incision; recovery. GUILLEMEAU (J.) (Les Oe.urres de Chirurgie, Rouen, 1G49, Chap. IV, p. (i52): M. de la Tour received, in the barricades of Paris, a shot wound of the left knee joint : ball entered above the crest of the tibin, fractured " le petit fossile" in several pieces. Barber-surgeon Habicot made an incision and removed the spiculae ; recovery. WISEMAN (K.) (Severall Chirury. call Treatises, London, Ki7, p. 430): A page of Lieut. General D. L was shot through the knee, the ball fracturing the joint : excessive pain and aneurismal bleeding; putrefaction, delirium, spasms, death. BELLOSTE (Le Chirurgien d Uopital, Paris, 171(i, p. 21(i): A captain, shot through the right knee, at Pignerol, in 1G91 ; extensive suppuration; wound of entrance enlarged by incision; recovery in five months. MoiiAXl) (Opuscules de Chirurgie, Paris, 1768, T. II, p. 252): General Keith, shot at the siege of Okzakow, in 1738, through the right knee ; extensive suppuration followed; two pieces of cloth escaped; the General recovered and was afterwards killed at the battle of Chemnitz. DESl Oin ( Traite des plaits d armes a feu, Paris, 1749. p. 22- et seq.): A cannonier, at the siege of Milan, in 1733, received a shot wound of the knee joint, fracturing the inferior extremity of the femur; wound enlarged and the ball, found embedded in the femur, removed. The patient recovered in two months. A soldier, shot in the right knee, at the battle of Parma, in 1733- the ball lodged in the joint. The extenial condyle of the femur was fractured; the ball was extracted, and the patient recov ered with complete anchylosis. A volunteer was shot, in Corsica, in the outer and anterior part of the knee. The wound was enlarged and fragments of the outer condyle of the femur and of the patella were removed, and the ball extracted; the patient recovered in two and a half months. TIIEDEN (J. C. A.) (Neue Remcrkungen und Erfahrunijen zur Sereicherung der YVnndarzne.ykunft, Berlin, 1782, 1?, I. p. 78): Major Kamke, wounded at Striegau, in 1745 : the ball perforated both condyles of the femur ; the wound was enlarged and a large number of spiculss removed from the extremity of the femur ; recovered with a stiff knee joint. BOUCllElt (Observations sur des playes d armes u feu, etc., in Alem.de, I Acad. Roy. de Cltir., Paris, 1753, T. II, p. 295): A drummer, wounded May 2, 1749. at Lille, through the internal condyle of the femur: wound enlarged and fragments removed; recovery, with stiff knee and one and a half inch shortening. BELMAS (BORUEXAVE) (Precis deplusieurs observations sur les plaijcs d armes . feu, etc.. in Mem. de I Acad. Roy. de Chir., Paris, 1753, T. 11, p. 527): A captain of an Algerian vessel was shot through the knee, the ball carrying away about throe inches of the upper part of the tibia. i small portion of the patella, the head of the fibula, and a portion of the condyle of the femur. Dr. BELMAS removed several fragments, and the patient recovered with anchylosis of the knee joint. Two similar cases are detailed by MEHEE (J.) (Traite des plain d armes it feu, Paris, An. VIII (1800), p. 175): A cavalier, wounded at Ludzerberek ; the ball passed through the right knee from before backwards, shattering the patella and the condyles of the femur: extensive incisions were made and numerous pieces of bones, some loose, some partly attached, were removed; recovery, with complete anchylosis. A laborer of Meaux was shot through the right knee from the outer to the inner side, shivering the articulation ; swelling of the thigh and gangrene ; large incision to allow the escape of fetid pus ; a piece of bone the size of a dollar, and of the thickness of the little finger, from the condyles of the femur, was removed, and other sharp points of bone were cut off; 15 days later another piece of bone, an inch long, from the loose portion of the shaft of the femur, was removed ; recovery, with hardly any defect of the articulation. HUNTER (JOHN) (A Treatise on the Jllood, Inflammation, and Gunshot Wounds, London, 4to, 17B4, p. 531): A French soldier at Bellisle, in 17(il, shot through the knee, the ball traversing the joint without fracture of bones; recovery. L. J. RABASSE (Sur les plaies des articulations faitcs par les armes dfeuou les instrumens tranclians. These a Paris. 1811, No. 84, pp. 10, 18): General Charles de Lameth, wounded at the siege of New York 1783,[H the ball traversing the left kneo through the condyles in its greatest diameter from the right to the left. The patient, who was treated by Surgeon-Major ROBILLAKD, of the French army in the United States, recovered without the least immobility of the limb. In a second case the eondyles of the femur were fractured, and the ball lodged. The missile could not be found. Extensive swelling followed, but the patient recovered in about three months, with anchylosis of the knee. The author regrets that the man s pantaloons were not examined, as the ball might have been found. DKSAULT (Journal de Chirurgie, Paris, 1791, T. I, p. 321): V. Viry, aged 15 shot in the right knee on January (i, 17! 0; fracture of the patella and the condyles of the femur; recovery without anchy losis. GEltMAIX LEVIKLS (Essai sur lex avantages qu il peut y aroir a amputer la cuisse, lorsqu itn coup de feu a travers: I articulation du ge.noti, ou lorfquf. la balle y eat demeuree profonddment engagie, Paris, These, Vol. XXXII, An Xl-1803, p. 40 et seq.) cites six fatal cases: J. Bourdon, wounded in I .aly, November 22, 1793; shot wound of knee joint; bones not fractured; fatal. Young man, aged 20; shot through knee joint in June, 1797; bones crushed; amputation refused; fatal. Two soldiers shot in the knee joint in October, 1793. The patella and the condyles of the femur were fractured in one case ; the ball lodged; erysipelatous swelling; death. In the other case the ball passed through the joint, perforating the condyles of the femur; several spiculae were removed; suppurative fever and death. Captain Milet, 72d Grenadiers, shot through the knee joint June 27. 1798; no bony lesion; suppuration relieved by incision; fever; death. Barot, 72d Grenadiers, shot in the right knee on October 2, 1799; extreme pain, swelling, inflammation, and death. PERCY (Manuel du Chirurgien- D Armee, Paris, 1792, p. 1U4) alludes to the ease of M. d Almons, an engineer; SECT. iv.| SHOT FRACTURES OF THE KNEE JOINT. 369 could not be ascertained. Three hundred and thirty-eight were successful, and five hundred and twenty-one fatal, a mortality of 60.6 per cent. Recoveries after Shot Fractures of the Bones of the Knee Joint treated by Conserva tion. Examples of the three hundred and thirty-eight recoveries after shot injuries of the bones of the knee joint treated throughout on the expectant plan, will be cited in the order of the groups indicated in TABLE LII. In the following five cases the joint was opened and the condyles of the femur injured: CASE 546. Captain A. P. Fisk, Assistant Adjutant General, U. S. V.. was wounded at Fair Oaks, June 1, 1862, by a conoida! musket ball, which entered the inner side of the right knee and was cut out from beneath the skin on the outer aspect. The haemorrhage following the injury was slight. The case was reported by Surgeon G. Grant, U. S. V., who, together with Surgeons J. A. Lidell and A. N. Dougherty, was satisfied that the joint was implicated. Immediate amputation was advised but rejected by the patient. The pain in the joint was excruciating. Surgeon Grant dressed the wound, after which the patient the ball encrusted itself in the condyle of the femur, and the patient recovered. WEDEKIND (GEORGE) (Nachrichten ueber das FranzBsische Kriegs- apitalwesen, Leipzig. 1798, B. II, p. 05): J. H. Barzou, Corporal, 10th demi- brigade of Light Infantry; shot comminution of right knee, in 1795, near Uastadt : tetanus: death. CHEVALIER (T.) (A Treatise on Gunshot Wounds, 1804, p. 116): J. T , aged 19, August 27, 1799, external condyle of femur split ; October 1st, a piece of bone removed ; 10th. amputation proposed but abandoned as the patient fainted on moving ; death in a few days. At the post-mortem the ball was found in the internal condyle of the femur. LAUKEY (D. J.) (Mem. de Cliir. Mil. ft Camp., Paris, 1812, T. Ill, p. 236): Ibrahim, a mameluke, received, in August, 1799, a shot fracture of the patella; the ball traversed the knee joint; the patient recovered. FENECH (E.) (Obs. recueillies d Varmce d Espagne svr les plates d armes a feu aux extremites, Paris Thesis. 1813, pp. 13, 19): Obs. XIII, soldier of 62d regiment, wounded at Yimeira, in Spain, August 17, 1808 ; fracture of inner condyle of femur; recovery. Obs. XXVIJ, Gracieux, Adjutant, 62d regiment, wounded August 17, 1808; fracture of patella and inner condyle of femur; fatal. MEALOXIER (Sur les plaies de I articulation du genoufa ites par les armes tiifeu, Paris, These No. 16, 1814, pp. 19, 22, 24): Lecoeur, 50lh line, shot through the right knee, at Salamanca, July 12, 1812; the ball traversed the joint; no bony lesion ; death. A dragoon, 10th line, in Calitzia, in 1806, was shot in the left knee; ball lodged in the external condyle of the femur; incision made, and ball and large fragment of bone removed; death. A soldier, at Pultusck, December 26, 1806, received a shot fracture of the inner condyle of the femur, the ball traversing the joint; tumefaction; death. DEGUISE (CH.) (Dissertation sur les plaies des articulations, Paris These, 1815, No. 4, p. 17): A sub-lieutenant of the 80th line; shot in Spain, through the knee; no lesion of bone; complete recovery. BLONDEAU (J.) (Propositions de patkologie fondies sur des observations, Paris, 1815, These No. 64, p. 21, Obs. X): A soldier at the battle of Aropiles, in Spain, in 1810, was shot in the right knee, the ball lodging under the patella, whence it was removed ; he recovered. BELL (C.) (Report on Gunshot Wounds of the Knee Joint in Surgical Observations ; being a Quarterly Report of Cases in Surgery treated in the Middlesex Hospital, London, 1816, p. 429): D , shot in the knee September 6, 1812; ball lodged in condyle of femur; recovery. TROWliKIDGE (A.) (Gunshot Wounds, in Boston Medical and Surgical Journal, 1838, Vol. XVIII, p. 342): Colonel McNeil, shot in the knee, at the battle of Bridgewater, July 25, 1814 ; the ball entered above the patella and injured the condyles of the femur; recovery, with partial anchylosis. MANN (JAMES) (Medical Sketches of the Campaigns of 1812-13-14, etc., Dedham, 1816, p. 211): A soldier of the 33d regiment, admitted into hospital at Burlington with a shot wound through the knee; amputation proposed but refused; sinuses laid open and a spiral bandage applied from foot to trunk; recovery, with a stiff joint. EHULICH (J. A.) ( Chir. Beobachtungen, Leipzig, 1815, B. II, p. 115): A soldier of the 5th Italian regiment, aged 22, shot at Liitzeu, May 3, 1813, through the right knee joint, fracturing the external condyle of the femur and internal condyle of tibia ; recovery, with anchylosis of joint. CHAMPION (L.) (Traite de la Resection des os caries dans leur continuile on Uors des articulations, Paris, 1815, No. 11, p. 77, Obs. XIV): Chauveau, 42d demi-brigade, shot in the right knee, at Ltltzen, May 2, 1813; ball struck internal condyle of tibia and lodged, and was removed in April, 1814, by chiseling away the carious surface of the bone; recovery, with good use of limb. BLKNKIXS (G. E.) (Article Gunshot \Younds, in COOPER S Dictionary of Practical Surgery, London, 1861, Vol. I, p. 816): A soldier of the 95th regiment was shot through the knee joint, at Merksam, near Antwerp, in 1814 ; he died after several months suffering. CAilliUAY (Journal de Chirurgie, par M. MALGAIGNE, 1846, T. IV, p. 361): A young man, aged 15, shot through the patella, at the storming of Cambria, near Water, loo, in 1815; recovery. HEXNEN (Joiix) (Principles of Military Surgery, London, 1829, p. 147 et seq.): A soldier, shot in the knee joint at the storming of Nivelle, Nov. 10, 1813, the ball perforating the join*; inflammation, and death on the fourth day. Lieutenant-Colonel R , shot in the right knee joint, June 18, 1815; the patella was fractured; the missile lodged ; recovered, with good use of limb, in about five weeks. Major B . aged 28, received a shell wound of the right knee, June 18, 1815; the patella was fractured and the femur grazed; fever; swelling of lower part of thigh; incision on external part of thigh four inches deep: a pint of pus evacuated; July 6th, portion of patella removed; recovery, with complete anchylosis. BEGIN (L. J.) (Memoire sur le traitcment des plaies des articulations, in Kec. de Mem. de Med. de Chir., etc., 1825, T. XVI, 1st s6r., p. 6): J. A , chasseur, wounded at Barcellona, Spain, September 15, 1823 ; fracture of patella and condyle of femur ; recovery. JOBERT UE LAMISALLE (Plaies d armes dfeu, Paris, 1833, p. 266 et seq.) gives brief details of 11 penetrating wounds of the knee joint from the revolution in Paris, in 1830; 10 recovered and 1 proved fatal. In the fatal case the femur and tibia were interested ; of the 10 cases of recovery the condyles of the femur were injured in 5, and in 5 there was no bony lesion. LAKKEY (II.) (Kel. cln r. des ecenemens de Juillet, 1830, Paris, 1831, p. 110): C , 50th line, in July, 1830, received a shot in the left knee; the internal condyle of the tibia was fractured; swelling, pain, and infiltration, and death on August 25, 1830. MEXIERE (P.) (L Hotel Dieu de Paris en July et Aout, 18:50. Paris, 1830, pp. 314-320) briefly cites 5 cases ; 4 were fatal and the result in 1 is not indicated. In one case the head of the tibia was fractured ; in the other 4 cases no mention is made of fracture of the bony structure. ARNAL (Mem. sur quelques particular it(s des plaies par armes a feu, in Jour. univ. et hebd. de Med. et de Chir., Paris, 1831, T. Ill, p. 38) alludes to 8 cases of shot wounds of the knee joint, with injuries of the bony structure; all recovered with false anchylosis. DE MOUTAIX (Observation d un coup de feu ayant travcrs^ I articulation tibio-femorale droite : gw rison avec ankylose, in Rec. de Mem. de Med. de Chir. et de Phar. Mil., 1839, 1st ser., T. XLVI, p. 9Vi): C , 48th line; perforation of knee joint; articular surfaces ploughed through ; recovery, with anchylosis. ALCOCK (R.) ( Observations on injuries of Joints, in Med.-Chir. Transactions, 1840, Vol. XXIII, pp. 60, 261) tabulates 18 cases of shot wounds of the knee joint; 3 recovered, 15 were fatal. HOME (WILLIAM) (Report on various cases of Gunshot Wounds received in actions in Upper Canada, in 1858, in Edinburgh Med. and Surg. Jour., 1840, Vol. LIV, p. 28) relates a case of fracture of condyle of femur, the ball traversing the joint ; recovery, with anchylosis. WARD (BRAXSliY COOPER, The History of a Gunshot Wound in which he Patella u-as carried away and the Knee Joint completely laid open, in GUY S Hospital Reports, J840, Vol. V, p. 88): E. M , patella shot away, November 2, 1838; joint opened; recovery, with considerable motion of joint; walks without a cane. BAUDEXS (L.) (Clinique des Plaies d armes I feu, Paris, 1836, p. 446): A sergeant, 20th regiment, in 1631, was shot through the condyles of the right femur; small fragments of bone removed from osseous channel ; recover)-, with slight anchylosis. WILLIAMSON (G.) (Military Surgery, London, 1863, p. 172) cites a case from the war in India, in 1833: E. Marr, 20th regiment ; patella fractured, joint opened October 21, 1833; recovery, with anchylosis ; died 19 months later, of disease of the liver. LEHEUT (06s. Cliniqucs sur les plaies d armes a feu et sur quelques avtres blcssures, in Arch. Gen. de Mid., 1845, T. VII, IV ser., p. 327): Ottwiller, aged 24, wounded at Trient, May 21, 1844 ; joint perforated ; recovery, with good use of limb. Coudray, aged 35, ball passed through the joint behind the patella ; several pieces of the patella and head of the tibia removed ; severe pain and inflammation ; death. The space assigned to this section ot Chapter X will not permit a detailed reference to the cases of shot wounds of the knee joint treated by conservation during the last 30 years. A numer ical statement of these cases will be given in the concluding remarks of this section of Chapter X. SURG ITT 17 370 INJURIES OF THE LOWER EXTREMITIES. [CHAP.X. was sent to the rear, where he was examined by Assistant Surgeon A. J. Baxter, U. S. A., who stated that he found the inner condyle of the femur fractured and that he passed his finger into the joint. The patient was subsequently sent to New York, where he came under the care of Dr. Willard Parker. Surgeon J. F. Hammond, U. S. A., August 19, 1862, certified to a description of the wound and stated: "The knee is swollen and the joint semiflexed. The orifices of the wound are healed, but one retains the crust, It is subjected to passive motion and gradual extension." In a certificate dated three months later, Surgeon Hammond reported: "He is gradually convalescing from the gunshot wound of the knee joint described in my former certificate. He cannot flex his leg quite to a right angle, and the knee becomes painful and swollen when exercised," etc. Surgeon Grant added to his report that Captain Fisk ultimately recovered, and served as Assistant Adjutant General in the Department of the East. He was mustered out of service November 22, 1865. He did not apply for pension until nearly thirteen years afterwards, when the New York City Examining Board described his condition as follows: "Circum ference of right knee over patella one-half inch larger; loss of bone probably from both the femur and tibia; bony projection on one side of aperture of exit. Motion of extension nearly complete; flexion one- third impaired. External curvature of the limb at knee joint, Crepitus on motion in joint; pain from effort always, from change of weather, and also from maintaining one position; walking and standing particularly irksome," etc. Captain Fisk was paid as a pensioner, September 4, 1879. CASE 547. Private P. Stuck, 1 Co. E, 116th Pennsylvania, aged 18 years, was wounded in the right knee, at Spott- sylvania, May 12, 1864, and entered Douglas Hospital, Washington, six days afterwards. Acting Assistant Surgeon H. Gib bons, jr., described the case as follows: "The missile, probably a rninig ball, entered at the inner border of the patella and escaped a little external to the center of the popliteal space, going directly through the joint and grooving the articular surface of the internal condyle, but passing mainly through the intercondyloid notch. The patient was a man of delicate organization. He had but little constitutional disturbance and not much inflammation in the joint, which, however, was somewhat swollen. Simple water dressings were applied. The discharge was free, abundant, and thin, the pus being mixed with synovial fluid. On June 9th ; there was some loss of appetite, with small, frequent pulse, and the patient complained of pain in the knee, which was swollen considerably. Flaxseed poultices, applied for two or three days, procured a free discharge from the posterior wound (the anterior wound having healed), when the symptoms immediately abated. In the latter part of August the patient began to walk about on crutches, the leg being flexed at an angle of about 135 with the thigh. The discharge was now not so copious, nor the pain at all severe; his appetite was fair, bowels regular, sleep refreshing, etc., as had indeed been the case during the greater part of the time. In the latter part of October, in order to reduce the flexion, the limb was bandaged to a double-inclined plane splint, which resulted in almost entire extension without occasioning any bad symptoms in the joint or con fining the patient to his bed. For the following eight months nothing of special interest occurred, though there were several inflammatory attacks, moderate in degree and readily subdued by poulticing. On these occasions abscesses sometimes formed on the posterior thigh. The case is doubly interesting from the fact that the wound only received the ordinary dressing of cold water on cloths, with charpie to absorb the discharge. Tincture of iodine and poultices, or hot fomentations with flannel cov ered with oiled silk, were used when signs of inflammation showed themselves. No ice was used in the treatment, A photo graph (Surg. Phot. Series, No. 63, A. M. M.) of the patient, taken July 9, 1865, is represented in FIG. 2 of PLATE LXVIII. The soldier was discharged from service July 13, 1865, in good health, the posterior wound being still open and permitting the introducing of a probe for three inches. There was also a large deposit of new bone, and the patella was firmly anchylosed to the femur. Some motion of the joint remained." Examiner H. Brubacker, of Somerset, Pennsylvania, certified, September 23, 1867 : "The knee is very much enlarged, and the muscles of the thigh are gradually shrinking away. The wound is still dis charging pus very freely, and there is evidently some disease of the bones about the joint, which keeps up the discharge." In January, 1876, the same examiner reported: "The joint is completely anchylosed and the leg flexed upon the thigh, so that the heel cannot be made to touch the ground. He walks on the front of the foot. The ball of the foot behind the great toe is enlarged, hardened, and tender, which renders walking very difficult. The leg, including the thigh and hip, is becoming atrophied. His condition is gradually growing worse." The pensioner was paid March 4, 1880. CASE 548. Private J. C. Simmerman, of the Marine Corps, aged 21 years, while serving on board of the U. S. Steamer Minnesota, was wounded in the knee during the attack on Fort Fisher, January 15, 1865. He was treated at the Naval Hos pital at Portsmouth, whence he was discharged June 19, 1865, and pensioned, by reason of "shot wound of left knee joint, causing compound fracture, and resulting in anchylosis of the joint with incapacity to use the leg, which may ultimately require amputation." In the succeeding year, while at Philadelphia, the pensioner presented himself for treatment to Dr. G. H. Napheys, formerly connected with the Navy and with the Army, who made the following report of the case (Medical and Surgical Reporter, Vol. XVI, 1867, p. 307): "He was struck, while lying down, by a grapeshot entering the inner condyle of the femur and passing through the articulation. When discharged from hospital his knee was perfectly stiff and flexed at right angle. Afterwards there was a constant discharge and the passage from time to time of pieces of bone from the part, the last fragment coming away in June, 1866. When he presented himself at the clinic he had bony anchylosis of the wounded knee, and the leg was flexed at such an angle with the thigh that the distance between the heel and the corresponding buttock was only seven and a half inches. The operation consisted in breaking up the extensive osseous adhesions by means of perforators and other instruments. The hamstring muscles were divided subcutaneously. The limb was then bandaged throughout its whole length. It was afterwards placed upon a double-inclined plane with a screw arrangement, so that it could be gradually brought down. About two months after the operation the limb was straightened sufficiently to enable him to rest on the ball of the foot, which is all that can be desired. The heel is somewhat elevated ; it will be brought down at some future time by dividing subcutaneously the tendo-Achilles. He walks readily by the aid of a cane. On April 1, 1867, the patient writes that he has good motion of the ankle joint and walks with increasing ease and comfort." The Philadelphia Examining Board, in 1873, and at subsequent dates, certified to the injury and to firm anchylosis as resulting therefrom, together with dislocation of the tibia backwards. In 1873, the leg was described as being flexed at an angle of 25, and two years later at 40, with the heel drawn up two and a half inches. An operation on account of necrosed bone is also alleged to have been performed. Circular No. 6, War Department, Surgeon General s Office, Washington, 1865, p. 37. Mril.fi- Sui-j. Ili.-l.oi the War of the Rebellion. I ari III .Vol. II. ni;i|>.\ PLATE LXVIII._ RESULTS OF SHOT INJURIES OF THE KNEE-JOINT. l ( as. of IViv;il<- I clci ll(i I I -MILS viva i titi SECT. IV.] SHOT FRACTURES OF THE KNEE JOINT. 371 Examiner J. A. Armstrong, of Camden, reported, September 17, 1877 : "At present the leg is in a straight position, the knee joint anchylosed, and the parts surrounding it calloused and indurated." At a subsequent examination by the Board the thigh and leg were represented as being much wasted, and the condition of the foot was described as that of a case of "talipes equinus." The pensioner was paid December 4, 1879. CASE 549. Private N. Gray, Co. H, 4th Maine, aged 24 years, was wounded in the right knee joint, at the Wilderness, May 5, 1864, and entered Harewood Hospital, Washington, three weeks afterwards. Surgeon R. B. Bontecou, U. S. V. con tributed the following history : "The ball entered in the middle of the internal condyle three-fourths of an inch above the inferior margin, passing in an oblique direction inward and downward. At the time of his admission the general state of his health was good and color of skin normal ; knee joint a little swollen. The patient complained of a fixed pain right below the centre of the patella, which was increased by pressure upon the patella. The thigh was swollen, especially on the inner side, about five inches upward, and fluctuating. On enlarging the opening upward a quantity of pus was discharged and the ball was discovered and removed. The hole made by the ball was one inch deep; its direction inward and downward. An ice bag was applied to the joint. On June 2d, an incision was made in the fossa poplitea three inches long, and the lower third of the pos terior side of the femur was found to be surrounded with pus, but the bone was yet covered with periosteum. The discharge was free and copious; the ice was still kept on. On July 20th, there was cedema of the right leg, which was bandaged from the toes to the knee joint; discharge healthy and copious. Solution of chlorinate of sodse was now used in the dressing. By September 1st, the wound was doing well, discharging but little, and the incision in the fossa poplitea being healed. Exudation below the patella had disap peared, and the movements of the knee joint were perfectly free and painless. The patient went on furlough, and returned on September 14th. Small pieces of bone were coming from the wound in the condyle; movement of the joint perfect. On December 1st, erysip elas of the right leg commenced below the patella, attended with high fever, vomiting, and headache. For this ten drops of muriated tincture of iron were given every three hours. By December 10th, the erysipelas had disappeared and the patient was doing well. The process of exfoliation was going on slowly on January 1, 1865. On February 13, 1805, the patient was discharged from service, the process of exfoliation not yet having terminated, but the knee joint being of normal size and color, and its movements perfectly free and painless in every direction." Examiner I. H. Harding, of Ellsworth, Maine, Feb- .S ruary 1, 1867, certified to the injury and added: "The joint and leg are weakened and atrophied so much that he walks quite lame." The Boston Examining Board reported, September 13, 1875 : " There are two large adherent cicatrices in the popliteal space, which impair the motions of the hamstrings." The pensioner was paid December 4, 1879. The , . r>r,->\ / i i o -n / n VlG. 222. Shot fracture of internal con- wood-cut (IG. x22) is a copy of a photograph contributed by burgeon Bontecou (Card <i vie of right femur. [From a photograph.] PJiotographs, Vol. 3, p. 22). In the next instance a conoidal ball struck the left knee, passing through the centre of the patella and through the inner condyle of the femur: CASE 550. Private J. T. Long, Co. G, 16th Wisconsin, aged 26 years, was wounded at Shiloh, April 6, 1862. Acting Assistant Surgeon J. A. Murphy, in charge of Third Street Hospital, Cincinnati, described the injury as "wound of the left knee joint," and reported : "A ball entered the centre of the patella and passed inward and backward, escaping through the inner condyle of the femur. The patient entered this hospital May 2d, having been brought here on a hospital boat from Pittsburg Landing. He was free from fever and diarrhoea, and his general health on admission was excellent. In stature six feet and two inches, well and strongly developed in every respect, he was a man who had always enjoyed very good health and never indulged in ardent spirits. The injured joint was much swollen and very red when he arrived here; a copious discharge of pus and sy no vial fluid was escaping from the wounds. A few days afterwards a large abscess, exterior to the joint, developed itself and was opened, discharging about one pint of pus. After this, from time to time until the wounds healed, sixteen abscesses formed around the joint and in the leg as low down as the middle third. They were opened and healed readily. Cold-water dressings and fomenting poultices were the only applications used to the wounds. He was kept on low diet throughout the treatment. Tonics were given for a very short time and then discontinued, as the inflammation about the wound seemed to increase under their use. On the subsidence of the inflammation about the joint crepitation could be heard in moving the patella; a fissure could also be felt in the patella. On July 16, 1862, the patient was discharged from service. At that time he had mobility of the joint and was able to walk with great ease to himself. Just before completing extension or flexion, however, he would feel a slight obstruction, causing him to make an increased effort to complete the extension or flexion, when the former or the latter was accomplished." The man subsequently became a pensioner, the nature of his injury being corroborated by various examining surgeons, the last of whom, Dr. W. T. Nichols, of Meuomonee, stated November 17, 1877, that " the wounded joint is weak and the leg a little lame." The pensioner was paid June 4, 181$. CASE 551. Sergeant P. H. McGrew, Co. F, 17th Ohio, aged 22 years, was wounded in the left knee while on picket near Corinth, May 22, 1862. He was discharged from service at Camp Chase, March 18, 1863, Surgeon D. Stanton, U. S. V., certifying to partial anchylosis and necrosis of head of tibia resulting from a shot wound through the knee joint." Dr. W. L. Schenck, late Surgeon 17th Ohio Volunteers, who personally treated the case, communicated the following history: "The mis sile, supposed to have been a small conical ball, entered just above the outer tuberosity of the left tibia and passed diagonally through the joint, slightly fracturing the articulating surface of both condyles of the femur and the spine of the tibia. I was at 372 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 2-~>3-W urdof FJG .._>04 ._ Wo undof xit at left knee joint. * * the Brigade Hospital at the time, a mile or two in the rear, and did not see the wound for two days. The knee had become very painful then and was greatly swollen, so I concluded there was no time to consider the propriety of an operation, and put the patient upon active antiphlogistic treatment with irrigation to the parts. The next day Medical Directors Smith and Strew. with several other surgeons, called to see the case, and all, excepting Surgeon I. A. Coons, 38th Ohio, and myself, decided in favor of exsection or amputation ; but I was allowed to use my own judgment, declined to operate, and continued the treatment. When the acute stage had passed and suppuration was well established, I used water dressings and prescribed a liberal diet. with some preparation of iron hydrochlorate of the sesquioxide, iodide, citrate with quinine, or phosphate with lime, etc. When the pain was intense or destructive meta morphosis greatly in excess, opium and brandy was administered. On the 15th of June, I received a leave of absence, and was permitted, through the kindness of the General Com manding and the Medical Director, to take the patient with me to Ohio. He was carried on a stretcher over all the bad roads from Corinth to Pittsburg Lauding and there placed on a cot, from which he was not removed until he reached my home in Franklin, Ohio, where I treated him until the expiration of my furlough. During that time several small pieces of bone were removed, and when I left him the outer wound had healed and he was able to go about his room on crutches. I left him in charge of the Ladies Aid Society, who cared for him until he was able to go to his home in Lancaster, Ohio. On the 15th of December following he wrote to ine>: Since leaving Franklin there have two tolerably large and twenty-three small pieces of bone come out of my knee. It is getting along fine. I can put out my foot and take a good old-fashioned step, such as I used to take in the long marches down in Dixie. I do nothing for it now but wash it in salt water. I am in n hurry for it to get well that I may get satisfaction out of those rebels, etc. After McGrew - ^ a( ^ ^ een discharged ^ rom service for disability, he recovered sufficiently to again enter entrance at left knee, the army, and accepted a commission as 1st Lieutenant of the 178th Ohio. On April 2, DrTcHKNc k K.T h by 1885 > he wrote to me from Shelby ville, Tennessee : Thanks to you this leg of mine, which so many predicted would have to come off or be worthless, is worth a good many cork legs yet. I can do anything with it but run, and that is not in our line. I was at a ball the other evening and danced several sets. That is better than even you expected. By this time the injured joint was sound and the leg could be straightened or bent to a right angle." Lieutenant McGrew left the service in April, 1865. He had been a pensioner under his former designa tion until his re-entry into the service in September, 1864, since when he has not communicated with the Pension Bureau. Drawings of the wounds of entrance and exit, shown in the wood-cuts (FlGS. 223, 224), were contributed by Dr. Schenck. Iii the following remarkable case the ball passed diagonally through the left elbow, entered the left knee joint, and lodged in the outer condyle of the femur, where it remained innocuously for over fifteen years: 1 CASE 552. Lieutenant E. B. Blake, Co. F, 35th Massachusetts, aged 25 years, was wounded at the battle of Antietam, September 17, 1862. While he was stooping down to tie his handkerchief around the thigh of a bleeding comrade whose leg had been earned away by a cannon ball, he received a shot which passed diagonally through the left elbow and entered the outer aspect of the left knee joint. Copious bleeding from the exit wound in the elbow denoted injury in the large vessel. The bleeding was checked by a strap around the arm. He limped off on his injured leg to the nearest ambulance station, where the wound in the knee joint was examined by a surgeon. The probe entered the joint freely; but the ball could not be detected. From the strongly bent position of the limb, it had apparently escaped the tibia and passed in be tween the condyles of the femur, where it was securely lodged and concealed. His arm and leg had water dressings applied, and were put in splints; and he was immediately placed in the cars and transported to Boston, where he arrived in the course of a week, with many other soldiers, some of whom had received equally serious wounds, and to whom the danger of transporta tion, except under existing circumstances, would have been considered almost a fatal movement. The foregoing account is taken from J. Mason Warren s Suryical Observations, with Cases, etc., Boston, 1867, p. 563. Dr. Warren attended Lieutenant Blake on his arrival in Boston. He was then in a feeble condition, having an almost constant diarrhoea. Dr. Warren remarked: It is probable that to this condition he owed his safety." The knee joint was free from pain and inflammation, but the wound on the outside suppurated slightly. It was dressed with a ham splint and kept in a state of entire rest. The elbow joint was quite loose, both condyles broken off, the joints swollen, with an effusion on 1 Examples of missiles remaining lodged in the bones of the knee joint have been reported by PEKCY (Manuel da Chirurgien d Armie ou Instruc tion de Chir. Mil., Paris. 1792, p. 16 4), who alludes to a case in which the missile became iucrusted in the condyles of the femur "hasard heureux dont on a eu tin exemple dans la personne de M. d Almons, ingcnic hr employ6 dans la dernieire guerre." RAUASSE (L. J.) (Considerations g nerales sur If.s plaies des articulations faites par les armes a feu ou le,s instru.me.ns Iranchans, Paris, 1811, These No. 84, p. 18) reports that Weber, a miner at the siege of Dantzig, iu April, 1807, was struck by a ball at the outer portion of the left knee joint. From the depression and cavity in the external coudyle of the femur the ball was believed to have lodged in the articulation, as there was no wound of exit. Futile searches for the missile were made ; extensive swelling followed, but the patient recovered in about three months with anchylosis of the knee. BELL (C.) (Report on Gunshot Wounds of the Knee Joint in Surgical Observations ; being a Quarterly Report of Cases in Surgery treated in the Middlesex Hospital, London, 1810, p. 429): Russian General Baron Driesen, wounded at Borodino, September 6, 1812; musket ball struck the inner condyle of the left femur ; ball remained in condyle ; improved in spring of 1813. Wound closed and reopened in 18H>: inflammation, abscess, incision; amputation January 7, 1817; recovery. ALCOCK (11.) ( ^. isvroo- FlG. 225. Anterior and posterior views of the left elbow joint. Spec. 6811. Med.ft Surg. Hirft. of the War of the Rebellion, Part lU.Vol.U.Cliap.X Ward phot. T Sinclair* San lith PLATE LXVII.._ BALL LODGED IN OUTER CONDYLE OF LEFT FEMUR OVER 15 YEARS, ( use- of I.H iiti-nurit K.B. ( o F, 35 L . h Mnjs.stu-lm.sctl s SCOT. IV.) SHOT FRACTURES OF THE KNEE JOINT. 373 PIG. 226. Appearance of knee joint nine years after in jury. [From a photograph.] the inside, a bullet hole below the joint on the outside and above it on the inside. The elbow was made immovable with splints, and, after a moderate amount of inflammation, which at no time amounted to anything threatening, both the knee joint and the elbow joint did perfectly well ; and at the end of two months he was able to go out of doors. He finally recovered all the motions of the elbow joint; he could walk without the least sign of lameness, the ball still remaining in the knee. The power of entire flexion only of the leg was wanting. He continued actively engaged ill business until February 11, 1878, when he died of pneumonia. An autopsy was made by Dr. J. Foster Bush, 1 of Boston, who presented the specimens of the injured elbow and knee to the Army Medical Museum, where they are numbered 6811 and 6812, respectively, of Section I. There was not a trace of caries in the cancellated structure around the ball. The artic ulated cartilages were perfectly smooth, and the foreign body had apparently remained innocuously in the outer condyle for over fifteen years. The bones of the elbow are shown in the wood-cut (FlG. 225); the articular extremities of the femur and tibia (Spec. 6812, and Photo. Scries, No. 366, A. M. M.) are represented in PLATE LXVII, opposite p. 372, a vertical section of the femur bisecting the ball. CASE 553. Private J. McDonnell, Co. C, 124th Ohio, was wounded at Chickamauga, Sep tember 19, 1863, by a conoidul ball, which entered over the inner crest of the left tibia, passed upward through the inner condyle of the femur and lodged. He was made a prisoner, and confined at Bich- mond, Danville, and Andersonville. Treatment: Two stitches in the wound and cold-water dress ings. A portion of the ball was removed, also sixteen spiculse of bone at various times. He suffered from scurvy whilst in prison; was exchanged March 28, 1865, and finally discharged from service July 8, 1865, from Camp Chase, Ohio. He received a pension of six dollars per month. Mr. McDonnell called at the Army Medical Museum September 17, 1872, made the above statement, and exhibited his wound, when the photograph (No. 329, Surg. Phot. Series, A. M. M.) was taken, of which the annexed wood-cut (FlG. 226) is a copy. His general health was indifferent. There was a large cicatrix on the inner side of the knee joint, and several smaller ones about three inches above the outer condyle; there was tenderness and preternatural mobility about the joint; it seemed to have undergone a spontaneous dislocation, the femur and patella projecting forward over the tibia. The foot could be inverted and everted much farther than usual, and the limb was shortened about two inches. He could walk with comparative ease, and could readily ascend a stairway. A plaster cast of the injured knee was made and numbered 6199 of the Surgical Series. His pension was paid December 4, 1879. In the next case a round musket ball passed through the middle of the patella and, perforating the joint, crushed the articular ends of the femur and the tibia: CASE 554. Private X. Gauter, Co. D, 14th Missouri Home Guards, aged 18 year?, was wounded in the right knee, at Lexington, September 18, 1861, and was conveyed to St. Louis one month afterwards. Assistant Surgeon S. M. Horton, U. S. A., in charge of the New House of Refuge Hospital, reported: "This is a case of gunshot wound through the knee joint, which at present (September 17, 1862) is discharging sanious pus at the point of entrance, from which pieces of necrosed bone are being extracted every few days. The use of the limb is but partial, the joint being rendered immovable. The patient came here from the City General Hospital on 5th Street seven months ago. He had been wounded by a round musket ball, which penetrated the patella through its centre, going right through the joint and escaping through the popliteal space, crushing in its course the articulating ends of the femur and the tibia." The patient was discharged from hospital June 3, 1863, and pensioned, his term of service having expired one month after being wounded. Examiner W. P. Boulware, of Lexington, Missouri, at successive dates certified to the injury and reported anchylosis of the knee joint as resulting therefrom. Dr. F. Cooley, of the Kansas City Examining Board, reported September 17, 1875, that he found "depression with adherent cicatrix over the patella, and also adherent cicatrix with considerable loss of bone on outer condyle of femur, so that I can pass my fingers into it for three-fourths lions on Injuries of Joints and their Treatment, in Medico Chirurgical Tranasactions, London, 1840, Vol. XXIII, p. 298) records a case in which the ball remained in the condyle for four years: "A sailor of a man-of-war steamer, in 1836, received a musket shot while rowing a boat employed in the dis embarkation of troops. He was immediately forwarded to one of the hospitals, under my direction, in San Sebastian. Although there was every reason to believe that the ball had lodged in the cancellated structure of the femar, yet, from the absence of any detached portion of bone, or rough frac ture in the articulating surface of the bone, so far as I could ascertain, I felt warranted in an endeavour to save the limb. In a few weeks the wound healed, and the knee, to all appearance, was undiseased, the patient only complaining of some weakness and difficulty in walking, with occasional pain; he was invalided home. Three months ago he came to me with a request that I would amputate his leg, for that, to use his own expression, it so both ered him in walking, and gave him occasionally such acute pain, that he would infinitely rather stump about on a leg of wood. Not being attached to any metropolitan hospital, I sent him down to the Westminster, to my friend, Mr. GUTHHIE, who removed the leg, which externally presented a cicatrix, but no other mark of injury or disease, past or present. The ball was found to have passed through the internal condyle, and presented a somewhat flat tened, yet convex, smooth surface, on a level with the articulating surface, resembling a piece of metal let in. It had fissured the bone (as may be seen in a very slight and hasty sketch I made at the time) and this fissure had been nearly entirely filled up with osseous matter. In four years the only mischief done to the joint was some thickening of synovial membrane and a partial absorption of cartilages. No very active, acute, or destructive disease had been developed either at the time of the accident or since." ROCCO GKITTI (Nuovi Documenti in favore della euro, conservativa nelle frat- ture delfemore per arma dafuoco, in Annali Universali di Medicina, Melano, 1868, Vol. CC V, p. 524, case 37) : Pompeo Morandi, 3d Volunteers, wounded at Monte Suello ; wound of knee joint with lodgement of the ball in the condyle ; recovery. The ball remains in the joint, which is anchylosed. STKO- MEYEll (L.) (Erfahrungen iiber Schusswunden im Jahre 1866, Hannover, 1867, p. 58) remarks: "Among the noteworthy cases of shot fractures of the knee joint treated by conservation, is the case of a young officer, the bullet yet remaining in the outer condyle of the left femur. . . At present there is no exudation into the capsule, and the ball lies so near the surface that it can be felt through the soft parts covering it. But as it is nearly immovable, and causes hardly any suppuration, it has been considered the wisest course to avoid operative interference." GROSS (S. D.) (A Si/stem of Surrjer;/, Phil adelphia. 1872, 5th ed., Vol. I, p. 1039): Knee joint opened by a pistol ball, which lodged permanently in one of the condyles of the femur; recovery with slight lameness. Brsil (J. F.). Penetrating Gunshot Injury of the. Elbow and Knee Joints, in Ro.itnn Me.dirnl and Surgical Journal, 1879, Vol. C, p. 14-t. 374 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. of an inch. There is also loss of portion of the tibia some four inches below the patella, and I find very large varicose veins of the leg and thigh. The knee is entirely anchylosed. Just below the condyle, on the outer part, there is a small hard sub stance, the size of a goose-shot, floating under the skin. The muscular tissues on the outer and lower part of the thigh are destroyed. I also find shortening of the limb one and a half inches, and the old cicatrices look as though they might break out at any time," etc. Subsequently the same Board found increase of size and number of varicose veins, tumefaction of limb, etc. The pensioner was paid December 4, 1879. In the following four cases tke patella was fractured. In two of the cases the synovial sac was involved; in one instance both knees were injured: CASE 555. Private W. H. Hirst, Co. A, 118th Pennsylvania, aged 22 years, was wounded through the left knee, at Shepherdstown, September 20, 1862. Surgeon J. Neill, U. S. V., reported: "The wounded man was admitted to Broad and Cherry Streets Hospital, Philadelphia, September 27th, with a compound comminuted fracture of the patella involving the knee joint. The injury was produced by a minie" ball, which entered in front, one inch above the patella, passed downward and out ward, and made its exit on the outer side of the leg just below the head of the fibula. At the time of admission the patient s general condition was good, but the knee was very much inflamed and the wound suppurated freely. Flaxseed poultices were applied around the joint, and the limb was kept at rest in a fracture box; the patient was ordered a good diet, with tonics and stimulants. A few days afterwards a large abscess formed on the outer side of the thigh a short distance above the joint, which was opened and discharged freely. Under the treatment adopted the patient improved rapidly, the limb bidding fair to be a useful one. One fragment of bone was extracted." The fragment of the patella removed from the wound is Specimen No. 670 of the Army Medical Museum. The patient was subsequently transferred to Haddington Hospital and thence to Christian Street. On July 4, 1864, he was discharged from service and pensioned, Acting Assistant Surgeon R. J. Levis certifying to "wound of -knee joint, resulting in great lameness from anchylosis." The Philadelphia Examining Board at various intervals certified to the injury and its results, and described the limb as wasted and the veins varicosed. The pensioner was paid December 4, 1879. CASE 556. Corporal D. Golden, Co. M, 14th New York Artillery, aged 33 years, was wounded at Petersburg, June 17, 1864. He was admitted to the field hospital of the 1st division, Ninth Corps, where Surgeon M. K. Ilogan, U. S. V., noted : "Wound of left knee by minie" ball; simple dressings applied." From the field the wounded man passed to the Depot Hospital at City Point, and thence, on July 2d, to Harewood Hospital, Washington. Surgeon E. B. Bontecou, U. S. V., in charge of the latter, described the injury as "a wound through the patella," and reported that the patient was discharged from service April 14, 1865, for total dis ability. Examiner C. C. Bates, of Potsdam, N. Y., April 29, 1865, certified : * * "He can flex but cannot extend the leg, except enough to touch the toe to the floor. Thigh and leg much atrophied; knee much swollen and painful. Exam iner G. R. Baldwin, of Fort Scott, Kansas, reported November 13, 1877 : " The pensioner received a wound of the left knee. The ball entered at the lower border of the patella, passed outward and upward, and made its exit at the outer border of the patella. Synovial fluid escaped. There is a large, irritable, and tender cicatrix. The patella is immovably attached to the tibia. The leg requires rest, motion and strength being very much impaired. Pain is a prominent symptom." The pensioner was paid September 4, 1879. A photograph (Card Photographs, Vol. I, p. 17), represented in the annexed wood-cut (FiG. 227), was contributed by Surgeon R. B. Bontecou, U. S. V. CASE 557. Private W. Patterson, Co. K, 6th Wisconsin, aged 36 years, was wounded through both knees, at Gainesville, August 28, 1862. He was treated at Carver Hospital, Washington, whence he was discharged and pensioned Decem ber 9, 1862, Surgeon O. A. Judson, U. S. V., certifying to: "Shot wound of both knee joints, involving a fracture of the right patella and causing extensive effusion in the left knee joint." Examiner J. Hobbins, February 18, 1863, certified to "imperfect flexion and limited and difficult extension," resulting from the wounds. Examiner D. C. Green, of Mauston, Wisconsin, reported, April 28, 1870: "The wound was caused by a ball which entered the left knee at the left side and passed through, striking the bone. The missile then, being slightly turned in its course, struck the right knee and passed through it anteriorly, fracturing the patella and lacer ating the muscles badly. At present both knee joints are stiff." Subsequent examiners report no additional information. The pensioner was paid December 4, 1879. CASE 558. Private J. W. Warrington, Co. C, 110th Ohio, was wounded on April 2, 1865, at Petersburg, by a round ball from a spherical case shell. The ball entered the centre of the patella, and, producing a stellate fracture of that bone, passed downward, backward, and inward, and was cut out, on the field, one and a half inches below the tuberosity of the tibia. On April 12, 1865, the patient was admitted into Judiciary Square Hospital. There was no pain in the knee joint, and but little swelling. The treatment had been limited to dressings of cold water, which were continued for a few days, and followed by applications of ice. The patient was removed to Douglas Hospital June 19, 1865, when three small necrosed fragments of the patella were removed. A photograph of the patient, taken July 9, 1865, is No. 64, Sary. Phot. Scries, A. M. M. The wounds had healed and the patient walked about with a cane. There was at no time any indication of the formation of pus within the joint. The facts of the case were communicated by Acting Assistant Surgeon H. S. Colton. Warrington was discharged July 24, 1865, and pensioned. He was paid September 4, 1879. FIG. 227. Appearance of knee joint a few months after injury. [From a photograph.] SECT. IV.J SHOT FRACTURES OF THE KNEE JOINT. 375 Fracture of the head of the tibia and of the patella was noted in the next example: CASE 559. Corporal G. L. Keyser, Co. B, 8th Pennsylvania Cavalry, aged 21 years, was wounded at "Snicker s Gap, November 1, 1862, and admitted to hospital at Knoxville two days afterwards. Surgeon B. Beust, U. S. V., reported: "A gun shot wound through knee joint. The patient, a man of small stature and delicate appearance, was in a kneeling posture when he was struck by a conical ball, which entered the right knee at the inner side of the patella, near the lower border, striking against the inner condyle of the tibia, producing considerable injury by shivering to some extent the epiphysis, and emerging on the outer side of the leg two inches below the joint. When the patient was brought here the knee was much swollen and pain ful. Applications of cold water were immediately made and continued for four weeks. When the active inflammation had entirely subsided, a small quantity of healthy pus was discharged from both openings. The patient, feeling strong and quite well at this time, became careless and moved his leg, in consequence of which very active and extensive inflammation set in. The cold-water dressings were then (December 3d) changed to warm flaxseed poultices. From the 15th to the 31st of December the patient suffered much from irregular chills, delirium, sleepless nights, and loss of appetite, and showed great symptoms of exhaustion. Large quantities of foDtid pus were discharged from both openings. On December 31st, an examination was made with the finger, which proved the upper portion of the tibia to be much fissured. Amputation was then proposed but objected to by the patient, who wished to save his limb if there was any possible chance. He continued to fail, and his night vigilance and loss of appetite persisted undiminished. On January 6, 1863, the fever assumed a periodical character, coming on in the afternoon. For this he was treated with quinine and morphine, followed by wine and cinchona bark. Since then he has improved rapidly. By January 31st, the patient had regained a good appetite, slept well, and was improving in strength ; the discharge of pus was now very slight and healthy. He will undoubtedly recover if no unexpected change or accident occurs to intercept or impede the restorative progress." Three weeks later the patient was transferred to Camden Street Hospital, Balti more, whence Acting Assistant Surgeon E. G. Waters reported the following result in the case: When admitted his condition was moderately good, the knee being much swollen and inflamed, however, for which solution of lead and opium was applied. Small fragments of bone came away at various times from the external opening. Absolute rest was maintained, and mercurial ointment, with camphor, was used locally to diminish the swelling. On May 30, 1863, the patient was discharged from service, with his knee joint permanently anchylosed and some deformity consequent upon a partial dislocation of the extremity of the femur inwardly." The man became a pensioner; but in the following year he re-entered the army as Lieutenant of the 195tli Pennsylvania, and while belonging to that organization sustained an additional injury to his wounded limb by a railroad acci dent in October, 1864. He was ultimately mustered out February 26, 1865, when his name was again placed on the Pension Rolls. Examiner J. S. Crawford, of Williamsport, at successive dates certified to the injury and its results, and added, in Jan uary, 1867, that the injured joint was very much enlarged. On July 16, 1873, he reported: "The leg is flexed on the thigh at an angle of about forty degrees, with an enlargement on the inside of the joint. The flexion of the knee shortens the limb, which throws the weight in walking on the toes and necessitates a high heel to the boot. The thigh and leg are both very much atrophied and he complains of soreness in the joint." No changes were reported in the condition of the patient in September, 1875, since when he has been exempted from further examinations. His pension was paid June 4, 1879. In the succeeding six cases the seat of fracture appeared to be confined to the head of the tibia: CASE 560. Private John O Neil, Co. M, 1st Artillery, aged 26 years, was wounded at Pocotaligo, October 22, 1862. On the following day he was admitted to hospital at Hilton Head, where Assistant Surgeon J. Bell, U. S. A., recorded: "Gun shot wound by a ball from a spherical case, in left side of left knee, entering deeply and lodging." The patient w 7 as subsequently transferred to hospital No. 1, at Beaufort, whence Surgeon F. L. Dibble, 6th Connecticut, reported that he was discharged March 7, 1863, by reason of "a gunshot wound involving the left knee joint." Examining Surgeon J. E. King, of Buffalo, certified May 19, 1863: "The ball entered near the head of the tibia, passing through and lodging in the popliteal space, whence it has been extracted by incision. The wound is healed, leaving the leg useless. There is complete anchylosis, and wasting of leg," etc. In February, 1867, the pensioner enlisted in the 44th Infantry (Invalid), in which organization he served until March 29, 1869, when he was again discharged. Examining Surgeon J. W. Toward, of Augusta, Maine, at various subsequent dates examined the pensioner, and described the injury by the ball " breaking both bones and remaining embedded in the joint. Leg quite crooked, appearing as if upper ends of bone had been pushed outward ; knee slightly bent and perfectly stiff, swelling badly after walking ; limb painful to hip joint." The pensioner was paid December 4, 1879. A case in which the missile was extracted from the head of the tibia six months after the injury and the patient finally recovered with a useful limb, is reported by Surgeon R. A. Kinloch, 1 P. A. G. S. A brief abstract is appended: CASE 561. Private L. C , 6th South Carolina, aged 17 years, was wounded at Seven Pines, May 31, 1862. The ball entered upon the inner side of the right knee, apparently, a line or two below the articulation ; there was no orifice of exit. When wounded he was lying on his back, reloading his gun, With his knee slightly flexed. The patient walked some distance after he was shot without experiencing very great pain. On the following day he was sent to the St. Charles Hospital, at Rich mond. The limb was then much tumefied and very painful. In the opinion of most of the examining surgeons the ball had lodged; but a few of them, after the progress of the case, were inclined to believe that it had escaped through the orifice of entrance. He remained in hospital until August 3d, never leaving his bed, and scarcely ever changing from the supine position ; he suffered continually from fever, and a portion of the time from traumatic delirium. About the middle of October he tried the 1 KlNLOCll (R. A.) , Case of Gunshot Wound of the Knee Joint. Ball lodged in the Head of the Tibia Extracted through the Joint Six Months after the Accident Recovery with a Useful Limb, in Confederate States Medical and Surgical Journal, 1804, Vol. I, p. 102. 376 INJURIES. OF THE LOWER EXTREMITIES. [CHAP. X. use of crutches, but was compelled to take to bed again, and was a week in recovering from a very painful and inflamed condi tion of the limb engendered by the efforts he had made. The patient enjoyed the comforts of a home and good nourishing diet, and gained flesh and strength; but the irritation of the knee persisted in a sub-acute form, and the wound continued to discharge, the suffering being always less when the discharge was free. On November 23, 1862, he was seen by Dr. Kinloch. The limb was flaccid and attenuated. A fistulous opening upon the inner side of the joint, just below the articular margin of the tibia, indicated the original orifice of entrance, which was discharging a thin pus. The joint was imperfectly anchylosed ; the leg very slightly flexed upon the thigh. Dr. Kinloch believed the ball had lodged in the head of the tibia and determined to search for it. On November 29th, the patient was fully chloroformed. A semi-lunar flap of integuments, including the fistulous opening, was dissected and turned up from the deeper tissues over the inner side of the joint; with the finger, and afterwards with a large probe, the track of the ball could be traced through the lateral ligament of the joint to the depth of several inches. The lateral ligament was incised freely and a piece of necrosed bone, a portion of the articulating surface of the tibia about the size of the last phalanx of the finger, was discovered and turned out. As the joint was but slightly flexed the finger could only advance to a certain depth because of the inner condyle of the femur. Forcible flexion of the joint was instituted and the finger pushed on into a deep cavity in the outer portion of the head of the tibia, where it rested upon the foreign body, which was seized with a pair of bullet forceps and extracted with great ease. It proved to be a large mini6, much flattened, and having a piece of the patient s pantaloons attached. A sponge full of warm water was thrown two or three times into the joint to wash out the debris from the cavity in which the ball had rested. The tegumentary flap was brought into position and secured by three points of suture, only the dependent corner of the wound being kept open by a tent; the limb was extended upon a bolster, cold-water dressing applied, and a full anodyne administered. The wound healed kindly, and in three weeks the patient experienced a feel ing of relief that he had not known since the accident. In a letter to Dr. Kinloch, dated April 23, 1864, the patient states: "The only drawback to my convalescence was an attack of erysipelas, in January 1863, which I attributed to imprudence in eating. On the 17th of February, 1863. I began to move about on crutches, the wound having entirely healed before this. Since then, the limb has gained rapidly in strength. In May, I laid aside my crutches and took to using a stick. I can now walk a mile without resting, and often walk some without my stick. My joint is stiff, but I think I shall some day be able to run. I can now run a few steps, and can truly say the leg is well. I practise walking without my stick as much as I can." CASE 562. Private M. Hoffman, Co. H, 8th New Jersey, aged 21 years, was wounded at Williamsburg, May 5, 1862. He was admitted to the field hospital at Allen s Farm, where his injury was recorded as " a serious wound of the left knee joint." From the field the wounded man was moved to Hygeia Hospital at Fort Monroe, whence he was sent to his home on furlough May 21st. Surgeon R. B. McCay, U. S. V., reported that the patient was discharged from Chesapeake Hospital September 6, 1862, by reason of "partial stiffness of the knee joint resulting from the wound." The man was subsequently admitted on the Pension Rolls, his physicians certifying to the following description of his injury: "A ball entered the popliteal space, passed into the knee joint, and produced partial anchylosis, within all probability obliterating the synovial sac ; perceptible crepitation resulted, together with inability to extend the limb." Assistant Surgeon R. B. Browne, U. S. V., who contributed the photograph of the patient (Contributed Photographs, Vol. XII, p. 5) shown in the adjoining wood-cut (FlG. 228), reports the following history: "The missile entered about one inch below and behind the knee, directly in the median line of the limb, passed upward, forward, and inward through the head of the tibia, and lodged, as was surmised at the time, somewhere in the centre of the joint, between the head of the tibia and the internal condyle of the femur. After his admission into hospital the patient was strongly advised to submit to amputation of the thigh. To this he stoutly objected, how ever, and shortly afterwards he was sent to his home on fui lough, where I saw him and commenced the treatment of his case somewhere about the 1st of June, 1862. I searched carefully for the bullet but was unable to reach it. The patient had but little pain, was in good health, strong and robust, and the wound suppurated nicely. There was little or no inflammation of the joint, nor could I detect any synovia in the discharge. The treat ment was therefore simple. I made use of emollient applications and enjoined rest, but not perfect rest, as I permitted him to move carefully about the house. The wound healed about the middle of July, from which time he was able to go about on crutches, the limb being flexed at an angle of 135, or rather incapable of extension beyond that point. About the middle of the following September I entered the army as Surgeon of the 31st New Jersey, and consequently lost sight of the patient until the summer of 1863, when I was mustered out. At this time he had regained some mobility of the joint and could, by giving the limb a peculiar twist, make apparent the position of the bullet. He himself at least was so confident of its whereabouts that I concluded to cut down to the point indi cated with a narrow-bladed bistoury. This operation I performed on September 7, 1863, being aided by Dr. Edward Swift, of Easton, Pennsylvania, who put the patient under the influence of an anaesthetic. I entered the knife immediately over the middle and inside of the joint and fortunately struck the bullet in its centre, about an inch below the integuments. I then enlarged the opening just far enough to enable me to extract the missile with the aid of a forceps, and quickly closed the wound so as to admit as little air as possible. A small quantity of synovial fluid made its escape. The ball, which proved to be a spherical one, five-eighths of an inch in diameter, was slightly battered, and appeared to have embedded itself between the articulating extremities of the femur and the tibia, being fairly covered by the synovial sac. The limb was then placed in a splint and kept at perfect rest until all fear of inflammation of the joint had subsided. The wound healed by first intention, and in one month the patient was again able to get about with the aid of crutch and cane, both of which he dis- Fio. 2-J8. Shot perforation of the head of the left tibia. [From a photograph.] SHOT FRACTURES OF THE KNEE JOINT. 377 pensed with after a period of five months. When last I saw him, in July, 1868, the man was walking with scarcely a limp, free from all pain, in perfect health, and without deformity excepting a slight bony prominence where the ball had been extracted. The joint retained all its motions except that of extension, which was limited, the leg assuming an angle of about 170 when fully extended." Various examining surgeons at successive dates have certified to the pensioner s disability, which is rated one-half. His pension was paid June 4, 1879. The following interesting case was reported to this Office as an illustration of control ling inflammation of the knee joint through ligation of the femoral artery. The details were given by Assistant Surgeon A. A. Woodhull, U. S. A., in an essay on "Ligation of Arteries as a Means of modifying Traumatic Inflammation of the Joints" read before the Atlanta Academy of Medicine, at its meeting, 1 June 1, 1874. The subject of preventing or controlling inflammation of the joints through cutting off the supply of blood was, in the early part of the present century, considered by D. L. Rogers: CASE 563 Captain W. H. Jordan, 58 9th Infantry, was wounded in the right knee, at the battle of Gaines s Mill, on the afternoon of Friday, June 27, 1862. " I saw him not far from the line of battle shortly after he was shot, and had him conveyed to my field station hard by. By examination with the little finger I satisfied myself that the joint was perforated and that the articulating surface of the tibia was grooved as if by a round ball or buckshot. He was immediately put into an ambulance wagon and sent across the Chickahominy to the field hospital at Savage Station, a few miles distant. This was the general ren dezvous for the disabled of General McClellan s army, and in addition to the commissioned medical officers there were present a few civil surgeons who had volunteered their temporary services. Among them was Dr. David L. Rogers, of New York, who had long been an advocate of the control of traumatic inflammation of the joints by the liga tion of the main artery of supply. s As I am informed, the wounded officer would not consent to primary amputation as was proposed, and Dr. Rogers then suggested the ligation of the femoral at the apex of Scnrpa s triangle, with the view of preventing, or at least of modify ing, the inevitably ensuing inflammation of the joint. This was acceded to, and it was at once done I believe by Dr. Rogers himself. The operation must have been performed within forty hours of the reception of the injury, and was probably done on the succeeding day, for the hospital was abandoned on Sunday, the-29th, the second day after the battle. The gen eral belief that the serious operation of ligating the femoral would add to instead of detracting from the perils already due to the wounded joint, the fact, as it was understood, that the severely wounded whom the Army of the Potomac was obliged to leave at Savage s were conveyed to Richmond, a distance of about fifteen miles, over rough roads, and the unfortunate condition of that city as to temperature, supplies, and general accommodations, precluded, in my mind, the possibility of this officer surviving the double injury, as we were tempted to call it. Accordingly, in writing to his friends at the north, he was reported as having prob ably died of his wounds in the hands of the enemy; for, at that time, there was no exchange of prisoners. Between three and four weeks after the battle, however, an exchange or release on parole of the wounded was negotiated, and, witli the first boat load from Richmond that passed Harrison s Landing, I was sent north for a few days. To my great surprise, on this boat I found my friend, greatly emaciated and suffering; but the ligature had come away successfully, and the primary violence of the joint inflammation was fairly overcome. At that time, although both wounds were suppurating, the incision over the artery gave quite as much apparent trouble as the original injury. His general strength was much prostrated and lie appeared to be in a condition of hectic irritation, lie was carried to Baltimore, and I saw no more of him until the following December, when, on being ordered out of the field, it so happened that I was for a time placed in charge of sick and wounded officers in that city. At this date his general health was good, the wound in the knee had healed, the incision in the thigh, singularly, had not entirely cicatrized, and, which was of the most inconvenience, the leg was partly flexed upon the thigh and was fixed by false anchylosis. This condition must be attributed to the position that the limb had naturally assumed under the influence of whatever inflammation had occurred at the time of the severest suffering, and which his medical attendant had neglected or feared to alter while, the healing was in progress lest the inflammation might be again excited. Fortunately there was no torsion, whence it may be inferred that the morbid action was not severe. In a week or two he passed from under my charge to that of Surgeon Thomas P. Gibbons, U. S. V., but I saw him frequently during the winter of 1862-(>I?. By the repeated application of force, sometimes with the hands and 1 The essay is only briefly adverted to on page 288 of the Atlanta Medical and Surgical Journal, 1874-75, Vol. XII. A manuscript copy of the lecture was forwarded to the Surgeon General s Office by its author. "The case is identical with the case referred to at the meeting of the New York State Medical Society in February, 18(33, by Dr. JOHN Swix- UURNR (Resection of Joints and Conservative Surgery, in Transactions of the Medical Society of the State of New Tori;, for the year 1SOJ, Albany, 1803, p. 170, and Medical and ^Surgical Reporter, 1803, Vol. IX, p. 401): "A captain in the Regular Army was wounded by a ball passing through the knee joint. We could not ascertain to a certainty that the same was injured, as the course of the ball was directly through the centre of the joint, from side to side, so it is pcsslble that only the cartilage was wounded. L r. ROGERS tied the femoral artery, so as to interrupt and break the current of blood to the injured ports. When I last saw him, thirty days a;;er the injury, Ihere had been little inflammation, and the prospects were good for entire recovery. I have since learned that he 7tas entirely recovered, with a good limb." 3 Ror,EHS (DAVID L.), A memoir on the utility of tying Large. Arteries, in preventing Inflammation in wounds of the principal joints and important surgical operations, illustrated by cases, in New Yorl; Medical and Physical Journal, 1824, Vol. Ill, p. 453. SURG. Ill 46 FIG. 229. Appearance of limb 18 years after injury. [From a photograph.] 378 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. sometimes with a screw apparatus, the adhesions were gradually broken up, and he gained a fair passive use of the joint; in the spring he was able to go on sick leave to his home in Ohio, and in the summer of 1863 was, I believe, assigned to duty as a mustering officer. He saw no more campaign service, but, while the war was still in progress (I think in 1863). joined his regi ment on the Pacific coast. It is now nearly twelve years since he was shot, and it is more than eleven years since I have seen or heard directly from him ; but I have seen officers who have served with him in garrison who were not aware that lie had been wounded. I should suppose that he is practically a sound man, although it is probable that he cannot discharge the more fatiguing duties of the field." A letter of inquiry by the editor, in March, 1880, elicited the following response from Captain Jordan: "Recruiting Rendezvous, U. S. Army, No. 9 South Clark Street, Chicago, Illinois, April 2d, 1880. Dear Doctor: Your letter of the 29th ult. was received yesterday. In reply thereto, I would inform you as follows viz: The ball (spherical) with which I was wounded entered just below the patella through the left side of the ligament of the same and the head of the tibia, and passed out a little below the centre of the popliteal space. The synovial sac, I think, was injured, although I did not have synovitis, as the doctors feared, but am under the impression that some synovial fluid escaped from the joint. There was profuse bleeding; so much so, that my pantaloon leg and stocking had to be cut oft on account of being so stiff from the blood. I have never had any pain in the knee except when I have hurt it. There is no stiffness except after using the limb in march ing or much dancing. The joint is nearly as good as the other one, although I cannot flex the wounded limb quite as. much as the other one. No bone came out of or was removed from the wounded joint. The patella of the wounded limb is one inch and a half lower than the other one. The femoral artery was ligated a little over half way up from the knee, to prevent inflamma tion. I am not certain whether Dr. Rogers or Dr. A. K. Smith did it. Dr. Woodhull attended me in hospital in Baltimore ns late as February, 1863, and saw me on the ferry boat between Oakland and San Francisco in September, 1877. A few days after I was wounded I was taken prisoner and remained so about three weeks. I was then taken to Baltimore, Maryland, where I remained in hospital until, in February, 1863, 1 was granted a sick leave, and was on crutches thereafter for about six months. When my wound had healed while in hospital, my limb was stiffened with the lower part of the leg at right angles to the upper part. Dr. Woodhull and another surgeon placed me under the influence of chloroform and partially removed the stiffness. I then wore an apparatus for about six months until the limb had become very nearly as straight as the other, i. e., straight enough, my other leg being a little knock-kneed. * * Very respectfully, your obed t servant." (Signed.) WM. H. JORDAN, Captain, 9th Infantry. The letter was accompanied by a photograph, a copy of which is shown in FiG. 229. Ligation of the femoral artery for secondary haemorrhage was successfully performed in two instances of shot fracture of the head of the tibia: CASE 564. Lieutenant Thomas W. Robertson, 79th New York, was wounded, on June 16, 1862, in the assault on the works on James Island, by a musket ball, which struck the outer side of the head of the left tibia and passed upwards and lodged, as was believed, in the intercondyloid notch of the femur, or somewhere about the knee joint. Amputation of the thigh was advised but refused by the patient. The limb was then placed in an easy position and cold-water dressings were applied. The patient was treated in the regimental hospital until June 28th, when he was sent to New York. On July 6th, there was profuse haemorrhage from the anterior tibial artery. On July 8th, the femoral artery was tied by Professor Willard Parker. At this date the knee joint was excessively swollen, and there was free suppuration from the wound. After a very protracted confinement the patient ultimately recovered, with complete anchylosis of the knee joint, the straight position of the limb being preserved. Lieutenant Robertson was transferred to the Veteran Reserve Corps on February 29, 1864, and was on duty at Emory Hospital in 1865. On July 18, 1865, the photograph (Sury. Phot. Series, No. 78, A. M. M.) was taken, a copy of which is shown in FiG. I of PLATE LXVIII, opposite p. 370. The facts of the case were communicated by Surgeon N. R. Moseley, U. S. V., who reported that Professor Parker and the other surgical advisers of Lieutenant Robertson entertained no doubt that the knee joint was primarily involved in this case. The exact location of the hall was never ascertained. Lieutenant Robertson was discharged and pensioned. Examining Surgeon E. Bradley, of New York, reported October 24, 1866: "Ball shattered upper third of left fibula; resection of a portion followed. The femoral artery had to be tied. Knee is anchylosed, foot atro phied, cold, paralyzed, and limb of little more use than an artificial limb." Examiner Th. F. Smith, in September, 18F3, states: "Ball entered outside of upper part of left leg and has never been removed; there is a large cicatrix on the opposite side of the leg, the result of an abscess; complete anchylosis of the knee joint." Drs. J. F. Ferguson and M. K. Hogan report, Septem ber 7, 1875: "The femoral artery has been tied. The knee joint is solidly anchylosed." The Examining Board, consisting of Drs. S. S. Burt, A. B. Judson, and Wm. O. McDonald, state, September 14, 187? : "Left knee anchylosed, nearly straightened; femoral artery tied on left side." Pension paid March 3, 1880. CASE 565. Private A. J. Scott, Co. A, 9th Maine, aged 24 years, was wounded at Deep Bottom, August 16, 1864, and admitted to hospital at Beverly six days afterwards. Assistant Surgeon C. Wagner, U. S. A., reported: "Shot wound of right leg, injuring the head of the tibia. Secondary haemorrhage took place from the anterior tibial artery and sixteen ounces of blood was lost on December 17th, when the femoral artery was ligated in its continuity at the lower third of the thigh by Acting Assistant Surgeon J. C. Morton. Chloroform was used and the patient reacted promptly. Two weeks after the operation he had recovered." He was discharged from service June 6, 1865, and pensioned. Examiner C. E. Snow, of Calais, Maine, March 7, 1866, certified to the wound and to its being "well healed; but there is considerable lameness as yet, the weakness of the joint forbidding any continued use of the limb." Examiner E. H. Vose in his report, April 15, 1874, stated that the ball lodged and remained in the bone for four months; also that when it was extracted haemorrhage occurred and necessitated liga- tion of the femoral. "Head of tibia enlarged and somewhat tender to the touch. Rheumatism from the joint downwards. Leg weak, and he cannot bear his weight upon it when at work ; foot slightly extended; walks lame with a peculiar swinging gait." In the following year the same examiner described the joint as stiff; circulation feeble; considerable numbness on inner side of leg, eto.. and added: "He has been under my personal observation for eight years and the disability has largely increased." .11. -r was paid December 4, 1879. SECT. IV.l SHOT FRACTURES OF THE KNEE JOINT. 379 The series of recoveries after shot fractures of the knee joint will be concluded with three examples, in which particular bones injured were not specified: CASE 566. Private H. W. Pomroy, Co. F, 1st Maine Heavy Artillery, aged 36 years, was wounded at Laurel Hill, May 19. 1864, and entered Mount Pleasant Hospital, Washington, three days afterwards. Assistant Surgeon IT. Allen, II. S. A., reported: "The wound was apparently through the knee joint. A conoidal ball entered at the inner border of the right patella and made its exit posteriorly at the external central part of the popliteal space, on a line with the inferior border of the condyh-s. The progress of the case has been imperfectly recorded. All that can be ascertained is to the effect that the patient was bed ridden for eight weeks; that in the third week two pieces of bone were removed from the posterior wound, and in the fifth week two others were taken out; also that he suffered greatly, and according to his account had marked rigors. The patient came under my notice in January, 1865, when presenting himself for discharge. At this time the appearance of the limb was as fol lows: The entire extremity was rigid, the knee joint permanently auchylosed, and the region of the joint much swollen: all original contour of the outline was destroyed, and the integuments were semi-cedematous up to the hip joint. The skin was of a dead purplish red color and extremely sensitive, especially around the knee joint. The surgeons at the field hospital were desirous of amputating the limb, but the patient refused to give his consent, and the case was then treated conservatively. The patient was discharged from service January 26, 1865, and asserted, prior to his departure for his home, that should the limb continue to be so excessively painful he would have it amputated. Thus it is shown that, should conservative treatment be successful in this class of cases, the limb resultant of months of suffering is apt to be worse than useless." Examiner R. K. Jones, of Bangor, Octo ber 8, 1866, certified: "The wound is healed and he retains the power of flexing the leg slowly and feebly to an angle of 135. He walked with crutches till the fall of 1865. He now walks with one cane, flexing the body on the left thigh and swinging with much effort the right limb forward not flexing the knee. The foot and leg swell much after use and are now cedematous. The outside of the leg and foot are numb. He suffers much from pain after use," etc. Subsequent examiners substantially show the same disabling effects, and the BangoV Board in September, 1876, described the exit wound as very tender, and stated that a solid substance like a buckshot or a spicula of bone could be felt under the cicatrix. The pensioner was paid June 4, 1879. CASE 567. Allison Shutter, Drummer, Co. C, 7th Pennsylvania Reserves, received, in one of the earlier of the seven days battles before Richmond, in June, 1862, a shell wound of the left knee joint. He was taken prisoner, and while he was in the enemy s lines it was decided that primary excision of the knee joint should be performed on the field. The operation was com menced, but was interrupted by an advance of the Union troops, who regained the ground they had lost earlier in the day. The parts were brought in apposition and the limb secured to a splint, and the patient was sent to Fort Monroe, and admitted to Hygeia Hospital on June 30th. On July 6th, he was. sent to Philadelphia on the steamer Daniel Webster. He was admitted, on July 7th, to the Satterlee Hospital. The wound cicatrized and left a comparatively useful limb. This soldier was discharged February 5, 1883, by Surgeon I. I. Hayes, U. S. V., for "lameness resulting from a shell wound of the left knee." His name does not appear on the Pension List. The photograph of the patient (Sury. Phot. Series, No. 204, A. M. M.), represented in FIG. 230. was contributed by Surgeon R. B. Bontecou, U. S. V. CASE 568. Private C. Volgel, Co. F, 14th Connecticut, aged 37 years, was wounded before Petersburg, October 2, 1864, and admitted to the field hospital of the 2d division, Second Corps, where Surgeon I. Scott, 7th West Virginia, recorded: "Shot fracture of right knee." Surgeon J. C. McKee, U. S. A., reported that "the patient was admitted to Lincoln Hospital, Wash ington, October 8th, with shot wound of right knee joint, the ball entering antero-posteriorly, severing the capsular ligament on its internal aspect and opening the joint. When admitted, the parts were highly inflamed and synovial fluid was constantly discharging from the wound. The limb was placed in a box splint and surrounded with bran. Improvement followed the treatment. In the course of three months recovery had taken place with complete anchylosis of the joint." On June 2, 1865, the patient was discharged from service and pensioned. Examiner H. L. Burritt, of Bridgeport, Connecticut, at successive periods certified to the character of the wound and to the leg being fixed "in a nearly straight position ; joint painful and whole limb swollen on motion and useless." The pensioner was paid December 4, 1879. A photograph of the injured limb, taken at Lincoln Hospital, was contributed by Surgeon McKee (Contributed Photographs, Vol. 3, No. 34), and is represented in the wood cut (FiG. 231). The records in the cases of recovery after shot fracture of the bones of the knee joint treated by conservation show that of the three hundred and thirty-eight patients, fifty- nine recovered with complete, and one hundred and sixty-five with partial anchylosis; in twenty-three instances impaired motion, with lameness or weakness of the limbs, or partial FIG. 230. Appearance of left knee joint about 2 months after injury. [From u photograph.] FIG. 231. Auchylosed knee [From a photograph.] nt. about (J months after injury. 380 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. phtb paralysis with atrophy of muscles, was indicated; in eight instances the motions of the joint were reported perfect, and in eighty-three cases the condition of the limb has not been ascertained. Thirty-two of the patients were Confederate and three hundred and six Union soldiers. Two hundred and thirty-six of the three hundred and six Union soldiers became pensioners; but twenty of them have died, since the close of the War, of lisis and other diseases, and one has committed suicide. Fatal Cases of Shot Fractures of the Bones of the Knee Joint treated by Conserva tion. This group comprises five hundred and twenty-one cases. The graver complica tions were pyaemia in seventy-seven instances, tetanus in two, gangrene in seventeen, and erysipelas in eighteen instances. Forty-three of the patients were Confederate and four hundred and seventy-eight Union soldiers. CASE 509. Private S. Eisner, Co. E, 7th Michigan, 1 aged 29 years, was wounded on picket near Chantilly, June 19, 1863, by a carbine shot, which entered the left thigh anteriorly at about its middle, passed downward and inward, and lodged beneath the integument on the inner side of the knee joint. He was brought to Washington and admitted to Stunton Hospital six days after being wounded. On June 27th, a conical ball was readily extracted through an incision, its situation being superficial. The joint at this time was neither swollen nor tender and did not appear to be involved in any way. On July 2d, some pain and swelling was noticed for the first time, when an ice-bag was applied to the knee. Two days later the swelling had extended up the thigh, and by July 6th there was well-marked erysipelas as well as effusion in the knee joint. Tincture of iodine was applied and tincture of muriate of iron was administered; stimulants were given freely. By July 8th, the erysipelas had extended clear up to the groin. On July 12th, the discharge of pus was free, and in consequence the tension and swelling of the thigh were sensibly diminished. The patient, however, was manifestly failing. On July 18th, he was seized with diarrhoea, and death supervened in the evening. The autopsy showed that the bullet had lacerated the sartorius muscle extensively and splintered the internal condyle of the femur. The joint arid the cellular tissues of the thigh were filled with dark colored and very offensive pus, and the articular surfaces of the femur and tibia were denuded of cartilage. Surgeon J. A. Lidell, U. S. V., who furnished the history, with the pathological specimen (FiG. 232) and the missile (Specimen 3074, Surgical Section, A. M. M.), remarks : "The case interested me greatly, because when the bullet was extracted there was not the slightest evidence of injury to the inner condyle, nor indeed to any other bone whatever. The bullet was located quite superficially and not in relation with the injured condyle. During the eight days which elapsed between the receipt of the wound and the extraction of the missile said bullet must have slipped away from the bone into a new position. When, therefore, on July 2d, some inflammatory trouble in the knee appeared, we thought it was not due to an injury of the bone, but that the involvement of the joint originated from the soft parts. The case also affords a good illustration of the obscurity of the symptoms and the difficulty of diagnosis which may attend a serious gunshot injury of an articulation so thinly covered with soft parts and so easy of examination from every side as the knee joint." CASE 570. Private A. Simms, 19th Georgia, was wounded in the right knee, at Antietam, Sep tember 17, 1862, and treated at a hospital near Sharpsburg. Surgeon J. H. Ranch, U. S. V., forwarded the specimen (FiG. 233), with the following history: "This was a robust young man, 19 years old. The surgeon who first attended him could not find the ball, the external opening of the wound being about four inches below the knee joint, but was satisfied that it had passed obliquely in the direction of the knee joint. Acting Assistant Surgeon H. De Young called my attention to this case five weeks after the man was wounded. His limb was much swollen, and his constitutional symptoms such that I decided against amputation, which was proposed, and placed him on a stimulating and nourishing diet, hoping that we thus might get him into a fit condition for an operation. For a week he seemed to improve, but after this he lost his appetite, and gradually sank from exhaustion, and died on November 10, 1862. This man s life would no doubt have been saved had an immediate amputation of his limb been made." The specimen consists of the bones of the knee, with the outer condyle shattered, and shows that there lias been a trivial deposit of callus, with much caries and destruction of the articular surfaces of the joint. CASE 571. Private I. N. Sarvis, Co. C, 131st Pennsylvania, was wounded at Fredericksburg, December 13, 1862, and was admitted to Mount Pleasant Hospital. Washington, four days afterwards. Acting Assistant Surgeon J. C. Wyer forwarded the pathological specimen (FiG. 234) and reported the following detailed history: "Sarvis received his wound by a ball perforating the patella of the left withonter condyle of femur fff. passing through the knee and making its exit at a point nearly opposite in the popliteal space, shattered. Sprc. 351. When admitted his whole constitution was suffering from the effects of the injury ; the pulse quick and frequent (120), denoting irritability; the skin dry and hot; appetite poor; sensibility of the joint extreme, the patient shrieking on account of the pain occasioned by the slightest motion of the limb. The discharge from the wound consisted of synovia and 1 A brief abstract of this case was published in Circular No. (i. War Department. 8. G-. O.. Washington. 1865, p. 36. FIG. 232. The bones of the left knee ; the posterior portion of the internal con dyle is split off. Spec. 1 399. SKCT. rv. J SHOT FRACTURES OF THE KNEE JOINT. 381 thin unhealthy pus. There was nothing peculiar about the aspect of the limb except a general tumefaction. The tongue was furred lightly, and the expression anxious; bowels constipated. On the tenth day after admission he was attacked with a severe chill, which was followed by fever, and from this period the hectic flush began to appear upon the cheeks periodically. Sub sequently there were recurrences of the rigors. Occasionally the mind wanders. The features are pinched, the skin is sallow, and countenance exhibits the icteroid appearance always present in pyaemia. There is great thirst, and the respiration is quick and irregular. On December 28th, he was attacked with a cough, the expectoration being tough, gelatinous, and streaked with blood. Auscultation revealed crepitant and sibilant rales through both lungs. On the 5th of January, 18(53, Surgeon J. H. Briuton, U. S. V.. visited the hospital and his attention was called to the case. At this period the case was one of well-marked pyaemia; the lung complication Dr. Brinton pronounced as multiple or metastatic abscess. 6th, no abatement in any of the symptoms. 7th, rales and rhonchi still audible through the lungs; pulse continues 120 beats in the minute; skin dry and hot; tongue dry and fissured; appetite much impaired; patient lies drowsy and dull most of the time. The discharge from the knee is profuse, ichorous, and of a sickening odor. From the 8th to 13th the symptoms have continued the same: respiration quick, pulse 130; tongue dry and crusty; discharge from the knee ichorous and extremely offensive ; expectoration rusty and gelatinous. Has had slight rigors. Rales and rhonchi still present. Complains of pain on the least motion of his body. Urine scanty and turbid ; bowels constipated ; loss of appetite. Continues in a semi-comatose, dull condition. 14th: This morning he is unable to protrude his tongue; the features are pinched and sunken ; pulse very feeble and rapid ; deep hectic flush. Evening : has been moaning all day and refused his stimulants. The peculiar odor is very evident. Died at 4.30 A. M. on January 15, 1863. Autopsy eight hours after death: Rigor mortis was still present; emaciation extreme. The thorax being laid open revealed the superior lobes of the lungs apparently healthy, but upon removing them the inferior lobes were found to be consolidated and studded with abscesses varying in size from a pea to larger ones, the diameter of which measured about half an inch. The consolidation and effusion extended also to the dependent portions of the superior lobes. There was considerable effusion in the left pleural cavity. The condyles of femur perfb- heart was perfectly normal; no deposit upon the valves. A small clot was discovered in the right ven tricle; there was also some of the separated fibrin; no effusion in the pericardium. The inferior lobes of both lungs sank readily in water. On making the incision to resect the knee joint, pus escaped from beneath the muscles of the lower third of the thigh. There was a, good deal of disintegration of the tissues. The extremities of the femur and tibia were entirely sep arated, the crucial ligaments having been destroyed by the ball in its passage through the joint and the capsule ulcerated through at several points. The patella was perforated about its centre, dividing it into several fragments, which, however, were retained in position by the ligamentum patellae. The internal condyle of the femur was crumbled into small fragments, and a deep furrow marked the course of the ball." In addition Dr. Wyer remarks that "at no period since his admission has an operation been admissible," also that the patient had likewise a wound of the right shoulder, involving the joint. The specimen consists of the bones of the injured knee. CASE 572. Private E. Overman, Co. H, 1st Ohio Cavalry, received a shot wound of the right knee joint, at Mission Ridge, October 24, 1863. Surgeon I. Moses, U. S. V., contributed the pathological specimen (Cat. Surg. Sect., 1866, p. 332, Spec. 2137), with the following history: "A ball entered the external condyle of the femur, penetrating the joint and lodging in the cancellated structure. He was taken to hospital in Chattanooga, where the missile was extracted, and where he remained for nearly two months. On December 20th, I saw him for the first tune in hospital at Murfreesboro , to which place he had been removed by railroad, a distance of a hundred miles. The knee was very much swollen, the joint and surrounding tissues infil trated with pus, and there was general prostration of vital force. Incisions were freely made to evacuate pus, and the symptoms generally improved. But on January 10, 1864, the patient was attacked with vomiting and prostration, and the left leg as far as the knee became gangrenous. He died on the following day." The specimen comprises the bones of the injui ed knee joint and shows the articulating surfaces to be completely destroyed by suppurative action. CASE 573. Private W. J. Lowry, Co. E, 25th Ohio, was wounded at Bull Run, August 30, 1862, and admitted to hos pital at Alexandria several days afterwards. Surgeon E. Bentley, U. S. V., reported : "A mim 6 ball passed through the right thigh antero-posteriorly, terribly shattering the lower third of the femur, opening the knee joint, and driving fragments of bone into it. The wounded man laid exposed on the battle field for two days and was then removed in an army wagon. He was treated by rest and stimulants. The patient died from pyaemia and exhaustion October 3, 1862, not having been in condition for an operation at any time before his death." In a case of grapeshot wound of the left knee an abscess was found, at the post mortem examination, which extended from two inches below the greater trochanter to a point two inches below the articular surface of the tibia: CASE 574. Private T. J. Barnett, Co. I, 40th Illinois, aged 24 years, was wounded at Mission Ridge, November 25, 1863, and admitted to the field hospital of the 4th division, Fifteenth Corps. Surgeon W. W. Bridge, 46th Ohio, described the injury as "a severe grapeshot wound of the left knee joint," and reported that the patient was transferred to the General Field Hospital at Chattanooga, December 20th. Acting Assistant Surgeon C. E. Ball communicated the result of the case from the latter hospital as follows : "When admitted the patient was very much emaciated, his injured knee and leg being badly swollen and the knee very painful on the slightest touch or movement; pulse 110. About a pint of pus, thin, very fetid, and of greyish color, was discharged daily. The wound ceasing to suppurate sufficiently, I made an incision just above, and by keeping the whole extent of the leg bandaged reduced the swelling in a few days. The discharge of pus, however, continued the same in amount and character. The patient was kept on nourishing diet, tonics, stimulants, and anodynes the whole time he was in hospital; but he gradually grew weaker, and died January 14, 1864. The autopsy disclosed a large sloughing wound on the INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. anterior surface of the knee joint; the patella fractured in four fragments. On laying open the thigh an abscess was found extending from two inches below the great trochanter to a point two inches below the articular face of the tibia, containing ichorous pus with masses of cheesy appearance and consistence. The knee joint was opened posteriorly as well as anteriorly, and the ligaments and cartilages were somewhat softened. A portion of the articular surface of the tibia was laid bare; the limb generally infiltrated with serum." The lowest third of the femur of the wounded hmb, being also injured, was forwarded to the Museum by Dr. Ball, and constitutes specimen 2168 of the Surgical Section, showing a longitudinal fissure to the extent of four inches on the posterior surface of the shaft, the articulating surface being destroyed by suppuration. CASE 575. Private W. J. D. Parks, Co. H, 132d Pennsylvania, was wounded at Freder- icksburg, December 13, 1862, and entered the Harewood Hospital, Washington, on December 18th. Surgeon T. Antisell, U. S. V., recorded as follows: "Gunshot wound in right knee, opening the joint. Ball entered on the inner side of the patella on a level with it, and emerged at the popliteal space. Patient in general poor health and anaemic. Cold-water dressings were used December 22d ; irritative fever ; tongue dry ; pulse 100. He continued to decline, there being no time at which he could bear an operation. He died on December 28, 1862. Post-mortem: Inner condyle of femur fractured. Ball passed directly into the joint, cutting a part of the crucial ligament and emerging from below into the popliteal space. Suppuration and burrowing of pus existed on outer The bones of the injured knee are shown in Assistant Surgeon W. A. 235. The bones of the riirht knoe. with the inner con- side of thigh, extending four inches above the joint." the annexed cut (FiG. 235). The specimen was contributed by Actin dyle und the head of the tibia Harvey, and shows that, besides the injury to the inner condyle of the femur, the head of the tibia fractured posteriorly. Spec. 98:i. J J J was fractured posteriorly. CASH f>76. Private J. Traverse, Co. I, 7th Michigan, aged 26 years, was wounded at Antietam, September 17, 1862, and admitted to hospital No. 1, Frederick, twelve days afterwards. Acting Assistant Surgeon R. Davies furnished the follow ing minutes of the case: "Wound in the left knee by a bullet. No inflammation followed. The missile was first perceived October 27th, being situated at the outside of the patella, two inches from the tubercle of the tibia and directly under the integument. On extracting it about half a dozen drops qf synovia escaped, the joint being opened to a very small extent by the edge of the base of the bullet. Wound closed by plaster. October 29th, inflammation of the joint having set in, cupping to the amount of six ounces was resorted to; ice applications and opiates; low diet. October 30th, measurements around the left or affected knee show, above the patella, thirteen and a half inches; across the patella, fourteen and three-quarter inches; and below the patella, eleven and a half inches; while at the right or sound knee they show thirteen, fourteen, and eleven inches respectively. November 4th, patient had a sleepless night and pain, notwithstanding a dose of morphia. There is an opening on the outer side of the patella, from which pus is freely escaping. The injured knee now measures fourteen inches above, sixteen and a half inches across, and thirteen and a half inches below the patella. 13th, measurement shows fourteen, fifteen, and thirteen inches above, across, and below the patella. Two openings have been made on the inner side, one opposite the upper border of the patella and the other four inches above. Pus of a healthy character exudes. Complains of much startling pain at times, in the intervals is not in much pain; pulse 100. 14th, there was a chill, and again the next day. 16th, another chill. Burrowing of pus on the inside of the thigh. Discharge Via. -.>:!<!. The bones thin j n quality, like dirty greenish water. The slightest pressure above and below the patella, especially of the left knee; thn ,.. ., ... . patella is fnu-turedinid on the inner side, induces an immediate escape of pus. No pain or redness in course of the saphena vein. involved 1 "ftnec*" ^ as hiccough; skin hot; pulse 120. 20th, discharge as thin and watery as possible, emerging upon the slightest pressure at any part of the thigh; surface of body and extremities bathed with perspiration; pulse too fast to be counted. Patient evidently sinking. Died on November 21, 1862. Post-mortem: A collection of partially fluid dark blood was found in the thigh, corresponding to the attachments of the inner and outer layers of the fascia. The periosteum was easily detached over the lower two-thirds of the femur, on the anterior, interior, and external portions; bone laid bare for about the size of a sixpence at the lower portion of the femur. The articular surface of the femur was entirely bare, as was also its anterior and lateral borders. The borders and the articular surface of the head of the tibia were bare and the bone rough ened, and there was fracture and bony separation of the patella into three portions. There was a sequestrum about the size of a nut on the left side of the tubercle of the tibia." The bones of the knee were contributed to the Museum by Acting Assistant Surgeon Davies, and are represented in the annexed wood-cut (FiG. 236). CASE 577. Private W. West, Co. C, 51st Georgia, nged 17 years, was wounded at South Mountain, September 14, 1862, and admitted to hospital at Frederick three days afterwards. Acting Assistant Surgeon W. W. Keen, jr., reported : " Gunshot wound of left knee joint, a ball passing through the head of the tibia, involving the joint. There was also a flesh wound of the right leg just below the knee joint. Irritative fever ensued and continued for one week after the patient s admission. The treatment was supporting and poultices were applied to the joint, which improved in external appearance. Pieces of the artic ular surface of the tibia were nearly detached on September 25th. Two days later suppuration was free and of a flocculent character; tongue dry and furred; pulse 116. On October 4th, the joint was laid open by free incisions on each side of the patella, when the pus was found to be burrowing up the thigh to a very great extent. On October 8th, the condition of the thigh was apparently improved, but the pulse was no better and the patient had a severe chill. He continued to grow weaker. On October 13th, there was some haemorrhage from the wound, and on the following day the patient died. At the post-mortem, examination a broad abscess was discovered to extend from the knee to the groin. The ball was found to have passed directly through the joint from side to side, knocking off pieces of the internal condyle of the femur and the articular surface of the tibia. This patient had been told at an early stage of the treatment that his limb ought to be amputated. But he expressed his certainty of recovering without amputation and begged off, declaring his readiness arid willingness to incur all risks of that SECT. IV. | SHOT FRACTURES OF THE KNEE JOINT. 383 FK;. 237. Shot perforation of innor ttibcrosity of the left tibia. Spec. :i5fi. FIG. 238. Shot comminution of head of right tibia. Spec. 7fiO. course. He was therefore not operated upon." The bones of the injured knee joint, showing the articular surfaces to be eroded, were contributed to the Museum by Acting Assistant Surgeon J. H. Bartholf, and constitute specimen 825 of the Surgical Section. CASE 578. Private J. W. Shcttles, 2d Mississippi, was wounded at Antietam, September 17, 1862, and admitted to a hospital near Shurpsburg. Surgeon J. H. Ranch, U. S. V., contributed the specimen represented in the annexed wood-cut (FiG. 237), and reported: "This man was wounded through the knee joint, from the effects <>f which he died on November 9, 1862. Had this man been operated upon, I am satisfied his life would have been saved." The specimen consists of the bones of the left knee with the inner tuberosity of the tibia perforated obliquely down ward by a round ball. The articular surface is eroded by suppuration. The bullet is seen at the point of entrance, whither it appears to have gravitated through its own track and where the fragments are necrosed. The partial fracture of the shaft of the tibia has been slightly consoli dated by effusion of callus. CASE 579. Private P. Gregory, Co. IT, 1st Delaware, was wounded in the right knee, at Antietam, September 17, 1862. Surgeon I. Scott, 7th West Virginia, noted his admission to the field hospital of the 3d division, Second Corps, with "wound of leg." On September 27th, the wounded man was transferred to hospital No. 1, Frederick, where he died October 16, 1862. The specimen, shown in the cut (FiG. 238), was preserved at the post-mortem examination and contributed to the Museum by Acting Assistant Surgeon W. W. Keen, jr. It consists of the upper portion of the bones of the leg, with the head of the tibia shattered by a ball passing through it transversely. The fragments are necrosed. CASE 580. -Private J. McNulty, Co. E, 22d Michigan, was wounded in both knees, at Chickamauga, September 19, 18(53, and admitted to hospital at Chattanooga some days afterwards. Surgeon J. T. Woods, 99th Ohio, reported: " Fracture of head of each tibia; patient suffering from chronic diarrhoea; simple treatment. Haemorrhage occurred; popliteal artery and branch, with popliteal vein, ligated. Gangrene set in below the location of the ligatures, and death supervened October 15, 18fi2." CASE 581. Sergeant J. McCarthy, Co. C, 149th New York, was wounded at Wauhatchie, October 27, 1863, and admitted to the field hospital of the 1st division, Fourteenth Corps. Surgeon W. M. Wright, 79th Pennsylvania, reported: "He was wounded by a conical leaden bullet, which entered on the posterior aspect of the right leg about four inches below the knee, taking an upward course, and passing out just one inch beneath the patella. The wound was probed by a competent surgeon, who concluded that it was not a case warranting amputation, although in the end it might prove to have been judicious. Two or three days afterwards the patient complained of severe pain in the knee which required large doses of anodyne to alleviate. The pus assumed a thin watery consistence of a brownish coffee-like appearance and discharged quite freely; odor somewhat unpleasant though not fetid. The limb was greatly increased in size throughout its whole extent, and to the touch it gave evidence of oedema. Several days later pressure upon the knee gave a crackling sensation to the hand, giving unmistakable evidence that the; joint was implicated. The patient died on the morning of November 8, 1863, after extreme suffering during the previous twenty-four hours. During the period succeeding the first three days there was great gastric irritability which remedies failed to correct. During the last two days the discharges from his bowels were black, and for twelve hours previous to death a black substance, resembling thin coffee grounds somewhat and amounting \o a pint probably, was discharged from the mouth. An examination of the limb after death showed a fracture of the head of the tibia behind, external to the popliteal notch, extending into the articulating surface from an inch and a half below it. Necrosis of the bone had commenced to a slight degree. The femur and fibula were untouched." CASE 582. Private B. Madden, 1 Co. A, 28th Massachusetts, was wounded at Fredericks- burg, December 14, 1862, by a shell in the left knee joint. He was admitted to Douglas Hos pital, Washington, twelve days afterwards. Medical Cadet S. T. Kingston, TJ. S. A., contributed the pathological specimen, represented in the annexed wood-cut (FiG. 239), and reported that "the patient died December 29, 1862, from the effects of a shell wound in the left knee." The specimen consists of a ligamentous preparation of the injured knee, showing fearful laceration and complete destruction by the missile, two fragments of which are mounted with the preparation. CASE 583. Private F. L. Mellott, Co. K, 12th Pennsylvania Reserves, was wounded at South Mountain, September 11, 1862. Acting Assistant Surgeon G. W. Corey reported: "He was wounded by a musket ball entering the left knee near the lower border of the patella, a little to the outer side of the ligamentum patella, passing obliquely backward and outward through the outer tuberosity of the tibia and through the head of the fibula. The man was brought to the temporary hospital at Middle- town some time in the night following the battle, and the second day after the injury the femoral artery of the wounded limb was tied by the Surgeon in charge for the purpose of keeping down the inflammation and saving the limb. Water dressings were applied and stimulants and anodynes freely administered. About six days after the battle the hospital was permanently established and the patient came under my care. At this time I found him suffering from severe pain, the redness and swelling FIG. 239. Destruction of left k IK by a shell explosion. Spec. 70! . 1 This case has been alluded to and the specimen figured in Circular No. C, War Department, S. G. O., Washington, 1865, pp. 37, 38, FIG. 50. 384 INJURIES OF THE LOWER -EXTREMITIES. [CHAP. x. of the joint being moderate, suppuration profuse, and the temperature of the parts below as I expected to find it. In fact t>o marked was this latter symptom that I feared the occurrence of gangrene of the part and immediately discontinued the water dressing. Gangrene, however, did not set in; but the soft tissues, wherever the limb rested on the pillow, sloughed very rap idly, indicating the low vitality of the parts. The treatment from this time consisted of emollient applications and stimulant and astringent lotions, with a free use of alcoholic stimulants internally. The case went on for some time without any marked change, the discharge becoming more profuse and the sloughs extending and presenting no disposition to granulate. Finally diarrhoea, loss of appetite, night-sweats and delirium supervened, and death resulted on October 28, 1862, forty-three days after the reception of the injury. An examination of the joint after death showed the most perfect destruction of the synovial membrane and of the articular cartilages and other soft tissues." The bones of the fractured knee joint were contributed to the Museum by Dr. Corey, and constitute specimen 915 of the Surgical Section. The specimen shows the condyles to be split vertically, the inner one being broken posteriorly and nearly detached, and the articular space eroded by suppuration. The fractured extremities of the tibia and fibula are thoroughly carious. Four hundred and seventy-eight of the five hundred and twenty-one fatal cases of shot fractures of the knee joint treated by conservation were Union and forty-three were Confederate soldiers. Specimens illustrating the nature of the various injuries of the bones of the knee are preserved in the Army Medical Museum in ninety-nine cases. The side of the injury was reported in seven hundred and ninety-seven of the eight hundred and sixty-eight cases of shot fractures of the knee joint. The right side was involved in four hundred and thirty-one, the left in three hundred and sixty-six. Of the former, one hundred and seventy-four were successful, two hundred and fifty-four were fatal, and three undetermined, giving a mortality rate of 59.3 per cent.; of the latter, one hundred and fifty-two were successful, two hundred and thirteen fatal, and one undeter mined a mortality rate of 58.3 per cent., or 1 per cent, in favor of the injuries gf the left side. Of eight hundred and sixty-eight patients, seven hundred and eighty-seven were Union soldiers. Three hundred and six recovered; four hundred and seventy-eight proved fatal, and in three cases the result was not ascertained a fatality of 60.9 per cent. Of eighty-one Confederate soldiers, thirty-two recovered, forty-three died, and six cases were undetermined a mortality of 57.3 per cent., or 3.6 per cent, less than the percentage of deaths among the Union soldiers. In forty-four instances, with twenty-four recoveries and twenty deaths, fragments of the patella or of the articulating ends of the -femur or tibia were removed. EXCISIONS AT THE KNEE JOINT FOR SHOT INJURY. As far as the records of this Office indicate, fifty-seven excisions at the knee joint for shot injury were performed during the American civil war, the first operation having been done on September 15, 1862, at the Fairfax Seminary Hospital, near Alexandria, Virginia. It is to be regretted that the name of the operator in this instance is not reported. Prior to that time there were recorded eighteen examples of this operation for shot injury, fifteen in Europe, 1 and Excision of the patella for shot fracture is mentioned by J. CH. A. THEUEX (Neue Bemerkungen und Erfahrungen zur Bercicherung der Wund- arzntykunst, Berlin und Stettin, 1782, B. I, p. 101): "I cannot, therefore, approve of the excision of the patella fractured by shot, which I have seen undertaken by somebody but very unfortunately, as gangrene and death supervened." No pia^iculars are recorded. KAJETAX v. TEXTOK (LUDWIG FUCHS, Veber Resection im Kniegelenke, Inaug. Diss., AVlirzburg, 1854, p. 9, No. 13) resected, on November 4, 1847, the fractured condyles of the femur of a laborer, aged 37, shot in the left knee while poaching ; death from pyaemia, November 11, 1847. KXOUKE, of Hamburg (L. SxuoMEYElt, Maximen dcr Kriegshcilkunst, Hannover, 1861, p. 523, note, and GUULT (E.), Die Gelenk- Resect ionen nach Schussverletzungcn, Berlin, 1879, p. 1189), resected the joint in the case of Carl Kunsch, aged 121, wounded August 13, 1849 ; missile entered the upper part of the right leg, at the inner side of the crest of the tibia, and emerged at the same height posteriorly; inner half of upper portion- of tibia shattered. On August 15th, decapitation of tibia and fibula, sawing off 2J inches of each. By November 1st, firm union between femur and leg. Left hospital in June, 1850. Seen by the operator in the summer of 1859, carrying a heavy basket, entirely well, and, with the exception of stiffness, not suffering from any inconvenience from the leg. On January 17, 1875, the operator reports the patient as having a blooming complexion, being well fed, and having maintained his family without assistance. He was able to carry 150 pounds ; fur the past two years the strength of the leg has diminished, compelling him to earn his bread as a night-watchman. He was able to walk two or three miles (German) a day without tiring. He has continuously used a linen bandage two inches wide and four yards long to support the leg since leaving hospital. Cicatrix sound, pale, and movable. The limb is (J centimetres shortened. FAHLE (F. ESMARCII, Vebcr Jtesectionen nach Kchusswun- den, Kiel, 1851, p. 133) operated in the case of Philip Blumenthal, volunteer, 2d Chasseur Corps, 2d Co., wounded in a reconuoissance, December 31, 1850, a ball entering the outer side of the left knee. On January 3, 1851, by Dr. STJIOMEYEU S advice, the patella, 1* inches of the condyles of the femur, and portions of the tuberosities of the tibia were excised; death February 3, 1851. J. II. LAKIX (T. P. M vrniEW, Med. and Surg. Hist, of the British Army which served in Turkey and the Crimea, London, 1858, Vol. II, p. 379, and GUULT (E., toe. cit., p. 126): Case of II. Gribbins, 77th British Regiment, aged 19, wounded Sept. 8, 1855, during the retreat from the Redan, in the left knee ; Sept. 30, 1855, excision of about 1 J inches of the condyles of the femur and SECT. IV.] EXCISIONS AT THE KNEE JOINT. 385 three on this continent. 1 Eight of the operations had been successful, nine fatal, and in one instance the result had not been ascertained. The results of the fifty-seven cases of excision of the knee joint of the American civil war are indicated in the following table: TABLE LIII. Classified Statement of Fifty-seven Cases of Excisions at the Knee Joint for Shot Fracture. PARTS EXCISED. TOTAL CASES. TIME OF OPERATION. PlilMAUY. INTERMEDIARY. SprnvnARY I! TIME NOT SPECI FIED. 3 5 Recovery. .= 8 C 4 1 16 4 ; ; Undeter- ; ** : mined. Ratio of mortality of determined cases. g 3 - 2 2 10 6 5 1 6 Recovery. Death. Undeter mined. 1 3 Recovery. Death. U Recovery. Death. -." Recovery. Death. Undeter mined. Condyles of the Femur 5 3 19 1 3 T 80.0 50.0 84.2 57.1 100.0 75.0 87.5 o l 1 1 1 1 1 1 Condyles of the Femur and Patella 1 3 10 3 5 1 1 6 1 Condyles of the Femur, Patella, and Head of Tibia Condyles of the Femur and Head of Tibia 1 5 1 3 2 1 Patella or portion thereof q q 2 2 1 1 1 2 1 1 1 Head of Tibia 4 10 57 1 1 3 7 2 1 1 1 1 Parts not specified 4 5 1 1 3 1 1 1 1 1 12 3 10 44 3 81.4 32 26 2 13 7 4 5 3 1 In three instances the terminations were not ascertained; ten operations were followed by recovery and forty-four by death, a fatality of 81.4 per cent. As indicated in TABLE a thin slice of the head of the tibia ; patella removed ; death Oct. 28, 1855. JOHN BROWN, Assistant Surgeon Bengal Medical Sen-ice (Edinburgh Mtd. Jour., 1860, Vol. VI, p. 320): Case of Mahun Singh, aged 30, wounded Jan. 16, 1858, in an attack on the English at Alumbaugh. Wound over the left knee; limb severed and hanging by a shred of skin ; also compound fracture of patella of right knee. Left femur immediately amputated at middle third, and right knee resected by an H-incisiou ; no haemorrhage, no anaesthetic used ; death on the evening of Jan. 17. 1858, frum the effects of shock. J. NEUDORFER (Handbuch der Kriegschirurgie und der Operationslehre, Leipzig, 1872, Zweite Halfte, p. 1545 et seq.) gives details of six operations performed by himself: Johann Zelenka, Austrian Infantry Regiment E. H. Rainer, wounded at Solferino June 24, 1859. Shot fracture of left hand, causing amputation of index and middle fingers, and shot wound of thoracic parietes, and a shot fracture of the left knee joint. November 20, 1859, resection of about 2J inches of the end of the femur, a thin slice of the head of the tibia, and part of the patella. Wound healed in three months, leaving several fistulas. He could bend the joint to an angle of from 5 to 8 degrees. Johann Dubou, Prince Hohenlohe Austrian Infantry Regiment. Shot fracture of the right knee joint. September 8, 185 .), secondary operation, by reason of progressive caries; death September 24, 1859. Michael Fonta, 5th Austrian Infantry Regiment. Wounded at Solferino June 24, 1859. Shot fracture left knee joint. Resection February 10, 1860; death from exhaustion February 28, I860. Abraham Maksa, Prince Wasa Austrian Infantry, 3d Co., wounded at Solferino June 24, 1859, in the right knee joint. Resected February 11, 1800. Complete recovery. Antonio Mazzini; shot fracture of right knee joint. Resection March 20, 1800, of condyles of femur (about nine months after injury), in hospital at Veronu. Sent home six weeks after the operation in a fair way of recovery. Not heard of afterwards. Anton Potesch, Austrian Infantry Regiment " Kaiser." Wounded in right knee joint. Resection May 18, 1800 (about a year after injury) ; death from pysemia May 22, 1860. D. W. CROMPTOX, of Birmingham (Medical Times and Gazette, 1861, Vol. I, p. 518): George W., aged 19, wound in left knee joint by accidental discharge of gun, December 26, 1860. Admitted the saint- day into Birmingham General Hospital. Resection of the joint, sawing off a thin portion of the head of the tibia and corresponding thin portion of the condyles, after which nearly the entire shattered condyle of the femur was sawn off diagonally, and numerous shot were removed. The patella, as well as the articular cartilage of the parts not resected, was left intact. April 5, 1861, discharged from hospital cured. Could walk with ease with the aid of a cane. Limb from J to f inch shortened. HuTCHINSON, of London (Lancet, 1861, Vol. I, p. 386): A healthy young man, who bad been severely wounded February 13, 1861, in both legs, at a distance of twelve paces, by the accidental discharge of a gun loaded with No. 6 shot and :i pasteboard stopper. The charge penetrated just over the right knee, going diagonally downward through the condyles of the femur, and entering the inner side of the left leg below the knee and behind the inner margin of the tibia, lodging superficially on the outer side of the left leg. Admitted into London Hospital February 13. 1861. Resection an hour after injury, removing about an inch and a half of the femur, a very thin slice of the tibia, and extirpating the entirely intact patella; death February 23, 1861, of tetanus. HEXUY SMITH (Medical Times and Gazette, 1863. Vol. II, p. 376): John II., aged 29, private, English Fusileer Guard, wounded at the battle of Inkerman, November 10, 1854, in the left knee joint. Ball lodged in popliteal space and extracted in hospital at Scutari. Resection September 6, 1862, at King s College Hospital, London. Discharged from hospital December 9, 1862, cured. The cases of LAHREY, PERCY and LAURENT, and CHAMPION, cited by OSCAR HEYFELDER (Lehrbuch der Resec- tionen, Wien, 1803, p. 135) and by H. Cui.liERTSON (Excision of the Larger Joints, Prize Essay, Philadelphia, 1876, p. 188, in Trans. Am. Med. Assoc., Supplement to Vol. XXVII), have been omitted. In LAUREY S case (D. J. LARREY, Mem. de Chir. Mil. et Camp., Paris, 1812, T. Ill, p. 256) of an Arab, named Ibraham, only loose fragments of the patella were removed. The cases ascribed to PERCY and LAURENT are evidently the operations referred to by them in their article Resection, in Diet, des Sci. Med., Paris, 1820, T. XLVII, p. 555: the operations were for disease of the knee joint and were performed by MOREAU. In the operation ascribed to CHAMPION, which is found in his Traiti de la Resection des os caries dans leur continuite, ou hors le.s articulation*, Paris, 1815, No. II, p. 77, carious bone was chiseled away from the tibia to allow the removal of the ball. GURDON BUCK (Excision of the Knee Joint ffir Anchylosis, in New York Med. Times, March, 1854, Vol. Ill, p. 205): Gunshot wound of knee joint, received about April 20, 1853 ; healed with anchylosis at an angle of about 135 degrees upon the thigh. August 9, 1853, adhesions broken up: * slice removed from the inferior surface of the condyles of the femur, including the pulley-like surface intervening between, and the articular surface of the tibia on a level with the upper extremity of the fibula; coaptation of cut surfaces, which were held together by a wire; the wound healed in nine weeks. Dr. BUCK exhibited the patient to the New York Academy of Medicine, February 1 , 1854. E. S. COOPER ( Case of Bisection of the Knee Joint in consequence of Disfane nf Bone* caused by a gunshot wound, in The Cleveland Medical Gazette, 1861, Vol. Ill, p. 604): N. F., aged 24, shot through the SUUG. Ill 49 386 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. LII, page 367, the articulation was primarily involved in fifty-six instances; in the remain ing case the operation was performed for shot fracture of the upper thirds of the bones of the leg. Primary Excisions at the Knee Joint. In thirty -two of the fifty-seven cases of excision of the knee joint performed during the American civil war the operation was done within forty-eight hours after the reception of the injury. The results in two of the thirty- two cases could not be ascertained; four of the patients survived the operation, and in twenty-six instances death resulted, a mortality rate of 86.6 per cent. Recoveries after Primary Excision of the Knee Joint. Portions of the condyles of the femur and the head of the tibia were removed in three of the four cases of this group; in the remaining case the extremity of the tibia and the patella were excised. Three operations involved the right limb and one the left. Two were Confederates and two Union soldiers. In one of the four instances amputation of the thigh became necessary on the fifth day, and, although the patient survived both operations, the case cannot well be cited as an instance of recovery after primary excision at the knee joint: CASE 584. Surgeon A. W. Bailey, 1st South Carolina Infantry, of Barnwell District, reports the following remarkable example of successful partial excision of the right knee: "Lieutenant J. W. Harlee, Co. I, 1st South Carolina Regiment, Brat ton s Brigade, aged about 27 years, and of robust constitution, was wounded in the battle of the Wilderness, May 0, 18G4. / mini6 ball passed laterally through the right knee joint, fracturing the head of the tibia. A curved incision was made, extend ing from one condyle to the other, reaching just below the inferior border of the patella. All the ligaments, with the synovia! sac, were divided, and the semilunar cartilages removed. A transverse section of the head of the tibia, embracing the fractured portion, was made above the articulation with the fibula. The patella was not ablated. The wound was closed with sutures and adhesive straps, and the limb secured to a long outside splint. The next day he was transported about twenty-five miles over a rough road to the rear, and two of the sutures cut out, thereby exposing the internal condyle. In a short time the exposed surface was covered with healthy granulations and the space soon filled up. In the course of six or eight weeks true anchylosis had taken place, and the wound healed, except a small place where the condyle was exposed, leaving a small fistula, which healed in a short time afterwards. This officer, who returned to his command to be retired on the Invalid Corps, gives the following account of the treatment carried out after being sent to the General Hospital : He Avas furnished with a quart of good whiskey daily, and requested to drink as much as he could, and use the balance on his leg. He says he drank the quarter portion each day, and dressed his wound twice daily with one part of whiskey to three of water. His leg is about three inches shorter than the other; he wears a high heel and thick sole to his boot, by which means he is enabled to walk without crutches, and even dance with ease." CASE 585. Private W. F. Jackson, Co. G, 6th South Carolina, aged 21 years, received a shot fracture of the left knee joint, near Richmond, October 7, 1864. He underwent the operation of excision on the day of the injury, at the hands of Sur geon Stony, C. S. A., who removed the condyles of the femur and the detached fragments of the patella through a straight incision in the line of the wound. Fragments of bone continued to discharge for about twelve months after the operation, after which time the wound remained perfectly healed. The case was reported by Dr. C. H. Ladd, late Surgeon 56th North Carolina, who stated that when last heard from, in December, 1872, the man had very limited motion of the injured joint. The records of Jackson Hospital (Confederate), Richmond, show that the patient was admitted with "shot wound of knee joint, treated by ablation of patella," and that he was furloughed March 13, 1865. In a letter, written and forwarded in 1868, the man repre sented his wounded limb which, in the opinion of all who examined it, had undergone "one of the most remarkable surgical operations" as "a good sound leg, which answers every purpose." CASE 586. Private A. Rider, Co. G, 76th Pennsylvania, aged 25 years, was wounded in the right knee, at Pocotaligo, October 22, 1862, and admitted to hospital No. 1, Beaufort, two days afterwards. Surgeon R. B. Bontecou, U. S. V., contributed the pathological specimen (FlG. 240) and the following report: "The missile was a rough leaden canister ball of ordinary size, which entered the limb over the front of the external condyle, passing through the posterior margin of it, opening the capsule and lodging in the popliteal space. The circulation and appearance of the limb was good, but there was some swelling of the knee and pain on motion or to the touch. The bullet was removed from beneath the integuments by incision on the morning of his admission. Resection of the lower portion of the condyles of the femur was done the same day, at 3 P. M., and the semilunar cartilages removed from the tibia. The H-incision was employed, and the transverse cut united by lead wire accurately. Morphia was applied to the wound, and wet lint and the ice bag kept constantly in use. On the next day, the patient s bowels not having knee joint, in June, 1857 ; fracture of condyle of femur and upper part of tibia. October 25, 1857, excision of condyles of femur, of more than an inch of the head of the tibia, and of the patella; complete recovery. CHAULKS A. Poi E (Complete, Osseous Anchylosis of the Knee Joint. Successful!;/ operated on by Barton s method, in Am. Jour. lied. Kci., 1861, Vol. XLII, p. 298, and St. Louis iled. and Surg. Journal, May, 1861. Vol. XIX, p. 211): Mr. A., a healthy man, aged 40, received, when about 10 years old, an accidental shot wound of the knee, the ball passing just below the right knee joint. The articulation became secondarily involved and complete osseous anchylosis resulted. For long years he wore a wooden peg with the knee resting in a socket at its upper extremity, for purposes of locomotion. March 14, 18G1 , resection of knee by Dr. POPE, assisted by Drs. SMITH, GllEGOny, and DF.WF.Y. Recovery; walks without a stick ordinarily. 1 Bailey (A. W.), A case of Knee-joint Resection, in Southern Medical and Surgical Journal, 1866, Vol. XXI, p. 460. n x O co O 2 O) l ^ i j "n | 3 r - 05 ^ i o J f j S < SECT, iv.l PRIMARY EXCISIONS AT THE KNEE JOINT. 387 been moved for some days, an ounce of sulphate of magnesia was administered. October 30th, diarrhoea having been trouble some for twenty-four hours, pills of argentum, opium, and camphor were given, and on the following day, the diarrho3a still continuing and there being some febrile symptoms, spirits of mindererus was prescribed and milk porridge for diet. Wet dressings with ice were continued until November 2d, when cerate dressings and dry lint with ice bag were ordered. Starch and laudanum injections arrested the looseness. The limb had been kept on a pillow, and great pain was experienced on the slightest movement until I constructed a rest for it out of two parallel cushions of hay tacked on a plank, leaving a space under the knee unstuffed. When laid on this, on October 27th, the limb was very comfortable. Before that time the poor fellow had frequently regretted that it was not removed. The transverse incision healed without suppuration, and no swelling of the limb, above or below the knee, took place. The only ligature employed was on the azigos artery, which came away November 16th. Scarcely any inflammation about the knee took place until November 18th, when I observed that the line of incision, which had healed many days ago, reopened in places and discharged pus. Cerate dressings were applied and straps to approximate the lateral wound; the limb exposed and a wet napkin kept on the knee. December 1st, the bones have apparently united and there is very little discharge, the incisions having healed, with the exception of a point on either side of the joint, from which a few drops of pus are escaping. The patient suffers no pain, and I shall to-day flex the knee a trifle permanently. The leg was kept on a straight plank and between the hay cushions until December 20th, when I put the limb in a starch bandage, well stiffened by strips of pasteboard. On Decem ber 26th, I slit the bandage open from the toe to the hip and discovered some erythematous blush on the skin, also a slight general disturbance, accompanied by dry tongue. The febrile symptoms yielded readily to acidulated drinks and a little spirits of mindererus. On December 28th, the patient was sent to a Northern hospital by the steamer Star of the FIG. 240. Condyles of right femur South. 1 saw the man in hospital at lort Wood in July following. He was not able to primarily excised. Spec. 2030. walk then, but subsequently he did so with the assistance of a cane, and was discharged." The records of Fort Wood Hospital, Bedloe s Island, show that the patient was admitted December 31st, and that he was discharged August 28, 1863, Acting Assistant Surgeon O. W. Gibson certifying to the disability arising from "resection of knee joint." Five months afterwards, when making an application for pension, the man was examined by Surgeon J. A. Wolf, 29th Pennsylvania, who certified to the following disabilities as resulting from the wound: "He has anchylosis of the injured joint, also paralysis of both inferior extremities. He is now permanently confined to his bed. being entirely unable to move his body or inferior extremities." The reports of different examining surgeons show no improvement in his condition up to September, 1874, at which time the pensioner was exempted from further examinations. The photograph represented in FIGURE 2 of PLATE LXV, opposite page 386, was obtained from Dr. Bontecou, who mentioned that the paralysis came on some time after the patient s recovery from the operation and after his arrival at home. He also suggested that the attack "may have been caused by malarial poison." In several letters received from the pensioner, the last one being dated April 14, 1877, he depicts his condition as that of "a poor wreck," and states that owing to "the lower portion of his body being entirely powerless from the effects of the wound" he is obliged to keep in his bed all the time. His pension was paid December 4, 1879. 1 In the following instance the primary excision was followed five days later by a suc cessful intermediary amputation of the thigh at the junction of the middle and lower thirds of the femur: CASE 587. Private W. M. Constable, Co. H, 1st U. S. Cavalry, aged 26 years, was wounded in the right knee, at Din- widdie Court House, March 31, 1865. He was admitted to a Cavalry Corps field hospital, whence Assistant Surgeon E. J. Marsh, U. S. A., reported: "Severe fracture of external condyle of femur and of head of tibia by a bullet; treated by excision; missile removed ; chloroform used." Five days after the date of the wound the limb was amputated by the circular method at the junction of the middle and lower thirds of the thigh. This operation was done at Judiciary Square Hospital, Washington, by Acting Assistant Surgeon F. H. Colton, who also, three months later, at Douglas Hospital, performed a second operation, removing a sequestrum, two inches long and one-fourth inch wide, from the stump. By August 29th the stump had entirely healed, and one week afterwards an artificial limb was fitted by the Jewett Patent Leg Co. The patient was subsequently dis charged from Harewood Hospital, November 18, 1865, and pensioned. Several years afterwards he served for a period in the 44th Regiment (Invalid) of Infantry. The pensioner was paid March 4, 1880. 3 Fatal Cases of Primary Excision at the Knee Joint. Twenty-six primary excisions of the knee joint terminated fatally. In ten instances, the condyles of the femur, the head of the tibia, and the patella; in two, the condyles of the femur; in three, the con dyles of the femur and head of tibia; in one, the head of the tibia; and in five, the patella were the parts excised; in five instances the excised portions were not specified: CASE 588. Private J. F. Black, Co. H, 26th Illinois, was wounded in the left knee, at Jonesboro/ September 2, 1864. Surgeon W. M. Cake, 53d Ohio, reported his entrance into the field hospital of the 4th division, Fifteenth Corps, with "a frac ture and comminution of the patella by a bullet; exsection of patella by Surgeon D. Halderman, 46th Ohio, six hours after the injury, under chloroform." Two days after the operation the patient was transferred to the general field hospital of the Fifteenth Corps, where he died September 11, 1864. "See Circular No. 6, War Department, S. G. O., Washington, 1865, p. 58. LYOX (I. W.), Excision of the Knee and Hip Joints, in Am. Jour. Wed. Set., 1865, Vol. XI,IX, N. S., p. 64 ; CULHEKTSOX (H.), Excision of the Larger Jointt of the Extremities, Prize Essay, in Transactions of the Am. Med. Assoc., Philadelphia, 1876, Supplement to Vol. XXVII, p. 182. 2 See TABLE XXXV, No. 43, p. 280. 388 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 589. Private T. Clark, Co. D, 2d New Hampshire Cavalry, 1 was vrounded near Alexandria, Louisiana, May 4, 1864. Surgeon C. Powers, 160th New York, in charge of the Alexandria Hospital, reported his admission with "a wound of the right knee joint, a ball entering the inner condyle of the femur, passing behind the blood-vessels, and emerging two inches above the joint on the outer side. The internal condyle was shattered, but there was no appearance of injury to the blood vessels. Prostration was not great, the pulse being 90, but not strong. Amputation was immediately advised, but the patient positively refused to submit to it, preferring rather to lose his life than his limb. Chlorof<>nn was then administered and excision was performed by Assistant Surgeon J. Romans, jr., U. S. A., removing two inches of the femur and half an inch of the tibia through a horizontal incision. The patient reacted slowly. The wound was brought together with sutures and the limb was placed in a fracture-box. A full anodyne was administered to enable the patient to sleep. Next moming all that part of the limb below the incision was found to be cold and without pulsation in any of the arteries. On May 5th, the patient was moved on board of a transport for the purpose of being conveyed to hospital at New Orleans. He continued to sink, and died." The records of the Hospital Steamer Laurel Hill show that the patient s death occurred on May 7, 1864. Four years afterwards the operator communicated the following additional information in the case: "My view of the cause of death is this: The bullet in its course lacerated somewhat the coats of the popliteal artery. The anastomosis was cut off by the division of the arterial branches of the popliteal in the incision, which was the usual semilunar one, running from the posterior edge of one condyle to the other. The dorsalis pedis beat strongly for several hours following the operation, after which pulsation gradually ceased in it, and the limb became cold and then gangrenous below the line of the incision and the bullet wound. Undoubtedly a clot formed in the popliteal, and, afterwards, the coats of the artery gave way more or less, thus causing the haemorrhages. The weather was very hot and the hospital boat very crowded and on a narrow river; but these circumstances had nothing to do with the patient s decease, which was caused, I believe, by occlusion of the popliteal artery." CASK 590. Corporal S. B. Carlton, Co. I, 4th Maine, was wounded at Chancellorsville, May 3, 1863, and admitted to the field hospital of the 1st division, Third Corps. Surgeon E. L. Welling, llth New Jersey, recorded: "Shot wound of left knee; resection of internal condyle of femur;" and reported the patient s death May 9, 1863. CASK 591. Private C. Crowley, Co. C, 8th New Hampshire, was wounded at Port Hudson. May 27, 1863, and entered the field hospital of the Nineteenth Corps. Surgeon M. D. Benedict, 75th New York, reported: "Shot wound of right knee by musket ball ; resection." Surgeon A. H. Van Nostrand, 4th Wisconsin, recorded that the wounded man was admitted to hospital at Baton Kouge, May 30th, with a "shot injury to the right knee joint," of which he died June 17, 18G3. CASK 592. Corporal C. Dewell, Co. F, 74th Indiana, 2 aged 27 years, was wounded by a round ball, at the taking ol Missionary Ridge, November 25, 1863, the missile entering the inner aspect of the right knee joint, fracturing the inner condyle of the femur, passing obliquely downward and outward, and lodging in the head of the tibia. He was conveyed to hospital No. 6, at Chattanooga, where, on the next day, he was placed upon the operating table, when the wound was examined. On consultation it was determined to practise exsection as affording the best means of saving the man s life. A semilunar flap was resorted to, the incision including the wound made by the ball as well as the opening made in examining the wound. The patella, seven-eighths of an inch of the femur, and five-eighths of an inch of the tibia were removed; no arteries were tied two or three were twisted with the forceps. The patient did well until about Christmas, when he began to show marked symptoms of nervous exhaustion, which continued to increase in spite of the most sustaining treatment. He gradually sank until Jan uary 18, 1864, when he died. The operation was performed by Surgeon J. Haller, 38th Ohio, and the history was communicated by Surgeon J. R. Arter, 31st Ohio. CASK 593. Private J. Forster, Co. C, 15th New York Artillery, was wounded before Petersburg, July 9, 1864, and entered the field hospital of the 2d division, Fifth Corps. Surgeon T. M. Flandrau, 146th New York, reported : " Severe shell wound of both legs. Exsection of left and part of right patella." Three days after the reception of the injury the patient was moved to the corps hospital at City Point, where he died July 25, 1864. CASE 594. Private J. P. Goforth, Co. K, llth South .Carolina, aged 25 years, was wounded near Petersburg, and sent to the division hospital in the city about two hours after the injury, June 24, 1864. Surgeon Samuel Logan, C. S. A., reported: 3 "A gunshot wound, penetrating the left knee joint obliquely, tearing away both articular surfaces, but producing no splintering of the cancellated structure or shafts, merely grooving the articular surfaces and fracturing the patella. The pulse was at 90, and there was slight shock or constitutional disturbance. As the general hospital where he could be permanently treated was less than a quarter of a mile from the place where he was wounded, and the excellent state of the patient s general health and nature of the wound were encouraging, Dr. Logan considered the case as one in which excision was justifiable, the patient pre ferring any risk to the loss of his limb. He was placed under chloroform a few hours after the injury, June 24, 1864, and the operation was performed by H- mcision, the cross cut including both orifices of the wound. The contused soft parts were removed with the patella after the articular surfaces of the femur and tibia had been sawn off. The parts seemed to present favorable conditions for a speedy union. A long splint was applied to the wound. On June 28th, Dr. Logan found the patient comfortable, the pulse at 110, skin warm and moist. The wounds were slightly swollen but not painful. The limb was dressed with Smith s anterior wire splint and suspended, water dressing being employed by irrigation. July 1st, the patient was found restless, the pulse at 120; tongue dry; the wounds were erysipelatous in appearance and swollen. The patient sank and died. Surgeon Logan could not ascertain the precise date, but it was prior to July 14, 1864. CASE 595. Private G. Gregory, Co. K, 57th New York, aged 28 years, was wounded at Fredericksburg, December 13, 1862. Surgeon C. S. Wood, 66th New York, reported that he was admitted to the field hospital of the 1st division, Second 1 See Circular No. 6, War Department, Surgeon General s Office, Washington, 186o, p. 59, and CfUVEKTSON (H.), Excision of the Larger Joints of the Extremities, Prize Essay, in Transactions of the American Medical Association, Philadelphia, 187(i. Supplement to Vol. XXVII, p. 184, Case No. 15. 2 See Circular No. 6, War Department, S. G. O., Washington, 18C5. p. 58, and Cf LEERT60N (II.). Excision of the Larger Joints of the Extremities, in Transactions of the American Medical Association. Philadelphia, 1876. Prize Essay. Supplement to Volume XXVII, p. 182. Case 10. LOGAN (SAMUEL), Report of Two Cases of Primary Resection at tlte.Knee Joint for Gunshot Wounds, in Southern Med. and Surg. Jour., 1866, Volume XXI, p. 293. SECT. IV.] PRIMARY EXCISIONS AT THE KNEE JOINT. 389 Corps, with "exsection of the left knee joint, performed by some unknown surgeon," and that the limb was placed in a long padded splint, bandaged in its whole length, and dressed with cold-water applications. Surgeon W. Clendenin, U. S. V., reported that the patient was admitted to Emory Hospital, Washington, December 26, 1862, with gunshot wound, and that he died the same day. CASE 596. "Private E. M. Hogston, Co. D, 4th Virginia, aged 29 years, was wounded in the right knee joint, at Chan- cellorsville, May 3, 1863, a ball entering through the patella, fracturing the inner condyle and lodging. In addition there was a flesh wound of the same leg. The patient positively and persistently declined amputation, which was urgently recommended. As a final resort, resection was advised and accepted in preference to amputation. The operation was performed on May 5th, the joint being opened by an H-incision, and the fragments of the fractured patella removed with the ball lodged in the inner condyle. The synovial membrane and articular cartilages of the articular surfaces were carefully dissected out, and, in addition, a thin slice of bone was removed from the contiguous surfaces of the condyles and upper surface of the tibia, so that when the parts were brought into apposition an obtuse angle was formed at the joint site. The limb was firmly fastened to a well padded and suitably arranged posterior angular splint; the joint was dressed with dry lint and oiled silk covering. On May 10th, the wound was suppurating freely. 12th, still doing well. 14th, weaker, with tendency to diarrhoea, loth, gangrene of thigh. 17th, patient died." The history was contributed by Dr. I. W. Walls, late Surgeon P. A. C. S., in November, 1877. CASE 597. Private J. Lambert, Co. E, 1st Michigan Cavalry, aged 33 years, was svounded in the left knee joint, at Cold Harbor, May 31, 1864. Surgeon W. H. Rulison, 9th New York Cavalry, reported that resection was performed at the field hospital of the 1st division, Cavalry Corps. Acting Assistant Surgeon S. Graham reported that the patient was admitted to Emory Hospital, Washington, June 7th, in a weak and debilitated condition, caused by a shot fracture of the knee joint, the head of the tibia having been excised" before admission. Tonics, stimulants, and nourishing diet constituted the treatment, and water dressings and bandages were applied locally. The patient became delirious June 12th, and died June 16, 1864. CASE 598. Private E. Lewis, Co. B, 87th Pennsylvania, was wounded .at Winchester, September 19, 1864. Surgeon R. Burr, 67th Pennsylvania, described his injury as a "severe wound of the right thigh by a minie ball, fracturing the cou- dyles" of the femur, for which "resection" was performed at the field hospital of the 3d division, Sixth Corps. Acting Staff Surgeon N. F. Graham reported that the patient was admitted to the general field hospital at Sandy Hook six days after the date of the battle, and that he died of his injury, a "shot wound of the right knee," on October 10, 1864. CASE 599. Sergeant Henry J. Moore, Co. F, 7th Maine, aged 24 years, received, May 12, 1864, a shot wound of the left knee joint, at the battle of Spottsylvania. Surgeon F. M. Everleth, 7th Maine, 1 practised a primary total excision on the morning of the reception of the injury "by making an anterior incision across just below the joint, curving up over the external condyle, and joining at right angles an incision extending over the internal condyle; one inch and a half of the femur, with a conoidal ball implanted, was removed by sawing squarely through the condyles, and the articular surface of the tibia was removed, being bruised. No ligatures were required. The specimen was sent to the Museum at Washington with an account of the case." The patient was admitted May 24, 1864, to the Third Division Hospital, at Alexandria, with the left lower extremity in a fracture box, the wound being partially closed by sutures and discharging little pus. The patient was prostrated by the fatigues of transportation, and he died of exhaustion May 26, 1864. CASE 600. Private /. Moore, Co. B, 44th Alabama, received a shot fracture of the right knee joint October 1, 1864, for which resection by a semilunar flap was performed on the following day. The record of the case was found on the Confederate register of Howard Grove Hospital, Richmond, where the patient died October 22, 1864. CASE 601. Lieutenant G. W. Pettigrew, Co. A, 26th Georgia, was wounded and captured at Fredericksburg, December 13, 1862. Surgeon C. J. Nordquist, 83d New York, recorded his admission to the field hospital of the 2d division, First Corps, with "shot wound of left knee; patella removed." Acting Assistant Surgeon J. D. Robinson reported that the patient was admitted to the Patent Office Hospital, Washington, December 25th, and that he died of his injury, "a shot wound of left side and knee," December 30, 1862. 2 CASE 602. Dr. J. J. Knott, late Surgeon of the Confederate army, in a letter from Griffin, Georgia, November 6, 1868, makes mention of the following: "I practised excision of the knee joint in one case only. This was performed on a German, belonging to the Federal army, after the battle of the Wilderness, in May, 1864. The patient died from the effects of chloroform." CASE 603. Private J. Wheeler, Co. E, 97th New York, was wounded at Fredericksburg, December 13, 1862. Surgeon C. J. Nordquist, 83d New York, recorded his admission to the field hospital of the 2d division, First Corps, with "shot wound of knee ; patella removed." On December 25th, the wounded man was admitted to the Patent Office Hospital, Washington, whence Assistant Surgeon G. W. Hoover, 132d Pennsylvania, reported that the patient died from the effects of a "wound of the left knee joint," February 1, 1863. 3 1 At the date of the publication of this case in Circular No. 6, S. G. O., 1865, p. 59, the operator s name and the date of the excision were unknown ; but these particulars were communicated in a letter to Assistant Surgeon General C. H. CUANE, dated Waldoboro, Maine, March 26, 1868, by Dr. P. M. EVEHLETH. The specimen, with the impacted ball in the condyles, and the account of the case, alluded to by Dr. EVERLETH, it has been impossible to trace in the Museum. See also CULHEHTSON (H.), Excision of the, Larger Joints of the Extremities, Prize Essay, in Trans. Am. Med. Assoc., Philadel phia, 1876. Supplement to Vol. XXVII, p. 184, Case 16. 2 A letter of inquiry was addressed, in February, 1868, by the editor to Dr. R. S. Dana, formerly Surgeon 107th Pennsylvania, who, in an answer dated March 23, 1868, states: "1 have written to several of the surgeons who were there, to learn if possible more of the case than I can recollect ; one answer only has been returned. From all that I can learn or remember of the case, Lieutenant Pettigrew was operated on by Dr. E. G. Chase, Surgeon 104th New York, and Dr. J. F. Hutchinson, at that time Surgeon of the 107th Pennsylvania. The operation was the resection of the head of the fibula, which was destroyed by a ball, the operation not involving the knee joint proper." 3 In response to the editor s letter of inquiry. Dr. R. S. Dana, of Morrisville, Pennsylvania, formerly Surgeon 107th Pennsylvania, wrote under date March L 3, 1868 : " Private Jerome Wheeler I cannot be so positive about, but think that he was operated on by Drs. Nordquist and Coxe, Surgeons of New York regiments, and that in his case the joint was penetrated by a ball, aud the operation consisted in the removal of the upper portion of the head of the tibia and the opposing surface of the condyles of the feniur, calculating that bony union and a fixed knee would result, shortening the limb from 1 to 1 J inches. The result of the operation we know nothing about, as the hospital WHS cleared as rapidly ns possible." 390 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 604. Corporal J. White, Co. I, 21st South Carolina, aged 25 years, was wounded June 24, 1864, at Petersburg He was conveyed to the division field hospital in the city, and, two or three hours after the injury, was examined by Surgeon Samuel Logan, 1 C. S. A., who found that the missile, probably a conical musket ball, had passed through the external condyle of the right femur, laying open the joint freely and carrying away a portion of the articular surface. There was a slight flesh wound in the right arm. The case was considered favorable for excision, and the operation was done immediately by Dr. Logan, through an H-incision, removing an inch from the condylesof the femur, slicing off the top of the tibia, and removing all con tused soft parts. The limb was bound to a long external splint. June 26th, the wounds were somewhat swollen, and the dressing had caused pain by undue pressure. The patient was restless, with pulse at 115. June 27th. general symptoms unaltered. The limb is as much swollen but is more comfortable since the dressings have been arranged. June 28th, the flesh wound in the arm is painful and swollen. The leg is less swollen, and union appears to betaking place. July 8th, general con dition favorable; pulse 110; leg somewhat swollen. All retentive apparatus was removed; every movement of the body or limb thus disturbed the relations of the osseous surfaces. Dr. Logan did not see the patient again, but he heard that death occurred prior to July 15, 1864. In three instances of primary excision at the knee joint recourse was had to amputa tion of the thigh. Death ensued in two, four, arid thirty-nine days, respectively: CASE 605. Private J. W. Derr, Co. E, 7th Maryland, aged 18 years, was wounded at Hatcher s Run, March 31, 1855, and admitted to the field hospital of the 2d division, Fifth Corps. Surgeon A. A. White, 8th Maryland, reported : "A musket ball struck the patella of the right knee laterally, shattering the patella into a number of fragments, but not involving the knee joint proper. I excised the entire patella, carefully dissecting it from its covering." Surgeon A. F. Sheldon, U. S. V., reported that the patient was admitted to Campbell Hospital, Washington, April 5th, with the incised wound of the operation healing by first intention. After doing well for three weeks, inflammation commenced and suppuration became very great. Circular ampu tation through the lower third of the thigh was performed on May 15th, by Acting Assistant Surgeon F. Hall, after which there was favorable progress for a time. On June 10th, there were signs of morbid poisoning, and on June 15th the stump was opened, allowing a canal filled with pus to discharge. Death resulted from exhaustion June 23, 1885. The amputated part of the femur, together with the upper portions of the tibia and fibula, were contributed to the Museum by Surgeon Sheldon, and constitute specimen 4199 of the Surgical Section. CASE 606. Corporal A. Glazier, Co. B, 1st Minnesota, aged 29 years, was wounded at Reams s Station, August 25, 1864. Surgeon N. Hayward, 20th Massachusetts, reported the injury as a "shot fracture of the left knee joint," for which he performed excision at the field hospital of (he 2d division, Second Corps. Surgeon D. W. Bliss, U. S. V., reported that the patient was admitted to the Armory Square Hospital, Washington, August 28th, in a low condition and suffering severe pain from nervous spasms of the limb, caused by a wound of the knee joint with slight fracture of the external condyle, the patella having been removed on the field. Circular amputation at the lower third of the thigh was performed by Acting Assistant Surgeon D. W. C. Van Slyck on the day after admission. Chloroform inhalation induced alarming symptoms, and electricity was resorted to. Opium and alcoholic and diffusible stimulants were administered. Gangrene appeared in the stump the second day and spread rapidly. Death resulted on September 2, 1864. CASE 607. Private W. E. L. Morrison, Co. I, 29th Connecticut, aged 21 years, was wounded near Richmond, October 27, 1864, and admitted to the Flying Hospital of the Tenth Corps. Surgeon M. S. Kittinger, 100th New York, recorded: "Shot wound of left knee; excision of knee by Surgeon A. C. Barlow, 62d Ohio." The subsequent progress and the result was reported by Assistant Surgeon E. McClellan, U. S. A., as follows: "The patient was admitted to hospital at Fort Monroe, October 30th, with shot fracture of knee joint. Circular amputation at the middle third of the thigh was performed on November 10th by Acting Assistant Surge^p J. Pitkin. Chloroform and ether constituted the anaesthetic. The patient died November 12, 1H64, of exhaustion." To the primary cases of excision at the knee here detailed should be added six instances observed by Professor Hunter McGuire, 2 of Richmond, formerly Surgeon of the Confederate States Army: CASES 608-613. "In May, 1864, at Spottsylvania Court House, the operation was performed in six cases by some surgeons sent from this city to our assistance. Not to subject them to the danger of transportation, I left these cases, with others too badly hurt to be moved, in a hospital, prepared for them near the field of battle, and in charge of one of the best surgeons in the army, Dr. Taylor, who gave ihein every possible attention. Three of them died before the end of the third day. In two of fhe cases, secondary amputation was performed with a view of preserving life, but unsuccessfully, and the sixth lingered for about four weeks, I think, and proved fatal from sheer exhaustion. Such, as far as I can gather, is the melancholy record, and although the number is too small to justify a comparison with amputation, I do not think there is any one who saw the six patients I have reported men who a day or two before were stout, strong and brave soldiers who would not agree with me in saying, this operation for wounds occurring upon the battle field is nothing more nor less than butchery." Primary Excisions at the Knee Joint of Undetermined P^esult. The results of two of the thirty-two primary excisions at the knee joint could not be ascertained: CASE 614. Private A. McDowell, Co. K, 1st North Carolina, received a shot fracture of the patella and the external 1 LOGAN (S.) t Report of two cases of Primary Resection at the Knee Joint for gunshot wound ; death resulting in both cases, in Southern Medical and Surgical Journal, 1866, Vol. XXI, p. 295. 2 MCGUIKE (HUNTER), Clinical Remarks on Gunshot Wounds of Joints, delivered January 10, 1866, at Howard s Grovo Hospital, in Richmond Medical Journal, 1866, Vol. I, p. 263. CULBEKTSOX (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Aisoc., Philadelphia, 1876. Supplement to Vol. XXVII, pp. 184, 186. SECT, iv.] INTERMEDIARY EXCISIONS AT THE KNEE JOINT. 391 condvle of the femur by a mini6 ball, at Hauover Junction, May 24, 1864. He was admitted to tbe Receiving and Wayside Hospital, Richmond, where, on May 26th, he was placed under the influence of chloroform, and excision of the fractured parts was performed by Surgeon C. B. Gibson, C. S. A. Splints and water dressings were used after the operation. Reaction wa fully established on the following day. On May 30th, the wound looked well, and the patient was transferred to another hospital at the request of Dr. Gibson. The record of the case was obtained from the Confederate register of the Receiving and Wayside Hospital, Richmond. CASE 615. Among the names of wounded men admitted to the Nineteenth Corps field hospital from the battle of Port Hudson, May 27, 1863, Surgeon M. D. Benedict, 75th New York, includes that of "Private A. W. Mousky, Co. B, 4th Wiscon sin," whose injury Avas reported as follows: "Shot wound of right leg; excision of knee joint." It has not been practicable to ascertain the termination of the case. Intermediary Excisions at the Knee Joint. Thirteen cases were referred to this group; one only proved successful, a ratio of fatality of 92.3 per cent. The operations were practised on ten Union and three Confederate soldiers. Recovery after Intermediary Excision at the Knee Joint. A successful intermediate operation 1 was performed on a captain of the Confederate army wounded at Mine Run, November 27, 1863. He was last heard from in 1877, fourteen years after the operation. He then experienced only little disability, principally due to shortening, and he could walk for miles without fatigue. CASE 616. Captain Charles Knowlton, 10th Louisiana, of Ewell s Corps, aged 26 years, was wounded at Mine Run, Virginia, November 27, 1863, by a conoidal musket ball, which grooved the outer condyle of the right femur, barely touched the cartilage, opened the synovial sac, was deflected, and lodged near the upper edge of the patella, whence it was removed, on the field, through an incision, after the wounded man had walked half a mile to the rear leaning on the shoulder of one of his men. He was then transported over rough roads in an ambulance to the nearest railway station, and conveyed to Richmond, and entered general hospital No. 4 two days after receiving the injury. His condition on admission was good. There appeared to have been no haemorrhage. The movements of the knee joint were perfect. Moist dressings, absolute rest, and saline aperients were ordered. On December 2d, a serous or synovial discharge from the wound was observed. This became slightly puriform on the following day. Still there was no mark of inflammatory reaction. On December 8th, there was much pain in the joint and the discharge was increased. Warm fomentations were substituted for the cold dressings. His pulse rose to 104. On the 9th, the joint was excessively inflamed and the pulse was 128. Surgeon James B. Read, P. A. C. S., in consultation with Sur geons C. B. Gibson and M. Michel, decided that excision of the joint was expedient. The operation was performed by Surgeon Read. An elliptical incision with its concavity upward was made to extend from one condyle to the other, passing below the patella and dividing its ligament. The joint was then laid open, and an inch and a half of the condyles of the femur and an inch of the tibia were sawn off. The patella was also removed. No ligatures were required. The section of the femur was made obliquely downward and backward; the section of the tibia was the reverse of this, so that when the extremities were approx imated the limb was slightly flexed. The synovial sac was reddened and contained a turbid flocculent fluid. The sawn ends of the bones were then wired together. The limb was then placed in a long well padded fracture box. After a few days a long bracketed splint was substituted for the fracture box. He had a liberal stimulating diet of eggs, oysters, and beef tea, with half an ounce of brandy every two hours. The patient was restless and irritable, and on December 16th, and again on the 20th, had venous haemorrhage to the extent of a few ounces, the bleeding being arrested on both occasions by the use of persulphate of iron. There was tumefaction about the joint and burrowing of pus, until Acting Assistant Surgeon Howell L. Thomas sug gested a suspension of the limb by Smith s anterior splint. By January 3d, the internal half of the horse-shoe incision had closed. The patient enjoyed an excellent appetite, which was appeased by venison, turkey, partridges, and other hearty food, and a pint of porter daily. By the middle of February there was only a small fistulous orifice remaining of the wound, which discharged a thin, sero-purulent matter. A starch bandage was now applied, with an aperture over the unhealed portion of the wound. All the wires had been removed at this date except one. In March, the patient sat up daily and attempted to walk on crutches. In April, he Avas discharged from the hospital; his limb was supported by a leathern splint. There was still slight motion between the femur and tibia, but the ligamentous union appeared quite firm. He subsequently went to the West Indies. At Nassau, Dr. Hunt, of New Orleans, removed the starch bandage and found the consolidation was very firm. In a few months Captain Enmclton laid aside his crutches and walked very satisfactorily. He returned to Louisiana in 1866. He was able not only to walk almost as well as ever, but to dance even the round dances. His address as a purser on the steamship "Sen ator," one of the Pacific mail steamers plying between San Francisco and San Luis Obispo, having been discovered, Surgeon Charles McCormick, U. S. A., at San Francisco, examined his limb, December 17, 1868, and had prepared the photograph from which FiGCRE 1 of the lithographic plate (PLATE LXV) opposite p. 386 was taken. There was no evidence of disease about tbe cicatrix. The muscular development of the limb was good; and the inability to flex it at the knee was the only inconvenience suffered, a result as gratifying as it is unusual. A letter from Surgeon Charles C. Keeney, U. S. A., Medical Director at San Francisco, dated April 20, 1877, mentioned that he had met Captain Knowlton about a year previously and learned that he experienced no disability save that due to the shortness and stiffness of the limb, and walked for miles without fatigue. 392 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Spec. 1065. PIG. 242. Left knee lifter excision. Spec. 629, A. M. M. Flo. 241!. Soft parts from same excision. Spec. 600. fatal Instances of Intermediary Excision at the Knee Joint. This group comprises twelve cases, ten in the Union and two in the Confederate armies: CASE 617. Private O. Derocher, Co. 1, 1st Maine Heavy Artillery, aged 31 years, was wounded in the right knee, at Spottsylvania, May 19, 1864, by a conoidal musket ball, which fractured and comminuted the patella. Three days after the reception of the injury he was admitted to Emory Hospital, Washington, the soft parts about the knee being badly swollen. On May 23d, the inner half of the patella was excised by Surgeon N. R. Moseley, U. S. V. The operation was followed by cold-water dressings. By May 30th erysipelas had invaded the limb, for which carron oil and copper wash was applied, and tincture of iron was administered. Stimulants and generous diet were allowed liberally. The patient died from the effects of constitutional irritation and exhaustion, June 10, 1864. The history and the excised bone (FlG. 241), consisting of two fragments (Cat. Surg. Sect., 1866, p. 363, Spec. 1065), were contributed by the operator. 1 CASE 618. Private Charles F. Gould, Co. I, 1st Pennsylvania Reserves, was wounded at the second battle of Bull Run, August 30, 1862. A musket ball appeared to have entered the outer side of the joint near the head of the tibia. The patient was sent to Fairfax Seminary Hospital, near Alexandria, September 9, 1862. On September 15th, an excision of the knee joint was performed. The condyles of the femur, the patella, and the heads of the tibia and fibula were removed through an H-shaped incision. The wound united, and there seemed every prospect of a satisfactory result, when, on October 8th, symptoms of pyaemia were developed, and death ensued October 12, 1862. The pathological preparation was forwarded to the Army Medical Museum by Acting Assistant Surgeon T. 0. Bannister. The specimen represented in the left-hand wood-cut (FlG. 242) shows the osseous portion, while the appearance of the soft parts are shown in the right-hand wood-cut (FlG. 243). (See Cat. Surg. Sect., 1866, pp. 336, 500.)- CASE 619. Corporal G. W. Hays, Co. K, 2d Michigan, aged 19 years, was wounded in both knees, at Petersburg, June 17, 1864. Surgeon R B. Bontecou, U. S. V., reported: "He was admitted to Harewood Hospital, Wash ington, June 20th, suffering from amputation at the lower third of the thigh, performed on the field for a shot wound of the knee joint by a ball, which frac tured the condyles of the femur and the patella. The right knee was also wounded, a ball entering the joint, fracturing the patella, and denuding the condyles of the femur and the head of the tibia. Extensive suppuration followed in the right knee, and an abscess burrowed half way up the thigh ; the joint itself became entirely disorganized and much swollen." On June 24th, resection of about two-thirds of the condyles of the femur, with the entire patella and the articular face of the tibia, was per formed by Surgeon R. B. Bontecou, U. S. V. Sulphuric ether was used as the anaesthetic. The stump of the left thigh progressed very satisfactorily towards healing, while the resected joint com menced to fill up with healthy granulations also and looked well in other respects. Profuse suppu ration of healthy looking pus, however, continued. The constitutional treatment was mainly directed towards supporting the strength of the patient, and consisted of stimulants, tonics, and nourishing diet. The right thigh and leg were supported and kept in place by means of a wide board, to which a bag of bran was attached and so arranged as to embrace the parts on either side, it being readily adjusted and kneaded to suit the manipulations during dressing. The entire extremity, from the foot to the great trochanter, was confined in a Scultetus bandage. The patient did tolerably well up to June 30th, from which date he became drowsy and was only waked with difficulty. He continued so, with intervals of wakefulness, until his death, which occurred on July 2, 1864, from exhaustion. There were no pysemic symptoms. The exsected patella and condyles of the femur were contributed to the Museum by the operator and are represented in the cut (FlG. 244). 3 CASE 620. " Private J. W. Holtzman, Co. B, 2d Virginia, about 35 years of age, was wounded at Chancellorsville, May 3, 1863. a ball entering the knee joint through the patella and lodging in the head of the tibia. The patient persistently declined amputation and other active interference until much suffering and pain induced him to accept the chances of a resection, which was reluctantly performed on May 10th. The joint was laid open by a semilunar incision, the synovial membranes and cartilages were removed, and thin slices of the contiguous surfaces of the condyles and head of tibia were taken off. The limb was placed in a posterior angular splint and carefully watched. The patient, however, finally succumbed to diarrhoea and exhaustion about May 20, 1863." The history of the case was communicated by Dr. I. W. Walls, late Surgeon P, A. C. S., in November, 1877. CASE 621. Private M. B. Horan. Co. F, 63d New York, was wounded at Antietam, September 17, 1862, and entered Frederick Hospital one week afterwards. Surgeon H. S. Hewit, U. S. V., contributed the pathological specimen (Cat. Surg. Sect., 1866, p. 290, Spec. 445), and reported the case as a "partial resection of the knee joint, performed, October 4th, for a shot injury of the condyles of the femur, and followed by death October 14, 1862." The specimen consists of thirteen minute frag ments of dead bone. See also CULBEHTSON (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. filed. Assoc., Philadelphia, 1876. Supplement to Vol. XXVII, p. 188, Case 11. 2 Circular No. 6, War Department, S. G. O., Washington, 1865, p. 60; CULBEKTSON (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Ned. Assoc., 1876, p. 182, Case 8. s Circular No. 6, War Department, S. G. O., Washington, 1865, p. 59; CULBERTSON (H.), Excision of the Larger Joints of the Extremitia. Prize Essay, in Transact. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVII, p. 184, Case 17. FIG. 244. The patella and condyles of the right femur. Spec . 3046. SECT, iv.] INTERMEDIARY EXCISIONS AT THE KNEE JOINT. 393 CASE 622. Private H. Lawson, Co. D, 36th Colored Troops, 1 aged 17 years, was accidentally wounded March 5, 1864, and entered Point Lookout Hospital six days afterwards. Surgeon A. Heger, U. S. A., reported: "He was admitted with shot fracture of the right knee joint, caused by a conical musket ball, which entered one-half inch inside of the tuberosity of the tibia and emerged at the middle of the popliteal space. The knee joint was inflamed and suppurating; the patient, suffering from acute bronchitis, was otherwise in good constitutional condition. On March 12th, resection of the knee joint was performed by a longitudinal incision seven inches long over the anterior border of the internal lateial ligament, dividing the capsule and crucial ligament, and removing the fractured portions of the tibia and the articular cartilages. All the cartilaginous covering of the femur and the tibia was removed with a scraper; the nynovial membrane was destroyed by iodine; no arteries ligated; wound closed by sutures of iron wire. The ansesthetic, consisting of chloroform, acted well for forty-five minutes. After the operation, which was performed by Acting Assistant Surgeon T. Liebold, the limb was placed at once in a plaster of Paris splint, enclosing the whole extremity. The next day an opening was cut over the wound so as to permit its being syringed with tepid water four times a day. Solution of permanganate of salts was also applied, and oakum was used to absorb the discharge. For the bron chial affection wine of antimony and infusion of ipecacuanha was prescribed. The patient died during a paroxysm of cough ing, March 24, 1864. The post-mortem examination exhibited extensive inflammation of the bronchii, the smallest ramification being filled with pus ; other organs healthy. The parts operated on looked well. Good pus was found in the bursa mucosa quadriceps." CASE 623. Private J. Miller, Co. A, 3d Pennsylvania Cavalry, 2 aged 38 years, was wounded at Mine Run, November 27, 1863, by a conical ball, which entered the right knee above and internal to the patella and emerged below and external to that bone. The missile fractured the patella, denuded the external condyle of the femur of a portion of its articulating surface, and fractured the outer articulating surface of the tibia. The wounded man was admitted to the Third Division Hospital, Alexandria, December 5th, considerably prostrated and the parts being tumefied. Two days after admission chloroform was administered and resection was performed by Surgeon E. Bentley, U. S. V., who removed the patella and half an inch of the articulating surfaces of the femur and tibia. The subsequent treatment consisted of simple dressings, tonics, stimulants, and nourishing diet. There was profuse suppuration. The patient progressed favorably for one week, when he was seized with chills accompanied by loss of appetite, quick and feeble pulse, and sallow hue of skin. He died of pysmia December 18, 1863. The history was reported by the operator. CASE 624. Sergeant G. Northard, Co. G, 2d Ohio Cavalry, 3 aged 23 years, was wounded at Five Forks, April 1, 1865. Surgeon W. W. Bowlby, 3d New Jersey Cavalry, reported his admission to the field hospital of the 3d division, Cavalry Corps, with " severe shot wound of right knee." Surgeon R. B. Bontecou, U. S. V., in charge of Harewood Hospital, Washington, subsequently operated on the injured limb, of which he contributed a photograph (Contr. Photo s, S. G. O., Vol. I, No. 41), with the following history: "The patient was admitted April 5th. He had been wounded by a ball entering just above the patella, through which it passed and which it fractured into six fragments. Ranging downward and outward the missile fractured the external condyles of the femur and escaped. On April 8th, the patient was etherized, when the fractured patella and a fragment of the external condyle of the femur were removed. The constitutional state of the patient at the time of the operation was very good. After the operation the limb was placed in a box containing bran and the patient was put on low diet. Subsequently the limb was placed upon a light open splint, extending from the tuberosity of the ischium to a point near the heel, and suspended by a cord. The patient was put on nutritious diet, with wine and porter. On April 13th, he was transferred to a tent ward. Up to this time he had suffered considerable pain in the joint and was very restless and irritable. His appetite now became poor, and hiccough and vomiting set in. Suppuration was profuse. The patient died April 22. 1865, from exhaustion." CASE 625. Private J. Noble, Co. D, 30th Ohio, was wounded at South Mountain, September 14, 1862, and admitted to hospital No. 5, Frederick, four days afterwards. Surgeon H. S. Hewit, U. S. V., recorded: " Comminuted fracture of right knee by minie ball. Excision of a large portion of knee joint on September 30th. Death on October 5, 1862." CASE 626. Private D. F. Eogers, Co. I, 49th Georgia, 4 aged 34 years, was wounded at Petersburg, April 2, 1865, by a muskot ball, which struck the right knee joint anteriorly, passed through the patella, comminuting it completely, and the outer condyle, and made its exit at the outer posterior aspect. He was admitted to the general hospital at Fort Monroe, April 13th. Surgeon D. G. Rush, 101st Pennsylvania, who operated in the case after applying an ansesthetic composed of chloroform and ether, reported as follows: "My attention was called to the case on April 18th, when the patient was suffering from great pain, and the knee, leg, and thigh were extremely swollen. A dense fibrous involucrum of the joint closed the track of the ball, thus preventing the escape of pus. I at first decided to lay the joint freely open and to remove the patella only, but discovering the disorganized and injured state of the condyles, they were also removed, with little hope of saving the patient, however, the operation being performed at PIO.M45. Bones of right knee XCIS6<1 ODC. 421^;. too late a period. A piece of catheter was fixed in the joint to drain it. Cold-water dressings were applied. The patient rallied perfectly and lived comfortably for six days. He died of exhaustion the eighth day. He could not have survived amputation twenty-four hours. I think this operation could be performed with success primarily in cases in which the patella and condyles alone are involved." The excised bones were contributed to the Museum by the operator, and are represented in the cut (FiG. 245). 1 CULBKIITSON (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVII, p. 190, Case 17. 2 See CULBERTSON (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supple ment to Vol. XXVII, p. 184 ; Circular No. 6, War Department, S. G. O.. Washington, 1865, p. 59. 3 CULliEinsON (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVII. p. 186, Case 29. * See Circular No. 6, War Department, S. G. O., Washington, 1865, p. 60 ; CULBEKTSON (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Herl. Assoc., Philadelphia, 1876. Supplement to Vol. XXVII. p. 186, Case 30. SURG. Ill 50 394 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FlO. 246.-Right femur, tibia, and fibula, after excis n of joiut surfaces. Spec. 1909. CASE 627. Corporal J. Sims, Co. B, 4th Ohio, 1 aged 23 years, was wounded at Mine Run, November 27, 1863, by a conoidal ball, which entered the right knee joint just below the patella, on the inner and anterior aspect, fracturing the inner con- dyleand opening the joint, passed downward and forward, and was extracted about four inches from point of entrance. He was admitted to the Third Division Hospital, Alexandria, December 5th. "At the time of admission the joint and thigh were very much inflamed and discharging pus copiously, and the man was much prostrated and terribly anxious as to the result of the wound. But after being washed and fed and otherwise cared for, he appeared much recruited. On the 8th of December the operation of excision of the knee joint was performed by Surgeon E. Bentley, U. S. V., who removed one inch of the femur and about one and a half inches of the tibia and fibula. The haemorrhage was slight, but the condition of the tissues was not very satisfactory. The patient endured the operation well under the influence of chloroform, and reacted well. On the following day he complained of severe pain over the lung on the right side of the chest, which continued for several days. On the 10th, he had a severe chill at night, which was followed by two, more severe, on the llth. Stimulants were freely given with raw eggs well beaten up, and beef essence for diet. He continued to have chills till the night of the 13th, when he was seized with a very severe one, from which he never rallied. He died on the morning of December 14, 1863. The post-mortem examination showed no attempt at repair, there being considerable sloughing, while on the inside of the thigh there were numerous small abscesses. The heart and left lung were healthy, but the right lung was infiltrated with pus, and a single large abscess appeared upon the surface of the inferior lobe. There was no pus nor abscess found in the liver, but it was very much softened." The history, with the post-mortem speci men, represented in the cut (FlG. 246), was contributed to the Museum by the operator. Surgeon J. B. Briuton, U. S. V., who examined the limb two days after the patient s decease, found "the whole joint one suppurating mass; pus extending up and down, far down under the gastrocnemius and up between the muscles on the inside of the thigh ; a long abscess in the sheath of the vessels, extending up to the middle of the thigh; small clot in femoral artery, thin and three inches long; none in femoral vein; surrounding tissues of vessels hardened in some places where pus had not readied; long membrane of femoral vein of dirty gray color and softened; clot in saphena vein." CASK 628. Corporal I. Wells, Co. A, 33d Wisconsin, 2 aged 42 years, was wounded at Tupelo, July 15, 1864, and admitted to Adams s Hospital, Memphis, five days afterwards. Assistant Surgeon J. M. Study, U. S. V., reported: "Shot wound of left knee by a conical ball, fracturing the patella and opening the joint; missile emerged over internal condyle. On July 21st, the inner third of the patella was removed through a vertical incision by Acting Assistant Surgeon K. W. Coale. The constitutional condition of the patient at the time of the operation was good. Cold-water dressings were applied to the parts, and stimulants, with beef juice, was given freely. The patient appeared to improve up to July 26th, after which date he commenced to decline. Pyaemia developed on July 29th, and from that time he continued in a comatose condition. Death resulted on August 2, 1864." Secondary Excisions at the Knee Joint. Seven examples of secondary excision at the knee joint are recorded; four were successful and three fatal, a rate of mortality - of 42.8 per cent. The patients were all Union soldiers. Examples of Recovery after Secondary Excision at the Knee Joint. Of the four patients of this group, two were pensioners in 1880; one has never applied for a pension, and one died two years and a half after the operation : CASE 629. Private E. Jewell, Co. I, 8th New Jersey, aged 19 years, was wounded at Williamsburg, May 5, 1862, a musket ball fracturing both bones of the right leg near their articulation at the knee. He was sent to Hygeia Hospital, Fort Monroe, and thence in the following month to Philadelphia, where he entered Fifth Street Hospital on June 8th. Acting Assist ant Surgeon A. C. Bournonville, in charge of the latter, reported that "the leg was bent at a right angle with the thigh and had been in that position since the injury. Caries had taken place, and an excision of the head of the fibula and partial resection of the head of the tibia was performed. The patient is now (November 6th) doing well, and has been able to rise and walk about the ward with the aid of crutches." The patient was subsequently transferred to Haddington Hospital, and was discharged February 23, 1863, and pensioned. Pension Examiner A. W. Woodhull, of Newark, October 24, 1868, described the injury: "A conoidal ball fractured both bones of the right leg just below the knee joint. Large portions of bone have been lost either by operation or nature. The bones are now extensively necrosed and enlarged, and there are two large sinuses, which always suppurate. The leg is shortened four or five inches," etc. The Newark Board reported, in September, 1875, that the limb is greatly atrophied and deformed. Two years later the same board reported "contraction of muscles of calf, producing talipes equinus; anchylosis of ankle and partial of knee. Wound open." The pensioner was paid March 4, 1880. CASE 630. Private J. E. Berry, Co. B, 5th Missouri State Miiitia, aged 22 years, was wounded by guerrillas in Carroll County, Missouri, December 1, 1862, a musket ball fracturing the external condyle of the femur and lodging in the knee joint. Acting Assistant Surgeon J. Thorne, who described the injury, reported that the wounded man was successfully treated in hos pital at Kansas City for pyaemia, the systemic infection of which had appeared prior to the patient s admission, and was attended with formation of pus in the knee joint. In addition, Dr. Thorne also reported that the operation of removing the external con dyle of the femur, together with the bullet, was performed on May 10, 1863, the missile being found embedded in the articulation. See Circular No. C, War Department, S. G. O., Washington, 1865, p. 59; CULHEKTSOX (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVII, p. 184, Case 13. 2 See CULHEUTSON (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supple ment to Vol. XXVII, p. 190, Case 15; Circular No. 6, War Department, S. G. O., Washington, 1865, p. 60. SECT. I V.I SECONDARY EXCISIONS AT THE KNEE JOINT. 395 The records of the hospital do not show the exact dates of admission or disposition of the patient. Adjutant General S. P. Simpson, of Missouri, communicated that Berry was mustered out of service June 22, 1863. There is no record of his ever having applied for pension. CASE 631. Private J. Friel, Co. F, 2d Kentucky, aged 29 years, was wounded in the right knee joint, at Chickamanga, September 19, 1863. Dr. G. E. Fuller, of Brooklyn, late Surgeon U. S. V., reported the following history : "The wound was caused by a musket ball, which entered just over the external condyle of the femur, passed obliquely downward and inward, and emerged at the junction of the middle and lower thirds of the tibia. He was in the hands of the rebels for eleven days, and was then taken to hospital No. 3, at Chattanooga. On January 18, 1864, he was transferred to hospital No. 8, at Nashville, where he first came under my observation. At this time the leg was flexed upon the thigh at something less than a right angle. Anchylosis of the knee joint had taken place and the patella was firmly attached to the condyles of the femur. Both the original wounds were healed, but there was still some purulent dis charge from an abscess about four inches below the knee joint. Under a general tonic treatment he rapidly improved in strength and flesh, the abscess healed, and he was about the ward on crutches, being anxious to be discharge d. On March 19th, he was transferred with other convalescents, and I lost sight of him. I had no reason to doubt the entire recovery of this patient, after a fracture of the femur and also a wound of the knee joint. The external treat ment consisted of cold-water dressings." Surgeon G. F. French, U. S. V., under whose notice the patient came before his transfer, in a communication citing instances of successful conservatively treated cases of shot fractures of the knee joint, corroborated Dr. Fuller s description of the wound and its results, and added that the missile in its course "fractured the head of the tibia into the joint." The patient subsequently entered Jeffersonville Hospital, and lastly Main Street Hospital, Covington, where he was mustered out, by expiration of service, January 26, 1865, and pensioned. About twenty months afterwards the pensioner, with his injured knee joint in a diseased condition, entered the Good Samaritan Hospital, at Cincinnati. Dr. G. W. Haile, 1 the resident physician, reported: "The patient, being in an anaemic condition on admission, was ordered iron and generous diet, under which his health soon began to improve. On October 15, 1866, Professor G. C. Blackman operated for the removal of the dead bones, which could be readily felt with the probe. A crucial incision was made along the outer aspect of the joint, when some detached fragments of bone were found and removed, as was also the outer por tion of the head of the tibia, which was in a carious condition. The wound healed very kindly, and the parts seemed for a while to be in a healthy condi tion ; but in the course of a month from this operation the patient suffered at times violent pains in the part, and, on the 20th of November, a large collection of pus had formed in the joint, nearly a pint, mingled with fragments of necrosed bone, having been discharged during the twenty-four hours. His health began again to fail, but under the influence of tonics and a generous diet it was so FIG. 247. Appearance of right knee after excision of the patella and the articular ends of the femur and tibia. [From a photograph. 1 far improved on the 14th of December, that Professor Blackman, in the presence of the class of the Medical College of Ohio, exsected the joint. An incision, resembling the letter H, was made on the anterior aspect of the joint, exposing the articular surfaces of the tibia and femur. With the ordinary amputating saw an inch and a half of the condyles of the femur, in a softened and carious condition, was removed, together with about one inch of the head of the tibia. The bone-gouge forceps were then employed to take away every suspicious looking portion and to round off the posterior margins of the divided surfaces, so as to render the popliteal vessels less liable to injury. The patella was removed. As the leg had been for a long time somewhat flexed upon the thigh, it was necessary to resort to considerable and prolonged force to overcome this contraction. At length the ends were found to be in apposition, and more of the soft parts included, when the flaps were brought together, and the limb was placed in a neat and carefully padded fracture box. During the operation the loss of blood was trifling; but shortly after the patient had been removed to his bed considerable haemorrhage occurred. It appeared to come from no partic ular vessel, but there was a general oozing from the cut surfaces, which lasted several hours. The dressings were not disturbed for four days, the blood being wiped away as far as practicable, with a sponge, while *the odor of that which could not be removed without disturbing the parts was corrected by disinfectants. Cold applications were applied over the joint; but little irritation followed, and the transverse incision healed by primary adhesion. A little pus was discharged for several days through the lateral incisions, after which it became very slight, and on the twenty-first day the entire wound seemed to have almost perfectly united. On the eighteenth day after the operation there was secondary haemorrhage from a small superficial vessel and about ten or twelve ounces of blood were lost before it was discovered. It was readily controlled by pressure. Although perfect union between the tibia and femur seemed about this time to have taken place, the patient was ordered to remain per fectly quiet until the end of the eighth week, when he was allowed to walk on crutches. Just ten weeks from the operation he left for his home in Ironton, Ohio, and from a letter since received froiw him he seems highly pleased with the result of the operation." Examining Surgeon G. K. Taylor, of Cincinnati, June 25, 1867, certified to the injury and that " the joint is com pletely anchylnsed, with the leg shortened several inches. He has also talipes equinus of the right foot." Examining Surgeon D. C. Wilson, of Ironton, Ohio, at several subsequent examinations, also described the leg as "auchylosed in a straight 1 HAILE (G. W.), Good Samaritan Hospital, Surgical Clinic, by Prof. BLACKMAN. Exsection of the Knee Joint for Gunshot Injury, in Cincinnati Journal of Medicine, 1867, Vol. II, p. 157. 396 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. position, with four inches shortening." Examiner C. K. Crennit, of Jackson, Ohio, on April 29, 1879, reported the "muscles below the wound considerably atrophied, but sufficient to bear the weight of the body." The pensioner was paid December 4, 1879. The wood-cut (FiG. 247) is a representation of a photograph contributed by the operator. CASE 632. Private S. Miller, Co. L, 1st Missouri State Militia Cavalry, 1 aged 27 years, was accidentally shot in the right knee, by the discharge of his pistol, near Independence, December 28, 18G2. The ball passed through the outer condyle of the femur, going obliquely through the patella and lodging in the head of the tibia. Three months after the injury the wounded man entered the Kansas City Hospital, where, on April 7, 1863, Acting Assistant Surgeon J. Thorne performed excision of the outer condyle of the femur, with part of the shaft, removing, by an oblique section, two and a half inches of the f<;mur, together with the patella and the articulating surface of the tibia. No anaesthetic was used. At the time of the operation the leg had become extensively inflamed, the wound was found full of shattered bone, and an extraordinary amount of pus was corning out of the joint. Metastatic abscesses had appeai ed in the popliteal space. The patient had been suffering from severe pain and was almost insensible ; pulse 120 and feeble. He had also severe diarrhoea and was much emaciated, his skin being dark and dry almost like parchment. The patient sank after the operation, but on the next day he revived and continued to do well. London porter was given as tonic. Complete union took place and complete anchylosis resulted, with the limb bent about ten degrees, so as to be almost as good as ever in walking. The details of the case were reported by the operator. The patient was discharged from service December 7, 1863, and pensioned. He died August 15, 1865. Dr. F. A. Simmons, of Rochestei 1 , Mis souri, certified that he attended the pensioner from the time he returned to his home, and found that the injury had produced extensive suppuration, involving the leg and the thigh; also that he was very much emaciated, and that metastatic or pyaemic abscesses appeared in various parts of his body, which caused his death. Fatal Cases of Secondary Excision at the Knee Joint. Three instances are recorded. In one the entire knee joint was excised; in the second case the patella was removed; and in the third case the heads of the tibia and fibula were resected: CASE 633. Private G. Lewis, Co. B, 19th Indiana, 2 aged 22 years, was wounded at Gettysburg, July 1, 1863. He remained for two months at the First Corps field hospital, was then admitted to Camp Letterman, and subsequently transferred to Baltimore, where he entered McKim s Mansion and afterwards Jarvis Hospital. Assistant Surgeon D. C. Peters, U. S. A., in charge of the latter, reported: "The patient was admitted November 17th, with a wound of the right knee joint by a round musket ball,, which lodged in the inner coudyle. The position of the missile was detected by the N61aton probe. Two weeks after the date of admis sion the wounded joint was in a state of disorganization and pouring oft a large quantity of highly offensive pus, and the entire knee joint was excised by Acting Assistant Surgeon F. Hinkle, the patient having protested against amputation. Ether was used and an H-incision employed; wire sutures were applied to draw the sawn bones together. At the time of the operation the patient was feverish and unable to sleep from pain in the wound; pulse 100; skin dry; secretions scanty; appetite wanting. On the twelfth day he was seized with a violent chill, which lasted two hours and recurred every other day. Death resulted from pyaemia on December 23, 1863. At the autopsy both lungs were found filled with pus, the right being covered with abscesses. Six ounces of pus was also dis covered in the left pleural cavity and four ounces of fluid in the pericardium. The wounded parts were healed externally and the bones in apposition ; but no signs of union were manifest." The excised bone, embracing five-eighths of an inch of the upper extremity of the tibia and nearly two inches of the lower portion of the femur, with the bullet remaining lodged in the inner condyle, was contributed to the Museum by the operator, and is represented in the annexed cut (FiG. 248). CASE 634. Private D. Sexton, Co. H, llth Massachusetts, aged 18 years, was wounded at Bull Run, August 29, 1862. Surgeon D. P. Smith, U. S. V., recorded his admission to Fairfax Seminary Hospital, September 9th, with "shot wound of left knee joint," and reported that secondary resection of the patella was performed, also that the patient died November 6, 1862, from the effects of his wound and "exsection of the patella." The wood-cuts are representations of two post mortem specimens, contributed by Surgeon Smith, one of which (FiG. 249) consists of a dried ligamentous preparation of the bones of the knee, presenting the appear ance of inflammation having been followed by anchylosis; the other (FiG. 250) comprises the soft structures of the knee, and shows an H-shaped cicatrix, the horizontal portion being four inches and the upright three inches in length. The integument appears to have sloughed over a large portion of the front of the knee and to have cicatrized imperfectly, while on the lateral and posterior portions there are marks of several abscesses. CASE 635. Dr. H. Culbertson tabulates 3 a secondary operation, performed by Surgeon J. T. Hodgen, U. S. V., at the City Hospital, St. Louis, Missouri, in the fall of 1862, on a United States soldier, for a transverse shot wound of the head of the tibia, in which a U-incision was employed, and one inch of the head of the tibia and the tip of the fibula was removed, resulting fatally in three days. 1 Circular No. 6, S. O. O., 1865, p. 60. 2 See Circular No. 6, War Department, S. G. O., Washington, 1865, p. 59; CULBEUTSON (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. Med. Assoc., Philadelphia, 1876. Prize Essay. Supplement to Vol. XXVII, p. 182. 3 CULBERTSON (H.), Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. Med. Assoc., Philadelphia, 1876. Supplement to Vol. XXVII, p. 188, Case 9. Fir:. 248. Extremities of the right femur and tibia; the missile rests in the inner con dyle. Spec. 1956. \ FiG. 249 Bones of left knee after excision ofthepatella. Spec. 556. FIG. 250.-Soft structures of the knee after excision of the patella. Spec. 607. SECT. IV.] AMPUTATIONS AT THE KNEE JOINT. 397 Excisions at the Knee Joint of Uncertain Date. Five cases belong to this group; one proved successful, three were fatal, and the result in one is undetermined. The meagre details of these cases are of little value for statistical purposes: CASE 636. Sergeant L. E. McWhorten, Co. C, 60th Georgia, appears recorded on the Confederate register of Jackson Hospital, Richmond, as having undergone "excision of knee joint" for gunshot wound received August 28, 1862, and as having been "furloughed September 24, 1864." CASE 637. Private E. Bigman, Co. D, 26th South Carolina, appears recorded on the Petersburg Confederate general hospital as having been admitted August 6, 1864, with "resection of the patella and partial resection of the knee joint," per formed by reason of "gunshot wound," and as having "died August 23, 1864." CASE 638. Lieutenant /. M. Dickens, Co. C, 44th Tennessee, aged 30 years, appears recorded on the register of Con federate hospital No. 4, Richmond, as having received a "shell wound of both patellas and of the left little finger," for which "ablation of the left patella and amputation of the injured finger was performed May 20, 1864." His entrance into the hospital was dated two days after the operation, and his death, preceded by febrile excitement, was noted June 5, 1864. CASE 639. Private S. Lininger, Co. H, 74th Indiana, aged 32 years, was wounded at Chickamauga, September 19, 1863. He was admitted to the general field hospital near Chattanooga (date not recorded), where Surgeon J. A. Stillwell, 22d Indiana, noted the following: "Shot wound of right knee joint; excision of internal condyle of femur. Thigh amputated at junction of middle and lower thirds on November 19th. Stump opened and dressed November 23d. Milk punch given freely. November 26th, stump granulating some; resin cerate applied and stump bandaged as tight as it would bear. On November 30th, the sutures all sloughed out; granulations poor. December 6th, patient transferred." Surgeon L. D. Waterman, 39th Indiana, reported that the patient was admitted to the general hospital at Bridgeport, and that he died on the following day, December 7, 1863. CASE 640. Private L. T. Huffman, Co. E, 57th North Carolina, appears noted on the records of Confederate hospital No. 4, Richmond, as having been admitted December 15, 1862, with " excision of knee joint," performed for shot wound. The result of the operation was not recorded. AMPUTATIONS AT THE KNEE JOINT. One hundred and eighty-nine exam ples of exarticulation at the knee joint 1 for shot fractures are found on the returns. The results of two cases could not be ascertained; eighty-one were followed by recovery, and one hundred and six by death, giving a mortality of 56.6 per cent., thus exceeding the 1 The operation of amputation at knee joint, mentioned by HIPPOCRATES ( CEuvres completes, par . LlTTRE, Paris, 1844, T. IV, p. 285) and GUT l)E CHAULIAC (La Grande Chirurgie de GUY UE CHAULIAC, Rouen, 1615, p. 464), was advocated by J. GUILLEMEAU (Les (Euvres de Chirurgie, Rouen, 1649, p. 710) as preferable, under certain circumstances, to amputation in the thigh : " Vray est que si la gangrene, ou fracas d os, finissoit a la joincture du genoiiil ou fort proche d icelle, sans monter au dessus, comme au commencement de la cuisse, 1 amputation se doit plustost faire en la joincture que de coupper plus haut, et prineipalement en la cuisse : car les accidens en seroient tousiours pires, a raison des vaisseaux, veines, arteres et nerfs, lesquels tant plus on tire et montevers le hant, tant plus sont trouuez gros: joint aussi qu il conniendroit appuyer la partie cicatrisee sur la jambe artificielle, comme si on lacouppoit & la joincture." The statement of R. B. SABATJEU (Mid. Operatoire, Paris, 1824, T. IV, p. 548) and others that the operation had been performed by FAISRICIUS HILDANUS in 1581, is evidently erroneous. The latter (Opera qua extant omnia, Francofurti, 1646, p. 805) amputated the hand at the wrist joint for shot injury, in a young man of Dusseldorf, in 1581, and adds : " Sin Sphacelus poplitem superarit, in ipsa genu articulatione incisio faciendaveniet." Cases of amputation at the knee joint for disease are cited by J. L. PETIT ( (Eurres Completes, Paris, 1844, p. 814), BlUSUOR (Essai sur les amputations dans les articles, in Mem. de I Acad. Roy. de Chir., Paris, 1774, T. V, p. 771), and others; but the first examples of this operation in military surgery are mentioned by: MlCHAELlS (Brief e aus New York, in RICHTEIS S Chirurgische Bibliothek, Gottengen, 1782, B. VI, p. 125), who visited the wounded Frenoh in Charleston, left there by Count D Estaing after his unsuccessful expedition to Savannah, in September, 1779. He found 4 cases of amputations at the knee joint ; all proved fatal. The surgeon in charge ascribed these unfortunate results partly to venereal poisoning, partly to scorbutus, and partly to the insalubrious air of Charleston. JOBKKT DE LAMBALLE (Plaies d armes u feu, Paris. 1833, p. 293): A. M., aged 15, shot in left leg July 28, 1830 ; amputation at the knee joint two months after injury. VELPEAU (Nouveaux Elements de Medecine Operatoire, Paris, 1839, T. II, p. 521) states that disarticulation of the leg had been successfully practised once since 1830, by M. NlVERT, of Azai-le-Rideau, on a man whose leg had been fractured by shot. BAUDEXS (L,.) (Clinique des plaits d armes a feu, Paris, 1836, pp. 532, 536): A soldier, wounded at Tafna, January 26, 1836, in right knee ; patella shattered ; ball lodged in condyle of femur ; amputation through joint ; portion of condyles removed ; recovery, with serviceable stump. A soldier of the 13th regiment, wounded April 1, 1836, at Atlas; fracture of the head of the tibia; amputation through joint ; recovery. SEDIL- LOT (G.) (Campagne de Constantino de. 1837, Paris, 1838, p. 266) tabulates 3 fatal cases of exarticulation at the knee for shot injuries. SMITH (STEPHEN) (Cases in Surgery Amputation at the Knee Joint, by \V. PAitKEU, in New fork Jour, of Med., 1852, Vol. IX, p. 318): A saddler, shot in the leg; ampu tation at the knee joint with a razor, the surgeon having no other instrument; recovery with a good stump, which was tender on pressure. Dr. I. MOSES (T. M. MARKOE, Amputation at the Knee Joint Illustrated by the Cases which have occurred in American practice, and mainly by those which have bf.en treated in the New York Hospital, in The New York Jour, of Ned., 1856, Vol. XVI, p. 30) operated in the case of J. Senno, a Mexican, aged 26, who had received a shot fracture of the left tibia in June, 1854; amputation at the knee November 22, 1854; recovery, with firm stump, in six weeks. MAZANOWSKY (JOSEPH) (Zur Exarticulatinn im Kniegelenke, in LAXGEXBKCK s ArcMv fur Klin. Chir., 1866, B. VII, S. 489): Osman Babassy, aged 2">, wounded in the Crimea, July 17, 1R54 ; fracture of bones of both legs; January 30, 1855, exarticulation at knee joint after BAUDEXS; recovery. CHEXU (J. C.) (Rapport, etc., pendant la Campagne d Orient en 1854-55-56, Paris, 1865, p. 416) tabulates 67 cases of amputation at the knee joint ; 5 were successful and 62 proved fatal. The successful cases are : J. P. Bernad, 80th line, shot fracture of left leg, September 8, 1855 ; primary disarticulation. A. A. Boullier, 97th line, shot fracture of right leg, June 7, 1855; primary amputation at the knee. J. N. Dewatine, 82d line; shot comminution of right leg, September 20, 1854, at the Alma ; amputation on the same day. L. A. Roudil, 3d Zouaves ; shot fracture of right leg at Inkerman. November 5, 1?54; exarticulation at knee. J. B. Sainpy, 26th line, shell fracture of left leg, September 8, 1855; primary exarticulation. MATTHEW (T. P.) (Med. and Surg. Hist, of the British Army in the years 1854-55-56, London, 1858, Vol. II, p. 368) tabulates 7 amputations at the knee joint ; 3 were suc cessful and 4 fatal ; the 3 successful cases were all primary; of the 4 fatal cases, 3 were primary and 1 secondary. CHEXU (J. C.) (Stat. Med.-Chir. de la Camp. d Jtalie en 1859 el 1860, Paris, 1869, T. II. p. 775) tabulates 4 cases of amputations at the knee occurring in the French army during- the cam paign in Italy in 1859-60; 1 recovered, 3 died. The instance of recovery is detailed: L. Dumas, 37th line, comminuted fracture of upper third of left leg, Solierino, June 24, 185!); amputation at the knee December 19, 1859; recovery, with good stump, February 25, 1860. The same author states that 398 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. fatality of amputations in the continuity of the femur by 2.8 per cent. One hundred and eight were primary operations, fifty-one intermediary, and twenty-six secondary, while in four instances the period of operation was not indicated: TABLE LIV. Summary of One Hundred and Eighty-Nine Amputations at the Knee Joint for Shot Fracture. OPERATIONS. CASES. RECOVERY. DEATH. UNDE TERMINED. MORTALITY RATE OF DETERMINED CASES. 108 50 57 ] 53.2 51 16 34 ] 08.0 26 14 53.8 4 3 25.0 189 81 106 2 56.6 Fifty-four of the one hundred and eighty-nine exarticulations 1 at the knee were per formed for lesions of the bones of the knee joint. In the remaining one hundred and thirty-five cases the original injuries were: Fractures of one or both bones of the leg in one hundred and sixteen, fractures of the ankle joint in thirteen, and fractures of the bones of the foot in six instances. Primary Amputations at the Knee Joint. Of one hundred and eight operations of this group, fifty were followed by recovery, fifty-seven by death, and, in one instance, the final result could not be determined. The mortality rate, 53.2 per cent., exceeds that of the primary amputations in the lower third of the thigh (TABLE XXIX, p. 213) 4.5 per cent., and that of the primary operations in the thigh, whether in the upper, middle, or lower thirds, 3.2 per cent. Recoveries after Primary Amputations at the Knee Joint. Thirty-eight of the fifty successful primary operations were performed on Union, and twelve on Confederate soldiers. Thirty-seven of the thirty-eight Union soldiers became pensioners, and six have since died, one, one year; one, two years; one, five years; two, sixteen years; and one, eighteen years 3 amputations at the knee were performed on Austrian soldiers ; all proved fatal. According to B. BECK (Kriegs-Chirurgische. Erfahrungen wa.hre.nd des Feldzuges, 1866, Freiburg, i. B., 1867, p. 340), the operation was successfully performed in 1866, in WUrzburg, by LlXHART. OTIS (G. A.) (A Report of Surgical Cases treated in the Army of the United States from 1865 to 1871, Circular No. 3, War Department, S. G. O., Washington, 1871) records 2 successful operations: Pt. T. Nipple, 3d Cavalry; March 31, 1870, pistol ball wound of right kuee, perforating head of tibia; May 3, amputation through knee joint, sawing off about an inch of the condyles after the manner of Mr. GARDEN*, of Worcester, by Ass t Surgeon J. D. HALL, U. S. A.; recovered, with a well rounded stump. Pt. L. Shire, 3d Cavalry; wounded by Apache Indians October 6, 1870; ball embedded itself in internal condyle of left femur; October llth, amputation, sawing off about an inch of the condyles, by Ass t Surgeon J. D. HALL, U. S. A.; recovery, with a good stump. CHEXU (J. C.) (Aperfu Hist. Stat. et Clin, etc., pendant la guerre de 1870-71, Paris, 1874, T. I, p. 493) tabulates 23 amputations at the knee ; 5 were successful and 18 fatal. BECK (B.) (Chirurgie der Schussverletzungen, 1872, p. 852): U. O. L., 43d East Prussian Infantry; shot fracture of both bones of right leg January 15, 1871; exartieulation at knee joint January 23, 1871; periostitis of lemur; recovery in 6 weeks; stump not well covered. FISCHER (G.) (Dorf Fining und Schloss Versailles, in Deutsche Ztitschrift fur Chirurgie, 3872, B. I, p. 187) tabulates 1 secondary amputation at the knee joint ; the result is not stated. GRAF (E.) (Die Kimiglichen Reserve-Lazarethe, zu. Diissddorf wahrend des Krieges, 1870-71, Elberfeld, 1872, p. 53): Martinet, shot fracture of fibula; exarticulation at knee by BCCHXEK; death. LO8SEX (II.) (Kriegschirurgische Erfahrungen, in Deutsche Zeitschrift fur Chirurgie, 1873, B. II, p. 137) mentions a case of successful primary exarticulation at the knee. SOCIN (A.) (Kriegschirurgische Erfahrungen, Leipzig, 1872, p. 153) tabulates 3 fatal cases of amputation at the knee joint, but gives no details. Of the 128 cases referred to in this note 25 recovered, 102 died, and the result in 1 case is undetermined ; 11 were primary, 2 intermediary, 7 secondary, and 108 were operations of undetermined date. 1 To these 189 cases of amputation at the knee joint for shot fractures should be added 6 exarticulations for shot flesh wounds, cited in the first section of this Chapter, on page 56, making a total of 195 cases, with 82 recoveries, 111 deaths, and 2 undetermined results. In an article by Dr. J. H. BRIXTO.v, On Amputation at the Knee Joint and at the Knee, in The Am. Jour, of the Med. Sci., April, 1868, Vol. LV, p. 311. occurs the following: "In a communication from Surgeon OTIS, received since the preceding pages were penned, the following additional information has, with the permission of the Surgeon General, been furnished to the writer. The whole number of cases of knee joint amputations recorded in the Surgeon General s Office is two hundred and eleven. Of these, iiinety-six recovered, one hundred and six died, one is still under treatment, and in eight the result is undetermined." This information was furnished to Dr. BlUNTON in the early part of 1868, when every moment of the editor s time was occupied with the analysis of the injuries of the head, and when, with the limited clerical assistance at his command, it had only been possible to examine into the details of such cases as were under immediate discussion. Although there were entered on the records at that time 211 cases of alleged exarticulations at the knee, it has been ascertained from subsequent careful analysis and comparisons, and from additional information gathered from artificial limb statements and pension records, that 16 of these 211 cases were, in reality, amputations of the femur immediately above the condyles. The editor exceedingly regrets to have been the cause of this, although unavoidable, erroneous statement in Dr. BUIXTON S excellent paper on knee joint amputations. SECT. IV.] PRIMARY AMPUTATIONS AT THE KNEE JOINT. 399 after the exarticulation at the knee. In one instance, the case of Corporal Lapham, 1st Vermont Cavalry, detailed on page 224, ante, the opposite thigh was simultaneously removed at the middle third; in six instances the exarticulation was followed by amputation in the thigh, viz: four in the lower and two in the middle thirds. CASE G41. Private L. J. Matson, Co. K, 2d Ne\v York Cavalry, aged 21 years, was wounded at Petersburg, April 1, 1863. T\vo days after the reception of the injury he was admitted to the Depot Hospital at City Point, whence he was forwarded to Washington. Surgeon R. B. Bontecou, U. S. V., contributed a photograph of the wounded man (Contrib. Photo s, S. G. O., Vol. VIII, p. 21), with the following history: "The patient was admitted to Harewood Hospital, April 5th, suffering from amputation at the left knee joint, which was performed on the field by the antero-posterior flap method, for shot wound of the leg involving injury to the knee joint. The operator and the extent of the injury were unknown. At the time of admission the condition of the stump and the constitutional state of the patient were tolerably good. The parts subsequently became gangren ous; but by timely application of eschai-otics, and by supporting treatment throughout, the patient did well and made fair progress in his recovery. A part of the femur was removed with the dressing forceps." The patient subsequently passed through Lin coln and Armory Square Hospitals, and on September 2, 1865, he was discharged from service, and furnished with an artificial limb by the Jewett Patent Leg Company. The pensioner was paid December 4, 1879. In his application for commutation he represented the stump as being in a sound condition. CASK 642. Private R. Kelly, 1 Co. A, U. S. Engineer Battalion, aged 23 years, was wounded in the left knee by one of the sharpshooters in front of Petersburg, August 18, 1864. Assistant Surgeon G. M. McGill, U. S. A., reported: "The ball entered somewhat to the left of the median line, near the tuberosity of the tibia, passed upward and backward, and lodged in the face of the external condyle, partially embedding itself crosswise. On consultation with Surgeon J. R. Ghiselin and Assistant Surgeon J. R. Gibson, U. S. A., and Acting Assistant Surgeon B. F. Goodrich, who had charge of the case, it was decided to amputate through the knee joint. I introduced a scalpel opposite the termination of the external condyle and outlined an anterior flap the lowermost part of which was two inches below the terminal insertion of the quadriceps extensor with a firm cut that divided the skin and the superficial fascia: terminating the primary incision of the anterior flap opposite a point of the internal condyle corresponding to the point of introduction opposite the external condyle. From this termination the scalpel was reversed and the inner half of the posterior flap formed, the depth of my incision being sufficient to insure section of the superficial fascia as well as the skin proper. The knife was then removed and reinserted near the original point of entrance from which the outer half of the posterior flap was formed. This posterior flap was very long, extending fully half way down the leg, and the angles of the union of the anterior and posterior lines of incision were made very acute, so that retraction would not tend to separate the angles of the stump by drawing the sac of the stump tightly over the large extent of bone substance left. The anterior flap was now raised, and in raising it I took care to dissect so as to inflict as little injury as possible to the superficial fascia. The ligament of the patella was incised closely above the tuberosity of the tibia, and the patella, with its connections, was left untouched so far as practicable. The ligaments remaining were then divided at their insertion and so cut through that the semi- lunar cartilages remained in the stump. All the ligaments having been thus severed, I cleared the posterior flap with a large operating knife, cutting in the plane of the retracted posterior skin flap, outlined as described above. This procedure afforded a base of flesh to what was essentially a skin flap, in addition to which I found that by the method adopted the fleshy part of the posterior flap had been so formed as to expose so much of the anterior surface of the deep posterior layer of crural fascia that a fibrous sheet fitted upon the synovial surfaces exposed by the removal of the tibia. I now cut away all points and strips of cartilage or fibrous tissue accidentally made in operating. The ball was elevated from its bed in the face of the external condyle and this bed cleared. Nothing unusual took place in the subsequent steps of the operation; unfortunately, however, the silk ligature threads used were rotten. There was also a ball hole in the anterior flap besides the wound in the face of the condyle to complicate the case. The latter was oozing blood from its sides when last observed. Throughout the operation any injury to what was left of the synovial sac was avoided. September 9th, patient is doing very well; none of the ligatures have yet come away, and gentle traction met with firm resistance this morning. The patient is afflicted with pains of a darting lanci nating character, shifting in location. The wound of entrance in the outer border of the anterior flap has healed rapidly by granulation, and to a great extent the flaps have united. A sinus, the mouth of which is to the right of the middle of the cicatricial line, communicates with the bed of the ball; but so little discharge takes place through this that the bed is thought to be already filled with callus. A peculiar leaden feeling about the patella has been observed by the patient. He is not able to move this bone, but moves the thigh without pain. September 14th, patient is doing finely. One of the ligatures on the inside, that of an articular artery, has broken off short. The popliteal ligature has not yet separated. September 22d, the patient has steadily improved. The tumor of the stump has subsided and the line of the cicatrix is somewhat depressed. There is still discharge from where the ligature is broken off, and it is probable that the knot of this ligature will remain in the stump for some time. The main ligature has not yet come away ; the thread being fine and rotten, I dreaded to pull it even gently. The patella is now freely movable up and down, to the right and left. The capsule of the joint, as a whole, has adhered strongly to the condyloid surfaces of the femur, and affords a sufficient stay to the connected muscles. On September 27th, the patient was sent away to West Point, New York. He was then able to walk on crutches, and I had only to regret that knots of all the ligatures remained in the stump, having considered it inexpedient to search for them. On his way to West Point the patient as he informed me by letter was attacked with what he termed gangrene, rendering some operation necessary, which, I believe, was performed at West Point. From his description of it I understood that this operation did not extend to interference with the bone or the remains of the synovial sac." Surgeon J. F. Head, IT. S. A., certified to the patient being treated in hospital at West Point. The man was discharged by expiration of service, January 23, 1865, and pensioned, and after reaching his home he was supplied with an artificial limb by the Palmer Arm and Leg Company. The Brooklyn Examining Board, December 16, 1 Abstracts of this case have been cited by MAUKOE (T. JI.), Amputation at the Knee Joint, in New York Medical Journal, 1868, Vol. VI, p. 503, CASE XXXli, and in Circular No. 3, War Department, S. G. O., "\Vashington, 1871, p. 278. 400 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 1874, certified to the amputation, and to the patella being unremoved" and remaining embedded in the extensor muscles of the anterior surface of the stump; also to the integuments being adherent to the stump and parts so thin that an artificial limb can be worn but little of the time without creating inflammation. The pensioner was paid December 4, 1879. CASK 643. Private E. Baker, Co. A. 38th Wisconsin, aged 17 years, was wounded in the right leg, before Petersburg, July 17, 1864, and admitted to the field hospital of the 3d division, Ninth Corps. Surgeon M. K. Hogan, U. S. V., recorded : "The ball entered at the outer tuberosity of the tibia, ranged inward and slightly upward, and embedded itself between the tuberosities. The synovial membrane was lacerated and synovia escaped. The leg was amputated by Surgeon A. F. Whelan, 1st Michigan Sharpshooters, the operation being performed on Butcher s plan." From the field hospital the wounded man was moved to City Point, and thence to Philadelphia. Surgeon S. J. W. Mintzer, U. S. V., reported that "the patient was admitted to South Street Hospital, July 26th, his right leg having been amputated on the field, on the day following the injury, at the knee joint, and the patella removed. When admitted, parts of the integuments had sloughed away, leaving the extremity of the bone exposed. On July 30th, haemorrhage occurred without much loss of blood, from which the patient rallied, though much weakened by diarrhoea. A narrow semicircle of bone was removed, after which granulations began to cover it. There was considerable suppuration from the depth of the posterior flap." About eight months afterwards the patient was supplied with an artificial limb, and on May 30, 1865, he was discharged from service. The pensioner was paid December 4, 1879. In his application for commutation he stated that the stump of his amputated limb remained in good condition. Fatal Cases of Primary Amputation at the Knee Joint. Fifty-seven cases were reported; in fifty-one instances the patients were Union, and in six Confederate soldiers. Seven deaths were referred to pyaemia, two to tetanus, three to haemorrhage, one to gan grene, one to typhoid fever, and seventeen to exhaustion. The average period between the day of the operation and the date of death was forty-one days. CASE 644. Private W. Stanley, Co. H, 53d Pennsylvania, aged 26 years, was wounded at Fredericksburg, December 13, 1862. He was admitted to a Second Corps field hospital, and thence transferred to Washington. Assistant Surgeon C. C. Lee, U. S. A., reported: "The patient entered Douglas Hospital December 26th, having received a comminuted fracture of the upper third of the right leg, for which amputation through the knee joint was performed the following day. He stated that haemorrhage was profuse both before and since the amputation. The stump sloughed somewhat and did badly. On March 1, 1863, when I took charge of the case, the stump was tightly bandaged from above downward, the extremities being swollen and bulbous, and the thigh completely honeycombed in appearance by small abscesses and sinuses for six inches above the condyles. The bandage was removed and the sinuses and abscesses laid open. The patient was also greatly enfeebled by chronic diarrhoea, from which he had suffered for six months, and which, though checked from time to time, always returned with full force. In this state he vacillated from better to worse until April 20th, when, without any ostensible cause, he was seized with obstinate nausea and vomiting. This resisted every means employed to remedy it and exhausted what little strength remained in the patient. He sank steadily until the night of April 26, 1863, when he expired of sheer debility. At the autopsy, the thoracic viscera were found healthy with the exception of old pleuritic adhesions on the right side; lungs crepitant throughout and with out tubercular deposit. The liver and kidneys were shrunken and showed evidence of chronic congestion, but were otherwise normal; stomach and spleen healthy. In the large intestines well-marked congestion was observed and partial maceration of the mucous membrane, which was here and there dotted with dark maculae. These spots were surrounded by depressions and apparent cicatrices in the mucous membranes, and were thought to be the result of ulcers that had already cicatrized. The condition described was chiefly noticed in the upper portion of the rectum. The small intestines were here and there greatly congested, but no ulceration was detected. The stump had healed completely; but from the removal of the patella in the opera tion and the subsequent emaciation of the patient the edges of the condyles were too superficial to have borne pressure with success. A large abscess, which had been very troublesome during life, existed between the rectus and cruraeus muscles. The latter was wasted to the last degree, but seemed to have protected the bone, which was not diseased. A very complete calca reous degeneration of the mesenteric glands should also have been noted above." The lowest portion of the femur was saved and contributed to the Museum by Assistant Surgeon W. Thomson, U. S. A. (Cat. Sury. Sect., 1866, p. ,563, Spec. 1240.) CASE 645. Major A. McQ. Corrigan. 9th New York Cavalry, aged 27 years, was wounded in the right leg, at Meadows Bridge, May 12, 1864. Surgeon A. P. Clark, 6th New York Cavalry, described the injury as follows: "At the time of receiving the wound he was in command of a detachment of his regiment and at a considerable distance in advance, endeavoring to force the enemy from his entrenchments on the other side of the bridge, when he was struck by a conical musket ball, which passed from the anterior to the posterior aspect of the limb, fracturing the upper extremity of the tibia and wounding the anterior tibial artery. The haemorrhage was, in a measure, controlled by the men who brought the patient a short distance to the rear, where a tourniquet was applied. A few minutes afterwards the enemy was dislodged, when orders were received for the troops to cross as speedily as possible, and the train was not allowed to halt until it reached Mechanicsville, five miles distant, where Acting Assistant Surgeon C. Rodgers, assisted by another medical officer and myself, amputated the leg at the knee joint, adopting the method of double flaps and removing the patella and a section of the condyles of the femur. The patient was then placed in an ambulance and taken to Haxall s Landing, which place was reached on May 15th, and whence he was sent by water to general hospital." Acting Assistant Surgeon T. Liebold communicated the following termination of the case: "The patient was admitted to Point Lookout Hospital May 16th. The stump was much inflamed and the pus retained by sutures, which were removed. Two days after his admission, secondary haemorrhage came on at noontime. Happening to be near at the time I was enabled to stop it immediately, so that not more than from four to six ounces of blood was lost. The stump was then opened again entirely and the anterior tibial artery, from which the ligature had come off, was religated in a few minutes by Surgeon A. Heger, U. S. A., in charge of the hospital. The patient died May 28, 1864, from exhaustion, having had severe diarrhoea and profuse discharge of pus from an abscess in the stump. He was also attacked with vomiting of bile." SECT. IV.) PBIMARY AMPUTATIONS AT THE KNEE JOINT. 401 TABLE LV. Summary of One Hundred and Eight Canes of Primary Amputation at the Knee Joint for Shot Fracture. [Recoveries, 1-50; Deaths, 51-107; Result unknown, 108.] DATE DATE No. DESCRIPTION, AND AGE. OF INJURV. NATURE OF INJURY. OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Baker, E.V., Pt., A, 38th July 17, Rifle ball fracture of bones of July 18, Flap ; remov g patella ; Butch July 30th, hsem. Semicircle of Wisconsin, age 17. 1864. right leg, involving knee. 1864. er s operation, by Surg. A. F. bone removed. Disch d May Whelan. 1st Mich. S. S. 30, 1865. o Becker, H., Serg t, F, 5th July 3, Conoidal ball comminuted head July 4, Antero-posterior flap Stump heal d by first inten. Disch. Mich. Cavalry, age 27. 1803. of left tibia. 1803. Dec. 14, 63. (Also fract. jaw.) 3 Begle. G., Pt., E, 91st Indi Aug. 3, Conoidal ball fracture of left Aug. 3, Flap ; thro condyles of femur, Stump perfectly healed. Disch. ana, age 22. 1864. leg, involving knee joint. 1864. by Surg. J. T. Woods, 99th O. June 21, 1865! 4 Kowe.n. H., Pt., K, 52d North July 3, Shot fracture of left leg. (Also July 3, Amputation at knee joint Recovery, January 12, 1804. Carolina. 1863. wound of right ankle.) 1803. 5 Bragg, W., Serg t, F, 8th Mav 27, Conoidal ball fracture of left May 27, Flap amputation, by Assistant Discharged April 6, 1865. Penn. Cavalry, age 23. 1864. tibia. 1864. Surg. H. G. Chritzman, 8th Penn. Cavalry. 6 Brooks, J. M., Pt., A, 17th June 21, Cannon shot fracture two ins. June21, Amputation at knee joint Sept. 10, amp. lower third thigh. Penn. Cavalry, age 28. 1863. below left knee joint, sever 1863. Disch d July 28, 1865. (TABLE ing leg. XL, No. 14. p. 320.) 7 Credon,.)., Pt., A, 91st New May 27, Musket ball comminuting left May 27, Ant. and post, flaps; one half of September 1st, entirely healed. York, age 45. 1863. patella and opening knee joint. 1863. patella retained, by A. Surg. Discharged Mar. 29, 1866. The J. T. Myers, 91st New York. stump is tender. 8 Darkes, J., Pt., B, 10th In Aug. 19, Disrupture of left leg at upper Aug. 20, Anterior rectangular flap ampu August 30, gangrene. To regi fantry, age 33. 1864. third by a solid shot. 1864. tation, involving patella, lat mental headquarters Dec. 17, eral and inferior surfaces of 1864. Stump healed. condyles, by Surg. A. A. White, 8th Maryland. 9 David, T., Pt., A, 90th Penn Dec. 13, Shot fracture of right tibia and Dec. 13, Flap amputation at knee, re Disch d Feb. 21, 1803. Died Feb. sylvania, age 27. 1862. fibula, upper third. 1862. taining patella and condyles, 25, 1870. BRINTON (J. H.), On by Ass t Surg. C. C. Lee, U. Amp. at the Knee Joint, etc., in S. Army. Am. Jour. Med. Sci., 1868, Vol. LV, p. 324. 10 Dow, G. E.. Pt., G, 12th N. June 3, Grape shot fracture of left leg. June 3, Flap amputation at knee joint. June 23d, haem.; 24th, lig. fern. Hampshire, age 22. 1864. 1864. artery. Disch d Nov. 18, 1864. 11 Everett, J., Serg t, G, 142d Mav 23, Conoidal ball fracture of right May 24, Lateral flap ; patella retained ; Discharged January 22, 1865. Pennsylvania, age 27. 1864. tibia and fibula. 1864. a small section of condyles Spec. 4857. size of ahalf dollar remo d, by Surg. J. Ebersole, 19th Ind. 12 Freeman, C., Pt., B, 210th Mar. 31, Conoidal ball fracture and great April 1, Antero-posterior flap ; remov Discharged Aug. 3, 1865; good Pennsylvania, age 32. 1865. splinteringof patella and tibia 1865. ing patella, by Surg. J. J. stump. of left leg. Comfort, 190th Penn. 13 Gallot. E. F., Pt., E, 146th June 2. Conoidal ball comminuted frac June 3, A ntero posterior flap, by Surg. Discharged January 20, 1865. New York, age 26. 1864. ture of upper third of left leg. 1864. La Grange, C. S. A. Healthy stump. 14 Hare, F., Corp l, B, 6th Wis May 5, Shot fracture of bones of left May 6, Amputation at knee joint, by a Gang. Aug. 0, re-amp, mid. th d consin, age 23. 1864. leg. 1864. Confederate surgeon. thigh. Disch d May 22, 1805. (TABLE XXXIX, No.39, p. 314.) 15 Harkins, J. B., Pt.. K, 119th Dec. 13. Shot wound of the left leg Dec. 13, Amputation at knee joint, by Disch d Mar. 19, 1863. Diseased Pennsylvania, age 22. 1862. 1802. Surgeon J. P. Leidy, J19th stump : violent neuralgia : hec Pennsylvania. tic fever; exhausting diarrhoea. Died May 19, 18(57. 16 Heinle, J., Pt., G, 51st Penn June 3, Shell wound of right leg, upper June 3, Flap; by Surg. A. F. Whelan, Discharged June 1, 1865. Died sylvania, age 23. 1864. third. 1864. 1st Michigan S. S. May 1, 1870. 17 Herbert, C., Pt.. C, 69th N. York, age 19. (Alias Chas. Aug. 25. 1804. Two shot wounds of right leg by conoidal balls, fracturing Aug. 27, 1864. Long posterior flap, by a Con federate surgeon. Discharged June 9, 1805. Can not wear an artificial limb. St. J. Nichols.) heads of both bones and their lower thirds. 18 Hopkins, W., Pt.. E, 6th Sept 10, Conoidal ball penetrating cav Sept. 17, i Amputation at knee joint, by a Sound stump. Disch d March Michigan Cavalry, age 32. 1863. ity of left knee joint. 1863. Confederate surgeon. 23, 1864. 19 Ilcm-ard. J. W., Corp l, D, Mav 12, Shot wound of knee joint May 12 Amputation at knee joint Recovery. 61st Virginia. 1864. 1864. 20 Ivey, A., .Serg t, D, 7th Wis July 1, Shot fracture of upper third of July 1, Bi-lateral skin flap, by Surg. J. Discharged May 14, 1804. consin, age 20. 1863. left tibia. 1863. Ebersole, 19th Indiana. 21 Jones. 11. (J., Lieut., E, 15th May 16, Shot wound of knee joint Mav 16, Amputation at right knee joint. Recovery. Virginia. 1864. 1864. 22 Kama;, W. H., Pt., G, llth Virginia Cav.. age 40. June 9, 1863. Conoidal ball frn^ture of head of left tibia. June 10, 1863. Amputation left knee joint, by a Union surgeon. Exchanged and furloughed Mar. 12, 1864. O;j Kaul, J., Pt., G, 29th New Aug. 29, Musket ball perforated head of A tiff 29 Double flap amputation Mar. 12, 1863, patella raised and York, age 21. 1862. right tibia : joint not involved. v ft 1862. movable. Disch d April 30, 63. Died Dec. 13. 1878; dropsy. 24 Kelly, R., Artificer, U. S. Aug. 18, Conoidal ball entered near tu- Aug. 18, Antero-posterior flaps ; patella Disch d Jan. 23, 1805. MARKOE Engineers, age 23. 1864. berosity of left tibia, lodging 1864. not removed, by Ass t Surg. (T. M.), Amp. Knee Joint, in on external condyle of femur, G. M. McGill, U. S. A. N~. r. Med. Jour.. 1867-68, Vol. slightly injuring it. VI, p. 503. Stump tender. 25 Kerr, G., Serg t, H, 2d Cav June 11, Conoidal ball wound of upper June 1 1. Amputation at knee joint, by Disch d October 17, 1864. Died alry, age 41. 1864. third of right leg. 1861. Union surgeon. 1865. *iO Kuhn, A., Pt., F, 99th Ohio. July 19, Conoidal ball comminuted frac- .hilv 19. Short flap, leaving condyles of Discharged June 21, 1865. age 28. 1864. ture of right tibia, extending 1864. femur intact, by Surg. J. T. nearly to knee joint. Woods, 99th Ohio. - 7 Lapham. C. N., Corp l, K, 1st July 8, Both legs carried away by a July 10, Amputation left knee joint by Disch d August25, 1864. (CASE Vermont Cavalry, age 23. 1863. solid shot. 1863. ant. -post, flap also amp. right 436, p. 224, and No. 336, TABLE thigh, middle third), by Surg. XXXI, p. 231.) L. P. Woods, 5th N. Y. Cav. 28 Leonard. tV. J.. Pt., K. 43d May 16, Shot comminution of tibia and May 16, Antero-posterior flap; remov Recovered July 31, 1864. Alabama, age 20. 1864. fibula just below knee joint. 1864. ing patella. 29 Matson, L. J.. Pt., K, 2<t N. April 21. Conoidal ball wound of left log, April 1. Antero-posterior flap amputa Gangrene ; Sloughing. Portion of York Cavalry, ago 21. 1865. injuring knee joint. 18(!.">. tion. femur removed with forceps. Discharged Sept. 2, 1865. 30 McGee, J., Pt.. G, 2d Rhode May 5, Conoidal ball fracture of right Mav 5. Short post, flap ; patella remo d. Discharged Oct. 1"), 1864. Stump Island, age 22. 1864. libia and fibula. 1664. by Surg. ( ,. W. Carr, 2d R. I. never healed entirely. 31 Me Mullen, R. J.. Pt.. I. 4th May 3, Shot fracture of the leg Mn v 4. Amputation at knee joint Protrusion of condyle! May 23d, Georgia, age 20. 1863. 1863. amp. thigh, lower third. June oth, hpein.; lig. femoral artery. Recovery. (TABLE XXXVI, No. 130, p. 295.) SURG. Ill 51 402 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMAP^S. 32 Mitchell, A., Pt., F, Palmetto May 24, Shot wound of the upper ex May 25, Amputation at knee joint Slough g; both condyles exposed. S. S., age 17. 1864. tremity of tibia. 1864. Furloughed Sept. 10, 1864. 33 Muir, L., Pt... I, 5th Vermont, May 5, Shot fracture of left leg four May 6, Circular amputation at knee Discharged May 22, 65. Stump ago 25. 1864. inches above ankle. 1864. joint. enlarged : cannot use nrtif. leg. 34 O Brien, P., Pt., F, 39th N. Aug. 14, Conoidul ball fracture of left Aug. 10. Flaps, by Surg. N. Hay-ward, Discharged June 19, 1865. Died York, age 27. 1864. tibia two ins. below knee j t. 1864. 20th Mass. August 11, 1866. 35 Pace, H., Pt., G. 113d Penn May ."), Conoidal ball fract. of artieula- May 5, Skin flaps, by Surg. J. Eber- Discharged August 31, 1864. sylvania, age 33. 1864. ting surface head of right tib. 1864. sole, 19th Indiana. 36 Padgett, C. S., Serg t, K, June 3, Conoidal ball comminuted frac June 4, Antero-post. flaps; retaining Discharged July 13, 1865. BiiiN- 12th New Jersey, age 23. 1864. ture of right tibia and fibula. 1864. patella but removing articular TOX (J.H.),Am. Jour. McJ. Sci., (Also fracture of left radius.) surface of condyles, by Surg. 1868, Vol. 55, p. 322. A. Satterthwaite, 12th N. J. 37 Kaftay, P., Pt., C, 21st Mis May 6. Shot wound of left knee. May 6, Amputation at knee joint Retired January 31, 1865. sissippi, age 40. 1864. 1864. 38 Rist, C. H., Pt., A, 36th Wis June 1, Conoidal ball fracture of upper June 1, Osteoplastic. leaving patella Ulceration of cartilages. Dec. 15, consin, age 19. 1864. third of left tibia, extending 1864. and condyles, by Surg. J. M. amp. thigh, lower third. Dis- into knee joint. Burr, 42d New York. chargedMav20, (i5. Sj>ec. 3514. (CAKE 492, V 318, and TABLE XL, No. 82, p. 321.) 39 Rogers, .1. W., Pt., D, 6th Aug. 18, Conoidal ball fracture of left Aug. 19. Flap amputation at knee joint. Bone protruded. Disch d March Wisconsin, age 47. 1864. tibia and fibula immediately 1864. 23, 1865. below knee. 40 Sholes, H.. Pt., D, 26th New- Dec. 13, Shot wound of right knee Dec. 15. Amputation, by Surg. T. Sim, Gang. March, 1863. amp. thigh, York, age 20. 1862. 1862. u. s. v. low. third. Disch d Dec. 11, 63. (TABLE XL, No. 84, p. 321.) 41 Stewart, W., Pt,, K, 2d Mich June 17. Shell wound just below right June 17. Antero-posterior flaps; remov Sloughing. Discharged May 4, igan, age 22. 1864. knee, nearly severing leg. 1864. ing patella and condyles, by 1965. Tender cicatrix. Surg. S. S. French, 20th Mich. 42 Stmtton, E. L., Capt , F, May 3, Conoidal ball fracture of head May 4, Amputation knee joint, leaving Discharged January 3. 1864. 12th New Jersey, age 24. 1863. of right tibia. 1863. patella intact, by Ass t Surg. J. T. Calhoun, IT. S. A. ;:, Struble, E. H., Pt., F, 19th May 22, Shell, taking off left leg below May 22. Flap amputation, by Surg. F. Discharged March 16, 1863. Ohio, age 25. 1862. knee. 1862. T. Hurxthal, 19th Ohio. 44 Swittenburg, J. C., Capt., II, Aug. 21, Conoidal ball shattering upper Aug. 21. Amputation at knee joint, by Exchanged February 23, 1865. Kith Miss., age 27. 1864. third left leg. 1864. Surg. J. Ebersole, 19th Ind. , Trent S. A., Pt. 2d Rich May 12, Gunshot wound of knee May 1 2. Amputation at knee joint, by Retired Novembers, 1864. mond Howitzers. 18(54. 1864. Surg. Capers, C. S. A. 46 Turner, J. L., P., G, 1st S. July 1, Shell wound of right leg, in July 2, Amputation at knee joint Exchanged March. 3, 1864. Carolina, age 20. 1803. volving knee joint. 1863. 47 Unknown RITP Rbont *}0 Dec. 13 Shot fracture of the leg Primary Long ant. and short post, flaps : Recov d, with good stump. BIEIN- ^ 1862. patella and condyles retained, TON (J. II.), On Amp. atllie Knee by Surg. J. H. Brinton.U.S.V. Joint, etc., in Am. Jour. Mrd. Sci., 1868, Vol. LV, p. 316. 48 Wheeler, T. H., Serg t. E, May 31, Shot wound of right tibia and May 31, Flap amputation, by Surg. G. June 10th, gangrene. Disch d 1st Mich. Cav., age 32. 18"64. fibula, implicating knee joint. 1864. K. Johnson, 1st Mich. Cav. Nov. 12, 1864. 49 Woodruff. A. O., Corp l, D, July 3, Conoidal ball fracture of upper July 3, Amputation, by Ass t Surg. B. Discharged May 28, 1864. Poor 5th Artillery, age 23. 1863. third of left tibia. (Also 1863. Howard, U. S. A. stump, with very thin covering. wound of right leg.) 50 Ymtng, L. C., Pt., A, 3d Vir May 12, Pistol ball injuring both right May 14, Long anterior flap, by Surg. C. July 27th, amp. thigh, mid. third; ginia Cavalry, age 31. 1864. tibia and femur, involving the 1864. B. Gibson, C. S. A. gangrene; recovery. Spec. 5514. knee joint. (TAB. XXXIX.No. 100, p. 315.) 51 Barger, J. C., Pt., G, 52d May 30, Shot wound right leg and left Primary Amputation at knee joint . . Died June 14, 1864. Virginia, age 40. 1864. shoulder. 52 Barker, J., Pt., I, o8th Mass., June 17, Shot wound left leg and right June 17. Oval flap amput n at left knee Died June 28, 1864. ( TABLE age 42. 1864. thigh. 1864. and amp. low. third r t thigh. XX XII, No. 1014, p. 257.) 53 Bates. O. S.. Pt , A, 20th June 24, Shell fracture of middle third June 24. Antero-posterior flap, at left Gangrene. Died August 19, 64 ; Mass., age 24. 1864. of left leg. 1864. knee joint, by Surg. N. Hay- exhaustion. ward, 20th Mass. 54 Bingham, D.,Corp l, H,118th June 26, Shot shattering right leg ex June 26. Double flap ; condyles of femur Gang.; lisem. Died July 25, 64 ; Pennsylvania, age 36. 1864. tensively. 1864. sawn off and patella removed. pyaemia. r>5 Briggs, J., Pt.. A, 20th New Dec. 13, Shot fracture of left tibia Dec. 13, Amputation at knee joint, re Died December 1 3. 1 862. York. 1862. 1862. taining patella. 56 Brooks, E., Pt., K, 19th Vir April 20, Shell fracture of right leg April 20. Amputation at knee joint Erys.; bedsores; large abscesses. ginia, age 26. 1865. 1865. Died May 11, (!.">: exhaustion. 57 Butler. G.. Pt., C, 8th New Aug. JO. Fracture of left le*^ by a fracr- Aug. 16, Amputation at knee joint Died November22, 1864 ; chronic Jersey, age 19. 1864. ment of shell. 1864. diarrhoea. 58 Campbell, B. J., Pt., H. 5th Aug. 19. Shot wound of right leg, in A ug. 20. Flap amputation at knee joint. Died September 1 A 1864. New York, age 22. 1864. volving knee joint. 1864. 59 Chase, J. B.. Pt., K, 24th N. June 16, Shot fracture of left tibia and June 16, Amputation at knee joint July 7th, lig. fern, artery. Died York Cavalry, age 49. 1864. fibula. 1864. July 9, 1864 ; constitutional irri tation. 60 Clark, W., Pt., A, lllth Sept. 17 Shot fracture of right leg Sept. J7 Amputation at knee joint. . . Died October 10, 1862. Pennsylvania. 1862. 1862. 61 Cole, F., Pt., G, 61st New July 3, Shot fracture of both bones of July!!. Amputation at knee joint, by Died July 9, 1863. York. 1863. left leg. 1863. Surg. C. S. Wood, 66th N.Y. 62 Conland, ()., Pt., I, (Ust N. Mar. 25, Shot wound of the left knee Mar. 25. Amputation at knee joint, by Died April 19, 1865. York. 186o. joint. 1865. A.Surg.C.S.Hoyt,12Gth N.Y. 63 Cornell. J.. Pt., B, 7th West May 31, Shot fracture of left knee joint. Primary Amputation at knee joint, by Died June 3, 1864. Virginia. 1864. Surg. M. Rizer, 72d Penn. 64 Corrigan, A. McQ., Major, May 12, Conoidal ball fracture of upper May 12, Antero-posterior flap: remov g May 18th. haem., 6 oz.; popliteal 9th New York Cavalry, 1864. extremity of right tibia and 18u4. patella and a section of con artery ligated; diarrlwa. Died age 27. wound of ant. tibial artery. dyles of femur, by A. A. Surg. May 28, 1864; exhaustion. ( . Rodgers and Surg. A. P. Clark, Gth N. Y. Cavalry. 65 Councell, E. C., Col., 16th Aug. 21. Musket ball fracture of right Aug. 21. Antero-posterior flap, by Surg. Sept. 2d, hsem., 14 oz.; Sept. 3d, Miss., age 32. ; 1864. leg near knee. 1864. A. A. White. 8th Maryland. lig. femoral ; Sept. 10th, haem. recurred and proved fatal. 66 Douglass, J., Serg t, G, 63d Nov. 24. Fract ure of right leg. extending , Nov. 24. Amputation at knee joint Died November 25, 1864. Indiana. 1864 to knee it. by a cannon ball. ; 1864. 67 Draher, W., Pt., B, 51st June 3, Shot fracture of upper third of June 3. Lateral flap amp. at knee joint, June llth, hajm. Died June 24, Pennsylvania, age 32. 1864. left leg. (Wound of shoulder.) 1HM. by Surg. A. F. Whelan, 1st 1864 ; exhaustion. Michigan S. S. 68 Conoidal ball fracture of right June 18, Amputation at knee joint Parts gangrenous. Died August 19th Indiana, age 22. 18G4. leg. 1864. 17, 1864, of injury. 69 Gervig, II., Pt., K, 15th N. Mar. 3), Conoidal ball fracture, involv- Mar. 31, Amputation at knee joint, by Died April 7, 1865; exhaustion. York Artillery, age 28. 1865. ing right knee joint. 1865. Surg. A. A. White, 8th Md. SECT. IV.] PRIMARY AMPUTATIONS AT THE KNEE JOINT. 403 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF Ol ERA- TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 70 Gooley, N., Pt, C, 73d Ohio. May 25, Shot wound of the knee. (Also May 25, i Amputation at knee joint, by Died August 14. 1864. . . 1864. wound of neck.) 1864. | Surg. I. N. Himes, 73d Ohio. 71 Gould, M. W., Corp l, H, May 14, Conoidal ball fracture of left May 15, Circular amput n at knee joint. Died September 19, 1864 ; chronic 3Cith Illinois, age 20. 1864. tibia and libula in mid. third. 1864. diarrhoea. 72 Grice, T., Pt., E, 38th Col d Sept. 29, : Conoidal ball fracture of right Sept. 29, Amputation at knee joint Died March 21, 1865. Troops, age 22. 1804. j leg. 1864. 73 Gutiek, W. O., Corp l, M, 1st Aug. 27, Shot fracture of the right leg. Aug. 27, Disarticulation at knee joint, by Died September 3, 1863. Iowa Cavalry. 1863. 1863. Surg.J.C. Lynch, IstMo. Cav. 74 Harbor, E.. Pt., G, 21st Vir Aug. 4, Shell fracture of right tibia and Aug. 4, Anterior skin flap; patella re- ; Died Aug. 20, 1864 ; exhaustion ginia Cavalry, age 33. 1864. fibula, extending into knee j t. 1864. moved ; condyles of femur consequent upon excessive ich- uudisturbed. orous discharge : autopsy. 75 Hedder, W., Pt,, C, 56th N. June 1, Shot fracture of leg, involving June 1, Amputation at knee joint June 13th, amp. thigh, mid. third; York. 1862. the knee joint. 1862. ; 29th, haem. Died July 3, 1862; exh., diar., bed sore. Kpec. 4933. 76 Hughes, A. J., Pt., B, 14th May 5, Conoidal ball wound of left May 5, : Antero-posterior flap at knee Died June 6, 1864. Card Photo s lufautry, age 26. 1864. knee. 1864. joint. A. M. M., Vol. 2, p. 45. 77 Johnson, T. II., Pt., F, 95th Ohio. Aug. 30, 1862. Gunshot wound Aug. 31, Amputation at left knee joint. Died September 21, 62 ; tetanus. 1862. 78 Jiidd, W. B., Adjutant, 97th Feb. 7, Shot fracture of knee, severe. . Feb. 7, Amputation at knee joint Died February 19, 1865. New York. 1865. 1865. j 79 Kennedy, J. A., Corp l, H, Sept. 1, Conoidal ball fracture of the Sept. 2, Flap amputation at knee joint. Died December 24, 1864 chronic 38th Ohio, age 24. 1864. right tibia. 1864. pneumonia. 80 Koch, J. H., Serg t, F, 69th June Hi, Grapeshot fracture of left knee June 16, Circular amput n at knee joint, July 3, 4, haem., 15 oz.; lig. fern. Penn., age 22. 1864. joint. 1864. by Surg. G. L. Potter, 145th ; artery. Died July 12,~18t>4 ; Pennsylvania. exhaustion. 81 Krowlow, H., Pt., A, 66th Mar. 31 , Shot wound of the right leg. . . April 1,! Antero-posterior flaps at knee Gang.; slough.; femur protrud.; New York, age 18. 1865. 1865. joint. haem.; femoral artery lig.: June 23d, recur d; re-lig. Died June 24, 1865: exhaustion. 82 Lepper, W. F., Pt., H, 143d May 5, Conoidal ball fracture, involv May 5, Antero-posterior flaps at knee Died May 15, 64, haem. il) BuiN- Pennsylvania. 1864. ing right knee joint. 1864. joint, leaving condyles and TOS(J.Jl.),Am.Joitr.jUed.Sci., patella, probably by Surg. J. 1868, Vol. 55, p. 316. II. Brinton, U. S. V. 83 Long, J. W., Serg t, I, 8th Dec. 16, Conoidal ball fracture of right Dec. 17, Flap, by Surg. J. R. Ludlow, Dec. 18th, haem.; lig. int. artic. art.; Kansas, age 23. 1864. leg. 1864. U. S. V. Dec. 25th, haem. fromext. artic. art., 1 qt. Died Deo. 26, J864. 84 Long, W., Pt., A. 1st Mis- Sept. 21, Shot wound, involving head of Sept. 21, Amputation at knee joint Died October 27 1862 pyaemia souri Artillery, age 40. : 1862. right tibia and patella. 1862. Spec. 467. 85 Matthews, S., Pt., A, 93d May 15, Shot comminuted fracture of May 17, Lateral flao at knee ioint Alnv3(lth hspm . rpc..Tnnp3 S R Pennsylvania, age 28. 18ti4. left tibia and libula. 1864. 12; lig. pop. artery; haem. June 16. Died June 17, 64 ; pyaemia. 80 McCullough. W. T., Serg t, AUB-. . Gunshot wound of leg On field. Amputation at knee joint L g- sloug haem attempt to lig I, 2d New York. 1862. tetanic sj-mp. Died Sept. 7, 62. 87 Merrill, S., Pt., I, 39th Mass., Feb. 7, Shot fracture of upper third of Feb. 7, Flap amputation at knee joint. Typhoid symptoms. Died March age 39. 1865. right tibia. 1865. 3, 1865; pyaemia. 88 Opperman. J., Pt., E, 8th May 5, Conoidial ball fracture of left On field. Amputation, by Surg. N. Hay- Bone removed. Died May 15, New Jersey. 1864. knee joint. ward, 20th Mass. 1864. 89 1 armenter, - E. M., Pt., I, Sept. 17, Gunshot fracture of leg On field. Amputation at left knee joint.. Died October 13, 1862. 15th Massachusetts. 1862. 90 Rathburne, >., Pt., C, 36th May 31, Conoidal ball fracture of right May 31, Flap, through the knee joint, Sloughing. Died June 9, 1864 ; Wisconsin, age 27. 1864. tibia. 1864. i by Surg. N. Hay ward, 20th pyaemia; autopsy. U.S.San. Massachusetts. Com. Mems., Surg. Vol. I, p. 372. 91 fiea, J"., Pt., H,24th Virginia. May 16, Conoid, ball fract. of patella and May 18, Long posterior flaps, by Surg. Bone protruded. Died July 19, , 1864. articular surf, of head of tibia. 1864. C. B. Gibson, C. S. A. 1864. 93 Ribinger, It., Pt., 15, 27th . June 11, Gunshot wound of the knee June 11, Amputation at the knee joint.. Died June 15, 1862. Pennsylvania. 1862. joint. 1862. 93 Roberts , E. P., Corp l, G, Feb. 18, Shell shattering both bones of Feb. 18, Antero-posterior flap, Bauden s Slough.; cond. pro. Died Apr. 22, 107th Illinois, age 20. 1865. left leg in upper third. 1865. operation, by Surg. E. Ship- 65; pyae. BRINTOX (J.H.), Am. ! pen, U. S. V. Jour. Mcd. &cj ., (>8,Vol.55,p.321. 94 Russell, J., Pt., D, 27th July 30, Fracture of upper third of right July 30. Double skin flap, by Surg. A. Thigh inflam.; disch. from cud of Michigan, age 51. 1864. leg by a Conoidal ball. 1864. , F. Whelan, 1st Mich. S. S. stump. Died Aug. !8, 61 ;asthe. 95 Scott, J.. Pt., F, 1st N. Y. May 31, Conoidal ball shattering bones June 1, Amputation at knee joint Sloug*. June 16, ham.: lt?(h,lig. Dragoons, age 33. 1864. of left leg. 1864. fern. art. Died June 18, 64 ; col. 96 Slater, I ., Pt.. I, 370th New May 24, Fracture of upper third of left May 26, Amputation at left knee j t, by Died June 4, 1864; effects of York, ago 45. 1864. leg by a Conoidal ball. 1864. Surg. N. Hay ward, 20th Mass. wounds. 97 Smith, H., Pt., I, 14th New June 7, Conoidal ball wound of left leg June 7, Flap amp. at left knee j t and Died June 17. 1864. (TABLE Jersey, age 24. 1864. and right thigh. 1864. amp. right thigh, lower third. XXXII, No. 1745. p. 265.) 98 Stanley, W., Pt., II, 53d Dec. 13, Conoidal ball fracture of upper Dec. 14, Amputation at knee joint, re- Stump swollen and bulbous.thigh Pennsylvania, age 26. l 1862. third of right leg. 1862. moving the patella. honey-comb, by small abscesses; chronic diarrh. Died April 26, 1863: exhaustion. Spec. 1240. 99 Storey, J. M., Pt., H, 37th Jnlv 3() Grapeshot fracture of left tibia July 31, Amnilt.itinn nt knpp i t T5ntrh- Slimrrh \r.<r. !f,tli. lisnm.: Anr. Wisconsin, age 30. 1864. and fibula. 1864. er s operation, by Surg. A. F. 14, 1865, amp. thigh, mid. third. Whelan, 1st Mich. S. S. Died July 3, 65: gang. (T.\1!LE XXXIX. "No. 157. p. 316.) 100 Sutton, G. H., Pt.. B, Pur- Aug. 18, Fract. of mid. third of left tibia Aug. 19, Amp. at knee joint, by Surg. Died September", 1864 ; exhaus- noil s Md. Legion, ago 34. : 1864. and fibula by Conoidal ball. 1864. j A. A. White, 8th Maryland. tion. 101 Swan, D. K., Pt., F, 38th Sept. 1, Shot fracture of the right tibia. Sept. 1, Antero-posterior flaps ; remov- Died December 26. 1864. Ohio, age 18. 1H64. 1864. ing condyles. 102 Thompson, I. R., Pt., I, 6th May 11, Shell comminuted fract. of left May 12, Antero-posterior flaps, by Surg. Died June 27, 1864; exhaustion. Wisconsin, age 29. 1864. tibia and fibula near knee. 1864. \ A. J. Ward, 2d Wisconsin. 103 Tilhurv, G., Pt., E, 74th May 27, Shot fracture of the right leg. . May 27, Amp., by Surgs. W. P. Pierce, Died June 12, 1664. Illinois. 1864. 1864. 88th Il l., and II. E. Hasse, 2-Ith Wis. 104 Turner, W. H., Serg t, 6th May 6, Cannon ball struck left leg, May 6, The patella, condyles. and sy- May 20th, haem., 4oz.; haemorrh. New York Battery, age 26. 1864. fracturing the tibia and the 1864. novial surfaces were not re recurred ; flaps opened, sloughy fibula. moved: and the capsules nf tissue removed : end of bone thejoint.divided at their distal necrosed. Died May 27, 1864; by Ass t Surg. (1. M. McGill, U. S. A. 105 Waldenburg, G ,Pt.,A,46th July 30, Conoidal hall fracture of right July 30, Butcher s operation ; long ant. Abscess: diarrhoea. Died Aug. New York, age 29. 1864. tibia. (Also wound of left 18*64. flap; small portion ntVundylos 15, 1864 ; exhaustion. heel.) sawn off articulating surface, by Surg. A. F. Whelan, 1st Michigan S. S. INJURIES OF THE LOWER EXTREMITIES. [CHAP. X NO. NAME, MIUTAUY DESCRIPTION, AND AGE. DATE OF INJURY. NATUUE OF IXJUKY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 106 107 108 Westaoott 11 Pt V 19th Dec. 13, 186:2. Oct. 8, 186-2. MavlS, 1864. Shot fracture of lef Dec. 13, 1862. Oct. 8, 1862. May Ki, 18C4. Amputation at knee joint Died December 30, 1862. Died November 14, "62; typhoid fever. May 15th, transferred to private quarters. Massachusetts. Wood, W. B.. Serg t, I, IGth Tennessee. Baker, J. ."?., Pt., D, SSth Virginia. Conoidal ball fracture of patella and head of tibia. Large posterior flap, by Surg. C. B. Gibson, C. S. A. Intermediary Amputations at the Knee Joint. Fifty-one intermediary operations gave a fatality of 68.0 per cent., only sixteen of the fifty determined cases having a suc cessful issue. Three patients submitted to re-amputation in the thigh; one survived and two succumbed. Recoveries after Intermediary Amputation at the Knee Joint. Of the sixteen cases of this group three were Confederate and thirteen Union soldiers. * The latter are all pen sioners, and were living in August, 1880. In one instance primary amputation in the upper third of the leg had preceded the exarticulation at the knee, and in a second case haemorrhage to the amount of sixteen ounces occurred from the popliteal artery seven days after the amputation. The bleeding vessel was ligated, but haemorrhage recurring three days later, the femoral was successfully ligated: CASE 646. Private D. Meikle, Co. B, llth Massachusetts, aged 20 years, was wounded at Bull Run, August 30, 1862, and admitted to Fairfax Seminary Hospital nine days afterwards. Surgeon D. P. Smith, U. S. V., reported: "The case was one of gunshot wound of left knee joint, and the sequence of the injury was an amputation at the knee joint, performed by lateral flaps, on September 28th. Secondary haemorrhage to the amount of sixteen ounces occurred on October 4th from the popliteal artery, when the stump was opened, the vessel dissected up for about two inches, and again tied. Three days afterwards haem orrhage recurred ; the stump was again reopened and the artery dissected up into Hunter s canal, where, becoming the femoral, it was then ligated. No further bleeding took place, and the patient recovered Avith a beautifully firm and broad stump." The patient was discharged from service December 16, 1862, and pensioned. He was paid March 4, 1880. The stump was described to be in good condition in the pensioner s application for commutation. CASK 647. Private J. M. McGee, Co. E, 119th Pennsylvania, age 19 years, was wounded at the Wilderness, May 5, 1864. Surgeon E. 15. P. Kelly, 95th Pennsylvania, recorded his admission to the field hospital of the 1st division, Sixth Corps, with "shot wound of right knee by a conical ball. Surgeon E. Bentley, U. S. V., who operated in the case, made the following report : "The patient entered Third Division Hospital, Alexandria, three weeks after receiving a wound of the right knee joint, the ball passing beneath the patella. The bones were not much fractured, but the joint Avas swollen and painful and the leg oedematous. Circular amputation at the knee joint, by skin flaps, was performed on June 2d, sulphuric ether being employed as the anaesthetic. At the time of the operation the patient had become very weak, his pulse quick and feeble, and he perspired considerably, had cough and spat up blood. He reacted very well. Tonics, stimulants, and nourishing diet were given, and simple dressings used. The wound healed up kindly, and the patient s general condition became much improved." The patient was subsequently treated at various hospitals, and finally, after being provided with an artificial leg, he was discharged Septem ber 9, 1865, and pensioned. Examining Surgeon E. A. Smith, of Philadelphia, certified to "amputation at the knee joint, with preservation of the patella." The pensioner was paid March 4, 1880. In his application for commutation he represented the stump of the amputated limb as being in a "sound" condition. CASE 648. Private W. H. Thomas, Co. A, 17th Infantry, aged 19 years, was wounded at Bull Run, August 29, 1862, receiving a shot fracture of the upper third of the right leg. Assistant Surgeon B. Howard, U. S. A., reported that he ampu tated the leg on the field, on September 1st, at the knee joint, including the removal of the patella in the operation, which was performed by the double flap method. Several days after the date of the injury the wounded man was removed to Washington and admitted to Ascension Hospital, whence Surgeon J. C. Dorr, U. S. V., described his case as follows : "After his admission, the sutures were found upon examination to have given away and the flaps were gaping. The patient had been much exhausted by long marching prior to the battle, and it was feared that he would not survive the effects of the operation. Stimulants, beef tea, and quinine were freely given, and finally, after repeated relapses, he has now (December 3d) nearly recovered, the stump being covered with fine granulations, and his strength having recuperated to its normal standard." The patient subsequently passed through Carver and St. Elizabeth Hospitals, and on June 16, 1863, he was discharged, having been previously furnished with an artificial leg. He afterwards entered the Veteran Reserve Corps, and was ultimately discharged from service AprU 5. 1864, and pensioned. He was paid March 4, 1880. In his application for commutation he reported the stump as being in a good condition. Fatal Cases of Intermediary Amputation at the Knee Joint. The thirty-four opera tions were performed on three Confederate and thirty-one Union soldiers. Primary excision of three inches of the fibula, and primary amputation of the leg at the upper third, had SECT. 1V-1 INTERMEDIARY AMPUTATIONS AT THE KNEE JOINT. 405 preceded the exarticulation at the knee in one instance each. Death was ascribed to pyaemia in eleven, to haemorrhage in two, to gangrene in six, and to exhaustion in eight instances. Autopsies were recorded in four cases, and of nine cases specimens are preserved in the Army Medical Museum. 649. Private M. 13. Aseltyne, Co. F, 10th Vermont, aged 22 years, was wounded in the left foot, at Mine Run, November 27, 18G3, and entered the Third Division Hospital, Alexandria, one week afterwards. Acting Assistant Surgeon A. P. Crafts reported: "A conical ball entered the anterior surface of the foot, fractured the cuneiform bones, and was extracted through the orifice of entrance, on the field. At the time of the patient s admission there was much tumefaction and inflamma tion of the foot and leg, which at first seemed to yield to treatment. But, on December 10th, evidences of gangrene began to show themselves, and four days afterwards the leg was amputated at the knee joint by Surgeon E. Bentley, U. S. V. The operation was performed by the circular method, and by retaining the patella after disarticulating the joint. Chloroform constituted the anaesthetic. Simple dressings were used to the stump, and tonics and stimulants, including iron and quinine, and acetate of ammonia were given in the treatment. On December 20th, there were symptoms of pyremia. The patient s countenance became sallow and anxious, a severe chill occurred, and hiccough set in, followed by loss of appetite and by profuse sweating. Death supervened on December 27, 1863. At the post-mortem examination the liver, kidneys, spleen, and intestines were found healthy, the lungs much discolored, and some effusion in the cavity of the chest. There was also great hypertrophy of the heart and some effusion within the pericardium." A section of the stump, made by Surgeon J. H. Brinton, U. S. V., showed the femur to be healthy, although denuded of periosteum for six inches above the joint. The synovial membrane on the crucial ligament was congested, and the cartilage of the femur was thinned and softened, the whole color being changed and absorption commencing. The ligature of the popliteal artery had partially sloughed, and the base of the long internal clot had come down and projected through the opening made by sloughing in the walls of the vessel. The artery, showing its condition as described, was con tributed to the Museum by the operator. A wet preparation of it constitutes specimen 1989 of the Surgical Section, and a chromo-lithographic representation is shown on PLATE XXII, opposite page 736 of the Second Surgical Volume. CASE 650. Corporal A. A. Lepper, Co. L, 8th Iowa Cavalry, aged 27 years, was wounded in the left leg, at the battle of Cassville, May 20, 1864. He was admitted to hospital at Chattanooga on the following day, and ten clays afterwards he was transferred to hospital No. 8, Nashville, whence Acting Assistant Surgeon R. T. Higgins made the following report: "The injury consisted of a compound fracture of the tibia at the upper third. The day after admission the leg was placed in a box splint and kept there until, finding that the limb could not be saved, amputation or excision was determined upon; the foot having become considerably swollen and slightly cedematous, and the wound discharging ichorous pus. On June 8th and 10th, the patient also had severe chills, each attack lasting from twenty minutes to half an hour; pulse feeble and frequent; appetite wanting. Upon a thorough examination of the parts, amputation was decided to be the more advisable operation, and was per formed at the knee joint, on June 13th, by Surgeon R. R. Taylor, U. S. V., in charge of the hospital. Rectangular flaps were made, with circular section of muscles, and the condyles of the femur were taken off in the operation, chloroform being employed as the anaesthetic. Two ounces of whiskey and forty drops of laudanum were administered at once after the operation, and mustard plasters were applied to the ankle and wrists. The patient reacted slowly. Milk punch and beef tea were given alternately every twenty minutes in half-ounce doses. On the following day he was troubled with colliquative diarrhoea and involuntary discharges and began to sink rapidly. There was also another chill, but not so severe as the previous ones, and on the second day the upper flap was found to be sloughing, dark in color, and gangrenous. Stimulants and nourishments were continued freely. Death occurred on June 16, 1864. At the post-mortem examination the lungs were found to be engorged and slightly hepatized and the intestinal canal slightly inflamed, the other organs being normal. The clot found in the femoral vein was slightly adherent and the internal coat of the vein very much inflamed. The cause of death was thought to be pyaemia." The upper half of the tibia of the amputated leg, a large fragment of it being partly necrosed and remaining in position, was contributed to the Museum by Assistant Surgeon C. C. Byrne, U. S. A., and is specimen numbered 3758 of the Surgical Section. TABLE LVI. Summary of Fifty-one Cases of Intermediary Amputations at the Knee Joint for Shot Fractures. [Recoveries, 1 16 ; Deaths, 17 50 ; Unknown result, 51.] NO. NAJIE, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY. NATUKK OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Sutler, T. J., Lieut., A, 38th July 3, Fracture of upper third <if left July 19, Amputation nt knee joint, by To prison April 23, 1864 ; after Virginia, age 28. 1863. leg by conoklal ball. 1863. A. A. Surg. L. Fisher. wards exchanged. 2 Clark, O. 11., Serg t, II, 1st NOV.;. ?, Pistol ball wound of left knee Dec. 2, Flap amputation at the knee Discharged Oct. 4, 1864. Stump Mass. Cav., age 30. 18(i3. joint. 1863. joint. tender. 3 Desmond, H., Pt., I, 28th Dec. 1 3, Fracture of head of right tibia Dec. 21, Amputation at the knee joint. Secondary amp. lower third of Mass., age 29. 18(12. and patella; colloidal ball. 1862. thigh. Disch d Dec. 2?, 1803. (TABLE XL, No. 2">, p. 3-JO.) 4 Frame, J. 31. F., Pt., 15. 4th Sept. 19, Fracture and extensive com Sept. 22, Circular amputation, patella Stump sloughed ; typhoid fever. Virginia, age 33. ISC ). minution of right tibia 3 ins. 1864. retained, by Assistant Surg. Released June 28, 1865. below knee joint. O. M. ISurdctte, P. A. C. S. 5 Hun-ley. I.. M., Serg t, I, July 2, Shot fracture of both bones of July 5, Flap amputation, bj- Surg. F. Sept. 24th, entirely healed. Dis /1st JNew \ (irk, age 21. 1SU3. left leg in lower third. 1863. Prentice, 73d New" York. charged April 19, 1865. 6 Laasiter, V. M., Pt.. K, 32d May 20, Ciinoidul ball fracture of both June 5, Amputation through condyles, Post, ilap slough.: June 10, haem.; Texas, age 17. 1804. bones of right leg in middle 1804. removing patella; long ant. stump cicat d ; recovery. C. S. third. j short post, flaps. JUed.andSurg.Jour.,\o\.2, p.28. 406 INJURIES OF THE LOWER EXTREMITIES [CHAP. X. NO. NAME, MILITARY DESCKIi TlO.N, AND AGE. DATE OF IXJUUY. NATURE OF IXJUUY. DATE OF OPEBA- TIOX. OPERATION AND OPERATOR. RESULT AND REMARKS. 7 McCaigue, S. B., Corp l, H, May 12, Shell fracture of bones of left May 27, Amputation, bv Ass t Surg. A. Mustered out July 13,1865. He 183d Penn., age 21. 1864. leg: primary amputation up- 1864. Delaney, U. S. V. has caries of right tibia. Stump per third ; sloughing. tender. 8 McGee, J., Pt., E, 119th May a, Conoid, ball passed ben thpatel. June 2. Circular skin flaps, by Surg. E. Discharged September 9, 18G5. Pennsylvania, age 19. 18U4. rt knee, bones not much tract. , 180*1. Bentley, U. S. V. 9 Meikle, I)., Pt., B, llth Aug. 30, Shot wound of left knee joint. Sept. 28, Lateral flaps, by Surg. D. P. Oct. 4, hsem.: lig. of popliteal; 7th, Massachusetts, age 20. 1802. 1802. Smith, U. 8.V. haem.; lig. fern. Dis. Dec. 16, 62. 10 Nolan. P., Pt.. G, 13th Mass., Aug. 29, Musket ball fracture of right Sept. :!, Markoo s operation; patella re Patella raised 4 inches. Disch d age 21, 1862. tibia and fibula. 1862. tained : condylcs sawn off, by August 29, 1803. Surg. E. Donnelly, 2d Pa. It. 11 Palmer, E., Pt., 6th Maine Aug. 9, Shell fracture of right tarsus, Aug. 14, Anterior operation ; articular Discharged Oct. 23. 1862. Spec. Battery, age 19. 181.2. metatarsus, and tibia. 1802. surfaces of condyles sawn off, 53. BUINTON (,}.!!.), Am. Jour. leaving patella, by Surg. E. Med. Sci., 18G8, Vol. 55, p. 322. Bentley, U. S. V. 12 Pittman. W., Pt., G, 148th May 9, Shell, carrying away external May Id , 1 oste. muscular flap, by Surg. Disch d June 22, G5. 1870, stump Penn.. age 23. 1864. of inalleulns of right ankle. 1804. E. Bentley, U. S. V. sound. 13 Shambaugh, C., Corp l, B, Aug. 29, ; Musket ball fracture of both Sept. 4, Single upper flap, patella not Stump healed: patella movable llth Penn. Res., age 24. 1862. i bones of left leg in upper third. 1802. removed, bv Ass t Surg. 15. 4 ins. up the limb. Discharged Howard. U. S. A. May 22, 1863. 14 Sheppard, P., Pt.. C, 34th Mav 31, Shot fracture of right leg .. . . . | June 5, Circular amputation at knee Discharged April 2, 1803. Can New York, age 25. 1862. 1862. joint. not wear artificial limb. 15 Thomas, \V. 11.. Pt., A, 17th Aug. 29, Conoidal ball fracture of right | Sept. 1, Double flap 2^ ins. long, rem g Sutures gave way ; flaps gaped. Infantry, age 19. 18C2. tibia and iibula 3 ins. below | 18G2. patella and art. surfaces, by Disch d April 5, 1804. Stump joint. A. Surg. B. Howard, U. S. A. good, 1870. 16 Wright, O., Pt., B, 15-th Dec.ll/Musket ball wound of right Dec. 14, Flap amputation, by a Confed Discharged January 19, 1863. Penn. Res., age 20. 1802. leg, involving knee joint. i 1SG2. erate surgeon. 17 Aseltyne, M. B., Pt., F, 10th Nov. 27, Conoidal ball fracture of cunei- Dec. 14, Circular amp., leaving patella, Died Dec. 27, 18G3; pyaemia. Vermont, age 24. 18G3. form bones left foot : inflam- 18G3. by Surg. E. Bentley, U. S. V. Autopsy. Spec. 1989. ination of foot and leg. 18 Bailey, W. H.. Pt., A, 2d June 9, Shot fracture of right le" r JunelS, Amputation at the knee joint. Sloughing ; hiemorrhage, 20 oz. New York Cav., age 23. 1863. 18G3. Died June 29, 1803. 19 Blancbeau, P., Pt.f I, 28th June 4, Fracture of exter. condyle and June 8, Skin flap, 1 inch of condyle, in June 12th, gang.; 14th, liaem. Massachusetts, age 22. 1864. slight fract. of inter, condyle 18G4. cluding fract. portion, rem d, Died June 16th, 04; gangrene of right femur. by A.Surg.S.B.Wurd.U.S.V. and haemorrhage. Spec. 2656. 20 Britton, M., Corp l. F, 7th Ucc. 13, ! Musket ball fracture of cuboid Dec. 2G, Circular, by Surg. E. Bentley, Jan. 7, 03, hsem.: lig. fern.; gang. Penn. lies., age 21. 1862. and astragalus of right foot. 1802. U. S. V. Died Jan. 12, 1803. Spec. 4541. 21 Carroll, F., Pt., K, 45th June 3, Shot injury of right fibula ; June 18, Ant. -post, flap, rem g patella, by Hsem. from ant. tibial art. Died Pennsylvania, age 23. 1804. primary excision. 18G4. Surg. R. B. Bontecou, U. S.V. June 22, 1804 : exhaustion. 22 Danzenbaker, L. 11., Pt., D, June 2, Grapeshot struck inner condyle June 7, Circular amp., skin flaps, by Died June 12, 1804 ; gangrene. 10th New Jersev, age 21. 1864. of femur; joint opened. " 18G4. Surg. E. Bentley, U. S. V. 23 Eno, C., Pt., B, 91st Ohio, July 20, Musket ball" fract. right tibia; ! July 31, Antero-posterior flap, by Surg. Diarrhoea. Died August 9, 1864. age 23. 1864. leg swollen and ecchymosed. 1804. J. B. Lewis, U. S. V. 24 Farley, A.. Pt., I. 83d New May 9, Shot fraot. inter, malleolus of r t May 15, Circular bv skin flaps, by Surg. Died June 1, 04 : pyaemia. Spec. York, age 51. 1804. ankle j t : tissues oadeinatous, 1 b04. E. Bentley, U. S. V. 2655. pus extend, nearly to knee j t. 25 Fuller, C. E., Pt., D, 36th June 3, Conoidal ball t rnot. ofos-caleis? June 9. Skin flap, i inch of condyle Gangrene. Died June 13, 1864; Wisconsin, age 25. 1864. left foot and leg in very bad 18G4. removed, by Ass t Surg. S. pyasmia. Spec. 2600. (Ampu condition. B. Ward. U. S. V. tation was a last resort.) 26 Glazier, J. M., Pt., H, 55th May 31, Wounds through both ankles ; June 4, Antero-post. flap tt left knee Died June 10, 1862; pyaemia. New York, age 27. 1862. comminution left ; fract. right; 1802. joint, bv Surg. R. 13. Bontecou, swollen and sloughing. r. s.v. 27 Headley, S. G., Pt., F, 12th May 10, Conoidal ball commin. fract. of Mav 18, Flap amputation, by A. A. Tendency to slough. Died May New jersey, age 34. 1864. up. third of right lib. and fib.; ; 1804. Surg. W. II. Ensign. 30, 1864. j t swollen and erysipelatous. 28 Ilennessij, D., Pt., I, 8th May 5, Shot frac!. up. third left tibia; May 17, Amputation at knee joint, by Died August 27. ] 802. Spec. 929. Alabama. 1862. knee joint opened by fissures. 1802. A. Surg. J.S. Billings, U.S.A. 29 Hicks, W., Serg t, B, 14th July 1, Left tibia seriously injured and July 25. Long ant. flap, leaving patella Slough. Died Aug. 10, 63 ; oxli. Tennessee, age 28. 1803. partly fractured: sloughing : 1863. and condyles. by A. A. Surg. Spec. 2051. BUINTOX (J. 11.), hoem. from post, tibial artery. J. A. Draper. Am. Jour. Mcd. Sci., 1868, Vol. 55, p. 324. 30 Hoscid, A., Pt., I, 4th Mary May 7, Conoidal ball fract. of malleo- May 15, Ant. post. flap, retaining pa Slough. Died May 28. 04 ; gang.; land, age 27. 1804. lus and astragalus; left foot 18 64. tella and condyles, by Ass t absorption. Am.Jour.Me.d.Sci., and ankle much swollen. Surg. H. Allen, U. S. A. 1805, XLIX. p. 33. 31 Jewell, W., Pt., D, 59th May 10, Conoidal ball fracture of meta- May 22, Long post, flap, by Surg. C. B. Mav 24th, delirium. Died May Georgia. 1804. tarsal bones. 1864. Gibson, C. S. A. 29, 1804. 32 Lepper, A. A., Corp l, L, 8th May 20, Comminuted fract. up. third of June 13, Rectangular flaps; circ. sect. Slough.: gang.; colliquativcdiar. Iowa Cavalry, age 27. 1804. left tibia by con. ball; foot 1864. muscles: condyles sawn off, Died June 10, 1804; pyaemia. swollen and cedematous. by Surg. H. It. Taylor, U.S.V. Spec. 3758. 33 McConnell, D. W.. Pt., H, April 6, Shot fracture of the leg April 10. Amputation, by Ass t Surg. W. Slough.: iiitermed. amp. thigh. 4Gth Ohio. 1862. 1802. I). Turner, 1st Illinois Light Died April 25. 1802. (TAHLK Artillery. XXXVI, No. 481, p. 300.) 34 McFarlaml, A., Pt., I, 150th Mav 10, Ball lodging in articulation be- May 27, Anteriorcival skin flap, by Surg. May 29th. gamy., which caused Penn., age 23. 1864. side right external malleolus ; 1804. E. Bentley, U. S. V. death Juno 7,1804. tissues cedi matous. 35 McKenna, J., Pt., D, 39th April 2, Conoidal ball wound of left April 24, Circular amputation at knee Died May 2, 1805; exhaustion. New Jersey, age 2!. 1865. ankle ; infiltration of pus in 1865. joint, by Surg. E. Bentley, tissues of leg. U. S. V." 36 Mansfield, M., Corp l, F, 2d Mav 31, Shot fracture of right tibia, ex June 4, Post, flap ; ant. incision from Died June 16, 1864 ; pyaemia. Connecticut H vy Artillery, 1864. tending into knee joint. 1804. condyle over mid. of patella, age 21. and condyles sawn off, by A. A. Surg. J. F. Thompson. 37 Marys, D., Pt., C,90th Penn Mav 5, Shot wound of right leg ; parts May 10, Amputation at knee joint, by Popliteal sloughed : luem., 50 oz. sylvania. 1864. gangrenous. 1804. Surg. J. Ebersole, 19th Ind. May 20th, amp. thigh. Died Mav20, G4. Spec. 2340. (TABLE XXXVI. No. 475, p. ."00.) 38 Mearns, J., Pt., D, 154th N. May 4, Shot wound of leg May 14, Amputation at the knee joint. Died June 7, 1803; haemorrhage York, age 22. 18G3. 18G3. and anasmia. 39 Murray, J., Pt., B, 51st N. May 6, Shot wound of right ankle. . . . Mav 18, Amputation at the knee joint. Died May 20, 1864. York. 1804. 1864. 40 Ostre, P., Pt., H, 72d New Mav 10, Conoidal ball fracture of tibia. May 21, Long anterior, short post, flap, Died June 1, (54 ; pyaemia. U. S. York, age 21. 18"G4. ankle joint opened; leg swol 1864. leaving patella. byAss t Surg. .Van, Com. Mans., Surg. Vol. 1, len to knee. ( ,. A. Mtirsick, U. S. V. p. 522. 41 Parks, L. C., Pt., E, llth June 1, Ball lodged in condyle of left June 7, Ant. skin and post. muse, flaps : ,Iune 10th. gangrene. Died June Vermont, age 28. 1864. femur, splitting it into knee 1864. J inch of condyles of femur 17, 1864 ; prostration. joint. removed, by Surg. E. Bent- ley, U. S. V. SECT. IV.] SECONDARY AMPUTATIONS AT THE KNEE JOINT. 407 NO. NAME, MILITARY DESCRIPTION, A.ND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 42 Rhinehart, C., Pt,, K, 74th Aug. 27, Shot wound of leg; primary Sept. 21, Circular amputation at knee Died September 23, 1862; gan Pennsylvania, age 21. 1862. amputation up. third ; slough 1862. joint, by Surg. E. Bent ley, grene. ing. U. S. V. 43 Sandford, W. W., Pt., F, Dec. 18, Ball passed between bones of Jan. 10, Antero-posterior flaps; condyles Jan. llth, chill and dyspnrea. 103d Pennsylvania, age 21. 18G2. right leg 3 ins. below knee 1863. were sawn off and patella re Died Jan. 12, 1863; pyaemia. joint ; tibia indented ; pus in moved, by Surg. E. P. Mo- synovial cavity. rony 2d Maryland. 44 Schreiber, A., Pt., A, 50th May 10, Wound of both legs ; fracture May 19, Antero-posterior flap, remov g June 1st, pysemic symp. Died Pennsylvania, age 17. 1864. of right tibia: round ball; 1864. patella, by Surg. 11. B. Bonte- June 9, 1864; pyaemia. 19tb. haetn.; lig. post. tib. art. cou, U. S. V. 45 Sheldon. C. S., Serg t, G, June 3, Grapeshot fract. left ext. inalle- June 22, Anterior post, flap, bv Surg. K. Progress unfavorable. Died June 12th New Hampshire, age 1864. olus. communicating with an 1864. B. Bontecou, U. S. V. 27, 1864; exhaustion. 81. kle joint; gangrenous. 46 Sweeney, J., Pt., H, 9th July 18, Right leg shattered by a grape- July 27, Posterior flap amputation at t he Died July 28, 1863. Maine. 1863. shot. 1863. knee joint. 47 extending into knee joint. days af leaving patella; sawing oil ti] is ation ; exhaus.: pyaemic symp. ter inju of condyles, by Ass t Surg. BRINTON (J. ll.).Am.Jr>ur.Med. ry. C. C. Lee. U. S. A. Sci., 1868, Vol. 5.3, p. 324. 48 Veazie, C. IT., Pt., C, 1st Nov. 27, Fract. and extensive comminu Dec. 6, Antero-posterior flap through Dec. 10th, gangrene. Died Dec. Mass. Cavalry, age 21. 1863. tion of r t tibia and fibula near 1863. knee joint, by Surg. E. Bent- 21, 1863; pyj-emia; autopsy. ankle j t; much ecchymosed. ley, U. S. V. 49 Velsor, A., Pt., D, 127th N. Nov. 30, Ball thro, head of tibia, fract. Dec. 9, Antero-posterior skin flaps, by Died Dec. 22, 1864 ; pytemia. York, age 36. 1864. tibia and fibula; knee joint 1864. Ass t Surgeon C. F. Reber, involved. U. S. V. 50 Wilhelm, J., Pt., A, 37th May 17, Musket ball fracturing both May 31, Amputation at the knee joint, Diffused abscess extending to hip. Ohio, 1862. bones of left leg in middle ; 1864. by Surg. J. F. Gabriel, llth Died June 14, 1862. sloughing. Ohio. 51 Chandler, A. J., Lieut., G, May 26, Fracture of right tibia, middle June 21, Amputation at knee joint thro June 30, 64, sloughing of stump. 40tb Georgia, age 25. 1864. third ; conoidal ball ; large 1864. condyles, leaving patella. C. S. Med. and Surg. Jour., Vol. ulcer in leg. 2, p. 33. Secondary Amputations at the Knee Joint. The secondary exarticulations at the knee joint numbered twenty-six; twelve were successful and fourteen were fatal, a mortal ity of 53.8 per cent. In four cases excision in bones of the leg, in four amputation of the leg, and in one amputation of a toe, had preceded the amputation at the knee. Successful Cases of Secondary Amputation at the Knee Joint. The patients were ten Union and two Confederate soldiers. Two of the ten Union soldiers have since died; the remaining eight were pensioners in 1880. In the following instance primary amputation in the middle third of the leg had been performed for shot fracture of the ankle joint. Sloughing and ulceratiori followed, and the limb was exarticulated at the knee fourteen months after the ablation of the leg: CASE 651. Private W. Neveling, Co. N, 71st Pennsylvania, aged 26 years, was wounded at White Oak Swamp, June 30, 1682, and was admitted to Broad and Cherry Streets Hospital, Philadelphia, one month afterwards. Surgeon J. Neill, U. S. V., reported : "The injury was produced by a mini ball, which entered the outer side of the right ankle joint and passed directly through, severely comminuting the bones. Amputation of the leg at the middle third was performed the same day on the field, the operation being performed by the double flap method. The wounded man was taken prisoner and remained on the field for ten days, when he was sent to Rich mond. After being paroled he was brought to this hospital, entering on July 30th, at which time the flaps had sloughed and both bones were protruding from the stump. There was also profuse discharge of unhealthy pus, and the patient s health was very much broken down. Stimulating poultices were applied, and the patient was ordered extra diet, with tonics, milk punch, and beef tea. Under the treat ment adopted new tissue developed in the stump arid the patient improved; but his recovery was neces- saiily slow. On November 13th, a piece of necrosed bone, four inches in length, was removed from the fibula, and three days later a large piece was removed from the tibia. After this the stump improved rapidly and the patient s general condition continued very good until March 15, 1833, when he injured the ^tump by a fall. Immediately after, sloughing recommenced, which was not checked until a month had elapsed and produced a condition of the parts from which recovery was slow. Under the application of fermenting poultices, with solution of chloride of zinc and sulphate of copper used alternately, the nicer slowly diminished. On June 22d, when the patient was transferred to Satterlee Hospital, the lower end of the stump appeared to be made up of a carneo-osseous matter, on the extremity of which there remained an nicer about two inches in diameter." Acting Assistant Surgeon T. G. Morton reported the subsequent progress of the case at Satterlee Hospital as follows: "At the time of admission the stump was still unhealed, and from the end of the bone a bulky exostosis sprang out as large as an orange. The tissue over this growth was constantly ulcerating and painful, and the disease continued to involve the tibia further up, reaching as high as the liga- mentous patella. On August 2?th, I proposed amputation at the knee joint for the reason that less shock follows that operation and a better stump is obtained, with more power, from non-division of the muscles of the thigh and non-interference with the medullary canal, lessening the danger of pyaemia. I made a long anterior and short posterior flap, leaving the patella in. FIG. 251 . Ilypcrostosis of bones of risrht leer, after amputation. Spec. xi778. 408 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No necrosis followed the operation, and the patient recovered with a most useful and firm stump." The patient was discharged from service March 3, 1864, and pensioned. He was paid December 4, 1879. The specimen, numbered 2778 of the Surgical Section, is represented in the annexed cut (FlG. 251), and forwarded to the Museum by the operator, shows an extraordinary osseous formation at the divided extremities of the tibia and fibula, due to an exaggeration of the natural process by which the extremities of the bones are rounded off, and presents the histological characters of ordinary callus. The sequestrum, removed from the fibula prior to the second amputation, was also. contributed by Surgeon Neill, and a cast of the stump of the disartic ulated knee was furnished by Surgeon I. I. Hayes, U. S. V. The former is numbered specimen 668, and the latter 2458 of the Surgical Section. 1 CASE 652. Corporal E. C. Wright, Co. H, 21st New Jersey, aged 19 years, was wounded at Frederick sburg, May 3, 1863, by a solid ghot, which carried off his right foot. Amputation of the leg by posterior flap, at the junction of the middle and lower third, was performed on the field by Surgeon D. McNeill, 21st New Jersey, and several days afterwards the patient was sent to Washington, where he entered Judiciary Square Hospital. He was discharged from service June 13, 1863, and pen sioned. Subsequently the stump became diseased, inducing the pensioner, in January following, to seek relief by treatment at St. Luke s Hospital, New York City. The tibia became necrosed and cloaca formed, leading to sinuses in the substance of the bone, so that an injection would find its way through the canals. On June 23, 1864, amputation through the knee joint by antero-posterior flaps was performed by Dr. Gurdon Buck, the cartilages and patella being allowed to remain. Sulphuric ether was used as the anaesthetic. At the time of the operation the patient was in feeble condition, owing not only to the amount of pus discharged from the stump, but also to the presence of an abscess in the region of the liver, which had formed some months after the first amputation. This abscess discharged itself by a track passing between the ribs over the right lobe of the liver. There had been no admixture of bile, however, in the discharge, nor did jaundice exist at any time. A succession of abscesses formed during the healing of the stump. The first appeared at the upper boundary of the synovial sac and was freely laid open by Dr. Buck. Six days after the operation a tendency to slough appeared, and permanganate of potash was applied to the affected parts. Dr. Buck s method of extension by weight and pulley, with bands of adhesive plaster, was also used to prevent the retraction of the edges of the flaps and maintain them in apposition. This afforded great relief to the patient, steadying the limb and taking all the strain off the flaps. On September 1, 1864,. the patient was discharged from hospital, the stump being solid and well rounded. The abscess in the side had ceased to discharge. In the following month the pensioner was fitted with an artificial leg by Dr. E. D. Hudson, of New York City. Pension Examining Surgeons who have inspected the stump have described it as a "very good" one, and the pensioner has reported its condition as "sound and healthy." He was paid March 4, 1880. CASE 6"3. Private H. A. Steward, Co. B, 8th Pennsylvania Reserves, aged 23 years, received a fracture of the right leg by a fragment of a shell, at Gaines s Mill, June 27, 1862. He was conveyed to Washington, where he remained under treatment at the Cliff burn Hospital until November 20, 1862, when he was discharged and pensioned, Surgeon H. Bryant, U. S. V., certifying to "exsection of a large portion of the tibia in consequence of the wound." Examiner George McCook, of Pittsburg, December 17, 1863, testified to the injury, and that "exfoliation is going on in a slight degree. He can walk inconveniently," etc. The pensioner subsequently entered the Good Samaritan Hospital, Cincinnati, where the injui ed limb was amputated on April 1, 1867, by Dr. Thomas H. Kearney, who certified as follows: "I amputated the log through the knee joint, the section of the bone being performed through the condyles of the femur. The amputation was rendered necessary in consequence of inflam mation of the tibia, leading to abscesses and general infiltration of the tissues. Removal of the condyles was necessitated in consequence of the want of sufficient healthy integument to cover them. The wound he had received involving the tibia, doubt less left it impaired in vitality and prone to attacks of inflammation, such as rendered its removal ultimately necessary." The Quincy Examining Board, in 1872, reported that "the flaps have sloughed from gangrene, leaving the bone only covered with tender cicatricial tissue, which often gives away and becomes an open ulcer," etc. The pensioner was paid March 4, 1880. Fatal Cases of Secondary Amputation at the Knee Joint Fourteen operations were performed, three on Confederate and eleven on Union soldiers. The fatal results were attributed to pyaemia in three, to erysipelas in one, to exhaustion in eight instances: CASE 654. Private P. Fallon, Co. D, llth Infantry, aged 20 years, was wounded in the left leg, at Gaines s Mill. June 27, 1862. He was captured by the enemy and remained a prisoner for one month, when he was exchanged and conveyed by the Hospital Steamer Daniel Webster to Philadelphia. Acting Assistant Surgeon R. R. Thomas recorded the following description of the case: "The patient entered the Episcopal Church Hospital July 30th, there being an irregular cavity in the front of his injured leg, running into the tibia but not reaching the fibula. He had been wounded by a bullet, which entered about nine inches above the inter-malleolar space, and was extracted, in part, two days after his admission. The opening in the leg was about one and a half inches square and about one inch deep, its sides being formed by necrosed bone and injured flesh. Pieces of bone had been taken out on previous days, and the patient was doing well. On August 6th, Acting Assistant Surgeon R. S. Kenderdine amputated the leg at the knee joint. On August 22d, secondary haemorrhage occurred from ulceration and resulted in considerable loss of blood, the patient being found quite blanched. A tourniquet was then applied and the instruments were gotten ready to tie the bleeding vessel ; on loosening the tourniquet, however, the bleeding was found to be arrested and no liga- tion necessary. The patient died October 6, 1862, worn out by puriform discharges and of pyaemia. The end of the stump was in pretty good condition, but large abscesses had formed in the thigh, and his back was covered with bed sores." The upper half of the amputated tibia, with the integument over the wound of entrance, enlarged by sloughing, attached, was contributed to the Museum by the operator (Cat. Sunj. Sect., 1866, p. 396, Spec. 500). The specimen shows an oblique fracture of the bone, with comminution, and a portion of the bullet remaining in the medullary canal. The cavity in the shaft is also exhibited, and the posterior surface of the shaft is covered with a moderate layer of new osseous tissue. 1 A brief abstract of this case was published by Dr. JOHN H. BRINTOX, On Amputation at the Knee. Joint and at the Knee, in Am. Jour. Mf.d. Sci., 1868, Vol. LV, p. 3i9. SECT. IV.J SECONDARY AMPUTATIONS AT THE KNEE JOINT. 409 TABLE LVII. Summary of Twenty-six Cases of Secondary Amputation at the Knee Joint for Shot fracture. [Recoveries, 1 12; Deaths, 1326.1 NO. NAME, MILITAUY DESCRIPTION, AND AGE. DATE OF INJURY. NATUKK OF INJURY. DA-IK OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Brady. J. W., Pt., E, Gth Aug. 29, Shot wound of the leg Nov. 20 Amp. at left knee j t, by Surg. Recovery. Louisiana. 186V. 1863. J. C. Nott, C. S. A. 2 Bronchard, A., Pt., A, 5th April 7, Fract. meta. bones of left foot ; Feb. 18, Amputation at knee joint, in Amputation of thigh nearmiddle; New Hampshire, age 31. 1865. oonoidal ball; April 17, exc. 1866. New York City Hospital. recovery ; 1870, stump healthy. ineta s ; May 15, amp. leg. (TABLK XXXIX, No. 11, p.313.) Disoh d Aug. 12. 1865. 3 Frost, N. G., Pt., G, 32d July 30. Shot fi-act. left leg : prim. amp. Mav 29, Amp. knee joint, patella re April, 1866, leg in bad condition ; Maine, age 34. 1864. at mid. third. Disch d Feb. 1865. tained, by Dr. J. Lord, Nor 1870, stump tender and irreg 8, 1865. way, Maine. ular. 4 Marseiu, J., Pt., A, 115th Feb. 20, Musk t ball lodged in r t patella; Mav 28, Antero-posterior flap ; 1 inch Haemorrhage : ice ; flap healed al New York, age 28. 1864. remo d on 21st. Disch d May 1866. of extremity of oondyles of most by first intention ; left hos 2:!, 65 ; anchy. knee j nt. May, femur sawn off; patella re pital cured, July 28/66. BlUX- 186(i, leg atrophied ; condy. of tained, by Dr. E. Mason, New TOX (J.H.)..-lm. Jour. Med.Sci., femur eroded. York City. 1868, Vol. 55, p. 321. 5 Neveling, W., Pt., N, 71st June 30, Con. ball shattering bones of Aug 27, Long ant, and short post, flap, Disch d March 3, 64. Specs. 668, Pennsylvania, age 26. 1862. right ankle. Prim. amp. mid. 1863. retaining patella and condy les 2458, 2778. BRINTON (J. H.), third; sloughing. Nov. 13, of femur, by A. A. Surg. T. loc. cit., p. 319. sequestra removed. ; G. Morton. 6 Pattee, J. H., Pt., D, 26th Sept. 19, Shotfract. mid. third of left. tib. Jan. 24, Circular amputation, by Surg. Disch d July 14, 1864; stump Ohio, age 23. 1863. Sept. 21, exo. 2 ins.; boneexf.; 1864. J. Y. Finley, 2d Kentucky sound, 1870. separation of bone 2 ins. Cavalry. 7 Perigo, H. C., Pt., B. 12th June 27, Hound ball fract. of mid. third Mar. 14, Long anterior flap, leavingcon- Recovery rapid ; discharged Nov. New York, age 30. 1862. right tibia; nee.; large seq. 1863. dyles and patella, by A. A. 14. 186:i. Spec. 2065. BKIXTOX firmly set. Surg. J. A. Draper. (J. II.), loc. cit., p. 323. 8 Reeder. J. H., Pt., E, 1st Aug. 12, Fract. upper third of left tibia; Mar. 19, Double flap, by A. A. Surg. O. Discharged Nov. 8, 1865. Died Colored Troops, age 22. 1864. conoidal ball ; necrosis. 1865. ! Shiftier. August 5, 1870. 9 Steward, 11. A., Pt., B. 8th June 27, Fraet. right tibia ; shell ; excis. April 1, Amputation ; removal of con- Gangrene; sloughing of flaps; Pennsylvania, age 23. 1862. tibia. Discharged Nov. 20, 1867. dyles necessitated by want of 1872, tender covering of stump 1862 ; exfoliation ; general in healthy integument, by Dr. often gives way and becomes filtration of tissues. T. II. Kearney. Cincinnati. an open ulcer. 10 Wall. \V., Pt., D, 52d North July 3. Con. ball fract. left tib. and met- Aug. 4, Flap amputation, leaving pa Exchanged March 17, 64. Spec. Carolina, age 22. 1863. atarsal ; tissues slough, nearly 1863. tella and condyles, by A. A. 2061. BRLNTON ( J. H.), loc. cit.. two-thirds circumference of Surg. J. A. Draper. p. 324. leg- 11 Walter, G., Pt., H, 98th July 2, Shell fract. of mid. third of left Nov. 8, Ant. post, flap, retaining patel Disch d Aug. 2, 1865. Spec. 2791. Pennsylvania, age 37. 1863. leg; gangrene; tibia much 1863. la and condyles of femur, by Died Dec. 5, 1873. BuiNTON diseased. A. A. Surg. M. S. Perry. (J. 11.), loc. cit., p. 319. 12 Wright, E. C., Corp l, H, 21st May 3, Solid shot taking off right foot ; Juno 23, A nt. post, flap, cartilages and Succession of abscesses. Buck s New Jersey, age 19. 1863. amp. juncture of low. thirds; 1864. patella allowed to remain, by method of extension to prevent necrosis of tibia. Discharged Dr. Gurdon Buck, New York retraction of flaps. Recovered June 13, 1863. City. Sept. 1, 1864. 13 Adams, D. F.. Pt., A, 55tb July l, Shot fract. June. low. thirds left Aug. 29, Flap amputation left knee joint, Ascites; general anasarca. Died North Carolina. 1863. tibia (also fract. or oital arch 1863. leaving patella, by A. A. Sept. 20, 1863. Spec. 2049. and flesh wounds right leg): Surg. C. G. M. Griffith. necrosed tibia. 14 Billington. H., Pt., I, 110th Aug. in, Conoidal ball inj y of left tibia; Sept. 26, Antero-posterior flap, bv Ass t Died September 28, 1864; ex New York, age 45. 1864. gangrene ; tibia necrosed. 1864. Surg. C. Wagner, LI. S. A. haustion. 15 Fallon. P., Pt., D, llth In June 27, Shot lodged in left leg. Aug. I, Aug. 6, Amputation at the knee joint, Aug. 22d, haem. from ulcer.ition ; fantry, age 20. 1862. ball cxt.; cavity in front of leg 1862. by A. A. Surg. R. S. Ken- large abscess in thigh ; bed sores. excavated into tibia 1 inch derdine. Died Oct. 6, 1862; exhaus. and square and deep. pyiemia. Spec. 500. 16 Forbes, W. A., Pt,, A. 55th July 1, Con. ball fract. lower third left Aug. 6, Flap amputation, leaving pa Died August 11, 1863; exhaus North Carolina, age 24. 1863. tibia; caries and nee.: slough.; 1863. tella, by Ass t Surg. B. Stone, tion. Spec. 2058. bone exposed one fourth its U. S. V. length. 17 Foster, W., Pt., A, 22d Ind., Aug. 7, Shot fract.. fourth toe, left foot ; Nov. 24, Circular amputation, by Ass t Died November 27, 1864. age 22. 1864. con. ball; amp. toe; gang.; 1864. Surg. 11. McGowan, U. S. V. dis. of tibia : caries. 18 Garrity, M., Pt., I, 9th Mass., May 5, Right tibia extensively commi June 10, Ant. skin and post, muscular Never rallied thoroughly; wound age 25. 1864. nuted near crest ; con. ball 1864. flaps; condyles of femur re did well, nearly uniting. Died lodged ; suppurat n from knee moved, bv Ass t Surg. S. B. June 17, 64 ; prostration. Spec. to ankle. Ward, U. S. V. 2551. 19 Grainger, S. M., Pt., A, 38th Dec. 30, Shot fracture of left tibia and Mar. 15, Malgaigne s oval flap amputa April 1, 1863, haetn. from branch Indiana, age 23. 1862. fibula. Jan. 14, 1863, excision 1863. tion at the knee joint. of popliteal : sloughing. Died fractured portions. Feb. 20, April 23, 1863 ; pyaemia. gangrene. 20 Kane, W. H., Serg t, 1, 115th Aug. 16, Con. ball injury of left tibia; Sept, 17, Antero-posterior flap, by Ass t Sept. 25th, haem.. 15 oz.; lig. fern. New York, age 23. 1664. gangrene ; tibia exposed five 1864. Surg. C. Wagner, U. S. A. Died Sept. 26, 1864 ; exhaustion inches. and haemorrhage. 21 Peddie, J., Pt., B, 139th N. June 3. Shell fracture lower third left Aug. 1, Antero-posterior flap, by Surg. Died August 18, 1864; exhaus York, age 24. 1864. tibia ; gangrenous. 1864. R. B. Bontecou, U. 8. V. tion. Spec. 3065. 22 Sager. S., Pt.. K, 5th Ver June 29. Fracture middle third of left Oct. 6, Antero-posterior integument ry Died Oct. 9, 1862; pyaemia. Spec. mont, age 18. 1862. tibia and fibula by a round 1862. flap; patella and condyles 270. BUIXTOX (J. H.), loc. cit., ball. were left. p. 323. 23 Sharp, T., Corp l, I, 38th Feb. 6, Conoid, ball fract. of right tibia; April 5, Circular amp. at knee joint, bv Gangrene. Died June 23, 1864 ; Illinois, age 30. 1864. injury of artery. Feb. 7, exc. 1864. Surg. I. Moses, U. S. V. erysipelas. tibia; slough.; bones carious; . tibia separated 3 inches. 24 Skilton, G. T., Pt., I, 36th June 3, Conoidal ball fract. of low. third Aug. 8, Antero-posterior flap, bv Surg. [ Aug. 10th, gangrene : condyles of Wisconsin, age 31. 1864. right tibia and fibula ; gang.; 1864. R. B. Bontecou, U. S. V. femur protr.: haem. Aug. 30th, sloughinjr of post, tibial art.; amp of thigh. Died Sept. 19, August 4, haemorrhage. 1864. (TABLE XXXIX, No. 156, p. 316.) 25 Toppings, E.,Corp l, D,147th June 18, Conoidal ball fract. of mid. third Oct. 10, Posterior flap, removing patel October 20th.partial union. Died New York, age 29. 1864. of right tibia ; necrosis. 1864. la, by A. A. Surg. H. Board- May 1 1, 1865 ; variola. man. 26 Waddell, W. E., Pt., H, 1st Julv 3 Conoidal ball fracture of exter Aug. 8, Flap, leaving patella, by A. A. Died August 12, 1863; exhaus Virginia, age 33. 1863. nal malleolus of right tibia, 1863. Surg. C. G. M. Griffith. tion. Spec. 2064. opening ankle joint jslough g. SURG. Ill S2 410 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Amputations at the Knee Joint of Uncertain Date. The date of the exarticulation at the knee was not reported in four cases. Two of the patients were Confederate and two Union soldiers. Of the latter one died, the other is a pensioner. The meagre details are recorded in the following summary : TABLE LVIII. Summary of Four Cases of Amputation at the Knee Joint of Uncertain Date. [Recoveries, 13; Death, 4.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 2 3 Faubion, H., Pt., K, 9th Texas. Keefe, P., Seaman, U. S. Brig Perry, age 24. Moore. J. R., Lieut., K, 33d Before June H), 1863. April 28, 18(33. Before Gunshot wound; fract. of knee joint. Shot wound of left ankle Shot fracture of left leo- Amputation at the left knee joint. Amputation at the knee joint. . Transferred August 19, 18fi3. Discharged November 12, 1864 ; pensioned. Transferred September 30 1864 4 North Carolina. Call, G., Pt., H, 18th Ohio. Aug. 2C, 1864. Dec. 31, Died January 1C 1863 1862. Adding to the one hundred and eighty-nine cases of amputations at the knee joint performed for shot fracture during the American civil war, six cases of exarticulation for shot flesh wounds, cited in TABLE VII, on p. 56, one hundred and twenty-eight cases col lected in Note 1, on p. 397, and four operations performed by medical officers of the United States Arrny 1 since 1871 , not heretofore published, we have in the annals of surgery a total 1 The exarticulations at the knee joint performed in the United States Army since the date of the publication of Circular 3, A Report, of Surgical Cases Treated in the Army of the United States from 1865 to 1871, Washington, War Department. S. G. O., 1871, are: 1. Private G. Grove, Co. F, 2d Infantry, aged 34 years, while firing a small swivel gun near Mount Vernon Barracks, Alabama, July 5, 1875, was wounded by the bursting of tho piece, a fragment of which, weighing six and a half pounds, passed through his left leg, earning away a portion of both bones to within a short distance of the knee joint, destroying the main arteries and lacerating the soft parts. The fracture extended into the articulation. The man had been drinking excessively, and the injury occurring some distance from the post, considerable haemorrhage took place before assistance could be procured and a tourniquet applied. While bein .j conveyed to hospital he fainted several times and had involuntary evacuations of faces and urine. No reaction taking place and the venous haemorrhage being uncontrollable, the patient was with difficulty etherized, and disarticulation was rapidly performed by Assistant Surgeon J. 1C. Corson, U. S. A. The operation was performed without removing the patella, the condyles of the femur being sawn through, and a long anterior and short posterior flap being made. There was scarcely any arterial haemorrhage, and only two vessels besides the popliteal were ligated. Reaction was slow, and irritability of the stomach great on account of the large amount of liquor imbibed. The wound was closed with silk sutures; adhesive strips and water dressings and carbolic acid solution were applied. The case progressed favorably and the stump had almost closed, the man being able to sit up, when, on July 27th, erysipelas ensued with symptoms of an alarming nature. Sloughing of the flaps followed, and an abscess formed on the outer side of the thigh. Under the local application of hot fomentations and the internal administration of tincture of chloride of iron the inflammation subsided. About one month afterwards the stump had almost entirely healed, having the appearance of being a good one as regards bearing pressure. On December (i, 1875, the patient being entirely cured, he was discharged from service and sent to the Soldiers Home. The bones of the amputated log and the removed ends of the condyles of the femur, together with the fragment of the gun which inflicted the injury, were contributed to the Museum by the operator, and constitute specimen 6581 of the Surgical Section. 2. Sergeant H. F. Gude, Co. G, 12th Infantry, was wounded in the battle at the Modoc Caves, Lava Beds, California, April 15, 1873. by a conical bullet, which caused a compound comminuted fracture of the right tibia at tho upper third and wounded the posterior tibial artery. Both ends of the vessel were ligated and temporary splints were applied on the field. The wounded man was conveyed to hospital at Peninsula Tula Lake, California, where Smith s anterior splints were employed. The leg was swollen, and mortification had appeared about the wound on April 19th, when amputation at the knee joint was performed by Assistant Surgeon H. McElderry, U. S. A., the patella being dissected out and the articulating surface of the femur removed. The patient suffered high surgical fever and constitutional excitement. During the period of suppuration the flaps retracted and the suture was torn out. The treatment consisted of antiseptic applications, tonics, and stimulants. In October following the stump had healed, and on Jan uary 7, 1874, the patient was transferred to his command. 3. Private F. Ileber, Co. M, 1st Cavalry, aged 32 years, was wounded in the right arm and right leg during the fight at Clearwater River, I. T., July 11, 1877. He arrived at the field hospital at Grangevillc three days alter tho injury, and six days later he reached the post hospital at Fort Lapwai. During the night previous to his arrival at the latter place a profuse haemorrhage, probably from the anterior tibial artery, occurred, which was quickly arrested by compression of the femoral artery by Surgeon G. M. Sternberg. U. S. A., who, as soon as candle lights could be procured and a tourniquet applied, placed the man under the influence of ether and enlarged the wound in the upper part of the calf of the leg for the purpose of securing the bleeding vessel. It was then discovered that the head of the tibia was badly shattered by the ball, which entered two inches below the knee joint, perforating the bone and comminuting it to a considerable extent posteriorly ; and amputation through the knee joint was at once decided upon as preferable to ligation of the femoral with a certainty almost that amputation would have to be performed subsequently. The operation was performed by Surgeon Sternberg, with the assistance of the Hospital Steward only, the patient being feverish from his wound, which had been painful, and fatigued from his transportation in a farm wagon. The stump was dressed with carbolic acid mixture. A largo portion of the wound healed promptly, but some sloughing occurred near the centre of the extremity of the stump. On August 7th. when the patient was transferred to Fort Vancouver, only a space the size of a half-dollar piece remained to be filled by granulations. On March 115, 1878, the patient was discharged from sen-ice entirely cured 4. Beatrice Hanciva, a woman twenty-two years of age and in the third month of pregnancy, was accidentally shot, at or near Fort Clark, Texas, November 28, 1871. A full charge of buckshot, discharged at a distance of a few feet, passed through her right leg at the junc tion of the middle and upper third, shattering the bones and extensively destroying (he soft parts. Acting Assistant Surgeon A. L. Buflington failed to obtain the consent of the patient and her relatives to an amputation until December 2d, when, in consultation with Assistant Surgeon J. II. Patzki, U. S. A., amputation through the knee joint was decided upon. The amputation was performed with long anterior and short posterior flaps, retaining the patella SECT, iv.) SHOT INJURIES OF THE KNEE JOINT. 41 1 of three hundred and twenty-seven amputations at the knee joint for shot injury, with one hundred recoveries, two hundred and twenty-four deaths, and three undetermined results, giving a mortality rate of 69.1 per cent. CONCLUDING OBSERVATIONS ON SHOT INJURIES OF THE KNEE JOINT. With a very few exceptions, 1 writers on military surgery prior to the American civil war 2 agreed that shot wounds of the knee joint with fracture of the articulating sur faces of the bones required immediate amputation, and the correctness of this rule seems to have been generally accepted by the medical officers serving in the Union and Confed erate armies. Surgeon T. H. Squire, 89th New York Volunteers, in his note-book of surgical cases at the Big Spring Hospital, near Sharpsburg, Maryland, on October 16, 1862, writes: "Every knee joint fractured by a ball should be amputated, and the quicker the better. Surgeon David Judkins, U. S. V., at the West End Military General Hospital, Cincinnati, in September, 1862, reports: "I have had three cases here of shot wounds in the knee joint, admitted, one in twelve, another in fifteen, and a third in seventeen days after the reception of the injury, in all of which the hope of successful issue in the removal of the leg by amputation had passed away. They all died. The operation should have been performed on the field." Surgeon H. S. He wit, U. S. V., in charge of the Frederick Hospital, Maryland, January, 1863, argues: "The absolute law of strictly primary ampu tations in perforations of the knee joint has been distinctly asserted. In compound frac- but dividing the rectus tendon and extirpating the lower bursa. The condyles were not removed, and only four ligatures were required. The wound was closed by stitches and adhesive straps. The stump was dressed with carbolated ointment, and when suppuration had commenced it was syringed twice a day with solution of permanganate of potash. The popliteal ligature came away on the twelfth day. The patient (who remained ignorant of the loss of the limb) continued to do well, the wound healing kindly, until December 20th, when rigors were soon followed by marked S3 mptoms of pyaemia, which terminated her life on December 29th. She aborted a few days before death. 1 JOBERT PE LAMUALLE, who, according to PAL !. (Die Conservative Chirurgie der Gliede.r oder Darstellung der Mittel and Methoden, welche zur Vermeidung. respective Beschrdnkung, der Amputution vnd Knochen-Resectionen sich darbieten, Breslau, 1859, p. 192), was the onlv advocate of con servative measures in shot fractures of the knee joint, contended (Des p laics d armes a feu. Communications par MM. les Docteurs BAUDENS, etc., Paris, 1849, p. Ki6): Les plaies p6netrantes de 1 articulation du genou, regardees principalement connne necessitant 1 amputation, ont 6te traitees par la position horizontale et par uue medication antiphlogistique tres energique et les cataplasmes froids C e traitement a et6 egalement employe, soit que les os fussent interesses, ou que la membrane synoviale ait 6to seule ouverte. Trois malades ont gu6ri sur six, et ou sait que JOHN BELL avait defie qu on lui montrat une guerison surmille." But nearly fifty years before JOIJEKT, JEAN MEHEE (Trait des plaies d armes ufeu, Paris. An. VIII, p. 170) had urged conserva tion in such cases : " Une balle pent causer un grand delabrement dans ces articulations, briser les os, dechirer les tendons, les ligamens. les capsules ; accidens tous fort graves, mais qui n indiquent point 1 amputation. Une balle, quelque violente contusion qu elle cause, ne sauroit detruire les ressources des parties qu elle frappe, et la contusion qu elle petit causer ne s etendant que dans son trajet et dans les parties qu elle divise, ne presente qu une indica tion principale, celle des incisions. Lorsque ces incisions sont bieu dirig6es, et que 1 escarre est divisee, tous les accidens que pourroit entrainer 1 espece de contusion que la balle a faite, cessent, et 1 amputation ne sauroit etre indiquee." 2 WisKMAN ilv.) (Severall Chirurgicall Treatises, London, 167(>, p. 430) cites a case of shot fracture of the knee joint: "Death followed, as com monly it doth in all such Wounds of the great joints. Therefore at sea, while they are warm with heat of Fight, we dismember them. 1 DESPOKT ( Traite des J laies d Armts ufeu, Paris, 1749, p. 225): " Si toute I extremit6 inferieure du femur est fracassee et toute la partie superieure du tibia, et plus encore si ces deux os sont fraeasses a la fois, il est absolument indispensable de couper la cuisse. SCHMUCKEU (J. L.) (Vermischte Cliirurgische Schriften, Berlin und Stettin, 1785, B. I, pp. 37, 38) declares that when the bones of the knee joint are comminuted, its ligaments are torn, or when the popliteal artery is shot through, amputation must be performed at once: "The sooner the Qperation is done the better will be the result." THOMSON (JOHN) (Report of Observations made in the British Hospitals in Belgium after the. Battle of Waterloo, Edinburgh, 1816, p. 243): "Immediate amputation has generally been acknowledged to be particularly necessary in wounds in which bullets have passed through the knee joints and have fractured the articu lating surfaces of the bones. Almost every case of this kind which we saw in Belgium seemed to afford a proof of the propriety of this rule in military surgery." HEXNEN (JOHN) (Observations on some important points in thepractice of Military Surgery, Edinburgh, 1818, p. 159): "In my own practice, I have met with only two cases where the limb was saved after a serious injury of the knee joint, and in one of them only was the perfect use of it restored." GTTHKIK (G. J.) (Treatise on Gunshot Wounds, London, 1827, p. 379): "Wounds of the knee joint, with fracture of the great bones com posing it, from musket balls, require amputation . . from an extensive practice in wounds of the knee joint, with fracture of the articulating surface of the femur or tibia, 1 have no hesitation in declaring amputation to be imperiously demanded, and that it ought to be performed with the least possible delay consistent with propriety ; and on no account should the surgeon wait to give the wound a trial ; for I most solemnly protest, I do not remember a case recover in which I knew the articulating end of the femur or tibia to be fractured by a ball that passed through the joint, although 1 have tried great numbers, even to the last battle of Toulouse." In 1855, in his Commentaries on the Surgery of the War in Portugal, Spain, France, etc., London, Gth ed., 1855, p. 82. the same author remarks: "Wounds of the knee joint from musket balls, with fracture of the bones composing it, require immediate amputation, for although a limb may be sometimes saved, it cannot be called a recovery, or a successful result, where the limb is useless. 1 ESMARCH (F.) ( Ueber Ite.sectionen nach Schttsswunden. Kiel, 1851, p. 129): "All shot wounds of the knee joint in which the epiphysis of the femur or tibia has been injured demand immediate amputation of the thigh ; this is a deplorable sentence, already given by the best authorities, mid which our experience has fully confirmed." MACLEOD (G. II. B.) (A otes on the Surgery ff the War in the Crimea. London, 1858, p. 310) remarks: "The knee when penetrated by gunshot, presents an injury of the gravest description. Taking much interest in cases of this description, I visited every one I could hear of in camp, and can aver that I have never met with one instance of recovery in which the joint was distinctly opened, and the bones forming it much injured by a ball, unless the limb was removed." LOHMEYEK (C. 1 .) (Hie Schusswunden und ihre Jiehandlung, Gottingen, 1859, p. 202): " But when the capsule is opened and the condyles of the femur or tibia are injured, the prospect for the preservation of the limb, and. should the latter be attempted, for the pres ervation of life, is very poor. Therefore amputation of the thigh is always indicated in such wounds, and is to be performed as early as possible. 412 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. tures of the thigh the fatal result is usually the indirect, in gunshot wounds of the knee the direct, result of the accident. Much greater latitude both as respects operation and the period of operation in the former than in the latter class of cases, for obvious reasons, must be allowed. The shock of a wound of the knee joint when recognized by the system is profoundly constitutional and speedily fatal, in obedience to an obscurely understood physiological law. When the joint has been pierced and rent in the wedge-like manner described, molecular death commences. The system does not immediately recognize the fact, and this explains the delay of shock and the delusive appearance which these cases present. At a varying period of from three to ten or twelve days, according to constitu tional and local circumstances and the rapidity of interstitial degeneration, postponed shock occurs, commencing with undefined but threatening expressions of uneasiness, and attain ing its full development in surgical rigor and fatally declining reaction in typhoid surgical fever, with pyaemia, traumatic pneumonia, purulent cachexia, or uraemia, as the case may be, and all equally indicating hopeless injury overwhelming vital force." Surgeon A. B. Crosby, 1 U. S. V., advised amputation in shot fractures of the articulating surfaces of the knee joint, and added: "Slight injuries of this joint, it is true, may recover under favorable circumstances, although injuries seemingly insignificant often prove fatal." Surgeon J. T. Woods, 99th Ohio Volunteers, gave it as his experience 2 that "if bony structure is involved, fracture and comminution produced, the only warrantable procedure is amputation, the attempt to save the limb no less than a wanton robbing of the unfortunate sufferer of the only chance for life, by operative procedure." Based upon his experience as medical inspector during the War. Professor F. H. Hamilton declared, immediately after its close, that the surgeon should not attempt to save the limb 3 "when the fracture implicates the knee joint, or even when it is near the knee joint, experience having shown that amputa tions near the knee joint give a better percentage of recoveries than any other thigh ampu tations, while, on the other hand, attempts to save the limb in these cases give a worse percentage of success than in any other fractures of the thigh." Equally emphatic are the opinions of the surgeons of the Confederate army. Dr. Hunter McGuire 4 says: "As Med ical Director of a large army, and one more actively engaged, probably, than any similar force in the late Confederacy, I saw a larger number of these cases of wounds of the knees involving the extremity of the bones, but not one which recovered without amputation. Whenever the surgeon persisted in his effort to save the limb, the patient died." Confed erate Surgeon J. W. Thompson, 5 of Kentucky, maintained: "Gunshot wounds of the knee joint have claimed much attention during the past half century in both military and civil practice. I feel confident that the surgical experience in our late war in reference to this class of wounds is largely in favor of primary amputation," and Confederate Surgeon T. Gr. Richardson 6 declared that during his whole experience in the army he did not witness "a single recovery without amputation from unmistakable gunshot wound of the knee joint, with injury, however slight, to the femur or tibia." The attempts at conservation after shot fractures of the knee joint were therefore fewer than those after shot fractures of the 1 CROSBY (A. B.). Gunshot Injuries of the Knee Joint requiring Amputation, in Transactions of the New Hampshire Medical Society, 1864, p. 31. 2 WOODS (J. T.). Gunshot Knee Joint Injuries, in Ohio Medical and Surgical Journal, 1864, Vol. XVI, p. 297. N (P. H.), A Treatise on Military Surgery and Hygiene, New York. 1865, p. 400. 4 McGuiUE (HuNTF.lt), Clinical Remarks on Gunshot Wounds nf Joints, delivered January 10, 1866, at Howard s Grove Hospital, in Jtidimond Medical Journal, I860, Vol. I, p. 260. 5 THOMPSON (J. W.), Cases nf Resection Fractures of Upper Third of Femur Gunshot Wounds of Knee Joint, in Nashville Medical Journal, I860, Vol. I, p. 342. "RICHARDSON (T. G.), Gunshot Wounds of the Knee Joint, in New Orleans Medical and Surgical Journal, 1866-67, Vol. XIX, p. 57. SECT. IV.] SHOT INJURIES OF THE KNEE JOINT. 413 femur. We have seen on page 175, ante, that of six thousand five hundred and seventy- six shot fractures of the shaft of the femur, three thousand four hundred and sixty-seven, or over one-half, were throughout treated without operative interference; but in only eight hundred and sixty-eight, or about one-fourth of the three thousand three hundred and fifty-five reported cases of shot fractures of the articular extremities of the bones of the knee joint, conservation of the limb was attempted, and this preference for amputation in shot fractures of the knee joint was, in many instances, not so much due to the teachings of the masters of surgery of the first half of the present century as to the sad experience gained from the attempted practice of conservative measures which a number of the Amer ican surgeons were desirous to give a fair trial. Surgeon J. Moore, U. S. A., Medical Director of the Department of Tennessee, after the battle of Chattanooga, in November, 1863, declared that: "The attempts at conservative surgery in wounds of the knee joint were not encouraging. Of sixteen cases reported as occurring in the 2d, 3d, and 4th divisions, seven underwent primary amputation and seven were treated without amputa tion. On the twenty-fifth day one case not amputated had died and only two reported favorable for recovery." Surgeon M. Gr. Sherman, in charge of the 2d division, Twenty-first Corps, in a letter to Medical Director A. J. Phelps, reports cases of shot wounds of the knee joint observed by him, and remarks: "Believing the surgeon who saves a limb is more justly entitled to credit than he who operates scientifically, I was inclined to be conserva tive in my practice and treatment of those who came under my care, and operated only when it was fully apparent the patient could not be saved without an operation, and was com pelled, as a result, to perform more secondary operations than I otherwise should have been." Surgeon I. Moses, U. S. V., believing that in cases of shot wounds of the knee "the patients had not so much died from the injury itself as from timid surgery," the surgeon failing to freely lay open the joint, determined to save the limb in a number of cases under his charge at the hospital at Chattanooga, in the summer of 1863; but the ultimate results were very discouraging, 1 and Surgeon Moses had to admit 2 that he had "lost confidence in the possibility of saving gunshot wounds of the knee joint, involving fractures of the con- 1 Dr. I. MOSF.S (Surgical Notes of Cases of Gunshot Injuries occurring during tlie advance of the Army of the Cumberland, in the summer of 186:5, in Am. Jour. Med. Science, April, 1864, Vol. XLVII, pp. 339 et seq.): " Ten cases of wounds of the knee joint were admitted." " Of these," Dr. MO8ES reports three died without operation; one died after amputation; one died of secondary haemorrhage from a branch of the popliteal artery; three wore nearly recovered when 1 left the post, September 15 [18(i3], and two remained with fair chances of ultimate recovery. Thus we have one-half the cases, which will, in all probability, be saved with useful limbs and various amounts of motion in the joints." Surgeon MOSES admits that "these cases were treated under the most favorable circumstances ; the physical condition of the men was most excellent, and soon after the reception of the injury they wore taken to well-appointed hospitals, surrounded with comfort and with every luxury of diet at command, and skilful surgical attendance." But let us examine the five cases of alleged recovery after shot fractures of the knee joint, cited by Dr. MOSKS, and see how his expectations were realized: Private A. Loutenschlager (MOSES, loc. cit., CASE V, p. 341;, Co. A, 77th Pennsylvania, admitted to general field hospital at Murfreesboro , Juno 27, 1863, who, it was thought on September 15, 1803, would "recover with an anchylosed joint," died on September 26, 1863, in consequence of active inflammation and burrowing of pus in the joint and up the thigh. Captain 1 ettigrew. 20th Tennessee (MOSES, loc. cit., CASE III, p. 340), admitted to general field hospital at Murfreesboro . June 27, 1863, and declared "beyond all danger" on September Kith, submitted to secondary amputation in the lower third of the thigh on January 4, 1864. and died on January 7, 1864. (See TABLE XL, No. 178, p. 322, ante.) In the case of Adjutant Y [/. R. Youre], Caswell s Georgia Sharpshooters (MosES, loc. cit., CASE II, p. 340), admitted to hospital No. 1, Murfreesboro 1 , June 26, 1863, no information later than July 27, 1863, can be obtained, when the prisoner was sent to Nashville with wound healed and partial anchylosis of joint. Sergeant Haynie (MOSES, loc. cit., CASE I, p. :!40). 10th Ohio Cavalry, wounded at Hoover s Gap, June 24. 1863 [not June 6, 1863, as stated by Dr. MOSES], and admitted to hospital at Murfreesboro , June 27th, recovered, was promoted to 1st Lieutenant, and mustered out with his regiment July 24. 1865. This case is reported on the Murfreesboro hospital register as "a fracture of the patella, carrying- away the upper half of it and opening the knee joint." Uaynie is not a pensioner. Private Edward Phipps, Co. F, 6th Indiana (MOSES, loc. cit., p. 341, CASK IV). also wounded at Hoover s (Jap, Tennessee, June 24, 1863, and admitted to hospital at Mur freesboro , June 27th : recovered, and was discharged September 20, 1864, with almost complete anchylosis. He is a pensioner, and Pension Examiner G. W. MEAI .S reported, on September 24. 1864 : " Hall entered inside right knee, and ranging outward and downward, escaped about two inches lower clown, upon outside, passing into joint on inside and through upper part of head of tibia on outside ; . . leg weak, and a partial anchylosis exists with slight angle at the knee." In September, 1877, the Dayton Board of Examiners stated : There is a creaking in the joint on motion being made, and par. tial anchylosis ; leg is weak, and he carries a cane constantly." Granting that in the two cases cited last the articular extremities of the femur or tibia were implicated, which is by no means certain, we find that of the 8 cases treated conservatively, possibly 3. or, considering the case of Youre as unde termined, only 2 recovered, a mortality rate of, respectively, 60.5 or 71.4 per cent. As the cases cited by Surgeon MOSES have been made a basis for the advocacy of conservative measures in shot fractures of the knee joint by DEININGEH (C.) (Veber die conservative Behandlung der Schusswunden des Knief/elenkes, MUnchen, 1867, p. 28) and by other European surgeons, it has been deemed best to refer to the cases here somewhat in detail. 2 MOSES (I.). Surgical Notes of Cases of Gunshot Injuries occurring near Chattanooga in the Battles of September, October, and November, 1803, in American Journal Medical Science, October, 1864, Vol. XLV11I, p. 363. INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. dyles of the femur or head of the tibia, under the usual circumstances of bustle and con fusion of the field, and repeated removals of wounded in ambulances to the rear." When it is considered that of three thousand three hundred and fifty-five shot injuries of the knee joint with lesion of the articulating surfaces of the bones, grouped in TABLE LII, on page 367, only eight hundred and sixty-eight, with three hundred and thirty-eight recoveries, were conservatively treated, and that in these eight hundred and sixty-eight cases are included one hundred and seventeen, with eighty-four recoveries, in which the synovia*! cavity was not primarily opened and only the patella fractured; furthermore, that with the exception of a few instances, in which amputation was refused or in which the cases came to the notice of the surgeons at a period when the proper time for amputation had passed, the cases reserved for conservative treatment were those deemed to have the best chances of a favorable result, the percentage of mortality (60.6 per cent.) must be regarded as very large, and the question naturally arises whether fewer attempts at con servation would not have saved more lives. It has already been pointed out on page 332 that the mortality of the two thousand three hundred and ninety-nine amputations of the thigh after shot fracture of the knee joint was only 51.1 per cent. Of these two thousand three hundred and ninety-nine amputations in the thigh for shot wounds of the knee joint, one thousand five hundred and twenty-five, with six hundred and sixty-nine deaths, were primary operations, giving a mortality of 43.8 per cent., while eight hundred and thirty- nine, with five hundred and thirty-two deaths, or 63.4 per cent, fatality, were intermediary or secondary operations, performed, generally as a last resort, when it became evident that a continuance of the conservative treatment would inevitably lead to a fatal issue. Thus it will be seen that the mortality after shot fractures of the bones of the knee joint treated conservatively, even under the most favorable circumstances, exceeded the mortality after primary amputation in the thigh by 16.8 per cent. Shot fractures of the knee joint by small projectiles, in their early stages, are among the most deceptive of serious injuries. Surgeon H. S. Hewit, U. S. V., observed, in a report from Frederick Hospital, in January, 1863: "The conical wedge-like missile, pro pelled by an irresistible force and revolving with the rapidity of a steam augur, pierces, bores, arid comminutes without occasioning great displacement. The bones are broken into a great number of minute fragments which are still held together by their capsular and ligamentous investments. The destruction is as great ab interno, as it would be ab externo by crushing between a railroad carriage wheel and the iron rail." Deluded by the seeming insignificancy of the external injury, the patient not rarely refuses to submit to amputation until the moment of hopeful operation has passed. Several cases of recovery after severe comminuted fractures of the bones of the knee joint are, it is true, recorded in the annals of surgical literature. Such examples have been cited among the cases of shot injuries adduced in Note 3, on page 368, and similar instances will be found among the cases col lected in the appended table (TABLE LIX, page 417), in which it has been attempted to give a numerical summary of the cases of this nature recorded by writers on surgery; but these fortunate results only seem to indicate, as Professor von Langenbeck 1 remarks : "that if amputation is refused, the surgeon must never despair of saving life." It has been shown on page 28 that of three hundred and fifty-one cases of shot wounds of the knee joint with either primary or secondary involvement of the joint capsule, but without lesion of the bony structure, ninety-eight, or 27.9 per cent., proved fatal. The 1 LANGEXBKCK. (B. V.), Uebtr die Schussfracturen der Gelenke und ihre Behandlung, Berlin, 1868, p. 28. SECT. IV.j SHOT INJUKIES OF THE KNEE JOINT. 415 attempt to save the limb should always be made in injuries of this nature, and amputation has not been advocated by military surgeons, although Schwartz 1 remarks that: "According to our experience we cannot find fault with the surgeon who, in a case of clearly defined extensive wound of the joint capsule, prefers immediate operation to generally useless attempts at conservation with subsequent secondary amputation." Stromeyer, Langen- beck, Legouest, 2 and others believe simple wounds of the joint capsule, without lesion of the bony structure, to be very rare; but the records of the American civil war, of the Franco-Prussian War of 1870-71, and of the Russo-Turkish War of 1877 (TABLE LIX, page 417), furnish examples of such injuries, and the experiments of Woods, 3 Simon, 4 and 1 SCHWARTZ (HARALD), Beitrage zur Lehre von den Schusswunden, Scbleswig, 1854, p. ]73. 2 .STROMEYElt (L.) (Erfahrungen ilber Schus$wunden im Jahre 1800, Hannover, 1807, p. 57): "I will not deny that there are cases in which an opening in the knee joint made by a bullet will heal, but they must be very rare. 1 have not and do not expect to see one, because a ball which opens the joint must, as a rule, interest one of the articulating ends." LANGKXBECK (B. v.) (Ueber die Schussfracturen der Geknke itnd Hire Behandlung, Berlin, J808, p. 36): "That the knee joint can be shot through from before backwards without lesion of bone I cannot think possible. There will alwftys be more or less deep grooving of the condyles, and I have been able to feel the grooving in two cases of recovery." LEGOUEST (L.) (Trait de Cliirurgie d Armee, Paris, 1872, p. 444): "On voit cependaiit quelquefois des balles atteindre et meme traverser de part en part de grandes articulations sans toucher les os. Xous avons traite, pendant la cainpagne d Orient (1855), un militaire qui eut manifestement 1 articulation du genou ouverte par une balle : le pro jectile passa immediatement au-dessus de la rotule entre le tendon de cet os et les condyles du femur sans fracturer ni les uns ni les autres et sans meme determiner d accidents serieux ; mais ce sont la. de rares exceptions." 3 WOODS (J. T.) (Gunshot Knee Joint Injuries, in Ohio Med. and Surg. Jour., 1864, Vol. XVI, p. 295): " The joint is only traversed by the ball, no fracture being inflicted, or at most simply a grooving or abrasion of the articular cartilages occurring. This idea seemed to find confirmation in the fact that in these cases the ball uniformly passed antero-posteriorly, or laterally in certain directions at the level of the joint, thus affording the first quali fication of this occurrence. Passing antero-posteriorly the nearly level articular surface of the tibia, the large size of the inter-condyloid notch would, especially if the knee were partially bent, render the passing of a ball, without violently impinging on bony structure, quite easy of occurrence ; and similar considerations of anatomy and varied position seemed to afford a similar explanation to the harmlessness of the balls cases where their course was laterally through the anterior third of the joint. These theoretic views it was found quite easy to demonstrate upon the dead subjects ; making a slit in the ligamentum patellae below the patella itself, passing in a narrow bladed knife to clear away the sort parts, and slightly flexing the leg upon the thigh, I was enabled to introduce through the joint into the popliteal space a round piece of wood one-third greater in diameter than a minie ball, and by flexing the leg to a right angle with the thigh, the space between the bones of the joint on the anterior aspect was found to be quite sufficient for the passage of a minie ball laterally, and through the tense skin the opening would be so small that when the leg was straightened it would appear to have entered immediately below the inner condyle." 4 SIMON (Kriegschirurgische Mitlhc.ilu.ngtn. Zur Prognose und Behandlung der Schusswunden des Kriegele.nkes, in Deutsche Klinik, 1 871, B. XXIII, p. 258 et seq.) tried to "determine these questions by experimental means, and obtained surprisingly clear results. I had three round iron rods made pro vided with very sharp points ; one of the rods had the thickness of a Chassepot missile, the other that of the Prussian Langblei, and the third a yet greater thickness; and with these I attempted to penetrate the knee joints of dead bodies in various directions. With the limb extended it was impossible to push any one of the rods through, bone being struck everywhere. But on very little flexion, with the knee bent at 170, the joint became so far opened that one could put the thinnerrod through the intercondyloid notch with the greatest ease, and without touching the bones immediately below the lower margin of the patella through the ligamentum patellae as well as by the sides of the same (Fir,. 252). The rod penetrated antero-posterior- fr^^^M^lA^^f^ 8 ^ ^^ ly through the middle of the FIG. 253.-The same, with greater flexion. [After SiMus.l joint, and appeared in the popli teal space or several centimetres above the same. When the rod was pushed in at the median line of the extremity immediately below the patella, or through the ligamentum patellae, it would also appear in the median line on the posterior aspect ; but when it penetrated beside the ligamentum patellne, the rod had to be forced through the joint in a somewhat oblique direction, and its point would appear on the posterior aspect one to two centimeters distant from the median line. The rod of the calibre of the Prussian Langblei could be pushed through the joint in the same direction without injury to the bone, if the flexion of the joint was increased to an angle of 150; and, with a still greater flexion, at an angle of 130, the perforation could be accom plished with ease by the third or the thickest of the rods. But in these greater flexions the point of the rod appeared in the posterior side of the thigh much higher, about to 12 centimeters, above the popliteal space (FIG. 253), and these various experiments proved that the greater the flexion in which the knee was perforated the higher the exit wound came to be located. Nor could the joint be penetrated from side to side when the limb was in a straight position. But when the knee was bent to an angle of 105, the front portions of the articular surfaces of the femur and tibia would separate sufficiently to allow the thinner rod to be pushed through the anterior third of the joint, and, on greater flexion, the space between the bones would open to such a degree that the iron rod of the calibre of the Prussian Langblei penetrated (FlG. 254). After withdrawing the rod mid stretching the knee, essential local changes wore observed in the aperture of the canal, which were brought about by displacement of the bones and of the skin. The knee pan elevated itself out of the sulcus intercondylicus upon which it had been held down, and the anterior parts of the articulating surfaces of the femur and the tibia fixed themselves so upon each other that one could neither penetrate from the front nor from the side towards the middle of the joint. But the wound in the skin suffered the greatest displacement. In the penetrations from before backward, the entrance aperture, which, when the knee was bent, was located Immediately below the lower margin of the patella, either in the middle or at the side of the ligamentum patella:, pushed itself upwards upon the lower part of the patella, so that this bone, being covered by periosteum and a mass of fibrous bands, formed the underlying base of the wound in the skin. The opening in the synovial membrane was thereby so completely closed that the synovia could not at all or only very sparingly ooze out 416 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Socin 1 clearly prove their feasibility. Hoffmann 2 states that among shot wounds of the knee, examples of missiles striking the knee, running around under the skin, and escaping on the opposite side, are very frequent; but no examples of such injuries were recorded from our civil war, and it can hardly be believed, as von Langenbeck 3 justly remarks: "That when the wound of entrance is in the middle of one side and the wound of exit in the middle of the other side of the joint, or when the former is in front, the latter in the bend of the knee, the ball should pass around the joint. the angular projections of the condyles and of the edges of the patella would not permit it." Analyzing the eight hundred and sixty-eight cases of shot fractures of the bones of the knee joint treated by conservation (TABLE Lli, p. 367, ante), we find that in one hundred and seventeen cases the patella alone was injured, without lesion to the synovia] cavity; eighty-four were successful, thirty proved fatal, and in three instances the result was unde termined, a fatality of 26.3 per cent., or 1.6 per cent, less than that of the cases of pene tration of the joint capsule without bony lesion. Ten cases of fractures of the patella and head of tibia gave a mortality of 40.0 per cent., and of seventeen cases of fractures of the patella and condyies of femur_47.0 per cent, proved fatal. In the majority of the cases of these two groups the missile grazed the joint on the side, grooving or fracturing the bone and only slightly injuring the joint capsule. Forty-seven instances of fractures of the patella with primary lesion of the joint cavity gave a mortality of 53.1 per cent. Of the remaining six hundred and seventy-seven cases with fractures either of the condyles of the femur or the head of the tibia or both, or of the femur, tibia, and patella, two hundred and seventeen recovered, four hundred and fifty-four proved fatal, and six were undetermined, a mortality of 67.6 per cent., exceeding the mortality rate of primary amputations in the lower third of the thigh 18.9 per cent. On examining the reports of the eight hundred and sixty-eight cases of shot fractures of the bones forming the articulation of the knee, it was found that pya9mia supervened in seventy-seven instances, all proving fatal, haemor rhage in twenty-five, with nineteen deaths, hospital gangrene in twenty, with seventeen deaths, phlegmonous erysipelas in twenty, with eighteen deaths, and tetanus in two, both resulting fatally. Fragments of bone or sequestra were removed in forty-four instances, twenty belonging to the group of fatal cases. The consideration of the shot wounds of the knee joint treated by conservation will be concluded by an enumeration of such cases from other wars and from accidents in civil life. from under the edge of the membrane. At the wound of exit upon the posterior aspect of the knee the displacement of the skin m:ide itself also apparent, but in a reversed direction, namely, from above downward, entirely in accord with the fact that the anterior opening was made during tension, the /f^ posterior during great relaxation of the skin. Hence, too, the parallelism of the subcutane ous and of the skin wound on the posterior aspect was so completely broken up that with the finest probe we could only penetrate to the depth of the skin wound. By stretching, after transverse perforations, the anterior part of the articular end of the tibia laid itself against that of the femur, so that the synovial membrane, and with it the wound, was so compressed that ihe joint became closed beneath the gaping skin wound. The openings in the skin moved either upon the condyles of the tibia or of the femur. The displacement here was generally much less, and, in several instances, one could see beneath the entrance aperture of the skin the compressed opening in the synovia! capsule. As a rule also synovia escaped from these transverse perforations. . . After these experiments and observations at the patient s bed side, no doubt really remains to be overcome that so inexplicable swiftly healing shot injuries of the knee are to be taken up as wounds in which the knee joint was perforated during flexion (to bring ah ut a perforation of the joint the flexion need not be greater than that produced in ordinary walking by the advancing leg) by the missile without injury to the bone, anu which through the displacing of the skin, on straightening the joint immediately after the injury, FIG. 254,-Transverse perforation. [After SlMOX. ] wcre change(l fr()m open into subciltaneous joint wounds ." 1 SOCIN (AUGUST), KriegsclrirurgiscJie Erfahrungen, Gesammelt in Carlsruhe 1870 und 1871. Leipzig, 1872, p. 168, and PLATE IX. 2 HOFFMANN, Ueber Verletzungen lies Kniegelenks durch KleingeAvelirprajectileundderen Beliandlung, in Deutsche MilitairdrztUche. Zeitschrift, Berlin, 1875, Jahrgang 4, p. 243. LANGENBECK (B. v.), Ifeber die Schussfracluren der Gelenke und ihre Behandlung, Berlin, 1868, p. 37. \ SKCT. IV.) SHOT INJURIES OP THE KNEE JOINT. TABLE LIX. 417 Shot Wounds of the Knee Joint treated by Conservation on the Occasions named and from the Authorities quoted. OCCASIONS. CASES. No BONY LESION. FRACTURE OF BONE INDICATED. > i 9 8 o "3 S 5 CJ -*3 ** Ratio of Percentage. Recovery. 1 fe Unknown. Recovery. 1 34 1 1 3 19 1 92 i Cases prior to 1846 (Note 3 on page 368, ante) 99 61 37 2 1 1 1 37.7 50.0 8 3 53 1 2 7 5 1 War in Mexico, 1846-48 (JARVIS, 1 PORTER 2 ) Revolution in Baden, 1848 (SIMON*) . . . 321 33.3 Revolution in Paris, 1848 (BAUDEN8, HUGUIEK, JoiiERT DE LAMHAI.LE 4 ) Schleswig-Holstein War, 1848-50 (STROMEYER*) 10 7 3 30 24 5 19 i 79. 1 - Campaign in Algiers 1854-57 (BERTHERAND C ) 2 1 1 100. 67.3 1 Crimean War, 1854-57 (CHENU, 7 MATTHEW, 8 ) 138 45 93 2 1 1 1 43 Campaign in Nicaragua, 1856 (MOSEB 9 ) 1 l British in India, 1857-58 (WILLIAMSON," GORDON ll WOODS 12 ) 642 33.3 3 2 Italian War, 1859-60 (CHENU, 13 DEMME 14 ) Hf> 4u :i(i i 42. 3 49 1 1 40 4 3 41 23 20 13 36 1 3 29 2 New Zealand War, 1863-65 (MOUAT 18 ) 2 11 50.0 Danish War, 1864 (HEINE 16 ) 4 1 3 .. 75.0 Austro-Prussian War, 1866 (BlEFEL, 17 K. FISCHER, 18 GRlTTl, 19 LANOEN- BECK, 20 MAAS, 21 STROMEYER 22 ) 78 44 34 43.5 4 5 Revolution in Japan, 1868 (SlDDALL 73 ) 6 ! 4 2 United States Army, 1865-70 (OTIS 24 ) 4 4 44 10 18 4 Franco-German War, 1870-71 (GERMANS 28 ) 166 85 : 79 <J 48. 1 88 33 49 6 59.7 58 38 15 5 28.3 17 17 14 3 65 46 IS 2 6 2 Franco-German War, 1870-71 (FRENCH 215 ) Russo- Turkish War, 1877 (BERGMANN, 27 A88ENDELFT 28 ) 3 Isolated Cases since 1846 (HARRIS, 29 COBB, 30 Ross, 31 SCHUH, W VAN BU- REN, 33 I8NARD, 34 JOHNSON, 38 ROOKER, 36 ATLEE, 37 MAIR,* 8 HUBBARD, 39 HOLDEN, 40 POWELL, 41 KOBER, 4 VOLKMAXN, 43 CHANDLER, 44 GROSS 48 ) 309 Aggregates 793 402 376 15 48. 3 ! 93 26 3 350 12 It is noticeable that all the isolated cases of shut injuries of the knee joint collected from civil life since 1846, seventeen in number, recovered, and it is only reasonable to sup- 1 JARVIS (N. S.) (Surgical Cases at Monterey, iu New York Journal of Medicine, 1847, Vol. VIII, p. 158): Soldier of 4th U. S. Infantry; fracture of patella by grapeshot. Died, seven days after injury, of tetanus. 2 PORTER (.T. B.) (Medical and Surgical Notes of Campaigns in the War with Mex ico, during the years 1845, 46, 47, and 48, in Am. Jour. Med. Sci., 1852, Vol. XXIII, p. 33): Case of G. R. Brush, Hays s Rangers, wounded at Monterey, September 22, 184(1; musket ball perforated left patella; considerable inflammation; fragments of broken patella kept in place. Recovered. Seen at Vera Cruz iu the autumn of 1847, serving with a mounted company of Texans, at which time there was no stiffness of the joint and but little deformity. 3 SIMON (G.), Weber Schusswunden , Giessen, 1851, p. 90 . l Des plaie.s d armcs a feu ; Communications, etc., Paris, 1849, par BAUDENS, p. 231 (1 fatal); HUGUIER, p. 131 (4 recoveries): JOBERT DE LAMBALLK, p. 153 (3 recoveries, 2 fatal). STKOMEYER (L.), Maximen der Kriegslieilkunst, Hannover, 1855, pp. 756, 757. "BERTHEEAND (A.), Campagnes de, Kabylie, Paris, 1862, pp. 110, 2CT. 7 CHENU (.f. C-), Rapport, etc., pendant la Campagne d Orient en 1854, "5."), 56, Paris, 1865, p. 410 (37 recoveries, 87 fatal). * MATTHEW (T. P.), Med. and Surg. History of the British Army, etc., in the years 1854, 55, 56, London, 1858, p. 350 (8 recoveries, 6 fatal). 9 MosES (I.) (Military Surgery and Operations following the Battle of Kivas, Nicaragua, April, 1856, in Am. Jour. Med. Sci., 1857, Vol. XXXIII, p. 28): Case of Major Markham ; ball struck on inside and a little above patella, involving cavity of joint; synovial fluid oozing from wound; absolute rest and abstemiousness enjoined, and cold dressings applied. Recovery, with free motion of joint. 10 WILLIAMSON (G.), Military Surgery. London, 1863, pp. 170, 172 (4 recoveries). "GORDON (C. A.), Experiences of an Army Surgeon in India, London, 1872, p. 25 (1 fatal). 12 WOODS, Description of a Mortal Gunshot Wound perforating the Knee Joint, in Dublin Medical .Press, 1862, Vol. XLVII, p. 158 (1 fatal). 3 CHENU (J. C.), Stat. Med. Chir. de la Camp. d Jtalie, en 1859 r.t 1860, T. II, p. 766 (45 recoveries, 22 fatal). 4 DEMME (H.), Militiir- Chirurgische Studien, WUrzburg, 1861, Zweite Abth., p. 274 (4 recoveries, 14 fatal). 15 MOUAT, The New Zealand War of 1863, 64, 65, in Stat. San. and Med. Reports for the year 1865, London, 18C7, Vol. VII, p. 5<)9. 16 HEINE (C.), Die Schustverletzungen der unteren Extremitdten, Berlin, 1866, p. 371. I7 BIEKEL (K.), Im Re.sene-Lazareth. Kriegschirurgische Aphorismen i-on 1866, in LANGENBECK S Archiv fur Klin. Chir., Berlin, 1869, B. XII. p. 449 (5 recoveries, 8 fatal). I8 FISCHER (K.), Militairdrztliche Skizze.n, Aarau, 1867, p. 93 (25 recoveries. 21 fatal). 19 Rocco GKITTI, Nuovi docu- menti in favore della cura conservativa nelle fractura del femore par arma da fuoco, in Annali Universali di Medicina, 1868, Vol. CCV, p. 527 (0 recoveries, 1 fatal). LANGENBECK. (B. v.), Utber die Schussfracture.n der Gelenke und ihre Behandlung, Berlin, 1868, p. 30, etc. (9 recoveries, 2 fatal). 21 MAAS (II.), Kriegschirurgische Bcitrdge aus dem Jahre 1866, Breslau, 1870, pp. 52, 54 (2 recoveries, 2 fatal). "STROMEYER (L.), Erfahrungtn ubcr Schusswunden im Jahre 1866, Hannover, 1867, p. 58 (1 recovery). ^ SlDDALL (J. B.), Surgical Experiences in Military Hospitals in Japan, in St. T/iomas s Hospital Reports, London, 1874, Vol. V, p. 95. 24 OTIS (G. A.), Circular No. 3, War Department, S. G. O., Washington, 1871, pp.79, 80. 25 BECK (B.), Chirurgie der Schussverletzungen, Freiburg, i. B. 1872, pp. 609 et seq. (16 recoveries, 11 fatal). BlLLROTH (T.), Chirurgische Briefe aus fltn Kriegs-Lazarethen, Berlin, 1872, p. 230, etc. (2 recoveries, 6 fatal). BOCK, Verhandlungen der Militairdrztlichen Gesellschoft zu Orleans im Winter 1870-71, in Deutsche Militairdrztliche Zeitschrift, Berlin, 1872. Jahrg. I, p. 265 (1 recovery). BURKHARDT, Aus der Schweizer Ambulance, in Lure, in Correspondenz-Blatt fur Schweizer Aerzte, Bern, 1871, Jahrg. I, p. 217 (3 fatal). CZKRNY (V.), Bericht iiber die im College Stanislaus in Weissenbur;/ behandelten Verwundeten, in Wiener Med. Wochenschrift , 1870, No. 60, p. 1447 (5 fatal). FISCHER (G.), Dorf Floing und Schloss Versailles, in Deutsclf Zeitschrift fur Chirurgie, Leipzig, 1872, B. I, p. 240 et seq. (3 recoveries, 2 fatal, 2 unknown). FISCHER (H.), Kriegschirurgische Erfahrungen, Erlangen, 1872, p. 202 (8 recoveries, 9 fatal). GEI88EL (R.), Kriegschirurgische Rfminiscenzen von 1670 bis 1871, In JD^itsche Zrittchrift fur Chirurrrir. Suno. Ill 53 418 INJURIES OF THE LOWEK EXTREMITIES. [CHAP. X. pose that similar instances with fatal issue occurred during the same period, but were not reported by the attending surgeons. The percentage of fatality (48.3) must therefore be considered as too favorable. Attention should here be called to the favorable results claimed to have been achieved in the late Russo-Turkish War, 1877, by Professor Bergmann. Of twenty-one cases without bony lesion, eighteen recovered and the results in three were undetermined. None had died at the date of Professor Bergmann s report. Of thirty-one instances of shot fracture of the bones of the knee joint, two had undetermined results, twenty recovered, and nine died, giving the favorable mortality of 31.0 per cent. Professor Bergmann had hoped to have occasion to try Lister s antiseptic mode of treatment on the field of battle, and had provided himself with a complete outfit for that purpose ; but he soon realized that in the excitement and confusion following an engagement it was impossible 1 to proceed with the care and precision requisite to a successful practice of Lister s somewhat 1875, B. V, p. 45 (1 recovery, 3 fatal). GRAF (E.), Die Koniglichen Reserve-Lazanthe zu Dusseldorf wahrend des Krieges 1870-71, p. G7 (G recoveries, 5 i atal). HEINZEL, Ueber die conservirende Behandlung der Kniegelenkschiisce, etc., in Deutsche Militairdrztliche Zeitschrift, Berlin, 1875, 4 Jahrg.. p. 318 (1 recovery). KlRCHNER (C.), Acrztlicher Bericht iiber das A . P. Feld-Lazareth im Palast zu Versailles, Erlangen, 1872, p. GO (8 recoveries, 11 fatal). KOCH (\V.), Notizen tiler Schussverletzungen, in LANGENUECK s .-I rchiv fur Klin. Chir., Berlin, 1872, B. XIII, p. 512 (3 fatal). LOSSES (II.), Kriegschirurgische Erfahrungen aus den Barackenlazarethen zu Mannheim, Beidclburg und Karlsruhe 1670 und 1871, iu Deutsche Zcitschrift fiir Chirurgic, Leipzig, 1873, B. II, p. 128 (8 recoveries). Lt CKK (A.), Kriegschirurgische Fragen und Bcmerkungen, Bern, 1871, p. 02 (1 fatal). MAYER (L.), Kriegscliirurgische Mittheilungen aus den Jahren 1870-71, in Deutsche Zeitschrift fiir Chirurgic,, 1873, B. Ill, p. 83 (1 recovery, 1 fatal). MOSETTO, Erinnerungen aus dem deutsch-franzosischen Kriege, in Der Militdrarzt, with Wiener Medizinische Wochcnschrift, 1872, p. 92 (1 recovery). OTT, Slittheilungen aus dem Ludwigsburgtr Reservespital, in Med. Corre.spondenz-Bla.tt des Wiirttemberg. drztl. Vereins, Stuttgart, 1871, B. XLI, p. 156 (2 recoveries, 1 fatal). SALZMAXX, Mittheilungen aus dem Vereinsspital in Esslingen, in Med. Correspnndenz-Blatt des Wiirltemberg. iirztl. Vereins, 1871, B. XLI, pp. 138, 154, 155 (3 recoveries, 1 fatal). SCHAFl EU (T.), Chirurgische Studien und Untersuchuiigen aus dem Fcldzuge von 1870, in LAX- GEXi;ECK s Archiv fiir Klin. Chir., 1872, B. XIII, p. 102 (1 recovery, 1 fatal). SCHIXZIXGEU (A.), Das Reserve- Lazarc.th Schwetzingen im Kriege 1870-71, Freiburg, i. B., 1873, p. 76 (4 recoveries, 2 fatal). SciIL l.r.ER (M.), Kriegschirurgische Skizzcn aus dem deutsch-franzosischen Kriege 1870-71, pp. C7, G8 (2 recoveries). ScnWAliE, Verhandlungen der Militairdrztlichen Gesellschaft zu Orleans im Winter 1670-71, in Deutsche Militairdrztlichf. Zeitschrift, 1872, B. I, p. 480 (1 fatal). SOCIX (A.), Kriegschirurgische Erfahrungen, Leipzig, 1872, p. 174 (15 recoveries, 10 fatal). STOI.L, Bericht aus dem Koniglich Wiirttembergischen 4. Feldspital von 1870-71, in Deutsche Mililairdrztliche Zeitschrift, 1874, B. Ill, p. 205 (2 recoveries, 2 fatal). STUJU F (L.), Bericht ueber das Kriegs-Spital des St. Georg-Ritter- Orde ns zu Neuberghausen im Jahre 1870-71, in Aerztliches Intelligenz-Blatt, Mun- chen, 1872, p. 657 (1 fatal). 26 CHH AULT (A.), Fractures par armes a feu, Paris, 1872, p. 37 (3 recoveries, 3 fatal). CHRISTIAN (J.), Relation sur les plaies de guerre observers a I ambulance de Bischwiller, 1870-71, in Gaz. Med. de Strasbourg, 167L-73, p. 283 (3 recoveries, 6 fatal). COU61X (A.), His- toire Cliirurgicale de I ambulance de I &ole des Ponts et Cliaussces, in L Union Medicale, 1872, T. XIII, p. 157 (3 recoveries, 1 fatal). DESl KES (A.), Rapport sur les travaitx de la 7 e ambulance a VarmeeduRhin et a I armfe de la Loire, Paris, 1871, pp. 46, 48 (G recoveries. ~G fatal, 5 unknown). FELTZ ET GKOI.I.EMUNII, Relation clinique sur les ambulance de Eaguenau, iu Gaz. Med. de Strasbourg, 1671, p. 145 (4 recoveries). GOLTDAMMEU, Bericht iiber die Tlidtigkeit des Reserce-Lazaretts des Berliner Hilfsvereins in tier Garde- Ulanen-Kaserne zu Muabit, in Berliner Klin. Wochenscrift. 1 871, Jalirg. VIII, p. 150 (3 recoveries). GORDON (C. A.), Lessons on Hygiene and Surgery from, the Franco-Prussian War, London, 1813, p. 157 (G recoveries). GROSS (F.), Notice sur I liopital civil pendant le siege et le bombardemcnt de Strasbourg, in Gazette Med. de Strasbourg, 1871, p. 189 (2 fata)). JOESSEL, Ambulances de Haguenau, in Gazette Med. de Strasbourg, 1871, p. 21 (1 recovery). MACCORMAC (W.), Notes and Recollections of an Army Surgeon, London, 1871, p. 128 (3 recoveries, 9 fatal). MUNDY, Revue Medico- Cliirurgicale des Ambulances, in Gazette des Hopitaux, 1870, p. 593 (1 fatal. 1 unknown). PONCET (F.), Contribution a la Relation medicale de la guerre de 1870-71, in Montpellier Medical, 1872, T. XXVIII, pp. 41, 44 (1 fatal). VASLIX (L.), tude sur les plaies par armes a feu, Paris, 1872, p. 189 (1 recovery). - BERGMANS (E./, Die Behandlung der Schusswunden des Kniege- lenks im Kriege, Stuttgart, 1878 (26 recoveries, 14 fatal, 5 unknown). 28 ASSENDELFT, loc. cit., p. 44 (12 recoveries, 1 fatal). w HARRIS (S. N.), Gunshot Wound of the Knee Joint, with Transverse Fracture of the Patella, in Charleston Medical Journal and Review, 1848, Vol. Ill, p. 42 (1 recovery). soCOHli (YV. II.), Case* and Observations, in Western Journal of Medicine and Surgery, 1854, Vol. II, 4th ser., p. 435 (1 recovery). 31 Ross (F. A.), Gun shot Wound of the Knee Joint, in New Orleans Medical and Surgical Journal, September, 1850, p. 178 (1 recovery). ^SCHUH, Ausschneidcn cincr Kartdtschenkugel aus dem Kniegelenke, in Wiener Med. Wochenschrift, 1851, p. 129 (1 recovery). 33 VAX BUHEN (W. H.), Gunshot Wound of Knee Joint, in New York Medical Times, August, 3855, Vol. IV, p. 387 (1 recovery). M ISNAHD (C.), Plaies penetrantes du genou, in L Union Medicale, Paris, 1865, T. XXVIII, 2 s6r., p. 595 (1 recovery). x JOHNSON (R. H.), Gunshot Wound of the Knee Joint, in Cincinnati Lancet and Observer, Cincin nati. 18G9, Vol. XII, p. 659 (1 recovery). ^ROOKKll (J. L), Gunshot Wound of the Knee Joint, with fracture of the Patella, in Western Join-, of Med., 18C8, Vol. HI, p. 281 (1 recovery.) 37 AlLEE (W. F.), Case of Gunshot Wound of the Knee Joint ; Removal of the Ball from the Articulation and Recovery, in Am. Jour. Med. Sci., 1867, Vol. L1V, p. 127 (1 recovery). ^M AIR, Schwere Kiirpcrverletzung durch einen Sclirotschuss in das Knie, in Friedreich s Blatter fiir gerichtliche Medicin und Sanitdtspolizei, Niirnberg, 1873, B. XXIV, p. 11 (1 recovery). 3 " IIUliBAKL) (L.), Gun-ihot Wound in the Knee-joint, in Pacific Hied, and Surg. Jour., 1870, Vol. IV, p. 302 (1 recovery). 40 IIOLDEN, Gvnshot Wound into the Knee-Joint, in British Medical Journal, London, 1871, Vol. I, p. 169 (1 recovery). 41 POWELL (J. L.) (Cases of Gunshot Wounds of Knee Joint and Pelvis, iu Virginia Med. Monthly^ Richmond, 1875, Vol. II, p. 35): Case of Lieut. G. L , Co. I, 5th Infantry, aged 32, wounded in fight with Indians, September 9, 1674, near Washitu River, Texas; fracture of patella and inner condyle of fomur of left knee; recovery. ^KOliER (G. M.) (Report of a Case of Gunshot Wound of the Right Knee-Joint and Right Hand, in Am. Jour. Med. Sci., 187G, Vol. LXXII, p. 427): Case of Serg t E. MoM , aged 24, accidentally wounded December 5, 1874; a load of duckshot entered the right knee, involving the tuberosity of the external condyle; lacerated wound of right hand; ring finger amputated through middle of second phalanx. Carbolated lotions applied to the knee without avail ; injections of solution of iodine substituted ; recovery, with anchylosed joint. 43 VOLKMANN, Verhandlungen der Deutschen Gesellschaft fiir Chirurgie, \1 Congress. Berlin, 1877, p. 39 (1 recovery). " CHANDLER (\V. T.) (Conservatism in the Treatment of Gunshot Wounds of the Knee, in Louisville Medical Mews, 1677, Vol. HI, p. 159): R. J , aged 18 ; ball entered about 1 inch above patella, passed downward through the knee, fractured the femur, and emerged in thu popliteal space ; amputation advised but not allowed by patient; recovery, with probably a useful limb. 46 GROSS (S. D.) (A Si/stem of Surgery, Philadelphia, 1872, 5th cd., Vol. I, p. 1039): Shot wound of the knee joint ; recovery. 1 BERGMANN (E.) (Die Behandlung der Schusswunden des Knicgelenks im Krieyv, Stuttgart, 1878, p. 15): In the night of the extensively planned and so gloriously successful crossing of the Danube, I was at the place of first dressing with a complete LISTER apparatus, with spray and excellently prepared gauze, aided by my Dorpat assistant, well schooled in the application of antiseptic dressings. The number of wounded was small, not exceed ing 480, and plenty of helping hands were present. The wounded were brought to us in very little time after receiving their injuries in short, I could not help taking hold, as I have just explained, of the gunshot fractures, and amongst them, also, of the fcnee wounds. But I soon desisted from my SECT. IV.] SHOT INJURIES OF THE KNEE JOINT. 419 complicated mode of treatment. Discarding the use of the spray apparatus, he dressed the wounds, immediately after the bleeding had ceased, thickly with salicylic cotton or jute, covering the same with a Mclntosh rubber cloth, and applied the gypsum bandage without fenestration over the entire extremity and part of the pelvis. Adding to the seven hundred and ninety-three cases collected in TABLE LLX, p. 417, the three hundred and thirteen cases of capsule wounds (page 28, ante] and the eight hun dred and sixty-eight cases of shot fracture of the knee joint treated by conservation during the American war (TABLE LIT, p. 367, ante), we have a total of one thousand nine hundred and seventy-four cases. The bony structure was not involved in four hundred and thirty- five, with three undetermined cases, three hundred and thirty-seven recoveries, and ninety- five deaths, or a mortality rate of 21.9 per cent. In one thousand five hundred and thirty- nine cases, lesion of the articulating ends of the knee joint was indicated; of these, six hundred and forty-seven were recoveries, eight hundred and seventy-one proved fatal, and in twenty-one the results remained undetermined, a fatality of 57.3 per cent. Excision at the Knee Joint. The results of the excisions at the knee joint performed during the late civil war, whether the operations were primary, intermediary, or secondary, were not very encouraging, forty-four of the fifty-four cases in which the issues were ascertained having terminated fatally, a mortality of 81.4 per cent., exceeding the mortal ity rate of the amputations in the thigh (53.8) by 27.6 per cent. Of the ten patients who survived excisions at the knee joint, one, Private W. M. Constable, 1st U. S. Cavalry (CASE 587, p. 387, ante], submitted to successful amputation at the junction of the middle and lower thirds of the thigh five days after the excision. Another, Private S. Miller, 1st Missouri Cavalry (CASE 632, p. 396, ante], was discharged the service and pensioned; but died two years and four months after the operation, from extensive suppuration of the leg and thigh and metastatic and pysemic abscesses in various parts of the body. As regards the results of the instances of excisions at the knee joint, these cases, therefore, must also be considered as failures. Of the remaining eight cases three recovered with fair use of limb. In the case of Lieutenant J. W. Harlee, 1st South Carolina (CASE 584, p. 386, ante], the upper portion of the head of the tibia was excised. The patella was not removed. The leg is shortened three inches; but with the aid of a high heel and thick sole to the boot the patient can walk without crutches. Private W. F. Jackson, 6th South Carolina (CASE 585, p. 386, ante], in whose case the condyles of the femur and the patella were removed, has a "good sound leg which answers every purpose." In the case of Captain Charles Knowlton, 10th Louisiana (CASE 616, p. 391, ante], one and a half inches of the condyles of the femur, one inch of the tibia, and the patella were excised. Firm ligamentous union followed, and, when last heard from in 1877, the patient could "not only walk almost as well as ever, but could dance even round dances." Less favorable than in the three fore going cases was the result in the case of Private J. Friel, 2d Kentucky (CASE 631, p. 395, ante). As in the case of Knowlton, the entire articulation, viz: one and a half inches of the condyles of the femur, one inch of the tibia, and the patella, was removed. The patient recovered with an anchylosed joint and four inches shortening; but the muscles of the limb below the knee became considerably atrophied and contracted, producing "talipes efforts, for I was unable to disinfect, cleanse, and wash out scrupulously, to bandage and to place in position with the care that this dressing, according to my conviction and experiences, absolutely requires. The water which we drew at the banks of the Danube to solve our carbolic acid in was anything but clear and transparent, being, on the contrary, turbid with slime, mud, and sand. For the purpose of filtering, or even ccoking itself, time and means were wanting. The spray apparatuses immediately became choked and spoiled, and in spite of a superabundant addition of carbol crystals, the water intended for disinfection retained its putrid odor." 420 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. equinus" while the muscular development of Captain Knowltoris leg remained excellent. In the case of Private Anson Rider (CASE 586, p. 386, ante), in which the condyles of the femur and the semilunar cartilages from the tibia had been excised, the patient was able to walk with the assistance of a cane at the time of his discharge ten months after the oper ation. Both lower extremities afterwards became paralyzed; but, according to the Pension Examining Surgeon s report, this may have been caused by malarial poisoning. Private E. Jewell s (CASE 629, page 394, ante) limb became atrophied and deformed, with contrac tion of the muscles and distortion of the foot. A portion of the head of the tibia and the head of the fibula had been excised. The evidence in the cases of Private J. E. Berry (CASE 630, page 394, ante) and Sergeant L. R. McWhorten (CASE 636, page 397, ante) is rather unsatisfactory, and beyond the fact that the former was mustered out forty-three days, and the latter furloughed twenty-seven days after the operation, nothing is known of their subsequent histories. As in the excisions at the elbow, the operations performed by the Confederate surgeons would seem to have given the best results; but it must be con sidered that, with the exception of the remarkable case of Captain Knowlton, the histories of the Confederate patients end with their discharge from hospital. In the cases of the Union soldiers the records are completed up to the present writing, and the remote results are found far less gratifying than the conditions of the patients at the time of their discharge from the service would seem to have warranted. For instance, in the case of Private Mil ler the success reported was so remarkable as to lead the editor, in the preliminary report, 1 published immediately at the close of the war in 1865, to doubt its authenticity. But, as stated above, and in CASE 632, p. 396, ante, subsequent reports, while verifying the account of the operative interference, revealed also the final fatal issue. These unfavorable results would seem to justify the declarations of Surgeon D. P. Smith, 2 U. S. V., that "this opera tion should be utterly discarded from the list of operations to be performed for gunshot injury;" of Surgeon H. S. Hewit, 3 U. S. V., that it is "highly questionable whether excision, gouging, or resection of any kind is to be permitted in traumatic surgery of the knee;" and of Dr. John Ashhurst, jr., 4 that "excision of this joint should be banished from the practice of military surgery." The results of this operation in the late European wars (TABLE LX, p. 422) were equally discouraging. In the Schleswig-Holstein War of 1864, the mortality after knee joint excision was 85.7 per cent.; in the Austro-Prussian War of 1866, 86.6 per cent.; in the Franco-Prussian War of 1870-71, 80.0 per cent.; and in the Russo-Turkish War of 1876-77, 100. per cent.; and, while some of the European surgeons 5 yet hope for 1 Circular No. 6, War Department, S. G. O., Washington, November i, 1865. Reports on the Extent and Nature of the Materials available for the preparation of a Medical and Surgical History of the Rebellion, Philadelphia, 1865, p. CO. 2 Surgeon D. P. SMITH, in charge of Fairfax Seminary Hospital, declares (Experiences in Military Surgery, in American Medical Times, 18C3, Vol. VI, p. 100): "I am prepared to utterly discard this operation from the list of operations proper to be performed for gunshot or other injury, for this reason, even in civil practice, where every advantage of rest and careful nursing can be had, it is a doubtful remedy. But it is admissible because it is, or should be, always done for caries, which should most certainly be considered by every surgeon as imperatively demanding as thorough excision as cancer." 3 Surgeon H. S. HKWIT, in his Report of the Surgery of the U. S. A. General Hospital No. 5, at Frederick, Md., in 1862 (B. MSS. 33, p. 37), states: " Three partial resections of the knee were performed. The operation consisted in laying open the joint, removing the fragments, and smoothing the abraded and roughened surfaces. In one case the whole of the internal condyle and two- thirds of the head of the tibia were taken away, leaving the patella untouched. In the other cases the operation was confined to the head of the tibia. They all three failed, as might have been expected;" nod on p. 43 adds: "The experiment of incising the knee joint and partially resecting signally failed. It was undertaken after consultation with several eminent civil and military surgeons, and I do not regret it, although the result of my experience has determined me never to repeat it. It is highly questionable whether excision, gouging, or resection of any kind is to be permitted in traumatic surgery of the knee." *AsnnunsT (.TOILS, Ju.), The Principles and Practice of Surgery, 2d edition, Philadelphia, 1878, p. 166. *HEIXK (C.) (Die Schussverlf.tzungen der Unteren Extremiti:ten, Berlin, 1866, p. 395) regrets that excision at the knee joint was not more frequently performed, and hopes that in a future campaign the question as to its value may be more definitely settled. SEXFTLEliEN (HUGO) (lieobachtungen und Bemerl-ungen ueber die Indikationen, dtn Ueilungsprocess, nnd die Nachbehandlung der Rcstctionen grosserer Gelenke, in LANGEKBECK 8 Archiv, B. Ill, Berlin. 1862, p. 101) declares the introduction of the excision at the knee joint in military surgery a problem of the future, which he hopes will take the place of amputation in the thigh. BlLLROTll (TH.) (ChirurgischeEricfe, Berlin, 1872, p. 2(57): " The unfavorable results of this operation in war seem to prove that the therapeutic of knee joint injuries by resection, until now, has not accomplished any more than before ; " but adds, on p. 271 : " To discard primary respctioti altogether, the observations are yet too few." STAHK (W.) (Veitriige zu der Statislik und den Endresultaten der Gelcnkresectionen, in SECT. iv.J SHOT INJURIES OF THE KNEE JOINT. 421 better results in future wars, considering the number of observations on record too few to arrive at general conclusions, and while others, 1 basing their opinions generally on the more propitious results obtained in civil practice, approve of the operation under favorable circumstances, the most experienced 2 have declared themselves against the expediency of excision at the knee joint in times of war, and only perform it when amputation has been refused by the patient. Of the fifty-seven patients on whom excision at the knee was performed, thirty-five were Union and twenty-two were Confederate soldiers. Of the former six survived, twenty- eight died, and one result remained undetermined, a mortality rate of 82.3 per cent. Of the latter four recovered, sixteen died, and the terminations in two cases could not be ascer tained, a fatality of 80.0 per cent. In twenty-six instances 7 recoveries, 18 deaths, and 1 undetermined case the right limb was injured; in seventeen 1 recovery and 16 deaths the left; in fourteen instances the side injured was not recorded. In seven cases, 3 with 1 recovery, the excision at the knee was succeeded by amputation in the thigh. V. CZERXY, BeitrVge zur Operative*, Chirurgie, Stuttgart, 1878, p. 325) trusts that "primary excision may retain its place in wur surgery." SuciN (A.) (Kriegschirurgische Erfahrungen, Leipzig, 1872, p. 1C9), although he performed 4 excisions at the knee joint, all of which proved fatal, concludes: "For all cases in which not only the nature of the injury, but also the surrounding circumstances permit it, I would recommend the primary excision. I live yet in hope that this operation will retain its place in military surgery." Professor v. XUSSBAUM, on the other hand, considers excision at the knee joint in peace as well as in war as a less dangerous operation than amputation in the thigh ( Ueber die Resectionen des Kniegelenks, in Aerztliches Intelligent blatt, 1873, No. 9, p. 136): Dr. NU8SBAUM performed, during the Franco- Prussian War, 1870-71, 26 excisions at the knee joint (25 on the battlefield and 1 in hospital), and claims that 7 of these operations terminated successfully. But Professor E. GURLT, in his exhaustive work : Die Gelenk- Resectionen nach Schussverletzungen, etc., Berlin, 1879, p. 603, etc., thoroughly analyses the results in the alleged cases of recovery after excision in the knee joint by V. NUSSBAUM, and proves that in one case the excision was followed by amputation in the thigh terminating in death ; that in another the patint died after 4 years of suffering from fistulous openings in the joint; that in the remaining four cases no subsequent history can he obtained, as the names given by Dr. XUSSBAUM, after a most careful scrutiny, cannot be found on the official muster rolls, nor among the claimants for pension; and Professor GURLT concludes, therefore, that of the excisions performed by v. NU68BAUM only one can be claimed with certainty as a successful operation. 1 RUPPRECHT (L.) (Militiirarztliche Erfahrungen, Wtlrzburg, 1871, p. 82): "Resection at the knee should not be performed unless immediately after the operation the measures are at hand for the most careful after treatment and perfect rest." KtiSTEll (E.) (Zur Resection des Kniegelenks im Kriege. .* in Deutsche Militairilrztliche Zeitschrift, 187;!, p. 447): "Primary total excision of the knee joint for shot injuries, unless contravened by especially unfavorable circumstances, is preferable to amputation." FEHR (M.) (Ueber die Resection im Kniegelenk, in Berliner Klinische Wochenschrift, 1872, No. 4(>) concludes that : " In superficial shot injuries of the epiphysis of the femur or tibia, excision at the knee joint is indicated whenever the external circumstances are favorable and whenever by resection of the bony structure everything obnoxious can be removed. KOENIG (Beitrllge zur Wiirdigumj df.r Resection des Kniegelenkes nach Schussverletzungen, in Berliner Klinische Wochenschrift, 1871, No. 30, p. 355), from his experience in civil life ami in military hospitals far remote from the seat of war, is inclined to favor excision at the kuee in military surgery, while Oberstabsarzt J. ECKER (Zur Total Resection des Kniegelenkes, in Wiener Medicinische Wochenschrift, No. 34, 1877, p. 817) defends the operation on the ground of art and humanity. 2 MACCoilMAC (\VM.) (Notes and Recollections of an Ambulance Surgeon, London, 1871. p. 119): "Excision for wounds of the knee maybe success fully performed in civil practice, but is not justifiable in military." LOCKE (A.) (Kriegschirurgische Fragenund Bemerkungen, Bern, 1871. p. GO): " Resec tioii of the knee in war surgery has not recommended itself; I only perform it when amputation is refused; and I cannot boast of my success." COUSIN (A.) (De la valeur de la resection du genou en temps de guerre, in Bull. Gen. de la, Therapeutique Med. et Chir., Paris, 1873, T. 84, p. 161): " Mais, en temps do guerre, a la suite des batailles qui amenent fatulement rencombremeut des ambulances, la necessit6 des Evacuations successives des blesses avec des moyens de transport le plus souvent defectueux et partant I irnpossibilit6 d assurer aux oper6s, d une part, les soins minutieux dont ils doivent e tre 1 objet, 1 isolement, seule gnrantie certaine contre I infection purulente et la septic6inie, et, d autre part, I immobilisation absolue du membre blesse, condition sine qua non du succds de 1 expectation ou de la resection, selon que Ton a adopt6 1 uu ou 1 autre de ces modes de traitement, toutes ces conditions dleo- tueuses que nous venous d enum6rer expliquent et justifieut la reprobation dont les chirurgiens militaires ont frapp6 la resection du genou." Sl ILLMANN (E.) (De la resection du genou envisagee au point de vue du traumatisme, in Archives Generates de Medecine, 1868, T. XI, ser. VI, p. 690) cites 19 cases of excision at the kuee joint with only 2 recoveries, and exclaims: "Toutes les illusions doivent tomber devaut une pareille experience; la rdsection no pent s appliquer a la chirurgie d arm6e, si ce n cst dans des conditions Ires exceptionnelles." CZERNY (VixcEXZ) (Bericht ueber die im College Stanislaus in Weissenburg behandelten Verwundeten, in Wiener Med. Wochenschrift, 1870, No. 59, p. 1429), on account of his many sad experiences, "could not persuade himself to perform knee joint resection again." Induced by the excellent results achieved in civil practice, Generalarzt BECK recommended and practised primary excisions in cases of shot fractures of the articular extremities without lesion of the blood vessels and without extensive laceration of the soft parts. "The results," he remarks {Chirurgie der Schussverletzungen, Freiburg, i. B. 1872, p. 883), "> n no way came up to my expectations, although, with the exception of two cases, the operation was clearly indicated, the condition of the wounds was well suited to the operation, and, with one exception, the operations were skilfully performed, and in one instance only, too early transportation perhaps interfered with the result. Of the nine patients operated upon, seven died; of the remaining two, one had to have the thigh amputated afterwards, and one only, therefore, survived with preser vation of the limb." LEGOUKST (L.) (Traite de Chirurgie d armee, Paris, 1872, p. 57!)): "Xous doutons que la resection du genou puisse jamais etre substitu6e d une maniere genurale a 1 amputation de lacuisse, dans la chirurgie d armee. LOTZHECK (Zur Kniegelenk-Resection nach Schussverletzungen, in Aerztliches Intelligenz-Blatt, 1872, No. 32, p. 419) advises amputation in thelower third of the femur as preferable to excision. PIUOGOFF (N.) (Btricht ueber die Besichtigung der Mil.-Sanitiltsanstalten in Deutschlnnd, etc., im Jahre 1870, Leipzig, 1871, p. 110) has not, in the seventy hospitals he visited, seen a single case of recovery after amputation in this joint. HUKTER (C.) (Klinik der Gelenkkrankheittn mit Einschluss der Orthopxdie, Leipzig. 1870-71, p. 507): " Resection of the knee joint in perforating shot wounds must not be performed when the accompanying fracture of the femur or tibia extends beyond the joint surface. It must also not be performed when the necessary guaranty cannot be had for careful attention and after treatment of the wounded. 1 3 The cases in which the excision at the knee joint was followed by amputation in the thigh arc: 1. Private \V. E. L. Morrison, 1, 29th Connecticut (TABLE XXXV, No. 388, p. ?85, and CASE 607, p. 390), intermediary, in middle third of femur; fatal. 2. Private W. M. Constable, H, 1st Cavalry (TABLE XXXV, No. 43, p. 280, and CASE 587, p. 387), intermediary, in the middle third; recovery. 3. Corporal A. Glazier, B, 1st Minnesota (TABLE XXXVI, No. 366, p. 298, and CASE 606, p. 390), intermediary, in lower third; fatal. 4. Private J. W. Derr, E, 7th Maryland (TABLE XL, No. 128, p. 321, and CASE COS, p. 390), secondary operation in lower third; fatal. 5. Private S. Lininger, H, 74th Indiana (TABLE XL, No. 157. p. 322. nnd CASE 639, p. 397), secondary operation in lower third; fatal. C, 7. Two unknown Confederate soldiers (TABLE XL1. p. 303. Nos. 9, 10, and CASES 611, 612, p. 390). 422 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TABLE LX. Excisions ai the Knee Joint for Shot Injury on the Occasions named and from the Authorities quoted. OCCASIONS. CASES. PKIJIARY. INTERMEDIARY. SECONDARY. PERIOD UNKNOWN. Recovery. "3 1 Result M Unknown. Mortality of Determined Cases. Recovery. "3 1 Recovery. "3 "a PM . c If Recovery. 1 fc Result > Unknown. Recovery. "3 "5 h Prior to September 15 1862 (Note 1 p 384) 18 2 7 o 8 2 1 1 9 52.9 .0 o 3 o 1 6 3 ~ Accidents 1862 1863 (VERNEUIL 1 ) Danish War, 1 864 (NEUDORFER, 2 LCEWENHARDT, 3 OCHWADT, 4 ESMARCI-I 6 LANGENBECK 6 ) 6 1 13 85.7 50.0 2 1 1 1 3 French in Mexico and Algiers, 1865 (NEUDOUFER, 7 DAUVE 8 ) SixWeeks War,186G(BAERWINDT, 9 BlEFEL, 10 BURCIIARDT, n BUSCH, 12 FIEBER, 13 HA1IX, 14 JUNG, 18 KOXIG, 16 LANGEN BECK 7 MlDOELDORPF I8 RAST " TEXTOR 20 WAGNEH 21 ) 1 86.6 1 7 1 1 5 1 Accidents, 1866-1868 (BUXMANN, 22 THOMPSON, 23 OATMAN 24 ). Franco-Prussian War, 1870-71 (GUKLT 25 ) 3 3 IT .0 60 80.0 33.3 100. .0 9 1 14 1 o 1 35 1 1 10 3 1 Accidents, 1871-1873 (NEWMAN, 26 MINER, 27 MEU6EL 28 ) Russo-Turkish War, 1876-1877 (REYHER, 29 BERGMANN, 30 KADE 31 RuooucK 32 ) 3 2 1 6 1 o 1 1 ] Accident 1876 (TwiTCHFLL 33 ) 133 1 96 23 1 3 35 2 73.2 14 46 1 n 22 1 VERNEUIL (A.) (De la resection du genou, iu Gazette Hebd. de M&d. et de Chir., Paris, 1862, T. IX, No. 46, p. 722): A young man, aged 18, in the fall of 1862 received a pistol shot in the knee joint ; resection, five days after injury, of the articulating ends of the bone ; cicatrized in seven weeks. In a communication to the Societe de Chirurgie ( Gaz. des Hop., Paris, 1864, No. 54, p. 215), at their meeting of April 27, 1864, VERNEUIL related the case of a poacher shot through the patella in 1863; neither femur nor tibia fractured ; secondary excision of condyles of femur and tibia ; recovery with anchylosis in HJ months. 2 NEUDORFER (J.) (Uandbuch der Kriegschirurgie und der Operation slchre, Leipzig, 1872, Zweite Halfte, Zweite Abtheilung, p. 1546, and GUKLT (E.) (Die Gelenk-Kescctionen nach Scliussverletzungen. litre, Geschichtf, Statistik, Endresultate, Berlin, 1879, p. 278): Ferd. Blumaner, 27th Austrian Infantry Regiment, 1st Co., wounded February 6, 1864, at Oversee, by ricochet snot in the left knee. March 11, 18G4, resection in hospital at Schleswig. Death April 2, 1864. Wasil Dumma, 30th Austrian Infantry, wounded at Oversee, March 5, 1864, in the left knee joint. Wound healed rapidly in seven weeks, but broke open again and suppuration ensued. Resection March 13, 1864. Amputation of thigh April 8, 1804. Death from exhaustion April 13, 1864. 3 Prussian Staff Surgeon LCEWENIIARDT operated in the case of Peter Jensen Ugle, 4th Danish Infantry, aged 27, wounded at . Alsen, June 29, 1864 ; epiphysis of the right femur perforated antero-posteriorly, and external condyle shattered. July 13, 1864, resection, by H-incision, in hospital at Ulderup: about 4 inches of the femur, the patella, and a slice of the tibia removed. Recovered, and living in 1874 (C. HEINE, Die Schuss- verletzungen der Untcren Extremitdten, Berlin, 1866, p. 393, and GuitLT, Joe. cit., p. 318). 4 OCHWADT (A.) (Kriegschimrffische Erfaltrungen, etc., wiihrend des Krieges gegen Danemark 1864, Berlin, 1865, Anhang, Tdbelle der Operationen, p. VI, No. 20, and GURLT, loc. cit., p. 319): Sb ren Jacobsen, 9th Danish Infantry, wounded at Diippel, April 18, 1864, in the left knee ; epiphysis of the femur split into three parts and joint opened; patella and tibia intact. Resection April 19, 1864, in hospital at Flensburg. Only the epiphysis of the femur was removed. Death May 7, 1864. 8 EBMAHCH S case of Chremers Petersen, 9th Danish Infantry, -wounded at Diippel, April 18, 1864, in the right knee; joint opened; resection in hospital at Broacker, April 21, 1864, by oval incision; patella retained. Death May 1, 1864 (GURLT (E.) (toe. cit., p. 319). B. v. LANGENBKCK twice excised the knee joint in the Schleswig-Holstein campaign of 1864: Jensen, 3d Danish Infantry, wounded at Alsen, June 29, 1804, through the right joint, shattering the bone; ampu tation was refused; subperiosteal resection, with inner longitudinal incision; patella retained, July 19, 1864. Death July 22, 1864. Stjernholm, 18th Danish Infantry, wounded at Alsen, June 29, 1864 ; penetrating shot wound of right knee joint. August 1st, subperiosteal resection of both carious ends of the joint. Death August 7, 1864 (GURLT, loc. cit., p. 319). 7 NEUDORFER (J.) (IlandbucJi der Kriegschirurgie und der Operationslehre, Leipzig, 1872, Zweite Halfte, Zweite Abth., p. 1550, and GURLT, loc. cit., p. 328): Kaspar Ruppnik, 1st Austrian-Mexican Chasseur Co., aged 41, wounded at Tlapa- coyan, November 22, 1865, in the left knee; patella shattered, joint opened on the outer side. December 28th, resection. Living in 1872, his confessor writing from Schwarzenberg that the injured extremity is entirely stiff; that he is unable to do any hard labor, but can make considerable journeys with the aid of a cane. 8 DAUVE (Lesions traumatiques des deux genmix par coup de feu. Articulation du genou gauche ouverte el broyee ; resection du genou, in Rec. de Mem. de Aled. de Cliir. et de Phar. Mil., Paris, 18G7, T. XIX, 3 me s6r. p. 29): An Arab, nearly 20 years of age, was shot in both knees, on July 26, 1865, and, on the following day, was admitted into the hospital at Boghar. The upper part of the internal rondyle of the right femur was frac tured, but the capsule was not thought to be interested; two small pieces of bone were removed. The injury of the left limb was more severe. The internal condyle of the femur was crushed and the articulation largely opened. Amputation proposed but not allowed by the patient. July 27th, patella removed, and portion of condyles of femur and tibia excised. Death August II), 1865. BAERWINDT, of Frankfurt, operated in the case of W. Ranch, 2d Silesian Grenadiers, No. 11, 8th Co., aged 26, wounded at Vettingen. July 26, 1866, in the left knee joint. Septembpr2d, admitted into Garrison hospital in Frankfurt, a. M. Resection of both condyles in their middle September 12th ; ball not found. Death October 5, 1866 (GUULT, loc. cit., p. 397)- 10 BiEFEL (II.) (Im Reserve- Lazareth. Kriegschirurgische Aphorismen von 1866, in LANOENKKCK S Arcliiv fur Klin. Chir., Berlin, 1869, B. XI, p. 450): Joh. Palyo, 34th Austrian Infantry, 13th Co., aged 24, wounded at Koniggratz, July 3, 18G6, in the left knee joint, shattering the patella. July 8th, admitted into reserve hospital at Landeshut. Resection August 9th. Death September 14, 1866. n Dr. BURCIIARDT excised the knee in the case of Josef Drozdz, 20th Austrian Infantry, aged 27, wounded at Koniggratz, July 3, 1866, close beneath the right knee. Resection July 10th, removing the patella and portions of the tibia and condyles of the femur. July 19th, haemorrhage from popliteal artery ; ligation of femoral artery. Death 20 minutes afterwards, July 19, 1866 (GURLT, loc. cit., p. 487). 12 Dr. Buscn (ScilOLZ W.) (Bericht iiber das Verwundeten-Spital Schloss Hradek bei Koniggratz vom 28. August bis zu dessen Aujlasung am 6. November 1866, in Allgcmeine Militararztliclie Zeitung, 1867, S. 324, 357, and GURLT, loc. cit., p. 486): Case of Joh. Necasek, Corporal, 74th Austrian Infantry, aged 24. wounded at Problus, July 3, 1866, in the right knee joint; the ball lodged and was removed SECT. IV.] SHOT INJURIES OF THE KNEE JOINT. 423 Amputations at the Knee Joint. As indicated in TABLE LIV, on page 398, the fatal ity of one hundred and eighty-seven cases of amputation at the knee joint in which the <m the Uth day. July 13th, conveyed to Castle Ilmdek Hospital. Resection July 15th ; fistulas, erysipelas, etc., ensued, and on July 3, 1867, at the solicita tion of the patient, amputation was performed in the middle third of the thigh. Dr. BUSCH performed two additional operations in 18GG: Alfred Graf, sublieutenant, Austrian Cuirassiers Regiment, Xo. 2, aged 18, wounded at Koniggratz, July 3, 186G, through the right knee joint, fissuring the femur extensively. Admitted into Castle Ilradek Hospital. Resection, July 27th, of about four inches of the lower end of the femur and patella. Death Aug. 2, 1866. Anton Dnnda, 8th Austrian Infantry, aged 25, wounded at Koniggratz, July 3, 1866, in the left knee joint. Admitted into Castle Hradek Hospital. August 1st, resection of about 1J inch of end of femur. August 6th, ligation of femoral artery below Poupart s ligament on account of arterial haemor rhage. Death August 7, 1866 (GURLT, loc. cit., pp. 487, 488). 13 FlKBEK (CAUL) (Chirurgische Studien und Erfahrungen mit Zv.gr undelegung der im italienischcn Feldzuge des Jalires 18G6 gemachten Beobachtungen, in Allgemeine Wiener Med. Zeitung, 1875, No. 21, p. 202): Nicolo Pinosco, 1st Italian Grenadier Regiment, wounded at Custoza, June 24, 18GG, in the left knee by a grenade splinter; patella shattered, joint opened. Admitted into hospital at Verona. Resection July 7th; pieces of patella entirely extirpated; both condyles removed. Death on the evening of July 9, 1866. 4 Dr. HAHN operated on Carl Bcihm, 42d Austrian Infantry, wounded at Koniggratz, July 3, 1866, through the right knee joint. Admitted, July 6th, into hospital at Horic. August 7th, resection of about 1 inch of tibia and fibula and 1J inch of femur. August 27th, haemorrhage, followed by death in a few minutes (GuiiLT, Inc. cit., p. 488). 16 Dr. JUNG, of Frankfurt, a. M., operated in the case of Gustav Hombogen, non-commissioned officer of Magdeburg Fusileer Regiment, No. 36, aged 23, wounded at Vettingen, July 26, 1866; penetrating shot wound of the knee joint. Admitted into Relief Hospital Xo. 4, Frank furt, August 9th. Resection, August 15, 1866, of knee joint. Death from pyaemia August 19, 1866 (GuilLT, loc. cit., p. 398). IB K6.\IG (Beitrdge zur Resection des Kniegclcnkes, in Archie fur Klin. Chir., 18C8, B. IX, s. 465, and GURLT, loc. cit., p. 485): Leopold Anzenberger, Austrian Infantry Regi ment, No. 40, aged 25, wounded near Aschaffenburg, July 14, 18GG, in the left knee joint. On September 10th he was admitted into hospital at Ilanau. Resection, September llth, of about 2i centimetres (broad) of the femur, the fractured patella, and a piece of Hie tibia about a centimetre broad. Living October 11), 1874, having been engaged in shoemaking for three years. Leg shortened 2 inches. I7 B. V. LANGENBECK ( Ueber die Schusi-fracturen der Gelcnlce, etc., Berlin, 1868, p. 33. and GUULT, loc. cit., p. 398): Case of Simon Bach, Pommeranian Field Artillery, aged 24, wounded at Koniggratz, July 3, 1866; right knee joint shattered by splinter of grenade; capsule opened. Admitted into hospital at Milowie, July 30th. Subperiosteal resection of the knee joint. Death August 5, 1860. 18 Dr. MlDDELDORPF operated on Constantin v. Memerty, 2d Lieutenant, 7th East Prussian Infantry, No. 44, aged 23, wounded at Koniggratz, July 3, 1866. Besides two slight flesh wounds, the left knee joint was shattered by a piece of grenade, the patella carried off, and the joint opened. Resection, July 10th, in hospital at Koniginhof. Death from pyaemia, July 27, 1866 (GURLT, loc. cit., p. 398). 19 Surgeon RAST excised the knee in the case of Michael Maier, 1st Bavarian Infantry, aged 2G, wounded at Vettingen, July 26, 18G6, at inner condyle of left knee. Admitted into hospital at Wilrzburg August 18th ; resection, August 30th, of condyles, patella, and a slice of tibia. Death, September 17, 1866, from pyainia (GURLT, loc. cit., p. 418). 20 Professor KARL TEXTOR, in the case of Andreas Jorg, 9th Bavarian Infantry, 3d Co., resected the knee joint in hospital at Wttrzburg. Death August 1C, 18GG (GURLT, loc cit., p. 419). 21 Generalarzt WAGNER, in the case of Franz Skazel, Field Chasseur Bat talion, No. 27. aged 20, wounded at Koniggratz, July 3, 1866, in the left knee, and admitted into hospital at Gorlitz on July 30th, removed, on August 3ist, the patella. Death September 29, 1866 (GURLT, loc. cit., p. 488). 22 Surgeon BUXMANN: Case of Corporal H. Schildgen, Hessian Sharpshooter Corps, aged 30, wounded accidentally, September 16, 1866, in the right knee ; joint opened, tibia and fibula uninjured. Resection of knee joint about 16 or 18 hours after injury; removal of patella, head of fibula, articular portion of tibia, and the splintered femur 1J inch above its articulating extremity. Recovered July 21, 1875; shortening 10 centimetres; walks about all day, but feels very tired in the evening. Cicatrix adherent; total anchylosis of joint; leg entirely straightened; can walk up hill easier than down hill; uses no supporting apparatus (GURLT, loc. cit., p. 1191). "THOMPSON (HEXHY) ( Gunshot Wound of the Knee Excision of the Knee Joint, in The Dublin Quarterly Journal of Medical Science, 1868, Vol. XLVI, p. 27): Case of Peter McSorley, a carpenter, shot February 29, 18(i8, in his bent right knee. Admitted into Tyrone County Infirmary at Omagh. March 1, 1868, resection of 2.V inches of the femur, a very thin slice of the head of the tibia, and all the fragments of the patella, shot, and pieces of lead. For weeks afterwards pieces of bone, lead, shot, etc., continued to discharge. July 1, 1868, patient able to go about with the aid of a crutch and cane and without splints, limb being shortened about H inch. 24 OATMAN flUA T.) (Excision of the Knee Joint, in Pacific Med. and Surg. Jour., 1869, Vol. Ill, N. S., p. 56): C. G , of Yolo County, California, aged 16, wounded March 10, 1868; penetrating shot wound of knee joint, resulting in caries. Resection May 21, 1868; removal of lower portion of condyles, anterior articular surface of femur beneath the patella, the patella, head of tibia, and fragments of fibula. October 15, 1868, amputation of thigh on account of continuous progress of caries of the femur and leg ; recovered. 26 For details of the cases of excision of the knee joint of the Franco-Prussian War of 1870-71, the reader is referred to the exhaustive work of Professor E. GURLT, Die. Gelenk-Resectionen nach Schussverletzungen, etc., Berlin, 1879, pp. 602, etc. From a careful and critical examination of the sources at his command, Dr. GURLT collects 75 authentic cases of excisions at the knee joint performed during that short but decisive struggle: 15 were successful and GO proved fatal, a mortality rate of 80.0 per cent. - XEW5IAN (Wll.) (Gunshot Wound of Right Knee Joint, twenty-fire years ago Removal of Lower Half of Patella (carious), and of shot imbedded in inner Condyle of Femur, from a patient aged 55, in St. Bartholomew s Hospital Reports, London, 1874, Vol. X, p. 392), in the case of J. T , accidentally shot in the right kneo. Excision March 29, 1871. Recovery, with bony anchylosis. "MINER (J. S.) (H. CUMiERTSON, Excision of the Larger Joints of the Extremities. Prize Essay, in Trans. Am. iled. Assoc., Philadelphia, 1876, Supp. to Vol. XXVII, p. 186, Case No. 37): Thomas S. Cobb, of Buffalo, N. Y., aged 35, received, on November 8, 1871, a pistol shot in the articulating surface of the tibia. Resection, on November 10th, of both surfaces of joint. Died 15 days afterwards of pyaemia. ^Dr. MEUSEL (Einc, Kniegelenkrescction nach Schussverletzttng, in Ber liner Klin. Wochcnschrift, 1875, XII Jahrg, S. 272): Case of Zeiss, aged 25, wounded November 1, 1873, by a revolver shot in the left knee ; ligamcntum patella? perforated, missile lodged in the epiphysis of the tibia about 5 centimetres deep. Resection November 9, 1873. removing a piece from the con dyles of femur 4 centimetres thick, without touching the patella, and resecting the tibia so as to leave the fibula joint unopened. Discharged from treat ment April 8, 1874, walking on crutches; he subsequently accustomed himself to walk with a light cane; shortening 5 centimetres. ^REYIIER (G. TILING, Bericht iiber 124 im Serbisch-Tiirfischen Kriege im Baracken-Lazareth des Dorpater Sanilats-Ti-ains zu Swilainatz belinndelte Schussverlet- zungen, Dorpat, 1877, pp. 67, 68, and GURLT, loc. cit., p. 1160) performed 3 excisions at the knee joint during the Russo-Turkish War, 1876-78 : Rista Bokowitsch, nged 35, wounded September 18, 1876, in the external condyle of the right femur; ball removed. Resection of knee joint SeptemberSl, 1876, at Swilainatz. Death September 22, 1876. Radojiza Schiwanowitsch, aged 40 ; admitted into hospital at Swilainatz, September 2, 187G, with penetrating shot wound of left knee joint, fracturing the femur, received several days previous. Resection of entire lower portion of femur. Died September 13, 187G. Gaja Miliwojewitsch, aged 34, admitted into hospital at Swilanatz, August 22,1876, with a shot wound of left knee joint received two and a half weeks previously. Resection of both condyles of femur, August 23, 1876. Death from pyaemia August 31, 187G. 30 BERGMAN.v (E.) (Die Behandlung der Schusswunden des Kniegelenks im Kriege, Stuttgart, 1878, pp. 30, 31): Aleksci Neboschenko, Russian Regiment WoUiynicn. aged 27. wounded at the crossing of the Danube, June 15, 1877, in the right knee joint. Primary resection of the shattered condyles of femur. Death July 2, 1877, from pyamiin. 31 KADE (E.) (Das tewpordre Kriegslazareth des Rcssorts der Anstalten der Kaiserin Maria im Kloster Mariahimmelfahrt bei Sistowa, in St. Peters- burger Sled. Wochenschrift, 1877, S. 381. 1878, s. 19): Peter Petrunja, 14th Russian Sharpshooter Battalion, wounded on the Nicolai Mountain. August 13, 1877. through the left knee. Resection, October 5, 1R77, in hospital at Sistowa, of articulating ends of femur and tibia. Death October 8, 1877. 32 RUDnuCK operated twice during the Russo-Turkish War, 1876-78 (SociM ottomane de secours aux blessfs et malades militaires constitute d apres la Convention de Geneve, Vol. Ill, Ambulances fixes et mobiles du Croissant rouge, Constantinople, 1878, pp. 137, 232): Ahmed Ibrahim, wounded September 8, 1877, in the right knee. Resection, September 22, 1877, of the condyles and articular facet of the tibia, in hospital Le Mevle-Hane, at Philippopolis. Hassan Ali, penetrating wound of right knee joint; ball in one of the condyles of the femur. Resection. October 25, 1877, of knee joint, in field hospital No. 5, at Orkhanie. Death from pyaomia. 33 RlcilARDSON (A. P.) (Proceedings of the Connecticut River Valley Medical Association, in Boston Med. and Surg. Jour., 1878, Vol. XCVIII, p. 43): A girl, aged 14, accidental shot wound of knee joint, in 1876 ; excision of articular end of bones by Dr. TWITCHELL, of Keene, N. H. Recovery, with 2 inches shortening and a useful leg. 424 INJURIES OF THE LOWER EXTREMITIES. [OHAV. X. final issues were determined was 56.6 per cent., viz: fatality of one hundred and seven primary operations, 53.2 per cent.; of fifty intermediary, 68.0 per cent.; of twenty-six secondary, 53.8 per cent.; and of four operations in which the date of the amputation was not ascertained, 25.0 per cent. These results do not sustain the opinion expressed in the preliminary report, issued in 1865, that the mortality, especially of primary amputa tions in the lower third of the thigh, is much larger than that of the exarticulations at the knee joint. It will be remembered that the fatality of the amputations in the lower third of the thigh was 53.6 per cent., and of the primary amputation in the lower third only 48.7 per cent. (TABLE XXIX, p. 213), or 3 and 4.5 per cent., respectively, less than that of the corresponding groups of amputations at the knee joint, and the former operation would, therefore, seem to give a better chance for life than the latter. It must also be taken into consideration that in 8, or nearly 10 per cent., of the eighty-one cases of recovery after amputation at the knee, amputation in the thigh subsequently became necessary. The mode of operation in amputations at the knee joint has been varied in many ways: by a semilunar incision .in front and a long posterior flap behind, as practised by Hoin, in 1764; 1 by the long anterior flap of Le veille ; 2 by the anterior and posterior semi circular flaps of N. Smith, 3 the patella being retained; by the circular method of Velpeau, 4 three or four inches below the patella; by the oval method of Baudens, 5 consisting of one flap, long anteriorly and short posteriorly; by the lateral flaps of Rossi; 6 and by three sub cutaneous flaps (one anterior and one posterior, the latter split up along the middle of the popliteal space) from the circumference of the upper part of the leg, as proposed by Pan- coast. 7 Syme, 8 in 1845, made a semilunar incision on a line with the upper edge of the patella and a long flap from the calf of the leg, after the manner of Hoin, but he removed the condyles and the patella. Garden, 9 since 1846, cut an anterior semioval skin flap, removing the patella and portions of the condyles of the femur. Operations similar to Garden s were performed by Melchiorj 10 in 1850 and 1851, but the patella was retained in these cases. In 1857, R. Gritti proposed to cut an anterior rectangular flap, to saw through the condyles of the femur, to remove a segment of the inner portion of the patella and to place the sawn surfaces in apposition, to secure in this manner a sound surface to 1 BRASDOII (Sur les amputations dans les articles, in Mem., de VAcad. Roy, de C ltir., Paris, 1774, T. V, p. 773;, who practised the operation at Dijon, in 1764, on a laborer who had fallen from a building. 2 LEVEILLfc (J. B. F.), Nouvelle doctrine chirurgicale, Paris, 1812, T. IV, p. 586. 3 SMITH (NATHAN) ( On Amputation at the Knee Joint, in the American Medical Review and Journal, 1825, Vol. II, p. 370) marked "two points one on the out and the other on the inside of the limb, the latter half an inch below the head of the tibia, and the other opposite to it. Then draw u semicircular line from one point to the other, over the anterior part of the leg, and in such a direction that its lower part shall touch the lower part of the tubercle on the tibia into which the ligament of the patella is inserted, and then mark another circle on the posterior part of the leg, exactly corresponding to the former. The above lines limit the two flaps, the former of which will be formed of the patella and its ligament, together with the investing integuments, and the latter of the head of the gastrocnemius, the tendons of the flexor muscles, and the popliteal blood-vessels and nerves. The operator should first raise the anterior flap with the patella, which will expose the anterior part of the joint and render the division of the lateral ligaments easy. Two or three strokes of the knife will then complete the section of the lower flaps, with the crucial ligaments." 4 VELPEAU (A.), Memoire sur I amputation de la jambe dans I articulation du genou, et description d un nouvcau procede pour pratiquer cette operation, in Archives Genirales de Medecine, 8 me annee, T. XXIV, 1830, p. 58. *BAVDEXS (L.) (Clinique des plaies d armes <t feu, Paris, 1830, p. 537, and Desarticulation cnxo femoral et tibio-femorat, in Bulletin de I Acad. Roy. de Mid., Paris, 1836, T. I, p. 324) recommends a combination of the oval and flap methods. A long oval flap anteriorly, commencing five inches below the patella, is dissected and turned up ; the ligaments, muscles, and vessels are next divided by a circular incision, the articulation la opened, and the semilunar cartilages and crucial ligaments detached as in the circular process of VELPEAU. 6 ROSSI (R.), Eltmensde Medecine Operatoire, Turin, 1806, T. II, p. 227. 7 PAXCOAST (JOSEPH), A Treatise on Operative Surgery, Philadelphia, 1846, p. 171. 8 SYME (JAME?), Surgical Cases and Observations, in London and Edinburgh Monthly Journal, 1845, p. 339. 9 GARDEN (HENRY D.) (On Amputation by Single. Flap, in British Medical Journal, 1864, Vol. I, p. 416): It consisted "in reflecting a rounded <jr gemi-oval flap of skin and fat from the front of the joint; dividing everything else straight down to the bone; and sawing the bone slightly above the plane of the muscles ; thus forming a flat-faced stump with a bonnet of integument to fall over it." The patella was not retained in this operation. 10 MELCHIORJ (G.) (Caso di amputazione sopracondiloidea del femore col metndo del dott. ROCCO GlUTTI, doe con lembo patellarc, per ferita da arma dafuoco; prectduto da allri due, in cuifu conservata larotelladisarticolando il ginocchio ed amputando ai condili femorali ; in Annali Universali di Medicina, Miluno, 18G7, Vol. CO, pp. 370, 371); but in these operations the entire patella was retained. One of the patients on whom the amputation was performed recovered from the operation, but died of recurring cancerous tumors four and a half months after the operation. The patella, deprived of its cartilage, was found, held by adhesions, in the intercondyloid notch ; the skin of the flap adhered to the condyles. In the other case, the operation was performed at the level of the condyles for a railroad accident, in 1851. The anterior flap sloughed, but filially the patella became unchylosed to the outer part of the femur and the patient recovered with nn excellent stump. SECT, iv.] SHOT INJURIES OF THE KNEE JOINT. 425 the stump. 1 From the records it would seem that this mode of amputating at the knee joint was practised once only during the late civil war in the case of Private C. H. Hist, 36th Wisconsin (CASE 492, p. 318, and TABLE LV, p. 402, No. 38), who subsequently underwent secondary amputation in the lower third of the thigh; although, as already stated on page 357, ante, similar procedures were employed by Surgeon B. A. Vanderkieft, U. S. V., and Assistant Surgeon J. W. S. Gouley, U. S. A., in two instances of amputations in the lower third of the femur. In the Danish War of 1864, the Austro-German War of 1 R. GRITTI, Dell amputazione del femore al terzo inferiore e delta disarticolazione del ginocchio. Valore relative di cadauna, coll indicazione di un nuovo metodo denominate amputazione del femore ai condili con lemlo patellare, in Annali Universali di Medicina, Milano, 1857, Vol. CLXI, p. 5. The author, who found no occasion to practise the amputation on the living subject, gives, on page 18, a minute description of the operation, of which the following is a brief outline : An incision is made from the upper edge of the head of the fibula transversely across the leg, about one inch below the patella, to the inner tuberosity of the tibia. From the extremities of this incision a vertical cut is made upward to the level of the middle of the patella. The rectangular flap thus outlined is dissected, the joint is opened by cutting through the ligamentum patellae. The patella is then thrown back, and a segment, about two lines in thickness, removed from the inner surface by a small saw. The condyles of the femur are eawn through. The posterior flap is then made by an incision direct to the bone, connecting the upper extremities of the lateral cuts. This flap is separated from the femur for a short distance, the periosteum cut through, and the limb removed. The vessels are ligatetl, the sawn bony surfaces arc placed together, and the edges of the flaps secured by several interrupted sutures. Professor J. NEUDORFER, in the preface to his Handbuch der Kriegschirurgie. Ein Vademecumfiir Feldarzte, Leipzig, 18f>4, Erste Halfte, p. IX, claims that he performed an operation similar to GltlTTl s in 1859: "The work of GRITTI was unknown to me; but it struck me, in the fall of 1859, to combine exarticulation at the knee with resection, and to practically test it," and on p. 1559 of the Zweite Ilalfte states that he performed the operation in 1859, but he fails to give details of the case. In an article, Beitrag zur Amputation, in Vierteljahrschrift fur die Praktische Heilkunde, Prag, 1860, Vol. I, p. 80, Professor SZYMANOWSKY advocates GRITTl s mode of operation, and details his experimental efforts on the cadaver; but at that time he found no occasion to employ this method on the living subject. SAWOSTITZKI seems to have been the first to prac tically test GRITTI S operation, in 1802. The case is published in the St. Petersburger Medicinische Zeitsclirift, 1862, B. Ill, p. 372 : The patient, aged 19, fell from a wagon and received a fracture of the right leg. The operation was performed according to GlUTTl S mode as described by SzYJIAXOWSKY; the sawing of the patella caused the only difficulty ; the sawn surfaces of the femur and patella fitted readily; the wounds healed principally by first intention. On the sixth day after the operation the patella was found to have been drawn upwards on the anterior surface of the femur by the quadri ceps, and could not be replaced. The patient recovered with a good stump. The first recorded operation after shot injury is a case reported by SZY- MAXOWSKY (Die Rechtfertigung der GltiTTl schen Operation durch Wort und That, in Vierteljahrschrift fiir die Praktische Ecilkunue, I rag, 1866, B. II, S. 38): "February 5, 1863, shot fracture of leg, gangrene ; GlUTTl S operation with dissection of the synovial pouch; gangrene of thigh ; death. The patella was found unmoved upon the sawn surface of the femur." In the Schleswig-Holstein War of 1864, 10 cases of GRITTI S operation were reported. A. LUCKE (Kriegschirurgische Aphorismen aus dem zwciten Schleswig-Bolsteinschen Kriege im Jahre 1864, in LANGEXHECK s Archiv fur Klin. Chir., Berlin, I860, B. VII, pp. 23, 24, 134, 147) reports 4 cases. 2. Christian Balzer, 24th Regiment, shot wound of left knee joint, June 29, 18G4; amputation June 30th, by Surgeon SCHILLING; fatal. 3. Thomas Thomsen, 9th Danish Infantry, shot wound of right knee, April 18, 1864; amputation April 2?th.by Dr. LfJCKE; death May 1, 1864. 4. Carl Neumann, 4th Guards, shot wound of right knee joint, April 18, 1864 ; amputation by Dr. LlJCKE, April 2Gth; recovery. 5. Hoffmann, wounded in right knee, February 2, 1864 ; amputation February 10th, by Dr. LlJCKK ; death about the end of February. Six other cases of the War of 1864 are mentioned by C. HEINE (Die Schussverletzungen der unteren Extremitdten, etc., in LANGENliECK s Archiv fiir Klin. Chir., 1866, B. VII, p. C07. 6. Prussian soldier, shot fracture of the leg. Operation by Generalarzt von LANGEXBECK ; fatal. 7. Primary operation by Professor ESMARCII, at the hospital at Breaker, April 18, 1864, for shot wound of upper extremity of tibia; fatal. 8. L. Chr , 8th Prussian Grenadiers, comminution of left leg, April 18, 1864. Operation, April 18, 1864, by Staffsurgeon OCHWADT, at Flensburg; fatal. (See also OCHWADT, Kriegschir. Erfahrungcn, Berlin, 1865, No. 18 of Table of Operations). 9. Private J. K , 9th Danish Infantry, wounded April 18, 1864; operation, April 21st, by Staflsurgeon FISCHEK, at the Latin School Hospital at Flensburg, for shot fracture of the tibia with splintering into knee joint; the patient died eight days after the operation. The autopsy showed that no consolidation of the femur and patella had taken place. 10, 11. After the naval engagement at Helgo land, in 1864, two of these operations were performed ; one at the hospital at Altona, by L)r. STEINLECHXER (H. KUCIXIC, Bericht iiber die Verwundeten, der K. K. Kriegsmarinc, in Allgeineine Militararztliche Zeitung, 1864, B. V, p. 52): Sailor A. Gaspare, of Frigate Radetzky, shot fracture of left leg. May 9th ; amputation after GRITTI, May 13th; recovery. The other (HEINE, loc. cit., p. CCS, and SALZMAXN, Die GlUTTl sche Operationsmethode und ihre Verwerthung in der Krirgscltiriirgie, in B. VON LANGENBECK S Archiv fiir Klinische Chirurgie, Berlin, 1860, B. XXV, p. 662) was the case of an. Austrian naval cadet, wounded in the same engagement; amputation after GRITTI on the day of the injury, May 9, 1864. It is stated that union oi the patella had taken place, but that on his return to Austria the patient fell upon his stump, necessitating amputation in the middle third of the thigh. 12. MEI.CllIORJ (G.) (Annali Universali di Medicina, 1667, Vol. CO, p. 374): P. Pietro, 5th Italian Artillery, aged 27, shot in the right leg, July 21, 186(i . GlUTTl S amputation August 16th ; recovery. Of the Austro-Prussian War of 1866, seven operations after GRITTI S method are reported by SALZMAXX (loc. cit., p. 669, etc.). 13. Austrian soldier, aged 17, comminution of left leg by shell, at Konigsgratz, July 3, 1866; operation July 3d; healed by first intention; August 12th, recovered. 14. Prussian Infantry soldier, comminution of bones of right leg, Konigsgratz, July 3, 1866; operation at Castle Prim, July 15th, by Dr. BUSCII ; death same day. 15. Franz AValichowski, comminution of lower third of left tibia und fibula, and of right elbow joint ; July 15th, resection of elbow joint ; July 27th, GRITTl s amputation at knee joint ; death August 15, 1866 ; operation by Dr. BUSCII. 16. Johann Bielin, 8th Aus trian Infantry, fracture of tibia and laceration of the peronacus, July 3, 1866; operation by Dr. BROCK, July 27, 1866; death from pyaemia. 17. Austrian soldier, shot fracture of head of tibia, July 3d; amputation at Nechanic, August 10, 1866, by Dr. BUSCII; death from pyaemia, August 10, 1866. 18. Austrian soldier, shot fracture of leg; operation at the hospital at Nedelist, by Dr. SPAXXER; death 50 days after the operation. 19. O. Weiser, 3d Baden Infantry, shot fracture of right leg, Werbach, July 24, 1866; operation by Dr. MfJLLER, August 2d ; death August 9, 1866. Of the Franco- Prussian War of 1870-71, Staffsurgeon SALZMANN (loc. cit., p. 674, etc.) collects 15 cases, viz : 20. G , 94th French Infantry, shell laceration of both calves. August 22, 1870; GRITTl s operation at the knee on one limb; amputation in the thigh on the other, August 23d; operation by Dr. MtJI.I.EK; death August 24, 1870. 21. T. II , 1st French Infantry, shell fracture of left leg, August 18, 1870; operation, August 24th, by tr. MARQUARPT; death.- 22. Private A. Ihl, 88th Infantry, comminution of left leg, September 1, 1870; amputation, September 4th, by Dr. LAXG (?); recovery, with good stump. 23. A. Brauer, 3d Grenadiers, splintering of left tibia, August 18, 1870 ; GRITTl s operation by Dr. MATZ, September 7th ; recovery, with tender stump. 24. Reimnnn, 14th Bavarian Infantry, shot fracture of right leg; gangrene; operation, September 13th, in hospital at Aix-la-Chapelle, by Dr. BllAXDlS; death in a week. 25. (J. G. Renner, 46th Prussian Infantry, shot fracture of right leg; GlUTTl S amputation performed by Dr. STAHL, October 17th, at the 7th field hospital of the IXth Corps; recovery, with good stump. 26. W. Pluta, 1st Posen Infantry, No. 19; groove shot of right tibia, with opening of the joint, October 7, 1870 ; amputation by Dr. MOLLElt, October 25th, at the 7th field hospital of the Xth Corps at Hngondange ; death October 31, 1870. 27. Private P. H. KfJPPEU, C. r )th Infantry, comminution of left leg. October 28, 1870 ; operation by Dr. M BLLKR, November 1 9th, at Hagondange ; death from pyaemia, November 24, 1870. 28. J. Ollngnon, 13th French Infantry, shot fracture of left tibia, August 18, 1870; operation by Dr. MOLLKK, in hospital at Nancy, March 2, 1871 ; recovery in 29 days. 29. Lieut. W. von du Prel, Infantry body guard, shot fracture of left knee joint, September 1, 1870; GRITTI S operation, by Professor V. NUSSHAUM, at Bazeijles, September 1st; September 14th, resection of exposed portion of femur; death September 25, 1870. 30. P. Zoll, 10th Bavarian Infantry, shot fracture of left leg at Remilly, August 31, 1870 ; operation by Dr. LOTZliliCK, September 8th ; death September 17, 1870. 31. O. Willner. 9th Bavarinn Infantry, ngpd 04, shell fracture of leg near the knee joint, October 7, 1870: GiMTTl s umputa- SUHG. Ill 54 426 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. 1866, and the Franco-Prussian War of 1870-71, Gritti s operation was performed in a number of instances, and, in 1870, a modification of Gritti s plan was presented by Stokes, 1 but the results of these operations in war surgery have not been very favorable, and the opinions of military surgeons generally are recorded against its performance." In nine of the one hundred and eighty-nine cases of exarticulation at the knee the condyles of the femur and the patella were removed; in sixteen the condyles were removed and the patella retained; in seven the condyles were retained and the patella removed; in twenty-eight the condyles and the patella were retained; and in one hundred and twenty- nine instances this point was not indicated. Regarding the value of the stump after knee joint amputations, the records would seem to confirm the opinions of Velpeau, Stephen Smith, Markoe, and Syme, 3 that the stump formed by the articular surface of the lower extremity of the femur is as well, and perhaps better adapted to the successful wearing of an artificial limb than the thigh stump. Of the eighty-one cases of recovery after amputation at the knee, the condition of the stump is known in sixty instances; in forty it is recorded as sound and healthy, and, in twenty, as tender or painful, or as not allowing the use of an artificial apparatus. tion, by NEUIIOFER, October 8th ; discharged the service July 17, 1871, and died in February, 1872; stump had healed after tedious exfoliations of small particles of bone, but union of bone of the cut surfaces of the femur and patella had not taken place. 32. F. Borron, 9th French Chasseurs, aged 29, shot fracture of right leg, October 11, 1870, at Artenay: operation by v. NUSSBAUM, October llth; result undetermined. 33. J. Krum, 1st Bavarian Jaegers, shot fracture of left leg, October 11, 1870; operation, October 15th, by LOTZUECK; result unknown. 34. G. Koflcr, 3d Bavarian Infantry, shot fracture of left knee joint, October 11, 1870; operation by LOTZBECK, October 21st; death October 25, 1870. The results of two of the 34 amputations at the knee after GRITTI S method, here cited, are 7iot recorded; 10 had successful and 22 fatal issues, a mortality rate of 68.7 per cent. STORES (WILLIAM) (On Supra- Condyloid Amputation of the Thigh, in Medico- Cliirurgical Transactions, London, 1870, Vol. LIII, p. 180). The author claims that his mode differs from GRITTI S in the following particulars : "1. That the femoral section is made in all cases at least half an inch above the antero-superior edge of the condyloid cartilage. 2. That in all cases the cartilaginous surface of the patella is removed. 3. That the flap is oval, not rectangular. 4. That there is a posterior flap fully one-third of the length of the anterior flap." In regard to the second point of modification, Dr. STORES remarks that "much importance was not attached by GRITTI to the removal of this portion of the bone," and, in proof thereof, cites three cases reported by MELCHIORJ, in two of which the articular surface of the patella was not removed. Dr. STOKES evidently overlooked the fact that these two operations were performed G and 7 years before Dr. R. GlUTTI proposed his osteoplastic operation, while the third operation, in which the inner surface of the patella was removed, was performed in 18fiG, or 9 years after Dr. GRITTI S plan had been published. Dr. GlUTTI (loc. cit., p. 18) clearly insists upcn the division of the patella, and, in FIG. Ill, at the conclusion of his article, delineates the manner of the division. 2 BECK (B.) (Kriegs-Chirurgische Erfahrungen wiihrend des Feldzuges 1866, Freiburg, i. B., 1867, p. 62): " GRITTl s operation, which must be designated as one entirely without purpose, is to be rejected as oce too complicated, having no advantages and only disadvantages." ZEIS (E.) (Einige Bemerkungen zur Wiirdigung der Exarticulation des Unterschenkels im Kniegelenke, in Arch.fiir Klin. Chir., Berlin, 18(iC, B. VII, p. 770): I confess that my great predilection for this operation, by which, when successful, unquestionably great advantages are gained for the patient, has greatly dimin ished, and I. therefore, do not feel encouraged to perform the operation after GRITTI, as the dangerous consequences alluded to by me must be the same." Dr. II. F. WEIR (Ore GRITTI S Supra-condijloid Amputation of the Thigh, in the Medical Record. New York, 1879, Vol. XV, p. 342) tabulates 76 operations after GlUTTI, of which 54 recovered and 22 died, and remarks, on p. 341 : " For gunshot wounds or compound fractures involving the condyles of the femur, its practicability is yet undetermined, and time will probably record an adverse judgment against it in such cases. For diseases of the knee joint it affords a better operation, in my judgment, than disarticulation, which has lately been revived." The unfavorable results of the few cases of GRITTI S amputation after shot injuries that the editor has been able to collect would seem to confirm the conclusions of Dr. WEllt. Dr. SAT.ZMAXN (loc. cit., in Archiv fur Klin. Chir., Berlin, 1880, B. XXV, p. 658): Taking into consideration, besides the high mortality, the disadvantages of a complicated operative technic, requiring a certain aptitude and at least 36 minutes time, the readily injured and for transport little adapted stump, liable to displace ment of the patella, and bleeding from the popliteal artery ; farthermore, the slow healing process with its uncertain results ; we must come to the conclusion that neither on the field of battle nor in the field hospitals GRITTI S operation seems to have any value as an operation in war surgery." 3 VELPEAU (A.) (Memoire sur I amputation de la janibe dans I articulation du genou, et description d un iiouveau procede pour pratiquer cctte operation, in Archives Generates de JUtdecine, 8"" 1 ann6e, T. XXIV, 1830, p. 60) considers amputation at the knee preferable to amputation in the thigh as being less dangerous, easier performed, and furnishing a good stump for the use of a wooden leg. SMITH (STEPHEN) (Cases in Surgery. Amputation at the Knee Joint. By W. PAKKER, M. D., Professor of Surgery in the College of Physicians and Surgeons, New York. Reported by STEPHEN SMITH, in the New York Journal of Medicine for November, 1852, Vol. IX, p. 326) arrives at the following conclusions: "1. That amputation at the knee joint is a justifiable operation, as respects the nature of the structures engaged. 2. That it is a justifiable operation as respects the point of election. 3. That the stump formed by the articular surface of the lower extremity of the femur is as well adapted to the adjustment of an artificial limb, and to sustain and transmit the weight of the body, as when the operation is performed in the continuity of the thigh-bone. MAI:KOE (T. M.) (Amputation at the Knee Joint, Illustrated by the Cases which hare occurred in American practice, and mainly liy those which hare been treated in the Jfew York Hospital, in New York Jour, of Med., New York, 1856, Vol. XVI, N. S., p. 35, etc.) presents eight points of comparison between this operation and the amputation in the thigh, all favoring knee joint amputation. SYME (JAMES) (On Amputation at the Knee, in Edinburgh Medical Journal, Edinburgh, 1866, Vol. XI, p. 874) concludes that the resulting stump is comfortable and serviceable. MAKKOE (T. M.) (Amputation at the Knee Joint, in Few York Medical Journal, 1868, Vol. VI, p. 509) sums up the cases of amputation in the thigh and at the knee joint performed from 1830-18C4, in the New York Hospital, both showing a mortality of 54 per cent., and admits that as far as the percentage of fatality is concerned "this exhibit shows no advantage on the side of the knee joint operation." but claims a decided advantage for the usefulness of the knee joint stump. In this opinion he is corroborated by Dr. E. D. HUDSON, the ingenious deviser of various mechanical appliances for the relief of maimed soldiers ; but the latter (Meclianical Surgery. 1 rothe tic Appliances and Apparatus for Amputations. Resections, etc.. New York, 1878, p. 24) deprecates the removal of the condyles as an operation neither "sustained by any rational hypothesis nor practised on any scientific principles. Except disease or injury of the condyles compel their excision, their thin anatomical and functional vestments should be kept inviolate from knife and saw. The condyles, their cartilage and vestment, as constituted, are nature s strongest, most tolerant and important supports in the entire body, and when these parts are amputated or disturbed, a valid, a positive reason should exist for so doing." SECT, v.l WOUNDS AND OPERATIONS IN THE LEG. 427 SECTION V. WOUNDS AND OPERATIONS IN THE LEG. The consideration of examples of simple and compound fractures, of burns, frost-bites, and other miscellaneous injuries of the leg will be reserved for Chapter XII, and as no cases of sabre or bayonet injuries of the tibia and fibula are recorded, it remains therefore only to examine the instances of shot injuries of this portion of the human structure. There are found on the registers one hundred and eighty-three shot contusions, and eight thousand nine hundred and eighty-eight shot fractures, making a total of nine thousand one hundred and seventy-one shot injuries of the bones of the leg. Four thousand one hundred and three were treated by conservation, and in five thousand and sixty-eight instances operative interference was resorted to, viz: excision in the bones of the leg or at the knee in three hundred and eighty-eight; amputation in the leg in three thousand seven hundred and thirty-six; amputation in the leg and subsequent exarticulation at the knee in three; amputation in the leg and subsequent amputation in the thigh in thirty-nine; exarticulation at the knee joint in one hundred and one; exarticulation at the knee and ablation in the thigh in seven; and amputation in the thigh in seven hundred and ninety- four instances. The exarticulation a at the knee joint and the amputations in the thigh following shot fractures of bones of the leg have already been considered in the preceding sections of this Chapter, leaving the amputations in the leg to be examined in this Section. SHOT CONTUSIONS OF THE BONES OF THE LEG. One hundred and eighty- three examples of shot contusions of the bones of the leg are entered on the records. The injuries involved the tibia in one hundred and thirty-six, the fibula in twenty, the tibia and fibula in twelve instances, and in fifteen cases the precise seat of the injury was not specified. One hundred and sixty-five cases, of which fifteen resulted fatally, were treated throughout by expectation; in eight amputation in the leg was resorted to, unsuccessfully in four; one was followed by an unsuccessful amputation at the knee; and nine three successful and six fatal by amputation in the thigh. Shot Contusions of the Bones of the Leg Treated by Conservation. Of the one hundred and sixty-five cases of this group, fifteen, or 9.09 per cent., had fatal terminations. The right limb was injured in sixty-six, the left in seventy-eight, and in twenty-one cases the side was not indicated. Sequestra or exfoliations were removed in twenty-two instances. In one hundred and thirty-two of the one hundred and sixty-five cases the tibia was the seat of the injury, the lesion generally being on the inner anterior flat surface. Recoveries after Shot Contusions of the Bones of the Leg treated by Conservation. Generally the healing process was very slow, and not rarely attended by necrosis of the bone and tedious exfoliation, as in the following instances: 428 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 256. Exfoliation from right tibia. Spec. 2620. CASE 655. Sergeant J. Meier, Co. H, 52d New York, aged 43 years, was wounded at Spottsylvania, May 12, 1864, by a musket ball, which entered the middle third of the right leg and injured the tibia. Surgeon D. II. Houston, 2d Delaware, reported that the wounded man was admitted to the field hospital of the 1st division, Second Corps, where the missile was extracted. Two weeks after the reception of the injury he was sent to Washington, and several days later to Philadelphia. Assistant Surgeon T. C. Brainerd, U. S. A., reported that "the patient entered Broad and Cherry Streets Hospital May 31st, the wound being healthy at date of admission and continuing so until July 3d, when sloughing set in. This was successfully treated by applications of nitric acid, followed by dressings of coal oil, together with internal administration of tincture of chlo ride of iron, porter, and generous diet. By July 12th, the wound was again granulating and his general health improving. Complete cicatrization being prevented by the presence of dead bone, that portion of the tibia was removed by Acting Assistant Surgeon D. W. Cadwallader, on October 1st, through an incision over the spine. The small, fragments of bone were then thoroughly washed out with a syringe and the parts coaptated by adhesive plaster, over which simple water dressing was applied. Cicatrization progressed rapidly and was complete by October 28, 1864, when the patient was discharged from hos pital," his term of service having expired three weeks previously. The removed sequestrum, six inches long, and contributed by the operator, is represented in the wood-cut (FiG. 255). Examining Surgeon G. J. Fisher, of Sing Sing, N. Y., August 22, 1865, certified to the injury, and stated: "The front of the injured leg is covered with delicate blue integument, not perfectly healed. He is unable to labor, and an artificial leg would be far preferable." The New York Examining Board reported, September 3, 1873: "There has been considerable loss of osseous substance. The entire anterior and inner aspect of the middle and upper portion of the leg is covered with encrustations, and there is periostitis and necrosis of bone at present." At subsequent examinations the same indurated, ulcerated, and partly indolent condition of the parts, interfering with locomotion, was reported. The pensioner was paid December 4, 1879. CASE 656. Corporal G. Ditch, Co. D, 82d Ohio, aged 21 years, received a shot wound of the right leg, with injury to the tibia, at Gettysburg, July 1, 1863. He was admitted to Satterlee Hospital, Phil adelphia, eight days after the injury. Acting Assistant Surgeon M. Lampen contributed the patholog ical specimen, represented in the annexed cut (FiG. 256), with the following report: "The injury was caused by a round ball, which entered the leg anteriorly at the junction of the upper with the middle FIG. 253. third of the tibia. On admission the wound was in a healthy condition. Hospital gangrene first hequestriun a pp eare( j on July 23d, and spread rapidly for several days. Creasote mixture and yeast poultices were tibia. Spec, used to the wound and tonics internally, which treatment was continued for two weeks, when all signs of the disease had disappeared, a small portion of the tibia being left exposed. The patient s general health was good with the exception of an obstinate intermittent fever, which yielded but temporarily to quinine. On September 26th, a segment of bone about five inches long, one and a half inch in width at its widest part, and from one-eighth to one-fourth of an inch thick, was removed from the wound, the entire exfoliation of it having taken place in a few days from the time it was first observed. During the succeeding days several small spiculse of bone were removed, after which exfoliation still pro gressed downwards, indicating that more bone would have to be removed." In October the patient was transferred to Seminary Hospital, Columbus, and lastly he was sent to Camp Dennison, where he was discharged March 30, 1864, and pensioned. Examining Surgeon R. L. Sweeney, of Marion, Ohio, describes the injury as follows: "A gunshot wound by a musket ball impinging on the leg just above the junction of the middle and upper thirds of the tibia. Contraction and adhesion of the muscles afterwards resulted from gangrene." The same Examiner reported, in 1870, that the wound had reopened and after wards again closed imperfectly. On June 21, 1874, he stated that "the wound is still open and the bone diseased;" and in September, 1877, he reported a "large, adherent, and irritable cicatrix over the spine of the tibia, with malformation of the bone." The pensioner was paid December 4, 1879. CASE 657. Corporal H. Rail, Co. D, 15th New York Heavy Artillery, aged 22 years, was wounded at the battle of Old Church, May 30, 1864. Surgeon L. W. Read, U. S. V., reported his entrance into the field hospital of the 3d division, Fifth Corps, with "shot wound of left leg." Surgeon B. B. Wilson, U. S. V., in charge of Stauton Hospital, Washington, contributed the path ological specimen (No. 4337 of the Surgical Section, A. M. M.), with the following history: "This young man was admitted to this hospital on June 4th. He had been wounded by a mini6 ball, which passed across the spine of the tibia about four inches from the head of the bone, bruising it and denuding it of periosteum along the track of the ball. He was somewhat debilitated when admitted, but being young and of. good constitution, his general condition was not unfavorable. He was treated with applications of cold water and ice dressings to the wounded limb, and stimulating and supporting constitutional remedies. During the month of June and the beginning of July the limb was highly inflamed, and there was profuse suppuration and some sloughing in the vicinity of the wound; with considerable sympathy of the general system as manifested by chills, great debility, loss of appetite, and general febrile action. In the month of July, deep-seated fluctuation having been observed in the course of the shaft of the tibia, the pus was evacuated by free incisions in the direction of the length of the limb, with great relief to the patient. The periosteum was found to FIG. 257. Appearance of ^ e extensively separated and the shaft of the bone necrosed. During the months of September, limb fourteen months after in- October, November, and December his condition gradually improved as the process of formation of jury. [From a photograph.] ... . . the involucrum and the separation of the necrosed portion went on. A number of cloacse formed in the line of the incisions for liberating pus, through which the necrosed bone could be felt gradually becoming detached from the living portion. The limb was, during this time, for the most part treated with emollient poultices. About the first of January the upper part of the shaft of the tibia could be distinguished at the position of the original wound, and about March 1st, upon seizing it with a forceps the whole dead mass could be moved within the sheath of the investing new bone. The operation for Mod H Surj. lli.-l.of UK- War of the Rebellion, Part III Vol .11. (. Imp. X. Ward phot. T Sinclair <m Uth PLATE LXXI._- TUBULAR SEQUESTRA AND PIECES OF NECROSED BONE FROM TIBIA. Fig.L-Ccjrporal Henry Rail, D. IS New York H.A, Spec. 4337, A.M. M. Fig 2.. Private .lo.seph Wjilkep, A. 7 AVlscoiisin Vols. Speo. 3283, AMM. R^. . J._ Private O.M. Armstrong, B, 120 Xew York Vols. Spec. 3284 , A. M. M. Fig4_Private GeurpV fulloiii, D. 83 Ohio Vols Spec. 2099, A.M.M. SECT. V.] SHOT CONTUSIONS OF THE TIBIA AND FIBULA. 429 the removal of necrosed bone was performed by Surgeon A. N. Dougherty, U. S. V., on March 14, 1865, by turning back the soft parts on each side from an incision through the centre of the cloacae, and cutting away with the mallet and chisel sufficient of the new growth to permit the sequestrum to be lifted directly from its bed. It was found to consist of the entire shaft of the tibia from one epipliysis to the other, except small portions eroded by the absorbents. The after-treatment consisted of simple- water dressings with slightly stimulating applications, and was unmarked with any noteworthy complication. On June 6, 1865, the patient was discharged on certificate of disability, being able to walk with ease and comfort, though the wound was not entirely healed. In July a photograph was taken, of which the adjoining wood-cut (FlG. 257) is a copy. He left the hospital in July and returned in the following month, asking to be employed under contract. Since that date he has been doing duty as chief nurse of one of the wards of this hospital, being in robust health, though his limb was not yet entirely healed." The speci men, consisting of a sequestrum nine inches long and eleven smaller pieces of necrosed bone, is shown somewhat reduced ill FIG. 1 of PLATE LXXI, opposite page 428. Examiner T. F. Smith, of New York City, September 22, 1873, certi fied: "Shot fracture of left tibia, with union and great loss of bone substance, leaving a cicatrix over the anterior surface of the bone nine inches in length, red, unhealthy, and ulcerating," etc. The Brooklyn Examining Board reported, September 8, 1877 : " We find an adherent, chronically inflamed cicatrix extending along the anterior face of the left tibia from below its head to within three inches of the ankle. There is tenderness on pressure. He requires the application of a bandage, and complains of pain in damp or cold weather. The usefulness of the limb is well nigh destroyed." The pensioner was paid March 4, 1880. CASE 658. Private W. Hargrave, Co. C, 142d New York, aged 25 years, was wounded at Chapin s Farm, September 29, 1854. Assistant Surgeon E. McClellan, U. S. A., reported his admission to hospital at Fort Monroe, October 4th, with "shot wound of right leg at middle third by a mini6 ball." On December 20th, the patient was permitted to leave for his home on furlough, and in June following he entered the Ira Harris Hospital, Albany, whence Assistant Surgeon J. H. Armsby, U. S. V., contributed the specimen, represented in the annexed cut (FlG. 258), with the following description : " The ball struck the tibia without fracturing it. The leg became inflamed and tender and a number of fisttilous openings appeared. By exploring with the probe a large sequestrum was discovered on July 15th. when chloroform was administered and the necrosed bone was withdrawn with a forceps through a straight incision four inches long. After this operation the wound healed rapidly." The patient was mustered out of service July 17, 1865, but, owing to his becoming insane for u time, he did not apply for a pension until seven years FlG - 258. afterwards. Examining Surgeon B. F. Sherman, of Ogdensburg, N. Y., October 9, 1872, certified to the injury, and questrum added that "the skin is now closely attached to the bone, and the slightest abrasion produces a sore difficult to heal. f. r ,V m I eft " A tibia. Spec. There are now two small unhealed surfaces. The man states he suffers great pain in the leg at night after walking." 420. In 1877, the wound was reported as healed. The pensioner was paid March 4, 1880. CASE 659. Private J. C. Coats, Co. I, 5th Vermont, aged 22 years, was wounded at Fredericksburg, December 13, 1862. He was conveyed to Harewood Hospital, Washington, and transferred to Satterlee, Philadelphia, December 23d. Acting Assistant Surgeon W. W. Keen, jr., from the latter hospital, described the wound as " an injury of the right tibia," and reported: "The man had been hit by a fragment of a shell, which struck his left shoe without seriously injuring the foot ; it then glanced and struck the right tibia antero-internally in the lower third. On admission to the hospital there was a swelling, fluctuating but quite tense, at the point of the injury in the leg, which I opened by an incision about three-fourths of an inch long. About an ounce and a half of coagulated blood and some pus was evacuated, and poultices were ordered to be applied. The wound did well till January 1, 1863, when it began to enlarge and look very much like hospital gangrene. I suspected this the more from the prevalence of this disease at that time in the ward. The edges of the wound had become everted, its base rather ashy grey, and the discharge unhealthy, and a considerable circle of inflammation was around the opening. But the characteristic stinging pain being absent, I determined not to treat it as hospital gangrene but by the ordinary measures for inflammation. I ordered three compound cathartic pills to be taken and tincture of iodine to be applied locally, also a large poultice. On Jan uary 6th, the wound had increased to two and one-fourth inches in diameter, but was still entirely without the peculiar pain of hospital gangrene, when I ordered a mixture, consisting of half an ounce of hydrochloric acid, two ounces of laudanum, and one pint of water, to be used locally with lint. The acid wash was gradually diluted, and finally abandoned on January 25th. The patient being rather anaemic, I ordered two grains of quinine and four ounces of milk punch to be given daily. On Jan uary 30th another abscess was opened, and on February 9th yet another, each being preceded by severe pain, tenderness, and swelling. No doubt they as well as the original one were the result of severe local periostitis. They were readily subdued by cathartics and poultices, with morphia at night. No bone was at any time discharged, although considerable depression existed on the tibia from absorption of the tissue. On February 20th, the patient was transferred to Brattleboro , the wound having almost entirely healed and there being but little depression." The man entered the Marine Hospital at Burlington, and on March 8, 1864, was assigned to the Veteran Keserve Corps, and discharged July 13, 1865, and pensioned. Examining Sur geon A. P. Belden, of Whitehall, N. Y., reported the wound as being in an inflamed condition, and added that "it opens at any time the limb is much used in standing or walking. There is adhesion of the peroneus longus muscle and ligament, and inflam mation produced partial anchylosis of the ankle joint." Examiner J. Lambert, of Salem, N. Y., August 10, 1878, reported that "the injured bone is necrosed for about three inches and demands an operation." The pensioner was paid September 4, 1880. In the next instance copious haemorrhage followed the injury, and the femoral artery was successfully ligated in Scarpa s triangle: CASE 660. Private T. Dassel, Co. G, 60th Indiana, aged 25 years, was severely wounded in the right leg, at Arkansas Post, January 11, 1863. He was placed on board of a hospital steamer several days after the reception of the injury and con veyed to St. Louis, where he entered Lawson Hospital, January 22d. Surgeon C. T. Alexander, U. S. A., in charge, reported: "The wound \vas located on the inner side of the upper third of the leg and the tibia was slightly injured. Haemorrhage to the amount of eight ounces occurred from the anterior tibial artery on February 20th, on account of which the femoral artery 430 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. was ligated in Scarpa s triangle. Pysemic infection also existed, which was successfully combated with the administration of quinine and brandy." The patient was discharged from service December 22, 1863, and pensioned. Examining Surgeon B. J. Day, of Evansvillc, Indiana, on April 25, 1864, certified to the anterior wound as "still discharging," and reported the same as "recently healed, in September, 1865, leaving a deep and adherent cicatrix." Examiner I. Casselberry subsequently certified: "The ball injured the tibia without fracturing it." At later examinations chronic inflammation of the bone and the impaired usefulness of the leg was described. The pensioner was paid March 4, 1880. Fatal Cases of Shot Contusions of the Bones of the Leg treated by Conservation. Fifteen of the one hundred and sixty-five cases of this group proved fatal : CASE 661. Private J. Buchfinck, Co. A, 16th Michigan, aged 26 years, was wounded at Poplar Grove Church, Septem ber 30, 1864, and admitted to the field hospital of the 1st division, Fifth Corps, with "severe wound of left leg, caused by a musket ball." A week later the man was transferred to Harewood Hospital, Washington, whence Surgeon R. B. Bontecou, U. S. V., contributed the specimen and reported the result of the case: "The leg was wounded in the lower third, the ball passing anterior to the tibia and injuring the periosteum. The patient, although weak, did tolerably well up to October 13th, at which time the parts became gangrenous, destroying the tissues from the ankle joint to the upper part of the middle third of the leg and leaving the tibia exposed for about six inches. Under the application of escharotics the wound became healthy and the limb improved until January 2, 1865, when gangrene reappeared and the tissues of the heel commenced sloughing, the exposed tibia being necrosed and exfoliating. In addition to escharotics the treatment was supporting throughout. The patient died of exhaustion January 26, 1865." The specimen (No. 3609, Surgical Section, A. M. M.) consists of the tibia, and shows one longi tudinal half of the bone to be necrosed and nearly separated, the other portion being sheathed with callus. CASE 662. Corporal T. N. Chapin, Co. JI, 21st Michigan, aged 35 years, was wounded at the battle of Stone River, January 1, 1863, and admitted to the field hospital of the 1st division, Fourteenth Corps, with "shot wound near the left ankle." Assistant Surgeon C. C. Gray, U. S. A., contributed the specimen (Cat. Surg. Sect., 1866, p. 375, Spec. 1916), with the following history : " The ball entered at the inner side of the middle of the calf of the leg, passed obliquely downward under the bone, and came out a little above and posterior to the malleolus. The patient was admitted to hospital No. 8, Nashville, January 19th, his wound being erysipelatous, with great swelling of the entire leg. Gangrene invaded the limb so as to destroy the soft struct ures covering the tibia for nearly half way around the leg, and from within two inches of the insertion of the tendon of the patella to a point about three inches from the ankle joint. The bone was exposed and became badly necrosed. Chlorinated solution of soda in its full strength, and applied with picked lint, was used three times a day in the treatment, with general stimulants, bromine being used in the room as a general fumigant. The gangrene was arrested in about four weeks. The patient died June 1, 1863. Two weeks previous to his death granulations were feebly struggling to extend over the diseased bone, much of which was covered. The patient s general condition had become very low; his stomach refused almost every thing, and the first symptoms of hydrothorax presented themselves. The autopsy disclosed the chest full of serum, also slight recent pleuritic adhesions." The specimen shows the diseased portion of the contused tibia encircled with a fringe of callus. CASE 663. Private N. Hollenbeck, Co. F, 7th New York Heavy Artillery, aged 37 years, was wounded at Tolopotomv Creek, May 30, 1864. He was admitted to Emory Hospital, Washington, June 8th, with "shot wound of left leg, over tibia." Acting Assistant Surgeon A. McLetchie contributed a specimen (Cat. Surg. Sect., 1866, p. 519, Spec. 3133), with the following report : "The wound was caused by a mini6 ball, which entered the leg directly over the spine of the tibia, middle third, injuring the periosteum but not splintering the bone itself. The missile was extracted through the wound of entrance. The wounded man was admitted to Patterson Park Hospital, Baltimore, June llth. He was in a very asthenic condition, and I ordered stim ulants and good nourishing diet. About the 18th of June gangrene set in, manifesting itself by constitutional symptoms, fever, loss of appetite, etc., some days before the distinctive symptoms appeared in the wound. The disease was treated with nitric acid, cautery, dressings of chlorinate of soda, linseed poultices, charcoal, turpentine, and linseed oil, with frequent use of the syringe. On August llth, he was returned from the gangrene ward with the wound much enlarged, but entirely free from gangrene, and nearly four inches of the bone exposed. Tincture of chloride of iron was administered daily, and milk punch, from tlie first appearance of the disease. Diarrhoea, which had been checked on his entrance into the hospital, now set in again, complicated with acute dysentery, and was treated with chalk mixture, vegetable astringents, and pulverized iron and opium. But the patient gradually wasted away from the steady strain on his system, and died August 26, 1864." The specimen is a wet prep aration of the leg, showing a contusion in the middle third of the tibia, and necrosis extending up the shaft of the bone on its posterior surface to near its head, also two openings from ulceration in the lower third. Shot Contusions of the Bones of the Leg followed by Amputations. In eighteen instances the shot contusions of the bones of the leg were followed by amputation : eight in the leg, one at the knee joint, and nine in the thigh. The cases of amputation in the thigh and at the knee joint have already been cited in SECTIONS 2 and 3 of this CHAPTER. 1 The cases of amputation in the leg will be briefly reported: Amputations in the thigh for shot contusions of the bones of the leg: Corp l S. B. Besley, H, 147th New York (TABLE XXXIX, Xo. 6, p. 3K<), secondary, middle third; recovery. Ft. C. C. Cannivan, G, 88th Pennsylvania (TA13LE XL, No. 123, p. 321), secondary, lower third; fatal. Pt. C. P. Cobb, F, 1st Michigan (TABLE XXXIX, No. 113, p. 315,, secondary, middle third ; fatal. Serg t H. A. Colby, G, 2d U. S. 8. S. (TABLE XL, No. 125, p. 3J1), secondary, lower third; fatal. Pt. J. C. Lemar, B, 97th Illinois (TAJ5LE XXXIX, No. 136, p. 215), secondary, middle third; fatal. Serg t Z. H. Mather, M, 5th Michigan Cavalry (TABLE XXXVI, No. 476, p. 300), intermediary, lower third; fatal. Pt. J. Moran, 1, Cth New York (TABLE XXXI, No. <J7U, p. 238), primary, middle third; fatal. Corp l E. McGinley, I, 23d Wisconsin (TABLE XXXVI, No. 126, p. 05), intermediary, lower third; recovery. Corp l S. H. Powell, C, 14th New Jersey (TABLE XL, No. 77. p. 321), secondary, lower third ; recovery. Amputation at the kuce joint for shot contusion of the tibia was performed in the case of Pt. W. W. Sandford, F, 103d Pennsylvania (TABLE LVI, No. 43, p. 407), intermediary; fatal. SECT. V.] AMPUTATIONS AFTER SHOT CONTUSIONS OF THE BONES OF THE LEG. 431 CASE 604. Sergeant R. T. Beatty, Co. H, 22(1 Pennsylvania Cavalry, aged 27 years, was wounded in thu right leg, at Mount Veruon Forge, September 27, 18G4, by a musket ball, which injured the tibia. He was discharged from service for dis ability, December 20, 1804, and pensioned. Extensive necrosis followed the injury, finally involving nearly the entire shaft of the tibia and rendering amputation necessary. The operation was performed, December 27, 18G5, below the knee, by Pension Examining Surgeon C. A. Rahter, of Harrisburg, Penn., and resulted successfully. In his application for commutation, the pensioner described the stump as being in a fair condition. CASE 665. Private W. Bell, Co. I, 7th Michigan, aged 34 years, was wounded in both lower extremities and the head at Antietam, September 17, 1862, one ball grazing the right tibia and fibula on their posterior surfaces just above the ankle joint. The patient became a great sufferer from extreme irritation of his nervous system and great irritability of the stomach. Repeated appearances of gangrene necessitated amputation, which was performed on November 3d, about one inch below the tubercle of the tibia, by Surgeon J. O. Bronson, U. S. V. Under the administration of vigorous tonics and stron- stimulants including narcotics, the patient gradually improved, and was able to start for his home December 5, 1862, when he received his discharge from service. He died March 30, 1874, of typhoid fever. A ligamentous preparation of the bones of the foot and the lower portion of the leg constitutes specimen 254 of the Surgical Section of the Museum, contributed by the operator. CASE 666. Private J. L. Hosford, Co. H, 4th Vermont, aged 21 years, was wounded at the Wilderness, May 5, 1864, by a musket ball, which entered the right leg, striking the tibia above the malleolus and lodging. He was admitted to Cumden Street Hospital, Baltimore, where, on May 21st, an abscess was opened, through which the missile, together with several pieces of bone, were discharged. Considerable erysipelatous inflammation followed, attended with profuse and very fetid discharge, and the limb became exceedingly painful, necessitating its removal. The operation was performed by the skin-flap method, at the middle third, by Surgeon Z. E. Bliss, U. S. V., on May 31st. The patient recovered and was furnished with an artificial leg. He was discharged March 20, 1865, and pensioned. CASE 607. Private J. Esses, Co. K, 108th Ohio, aged 16 years, received a gunshot contusion of the right tibia, near Kenesaw Mountain, June 23, 1864. He entered hospital No. 2, Nashville, where flap amputation of the leg at the upper third was performed, by reason of gangrene, on July 26th, by Acting Assistant Surgeon J. A. Hall. The patient recovered, and was discharged May 22, 1835, and pensioned. Four of the eight cases of amputation in the leg for shot contusions of the tibia or fibula had fatal terminations: CASE 663. Private J. Dicey, Co. F, 17th Michigan, received a flesh wound of the left thigh and a contused wound by a shell on the fore part of the middle of the right leg, at Antietam, September 17, 1862. He entered Casparis Hotel Hospital, Washington, October 13th, with the latter wound in a gangrenous condition and the tibia denuded of periosteum for four or five inches. The best antiseptic remedies failing to check the spreading of the disease, the limb was amputated on October 21st, by Acting Assistant Surgeon L. Heard, some five or six inches below the knee. The patient was very feeble and failed to rally. He died October 24, 1862. The amputated bones of the leg were contributed to the Museum by the operator, and constitute specimen 212 of the Surgical Section, A. M. M. CASE 609. Private G. W T ilson, Co. B, 1st Ohio Artillery, aged 21 years, was wounded in the left leg, at Chickamauga, September 20, 1863. Acting Assistant Surgeon M. L. Hurr, who amputated the injured limb at hospital No. 1, Nashville, contributed the specimen (FlG. 259), with the following history: "The injury was caused by a mini6 ball, which passed across the crest of the tibia at its middle third, merely cutting the tissues covering it and slightly injuring the bone. The man bandaged his wounded leg and remained with his regiment about a week, when the limb became very sore. He was then sent to hospital at Stevenson, Alabama, where he i-emained until he came here on October 14th. On examination I found the tibia denuded of periosteum for about four inches below the wound and for some distance above. The integuments were in a highly inflammatory condition, excessively painful, and suppurating freely, the pus being of a very offensive character. The patient was pale, though not much emaciated; his appetite good; bowels costive. Tincture of chloride of iron and whiskey were prescribed. The leg was bandaged from foot to knee so as to maintain equable pressure, and constant application of cold water was made. He continued to grow worse, the leg being very painful and the discharge very profuse, and on Octo ber 25th I found upon examination that the patient also had hypertrophy of the heart, from which he suffered considerably. On November 2d, I observed hectic or indication of irritative fever for the first time. His appetite was still good, and he complained of no pain except in the leg; but he was very weak and pale. Quinine, with morphia, was administered every three hours. On November 6th, the patient having expressed his wish of taking advantage of surgical interference, the limb was amputated at the upper third. Chloroform and sulphuric ether constituted the anaesthetic. No reaction took place, and the patient died the next morning. At the post-mortem examination four ounces of watery fluid were found in each pleural cavity, with slight pleuritic adhesions on the right side and small multiple abscesses through both lungs, the posterior portion of each being engorged. Some of the abscesses contained an inspissated matter or pus, not well broken up. The heart was very much enlarged and weighed seventeen and a half ounces; the pericardium contained two or three ounces of fluid, but the valves were Portion ot left not diseased. Four or five large abscesses were found on the anterior surface of the right lobe of the liver, which tibia amputa- organ contained eight and a half ounces of pus. 1 The specimen consists of the injured tibia, being thoroughly contusion, denuded of periosteum and necrosed in its greatest extent. CASE 670. Corporal G. L. Stephens, Co. I, 30th Maine, was wounded at Cane River, April 23, 1834, by a musket ball, which entered the left leg, injuring the tibia but not fracturing it. One week after receiving the injury he was admitted to hos pital at Baton Rouge, where the missile was extracted from the calf the leg on May 15th. By reason of erysipelatous inflam mation of the foot and leg, attended with sloughing ulceration, circular amputation of the leg at the middle third was performed, on August 2d, by Surgeon D. W. Taylor, 34th Indiana. The patient died August 15, 1864, from exhaustion. 432 INJURIES OF THE LOWER EXTREMITIES. [CHAT. X. CASE 671. Captain F. L. Thompson, Co. D, 36th Mississippi, aged 29 years, was wounded at Nashville, December 16, 1864. by a musket ball, which entered the right leg over the anterior aspect of the tibia, five inches above the ankle joint, passed downward, and lodged directly over the dorsura of the foot. Erysipelatous inflammation ensued; the ankle joint opened; tibia denuded of periosteum. On December 31st, the patient suffering from much pain and being apparently threatened with tetanus, the leg was amputated, by the circular method, at the junction of the upper and middle third, by Acting Assistant Surgeon C. H. Fisher. The patient was much emaciated, and died of exhaustion January 9, 1865. SHOT FRACTURES OF THE BONES OF THE LEG. Eight thousand nine hun dred and eighty-eight cases of shot fractures of the bones of the leg are reported, and the results have been ascertained in all but two hundred and seventy-eight cases. The tibia was injured in two thousand five hundred and eighty-eight, the fibula in one thousand and thirty-three, the tibia and fibula in one thousand four hundred and fifty-one instances, and in three thousand nine hundred and sixteen cases the diagnosis failed to indicate the precise seat of the bony lesion. TABLE LXI. Numerical Statement of the Nature and Treatment of Eight Thousand Nine Hundred and Eighty-eight Shot Fractures of the Bones of the Leg. TREATMENT. CASES. FRACTURES OF THE TIBIA. FKACT. OF THE FllJULA. FRACTIIUKSOF TIIETIIIIAANI) FlIJULA. BONE NOT SPE CIFIED. 8 3 o Recovery. "3 fe Result Un determined. Ratio of Mortality. Recovery. 3 ? fe Result Un determined. Recovery. 1 h Result Un determined. Recovery. Fatal. Result Un determined. b 1 i & Result Un determined. 3,938 339 19 2 5 22 1 3,728 3 39 100 785 3,296 248 15 2 10 1 2,354 o 19 40 3 344 528 87 4 2 3 12 114 4 13.8 25.9 21.0 100. 60.0 54.5 1,737 109 11 201 39 1 34 o 721 119 2 78 41 1 1 7 295 19 2 75 7 4 543 174 1 69 Followed by Excision 111 the Bones of the Leg Excision in Bones of Leg and Amp. of Leg Excision in Leg Amp. in Leg Amp. in Thigh.. Excision in Leg Amp. at Knee Joint 2 5 1 4 1 1 1 Excision in Leg Amp. in Thigh 5 r, o 1 1 Excision at the Knee Joint 1 539 1 f) Amputation in the Leg 1,215 5i> 4 441 159 34.0 33 3 151 88 1 8 13 206 10 1,656 908 1 1 6: 11 14 26 I 2 137 217 148 .... Amputation in Leg Amp. at Knee Joint Amputation in Leg Amp. in Thigh 1 51.2 59.0 57.1 3 11 3 20 1 (; Amputation at Knee Joint 1 15 n Amputation at Knee Joint Amp. in Thigh o Amputation in Thigh 56.1 69 95 452 -*/ 588 8 864 V 20 130 109 Aggregates 8,988 6,334 2,376 278 27.2 2,098 o 38 ICO I, OX 9 1,013 424 MsT 14 2,359 1,340 iuue 217 Three thousand nine hundred and thirty-eight, or less than one half of the cases, were treated by conservation, and five thousand and fifty, or 56.2 per cent., were followed by operation, viz: three hundred and forty by excision, forty-eight by excision and subse quent amputation, and four thousand six hundred and sixty-two by amputation either in the leg, at the knee, or in the thigh. It has already been stated on page 175, ante, that of the six thousand five hundred and seventy-six instances of shot fracture of the thigh bone, operative interference was resorted to in three thousand one hundred and nine, or 47.3 per cent., thus showing that the percentage of operations after shot fractures of the bones of the leg exceeded that after shot fractures of the femur by 8.9 per cent. SHOT FRACTURES OF THE BONES OF THE LEC TREATED BY CON SERVATION. The results as to fatality were ascertained in three thousand eight hun dred and twenty-four of the three thousand nine hundred and thirty-eight shot fractures of one or both of the bones of the leg treated without operative interference, giving a mortal- SECT. V.| SHOT FRACTURES OF THE TIBIA TREATED BY CONSERVATION. -133 ity rate of 13.8 percent. In seven hundred and eighty-six cases the seat of injury was not specified; in the remaining three thousand one hundred and fifty-two cases the tibia was implicated in nineteen hundred and seventy-two, the fibula in eight hundred and six, and both bones in three hundred and seventy-four instances, with death rates of 10.3, 7.8, and 20.3 per cent., respectively. SHOT FRACTURES INVOLVING THE TIBIA TREATED BY CONSERVATION. The tibia alone W3S involved in nineteen hundred and seventy-two instances, or in over one-half of the total number of cases of shot fractures of the leg treated conservatively. Of the nineteen hun dred and thirty-eight instances in which the results were determined, two hundred and one proved fatal, a mortality of 10.3 per cent. Recoveries after Shot Fractures of the Tibia treated by Conservation. A few of the one thousand seven hundred and thirty-seven instances of this group will be detailed: CASE 672. Private J. Wells, Co. G, 71st Pennsylvania, aged 26 years, was wounded in the right leg, at Spottsylvania, May 12, 1864. He entered Columbian Hospital, Washington, and was subsequently transferred to Harewood Hospital. Surgeon R. B. Bontecou, U. S. V., in charge of the latter, contributed the photograph (Card Photographs, Vol. 3, p. 30, A. M. M.). and reported that the patient was discharged from service June 29, 1865, by reason of "shot comminuted fracture of the tibia at the middle third." Examiner C. C. Halsey, of Montrose, Penn., December 4, 1865. certified to the injury, and stated: "The wound at point of entrance is not sound and the skin for from two to three inches around it is a mass of scabs and sores. He complains of pain about the ankle and foot." The man drew pay as a full pensioner until September 4, 1866, after which time he ceased to communicate with the Pension Office for nearly thirteen years, when he reapplied and was restored, having in the meantime changed his resi dence tt) the State of Mississippi. Examiner T. G. Birchets, of Vicksburg, reported, February 16, 1880: "The wound is about the middle of the shaft of the tibia, resulting in a very large scar, and, from feeling, there has been loss of bone. His personal appearance is healthy. There is no disability." The pensioner was paid March 4, 1880, having his rate, in consequence of the last Examiner s report, reduced from total to one- fourth. CASK 673. Private W. Kelly, Co. C, 149th New York, aged 30 years, received a shot fracture of the left tibia by a minUi liall, at Williamsport, July 11, 1863. He was admitted to Frederick, and subsequently passed through various hospitals, being ultimately discharged from service at Harewood, Washington, June 19, 1865. Surgeon R. B. Bontecou, U. S. V., in charge of the latter hospital, contributed the photograph represented in the annexed cut (FiG. 260), and reported that the patient s disability was total. Examiner G. W. Cook, of Syracuse, N. Y., February 25, 1867, certified to "shot wound of left leg at middle third, fracturing the tibia. A part of the bony substance was removed, leaving a large and extensive excavation, cicatrix, and deformity, with several minute fistulre. Abscesses frequently form ; the knee is stiff and the leg bad." Subsequent examiners report the same description of the injury and its results. The pensioner was paid March 4, 1880. CASE 674. Private S. Prillaman, Co. G, 24th Virginia, aged 28 years, was wounded and captured at Williamsburg, May 5, 1862. He was admitted to Camden Street Hospital, Baltimore, nine days after the injury, whence Acting Assistant Surgeon E. G. Waters reported the following history: "A bullet entered the anterior and inner aspect of the left leg five inches above the ankle joint, fracturing the bone at that point through its continuity and comminuting the entire shaft for four inches upward, where a second solution of the continuity was produced. The missile on coming in contact with the bone separated into three portions, one passing inward, backward, and slightly upward, and emerging posteriorly through the calf of the leg; the second passed upward, backward, and outward, lodging under the integuments on the outer aspect of the leg; the third passed into the canal of the shaft, then upward, destroying the continuity of the bone and lodging some four inches above the point of entrance. The two last mentioned fragments were subsequently discovered and removed. When admitted the patient was much broken down in health, having little or no appetite and his complexion being sallow. The leg was much swollen and discharging profusely. It was placed at once in the anterior splint and emollient poultices were applied. Some days later the limb below the knee assumed a livid line, giving rise to apprehensions of gangrene. This appearance, however, readily yielded to the free exhibition of quinine and stimulants, with cataplasms of bran and yeast applied locally, and the attempt to save the limb was persevered in. On June 24th, the patient was put under the influence of chloroform and the denuded fragments of bone were removed. The centre of the entire length of the fractured shaft was taken out, leaving only a thin scale on each side attached to healthy periosteum. It was hoped that nature would fill the cavity thus left and consolidate the limb. This expec tation was fully answered in the sequel. During his stay in the hospital the patient suffered nine distinct attacks of erysipelas, several of them being of extraordinary severity, even for cases of gunshot fracture, the writer having had under his care nearly two hundred cases of the disease resulting fiom such causes and met with not more than two or three of equal violence. The first attack came on about July 1st, extending no higher than the knee, and yielding after five days treatment. On September 28th, the patient was suffering from the fifth attack, and several fistulous orifices were noticeable over the anterior aspect of the SURG. Ill 55 FIG. 260. Shot fracture of left tibia. [From n photograph.] INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. leg, between the points of the fracture, through which the probe detected necrosed bone. It was then deemed expedient to remove several more detached fragments of bone, and -with this view the fistulous orifices were dilated and a number of pieces were seized and withdrawn. Afterwards the leg became enormously swollen and the discharge grumous and offensive. The tissues around the knee joint also began to sympathize with the general disturbance and swelled to twice their natural size. About October Gth, fluctuation manifested itself over an extensive surface about the joint, when a bistoury was carefully intro duced to the depth of an inch, giving exit to a quantity of sero-purulent fluid. The patient was actively plied with stimulants and tonics, the leg was maintained in the suspensory splint, and bran and yeast cataplasms were kept constantly applied, under which treatment the inflammation and swelling rapidly subsided, the discharge soon became healthy, and the patient s strength and spirit revived. He finally recovered with a strong and fine limb, an anchylosed knee joint, and a semi-flex ed leg. On June 27, 1863, he left the hospital cured, to be sent south, having been for thirteen consecutive months under my care. All of the sinuses (of which there were many) had healed prior to his discharge except two, and these were satisfactorily ascertained not to communicate with dead bone but with aponeurotic expansions. Bony union had taken place to an ample extent, the entire canal of the shaft which as above stated had been opened for the distance of four inches being filled in its entire depth with new osseous tissue." This patient was heard from at his home in Franklin County, Virginia, in 1877, fifteen years after the injury, when his condition was described in a letter as that of a "bad cripple." CASE 675. Private T. Schrup, Co. B, 10th New York Cavalry, aged 22 years, was wounded in the left leg, near the South Side Railroad, April 2, 1865. He was conveyed to the Depot Hospital at City Point two days after the injury, and transferred to Washington April 30th. Surgeon R. B. Bontecou, U. S. V., in charge of Harewood Hospital, contributed the photograph shown in the adjoining cut (FlG. 261), and described the injury as "a shell wound, severely fracturing the tibia, lower third. On admission the patient was in good health ; condition of injured parts good, although severely lacerated. Treatment: Simple dressings, splints, and supporting diet. The parts healed kindly, and the patient was doing well when transferred to Lincoln Hospital, July 20, 1865." He was discharged from service, at the latter hospital, August 12, 1865, Surgeon J. C. McKee, U. S. A., certifying to "partial paralysis of the left foot and leg, resulting from the wound." Immediately after being discharged the patient made an application for pension, and was examined by M. D. Ben edict, Pension Examining Surgeon, who described the fractured bone as "united with slight shortening and some deformity," and the limb as useless for the time being. The man has not been heard from since filing his application. CASE 676. Sergeant J. R. Rice, Co. K, 1st Vermont Cavalry, aged 30 years, was wounded in a cavalry charge between Hagerstown and Williamsport, July 6, 1863, by a minie ball, which entered the outer aspect of the lower portion of the right leg, fracturing the tibia and lodging in the bone. Two days after the injury he was admitted to hospital at Frederick, whence Acting Assistant Surgeon W. S. Adams reported as follows : " The patient was admitted under care of Acting Assistant Surgeon W. P. Morgan, who removed a few fragments and placed the limb in Smith s anterior splint. His general condition was good. On July 22d the patient came under my care, when I found that he had considerable irritative fever; tongue disposed to be dry; slight diarrhoea and but little appetite; limb painful and oedematons. I took off the splint to examine the limb and removed several frag ments of bone and the missile, which was found embedded in the medullary cavity about two inches below the point of the injury. Stimulants, with tonics and good diet, were ordered. By August 1st, the appearance of the limb had much improved, the patient having experienced but little pain since the removal of the ball ; appetite and general condition improving. On August 14th, his countenance had assumed a sallow appearance, and he had a slight headache, accompanied by constipation of bowels, for which three compound rhubarb pills were administered. Three days later there was well-marked jaundice, when pills of blue mass and compound extract of colocynth were prescribed. By August 21st, the jaundice was disappearing; condition of leg good. On September 1st, union of bone seemed quite firm; wound yet discharging quite freely. The limb now was allowed to rest on pillows during the day time and suspended in splints at nights. On Septem ber 20th, the splint was removed from the leg, union being firm, with no evidence of necrosis, and the wound healing kindly. About October 1st, the patient was going around on crutches, and two weeks later he laid these aside and walked with a cane, the wound having all closed with the exception of an opening barely large enough to admit a probe, On February 1, 1864, the patient was furloughed, having been able for a considerable time to walk without the aid of a cane and the wound being healed." He was subsequently promoted to Lieutenant, and ultimately mustered out of service June 21, 1865. In 1876, when applying for pension, he was examined by Surgeon C. B. Currier, of Middlebury, Vermont, who reported that "from loss of bone there is a .depression as large as a twenty-dollar piece and about one-eighth of an inch deep ; cicatrix tender to the touch ; cedema of leg and foot; leg one and a half inch shorter than the other; muscles of leg flabby and evidently weak. He cannot stand or walk much; health good." The pensioner was paid September 4, 1880. CASE 677. Captain W. W. Ellis, Co. D, 61st Pennsylvania, aged 23 years, was wounded in the left leg, at Chancellors- ville, May 3, 1863, and entered Douglas Hospital, Washington, five days afterwards. Assistant Surgeon W. Thomson, U. S. A., reported: "This officer suffered a fracture of the tibia near its middle by a ball, which entered posteriorly at the gastrocnemius muscle, and was retained. The fracture united without exfoliation, necrosis, or even free suppuration. The leg was placed in a bran box and dressed with cold-water applications. The patient suffered from severe catarrh, which yielded to treatment. There was also hyperaesthesia of the foot, for which, before the patient left on furlough in June, I made an incision in search of the ball and disturbed the cicatrix with good effect, relieving the nervous irritation of the foot. When the patient returned from furlough, September 1st, he was ordered to report to Surgeon M. Clymer, U. S. V., for treatment, and I lost sight of him. His recovery was good, but the leg was yet feeble and contracted, owing to want of passive motion while at his home." Cap tain Ellis resigned January 1, 1864, and was commissioned in the Veteran Reserve Corps, in which organization he served until FIG. 201. Shell fracture of lower third of left tibia. [From a photograph.] 1 PLATE LXXIV. UPPER PORTION OF RIGHT TIBIA SAWN LONGITUDINALLY. 1 . 2 . Out CT Yii M-s . { . 4 . IniH r MCMVS . Case ol C oloiu I VT.F.Liynch. ")8 llliimis Volunteers . Spoc-inifii <>7S4 . Sin S-i t A . M . M . SECT. v.J SHOT FRACTURES OF THE TIBIA TEEATED BY CONSERVATION. 435 March 13, 1866, when he was mustered out and pensioned. Examining Surgeon G. Urquhart, of Wilkesbarre, Pennsylvania. August 22, 1866, certified to half an inch shortening of the limb; also to painfulness, weakness, and occasional lameness. Exam iner J. W. Martin, of Red Oak, Iowa, reported, September 4, 1873: "There are large cicatrices on the left side of the tibia; leg bent and shortened ; foot swollen and tender, and muscles shrunken above the ankle. He suffers extreme pain in the leg and is unable to bear much weight upon it; general health not good." The pensioner was paid September 4, 1880. CASE 678. Private J. Walker, Co. A, 7th Wisconsin, aged 27 years, was wounded at the Wilderness, May 6, 1864. Surgeon C. N. Chamberlain, U. S. V., reported his admission to the field hospital of the 4th division, Fifth Corps, with "shot fracture of left leg, caused by a minie ball. On May 12th, the wounded man entered Armory Square Hospital, Washington, where his injured leg was operated on by Surgeon D. W. Bliss, U. S. V., who made the following report of the case: "The ball was found embedded in the shaft of the tibia at about its middle, whence it was extracted on August 13th. The leg went through all the symptoms of neci-osis of one or both the bones, the first signs of which appeared on August 19th. On October 10th, the patient was placed upon the operating table and four inches of the shaft of the tibia was removed, together with all the necrosed spicula of bone. Chloroform was used as the anaesthetic. Simple dressings, stimulants, and nourishing diet constituted the treatment. The patient did well after the operation." He was discharged from service January 24, 1865, and pensioned. Examiner A. McBean, of Chippewa Falls, Wisconsin, certified, July 9, 1867: "The remaining portion of the bone from the ankle joint to within four inches of its head has become carious. A large open ulcer is the consequence." Examiner F. A. Reckard reported, March 4, 1874: "The wound is yet open and discharging from an orifice some four inches in length. The remainder of the tibia is badly diseased and portions have come away at different times. The limb is very much swollen at times and retains him in bed for months." The pensioner was paid March 4, 1880. The bone removed consists of a sequestrum six inches in length, and for four inches is tubular. It was contributed to the Museum by the operator, and is numbered specimen 3283 of the Surr/ical Section. The specimen is shown in FIGURE 2 of PLATE LXXI, opposite page 428. CASE 679. Private A. Elmer, Co. I, 69th Pennsylvania, aged 21 years, was wounded at Petersburg, June 18, 1864, and admitted to the field hospital of the 2d division, Second Corps. Surgeon J. F. Dyer, 19th Massachusetts, reported: "Shot fracture of left leg by mini6 ball; anterior tibial artery divided. Ligation performed by Surgeon N. Hayward, 20th Massachu setts." Surgeon B. B. W ilson, U. S. V., reported that the wounded man was admitted to Stanton Hospital, Washington, July 1st, with " shot fracture of left tibia, lower third," for which splints and simple dressings were used, and that he was furloughed January 4, 1865. The patient was subsequently transferred to Satterlee Hospital, Philadelphia, whence he was discharged July 7, 1865. by reason of " lameness resulting from the injury," and pensioned. Examiner A. D. Newell, of New Brunswick, N. J., March 5, 1878, certified to the wound and fracture, and stated: "The bone is not sound now. The wounded leg is smaller. The tendo-achillis has contracted so that in walking his toes strike the ground is quite lame." The pensioner was paid December 4, 1879. In the following instance a portion of the missile remained lodged in the tibia, keeping the wound open until the time of the officer s death, twelve years after the injury: CASE 680. Colonel W. F. Lynch, 58th Illinois, aged 25 years, was wounded at Yellow Bayou, May 18, 1864. Surgeon G. L. Lucas, 47th Illinois, reported his admission to the field hospital of the 1st division, Sixteenth Corps, with "a bullet frac ture in right leg; missile extracted by Surgeon J. E. Murta, 8th Wisconsin." From the field hospital the patient proceeded to his home, and, on February 7, 1865, he was mustered out by expiration of service. His condition at this time was described by Surgeon B. Norris, U. S. A., as follows: "The wound is a very remarkable one of the tibia, about two inches from the knee joint, being a perforation of the bone to the depth of more than an inch, and open as an augur hole. A fetid discharge escapes through the opening, and the soft tissues around it are inflamed over a circle of more than two inches in diameter. These signs indicate disease which can only be entirely removed by amputation of the leg. I further certify that in conse quence of this wound his nervous system has become morbidly excitable and his health so much impaired as to unfit him for any regimental duty." About a year after his muster out of service Colonel Lynch received a commission as an officer of the Regular Army, and, on December 15, 1870, he was finally placed on the retired list with the rank of Brigadier General. Acting Assistant Surgeon F. H. Atkins reported that this officer died, from the ultimate effects of his wound, on December 29, 1876, at Fort Larned, Kansas, and contributed the pathological specimen numbered 6734 of the Suryieul Section, and represented in PLATE LXXIV, opposite p. 434, with the following information in regard to the case: "A portion of lead was cut out on the inner aspect of the limb a long time after the injury, while another portion remained lodged in the bone. The wound of exit healed early, both the soft and osseous tissues; but the anterior wound remained open up to the time of his death, small pieces of dead bone being occasionally removed, and a profuse and extremely offensive discharge continuing. All efforts on the part of many able surgeons to induce the patient to submit to the removal of the dead or diseased interior of the tibia were futile until within three months of his death, when he desired an operation, which I refused in view of his previous disease and present prostration, a position concurred in by Assistant Surgeon W. S. Tremaine, U. S. A., who saw him during consultation on December 11, 1P76. Meanwhile, in the winter of 1675-6, he had a serious illness, apparently of pyaemic character. About July 1, 1876, a severe pneumonia, followed by diarrhoea, nearly proved fatal, and after that there was constant diarrhoea and almost complete interrup tion of the digestive functions. From October until his death the apparently tuberculous disease in his left lung progressed rapidly, a large cavity forming. His death seemed to result from inanition. No general autopsy was permitted, though the upper half of the tibia was allowed to be removed. The bone was ripped by a saw longitudinally, the incision running obliquely backward and inward to avoid cutting the wound of entrance. A condition of the bone was displayed which, in my opinion, would have given prompt and absolutely favorable results had excision of the diseased portion been performed at any time prior to the winter of 1875-6. A cavity averaging one and one-fourth inch in diameter, and located most favorably for removing the dead bone successfully, was found directly behind the wound of entrance. The cavity was lined throughout by a membrane continuous with the edges of the soft tissues and the skin. The dead bone approached the surface of the tibia rarely as near as one-third of an inch, and the kneu joint about one inch, extending only one-half to three-fourths of an inch below the wound of entrance. At the lowest part of the cavity, on the posterior segment, there was a group of black masses, white internally. A 436 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. minute portion of this substance, treated with carbonate of soda on charcoal under the blowpipe, gave numerous metallic globules, malleable under pressure, showing that the mass was part of the missile now carbonate of lead within and sulphuret without. The upper third of the tibia was greatly hypertrophied." Fatal Cases of Shot Fractures of the Tibia, treated by Conservation. Two hundred and one cases of this group were reported, the fatal issue being generally ascribed to pyaemia, gangrene, or exhaustion: CASE 681. Private I. D. Mason, Co. D, 17th Maine, aged 30 years, was wounded at the Wilderness, May 5, 1864, by a musket ball, which entered the external aspect of the left leg, fracturing the tibia immediately below its head, passed into the right leg about two inches lower down, fracturing the right tibia also, and lodging. The wounded man was treated at Fred- ericksburg until May 25th, when he was admitted into Douglas Hospital, Washington, in a typhoid state. Death took place from exhaustion May 31, 1864. The upper halves of the bones of both legs are represented in the adjacent cuts (FiGS. 262, 263), exhibiting each tibia to be shat tered in the upper third, and showing incipient necrosis as the only observable change. The history and the specimens were contributed by Assistant Surgeon W. Thomson, U. S. A. CASE 682. Corporal W. Smith, Co. K, 1st Louisiana, aged 18 years, was wounded at Gettysburg, July 2, 1863, by a musket ball, which fractured the left tibia at the lower third. On July 27th, he was admitted to Camp Lettermau, the leg being considerably swollen and painful. Acting Assistant Surgeon P. S. Leisenring reported that the limb was placed in a fracture box and solution of lead and opium applied. On August 6th, the use of flaxseed poultices was com menced, and an abscess opened posterior to the wound. After this there was some improvement. On August 18th, the fracture-box was removed, and four days later the patient was able to move his limb. The administration of febrifuge remedies, including quinine, was subsequently prescribed, the patient having a severe chill on August 25th. Another abscess, forming anterior to the tibia, was lanced several clays afterwards, after Avhich there was improvement for some days. On September 14th, the patient came under the care of Assistant Surgeon R. G. Southall, C. S. A., who found him very much emaciated and with several ulcers on the leg. The patient was also troubled with diarrhoea and had lost his appetite. Under the administration of tonics, stimulants, and astringents, and the application of stimulating lotions and nitrate of silver, the patient slowly mended until September 22d. when the ulcers assumed a phagedenic form and the improvement ceased. On September 28th, two spiculse of considerable size were removed from the tibia. Acting Assistant Surgeon W. M. Welch reported the termination of the case as follows: "The case came under my charge on October 13th. The bone had united, but the leg presented two ulcers near the region of the wound, which had sloughed largely. Nitric acid applications were resorted to. under which treatment the leg improved until October 24th, when the ulcers again became phagedenic and nitric acid was again resorted to. Bromine was also used, but neither remedy produced any salutary effect. the patient s s\ stem lacking sufficient vitality to separate the sloughs from the living tissues. The patient also continued to be a sufferer from obstinate diarrhoea, which baffled ;ill treatment. He died from exhaustion November 3, 1863. On examination, the fractured portion of the tibia was found to be very feebly united; callus insufficient in quantity and unhealthy in quality. The proximate portion <>f the fibula was also diseased." The lower third of the bones of the wounded leg, represented in the cut (FlG. 264), were contributed to the Museum by Acting Assistant Surgeon E. T. Townsend. The specimen, to which a sequestrum remains attached, shows the fractured shaft of the tibia to have been invaded by caries to a considerable degree and a large portion of i 1 lost by suppuration. CASE 683. Private -/. Guy, Co. D, 39th North Carolina, aged 19 years, was wounded in the left leg, at Stone River, December 31, 1862. Surgeon C. W. Horner, U. S. V.. reported : The injury was caused by a conical ball, which passed from the inner to the outer aspect t the middle third of the leg, producing a comminuted fracture of the tibia and carrying away one and a half inch of its shaft. The man was captured soon after the reception of the wound and carried to hospital at Murfreesboro , where he remained until August 1, 1863, when he was sent to the Prison Hospital. According to his statement no splints had been applied to the limb. On January 4, 1864, the patient was admitted to Hospital No. I, at Nashville, at which time he was very much reduced, even to emaciation, numerous and large abscesses having Fin. 262. Shot fracture of upper third of left tibia. Spec. 3549. FK ;. 2t>.">. -Shot fracture fright tibia. Spec.35W. FIG. 264. Shot fracture of lower f ornie( l about the leg and particles of bone being brought away with the discharge from th Spec. 1930. Kir,. 265. Por tions of the bones of the left leg, with shot fract tire of tibia at junction of middle and upper thirds. Spec. 2184. wound. The upper fragment of the tibia was displaced outward and forward, and an interval of about an inch existed between it and the lower fragment. The head of the fibula, too, was displaced upward and outward, and the slightest motion of the limb produced excessive pain. The patient had no appetite; stomach irritable; pulse quick and weak. Erysipelas also supervened, and severe cough and diarrhoea. The former was checked and the wound healed ; but the cough and diarrhoea continued troublesome and persistent. The pulmonic trouble became more aggravated, and the patient died February 15, 1864." The bones of the injured leg, represented in the annexed cut (FlG. 205\ were forwarded to the Museum by Acting Assistant Surgeon R. T. Higgins, and a cast of the limb, taken some weeks prior to the patient s decease, and contributed by Ass t Surgeon C. J. Kipp, U. S. V., constitutes specimen 6683 of the Surgical Section* SECT. V.] SHOT FRACTURES OF THE FIBULA TREATED BY < OBSERVATION. 437 SHOT i RACTUKES OF THE FIBULA TREATED BY CONSERVATION. The results of the injuries were ascertained in seven hundred and ninety-nine of the eight hundred and six cases of this group. Seven hundred- and twenty-one recovered and seventy-eight died, a mortality of 9.7 per cent. Examples of Recovery after 8hot Fractures of the Fibula treated by Conservation. These injuries healed without serious complications; but it would appear from the records of the Pension Office that the movements of the ankle joint frequently remained impaired: CASE (584. Private A. McPhee, Co. B, 16th New York, aged 20 years, was wounded in the left leg, at Gaines s Mill, June 27, 1862. He was convoyed to hospital at Fort Monroe, and several days afterwards to Philadelphia. Assistant Surgeuu C. W. Horner, U. S. V., in charge of Wood Street Hospital, reported: He was wounded l>y a ininie ball, which entered the leg on its outside at the middle, fractured the fibula extensively, and passing downward made its way to the inside of the limb below the ankle, where it was retained, and whence it was removed at the Pennsylvania Hospital about the 10th of July. He was transferred to this hospital October (5th. His treatment consists of bandaging, occasional poultices, and cerate dressing. The patient is progressing favorably." He was discharged January 19, 1863, and pensioned. Examining Surgeon J. Cummis- kev, of Philadelphia, February 6, 18(53, certified to "elevation of the heel and stiffness of the ankle joint resulting from the wound. He is very lame, and obliged to carry a cane in walking." Examiner E. H. Lesvis, of Car ver, Minnesota, reported, August 5, 1874: "At present the lower or articulating portion of the fibula is in a process of acute caries: ankle joint anchylosed, pus discharging from six sinuses," etc. The St. Paul Examining Board reported, several years afterwards, that "the wound continually opens and discharges, small pieces of bone escaping. Cicatrix large and weak; motion of ankle much impaired. The greater toe is doubled under and the tendo-achillis hampered by the wound." The pensioner was paid March 4, 1880. CASE 685. Corporal C. A. Woodruff, Co. A, 10th Vermont, aged 19 years, was wounded through the right leg, at Cold Harbor, June 3, 1864. He was admitted to Mount Pleasant Hospital, Washington, four days after the injury, and subsequently to Brattleboro . On December 27th, the patient was transferred to Sloan Hospital, Montpeliet*, whence Surgeon H. Janes, U. S. V., contributed the photograph (FiG. 266), with the following history: "The wound was caused by a musket ball, which entered about the middle of the leg, on the outer and posterior aspect, passed forward and emerged anteriorly between the tibia and fibula, two inches below the point of entrance, fracturing the fibula. Several pieces of bone w r ere removed at the time of the injury. Gang7-ene followed, and the wound opened to the size of an open hand. The wound of entrance closed in April, 1865, but that of exit had not healed at the time of his discharge from service. He was then obliged to use a crutch in walking. The patient also had a congenital malposition of the heart, which he never discovered until the time of his enlistment, the location of it being on the right side, with the apex beating under the right nipple. His chest was well formed, and he was a stout and, excepting his wound, a healthy man." The patient was discharged from service August 18, 1865, and pensioned. Examiner G. B. Bullard, of St. Johnsbury, Vermont, certified, on January 25, 1866, that particles of bone were still being discharged from the wound, and the pensioner complained of stiffness of the ankle joint, and that he was unable to bear his weight on his right foot or walk without crutches. He was last paid September 4, 1866, since when he has not been heard from. Fatal Cases of Shot Fractures of the Fibula treated by Conservation. Seventy-eight cases are recorded in this group. The fatal issue was frequently due to complications, as in the following instance, in which the patient died with the ordinary symptoms of typhoid fever eight days after the reception of the injury: CASE 686. Sergeant D. P. Spicer, 1st Iowa Battery, was wounded in the right leg, at Eesaca, May 15, 1864, and admitted to the field hospital of the 4th division, Fifteenth Corps. Dr. J. M. Woodworth, Surgeon 1st Illinois Light. Artillery, and Med ical Inspector, contributed the following report : "A gunshot wound just below the knee joint, fracturing the head of the fibula and passing out at the centre of the lower border of the popliteal space. The artery was not wounded. The subject was a large, healthy, muscular man, about 30 years old. After his admission to hospital the fragments of bone were removed, the wound was cleansed and cold-water dressing applied. The wound looked well until the morning of the 18th, when it presented a red inflamed margin, with tumefaction of the surrounding soft parts and enlargement of the veins of the thigh. A thin sunious discharge exuded from the opening, and the entire limb as far as the swelling extended was remarkably hot; pulse full and strong. The patient was separated from the rest of the wounded, and his treatment was the same as in similar cases. On May "20th, the wounded limb was tensely swollen from tint ankle to the body. At first the surface of the inflamed part was florid, but it became yellowish and mottled with greenish-purple gangrenous blotches. It was completely blistered with the stronger preparation of iodine, and kept imbued Avith a mixture of tincture of chloride of iron, creasote, and tincture of iodine in alcohol. The patient was also kept on a full course of tonics, stimulants, and generous diet. The disease or erysipelatoiia inflammation did not extend further, but the pulse grew more and more feeble. The patient became incoherent in mind and sank steadily, expiring on May 23, 1864. He died with the ordinary symptoms of the more grave form of typhoid fever." FIG. 266. Shot fracture of right fibula. [From a pho tograph.] INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. SHOT FRACTURES INVOLVING BOTH BONES OK THE LEG TREATED BY CONSERVATION. The shot fractures involving both bones of the leg, while far less numerous than those of the tibia or of the fibula, largely exceeded them in fatality, seventy-five of the three hundred and seventy determined cases having resulted in death, a mortality of 20.2 per cent. Examples of Recovery after Shot Fractures involving both Bones of the Leg treated by Conservation. There were two hundred and ninety-five instances belonging to this group. In nearly all the cases there was more or less shortening of the limb, and in some instances considerable deformity, especially convexity, but many of the patients recovered with useful limbs: CASE 687. Private B. F. Hayner, Co. H, 125th New York, aged 19 years, was wounded at Gettysburg, July 3, 1863. He remained at the Second Corps Hospital for one month, when he \vns transferred to Camp Letterman. Acting Assistant Surgeon W. B. Jones reported: "Compound fracture of right and left tibia, lower third, by a piece of shell, which struck the outer side of the left leg, passed transversely, and grazed the anterior aspect of the right leg. Cold-water and simple cerate dressings were used; splints, etc. Union took place in both legs, and by September IMh the patient was cured, but still unable to walk." He was transferred to McKim s Mansion Hospital, Baltimore, October 2Ikl, and subsequently to Camden Street. Surgeon Z. E. Bliss, U. S. V., in charge of the latter, corroborated the description of the injury, and reported that the fracture box was used in the treatment of both legs; also that in April, 1864, the wound of the right leg had closed, while that of the left leg was still unhealed, there being slight lateral curvature in both legs; the patient able to walk well with the aid of a cane. The patient subsequently passed through different hospitals, and on August 27, 1864, he was returned to his command in the field. Being found entirely unfit for duty, he was returned to hospital for treatment until June 5, 1865, when he was mustered out of service and pensioned. Examining Surgeon E. B. Bontecou, of Troy, N. Y., reported April 7, 1875, that "the tibia and fibula were both broken in the right leg, and have united, with some deformity, leaving a useful limb. The left leg has united with an outwardlv curved deformity, and there remains some carious bone in the tibia, with a h stulous opening and constant discharge, considerable tumefaction and inflammation in the vicinity of the wound. There is considerable loss of soft parts, leaving a long cicatrix, and the limb is lame in consequence of the injury." Substantially the same was reported at subsequent examinations. The pensioner was paid December 4, 1879. CASE 688. Private M. Lynn, Co. I, 26th Pennsylvania, aged 26 years, was wounded at Chancellorsville, May 3, 1863. He was admitted to the field hospital of the 2d division, Third Corps, where Assistant Surgeon E. Marshall, 124th New York, recorded "shot fracture of left leg." Surgeon J. A. Lidell, U. S. V., reported as follows: "The patient entered Stanton Hos pital, Washington, June 15th, with compound fracture of tibia and fibula at the middle third, caused by a minie" ball entering at the posterior and inner side of the calf of the leg and escaping in front. At the time of his admission the leg was in a fracture box; the wound suppurated freely; patient s general condition good. Previous to his entrance to this hospital several detached fragments of bone had been removed, and a portion of the bullet had also been extracted; subsequently about half a dozen more fragments of bone were removed at different times. Splints and water dressings were used. About July 1st, the fracture had united, and one month later there was firm union of the bones and the wound was healing rapidly. On September 22d, the patient received a furlough and was allowed to go to his home for two months. The orifice of entrance healed about the 1st of October, and before the patient was transferred to Philadelphia, in April, 1864, the orifice of exit had also closed. The atrophy of the wounded limb had disappeared entirely and the muscles of the leg acted freely, the patient being able to walk well with out the aid of a cane and without limping. There was no shortening, and no deformity aside from some loss of osseous tissue at the seat of the fracture. The patient stated that the wounded limb had not caused him to feel sick at any time. He made the best recovery of any case of shot fracture of the leg that has come under my observation." After his transfer the patient was admitted to McClellan Hospital, whence he was returned to duty May 31st, to be discharged. He was mustered out of service June 18, 1864, and pensioned. The Philadelphia Examining Board at different dates certified to the injury, and reported that an adherent cicatrix resulted, causing impaired use of the limb; also that the fractured space had filled with cartilaginous tissue. The pensioner has been exempted from further examinations since 1873. He was paid December 4, 1879. In the following cases a longitudinal incision was made along the crest of the tibia, and a number of pieces of both the tibia and fibula were removed: CASE 689. Private S. McNitt, Co. D, 4th Delaware, aged 23 years, was accidentally shot in the left leg, while in camp near Fairfax Court House, October 22, 1863. Surgeon D. S. Hopkins, 4th Delaware, reported: "The ball entered the limb posteriorly, at the junction of the upper with the middle third, passed directly through, causing a compound comminuted fracture of the tibia and fibula, and came out anteriorly, carrying with it fragments of bone. Comparatively slight haemorrhage ensued, and that principally of a venous character. An examination showed that although extensive laceration of the soft parts had taken place, yet the arteries were found entire and pulsation at the extremities very perceptible. The leg was, therefore, placed in a horizontal position and loose spiculsc of bone were removed. Cold-water dressings were applied, and the patient was made as comfortable as circumstances would permit. Solution of morphia, two grains to an ounce of water, was adminis tered at intervals of an hour until the patient became quiet. Next morning, October 23d, his system seemed to have suffered but little from the shock, he being comparatively comfortable. More minute examination revealed the fact that a number of pieces of bone still remained in the wound, which it was deemed necessary to remove. Accordingly a longitudinal incision was made along the crest of the tibia, the patient being under the influence of chloroform, and several spiculsc of bone were taken out varying in length from one to two and a half inches. The largest, from the crest of the tibia, included in its thickness much SECT. V.] SHOT FRACTURES OF TIBIA AND FIBULA TREATED BY CONSERVATION. 439 of the cancellated structure of the bone, as was the case with each piece removed ; the average breadth was three-fourths of an inch. After the fragments had been removed the parts were coaptated, the limb was adjusted in a fracture-box, and cold-water dressings were reapplied. The patient was comparatively comfortable during the night." Some months after the reception of the injury the patient was admitted from the field into hospital at Alexandria, and lastly he was transferred to Tilton Hospital, Wilmington, where he was discharged June 19, 1835, Surgeon E. I. Baily, U. S. A., certifying to the shot fracture resulting in " necrosis and shortening of the leg." The Wilmington Examining Board, in describing the injury, December f>, 1871, reported: "Large and irregular cicatrices in front and rear of the limb; unnatural condition of skin ; shortening of leg by an incli and a half. On account of occasional suppuration and exfoliation the limb has become much weakened and the convexity of it more marked. The disability is permanent in its present degree." After another inspection two years later the pensioner was exempted from further examinations. He was paid September 4, 1880. In the next case a sequestrum nine inches and a half in length was removed. New bone of sufficient thickness had formed to hold the limb in its normal position. The patient died, nine years after the reception of the injury, of dropsy: CASE G90. Lieutenant C. G. Martyn, Co. A, 2d New York Heavy Artillery, aged 29 years, was wounded at Deep Bot tom, August 14, 1834, and entered Armory Square Hospital, Washington, three days afterwards. Assistant Surgeon C. A. Leale, U. S. V., contributed the pathological specimen (FiG. 267), and the following history of the case: He was wounded by a mini6 ball, which entered the right leg between the tibialis anticus and extensor longus digitorum muscles, opposite the centre of the middle third of the tibia, passed through the leg transversely, fracturing the tibia and fibula, and made its exit at the anterior lateral aspect of the soleus muscle. Immediately after the reception of the injury the patient was removed to a field hospital, and on the following day he was placed under the influence of chloroform, when several spiculae of bone were removed. Splints were then applied, and he was transferred to Washington, where the wound was dressed and the limb placed in a fracture-box. The general condition of the patient at that time was good. On account of great pain the fractuT-e-box was removed on October 7th, and Smith s anterior splint was adjusted, which allowed the patient to rest more comfortably. On November 1st the splints were removed, and the limb was laid on a pillow and dri-ssed twice a day with simple dressings. The wound had now nearly closed, but several sinuses existed and communicated with the bone, and the fracture had not yet united. By March 16, 1865, the patient was able to leave his bed and walk on crutches. He first came under my charge on April 1st, when, on an examination with the probe, I found the sinuses to communicate with dead bone; the discharge of pus was about three ounces per diem; appetite and general condition good. The discharge continuing to increase and the patient gradually grow ing weaker, he was placed under the influence of ether on April 25th, and an incision was made nine inches in length over the anterior portion of the tibia, when it was found that necrosis extended to within two inches of the ankle joint and nearly to the head of the tibia. A sequestrum nine and a half inches long was then removed, also several small pieces, and in the operation a longitudinal piece of newly formed bone had to be withdrawn. After the removal of the necrosed portion, new bone was found of sufficient thickness to hold the foot in its proper posi tion. The loss of blood during the operation amounted to about ten ounces. The wound was dressed with charpie and cold water, and the patient took stimulants and an anodyne every four hours. On the next day he was very weak and had continued nausea, no appetite, and vomited all food as soon as swallowed, not being able to retain brandy even, which increased the nausea. Two ounces of beef tea was then given every four hours > but it also was nearly all thrown off. On April 27th, he was still weaker and the nausea continued, when two ounces of & champagne with ice was administered every four hours, and four ounces of beef tea, per enema, was given three ge ^ue8tnim~94 times a day. This was continued for two days, when the patient had a well-marked chill and was sinking fast, ins. long, from his nausea having increased to such an extent that the sight of other patient s food caused him to vomit. On April ^"^439! 30th. he was worse in every respect, when doses of five grains of oxalate of cerium was ordered to be given when ever the patient felt as though he would immediately vomit. By 9 o clock P. M. he had used six powders, not having vomited once since taking the first, and having retained food eaten at noon. The champagne and beef tea were continued. By May 6th great improvement was noticed, and, there being no nausea or vomiting, the powders were discontinued. The Avound was now granulating finely, and the discharge consisted of perfectly healthy pus. About June 25th, the patient could leave his bed and sit in a chair, the cavity having nearly filled and the wound being healthy and reduced to about half the size of the incision. He had perfect use of the ankle joint and the tibialis anticus muscle, and there was all probability of a very useful limb. By July 15th, he could bear considerable weight on the injured leg. The patient was subsequently transferred to Douglas Hospital, where he was discharged from service by special order of the War Department, October 13, 1865. In his publication 1 of the case Dr. Leale mentioned Surgeon D. W. Bliss, U. S. V., as the operator, and added that he saw the patient again just before he left Douglas Hospital, at which time the limb was in a healthy condition and the wound had nearly closed, leaving three small openings, which were prevented from closing by the great tension on the newly formed integuments. There was also slight contraction of the tendo-achillis, which could be easily overcome, although every possible care had been taken to guard against that result. The patient s name was subsequently admitted on the Pension Rolls, and afterwards he obtained employment in the New York City Custom House. Dr. G. K. Smith, of Brooklyn, May 11, 1874, certified that the patient, after receiving his dis charge from service, entered Bellevue Hospital, New York City, where "Professor J. K. Wood performed an operation on his leg, cutting the tendo-achillis, and, I think, he also removed a large portion of the fractured bone. The wound healed in 1866, but soon broke open again, and continued to discharge until the month of June, 1873, when it finally healed. After leaving Bellevue Hospital he came under my care, and though his health was feeble, he performed his duties at the Custom House, with occasional loss of time, until the wound healed, in June, 1873. From that date his health failed rapidly. His liver began to 1 LEALE (C. A.), Extensive Necrosis of the Shaft of the Tibia following Gunshot Fracture of the Bone, in United States Sanitary Commission Memoirs, Surgical Volume I, New York, 1870, p. 492. 440 INJURIES OF THE LOWER EXTREMITIES. - [CHAP. X. increase in size, the heart became irregular in its action, respiration difficult and circulation very feeble. At length dropsy set in, and he died December 1, 1873. An external examination showed the liver to be nearly twice its normal size, and I have no doubt that death was caused by a waxy degeneration of the liver, the result of the shot fracture." CASE 691. Captain E. Bernard, Co. I, Goth New York, aged 29 years, received a gunshot wound through the left leg just below the knee, fracturing the tibia and fibula, at Malvern Hill, July 1, 1862. He was conveyed to Harrison s Landing, and thence by steamer to Fort Monroe. From there he proceeded to his home in New York City, where he obtained the profes sional attendance of Dr. L. A. Sayre, who subsequently furnished the following report of the case: I was called to see Captain Bernard on July 12th, when he had just arrived from Fort Monroe, and was supposed to be in a dying condition from septicasmia. Many surgeons who had seen him at Harrison s Landing and Fort Monroe had all advised amputation of the wounded limb. The leg had become about two and a half inches shorter than the other and very much twisted on its axis. Extensive suppuration extended up the thigh and down the leg, both openings having been hermetically sealed with closely packed lint, which, when soaked off, caused the escape of a greater amount of imprisoned pus than I have ever seen from a single wound. Mingled in the pus there was also a large quantity of very finely broken tip and macerated bone, and over the tubercle of the tibia a loose fragment was detected which, when cut down upon, escaped, having the appearance of a polished metal, like a silver sixpence, and the shape of a hollow segment of a robin s egg. This fragment, which, before extracting, I had suspected to be a loose piece of bone, the patient declared to be the end of an explosive ball. His thigh at this time was so infiltrated with pus as to make amputation hazardous. I therefore made free incisions for its escape and drainage, and treated the limb by extension and plaster-of-paris, using adhesive plaster, weight and pulley over the foot of the bed, which was elevated to make the body act as a counter-extending force. Several large fragments of bone, having been macerated in the pus so long, were subsequently easily picked out without removing the periosteum. He made a very satisfactory recovery with but very little shortening, although there must have been more than an inch of entire bone removed. There is still (1874) a small piece of dead bone remaining, which, however, gives uo trouble as long as he wears the tent to keep up the drainage. Whenever he leaves this out and the wound closes, he becomes sick until the discharge again takes place. I have been anxious to remove the diseased part, but he can never find time for that purpose, having to work constantly for his living and being too poor to lay up for the operation." The New York City* Examining Board, on October 1, 1877, reported the sinus leading to dead bone as still open, having never ceased to discharge, and requiring constant dressing. Captain Bernard obtained his discharge from service October 22, 1863, and has since become a pensioner. He was paid September 4, 1880. In a number of cases of recovery after shot fracture of both bones of the leg, the knee joint or the ankle joint or both became partially or totally anchylosed: CASE 692. Major A. J. Bolar, 12th Pennsylvania Reserves, aged 31 years, was wounded in both legs and captured at Fredericksburg, December 13, 1862. After remaining a prisoner some weeks he was exchanged and conveyed to Annapolis, where he was admitted to hospital on February 21, 1863. Acting Assistant Surgeon J. H. Longnecker reported : " This officer was wounded in the left leg by a round ball entering three inches below the knee joint and fracturing the fibula ; also by a buck shot in the same locality and a mini6 ball entering the external upper third of the leg. There was compound fracture of both the tibia and fibula. The ball has never been found, and is supposed to have lodged in the muscular part of the leg. The right leg was also wounded by a mini6 ball entering at the outer tuberosity and passing under the patella. At the time of admission the wound of the right leg was open and discharging. On September 9th, when the patient was put under my care, it had closed and there was anchylosis of the knee joint. The left leg was very much swollen and inflamed, there being two angry looking ulcers about three or four inches below the knee joint, with a tendency to sloughing. The patient s general health was good. Charcoal poultices were ordered, to be renewed twice a day. On September 21st, fiaxseed was substituted for the charcoal, the wound looking more healthy and granulating, with not so much swelling or redness, and the pain less acute. On October 1st, two small fistulous openings remained, discharging a thin, sanious, arid offensive ichor with small parts of decayed bone, which were injected with a mixture of opodeldoc and sweet oil twice a day. By November 1st, the discharge was much less and of a better quality, the leg of natural size, and the patient able to walk much easier with the aid of crutches. About December 1st, there was still slight discharge, the pus being mixed with small black particles, indicating exfoliation. Gradual improvement continued, and one month later the patient was able to walk by the support of a cane." He was honorably dis charged from service January 30, 1864, and subsequently entered the Veteran Reserve Corps, being ultimately mustered out June 6, 1865, and pensioned. Examining Surgeon G. R. Lewis, of Indiana, Pennsylvania, certified, February 8, 1867: "The pensioner was wounded in the left leg by several balls, one being still unremoved. The wound is still discharging and requires to be dressed daily. He was also wounded in the right knee, the ball lodging. Complete anchylosis resulted." On September 21, 1875, the same Examiner reported : "The ball in the left leg has not been removed and the wound still discharges, etc. There is partial stiffness of the knee joint, and he is totally disabled for manual labor." Examiner M. L. Miller, of Blairsville, Pennsylvania, September 4, 1877, certified to the injuries and added: "There has been much muscular waste and tenderness of the parts (left leg), and there is discharge of offensive matter from the place of injury, requiring daily dressing." The pensioner was paid September 4, 1880. CASE 693. Assistant Surgeon A. H. Laridis, 35th Ohio, aged 39 years, was wounded near Kenesaw Mountain, June 22, 1864, by a twelve-pound solid shot, which, after hitting a tree and bounding off, struck his right leg, causing fracture but not breaking the skin. Surgeon F. D. Morris, of the regiment, reported that the missile fractured both bones of the limb midway between the knee and the ankle, and that the soft parts were much contused. The patient was admitted to the field hospital of the 3d division, Fourteenth Corps, where he received a leave of absence on the following day. He was mustered out of service September 27, 1864, and pensioned. Examining Surgeon J. S. McNeeley, of Hamilton, Ohio, certified, October 31, 1865: "The leg was struck at the posterior part of the middle third, fracturing both the tibia and fibula and lacerating the gastrocne- mius and soleus muscles. The resulting cicatrices have formed adhesions to the adjacent parts, entirely destroying their action. In adjusting the fracture complete apposition was not attained, and, from extension of inflammation, there is partial anchylosis SECT, v.] SHOT FRACTURES OF TIBIA AND FIBULA TREATED BY CONSERVATION. 441 of both kuee and ankle joints, rendering locomotion Loth painful and difficult." Subsequent examiners report no additional information. The pensioner was paid September 4, 1879. Both bones of the left leg as well as of the left forearm were fractured in the next case. The arm was amputated at the middle third, but the patient was so utterly prostrated that amputation in the leg was deemed inadvisable: CASE 694. Sergeant J. McLeer, Co. C, 84th New York, aged 23 years, was wounded by a shell in the left arm and left leg, at Bull Run, August 29, 1862. He entered Mount Pleasant Hospital, Washington, several days afterwards. Assistant Surgeon C. A. McCall, U. S. A., in charge, describes the injury of the arm as a compound comminuted fracture of the radius, ulna, and elbow joint, and that of the leg as a fracture of the tibia and fibula, lower third, and reports: "On or about the 2d of September I amputated the arm at the middle third (Second Surgical Volume, TABLE LXXVIII, p. 765, No. 167), and would have also amputated the leg, but that the utter prostration of the patient threatened death upon further surgical procedure. Operating on the leg was therefore left to a future time; but as symptoms of promise developed themselves afterwards, an efi ort was made to save the leg, which, after long and critical treatment, was successful, although the limb was left somewhat shortened and to a considerable extent unfit for useful progression. The case was one of singular interest to myself and staff, proving as , it did the wonderful endurance of the human system and the almost strained limit to which conservative surgery may trust nature. It had been looked upon and classed by me as an excision of the lower portion of both bones of the leg: for though no special operation was performed, yet I know I was over half an hour cleaning out the broken fragments and adjusting loosened spiculse before trusting it to the fracture-box." In a published account of the case 1 it is mentioned that, under a tonic and stimulant treatment and the application of simple absorbent dressings to the parts, the stump of the arm healed rapidly. The patient was discharged from service July 27, 1863, and pensioned. On September 22, 1880, he was examined by the Brooklyn Pension Board, who certified to the loss of his left arm and added: "There is evidence of a compound comminuted fracture of the tibia and fibula of the left leg in the lower third. Portions of both bones were removed. The cicatrices of entrance and exit of the missile are found upon the internal and anterior aspects of the part. In the latter situation, over the tibia, a firmly adherent cicatrix, three inches long by one inch wide, is present. The leg is bowed outward to a very marked degree, the fibula being very prominent and thickened. There is shortening of the limb of about one inch. The extensor tendons are not full in their movements, being partially bound down by cicatricial tissue, and the ankle is somewhat stiffened and restricted in its motion. The great toe is not supple, since the plantar tendons are somewhat contracted. Altogether the objective signs show that the original Avound was of the most severe character. In manual labor, walking, standing, etc., the member would speedily become the seat of great swelling and pain, as is the case after any unusual exercise." Fatal Cases of Shot Fractures of both Bones of the Leg treated by Conservation.- Of the seventy-five instances of shot fractures of the tibia and fibula with fatal issues three will be detailed: CASE 695. Private G. F. Skinner, Co. H, 6th Maine, aged 30 years, was wounded at Chancellorsville, May 3, 1863, and admitted to Douglas Hospital, Washington, five days afterwards. Assistant Surgeon C. C. Lee, U. S. A , reported: "This man suffered a comminuted fracture of the left leg from a musket ball, which entered one-half inch internally to the spine of the tibia, passed through antero-posteriorly, and emerged at a corresponding point at the back of the leg. Much contusion and ecchymosis existed at the time of his admission to the hospital, and but for the high state of inflammatory action then existing the leg would have been removed. The limb was then placed in a fracture-box filled with bran, and covered with water dressings; nutrients and stimu lants were given freely. No change was perceptible until the morning of May 16th, when the foot and leg were found in a state of advanced gangrene. To show how rapidly this condition supervened it is only necessary to state that a most careful examination during the previous evening failed to reveal anything of the kind, the patient in all respects seeming as well as usual. By the next morning this condition of the leg was rapidly extending up the thigh, the soft tissues of which became boggy and crepitant; the patient being bathed in clammy sweats, and his circulation so depressed that the pulse was imperceptible at the wrist, though at the groin it was 160 per minute. At the same time the patient s spirits were not at all depressed, and he could hardly believe he was in any danger. His prostration was such that amputation was deferred ; but the most energetic stimulation failed to bring his condition into one of sufficient reaction to bear the operation. He gradually sank, and died at 2 o clock on the morning of May 17, 1863. At the autopsy, the internal organs were discovered to be generally healthy. The bone was found to be exten sively comminuted, with a portion of the bullet lying upon the lacerated and obliterated posterior tibial vessels, thus probably furnishing the main cause of the gangrene. No secondary abscesses were found, and it was concluded that the patient had died in the primary stage of blood poisoning." The upper halves of the injured bones, showing a transverse fracture of the fibula and comminution of the tibia, with the bat- left tibia and fibula, tered bullet attached, were contributed to the Museum by Assistant Surgeon W. Thomson, U. S. A., and are shown in the annexed cut (FlG. 268). CASE 696. Private J. Bailey, Co. B, 211th Pennsylvania, aged 29 years, was wounded at Petersburg, April 2, 1865. Surgeon A. F. Whelan, 1st Michigan Sharpshooters, reported his admission to the field hospital of the 3d division, Ninth Corps, with "Canister shot fracture of right leg." Surgeon E. Bentley, U. S. V., recorded the result of the injury as follows: "The CoUEiS (ELLIOTT), Report of some Cases of Amputations and Resections from Gunshot Wounds, performed at the Mount Pleasant U. S. General Hospital by C. A. McCALL, M. D., U. S. A., in Medical and Surgical Reporter, New York, 186-2-3, Vol. IX, p. -229. SURG. Ill 56 442 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. man was admitted to Slough Hospital, Alexandria, four days after receiving his wound. The tibia and fibula were badly shat tered. Cold-water dressings were employed, and tonics and stimulants were freely administered, together with all the nourish ment the patient would take. He died May 2, ISoo, from the severity of suppurutive inflammation of the wound. The autopsy showed the tibia to be comminuted for several inches at the upper third and the fibula fractured at the lower third, no union having taken place. The wound was gangrenous." In the following instance of lesion of both bones of the leg in the middle third, osteo myelitis of the medulla of the femur was noted at the autopsy. The upper and lower thirds of the tibia were found upon opening to be quite healthy : CASE 697. Musician G. H. Potter, Co. E, 60th Ohio, aged 14 years, was wounded in the right leg, before Petersburg, July 16, 1864. Surgeon P. A. O Connell, U. S. V., recorded the following description of the injury at the field hospital of the 3d division, Ninth Corps: "A ball entered the outer side of the limb about the upper third of the fibula; exit below on anterior aspect, gouging tibia and fibula." The wounded man was conveyed to the Depot Hospital ;it City Point the day after the injury, and one week later he was transferred to Fairfax Seminary Hospital. Assistant Surgeon H. Allen, U. S. A., in charge of the latter, made the following report: "On entering the hospital the lad was in fine spirits, though somewhat anaemic; wound look ing well. On August 5th, the wound assumed an indolent appearance and the discharge became greater and more fetid. Bro mine was thoroughly applied in the ordinary way and at first checked the progress of the disease. But the patient appeared to have no recuperative energy and a tendency to subcutaneous sloughing was evinced, which, by the 12th of August, had increased BO far as to necessitate the slitting up of the integuments and a second rigorous application of bromine. It was observed during the operation that the tibia was exposed and a superficial area of bone was being thrown off. The patient was exceedingly irritable, appetite capricious. The wound still presented a gluing and unhealthy appearance, and the tendency to undermining continued in spite of all efforts to check it. The patient gradually sank. By September 15th, violent and persistent vomiting came on, and from this time until the date of his death, September 2(5, 1834, he was almost entirely sustained by beef tea encmata. He had no chills and no discoloration of skin, and his mind at all times was clear. Autopsy: emaciation extreme; limb not much swollen; foot somewhat ocdematous; ulcer extending from four inches below the knee to the ankle joint; femoral vein healthy; internal organs all healthy except the liver, which was exceedingly fatty. The outer surface of the tibia at the middle third was dead and much blackened from the action of the vapor of the bromine, and the living bone around its borders was covered with several roughened spiculae of bone. Upon opening the tibia the upper and lower thirds were found to be quite healthy, but the middle third was the seat of varied diseased action. The walls at this point were partially necrosed, of a greyish slate color, roughened, and so thin that at one point they appeared to be nearly destroyed. The medullary substance at this place was shrunken, of l blackish grey color, and closely adherent to the posterior and lateral walls of the cavity. No new deposit of bone was seen. The tissues both above and below this point had taken on active efforts of repair. The cavity of the medulla was much contracted by delicate cancelli extending from either side, and the original walls of the cavity for the extent of a full inch either way were vascular and thickened. The medulla lying in the diminished calibre of canal was of a lively red color, filled with blood, and presented all the appearance of a highly nourished medium. As above observed, no inflammation was noticed in either extremity of the affected bone. Upon examination of the femur an interesting appearance was presented. The walls of the bone were much thickened and dotted with reddish spots; the enlarged nutritious arteries and the periosteum were also thickened, vascular, and easily detached. When the bone was opened the upper two-thirds of the medulla were found to be acutely inflamed, which as usual was more intense towards the neck of the bone than elsewhere." The tibia and fibula of the injured leg, contributed, with the history, by Dr. Allen, constitute specimen 2G33 of the tiuryical Section of the Museum. 1 The precise seat of the bony lesion was not indicated in seven hundred and eighty-six of the three thousand nine hundred and eighty-eight cases of shot fractures of the bones of the leg treated by conservation. The results in sixty-nine of these cases were not ascertained; five hundred and forty-three patients recovered and one hundred and seventy- four died, a mortality of 24.2 per cent. An analysis of the cases of shot fracture of the bones of the leg treated by conserva tion indicates that pyaBrnia was noted in eighty-one instances (six recoveries and seventy- five deaths), gangrene in seventy (forty recoveries, thirty deaths), tetanus in twenty-four (two recoveries, twenty-two deaths), erysipelas in forty-five (thirty-five recoveries, ten deaths), and in three hundred and forty-seven cases (two hundred and ninety-nine recov eries, forty-two deaths, and six undetermined results) fragments of bone or sequestra were removed. Secondary haemorrhage is reported in sixty-five instances (twenty-four recov eries, forty-one deaths), and in twenty-six instances ligation of the tibial, popliteal or fem oral arteries were performed, viz: ligation of anterior tibial artery in five (three recoveries, two deaths); of anterior tihial and popliteal in one (fatal); of anterior and posterior tibials 1 ALLKX (II.), Remarks on the Pathological Anatomy of Osteomyelitis, with Cases. Gunshot Wound of the Rigid Leg ,- phagedcna ; no pytemia ; in American Journal ilediail Sciences, 18G5, Vol. XLJX, N. S., p. 44. SECT, v.l SHOT FRACTURES OF TIBIA AND FIBULA TREATED BY CONSERVATION. 443 in one (fatal); of posterior tibial in eight (five recoveries, three fatal); of - - tibial in one (fatal); of popliteal in five (two recoveries, three fatal); and of femoral in five (two recoveries and three fatal). Details of the five cases of ligation of the femoral artery are adduced: CASE 698 Private J. W. Moore, Co. I, 13th Mississippi, aged 23 years, was wounded and captured at Gettysburg, July 2, 1863. Surgeon H. Janes, U. S. V., reported: "Compound fracture of right leg, middle third. Haemorrhage from the posterior tibial artery occurred to the amount of one pint daily from July 12th to July 17th, when the femoral artery was ligated in the continuity." The patient recovered, and was transferred to Baltimore October 15th, the wound having entirely healed. Surgeon T. H. Bache, U. S. V., reported that he was paroled from West s Building Hospital, and sent south November 12, 18G3. CASE 699. Corporal P. Lahany, Co. G, 5th Vermont, aged 21 years, was wounded at Petersburg, April 2, 1865, and admitted to the field hospital of the 2d division, Sixth Corps, where Surgeon S. F. Chapin, 139th Pennsylvania, recorded: "Shot fracture of left leg." Surgeon D. P. Smith, U. S. V., reported the wounded man s entrance into Fairfax Seminary Hospital, April 6th, with " Shot fracture of left fibula," but made no record of any surgical treatment in the case. On May 30th, the patient was transferred to Baxter Hospital, Brattleboro , and subsequently to Sloan Hospital. Montpelier. Surgeon H. Janes, U. S. V., in charge of the latter, contributed a photograph of the patient, which is copied in the wood-cut (FlG. 269), together with the following history: "The wound was produced by a mini<5 ball, which entered the leg on the outer side two inches below its middle, passed backward and inward, fracturing the fibula, and emerging posteriorly one inch lower than the point of entrance. Several fragments of bone were removed on the field four hours after the injury. Secondary haemorrhage occurred on April 9th, for which the femoral artery was ligated in Scarpa s space by Dr. Smith, at Fairfax Seminary Hospital. The patient was much prostrated after the operation, and artificial heat was required for about a week to keep up the temperature of the limb. No recurrence of the haemor rhage took place, and the wound closed rapidly after the operation. At the time of his admission to Sloan Hospital, June 12th, both wounds were nearly healed and he could walk without crutches, but could not bring the heel to the ground on account of contraction of the muscles of the calf. In the early part of July an abscess formed at the place of ligation, which healed however in a short time. On August llth, the patient was discharged from service, though unable to leave the hos pital on account of an abscess at the original wound, caused by a fragment of necrosed bone. Three weeks afterwards the abscess had nearly healed and he left the hospital in good health, but still unable to get the heel to the ground. This patient had also been wounded through both buttocks, at the Wilderness, May 5, 1864, from which injury he had recovered in three months, when he rejoined his command for duty." Various surgeons, at consecutive intervals, certified to the injuries, and Examiner F. W. Goodall, of Bennington, October 5, 1877, adds: "The left leg below the knee is one-half smaller than its mate, one-half smaller at the calf, and one-quarter at the ankle; muscles attached to the integument on back of leg, impairing the action of the tendo-achillis. 1 also find a large cicatrix in the left triangle of Scarpa, from ligation of the femoral artery." The pensioner was paid March 4, 1880. CASE 700. Corporal J. Ferguson, Co. G, 142d Pennsylvania, was wounded in the right leg, at Fredericksburg, Decem ber 13, 1862. He remained at a First Corps field hospital for one week and was then transferred to the Patent Office Hospital, and subsequently to Stanton Hospital, Washington. Surgeon J. A. Lidell, U. S. V., in charge of the latter, described the case as follows: "The wound was produced by a bullet, which passed through the calf of the leg in the upper third in a downward and outward direction. The wound did well until the middle of January, when the granulations assumed an unhealthy appear ance and the discharge became thin and serous. The patient also exhibited typhoid symptoms, having a hot skin, frequent pulse, and dry red tongue, watchfulness, and no appetite. This went on until the morning of January 23d, when haemorrhage occurred unexpectedly from the external orifice behind the fibula. The bleeding was readily controlled by application of pressure by bandage and ice, the patient having lost about ten ounces. Throughout the day and the night following the loss of blood by oozing was very little, but on the following morning haemorrhage recurred from the internal orifice, behind the tibia this time. This amounted to from four to six ounces, and was also readily controlled by the application of persulphate of iron, lint, ice, and bandaging. In the meantime the typhoid symptoms became more marked. The patient also complained of great tenderness throughout the leg and thigh ; the inguinal glands were somewhat swollen and tender, and there was dusky redness, with soreness in the track of the long saphenous vein. His skin was now pale and yellow. On the morning of January 25th, another slight bleeding occurred from the internal wound and was readily controlled by pressure. A marked increase of the swelling was now noticed, extending from the leg to the thigh, especially over the external and internal condyles and the pop liteal space, and infiltration with blood was suspected. The patient was now very pale and expressed a great deal of anxiety, his pulse being 120, quick and weak. The first day the hremorrhage was thought to come from the peroneal artery, the next day from the posterior tibial, but now we were uncertain in regard to the source of the bleeding, and the case presented an unpromising appearance on account of the debility from the loss of about eighteen ounces of blood superadded to his typhoid condition. We then decided to tie the femoral artery at the apex of Scarpa s space as affording the best chance of benefit, which operation I performed without any difficulty on the afternoon of January 25th, forty-three days after the reception of the wound. On the following morning the patient appeared brighter; pulse 130; tongue more moist ; leg getting warmer down to the ankle. The plugs being removed some dark offensive blood flowed away. In the evening his foot was cold, leg cooler, and blackness was extending across the leg in the track of the wound. Patient had a slight chill; somewhat delirious; pulse 130 and weak; tongue dry. On the morning of January 27th the patient looked better; pulse 132 and stronger; leg warm and blacker; foot pale and swelled ; serous infiltration and discoloration extending up the thigh. The next day the patient presented a pale yellow hue; blackness of limb deepening and extending, having reached the lower end of the incision made for the liga- Fiu. 269. Shot fracture of left fibula and ligation of femoral. [From a photograph.] 444 INJURIES OF THE LOWER EXTREMITIES. ICIIAI-. X. lion ; odor gangrenous. Death supervened on the evening of January 29, 1863. The autopsy showed that the bleeding did not come from the posterior tibial or peroneal artery, but from the lower part of the popliteal, which had been opened to a large extent by ulceration. Some loose splinters of bone were also found, the ball having grazed the hind part of both the tibia and fibula. On the proximal side of the ligature the clot was firm, closely attached to the walls of the artery, and about three-fourths of an inch long, with its apex pointing upward towards the heart. There was also a firm clot on the distal side, adherent to the walls of the artery, but much smaller than the proximal one." A piece of the femoral artery, about four inches long and embracing the seat of the ligature, was contributed to the Museum by Surgeon Lidell, and constitutes specimen 1140 of the Surgical Section. CASE 701.- Sergeant J. Daly, Co. K, 82d New York, aged 27 years, was wounded in the left leg, at the Wilderness, May G, 1864, and admitted to Douglas Hospital, Washington, six days afterwards. Assistant Surgeon W. Thomson, II. S. A., described the injury as " -a gunshot fracture of the fibula," and reported: "On May 17th, a bullet was extracted fiom the inner side of the leg, through a deep and oblique incision two or three inches below the knee. Three days afterwards three haemor rhages occurred from the posterior tibial artery, amounting to one, three, and ten ounces respectively, and necessitating ligation of the femoral artery, which was performed below the profunda in Scarpa s space by Assistant Surgeon W. F. Norris, U. S. A. Ether was used as the anaesthetic. On the following day there was venous haemorrhage to the amount of four ounces. A further loss of eight ounces of blood took place on May 25th, and of one and a half ounces the next day. Four more attacks followed on June 1st, each causing the loss of one-half ounce to an ounce of blood, and being checked by compression over the femoral where it emerges from the pelvis. Death resulted from exhaustion, June 3, 1864. At the post-mortem examination the ligature was found to have nearly sloughed through; clot below, but none above it." CASE 702. Corporal H. Day, Co. A, 6th Alabama, was wounded in the right leg, at Chancellorsville, May 3, 1863. The records of Chimborazo Confederate Hospital No. 4, Richmond, show his admission May 14th, with the following description of the injury and its result: "The ball entered at the external malleolus, slightly fracturing the fibula, ranging upward and inward, and making its exit about an inch and a half from the posterior edge of the tibia and about four inches from the knee joint. On May 26th, a haemorrhage from the upper wound estimated at from ten to twelve ounces, and probably coming from the posterior tibial artery, was arrested by compression of the femoral on the pubis, after which a tourniquet was applied to the thigh. On May 28th, another haemorrhage occurred from the upper wound and from fifteen to twenty ounces of blood were lost, when it was checked by introducing the fingers into the wound and seizing the vessel and adjacent tissues. Liga- tion of the femoral artery was then performed. The tissues were found to be disorganized and reduced to a soft pulpy mass, in which it was impracticable to define any healthy structure. While preparing for the operation the patient had a slight convulsion, and for a few moments all proceedings were suspended in anticipation of immediate death. Haemorrhage did not recur after the operation. On June 2d, there was a slight chill followed by fever. On the next day the discharge from the upper wound was of a greenish-gray color, offensive in odor, and indicative of gangrene. Gangrenous symptoms increased, and by June 4th the foot and leg were livid and swollen, odor very offensive. He died in a comatose condition, June 5, 1863, the whole leg and thigh having become thoroughly gangrenous. It is probable that the posterior tibial artery was not divided by the ball, but opened by the softening of the tissues subsequent to the occurrence of the wound." EXCISIONS IN THE CONTINUITY OF THE BONES OF THE LEG FOR SHOT INJURY. Three hundred and eighty-seven examples of excision in the bones of the leg are recorded. Two hundred and fifteen, or over one half of the total number of these operations, were primary, eighty-seven intermediary, and fifty secondary; in thirty- five instances the interval between the dates of injury and operation could not be ascer tained. Two hundred and seventy-five of the patients survived the operation, one hundred and eight died, and in four the results were undetermined, a mortality rate of 28.2 per cent. In comparing the results of the excisions and amputations in the long bones of the upper extremity it will have been noticed that in the upper arm the fatality of the excisions (28.5) exceeded that of the amputations (23.6) by 4.9 per cent., while in the forearm the mortality of the amputations (13.9) was 2.7 per cent, in excess of the death rate of the excisions (11-.2). Similarly, in the lower extremity, we find that while the fatality of the excisions in the shaft of the femur (69.4) surpasses that of the amputations through the thigh (53.8) by 15.6 per cent., the excisions in the continuity of the bones of the leg show a death rate of 28.2 per cent., or 4.7 per cent, less than the fatality after amputations in the leg (32.9 per cent.). It would appear, therefore, that in the arm and thigh amputations were less fatal than excisions, while in the forearm and leg the mortality of the amputations exceeded that of the excisions. The low rate of fatality after excisions in the forearm or leg may be ascribed to the fact that in the large majority of the cases of recovery portions of one of the bones of the forearm or the leg only were excised; in the cases in which the excision extended to both bones of the limb, the mortality exceeded that of the amputations. SECT. V.] PEIMARY EXCISIONS IN THE BONES OF THE LEG. 445 TABLE LXII. Numerical Statement of Three Hundred and Eighty-seven Excisions in the Bones of the Leg for Shot Fracture. OPERATIONS. 1 o CASES. EXCISIONS. TIBIA. FIBULA. TIBIA AND FIBULA. BONES NOT SPECIFIED. Recovery. Death. Undeter mined. Mortality rate of deter mined cases. Recovery. Death. Undeter mined. Mortality rate of deter mined cases. Recovery. Death. Undeter mined. Mortality rate of deter mined cases. Recovery. Death. X "3 2 II S Recovery. Death. 215 87 50 35 148 58 42 27 67 29 8 4 4 31.1 33.3 16.0 12.9 69 24 26 17 30 .... 9 ... 5 .... 3 2 30.3 27.2 16.1 15.0 78 31 13 9 32 15 1 1 2 29.0 32.6 7.1 10.0 3 3 1 5 4 o 100.0 57.1 40.0 1 1 Time between injury and operation not recorded. 387 275 108 4 28.2 136 47 o 25.6 131 49 2 27.2 7 11 61.1 1 1 Primary Excisions in the Shaft of the Tibia, of the Fibula, or of both bones. The series of two hundred and fifteen primary excisions in the bones of the leg contains one hundred and forty-eight recoveries and sixty-seven deaths, a mortality rate of 31.1 per cent. Portions of the tibia were excised in ninety-nine, of the fibula in one hundred and ten, and of the tibia and fibula in five instances; in one case the seat of excision was not specified. The operations were performed on one hundred and ninety-two Union and twenty- three Confederate soldiers. Recoveries after Primary Excisions in the Continuity of the Bones of the Leg. There were one hundred and forty-eight recoveries after primary excisions in the continuity of the bones of the leg; in sixty-nine, portions of the tibia, and in seventy-eight, parts of the fibula had been excised; in one instance the bone was not indicated. No instances of recovery after primary excision in both bones of the leg are recorded. The one hundred and forty- eight operations were performed on seventeen Confederate and one hundred and thirty-one Union soldiers. Of the latter one hundred and twenty-four were pensioned; but ten have died since the date of their discharge two of phthisis, and three of remote effects of the injury; in five instances the cause of death was not reported. In the following five cases from three to six inches of the tibia were excised: CAKE 703. Private J. Hogan, Co. F, 127th Pennsylvania, aged 41 years, was wounded in the right leg, at Fredericks- hurg. December 13, 18(52. Surgeon J. E. MacDonald, 79th New York, reported his admission to the field hospital of the 1st and 2d divisions. Ninth Corps, and described the injury as "fracture of the tibia," for whicli "resection of six inches" of the bone \v;is performed. Assistant Surgeon W. Thomson, U. S. A., contributed the following history of the case: "This man was struck by a minio ball four inches below the knee joint. The tibia was extensively comminuted, the fibula being uninjured. A resec tion of the shaft of the tibia from a point just below the tubercle to (about) seven inches below was performed by Surgeon J. P. Prince, 36th Massachusetts, at a field hospital. The man was admitted to Douglas Hospital December 26th. The dressing consisted in keeping the incision open with charpie to encourage granulations from the bottom of the wound. On February 26. 186:?, a crown-shaped exfoliation (Spec. 2237, Sect. I, A. M. M.) was removed from the end of the lower portion of the tibia. The wo ind now healed rapidly, no change having been made in the dressing and the leg being retained in quietness by a frac ture box filled with bran. His general health became perfect as the discharge ceased. On May 1st, several small exfoliations were removed from the spongy portion of the tibia at the superior part of the wound. There was of course no reproduction of the tibia and no conservative hypertrophy of the fibula, and hence the leg was perfectly helpless. Before the fistulous orifice had entirely closed at the upper portion of the incision, well marked but mild hospital gangrene appeared. The sloughing extended very deeply as far as the lower side of the tibia. Several applications of bromine checked the spread of the gangrene but not until a large excavation had been caused. This filled up gradually, the patient got up on his crutches and with the aid of a starched bandage hobbled painfully about the wards. His term of enlistment expired on May 29, 1863, but he remained until October 12th, when be returned to his home. No more useless or unphilosophical operation coidd be devised than the one done in this case. The leg was perfectly helpless, a hiatus of nine or ten inches existing in the tibia and there being no hope of any further improvement from the lapse of time; fibula no larger than natural. Unless some novel means of support can be 446 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. applied this man will be infinitely worse oft than with an artificial leg." Examining Surgeon S. T. Charlton, of Harrisburg, reported in October. 1866: "There is complete atrophy of the whole limb, as well as deformity from curvature at the point of resection and the pushing out- of the head of the fibula from its articulation. He cannot walk or stand upon the limb without the use of a cumbrous apparatus furnished by the Government," etc. At subsequent examinations no change or improvement was reported. The pensioner died May 24, 1877. CASE 704. Lieutenant O. R. Fyler, Co. I, 2d Connecticut Heavy Artillery, aged 25 years, was wounded in the left leg, at Opequan Creek, September 19, 1864. He was admitted to the field hospital at Winchester, where Surgeon E. B P. Kelly, 95th Pennsylvania, recorded a "shot fracture of the tibia, middle third, by a mini6 ball, followed by exsection, the same day, of three inches of the bone by Surgeon H. Plumb, 2d Connecticut Artillery." Acting Assistant Surgeon J. H. Bartholf made the following report: "The patient entered Frederick Hospital on November 12th. On December 15th, I discovered and removed the ball, or what appeared to be the greater part of it, from the lower part of the wound, close to the upper extremity of the lower fragment. It was embedded about two inches and found to be exceedingly battered and misshapen. The patient informed me that Smith s anterior splints were used and con tinued for three weeks after the injury. A plaster-of-Paris splint was then applied, with which he came here, having traveled by the rough railway from Winchester without inconvenience. I found him with his limb looking well, but there was no union of bone and no coaptation even of the ends, the fibula of course holding the extremities apart. Besides removing the ball, as stated, and a few small fragments of bone, the patient s treatment in this hospital consisted of simple dressings and the continued use of the plaster-of-Paris splint. On January 13, 1865, he left on leave of absence, his general condition being excellent and the wound presenting a granulating surface five inches long. No deposit of bony matter in the interspace between the ends of the bone could be discov ered. The sawn face of the upper fragment came away in the early part of January." The patient was discharged from service April 6, 1865, and pensioned, and subsequently supplied with a supporting apparatus for his injured limb by Dr. E. D. Hudson, of New York City. Examining Surgeon H. E. Gates, of Litchfield, Connecticut, certified, June 4, 1877: "The wound was from aminie^ ball received directly in front, striking the tibia, mashing that bone and lodging in it; it remained there two months, causing exfoliation, profuse discharge, and an attack of gangrene. Resection was done the day the injury was received, the periosteum being removed (or badly torn) with three inches of the bone. It is supposed that the periosteum was so badly torn as not to be able to repair the loss of bone substance. Present aspect : whole leg and thigh atrophied. The fibula is bowed outward and there is partial dislocation of its head. The leg bends easily at the seat of the injury and no weight can be borne upon it. I have no doubt the fibula would instantly give way if the applicant stood upon it. There is great tenderness at the head of the fibula from stretching of the ligaments, the line of support from the bending of the leg being thrown outward toAvards this articulation. The pensioner wears an appliance weighing seven pounds, which incases the limb and gives the only support. The disability is progressive on account of displacement and bending of fibula, etc. I consider his present condition worse than if he had amputation above the knee; locomotion is very painful indeed/ etc. The pensioner was paid March 4, 1880. In the accompanying wood-cut (FiG. 270) the appearance of the limb about one year after the excision is shown. CASE 705. Colonel W. T. Fitch, 29th Ohio, aged 40 years, was wounded at Mill Creek, May 8, 1864. He entered the field hospital of the 2d division, Twentieth Corps, where Surgeon A. Ball, 5th Ohio, recorded : " Shot compound fracture of right tibia ; resection at middle third by Surgeon A. K. Fifield, 29th Ohio." Surgeon J. E. Herbst, U. S. V., reported that the patient entered the Officers Hospital, Nashville, four days after he was wounded, having undergone excision of about three inches of the shaft of the tibia by a longitudinal incision of four inches over the crest. Chloroform was used and prompt reaction followed the operation. The limb was placed in a box-frame splint and wet applications were made. On June 20th the patient left for his home on leave of absence, the wound being in excellent condition. On October 13, 1864, Colonel Fitch resigned and obtained his discharge from service, and subsequently he became a pensioner, his physician testifying that "the wound on the surface has healed, but the vacancy caused by the removal of the bone has not yet filled up." Examiner W. M. Eames, of Ash- tabula, Ohio, certified, September 15, 1865, that "the leg is now very small and weak and of no manner of use in walking, a source of constant discomfort. The foot is cold and swollen and not under the control of the muscles. On December 8, 1870, when the pensioner visited the Army Medical Museum, he was in good general health and his wound soundly healed; but the bone remained ununited, the calf of the leg entirely atrophied, and the foot swollen and useless. He also stated that "he regretted greatly that amputation had not been performed." The Cleveland Examining Board at subsequent dates reported that the pensioner was obliged to wear steel splints on the outer and inner aspect of the leg. In September, 1877, the cicatrix was described as being quite irritable and as ulcerating and discharging often. The pensioner was paid December 4, 1879. CASE 706. Private D. M. Gould, Co. D, 102d New York, aged 21 years, was wounded in the left leg, at Dallas, May 27, 1804. Surgeon A. Ball, 5th Ohio, reported his admission to the field hospital of the 2d division, Twentieth Corps, with "shot fracture of tibia; resection of four inches by Surgeon C. H. Lord, 102d New York." Ten days after receiving the injury the wounded man was conveyed to Chattanooga, and subsequently he passed through different hospitals, entering Ira Harris Hospital, Albany, on February 9, 1865. Assistant Surgeon J. H. Armsby, U. S. V., in charge of the latter, contributed a plaster FIG. -J70. Excision of three inches of the left tibia. [From a photograph.] 1 A detailed history of the case will be found in American Journal of Medical Sciences, New Series, 1804, Vol. XLVII, p. 395, Report of Gates of Hospital Gangrene treated in Douglas Hospital, Washington, D. C., by WILLIAM THOMSON, M. D. SECT. V.) PRIMARY EXCISIONS IN THE BONES OF THE LEG. 417 Flu. 271. Lertleff af ter excision of 4 inches of shaft of tibia. .Spec. 2552. [From a cast.] cast (Spec. 2552, Sect. I, A. M. M.) of the injured limb, represented in the annexed cut (FiG. 271), and reported the patient s discharge from service July 20, 1865, by reason of disability resulting from the wound. Examining Surgeon J. B. Chapin, of Canandaigua, N. Y., reported, July 2, 1869: "The disability had its origin in a gunshot wound of the upper third of the tibia. The bone was shattered, leaving the head uninjured. The operation of resection, by which four inches of the tibia was removed, was performed. The fibula is thrown out of line externally by the action of walking and the weight of the body, and a false joint exists below the knee joint. The limb requires a splint and bandage to be applied constantly for support, and in addition the pensioner requires the aid of a cane/ etc. The Canandaigua Examining Board certified, September 4, 1877, to the following: "Leg shortened about two inches; false joint, large cicatrix along spine of tibia; upper end of fibula projecting. Leg curved outward. Tin- pensioner was paid March 4, 1880. CASE 707. Sergeant J. Measor, Co. C, 137th New York, aged 37 years, was wounded in the left leg, atWauhatchie, October 29, 1863, and admitted to the field hospital of the 2d division, Twelfth Corps. Surgeon G. Perin, U. S. A., reported the injury as a "fracture of the tibia," for which excision was per formed at the upper third by Surgeon A. K. Fifield, 29th Ohio. Assistant Surgeon H. T. Legler, U. S. V., reported that the wounded man entered the general hospital at Bridgeport three days after receiving the injury, and that he left for his home on furlough April 4, 1834. Acting Assistant Surgeon J. \V. Robie reported that the patient was subsequently admitted to Ladies Home Hospital, New York City, where a second operation for the removal of bone became necessary, by reason of necrosis, on August 22d. He was discharged from service April 5, 1865, and pensioned. From a description of the case by Dr. E. T). Hudson, of New York City, who supplied the pensioner with a surgical apparatus for the wounded limb, it appears that the total amount of bone removed comprised three and a half inches, the first operation consisting of the posterior and main part of the shaft of the tibia, while, at the second, the remaining anterior portion was removed by Acting Assistant Surgeon J. C. Stone. Examining Surgeon D. W. Hunt, of Fairmont, Minnesota, reported: "The wounded limb is much smaller than the other, the muscles being shrunken and somewhat shorter than the other. The deformity modifies his gait very much, causing an appearance of lameness." The pensioner was paid December 4, 1879. In the next case six inches of the fractured fibula were excised, and the posterior tibial artery was successfully ligated for secondary hemorrhage: CASE 708. Private J. Leichty, Co. F, 8th Pennsylvania Reserves, aged 21 years, received a shot fracture of the fibula of the left leg, at Spottsylvania, May 11, 1864. Surgeon L. W. Read, U. S. V., reported that he was admitted to the field hospital of the 3d division, Fifth Corps, where "resection was performed by Surgeon T. Jones, 8th Pennsylvania Reserves." Assistant Surgeon A. Ingram, U. S. A., contributed the following history: "The wounded man entered Judiciary Square Hos pital, Washington, May 18th. About six inches of the injured fibula had been excised on the field. Secondary haemorrhage occurred from the posterior tibial artery to the amount of thirty -two ounces, when the vessel was ligated in the wound. By June 14th the patient was progressing well. Cold-water dressings were used, and milk punch and a supporting treatment was administered." The patient was subsequently transferred to hospital at Alexandria, whence he was discharged from service January 11, 1865, and pensioned. Examining Surgeon J. McCullock, of Huntingdon, Pennsylvania, April 18, 1867, described the wound, and added that the "leg has sloughed largely and discharged a number of pieces of bone, the last one about three weeks ago. Since that time the wound has healed; tendons back of knee contracted; walks lame; wound painful," etc. Exam iner A. B. Brumbaugh reported, in 1877, that, as a result of the resection, "The foot cannot be planted even, as it would turn outward from the want of fibular support, and he has to keep his shoe blocked up accordingly to support the foot. The toes of the left foot tend to turn downward, like hooks, from injury to the nerves and muscles. The leg is not quite but almost useless for all purposes of manual labor." The pensioner was paid March 4, 1880. Of the one hundred and forty-eight survivors after primary excision in the bones of the leg nineteen submitted to subsequent operations, viz: fourteen 1 to amputation in the leg; one 2 to exarticulation at the knee; and four 3 to amputation in the thigh. fatal Cases of Primary Excision in the Continuity of the Leg. The sixty-seven fatal cases of primary excision in the bones of the leg comprised thirty excisions in the shaft of the tibia, thirty-two in the shaft of the fibula, and five of both bones of the leg. Subse- 1 In nine of the fourteen cases of amputations in the leg the operation was performed in the upper third, viz: Pt. S. B. Andrews, Co. F, 70d Penu.. right log, secondary operation ; Pt. L. Arnold, Co. G, 143d Penn., right leg, intermediary operation: Lieut. Col. W. W. Dudley, 19th Indiana, right leg, intermediary operation ; Corp l W. H. Goldsmith, F, 2d New Hamp., left leg, secondary operation ; Pt. D. A. Hatch, C, t- d Mass., right leg, secondary operation, Spec. 2155, A. M. M.; Corp l C. McCarty, E, 1st N. Y., right leg, secondary operation; Pt. T. Powell, F, 6th U. S. C. T., left leg, secondary operation: Musician C. A. Runyan, F, 9th N. Y. H. A., left leg, secondary operation; Pt. P. O Rourke, F, 7th N. Y. H. A., left leg, intermediary oper ation, Specs. 1502 and 3546, A. M. M. In five cases the operation of amputation was performed in the middle third, viz: Pt. T. Beirn, G, 60rh Illinois, left leg, intermediary operation; Pt. J. R. Cowling, A, 62d Penn., right log, secondary operation ; 1 t. P. Steif, K, 139th N. Y., right leg, intermediary operation; Pt. J. Koehler, I, 150th Penn., left leg, intermediary operation. Specs. 2404 and 3533, A. M. M.; Pt. J. J. Toomey, I, 29th Penn., left leg, intermediary operation, Spec. 3361, A. M. M. These cases will appear in the tables of amputations in the leg. 2 Amputation at the knee joint was resorted to in the case of Pt. J. H. Pattee, Co. D, 2fith Ohio (TABLE LVII, p. 409, No. 6). 3 Two o Jhe four cases of amputation in the thigh were done in the middle third, viz: Pt. S. Montgomery, I, 139th Penn., left thigh, secondary operation (TABLE XXXIX, p. 314, No. 63): Pt. \\. Stocdale, D, 48th Indiana, right thigh, secondary operation (TABLE XXXIX, p. 314, No. 87); nm two in the lower th .rd, viz: Corp l M. Uunn. II, 4(ith Penu., both thighs, primary operations, Spec. 3193 (CASE 448, p. 242, and TABLE XXXII, p. 248, Nos. 239, 240); Pt. P. Walsh, A, G9th N. Y., left thigh, intermediary operation (TABLE XXXVI, p. 296, No. 202). 448 INJURIES OF THE LOWER EXTREMITIES. [CHAT. X. quent amputation was performed in fourteen instances, three times in the leg, 1 twice at the knee joint, 2 eight times in the thigh, 3 and once in the leg with subsequent re-amputation in the thigh. 4 The patients were sixty-one Union and six Confederate soldiers. Pyremia was noted in eight, gangrene in twelve, erysipelas in four, and haemorrhage in fifteen instances. CASE 709. Private N. Biehl, Co. I, 155th Pennsylvania, aged 27 years, received a shot fracture of the right tibia, at Petersburg, June 19, 1804. He was conveyed to the field hospital of the 1st division, Fifth Corps, where excision was performed but not recorded, and whence he was transferred to City Point and subsequently to Alexandria. Surgeon E. Bentley, U. S. V., who amputated the limb, reported the following history: "The patient was admitted to the Third Division Hospital June 28th. Exsection had been performed on June 21st, in the field, by Surgeon J. A. E. Read. 155th Pennsylvania, who removed t\vo inches of the middle third of the tibia by a straight incision four inches in length. "When admitted the lips of the wound were widely separated, having apparently never been brought together closely or supported except by straps and bandages. The incision remained open in its whole length, leaving a portion of the crest of each extremity exposed and uncovered of periosteum. The granulations were healthy and covered with laudable pus ; but the leg and foot were badly swollen, particularly about the ankle, where the integument was cedematous and pitted deeply on pressure. Water dressings were applied to the wound and stimulants were given internally. On July 14th, gangrene appeared in the wound. Remedies used successfully in other cases signally failed in this. The disease extended along the medullary cavity of the bone and the muscles behind, seemingly bidding defiance to local applica tions and becoming very offensive. The patient sank very rapidly under the effects of the pain and poison, and the loss of blood from an artery opened by ulceration. On July 19th, amputation at the middle third of the thigh was performed by circular skin flaps. The patient was much prostrated at the time of the operation; had no appetite, great thirst, and dry tongue; face sunken and anxious; pulse quick and tremulous. Alcohol was applied to the stump, which was covered with a compress wet with the same. Whiskey and morphine was given internally. The next day gangrene attacked the stump, spreading rapidly on its face and extending three inches up the inner side of the thigh. The patient died on July 21, 1864, of exhaustion. The post-mortem examination, twenty-two hours after death, revealed extensive gangrene of the stump and mortification extending to the body." The bones of the wounded leg, showing the tibia to be dead for one inch on each side of the excision, were contributed by Dr. Bentley and are shown in the annexed cut (FlG. 272). CASE 710. Corporal P. Lovell, Co. C, 10th Missouri, aged 41 years, was wounded at Mission Ridge, November 2o, 1863. He entered the field hospital of the : .d division, Fifteenth Corps, where Surgeon J. L. Prout, 26th Missouri, noted: " Fracture of leg and wound of right shoulder, resection of portion of tibia." Assistant Surgeon J. J. Whitney, 8th Wisconsin, reported the following history: FIG. 272. Bones of right J leg. with 2J inches of tibia The patient was of previous good constitution, but asthmatic. He was severely wounded, the left tibia excised. Spec. 3337. being fractured at the junction of the middle and lower third. Two and a half inches of bone were resected the evening following the injury. Up to the time of the patient s admission to the general field hospital at Chatta nooga, December 20th, no attempts at repair had taken place, the wound granulating feebly and suppuration being profuse. On January 10, 1864, secondary haemorrhage occurred from the posterior tibial at its superior portion: tissue of the calf infil trated, and blood flowing from the posterior wound at the seat of the fracture. Up to this date the patient had been generally quiet and had had a good appetite; no diarrhoea, chills or fever. Assistant Surgeon R. Bartholow. U. S. A., in charge of the hospital, being called in consultation, it was determined to amputate below the knee, which operation was then immediately performed by him, at the junction of the upper and middle thirds, by the circular fiap incision. During the operation the fibula was found to be fractured just below its articulation with the tibia, when a longitudinal incision was made and the upper fragment was smoothly excised. On January 15th, the stump was sloughing somewhat; discharges comparatively healthy, patient having no constitutional symptoms. On the following day there was a profuse hremorrhage, the ligatures having sloughed away, and the patient losing about sixteen ounces of blood. The bleeding was controlled by the application of cold and pressure. The skin about the stump now assumed a puffy erysipelatous character; patches looking gangrenous; bone protruding and healthy look ing; pulse 100 and feeble. The treatment up to this time had been decidedly supporting, such as quinine, wine, beef tea, and milk. On January 17th, another haemorrhage occurring, I opened the wound down to the bleeding point and applied actual cautery, which instantly staunched the flow. The dead portions of tissue were all cut away and the stump was dressed with common solution of bromine. This treatment was continued until the 19th, when the artery opened again late in the evening, but the bleeding was controlled so soon that he lost only about four ounces; actual cautery was again employed. On January 1 The three amputations in the leg were done in the upper third, viz., cases of: ] t. J. S. Deu-es, II, 18th Virginia, primary operation ; Capt. II. R. Schwerin, C, 119th New York, right leg. interim-diary operation ; Pt. R. Whistler, H, 49th Ohio, right leg, secondary operation. 2 Amputation at the knee joint was performed in the eases of: Pt. V. Carroll, K. 45th Penn., right leg, intermediary operation (TABLK LVI. p. 40G, No. 21): and Corp l T. Sharp, I, 38th Illinois, right leg, secondary operation (TAliI.E LVII, p. 409, No. 23). Subsequent amputations in the thigh were performed in the cases of: Corp l C. Jackson, G, 2d Michigan, left thigh, intermediary operation in upper third (TABLE XXXIV, p. 270, No. 91); Pt. J. II. Carpenter, E, 1 10th Ohio, left thigh, intermediary operation in middle third, ftprc. 275! , A. M. M. (TABLE XXXV, p. 283, No. 24]); I t. N. Biehl, I, 155th Penn., right thigh, intermediary operation in middle third, Spec. 3337, A. M. M. (TABLE XXXV, p. 283, No. 223); Pt. N. II. Atwood, C, fith Vermont, right thigh, intermediary operation in lower third (TAUI.K XXXVI, p. 290, No. 230); Pt. C. A. Eaton, K, 39th Mass., right thigh, intermediary operation in lower third (TAHI.K XXXVI. p. 298. No. 324): Pt. I). A. Johnson. E, 43d N. V., right thigh, secondary operation in lower third (TABLE XL. p. 322, No. 14f): I t. .1. liader. F, SUth Illinois, left thigh, secondary operation in lower third (TAltLR XL, p. 322, No. 181); Serg tL. Heath, D, 2d Michigan, right thigh, intermediary operation in lower third, Spec. 2867, A. M. M. (TABLE XXXVI, p. 299, No. 390). 4 Case of Corp l P. Lovell, Co. C, 10th Missouri, left thigh, secondary operation, Spec. 2108 (TABLE XL, p. 322, No. 160). SECT. V.] PRIMARY EXCISIONS IN THE BONES OF THE LEG. 419 21st the patient was much the same; stump looking better; pulse 110 and full; appetite good; no pyoeinic symptoms. Artnnl cautery was applied every third day, thus anticipating the occurrence of haemorrhage. On January 28th, the outer portion of the stump was gangrenous and looked badly; patient now failing; slough cleansed and bromine applied with good efiVcf. On January 31st, the artery gave away further above, bleeding again profusely, when actual cautery and pressure were successfully employed; patient losing eight ounces of blood ; very feeble; gangrene progressing. Haem orrhage recurring on the morning of February 2d, I consulted with the other members of the faculty, when it was icsolved to re-amputate, which was promptly done by Assistant Surgeon R. Bartholow by circular incision above the condyles of the femur. The operation was endured but indifferently well. Ether was solely employed in the production of anaes thesia. The patient did not rally, his stomach rejecting all food and stimulants; pulse 100 and very feeble ten hours after the operation. He died February 3, 1864." The specimen (No. 2108, Sui-ff. Sect.), comprising the two lower thirds of the tibia and fibula and repre sented iu the wood-cut (FiG. 273), was contributed by the operator. CASE 711. Sergeant L. Heath, Co. D, 2d Michigan, aged 22 years, received a shot fracture of the right leg, before Petersburg, June 18, 1864. He was admitted to the field hospital of the 3d division, Ninth C O1 P S > where excision was performed but not recorded. Assistant Surgeon A. Ingram. U. S. A., contributed the pathological specimen, shown in the annexed cut (FiG. 274), with the following report: "The patient entered Judiciary Square Hospital, Washington, July 1st, with a wound about the junction of the upper and middle thirds of the tibia. Resection of about two inches of the continuity of the bone was per formed on the day of the injury. The tibia was somewhat shattered for about an inch above and below the points of resection. Amputation at the lower third of the thigh was performed in this hospital on July 7th, by Acting Assistant Surgeon J. H. Thompson, the condition of the injured parts and the constitutional state of the patient rendering the opera- The circular method was chosen and ether was used as the anaesthetic. Tonics and stimu lants were administered after the operation. Haemorrhage to the amount of six ounces occurred from the femoral artery on July 12th, when the vessel was taken up in Scarpa s triangle. Death occurred from pyaemia July 28, Ie64. The specimen (No. 2867, Surg. Sect.) consists of the upper half of the injured tibia and shows the extremities to be somewhat irregularly necrosed. TABLE LXIII. Summary of Two Hundred and fifteen Primary Excisions in the Bones of the Leg for Shot Injury. [Recoveries, 1148; Deaths, 149215.] FIG. 273. Lower thirds of left tibia and fibula. Spec. 2108. tiou necessary. FIG. 274. Upper half of right tibia. Two inches of shaft have been excised. .Spec. 2867. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS. OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, ANH AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Adams, I. X., Pt., D, April 2, Left ; 5 inches lower part tibia ex 14 Carson, J. W.. Pt., B, June 18, Left ; 4 inches of fibula. Dis 110th Ohio, age 29. 2. 1865. cised : amputation leg April 12. 7th Ohio, age 25. 19. 1864. charged July 5, 65 ; leg disabled. Disch d Sept. 11, 65; leg useful. 15 Chandler. N. W., Lieut., June 17, Left ; portion of upper third tibia 2 *AUen, , Major. April 6, Right; 6 inches fibula. Surgs. B. H, 109th New York, 18, 1864. excised. Surg. \V. B. Fox, 8th , 18(52. W. Avent and J.W. Thompson, age 21. Mich. Disc d Nov. 5, 64 ; unable C. S. A. 1866, walks well. to walk without assistance. 3 Andrews. S. B., Pt.. F, May 10, Right : 2i inches tibia, middle 16 Clark, G.. Lieut. Col., April 2. Right : 3 inches upper third tibia 72(1 1 enn., age 28. 10, 1864. third ; amputation leg Sept. 27. 119th Penn.. age 44. 2, 1865. excised. Must d out June 19/65. Discharged Nov. 27, 18G4. 17 Clark, J., Pt, D, 26th Sept. 3, Left : 2J inches of fibula excised. 4 Arnold, L., Pt., G, 143d May 25, Right ; tibia; amp leg Mav 29. Illinois, age 49. 3, 1864. Ass t Surg. D. Haldennan, 46th Penn., age 20. 25, 18G4. ; Discharged June 17, 1865." Ohio. Disch d June 29, 1865; 5 Bain, T., Pt., G, 60th July 4, Left ; 4 inches tibia, lower third. can only walk with crutch. Illinois, age 34. 4, 1864. Surg. E. But well. 14th Mich. 18 Coddington, R., Pt,, C, Mav 3, Right ; 4 inches fibula excised. Gangrene; non-union. Aug. 1, 21st New Jersev, age 3, 1863. Mustered out June 19, 63 ; limb amp. leg. Disch d Mav 9, 65. i 23. useless. Died May 4, 1867. 6 Bell, U. V., Pt., I, 5th July 2, Right: 3j inches fibula, middle 19 Collier, C.. Pt., G, 4th Mav 3. Right : 5 inches mid. third tibia Virginia. 2. 1863. third. Recovery. Ohio. 5, 1863. excised. Disch d Mar. 31, 64 ; 7 Bennett, N., Corp l, A, Oct. 8. Left : middle third tibia excised. use of splint necessary. 7th Michigan. 8,1864. Disch d July 18, 1865; perma 20 Collins, F., Pt., A, 184th Oct. 19, Left ; 2 ins. fibula, middle, exc d. nently lame. New York, age 35. 19, 1864. Disch d May 22, 1865. 8 Binqham. J. .If., Pt., K, Mar. 25, Right; mid. third tibia excised. 21 Cooper, J., Pt., C, 10th April 2, Left ; 2 inches middle third tibia 56th N. C., age 37. 25, 1865. Ass t Surg. E. M. Sinyser, 48th N. Y. Artillery, age 25. 2, 1865. excised. A. Surg. O. S. Cope- Peon. Released Aug. 2, 1865. land, 10th N. Y. Artillery. Dis 9 Bovie, P. P.. Pt., B, July 4, Left ; li inch lower third fibula. charged July 19, 1865; partial 129th Indiana. 4, 1864. Surg. C. D. Moore, 13th Ky. anchylosed ankle .joint. Disch d May 29, 1865; partially 22 Copeland, M., Pt.. M, 1st Mar. 31, Right : upper third iibulaexcis d. anchylosed ankle. Maine Cav., age 18. 31, 1865. Disch d July 19, 1865. 1867. 10 Bowers, G., Pt., B, 77th Sept, 19, Right : 5 inches lower half fibula bone discharged. i New York, age 31. 19, 1864. excised. Surg. G. T. Stevens, 23 Cowling. J. R., Pt., A, Julv 2, Right : 3 inches mid. third tibia 77th N. Y. Gang.: haem.: lig. 62d Penn., age 21. 3, 1863. excised. Surg. J. Kerr, 6 Jrt post, tibial. Diseh d June5. 65. Penn. Mustered out Julv l.\ 11 Brandon, J. <7.,Pt..Clay- Nov. 30, Right ; 4 inches mid. third tibia 1864. Amp. leg Sept. 21, 1864. borne s Escort, age 19. Dec. 1, excised. Sent to Provost Mar 24 Crawford. L. S., Pt., F, Sept. 22, Left ; 3 inches mid. third fibula 1864. shal March 27. 1865. 126th Ohio, asre 21. 22. 1864. excised. Disch d Mar. C, 1865. 12 Brown. W.C., Corp l, K, Aug. 16, "iglit : portion of middle third of 25 Croston. W., Pt., F. 1st Aug. 15, Right: portion of fibula. Dis 141st Penn., age 21. 17, 1864. ibia: removal exfoliated bone. Mass. II. Art., age 24. 15. 1864. charged July 27. 1865. Disch d June 27, 65: necrosis. 26 Crow. E.. Pt.. C. 123d June 22, Left ; 2 inches middle third fibula 13 Burton, G. \V., Pt., E, April 2, Left : middle third tibia (fracture New York, age 20. 22, 1864. excis d. Surg.J. Chapman. 12Cd .l*h Wisconsin, age 20. 2, 1865. and trephining of occipital). N. Y. Disch d March 27. 1865. Discharged July 24. 18(!5: leg 27 Denny. M., Serg t, F, Julv 20, Left : lower third fibula excised. disabled. 70th Indiana, age 37. 20, 1864. Disch d July 7, 1865. 1 THOMPSON (J. W.), Cases of Resection. Fractures of Upper Third of Femur. Gunshot Wounds of Knee Joint, etc.. in Nathmlle Medical Jour nal, 1866, N. S., Vol. I, p. 341 ; and Resection of the long Bones, in the Medical Record, New York, Vol. Ill, 1868-69, p. 28. SURG. Ill 57 450 INJURIES OF THE LOWEE EXTREMITIES. [CHAP. X. NAME, MILITARY OPERATIONS, OPERATORS, NAME, MILITARY OPERATIONS, OPERATORS, NO DESCRIPTION, AND AGE. DATES. RESULT. Ii (J. DESCRIPTION, AND AGE. RESULT. 28 Diekerson, C., Corp ), C, Dec. 4, Right ; 2 inches fibula excised 57 Hersh, Z. E., Capt., B, April 2, Left ; 3 inches of fibula excised. 51st Indiana, age 25. 5, 1864. (also fracture left tibia). Mus 87th Penn., age 24. 2, 1865. Mustered out June 29, 1865. tered out Mar. 8. 65; paralysis. 58 Hinsdale, A., Pt., E, July 2, Left : 4 inches lower third tibia 29 Dodds, W. P., Pt., D, July 2, Left; portion uf fibula. Paroled 137th N. York, age 20. 2, 1863. excised. Surg. H. E. Goodman, 17th Miss., ape 21. 2, 1863. November 12, 1863; union. 28th Penn. Disch d May 15/65 ; 30 Driggs, J.A., Pt., E,67th Oct. 27, Right; 2 inches mid. third tibia ankle joint anchy.; deformity. Ohio, age 22. 27, 1864. excised. Surg. A. C. Barlow, 59 Hogan, J., Pt., F, 127th Dec. 13, Right ; 6 ins. middle tibia exc d. 62d Ohio. Disch d May 1 6, 65 ; Pennsylvania, age 41. 14, 1862. Surg. J. P. Prince, 36th Mass. ligameutous union only. Exful. of sequestra. Mustered 31 Dudley, W. W., Lieut. July 1, Right; 3 inches mid. third fibula out May 29, 1863; 8 ins. separa Col., 19th Ind., age 22. 3, 1863. excised. Surg. J. E. Ebersole, tion ; deformity. Died May 14, 19th Ind. Gang.; hsem. July 9, 1877. Spec. 2237. amp. leg. Disch d April 9, 64. 60 Hollcroft, W., Serg t, L, April 8, Left ; 3 inches middle third fibula 32 Dunham, H., 1 t., I, 2d Dec. 31, Right ; most of mid. third of tibia 2d N. Y. Cav., age 24. 8, 1865. excised. Disch d July 3, 1865. Ohio, age 23. 18G2, excised. Disch d August 3, 63; 61 Hope, J., Pt., D, 51st July 30, Left ; portion of tibia excised. Jan. 1, 63. shortening 3 inches. New York. 30, 1864. Mustered out May 19, 1865. 33 Dunn, M., Corp l, H, May 25, Left ; head of fibula excised (also 62 Hoy, M., Pt., B, 61st May 3, Left ; portion of fibula excised. 46th Penn., age 21. , 18G4. amp. rightthigh). May27, amp. New York. 3, 1863. Surg. T. C. Wallace, 6Jst N. Y. left thigh ; re-amp, right thigh. Recovery July 14, 1863. Disch d August 17, 1865. Died 63 Hurst, \V. L., Corp l, E, Sept. 20, Left : 3 inches middle third fibula October 23, 1877. Spec. 3193. 115th Illinois. 20, 1863. excised. Disch d Aug. 3, 1864. 34 Farusworth, R. R., Pt., July 3, Right ; upper and middle thirds 64 Ibach. F., Pt., A, 9Dd May 5, Left ; 2 inches middle third tibia C, 7th Mich. Cavalry, 4, 1803. tibia. Aug. 6, excised. Disch d Pennsylvania, age 16. 5, 1864. excised. Disch d Oct. 6, 1864 ; age 32. July 1, 1864; bone diseased. permanently disabled. 35 Ferguson, W. J., Pt., H, July 22, Left ; 4J inches tibia, upper third, 65 Johnson, J. F., Serg t, June 20, Left ; 4 ins. middle tibia excised. 81st Ohio, age 34. 22, 1864. exc d." Surg.W. C. Jacobs, 81st H, 9th Indiana, age 26. 20, 1864. Diseh d Nov. 4, 1864; shorten Ohio. Oct. 7, spiculse removed. ing 2 ins. and firm union. Disch d May 12, 1865; caries. 66 Johnson, S. P., Pt., B, July 28, Right ; portion of tibia excised. 36 Fitch, W. T., Col., 29th May 8, Right ; 3 ins. tibia, middle, exc d. 13th South Carolina, 28, 1864. Surg. D. W. Maull, 1st Del. Ohio, age 40. 8, 1864. Surg. A. K. Fifield, 2 .!th Ohio. age 29. Sent to prison Feb. 5, 1865. Resigned Oct. 13, 1864. 1870, 67 Jones, S. W., Corp l, A, Oct. 8, Left ; 2 inches fibula excised ; lig. bone not united. 4th Delaware, age 29. 8, 1864. post, tibial and peroneal arteries. 37 Flynn, J. P., Pt., E, 56th May 6, Left; 1 inch fibula, lower third, Surg. A. A. White, 8th M:iry- Mass., age 34. 6, 1864. exc d. Surg.J. Barber. 1st Penn. land. Disch d June 22, 1865 Reserves. Disch d July 12, 65; 68 Keech, H., Pt., K, 2d N. May 2, Left ; 2 inches fibula, up. third, ankle lame. York Cavalry. 3, 1864. excised. Ass t Surg. C. H. An- 38 Frair, J. E., Pt., F, 9th Oct. 19, Right; 4 inches mid. third fibula; drus, 128th N. Y. Furloughed N. Y. H. Art., age 19. 21, 1864. necrosis. Disch d May 31, 1865 ; June 19, 1864. requiring continuous bandaging. 69 King, J. R., Serg t, H, May 5, R t ; 2 ins. mid. third fibula exc d. 39 Freeman, D. B., Pt., G, Sept. 19, Left : 3 inches middle third fibula 6th Maryland, age 21. 6, 1864. Ass t Surg. R. L. Disbrow, 14th 10th Vermont, age 22. 21, 18C4. exc d. A. Surg. W. G. Bryant, N. J. Disch d May 18, 1865. 122d Ohio. Disch d May 31 , 65. 70 Koehler, J., Pt., I, 150th May 5, Left; 4 ins. low. third fibula exc d. 40 French, G. W., Pt., A, June 3, Left; 3 inches upper third fibula Pennsylvania, age 36. 5, 1864. Surg. W. T. Humphrey, 149th 27th Mich., age 27. 3, 1864. excised. Surg.H.E. Smith, 27th Penn. May 29, amp. leg. Disc d Mich. Disch d April 18, 1865. April 19, 65. Specs. 2404, 3533. 41 Fuller, A., Pt., G, 109th July 30, Left ; 3 ins. fibula, low.th d, exc d. 71 Lamb, J. M., Tt., A, 58th June 18, Right ; 2 inches upper third fibula New York, age 22. 30, 1864. Surg.W.C. Shurlock. 51st Penn. Mass., age 22. 18, 1864. excised. Disch d July 31, 1865 ; Disch d May 16/65; walks well. wears bandage. 42 Fyler, O. R., Lieut., I, Sept. 19, Left; 3 inches middle third tibia 72 Lawcook, T.,Pt.,K,151st Oct. 19, Left : 2 ins. low. third fibula exc d; 2d Conn. Artillery, age 19, 1864. excised. Surg. H. Plumb, 2d New York, age 31. 19, 1864. caries. Diseh d June 12, 1865; 25. Conn. Art. Disch d April 0/65; ankle deformed. deformity of tibia. 73 Leichty, J., Pt., F, 8th May 11, Left ; (i ins. mid. third fibulaexc d. 43 Gardner. C. J., Pt., B, Oct. 1, Left ; middle third fibula excised. Pennsylvania, age 21 . 11, 1864. . Surg. T. Jones, 8th Penn. Res. 6th N. Hamp., age 32. 1, 1864. Surg. S. Cooper, 6th N. Hamp. Ha?m., 32 oz.; lig. posterior tibial Disch d June 19, 1865. artery. Disch d Jan. 11, 1865; 44 Gibbons, J., Corp l, C, Dec. 13, Right ; 3 inches mid. third fibula bone discharged, 1867. 90th Illinois, age 22. 15, 1864. exc d. Surg. I. N. Barnes, 116th 74 Lewis, J., Pt., G, 12th May 30, Right ; 3 inches mid. third fibula 111. Mustered out June 5, 1865. Mass., age 19. 30, 1864. exc d. Surg.W. H. W. Hinds, 45 Gibbons, T., Pt., A, 125th June 16, Left ; fibula, lower third, excised. 12th Mass. Disch d March 8/65; New York. 16, 1864. Surg. P. E. Hubon, 28th Mass. regeneration of bone. Mustered out May 31, 1865. 75 Lisle, J. D., Pt., C, 1st July 3, Left; portion of tibiaexc d. Surg. 46 Goldsmith, W.H., Corp l, June 9, Left; 4 inches middle third tibia Maryland. 4, 1863. A. Chapel, U. S.V. Removal of F, 2d New Hampshire, 9, 1864. excised. Surg. G. P. Greeley, fragments. Disch d May 14/64. age 24. 4th N. Hamp. May 15/65, amp. Spec. 1655. leg. Disch d Oct. 14, 1865. 76 Lyon, C., Pt.. D, 190th May 12, Left ; H inch up. third tibia exc d. 47 Gould, D. M., Pt., D, May 27, Left ; 4 inches up. third tibia ex Pennsylvania, age 25. 12, 1864. Surg. B. Rohrer, 10th Penn. Res. 102d New York, age 21. 27, 1864. cised. Surg. C. II. Lord, 102d Disch d January 16, 1865; one N. Y. Disch d July 20, 1865 ; inch shortening ; deformity. constant support required; false 77 Mattern, L., Pt., F, 184th May 30, Left ; 4 inches middle third fibula joint. Spec. 2">52. Pennsylvania, age 19. 30, 1864. excised. Surg. M. Rizer, 72d 48 Graham, J., Pt., B, 74th June 21 , Right ; middle third tibia excised. Penn. Disch d May 27, 1865. Illinois. 21, 1864. Surg.W. P. Pierce, 88th Illinois. 78 Maves, J. H., Corp l, F, Mar. 25. Right ; 5 inches mid. tibia exc d.. Disch d June 6, 186. ); necrosis. 6th Ky. Cavalry. 25, 1863. Disch d Sept. 16, 1863. 49 Green, F. F., Pt., B, 12th July 1, Left ; lower portion of fibula ex 79 McCandless, A., Corp l, Sept. 3, Left; (i inches middle tibia exc d. Georgia, age 21. 3, 1863. cised. Paroled Nov. 12, 1863. K, 8th Ohio Cavalry, 6, 1864. Discharged Juno 28, 1865 : limb 50 Gurlr.y, W. H., Pt., D, July 3, Left ; 3 inches middle third tibia age 35. shortened 2 inches. Died Feb. 4th N. Carolina, age 30. 3, 1863. excised. Exch d Nov. 12, 1863. 18, 1877; phthisis. 51 Hall, J.. Corp l, A, 107th Mar. 19, Left; portion of fibula excised. 80 McCarty, C., Corp l, E, June 30, Right; 3 inches middle third tibia New York. 19, 1865. Discharged July 15, 1865. 1st New York, age 28. 30, 1862. excised; nee.; slough. Aug. 28, 52 Hannoway, J., Pt., A, Aug. 15, Right ; i inch fibula, lower third, leg amp. Disch d May 11, 1863. 69th N. Y., age 39. 15, 1864. excised. Surg. G. Chaddock, Died August 21, 1867. 7th Mich. Disch d June 23, 65. 81 McCracken, R.W., S g t, June 17, Right ; upper third fibula excised. 53 Harris, H. A., Lieut., B, July 2, Left ; 4 inches fibula, upper third. C, 170th N. Y., age 32. 17, 1864. Surg. F. Douglas, 170th N. Y. Kith Mass., age 22. , 1863. Disch d Dec. 19, 1863. Died Also wound < if anterior tibial art June 24, 1865. ery and side. June 22, ligation. 54 Hatch, D. A., Pt., C, 2d July 3, Right; 2 inches mid. third tibia Disch d Jan. 20, 1865; anchy Massachusetts, age 25. 5, 1863. excised. Surg.AV. H. Heath, 2d losis of ankle joint. Mass. Amp. leg Dec. 16. Dis 82 McDonald, B., Pt.,A, 8th 1 c. 16, Right; 3 inches lower third fibula charged April 2, 64. Spec. 2155. Kansas, age 28. 1864. excised. A.A.Surs. M. L. Ilerr. 55 Hendley, J. B., Pt., D, June 27, Left; :i^ inches mid. third fibula Duty August 1, 1865. 46th Ohio. 27, 1864. exc d. A. Surg. D. Halderman, 83 McGuire, J., Pt., F, 20th Dec. 13, Right ; 4 inches mid. third fibula 46th Ohio. Disch d Apr. 10/65. Massachusetts. 13, 1862. and splinters of tibia excised. 56 Henry, C., Pt., I, 29th May 15, Right ; 3 ins. low. th d tibia exc d. Disch d May 28, 1863 ; shorten Pennsylvania, age 19. 15, 1864. Surg. G. P. Oliver, lllth Penu. ing ; deformity. Disch d June 29, 1865; necrosed 84 McKim, W., Pt., L, 8tli .Tune 11, Left ; middle third fibula. Dis bone removed ; deformity. Penn. Cav., age 23. 11, 1864. charged Nov. 10, 1864. 1 SECT. V.J PRIMARY EXCISIONS IN THE BONES OF THE LEG. 451 NO. NAME, MILITARY DESCUIPTIOX, A.ND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MII.ITAHY DESCRIPTION, AXD AGE. DATES. OPERATIONS, OPERATORS, RESULT. 83 Measor, J., Serg t, C, Oct. 29, Left ; post, portion up. third tibia 117 Sodon, R. D., Corp l, I, May 25, Left ; portion of tibia excised. 137th N. York, age 37. 29, 1803. exc d. Surg. A. K. t ilield, 2!:th 33d New Jersey. 25, 1864. Sitrg. J. Roily, 3:;d New Jersey. Ohio. Aug. 22, 1864, excision Disch d July 14, 1805. anterior portion. Disch d April 118 Sprague, O., Pt., I, 8th June 15, Left; portion of fibula excised. 5,1805; shortening; deformity. Connecticut. 15, 1864. Disch d July 19, 1K65; partial 86 Montgomery, S., Pt., I, May 12, Left; 2 inches tibia excised. July anchylosis of ankle ji.int. 13:)th Pennsylvania. 12, 1804. 29, amputation thigh. Disch d 119 Spring. W.F., Serg t, C, Mav 14, Lett; 6 ins. tibia excised. Surg. August 2, 1865. 44th Illinois, age y!*. 15/1804. W. I . Pierce, 88th HI. Disch d -; Moore, J.W.,Major, 97th June 22, Left ; 2 inches lower third fibula Mar. 18. 05; non-union; useless. Ohio. 22, 1804. excised. Surg. E. 15. (5 lick, 4lth 120 Steih, D., Pt., F, 9th N. Oct. 19, R t ; inn. part low. th dtibiaexc d. Indiana. Resigned Oct. 7, 1804. Y. Il vy Artillery. 20, 1864. Disch d June 20, 18 i5; necrosis. 88 Moore, W., Corp l, E, June 3, Right ; portion of fibula excised. 121 Stermer, P., Pt., F, 5th Nov. 25, Left ; 3 ins. low. third fibula exc d. 71st Penn , age 29. 3. 1804. Discharged March 22, 1805. Iowa, age 25. 25, 1803. A.Surg.W. 11. Darn iw,. r )ih Iowa. 89 Morse, F.E.,Pt.,H, 17th Mav 12, Right ; lower third tibia excised. Disch d July 18, 1804. Maine, age 23. 12, 1804. Disch d May 11, 1865; necrosis 122 Stevenson, J. A., Adj t, April 1, Right ; 3 inches middle third tibia and exf illation. llth Penn., age 27. 1, 1805. excised. Surg. J. \V. Anawnlt, 90 Morse, S. C., Pt., F, 97th May 10, Right ; 2J inches low. third fibula llth Penn. Disch d July 1, 65 ; New York, age 25. 11, 1864. excised. Disch d Dec. 12, 1804. separation of 1 h inch. 91 Mosier, W., Pt., C, 148th May 10, Left; 3J inches fibula excised. 123 Stief, P., Pt., K, 139th N. July 30, Right ; lower third tibia excised; Pennsylvania, age 35. 10. 1804. Disch d May 9, 05. 1809, caries. York, age 39. 30, 1804. hasm. A ug. 1 amp. le":. Disc d. 92 Moury, B. S., Pt., B, Oct. 29, Left ; port.ion of mid. third tibia 124 Stinebuck. P.., Serg t, E, Nov. 24, Right : 3J ins. fibula exc d. Stirg. 137th New York. 29, 1863. exc d. Surg. J. L. Dunn, 109th 2d Michigan, age 27. 25, 1863. J. P. Prince, 30th Mass. Disch d Penn. Disch d May 24, 1865. May 25, 1804; lame. 93 O Connor,!., Pt.,G, 90th Dec. 13, Right ; 5 inches mid. thid fibula 125 Stocdale,\V., Pt., B, 48th May 14, Right; portion ,f fibula excised. Illinois, age 23. 13, 1864. excised. Ass t Surg. C. 15. Rich Indiana, age 28. 14, 1803. July 0, amputation thigh. Dis ards, U.S. V. Disch dJuneO, 05. charged July 15, 1805. 94 O Mnley, J., Pt., L, 2d July 1, Left ; upper third tibia. Disch d 126 Strass, G. N., Serg t, E, June 30, Left ; 2 inches of tibia excised. N. Y. M. R., age 32. 1, 1864. July 31, 1865; leg Hexed. 10th Alabama, age 25. 30. 1864. Furloughed Sept. 3<>, 1804. 95 O Rourke, P., Pt., F, 7th May :U, Left ; 6 ins. low. third tibia exc d. 127 Sweet, 15. R., Pt.,A,26th June 14. Left ; upper third tibia excised. N.Y. H vyArt., age 41. 31, 1864. Surg. (}. L. Potter, 145th Penn. Conn., age 45. 14. 1863. Mustered out August 17, 1803. June 6, leg amputated. Disch d 128 Sweitzer.C., Pt.,A,208th Mar. 25, Left : 3 inches middle third fibula July 28, 05. Specs. 1502, 3546. Pennsylvania, age 44. 25, 1805. excised: gang. Disch d July 96 Pattee, J. H.,Pt.,H, 26th Sept. 19, Left ; 2 ins. low. third tibia exc d. 15, J805. Died March 14, 1875. Ohio, age 23. 21, 1863. Jan. 21, 1864, amp. knee joint. 129 Taylor, W.C., Pt., M, 4th Aug. 25, Right ; 2 inches internal edge up. Discharged July 14, 1804. Wisconsin Cav., age 23. 27, 1864. third tibia excised. A. A Surg. 97 Peden, W. B , Corp l, A, Nov. 29, Right ; amp. left leg. Surg. J. P. J. F. Musgrave. Dis. Mar. 5. 05. ]7th Mississippi. 29, 1803. Prince, 30th Mass. Exchanged. 130 Thiebeau, A., Serg t, I, April 6, Left : middle third fibula excis d. 98 Penroad, G. W., Pt., E. Sept. 30, Left ; 2 inches middle third fibula 24th New York Cav. 6, 1805. Discharged June 28. 1805. l. Jth Ohio Cavalry, age 30, 1864. excised. Surg. W. C. Shurlock. 131 Thistlewood, R. K., Pt., Sept. 19, Left ; lower third tibia excised. 22. 51st Penn. Disch d Nov. 21, 05; E, 7th Maine. 19, 1864. Surg. G. T. Stevens, 77th N. Y. cartilaginous union to tibia. Discharged April :!, 1805. 99 Pitts, B. F., Pt., K, 123d May 25, Left ; 2J inches mid. third fibula 132 Thomas, AV.,Pt.,K,110th Mar. 25, Right : mid. third fibula excised. New York, age 25. 27, 1864. exc d. A. Surg. L.W. Kennedy, Ohio, age 24. 25, 1805. Discharged June 20, 1805. 123d N. Y. Disch d April 3, 05. 133 Toomey, J. J., Pt..I,29th May 15, Left ; lower third tibia excised.. 100 Posey, O., Pt., H, 31st July 22, Left ; 3 inches lower third fibula Pennsylvania, age 21. 15, 1864. Surg. H. B. Whiton. 00th N. Y. Illinois. 22, 1804. excised. Disch d July 19, 1805; May 31, amputation leg. Dis ligameutous union. charged July 2, 05. Spec. 3361. 101 Powell, T., Pt., F, 6th Jan. 15, Left; 3 inches lower third tibia 134 Trent, J. L., Corp l, B, May 5, Right; lower third tibia excised. Colored Troops, age 30. 15, 1865. excised ; necrosis. April 26, 65, 63d Penn., age 24. 5, 1864. Surg. G. T. Stevens, 77th N. Y. amp. leg. Disch d Oct. 14, 65. Disch d May 4, 05 ; 3 ins. short. 102 Powers, R.M., Serg t, E, Nov. 30, Left ; 2 inches upper third fibula 135 Tucker, N., Pt., B, 43d July 30, Left ; 2J ins. low. third tibia exc d. 4yth Tenn., age 25. 30, 1864. excised. Transferred to Provost Colored Troops. 31, 1864. Surg. F. M. Weld, 27th C. T. Marshal Jan. 3, 1805. Disch d May 27, 1805* atrophy. 103 Ready, W. B., Corp l, E, Nov. 16, Right; por. low. third tibia exc d. 136 Verstrappen, J., Pt., H, April 6, Left; 4 inches middle third fibula 2d Michigan, age 25. 16, 1863. Disch d June 11, 1864; perma 1st Maine, age 20. 6, 1865. excised. Must, out July 2, 05; nently lame. Died Sept. 9, 06, anchylosis ankle joint. ulterior effect of injury. 137 Walsh. P., Pt., A, 69th June 3, Left ; portion of upper third tibia 104 Ried, J. H., Lieut., K, 3d Nov. 29, Right ; 5 ins. fibula excised. To New York N.G., age 29. 3, 1864. exc d. Surg. J. A. Spencer,0!ith Miss., age 20. 3(i, 1864. Provost Marshal March 7, 1865. N. Y. June H, amputat n thigh. 105 Rogers, S. T., Lieut., A, June 27, Left ; 2 inches upper third fibula Disch d Sept. 20, 1805. 80th Illinois, age 23. 27, 1864. excised. July 17, excision head 138 Warfield. A. B., Serg t, E, May 25, Left; small portion fibula excis d. of fibula. Disch d Oct. 25, 1804 ; 7th Rhode Island. 25, 1864. Surg. J. Harris, 7th R. I. Dis passive motion only. charged June 3, 1805. 106 Ronald, J. S., Corp l, A, June 18, Left ; 4 inches lower third fibula 139 Warren, D. A., Serg t.C, Mar. 19, Left ; lower third fibula excised. 97th New York, age 30. 18, 1864. excised. Disch d June 23, 1805; 55th Ohio, age 29. 19, 1865. Discharged July 3, 1865. constant bandaging ; anch. ank. 140 Wehmhoff, H., Pt., P, May 14, Left ; 2 inches middle third tibia 107 Rose, F., Pt., L, 1st Mis Dec. 25, Left ; 4J inches middle third tibia 12th Missouri, age 30. 14, 1864. excised : necrosis. Discharged souri Artillery, age 19. 26, 1803. excised. Disch d Jan. 27, 1865. Sept. 19, 1864: anch y. ank. joint. 108 Rosemond, \V. E , Capt., June 22, Left ; 1 J inch middle third fibula 141 Weyl, J., Serg t, E, 5th Dec. 16, Right ; 2J inches lower third tibia A, 97th Ohio, age 23. 22, 1804. excised. Surg. E. B. Click, 40th Minnesota, age 32. 16, 1864. excised. Disch d April 14, 05. Indiana. Disch d Oct. 7, 1864. Died Jan. 20, 77 : absc. of over. 109 Runyan,C. A., Musician, May 3, Left; 4 ins. tibia excised. Surg. 142 Wiggs, B., Pt., K, 43d July 11, Left ; 3 inches middle third fibula F, !)th New York Il vy 3, 1863. S. A. Sabin, 9th N. Y. Heavy North Carolina, age 24. 11, 1864. exc d. Surg. Brewer, C.S. A. Artillery, age 19. Artillery. Oct. 17, leg amputa To prison February 5, 1 805. ted. Disch d July 26, 1865. 143 Wilkins,J.S.,~L\e\it.,H, Sept. 3, Left; 2 inches lower third fibula 110 Rusk, ,T.D.,Pt.,G, ] 07th May 31, Left ; 4 inches lower third fibula 21st Miss., age 20. , 1804. excised. To prison Dec. 9, 04. Illinois, age 26. 31, 1864. excised. Surg. J. W. Lawton, 144 Williams, J.6., Capt., D, July 3, Right : upper third tibia excised. U. S.V. Disch d Dec. 12, 1864 ; 12th Mass., age 43. , 1863. Disch d June 8. 04. Died April uses crutches. 4, 1875; phthisis piilmonars. 111 Ryan, P.. Pt.,K,9th Con Jan. 5, Right; 1J inch upper third tibia 145 AVilliamson.R.J., Lieut., May 29, Left; 3 ins. up. third tibia exc d. necticut, age 19. 5, 1804. excised. Surg. E. A. Thompson, D, 66th 111., age 27. 29, 1864. Surg. J. Pogue. 00th Illinois. 12th Me. Disch d May 17, 1865 ; Disch d Jan. 4. 05; leg useless. knee joint anchyl d; 3 inches 146 Wilson, S., Pt., E, 7th Oct. 27, Right; lower third fibula excised. shortening. Spec. 2530. West Virginia. 27, 1864. Surg. W. I. Burr. 42d N. York. 112 Sieger, J., Pt., K, 16th Mav 8, Right ; middle third tibia excised ; Mustered out June 29. 1805. Michigan, age 21. 8, 1864. caries. Disch d Feb. 20, 1865; 147 Wilson, T. C., Capt., D, July 9, Left ; 2 inches lower third fibula deformity. 27th Virginia, age 23 9, 1804. excised. To prison Oct. 9. 04. 113 Smith, E. J., Corp l, H, May 23, Left ; middle third tibia excised. 148 Zimmerman, J., Serg t, Oct. 19, Right ; 4 inches lower tliinl fibula 56th Pennsylvania. 23, 1864. Disch d July 1, 1805; shorten E, 1st West Va., age 23. 22, 1804. excised. Disch d July -^7, 1865; ing i inch. partial anchylosis ankle. 114 Smith, S. B., Pt., I, 15th Oct. 7, Right ; 4 ins. middle third fibula 149 Adams, M.,Pt,B, 130th July 21, Left : 2 ins. mid. third tibia exc d. Alabama, age 25. 7, 1804. excised. Retired Feb. 9, 1865. Indiana, age 24. 21, 1864. Surg. J. \V. Lawton, I". S. V. 115 Snooks, I., Serg t, H, 23d Oct. in, Left ; mid. th il tibia exc d ; necro. Gangrene. Died Sept. 20. 1804. Ohio. 19, 1804. Disch d May 9, 1805: deformity. 150 Alley, S. D., Pt., B, 99th May 25, Left: li inch fibula exc d. Surg. 116 Snow, n., Pt., L, 4th Va. May 5, Right ; portion of head of fibula Indiana. 25, 1864. R. M.Trris. 103d Illinois. Died Cavalry, age 23. 5, 1864. excised. To prison Jan. 27, 05. Sept. 3, 1864. 452 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NAME, MILITARY OPERATIONS, OPERATORS, NO NAME, MILITARY DATES OPERATIONS, OPERATORS, No. DESCRIPTION, AXI> AGE. DATEB. RESULT. DESCRIPTION, AND AGE. RESULT. 151 Atwood, N. H., Pt,, C, April 2, Right ; portion of fibula excised ; 182 Jamison, B. A., Pt., A, July 3, Left; lower third tibia excised. 6th Vermont, age 22. 2,1865. slough g. April 13, amp. thigh. 21st Virginia, age 21 . 6, 1863. Surg. J. A. Wolf, -J9th Penn. Died May 23, 1865: pyaemia. Died July 18. 18(13: tetanus. 152 Babcock, E. H., Pt., K, July 3, Left ; port. up. third fibula : gang. 183 Johnson, D. A., Pt., E, Nov. 7, Right ; portion of tibia excised ; 1st Michigan Cavalry, 3. L863. Oct. 18. haem., 3 pts.; lig. ante. 4Jd New York, age 37. 7. 186:i. non-union. July 2, j8(>4, amp. age 39. tibia! artery. Died Oct. 18, 63, thigh. Died August 6, 1864. effects of hiem. Spec. 2(511 . !l84 Lancaster, W. B., Pt., B, June 18, Right : middle third tibia exc d ; 153 Barrett, J. E., Lieut., D, June 15, Left : 2 inches middle third fibula 66th N. C., age 20. 18, 1864. gangrene. Died July 16, 18l>-1. 9 1st Indiana. 15, 1864. excised. Surg. J. W. Lawton, 185 Lay, T. S., Pt.. D, 53d Mar. 25, Left; head of fibula and pan of U. S. V. Died July 20, 1864. Georgia, age 21. 25, 1865. tibia exc d. D:ed April 21, 65. 154 Biehl, N., Pt., I, 155th June 19, Right; 2ins.mid. third tibia exc d. 186 Lemon, T. A., Corp l, A, May 11, Lef . 8 inches tib. a t xcised. Died Pennsylvania, uge 27. 21, 1864. Surg. J.A. E. Reed, 155th Penn. 61st Pennsylvania. 11, 1864. May 16, 1864. July 19, amp. thigh. Died July 187 Lohser, A., Pt., I, 24th May 25, Left; nj inches u.id third fibula 21, 1864 : exhaust n. Spec. 3337. Michigan, age 20. 25, 1864. excised; also wound of right 155 Blair, W. F., Pt., H, 5th May 12, Left ; 3 inches lower third fibula ankle. Died June 17, 1864. Penn. Res., age 28. 12, 1864. excised. Surg. B. Rohrer, 10th 188 Lovell, P., Corp l, C.lOth Nov. 25, Left; 2J inches lower third tibia Penn. Res. Wire sutures. Died Missouri, age 41. 25, 1863. exc d. Jan. 10, 64. haem. from June 12, 1864 ; pyaemia. post. tib. art.; amp. leg; slough.; 156 Canfield, D., Serg t, M, June 17 Right ; 2 ins. lower third excised. haem.; gang. Feb 2, amp. thigh. 14th N.Y. H.A.,age20. 17, 1864. Died July 28, 1864. Died Feb. 3, 1864. S/>ec. 2108. 157 Canter, J., Pt.., E, 53d June 27, Left; 3 inches middle third tibia 189 Mann, A. A.. Corp l. A, April!, Right; middle thirl tibia exc d. Ohio. 28, 1864. exc d. Surg. A. C. Messenger, 16th Maine. 1, 1865. Died April 24, 186"). 57th Ohio. Died July 3, 1864. 190 Martz. S. V., Pt., I. 87th Mav 18, Right ; upper third fibula exc d. 158 Carpenter, J. H., Pt., E, June 22, Left; 1J inch upper third fibula Pennsylvania. 18, 1864. Died June 4, 1864. 110th Penn., age 40. 22, 1864. excised. July 5, 1864, amputa 191 Mclnt_yre, A.,Corp l, D, June 22, Left; 2 inches upper third fibula tion thigh. Died July 16, 1864 ; 6th New York Heavy 23, 1864. exc d. Aug. 5, parench.; ha-m. pyaemia. Spec. 2759. Artillery, age 37. Died Aug. 10, 1864; pya inia. 159 Carroll, F., Pt., K, 45th June 3, Right ; 3 ins. middle third fibula 192 Meade, L., Pt., B, 2d N. June 18, Right; middle third tibia exc d. Penn., age 23. 4, 1864. excised ; haem., 8 oz. June 18, York M. R., age 17. 18, 1864. Died July 17, 1864. 1864, amput n knee joint. Died 193 ilunn, J., Pt., E, 15th Oct. 7, R t ; 3J ins. mid. th d tibia exc d. June 22, 1864 ; exhaustion. Alabama, age 32. 7, 1864. Died July 9, 65 ; chr. diarrhoea. 160 Carter, T.F.,Pt.,E, 12th May 13, Right; 2 inches tibia and fibula 194 Norman, C. H., Pt., K, May 8, Left; portion of fibula excised. Indiana. 14, 1864. excised. Surg. W. Lomax, 12th 8th Maryland, age 20. 8. 1864. Died May 22, 64 ; haemorrhage. Indiana. Died May 31, 1864. 195 Rader, J., Pt., F, 59th Aug. 19, Left ; 4$ inches middle third tibia 161 Chaffee, A. J.,Pt.,E, 44th July 3, Right ; 3 inches tibia exc d ; also Illinois, age 21. 19, 1864. exc d. Dec. 7, 64, amp. thigh : New York, age 28. 4. 1863. wound left leg. Died Aug. 16, gang. Died Jan. 4, 65; exhaus. 1863; diarrhoea and erysipelas. 196 Reed, N. H., Pt.,H, 30th June 15, Right ; middle third tibia fxr d. 162 Cook,J. T., Pt.,K,2dN. April 1, Left; portion of tibia exc d; also Iowa. 15, 1864. Surg. B. A. Bond. 27th Missouri. York Cavalry. 1, 1865. w ndofarm. Died April 11, 65. Died July 10, 1864. 163 Cosman, W. T., Corp l, Sept. 17, : portions of tibia and fibula 197 Rice, H., Corp l, C, 36th Mav 25, Right; head of fibula excised. F, 9th New York S. M. 20, 1862. exc d. Died Oct. 2, 62 : pyaemia. Massachusetts. , "1864. Died June 1, 1864. of wound. 164 Cramp, T., Pt., G, 5th Dec. 16, Right: 4 ins. low. third tibia exc d. 198 Rice, W., Pt., B, 14th June 22, Right ; 3 inches mid. third fibula Minn., age 33. 17, 1864. Surg. V. B. Kennedy, 5th Minn. Kentucky, age 29. 22, 1864. excised. Surg. J. W. Lawton. Lac. wound post, t ibial artery. U. S.V. Died Sept. 22, 1864. Dec. 27, lig. Died Feb. 4, 1865. 199 Robbins, J. A., Capt., G, June 29, Left : 2J inches upper third fibula, 165 Davis, S., Pt., F, 27th Mav 24, Left ; portion of fibula excised. 129th Indiana. 29, 1864. including the head, excised. Michigan. 24, 1864. Surg. A. F. Whelan, 1st Mich. Surg. S. K.Crawford, 50th Ohio. S. S. Died May 30, 1864. Died July 24, 1864. 166 Deegan, T., Capt., C, Dec. 13, Left ; portion of fibula excised. 200 Root. W. R., Pt,, E, 7th June 3, ; portion of fibula excised. 107th Pennsylvania. 13, 1862. Died January 9, 1863. N. Y.H vy Artillery. 3, 1864. Surg. G. L. Potter, 145th Penn. 167 Dewts, J. S., Pt., H, 18th May 12, ; portion of lower end fibula Died June 9, 18(i4. Virginia. 12, 1864. excised. May 14, amputation 201 Rutledge, T., Lieut., G, Dec. 15, Left ; 2 inches middle third fibula of leg. Died May 21, 1864. 33d Missouri. 15, 1864. excised. Surg. A. T. Tiartlt-tt, 168 Dodson, J. S., Serg t, H, July 22, Right ; 3J inches tibia excised. 33d Mo. Dec. 26, ha?m.. 32 <?.. 99th Indiana. 23, 1864. Ass t Surg. D. Halderman, 46th Died Dec. 28, 1864. Spec. 6(,:i4. Ohio. Died August 18, 1864. 202 Sanders. G. W., Corp l, Sept. 19, Left; 2 inches lower third tib;a 169 Eaton, C. A., Pt., K, 39th May 9, Left ; portion of upperthird fibula K, 26th Ohio. 21, 1863. excised. Died Oct. 22, 1863. Mass., age 40. 9, 1864. excised. May 17, haemorrhage, 203 Schwerin, H. R., Capt., May 2, Right (May 3, spicula and ba. l 30 oz.; amputation thigh. Died C, 119th New York. 5, 1863. rem.); exc. in mid. third. Surg May 29, 1864: exhaustion. J. D. Hewett, 1 1 9th N. Y. Maj 170 Greenstreet, J., Pt., F, May 27, Left ; 3 inches fibula exc d. Surg. 9, amp. of leg. Died May 10, 63. 32d Missouri. 27, 1864. G. L. Carhart, 31st Iowa. Died 204 Sharpe, T.,Corp l, I,38th Feb. 6, Right; por. of tibia exc d. Surg. June 20, 1864. Illinois, age 30. 7, 1864. J. Y. Finley. 2d Ky. Cav. April 171 Haas, P., Pt., E, 64th Jan. 1, Left ; middle third tibia excised. 5, amp. knee joint. Died June Ohio. 4, 1863. A. Surg. L. C. Fonts, 94th Ohio. 23, 1864; erysipelas. Died Jan. 26, 1863 ; gangrene. 205 Smith, J., Pt., I, lllth July 20, Right ; portion of fibula excised. 172 Harrison, G. C., Corp l, May 27, Left; portion of tibia excised. Pennsylvania. 20, 1864. Died July 21, 1864. K, 102d New York. 27, 1864. Surg. C. H. Lord, 102d N. York. 206 Smith, J., Pt., F, 17th June 17, Right ; portion of fibula excised. Died June 9. 1864. Vermont, age 40. 17, 1864. Died July 6, 1864. 173 Heath, L., Serg t, D, 2d June 18, Right; 2 inches tibia. July 7. 207 Springer, J. M., Chap May 15. Right; 2| inches mid. third tll/ia Michigan, age 22. 18, 1864. amp. thigh. Died July 28," 64. Spec. 2807. 208 lain, 3d Wis., age 37. Thompson, W. B , Pt., 15, 1864. Dec. 17, exc d. Died May 22, 64; pya?m. Right; 3 inches excised. A. A. 174 Henderson, W., Serg t, June 1, Right ; middle third fibula exc d. K, 124th Ohio, age 19. 18, 1864. Surg. L. Sinclair. Died Feb. 2, E, 83d New York. 1, 1864. Died June 11. 1864. 1865; gangrene. 175 Hensler, J., Pt., F, 29th June 21, Right; fibula; lig. ant. tib. artery. 209 Utzey, G. C., Pt.. G, 4th May 29, ; 5 inches of tibia excised. Pennsylvania. 21, 1864. Surg. J. A. Wolf, 29th Penn. South Carolina Cav. 30, 1864. Surg. C. I!. Gibson, C. S. A. Died July 9. 1864. Died June 24, 1864. 176 Herzog, F., Pt., C, 8:Jd May 12, Right ; 3 ins. fibula exc d. Died 210 Walton, J., Corp l, G, July 27, Left ; port, of fibula exc d. Died New York, age 29. 12. 1864. May 30. 1864 ; exhaustion. 20th Ohio, age 28. , 1864. Sept. 26, 1864; dysentery. 177 Hiney, W. H., Lieut., C, June 1, Right : 3 inches upper third fibula 211 Whistler, R., Pt.,H, 49th June 2, Right; portion of tibia excised. 50th Pennsylvania. 1, 1864. excised. Died July 8, 1864. Ohio. 2, 1864. July 5, leg amputated. Died 178 Hitchings, W..Pt,,H, 8th April 9, Left : middle third fibula excised. July 14, 18(14 ; pyaemia. Illinois. 9, 18(55. Died April 17, 1865: gangrene. 212 William?, J. S., Pt., F, Nov. 30, Left; 4 inches of fibula excised. 179 Hughes, N., Pt., M, 3d Nov. 16, Right ; portion of tibia excised. 127th New York, age Dec.2, 64. A. A. Surg. H. Lcaman. Gan Artillery. , 1863. Died December 18, 1863. 35. grene. Died Doc. 4. 1864. 180 Jackson, C., Corp l, G, June 25, Left ; partial excision of fibula. 213 Wii;ingmire, S., Pt., C, May 25, Right ; portion of tibia excised. 2d Michigan. 25, 1864. Surg. A. F. Whelan, 1st Mich. 29th Pennsylvania. 25, 1864. Surg. G. P. Oliver, lllth Penn. > S. S. June 28. 64, amp. thigh. Died June 17, 1864. Died July 2, 1864. 214 Wilson, J. M., Pt., D, 2d May 5, ; portion of upperthird tibia 181 Jackson,W., Pt,, E, 97th May 11, Left ; 4 inches middle third fibula U. S. Sharpshooters. 5, 1864. excised. Died May 29, 1864. New York, age 34. 11, 1864. exc d. Surg. W. B. Chambers, 215 Woodward, E. F., Pt., I, Dec. 13, Left; part of tibia and radius ex 97th N. Y. Died June 1, 1864. 53d Pennsylvania. 13, 1862. cised. Died Jan. 6, 1863. 1 LIDELL (J. A.). Resff.tion of Fibula in Continuity for Gunshot Fracture, etc., in United Mates Sanitary Commission Memoirs, New York, 1870. Surgical Volume I, p. 530. SECT. V.) INTERMEDIARY EXCISIONS IN THE BONES OF THE LEG. 453 Of the two hundred and fifteen primary excisions in the continuity of the leg, forty-two with twelve deaths were in the upper, eighty-four with twenty-one deaths in the middle, forty-six with eight deaths were in the lower third of the leg, and in forty-three instances with twenty-six deaths the seat of the operation was not indicated. Intermediary Excisions in the Continuity of the Bones of the Leg. Eighty-seven excisions in the leg were intermediary operations; of these twenty-nine proved fatal, a mortality rate of 33.3 per cent. Portions of the tibia were excised in thirty-three, of the fibula in forty-six, and of both bones in seven instances, and in one case this point was not recorded. Recoveries after Intermediary Excisions in the Continuity of the Bones of the Leg. The fifty-eight successful intermediary operations were performed on fifty-one Union and seven Confederate soldiers. One, an officer, is still (November, 1880) in active service, another has been placed on the retired list, and forty-nine became pensioners*. Of the lat ter, five have died since the date of their discharge two from debility, one from phthisis, and two from causes not recorded. Four patients submitted to subsequent operations one to amputation in the leg 1 and three to ablation in the thigh. 2 CASE 712. Colonel H. A. Morrow, 24th Michigan, aged 33 years, received a shot fracture of the upper third of the fibula of the right leg, at the Wilderness, May 6, 1864. Five days after being wounded he entered the Seminary Hospital, Georgetown, where his injured limb was operated upon by Surgeon H. W. Ducachet, U. S. V., who reported the following : " When admitted the patient had no appetite and was feverish, very nervous and irritable, complaining of every noise. The wounded leg was very much swollen, painful, and discharging an unhealthy sanious pus. Resection of three inches of the upper third of the fibula was performed on May llth, chloroform being used. The patient suffered intensely for twenty-four hours after the operation, when he began lo improve. There were no unfavorable symptoms afterwards. Simple dressings were applied. The patient left the hospital on leave of absence July 1, 1864." Colonel Morrow subsequently returned to the field and again held active commands. He was mustered out of the Volunteer Service after the close of the war in 1865, and recom- missioned in the 36th regiment of Infantry of the Regular Army in the following year, since when he has been promoted to Colonel of the 21st Infantry. CASE 713. Private G. Fuller, Co. H, 19th Maine, age 18 years, was wounded in the left leg, at Ream s Station, August 25, 1864, and entered Emory Hospital, Washington, three days afterwards. Acting Assistant Surgeon J. M. Downs forwarded the specimen (FlG. 275), with the following description of the injury: "The wound was produced by a musket ball, winch passed through the leg near the ankle, shattering the lower third of the fibula in its course. Upon examination the operation of excision was thought advisable, and was performed, on August 29th, by Surgeon N. R. Moseley, U. S. V., who removed two and a half inches of the fibula near the ankle joint through an incision three and a half inches long. Ether and chloroform constituted the anaesthetic." The patient was subsequently transferred to Webster Hospital, Manchester, and on May 27, 1865, he was mustered out of service and pensioned. Various examining surgeons certified to the injury and operation, and Dr. C. B. Pearson, of Spring Green, Wisconsin, February 5, 1873, added: "The wound is healed, but the muscle has grown fast to the tibia so as to destroy action of the tendons," etc. Subsequent examiners corroborate the previous reports. The pen sioner was paid December 4, 1879. FIG. 275. CASE 714. Private W. H. Curtin, Co. H, 23d Massachusetts, aged 20 years, was severely wounded half inches i" the left leg, at Whitehall, December 15, 1862. Surgeon C. A. Cowgill, U. S. V., reported: "The cfsed" ^* wounded man was admitted to Academy Hospital, New Berne, five days after receiving the injury. The 1910. fibula was badly comminuted and shattered. On December 26th, I excised six and a half inches of the bone, including the finely comminuted portion. The patient recovered pleasantly and has gone home on furlough, able to walk comfortably." He subsequently entered Foster Hospital, where he was discharged May 28, 1863. Examining Surgeon W. C. Robinson, of Portland, October 10, 1863, described the injury and reported : "A large cicatrix nearly the whole length of the leg, showing the nature of the operation. It appears that nature is in J^* f fiiche* a measure restoring the bone. A large ulcer still exists at the point where the ball entered the leg. He has walked of fibula ex- a cised. Spec. with a crutch until recently; is now able to walk with a cane." Several months alter being discharged the man 1326. re-enlisted in the Veteran Reserve Corps, whence he was ultimately mustered out November 16, 1865, and pensioned. The Portland Examining Board reported, September 4, 1873, that "the nerves were injured so that the foot is greatly impaired in its motions." At a subsequent examination it was stated that "the tendo-achillis is contracted, so that there is butlittle antero- Case of Private D. P. Griswold, Co. C, 7Gth New York, right leg. secondary amputation in the middle third. 2 Cases of Pt. W. II. Burdick, Co. B, 82d Pennsylvania, right thigh, secoudary operation in lower third (TABLE XL, p. 320, No. 17); Pt. I. A. Angell, Co. D, 1st Wisconsin Cavalry, right thigh, secondary amputation in lower third (TABLE XL, p. 320, No. 2); Pt. E. A. Bennett, Co. F, % 44th New York, left thigh, secondary amputation in lower third (TABLE XL, p. 3x?0, No. 7). 454 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. posterior motion of the ankle joint. The leg is atrophied and the parts bound down by the indurated cicatrix." The pensioner was paid December 4, 1879. The specimen represented in the wood-cut (FlG. 276) was contributed by the operator. Fatal Cases of Intermediary Excisions in the Bones of tlie Leg. The twenty-nine operations of this group were performed on Union soldiers. Pyaemia was noted in eleven, gangrene in eight, and erysipelas in one case. Subsequently, amputation in the leg was performed in one, 1 exarticulation at the knee in one, 2 and amputation through the thigh in five instances. 3 Reports of post-mortem examinations were received in five instances. CASE 715. Private H. M. Grimes, Co. C, 116th New York, aged 24 years, was wounded at Port Hudson, May 27, 1863. Surgeon C. B. Hutchins, 116th New York, reported his admission to the field hospital of the 1st division, Nineteenth Corps, with "shot wound of leg ; severe." Assistant Surgeon P. S. Conner, U. S. A., who operated in the case and contributed the pathological specimens (FlGS. 277, 278), reported the following description of the injury and its results: The man was wounded in the left leg by a minie ball, which was found to have struck the tibia anteriorly, causing compound comminuted fracture. He was admitted into University Hospital, New Orleans, May 30th, where, a few days laten, several loose fragments of bone having been removed and the extent of the injury Fmirinii of determined, the entire fractured portion was resected, amounting to nearly five inches of the tibia, witL tibia, and including the shaft to within less than an inch from the ankle joint. The ball was baH.i xcis d. found to be wedged in among the fragments and the fibula uninjured. The case progressed Spec. 1307. very favorably until early in July, when diarrhoea came on, which caused the patient s death August 14, 1863. The bones of the injured leg (FlG. 278) indicate the extent of the reparative process, and the probabilities that the man would eventually have had a serviceable leg had he lived." The extremity of tlie lower fragment is carious,-a spur from the upper fragment projecting three inches downward, and the face of the fibula is involved in callus. CASE 716. Private H. Mink, Co. H, 4th New York Heavy Artillery, aged 20 years, -was wounded at Petersburg, April 2, 1865, and was conveyed to City Point two days afterwards. Acting Staff Sur geon J. Aiken recorded his admission to the Depot Hospital of the Second Corps with "compound fracture of left leg." On April 15th the wounded man was transferred to the First Division Hospital, Annapolis, where the injured limb was operated on by Surgeon B. A. Vanderkieft, U. S. V., who reported as follows: The wound was produced by a minie ball, causing a compound comminuted fracture of the tibia and oblique fracture of the fibula at the middle third of the leg. Resection was performed on April 17lh, removing a longitudinal portion of the fibula and parts of the upper and middle thirds of the tibia, one being five inches in length, two others one and a half inches each, and three smaller pieces. Very little inflammation existed at the time of the operation, and the patient was in good condition. Chloro form constituted the anaesthetic. Oakum dressings were applied and quill sutures used as means of partial coaptation of the flap. Purulent accumulations were removed by the syringe. Eight ounces of wine were given daily. Progress was favorable." Three weeks after the date of the operation the patient was transferred to the Second Division Hospital. Annapolis, where he died of exhaustion, May 11, 1865. Surgeon G. S. Palmer, U. S. V., in charge of the latter hospital, reported that the patient when admitted was in a moribund condition, also that the wound was in an unhealthy state and filled with maggots. The excised bone, shown in the wood-cut (FlG. 279), was contributed by the operator. CASK 717. Corporal W. N. Esworthy, Co. E, 1st Pennsylvania Cavalry, aged 24 years, was wounded in the left leg. at White House Landing, June 21, 1864, and admitted to Carver Hospital, Washington, two days afterwards. Surgeon O. A. Judson, U. S. V., reported: "The missile, sup posed to be a conoidal ball, entered the leg anteriorly about three inches below the knee joint, passed backward and outward, making its exit posteriorly and producing a compound comminuted fracture of tbe upper third of the tibia. Supporting treatment was adopted and simple dressings applied. Erysipelas attacked the wound on June 27th, but yielded readily to an application of solution of copperas. By July 1st no erysipelatous spmptoms were present ; constitutional state of patient good ; wound secreting laudable pus in large quantity. On July 6th, the patient was anaesthetized and excision of about five inches of the upper third of the shaft of the tibia, by means of the chain saw, left leg:, with four ami a was performed by Acting Assistant Surgeon O. P. Sweet, making a straight incision over the crest Pio. 280 Five ins. of left tibia of the tibia. The wound was then filled with scraped lint, cold-water dressings were applied, and stimulants given freely. The patient appeared to be doing quite well up to July 18th, the wound exc d. 5pec.-J J40. filling with healthy granulations and secreting laudable pus. For ten days previous, however, he had anorexia, and this morn ing he bad a very severe chill. A recurrence of chills followed every morning and sometimes two or three times during the day, and these were followed by other pyscmic symptoms, the integuments assuming a deep icteric tinge; pulse rapid ; slight cough; Case of Private A. E. Luther, Co. E. M Massachusetts Cavalry, left leg. intermediary operation at junction of upper and middle thirds. 2 Case of Prhate S. M. Grainger. Co. A, 38th Indiana, left leg, secondary operation (TAlil.K LV11, page 4C!). No. 19). Cases of I t. II. Conrad. I, -J-lth Mich., left thigh, intermediary operation in middle third, Spec. 3t>Tj3 (TAr.l.r. XXXV, p. 283, No. 253) : I t. A. Allen, II, 5th I". S. Artillery, intermediary operation, lower third iTAJ .l.F. XXXVI. p. 29(i, No. 2C3): Cor] 1 1 (: v. II, Ifth Wisconsin, intermediary operation iu lower third (TA11I.K XXXVI. p. C . t". No. :i. r ;7). l j t. M. C.ilinore. I>. .",4th Mass., left thigh, intermediary operation in lower third (TAia.K XXXVI. p. -J. .i8, No. 3()5); I t. J. Bloomer, K, ITUth N. Y., right thigh, intermediary opemtiou iu lower third, Sped. MM, Ifcioy, A. M. M. (TAliLE XXX VI, p. ^ J7,.Ni>. ;MtJ). SECT. V.] INTERMEDIARY EXCISIONS IN THE BONES OF THE LEG. 455 anorexia continuing. The treatment, decidedly stimulating and tonic, was continued. The symptoms continued in a more aggravated form and the patient steadily sank, the whole surface of his body being of a deep yellow color. He died on July 23, 1864. At the autopsy a large number of metastatic abscesses were found in both lungs; liver enlarged; spleen also enlarged, dark colored, and soft. A purulent offensive fluid mixed with lymph was shown in the left pleural cavity, and a large disinte grated clot in the femoral vein." The excised bone, contributed by Surgeon Judson and exhibiting superficial necrosis, is rep resented in the wood-cut (FlG. 280). TABLE LXIV. Summary of Eighty-seven Intermediary Excisions in the Bones of the Leg for Shot Injury. [Recoveries, 1-58; Deaths, 59-87.] NO. NAME, MILITARY DESCRIPTION, AXL) AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPEKATOUS, RESULT. 1 Angcll, I. A., Pt., D, 1st July 23, Right ; gang.; 7 inches mid. third 23 House, T. J., Pt.,K, 16th Sept. 30, Right ; head of fibula and part of Wisconsin Cav ry, age Aug. 1, tibia excised. A. A. Surg. J. C. Illinois, age 22. Oct. 15, shaft excised. Dutv Nov. 14, 23. 1864. Thorpe. Sept. , hsem.; 18th, 1863. 1863. Died Dec. 2G. 1866. amp. thigh. Disch d Jan. 7, G5. 24 Hnugh, S. R., Serg t, A, Sept. 17, Left ; 5J inches upper third tibia Re-amp. June 1C, 65. Spec. 5549. 107th Penn., age 32. Oct. 4, 62. excised. Disch d Feb. 3, 18G4 ; 2 Bennett. E. A., Pt., F, Mav 22, Left: middle third fibula excised. ntn-union; limb useless; deform 44th N. York, age 41. 31, 1804. A.A. Surg. R. Ottman. Disch d ed ; should be amputated. Oct. 11, 64. Amputation thigh 25 Howard, J. M., Pt., F, May 16, Right ; 3 inches of tibia excised. 3 Botjer, G. C., Pt., II, 2tl Sept. 19, March 2, 1809 ; re-amputation. Left ; 2 ins. in length, J inch in 26 49th N. C., age 24. Jenkins, \V. H., Pt., Ash 23/1864. Sept. 17, Furloughed August 22, 1864. Left; 3 inches fibula in middle North Carolina, age 20. 25, 1864. depth of upper third tibia exc d. land Battery, nge 25. Oct. 15, third excised. To prison April Surgeon A. Atkinson, C. S. A. 1862. 10, 1863. To prison Feb. 1G, 18G5. 27 Jordan, W. B., Corp l, Aug. 21, Right ; 2J ins. lower third fibula ! Burdiek, W. H., Pt., B, ! April (i, Right -, 2 inches middle third tibia I, Gth Vermont, age 20. 29, 1864. excised. A. Surg. C. Bacon, jr., 8,M Pennsylvania, age 13, 18G5. excised. Disch d Oct. 12, 18G5. U. S. A. Disch d July 19, 1865. 21. Amp. thigh March 27, 1866. 28 Langton, A., Pt., E, 27th May 3. Right ; 4 inches middle third tibia 5 Burke, J. C., Pt., H, 78th Mav 3, Right ; 2 ins. mid. th d tibia exc d. Indiana. 17, 1863. excised. Disch d Feb. 19, 1864 ; New York, age 20. 18, 1863. Disch d March 18, 64 ; caries. exfol.; short. 1 inch. Spec. 1280. 6 Carse, G. 15., Cap!., C, Mav 2, Right ; 3 ins. fibula exo d. Disc d 29 Lohr, S. G., Serg t, G, Dec. 13, Right : 6 ins. middle third fibula 4Uth New York. 30. 1863. | Dee. 15, 1803; slight shortening. 19th Infantry, age 26. 25, 1862. excised ; gang. Disch d Feb. 25, 7 Casper. J. M., Corp l, K, May 23, Right ; partial excision of upper 1863 ; paralysis of toes. 7th Wisconsin, age 21. June 13, third fibula. A. A. Surg. P. C. 30 Lotts, P., Pt., K, 5th Mav 3, : 2 inches upper third tibia 1864. Porter. Disch d Mar. 24, 18G5; 9, 1863. exc d. Recovery: useful limb. partial paralysis foot. 31 Lucas, W. J., Pt., H, Aug. 25, Left ; 2^ ins. low. th d fibula exc d. 8 Charles, R Y., Corp l, G, June 1, Left ; 3 ins. mid. third tibia exc d. 148tb Penn., age 21. 29, 1864. Surg. N. R. Moseley, U. S. V. 1st New Y Tk Drag s, 15, 18.J4. Surg. R. B. Bontecou, U. S. V. Disch d Mar. 27, 65 ; anch. ank. age 22. Disch d May 6, 1865; necrosis; Died June 7, 1868. Spec. 1982. shortening. 32 Lynn, A., Pt., F, 47th Oct. 19, Right ; 2J ins. middle third tibia 9 Collins, O., Pt., D, 151st Nov. 27, Left ; 3 inches lower third fibula Pennsylvania, age 18. Nov. 1, excised. A. A. Surg.W. Kemp- New York, age 32. Dee. 9, exc d. , jurg. E. Bentley.U.S.V. 1864. ster. Disch d Oct. 14, 1865. 1803. Ligation post, tibial art.; haem. 33 Lytle, H., Serg t, A, 83d Sept. 30, Right ; 2.V ins. mid. th d fibula and Disch d Feb. 25, 1865. Pennsylvania, age 22. Oct. 17, half the thickness of tibia exc d. 10 Coyle, M., Pt., B, 81st June 3, Right; 3 inches mid. third fibula 1864. A. A. Surg. J. II. Robinson. Dis Pennsylvania, age 23. 15, 18G4. e xe d. Surg. E. Bentlev.U.S.V. charged July 31, 1865; necrosis. Disch d Oct. 3, 1865. Died Jan. 34 Malow, L., Pt., F, 24th Sept. 19, Left ; upper third tibia excised. 27, 76 ; debility, result of w nd. Illinois. 29, 1863. Surg. I. Moses, U. S. V. Disch d 11 Crowley, J., Pt,, E, 5th Sept. 20, Right ; head and 3 ins. up. third August 6, 64 ; periostitis. Died New York, age 25. Oct. 20, fibula excised. Disch d Nov. June 10, 1876. Spec. 2149. 18G2. 22, 1862. Bone diseased. Died 35 Mann, O. L., Lieut. Col., May 20, Left ; portion of mid. tibia excised. July 10, 1871. 39th Illinois, age 31. June 8, A. Surg. E. McClellan, U. S. A. 12 Curtin, M. 11., Pt.,H, 23d Dec. 15, Left ; 6J inches fibula excised. 1864. Diseh d Dec. G, 65. 1870, bone Massachusetts, age 20. ! 20, 1862. Surgeon C. A. Cowgill. U. S.V. discharging. Disch d May 28, 6:i. Spec. 13-26. 36 Merrihew, D. J., Corp l, Mar. 25, Right ; 2 inches lower third fibula 13 Farnin, J., Lieut., I, 1st De.31, G2, Right ; largo portion mid. third I, 121st N. Y., age 22. April 8, excised. A. A. Surg. J. H. Rob Kentucky, age 25. Jan.5, (i3. tibia excised; fibula exfoliated. 1865. inson. Disch d Aug. 2, 1865. Disch d June 18, G4; short. lin.; 37 Minor, W.W., Pt., H,2d Mav 5, Right ; 8 inches lower part fibula deformity. Wisconsin, age 46. 30, 1864. excised. Disch d Sept. 23, 1864 ; 14 Fellows, J., Corp l, D, Sept. 19, Left ; 3 inches middle third tibia bone carious. 100th Illinois, age 24. 24, 18li3. excised. Disch d Aug. 11, 18G4; 38 Morrow, 11. A.,Col., 24th May G, Right ; portion of up. third fibula caries ; shortening. Michigan, age 33. 11, 1864. excised. Surg. II. VV. Ducachet, 15 Fuller, G., Pt., H, 19th Aug. 25, Left ; 2J inches lower third fibula U. S.V. Disch d June 30, 1865. Maine, age 18. 29, 18G4. excised. Surg. N. R. Moseley, 39 Naslv O. T., Pt,, K, 12th Aug. 23, Left ; 4 inches middle third fibula U. S. V. Disch d May 27, 1865. Wisconsin, age 21. 29, 1864. excised and arterv lig. Surg. Spec. 1910. A. J. Miller, 13th Iowa. Disch d 10 Griffin, D. O.,Pt.,K, 17lh April G. Left; li inch lower third tibia June 30, 1865. Illinois, age 24. , 18G2. excised. Disch d Oct. 15, 18G2 : 40 Oberrender, J. S.. Lieut., Mav 6, Left ; 2 inches lower third fibula toes and heel contracted. E, 96th Penn., age 35. 14, 1864 excised. A. A. Surg. J. O. Stan- 17 Gould, J. A., Pt.,H, llth Sept. 30, Left ; 3 ins. low. third fibula exc d. ton. Disch d Sept. 20, 1864; New Hamp., age 39. Oct. 9, Surg. G. L. Panooast, U. S. V. anchylosis ankle joint. 1864. Gangrene. Disch d Feb. G, 65. 41 Olinger, G., Pt., D, 100th Aug. G, Left; 4 inches mid. third fibula 18 Green, W. C., Lieut., II, June 1, Left; middle third fibula excised. Ohio, age 22. Sept. J. excised. Gangrene. Disch d 37th New York, age 22. 20, 18G2. Disch d Sept. 13, 18G2: bone 1864. Mav 26, 1865. united; J inch shortening. 42 Peters, M. H., Lieut., F, May 9, Right ; 2J ins. middle third tibia 19 Griswold, D. P., Pt., C. July 1, Right ; portion of mid. third tibia 74th Ohio, age 21. 15, J 864. excised. Surg. C. N. Ellinwood. 76th N. York, age 19. 5, 1863. excised. Disch d Sept. 23, 1864. 74th 111. Disch d July 10, 1865 ; May 11, 186 .), amputation leg. bone discharging. 20 Harvey, G., Pt., D, 63d Mav 3, Right : 2 ins. lower third fibula 43 Pfeifer, J., Pt., F, 108th Mav 14, Left ; 2 inches lower third fibula Pennsylvania, age 24. 12, 1863. excised. Mav 21, haem., 12 oz. Ohio, age 19. 21, 1864. excised. A. Surg. C. C. Bvrne. Disch d Jan. 22, 1864. U. S. A. Disch d Mav 23, 1865 ; 21 Hayward, R., Pt., E, Oct. 29, Right ; upper third excised. anchylosis ankle joint. Knapp s Peun. Bat ry, Nov. 12, Surg. I. Moses, U. S.V. Disch d 44 Pierce, W. K., Serg t, D, May 10, Left: 2 inches upper third tibia age 2-1. 1863. August 13, 64; union; deform 183d Penn., ago 20. June 5, exc d. Surg. E. Bentley, IT. S.V. ity; shortening. 1864. Disch d July 15, 1865; * inch 22 Herrald, S., Pt., II, 2d Sept. 19, Right ; middle third tibia exc d. shortening: exfoliation. Kentucky Cavalry. 29, 1863. Surg. I. Moses, U. S.V. Disch d 45 Ravmoud. J. O.. Serg t. Mav 3, Left; 2 inches lower third tibia Nov. 12, 1864; reproduction of E", 60th N. Y., age 29. 17, 1863. excised. Disch d Mar. 21, 1864. bone. Spec. 2148. Sept., 1877, exfol.; deformity. KEMI STEK (W.), Report of an Exsection of Right Tibia ; Recovery, in American Journal of Medical Sciences, 1866, N. S., Vol. LI, p. 279. 456 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY , n . Tr , DEJCRIPTIOX, AXL> AGE. OPERATIONS, OPERATORS, RESULT. NO NAME, SIJLITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 46 Salsbury, D., Pt.,K,24th De.31, 62, Left -, 2 inches middle third tibia 67 Esworthy, W. N., Corp l, June 21, Left ; 5 ins. up. third tibia exc d. Wisconsin, ago 29. Ja. 15, 63.| excised. Disch d Aug. 12, 18G5; E, 1st JVnn. Cavalry, July 6, A. A. Surg. O. P. Sweet. Died great lameness. age 24. : 1864. July 23, 64 ; pyaein. Spec. 2940. 47 1 Saunders, N., Pt., 18th Oct. 21, Left ; 5 inches lower third fibula 68 Forester, G. W., Pt., A, June 3, Right; 4 ins. lower third fibula 31, 1861. exc d (hxmorrhage). Sent home 188ih Penn., age 45. 15, 1864. excised. A. A. Surg. F. G. H. in two months. Bradford. Died July 6, 1864; 48 Sloan, J., Pt., K, 100th Sept. 19, Left ; 2 ins. low. third tibia exc d. irritative fever. Illinois. 23, 18G3. Disc d Feb. 19, 1865 ; limb much 69 Freeman, G. B., Pt., F, June 3, Right ; lower third fibula oxc d deform.; false joint ; short 3 ins. 58th Mass., age 32. !), 1864. and lig. posterior tibial artery. 49 Smith, J. E., Corp l, E, Aug. 16, Right ; 6 inches fibula excised. Surg. O. A. Judson, U. S. V. 7th Conn., ago 6. Sept. 7, Disch d May 22, 1865 ; club foot, Died June 17, 64; exhaustion. 18G4. anchylosis ankle joint. 70 Gay, E., Corp l, H, 18th April 6, . Ass t Surg. W. D. Turner, 50 Stinson, IV. C., Pt., H, .Tulv 3, Right ; middle third tibia excised. Wisconsin. , 1862. 1st Illinois L. Art y. April, 62, 49th Virginia. 8, 1863. Surg. J. A. Wolf, 29th Penn. amputation thigh. Died April Paroled Sept. 25, 1863. 22, 1862; pyaemia. 51 Swift, F. B., Pt., C, 8th May 12, Left: 2^ inches lower third fibula 71 Gilmore, M., Pt., D, 54th July 18, Left ; 6 ins. tibia and 1 inch lower Michigan, age 25. 28, 1864. excised. A. Surg. S. B. Ward, Massachusetts. 23, 1863. part fibula exc d. Slortification. U. S. V. Gangrene. Disch d July 27, amputat n thigh. Died Oct. 6, 1864; anchy. ank. joint. July 27, 1863. 52 Taunt, H., Pt., B, 2d Oct. 19. Left ; head and 2J inches fibula 72 Golden, J. P., Pt., F, 6th Mav 19, Right ; 4 inches lower third fibula Wisconsin, age 19. 29, 1663. and frag s of tibia exc d. Surg. New York H vy Art y, 29, "1864. exc d. A. A. Surg. O. P. Sweet. O. A. Judson, U. S. V. DiselVd ago 27. Died June 9, 1864; pyaemia. January 17, 1865 ; lameness and 73 Grainger, S. SI., Pt., A, Dec. 31, Left ; fraet. portions of tibia and paralysis foot. 38th Indiana, age 23. 1862, fibula excised. Gang. Slar. 15, 53 Washburn, A. S., Serg t, Nov. 30, Right ; 5 inches lower third fibula Jan. 14, amp. knee joint. April 1, haetn. C, 127th N. Y., age 27. Dec. 7, excised. A. A. Surg. H.Leaman, 1863. Died April 23, 1863. 1864. Disch d May 26, 1865. 74 Grimes, H. M., Pt,, C, May 27, Left; 4& inches lower third tibia 54 Welch, P. H., Lieut., C, Slav 6, Left; 4 ins. fibula, middle, exc d. 116th New York. June , excised. Died Aug. 14, 1863; lllth New York, age 16, 1864. A. A. Surg. J. O. Stanton. Dis 1863. diarrhoea. Fpecs. 1307, 2956. 23. charged Oct. 29, 1864 ; exfol. 75 Jones, A. M., Ft., H, 21st June 2, Left ; 4 ins. mid. th d fibula exc d. 55 Wilcox, M. B., Corp l, May 12, Right ; 3 inches mid. third fibula Mass., age 22. 25, 1864. A. A. Surg. F. G. 11. Bradford. B, 58th Mass., age 19. 29, 1864. exc d. Surg. E. I!entlev,U.S.V. Died June 30. 64 ; exhaustion. Disch d July 20, 1805. 76 Luther, A. E., Pt., E, 3d Mar. 4, Left ; 3 inches fibula, lower third, 56 Williams, F. M., Pt., D, May 15, Right ; 4 inches middle third tibia Slass. Cavalry, age 32. 13, 1864. excised. A. A. Surg. U. W. W. 12th Tenn.. age 24. 30, 1864. exc d. To Pro. Mar. June 11, 65. Carroll. Peroneal art. wounded. 57 Wright, II. C., Capt., G-, May 7, Left ; lower third fibula excised. Slar. 15. hasm.; 19th, amp. leg. 42d New York, age 2(i. 17, 1864. A. A. Surgeon J. M. SfoCalla. Died April 6, 1864 ; pyaemia. Disch d .July 13, 1864; partial 77 McGuire, T., Pt., D, 53d Dec. 13, Left (hiBin.); 3 ins. up. extremity anchylosis ankle pint. Pennsylvania, age 19. 31, 1862. fibula excised ; lig. fern, artery; 58 Younfj, W. H., French s Nov. 30, Left; 1J inch lower third fibula sphacelus. Died Jan. 3, 1863. Division, age 34. Dec. 24, exo d. A. A. Surg. M. L. Herr. 78 Slink. II., Pt., H, 4th N. April 2, Left ; portion upper third tibia and 1864. To Provost Marshal Feb. (i, 65. York Heavy Artillery. 17, 1865. fibula exc d. Surg. B. A. Van- 59 Allen, A., Pt., 11, 5th April 6. : por. oftibiaand fibula exc d. age 20. derkieft, U. S. V. Died Slay 11, Artillery. 10, 1862. A. Sura. W. D. Turner, 1st 111. 1865; exhaustion. Spec. 4101. L. A. Mortiflcat n. April, 1862, 79 Mitchell. S., Pt.,D, ia9th June 3, Left; 2 inches fibula, upper third, amp. thigh. Died May 1 1 , 1862. Pennsylvania, age 23. 27, 1864. exc d (haem.); lig. peroneal art. GO Barney, W., Pt., F, 1st Jan. 2, Right ; 6 inches lower part fibula A. A. Surg. II. W. Slerrill. Died Ohio Artillery. 11, 1863. excised. Died July 14, 1863; Aug. 7, 1864 ; chronic diarrhoea. phthisis pulmonulis. 80 Partridge.G.V., Saddler, April 2, Left; portion of tibia exc d, also til Bloomer, J.,Pt..K. 170th Aug. 25, Right ; mid. third fibula excised. B, 4th Slass. Cavalry, 9, 1864. lig. ant. tibial art. A. A. Surg. New York, age 44. Sept. 12, A.A.Surg.W.H. Ensign. Gang.; age 21. W. A. Green leaf. April 27, hasm. 1864. luem.; lig. femoral. Sept. 18/64, | Died Slay 2, 1864 ; pyasmia. amputation thigh. Died Sept. i 81 Perkins, P. D., Pt., B, June 3, Left ; !i inch fibula exc d, upper 21, 1864; constitutional irritabil- j 12th New Hampshire, 13, 1864. third. "A. Surg. II. Allen. U.S. A. ity. Specs. 3250, 3269. age 32. (I-Isem.) Died Juno 25. 1864 ; G-2 Brown, O., Pt., A, 147th July 1, Right ; portion of tibia excised. pyaemia. New York. 6, 1863. Died July 14, 18f>3. 82 Shoroy, I!, Pt., D, 3d May 10, Right ; 6 ins. tibia excised. A. 63 Bull, J. H., Serg t, H, Mav 15, Left (necrosis); 3?s ins. tibia exc d. Slaine, age 30. June 8, Surg. A. Delanv, U. S. V. June 9-1 tli Ohio, ;ige 21. June 13, A. A. Surg. 1LC. May. Died 1864. 26, gang. Died July 1, 1864. 1864. June23, 6 l ; pyaein. Spec. 3367. 83 Sprague, O., Pt., F, 73d Slay 5, Right; 2 ins. middle third tibia 04 Conrad, H., I t., I, 24th May (i. Left; 1 inch up. third fibiilaexc d. New York, age 45. June 2, excised. Surg. 11. 15. Bontecou, Michigan, age 21. 19, 1864. Surg. O. A. Judson. U. S. V. 1864. ! U. S.V. Died July 6, 1864; ex- Post, tibial art. divided ; gang. haustion. Slay 22, amp. thigh. Died May 84 Tobin, T., Pt., E, Gist June 3, Right : 3 inches lower third tibia 27/1864 ; pyaemia. Spue. 3653. New York, age 23. 8, 1864. exc d. Surg. K. Bentley, U.S.V. 65 Curtis, F.. Pt., 17th Ver June 2, Right; 2.V inches low. third fibula Died June 22, 64 : pyuimia. mont, ago 31. 9, 1864. excised. Surg. O. A. Judson, 85 Travis, S.. Pt., H, 137th Oct. 28, Left; portion middle third tibia U. S. V. Juno 11, 1864, haam. New York, age 22. No.l9, G.3J exo d. Died Nov. 23, G3; pyiem. Died June 17, 1864; exhaustion. 80 Welsh, D. G.,Pt.,F, 28th Dec. 13, Right ; lower third fibula exc d. GO DeWitt.J. E., Pt., A,9th June 21, Right ; por. up. third fibula exc d New Jersey. 26, 62. Died Jan. 5, 1863. N. Y. Cavalry, age 23. 25, 18G4. and peroneal artery lig. A. A. 87 White. S. G!.Pt..A, 14th Aug. 21, Left; 2 inches lower third fibula Surg. O. P. Sweet. Prostration Now York H vy Artil Sept. 1, exc d. A. A. Surg. R. K. Price. and haemorrhage. Died June lery, age 37. 1864. Sloughing. Died Sept. 13, 1864; 25, 1864 ; exhaustion. exhaustion. Twenty-one intermediary excisions, with eight deaths, were in the upper third of the log; thirty-five, with seven deaths, in the middle third; twenty-four, with nine deaths in the lo\ver third; and in seven, with five deaths, the precise locality was not indicated. Secondary Excisions in the Continuity of the Bones of the Leg. In point of mor tality, the secondary excisions in the bones of the leg were attended by better results than the primary and intermediary operations, only eight of the fifty cases of this group having fatal issues. The excision included both bones in five, the tibia alone in thirty-one, and the fibula in fourteen instances. 1 HOLLOWAY (J. SI.), Consecutive and Indeterminate Uxmorrhage from Large Arteries after Gunshot Wounds; with Report of Cases treated by Different Methods ; Appreciation, in American Journal Medical Sciences, 1865, Vol. L, N. S., p. 348. SECT, v.] SECONDARY EXCISIONS IN THE BONES OF THE LEG. 457 Recoveries after Secondary Excisions in the Continuity of the Bones of the Leg. This group includes forty-two operations, five performed on Confederate and thirty-seven on Union soldiers. Three of the latter, it appears, never applied for pensions, and thirty-four became pensioners after their discharge from the service. Four have since died two from remote results of the injuries, one from phthisis, and one from cause not stated. Of the complications during treatment are noted gangrene in five instances and hemorrhage in one. CASE 718. Corporal J. Downey, Co. D, 56th Pennsylvania, aged 23 years, was wounded in the left leg, at Bull Run, August 28, 1802. He was admitted to Eckington Hospital, Washington, several days afterwards, where the injury was noted but no treatment recorded. Surgeon J. Hopkinson, U. S. V., in charge of Mower Hospital, Philadelphia, made the following record of the case: "The wound was caused by a ball, which entered the outer side of the tibia, fractur ing the bone, and emerging on the inner side of the leg at the lower third. The tibia was resected at Eckington Hospital, from where the patient was transferred to this hospital September 23, 1863, the wound being nearly healed. Subsequent entries show that in addition to applications of water dressings to the wound the patient for a time received treatment for a syphilitic affection. He remained in the hospital until January 17, 1865, when he was mustered out and pensioned. Examining Surgeon D. W. Shindle, of Sunbury, Pennsylvania, certified to the fracture and excision, and added: "The wound healed, leaving the leg, however, very crooked, shortened, and necessarily much weakened, and rendering his locomotion unsteady, difficult, and at times painful, also liable to tire in standing as well as walking. General system much impaired." The pensioner died of phthisis puhnonalis, October 20, 1870, his attending physician testifying that the injury remained " a constant source of irritation until a short time previous to his death. Exfoliation of bone was frequent, resulting in nervous prostration, innutrition, and impairment of his general health, a condition favorable to the development of tubercle. He never would undergo an operation for the removal of sequestra," etc. The specimen (FlG. 281), embracing the removed portion of the tibia and showing some periosteal thickening, was forwarded by Surgeon J. R. Smith, U. S. A., having been excised on October 4, 1802. CASE 719. Private J. Lagro, Co. F, 10th Vermont, aged 18 years, was wounded at Cold Harbor, June 3, 1864. Surgeon R. Barr, 67th Pennsylvania, reported his admission to the field hospital of the 3d division, Sixth Corps, with "shot fracture of left leg, caused by a musket ball." Assistant Surgeon W. Webster, U. S. A., described the injury as a " compound fracture of the tibia and fibula at the upper third," and reported: "The patient entered DeCamp Hospital, David s Island, twelve days after he was wounded. On July 30th, the parts being gangrenous, excision was performed by Acting Assistant Surgeon H. Sanders, who removed about four inches of the tibia and three inches of the fibula. Ether was used as the anaesthetic. The patient did well after the operation." On February 10, 1865, he was transferred to Burlington, and subsequently to Sloan Hospital, Montpelier. Surgeon H. Janes, U. S. V., in charge of the latter, contributed a photograph (Card Photographs, A. M. M., Vol. II, p. 1), and reported that the patient was able to walk with crutches, but could not bear" much weight on the limb. Several months afterwards the patient was re-transferred to De Camp Hospital for the purpose of having his wounded leg fitted with an apparatus, which was supplied by Dr. E. D. Hudson, of New York City. He was ultimately discharged October 26, 1865, and pensioned. Examiner O. F. Fassett, of St. Albans, certified, September 10, 1866: "Wound of left leg, with fracture of both bones. It is now an open sore from necrosis. The bones have never united except by ligament, so that a false joint now exists. The bone is much denuded and so much deformity exists that no treatment but amputation can be of any benefit; the leg is worse than useless." In 1877, the same examiner again reported "the wound still an open, suppurating, and dischai ging sore, the bone being extensively diseased. The disease is so near the joint that amputation must be above the knee. His con dition now is worse than with loss of the leg above the knee. The leg is bent into a curve and greatly deformed." Three years later the disease of the bone was reported to be extending almost or quite to the joint, and the pensioner s health as failing in consequence of the suppuration, his appearance being pale, anaemic, emaciated, and weak. He was paid June 4, 1880. CASE 720. Private R. L. Noe, Co. D, 5th Michigan, aged 35 years, was wounded at Fair Oaks, May 31, 1862, and entered De Camp Hospital, David s Island, two weeks afterwards. Acting Assistant Surgeon J. E. Steel reported: "He was wounded by a rifle ball, which passed through the fibula of the left leg about the middle. The patient had received no previous treatment. After the removal of several small pieces of bone and some blue cloth the wound healed ; but subsequently it again suppurated and continued to do so for two months. I then deemed it necessary to exsect (with the approval of Surgeon J. Simons, U. S. A., in charge of the hospital) the entire fibula. The patient having been placed under the influence of chloroform, I made an incision from the head of the bone to within an inch of the external malleolus and found that it was difficult to remove the bone in longer pieces than about three inches, some of them of coui-se being much smaller and adherent to the tendons, which had to be pulled oft with the forceps. On carefully examining the bone I found that about one inch of the external mal leolus could be preserved, Avhich was done, thereby avoiding the opening of the ankle joint. The operation was attended with a great deal of venous haemorrhage ; but there being no artery of any importance severed, it was not found necessary to apply any ligature. No sutures were employed, the lips of the wound being brought together by adhesive plaster and then firmly bandaged. The wound healed two-thirds of its length by first intention. The patient recovered in three weeks and was able to leave the hospital six weeks after the operation." He was discharged from service December 31, 1862, and pensioned Examiner M. L. Green, of Pontiac, Michigan, certified, May 7, 1863: "The fibula has been removed and the leg is now useless, having no support upon the outer side. Can never be of any service to him." Examining Surgeon C. Earl subsequently reported: "There remains a cicatrix extending from knee to ankle, involving the tendons and muscles and causing loss of power of leg. The tibialis anticus muscle is destroyed." In September, 1877, the same examiner stated: "Near the ankle the cicatrix has the appearance of breaking out again soon, as the tissues are getting dark and infiltrated." The pensioner was paid March SURG. Ill 58 458 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 4, 1880. The head of the removed fibula together with part of the necrosed shaft, contributed by the operator, constitute specimen 1003 of the Surgical Section of the Museum. Three of the forty-two survivors of secondary excision in the bones of the leg after wards submitted to amputation in the lower third of the thigh. 1 fatal Cases of Secondary Excisions in the Continuity of the Bones of the Leg. The eight operations of this group were performed on Union soldiers. The fatal issue was ascribed to pyaemia in one, gangrene in one, haemorrhage in one, shock of operation in one, and to exhaustion and typho-malarial fever in two cases each. In one instance the excision was followed by amputation in the leg and subsequent amputation in the thigh. 2 CASE 721. Private E. J. Wyman, Ct>. A, 6th Wisconsin, aged 22 years, was wounded in the right leg, at Hatcher s Run, February 7, 1865. Surgeon D. C. Chamberlain, 94th New York, reported his admission to the field hospital of the 3d division; Fifth Corps, and described the injury as a "fracture of tibia." From the field the wounded man passed to the Point Lookout Hospital, subsequently to Judiciary Square Hospital, Washington, and on June 15th to Harvey Hospital, at Madison. Surgeon H. Culbertson, U. S. V., in charge of the latter, who operated in the case, communicated the following description of the result : "The tibia was fractured in the upper fourth. On July 2d, when the operation was performed, the wound was apparently healing, but had recently been gangrenous. Venous hasmorrhage appeared, and the bone was carious and softened. Some new bone had been thrown out at the seat of the fracture and had also become diseased. This presence of diseased bone and unheal thy discharges induced the haemorrhage and previous gangrene and caused the patient s constitutional condition to be much impaired. The operation consisted of the excision of five inches of the shaft of ihe tibia, beginning opposite the opening of the interosseus membrane, making an incision in the middle line of the bone, and separating the skin, periosteum, and muscles by enucleation. The chaJin saw was then passed beneath the bone below, the shaft sawn through and raised from below upward. At the upper part the bone was divided with the forceps. No vessels were divided or important nerves injured during the oper ation. Chloroform was used as the anaesthetic with good effects. The edges of the wound were approximated, having been packed with lint, and persulphate of iron was used at the seat of the venous haemorrhage, a light bandage being applied over all. The limb was secured in a plaster-of-Paris splint and arranged so as to expose the wound. The treatment consisted of animal broths, alcoholic stimulants, quinine, and iron. The case did well for one week, Avhen the patient had a slight chill, which recurred at regular intervals morning and evening, and was followed by fever and sweating. Antiperiodics were persistently used without any good effect. The patient died of exhaustion, resulting from typho-malarial fever, July 23, 1865. The wound had been lacking in action, but the matter, though sparse, was healthy." TABLE LXV. Summary of Fifty -Secondary Excisions in the Bones of the Leg for Shot Injury. [Recoveries, 1-42; Deaths, 43-50.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. |NO. NAME, MILITARY DESCRIPTION, AND AGE. DATKS. OPERATIONS, OPERATORS, RESULT. 1 Barber, C., Pt, E, 88th July 1, Left ; portion of upper third fibula 9 Collins, M., Pt., G, 1st Aug. 30, Right; head of fibulaexc d. Surg. Penn., age 30. Dec. 19, exc d. Surg.C. N. Chamberlain, Michigan. 1862, D. P. Smith, U. S. V. (Necro.) 1863. U. S.V. Disch d Sept. 17, 1864; Mar. 17, Disch d April 27, 63 ; anchylosis ankle joint anchylosed. 1863. knee joint. Spec. 1193. 2 Bounting, R. A., Corp l, July 1, *- ; por. of up. third tibia exc d. 10 Davis, W., Pt, D, 89th Nov. 25,, Right ; mid. third of tibia exc d. K, 16th Mich., age 26. Sept. 4, A. A. Surgeon A. W. Colbum. Illinois, age 27. 1863, Surgeon L. D. Harlow, U. S. V. 1862. Disch d Nov. 17, 1802; lame. June 10, Feb. 4, 15, 1865, sequestra rem d. 3 Brown, J, Pt., D, 5th June 27, Left; por. of tibia, mid.th d, exc d. 1864. Disch d June 17, 65. Died July U. S. Artillery, age 25. Sept. 6, Disch d Dec. 29, 62. Legshort- 26, 1876; bone diseased. 1862. ened and distorted. Spec. 412. 11 Downey, J., Corp l, D, Aug. 28, Left ; 4 J ins. low. third tibia exc d. 4 Brunett, N., Pt., G, 1st June 17, Left; head and 2 ins. fibula exc d. 56th Penn., age 23. Oct. 4, Disch d Jan. 17, 65; leg crooked. Penn. Rifles, age 22. Nov. 28, A.A. Surg.C. B. King. (Xecro.) 1862. Died Oct. 20, 1876; plith. jiulmo. 1864. To Vet. Res. Corps May 1, 1865. Spec. 555. 5 Bryant, J., Pt., B, 62d June 27, Right ; portion of middle third 12 Fergus, J., Pt., A, 70th May 14, Left; Sins. mid. third fibula exe d. Pennsylvania, age 40. July 29, tibia excised. Disch d Jan. 30, Indiana, age 34. June 24, A. A. Surg. T. H. Hammond. 1862. 1863; necrosis; shortening and 1864. Gang.; post, tibialart. sloughed; deformity. bsem. Aug. 15, 18fi4, amputat n 6 Bullock, J. L., Corp l, C, De.16, 64, Left ; 3J inches middle third tibia thigh. Disch d Jan. 20, 1865. 5th Minnesota, age 36. Jan. 25, excised. A. A. Surg. J. Butter- 13 Fitzgerald, T. J., Pt,, K, Sept. 19, Left ; 2J inches middle third tibia 1865. baugh. Disch d Nov. 23, 1865 ; 6th Louisiana. De. , 64. exc d. Released Aug. 25, 1865. leg scarcely of any use; cartil- 14 Fowler, L., Pt., E, 6th Au.30, G2, Right ; 3 inches lower third tibia, aginious union only. Wisconsin, age 27. Feb. 16, 3 of its thickness excised. Duty 7 Canty, T. F., Pt., D, 63d Aug. 14, Right; Sins. low. th dfibulaexe d. 1863. July 1, 1863. New York, age 24. 1864, Dr. J. E. Pomfret. Disch d May 15 Grav, E. T., Pt., B, 38th Aug. 4, Left : 4 ins. tibia and 8 ins. fibula , 66. 30, 65; bone exfol.; unbealedm Ohio, age 23. Sep.4, 64. excised. Disch d May 12, 1865. 1872 ; requires bandages, 1875. 16 Harris, ,/., Pt., H, 12th Sept, 17, ; fract. por. upper thirds tibia 8 Collins, J., Pt., B, 12th Sept. 17, Left ; por. of up. third tibia exc d. South Carolina, age 30. 1862, and fibula exc d. A. A. Surg. Mass., age 19. Nov. 11, A. A. Surg. A. V. Cherbonnier. Jan. 26, A. North. To Provost Marshal 1862. To Vet. Res. Corps Julv 1, 1863. 1863. May 16, 1863. t. J. Fergus, A, 70th Indiana, left thigh, secondary operation in lower third (TABLE XL, page 320, No. 34); Corp l T. O Dell, Co. H, high, secondary operation in lower third (TABLE XL, page 321, No. 73); Serg t J. Lowth, M, 4th Wisconsin Cavalry, right thigh, 1 Cases of: Pt. 5th Michigan, left thigh, secondary operation in lower third (TABLE XL, p. 320, No. 57). 2 Case of Pt. H. Linn, A, 6th Pennsylvania Reserves, left leg amputated Dec. 4, 1862, in middle third; January 15, 1863, amputation in thigh at middle third; haemorrhage, Feb. 4, 1863, ligation of femoral artery; death March 31, 1863. Specs. 748, 3818, 3983 (TABLE XXXIX, p. 315, No. 137). SECT. V.] EXCISIONS IN THE BONES OF THE LEG OF UNCERTAIN DATE. 459 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AXI> AGE. DATES. OPERATIONS, OPERATORS, RESULT. 17 Holt, T., Pt., G, 15th Sept. 17, Left : head of fibula exc d. Surg. 33 Smith, G., Pt., A, 1st N. March !, Left ; portion of lower third tibia Mass., age 19. 18(52, S. D. Freeman, II. S.V. Disch d York Cavalry, age 34. Sept. , excised. Surgeon A. B. Mott, Feb.2, b3. Feb. 4, 1864. Spec. 1109. 1803. U. S. V. Discharged Aug. 5, 18 Jones. E. P., Pt., K, 22d Sept. 20, Left ; necrosed ends of mid. third 1804; 1806, bone diseased; 1873, Michigan. 1803, tibia exc d. A. A. Surg. D. O. bone healed. Jan. 10, Farrand. Gang. Disch d Oct. 34 Thompson, T. E., Corp l, May 20, Right ; 2 inches tibia, lower third, 1864. 12, 1864. I, 89th New York, age 1864, exc d. Ass t Surg. W. D. Wool- 19 Lagro, J., Pt., F, 10th June 3, Left ; 4 inches tibia and 3 inches 24. July 1, vert on, U. S. A. Disch d Oct. Vermont, age 18. 1804, fibula, up. third, exc d. A. A. 1864. 11, 1865. Died May 3, 1873; July 30, Surg. H. Sanders. (Gangrene.) lungs diseased. 18(34. Disc dOct. 20, 05; much deform.; 35 Vaughn, A. S., Pt., K, July 1, ; 3J inches lower third tibia false joint. 57th Virginia, age 24. Aug. 4, exc d. A. A. Surg. E. Borck.jr. 20 Lennox, W., Pt., F, 82d July 3, Left ; middle third tibia excised. 1803. ( N ecrosis. ) Paroled A ugust 22, New York. Sept. , Surgeon A. B. Mott, U. S.V. 1803. 1863. (Necrosis.) Discharged July 36 Vollmer, M.,Pt.,C, 136th July 4, Left; 1J inch fibula, lower third, 25, 1864. New York, age 29. Au.25, 03. excised. Disch d July 8, 1805. 21 Lord, B. E.,Pi., 11,24th Sept. 14, Left ; 3J inches upper third tibia 37 Waldron, S. H., Pt., B, May 3, Right: 3 inches middle third fibu Georgia, age 23. Nov. 26, excised (caries and necrosis). 17th Maine, age 19. Nov. 3, la. A. A. Surgeon K. Seyfl arth. 1862. Paroled April 27, 1863. 18G3. (Caries ; sloughing.) Disch d 22 Lowth, J., Serg t, M, 4th Aug. 24, Right ; 6 inches upper part fibula July 0, 1865. Wisconsin Cuv., age 26. 1804, excised. Surg. H. Culbertson, 38 White, J. W., Pt., C, June 27, Right ; 3 inches tibia, lower third, May 27, U. S. V. Lig. post, tibial artery 113th Ohio, age 19. J y30, 04. excised. Disch d Feb. 22, 1805 ; 1805. (caries; gang.). June 2, amp. wound open. thigh. Disch d July 17, 1805. 39 Williams, J. M., Serg t, J e24, G3, Right ; 3 inches lower third tibia 23 Luce, J. B., Pt., F, 179th June 17, Right ; 8J ins. tibia exc d. A. A. G, 2d Georgia, age 23. Feb. 15, excised. Assistant Surg. J. E. New York, age 30. Oct. 24, Surg.W. P. Moon. (Sloughing; 1864. Link, 21st 111. Provost Marshal 18C4. bone diseased.) Disch d Dec. April 15, 1864. 31, 1864 ; leg useless. 40 Williamson, J., Pt., G, June 16, Left : 5 inches middle third tibia 24 Mcllheran, J., Pt., C, July 22, Right ; up. third and head of tibia, 57th New York, age 42. Nov. 7, excised. A. A. Surgeon W. P. llGth Illinois, age 24. 18G3, except shell of bone articulating, 1864. Moon. Discharged June 28, 65 ; March 7, excised. Surg. J. G. Keenon, new bone formed. 1864. U.S.V. (Carious.) Disch d Feb. 41 Wilson, G. E., Pt., D, Oct. 19, Right : 3i inches fibula, in middle 24, 1805. 30th Mass., age 23. 1864, third, excised. A. A. Surg.W. P. 25 McQuiggan, J., Pt., E, July 1, Left ; middle third tibia excised. March 2, Moon. (Necrosis.) Lnsch d July 82d Peun., age 20. Sept. 1, A. A. Surgeon G. H. Dare. De 1805. 22. 1865. Spec. 1479. 1862. cember, 1802, another operation. 42 Wilson, J., Pt., E, 15th Aug. 7, Right ; 3 inches tibia excised. Discharged July 3, 1803. Spec. Infantry, age 21. Xov.5, 04. Disch d April 1, 1865. 428. 43 Ackley, j. B., Pt., I, 7th June , Left ; 4 of shaft of fibula excised ; 20 Mears, J. E., Pt., G, 81st July 1, Right : middle third tibia excis d. Infantry. J y 29/02. missile extracted. Died August Pennsylvania, age 20. Aug. 21, Disch d Feb. 27, 1863 ; consider 13, 02 ; typh. fever. 1862. able shortening and deformity. 44 Evans, L., Pt., D, llth July 26, Left ; 3 inches middle third tibia Spec. 398. Michigan, age 19. Oct. 4, excised. Ass t Surg.W.B.Trull, 27 Noe, R. L., Pt., D, 5th May 31, Left ; almost entire fibula excis d. 1864. U. S. V. Died March 12, 1865; Michigan, age 35. Nov A. A. Surg. J. K. Steele. Disc d exhaustion. 1862. Dec. 31, 1862; leg of not much 45 Hockirk, O. D., Pt., A, Sept. 29, Left : small por. upper thirds both service. Spec. 1003. 46th New York, age 25. Dec. 4, bones exn d. A. A. Surg. B. N. 28 Odell, T., Corp l, H, 5th June 18, Left ; up. third tibia exc d. A. A. 1864. McCleery. July, 1805, erysip.; Michigan, age 20. Sept, 7, Surg. J. M. Boisnot. Sloughing. gang.; diarr. Died Aug. 14, 05. 1864. Jan. 13, G5, amp. thigh. Disch d 46 Holmes, H., Pt., H, 50th Nov.9, 64, Right ; por. of tibia exc d. Died May 22, 1865. Colored Troops. J y20, 65. July 24, 05; shock of operation. 29 Ohmit, S. K., Pt., D, 1st June 30, Left ; 6 inches lower third tibia 47 Linn, H., Pt., A, 6th Sept. 17, Left; large por. of tibia and fibula Penn. lies., age 20. 1862. excised. A. A. Surgeon J. H. Penn. Res., age 25. Dec. 3, exc d. A. A. Surg. A. V. Cher- Sept. 23, Boone. Disch d Feb. 23, 1803 ; 1862. bonnier. Dec. 4, amp. leg ; hsem.; 1862. complete anchylosis ankle, and gang.; necro. Jan. 15. 03, amp. partial knee joints. thigh. Feb. 4, lig. fern, artery; 30 Peters, W., Pt., B, 8th June 27, Left ; 3 J inches upper third fibula necro.; haem. Died March 31, Penn. Res., age 20. 18G2, exc d. A. A. Surg. T. Artaud. 1803. Specs. 748, 3818, 3983. Feb.2/63. Discharged November 28, 1865. 48 Pickell, G. F., Pt., K, Aug. 30, Left ; fractured ends upper third Spec. 1110. 13th New York, age 17. Oct.6, G2. tibia excised. Died October 29, 31 Pritchard, R., Pt., K, May5, G4, Left ; 3 inches lower third tibia 1802; pyaemia. ll Jth Peun., age 29. Jan. 15, excised. Discharged June 19, 49 Richardson, H.S. , Lieut., July 12, Left : 4 inches middle third tibia 1865. 1865. Necrosis. Died March 27th Michigan. 1803, exc d. Surg.C.S.Tripler.U.S.A. 2, 1871. Jan.5, 64. (Necrosis. ) Died Jan. 3 1 , 1864 ; 32 Simmons, A. R., Pt., I, Aug. 29, Left ; 3 inches middle third fibula malignant measles. 2d N. llainp., age 20. 1802, excised and sequestrum of tibia 50 Wyman, E. J.,Pt.,A,6th Feb. 7, Right ; 5 inches upper third tibia Sept. 16, removed. Ass t Surg. H. Allen. Wisconsin, age 22. July 2, excised. Surg. H. Culbertson, 1864. U. S. A. (Discharged Nor. 20, 1805. U. S.V. (Bone carious; venous 1862; non-union; necro.); w nd hsem.; gangrene.) Died July 23, re-opened. 1877, bone carious. 1865; typb old malarial fever. Excisions in the Continuity of the Bones of the Leg of Uncertain Date. In thirty- five instances of excision in the bones of the leg, either the time of injury or of operation or of both were not recorded. Twenty-seven of the patients survived the operation, four died, and in four the final issue could not be ascertained. The excision was confined to the tibia in twenty-two, to the fibula in twelve instances, and in one case portions of both tibia and fibula were excised. Of the cases of recovery of this group nineteen were Union and eight Confederate soldiers. Seventeen of the nineteen Union soldiers were subse quently borne on the Pension Roll; one has since died, and another had the limb removed at the knee joint. 1 The four fatal operations were performed on three Confederate and one Union soldier; pyaemia being cited as the cause of death in two instances. Case of Pt. II. A. Steward, Co. B, 8th Pennsylvania Reserves, secondary operation at right knee joint (TABLE LVII, p. 409, No. 9). 460 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TABLE LXVI. Summary of Thirty-jive Cases of Excisions in the Bones of the Leg for Shot Injury of Uncertain Date. [ Recoveries, 107 ; Deaths, 28 31 ; Unknown Results, 35 35.] No. NAME, MILITARY DESCRIPTION", AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Davis, J. L., Pt., F, 27th June 27, Right; lower third tibia excised. 19 Quirk, P., Lieut., 2d June 9, Left; 3 inches lower third tibia New York. , 62. Disch d Sept. 24, 1862 necrosis. Cavalry. 63, excised. Retired Jan. 5, 1865 ; { 2 Freehand, R., Pt., G, 1st Nov. 8, Right ; portion of tibia excised ; uses staff in walking. 3 Cavalry, age 22. Gardner, W. H., Lieut., , (i3. July , necrosis. Duty Feb. IS, 1865. ; por. of tibia excised. Pa 20 Steward, H. A., Pt., B, 8th Pennsylvania Re June 27, , 62. Right ; large portion tibia, upper third, excised. Disch d Nov. 20, K, 3d Alabama. , 63. roled October 24, 1863. serves, age 23. 1862. April 1, 1867, amputa 4 Garrett, J., Pt., H, 12th Aug. 21, Right ; 4 ins. middle third fibula tion at knee joint. Miss., age 24. 64, excised. Retired Mar. 25, 1865. 81 Stineman, M. C.,Pt, M, July 2, Right ; 5J inches mid. third tibia 5 Harrell, J. P., Pt., F, 82d Sept. 19, Right ; portion upper third fibula 62d Penn., age 25. , 63. excised. Disch d Sept. 8, 1864 ; Indiana. 63, excised. To Vet. Res. Corps. leg shortened and bent. Disoh d June 17, 1865. 22 Walker, R., Serg t, I, Sept. 17, Left ; 3 inches lower third tibia 6 Harris, J. D., Serg t, C, May 6, Right ; portion of fibula excised. 104th New York. , 62. excised. Disch d Dec. 20, 1862 ; 14th Alabama, age 3L. 64. Retired Feb. 15, 1865. 1J inch shortening. 7 Hull, F. S., Pt., G, 8th June 14, Right ; por. of middle third fibula 23 Walker, W. T., Pt., G, Sept. 14, Left ; 5 inches upper third fibula Vermont, age 34. 03, excised. Disch d June 22, 64. 12th Massachusetts. , 62. excised. Disch d Dec. 13, 1862. 1865, exfoliation necrosed bone. 24 Warren, 0., Serg t, B, Oct. 27, Right ; portion of tibia, low. third, 8 Imbrie, D., Pt., K, 10th June 27, Right ; 1 inch of fibula excised. 44th N. C., age 24. , 64. excised. Retired Feb. 28, 1865 ; Penn. Res., age 19. , 62. Disch d Nov. 27, 1862. partial anchylosis ankle joint. 9 Johnson, W. B., Lieut., Nov. 25, Left; 2 inches lower third tibia 25 Wheeler, G., Pt., K, 6th May 19, Left ; middle third fibula excised. E, 26th Ohio. 63, excised. Disch d Oct. 19, 1864. N. Y. Artillery, acre 43. , 64. Disch d Jan. 7, 1865. 1866, bone carious and exfol ing. 26 Williams, J. H", Corp l. Oct. 21, Left ; por. low. third tibia exc d. HI Jordan, N., Pt., C, 19th Nov. 30, Left ; 3 ins. mid. third tibin exc d. E, 15th Massachusetts. 01, Disch d Oct. 14, 1862. Died Tennessee, age 19. 64, To Pro. Marshal April (!, 18C5. April 6, 1863. 11 Kubn, H., Ft., H, lllth Sept. 17, Left ; portion of lower third fibula 27 Williams, J. O., Pt., E, July 1, Left ; 3 inches lower third fibula Pennsylvania, age 21. 1862. excised. Disch d Jan. 10, 1863; 143d Penn., age 25. f-63. excised. Disch d May 9, 1864; anchy. ankle joint. shortening; anchy. ankle joint. 12 Lautenshlager, S., Pt., July 1, Left ; por. of low. third tibia exc d. 28 Baldwin, H. J., Pt., E, May3, Left; 4 ins. tibia exc d. (Necrosis.) G, 24th Michigan. 63, Disch d March 28, 1864; false 27th Indiana. , 63. Died June 15, 18C3; pyaemia. joint in tibia ; unable to bear his Spec. 1283. weight on leg. 29 l Dukoy, S. L., Pt., D, Left ; 4 inches middle third tibia 13 Lewis, W. B., Pt., B. 1st July 1, Right ; 4 ins. middle third tibia 15th Texas, age 24. excised ; erysipelas ; gangrene. Texas, age 20. 62, excised. Recovery. I Died of pyaemia. 14 Marshall. M. F., Pt., B, May 5, Right ; por. of middle third tibia 30 Farr, T. A., Serg t, B, Left ; portion of tibia excised. 5th New Jersey. excised. Disch d Sept. 25, 1862. llth South Carolina. Died May 29, 1864. 15 Me.tcalf, ./., Serg t, 1. 54th Mar . 25, Left ; 1 J inch of lower third tibia 31 Gray, J. F., Pt., B, 4th Mar. , Left; 12 inches of fibula excised. North Carolina, age 29. , 65. excised. Released Aug. 25, 65. Georgia. , 65. Died April 28, 1865. 16 Mullins, J., Serg t, D, July 1. Left ; 5 ins. tibia and por. of fibula, 32 Knowles, L. T., Pt., F, Aug. 15, Right ; portion of fibula excised. 12th Massachusetts. , 63. upper third, exc d; gang. Dis 9th Georgia. 64, charged May 6, 64. 1877, bone 33 Parnell, J., Pt., I, 14th Aug. 16, Right; portion of tibia excised. still diseased. South Carolina. 64, 17 Perrin, J. T., Capt., E, May 20, Right: portion of upper third tibia 34 Sullnot, J. B., Pt., C, Oct. 19, Left ; partial excision of tibia. 26th Virginia. , 64. exc d. Furloughed Aug. 29, 64. 44th Georgia. 64, 18 Pettee, L., Lieut., llth July 2, Right; 1J inch lower third tibia 35 Tatley, S., Pt., C, 41st Aug. 19, Left ; 2J inches fibula excised. Infantry. , 63. excised. Duty Nov. 24, 1863. Virginia, age 25. 64, The side injured was not indicated in twelve of the three hundred and eighty-seven cases of excisions in the continuity of the bones of the leg. The right limb was fractured in one hundred and sixty-three one hundred and sixteen recoveries, forty-five deaths, two unknown results, and the left in two hundred and twelve one hundred and fifty-four recoveries, fifty-six deaths, and two unknown results. AMPUTATIONS IN THE CONTINUITY OF THE LEG FOR SHOT FRAC TURES. The precept of Guthrie 2 that "a leg should be seldom amputated for a fracture from a musket ball" seems to have been very generally disregarded by the surgeons of the American civil war. Of eight thousand nine hundred and eighty-eight cases of shot frac tures in the continuity of the bones of the leg, of which 88.4 per cent, were caused by musket balls, 3 amputation was performed in four thousand seven hundred and ten, 4 or 52.4 per cent. Of these four thousand seven hundred and ten cases of amputations for shot 1 AMJKKteO.N, Pyttnda supervening upon Hospital Gangrene, in U. S. Sanitary Cominissicn Memoirs, New York, 1871, Surgical Volume 11, p. 443. 2 GUTHUIE (G. J.), Commentaries on the Surgery of the War, etc., sixth edition, London, 1855, p. 150: "The bones of the leg being more exposed, admit of greater liberties being taken with them, and of larger portions, or even parts, being taken away successfully, than ought to be attempted in the thigh. A leg should therefore be seldom amputated for a fracture from a musket ball." 3 The nature of the missile was reported in 6,336 of the 8,988 cases of shot fractures in the continuity of the bones of the leg without primary injury to the knee or ankle joints: 79 were caused by cannon or solid shot; 654 by shells ; 5,603 by musket, pistol, or other small balls; and in 2,652 instances the missile was not specified. 4 See TAIJLK LI, p. 432, ante. The cases are: 19 excisions in the leg followed by amputations in the leg: 2 excisions in the leg with subsequent amputations in the leg and thigh ; 5 excisions in the leg followed by amputations at the knee joint ; 22 excisions in the leg followed by amputations in the thigh ; 3,728 amputations in the leg ; 3 amputations in the leg and subsequent amputation at the knee joint ; 39 amputations in the leg followed by ampu. tations in the thigh ; 100 amputations at the knee joint; 7 amputations at the knee joint followed by amputations in the thigh; and 785 amputations of thigh ; a total of 4.710 amputations following shot fractures in the bones of the leg. SECT. V.] PKIMARY AMPUTATIONS IN THE LEG. 461 fractures of the bones of the leg, eight hundred and seven performed in the thigh and one hundred and twelve performed at the knee joint have already been considered in the pre ceding two sections of this chapter. Deducting these from the four thousand seven hundred and ten cases of amputations for shot fractures in the bones of the leg, there remain three thousand seven hundred and ninety-one cases of ablation in the leg, to which should be added one thousand six hundred and sixty-one amputations in the leg following shot frac tures of the ankle joint or foot, making a total of five thousand four hundred and fifty-two cases of amputations in the leg to be considered in this section. A numerical statement of the cases is contained in the following table: TABLE LXVII. Numerical Statement of Fifty-Jour Hundred and Fifty -two Amputations in the Leg for Shot Injury. CASES. UPPER THIRD. MIDDLE THIRD. LOWER THIRD. SEAT NOT RE CORDED. ss OPERATIONS. d V a fS "2 1 1 rrt 1 1 f? 1 = >, g 1 ft 1 o a 3 1 1 ^ i o t> -: ^ i ^ 3 ** > j 1C a 1 d t 5 I "3 d a s -= 2 cj -d 5 | "S d o O C o EH ft P rt ft H ft P H H ft D H PS ft P H PS ft P 3, 392 2,307 1,032 51 30.9 1,029 771 04Q q 892 736 150 6 900 676 915 q 571 194 418 94 1,046 682 364 34.7 296 194 10" 368 258 110 335 215 190 47 15 444 327 117 26.3 133 96 17 174 137 17 121 86 15 16 a 8 Time between injury and oper- 570 245 240 85 49.4 51 33 18 47 39 8 51 34 17 421 139 197 85 [ J ll 5,452 3,561 1, 753 138 32.9 1,509 1,094 406 9 1,481 1, 170 305 6 1,407 1,011 387 9 1, 055 286 655 114 In one hundred and thirty-eight of the five thousand four hundred and fifty-two instances of amputations in the leg the final result could not be ascertained; three thousand five hundred and sixty-one had successful, and one thousand seven hundred and fifty-three fatal terminations, a mortality rate of 32.9 per cent. Three thousand three hundred and ninety-two were primary, one thousand and forty-six intermediary, four hundred and forty- four secondary, and five hundred and seventy were operations of unspecified date, the primary amputations, by far the most numerous, comprising 69.4 per cent, of the cases in which the time between the injury and the operation could be ascertained. PRIMARY AMPUTATIONS IN THE CONTINUITY OF THE LEG FOR SHOT INJURY. Of the three thousand three hundred and ninety-two primary operations, one thousand and twenty-nine were in the upper third, eight hundred and ninety-two in the middle third, nine hundred in the lower third, and in five hundred and seventy-one the seat of the operation was not indicated. Primary Amputations in the Upper Third of the Leg for Shot Injury. The results in nine of the one thousand and twenty-nine instances of this group were not ascertained; seven hundred and seventy-one had successful, and two hundred and forty-nine fatal term inations, a mortality of 24.4 per cent. jExamples of Successful Primary Amputations in the Upper Third of the Leg. The seven hundred and seventy-one amputations of this group were performed on seven hun- 462 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. dred and sixty-six patients, live being successful amputations of both legs in the upper third. One of the cases of double amputation will be given in detail: CASE 722. Private S. L. Willson, Co. D, ?2<1 New York, aged 18 years, was wounded at Gettysburg, July 2, 1863. He was admitted to the field hospital of the 2d division, Third Corps, whence Surgeon C. K. Irwin, 72d New York, reported: "Compound comminuted fracture of right and left leg by mini<5 ball, followed by amputation of both legs." Surgeon H. Janes, U. S. V.. forwarded the following history: "The patient entered Camp Letterman August 30th. Both of his legs had been shattered at the lower third, and amputation was performed at the upper third on the day following the injury. The stumps granulated well and the patient s general health was good. Simple dressings, with tonics and stimulants, constituted the treat ment. On October 21st, when the man was transferred to another hospital, the stumps were in tolerable good condition. There had been ulcers in the cicatrices, threatening gangrene, which was controlled with citrine ointment, leaving small abrasions." The patient subsequently passed through hospitals at Baltimore and Alexandria, and lastly he was transferred to Rochester, where he was discharged May 31, 18C5, and pensioned. Since leaving the service he has been furnished at regular intervals with artificial le^s of the " Bly" pattern, which he reports as satisfactory, and the use of which enabled him to accept and hold employment as messenger of the U. S. Senate at the Capitol building for a number of years. In his several applications for these artificial limbs he described the stumps as being in good condition. His pension was paid March 4, 1880. Brief histories of the remaining four instances of successful primary amputation in the upper third of the leg are related in the foot-note. 1 CASE 723. Corporal J. H. Wilkins, Co. E, 1st Louisiana, aged 25 years, was wounded at Port Hudson, June 14, 1863, and conveyed to New Orleans three days afterwards. Assistant Surgeon P. S. Conner, U. S. A., recorded his admission to University Hospital, with "amputation of left leg performed on the battle field," also his departure on furlough October 26th. Several weeks afterwards the patient entered Central Park Hospital, New York City, whence Surgeon B. A. Clements, U. S. A., reported the following history: "The wound was caused by a musket ball, which passed through the middle of the leg antero-posterioriy, comminuting both bones badly and wounding the arteries. There .was much haemorrhage. Amputation through the upper third, by antero-posterior flaps, was performed under chloroform one-half hour after the injury. At first sutures and water dressings were applied. The parts united mostly by first intention and had entirely healed at the end of six weeks. When admitted to this hospital, November 12th, the stump was in good condition and the patient s general health good. On December 20th, he contused the stump by a fall, which was followed by great swelling, heat, and pain. Four days later an abscess, which had formed two inches above the cicatrix on the anterior face of the stump, was opened, when one-half ounce of pus was discharged. By Feb- ruai 7 %25 > 18G4 > the inflammation and swelling had subsided, but there remained considerable rigidity of the knee joint, flexion and extension being imperfect. Three weeks later the swelling of the stump had entirely subsided, and several months afterwards flexion was again restored, though extension was not perfect. When discharged from service, August 9, 1864, the patient had had an artificial limb for about one month, not being able to use it very well owing to the want of perfect extending power, but improving with it constantly." The pensioner was paid March 4, 1880. A cast of the stump (Spec. 4371, A. M. M.), presenting an excellent appearance, with the wound well united, was contributed by Acting Assistant Surgeon G. F. Shrady, and is represented in the wood-cut (FlG. 282). CASE 724. Private Z. Holcomb, Co. B, 36th Ohio, aged 26 years, was wounded at Opequan Creek, September 19, 1864. He was admitted to the field hospital at Winchester, and thence removed, on November 12th, to Frederick Hospital. Assistant Surgeon R. F. Weir, U. S. A., in charge of the latter hospital, made the following report: "On examining the patient it was found that he had undergone an amputation of the right leg at the upper third, which was performed for a shell wound of the same at the middle and lower thirds. The stump is nearly healed. He had also a shot wound of the thigh of the same limb, the ball lodging. The latter wound was supposed to be a simple flesh wound and had entirely healed, the missile having evidently passed downward, for it could not be felt. On December 1st, there was evidence of the formation of an abscess on the posterior portion of the thigh, at the lower part of the upper third, and poultices were ordered to be applied. On December 5th, the fluctuation being well marked over the abscess, a free incision was made and about an ounce of pus evacuated. On introducing the finger the missile was then discovered, which proved to be a cast-iron ball from a Shrapnell shell, and was removed by means of a forceps by Acting Assistant Surgeon W. S. Adams. On further examination of the limb quite an amount of callus was found around the femur at the junction of the upper and middle thirds, and on questioning the patient he stated that his surgeon had informed him that a non-comminuted fracture was produced by the missile; also that a conptntion splint had been applied for the same. On measurement there was found to be a little over one inch shortening. On December be! Ji Jersey, age 35, wounded at Roanokc Island, February 8, 1802, by a cannon ball. Two hours after the injury Surgeons J. H. Thompson, U. S. V., and II. W. Rivers, 4th Rhode Island, removed both legs about two inches below the knee joint. The patient was discharged and pensioned September 30, to Bcaverdale, Alabama. 4. Corp l James Tanner, Co. C, 8?th New York, received a shell wound of both legs, at Dull Run, Virginia, August M, IS(>J. Both limbs were removed on the field, at the upper thirds. The stumps healed perfectly, and the patient was discharged October 15, 18G2, and pensioned. In 1874, he declared that the cicatrices had become adherent to bone and were very tender. He was paid June 4, 1880. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 463 21st, when the patient was transferred, his general condition was good and the wounds were entirely healed." The missile was contributed to the Museum by the operator, and constitutes specimen 1498 of the Surgical Section. The patient subsequently entered Camden Street Hospital, Baltimore, and afterwards Broad and Cherry Streets Hospital, Philadelphia, and on May 20, 1865, he was discharged from Chester Hospital and pensioned. Two months afterwards he was supplied with an artificial limb by the Palmer Arm and Leg Company of Philadelphia. Examiner A. B. Monahan, of Jackson, Ohio, September 6, 1876, certified : " The pensioner has lost his right leg three inches below the knee joint. The stump is tender and he cannot wear an artificial leg. There is also a wound of the right thigh, the ball striking the femur, upper third, and passing down about three inches, where it lodged and was removed. There is caries of the femur and the wound is open, small spicula? of bone being sloughed through the opening. The thigh is painful, lame, etc." The pensioner was paid September 4, 1880. In the following instance the amputation was performed close to the knee joint, through the tuberosity of the tibia, and the fibula was disarticulated a method advocated and frequently performed by the elder Larrey i 1 CASE 725. Private J. Strider, Co. K, 56th North Carolina, aged 34 years, was wounded at Plymouth, April 20, 1864, by a minie" ball, which produced a compound comminuted fracture of the right tibia. Surgeon C. H. Ladd, C. S. A., who ampu tated the leg on the day of the injury, reported: "The operation was performed by the circular skin-flap method close to the knee joint, and the fibula was disarticulated. The stump healed by first intention. I have never before or since performed an amputation so close to the knee joint; think it might often replace disarticulation at the knee joint or amputation above." The patient recovered and was retired from service January 17, 1865. One of the seven hundred and seventy-one survivors after primary amputation in the upper third of the leg subsequently underwent amputation at the knee joint, and nine, amputation in the thigh: CASE 726. Private J. Morrin, Co. G, 126th New York, aged 21 years, was wounded at Gettysburg, July 3, 1863, and admitted to the field hospital of the 3d division, Second Corps. Surgeon I. Scott, 7th West Virginia, recorded: "Compound comminuted fracture of left leg by miiiie" ball, followed by posterior flap amputation by Surgeon J. Aiken, 71st Pennsylvania." The patient remained in hospital at Gettysburg for three months and was then transferred to Philadelphia, whence Surgeon J. Hopkinson, U. S. V., in charge of Mower Hospital, reported the following description and progress of the case: "The tibia and fibula had been shattered to such an extent that amputation below the knee was rendered necessary on the field. When admitted to this hospital, September 9th, the flaps were open and the ends of the bones exposed. Gangrene had set in and the patient was in a low and typhoid condition. A solution of sulphate of copper was applied to the stump, and quinine with tincture of chloride of iron was prescribed internally; milk punch and beef tea at pleasure. The patient improved under the treatment until November 3d, when haemorrhage from the anterior tibial took place at 11^ p. M. Amputation of the lower third of the thigh (see TABLE XL, No. 69, p. 321, ante) by antero-posterior flaps was then resorted to by Assistant Surgeon T. C. Brainerd, U. S. A. Sixteen ounces of blood were lost. Injections of brandy and carbonate of ammonia were given to induce reaction, which took place six hours after the operation. After reaction had fully set in the patient continued to improve until recovered. The ligatures were removed on November 19th. By January 9, 1864, the cicatrix had entirely healed, leaving a most excellent stump." The subsequent record of the case was furnished by Surgeon B. A. Clements, U. S. A., who re-ported that "the patient was admitted, March 30, 1864, to Central Park Hospital, New York City, where several months later two sinuses were discovered in the cicatrix of the stump, leading to necrosed bone. On November 23d, the patient was put under the influence of chloroform and a trans verse incision, three inches long, was made across the lower edge of the flap, when it was found that a ring of boue had exfoliated from the end of the femur, but was still bound down by an overlapping growth of Fir - 283^ Bones of , ,. . . . stump of leTt leg- three new bone trom the endosteum. llns, with a portion of the new growth, was removed by Acting Assistant months after amputa- Surgeon S. Teats, assisted by Acting Assistant Surgeon J. K. Merritt." The patient remained under treat- tion- Spec - 2(i04- ment until June 17, 1865, when he was discharged from service and pensioned. Examining Surgeon R. C. Dunham, of Seneca Falls, N. Y., August 6, 1873, certified to amputation of the thigh and added : "There is no amount of flesh over the end of the bone; it is covered by the skin only, and it appears to be very tender to the touch. He cannot wear an artificial limb very long at any time to be of any use to him by way of walking or standing," etc. The pensioner was paid June 4, 1880. The stumps of the tibia and fibula, removed at the second amputation, and the nearly circular sequestrum, together with four small frag ments removed at the last operation, were contributed to the Museum by the operators. They constitute specimens 2604 and 1416, respectively, of the Suryical Section. A representation of the former appears in the wood-cut (FiG. 283). Six hundred and twenty-seven of the patients who recovered after primary amputa tion in the upper third of the leg were Union soldiers. Of these, three officers were retired from the service, and six hundred and twenty-one enlisted men became pensioners. The 464 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. names of three of the patients cannot be found on the Pension Rolls. Fifty-one of the pensioners have died since the date of their discharge. CASE 727. Private J. Walsh, Co. A, 57th Massachusetts, aged 39 years, was wounded at Fort Steadman, March 25, 1865, by a musket ball, which fractured the left leg in the upper third, perforating the tibia transversely and completely destroying the upper part of the fibula. Surgeon M. K. Hogan, U. S. V., reported the wounded man s admission to the field hospital of the 1st division, Ninth Corps, where the leg was amputated below the knee by Surgeon W. C. Shurlock, 51st Pennsylvania. Assistant Surgeon S. Adams, U. S. A., who contributed the amputated bones (Spec. 4081), represented in the annexed wood-cut (FlG. 284), reported that the patient nearly died during the operation from the effects of chloroform, having become pulseless and his respiration having ceased. One week after the reception of the injury the patient was sent to City Point, and afterwards ho passed through various hospitals, being ultimately discharged from service September 12, 1865, and pensioned. In the statement subsequently furnished by B. F. Palmer, of Philadelphia, for an artificial leg, the amputation was described as having been performed by the "flap method." In his application for commutation, dated 1870, the pensioner described the condition of the stump as "sound and free from pain," and its length as "one inch and three-fourths from the patella." The pensioner was paid March 4, 1875. He is reported as having died since that date. Examples of fatal Primary Amputations in the Upper Third of the Leg. Two hundred and forty-nine cases of amputation in the upper third of the leg were performed on two hundred and forty-eight patients, in one instance both legs having been primarily amputated in the upper third: CASE 728. Private J. H. Metz, Co. G, 9th Regiment Veteran Reserve Corps, aged 33 years, was wounded in the left leg, near Fort Stevens, Defences of Washington, July 11, 1864. Surgeon O. A. Judson, U. S. V., made the following report of the injury: "A conoidal ball entered the limb anteriorly, passed through transversely, and produced a compound comminuted fracture at the upper third of the tibia, the man by his weight soon after fracturing the fibula. He was conveyed to Carver Hospital, Washington, where the leg was amputated at the upper third, by the lateral flap method, by Medical Inspector J. Wilson, U. S. A., on the day of the injury. The patient was anaemic and very nervous at the time of the operation. Cold-water dressings were applied. On the following day the clot had formed beneath the flaps, rendering it necessary to cut the suture and reopen the wound. The clot was then turned out and the flaps, after remaining open for some time, were closed up again. On July 13th, the flaps looked dark and were opened again, when a strong solution of sulphate of copper was applied. Sloughing commenced the next day, causing the tibia to protrude. Citrate of iron and quinine, with stimulants, were administered freely and the external applications repeated. By July 17th granulations were starting up over a portion of the surface of the flaps. Secondary hfemorrhage occurred on the following day. The patient appeared greatly exhausted, had very poor appetite, and was troubled with diarrhoea. Dry dressings were now applied to the stump. On July 23d an abscess was found to have formed above the knee, after which sloughing extended upwards. The patient continued to sink, his diarrhoea resisting all treatment; pulse rapid; skin of an icteric tinge. Death occurred from exhaustion, July 28, 1864. At the autopsy pus was found to have burrowed up the outer and posterior portion of the leg, extending to the dorsum of the ilium. The pus was of a dark color and contained a large quantity of free fat. The right lung adhered to the wall of the chest anteriorly, otherwise healthy. Both lobes of the left lung were slightly congested ; heart normal ; liver somewhat congested and gall-bkidder distended with bile; spleen covered on lower portion with patches of lymph; stomach distended with dark fluid. The mucous membrane of the small intestine was thickened and covered with pseudo-membrane, easily removable." The ainputateS bones of the leg (Spec. 3166), represented in the wood-cut (FlG. 285), were contributed to the Museum by Acting Assistant Surgeon A. W. Merrill. CASE 729. Private G. Kronmiller, Co. C, 14th New York Heavy Artillery, aged 38 years, was wounded before Peters burg, July 9, 1864, and admitted to the field hospital of the 1st division, Ninth Corps. Surgeon M. K. Hogan, U. S. V., reported: "Fracture of left tibia by min56 ball; leg amputated at junction of upper and middle thirds by Surgeon T. F. Oakes, 56th Massachusetts." The wounded man was sent to the Depot Hospital at City Point the day following the injury, and two weeks later he was transferred to Philadelphia. Acting Assistant Surgeon R. J. Levis recorded the following result of the case : "The patient was admitted to South Street Hospital on July 26th. He stated that he reacted tolerably well after the amputation was performed, but felt weak from diarrhoea and previous loss of blood. At the time of his admission the tibia was exposed nearly two inches anteriorly, caused by the sloughing of the flaps. The granulations were healthy, but his condition was weak. On August 3d, his general condition was much improved and the granulations were apparently extending themselves over a portion of the bone, which, however, was black in color. Some days afterwards the patient was attacked with diarrhoea, and on August 16th the parts showed some disposition to slough, when diluted creasote and afterwards Labarraque s solution was applied. By August 20th the diarrhoea had changed into dysentery; general condition weak; pulse 100 to 110 arid feeble; some enlarge ment of liver, and icteroid complexion. On August 30th the sloughing had ceased and the diarrhoea was relieved; but the patient had cough, dulness and crepitation being heard over the inferior portion of the right lung. This condition continued nearly the same for some days, expectoration being more free and the diarrhoea again increasing for a time. By September 20th the stump was gradually healing, excepting where the bone protruded. October 3d, liver less large; subcrepitant rales in lower portion of right lung posteriorly up to the middle of the base of the scapula; rales heard in left lung posteriorly also, but no change in resonance. In this manner the patient remained, with occasional improvements, until October 7th, when the diarrhoea - 1 . ,. FlO. 285. Fracture of left tibia and fibula in upper third. Spec. 3166. SECT, v.] PRIMARY AMPUTATIONS IN THE LEG. 465 increased much and he began to sink gradually. Death occurred on October 8, 1864. The autopsy showed the lower lobe of the i-ight lung partly solidified and studded with unsoftened tubercles. The rest of the posterior right lung was congested and filled with frothy exudation ; left lung congested and likewise filled with frothy liquid. In the anterior lower lobe a small abscess was found containing about a drachm of pus; the anterior portions of both lungs were mostly respirable. The liver was somewhat enlarged and undergoing fatty degeneration ; spleen congested and enlarged. The lower part of the colon showed evidence of chronic inflammation, the mucous membrane being dark, thickened, and degenerated. This condition diminished higher up, but in no part was the colon healthy. Part of the iliurn was inflamed; mucous coat of stomach much thickened but not inflamed." The upper part of the amputated tibia, exhibiting the seat of the fracture, was contributed to the Museum by Surgeon H. Ludington, 100th Pennsylvania, and constitutes specimen 6529 of the Surgical Section. In one of the two hundred and forty-nine fatal cases of primary amputation in the upper third of the leg the operation was followed by exarticulation at the knee joint, and in nine by amputation in the thigh: 1 CASE 730. Private B. G. Waters, Co. H, 19th Maine, aged 19 years, was wounded at Petersburg, October 15, 1864. Surgeon I. Scott, 7th West Virginia, reported that "he entered the field hospital of the 2d division, Second Corps, with shot fracture of leg, caused by a minie ball, for which Surgeon W. ,T. Burr, 42d New York, performed amputation." Surgeon E. Bent- ley, U. S. V., reported the following result of the case: "The patient was admitted to Baptist Church Hospital at Alexandria six days after being wounded. His left leg had been amputated at the upper third by anterior and posterior flaps on the day of the injury. When admitted his general health was fair, although he complained of considerable pain and required opiates to procure sleep. The integument over the spine of the. tibia was black and had commenced to slough. This continued until the ends of both bones were exposed and the stump around presented a large mass of sloughing tissue. Stimulating lotions were applied and some improvement followed; all sloughing ceased and granulations commenced; but the granulations were pale and flabby, the edges of the integument everted, and the patient suffered excessive pain. On November 18th, sloughing reappeared and extended rapidly towards the popliteal region. He was also troubled some with diarrhoea, having about four passages daily. He was daily growing weaker from suffering and loss of appetite, and the stump became so painful that lie would cry out frequently, complaining of spasmodic twitching. Taking these circumstances arid the danger of secondary haemorrhage into consideration, the limb was reamputated in the lower third of the femur (see TABLE XL, No. 200, p. 323, ante) on November 24th, by Assistant Surgeon W. A. Harvey, U. S. V., who used sulphuric ether as the anesthetic and performed the operation by the circular method. Three days after the operation the patient s appetite had improved and he could sleep well, was more cheerful, and complained of but little pain. No union had yet taken place in the stump, but suppuration had com menced. On December 7th, when transferred to Prince Street Hospital, he was still doing well. . The subsequent records show the patient died of exhaustion April 25, 1865. The stumps of the tibia and fibula, removed at the second amputation, together with portion of the popliteal vein, external and internal popliteal nerves, were contributed to the Museum by Surgeon E. Bentley, and constitute specimens 3445, 3446, 3447, and 3448, respectively, of the Surgical Section. In the next cftse haemorrhages from the stump occurred twenty-four days after the operation. The patient died from exhaustion four days later: CASE 731. Private G. Hoascb, Co. E, 110th Ohio, aged 45 years, was Avounded in the left leg, at Monocacy, July 9, 1864, and admitted to hospital at Frederick the following day. Assistant Surgeon E. F. Weir, U. S. A., reported: "The injury was produced by a mini6 ball, which fractured both bones at the lower third. The leg was removed on July llth. at the upper third, by the circular method, by Acting Assistant Surgeon W. S. Adams. At the time of the operation the patient s condition was very poor from diarrhoea and the fatigue of marching; the leg swollen, sloughing, and threatened by gangrene. On July 20th there was slight sloughing of the flaps, and yeast poultices were applied. On the following day the slough was carefully trimmed away with scissors, and permanganate of potassa was applied in full strength by means of a mop, after which the end of the stump was covered with oakum wet with a dilution of the permanganate of potassa, and the whole enwrapped with oiled silk. On July 25th the slough came away nicely and a good granulating surface was found beneath it; general condition of patient slightly improved. Haemorrhage occurred at 1 A. M. on August 4th, and another at 5 A. M., when thirty-two ounces of blood were lost. Bleeding was controlled by the application of a tourniquet before the attending medical officer arrived, and no attempt to ligate was made. At 9 A. M. the patient was found with his extremities cold and pulseless, and when the tourniquet was removed the bleeding had ceased. Stimulants were then ordered to be given freely and a hot-air bath, a nurse being placed by the side of the bed to watch the stump. At 11 A. M., a slight oozing was observed from the posterior tibial, which was drawn out and ligated. On the morning of August 6th the ligature came away during the dressing of the stump ; the patient had not yet rallied from the attack of hemorrhage; treatment continued. The patient died of exhaustion on August 8, 1864. An examination of the stump showed total absence of the clot in the cut extremities." The amputated bones of the leg, exhib iting a bad comminution throughout the lower third of the tibia and a transverse fracture in the fibula, were contributed to the Museum by the operator, and constitute specimen 3829 of the Surgical Section. 1 The limb was subsequently amputated at the knee joint in the case of Pt. C. Rhinehart, K, 74th Pennsylvania (TABLE LVI, CASE 42, p. 407); intermediary operation. Amputation in the thigffwas performed in the following 9 cases : Pt. G. Tompkins, G, 1st N. V. Battery, intermediary operation in upper third of thigh (TABLE XXXIV, Xo. 137, page 277); Pt. W. L. Hindman, K, 355th Pennsylvania, secondary operation in middle third of thigh (TAlil.K XXXIX, No. 12"), page 315); Pt. L. Winters, K, 50th Georgia, secondary operation in middle third of thigh (TABLE XXXIX, Xo. lu ti, page 31 (J); Corp 1 II. G. Brown, B, 37th Wisconsin, secondary operation in middle third of thigh (TAIU.K XXXIX. Xo. 108, page 315); Pt. O. 51. Corey, H, 114th Xew York, intermediary operation, lower third of thigh (TA1SLE XXXVI, Xo. 286, page 297); Pt. E. De Hoff, H, 38th Ohio, secondary operation, lower third of thigh (TABLE XL, Xo. 127, page 321); Pt. H. E. Eldred, E, 2d U. S. S. S., intermediary operation, lower third of thigh (TABLE XXXVI. Xo. 327, page 298); Pt. J. Morse, B, 2d Pennsylvania Heavy Artillery, intermediary operation, lower third of thigh (TABLE XXXVI, Xo. 502, page 300); Pt. B. G. Waters, H, 19th Maine, secondary operation, lower third of thigh. Specs. 3445, 344(i, 3447, 3448 (TABLE XL, Xo. 200, page 323). SURG. Ill 59 466 INJURIES OF THE LOWER EXTREMITIES. ICHAP. X. TABLE LXVIII. Summary of One Thousand and Twenty-nine Cases of Primary Amputations in the Upper Third of the Leg for Shot Injuries. f Recoveries, 1771; Deaths, 772 1020 ; Result unknown, 10211029.] NO. NAME, MILITARY DESCRIPTION , AND AC.K. DATES. OPERATIONS, OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. 1 Abrams, A.J., Serg t, K, June 22, Right; ant. post. flap. Surg. S. 41 Bouch, W. B., Pt., B, Sept. 21, Left; ant. post. flap. Surg. E. R. 9th N. Y. Heavy Artil 22, 64. A. Sahin, 9th N. Y. H vy Art y. 139th Penn., age 24. 22, 64. Umberger, 93d Penn. Disch d lery, age 33. Disch d Feb. 25, 1865. July 11, 1.865. 2 Adams, J. H., Pt., F, 3d July 2, Left. Surg. Rouch, C. S. A. 42 Bovee, J. N., Pt., E, 18th June 27, Right. Confcd. surgeon. Dis Arkansas, age 21. 2, 63. Paroled Nov. 12, 1863. New York, age 19. i. 9, 62. charged Sept. 15, 1862. 3 Adams, W., Pt., D, 7th May 16, Right. Furloughed July 28, 64. 43 Boyle, J., Pt, G, 34th Oct. 13, Right. Disch d March 18, 1865. South Carolina, age 38. 16, 64. Mass., age 20. 14, 64. 4 Alkin, A. S., Serg t, K, July 20, Left : flap. Disch d Mar. 13, 65. 44 Bradley, H., Corp l, Ord Aug. 9, Left; circ. Sunr.W. O Meagher, 18th Indiana, age 27. 20, 64. nance Depart., U.S.A., !), f 64. 69th N. Y. Disch dMay 31, 65. 5 Allen. J. W., Pt., King Sept. 14, . Surg. Robertson. Re age 34. (Also wound of left foot.) William Artillery. 14, 63. covery. 45 Bradley, L. F., Corp l, I, Sept. 29, Left ; flap. Disch d Oct. 8, 1 865. 6 Allen, L. F., Pt., 1, 35th Dec. 13, Left. Discharged June 6, 1863. 8th Conn., ago 22. 29, 64. New York. 13, 62. 46 Bradley, P., Pt., E, 104th June 16, Left: ant. post, flap. Discharged 7 Andrews,A.,Pt.,G, 27tb July 3, Right. Discharged Jan. 11, 1864. New York, age 38. 16, 64. July 31, 1865. Spec. 257. Died Ohio, age 39. 3, 63. July 30, 1870. 8 Andrews, J. N., Serg t, July 1, Left: circular. Exchanged Sept. 47 Brady, J., Capt., G, 26th Sept. 19, Left. Surg. J. G. Bradt, 26th F, 5th Ala., age 29. 1, 63. 25, 1863. Massachusetts, age 33. 20, 64. Mass. Disch d Dec. 31, 1864. 9 Andrews, O. J ., Lieut., April 6, Right. Discharged August 21, 48 Branch, E. B., Pt., D, May 3, Left ; circ. Surg. G. T. Stevens, C, 15th Illinois. 8, 62. 1862. 77th N. York, age 20. 3, "63. 77th N. Y. May 17. (i4, re-amp. 10 Audrus, C. E., Pt., K, June 3, Left; circ. Surg. M. Rizer, 72d leg. Disch d Sept. 20, 1864. 106th Penn., age 20. 3, 64. Penn. Discb d Dec. 28, 1864. 49 Brandenberg, A., Serg t. April 2, Right ; circ. Surg. E. K. Fore- 11 Aney, T. L., Pt., K, 56th July 1, Right; circular. Disch d Jan. H, 6th Maryland. 2, 65. roan, 6th Maryland. Disch d Penn., age 18. 3, 63. 17, 1865. July 13, 1865. " 12 Arnell, J., Pt., B, 14th April 30, Right; flap. Discharged Nov. 50 Brannan, J., Pt., C, 44th July 2, Right; flap. July 12, hiein.; post. Iowa, age 19. 30, 64. 15, 1864. New York, age 26. 4, 63. tibial lig.; 15th, haem.; femoral 13 Avers, J. M., Pt., F, 76th Julv 11, Left; circ. Mustered out Nov. ligated. Recovery. Pennsylvania. 13, 63. , 1864. 51 1 Brannan, M., Corp l, B, June 3, liight; don. skin Hap. A. Surg. 14 Bagwell, N. B., Serg t, Sept. 17, Left. Union surgeon. Retired 9th Mass., age 30. 4, 64. J. Ryan, 9th Mass. Disch d B, 38th Georgia. 19. 62. Dec. 30, 1864. A ugust 20, 1864. 15 Barrett. F. J., Corp l, D, 59th New York. May 3, 4, 63. Right; flap. A. Surg.W. J. Burr, 59th N. Y. Disch d April 18, 64. 52 Breen, J., Pt., B, 15th Connecticut. Dec. 13, 13, 62. Right. Discharged June 18, 63. 16 Barron, W., Serg t, B, 2d April 9, Right; post. flap. Disch d Oct. 53 Breeze, S., Pt., C, 76th Aug. 16, Left; flap. Disch d Nov. 29, 64. Corps d Afrique,age24. 9, 63. 5, 1863. Spec. 1420. Penu., age 45. 16, 64. Died of prostration August 11, 17 Bartholomew,*;., Corp l, Sept. 19, Left ; flap. Disch d June 1, 1865. 1869. D, 67th Penn., age 23. 19, 64. Died Nov. 14, 1867. 54 Brest, J. P., Pt., E, 100th June 2, Left; ant. post. flap. Surg. H. 18 Bartlett, J., Pt., (i, 5th Oct. 19, Right ; lateral flap. Confederate Penn., age 24. 3, u 4. Ludington, 100th Penn. Dis N. Y. H vy Artillery, 19, 64. surgeon. Disch d July 4, 1865. charged May 6, 1865. age 20. Spec. 3092. 55 Bridge. J., Pt., K, 57th May 3, Right; circ. Surg. C. S. Wood. 19 Basine, C., Pt., H, 8th Sept. 17, Right. Discharged Dec. 6, 1862; New York, age 20. 3, 63. 66th N. Y. Gangrene. Disch d Penn. Res., age 20. 17, 62. gang. Dec., 1862, amp. thigh. Sept. 24, 1863. 1870, stump sound. 56 Bridges, J. W., Pt., K, Aug. 19, Left ; lat. flap. To prison March 20 Battelle, C. P., Serg t. A. Mar. 25, Left ; ant. post. flap. Discharged 6th Georgia, age 24. 20, 64. 28. 1865. 59th Mass., age 20. 25, 65. July 13, 1865. 57 Briggs, H. E., Pt., G, 3d Sept, 17, Right. Discharged Dec. 27, 62. 21 Baughman, J., Pt., M, Aug. 15, Right ; flap. Surg. G. W. Bowen \\isconsin. 17, 62. 5th Col d Cavalry, age 15, 64. and A. Surg. J. Swan, 5th Col d 58 Brith,J. //..Surgeon, 1st June 9, . Surg. B. D. Lay, C. S. A. 20. Cavalry. Disch d Feb. 15, 1865. Missouri. 9, 63. Recovered. 22 Beach. J. (alias Smith), Mar. 25, Left ; circular. Surg. M. C. Row 59 Britten, W. B., Serg t, June 17, Left ; flap. Surg.W. B. Fox, 8th Pt., D, 28th Mass., age 25, 65. land, 61st N. Y. Disch d July F, 60th Ohio, nge 23. 17, 64. Mich. Disch d Jan. 10, 1865. 20. 15, 1865. 60 Britton, J., Serg t, H, Sept, 30, Left; double flap. Disch d Aug. 23 Bean. W. II., Pt., K, 8th June 17, Left; circular. Furloughed Sept. 18th Massachusetts. 30, 64. 21, 1865. North Carolina, age 26. 17, 64. 16, 1864. 61 Brockham, A., Pt., E, Sept. 29, Left ; post. flap. Disch d June 24 Beardsley, W. W., Pt., Aug. 29, R t;flap. A.Surg.A.W.Munson, 58th Penn., age 47. 29, 64. 27, 1865. IT, 82d Ohio. 30, 62. 82d Ohio. Disch d Nov. 3, 1862. 62 Broderick, J., Pt., D, May 3, Right; circ. Surg. C. N. Cham 25 Beaumont, S., Capt., E, Dec. 17, Left ; circ. Surg. J. A. Wolf, 29th 36th New York. 3, 63. berlain, U. S. V. Disch d Aug. 29th Penn., age 26. 17, 64. Penn. Must, out July 11, 1865. 7. 1863. 26 Beeson, W. H., Pt., G, June 1, Right; flap. Disch d Julv 20, 63 Brondstettcr, W., Pt., G, Dec. 16, Left; double flap. Surg. G. A. 82d Penn., age 22. 2, 64. 1865. Died Jan. 3, 1870. " 9th N. Jersey, age 21. 16, 62. Otis, 27th Mass. Disch d Jan. 27 Bersehig, A., Pt., A, 23d Sept. 22, Left ; ant. post. flap. Discharged 21, 1864. Ohio, age 20. 22, 64. Jan. 5, 1865. 64 Brown, H., Pt., K, 22d July 30, Right. March 19. 1865, amp. left 28 Bierce, P., Pt., A, 1st Nov. 13, Left; flap. Dec. 25, amp. arm. Col d Troops, age 19. 30, 64. thigh. Disch d Mar. 20, 1865. Ohio Artillery, age 20. 13, 63. Disch d August 29, 1864. 65 Brown, M., Pt.. E, 99th Aug. 6, Left. Surg. A. M.Wilder.U.S.V. 29 Biyby, W. A., Pt., K, 1st June 27, Right. Surg. Evans, C. S. A. Ohio, age 20. 7, 64. Nov. 14, re-amp. Mustered out South Carolina. 27, 62. Disch d August 6, 1864. May 30, 1865. 30 Bingenheimer, C., Corp l, Mar. 30, Left ; flap. Surg. J. W. Green,95th 66 Bruback, D., Pt., 15, 1st June 30, Right. (Jonl cd. surgeon. Dis A, 33d Vvis.. age 30. 30, 65. 111. Disch d June 20, 1865. Penn. L. Art y, age 21. Jyl, 62. charged Dec. 3, 186;. . 31 Bird, S. A., Pt., G, 12th Julv 1, Right. Exchanged Nov. 12, 63. 67 Bryan, I>. M., Pt,.B, 84th Oct. 27, Left; flap. Disch d Sept. 2, 65. South Carolina, age 26. 2, 63. Penn., age 19. 28, 64. 32 Black, L. C., Lieut., F, Sept. 19, Left. Surg. J. M. Lawson, 30th 68 Buckner, 1!., Pt., G, Kith Aug. 13, Right; ant. post. flap. Disch d 12th Georgia, age 21 . 19, 64. N. C. To prison Dec. 9. 1864. New York H vy Art y, 13, 64. Nov. 17, 1864. Died March 3, 33 Blake, C. A., Pt., C, 14th Oct. 19, Right ; ant. post. flap. Disch d age 43. 1865; inflammation of stump. New Jersey, age 24. 19, 64. July 7, 1865. 69 Bullctt. J., Pt., C, 13th Doc. 16, Right; flap. A. A. Surg. J. S. 34 Blomley. A., Corp l, A, June 18, Right ; circ. Surg. J. Kerr, 62d Col d Troops, age 24. 16, 64. (liltner, U. S. A. Disch d July 91st Penn., age 27. 20. 64. Penn. Disch d Sept. 27, 1864. 15, 1865. 3.") Bobo, J. E., Pt., E, Hoi- Mar. 2!), Right; circ. Released June 14, 70 Bumm, J., Pt., F, 29th June 15, Right; flap. Surg. J. A. Wolf, comb s Legion, age 18. 29, 65. 1865. Pennsylvania, age 20. 15, 64. 29th Perm. Disch d Aug. 4, 65. 36 Bodwell, J., Serg t, G, Dec. 15, Right; ant. post. flap. Surg. D. 71 Burk, J.. Pt., F, 38th Feb. 6, liight : circular. To prison June 71st Ohio, age 22. 15, 64. C. Patterson, 124th Ohio. Dis Georgia, age 23. 7, 65. 8, 1865. charged May 12, 1865. 72 Burnett. J., Pt., D, 107th May 3, liight ; circ. Disch d Sept. 18/63. 37 Boliannan, J. IF., Corp l, Aug. 14, Left ; double flap. Released June New York, age iitf. 5, 63. G, 8th Georgia, age 24. 14, 64. 28, 1865. 73 Bun-ell, J., Pt., K, 9th Feb. 8, Left. Surg. L. Braanti, 9th New 38 Boon, W. J., Pt., A, 5th May 3, . Furloughed July 23, 1863. New .Terse}-. 8, 62. Jersey. Disch d Aug. 18, 1802. North Carolina, age 27. , 63. 74 Byers, A. F., Pt., H, 1st Jan. 6, Right; circular. Disch d May 39 Bornman, J. M., Corp l, Sept. 22, Right (also w d left leg and hand) ; Tennessee. 6, 65. 26, 1865. I, 61st Penn., age 28. 22, 64. flap. Surg. G. R. Lewis, 61st 75 Byrne, J., Pt., F, llth July 3, Left. Surg. - White, C. S. A. Penu. Disch d July 21, 1865. North Carolina. 5, "63. Recovered. 40 B-ntntr, JV. J., Pt., I, 33d July 10, Left ; circular. Provost Marshal 76 Cadon, Z. P., Pt.,E,llth July 2, Left. Union surgeon. Exch d Mississippi, age 22. 11, 64. March 7, 1865. Virginia, age 26. 3, 63. Nov. 12, 1863. "LlUELL (J. A.), Primary Amputation of Right Le.g, for Injury inflicted ly a Cannon Ball ,- Pytemia developed thirty-one days afterwards with well-marked symptoms, in V. S. Sanitary Commission Memoirs, Surgical Volume I. New York, 1870, page 53.1. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 467 NO NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPEHATORS, RESULT. 77 Cage, J., Serg t, E, 7th April 2, Left; circular. Released May 123 Conover, J., Pt., C, 82d May 3, Left ; flap. Surg. L. M. Emanuel, Tennessee, age 24. 2, 65. 30, 1865. Pennsylvania. 3, 63. 82d Penn. Disch d Sept. 5, 63. 78 Cahill, T. J., Lieut, D, July 3, R t. Surg. R. Gibbon, 28th N. C. 124 Conk, A. W., Pt., F, 55th Mav 2, Right. A. Surg. W. J. Green, 7th N. C., age 26. 4, 63. Retired March 1, 1865. North Carolina. 2, 63. 44th N. C. Recovery. 79 Calkins, E. D., Pt, A, Sept. 17, Left. Disch d January 5, 1863. 125 Cook, W. W., Pt, G, 2d Mav 3, Left; flap. Surg. W. J. Sawin, 6th Wisconsin. 17, 62. Vermont. 3, 63. 2d Vt. Disch d April 12, 1864. 80 Callaghan, D., Pt., C, 1st Oct. 5, Left : flap. Discharged May 30, 126 Coons, H., Pt.. I, 103d Nov. 25, Left. Discharged June 8, 1864. Kansas. 5, "02. 1863. Illinois, age 28. 27, 63. 81 Callahan, R., Corp l, G, Jan. 15, Right ; circ. Surg. G. C. Jarvis, 127 Copps, W. P., Pt., A, June 3, Right ; flap. Surg. D. M. Good 203d Penn., age 23. 15, 65. 7th Conn. Discharged. 40th Mass., age 27. 3, 64. win, 3d Vermont. Gangrene. 82 Campbell. W. R., Pt., K, Nov. :-:o, Right; ciro. To Provost Mar Disch d Feb. 15, 1865. 2d Arkansas, age 24. 30, 64. shal March 15, 1865. 128 Corley, J. D., Corp l, H, Oct. 15, Right; flap. Surg. W. B. Water 83 Cantelli, A., Pt., A, 1st May 27, Left ; circular. Disch d Feb. 27, 1st Arkansas, age 32. 17, 64. man, 1st Ark. Disch d July Artillery. 27, 63. 1864. Spec. 1026. 20, 1865. 84 Carbeny, A".,Corp l,Ches- May 2, . Surg. Hunter, C. S. A. 129 Coughlin,M.,Pt,A,15th Aug. 7, Left; flap. Disch d July 15, 65. apeake Artillery. 2, %3. Recovery. Infantry, age 42. 7, 64. Died April 13, 1870. 85 Carey, J., Pt, H, 3d N. May 16, Right: circular. Disch d May 130 Cowan, W., Pt., E, 21st Mar. 19, Left ; circ. Disch d July 20, 65. Hampshire, age 37. 18, 64. 30. 1865. Michigan, age 33. 19, 65. 86 Carmady, R., Pt.,B, 13th Jan. 2, Right ; flap. Surg. F. Pratt, 13th 131 Coyle, P., Pt., E, 90th May 5, Right. Mustered out Julyl, 65. Michigan, age 34. 2, 63. Mich. V. R. Corps. Died 1876. Penn.. age 22. 6, 64. 87 Carpenter, J. V., Pt., B, May 12, Right; post. flap. Mustered out 132 Crabtree, N.,Pt,F,112th Nov. 18, Left ; flap. Disch d July i!3, 64. 70th New York, age 43. 12, 64. Dec. 5, 1864. Illinois, age 22. 18, 63. 88 Carson, W., Pt., K, llth July 2, Right; flap. Disch d June 10, 133 Craig, W., Pt., K, 53d Mar 10 New Jersey, age 22. 3, 63. 1865. Indiana, age 33. 10, 65. 11, 1865. 89 Casada, A. P., Serg t, July 2, Right. Surg. Means, C. S. A. 134 Crallwell, W. H., Pt.. A, Sept. 1, Right ; flap. Surg. C. N. Fowler, E, llth Ga.. age 20. 2, 63. Exchanged Jan. 10, 1864. 14th Ohio, age 19. 2, 64. 105th Ohio. Disch d Nov. 18, 65. 90 Cashdollar, L. W., Pt., Sept. 19, Right ; flap. Surg. C. H. Andrus, 135 Cranston, D. J., Pt, H, Nov. 27, Left ; flap. Disch d April 26, 65. C, 128th N. Y., age 21. 20, 64. 176th N.Y. Oct. 27, hsem.; post. 26th Iowa, age 21. 27, 63. tib. lig. Disch d May 30, 1865. 136 Cresswell, W., Pt., C, Jan. 9, Left ; circ. Surg. White, C.S.A. 91 Castatar, A. J., Serg t, Aug. 29, . Discharged Feb. 11 , 1863. 1st New York Rifles. 11, 63. Gang. Disch d Sept. 26, 1863. G, 20th Indiana. 29, 62. 137 Critchett, T., Pt., 1, 12th April 30, Right; flap. Surg. A. M. Clark, 92 Cavanaugh, G.E., Serg t Dec. 13, Left. Discharged April 9, 1864. Massachusetts. 30, 63. U. S.V. Disch d Aug. 19, 1863. Major, 20th Indiana. 13, 62. 138 Crocker, A. B., Corp l, I, Sept. 17, Left. Surg. D. E. Kelsey, 64th 93 Cavanagh, W.. Pt., D, July 18, Right; ant. post. flap. Confed. 64th New York. 18, 62. N. Y. Bone cut off. Disch d 5th N.Y. H. A., age 30. 19, 64. surgeon. Disch d Oct. 21, 1865. Dec. 6, 1862. 94 Cavil, E., Pt., B, 44th Dec. 16. Right ; circ. Surg. Brothers, 139 ! Crocker, P. B., Serg t, F, Aug. 29, Left. Disch d January 15, 1863. Miss., age 19. 17, 64. C. S. A. Pro. Mar. Mar. 30, 65. 14th New York. 30, 62. 95 Champeau, A. L., Pt, E, Aug. 21, Left; circ. Surg. C. B. Park, llth 140 Crooks, A., Pt., D, 149th July 1, Right; post. flap. Surg. W. T. llth Vermont, age 24. 21, 64. Vermont. Disch d July 25, 65. Pennsylvania, age 23. 2, 63. Humphrey, 149th Penn. Disch d 96 Chapin, A.,Pt, B, 10th Oct. 8, Right; flap. Siug. S. Marks, 10th July 26, 1865 Wisconsin. 10, 62. Wis. Disch d Dec. 9, 1862. 141 Crowe, J., Pt., I, 63d Feb. 1, Left. Disch d April 30, 1862. 97 Cherry, I., Pt., C, 19th June 18, Right; flap. Disch d June 13, New York. 1, 62. Indiana, age 17. 19, 64. 1865. Died Oct. 13, 1867. 142 Curie, H., Pt., F, 7th Aug. 16, Left. Confed. surg. Re-amp, in 98 Childers. A. A., Pt., F, Oct. 19, Right; circ. Exchanged Octo Connecticut, age 27. 17, 64. thigh Aug. 19, 1864. Disch d 2d N. C., age 19. 19, 64. ber 27, 1864. June 10, 1865. 99 Christner, W., Corp l, B, July 26, I Right. Disch d March 8, 1865. 143 Currier, C. P., Serg t, I, Mav 8, Left ; fla->. Surg. Mitchell, C. 2d Maryland, age 26. 26, 64. 39th Mass.. age 27. 9, 64. S. A. Disch d March 10, 1865. 100 Clark, J., Pt., I, 41st Nov. 25, Left. Disch d July 28, 1864. 144 Currev, J. B., Corp l, F, Sept. 19, Left. Surg. W. O. Hudson, 4th Ohio, age 45. 25, 63. 4th Texas. 20, 63. Alabama. Recovery. 101 Clark, L. R., Capt, F, Oct. 27, Right; flap. Surg. H. W. Car 145 Dale, G. H., Pt., B, 22d July 2, Right Surg. McCadden, C. S. 117th New York. 27, 64. penter, 117th N. Y. Disch d North Carolina. 2, 63. A. Retired Feb. 13. 1865. March 20, 1865. 146 Damon, A., Serg t, I, July 2, Left; flap. Surg. N. Havward, 102 Clark, P. D. r Corp l, E, May 5, Right ; circ. Disch d June 5, 65. 19th Mass., age 20. 3, 63. 20th Mass. Disch d April" 12, 64. 3d Vermont, age 24. 5, 64. Died Nov. 14, 68 ; dis. of liver. 147 Danbert, J., Pt, D, 24th Feb. 7, Right; circ. Surg. J. H. Beech. 103 Clark, S., Pt., F, 12th July 9, Left. Exchanged Sept. 21, 1864. Michigan, age 23. 7, 65. 24th Michigan. Disch d May Georgia Bat ry, age 20. 9, 64. 16, 1865. 104 Clark. S. W., Corp l, G, June 17, Left : circ. (also wound lie-lit le<y). 148 Davenport, J. C., Pt., C, May 3, : flap. Furloughed July 1, 2d Penn. H. A. 17, 64. Disch d April 29, 1865. 53d Georgia. 3, 63. 1863. 105 Clay, R., Pt,, B, 65th Nov. 26, Right. Discharged June 5, 1865. 149 David, A., Pt, H. 1st Aug. 29, . Disch d Nov. 30, 1862. Illinois, age 23. 26, 64. New York. -, 62. 106 Cleary, M., Pt., D, 5th Nov. 4, Left; circular. Disch d August 150 Davis, C., Pt.. G. 48th April 2, Left ; ant. post, skin flap ; circular Cavalry, age 24. 4, 62. 18. 1863. Colored Troops, age 23. 2, 65. sect. mus. Surg. N. N. Horton, 107 Clements, J.,Pt.,F, 18th Dec. 13, Left. Disch d August 28, 1863. 47th C. T. Disch d Aug. 7, 65. Massachusetts. 14, 62. 151 Davis J H Pt. D 97th June 27, Right; flap. Surg. E. B. Glick. 108 Clements. S. W., Pt., F Nov. 25, Right ; flap. Surg. H. McHenry, Ohio, age 22. 27, 64. 40th Ind. Gangrene. Disch d 40th Indiana. 27, 63. 125th Ohio. Disch d Oct. 7, 64. October 31, 1865. 109 Closser, S., Pt.. F, 104th July 1, Right; flap. Disch d March 25, 152 Davis. J. S., Pt., ( ,, 17th Mar. 10, Left ; circ. Released May 1 9, 65. New York, age 26. 2, 63. 1864. North Carolina, a.se 38. 12, 65. 110 Cobaugh, W. D., Pt, II, Jan. 7, Left. Disch d June 15, 1864. 153 Decker, B., Pt., K, 38th May 3, Left Disch d August 28, 1863. 3d Penn. Cav., age 27. 7, 64. New York. 3. 63. 111 Cobett, G. W., Serg t, F, May 10, Right; ant. post. flap. Disch d 154 Decker. H., Pt., B, 95th Oct. 27, Left ; circ. Ass t Surg. F. Whit 22d Mass.. age 30. 10, 64. October 17, 1864. New York, age 42. 28, 64. man, 58th Mass. Mustered out. 112 Cole, E., Pt., F. 120th July 2, Right: flap; ha?m.; lig. muscular Died Sent. 25. 1867. of iniurv. New York, age 24. 4, 63. branch. Disch d April 20, 1 804. 155 DeForrest, D.. Pt., H, Dec. 10, I Right ; ant. post. nap. A/Surg. 113 Coles, H. C., Pt., B. 4th May 19, "Rio-lit p.irn. Fnrlinnrliprl .ftinft 100th N. York, age 26. 10, 63. J. W. Applegate, U. S. V. Dis Tenn. Cav.. age 18. 19, 64. 30. 1864. charged Sept. 22, 1864. 114 Culestock.W.W., Corp l, May 8, Right ; ant. post. flap. Disch d 156 DeJean. C., Corp l. H, Mav 2, Left ; flap. Disch d December K. 16th Mich., age 24. 9, 64. Dec. 9. 1864. 55th Ohio. 4, 63. 29, 1863. 115 Collier,,!. W., Pt., "Hart s May 3, . Surg. A. Bowie, C. S. A. 157 Delany, W., Corp l, A, Aug. 25, Left. Confed. surgeon. Disch d Battery. 3, 63. Recovered. 5th N. Hamp., a<re 29. 27, 64. October 29, 1864. 116 Conklin, A., Pt.,K,]09th June 17, Left ; flap. Disch d May 15, 65. 158 Delbriger, W., Pt, E, Oct. 5, Left; flap. Disch d April 7, 63. New York. 17, 64. 25th Indiana, age 24. 5, 62. 117 Conklin, A. J., Pt., D, Dec. 13, Left; circ. Disch d Oct. 1, 1863. 159 Dempsey. J., Pt.. C, Dec. 13, Left ; flap. Disch d April 19, 64. 106th Penn., age 23. 13, 62. 116th Penn., age 26. 14, 62. 118 Conley. J. II., Serg t, G, Nov. 27, Right; circular. Recovery. 160 Devlin, J.. Pt., I, 61st Dec. 7, Left: ant. post flap. Surg. llth Virginia, age 30. 27, 64. New York, age 20. 8, 64. Richards, C. S. A. Discharged 119 Conley, W., Pt., G, 17th Mar. 16, Left ; ant. post. flap. Surg. E. Nov. 7, 1865. New York, age 25. 17, 65. Batwell, 14th Mich. Disch a 161 Deyoe. N. W., Corp l, E, July 2, Left ; ant, post. flap. Discharged July 25, 1865. 61st New York, age 21. 2, 63. March 2. 1864. Spe.c. 4374. 120 Connel. J., Pt, C, 7th \ May 12, Left; circ. Disch d Dec. 3, 1863. 162 Dickson. A. S., Corp l, June 27, Right ; ant. flap. Surg. J. W. Missouri. 12, 63. H, 125th 111., age 26. 27, 64. McGee, 57th N. C. Mustered 121 Conner, C. R., Corp l, B, May 27, Right ; circ. Surg. T. F. Duncan, out June 9, 1865. 19th Ohio, age 19. 28, 64. P. A. C. S. Disch d Aug 2, 05. 163 Diedrich, H., Corp l, I, Oct, 21 , Right : circ. Surg. J. C. Morgan. 122 Connolly, D., Pt, B, June 3, R t; flap. Con. surg. (Also other 30th Iowa, agn 23. 21 , 63. 29th Mo. Gangrene. Disch d 164th N.Y.. age 22. ". 64. wounds.) Disch d June 19, 65. May I.".. 1W5. 1 O KEKKE ( D. C.i, Surgical Cases of Interest, treated at Institute Hospital, Atlanta, Ga.. etc., in Confed. States Me !. 468 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 164 Dines, D., Ft., D, 27th July 22, Right; flap. Surg. A. B. Mono- 207 Evercost. G., Corp l. B. July 4, Left : flap. Surg. F. M. Rose, 43d Ohio, age 21. 22, 64. han, 63d Ohio. Disch d July 27th Ohio, age 26. 4, 64. Ohio. Gangrene. Disch d July 24, 1865. 17, 1865. 165 Dolley, T. W. Corp l, K, April 9, Left ; circ. Disch d Nov. 22, 64. 208 Everett, D., Pt., L, 15th June 15, Right; ant. post, flap; slough.; 30th Maine, age 22. 9, 64. Died Aug. 4, 67 ; phth. pulmo. Kansas Cav., age 18. 17, 64. gangrene. June 20, re-amp, in and chr. diarrhoea. Spec. 4299. thigh. Disch d Aug. 19, 1864. 166 Donaghy, W., Seaman, Nov. 4, Right; circ. Surg. L. C. Fonts, 209 Failing, J., Pt., A, 122d May 6, Left. Disch d July 6, 1865. gunboat Tamah,agc 27. 4, 64. 2d Tcnn. Duty Feb. 7, 1865. New York, age 21. 7, 64. 167 Donahue, J., Pt., H, 07th Oct. 19, Right; circ. Disch d June 28, 210 Farnsworth, J. W., Pt., June 17 Left; flap. Surg. T. F. Oakes, Penn., age 38. 21, 64. 1865. F, 57th Massachusetts. 18, 64. 56th Mass. Mar. 23, 65, re-amp . 168 Donaldson, L. J., Pt., F, May 12, Left ; flap. Surg. E. L. Hill, 20th Disch d June 2, 1865. 2l)th Ohio. 12, C3. Ohio. Disch d August 14, 1863. 211 Farry, M., Pt., I, 38th Oct. 19, Right; flap. Disch d July 12, 65. 169 Donnelly. J., Pt., A, May 17, Left; flap. Surg. E. Harrison, Massachusetts, age 30. 19, 64. Died Oct. 12, 69 ; consumption. 124th Illinois. 17, G3. 68th Ohio. Disch d Aug. 10/63. 212 Fehrman, H., Corp l, I, Aug. 18, Left; flap. Disch d June 2, 1865. 170 Doolan, P.. Pt., B, 90th Mav 5, Right; flap. Disch d Dec. 10. 64. 1st Maryland, age 25. 19, 64. Penn., age 45. 5, 64. 213 Felloon, R., Pt.. E, 6th June 27, Right ; post. flap. Disch d Oct. 171 Dooley. H. C., Pt., C, Mar. 27, Right. Surg. T. W. Flora, 26th Michigan, age 43. 27, 63. 5, 1863. Died Nov. 6, 1867; 2lith Indiana, age 27. 27, 65. Ind. Disch d June 2, 1865. chronic diarrhoea. 172 Dorsey, J., Corp l, H, Nov. 29, Right ; gangrene. Disch d July 214 Fentress, H., Pt., C, 6th Aug. 30, . Surgeon J. H. Clairbome, 16th Kentucky, age 21. 30, (54. 17, 1865. Virginia. 31, (12. P. A. C. S. Recovered. 173 Porsey. E. W., Lieut., B, July 2, Right ; circ. To prison January 215 Ferguson, A., Lieut., 33d Nov. 30, Right ; ant. post. flap. To Prov. llth X. C., age 24. 2, 63. 29, 1864. Alabama, age 32. 30, 64. Marshal Feb. 14, 1865. 174 Dougall, J. 8., Pt., H, Aug. 30, Left. Surgeon W. Frothingham, 216 Fink, J., Pt., E, 8th N. June 16, Right : flap. Surg. N. Hayward, 44th New York. 30, 62. 44th N. Y. Disch d Oct. 27, 62. Y. Heavy Artillery. 17, 64. 20th Mass. Disch d July 4, 65. 175 Dougherty, H., Colonel, Nov. 7, Left (also w nds of arm and lung). 217 Fisher, C. S. M., Pt,, H, June 18, Right. Disch d Feb. 7, 1865. 2Cd Illinois. , 61. Mustered out May 7, 63. Died 2d Penn. Art y, age 23. 19, 64. 176 Douglass, J. C., Capt., II, 2d Missouri. Oct. 4. 4, 62. April 7, 68 ; wound of long. . Recovered. 218? 219) Fisher. E. H., Lieut., A, 21st Indiana. Oct. 20, 20, 62. Both. Surg. E. Reed, 21st Ind. Disch d Nov. 20, 1863. 177 Dow, J. H., Pt., II, 2Pth July 30, Left : circular. Disch d May 26, 220 Fitch, G., Serg t. C, 6th June 3, Right: double flap. Discharged Massachusetts, ago 36. 30, 64. 1865. Vermont. 3, 64. Oct. 28, Ib64. 178 Dowliug.W., Pt.,F,59th Aug. 14, Left ; long ant. post. flap. Surg. 221 Flaherty, T., Pt., C, 8th May 27, Left; circ. Disch d Nov. 1, 1863. New York, age 28. 15, 04. S. H. Plumb, 59th N. Y. IIm. New Hampshire. 27, 63. Disch d August 18, 18G5. 222 Flanders, W.M. F., S g t, June 18, Right ; circ. Disch d December 179 Downing. F. T., Corp l, Dec. 13, Right. Surg. J. F. Whitbeck, G, 16th Mass., ago 23. 19, 64. 28, 1865. F, 108th New York. 14, 62. 1 08th N. Y. Disch d A ug. 6, 63. 223 Flanigan, M.,Lieul.Col., July 1, Left. Disch d Nov. 24. 1863. 180 Dresson, G. F., Pt., A, Dec. 13, Left. Disch d August 29, 1863. 24th Mich., age 37. 1. 63. 35th New York. 13, 62. 224 ^Fleming. R. J., Serg t, May 14, Right; flap. Surgeon Hall, 181 Duffy, J. P., Ft., O, 28th Sept. 17, Right. Disch d June 27, 1863. D, 20th Tenn., age x;5. 14, 64. C. S. A. Sloughing. Recovery. Pennsylvania. 17, 62. 225 Fletcher. D.M.,Pt., 10th Oct. 27, Right: flap; re-amput n in thigh. 182 Duffey, O., Serg t, G, Aug. 16, Right ; double flap. Confederate Ind. Battery, ago 24. 28, 64. Mustered out July 10, 1865. 48th New York, ago 23. l(i, 64. surgeon. Disch d Nov. 30, 1864. 226 Foley, W., Pt., I, 62d N. Mar. 25, Right ; ant. post. "flap. Disch d 183 Dunlap, J. R., Ft., C, July 3, Right. Exchanged September York, age 43. 25, 65. Oct. 26, 1865. Davis Cavalry, acre 20. 3. t;3. 25, 1863. 227 Ford, T., Pt., K, 35th Aug. 19, Right ; ant. post. flap. Surg. G. 184 | Dunn, W. F., Serg t, E, Oct. 5, Left; flap. Disch d June 14, 65. Mass., age 33. 20, 64. W. Snow, 35th Mass. Disch d 93d Illinois, age M. 5, 64. April 1, 1865. 185 Durand, E., Pt., K, 31st J une 4, Right: circ. Stirg. P. S. Arndt, 228 Foreman, R., Pt., D, July 9, Right; flap. A. A. Surg. G. M. Wisconsin, age 37. 5, 64. 31st Wis. Disch d Feb. 9, 65. 151st N.York, age 17. 10, 64. Paullin. Disch d Sept. 4, 1865. Died April 28, "iO : consumption. Spec. 2341. 186 Durnap, J. B., Pt., D, June 20, . Surg. VV. H. Lipscomb, C. 229 Forrester, M.. Pt.,E, 26th July 3, Left. Exchanged March 3, 1864. Perrin s Ala. Battery. 20, 63. S. A. Recovery. North Carolina. 3, 63. 187 Dwyer, A., Serg t, G, 3d Oct. 7, Right ; flap. Disch d March 28, 230 Foster, W. G., Pt., E, July 2, Right; flap. Disch d Nov. 24, New York. 7, 64. 1865. 16th Maine. 3, 63. 1863. 188 Bakes, J/., Pt., I, 23d July 1, Left. Exchanged Sept. 25, 1863. 231 Foust, E., Sergeant, C, Oct. 19, Right; flap. Disch d May 17, North Carolina, age 19. 2, 63. 126th Ohio. 19, 64. 1865. 189 Ecliols. J., Pt., II, 24th May 16, : flap. Surg. C. B. Gibson, 232 Fowler, E. B., Pt., F, July 3, Left. Surg. G. L. Potter, 145th Virginia. 17, 64. C. S. A. Transferred. 27th Connecticut. 4, "63. Peun. Disch d July 27, 1863. 190 Edmunds, C., Pt., L, 1st May 3, Right. Surg. C. S. Wood, 66th 233 Francis, W., Pt.. A. 117th Sept. 29, Left ; ant. posterior flap. Disch d Ohio Batterv. 3. 63. N. Y. Disch d Feb. 23, 1864. New York, age 21. 30, 64. May 31, 1865. 191 Edson. S.VV.,"Pt.,E, 22d May 10, Left ; ant. post. flap. Surg. I. H. 234 Frank. C., Pt., K. 149th Mav 25, Left; circ.; gangrene. Disch d Massachusetts, age 29. 10," 04. Stearns, 2-Jd Mass. Disch d New York, age 34. 2o," 64. August 18, 1865. Jan. 8, 1865. 235 Freed,J. M..PI..G, 89th April !), Right; flap. Disch d June 5, 65. 192 Edwards, F. W., Pt., II, May 19, Right; flap. Disch d July 8, 64. Indiana, age 23. 9, 65. 1st Mass., age 22. 19, 64. 236 Freeman, J. D., Pt., F, Sept. 19, Right ; lateral flap. Discharged 193 Elliott, J. H., Corp l, G, Oct. 13, Right ; circ. Disch d February 15th W. Va., age 33. l!t, 64. June 19, 1865. 34th Mas?., age 21. 14, 64. 4, 1865. 237 French, B. F., Pt., H, July 2, Right; circ. Disch d June 14, 194 Elliott, P., Pt., K, 15th Sept. 17. Left; circ. Disch d Dec. 4, 1862. 20th Maine, ago 21. 4, 63. 1864. Massachusetts. 17, T.2. Died Dec. 4, 1863. Spec. 4200. 238 Frum, P., Corp l, F, 3d Aug. 29, Left. Surg.R.W. Hazlett, 2d W. 195 Ellis, A.. Pt., A,142d N. May 16, Left ; flap. Discharged. West Virginia, age 28. 29, 62. Va. Gangrene; re-amp, in thigh York, ng<> 40. 16, 64. Sept. 21, 1862. Disch d JulvT, 196 Ellis, T. S., Pt., G, 2d Aug. 29, Left ; circ. Disch d April 25, 63. 1864. Spec. 1665. U. S. Sharpshooters. 30, 62. 2.39 Fuller, W. H.. Pt., H, Sept. 19, Right; oval flap. Surg. O. 11. 197 Ellis, \V., Pt., A, 14th April (i, Right. Disch d June 7, 1862. 5th New York Cavalry, 19, 64. Armstrong, 5th N. Y. Cavalry. Illinois, 6, 62. age 23. Disch d March 16, 1865. 198 Ellin, W. T., Capt.. B, Aug. 21, Left : comb n flap and circ. Surg. 240 Furman, R., Corp l, B, June 3, Left ; long post. flap. Ass t Surg. 24th N. C., age 32. 21, 64. Wilson, C. S. A. Furl d Oct. 8th New York Heavy 4, 64. C. H. Pegg, 8th N. Y. 11. Arfy. 21, 1664. Artillery, age 24. Gang. Disch d Aug. 30, 1865. 199 Ellison, A r . A., Pt., B, July 3, Right. Surgeons Schaffer and 241 Galavan. D., Pt., II, 26th June 14, Right ; circ. Disch d August 17, 16th Georgia, age 18. 3, 63. Bnsch, C. S. A. Retired Feb. Connecticut. 14, 63. 1863. 1, 1865. 242 Gale, A., Pt., B, 51st Sept. 14, Right. Surg. J. L. Dodge, 51st 200 Enerlish, W. W., Pt., H. Aug. 30, Right : circ. Confed. surgeon. New York. 15, 62. N. Y. -Disch d March 4. 1803. 71st Indiana. 30, 62. Disch d Nov. 28, 1662. 243 Gallant, W. H., Pt,, F, Mar. 25, Left. Discharged July 1, 1865. 201 Erway, J. B., Pt., G, May 3, Lefr. Surg. W. F. Humphrey, 122d Ohio, age 23. 25, Go. 149th Pennsylvania. 3. 63. 14!)th Penn. Discharged. 244 Gant,M.,Pt.,B. 8th Penn. Sept, 14, Left ; flap : gangrene. Disch d 202 Evans, A., Serg t, II, Dec. 13, Right. Surg. C. S. Wood, 66th Reserves, age 18. 14, 62. January 16, 1863. 66th Now York. 13, 62. N. Y. Disch d Feb. 21, 1863. 245 Ganto, L. it., Pt.. H, 9th Oct. 7, Left. Surg. T. C. Pugh, C. S. A. 203 Evans, J., Pt., C, 96th May 12, Lett; circ. Disch d March 23, Georgia. 7, 64. Recovery. Penn., age 30. 13, 64. 1865. 246 Garland. J. C., Capt., A, July 4, Right. Union surgeon. Ilacm. 204 Evans, S. P., Capt., A, May 14, Left; circ. Mustered out, 1865. Glen s Reg t, age 31. 4, 63. To prison April 21, 1864. 5th Tennessee. 15, 64. 247 Geary, M., Serg t, C, Sept. 17, Left ; flap. Ass t Surgeon T. A. 205 Evans, W., Lieut., F, Mav 16, Left: circ. Confederate surgeon. 128th Pennsylvania. 19, 62. Hchvig, 128th Penn. Mustered 100th N. Y., ago 27. 17/64. Disch d Jan. 26, 1865. out May 19. 1863. 20ii Evers, B., Pt.. G, IGtli Mav 23, Right; flap. Disch d June 19, 248 Geddes, G., Pt., K, 126th Dec. 13, Left; circ. Disch d March 19. Michigan, age 20. 23, 64. 1865. Pennsylvania. 14, 62. 1863. 1 KEEFE (D. C.), Surgical Cases of Interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confederate Stales Medicnl and Surgical Journal, Richmond, 1865, Vol. 2, p. 30. SECT. V.] PEIMARY AMPUTATIONS IN THE LEG. 469 NO. NAME, MILITARY DEscmrnoN, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 249 Gerhard, P., Corp l, K, Mar. 31, Left ; large post., short semi-lunar 291 Hammond, G.,Pt.,A, 1st Aug. 16, Left ; aut. flap. Surg. R. A. Dod- 1st Maryland, age 45. 31, 65. flap. Disch d Oct. 11, 1865. Maryland Cav., age 25. 16, 64. son, 1st Maryland Cav. Disch d 250 Gervin, J. G., Corp l, D, Dec. 17, Right. Surg. G. W. Brady, 8th May 18, 1865. 8th Tenn. Cav., age 31. 17, 64. Tenn. Disch d June 26, 1865. 292 Haucock,E. A., Capt.,B, Mar. 16, Left ; flap. Surg. C. Helms, 92d 251 Getchell, H. W., Pt., K, June 18, Left ; ant. post. flap. Disch d 9th Penn. Cav., age 25. 16, 65. 111. Mustered out July 18, 1665. 1st Me. H. Art,, age 24. 19, 64. June 6, 1865. 293 Harlocker, H. H., Pt., C, May 5, Right ; flap. Discharged May 252 Gibbonv, 8. H., Pt., C, May 31, Right. Surg. G. Chaddock, 7th 6th Wisconsin, age 18. 7, 64. 26, 1865. 7th Mich., age 25. J e 2, 62. Mich. Disch d Sept, 25, 1862. 294 Harris, W.C., Lieut., D, Nov. 27, Left. Surg. Mitchell, C. S. A. 253 Gibbs, G., Pt., G, 25th Oct. 5, Right, Surg. B. F. Stephenson, 2d Louisiana. 27. 63. Recovery. Indiana, age 36. 5, 62. 14th 111. Disch d April 7, 1863. 295 Harris.W. H., Pt., K, 1st July 9, Left ; circ. Surgeon Newell, 254 Gibson, T., Pt., B, 5th Aug. 29, Left ; circ. Disch d Feb. 9, 1863. Potomac Home Brig 9, 64. C. S. A. Disch d June G, 1865. New Jersey. 29, 62. ade, age 22. 255 Gibson, W. B., Pt., F, April 30, Left; flap. Discharged Sept. 2, 296 Hart, A. W.,Pt.,B, 185th Mar. 29, Right ; flap. Discharged Sept. 33d Iowa, age 24. M y2, 64. 1865. New York, age 19. 30, 65. 25, 1865. 256 Gilliglten, J. 3/.,Pt., A, Jan. 11, Right, Transferred to Confed 297 Hart, W. H., Serg t, C, July 2, Right ; flap. Surg. F. Wolf, 39th 16th Georgia, age 30. 11, 65. erate hospital. lllth N. York, age 41. 3, 63. N. Y. Disch d March 12, 1864. 257 Gillis, 8., 1 t., K, 68th May 16, Left ; flap. Surg. E.Harrison, 68th 298 Hartley, H. U., Pt., 7th June 2, . Surgeon F. M. Hereford, Ohio. 16, 63. Ohio. Disch d Dec. 10, 1863. Mississippi Artillery. 3, 63. P. A. C. S. Recovery. 258 Gillroy, B., Pt., H, 6th April 6, Left. Recovered. 299 Harwood, T. F., Serg t, July 1, . Surgeon Harris, C. S. A. Tennessee. 6, 62. K, 53d Virginia. 3, 62. Recovery. 259 Godfrev. A. A., Pt., A, Dec. 13, Left. Discharged July 23, 1863. 300 Hastings, W., Pt., E, 2d April 4, Left ; ant. post, flap ; profuse pri 2d Maine, age 23. 13, 62. Artillery, age 27. 4, 64. mary haemorrhage. Discharged 260 Godfrey, C. P., It., F, May 12, Left ; flap. Surg. W. B. Fox, 8th Jan. 20, 1865. 109th N. Y., age 22. 13, 64. Mich. Disch d May 23, 1865. 301 Hastness, O.,Pt., E, llth June 14, Left. Surg. G. C. Harlan, llth 261 Gough, J. F. K., Pt., B, June 14, Right ; flap. Disch d October 19, Penn. Cav., age 21. 14, 63. Penn. Cav. Disch d May 3, 64. 173d New York. 14, G3. 1863. 302 Hawkins, F. A., Pt., B, Sept. 17, Right. Surg. McAden, 13th N.C. 262 Good, A., Col d laborer, Aug. 9, Right ; circ. Ass t Surg. W. Blun- 13th North Carolina. 18, 62. Recovery. Quartermaster Depart 9, ? 64. dell, 5th N. J. Recovered June 303 Hayes,A.G.,Pt.,C, 110th May 6, Left ; flap. Surg. D. S. Hays, ment, age 30. 26, 1865. Spec. 4153. Pennsylvania, age 20. G, 64. 110th Penn. Disch d April 6/65. 263 Goodsell, J. B., Corp l, Sept, 19, Left; flap. Ass t Surgeon C. H. 304 Haynes, S. M.,Corp I, B, Sept. 30, Left ; flap. Disch d July 3, 1865. K, 114th N. Y., age 23. 20, 64. Allen, 8th Vermont. Disch d 59th Alass., age 32. Oct. 1, G4. April 13, 1865. 305 Hays, J. K., Pt., G, 28th June 17, Right. Transferred July 14, 64. 264 Goodwin. S. U., Pt., E, June 3, Right; flap. Surg. D. Merritt, Georgia, age 18. 17, 64. 188th Penn., age 24. 3, 64. 55th Penn. (also wound left leg). 306 Heary, P., Pt., B, 46th July 30, Left ; ant. post. flap. Surg.W. B. Disch d Sept. 19, 1864. Died New York, age 20. 31, 64. Fox, 8th Mich. Disch d March August 12, 1867. 30, 1865. 265 Graham. J. Q., Pt., D, May 12, Right; flap. Disch d April 30, 307 Helm, E. B., Pt., B, 4th April 2, Right; flap. Disch d June 20, llth Infantry, age 18. 12, 64. 1865. New Jersey, age 28. 2, 65. 1865. 266 Gray, E.. Pt,, C, llth April 2, Right; flap. Surg. J.W.Anawalt, 308 Henderson, W. P., Pt., Oct. 27, . Recovery. Pennsylvania, age 21. 2, 65. llth Penn. Disch d Sept. 30, 65. I, Hampton Legion. , 63. 267 Gray, J., Pt., K, 1st West July 18, Right : flap. Disch d Nov. 26, 64. 309 Henry, E., Pt., C, 1st Feb. 20, Left ; flap. Ass t Surgeon H. C. Virginia, age 26. 18, 64. Died December 17, 1873. Col d Troops, age 21. 20, 65. Merry weather. 5th Col d Troops. 268 Gray, J. R., Pt., C, 2d Nov. 30, Right ; ant. post. flap. To Prov. Disch d Oct. 18, 1865. Arkansas, age 25. De. 1, 64. Marshal March 7, 1865. 310 Henthorne, E., Pt., E, June 5, Left; flap. Surg. D. Baguley, 1st 269 Greaney, P., Serg t, D, Sept. 17, Left ; flap. Surg. R. Loughran, 116th Ohio, age 24. 6, 64. W. Va. Disch d July 5, 1865. 80th New York, age 43. 19, 62. 80th N. Y. Disch d Dec. 6, 62. 311 Herron, J., Pt,, I,4th Del Aug. 21, Right ; flap. Disch d May 29, 65. Died July 31, 1874. aware, age 23. 21, 64. 270 Green, B., Pt., H, 37th Sept. 30, Right ; ant. post. flap. Disch d 312 Hershberg, D., Pt., F, Nov. 23, Right; post. flap. Ass t Surg. J. Col d Troops, age 27. 30, 64. April 14, 1865. G2d New York. 23, 61. R. Smith, U. S. A. Discharged 271 Green, G., Corp l, H, May 14, Left. Surgeon J. McCurdy, llth April 23, 1862. llth Ohio. 14, 64. Ohio. Mustered out June, 1864. 313 Hill, C. M., Pt., G, 64th May 12, Left ; circ. Surg. J. W. Wishart, 272 Green, J., Pt., H, 65th Aug. 6, Left: flap. Surg. A. M. Wilder, New York, age 28. 12, 64. 140th Penn. Disch d July 13, G4. Indiana, age 36. 6, 64. U. S. V. Disch d June 9, 1865. 314 Hill, G. A., Pt., K, 13th Oct. 19, Right ; ant. post. flap. Disch d 273 Green. W. U.. Pt., H, 2d Sept. 19, . Transferred Nov. 15, 1864. West Virginia, age 18. 19, 64. June?, 1865. South Carolina. 19, 64. 315 Hill, R. A., Pt., A, 155th Sept. 14, Left : ant. post. flap. A. A. Surg. 274 Greenwald, A., Seaman, June 28, Right. Discharged April 24, 63. Pennsylvania, age 20. 15, 62. W. H. Butler. Gang. Disch d U. S. Steamer J. P. 28, 62. June 9, 1863. Spec. 179. Jackson, age 22. 316 Hill, S. P., Pt., A, 7th Aug. 23, Right; flap. Surg. Gurley, 275 Gridlev, C. W., Corp l, Mar. 31, Left; circ. Mustered out Sept. Kentucky Cavalry. 24, 62. C. S. A. Disch d July 14, 1863. G, 53d Penn., age 27. 31, 05. 8, 1865. 317 Hilton, N., Pt., B, 16th Dec. 31, Right. Surg. C. S. Mus croft, 10th 276 Griffin, J., Pt.. G, 2d Mar. 5, Right : flap. Surg.W. A. McCul- Infantry. 31, <52. Ohio. Recov d June 27, 1863. Colored Troops. 5, 65. ley, 2d Col d Troops. Disch d 318 Hiltz, J. W., Capt., C, Sept. 19, Right ; flap. Surg.W. S. Newton, June 9, 1865. 23d Ohio, age 33. 19, 64. 91 st Ohio. Disch d A ug. 2, 65. 277 Grimaldi, M., Pt., I, 82d May 12, Right ; circ. Surg. S. H. Plumb, 319 Himelberger, H., Pt., F. June 16, Right ; circ. Surg. H. F. Lyster, New York, age 23. 13, 64. 82d N. Y. Disch d Dec. 6, 1864. 5th Mich., age 26. 17, 64. 5th Mich. Disch d April 11, 65. 278 Grimes, W. M., Pt., B, Dec. 13, Left. Surg. J. Evans, 3d S. C. 320 Hobart, H., Lieut., 2d Sept. 17, Right ; post. flap. Recover}-. 3d South Carolina. 13, 62. Recovery. Louisiana, age 26. 17, 62. 279 Grimm, L., Pt., A, 121st Dec. 13, Right. Disch d August 10, 1863. 321 Hodge, A. D., Corp l, A, Jan. 30, Left; flap. Surg. G. C. Harlan, Penn., age 44. 13, 62. llth Penn. Cav.,age 32. 30, G3. llth Penn. Cavalry. Disch d 280 Groove, W. S., Pt., B, May 6, Right. Surg. E. R. Umberger, August 27, 1864. 93d Penn., age 16. 6, 64. 93d Penn. Disch d June 15, 65. 322 Hodge, T., Pt., A, 17th July 20, Left. To prison Oct. 31, 1864. 281 Gross, E., Pt., E, 102d Sept. 19, Right : flap. Disch d May 31, 65. Alabama. 20, 64. Penn., age 28. 19, 64. 323 Holcomb,Y., Pt.,B,3Gth Sept. 19, Right ; flap. Disch d May 20, 65. 282 Grove, G.W., Serg t, D, June 22, Right; flap. Disch d August 18, Ohio, age 26. 19, 64. Spec. 1498. (Also w d at thigh.) 6th Maryland, age 24. 22, 64. 1865. 324 Holley, J. H., Pt.,C,38th Sept. 29, Right ; flap. Disch d Sept. 7, 65. 283 Gulledge,J. W., Pt., K, May 16, ; flap. Surg. C. B. Gibson, Col d Troops, age 19. 29, 64. 59th Alabama. 17, 64. C. S. A. Retired Jan. 2, 1865. 325 Hollinger,C., Pt.,F, 55th Mar. 16, Left ; flap. Disch d July 19, 65. 284 Gulseth, O.. Pt., K, 3d Mar. 16, Left ; ant. post. flap. Disch d Ohio, age 21. 16. 65. Wisconsin, age 24. 16. 65. July 18. 1865. 326 Hopes, J., Pt., M, 2d June 9, Right. Disch d Nov. 10, 1863. 285 Hafferin. C., Pt., F, 65th Oct. 19, Right ; circ. Surg. C. B. Hutch- Cavalry. 9, 63. Died 1868. New York, age 19. 20, 64. ins, 116th N. Y. Haemorrhage. 327 Horton, F. B., Pt., D, 8th Sept. 29, Left, Sent to prison May 30, 65. Disch d October 28, 1865. North Carolina, age 18. 30. 64. 286 Haganeier, F. H., Pt., F, May 3, Right ; post. flap. Discharged 328 Horton, J. R., Serg t, D, Mar. 31, Right ; ant. post. flap. Disch d 73d N. York, age 23. 4, 63. October G, 1864. 17th Penn., age 41. Ap. 2, 65. August 12. 1865. 287 Halderman, P., Pt., K, Oct. 28, Left; flap. Discharged March 329 Horton, S. J., Corp l, E, July 22, Left ; ant. post. flap. To Provost 13th Penn. Cav. .age 20. 29, 64. 29, 1865. 7th Texas, age 23. 22," 64. Marshal Dec. 8, 1864. 288 Haley, R. F., Corp l, E, Sept. 17, Right. Surgeon G. Chadwick, 330 Hovatter, M. J., Pt., F, Oct. 13, Right ; ant. post. flap. Surg. W. 18th Mississippi. 19, 62. 7th Michigan. 15th West Va., age 40. 13, 64. S. Walsh. 15th West Virginia. 289 Hall, L. J., Pt., I, 147th May 6, Left ; double flap. Surg. H. H. Disch d July 4, 1865. New York, age 19. 6, 64. Hubbard, I . A. C. S. Disch d 331 Howard, E., Pt., F, 3d July 2, Right; circ. Disch d October 12, March 18, 1865. Infantry, age 32. 4, 63. 1863. 290 Halleck, S. K., Pt., B, Oct. 27, Left ; circ. Disch d October 5, 332 Howard, J. W., Corp l, Mav 12, Left. Confederate surgeon. Re 148th N. York, age 18. 28, 64. 1865. D, 61st Virginia. 12," 64. covery. 1 FISCHER (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Sharpsburg, Md., after the battle of Antietam, etc.. in American Journal Medical Sciences. 1863, Vol. XLV, p. 48. 470 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATOKS, RESULT. 333 Hubbard, G. E., Pt., F, Sept. 17, Left ; flap. Ass t Surg. J. S. Em 375 Lawson, B. F.. Corp l, F, Dec. 16, Left : flap. Transferred July 31 , 9th New Hamp., age 18. 17, 62. erson, 9th N. H. Discli d Feb. 89th Illinois, age 23. 16, 64. 1865. 4, 1863. 376 Lee, C. P., Pt., H, 8th May 5, Left ; flap. Disch d Sept. 12, 64. 334 Hummel, G., Lieut., B, Sept. 17, Left. Disch d Feb. 15, 63. Died New Jersey, age 21. (i. 64. Died May 18. 1867. 28th Ohio. 18, 62. May 25, 1865; cong. pneumonia. 377 Lee, D. L., Serg t, E,71st Dec. 16, Left; flap. Surg.C.N. Hoagland, 33a Huston. R., Corp l, I, May 11, Right; flap. Surg. H. M.Craw Ohio, age 21. 16. 64. 71st Ohio. Disch d April 22, 65. 58th Illinois, age 19. 12, 64. ford, 58th 111. Mustered out. 378 Leggett, R., Lieut. Col., July 25, Left. Surg. M. T. Newton, 10th 336 Hutchinson, J., Ft., I, 2d Oct. 19, Left; long post. flap. Surg. H. 10th Connecticut. 25, 63. Conn. Disch d Aug. 23, 1864. Connecticut, age 20. 19, 64. Plumb, 2d Conn. H vy Artil ry. Died Sept. 18/74 ; chr. phthisis. Disch d Sept. 13, 1865. Died Sept 10 18o9 379 Lennox, J. H., Pt., B, 3d April 6, 6 62. . Confederate surgeon. Re- 337 Hutson, W., Pt., G, 28th Sept. 17, Right ; ci rc. Surg. H. E. Good 380 Leonard, H. D., Corp l, June 2, Right ; flap. Disch d Jan. 19, 65. Pennsylvania. 19, 62. man, 28th Penn. Disch d July D, 92d X. Y., age 29. 2, 64. Died Mar. 21. 70; consumption. 21, 1863. 381 Lewis, E.G., Pt., K, 8th April 2, Right ; circ. Disch d Nov. 4, 65. 338 Ingrain, J., Pt., A, 1st Dec. 13, Right; circ. Disch d July 11, New Jersey, age 18. 2. 65. Pennsylvania Artil ry. 13, 62. 1863. Spec. 1775. 382 Leuscher, \V.,Pt., C, 6th July 18, Left. Surg. Colton, C. S. A. 339 Jackson, G. L.,Serg t, B, July 28, Right ; circ. To Provost Marshal Conn., age 36. 20, 63. Disch d Sept. 6, 64. Died since. 17th Alabama, age 21. 29, 64. Dec. 1, 1864. 383 Lewis, R., Lieut. ,B, Pal Oct. 7, Left ; flap. Released May 8, 65. 340 Jarrrll, C., Pt., G, 30th June 3, . Surg. Hunter, C. S. A. metto S. S., age 23. 7. 64. Virginia. 3, 64. Recovery. 384 Lewis, W., Corp l, C, July 22, Left ; flap. Discharged June 27, 341 Jensen, P.,Corp l,G.15th Feb. 6, Right; double flap. Discharged 39th Ohio, age 30. 22, 64. 1865. N. Y. H. A., age 24. 6, 65. Nov. 20. 1865. 385 Linker, J., Corp l, B, 7th July 3, Left. Surg. Higginbotham, C. 342 Jesse. T. H., Pt., A, 15th June 27, Right ; ant. Surg. R. Q. Stoney, North Carolina, age 24. 4, 63. S. A. Transferred Nov. 25, 63. Georgia. 28, 62. C. S. A. Recovery. 386 Little, G.W.,Pt., 1, 24th May 6, Right. Surg. Mitchell, C. S. A. 343 Johnson, A. O., Pt., C, July 2, Right. Exchanged Nov. 12, 63. Georgia. 6, 64. Recovery- 11 th Georgia, UCTG !!) 3, 63. 387 Livermore, W. H., Pt., July 28, Right ; circ. Surg. I. N. Barnes, 344 Johnson, E. H., Pt., E, Sept. 2, Right : circ. Disch d January H, 55th Illinois, age 17. 28, 64. 116th Illinois. (Hsem.) Disch d 4Cth Indiana, age 26. 2, 64. 28, 1865. February 5, 1865. 345 Johnson, G., Col d serv Dec. 14, Left ; flap. Surg. W. F. Smith, 388 Loafman, W. J., Pt., F, April 7, Left. Disch d June 24, 1862. ant, age 21. 14, 64. 73d Penn. Duty June 1, 1865. 9th Kentucky. 7, 62. 346 Johnson. J., Pt., D, 9th Aug. 18, Left : circ. Disch d April 14, 65. 389 Loeweg, M.,Pt.,D, 125th June 17, Right ; lateral flap. Discharged New Jersey, age 20. 18, 64. New York, age 19. 17, 64. October 21, 1865. 347 Jones, G. H., Pt., I, 2d July i, ; flap. Surg. Hubbard, 390 Lohr, N., Pt., F, 55th June 17, Left ; flap. Surg. G. T. Stevens. Mississippi, age 20. 3, 63. 2d Miss. Retired Aug. 29, 1864. Pennsylvania, age 26. 18, 64. 77th New York. Disch d March 348 Jones, L., Pt., E, 5th Mar. 16, Right ; post, flap; gang. Disch d 16, 1865. Conn., age 40. 16, 65. August 11, 1865. 391 Long, G. P., Pt., 4th In Mar. 16, Left; flap. Surg. E. Switt,U.S.A. 349 Jones, W. 15., Pt., B, 5th Nov. 25, Left; circ. flap. Disch d June diana Battery. 16. 62. Disch d Dec. 8, 1863. Kentucky, age 38. 26, 63. 22, 1864. 392 Long, J. J., Pt., C, 139th May 12, Left. Surg. S. F. Chapin. 139th Joseph, C., Pt., B, 100th June 16, Left. Surg. H. Luddington, 100th Pennsylvania, age 30. 13, 64. Penn. Disch d May 12, 1865. Pennsylvania. 16, 62. Penn. Disch d Sept. 17, 1862. 393 Long, J. S., Pt., F, 33d Mar. 19, Right; flap. Disch d June 28, 351 Joyce, A. J., Pt., E, 16th July 3, Left ; antero-post. flap. Surg. J. Ohio. 21, 65. 1865. Michigan, age 20. 3, 63. Thomas, 118th Penn. Ham. 394 Long, L. R., Pt., I, 17th JulyH, Left ; flap. Discharged Nov. 16, Disch d March 18, 1864. Pennsylvania. 14, 63. 1863. 352 Jubb, O. A., Pt., M, 7th Aug. 25, Left ; circ. Surg. G. S. Dilts, 5th 395 Loomis, J.,Serg t,B,56th April 9, Right ; double flap. Surg. C. E. Mich. Cavalry, age 24. 25, 64. N. Y. Artillery. Gang. Disch d New York, age 23. 9, 65. Briggs, 54th Mass. Discharged August 9, 1865. October 13, 1865. 353 Keenan, L., Pt., E, 140th July 3, Right. Surg. C. S. Wood, 66th 396 Loomis, R. D., Pt., H, May 12, Left ; circ. Ass t Surg. S. Adams, Pennsylvania, age 18. 4, 63. N. Y. Disch d Jan. 25, 1864. 57th Mass., age 32. 13, 64. U.S.A. Disch d Sept. 12, 1865. Died Feb. 22, 1868. 397 ( 1 Lorence, J., Corp l, K, Feb. 8, Both : flap. Surg.H.W.Rivers,4th 354 Kelly, P., Pt., G, 3d Ar May 4, Left. Disch d June 26, 1862. 398s 9th New Jersey, age 35. 8, 62. R. I. .and Surg. J. 11. Thompson, tillery, age 27. 4, 62. U. S. V. Disch d Sept. 30. 62. 355 Keuney, J., Corp l, E, April 2, Left; circ. Mustered out Sept. 399 Levering, H. B., Pt.,C, Sept. 19, Left; circ. Surg. D. F. Leavit, 10th Conn., age 33. 2, 65. 29, 1865. 3d Mass. Cav., age 23. 19, 64. 3d Mass. Cavalry. Discharged 356 Kenney, J., Pt., K, 20th Massachusetts. Sept. 17, 17, 62. Left. Discharged Feb. 10, 1863. 400 Lovett, J. H., Corp l, F, May 16, June 10, 1865. Left; circ. Disch d June 14, 65. .. Kennidy, I. S., Pt.. H, May 3, Right; circular. Recovery. 40th Mass., age 19. 16, 64. 5th Virginia. 4, 63. 401 Lowell, C., Lieut. ,C, 7th May 5, Right ; fl;ip. Surg. W. Buck, 6th 358 Keiner, W., Serg t, E, July 24, Left ; circ. Surg. C. Bower, 6th Maine, age 29. 5, 64. Maine. Disch d Oct. 3, 1864. Cth Penn. Reserves. 24, 61. Penn. Reserves. Disch d Mar. 402 Lowry, T., Pt., F, 48th July 18, Right ; circ. Surg. G.W. Miller, 26, 1862. New York. 20, 63. 97th Penn. Disch d Aug. 25, 63. 359 Kerrin, J., Pt., G, ]9th Aug. 13, Right; flap; gang.: re-amputat n 403 Luckenbach,O.A.,Capt., Aug. 9, Right ; flap. Surg. T. Antisell, Infantry, age 27. 13, 64. thigh. Disch d June 4, 1865. C, 46th Pennsylvania. 11, 62. U. S. V. Disch d Oct. 2, 1862. 360 Kiscadeu, J., Pt., C, 99th Oct. 27. Left ; ant. post. flap. Discharged 404 Luffman, M. M., Pt., A, June 18, Right ; flap ; gangrene. Disch d. Pennsylvania, age 21. 28, 64. August 7, 1865. 3d Delaware, age 22. J9, 64. 361 Kitson, T. W., Miss. Ma Mar. 26, Left. Surgeon J. Roberts, Miss. 405 Luke, J., Pt., K, 99th May 5, Left; flap: gangrene. Discli d rine Brigade. 26, 62. Mar. Brig. Disch d Nov. 21, 63. Pennsylvania, age 20. 5, 64. March 16, 1865. 362 Knight, M.,Pt., D, 56th May 27, Left ; flap. Surg. D. A. La Force, 406 Lunon, G., Pt., B, 22d Sept. 19, Right ; circ. Surgs. J. W. H.Vest, Colored Troops. .27 , 6.-.. 56th Col d Troops. Discharged. Iowa. 20, 64. 28th Iowa, and J. C. Shradcr, 363 Knittle, J., Pt., D, 150th June 1, Right ; circ. Discharged Juno, 22d I ,\va. Disch d May 29, 65. Pennsylvania, age 1 9. 3, 64. 165. 407 Lupton, T., Corp l, A,2d June 16, Right; Hrc. Surg.J.W. VVishart, 364 Koehler, F., Pt., I, 7th July H, Left ; ciro. Disch d May 14, 1864. N. Y. H. Art y, age 19. 17, (14. 140th Penn. Discli d Nov. 28, 64. Connecticut. 11, 63. Died Oct. 4. 1875. Spec. 1510. 408 Macomber, C., Pt., B, May 12, Left; flap. Surg. S. S. French, 365 Kuchman, D..Pt.,B,29th Aug. 29, Right. Disch d January 27, 1863. 20th Mich., age 29. 12, 64. 20th Mich. Disch d Jan. 26, 65. New York. 29. 62. 409 Muggard, J., Pt..K, 13th Oct. 19, Left; post. tlap. Ass t Surg. E. L. 366 Kuemmel, H., Corp l, II, July 30, Right : lateral flap. Surg. A. F. Mississippi, age 18. 20, 64. De Long. 77th New York. To 2d Michigan, age 22. 30," 64. Whelan,lst M-ich.S. S. Disch d Provost Marshal April 1, 1865. March 17, 1865. 410 MaJiony, G., Pt., B, 19th Aug. 29, Right. Surg. R. Hatty, 19th Ga. 367 Kuen.W., Corp l. E, 55th May 16, Right; flap. Disch d April 29, Georgia. 29, 62. Recovery. Pennsylvania, age 22. 16, 64. 1865. 411 Manchez, E., Pt., B, 17th May 27, Right; circ. Ass t Surg. D. C. 368 Kuhn, L., Serg t, B, 88th Nov. 25, Right ; flap. Surg. L. D. Water Missouri, age 23. 27, 64. Greenleaf, 4th Iowa. Disch d Indiana, age 24. 25, 63. man. 39th Ind. Disch d July September 15, 1804. 4, 1864. 412 Mangan, M., Lieut., E, July 2, Right; flap. Resigned April 3, 369 Kyner.J. H.,Pt., F, 46th April 6, Right; flap. Disch d June 30, 62. Qth Wisconsin, age 33. 3, 63. 1864. Ohio. 8, 62. 413 Mann, E. M., Pt., llth May 3, Right. Discharged. 370 Lackey, L., Pt., A, 209th Nov. 17, Right ; long post, and short ant. New York Battery. 3, *63. Pennsylvania, age 20. 18, 64. flap; gangrene. Disch d April 414 Manning, W., Corp l, I, Aug. 16, Left; flap. Surg. N. Havward, 11, 1865. 20th Mass., age 21. 16, 64. 20th Mass. Disch d May 10. 65. 371 Lahon. R. E.. Lieut., F, Aug. 30, . Surg. Morgan, C. S. A. 415 Mars, U., Pt., K, 34th May 2, Right. Discli d July 17,"l863. 23d Georgia. 30, 63. Recovery. Indiana. 2, 63. (372 Latimer, O . P., Pt., E, Sept. 1. Left ; circ. Surg. C. N. Fowler, 416 Martin, A. }!.. Pt., G, July 28, Left ; ant. post. llap. To Provost 10.")th Ohio, age 29. 1, 64. 105th Ohio. Disch d Mar. 7, 65. 17th Ala., age 39. 28." 64. Marshal Dec. 28. 1864. 373 Lawrence, It. E., Pt., F, June 3, Right; circ. flap. Disch d May 417 Martin, E.T., l t.,B, 56th June 20, Right: circ. Disch d Mar. 31. 65. 81st New York, age 20. 3, 64. 23, 1865. Pennsylvania, age 21. 20, 64. Died Jan. 18, 69 : absc. of brain. 374 Laws. B., Pt., E, 30th Feb. 11, Right; flap. Disch d Oct. 18, 418 | Martin. F., Pt., H, 19th July 1, Right ; flap. Disch d April 9, Col d Troops, age 23. 11, 65. 1865. Died Oct. 5, 1868. Massachusetts. 2, 62. 1863. 1 THOMPSON (J . II.), Report of Cases occurring at the Battle of Roanokr Island, Virginia, in Am. Mail. Times, Vol. I V, 1862, page 199. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 471 No NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. XO NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. 419 Martin, R., Pt., A, 13th Dee. 17, Left ; flap. A. A. Surg. J. S. Gilt- 463 Michaels, J., Pt., A, 16th April 6, Left ; circ. Surg. G.W. Eastman, Col d Troops, age 40. 17, 64. iier. Disch d August 12, 18fi5. Wisconsin. 8, 62. 16th Wis. Disch d Aug. 15, 62. 420 Martin, R., Ft., \i~ih N. June 20, Left ; circ. Duty Sept. 12, 1864. 464 Micue, P., Pt., G, 34th Oct. 13, Left; ant. post. flap. Disch d York, age 24. 21, 64. Massachusetts, age 33. 13, 64. May 20. 1865. 4-21 Martin, \Y., Corp l, 1, 6th Sept. 19, Left; Surg. Gardner. Disch d 465 Miles, A., Pt., G, 15th Mar. 31, Right ; lateral flap. Discharged Indiana, age 30. 21, 63. June 8, 1864. N. Y. H. Art y. nge 18. Ap. 1, 65 August 2, 1865. 422 Mason, R. U., Pt., Ash- July 2, Right. Confed. surgeon. Retired 466 Miles, F. N.. Pt., F, 29th Oct. 19, Left: flap. Disch d January 21, land s Va. Bat y.age 36. 3, 63. March, 1865. (Also w d left leg.) Maine. 20, 64. 1865. 423 Mathis, W. M., Pt., I, Aug. 21, Right; circular. Transferred. 467 Miller, J. K., Serg t, E, April 2, Right; post. flap. Disch d Aug. 1 1th Ala., age 27. 21, 64. 205th Pennsylvania. 3, 65. 18. 1865. 424 Matthews, D.,Pt.,B,39th April 2, Left; circ.; gangrene. Recovery 468 Miller, W., Pt., E, 15th July 5, Right ; flap. Surg. E. M. Rogers, New Jersey, age 28. 2, 65. August 2, 1865. Iowa, age 25. 5, 64. 12th Wis. Must, out Feb. 1 1, 65. 425 Matthews. S. J., Serg t, July 2, Right ; circ. Paroled Sept. 25, 469 Mink, J., Pt., A, 61st N. April 7, Right; ant. post. flap. Disch d I, 9th Ala., age 22. 3, 63. 1863. York, age 18. 7, 65. November 25, 1865. 426 Matthews, T., Lient., F, Aug. 9, Left ; circ. Disch d Dec. 29, b 2. 470 Mishaw, E., Pt.,C, 118th Sept. 20, Right, Surg. J. Thomas, 118th 46th Pennsylvania. 11, 62. Pennsylvania. 22, 62. Penn. Disch d April 21, 1863. 427 Maxwell, W. E., Corp l, May 8, Right ; flap. A. Surg. J. T. Duf- 471 Mitchell, W., Pt., K, June 8, Uight. Disch d Oct. 17, 1862. G, 95th N. Y., age 22. 8/64. field, 7th Indiana. Disch d Jan. 27th Pennsylvania. , 62. 7, 18C5. 472 Mizner, W., Pt., H,34th Mar. 19. Left ; circ. Disch d June 16, 65. 428 McCaigue, S. B., Corp l, May 12, Left. Surg.W. J. Burr, 42d New Illinois, age 21. 20, 65. H, 183d Pennsylvania. 12, 64. York. May 27, amp. knee .joint. 473 Moats, M., Pt., F, 15th Sept. 19, Right ; flap. Disch d June 9, 65. Mustered out July 13, 1865. West Virginia, age 24. 19, 64. 429 McCarty, J., Pt., M, 4th Nov. 5, Left; flap; gangrene; subsequent 474 Moffatt, R., Serg t, K, July 15. Left ; flap. Surg. F. C. Reamer, Artillery. 5, 64. operation. Discharged. 121st Penn.. age 23. 15," 64. 143d Penn. (Also excis. hum.) 430 McOlnre, VV. H., Pt., A, July 2, Left; post, flap; haem. Disch d Disch d June 29, ]865. 137th N. York, ago 46. 3, 63. May 17, 1864. 475 Moneyhan, B. F., Pt., D, April 17, Right. Surg.V. H. Coff.nan, 34th 431 McCluskey, P., Pt., B, Dec. 13, Right. Discharged August 17, 24th Indiana, age 26. 17. 6J. Iowa. Disch d Sept. 12, 1865. 69th New York. 13, 62. ]863. 476 Monroe, H., Pt., I, 20th June 22, Right; flap; haem.: lig. femoral. 432 McConnell, J. E.,Pt, B, June 18, Left; flap. Surg. J. H. Beech, Maine, age 25. 22, 64. Disch d January 13. 1865. Died 24th Mich., age 19. 18, 64. 24th Mich. (Also wound right May 16, 1870; phthisis pulmo. leg.) Disch d Sept. 12, 1865. 477 Mooney, J., Pt., D, 13th May 10, Left ; flap. Disch d May 27, 65. 433 McCord, M. D., Corp l, Aug. 25, Left; flap. Confederate surgeon. New York, age 29. 11, 64. A, 4th N. Y. H. Art y, 27, 64. Disch d May 20, 1865. 178 Moore, C. W., Lieut., Dec. 10, Left; flap. Mustered out June age 25. 15th Ohio Battery. 10, 64. 20, 1865. 434 McGalliard, W.M..Cap., July 2, Right ; circ. Hasmorrhage. To 479 Moore, D., Colonel, 21st April 6, Right. Mustered out Feb. 12, E, 8th La., age 25. 3, 63. prison Mar. 2, 1864. Missouri. 6, 62. 1865. 435 McGce,A.. Serg t, D, 7th Oct. 19, Right ; post. flap. Ass t Surg.W. 480 Moore, D. A., Capt., B, June 30, Right ; flap. Surg. A. N. Dough South Carolina, age 23. 20, 64. A. De Long, 77th New York. 61st New York, age 29. 30, 6- . erty, U. S. V. To V. R. C. To Provost Marshal April 1, 65. 481 Jfoore, J. A., Pt., Gi 38th May 16, : circ. Furloughed July 20. 436 McGee, A. S., Pt., D, 5th June 29, Right ; flap. Confed. surgeon. Virginia, age 26. 16, 64. 1864. Vermont, age 43. 30, 62. Disch d Feb. 11, 1863. 482 Morgan, J., Pt.. K, 14Cd Dec. 13, Right ; flap. Confed. surgeon. 437 McGlynn,M., Pt., D,63d Sept. 17, Left. Discharged Dec. 30, 1862. Pennsylvania. 15, 64. Disch d June 22, 1865. New York, age 36. 17, 62. 483 Morgan, J., Pt., B, 26th Oct. 19, Right. Surg. G. McDonald, 22d 438 McGowan, J., Pt.,C,94th April 2, Right; circ. Disch d July 27, Virginia, age 21. 19, 64. Va. To prison Feb. 16, 1865. New York. 3, 65. 1865. 484 Morgan, J. C., Serg t, D, Mar. 31, Right; oval flap. Surg. D. C. 43!) McGrath, W., Pt.. E, 3d Feb. 2, Right; ant. post. flap. Surg. M. 7th Wisconsin, age 25. 31, 65. Ayres, 7th Wis. Disch d July Rhode Island H. Art y, 2, 64. S. Kittinger. 100th New York. 20. 1865. age 48. Disch d Oct. 14, 64. Spec. 2910. 485 Moris, U., Pt., K, 34th May 16, Right ; flap. Disch d July 18, 63. 440 McGuire, C., Corp l, G, July 1, Left; flap; haBin. Disch d June Indiana, age 36. 16, 63. 19th Indiana, age 31. 2, 63. 11, 1864. Died Feb. 7, 1870. 486 Morningstar, J. J., Pt., July 11, Left; circ. Confederate surgeon. 441 Mcllane, H., Major, 12th Nov. 30, Left ; oval flap. To Pro. Marshal D, 76th I enn. 13, 63. Disch d Jan. 17, 1864. Spec. 473. Louisiana, age 26. De. I, (i4. March 27, 1865. 487 Morrin. J.. Pt,, G, 126th July 3, Left; post. flap. Surg. J. Aiken, 442 MoHenry, U. \V., 1 t., K. July 2, Right; flap. Disch d July 11, New York, age 21. 4, 63. 71st Penn. Haem.; amp. thigh 105th Penn.,age21. 2, 63. 1865. Nov. 3. Disch d June 18, 1865. 443 Mclntire, G.. Pt., I, 7th May 10, Right. Surg. F. M. Everleth, 7th Specs. 1416, 2604. Maine, age 24. 10, 64. Maine. Oct. 16, amp. thigh. 488 Morris, A.W., Pt., B, 6th June 16, Left; circ. Ass t Surg. D. Hal- Disch d June 16, 1865. Iowa, age 21 . 16, 64. dennan, 46th Ohio. Disch d 444 Mclntosh, J. B., Brig. Sept. 19, Right. Retired July 30, 1870. July 10, 1865. General U. S. V. 19, 64. 489 Morrison, A., Pt., K,23d July 24, Left : circ. Discharged March 1 . 445 McKalvey, J., Pt., I). Mav 31, Left. Discharged June 10, 1863. Illinois, age 23. 24, 64. 1865. 10_ d Pennsylvania,. 31," 62. 490 Moss, J. E., Corp l, E, Nov. 25, Left: flap. Surg. H. McHenry, 446 McKenno, M. J., 1 t., F, June 27, Right. Confederate surgeon. Re- 36th Illinois. 27, 63. 125th Ohio. Disch d Sept. 24, 8th (Jeorgia. 28, 6-i. covery. 1864. 447 McKnight, J., Pt., B, 2d Deo. 13, Right; circ. Disch d April 13, 491 Mount, D. M., Serg t, B, Dee. 13, Right. Mustered out June 5, 63. Delaware, age 45. 14. 62. 1864. Died in 1864. 35th New York. 13, 62. 448 McLaugltUn., A., Pt., C, Mar. 25, Left ; circ. A. Surg. E. P. Roche, 492 Mullen, J., Pt., C, 30th Get. 19, Right : flap. Disch d February 24th X. C.. age 17. 25, 65. 35th Mass. Releas d June 14/65. Mass., age 20. 20, 64. 12. 1865. 449 McLuughlin, T. A., Pt., Oct. 19. Left ; circ. Surg. G. T. Stevens, 493 Muller, H., Pt., E, 45th June 3, Left ; ant. post. flap. Surg. 11. K, 29th Maine, age 22. 20, 64. 77th N. Y. Disch d July 19, 6.5. New York. 3, 62. Ideler, 45th N. Y. Discharged 450 McLean, G., Pt.,E, 173d April 9, Right; circ. Disch d August 21, Nov. 1, 1862. New York, age 28. !), 64. 1864. 494 Muller, M., Pt., F, 4th April 2, Left; flap. Disch d October 1, 451 Mc.Murtrio, T., Lieut., Dee. 13, Left ; Hap. Confederate surgeon. N. Y. H vy Artillery. 2, 65. 1865. 12th Pennsylvania. 14, 62. V. R. Corps Oct. 18. 1863. 495 Mulligan, J., Pt., E, 5th Mar. 22, Right: flap; gangrene. Disch d 452 Me Nab, J. U., Pt., G, 3d May 10, Left. Surg.D.L.Ileath, 23d Mich. N. Y. Cavalry, age 18. 23, 64. October 28, 1864. Tennessee, age 21. 12. 64. Disch d July 6, 1865. 496 Munday, L. G., Pt., I, June 20, Right; circular. Recovery. 453 J/cAawiee, G., Pt., 1st July 1, Left ; flap. A. Surg. J. W. Jones, 26th Virginia, age 38. 20. 64. Virginia Art v, age 19. 2, 63. C. S. A. Retired Sept. 28, 1 864. 497 Mundy, F. H.,Pt.,G, 83d Dee. 13, Left; circ.: gangrene. Disch d 454 McRay, G. A~, Pt., G, April 2. Left. Released June 29, 1865. New York, age 20. 14. 62. Nov. 22. 1863 5th N. C. Cav., age 22. 2, 65. 498 Murray, J. H., Pt , D, 2d May 3, Left; double flap. Ass t Surg. 455 Mmsels, J., Pt.. G, 31st Oct. 19, Right; flap. Surg. II. F. Butt, Vermont. 3, 63. A. A. Atwood, 2dVt. Disch d Georgia, age 42. 19, 64. I .A.C.S. To prison Jan. 5, 65. April 13, 1864. 456 Medley, J., Pt., A, 22d Oct. 27, Right; circ. Mustered out Mar. 499 Myers, H., Pt., F, 119th Nov. 7, Lett. Surg. P. Lculv, 119th I enn. Col d Troops, age 25. 27, 64. 1H, 1S65. Penn., nge 39. 7, 63. Disch d June 27, 1864. 457 Meekins, J. D., Pt., E, June 3, Left: circ. Surg. J. W. Wishart, 500 Neal, T., Pt., C, 28th May 15, Left ; flap. Disch d Oct. 3, 1863. ]-18th Penn.. age 23. 3, 64. 140th Penn. Disch d May 29, 65. Iowa, age 19. 15, 63. 458 Merry, T. a., Ft., E, 4th May 3, Left ; flap. Transferred Sept. 8, 501 Neff, J., Corp l, B, 25th Mav 16. Right; circ. Confed. surgeon. North Carolina, nge 20. 3, 63. 1863. Mass., age 25. 18," 64. Disch d Sept. 6, 1865. 459 Messmore, J., Pt.,I),10th May 19, Right ; ant. post. flap. Disch d 502 Newton, W. J., Lieut., May 3, . Surg.W. A.Spence,C.S.A. Infantry, age 22. 19, 64. April 8, 1865. Died May 27, K, 40th Virginia. 3, 63. Recovery. 1871 ; epilepsy and oonsumpt n. 503 Nicholson, J., Pt., C, 8th Aug. 20. Left; lat" skin flap. Surg. A. 400 Meyer, P., Serg t, A, 16th Aug. 24, Right; flap. Disch d Jan. 13, N. Y. Cavalry, age 47. 20, 64. Hard. 8th Illinois Cav. Disch d Indiana, age 26. 24, 64. 1865. Died Dec. 4, 1868. Nov. 19, 1864. 461 Meyers, J., Pt., E, 5th July 3, Left. Disch d December 13, 63. 5C4 Nimoeks, R. J., Pt., B, July 22, Right; circ. Disch d June 30, New Jersey, age 36. 3, 63. 25th Wis., age 44. 23, 64. 1865. 462 Meyers, W., Pt., G, 2d Aug. 30, Left. Disch d November 13, 62. 505 Nolan, K., Pt., K, 22d Mav 17, Right; circ. Disch d Feb. 13. Infantry. 31, 62. Indiana, age 20. 17," 64. 1865. Died May 26, 1867. 472 INJURIES OF THE LOWER EXTREMITIES. (CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, KF.SULT. :NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 506 Norton, E. D., Corp l, I, June 17, Left ; post. flap. Disch d Nov. 26, 549 Platz, A., Musician, A, May 22, R t ; flap. A. Surg. J. C. Norton, llth Conn., age 21. 19, 64. 1864. 19th Infantry, age 18. 22, 64. U. S. V. Disch d Jan. 17, 1865. 507 Norton, J., Seaman. U.S. July 9, Left. Surg. Johnson, U. S. N. 550 Popp, M., Pt., E, 55th May 22, Left ; flap. Disch d Sept. 26, 63. S. Montaiik, agp 25. 9, 64. Disch d Oct. 24, 1864. Illinois. 22, 63. Died June 13, 1874. 508 Novell, W. W., Corp l, May 31, Right. Surg. J. M. Holloway, 551 Porter, H., Pt., G, 13th July 1, Left ; circ. July 30, re-amputat n. F, 49th Va., age 22. J e 1, 62. C. S. A. Retired Mar. 15, 1865. Massachusetts. 2, 63. Disch d Jan. 30, 1864. 509 O Brien, J., 1 t., A, 7th May 22, Right ; eirc. Disch d June 4, 64. 552 Pyle, J. M., Pt., H, 89th May 18, Right; flap. Disch d May 21, Missouri. 22, 63. Indiana, age 24. 18," 64. 1865. 510 O Brien, M., Pt., E, 2d Aug. 9, Right. Surgeon E. McDonnell. 553 Rabbidan, L.,Pt.,F, 14th June 23, Right; flap. Surg. H. McKennan, Massachusetts, age 26. 11, ti2. U. S. V. Disch d Dec. 6, 1862. Wisconsin, age 21. 23, 64. 17th Wis. Disch d Sept. 1, 65. 511 Ogden, M. H., Pt., H, June 18, Left ; flap. Disch d July 21 , 65. 554 Radichel, C., Pt., F. 6th Feb. 5, Right. Disch d August 23, 1865. 1,8th I enn., ago 21. 18, 64. Wisconsin, age 40. 7, 65. 512 Ohm, F., 1 t., O, 37th April 2, Left ; flap. Surg.W. C. Sum-lock, 555 Rady, D., Colored. May 14, Left. Recovery. Spec. 1809. Wisconsin, age 40. 2, 65. 51st Penn. Disch d Sept. 7, 65. 14, 63. 513 Oliver, J. W., Corp l, D, May 3, Left; flap. Furloughed. 556 Ralston, R., Musician, C, Oct. 26, Right; flap. Surg. A.T. Hudson, 12th Georgia, age 21. 3, 63. 26th Iowa, age 22. 26, 63. 26th Iowa. Disch d June 25, 64. 514 O Neil, J., Pt., 0. 28th Sept. 17, Left. Surg. II. E. Goodman, 28th 557 Ralyea, A., Pt., G, 147th Feb. 6, Left; ant. post. flap. Surg. A. S. Pennsylvania: 17, 62. Penn. Disch d Nov. 15, 1862. New York, age 25. 6, 65. Coe, 147th New York. Disch d 515 Opperman. P.,Pt.,E, 6th Aug. 16, Right; flap. Surg. B. E. Osborn, June 14, 1865. Missouri Cavalry. 17, 62. 1st Mo. S. M. Cav. Disch d Jan. 558 Rauscher, C., Pt., B, 42d Aug. 15, Left; flap. Disch d April 5, 1865. 9, 1863. Indiana, age 26. 15, 64. 516 Ormsby, S. S., Corp l, K, June 18, Right; cire. Surg. W. C. Shur- 559 Rawls, H., Pt., D, 2d Aug. 31, ; anterior. Ass t Surg. F. R. 50th Penn., age 26. 19, 64. lock, 51st Penn. Disch d May Georgia. 31, 62. Gregory, C. S. A. Recovery. 29, 1865. 560 Read, C. A., Serg t, A, Sept, 13, Right; flap. Surg.W. H.Wilbur, 517 Osborn, J. H., Serg t, I, June 29, Left;circ. A. Surg.O.H. Adams, 1st Mass. Cav., age 24. 13, 63. 1st R. I. Cav. Disch d April 8th N. Y. Cav., age 24. 29, 64. 8th N. Y. C. M. O. June 7, 65. 16, 1864. :,;,- O Shaughnessy, J., Pt., Jan. 1, Right; circ. Surg. A. I. Cum- 561 Reeh, F., Pt.,E, 2d Dela May 10, Right; flap. Surg. J. W. Wis- P, 42d Mass. 3, 63. ming, 42d Mass. Discharged. ware, age 21. 10, 64. hart, 140th Penn. Mustered out 519 O Sullivan, D., Corp l, July 2, Right; circ. A. Surg. C.Wagner, June 3, 1864. F, 3d Infantry, age 28. 2, 63. U. S. A. Disch d Jan. 8, 1864. 562 Redman, T., Serg t, K, July 10, Right ; post. flap. Veteran Re Spec. 4375. 5th Cavalry, age 26. 10, 63. serve Corps Oct. 30, 1863. 520 Overman, A. A., Serg t, May 19, Left; flap. Disch d August 10, 563 Reeder,G.W".,Pt., B.llth May 5, Left ; circ. Surg. J.W. Anawalt, A, 93d Indiana. 19, 63. 1863. || Penn., age 31. 5, 64. 1 1th Penn. Disch d A ug. 16, 64. 521 Sept. 17, Rifjlit circ. Discli tl DecGrnbGi* 564 Reeves, J. H. Pt. G 39th MIX Ifl I oit fl in Sure C S \- Purnell Legion. 17, 62. 6, 1862. Illinois, age 24. v J " 18, 64. Dis ch d March 19, 1865. 522 I aden, P., Fireman, U.S. Mar. 28, Right ; post. flap. Surg. Ellis, 565 Refolt, E., Pt., G, 22d Oct. 9, Right; flap. Disch d Feb. 28, 63. Gunboat Diana. 30, 63. U. S. N. Disch d Dec. 31, 1863. Indiana. 10, 62. Died April 16, 64; small-pox. 523 Paliu, R. D., Pt., B, 9th June 8, Left ; post. flap. Surgeon S. A. 566 Reider,G.W.,Pt..C,14th May 24, Right; circ.; erysipelas; gang. N.Y. H vy Art., age 26. 8, 64. Sabin, 9th N. Y. Disch d Jan. Infantry, age 34. 24, 64. Disch d March 6, 1866. 20, 1866. 567 Reiff, E.,"Pt., A, 12th In July 2, Left ; circular. Discharged. 524 Parker. B., Pt., G, 2d July 3, Rigiit. Paroled Nov. 12, 1863. fantry, age 19. 3, 63. South Carolina, age 27. 3, 63. 568 Reiley, J., Pt., C, 7th N. June 17, Left ; lat. flap. Surg. J. W. Wis- 525 Parker, C., Pt., C, 150th July 1, Right; ant. post. flap. Disch d York Heavy Artillery, 18, 64. hart, 140th Penn. Disch d Mav Penn., age 23. 1, 63. January 29, 1864. age 29. 16, 1865. Died Feb. 14, 1876; 526 Parker, C.W.,Pt.,D,13th Sept. 30, Left. Discharged June 21, 1865. consumption. New Ilamp., age 21. 30, 64. 569 Restle, M., Serg t, G,52d Feb. 3, Left ; long post, and short anterior 51-7 Parker, /., Pt., H, 44th May 2. ; circ. Transferred May 26, j New York, age 28. 3 65. flap. Disch d Dec. 1, 1865. Georgia, age 21. 3, 63. 1863. ! 570. Reynolds, J. S., Lieut., May 28, Left; circ. Surg. 11. K. Clark, 5^8 I arkes, J. M., Serg t, B, July 20. Left ; ant. post. flap. Surg. J. H. H, 10th N. Y. Cavalry, 29, 64. 10th N. Y. Cav. Disch d Sept. 20th N. C., age 27. 21, 64. Ayers, 34ih Ohio. To Provost age 38. 8, 1864. Marshal Nov. 1, 1864. 571 Rice, F.R.. Lieut., F.lst Dec. 13, Left ; flap. Surg. D. P. Chamber- 529 Pnrlon.A. B., Pt.,G,193d Oct. 14, Right ; flap. A. Surg. L. Phinney, Michigan. 13, 62. lin, 4th Michigan. Veteran Re New York. 14, 65. 193d N. Y. Discharged. serve Corps July 2. 1863. 530 Parmenter, J., Capt., E, June 3, Right ; ant. skin flap. A. Surg. J. 572 Rider, J. A., Pt., A, 4th May 3, ; circ. Surg. Walls, C. S. 118th N. Y., age 42. 3, 64. G. Portcous,118th N.Y. Disch d Virginia, age 30. 4, 63. A. Nov. 12, 1877; good stump. Nov. 15, 1864. 573 Riley, J., Ordinary Sea Jan. 15, Right. Disch d July 14, 1865. 531 Paxton, J. T., Pt., H, Mar. 27, Right : circ. Surg. P. Harvey, IT. man, U. S. S. Wabash. 16, 65. I . th Iowa, age 21. 27, 65. S. V. Must, out July 10, 1865. 574 Roberts, G. W., Pt., B, July 1, Right; circular. Ass t Surg. J. r.32 Peet, G. W., Serg t, A, Dec. 13. Left. Discharged March 8, 1863. 1st Maryland Artillery, 1, 62. S. O Donncll. Purnell Legion. SUthN.Y. S. M., age 26. 13, 62. age 16. Disch d May 18. 1863. 533 Pels, A., Pt., B, 4th New June 37, Right; circ. Diseh d Sept. 28, 1 575 Roberts, H., Lieut., H, Aug. 29, Left ; circ. A. Surg. T. F. Oakes, York Artillery, age 29. 19, 64. 1864. 1st Massachusetts. 29, 62. 1st Mass. Digch d Feb. 5, 1864. 534 Penninyton, J. i ..Pt.,D, May 3. Left : flap. Transferred May 24, 576 Roberts, J. B., Corp l, K, Mar. 19, Left ; oblique flap. Confederate 26th Alabama, age 18. 4, 63. 1863. 88th Indiana, age 31. 20, 05. surgeon. Gangrene. Mustered 535 Perkins, M.V. 15., Corp l, July 18. ll t; circ. A. Surg. F. 15. Kimball, out June 7, 1805. F, 7th New Hampshire. 20, 63. 3d N. 11. Disch d Nov. 14, 63. 577 Roberts, M., Pt., H, 21st April 1, Right; double flap. Discharged 530 Perry, A., Pt., C, 44th Dec. 13, Left ; flap. Disch d Feb. 28, 63. N. Y. Cavalry, age 18. 3, 65. September 14, 1865. New York. 13, 62. 578 Robinson, J. B., Lieut., May 12, Right; ant. post. flap. Surg. C. 537 Peters, A., Pt., E, 37th June 17, Left : circ. Surg. W.C. Shurloek, C, 2d Penn. Reserves, 12, 64. Bowers. 6th Penn. Ites. Disch d Wisconsin, age 37. 18, 64. 51st . Penn. Gangrene. Disch d age 32. June 16, 1864. Spec. 4511. May 23, 1865. Spec. 3129. 579 Robinson, W.,Pt., D, 82d May 10, Right; circ. Surg. S. 11. Plumb, 538 Peters, S., Pt , C, 139th Sept. 21, Left ; ant. post. flap. Discharged New York, age 41 . 11, 64. 82d N. Y. Disch d Nov. 10, 64. Pennsylvania, age 19. 21, 64. June 6, 1865. Spec. 4372. 539 PctcrsJMd, W. J., Pt.,C, Nov. 30, Right ; circ. Surg. Hamilton, 580 Rodrjers, T. J., Pt., D, July 3, Right. Confed. surgeon. Ex 1st Alabama, age 21. Dec. 2. 1st Ala. To Provost Marshal 50th Georgia. 3, 63. changed March 17, 1864. 1864. May (i. 1865. 581 Rodgers, W. H., Corp l, May 5, Right ; flap. Surg. LeG. Capers, 540 Pe.llirjrr.ui, F., Pt., K, June 1, Right ; cire. Retired Jan. 18, 65. A, 146th N. Y., age 38. 6, 64. C. S. A. Disch d Nov. 19, 1864. 13th North Carolina. 1, 64. 582 Ross. I. C., Pt., F, 15th Nov. 25. Left; circular flap. Surg. H. E. 541 Petty, G. B., Corp l, E, June 29, Right ; flap. Confed. surgeon. Indiana, age 29. 27, 63. Ilasse, 24th Wisconsin. Disch d 5th Vermont. 30, 62. Disch d Jan. 31, 1863. April 21, 1864. 540 Phillips, I}. F., Captain, Nov. 30, Right ; fire. To Provost Marshal 583 Rosselit, M.,Pt ,F, 118th Dec. 29, Left. Surg.J. W.Alexander, lf>ih ago 29. De. 1, C4. April 6, 1865. Ohio, age 25. 30, 63. Penn. Cav. Disch d Nov. 2J, 64. 543 Phittips.J.J., Serg t, II, May 15, Right: ant. post. flap. A. Surg. Died Julvll, 71; tuber. disease. 3: d Tennessee, age 32. 17, 64. H. E. Goodman, U. S. V. To 584 Rouischkolb, F., Pt., E, Sept. 17, ll t ; lat. flap. Surg. C. S. Wood, Provost Marshal Dec. 1, 1864. 66th New York, age 4 1 . 17, 62. With New York. Disch d Dec. 544 Pidgeon, J., Pt., G, 22d Sept. 18, Right; flap. Disch d May 22, 65. 31, 1862. Colored Troops, age 38. 20, 64. 585 Rouse, T. D., Pt., F, 2d July 2, Right. Exchanged Nov. 12, 63. 545 Tierce, D. M., Pt., A, 4th June 1 8, Right; circ. Disch d May 12, North Carolina, age 20. 2, 03. Delaware, age 19. 18, 64. 1864. 586 Rudrauff, W. H., Lieut., June 1, Left; circ. Surg. L. Emanuel, 546 Pierce, W., Lieut., Aus Sept. 20, Right. Surg. Kratty, C. S. A. F, 82d Penn., age 24. 1, 64. 82d Penn. Disch d Sept. 2;!. 04. tin s Sharpshooters. 2(1. 6:i. Recovery. 587 Russell, E. M.,l t.,A, 1st Sept. 14. Left. Disch d November ?9, 62. 547 Pike, H. L., Lieut., Bat May 5, Left. Surg. St. John W. Mintz- Penn. Reserves. 14, 62. tery H, 1st Artillery. 5, 62. ner, 26th Penn. Retired Feb. 588 Russell. J. IL.Pt. ,15,29th Oct. 27, Right ; flap. Surg. A. C. Barlow, 21, 67. Died March 25, 1875. Connecticut, age 20. 28, 04. 62d Ohio. Disch d May 16, 65. 548 Plant, U., Pt., I), 7th In Dec. 13, Left. Disch d September 8, 1865. 589 Russell, P. A., Corp l, G, June 18, Left; flap. Discharged Nov. 4, fantry, age 19. 14, 62. 89th New York, age 24. 18, 64. 1PC4. SECT. V.) PRIMARY AMPUTATIONS IN THE LEG. 473 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 590 Ruth, R. A., Pt., E, 59th June 2, Right; flap. Disch d June 13, 630 Smith, J., Pt., C, 22d June 27, Right ; post. flap. A . Surg. S. A . Massachusetts, age 19. 4, 64. 1865. Indiana, age 22. 27, 64. Simpson, 52d Ohio. Disch d 591 Ryan, J., Pt., E, 10th Sept. 19, Left ; circ. Surg. I. Moses.U.S.V. June 20, 1865. Wisconsin, age 23. 21. 63. Disch d Sept. 30, 1864. 631 Smith, J., Pt., C, 69th May 16, Left; flap. Surg. J.W.Wishart, 592 Sampson, C. H., Serg t, A, 3d Maine, age 30. July 1, 1, 62. Right ; flap. Disch d Dec. 4, 62. Died Jan. 28, 1*70; effects of 632 New York, age 24. Smith J. B., Pt., H, 9th 16, 64. July 13, 140th Penn. Disch d Mar.10, 05. Right ; flap. Discharged. sunstroke. Michigan. 14," 02. 593 Sanders, J. A., Corp l,E, Aug. 21, Left; flap. Exchanged. 633 Smith, J. L., Lieut., F, June 27, Left. Resigned March 7, 180!!. 7th S. C. Bat y, age 30. 21, 64. 4th Michigan. 28, 62. 594 Santy, J., Pt., C, 91st Oct. 6, Left ; flap. Surgeon J. M. Leet, 634 Smith, J. R., Pt., C, 14th July 1, Right. Surg. J. J. Knott, I . A. Ohio, age 21. 7, 64. U. S.V. Disch d May 20, 1805. South Carolina. 2, m C. S. Recovery. 595 Saul, F., Pt., G, 183d June 16, Right; circ. Surg. J.W.Wishart, 035 Smith, P., Pt., K, 12th April 7, Left. Surg. H. Wardner, U.S.V. Pennsylvania, age 21. 17. 64. HOthPenn. Disch d Apr. 27, 65. Illinois, age 42. 7, 62. Disch d August 1. 1802. 596 Saxon, T. If., Pt., E, 4th May 3, ; ant. and post. flap. Rapid 636 Smith, V., Pt., E, 49th Dec. 8, Left; flap. Disch d March 29, North Carolina, age 20. 3, 63. ly improving. Indiana. 28, 62. 1863. 597 Scott, J. G., Pt., D, 77th May 6, Left ; circ. (also amp. right at low. 637 Smith, W., Pt., H, 93d Sept. 22, Left ; ant. post. flap. Recovered New York, age 23. 6, 64. third). Surg. E. B. P. Kelly, Pennsylvania, age 23. 22, 64. Nov. 27, 1864. 95th Penn. Disch d Nov. 3, 64. 638 Smith, W. D., Serg t, D, July 2, Left : flap. A. Surg.C. Bacon, jr., Spec. 513. 6th N. Jersey, age 35. 3, 63. U. S. A. Disch d Nov. 21, 1803. 598 Scott, O. D., Pt,, F, 17th June 7, Right ; ant. post. flap. Disch d 639 Smith. W. H., Pt., F, 4th May 5, . Surg. W. P. Young, 4th Vermont, age 21. 7, 64. May 18, 1805. Georgia. 5, "64. Georgia, Recovery. 599 Scroggs, W., Pt., I, 39th Juno 18, Right ; flap. Provost Marshal 640 Smith, W. N., Pt., H, Aug. 12, Right ; ant. post. flap. Assistant North Carolina, age 19. 19, 64. October 21. 1864. 52d Penn., age 19. 12, 64. Surg. J. Flowers, 5Cd Penn. 600 Scroth, J., Serg t.C, 19th May 14, Left: circ. Disch d November Disch d Nov. 14, 1864. Infantry, age 24. 14, 04. 10, 1864. 641 Smith, W. P., Pt., 1st July 2, Right. Surg. Jones, C. S. A. 601 Seaman, \V. P., Pt., C, Aug. 14, Right ; flap. Disch d October 1 0, Richmond Howitzers. 3, 03. Disch d Feb. 18, 1864. llth Missouri. 14, 62. 1802. 042 Snarr, P. H., Lieut., B, Sept. 19, Left. Exchanged November 22, 602 Seaver.C. E., Pt., 1, 13th July 3, Right: flap. Surg. G. Nichols, 18th Va. Cav., age 33. 20, 64. 1864. Vermont, age 28. 4, "03. 13th Vt. Disch d Nov. 7, 1803. 043 Snodgrass, J. ^4.,Pt., F, Jan. 10, Right. To prison May 4, 1863. 603 Secor, J. S., Pt,, A, 9th Oct. 19, Right; flap. Disch d June 29, 6th Texas. 10, 63. N.Y. H wArt., age 19. 20, 164. 1865. 644 Snyder, J., Pt., B, 4th N. Aug. 25, Left; single flap. Disch d Feb. 604 Segar, E., Pt., K, 22d April 29, Left ; anr. posterior flap. Surg. J. Y. H vv Art y, age 48. 26, 64. 7, 1865. New York, age 21. Majrl, Ebersoie, 19th Indiana. Disch d 645 Snyder, J., Pt., G, 149th May 10, Right ; flap (amp. left leg, lower 1863. Nov. 19, 1864. Spec. 1146. Pennsylvania, age 19. 11, 04. third). Disch d July 21,1865. 605 Seiforth, M., Pt., 1, 124th Mar. 10, Left; post. flap. Surg. V. H. 646 Southard, S. M., Pt., I, July 3, Left; ant. post. flap. Surg. O. Indiana, age 17. 10, 65. Gregg, 124th Indiana. Disch d 14th Vermont, age 33. 3, 63. Munson, 108th N. Y. Disch d June 30, 1805. Dec. 2, 1864. 606 Sellers, J. B., Pt., I, 27th May 25, Left ; circular. Discharged. 647 Spare, A., Pt., K, 187th June 18, Left ; flap. Disch d Jan. 13, 65. Indiana, age 21. 26, 64. Penn., age 37. 19, 64. 007 Shanger, A., Serg t, B, July 2, Left. Disch d June 4, 1&04. 648 igpath. J. F., Serg t, 1st Sept, 17, Right ; posterior flap. 86th New York, nge 31. 2, 63. Louisiana, age 20. 18, 62. (508 Shappee, W. A., Ft,, A, April 6, Right; flap. Disch d June C8, 649 Spenard, B., Pt., G, llth Oct. 19, Right; ant. post, flap. Surg.C. 81st Pennsylvania. 8, 05. 1865. Vermont, age 21. 19, 64. B. Park, llth Vermont. Dis 609 : Sharp, W. II. 11., Serg t, Mar. 10, Left ; ant. post. flap. Surg. C. charged July 21, 1865. L, 9th Penn. Cavalry, 16, 65. Helm, 92d Illinois. Discharged 650 flpence, J. D., Corp l, C, Oct. 19, Right ; posterior flap. Surg. J. G. age 24. Sept. 12, 1865. 3d S. Carolina, age 20. 20, 64. Hardy, 6th N. C. To Provost 610 Shaw, J., Pt., C, 19th July 3, Right. Surg. N. Hay ward, 20th Marshal April 8, 1865. Maine, age 28. 4, "63. Mass. Disch d Feb. 8, 1865. 651 , Spencer, M. L., Pt., K, Jaly 30. Right; circ. Disch d March 27, 61 1 Sheehan, M.,Pt., 11,100th July 18, Right: ant. post. flap. Assistant 4th Kentucky, age 24. A u.l. 64. 1865. New York. 18, 63. Surg. W. D. Murray, 100th N.Y. 052 Sperry, E. F., Pt., B, 3d April 6, Right; flap. Disch d August 4, Disch d Feb. 3. 1804. Iowa, age 20. 7, 62. 1862. 612 Shephard,-G., Pt., K, 3d Oct. 19, Right ; flap. Disch d September 053 Sprague, O., Pt., B, 9th Sept. 29, Left ; ant. post. flap. Discharged Vermont, age 32. 19. 64. 1. 1805. Vermont, age 18. 30, 64. Sept. 6, 1865. 013 Shields, T., Pt., G, 62d May 3, Left ; post. flap. Discharged. 054 Sprowl, T. J., Corp l.C, May 12, Left; flap. Disch d Jan. 15, 1865. New York. 3, 63. 12th N.Jersey, age 19. 12, 64. 614 Shoals, J., Corp l.C, 27th Mar. 8, Left; flap. Confederate surgeon. 055 Starin, P. D., Pt., H, 43d Nov. 5, Right ; flap (amp. left leg, lower Mass., age 1!). 10, 65. Disch d Sept. 4, 186."). Wisconsin, age 19. 5, 64. third). Disch d July 2, 1865. 615 Sibley, R., Pt., E, Oth : Aug. 31, Right; circ. Disch d July 15, 656 Stebbins, M. M., Serg t. Sept. 19, Left; posterior flap. Surg. J. G. Missouri, age 27. 31, 04. 1805. | K, 26th Mass., age 23. 19, 64. Bradt. 20th Mass. Disch d July 616 Siegrist, J. E., Serg t, C, Sept. 17, Left ; flap. Disch d Feb. 17, 63. 3, 1865. 7th Pennsylvania. 17, 62. 657 Steineman, J., Pt., K. Aug. 31, Right ; flap. A. Surg. C. B. Rich 617 Simmons, if. IT., Capt., July 2, Right; circ. Surg. Hill.C.S.A. i 37th Ohio, age 19. 31, 64. ards. 30th Ohio. Disch d May F, 2d Miss., age 24. 2, f 03. Hrem.; lig. fein. Provost Mar 18, 1865. shal March 17, 1864. 658 Steingraber, W.. Pt., E, July 22, Left; lateral flap. Disch d July 018 Simmons, W. S., Lieut.. Feb. 20, Left ; post. flap. A. Sure. II. C. 25th Iowa, age 20. 23," 64. 12, 1865. A, 5th Colored Troops, ! 20, 65. Merry weather,5th Col d TrA>ps. 651) Steinwater, J., Pt., Pur- Aug. 30, Right, Disch d August 14, 1863. 619 age 24. Sine. J. F., Pt., G, 90th Dec. 13, Disch d May 15. 1865. Left; flap. Disch d April 15, cell s Battery.Virgiuia. 600 Stephens, J., Serg t, K, 30. 02. Sept. 20, Left; flap. Confederate surgeon. Pennsylvania. 14, 62. 1863. 19th Illinois, age 25. 21, 03. Disch d June 24. 1864. 620 Singleton. J. R.,S g t, M, Sept. 19, Left ; ant. post. flap. Discharged 661 Stevens, R., Pt., F, 107th May 25, Right; flap. Surg. P. II. Flood, 16th N.Y. Cav., nffe 26. 1 !>", 64. June 1, 1865. New York, age 25. 26, 04. 107th N. Y. Disch d Mar. 2. 65. 621 Skelton, J., Serg t Major, June 28, Right ; flap. Surg. <V. B. Mona- 602 Stevens, W. P.,Corp l,B, Oct. 19, Right ; ant. post. flap. Disch d 2?th Ohio, age 27. . 28, 64. han, 63d Ohio. Disch d Feb. ; 184th N. York, age 19. 19, 04. July 27, 1805. 17, 1805. 003 Stitle, W., Pt., I, 29th May 8, Right ; circ. Surg. A. K. Fifield, 022 Skinner, M. C., Pt., E, June 18, Lett; ( ire. Surg. W. P. Pierce, Ohio, age 21. 9, 64. 29th Ohio. Disch d Aug. 10, 65. 36th Illinois, age 2?. 18, 64. 88th 111. DischM Feb. 27, 1865. March 15, 1800, amp. thigh. 6J3 Slavan. J., Pt., B, 170th June Ifi. Left ; ant. post. flap. Discharged 664 Stoddard, T.,Pt.,G, 64th Mar. 25, Left : circ. Surg. W. J. Burr. 42d New York, age 48. 17. 64. Nov. 7, 1865. Died March 30, New Y r ork, age 19. 26, 65. N. Y. Disch d August 2, 1805. 1873; pyaemia. 665 Stone, J. G., Pt., K, 7th Oct. 1, Right ; circ. A. A. Surg. W. H. 024 Small, R., Pt., F, 34th Nov. 30, Right ; ant. post. flap. Disch d N. Hampshire, age 21. 1, 63. Finn. Disch d April 28, 1864. Colored Troops, age 18. 30, 04. Dec. 23, 186.). Spec. 4188. 025 Smalhvood.W.J.. Lieut., Oct. 1, Left: circ. Sure.C.W. McMillin, GOO Stone, S. H., Serg t, B, Dec. 28, ! Left. Surg. W. C. Shurlock. 51st j A, 7th Kentucky. 1, 62. 1st Teun. Resitrned Jan. 2:i, 03. 37th VVis., age 27. 28. 64. Penn. Disch d June 18, 1805. 026 Smith, A. A., Pt., A, 3d April 9. Left; flap. Surg. F. L. Dibble, 667 Stonebreaker, D. T., Pt., Sept. 22, Right; flap. Disch d June 10, 05. Rhode Island Art rv. 9. 03. Oth Conn. July 10. amp. right F, 14th W. Va., age 22. 22, 04. leg. Disch d August 25, 1804. 008 Stonehouse, J.,Pt.,F,7th June 18, Left ; lateral flap. Disch d Sept. Spec. 1103. Wisconsin, age 21 . 18, 64. 28, 1804. 627 : Smith, G. T., Pt.,F, 13th June 21, Left; flap. Surg.A. W.Whitney, 669 i Storey, J. H. R., Serg t, May 28, Right; circ. Mustered out Jan. Mass., age 22. j 21, 64. Kith Mass. Disch d Oct. 17, 04. F, li)9th Penn., age 25. 28," 04. 17, 1866. 028 Smith, II., Pt., E, llth Sept. 13, Left; flap (amp. arm). Surg. C. 670 Storm, H. F., Pt., C, 71st Aug. 30. Left. A. Surg. J. D. Gatch, 16th ! Vermont, atre 19. 13, 64. B. Park, llth Vermont. Sept. i Indiana. 30, 62. Ind. Disch d Nov. 27, 1862. 26, hsem.; ant. tib. lig. Disch d i71 Stout, J., Pt., D, 101st May 15, Right ; ant. post. flap. Disch d Sept. 14, 1865. Illinois, age 25. 15," 04. January 18, 1865. 629 Smith, If. C., Pt., E, 5th July 22, Right ; circ. Provost Marshal 672 Stratton, C. H., Pt,, F. Feb. 8, Right ; circ. Disch d August 7, Mississippi, age 24. 23. 64. and exchanged. 25th .Massachusetts. 8. 02. 1802. FISHER (G. J.), Report of Fifty-seven Cases of Amputations in Hospitals near Sharpsburg, Md., etc., in Am. Jour. Med. Sciences, Vol. XLV, p. 48. SUKG. Ill 00 474 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Ne. NAME. MILITARY DESCRIPTION. AND AOE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 073 Stricter, J., Pt., K, 56th April 20, Right; circ. skin flap; fibula dis 718 Wagner, D., Pt., H, 90th Dec. 13, Right. Disch d August 5>4, 1864. North Carolina, age 34. 20, 64. articulated. Surg. C. H. Ladd, Penn., age 23. 13, 62. 56th N. C. Retired Jan. 17, 65. 719 Wagner, J., Pt., C, 69th Dec. 13, Left. Disch d December 16, 63. 674 Strock, S. D., Corp l, F, July 2, Right; circ. Surg. J.W.Wishart, Penn., age 36. 13, 62. 140th Penn., age 36. 3, r 63. 140th Penn. Disch d Jan.4, 64. 720 Walbert, J., Pt., D, 25th June 16, Right ; circ.; gangrene. Disch d 675 Sullivan, J., Pt., E, 64th Oct. 4, Left; flap. Disch d April 6, 63. Michigan, age 21. 16, 64. Sept. 13, 1865. Illinois. 6, 62. Died Dec. 2, 1867. 721 Wallace, D., Corp l, A, June 19, Left ; flap. Discharged. 676 Sullivan, M., Pt.. H, 2d June 17, Left : flap. Surg. S. S. French, 10th N. Y. Cavalry. 19, 64. Michigan, age 27. 18, 64. 20th Mich. Disch d Mar. 29, 65. 722 Walker, J., Corp X C, Sept. 19, Left; flap. Surg. S. F. Chapin, 677 Summers, J., Capt., B, May 3, Left ; circular ; gang. Recovery. 139th Penn., age 24. 20, 64. 139th Penn. Disch d Apr. 20, 65. 5th Alabama. 4, fe. 723 Walker, J. S., Pt., K, July 1, Right: flap. Disch d May 31, 678 Sumner, A., Pt., B, 3d May 2, . Ass t Surp-. R. E. Dennis, llth Penn., age 22. 2, 63. 1865. North Carolina. 3, 63. C. S. A. Recovery. 724 Walker, L. J., Pt., B, July 1, Loft; flap. Surg. J. H. McAden, 679 Swank, H. J., Pt., G, Sept. 19, Right ; flap. Discharged April 13th N. C., age 21. 2, 63. 13th N.C. Paroled Oct. 22, 63. 126th Ohio, age 23. 19, 64. 3^1865. 725 Walker, W.S., "Brigadier May 20, Left (also other wounds). Ex 680 Swarman, F., Corp l, E, Sept. 17, Right. Disch d and pensioned. General, age 42. 20," 64. changed Sept. 19, 1864. 12th Massachusetts. 18. 62. 726 Walsh, J., Pt., A, 57th Mar. 25, Left; flap. Surg.W. C. Shurlock, 681 Swarthout, O., Corp l,G, May 12, Left; ant. post. flap. Disch d Mass., age 39. 25, 65. 51st Penn. Disch d Sept. 12, 65. 86th N. Y., age 19. 12, 64. Nov. 10, 1864. Spec. 4018. Died after 1875. 682 Sweet, J. O., Serg t, C, June 9, Right; flap. Surg. S. Maguire, 727 Ward, J., Corp l, H, 56th July 1, Left; circ. Disch d May 21, 65. 12th Ohio, age 21. 9, 64. 45th Ky. Disch d Dec. 20, 1864. Penn., age 31 . 2, 63. 683 Sweetland, L. D., Pt., June 14, Left : flap. Disch d August 26, i728 Warner, J. C., Pt., A, Mar. 19, Right ; flap. Surg.T.B. Williams, E, 128th Ohio. 15, 63. 1863. 12lst Ohio, age 21. 20, 65. 121st Ohio. Disch d June 25, 65. 684 Sweezy, L. A., Pt., F, July 3, Right ; flap. Disch d December 729 Warner. N.C., Lieut., E, Aug. 16, Right; flap. Disch d Dec. 15, 7th Mich. Cavalry. 4, 63. 14, 1863. 39tb Illinois, age 34. 16, 64. 1864. 685 Swett, G. W., Serg t, K, April 23, Right ; circ. Surg. S. C. Gordon. 730 Warner. T., Pt., H, 8th June 3, Right; flap. Surg. G. Chaddock, 30th Maine. 23, "64. 1st La. Disch d June 23. 1864. N. Y. H. Art y, age 32. 4, 64. 7th Mich. Disch d Dec. 12, 65. July 2, Left; flap. Disch d Jan. 19, 64. 731 Warren, J. M., Pt., H, June 1, Right; circ. Disch d Oct. 16, 686 Swett, V. W., Pt., A, 4, 63. Died Mar. 24, 72; phth. pulmo. 106th N. York, age 21. 1, 64. 1864. 14th Infantry, age 22. Oct. 19, Left ; posterior flap. Surg. G. T. 732 Washburne, J., Pt., A, Sept. 29, Left ; circ. Confederate surgeon. 687 Swords, W. J., Pt., H, 20, 64. Stevens, 77th N. Y. Exchanged 142d N. York, age 32. Oct. 1, 64. Disch d June 14, 1865. 51st Georgia, age 20. Feb. 16, 1865. 733 Wathier, F., Pt,, D, 2d Nov. 8, Left. Discharged July 2, 1804. 688? Tanner, J., Corp l, C, Aug. 30, Both ; flap. Discharged October Artillery, age 28. 8, 63. liS .IS 87th New York. 30, 62. 15, 1862. 734 Weber, A., Pt.. D, 20th Sept. 17, Left; ant. post. flap. Surg. J. 690 Tanton. H. J. D., Pt., C, July 2, Right. To Pro. Marshal Sept. New York. 17, 62. Hausen, 20th N. Y. Disch d 47th Alabama, age 33. 3, 63. 10, 1863. Dec. 6, 1862. 691 Tatro, L., Pt., E, 27th May 16, Right ; flap. Disch d A ugust 23, 735 Weber, J.. Pt., H, 150th Mar. 2, Left; circ. Disch d August 30, Massachusetts, age 19. 16, 64. 1865. New York. 3, 65. 1865. 692 Taylor, J., Pt., K, 8th Sept. 20, Left ; flap. Surg. E. M. Seeley, 1736 Webner, C., Pt,,E,lllth June 1, Left; flap. Surg. P. E. Hubon, Kansas, age 23. 20. 63. 21st 111. Disch d May 20, 1864. New York, age 22. 1, 64. 28th Mass. Disch d July 4, 65. 693 Taylor, S., Pt., E, 22d Sept. 14, Left : flap. Surg.W. F. Hutchin- Spec. 4878. New York, age 24. 14, 62. soni 22d N.Y. Disch d Dec. 19, 737 Weeks, H. C., Serg t, E, Oct. 19, Left ; circ. Disch d June 8, 65. 1862. Spec. 2303. 6th N. Y. H. A., age 21. 19. 64. 694 Tebbetts, E. W., Pt., D, May 10, Right; flap. Disch d June 3, 738 Weeks, T., Pt., G, 1st July 3, Left. Surg. Frost, C. S. A. 7th N. Hamp., age 44. 10, 64. 1865. South Carolina, age 19. 3, *63. Exchanged Sept. 25, 1863. 695 Thomas.C., Pt., D, 121st Dec. 13, Lett; gangrene. Disch d Aug. 739 Welch, J., Corp l, A, 52d June 16, Left ; flap. Surg. J. W. Wishart, Pennsylvania, age 26. 13, 62. 12, 1863. New York, age 35. 16, 64. 140th Penn. May, 65, necrosed 696 Thompson, A. E., Pt., A, July 12. Left. Surg. J. L. Dicken, 47th end of tibia removed. Disch d 29th Wisconsin, age Ifi. 12, 63. Indiana. Disch d Oct. 1, 1863. July 29, 1865. Died July Ifi. 1864. 740 Welsh, A., Pt., H, 9th June 29, Left." Surg. Kelly, 12th Ala. 697 Thompson, J. J/., Pt., F, July 2, Left ; flap. Paroled November Pennsylvania Cavalry. , 62. Disch d Sept. 26, 1862. Died 21st Miss., age 20. 3, 63. 12. 1863. Oct. 16, 1865. 698 Thompson, J. S., Pt., F, Nov. 30. Right; circular. Transferred. ;741 Werner, F., Pt., C, 13th July 21, Right: flap. Disch d March 6, 31st Miss., age 21. Dec. I, 64. New York. 23, 61. 1862. 699 Thompson, L., Pt., B, Sept. 1, Right: circ. Surg. S. C. Moss, 742 Wliatlei,. T. J., Pt., D, July 2, Left ; circ. To Provost Marshal 78th Illinois, age 22. 1, 64. 78th 111. Disch d May 26, 1865. 8th Alabama, age 23. 2, 63. Sept. 17, 1863. 700 Thompson. R., Pt., T,5th Sept. 17, Right; circ. A. Surg. S. Adams, 743 Wheoler.W. W., Corp l, May 27. Right ; circ. Disch d January 8, Artillery, age 20. 17, 62. U.S.A. Disch d Mar. 30, 1863. D, 22d Indiana, age 25. 28," 64. 1865. 701 Tinker, W. H., Pt..B,5th Sept. 27, Right. Dr. E. McCuen, Louis 744 Whitbeck. G. H., Pt., E, July 2, Right ; flap. Disch d May 30. 64 . Mo. S. M., age 23. 27, 61. iana, Mo. Disch d Feb. 10, 1862. 134th N. Y., age 19. 3, 63. Died July 21, 77 ; cerebritis. 702 Traut, W., Pt., C, 20th June 17, Right; half circ., with posterior 745 Whitney, A., Pt., B, 5th June 29, Left. Oct. 11, 1862, re-amputa Michigan, age 31. 17, 64. flap. Surg. S. S. French, 2()th Vermont. 30, 62. tion. Disch d Sept, 25, 1863. Mich. Disch d June 24, 1865. 746 Whitten, L. T., Pt., B, Aug. 19, Right; circ. Surg. S. A. Green, i03j Trim, S. H., Pt., B, 41st May 21, Both; circ. Surg. J. D.Jackson. 40th Mass., age 23. 19, 63. 24th Mass. Discharged. 704) Alabama, age 19. 21," 64. 44th Tenn. Furl d July 13. 64. 747 Wieland, J., Pt., A. 43d April 6, Right; flap. Disch d October 10, 705 Troy, B. F., Pt., G, 10th May 16, Right; left leg amp., mid. third. Illinois. 6, 62. 1802. Iowa. 1C, 63. Disch d Sept. 3, 18(i3. 748 Wike, G., Pt,, F, 55th Sept. 29, Left; flap. A. Surg. H.C. Merry- 706 Tucker, J. M., Pt., A, Aug. 29, Left; circ. Disch d Mar. 0, 18(i3. Pennsylvania, age 23. 29, 64. weather, 5th Col d Troops, and 20th Indiana. 29, 62. Died March 20. 1864. Surg. T. H. Squire, 89th N. Y. 707 Turner, C.A.,Pt., 1, 13th June 5, Left: ant. post. flap. Surg. A. W. Disch d May 17, 1865. Mass., age 21. 5, 64. Whitney, 13th Mass. Disch d 749 AVilbur, M. J., Pt., C, May 27, Right; circ. Surg. B. B.Wilson. Nov. 6,"65. Died Aug. 17, 1875. 261 h Maine. 27," 63. U. S. V. Disc-h dAug. 17, 1863. 708 Twaits, J. B., Serg t, H, Aug. 29, Left. Discharged Feb. 9, 1863. 750 Wilds, J., Pt., K, 121st Feb. 6, Right; circ. Mustered out May 14th N.Y. S. M.. age 24. 30. 62. Pennsylvania, age 25. 6, 65. 18, 1865. 709 Twinem, H., Pt..A, 122d May 6, Left ; flap. Surg. Gillispie,C.S.A. 751 Wilkins, J. H.,Corp l,E, June 14, Right ; ant. post. flap. Disch d New York. 7, r 64. Disch d Julv20, 65. Died, 1874. 1st Louisiana, age 25. 14, 63. Aug. 9. 1804. Spec. 4371. 730 Uncleson, J.. Landsman, Mav 3, Right. Disch d April 3, 1865. 752 Williams, G.,Pt.,G,50th April 10, Left; ant. post, flap; circ. sect. IT. S. Gunboat Com. 4, 03. 1875. chronic ulcer; necrosis. Colored Troops, age 35. 10. 65. muscles. Disch d June 10, 05. Barney, age 23. ,753 Williams, G., Lieut., 4th July 2, Right : flap. Retired November 711 VanAlstyne, I., Pt., B, June 3, Left ; circ. Surg. J. W. Wishart, Infantry. 3, 63. 11, 1803. 7th N. Y. Heavy Artil 3, 64. 140th Penn. Disch d Aug. 9, 754 Williams, G., Quarter- Mav 25, Loft : flap. Act. Staff Surg. C. B. lery, age 23. 1865. mast s emplove\age 20. 26," 65. Richards. U. S. A. 712 Van Fosson, W. E., Pt., July 3, Right : circ. Surg. C. B. Gibson, 755 Willson.C. C., Pt., I, 6th Aug. 5, Left : flap. Disch d October 16, F, 52d Virginia. 5, 63. C. S. A. Retired Feb. 17, 1865. Michigan. 5, 62. 1802. 713 Vincent, G. W., Pt., D, June 16. Right ; ant. post. flap. Surg. J. 756) Willson.S. L.,Pt.,D,72d July 2, Both : flap. Surg. C. K. Invin, 88th New York, age44. 18, 64. W. Wishart, 140th Penn. Dis 757 ( New York, age 18. 3, 63. 72d N. Y. Disch d May 31, "05. charged March 2. 1865. i758 Wilson, J.E.,Pt.,G, 67th June 16, Loft: flap. Mustered out July 714 Vining, R. H., Pt., H, June 15, Left ; circular. Surg.G. A. Colla- Now York, age 23. 16, 64. 15, 1805. 112th Illinois, age 16. 15, 64. more, 100th Ohio. Discharged 759 Winklehaus, J., Pt., K, Sept. 17, Left ; lat. flap. Surg. C. S.Wood. Feb. 21, 1865. 66th New York. 17, 62. 00th K. Y. Disch d Nov. 6, 62. 715 Vogt, G., Pt., D, 61st July 20, Left. Discharged June 22, 1865. 760 Winn,B. D., Pt., A, 143d May 6, Left; circ. Disch d June 15, 65. Ohio, age 27. 21, 64. Pennsylvania, age 24. 8, 64. 716 Vorce, E., Pt., B, 14th May 12, Left ; flap. Disch d May 20, 65. 701 Winn. J. W., Corp l, B, Sept. 14, Left. Disch d December 22, 62. Infantry, age 35. 12, 64. Died August 23, 1870. 6th Wisconsin. 14, 62. 717 Vossler, J., Pt., G, 16th Oct. 7, Right ; circ. Disch d July 6. 65. ; 762 Winstead, T. T., Pt., I. July 2, Right : flap. Surg. J.W. Tracey. N. Y. H. Art y, age 20. 7, 64. 30th N. C., age 18. 2, 63. 14th N. C. Exch d Nov. 12, 03. SECT. V.I PRIMARY AMPUTATIONS IN THE LEG. 475 No. NAMK, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS. OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 763 Wisnor. .1. \V., Ca-t., D, April 9. Left. Surg. C. Davis, 97th 111. 805 Cain.C., Pt., D, 52d New June 16, Right. Surg. G. L. Potter, 145th 97th Illinois. 9, (15. Mustered out May 15, 1865. York. 16, 64. Penn. Died June 24, 1864. 764 Wondens, G.,Pt.,B, 14th June 2, Right. Discharged Aug. 6, 1861. 806 Cain, T., Pt., E, 96th N. Sept. 29, Right. Died October 15, 1864 ; Pennsylvania. 2, 61. York, age 40. 29, 64. exhaustion. 765 Wood, J. 1$.. Lieut., M. June 21, Right; post. flap. Disch d Oct. 807 Camp, W. H., Pt., I, 40th June , Left. Died July 3, 1864. ]7tb I enn. Cav. .age 24. 21. 63. 6, 1863. Alabama. , 64. 766 Woolley. 11. A., Pr., F, July 2, Right. For exchange Nov. 12, 808 Campbell, D.;Pt.,E, llth June 3, Right; circular; bone necrosed. 8th Alabama, age 52. 3, "6:5. 1863. N. Hampshire, age 28. 3, 64. Died July 12, 1864. 767 Wucherer, C.. i t., D, Aug. 22, Left. Confederate surgeon. Dis 809 ^Cannon, S. />., Pt., D, May 18, Left. Died June 25, 1864 ; gan Gist Ohio. 23. 62. charged Nov. 27, 1862. 2d Ala. Cav., age 22. 18, 64. grene. 708 Yarian, J., Pt., A. 35th Hoc. 16, Left; ant. posterior flap. Disch d 810 Carman, L. A., Serg t, A, Oct. 19, Right. Ass t Surg. H. M. Lyons, Indiana, age 27. 16, 64. May 25, 1865. 24th Iowa, age 22. 20, 64. 24th Iowa. Died Nov. 14, 1864 ; 769 Yoder, A.,Corp l, E,55th May 16, Left; flap. Confederate surgeon. irritative fever; exhaustion. Pennsylvania, age 24. 18, 64. Disch d June 8. 1865. 811 Carney, P., Pt., A, 48th July 12, L t. A. Surg.R. L.VonHarlingen, 770 Young, L.R.,Pt.,K, 31st June 17. Right: circ. Surg. J.D.Mitchell, Illinois. 12, 63. 53d Ohio. Died July 26, 1863. Maine. 17, 64. 31st Maine. Disch d Jan. 14, 65. 812 Carr, C. C., Pt., D, 14th Oct. 19, Left; circular: sloughing. Died 771 Yunkings, E.,Pt..H, 42d Dec. 13. Left; cire. Disch d June 29, 63. N. Hampshire, age 21. 20, 64. Nov. 25, 1864 ; anaemia. Pennsylvania. 15, 62. 813 Carroll, P.,Corp l,C, 22d Dec. 29, Left ; erysipelas. Died Feb. 2, 772 Abbert. C., Pt., A, 38th June 17, Left. Died June 21, 1864. Kentucky. 29, 62. 1863. Wisconsin. 17, 64. 814 Carter, J., Pt., I, 10th Aug. 21, Left; flap. Died Sept. 15, 1864; 773 Adams, I. N., Serg t, K, Sept. 1, Left. Died November 4, 1864. Florida, age 46. 22, 64. pyaemia. 125th Illinois. 1, 64. 815 Cecil, H.,Pt.,B. 3d Iowa. July 12, Left. Died July 22, 1863. 774 Adams, J., Pt., G, 59th June 30, Right ; ant. posterior flap. Died 12, 63. Massachusetts, age 21. 30, 64. August 8, 1864 ; pyaemia. 816 Chaffee, W. R., Pt., A, May 16, Right; flap. Died August 31, 775? Albert, J., Pt., F, "1st Oct. 12, Both. Died November 4, 1864; 142d N. York, age 28. 16, 64. 1864. 776J New York, age 19. 13, 64. pyaemia. 817 Chase, H. C., Serg t, B, April 9, Right. July 1 8, bone exfoliated. 777 Alexander. R., Pt., L, 2d Aug. 14, Right ; circ. Died Sept, 7, 1864 ; 30th Maine, age 28. 10, 64. Died July 20, 1864; gangrene. N.Y. H vv Art., age 42. 14. 64. gangrene. 818 Clark, G. W., Pt., C, 93d April 2, Left: circular. Died April 28, 778 Atkinson, .!., I t., I, 4th July 12, Left; flap; head of fibula excised. Penn., age 36. 3, 65. 1865; pyaemia. Iowa. 14, 63. Died August 3, 1863. 819 Clark, J. W., Serg t, I, July 19, Left. Surg. E. Shippen, U. S. V. 779 Babcoek. E., Pt., B, 10th April 2, Left. Died May 9, 1865; exhaus 129th Indiana, age 37. 19, 64. July 19, haem.; lig. of ant. tibial ; N.Y. H vv Art., age 39. 2, 65. tion. gangrene. Died Sept. 19, 1864. 780 Barry, J., Pt., D., 2d N. May 16. Right; haem., 20 oz. May 25, 820 3 Cloar, W. F., Pt., A, 33d Aug. 30, Right; flap. Sept. 21, gangrene. Hampshire, age 20. 16, 64. amp. thigh. Died May 30, 64 ; Tennessee, age 24. 30, 64. Oct. 5, haemorrhage. Died Oct. exhaustion. 12, 1864 : pyaemia. 781 Bartholomew, A. L., Pt., June 5, Left. Died June 28, 64 ; pyaemia. 821 Closson, 1. H., Capt., H, Oct. 27, Right. Died" November22, 1864. F, 3d Vermont, age 25. 5, 64. 91st Pennsylvania. 27, 64. I C.-, Basum, A., Pt., F, 63d May 5, . Surg. G. T. Stevens, 77tb 822 Cochrane. J., Lieut,, K, May 16, Lett. Died May 28, 64 ; exhaus- Pennsylvania. 5, 64. N. Y. Died May 18, 1864. 67th Ohio, age 28. 16, 64. tion from haemorrhage. 783 Bell, J. W.,Corp l, 1, 73d Mar. 19, Right. Died March 30, 1865. 823 Coleman, J., Pt., F, 75th May 7, Left. Died May 10. 1862. Ohio. 19. 65. Ohio. 7, 62. 784 Bennett. C., Pt., G, 2d June 28, Right. Surg. J.W.Wishart,140th 824 Collins, T., Pt., K, 1st June 18, Left ; ant. post, flap ; gangrene. New York Artillery. 28, 64. Penn. Died July 27, 1864. Me. H vyArt.,age21. 19, 64. Died July 9. 1864. 785 Bernhard, A., Pt., K, 4th Feb. 25, Right. Mar. 5, 18, hasm., 16oz. 825 Corey, O. M., Pt., H. Oct. 19, Right. Oct. 29, haem.; amputa Ohio Cavalry, age 35. 25, 64. each time; lig. popliteal. Died 114th N. York, age 21. 19, 64. tion thigh. Died Nov. 11, 1864. March 22, 1864 ; pyaemia. 826 Corser, C. M., Pt., H, 1st June 1 9, Right (wound of arm, hip, and 786 Bing, A., Lieut., A, 2d Oct. 3, Left (haemorrhage). Died Oct. Ohio Artillery. 20, 64. foot). Died June 25, 1864. Iowa. 4, 62. 5, 1862. 827 Coverdale, J. B., Pt., A, Nov. 7, Left. Died November 28, 1861. 787 Blair, L., Pt., F, 9th Ver Sept. 28, Left. Died November 13, 1864; 22d Illinois. 9, 61. mont. 29, 64. pyaemia. 828 Croyle, J., Pt., I. 54th Sept. 19, Right ; ant. posterior flap. Died 788 Boring, R. M., Pt., K, July, Right. Died July 23, 1863. Pennsylvania, age 20. 20, 64. Dee. 20, 1864 ; typhoid fever. 4th Georsria. >p,3 829 Cummings, J. S., Pt., B. June 18, Left; circ. Surg . B. N. Bond, 789 Boughton, S. E., Pt..G, June 27. Right ; flap. Surg.W. H. Hoag, 70th Ohio, age 16. 18, 64. 27th Mo. Died July 7. 1864: 134th N. York, age 21. 27, 64. 134th N. Y. Died Feb. 17, 65 , pneumonia. typhoid pneumonia. 830 Davis, J. D.. Corp l. D, June 6, Left ; ant. post. flap. Surg.A. T. 790 Bowen, F. P., Lieut., L, May 28, Left; circ. Died June 15, 1864 ; 33d Missouri, age 23. 6, 64. Bartlett, 33d Mo. Died Oct. 4th Penn. Cav., age 26. 28. 64. pyaemia. 11, 1864. 791 Bovd, J.. Pt., D, 52d June 28. Right; circ. Died Aug. 7, 1864 : 831 Dawson, H., Pt., A, 49th May 10, Left ; ant. post. flap. Surg. F. M. Ohio, age JO. 28, 64. exhaustion. New York, age 25. 10," 64. Everleth. 7th Me. Died June 792 Boyer. J., Pt., I, 102d July 2, Right, Died July 3, 1863. 16, 1864 ; exhaustion. New York. 3, 63. 832 Dean, W., I t., B, 1st Oct. 29, Right ; flap. Died March 25, 65 ; 793 Boyle, P., Pt., B, 19th Aug. 26, Right (also wound of thigh and Cavalry, age 39. , 64. chronic diarrhoea. Georgia, age 51. 26, 64. scrotum); ant. post. flap. Died 833 DeHoff, E., Pt., H, 38th Aug. 7, Left ; ant. post, flap ; gangrene. Sept. 2. 1804; exhaustion. Ohio, age 33. 7, 64. Dec. 5, amp. thigh. Died Jan. 794 Bradley. J., Maj., H2d Dee. 13, Left. Died Jan. 3, 1863 ; tetanus. 16, 1865. Pennsylvania. 13. 62. 834 Dempson, C., Corp l, G, May 12, Left. Died June 9, 64 ; pyaemia. 795 Branson, \V., I t., I, 8th July 5, Right (also wound lung). Died 32d Mass.. age 32. 12, 64. New York Cavalry. 5. 63. July 25. 1863. Spec. 3843. 835 Densmore, F. M., Pt., F, July 20, Left. Died July 24, 1864. 796 llrileii, E., I t., F, 2d Sept. 27, Left; circ. Died Nov. 9, 1864; 40th Indiana. 20, 64. Tennessee, age 2(i. 27. 64. exhaustion. 836 Dewes, J. S., Pt., H, 18th May 1 2, ; post. flap. May 12, partial 797 Erodes, K., Pt., E, 8th Aug. 21, Right; circ. Died Oct. 6, 1864; Virginia. 14," 64. exc. Surg. C. B. Gibson.C.S.A. Maryland, age 03. 21. 64. gangrene. Died May 21, 1864. 798 Brooks, H., Pt., K, 20th Mar. 25. Right: typhoid symptoms. Died 837 Dillon, J., Pt., E, 56th July 30, Right; long posterior flesh flap. Michigan, age 22. 25. 65. April 14, 1865. Mass., age 43. 30," 64. Surg. T. V. Oakes, 56th Mass. 799 Brown, G., Laborer, Aug. 9. Right. A. Surg. J. T. Calhonn, Died Ausr. 6, 1864 ; exhaustion. Quartermaster s Dep t- , 64. IF. S. A. Died August 29, 1864 ; 838 Dimond, J., Serg t, K, Mav 12, Left. Surg. J. W. Wishart, 140th went. pyaemia. Spec. 4152. 61st New York. 12, 64. Penn. (Tibialartery wounded.) 800 Brown, H. G., Corp l, B, June 17. Right; circ. July 21, amputat n Died Mav 12, 1864. 37th Wisconsin, age 21. 17. 64. thigh ; 31, three inches femur 839 Droker, A., Pt., B, 57th Dec. 31, Left. Died January 8, 1863. removed. Died Aug. 3, 1864; Indiana. 31, 62. pyaemia. S>c.s-. 2897, 2945. 840 Dunham, J. H., Pt., D, Oct. 27, Right. Surg. N. Y. Leet, 76th 801 Brown, W., Pt., B, 174th Dec. 7, Left ; ant. post. flap. Surg. F.W. 117th N. Y., age 32. 27, 64. Penn. Died Xov. l 7/64; pj-aem. Ohio, age 32. 7, 64. Morrison, ]74th Ohio. Died 841 Eldred. H. E., Pt., E, 2d June 18, Left; circ. June 25. gangrene. Dec. 23. 1864 ; pyaemia. U. S. Sharpshooters.age 18, 64. July 1 , amputation thigh. Died 802 Bryan, C., Pt., H, 119th May 10, Left. Died June 23, 1864. 27. July 6, 1864 ; tetanus. Pennsylvania, age 24. ," 64. 842 Engleman, W., Pt., K, June 10, Right ; circ. Surg. J. Wasson, 803 1 Bandy, C., Pt., F, 6th May 10, Left ; circ. Died June 17, 1864 ; 9th Iowa Cav., age 14. 10, 64. 9th Iowa Cavalry. Died July Wisconsin, age 30. 11, 64. pyaemia. 1, 1864 : exhaustion. 804 Burns, J., Pt., F, 140th Dec. 7, Left; flap. Surg. H. B. Johnson, 843 Evans, If., Pt., E, 25th Aug. 21, Right. Died September 11 , 1864. Indiana, age 22. 7. 64. 115th Ohio. Died Feb. 26, 1865. South Carolina, age 45. 21, 64. LlDELL (J. A.), Example of Pyarthrosis and Spreading Osteomyelitis, in U. S. Sanitary Commission Memoirs, New York, Surg. Vol. 1, p. 395. 2 O KEEFE (D. C.), Surgical Cases of Interest, treated at Institute Hospital, Atlanta, Ga., May and June, 1864, in Confederate States Medical and Surgical Journal, Volume 2, p. 29. 3 JONES (J.), Case of Pyiemia Supm-ening upon Hospital Gangrene, in U. S. San. Com. Memoirs, New York, 1871, Surg. Vol. II, pp. 3:!7 and 439. 476 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. XT i- NAME, MILITARY Ol EItATlOXS, OPERATORS, XTri NAME, MILITARY T* * TI7C OPKISATIOXS, OPERATORS, iso. DESCRIPTION, AND A(,R. RESULT. DE8CRI1TION, AND AGE. RESULT. 844 Everson.J., Pt., P, lllth June 19, Right. Surg. G. L. Potter, 145th 887 King, T., Serg t, C, 71st July 2, Left. July 15, haem. Died July New York. 19, 64. Penn. Died July 8, 1804. New York, age 20. 3, 63. 15, 1803. 845 Fieger. J., Corp !, B,98th April 2, Right ; circ. Died" May 18, 1865 ; 888 Knapp, A. J., Pt., F, 93d May 14, . Surg. J. B. Rice, 72d Ohio. Pennsylvania, age 30. 2, 05. exhaustion. Indiana. 14, 63. Died July 27, 1863. 840 Fleshman, E., Pt., E. June 27, Left. Surg. A. M.Wilder.U.S.V. 889 Knowlton, C. C., Pt., I, Sept. 20, Left. Oct. . slough.: maggots ; 118tu Ohio. C-7. 64. Died July 19, 1864. 22d Mass., age 22. 20, 02. bed-sores. Died Oct. 13, 1862. 847 Fry, G., Pt., K, 16th May 14. Left. Died May 19, 1864. 890 Kronmiller, G., Pt, C, July 9, Left. Surg. T. F. Oakes, 56th Kentucky. 14," 64. 14th New York Heavy 10, 64. Mass. Died October 8, 1804. 848 Fuller, B. ZT.,Pt.,B, 12th July 9. : double flap. Surg. C. H. Artillery, age 38. Spec. 6529. Georgia. 10, 64. Todd, C. S. A. Died Aug. 19, 891 Laws, C., Pt., E, 43d July 30, Left; circ. Surg. D. MacKay ,29th 1864; exhaustion; diarrhoea. Colored Troops. 30, 04. Col d Troops. Died Aug. 6, 04. 849 Gaylord, A., Pt., B, 75tb Oct. 8, Right. Died October 14, 1862. 892 Lease, H. A., Pt.,E, 14th Oct. 4, Left. Died Nov. 14, 62; wound Illinois. 8, 62. Missouri. , 02. and amputation. 850 Gibson, W., Serg t, C, June 17, Right. Died June 18, 1804. 893 Lee. H., Pt, D, 9th Col Dec. 5, Right; flap. A. A. Surg. J. S. 27th Michigan. 17, 64. ored Troops, aged 21. 6, 64. Giltner. Died Dec. 23, 1864 ; 851 Gillatt.C.W., Pt.,A,56th July 1, Right. Died June 23, 1804 ; chr. . pyaemia. Pennsylvania, age 19. 2, 03. diarrhoea; phthisis pulmonalis. 894 Leininger, A., Pt., E, April 2, Right ; flap. Died May 17, 1865; 852 Gillespie, J., Pt., ! , 59th Dec. 15, Right: ant. post, flap ; gangrene. 98th Pennsylvania. 2, 65. exhaustion. Illinois. as;e 29. 15, 64. Died Feb. 2, 1805; gangrene. 895 Lenzenmeyer, R., Serg t, July 3, Right. Died July 23, 1863. 853 Goddard, J. F., Pt.. A, July 22, Right ; ant. post. flap. Died Jan. F, 2d Pennsylvania. 3, 63. 57th Georgia, age 28. 22." 64. 1, 1865; chronic diarrhoea. 896 Lewis, J. R., Pt., G, 53d July 3, Right (also amputat n left thigh). 854 Goodell, L., Pt., C, 2d Nov. 4, Left; ant. post. flap. Surg.W. J. North Carolina, age 32. 3, 63. Surgeon J. J. Knott, P. A. C. S. Vermont, age 2:!. 4, 63. Sawin, 2d Vt. Erysip.; gang.; Died July 10, 1863. tibia exfol. Died June 6, 1864 ; 897 Limb, W. P., Pt., B,26th June 20, Right. Surg. W. B. McGavran, pseudo-membranous croup. Ohio. 20, 64. 26th Ohio. Died Aug. 8, 1864. 855 Gould, J. L., Serg t, G. July 2, Left. Died July 8, 1863. 898 Linch, N., Pt., B, 163d Dec. 13, Right. Died December 21, 1862. 4th Texas. , 63. New York. 13, 62. 856 Greenhart, H.. Pt.,G.9th Oct. 19, Left ; flap ; erysipelas. Died Oct. 899 Lympus, N. S., Pt., K, Dec. 13, Left ; flap. Acting Staff Surg. C. Connecticut, age 45. 19, 64. 31, 1864; tetanus. 10th Iowa. 13, 64. B.Richards, U.S.A. (Alsow nd 857 Groesbeck, W., Pt., B, Aug. 0, Right. Died August 25, 1864. of arm.) Died Dec. 14, 1864. 74th Indiana. 6, 04. 900 , Lynch, M., Serg t, C, 2d Oct. 19, Right. Died December 14, 1864. 858 Hagan, P., Pt., A, 7th Sept. 19, Left ; oval skin flap ; anaemia ; Vermont, age 22. 19, 64. Michigan. 19. 64. gang. Died Oct. 19, 64 ; pysem. 901 Maddox, W. /., Pt., A, May 3, Right, Surg. J. J. Knott, P. A. &>9 Hammer, H., Pt., F, 15th Nov. 25, Right; circ.: gang. Died Dec. 53d Georgia. , 03. C. S. Died June 18, 1863. Indiana, age 24. 27, 63. 6, 1803. 902 Marcev, H. P., Pt., K, May 17, Right; flap. June 8. haemorrhage. 8CO Hammond, S., Pt., B, July 12. Left. Surg.W. Lomax, 12th Ind. llth Penn. Cav.,age 23. 17, 64. Died June 25, 1864: haem. 1,7th Indiana. 12, 63. Died August 5, 1803. 903 Martin, D., Pt., C,~28th Nov. 27, Right. Died December 17. 1863. 801 Han-is,.!), W. 11., Pt., B, May 10, Right : ant. post, flap : sloughing. Pennsylvania. 27, 63. 4ih Michiiran, age 24. 10, 64. Died May 21, 1804; p3 aemia. 904 McCard le, J., Pt., E, 2d July 2, Left (also amp. right, low. third). 862 Ilaskill, J.M., Serg t, A, July _ , Left (also right knee); sloughing. Penn. Artillery, age 23. 2, 64. Died July 3, 1804. 3-Jd Mass., age 28. 3, 63. Died Aug. 25, 1803; diarrhoaa. 905 McCarmichael A., Pt., Nov. 30, Left ; ant. post. flap. Died Mar. 863 Hawkins, G. W., Capt., Oct. 27, Left. Surg.M. S. Kittenger, 100th D, 7th Miss., age 43. Dec.1, 64. 3, 1805. I, 97th Pennsylvania. 27, 64. N. Y. Died Oct. 27, 1804. 906 McCluskev, P., Serg t, Dec. 13, Left. Jan. 3, 63, haem.; lig. post. 8G4 Hayden, F.W.,"Serg t,F, 34th Mass., age 25. Oct. 13, 14, 64. Left ; ant. post. flap. Died Nov. 9, 1864; exhaustion. 907 F, 26th N. Y., asre 27. McDemitt, T. J., Pt., E, 13, 62. May 10, tibial. Died January 11, 1863. Right ; flap. Died September 8, 665 Hill, J., Pt., A, 32d May 11, Right; ant. post. flap. May 22, 49th Penn., age 25. 10, 64. 1864. i Massachusetts, age 49. 12, 04. haem. Died May 22, 64 ; pysem. 908 McDermott, O., Pt, M. June 20, Left ; ant, post. flap. Surg. C. C. 8GG Hindman, W. S., Pt., E, May 23, Left. June 24, amputation thigh. 1st Mass. H vy Art y, 20, 64. Jewett, 16th Mass. Died July 155th Penn., age 20. , 64. Died June 24, 1864. age 30. 17, 1864. Spec. 4579. 807 Hoasch, G.,Pt., E, 110th July 9, Left: circ. A. A. Surg. W. S. 909 McDevift, J., Pt., I, 7th June 3, Left; circ. Surg. J. Harris, 7th Ohio, age 45. 11, 64. Adams. Aug. 4, haem.: lig. post. Rhode Island, age 27. 3, 64. R. 1. Gangrene. Died July 8, tilt. Died Aug. 8, 64 ; haemor 1 864 ; pyaemia. rhage. Spec. 3829. 910 MoElhannon, W. J., Pt., June 26, Right (also five other wounds). 808 Holmes, R. A. R., Pt., T, May 16, Right ; circ. Died May 27, 1864 ; B, 45th Illinois. , 63. Died July 15, 1863 ; pyaemia. 3d N. Ham p., age 35. 16, 64. exhaustion. 911 McLean, M., Pt., B, 80th May 27, Right. Surg. J. T. Woods. 9!>th 809 Hough, J., Serg t. H, 15th Aug. 19, Right; flap. Died Aug. 31,1864 ; Illinois. 27," 64. Ohio. Died June 1, 1864. N.Y. H vyArt.,age47. 19, 64. exhaustion. 912 McMillan. J., Pt., H, 4th June 24, Right : circ. A. Surg.W. B. Price, 870 Hufnagle, J., Pt., A, 4th May 12, Right ; circ. Died June 8, 1864 ; Penn. Cavalry, age 18. 26, 64. 4th Penn. Cavalry. Died July Vermont, age 34. 12," 64. dysentery. 9, 1804: asthenia. 671 Hughes, G., Pt., I, 8th June 1, Left ; apparently flap. Died July 913 McNeil, F., Pt., E, 114th Sept. 19, Right ; circ. Surg. L. P.Wagner. North Carolina. 2, 64. 9, 1804 ; exhaustion. New York, age 23. 19, 64. 114th N. Y. Died Oct. 8, 180-1 : 872 Hunt, T., Pt., A, 44th July 3, Right. Died July 25, 1863. pyaemia. New York. , 03. 914 Mensen, M., Pt, E, 22d May 25, Left. Died June 12, 1804. 873 Hunter. J., Corp l, B, 7th Oct. 5, Left; flap. Died Oct. 21, 1804; Wisconsin. 25, 64. Illinois. 5. 64. exhaustive suppuration. 915 Metz, J. H., Pt., G, 9th July 11, Left; lat. flap. Surg. J. Wilson, 874 Ingram, G. W., Pt., A, .Tnlv 2 T.pft .Tnlw 90 " huwnnrrh 12 ra Veteran Reserve Corps, n," G4. Med. Insp. U. S. A. Died July 08th Penn., age 25. 4, 63. Died July 24, 63; haemorrhage. age 33. 28, 1864; exhaust n. Spec. 3100. 875 Johnson, C. L., Pt., B, Aug. 6, Right (also amptitat n left thigh). 916 ; Mier, J., Pt., I, 113th June 27, Left. Died July 0, 1864. 1st Tennessee. 6, 04. Died August 21, 1804. Ohio. 27, 04. 870 Johnson, F., Pt., D,117th Oct. 27. Right (also flesh wound). Died 917 Miller, J., Pt., D, 157th June 17, . Died June 23, 1804. Col d Troops, age 20. 27, 64. Nov. 16, 1864: exhaustion. Pennsylvania. 17, 64. 877 Johnson, J., Pt., E, 57th May 27, Right : flap. Surg. E. B. Glick, 918 Miller, L., Pt., K, 56th April 19, Left ; ant. skin and post. mus. skin Indiana, age 31. 27, 64. 40th Indiana. Died Sept. 1, 64. N. Carolina, age 26. 19, 64. flap. Surg. C. H. Ladd, 50th 878 Johnson. H., Pt., D, 7th June 17, Left. Died June 29, 1804. N. C. Probably died. N. Hampshire, age 21. 17, 64. 919 Miller, M., Pt., B, 40th Dec. 31 , Left. Died December 31. 1802. 879 Johnson, R. H., Pt., C, ; Sept. 29, Right. Surg. T. H. Squire, 89th Indiana. 31, 62. 139th New York. 29, 64. New York. Death (?). 920 Miller. W.,Serg"t,G,45th May 2, Left; flap. Died May 28, 1863. 880 Hauler, N., Pt., A, 100th Nov. 25, Loft: including head of fibula; New York. 3, 63. Illinois, age 24. . 27. 63. gang. Died Dec. 10, 1864. 921 Moffitt, B. L., Lieut., , May 5, Right (also flesh wound of leg). 881 Kennedy E Pt F 13th v,.v. t T ,><*. ,.;... .,,1.,,. i\;..,i I A V pr.r TprCpV 5, 64. Died May 8, 1864. Virginia, age 25. 7, 65. exhaustion. 922 Molter, P., Pt., H, 6th May 10, Left; cire.- diarrhoea. Died July 882 Kennedy, J.rpt., A. (,9th June 3. Right : flap. Surg. J. A. Spencer, Wisconsin, age 23. 11, 64. 6. 1864; exhaustion. Spec. 3574. New York, age 30. : 5, 64. 69th N. Y. N. G. Died June 12, 923 Monaghan, M., Pt., C, 2d June 16, Left ; C irc. July 20, lig. femoral ; : 1864: exhaustion. Michigan, age 43. 17, 64. gangrene. Died J uly 25, 1804 ; 883 Kenion, R., Pt., E. 149th June 27, Left ; flap. Surg. J. L. Dunn. haemorrhage. New York, age 25. 27, 64. 109th Penn. Died Mar. 4, 1865; 924 Moody, J., , , age 20. May . . Died May 28, 1863. small-pox. ," 63. 884 Kennerson, A.. Serg t. K, June 10, Right; lateral flap. Died Aug. 925 Moore, J. H., Lieut., A, Sept. 1, Left. Surg.W. Lomax, 12th Ind. 17th Maine, age 33. > 16. 64. 4,1864. 100th Indiana. 2, 64. Died October 1, 1864. 885 Kimple, A.. Lieut., C, . Aug. 31, Right. Died September 17, 1804. 926 Aoore. W., Pt., K, 14th July 20, Left. Died Aug. 4, 04 ; nervous 25th Iowa. 31. 64. ; West Virginia, age 34. 21, 64. prostration and emaciation. 886 King, H. M., Corp l. H, May 5, Right. Surjr. J.W.\Visliart,140th 927 Morse, J.,Pt.,B, 2d Penn. July 10, Right. Haemorrhage. July 25, 145th Penn., age 27. , 7, 64. Penn. (Gangrene.) Died May H vy Artillery, age 22. , 64. 1864, amp. thigh. Died August 27, 1864; exhaustion. 10, 1864 ; pyaemia. LlDKLL (J. A.), Example, of Osteomyelitis with Thrombosis, in U. S. Sanitary Commission Memoirs, New York, 1870, Surgical Volume I, p. 404. and American Journal Medical Sciences, N. S., 1872, Vol. LXIV, p. 358. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 477 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AXD AGE. DATES. OPERATIONS, OPERATORS, RESULT. 923 Morris, S. P., Serg t, K, July 2, Left. Died July 12, 1863. 973 Snodderv. L..Pt..II. 57th June 14, Left. Died July 14, 1864. 20th Pennsylvania. 2, 63. Indiana. , 64. 929 Mullen, W., Pt., J, 105th Aug. 12, Left; flap; diarrhoea. Died Aug. 974 Snodgrass, J., Pt.,C,36th June 27, Left ; circ. Surgs. H. E. Hasse, Pennsylvania, age 40. 12, 04. 29, 1864. Illinois. 27, 64. 24th Wis., and W. P. Pierce, 930 Murphy, It. /., Pt., C, May 3, Left; ant. post, flap; erysipelas. 88th Illinois. Died July 17, 64. 45th Georgia, age 35. 3, 63. Died May 24, 1803; gangrene 975 Snow, J., Pt., C, 169th June 30, Left; large post, and inus. flap; of stump. New York, age 27. 30, 04. sloughing; haemorrhage. Died 931 Murphy, T. J., Pt., H, Sept. 19, ; circ.; typhoid fever. Died October 15, 1864. 30th North Carolina. 19, 04. October 10, 1804 ; cachexia. 976 Stalze, W. B., Corp l, B, July 18. Right; haem. from gangrenous 932 Newell, R. J., Corp l, D, July 1, Right. Sura;. S. H. Plumb, 82d 62d Ohio. , 03. stump, fatal July 31, 1803. 19th Maine. . " 03. N.Y. Died July 10, 1863. 977 Stanley, W., Lieut., G, Deo. 15, Left; circ. A. A. Surg. A. Rolls. 933 Nichols, F. C., Pt., F, Sept. 19, Eight; flap. Died October 5, 12th Mo. Cav., age 30. 17, 04. Mortification. Died Deo. 19. 04. 159th New York. 19, 64. 18b 4; gangrene. 978 Sullivan, H., Pt., D,llth July 2, Left. Died November 25, 1864. 934 O Daniel, T., Pt., F,37th June 11, Right. Died July 4, 1804. Mass., age 39. 4, ? 63. Kentucky, age 18. 11. 04. ; 979 Swain, F. F., Capt,, E, Aug. 6, Right. Surg. J. \V. Lawton, U. 935 Odom, J., "Serg t, H, 21st Aug. 21, Right. Surg. A. A. White, 8th 123d Indiana, age 45. , 04. S. V. Gang. Died Aug. 23, : G4. South Carolina, age 30. 21, 64. Md. Died Sept. 13, 1804. 980 Taft, G. R., Capt., A., June 14, Right; gangrene; harm rrhago ; 930 Oliver, H., Pt., K, 19th July 3, Right. Surg. A. J. Billings, 19th 53d Massachusetts. 14, 63. lig. femond. Died July- 1 !. 1H03; Maine. 3, 03. Maine. Died July 11, 1803. pyaemia. 937 Osborne, W., Serg t, K, June 17, . Surg. G. L." Potter, 145th 981 Theobald, D.,Pt.,G,97th June 18, Right. Died June 2, 1804. 57th New York, age 42. 17, 64. Penn. Died July 2, 1864. New York. 18, 64. 038 : Owens, T. D., Pf., H, May 22, Left ; pvaemia. Died July 12, 982 Thewing, H. S., Pt.. C, May 31, Right; ant. post, flap; sloughing. 81st Illinois, age 25. 23, 03. 1803. 4th Michigan, age 18. 31, 04. Died June 19, 1864; exhaustion. 939 Parks, J., Pt., E, 91st 1 June 18, Left; lat. flap. June 30, haem.; 983 Tichenor, G., Pt., F, 9th Oct. 19, Left. Died November 20, 1864 ; Pennsylvania, age 38. 18, 04. femoral lig. July 0, fern, delig. N. Y. H vy Artillery. 19, 64. pyaemia. Died July 12, 04; haemorrhage. 984 Titan, N., Pt., H, 7th April 7. Right ; circ. Died May 8, 1865; 940 Parsell. M., Pt., K, 5th April 6, Left ; ant. post. flap. Died April New York, age 21. 8, 65. pyaemia. Wisconsin, age 33. 8, 05. 19, 1805. 985 Toinpkins, G., Pt., G, 1st July 3, Right (also wound of left); gang. 941 Parsons, J., Pt., F, 80th May 14, Right. A. A. Surg. L. Darling. N. Y. Heavy Artiller}-, 4, "03. July 17. amp. thigh; 21, haem.; Indiana. 14, 64. Died July 15, 1864. age 45. femoral ligated. Died July 26, 942 Phillips, N.,Pt., A, 188th Feb. 6, Right ; circ. Died February 18, 1803; pyaemia; haem.; gang. New York, age 20. 6, 65. 1865; pyaemia. 986 Toomey, J., Pt,, I, 1st Aug. 29, Left ; ant. post, skin flap. Surg. 943 Pierson, E. J., Pt., B, Mar. 31. Left. A. Surg. W. B. Hartman, New Jersey Cavalry 29, 64. A. Hard, 8th 111. Cav. Lfied Sept. 19th Virginia. A p. 1, 65. 116th Penn. Died April 12, 65. age 30. 28, 64 ; pneumonia. Spec. 3158. 944 Pierson, J., Pt., F, 80th May 14, Right. Died June 15, 1804. 987 Torrence, G. A.. Corp l, May 13, Left. Surg. A. T. Hudson, 26th Indiana. . 64. A, 4th Iowa. 13, 64. Iowa. Died May 20, 1864. 945 Posey, E., Corp l, E, 30th Oct. 4, Right; circ. Died November 9, 988 Tripp, J. W., Pt., A, 1st Mav 25, Right; ant. post. flap. Surg. A. Colored Troops, age 41. 4, 64. 1804 ; pyaemia. Michigan, age 18. 25, 64. F. Whelan, 1st Michigan S. S. 946 Posey, J., Pt., D, 21st June 20, Right ; flap. Surg. J. T. Woods, Died June 8, 1864 ; pyaemia. Kentucky, age 34. 20, 64. 99th Ohio. Died Aug. 12, 1804. 989 Turner, H. W., Serg t. Nov. ::o, Right ; ant. post. flap. Surg. 947 Pouffe, L. G., Corp l, E, Mar. 25, Right. Surg. D. C. Roundy. 37th G, 1st Alabama, age 24. Dec.1, 64. McMahon, C. S. A. Died Mar. 17th North Carolina. 25, 65. Wisconsin. Died April 10, 65; 4, 1865; small-pox. irritative fever. Spec. 4032. 990 Unknown, I. B., 148th May 3, . Surg. C. S. Wood, 66th N. 948 Ramer, J. P., Corp l, K, June 6, Left. Died June 25, 1864. Pennsylvania. , 63. York. Haem. Died of pyasmia. 5th N. Hamp., age 25. 0, 64. 991 Unknown, J., Colored Dec. , Right, Died December 19, 1864. 949 Ranaghan, J., Pt., E, May 18, . Surg. G. L. Potter, 145th servant, age 30. , 64. 09th New York. 18, 64. Penn. Died June 10, 1804. 992 Vail, W., Pt., A, 2d N. Oct. 19, Right ; oval skin flap. Surg. D. 950 Rathburn, J. H., Pt., F, June 16. Right; ant. post, flap; dysentery. > \ York. 19. 64. B. Van Slvck, 22d N. Y. Cav y. 149th Penn., age 22. 16, 04. Died July 10, 1864. Died Oet/27, 1864 ; tetanus. 951 Re.ddick, W. J., Pt., C, Sept. 19, ; circular. Died November; 993 Valentine, R. H., Pt., D, April 7, Right. Died April 11, 1865. 20th North Carolina. 19, 64. 7, 1864 : pyaemia. 5th New York. 7, 65. 952 Reinhart, C.,Pt.. K, 74th Aug. 27, ; ant. post, flap ; sloughing ; 994 Van Carder, J., Pt., F, Sept. 28, : Left. Died October 30, 1864 ; Pennsylvania, age 21. , 62. re-amp, knee joint. Died Sept. 58th Penn., age 22. , 64. exhaustion. 23, 1863; gangrene. 995 Vannatter, W. A., Pt., I, Dec. 13, Right. Confed. surgeon. Gan 953 Rhodes, J. H., Pt.K, 5th May 3, Right, Surg. G. P. Oliver, lllth 121st Penn. Reserves. 15, 62. grene. Died Feb. 13, 1863. New Jersey. 3, V>3. Penn. Died May 13. 1863. 996 Walker, F., Corp l, K, May 22, Right. Died May 22. 1863. 954 Ring, P., Pt., E, 69th June 3, Right ; circ. Died June 21, 1864. 47th Ohio. 22/63. New York, ase 45. 3, 64. - 997 Walker, J. B., Serg t, K, Sept. 14, Right; ant. lat. flap. A. Surg. 955 Rouch, J. T., Pt., A, 8th Mav 5, Left. Died May 18, 1864. 12th Missouri Cavalry, 14, 64. J. M. Study. U. S.V. Gangrene. Maryland. 5, 64. age 22. Died Sept. 19, 1864: pyaemia. 956 Rouse, G. W., Adjutant, July 28, Right. Died August 4, 1864. 998 Wallick. E. F , Pt., E, Sept. 19, Left. Died Sept. 23, 1804 ; shock 100th Illinois. 28, 64. 126th Ohio. 19, 64. of operation. 957 Ryan, J. C., Corp l, K, Dec. 13, . Died January 0, 1803. 999 Walters, B. G., Pt., H, Oct. 15, Left : flap. Surg.W. J. Bun-, 42d Oth Ne\y Hampshire. 13, 02. 19th Maine, age 19. 15, 64. N. Y. Slough. Nov. 27, amp. 958 Sanders. C. W., Pt,, B, May 31, Right ; ant. post, flap ; sloughing. thigh. Died April 28. 65; exh n. 4th S. C. Cav., age 23. 31, 64. Died June 11, 1804; pyasmia. Specs. 3445, 3440, 3447, 3448. 959 Savage, J., Major, 2d Aug. 9, . Died October 22, 1802; 1000 Wannamaker,J. ir.,Pt., Aug. 22, Right. Surg. G.W. Metcalf, 76th Massachusetts, age 20. 9, 62. haemorrhage. F, 25th S. C., age 27. 22, 64. N. Y. Died Aug. 26, 64 ; exh n. 900 Sawney, L., Serg t, F, June 25, Left; flap. Died July 1, 1803; 1001 Ward, L.. Corp l, B, 94th June 18, Right. Died August 5, 1864. 79th Pennsylvania. 26. 03. pyaemia. New York, age 18. 19, 04. 901 Schoeneck,J.,Pt.,B,55th June 3, Left; ant. post, flap; sloughing. 1002 Warren, R., Pt., C, 17th July 1 , Left. Died July 17, 1863. Pennsylvania, age 30. 5, 64. Died July 9, 1804 ; gangrene. Connecticut. -, 63. 962 Scott, S., Pt., A, 48th April 1, . Sur>. H. Osborne, 51st C. 1003 Weaver, C. D., Pt., H, Dec. 15. Left ; ant. post. flap. Died Dee. Colored Troops. 1, 65. Troops Died April 3, 1865. 43d Mississippi, age 33. 15, 04. 25, 1864 ; shock. 903 Sheridan, S., Pt., B, 12th Dec. 15, Right; flap. A. A. Surg. J. S. 1004 Weed, A. 1ST.. Pt.,C,10th May 3, ; flap. Died July 9, 1803; Colored Troops, age 28. 17, 04. Giltner. Died Jan. 2, 1865. Georgia, age 24. 4, 63. gangrene. 9(54 1 Shields, R., Corp l, G, Nov. 27, Right. Surg. D. B. Allen, 30th ; 1005 Weight, J., Pt., A, 148th July 3, Left. Died July 24, 1863. 4th Iowa, age 24. 27, 63. Iowa. Died Jan. 14, 64 ; pyaem. Pennsylvania. 3, 63. 965 Sliolan, A., Pt., D, 121st May 18, Right ; circ.; slough.; diarrhoea. 1006 Westerfnan, W T ., Pt., C, June 3, Left; flan. Died June 14, 1864; 1 Pennsylvania, age 40. 18, 64. Died May 26, 1804; exhaustion. | 2d New Hamp.. age 28. 3, 64. gangrene. 966 Shull, V., Pt., D, 13th May 19, Right. Died June 16, 1804. 1007 White, L., Serg t, F, 7th May 5. Right. Died May 5, 1864. 1 Indiana, age 22. 19. 64. New Jersey. 5, 64. 967 Sill, \V. J., Lieut., C, July 1, Left. Died July 21, 1863. 1008| Whiting, T . J., Serg t- May 6, Left (also amp. finger). Died 75th Pennsylvania. , % 63. ; Mai or, 2d Michigan. 6, 64. May 13, 1804. 968 Skinner, J., Col d team- Sept. 20, Right. Died September 25, 1864. 1009 TVJnttalcer, J. P., Pt., A, June 16, Right ; circular. Died July 20, ster. acre 56. 20, 64. 17th N. C., age 44. 10, 04. 1864. 909 ! Smith, ~G. IK., Pt., E, Sept. 29, Right; flap; sloughing. Died 1010 Williams, C. D., Pt., E, June 19, Left. Surg. P. E. Hubon, 28th 63d Tennessee, ago 30. 29, 64. 970 Smith, J. C., Corp l, A, April 2, October 21, 1864. 35th North Carolina. Right; ant. post. flap. Died May 1011 Williams, J. M., Pt., H, 19, 6-1. Sept. 19, Mass. Died June 20, 1864. Left; mortification. Sept. 20, 14th N.Y. H. A. .age 27. 2, 65. 16, 1865. 26th Ohio. 19, 63. amputation of thigh. Died. ; 971 ! Smith, J. J., Pt.. D, 5th Tenn. Cavalry, nsc 21. April 7, 9, 62. Right; circular. Died May 21, 1862. 1012 Williams, J. H., Major, 18th Indiana. Oct. 19, 20, 04. Right (also w nd left thigh) ; circ. Died Oct. 24, 64 ; shock of op n. 972 Smithus, E., Pt.,F, 127th July 28, Right: double flap. Act. Staff 1013 Wilson, R., Pt., E, 29th July 3d, Left: flap. Surg. F. M. Weld, Illinois, age 25. 28, 64. Surg. C. B. Richards, U. S. A. Colored Troops. 31, 04. 27th Col d Troops. Died Aug. Died Aug. 18, 1864. 20,1864; diarrhoea and exh n. 1 LlDELL (J. A.), Pyxmia connected with Thrombosis, in U. S. Sanitary Commission Memoirs, Surgical Volume I, New York. 1870, page 550. 478 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. 1014 1015 1016 1017 1018 1019 1020 1021 NAME, MILITAUT DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. 1023 1023 1024 1025 1026 1027 1028 1029 NAME, MIUTAUY DESCRIPTION, AND AGK. DATES. OPERATIONS, OPERATORS. RESULT. Winters, L., Pt., K, 50th Georgia. Wise, G. A., Pt., F, 25th South Carolinn, ape 24. Wolf, A. M., Pt., C, 62d July 3, 3, 63. Aug. 21, 21, 64. May 8, 8, 64. April 12, 12, 65. Sept. 19, 19, 63. May 25, 25, 64. Dec. 13, 13. 62. May 18, . <>4. Right. Aug. 25. slough.; hasm. Sept. 11, amput n thigh. Died Sept. 30, 1863; pyaemia. Right. Died September 2, 1864 ; effects of wound. Right. Died July 20, 1864. Left. Died May 14, 1865; men ingitis. Right. Died. Right. A. Surg. J. P. Dowling, 29th Penn. Died Aug. 28. 1 864. Left (thigh and chest wound). Surg. C. S. Wood, 66th N. Y. Died Dec. 13, 1862. Left. Surg. X. Hay ward, 20th Massachusetts. Gorntoe, M. Z., Pt., H, 9th Georgia. McCowan, W. C., Pt., 2d Mississippi. Mast, D. P., Lieut., D. Jst North Carolina. 1 O Brien. M. J.. Pt., 10th Oct. 7, , 64. July , Mar. 31, , 31. 65. Sept. 17, Left. . Surg. C. S. Wood, 66th New York. Right. Right; circular; sloughing. Left; flap. Left. Surg. W. Graham, 40th Illinois. Left. Surg. G. L. Potter. 145th Peun. (Also woundof right leg.) Pennsylvania. Wood, /?.#., Pt., D, ]<lth Virginia Art v, age 18. Votes, T., Pt. , V, 21st Ohio. Ztllman. I. C., Pt., B, 58th Alabama, age 18. Zimmerman, M., Pt.. H, 81st Pennsylvania. Bennett, M., Pt., A, 69th Georgia, age 31. Scott. J. C ., Corp l, A, 42d Miss., age 30. Steward, , Lieut., I, llth Georgia, age 41. Tutter, G. W., Pt., G, 3d Arkansas. Vanzoger, J., 2d Missis sippi Battery. 38. 62. July 1, 2, 63. Nov. 22, 22, 64. May 18, , 64. Oct. 5, , 62. New York. Primary Amputations in the Middle Third of the Leg for Shot Injury. Eight hun dred and ninety-two of the three thousand three hundred and ninety-five primary amputa tions in the continuity of the bones of the leg were performed in the middle third. The result in six of these cases was not determined; seven hundred and thirty-six proved suc cessful, and one hundred and fifty were fatal, a mortality of 16.9 per cent., or 7.5 per cent, less than that of the primary ablations in the upper third of the leg. Examples of Successful Primary Amputations in the Middle Third of the Bones of the Leg. The operations of this group numbered seven hundred and thirty-six; one hundred and fifty-five were performed on Confederate and five hundred and eighty-one on Union soldiers. Of the latter the names of five hundred and seventy-six are found on the Pension Rolls; two are retired officers, and three do not seem to have applied for pensions. Twenty-seven have died since the date of their discharge from the service one of erysip elas, one of epilepsy, one of congestion of the brain, seven of phthisis, three of accidents, and fourteen of causes not stated. CASE 732. Private D. S. Crawford, Co. A, 47th Pennsylvania, aged 20 years, was wounded at Cedar Creek, October 19, 1864, and admitted to Camden Street Hospital, Baltimore, one week afterwards. Assistant Surgeon G. M. McGill, U. S. A., contributed the pathological specimen shown in the adjoining wood-cut (FlG. 286), with the following description: "The patient had received a shot fracture of the right leg at the lower third, for which amputation was performed the same day at the middle third. Necrosis of the stump of the tibia ensued to the extent of several inches, necessitating resection, which was per formed by Acting Assistant Surgeon W. G. Smull on March 24, 1865, chloroform being used and the operation performed by lateral flaps. The patient did very well afterwards. The upper portion of the stump healed by first intention." The patient was subsequently transferred to Jarvis Hospital, where he was discharged from service May 31, 1865, and afterwards supplied with a "Palmer" artificial leg. His pension was paid June 4, 1880. In his applications for commutation he described the condition of the stump as " continuing good." The specimen, No. 4225, Sunjical Section, A. M. M., consists of bones of the stump, removed at the second operation, and measuring five inches in length. A large sequestrum extends the entire length, embraced by an involncrnm, which is wanting on the anterior border; and the fibula, well rounded, has joined its extremity to the tibia. CASE 733. Private D. Jerman, Co. F, 190th Pennsylvania, aged 23 years, was wounded before Petersburg, July 11, 1864. He was admitted to the field hospital of the 3d division, Fifth Corps, whence i>f right leg, five" months Surgeon L. W. Read, U. S. V., reported: "Severe wound, with fracture of right leg, caused by a solid shot, after amputation. Spec. and followe(1 by air ,p ut ation at middle third." The operation was performed by the flap method. From the field the patient was transferred to City Point, thence to Beverly Hospital, and subsequently he passed through various hospitals in Philadelphia, where he was supplied with a "Palmer" artificial leg. On August 7, 1865, he was discharged from service and pensioned. In his subsequent application for commutation for an artificial limb he represented the stump as being "sore occasionally," and mentioned Surgeon L. W. Bead, U. S. V., as the operator. The pensioner died May 9, 1880, his attending physician certifying that "the stump of the limb was diseased and in an ulcerating condition, resulting in his death." The colored lithograph opposite (PLATE LXXVI) is a copy of a drawing by Hospital Steward E. Stanch, made immediately after the amputation, and shows the comminution of the bone, and especially the terrible laceration of the soft parts, caused bv the missile, a solid shot. 280. Bony stump bllEU (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Skarpsbunj. Md., in Am. Jour. Med. Sci s, 1863, Vol. XLV, p. < -. o m r 3) ;_ > = O : 2 -o .SECT. V.] PRIMARY AMPUTATIONS IN THE LKG. 479 FIG. 287.-Bony stump of the left leg, five months after amputat n. Spec. 4:^0. FIG. 288. Stump after an- tero-posterior flap amputa tion. Spec. 4305. CASE 7.34. Private F. \V. Knight, Co. E, llth Vermont, aged 21 years, was wounded in the right leg, at Winchester September 19, 1864, by a minie" ball, which passed through the ankle joint. He was conveyed to the Depot Hospital of the Sixth Corps, where amputation was performed but not recorded. Surgeon F. V. Hayden, U. S. V., noted the following history : "The wounded man was admitted to Sheridan Hospital, Winchester. October 5th, with amputation of the right leg at middle third, performed the day after the injury by Surgeon W. A. Barry, 98th Pennsylvania, the flap method being used, with circular section of the muscles. Erysipelas appeared a few days after the operation. One and a half inches of protruding bone was removed on October 10th. The treatment consisted of stimulants and tonics, including quinine, etc." On December 5th, the patient was transferred to Frederick Hospital, and two weeks later to Central Park, New York City, whence Acting Assistant Surgeon S. Teats contributed the specimen, No. 4330, Surgical Section, A. M. M., represented in the annexed cut (FiG. 287), with the following result of the case: "The stump became painful and tender, its end cold and bluish in appearance, and a circular exuberant ulcer formed in the cicatrix. On February 15, 18G5, chloroform was administered and re-amputation was performed by the circular method by Surgeon B. A. Clements, U. S. A. Sutures, adhesive straps, and water dressings were applied after the operation. The result was favorable and the stump healed." The patient was discharged from service August 17, 1865, and pensioned, having been previously furnished with an artificial leg by Dr. E. D. Hudson, of New York City. In his applications for commutation the pensioner reported the stump as remaining in good condition." His pension was paid March 4, 1880. The specimen consists of the re-amputated stumps of the tibia and fibula, showing an excellent deposit of callus but being carious internally. CASE 735. Private J. Shaud, Co. K, 93d Pennsylvania, aged 26 years, was wounded at Fair Oaks, May 31, 1862. He was conveyed to White House Landing and thence by transport steamer to New Haven, Connecticut. Surgeon P. A. Jewett, U. S. V., in charge of Knight Hospital, recorded the wounded man s admission, June 9th, with " amputation of leg," and reported that he recovered and was transferred to New York City January 19, 1864, "to be furnished with a wooden leg." Surgeon B. A. Clements, U. S. A., reported that the patient was dis charged from service at Central Park Hospital March 9, 1864, by reason of " loss of right leg by pi imary amputation, performed for shot fracture involving the ankle joint." A cast of the stump (Spec. 4305, Suryical Section, A. M. M.), showing the cicatrix to be located on the anterior face above the extremity, was contributed by Acting Assistant Surgeon G. F. Shrady, and is shown in the adjoining wood-cut (FiG. 288). Dr. E. D. Hudson, of New York City, who supplied the pensioner with an artificial leg before he left the hospital, described the stump as having been formed by an "antero-posterior flap amputation at the junction of the middle and lower thirds" of the limb. The pensioner was paid June 4, 1880. He reports the condition of the stump as remaining sound and healthy. In the following instance both legs were successfully amputated at the middle thirds one day after the injury: CASE 736. Private E. B. Higyinbotham, Co. F, 38th Georgia, appears recorded on a Confederate hospital register as having had "both legs fractured by gunshot, at Spottsylvania Court House, May 12, 1864," for which "both limbs were ampu tated at the middle third by Surgeon W. J. Arrington, P. A. C. S., on the following day." The man recovered, and was subse quently furnished with artificial legs by the Confederate Association for the relief of maimed soldiers. Fatal Primary Amputations in the Middle Third of the Bones of the Leg. The one hundred and fifty operations of this group were performed on twenty-two Confederate and one hundred and twenty-eight Urik>n soldiers. Exhaustion, pyaemia, and gangrene were reported as the principal causes of death. CASE 737. -Private E. J. Valleley, Co. A, 3d Rhode Island Artillery, aged 18 years, was wounded by the explosion of the magazine of the Gunboat "George Washington," near Beaufort, S. C., April 10, 1863. His injuries comprised two scalp wounds of no great importance, a compound fracture of the upper fifth of the right ulna, a fracture of the right femur at its middle, and compound comminuted fracture of the bones of the right leg and foot. There was most alarming nervous depression. Stim ulants and nourishment were liberally supplied, but no decided reaction followed. Forty-eight hours after the receipt of the injuries it was thought best to amputate the leg, which operation was performed at the middle third on April 12th. After the operation the thigh continued to swell till it reached an enormous size, which circumstance gave reason to believe that the femoral artery had been ruptured by the fractured ends of the femur. The patient was delirious a good part of the time after the operation. He died on the morning of April 14, 18o3. There was no attempt at union in the incisions that were made for the removal of the limb, and the stump had an unhealthy look, the discharge being of an ashy color and past} consistence. For two days before he died he was isolated from the other wounded patients. After death a large quantity of bloody serum was found in the cellular tissue of the thigh; the artery and vein were entire in their whole length. The lower fragment of the femur was pushed up behind the lower end of the upper fragment, denuding the latter of its periosteum for more than three inches. The amputated portions of the tibia and fibula were found to be both broken at the junction of the malleoli with these bones, the tibia being stripped of peri osteum for about four inches upward from the joint. The fibula was also broken about three inches above the joint. The posterior end of the os-calcis was broken oft , and this bone was extensively fissured and otherwise injured; the cuboid bone was comminuted. The wound in the soft parts was about four inches long, running upward from the superior surface of the astrag alus on the inner side of the leg, and the tibia protruded some two inches. The history, together with the specimen (No. 1165, Surf). Sect., A. M. M.), consisting of the amputated bones of the leg, was contributed by Surgeon F. L. Dibble, 6th Connecticut. 480 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 738. Brigadier General G. W. Taylor. U. S. V., was wounded in the left leg, at Bull Run. August 27, 186^. The character of the injury and its result was reported by Assistant Surgeon J. B. Brinton, U. S. A., as follows: "A ball entered at the inner edge of the tibia, about six inches above the internal malleolus, passed directly through and comminuted the bone very badly for about six inches above and below, making two openings of exit on the anterior and outer aspect of the leg about five inches above the external malleolus. The patient was admitted into the Mansion House Hospital, Alexandria, thirteen hoxrs after the reception of the injury, where Surgeon J. H. Brinton, U. S. V.. amputated the limb by the double flap method at the middle third. The operation was performed twenty-six hours after the reception of the injury, the patient losing considerable blood and all the vessels requiring ligation. He had been with the army through the Peninsular campaign and his blood appeared to be very much vitiated by morbific influence of malaria. After the amputa tion it was discovered, what was previously suspected, that the fibula was not broken by the force of the ball, but by the weight of the patient coining upon it suddenly when the support from the tibia was destroyed by its fracture. The patient s arterial system did not fully react; his pulse, which was feeble, tremulous, and very irregular at times, evidently denoted a depraved condition of the system. He refused to take stimulants except sparingly. This condition continued until September 1, 1862, when he died at 4 o clock A. M. He was under the influence of chloroform during the operation." The amputated parts of the tibia and fibula (Spec. 313, Surg. Sect., A. M. M.), represented in the wood-cut (FlG. 21~9), were contributed to the Museum by the operator. CASE 739. Lieutenant C. J. Sergeant, Co. F, 7th Iowa, aged 31, was wounded in the left leg, during the siege of .Atlanta, August 11, 1864. Surgeon J. M. Woodworth, 1st Illinois Light Artillery, described the injury as an "extensive fracture of both bones of the leg, produced by a musket ball, for which amputation was per formed on the same day by Surgeon W. R. Marsh, 2d Iowa, at the field hospital of the 2d division, Sixteenth Corps." Five days after the date of the injury the patient was moved to the field hospital at Marietta, and two months later he Avas transferred to Chattanooga, thence to Nashville, and later to the Officers Hospital at Louis ville. Surgeon F. Greene, U. S. V., in charge of the latter, described the amputation to have been performed by the " antero-posterior flap method at the middle third," and reported that " for a month after the operation oozing of blood continued from the stump, the patient s condition being feeble. Gangrene supervened in the latter part of September, chiefly attacking the anterior flap. The bone became necrosed, and in October two pieces were removed and the gangrene controlled." The patient was lastly admitted to Grant Hospital, Cincinnati, where he obtained a leave of absence on December 12th. He died at his home in Ottumwa, Iowa, April 10, 1865. his attending physician, Dr. J. C. Hinley, certifying that "his disease was pyajmia, being caused by the amputation of one of his lower extremities, the stump of which never healed." FIG. 28!).-Left tibia fractured by a musket bal I; fibula frac tured by the subject sweight suddenly com ing upon it. Spec. 313. TABLE LXIX. Summary of Eight Hundred and Ninety-two Cases of Primary Amputations in the Middle Third of the Leg for Shot Injuries. [Recoveries, 1736; Deaths, 737 88G; Results unknown, 887 892. J NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS. RESULT. 1 Abbott. F.A., lt.,K, 7th May 16. Left ; double flap. Mustered out 17 Bailey, />., Pt., I), 7th S. Aug. 21, Right. Provost Marshal April N. Hampshire, age 38. 17, "64. December 22, 1864. Carolina Bat ry, age 44. 21, 64. 1, 1865. 2 Ackerman, ,1. 11., I t., C, Jan. 11, Left; flap. Surg. G. L. Carhart. 18 Buird, J. N., Corp l, A, April 7, Left. Discharged. 31st Iowa, age 24. 11, "03. 31st Iowa. Disch d April 13, 63. 34th Illinois. I 62 : Allen, U. F..Pt., F, 120th Nov. 2, Left; flap. Surg. 11. A. Reynolds, 19 Raird, J. T., Lieut., C, Aug. 19, Left; circular; gangrene. Trans New York, age 20. 2, 64. 1st Me. H vyArt y. Recovery. 16th Vii^inia. age 31. 20. 64. ferred Nov. !). 1864. April 9, 1870. stump good. 20 Baldis, J., Pt., C. 3Uth July 2, Left; ant. post. flap. Surg. F. 4 Alt, M., Pt., F, 26th May 16, Right; circ. Surg. J. S. Prout. New York, age 7. 2, 63. Wolf, 39th X. Y. Discharged Missouri. 17, 63. 2(ith Missouri. Gang.; crysip. April 10. 1864. Disch d Oct. 24, 1863. 21 Ball, Tl. G., Serg t, D, Mar. 31. Left: lateral flap. Surg. A. S. Ambrose. R., Pt.. ! , 8th May 7, Right ; flap. Surg. M. Storrs, Sth 147th N. York, nge 20. A p. 1, 65. Coe. 147th New York. Disch d Conn., age 27. 7, 64. Conn. Disch d May 7, 1865. August 2, 1865. : Anderson, J..Pt., 1C, 18th July 22, Right; flap. Surg. A. B. Mono- 22 Iianentinr,i;.W.,V\..\l, Oct. 1. L t; oval flap. Surg. A.G.Emory, Missouri, age 20. 22," 64. han. 63d Ohio. Disch d Aug. 14th Tennessee, age 25. 1. 61. C. S. A. Retired Jan. 20, 1865 2. 186. ). 23 Barber, S. M., Capt., II, May 22, Right; flap. Surg. J. Pomerene, 7 Anderson. W.,Pt.,H,. r ,th Sept. 21), Left; circ. Surg. If. C. Merry- 42d Ohio. 22," 63. 42d Ohio. Disch d Mar. 15, 64. Col d Troops, age 18. 29, 04. weather. 5th Colored Troops. 24 Hates. C., Corp l, G, 51st Sept. 17, Left ; ant. post. flap. Surg.W. II. Disch d May 8, 1863. New York, age 23. 1L<, : 6, . Leonard, 51st N. Y. Disch d .- Andrews. A. S., Capt., B, June 9, . Surgeon Gill, C. S. A. January 17. 1863. 2d North Carolina. !), 63. Recovery. 25 Bates, O. W., Pt., M, 1st \pril 6, Right ; flap. Discharged Sep 9 An ilim, N. J., I t., I, Do. 31. 62. . Recovery. Me. Il vv Art., age 37. (i, 65. tember 12, 1865. 24th Tennessee. Jan. 2, 63. 23 Baum, F.W., Pt.,C, 10th Nov. 25, Left ; circ. Surgeon R. J. Mohr, 10 Apple. L., I t., I, 1st Flor Deo. 7, Right; circ. Provost Marshal Missouri. 25, 63. 10th Iowa. Disch d Apr. 22. 64. ida Cavalry, ago 33. 8. 64. March 4, 1865. 27 Baxter, W. 11 , Lieut., K, June 27, Right : flap. Discharged Dec. 11 Armstrong, j. M., Pt., K, July 21, Left: flap. Surg. M.W. Thomas, 113th Ohio, age 21. 27, 64. 29, 1864. i:;th Iowa. 21, 64. 13th Iowa. nisch dJuly21, 65. 2S Bean, W r . R., Pt., 7th May 12, Left: circ. Discharged Septem 12 Ashlerman, J., Pt , B, June 17, Left; flap. Surg. M. C. Wood- Maine Bat rv, age 27. 12, 64. ber 5, 1864. r-lst Ohio. 18, 62. worth. 51st Ohio. Disch d Feb. 29 Beaton, 1J. P.) Serg t, M, June ! , Right: flap. Surg. W. II. Me- 23. 1863. 2d()hioCav., age 21. 10, 63. Reynolds, 2d Ohio Cavalry. 13 Augustine, F., Pt..I, 21st Miiv 14, Left: flap. Discharged. 1870, Disch d Oct. 15. 1864. Wisconsin, age 24. 14, 64. stump sound. 30 Beatty, T., Pt., I, 4th N. June 3, Left; flap. Discharged January 14 Averill, J. B., Pt., E, 8th Sept. 19, Right : circ. Surg. J. G. Thomp York Artillery, age 39. 3, 04. 26, 1864. Vermont, age 23. ID, 04. son, 77th N. York. Gangrene. 31 Bee, 1). II., Pt", A, 6 1st | July 12, Right ; ant. post. flap. A. A. Surg. Disch d Oct. 11, 1865. Penn., age 25. 12, 64. M. F. Price. M. O. Sept. 7, 64. 15 Babbitt, .1. W., Pt., C, July 1, Right; flap. Surg. A. J. Ward. 33 Beeman,G.W..Pr., K, 2(1 Oct. 19, Right; circ. Surg.W. A. Barry, 24th Michigan. 2, 63. 2d Wis. Disch d Nov. 6, 1863. Conn. II. Art., age 20. 20, 64. !)8th I enn. Disch d July25, 65. 16 Bailey, A. W., Pt., A. Sept. 14, Left ; flap. Disch d Dec. 13, 62. 33 Beer, A. G., Pt., D, 20th De.31, 62, Left. Surg. M. M. Stimmel. 26th 24th New York. 16, 62. Died October 11, 1867. Ohio. :Jan.l. 63. Ohio. Disch d Aug. 9, 1863. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 481 No. NAME, MILITARY DESCUU TION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AXD AGE. i ___ DATES. OPERATIONS, OPERATORS, RESULT. 34 Beers, B., Pt., D, 69th Nov. 25, Right; circ. Disch d May 20, 76 Brown, C. K., Pt., A, 7th May 8, Left; circ. Surg. A. J. Ward, 2d Ohio, age 21. 27. 63. 1864. Wisconsin, age 24. 9, 64. Wis. Disch d July 16, 1864. 35 Beers, J. H., Pt., E, 146th Sept, 16, Right ; circ. Surg. A. A. White, Feb. 6, 65, amp. leg. Recovery. New York, age 29. 17, 64. 8th Md. Disch d March 23, 65. 77 Brown, J. M., Pt., D, 5th July 2, Right. A. Surg. T. C. Hill, 5th 36 Bennett, M.,Pt., 15, 125th Mar. 31, Left ; flap. Surg. W. S. Cooper, Alabama, age 28. 2. 63. Ala. Paroled Sept. 25, 1863. New York. 31, 65. 125th N.Y. Disch d Aug. 12, 65. 78 Brown, W. M., Pt., F, July 20, Left ; ant. post. flap. A. Surg. A. 37 Bennett, R, H., Pt., D, Sept. 29, Right; flap. Disch d May 17, 91* Ohio, age 23. 21, 64. Titus, 31st W.Virginia Cavalry. 7th C. Troops, age 23. 3:i. 64. 1865. Disch d January 31, 1865. 38 Benson, L. W., Pt., I, Sept. 17, Right ; flap. Surg. A. S. Warner, 79 Bullard, F. W., Pt., B, May 6, Left: flap. Confederate surgeon. 16th Conn., age -10. 19, 62. 16th Conn. Disch d Jan. 23, 63. 57th Mass., age 19. 8, 64. July 7. 1865, re-amputation leg. 39 Berg, M.,Pt..B, 7th Kan Dec. 24, Left. Discharged April 7, 1863. Disch d Nov. 23. 1865. sas Cavalry. 24, 62. 80 Bumgardner, S., Serg t, Sept, 22, Left (also amputation right foot). 40 Biddle. A. lL, Pt., K, Dec. 13, Left. Discharged June 29, 1863. F, 14th W. Va., age 35. 23, 64. Disch d March 4. 1865. 24th New Jersey. 14, 62. 81 Bunger.W., Pt.,G, 118th May 1, Left; flap. Disch d August 1, 41 Biggert, H., Pt., L, 15th July 2, Right ; flap. Surg. J. W. Alex Illinois. 1, %3. 1863. Penu. Cavalry. 2, 63. ander, 15th Pennsylvania Cav 82 Burd, S.,Corp l, B, 188th Sept. 29. Right; ant. post. flap. Disch d alry. Disch d June 16. 1864. Pennsylvania, age 24. Oct. 1/64 September 23, 1865. 42 Bitten, L. C., I t., K, 1st Mav 31, R t : circ. Surg. G. M. Brennan, 83 Burke. "./., Pt., A, 13th June 4, Left ; flap. Disch d May 25, 65. U. S. S. S., age 21. 31," 64. 1st Sharpshooters. Disch d Sept. New Hamp.; age 23. 4, 64. Died 5Iarch 31, 1870; epilepsy. 13,1864. Re amp. April 7, 66. 84 Burns, B., Pt., B, 22d Sept. 17, Right ; circ. Disch d May 6, 63. 43 Bixby, L. C.,Pt.,G, 45th Feb. 11, Right; flap. June, 1862, re-amp. New York, age 24. 17 62. Spec. 2540. Illinois. 11, 62. Disch d July 23, 1862. 85 Burns, R., Pt., A, 35th Mar. 7, Right ; flap. Disch d August 2, 44 Blake, J., Pt., K, 20th Dec. 13, Left. Surg." N. Hayward. 20th Illinois. 7, 62. 1862. Massachusetts. 15, 62. Mass. Disch d Oct. 1. 1863. 86 Burns,R. R., Pt., C. 14th June 26, Left. Retired February 20, 1865. 45 Blakf.ley, II. P., Pt., F, July 2, Right. Confederate surgeon. Pa Tennessee, age 25. 26, 64. 14th South Carolina. 3, (53. roled Sept. 5. 1863. 87 Burr, D. B., Pt., A, 14th Dec. 13, Right. Surg. G. T. Stevens, 77th 46 Blakla, W., Pt., E, 46th Aug. 16, Right; flap. Surg. W. B. Fox, Connecticut, age 28. 13, 62. N. Y. Re-amp. Disch d Mav New York, age 29. 16, 64. 8th Michigan. Discharged. 23, 1864. Died April 28, 1868"; 47 Blevins, J., Pt., E, 49th April 9, Right; ant. post. flap. Surg. G. consumption. Illinois, age 21. 9, 64. L. Lucas. 47th 111. Stustered 88 Burst, J. W.,Lieut,, 105th Mav 26, Right; flap. Surg. A. 51. Reagan. out Sept. 9, 1 865. Illinois, age 22. 26," 64. 70th Ind. Gangrene. Disch d 48 Bloxon, W. N., Pt., E, Sept. 7, Left; flap. Disch d 5Iay 26, 65. October 19, 1864. 22d C. Troops, age 20. 8, 64. 89 Buslt, J. F., Pt., G, Kith July 9, Left ; circ. Surg. C. H. Todd, C. 41) Bocklay, H., Pt., D, 2d Dec. 13, Right ; circular. Disch d April Georgia. 11, r 64. S. A. Exchanged Sept. 21, 64. Maryland, age 22. 13, 62. 21, 1863. 90 Bushnell, M. D., Corp l. June 24, Right ; flap. Surg. J. Reily, 33d 50 Bodley, C., Corp !, K, 5Iay 16, Right; flap. Disch d June 16, H, 154th New York, 24, 64. N. J. Gangrene. Disch d Aug. 28th Iowa, age 24. 16." 63. 1865. Died June 17. 1870. age 22. 12, 1865. Died June 5, 1866. 51 Boehme, F., Pt., C. 20th May 6, Left .- circ. Confederate surgeon. 91 Busick, D. W., Serg t, E. July 2, Left. Surg. P. G. Robinson, 22d 51ass., age 27. 7, ^64. Discharged. 1870, stump good. 22d North Carolina. 2, 63. N. C. Paroled Sept. 12, 1863. 52 Bond, J. D. 51.. Pt., C. Sept. 1, Right: flap. Surg.T. B.Williams, 92 Butler,.!. H., Pt.,E, 30th June 20, Right; circ. Surg. G. J. Potts, 78th 111., age 38. 2, 64. 12lst Ohio. Disch d May 6, 65. Col d Troops, age 26. 20, 64. 23d Colored Troops. Disch d 53 Bunedun, C. W., Pt., G, July 1, Left. Union surgeon. Recovery. July 25, 65. Died Nov. 10, 67. 7th Virginia Cavalry. 1. 63. 93 Butts, J. W., Capt., H, July 12, Left." Surg.W. P. Young, 4th Ga. 54 Book, (J., Pt., E, 6th Col Feb. 11, Left; circ. Surg. N. S. Barnes, 4th Georgia, age 25. 12," 64. To prison Feb. 5, 1865. ored Troops. 11. 65. U. S.V. Recovery May 6, 1865. 94 Cady, E. A., Pt., H, 33d May 3, Left; circ.; re vmp.: gangrene. 55 Booth, J. L. Pt.. B, 12th June 13, Right; ant. post. flap. Confed. New York, age 21. 3, 63. Disch d Nov. 14, 1863. W. Virginia, age 22. 14, 63. surgeon. Disch d May 15. 65. 95 Cain, F., Pt., E, 40th Nov. 25, Right : gangrene. Disch d Oct. 56 Boucher, P., Pt., I, 28th June 3, Right : lateral flaps. Surg. P. E. Indiana, age 19. 26, 63. 12, 1864. Massachusetts, age 26. 3. 64. Hubon, 28th 5Iass. Disch d 96 Cain, R. M., Pt., C, 18th Sept. 9, Left. Surg. Green, C. S. A. Nov. 28, 1664. Mississippi. 9, 63. Recovery. 57 Bowen. J., Pt., C, 42d Dec. 30, Right. Surg. T. I). Fitch. 42d 97 Campbell. J. F., Pt., G, June 27, . Surg. C.C.Clarke, C.S. A. Illinois, age 21. 31, 62. Illinois. Hiem. June 20, 1863. 9th Alabama. 27, 63. Recovery. amp. thigh. Dis. April 28, 1864. 98 Canfield, M., Pt., B, 34th June 5, Left ; flap. Surg. R. R. Clarke, 58 Bowland.W.,Pt.,C, 142d Ort. 13, Left: flap. Surg. D. McFalls, Mass.. age 34. 5, 64. 34th 51ass. Disch d 5Iay 31, 65. New York, age 21. 13, 64. 142d N. Y. Gang. Oct. 27, re- 99 Carpenter.C.G., Pt.. Bat 51 ay 3. Right : flap. Surg. C. S. Wood, amput n. Disch d Sept. 11. 65. tery H, 1st Art., age 25. 5, 63. 66th N.Y. Disch d Feb. 23, 64. 59 Bowman. H. A.. Pt.. G, July 21, Left ; flap. Surg. E. T. Perkins. 100 Carroll, F., Pt., D, 32d Dec. 6, Left : post. flap. Surg. C. 51. 2d N. Hampshire. 23, bl. 71st N. Y. S. M. Disch d Nov. Col d Troops, age 29. 6. 64. Wight, 32d Col d Troops. Dis 1, 1861. charged May 24, 1865. 60 Boi/d, J. E., Pt., I, 41th Dec. 14, Right. Surgeon G. McDonald, 101 Carroll, P., I t., G, 19th Feb. 16, Right. A. A. Surg. J. E. Lynch. Tennessee. 14, 63. 22d Virginia. Recovery. Penn. Cavalry. 16, 65. Disch d June 7, 1665. 61 Bradin, R.. Lieut., E,7th June 16, Right ; ant. post. flap. Surg. J. 102 Carter, S. H., Corp l, A, June 6, Left : circ.; gangrene. Disch d N. York Heavy Artil 17, 64. E. Pomfret. 7th N. Y. H vy Art. :i6th Mass., age 20. 6, 64. June 16, 1865. lery, age 34. Disch d January 27, 1865. 103 Catlin, I. S., Col., 109th July 30, Left. Surgeon W. B. Fox, 8th 62 Bra ci(j, J. W., Pt.,G, 25th Dec. 13, . Surg. Blandy, C. S. A. New York, age 30. 30, 64. 5Iich. 5Ius. out June 4, 1865. Virginia. 13, 61. Recovery. 104 Cavwood.P.,Pt.,B.110th June 14, Right; flap. Ass t Surg. R, R. 63 Braillie, J., Pt., A, 1st July 3, Right : circ. Disch d February Ohio. 14, 63. 5IcCandliss, 110th Ohio. Dis Artillery, age 33. 3. 63. 29. 1864. charged Aug. 26, 1863. 64 Brannon, P., Pt., E, 28th Oct. 5. Left. Surg. W. F. West. 28th 105 Chad wick, J. A., Pt., D, Aug. 16, Lett. Disch d January 20, 1865. Illinois. 5, 62. Illinois. Disch d April 7, 1863. 9th Maine, age 22. 17, 64. 65 Brantley. L. <;., Pt., C, July 3. Left. Surg. .1. A. Vigae, 33d N. 106 Chalfant, F. D., Serg t, July 18, Right. Coufed. surgeon. Disch d 33d North Carolina. 4, 63. Carolina. Recovery. F, 4th W. Va., age 21. 19. 64. June 24, 1865. 66 Bray.J .. Pt., G, 1st Mas Oct. 2, Right: ciro. Surg. O. Everts, 107 Chamberlain. D., Serg t, April 1, Left ; flap. Disch d June 28, 65. ! sachusetts H vy Artil 4, 64. 20th Indiana. Gangrene. Dis D, 21st Penn. Cavalry, 2, 65. lery, age 33. charged June 14, 1865. age 30. 67 Bremenkamp, F.. Pt.. A, April 6, Left; circular. Disch d March 108 Chamberlain, T., Corp l, 5Iar. 19, Right ; double flap. Confederate 9th Illinois. 7. 62. 13. 1863. B, 79th Penn.. age 26. 19. 65. surgeon. Disch d June 28, 1865. 68 Bridgem, L. H., Serg t, May 3, Right. Disch d Sept. 15, 1863. 109 Chamberlain, W. H., Pt., Nov. 25, Left: circ. Surg.A. 5I.McMahon, ; II, 26th New Jersey. 3, 63. II, 42d Illinois, age 21. 27, 63. 64th Ohio. Gangrene. Disch d 69 Brining, .1., Pt., E, 116th Oct. 19, Right: flap. Discharged Aug. : Sept. 27, 1864. New York, age 19. 20, 64. I. 18(55. 110 Chapman, J. II., Capt., Aug. 9, Right. Surg. A. 51. llelmer, 26th 70 Bronson. D.. Pt., II, (ith Mav 30, Right: ant. post, skin flap: circ. B, 5th Connecticut. 1 1, 62. N. Y. Veteran Reserve Corps N. Y. Artillery, ago 29. 31," 64. sect. mus. Disch d Feb. 25, 65. September 2, 1863. 71 Bronson, J. B..Pt. ,1,14th A ug. 5, Right. Surg. G. E. Sloat, 14th 111 Charlton, O.. Pt., E, 34th Sept. 10, Right; flap. Disch d March 15. Ohio, ago 18. 5, 64. Ohio. Amputation thigh. Dis Ohio. 10, 62. 1863. Died Sept. 4. 1870. charged June 21. 1865. 112 Chichester. A., I t., E, Nov. 30, Right : post. muse. flap. Disch d 72 Brookings, D., Serg t,H, June 16, Right : ant. skin and post, rnuso. 127th N. Y.. age 24. 30. 64. 5?av 23. 1865. 17th Maine, age 22. 16, 64. flaps. Disch d Jan. 10. 1865. 113 Chiddes, C., Pt., D, 13th Dec. 17, Right : flap. A. A. Surg. J. S. Died Dec. 6, 1870. Colored Troops. 18, 64. Giltner. Discn d Aug. 8, 1665. 73 Brotherson, C., Pt., G, Sept. 19, Left : ant. post. flap. Discharged 114 Christenson, W., Pt., I, Mav 7, Right; circ. Confed. surgeon. 151st N. Y.. age 30. 19, 64. August 11, 1865. 115th N. Y.,age 23. 7, 64. Disch d 51ay 30, 1665. 74 Brott, J. C., Pt., I!, 2d June 2, Left: circ. Surg. G. L. Potter, 115 Clardy, J.B., Pt.,C,24th Sept. 20, . Surg. J. L. Cunningham. N.Y. H vy Art., age 24. 2, 64. 145th Penn. Recovery. Alabama. 20, 63. 24th Alabama. Recovery. 75 Brower, H. H.. Serg t, D. May 10, Right ; flap. Surg. M. Rizer, 72d lie Clark, E. T., Pt., E, 77th Nov. 30, Right: flap. Surgs. White and 10th N. Y., age 21. 10," 64. Penn. Skiy 15. amputation leg. Penn., age 20. DC. 1, 64. Hanna, C. S. A. Disch d April Disch d Nov. 2. 1865. 21, 1865. SURG. Ill 61 482 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAMK, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 117 Clark, H. B., Pt., F, 20th May 4, Left ; circular. Confed. surgeon. 158 Daniels, H.. Pt., C, 5th June 2, Left; circ. Surg. J. W. Buck- Maine. 6, 64. Disch d Nov. 22, 1864. N. Hampshire, age 22. 2, 64. man, 5th N. 11. Disch d Oct. 118 Clark, J. B., Pt., llth Sept. 19, Right; flap. Surg. C. B. Park, 15, 1864. Vermont, age 29. 19, 64. llth Vt. (Wnd arm, necrosed.) 159 Daniels, J., Pt., K, 47th May 16, Right ; circular. Disch d Oct. Disch d Sept. 28, 1805. Indiana. 17, 63. 14, 1863. 119 Class, C., Pt., G, 25th Feb. 8, Left ; circ. Surg. G. A. Otis, 27th 160 Danuiker, E. T., Serg t, Sept. 17, Right ; flap. Surg. M. Rizer, 7M Mass., age 26. 8. 62. Mass. Disch d Aug. 14, 1862. A, 1st Maryland Art v. 17. 62. Pcnn. Disch d July 4, 1863. 120 Clayton, H., Pt., E, 77th Oct. 19, Right; ant. post. flap. Surg. G. 161 Vavey, T. 1 ., 1 t., I, (ith Mar. 5, . A. Surg. R. E. Hill, C. S.A. New York, ago 20. 19, 64. T. Stevens, 77th N. Y. Disch d. Texas. 5, 64. Retired December, 1864. 121 Clement, J. M., Serg t, I, July 22, Left ; ant. post. flop. Returned to 162 Davis, B. W., Corp 1, B, June 17, Left : circ. Surg. W. C. Shurlock, 43d Georgia, age 25. 23, 64. Provost Marshal Dec. 1, 1864. 24th N.Y. Cav.,age23. 19, 64. 51st Penn. Disch d May 31, 65. 122 Clements, F. S., Pt., D, June 1, Right ; circ. Disch d September 163 Davis, F. M., Serg t, A, Sept. 1! , . Surg. J. T. Grant, 32d 6th N. Y. H. A., age 22. 1, 64. 17, 1864. 32d Tennessee. 21, 63. Tennessee. Recovery. 123 Clingman, G.W., Pt., A, May 8, Left; circ. Disch d September 164 Davis, H. T.. Pt., G, 5th Mav 5, Right : ant. post. flap. Disch d 88th Penn., age 33. 8, T>4. 21, 1864. Vermont, age 24. 7, r 64. January 13. 1865. 124 Clinton, F. D.. Pt., C, Dec. 13, Right; circ. Surg. J. Riley, 25th 165 Davis, J. B., Pt., I, 96th Sept. 14, Right; circular. Disch d March 25th New Jersey. 14, 62. N. J. Disch d Feb. 2, 1863. Pennsylvania. 15, 62. 1. 1863. 125 Closs, W., Pt., K, 10th April 2, Left; circ. Surg. G. H. Blick- 166 Dawson, A. J., Pt., G, Mar. 25, Left. Released June 24, 1865. N. Y. Heavy Artillery, 3, 65. hahn, 28th C. Troops. Disch d 49th Virginia, age 30. 25, 65. age 37. August 11,1865. 167 Day, C. H., Pt., A, 32d May 12, Right; circular. Disch d Aug. 126 Clunk, J., Pt., F, 76th June 18, Right ; flap. Surg. A. Sabine, Maine, age 30. 12| 64. 26, 1864. Ohio, age 18. 18, 64. 76th Ohio. Disch d May 23, 65. 168 Decker, P., Pt., I, 23d May 12, Left; flap. Snrg. M. Brucker, 127 Cobb.G.W., Pt., K,20th Mav 5, Left ; ant. post. flap. Confederate Indiana. 14, 63. 23d Ind. Disch d Aug. 8, 1864. Maine, age 21 . 7, 64. surgeon. Disch d May 7, 1865. 169 Deckertt, A.,Pt., B, 79th Mar. 19, Right; flap. Disch d June 11, 128 Cobb, J. P. C., Capt., H, Sept. 19, Left: circ. Surg.B.M.Crowell.lst Penn., age 19. 19, 65. 1865. 2d North Carolina. 20, 64. N. C. Exch d Dec. 9, 1864. 170 DeForest.A., Pt., D,15th Mar. 31, Left : circ. Disch d September 129 Cobb, M. A., Lieut., K, Dec. 15, Right; circ. A. A. Surgs. J. C. N.Y. H vy Art., age 40. 31, 65. 20, 1865. 23d Alabama, age 37. 17, 64. Thorpe and J. R. Holmes. Gan 171 Demasner, J. G., Pt., H, Oct. 19, Left ; flap. Discharged Septem grene. Jan. 9, 65, amp. thigh. 30th Mass., age 36. 20, 64. ber 5, 1865. Provost Marshal June 3, 1865. 172 Deniston, W. H., Corp l, April 7, Left; flap. Surg. S. T. Trow- 130 Cochennour, J. S., Capt., Sept. 1, Left : circ. Surg. E. Batwell, 14th A, 15th Ohio. 8, 62. bridge, 8th Illinois. Disch d H, 60th Illinois, age 34. 1, 64. Mich. Disch d Dec. 14, 1864. June 2, 1862. 131 Cogswell, A. H., Pt., B, Oct. 27, Loft ; flap. Confederate surgeon. 173 Dennis, A., Pt., G, 79th Sept. 19, Left : flap. Surg. W. M. Wright, 1st Mass. H. A., age 18. 29, 61. Disch d Sept. 11, 1865. Pennsylvania. 19, 63. 79th -Penn. Dfsch d Feb. 9, 64. 132 Cole, A. J., Pt., C, 44th Dec. 13, Right : circular. Disch d April 174 Dennis, A., Pt., D, 38th Dec. 11, Left ; ant. post. flap. A. A. Surg. New York. 15, 62. 8, 1863. Indiana, age 132. 12, 64. E. Jennings. Dis. Mar. 10, 1865. 133 Cole, W., Pt., H, 31st May 18, Right; flap. To Veteran Reserve 175 Denny. F. J., Serg t, A, July 28, Right ; circ..; gangrene. Disch d Massachusetts, age 21. 18, 64. Corps Nov. IP, 1864. 1st Cavalry, age 26. 28, 64. Nov. 22. 1864. 134 Coogan, R., Pt., E, 4th Oct. 16, Right. Disch d Jan. 12, 1863. 176 De.pratto, J., Pt.,H,lIth July 2, Left. Surg. J. Harrison, C. S.A. Artillery. 16, 62. Virginia, age 27. 3, 63. Exchanged Nov. 12, 1863. 135 Cook, A., Pt., E, 31st June 27, Right ; flap. Surg. E. J. McGor- 177 Devall, E., 1 t., K, llth Mar. 14, Right ; flap. Surg. G. Derby, 23d Iowa, age 34. 27, 64. risk, 9th Iowa. Gang. Disch d Connecticut, age 19. , 62. Mass. HsDin. Disch d Oct.15, 62. January 26, 1865. 17,- Dewalt, J. S., Pt., M, June 2, Left : ant. post. flap. Surg. II. 136 Coombs, L., Pt., K, 4th Mav 24, Right ; flap. Confed. surgeon. 100th Penn., age IP. 3, 64. Ludingtoi), 100th Penn. Mus Infantry, age 28. 26, 64. Disch d November 14, 1865. tered out Sept. 7, 1864. 137 Cooper, J., Pt., F, 47th July 22, Right ; flap. Surg. I. N. Barnes, 179 Dewey, G., I t., D, 51st Dec. 13, Left; slough. Dec. 28. re-amp. Ohio, age 25. 23, 64. 116th 111. Disch dDec. 3, 1864. New York. 14, 62. Jan., 1863, amp. thigh. Disch d 138 Corbet, J., Pt., G, 12th Oct. 19, Left ; double flap. Ass t Surg. Oct. 23, 1863. Maine, age 26. 20, 64. W. C. Towle, U th Maine. Dis 180 Dibble, C. A., Serg t, E, Mav 1, Left : circular. Disch d Septem charged June 21, 1865. 29th Wisconsin. 3, 63. ber 7, 1863. 139 Corlew, H. M.,Corp l, G, June 2, Right ; double flap. Surg. C. B. 181 Dibble. H., Corp l, G, June 15, Left ; circular. Disch d Septem Llth Vermont, age 19. 2, 64. Park, 1 1th Vt. Dis. Oct. 27, 64. 14th New York Cav. 15, 63. ber 24. 1863. 140 Costello, H., Pt., D, 24th Aug. 16, Left ; post, flap ; necro. Disch d 182 Dicker son, J. M., Pt., I, May 1 5, Right ; circ. Surg.C. J. Bellows, Massachusetts, age 30. 16, 64. January 25, 1865. 18th Alabama, age 23. 15, 64. 7th Ohio. To Provost Marshal 141 Cotton, S. O., Capt., A, Mav 6, . Union surgeon. Recovery. December 1, 1864. 4th Louisiana. 6, 64. 183 Dickson, J. H., Pt., C, May 12, Right; flap. Discharged Jan 142 Crago, G.W., Pt.,D,89* Sept. 20. Right ; circular. Disch d Feb. 7, llth Infantry, age 19. 12, 64. uary 3, 1865. Ohio. 22, 63. 1864. 184 Dickson, W.,Pt., 1, 109th July 20, Right : ant. post. flap. Surg. J. 143 Crane, A. F., Serg t, H, Dec. 13, Left. Disch d February 6, 1863. Pennsylvania, age 24. 20, 64. A. Wolf, 29th Penn. Diselrd 145th Penn. 13, 62. April 20, 1865. 144 Crawford, D., Pt., G, 1st July 28, Right ; flap. Surg. D. W. Maull, 185 Donley,J.P..Pt.,L, 18th June 15, Left; ant. post. flap. Dec. 23, S. C. Rifles, age 34. 28," 64. 1st Del. To prison Jan. 21, 65. Penn. Cavalry, age 40. 15, 64. re-amp. Disch d Mar. 15, 1865. 145 Crawford, D. S., 1 t., A, Oct. 19, Right : flap. A. A. Surg. W. G. 186 Donsheidt, W., Pt., I, Sept. 19, Left; circ. Ass t Surg. S. Adams. 47th Penu., age 20. 19, 64. Smull. Necrosis. Discharged 5th Artillery, age 29. 19, 62. U. S. A. Disch d May 3, 1863. May 31, 1865. Spec. 4225. 187 Doty, J. S., Pt., D, 19th June 16, Left; flap. July 7, re-amputat n. 146 Crosby, D. P., Pt., I, 6th Sept. 30, . Union surgeon. Recovery. Michigan. 16. 64. Disch d July 17, 1865. South Carolina. 30, 64. 188 Dougherty, J.L., Serg t, July 6, Left : flap. Drs. F. Dorsey and 147 Crowe, D.. Pt., E, 107th Sept. 17 Right. Discharged May 15, 1863. M, 18th Penn. Cavalry, 7, 63. N. B. Scott, llagerstown, Md. New York. 19, 62. age 24. Disch d Dec. 19, 1864. 148 Ouniff, J., Pt., H, 35th Feb. 15, Left; flap. Ass t Surg. J. T. 189 Dougherty, S..Pt., I, 8th Dec. 13, Left; flap. Disch d March 14, New Jersey, age 26. 15, 64. Lanning, 35th N. J. Disch d Penn., age 27. 13, 62. 1864. June 4, 1865. 190 Douglas, W., Pt., B, 6th June 1 8, Left ; ant. post. flap. Ass t Surg. 149 Cunningham, C., Pt., D, Julv 2, Right ; ant. post. flap. Confed. Wisconsin, age 34. 19, 64. J. C. Hall. 6th Wis. Disch d 140th Penn., age 20. 4, 63. surgeon. Disch d Feb. 22, 1864. May 4, 1865. ]50 Curley, M., Pt., G, 2d June 1, Left ; circ. Surg. H. Plumb, 2d 191 Downing, D. J., Capt., July 1, Left; flap. Surg. E. G. Chase, Conn. H. A., age 2G. 1, 64. Conn. H. A. Disch d Mar.18, 65. H, 97th N. Y., age 22. 1, 63. 104th N.Y. Resig d Feb. 12, 64. 151 Curran, T., Pt., H, 2<1 April 6, Left ; flap. Subsequent opera 192 Drake, A. H.,Pt.,C,13th Mar. 18, Left ; flap. Disch d July 26, 65. Iowa. 6, 62. tion. Disch d Oct. 14, 1862. Michigan. 20, 65. 152 Curry, J., Pt., H, 7th Mav 5, Right. Confed. surgeon. May 193 Drake, C. N..Pt., C, 12th July 2, Left. Surg. H. B. Fowler, 12th Maryland, age 21 . 6, 64. 19, 1865, re-amp. Discharged N. Hampshire, age 24. 3, 63. N. H. Disch d March 16, 1864. November 3. 1865. 194 Duddenhausen, A., Pt., Sept. 2, Right. Discharged May 4, 1865. 153 Daicy, G. W., Corp l, D, June 3, Left: circ. Surg. G. L. Potter, G, 17th N. Y., age 24. 3, 64. 53d Penn.. age 29. 3, 64. 145th Penn. Disch d July 6, 65. 195 Dudley, W. F.,Pt.,F, 1st Mar. 1, Left. Surg. W. A. Spence, C.S.A. 154 Dale, H., Pt., F, 5th N. June 3, Right ; flap. Surg. J. H. Buck- Maine Cavalry. 2, 64. June 14. amp. thigh. Disch d Hampshire, age 26. 3, 64. man, 5th N. H. Disch d May August 14, 1665. 6, 1865. 190 Duey, J., Pt., C, 54th Julv 22, Left; circ. Surg. I. N. Barnes. 155 Daller, J., Pt., D, llth May 16, Right; flap. Surg. J. A. Comin- Ohio, age 25. 23, " 64. 116th 111. Mustered out Oct. 24, Indiana, age 25. 16, 63. gor, llth Indiana. Disch d July 1865. Died July 22, 1870: 31, 1863. 197 Duffy, P. H., Pt., B, 2d Feb. 22, Left : flap. Ass t Surg. B. Norris, 156 Dalrymple. J., Pt., B, Oct. 10, Left: circ. Surg. J. P. Prince. Colorado. .23, 62. U. S. A. Disch d July 16, 1862. 79th N. York, age 29. 10, 63. 36th Mass. Gangrene. Disch d 198 Durkee, W. P., Pt., B, Dec. 13, Left : circ.; gangrene. Disch d Feb. 15, 1865. Re amp. 1868. 4th Vermont, age 22. 14, 62. April 25, 1863. 157 Dangerfield, L. J., Pt., June 3, Left. Surgs. Yost and White, 199 Eades, J. M., Corp l, F, June 15, Right : flap. Surg. A. W. Reasran, Richard s Cavalry. 3, 61. C. S. A. Recovery. 70th Indiana, age 23. 15, 64. 70th Ind. Disch d June 8, 1865. FISHER (G. J.), Report of Fifty-seven Canes of Amputations, in f)ie Hospitals near Sharpsburg, Md., after the Battle of Antietam September 17, 1862, in American Journal Medical Sciences, 1863, Vol. XLV, p. 48. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 200 Eaton, D. C., Corp l, H, Sept. 17, Left. Surg. L. M. Knight, 5th N. 242 Fryer, E., Pt., A, 1st June 3, Left; flap. Surg. D. W. Maull, 5th N. Hamp., age 30. 17, 62. H. Gangrene. Dec. 29, amp. Delaware, age 33. 3, 64. 1 st Del. M. O. Nov. 19, 1864. thigh, lower third. Discharged 243 Fuller, C., Pt., K, 14th June 18, Right ; flap. Disch d July 7, 65. Mar. 13, 1863. Died July 1, 63. N.Y. H vyArt.,agel9. 20, 64. 201 Eaton, G., Pt., D, 121st Nov. 7, Right. Disch d June 15, 1864. 244 Furney, M., Pt.,G, 126th Sept. 22, Left; flap. Disch d March 27, New York, age 27. 7, 63. Ohio, age 26. 23, 64. 1865. 202 Eckerman, D. F.,Pt., H, Aug. 5, Right ; flap. Surg.W. R. Marsh, 245 Fyans, A., Corp l, F, 32d May 7, Left. Surgeon F. H. Hamilton, 2d Iowa. 5, ? 64. 2d Iowa. Disch d June 20, 1865. New York. 8, fe. U. S. V. Disch d July 15, 1862. 203 Edleman, W., Pt., K, June 15, Right ; circ. Surg. D. Johnson, 246 Gallup, E. A., Pt., L, 1st June 1, Left; double flap. Gangiene. 129th 111., age 26. 16, 64. 129th 111. Gangrene. Disch d Vt. H vy Art., age 21. 2, 64. Discharged Oct. 21, 1865. June 6, 1865. 247 Ganster, W. A., Pt., D, Aug. 18, Right ; circ. Surg. E. Jackson, 204 Ehret, J., Pt., G, 1st N. July 28, Left; circ. Surg. W.W. L. Phil Independent Penn. Ar 18, 64. 30th Colored Troops. Disch d Jersey Cav., age 19. 28, 64. lips. 1st N. J. Cavalry. Disch d tillery, age 21. Jan. 3, 1865. Nov. 11, 1864. 248 Garner, J., Pt., I, 5th N. Sept. 17, Right. Union surgeon. Fur- 205 Ehrman, C., Serg t, C, June 25, Right; circ. Surg.A.Sabine,76th Carolina. 17, 62. loughed Dec. 19, 1862. 17th Mo., age 28. 25, 64. Ohio. Disch d March 14, 1865. 249 Garvin, M., Corp l, C, June 18, Right. Surg. O. J. Evans, 40th 206 Eisert, C. H. F., Pt., C, May 12, Left; ant. post, flap; sloughing; 40th New York, age 33. 18, 64. N. Y. Disch d March 4, 1865. 17th Infantry, age 38. 12, 64. exfol. Veteran Reserve Corps 250 Gaskins, J., Pt., D, 4th July 1, . Recovery. March 3, 1865. Virginia Battery. 1, 62. 207 Elliott, T., Corp l, A, May 10, Right ; circ. Surg. P. Leidy, 251 Gates, E. B., Capt,, H, June 30, Left. Surg. M. S. Kittinger, 100th 119th Penn., age 20. 10, 64. 119th Penn. Disch. June 15, 65. 4tb Pennsylvania. J yl, 62. N. Y. Disch d Oct. 31, 1862. Died Oct. 29, 73 ; cong. brain. 252 Gieseke, A., Pt., I, 12th July 17, Left; flap. Surg.J.Spiegelhalter, 208 Erving, R. M.,Pt.,B,26th Sept. 19, Right ; long post, flap ; slough.; Missouri. 17, 63. 12th Mo. Disch d April 14/64. Mass., age 20. 19, 64. necrosis. Disch d Nov. 7, 1864. 253 Gilbert, D. .R.,Pt.,K, 23d July 2, Right. Exchanged Nov. 12, 63. 209 Mstis, F. M., Pt., D, 34th July 30, . Surg. Mason, C. S. A. South Carolina, age 35. 3, 63. Virginia. 30, 64. Retired Feb. 17, 1865. 254 Gillen,J., Pt., A, 35th N. Dec. 9, Left; double flap. Surg. A. B. 210 Everts, D., Pt., H, 142d Oct. 27, Right; circ. Surg. G. C. Jarvis, Jersey, age 23. 9, 64. Monahan, 63d Ohio. Trismus. New York, age 24. 27, 64. 7th Conn. Disch d June 26, 65. Transferred April 14, 1865. 211 Faas, C., Serg t, I, 7th June 1, Right. Surg. O.Adams, 7th Mass. 255 Gilkerson, J., Corp l, G, April 6, Right ; circular. Mustered out. Massachusetts. 1, 62. Disch d Sept. 28, 1862. 140th Pennsylvania. 6, 65. 212 Facks, J., Corp l, B, 6th July 1, Left; flap. Disch d March 16, 256 Gillighan. H., Pt., K,22d May 11, Left ; ant post. flap. Surg. I. H. Wisconsin, age 32. 3, %3. 1864. Mass., age 23. 11, 64. Stearns, 22d Mass. Discharged 213 Fairley, H., Pt., I, 28th July 2, Left. Surg. Z. E. Bliss, U. S. V. October 17, 1864. Massachusetts, age 34. 4, 63. Bone removed; haein. Disch d 257 Gilmore, T., Pt., 1, 107th May 25, Left ; circular. Discharged July March 22, 1865. New York, age 21. 27, 64. 20, 1865. 214 1 Faiver, A. J., Pt., 18th Sept. 17, Left ; posterior flap. 258 Ginnings, E. K., Pt., K, Mar. 22, Right ; lateral flaps. Surg. A. Miss., age 19. 18, 62. 26th Illinois, age 19. 22, 65. T. Hudson. 26th Iowa. Disch d 215 Fallen, T., Pt., D, llth May 3, Right ; flap. Disch d September June 27, 1865. Massachusetts. 3, fe. 21, 1863. 259 Glatzel, P. P., Pt., E, June 1, Left ; flap. Disch d Sept. 21, 65. 216 Farmer, If., Pt., , 13th Aug. 16, Right, Surg. Bace, C. S. A. 26th Wisconsin, age 28. 1, 64. North Carolina. 16, 64. Retired Jan. 9, 1865. 260 Glynn, M., Pt., A, 107th Mar. 16, Right ; ciro. Surg. P. H. Flood, 217 Farmer, T. F., Serg t, G, Sept. 30, Left ; flap. Confederate surgeon. New York, age 48. 16, 65. 107th N. Y. Disch d Feb. 20, 66. 51st New York. 30, 64. Disch d Jan. 5, 1865. 261 Godchalke, A., Capt.,H, Sept. 19, Left; flap. Surg.W. M. Wright, 218 Farns worth, E.. jr., Lieut., Oct. 19, Left. Surgeon J. G. Bradt, 26th 79th Pennsylvania. 19, 63. 79th Penn. Nov. 21, 65, re-amp. C, 2Gth Massachusetts. 20, 64. Mass. Disch d Feb. 11, 1865. 23d, ham. M. O. June 30, 1 866. 219 Fan-ell, W., Pt., F, 158th Sept. 29, Left : circ. Disch d April 11, 65. 262 Goery, L., Serg t, B,90th Sept, 17, Right. Disch d Nov. 20, 1862. New York, age 32. 29, 64. Pennsylvania. 17, 62. 220 Farthing, W. G. W., Pt., July 2, Left. Paroled November 12, 63. 263 Goodno w, A. H., Pt., C, May 13, Right ; flap. Surg. A.T. Hudson, 1). 5th Texas, age 26. 3, 63. 30th Iowa, age 22. 13, 64. 26th Iowa. Disch d June 16, 65. 221 Faulkner, L., Pt., C, 2d April 13, Right; flap. Disch d October 264 Goslon, L., Lieut., I, 33d April 2, Right; circular. Released June Artillery. 14, 63. 10, 1863. N. Carolina, age 22. 3, 65. 9, 1865. 222 Fellers, J. A., Pt,, I, 87th Sept. 19, Left ; flap. Mar. 22, 65, re-amp. 265 Gosper, J. J., Lieut., C, Dec. 4, Left. Surg. D. MacKay, 29th C. Pennsylvania, age 2l . 20, 64. Disch d May 20, 65. Spec. 4198. 29th C. Troops, age 24. 4, 64. Troops. Disch d May 15, 1865. 223 Felman, J. R., Capt, I, July 3, Right. Surg. F.Wolf, 39th N.Y. 266 Graham, G. W., Serg t, Dec. 16, Right ; flap. Surg. V. B. Kenne 108th New York. 3, 63. Disch d April 22, 1864. E, 7th Minnesota, age 17, 64. dy, 5th Minn. Disch d April 4, 224 Fenlin, W. H., Serg t, F, Dec. 13, Right; flap. Disch d June 14, 24. 1865. 88th Pennsylvania. 15, 62. 1864. 267 Graham, R., Pt., A, 98th April 17, Right; flap. Ass t Surg. A. T. 225 Ferguson, j . W., Pt., I, July 22, Right ; ciro. Transferred Sept. Illinois, age 19. 18, 64. Barnes, 98th 111. Disch d July 19th Alabama, age 24. 23, 64. 22. 1864. 23, 1864. 226 Ferriter,J., Pt.,Letcher s July 2, Right. Retired February 9, 1865. 268 Grant, J., Pt., F, 12th Deo. 13, Right. Ass t Surg. J. G. Wilbur, Battery. 2, 63. Rhode Island. 14, 62. 18th Mass. Disch d Mar. 13, 63. 227 Fieldson, T., Serg t, F. Mar. 25, Right ; flap. Surg. "W. C. Shur- 269 Graves, B. V., Pt,, Cren- June 27, . Surg.W.C.Warreu,C.S.A. 14th New York Heavy 25, 65. lock, 51st Penn. Disch d Nov. shaw s Va. Battery. 27, 62. Retired Feb. 22, 1865. Artillery, age 21. 6, 1865. Spec. 1145. 270 Greely, P., Pt., A, 1st July 21, Left ; flap. Surg. L. J. Dixon, 228 Fink, F., Pt., B, 5th New June 2, Right ; flap. Confed. surgeon. Wisconsin, age 22. 21, 64. IstWis. M. O.March 1, 1865. York, age 18. 2, 64. Duty Oct. 19, 1864. 271 Green, D. M., Pt.,A,97th June 12, Right ; circ. Surg. W. B. Cham 229 Fletcher, T., Pt., I, 82d July 2, Right; nap. Disch d July 4, 64. New York, age 26. 13, 64. bers, 97th N. Y. Disch d June New York, age 23. 2, 63. 13, 1865. 230 Foote, D. W., Lieut., I, Oct. 5, Left. Surg. B. F. Keables, 3d 272 Green, E., Pt., H, 5th N. May 5, : flap. Discharged October 3d Iowa, age 33. 5, 62. Iowa. Resigned Aug. 21, 1863. Carolina Bat y, age 23. 6, 62. 17, 1862. 231 Foss, J. A., Serg t, C, 1st April 2, Left. Surg. F. M. Everleth, 7th 273 Greenison, S. W., Pt., E, Aug. 21, Right. Surg.W.P.Young,C.S.A. Maine, age 22. 2, 65. Me. Disch d July 2, 65. Bone 4th Georgia. 21, 64. Exchanged. removed in 1867. 274 Greentodl.J. A.,Pt..Bal- Sept. 17, Right. Surg. R. A. Lewis.C.S.A. 232 Foster, M. F., Serg t, H, June 17, Left .- flap. Disch d May 23, 65. timore Light Artillery. 17, 62. Recovery. 59th Mass., age 26. 18. 64. Died Aug. 23, 76; tuberc. dis. 275 Griffith. W. C. P., Pt., H, May 14, Right : ant. post. flap. Ass t Surg. 233 Fought v, G. W., Serg t, Dec. 28, Right; flap. Surg. E.O.F. Roler; 80th Indiana, age 20. 15, 64. W. P. Welborn, 8nth Indiana. B, 57tli Ohio. 28, 63. 55th 111. Disch d Mar. 7, 1863. Disch d May 18, 1865. 234 Franklin, J. S., Serg t, Aug. 29, Right. Surg. J.T. Calhoun, 74th 276 Grim, G. W., Corp l, V, Feb. 5, Right ; ant. post. flap. Disch d A, 74th New York. 30, 62. New York. Disch d Oct. 29, 62. 6th Ohio Cav., age 30. 5, 65. August 16. 1865. 235 Franklin, S., Pt., G, 54th Nov. 30, Left ; circ. Disch d July 2, 1865. 277 Gross, W., Pt., C, 7th Dec. 13, Right. Gangrene. Discharged Massachusetts, age 42. Dec 1, 64. Penn. Res., age 27. 13. 62. May 2, 1863. 236 Frazier, W., Pt., I, 140th April 6, Right ; flap. A. Surg. B. F. Hill, 278 Grove, S., Pt., K, 3d July 12, Left flap. Discharged October Pennsylvania. 6, 65. 140th Penn. Disch d June 27, Iowa. 14, 63. 13, 1863. 1865. 279 Groves, C. H.,Pt.,K,18th Nov. 7, Left. Surg. W. Holbrook, 18th 237 Free, S. S., Pt., B, 170th May 18, Right ; flap. Surg. D. W. Maull, Massachusetts, age 2 *. 7 63. Mass. Disch d March 28, 1864. New York, age 20. 18, 64. 1st Del. Disch d Nov. 10, 1864. 280 Haclder, J.P., Serg t, K, Nov. 30, Left ; circ. To Provost Marshal 238 Freiclrich, J., Corp l, K, June 18, Right ; flap. Surg. W. B. Fox, 3d Mississippi, age 23, 30, 64. March 7, 1865. 2d Michigan, age 28. 18, 64. 8th Mich. Discli d July 4, 1865. 281 Hadlow, H., Pt., H, 81st May 31, Right. Confed. surgeon. Gang. 239 Frost, L. G., Pt., C, 3d Alay 10, Right; flap. Surg. T. Hndreth, New York, age 21. J e 1, 62. Aug. 1, amp. thigh: 15, re-ninp. Maine, age 23. 10. 64. 3d Me. Disch d Nov. 19, 1864. thigh. Disch d May 2. 186:!. 240 Frost, N. G., Pt., G, 32d July 30, Left ; flap. Disch d Feb. 8, 1865. 282 Hahn, M., Serg t. C, 26th Mar. 19, Left ; circular. Disch d Nov. 23, Maine, age 34. 30, 64. May, 1865, amp. knee joint. Wisconsin, age 32. 19, T,5. 1865. 241 Fry, H.S., Corp l, B,12th Mar. 27, Left; flap. Disch d September 283 Haight, O., Pt., L, 2d April 7, Right ; flap. Disch d June 6, 65. Iowa, age 24. 27, 65. 25, 1865. 1 N. Y. H. Art y, age 26. 8, 65. 1 FISHER (G. J.). Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the battle of Antielam, September 17, 1862, in American Journal Medical Sciences, Volume XLV, page 48. 484 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Vr NAME, MILITARY 1) ATKS. OPERATIONS, OPERATORS. K NAME, MILITARY r> .-,-,.* OPERATIONS. OPERATORS, iNO. DESCRIPTION, AND AUE. RESULT. L DESCRIPTION, AND AGE. * RESULT. 1 284 Hallam, H. C., Pt.. Fred- Mav 2, Right. Ass t Surg. H. L. Hines, 327 Hochstetler, C., Pt., D, June 18, Right; ant. posterior double flap. ericksburg Artillery. 2, ! 63. C. S. A. Recovery. 54th Penn.. age 19. 18, 64. Disch d April 1, 1865. 235 Ilullett, D., Serg t, F, April 2, Right ; ant. post. flap. Disch d 328 Hotfses, R. W., Corp l, E, May 5, Right ; circular. Disch d Decem 67th Ohio, age 2-1. 2, 65. July 29, 1865. 20th Maine, age 29. 6, 64. ber 12, 1864. 286 Halsey, H., Pt., F, 48th Mav 11, Left ; circular. Disch d January 329 Hogue, W., Pt., G, 83d July 1, Right. Discharged May 30, 1863. Pennsylvania, age 26. 11, 64. 5, 1865. Pennsylvania, age 24. 1, 62. 287 Hamil, T., Serg t,E,12th Sept. 19, Right ; flap. Surg. Lamar, 330 Holladay, J. F., Pt., C, Mar. 12, Right; flap. Disch d July 23, Georgia. 19, 64. C. S. A. To Fort McHenry 48th Ohio, age 22. 13, 63. 1863. Jan. 5, 1865. 331 Hood, i. E., Serg t, F, July 30, Left; circ. Surg. G. W. Snow, J288 Hamilton, T. P., Pt., K, April 29, Left. Surg. J. Ebersole, 19th Ind. 35th Mass., age 23. 30," 64. 35th Mass. Disch d April 12, 65. 13th Georgia. , 63. Prison June 25, 63. Spec. 4819. 332 Hooks, B. A., Pt., B, 59th Aug. 14, Right. To prison October 15, 289 Hamilton, W. J., Serg t, May 23, Left ; circ. Surg. C. Bower, 6th Georgia, age 27. 14, 64. 1864. J, llth Pennsylvania 23, 64. Penn. Reserves. Mustered out 333 Hope, J., Pt., H, 2d Vir- Nov. 6, Left; flap. Surg. W.Wynne, 14th Reserves, age 23. June 13, 1864. ginia, age 30. 8, 63. Penn. Cav. Disch d June 29, 64. 290 Hammer, G., Serg t. E, June 14, Left; circ. Surg. J.W.Wishart, 334 Horton, B. J., Lieut., I, De.31, 62 Left. Resigned June 10, 1863. 52d New York, age 37. 15, 64. 140th Penn. Disch d May 22, 65. 24th Ohio. Jan.1, 63 291 Hanlon, W., Pt., E, 27th July 21, Right ; flap. Surg. Smith, C. 335 Hough, W., Pt., A, 58th July 14, Right ; flap. Mustered out May New York. 23. 61. S. A. Must, out May 31, 1863. Illinois. 14, 64. 3, 1865. 292 Hannah, G., Pt., G, 3d July 22, Left ; circ. To Provost Marshal 336 Howard, W. F., Pt., I, Sept. 18, Right : flap. Surg. W. H.Th;r,-r, Florida, age 24. 22, 64. Dec. 1, 1864. 14th N. Ilamp., age 24. 19, 64. 14th N. H. Disch d Jan. !l, 65. 293 Hardin, J., Lieut., G, May 25, Left; flap. Disch d Oct. 13, 64. 337 Howie, ^.iV.,Pt.,B,53d Sept. 5, Right; flap. Surg. L. Hill, 53d 101st Illinois, age 39. 26. 64. Oct., 1865, re-amputation. North Carolina, age 31. 6, 64. N. C. Recovery Jan. 8, 1865. 294 Harding, W. R., Pt., C, Sept. 17, Right. Furloughed. 338 Hubbard, J. M., Serg t, Sept. 17, Left ; flap. Transferred Decem 15th North Carolina. 17, 62. II, 2d Miss., age 26. 17, 62. ber 14, 1862. 295 Harper, F. M., Pt.,C, 6th April 10, . Confederate surgeon. Re 339 Hudson, J.. Pt., H, 31st May 12, Left; circ. A. Snrg. A. C. Mills, Mississippi. 11, 63. covery. Indiana, age 25. 12, 63. 1 25th 111. Disch d Oct. 16, 1863. 296 Harrell, If. D., Pt., G, Sept. 30, Left. To prison January 23, "65. 340 Huffman, C., Pt., K. 7th Feb. 15, Right; double flap; re-amput n. 31st N.Carolina,age22. 30, 64. Illinois, age 17. 15, 62. Discharged May 1 , 1862. 297 Harrigan, J. M., Corp l, Dec. 4, Right ; circular. Disch d May 341 Hugqins, A. C., Serg t Apr! 120, . Surg. W. R. Wilson, 24th A, 20th Ohio, age 22. 4, 64. 15, 1865. Maj., 24th N. Carolina. 20, 64. N. C. Retired Feb. 24, 1865. 298 Harriger. J., Serg t, B, July 2, Right ; flap. Surg. Patterson, 342 Hunn, W. R., Corp l, A, Oct. 19, Rifrht ; flap. Surg. G. T. SteveLS, 105th Penn., age 19. 2, 63. C. S. A. Disch d Sept. 8, 1864. 122d N. Y., age 35. 20, 64. 77th N. Y. Disch d May 31, 6.">. 299 Harrington, G. W., Pt., Aug. 5, Left; flap. Surg. J. Haller, 38th 343 Idner, G. W., Pt., I, 23d May 12, Right ; circ. Surg. M. Bruckei, K, 38th Ohio, age 22. 5, T 64. Ohio. Gangrene. Discharged Indiana. 12," 63. 23d Ind. Disch d Aug. 7, 1863. May 27. 1865. 344 Ingraham, ff.,Pt..H,43d May 30, Right ; circ. A. Surg. J. T. Duf- 300 Harris, J. M., Pt., D, July 3, Right. Surg. Butler, ( . S. A. North Carolina, age 49. June 1, iield, 7th Indiana. To prison 37th Virginia. 3, 63. Exchanged March 3, 1864. 1864. Dec. 30, 1864. 301 Harris, L., Corp l, G, May 5, ! Left ; flap. Disch d Jan. 23, 65. 345 Inmau, ,S., Pt., F, 16th April 1, Right; flap. Discharged August 143d Pennsylvania. 7, f 64. Maine, age 31. 2, 65. 23,18(15. 302 Harris, L. S.. Corp l, C, June 14, . Surg. Metoalfe, C. S. A. 346 Irvin, J., Lieut., E, 45th May 18, Right ; circ. Surg. II. E. Smith, Jeff. Davis Legion. 14, 64. Recovery. Penn., age 36. 18, 64. 27th Mich. Disch d Jan. 18, 303 iHarwood, E. F., Pt., Sept. 17, Right : post. flap. Doing well. 1865. Died April 17, 1871. 18th Mississippi, age 30. 17, 62. 347 Irving, W., Major, 38th Aug. 5, Left; flap. Surg. J. Bailor, 38th 304 Hasenour, G., Pt., 1, 49th May 1 6, Left : flap. Surg. J. A.Ritter, 49th Ohio, age 30. 5, y 64. Ohio. Must, out July 12, 1865. Indiana. 16, 63. Indiana. Disch d Feb. 8, 18G4. 348 Isham, F. W., Corp l, D, Mar. 31, Left; circ. Surg; D.C. Ayers,7th 305 Havens, J. 8., Pt., H, 33d Dec. 13, Right. Discharged. 7th Wisconsin, age 32. ; 31, 65. Wis. Disch d June 13, 1865. New York. 13, 62. 349 Jackson, J., Serg t, F, Dec. 37, Right; circular. Disch d July 306 Hawkins, W.W., Serg t, May 5, Right. Ass t Surg. A. B. Haines, 12th Mo. Cav., age 22. 18, 64. 2, 1865. I, 93d N. York, age 21. 6, *64. 20th Ind. May 16, amp. thigh. 350 James, J., Pt., B, 57th i Oct. 5, Right ; ant. post. flap. Surg. J. R. ( Disch d July 12, (>5. ^>ec.4497. Illinois, age 18. 5, 64. Zcaring, 57th 111. Discharged 307 Ilaynes, C. H., Serg t, E, May 5, Left : flap. Confederate sure-eon. July 22, 1865. 20th Maine, age 28. 7, 64. Disch d April 10, 18H5. 351 Jecko.P., Serg t, D, 15th Nov. 29, R t ; flap. A. Surg. W. L. Graves. 308 Heist, E., Pt., E, 27th June 8, Left; flap. Discharged Septem- Missouri, age 29. 29, 64. 6th Ark., C.S.A. Disch d July Pennsylvania. 10, 62. berl6, 1862. 31, 1865. Also amp. forearm. 309 Heist, J. A., Pt., G, 6th July 6, Left; flap. Confederate surgeon. 352 Jedowin, T., Pt., C, 1st Mar. 25, Left ; flap. Surg. J. J. Meigs, 3d Michigan Cavalry. 6, 63. July 27, re-amp. Discharged Vt. H vy Art., age 17. 25, 65. Vermont. Disch d Sept. 14, 65. May 21, 1864. 353 Jellison, N. F., Pt., llth Sept. 19, Left. Disch d April 4, 1803. 310 Hemingway, N. M., Pt., Dec. 13, Right; circular. Disch d June Ohio Battery. | 20, 62. II, 32d Mass., age 17. 13, 62. 18, 1863. 354 Jenne, R. C., Corp l, J, April 2, Right ; flap. Surg. L. W. Bliss, : 311 Hemminway, A., Pt., K, 4 Jth New York, age 25. May 6, 6, r 64. Right ; circ. flap. Discharged March 30, 1865. 355 17th Vermont, age 20. Jerinan, D., Pt.,F, 19Cth 2, 65. July 11, 51st N. Y. Disoh y d Oct. 13, 65. Right ; flap. Surg. L. W. Read, 312 Henderson, S. K., Pt., F, June 5, . Surgs. Bell and Cross, C. Penn., age 23. 11, 64. U. S. V. Disch d Aug. 7, 1865. ! 36th Virginia. 5, 64. S. A. Retired Dec., 1864. Died May 9, 80 : ulcera. stump. 313 Hendricks, M., Pt., K, Jan. 2, Left. Discharged February 28, 356 Johnson, A., Pt., K, 1st July 7, Left; circular. Discharged. 70th Indiana. 2, 63. 1663. N. J. Cavalry, aere 11>. 8. 64. 314 Hondrickson, J., Lieut. Dec. ]3, Right. Mustered out June 30, 357 Johnson. G., Pt.,"A,43d Oct. 27, Right; circ. Surg. E. Jackson, Col., 83d New York. 13, 62. 1866. Colored Troops, age 38. 27, 64. 30th C. T. Diseh d Sept. 14, 65. 315 Hessler, P., Pt., K, 82d May 18, Right ; circ. Surg. S. II. Plumb, 358 Johnson, J., Pt., G, 17ih Nov. 11, Right; circular. To prison Feb. New York, age 23. 18, 64. 82d New York. Disch d June Virginia, age 18. 12, 64. JO, 1865. 9, 1865. 359 Johnson, J. M., Pt., C, 3d June 3. Right. Surg. D. E Wolf, 3d Del. , 316 Hibbs, T., Pt., G, 2d N. June ], Left; cire. Surg. G. L. Potter, Delaware, age 31 . 3, 64. (Also amp. at left ankle joint.) Y. H vy Art., age 47. 1, 64. 145th Penn. Gangrene. Disch d Discharged June 8, 1865. Nov. 4, 1865. Re-amp. 1866. 360 Johnson, W. T., Pt., I, Aiiff. 6, Left; flap; Surg. T. B.Williams, 317 Hickey, P., Pt., E, 3d May 14, Right. Discharged December 7, 113th Ohio, age 21. 6, "64. 121st Ohio. Disch d May 23, N. Y. Artillery, age 31. 14, 64. 1864. (Alias T. F. Ricker.) 1865. Died May 11, 1874. 318 Hicks. J., Pt., B, Cth May 14, Left; circular. Discharged No- 361 Johnstone, R., Pt., G, April 1, Right ; circular. Disch d Sept. Tennessee. 14. 64. vember 21, 1865. 121st Penn., age 31. 2, 65. 30, 1865. 319? 320) Higginbotham, E.B.,t., F, 38th Georgia. May 12, Both. Surgeon W. J. Arrington, 13, 64. P. A. C. S. Recovery. 362 Jnline,W. II.,Pt..E,12th Miiy 10, Penn. Reserves, age 20. 10, 64. Left; ciro. flap. Surg. B. Rohrer, ! 10th Penn. Reserves. Disch d : March 24, 1865. 321 Higgins, V. X., Pt., H, Mav 4, Left. Discharged June 9, 1863. 363 Jones, W., Corp l, H, 8th June 22, Left; ant. post. flap. Surg. G. 2d Maine, age 24. 5. 63. i New York H vy Art., 23, 64. Chaddock, 7th Mich. Disch d 322 Ililler, J. A., Corp l, P, Sept. 26, Left ; post. flap. Surgeon A. P. age 25. December 5, 1864. 9th New York Cavalry, 26, 64. Clark, 6th N. Y. Cav. Disch d 561 Jimr*, JT. M., Serg t, K, July 2. Right. Exchanged March 17, age 26. June 29, 1865. 50th Georgia, acre 22. 4, 63. 1864. 323 Hines, G.W., Pt.,C, 98th Pec. 17, Right; circular; gang. Disch d !65 Jones, W. I>7, Pt.,~F, 12th July 21, Left; flap. Surg. E. M. Rogers, Ohio, age 19. 17, 64. May 26, 1805. Wisconsin, age 24. 21, 64. 12th AVis. Disch d June 1 , 1865. 324 llinson. J. L., Lieut., I, Sept. 19, R t: circ. Surg. Weatherby, 566 Jones, W. S., Lieut., I, Jan. 2, Left ; flap. Disch d November 6th Alu nuna, age 29. 19, 64. C. S. A. To prison Dec. 9, 64. 2d Arkansas, age 21. 3, 63. 7, 1864. 325 Hinson, J.W., Pt.,C, 33d June 29, Right; flap. Surg. J. Bennett, 367 Jones, Z., Pt., B, 24th N. April 2, Left. Released July 22, 1865. Indiana, age 22. 29, 64. 19th Mich. Disch d July 21, 65. Carolina, age 25. 2, 65. 326 Hobbs, J., Pt., B, 39th Sept. 19, 1 Right ; flap. Disch d January 568 Jordan, J. I ., Lieut., B, May 29, . Surg. Price. 7th Vir Indiana. 19, 63. 9, 1864. 7th Virginia Cavalry. 29, 64. ginia. Furloughed. FISHER (G. J.). Report of Fifty-seven Cases of Ampvtatirms. in tlie Hospitals -near FSharpsbvnj. Md., after the battle of Antietam, Se.ptrmlit 18(>2. in A ni rican Journal Medical Sciences, Volume XLV, page 48. PRIMARY AMPUTATIONS IN THE LEG. 485 KTr^ NAME, MILITARY OPERATIONS, OPERATORS, TJr> NAME, MILITARY OPERATIONS, OPERATORS, ttO. DESCRIPTION, AXI> AGE. RESULT. liv . DESCRIPTION, AND AGE. DATES. RESULT. 369 Jowers, W., Pt., F, 17th July 2, Right ; flap. Re-amput n. Ex 408 j 3 Laiorence, J. It., Lieut., Sept. 17, Right; post. flap. Transferred Miss., age 39. 3. 63. changed March 17, 1864. ! 1, 1st Louisiana, age 33. 17, 62. November 28, 1862. 370 Kapp, J., Pt., I, 17th Jan. 11, Right; ant. post. flap. Surg. E. 409 , Lee, A. W., Pt., K, 2d Aug. 16, Right; circ. Disch d June27, 65. Missouri. 1 1, 63. C. Franklin, U. S. V. Disch d N.Y. H vy Art., age 22. 17, 64. Died Sept. 25, "68; consumption. Jan. 22. 1864. 410 Lemmon, E., Pt.. E, 16th Dec. 29, Left ; flap. Surg. J. Pomerene, 371 Kaufman, W., Serg t. E, Jan. 11, Right ; flap. Discharged May Ohio. 30, 62. 42d Ohio. Disch d April 3, 63. 3d Missouri. 11, 63. 29, 1863. 411 Lentz, D., Pt., L, 5th Oct. 6, Left ; circ. A. Surg. J. McCann, 372 Kean. R. M., Pt., F, 50th July 2, . Surg. J. L. Harris, C.S. A. Penn. H vy Artillery, 6, 64. 5th Penn. Heavy Artil y. Dis Georgia. 4. 63. Paroled Nov. 12, 1863. age 40. charged June 8, 1865. 373 Keffer," H., Pt., K, 55th June 3, Left; flap. Discharged March 412 Leonard, A. G., Pt., B, Sept. 26, Right : flap. Discharged March Pennsylvania, age 23. , 3, 6-1. 2, 1865. 1st W.Va. Cav., asje23. 28, 64. 27, 1865. 374 Keister, J. >F.,Serg t,6th May 5, . Surg. G. Whitfield, 12th 413 | Lewis, J.W., Pt., lO:h Nov. 16, Left : flap. Discharged May 17, Alabama. 6, 64. Alabama. Recovery. Kentucky, age 21. 17, 63. 1864. 370 Keller, I. N., Corp !, B, Sept. 1, Left; flap. Surg. D. S. Young, 414 Light, O.H.,Pt.,F, 12th Dec. 13, Right; circ. Discharged April 21st Ohio, age 2-, . 1, 64. 21st Ohio. Disch d Feb. 21, 65. i Rhode Island. 13, 62. 6, 1863. 376 Kelly, K., Pt., A, 29th Sept. 17, R t ; flap. Surg. G. B. Coggswell, 415 Little, A., Pt., F, 106th June 1, Right ; flap. Surgeon M. Rizer, Massachusetts-. 18, 62. 29th Mass. Disch d Mar. 3, 63. Penn.. age 22. 1, 64. 72dPenn. Disch d April 15. 65. : 377 Kelly, L. C., Corp l, K, Jan. 27, Right ; flap. Surg. M. M. Hooton, 416 Locke, W. $., Pt., K, 41st Sept. 20, Right. Surg. J.S.Cain, C.S. A. 52d Ohio, age 21. 28. b 4. 86th 111. Disch d Jan. 26, 1865. Mississippi. 20, 63. Recovery. 378 ! Keltner, S., Pt., I, fifth ! Dec. 19, Right; ant. post. flap. Disch d 417 Lockett. E. F., Pt., C, 23d May 3, Left. Ass t Surg. Dennis, 23d Ohio, age 18. 10, 64. J\me 30, 186.">. Virginia. 3, 63. Virginia. Recovery. 379 Kendall, T. C., Car*., B, May 4, Right : circ. Surg.E.G.Greenleaf, 418 Loclce.tt. W. F., Pt., E, Oct. 19, Right; circ. Surg. J. Watkins, 21st X. J., age 35. C, 63. 54th N. C. Mustered out June 36th Virginia, age 20. 19, 64. 36th Va. To Provost Marshal 19, 1863. February 11, 1865. 380 Kenfield. C. P>., I t., K. Sept. 17, Right ; flap. Surg. G. W. Snow, 419 Loetech.C., Serg t, B, 2d June 18, Left: flap. Snrg. E. Griswold, 35th Massachusetts. 19, 62. 35th Mass. Disch d Mar. 4, 63. Penn. Art ry, age 36. , 64. 2d Penn. Disch d Oct. 19, 1865. 381 Kennedy, J., Pt., 5th June 5, Left. Surg. C. Carle, 41st 111. 420 Long, J. C., Pt., A, 3d Oct. 11, Right. Surg. E. W. H. Beck, 3d Ohio Battery. 5, 63. Gangrene. Disch d Sept. 8, 64. Indiana Cav., age 22. 11. 63. Ind. Cav. Disch d April 6, 64. 380 Kent, L. S., Pt., G, 4th Aug. 31, Left. Recovered. 421 Long, J. D.. Pt., C, 15th De.31, 62, Left, Discharged March 6, 1 863. Louisiana. 31, 64. Indiana. Jan. 1, 63. 383 Keuworthy, L., Pt., B, Mar. 1C, Left ; flap. Surg. J. A. Stillwell, 422 Lord, T. W., Lieut,, K, May 3, Left; flap. Surg. C. S. Wood, 22d Indiana, age 23. 16, 65. 22d Ind. Disch d June 12, 1865. 17th Maine. 3. 63. 66th N. Y. Disch d Sept. 10, 384 Kcrr, J. If., Lieut., H, July 20, Left. Confederate surgeon. To 1863. Re-amp. November, 1864. 57th X. C., age 20. 1 , 64. prison February 16, 1865. 423 Lorell,B. L., Pt., B, 17th Aug. 7, . Surg. R. Fleming, C. S. A. 385 Keziah, P.G .,Pt., F,35th ; May 19, . Surg. C. J. O Hagan, 35th Virginia Cavalry. 7, %4. Recovery. North Carolina. 20, 64. N. C. Recovery. 424 : Lucore, L., Pt., C, 1st Dec. 13, Right ; flap. Discharged Sep 386, ^Kidd, W. J., Pt,, 49th Sept. 17, Left: post. flap. Transferred. Penn. Rifles. 13, 62. tember 28, 1863. Virginia, age 26. i 17, 62. 425 Luzader, T., Pt., C, 33d Sept. 27, Left. Discharged October 29, 367 KHlebrr.il-, r. H., Pt.. C, July 2, Left. Surg. Etheridge, C.S.A. Ohio, age 21. 27, 62. 1862. 12th Georgia, age 22. 2, r 63. Exchanged Nov. 12, 1863. 426 : Lyons, W., Pt., E, 1st Oct. 12, . Ass t Surg. M. P. Shelton, 388 Kissinger, //., Pt., F, Sept. , Right. Doing well October 25, Tennessee Cavalry. 12, 63. C. S. A. Recovery. 34th Virginia. 29, 64. 1864. 427 Jfa6ers,f.5.,Pt.,H,llth July 2, Left. Surg. L. L. Saunders, P. A. 389 Knight, C. E.,Pt.,F, 19th Dec. 7, Right; flap. Surg. M. B. Coch- Alabama, age 24. 3, 63. C. S. 8th, re-am putatiou. Ex Iowa. 8, 62. ran, 1st Iowa Cavalry. Disch d changed Nov. 12, 1863. April 25, 1863. 428 Mainor, J. M., Pt., B, De.31, 62, Right. Surg. Gardner, C.S.A. 390 Knight, F.W., Pt., E. 1st Sept. 19, Right ; flap of skin, circ. of mus. 37th Georgia, age 22. Jan. 1, 63. Recovery. Vt. H vy Art., age 21. 20, 64. Feb. 15, reamputat n. Disch d 429 Male, G. W., Seaman, Mar. 13, Left; flap! Surg. J. Wise, U.S.X. Aug. 17, 1865. Spec. 4330. Baron DeKalb, U. S. N. 13, 63. Disch d Oct. 22, 1863. 391 Knowles, J.. Corp l, K, July 15, Left; flap. Discharged October 430 Maley, J., Pt., H, 7th May 14, Left; flap. Surg. G. C. Jarvis, 114th Illinois. 15, 64. 9. 1864. Conn., age 26. 14, 64. 7th Conu. March 2. 65, re-amp. 392 Koch, D., Pt., A, 54th i Aug. 29, Right. Surg. C. W. Hagen, 54th Discharged Sept. 13, 1865. New York. 29, 62. N. Y. Sept. 3, re-amp, up. third. 431 Malloy, P., Pt., A, 10th Sept. 19, Right ; flap. Surg. Pitts, 2d Disch d April 14, 64. Spec. 6707. Tennessee, age 38. 21, 63. Miss. To Provost Marshal June 393 Koch, II., Serg t, F, 82d May 25, Left ; circular. Discharged A ug. 14, 1864. Illinois, age 26. 26, 64. 31, 1865. 432 Malters, B., Pt,, A, 108th Julv 3, Right ; ant. post. flap. Surg. O. 394 Koehler, A., Pt., D, 4th Dec. 13, Right. Discharged August 28, New York, age 17. 3, r 63. Munson, 108th N. Y. Hsem.; New York. 13, 62. 1863. lig. ant. tibial artery; necrosed. 395 Kopp, E., Pt., K, 12th Mar. 25, Left; flap. Surg.A.Satterthwaite, Disch d Nov. 3, 64. Spec. 4323. New Jersey, age 32. 27, 65. 12th N. J.. and A. Staff Surg. W. 433 Manahard, W. E., Pt., May 31, . Surgeon II. H. Hubbard, J.Burr,U.S.A. (Also amp. right G, 2d Mississippi. 31, 62. P. A. C. S. Recovery. leg, low. third.) April 2, slough. 434 Maugan. R., Lieut., D, June 24, Lett. Surg. S. H. Kersey, 36th Discharged Oct. 3, 1865. 75th Illinois. 24, 64. Indiana. Disch d Dec. 2, 1864. 396 2 Kosack, O., Pt., K, 2d Dec. 13. Left ; gangrene. Disch d June 435 M<tnsnn,n. W., Serg t,!!, April 2, Right; circular. Released June Maryland, age 26. 13, 62. 15, 1864. iipcc. 6706. 7th Tenn., age 22. 3, 65. 14, 1865. 397 Kriner. J., Tt, 13, 48th Oct. 29. Right ; circ. Surg.W.O Meagher, 436 Mapes, W. Tf., Pt., F, Oct. 19. Right : ant. post. flap. Surg. N. Pennsylvania, age 26. 29, 64. 69th N. Y. Disch d June 6, 65. 5th X. Y. Cav., age 42. 20, 64. D. Ferguson, 8th N. Y. Cavalry. 398 Lao/, J. P., Capt., B, May 3, Right. Surg. P. F. Whitehead, Disch d May 3, 1865. 44th Virginia. 3, 63. C. S. A. Recovery. 437 Martin, F. S., Pt., F, 2d Oct. 19, Left ; ant. post. flap. Surg. M. J. 399 Laird, I>. P., Pt., D. 49th Aug. 21, Right : flap. Surg.G. T. Stevens, Vermont, age 21. 20, 64. Hyde, 2d Vt. Oct. 31, bone re New York, age lit. 21, 64. 77th N.Y. Disch d July 18, 65. moved. Disch d Aug. 25, 1865. 400 : Langfit. J. W., Pt., A, May 5, Left : flap. Surg. W. V. White, Accidentally killed Oct. 1 1, 65. 100th Penn., age 21. | 7, 64. 57tb Mass. Dis. July 18. 1865. 438 Martin, J., Pt., L, 2d June 1 6, Right ; circ. Amp. toes, left foot. 401 Lariviere. A.. Pt., 1), 5th July 10, Left ; flap. A. Surg. A. R. Stone, N.Y. H vy Art., age 21. 16, 64. Disch d Nov. 11,1864. May 11, Mich. Cavalry, a-e 35. 10, 63. 5th Michigan Cavalry. Disch d 1865, re-amputation. December 7, 1863. 439 : Martin, W., Pt., D, 7th May 18, Right ; flap. Confederate surgeon. 402 Larkins, W.. Pt., G, 91st 1 Mar. 31, Left ; ant. post. flap. Surg. R. Maine, age 16. 18, 64. Recovery. New York, age 19. 31, 65. Morris, 91st N.Y. Discharged 440 Mason, D. L.,Pt..B, 38th July 30, Right : ant. post. flap. Surg. W. July 21, 1865. Wisconsin, age 15. 30, 64. B. Fox. 8th Michigan. Disch d 403 Lathrop, W., Pt., F, April 2, Left; ciro. Surg. J.Westfall,67th July 11, 1865. 67th Ohio, age 18. 2, 65. Ohio. Disch d Aug. 12, 1865. 441 Mason, E.F.,Pt.,C, 29th July 3, Left ; flap. Snrg. A. K. Fifield. 404 Latimer, J. T., Pt.. L, May 2, ; flap. Transferred June 9, Ohio, age 19. 3, 63. 29th Ohio. Discharged Novem 3d Alabama, age 21. 3, <63. 1863. ber 20, 1863. 405 Latta, W. T., Pt., A, 53d July 10, Right. Surg. E. M.Waters, P. A. 442 Masterson, P.,Pt..A,f>9th Aug. 25, Left: double flap. Discharged Georgia, age 22. , 10, 63. C. S. Exch d March 17. 1864. New York, ago 51. 27, 64. July 24, 1865. 406 Law. A. H.," Pt., C, 33d July 20, Left: flap. Gangrene. Disch d 443 Maunj, J., Pt., E, 31st June 2, . Retired January 31, 186">. Indiana, age 24. 20, 64. July 21, 1865. Georgia, age 38. 3, 64. 407 Lawrence. C. P.. Pt., B, July 2, Left;" circ. Surg. 7,. B. Adams. 444 May, E. A., Pt., A, 27th Nov. 16. Right ; flap. Discharged June 32d Mass., age 21. : 3, 63. 32d Mass. Disch d July 27, 64. Michigan, age 21. 17, 63. 3ri864. 1 FISHER (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg. 3Id., after the Battle of Antietam, September 17, 1862, in American Journal Medical Sciences, Vol. XLV, p. 48. 3 THOMSON (WILLIAM), Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, D. C.. in American Journal Mcdiral Sciences, Vol. XLVII, p. 380. 3 FisiiEii (G. J.), Rejvirt of Fifty-seven Canes of Amputations, in the Hospitals near Sharpsburg, Md., after the Uattlt of Antietam, September 17, 1862. in American Journal Medical Sciences, Vol. XLV. p. 48. 486 INJURIES OF THE LOWEE EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATKS. OPERATIONS, OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 445 May. J. H., Pt., D, 22d Sept. 21, Right ; circ. Discharged May 487 Munger, L. L., Pt., E, Sept. 17, Left ; circular. Discharged. Col d Troops, Hge 37. 21, 04. 22, 1865. 105th New York. 17, 62. 446 May, P. J., Pt., C, 1st R. May 3, Right ; ant. post, flap ; nee. bone 488 Murphey, J. F., Pt., B, Sept, 16, . Surg. Trescott, C. S. A. Island Art ry, age 20. 4, r 03. removed. Disch d Aug. 9, 1864. 28th North Carolina. 16, 64. Retired January 30, 1865. 447 McCandless, G., Pt., K, Nov. 7, Right. Disch d May 3, 1864. 489 Myers, P., Pt., M, 1st Sept. 5. Left: circ. Surg.W. II. Thome, 118th Peun., age 48. 7, 63. Perished Nov. 20, 1868, in a se Wis. Cav., age 22. 5, 64. U. S. V. Discli d Aug. 30, 1865. vere snow storm. 490 Nance. R. G., Capt., B, July 28, Right; flap. Surg. A. Goslin, 448 McCloy. R., Pt., A, 10th April 6, Left; ant. post, flap.; sloughed; 40th Illinois, age 42. 28, 64. 4Hth 111. Aug. 2, re-amputat n. New York, age 18. 7, 65. exfol. Disch d Oct. 21, 1865. Discharged Jan. 7, 1865. 449 McClure, S.. Pt., H, 83d May 19, Left ; circ. Surg. E. C. Franklin, 491 Neeley.J. T., Pt., F, 2Ist July 4, Left. Exchanged March 17, 64. Indiana, age 28. 20, 63. U. S. V. Gangrene. Disch d Mississippi, age 19. 6, 63. February 23. 1864. 492 Neighbors, W.R.. Lieut., Sept. 20, . Surg. Berton, C. S. A. 450 M.-Comas. D. H., Serg t, Sept. 30, Right. Surg.W.C. Shurlock, 51st G, 4th Tenn. 20, 03. Recovery. E, 8th Mich., age 21. 30, 64. Penn. Disch d June 11, 1865. 493 Nelson, E., Pt., H, 7th May 22, Right ; fla p. Surg.W. Berry, 7th 451 McCoy, J., Pt., A, 64th May 9, Right ; circ. Confed. surgeon. Kentucky. 22, 63. Kentucky. Disch d Aug. 8, 63. Ohio, age 20. 10, V 64. Disch d April 27, 1865. 494 Nelson, S., Pt., B, 22d July 20, Left; flap." A.Surg.C. S. blanch- 452 McCoy, W., Pt., G, 5th Aug. 5, Right; lateral flap. To Provost Wisconsin, age 20. 20, 64. ard, 22d Wis. Disch d J uly 4, Tenn. Cav., age 19. 5, 64. Marshal Nov. 23, 1864. 1865. Died Feb. 25, 1867. 453 McDonald, J. H., Pt., A, July 20, Left; circular. To Provost Mar 495 Neveling, W., Pt., N, June 30, Right; double flap. Sept. 1, 1863, 23d Miss., age 19. 21, 64. shal December 1, 1864. 71st Penn., age 26. 30, 02. amp. knee joint. Disch d Mar. 454 McParland, G. P., Lieut. July 2, Right. Mustered out July 27, 3, 1864. Specs. 668, 2458, 2778. 455 Col., 151st Penn. McFarland,J. H.,Capt., 2, 63. May 16, 1863. Right. Surg. Node, C. S. A. 496 Newton, J. B., Lieut. ,K, 28th Illinois. Oct. 5, 6, 62. Right. Discharged June 10, 1863. 456 G, 1st Missouri. McGiveney, J., Corp l, 17, 63. May 18, Recovery. Right ; circular. Disch d March 497 Noyes, C. II., Serg t, H, 169th N. York, age 21. Jan. 16, 16, 65. Left ; ant. post. flap. Discharged Nov. 3. 1865. Spec. 3512. 457 D, 155th N. Y., age 26. McGowan, J., Pt., C, 6th 18, 64. May 5, 17, 1865. Right ; circular. Disch d Aug. 498 Nutter, L. S., Pt., A, 5th New Hamp., age 16. July 1, 3, 62. Left : flap. Surg.G. B.Coggswell, 29th Mass. Jan. 3, 63, re-amp. Vermont, age 26. 5, %4. 2, 1865. Disch d Sept. 25, 1863. 458 McGrath, M., Pt.,K,27th Mass., age 26. Mar. 14, 14, 62. Left; circ. Swrg. G. Derby, 23d Mass. Disch d Sept. 21, 1862. 499 Nutter, W. S., Pt,, A, 42d Missouri, age 22. May 18, , 65. Right; flap. Surg.S.Ilart,U.S.V. Disch d June 28, 1865. 459 McGuire, J., Pt., A, 12th Dec. 13, Left ; circ. Surg. A. W.Whitnev, 500 O Brian, T., Corp l, D, Sept. 17, Right; flap. Surg. L. Reynolds, Massachusetts, age 27. 14, 62. 13th Mass. Disch d Apr. 30, 63. 69th New York. 19, 62. 63d N. Y. Disch d Mar. 4, 1863. 460 McGuire,T.,Pt.,A,105th Dec. 13, Left. Discharged, 1863. 501 O Brien, J., Pt., E, 188th Mav 16, Right ; flap. Disch d Dec. 23, 64. New York. 14, 62. Pennsylvania, age 26. 16, 64. Insane Asylum 1870. 461 McMullen, W., Pt., H, Aug. 9, Right; flap. Discharged Jan 502 2 O Connor. D., Pt., C, Sept. 21, Left: circ. April 14, 64, re-amp. 60th Ohio. 11, 62. uary 15, 1863. Cobb s Legion, age 28. 21, 63. To prison Oct. 4, 64. Spec. 2212. 462 McN aughton. C., Serg t, May 2, Left ; circ. Ass t Surgeon R. A. 503 O Keefe, R., Pt., A, 1st Oct. 7, Right ; flap. Discharged Aug. I, 5th Michigan. 2, 63. Everett, 5th Mich. Discharged Artillery, age 21. 7, 64. 28. 1865. Dec. 11, 1863. 504 ; Oliver, D. S. Pt., E, 6th July 22, Right : ant. post. flap. To Provost 463 Mears, T., Pt., H, 61st June 23, . Recovery. ; Kentucky, age 24. 23, 64. Marshal Dec. 8, 1864. Virginia. 23, 64. 505 Oliver, J. B., Corp l, 6th May 28, Left; cire. Surg. A. Wood, 1st 464 Meinhardt, J., Corp l, D, Mar. 8, Left ; flap. Surg. C. Cook, 12th N. Y. Battery, age 21. 28, 64. Mass. Cav. Disch d Aug. 18. 64. 12th Missouri. 8, 62. Missouri. Discharged. 506 Orkney, J. A., Corp l.A, Aug. 25, Right; ant. post. flap. Disch d 465 Meissner, G. H., Pt., F, Aug. 3, Right, Surg. J. Chapman, 123d 4th Ohio, age 25. 27, 64. December 21, 1864. 3d Wisconsin, age 26. 3, 64. N. Y. Disch d May 27, 1865. 507 O Rourke, M., Pt,,M,6th May 9, Left; flap. Disch d March 16, 466 Merry, E. W., Serg t- July 20, Left; flap. Surg. D. S. Young, N.Y. H vy Art., age 23. 10, 64. 1865. Maj., 21st Ohio, age 21. 20, 64. 21st Ohio. Mustered out May 508 Ostrander, C. W., Lieut., May 6, Right; ant. post. flap. Confed. 31, 1865. C, 122d N. Y., age 31. 7. 64. surgeon. Disch d March 10, 65. 467 Metz, L., Lieut., E, 78th New York, age 28. June 15, J6, 64. Left ; flap. Discharged July 12, 1864. 509 Ostrander, M., Pt,, F, i Nov. 30, 15th N.Y. Cav., age 19. 30, 64. Right ; lat. double flap. A. Staff Surg. N. P. Graham. Disch d 468 Miller, I. D., Pt., C, llth May 12, Right ; flap. Discharged March August 18, 1865. Infantry, age 24. 13, 64. 27, 1865. 510 Otts, F. M., Serg t, B, July 20, Left ; circ. To Provost Marshal 469 Miller, J., Pt,, C, 19th Oct. 27, Left ; ant. post. flap. Discharged 31st Miss., age 23. 21, "64. April 2, 1865. Wisconsin, age 27. 29, 64. May 22, 1865. 511 Parker, J., Lieut., B, May 19, Left. Surg. Dickson. C. S. A. 470 Miller, J. II, Pt., A, 54th July 22, Right; flap. Ass t Surg. C. B. 14th Louisiana. 20, 64. Recovery. Ohio, age 35. 23, 64. Richards, 30th Ohio. Disch d 512 Patterson, G. G., Pt., B, Dec. 31, Left ; flap. Discharged March May 20, 1865. 44th Illinois. 31, 62. 31, 1863. 471 MiUer, J. T., Lieut., E, July 1, R t. Surg. J. McAlpine, C. S. A. 513 : Patterson, J. M., Pt., K, July 20, Left ; circular. Furloughed Oct. 38th Virginia, age 24. 1, 63. Exch d and furloughed, 1864. 50th Alabama, age 34. 20, 64. 18, 1864. 472 Miller, W., Pt., A, 4th July 3, Left ; post. flap. Surg. H. M. Mc- 514 Patterson, J. W., Pt., E, Oct. 8, Right; flap. Surg. .T.A. Stillwell, Artillery, age 28. 4, 63. Abee, 4th Ohio. Headquarters 42d Indiana. 9, 62. 22d Ind. Disch d Dec. 17. 1862. March 26, 1864. 515 Patterson, T. B , Serg t, Sept. 19, Left ; flap. Surg. W. S. Love, 473 Milliken, G. A., Corp l, July 2, Left ; flap. Surg. J. B. LeBlond, H, 51st Ala., age 30. j 19, 64. C.S.A. To prison Jan. 5. 1865. 1, 1st Minnesota,age21. 3, 63. 1st Minn. Disch d Dec. 15, 63. 516 Patton, J. F., Pt., K, 6th Sept. 30, Right: double flap. Transferred 474 Mills, II. L., Serg t, H, Dec. 16, Risjht; flap. Disch d October 5, Georgia. 30, 64. October 8, 1864. 7th Minn., age 31. 16, 64. 1865. 517 Paul, D., Pt., I, 103d Nov. 25, Right: flap. Surg. R. Morris. 475 Milner,S.,Serg t,G, 10th Oct. 8, Left. Surg. C. S. Muscroft, ] nth Illinois, age 23. 25, 63. 103d Illinois. Disch d June 6, Ohio. 10, 62. Ohio. Disch d Dec. 14, 1862. 1864. Died June 12, 1870. 476 Mitchelfelder, E., Pt., B, Dec. 13, Left; double flap. To Veteran 518 Pavne, M., Corp l, A, June 26. Left; ant. post. flap. Surg. I. V. 163d New York. 14, 62. Reserve Corps Feb. 29, ]864. 14th -N. Y. H vy Art y, 26, 64. Mullen, 14th N. Y. H vy Art y. 477 Monaghan, T., Pt., A, Dec. 13, Right, Surg. L. Reynolds. 63d acre 26. Disch d Dec. 29, 1864. 63d New York, age 50. 14, 62. N. Y. Disch d Aug. 31, 1863. 519 3 Peeblcs, D. P., Pt., D, Sept. 17, Right; post. flap. Discharged Died December 25, 1874. 18th Miss., age 22. 19, 62. November 10. 1862. 478 Monroe, J. M., Pt.,G,42d Dec. 28, Left : flap. Discharged April 2, 520 Penet, J. D., Capt., A, Oct. 30, Left; circ. A. A. Surg. H. R. Ohio. 28, 62. 1863. 144th N. York, :ige 25. 30, 64. Durant. Must. out.Tune25. 65. 479 Moon, J. B., Pt., E, 71st Aug. 30, Right; flap. Discharged Octo 521 Perry, E. J., Corp l, C, April 2, Left ; flap. Surg. J. 11. Kimball, Indiana. 31, 62. ber 1, 1862. 61st Mass., a<re 21. 3, 65. 32d Me. Disch d J ul y 27, 1865. 480 Moore, S. H.,Pt., A, 30th Nov. 27, Right ; flap. Surg. A.T. Hudson, 522 Peters, J., Pt ., K, 1st Sept. 14, Right; flap. Surg. B. F. Ste Iowa, age 31. 27, 63. 26th Iowa. Disch d Jan. 1, 65. Kansas. 15, 63. venson, 14th 111. Mustered out 481 Moore. T., Pt., B, Aus May 25, . Surg. W. A. Holt, C. S. A. June 17, 1864. tin s Louisiana Bat ry. 25, 64. Retired March 21, 1865. 52:! Peterson, D. M., Pt., M, Oct. 18, Left circ. A.A.Surg.J.L.Wade. 482 Morse, B. P., Corp l, A, Sept. 17, Left. Discharged December 6, 2d Mass. Artillery. 18, 64. Disch d March 30, 1865. 5th New Hampshire. 17, 62. 1862. 524 Pfeiffer, O., Pt., B, 47th Aug. 18, Left ; flap. Discharged March 483 Morse, W. B., Pt., 11,1st June 18, Left ; flap. Discharged July 8, Pennsylvania, age 19. 19. 64. 15, 1805. Mass. Artillery, age 23. 19, 64. 1865. 525 Phelps, H., Pt.. K, llth Oct. 19, Right ; post. flap. Discharged 484 Mortanto, L., Pt.,G, 57th Aug. 25, Right ; dou. flap. Surg. Tay Vermont, age 20. 20, 04. September 11, 1805. New York, age 59. 27, 64. lor. C.S.A. Disch d,)une16, 65. 526 Phelps, M., Pt.. F, 10th Mar. 21, Left ; bilateral flap. Surg. A. 15. 485 Mosrly, W. D., Pt., G, Sept. 20, Right ; circ. Surg. J.W. Lawson, Illinois, age 35. 21, 65. Monohan, 63d Ohio. Disch d 25th Va. Cav., age 27. 20, 64. P. A. C. S. To prison Jan. 5. 65. June 30, 1865. 486 Midler, W., Pt., II, 20th Jan. 2, Right. Surg.W. A. Holt, C. S.A. 527 Piclcett. IT., Pt., G, 27th Oct. 14, Right ; Hap. Confed. surgeon. Louisiana. 2, 63. Recovery. North Carolina. 15, 63. Recovery. 1 BuiNTON (J. H.), On Amputation at the Knee Joint and at /he Knee, in American Journal Medical Sciences, 1868, Vol. LV, p. 319. * Ll DELI. (J. A.), On the Secondary Traumatic Lesions nf Bone, etc., in U. S. Sanitary Commission Memoirs, Surgical Volume I, p. 459. 3 Fisi! Kit (G. J.), Report of Fifty -seven Cases (if Amputations in the Hospitals near Sharpsburg, Md., etc., in American Journal Medical Sciences, 1863, Vol. XLV, p. 48. PRIMARY AMPUTATIONS IN THE LEG. No. NAME. MILITARY DESCRIPTION. AND A(;E. DATKS. OPERATIONS. OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION , AND AGE. DATF.S. OPERATIONS, OPERATORS, RESULT. 528 I ierce, A. .1 , Curp l, E, July 1, Right; flap. Surg. E. G. Chase, 573 liogers, J. H., Pt., D, May 10, Left ; ant. post. flap. Surg. W. S. 104th N.York, age 21. 2, 63. 104th N.Y. Disch d Aug. 9, 64. 125th N. Y., age 35. 10, 64. Cooper, 125th N. Y. Disch d 529 Pinckney, J., Pt., E, 5th Mar. 20, Left; Hap. Surg. L. Barnes, 6th June 24. 1865. Col d Troops, age 20. 21, " 65. C. Troops. Disch d Oct. 18, 65. 574 Rolltton, G. IV.. Capt., Dec. 16, Right; circ. Surg. Mitchell, 530 J*leasants, G. S., Pt., July 1, Right. Exchanged March 17, H, 9th Ark., age 33. 16, 64. 4th Ark. To Provost Marshal Page s Virginia Bat ry, 3, 63. 1864. March 7, 1865. age 19. 575 Ropp, S., Pt., I, 42d Dec. 16, Right ; ant. post. flap. Disch d 531 Pool, J. D., Pt., I, 148th June 18, Right ; circ.: gangrene. Disch d Illinois, age 42. 16, 64. July 6, 1865. New York, age 19. 18, 64. July 27, 1865. 576 Ross, L., Corp l, C, 39th July 22, Left. Furloughed Nov. 10, 1864. 532 Porus, J., Pt., F, 25th May 28, Left. Surg. C. Robertson, 159th Ohio, age 30. , 64. Connecticut. 28, 63. N. Y. Uisch d Aug. 26, 1863. 577 Ross, L. T.. Serg t, A, May 22, Left; flap. Discharged August 533 Potts, J. G., Tt., B. 14th July 1, Right ; flap. Surg. J. M. Farley, 81st Illinois. 22, 63. 5. 1863. N. Y. S. 11., age 32. 2, 63. 84th N.Y. Disch d Nov. 28, 63. 578 Rowley, R., Pt,, G, 29th May 1, Left; flap. Discharged July 16, 534 Pousch, J., Pt., B, 47th Mar. 31. Right ; flap. Surg. V.B.Kennedy, Wisconsin. 2, "63. 1863. Illinois, nge 22. 31, 65. 5th Minn. Disch d Feb. 16, 1866. 579 Rucker, A., Pt., B. 10th Oct. 19, Left ; circular. Discharged May 535 Powell, K. II., Serg t, C, Sept. 7, . Surg. Swann, C. S. A. West Virginia, age 35. 20, 64. 14, 1865. 6th Georgia. 9, 64. Recovery. 580 Rudiger, J., Corp l, A, July 2, Right; circ. Surg. C. S. Wood, 536 Powers, L. J., Pt., F, 2d June 9, Right. Surg. A. Hard, 8th 111. 66th N. York, age 24. 3, 63. 66th N. Y. Disch d Dec. 8. 63. Massachusetts. 9, 63. Cavalry. Disch d January 25, 581 Ryan. S. W., Corp l, B, May 9, Left ; flap. Surg. B. Rohrer, 10th 1864. Spec. 1219. 191st Penn., age 20. 10, 64. Penn. Reserves. Disch d Feb. 537 Presan, H., Pt., I, 1st Aug. 16, Left ; flap. Discharged January 16, 1865. Maryland Cavalry. 16, 64. 15, 1865. 582 Sanborn. J. O., Pt., E, Sept. 17, Right ; circular. Disch d March 538 Pretty man, J. J., Pt., I, Oct. 19, Right ; ant. post. flap. Mustered 10th Maine. 19, 62. 23, 1863. lltli West Va., age 25. 20, 64. out June 17, 1865. 583 Sanders, C. H., Pt., H, July 1, Left. Recovered and paroled. 539 Price, J. T.. Pt., C, 5th Sept. 19, Left ; ciro. Surg. I. F. Pearson, 38th Georgia, age 25. 2, 63. North Carolina, age 26. 19, 64. 5th N. C. To prison Feb. 25, 65. 584 Sans Souci, L.,Corp l, E, Dec. 16, Left ; flap. Surg. V. B. Kennedy, 540 Priest, A. M., Pt., M, 1st Aug. 25, Right ; flap. Discharged July 5th Minn., age 45. 17, 64. 5th Minn. Disch d April 25, 60. D. C. Cavalry, age 20. 25, 64. 21, 1865. 585 Sargent, C. A., Pt., B, Dec. 13, Left. Feb. 7, 63, hsem.; lig. ant. 541 Priest, J. T., Pt., B, 36th June 3, Left; flap. Discharged June 17, 4th Vermont, age 24. 13, 62. tibial. Disch d August 25, 63. Massachusetts. 3, 64. 1865. 586 Sargent, L. N., Pt., G, May 31, Right. Discharged July 18. 65. 542 Prueller, F., Pt., H, 39th Oct. 13, Right. Confed. surgeon. Dis 9th N. Hamp., age 28. 31, 64. Spec. 3072. Illinois, age 46. 13, 64. charged October 17, 1865. 587 Sarver, W. J., Pt., D, Aug. 16, Left; circular. 543 Purman, J. J., Lieut., A, 140th Penn., age 2.J. July 2, 3, 63. Left ; flap. Discharged May 23, 1864. 588 Virginia Artillery. Sawyer, O., Pt., E, 29th 16, 64. Oct. 19, Left ; circ. Surg. J. F. Day, jr., 544 Quintan, M., Pt., E, 14th July 1, . Surg. White, C. S. A. Maine, age 33. 19, 64. 29th Me. Disch d May 30, 65. Louisiana. 2, 63. Recovery. 589 Sayles, H., Serg t, E, May 22, Left; flap. Surg. J. E. Murtha. 545 Quinn, J., Pt., D, 12th May 12, Right ; circular. To regiment 8th Wisconsin. 22, 63. 8th Wis. Disch d June 3, 1864. Infantry, age 19. 13, 64. June 27, 1864. 590 Schaniski,L.,Saddler,G, Nev. 3, Left ; circ. Confederate surgeon. 546 Quinn, J., Pt., C, 73d Dee. 16, Right; ant. post. flap. Disch d 1st Louisiana Cavalry, 3, 63. Pieces of necros d bone remov d. Pennsylvania, age 34. 16, 64. June 28, 1865. age 43. (Also left little finger shot off.) 547 Race, J., Pt., B, 194th Mar. 22, Left; circ. A. A. Surg. J. F.Cleve Disch d Feb. 1, 64. Died Sept. New York, age 42. 22, 65. land. Disch d July 19, 1865. 20, 70 ; erysipelas and pyaemia. 548 Rackmyer, P. N., Pt., I, Sept. 29, Right ; ant. post. flap. Confed. Spec. 4310. 115th N. York, nge 21. Oct. 1, 64. surgeon. Disch d April 6, 1865. 591 Schweitzer, J., Pt., H, Aug. 16, Right ; double flap. Confed. sur 549 Ramaley,L.,Pt.,F,139tb Sept. 19, Right ; lat. flap. A. Surg. S. B. 47th N. York, age 35. 17, 64. geon. Disch d June 24, 1865. Pennsylvania, age 20. 19, 64. Sturdevant, 139th Penn. Disc d 592 Scott, J. T., Serg t, A, July 2, Right ; circular. Retired Feb February 1 0, 1865. Philips s Georgia Le 3, 63. ruary 7, 1865. 550 Rand, M., Serg t, C, 16th July 3, Left ; flap. Surg. C. C. Jewett, gion, age 21. Massachusetts. 4, 63. 16th Mass. Disc d April ]2, 64. 593 Seagle, P., Serg t, B, Sept. 19, Left ; flap. Surgeon Atkins, 551 Ranger, G., Pt., I, 122d Mar. 25, Left : ant. post. flap. Discharged 23d N. C., age 27. 20, 64. C. S. A. To prison Feb. 16, 65. New York, age 42. 25, 65. July 6, 1865. 594 Seaton, J. A., Pt.,B, 13th May 12, Left ; circular. Disch d October 552 Rankin J, S. Pt.. Orr s .Fill.. OS 12 63. 5. 1863. S. C. Rifles." 28, 64. Orr s S. C. Rifles. 595 Secor, E. C., Serg t, H, July 3J Left; flap. Discharged August 553 Ranzow, H., I t., II, 16th Dec. 13, Left; flap. Surg. E. Batwell,14th 61st New York, age 20. 4, 63. 24, 1864. Illinois, age 34. 13, 64. Mich. Disch d July 6, 1865. 596 Seibert, J.. Pt., E,~100th Aug. 30, Left ; circ. Surg. M. S. Kittenger, 554 Ratcliffe, J. K., Corp l, April 13, Right. Discharged August 22, New York. 30, 63. 100th N.Y. Disch d Sept. 22/64. II, 18th La., age 28. 13, 63. 1863. 597 Seng, T., Pt., A, 41st July 2, Left: circular. Discharged May 555 Raymond. J. R., Serg t, July 20, Left ; flap ; gangrene. Disch d New Jersey. 4, 63. 17, 1864. A, lllth Penn., age 22. 20, 64. May 22, 1865. 598 Shafer. J., Sergeant. K, April 1, Right; circular. Disch d Jir.ie 556 Reed, G. R., Pt., I, 18th Dec. 13. Right. Discharged April 21, 63. 198th Penn., age 44. 1, 65. 21, 1865. Massachusetts, age 29. 15 62. 599 Sharp J H Pt. F Right : circ. Furloughed Octo 557 Reeve, J. H.,Capt., K,3d Jan. 12, Right ; ant. post. flap. Surg. G. 1 Cobb s Ga. Legion. ber 17, 1864. New York, age 24. 12, 65. C. Jarvis, 7th Conn. Disch d 600 : Sharpe, G., Pt., C, 38th Oct. 19, Right : ant. post. flap. Disch d June 26, 1865. Spec. 6934. Massachusetts, age 27. 19, 64. March 30, 1865. 558 Resa, F., Pt., B, 3dlo\va, Oct. 5, Right ; flap. Discharged April (iOl Shaud, J., I t., K, 93d May 31, Right: ant. post. flap. Disch d age 29. 6, 62. 7, 1S63. Pennsylvania, age 26. J e 2, 62. March 9, 1864. Spec. 4305. 559 Reynold, J., Corp l, D, Sept. 19, Right; lat. oval flap. Surg. N. S. 602 Shears, C. R.. Serg t, C, May 11, Right ; circ. A. A. Surg. D. O. 12th Conn., age 24. 19, 64. Snow, 153d N. Y. Discharged 26th Michigan, age 31. 13," 64. Farrand. Disoh d May 2, 1865. March 10, 1865. 603 Sherwood, D., Pt., E, May 27, Left: flap. Surg. C. Robertson, 560 Reynolds, J., Pt., A, 6th May 9, Left ; ant. post. flap. Discharged 131st New York. 27, 63. 159th N.Y. Discharged Octo Connecticut, age 24. 10, 64. November 4, 1865. ber 20, 1863. 561 Reynolds, S. II., Serg t, Dec, 13, Right. Discharged June 5, 1863. 604 Siemens, H., Pt., B, 39th July 3, Right : flap. Mustered out June A". 1st Mass. Battery. 13, 62. New York, age 26. 4, 63. 29, 1864. Died Dec. 10, 1867. 562 Rice. C., Pt., D, 87th Sept. 19, Left. Discharged April.17, 1864. 605 Skeen, Wm., Pt., G, 87th April 2, Left ; ant. post. flap. Discharged Indiana, age 331 20, 63. Pennsylvania, age 21. 2, 65. September 25, 1865. 563 Ricliardson, J. M., Capt. Sept. 19, . Surg.W. T. Sutton,C.S.A. 606 Skinner, J., Pt., E, 5th June 22. Left; circ. Confederate surgeon. and A. A. General. 19, 64. Recovery. Connecticut, age 20. 23, 64. Gangrene. Disch d Aug. 22, 65. 564 Rider, J., Pt., B. 49th Aug. 21, Right; flap. Surg.G.T. Stevens, 607 Slater, E., Pt., D, 10th Nov. 19, Right; flap. Surg. M. Hawes, New York, age 40. 21, 64. 77th N. Y. Discharged Dec. 19, Ohio Cavalry, age 31. 19, 64. loth Ohio Cavalry. Disch d 1864. Spec. 2460. June 18, 1865. 565 Riggins, J., Pt., II. 99th May 12, Left : flap. Disch d Sept. 24, 64. 608 Slaver. H. P., Corp l, E, Aug. 17, . Surg.W. S. Love, C. S. A. Pennsylvania, age 29. 12," 64. Died Aug. 15, 68 ; consumpt u. i 36th Virginia. 19, 64. Retired Feb. 14, 1865. 566 Roache, F. T., Pt., A,32d Sept. 24, R t ; circ. Surg.W. V. Harrison. 609 Sloan, W. A., Pt.. H.lOth Sept. 19, Right : flap. Surg. W. A. Barry, Virginia. 24, 6-1. C. S. A. Trans. Oct. 26, 1864. 1 Vermont, age 26. 19, 64. 98th Penn. Disch d Sept. 11, 65. 567 Rohb, L. A., Corp l, L, Sept. 17, Left ; circ. Surg. H. E.Goodman, 610 Small. T.. Pt., H, 60th Nov. 27, Left : circ. Vet. Reserve Corps 28th Pennsylvania. 17, 62. 28th Penn. Dis. Nov. 27, 1862. New York, age 19. 27, 63. Nov. 19, 1864. Died July 6, 5C8 Roberts. H., Serg t. K, May 22, Left ; flap. Discharged May 30, 1870; consumption. 47th Illinois, age 38. 23, 63. 1864. 611 Smith, A., Pt., G, 18th Aug. 29. i Left. Surg. A. J. Semmes.C.S.A. 569 Robertson. J. F. M., Cor July 1, . Surg. McAden, C. S. A. Georgia. 31, 62. i Recovery. poral, H, 13th Tenn. 2, 63. Recovery. 612 Smith, D. F.,Pt.,B, 12th July 2, Loft; flap. Surg. J. M. Merron, 570 Robinson, B., Serg t, D, June 29, Right ; circ. Surg.W. P. Russell, New Hamp., age 20. 2, 63. 2d N. II. Discharged March 5th Vermont. 30, 62. 5th Vt. Disch d Oct. 22, 1862. 17, 1864. 571 Rode, C., Pt., G, 123d June 13, Left. Discharged Aug. 26, 1863. 613 Smith, E., Pt., G, 45th June 3, Left; circ. Surg. T. Christ, 45th Ohio. 14, 63. Pennsylvania* age 26. 3, 64. Penn. Disch d July 4, 1865. 572 Roe, D. W., Pt., E 69th liar. 25, Right circ Discharged Aug 614 Smith, Q. H., Pt., F, 7th July 1, Left; flap. Discharged Decem New York. 26, 65. 14, 1865. Wisconsin, age 21. 2, 63. ber 22, 1863. 488 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. "Vr\ NAME, MILITARY OPERATIONS. OPERATORS, No NAME, MILITARY D ATES OPERATIONS, OPERATORS, JN v* DESCRIPTION, AND AGE. RESULT. DESCRIPTION, AND AGE. RESULT. 615 Smith, H., Pt., H, 13th April 9, Right; circ. Disch d Jan. 30, 655 Thurber, F. N., Pt., II, June 16, Left. Discharged September 9, Connecticut, age 34. 10. 64. 1865. Died June 28, 1869. 3d New Hampshire. 10, 62. 1862. 616 Smith, H. D., Pt., C, 2d May 3, Right; flap. Discharged Aug. 656 Tilbe, R., Corp l, E, 17th Aug. 21. Right ; ant. post. flap. A. Surg. C. Delaware, age 31. 3, 63. 10, 1864. Connecticut, age 24. 21, 63. Mudge, 1st N. York Engineers. 617 l Smilh, L., Serg t, H. Sept. 17, Left ; circular; gang. Disch d Disch d July 2, 1864. ICth Georgia, age 31. 18, 62. March 6, 1863. 657 Tillson,W. F., Lieut., G, April 2, Right : necrosed bone removed. 618 Smith, T. A., Corp l, A, Aug. !>, Right; flap. Surg. W.O.Bennett, 4th Vermont, age 22. 2, 65. Mustered out Sept. 28, 1865. 5th Conn., age 21. 11, 62. 5th Conn. Gangrene. Disch d 058 Todd, J., Pt., C, 43d N. Aug. 21. Right; circ. Surg. W. T. Brewer, July 30, 1803. Carolina, age 38. 21, 04. 43d N. C. Trans. Jan. 8, 1865. 619 Smithson, C.. Pt.. C, Oet. 1, Left: flap. Surg. D. Meeker, F. 659 Traumicht, H., Pt., E, Oct. 8, Left ; circ. Surg. C. Spinzig, 2d 116th Col cl Troops. 1, 64. S. V. Disch d May 31, 1865. 2d Missouri. 8, 02. Mo. Disch d Dec. 17, 1864. 620 SnellinQ, E.A., Pt., Not- June 22, Left (also right, low. third). Con 660 Triridle, J., Pt,, K, 56th July 21, Left; flap. Discharged August tawav s Artillery. 22. 64. federate surgeon. Recovery. Massachusetts, age 22. 21, " 64. 23, 1865. 621 Snow, JB. N., Pt., C, 97th Sept. 17, Left. Discharged November 30, 661 Tripp, E. .Corp l. 1,140th June 18, Right ; flap. Surg. T. M. Flan- New "Sprit. , 62. 1862. New York, age 28. 18, 64. dreau, 140th N. Y. Haemor 622 Snyder, G., Pt., K, 200th Mar. 25, Right ; flap. Discharged July 4, rhage. Disch d June 24, 1865. Pennsylvania. 25, 65. 1865. bbS3 1 nsket, A. J., Pt., E, 1st June 12, Right ; flap. Surgeon Wier. 623 Speer, A. C.. Lieut., A, July 5, Rip .t; flap. Surg. E. Batwell, Michigan, age 30. 12, 64. C. S. A. Disch d Sept. 8. J805. 14th Mich., age 30. 5, 64. 14th Mich. Disch d Nov. 1, 64. 603 Troy, B. F., Pt., G, 10th May 10, Left (amp. right, uppor third). 624 Speer, A. C., Pt., K, 4th Mar. 25. Right; circular. Released June Iowa. 10, 63. Discharged Sept. 3. 1803. Georgia, age 37. 25, 65. 28. 1865. 664 Tucker, W., Pt., K, 13th Sept. 17, Left ; flap. Surg. J. T. Gilmore, 625 Spe!lman,T.,Pt., F, 37th Sept. 19, Left ; circ. A. Surg. J. G.Thomp Mississippi, age 21. 17, 62. C. S. A. Retired Jan. 31, 1805. Massachusetts, age 21. 20, 04. son, 77th N. Y. Disch d Jan. 17, 665 Tyson, J. H., Pt., H, 51st Sept. 30, Left. Released July 26, 1805. 1866. July8, 68, re-amputat n. North Carolina, age 22. 30, 64. 626 Spiker, J., Pt., K, 100th July 11, Left; flap. Surg.W.C. Shurlock, 666 Urich, C., Pt., E, 45th July 1, Left ; post. flap. Disch d April Pennsylvania, age 21. 11, 64. 51st Penn. Disch d June 1, 05. New York, age 20. 2, r 63. 2, 1804. Died June 12, 1870. 627 Spivey,A.A., Pt., 1), 54th Aug. 21, Left; circular. To Provost Mar Spec. 4307. North Carolina, age 21. 21, 64. shal October 25, 1864. 667 Utz, C. E., Pt., 5th Ohio July 12, Left. Surg. W. S. Edgar, 32d 628 Sprague. F. E., Pt., A, Sept. 19, Left; circ. Surg. J.G. Bradt.26th Battery. 12, 03. Illinois. Discharged. 20th Mass., age 20. 20, 64. Mass. Disch d Nov. 7, 1804. 068 Valentine. L. W., Pt., H, May 3, Left; double flap. Surg. F. S. Springer, F., Pt., G, Sept, 14, Left; circular. Furloughed Dec. 6th Maine. 5, 63. Holmes, Oth Me. Haemorrhage. Cobb s Ga. Legion. 15, 62. 19, 1862. Disch d October 27, 1863. 1 Springsteen. W. E., Pt., Sept. 1, Left ; flap. Surg. E. Batwell. 14th 669 Van Doozer, B. S., Pt., April 9, Risrht ; circ. Discharged July G, G, 14th Mich., age 24. 1, 64. Mich. Disch d. Aug. 11, 1865. B, 58th Illinois, age 19. 9, 05. 1865. 631 Stampen. W. H., Pt., D", Aug. 21, Right. Exchanged October 27, 670 Van Kirk, J., Pt., C, 1st May 28, Left ; ant. post. flap. A. A. Surg. 43d N. Carolina, age 22. 21, 64. 1864. Penn. Cavalry, age 23. 28," 64. W. H. True. M. O. Sept. 9, 04. 632 Starr, R. H., Serg t, K, May 17, Right ; circ. Surg. W. P. Peirce, 071 Vann. L., Pt., A, llth Sept. 17, . Surg. Bacon, C. S. A. 36th Illinois, age 24. 18," 64. 88th 111. Disch d Jan. 6, 1805. Florida. 18, 64. Recovery. 633 Steece. J., Pt., G, 4th Oct. , Left. Discharged March 12, 63. 672 Van Ness, J., Pt., C, 43d Oct. 19, Left; double flap. Surg. G. T. Ohio Cavalry. , 62. New York, age 20. 19, 04. Stevens, 77th N. Y. Gangrene. 634 Steel, S. G., Pt., H,149th Mar 8. Left; flap. Discharged July 4, Disch d May 16, 1805. Pennsylvania, age 33. 8, 64. 1865. 673 Verner, W., Landsman, Aug. 5, Right. Surg. J. C. Palmer, U. S. 035 Stever, O., Serjft, A, Sept. 29, Right; long post. flap. A. Surg. U.S.S.IIartford,age20. 5, 64. Navy. Disch d May 5, 1805. 90th New York, age 28. 29, 64. H. C. Merryweather, 5th Col d 674 Vide, E. C., Pt., E, 7th Nov. 14, . Retired February 11, 1805. Troops. Discharged. North Carolina. 14, 62. G36 Stewart, C. W., Pt., D, May 5, Left ; flap. Discharged May 0, 675 Waber, W., Pt., C, 44th De.31, 62, Left ; flap. Discharged May 19, 4th Maryland, age 18. 5, 64. 1865. Illinois. Jan. 1, 03. 1VJ3. 637 Stiles, J., Corp l, I), 27th Dec. 14, Right ; flap. Surg. A. Nash, 9th 676 Wade, G. B., Pt.,G, 13th April 0, Right: flap. Discharged Aug. Kentucky, age 22. 14, 63. Mich. Cav. Disch d May 17, 04. Missouri. 6, 62. 21, 1862. 038 Stinebaugh. G. 15., Pt., Sept. 1, Left; flap. Surg. C. N. Fowler, 077 Wagner, G.,Pt..D, Inde Sept. 9, Right; lat. flap. Surg. S. W. H, 38th Ohio, age 24. 1, 64. 105th Ohio. Discharged July pendent Battalion New 9, 63. Gross, U. S. V. Disch d June 14, 1805. York Vols. 23, 1804. 639 St. Julien. J.,Pt., C,8th May 4, Right. Surg. Mammir,C.S.A. 078 Walcott, W. H., Lieut., July 3, Left. Ass t Surg. J. S. Billings, Louisiana. 5, 63. Recovery. B, 17th Infantry. 3, 63. U.S.A. Re-amputation. Re 640 Stonehouse. S., Pt., H, June 18, Left : flap. Surg. H. E. Smith, tired January 7, 1PG5. 27th Michigan, age 31. 20, 64. 27th Mich. Bonerem d. Disch d 079 Walker, F., Pt., F, 24th Oct. 7, Right. Duty Feb. 10, 1865. June 8, 1805. Spec. P.203. Michigan, age 24. 7, 64. 641 Stratton, J. P., Serg t.D, Dec. 16, Left ; ant. post. flap. A. A. Surg. 080 Walker, J., Pt., B, 8th June 3, Left ; long post., short ant. flap. 31st Indiana, age 22. 10, 64. T. C. Eakin. Erysipelas. Dis New York Heavy Ar 4, 64. Surg. C. 11. I cgg, 8th N. York. charged April 11, 1805. tillery, age 19. II. A. Disch d Sept. 14, 1865. 642 Strode, C. E., Pt., H, 5th June 28, Right ; circ. A. Surg. A. Mather- 081 Wallingford. G., Pt., G, May 6, Right ; ant. post. flap. Confcd. Texas Cavalry, age 19. 28, 63. son, TI. S. N. Bone removed. 17th Maine, age 46. 7, 64. surgeon. Disch d Nov. 29, 1S04. To prison April 28, 1864. 682 Walsh, J., Pt., A, 64th May 12, Right : lat. flap. Surg. C. T. Kcl- 643 Stubbs, R.. Pt., F, 4th Sept. 17, Left ; post. flap. Ass t Surg. C. New York, age 42. 13, 64. sey. 64th N. Y. Disch d Julv Rhode Island, age 25. 18. 02. L. Duffell. 51st Pcnn. Disch d 30, 1865. Nov. 7, 1863. Re-amputation 83 Walsh, J., Corp l, K, 37th April 2, Right : circ. Surg. E. M. White, Sept. 19, 1805. Massachusetts, age 24. 2, 65. 37th Mass. Disch d Sept. 12, 05. 644 Suttin, R. C., Pt., A, 4th July 6, . Surg. Redruff, C. S. A. 084 Wandrey, A., Serg t, K, July 1, Ri^ht ; circ. Ass t Surg. P. S. Mississippi. 6, 63. Recovery. 2d Wisconsin, age 25. 3, 63. Arndt. 2dWis. Dis. April 1, 04. 045 Switzer, J. C.,Pt., A, 22d Sept. 19, Right; circ. Ass t Surg. W. G. 085 Ward, J., Pt., C, 88th Aug. 29, Left ; ant. post. flap. Surg. J. S. Iowa. 21, 64. Bryant, 122d Ohio. Disch d Pennsylvania, age 25. 30, 62. Jemison, 80th N. Y. Disch d October 4, 1865. September 29, 1863. 646 SyTfes, A., Pt., B, 6th June 2, . Ass t Surg. Wcatherly, (i86 Warden, W. H., Serg t, April 9, Left; double lateral flap. Dis Alabama. S3, 64. P. A. C. S. Recovery. P, 70th Illinois, nge 22. 9, 65. charged June 24. 1865. 647 Tait. G. F., Captain, B, May 6, Left : circ. Surg. B. Ge sner, 10th 687 Warford,S. J.,Pt., B.Sth Jan. 2, Left; flap. Discharged Novem 10th New York. 6. 64. N. Y. Disch d Aug. 10, 18G4. Kentucky, age 24. 2, 63. ber JO, 1803. 648 Taylor. M. A., Corp L Dec. 13, Right ; ant. post. flap. Surg. C. ;-> Warner, J. T., Corp l, K, Sept. 30. Left ; ant. post. flap. Discharged D, 13th New Hamp 14, 62. Gray, 7th N. Y. Disch d June 118th N. York, age 22. 30, 64. September 12, 1865. shire, ago 40. 8. 1864. Spec. 0700. 689 Warwick, N., Pt.,B,13th May 18. Left : flap. Discharged. 649 Taylor, T., Pt., G, 155th Sept. 30, Riffht ; ant. post. flap. Surg. J. Infantrv. 20, 03. Pennsylvania, age 22. 30, 64. A. E. Reed, 155th PennT Dis 690 Watson, W., Pt., M, 2d June H, Left: circular. Disch d Marrt charged June 8, 1805. Artillery, age 27. 11. 04. 18, 1865. 650 Terrell, J. J.. Lieut., I. July 1, . Surg. Manson. C. S. A. 091 Wcatherlow, S., Serff t, July 4, night. Discharged December 1st North Carolina. 1, 62. Recovery. I, 12(ith N. Y., age 25. 4, 03. 25, 1864. 651 Thomas, A., Seaman, U. Aug. 20, Left, Recovery March 7, 1865. 692 Wearer. T., Pt., H, GOth Nov. 30. I ight ; circ. To Provost Marshal S. Gunboat Choctaw, 20, 64. Georgia, age 2."). De. 1. 64. March 7, 1805. age 2(i. j 693 Weber, W., Pt., K, 2d June 10, Right; circ. Surg. J. W. Wis- 652 Thomas, P., Pt., I, 7th Dec. 15, Left ; circular. A. A. Surg. J. H. New York Heavy Ar 11, 04. liart, 14()th Pcnn. Discharged Ohio Cavalry, age 40. 10, 04. Mclntyre. Disch d May 17, 05. tillery, age 22. December 9, 1864. 053 Thomas, H., Pt., K, 13th April 29, Left. Surg. J. Ebersole, 19th In 694 Wells, H. W., Serg t, H, Dec. 13, Right. Discharged May 3, 1804. Georgia, nge 18. 21), 03. diana. Exch d June 25, 1803. 16th Maine, age 20. 14, 62. 654 Thompson, C. H..Pt.,C, Dec. 13, Left ; circular. Discharged Sep 695 Welsh, M.. Pt., E, 102d July 27, Riffht; lat. flap. Disch d Oct. 18th Massachusetts. 14, 02. tember 18, 1803. New York. 27, 64. 21, 1805. Re-amputation. FlSHEK (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals ntar Sharpslurr/, Md., after the battle of Anlietaiit, in American Journal Medical Sciences, 1863, Vol. XLV, p. 48. Z PI8HEU (G. J.), Inc. cit., p. 48. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 489 v NAME, MILITARY r )ATIi . R iNO - DESCRIPTION, AXD AGE. J OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 696 Welsh, M., Pt., H, 49th May 10, Right; circular. Disch d Janu 740 Armstrong, J. G., Pt., G, Nov. 29, Right. Surg. J. P. Prince. 36th Pennsylvania, age 20. 11, 64. ary 22, 1865. 8th Michigan. 29, 63. Mass. Died Dec. 27, 1863. C97 Welsh, >.. Pt., C, 34th June 18, Right; flap. Discharged April 741 Austin, E. B., Pt., A, May 14, Right. Died June 30, 1864 ; py- Ohio, age 27. 18, 64. 1, 1865. lllth Ohio. 14, 64. arnia. 698 West, G. F., Pt., I, 5th April 2, Left; circ. Discharged July 12, 742 Axtelle,F.II.,Pt,,B,34th June 5, ; circular. Died July 21, Wisconsin, age J8. 2, 65. 1865. Massachusetts. 6, 64. 1864 ; pyasmia. 699 Westbrook, J., Pt., A, Sept. 17, Right ; ant. post. flap. Disch d 743 Bailey, S. G., Lieut., H, Mav 3, Right. Died May 30, 1863; py 104th New York. 17, 62. December 26, 1862. 5th Maine, age 29. 3, 63. aemia. 700 Wester, AM., Pt.,I, 30th July 3, Right. Surg. G. W. Briggs, 30th !?44 Bailey, S. W., Serg t, I, Sept. 19, Right; flap. Surg. G. T. Stevens, North Carolina, age 24. 3, 63. N. C. Paroled Nov. 25, 1863. 2d Vermont, age 31. 20, 64. 77th N. Y. Died October 21. 701 Wheeler. C., 1 t., 1, 4th Feb. 11, Right ; circular. Disch d July 1864 : diphtheria. Colored Troops. 11, 65. 25, 1865. 745 Ballard, J., Pt., G, 143d May 5, Right. Surg. II. F. Lyster, 5th 702 Wheeler, E. 11., Pt., G, May 3, Left. Surg. N. A. Hursam, 17th Pennsylvania. 5. 64. Michigan. Died May 16, 1864. 17th Maine, age 22. 3, 63. Maine. Disch d Dec. 16, 1863. 746 Hammond. C., Pt., Car Mav 14, Right. Surg. II. F. Lvster. 5th 703 Wheeler, H.,Pt.,D,125th July 2, Right ; flap. Surg. W. S. Cooper, ter s 1st Virginia Bat 14, 64. Michigan. Died May" 26, 1864. New York, age 22. 3, 63. 125th N. Y. Dis. June 20, 1864. tery, age 38. 704 Whitcoinb,W.\V.,Corp., July 2, Right : circ. Surg. H. B. Fowler, 747 Barnes, B. J..Pt.,E,10th July 22, Left. Surg. M.W. Robbins, -1th C, llth Mass., age 21. 4, 63. 12th N. H. Disch d Nov. 21, 63. South Carolina. , 64. Iowa. Died July 30, 1864. 705 WhitltKk, O. J., Pt., 15. Mav 3, . Surg. P. F. Whitehead, i 748 Binger, L., Pt., E, 5th Nov. 25, Right; circular ; gangrene. Died 44th Virginia. 4, 63. P. A.C. S. Retired Dec. 28. 64. 1 Kentucky. 26, 63. December 17, 1863. 706 Whitman, F. M., Pt,, G, May 18, Right; ant. post. flap. Surg. T. ,749 Bohrer, C., Pt., G, 107th July 1, Right. Died July 16, 1863. 35th Mass., age 25. , 64. F. Oakes. 56th Mass. Disch d Ohio. , 63. Dec. 15, 1864. Re-amputation. 750 Bradley, J., Pt., K, 1st May 19, Left. Died June 22, 1864. 707 Wicks, W., Pt., H, 8th Oct. 27, Right ; circular. Disch d Sept. Mass. 11 vy Art.. age 33. 19, 64. ! New Jersey, age 23. 29, 64. 23, 1865. 751 Brongher, S. II., Serg t, Mav 5, Right: ant. post. flap. Surg. L. 708 Wierman, j". H., Pt., A, April 9, Left: circ. Surg.W. A. Babcock, C, 142d Penn., age 20. 5, 64. Holt, C. S. A. Died April 4, 69th Indiana, age 24. 9, 65. 76th 111. Disch d June 5. 1865. 1865 ; pleurisy. 709 Wilburn. J. M., Pt,, D, May 14, Left ; flap. Surgs. B. G. Pierce, 752 Bruce. L. H. C., Corp l, May 18, Right ; circ. Surg. C. Powers, 03d Indiana, age 23. 15, 64. 96th 111., and H. E. Hasse, 24th K, 14th Iowa. 18, 64. 160th N. Y. (Also wound of AVis. Disch d Nov. 21, 1864. thigh.) Died June 14, 1864. 710 Wiley. W. C., Pt., E, July 3. Left: flap. Surg. J. Ash, 70th |753 Brugart. C., Lieut., I, July 1, Right. Died July 16, 1863. 70th New York. 3, 63. X. Y. Discharged. 26th Wisconsin. . "63. 711 Wilkinson. J. A,, Serg t, Aug. 25, . Surg. C. C. Henkel.C.S.A. 754 Burdett, C., Corp l, II, July 3, Left; circular. Died July 26, F, 23d Virginia. 25, 64. Retired December 30, 1864. X. d Massachusetts. 4, 63. 1863. 712 Williams, J., Pt,, B, 5th May 8, Right; circ. Surg. B. Rohrer, ^755 Burns, F., Pt., 11, 88th June 19, Left. Surg. P. E. Hubou, 28th Penn. Reseryes, age 24. 8, 64. 10th Penn. Res. Disch d June New York. -, 64. Mass. Died June 26, 1864 ; ty 8. 1865. Spec. 2969. phoid fever. 713 Williams, J. If., Pt., I, Aug. 5, Left. Surg. Patton, C. S. A. 756 Carter. C., Pt., G, 61st July 15, Right; circ.; erysipelas; gang. 2d Kentucky. 5, 62. Recovery. Col d Troops, age 40. 15, 64. Died Aug. 5, 1864; gangrene. 714 Williams. R. ~\V., Serg t, Mar. 25, Right ; circ. A. Surg. S. Adams, 757 ! Cassidy, I., Pt., H, 16th June 17, Right. Surg. J. T. Kimbly, llth I. 57th Mass., age 22. 25, 65. U. S. A. Disch d Oct. 30, 1865. Kentucky. 17, 64. Kentucky. Died June 17, 1864. Spec. 4028. 758 : Chapel, G., Pt., B, 6th Left ; ant. post. flap. Died May 710 Williams, T., Serg t, K, June 4, Right : flap. Surg. J. B. Ensey, 1 Virginia, age 19. 27, 1864; prostration. 5th Illinois Cavalry. 5, 63. 5th 111. Cav. Dis. Aug. 11 , 63. 759 Clevantine, J., Serg t, F, June 3, . Died June 12, 1864. 71G Williams, T.,l t., E,"l7th Dec. 14, i Riffht; flap. Surg. P. H. Clem- : 150th Pennsylvania. 3, 64. Col d Troops, age 25. 15, 64. ons, 17th Col d Troops. Mus 760 ! Colcord. C. E.. Serg t, C. Mav 16, Left. Died June 27, 64; tetanus. tered out May 3J , 1865. 4th N. Hamp., age 26. 16," 64. 717 718 Williams, T. G., Pt., 1, 23d North Carolina. Willis, F. J., Serg t, A, July 2, 3. 63. July 30, Left. Paroled* September 25, 63. Right ; circ. Surg. L. W. Bliss, 761) 762[ Vooksey, A. J., Pt., D, 3d Miss., age 35. Dec. 15, 16, 64. Both ; circ. Died Jan. 2, 1865 ; exhaustion from sloughing. 51st New York, age 24. 30, 64. 51st N. Y. Disch d Mar. 1, 65. 763 Cork. L, Serg t, C, 4th , Sept. 29, Left ; flap. Died Oct ober 1 , 1864. 719 Willis, N. J., Pt., D, 15th May 20, Left ; circular. Discharged De- Col d Troops, age 25. 29, 64. V N.Y. IIv yArt,,age)9. 20," 64. cember 30, 1864. 764 1 Craig, J. S., Pt., H, 14th Dec. 13, Right. Died January 6. 1863. 720 Wilson,W.L., Lieut., H, Nov. 25, Left. Sur<r. Gunnal, C. S. A. Indiana. 13, 62. 15th Alabama. 26, 63. Recovery. 765 Crumley, H. W., Corp l, ! July 18, Left. Died July 28, 64; tetanus. 721 Wilson, W. P., Serg t. F, July 1, Left ; flap. A. Surg. P. S. Arndt. D, 110th Ohio, age 20. 18." 64. 19th Indiana, age 35. 2, 03. 2d Wis. Disch d Dec. 13, 1863. 766 Curran, G., Pt., 1, 124th July 29, Left ; ant. post, flap ; gangrene. 722 Wilson, W. W., Serg t, June 9, Right; flap. Confed. surgeon. New York, age 33. 29, 64. Died Aug. 26, 1864 ; exhaust n. G, 66th Ohio. 10, 62. Disch d Jan. 6, 1863. 7(i7 Currv, D., Pt., K, 6th July 9, Right; circ. Surg. C. H. Todd, 723 Winus, T., Pt., A,4thN. Aug. 23, Loft; flap. Surg. O. L. Potter. ! Louisiana. 11, 64. C. S. A. Died July 16, 1864. Y. H yy Art., age 20. 24; 64. 145th Penn. Dis. June 16, 65. 768 Curtis, J., Pt,, C, 28th ; May 10, Left; flap. Surg. P. E. Hubon, 721 Wood, E. R., Pt., B, 18th June 17, Right. Surg. L. Holbrook, 18th Massachusetts, age 26. 11, 64. 28th Mass. Died Mav 17, 1864. Connecticut. 18. 6-1. ; Conn. July 29, amput n thigh. 769 i Day, J. E., Lieut., K, Aug. 28, Left. Surg. R. W. Hazielt. 5th Discharged May 4, 1865. 3d West Virginia. 28, 62. West Virginia Cavalry. Died 725 Wood, G., Pt., D, 33d Mar. 19, ; Left; c\rc. Confederate surgeon. Sept. 27, 1862; pyaemia. Ohio, age 25. 20, 65. Discharged July 31, 1865. 770 Deneza. C., Pt., L, 5th Oct. 23, Left, Died Nov. "10, 1864; gan 726 Wood, M., Serg t, C, 1 1th Sept. 19, Left; double flap. Surg. C. B. Mo. Mil. Cav., age 30. 23, 64. grene. Vermont, age 19. lit, 64. Park, jr.. llth Vermont. Disc d 771 Drain, J. F., Pt,, A, 53d J July 2. Left. Oct. 1, hoem.: 9th, amp. July 6. 1865. Virginia, age 26. 4,63. thigh. Died Nov. ~>. If- n3; ex- 727 Woodruff, S. B., Serg t, Aug. 10, Left ; circ. Surg. J. C. Welch, haustion. Specs. 1963, 1975. F, 20th Ky.,age2!. 10. 64. 20th Kv. Disch d Mar. 10. 65. 772 Durkin. J. W., Pt., F, Mar. 31, Left; gangrene. Died April 25, 728 Woodward, W., Pt., B. Oct, 19, Left ; circular. Discharged June : 120th N. York, age 35. 31, 65. 1865." 116th New York. 20, 64. 6.1865. 773 Edwards, B. T., Serg t, \ , 64, Right. Died. 729 Workman, H., Pt., E. Jan. 11, Left; circ. Surg. J. Pomerene, i E, 19th S. Carolina. Primary. 83d Ohio, age 18. ]l, 63. 42d Ohio. Diseh d Dec. 17, 64! 774 Elmer, A., Pt., F, 1st Mar. 31, . Died May 14, 1865. 730 Wright, E. C., Corp l, II, May 3, Right; posterior flap. Surg. I). New York Cavalry. 31, 65. 21st N. Jersey, age 19. 3, 63. McXeill,21stN..T. Disch d June 775 Emerson, C. A., Pt., H, June 27, Right. Died July 18, 1864. 13,1863. Amp. knee joint. , 97th Ohio. 27, 64. ! 731 Wmiderlin, J. E., l t..r, Mav 3, Left: flap. Mustered out April 776 Farman, D., Corp l, H, Aug. 16, Right. Died October in. 1864; 33d New York, ne e 27. 5. 63. 1.1864. 155th Penn., age 23. 10, 64. exhaustion. 732 Yaeger, W., Pt., B, 26th May 14, Left; flap. Surg. J.W. Hastings, 777 Fisher, ( ,., Pt, D, 24th May 18, | Right. Died July 14, 1864 ; ex- Wisconsin, age 24. 14." 64. . 33d Mass. Done rein. Disch d. ! N. Y. Cavalry, age 44. 19, 64. i haustion. 733 i Yoder, N. W., Lieut., A, Jan. 2. Left. Discharged July 30, 1863. 778 Folkarts, J., Pt., K, 5th July 2, Right. Died September 5. 1863; 51st Ohio. , 63. Drowned March 9, 1877. Michigan, age 50. 3, 63. exhaustion. 734 York. J. C., Pt., C, 94th Aug. 19, Right ; circ. Discharged March 77!) French. D. H., Serg t, E, Oct. 13, Right; ant. post. flap. Died Nov. New York, age 28. 20, C4. 17, 1865. 34th Mass., age 24. 14, 64. i 13, 1864 ; exhaustion. 735 Zibble, A. H., Pt., L,7th July 10. Right; circ. Confed. surgeon. 780 Gibson, C. O., Pt., H, 4th Oct. 19, Right. Died November 26, 1861; Mich. Cavalry, age 18. 10," (14. Discharged May 19, 1865. Vermont, age 31. 19, 64. diphtheria. 36 Zwickcr, E., Pt., B, 7th Aug. 9, Right; double flap. Discharged 781 Ginnicker. C. B., Lieut., May 5, Right, Died June 9, 1864. Ohio. 11, 60. October 27, 1862. D. 9th Mass., age 27. , 64. 737 Alcock, A.O.,Pt.,C,lCth May 10, Left. Died June 16, 1864. 782 Givens, S., Pt,, A, 9th Sept. 29, Left. Died October 21, 1864; New York, age 41. 10. 64. Col d Troops, age 28. 29, 64. exhaustion. 738 Aldrioh. J., Corp l, F. Feb. 6, Left ; double flap. Died March 783 Goodrich, M. B., Lieut., May 5, Left; flap. Died June 14, 1864; 188th N. York, age 43. 6. 65. 2, 1865; pyaemia. 11, 93d Penn., age 25. 5, 64. pyaemia. 739 Anderson. D., Corp ], H, Aug. 21, Right (also" amp. left leg. lower 784 Goudv, C. W. C., Pt., D, May 19, Right; gangrenous. Died May 7th Maryland, age 41. 21. 64. third). Died Oct. 1, 1864. 1st Mass. H. A., age 22. 19, 64. 24, 1864. SURG. Ill 6 2 490 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPEUATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 785 Gray, J. C., Pt., B, 10th July 22, Right ; ant. posterior flap. Died 827 McEntyre, D., Pt., B, May 15, Right ; single post. flap. Gang. Texas, age 20. 24, 64. March 13, 1865. lOOth N. Y., age 22. 15, 64. Died July 20, 1864. 786 Green, M., Pt., B, 2d June 17, Right. Surg. S. S. French, 20th 828 McLane,\V., Pt., D, 69th May 12, Right. Died May 26, 1864: py Michigan, age 20. 17, 64. Mich. Died July 2, 1864; irrita Pennsylvania. 12, 64. aemia. tive fever. 829 Mecham.J. E..Corp l,H, Dec. 15, Right; flap. Died January 16, 787 Greene. W. P., Lieut., A, Sept. 22, Left; circ. Died Oct. 31. 1864 ; 114th 111., age 20. 15, 64. 1865. 14th West Virginia. 23, 64. irritative fever. 830 Mills. A.. Pt., K. 6th Nov. 30, Right ; ant. post. flap. Surg. 788 Hatch, A., Sorg t, A, 7th Aug. 16, R t. Surg.G. C. Jan-is. 7th Conn. Mississippi, age 24. Dec.1, 64. Wayles.C. S.A. Died May 13, Connecticut, age 22. 16, 64. Died Sept. 9, 1864 ; exhausfn. 1865; exhaustion. 789 Hatch. T..Pt., D, 1st Me. June 19, Right; flap; pyaemia. Died July 831 Modlin. J. H., Serg t, C. Mav 30, Right. Sui-ff. S. H. Kersey, 36th Heavy Art y, age 45. 19, 64. 13, 1864; exhaustion. 36th Indiana, age 24. 30, 64. Indiana. Died July 23, 1864; ; 790 Haynes, H., 1 t., C, 14th May 24, Left; circular. Died August 20, chronic diarrhoea. Infantry, age 19. 25, 64. 1864. 832 Moore, A. J., Pt., D, 50th May 10, Left (also flesh wound right leg). 791 Hayward, J. W., Pt., A, Sept. 29. Right. Died October 31, 1864; Pennsylvania. 10. 64. Died May 13, 1864. 9th C. Troops, age 25. 30, 64. tetanus. 8133 Morris, W. F., Pt., A, July 22, Right ; circ. A. Surg.C. B. Rich 792 Hella, C., Pt., B, 121st Dec. 13, Left. Died March 5, 1863 ; gan 116th Illinois. 22, 64. ards, 30th Ohio. Erysipelas. Pennsylvania. 13, 62. grene. Died August 5, 1864. 793 Hewlett, J., Pt., E, 30th Mar. 25, Right. Died April 25, 1865. 834 Munn. W., Pt., I, 27th Mav 10, Right ; ciro.; gangrene. Sept. 20, Virginia. 25, 65. Michigan, age 31. 10," 64. amp. thigh. Died Oct. 4, 1864 ; 794 Hobart, C. J., Pt., I, 27th Sept. 14, Right; circular; slough. Died exhaustion. Spec. 3330. New York. 15, 62. October 28, 1862 ; pleur. eff n. 835 Nason, II., Pt., C, 1st Nov. 30, Left ; flap (also amp. right leg, 795 Hollanbeck. S., Corp l, Aug. 15, Left ; flap. Died September 7, Ehode Island Artil ry, Dec. 2, 63. lower third). Died December D, 52d N. Y., age 28. 16, 64. 1864. age 38. 21, 1863; pyasmia. 796 Hopkins, S. M.. Lieut., I, Dec. 13, Left; flap. Died December 26, .836 Neff, J., Pt., K, 10th May 10, Left ; flap. "Died May 28, 1864. 12th Kbode Island. 13, 62. 1862. Massachusetts, age 27. 10, 64. 797 Irwin, D., Pt., G, IstMd. Aug. 16, Left. Died September 1, 1864; 837 Noe. A. W., Pt., E, 13th Nov. 27, Left. Surg. S. C. Plummer, 13th Cavalry, age 21. 16, 64. mortification. Illinois. 27, 63. Illinois. Died Dec. 19, 1863. 798 Irwin, T., Pt., C, 14th Mav 10, Right; circular. Died June 10, 838 Nolan, R., Pt., B, 12th Dec. 15, Left. A. A. Surg. J. S. Giltner. New Jersey, age 20. 10," 64. 164 ; gangrene. Col d Troops, acre 24. 17, 64. Died Dec. 30, 1864 : gangrene. 799 Jacobson, F., Pt.,C, llth June 18, Right ; circ.: gangrene. Aug. 20, 839 Pucie., ? C. , Serg t, II, Nov. 30, Left ; circular ; gangrene. Died Connecticut, age 18. 18, "64. re-amp, thigh; gangrene; haem. 15th Miss., age 25. Dec.2, 64. March 26, 1865; pneumonia. Died August 26. 1864. 840 Park, A. G., Pt., K, llth Sept. 19, Left. Died October 23, 1864. 800 Job, J., Pt., M, 2d New June 16, Right. Surg. J.W. Wishart, 140th West Virginia. 19, 64. York Artillery. 16, 64. Penn. Died July 11, 1864. 841 Pierson. W. C., Pt., F, Dec. 16, Right : circular. Died February 801 Johnson, J. W., Pt., II, Nov. 30, Right; circ. Surg. Ruskin, | 14th Texas, age 25. 16, 64. 11, 1865: exhaustion. 19th Arkansas, age 25. Dec.l, 64.| C. S. A. Died Mav 27. 1665. ! 842 * Powell, W. B., Pt., I, 3d Sept. 17, Right; flap; slough.; necrosis. 802 Johnson, M. ]i., Pt., G, Sept. 14, . Died October 7, 1862. South Carolina, age 20. 18". 62. Nov. 30, amp. thigh. Died Mav Kith Georgia. 16, 62. 2, 1863: exhausfn. Specs. 3962. 803 Jones. L., Pt., D, 58th June 3, Right; flap. Died July 1, 1864. | 795, 3837. Massachusetts, age 45. 3, 64. 843 Preston. J. A., Serg t,A, May 11, Right; flap. Died August 20, 804 Jullivett.N., Pt., D, 98th Sept. 29, Right (also amp. arm). Surg. J. 1st Mich. Cav., age 32. 11, 64. 1864. New York, age 19. 30, 64. A. Bigelow, 8th Conn. Died 844 Pvles. W. IF.. Pt.. II. Aug. 4, Left ; circ. sect, skin and muscles. , October 9, 1864 ; exhaustion. llth West Virginia, age 5, 64. A. A. Surg. W. B. Crain. Ery 805 Kirk, A., Pt., K, 95th! May 12, Left; circular. Died May 31, I 32. sipelas. Died August 11, 1864. New York. 12, 64. 1864; exhaustion. 845 Queen, G., Pt., E, 1st Aug. 17, Left. Died September 1 1 , 1864 ; 80<! Klock, M., Pt., 15, <Jth Dec. 16, | Right ; ant. post, flap ; sloughing. 1 Col d Troops, age 20. 17, 64. exhaustion. Minnesota, age 51. Hi, 64. Died Dec. 29, 04 ; irrita. fever. 84G Quin, ./.. Pt., A, Austin s De.30, 62, Left. Sur-r. E. Swift, II. S. A. 807 Korff, C., Corp l, B. 6th Dee. 4. Left : ant. post. flap. A. A. Surg. i Sharpshooters, age 30. Jan. 1, 63. Hsem. Died January 8, 1863. Indiana. 4, 64. J. E. Patterson. Died Decem- 847 Raymond, W. M.,~Capt.. Dec. 10, Left ; ant. post. flap. Jan. 12, 65, ber 11. 1864. D. 52d Indiana. 16. 64. re-amputation. Died Jan. 13. 808 Kruppel, L., Corp l, D, June 17, Left. Died June 24, 64: pyaemia. 1865; irritative fever. 46th Xew York, age 37. 17. 64. 848 Remkwitz. G. A.. Pt., G, Oct. 8, : typhoid fever. Died Nov. 809 Larabee, J., Pt., E,75th July 1, Left; hsem.: lig. femoral. Died 24th Illinois. 8, 62. 19, 1862. Ohio, age 19. 1, 63. August 20, 1863: pneumonia. 849 Roberts. L, Pt., 1 , 100th Dec. 15, Left; flap. Died December 22, 810 LaRose, C., Corp l, H, May 5. Left. Died May 30. 1864. Col d Troops, age 22. 15, 64. 1864 ; effects of amputation. 93d New York, age 27. 6, 64. 850 Robinson, G. H.. Pt., D, May 12, i Right. Died May 25, 1864. 811 Lee, T., Pt., E,43d New July 12, Right; circ. A. A. Surg. M. F. 39th Illinois. 12 , 64. York, age 45. 12, 64. ; Price. Died Nov. 14, 1864. : 851 i Roehl. C., Corp l. E, 21st May 1. Left; double flap; slough. Died 812 Levan, G. W., Pt., C, Dec. 13, Right. Died. Iowa. 1, 63. May 20, 1863. 131st Pennsylvania. , 62. 852 Sapp. W. E., Musician, June 23, Left. Died July 31. 1864. 813 Lewis, N., Lieut., C, Oct. 19, Right; sloughing. Died Nov. A~,~llth N. J., age 20. 23. 64. 1 14th Xew York. 19, 64. 30, 1864 : pyaemia. i 853 Saunders.J., Pt., E, 95th Feb. 6, Right ; post. flap. Died March 814 Lewzader, W., Pt., B, June 15, Left; gangrene. Died July 4, i New York, age 3:). 6, 65. 19, 1865; tetanus. !>th Indiana, age 24. la, 64. ; 1864. 854 Sehweichardt, F., Pt..D, June 26, Left. Surg. C. S. Frink, U. S. V. 815 Livingstone,L. yl.,Capt., July 2, Left jerysip. July 14, amp. thigh: 16th Illinois, age 38. \ 26, 64. Died July 7, 1864. F.8tii Alabama, age 23. 3, 63. haem. Aug. 4, "three ins. bone 855 Seerwald, C., Pt., A, 8th July 3, Right. Died August 7, 1863. removed. Died Sept. 27, 1863 : j ! Ohio. , 63. erysipelas; haemorrhage. , 856 Sergent, C. J., Lieut., F, Aug. U, Left ; ant. post. flap. Surg.W. R. 81G Long, O., Pt., G, 40th Sept. 19, Left ; flap. Died October 6, 1 864 ; 7th Iowa, age 31 . 11, 64. Marsh, 2d Iowa. October, 64, Pennsylvania. 19, 64. exhaustion. necrosed bone removed. Died 817 Longe, J., Pt., L, llth June!, Right. Died September 2, 1864. i April 10, 1865. Vermont, age 18. 2, 64. 857 Sharp, D. C., Pt., B, Kid Oct. 28. Left. Nov. 10, erysipelas. Died 818 Lozo, J., Corp l, B, 21&t Mar. 19, Right. Died May 18, 1865; py- Iowa, age 25. 29, 62. Nov. 18, 1862; erysipelas and Michigan, age 22. 19. 65. asrnia. pyaemia. Spec. 470. 819 Magner, E., Pt., I, 60th Sept. 17, . Died October 20, 1862. 858 Sherman, R. T., Pt., F. May 12, Right. Surgeon I!. Rohrer, 10th New York. , 62. 2d Pennsylvania Ues., 12," 64. Penn. Res. Died June 3, 1664 ; 820 Mann, B. 11., Lieut., I. M;i\- 20. Riirht. Dird M.iv 24 IRI14- PV. n<rp 01 exhaustion. Sppc. 4510. 59th Virginia, age 44. 20, 64. haustion. 8.7.) Sinkswillr.r, J., Pt., K, May 30, I ight; circular. Bone removed. 821 Manny, !>., Pt., 7th New June 28, i Left ; sloughed. Died July 24, i 52d Virginia, age 34. 31," 64. Died August 12, 1864. York Battery, age 24. 28, 64. 1864. 860 , Small, J. \V. M., Corp l, July 2, Left. Died July 14, 1863; py- 822 Marshall, B. V., Pt., A, Sept. 14, Right ; Teal s method. Surg. R. i D, 17th lnfantry,age~32. 3, 63. zemia. 1st N.Hampshire H vy 14, 64. B. Bontecou, U. 8. V. (Also 861 Smith. G. R., Pt., I, 50th Oct. 27, Right. Died October 30, 1864. Artillery. wound of thigh, fract. left foot.) ! New York. 27, 64. Haemorrh. Died Sept. 14. 1864 ; 862 Smith, L. C., Serg t, G, May 10, Right ; flap. Died May 27, 1 864 . exhaustion. Spec. 3245. i 4th Mich., age 26. 11, 64. 823 McCarthy, D., Corp l, C, Sept. 19, Left ; circular. Died October 7, 863 Spriggs, I. B., Pt., D. May 14, Right ; circ. Surg. S. K. Craw 26th Massachusetts. 19, 64. , 1864. 118th Ohio, aire 20. 15 64. ford, 50th Ohio. Died Sept. 1, 824 McClure, D.,Pt., D,28th July 30, : Right: flap. Surg. D. MacKay, 1864 ; pyaemia. Colored Troops. 30, 64. 29th Col d Troops. Died July 864 Storm. J., Pt., A, 17th May 19, Right. Died July 15, 1863. 30, 1864. Wisconsin. 19, 63. 825 McCullough, L., Corp l, July 20, Left; circ. Died Feb. 26, 1865; : 865 Stout, C. R., Pt., K, 25th July 1, Right. Died July 14, 1864 ; tet H, 31st Miss., age 19. 21, 64. chronic diarrhoea. Massachusetts, atre 20. 1, 64. anus. 826 McDermott, E., Pt., II, June 20, Left ; circular. Died June 27, 866 Sturtevant, L., Serg t, F, April 2, Right ; lateral flap. Died May 7thN.Y.H.Art., age 48. 20, 64. 1864 ; exhaustion. IstMe. II. Art y, age 22. 2, 65. 14, 1865; exhaustion. 1 FISHER (G. J.), Report of Fifty-seven Cases of Amputations, in tlie Hospitals near Skarpsburg, Aid., after the battle of Antietam, in American Journal Medical Sciences, 1863. Vol. XLV, p. 48. SECT. V.) PETMARY AMPUTATIONS IN THE LEG. 491 No. NAME, MILITARY DESCUITTIOX, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 867 Taylor, A., Pt., I, 15th Oct. 19, Right: flnp. Died November 18, ! 880 Watson, W., Pt., C, 4th May 13, Left. Surg. J..Spiegelhalttr, Ifth New York, age 40. 19, 64. 1H64 ; pyajmia. Iowa. 13, 64. Missouri. Died May 14, 1864. 868 Taylor, G. W., Brig. Aug. 27, Left; double flap. Surg. J. H. 881 White, A., Pt,, C, 2d Oct. 19, Right ; cire. Died October 21, General U. S. V. 28, 62. Brinton, U. S. V. Died Sept, Virginia Cavalry. 19, 64. 1864 ; erysipelas. 1, 1862 r ; exhaustion. Spec. 313. 882 Wiuslow. S., Pt., I, 37th April 2, Left. Died April 24, 1865; py- 869 Thiback, H., Pt., D, 5th May 10, R t : circ. Surg. O. E. Crane, 5th Massachusetts. 2, 65. rernia. Wisconsin, age 30. 10," 64. Wis. DiedJuneo, "64; pyaemia. 883 Word, W. F., Corp l, G, May 16, Right ; flap. Died September 870 Thompson, J. T.. Pt., H. Sept. 30, Left (also w nd of pelvis;. Died 48th New York, age 22. 16, 64. 23, 1864. 51st N. Carolina.agelO. 30, 64. Oct. 10, 1864 : exhaustion. 884 Wyman, A. R., Corp l, June 22, Left : circ. Surg. W. A. Child, 671 Thompson, T. N., Vt.,D, June 2, Right (also w d of thigh and fract. B, 9th New York H vy 22, 64. 10th Vermont. Died July 10, 8th New York Heavy 3, 64. left leg). Surg. S. H. Plumb, Artillery, age 27. 1864; tetanus. Artillery, age 17. 82d N. Y. Died June 24, 1864. 885 Yardley, W., Pt., , 85th Mar. 10, Right ; circular. Died March 27, 872 Tracy, G". B., Serg t, E, May 12, Left. Died June 6, 64; pyaemia. New York, age 19. 10, 65. 1865; typhoid fever. 9th N. Hamp.,age28. 12, V54. 886 Young. H. E., Pt., B, 1st April 26, Right. Surg. J. Robarts, 1st M. 873 Troope, S., Pt., B, 12th Dec. 15, Left ; flap. A. A. Surg. J. S. Gilt- Miss. Marine Brigade, 26, 63. Marine Brigade. May 15, re- Col d Troops, age 28. 16, 64. ner. Died Dec. 30, 64 ; gang. age 18. amputat n; haemorrhage. Died 874 Twining, L. C., Serg t, Mar. 19, Right (also fracture left fibula). May 31, 1863. B, 136th New York. 19, 65. Died April 8, 1865; pya?mia. :887 Bradford, F. L., Pt., A, Sept. 1, Left. 875 Twining, P.E.,Serg t.F, June 1, Left; cir. Surg. S. H. Plumb, 10th Mississippi. 1, 64. 36th Wisconsin, age 26. 3, 64. 82d N. Y. Sept. 14, amp. thigh. 888 Emfi-nger, E,, Pt., E, 7th Aug. 31, . Died October 16, 1864. Mississippi. 31, 64. 876 Vallcley, E. J., Pt., A, 3d April 9, Right Calso fract. ulnaand femur). 889 Gambill, A. M., Pt., A, May 1, Right. R.I. Artillery, age 18. 11, 63. Died April 14, 63. Spec. 1165. 6th Missouri. , 63. 877 Vetter, J. C., Pt., G, 26th May 3, Left. Died May 18, 1863. 890 ^O Brien, J.,Pt., 1st Va., Sept. 17, Left ; post, flap ; sloughing. Re Wisconsin. 3, 63. age 30. 19, 62. covery doubtful. 878 Wait, B., Corp l, C, 16th Aug. 19, Right ; flap. Died September 18, 891 Oxford, E. J., Serg t, E, Aug. 31, Left. Michigan, age 30. 20, 64. 1864 ; pyaemia. 2d Georgia. 31, 64. 879 1 Waters. W.,Pt,,K, 123d May 15, Right (also amp. left hip joint). 892 Weaver, T... Pt., H, 66th Nov. 30, Right ; circular. New York. 15, 64. Rurg. J. W. Brock, 66th Ohio. Georgia, age 25. Dec.1, 64. Died May 15, 1864. Primary Amputations in the Lower Third of the Leg for Shot Injury. There appear on the jecords of this Office nine hundred examples of primary amputation in the lower third of the leg. Six hundred and seventy-six terminated successfully, two hundred and fifteen fatally, and the results in nine instances are not recorded, a fatality of 24.1 per cent., exceeding the mortality of the primary amputations in the middle third 7.2 per cent. Successful Primary Amputations in the Lower Third of the Bones of the Leg. The six hundred and seventy-six operations of this group were performed on six hundred and seventy-three patients, three being amputations of both limbs. Five hundred and thirty- two were Union and one hundred and forty-one were Confederate soldiers. Of the former, five hundred and twenty-eight were pensioned or placed on the retired list; forty-three of these have died since the date of their discharge. In fifty-two instances re-amputation in the leg and in six amputation in the thigh was subsequently performed. CASE 740. Lieutenant E. F. O Brien, Co. A, 28th Massachusetts, aged 29 years, was wounded at Cold Harbor, June 3, 1864. Surgeon W. S. Cooper, 125th New York, reported his admission to the field hospital of the 1st division, Second Corps, with "shot fracture involving the left ankle; leg amputated at lower third by Surgeon P. E. Hubon, 28th Massachusetts." Five days after the reception of the injury the patient entered Armory Square Hospital, Washington, and one month later he proceeded to his home on leave of absence. He was discharged from service October 13, 1864, and afterwards entered the Veteran Reserve Corps, in which organization he served until April 17, 1867, when he was mustered out and pensioned. Subsequently he obtained employment as clerk in the Post Office and Interior Departments at Washington. In May, 1869, when visiting the Army Medical Museum, he was in excellent health, and stated that he had worn a "Salem artificial leg with satisfaction for over five years. In his application for a new artificial limb, supplied in 1880, the pensioner reports the stump as continuing in very good condition." His pension was paid September 4, 1880. The amputated bones of the leg, together with the astragalus (Spec. 4494, Surg. Sect., A. M. M.), were contributed to the Museum by the operator, and are represented in the wood-cut (FlG. 290), showing the tibia to be shattered into the ankle and the fibula fractured transversely. CASE 741. Lieutenant Robert Catlin, 5th U. S. Artillery, was wounded in an engagement on the Weldon Railroad, near Petersburg, August 21, 1864, by a twelve-pound round shot which crushed his left foot. Three hours after the reception of the injury the limb was amputated in the lower third, by circular incision, by Surgeon W. B. Fox, 8th Michigan. The wound healed rapidly, and Lieutenant Catlin was able to be about in a month. Dr. S. Weir Mitchell, 3 who had the patient under treatment for a period of three years on account of neuralgia of the leg stump, published an 1 Circular No. 6, S. G. O., November 1, 1865. Circular No. 7, S. G. O., July 1, 1867, pp. 29, 58. 2 FISHER (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the battle of Antietam, September 17, 1862, in American Journal Medical Sciences, Volume XLV, page 48. s MITCHELL (S. W.), The Relations of Pain to Weather, being a study of the natural history of a case of Traumatic Neuralgia, in American Journal of Medical Sciences, 1877, Vol. LXXI1I, p. 306. FIG. 290. The lower portion of the bones of the left leg and the astragalus. The tibia isshattered into the ankle. Spec. 4494. 492 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FlG.291.-Sixias.rf the stump oft he bones of the left leg, show ing a massive invo- lucrum. Spec. 1526. elaborate account of the results of his observations. In July, 1866, Lieutenant Catliu was promoted Captain. Dr. John H. Brinton, in the spring of 1875, at the request of Dr. Mitchell, exsected one and a half inches of the peroneal nerves, but without material influence on the neuralgic pains. The patient was furnished with an artificial limb by A. A. Marks, of New York. He \vas placed on tlie retired list as captain December 15, 1870. CASE 742. Private J. Cavanaugh, Co. C, 7th "Wisconsin, aged 27 years, was wounded before Petersburg, June 18, 1864, by a shell, which caused a fracture of the lower portion of the left leg, involving the ankle joint. Surgeon C. N. Chamberlain, U. S. V., reported that the injured leg was amputated at the field hospital of the 4th division, Fifth Corps. Surgeon B. B. Wilson, U. S. V.. contributed the pathological specimen, No. 1526, Surg. Sect., A. M. M., shown in the adjoining wood-cut (FlG. 291), and reported the following history of the case: "The patient was admitted to Stanton Hospital, Washington, from City Point, July 1st. He had suffered amputation of the leg at the lower third, by the circular method, the day after he was wounded, being, according to his statement, in a high fever at the time of the operation. He was treated with stimulants, and ice dressings? locally. During the month of September the limb became much swollen and abscesses formed in the line of the middle third of the bone, which, after discharging, left fistulous openings, clearly indicating necrosis of the shaft of the tibia. His term of service having expired, the patient was discharged October 5, 1864, but being unable to leave, he was retained as a patient in the hospital. The shaft of the tibia being evidently extensively necrosed, I determined to perform another amputation above the diseased portion. This operation though opposed by the medical staff of this hospital and by Surgeon A. N. Dougherty, U. S. V., as well as Surgeon T. F. Betton, 1st U. S. V. V., who saw the case was preferred by me to that of exsecting the sequestrum for the reason that it involved no more danger and would give the patient a much better stump (though six inches shorter) for fitting an artificial limb. The operation was performed one inch below the tubercle of the tibia, by the cir cular method, on February 25, 1865, and the stump was treated with cold-water dressings. Traumatic ei ysipelas followed (an epidemic of erysipelas breaking out in the hospital the same week), and for a few days fears were apprehended as to the result. The patient, however, made a good recovery, and by March 15th the inflammation, which had extended to the abdomen, had subsided. Before he finally left the hospital the patient received an artificial limb, on which he walked with great ease and comfort. The specimen indicates clearly and in a marked degree the efforts of nature in throwing off dead bone and supplying its place by new growth. The adventitious process, thrown out to unite the amputated ends of the tibia and fibula and thus give the extremities of those two bones firmness and solidity, shows to how great an extent the reparative process can be carried. By what agency the want of bony matter at this point was perceived and its deposit determined at the proper place and in the proper form is beyond the scope of human knowledge at the present time. The fact, however, evidences the powers of nature to accommodate herself to circumstances and to repair in a limited degree the effects of losses which are irremediable." The specimen, consisting of the re-amputated stumps of the bones of the leg joined by osseous deposit at their lower extremities, shows a massive involucrum except on the anterior border, where a heavy sequestrum is visible. The patient became a pensioner after leaving the hospital. On September 2, 1874, he was examined by Dr. C. F. Falley, pension examiner at Lancaster, Wisconsin, who certified to the loss of the leg and reported: "The amputation has left rather an irritable stump, but, as his cork leg does not press on it, I do not think it any great injury in wearing an artificial limb. He can flex and extend the stump freely," etc. The pensioner was paid March 4, 1880. In his application for an artificial leg he reported that Surgeon D. C. Ayres. 7th Wisconsin, performed the first amputation. CASE 743. Private F. Grahame, Co. A, 6th Wisconsin, aged 26 years, was wounded at Spottsylvania, May 10, 1864. Surgeon C. N. Chamberlain, U. S. V., reported his admission to the field hospital of the 4th division, Fifth Corps, with "shot fracture of right ankle joint, followed by amputation of leg at lower third." The wounded man was conveyed to Armory Square Hospital, Washington, several days after the reception of the injury, and two months later lie was transferred to Harvey Hospital at Madison, where, on September 7th, a second operation was performed by Surgeon H. Culbertson, U. S. V., who made the following report : "The stump of the tibia became necrosed from the lower end to its tuberosity. New bone formed, but the necrosed portion was not separating. There were several cloacae, and the lower end of the tibia projected through the soft parts of the stump. The patient was in an anaemic condition and his system was failing from the constant discharge and reflex irritation from the diseased stump. Designing to resect the diseased tibia, I made an incision from the tuberosity of the bone down to its lower extremity, but on separating the soft parts I found the disease so extensive as to lead me to amputate by a short anterior and a long posterior flap at the tuberosity of the tibia. In notching the tibia the periosteum was pushed back, the notch sawed off, and the periosteum laid over the surface of the bone. The anterior and posterior tibial arteries were ligated. Simple dressings were applied after the operation, and quinine and iron was administered. The sutures were removed on the fifth day and the ligatures came away on the fourteenth day. The wound steadily healed." The re-amputated stump of the tibia and fibula (Spec. 3696, Sury. Sect., A. M. M.), the latter being well rounded and united at its extremity with the former, were con tributed to the Museum by the operator, and are represented in the wood-cut (FlG. 292). The specimen shows a sequestrum in the tibia six inches long; over the upper part of the anterior border the involucrum is wanting. The patient was discharged from service August 22, 1865, and pensioned, having been previously furnished with a "Ely" artificial leg. In his application for commutation he described the stump as continuing in "healthy condition." This pensioner was paid March 4, 1880. In the following instance both legs were amputated in the lower thirds on the day of the injury. The patient survived the operation ten years: CASE 744. Private D. Lee, Co. G, 2d New York Artillery, aged 20 years, was wounded in both legs by a shell during the siege of Petersburg, June 16, 1864, and entered Harewood Hospital. "Washington, six days afterwards. Surgeon R. B. FIG. 292. Ke- araputated por tions of the right tibia nncl fibula. Spec. 3ti96. SKCT. v.] PRIMARY AMPUTATIONS IN THE LEG. 493 Bontecou, U. S. V., reported: " The patient Lad both legs amputated by Assistant Surgeon O. S. Paine, 2d New York Artillery, on the day he wa.s wounded, the operation being performed by the circular method at the lower thirds. He stated that he was in good health at the time of the operation. At the time of his admission he was suffering from diarrhoea, and there were symptoms of gangrene in the stump of the right leg, the tibia and fibula protruding; granulations of stump of left leg not very good. The treatment was supporting, and included opiates, astringents, and the external application of solution of chloride of lime to the gangrenous stump. By June 26th the patient was improving and the granulations had become healthy. He was subsequently transferred to the General Hospital at Rochester, discharged May 31, 1805, and pensioned, having been previously furnished with artificial legs of the "Ely" pattern. In his application for artificial limbs, dated 1870, the pensioner described the stumps as being in a "sound condition." He died September 25, 1874. Though the immediate cause of his death was not ascertained, the pensioner s health had been reported as having become very much impaired. Fatal Primary Amputations in tlie Lower Third oj the Leg. -Two of the two hun dred and fifteen operations of this group were double amputations; the operations were therefore performed on two hundred and thirteen patients,- one hundred and ninety-one Union arid twenty-two Confederate soldiers. Re-amputation in the leg was performed in seven and amputation in the thigh in two instances. CASE 745. Private W. J. Holmes, Co. G, 33d Mississippi, aged 18 years, was wounded in the left leg, at the engagement of Peachtree Creek, near Atlanta, July 20, 1864, and suffered amputation two days afterwards. About four months after losing his limb he was taken prisoner at Franklin, Term., whence he was conveyed to Nashville and sub sequently to Louisville. Surgeon R. R. Taylor, U. S. V., who contributed two post-mortem specimens from the stump, reported the result of the case as follows: "The patient was admitted to Crittenden Hos pital on December 9th. He was suffering from chronic diarrhoea, of which he died December 23, 1864. His left leg had been amputated by the circular method, at the lower third, in consequence of gunshot fracture of the lower portion of the tibia and fibula. In October a portion of the fibula came away, after which the stump healed rapidly. At the time of his death the stump was entirely well. The accompany ing specimens are intended simply to illustrate the changes in the cut ends of the bouts and nerves. The latter, consisting of the extremities of the posterior and anterior tibial and of the musculo-cutaneous nerves, are bulbous." The nerve portions constitute specimen 4244 of the Surgical Section of the Museum. A representation of the specimen of the bones of the stump (Spec. 4243, Sury. Sect.. A. M. M.) appears in the wood-cut (FlG. 293). In the history of the specimen on page 400 of the Catalogue of The Sur jical Section of the U. S. A. Medical Museuiii, Washington, I860, it is remarked that "though the stump is said to have been entirely healed, * * the specimen shows the extremity and posterior surface of the tibia necrosed." In a letter dated December 18, 1867, Dr. II. M. Lilly, late Acting Assistant Surgeon, states that he prepared this specimen, and adds: "I can corroborate Surgeon R. R. Taylor s statement that the O f i e ft~ieg, five months stump was entirely healed. In explanation of the necrosed appearance of the end and posterior portion ^ V I amputation. Spec. of the tibia, I offer the following history of the preparation of the specimen as possibly giving it the appear ance of necrosis. Owing to the inconvenient arrangements of the hospital (the hospital not being finished at that date). I macer ated the specimen in a tin can in my private room. Under such circumstances it was of course desirable to destroy completely all effluvium. To this end I supplied the water in the can liberally with the solution of permanganate salts furnished by the Medical Purveyor. May it not be that the chemical action of these salts has slightly damaged the specimen, giving it a partially necrosed appearance?" CASE 746. Private B. Spriggle, Co. I, 17th Pennsylvania Cavalry, aged 28 years, was wounded in the engagement near Funkstown, July 10. 1863, and entered the General Hospital at Frederick ten days afterwards. Assistant Surgeon R. F. Weir. U. S. A., reported: "He was wounded by a minie ball, which entered the outer side of the left foot just below the external malleolus, passing directly through, involving the bones of the ankle joint and emerging three-fourths of an inch below the internal malleolus. The leg was amputated at its lower third by flap operation the same day he received the injury. At the time of admission the stump looked well and there was healthy suppuration; patient doing well constitutionally, suffering none and having good appetite. He was allowed a generous diet, and in addition one-half pint of port wine daily, and the stump was dressed with adhesive plaster straps and cold-water applications. On August 4th, the flaps having firmly adhered, the straps were taken off the stump and simple cerate dressing was applied. Two days afterwards the patient was able to sit up for a few hours in a chair, and on the next day an abscess was opened which had formed near the end of the stump. The patient s appetite now had become a little depraved and he had some irritation of the stomach. During the evening of August 7th he had a severe chill, followed by some fever the next morning. Quinine and fever mixture was then prescribed and the wine con tinued. August 9th, pulse 106 and rather feeble; appetite not improving; some discharge still coming from the superficial abscess. On August 10th, the patient had improved a little, but the granulations were not looking very healthy and the stump was ordered to be dressed with Hay s lotion. On the following day there was another chill; pulse 130; no improvement. On August 12th, the chills continued, the tongue looking pale, and the pulse being accelerated; but the patient was apparently much better. A bandage was applied to prevent the burrowing of pus towards the knee joint. August 13th, pulse 134 and very irregular; tongue dry: patient complaining of a great deal of thirst, having some cough, and gradually sinking. Milk punch wa.s now substi tuted for the wine. The next day the patient was very delirious, the pulse accelerated and threadlike; great deal of tenderness in the knee; joint doubtless involved; fluctuations detected. August 15th, patient sinking and still very delirious; pulse 156; a good deal of subsultus; very little diarrhoea; tongue red and dry; knee joint seemingly enlarging. Patient taking no nourish ment but beef tea, having no relish for other food; stimulants and opiates administered in large doses. Death occurred at ll..)5 494 INJURIES OF THE LOWEE EXTREMITIES. [CHAP. X. A. M. on August 16, 1863. On dissecting up the integuments and opening the chest during the post-mortem examination, the lungs were found to be healthy and weighing eighteen ounces; heart normal and weighing eight ounces; liver healthy and weighing three pounds and fifteen ounces; weight of spleen seven ounces, and weight of kidneys nine ounces. On removing both bones of the leg from the point of the operation to the knee joint, a circumscribed abscess, containing about an ounce of pus, was found in the belly of the gastrocncmius muscle. The knee joint contained between three and four ounces of pus. The capsule was broken down and the pus extended up the outer side of the thigh about six inches above the joint; cartilage quite soft and commencing to erode around its edges." The bones of the stump, exhibiting a minute sequestrum, nearly separated on the carious extremity of the tibia, were contributed to the Museum by Acting Assistant Surgeon J. C. Shinier, and constitute specimen 3878 of the Surgical Section. CASE 747. Private A. C. Paine, Co. F, 42d New York, aged 30 years, was wounded in both lower extremities, at the battle of Gettysburg, July 3, 1863. He was admitted to the field hospital of the 3d division, Second Corps, where Surgeon I. Scott, 7th West Virginia, recorded the injury as "fracture of both feet, caused by a solid shot," necessitating primary ampu tation of both legs at the lower third, which operation was performed by Surgeon H. M. McAbee, 4th Ohio." Surgeon H. Janes, U. S. V., recorded that the patient died at the Seminary Hospital, Gettysburg, July 23, 1863, from the effects of his injuries. TABLE LXX. Summary of Nine Hundred Cases of Primary Amputations in the Lower Third of the Leg for Shot Injuries. [Recoveries, 1 676; Deaths, 677891 ; Results unknown, 892900.] No NAME, MILITARY OPERATIONS, OPERATORS, NAME, MILITARY OPERATIONS, OPERATORS, DESCRIPTION, AND AGE. DATKS. RESULT. DESCRIPTION, AND AGE. D ATES. RESULT. 1 Abbey, C. F., Serg t, C, Mar. 16, Left; circ. Surg. P. H. Flood, 27 Barnes, W.H.,Pt., B, 3d Jan. 3, Left; circ. Surg. W. L. Peck, 107th New York. 16, 65. 107th N. Y. Disc d Aug. 23, 65. Ohio. 4, 63. 3d Ohio. Discharged. 2 Abbott, U.S., Pt., D,32d Aug. 14, Right ; lateral flap. Surg. J. C. 28 Bartholomew, C. F., Pt., July 12, Left, Surg. J. B. Hinkle.C. S. A. Wisconsin, age 20. 14, 64. Denise. 27th Ohio. Discharged D, 3d Iowa. 12, 03. Discharged Dec. 29, 1 863. July 17, 1865. 29 ^Barwick, J. H., Pt., , Sept. 17, Right; circular. Doing well. 3 Allen, C., Lieut., H, llth May 22, Right. Surg. H. P. Strong, llth 6th S. C., age 20. 17, 02. Wisconsin. 23, 63. Wis. Resigned Jan. 11, 1864. 30 Bass, G., Pt., B, 34th June 5, Right; circular. Discharged Oct. 4 Almany, J., Pt., B, 9th Sept. 19, Left; flap. Discharged January Massachusetts, age 21. 5, 04. 17. 1864. Kentucky, age 39. 20, 63. 28, 1864. 31 Bass, J. C., Pt., I, 5th Oct. 19, . Recovered. 5 Arnelunxen, M., Lieut., Aug. 29, Right, Surg. L. Schultz, 68th Virginia Cavalry. 19, 64. H, 68th New York. 297 62. N. Y. Mar. 29, 1863, re-amp. 32 Bassett, O. J., Pt., F, June 15, Right; circ. Discharged Feb. mid. third. Disch d Aug. 3, 63. 70th Indiana, age 18. 15, 04. 27, 1865. Died June 10, 1872. 6 Andrew, J. J., Pt., E, Oct. 22, . Confederate surgeon. Re 33 Bates, C. A., Pt., D, 57th Aug. 19, Right; flap. Surg. W.V.White, 26th North Carolina. 24, 64. covered. Massachusetts, age 18. 20, 64. 57th Mass. Disch d Mar. 10, 05. 7 Annand, A., Adj t, 28th May 18, Left. Nov. 20, removal of ne 34 Bauvais, D., Pt., H, 97th Feb. 6, Right ; lateral flap. Discharged Massachusetts, age 30. 19, 64. crosed bone. Disch d May 6, 65. New York, Bge 25. 7, 65. Aug. 17, 1805. 8 Antis, T. S., Pt., L, 2d July 2, Left ; circ. Surg. R. T. Paine, 2d 35 Bay, M. S., Lieut., K, July 3, . Exchanged September 15, N. Y. M. R., age 22. 3, 64. N. Y. M. R. Discharged Feb. 38th N. C., age 30. 3, *63. 1803. 25, 1865. 36 Bayless, B. J., Pt., F, July 20, Right. Surg. E. Hutchinson, 9 Armstrong, A. H., Corp l, Sept. 19, Left ; flap. Surg. J. N. Freeman, 137th N. Y., age 20. 20, 64. 137th N. Y. Aug. 8, 04. re-amp. A, 100th N. Y., age 22. 19, 04. 106th N. Y. Discharged. at up. third. Disch d June 16, 65. 10 Armstrong, S. J., Pt,, C, July 14, Left. Discharged December 26, 37 Beath, R. B., Capt., G, Sept 29, Right; circ. flap. Surg. D. G. 1st Michigan Cavalry. 16, 63. 1863. 6th C. Troops, age 25. Oct,l, 64. Rush, 101st Penn. Discharged 11 Augustine, A., Pt., B, Sept. 17, Left ; ciro. Discharged Dec. 13, Sept. 20, 1805. 50th Pennsylvania. 17, 62. 1802. Died Aug. 20, 1869. 38 Bedford, P. B., Corp l, July 3, Right. Transferred to prison De 12 Auman, P., Pt., H, 211th April 2, Left ; flap. Surg. W. G. Hunter, B, 50th Ga., age 36. 4, 03. cember 5, 1803. Pennsylvania. 2, 65. 211th Penn. Disch d July 20, 65. 39 Beers, C. E., Serg t, G, June 30, Left; flap. Surg. W. H. Rice, 13 Ayres, "//., Pt., B, 27th Aug. 25, Left. Surg. E. L. Howard, 27th 81st New York, age 25. 30, 04. 81st N. Y. Diseh d Dec. 29, 04. North Carolina. 26, 04. N: C. Furloughed. 40 Beers, E. J., Corp 1, C, June 27, Right. Surg. T. B. Williams, 14 Babb, J. A., Corp l, K, Aug. 3, Left ; circ. Discharged July 18, 113th Ohio, age 27. 27, 04. 121st Ohio. Re-amput n. Dis 10th Indiana, age 24. o li4 o, ot. 1865. Died Feb. 17, 1806. charged May 10, 1805. 15 Babcock, E. A., Pt., G, June 18, Left ; circ. Surg. T. M. Flan- 41 Bell, F.. Capt.. I, 1st July 3, Right. Surgeon C. Bower, 6th 146th N. Y., age 18. 18, 64. drau, 146th N. Y. Discharged Pennsylvania Rifles. 3. 03. Penn. Res. Disch d Oct. 19, 63. May 18, 1865. 42 Bell, J., Pt, G, 12th Ga. Sept, 19, R t. Surg. S.V. D.Ilill,P. A.C. S. 16 Babe, R., Pt., D, 97th Mav 20, Right; circ. Surg. J. R. Ever- Battalion, age 26. 20, 04. Trans, to Pro. Mar. Apr. 1, 05. Pennsylvania, age 22. 20, 64. hart, 97th Penn. Discharged 43 Bell, J. H., Lieut., D, July 20, Left ; flap. Surg. II. K. Spooner, August 20, 1864. Gist Ohio, age 52. 20, 64. Olst Ohio. Disch d Deo. ] 5, 64. 17 Badger, S., Pt., F, 26th July 1, Right. Gangrene. Transferred Oct. 27, 70, amp. thigh at mid. North Carolina, age 17. 1, 63. for exchange March 3, 1804. third for neuralgic air. of stump. 18 Baker, L. A., Capt., A, Aug. 16, Left. Surg. C. M. Clark, 39th 44 Bender, P., Pt,, B, 74th July 2, Right ; circular. Discharged J uly 39th Illinois, age 29. 16, 04. 111. Discharged Dec. 17, 1864. New York, age 35. 3, 63. 25, 1804. 19 Baldwin, R. F., Lieut., Nov. :;o, Left ; ant. post. flap. Surg. 45 Bennett, E. F., Pt., B, July 11, Left. Confed. Surg. Necrosis. F, 1st Arkansas, age 25. Dec.1, 64. Mitchell, 1st Ark. Transferred 70th Pennsylvania. 13, 63. Oct. 0, amp. at mid. third. Dis to Pro. Mar. Feb. 6, 1865. charged July 21, 04. Spec. 4308. 20 Bales, A.. Pt., A, 4th June 1, Left; circ. Asst. Surg. II. D. 46 Bennett, F. H., Corp l, May 10, Right; ant. post. flap. Surg. J. Indiana Cav., age 19. 1, 64. Garrison, 4th Ind. Cav. Dis G, 48th New York, age 17, 64. L. Mulford, 48th N. Y. Dis charged Nov. 1, 1864. 23. charged May 24, 1865. 21 Banton, S. A., Pt., K, July 2, Left. Paroled Sept. 22, 1863. 47 Bennett, G. B., Serg t, I, Mar. 16, Left; circ. Surg. P. II. Flood, 20th N. C., age 19. 2, fa. 3d Wisconsin, age 36. 10, 05. 107th N.Y. Disch d June 14, 05. 22 Barber, C., Pt., F, Cth May 13, Right ; ant. post. flap. Surg. W. 48 Benton, E., Pt,, Hart s Oct. 14, Left. Surg. Green, C. S. A. Iowa, age 28. 13, 04. Lomax, 12th Ind. Discharged Battery. 15. 03. Recovered. July 10, 1805. 49 Bergeron, J., Pt., H,39th May 9, Right ; flap. Discharged April 23 Barfield, T., Serg t, L, Sept. 20, . Surg. Walker, C. S. A. Massachusetts, age 20. 9, 04. 7, 1805. 8th South Carolina. 21, 03. Recovered. 50 Beto, R. W., Lieut,, II, May 13, Right (also flesh wound left arm); 24 Barqe, A. L., Corp l, B, Aug. 24, . Surg. Mathis, C. S. A. 56th N. C., age 20. 14, 04. gangreno. Exch d Aug. 18, 04. 28th Georgia. 24, 04. Recovered. 51 Betterley, C. M., Pt., II, Mar. 29, Right; flap. Discharged July 25 Barnes, I. M., Pt., F, Jan. 29, Right; flap. Asst. Surg. J. P. 198th Penn., age 27. 29, 05. 6, 1805. 83d Illinois. 29, 03. McClanahan, 83d 111. Disch d 52 Beverly, D., Serg t, D, Sept. 17, Left. Discharged Dec. 0, 1802. April 10, 1864. 97th New York. 18, 62. 26 Barnes, M. J., Pt., E, July 6, Left. Surg. G. H. Parks, 05th 53 Birns, W. G., Pt., D, July 3, Right. Surg. Baxter, C. S. A. 65th Illinois. 6, 62. 111. Discharged Aug. 19, 1862. 50th Virginia. 3, 63. Rccovcnl. FISHER (G. J.), Report of Fifty-seven Cases of Amputations, in thr. Hospitals near SJiarpsburg, Md., after the Battle of Antietam, September 17, 1862, in American Journal Medical Sciences, 1863, Vol. XLV, page 48. SECT. V PRIMARY AMPUTATIONS IN THE LEG. 495 No. NAME. MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 54 Black, G., Serg t, C, 4th May 8, Left ; circ. Surg. Mitchell, C. 91 Carshaw, W. E., Pt.. E, July 1, Left; circ. A. Surg. P. S. Arndt, Maryland, age "3. 8, 64. S. A. Disch d Nov. 11, 1864. 14th N.Y. State Militia. l, *63. 2d Wis. Disch d Nov. 20. 1 863. 55 Blair, J. ., Pt., A, 10th Sept. 17, Left ; Surg. R.Y.Royston.C.S.A. 92 Carter, C. A., Pt., B, June J 7, Left ; circ. Disch d June 28, 65. Alabama. 18, 62. Recovered. llth Maine, age 21. 17, 64. Re-amp, below knee. Died Oct. 56 Blanchard, C., Pt., H, Sept. 29, Right ; flap. A. Surg. M. Hines, 31, 1869, from chronic diarrhoea. 9Gth N. Y., age 29. 29, 64. 96th N.Y. Disch d Apr. 17, 65. 93 Carter, W. A., Pt., D, May 12, Right; flap. Discharged July 28, Re-amp, at mid.th d June 15, 65. 148th Penn., age 26. 13, 64. 1865. 57 Bloom, C., Pt., D, 2d June 3, Left; circular. Discharged Jan. 94 Carter, W. F., Pt., G, Sept. 22, Left. Transferred to Provost N. H., age 2:3. 4, 64. 8, 1865. 45th N. C., age 21. 22, 64. Marshal June 1, 1865. 58 Bcehme, U. F., Pt., A, April 2, Left ; circ. April 10, hrem. from 95 Case, C. P., Pt., D, 8th May 2, Left. Discharged May 24, 1864. 52d New York, age 25. 4, 65. ant. and post. tib. arteries; necro. Penn. Cavalry, age 18. 3, 63. bone removed. Disch d Nov. 14, 96 Case, S., Pt., C, llth May 22, Left: flap. Discharged Aug. 20, 1865. Died Aug. 18, 1874. Wisconsin. 23, 63. 1863. 59 Bonhomme, E., Pt., E, April 10, Left; ant. post, flap; slough. Apr. 97 Castello, P., Pt., F, 3d Sept. 17, Left. Surg. Mitchell, C.S. A. 73d C. Troops, age 27. 10, 65. 24, 65, re-amp, low. third thigh. Alabama. 18, 62. Recovered. Discharged J une 17, "65. Died 98 Casto, A. H., Serg t, G, June 10, . Surg. Bee, C.S. A. Re June 3, 1867; marasmus. 17th Virginia. 10, 63. covered. 60 Banner, R., Pt., D, 1st Nov. 30, Right ; circular. Provost Mar 99 Catlin, R., Lieut., D, Aug. 21, Left ; circ. Surg. W. B. Fox, 8th Mississippi, age 21. Dec.1, 64. shal March 2, 1865. 5th U. S. Artillery. 21, 64. Mich. Retired Dec. 15, 70. Ex- 61 Boyle, P., Pt., G, 24th Oct. 8, Left. Feb. 9, 1863, re-amp, mid. section of 1J in. peroneal nerve Mississippi, age 48. 8, 62. third, circ. lat. flaps. Trans by Dr. J. H. Brinton, 1875. ferred Oct. 8, 1863. 100 Cavanaugh, J., Pt., C, June 18, Lett; circ. Surg. D. C. Ayres, 62 Braekett, E. J., Pt., D, Sept. 30, Left; flap. Surg. S. Cooper, 6th 7th Wisconsin, age 21. 19, 64. 7th Wis. Disch d Oct. 5, 64. 35th Mass.. age 22. 30, 64. N. H. Discharged Jan. 18, 65. Spec. 1526. Feb. 25, 65, re-amp. 63 Brady, F., Pt., K, 46th July 20, Right; circ. Discharged Aug. 1 inch below tubercle of tibia. Pennsylvania, age 22. 21, 64. 25, 1865. 101 Cavender, ~L., Pt., H, 3d May 5, Left ; flap. Discharged Feb. 10, 64 Brazell," M., Pt., F, 61st July 20, Right; flap. Disch d Apr. 26, 65. Michigan, age 22. 5, 64. 1865. Illinois, age 38. 21," 64. He-amp, mid. third July 17, 65. 102 Chalfant, G. W., Pt., E, July 19, Left. Surg. H.M. Duff, 52d Ohio, 65 Bickford, C., Corp l, G, Oct. 19, Left ; circ. Disch d Mar. 30, 65. 52d Ohio, age 21. 19, 64. Two subsequent amputations. 14th Maine, age 21 . 20, 64. Died Jan. 27, 69 ; consumption. Discharged Oct. 17, 18(i5. 66 Brian, W., Capt., K, 3d Dec. 13, Left. Confed. Surg. Discharged 103 Chartier, N. A., Pt., A, June 18, Right. Surg. W. C. Shurlock, Pennsylvania Res. 13, 62. Sept. 15, 1863. 37th Wisconsin, age 20. 18, 64. 51st Penn. Disch d June 26, u3. 67 Brockway, J. W., Capt., July 30, Left; circ. Surg. J. P. Prince, 104 Chase, G. W., Corp l, May 12, Right : circ. Surg. T. F. Oakes, C, 29thC. T., age 29. Au.1, 64. 36th Mass. Disch d Mar. 9, 65. G, 56th Mass., age 25. 12, 64. 56th Mass. Disch d Dec. 15, 64. 68 Brooks, F. C., Pt., D, 3d Julyl, Left ; circ. Surg. C. W. McMil 105 Christ, W., Pt., 1, 57th June 16, Left; flap. Surg. J. W. Lyman, East Tenn., age 20. 1, 64. lan, 1st East Tenn. Gangrene. Pennsylvania, age 23. 17, 64. 57th Penn. Disch d Sept. S. 65. Discharged Feb. 26, 1865. 106 Christian, G. L., Serg t, May 12, . Surg. Roscoe, C. S. A. 69 Brothers, C. P., Serg t, Aug. 21, . Surg. Loben, C. S. A. 2d Richm d Howitzers. 12, 64. Retired Oct. 12, 1864. II, llth South Carolina. 21, 64. Recovered. 107 Church, J. P., Capt., K, Deo. 16, Right ; ant. post. flap. Surg. W.F. 70 Brown, T., Pt., K, 15th July 3, Left ; ant, post. flap. Discharged 48th Tennessee, age 33. 17, 64. Westmoreland, 5: d Tennessee. Massachusetts, age 21. 4, 63. Jan. 2!>, 1864. Trans, to Pro. Mar. March 7, 65. 71 Brown, W.F., Serg t, G, Dec. 13, Left ; circular. Discharged June 108 Clark, A., Lieut., F, llth May 18, Left; flap. Surg. N. F. Blunt, 24th New Jersey. 13, 62. 29, 1863. Maine, age 25. 19, 64. llth Me. Disch d July 10, 65. 72 Brubakor, D., Pt., C, Dec. 13, Left; flap. Mustered out May 109 2 Clark, H. W., Pt., H, May 13, Left; lat. flap.; and right foot. 127th Pennsylvania. 15, 62. 29, 1863. 100th N. York, age 30. 13, 64. Chopart s op. Surg. M. S. Kit- 73 Bryan, W. A., Pt,, C, Dec. 13, Right. DischargedFeb.il, 1863. tinger. 100th N. Y. Discharged 1 1th Penn. Reserves. 15, 62. Dec. 13, 1864. Spec. 2857. 74 BurdM.I.J., Pt., Hamp May 31, . Surg. Darby, C. S. A. 110 Clark, J., Pt., E, 89th July 27, Left ; ant. post. flap. Discharged ton Legion. J e 1, 62. Recovered. Illinois, age 29. 28, 64. Dec. 1, 1864. 75 Burk, C. J., Serg t, A, Nov. 27, Right ; circ. Surg. J. W. Wis- 111 Clark, P., Pt., D, 140th July 2, Right; haem.; lig. of post, tibial 140th Peuu., age 44. 28, 63. hart, 140th Penn. Discharged New York, age 28. 3, 63. arterv. Recovered. March 16, 1865. 112 Clay, W. C., Pt., D, 2d May 31, Left; circ. Surg.W. B. Reynolds, 76 Burke, M., Pt., D, 20th May 10, Right. Surg. X. Hayward, 20th U. S. S. S., age 35. 31, 64. 2d U.S.S.S. Uisch d Mar.22, G5. Mass, age 22. 10, 64. Mass. Discharged Oct. 12, 1664. Spec. 517. 113 Clayton, G., Pt., I, 4th N. Hampshire, age 37. May 16, 16, 64. Right : flap. Discharged Sept. 27, 1864. 77 Burkett, J., Pt., M, 5th April 9, Right; flap. Surg. A. K. St.Clair. 114 Clayton, H., Pt.. A, 74th June 15, Right ; circ. Discharged March Cavalry. 9, 65. 1st Michigan Cavalry. Dis Indiana, age 44. 15, 64. 17, 1865. charged August 10, 1865. 115 Clearwater, R., Pt., G, Sept. 20, Right ; flap. Surg. J. Y. Finley, 78 Burr, C. M., Pt., E, 2d Oct. 19, Right ; ciro. Surg. II. Plumb, 2d 125th Illinois, age 33. 21, 63. 2d Kentucky Cav. Discharged Conn. H. A., age 21. 20, 64. Conn. H. A. Disch d June 9, 65. Feb. 18, 1864. 79 Burt, A. W., Lieut,, A, July 2; Left. Paroled Nov. 14, 1863. 116 Clemens, H.,Pt.,H, 12th July 18, Right; flap. Surg. R.W. Pease, 7th S. C.. age 22. 3, 63. New York. 18, 61. 12th N. Y. Duty Sept. 9, 1861. 80 Burtner, J., Corp l, E, April 19, Left ; ant, post. flap. Surg. 117 Cochran, S. H., Pt., A, Oct. 28, Left; circ. Surg. Skinner, 44th 103d Penn., age 19. 20, 64. Gott, 21 st Ga. Discharged Apr. 2d S. C. Rifles, age 20. 29, 63. Ala. Furloughed Mar. 14, 65. 19, 1865. 118 Colburn, A. T., Pt,, A, Oct. 13, Left ; circ. Nov. 23, removal of 81 Bushey, F. P., Pt., C, May 18, Left ; flap. Surg. W. V. White, 34th Mass., age 23. 14, 64. two inches tibula and fibula. 56th Mass., age 22. 18, 64. 57th Mass. Necrosis. Dec. 25, Disch d May 11, 1865. lateral flap amp., middle third. 119 Colby, A. T. G., Pt., B, Dec. 13, Right. Re-amp. 6 inches below Disch d Apr. 3, 65. Spec. 4336. 28th New York. 14, 62. knee. Disch d Jan. 21, 1863. 82 Butler, J. H., Lieut., G, Nov. 8, Left. Surg. E. W. H. Beck, 3d 120 Collins, A., Pt., D, 2d Aug. 16, Left. Discharged May 15, 1865. 2d Artillery. 8, 63. Ind. Cav. Aug. 5, 1864, rein. 6 Pennsylvania, age 19. 17, 64. ins. tibia from stump. Retired 121 Collins, J., Pt., C, 82d June 3, Right ; ant, post. flap. Surg. S. Feb. 7, 1865. New York, age 20. 3, 64. II. Plumb, 82d N. Y. Disch d 83 Bvington, A., Corp l, I, June 2, Right; circ. Surg. A. P. Clark, June 30, 1865. Spec. 1524. 6th N. Y. Cav., age 25. 2, 64. 6th N. Y. Cav. Discharged Sept. 122 Colomy, M. G., Pt., K, Sept. 30, Right ; circ. Discharged Aug. 20, 1864. 31st Maine, age 42. Oct. 1, 64. 24, 1865. 84 Caldwell, J. P., Pt., A, July 30, Left : flap. Discharged May 23, 123 Comerford, J., Pt., B, Feb. 6, Left; flap. Snrg. B. Gesner. 10th . 115th N. Y.. age 39. 30/64. 1865. 10th New York, age 21. 6, 64. N. Y. Disch d July 10, 1864. 85 Call, C. K., Pt., K, 35th Dec. 13, Left ; flap ; bone removed. Dis Spec. 4302. Massachusetts, age 24. 14, 62. charged Mar. 5, 1863. 124 Compton, T., Pt., D, 29th May 2, Left. A. Surg. J. T. Brown. 94th 86 Cann, C., Pt., D, 30th July 30, Left ; circ. Surg. D. MacKay, New Jersey. 2, 63. N. Y. May 20, re-amp, at mid New York. Au.1, 64. 27th C. T. Disch d Dec. 20, 64. dle third. Disch d June 30, 63. 87 Carey, J. H., Pt., D, 27th Michigan, age 26. June 3, 3, 64. Right; circ. Surg. A. F. Whelan, 1st Michigan S. S. Discharged 125 Conaway, J., Pt., H, 1 3th Pen n . Cav. , age 37. Aug. 14, 14, 64. Right. Surg. G.T.Stevens. 77th N. Y. Discharged June 21, 65. October 28. 1864. 126 Condon, E., Pt., F, 1st Oct. 19, Right ; flap. Discharged July 88 Carney, P., Pt., A, 2d Dec. 13, Right, Discharged April 7, 1863. Maine. 19, 64. 20, 1865. Maine. 13, 62. 127 Connelly, J. F., Pt., G, Oct. 19, Right; ant. post. flap. A. Surg. 89 Carpenter, S. B., Pt.. F, June 1 0, Left; flap. Surg. C. B. Park, llth 7th Maine, age 30. 19, 64. D. H. Armstrong. 160th N. Y. llth Vermont, age 20. 10, 64. Vt. Discharged Dec. 24, 1864. Disch d Mar. 8, 1865. June 3, 90 Carr, H. C., Pt., B, 22d Oct. 8, Left ; flap. Discharged Feb. 10, 1869, re-amp, at June. mid. and Indiana. 9, 62. 1863. lower thirds. Spec. 524. 1 MITCHELL (S. W.), The Relations of Pain to Weather, being a study of the natural history of a case of Traumatic A euralgia, in American Journal of Medical Sciences, 1877, Vol. LXX1II, page 306. 2 SMITH (STEPHEN), Analysis of 439 recorded amputations in the Continuity of the Lower Extremity, in Vnited States Sanitary Commission Memoirs, Surgical Volume II, New York, 1871, pages 110, 140. 496 INJURIES OF THE LOWER EXTREMITIES. [CHAP, X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AKU AGE. DATES. OPERATIONS, OPERATORS, RESULT. 123 Conner, H., Pt., D, 20th May 24, Left ; ant. post. flap. Discharged 170 Diamond, R., Pt., K, 3d Sept. 19, Left; circ. Surg. A. Bowie, 3d Massachusetts, age 35. 24, 64. April 17, 1865. Alabama, age 25. 19, 64. Ala. To prison Jan. 5, 1805. 12!) Conover, J., Pt., C, 33d May 25, Left : ant. post. flap. Surg. J. 171 Dietrich, C., Pt, E, 91st A prill 3, Left. Discharged April 10, 1864. New Jersey, age 45. 25, 64. Reily, 33d N. J. Discharged New York. 13, 63. March 16, 1865. 172 Dillon, J., Pt., K, 20th Dec. 13, Left. Surg. X. Hayward, 20th 130 Cooley. S.I., Pt.,K,97th June 18, Right; circ. Surg. W. B. Cham Massachusetts. 13, 02. Mass. Disch d Aug. 12, 1803. New York, age 23. 18, 64. bers, 97th N. Y. Discharged 173 Divers, P. D., Pt., K, 1st May 5, Left. Snrg. Graham, C . S. A. Oct. 27, 1864. Virginia. 5, r 64. Recovered. 131 Cook, S. A., Pt., A, 2d Sept. 17, Left ; flap. Surg. A. J. Ward, 2d 174 Douglas, J. II., Pt., G, July 3, Right : oirc. Asst. Surg. E. T. Wisconsin. 17, 62. Wis. Discharged Dec. 6, 1802. 91st Penn., age 33. 3, 03. Whiitingham, t;. S. A. Disch d 132 Cornell, M. E., Pt., E, May 14, Right: flap. Surg. W. P. Pierce, Feb. 8, 05. Died June 30, 77. 36th Illinois, age 21. 15, 64. 88th 111. Disch d Oct. 29, 1864. 175 Dowd, J., Farrier, M, April 18, Right. Surg. P. N. Woods, 39th 133 Cornish, J., Serg t, B, July 30, Right ; circ. Surg. F. M. Weld, 10th Missouri Cavalry, 19, 63. Iowa. Disch d. Jan. 25, 1804, 39th Colored Troops. Au.1, 64. 27th Colored Troops. Disch d age 24. amp. thigh ; necro. Nov.. 07, Dec. 21, 1864. re-amp. Died Nov. 15. 1807. 134 Coruish, J., Pt., F, 8th Aug. 15, Right; circ. Discharged Feb. 176 Downing, H., Pt., C, 4th July 1, Left. Discharged Aug. 30, 1802. Colored Troops, age 35. 16, 64. 11, 1865. Rhode Island Artil rv. 1, r 02. 135 Corson, G. F., Serg t, B. Oct. 1, Left; circ. Surg. C. M. Clark, 177 Downs, S. N., Pt., H, June 18, Right : flap. Surg. S. H. Plumb, 7th N. H., age 27. 1, 64. 39th 111. Re-amp, mid. third. 19th Maine, age 25. 18, 64. 82d N. Y. Disoh d Mar. 10, 65. Discharged May 7, 1865. 178 Dreibilbis, A., Pt., G, Juno 1, Right; circ. Surg. D.W. Bland, 136 Cotton, G. E., Pt., M, Aug. 25, Right ; circ. Surg. J AV. Wishart, 96th Penn., age 21. 3, 64. 90th Penn. Disch d Apr. 0, 65. 4th N. Y.H. A., age 25. 26, 64. 140th Penn. Disch d July 6, 65. 1.79 Drost, M., Pt., K, 1st June 3, Right; flap. Discharged June 3, 137 Couse, F. H., Pt., B, Dec. 13, Left ; circ. Discharged August Maryland, age 29. 4, 04. 1865. 83d Pennsylvania. 14, 62. 27, 1863. 180 Drury, J. T., Lieut.. I, Sept. 19, Left ; circ. Surg. A. Ewing, 13th 138 Cox, E., Pt., I, Kith Sept. 20, Right. Surg. L. Holt, C. S. A. 17th Indiana, age 25. 19, 63. Mich. Disoh d June 1, L864. Louisiana. 22 63. Recovered. 181 Uunkin, J.H., Pt ., E, 6th May 12, Left ; circ. Surg. T. B. Ward, 139 Cox, L. C., Corp l, D, Dec. 15, Right; ant. post. flap. A. Asst. Virginia. 13, 64. Gth Virginia. Recovered. 6th Tenn., age 29. 16, 64. Surg. J.K. Simmons. Disch d. 182 Dunn, J. R., Pt., H, 90th May 15, Left; flap. Discharged January 140 Coy, S., Pt., K,2d Mich June 17, Left; flap. Disch d Apr. 15, 65. New York, age 35. 15, 04. 25, 1805. igan, age 33. 18, 64. Died Nov. 20, 1868, of phthisis 183 Durall, A., Pt., A, 1st July 14, Right. To prison March 22, 65. pulmonalis. Virginia Art y, age 18. 14, 04. 141 Grain. I,. G., Serg t, C, July 22, Right ; flap. Surg. A. B. Mona- 184 Dyer, C. F., Pt,, A, 12th Dec. 13, Left ; ant. post. flap. Oct. 8, 63, 39th Ohio, age 23. 24, 64. han, 63d Ohio. Discharged Mass., age 24. 14, 62. re-amp, middle third. Disch d August 9, 1865. March 17, 1864. 142 1 Crawford, R. D., Pt., Sept. 17, Right; circular. Recovered. 185 Eaton, G.W., Pt., A, Gth June 3, Left; flap. Discharged Decem Gth S. Carolina, age 27. 18. 62. Maine, age 21. 3, 04. ber 3, If 64. 143 Cregar, H., Pt., F, 35th July 21, Left ; circ. Surg. C. N. Fowler, 186 Edmunds, J., Pt., I, 32d Feb. 11, Right: circ. Discharged Octo Ohio, ::ge 20. 21, G4. 105th Ohio. Diseh d June26, 65. Col d Troops, age 27. 11, 65. ber i-8, 1805. Died November 29, 1866. 187 Edwards, J. A., Pt., G, Sept. 1, Right: tlap. Surg. C. H. Mills, 144 Crew, J., Pt., K, 31st May 27, Left ; circ. Disch d Dec. 3, 1803. 10th Mich., age 24. 2, 64. 125th 111. Disch d July I. 05. Illinois, age 30. 27, G3. Died Dec. 23, 1809. 188 Eisenhart,S.A.,Corp.,M, June 24, Right ; circular. Discharged Oc 145 Crilley. O.. Serg t, E, June 21, Left ; ant. post. flap. Surg. J. 8th Penn. Cav., age 26. 25, 04. tober 19, 1804. 81st Pennsylvania, age 21, 64. W. Wishart, 140th Penn. Dis 189 Eldridge, N., Pt., D, 77th Mar. 25, Left: circ. Surg. E. Phillips, Oth 21. charged January 6, 1865. New York, age 27. 25, 05. Vermont. Disch d Aug. 12, 05. 14C Croft, A. C., Pt., D, 7th Sept. 14, Left; circular. Discharged July 190 Elligott, T., Pt,, I, lODth Dec, 13, Left; long post. flap. Discharged Wisconsin. 10, 62. 23, 1803. New York. 14, 02. Nov. 0, 1863. Spec. 2714. 147 Cross, H., Pt., A, 16th Sept. 1, Left; circular; gangrene. Dis 191 Elliott, J., Lieut., 2d Aug. 21, Left; circ. Surg. A. F. Whelan, Infantry, age 19. 1, G4. charged May 20, 1865. Artillerj . 21, 04. 1st Mich. S. S. Retired Feb. 1, 148 Cunningham, R., Pt., E, May 7, Right ; flap ; erysipelas. Dis 1865. Died April 18, 1871. 8th Iowa Cav., age 18. 7, r 64. charged. 192 Elliott, W., Pt., A, 7th Oct. 23, Right ; flap. Surg. G. C. Jarvis, 149 Cunningham, W.. Pt.,H. Aug. 29, Left : circ. Surg. D. Baguly, 1 st New Hamp., age 22. 23, 04. 7th Conn. Disch d June I3, 05. 1st W. Virginia, age 23. 29. 02. W.Va. Disch d Mar. 16,1803. 193 Ellis, L., Pt., Oth Maine June 3, Left ; llap. Disch d December 150 Daniels. D. B., Pt., K, Feb. 15, Right; circ. Discharged May Battery, age 23. 3, 04. 29, 1804. 7th Illinois. 17, 62. 1. 1802. 194 Engle, G. W., Pt., E, Aug. 28, R t ; dou. Ha]). Surg. J. E. Sum- 151 Daniels, V., Pt.. K, 70th April 1, Right. Discharged July 7, 1804. llth Ohio Cav., age 19. 29, 02. mers,U.S.A. Disc dMar.14, 63. New York, age 39. 1, 64. Spec. 2211. Died Jan. 18, 1 871. Spec. 314. 152 Daniels, W. 11., Pt.. B, May 20, Left ; circular. Discharged Mar. 195 Erskine, W. M., Pt., B, May 31, Left. Surg. C. II. Pegg, 8th N. Y. 1st Mass. I-I vv Art v. 20, 64. 11, 1865. 1st Maine Heavy Artil 31, 64. Art. July 0, re-amp, at up. th d. 153 Danley, S. B., Serg t, B, May 12, Left ; ant. post. flap. Surg. R. lery, age 20. Disch d Oct. 28, 64. fipec.3173. 15th N. J.,age 27. 12, 64. Sbarpe, 15th N. J. Discharged 196 Evertson, J., Lieut., G, July 3 fc Left. Surg. G. Chaddock, 7tb May 23, 1865. 82d New York, ago 27. 4, T G3. Mich. Disoh d June 12, 1804. 154 Danver, J. IT., Pt.,H, 1st July 3, Right. Paroled Sept. 25, 1863. 197 Fairy, P. W., Serg t, G, May 28, Left ; ant. post. flap. Recovered. Virginia. 3, 03. 4th S. C. Cav., age 29. 29, 64. 155 Davidson, A. J., Pt., B, Aug. 7, . Surg. Fleming, C. S. A. 198 Fan-ell, T., Pt., E, lllth Mar. 31, Right ; flap. Surg. W. Vosburg, 17th Virginia. 7, 04. Recovered. New York. 31, 65. lllth N.Y. Disch d July 25, 65. 156 Davis. E., Pt., D, 70th April 12, Left ; ant. post, skin flap and oirc. 199 Favour, C. L., Corp l, II, Julyl, Left : flap. Discharged Novem Col d Troops, age 37. 12, 60. section of muscles. Discharged 10th Maine, age 21. 2, 63. ber 28, 1803. June 17, 1865. 200 1 ayent, F., Pt., D, 7th May 5, Right ; circ. Disch d Oct. 3, 64. 157 Davis, G.,Pt.,F,2d Mich Nov. 16, Left : flap. Discharged May 31 , Wisconsin, age 23. 7, 64. Stump nevf r healed permanent igan, aged 23. 16, 63. 1804. ly. Died (Jot. 8. 1870. 158 Davis, J., Pt., A, 28th Sept. 17, Right : flap. Discharged Sept. 201 Fennee, J., Pt., E, 6th May 22, Right ; flap: gangrene. Disch d Pennsylvania. 17, 62. 25. 1863. Missouri. 22, 03. October 18, 1863. 159 Davis, J. A., Pt., F, 5th Dec. 15, Right ; cire. A. A. Surg. J. H. 202 Ferguson, A.,Pt.,G,88th May 8, Right: circ. Surg. J.W. Rawlins, Iowa Cavalry, age 23. 17, 64. Mclntyre. Disch d June 29, 05. Pennsylvania, age 21 . 9, 64. 88th Penn. Disch d July 4, 65. 160 Vavis, R. L, P t., B, Pur- June 20, Right. Surg. Capot, C. S. A. 203 Ferris, j. A., Pt., A,2d June 1, Right ; circ. Surg. II. Plumb, 2d cell Battery. 26, 02. Discharged Oct. 28. 1864. Conn. H. Art., age 29. 1, 64. Conn. Art. Gangrene. Disch d 161 Dean, S. If., Pt., F, Gth Feb. 12, Right. Surg. C. J. Towles, C. August 4, 1805. Georgia Cavalry. 12, 62. S. A. Recovered. 204 Fezer, H., Pt., K, 7th Nov. 27, Left; oirc. Surg. C. J. Bellows. 162 Dearolf. E., Pt., II, 127th May 19, Right : flap. Surg. J. R. Gore, Ohio, age 2! . ~7, 03. 7th Ohio. Disoh d June 24, 64. Illinois, age 31 . 19, 63. 127th 111. Disch d Aug. 27, 64. 205 Fink, R. P., Pt., F, 10th April 21, Right : eirc. Disch d September 103 Deforest, M. J., Capt., B, June 3, Left ; flap. Discharged October Penn. Cavalry, age 21. 22, 04. 28, 1664. 81st .V. Y., ago 25. 3, 04. 27. 1864. 206 Finkbeiner, C., Pt., L, 3d Oct. 25, Right ; flap. Disch d March 17, 164 Deighton. J., 1 t., I, 6th Sept. 29, Right ; flap. Discharged April Ohio Cavalry, age 18. 25, 04. 1805. Colored Troops. 29, 04. 19, 1865. 207 Fisher, J., Pt., E, 8th Mar. 9, Left. Discharged June 25, 1864. 105 DC Lai S/htf-r, A., Lieut., Aug. 21, . Surg. G. S. West, C. S. A. Indiana Cav., age 18. 9, 64. D, 5th Florida. 21. 04. Recovered. 208 Fisher, J., Pt., D, 70th July 30, Left ; circ. Surg. D. Merritt, 55th 166 Dennis,A.W., Pt., D, 1st May 5, Left; circular. Discharged Jan. Pennsylvania, ago 21. 31, 64. Penn. Re-amputation. Disch d N. Y. Artillery, age 18. 6, 62. 13, 1863. January 27, 1865. 167 Derr, J., Pt., K, 148th May 10, Right ; flap. Discharged Feb. 209 Fisk, J.. Corp l, D, 19th Mar. 27, Left. Surg. L. M. Sloanaker,19th Pennsylvania, age 26. 10, 04. 10. 1865. Iowa, age 24. 27. 65. Iowa. Disch d June 5, 1805. 168 De Tar, T., Capt., D, Dec. 16. Right : flap. Surg.V.B. Kennedy, 210 Fitch, E., Corp l, D, 23d Sept. 19, Left : circ. Surg. J. M. McGuire, 32d Iowa, age 37. 17, 04. 5th Minn. Disch d May 15, 65. Virginia. 20, 64. C. S. A. To prison Jan. 5. 1865. 169 Dewey, D. A., Serg t, B, 121st N. Y., age 23. May 6, 7, 64. Right ; flap. Surg. Moffatt, C. S. A. Disch d June 29, 1865. 211 Flemmer, C., Pt., II, 4th Col d Troops, age 20. June 15, 15, 64. Left; circular. Discharge*! I d). 10, 1865. 1 FlSFIF.R (G. J.), Report of Fifty-seven Cases of Amputations, in the Hospitals near Sharpsburg, Md., after the Battle of Antietam September 17, 1862, in American Journal Medical Sciences, 1806, Vol. XLV, p. 48. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 497 NAME, MILITARY OPERATIONS, OPERATORS, Vr NAME, MILITARY DATES OPERATIONS, OPERATORS, No. DESCRIPTION, AND AGE. i DATES. RESULT. i-N \J, DESCRIPTION, AND AGE. RESULT. 212 Flesh, J., Pt., 1?, 73d May 14, Right ; flap. Surg. f. N. Hines, 254 Greenfield, C. S., Pt., B, Sept. 14, Left; flap. Discharged Novem Ohio, age 23. 14, 64. 73d Ohio. Disch d Sept. 24, 64. 19th Illinois. 14, 61. ber 19, 1861. Died Dec. 3, 1868 ; consumption. 255 Greer, D., Pt., F, 90th July 1, Left : circ. Disch d May 9, 1864. 213 Flower, E. W., Pt., E, May 24, Right; circ. Surg. W. C. Shur- Pennsylvania, age 45. 2, 63. Died March 1, 1865. 8th Michigan, age 22. 24, 64. lock, 51st Peun. Discharged 256 Gregory, A. H., Pt., K, Sept. 17, . Surg. J. II. McAden, 13th February 1, 1865. 13th North Carolina. 17, 62. N. C. Recovered. 214 Fluetsch, J. L., Pt.. K, Mav 14, Left; circ. Surg. W. P. Pierce, 257 Griffin. G. W., Pt., G, 1st Oct. 27, Right; flap. Discharged August 15th Missouri, nge 30. 14. 64. 88th 111. Disch d Mar. 20, 65. N. Y. Art y, age 23. 28, 64. 2, 1865. 215 Flynn, Patrick, Pt., 0, May 5, Left; flap. Surg. G. T. Stevens, 858 Griffin. T. 11., Lieut., C, July 2, Right. Surg.J.T.Gilmore.C.S.A. 12th Infantry, age 31. 5, r 64. 77th N. Y. Disch d Feb. 28, 65. 18th Miss., nge 25. 3, 03. Exchanged Oct. 20, 1863. Died April 13. 1872. 259 Gullisath, B., Capt., F, Dec. 10, Right. Discharged May 15, 65. 216 Foley, J., Serg t, E, 35th July 14, Left; circ. Surg. G. L. Lucas, 5th Pei, D. Cav., age 27. 11, 64. Iowa, age 25. 14. 64. 47th 111. Disch d Oct. 17, 1865. 260 Gulmire, N., Serg t, II, Nov. 22, Left ; flap. Surg. J. P. Prince, 217 Folk, N., Pt., K, 93d Sept. 22, Left; flap. Surg.E.R. Umberger, 8th Michigan, age 20. 23, 63. 36th Mass. Disch 1 May 4, 64. Pennsylvania, age 31. 22, 64. 93d Penn. Re-amp, at June. mid. : 261 Gutman, C., Pt., B, 19th Oct. 27, Right : circ. Surg. J. Harrison. and lower thirds. Discharged : Wisconsin, age 27. 29, 64. C. S. A. Disch d May 23, 1865. October 2, 165. 262 Haight, L., Pt., F, 6th July 24, Right. Surgeon E. Powell, 72d 218 Folsoin, H. W., Pt., E. April 1), Left: flap. Discharged July 7, Michigan, age 23. 24, 64. 111. Gang. Disch d Jan. 3, 65. 31st Maine, age 2(i. 6, 65. 1865. 263 Halford, J. If., Pt., G, July 28, Left ; flap ; gang. Recovered. 219 Ford, T., Pt., C, 69th In April 9, Left ; flap. Surg. W. A. Babcock, j I 12th Louisiana, age 26. 28, 64. diana. 9, 65. 76th 111. Mustered out, 1865. 264 Hallr.wanger, J., Serg t. July 3, Left. Exchanged November 12, 220 Foster, T. F., Lieut., H, July 20, Right : ant. post. flap. Provost H, 3d S. C., age 24. 4. 63. 1863. 55th Alabama, age 24. 21," 64. Marshal Dec. 8, 1864. 265 Hammond, G.M., Lieut., July 2, Left ; circular. Discharged Sep 221 Foy, P., Pt., H, 8th May 1, Right; circ. Discharged Feb A, 86th New York. 2, 63. tember 22, 1863. Pennsylvania. i, la. ruary 16, 18(14. 266 Hammond, J. A., Corp l, ! Aug. 14, Left : circ. Discharged April 232 Friel, J., Pt., H, (i3d Aug. 29, Right. Discharged January 5, C, llth Maine, age 22. 14, 64. 17, 1865. Pennsylvania. 29, 62. 1863. 267 Hamriclt, !T.,Pt.,D,19th Oct. 13, . Surg. Grammon.C.S.A. 223 Fry, J. J., Pt., D, 78th Sept. 1, Left; double flap. Surg. S. C. 1 Virginia Cavalrv. 13, 63. Recovered. Illinois, age 20. 1, 64. Moss, 78th 111. Gangrene. Dis- ! 268 Handley, J. R., Pt., K. June 18, Left; circ. Surg. G. T. Stevens, charged July 6, 1865. llth Conn., age 23. 18, 64. 77th N. Y. Disch d May 7, 65. 224 Fulkineer, J. M., Pt, E, July 24, Left ; flap. A. Surg. T. Morton, 269 Hanlin, T., Pt., E, 10th Sept. 19, Right : flap. Discharged July 3d\V.Va. Cav.,agel9. 24, 64. 3d West Virginia Cavalry. Dis- , West Virginia. 20, 64. 20. 1865. charged July 18, 1865. : 270 Hargrove, B. F., Lieut., i Nov. 30, Right : circ. Provost Marshal 225 Gallup, S. H., Corp l, G, June 5 L t ; post. flap. Surg. L.Holbrook, L, 12th La., age 31. 30, 64. March 7, 1605. 18th Conn., age 4:!. 5, 64. 18th Conn. Disch d May 4, 1865. 271 Harmon, S., Pt., 1, 105th April 9, Right ; flap. Mustered out July 226 Ganthrop, H., Lieut., F, April 1, Right. Surg. D. E. Wolfe. 3d Pennsylvania, age 27. 9, 65. 1, 1865. 4th Delaware, age 24. 1, 65. Delaware. Recovered. 272 Barneu. W. A.. Pt.. B. Mav 5. Left. Surg. E. L. Howard, 27th 227 Garrity, T.. Pt., D, 24th June 1, Right; circ. Surg. S. A. Green, 27th North Carolina. 5, f 64. N. C. Furloughed Jan. 23, 65. Alassachusetts. 1, 63. 24th Mass. Disch d Sept. 21/63. 273 | Harris, A., Pt., A, 57th April 6, Right. Discharged June 13, 62. Nov. 30, 67, re-amp, mid. third. , Ohio. 7, 62. Gnt/>Jioll I"* If <*anr t M., .. 1 O T oft H mi HI A Hun vinro- TT P O M TT/i rr/c/tH J" T 1-*t R V*ktr 1 ft aicnen, i_>. **, ^erg T, E, 1st Maine Heavy tly 1, 19, 64. i-cu, uouuit? iid.p. rurf. n. r. 4*** xzt*/ / t-su/i, j. /., ITU, JD, i>ov. io Lyster, 5th Mich. Disch d June 15th Georgia. 18, 64. 15th Georgia. Recovered. Artillerv, age 24. 24,1865. 275: Hart, C., Pt., D, 148th May 3, Right. Surg. G. L. Potter, 145th 229 Gault, T." J., Pt., F, 3d Mav 14, Right ; flap. Discharged. Pennsylvania. 3, 63. Peun. Disch d Sept. 19, 1863. Tennessee, age 22. 14/64. 276 Hart, G. W., Pt., C, 30th Sept, 19. Left ; circular. Discharged May 230 Gavin, S., Pt., L, 15th Mar. 8, Left; flap. Confederate surgeon. Indiana. 21. 63. 12. 1864. Connecticut. 10, 65. Disch d June 29, 1865. 277 Hastings, J. K.. Pt., H, July 2, Right. Surg. J. Kerr, 62d Penn. 231 Geiger, J., Pt., D, 46th June 20, Kight ; circular. Disch d Mav 29, 62d Peun., uge 24. 3, 63. July 13, re-amp, middle third. Pennsylvania, age 27. 20, 64. 1865. Dis ch d Sept. 20, 1864. 232 Geissler. E., Corp l, K, Aug. 17, Left ; dou. flap. Sur-. H. Fearn, 278 Huvs.G., I t..C, 6th N.Y. Oct. 19. Right ; post. flap. Discharged 3d N. J. Cav.. age 36. 19, 64. 175th N. Y. Disch d Sept. 23, 65. H vy Art y, age 34. 20, 64. September 12, 1865. 233 Gibson, II., Corp l, F, Mar. 19. Left; flap. Confederate surgeon. 279 : Hazelbaker, A. J., Pt., Dec. 7, Right; circ. Surg. C. H. Hood, 21st Michigan, age 30. 20, 65. Discharged. G. 181st Ohio, age 27. 7. 64. U. S. V. Discharged. 234 Gilmore, G., Pt., G, 33d Mar. 31, Right : eirc. Surg. A. T. Bartlett. 280, Heffler, J., Pt., K. 6th July 23, Right. Discharged June 15, 1864. Illinois, age 19. 31, 65. 33d Mo. April 22. rem. of half Maryland, age 37. 23," 63. inch of bone. Diso d Oct. 15/65. 281 Helsabeck. G. J., Pt., C, July 28, Right; flap. Surg. D.W. Maull, 235 Gladsm, W. D., Serg t, Aug. 21, . Surg. W. R. Wilson, C. S. A. 33d N. C., age 20. 28." 64. 1st Del. To prison Dec. 14/64. D, 44th N. Carolina. 21, 64. Retired Feb. 17, 1865. 282 Benson, J. f., Pt., M.7th July 1, Left. Exchanged Sept. 25, 1863. 236 Glascoe, W.. Pt., G, 29th Oct. 27, Left; circ. Surg. G. C. Jarvis, South Carolina, age 19. 2, 63. Connecticut. 27, 64. 7th Conn. Discli d Aug. 7. 65. 283 Herrick, M. S., Lieut.,E, i April 26, Right. Surg. N. Smith, 6th Mass. 237 Glaser. J., Serg t, C.lSth July 8, Kight: circular. Disch d April 8th Massachusetts. 26, Cl. Disch d May 21. 1861. N.Y. H vyArt.,a?e37. 9, 64. 13, 1865. 284 Hess, G., Pt., I, 28th June 24, Left ; flap. Surg. H. E.Goodman, 238 Glassie. .]., Pt., B, 03d June 3, Left ; oval Hap. Surg. P. E. Hu- Penn., age 18. 24, 64. U. S. V. Disch d May 29. 1865. New York, age 22. 3, 64. bon, 28th Mass. June 25, amp. 285 Hibbs, ,S.T.,Pt.,H, 107th June 1. Left ; flap (also flesh wound right lower third thigh. Mar. 19, 65, Illinois, ago 19. 1, 64. leg). Disch d May 27, 1865. seq. rem. Disch d Aug. 15, 65. 286 Hibner, C., Pt., K, 5th May 6, Right; ant. post. flap. Confed. Died Nov. 12, 67. Spec. 3100. Michigan, age 30. 6, 64. surgeon. Caries. Discharged 239 Gondennau, C.. Pt., C, Juue 8, Left ; circular. Discharged May Jan. 21, 1865. March 13, 1865, 98th Penn., age 19. 8, 64. 30, 1865. re-amp, upper third : circular. 240 Goodwin, A., Corp l, B, June 27, Left; circ. A.Surg.C.B.Richards, -287 Hiekie, J., Pt., A, 10th June 3, Right : flap. Surg. W. A. Child. 30th Ohio, age 20. 27, 64. 30th Ohio. Disch d Feb. 17, 65. Vermont, age 18. 3, 64. 10th Vt. Disch d June 27, 1865. 241 Goodspeed, H. M., S g t, July 4, Right ; circ. Surg. S. II. Kersey, 288 Higgins, D., Pt., G, llth June 2, Left ; unt. post. flap. Surg. C. B. C, 30th Indiana, nge 25. 4, 64. 36th Ind. Duty Sept. 21. 1864. Vermont, age 30. 2, 64. Park, llth Vermont. Gangrene. 242 Gordon, C. 71.. Pt., B, Nov. 30, Right; ciro. To Provost Marshal Disch d August 11, 1865. 33d Miss., age 24. 30, 64. March 7, 1865. ; 289 Hill, S., Pt., D, 198th Mar. 31, Left; flap. Disch d August 7, 243) Gordon, J.. Teamster U. Aug. 30. Both. A. A. Surg. M. J. Davis. Penn., age 30. 31, 65. 1865. 2445 S. service, age 38. Sep.1, 62. Recovered. 290 Hinohey, F , Pt., D, 8th June 16, Left; circ. Surg. M. F. Regan, 245 Gordon, W.. Pt., C, 2d May 9, Right. A. Surg. G. H. Noyes, 2d N. Y. Heavy Artillery, 16, 64. 164th New York. Disch d July Iowa Cavalrv. 9, r 62. Iowa Cav. Disch d Aug. 11, 62. age 21. 27, 1663. 246 Grahame, F., Corp l, A, Mav 10, Right. Sept. 7, re-amp, at tu 291 Hihson, J. D., Pt., A,57th Dec. 10, Left. Surg. R. S. Peebles, P. A. Oth Wis.. age 26. 10, 64. bercle of tibia. Disch d August < North Carolina. 12, 64. C. S. Fnrloughed Jan. 26, 1865. 22. 1865. Spw. 369(i. 292 Hobbs, J., Pt., II, 15th Nov. 30, Left ; flap. To Provost Marshal 247 Grant, A. A., Pt., A, 2d Mav 5, Left : flap. December 2, bone Tennessee, age 25. 30, 04. March 7, 1865. Vermont, age 27. 6, 64. removed. Disch d May 29, 65. 293 Holland, T. F., Pt., E, May (i, Right : flap. Surg. A. Holt. C. S. 248 Grant, A. Z)., Pt., C, 8th July 2, Right. Exchanged Nov. 12. 63. 2d Rhode Island. 8, 64. Discharged. South Carolina, age 19. 2, 63. 294 Holman, J.G., Serg t, F, Mav 27, Right: circ. Surg. E. Guelich. 249 Grant. E.L..Pt.,F,145th June 8, Right ; circ. Surg. G. L. Potter, 52d Illinois, age 22. 27, 64. 9th Illinois. Disch d July 6/05. Pennsylvania, age 20. 8, 64. 145th Penn. Disch d May 15, 65. I 295 Holmes, W. L., 1 t., 1, 1st May 19, Right ; circ. Surg. H. F. Lvster, 250 Grant, T., Pt., D, 21st June 18, Right. Surg. G. T. Stevens. 77th Me. H vyArt y, age 33. 20, 6-1. 5th Mich. Disch d Jan. 20, 65. South Carolina, age 19. 19, 64. N. Y. To prison Sept. 23, 1864. 296 Holton, C., Pt!, G, 4th Sept. 27, Right; ant. post. flap. Disch d ;251 I Green, P., Pt.. A. fifth Mar. 21, Right : flap. Surg. J. Pogue,66th Tenn. Cav., age 21. 27, 64. June 20, 1865. Illinois, age 23. 22, 05. Illinois. Disch d July 7. 1865. 1J297 Hoon, S., Pt., D, 63d July 22, Left ; flap. Surg. N. Gav, U.S.V. 252 Green, W. J., Pt., F, 42d Mav 15, Right ; ant. post. flap. Provost Ohio, age 21. 22," 64. Disch d March 12, 1865. Died Georgia, age 20. 16, 64. Marshal Dec. 1, 1864. Oct. 11, 1867; consumption. 253 Greene, J. II., Pt., A, 7th Dec. 13, Right ; ant. post. flap. Disch d 2o.fi Hoover J. W., Pt,, K. Mav 9, Left; circular. Disch d Septem Rhode Island. 13, 62. February 6. 1863. 20th Indiana, age 24. 9. 64. ber 12, 1864. SURG. Ill 63 498 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, j Vn RESULT. NAME, MILITARY TUTFS DESCRIPTION, AND AGE. OPERATIONS, OPERATORS, UESULT. 299 Hostetter, C., Corp l, L, April 5, Uight; circular. Disch d July 341 Kidder, N. P.,Pt.,M, 1st Nov. 12, Left; flap. Surg. J. W. Smith, 1st Penn. Cav., age 19. 5, 65. 7, 1865. N. H. Cavalry, age 20. 12. 64. 2d Ohio Cav. Disc. June 2, 65. 300 Hotchkiss, L. P., Lieut., Mar. 31, Uight. Mustered out May 30, 342 Kierman, M., Pt., II, 2d May 27, Left ; flap. Disch d April 18, 64. B, 189th N. Y., age 23. 31, 65. 1865. Louisiana. 28, 63. July 2, 1864, re-amputation. 301 Hough, P., Pt., I, 7th May 23, . Surg. Triplet!, C. S. A. 343 Kimball, L. N., in., H, May 10, Uight; ant. post, flap: small art. Louisiana. 23, 62. Uetired Feb. 21, 1864. 22d Mass., age 19. 10, 64. ligated. Disch d Oct. 17, 1864. 303 Hoyt, S., Pt,, B, 16th June 27, Left. A. A. Surg. J. Swinburne. Jan., 67, amp. thigh, low. third. Michigan, age 24. 29, 62. Jan. 6, "63, re-amp, middle third. 344 ! Kimberly, C. A., Lieut., Sept. 29, Left; circular. Disch d March Discharged August 24, 1864. i B, 112th N. Y., ago 22. 29. 64. 23, 1865. 303 Hubbs, A. H., Corp l, B, May 6, Uight; ant. post. flap. Confed. 345 Kinnard. II., Pt., H, 39th July 30, L t ; circ. Surg. D. MacKay, 29th 122d N. York, age 21. 7, 64. surgeon. Disch d June 14, 65. |J Colored Troops. 31, 64. C. Troops. Disch d Deo. 20, 64. 304 Huddleston, S. H., Pt., Mar. 25, Left ; circular. Ueleased June 346 Kinner, G. W., Corp l, July 10, Uight. Disch d June 10, 1865. G, 44th Va., age 25. 25, 65. 14, 1865. G, 139th N. Y., age 31. 10, 64. 305 Hughes, H. H., Pt., C, April 8, Left ; flap. Discharged June 10, i 347 Kirkpatrick, W., Pt., C, Aiiij. 18, Left; flap. Surg. W. C. Jacobs, 4th Indiana, age 28. 8, 64. 1864. 2d Iowa, age 1 8. 18 , 64. 81st Ohio. Disoh d Mar. 23, 65. 306 Hughs, P., Pt., I, 17th Sept. 20, Bight ; flap. Confed. surgeon. 348 Kirvvin, P., Pt., A, 155th May 18. Left ; circ. Disch d Mar. 27, 65. Ohio. 22, 63. Disoh d January 21, 1864. New York, age 20. 18, 64. Died April 3, 68: consumption. 307 Hulbert, E. 1)., Serg t, K, May 27, Right ; flap. Discharged August 1 349 Knecht. A., Lieut., A, : Aug. 7, Uight; flap. . Surg. H. M. Duff. 83d Pennsylvania. 28, 62. 14, 1862. Died June 13, 1868 ; 52d Ohio, age 27. 7, 64. 52d Ohio. Disch. March 18, 65. consumption. 350 Knight, J. J., Pt., I, 31st Sept. 1 9, Uisrht ; circ. A. Surg. Dorscv, 308 Huntlev, O. P., Pt., A, May 7, Right ; ant. posterior double flap. Georgia, age 25. 21, 64. 1st Md. Cav., C. S. A. To Pro 5th Mich., age 42. 7, 64. Surg. W. O. Hudson, 4th Ala. vost Marshal April 1, 1865. . Disch d May 5, 1865. 351 Knott, D., Pt., K, 4th N. June 1, Uight ; circular. Disoh d May : u >: Hurley, M., Pt,, C, 101st Mar. 15, R t ; flap. Surg. J. M. Chapman, Jersey, age 40. 1, 64. M 3, 1865. Illinois, age 39. 15, 65. 123d N. Y. Disch d June 15, 65. 352 Knowlton, II. L., Corp l, June 1, Left; flap. Surg. D. M. Goodwin, 310 Hyde, A. J., Pt., H, 21st May 14, Right; flap. Surg. J. T. Reeve, ij H, llth Vt.,age22. 1, 64. 3d Vt. Disch d June 2, 1865. Wisconsin, age 27. 14, 64. 21st Wis. Disch d Mav 22, 65. 353 Kopp, E., Pt., K, 12th N. Mar. 25, Uight; flap. March 27, left mid. 311 lago, H., Pt., C, 5lst May 6, Uight; flap. Surg. W. C. Shur- Jersey, age 32. 26, 65. third, flap. Surg. A. Satter- Pennsylvania, age 21. 7, 64. lock, 51st Penn. Disch d June thwaite, 12th N. J., and Acting 16, 1865. Staff Surg. W. J. Burr. Dis 312 Jackson, J. A., Corp l, D, Sept. 19, Left; cire. Surg. C. F. Crehore, charged Oct. 3, 1865. 4 Jth Penn., a 3:, . 19, 64. 37th Mass. Disch d Sept. 8, 65. 354 Kriuinger, C., Corp l, C, May . i. Uight. Surg. I). J. Griffith, 2d 313 Jameson, A. W., Pt., G, Dec. 13, Left (also w nd of arm and face). 2d Kentucky. 21, 62. Ky. Disoh d Jan. 19, 1863. 4th Ohio. 13, 62. June 24, 63, re-amp, mid. third. 355 Kunz, L., Pt., E, 126th May 6, Uight ; flap. Discharged March Disch d. Dec. 25, 1863. Ohio, age 46. 6, 64. 7, 1865. 314 1 Jellison, C. W., Pt., C, May 19, Uight ; circular. Disch d Decem 356 Lad ford. S. E., Pt., II, 2d Jul v 3, Right. Exchanged November 1st Me. II. Art., age 22. 19, 64. ber 3, 1864. N. C. Battery, age 20. 3, 63. 12, 1863. 315 Johnson, C., Serg t, K, Nov. 30, Left ; ant. post. flap. Discharged 357 LaFleur, A. B., Serg t, May 10, Uight; flap. June 20, 2 ins. of 5(ith N. Y., age 22. 30, 64. July 9, 1865. H, 4th Mich., age 22. 10, 64. stump removed. Dis. June 5, 65. 3Ui Johnson, F. M., Pt,, A, Oct. 8, Uight, Discharged Feb. 21,1 863. 358 Lambeth, A. M., Pt., 1 ., May 9, . Surg.R. J. Hicks, 23d N.C. 38th Indiana. 8, 62. 23d North Carolina. it, 64. Uecovered. 317 Johnson, II. C., Serg t, Feb. 24, Left ; circ. Surg. F. Salter, U. S. 359 Lampman, A., Pt., K, Juno 22, Left. Surg.W. J. Burr, 42d Now C, ~ 8th Ky., age 25. 25, 64. V. Feb. 26, post, tibial artery 36th Wis., age 36. 23, 64. York. Disch d Aug. 24, 1864. lig. July 11, re-amp, mid. third. 360 Lampman, J. M., Corp l, Nov. 16, Left; flap. Confederate surgeon. Disch d June 24, 1865. Died II, 17th Mich., age 26. 17, 63. Discharged May 17, 1864. June, 1877; effects of fall on ice. 361 Lancaster, T. W., Pt., K, May 12, Left; ant. post. flap. Surg.W. J. 318 Johnson, J., Pt., H, 1st June 15, Left ; flap. Surg. U. B. McXary, 42d New York, age 44. 13, 64. Burr, 42d N. Y. Uecovered. Ohio Cavalry, age 25. 15, 64. 3d Ky. Cav. Disc. May 30, (i5. Transferred .July 18, 64. Died 319 Johnson, N., Pt., H, 14th July 30, Left ; flap. Surg. W. V. White, March 8, 1865. N. Y. H. Art., age 24. Aug.1, 64. 57th Mass. Disch d Oct. 21, 65. 362 Langstnn, W., Pt., F, 1st Sept. 17, Uight. Discharged November 3211 Johnson, \V., Serg t, K, June 19, Uight; flap. Surg. H. E. Smith, Texas, age 37. 18, 62. 12, 1862. 27th Mich., age 32. 11), 64. 27th Mich. Disch d Sept. 19, T>5. 363 Lapp, C., Pt., F, . r )th Mav 25. Left; flap. Surg. W. Altman, 321 Johnston, L. A., Capt., Dec. 13, Right; flap. Confed. surgeon. Ohio, age 22. 26, 64. 28thPenn. Disch d Feb. 24. 65. H, 11 tli Penn. UPS. 15, 62. Discharged Oct. 5, 1863. 364 Larabee, C., Pt., A, 142d Oct. 27, Left; circ. Surg. A. C. Barlow, 322 Jones, A. J., Pt., L, 1st Oct. 19, Left. Discharged May 12, 1865. New York, age 46. 27, 64. 62d Ohio. Necrosis. Juno 15, | Ohio Battery. 20, 64. 1865, re-amp, mid. third. Dis 323 Jones, T., Pt.. M, 2d X. Aug. 14, Uight; ant. post. flap. Disch d charged Oct. 13, 65. Spec. 4328. York Artillery. 14, 64. May 31, 1865. 365 Latney, T., Pt,, D, 36th April 6, Uight. Discharged January 31, 324 Jones, W., Pt., A, 20th Mar. 31, Left ; flap. Discharged June 19, Col d Troops, age 21 . 7, 65. 1866. Maine, age 27. 31, 65. 1865. 366 Law, H., Pt., D, 34th De.31, 62, Uight ; flap. Confed. surg. Jan. 325 Jordan, G. P., Corp l, V, May 3, Uight ; flap. Disch d September Illinois. Jan.2, 63. 27, re-amputation. Discharged. 17th Maine, age 34. 3, 63. 16, 1863. 367 Lauf, J., Pt., F, 91st N. Mar. 31, Left; ant. post. flap. Discharged 326 Joye, T. K., Pt., E, 6th Mav 6, . Surg. U. H. Jordan, 6th 1 York, age 22. 31, 65. July 27, 1865. South Carolina. 6, 64. S. C. Uccovered. j.368? Lee, D., Pt., G, 2d N. Y. June 16, Both : circ. A. Surg. O. S. Paine. 327 Judge, H , Pt.. I), 90th Mar. 31, Left; circ. A.A.Surg.T.T. Smi- I 1 369) H vy Artillery, age 20. 16, 64. 2d N. Y. ll vy Art v. Disch d Illinois, age 23. Ap.1, 63. ley. Disch d Feb. 20, 64. Aug. May 3! , 65. Died Sept. 25,74. 3, 64, re-amp., flap, mid. third. : 370 Lehr, G. M., Corp l, G, Mav 22, Uight; flap. Ass t Surg. II. M. 328 Jung, H., Pt., I, 46th N. Aug. 30, Uight. Surgeon O. Shenk, 46th llth Missouri. 24, " 63. Spraguo, U. S. A. Discharged. York. 30, 62. N. Y. Disch d Dec. 30, 1862. .371 Le.mons, J., Pt., K, 38th An?. 30, Left. Surg. McAlbine, C.S.A. 329 Justice, T. J., Pt.. F. Oct. 27, Uight; ciro. Surg. M. S. Kittin- , Virginia. 30^ 62. Uecovered. 67th Ohio. 28, 64. ger, 100th N. Y. Discharged. 372 Le Roy, J. D., Pt., C, May 19, Left: circ. Surg. W.S. Thompson, 330 Kanyon, E. H., Corp l, July 12, Right; flap. Surg. B. F. Keables, 4th N. Y. Art., age 44. 20, 64. U. S. V. Disoh d March 7, 65. P, 3d Iowa. 12, 63. 3d Iowa. Disoh d May 20, 64. 373 Lewis, J. A., Pt., F, 17th July 28, Right ; circular. Sept. 8, re-amp. 331 Kasmire, C. P., Serg t. Sept. 19, Right ; circular. Disch d March Florida, age 22. 28, 64. in up. third. Trans. Sept. 22, ti4. A, 3d Me. Cav., age x!8. 19, 64. 16, 1865. 374 Linn, E. D., Pt., C, 178th Doc. 14, Right; ant. post. flap. Surg. J. 332 Kelly, V. A.,Pt., H, 18th May 30, Left ; flap. Discharged Septem Ohio, age 36. 14, 64. Campbell, 178th Ohio. Disch d Infantry, age .23. 30, 64. ber 20, 1864. June 29, 1865. 333 Kelly, G., Pt,, C, 122d Dec. 31, Left; flap. Discharged April 7, 375 Little, F., Pt., B, 53d June 3, Uig-ht; circ. Surg. J.W.Wishart, Illinois. 31, 62. 1863. Penn., age 18. 3, 64. 140th Penn. Oct. 15, excision of 334 Kelly, J., Pt., H, 107th June 19, Left; ant. post. flap. Surg. J. P. 1 1 inch tibia and fibula. Disch d Pennsylvania, age 23. 20, 64. Hutchinson, 107th Penn. Disc d December 8, 1864. May 28, 1865. Spec. 4141. 376 Little, J. S., Lieut., A, May 23, R t ; flap. A.Snrg. J. D. Stewart, 335 Kelly, J., Pt., G, 38th Feb. 16, Right ; flap. Surg. W. C. Shur- 93d New York, age 29. 23, 64. 74th N.Y. Disoh d Sept. 26, 64. Wisconsin, age 24. 16, 65. lock, 51st Penn. Dis. Oct. 11, 65. 377 Littleficld. I.,Pt.. K,31st July 30, Left; circular. Disch d Decem 33G Kelly, T., Pt., I, llth May 18, Right: flap. Surg. N. F. Blunt, Maine, age 26. 30, 64. ber 23, 1864. Maine, age 39. 18, 64. llth Me. Must, out Nov. 18, 64. 378 Livingston, II. B.,Pt., A, May 16, Right ; flap. Surg. J. L. Mulford, 337 Kelly, W., Pt., G, 26th Nov. 6, Left; flap. Discharged Decem- j 48th New York, age 30. 16, 64. 48th N.Y. Disch d Oct. 19, 64. Iowa, age 48. C, 62. ber 26, 1862. 379 ; Lockwood, J., Pt.,G, 5th Aug. 29, Right; ant. post. flap. Surg. P. 338 Kennedy, J. M., Corp l, July 10, Left ; ant. post. flap. Surg. J. West Virginia, age 29. 29, 62. U. Randall, 5th VV. Va. Dis G, 20th Me., age 25. 10, 64. Thomas, 118th Penn. Disch d 1 charged March 24, 1863. April 18, 1865. 380 i Loveland, W., Pt., E, Julv2 t, Right; circular. Surg. J. W. 339 Kenner, L. C., Pt., H, July 2, Left. Discharged. 20th Conn., age 35. 20, 64. Terry, 20th Conn. Discharged 71st New York, age 21. 3, 63. January 21, 1865. 340 Kenney, C., Pt., B, 21st May 24, Left ; ant. post. flap. Discharged 381 Lucius, W. M., Colored June 8, Right. Transferred June 17, 64. Maine, age 39. 24, 64. February 11, 1865. serv t, 2d Mich., age 12. 8, 64. 1 SMILEY (T. T.), G-unshot Wounds, from Arkansas Post, in the Boston Medical and Surgical Journal, 1863, Vol. LXIX, p. 157. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 499 No NAME. MILITARY DATES OPERATIONS. OPERATORS, No. NAME, MILITARY DATE* OPERATIONS, orKi;.\ ioi>. DESCRIPTION, AND AGE. RESULT. DESCRIPTION, AXU AGK. RESULT. 382 Lynch, D., Pt., A, 33d Mar. 30, Left"; circular. Disch d July 17, 418 Mclnturf. S., Pt., I, 2d Oct. 10, Left; ant. post. flap. Surg. J. T. Wisconsin, age 29. 30, 65. 1865. East Tenn., age 29. 10. 63. Smith, 2d Ohio Cav. Disch d. 383 Lynch, M. J., Pt., B, 3d Oct. 22, Right ; circ. Disch d March 10, 419 McLain, E., Pt., D,125th May 14. Left; circ. Discharged June _ !, N. Y. Light Artillery, 22, 64. 65. March 12, 65, rem. 4 ins. Ohio, age 20. 16, 64. 1865. age 20. necro. fibula. Spec. 1406. 420 McLean, J., Lieut., A, April 6, Left. Resigned September 23, 384 Lyons, J., Pt., 11, 20th July 28, Right : flap. Confed. surgeon. 40th Illinois. 6, 62. 1862 Mass., age 27. 28, 64. Disoh dDec. 28. 1864. 421 3 McQuaid, ! ., Pt., C. Juno IS. ! Right: ant. post, (lap: gangrene. 385 Mab, E., Pt., II, 24th In May 16. Right; flap. Surg. K. B. Jessup, 95th New York, age 22. 18, 64. Diseh d Nov. 29. 1864. Nov. 28. diana. 17, 63. 24.h Ind. Disch d July 31, 63. 1865, sequestra removed. 386 Mace, J , Pt., B, 4th N. June 12, Left : circ. Surg. B. G. Streeter, 42-.> Meader, G. P., Pt., G. Oct. 19, Left. Disch d August 12. 1865. Y. Cav., age 22. 12, 64. 4th N. Y. Cav. Discharged. 29th Maine, age 25. - 20. M. : 387 Mahari, J., Pt., G, 18th Oct. 19. Right; circular. Disch d , I ulv 423 Merretl, J.. Serg t, D, 8th Nov. 30, Left; circular. Provost Marshal Penn. Cav., age 19. 21, 64. 17, 1865. Arkansas, age 29. Dec.l. fi4. March 7. 1865. 388 Major, W. T., Corp l, E, July 30, Left ; long post. flap. Surg. J. L. 424 Mershon, J. N., Pt., 6th May 30, Left ; circular. Discharged Sep 4efth N. Y., age 29. 30, 64. Mulford, 48th N. Y. Disch d N. Y. Battery, age 19. 31, " 64. ternber 24. 1H64. July 14, 1865. 425 Met-/,, J., Pt. G, 142d May 22, Left; circular; gangrene: bone 389 Malock,A. F., Pt., B, 23d July 1, Left. Retired from service Dec. Penn., age 20. 22, 64. ! removed. Disch d July 4. 1865. N. C., age 29. 2, "63. 21, 1864. 426 Miller, C., Pt., H, 2d Sept. 29, Right: double flap. Confederate 390 Malone, M., Pt., K, 6th July 1, Right ; circ. Transferred for ex Penn. Art y, age 44. 30. 64. surgeon. Discli d July 12, 65. N. C., age 26. 2, 63. change September 10, 1863. 427 Miller, H. H., Corp l, K, Aug. 29, Left ; flap. Surg. H. W. Carpen 391 Malony, M., Pt., G, 25th July 3, -. Snrg. G. I,. Miller, C. S. A. 117th N. Y., age 24. 29, 64. ter, 117th N. Y. Discharged Virginia. 3, 63. Recovered. May 31, 1865. 392 Mance, G.,Serg t,C,14th May 8, Right: flap. Discharged Sept, 428 Miller, -P. D., Corp l, I, June 1, Right ; circ.; gangrene. Disch d N. Y. S. Militia, age 24. 8, 64. 27, 1864. 87th Penn., age 25. 1, 64. October 13, 1864. 393 Mansur, N., Pt., A, 5th July 27, Right; bilat. flap. Surg. J. H. 429 Miller, R. M., Pt.,G, 14th May 3, Right. A. Surg. J. E. Logan, 14th N. Hampshire, age 42. 27," 64. Buckman, 5th N. H. Disch d North Carolina. 3, 63. N. C. Recovered. June 18, 1865. 430 Miller, W. S., Pt., H, May 18, Left; circ. Surg. .I.W.Wishart, 394 Marple, T. J., Corp l, K, June 18, Left ; circular. Discharged Oct. 116th Penn., age 19. 18, 64. 140th Penn. Disch d July 10/65. 91st Penn., age 34. 18. 64. 21, 1864. Feb., 1871, re-amp, in up. third. 395 Marsh, E. C., Pt., H, 8th June 3, Right ; flap. Surg. W. B. Fox, 431 Mills, II., Pt., A, 14th July 10, Right ; flap. Sura-. G. W. Snow, Michigan, age 17. 3, 64. 8th Michigan. Discharged. N. Y. Art y, age 22. 10," 64. 35th Mass. Diseh d June 19, 396 Martin, A. P., Pt.. I, 5th June 2, Left: circular. June 7, re-amp. 1865; subsequent operation. Tenu., age 21. 2, 64. mid. third. Disch dMar. 31, 65. 432 Miser, J. W. K., Pt., G, July 3. L t: circ. A. Surg. C. B.Richards, 397 Martin, F., Pt., K, 17th Mar. 19, Left ; circular. Discharged June 30th Ohio, age 20. 3, 64. 30th Ohio. Disch d June 15/65. New York, age 25. 19, 65. 9, 1865. Nov. 24/66, re-amp, upperthird. 398 Martin, J. I., Serg t, B, April 2, Left; circular. Released July 433 Mitchell. C. L., Serg t, Nov. 30, Riffht; flap. Disch d Aug. 29, 41st Tenn., age 23. 2, 65. 5, 1865. F, 55th Mass., age 35. Dec. 1/64. 1865. 399 Martin, L., Pt., E, 29th July 30, Left ; circ. (also right arm at up. 434 Molter, J., Pt., D, 39th Dec. 1, Left ; circ. Confederate surgeon. Colored Troops. 30," 64. third). Surg. D. MacKay, 29th New York, age 25. 3. 63. Disch d August 31, 1864. Col d Troops. Also w d of face. 435 Moore, J. B., Pt., D, 12th July 20, Right : circular. Recovered. Discharged Dec. 6, 1865. Tennessee. 20, 64. 400 Martins, W. F., Capt., I, May 19, Left ; flap (also w d right elbow). 436 Moore, W. H., Cotnm y Mar. 2, Right : ant. post. flap. Surg. P. 1st Mass. H. A., age 47. 19," 64. Disch d Oct. 5, 64. Spec. 4498. Serg t, 8th New York 2, 65. E. Sickler, 8th N. Y. Cavalry. 401 Mathews, H. C., Pt., H, April 2, Left; circ. June 23, 65, re-amp. Cavalry, age 24. Disch d June 19, 1865. 116th Ohio, age 21. 2, 65. in middle third. Disch d Sept. 437 Morris, T., Pt., F, 4th R. July 30. Right ; ant. post, flap (also w d of 8, 1865. Spec. 4334. Island, age 22. 31/64. left leg). Disch d Mar. 11, 65. 402 MoAnalty, H.. Corp l, A, Aug. 25, Left. Ass t Surg. H. S. Bradley, 438 Morrison. T. W., Pt, I, July 28, Tlight : flap. A. Surg. C.B. Rich 69th New York. 27, 64. C. S. A. Disch d March 27, 65. 83d Indiana, age 30. 29, 64. ards, 30th Ohio. Discharged 403 McCarty. P., Pt., F, 16th May 28, Left; ant. post. flap. August 20, November 29, 1864. Infantr} , age 19. 28. 64. re-amp. Disch d March 22, 65. 1H!I Morrison, W. H., Pt., F, June 14, Left ; lat. flap. Surg. E. S. Hoff Died Nov. 4. 1879. 90th New York. 14, 63. man, 90th N. Y. Disch d Sept. 404 McClaughry,Yv ., Pt., A, June 3, Left; lateral flap. Surg. J. A. 29, 1864. Died July 8, 1869; 155th N. Y., age 34. 3, 64. Spencer, 182d N. Y. Disch d consumption. April 13, 65. Oct. 3, 68, re-amp. 440 "Morrissey, I ., Pt,, K, Dec. 11, Left, Surg. N. Hayward, 20th at middle third. 20th Mass., age 39. 12, 62. Mass. Disch d June 18, 1864. 405 2 McCollom, J.,Corp l, B, Sept. 29, Left ; ant. post. flap. Disc d June July25/64, re-amp., flap. Died IstD. C. Cav., age 23. 29, 64. 23, 1865. Oct. 12, 65, re-amp. October 26, 1870. 406 McOommon, J. S.,Capt., Juno 27, Left ; flap. Surg. J. W. Hastings, 441 Morrow, B. M., Major, April 2, Right ; circ. Surg.W.G. Hunter, K, 73d Ohio, age 26. 27, 64. 33d Mass. Disch d Nov. 2, 64. 205th Penn., age 30 . 2, 65. 211thPenn. Disch d June 3/65. 407 McCoy, J., Pt., F, 64th May 18. Left. Surg. G. L. Potter, 145th Died March 7, 67 ; consumpt n. New York, age 23. 18, 64. Penn. Disch d Jan. 20, 1866. 442 Mullen, E., Pt., G, 161st Feb. 16, Left; circ. A. Surg. J. S. Dolson, Died May 29, 1868. New York. 16, 63. 161stN.Y. Disch dMav 31/83. 408 McCracl;en,J.D., Lieut., Nov. 30, : ant. post. flap. Surg. 443 Mitlvay, M., Pt., G, 25th July 3, Left. Snrg. G. L. Miller. C. S. A. K, 7th Texas, age 37. De. 1. 64. Richardson. 7th Texas. Pro Virginia. 3, 63. Retired January 4, 1865. vost Marshal March 7, 1 865. 444 Murdock, J., Pt., I, 7th Oct. 19, Right; ant. post. flap. Surg. G. 409 MoCurley, F.. Serg t, I, June 1, Left ; flap. Surg-. C. T. Simpers, Maine, age 44. 21, 64. T. Stevens, 77th N. Y. Disch d 6th Maryland, age 30. 1, 64. 6th Md. Disch d Nov. 10, 1864. June 22, 1865. 410 Me Donald, B..Pt..B,l 6th Oct. 7, Right ; circ. Disch d August 11, 445 Murphy, J. L, Pt., D, July 2, Left ; circ. Transferred for ex N. Y. H. A., age 35. 7, 64. 1865. 14th Virginia, age 21. 4, 63. change Nov. 12, 1863. 411 McDonald, J., Pt., K, Oct. 3, Right; bi-lat. flap. Discharged 446 Murphy. W. H., ls : t S g t, Nov. 16, Left ; ant. post. flap. Surg. B. N. 1 1th Penn. Cav., age 24. 3, 64. Sept. 19, 65. Died September B, 3 1st Mo., age 20. 16, 64. Bond, 27th Mo. Disch d April 26, 1866; chronic diarrhoea. 24, 1865. 412 McElroy, C., Pt., E, 36th June 1, Right; ant. post. flap. Surg. H. 447 Musselman. A. L., Corp l, Dec. 16, Right; flap. Disch d June 2/65. Wisconsin, age 31. 1, 64. A. Martin, IT. S.V. Discharged D, 71st Ohio, age 22. 16, 64. May 6, 1865. 448 Mi/ear, F., Pt., B, 2d Va. July 9, Right. Surg. Carter, C. S. A. 413 McGee, J. H., Pt., L, 1st Oct. 19, Right: circ. Disch d May 17, Reserves. 9, 64. Recovered. 414 Ohio L. Art,, age 24. McGlaflin, C., Pt., K, 3d 19, 64. Sept. 19, Right ; flap. Surg.W. A. Barry, 449 Nellis. F.., Serg t, B, 6th Connecticut. Aug. 28, 28, 64. Left ; circ. Surg. G.C. Jarvis, 7th Conn. Disch d Aug. 14, 1865. Vermont, age 20. 19, 64. 98th Penn. Discharged Octo 450 Neville.. W., jr., Pt., A, May 3, Left. Surgeon G. A. Nott, P. A. ber 3, 1865. 3d Alabama. 3. 63. C. S. Recovered. 415 McGuire, H.,Pt.,G.120th Oct. 27, Left; circ. Disch d June 16, 65. 451 Newman, J., Pt., F, 84th May 8. Right; circ. Surg. O. Smith. 14th New York, asre 34. 28, 61. New York, acre 31. 9, 64. N.Y. State Militia. Oct. 5, seq. 4-io Mr-Henry, J. 11.. Pt., II. July 7. Left ; flap. Surg. A. Goslin. 48th removed. Disch d June 6, 65. 48th Illinois, age 21. 7, 63. 111. Discharged Nov. 12, 1864. Spec. 3278. Died April 5/1868. 452 Newman, P., Pt.,C, 182d Aug. 25, Left ; flap. Surg. L. G. Hunt, 27th 417 Mclntire, II. M., Lieut. June 30, Left. Disch d January 7, 1863. New York, age 37. 27 64. N. C. Also four other wounds. Col.. 1st Penn. Res. 30, 62. Died June 12, 1863. Disch d Sept. 13. 1865. l (W.). Surgical Cases from Field Hospitals, in the Medical and Surgical Reporter, 1865, Vol. XII, p. 253. 2 MOKGAX (C. R.), Re-amputation, for Intense Neuralgia in a Stump. Anxsthesia induced by Nitrous- Oxide Gas. Surgical Clinic by Dr. T. G. MOUTON, in Medical and Surgical Reporter, 1865, Vol. XIII, p. 365. 3 Ln>ELL (J. A.), Clironic Osteo-myelitis of Tibia following Primary Amputation and Sloughing of Stump, etc., in U. S. Sanitary Commission Memoirs, New York, 1870, Surgical Volume I, p. 297. ^THOMSON (VVM.), Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, D. C., in American Journal Medical Science, 1864, N. S., Vol. XLVII, p. 384. 500 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 453 Newman, W., Pt., D, May 25, Right ; flap. Surg. J.V. Kendall, 496 Kay, A T ., Capt., D, 6th May 30, Left. Surg. J. G. Hardy. C. S. A. J49th N. York, age 20. 20, 64. 149th N.Y. Disch d Oct. 5, 05. North Carolina, 30, 64. Recovered. 454 Nichols, J. B., Pt., A, 8th Nov. 4, Left : circular. Discharged Slav 497 Rea,W.M.,Pt.,K, 140th Mav 8, Right ; circ. Surg. J.AV. Wishart, Michigan, age 35. : 4. 64. 25, 1805. Pennsylvania. 8, 64. 140th Penn. Disch d May 29, 65. 455 Formon, W. H. H., Pt., July 2, Left; llap. Surgeon Davids, 498 Reed, j". M., Pt., B, 10th May 22, Right : circ. Discharged Septem H, 50th Ga.. ago 22. 3, 63. C. S. A. Also w nd right thigh. Iowa. 23, 03. ber 28, 1863. Exchanged Nov. 12, 1803. 499 ; Reen, C., Lieut. Col., April 2. Left. Discharged June 29, 1865. 456 Northrop. A.. Corp l, G, June 20, Left; flap. Discharged April 20, 98th Penn.. age 35. 2, 65. 107th Pennsylvania. 20, 64. 1865. 500 Regan, D., Pt., A, 59th July 7, Left; flap. Surg. T. F. Oakes, 457 O Beirne, W., Pt., D, July 27, Left; circ. Surg. P. K. Hiibou, Mass., age 25. 7. 64. 50th Mass. Disch d June 2, 65. 28th Mass., age 23. , 27, 64. 28th Mass. Disch d Oct. 9, 64. Died April 22, 1809. Spec. 6533. Nov. 15, 07, re-amp, mid. third. 501 RcilVrt. L., Serg t, D, Oct. 3, Left. A. Surg. J. W. S. Gouley, 458 O Brien. E. F., Lieut., A, June 3, Left; ciro. Surg. P. E. Hubon, 21fth New York. 4, 61. U. S. A. Disch d Dec. 13, 1801. 28th Mass., age 29. 3, 64. 28th Mass. Disch d Oct. 13. 64. 502 Reisinger, C. S.. Serg t, June 19, Left: flap. Surg. W. F. Hum Subs. V. R. C. Spec. 4494. 11. 150th 1 enn., age 25. 19, 64. phrey, 149th Penn. Discharged. 459 O Brien, H., Pt., C, 170th June 16, Left; flap. Surg. F. Douglas, 503 Relyea, W., Pt., 11, 77th May 3, Left : flap. Discharged Novem New York, age 35. 18, 64. 170th N. Y. Disch d Oct. 10, 65. New York. 3. 63. bers, 1803. Mar. 1, 1867, bi-lateral flap am 504 Rennoe, D. M., Pt., H, Jan. 2, Right; flap. Discharged March putation at middle third. 29th Indiana. 2, 63. 23, 1863. 460 O Brien, J., Pt,, G, fi6th June 22, Right ; lat. flap. Confed. surgeon. 505 Reynolds, M.,Pt.,J,114th Oct. 19, Right ; lateral flap. Discharged New York, age 50. 23, 64. Disch d Oct. 21, 1865. New York, age 27. 20, 64. June 12, 1865. 461 O Dougherty, B., Serg t, June 22, Right : circ. Surg. J. Reilv, 33d 506 Rice, C. H., Pt!", F, 129th Dec. 13, Right ; flap. Discharged Hay H, 33d N. J., age 29. 22, 64. N. J. Disch d April 3, 1865. Pennsylvania. 14, 62. 25, 1863. 462 O Driscoll, B. J., Lieut., June 16, R t: flap. Surg. W. O Meagher, 507 Rice, M. G., Pt., I, 27th June 18, Left ; circ. Surg. G. T. Stevens, C, 188th New York. 16, 64. C9th N. Y. Disch d Jan. 17, 65. Mass., age 31. 18, 64. 77th N. Y. Disch d Oct. 3, 05. 463 O Keer, J. M., Pt., D, 1st Nov. 7, Left. Transferred to prison Mav 508 Rich, W. H.. Corp l, F, Sept. 8, Left ; ant. post. flap. Surg. S.W. Texas, age 27. 7, 64. 30, 1865. 4th N. H., age 20. 8, 63. Gross, U. S. V. Disch d June 1 , 464 Osborne, E. J., Pt., B, Dec. 15, Right; flap. A. A. Surg. F. G. 1864. Spec. 4315. 18th Ohio, age 21. 17, 64. Albright. Disch d April 6, 65. 509 : Ridenour, C., Corp l, I, May 5, Right ; flap. Discharged Decem- 465 Ostrander, P. V. L., Pt., May 13, Right; circ. Ass t Surg. W. D. 7th Maryland, age 22. 5, ^64. ber 12. 1864. B, 100th N. Y., age 28. 13, 64. Murray, 100th New York. Dis 510 Rifenverrick.W. M.,Cor- May 12, Left; flap. Surg. W. F. Hum charged January 13, 1865. poral, H, 149th Penn.. 12, 64. phrey, 149th Peun. Discharged 466 Overslrut, W. J., Pt., K, Nov. 30, Right ; ant. post. flap. To Provost age 30. January 26, 1865. 43d Miss., age 20. 30, 64. Marshal March 1, 1865. 511 Riley, S., Pt., K, 10th Aug. 3, Left ; circular. Discharged Feb 467? Page, F., Pt., K, 3d April 16, Both ; circ. Discharged August Indiana, age 23. 3, 64. ruary 21, 1865. 468$ Michigan. 16, 62. 16, 1862. 512 Sister, T. W., Pt., H, May 3, ; circular. Recovered. 469 Palmer, J., Corp l, F, 62d Oct. 13, Left; circular. Surg. A. C. Bar 13th S. C., age 19. 4, fe. Ohio, age 22. 13, 64. low, 62d Ohio. Discharged. 513 Rittfnliouse,, J. H., Pt., Sept. 26, . Surg. Hoyt, C. S. A. 470 Parker, D., Pt., F, 61st July 2, Left ; circular ; gangrene. Dis E, 51st Georgia. 26, 64. Retired February 1 0, 1805. New York, age 29. 4, *G3. charged Dec. 8, 1804. 514 . Robar, A., Pt., I. 6th May 10, Left. Discharged August 25, 04. 471 Partain, J., Pt., U, Phil May 6, Right (also amputation middle Vermont, age 10. 11, 64. ip s Legion, Georgia. 6, 64. third right arm). Recovered. 515 Robertson. W. T., Pt., D, ; May 31, Left. Union surgeon. Recovered. 472 Patten, G. W., Corp l, F, Mar. 25, Left ; circular. Discharged Sep j llth Mississippi. J e 2, 62. 1st Maine, age 18. 25, 65. tember 11, 1865. 516 Robinson, S. C., Pt., C. July 2, Right; circ. Recovered. Dis 473 Paul, P., Pt., F, 3d In May 1, Left ; circular, Discharged Feb 12th New Hampshire. 3, 63. charged. fantry, age 27. lj3. ruary 11, 1864. 517 Robinson, T. B.. Corp l, May 12, Left ; flap. Surg. M. Rizer, 72d 474 Percy, J., Serg t, B, 5th SepT 17, Right. Confederate surgeon. Re B, 72d Penn., age 32. 12, 64. Penn. Disch d" Feb. 15, 1805. Alabama. 17, 62. covered. 518 Robnault, J., Pt,, B, 1 1th Dec. 13, Right ; flap. Discharged Decem- 475 Perkins, P., Pt., G, 7th Sept. 18, Left : circular. A. A. Surg. M. H. Pennsylvania, age 27. 14, 62. ber 10, 1863. Kentucky, age 20. 19, 64. Head. Disch d Oct. 5, 1 804. 519 Roe, E., Pt., Texas Bat- Deo. 15, Left; circular. To Provost Mar- 476 Perry, L., Corp l, G, 3d July 2, Left. Transferred for exchange tery, age 20. 16, 64. shal March 7, 1805. Arkansas, age 25. 2, 63. November 12, 1863. 520 Rogers, J., Pt.. B, 29th i Oct. 27, Right; circ. A. Surg. II. Grange, 477 Peters, W., Pt., C, 139th Sept. 19, Right; flap. Discharged May Conn., age 38. 27, 04. 7th Col d Troops. Discharged Penn., age 22. 19, 64. 6, 1865. April 11, 1805. 478 Pettet, J. A., Pt., B, 8th Mar. 23, Left ; flap. Discharged May 22, 521 Rosevelt, G. W., Serg t. July 2, Left; flap. Surg.St.J.W.Mintzer, Wisconsin. 23, 65. 1865. K, 20th Penn. 4, f 63. 26th Penn. Disch d Mar. 14, 64. 479 Pheiffer, P., Pt., A, llth Aug. 22, Right; sloughing. Dec. 8, flap 522 Runeiman, F., Pt., H, Nov. 22, Left: circ. Surg. J. P. Prince, Penn. Cav., age 35. 22, 04. re-amp, middle third. Disch d. 27th Mich., age 30. 22 63. 36th Mass. Disch d Jan. 20, 05. 480 Pickering, B.,Pt. A, llth Nov. 25, Right. Discharged August 22, 523 Runyon, S. C. , Pt., H, July 0, Right; posterior flap. Disch d Michigan, age 22. : 25. 63. 1864. 2d Penn. Art y, age 46. 6, 64. July 18, 1865. 481 Pierce, F. O., Serg t, B, Oct. 19, Right : ant. post. flap. Surg. E.F. 524 Ryerson, J., Pt., E, 13th July 30, Left circ. Surg.W. B. Fox, 8th 14th N. H., age 28. 20, 04. Ward, 38th Mass. Discharged Ohio Cavalry. 30, 64. Michigan. Discharged. September 11. 1865. 525 Rynearson, L, Pt.. B, May 5. Left: circular. Discharged Nov. 482 Pleasants, J. W., Pt., Sept. 19, Left ; circ. Surg. G. W. Semple, 110th Ohio, age 20. 6, 64. 2, 1864. B, Richmond Howitzer 19, 64. P. A. C. S . To Provost Marshal 526 Sanders. J. H., Pt., D, Sept. 19, Right ; circ. Discharged June Battery, age 22. April. 1, 1865. 34th Mass.. age 31. 19, 04. 8,1865. 483 Plumstead.M. K., Serg t, June 3. Right : circ. Disch d Mar. 30/64. 527 Savage, H. F., Pt,, A. 1st Aug. 26, Left : flap. Disch d Dec. 29, 64. H, 131st N. Y., age 21. 3, 63. Died Jan. 11, 1867; typh. fever. Maine Art y, age 18. i 20, 64. Re-amp, at middle third. 484 Pohner, M., Pt., D, 23d July 27, Right: circ. Surg. A. M.Morrison, SOQ icD Scofield. R. Pt., A, 9th Sept. 29, ; Right ; circular. Discharged Sep- Kentucky, age 21. i 27, 64. 23d Ky. Disch d April 28, 05. Colored Troops. 29, 64. tenibcr 7, 1 865. 485 Polly, M. H., Corp l, A, July 3, Rigut ; circ. Surg.O. S.Copeland, 529 Scott, H., Pt., C, 2d Del- May 2, Right ; circ. Discharged August 10th N.Y. II. A., age 23. 3, 64. 10th N.Y. Art. Dis. May31, 65. aware. 4, 63. 20. 1803. 486 Pnole, W. /?., Serg t, I, Nov. 16, Right ; circ. To Provost Mar 530 Scott, J. G., Pt., D, 77th May 6, Right ; circ.; flap (also left at up. 5th S. C., age 33. 16, 63. shal December 1, 1864. New York, ago 23. 6, 64. third). Surg.E.Pi. P. Kelly. f."th 487 Porter, J., Pt., E, 16th Aug. 16, Right : lat. flap. A. Surg. A. F. IVziu. Discharged Nov. 3, 180-1. Penn. Cav., age 20. 1C, 04. Herman, 16th Penn. Cavalry. ; ;".. 513. H;em. Disch d April 6, 1865. 531 Scrorinins, T. G., Serg t, July 9, Left. Exchanged September 21, 488 Porter, W., Pt., B, 60th April 2, Left ; ant. post. flap. A. Surg.W. \ A, 31st Ga., age 22. 9, 64. : 1864. Ohio, age 22. 2, 65. Carrol], U. S. V. Discharged 532 Scullion, J., Pt., E, 155th , June 16, Right: circ. Discharged June July 17, 1865. Spec. 4140. Died New York, age 20. 17. 04. 1.1805. i June 22, 1868. 533 Secor, I., Pt." D, 28th Juno:!, Loft: circ. Surg. P. K. lhib.ni. 489 Powell, J. E., Pt., H, 7th : May 14, Right; circ. Confed. surgeon. Mass., age 23. 3, 04. 2.- ih Mass. Disch d Feb. 0, "65. S. C. Battery, age 26. 14, 64. Furloughed July 23. 1804. 534 Seibert, J., Pt., II, 53d Nov. 27, Left : ant. post. flap. Sury. J. W. 490 Prizer, W. J., Serg t, A, Nov. 30, Right : lateral flap. To Provost Penn., age 21. 27, 03. ; Wishart. 1-JOth Trim. Disi-h d 9th Arkansas, age 24. Dec.], 64. Marshal March 7. 1805. March 28, 1865. Killed DC-. 491 Quint), J.A.,Pt., K, 109th July 30, Right. Surg. W. C. Shurloek, 22, 1879; railroad aci-idrnt. New York, age 20. 30, 64. 51st Penn. Disch d Jan. 30, 65. 535 Seitzmeyer, J.L.. Pt., E, Sept. 29, Left ; circular. Discharged July 492 Quinn. P., Pt., D, 5th N. July 18. Left; flap. Discharged October 5th Penn. Cav., age 21. < 29, 64. 18, 18:. 5. Y. H vy Art y, age 27. 19," C4. 17, 1805. Died May 17, 1S74. 530 Sessions, G. W., Pt., K, Julyl, Right: ant. Surg. T. C. Hill. 5lh 493 Rafford, O., Pt., II, 20th Sept. 30, Right; circ. Discharged Feb 5th Alabama, age 22. 1, 63. Ala. Exchanged Nov. I ?; 1803. Maine, age 28. Oct. 1, 64. ruary 21. 1865. 537 Setley, S., Pt., F, 58th April 17, Left: circ. Snnr. K. P. Morong. 494 Rank, B. H., Pt., K, 51st June 3, Left; flap. Discharged July 18, ; Penn., age 19. 17, 63. 2d Md. Disch d Oct. 7. lf-04. Penn., age 27. i 3, 64. 1805. 538 Shaff, P., Pt., F, llth Oct. 2, Left; circ. Surg. L.C. Woodman, 495 Rathburn, W., Pt., H, ; Dec. 13, Right ; circ. Discharged March Mich. Cav., age 38. 2, 64. llth Michigan Cavalry. Dis 7th Rhode Island. 13, 02. 6, 1863. ! charged July 1, lt-b 5. 1 O MEAGHER (W.), Surgical Cases from Field Hospitals. Amputation of Left Leg, Lower Third, Stump healed in three weeks, in Medical and Surgical Reporter, Philadelphia,,1805, Vol. XII, p. 253. SECT. V.J PRIMARY AMPUTATIONS IN THE LEG. 501 No NAJIE, MILITARY DATES OPERATIONS, OPERATORS, No NAME, MILITARY OPERATIONS, OPERATORS, Dnsciiii Tiox, AMD AGE. RESULT. DESCRIPTION, AND AGE. RKSULT. 539 , Sharp, J.W., Pt., G, 5th Oct. 19, Left;circ. Surg. R. Watts, 133d 580 Stein F. Pt. H 10th July 3, Right. Discharged December Georgia, age 26. 19, 64. N. Y. To Pro. Mar. April 8, 65. Infantry. 3, 63. 23, 1863. Spec. 1454. 540 Shay, AI., Pt., K, 94th June IS, L t ; circ. Surg.D.A.Chamberlain, J581 Stetler, J. A., Pt., A, June 18, Right ; flap. Surg. F.C. Reamer, New York, age 21. 19, 64. 94th N. Y. Disch d Mar. 2, 65. 143d Penn., age 19. 18, 64. 143d Peun. Disch d June 1/65. 541 Sheets,./. S.. Pt., E, 52d Oct. 19, Left; Hap. Surg. C. B. Gibson, Re-amp, at mid. third Jan., 1867. Virgiiiia, age ~2. 19, 64. C. S. A. Trans, for exchange 582 Stevens, J., Pt., C,-79th July 20, Left ; circular. Discharged. February 10. 1865. Ohio, age 45. i- J , 64. 542 Sheibly, T. J., I t., B. 1st May 8. Left : circ. Surg. J. J. Comfort, 583 Stewart, J., Pt., K, 1st Aug. 19, Right; circ. Surg. A. A. White, Penn. Hides, age 19. 9, 64. 1st Penn. Rifles. Disch d Nov. Maryland, age 24. 20, 64. 8th Md. Disch d Aug. 1, 1865. 18, 1864. 584 Stewart, R. F.. Capt., B, June 17. Left; circ. A. A. Surg. W. H. 543 Shell, J., Pt., H, 13th Nov. 11, Right; flap. Surg. W. H. Mat- 179th N. York, age. M. 17, 64. Randolph . Disch d Jan. (i, 1 865. Tenu. Cavalry. 12, 64. lock, 13th Tenn. Cav. Disch d Died August 30, 1870. July 21, 1865. 585 Stewart, T. G., Pt., D, Dec. 16, Left ; circular. Discharged July 544 Wiell,W.T., Serg t, 18th Sept. 17, Right ; circular. Doing well. 36th Illinois, age 41. 16, 64. 12, 1865. Died July 1, 1870. Mississippi, age 24. 18, 62. 586 Stills, J., Pt., D, 90th Sept. 4, Left ; flap. Surg. A. C. Fosdick. 545 Simons, C. 11., Pt., K, June 17, Left : ant. post. flap. Discharged Indiana, age 20. 4, 63. 90th Ind. April 22, 64, re-amp. 59th Mass., age 33. 17. 64. May 11, 1865. atrtid. third. Disc. Nov. 11/64. 54li Simuums, C., Pt., L, 6th Sept. 19, Right ; flap. A. Surg.G. R. Rich 587 Stokes, C., Serg t, C, 7th Dec. 7, ; circular. To Provost Mar Mich. Cav., age 21. 19, 64. ards, 1st Mich. Cavalry. Dis Florida, age 35. 7, 64. shal March 7, 1865. charged May 3, 1865. 588 Stone, J. F., Pt., E, 29th Nov. 30, Left ; circ. Surg. Lynch, C. 547 Simmons, S.. Pt., I, 20th July 20, Left ; circular. Transferred Sep Mississippi, age 23. De. 1/64. S. A. To Pro. Mar. May 6, 65. Miss., age x;2. 20," 64. tember 22. 1864. 589 Street, T. G., Pt., C, 7th May (i. Right; circ. Discharged March ]546 Simmons, W. J., Pt., 10, Nov. 30, Right ; circular. To Provost Mar Maryland, age 19. 7, 64. 24, 1865. 37th Georgia, age 22. Dec. 1/64. shal March 7, 1865. 590 Striep, M., Corp l, B, 6th Aug. 29, Right; flap. Discharged. 549 .Simpson, K. A., Serg t, Oct. 19, Left ; ant. post. flap. A. Surg. B. N. Y. Cavalry, age 25. 29, 64. B, 30th Mass., age 34. 21, 64. Pordyce, 160th N. Y. Gang. 591 Strolmber. G., Pt., A, Oct. 27, Left; circular. Discharged Mav Oct. 26, re-amput u thigh, low. 188th N. Y., age 20. 27, 64. 26, 1865. third. Disch d Oct. 16, 1865. 592 Strong, L. M., Pt., K, 3d April 2, Left ; ant. post. flap. Surg. J. J. 550 Simpson, J. If., Pt., I, Sept. 3. Left. Surg. J. Evans, M S. C. Vermont, age 21. 2, 65. Meigs. 3d Vermont. Disch d. 7th S. C., age 29. 4, 64. To Provost Marshal for exch ge 593 Stroup, C. W., Pt., H, July 3, Right. July 11, reamp. Trans February 11, 1865. 52d N. C., age 29. 3, 63. ferred for exch. Nov. 12, 1863. 551 Sinclair, F. C., Lieut.,C, Nov. 6, Right; ant. Surg. S. V. D. Hill, 594 Suidon, J. K., Lieut., F, July 2, Right; circ. Recovered. Ex 13th Mississippi. 8, 63. C. S. A. Recov d; exchanged. 24th Virginia, age 22. 3, 63. changed. 552 Slade, S. G., Pt., A, 13th July 9, Left. Exchanged. 595 Stiratt, J. G., Pt., F, 7th July 3. Right. Paroled September 5. Georgia, age 24. 9, 64. North Carolina. 3, 63. 1863. 553 Sinedberg, W. K., Capt., May 5, Right. A. Surg. J. S. Smith, IT. 596 Talenfero, W. M., Corp l, Oct. 11, . Surg. Lee, C. S. A. Re F, 14th Infantry. 5, 64. S. A. June, 1864, re-amputat u E, 2d Va. Cavalry. 11, 63. covered. mid. third. Retired Dec. 15, 70. 597 Taylor, J.W., Pt.,C, 5th April 27, Left ; flap. A. Surg. O. H. Arm 554 Smith,A. R., Pt., F, 16th Nov. 30, Left ; circular. To Provost Mar N. Y. Cavalry, age 44. 27, 64. strong, 5th N. Y. Cav. Disch d South Carolina, age 24. 30. 64. sh*! March 29, 1865. Oct. 6, 1864. Spec. 2244. 555 Smith, C., Pt., K, 1st April 1, Right ; flap ; gangrene. Disch d 598 Taylor, J., Pt., B, 5th Feb. 19, Left ; ant. circ. Ass t Surg. G. V. Maryland, age 42. 2, 65. October 11, 1865. Colored Troops. 20, 65. R. Merrill, 6th Colored Troops. 556 Smith, C. G., Pt., F, 4th Sept. 17, Left : circ. A. Surg. J. R.Gibson, Discharged Nov. 10, 1865. Infantry, age 26. 17, 62. U. S. A . Disch d Aug. 22, 64. 599 Taylor, W. T., Serg t Mar. 25. Right; circular. Released June 1557 Smith,O. G., Pt., H, 102d May 15, Right ; circ. Surg.W. Hamilton, Maj., 56th N.C., age 24. 25, 65. 19, 1865. Illinois, age 18. 16, 64. 102dlll. Disch d May 18, 1865. 600 Teel, H., Corp l, H, 122d Sept. 19, Left ; ant. post flap. Ass t Surg. 558 Smith, D., Pt., G, 2 1st Aug. 21, Left ; ant. post, flap ; gang. Dis Ohio, age 22. 19, 64. J. G. Thompson, 77th N. York. Penn. Cav., age 24. 21, 64. charged August 2, 1865. Discharged August 14, 1865. 559 Smith, F., Serg t, G, 7th Mar. 25, Right ; ant. circular. Surg. H. N. 601 Temple, B., Serg t, E, July 2, . Recovered. Transferred Louisiana, age 28. 25, 65. Young, C. S. A. Released June 21st Virginia. 2, 63. July 15, 1863. 14, 1865. 602 Thaj/er, Vr. S., Lieut., H, April 18, Left. Surg. J. R. Ward, C. S. A. 560 Smith. H. C.. P.,G, 30th Nov. 24, Right ; Hap. Surg. A.T. Hudson, llth Virginia. 18, 64. Recovered. Iowa, age 32. 25, 63. 26th Iowa. Disch d Feb. 1, 65. 603 Thomas, H.H., Serg t, B, July 3, Right. Paroled October 24, 1863. 56J Smith, J. C., Pt., I, 24th May 16, Left ; flap. Discharged Septem 26th N. C., age 23. 3, 63. Iowa, age 20. 16, 63. ber 18, 1863. 604 Thomas, H. S., Major, April 5, Right ; flap. Discharged August 562 Smith, J. L., Pt., C, 12th May 3, Left ; gang. Transferred June 1st Penn. Cav., age 26. 5, 65. 17, 1865. North Carolina. 3, 63. 9, 1863. 605 Thomas, J., Pt., I, 30th July 30, Right : flap. Surg. G. R. Potts, 563 Smith, J. M., Pt., I, 23d July (>. Right. Surg. Morgan, C. S. A. Col d Troops, age 22. 30,* 64. 23d Col d Troops. Discharged Georgia. 7, 64. Retired February, 1865. August 23, 1865. 564 Smith, J. M.,Pt.,K,15oth Oct. 27, Right ; flap. Surgeon F. Wvlie, 606 Thomas, S. B., Pt., H, Mar. 25, Right ; circ. Surg. E. P. Roche. New York, age 53. 28, 64. 1 55th N. Y . Disch d May 27, 65. 37th Virginia, age 40. 26, 65. Released June 14. 1865. 565 Smith, X., Pt., II, 2d May 9. Right. Surg. G. Reeder, 2d Iowa 607 Thomas, W. B., Corp l, E, May 6, . Surg. G. S. West, C. S. A. Iowa Cav.. age 26. 9, 62. Cavalry. Disch d Aug\ 12, 62. 7th Georgia. 7, 64. Retired February 11. 1865. 566 Smith, S., Pt., K. 4th Mar. 25, Left ; circular. Released June 608 Thornton, M. L., Pt., K. Oct. 19, Right : circ. (also amp. right arm Georgia, age 17. 25, 65. M, 1865. 31st Georgia, age 22. 19, 64. at mid. third). Surg. G. G. But 567 Snelliny, E. A., Pt., Not- June 22. Right (also left leg at mid. third). ton, 31st Georgia. To Provost ta way s Artillery. 2.>, 64. Confed. surgeon. Recovery. Marshal April 8, 1865. 568 Snugg s, W., Pt.. 11, 14th Alav 12. Right ; flap. To prison October 609 Thornton, R. B., Pt., F, July 1, Left. Transferred for exchange North Carolina, age 18. 12, 64. 17, 1864. 12th N. C., age 21. 2, 63. September 25, 1864. 569 Snyder. J. D., Pt., G, May 10, Left ; flap (also amp. right leg, up. 610 Thurlkil, J., Pt., G,31st Oct. 27, Left; circular. Discharged Aug. 149th Penn., age 19. 11, 64. third). Disch d July 21, 1865. Col d Troops, age 29. 28, 64. 23, 1865. 570 Sopor. Ij- Serg t. A, llth April 2. Left : flap. Surg. C. IJ. Park, llth 611 Tnrrei/son, T. N., Corp l. May 8, . Surg. W. J. Allen, C. S. A. Vermont, age 32. 2, 65. Yermont. Disch d Sept. 14, 65. C, 35th Va. Battery. 8, 64. Recovered. 571 Spraker, W., Serg t, I, July 2, Left ; circular. Disch d May 3, 612 Torry, A., Pt., H, 99th Sept. 16, Left; circular flap. Surg. D. S. 64th X. Y., age 24. 4, 63. 1864. Sptc. 4364. Peiin., age 30. 16, 64. Hays, 110th Penn. Discharged 572 Spratt. J. R., Lieut., K, May 25, Right. Surg. NY. C. Bennett, U.S. June 1, 1865. Spec. 4113. 33d Indiana, age 27. 23, 64. V. Discharged Feb. 3, 1865. 613 Travis, C., Pt., E, 23d July 29, Left; flap. Discharged January 573 StalrjW. M. J/., Pt., B, Sept. 16, Left. Surg. McFarland.C.S.A. Missouri, age 30. 29, 64. 20, 1865. SOtli Tenn. 16, 63. Recovered. 614 Tribou, D. W., Corp l, Sept. 17, R t. Surg.G. B. Coggswell, 29th 574 Stanwcll, B. L., Pt., A, Sept. 19, Right: circ. Surg. Weatherby, C, 29th Mass. 17. 62. Mass. Disch d Jan. 13, 1863. 12th Alabama, age 22. 21, (>!. 6th Alabama. To prison Jan 615 *Trimble, J. E., Major July 3, . Surg. H. McGuire.C. S. A. uary 5, 18;>5. General, C. S. A. 3, 63. Transferred August 18, 1863. 575 Starin. F. D., Pt., II, 43d Nov. n, Left ; !Iap (also amp. right leg, up. 616 Tullis, J. IT., Lieutenant, July 2, Left. Surg. J. McC. Greene, C. Wisc iiisin, a:^o 19. 5, 64. third). Disch d July 2, 1865. Hardaway s Alabama 2, 63. .S. A. Recovered. Trans, for 576 Stark, II. M., Pt..G, 18th May 3 1, Left ; ciro. Surg. S. Marks, 10th Battery, age 24. exchange March 17, 1864. Infantry, aye 19. 31, 64. \Vis. (Also wound right foot.) 617 Turner, G., Pt., E, 1st May 31, Right; flap. Discharged Sep Disch d Dec. 2>, 1S64. Mich. Cav., age 34. 31, 64. tember 24, 1864. 577 Starr. A. D., Pt., H, 4th May 27, Left: circ. Surg. B.N. Bond, 27th 618 Tuttle, R. S., Corp l, F, July 11. Right; circ. Surg. J. P. Prince. Iowa, ago 20. 27, 64. Mo. Disc.h d May 23, 1865. 27th Michigan. 11, " 63. 36th Mass. Discharged Sept. 578 Step!, E. B., Pt., I, 35th Dec. 13, Left. Surg. W. A. Madill, 23d 16, 1863. New York. 13, 62. New York. Disch d June 6, 63. 619 Tyrrell, J. C., Serg t, I, Dec. 13, Right ; flap. Surg.W. D. Newell, 579 Stegor, .J., Pt., G, 52d Juno 1, Left. Discharged September 14, 28th New Jersey. 13, 62. 28th N. J. Discharged July New York. 1, 62. 1862. 6, 1863. 1 FISIIKU (G. J.), Report of Fifty-seven Cases of Amputations in the Hospitals near Sharpsburff, Md., etc., in American Journal Medical Sciences, 1863, Vol. XLV, N. S.. p. 48. 2 MuGL li:K (II.). Clinical RemarJcs on Gunshot Wounds of Joints, etc., in Richmond Medical Journal, 1866, Vol. I, p. 150. 502 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Mn NAME, MILITAKY Ol KliATIOXS. OPERATORS, Vit NAME, MILITARY D \TI":? Ol EKATIONS. OPERATORS, JJXU. DESCRIPTION, AND AGK. RESULT. AU. DESCRIPTION, AND AUK. RESULT. 020 Underwood, L. A., Cor April 2, : Left ; flap. Disch d Aug. 10, 65. 661 Woerts, C., Pt., I, ]08th Aug. 14, Left; circ. Surg. C. Spinzig, 2d poral, F, 4th Vermont, 2. 65. (Also wounds of right shoulder Ohio, age 20. 14, 04. Mo. Disch d June 16, 1805. age 21. ; and left hand. ) 662 Wolcott, II. P., Lieut.. Dec. 31, Left : flap. Surg.A.G. Hart, 41st 621 Van Kirk, A. .1., Pt, 1). May 12, Right ; circular. Surg. J. W. K, 41st Ohio. 31, 02. Ohio. Disch d May 27, 1803. 140th Penu., age 21. 12, 64. Wishart, 140th Penn. Disch d 663 Wolf, M., Pt., A, 160th Oct. 19, Right; circ. Discharged .Inly April 16. 1865. New Y ork, age 21. 20, 04. 10, 1865. 622 Van Kuren, J., Corp l, Mav 8, Left ; flap. Confederate surgeon. 664 Wood, W. Hf, I t., I, July 3. Right: circ. Discharged July B, 1st Mich., age 25. 8, ? 64. Discharged May 11, 18G5. 120th N. Y., age 23. 5, "03. 24. 1865. CJ3 Vanoeker, L., 1 t., F. Aug. 30, Left. Discharged October 2 .), 005 Woodruff, J., Pt.. K, July 4. Left. Dec. 18. re-amp, at June, of 104th New York. 30, 62. ]NI2. 57th Mass.. age 26. 4, 04. mid. and up. thirds. Dec. 22, 624 Vanpelt, 1>. P., I t., 1. June 1, Left ; circular. Discharged Feb ha?m. Disch d June 27, 1805. 14th N. J., age 24. 1, "64. ruary 3, 1865. 606 Woodward, J., Pt., ( , July 1, Right: ant. post. flap. Surg. J.M. 025 Van Scheffelin, A., I t.. Nov. 18, Right. A. Surir. N. It. Barnes, 14th N. Y. S. M. 1. 63. Farley. 14th N.Y. S. M. Dise d E, 76th N. Y., age 30. 19, 63. 70th N. Y. Disch d J uly 22, 64. Feb. -JO, 1804. ftjjn: 430!). 626 Vincent, H. G., Pt., II. April 6, Right. Discharged June 18, 62. 667 Worley, C. L. F., It., A, July 1, Right. Retired October 14, 1H04. 15th Iowa, age 21. 7, 62. 5th Ala., age 22. 1, 63. 627 Voaglin, F., Pt., G, 44t*t Sept. 17, Left. Dec. 16. reseo. of nee. tibia. 668 Wrieth, II., Pt., B, 20th July 28, Left; flap. Confederate surgeon. Alabama. 17, 62. Furloughed March 2. 1863. Mass., age 26. 29, 04. Discharged August 13, 1805. 628 Wallace, G. 11., Pt., I, Julv !>, Right; flap. Discharged March 669 Wright. P., Pt., H, 39th Feb. 11, Left; flap. A. Surg. F. B. Kim- 9th C. Troops, age 22. 9, 64. 21, 1865. Col d Troops, age 29. 11, 65. ball, 3d New Hamp. Disch d 1 Warner, G., Lieut., K. Mar. 14, Right; circ. Surg. G. A. Otis, October 19, 1865. 27th Mass., age 26. 14, 62. 27th Mass. Recov., prom., and 670 Wvbourn.W. A., Serg t, Feb. 0. Right; circ. Surg. A. S. Cue, transferred to Vet. Res. Corps. I, 147th N. Y., age 23. C, 65. 147th N. Y. Duty April 3, J865. 630 Waterhouse, B. W., Pt., July 24, Right ; ant. post. flap. Surg. Prom. Lieut. Dis. June 7, 1805. ft, 23d Ohio, age 27. 24, 61. Duffv, C. S. A. Disch d May 671 Yateg, S., Corp !, H, 33d Mar. 25, Left: circular. Released June 18, 1865. Virginia, age 38. 26, 65. 14. 1865. 631 Watrous, H. S., Pt., A, July 1, Left. Trans, to Headquarters 672 Yerkes, W. H., Pt., C, Sept. 17, Right. 1 Hseharged May 1 J , 1803. 2d Artillery, age 20. 1, 63. January 17, 1864. 128th Pennsylvania. 17, 62. 632 Watson, W. H, Pt., A, Aug. 18, Right ; circular. Recovered. 673 Young, F.V.,Pt., 1,111th May 6, Right : flap. Confed. surgeon. 33d Alabama, age 24. 18, 64. New York, age 18. 6, 64. Discharged June 16, 1865. 633 Weaver, J., Pt., K, 12Gth Sept. 19, Right; circular (also wound left 674 Young, G. A.,Pt., F,5th Nov. 7, Left. Discharged August 19, 04. Ohio, age 20. ]!), 64. leg). Discharged June 2, 1865. Artillery, age 23. 7, 63. 634 Webb, J., Pt., C, 155th May 8, Left ; ant. post. flap. Discharged 675 Young, j . B.,l t., K, llth Mav 16, Left : flap. Surg. R. B. Jessup, Penn., age 2(i. 8, 64. April 6, 1865. Indiana, age 21 . 17," 03. 24th hid. Discharged August 633 Webber, ir. A., Capt., A, May 10, . Surg. C.C. Henkle.C.S. A. 31, 1864. 23d Virginia. 10, 64. Recovered. 076 Ziegler.S. R., Pt.,A,49th May 5. Left; flap. Discharged Novem 636 Weber, T., Pt., 5th Ohio July 12, Left; ant. post. flap. Surg. C. Penn., age 23. 6, 04. ber 10, 1864. Batter)-, age 20. 12, 63. Carle, 41st 111. Gang. Oct. 7, 077 Abbott, J. I., Pt., C, 2d June 27, Right: circular. Died August re-amp, by Luke s flap method. Conn. H. A., age 20. 27, 64. 20, 1804 ; typhoid fever. Discharged Sept. 13. 1864. 678 Adams, N., Pt., D, 30th June 17, Left. Died June 29, 164; gan 637 Weeks, J., I t., K, 4th Dec. 7, Loft; circular. To Provost Mar Wisconsin, age 34. 17, 64. grene. Florida, a^e 20. 7, 64. shal March 21, 1805. 079 Anderson, D., Corp l, H, Aug. 21, Left (also amp. right leg at mid 038 Welch, J. M., Pt., B, 9tu Oct. 29, Left ; flaps. Surg. D. B. Allen, 7th Maryland, age 41. 21, 04. dle). Died Oct. 1, 1864. Iowa, age 19. 29, 63. 30th Iowa. Disch d Aug. 26, 64. 680 Angell, G. W., I t., K, Dec. 31, ; erysipelas. Re-amputat n. 639 Weschke, C.,l t,, U, 67th May 12, Right: ant. post. flap. Surg. R. 18th Ohio. , 62. Died March 18. 63 ; exhaustion. New York, age 30. 12, 64. Sharp, 15th N. Jersey. Disch d 681 Arahood, J., Pt., C, 17th Sept. 19, Left. Died October 17, 1803; May 11, 1865. Ohio. , 63. pneumonia. 640 West, J. SI., Pt., C, 9:th Mav 26, Left; circ. Surg. E. B. Glick, 682 Artc, Ph., Saddler, H, Aug. 11, Left: flap. Died November 17, Ohio, age 30. 26, 64. 40th Ind. Disch d Nov. 12, 64. 17th Penn.Cav., age24. 11, 64. 1864. Spec. 3395. 683 Austin, J., Pt., G, IHh De.31, 62, Right. Died January 20, 1803. 041 Wetherbee, J. M., S g t, Nov. 27. Left. April 4, 18(54, re-amp, in Michigan. Jan. 1, 03. B, 151st N. Y., age 25. 27, 63. upper third. Discharged July 684 "Austin, S. J., Pt., A, 33d June 1, Right. Died July 18, 1864. 6, 1865. Massachusetts. 1, 04. 642 Whartum,J..l>t.,K, 10th May 2, Right. Recovered. 685 Baker, S., Pt., B, 8th W. Aug. 23, Left. Died September 20, 1803. Louisiana. 2, 63. Virginia. , 03. 643 Wheeler, J.R.,Pt.,C,2d Dec. 13, Left. Re-amp, in upper third in 686 Bakehouse, II., Pt., B, June 3, Left : circular. Died April 9, Vermont, age 25. 13, 62. 1863. Disch d April 22, 1864. 82d Penn., age 36. 3, 04. 1865. Spec. 1 358. 687 Banks, S., Pt., C, 43d July 30, Lelt (also ampiitat n right thigh). 644 White, A., I t., E, 52d Sept. 5, Right; flap. DiscVd Sept. 20, 64. Colored Troops. 30, 04. Surg. D. MacKay, 29th Colored Penn., age 23. 5, 63. Re-amputation May, 65. Died Troops. Died July 31, 1864. May 8. 1865. 688 Barstow, T. A., Serg t, May 27. Right. Died May 27, 1863. 645 White. B. E., Pt.,E, 16th July 3, Left. Discharged October 29, B, 15th New Hamp. 27, 63. Vermont. 4. 03. 1863. 689 BaTnftt.D. J.,V\., B, 42d May 15, Left. Surg. E. Hutchinson, 137th 646 White, J. E., Serg t, F, Oct. 19, Left; lat. flap. A. Surg. D. II. Alabama. ," 64. N. Y. Died May 25, 1864. 160th X. York, age 34. 21, 64. Armstrong, 160th New Y ork. 690 P.assett.G. L.,Pt.,G,19th May 15, Left. Died May I d. 1804. Discharged April 28, 1865. Michigan. 15, 04. 647 Wliitesell, D. A., Serg t, July 2, Left: flap. A.Surg.H.K.Spooner, 691 Bates, E. C., Pt.. C, 9th June 30, Right. Died August 12, 1864 : C, 5th Art y, age 20. 3, 63. 55th Ohio. Disch d Oct. 12/03. Maine, age 17. 30, 04. exhaustion. fi48 Whitlow, J. II., Pt., A, Julv 2, Right. Retired February-2, 1865. 692 Baysman,T.,Pt.,D, 14th Mar. 30, Right (also w (1 left leg and hand); 57th Virginia. 3, 03. Col d II. Art y, age 22. . 65. sloughing. Died May 16, 05. 649 Wilcox, B. F., Pt., E, Julv 20, Right flap; gangrene. Disch d 693 Billings, D., Serg t, A, July 20, Right. Died October 9, 1804. 149th N. York, age 22. 20," 64. August 8. 1 865. 149th New Y ork. 20, 64. 650 Wilder, W. W., Pt., K, Aug. 29, Right; double flap. Discharged 094 Bird. E., Pt., II, 8th Sept. 30, Left. Died October 24, 1804; 3d Mich., age 27. 30, 62. July 30, 1863. Michigan, age 19. Oct. 1/64. exhaustion. 651 Williams, H.,Pt.,K, 98th April 9, Left; circ. (amp. right foot, Hey s 695 Black, A., Pt., A, 3d N. .Inly 30, Left; circular : sloughing. Died Pennsylvania, age 23. 9. 65. method). Disch d Oct. 6. 1865. Jersey, age 43. 30, 64. August 28, 1804: pyaemia. 652 Williams, J. B., Pt., H, Julv 19, Left: flap. Discharged Julv 4, 096 Boling" R. E., Corp l, D, June 24, Left. Died July 25, 1804. 2d Penn. Art., age 27. 19, 64. 1865. 6th Kentucky Cavalry. 24, 04. 653 Williams. S. W., Serg t, Oct. 26, Right; circ. Discharged Feb. 4, 697 Borosky, J., P1..A, 199th April 9. Right. Surg. C. M. Clark, 39th C,27th MIL. age 29. 26, 63. 1864. Died Dec. 19. 1871. Pennsylvania. 9. 65. Illinois. Died May 8. 1865. 654 Williams, W. P., Pt., B, Sept. 29, Left ; circular. Disch d March 698 Bounds, 0. J., Pt.. II, 39th Dec. 16, Right; circular. A. A. Surg. R. 188th Penn., age 18. 29, 64. 26, 1865. Alabama, age 18. 16, 64. L. McClure. Died Feb. 2, 1805; 655 Willis, W., Pt., I, 8th Mar. 20, Right: lateral flap. Surg. J. D. chronic diarrhcra. Maine. 27, 63. Mitchell, 8th Maine. Disch d 699 Boivcn, ft., Pt., E, 32d Mav 15, . Died May 23, 1804. December 24. 1863. Alabama. .." 64. 656 Willison, S. D., Pt., C, June 3, Right. Discharged February 4, 700 Bowman, D..Pt., B, 15th Juno 3, Left. Died July 18, 1864. 2d Mich., age 28. 3, 64. 1865. Infantry, age 24. 3, 64. 657 Wilson. U., Pt., A, 73d Ohio, age 29. Oct. 29, 29, 63. Right. Discharged February 24, 1864. Died in 1865. 701 Boyd, W.J., Pt., D, 21st North Carolina, age 28. Oct. 19, 19, 64. Right: circular. Died Novem ber 10, 1864; pyaemia. 658 Wilson, R. E., Major, Nov. 30, Left: circular. To Provost Mar- 702 Briggs. K. C., Pt., P., Sept. 19, . Died October 21, 1863. 37th Georgia, age 33. De<!.l. G4. shal March 18, 1865. 125th Ohio. 19. 63. 659 Wilson, S. L., Lieut., F, Dec. 29, Left. Discharged August 14, 03. 703 Brown, A., Pt., A, 5th Julv 7, Left. Died July 24, 1864. 114th Ohio. 29, 62. N. Y . Cavalry, age 47. 9, 04. 600 Wise, W. M., Lieutenant. May 15, Right. Surg. F. A. Walker. Re- 704 Bryan, M. W., Pt., G, Aug. 7, Right (amputation arm). Died 15, 64. j covered. Furloughed. 11th Michigan. 7, ^04. September 6, 1864. 1 OTIS (G. A.), Army Meilical Intelligence, in IJoston Medical and Suryical Journal, 1862, Vol. LXVI, p. 239. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 503 NO. NAME. MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 705 Bryant, J., Pt., G, 23d May 14, Right. Died July 14, 1864. 749 Green, J. L. W., Pt., F, Dec. 13. Right: circular. Died January Michigan. 14, 64. 26th New York. 13, 62. 2, 1863. 786 Bunn, J. K., Pt., 6th N. May 28. Left ; circular. Died June 22, 750 Green, R. B., Pt., G, 7th Dec. 13, Left. Died January 2, 1863. York Battery, age 19. 28," : 64. 1864 ; pyaemia. Rhode Island. , 62. 707 Burge, W., Pt, K, 103d Nov. 25, Left. Surg. J. Hutchison, 15th 701 Griffith, J., Pt., H, 4th June 2, Right ; circular ; sloughing. Died Illinois. 25, 63. Michigan. Died Dec. 16, 1863. Delaware, age 39. 4, 64. July 1, 1804. 708 Burr, G., Pt., K, 25th June 30, Left; sloughing, Died July 12, 752 Hall, H., Pt., K, 50th July 22, Right. Surg. J. C. Welch. 20th Mass., ago 39. 30, 64. 1804 : exhaustion. Ohio, age 20. 22, 64. Kentucky. Gangrene. Died 709 Campbell, S., Pt, A, 63d June 3, . Surg. J.W. Wishart, 140th Septembers, 1804. New York. 3, 64. Penn. Died June 8, 1864. 753 Hall, J. F., Pt., B, 68th July 3. Right. Died August 1, 1803 710 Carknaril, J. E.. Pt., E. June 10, Left ; circ. Surg. J. E. Pomfret, Pennsylvania. -, ; 7th N. Y. Heavy Artil 17, 64. 7th N. Y. H vy Artillery. Died 754 Hanson. J., Pt, K, 3d July 4. Left. Died July 9, 1804. lery, age 21 . July 28, 1864. Wisconsin. , 64. 711 Carney, A. li., Pt., E, Mar. 25, Right. Died April 19, 1865. 755 Harrigan,W..Pt.,M,24th June 16, Right. Died July 13, 1864. 55th N. Carolina. 25, 65. N. York Cav., age 21. 10, 04. 712 Carrington, W. 1 1 ., Serg t, Mar. 14, Left. Died May 9. 1862. 756 Harris, R.. Pt., G, 132d Feb. 1 . Left: circ. A. Surg. J.W. Gray, E, 51st New York. 14, 62. New York, age 20. 2, 04. 96th N. Y. Died May 20, 1864, 713 Chedister, J. A., Pt, I, Sept. 3, Left. A. A. Surg. J. R. Uhler. unTlcr intt. chlo. during operat n. 15th West Va., age 30. 4, 64. Died October 3, 1804. 757 Hart, J., Pt., G, 74th July 22, Right. Died August 14, 1864. 714 Childers,JU., Pt, G, 15th April 6, Left. Died May 5, 1805; gan Indiana, age 29. 22 " 04 Virginia, age 42. 8, 05. grene. 758 Hartman, T. R.. Serg t, Mar. 30, Right: lateral flap. Died June 715 Christy, D. L., Serg t, C, May 5, Left ; circular. Died June 18, K, 88th Penn., age 21. 31, 65. 7, 1865. . 102d 1 eun., age 24. 6, 04. 1804 ; exhaustion. 759 Henry, P., Pt., C, 78th May 31. Left. Died July 15. 1804. 716 Cobleigh, J. W., Serg t, Mar. 25, Right : flap. Died March 28, 05 ; Pennsylvania. 31, 64. A, IstVt H. A., age 24. 25, 65. exhaustion. 760 Higgius", A..Pt. E. 104th Aug. l!, Left; ant. post. flap. Surg. E. G. 717 Cogan.W. Il.,l t, l!,69th Aug. 16, 1 6 04 Left. Died September 16, 1804 ; New York, age 23. 19, 64. Chase, 104th N. Y. Died Sept. *^3 1804 erv**iix*l is 718 >Cox,J. / .,Capt.,D, 29th Aug. 31, Left; gangrene; erysip. Died 761 Hilsondegen, J., Pt., F. Sept. 30, Left, Died November 0, 1804 : Mississippi, age 31. 31, 04. October 31, 1864. 16th Michigan. 30, "64. pyaemia. 719 Crowlev, J., Pt., K, 88th May 1, Right (also amp. left great toe); 702 Hinkle,J. H.,Pt.,I,70th May 15, Left. Died June 1, 1864. New York. 1, "03. haem. Died May 26, 1863. Indiana. 15, 64. 720 Culler, M., Pt., IF, 73d Nov. 30, Left, Died December 28, 1864. 763 Hobson, .I.E., Pt., Brook s May 2, ; flap; typhoid fever; haem. Illinois, age 22. Dec.1, 04. 1st Va. Art v, age 23. 4, ; 63. Died May 29, 1863. 721 Daugherty, J., Pt.,C, 1st July 1, Left (also w d of leg). Surg.G. W. 764 Holmes, W. j .,V\.,( ,, 33d July 20, Loft ; circ. Died Dec. 24, 1804 ; Delaware. 1. 03. New, 7th Ind. Died July 3, 63. Mississippi, age 18. 22, 04. chr. diarrh. Specs. 4243, 4244. 722 Davis, A. W., Corp l, F, July 12, Right. Confed. surgeon. Aug. 705 Honestea, L.,Pt, B, 10th May 5, Right. Died November 2, 1804; 14th N. C., age 24. 12, 04. 4, re-amp, upper third. Died Infantry, age 18. 5, 64. variola. Aug. 10, 1804. Spec. 2923. 766 Howell, J. H., Pt.,C, 23d May 14. Left. Surg. D. L. Heath, 2: Id 723 Davis, W., Pt., H, 48th June 3, Right ; circular. Died Septem Michigan. 14," 64. Mich. Died July 6, 1804. Pennsylvania, age 28. 3, 64. ber 5, 1864 ; diarrhoea. 767 2 Hoyt, H. H., Pt., D, 6th Oct. 2. , Right ; post. flap. A. A. Surg. T. 724 Davis, W., Pt., A, 31st July 30, Left; ant. post. flap. Died Sept. Connecticut. 24, 62. T. Smiley. Died Oct. 30, 1862; Maine, age 19. 3 1, " 04. (i, 1864 ; pyaemia. gangrene . Spec. 733. 725 DeBarr, G., Pt, B, 109th July 14, Loft ; pyaemia. Died September 7> - Hubbard, J., Pt., I, 10th Dec. 14, Left ; circ. Surg. G. A. Otis, 27th New York, age 35. 14, 04. 25, 1864. Connecticut, age !>8. 14, 02. Mass. Haem. Died Dec. 10, 02. 726 Detchon, W. F., Pt., 9th July 30, Left; circular; sloughing. Died 769 Hukill, W. T., Pt., E, May 16, Right. Surg. J. Pogue, GOth 111. Co., 00th Ohio, age 19. 30," 04. August 13, 1804; exhaustion. 66th Illinois. 16, 64. Died July 9. 1804 ; pyaemia. 727 Devereux, C.. Corp l, F, Oct. 19, Right : ant. post. flap. Died Nov. 770 Hyatt, C., Capt, E, Oth Aug. 21, Left. Die d September 22, 1864. 1 1th Vermont, age 33. 19, 04. 17, 1864; exhaustion. Wisconsin. 21, 04. 728 frangan, C., Pt, H, 32d Nov. 25, Left. Died March 2, 1864; in 771 Ingraham, G. M., Pt., M, June 24. Left; circular. Died August 10, Alabama, age 28. , 63. flammation lungs. 4th N. Y. H. A., age 19. 24, 04. 1864. 729 Easterbrook, S., Pt., F, May 12, Right. Died May 24, 1804 ; ery 772 Johnson, J. M., Pt., E, July 30, Left; circ. Surg. F. M. Weld. R. Island Art., age 48. 12, 64. sipelas. 43d Col d Troops. 30," 64. 27th C. T. Died Aug. 5, 1864. 730 Edson, H., Pt., C, 22d May 10. Left ; ant post. flap. Surg. I. H. 773 Johnson, T. B., Pt., II, Nov. 30, Left ; circular. Died May 27, Massachusetts, age 35. 11, 64. Steans, 22d Mass. Sloughing. 19th Arkansas, age 35. 30, 64. 1865. Died Juno 30, 1804; exhaustion. 774 Johnson, Z., Pt., I, 8th May 9, Left. Died June 6, 1862. 731 Elder, W.. Pt, F, 03d May 5, Right (also tract, cranium); circ. Wisconsin. , 62. Pennsylvania, age 21. 6, "64. Died May 30, 1804. 775 Jones, P., Pt., I, 9th Sept. 29, Right. Died October 12, 1804. 732 Fisher, L>. E., Pt, B. Oth July 20, R t. Surg. A. M.Wilder, U. S.V. Col d Troops, age 23. 29, 64. Pennsylvania, age 31. 20," 64. Died Nov. 12, 04 ; exhaustion. 776 Kendall, Z., Pt., G, llth June 1, Left. Surg. H. Plumb, 2d Conn. 733 Flore, C., Pt., G, 10th April 5, Left ; circ. A. Surg. F. H. Milli- Vermont. 1, 04. H. A. Died Oct. 31, 1804. Minnesota, age 23. 5, 65. gan, 10th Minn. April 20, re- 777 Kent, H. O., Pt., E, 4th Dec. 13, Right. Died December 19, 1862: amputation. Died May 11, 05. Vermont. 13, 62. tetanus. 734 Fogle, M. P., Corp l, A, June 14, Right. Surg. R. Watts, "jr., 133d 778 Kipp, G. J., Pt, I. 1st May 5, Left. Died June 20, 1864. 133d New York, age 31. 14, 63. N. Y. Haem.; lig. post, tibial. New Jersey, age 21. 5, 64. Died Nov. 17, 1803. 779 Krappman, A., Pt., A, July 2, Left. July 16, haemorrhage, 24 735 Forbes, J. K., Pt,, A, 5th Sept. 19. Left Died September 23, 1862. 40th N. York, age 29. 4, 63. ounces ; fatal. Iowa. 19, 62. 780 Lamphere, L. O., Pt,, E, June 30. Right (also amput n left thigh): 736 Foxier, C. R, Pt., D, 27th Aug. 21, Right ; circular ; pyaemia. Died 21st Conn., age 19. 30, 04. sloughing. Died July 22, 64; South Carolina, age 29. 22, 64. September 17, 1804. tetanus. 737 Fox, J. M., Pt., C, 61st July 22, Left. Died August 27, 1804. 781 Larkins, J., Pt., E, 37th July 30, Right: circ. Surg. G. W. Snow, Ohio. 22, 64. Wisconsin. 30. 64. 35th Mass. Died July 30, 18 i4. 738 Francis, C., Pt., H, 83d Juno 27, Left. Aug. 6, ro-amput n. Died 782 Laughlin, E. AV., Pt., E, Jan. 11, Left. Feb. 9, re-amput n. Died Pennsylvania. 28, 62. August 9, 18(52; pyaemia. 77th Illinois, age 19. 11, 63. February 1 9, 1863 ; pyaemia. 739 Frost, A. C., Pt.,C, 15th July 2, Left. Sept 12, amp", thigh. Died 783 Layton, J., 1 t., F, 4th June 19, Right. Surg. W. Watson, 105th Massachusetts. , 63. Sept, 10, 1863 ; gangrene. N. Y. Heavy Artillery. 20, 64. Pennsylvania. Died June 28, 740 Fry, W. H., Pt., H, 50th May 12, Left Died June 14, 1864. 1864. Spec. 2649. Pennsylvania, age 21. 13," 64. 784 Leesholts, W., Pt., G, May 25, Right. Surg. H. B.Whiton, 60th 741 Galligh er, T., Pt., D, 4th June 3, Left. Died June 11, 1864. 147th Pennsylvania. 25, 04. N. Y. Died June 4, 1864. Delaware. 3, 64. 785 Leight, E. P., Serg t Maj., May 4, Right; circular. Died July 12. 742 Gerhart, J., Pt., B, 49th May 10, Left. Died June 1, 04 ; pyaemia. 1st Mass. Cav., age 24. 4, "04. 1864. Pennsylvania, age 32. 10, 64. 786 Lieber, J., Corp l, B, 1st Nov. 24, Left Died December 27, 1863. 743 Gibbs, M., Pt., C, 139th April 2, Left ; ant. post. flap. Died May Ohio. 24, 63. Pennsylvania, age 32. 2, 05. 10, 1865 ; exhaustion. 787 Littlefield, L. P., Pt., K, May 19, Right; flap: erysipelas; gang. 744 Gillam, J. 11., Pt., K, Sept. 14, : sloughing. Died October 1st Mass. H vy Art y. 19, 64. Died May 24. 1864. 15th North Carolina. 16, 62. 12, 1862. 788 Livingston, J., Pt., A, 1st May 9, Right; lateral flap. Surg. S. S. 745 Goodsell, C. H., Pt., C, May 3, Left. Died August 3, 1863. Mich. S. S., age 18. 10, " 64. French. 20th Michigan. Died 124th New York. 3, f S3. June 21, 1864; pyaemia. 746 Goodwin, T., Pt., H, 22d May 15, Left : circ. Surg.W. C. Bennett, 789 Lockland, B., Pt., C, 3d Sept. 23, Left. Died October 11, 1803. Wisconsin. 15," 64. U. S. V. Died July 12, 1864. Artillery, age 25. 23, 03. 747 Graff, S., Pt., B, 83d May 3, Right. Died July 3, 1863. 790 Long. M. B., Pt, B. 12th Aug. 30. Loft. Surg. E. M. Rogers, 12th Pennsylvania. 3, "63. Wisconsin, age 24. 30, 04. Wis. Died Nov. 23, 1864. 7-18 Grant, P., Pt., B, 67th May 12, Left. Died May 24, 1864. 791 3 Looney, M., Pt., B, 1st May 31, Left; circular. Died June8, 64: Ohio. 12, 64. Mass. Cav., age 23. J el, 04. pyaemia. 1 JONES (J.), Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene, etc., in U. S. San. Com. Mem., Surg. Vol. II, p. 260. 2 SMILEY (T. T.), Twenty Cases of Gunshot Wounds, in Boston Medical and Surgical Journal, 1863, Vol. 68, p. 419. 3 Lll>KI.T. (J. A.). On lite Secondary Traumatic Lesions nf Bone, etc., in U. S. Sanitary Commission Memoirs, Surgical Volume I, N. Y., 1870, p. 283. 504 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAMK, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS. OPERATORS. RESULT. No. NAME, MILITARY ., DESCRIPTION, AND AGE. OPERATIONS, OPERATORS, RESULT. 792 Loper, It., 1 t., F, 25th May 14, Left. Died July 21 , 1864. 839 Roach, W., Pt., F, 27th June 18, Left. Surg. G. T. Stevens, 77th Michigan. 14," 04. Massachusetts, nge 44. 18, 64. New York. Died July 6, 1864 ; |793 % Lottridge, D. P., I t., M, Dec. 6, Left : circular. Died. December exhaustion. 2d New York C avalrv. ; 6, 04. 20, 1804; exhaustion. 840 Rogers, J. F., Pt.,G, 24th April 8, Right. Died May 17, 1864. 794 Lovilett, P.C.J t., H, 1st May 19. Right: flap. Died June 7, 1864. Iowa. 8~ 64. Mass. H. Art v, ago 23. 19, 04. 841 Rosser, J., Pt,, B, 110th Oct. 19, Left. Died October 24, 1864. 795 Luther, F., Corp l, K, July 3, Right. Surg. C. S.Wood, 00th N. Ohio. 19, 04. 52d North Carolina. , ? 63. Y. Died Sept. 14, 1863. 842 Ryan, T., Pt., E, 8th Aug. 21, Right ; circ. Surg. A. A. White, 796 Magnus. X., Pt., A, llth Aug. 25, Left; Teal s method. Surg. C.E. Maryland, ago 23. 21, 04. 8th Md. Haem., 32 oz. Died Colored Troops. 20. 0-1. Swasev. 1 . S. V. Died March Sept. 16, 1864; haemorrhage. 12. 1865. 843 Sabine, C. D., Corp !, II, April 9, Left; circ. (also w nd clavicle); 797 Marks, P., Corp l, A, 1st July 2, Right. Surg. C. S. Wood, 60th 100th New York. 11, 63. slough.; pneum. Died April 30, Minnesota. 2, 63. N. Y. Died July 24, 1803. 1863; pyaemia. Spec. 1188. 798 Marquis, W. II., Pt., K, Aug. 27, Left (amp. right shoulder joint); 844 Sackhimer, G.F., Serg t, June 22, Left; circular. Died June 29, 8:Jd Penn., age 20. : 27, 03. lig. brachial. Died Sept. 12. 03. H, 81st Penn., age 27. 24. 64. 1864 ; gangrene. 799 Marsh. W.W., Pt., I, 14th .July 20, Loft: flap. Surg. W. V. White, 845 Snncerman, G, Corp l, G, May 5, Left: circular. Died May 30, New York Heavy Ar- 2<i, 64. r>7th Mass. Died Jan. S3, 1 865 ; 105th Penn., nge 34. 5, 04. 1804 ; exhaustion. tillery, age 29. phthisis pulmonalis. 810 Sanford, L., Bugler, C, July 3, Left. Died July 12, 1863. 800 Martin, F., Pt., K, 1 th July 24, ; Left ; flap. Died Aug. 7, 1801; 73d Ohio. , " 63. Maine, age 20. 24," 64. exhaustion. i 847 Schappie, N., Pt., K, 7th April 7, Left; flap: gangrene; anannia; 801 McAfoot. (J. W., Pt., A, Dee. 13. Left ; erysipelas. Died April 11, New York, age 30. 8, 05. diarrhoea. Died May 12, 1865. 8th Penn. lies., age 20. ].">. 02. 1803: nvmmia. 848 Schmehl, M., Pt., D, Mar. 31, Left. April 24, re-amput n. Died 802 McCuhan, J. D., Pt., H, .Inly 20, ! Left. Died July 2,">, 1864. 198th Penn., age 19. 31, 05. April 25, 1805: tetanus. 40th Pennsylvania. 20." 04. 849 Seville, J., Pt., II, 123d Dec. 13, Left. Died December 26, 1862; 803 McCardle, J., Pt., E, 2d July 2, Right (also amp. left upper third). Pennsylvania. , 62. tetanus. Pennsylvania, age 23. 2, 04. Died July 3, 1804. 850 Shannon, E., Pt., I, 38th April 13. Lett. Died May 5, 1863. 804 McCool, A., Pt., E, 188th June 1, Right (also flesh w d right thigh); Massachusetts. 13. 63. Pennsylvania, age 21. 1, 64. circular. Died July 21, 1804. i 851 Shea, D., Pt., F, 13th June 3, Left. Died June 25, 1864. 805 McCool, J.G.,Pt., I, 44th Sent. 19, Left. Died October 13, 1863. ; New Hampshire. 3, 64. Illinois. 19. 03. 852 Simmington, J. S., S g t, Sept. 10, Right. Surg. E. A. Clarke, 8th 801 McGraw, F., Pt., K, 42d July 3, Right. Died August 14, 3803. i B, 10th Illinois (Jay. 10, 63. Mo. Cav. Died Oct. 9, 1863. New York. 3, 3. 8.">3 Smiley, W. J., Pt.. F, June 24, Right. Died September 22, 1864. 807 Mc.Guire, J., Corp l, D, Mav 5, Left. Died May 14, 1804; haem 9th Alabama Cavalry. , 04. 40th New York, age 21. 5, *64. orrhage and exhaustion. 854 Smith, G. M., Pt., B, Oth June 20, Right. Died July 18, 1863; py- 808 McMillan/I ., Col d serv Nov. 25, Left. Surg. A. M.Wilder.T.S.V. Ohio Cavalry, age 38. 21, 63. aomia. ant, r>0th Pennsylvania. 25, 03. Died Decembers. 1803. 855 Smith, .1. S., Pt., F, 2d June 2, Left; flap. Dr. A. Garcelon, of 809 Meekins, J., Pt. , F, 2d July 18, Right; flap. Died August 11,: N.Y. H vy Art., age 17. 2, 64. Maine. Died July 29, 1864. Penn. Art v, age 45. 18, 04. If 64. 850 Smith. W. H.. Pt.. II. June 1, Left. Died June 28, 1864. 810 Mitchell. C. J5., Lieut., Sept.1, Left. Died September 20, 1804. 23d Penn., age 22. 1, 64. E, 14th Ohio. , 04. 857 Southworth, W. B., Pt., Nov. 25, Left. Died April 2, 1864, of ty 811 Mitchell, W. J., Pt., F, June 17. Right. Died July 21, 18G4. F. 42d Illinois, age 25. 25, 63. phoid fever. 50th Mass.. age 40. 18, 04. 858 Spriggle, 15., Pt., J,17th July 10, Left ; flap. Died August 16, 63. 812 Miz:elle, R., Pt,, D, 17th May 21, Left; circular. Died August 1, Penn. Cavalry, age 28. 10, 63. Spec. 3878. North Carolina, age 18. 21," 64. 1804. 859 Stahli, U., Pt.,"B, 187th Aug. 19, Left ; circular. Died September 813 Monson, J., Pt., H, 2d June 1, Left; circular. Died August 30, Penn., age 17. 20, 64. 7, 1864 : pyaemia. Conn. H. Art., age 27. 3, 04. 1804. 860 Stiers, W.. Pt., A, 97th June 22, Right. Died July 27, 1864. 814 Moore, A., Pt., A, 61st July 12, Left; gangrene. Died August Ohio. 22, 64. Pennsylvania, age 25. 12, 04. 7. 1804. 861 Stiteler, C., Pt., D, 16th Sept. 19, Right. Died September 29, 63 : 815 Moreloc k,W.,Pt., 1, 19th May 15, Left. A. Surg. D.L. Jewett. 20th Infantry. 19, 63. tetanus. Michigan. 15, 64. Conn. Died June 24, 1804. 862 Stover, J. II., Pt., 188th June 1, Left; ant. post, skin flap. Died 816 Murray, J., Pt., D, 51st May 0, Right. Died May 20, 1804. Pennsylvania, age 21. 1, 64. June 30, 1864: gangrene. New York. , 64. 863 Sutfin. M., Pt., II, 8th N. June 3, Left. Died August 13, 1804. 817 Myres,G., Corp l, li, 14th Aug. 18, Right ; circular. Died Septem Y. H vy Art v, age 28. 3, 64. Infantry, age 23. 18. 64. ber 11, 1804. 864 Swinger, J.,Pt .,K, 130th Aug. 3, Right. Surgeon J. W. Lawton, 818 Nash, ./. V., Serg t, K, July 20, Right. Sept. 20, re-amputation. Indiana, age 1 8. 3, 64. U. S. V. Died Sept. 1,1864. 40th Miss., nge 17. 20, 04. Died October 4, 1804. 865 Sykes, W. E., Corp l, G, May 19, Left ; flap. Died June 1, 1864. 819 Xason, H., 1 t., C, 1st R. Nov. 30, Right (also amp. left, mid. third); 1st X. Y. Art y, age 47. 19, 64. Island Art y, age 38. Dec. 2, 63. circular; gangrene. Died Dec. 860 Taylor, W. W., Pt., G, Aug. 20, Right ; circular. Died Septem 21, 18013; pvajmia. 25th S. C., age 25. 21, 04. ber 12, 1804; pya-mia. 820) Nock, P., Pt., E, 1st May 27, Both. Died May 27, 1803. 867 Taylor, W., Pt., II, 65th Sept. 19, Left. Died October 13, 1863. 821J Louisiana. 27," 03. Ohio. 19, 63. 822 O Neil, E., Pt., K, 124th May 31, Right. Died June 21, 1864. 868 Tliilks,M. J., Pt..A,19th Virginia. July 2, , 63. Right. Died August G, 1803. 823? Ohio. Paine, A. C., Pt., F, 42d 31, 64. July 2, Both. Surg. II. M. McAbce, 4th 869 Thomas, F., Corp l, 10th July 14, * . Died July 17, 1864. 8245 New York. 3, 63. Ohio. Died July 23, 1803. >7 i Michigan. Tibbetts, S., Corp l, D, , 64. June 18, Left ; circular. A. A. Surg. O. W. 825 Palm, J., Pt., F, 22d Aug. 21, Left; circular. A. Surg. C. W. 1st Me. H. A., age 29. 20, 64. Peck. Died July 30, 1804. Penn. Cavalry, age 19. 22, 04. Stinson. 23dlll. Died Sept. 2/04. 871 Timer, F., Pt., F, 189th Mar. 30. Left : gangrene. Died April 28, 620 Parker, M. F., Pt., E, May 15, Left. A. Surg. G. M.Trowbridge, New York. 31, 05. 1865; exhaustion. 19th Michigan. 15, 64. 19th Mich. Died May 25, 1804. 872 Van Buren, J. II., Pt., G, Sept. 19, Left ; circular. Died October 7, 827 Patterson, J., Pt., G, 2d June 16, Right. Died June 22, J 804. 2d Conn. H vy Art y. 19, 64. 1864; exhaustion. Penn. H. Art }", age 29. 10, 04. 873 Vandruff, H. C., Corp l, Dec. 16, Left. A. A. Surg. J. C. Thorpe. 828 Perry, A., Pt., E, 6th Dec. 13, Right. Died January 27, 1863. A, !)7th Ohio. 16, 64. Died January !>, 1865. New Hampshire. 13, 62. 874 Wakefield.W.,Pt.,E, 2d Mar. 31, Left. Surg. S. H. Plumb, 82d N. 829 Perry, O., Pt., F, 41st July 12, Right; gangrene; amp. thigh. Ohio Cavalry, age 20. A p. 1, 65. York. Died "June 4, 1805. Illinois. 12, 63. Died September 12. 1803. ft7 r Ward, T., ( apt., F, 67th Oct. 13, Left. Died October 21, 1804. 830 I hillips, W. A., Pt., B, July 12, Left; ciro. Surg. W. P. Young, Ohio, age 31. 13, 64. 14th Georgia, age 25. 13, C4. 4th Georgia. Died July 24, 04. 870 Wassenberg, J., Pt., I, Nov. 25, Left. Surg. J. Reily, 33d N. J. 831 Pickle, A. H.,Pt.,G,68th July 2, Left. July 10, haemorrhage, 24 oz. 27th Penn., age 23. 25, 63. Died April 1<>, 1804. Pennsylvania, age 25. , *63. Died July 12, 1863. 877 Webster, G. W., Pt., I, May 6, Left. Died May 27, 1864. 832 Potter, II. W., It., G, July 2, Right. Died August 18, 1863. 7th Maryland. 6, r 64. 14th Infantry. 4, fe. 878 Welch, J. B., Pt.,G, 35th July 14, Left. Died July 19, 1864. 833 Price. R. S., Pt., B, 1st July 3, Right (also amp. forearm); colliq. Iowa. 14, 04. N. J. Artillery, age 25. 4, 63. diarr. Died Aug. 22, 03; exh n. 879 Wells, W.W., Lieut., F, May 20, Left; circ. Surg. C. A. Cowgill, 834 Quinn, J., Sergeant, A, Aug. 25, Right ; double flap. Surg. N. 58th Penn., age 30. 20, 04. U. S. V. June (i, re-amputation. 17()th New York, age 25, 64. Hay ward, 20lh Mass. Necrosed ; Died Juno 11, 04 ; exhaustion. 45. removal of 6 ins. tibia. Died 880 Weyman, J. B., Pt., A, July 20, Left : circular. Died September Nov. 5, 1804. Spec. 3320. Cth Kentucky, age 22. 21, 0-1. 27, 1804: chronic diarrhoea. 835 Ransom, J. D., Capt., C, Sept. 29, Right. Surg. D. G. Rush, 101st B61 Wheatly, J., Pt., C, 61st May 3, Right. Died May 21, 1803. 142d N. Y., age 29. Oot.1, 64. Penn. Died Nov. 10/64; pyaem. Ohio. 3, 63. 836 Reed, J. M., Adj t, 10th April 2, Right. Died April 0, 1805." 882 Whittier, F. M., Pt.. K, June 27, Right. Died July 18, 1804. Vermont. 2, 65. 14th Kentucky. 27, 64. 837 Reither. J. G., Pt., F, Oct. 27, Left. Surg. A. M. Clark, U. S.V. 883 Wilson, A. N., I t., I, 5th Aug. 30, Right. Died October 10, 1802. 142d N. Y., age 26. 27, 64. Died Nov. 28, 1804; pyaemia. New York. 30, 62. 838 Riley, J., Pt., B, 9th Sept. 28, Left. Died October 31, 1864; ij 884 Wilson, W. C., Pt., B, Dec. 13, Left. Died January 13, 1863. Vermont, nge 21. , 64. exhaustion. 4th Vermont. 13, 02. j SECT. V.) PRIMARY AMPUTATIONS IN THE LEG. 505 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 885 Wilts, B. F., Pt., A, 21st Dec. 31, Left. Died January 7, 1863. 893 Ball, P., Pt., F, 3d In May 3, . Ass t Surg. J. S. Billings, Illinois. 31, 62. I fantry. 3, fo. U. S. A. 886 Wimpfler, S., Pt., C, 9th Nov. 25, Left (also amp. elbow joint). Died 1 894 Blackwell, W., Pt., B, Mar. 19, Right. Ohio. 25, 63. December 9, 1663. 1st S. C. Artillery. ]9, 65. 887 AVinget, C. B., Pt., 1!, 1st .lime 3, Left; circ. Surg. A. F. Whelan, 890 Culp, T. H., Lieut., H, Oct. 7, Left. Michigan, nge 45. 3, 64. 1st Mich. S. S. Died July 5, i 9th Georgia. , 64. 1864; exhaustion. 896 Page, L. L., Pt., E, 24th May 18, Right. 888 Woodrum, J., Sergeant, Aug. 16, Right ; circ. Surg. W. F. Rich Georgia. , 64. I- renoh s Virginia Ar , 04. ardson, P. A. C. S. Died Sep 897 Reed. J. W., Pt., K, 2d Mav 6, Right. tillery. tember 3, 1864 ; pysemia. Louisiana. , 64. 889 Woods, I., Pt., F, 19!ltli April 9, Right. Died May 29, 1865. 898 Simms, D. L., Pt., C, 1st Oct. 1, Left; circular (also severingtibial Perm., age r>7. !>, 65. Battery Va. Artillery. 1, 64. artery). 890 Wright, A. M., Capt., F, June 16, Left. Died July 2, 1864. 899 Speck, A., ft., A, 17th Oct. 21, 57th X. York, age 22. Hi, 64. Tennessee. , 61. 891 Wright, D., Pt., G, 92d June 27, Left. Died July 17, 1864 ; py 900 Thrift, W. H., Pt., A, pirpnlflr Ohio, age 24. 27, 64. aemia. 1st S. c. Rifles. 892 Bailey, N., Pt., B, 14th Mav 12, Left. Infantry. , 64. In thirty-eight of the nine hundred cases of primary amputations 1 in the lower third of the leg, the side was not reported; four hundred and sixty-nine operations involved the left, and three hundred and ninety-three the right limb. Specimens of forty cases belong ing to this group are preserved in the Army Medical Museum. Primary Amputations in the Leg for Shot Injury in which the seat of Operation was not indicated. In five hundred and seventy-one of the three thousand three hundred and ninety-two primary amputations in the continuity of the bones of the leg the seat of the operation was not specified. The results in twenty-nine cases were not ascertained. One hundred and twenty-four operations proved successful, and four hundred and eighteen fatal, a mortality of 77.1 per cent. Examples of Recoveries after Primary Amputations in the Continuity of the JB ones of the Leg, seat of operation not specified. The one hundred and twenty-four operations of this group were performed on one hundred and twenty-three patients, in one instance both limbs having been removed. One hundred and seventeen were Confederate and six Union soldiers: CASE 748. Private J. B. Barron, Co. I, Cobb s Georgia Legion, was wounded in the leg, and captured at Soutli Moun tain, September 14, 1862. Assistant Surgeon H. A. Du Bois, U. S. A., described the injury as a "gunshot compound commi nuted fracture of both bones. The man was admitted to the field hospital at Burkettsville, where amputation by the circular method was performed forty-eight hours after the reception of the wound. The patient recovered." After his recovery he was paroled and sent south. The Confederate hospital records show that he was admitted, on December 4th following, to the general hospital at Petersburg, whence he was furloughed two weeks later and proceeded to his home. In the following instance both legs were successfully amputated by a Confederate surgeon on the day of the injury: CASE 749. Corporal J. W. Alexander, Co. K, 13th Mississippi, was wounded at the battle of Fredericksburg, December 11, 1862. His injury appears recorded on a Confederate hospital register as "gunshot fracture of both legs, followed by ampu tation of both legs the same day by Surgeon J. T. Gilmore, C. S. A." The man recovered, and was subsequently furnished with artificial limbs by the Confederate Association for the relief of maimed soldiers. Of the six Union soldiers one, an officer, remained in the service and was afterwards killed in battle; three were pensioned, and two do not seem to have applied for pensions; one of the pensioners died six years after the operation. CASE 750. Lieutenant-Colonel George H. ~Ward v 15th Massachusetts, was wounded in the action at Ball s Bluff. October 21, 1801. Surgeon A. B. Crosby, U. S. V., states : "The wound was inflicted by a bullet; primary amputation was performed, the ankle being shattered and the circulation cut off." Lieutenant-Colonel Ward recovered, was promoted to the Colonelcy of his regiment, which he rejoined in February, 1863, and was killed at the battle of Gettysburg, July 2, 1863. CASE 751. Private M. Higman. Co. B, 46th Pennsylvania, aged 29 years, was wounded by a shell in the right leg, at Cedar Mountain, August 9, 1862. He fell into the hands of the enemy and suffered primary amputation. Two weeks after wards he was conveyed to the Hotel Hospital, at Piedmont, where he remained until exchanged during the following month. Surgeon R. B. McCay, U. S. V., recorded that the patient, after being paroled by the enemy, was admitted to the Chesapeake Smrto. Ill 64 506 INJURIES OF THE LOWER EXTREMITIES. ICIIAP. X. Hospital, Fort Monroe, and Surgeon A. E. Stocker, U. S. V., reported that he was discharged January 6, 1863. by reason of " loss of right leg." He was a pensioner until June 14, 1868, when he died. The cause of his death has not been ascertained. Fatal Cases of Primary Amputations in the Leg, seat of Operation not indicated. This group includes four hundred and eighteen amputations performed on four hundred and twelve patients; three hundred and forty-nine were Union and sixty-three Confederate soldiers. In three instances re-amputation in the thigh became necessary. CASE 752. Private J. Jameson, Co. A, 29th Illinois, aged 24 years, was wounded at the battle of Spanish Fort, March 2 J, 1865, by the explosion of a shell, which caused flesh wounds of the left shoulder and left hip and fracture of the tibia and flbula of the right leg. Assistant Surgeon W. E. Waters, U. S. A., reported that the wounded man was admitted to the Six teenth Corps Field Hospital, where the injured "leg was amputated by Surgeon S. L. Cheamy, 29th Illinois." Surgeon J. 15. G. Baxter, U. S. V., reported the following result: "The patient entered Barracks Hospital at New Orleans eight days after being wounded. He had undergone antero-posterior flap amputation of the leg on the field. The flesh wounds were granu lating feebly. Secondary haemorrhage took place from the anterior tibial on April 4th, amounting to thirty ounces, and being controlled by manual pressure on the groin for forty-eight hours. The patient was also troubled with some diarrhoea; he had a good constitution, however. Both bones protruded from the stump, and no union of the flaps took place up to April 12th, when one inch of the h bula was resected by Assistant Surgeon E. McClintock, U. S. V., who performed the operation without using anaesthetics. The patient died April 18, 1865." CASE 753. Private . Watson, Co. C, 118th Pennsylvania, was wounded in the left leg during the engagement at tin- crossing of the Potomac, on September 20, 1862. Surgeon E. McDonnell, U. S. V., contributed the following description of the injury and its result: "The wounded man was conveyed to the German Reformed Church Hospital at Sharpsburg, where the leg was amputated below the knee on September 21st. The operation was performed for compound fracture of the leg. On September "28th the patient s condition was favorable, but during the following two days it was critical. On October 1st, the aspect of the stump was unhealthy, the entire flap threatening to slough; no union; discharge black, sanious, and unhealthy. During the next two days he mended somewhat, and on October 4th he was much improved. The difficulty in the case was a complete falling apart of the flaps, there being no union whatever. The posterior flap was large and heavy and composed of the thick muscles of the calf of the leg, making a bad wound to heal by granulations, the bone being exposed. October llth. the patient s system has been sinking. He has some diarrhoea and tympanitis, and was restless and delirious during the night. He must die unless the whole stump is removed by an operation above the knee, and I have become sick of amputating thighs secondarily. October 13th, condition very low; pulse at times not perceptible; jaws and body rigid. Patient had a passage from the bowels during the night and passed water quite freely. Small doses of brandy and morphine were admimstered ; no relief. October 14th, at 8 P. M., applied a large bread poultice to stump. H:emorrhage from stump occurred during the follow ing night. Death at 11.30 A. M. on October 15, 1862." TABLE LXXI. Summary of Five Hundred and Seventy-one Cases of Primary Amputations in the Leg for Shot Injury, the point of operation unspecified. [Recoveries, 1104; Deaths, 125 542; Results unknown, , r >43 571.] No. NAME, MILITARY DESCRIPTION, AND AUK. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND ACE. DATES. O PEUATIONS, OPERATORS, RESULT. >{ Alexander, J. W., Corp l, Dec. 11, Both. Surg.J.T.Gilmore,C.S.A. 1C Birrd, L. S., Serg t, D, May 3, . Surg. A. S. Flinn, C. S. A. 2) K, 13th Mississippi. 11, 02. Recovery. 10th Virginia. 4, 03. Recovery. 3 Anderson, J. (1., 1 t., D, Sept. 17, . Surg. Black, C. S. A. 17 Calhoun, I . J., Pt., C, July 1, Left. Surg. II. F. Campbell, P. A. 4th Virginia. 17, G2. Recovery. 1st Texas. 3, 02. C. S. Recovery. 4 At well, C . /., Pt., L, 1st Aug. 29, Right. Surg. W. H. Priolean, P. 18 Calvert, J. W., Pt., A, May 0. . Surg. Brown, 2d S. C. South Carolina. 29, 0;>. A. C. S. Recovery. 2d South Carolina. 0, ? 64. Rifles. Recoveiy. r Ildilty, A. B., Serif t K Nov. 25, Left. Surg. Smith C. S. A. 19 Carnal A Pt F 3d Dec 12 Sure* 7th S C 29th Tennessee. 25, 03. Recovery. South Carolina. 13, 02. Recovery. G Barnard, A. 11., Pt., II, Sept. 30, Left (right leg wounded). To 20 Carroll, J., Serg t, C, 2d Dec. 13, . Surg. D. A. Maxwell, P. A. 8th N. C., age 20. 30, 04. prison February 22, 1865. South Carolina. 14, 03. C. S. Recovery. 7 Barney, J., Pt., I, 28th July 12, Left, Discharged October 31, 21 Carroll, S., Pt., A, 52d Aug. 28, Right. Surg. Leethe, C. S. A . Illinois. 12," t!3. 1803. Virginia. 28, 02. Recovery. 8 Barron, J. 13., Pt., ( ,, Sept. 14, ; circular. Furloughed De 22 Claxton, A. J., Pt., E, May 14, Right. Transferred May 28, 04. (Jobb s Ga. Legion. 1C, 02. cember 9, 1802. 18th Tennessee. , 64. 9 Berry, J. II., Pt., G, 25th May 5, . Recovery. 23 C/ai/burn, E., Pt., II, May 2, Left; flap. Furloughed Septem Virginia. 0, 64. 55th Virginia. 2, 03. ber 24, 1803. 10 Hir.kM,N.J..V\.,h.,4.m\ Oct. 14, . Ass t Surg. B.Chears, 48th 24 Clinton, T. L., Pt., II, May 2, Right. Surg. R. J. Hicks. 23d North Carolina. 15, 03. North Carolina. Recovery. 23d North Carolina. 2, ; C3. North Carolina. Recovery. 11 Bishop, II. I)., Pt., K, June 30, . Surg. Capeheart, C.S. A. 25 Cotfy, D., Pt., P., 32d July 22, Left. Transferred. Kith Virginia. 30, OJ. Recovery. Alabama. 22, 04. 12 Btakemore, W. T., Cap M a v 20, Eight. Surg. R. D. Jackson, 26 1 Collins, J., Pt., F, 10th Sept. 19, ; flap. Recovery. tain. 20, 04. C. S. A. Recovery. South Carolina. 19, 03. 13 Boatwrif/ht, J. D.A., Pt., May 0, . Surg. M. S. Thomas, P. A. 27 Conrad, B. F., Lieut., A, May 0, . Surg. Horton, C. S. A. D,2d Florida. 0, 04. C. S. Recovery. 35th Virginia. 7, 04. Recovery. 14 Broksher, C. E., Sorg t, July 2, Right. Paroled" September 25, 28 Cooper, A. B., Pt., D, May 14, Right. Transferred June 10, M. K, 24th (la., ago 27. 4, 03. 1803. 18th Alabama. , 04. 1!) lirowne, S. B., Pt., 15, June 30, . Confederate surgeon. Re ~j Cormicle, K. SI., Pt., II, Oct. 11, . Surg. Owens. "Recov llth Alabama. 30, 02. covery. 4th Virginia Cavalry. 11, 63. ery. 1 TERRY (C.), Report of Wounded treated in Field Hospital of Iliiidman s Division after the battle of Chickamaiiya, in Confederate States Medical aiid Surgical Journal, 1804, Vol. I, p. 70. SECT. V.] PRIMARY AMPUTATIONS IN- THE LEG. 507 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATKS. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 30 Crawford, E. D., Pt., A, June 11, . Union surgeon. Recovery. 77 McNiel, II. M., Pt., E, April 20, Left; ant. skin. post. nius. skin 7th Georgia. 11, 64. 56lh N. C., nge 26. 20, 64. flap. Surg. C. 11. Ladd.C. S. A. 31 Cross, J. W., Pt., C, Ga. Aug. 1, Left. Surg. Metcalf, C. S. A. Disch d June 15, 1864. Legion Cavalry. Recovery. 78 Michie, I)., Pt., A, Jeff. July 9, Left. Recovery. 32 Dry, O. F., Pt." 1!; 2d June 27, Right. Surg. H. 11. Hubburd, Davis Legion. 9, 63. Mississippi. 27 ( >2. 1 . A. C. S. Recovery. 79 l Middlelon, J., Pt., L, Sept. I 1 .), ; flap. Surg.T.P. Bailey,10th 33 Eehaluz, J. F., Corp l, May 3~l , Left. Discharged December 12, 10th South Carolina. 19, 63. S. C. Trans. Oct. 31, 1863. II. 05th New Turk. 31. 62. 1862. 80 Miller, L., Pt., Pure-ell s Aug. 29, Left. Surg. Haynes, C. S. A. 34 Falkland, J. B., 1 t., D, Sept. 30, Left. To prison April 13, 1865. Battery. 29, 62. Transferred Jan. 30. 1863. 8th N. C., age 22. 30, 64. 81 Miller, I ., Pt., 11, 33d July 21, . Surg. H. MeG uire, C.S. A. 35 Fisher, C., Pt., G, 2d July 3, Virginia. 21, "61. Recovery. North Carolina. 3, 63. 82 Mills, J. P., Lieut., G, May 3, Left. Transferred July 9, 1863. 36 Flaherty, G. W.. Pt., A, July 20, Left. To prison November 10, 21st Mississippi. , "<J3. 31st Mississippi. 20, W- 1864. 83 Mitchell, T. I . K., Pt., July 3, Left. Paroled September 5, 63. 37 Folkes, W. C., Pt., Shoe- Julyl. . Recovery. D, 1st Tennessee. , 63. maker s Battery. 2, 63. M Moody, 1C. J., Pt., B, 5th May 5, Left. Paroled August 31, 1862. 38 Ford, J. A., Pt., 11, 23il May 2, . Ass t Surg. B. Howard, North Carolina. , 62. North Carolina. 2, 63. U.S.A. Recovery. 85 Moore. A. E., Pt., K, 4th Nov. 1, Left. Ass t Surg. F. Gill-am, C. 39 *Foxworth, C.B., Pt., I, Sept. 19, . Transferred October 9, 63. Virginia Cavalry. 1, 62. S. A. Recovery. 10th South Carolina. 19, 63. Recovery. M; Moore, d. IF., Pt., C, July 28, Left. To prison February 18, 40 Frazier, G. W., 1 t., D, May 8, . Surg. 1 . F. \Vhitehead, P. 19th Alabama. 28, 64. 1865. 37th Virginia. 8, 62. A. C. 8. Recovery. 87 Moyer. V., Pt., B, 19th July 22. Right. To prison November 10, 41 Fuller, TF.. Serg t, G.lst July 21, . Surg. Sloan, C. S. A. South Carolina. 22, 64. 1864. South Carolina. 22. 63. Recovery. 88 Nash, P. W., Pt., E, llth Aug. 29, . Surg. Ward, C. S. A. 42 Green, II. \V., Pt., Bean- Julyl, . Recovery. Mississippi. 30, 62. Recovery. regard s Artillery. 1, "62. 89 Nolen, F. J., Pt., A, 83d June 27, Right. Discharged January 20, 43 Gregory, J. T., Pt., E, May 6, . Surg. Brown, 3d Ark. Pennsylvania. 27, 62. 1863. 3d Arkansas. 7, 64. Retired March 20, 1865. 90 Norton, W. C., Pt., B, July 1, Left. Surg. H. H. Ilubbard, P. A. 44 Scot 17 Ass t c^ nrfr 16th 1 63. C. S. Recovery. 16th Mississippi. 17, 62. Mississippi. Recovery. 91 O Niel, C., Pt.. G, 5th Right. Paroled August 31, 1862. 45 Harrell, E. B., 1 t., D, May 4, . Ass t Surg. Saunders. North Carolina. 48th Georgia. 4, 63. Recovery. 92 Outlaw, J. E., Pt., A, Oct. 19, Left; post. flap. Surg.R. J.I licks. 40 Bart, R.A., Pt., D, 12th May 2, . Snrg. T. B. Wilkinson, P. 23d N. Carolina, age 26. 19, 64. 23d N. C. Trans. Jan. 8, 1865. North Carolina. 2, r 63. A. C. S. Recovery. 93 Parker, J. C., Pt., A, Sept. 30, Right. To prison April 13, 1865. 47 Barrey, J., Pt., E, 5th May 5, . Transferred June 8, 1862. 8th N. Carolina, age 26. 30, 64. North Carolina. 5, 62. 94 1 rdtn. IF. B., Corp l, A, Nov. 29, Left (also resection bones of right 48 Botiield D. Pt. II, 5th Hip"lit T 1 1 1 rl 01 1 p"li p*l T^Wirnirv **() 17tli Mississippi. 29, 63. leg). Surg. J. 1*. Prince, lioth Tennessee. 1862. 1863. Mass. Exchanged. 49 Biggins, J., Pt., C, C3d June 22, . Surg. Hunt, C. S. A. 95 Proctor, S. A., 1 t., F, July 1, . Surg. T. P. Bailey, 12th S. Virginia. 22, 64. Recovery. 12th S. Carolina. 3, (53. Carolina. Recovery. 50 Hignian. M., Pt.,B, 46th Aug. 9, Right. Discharged Jan. 6, 1863. !>6 J utnam, W. A., Pt., B, Aug. 21, . Ass t Surg. C. Duffy, 24th Pennsylvania, age 30. 9, V2. Died June 14, 1868. 49th North Carolina. 21, 64. N. C. Retired Jan. 28, 1865. 51 Bowell, C., Pt., E, 5th Oct. 4, . Union surgeon. Feb. 6, 63, 97 Raburii, J. M., Corp l, F, Sept. 1 9, . Ass t Surg. F. R. Gregory, Missouri. 4, 62. re-amputated. Recovery. 25th Tennessee. 19, 63. C. S. A . Recovery. 52 Ilubbard, J. A., Pt.. A, Mar. 31, Right. Surg. M. C. Rowland.61st 98 Richardson, D., Pt., I, Dec. 11, . Ass t Surg. R. R. Murphy, 18th Virginia. A p. 1, 65. N. Y. Released June 6, 1865. 61st N. Carolina. 11, 63. Kith N. ( .. Recovery. 53 Hunter, J. B.. Pt., I, June 30, . Surg. H. \V. Thompson, 99 Roberts, J., Lieut., I, May 3, . Surg. Fleinming,C.S.A. 28th Virginia. 30, 62. C. S. A. Recovery. 48th Virginia. 3, 63. Recovery. 54 James, D. If., Corp l. G, Sept 30, Right. Released June 21, 1865. 100 Rodgers, T. M., Pt., C, Jan. 1, Right. Nurg. Manney,C.S.A. 8th N. Carolina, age 23. Ot.1, 64. llth Tennessee. 1, 63. Transferred August 3, 1863. 55 Johnson, C. L., Serg t. May <!, . Surg. J. E. Chancellor, 101 Ruby, C. W., Pt., D, 42d July 1, . Paroled August 22, 1863. L, 7th South Carolina. 6, 64. C. S. A. Recovery. Mississippi, age 29. 2, 63. 5(i Jones, B. C., Capt., E, June 27, . Surgeons Dunn and Lee, 102 Susse/l, W., Corp l, I, Sept. 19, Left. Transferred September 30, 56th Virginia. 27, 62. C. S. A. Recovery. 28th Alabama. 19, 63. 1863. 57 Kirl-land, J. G., Pt., D, May 25, . Surg. Lamond, C. S. A. 103 Rvss.J. J., Pt., D, 18th May 2, ; circular. Transferred June 2d South Carolina. 25, 6!. Recovery. N. Carolina, age 27. 2, 63. 5, 1863. 58 Kirldoj, r>. C., Lieut., Sept. 19, . Surg. Johnson, C. S. A. 104 Sadler, A. D., Serg t, G, Dec. 11, Right (also amp. left foot) . Surg. D, 15th S. Carolina. 19. 63. Recovery. 21st Mississippi. 11, 62. Hill, C.S. A. Recovery. 59 Lansing, J., Serg t, K, July 1, Left. Surg. Strickland, C.S. A. 105 Sounders, G. L., Pt., G, May 5, . Recovery. 5tli Louisiana. 3, 63. Discharged Dec. 8, 1864. 24th Virginia. 5, 62. GO Lead,, B. F., Pt., H. May 27, Left. To Provost Marshal Aug. 106 Scarborough, D. J.. Pt., Aug. 24, Right. Surg. P. B. Henderson, 10th Arkansas. 27, 63. 7, 1863. H, 14th S. Carolina. 24. 64. P. A. C. S. Recovery. Cl Le.wis. T. N., Pt., A, May 16, Left. Recovery. 107 S/iarrer, J., Pt., H, 48th June 22, . Recovery. 57th Georgia. 16. 63. Mississippi. 22, 62. 62 Lewis, W. M., Pt., 1), July 14. Right. Recovery. 108 Shcdd, W. H. U., Pt., C, Sept. 21, Right. Surg. Powell, 41st 1st Tennessee. 14, 63. 41st Mississippi. 21, 63. Mississippi. Recovery. 63 Lietner, W. Z., ( apt., E, July 2, Right. Surg. Lamond, C.S. A. 109 Slusser, S. S.,Ft.,H, 12th May 6, . Surg. W. H. Burton, 7th 2d South Carolina. 3, 63. Recovery. Virginia. 6. "64. Va. Cavalry. Recovery. 64 Lilly, E. J., Pt., C, 23d May 3. . Surg. R. J. Hicks, 23d N. 110 Still, B., Pt., C, 9th. Ga. Oct. 14, Left. Surg. G. F. Cooper. Re North Carolina. 3, 63. Carolina. Recovery. 14, 64. covery. 65 Lonan IF If Capt G May !( Right. Surij. J. B. Kdclin C.S. A. 111 111 Stiiiesprino TF. B. Pt. May 3, 4th Georgia Cavalry. 15." 64. Recovery. E. 10th Virginia. 3, 63. Recovery. 66 Love, W., Lieut., K, 40th July 20, Left. To" prison November 10. 112 Stone, S., Pt., B, 37th May 3, . Surg.C. C. Henkle, C.S. A. Mississippi. 20," 64. 1864. Virginia. 3, 63. Recovery. 67 Loivell, E. P., Pt., II, May 5, . Surg. L. P. Warren. 26th 113 Tulift.ro, J. M., Pt., H., Sept. 16, . Surg. Bland, C. S. A. 26th N. Carolina. 5, 64. North Carolina. Recovery. 52d Virginia. 18, 62. Recovery. C8 Mallard, W. W., Pt., E, May 3, . Furloughed June 10, 1863. 114 Terry, R. L., Pt., C, 78th June 27, Lett. Mustered out June 7, 1865. 3()th N. C., age 30. . 63. Illinois. , 64. 69 Marburg, E., Lieut., 7th July 4, Left. To prison August 13, 18C3. 115 Thompson,.!. IF., Corp l, Dec. 11, Right. Surg. Austin, C. S. A. Missouri Cavalry. , 63. II, 13th Mississippi. 11, 62. Recovery. 70 Mayer. C., Serg t, II. Gth July], . Surg. W. A. Robertson, C. 116 Todd, IF./- .. Pt., ,10th Sept. 19, ; erysipelas. Louisiana. 1, 62. S. A. Retired Feb. 1, 1865. South Carolina. 19, 63. 71 McClendm, W. M., Pt., July 2, Right. To prison January 25. 117 Tracy, J. N.. Corp l, I, May 1, Left. Recovery. D. 8th Gf :.rgia. , 63. 1864. 5th Missouri. 1, f 63. 72 McCoy. E. C., Pt., B, ls>t i Aug. 29, . Surg. W". A. Robertson. C. 118 Triplett, B. F., Pt., Stu Oct. 15, Right. Surg. J. H. Murray, P. A. South Carolina. 29. 62. S. A. Recovery. art Horse Artillery. 15, 63. C. S. Recovery. 73 McDoul, J., Pt., G, 21st May 2, : flap. Transferred May 26, 119 Vann, C., Pt., F, 12th Dec. 16, Right. Exchanged January 16, Georgia, age 21. 3, 63. 1863. Georgia, age 16. 16. 64. 1865. 74 McFull, J. A.. Pt., F, May 14, Left. Transferred June 9, 1864. 120 Walker, B. C., Pt., B, July ), . Paroled August 22, 1863. 18th Tennessee. 14, 64. 26th N. C., age 19. 3, 63. 75 McLewis, A., Major, 2d Sept. 19, . Surer. Headly, C. S. A. 121 Walker, J., Pt., A, 23d June 27. Right. Surgeon Rievers, 28th Georgia. 19. 63. Recovery! Virginia. 27, 62. Virginia. Recovery. 76 McXeely, IF. TF., Serg t. May 2. . Recovery. 122 Ward, G.H., Lieut. Col., Oct. 21, Left. Recovery. Killed at Get B, 9th Louisiana. 4, 63. 15th Massachusetts. 21, 61. tysburg. and Surgical Journal, 1864, Vol. I, p. 76. 508 INJURIES OP THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 123 Wa<iland, W. 7f.,Pt., K, Oct. 15, . Surg. J. T. Gilmore,C.S.A. 173 Bucklin, G., Pt., K, 12th Dec. 13, Right. Died January 9, 1803. 19th Virginia. 15, 61. Discharged February 22, 1S62. Rhode Island. 13, 62. 124 Webb, J. B., Serg t, O, Aug. 1, . Recovery. 174 Bulley, J., Pt., E, 16th May 3, . Died May 20, 1863. 13th Virginia Cavalry. 1, V 63. New York. 3, r 63. 125 Abbott. (>., Pt., H, 7th July 11, Right. Died. 175 Bunker. C. L., Pt., I, 1st June 10, Right. Died June 28, 1864. New Hampshire. , 63. Me. Heavy Artillery. , 04. 126 Ackennan, W., Pt., H, June 8, ; gangrene. Died June 15, 176 Burke. P. E., Colonel, May 16, Left. Surg. W. R. Marsh, 2d 8th New York. 8, 62. 1862; tetanus. 66th Illinois. 16, 04. Iowa. Died May 19, 1864. 127 Acres, G. C-, Pt., D, 4th July 28, Left. Surg. B. N. Bond, 27th Mo. 177 Bnrnes, J. P., Pt., II, Oct. 1!, Left; flap. Died October 28, Iowa. 28, 64. Died Augusts, 1864. 13th West Virginia. 19, 64. 1864 ; pyajmia. 128 Adsit, J. E., Pt., F, 97th Sept. 17, Right. Died October 17, 1862. 178 Butler, M., Pt., D, 15th June ,!, Left (also wound buttock). Died New York. 17, 62. New York. 3, 64. June 19, 1864; pyaemia. 129 Anderson, A., Pt., G, Sept. 19, . Died January 10, 1803. 179 Buxton, A., Capt.. H, 2d May 5, . Died May 7, 1864. 26th Missouri. 19, 62. U. S. .Sharpshooters. 6, 64. 130 Andrews, A. J., Lieut., Dec. 13, Right. Died January 26, 1863. 180 Bybce, J., Pt., F, 21st June 20, . Surg. C. J. Walton, 21st C, 104th New York. 13, 62. Kentucky. 20, 64. Kv. Died June 20, 1864. 131 Andrews, T., Pt., C, 20th June 3, Right (also wound of shoulder). 181 Byers, , Pt., E, 5th July 3, Right. Died July 24, 1863. Michigan. , 04. Died June 8, 1864. Alabama. , 63. 132 Amick, W. M., Serg t, June 18, Right. Died August 11, 1864. 182 Byrne, W.E.,Pt.,K,42d July 2, . Died July 24, 1863. H, 55th Penn., age 22. 18, 64. New York. , " 03. 133 Amidon, E. H., It., B, June 19, Left. Surg. C. Miller, 36th Wis- 183 Cahill, D., Pt., E, 10th Oct. 8, Left. Died October 15, 186 J. ID, 64. cousin 1 Heel July *J 1864 i(JO 134 Allen, J. W., Pt. , H.lst Oct. 8, . Died October 20, 1862. 184 Cain. Win., Pt., F, 7th N. June 10, Left. Surg. S. H. Plumb, 82d Tennessee. 8, 62. Y. H vy Art y, age 23. 10, 64. N. Y. Died July 25, 18G4. 135 Alverd, A. O., Pt., C, May 31, Left. Died June 12, 1862. 185 Callnwa y, R. W., Capt., July , . Died July 16, 1863. 100th New York. , 62. K. 22d Georgia. , 63. 136( Arkerson, A., Pt., D.llth June 18, Both. Died June 19, 1864. 186 Campbell, J. B., Pt., F, Mav 15, Left. Confederate surgeon. Died 137J Infantry. 18, 04. 3d Tennessee. ," 64. May 24, 1864. 138 Arnold, "T., Pt., F, 7th Feb. 21, . Died February 26, 1802. 187 Campher. L., Serg t, D, Sept. 29, Left. Died October 27, 1864; Infantry. 22, 62. 4th C. Troops, age 20. 30, 04. exhaustion. 139 Atheain, J., Serg t, II, Jan. U, Left. Died February 5, 1863. 188 CaiT, W., Serg t, I, 12th July 3, Left. Died July 14, 1863. 25th Iowa. , 03. Massachusetts. , ^63. 140 Bailey, S. W., Pt., H, May 27, Left. Died May 28, 1863. 189 Cathcart, B. F., Pt., G, July 3, Right. Died August in, 1803. 6th Michigan. 27, 63. 141st Pennsylvania. , 63. 141 Baker, A., Pt., G, 3d Nov. 27, Left (also amp. fingers). Died 190 Clialker, W. ~1L, Pt., A, July 3, . Died July 10, 1803. Missouri. 27, 03. December 28, 1863: pyaemia. 48th Georgia. , 63. 142 Barrett, E., Pt., K, 14th Mar. 23, Right. Died April 2, 1802. 191 Champlain, J., Pt., D, July 3, Left. Died July 0, 18C3; htem- Indiana. 23. 62. 12th Infantry. , 63. orrhage. 143 Baxter, W., Pt., K, 3d May 15, Right. Died June 18, 1804. 192 Chandler, J. S., Pt., E, Mav 14, Left. A. Surg. J. F. Smith, 55th Wisconsin. , 64. 11 1th Illinois. 14, 64. Illinois. Died May 10, 1864. 144 Rcckert, E., Pt., C, 25th Dec. 13, . Ass t Surg. H. R. Wirtz, 193 Chedister, J. O., Pt., I, Nov. 7, . Died November 30, 1861. Ohio. , 61. U. S. A. Died Jan. 28, 1862. 7th Iowa. 7, 61. 145 Bockstine, F., Lieut., I, July 20, Left. Died July 20, 1864. 194 Chism, R., Serg t, K, Mav 7, Left. Died June 1, 1864. 82d Illinois. 20, 64. 91st Penn., age 21. , 64. 140 Beeson, W. H., Serg t, July 2, . Died July 10, 1862. 195 Church, R., Pt., C, 40th Nov. 24, Right. Died December 4, 1863. G, 62d Pennsylvania. 4, 02. Ohio. 24, 03. 147 Beers, C., Pt", K, 7th July 3. Right. Died July, 1863. 196 Clayton, J., Pt., F, 4th June 18, Right. Died June 28, 1864. New Jersey. 3, 63. N. Y. H vy Artillery. 18, 04. 148 Bihl, A., Pt., E, 82d May 3, Left. Died May 31, 1863. 197 Cliff, J., Recruit, Col d 1864. Left. Died November 16, 1864. Illinois. 3, 63. Troops. 149 Binyham, W. 11. M., Pt., Sept. 19, . Died October 6, 1864. 198 Cleoman, P., Pt., K, 86th May 3, Right. Died May 20, 1863. B, 54th N. Carolina. 19, 64. New York. 3, 63. 150 Bitner, J., Pt., K, 102d Oct, 19, Left. Died October 20, 1864. 199 Clyde, O. C., Pt., Phil- July 1, Right. Died July 20, 1863. Pennsylvania. 19, 64. lips s Legion. Georgia. 3, 63. 151 Blackwell, G., Pt., B, July 14, . Surg. A. T. Bartlett, 33d 200 Cole, J., Serg t, Kane s June 8, Left. Died June 11, 1862. 7th Minnesota. 14, 64. Mo. Died August 6, 1864. Penn. Rifles. 8, 62. 152 Blakley, J. L., Pt., A, June 16, Left; post. flap. Died July 2, 20] Cole, M. R., Pt., A, 6th May 31, . Died May 31, 1804. 52d New York, ago 47. 17, 64. 1864 ; pyaemia. Indiana. 31, 04. 153 Blanchard, J., Pt., C, June 14, Riffht. Surg. T. B. Reed, U. S. V. 202 Cole, S. B., Pt., H, 18th Sept. 14, . . Died October 21, 1862; ; 91st New York. 14, 63. Died June 21, 1863. New York. 10, 62. exhaustion. 154 Blootnestine J. Pt. F Sept. 17, Died September 21 1862 ono Colstpn It Lieut -Col Died December ^3 1 ^6 ? 4th New York. , 62. ~u>> 2d Virginia. 155 Bower, J., Pt., A, 5th May 4, (also wound of arm). Died N 1 Colum, W., Corp l, G, July 1, . . Died July 6, 1803. New Jersey. , 62. May 17, 1862. 21st Mississippi. 1, f 03. 15(i Bowman, J., Pt., I, 46th July 20, Right. Died September?, 1864. 205 Conrad, C., Pt., G, 12th May H Loft ; flap. Surg. J. Spiegehalter, Pennsylvania. 20, 64. Missouri. 14, 04. 12th Mo. Died May 22, 1804. 157 Boyles, C., Pt., G, 55th July 20, Left. Died July 21, 1864. 206 Cooper, W., Pt., D, 2d Aug. 28, Right. Died October 24, 1864. Alabama. , 64. Cavalry, age 22. 28, 64. 158 Brady, P., Corp l, II, 3d Oct. 8, Left. Died November 7, 1862. 207 Crowell, S.W., Lieut., I, June IS, Right. Died June 28, 1864. Ohio. 8, 62. 1st Me. H vy Artillery. 18, 04. 159 Br.inson, J., Serg t, F, June 27, Left. Surg. W. Graham, 40th 208 Crowningshield, L. C., Dec. 25, Right (also amp. arm). Died 40th Illinois. 27, 04. Illinois. Died July 23, 1864. Pt., G, 142d N. Y. 25, 04. January 11, 1865. ICO Brierly, J., Pt., D, 97th May 20, Left. Died May 22, 1864. 209 Cuppernell, L., Pt., K, Mav 3, . Died May 15, 1863. Pennsylvania. , 04. 121st New York. 3, 63. 161 Brink, E., Seaman, Gun Oct. 11, Right. Died June 28, 1864 ; ex 210 Curtain, P., Pt., E, 152d Nov. 0, . Surg. J. L. Breuton, 8th boat Maratanza. , 62. haustion. New York, age 32. (i, 64. Ohio. Died Nov. 12, 1804. 162f Drinkman, A., Pt., G, Aug. 11, Both. Died August 12, 1864. 211 Davenport, C. O., Pt., G, Sept. 19, . Died September 25, 1804 ; 163J, 79th Pennsylvania. 11. 64. 36th Virginia. , 64. exhaustion ; shock. 164 Bronsher, L, Pt., D, 81st May 22, Left. Died June 14, 1863; py 212 Davis, J., Pt., E, 8th July 2, . Died July 11, 1803. Illinois, age 25. 22," 03. aemia. Virginia. , 03. 165 Brown, A., Pt., I, 3d Nov. 27, Right. Died December 14, 1863. 213 Dean.W. J.,Pt., D, 10th Sept. 19, . Died September 30, 1 862. North Carolina. , 63. Missouri. 19, 02. 166 Brown, CA Lieut., E. July 18, Right. Died August 13, 1863; -. I 1 De Gouth, B., Pt., M, May 6, Right. Died May 13, 1864. 100th New York. 20, 63. tetanus. 5th Artillery. 0, 64. 167 Brown, H. F., Corp 1 !, I, Sept. 19, Right. Died September 19, 1804. 215 Demay, H., i t., D, 20th May 3, Right. Died May 31, 1863. 14th New Hampshire. 19, (14. Connecticut. 3. 63. 168 Brown, J. D., Pt., B, 3d July, . Died July 18, 1803. : 216 Demby, W. H., Serg t, Feb. 11, Left; circular. Died. North Carolina. , 03. G, 4t h Col d Troops. 11, 05. 1(59 Brown, R., Pt., G, 49th June 7, Right. Died June 14, 1803. 217 Dennison, C. E., Capt., Dee. 31, Right. Died January 15, 1863. Colored Troops. . 63. B, 18th Infantry. 31, 62. 170 Brown, JF.>.,Pt.,Ander- July:!, . Died July 11, 1863. 218 Dettmer, G., Pt., E, 82d July 20, Right. Died August 8, 1864. son s Chesapeake Bat y. , 03. Illinois. 20, 64. 171 Brown, W. M., 1 t., G, May 14, Right. Died June 1, 1804. 219 Dixon, J., Pt., , 18th Aug., Left. Died August 10, 1864. 12th Illinois. , 64. 1 Infantry. , 64. 172 Bryant, W., Pt., D, 19th Jan. 2, Left. Died January 20, 1863. j 220 Dolph, I., Pt., C, 136th Dec. 13, Left. Died January 15, 1863; Ohio. , 63. ll Pennsylvania. 13. 02. pyaemia. SECT. V.] PRIMARY AMPUTATIONS IN THE LEG. 509 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS. -.,_ RESULT. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 221 Donahay, T., Pt.,A,19th May 15, Right. Snrg. J. Bennett, 19th 268 Grover, C. D., Serg t, F, April 13, . Died April 16, 1863. Michigan. 15, 64. Mich. Died May 23, 1864. 25th Connecticut, 13, 63. 222 Doster," J., Pt,, C, 90th Deo. 31, Left. Died February 9, 1863. 269 1 Groves, J., Pt., F, 7th May 3, Left. Died June 11, 1803. Ohio. , , 62. Massachusetts. 3, 63. 223 Dougnn, S. W., Corp I, Sept, 19. Left (also wound of right wrist). 270 Guild, J., Pt., C, 153d Sept. 19, Right. Died September28, 1864. C, 8th Kansas. , 19. 63. Died September. 1863. New York. : 19, 64. 224 Duncan, J. B., Capt., H, Oct. 5, . Died July 18. 1864: denil- 271 Halfhill, G., Pt., I, 21st May 22, (wound of both legs). Died 32d Illinois. 5, 62. ity resulting from injury. Iowa. 22, 63. June 9, 1863. 225 Dungan. J. W., Lieut., June 27, Lett. Died July 4. 1864. 272 Ball, J. F., Pt., B, 22d May* ; flap. Died May 24, 1863 ; 1 A, 113th Ohio. 27, G4. i Virginia, age 25. 4, %3. typhoid fever. 226 Eaton. I. V., Pt., D, 4th i July 2, Right. Died August 18, 1863. 273 Hanley, O., Pt., B, 31st July 20, Left. Died August 27, 1864. Maine. 2, 63. Mississippi. , 64. 227 Eberly. C., Pt., C, 98th May 12, Left. Died May 20, 1864. 274 Harard, J. AV., Pt., E, 3d Sept. 30, Right. Died October 2, 1864. Pennsylvania. 12 64. Colored Troops. 30, 64. 228 Efford, W., Pt., G, 53d- Oct. 5, . Died. 275 Hardy, II. J .,Pt.,F,llth July 2, Left. Surg. H. M. McAbee, 4th Indiana. 5, 62.- Mississippi. : 3, 63. : Ohio. Died July 20. 1863. J-,".) Elliinvood, A. AV., Pt., June 3, Left. Died July 6, 1864. 276 Harriman, C., Pt., E. July 2. Left (also fract. right leg). Died F, 2.)th Mass., age 21. ;j, 64. 19th Maine. 2, 63. July 7, 1863: hsBmurrhajr*. 230 Emmel, P., Pt., E, 163d Dec. 13, Left. Died January 5, 1863. 277 Harris, A. C., Pt.,A, 43d May 14, Left. Died May 22, 1864. New York. ]:j, 62. Georgia. , T>4. 231 Enos, J., Teamster, 39th Oct. 8, Right. Died October 25, 1862. 278 Haskall.H. A.,Pt.,C, 4th Sept. 29, Left. Died October 9, 1864. Indiana. 8, 62. New Hamp., age 24. Oct. 1,64. 232 Erisman, J., Pt., D, 57th Sept. ], Left. Died September 20, 1864. 279 Haskinson, A., Pt., G, Dec. 31, Left. Died January 8, 1863. Indiana. , 64. 84th Illinois. 31, 62. 233 E , J. N. P July 3, . Died July 3, 1863. , 280 Hatley, , Pt., I, 52d July 2, . Died July 17. 1863. 3, 63. North Carolina. , ^63. 234 Esson, H. J., Pt., G, 17th May 12, . Died May 21, 1864. 281 Hawkins, A., Pt., K, 4th May 6, Right, Died May 13, 1864. Michigan. 12, 64. I Maine. 7, 64. 23r. Faber, AV., Pt., H. 47th May 26, Left. Died September 7. 1863. 282 Heath, J., Serg t, K, 2d Right. Died October 24, 1864. Ohio. 26, 63. Colored Troops. 1864. 236 Farrell, J., Pt., F, 2d R. May 5, Right. Died June 6, 1864. 283 Heighly, H. O., Pt., C, July 2, Left. July 17, haem.,24oz., from Island, age 33. : 5, 64. * 1st U. S. Sharpshooters, 3, 63. post, tibial. Died July 18, 1863; 237 Farrington, P., Pt., G, : July 3, Right. Died July 10, 1863.. age 25. haemorrhage. 8~ d New York. : 3, 63. 284 Hess, T. W., Pt., K, 8th Sept. 30, Left. Died October 7, 1864 ; irri 238 Feller, J., Serg t, A, 21st i Aug. 21, Left. Died October 2, 1864. North Carolina. 30, 64. tative fever. Ohio. _, 64. 1 285 Hesterly, P., Pt., B, 12th Sept. 17, Left. Died October 11, 1862. 239 Fightrnaster, G. W., Pt., ! May 22, Right, Died May 28, 1863; py- Alabama. 17, 62. F, 22d Kentucky. ! , 63. aeinia. . : 286 Hevener, AV. C., Serg t, Oct. 5, . Died October 5, 1862. 240 Finclteler, If. S., PT., A, ! July 28, Right, Died August 11, 1864. E, 28th Illinois. 5, 62. 40th Alabama. 28 ," 64. 287 Higgins, F. M., Pt., B, Dec. 13, Right. Died December 27, 1862. 241 Follet, L. D., Pt., D, 92d , June 1, Left. Died June 14, 1864. 5th New Hampshire. 13, 62. New York, age 38. | 1, 64. 288 Hill, AV. S., Serg t, F, June 3, Right (also w nd of back). Died 242 Ford, J. H., Pt., C, 9th May 22, Right ; double flap. Snrg. A. T. 62d Penn., age 24. 3, 64. June 14, 1864. Iowa. , 63. Hudson, 26th Iowa. Died June 289 Hinchman. J. 1!., Serg t, July 18, Left. Died July 25, 1864. 24, 1863. L, 54th Penn., age 23. 18, 64. 243 Foss, C.A., Lieut.,C, 72d ; July 3, . Died July 7, 1863. 290 Hogan, J., Pt., I, 56th May 6, Right. Died May 13, 1864. New York. , 63. Massachusetts. , 64. 244 Foss, J., Serg t, C, 59th Sept. 17, (also amp. other thigh and 291 Eolloway, B. H., Corp I, July 3, . Died July 10, 1863; py New York. 17, 62. w dofarm). Died Sept. 21. 62. D, 13th Georgia. , S 63. aemia. 245 Fowler. R. II., Serg t, A, Dee, 13. . Died December 17, 1862. 292 Holmes, F., Corporal, June 8, Left, Died June 14, 1862. 27th Connecticut. 13, 62. Kane s Penn. Rifles. 8, 62. 246 Froni-r. I). ( ., Pt., ft, May 2, Right. Died May 20, 1863. 293 Hoover, F. M., Pt., B, May 6, Left. Died May 27. 1864. 141st Pennsylvania. 3. 63. 83d Penn.. age 24. 6, 64. 247 Friel, G., Pt.* D, 2d Ky. Sept. 1 0, Left. Died December 1, 1863, 294 Horminger, G., Pt., H, May 3, . Died May 24, 1863. 19. 63. while a prisoner. 1st New Jersey. 3, "63. 248 Fritz, J., Pt., A, 124th May 15, Right. Died July 18, 1864. 295 Home, G., Ft.," A, 15th June 19, Right. Died June 26, 1864. Ohio. ," 64. N. Y. H vy Artillery. 19, 64. 219 Fulton, ft. ,Liput.,C, 88th Dec. 13, (also wound of side). Died 296 Horner,AV., Pt., H, 155th June 17, Left. Died June 24, 1864. Pennsylvania. 13, 62. December 30, 1862. Pennsylvania. . 64. 2.-.0 Harrison. M.,Pt.,B,126th July 2, Right. Died July 18, 1863. 297 . Hortort , D. F., Pt., D, May 14, Right; circ. (also left leg). Died New York. 2, 63. 25th North Carolina. 14, 64. June 13, 1864. 251 Geary, AV. T., Pt,, E, Sept, 27, Left (also partial fract. right leg) . 298 Horton, II. R., Pt.,F. 7th June 24, Left. Died July 4, 1864 ; exhaus 10th Conn., age 19. 28, 63. Died October 7, 1863. R. I. Battery, age 37. , 64. tion. 252 Gehring, J., Pt., G, 59th Oct. 8, . Died October, 1862. 299 Howard. H., Pt., D, 20th July 1, Left, Surg. N. Hayward, 20th Illinois. 8, 62. Massachusetts. 1, 63. Mass. Died July 8, 1863. 253 Gentry, L., Pt., B, 33d July 20, Left. Died Septembers, 1864. 300 Howe, D., Serg t, C, 1st May 12, . Died May 22, 1864. Mississippi. , 64. New York. 12, 64. 254 Gilbei-t,P.,Seaman,Guu- Mar. 1, . Died March 4, 1862. 301 Howe, G. W., Pt.. E, May 15, Right. Died May 21, 1864. boat Tyler. ^ (52. 34th Massachusetts. 15, 64. 2.-,5 Gilchrisf, J. E., I t., 15, May 31, Left. Died June 5, 1864. ! 302 Hubbard, E., Corp I, B, Dec. 29, . Died January 1, 1863 ; ty 78th Pennsylvania. 31. 64. 3d Kentucky. , 62. phoid symptoms. 25(5 Gleiini, J.. Pt., II, 81st Dec. 13, Right Jan. 1, 63, re-amp, thigh. 303 Hubbard, AVlB.. Pt., E, April 6, Right. Died April 18, 1862 ; py Pennsylvania. 13. 62. Died Jan. 2, 63: shock andexh n. 2d Kentucky. , 62. aemia. j.Y? Goodwin, A. X., Lieut., July 20, Left. Died July 27, 1863. 304 Huylics. J. H., Pt., A, July 3, Left. Died July 28, 1863. A, 9th Maine. ," 63. 28th Virginia. , 63. 258 Grant, W. D., Lieut., B, April 5, Right. Died April 16, 1865. 305 Hughs, P.AV., Pt.,A,5th June 1, Right (also wound of left leg). 18th Georgia, 5, 65. I New York. , 64. Died June 4, 1864. 259 Green. J., Pt., D, 69th May 5, Left. Died May 5, 1862. 306 Hunt, J., Pt., H, 7th Mar. 23, . Died April 5, 1862. Pennsylvania. 5, "tez. Ohio. . 62. 260 Gregory. O., Pt.. H, 7th Mar. 23. . Died A pril 12, 1862. 307 Hyatt, J., Corp I, F, 48th July 18, Right. Died August 9, 1863; Ohio." 23, 62. New York. 18, 63. chronic diarrhoea. 261 Grey, A. R., Pt., G, 7th May 8, Left. Died May 13, 1864. 308 Jackson, J., Pt., D, 1st June 20, . Died June 25, 1864. AVisconsin. 8, 64. Maine H vv Artillery. 20, 64. 2G2 Gridley, E., Pt.. II. 57th Dec. 13, Right. Died December 17, 1862. 309 Jacobs, C., Pt., B, 19tb Sept. 19, Left. Died September , 1863. Pennsylvania. !3, 62. Ohio. 19, 63. 263 Gridley, AV., Pt.. A, 136th Pennsylvania. Dee. 13, 13. 62. Right. Died December 18, 1862. 310 Jamison. J., Pt., A, 29th Illinois, age 24. Mar. 29, 29, 65. Right ; ant. post, flap. Surg. S. L. Cheaney, 29th Illinois. April 4, 264 Griflith. J. L., Pt., I, 22d May 22, . Died May 24, 1863. haem. Died April 18, 1865. Iowa. 22, 63. :3ii Jesse, J. P., I t.. C. 37th July 2, Left. Died July 4. 1863. 265 Grogan, C. H., Serg t. 1, 6th Connecticut. July 11, -, 63. . Died July 23, 1863. 312 A irginia. Johnson, C., Pt., G, 1st 4, 63. April 26, Left. Died April 26, 1863. 266 Grossman, W., Pt., C, May 8, Right. Surg. B. Rohrer, 10th Pa. Wisconsin Cavalry. 26, 63. 11 th Penn. lies., age 23. 9, 64. Res. (Also amp. arm.) Died 313 Jollife, J., Pt., F, 70th July 2, Left. Died August 4, 1863. August 3, 1864. New York. 2, 63. 267 Grotenhaus, J., Pt., D, May 6, . Died May 19, 1864. 314 Jones, W. P., Pt.. D, 2d July 2, . Died July 20, 1863. 8th Michigan. , 64. Georgia. , 63. 510 INJURIES OF THE LOWER EXTREMITIES. (CHAP X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 315 Jones, W., Corp l, 23d July , Right. Died July 17, 1863. 364 Mclntyre, S., Pt.,A, 30th July 22, Right. Died August 18, 1864. Wisconsin. , 63. Illinois. 22, 64. 316 Kahoe, M., Pt., I, 113th June 27, Right. Died August 21, 1864. 365 McKeney, J., Pt., K. Sept. 17, . Died September 24, 1 862. Ohio. 27, 64. 108th New York. 17, 62. 317 Kalchback. J., Pt., , Sept. 5, Right. Died September 10, 1864. 366 McKenna,P.,Pt.,G,10th July 3, Left. Died July 11, 1863. 16th Infantry. , 64. Infantry. , 63. 318 Keely, B., Pt., F, 7th Oct. 4, . Died October 4, 1862. 367 McLaughlin, M., Pt., C. May 30, Left. Died June 23, 1864. Illinois. 4, 62. 46th Pennsylvania. 30," 64. 319 Kellogg, T. A., Corp I, July 3, Left. Died July 24, 1863; gan 368 McMurtrie, A. H., Lieut., July 12, Right. Died July 25, 1863. A, 14th Infantry. , 63. grene. D, 3d Iowa. , 63. 320 Kilcs, J. G.,Pt., A, 124th May 5, Right. Died May 24, 1863. 369 Medway,W., Pt.,C, 75th May 27, Right. Died July 3, 1863; gan New York. , 63. Colored Troops. , 63. grene. 321 King, G., Pt., K, 54th Aug. 30, Right. Died August 31, 1862. 370 Merwin, C. N., Drum June 14, Left, Surg. E. A. Thompson,12th Massachusetts. 31, 62. mer, A, 13th Conn. , 63. Maine. Died July 6, 1863. 322 King, I., Pt., E, 126th May 21 , Right, Died May 29, 1864; py- 371 Middleton, J., Pt., H, May 22, Left. Died May 28, 1863. Ohio, ace 21. 21, 64. temia. 22d Iowa. , 63. 323 Krumolhein, W., Corp l, Nov. 24, Right. Died February 12, 1864. 372 Miller, C., Pt,, H, 26th July 2, Right. Died July 10, 1803. E, 2d Missouri. 24, 63. Pennsylvania. , 63. 324 Kuster, J. W., Pt., F, 1862. Right. Died June 25, 1862. 373 Miller, J.W., Pt., E, 21st June 14, . Died June 17, 1863. 57th Pennsylvania. Maine. 14, 63. 325 Laib, F., Serg t, A, 7th July 3, . Died July , 1863. 374 Miller, L., Pt,, G, 96th May 14, Right, Died May 27, 1864. New Jersey. 3, 63. Illinois. , 64. 326 Lambert, W. H., Pt., H, April !), . Died May 26, 1864. 375 Miller, W., Pt., C, 13th July , Left, Surg. W. M. Wright, 79th 160th N. Y., age 31. 9, 64. Ohio. , 64. Penn. Died August 18, 1864. 327 Lamponi, D., Pt., II, 8th May 27, Left. Died June 1, 1863. 376 Miller, W., Pt., E, 153d July 2, Left. Died July 9, 1863. New Hampshire. 27, 63. Pennsylvania. , 63. 328 Langdon, B., Pt., H, 93d May 23, Left. Died June 8, 64; pyaemia. 377 Millsaps, G. W., Pt., A, June 22, Left; circular. Died September New York, age 19. 23, 64. 7th N. Carolina, age 18. 23, 64. 1, 1864; exhaustion. 329 Lawrence, J. B., Capt., May 16, Left, Died May 30, 1864. 378 Mitchell, M. L., Pt., G, Sept. 19, Right. Died October 9, 1863. H, 9th N. J., age 30. 16, 64. 74th Indiana. 19, 63. 3.30 Lehman, J. J., Pt., C, May 12, Right. Died May 25, 1864. 379 Mobtei/, H. M., Pt., A, July 20, Left. Died July 30, 1864. 5()th Pennsylvania. 12, 64. 55th Alabama. -, 64. 331 Lerch, J., Pt., B, 9th 1 enn. Reserves. Sept, 14, , 62. Left, Died October 21, 1862. 380 Montgomery, R. S., Pt., I, 105th Pennsylvania. Dec. 13, 13, 6 . . Left. I )ied December 23, 1862. 332 Lewis, II. F., Lieut., D, July], Left. Died July 2, 1863. 381 Moore. C. H., Pt., F, 13th July 3, Left, Died July 7, 1863. 145th Pennsylvania. , ^63. Mississippi. , 63. 333 Lewis, L., Pt., E, 55th June 5, Left. Died August 2, 1864 ; ex 382 Morrill, F. I,., Lieut., D, June 30, Left. Died July 13, 64 ; tetanus. Pennsylvania, age 18. , 64. haustion. 3d New Ilamp., age 23. 30, 64. 334 Lininger,W.,Pt.,B,145th July 2, Right. Died July 18, 1863. 383 Moser, J., Pt., H, 15th Sept. 19, Left. Died October 11, 1864. Pennsylvania. 2, r 63. New York Artillery. 19, 64. 335 Livcly,"L., Pt., K, 12th Dec. 13, . Died December 15, 1862. 384 Moss, J., Pt., H, 3d Ohio. Oct. 8, . Died October , 1862. Massachusetts, age 27. 13, 62. , 62. 336 Aug. 21, Left. Died en route to hospital. 385 Mounts, N., Pt., B, 121st June 27, Right (also wound of shoulder). 60th Ohio. -, 64. Ohio. 27, 64. Died June 28, 1864. 337 Locke. P., Pt., F, 22d Oct. 8, Left. Died October 16, 1862. 386 Mowers, H., Pt,, 1, 117th May 14, Right; gangrene. Died June 27, Indiana. , 62. New York, age 38. 14, 64. 1864 ; exhaustion. 338 1*00.11, N. B., Pt,, I, 4th April , Right. Died April 6, 1865. 387 Muller, W., Corp l, G, July 3, ; tetanus. Died from ex Virginia. , 65. 1st Virginia. , 63. haustion. 339 Lotz, C., Corp l, K, 151st July 2, Left, Died July 9, 1863. 388 Mullins, C. P., Capt,, A, April 8, Right. Died May 6, 1864. Pennsylvania. 2, m 130th Illinois. 8, 64. :!4< Luallcn, J., Pt,, D, 13th Jan. 15, Both. Surg. L. Barnes, 6th C. T., 389 Munsell, E., Pt,, I, 22d May 7, Right. Died May 7, 1864. 34 li Indiana. 15, 65. and Ass t Surg. H. C. Merry- Massachusetts. 7, 64. weather, 5th C. T. Died Jan 390 Munson, L. F., Pt., A, Dec. 14, Left. Surg. F.G. Snelling,U.S.V. uary 23, 1 865. 10th Connecticut. 14, 62. Died Dec. 29, 1862; exhaust n. 3-12 Lynch, M., Pt., K, 9th Dec. 13, Left. Died December 31, 1862. 391 Murphy, C., Pt., A, 63d Sept. 17, . Died September 18, 1862. Massachusetts. , 62. New York. 17, 62. 343 Madden, M., Pt., A, 4th Sept. 19, Right. Died December 20, 1863. 392 Murphy, J. C., Pt., G, May 3, Left (also wound of right leg). Kentucky. 19. 6:3. llth Massachusetts. 3, 63. Died May 11, 1863. 344 Mahorner, 11., Pt., F, July 2, Right. Surg. II. M. McAbee, 4th 393 Nance, T. J., Pt., H, 30th April 4, Right. Surg. C. E. Swasey, U.S. Ojrj llth Mississippi. 3, 63. Ohio. Died July 27, 1863. Texas Cavalr}-. 4, 64. V. May 1, amp. thigh. Died Ml V Manson, J. P., Pt., A. Dec. 13, Both ; flap. Died December 25, May 8, 1864; pysemia. .Md} 121st Pennsylvania. 13, 62. 1862. 394 Xewton., T., Pt,, A, 10th 1864. ; gangrene. Died May 24, 347 Markteller, W., Pt., F,, Dec. 10, Right. Died December 28, 1864. Louisiana. 1864. 5th IVnn. Cavalry. , 64. 395 Nichols, G., Serg t, E, Sept. 24, . Died September 24, 1 864. 348 Mfinm, J., Pt., C, 55th July 20, . Died July 29, 1864. 4th Colored Troops. 24, 64. Alabama. , 64. 396 Nicholson, G., Pt., 11, July 2, Right. Surg. F. Wolf, 39th K. Y. 349 Martin, J., Pt., E, 8th May 9, Right. Died September 8, 1864 ; 126th New York. 3, 63. Died .Inly 15, 1863. Connecticut, age 19. 9, 64. exhaustion. 397 Nolan, P., Serg t, K, 19th June 19, Left. Surg.W. J. Burr,42d N. Y. 350 Marx, A., Pt., C, 14th Mar. 23, Loft. Died April 8, 1862. Massachusetts. 19, 64. Died Juno 21, 1864. Indiana. 23, 62. 398 Nutter, H. F., Corp l, L, April 2, Left (also wound left arm). Surg. 351 Marx, P., Pt., A, 1st July 2, . Died July 24, 1863. 31st Maine. 2, 65. L. W. Bliss, 51st N. Y. Died Minnesota. , 63. April 3, 1865. 352 Mason, M., Pt., O, 5th July 2, Right. Died July 9, 1863. 399 O Neil, H., Corp l, K, 1865. Left. Died February 9, 1865. North Carolina. , 63. 79th Penn., ago 28. 353 Mathewx, J., Corp l, B, May 14, Right. Died June 12, 1864. 400 Osborn, W. D., Corp l, I, June 14, Right. Died June 24, 1863. 47th Georgia. 14, 64. 26th Connecticut. 14, 63. 354 Mattoon, II., Pt., D, 2d June 10, Left. Died Juno 14, 1864. 401 Owens, J., Pt., F, 8th Dec. 17, Right. Died. Conn. H. Art., age 30. 10, 6-1. Tennessee Cavalry. 17, 64. 355 Maynard, G., Pt., 145th May 12, . Died May 16, 1864. 402 Paisley, W., Pt., H, 32d Oct. 5, . Died October 5, 1862. Pennsylvania. 12, 64. Illinois. 5, 62. 356 Maywood, D., Pt., E, July 2, Right. Died July 15, 1863. 403 Parker, A. M., Lieut., B, July 3, Right. Died July 21, 1863. 74th New York. 2, (>3. llth Georgia. , 63. 357 McCafTertv, W., Serg t, Julvl, Left. Died July 12, 1863. 404 Parks, G., Pt., 1, 3d Iowa. Oct. 5, Left. Died October 17, 1862. C, 121st i enn. 1, 63. 5, 62. 358 McCartney, ()., Pt., E, June 2, Left (also wound left shoulder). 405 Parr, W., Pt., D, 38th May 5, . Died May 11, 1862. 106th New York. 2, 64. Died June 3, 1864. New York. 5, f 62. 359 McCune, A., Capt., G, J une 6, Left. Died June 9, 1864. 406 Patterson, J., Pt,, G, 30th May 18, Lett. Surg. S. C. Plummer, Kith 74th New York. 6, 64. Missouri. , 63. Illinois. Died June 16, 1863. 360 McDonald, E. P., Pt., II, Dec. 16, Right. A. A. Surg. J.C.Thorpe. 407 Paul, E., Pt,, I, 1st Min July 2, . Died July 13, 1863. 28th Kentucky. 16, 64. Died December 16, 1864. nesota. 2, 63. 361 McDowell. A., Corp l, D, July ]. Left. Died July 3, 1863. 408 Pellcy, R., Serg t, G, July 2, . Died July 4, 1863. 72d Pennsylvania. . 63. 53d North Carolina. 2, 63. 362 MoGinniken, C. B., Lt., May 5, Right. Died May 5, 1864. 409 Perkins, D., Pt., F, 8th July , Left. Died July 5, 1864. D, 9th Mass., age 25. 5, 64. Maine. ," 64. 3(53 McGraw. F., Pt,, A, 40th May 16, Left. Died May 22, 1864. 410 Perkins, D.. Pt., H, 4th Sept. 17, . Died October 2, 1862 ; ery Massachusetts, age 28. 16, 64. Penn. Reserves. 18, 62. sipelas. TRIMARY AMPUTATIONS IN THE LEG. 511 No. NAME, MILITARY DATES OPERATIONS, OPERATORS, DESCRIPTION, AND AGE. RESULT. NO. NAME, MILITARY DESCRIPTION, ASD AGE. DATES. OPERATIONS, OPERATORS, RESfLT. 411 Phillips, P., Pt., B. 1st May 9, . Died May 9, 1864. 458 Savage, W. E:, Pt.. K, Sept. 19, Left. Surg. L. P. Wagner, 1 1 4th Rhode Island Artillery. 9, 64. 1 114th New York. 19, 64. N. Y. Tetanus. Died Oct. 27, 41-2 Pickett, J. W., Pt., G, July 3. . Left. Died July 28, 1863. 1864 ; phthisis and exhaustion, 13th Alabama. , 63. 459 Saxby.W. H., Pt., K, May 27, Right. Died May 30, 1863. 413 Pierce, A., Pt., 1, 7th June 8, Right. Died June 20, 1864. 91st New York, age 22. 1 7, 63. Rhode Island. 8, 64. 460 Scliell, J., Pt., I, 1st N. Aug. 19, Left. Died August 27, 1864. 414 Pierce, L. D., Pt., K, 63d May 9, Left. Died June 9, 1862. York Artillery. 19, ( A. Ohio. i 9, 62. 461 Schilling, J., Pt., F, 3d Jan. 11, Right. Died January 24. 1863. 415 Pike, W., Pt., B, 75th ! Oct. 8, Left. Died October 15, 1862. Missouri. 11, 63. Illinois. 8, 62. 462 Schwab, D.. Pt., H-, 33d May 3, Left. Died June 10, 1863. 416 Pilgrim, M., Pt., C, 1st June 14, Right. Died. New York. . 63. Louisiana. 14, 63. 463 Scott, C.V.. Lieut., G, 1st Oct. 19, Left ; posterior flap. Died Jan- 417 Pine, J., Pt., I, 3d In- j July 3, Right. Died July 25, 1863. Rhode Island Battery. 19, 64. uary 21. 1865. fantry. , 63. 464 Scott, H. R. K., Lieut., July 3, Right. Died July 29, 1863. 418 Pinney, A. N., Capt., II, July 130, Right (also amp. arm). Surg. G. H, 8th Alabama. , " 63. 27th Colored Troops. 30, 64. J. Potts, 23d Colored Troops. 465 Scott. J., Pt., I. 1st New June 1. Left. Died June 19, 1864. Died August 8, 1864. York Dragoons. 1, 64. 419 PItimer, A. E., Pt., C, May 10, Left. Surg. W. J. Burr, 42d N. 466 Scott, J. W., Pt., D, 2d July 1, Right. Died Augusts, 1863. 19th Maine, age 31. 10," 64. Y. Died June 4, 64 ; pyaemia. 1 Wisconsin. 2, 63. 420 Pool, J., Pt., B, 16th July , (also amp. arm). Died July 467 Sernson, S. A., Pt., G, July 14, . Died July 17, 1864. Georgia. , 63. 6, 1863. 12th Iowa. 14, 64. 421 2 oole, M. C.. Pt., I, 13th May 12, Left (also wound right). Died 468( Shearer, F., Pt,, I, 35th Dec. 15, Both. Died December 16, 1864. Georgia, age 20. 14," 64. June 4, 1864; pyaemia. 4(>9S Indiana. 15, 64. 422 Potter, H. 11.. Pt., G, July , Right. Died August 18, 1863. 470 Shinn, W., Pt., I, 5th June 18, Left. Surg. S. II. Plumb, 82d N. 14th Mississippi. ," 63. New Jersey. 18, 64. Y. Died June 18, 1864. 423 Potter, W. A., Pt., B, April 6, . Died April 11, 1862. 471 Shores, P., Pt., D, 40th July 8, Left. Died July 18, 1864. 55th Illinois. , 62. Illinois. 8, "64. 424 Potts, J. C., Capt., F, Sept. 19, Right. Died October 4, 1863. 472 Simpson. II., Pt.,D, 137th June 15, Left. Died July 11, 1864. 39th Indiana. 19, 63. New York. ! 15, 64. 425 Powell, J., Serg t, 1,10th May 16, . Died May 26, 1863. 473 Slattery. E. T., Serg t, I, April 7, Right. Died April 17, 1862. Iowa. , 63. 55th Illinois. 7, 62. 426 Price, A., Pt., A, 58th April 8, Left. Died April 9, 1864. 474 Small, J. F., Pt.. B, 1st June 18, . Died June 29, 1864. Illinois. 8, 64. Mass. H vy Artillery. 18, 64. 427 Proctor, L, 1 t., E, 1 10th Juno 1, Right. Died Juno 2, 1864. 475 Smeltz. J. M., Pt., I, 98th June 27, Right. Died July 5, 1864. Ohio. , 64. Ohio. 27, 64. 428 Proseus. E.. Pt., E, lllth July 2, Left. Surg. H. M. MeAbee, 4th 476 Smith. R. M. Pt.. K. 8tb Sept. 17, Right. Died September 28, 1862. New York. 3, 63. Ohio. Died July 10, 1863. Florida. 17, 62. 429 Prugine, J. L., Pt.. F, July 3, Right. July 10, haemorrhage. 477 Smith, E., Pt., H, 2d N. June 17, Left. Died June 28, 1864. 1st Penn. Artillery. 5, 63. Died July 20, 1863; exhaustion. < York H vy Artillery. 18, 64. 4:K> Pullin. C,. B.. Corp l, II, Dec. 14, . Died December 14, 186, . 478 Smith, K., Pt., C, llth Aug. 14, Right; circular. Died Septem 35th New Jersey. 14, 62. I Maine, age 42. H," 64. ber 4, 18(54; pyaemia. 431 Piinly. J. A., Pt., E, May 22. Right. Died June 3, 1863 ; py- 479 Smith, P., Corp l, C, 3d Aug. 16, Right. Aug. 22, amp. left. Died 72d Illinois, age 24. 22, 63. semia. New Hainp., age 19. 16, 64. August 30, 1864: exhaustion. 432 Putnam. S., Serg t. E, Dec. 13, Left (wound of arm and breast). 480 Snapp.W., Serg t, F, 5th Dec. 31, Left. Died April 7, 1863. 145th Pennsylvania. 13, 62. Died December 13, 1862. Kentucky. 31, 62. 433 Quinly. J., Pt., B, 5th Aug. 30, . Surg. P. R. Randall, 5th 481 Spinning, W. W., Pt., B, Sept. 19, Left. Died. W. Virginia, age 42. 30, 62. W. Va. Died Sept. , 1862. 93d Ohio. 19, 63. 434> Randall. A.. Pt., C, 35th Dec. 13, Both. Died December 15, 1862. 48 ~ St .^!\ sl f^ , D F 1>t-1 C May 14, Left. Died May 28, 1864. 435^ New York. ,., v- o .52d Alabama. 483 Stanley, W., Pt., II, 53d , 64. Dec. 13, Right. Died April 26, 1863; am- 436 Rapcr, W., Pt., G, 5th May 5, Right (also w d right arm ; haem.; Pennsylvania. 13, 62. putation and diarrhoea. North Carolina. 5, 62. lig. axillary). Died June 14, 484 Starr. A., Pt., G, 106th July 3, Left. Surg. O. Munson. 108th N. 1862: exhaustion. Pennsylvania. 3, 63. Y. Died July 15. 1863. 437 Rn>l, A. J., I t.. K. 34th July 3, Left. Died July 31, |H13. 485 Shphnix, J. D., Pt., C, July 3, . Died July 18, 1863; ha?m North Carolina. 3, 63. 17th Mississippi. ," 63. orrhage. 438 Ray. S., Serg t. D, 84th Sept. 2, (also amp. arm). Sure. T. 486 Stephenson, W." < ., Pt., July 12, Left (also wound of thigh). Died Illinois. -J, (!. M. Cook, 101st Ohio. Died Sop- C, 3d Iowa. , 63. July 23. 1863. tember (i, 18(i4. 487 Stern, P., Pt., B, 29th Aug. 28, ." Surg. S. S. Schultz, 26th 439 Rml, C. 11., Serg t, F, July 3, Left. Died August 13, 1863. New York. . 62. Penn. Died Sept. 22, 1862. 7th North Carolina. 3, "63. 488 Stevens. .1. C., Capt., II. April (i, . Died April 16, 1862. MO R.-eder. ( ., Pt., F. 134th (M. 19, Right. Died October 19, 1864. 46th Illinois. 6, 62. New York. 19, 64. i 4S1 Stevens, M., Pt., 15, 1st July 9, Left. Died July 9, 1864. 441 /.Veres, L.A., Pt .D, 15th July 3. . Died July 14, 1863 ; py- New York Engineers. 9, 64. (loorgia. 3, 63. a mia. 490 SHnbacker. J., Pt., H, May 12, Left. Died May 20, 1864. 412 Reiminger. A., Pt., F, Dec. 13. Left. Died January 2, 1863. 56th Penn., age 36. . 64. 131st Pennsylvania. 13, 62. j 491 Stockhamnier. F.. Serg t. May 14, . Died May 22, 1864. 443 Rhinelmrt, A. R., I t., 11, May 3, Left. Died M::y 25, 1863. G, 12th Missouri. ," 64. 124th New York. 3. 63. 492 Stone. D. C., Serg t, F, Oct. 5, . Died October 9, 1 862. 444 Rice, 11. J., 1 t., A. 3d Oct. 8. Right. Died November 4, 186 . : 28th Illinois. 5, 62. Ohio. 8. 62. typhoid fever. \ 493 Stone, , Page s Battery. July 2, Left. Died July 11, 1863. 445 Rice, J. H.. 1 t.. B, 11 tli Julv 3. . Died July 11, 1863. 2, 63. New Jersey. 3. 63. 494 Stonestifler, J., Pt., E, June 18, Right. Died June 18, 1864. 446 Richard, J., Corp l, I -, .May Id. Left (also flesh w nd right thigh). 1st Maryland. 18. 64. 143d Penn., age 23, 10, 64. i Died August 4, 1864. j 495 Stouteng er, J., Pt., G, July 2, . Died July , 1863. 447 Rickard N.. I t.. A "(Itli M:iv ! Died M:iv I l 1HIM 147H, Vnw V.irt 2, 63. Pennsylvania. , 64. ,496 Stowbridge, B.. Pt.. I, April 8, Left. Died April 8, 1865. 448 Roberts, P., Pt., II, 41st July 12. Right. Died July 24, 1863. 82d Colored Troops. 8, 65. Illinois. ," 63. i 497 Spears. T. W., Pt., B, Oct. 19, . Died October 22. 1864. 449 Robinson. W., 1 t., 1.6th May 5, . Died June 2, 1862. 29th Maine. 19, 64. ! New Jersey. 498 Sperl, II., Pt.. II, 2d Dec. 1. Right. Surg. J- S. Ross, 1 1 th N. 450 Rodders. S. E.. Pt.. C. Oct. 8. Right. Died October 25, 1862. ( Maryland. 1, 63. Hampshire. Died Dec. 5, 186:?. 15th Kentucky. 8, 62. 499 Tatlo ck, A., Pt., E, 53d Oct. 5, . "Died October 16, 18G2. 451 Rogers, R., I t., 1!, 6th July 14, Left. Died July 30, 63 ; wounds. Indiana. 5, 62. Michigan Cavalry. ," 63. 500 Taylor. G.. Pt., G, lllth July 2, . Died July 20, 1863. 452 Rollins, E. (i., I t., A, May 3, Left. Died June 2, 1863. New York. 3, 63. 12th New Hampshire, j 3, 63. 501 Terwillager. T. S. G., May 5, . Died May 26, 1864. 453 Ross, E. D., Pt., I, 5th May 5, . Died. Pt., B. 120th N. Y. 5, 64. Michigan. 5, 62. 502 Tewcl, AV., Pt., A, 15th Sept. 19, ; Hap. Died September , 454 Sosser. E. A., Pt., C, 10th July3, . Died July 6, 1863. West Virginia. 19, 64. 1864. Georgia. , 63. 503 Thomas, G. B., Pt., C, Julv _, . Died July 10, 1863. 455 Rue, M., Pt., K, lllth July 1, Left. Surg. 11. M. MeAbee, 4th 51st Georgia. ," 63. : New York. , 63. Ohio. Died July 4, 1863. 504 Thomas, I., Pt., H, 8th Dec. 31, . Died January 8, 1863. 456 ! Ryan, S., Corp l, C, 66th June J5, Right. Died July 2, 1864. Kentucky. 31, 62. Ohio. 15, 64. 505 Thompson, P., Corp l, E, Nov. 27, Right (flesh w nd left leg). Ass t 457 Sarles, A., Pt., F, 53d Oct. 5, . Died November 3, 1862. 30th Iowa. 27, 63. Surg. S. S. Buck, 103d Illinois. Illinois. , 62. Died December 12, 1863. 512 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 500 Tiffany, J.. Lieut., D, July 3, . Died July 10, 1863. 539 Yantz, J., Pt., I, 9th Mar. 7, Left. Died March 12, 1862. 27th Virginia. 3, 63. Iowa. , 62. 507 Tinkham, C. G., Serg t, Sept. 17, Left. Died September 30, 1862. 540 York, 15. F., Pt., F, 2d Dec. 13, Right. Died December 27. 1862. A, 12th Mass., age 36. 17, 62. Maine. 13, 62. 508 Tolbogs, R. V., Pt., C, Oct. 5, Right. Died October 14, 1864. 541 York, J. M., Pt., E. 66th May 10. . Died May 22, 1804. 39th Iowa. , 64. Illinois. 1C, 04. 509 Trowbridge, .1. E., S g t. July 3, . Died July 14. 1863. 542 Young, J., Pt., V, 28th Oct. 19, Right. Died October 20. 1804. E, th N. V. Cavalry. , 63. Iowa. IS), 04. 510 Trumbull, A., Pt., K, May 27, Right. Surg. C. A. Robertson, 543 Bnlman, J. W., Pt., G, 2d Oct. 7, Left. 159th New York. 27. 63. 159th N. Y. Died June 23, 03. South Carolina. , 04. 511 Tubbs, 15.N., Pt., ,81st July 2, . Captured and died while 544 Boroff, J. H.. Serg t, A. June 5, Right. Pennsylvania. 4, 62. in prison. 123d Ohio. , 04. 512 KA\ Cook I ieut Col 8th T-M 1 1 T lift- gofY s amp. other foot. Surg. J. tri.l Virginia Cavalry. llllu. 1 . 11. 05. i jeii. T. Gilmore, C. S. A. Died. 546 Derr, A. ./., Corp l, C, May 3, ; circular ; sloughing. 513 Van Kleet, C. H., Pt., June 3, Left; circ. Surg. G. T. Stevens. 37th N. C., age 31. 4. 63. G. 77th N. Y., age 21. 3, 64. 77th N. Y. Died July 20, 1864 ; 547 Harrison, L., Corp l, F, Oct. 4, Left. exhaustion, diarrhoea. 63d Ohio. , 02. 514 Vanwinkle, M.. Pt., E. July 2, Left, Surg. H. M. McAbce, 4th 548 Hemingway, T., Pt., 15, Oct. 13, Left. lllth New York. 3, %3. Ohio. Died July 27, 63 ; gang. Hampton s Legion, S.C. . 64. 515 Varney, A. C., Pt., K, Aug. 6, Left. Died August 21, 1863. 549 James, F. M., Pt., B, 31st July 20, Left. Hth Maine. 6, 63. Mississippi. , 04. T.16 Virgin. A. J..Pt.,K, 25th Jan. 11, Right. Died January 15, 1863. 550 Kelley, J. JF.,Pt.,G, 40th July 20, Iowa, age 25. , 63. Mississippi. ," 64. 517 Wagnor, E. R.. Pt., A, June 14, Right. Died August 13, 180:!. 551 Linebcrger, J. L., Pt., H, May 2. Left. Ass t Surgeon B. Howard, 75th New York. 14, 63. 23d North Carolina. 2, 63. U.S. A. 518 Wales, W., Pt., F, 51st Dec. 31, Left. Died January 7, 1863. 552 Lisebone, J. ff., Pt., 2Sth July 27. . Ohio. 31, 62. North Carolina. , 62. 519 Wullaok. I., Pt., G,49th Nov. 24, Right. Died November 27, 1863. 553 Mason, W. A., Pt., B, 82d Aug. 28. Ohio. 24, 63. Ohio. , 62. 520 Waller, D. J.. , E, 23d Sept. 14, . Sept. 25, haem.; amputat n 554 McCrai/, C. B., Corp l, 1, May 15, Right. South Carolina. 15, 62. thigh. Died Oct. 13, 1862. 36th Alabama. , 64. 521 Walters, J. II., Pt., K, Aug. 22, Left; flap. Died September 3, 555 Razenmand, C., Pt., May , 14th New York. 22, 62. 1862. , 64. 522 Wanzer, J., Pt., G, 12th April 6, . Died April 14, 1862. 556 Read.W. H, Pt, A, 58th July 13, Left. Supposed to h:ivn died. Illinois. 6, 62. Illinois. 13. 64. 523 Watson, S.,Pt.,C, 118th Sept. 21, Left. October 14, hemorrhage. 557 Hf.arly, W., Pt., , 37th May 27, Pennsylvania. 21, 62. Died Oct. 15, 1862; tetanus. North Carolina. , 62. 524 Welch, W., Pt.. I,. 8th June 3, Left ; gangrene. Died July 1 3, 558 Reedy, D.E..Pt.,E,48th June 3, N. Y. H. A., age 43. 4, 64. 1804. Pennsylvania. . 04. 525 Welker, J., Pt., G, 35th Sept. 19, Left. Died October 11, 1863. 559 Rinehaft, L., Pt., E, 32d June 20, Right. Illinois. 19, 63. Indiana. 20. 64. 520 Wickham, 1., Pt.,A, 13th July 22, Left (also wound left arm). Died 500 Robertson, A. S., Pt., . Oct. 5, Iowa. 22, 64. July 27, 1804. 28th Illinois. , 62. 527 Wilburn, J. C., Pt., D, May 23, Right. Died May 28, 1863 ; py- 561 Rot brock, B., Pt.,B, 81st Dec. 13, Right (also wound of side and 2?d Kentucky. , 63. semia. Pennsylvania. 13, 02. foot). 528 Willey, C.W., Corp l, C, June 14, Left. Died June 14, 1863. 502 Soherring, H. P., Pt., , June 5, Right. 2t)th Connecticut. 14, 63. 4th Maryland. , 64. 529 Williams. J. M.. Corp l, Dec. 31, . Died January 24, 1863. 563 Sherrill, J. M., Pt., D, I, 69th Ohio. 31, 62. 18th North Carolina. 530 Williston, R. S, Serg t, Aug. 9, (also wound of hand). Died 564 Smith, J., Pt., D, 9th Oct. 4, G, 2d Massachusetts. 9, 62. August 9, 1862. Illinois. . 62. 531 Willson. J. W., Major, Sept.], Right. Died Oe ober 3, 1864. 565 Songtitery. J,Pt,E.55th July 20, Left. Hth Ohio. 1, 64. Alabama. , 64. 532 Winchester, W. H., Lt., July 1, Left. Died August 1, 1863; py 506 Stephens, J. F., Pt., A, May 3, ; flap. 1, 13th N. C., age 23. 2, 63. aemia. 49th Georgia, age 23. 4. 63. 533 \Vinegar,A.,Pt.,F, lllth May 6, Left. Died June 13, 1864. 507 Swaford, W. H., 1 t., C, July 20, Left. New York, age 18. 6, 64. 3:!d Mississippi. , 64. 534 Winemiller, J.C., Serg t, Aug. 16, Right. Died August 24, 1864. 568 Talifero, , Lieut., 9th Nov. 5, L, 1st Md. Cavalry. 16, 64. Virginia Cavalry. 5, 62. 535 Wood,K.C.,Pt.,B, l41st July 3, Right. Died July 13, 1863. 569 Willard, J., Pt.! A, Aug. 14, Right. Pennsylvania. , 63. South Carolina. , 64. 536 Woodsi de,H.,Pt.,C, 81st May , Left. Died July 1, 1863. 570 Williams, T. J., Pt., H, July 28, Left. Illinois. ," 63. 20th South Carolina. ," 64. 537 Worcester, J. H., Lieut., July 11, Left; flap. Died July 26. 1863. 571 Wilson, A. W., Pt, C, July 28, Left. II. 7th New Hamp. , 63. 19th Louisiana. , 64. 538 Worcester, O. P., Pt., C, Mar. 23, . Died April 15, 1862. 7th Ohio. , 62. Of the five hundred and seventy-one operations recorded in the foregoing table the amputation was performed in the right limb in one hundred and seventy-seven, in the left limb in two hundred and eight cases; in one hundred and eighty-six instances the side was not indicated. INTERMEDIARY AMPUTATIONS IN THE CONTINUITY OF THE LEG FOR SHOT INJURY. One thousand and forty-six of the five thousand four hundred and fifty- two amputations in the leg were intermediary operations. The results were determined in all cases; six hundred and eighty-two were followed by recovery, and three hundred and sixty-four by death, a mortality rate of 34.7 per cent., exceeding that of the primary oper ations (30.9 per cent.) 3.8 per cent. Two hundred and ninety-six operations were performed HOLLOWAY (J. M.), Comparative Advantages of Pirogoff t, Syme s, and Chopart s Amputations and Excision of the. Ankle Joint by Hancock s Method, after Gunshot Wounds and otJier Injuries, in American Journal Medical Sciences, Vol. LI, p. 85. SECT. V.J INTERMEDIARY AMPUTATIONS IN THE LEG. 513 in the upper, three hundred and sixty-eight in the middle, and three hundred and thirty-five in the lower third of the leg; in forty-seven the seat of the amputation was not indicated. Intermediary Amputations in the Upper Third of the Leg for Shot Injury. Two hundred arid ninety-six operations were recorded; one hundred and ninety-four had suc cessful, and one hundred and two fatal terminations, a mortality of 34.4 per cent. Successful Intermediary Amputations in the Upper Third of the Leg. The one hun dred and ninety-four operations were performed one on a civil employe, twenty-two on Confederate, and one hundred and seventy-one on Union soldiers. Of the latter, one officer was placed on the retired list, and one hundred and sixty-eight enlisted men became pen sioners, of whom twenty have died since their discharge. In three instances the amputa tion in the leg was followed by amputation in the thigh. 1 CASE 754. Colonel F. Fessenden, 30th Maine, aged 25 years, was wounded in the right leg during an engagement near Cane River, April 23, 1864, and entered St. James (Officers ) Hospital, New Orleans, six days afterwards. Assistant Surgeon S. H. Orton, U. S. A., reported: "The tibia was fractured irregularly for two and a half inches at the upper part of the middle third, two pieces of bone being entirely detached. Flap amputation at the upper third was performed on April 30th, by Surgeon F. Bacon, U. S. V.; chloroform was used. At the time of the operation the periosteum was detached, with infiltration of pus beneath the integuments down to the ankle joint. The patient s constitutional condition was good and he progressed favorably. He was granted a leave of absence, and left the hospital May 18, 1864." The specimen (3603) shown in the annexed wood-cut (FiG. 294) was contributed to the Museum by the operator, with the following supplementary description of the case: The tibia was splintered by a glancing bullet, which did not lodge in the leg and made but a single wound in the integuments. The fibula was not fractured and has not been preserved. I first examined the wound some seven days after it had been received and was surprised in view of its apparently small extent to find the bones stripped of periosteum and evidently dead for a distance of several inches above and below. One of the fissures ran directly across the nutrient foramen. The artery had been ruptured at that point and considerable haemorrhage had ensued, the blood being evidently infiltrated through the calf of the leg. To this fact I attributed the loss of vitality which had taken place even in the larger fragments of the bone. The leg was amputated without delay immediately after the examination." After leaving the hospital Colonel Fes senden returned to active service, and was promoted to Brigadier General and subsequently to Major General. He was retired from service November 1, 1866. At the battle of Shiloh, April 7, 1862, he had also been wounded in the arm. CASE 755. Private J. Wheeler, Co. A, 8th Connecticut, aged 23 years, was wounded at Antietam, September 17, 1862. Surgeon T. H. Squire, 89th New York, recorded hi* admission to the Locust Spring field hospital, near Sharpsburg, and noted the following description of the case: "The wound was through the right ankle joint by a musket ball. The leg was amputated one week after the injury by Surgeon W. H. Leonard, 51st New York, at the junction of the upper and middle thirds. The flaps sloughed and the ends of both bones became exposed, being surrounded by red granulations. By a healing pro cess the stump slowly changed for the better, the efforts of nature being supported by treatment as good as. could be, and the patient being cheerful and expecting a good recov ery. On November 12th, the ends of the bones exfoliated and were taken away, after which the stump improved and the patient s general health became quite good." He sub sequently passed through hospitals at Frederick, was transferred to Knight Hospital, New Haven, and finally admitted to Central Park, New York City, October 30, 1863. Acting Assistant Surgeon S. Teats reported from the latter hospital that "the stump had healed up perfectly sound by June 1, 1863; also that the patient had been discharged from service November 17, 1863, and received an artificial leg. The man has been paid as a pensioner to September 4, 1880. In his application for commutation, dated 1875, he described the stump as being "very uneven and sensitive;" but five years later he reported its condition as "sound." A plaster cast of the stump (Spec. 2746), contributed by Assistant Surgeon J. W. S. Gouley, U. S. A., is represented in the annexed wood-cut (FiG. 295). The specimen indicates the amputation to have been performed by the posterior flap, while the cicatrices resemble those following a circular operation. The integument on the anterior surface appears tightly drawn over the bone. CASE 756. Brigadier-General H. E. Payne, U. S. V., aged 37 years, was wounded at Port Hudson, June 14, 1863. He was conveyed to the field hospital of the 3d division. Nineteenth Corps, whence Surgeon S. C. Hartwell, 38th Massachusetts, reported: "Shot wound of left leg." Two days after the reception of the injury, which involved the fracture of both bones of the leg, he was conveyed to New Orleans, whence Dr. P. C. Boyer reported that the patient "was under treatment at the Hotel Dieu Hospital from June 16th to July 22d for gunshot wound of leg and amputation." The operation was performed by Dr. 1 Two of the operations were done in the middle third of the thigh : Cases of Ft. A. J. Cheever, H, 16th Mass. (TAliLK XXXV, No. 35, p. 280, ante): Corpora] H. W. Hughes, I, 133d New York (TABLE XXXIX, No. 4::, p. 314, ante); and one in the lower third: Ft. F. Hoffman, H, 2d Penn. Artillery (TABLE XL, No. 47, p. 320). SURG. Ill 65 FIG. 294.~Right tibia fractured in middle third. Spec. 3603. FIG. 295. Stump after flap amputation at junc tion of upper and middle thirds of leg. Spec. 2746. 514 INJURIES OF THE LOWER EXTREMITIES. [CHAP X FlG.296.-Frac- tured portion of right tibia ; :ie- crosis. Sp.2587. Warren Stone, of New Orleans, on June 23d, four inches below the knee; the patient entirely recovered and became able to walk with the aid of an artificial limb. General Paine ultimately resigned his commission May 15, 1865, after which he was pensioned. Since leaving the service he has served as a member of Congress, and has been Commissioner of Patents. CASE 757. Private A. Rutter, Co. C, 100th Pennsylvania, aged 20 years, was wounded, at Bethesda Church, June 2, 1864. Surgeon M. K. Hogan. U. S. V., reported his admission to the field hospital of the 1st division, Ninth Corps, with "shot fracture of right leg by minie" ball." Surgeon G. L. Pancoast, U. S. V., who amputated the limb, made the following report: "The wounded man was admitted to Finley Hospital, Washington, on June 15th, from the field hospital. His injury consisted of a compound comminuted fracture of the right tibia, for which amputation was performed at the upper third on June 20th. The operation was done by the flap method and chloroform was used as the anaesthetic, the patient s general condition being excellent. After two days of suffering the patient s progress of recovery was rapid. Cold-water dressings were applied." Apart of the amputated tibia (Spec. 2587), showing fracture in the upper third and exhibiting well-marked necrosis, was contributed by the operator and is represented in the wood-cut (FlG. 296). The patient was subsequently transferred to Judiciary Square Hospital, where, after being fur nished with an artificial limb by Jewell s Patent Leg Co., he was discharged from service May 4, 1865, and pensioned. His pension was paid June 4, 1880. In his applications for commutation he reported the condition of the stump as continuing "all right." CASE 758. Sergeant W. F. Johnson, Co. H, 84th Illinois, aged 19 years, was wounded in the right leg, at Dallas, May 30, 1864. Surgeon J. D. Brumley, U. S. V., reported his admission to the field hospital of the 1st division, Fourth Corps, with "shot fracture of tibia, lower third." Assistant Surgeon C. C. Byrne, U. S. A., vyho amputated the limb at the Field General Hospital at Chattanooga, made the following report: "The wounded man was admitted June 6th, and on the following day circular amputation was performed at the junc tion of the upper and middle thirds of the leg. Chloroform constituted the anaesthetic. The patient s consti tutional condition at the time of the operation was good, but the injured parts were swollen, infiltrated, and cedematous, and there was some erysipelatous inflammation. Two days afterwards the parts assumed a decidedly gangrenous appearance, and the pus become fetid, black, and profuse. This rapidly increased, though liquor of chlorinate of soda was freely applied. On the third day pure bromine was applied, which arrested it. A second application gave the parts a healthy aspect, granula tions springing up at once. Tonics and stimulants were given internally." On August 29th, the patient was transferred to hospital No. 19, at Nashville, where he obtained a furlough and was allowed to proceed to his home. In the following Novem ber he entered the Post Hospital at Rock Island, whence Acting Assistant Surgeon P. Gregg reported that "either in conse quence of deficient flap or subsequent sloughing the bones protruded and became necrosed. It was deemed necessary by Surgeon W. Watson, U. S. V., in charge, and myself to re-amputate. I performed the operation on May 17, 1665. It was necessary to remove the head of the fibula. The joint is useless for any practical purpose." The patient was discharged from service August 10, 1865, and pensioned, since when he has been supplied with artificial limbs at stated intervals. Surgeon G. G. Craig, of Rock Island, who examined the stump on February 9, 1677, reported that "the patella and a portion only of the head of the tibia are remaining, which are drawn back and anchylosed." The pensioner was paid June 4, 1880. CASE 759. Lieutenant-Colonel E. P. Taft, 9th New York Heavy Artillery, aged 32 years, was wounded in the left leg, at the battle of Monocacy, July 9, 1864. Assistant Surgeon T. H. Helsby, U. S. A., reported: "The patient was admitted to hospital at Frederick the day after receiving the injury, which consisted of a fracture of the tibia and fibula in the lower third, caused by a conical bullet. Buck s extension apparatus was applied, with water dressings to the wound, and a generous diet was ordered. Secondary haemorrhage having occurred from the posterior tibial artery, it became necessary on July 22 d to amputate the limb. The opera tion was performed by Assistant Surgeon R. F. Weir, U. S. A., in the upper third, near the tubercle, by the circular method. At the time of the operation the parts were in an unfavorable condition from fading erysip elas and loss of blood, and the constitutional state of the patient was anaomic and depressed. Simple dress ing was applied and a good diet administered. Secondary haemorrhage occurred from the stump on July 24th, for which the popliteal artery was ligated in the stump. Moderate sloughing was arrested by the application of a solution of permanganate of potash, and the after treatment consisted of quinine, porter, and stimulants. On September 7th, the patient received a leave of absence. When he left the hospital he was in fine spirits, his appetite and general condition was good, and the stump looked healthy and was almost healed." The amputated bones of the leg (Spec. 3926), showing the tibia to be shattered and the fibula fractured transversely, Avere forwarded to the Museum by the operator and are represented in the wood-cut (FlG. 297). Lieutenant- Colonel Taft was mustered out November 28, 1864, and subsequently re-commissioned as Colonel. He became a pensioner after being ultimately discharged from service. Dr. AVilliam G. David, of Lyons, N. Y., who testified that he was the attending physician of the pensioner, reported that "the shock to his constitu tion from the wound and loss of the limb, as well as the long-continued and excessive discharge from the stump, so prostrated and reduced him that he never recovered his health, but continued anasmic, and died of dropsy on January 20, 1867." Fatal Intermediary Amputations in the Upper Third of the Leg. The operations belonging to this group number one hundred and two fifteen performed on Confederate and eighty-seven on Union soldiers. Erysipelas was noted in five, tetanus in six, gangrene in eighteen, and pyaemia in nineteen instances. Specimens in twenty-two of the cases are preserved in the Army Medical Museum. Flff. 207 Lower third, left leg:: tibia shattered and fibula transversely frac tured. Spec. 39-30. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG 515 CASE 760. Private J. N. Coder, Co. K, 46th Pennsylvania, was wounded in the left leg, at Cedar Mountain, August 9, 1862. He was admitted to Wolfe Street Hospital, Alexandria, five days afterwards, where amputation was performed by Acting Assistant Surgeon S. E. Fuller, who reported the following history: "A rifle ball passed through the leg, fracturing the tibia about its middle. The limb was amputated three inches below the knee joint by the circular method, by order of Surgeon J. E. Summers, U. S. A., in charge of the hospital, on August 27th. Three days after the operation the stump had become much swollen, with red streaks extending up the limb; no suppuration. Quinine and brandy were ordered internally and warm- water dressings were applied to the stump. August 31st, patient much the same; treatment continued, and limb painted with muriated tincture of iron as far as the redness extended. September 1st, swelling great and no suppuration ; sutures removed and some thick dark-colored fetid matter washed out of the stump. September 4th, redness disappeared; swelling less; no suppuration.; treatment continued. On September 7th some sloughing of the stump appeared, when lint wet with solution of chloride of soda was applied, and the parts were occasionally touched with nitric acid. On September 14th about two inches of the soft parts came entirely away, leaving a granulating surface, and the patient appeared better and had good appetite. On September 16th, I called at 2 A. M., found the peroneal artery bleeding freely, and applied a tourniquet to the femoral, giving brandy and opium internally. There was no return of the haemorrhage, but the patient gradually sunk, and died September 19, 1862." The amputated tibia, showing periostitis to have covered the shaft with a delicate coating of callus, was contributed by the operator, and is specimen 321 of the Surgical Section A. M. M. CASE 761. Private G. Kimmel, Battery I, 1st New York Light Artillery, was wounded in the right leg, at Chancellors- ville, May 3. 1863. Assistant Surgeon J. R. Smith, 136th New York, recorded the wounded man s admission to the field hospital of the 2d division, Eleventh Corps, May 15th, and his "death from pyaemia, after amputation of the leg below the knee, June 3, 1863." Surgeon R. Thomaine, 29th New York, who contributed the specimen (No. 1542) shown in the adjoining wood-cut (FlG. 298), reported that the attempt was made to save the leg, but amputa tion had to be performed thirteen days after the reception of the injury on account of suppuration. The specimen consists of the amputated bones of the leg, exhibiting the tibia to be shattered in the upper third, and showing a decided effort of nature to throw off the dead bone. CASE 762. Private E. Williams, Co. F, 136th Pennsylvania, aged 45 years, was wounded at Fredericksburg, December 13, 1862. Surgeon C. J. Nordquist, 83d New York, reported his admission to the field hospital t>f the 2d division. First Corps, with "shot wound of right leg." Surgeon O. A. Judson, U. S. V., contributed the pathological specimen with the following description: "The wound was caused by a mini6 ball entering the upper part of the middle third of the tibia, passing obliquely downward and backward, fracturing the bone in its course and wounding the anterior tibial artery, and emerging through the gastrocnemius muscle. The patient was admitted to Carver Hospital, Washington, December 21st. The leg Avas placed in a fracture box and the bone kept well in apposition. Water dressings were applied. The patient progressed favorably until December 28th, when a profuse and continually recurring haemorrhage set in which resisted ordinary measures for its control. Amputation was accordingly resorted to, and performed at the upper third of the leg by flap operation. On January 1, 1863, haem orrhage to the amount of thirty ounces occurred from the anterior tibial artery in the stump, which was laid open and the bleeding vessel was secured. But the patient gradually sank, and died the evening of the same day. His system was also infected with pyaemia. Examination revealed an oblique fracture of the tibia, also that a piece of bone had been driven into the anterior tibial artery. The inter-muscular tissues of the limb were distended by pus." The wood-cut (FlG. 299) is a representation of the amputated shaft of the tibia (Spec. 634), which was comminuted in the middle third but shows very little displacement of fragments. TABLE LXXII. Summary of Two Hundred and Ninety-six Cases of Intermediary Amputations in the Upper Third of the Leg for Shot Injuries. [Recoveries, 1194; Deaths, 195296.] FIG. 298. Portions of bones of right leg; tibia fractured in up per third. Spec. 1542. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Adams, \V. J., Pt., A, Sept. 14, Right. Discharged Nov. 29, 1862. 9 Barron, J. G., Pt., C, 4th May 3, Left; flap. Surg. C. S. Wood, 12th Ohio. 17, 62. Suicide January 4, 1870. Artillery, age 19. 18, 63. 66th New York. Discharged 2 Ames, G. \V., Pt., E, 3d Aug. 30, Left; circular. A. A. Surg. R. August 20, 1863. Michigan, age 20. Sept. 15, Ottman. Discharged July 26, 10 Barrows, H. C., Pt., F, July 18, Left ; circ. Confederate surgeon. 1862. 1863. 9th Maine. 21, 6:i. Discharged March 8, 1864. 3 Antry, W. W., Serg t, C, April 6, Left; circular. To prison April 11 Beaty, M., Pt., C, 149th May 3, Right, Ass t Surg. D. H. Strick 24th N. C., age 25. 9, 65. 17, 1865. New York. 16, 63. land, lllth Pcun. Discharged 4 Armstrong, R., Pt., G, July 2, Left (also wound left arm); post. March 31, 18G4. Spec. 1271. 14th Infantry, age 23. 9, 63. flap. Ass t Surg. W. U. Ramsay, 12 Bechtel, H., Pt., I, 51st Dec. 10, Left; ant. post, flap; gangrene. U.S.A. Diseh d Sept. 15,1863. Indiana, age 24. 21, 64. Discharged June x!7, 1865. 5 Arnold, L., Pt., G, 143d May 25, Right (May 25, exo n tibia): flap. 13 Beckel, M., Pt., A, 25th De.31, 62, ,Right. Surg. J. Blount, 25th 111. Pennsylvania, age 20. 29, 64. A. A. Surg. C. Darby. Diseh d Illinois. Jan.6, 63. Discharged July 20, 1863. June 17, 1865. 14 Billings, C. T., Pt., D, July 10, Right ; circular. Exchanged 6 Baker, D., Lieut, G, 8th Sept. 19, Left ; ant. post. flap. To Veteran 7th South Carolina. 14, 63. July 23, 186o. Kansas, age 30. 23, 63. Reserve Corps June 28, 1864. 15 Booth, H., Pt., H, 40th Aug. 29, Left ; post. flap. A. Surg. G. M. 7 Barnes, II. H., Pt., B, 5th Vermont, age 47. May 5, 12, ^64. Left ; flap. Discharged July 15, 1865. New York. Sep.(i, (J2. McGill, U. S. A. Discharged July 7, 1863. Spec. 1966. 8 Barne.lt, A. J., Serg t, D, 32d Georgia, age 35. July 2, 6, %3. Right ; flap. Exchanged Septem ber 25, 1863. 16 Bowen, F. A., Serg t, K, 36th New York. July 1, 6, 62. Left ; flap. Discharged October 1, 1862. 516 INJURIES OF THE LOWER EXTREMITIES. [CHAT. X. No. NAME, MILITARY DESCRIPTION , AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AOE. DATES. OPERATIONS, OPERATORS, RESULT. 17 Bowers, E., Pt., B, 2d Mar. 6, Right; circ. Confederate surgeon. 56 Dudley, \V. W., Lieut. July 1, Right. Dr. S. O. Kinger, Littles- Col d Troops, age 25. 9, 65. Discharged Jan. 18, 1866. Colonel, 19th Indiana. 9, 63. town. (July 3, excision fibula: 18 Bowles, J. L., Pt, A, Sept. 1, Right ; post. flap. Discharged gangrene; haemorrhage.) Dis 10] st New York. 4, 62. February 12, 1863. charged April, J864. 19 Bowman, F. M., Pt., H, May 16. . Re tired February 9. 18C5. 57 Duffy. H., Pt., G, 8th Oct. 27, Left ; circular. Confederate sur 1st Missouri. 19. 63. New York, age 19. 30, 64. geon. Disch d Aug. 7, 18S5. 20 Bradish, A. L., Pt., K, May 3, Left; flap. Surg. F. S. Holmes, 58 Duffy, P., Pt., A, 50th May 24, Left ; ant. post. flap. A. A. Surg. 6th Maine, ape 40. 6. 63. 6th Maine. Discli d Aug. 21 , 63. Massachusetts, age 45. June 17, H. M. Dean. Discharged Aug. 21 Brings. D. J., Pt., B, 1st July 21, Right ; circ. Surg. St. G. Peachy, 1864. 24, 1865. Michigan. 26," 61. P. A. C. S. Discli d Jan. 26, 63. 59 Duncan, J. F., Pt.. H, July 2, Right. Exchanged November 22 Brooks, E., Pt., C, 145th May 3, Left; post. flap. Ass t Surg. L. 4th Alabama, age 19. 29, 63. 12, 1863. New York, age 18. 17, 63. W. Kennedy, 123d New York. 60 Elmer. IL, Corp l, A, July 2, Right. Discharged February 19, Discharged August 21, 1863. llth Mass., age 24. 12, 63. 1864. 23 Brooks, S. S., Pt., B, 8th Oct. 19, Left; lateral oval flap. A. A. 61 Farmer, M. S., Pt., B, Feb. 15, Left. A. Surg. A. P. Shackloford, Indiana, age 23. 29, 64. .Slug. R. H. Sterling. Discli d 17th Kentucky. 25, 62. 17th Kentucky. Discli d July July 28, 1865. 16, 1862. 24 Brown, H., Corporal, I. Sept. 30, Left: anterior posterior flap. Con 62 Fessenden, F., Colonel, April 23, Right; flap. Surg. F. Bacon, U. 50th Penn., age 31. Oct. 14, federate surgeon. Discharged 30th Maine. 30, 64. S.V. Promoted Brig. Gen. May, 1864. March 19, 1865. 1864, and retired. Spec. 3603. 25 Brown, P. J., Pt., K,24th Jan. 3, Right : circ.. Furloughed June 63 Fleming, S., Pt., D, 12th June 13, Kight. A. Surg. S. P. Bryan, 12th Alabama, age 24. 1863. 16, 1863. West Virginia. 19, 63. West Virginia. Disch d April 2ti Buttle, S. \V., Pt., 0. May 31. Right ; circ. A. Surg.W. Thom 21, 1864. 36th New York. June 20, son. June ~8. hsem. Disch d 64 Flyhouse,P.,Pt.,A,10th May 6, Left ; circular. Recovery. Acci 1862. May 25, 1863. Died Jan. 28, Infantry, age 27. 12, 64. dentally killed Jan. 26, 1865. 1869. Spec. 4937. 65 Foss, H., Pt., H, 9th Sept. 19, Right. Conl ed. surgeon. Dis 27 Carnaban. T. A., Corp l. June 30, Left. Discharged September 2, Ohio, age 25. 23, 63. charged June 4, 1H64. J, 9th Pennsylvania. J y3, 62. 1862. C6 Fox, J. N., Pt., K, 24th Nov. 25, Right; post, flap (haemorrhage). 28 Case, II., Pt., I, 12th Aug. i;9, Right : flap. Act. Ass t Surg. D. Alabama. Dec.8, 63. Exchanged February 14, 1864. New York. Sep.8. 62. Weisel. Disch d Nov. 11, 1862. 67 Friend, J., Pt., E, 43d Mar. 4, Left. Surg. F. M. Rose, 43d Ohio. 29 Catew,J. / ., Pt., E.llth July 3, Left. Union surgeon. Trans Ohio. 20, 62. Discharged August 7, 1862. Virginia. 10, 63. ferred July 23. 1863. 68 Fuchs, F., Serg t, A, Mar. 23, Left; flap. Discharged July 18, 30 Cavanaugh, J., Pt . P.. Sept. 17, Left. Surg. I!. A. Vanderkicft, 5th Ohio. 30, 62. 1862. 12th Massachusetts. Oct. 15, U. S. V. Discharged December 69 Gage, C. F., Pt., I, 15th Sept. 17, Left. Surg. S. N. Sherman, 34th 1862. 27, 1862. Massachusetts. 20, 02. N.Y. Discharged Jan. 10, 1863. 31 Chapman, J. P., Pt., I, July 9, Left (also w nd chest and thigh); 70 Galloway, E. T., Pt,, D, May 5, Right : circ. Surg. J. A. Phillips, 61st Georgia, age 27. 21, 64. circ. Surg. C. H. Todd, C. S. A. 56th Penn., age 15. 29, 64. 9th Penn. Reserves. Disch d Exchanged Oct. 17, 1864. May 19, 1865. 32 Cheevrr, A. J., Pt., K, July 2, Left July 18. amputation thigh, 71 Garvin. M., Pt., D, 69th July 1, Right; circ. A. A. Surg. D. W. 16th Massachusetts. 14, ^63. middle third. Discharged Jan New York, age 22. 18, 62. Cheever. Disch d May 22, 1863. uary 27, 1864. Died June 23, 1869: consump 33 Clark, G. \V., Serg t, C, Aug. 30, Right. A. Surg. IS. Howard, U.S. tion. Spec. 22. 30th New York. Sept. 6, A. Disch d Nov. 22, 62. Died 72 Gates, C. II., Pt., H, 1st July 2, Right ; circ. Surg. N. Hay ward, 1862. April 17,1868. New York, age 20. 5, ; 63. 20th Mass. Disch d Oct. 17, 64. 34 Clark, W. S., Pt., G, 5th May 2, Left ; circular. Discharged. 73 George, G. W., Lieut., I, Sept. 17, Left. Surg. L. M. Knight, ."th N. Artillery. 21, 63. 5th New Hampshire. 21 62. H. Disch d March 7, 1863. :;:, Clements , I. N., Pt., F, May 5, Left ; circ. Confederate surgeon. 74 Glenn, E., Corp l, D, Sept. 20, Right; circ. (other w nds). > s urg. 122d New York, age 23. 10, 64. Disch d November 30, 1864. 24th Wisconsin, age 19. 30, 63. T. L. Magce, 51st 111. Disch\l 36 Colson.C. H.,Pt., B, 31st July 3, Right: circular. Discharged Jan Nov. 28, 1864. Insane. 1872. Maine, age 22. 30, \A. uary 6. 1865. 75 Goodrich, L. II. , Tt., B, May 4, Left; flap. Confederate surgeon. 37 Connolly, T., Pt., H, Feb. 20, Left; ant. post. flap. Surg. E. 6th Vermont, age 30. 7, T 63. May 10. ha in.: lig. ant. tibia). 115th N. Y., age 20. 24, 64. Giddings, C. S. A. Discharged Discharged March 19, J864. June 9, 1865. 76 Graham, W. IL, Pt., E, June 5, Left; circ. (recur, haemorrhages). 38 Cooper, AV. H. M., Pt., Aug. 27, Kight ; flap. A. Surg. Green, 19th 1st W. Virginia, age 21 . 25, 64. Discharged November 2(i, 1864. K, ll. th Indiana, age 22. 27, 62. Ind. Disch d August 26, 1863. Died December 9, 1867. 39 Cotter, T.. Pt., F, 30th May 27, Left; flap. Surg. S. K. Towle, 77 Grant, A. D., Pt., K, 8th Oct. 19, Left: ant. post. flap. A. A. Surg. Massachusetts. June 4, 30th Mass. Discharged August Vermont, age 21. Nov. 13, A.W. Emory. Discharged June 1863. 25, 1863. 1864. 28. 1865. Spec. 3470. 40 Cotton, T., Pt., I, 26th July 7, Right: flap. Discharged July 78 Grant, J., Pt., A, 7th Sept. 14, Left. Ass t Surg. A. II. Smith. Col d Troops, age 38. 10, 64. 7. 1865. Wisconsin. Oct. 4, U. S. A. Gangrene. Disch d 41 Courtney, A. H., Corp l, July 1, Left. Paroled September 22, 63. 1862. April 2, 1863. Specs. 741. 78. ). V, 26th N. C., age 26. 6, 63. 79 Greenough, L., Pt., B, May 17, Right ; flap. Discharged March 42 Covert, A., Pt., I, 12th April 6, Left; flap. Discharged August 1st La. Cavalry, age 23. 20, 63. 14, 1864. Michigan. May 1. 62. 8, 1862. 80 Grigsby, P., Pt., C, 7ih De.27, 62, Right. Surg. A. K. Fificld, 29th 43 Craft. W. S., Capt., H. May 27, Right: ant. post. flap. A. A. Surg. Ohio." Ja.20, 63. Ohio. Disch d Aug. 13, 1863. 1st Penn., age 23. June 17, W. II. Finn. Discharged Sep 81 Guilford, G.. Pt., A, 67th July 18, Right; ant. post, flap (two w nds 1864. tember 27, 1864. Ohio, age 20. 21, 63. of left leg); gangrene. Disch d 44 Curtz, G. R., Pt., H, May 6, Right; flap. Diseh d April 20, August 23, J864. Spec. 4304. ("1st Penn., age 18. 9, 64. 1865. Died December 28, 1874; 82 Hachmann, J., Pt., B, Aug. 30, Left. Ass t Surg. A. M. Clark, chronic bronchitis. 41st New York. Se. 14, 62. U. S. V. Disch d Oct. 7, 1863. 45 Davis, H., Pt., K, 1st Aug. 10, Right. Discharged December 30, 83 Hall, J. ()., Pt., D, 8th June 16, Left ; circ. A. Surg. G. F.Wins- Kansas. , 61. 1861. N. Y. Heavy Artillery, 21, 64. low, U. S. N. Gangrene. Dis 46 Davis, M., Pt., F, 14th Sept. 19, Left ; circular. Discharged July age 28. charged June 19, 65. Spec. 50-. . New Hamp., age 19. 22, 64. 19, 1865. H Hamilton, A. C., Pt., H, Jan. 1, Right: flap. Discharged April 47 Davis, W. B.. Pt., C, Oct. 27. Right: ant. post. flap. Disch d 18th Ohio. 15, 63. 27, 1863. 10th New York, age 21. Nv. 4, 64. July 27. 1865. 85 Hammond, R., Pt., A, April 7, Right ; flap. Discharged Feb 48 Day, H. F., Pt., F, 12th July 2, Right; .out. post. flap. A. A. Surg. 15th Ohio, age 24. 11, 62. ruary 21, 1863. New Hampshire. 29, ^63. J. Dickson. Discharged July 86 Ilarkins. T., Pt., 1, 115th July 3, Right ; flap. Discharged Septem 9, 1864. .Spec. 1611. Pennsylvania, age 21. 10, 63. ber 20, 1864. 49 Decatur, D. !"., Pt., K, Sept. 17, Right. A. A. Surg.W. E. Towns- 87 Hatch, 6. C., Pt., C, 48th Aug. 29, Right; ant. post. flap. Disch d 35th Massachusetts. Oc.17, 62. end. Disch d March 13, 1863. Pennsylvania, age 29. Sep. 5. 62. September 29, 1863. 50 DfAman, J. B., Pt., A, July 2, Left. Surg. Harrison, C. S. A . 88 Bauer, L., Pt., C, 1st Aug. 10, Right; circular. Discharged. 56th Virginia, age 30. 5, 63. Paroled Sept. 25, 1863. Missouri Lt. Artillery. Sep. 4, 61. 5] Decry, 8., Pt., K, 90th July 13, Left ; flap. Surg. A. H. Van Xos- 89 Hay, T. H., Lieut., B, : July 2, Left. Surg. Z. F,. Bliss, U. S. V. New York. 21, 63. trand, 4th Wisconsin. Disch d 54th New York. 23, 63. Discharged June 19, 1864. December 10, 1863. 90 Hibbard, J. J., Serg t, July], Left ; circular. Discharged June 52 De Laney, C., colored, Mar. 10, ! Left; flap. A. Surg. E. Gregory, D, 7th Wisconsin. 20, 63. 6, 1864. civilian, age 47. April 4, 17th Conn. April 9, haemorrhage. 91 Heart, \V. A., Corp l, D, June 9, Right. A. A. Surg. W. B. Grain. 1865. Recovery May 18, 1865. : 29th Ohio. , 62. Disch d Dec. 23, 1862. Died 53 Dew, A., Pt., I, 31st Sept. 20, Right (necro.; gang.): ant. post. September 24, 72; colliquative Ohio, nge20. Oct. 4, flap. A. A. Surg. C. E. Bovle. i diarrhoea. SJMT. 4544. 1863. Discharged February 3. 1865. 92 TTf-dopotli, J. P., Pt., A, May 16. Left; post. (lap. Retired Decera- 54 Diviney, P.,Pt., B, 170th June 16, Left ; lat.~flap. Dr. A. Garccl.m, 31st " N. C.. age 25. J ne7, 64. her 8. 1864. New York, ago 23. 20, 64. of Maine. Discharged Feb. 1. 93 Hoffman, F., Pt., H, M June 18, Left; cire. A. A. Surg. J. Money - 1865. .Spec. 2775. Penn. Heavy Artillery, July 18, penny. Necrosis. Deo. 6, 1864. 55 Down, H., Pt., K. 44th June22, Left ; circ. A. Surg A. Delany. H&P 18. 1864. amputation thigh. Discharged New York, age 22. J y6, 64. Disnh d Mar. 18, 65. Spec.2807. Aug. 15, 1865. Spec. 3714. SECT. V.J INTERMEDIARY AMPUTATIONS IN THE LEG. NO. NAME, MILITAUY DESCRIPTION, AND AGK. DATKB. OPERATIONS, Ol KIJATOUS, RESULT. No. NAMK, MILITAKV DESCUIPTIOX, AND AGE. DATES. Ol EKATIONS, OPERATORS, RESULT. 94 Holtinsworth.J. W., Ser Dec. 15, Left ; ant. post. flap. A. A. Surg. 134 Myers, M. S., Pt., F, July 1, Right ; circ. Discharged Sept. geant, G, 22d Alalinina, 16, 64. A. Rolls. Haemorrhage. To 76th New York. 22, " 63. 26, 1864. Spec. 2456. age 22. Provost Marshal March 27, 1865. 135 Nearce, J., Pt., H, 27th Nov. 7, Right : flap. Surg. E. H. Bow 95 Hooper, G. A., Pt., M. Oct. 2, Right circular. Disch d April Illinois. 14, 61. man, 27th Illinois. Discharged 1st Maine Cav., age 25. 29, 64. 15, 1865. August 7, 1863. 96 Housely, H., Cook with April 2, Left; ant. post, skin flap, circ. of 136 Neff, W. W., Pt., G, 6th , July 6, Left; flap. Confederatesurgeon. the 33d Wisconsin, age 11, 05. muscles. Alsoauip. right thigh. Michigan Cav., age 18. 9. 63. Disch d May 24. 64. Spec. 6691. 20. Surg. F. E. Piquette, 86th Col d 137 Newton, W. C., S erg t, Oct. 5, Right. Discharged April 7, 1863. Troops. Recovery. G, 3d Iowa. i 8, 62. 97 Hughes, H. W., Corp l, June 14, Right. A. Surg. J. Homans, jr., 138 Nichols, A. F., Pt., G, May 9, Left; circular. Duty September I, 133d New York. 24, 63. U. S. A. Disch d Oct. 12, 1863. 4th Penn., age 22. 13, 64. ! 19.1864. Amputation thigh. Recovery. 139 O Leary, J., Pt., A, 8th Aug 9. Left ; long post. flap. Surjr. J. E. 98 Hughes, J. D., Serg t, 15. June 10, Left: ant. post, skin flap. A. A. Infantry. 14, 62. Summers, U. S. A. Discharged Morgan s Cav., age 31. 23, 64. Surg. I. L. Stockwell. Hasmor. June 16, 1863. Spec. 3646. To Provost Marshal Oct. 13, 64. 140 O Rourke.P., Pt., F,7th May 31, Left; circ. A. Surg. W. Thom 99 Hunt, II. C., Pt., C, 22d July 20, Left ; circ. Surg. E. L. Bissell, New York Heavy Ar- June 6, son, U. S. A. (May 31. excision Wisconsin, age 31. 29, 64. 5th Conn. Disch d Aug. 22, 65. tillery, age 41. 1864. 6 ins. tibia.) Discharged July TOO Htitchinson, H., Corp l, Mar. 8. Right. Surg. E. B. Haywood, C. 28, 1865. Specs. 1502, 3546. G, 15th Conn , age 25. 14. 65. S. A. Disch d Nov. 7, 1865. 141 Oviatt, F.V., Pt., A, 37th Aug. 21, Right; semi-oval skin flap, circ. 101 Irons, D. II., Pt., A, (ith Sept. 29, Right. Discharged May 16, 1865. Massachusetts, age 37. Sept. 2, tissue flaps. A. A. Surg. G. H. Colored Troops, age 24. Oct.2, 64. 1864. Dare. Disch d Aug. 2, 1865. 102 Jeffords, F., Pt., C, 77th April 4, Right : flap. Surg. A. Campbell, 142 ; Oivens, J., Pt., H, 10th July 1, ; circ. Surg. Rosser, C. New York. 7, 62. 77th N. Y. Disch d June 9, 62. Louisiana. 21. 62. S. A. Retired March 1. 1865. 103 Johnson, A. C., Pt., C, Sept. 26, Right; ant. post. flap. A. Surg. 143 Owens, W., Pt., H, Elli Oct. 25, Right; ant. post. flap. A. Surg. 3d Michigan. 29, 61. J.W. S. Gouley, U. S. A. Dis ott s Regiment, age 39. \ Nov. 15, W. H.Warner, 3d Wis. Cavalry. charged Jan. 26, 1862. Spec. 345. 1864. Exchanged January 27, 1865. 104 Johnson, W. F., Serg t, May 30, Right : circular. A. Surg. C. C. 144 Paine, H. E., Brigadier June 14, Left. Dr. Stone, New Orleans, H, 84th Illinois, age 19. June 7, Byrne, V. S.A. May 17, reamp. General, U. S. V., age 24, 63. La. Resigned May 15. 1865. 1864. leg. Discharged June 8, 1865. 37. Commissioner of General Land 105 Jokel, O., Pt., K, 15th Nov 30, Right: circ. Confederatesurgeon. Office in 1878. Missouri, age 23. Dec.5, 64. Discharged August 1, 1865. 145 Portingall, L, Pt., E, 3d Mav 16, Right; flap. Confederatesurgeon. 10G Jones, J. A., Pt., I, 8th Feb. 20, Left ; circular. Discharged Oct. N. Y. Artillery, age 21. 19," 64. Discharged June 25, 1865. Colored Troops. M hG. G4. 5, 1865. 146 Post, T. H., Pt., H, 2d Oct. 19, Left: circ. A. A. Surg. R. Bartho- 107 Keeney, R., Corp l, K, May 5, Left: circ. A. A. Surg. D.G.Cald- Infantry, age 30. 24, 63. low. Nov., gangrene. Disch d 143d Pe:iii., age 21. 30, 64. well. Disch d Nov. 17, 1864. February 18, 1864. 108 Kchr, C., Pt.. I, 58th N. Aug. 30, Left ; circular. Discharged Feb 147 Power. W., Corp l, D, July 30, Right; flap. A. A. Surg. S. J. i ork, age 3a. Sep.2, 62. ruary 1, 18t>4. 47th New York, age 23. Aug. 3, Holly. Disch d March 2, 1865. 109 Kenyon, L., Pt., 1), 28th Aug. 9, Left ; "circ. Disch d Nov. 10, 62. 1864. Died Sept. 18, 70 ; consutnpt n. New York, age 20. 12, 62. Died September 12, 1868. 148 Proper, J., Pt., K, 20th Sept. 1, Right; circular. A. A. Surg. C. 110 Kerns, G. D., Pt., II, June 18, Left; circ. A. A. Surg. W. E. New York. 12, 62. M. Ford. Discharged Novem- 15,")th Penn., age 19. 30, 64. Sparrow. Disch d Jan. 10, 1865. 27. 1862. 111 Kinney, 1. N., Pt., D, Mar. 7, Right. A. Surg. W. S. Grimes, 149 Rand, W. H., Pt., F, 4th July 3. Left; flap. Ass t Surg. H. M. 32th Illinois. 26, 62. 4th Iowa. Disch d July 30, 62. Mass. Cavalry, age 19. 22, 64. Sprague, U. S. A. Discharged 112 Klinker, H., Pt., C, 26th July 1, Left. Surg. J.A.Armstrong, 75th December 13, 1864. Wisconsin, age 28. 7, 63. Penn. Disch d April 9. 1865. 150 Rapp, A., Pt., I, 5th N. May 3. Right; post, and ant. flaps. Surg. 113 Koeth, G., Pt., B, 140th May 8, Right; post. flap. Discharged Jersey. 10, ^63. G. P. Oliver, lllth Penu. Dis New York, age 24. 14 V 64. April 28, 1865. charged Mar. 18, 64. Spec. 6695. 1!4 Krieger, A., Pt., B, 43d April 6. Left: flap. Discharged August 151 Rewitzer, E., Pt., 1, 15th j May 27, Left; flap. Mustered out Aug. Illinois. 9, 62. 7, 1862. New Hampshire. J e4, 63. 15, 1863. 115 Lacl-eij, J., Sergeant, G, May 5, Left : circular. Paroled July 12, 152 Ritter, J. J., Serg t. B, 1st Sept. 19, Left. Surg. Fithian. C. S. A. 14th La., age 23. 12, *64. 1865. Kentucky, age 30. Oc.17, 63. Discharged June 18, 1864. 116 Lawson, J., Pt., H, 12th Dec. 13, Right: flap. Discharged August 153 Ritter, M/V., Lieut., C, Sept. 14, Right. Resigned February 14, Penn. Reserves, age 21. 17, 62. 24, 1864. 23d Ohio. 17, 62. 1863. 117 Leonard, J., Pt.. D, 3Cth July 1, Left. Surg. A. B. Mott. U. S. V. 154 Rolph, S., Pt., H, 8th Mar. 23, Left ; circ. Surg. G. W. Clippin- New York, age 21. 13, " 62. Discharged May 6, 1863. Ohio. 27, 62. ger, 14th Indiana. Discharged 118 Lucas, J. P.. Lieut., E, Dec. 13. Right. Confed. surgeon ; gang. October 25, 1862. 5th Penn. Reserves. 17, 62. Discharged Sept. 17, 1863. 155 Rowe, R. W., Pt., H, 1st Aug. 10, Left ; flap. A. Surg. S. H. Mel- 119 Marble, .1. D., Pt., D, Aug. 28, Right; circ. Discharged Janu Missouri Artillery. 24, 61. eher. 5th Mo. Discharged. 7th Wisconsin. Sep. 1, 62. ary 22, 1863. 156 Ruffenah, J., Serg t, E, May 3, Left: flap. Retired February 22, 120 Martin, J., Pt., G, 4th Sept. 17, Left; flap. A. A. Surg. J. H. Pea- 48th Miss., age 31. 10, 63. 1865. New York, age 27. Oct. 12, bodv. Disch d Dec. 13. 62. Died 157 Rutter, A., Pt., C, 100th June 2, Right; flap. Surg. G. L. Pan- 1862. Dec. 24, 76. Specs. 744, 4433. Pennsylvania, age 20. 20, 64. coast. U. S. V. Disch d May 121 Martin. S. J., Serg t, G, Mar. 14, Right ; flap. Surg. J. S. Redh eld, 4, 1865. Spec. 2587. 6th Kansas Cavalry, 21. 64. 6th Kansas Cavalry. Disch d 158 Sandford, R. L., Corp l, Sept. 17, Left. Surg. M. Storrs. 8th Conn. age 27. October 7, 1864. E, 118th Penn., age 30. Oc.15, 62. Discharged March 16, 1863. 122 McCracken, J.H., Corp l, May 8, Right ; circ. Surg. S. Moore, C. 159 SaruJford. W. R., Pt., D, July 3, Right. Surg. Dorbet. C. S. A. A, 8th Md.,age24. 12, 64. S. A. Disch d March 17, 1865. 23d Virginia, age 25. 17, *63. Necrosis ; haemorrhage ; erysip 123 McDonald, J. S., Capt., May 6, Right also other wounds); circ. elas. Exch d March 17, 1864. 15, 15th New Jersey, 13, 64. Surg. L. W. Oakley, 2d N. J. 160 Shantz, J. J., Pt., K, 1st Feb. G, Right; circ. Discharged Aug. age 22. Discharged December 15, 1864. Michigan, age 33. 10, 65. 4, 1865. 124 McGuire, J., Pt., F, 73d May 4, Right; circ. Surg. A. B. Mott, 161 Smith, R. A., Pt.,G, 77th April 6, Right. Discharged September New York, age 17. 21, 63. U. S. V. Disch d May 11, 1865. Ohio. 11. 62. 29, 1862. 125 McKnight, J., Pt., A, Dec. 16, Left: flap. Surg. I. F. Galloupe, 162 Spahman, J., Pt., F, 62d July 1, Left; flap. Discharged October 17th Mass., age 25. 29, 62. 17th Mass. Discharged June Pennsylvania. 4, 62. 14, 1862. 2. 1863. 163 Squire, W. P., Pt., C, Sept. 2, Left; circ. A. Surg. T. A. Mo- 126 McLanghlin, H., Pt., E, June 27, Left. Confederate surgeon. Dis 75th Illinois, age 20. 19, 64. Graw, U. S. V. Disch d March 10th Infantry, age 22. 30, 62. charged January 22, 1863. 6, 1865. Sept., 1865, amp. thigh, 127 McNauny, C., Pt., G, Aug. 26, Left: circ. A. A. Surg. C. H. middle third: gangrene. 100th N. York, age 35. Sejtt. 21, Jones. Discharged June 1, 65. 164 Stack, W., Boatswain s Mar. 20, Right. Dr. Langler, U. S. N. 1864. Spec. 3432. Mate, U. S. Steamer 26, 65. Discharged August 18, 1865. 128 Metcalf, L. II., Pt., E, July 21, Left; flap. Surgs. Gibson and Meteor, age 25. Died July 29, 1872. llth New York. 26, 61. Peachy, C. S. A. Discharged. 165 Starkey, G. L., Pt., D, July 2, Left ; circ. A. Surg. H. C. Leveu- 129 Milan, J., Pt., G, 1st July 2, Right : short ant., long post. flap. 19th Maine, age 21. 11, 63. sallcr, 19th Maine. Recovery. T exas, age 30. 23, ? 63. A. A. Surg. B. Stone. Recovery. Died January 31, 1877. Spec. 2052. 166 Steele, W., Pt., G, 70th July 22, Left ; flap. Discharged January 130 MHle, J. M., Serg t, G, Sept. 20, . Sure. J. T. Gilmore. C. S. New York. Au.3, 63. 30, 1864. 8th South Carolina. 27, 63. A . Recovery. 167 Sullivan, J., Pt., D, 6tb Aug. 29, Left. Discharged May Z. 1863. 131 Miller, C., Pt., (!. S. th Juno 30, Left: circular. Aujr. 14. lucmor- , Massachusetts. Sep.-, 62. Died April 8. 70: lung disease. Pennsylvania, age 19. July 30. rhage: ligation femoral artery. 168 Sullivan, P., Corp l, K, May 2, Left; flap. Discharged Septem- 1862. Discharged June 29, 1863. 82d Illinois. 6/62. i ber 11, 1P63. 132 Mundhenk, H. W., Pt., May 9, Left : circular. A. A. Surer. L. E. 169 Taft, E. P., Lieut.-Col., July 9, Left (haein.t; circ. A. Surg. R. F. 1 B, 913(1 Ohio, aye 20. 2!>. " G4. Tracy. Necrosis. Discharged 9th New York Heavy 23, " 64. Wier, U. S. A. Ligation popli- February 17, 1865. Artillery, age 32. ; teal artery. Disch d Nov. 28, 133 Murphy, J., Pt., F, 5Cd May 5, Left : ant. post. flap. Discharged 1864. Spec. 3926. Died Jan. Pennsylvania, age 21. 13, 62. August 9, 1864. ; 20. 1867 ; dropsy. GALLOUPK (I. F.), Army Medical Intelligence, in Boston Medical and Surgical Journal, 1863, Vol. LXVIII, p. 205. 518 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TCr NAME, MILITARY ; r,Tir= OPERATIONS. OPERATORS, ,. NAME. MILITARY D VTFS OPERATIONS, OPERATORS, SHUf DESCRIPTION, AND AGE. RESULT. DESCRIPTION, AM) AOE. RESULT. 170 Thomas, J. A., Pt., K, July 2, Left. Surg. H. M. McAbee, 4th 209 Buck, M. II., Pt., B, Nov. 27, Left : flap. Surg. E. Bentley, U. lllth N. York, age 19. 10, ^03. Ohio. Haemorrhage. Disch d Infantry, age 25. Dec. 13, S.V. Gangrene. Died Decem April 25, 1804. 1803. ber 24, 1803; pyaemia. 171 Tracy, G., Pt., M, 1st Mar. 31, Left ; circ. A. A. Surg. F. II. Col- 210 Burns, II. C., Serg t, H, Oct. 21, Left; circ. A. Surg. T. A. Mc- Maine Cavalry, age 29. Ap.18, 65.: ton. Disch d July 13, 18C5. 7th Penn. Cav., age 39. Nov. 2, Graw, U. S.V. Gangrene. Died 172 Turner. J. W., Pt., A, Sept. 27, Right; circular; gangrene. Dis- 1804. November 19, 04 ; exhaustion. 5th C. Troops, age 34. Oct. 3, (14. charged March xl, 18G5. 211 Butts, J. II. , Pt.,F, 120th Dec. 13, Left. Jan. , 1803. re-amp, leg; 173 Tyrrell, 1 ., Pt., F, 4th Sept. 17, Right ; flap. Surg. H.W. Rivers, Pennsylvania. 2 i, 02. haemorrhage. Died Jan. 30, 03. Khode Island, age 18. Oct. 5, 4th R. 1. Discharged March 0, 212 Cain, P., Pt., D, 88th May 18, Left; flap (erysipelas); haemor 1802. 1803. Died Dec. 10, 1871. New York, age 34. June 8, rhage. Died June 14, 04 ; haem 174 Vangorp, J., Pt., C, 1st Oct. 5, Riffht ; flap. Discharged Feb 1804. orrhage. Spec. 2480. Missouri. 9, 62. ruary 24, 1863. 213 Camp, T. S., Serg t, C, May 3, Left. Surg. G. P. Oliver, lllth 175 Wald, C., Pt., C, 68th New York, age 25. July 2, 9, 03. Right ; circular. Discharged Jan uary 19, 1804. 214 2d Infantry. Campbell, W. II., Pt., B, 8, "03. June 3, Penn. Died May, 1803. Left; circ. A. A. Surg. H. M. 176 Warren. E. E.. Corp l, I, Nov. 26, Left. A. A. Surg. W. H. Butler. 139th N. York, age 23. 17, 04. Dean. Died June 28, 04 ; hasm. 144th New York. 29, 02. Discharged February 25, 1863. 215 Canfield, D. W., Pt., M, June 17, R t ; flap. Surg. C!. L. Pancoast, 177 Watson, C., Corp l, C, Aug. 24, Right ; flap. Surg. J. E. Quidor, 14th N.Y. H.A., ngeOl. 28, 64. U. S. V. Died July 28, 1864. 6th Kansas Cavalry. Se.l9, C2. U. S. V. Disch d Aug. 26, 1803. 216 Castle, W., Pt., 1), 17th Sept. 21, Left; ant. post, skin flap. A.A. 178 Watts, T., Pt., D, 40th Sept. 1, Right ; circ. Discharged May Maine, age 39. 29, 64. Surg. J. S. Waggoner. Died New York. 5, 62. 23. 1863. Sept. 30, 1804 ; tetanus. 179 Webber, E., Corp l, H, Aug. !), Left. A. Surg. J. Wightinan, 2d 217 Ce.cH, B., Lieut., K, 1st May 24, Left. (May 24, amput n at ankle 2d Massachusetts. 12. 62. Mass. Disch d Jan. 15, 1803. Virginia Cavalry. , 04. joint.) Died June 22, 1804. 180 Weiss, E., Pt., A, 1st Aug. 10, Right; flap. Discharged Novem 218 Clare, J., Pt., C, 145th May 2, . Surg. G. P. Oliver, lllth Missouri Lt. Artillery. Sep.4, 01. ber 29, 1B61. New York. 8, 03. Penn. Died May 15, 1803. 181 Welch, T., Pt., D, 3lith De.20, 02, Right ; flap. Discharged October 219 Cloniger, J. W., Pt., K, Sept. 27, Left. Surg. A. T. Barnes, 98th Illinois. Jan. 5, 63. 12, 1863. 72d Indiana, age 22. Oc.l4, G4. Illinois. Died Nov. 9, 1804. 182 Whalley, E., Pt., B, 18th De.13, 62, Left ; circular. Discharged April 220 Coder, J. N., Pt., K, 40th Aug. 9, Left ; circ. A. A. Surg. S. E. Ful Massachusetts, age 30. Jan.3, 63. 25, 1863. Pennsylvania. 27, 02. ler. Erysipelas ; haemorrhage. 183 Wheeler, J., Pt., A, 8th Sept. 17, Right ; post. flap. Surg. W. IT. Died Sept. 19, 1802. Spec. 321. Connecticut, age 23. 23, 62. Leonard, 51st N. Y. Hemorrb.; 221 Crabe, A. B., Pt.,H, 58th June 4, Left ; flap. A. A. Surg. J. C. Nel exfol.; bone removed. Disch d Massachusetts, age 18. 10, 64. son. Died; irritative fever and November 16, 1863. Spec. 2740. exhaustion. Spec. 2585. 184 White, F., Pt., G, 119th May 5. Left ; eire. Surg. P. Leidy, 1 IHth 222 Davidson, J.,Pt., E, 88th Aug. 30, Right. Surg. E. Bentley, U. S.V. Pennsylvania, age 21. ; 9, r C4. Penn. Disch d October 27, 1804. Pennsylvania. So. 12, 02. Died September 25. 1802. Died Dec. 2, 73; consumption. 223 Delaney, J., Pt., G, 07th May 6, Left ; circ. Surg. R. B. Bontecou, Spec. 1425. New York, age 20. 27, " 04. U. S. V. Died July 10, 1804 ; 185 White, J., Pt., I, 14th May 5, Right. Discharged October 11, exhaustion. Jiidiiiiici flfifG iJ3. 18, 64. 1 864. 224 Dow, W. R., Pt., E. 15th May 10. Left. Died June 18, 1864 ; diph 186 White, R., Pt., B, 17th April 2, Right; flap. A.Surg. R.W.Coale, New Jersey, age 35. J e2, 04. theria. Indiana, age 35. 7, 65. U. S. V. Disch d May 31, 1865. 225 Ellis, C. F., Pt., I, 20th Dec. 13, Left. Surg. P. Pineo, U. S. V. 187 Whitehouse, J., Pt., F, April 7, Right ; circ. A.A. Surg. J. Sweet. Massachusetts, affo 23. , 02. Died January 7, 1803. 5th N. Hamp., age 17. 20, 05. Disch d Sept. 29, 1805. Died 226 Eshleman, I.,Pt., E, 17th Aug. 25, Left. Surg. Z. E. Bliss. (Gan February 9, 1808. Spec. 4007. Penn. Cavalr}-, aere 31. Sep.7, 64. grenous.) Died Sept. 23, 1804. 188 Whitner, D., Corp l, A, July 1, Left ; circular. Discharged Feb 227 Ettinger, I., Serg t, F, Aug. 29, Right; flap. Surg. E. Bentley, 107th Ohio, age 21. 24, 63. ruary 7, 1804. Cth New Jersey. Sept. 19, U. S. V. Died September 20, 189 Williams, S. J., Pt., B, De.31, 62. Right. A. Surg. H. M. Duff, 52d 1862. 1802; pyaemia. 24th Wisconsin. Jan.6, 63. Ohio. Disch d Feb. 25, 1863. 228 Fisher, A., Pt., H, 6th May 3, Left. Surg. C. H. Lord, 102d N.Y. 190 Wilson, J., Pt., E, 56th May 31, Right ; circular. Discharged Au- New Jersey. , " 03. (Also w nd of right leg.) Died New York, age 25. J e 3, 02. e-ust 9, 1862. May 20, 1 863. 191 Winter, A. .Corp l, C, 6th July 18, Left. Confederate surgeon. Dis 229 ; Ganges. P., Pt., II, 32d Nov. 30, Left. Died December 27, 1864 ; Connecticut. 21, 03. charged February 20, 1864. Cord Troops, age 23. Dec.4, 04. pyaemia. 192 Woods, W. B., Pt., C, June 30, ; flap. Surg." A. Wauld, C. 230 Gerral, J., Pt., D, 14tb May 1, Right. Died May 10, 1803. llth Alabama, age 25. J y 3, 02. S. A. Recover} . Indiana. 15, 63. 193 Yingling, G., Pt., D, Oct. 27, Right ; circ. Confed. surgeon. 231 Gray, J. A., Lieut., B, Sept. 5, Left; flap. A. A. Surg. J. 11. 105th L*enn., age 37. No.22, 64. Discharged June 26, 1865. 8th Indiana Cavalry, 22, 04. Green. (Gangrenous.) Died 194 Zuelch, G., Serg t, 1C, Dec. 13, Left; circ. Surg. C. Gray, 7th N. age 32. October 2, 1864; pyaemia. 7th New York, age 25. 18, 02. Y. Gang. Disch d May 8, 63. 232 Gressnon, E., Pt., Dar- Dec. 16, Left; ant. pest. flap. A. A. Surg. Died July 2, 70; heart disease. den s Louisiana Batte 19, 04. R. L. McClure. Died Decem 195 Ackland, G., Corp !, H, April 4, Left; ant. post. flap. A. A. Surg. ry, age 28. ber 2 !, 1804 ; exhaustion. 21st Missouri, age 25. 24, 05. R. W. Tooker. April27, hrem.; 233 Grobe, C. W., Pt., F, July 1, Left ; circular. Died September 29, lig. fern. Died May 1 , 1 805. 153d Penn., age 31. 19, 03. 4, 1803 ; erysipelas. 196 Adair, F. M., Pt., D, 32d April 8, Left ; ant. post. flap. Surg. J. B. 234 Haines, J., Pt., A, 20th May 12, Left. July 7, hemorrhage. Died Texas, age 27. 13, 65. G. Baxter, U. S.V. Died April Michigan, age 40. 28," 04. July 8, 1864. 22, 1805; typhoid pneumonia. 235 Ball, W.H., Pt., D, llth May 9, Left; circ. A. Surg.II. C.Roberts, 197 Allen, J. P., Pt., D, 7th May 5, Left. Surg. G. T. Stevens, 77th South Carolina, age 34. 10, 04. U. S. V. Died May 16, 1804. Massachusetts. 10, 64. N. Y. Died May , 1864. 236 Hathaway.G. U., Pt.. A, June 27, Left. Aug. 11, amputation thigh. 198 Ash, G. W., Corp l, K, July 27, Right ; circ. A. A. Surg. C. S. 125th Illinois, nge 24. July , Died September 9, 1804; irrita 23d Kentucky, age 31. Au.12, 64. Merrill. Irritative fever. Died 1804. tive fever. August 13, 1804; non-reaction. 237 Herdman,G.,Pt.,G, 121st Nov. 17, Right: posterior flap. A. A.Surg. 199 Bates, S., Pt., I, 14th N. July 9, Right. A. A. Surg. G. M. Paullin. New York, ago 20. 19, 03. W. M. Hudson. Died Novem Jersey, age 18. 29, r 64. (Haemorrhage.) Died August ber 24, 1803. 23, 1804; pyaemia. Spec. 3941. 238 Hogan, D., Pt., H, 170th May 24, Right ; Kit, flap. A. A. Surg. R. 200 Beck, W. A., Pt., F, Sept. 19, ; circular. Ass t Surg. J. M. New York, age 40. 30, 04. Ottman. Died June 20, 1804. Thomas s Legion. Oct. 4, Lawson, 30th N. C. Died Octo Spec. 2472. 1864. ber 6, 1 804 ; py<emia. 239 Holmes, J. B., Pt., F, 1st May 19, Right. Surg. D.W. Bliss, U. S.V. 201 Bee, J. L., Pt., B, 4th S. May 30, Right ; oval flap. A. Surg. J. C. Maine Heavy Artillery, 25, 64. Died Juno 7, 04 ; haemorrhage Carolina Cav., age 21. June 29, McKee, U. S. A. Died July 2, age 18. and diarrhoea. 1864. 1864. Spec. 2716. 240 Homer, C. H., Corp l, L. June 24, Left; flap. Surg. B. S. Hcrndon, 202 Benson, N., Pt., C, 45th July 12, Left ; circ. A.A. Surg. N. A. Rob- 10th N. Y. Cav., nge 33. J y 9, 64. C. S. A. Died Sept. 9, 1804. N. Carolina, agp 42. Ang.1, 64. bins. Died Aug. 7, 64 ; exhaus. 241 Hood, T. M., Lieut., G, April 0, . Surg. E. C. Franklin, U. S. 203 Bland, F. M., Pt., D, 23d May 10, Left. A. A. Surg. J. Thompson. 40th Illinois. 12, 02. V. Died April 20, 1802. Ohio. June 17, (May 19, Symc s amp. ankle j t ; 242 Hotaling, A., Serg t, A, June 22, Left: circular. A. A. Surg. W. 1803. periostitis.) July 2, amp. thigh. 7th N. Y. H. A., age 25. J yl3, 64. W. Valk. Died July 20, 1804. Died July 10, 1803; exhaustion. 243 Hughs, E., Pt., G, 124th May 3, Left. Surg. G. P. Oliver, lllth Spec. 1700. New York. 9, 03. Penn. Died May 10, 1803. 204 Ely, E. P., Pt., A, 83d July 1, Left. Died July 25, 1802. 244 Hurlbnt, A. R., Capt..A, May 5, Left. Surg. G. T. Stevens. 77th Pennsvlvania, age 23. 5, -02. ! 5th Vermont, age 27. 10. 04. N. Y. Died June 0, 64 ; pyaem. 205 Bond, A., I t., K, 27th July 3, Left. Died September 30, 1863; 245 Huston, A.. Pt., H, 12th July 20, Right : flap. Surg. G. W. Brooks, Pennsylvania, age 37. 7, 63. 1 exhaustion : diarrhoea. Ohio Cavalry, age 18. 28," 04. 12th Ohio. Aug. 28, hiemorrh. 206 Brooks. 11., Pt., K, 20th Mar. 8. Right (gangrene). Died April Died Sept. 15, 04 ; hectic fever. Michigan, age 22. 25. 6."). 14,1805. 246 Jones. J., Pt., I, 27th Aug. 9. ! Loft ; ant. post. flap. A. Surg. J. 207 Brown, T. C., Pt., F, De.3I, 02, Right. Died January 21, 1863. Indiana. 15, 02. I U. Brinton. U. S. A. Aug. If, 34th Illinois. Ja. 12, 63. hasm.; ligation of ant. tibia! and 208 Brownfield, G., Pt., 19th Sept. 10, Right: sloughing. Died Novem- interosscous arteries : gangrene. Indiana Bat ry, age 24. Oct.8, 63. ber 19, 1803. Died August 20, 1802. 1 THOMSON ( W.), Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, in A m. Jour. Med. Sci s, 1804, Vol. XLVII, p. 389 SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 519 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RKSULT. NO. NAME, MILITARY DESCRIITIOX, AND AGE. DAJES. OPERATIONS, OPERATORS, RESULT. 247 Kelly, P., Pt., I, 65th Oct. 19, Left ; circ. A. A. Surg. J. Neff. 274 Redmond, J. W., Pt., D, Aug. 21, Left; circ. A. A. Surg. J. Cass. New York, age 26. 27, 64. Died Nov. 8. 1864 ; pyaemia. 25th S. C., nge 45. 31, 64. Died Sept. 3, 1864 ; diarrhosa. 248 Kimmel, G.. Pt., Battery May 3, Right. Died June 3, 1863; py 275 Roberts, W. J., Pt., D, Sept. 19. ; circular. A. Surg. G. M. I, 1st New York Light 16, 63. aemia. Spec. 1542. 4th North Carolina. 24, 64. Burdett, P. A. C. S. llasmor- Artillery. rhage. Died October 11, 1864 ; 249 Kirb>/, H. W., Pt., B, May 19, ; posterior flap. Died May exhaustion. 27th S. C.. age 50. 1864. 26, 1864 ; pyaemia. 276 Schwerin, H. R., Capt., May 2, Right. Surg. J. D. Hewett, 119th 250 Klump, G.. 1 t., D. 98th July 11, Right ; circ. (haemorrhage). Died C, 119th New York. 9, r 63. N.Y. (Haem.; May 5, excision.) Pennsylvania, age 50. 26, 64. August 3, 1864. Spec. 2888. Anaemic. Died May 10, 1863. 251 Lamoy, W. H., 1 t.. I. Mar. 31, Right ; post. flap. Surg. N. R. 277 Sheldon, B., Corp l, C, Oct. 28, Right ; circ. Surg. O. A. Judson, 97th New York, age 30. April 11, Moseley, U. S. V. Died April 4th N. Y. Heavy Artil Nov. 12, UtS. V. Died Nov. 16, 1864; 1865. 27, 186o; exhaustion. lery, age 29. 1864. pyaemia. 252 Latime.r, J. W., Pt., G, July 3, Left. Aug. 15, gangrene. Died 278 Shepjard, M., Pt., C, 7th May 21, Right; oval. A. A. Surg. J. C. 9th Virginia, age 24. 8, 63. Sept. 8, 1863; gang.; diarrhosa. N. Y. Heavy Artillery, June 6, Nelson. Died June 11, 1864; Spec. 1977. age 4 1 . 1864. diarrhoea. Spec. 2475. 253 Lattin, J. M., Capt., E, June 21, Left ; circular. Surg. A. B. Mott, 279 Shull, W. J., Pt., F, 37th Jan. 2, Left. Surgeon C. J. Walton, 21st lllth N. York, age 28. J y 13, 64. U. S. V. Died July 15, 1864. Indiana. 5, 63. Kentucky. Died January 11, 254 Loftice, D., Pt.. K, 5th May 14, Left ; circ. A. A. Surg. M. L. 1863; tetanus. Tennessee, age 26. June 1, Herr. Died June 10, J864; ex 280 Skinner, J. S., Pt., K, May 2, Right. Surg. J. A. Lidell.U.S.V. 1864. haustion. Spec. 3503. 2d New Jersey. 16, 63. (Also woundof left foot.) Died 255 Luther. A. K., Pt., E, 3d Mar. 4, Left ; circ. A. A. Surg. R. W.W. May 20, 1863; pyaemia. Mass. Cavalry, age 32. 19, 64. Carroll. (March 13, excision; 281 Stalker,G.W.,Pt.,I,83d July 2, Left. Died July 10, 1863; tet 15, haemorrhage.) Died April Pennsylvania, age 23. 9, r 63. anus. 6, 1864 ; pyaemia. 282 Stander, C., Pt., D, 17th Dec. 13, Left. Died December 23, 1862. 256 McBride, F., Pt., H, 75th May 3, Right. Died May 12, 1863 ; py Infantry. 20, 62. Ohio. 9, 63. aemia. 283 Stetson, M., Pt., A, 35th Aug. 29, Left ; ant. post. flap. A. A. Surg. 257 McDermott, J., Pt., A, June 3, Left ; ant. post. flap. Surg. N. R. New York. Sept, 5, R. Reyburn. Gangrene. Died 155th New York. 12, 64. Moseley, U. S. V. Died July 1862. September 11, 1862. 7, 1864. 284 Stout, J. H., Pt., B, 13th April 12, Right; flap. Surg. H. Wardner, 258 McGeary, J. S., Corp l, Dec. 13, Right ; ant. post, skin flap. A. A. Tenn. Cav., age 16. 16, 64. U. S. V. Died April 29, 1864; H, 8th Pennsylvania 28, 62. Surg. D. Weisel. Died Feb. 5, diarrhoea. Spec. 3314. Reserves, age 20. 1863; pneumonia. Spec. 206. 285 Strasburg, W., Pt., F,8th June 3, Right. Surg. S. H. Plumb, 82d 259 McKay, G.W., Capt., K, July 24, Right ; flap. A. Surg. C. W. Stin- N.Y. H vyArt., age 11-. 6, 64. N. Y. Died July 5, 64; pyaemia. 34th Ohio, age 23. 29, 64. son, 23d 111. Died Aug. 13, 64. 286 Tefft, J. A., Corp l, I, Mar. 31, Right. A. A. Surg. C. E." Golds- 260 McKenna, J., Pt., I, llth Aug. 30, . Ass t Surg. B. Howard. 146th N. York, age 25. April 25, borough. Erysip.; typhoid fev. Pennsylvania. Sept. 3, U. S. A. Died September 18, 1865. Died May 25, 1865; prostration. 1862. 1862; tetanus. 287 Thayer, A. H., Pt., H, May 21, Left ; circ. A. Surg. H. C. Rob 261 McQune, A., Pt.. H, 14th May 12, ; flap. A. A. Surg. J. H. 40th Mass., age 39. 25," 64. erts, U. S. V. Died J une 8, 64 ; Infantry, age 40. 23, 64. Thompson. May 26, haemorrh. exhaustion. Died June 11, 18(i4 ; exhaustion. 288 Thompson, J. W., Pt., G, July 3, Left. (Also flesh wound thigh.) 262 Me Williams. D. Jr., Pt., July 2, Left (necrosis). Died Sept. 11, 10th Alabama, age 38. Aug. 1, Aug. 19, slough. Sept. 8, haera. B. 17th Miss., age 34. -, ^63. 1863. Spec. 1979. 1863. Died Sept. 18, 63 ; haemorrhage 263 Mills, N.W.,Lieut.-Col., Oct. 4, Right; circular. Died October and gangrene. Spec. 1974. 2d Iowa. 11, 62. 12, 1862; tetanus. 289 Van Buskirk, I., Lieut., May 3, Right. Surg.W. H. Twiford,27th 264 Moore, C., Serg f, D, 42d July 2, Left (haem.; July 24, lig. post. F, 27th Indiana. 16, 63. Indiana. Died May 20, 1863. New York. Aug. 1, tibial). Aug. 20, capillary haem. Sprc. 1149. 1863. Died Sept. 5. 1863. Spec. 1648. 290 Van Antwerp, W.. Lieut., May 8, Right; circular. A. A. Surg. G. 265 Moore, G.W., Corp l, C, June 3, Left ; circ. A. A. Surg. C. P.Bige- F, 13th Indiana, age 24. 21, " 64. Coloosdian. Died May 26, 1664; 8th N. Y. Art v, age 26. 13, 64. low. Died June 20, 1864 ; hasm. exhaustion. 266 Moore. R. A., Serg t, I, Deo. 13, Right. Died January 8, 1863; 291 Vaughn, N., Pt., H, 1st April 1, Left : circular. A. A. Surg. C. B. 4th Penn. Reserves. 29. 62. haemorrhage. Spec. 581. Virginia, age 30. 20, 65. Wright. (Gangrene.) Haemor 267 Myrcs, D. T., Pt., H,5!st De. 16,^64, Left. A. A. Surg. W. Anderson. rhage; ligation posterior tibial. Indiana, age 20. Jan.4, 65. Died January 9, 1865. Died April 30, 1865 ; exhaustion. 2(i8 Norris. J., Pt., K, 68th July 2, Left; haemorrhage, 16 oz. Died 292 Wade, II. P., Pt., K, 32d July 2, Left. Died July 31/63; pyaemia. Pennsylvania, age 30. 28, 63. August 1, 1863. Massachusetts, age 30. 5. 63. 269 O Leary, T., Pt., K, 4th May 2, Right. Surg. G. P. Oliver, 11 1th 293 Whitney, A. S., Pt., E, May 8, Right; circular. A. A. Surg. C. Artillery. 8, 63. Peun. (Also wound of left leg.) 3d New Jersey, age 22. 28, "64. A. Lindsay. Died June 13, 64 ; Died May 14. 1863. pyaemia. Spec. 4576. 270 Passenge, C. E., Serg t, Oct. 26, Left ; circ. Surg. S. S. Boyd, 84th 294 Williams. E., Pt.. F, Dec. 13, Right; flap. (Haemorrhage.) Jan. E, 37th Illinois, age 23. Nov. 24, Ind. (Haemorrhage; ligation.) J36th Penn., age 45. 28. 62. 1, 63, lig. ant. tibial. Died Jan. 1864. Died December 13, 1864. 3, 1863, haemorrhage. Spec. 634. 271 Randall, C. E., Major, Nov. 30, Left; circ. Surg. A. Wynkoop, 2 .).". Wood. J., Pt., A, 3d May 18, Right ; double flap. A. A. Surg. 2oth Ohio, age 26. Dec.8, 64. U. S. V. Died Dec. 15, 1864. Maryland Cavalry, age June 3, C. Bausch. Died June 11, 1864; 272 Ray, J. L., Pt., D, 10th June 9, Left. A. A. Surg. D. Buck. Died 21. 1864. pyaemia. Kentucky C av., nge 18. 19, 64. June 26, 1864 ; exhaustion. 296 York. M.. Pt., E, 120th July 2, Left. A. A. Surg. F. Hinkle. 273 Reddick, ~M., Pt., K, 1st Jan. 2, Right. Surg. C. J. Walton, 21st New York, age 20. 27, 63. (Gang.) July 28, amp. right leg, Florida. 5, 63. Ky. (Also wound of left foot.) lower third. "Died Aug. 8, 1863; Died January 8, 1863. exhaustion. Specs. 1605, 1609. The operations were performed in the right leg in one hundred and twenty-seven and in the left leg in one hundred and fifty-eight instances; in eleven cases the side was not indicated. Intermediary Amputations in the Middle Third of the Leg. Three hundred and sixty-eight cases of intermediary amputations in the middle third of the leg are found on the records. The terminations are ascertained in all: two hundred and fifty-eight ended in recovery and one hundred and ten in death, a mortality rate of 29.8 per cent. Recoveries after Intermediary Amputations in the Middle Third of the Leg. The two hundred and fifty-eight operations of this group were performed on two hundred and thirteen Union and forty-four Confederate soldiers; in one instance the patient was a citizen employ^. Of the two hundred and thirteen Union soldiers the names of two hundred and . A.), On the Major Amputations for Injuries in both Civil and Military I ractice, in Am. Jour. Med. Sci t, 1864, Vol. XL VII, p. 365. 520 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 300. Stump of left leg 10 months after circu lar amputation in middle third. Spec. 4318. [From a cast.] ten were found on the Pension Rolls. Fourteen have died since the date of their discharge, one from constant discharge of stump, six from phthisis, and seven from causes not stated. In four instances amputation in the thigh was subsequently performed. CASE 763. Private G. W. Smith, Co. F, 76th New York, aged 20 years, was wounded in the left leg, at Gettysburg, July 1, 1863. He was conveyed to a field hospital of the First Corps, where amputation was performed but not recorded. Surgeon H. Janes, U. S. V., reported that the wounded man was admitted to Camp Letterman August 20th, his injured leg having been previously amputated, also that the patie nt did well afld required no other treatment than simple dressings to the wound. Surgeon B. A. Clements, U. S. A., reported the following description and termination of the case: "The injury involved the ankle joint and was caused by a mini ball, which passed through antero-posteriorly, fracturing the bones. The leg was amputated by the circular method, at the Express Office Hospital, Gettysburg, five days after the reception of the injury. The man at the same time was wounded by another ball in the upper part of the left thigh. This was a flesh wound and healed in about two months. The stump healed kindly, and was entirely well when the patient was transferred to Central Park Hospital, New York City, on October 14th. In December following the stump ulcerated and a portion of a ligature escaped, after which it again healed/ On May 20, 18(54, when discharged from service at his own request, the patient s general condition was good and motion of the knee joint perfect. After leaving the hospital he was furnished with a "Palmer" artificial leg. In his application for commutation the pensioner describes the stump as remaining in "good condition," and states that Surgeon J. H. Beach, 24th Michigan, performed the amputation. The pensioner was paid March 4, 1880. A cast of the stump (Spec. 4318), showing amputation to have been performed at the middle third, and exhibiting the curious marking of an equal-armed cross on the cicatrix, was contributed by Acting Assistant Surgeon G. F. Shrady, and is represented in the wood-cut (FiG. 300). CASE 764. Private G. Cullom, 1 Co. D, 83d Ohio, aged 20 years, was severely wounded in the left ankle joint, at Cham pion Hills, May 16, 1863. He entered and remained at a field hospital for three weeks, when he was sent on board of a Hospital transport. Assistant Surgeon H. M. Sprague, U. S. A., recorded the wounded man s admission on board of the Steamer City of Memphis, June 8th, and his transfer to Jackson Hospital, Memphis, June 14th. Surgeon W. Watson, U. S. V., in charge of Jackson Hospital, contributed the pathological specimen with the following history: "The patient was under the attendance of Acting Assistant Surgeon J. Witham. When admitted he was very much reduced by diarrhoea, greatly emaciated, and suffering from extensive bed-sores over the sacrum. He had undergone amputation of the wounded leg, eight inches below the knee, pre vious to admission, and both bones were protruding from the stump. Simple dressings were used and adhesive plasters applied to the bed-sores, and he was allowed a generous and nourishing diet, with porter. On June 18th, he was placed upon a water- bed, after which a constant but slow improvement ensued and the stump was healing. On August 2."th the bone, having become entirely detached, was removed. After this operation the patient s progress was more rapid, and he acquired strength enough to go about on crutches. On September 30th, when the patient was transferred to St. Louis, the stump had nearly healed." The removed fragment (Cat. Surf/. Sect., 1866, p. 405, Spec. 2099), consisting of semi-tubular sequestrum from the tibia, five inches in length, is represented on PLATE LXXI, FIGURE 4, opposite page 428. The patient was discharged from service, at Jeft erson Barracks Hospital, October 19. 1863, and pensioned. In the following year he was supplied with an artificial limb by Dr. Douglas Bly who described the amputation as having been performed by the flap method. In his application for commutation, dated 1870, the pensioner stated that his limb was amputated twenty-five days after the reception of the injury. The pensioner died August 27, 1872, of consumption, superinduced by the amputation, his attending physician certifying that the stump never healed and never ceased to suppurate, discharging fragments of bone at times. CASE 765. Private J. Sterritt, Co. C, 119th Pennsylvania, aged 39 years, was wounded iu the lower part of the left leg, at Spottsylvania, May 10, 1864. Surgeon O. A. Jiidson, U. S. V., contributed the patho logical specimen, shown in the annexed wood-cut (FiG. 301). with the following history: "The wound was caused by a conoidal ball entering the leg antei iorly about three inches above the ankle joint, passing trans versely through, producing compound comminuted fracture of the lower third of the tibia and involving the ankle joint. The man entered Carver Hospital. Washington, three days after being wounded. At the date of his admission the injured ankle was tumid, red, and painful, and the foot fpdematous; but his constitutional state was good and there was no emaciation. On May 14th the patient was etherized and the parts were examined, when the severity of the fracture was discovered and pus was found to have burrowed freely about the ankle joint. Consequently the leg was amputated at the middle third by the skin-flap method and circular section of muscles. The operation was performed by Acting Assistant Surgeon O. I . Sweet. The patient reacted well from the shock of the operation and continued to do well. Simple dressings were applied to the stump and stimulants were admin istered. About half of the anterior flap sloughed, but by June 1st the stump looked well and secreted laudable pus ; granulations red and healthy. About June 12th an abscess formed on the crest of the tibia, probably resulting from necrosis of a small por tion of the bone. The patient recovered and subsequently passed through different hospitals, being ultimately discharged August 7, 1865, and pensioned. Previous to leaving the service he was supplied with an artificial leg. In his application for commutation, dated 1870, he described the condition of the stump us "-unhealthy at present," and six years later he reported it as "inclined to be sore." The pensioner \\sis paid June 4, 1880. The specimen (No. 2284) consists of the amputated portions 1 BRYAN (JAMES), Seventeen Additional Cases of Amjmtatims from the Armies of the, South- West, in American Medical Timet, 1863, Vol. VII, p. 288. FIG. 301. Frac tures in lower thirds of the bones of loft leg. Spec. 2i.>84. SECT. v.J INTERMEDIARY AMPUTATIONS IN THE LEG. 521 of the bones of the leg, and shows the extremities of the fibula to have been carried away and the adjacent portion of the tibia to be broken. Another fracture, where the bone was chipped, is also exhibited five and a half inches above the joint, from which longitudinal fractures extend into the articulation. CASK 766. Sergeant J. Peart, Co. A, 21st New York Cavalry, aged 22 years, was wounded in the left leg, at Ashby s Gap, July 18, 1864. and entered the General Hospital at Frederick nine days afterwards. Assistant Surgeon R. F. Weir, U. S. A., in charge, reported tlie following history: "The injury was caused by a minie ball, which shattered the tibia near the ankle. When admitted here the limb was in a very bad state, being codematous, ecchymosed, and discolored. Amputation of the leg in the middle third was performed by Acting Assistant Surgeon J. H. Bartholf on July 31*t, by lateral flaps of skin and fascia and circular method through muscles. The patient s constitutional condition at the time of the operation was fair and his health good. One week afterwards the stump became gangrenous, when nitric acid was applied with success. The patient s progress went on gradually to recovery. Though the stump was not entirely cicatrized at the end of three months it was in good shape and there was no retraction of the flaps, extension of them by weight and pulley having been adopted at the beginning. The stump was healed, and the patient in good health on December 20th, when he was transferred to Central Park Hospital, New York City, for an artificial limb." The patient was discharged from service at the latter hospital May 23, 1865, and pensioned, and several weeks afterwards he was furnished with an artificial leg. In his application for commutation the pensioner described the stump as continuing in a "healthy condition. His pension was paid March 4, 1830. CASE *767. Private C. Burbridge, Co. K, 88th Pennsylvania, aged 40 years, was wounded at Spottsylvania, May 10, 1864, and entered Mount Pleasant Hospital, Washington, three days afterwards. Assistant Surgeon C. A. McCall, U. S. A., reported: "The injury was caused by a minis ball entering at the internal malleolus of the right leg, comminuting the fibular extremity and the astragalus and laying bare the tendon. The parts became swollen, tense, and discolored, and synovitis was fully developed. Amputation at the junction of the middle and lower thirds of the leg was performed by the antero-posterior flap method on May 24th, by Acting Assistant Surgeon P. C. Potter. The anaesthetic was made up of two parts chloroform and one part ether. At the time of the operation the patient was in a weak and debilitated condition and failing hourly, suffering from nervous trembling, restlessness, exhausting insomnia, and severe pain, which was lancinating and at times grinding and unsupportable. There was also copious discharge of ichor from the wound, and a sinus and abscess had extended up the limb and was opened a day or two before the operation. Interrupted sutures were applied to the stump, which broke out from ulceration of the flaps on the third day. Straps were then used and a tendency to slough counteracted by antiseptic poultices. Tonics and malt drinks were administered. By June 30th, the sloughing had stopped and abundant granulations were springing up. The greatest point of difficulty in this case was produced by the flaps falling asunder at each dressing, thus breaking up the nearly healed union and allowing the tibia to protrude." In the following month the patient was transferred to York, and subsequently he passed through various hospitals at Philadelphia, being ultimately discharged from service at Chester, June 27, 1865, and pensioned. He had been previously supplied with an artificial leg. In his application for commutation, dated 1870, the pensioner described the stump as being "tender;" but in his subsequent statements he represented it in "good condition." The pensioner w T as paid June 4, 1880. Fatal Cases of Intermediary Amputation in the Middle Third of the Leg. The one hundred and ten operations of this group were performed on one hundred and nine patients, in one instance both legs having been amputated. Ninety-eight were Union and eleven Confederate soldiers. In one case the amputation in the leg was followed by amputation in the thigh in the lower third. Death is ascribed to pysemia in thirty-four, exhaustion in eighteen, gangrene in five, and tetanus in four instances. CASE 768. Private J. Heakin, Co. D, 6th U. S. Cavalry, aged 24 years, was wounded in the right ankle, at the battle of Old Church, May 31, 1864. He was admitted to Stanton Hospital, Washington, four days afterwards, where amputation was performed by Surgeon J. A. Lidell, U. S. V., who made the following report: 1 "The wound was inflicted by a minis ball, which entered anteriorly, passed backward and inward, apparently going close to the posterior tibial artery and escaping behind the lower end of the tibia. The ankle joint was involved. The parts became swollen, red, and tender. During the night of June 7th the patient had secondary haemorrhage from the wound, losing about a pint of blood, bright red in color. On the following day the leg was amputated at the place of election by double flap method, the anterior flap being shorter than the posterior, and the tibia being divided after the procedure of Sanson. Sulphuric ether constituted the anaesthetic. The loss of blood was trifling during the operation and the patient s general condition at the time was favorable, there being no constitutional disturbance worth mentioning. The shock of the operation was little and passed away quickly; reaction moderate. The patient died of pyaemia June 21, 1864. The examination of the injured member showed the lower end of the tibia to be badly comminuted into the ankle joint, which was filled with pus. The posterior tibial artery was grazed by the bullet and some very smail fragments of bone had been driven into it. The haemorrhage occurred on the detaching of these fragments by suppuration, together with the separation of the bruised tissue 30" Bones belonging to the wall of the artery. The astragalus was uninjured." The latter bone and the lower portion of of the right ankle the amputated tibia (Spa: 2470) were contributed to the Museum by the operator, and are represented in the l^" e l spec. 2410. wood-cut (FiG. 302). CASE 769. Private W. Nixon, Co. H, 20th Illinois, was wounded in the lower part of the right leg, near Kenesaw Mountain, June 17, 1864, by a musket ball striking the anterior surface of the tibia and entering the bone. He was admitted to a field hospital at Big Shanty, and thence, ten days later, to the general hospital at Rome. Slight haemorrhage is said to have 1 LIDELL (J. A.), Secondary Hamorrhagc from Posterior Tibial Artery, etc., in U, S. Sanitary Commission Memoir*, New York, 1870, Vol. I, p. 23. SURG. Ill 66 522 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. occurred on June 21st, and while being transported in the railroad cars from Big Shanty to Rome the patient bled to syncope. After several more slight haemorrhages, which were temporarily checked by plugging the wound, it was found that the bleeding could no longer be restrained, it being impossible to secure the vessel at the point of the injury on account of extensive dis organization around the wound as well as on account of the depth of the artery and the uncertainty of finding it. Amputation was then decided upon and performed through the middle third of the leg, on July 6th, by Surgeon G. F. French, U. S. V. The ball was found in the medulla of the amputated bone, and the bleeding vessel was discovered to be the anterior tibial arterv. At the time of the operation the patient was enfeebled by the loss of blood. Reaction was fair, but his condition was low; pulse feeble; lips and skin very pale. For some days his condition continued very crit ical. On July 27th, a slight diarrho?a came on and the patient s .condition, although improved, was still critical. On August 3d, colli()uative diarrhoea set in and the patient s strength was fast failing; pulse flagging; appetite entirely lost. He died on August 19, 18*34, of exhaustion, though every eifort had been made from the beginning to sustain his strength by a nutritious diet and the generous use of stimulants. At the time of his death the stump had almost entirely healed The amputated tibia (Spec. 3382), longitudinal Iv frac tured, with a battered colloidal ball lodging in the lowest third of the bone, was contributed, witli the history, by the operator, and is shown in the wood-cut (FiG. 303). CASE 770. Sergeant P. Smith, Co. K, 69th New York, aged 30 years, was wounded at Deep Bottom, August 16, 1864. Surgeon J. F. Dyer, 19th Massachusetts, reported his admission to the field hospital of the 2d divis ion, Second Corps, with "shot fracture of both legs." Four da} s after receiving the injury the wounded man was admitted to Satterlee Hospital at Philadelphia, where both limbs were amputated by Acting Assistant FIG. 303. Frac- Fm. 304. Bones of both ankles. The astragalus and outer malleolus of the left and the base of the tibia of the right ankle are fractured. Spec. 3644. tured lower por- Surgeon J. H. Hutehinson, who described the wound as follows: "A tib7aSp<:c.3382. conoidal ball entered the left foot a little in front of the external malleolus, which it fractured, thence passing behind the joint and making its exit below and posterior to the internal malleolus. The missile then entered the right foot just in front of the internal malleolus, penetrated the joint, and lodged against the external malleolus, whence it was removed August 26th. Considerable difficulty was experienced in discovering the position of the ball, a large mass of loose bone having to be removed before it could be found. After the patient s admission it at once became evident that he would have to lose both feet; but it was considered more prudent to wait for the establishment of suppuration. About September 3d, both feet were discharging a large amount of healthy pus, and the patient was weak in consequence of this excessive drain, but was supported by means of quinine, beef essence, and milk punch. On September 6th I amputated both legs by the circular method, the left one above the ankle joint (at the junc tion of the middle and lower thirds) and the right one and a half inches higher up, the patient being etherized during the oper ation. By September 23d the patient, considering his situation, was still doing well. Considerable sloughing had taken place, particularly in the left stump, where the tibia was exposed. There was also two slight bed-sores notwithstanding the very careful nursing the patient received." Surgeon I. I. Hays, U. S. V., in charge of the hospital, reported that the patient died of exhaustion October 10, 1864. The amputated bones of the ankles of both legs (Spec. 3644) were forwarded to the Museum by the operator and are shown in the wood-cut (FiG. 304). In addition to the injuries described the specimen exhibits the left astragalus to be fractured, the base of the right tibia to be shattered, and the right fibula fractured transversely just above the malleolus as if by the propagated force. There are also traces of periosteal disturbance. TABLE LXXIII. Summary of Three Hundred and Sixty-eight Case* of Intermediary Amputations in the Middle Third of the Ley for Shot Injury. [ Recoveries, 1 258 ; Deaths. 2593(58-1 No. NAME, MILITARY DESCRIPTION, AND AGE. DATKS. OPERATIONS, OPERATORS, RESULT. NAME, MILITARY DESCRIPTION, AND AGK. DATKS. OPERATIONS, OPERATORS, RESULT. 1 Ackley, C., Pt., I, SJtli Mav 12, Kight ; circular. Disch d March 8 Barber, J. M., Pt.,H, 21st Sept. 20, Right ; circular. Discharged Feb Pennsylvania, age 21 . 21, 64. 28, 1865. Ohio. Oc.10, 03. ruary 27, 1804. 2 Adams, A. IV, Pt., C, Deo. 13, Left. Surg. E. Bentley, U. S. V. 9 Barney, IT. F., Pt., A, July 0, Right; circular. Surgeon E. A. Kith Maine, age l!i. 22, G2. Disch dMay 20, 1803. Spec. 590. 8th New Hampshire. 10, 63. Thompson, 12th Maine. Disch d 3 Allen, C., Corp l, <!, 62d Oct. 19, Right; lat. flap. A. A. Surg. C. Sept. 27, 1803. He-amp, in 1804. New York, age 20. 28, 04. H. Joues. Hasmorrhage. Dis 10 Beauboncher, V., Pt., E, June 4, Left; circular. Surg. K. Bentlev, charged Oct. 4, 18bT>. Spec. 104. 26th Mass., nge 27. 8, 64. U. S. V. DisoVd Jan. 0, 1865. 4 Allen, H.. Sergeant, G, May 3, Right ; flap. Surg. J. H. Baxter. 11 Heevers, H. G., Pt., A, 3d Sept. 21, Left. Surg. Sleigliton, C. S.A. 119th Penn., age 22. 30, 63. U. S.V. Discharged November Arkansas. Oo.l2, G3. Recovered. 14, 18G3. Specs. 1184, 1185. 12 Bennett, C., Pt., II, 14th Aug. 29, Left. Discharged Oct. 8, 1862. 5 Atkinson, P., Pt.,G. 67th Jnlv 1, Right ; double flap. Ass t Surg. N. Y. State Militia. Sep.4, 02. New York, age 34. 17, 02. W. Webster, U. S. A. Disch d 13 Benning, E., Pt., I, 52d May 12, Left; double flap. A. A. Surg. April 23, 1863. New York, age 28. 19, 04. J. F. Thompson. Discharged 6 Bain, T., Pt., G. 60th July 4, Left; flap. (July 4, excision of March 17, 1865. Illinois, age 34. Aug. 1, 4 inches of tibia.) Gangrene. 14 Benson, T., Pt., A, 32d May 12, Left ; oval flap. Discharged Sep 1864. Discharged Mav 9, 1805. Maine, age 20. 20, 04. tember 2, 1804. 7 Barbee, J., Pt., B, 5th May 12, Left; anterior posterior skin flap. 15 Berkley, C., Pt., E, 1st June 15. Right; posterior flap. A. Surg. North Carolina, age 29. 20, 64. Surg. D. W. Bliss, U. S. V. Ex Colored Troops, age 19. Julv 13, J. H. Frantz, U. S. A. Disch d changed. Spec. 2312. 1864. July 12, 1805. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 523 No. NAME, MILITAUY DESCRIPTION, AND AC;E. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1C Billman, H., Pt., A, 40th Nov. 25, Right: flap. Surg.W.W. Bridge, 49 Devan, R. P., Pt., D, 3d Aug. 9, Left; circular. A. A. Surgeon S. Ohio, age 25. Dec. 19, 46th Onio. Discharged March Wisconsin. 17, 62. E. Fuller. Discharged October 1803. 31, 1865. 29, 1802. Spec. 54. 17 Bolen, J., Pt., E, 6th April 8, Right ; anterior posterior skin flap. 50 Dickens, H. S., Pt., H, July 3, Left ; flap. A. A. Surg. S. R. Skil- Mass. Cavalry, age 25. May 7, A. A. Surg. H. W. W. Carroll. 126th N. York, age 30. 11, 63. lern. April 24, 1804, ant. post. 18 Bowers, S.M., Pt., F, 1 Hh 1864. July 3, Discharged October 4, 1865. Right ; circ. Exchanged March flap amput n thigh, lower third. Disch d April 28, 05. Spec. 2740. Mississippi, age 21. 7, 63. 3, 1864. 51 Dietz, W., Serg t, I, 29th May2, Right; circular. Surg. R. Tho- 19 Bowles, G. S., Pt., G, July 3, Right: circ. Exchanged March New York. 10, 63. main, 29th New York. Dis 18th Virginia, age 27. 7, 63. 17, 1864. charged June 20, 1803. 20 Boygon, \\ . (.}., Boat Mar. 29, Right ; circ. Surg. T. J. Turner, 52 Dillen, F. M., Pt., H, 7th May 10, Left; circ. Surg. D. C. Ay res, swain s Mate, U. S. April 1, 1). S. N. Discharged August 5, Wisconsin, age 24. 13, 64. 7th Wis. Disch d Oct. 8, 1864. Steamer Osage, age 39. 1865. 1865. Died June 20, 1868. 53 : Dotts, J. L., Lieut., D, Sept. 22, Right; circ. A. A. Surg. B. B. 21 Hrannun, J. J., Serg t, G, Sept. 19, Right ; anterior posterior flap. 54th Penn., age 22. Oc.15, 64. Miles. Discharged May 14, 05. 10th W. Virginia, age Oct. 14, Surg. H. F. Garrett, 10th W.Va. 54 Dresser, W. M., Pt., G, Sept. 17, Right : flap. Surg. W. H. Leon 27. 18C4. Discharged August 29, 1805. 35th Mass., age 24. 22, 62. ard, 51st N. Y. Discharged. 22 Bressin, C.. Pt., K, 4th May 2, Left. Ass t Surg. T. McMillan. 55 Drummond, R. A., Pt., April 9, Right ; circ. Discharged April Ohio Cavalry. 10, C2. 4th Ohio Cavalry. Discharged I, 89th Indiana. 12, 64. 30, 1865. July 8, 1862. jj 56 Ellis, W. F., Pt., B, 2d Aug. 30, Left : circular. Discharged May 23 Brown, H. G., Pt., A, Oth June 27, . Surgeon McKinney, C. Maine, age 24. Sep.2, 62. 23, 1863. Georgia. J v 1, 62. S. A. Recovered. 57 Fairfield, S. G., Pt., C, May 10, Left; modificat n of anterior flap. 24 Brooks, A., Pt., E, 72d July 2, Right ; flap. Discharged Feb- ! 1st Mass. Heavy Artil June 8, Surg. D. P. Smith, 1*. S.V. Dis New York, age 21. 5, 63. ruary 24, 1864. lery, age 43. 1864. charged July 8, 64. Spec. 3300. 25 Brooks, N. M., Capt., C, May 12, Right ; flap. Surg. 1). W. Bliss, 58 Farmer, S., Pt., H, 1st June 5, Left; circular. Confederate sur 12th N. Jersey, age 22. June 2, U. S. V. Discharged October West Virginia, age 22. J y 2, 64. geon. Discharged June 2, 1805. 1864. 4, 1804. Spec. 2429. 59 Fernandez, J., Serg t, A. May 5, Right. (Bone removed: haem.: 26 Brotts, H. A., Corp l, H, July 3, Left; flap. Surg. N. Hay ward, 2d Florida, age 19. June 4, erysip.) Teale s method. Ass t 8th Ohio, age 23. 25, 63. 20th Mass. Bone removed. Dis 1862. Surgeon J. S. Billings, U. S. A. charged December 15, 1863. Old Capitol prison July 21, 1802. 27 Bullock, S.J., Serg t, A, July 3, Right : circular. Ass t Surg. F. 60 Finn, E. A., Corp l, G, Sept. 19, Right : flap. Discharged Decem 108th New York, age 6, 63. Wolf, 39th N. Y. Sept. 1, rein. 13th Michigan, age 28. Oct. -, 63. ber M. 1804. Subseq. operation. 20. necrosed bone. Discharged July 61 Foote, G. A., Serg t, I, Dec. 14, Left : circular. Discharged July 15, 1864. Spec. 4370. 14th Conn., age 28. 17, 62. 31, 1803. Died Nov. 13, 1869. 28 Burb ridge, C., Pt., A, May 10, Right : anterior posterior flap. A. 62 Ford, T., Pt., K, 1st Jan. 2, Left. A. A. Surg.W. G. Work 88th Pennsylvania, age 23, 64. A. Surg. P. C. Porter. Disch d Florida, age 17. 5, 63. man. Discharged June 5, 1865. 40. June 27, 1805. 63. Foster, H. S., Serg t, E. July 1, Left; flap. Surg.C.H. Richmond. 29 Burr, H. C., Pt., K, 8th Sept. 17, Right; ant. posterior flap. Surg. 104th N. Y., age "22. 8, r 03. 104th N.Y. Disch d Mar. 23, 64. Connecticut, age 35. Oct. 15, G.H. Oliver, Hlth Penn. Dis- 64 Garlock, D. C., Pt., C. July 3, Left : circular. Ass t Surg. D. C. 1862. charged April 14, 1863. lllth New York. 27, 03. Peters, U. S. A. Discharged 30 Butler, J., 1 t., C, 3d May 3, Right. Discharged May 1, 1804. September 14,1 863. Spec. 100C. Michigan. 6, 63. 65 Gibson, E. M., Serg t, A, July 1, Right. Surg. J. M. Farley, 84th 31 Buttinger, C., Corp l, B, June 30, Right. Surgeon M. S. Kittinger. 19th Indiana, age 21 . 14, 63. N. Y. Discharged June 25, 64. 20th Massachusetts. July 4, 100th N.Y. Disch d Sept. 25, 62. 66 Giffnrd, J., Pt., C, 1st Aug. 29, Right. Surg. II. Black, C. S. A. 1862. Died Oct. 9, 05 ; consumption. Louisiana. Sep. 9, 62. Retired December 20, 1804. 32 Cadtigan, A., Corp l, I, July 13, Right; flap. Surg C. B. Hutchins. 67 Gifford, W. W., Pt., D, Sept. 19, Right : flap. Discharged Novem 116th New York. Aug. 10, 116th N. Y. Discharged Sep 30th Illinois. 26, 63. ber 11, 1803. 1863. tember 19, 1803. 68 Gilmar, J., Pt., A, 1st July 8, Left flap. Surg. N. R. Moseley, 33 Caldwell, J. X., Pt., K, May 12, Right ; circular. Old Capitol Vermont Cavalry, age 28, "04. U. S. V. Discharged February 3d N. C., age 30. 15, 04. prison October 14, 1864. 20. 17, 1865. Spec. 2895. 34 Campbell. J.. Pt., Stew Nov. 30. Right; circular. Transferred to 69 Ginsenger, J., Pt., K, Aug. 30, Right : double flap. Surar. D. P. art s La. Scouts, age 32. Dee.7, 64. prison July 22, 1805. 58th New York. Sept. 15, Smith, U. S. V. Discharged 35 Campbell, J. H., Pt.,D, Aug. 2!, Left; latera l flap. A. A. Surg. 1862. November 13, 1862. 95th Pennsylvania, age 28, 04. W. B. Morrison. Disch d Aug. 70 Goodell, F. A.. Pt., B, July 7, Left ; anterior post. flap. Surg. 15. 7, 1805. Subsequent operation. 75th New York. 28, 03. S. K.TowIe, 30th Massachusetts. 3G (, arr. ( .. Pt., E, 26th Aug. 29, Left. Discharged February 12, Discharged November 21, 1803. Pennsylvania. Sep.0, 02. 1803. 71 Granger, G., Corp l, D, Aug. 9. Right ; circular. Discharged No 37 Caufma n, C. E., Pt., K, June 3(1, Right. A. A. Surg. J. Swinburne, 5th Ohio. Sep. 3, 62. vember 12, 1802. 1st Penn. Reserves. J y 3, 62. Discharged November 3, 1802. 72 Griffin, J. M., Pt., H, July3, Right. Exchanged November 38 Church, G. S., Pt., G, Dec. 13, Loft ; flap. Discharged March 19, loth Miss., age 21. 12, 63. 12, 1803. Oth Penn. Itcserves. 25, 62. 1803. Spec. 649. | 73 Grir/sby, J. L., Pt., K, Sept. 20, Left ; flap. Discharged. 39 Church. M. F., Pt.. B, June 27, Left. Ass t Surg. R. Bartholow, 23d Kentucky. 25, 63. ICthNcw York, age 21. July 22, U. S. A. Necrosed bone rem d. 74 Gutheridge, J. L., Corp l, Aug. 9, Left ; double flap. Ass t Surg. 1802. Discharged January 11, 1863. A, 60th Ohio. 15, 62. J. B. Brinton, U. S. A. Disch d 40 Cole. J.. Pt.. D, 188th June :i, Left (June 3, amp. toes; gang.; October 27, 1862. Spec. 38. Pennsylvania, age 21. 22, 04. hsem.); anterior post. flap. A. 75 ! Haggerty, J., Pt., I, 35th June 21 , Left: circular. A. A. Surg. J.W. A. Surg. H. M. Dean. Disch d Indiana, age 30. 27, 64. Digby. Discharged July 10, August 3. 1864. Spec. 2635. 1864. Spec. 2311. 41 Condon, T., Pt , K. 42d \ Jan. 1, Left; circular. Surgeon T. D. 76 Hall, A. 3f., Serg t, B, July 2, Left. Paroled September 25, 03. fllinois. age 3 J. 15, 03. Fitch, 42d Illinois. Discharged 5~M N. C., age 26. 13, "63. Retired from service Feb. 10, 05. October 21, 1804. Spec. 277. 77 Hall, W., Corp l, I, 4th June 17, Right ; post. flap. Ass t Surg. J. 42 Cook, if., Pt., I, 20th April 7, : erysipelas. Trans. October Col d Troops, age 23. July 3, H. Frantz, U. S. A. Discharged Louisiana, age 23. 20, 62. 11, 1862, to military prison. 1804. November 28, 1805. 43 Courier. W. C.. Pt., F, Mar. 6, Left ; anterior flap. A. A. Surg. 78 Halley, M., Corp l, E, Sept. 17, Left : post. flap. Surg. L. Rey 43d Ohio, age 23. 11, 05. E. L. Mola. Discharged Aug. 03d New York. 23, 02. nolds, 03d N. Y. Discharged 8, 1865. December 15, 1862. 44 Cover, P., Pt., G, 14th Aug. 26, Right: posterior flap. Surg. J. 79 Harvey, W., Pt., C, 88th Aug. 16, Left ; circular. A. A. Surg. E. B. Pennsylvania Cavalry, Sept. 23, Paddock. 22d Virginia, C. S. A. Penn., age 24. 27, 64. Woolston. Disch d Nov. 22, 04. age 20. 1803. Discharged May 14. 1805. Died 80 Hasel, G., Pt., E, 72d April 6, Left : flap. Discharged Febru May 24. 05; phthisis pulmonalis. Ohio, age 20. 15, 02. ary 22, 1863. 45 Crawford. E., Pt., F, Sept. 19, Right ; ant. post. flap. Surg. W. 81 Healey, R. A., Pt., B, Mar. 14, Left: circular. Surg. S.A. Green, 105th Ohio, age 20. Oct. 4, 03. L. Johnson, 18th ( )hio. Aug. 5, 4th R. L, age 21. 21, 62. 24th Mass. Disch d Sept. 9, 62. 1804, amp. thigh, lower third. 82 Heitzman, F., Pt., K, Sept. 17, Right; anterior post. flap. Dis HsRrn.; ligat n of profunda. Dis 97th New York, age 31. 21, 02. charged April 30, 1863. Died charged Mar. 18. 05. Spec. 3108. June 15, 1806; continual dis 46 Crawford, T., Pt., I, 8th Sept. 14, Right ; circular. February, 1803, charge from stump. Spec. 1040. Michigan. 17, 62. operation 8 ins. below the knee. 83 Heller, A. E.,Pt.,C, 49th Sept. 17, Left. Discharged January 24, Discharged February 5, 1803. Pennsylvania. 20, 02. 1803. 47 Cullom, G.. Pt., D,83d May 16, Left ; flap. Aug. 25, rem. necro. 84 Herring, C. P., Lieut. - Feb. 0, Right. Discharged June 1, 1865. Ohio, age 20. June 10, bone. Discharged Oct. 1 9, 1 863. Colonel, 118th Penn. 20, 05. 1803. Died August 27, 1872: phthisis 85 Hipps. J. E., Pt., H, 17th July 2, Left : flap. Furlonghed Decem pulmonalis. Spec. 2099. Mississippi, age 21. 26, 63. ber 1, 1863. 48 Dallmeycr. ! ., Lieut., C, May 22, Right. Skey s method. A. Surg. 86 Undue, F. if., Pt., D, 5th Sept. 20, . Surgeon G. G. Crawford, 12th Missouri, age 24. 26, ( .3. H. M. Sprague. IT. S. A. Dis Arkansas. Oct. 0, 03. P. A. C. S. Recovered. charged Nov. 14, 1804. Died 87 Hofses, L. W., Pt., D, July 3, Right; circular. Discharged Au July 18, 1871. Xpec. 1627. 19th Maine, age 28. 11, 03. gust 27. 1804. 1 BRYAN (J.), Seventeen Additional Gates of Amputations from the Armies of the South- West, in American Medical Times, 1863, Vol. VII, p. 288 524 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No NAMK, MILITARY D Ol K!{ATI()XS, Ol KUATOKS, x NAME, MII.ITAUY OPERATIONS, OPERATORS, DESCRIPTION, AND AGK. RESULT. DESCRIPTION, AND AGE. RESULT. 88 llogan, C. II., Corp l, A, Sept. 1! , Left: aiiti i-i. r post. Hap. Ass t 124 , McGonigle, H., Pt., F, Nov. 25, Right ; ant. post. flap. Surg. W. 89th Ohio, age 26. Oct. 9, .Surgeon C . .S. Frink, U. S. V. 713d Penn., age 51. Dec. 25, ll.Gunkle, 73d Penn. Disch d 1863. Discharged Decembers, 1863. 1863. April 25, 1864. Died April 5, 89 Hootse.ll, J. F., Pt., A, 2d Fob 8, Right. .Surgeon G. L. Miller, 1868; consumption. Louisiana. 15, 62. C. S. A. Recovered. 125 Mc"Griff, J. C., Pt., B, Aug. 30, . Ass t Surg. II. W. Harding, 90 House, I . A., Pt , B, 33d Aug. 16, Left. Recovered. 7th Georgia. Se.20, 62 C. S. A. Recovered. North Carolina. 20, 64. 126 McGukiv, W.J .,Pt.,r, May 3, Right; circ. Transferred June 1)1 Huntzinger, J. W., Pt., Aug. 5, Right. Discharged November 2d S. C. Rifles, age 30. 7. 63. 9, 1864. A, 21st Indiana. 25, 62. 15, 1862. 127 Mcllvaine, R. I., Serg t, Aug. 29, Right; circular. A. A. Surg. J. 93 Hutchins, A. J., Pt., K, May 1, Right : posterior flap. Surg. C. K, 8th Penn. Reserves. Sept. 16, N.Goff. Discharged November 25th Ohio. 26, 63. L. Wilson, 75th Ohio. Disch d i 1862. 29, 1862. March 19, 1864. Spec. 6705. j 128 McTaggart, J., Pt., D, April 8, Right; flap. Surg. J. F. Hess, 93 Jamison, R. E., Pt., K, Dec. 7, Left; flap. Discharged Decem 46th Indiana, age 35. 12, 64. 96th Ohio. Duty .July 8, 1864. 19th Iowa. SR, 62. ber 12, 18G4. 129 Magee, W., Pt., K, 81st De.13, 62 Left. Surg. D. W. Bliss, U. S.V. 94 Jenkins, D. A., Pt., A, De.16, 64 Right: anterior posterior flap. A. Pennsylvania. Jan. 1, 63 Disch d Dec. 5, 1863. t<pec. 943. 19th Alabama, age 25. Jan. 11, A. Surg. L. Sinclair. To Pro 130 Maguire, S., Serg t, G, May 6, Left ; circular. A. A. Surg. D. L. 1865. vost Marshal March 7, 1865. llth Penn. Res., age 24. 31, 64. Ilaight. Haemorrhage ; gang. 95 Johnson, E., Pt., G, 54th Feb. 20, Right ; flap. Discharged July Discharged. Spec. 1222. Massachusetts, age 35. Mar.6, 64 16, 1865. 131 Mnlone, S. S.,Pt.,K,10th July 23, Left ; circular. A. A. Surg. C. H. 96 Johnson, T. G., Corp l, April 6, Left. Discharged July 11, 1862. West Virginia, nge 20. Au.U, 64 Jones. Disch d June 14, 1865. H, 4()th Illinois. 14, 62. 132 Manning, J ., Pt., 11, 5th Aug. 9. Right; flap. Ass t Surg. J. F. 97 Johnson, W., Pt., 1, 149th July 1, Left; anterior posterior flap. Dis Ohio, uge 23. 19, 62. Day, 10th Maine. Discharged Pennsylvania, age 23. 7. fo. charged January 30, 1864. May 5, 1863. Spec. 67C8. 98 Johnson, \V. H., C apt., Feb. 10, Left; circ. Ass t Surg. .1. G. Mur 133 Marston, B. F., Serg t- Aug. 9, Left; circular. A. A. Surg. M. H. F, 144th N. Y., age 27. 23, 65. phy, U. S. V. Feb. 17, lig. ant. Major, 3d Maryland. 12, 62. Barton. Disch d Nov. 28, 1862. tib. art y. Disch d May 15, 65. 134 Masterson, Jf., Pt,, H, Nov. 27, . Surg.W. P. Young, C. S.A. 99 Jones, B., Pt., A, 5th Sept. 29, Right: flap. Discharged June 10th Louisiana. De.12, 63 Recovered. Col d Troops, age 18. Oct. 2, 64. 2J. 1865. 135 Mauk, S. S.. Pt.,E, 90th Sept. 20, Right ; circ. Surg. II. Herrick, 100 June, M. F., Pt., L, 9th Oct. 19, Right ; lateral skin flap and ciro. Ohio. 24, 63. 17th Ohio. Disch d May 13, 64. N. Y. Heavy Artillery, Nov. 2, section of muscles. A. A. Surg. 136 Mays, C., Pt., K, 1st June 6, Left; circular flap. A. A. Surg. age 17. 1864. J. Neff. Disch d May 13, 1865. Artillery, age 19. 24, 64. T. Carroll. Disch d July 17, 65. Spec. 3428. 137 Meagher, D., Pt., C, 5th Aug. 9, Right: flap. Discharged October 101 Kahl, C., Serg t-Major, July 1, Left ; flap (also flesh wound of Connecticut. 23, 62. 27, 1862. 75th Penn., age 29. 4, 63. shoulder). Disch d Feb. 26, 64. 138 Merrill, S., Pt.. F, 2d July 2. Left; flap. Surg. J. M. Merron, 102 Kehoe,.!., Serg t, II. 39th April 21, Right; circ. (erysipelas). A. A. New Ilnnip , age 33. 5, 63. 2dN. H. Disch d June 21, 1864. New Jersey, age 29. 26, 05. Surgeon W. B. Chambers. Dis 139 Miller, C., Pt., D, 53d Dec. 13, Left. Discharged September 1 9, charged June 8, 1865. Pennsylvania. 16, 62. 1863. 103 Kelly, T., Pt , A, 22d De.29, 62, Right ; flap. Surg. H. P. Steam, 140 Miller, R, F.,Pt.,E, 123d Jan. 11, Left; flap. A. A. Surgeon E. L. Kentucky. Jan. 18, U. S. V. Re-amputated. Dis Illinois, age 27. 14, 65. Jones. Disch d June 4, 1 805. 1863. charged June 2, 1863. 141 Miller, W. W., Pt., G, Dec. 13, Right. Discharged April 2, 1863. 104 Kimball.V. ., Pt., K, 88th July 20, Right; anterior posterior flap. A. 40th New York, age 27. 16, 62. Illinois, age 21 . Aug. 19. A. Surg. M.W. Benjamin. Dis 142 Minott, J. S., Corp l, F, May 12, Left : circular skin flap. Surg. E. 1864. charged June 9, 1865. 1st Michigan Sharp 27, 64. Bentley, IT. S. V. Discharged 105 Rinnan, V., Pt., II. 147th June 19, Right ; flap. Surg. E. Bentley, shooters, age 31. October 17, 1864. New York, age 22. July 5, U. S. V. Discharged October 143 Myers, D., Pt., K, 12th June 27, Right. Ass t Surg. R. Bartholow, 1864. 27, 1 865. Specs. 25 1 7, 2833. Pennsylvania, age 20. I y23, 62. U. S. A. Disch d Oct. 16, 1862. 106 Kinnoy, V. F., Pt., (, , 2d July 1, Left : circular. Discharged No 144 Newkirk, G. W., Pt., I, Oct. 8, Left; flap. Discharged June P.), Wisconsin, age 21. 4, 63. vember 28, 1863. 42d Indiana, age 22. 22 62. 1863. 107 Knox, U. F., Pt.,C, llth Aug. 31, Left; anterior post. flap. A. A. 145 Newman, O., Pt., K, 7th Mar. 31, Right; circular. Surgeon A. F. Pennsylvania, age 28. Sept. 15, Surg. J. E. Warner. March 12, New York, age 20. April 8, Sheldon. 1 T . S. V. Discharged 1862. 1863, removal of exfoliat n from 1865. August 2, 1865. Spec. 4877. tibia. Discharged April 24, 63. 146 Nichols, A.. Pt., C, 6th July 2, Left. Surg. Hawley, C. S. A. 108 Koehler, J., Pt., I, 151, th May 5, Left: circular. A. A. Surg. II. North Carolina, age 20. 30, 63. Spic. rem. Retired Mar. 14, 65. Pennsylvania, age 36. 29, 64. Gibbons, jr. (May 5, excision 147 Norton, M., Pt., 1, 52d May 9, Left ; circular. Discharged Octo 4 inches of fibula.) Discharged New York, age 37. 12, 64. ber 26, 1865. April 19, 1865. Specs. 3533, 2404. 148 Nussbaumer, B., Pt., B, Mar. 23, Left. Surg. A. D. Gall, 13th Ind. 109 Koontz, A., Pt., H, Ifith Jan. 1, Right ; flap. Discharged May, 67th Ohio, age 27. April 22, (Also w nds of breast and leg.) Ohio. 5, 63. 1863. 1862. Disch d July 28, 1862. Cariesof 110 Laird, S., Pt., F, 4th De.16, 62, Right; circ. Surg. A.M. Wilder, stump. ] 863, amputation thigh, Vermont, age 21. Jan. 12, U. S. V. Discharged April 5, middle third. 1863. 1864. Spec. 4319. 149 O Brien, J.,Pt.,K, 124th May 3, Right. Surg. G. P. Oliver, lllth 111 Lavorty, E., Pt., E, 53d Dec. 13, Left; posterior flap. Snrg. O. A. New York. 9. r 63. Penn. Disch d April 5, 1864. Pennsylvania, age 43. 30, 62. Judson, U. S. V. Discharged 150 O Bryan, J. C.. Pt,, K, June 27, Right; flap. Dr. F. Hinkle, of October 4, 1864. Died January 45th Penn., age 18. J yl8, 64. Marietta, Penn. Discharged. 4, 1980. Spec. 6712. 151 ffDonall, J ., Pt., B, July 1, Left. Surgeon Hunt, C. S. A. 112 Lease, D., Pt., E, 1st Sept. 19, Right ; circular. Surg. D. S. 27th Virginia. 21, " 61. Recovered. Ohio ;IL< 25. 26 63. 152 O Donnell .1 Corp l F July 1, Left Ass t Surg I R Smith October?, 1864. 81st Pennsylvania. 22, 62! U. S. A. Disch d (Jet. 16, 1802. 113 Leslie, O., Pt., C, 5th Dec. 13, Right ; circ. Discharged April 153 O Neal, J., "Pt., I, 153d Sept. 19, Right ; flap. Surg. L. P.Wagner, New Hampshire. 23, 62. 4, 1863. New York, age 28. Oct. 19, 114th New York. Discharged 114 Littlefield, A., Pt., C, 2d May 3, Right; ant. post. flap. Surg. J. H. 1864. February 11, 1865. Rhode Island. 20, 63. Baxter, U. S. V. Discharged 154 O Neil, J., Pt., A, 3d May 11, Riglit ; flap. Surg. S. A. Welch. Oct. 7. 1 863. Died Dec. 6, 1 877 ; Penn. Reserves. 31, 64. 3d Penn. Reserves. Discharged phthisis pulinonalis. Spec. 1 135. September 23. 1864. 115 Lonergan, T., Serg t, B, Dec. 13, Right; circular. Surg. T. Jones, 155 Ortte, H., Pt., A, 5th May 5, . Surg. J. R. Page, C. S. A. 142d Penn., age 39. 17, 62. 8th Penn. Reserves. Discharged Louisiana. 30, 64. Retired from military service March 10, 1864. March (i, 1865. 116 Loughlin. J., Pt.,A,6yth July 2, Right : circular. August 5, re- 156 Paine, J. A., Pt., E, 2d Nov. 30, Left ; circular. Provost Marshal New York, age 36. 5, 63. amputation ; erysipelas. Dis Missouri, nge 21. Dec.2, 64. May 6, 1865. charged March 18, 1865. 157 Palmer, W., Lieut,, B, Julyl, Left circular. Surg. A. B. Mott, 117 Lowry, II., Pt., D, 93d May 12, Right ; anterior posterior flap. 82d New York, age 29. 31. *63. I . S. V. Transferred to Yet. Pennsylvania, age 19. June 6, Surgeon C. Page, U. S. A. Dis Res. Corps. Disch d June 30, dO. 1864. charged March 23, 1865. 158 Parris, G. W., Pt., C, June 30, Left. Discharged December 11, 118 LubbertW., Pt., B,20th June 3, Left : double flap. Surg. E. Bent- 19th Massachusetts. T v4, 62. 1862. Massachusetts, age 32. 9, 64. ley, U. S.V. Disch d Nov., 1865. 1.71 Patterson, W. L., Corp l, Mar. 29, Left ; circular. A. A. Surg. M. J. Died Oct. 6, 66; phthisis pulm. C, 198th Penn., age 21. April 3, Mungcr. Discharged August 7, 119 McAulr.y. A., Pt., H, 7tli June 9. Left. Recovered. 1865. 1865. Upec. 4037. Louisiana. i 12, 62. 160 Patty, T. W., Pt., F., Nov. 25, Left. March 12, 1864, re-amputa 120 McCarthy, J., Pt., D, May 3, Right. Surg. C. K. Irwine, 72d 4()tii Indiana, age 18. Dec. 6, tion 3 inches above. Discharged 71st New York. 10. 63. N. Y. Discharged July 30, 1864. 1863. January 11, 1865. 121 McCarty, W., Pt., B, 23d July 24, Loft : flap. Ass t Surg. J. 8. Tav- 161 Paul, L., Pt., C, 28th June .<, Right ; iiap. Surg. E. Bentley, lllinois. age 40. 28, 64. lor, 23d 111. Discb d May 3, 00. Massachusetts, age 40. 9, 64. U. S. V. Discharged March 29, 122 McFaddeu, D., Pt., G, Sept. 20, Left; flap. Discharged August 1865. Died July 24. 1869. 26th Ohio, a-e 39. 26. 63. , 26, 1864. 162 Peart, J.. Serg t, A, 21st July 18, Left; lateral flap of skin and circ. 123 MeGivern. L., Pt..G,5th Nov. 25, Right: flap. Discharged Sep- N. Y. Cavalry, age 22. 31, 64. of muscles. A. A. Surg. J. II. Kentucky, age 50. 28, 63. tember 27, 1864. Bartholf. Disch d May 23, 1865. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 525 tJf\ NAME, MILITARY DATES. OPERATIONS, OPERATORS, NO NAME, MILITARY DATFS OPERATIONS, OPERATORS, .WO. DESCRIPTION, AND ACE. RESULT. DESCRIPTION, AND AGE. RESULT. 163 Peck, H. C., Serg t, B, Aug. 30, Left ; flap. Surg. R. H. Coolidge, 200 Smith, G., Pt., K, 81st June 3. Right; anterior post. flap. Sure. 5th New York, age 26. Sep.2, 62. U. 8. A. Discharged May 14, New York, age 26. 13, 64. A. T. Sheldon, U. S. V. Dis 186:i. charged January 6, 18C5. 164 Perkins, J. D., Lieut., July 2, Left (also amputation left thumb). 201 Smith, G.\V.,Pt.,F, 76th July 1, Left; circular. Surgeon J. H. M, 2d Florida, age 19. 5, %3. Trans, to Provost Marshal Octo New York, age 20. 5, 63. Beach, 24th Mich. Discharged ber 22, 1863. Exchanged. May 20, 1864. Spec. 4318. 165 Phillips, D. W., I t,, F. Dec. 16, Left ; circular. A. A. Surg. R. 202 Snyder, P., Pt,, E, 151st July 1, Left; circular. Discharged July 32d Georgia, age 32. 19, 64. L. McClure. To Provost Mar Pennsylvania, age 21. 7, 63. 27, 1863. shal May 6, 1865. 203 Sparks, M. G., Serg t, I, April 2, Right ; ant. post, skin flap. A. A. 166 Piggott, M., Capt., F, May 14, Right; flap. Ass t Surg. T. A. 10th New Jersey, age 13, 65. Surg. /,. P. Denneler. (April 2, 66th Illinois, age 29. .June 5, McGraw, U. S. A. Discharged 25. 1865. excis. of fibular portion of 1864. January 24, 1865. ankle.) Disch d Feb. 2, 1866. 167 Pitts, R , Pt., F, 7Cth July 2, Left ; anterior posterior flap. Dis 204 Speehnan, B., Pt., K, Sept. 20, Left : flap. Confederate surgeon. New York, age 26. 16, %}. charged August 26, 1864. 98th Ohio, age 20. 24, 63. Discharged January 31. 1865. 168 Pollard, J., Capt., H, June 24. . Surg. J. G. Dudley, P. A. 205 Sprauer, H., Lieut., F, May 27. Right. Surgeon J. B. G. Baxter, 9th Virginia Cavalry. J v4, 64. C. S. Recovered. 2d Louisiana. 31, 63. U. S. V. Disch d July 3 ! , 1 863. 169 Poole, 0. H., Pt., G, 39th May 5, Left; circular; gangrene. Surg. 206 Steenis, P., Pt., E, 6th Sept. 14, Left ; anterior post. flap. A. A. Massachusetts, age 18. 26, 64. D. W. Bliss, U. S. V. Disch d Wisconsin, age 23. 30, 62. Surg. W.W. Keen. Discharged Dec. 17. 1864. Spec. 2354. Jan. 23, 1864. Sprcs. 791, 3833. 170 Porter, H. M., Pt., H, July 2, Left; flap. Ass t Surg. W. R. 207 Steinhaus, F., Pt., H, July L, Right ; flap. Discharged May llth Infantry. 9, 63. Ramsay, U. S. A. Transferred 26th Wisconsin. 12, ^63. 14, 1864. to regiment Sept. 12, 1864. 208 Steinmetz, W., Pt., F, June 8, Right. Ass t Surg. T. H. l.egler. 171 Potts, J., Pt., H, 123d Dec. 13, Left. Discharged March 9, 1863. 8th New York. 25, 62. 8th New York. Discharged Pennsylvania. 28, 62. Spec. 981. December 12, 1863. 172 Price, J. VV., Corp l, I, July 3, Left; post. flap. Surg. H.Janes, 209 Sterritt, J., Pt., C, 119th May 10, Left ; skin flap and circ. section of 20th Conn., age 24. Aug. 1, U. S.V. Nov. 9, re-amp, at June. Pennsylvania, age 38. 14, 64. muse. A. A. Surg. O. 1 . Sweet. 1863. of middle and upper thirds, flap Disch d Aug. 7. 65. ,<pcc. 2284. method. Disch d June 24, 1864. 210 Stevens, T. M., Serg t, B, July 3, Right. Surgeon J. R. Raine. 45th 173 Past, H., Pt., K, 104th Dec. 7, Left ; flap. Surgeon R. F. Dyer, 45th N. C., age 21. 6, 63. N. C. Erysipelas. Exchanged Illinois, age 25. 11, 62. 104th Illinois. Anehy. of knee. November 12, 1863. Oct. 24, 1863, amp. thigh, mid. 211 Stief, P., Pt., K, 139th July 30, Right: flap. A. A. Surg. S. J. third. Disch d March 4, 1864. New York, age 30. Aug. 14, Holley. (Excision Sins, shaft of 174 Reece, B., Pt., K, 49th April 7, Right; flap. Discharged July 1864. tibia.) Disch d .lime 19, 1865. Illinois. 13. 62. 7, 1862. 212 Stigall, K., Corp l, G, 1st Jan. 2. Left. Surgeon C. J. Walton, 21st 175 Reynolds, J., Serg t, C, July 14, Right; flap. June 12, 1864, re Florida. , 63. Kentucky. Recovered. 6th Michigan Cavalry, 17," 63. moval of necrosed end of tibia. 213 Stilts, A., Pt., I, 4th New Sept, 14. Left; circ" Snrg. I,. W. Oakley, age 30. Discharged October 26, 1864. Jersey. 21, 62. 2d N. J. Disch d Jan. 3, 1863. 176 Richardson, J. M., Pt., Oct. 4, Right. Surg. S. L. Nidet, C. S. A. 214 Stone, E. W., Corp l, A, Mar. 14, Right; circular. Surg. George H, 35th Mississippi. 21, 62. Recovered. 21st Massachusetts. April 6, Derby, 23d Mass. Discharged 177 Richardson, (>., Serg t- July 13, Left ; circular. A. A. Surg. J. A. 1862. February 17, 1863. Maj., 7th Minn., age 31. 31, 64. Edmonson. Disch d April 10, 65. 215 Storke, L., Pt., A, 72d Julv 1, Left. Discharged. 178 Rigor, I)., Pt., H, 36th Sept. 19, Left ; flap. Discharged Septem New York. 23, 62. Indiana, age 26. 28, 63. ber 21, 1864. 216 Strayer, L., Serg t, A, April 1, Right; flap. Discharged August 179 Rinard, C. B., Pt., K, 4th July 15, Left; circular. A. A. Surg. A. 2!0 th Pennsylvania. 14, 65. 4, 1865. Iowa Cavalry, age 15.- 21, 64. Sterling. Discharged Septem 217 Sullivan, J., Corp l, F, Aug. 30, Right. Discharged August 11, ber 1, 1865. 40th New York. Sep.7, 62. 1863. 180 Ritzert, P.. Pt., K, 100th July 18, Right ; circular. Surg. D. Merritt, 218 Sullivan, P. T., Pt,, A, June 16, Right: anterior post. flap. A. A. Now York. 22," 63. 55th Penn. Discharged Decem 1st Mass. Heavy Artil July 9. Surg. J. M.Boisnot. Discharged ber 22, 1863. lery, age :)8. 1864. June 13, 1865. 181 Roberts, D. R., Pt., B, 3d Nov. 30, Right; anterior posterior flap. A. 219 Swing, H., Pt., A, 1st Mav 3, Left. Surgeon Bratton, C.S. A. South Carolina, age 33. Dec. 29, A. Surg. W. Vance. Trans, to Louisiana. 9, *C3. Recovered. 1864. Provost Marshal March 7. 1865. 220 Terry. J. D., Serg t. E, Mar. 14. Left : circular. Surg. S. E. Stone, 182 Roberts, M. S., Pt., 15, May 3, Left. Confpd. surgeon. Disch d 23d" Massachusetts. 22, 62. 23d Mass. Disch d July 7, 1863. 5th Maine, age 23. 7, 63. March 15, 64. Spec. 6694. 221 Texter, G., Corp i, I, 7th June 16. Left; circular. Surg. W.Watson, 183 Robinson. R. R., Gov t Feb. 20, Right; circular. Surgeon J. H. ! New York Artillery, 25, 64. 105th Penn. Discharged July employe, a<re 24. 26, 65. Phillips, U. S. V. Recovery. age 27. 14.1865. Specs. 818, 3081. 184 Rodenhoffer, L., Pt., A, June 18, Left ; circular ; gangrene. A. A. 222 Thomas, F. M., Serg t, I, July 30, Left ; lateral flap. Discharged 1 17th Penn., age 18. July 13, Surg. T. L. Van Norden. Dis 8th Iowa Cav., age 22. An. 4, 64. July 14, 1865. 185 Ryan. .1., Pt., H, 20th Connecticut, age 39. 1864. May 3, 6, fe. charged March 24, 1865. Right; anterior post. flap. Con federate surgeon. Discharged 223 Thompson, B., Pt., C, 28th Pennsylvania, age 33. Sept. 17, Oct. 4, 1862. Right: flap; gang.; erysipelas. April 14, 1863. circ. amp. thigh, lower third. Discharged May June 30. 1865. 6, 186:!. fyccs. 3883, 3965. 186 Ryan, V., Pt., D, 1st Sept, 20, Right. Surgeon Sizemore, C. 224 Todd, J. C., Capt., A, May 3, Right. Ass t Surg. W. C. Good Arkansas. 24, 63. S. A. Recovered. 14th Alabama. 15, "*63. win, C. S. A. Discharged Jan 187 Sanders. I. J., Pt., E, Nov. 7, Right. Surgeon T. Sim, U. S. V. uary 14, 1865. 31st Illinois. 10, 61. Discharged August 2, 1862. 225 Toomey, J. J., Pt., A, May 15, Left ;" circular. Ass t Surg. M. C. 188 Scarberry, J., Pt., D, May 9, Left; flap. A. A. Surg. W. W. 29th Pennsylvania, age 31, 64. Wood worth, U. S. V. (May 1 5, 91st Ohio, age 19. 26, 64. Mills. Disch d July 30. 1864. 21. excis. lower third lib.) Disch d iey Seism, J., It., L, 2d Mis Oct, 25, Left; anterior posterior flap. A. July 2. 1865. Spec. 3361. souri 8. M. Cavalry, Nov. 2, A. Surg. J. II. Page. Necrosis. 226 Trapp, D.. Pt., B, 125th June 18. Left ; circular. Surgeon A. F. age 18. 1864. Discharged June 11, 1865. New York, age 32. July 2, Sheldon, U. S. V. Discharged 190 Scott. C. L., Serg t, E, May 3, Right. Surg. R. Thomain, 29th 1864. JuneS, 1865. 154th New York. 19." G3. New York. Discharged Nov. 227 Trausdale, W. F., Lieut., May 14, Left. Surg.W. F.Westmoreland, 4,1863. (Spec. 1544. E, 7th Alabama Cav. 27," 64. P. A. C. .S. Recovered. 191 Seligar, A., Pt., A, 43d April 7, Left; flap. A. A. Surg.O. Blanck. 228 Travis, J. A., Serg t, D, May 3, Right. Abs t Surg. C. C. Byrne, Illinois, age 27. 17, 62. Discharged October 7, 1862. 86th N. York, age 26. 20, Y 63. U.S.A. (Haemorrhage.) Dis 192 Sercey, \V., Coloredfire- Nov. 1, Left; anterior posterior flap. Duty charged March 28, 1864. man, Steamer, age 25. , 64. January 28. 1865. 229 Truekey, P.,Pt., G, 14th Sept. 17, Right/ A. A. Surg. J. C. Douglas. 193 Shaffer, F.. ( apt., I, 73d Nov. 25, Left. Siirg. B. L. Hovcy, 136th Indiana. 25, 62. Discharged March 4. 1863. Pennsylvania, age 26. De.11, 63. N. Y. Resigned July 5, 1864. 230 Tryon, L. J., Corp l, K, June 2, Left; ant. post. flap. Surg. N. R. 194 Shell, it. C., Serg t, C, Nov. 30, Left; anterior posterior flap. A. 8ist New York, age 21 . 11, 64. Moselev, U. S. V. Discharged 31st Miss., age :!2. Dec. 26, A. Surg. T. Morrison. Trans, to September 30, 1864. Spec. 203. 1864. Provost Marshal March 7, 1865. 231 Tucker, J. G., Pt., K, June 18, Right ; circ. A. A. Surg. A. F. A. 195 Shewalter, C.W., Pt., G, April 12, Left; flap. Discharged August 20th Michigan, age 22. July 8, King. Disch d April 4, 1865. 8th Tenn. Cavalry. 16, 65. 11. 1865. 1864. Spec. 2826. 19ti Shute,W. A., Pt., I, 13th Aug. 30, Left; double flap. Surgeon J. 232 Upright, G. T., PI., B, July 2. Right: circ. A. A. Surg. A. A. Massachusetts, ago 31. Sept. 2, Jamison, 86th New York. Dis 8th Ohio, age 21. 23. 63. Hamilton. Disch d May 9, 1864. 1862. charged June 4. 1863. 33 Van Gundy, J., I t., K, Mar. 3, Right; flap. Discharged Janu 197 Skigoll, I., Pt., M. 2d N. April 7, Right; circ. Discharged Julv 4th Iowa, age 18. Apr.1, 62. ary 28. 1863. Y. U vy Art v, age 22. 18, 65. 29, 1865. ( 234 Walker, J., Pt., Carpen May 25, Left. Surg.W. H. Baldwin, C. S. 198 Slack, li., Pt., H, 100th Mav 3, Right : anterior post. flap. Ass t ter s Battery. 29," 62. A. Recovered. New York, age 27. 13, 64. Surg. VV. D. Murray. 100th N. Y. 235 Ward, A. S., Serg t. C, May 3, Right. Surg. H. K. Goodman, Discharged December 26, 1864. 107th N. York, age 22. 8, 63. 28th Penn. Disch d July 27/63. 199 Smith.C.W., I t., D. 10th July 3, Left; single flap. Surg. F. H. 236 Warn, E. S., Serg t, C, July 3, Left, Surgeon C. S. Wood, 66th West Virginia, age 24. 29, 64. Gross, U. S. V. Discharged 19th Virginia, age , 5. 6, 63. New York. Exchanged Nov. March 18, 1865. 12, 1863. 526 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NAME, MILITARY OPERATIONS, OPERATORS, Vn NAME, MILITARY DATES OPERATIONS, OPEKATOUS, NO. DESCRIPTION, AND AGE. DATES. RESULT. >t W. DESCRIPTION, AND AGE. RESULT. 237 Watson, W., Pt., E, 7th May 15, Right ; flap : gangrene. Disch d 27-2 Bourn. W. L, Pt., F, 12th July 9, Right: circular. A. A. Surg. T. Michigan, age 24. 21, 64. December 29, 1804. Spec. 4540. Georgia, age 30. 13, ^64. E. Mitchell. Died August 12, 238 Weaver, J., Pt., C, 154th Mar. 1, Left ; circular. A. A. Surg. E. L. 1864 ; diarrhoea. New York. 12, 65. Mola. Disch d June 15, 18ti5. 273 Boylan, A., Pt., E, 35th Aug. 30, Right. A. A. Surgeon W. Eddy. 239 Webster, E. H., Pt., I, Sept. 19, Right; anterior post. flap. Sure;. New York. Se. 10, 62. Died October 12, 1862. Spec. 61. 98th Illinois, age 26. 24, 63. S. B. Hawley, 35th 111. Dis 274 Bradbury, G.W., Corp l. Sept. 19, Left. Died November 1, 1863 ; charged April 26, 1864. A, 98th Illinois. Oc.16, 63. secondary haem. and pyaemia. 240 Welker, C., Pt., K, 9th July 12, Right; flap. Surgeon C. Smith. 275 Sullen, H. W., Lieut., Nov. 30, Right; lateral flap. A. A. Surg. Michigan. 15, 62. 9th Michigan. Discharged No Darden s La. Battery. Dec. 30, R. McNeily. Tetanus. Jan. 6, vember 29, 1862. 1864. 1865, amp. thigh, lower third. 241 Welsh, J., Pt., H, 61st Sept. 17, Right. Surg. H. S. Hewit.U.S.V. Died January 7, 1865; tetanus. New York, age 26. 29, 62. Gangrene. Disch d July 23, 63. 276 Bumpus, M., Pt., A, 5th Mav 10, Right ; ant. skin flap and post. Died May 4, 1868. Svec. 402. Maine, age 29. 24 , 64. muse. flap. Surg. A. F. Sheldon, 242 Welsh, M., Ft., I, 154th May 3, Right. Surg. S. N. Sherman,34th U. S. V. (May 19, lig. of ant. New York. 25, 63. New York. Discharged March tibial artery for secondary haem. 3. 1864. Spec. 1550. Diarrhoea ; pyaemia.) Died May 243 Weston, W. P., Pt., H, De.31, 62. Left: flap. Discharged May 11, 29, 1864 ; toxjemia. 64th Ohio. Ja. 12, 63. 1863. 277 Burton, J. if., Serg t; G, Mar. 7, Left ; anterior post. flap. Surg. 244 Wheeler, H., Ordinary Jan. 15, Left. Dr. H. N. Adams, U. S. N. 1st Tenn. Artillery, age 20, 65. B. B. Breed, U. S.V. Gangrene. Seamau,U.S.N.,age 23. 30, 65. Discharged October 13, 1865. 38. Died March 26, 65; exhaustion. 245 1 Whitaker, J. F., Pt., K, Mav 16, Right; circular. June 30, 1864, 278 Butters, T. S., Corp l, I, July 3, Right. July 21, haemorrhage ; 8th Tenn., age 26. J el 2, 64. improving. 2d Mass., age 22. 17, 63. diphtheria. Died July 31, 1863. 246 Whitesel, J. W., Serg t, July 3, Left; circular. Surg. Chase, 279 Buxton, G. W., Corp l, Aug. 9, Left. A. A. Surg-. O. F. Scheldt. B, 19th Virginia, age 6, 63. C. S. A. Transferred for ex A, 2d Massachusetts. 15, 62. Diarrhcea. Died A ug. 31 , 1862 ; 25. change November 12, 1863. pyremia. Spec. 43. 247 Wieand, J., Pt., B, 47th Oct. 22, Risrht; posterior flap. Discharged 280 Castle, E. W., Pt., D, 2d April 6, Left : posterior flap. Surgeon B. Pennsylvania. 25, 62. December 3, 1862. Spec. 687. Conn. Heavy Artillery, 18, 65. A. Vanderkieft, U. S. V. Died 248 Wildm an, E. S., Lieut.. Julv 2, Right. Surg. Given, C. S. A. age 20. April 23, 1865. .Spec. 4100. G, 28thVirRinia,age35. 7, 63. To Provost Marshal Sept. ^5, 63. 281 Caughej-, L., Lieut., C, July 28, Right ; circular. Surgeon A. B. 249 Willburn, R.,Pt.,A, 81st May 22, Right. A. Surg. H. M. Sprague, 1 6th Penn sy 1 van ia Cav AuglS, Mott, U. S. V. Diarrhcea. Died Illinois. 26, 63. U. S. A. Discharged August alry, age 23. 1864. August 23, 1864. 22, 1863. Spec. 1628. 282 Cavaugh, G., Pt., 1, 10th Aug. 30, Left. Ass t Surgeon B. Howard, 250 Willetts, J. P., Pt., B, June 1, Right; circular. Surg. E. Bent- New York. Sept. 5, U. S. A. Died September 13, 1st New Jersey, age 22. 7, 64. ley, U. S.V. Gangrene. Disch d 1862. 1862: pyaamia. June 8, 1865. Died Dec. 10, 66. 283 Cave,W. M., Pt., E, 18th Oct. 19, Left; lat. skin flap and circ. sect. 251 William, J.,Pt.,E, 118th May 16, Right ; flap. Surg. Gibbs, C. Indiana, age 22. Nov. 9, muse. A. A. Surg. C. H. Jones. New York, age 19. June 9, 1864. S. A. Disch d May 27, 1865. Re amp. in up. third Dec.. 1865. 284 Cearfas, G. W., Pt., D, 1864. May 12, Died Nov. 21, 64; exhaustion. Right ; lateral flap. Chills. Died 252 Wilson, G., Pt., B, 18th April 5, Left ; flap. Surgeon S. B. Houts, 100th Penn.. age 30. 22, (M. June 10, 1864. Missouri. 26, 62. 18th Mo. Disch d July 15, 1862. 285 Chase, C. B., Pt., G, 7th Sept. 17, Left; circular. Ass t Surg. J. H. -J..:; Wilson, L. P., Corp l, K, Sept. 17, Left; flap. Ass t Surg. W. M. Maine. Oct. 11, Searle. 26th N. Y. Died Oct. 88th Pennsylvania. 21, 62. Notson, U. S. A. Discharged 1862. 30, 1862; pyaemia. Spec. 770. February 19, 1863. 286 Clark, E. J., Pt., I, 8th May 10, Left; circular. Surg. A. F. Shel 254 Yost, S. R., Pt., A, 28th Sept. 17, Left; anterior post. flap. Ass t Michigan, age 36. June 4, don, U. S.V. June 6, hajm.; lig. Pennsylvania, age 24. Oct. 5, Surgeon C. P. Russell, U. S. A. 1864. ani. tib. art. Died J line 16, 1864 ; 1862. Disch d March 19, 63. .Spec. 810. secondary hemorrhage. 255 Young, W., Pt,, F, 7th Aug. 9, Left; flap. Discharged Novem 287 Clock, C. H., Pt,,G, 10th Aug. 16, Right; circular. Ass t Surg. C. Indiana. 12, : 62. ber 19. 1862. Connecticut, ago 23. 26, 64. Wagner, U. S. A. Died Sep 256 Zant, J. H., Pt., A, 37th Nov. 25, . Surgeon G. M. McDowell, tember 11, 1864; exhaustion. Georgia. De.18, 63. C. S. A. Recovered. .Spec. 3707. 257 Zergcr, J., Pt., B, 53d June 1, Left; circular. Subsequent am 288 Covil, G. B., Serg t, H, June 3, Right ; circ. Surg. N. R. Moseley, Pennsylvania. 5, 62. putation. Diseh d Nov. 7, 1864. llth Conn., age 32. 10, 64. U. S. V. June 13, ham. Died 258 Zook, C., Pt., C, 8th Dec. 13, Right; anterior post. flap. A. A. June 14, 1864 ; secondary haem Pennsylvania, age 19. 21, 62. Surgeon A.W. Tryon. Disch d orrhage. Spec. 2485. Nov. 15, 1863. /Specs. 650, 1596. :289 Craig, W., Pt., E, 74th Nov. 25, Right; flap; haem.; lig. of post. 259 Andrews, J., Pt,, C, 5th Dec. 13, Left ; flap. Surgeon E. Bentley, Illinois. 28, 63. tib. art. Dec. 4, re-amp, in upper Artillery, age 19. 20, 62. U. S. V. Died December 30, , third. Died Dec. 11, 1863. 1862; pyaemia. Spec. 599. 290 Crowter, J. D., Pt., D, April 2, Right ; circular. Ass t Surg. W. 260 Apgar, J., Pt., A, 15th May 2, Right ; anterior post. flap. A. A. 4th N.Y. Heavy Artil 23, 65. F. Norris, U. S. A. Died May 7, New Jersey. 16, 63. Surg. C. Carvallo. (Ball extr.; lery, age 24. 1865; pyaemia. .Spec. 226. gangrene. ) Died May 20, 1863 ; 291 Despond, P., Pt., A, 5th June 17, Left. Died June 22, 1864. exhaustion. Specs. 1251, 2226. Michigan. 20, 64. 261 Bambauer, J., Musician, Nov. 30, Right ; lateral flap. Ass t Surg. 292 Detrich, C., Pt., K, 82d Aug. 29, Left. Ass t Surg. B. A.Clements, H, 56th New York, age Dec. 20, J. F. Huber, U. S. V. (Dec. 2, Ohio. Sept, 18, U.S.A. Died Oct. 28, 1862; 22. 1864. excision tarsus.) Died Decem 1862. pyaemia. Spec. 62. ber 26, 1864 ; pyaemia. 293 Dowling, J. T., Lieut,, May 10, Right : circular. Med. Insp. F. H. 262 Barber, W. B., Serg t, I, May 23, Right; anterior post. flap. Surg. 17th Infantry, age 35. 20, 64. Hamilton. Died June 1, 1864 ; 93d New York, age 32. 30, 64. A. P. Sheldon, U. S. V. Died pyaemia. June 11, 1864: gangrene. 294 Eastman, C. E., Pt., E, July 18, Left. Surg. D. Merritt, 55th Penn. 263 Baxter, P., Pt., D, 1st Julv 2, Right; flap. Died July 26, 1863. 9th Maine. 23, 63. H;em. July 25, lig. of peroneal Potomac Home Brig. 5, 63. artery. Died August 8, 1863. 264 Berry, J., Pt., B, 39th Aug. 16, Left ; circular. A. A. Surg. S. J. 295 Evans, A., Pt., E, 1st Mar. 12, Right." A. A. Surg. A. Sterling. Illinois, age 38. 21, 64. Holley. Died September 4, 64 ; Illinois Artillery, age April 4, Died May 6, 1864 ; typhoid fever irritative fever. 27. 1864. and pyaemia. 265 Bigelow, L., Corp l, B, Aug. 30, . Died October 18, 1862. ; 296 Faust, J., Pt., H, 119th May 2, Right. A. Surg. C. C. Lee.U.S.A. 13th Massachusetts. , 62. Pennsylvania, age 24. 17, 63. Died May 19, 1863. Spec. 1250. 266 Biggs, M. L., Corp l, A, April 30, Left ; flap. Surg. N. Gay, U.S.V. 297 ; Frampton, T. H., Pt., G, May 22, Left ; rectangular flap. A. A. 53d Kentucky, age 20. May 12, Died June 17, 1865: exhaustion. 22d Mass., age 18. 30, 64. Surg. R. Ottman. Died June 9, 1865. j 1864 ; exhaustion. Spec. 2474. 267 Biornson, C., Pt., C, 2d June 1, Left ; flap. A. A. Surgeon S. B. 298 Fuller, J. P., Pt., F, 4th May 5, Left. Died June 21, 1864. Conn. H. Art., age 33. 14, 64. Ward. Died June 18, 64 ; gang. Michigan, age 35. 12, 64. 268 Blanchard, E. W., Pt., June 3, Left ; circular. Surg. K. Bcntley, 299 Gammrl, M. A., Pt., G, Sept. 17, Left ; gangrene. Died Decem H, 45th Penn., age 16. 16, 64. U. S. V. Died June 20, 1864; Arkansas, age 23. 30, 62. ber 5, 1862. tetanus. Spec. 2710. 300 Gibney, J., Pt., L, 2d N. June 1 6, Right. Ass t Surgeon F. Wolf, 269 Blodgett, E. J., Pt., E, May 6, Left ; anterior post. flap. Surg. York Heavy Artillery, , 64. U. S.V. Died July 16, 1864. 6th New Hampshire, 26, 64. A. Delany, U. S. V. Died May ; age 18. Spec. 2419. age 22. 30, 1864 /exhaustion. 301 Gilmore, J., Pt., F, 144th Feb. 10, Right ; anterior flap. A. A. Surg. 270 Blois, E., Lieut., C, 18th April 6, Left ; circular. A. A. Surg. J. P. New York. 22, 65. E. L. Mola. (Erysipelas.) Died Georgia, age 24. 27, 65. Arthur. (Also w nd left thigh. February 28, 1865. Erysipelas.) Died May 4, 1865; 302 Grace, E. C., Lieut., A, May 5, Right; circular. Med. Inspector exhaustion. 139th Penn.,ae;e 24. 20, 64. F. H. Hamilton, U. S. A. Died 271 Bolt, S., Pt., A, 77th May 22, Right. A. Surg. H. M. Sprague, June 5, 64; pyaemia. Spec. 4545. Illinois, age 25. JuneS, U.S.A. Died June 21, 1863; 303 Granger, B., Pt., K, 1st Aug. 29, Left, Died October 2, 1862. 1863. pysemia. Spec. 1633. Penn. Rifles. 1 62. Int. Surgical Journal, Richmond, 1865, Vol. II, p. 28. SECT. V.) INTERMEDIARY AMPUTATIONS IN THE LEG. 527 No. NAME, MILITARY DA-ITS OPERATIONS. OPERATORS, Vr\ NAME, MILITARY OPERATIONS, OPERATORS, DESCRIPTION, AND AGK. RESULT. A U DESCRIPTION, AND AGE. DATES. RESULT. 304 Graver. J. C., Corp l, M, June 18, Right :-circ. A. A. Surg. A. J. 335 O Harran, P., Pt., A, 52(1 June 10, Left ; posterior flap. A. A. Surg. 1st Massachusetts H w July 10, Smith. Gangrene. Died July New York, age 40. July 16, E. Seyffarth. Gangrene. Died Artillery, age 20. 1804. 15, 1864 ; exhaustion. 1864. July 25, 1864; pyiemia. 305 Harris, A. F., Corp l, G, June 16, Right; double flap. Died June 336 Parry, W., Pt., B, 5th May 28. Left. A.A.Surg.j". H.Thompson. 52d Xew York, age 37. | 19, 64. 29, 1864 ; pyaemia. Mich. Cavalry, age 33. J lie 6, 04 Died June 15, 1864; pyaemia. 306 Havens, W., Pt., K, 7th June 25, Right. A. A. Surgeon W. H. B. 337 Parsons, li. / .. Lieut., G, July 13, Right. A. A. Surg. N. A. Robbins. New York Heavy Ar- July 19, Post. (June 25, amp. 2d and 3d 4th Georgia, age 22. 18, 64. Died July 30, 1864. tillery, age 29. lt : 64. toes; gangrene. July 14, Piro- 338 Patterson, A., Pt., K, Oct. 28, Left; circular. Ass t Surg. W. goff s amputation.) Died July 4th Maine, iige 35. Nov. 13, Thomson, U. S. A. Died" Nov. 21,1864; exhaustion. 1861. 19, 1861 ; gangrene. Spec. 4926. 307 1 Heakin, J., Pt., D, 6th May 31, Right; short ant, and long post. 339 Peed, L, Pt., A, 16th Xov. 30, Left ; circular. Surg. J. R. LuU- Cavalry, age 24. June 8, flap. Surg. J. A. Lidell, U. S.V. Kentucky, age 28. Dec. 15, low, U. S. V. Died January 8. 1864. (Ihemorrhage.) Died June 21, 1864. 1805; pyaemia. 1864 ; pyaemia. Spec. 2470. 340 Perkins, A. W., Pt., E, -May 8, Left ; circular. Ass t Surg. W. 308 Jordan, W., Pt., D, 1st April 12, Left; ant. post. flap. Surg. H. llth Infantry, age 40. 24, Vi. F. Xorris.U.S.A. Haemorrhage. Alabama Artillery, age 15, 64. : Wardner. U. S. V. (Also w nds Died June 1, 1804 ; pyaemia. 27. of head left humerus, left arm, 341 Piper, E. C., Serg t, K, June 3, Left; ant. post. flap. A. A. Surg. and right thigh.) Died April 23, 12th New Hampshire, 29, 04. L. C. Dodge. Died August 8, 1864 ; pyaemia. Specs. 331 1 , 331 2. age 28.. 1864 ; chr. diarrhoea. Spec. 2715. 309 Keegan, T. F., Pt., B, ! July 3, Left. Died August 1, 1863; ex 342 Pittman, N., Pt., D, 1st May 19, Left: circular. A. A. Surgs. H. 73d New York, age 20. 12, ^63. haustion. Spec. 1450. Massachusetts Heavy June 10, B. Knowles and M. F. Price. 310 Kensey, R. C., Pt., K, June 1, Right ; sloughing ; haemorrhage. Artillery, age 32. 1864. Died June 14, 1864; pyaemia. 104th Pennsylvania. 8, 62. June 14, femoral artery tied. 343 Pit/el, A., Pt., E, 34th Sept. 10, Left. Died September lO, 1802: Died June 14, 1862. Ohio. 14, 62. tetanus. 311 2 Kroft, J., Pt., D, 7th Xew York, age 33. Sept. 16, Oct. 8, Left ; circular. A. A. Snr?. J. S. Waggoner. Nov. l : , re-amputa- 344 Pressr/rares,J.R., Lieut., 8th Virginia. July 2, 13, 63. Left. Surgeon C. S. Wood, 66th Xew York. Died July 15, 1863; 1864. tion. Died November 16, 1864 ; | tetanus. 312 Lahser, A.. Pt., I, 24th etfects of anaesthetic. May 23, Right. Surgeon G. L. Pancoast, 345 Reynolds, W., Corp l, I, May 31, 6th N.Y. H. A., age 32. J el5, 64. Left. A. A. Surg. J. H. Thomp son. Died July 6, 1864 ; pyaemia. Michigan, age^K). June 9, U. S. V. Died June 18, 1864. 346 Ross, W. A., Pt., I, 123d Deo. 13, Right. Died January 4," 1863; 313 Lannahan. J., Pt., H, 9th 1804. Oct. 19, Spec. 2464. Left ; circular. A. A. Surg. R. H. 347 Pennsylvania, age 18. 18. 62. Schuler, C., Corp l, C, 1 July 2, diarrhoea. Spec. 677. Left ; haemorrhage. Died July N. Y. Heavy Artillery, Nov. 7, 1 Stirling. (Gangrene.) Died De- 71st Xew York, a ge 23! 13, 63. 21, 1803; haemorrhage. age 20. 1804. cember 5, 1804 ; pyaemia. 348 Scott, E., Pt., G. 25th Nov. 30, Left; anterior posterior flap. A. 314 Laveve, D., Pt., F, 5th June 2, Right. A. A. Surg. W. H. Ran Ohio, age 18. Dec. 4, A. Surgeon W. Balser. Died New York, age 24. 19, 04. dolph. (Erysipelas.) Died June 1864. December28, 1804; hectic fever. 27, 1864 ; asthenia. 349 Sharp, W., Pt., I, 8th N. June 3, Left ; anterior flaps. Surg. F. F. 315 McClellan, J., Pt.,1, 40th Ohio, age 19. May 15, June 4, Left; circular. A. A. Surgeon H. C. May. Sloughing. Died York Heavy Artillery, age 21. 7, 64. Burmeister, 09th Penn. (Haem.) Died July 12, 1864. Spec. 3204. 1864. June 23, 1864 ; exhaustion. 350 Sieker, H., Pt., K, 35th Sept. 19, Left; sloughing. Died October 310 McClure, R., Pt., K, 82d April 1, Right; circular. A. A Surg. A. Ohio. 22, 63. 16, 1863. Pennsylvania, age 37. 17, 65. V. Cherbounier. Died July 3, 351 1 Smith, P., Serg t, K, Aug. 10, Both; circular. A. A. Surgeon 1865; dysentery. Spec. 4103. 1525 69th New York, age 30. Sept. 6, J. H. Hutchinson. Sloughing; 317 McCoy, G., Pt., E, 62d Jan. 23, Left; circular. A. A. Surg. W. 1864. bed-sores. Died October 10, Pennsylvania. Feb. 12, F. Peck. Died February 26, 1864; exhaustion. Spec. 3644. 1864. 1864 ; pyaemia. 353 Spiller, J. F., Corp l, I, Feb. 11, Right; lateral flap. A. A. Surg. 318 MoGeough, M., Lieut., May 7. Left : circular. A. A. Surg. J. C. 7th New Hampshire, Mar. 6, B. B. Miles. Died March 13, H, 1st Sharpshooters, 17, 64. McGee. Died May 22, 1864; age 21. 1865. 1865; pyaemia. age 30. pyaemia. Spec. 2275. 354 Steele, G. A., Serg t, K, Oct. 6, Right; circular. Died Xovember 319 McMillen, J., Pt.,K, 86th July 10, Left ; circular. Died August 17, 1st New Hamp. (lav. 9, 04. 12, 1864 ; gangrene. Illinois, asre 23. 17, 64. 1864 ; exhaustion. 355 Stilwell, C., Pt., K, 57th Sept. 17, Left. Surg. H. S. Hewit, U. R.V. 320 McMullen, G., Lieut., C, July 9, Left; circular. A. A. Surg. J. H. New York. Oct. 3, 62. Died October 9, 1862. Spec. 762. 321 110th Ohio, age 34. Madris, J., Pt., C, 33d 21. " 64. July 20, Bartholf. Died Aug. 21, 1864. Right ; ant. post. flap. Ass t Surg. 356 Temple, A., Serg t, F, ! Aug. 21, 1st Missouri Cavalry, Sept. 6, Right; circular. A. A. Surgeon C.A.Warner. Died September Indiana, age 35. Aug. 13, W. B. Trull, U.S. V. Died Aug. age 24. 1864. 20, 1864 ; pyaemia. 322 Magoon, J. B., Pt., A, 1864. . June 22, 29, 1864 ; irritative fever. Left; ant. post. flap. Ass t Surg. 357 3 Tillapaugh, G.W.,Cor- May 31, poral, B, 151st N. Y., June 6. Right; circular. A. A. Surgeon C. II. Osborne. Died June 21, 33d Mass., age 42. July 15. B. E. Fryer, U.S.A. Died July age 23. 1864. 1864 ; pyaemia. 1864. 18, 1864 ; pyaemia. 358 Umbarger, J.W., Corp l, Dec. 5, Left, A. A. Surgeon H. M. Lilly. 323 Martin, P., Pt., F, 18th April 7, : erysipelas. Died April 25, I, 117th Illinois, ago 30. 1864, (Dec. 15 1864. Chopart s amp. Louisiana, age 32. 16, 62. 1862; mortification of leg. Jan. 12, foot : gangrene.) Died January 324 Mayne, R., Pt., K, 6th May 5, Right. Surg. Z. E. Bliss, U. S.V. 1865. 14, 1805; pyaemia. Vermont, age 20. 29, 64. (May 22, rem. of ball and frag 359 Vangeson, J., Corp l, F, Aug. 16, Left; circular. A. A. Surg. S. J. ments of bone; erysipelas.) Died 4th Artillery, age 35. 23, 64. Holley. Died September 2, 64 ; June 2, 1864. exhaustion. 325 Miller, A. L.,Pt.,D, 121st May 11. Left flap. A. A. Surgeon W. E. 360 Van Scoter, G., Pt., G, Aug. 29, Left. Died October 12, 1862. New York, age 23. 17, 64. Chirk. Died May 23, 1864; 5th New York. 62. Int. pyaemia. 361 Velie, G. W., Pt., C, 24th June 3, Right; circular. Surgeon D. W. 326 Miller, L., Pt., 18th Ohio De.16, 64, Right; flap. A. A. Surg. F. G. Michigan, age 28. 28, 64. Bliss, U. S.V. (Excision ankle.) Battery, age 19. . Jan. 8, 65. Albright. Died Jan. 18, 1865. Gangrene. Died July 18, 1864. 327 Moore, C., Pt., E, 1st R. May 3 Left. Died June 30 1863. 362 White, A. J. Pt. A, 8th June 3 T oft rfiotin(ynlir fl*n Sure* F I. Light Art rv, age 38. 12, 63. New York Heavy Ar 9, 64. Bentley,U.S.V. Flaps sloughed. 328 Morrison, D.,Pt., A, llth May 31, Left. A. A. Surg. F. H. Brown. tillery. Died July 10, 1804 ; exhaustion. Maine. June 29, (Also wound of right femur.) Specs. 2497, 3340. 1862. Died July ~">, 62 ; tuberculosis. 363 Williamson, H., Pt., D, July 2, Right; sloughing. Died Febru Spec. 13. llth Miss., age 20. 5, 63. ary 18, 1864. 329 Mullen. E., Pt.. D, 5th July 18, Left ; flap. Ass t Surg. J. Willard, 364 VVitzel, J., Serg t, I, 1st Aug. 19, Right ; circular flap. Surg. A. A. X.Y. H vyArt., age 25. 24, 64. 1st Md. Died July 28, 1864. Maryland, age 24. 22, 64. White, 8th Maryland. Died 330 Mnsser, W., Pt., I, 83d July 1, Right ; flap. Ass i Surgeon J. S. September 10. 1864. Pennsylvania, age 22. 8, 62. Billings, U. S. A. Gangrene ; 365 Wood, F., Serg t, A, 5th Oct. 19, Right ; anterior post. flap. Ass t diarrhoaa. Died July 15. 1862. Michigan Cavalry, age Nov. 7, Surgeon D. C. Peters, U. S. A. 331 foil, J. P., Pt., G, 14th April 2, Left. A. A. Surg. J. M. Hotaling. 22. 1864. Died Nov. 18, 1804; pyaemia. 332 South Carolina, age 18. Nicholson, J., Corp l, C, 9, 65. April 2, Dieil April 20, 1865; diarrhoea. Rijrht- i;. ----.lar. A. Surgeon F. 36d Woolten, T., Pt., F, 32d Mar. 10, Virginia. 14. 64. : flap. Surgeon C. B. Gibson, C. S. A. Died May 19, 1864. 40th Penn., age 27. 22, 05. K. alartindale, U. S. V. Died 367 Wright, B., Pt., G, 8th May 6. Right ; iinterior post, skin flap. April 24, 1865. Michigan, age 23. 27, 64. Surgeon A. F. Sheldon, If. S. V. 333 Nixon, W., Pt., H, 20th June 17, Right. Surg.G. F. French.U.S.V. Died June 11, 1864; exhaustion Illinois. July 6, (Haemorrhage); diarrhoea. Died and typhoid condition. 1804. Aug. 19, 64 ; exh n. Spec. 3382. 368 Yagle, J. F., Pt., E, 87th Sept. 20, Left: circular (gangrene). Died 334 Norton, A. L., Corp l, D, June 3, Left. Died June 29, 1864 ; py Indiana, age 23. Oct. 5, October 14, 1863. 14th Conn., age 29. 6, 64. aemia. i 1863. "LlDEU. (J. A.), On the Wounds of Blond Vessels, etc., in United States Sanitary Commission Memoirs, New York, 1870, Surgical Vol. I, p. 23. PACKARD (JOHN H.), Death from Chloroform, in American Journal Medical Sciences, 1865, Vol. XLIX, N. S., p. 272. S LI1)KI.I. (J. A.) (Secondary Traumatic Lesions of Bone, etc., in U. S. San. Comm. Mem.. Surg. Vol. I, N. Y., 1870, p. 408) cites this case as an amputation in the thigh ; but in his report of cases of pyaemia, at Stanton Hospital, for the second quarter, 1864, he designates the operation an amputation in the leg. 528 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Intermediary Amputations in the Lower Third of the Leg for Shot Injury. The number of the intermediary amputations in the lower third of the leg is three hundred and thirty-five; two hundred and fifteen were successful and one hundred and twenty fatal a mortality of 35.8 per cent. Recoveries after Intermediary Amputation in the Lower Third of the Leg. The two hundred and fifteen operations of this group were performed on two hundred and fourteen patients fifty Confederate and one hundred and sixty-four Union soldiers. Of the latter, one hundred and sixty-two have been allowed pensions; the claim of one soldier is still pending, and the name of another has never appeared on the Pension Rolls. Twelve have died since their discharge from the service three of phthisis, one of softening of the brain, one of ulceration of the stump, six of causes not reported; one pensioner was accidentally drowned. CASE 771. Private O. Payne, Co. D, 20th Colored Troops, aged 19 years, was wounded in the right foot, near Peters burg, June 7, 1864, and entered Mount Pleasant Hospital, at Washington, three days afterwards. Assistant Surgeon C. A. McCall, U. S. A., reported : "Accidental gunshot wound through tendo-achillis, passing through the ankle joint and emerging almost at right angle with the line of entrance, literally grinding the astragalus and part of the os calcis. Sanguineous fluid was discharged from the wounds, and the foot became somewhat cedematous as far as above the malleoli. Two weeks after the patient s admission his pulse grew weaker, more compressible, and frequent, which was attended by loss of "appetite and sleep. On June 27th, an anaesthetic consisting of equal parts of ether and chloroform was administered, and the leg was amputated by the circular method, by Acting Assistant Surgeon A. Transue, the bone being divided one and a half inches above the malleoli. The patient reacted finely, and after the operation his appetite improved, he slept well, and the parts looked favorable." On October 8th, he was transferred to hospital at New Albany, where a second operation was performed by Acting Assistant Surgeon W. A. Clapp, who contributed the following description of the case: "The patient stated that he contracted syphilis previous to being wounded. Extensive necrosis of the shafts of the tibia and fibula followed the first amputation, and the pain and dis charge from the stump became so great as to necessitate a re-amputation, which was performed by the circular method, three inches below the knee, on March 18, 1865. At the time of the operation firm sequestra had formed and there was great swelling of the soft parts. The subsequent progress was favorable." The patient was ultimately discharged from service, at the Joe Holt Hospital, Jeffersonville, August 1, 1865, and pensioned, and one year afterwards he was furnished with an artificial limb of the Palmer patent. The bones removed at the second amputation were subsequently contributed to the Museum by Dr. T. W. Fry, late Surgeon U. S. V., who at the same time stated that the man was in good health and walking about on crutches, with a good stump, which had healed kindly. The specimen is numbered 4740 of the Surgical Section, and is represented in PLATE LXXII, FIGURE 1, opposite page 317, ante. The pensioner was paid March 4, 1880. CASE 772. Private L. Vermilyea, Co. K, 91st New York, aged 21 years, was wounded at (iravelly Run, March 31, 18(55. He was conveyed to the field hospital of the 3d division, Fifth Corps, whence Surgeon A. S. Coe, 147th New York, reported "a bullet wound with fracture of left ankle joint." Surgeon A. F. Shel don, U. S. V., reported the following description and result of the injury: "A musket ball entered the lower extremity of the tibia anteriorly, fracturing it into the joint and upwards for four inches. The wounded man was admitted to Campbell Hospital at Washington, six days after the injury. Suppuration set in about the wounded foot and extended to the muscle of the calf and the patient suffered considerable fever and irritation of the system. On April llth, circular amputation of the lower third of the leg was performed by Assistant Surgeon A. Delany, U. S. V., the operation being attended with the usual amount of hemorrhage and three ligatures being applied. Anaesthesia was produced by sulphuric ether. The patient did well after the operation, and was discharged from service June 19, 1865." Several months later he was furnished with an artificial limb by the Salem Leg Company. The amputated portions of the bones of the leg (Spec. 4054) were contributed to the Museum by the operator and are represented in the annexed wood-cut (FiG. 305), showing the tibia to be Fir.. 305. Low- fractured by a round ball, which is lodged just above the ankle, fissuring into it. In his first application for ^nes ofTefrfeg commutation, dated 1870, the pensioner represented the stump as being in a sound condition, but in subsequent the ball lodged in statements he reported it as troublesome. The Albany Examining Board, on February 5th, 1879. certified to tibia Spec 4054 the amputation, and stated that "the stump is tender and abscesses occasionally form on the posterior aspect of the leg, more especially if an artificial limb is worn for a few weeks at a time. The pensioner also states that he has neuralgic pains and is now and then laid up for from one to three weeks." The pensioner was paid June 4, 1880. CASE 773. Private T. B. Stewart, Co. C, 2d Connecticut Heavy Artillery, aged 31 years, was wounded, at Opequan Creek, September 19, 1864, and admitted to the Depot Field Hospital at Winchester three days afterwards. Surgeon R. Sharpe, 15th New Jersey, in charge, recorded the following history: "The injury consisted of a shot wound of both feet by a shell, severely fracturing and comminuting all the tarsal bones. On September 23d the right leg was amputated, and on the following day the left leg was amputated, both by circular operation, at the lower third, by Assistant Surgeon J. G. Thompson, 77th New York. Severe sloughing of the stumps followed, and on October 2d there was secondary haemorrhage from the inter- osseous artery of the left leg, which was controlled by taking up the vessel with the forceps. The patient recovered and was transferred from Winchester November 8th." He was subsequently admitted to hospital at Frederick, and lastly he entered Central Park Hospital at New York City, where he was furnished with artificial legs by Dr. E. D. Hudson. On August 13, 1865, SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 529 FIG. 306. Stump after flap amputation in lower third of the left leg. [From a cast.] Sprc. 1025. the man was discharged from service and pensioned. In his application for commutation, dated 1870, he described both stumps as being in " sound condition ;" but five years later he reported that " the bones stick out." The pensioner was paid March 4, 1880. CASE 774! Private G. Morgan, Co. E, 97th New York, aged 30 years, was wounded in the left ankle joint, at Hatcher s Run, February 6, 1865. Assistant Surgeon D. C. Peters, U. S. A., reported: "The wounded man was admitted to Jarvis Hospital, Baltimore, February lltli. The injury was caused by a musket ball entering the external malleolus, fracturing the astragalus, and making its exit internally. Caries of the astragalus ensued and the foot became greatly inflamed. On March 2d, the leg was amputated at the lower third by Acting Assistant Surgeon B. B. Miles. Ether was used, and the operation was performed by lateral Haps with circular section of muscles." The patient was subsequently transferred to Ira Harris Hospital at Albany, where he was discharged from service October 13, 1865, and pensioned. A plaster cast of the stump (Sptc. 1025), represented in the annexed cut (FlG. 306), was contributed to the Museum by Assistant Surgeon J. H. Armsby, U. S. V., in charge of the latter hospital, and shows the ends of the bone apparently rounded and sufficiently covered, while the cicatrix is slightly but not injuriously drawn on the pos terior surface. In his application for commutation the pensioner described the stump as continuing in a "healthy condition." His pension was paid June 4, 1880. CASK 775. E. Robinson, a landsman (colored), aged 24 years, while attached to the U. S. Steamer Rodolph, was wounded in the left leg by the explosion of a torpedo in Mobile Bay, April 1, 1865. The injury involved a dislocation of the tibia at the knee and a compound comminuted frac ture of the fibula and tibia near the ankle of the same leg. The fracture was impacted as well as comminuted. When he was admitted to the Naval Hospital at Pensacola, thi ee days afterwards, the dislocation had been reduced, but on examination (the patient being under the influence of chloroform) both the tibia and fibula were found to be severely injured near the ankle, the bones protruding from the wound and large and small fragments being easily felt by introducing the finger. It was then deemed useless to attempt to save the limb, and amputation was performed about four inches above the injury. The dislocated bone was kept in position by pasteboard splints and the greatest care was used in dressing the stump. The case progressed favorably until April 22d, when the patient com plained of headache and nausea, followed in a short time by a severe chill and high fever. Pyaemia being apprehended, the stump, though nearly healed at the time, was carefully examined, and fluctu ation was detected at the under portion near the cicatrix. After the escape of pus by free incision into this part the patient, who was a man of strong constitution, over six feet high and stout in pro portion, improved rapidly under the administration of quinine, and was soon able to be transferred to New York, where he entered the Naval Hospital on June 15th. He was discharged from service November 24, 1865, with a good stump, being able to walk easily and well on an artificial limb and suffering no weakness of the knee consequent upon the dislocation. The history was contributed by Passed Assistant Surgeon J. R. Tryon, U. S. N., who also forwarded the amputated bones of the leg, which constitute specimen 5662 of the Surgical Section of the Museum, and exhibit the seat of the injury, including a longitudinal fissure in the tibia about three inches in length. The man is a pensioner and was paid September 4, 1880. He reported the stump as continuing in "good and healthy condition." CASE 776. Private O. M. Armstrong, Co. B, 120th New York, aged 33 years, was wounded at Cold Harbor, June 3, 1864. Surgeon F. F. Burmeister, 69th Pennsylvania, reported his admission to the Second Corps Hospital, at White House, with "shot wound of left ankle joint, for which amputation was performed by Dr. Henry McLean, of Troy, N. Y., on June 10th." Two days afterwards the patient entered Armory Square Hospital, Washington, where a subsequent operation was performed by Surgeon D. W. Bliss. U. S. V., who described the case as follows: "The man was admitted with amputation of the leg at the lower third. The stump was very painful and symptoms of necrosis were exhibited. Simple dressings were used, and stimulants and nourishing diet were prescribed. On October llth, the patient was placed upon the operating table and put under the influence of chloroform, when the stump was opened and a ring of necrosed bone, which encircled the tibia, was taken away by means of a pair of dressing forceps. The patient did well after the operation, and was transferred to hospital at Rochester in February following." The removed fragment, consisting of a tubular sequestrum four inches long, was contrib uted to the Museum by the operator (Cat. Surrj. Sect., 1866, p. 404, Spec. 3284), and is represented on PLATE LXXI, FIGURE 3, opposite page 428, ante. The patient was discharged from service May 31, 1865, and pensioned, having been previously sup plied with an artificial limb by Dr. D. Bly, who described the amputation as having been performed by the flap method. The pensioner died October 22, 1870. The cause of his death is reported to have been softening of the brain. Fatal Intermediary Amputations in the Lower Third of the Leg. One hundred and twenty amputations one hundred and three performed on Union and seventeen on Con federate soldiers belong to this category. In two instances amputation in the lower third of the thigh was unavailingly resorted to. Death was ascribed to pyaemia in thirty-five, exhaustion in twenty, tetanus in five, gangrene in three, and secondary haemorrhage in four instances. CASE 777. Private L. Mock, Co. I, 119th Pennsylvania, aged 22 years, was wounded in the left foot, at Rappahannock Station, November 7, 1863, by a musket ball, which entered about one and a half inches below the internal malleolus, passing upward and outward, making its exit anterior and under the external malleolus and opening the ankle joint in its passage through the parts. He entered Armory Square Hospital at Washington two days after receiving the injury. On December 6th, Surgeon D. W. Bliss, U. S. V., amputated the leg above the ankle by Hap operation, the patient being under ether, to Sl iui. Ill 67 530 INJUKIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 307. The which a little chloroform was added towards the last. Three vessels were ligated, the loss of blood being small. The patient reacted well from the anaesthetic. At the time of the operation his constitutional condition was tolerably good and the tissues of the wounded parts were in a healthy state. The stump grew painful, but its appearance was good. Cold-water dressing was used and nourishing diet with stimulants were administered. On December 9th the patient had three chills, followed by profuse perspiration. On the following day there was no chill, the stump still looked well, and the patient suffered no pain. Quinine and opium were now prescribed in addition to the former treatment. By December 18th there was well-developed pyaemia, from the effects of which the patient died December 21, 18G3. After deatli yellowness, to an extreme degree, came on, and, on inspection, the shoulder and elbow were found to contain pus, the shoulder having a large quantity and the other joints being believed to be in a like condition. The tarsal bones of the amputated limb, contributed with the history by the operator, con stitute specimen 1903 of the Surgical Section of the Museum. The specimen exhibits no perceptible attempt at repair, and shows that the ball passed through the calcaneum, which is necrosed, and grazed the astragalus, opening the ankle joint. The appearance of the entrance and exit wounds is shown in PLATE XXXIX, FIGUHE 2. CASE 778. Corporal G. B. Scott, Co. K, 8th New York Cavalry, aged 19 years, was wounded in the right lower extremity, at Beverly Ford, June 9, 1863. He was conveyed to Washington and admitted to Lincoln Hospital on the following day, whence Surgeon G. S. Palmer, U. S. V., contributed the pathological specimen (No. 1347) represented in the adjoining wood-cut (FlG. 307), with the following description and result of the injury: "The wound was of the right ankle joint, affecting the internal malleolus and bones of the foot. The ball entered over the inner malleolus and was not extracted. Incisions with the knife were made over the external malleolus, allowing the free flow of pus, and fragments of bone were daily extracted. The leg was amputated at the lower third on June 20th. The patient never recovered from the shock of the operation. On the second day he had a severe chill, followed by profuse sweating. His tongue became dry and he complained of great thirst; pulse 130; appetite capri cious. The flaps of the stump grew whitish around the ligatures, and a watery offensive discharge commenced to escape from the stump. On the third day the anterior flap became tawny, having a decided tendency to slough, and the limb became decidedly erysipelatous. On June 24th, profuse diarrhoea set in and the patient complained of pain in the loins, but his mind was yet clear and he was in excellent spirits. The stump now had no sensation in it whatever. The chills followed each other in rapid succession, the patient having as manv as two daily, followed in each case by diaphoresis. He rested well until the evening of June 29th. On the following day twenty-five drops of laudanum were administered, which produced a quiet slumber. On awakening from this he became delirious and very restless; pulse 183 and compressible; respiration thirty-five per minute and labored; fever intense. He died on the morning of July 1, 1863. The wound at no time dis- lower portions ">f charged purulent matter, but profuse, thin, and offensive fluid, staining the dressings with a dirty blood color, the bones of right rp ne ^ & ^ s re t ame( i their proper relations, the ligatures not loosening. No erysipelas existed beyond tlie knee, which was slightly swollen. At the post-mortem examination the stump was found to have become blackened, the epidermis being readily detached from its base, and a large bleb full of brownish serum was discovered on the inner side of the knee. The anterior flap was perfectly black, and the muscles in the posterior flap had become a softened pultaceous mass. The periosteum of the fibula was detached and of a dark green color; the muscles were affected as far up as the union of the tibia and fibula. The anterior portion of the fibula and the crest of the tibia were dotted with a reddish color, the rest of the bones being pure white." The specimen consists of the amputated lower extremities of the bones of the leg, the external malleolus being broken off. CASE 779. Sergeant W. H. Gaslins, Co. K, 8th Virginia, aged 20 years, was wounded and captured at Gettysburg, July 3, 1863. His injury was described by Assistant Surgeon W. F. Richardson, C. S. A., from Camp Letterman, as follows: "A mini6 ball entered the centre of the sole of the right foot, passing through the tarsus and emerging at the top of the foot. The leg was amputated at the lower third on August 1st. The patient was troubled with abscesses which formed in the stump, and now and then attacks of diarrhoea came on, which brought his condition down. Astringents, nourishing diet, tonics, and stimu lants were administered. In the beginning of September the discharge had grown very slight; but about October 20th the stump became much swollen and inflamed, the discharge copious and unhealthy, and the tibia protruded one-halt inch, the bone being necrosed for six inches above the end of the stump. Diarrhoea was now profuse .and obstinate. By October 30th the patient had become much reduced and the necrosed portion of the tibia was loose. On November 4th the diseased portion of the bone, six inches in length, was removed. The patient died on the following day, November 5, 1863." A section of the bones of the stump (Spec. 1962), showing very extended ravages of disease, was contributed by Acting Assistant Surgeon E. P. Townsend and is represented in the wood-cut (FlG. 308). CASE 780. Private L. Smith, Co. D, 12th Infantry, aged 24 years, was wounded in the left foot, at ripottsylvania, May 12, 1864, and entered Stanton Hospital, Washington, six days afterwards. Surgeon J. I.-JP.. noa Sections A. Lidell, U. S. V., reported: "The nature of the injury was an extensive shell wound on the plantar sur face, all the tarsal bones except the cuboid being fractured. The foot became much swollen and inflamed and the wound was sloughing and full of maggots. Acting Assistant Surgeon C. H. Osborn amputated the leg at the lower third, on May 21st, by the circular method, using sulphuric ether as the anaesthetic. But little blood was lost during the operation. The patient reacted promptly and did not suffer much shock. Tonics and stimulants were administered. On May 26th, there was a pysemic chill, which returned at intervals for two weeks. The stump commenced to slough, abscesses formed in the thigh, and large bed-sores came on over the sacrum. The patient was also troubled with diiirrliu-a.. Death resulted from pyaemia July 3, 1864. At the autopsy the anterior part of the stump was found to have sloughed to within one inch below the tubercle of the tibia, exposing the bone, which was denuded of its periosteum. There were two large abscesses, one in the popliteal space and the other in the middle third of the thigh; small thrombi in the veins. The lungs of right tibia and fibu la, three months after amputation in lower third. Spec. 19C2. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 531 contained several superficial abscesses; the liver was enlarged, soft, and fatty; spleen soft and enlarged. All the other viscera were in a normal condition." *The stump of the lt j g, showing the tibia to be exposed for the extent of six inches, was con tributed to the Museum by Assistant Surgeon G. A. Mursick, U. S. V., and constitutes specimen 2739 of the Surgical Section. TABLE LXXIV. Summary of Three Hundred and Thirty -jive Cases of Intermediary Amputations in the Lower Third of the Leg for Shot Injury. [Recoveries, 1215; Deaths, 216335.] NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Adams, S. N., Pt., D, April 2, Right ; flap. A. A. Surg. P. H. 29 Bush, J., Pt., B, 54th May 31, Lett ; flap. A. A. Surgeon M. B. 110th Ohio, age 29. 12, 65. Colton. (Also fracture and exc. Indiana. June 3, Graff. Trans. July 24, 1863. lefttibia.) Disch d Sept. 11, 65. 1863. Died Jan. 14, 1870; ulceratiouof 2 Agan, H., Pt,, I, 7th Sept. 17, Right ; circular. S. G. Gray, Act stump. Spec. 1629. Michigan, age 17. 24, 62. ing Medical Cadet, U. S. A. 30 Carver, S., Pt., G, 45th May 5, Left. Surg. J. B. Edelin, C. S. A. Discharged June 6, 1863. North Carolina. 8, 64. Discharged March 4, 1865. 3 Anderson, R., Pt., H, April 12, Left ; ant. post, wkin flap ; circular 31 Clark, R. A., Pt., F, 14th July 9, Left; circ. A. A. Surgeon J. C. 76th Colored Troops, 20, 65. section muscles. Surgeon F. E. New Jersey, age 21. Aug. 3, Shinier. (Alsopenetr. wound of age 25. Piquette, 86th Colored Troops. 1864. lung.) Discharged September 1 Discharged June 10, 1865. 11, 1865. Spec. 3922. 4 Armstrong, O. M.,Pt.. B, June 3, Left ; flap. Dr. H. McLean, Troy. 32 Cluck, J., Pt., B, 7th Dec. 13, Left; circular. Surg. H. Bryant, 120th N. York, age 33. 10, 64. Necrosis ; sequestra removed. Penn. Reserves, age 28, 62. U. S.V. (Also w nd of hand and Disch d May 31, 1865. Spec. 30. buck.) Discharged December 3-284. Died October 22, 1870; 11, 1863. Spec. 4548. softening of brain. 33 Conklin, J. H., Pt., A, May5, Left ; circular. Discharged May 5 Babcock, E. G., Pt., I, June 18, Left ; flap. Confederate surgeon. 40th New York, age 22. 8, 64. 15, 1865. 34th Mass., age 27. July2, 64. Discharged July 6, 1865. 34 Conroy, J., Pt u C, 4th Aug. 30, Right; flap. A. A. Surg. F. H. 6 Bachtell, S., Pt., H, 7th Aug. 18, Right ; circular. A. Surg. T. A. Infantry. Sept. 4, Brown. Aug. 9, 63, bone rem.; Pennsylvania Cavalry, Sept, 17, McGraw, U. S.V. Disch d Jan. 1862. gangrene. Discharged. age 22. 1864. 30, 1866 ; subsequently re-amp. 35 Coombs, L. D., Corp I, May 5, Right; anterior posterior flap. 7 Bacon, A., Pt., B. 2d S. July 2, Left; circular. Surg. S. Baruch, F, 2d Wisconsin, age 15, 64. Surg. E. Bentley, U. S. V. Dis Carolina, age 21. 26, m 3d Battalion, S. C. To Provost 28. charged December 22, 1864. Marshal September 17, 1863. 36 Corey, R., Pt., C, 18th July 18, Left ; circular. A. A. Surgeon J. 8 Bacon, W., Pt., D, 7th July 12, Left; circular. A. A. Surg. T. Connecticut, age 34. 28, 64. Goldsborough. Disch d March Maine, age 21. 15, 64. Carroll. Necrosis. Discharged 23, 1865. June 16, 1865. Amputation 37 Crocker, N. C., Pt,, A, Aug. 14, Right; circular. A. A. Surgeon thigh in 1866. Spec. 2841. llth Maine, age 28. 25, 64. R. O. Sidney. Discharged June 9 Barnett, J. B., Pt., E, Mar. 31, Left ; ant. post. flap. Surgeon N. 12, 1865. 191st Penn., age 33. April 8, R. Moseley, U. S. V. (April 1, 38 Cruger, E., Pt., E, 5th Aug. 30, Right. Discharged February 11, 1865. Syme s amp. ankle joint ; slough New York. Se.20, 62. 1863. ing.) Disch d June 28, 1865. 39 Curtis, H. H.,Pt.,C,7th May 5, Left ; ciro. Confederate surgeon. 10 Bathurst, J. F., Serg t, I, Dec. 13, Left; circular. A. A. Surg. D. Wisconsin, age 22. 31, 64. Discharged May 26, 1865. 5th Pennsylvania Re 28, 62. Weisel. Gangrene ; exfoliat n. 40 Curtis, J. B., Pt., I. 8th June 3, Left ; circular. A. A. Surg. A. N. serves, age 23. Discharged December 19, 1863. New York Artillery, 14j 64. K. Andrews. Sloughing. Dis 11 Betty, W. M., Pt., K, 7th Sept. 19, Right. Surg. P. F. Eve, C. S. A. age 21. charged November 10, 1864. Arkansas. 28, 63. Recovery. Spec. 2533. 12 Biglow, J., Pt., E, 8th Sept. 17, . Union surgeon. Recovery. 41 Davidson, S., Pt., B, 7th June 9, Right ; circ. Surg. P. F. W hite- Louisiana. 20, 63. Indiana, age 23. 13, 62. head, C. S. A. Discharged Oc 13 Bisbee, A., Corp l, B, April 16, Right ; circular. Surgeon R. B. tober 3, 1862. 7th Maine, age 25. May 12, Bontecou, U. S. V. Discharged 42 Davton, B. F., Pt, B, May 12, Left; circular. Surg. O. A. Jud- 1862. February 10, 1863. April 8, 57th Mass., age 18. 27, 64. son, U. S. V. August, 1864, re- 1863, amputation thigh. amp. Discb d Dec. 27, 1864. 14 Blankenship, W. A., July 2, Right. Ass t Surg. W. Black, C. 43 Denniston, J. F., Capt. Aug. 25, Right; circular. Surgeon D. W. Capt., F, 25th Virginia, 9, 63. S. A. Exchanged Dec. 5, 1863. and Commissary, U. S. Sept. 10, Bliss, U. S. V. (Aug. 25, Piro- age 21. V., age 24. 1864. foiTs amp. ankle joint.) Disch d 15 Boardwell, I., Pt., C, June 6, Left : double flap. Ass t Surg. anuary 1, 1867. Spec. 3211. 36th Wisconsin, age 18. 19, 64. S. B. Ward, U. S. V. Disch ? d 44 Dersam, F. E., Pt., H, June 3, Right ; ant. posterior flap. Ass t May 4, 1865. 8th New York Heavy 9, 64. Surg. S. B.Ward, U. S. V. Dis 16 Bowles, R. A., Pt., H, June 28, . Surg. Peticolas, C. S. A. Artillery, age 31. charged Sept. 13, 65. Spec. 2664. 22d Virginia Battery. July3, 62. Recovery. 45 Devlin, J. R.,Pt.,E, 20th Sept. 17. Left; flap. Discharged Decem 17 Brady, B., Pt., E, 73d May 15, Left ; circular. A. A. Surg. C. S. Massachusetts. 20, 62. ber 12, 1862. Ohio, age 21. June 5, Merrill. Erysipelas. Disch d 46 Dodge, T. A., Lieut., , July 1, Right : flap. Ass t Surg. G. M. 1864. February 28, 1865. 119th New York. 6, fe. McGill, U.S. A. To V. R. C. 18 Brennan, "W. D., Capt., Sept. 29, Left ; circular. Surg. D. G. Rush, November 26, 1863. A, I42d New York, Oct. 19, 101st Penn. Discharged May 47 Downey, S. W., Lieut.,G, Dec. 15, Left ; circular. A. A. Surg. R. L. age 24. 18C4. 15, 1865. 28th Alabama, age 39. 18, 64. McClure. To Provost Marshal 19 Bromlev, W., Pt., A, May 6, Left; circular. Discharged May February 6, 1865. 149th N. York, age 33. 13, 64. 25, 1865. 48 Driscoll, D. O., Pt., B, May 5, Right; circular. To regiment 20 Brown, A. T., Pt., B, 43d Oct. 19, . Surgeon R. T. Baldwin, 14th Infantrv, age 19. 8, 64. October 7, 1864. North Carolina. 25, 64. C. S. A. Recovery. 49 Dudley, E. H., Pt., K, Julv 3, Left; circular. (July 4. Syme s 21 Brown, C. F., Pt., F, 1st June 20, Left; circular. Surg. A. F. Shel 16th Vermont, age 20. 18, 63. amputut n foot; sloughing); ne Connecticut Cavalry, July 3, don, U. S. V. Disch d March crosis. Dec. 21, re-amputation. age 24. 1864. 26, 1865. March. 1868, re-ampu Discharged April 23, 1864. tation. Specs. 2765, 4700. 50 Dyer, S. M., Pt., I, 5th Mav 4, Left. Confederate surgeon. Dis 22 Brown, J. C., Pt., E, July 21, Right ; skin flap. A. A. Surg. S. Wisconsin, age 20. 7, "63. charged April 25, 1864. 5id Ohio, age 20. Aug. 6, W. Blackwood. April 22. 1865, 51 Emory, J., Pt., A, 36th Sept. 10, Left ; flap. Discharged Septem 1864. re-amp leg. Disch d June 3, 65. Indiana, age 28. 22, 63. ber 21, 1864. 23 Brown, J. D.,Pt.,1, 109th Nov. 3, Left; circular. Surgeon D. W. 52 Emory, J. D., Pt., B, Mav 5, Left; flap. Discharged Febru New York, age 19. 6, 63. Bliss, U. S. V. Disch d March 139th Penn., age 24. 1V64. ary 25, 1865. 27, 1864. Spec. 1764. 53 Fale, L., Pt., G, 13th Oct. ID, Left ; flap. To prison June 6, 24 Brown, S., Pt., I, 107th July 2, Right; circular. Discharged Feb Mississippi, nge 23. 28, 64. 1865. Ohio, age 21. 5, 63. ruary 7, 1864. 54 Ferris, R. P., Pt.,F, 101st Aug. ~>9, . Discharged November 1, 25 Brmvn, W. A., Pt., F, Nov. 25, Left : flap. Surg. J. C. Morgan, New York. Sep.-, 62 1862. 38th Alabama. Dec. 5, 29th Mo. (Also wound of right 55 Fenpfrman, W.C., Serg t, De.13, 62, . Surg. Miller, C. S. A. 1863. leg.) Transferred. F, 7th North Carolina. IJan.-, ti3. Recovery. 26 Buist, C. B., Pt., C, 27th June Ifi, . Surg. H. linger, P.A.C.S. 56 Finnagan, P., Pt., 1), Sept. 17, Left; flap: exfol. Discharged South Carolina. 23, 62. Recovery. 108th N. York, age 24. Oe.ll. 6v>. November 13, 1862. Spec 386. 27 Burke, J., Serg t, II, 7th June 16, Left : necrosis. July 16, re-amp. 57 Fleet wood, L. A., 1 t., C, Julv 18, Left (carious). Nov. 6, re-amp. N.Y. H vv Art.,age21. 28, 64. ; Disch d Mar. 3, 65." Spec. 2^W). 54th Massachusetts (C. 23, 63. Discharged June 8, 1864. Died 28 Bush. H., Pt., D. 85th Aug. -. 9, T.pft circular. Snr<r. I). Meiritt. T.), age 22. September 3, 1866. Spfc. 4311. Pennsylvania, ago 33 Sept. 1, 55th Penn. Sloughing; erysip 58 Flippin, E., Pt., F, 49th May 30, Riglit ; circ. Exchanged March 1863. elas. Discharged July 6, 1864. Virginia, age 28. J neo, 64. 1, 1865. 532 INJURIES OF THE LOWER EXTREMITIES. [CHAP x. Ko NAME, MILITARY n . TI .. OPERATIONS, OPERATORS. No. NAME, MILITARY DATKb. OPERATIONS, OPERATORS, IX \J. DESCRIPTION, AND AGK. RESULT. DESCRIPTION, ANI> AGE. RESULT. 59 Forloint, R., Serg t, E. May 16, . Surg. J. G. Dudley, P. A. S 94 | Lavell, M., Scrg t.A, 7th July 3, Left; flap. Discharged June 4, 15th Virginia. 29, 64. C. S. Discharged Oct. 2, J804. ! Michigan, age 20. 14, 03. 1864. 60 Friddle, W., It., D, 21st June 10, Left. Ass t Surg. C. C. Byrne, 95 1 Lean-, alias Connell.D., June 3, Right ; circular. Surg. E. Bent- Illinois, age 25. : 26, 04. U. S. A. Disch d Feb. 18, 1665. It., C, 28th Massachu- 9, 64. ley, U. S. V. Discharged May 61 Fuhrman, J., It., K, 27th ! May 3. Right ; ant. post. flap. Ass t Surg. setts, age 32. 25.1865. Spec. 2663. Nov. 30, Indiana, age 24. 21, 63. W. Thomson, U. S. A. Erysip 1867, re-amp. Died of haetn. of elas. Disch d Sept. 16. 1803. lungs February 7, 1873. Spec. 1851. Died March 31, Ie76. 96 Leary, J., Pt., I, 106th Oct. 19, Right ; lateral flap. A. A. Surg. 62 Gaines, W. R., Lieut., B, 1 Aug. 17, Lel t. Surgeon Butler, C. S. A. New York, age 45. ov. 17, R. H. Sterling. Disch d June 14th Virginia Cavalry. Se. 15/64. Recovery. 1864. 14, 1865. 63 Gardner, C. J., Serg t, C, Aug. 11, Right ; Jong ant. short pest. flap. 97 Leathers, J. A., Pt., K, July 3, Left. Exchanged November 12, 1st N. York Dragoons, 26, 64. A. A. Surgeon G. H. Dare. Dis 19tli Virginia, age 24. 17, 63. 1803. age 21. charged April 28, 1865. 98 Leslie, A., Pt.,.D, 9th Dec. 13, Left; ant. posterior flap. A. A. 64 Glenn, W., Ft., A, 10th June 27, Right ; sloughing. Sept. 4, re- New York, age 21. 28, 62. Surg. T. II. Dearing. Disch d Pennsylvania, age 25. July 21. amp, posterior flap. Discharged July 29, 1804. Spec. 716. 1862. July 25, 1864. 99 Lewis, T. A., Pt., I, 2d April 8, Right; circular. A. A. Surg. H. 65 Grindstaff, J. R.. Pt., A, May 12, Right ; circular. Surgeon I). W. Illinois Cav., age 25. 22, 64. Smith. Disch d June 15, 1664. 7th West Virginia, age June 4, Bliss, U. S.V. Discliarged April 100 Lindley, T., It., L, 1st Sept. 13, Left. Surgeon D. W. Bliss, U. S. 38. : 1864. 15, 1865. Spec. 2428. Penn. Cav., age 21. Oct.9, 63. V. Discharged April J4, J804. 66 Gross, J., It., E, 200th Mar. 25. Left ; flap. Surgeon E. Bentley, 101 Lister, J., Pt., M, 2d New June 1, Left; flap. Surgeon W. Watson, Pennsylvania, age 21. Ap.24, 65.i U. S. V. Disch d July 15, 1607. York Heavy Artillery, 10, 64. 105th Penn. Discharged Nov. 67 Hannon, M., Pt., A, 9th Oct. 19, Left ; lateral skin flap ; circular age 26. 22, 1864. Spec. 3259. New York Heavy Ar Nov. 9, section muscles. A. A. Surg. 102 Loggins, N., Pt., A, 26th July 2, . Surgeon Bork, C. S. A. tillery, age 30. 1864. B. B. Miles. (Necrosis.) Dis N. Carolina, age 23. 23, 63. Paroled November 12, 1863. charged August 2, 1865. 103 Lawrij, J. C., Corp l, F, Nov. 30, Right; flap. A. A. Surg. J. E. 08 Happe, J., Pt., B, 4th July 1, Left ; circular. Discharged De 38th Tennessee, age 26. Dec. 28, Patterson. To Provost Marshal Artillery, age 30. 6, f 63. cember 9, 1863. 1804. March 7, 1605. 69 Hardern,"R., Pt., C, 61st May 12, Right; ant. posterior flap. Surg. 104 Mathews, B., Pt., B, 14th June 1, Right; ant. post. flap. Surg. E. Pennsylvania, age 51. 28, 64. E. Bentley, U. S. V. Disch d New Jersey, age 23. 28, 64. Bentley, U. S. V. Discharged June 8, 1865. April 15, 1605. 70 Hare. D., Pt., I, 95th Mar. 12, Right. A. A. Surg. J. B. Taylor. !l05 Matteson. P.. Pt.. C. April 2. Left ; circular. Surg. E. Bentley, Ohio. 15, 63. Discharged August 22, 1863. 186th New York. 29, 65. U. S.V. (W nds shoulder, back, 71 Harp, A., Pt., D, 8th July 3, Right. Exchanged November and hip.) Disch d July 15, 1805. Alabama, age 35. 8, 63. 12, 1863. 106 May, C. H., It., B, 16th June 18. Left : circular. Discharged Feb 72 Harris, W. W., Pt., B, April 2, Left ; flap. A. A. Surgeon W. F. Massachusetts, age 28. 27. 04. ruary 18, 1805. 186th X. York, age 34. 17, 65. Goodwin. Disch d July 20, 05. 107 Mayer, H., It., B, 12th Sept. 19, Right. A. A. Surgeon L. Fassilt. 73 Hart, J., It.. A, 14th Dec. 13, Left; flap. Discharged August Maine, age 30. Oc.10, 64. Discharged June J, 1865. Connecticut. 17, 62. 1. 1863. 108 McCann., H., It., D. Jan. 1 1, Riglit ; JateraJ flap. A. A. Surg. 74 Harty, D., It., F, 69th Sept. 17, Right; circular. Surgeon H. S. 127th Illinois. 31, 63. T. T. Smiley. Erysipelas: ne- Xew York. 25, 62. Hewit, U. S.V. Exfol. Disch d crcsis. Disch d Nov. 6. 1803. January 2, 1803. Spec. 210. 109 McGuire, G. F., Pt., I, Dec. 13, RigJit ; circular. Ass t Surgeon 75 Harvey, G. W., Pt., 1, June 17, Right ; flap. Surg. I. V. Miller. 57th New York, age 21. 24, 02. G. M. McGill, U. ,. A. Dis 14th New York Heavy 20, 64. 14th N. York Heavy Artillery. charged December JO, 18(14. Artillery, age 20. Discharged June 8, 1805 110 McLauqlili-n, I. T., It., July 3, Left. Surgeon C. S. Wood. OOih 76 Hausbeck, A., Pt., G, May 5, Right ; circular flap. Surg. E. B, 13th Ala., age 48. 6, 615. New York. July 14, tetanus. 105th Penn., age 19. June 2, Bentley, U. S. V. Gangrene. Exchanged April 27, 1864. 1864. Disch d May 25, 65. Necrosis. 111 McLaughlin, M., It., H. May 3, Left ; circular. Discharged De Nov. 29, 1865, re-amputation. 1 31st New York. 17, 63. cember 8, 1863. 77 Hawk, J., Pt., I, 36th Sept. 19, Left ; flap. Discharged Febru 112 McMontry, H., Corp l, A, May 28, Left : circular. To regiment Sep Ohio. Oc.19, 63. ary 15, 1864. 16th Infantry, age 34. J ne3, 64. tember 29, 1864. 78 lloerr, P.. 1 t., B, 62d July 2, Left; circular. Surg. J. Thomas, 113 McPherson. A. D., Serg t, July 2, Left. A. A. Surgeon J. Dickson. Pennsylvania, age 23. 12/63. 118th Penn. Discharged July A, 105th Pennsylvania. Aug. 1, Discharged June 4, 1804. .Spec. 13, 1864. 1803. 1649. 79 Homln-ee, J., It,, B, 16th July 1, Right. Recovery. 114 McQuilkin, D. L., Pt., E, Nov. 25, Left; flap. Discharged August North Carolina. 22, 63. 38th Ohio. 28, 03. 11, 1864. 80 flooA-*, .7. jR., Pt., K, 12th May 10, . Surg. Goodlett, C. S. A . 115 McQuinn, J.. It., K, 35th July 30, Right; double flap. A. A. Surg. Georgia. J ne5, 64. Recovery. Massachusetts, age 42. Aug. 20, E. Seyffarth. Discharged June 81 Hosington, G., Pt., E, June 13, Left. (June 14, amp. ankle joint.) 1864. 15, 1805. t ~Cd Ohio, age 36. 21 , 63. Necrosis. Sept. 17. re-amput n. 116 Mtinltard, P., Pt., D. May 2, Right. Surg. W. A. Robertson," Discharged May 1 6, 1665. Died 6th Louisiana. 5. f 63. P. A. C. S. Disch d Sept. 1, 64. December 16, 1866. 1 117 Merrill, J., Pt., B, 5th May 10, Right ; flap. Confed. surgeon. 82 l. ork, A., It., D, 8th July 2. Right. For exchange November W isconsin, age 35. 13, 64. Discharged June 17. 1865. Mississippi. 28, 63. 12, 1863. 118 Miller, W., It., A, 72d Sept. 17, Left: circular. A. A. Surgeon P. 83 Hunter, VV., Pt., I, 113th Sept. 18, Right ; circular. A. A. Surgeon Pennsylvania. 28, 62. Middleton. Necrosis. April 28, Ohio, age 54. Oct. 3, J. B. McPherson. Gangrene. 1864, amp. thigh. Discharged 1864. Feb. 27, 65, removed exfoliat n. September 3, 1864. Specs. "97, Discharged July 3, 1865. 2748, 4172. 84 Jaeger, C., Corp l, G, May 12, Left ; circular. A. A. Surg. D. L. 119 Mofflt, W., Pt., F, 1st Sept. 17, Left; circular. Surgeon B. Beust, 46th New York, age 27. 31, 64. Haight. Hieni. Sept. 30, bone Connecticut, age 20. Oct. 10, U. S. V. Discharged August 5, removed. 1 >Uch d Oct. 27, 1 864. 1862. 1803. 85 Jarvis, H. D., Lieut., A, June 5, Left; circ. Surg. S. A. Green, 120 Moore, O., Pt., I, 5th June 9, Left ; flap. Surg. P.F.Whitehrad, 24th Mass., age 19. 8, 02. 24th Mass. Disch d Sept. 9. J 803. Ohio. 13, 62. P. A. C. S. Disch d Feb. 1, 1803. Necrosed bone removed in 1800. 121 Morgan, C. F., Pt., B, 1st Aug. 19, Right ; circular. Discharged No 86 Johns, D. S., Pt., G, 23d Aug. 30, . Surg. Michel!, C. S. A. Massachusetts. 29 "62. vember 8, 1862. South Carolina. Gep.2, 62. Recovery. 122 Morgan, G., It., E, 97th Feb. 6, Left j lateral flap. A. A. Surgeon 87 Johnson, D. B., Pt., H, June 3, Right ; ant. posterior fliip. Dis New York, age 30. Mar. 2, B. B. Miles. Disch d Octolier 8th N. Y. H. A., age 21. 8, 64. charged August 2, 1865. 1865. 13, 1805. Spec. 1025. 88 Kendall, J., It., K, 2d Sept. 17, Left; ant. post. flap. A. A. Surg. 123 Morgan, J. M , Black June 16, Left. Surgeon J. II. Baxter. U. Delaware, age 21 . Oct. 6, J. Sweet. Necrosis. Discharged smith, H, 13th Penn July JO S. V. Disch d March 6, 1665. ; 1862. January 16, 1863. April, 1864, sylvania Cav., age 17. 1863. bone removed. Sprc. 2757. 124 Mori-ill, ,T. A.,Pt.,A,10th June 1, Left ; flap. Surg. E. Bentley, U. i 89 Keys. H., It., A, 18th Dec. 14, Right. A. A. Surgeon W. A. Vermont, age 19. 7, 64. S. V. Discharged January 2, Massachusetts, age 20. 19, 62. Harvey. Discharged June 10, 1805. Spec. 2548. 1863. Spec. !>80. 125 Morris, ^..Serg t.C, llth July 3, Left ; circular. Surg. S. R. Cham 90 King, A., Lieut., K, 62d June 27, Right. (June 28, amput n foot.) Mississippi, ngc 23. 7, 63. bers, P. A. C. S. Recovery. Pennsylvania, age 25. July , 1862. 1663, re-amput n. Discharged March 17, 03. Died July J2. 72. 126 Mueller, J.,Capt.,B. 17th Missouri. Nov. 27, Dec.1, 63. Left ; flap. Discharged Septem ber 14, 1864. 91 King, S. S., Serg t, I, May 22, Right; circular. A. A. Surge< n 127 Mulligan, .1., It., D, 89th Sept. 17, Left. Surg. I . H. Squire, 89th 190th Pennsylvania. June 17, M. F. Price. Discharged June Pennsylvania, age 32. 21, 62. N. Y. Disch d May 21, 1864. 1864. 29, J665. 128 Murphy, T., Pt., C, 15th July 21, Right ; flap. Surg. W. H. Gibbon, 92 Lamont, H., Pt., B, 8th Sept. 29, Right; flap. A. A. Surgeon E. Iowa, age 13. 28, 64. 15th Iowa. Discharged July ! Connecticut, age 40. : Oct. 27, K. Dcemev. Discliarged Octo 26, 1865. 1864. ber 28. 1865. ! 129 Myers, S. II., It., E, 75th June 20, Left ; circular. A. A. Surg. E. 93 Lane, L, Pt., A, 8th Sept. 17, Left; circular. Ass t Surgeon J. Indiana, ago 20. 30, 64. Stubbs. (June 21, excision of Michigan, age 24. Oct. 14, Oliver, 21st Mass. Dischargpd ankle ioint.) Disch d March 7, 1862. April 2, 1863. 1865. Died April 12, 1872. INTERMEDIARY AMPUTATIONS IN THE LEG. 533 No. NAMK, MILITAKY DESCKIl TION, AND AGK. DATES. ( H KUATIONis. Ol-Ki: ATO:;S, RKSUI.T. No. NAMK, MILITAUY DKSCIUPTION, ASI> AGK. DATEH. Ol KUATIONS, Oi KKATOKK, RKSULT. 130 Nase, A., Capt., K t L5th April 6, Right. Surgeon E. S. I enner, 166 Sherman. A., Pt.,D, 20th Oct. 20, Right: circular. Surg. N. Hay- Illinois. 24, "62. C. S. A. Resigned July 7, 1863. Massachusetts. Nov. 14, ward, 20th Mass. Discharged 131 Nash, C.. Serg t, A, 8~ d April 4, Right ; ant. post, skin Hap : circ. 1861. February 27, 1862. Col d Troops, age 21. 18, 65. sect. mus. Surg. F. E. Pianette. 167 Shirk, J.G., PL, F, 207th April 6, Right: circular. A. A. Surgeon 86th C. T. (April 4. exe. of yd Pennsylvania, age 26. 29, 65. F. 11. Getchell. Disch d Sep nieta. bone.) Disch d May 30, 65. tember 23. 1865. 132 Nason, C. I ., Pt., C, 1st May 19, Left ; ant. post, skin flap. Nov. 168 Simmon*, J. J., Lieut., Nov. 30, Right; circular. A. A. Surgeon Massachusetts Heavy 22, 64. 15. removed nee. bone. Disch d A, 6th Mississippi, age Dec. 26, R. McNeilly. To Provost Mar Artillery, age 25. June 30, 1865. Specs. 47.18, 341 1 . 24. 1864. shal March 7, 1865. 133 O Connor. J., l>t., I, llth Aug. 30, Right: circular. Disch d April 169 Sitgreares, J., Pt., C,8th April 6, Right. (Erysipelas.) Released Massachusetts, age 44. Se. 11/62. 29, 1863. Drowned Mar. 27, 70. Virginia, age 25. 12, 65. June 15, 1865. 134 Osgood. I., Pt., B, llth Dec. 13, Left ; circular ; necrosed. Jan. 2, 170 Smith, A. S.,Pt..D, 104th Nov. 25. Left : flap. Surg. R. F. Dyer, N. Hampshire, age ~3. 19, 62. 1863, re-amp. Discharged May Illinois. De.l2. 63. 104th HI. Disch d May 6, 1864. 3, 1864. Spec. 268. 171 Smith, R. R., Pt., E, 3d Aug. ^0, Left: Hap. A.Surg.T.A.AlcGraw, 135 Palmer, U., Pt., F, 45th Sept. 17, Left; flap. Surgeon H. S. Hewit, Ohio Cavalry, age 23. 24, 64. U. S. V. Disch d April 8, 1865. Pennsylvania. Oct. 2, U. S. V. Necrosis. Discharged 172 Smith, T.G.,Pt.,F, 107th Sept. 17, Right. Surg. S. N. Sherman, 34th 1862. March 6, 186;!. New York. 20, 62. N. Y. Disch d Dec. 6. 1862. 13fi Parker, G. L., Pt., I, 1st July :;, Left ; circular. Ass t Surgeon I . 173 Spearse, G. W., Pt., G, Sept. 19, . Surg. Roberts, C. S. A. Virginia, age 25. 7, 63. C. Yates. C. S. A. Erysipelas. 40th Mississippi. 29, 63. Recovery. Recovery. 174 Stabenfeldt, E., Pt., A, Sept. 17, Right ; flap. Ass t Surgeon J. B. 137 Parrott, J., Serg t, H, Nov. 30, Right; ant. posterior flap. A. A. 3d Wisconsin, age 30. Oct. 3, Brinton, U. S. A. Oct. 8, ligat n 28th Tennessee, age 34. Dec. 28. Surg. J. E. Patterson. To Pro 1862. ant. tibial. Disch d Mar. 6, 1863. 1864. vost" Marshal March 7, 1865. 175 Stamps, J. B.,Pt.,A, 12th July 9, Left ; circular. A. A. Surg. J. H. 138 Parsons, II., Pt., C, 9th July 20, Left; anterior posterior skin flap. Georgia, age 21. Aug. 6, Coover. Exchanged October West Virginia, age 23. Aug. 3, A. A. Surg. M. M. Townsend. 1H64. 17, 18U4. Spec. 3816. 1864. Discharged May 31, 1865. 176 Statem, E. S., Pt., B, 45th Sept. 19, Right. Surgeon Hill, C. S. A. 139 Pastorius.H., Pt.,E, 62d May 25, Right ; circular. A. A. Surg. M. Virginia, age 23. 23, 64. Exchanged November 24. 1864. Pennsylvania, age 25. 31, 64. F. Price. Disch d Jan. 18, 1865. 177 Stealey, J., Corp l, E, Sept. 19, Left ; flap. Discharged February 140 Paxton, J., Pt., K, 23d April 6, Right : circular. Released June 10th W. Va., age 22. 23, 64. 5. 1665. Virginia, age 33. 15, 65. 24, 1865. 178 Stewart, J. L., Pt., D, April 1, Left ; circular. A. A. Surg. W. E. 141 Payne, ()., Pt., D, 28th June 7, Right ; circular. A. A. Surg. A. 4<Jth N. C., age 30. 21, 65. Roberts. Released Aug. 2, 1865. Col d Troops, age 19. 27, 64. Transue. Necrosis. March 8, 179 Stewart, T. B., Pt,, G, June 2, Left ; circular. A. A. Surg. W. C. 1865, re-amp. Discharged Aug. 21st Massachusetts, age 24, 64. Mulford. Disch d Oct. 16, 1865. 1, 1865. Spec. 4740. 21. Nov., 1867, re-amp, upper third. 142 Pingel, ! ., Pt., C, 17th Mar. 16, Right ; circular. Discharged Sep 180) Stewart, T. B., Pt., C, 2d Sept. 19, Both ; right. Sept. 23d : left, 24th. Wisconsin, age 25. 19, 65. tember 1, 1865. 181) Connecticut H vy Ar 23, 64. Ass t Surgeon J. G. Thompson, 143 Pope, R., Pt., I, 5Jd X. July 2, Right. Paroled November 12, tillery, age 31. 77th N. Y. Oct. 2, haemorrhage. Carolina, age 20. 6, 63. 1863. Discharged August 7, 1865. 144 Powers, J. A., Pt., E, 63d Aug. 29, Left ; flap. Discharged January 182 Suite, J. M., Pt, E, 23d May 2, Left. Surgeon Lott, C. S. A. Pennsylvania. Sept. 3, 19, 1863. Died December 5, N. Carolina, age 20. 14, 63. Retired March 24, 1865. 1862. 1866 ; consumption. 183 1 S , L., Pt., , 22d May 3, Left; circular flap. Recovery. 145 Price, T., Pt., I, 43d N. Sept. 5, Left. To Provost Marshal April N. Carolina, age 21. 25, 63. Carolina, age 18. 19, 64. 1, 1865. 184 Terwilleger, T. R., Cor April 20, Right ; circular. Confed. surgeon. 14H Raborn, 1., Pt., F, 40th Dec. 1, Right. A. A. Surg. R. McNeilly. poral, D, 85th N. York, May 11, Partial anchylosis knee joint. Indiana, age 20. 13, 64. Discharged May 20, 1865. age 21. 1864. Discharged July 27, 1865. 147 Reagles, E., Pt., A, 36th Aug. 16, Left; circular. A. A. Surg. J. 1$. 185 Thayer, P. 0., Corp l, F, July 2, Right. Surgeon Meoms, 1 1th Wisconsin, age 30. Sept. 4, Roe. (Gangrene.) Discharged 8th Georgia, age 23. 5, 63. Georgia. Recovery. 1864. May 23, 1865. 186 Thompson, M., Pt., C, July 22, Left: double flap. A. A. Surg. E. 14H Reden, H., Pt., B, llth June 20, Left ; flap. Surg. J. D. Mitchell, 7th Indiana, age 25. Aug. 10, Seyffarth. (Hsemorrhage.) Dis New Hamp., age 30. 30, 64. 31 st Maine. Disch d Oct. 17, 65. 1864. charged September 20, 1864. Hi) Reeder, S. B., Serg t, U. Mar. 3, Left. Discharged August 26, 187 Tibbetts, J. G., Pt., M, June 3, Left; circular. Surg. W. Watson, S. Marines, age 21. 21, 65. 1865. 1st Maine Heavy Artil 9, 64. 105th Penn. Discharged Jan. 6, 150 Richard. J.. Pt., D, 5th July 4, Left. (July 4, exc. 4th and 5th lery, age 28. 1865. Died January 6, 1871. Connecticut, age 19. , 64. met) Aug. 12, re-amp. Disch d 188 Tibb ler, N. R., Lieut., K, Nov. 30, Left; anterior posterior skin flap. May 12, 1865. Died Feb. 24, 67. 6th Arkansas, age 26. Deo. 29, A. A. Surg. R. McNeilly. To 151 Richardson, G. O , Pt., Dec. 13, Left ; circular. Disch d March 1864. Provost Marshal Feb. 6, 1865. Iv, 13th New York. 16, 62. 10, 1863. 189 Toothe, I. H., Pt., B, 61st July 1, Left. Paroled September 25, 63. 152 Rklenour, W. M., Pt., B, June 15, Right ; circular. Discharged. Georgia, age 23. 4, 63. 14th W. Va., age 20. HO, 64. 190 Turner, S., Corp l, H, 21st July 2, Left; circular. Surg. Black, 153 Rideout, J. J., Pt., F, July 3, Right. Surg. Dailert, C. S. A. Virginia, age 20. 10, 63. C. S. A. Exch d March 3, 1864. 12th Virginia, age 21. 12, 63. Necrosis ; erysipelas. Exch d 191 Valentine, C. L., Pt., B, May 11, Right ; circular. Surgeon O. A. March 17, 1864. 5th Wisconsin, age 34. 15, 64. Judson, U. S. V. Discharged 154 Riebe, H., Pt., F, 68th July 1, Left. Discharged May 2] , 1864. September 12. 1865. New York, age 40. 4, 63. 192 Vermilyea, L., Pt., K, Mar. 31, Left : circular. Ass t Surgeon A. 155 Rix, G. S., Artificer, A, June 22, Right; circular. A. A. Surgeon 91st New York, age 21. April 11, Delany, U. S. V. Discharged 8th New York Heavy July 7, W. C. Mulford. Discharged 1865. June 21, 1865. Spec. 4054. Artillery. 1864. March 27, 1865. 193 Vick, T. W., Pt., C, 3d May 6, . Surg. Brown, C. S. A. 156 Robinson, E., Landsman, April 1, Lett. Ass t Surg. J. R. Tryon, Arkansas. 9, 64. Recovery. U. S. Steamer Rodolph, 4, 65. U. S. N. Discharged November 194 Wakefield, S. D., Pt., E, June 4, Left; ant. posterior flap. Surg. age 24. 24, 1865. Spec. 5662. 3d Maine, age 24. 7, 64. A. Garcelon, of Maine. Disch d 157 Rose, E. P., Pt., K, 6th July 1, Right ; circular. Ass t Surgeon March 6, 1865. Spec. 4474. Wisconsin, age 25. 6, 63. A. D. Andrew, 6th Wisconsin. 195 Waldon, E., Pt., E, 3d April 1, Right; circular. A. A. Surg. F. Discharged January 1 1, 1964. Delaware, age 25. 11, 65. Hall. Discharged October 6, 158 .Ross,,/., Pt., F, 2d South July 3, Left. Surgeon Barnes, C. S.A. 1865. Spec. 4055. Carolina. 20, 63. Recovery November 12, 1863. 196 Walsh, R., Pt., C, llth June 25, Right. A. A. Surg. C. H. Stowe. 159 Ross, W. W., Pt.. I, 9th June 21, Right: circular. Surgeon A. F. Massachusetts, age 20. J y 6, 62. Discharged June 10, 1863. New Hamp., age 21. 29, 64. Sheldon, U. S. V. Discharged 197 Wanzer, S. O., Pt., K, Sept. 20, Left; circular. Disch d March November 18, 1864. 36th Illinois, age 20. 23, 63. 16, 1864. 160 Savagt, J. W., Serg t, K, Sept. 30, Right. Retired March 20, 1865. 198 Warddle, J., Pt., G, 16th Aug. 29, Left. Discharged February 4, 13th Alabama, age 27. Oc.15, 64. Massachusetts. Sep.3, 62. 1863. 161 Scullen. M. 1 ., Pt., D, July :i. Kight : anterior posterior flap. 199 Warner, J., Pt., C, 3d May 3, Left ; flap. Ass t Surg. W. Tow 13th Vermont, age 21. 19, 63. Ass t Surgeon J. D. Johnson, Wisconsin, age 32. 15, 63. ers, 3d Wisconsin. Discharged U. S. V. Spec. 1 696. August 25, 1863. 162 Sears, O. H., Pt., K, 6th Sept 19, Left ; circular. A. A. Surg. T. J. 200 Weaver, H. Y., Corp l, July 2, Right ; circular skin flap. Surg. Vermont, age 24. Oct. 13, Dunott. (Amp. right great toe.) B, 155th Pennsylvania, 5, 63. J. A. E. Reed, 155th Penn. Re- 1H64. Oct. 13, haemorrhage: necrosis. age 19. amputation; ha?monhage. Dis Discharged October 28. 1865. charged July 21, 1865. 163 Selah, T.. Serg t. K, 96th May 3, Right: circular. Discharged Au 201 Welsheimer, E. W., Pt., Oct. 29, Left: anterior posterior flap. A. Pennsylvania. 6, 63. gust 7, 1863. G, 73d Ohio, age 19. Nov. 16, A. Surg. C. F. Havnes. Haemor 164 Sevael, A r . B., Turner s Jan. 8, Left ; circular. Ass t Surg. H. T. 1863. rhage. Disch d Dec. 30, 1864. Brigade, age 23. 14, 65. Leirler, U. S. V. To Provost 202 Welton. J. A., Lieut., E, April 30, Left. Confederate surgeon. Dis Marshal March 2. 1865. 51st Indiana. May4, 63. charged June 20. 1864. 165 Shappeard, S., Pt., D, May 26, Left; nnt. posterior flap. Ass t 203 Wheeler, W. W., Pt., E, Dec. 13, Left ; circular. Surg. E. Bentley, 14-, d New York, age 19. June 9, Surgeon W. Webster. U- S. A. 16th Maine, age 20. 22, 62. U. S. V. Discharged May 21, 1864. Discharged April 3, 1865. 1863. Spec. 597. SKMMES (A. J.), Surgical Notes of tht late War, in A t.w Orleans Medical and Surgical^ournal, 1866, Volume XIX, p. 534 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME. MILITAUV D ATFS OPERATIONS, OPERATORS, No. NAME, MILITARY DATES. OPERATIONS, OPERATORS, DESCRIPTION, AND AGE. RESULT. DESCRIPTION, AND AGE. RESULT. SM Wheel..ck, G. C., Pt., K. July 24, Right : circular. Surg G. L. Mil 237 Cummings, R. W., Pt., Dec. 13, . Died January 15, 1863; 7th Michigan, age 20. Aug. 6, ler, C. S. A. Discharged Aug. D, 28th X. J., age 21. 26, 62. pyaemia. 18(i4. 29. 1865. 238 Defnell, D., Pt., G, 10th July 2, . Died August 17, 1863 ; py- 205 White, J., Pt., D, 2cl Aug. 29, Right ; circular. Discharged Sep Georgia, age 21. 18, 03. icmia. Maryland, age 30. Sep.4, (i2. tember 29, 1863. 239 Dodge, L., Pt., D, 10th Sept. 22, Left ; circular. Surg. Z. E. Bliss, 206 Williams, J. C., Pt., F, Sept. 17, Left : flap. Discharged January Vermont, age 27. Oct. 12, U. S.V. Died October 29, 1864 ; 27th Indiana. Oct. 5, 62. 5, 1863. 1864. pyssmia. 207 Winters, Z., Pt., C, 129th July 10, Right; circular. Surgeon A. W. 240 Engleman, C., Ad.j t, 4th Mar. 30, Left ; circular. Surgeon D. W. Illinois, age 2IJ. 13, (i4. Reagan, 70th Indiana. Disch d Pennsylvania Cavalry, April 19, Bliss, U. S. V. Died May 12, July 29. 1865. asre 26. 1865. 1865; pyaemia. 208 Wood, D., Pt., A, 56th May 16, Right. Surg. W. X. King, 56th 241 Farnham, L., Pt., D, 5th June 3, Left; ant. posterior flap. Surg. Ohio. 19, 63. Ohio. Disch d August 1 J, 1863. New Hampshire, age 9, 64. E. Bentley, U. S. V. Died June 209 Woolbright, J. F., Pt., D, May 5, . Surgeon Fletcher, C. S. 37. 20, 1864 ; "gangrene. Orr s S. C. Rifles. 12, 64. A. Recovery. 242 Ford, J. E.. Pt., A, 33d Mar. 19, Left; flap. Ass t Surgeon W. 210 1 Wright, A., , H, 9th Sept. 19, Right. Surg. P. F. Eve, C. S. A. Ohio, age 29. April 8, Webster, U. S. A. Died May Kentucky. Oct. 1/63. Haemorrhage. Recovery. 1865. 13, 1865. 211 Wright, H. D.,Pt.,D, 5th Nov. 12, Left ; circular. A. A. Surg. W. P. 243 Frodine, J. W., Pt n G, Sept. 17, Left. Ass t Surg. C. Bacon, jr., Mich. Cavalry, age 21. 19, 64. Moon. Disch d June 24, 1865. 6th Wisconsin. Oct. 6, U.S.A. (Necrosis.) Haem. Died 212 2 Wright, J. B., Pt., H, Aug. 30, Right ; circular. Ass t Surg. C. A. 1862. Oct. 15, 1862; haem. Spec. 363. 16th Mass., age 30. Sept. 13, McCall, U. S. A. (Haem.) Nov. 244 4 Frost, G., Pt., B, 57th Jan. 3, Left; flap. Surg. J. Shrady, 2d 1862. 3. 1862. re-amputation. Disch d Ohio. 22, 63. Tenn. Died Jan. 28, 63; pyffitn. June 18, 1863. Spec. 136. 245 Gallagher. E.. Pt., F, June 3, Right. A. A. Surgeon A. Ansell. 213 Wright, W. H., Pt., E, Aug. 30, Right; necrosis. Jan. 16, 1864, 69th N. York, age 37. 17, 64. Died June 28, 1864; pyaemia. 30th New York, age 23. Sept. 7, re-amputat n. Discharged Sep Spec. 2572. 1862. tember 28, 1864. Died May 20, 246 Gaskins, W. H., Serg t, July 2, Right. Nov. 4, removed 6 ins. 1871 ; consumption. K, 8th Virginia, nge 20. Aug. 1, end of tibia. Died Nov. 5, 1863 ; 214 Yates, G., Pt., I, 4th N. May 5, Right ; flap. Surg. D. W. Bliss, 1863. diarrhoea. Spec. 1962. Jersey, age 25. 18, 64. U. S.V. Disch d March 16, 1865. 247 Gattan, T., Pt., C, 64th Dec. 31, Left. Ass t Surg. H. P. Ander 215 Zimmer, D., Corp l, E, Sept. 20, Right; circular. Discharged. Ohio. Jan. 4, son, 64th Ohio. Died January 2d Ohio. Oct.14,63. 1863. 8, 1863; gangrene. 216 s Acker, T., Pt., A, 155th May 28, Right ; ant. posterior skin flaps. 248 Gesner, H., Corp l, G, Oct. 19, Right. A. A. Surg. B. B. Miles. New York, age 40. June 13, Surgeon J. A. Liilell, U. S.V. 176th N. York, age 18. Nov. 7, Died Nov. 26, 1864 ; exhaustion. 1864. (Haemorrhage.) Died June 22, 1864. Spec. 3429. 1864 ; exhaustion. 249 Gilreath, L. P., Pt., B, July 2, Left; circular; necrosis of tibia. 217 Adams, W., Pt., D, 3d June 27, Left; circular. Ass t Surg. E. F. 2d S. Carolina, age 22. 20, V 63. Died October 2, 1863. New York Artillery, July 14, Hendrick, 15th Conn. Died July 250 Gravenstine, C., Pt., E, Aug. 2, Right; circular. Surgeon Z. E. age 24. 1864. 30, 1864; irritative fever. 95th Pennsylvania, age 29, 64. Bliss, U. S. V. Gangrenous. 218 Auliff, M., Corp l, G, 7th May 10, Right; ant. posterior flap. Surg. 24. Died August 31. 1864 : pyaemia. Wisconsin, age 20. 16, 64. E. Bentley, U. S.V. Gangrene. 251 Guntman, C., Pt., A, May 3, Left. Died June 7, 1863 ; typhoid Died June 16, 1864 ; pyaemia. 27th Pennsylvania. , 63. fever. Spec. 1548. 219 Barker, L. A., Pt., E, Dec. 16, Right; circular. A. A. Surg. R. 252 Hall, M. J., Pt., G, 2d Aug. 30, Right. Died September 16, 1862 ; 37th Georgia, age 43. 20, 64. L. McClure. (Gangrene.) Died New Hampshire. Sep.8, 62. tetanus. December 28, 1864. 253 Hannans, J., Pt., K, 97th May 20, Right; circular. A. A. Surgeon 220 Barker, M. H., Serg t, May 10, Left; anterior posterior flap. A. Pennsylvania, age 23. June 11, O. W. Peck. Died September C, 6th Vermont, age 20, 64. A. Surgeon O. P. Sweet. Died 1864. 20, 1864; diarrhoea. 2fi. May 24, 1864 ; pyaemia. 254 Harrington, II., Serg t, June 23, Left; circular. A. A. Surgeon 221 Belger, W., Pt., C, 1st May 12, Right ; circular. Surgeon N. R. B, 109th N. Y., age 26. July 20, A. Ansell. (Gangrene.) Died Massachusetts Heavy 23, 64. Moselev, U. S. V. Died June 1864. August 26, 1864. Spec. 3125. Artillery, age 30. 16, 1864 ; pyaemia. 255 Heagy, P.. Pt., C, 7th Dec. 13, Left ; flap. (Haemorrhage.) Dec. 222 Bliss, G. F., Corp l, D, May 23, Left ; circular. A. A. Surg. M. Pennsylvania Res. 24, 62. 27, hasm.; ligation. Jan. 1, li!, 30th Maine, age 21. 31, 64. F. Price. Died July 6, 1864; haemorrhage. Died January 30. asthma. 1863. Spec. 562. 223 Bellinger, B.,Pt.,C, 143d June 20, Right ; circular. A. A. Surg. M. 256 Hill, A., Pt., F, 18th Dec. lo, Right. January 25, haemorrhage, Pennsylvania, age 32. July 10, L. Baxter. Died July 15, 1864 ; Massaohusetts, age 27. 1862, 36 oz. Died January 29, 1863 ; 1864. exhaustion. Jan.4, 63. haemorrhage. 224 Brooks. J. P., Serg t, K, May 18, Left ; ant. posterior flap. Surg. 257 Hodgkinson, W., Corp l, Dec. 13, Left. Died January 27, 1863; 57th Mass., age 26. J une 5, C. Page, U. S. A. Died July A, 9th New York State 17, 62. pyaemia. 18(54. 14, 1864 ; typhoid fever. Militia, age 23. 225 Brown, A. A., Pt., D, 5th July 2, . Died July 14, 1863; teta 258 Hoffstickcr, W., Pt., B, Dec. 16. Right: circular. A. A. Surg. E. Florida. 13, 63. nus. 3d Mississippi, age 19. 1864, Woodruff. Carious ; gangrene. 226 Brown, J., Capt., H, 92d Sept. 19, Right. Sept. 28, hrem.; ligation Jan.2, 65. Died Jan. 11, 1865; exhaustion. Ohio. 27, 63. on face of stump. Died October 259 Holt, J.,Pt.,H, 6th Wis July 1, Left. Surg. S. P. Bonner, 47th 5, 1863 ; haemorrhage. consin. , 63. Ohio. Died July 16, 63; tetanus. 227 Burch, T. C., Pt., F, 83d May 8, Right ; ant. posterior flap. A. A. 260 Hudson, H. J., Pt., D, July 9, Right: circular. A. A. Surg. T. New York, age 43. 15, 64. Surg. A. P. Craft. Died June 12th Georgia Battery, 22, V>4. E. Mitchell. Died Jnly31, 1864; 9, 1864; exhaustion. age 24. chronic diarrhira. Spec. 3942. 228 Burns, J., Pt., C, 147th Nov. 25, Left. (Gangrene.) Died Decem 261 Hulle, II. R., Pt., A, 3d Dec. 5, Right. Died January 14, 1865; Pennsylvania. , 63. ber 3, 1863. Mississippi, age 24. 16, 64. amputation and diarrhoea. 229 C , L>., Pt., , . Feb. 15, Right ; circular. Died March 9, 262 Hyler, F. H.. Pt., B, 55th May 15, Left: circular. A. A. Surg. L. 26, 62. 1862; erysipelas. Ohio, age 20. June 6, Sinclair. Died June 8, 1864; 230 Cain, J. L., Pt., G, 1st June 18, Left: circular. Died August 5, 1864. exhaustion. Maine H. Art., age 23. 21, 64. 1864 ; pyaemia. 263 Iron. F., Pt., A, 76th April 1, Right ; ant. post, skin flap : circu 231 Campion. J. D., Pt., H, April 30, Right. Died May 13, 1864. Col d Troops, age 20. 26, 65. lar section muscles. Surg. F. E. 33d Iowa. M j-3,-64. Piqiiette. 86th C. T. (Gangrene; 232 Carthey, M. L., Pt., G, April 30, Left. Died May 28, 1864. diarrhoea.) Died May 11,1 865 ; 50th Indiana. May 25, hectic fever and acute diarrhoea. 1864. 264 Johl, W. H., Pt., D, 52d May 3, Left. Surg. C. S. Wood, 66th N.Y. 233 Childers, L. H., Corp l, June 3, Left ; circular. A. A. Snrg. G. New York. 17, 63. Died May 26, 1863. .Spec. 1173. G, 110th Ohio, age 26. 27, 64. W. Edwards. Died July 14, 265 s Johnson, M., Pt., G, 23d Jan. 11, Left. A. A. Surg. T. T. Smiley. 1864 ; exhaustion. Wisconsin. 31, 63. Died Feb. 5. 1863; exhaustion. 234 Clark, H., Pt., D, 8th Sept. 29, Left; circular. A. A. Surgeon T. 266 Jones, R. B., Pt,, B, 7th Oct. 9. Left ; circular. A. Surg. J. C. G. Col d Troops, age 33. Oct. 4, Hopkins. Died October 6, 1864 ; Illinois Cavalry. Nov. 11, Happersctt, U. R. A. Died Nov. 1864. tetanus. 1863. 15, 1863: congestive chill. 235 Cohatci, J., 2d Assistant June 4, Left : circular; sloughing. Died 267 Karnes. O. W., Pt., E, Oct. 19, Left; lateral flap A. A. Surgeon Engineer, age 24. 29, 64. July 26, 1864; pyiemia. 65th New York, age 35. Nov. 18, R. H. Stirling. Died November 23G Cowdrey, E. A., Capt., Mar. 31. liight ; anterior posterior flap. 1864. 20. 1864: pyaemia. A, 90th New York, age April 16, Surg. H. W. Ducaohet, U. S. V. 268 Keller. W., Pt., I, 1st Mar. 28, Right ; ant. pest. flap. A. A. Surg. 31. 1865. Died May 7, 1865; pyaemia. Cavalry, age :)9. April 12, J. H. Thompson. Died April 18, Spec. 4078. 1865. 1865; pyaemia and gangrene. EVE (P. F.), Cases of Secondary Hemorrhage, in If. S. Sanitary Commission Memoirs, 1870, .Surgical Volume I, pp. 210, 21 1; I COUE8 (E.), Report of Some Cases of Amputations, etc., in Medical and Surgical Reporter, 1862-63, Volume IX, p. 196. 3 LlDELL (J. A.), On the Wounds of Blood Vessels, etc.. in U. S. t-anitary Commission Memoirs, 1870, Surgical Volume I, p. 24. 4 SHRADT (J., jr.), Gunshot Wound Compound Comminuted Fracture of Left Metatarsus, etc., in Am. Jlle.d. Times, 1863, Volume VI, p. 113. 6 SM1LET (T. T.), Gunshot Wounds from Arkansas Post, in Boston Medical and Surgical Journal, 1863, Volume LX1X, p. 159. SECT. V.] INTERMEDIARY AMPUTATIONS IN THE LEG. 535 No NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. NO NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPKRATOIUS, RESULT. 269 Kelly, T., Corp l, D, 4th May5, Left ; antero-posterior flap. Surg. 303 Schulz, P., Pt., K, 4th May 3, Right. Surg. J. H. Baxter, T. S. Maine, ago 42. 15, 64. E. Bentley, U. S. V. Died May Artillery, age 28. 20, 63. V. Died May 31, 1863 : tetanus. 21, 1864; exhaustion. Spec. 113&. 270 King, T., Pt., , 4th May 31, Left; circular. A. A. Surg. H. B. 304 Scott. G.B., Corp l, K,8th June 9, Right. Died July 1, 1863: ery Michigan, age 22. June 11, Knowles. Died Oct. 24, 1864. N. Y. Cavalry, age 19. 20, 63. sipelas. Spec. 1347. 1864. 305 Shame, J., Pt., II, 90th Dec. 13, Right. A. A. Surg. D. Weisel. 271 Knowles, A. J., Corp l, June 18, Right ; circular. A. A. Surgeon Pennsylvania, age 29. 25, 62. Died January 12, 1863: pyaemia. M, 1st Maine Heavy July 10, M. L. Baxter. Died July 17, Spec. 479. Artillery, age 34. 1864. 1864; exhaustion. Spec. 2829. 306 Shlaffly, C., Pt., F, 1st Sept. 14, Left. Surg. H. S. Hewit, U. S. V. 272 Kurtz, F. E., Serg t, G, Aug. 25, Right; circ. Surg. /,. E. Bliss, Pennsylvania Rifles. Oct. 3, 62 Died October 17, 1862. Spec. 4:59. 159th N. York, age 22. 28, 64. U. S.V. Died April 28, 1865. 307 Shoemaker, I., Pt., H, Jan. 11, Left. (Jan. , amp. ankle joint.) 273 Lake, J., Pt., D, (ith N. May 19, Right ; ant. post, skin flap. Ass t 57th Ohio, age 33. 31, 63. Necrosis ; gangrene. March 8, York Heavy Artillery, June 18, Surgeon \V. Thomson, LI. S. A. re-amp, leg, middle third. Died age 40. 1864. Died July 11, 1864. Spec. 3565. March 19, 1863; gangrene. 274 Lance, S., Pt., I, 29th De.29, 62 Right. Died January 23, 1863. 308 Simmons, N. E., Pt., K, May 14, Right ; circular. Ass t Surg. C. Missouri. Jan. 19, Spec. 1031. 3d Tennessee, age 26. June 8, C. Byrne, U. S. A. Died June 1863. 1864. 16, 1864 ; pyaemia. 275 Linekin, J. F., Pt, K, May 5, Left ; ant. post. flap. Died June 309 Simpson, C. H., Pt., C, Oct. 29, Left. Ass t Surg. C. S. Frink, TJ. 20th Maine, age 17. 8, 64. 19, 1864; exh n and privation. 143d New York. Nov. 18, S. V. Died November 25, 1863 ; 276 Ling, C. B., Pt., B, 56th July 1, Right. Died July 18, 1863. 1863. pyaemia. Pennsylvania. 1C, 63. 310 Smith, H., Serg t, K, 2d Sept. 17, Left. Died October 15, 1862. 277 Long, T., Pt., H, 37th June 18, Left ; flap. Surg. T. R. Crosby, Infantry. Oct. 3, 62 Wisconsin, age 34. J y 2, 64 U. S. V. Died July 7, 1864; 311 Smith, II. S., Pt., F, llth May 12, Left ; ant. post. flap. Dr. Lewis. exhaustion. New Jersey, age 21. 21, 64. Philadelphia. Exfoliation. Died 278 McCawley, S. E., Pt., H, Oct. 19, Right ; circ. A. A. Surg. E. R. November 22, 1864 ; pyaemia. 28th Iowa, age 19. Nov. 7, Fell. (Necrosis); haemorrhage. 312 Smith, L., Pt., D, 12th May 12, Left ; circular. A. A. Surg. C. H. 1864. Nov. 11, ligation anterior tibial. Infantry, age 24. 21, 64. Osborn. Large bed-sores. Died Died Nov. 19, 64 ; haemorrhage. June 3, 64 ; pyaemia. Spec. 2739. 279 McCleary, A. P., Pt., B, July 2, Right. Died November 7, 1863. 313 Smith, P., Corp l, C, 3d Aug. 16, Left ; circular. A. A. Surg. C. F. 63d Perm., age 25. 8, 63. New Hampshire, age 22, 64. Bullen. (Amp. right leg.) Died 280 McClare, R. C., Pt., H, April 30, Right. Died May 22, 18C4. 19. August 30, 1864 ; exhaustion. 29th Iowa. May3, 64 314 Smith, T., Pt., G, 28th June 14, Left. Died June 29, 1863. 281 Me Oil ton, J. F., Pt., G, Nov. 30, Right; circular. A. A. Surgeon Connecticut. , 63. 6th Texas, age 18. Dec. 26, L. Sinclair. Died February 6, 315 Snyder, A. W., Corp l, Mar. 25, Right; circular. A. A. Surg. H. 1864. 1865. K, 183d Pennsylvania, April 5, E. Woodbtiry. Died April 24, 282 Minamom, J. G., Pt., May 18, Left ; double ant. posterior flap. age 20. 1865. 1865 ; pvasmia. L, 1st New York Artil 21, 64. Ass t Surg. G. A. Mursick, U. S. 316 Starwalt, M., Pt., K, 5th Oct. 19, Left ; circular. A. Surg. W. H. lery, age 23. V. Died June 8, 18ii4 ; pyaemic North Carolina, age 21. Nov. 1, Williams, 5th North Carolina. pneumonia. Spec. 2494. 1864. Died Nov. 10, 1864; pleuritis. 283 Mitchell, T., Pt., C, 36th Sept. 19, Left ; flap. A. A. Surgeon J. A. 317 Sterling, G., Pt., I, 20th Sept. 30, Left. Lenoir s method. Surg. R. Indiana. Oct. 7, Romayne. (Gangrene.) Died Maine, age 27. Oct. 11, B. Bontecou, U. S. V. Erysip 1863. October 15, 1863; pyaemia. 1864. elas; gangrene. Oct. 15, amp. 284 Mock, L., Pt., I, 119tb Nov. 7, Left ; flap. Surgeon D. \V. Bliss, thigh. Died October 20, 1864 ; Pennsylvania, age 22. Dec. 6, U. S. V. (Necrosis.) Died Doc. exhaustion. Spec. 3285. 1863. 21, 1863; pyaemia. Spec. 1903. 318 Steward. A. R., Pt., B, April 6, Left. Died April 25, 1862. 285 Morrison, S., Corp l, D, June 3, Left. Died July 26, 1864 ; py 34th Illinois. 20, 62. 81st New York, age 24. 27, 64. aemia. 319 Steward. R., Pt., I, 8th Dec. 13, Left. Died December 28, 1862. 286 MouUon, B., Ft., H, Gor Oct. 20, Right; flap. Surg. G. W. Hoge- Penn. Reserves. 27 62 don s Cavalry, age 28. 31, 64. boom, U. S. V. Gangrene. Died 320 Stoerzer, H., Pt., B, 22d July 1, Left. Died July 28, 1862. Nov. 6, 1864 ; typhoid fever. Massachusetts. 27, 62. 287 Murray, L., Pt., H, 1st May 27, Left; circular. Surg. R. B. Bon- 321 Stone, W., Pt., D, 2d June 1, Left : ant. post. flap. Ass t Surg. Maine Heavy Artillery, June 8, tecou, U. S. V. Died June 8, Connecticut H vy Ar 27, 64. W.Webster, U. S.A. Died July age 18. 1864. 1864 ; exhaustion. tillery, age 32. 24. 1864 ; pyaemia. 288 Nailan. P., Pt., II, 3d June 16, Right. Died July 27, 1862 ; diar 322 Thompson, J., Pt., A, April 9, Left ; flap (erysipelas). A. Surg. Rhode Island. , 62. rhoea. 14th N. York Cavalry, 24, 64. A. Hartaoff, U. S. A. Died May 289 Newburg, H.,Pt.,F, 24th Aug. 12, Left; circular. A. A. Surg. W. age 21. 5, 1864 ; pyaemia. Massachusetts, age 28. 24, 64. L. Welles. Died August 29, 323 Trumpleman, O., Lieut., July 3, Right (haemorrhage). Died July 1864 ; mortification of stump. C, 119th New York. 20. 03. 24, 1863. Spec. 1459. 290 Nivemeyer, J., Pt., G, April 30, Right. Died May 13, 1864. 324 Vangelder, L., Pt., D, May 25, Left ; circular. A. A. Surg. H. C. 33d Iowa. May4, 64. 107th N. York, age 21. June 24, May. (Necrosis.) Died July 291 Norton, M., Pt., I, 73d N. July 3, Left. Died August 1,1863. Spec. 1864. 29/1864; diarrhoea. Spec. 3496. York, age 23. 21/63. 1453. 325 VermiUirm, J. K., Pt., July 24, Left ; circular. A. A. Surg. A. R. 292 Owens, G. II., Pt., F, 6th Nov. 7, Right ; circular. Surgeon D. W. B, 1st Virginia Artil Aug. 5, Gray. (Neero.): pysemia. Died Maine, age 18. 11, 63. Bliss, U. S. V. Died January lery, age 20. 1864. August 20. 1864. Spec. 3808. * 31, 1864 ; variola. Spec. 1769. 326 Wagers, J.. Pt., B, 14th April 2, Left; circular. Died April 19, 293 Piles, W., Pt., A, 3d Vir Aug. 30, Right. Died October 21, 1862; South Carolina, age 17. 5, 65. 1865; pyaemia. ginia. Sept. 10, pyaemia. 327 Waters. D. J., Pt., F, May 11, Left ; circular. Surg. U. B. Bon 1862. 60th Ohio, age 21. 25, 64. tecou, U. S. V. Died June 25, 294 Pinager, J., Pt., H, 12th Dec. 15, Left ; ant. post. flap. Ass t Surg. 1864 ; pyaemia. Missouri Cavalry, age 25, 04 . W. B. Trull, U. S. V. (Gacg.; 328 Webber, G. A.. Pt., A, May 6, Left; circular. Ass t Surg. W. F. 24. tetanus.) Died December 27, 20th Maine, age 19. 29, 64. Norris, U. S. A. Died July 10, 1864 ; inflammation of lungs. 1864 : exhaustion and chronic 295 Poole, J. H., Lieut., I, June 27, Left; flap. Surg. J. E. Herbst, diarrhoea. Spec. 3534. 52d Ohio, age 33. July 17, U. S. V. (Gangrene.) Died 329 Wetzel, J., Pt., C, 165th May 27, Right. Died June 12, 1863. Spec. 1864. July 30, 1864 ; pyaemia. New York. J ne 8, 63. 130(5. 29(i Porsno, L., Pt., B, 14th May 6, Left ; circular. A. A. Surgeon T. 330 Wilson, H., Serg t, A, Sept. 2, Left ; flap. A. A. Surgeon D. II. New Jersey, age 23. 17, 64. Carroll. Died Sept. 24, 1864. 71st Ohio, age 26. 20, 64. Bell. (Gangrene.) Died Sept. 297 Porter, G. H., Pt., D, 3d May 5, Right ; circular. Ass t Surg. W. 24, 1864 ; exhaustion. Indiana Cavalry, age 17, " 64. Thomson, U. S. A. (May 5, 331 Wood, T-., Pt,, D, 5th April 6, Right; circular. A. A. Surg. C . 31. Syme sarnputat n.) Died June New Hampshire, age 18, 65. H. Pegg. Died April 26, 1865. 4, 1864 ; pyaemia. 15. Spec. 4098. 298 Redd, J. P. D., Serg t, E, Dec. 13, Left; circular. Died January 332 Woodward, H. B., Serg t, Aug. 16, Left ; circular. .A . A. Surg. G. P. 13th Virginia. 16, 62. 12, 1863. E, 125th New York, Sept. 10, Sar,cent. (Sloughing.) Sept. 299 Rclyea. H., Pt., I, 2d N. June 18, Left ; circular. A. A. Surg. W. H. age 22. 1864. 20. and Oct. 5, htemorrh. Died York Heavy Artillery, July 4, True. (Gangrene.) Died July December 7, 1 !?<>4 ; pneumonia. age 52. 1864. 10, 64 ; exhaustion. Spec. 2763. Specs. 3658. 3657. 300 Reynolds. P., Pt., K, 5th June 17, Left; circular. Surg. W.Watson, 333 U ormsley, L. W., Pt., K, July 2, Left ; necrosis. Dec. 29, amput n New Jersey, age 19. 20, 64. 105th Penn. Died July 30, 1864 ; 8th Florida, age 35. 6, 63. thigh. Died Dec. 30. 63: exh n. exhaustion. Spec. 4578. 334 Wright, M. F., Major, Dec. 20, Left. (Dec. 20. excision tarsus.) 301 Rickman, F., Pt., K, 55th July 8, Left ; antero-posterior flap. Died 29th Ohio, age 20. , 64. Died January 7. 1865. Massachusetts. 13, 64. July 28. 1864 : pyaemia. 335 York. M., Pt.. E, 120th July 2, Right. (July" 27, amp. left leg.) 302 RuthlPdge, J.W., Serg t, June 15, Right; circular. A. A. Surg. J. New York, age 20. 28, 63. A. A. Surg. F. Hinkle Died E, 97th Indiana, age 30. 30, 64. W. Digby. Died July 6, 18G4. Aug. 8, 1863. Specs. 1605, 1609. >LlDELL (J. A.), On Thrombosis and Embolism, in American Journal Medical Sciences, 1872, Volume LXIV, p. 354, and On the Secondary Trau matic Lesions of Bone, in U. S. Sanitary Commission Memoirs. 1870. Surgical Volume 1, p. 3;JO. 536 INJURIES OF THE LOWER EXTREMITIES [CHAP. X. Intermediary Amputations in the Leg, in which the Point of Operation is not specified. In forty-seven instances of intermediary amputation in the leg the precise point of ablation was not indicated. Fifteen operations were successful and thirty-two fatal; they were per formed on forty-six patients, in a fatal instance both legs having been removed. Twenty- nine were Union and seventeen Confederate soldiers. CASE 781. Corporal W. Dunlap, Co. E, Confederate Marine Corps, aged 32 years, was wounded during the naval engage ment with the Confederate Steamer Atlanta, June 17, 1863. He was captured and treated at various hospitals, lastly entering West s Buildings, Baltimore, on February 11, 1864. Surgeon T. H. Bache, U. S. V., in charge of the latter, described the injury as a " shot fracture of the right leg, produced by an iron splinter, for which amputation of the leg was performed on June 25th." Surgeon A. Chapel, U. S. V., reported that the patient recovered and was sent to Fort McHenry April 10, 1864. The Confederate hospital records show that the man was ultimately retired from service January 31, 1865. CASE 782. Private E. Field, Co. A, 6th Virginia, was wounded in the leg during an engagement on June 21, 1862. On the following day he was admitted to Confederate hospital Chimborazo No. 2, at Richmond, the records of which show the fol lowing description of the injury and its result: "There was a gunshot comminuted fracture of the tibia and fibula, implicating the ankle joint, the point of entrance being just above the external malleolus and that of exit three-fourths of an inch above the internal malleolus. When admitted the ankle joint was swollen and painful, but there was no swelling above the seat of the fracture, and no fever. On consultation it was decided to save the limb, which was laid on a pillow, cold-water dressings being applied and poultices used to promote suppuration. By June 26th there was high inflammatory fever, which abated on June 30th. The ankle joint was now greatly swollen and red and suppurating considerably; patient very much emaciated; appetite poor. Amputation of the leg was performed on July 2d, and on the night following haemorrhage took place from the stump. This was checked by elevating the stump and the application of cold water. The patient continued to decline, and died on the next day, July 3, 1862. An examination of the amputated leg revealed extensive injury to the soft parts in addition to the comminution of the bone. The tibia was split for three inches, and the ankle joint was filled with pus." TABLE LXXV. Summary of Forty-seven. Intermediary Amputations in the Leg, the Point of Ablation unspecified. [Recoveries, 115; Deaths, 16 47.] W). NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Ammons, S., Pt., G, 23d Aug. 30, Left. Surg. W. M. Michel, P. A. 24 Fingerle, J. A., Pt, H, April 30, Left. Died May 9, 1864. South Carolina. Sep.2, 62. C. S. Recovered 9th Wisconsin. Mav3. 64. o Branson, J. W.. Pt., G, Aug. 29, . Surg. Robertson, C. S. A. 25? Flemming, C., Pt, A. De c. 13, Both. Died December 21, 1862. 1st South Carolina. Sep.l, 6-J. Recov d. Disch d Oct. 10, 1862. 26) 35th New York. 18, 62. 3 Cox, J., Pt., K, 58th X. Nov. 25, Left. Transferred February 14, 27 Foster, S. C., Pt., G, April 30, Right , Died May 11, 1864. Carolina. 28, 63. 1864. 50th Indiana. Muy3, 64. 4 Dawson, W. L., Pt., G, April 6, Left. Discharged June 27, 1862. 28 Gardner, T., Pt., G, 10th July 28, Right. Surg. J. Spiegelhalter, 28th Tenn., age 30. , 62. Mississippi. , 64. 12th Mo. Died Aug. 11, 1864. 5 Dunlap, W., Corp l, E, June 17, Right. Retired from service Jan 29 Grion, 11. C., Serg t, G, April 30, Left. Died May 14, 1864. Cont ed. Marine Corps, 25, 63. uary 31, 18H5. 2!)th Iowa. May3, G4. age 32. 30 Hibbs, P. F. Lieut., D, Dec. 13, Right; gangrene. Died Decem G Gibson, J.K., Pt., E, 37th June 28, . Surg. Staunton, C. S. A. 71st Pennsylvania. 22 62. ber 30, 1862. 7 Virginia. Goodman, D, R., Pt., B, J y 3, 62. Aug 30, Recovered. . Surgs. W. J.Allen and J. E. 31 ; Hodgeboom, W. B., Pt., K, 5th N.ew York. A ug. 30, Sep.4, 62. . Ass t Surgeon B. Howard, U. S. A. Died May 10, 1863. 19th Virginia. Se.28, 62- Chancellor, C. S. A. Recovered. 32 Inman, J. T.. Serg t, K, Sept. 1, Right. Died October 1, 1864. 8 Hill, A. C., Pt., I), 28th Aug. 9, Right. Discharged January 14, 21st Ohio. 23, 64. New York. 13, U2. 1863. :!!! Lnughery. J. M., Pt., B, Aug. 30, Right. (Also wounds right thigh 9 Holt, J., Pt., 15. 37th Vir Aug. 9, . Union surgeon. Recovered. ulth Pennsylvania Re Sept. 4, and left leg.) Sept. 1, 4, hasm. ginia. 14, 62. serves, age 35. 1862. Died Sept. 8, 1862 ; haemorrhage. 10 Humphries, L. D., Pt., Aug. 7, . Surg. A. Atkinson, C. S. A. 34 Madden. R., Pt.. H, 29th April 30, . Died Aug. 16, 1864, while H, 31st Virginia. 1V64. Recovered. Iowa. May 26, u prisoner of war. 11 Lowre.y, S. B., Pt., E, 2d July 2, Left. Transferred to Provost Mar 1864. Georgia, age 39. , %. shal September 10, 1863. 35 Mandel, H., Pt, D, 27th April 30, Loft. Died May 13, 1864. 12 Uight, C., Pt., I, 48th April 1, Right ; ant. post skin flap and Wisconsin. May 3, 61 Colored Troops, age 23. 12, 65. ciro. section of muscles. Surg. 36 McCollum, A., Signal Mav 3, . Died May 14, 1863. F. E. Piquctte, 8(ith Colored Corps. 7, 63. Troops. Disch d July 22, 1865. 37 McDaniel, M., Pt., K, May 23, Left: sloughing; hasm. June 27, 13 Unknown. 26th Pennsyl Nov. 27, . Ass t Surg. J. T. Calhoun, 48th Virginia, age 51 . June !i. femoral arterv ligated. Died vania. , 63. U. S. A. Recovered. 1863. July 8. 1863. 14 Utt, L. II., Capt.. A, 7th April 24, Left; flap. Surg. W. R. Marsh. 38 Moselv, J. P., Serg t., P, April 30, Loft. Died May 11, 1864. Kansas Cav., age 22. 27, 63. 2d Iowa. Must, out Sept. 2!), 65. 13th Kansas. May5, G4. 15 Wood, C. E., .Musician, May 17, . St-.rg. R. F. Baldwin, P. A. 39 Newman, L. C., Lieut. May 3, Left. Surg. M. Clyinor, U. S. V. 5th Virginia. 25, 62. C. S. Recovered. Col., 31st New York. 17, "63. Tetanus; hoem. Died June 7, 63. 16 Anderson, J., Pt., G, 5th July , . Died July 11, 1863. 40 Richardson, J. H., Pt., June 20, Right. Died June 29, 1864. North Carolina. , 63. D, 5th Kentucky. 23, 64. 17 Baldwin, G-, Pt., F.fiGth Jan. 1, . Jan. 2fi, haemorrhage from 41 Schooling, J., Pt.. D, April 30, Loft Died June 4, 1864. Indiana, age 35. 11, 63. ant. tib, art. Died Jan. 15, 1863. 29th Iowa. May3, G4. 18 Cogin, .J., Pt., B, 20th April 7, Right; tubercles; diarrh. Died 42 Smith, J. A., Pt., C, 29th April 30, Left. 1 )iod May 5, 1865, while a Tennessee, age 29. 10, 62. April 25, 1862. Iowa. May3, G4. prisoner of war at Tyler, Texas. 19 Cookson, A., Pt., K, 32d May 12, Right. Died May 19, 1864. 43 Taylor, R. C., Pt., K, May 10, . Surg. C. B. Gibson, C. S.A. Maine. , 64. 19th Virginia. 13, 64. Died Mav 18. 1864. 20 Crawford, C. N., Pt., A, Sept. 17, Right. Died October 2, 1862. 44 Weber, A., Pt., I, 9th April 30, Left. Died May 7, 1864. 104th Pennsylvania. 20, 02. Wisconsin. May.3, 64. 21 Farley, J., Pt., F, 72d July 2, -. Died September 1, 1862. 45 Winn, M., Pt,, G, 14th Aug. 30, Left. Died October 1,1862; py New York. 5, 62. New York. Se.21, 62. aemia. 22 Fellows, H. H.. Pt., H, July 2, . Also wounds of face and 46 Wescott, O., Pt.,C, 121st Mav 3, Right. Died May 14, 1863. 12th New York. 5, 62. shoulder. Died July 6, 1862. New York. , 63. 23 Field, R., Pt., A, Cth June 21, ; haemorrhage. Died July 47 Youch, J., Pt., B, 28th April 6, Right. Died May 15, 1662, py Virginia. J y 2, 62. 3, 18G2. Illinois. 28, 62. aemia. 1 SWINBURNE (J.), Unnecessary Amputation of the Leg Tetanus Death, in Medical and Surgical Reporter, Philadelphia, 1863, Vol. X, p. 319. SECT. V.| SECONDARY AMPUTATIONS IN THE LEG. 537 In the case of Private M. McDaniel, Co. K, 48th Virginia (No. 37, TABLE LXXV), the left femoral artery was unsuccessfully ligated eighteen days after the amputation. SECONDARY AMPUTATIONS IN THE CONTINUITY OF THE LEG FOR SHOT INJURY. Of the amputations in the leg for shot injury, the secondary operations give the most favorable results. Of four hundred and forty-four cases, one hundred and seven teen were fatal, a mortality rate of 26.3 per cent., or 4.6 per cent, less than the fatality of the primary operations. One hundred and thirty-three operations were performed in the upper third, one hundred and seventy-four in the middle third, one hundred and twenty- one in the lower third of the leg, and in sixteen instances the reports failed to indicate the precise point of ablation. Secondary Amputations in the Upper Third of the Leg for Shot Injury. Of the one hundred and thirty-three cases of this group, thirty-seven, or 27.8 per cent., had fatal terminations. In sixty-two cases the right, in sixty-seven the left leg was removed; in four this point was not recorded. Example? of Recovery after Secondary Amputations in the Upper Third of the Leg for Shot Injury. The ninety-six successful operations were performed thirteen on Con federate and eighty-three on Union soldiers. Of the latter, eighty-one became pensioners; ten have died since the date of their discharge from the army. CASE 783. Private B. Fields, Co. C, 27th North Carolina, aged 21 years, was wounded in the right leg and taken prisoner at Autietam, September 17, 1862. He entered hospital No. 5, at Frederick, ten weeks afterwards, where Surgeon H. S. Hewit, U. S. V., recorded the following description of the injury: "A gunshot wound of the tibia and fibula by a minie ball; continuity of bone entirely destroyed ; leg very much swollen, offensive, and filled with pus. Flap amputation at the upper third of the leg was performed on November 28th by Acting Assistant Surgeon A. V. Cherbonnier. The stump was closed with three stitches and wet strips of muslin. Reaction was very satisfactory; patient cheerful. On the next day the dressing was removed and some adhesive strips were applied, the stump looking well but there being some pain, for which one grain of mor phia was administered. On November 30th the patient looked and felt well, having slept nearly all night ; appetite good ; wound suppurating well; stump dressed with lint and cold water and well supported with a roller. Secondary haemorrhage occurred on December 1st, when the popliteal artery was ligated by Surgeon Hewit. One week afterwards the ligature had not yet come away, but there was haemorrhage from the wound, the cause of which was not very obvious. The tourniquet was then applied to the femoral and the wound filled with charpie saturated with solution of persulphate of iron. By December llth the wound in the popliteal space was suppurating: stump healthy looking and dressed with wet strips of muslin ; patient pale in appearance, and ordered to take three grains of quinine and five grains of tartrate of iron and potassa every four hours. Early on the morning of December 15th another tolerably severe haemorrhage took place, the popliteal ligature not yet having come away; continued the tourni quet to the femoral and prescribed quinine and iron, cod-liver oil, and egg-nog. Two days later the tibia was found to protrude ; tourniquet still kept applied, though a little slackened. On December 18th there was another hemorrhage, the loss of blood being about six ounces, controlled by tightening the tourniquet. By December 20th reaction was slowly established, though the patient s face was still bloodless; appetite tolerably good ; treatment continued. An attack of diarrhoea had been promptly arrested by the administration of rhubarb powder, ipecacuanha, and opium. December 24th, patient rallying, though the stump still gives evidence of a low state of vital powers. Several days afterwards the stump looked healthier, and on Decem ber 20th, when the patient was transferred to hospital No. 1, he was in good spirits and good granulations were springing up." Assistant Surgeon R. F. Weir, U. S. A., in chaige of the latter hospital, recorded the subsequent progress of the case as follows: "The stump continued to look and suppurate well, the patient having but very little pain and his bowels remaining in good condition; appetite improving. For three days previous to January 26th he complained of great tenderness along the inner side of the thigh, where, on exam ination, fluctuation was detected, and where an incision was made which was followed by the evacuation of ten ounces of pus, the sinus extending under the deep muscles of the posterior and outer aspect. Injections of hydrochloric acid and laudanum diluted in water were then used, and by January 27th the ulcer of the stump had nearly cicatrized and the cavity of the abscess was rapidly filling up; patient improving in general health and able to sit up most of the time. About two weeks later the patient was in very good condition and going about on crutches, the stump cicatrizing rapidly and looking healthy. On February 28th the patient was discharged from hospital treatment, his general condition having improved very rapidly and the ulcer of the stump having healed." Several days afterwards the patient was paroled and sent south. The Confederate hospital records show that the man was admitted, on March 18th, to the General Hospital at Petersburg, and that he was permitted to leave for his home, on furlough, April 6, 1863. The greater portion of the amputated bones of the injured leg (Spec. 751), contributed to the Museum SURG. 11168 FIG. 309. Un- tibia and fibula. Spec. 751. 538 INJURIES OF THE LOWER EXTREMITIES. . X. FIG. 310. Stump of right leg thirteen months after antfro-posterior flap oper ation. Spec. 4373. by Dr. Cherbonnier, ar represented in the annexed wood-cut (FlG. 309), showing an ununited comminuted fracture of both bones in the lower part, followed by an effusion of a large amount of callus, fragments being attached to the fibula, while the tibia is carious within. CASE 784. Private B. F. French, Co. H, 7th New Hampshire, aged 21 years, was wounded in the right ankle during flie attack on Fort Wagner, July 18, 1863. On the following day he was admitted to hospital No. 9, at Beaufort, where secondary amputation was performed by Assistant Surgeon J. F. Weeds, U. S. A., who recorded " a musket ball wound of the right foot, followed, on September 19th, by amputation of the leg at the upper third, Lake s operation being employed." The patient was subsequently transferred to McDougall Hos pital at Fort Schuyler, and thence, on November 4th, to Lovell, at Portsmouth Grove. Surgeon L. A. Edwards, U. S. A., in charge of the latter hospital, reported that the slump was the result of an antero-posterior flap amputation, also that it had become unhealthy at the time of admission and showed a disposition to slough, for which bromine was applied. On March 3, 1864, the patient obtained a furlough, and subsequently he entered Central Park Hospital, New York City, where he was supplied with a "Hudson" artificial leg. Surgeon B. A. Clements, U. S. A., reported the following recapitulation and result of the case : "The injury was at the ankle, the missile passing from within outward and fracturing the bones entering into the composition of the joint. Not much haemorrhage took place. Water dressings were applied at first, and three days after the injury the ball was searched for but could not be found. Three weeks later the missile was removed, about which time erysipelas attacked the parts, extending up to the groin, but soon disappearing. The amputation was performed on account of extensive necrosis, the patient being under the influence of chloroform and ether. Sutures and adhesive strips were applied. The stump was very slow in healing, but at the time of the patient s admission to Central Park Hospital, June 21st, it was in good condition." The man was discharged from service at his own request, October 7, 1864, and pensioned. He was paid September 4, 1880. In his applications for commutation he continues to report the stump as being i:i good and healthy condition. A cast of the st.ump (Spec. 4373), made thirteen months after the date of the amputation and contributed by Acting Assistant Surgeon G. F. Shrady, is shown in the adjoining wood-cut (FlG. 310), and exhibits the cicatrix extending transversely across the face of the stump, which is well formed. CASE 785. Private H. Dimock, Co. K, 52d Pennsylvania, aged 20 years, was wounded in the left leg, fracturing the tibia, at Fair Oaks, May 31, 1862. One week after the reception of the injury the wounded man was conveyed to Philadelphia, where, after undergoing treatment at various hospitals, he was discharged from service April 21, 1863, Surgeon I. I. Hayes, U. S. V., in charge of Saterlee, certifying to "the wound rendering the limb of no use." Examining Surgeon C. Marr, of Honesdale, Pennsylvania, certified, September 25, 1863: "He received a gunshot wound through the leg below the knee, pro ducing a false joint." Several years later Drs. J. D. Lewis and J. M. Farrington, of Trumansburg, New York, testified that they examined the pensioner and found him suffering from the effects of the wound, also that they deemed amputation of said leg necessary, which was performed by the former on February 12, 1867, about five inches below the knee joint. They further certified that after the amputation they examined the wound carefully and found the tibia one and a half inches gone, a cartil aginous union having formed a false joint in its stead, and the fibula being partially dislocated at the knee joint in consequence of the whole weight of the body being thrown upon it in walking. Below the cartilaginous union in the tibia a number of pieces of lead were discovered in the substance of the bone below the periosteum, all of which rendered the leg useless and a source of irritation, causing a decline of his general health, etc. Dr. Farrington also stated that in addition to the condition described the tibia contained an oblique irregular fracture. About a year after the date of the amputation the pensioner was supplied with an artificial leg by the firm of B. F. Palmer, of Philadelphia, who described the operation as having been performed by "flap method." In his subsequent application for commutation the pensioner represented the condition of the stump as ; sound." He was paid December 4, 1879. CASE 786. Private G. C. Flanders, Co. E, 8th Ohio, aged 18 years, was wounded in the left leg, at Winchester, March 23, 1862. He was treated at several hospitals and lastly at Camp Dennison, where he was discharged for disability November 1, 1862. Surgeon B. Cloak, U. S. V., certified to "gunshot wound in the upper third of the tibia, producing compound comminuted fracture. At present the flexors of that extremity are very much contracted, rendering the leg nearly two inches shorter," etc. Some months after being dis charged the man re-entered the service and joined the llth Ohio Cavalry, in which organiza tion he served until May 26, 1865, when he was finally mustered out and pensioned. At the time of receiving his last discharge he was quite lame, the wound having broken out anew about two riionths previously and requiring surgical operations subsequently. Examining Surgeon J. W. Toward, of Augusta, Maine, in 1867, certified to the injury, and stated that "some of the bone lias been taken out and the ball remains in the leg. The wound frequently breaks out and is painful. He wears an apparatus attached to the boot and extending to the hip, relieving the leg of pressure by the weight being sustained by the hip and thigh. I think amputation will prove necessary," etc. Two years later Dr. J. C. IJeeve, of Dayton, Ohio, certified that during the six years following the reception of the wound the pensioner had seven operations performed on the leg without cure, and added: "On June 17, 1868, I amputated Flanders wounded limb, and subsequently I attended him for some weeks. Examination of the bones after the operation showed that the ball, apparently a mini6, had perforated the bone in an upward direction and remained embedded in the head of the tibia just below the line of the amputation." The ampu tated bones are represented in the wood-cuts (FlGS. 311, 312). The missile is battered, considerably flattened, and embedded FIG. 311. Por tions of left tibia and fibula anterior view. Spec. 5580. FIG. 312. Pos terior view of the same specimen. [Spec. 5580.] SECT. V.] SECONDARY AMPUTATIONS IN THE LEG. 539 in a projecting form in the posterior surface of the tibia. The specimens were contributed to the Museum by the operator. About nine months after the date of the amputation the pensioner was well enough to commence using a " Palmer " artificial leg. In the following year he described the stump as being in a "sound condition," but stated that the artificial limb did not prove satisfactory. He died on June 16, 1872. The immediate cause of his death has not been ascertained. CASE 787. Private F. Mullen, Co. E, 43d New York, aged 21 years, was wounded in the left leg, at Fredericksburg, May 3, 1863, and subsequently underwent secondary amputation. Surgeon J. A. Lidell, U. S. V., who performed the operation, 1 forwarded the following descriptive history : "The wound was caused by a minie" ball, which passed through and fractured the tibia in the lower third. The man was brought to Stanton Hospital, Washington, three days afterwards. His general condition was good, and it was judged expedient to attempt to save the limb without operation. It was accordingly placed in Hodgen s splint and cold-water dressings were applied; stimulants administered. After several days the parts suppurated freely, and by June 1st the wounds were discharging a good and healthy pus, consolidation taking place, and appetite and pulse being normal. The parts continued to heal nicely up to July 28th, when the patient fell and re-fractured the limb while attempting to walk across the Ward. On August 2d, several pieces of bone were removed. August ICth, parts oedematous ; discharge thin and fetid. On August 19th, several openings for the exit of pus were made, when a small necrosed splinter came away; pulse weak; general health suffering. The leg remained in about the same condition until September 1st, when compression by bandage was applied. About October 1st there was both general and local improvement, the discharge being of a thick and healthier character. The splints were now removed and stimulants continued. One month later necrosis of the shaft of the tibia had become extensive, the dead bone being completely encased in an involucrum; condition fair; discharges from several openings. But little change took place up to Decem ber 1st, and none for the better for one month afterwards. The involucrum was now large and the skin covering the front of it thin and about to ulcerate extensively; the foot being considerably twisted inward by abnormal muscular action (partial talipes varns) and the deformity steadily increasing ; ankle joint also becoming stiff. There being now no hopes of preserving a useful limb it was deemed advisable to remove it by amputation. The operation was performed on January 9th, at the junction of the upper and middle thirds, by the flap method (double flaps, the anterior one being short). The sawn end of the tibia was beveled off as recommended by Sanson, that is, by placing the saw obliquely not on the ridge, but on the internal surface of the bone. The fibula was divided somewhat higher up than the tibia, as practised by Roux. Throughout the operation the patient was kept insensible by sulphuric ether. He did not exhibit any perceptible shock. The flaps were carefully coaptated and secured at several points by interrupted sutures and strips of isinglass plaster. Several turns of a roller were placed around the leg to serve as a supporting bandage ; but no other dressing was applied. A full anodyne was administered after the operation and another at 12 P. M. On the following day the patient was sitting up in bed reading a newspaper, the stump being in fine condition, free from heat -and redness, and almost devoid of pain and swelling. On January 13th the sutures were removed and the stump was dressed for the first time and found to be uniting by primary adhesion. There was no constitutional dis turbance whatever. On January 24th the last ligature, that of the posterior tibial artery, came away. The patient had not at any time nor in any way suffered in consequence of the amputation, and the stump had united by first intention. In short, he recovered precisely in the same way as the most fortunate cases of amputation of the leg on account of disease get well." The amputated bones of the leg (Spec. 2022) were contributed to the Museum by the operator and are represented in the wood-cut (FlG. 313), showing the fractured tibia, with an abundant involucrum formed to nearly the point of section, and a large detached but imprisoned sequestrum being exhibited through the cloacae. A few points of osseous deposit are also seen on the fibula, which is uninjured. The patient entirely recovered, and was ultimately discharged September 5, 1864, and pensioned. In his application for commutation, dated 1870, he described the condition of the stump as being "in good order." He died March 5, 1871. The cause of his death has not been ascertained. Fatal Cases of Secondary Amputations in the Upper Third of the Leg for Shot Injury. The thirty-seven operations belonging to this group were performed seven on Confederate and thirty on Union soldiers. Pyaemia was noted in eight, gangrene in one, secondary hemorrhage in five, diarrhoea in three, and exhaustion in twelve instances as the immediate cause of death. CASE 788. Private S. E. Twitchell, Co. G, 89th New York, aged 25 years, was wounded in the left leg, at Antietam, September 17, 1862, and admitted to hospital at Chester two weeks afterwards. Surgeon J. L. LeConte, U. S. V., recorded the following history: "The injury was just above the ankle joint and was followed by limited necrosis of the tibia and forma tion of pus, which was evacuated by two incisions, one on the anterior aspect about six inches in length, and the other posteriorly about three inches long. For three weeks after the incisions were made the wound progressed favorably. It then commenced to slough, and this went on until the external wound measured six inches long and three inches wide. On February 15, 1863, amputation was performed by the flap method at the upper third by Acting Assistant Surgeon L. Fisher. Tonics, stimulants, perchloride of iron, quinine, whiskey, beef-tea, etc., were administered. The case progressed satisfactorily for a week after the operation, when signs of constitutional irritation showed themselves and the patient gradually became worse. On February 28th he had a rigor, lasting twenty-five minutes, and the case was diagnosed as one of pysemia. After this time the patient continued to sink until March 5, 1863, when he died. The post-mortem examination revealed nothing but pus in the knee joint." The amputated two lower thirds of the bones of the leg (Spec. 2067), contributed by the operator, show that the tibia was partially fractured in the lowest third, the injury being nearly repaired by callus, leaving, however, a sinus in the bone. 1 LlDELL (J. A.), On the Major Amputations for Injuries in both Civil and Military Practice, in Am. Jour. Aled. Sciences, 1864, Vol. XLVII, p. 376. FIG. 31 3. The lower t birds of the bones of the left leg, with in volucrum of the tibia. Spec. 2022. 540 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 314. Por tions of fractured tibia and fibula of left leg. Spec.748. CASE 789. Private H. Linn, Co. A, 6th Pennsylvania Reserves, aged 25 years, received a shot fracture of the left leg, at Antietam, September 17, 1862. Two weeks afterwards he was admitted to hospital No. 5, at Frederick, where Surgeon 1 1. S. Hewit, U. S. V., noted the following description and treatment of the injury: "A minid ball entered the lower part of the leg inside the gastrocnemius tendon, and emerged on the outer side of the leg near the crest of the tibia and six inches from the knee joint. On October 15th a fragment of lead was cut out from the outer part of the leg near the wound. Subsequently a sinus formed up the intermuscular space for four inches, for which incisions and poultices were applied, eight pieces of tibia being removed during the treatment. Towards the last week in November the patient was doing well. On December 3d a small portion of the fibula above the malleolus was excised. The bones were found considerably necrosed, and amputation, it was thought, would be necessary. On the next day the wound looked badly, the patient suffered a great deal, and amputation at the upper third was performed by flap method by Acting Assistant Surgeon A. V. Cherbonnier. In the following night the stump had to be re-opened in order to arrest hasmorrhage from some of the small vessels, persulphate of iron being used ; and when the bleeding ceased dry lint was applied. By December 17th the soft parts of the stump were much retracted, the ends of both bones exposed and necrosed, and there was an apparent effort at formation of an involucrum. Ten days later the granulations were healthy and the patient s condition had improved." On December 29th the man was transferred to hospital No. G, and subsequently to No. 1. Assistant Surgeon R. F. Weir, U. S. A., in charge of the latter, recorded the following result of the case: "Secondary amputation of the thigh was performed at the junction of the middle and lower thirds of the femur by Surgeon J. B. Lewis, U. S. V., on January 15, 1863. The patient progressed favorably until February 4th, when secondary hsemorrhage super vened, which was checked only by ligation of the femoral at the point of election. February 15th, patient about the same; pulse 135 and rather quick; tongue red and dry; sloughing condition of stump disappeared and healthy granulations commencing. Brandy administered every half hour; also beef-tea and cod-liver oil. After this the patient began to do well; appetite better; pulse much stronger; stump beginning to heal. On February 21st the ligature was removed from the femoral. On March 5th the patient was slightly etherized, and a piece of dead bone about one and a half inches in length was sawn off from the end of the femur; some small pieces were taken out with the forceps; patient doing well otherwise; stump dressed with adhesive strips and cold water. For about two weeks after this the patient still improved and felt quite comfortable; stump assuming a better appearance. At an exam ination on March 19th a sinus was discovered to be extending up on the posterior aspect to about the middle of the stump, and the bone was found to be dead when felt by the probe, with indications that the process of separation was going on; discharges copious, offensive, and of a dark color. Poultices were continued after syringing the parts with soda wash, and brandy, with generous diet, was ordered. By March 23d the patient s general health was quite poor and he had hut little appetite; stump not looking very healthy, there being considerable necrosed bone to come away; suppuration not as healthy as before. Two days later the patient was worse and weaker; tongue coated; teeth covered with sordes ; appetite poor; stump suppurating pretty freely and still having an offensive odor about it, hut integuments looking healthy. On March 28th the patient complained of soreness over the shoulder; general health about the same; stump looking rather better; appetite improving. On March 30th he was quite weak; tongue coated and dry; pulse 140; skin dry and getting more yellow; stump doing poorly; discharge unhealthy. Extensive necrosis of the femur was felt by the probe; wound syringed with acid and soda wash alternately and poultices applied. The next day the patient failed rapidly. At 1 P. M. he had a slight haemorrhage from the opening in the stump, losing about one and a half ounces of blood. No bleeding vessel could be found. Death occurred at 4 P. M. On examining the chest eleven hours after death ihe left lung was found thinly studded with tubercles; lower lobe of right lung thickly studded in upper and middle portion ; middle lobe a complete mass of tubercular matter and filled here and there with abscesses from the size of a chestnut to that of a pullet s egg; upper lobe in the same condition. Heart normal in size; liver somewhat enlarged and very fatty; spleen very much enlarged and highly congested; kidneys enlarged and fatty, and pelvis containing a large amount of phosphatic deposit on right side, also renal cal culi in upper portion of urethra. Specimen 3818 (FlG. 315), consisting of the stump of the femur, shows extensive necrosis from the seat of the operation to within an inch of the trochanter minor, the shaft on the outer &ide being thinly covered with an involucrum. On the posterior surface the involucrum is bare from the end of the bone to within three inches of the trochanter major, it having been broken down by ulcerative process, while on the anterior portion of the shaft the sequestrum is exposed at several points from the same cause. The neck of the bone was observed to be very short and its head quite large. Specimen 3983 (FlG. 31(i) com prises :i portion of the external iliac and femoral arteries, including the occluded portion of the latter, also part of the profundu and anastomotica magna, the end of which is covered with adipose tissue." The amputated portions of the bones of the leg (Spec. 748), contributed by Surgeon Hewit, are shown in wood-cut (FlG. 314), exhibiting the fibula with loss of substance of one inch in the lower third, and the adjacent portion of the tibin. which is superficially necrosed, while the superior portion of the fibula shows increased periosteal action. CASE 790. Private J. E. Eames, Co. F, 112th New York, aged 23 years, was wounded in the left leg, during the assault on Fort Fisher, January 15, 1865. He was conveyed to New York, and entered McDougull Hospital at Fort Schuyler ten FIG. 315. Stump of left femur. Spec. 3818. Flu. 316. Portions i.-f external iliac, fem oral, profundu. nml anastom imi j;.: femor al ligated. Sjjec. U08:(. SECT. V.] SECONDARY AMPUTATIONS IN THE LEG. 541 days after receiving the injury. Assistant Surgeon S. H. Orton, U. S. A., who amputated the wounded limb, made the follow ing report: "The wound was caused by a minis ball striking the outer aspect one and a half inches above the ankle, passing downward, inward, and a little backward, and emerging at the internal border of the tendo-achillis. At the time of the ampu tation, February 28th, the muscles were pale and flabby and there was not much retraction. The operation was performed by the circular method about three inches below the patella, the spine of the tibia being sawn off after severing the bones. Tlie soft parts were cut above the division of the popliteal, so that was the only artery requiring ligation. After severing the limb the incised edges of the integuments were brought together and held by a suitable number of sutures. Chloroform was used and the patient passed through the operation very well; in the evening his general appearance was better than it had been for a week. Water dressings were applied and oakum to catch the discharge. Stimulants, tonics, and a most nourishing diet were administered. On March 3d the ligature came away; stump looking healthy ; discharge free ; pulse 120. The integument over the upper part of what remained of the spine of the tibia ulcerated, exposing a small portion of the bone. The patient died of exhaustion March 17, 186.">. An examination of the amputated limb showed that the ball had passed through the base of the external malleolus and grazed the external border of the articulating surfaces of the tibia and astragalus, both of which were apparently necrosed. The whole ankle joint was filled with pus, as was also the articulation between the astragalus and scaphoid bone. The soft parts were cedematous and filled with sinuses running in every direction. The foot presented the anatomical curiosity though not bearing on the case of containing six toes, the supernumerary one being situated between the normal fourth and fifth. On dissection it was found that there were only five metatarsal bones, but the fifth was double the natural size in breadth and had two phalangeal articulations. The patient stated that both his father and grandfather were afflicted with the same deformity. His right foot was normal." CASE 791. Private H. Loud, Co. A, 183d Pennsylvania, aged 18 years, was wounded at the Wilder ness, May 8, 1864. Surgeon J. E. Pomfret, 7th New York Artillery, reported his admission to the field hospital of the 1st division, Second Corps, with wound of left ankle by a musket ball." Surgeon N. R. Moseley, U. S. V., who amputated the fractured limb, reported the following result of the case: "The wounded man was admitted on May 28th to Emory Hospital, Washington, where the soft parts became gangrenous and the bones of the ankle joint necrosed; tibia and fibula denuded of periosteum some three inches above the wound. Flap amputation of the leg at the junction of the upper and middle thirds was performed on August 23d, chloroform and ether constituting the anaesthetic. The after-treatment consisted of cold-water dressings, tonics, stimulants, and nourishing diet. Redundant granulations required the application of caustics about three weeks after the amputation. The patient s condition varied much after the operation, alternately recuperating and declining. He became weaker, yet, being young, hopes were entertained of his recovery until within a couple of weeks of his decease, when his appetite failed and he sank rapidly. Death occurred on October 14, 1864, from exhaustion and nervous irritability." The bones of the stump (Spec. 3318), exhibiting but little healthy action and showing sequestra which are about separating from each bone, were contributed to the Museum by the operator, and are represented in the adjoining wood-cut (FlG. 317). TABLE LXXVI. Summary of One Hundred and Thirty-three Secondary Amputations in the Upper Third of the Leg for Shot Injury. [Recoveries, 196; Deaths, 97133.] FIG. 317. Bones of stump of left leg seven weeks after ampnta- tion. Spec. 3318. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NASIK, MILITAHY DESCRIPTION, AND AGE. DATES. OPEUATIOXS, OPERATORS, RESULT. 1 Allbee, O. S., Pt., K, May 15, Left ; flap. Discharged March 11 Brown, L. K., Pt.. H, Au.29, 62, Left; flap. Surg. D. W. Bliss, 102d Illinois, age 18. J yl 7, 64. 29, 1865. Purnell Legion, Mary Jan. 8, G4. U. S. V. Discharged August 2 Andrews. S. B., Ft., F, May 10. Right : flap. A. A. Surg. \V. S. land Vols., age 19. 18, 1864. 72d New York, age 28. Sept. 27, Ward. (May 1 0, resection of 2i 12 Busby, T., Pt,, F, 19th N v30, 64, Left ; oval skin flap. Surg. B. B. 18G4. ins. of tibia; necrosis.) Disch d South Carolina, age 23. Feb. 20, Breed, U. S. V. Transferred to November 27, 1864. 1865. Provost Marshal May 6, 1865. 3 Atkinson, C. T., Serg t, Sept. 17, Right ; flap. A. Surg. J. S. Em 13 Chapin, II., Capt., D, Sept. 20. Right. A. A. Surg. C. C. Shoyer. G, llth Ohio, age 27. Oct. 21, erson, 9th N. Hampshire. Dis 27th Illinois. Nov. 27, Discharged September 20, 1864. 1862. charged January 16, 1863. Died 1863. December 3, 1870. 14 Chapman, H. E., Pt., A, Aug. 2!", Right. Surgeon C. Page, U. S. A. 4 Barraby, M., Pt., 1, 12th Nov. 1, Left ; circular. Ass t Surg. C. 6th Now Hampshire. Oct. 4, 62. Discharged March 8, 1863. Vermont, age 27. Dec. 20, Wagner, U. S. A. Discharged 15 Charlemaine, A., Pt., A, May 31, Right. Discharged March 6, 63. 18G2. May 17, 1863. 5jth New York. J y21, 62. 5 Bartram, A. E., Corp l, Sept. 2f), Left ; circular. A. A. Surg. T. S. 16 Connor. J. 0., Pt., C, July 22, Right. Surg. Cooper, C. S. A. I, 8th Connecticut, age Dec. 15, Bartram. (Haemorrhage.) Dis 27th Yirginia. Sep. -,"61. Recovered. 21. 1864. charged August 23, 1865. 17 Cook, J., Pt., H, 101st May 25, Right; oval flap. A. A. fV.rg. J. 6 Bates, E. G., Pt., A, June 14, Left: circular. Discharged April Illinois, age 19. Aug. 10, O Connor. Dischnr<.-vd January 12:!dOhin, age 19. Au.14, 63. 26, 1864. 1864. 24, 1865. 7 Becker, 11., Corp l, G, April 8, Right : ant. posterior flap. Surg. 18 Copas, W. II., Pt., B, Sept. 19, Right ; circular Surgeon Z. E. K!2dNe\v York, age 30. May 13, F. Bacon, U. S. V. Discharged 36th Ohio, age 28. Oct. 26, Bliss, U. S. Y. Haemorrhage. 1864. August 12, 1864. Spec. 4313. 1864. Oct. 27, ligation of post, tibial 8 Berry, YV. F., Corp ], G, .May 22, Loft; flap. Ass t Surgeon H. R. artery. Dis. h d June 5, 1865. 7tb Missouri. Oct. <!, Tilton, U. S. A. Discharged 19 Copeland, M., Pt., B, 2d Aug. 10, Right; circular skin flap. Surg. 1863. May 20, 1864. Colored Cavalry, age Oct. 24, F. E. Piquette, 86th C. Troops. 9 Brashear, K. H., Pt., H, July 2, Left. Surgeon R. Batty. C. S. A. 28. 1865. Discharged January 16, 1866. 3d Arkansas, age 20. Sept. 1, Transferred for exchange Nov. 20 Coyle, C. D., Pt., D, 83d June 27, Left; flap. Ass t Surg. R. Bar- 1863. 12, 1863. Pennsylvania. Aug. 1, tholow, U. S. A. Discharged 10 Brown, W., Pt., C, 15th Aug. 7, Right ; ant. posterior flap. Surg. 1862. May 3, 1863. Infantry, age 30. Oct. 18, B. B. Breed, U. S. V., and A. A . 21 Crawford, H. M., Corp l, April 8. Left: anterior posterior flap. A. 1864. Surg. R. McNeilly. Discharged K, 116th N. Y., age 28. May 16, A. Surg. H. Smilli. Discharged May 23, 1865. 1864. July 14, 1864. 542 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AXD AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 22 Crist, A., Pt., F, 70th April 2, Right ; flap. Surg. A. B. Hasson, 52 Leighton, B. D., Pt., I, June 4, Left, Dr. O. H. Bradley, of East New York. June 26, U. S. A. Discharged Septem 9th New Hampshire. July 29, Jaffrey, N. H. Discharged Feb 1862. ber 8, 1862. 1864. ruary 11 , 1865. 23 Daily, P., Ft., E, 48th Oct. , ; flap. Surgeon Holt, 16th 53 Lester, J. II., Pt., F, 1st June 27, Left; posterior flap. A. A. Surg. Mississippi, age 25. 20, 63. Miss. Recovered. New Jersey, age 20. 1862, R. A. Cleeman. Gangrene. Dis 24 Dawley, 1)., Pt., I, 9th June 2, Right ; circular. Discharged May Feb. 8, charged December 24, 1863. Indiana, age 22. J y 6, 64. 15, 1865. 1863. 25 Dimock, H., Pt., K, 52d May 31, Left ; flap. Dr. J. D. Lewis of 54 Logan, W. J., Pt., K, 91h Aug. 30, Left. Dr. J. Kirker, of Alleghe Pennsylvania, age 20. 1862, Truraansburg, N. Y. Disch d Penn. Reserves. Dec. 23, ny, Penn. 1869, popliteal aneur Feb. 12, April 21, 1863. 1869. ism ; dry gangrene. Recovered. 1867. 55 Loughlin, J., Pt., K, 67th July 2, Left ; flap. Surgeon S. D. Gross, 26 Corn, D. H., Pt., E, 1st June 12, Left; flap. Discharged May 15, New York, age 22. Sept. 16, U. S.V. (Erysipelas. July 26, Cavalry, age 23. Sept. 25, 1865. 1862. Pirogoff s amp. at ankle joint.) 1864. Disch d July -J9, 63. Spec. 214. 27 Eberhart, A. L., Pt., 1st Sept. 12, Left. Dr.W.L.Clemmer, Browns 56 MeCarty, C., Corp l, E, June 30, Rigbt. Ass t Surg. W. S. Forbes, W. Virginia Cavalry. 1862, ville, Penn. Recovered. 1st New York, age 28. Aug. 28, U. S.V. (Excision of 3 ins. of J el8, 63. 1862. tibia.) Discharged May 11, 1863. 28 Field, B., Pt., C, 27th Sept. 17, Right; flap. A. A. Surg. A. V. Died August 21, 1867. North Carolina, age 21. Nov. 28, Cherbonnier. Dec. 1, secondary 57 McLain, D. P., Pt., F, Sept. 17, Right; flap. Discharged May 1862. haem.; lig. of popliteal artery; 4th Cavalry, age 21. Dec. 22 26, 1865. recurrence. Exch d. Spec. 751. 1863. 29 Finnigan, P., Pt., F, June 2, Right; circular. Ass t Surg. W. 58 Macomber, G. W., Pt., July 2, Left; ant. posterior flap. (Gan 1st Confederate Bat ry. Aug. 20, F.Richardson, C. S. A. (June 1C, 126th New York, Sept. 10, grene.) Discli d May 3, 1864. 1864. 3, Chopart soperat n.) Recov d. age 20. 1863. Spec. 4303. 30 Fisher, J. P., Pt., A, 7th Aug. 16, Right. Surg. E. P. Smith. 7th 59 Masten, D., Pt., G, 4th Ap.15, 64, Left. Surg. G. R. Bibb, of Jack Missouri Cavalry. Sept. , Slissouri. Discharged February Illinois Cavalry. April , sonville, Illinois. (Discharged 1862. 6, 1863. 1866. September 17, 1864.) 31 Fisher, P. B.,Pt., 1, 113th June 22, Right ; circular. Ass t Surg. G. 60 Moran, S., Pt., G, 26th July 2, Right ; flap. A. A. Surgeon J. E. Ohio, age 27. July 28, W. Burke, 4(ith Penn. Disoh d North Carolina, age 24. Oct. 28, Steele. Nov. 8, profuse hemor 1864. June 26, 1865. 1863. rhage; flaps laid open; slough 32 Flanders, G. C., Pt., E, Mar. 23, Left; flap. Dr. J. C. Reeves, at ing. Trans, to Fort Delaware 8th Ohio, age 18. 1862, Dayton, Ohio. Recov d. Died April 19, 1864. J e 17, 68. June 16, 1872. Spec. 5580. 61 3 Mullen, F., Pt., E, 43d May 3, Left; double flap. Surg. J. A. 33 Flynn, M., Pt., A, 24th Aug. 30, Right. Ass t Surg. J. M. Palmer, New York, age 23. 1863, Lidell, U. S. V. Disch d Sept. 5, New York. Oct. 21, 85th N. Y. Discharged Septem Jan. <>, 1864. Spec. 2022. Died March 1862. ber 26, 1863. 1864. 5, 1871. 34 French, B. F., Pt., H, July 18, Right ; ant. posterior flap. Ass t 62 Newman, D. J., Pt., G, June 27, Left ; circular. A. A. Surg. J. C. 7th New Hampshire, Sept. 19, Surgeon J. F. Weeds. U. S. A. 24th Wisconsin, age 16. July 31, Thorp. (Gangrene.) Discli d age 21. 1863. Disch d Oct. 7, 1864. Spec. 4373. 1864. April 9, 1865. 35 Gilson, D., Corp l, G, 2d Sept. 17, Left; flap. Dr. N. J. Moore, of 63 Newton, J. W., Pt., E, July 3, Right ; circular. (July 16, amp. U. S. Sharpshooters. 1862, Nashua, N. H. Disch d March 14th Virginia, age 24. Aug. 10, foot, Pirogofr s opera.; slough Sept. 17, 2, 1863. 1863. ing.) Recovered. Transferred 1863. for exchange Nov. 12, 1 863. 36 Goldsmith, W.H., Corp l, June 9, Left ; circular. A. A. Surg. J. S. 64 Norris, E., Civilian, age April 16, Right ; circular. Ass t Surg. J. F, 2d New Hampshire, May] 5, Ross. (June 0, 1804, res. 4 ins. 20. June 2, E. Semple, U. S. A. Disch d age 24. 1865. tibia.) Disch d Oct. 14, 1865. 1864. July 17, 1864. 37 Grason, J. A., Pt., D, Aug. 28, Right ; flap. Dr. J. R. Ramsey, 65 Ougheltree, G., Serg t., June 27, Right. (Also fracture of skull.) 6th West Virginia. 1864, of Clarksburg, West Virginia. A, 12~th Infantry. July 28, Transferred to Veteran Reserve Au.8, 65. Recovered. 1862. Corps August 14, 1863. 38 Green, H. R., Pt., F, 8 1st De.31, C2. Left ; flap. Surg. F. Seymour, 66 Perigo, R., Pt., G, 66th Aug. 14, Left; flap. Discharged June 9, Indiana. Mar. 6, U. S. V. Discharged August Ohio, age 44. Se. L 0, 64. JS65. Died September 4, 1866. 1863. 1, 1863. 67 Perrin, F., Pt., H, 8th Nov. 30, Left : bi-latcral skin Hap and ciro, 39 Gurley, \V., Pt.,C, llth May 12, Right. Dr. H. J. Bigelow, at the Arkansas, age 25. 1864, section of muscles. A. A. Surg. Infantry, age 18. 1864, Mass. Gen l Hosp. (June 1, 64, Jan. 2, M. L. Herr. Trans, to Provost Feb. 18, amp. at ankle joint. Necrosis.) 1865. Marshal May 6, 1865. 1868. Disch d Feb. 7, 65. Spec. 2421. 68 Phillips, J. L., Serg t, C, Sept, 17, Right ; flap. Discharged March 40 Ilaire, 1!. 11., Corp l, E, July 2, Left ; circular. Surgeon G. L. 104th New York. Oc.18, 62. 23, 1863. 31st Illinois, age 32. Aug. 10, Lucas, 47th 111. (Gangrene.) 69 Pierce, O. H., Pt., H, June 30, . Surgeon W. A. Carrington, 1864. Discharged June 22, 1865. 38th North Carolina. Au. , 62. C. S. A. Recovered. 41 Hale, H., Pt., E, 84th May 12, Left. Dr. G. L. Potter, of Julian 70 Powell, T., Pt., F, 6th Jan. 15, Left ; circular. Ass t Surg. S. H. Pennsylvania, age 20. 1864, Furnace, Penn. Disch d April Colored Troops, age 30. April 26, Orton, U. S. A. (Jan. 15, exo. Jan.8, 69. 27, 1865. 1865. 3ins. tibia.) Disch d Oct. 14, 65. 42 Harback, 31., Pt., D, 5th May 27, Right; circular. Ass t Surg. T. 71 Pyne, C. M., Lieut., I, Aug. 30, Left; bi-lateral flap. Dr. W. II. Kentucky, age 21. Sept. 6, A. McGraw, U. S. V. Disch d 6th Infantry. 1862, Van JSuren of New York. Re 1864. June 9, 1865. M y4, 64. tired December 15, 1870. 43 Hatch, D. A., Pt., C, 2d July 3, Right ; ant. posterior flap. Surg. 72 Redding, J., Pt., K, 42d Sept. 20, Left ; circular flap. Surg. J. Y. Massachusetts, age 23. Dec. 16, C. W. Jones, U. S. V. Disch d Illinois, age 28. 1863, Finloy, 2d Kentucky Cavalry. 1863. April 2, 1864. Spec . 2155. Jan. 17, Discharged Sept. 29, 1864. 44 Hitchcock, J. N., Pt., F, Hay 15, Left ; flap. A. A. Surg. A. Trau. 1864. 34th Massachusetts. Sep.5, 64. Discharged April 19, 1865. 73 Renold, C. D., Pt., D, No.25, 63, Left ; circ, flap. Ass t Surg. B. E. 45 Hubbard, J. A., Corp l, Sept. 5, Right ; flap. Discharged Decem 37th Ohio, age 22. Feb. 26, Fryer, U. S. A. Disch d Aug. A, 115th New York. Oct. 9, 62. ber 30, 1862. 1864. 24,1864. Died August 17, 1870. 46 Hyatt, D., Pt., C, 4th June 18, Left ; flap. A. A. Surg. A. Trau. 74 Rhodes, J. H., Pt,, A, No.25, 63, Left ; flap. Ass t Surgeon A. G. Delaware, age 52. Nov. 18, (Erysipelas.) Discharged June 33d Ohio, age 30. Jan. 13, Albright, 79th Penn. Disch d 1864. 3, 1865. 1864. July 15, 1864. 47 Jenni, P., Serg t, C, Jef Sept. 11, Right. (Also flesh w nd of chest ; 75 Ross, C., Lieut., E, 26th July 2, Left. Discharged June 18, 1864. ferson Co. State Militia, Oct. 18, hsem. from anterior tib. artery.) Pennsylvania, age 41. , 63. Died November 30, 1866. age 23. 1862. Discharged January 19, 1863. 76 Runyan, C,A., Musician, May 3, Left. Dr. L. Briggs of Auburn, 48 Kellerman, 31., Pt., D, May 2, Left, Surg. D. W. Bliss, U. S. V. F, 9th N. Y. Heavy Oct. 17, N. Y. ( May 3, excision of tibia.) 75th Penn., age 48. June 18, (Haemorrhage.) Disch d June Artillery, age 19. 1863. Discharged July 26, 1865. 1863. 15, 1864. Spec. 1273. 77 Sampson, T., Pt.,H, 46th Sept. 8, Left ; flap. Ass t Surg. J. II. Ben* 49 2 Kelly, J.F., Pt.,A,26th July 28, Right. Ass t Surg. A.H.Powell, Colored Troops. Oct. 11, nett, 46th Colored Troops. Dis Alabama, age 25. Oc.18, 64. P.A.C.S. (Gangrene.) Recov d. 1864. charged March 9, 1 865. 50 Keyes, C. W., Lieut., E, May 12, Left; flap. Dr. P. Dyer, of Maine. 78 Schmidt, C., Corp l, K, May 6, Right (May 23, 1864, lig. of ant. 32d Maine, age 33. June 12, (June 8, amp. foot.) Disch d 39th New York, age 36. 1864, tibial art v) ; ant. posterior flap. 1864. September 27, 1864. Feb. 18, Surgeon S. B. Ward, U. S. V. 51 Lay, R., Serg t, E, 1st Dec. 18, Left; flap. Dr. C. P. West, at 1865. Re-amputation April 18, 1865. Kentucky Light Artil 1864, Louisville, Kentucky. Disch d Discharged July 14, 1865. lery. Feb. 13, August 28, 1865. 79 Shinn, W. J., Serg t, I, J e 18, 64, Right ; flap. Surg. D. W. Maull, 1866. 5th New Jersey, age 25. Ja.18, 65. 1st Delaware. Discharged. 1 SMITH (STEPHEN), Analysis of Four Hundred and Thirty-nine Recorded Amputations in the Continuity of the Lower Extremity, in United States Sanitary Commission Memoirs, Surgical Volume II, New York, 1871, p. 140. s JONES (J.), Investigations upon the Nature, Causes, and Treatment of Hospital Gangrene as it prevailed in the Confederate Armies, 1861-1865, in United States Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, p. 292. * LIUKLL (J. A.), On the Major Amputation for Injuries in both Cieil and Military Practice, in Am. Jour. Med. Sci s, 1864, Vol. XLV1I, N. S., p. 376. SECT. V.] SECONDARY AMPUTATIONS IN THE LEG. 543 No NAME, MILITARY DESCRIPTION, AXL> A(;E. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION:, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 80 Smith, A. A., Pt., A, 3d April 8, Right; circular. A. A. Snrg. J. 108 Heddon, N., Corp l, F, Aug. 13, Left ; ant. post. flap. A. A. Surg. Rhode Jsland Artillery. July 10, W. Gushing. (April 9, flap am 150th New York, age Sept. 17, J. C. Thorpe. (Gangrene ; diar 1863. putation left leg.) Discharged 45. 1864. rhoea.) Died September 22, 64 ; August 25, 1864. Spec. 1 103. haemorrhage. 81 Smith, H., Pt., H, :i2d Feb. 10, Left; circ. Stirg. A. II. Thurs- 109 Jackson, ir., Pt., K, 2d May 5, Left. Teale s method. A. Surg. Colored Troops, age 37. Mar. 29, ton, U. S. V. Discharged July Florida. June 28, J. S. Billings, U. S. A. (Krvsip- 1865. 26, 1865. 1862. elas.) Died July 6, 62. Spec.!. 82 Synead, A. J., Pt., Court Au. 9, 62, Right. Surg. T. II. Howard, C. 110 Jones, M. M.,Pt.,D, 19th May 5, Left ; circular. A. A. Surg. F. C. ney s Artillery. Aug. 9, S. A. Recovered. Furloughed Michigan, age 25. July 9, Leber. Died July 20, 1864; 1863. November 26, 1864. 1804. pyaemia. 83 Spencer. C., Pt., A, 1st De.13, 62, Right; flap. Recovered. Died 111 Keal, J., Pt., H, 118th May 14, Left; haemorrhage. 12 ounces. K. Island Light Artil Dec. 28, in 1871. Ohio, age 21. June 27, Died Aug. 20, 1804 ; exhaustion. lery, age 32. it-69. 1864. 84 Spicer, J., Pt., K, 14th Mar. 9, Right. Surg. J. M. Daniel, 47th 112 Kingsbury, A., Pt., D, June 26, Right. A. A. Surg. S. D. Gross. K y Cavalry, age 3. June 30, Kentucky. Discharged March 22d Massachusetts, age Aug. 1, (Aug. 12, haemorrhage ) Died 1863. 24, 1864. 18. 1862. August 31, 1862; enteritis. 85 Spivey, L. J., Serg t, F, May 10. Right ; posterior flap. Surg. 113 Levisee, L, Pt., E, 18th April 6, . Died May 10, 1862; py 51st X. Carolina, nge June 17, Sutton, P. A. C. S. Retired Wisconsin. May 9, aemia. 29. 1864. December 19, 1864. 1862. 86 Steinbeck, A., Pt., A, Aug. 16, Right. Dr. J. A. McArthur, Sol 114 Linn, II., Pt., A, 6th Sept. 17, Left; flap. A. A. Surgeon A. V. 5!>th New York, age 23. 186-1, diers Home, Philadelphia. (Dis Penn. Reserves, age 25. Dec. 4, Cherbonnier. (Excision); harm. April 12, charged July 20, 1865.) Recov 1862. Jan. 15, 1863, amp. thigh : nee.; 1866. ered. Died May 6, 18G8. lig. of fern.: haem. Died March 87 Struble, C. W., Corp l, July 3, Left; flap. Surgeon H. Pulmer, 31 , 1863. Specs. 3818, 3983, 748. F, 3d Infantry, age 23. Aug. 5, U. S.V. Discharged December 115 Loud, H., Pt., A, 183d May 8, Left; flap. Surg. N. R. Moseley, 1663. 8, 1863. Pennsylvania, age 18. Aug. 23, U. S. V. (Necrosis.) Died Oct. 88 Sullivan, A. W., Pt., F, Sept. 25, Left ; lateral flap. Surg. L. Slus- 1864. 15, 1864 ; exhaust n. Spec. 3318. 69th Ohio, age 20. Nov. 26, ser, 69th Ohio. March 3, 1864, 116 Lovell, P., Corp l, C, Nov. 25, Left; circular. Ass t Surg. R. 1803. spiculse removed. Furloughed 10th Missouri, age 41. 1863, Bartholow, U. S. A. (Primary March 12, 1804. Jan. 10, excis.; haem.) Jan. 15, slough 89 Swallow, II. R., Serg t, May 18, Left; flap. Dr. W. G. Breck, 1864. ing; erysipelas; haem. Feb. 2, G, 31st Massachusetts. 1804, Springfield, Mass. Recovered. amputation thigh. Died Feb Dec.3, 68. ruary 3, 1864. Spec. 2108. 90 Thompson, II., Pt., K, May 3, Left ; circ. A. A. Surg. J. B. Cut 117 l Mabry, S. D., Pt., G, 6th Sept. 17, Right. Teale s method. (Gang.) Oth Maine, age 24. Sept. , ter. (June 9, diseased bones of Alabama, age 22. 1862, Erysipelas ; diarr. Died March 1863. foot rem d.) Discharged May Mar. 16, 22, 63 ; exhaustion. Spec. 3891 . 14, 1864. Spec. 4316. 1863. 91 Vogel, P., Pt., I, 6th In June 27, Right. Act. Surgeon G. H. Mar- 118 Marlett, G., Pt.. M, 1st June 5, Left ; circular. A. A. Surg. A. D. fantry, age 25. 1802, mion, Soldiers Home, Hampton. Michigan Cavalry, age July 19, Hall. (Hasmorrh.) Died July June 27, (Also w nds of groin and skull. 19. 1864. 19, 1864; exhaustion. 1879. Necrosed. Rem. of fragments 119 Merrill, J. A., Pt., G, Nov. 30, Right. Died January 31, 1865; opening in occipital bone. Dis 51st Tennessee. 1864, exhaustion. charged Aug. 21, 1863.) Specs. Jan. , 429, 6941. 1865. 92 Wheeler, C. D., Corp l, Feb. 10, Left; circ. Surg. A. H. Thurs- 120 Moore, J., Pt., E, 8th Dec. 13, Left ; flaps of skin and circ. sect, 15, 32d Col d Troops, Mar. 16, ton, U. S. V. Discharged Aug. Penn. Reserves, age 20. 24, 02. of muscles. Ass t Surg. G. M. age 21. 1865. 17, 1865. Died Jan. 22, 1870. McGill,U. S.A. (Haemorrhage; 93 Wood,C.J.,Pt., II, 149th "May 3, Right. Surg. D.W. Bliss.U. S.V. diarrhoea.) Died Jan. 19, 1863 : New York, age 44. Aug. 1, 1863. Discharged November 16, 1863. 121 O Connor, J., Serg t, C, May 3, pyaemia. Spec. 4577. Left. (Necrosis.) Died June 23, 94 Woomer, E. M., Corp l, May 5, Left ; flap. A. A. Surg. E. Harts- llth Massachusetts. June 16, 1863. Spec. 1237. A, -93d Penn., age 21. July 21, home. Discharged September 1863. 1864. 9, 1865. Spec. 3678. 122 Patten, W. F., Pt., C, NOT. 30, Right ; ant. posterior flap. Ass t 95 Worrell, B. F., Pt., A, April 14, Left. A. A. Surg. O. F. Scheldt. 9th Mississippi, age 24. 1864, Surgeon J. C. Thorpe, U. S. V. 1st New Jersey. Nov. , Discharged January 5, 1863. Mar. 19, (Gangrene; necrosis.) Haem., 1862. 1865. 12 oz. March 24, amp. thigh. 9C Wurth, L., Pt., C, 41st Aug. 30, Left; double flap. A. A. Surg. Died April 20, 1865; pyaemia. New York, age 27. Dec. 1, T. O. Bannister. Discharged 123 Pierson, J. C., Pt., D, July 28, Right ; circular. A. A. Surg. E. 1862. September 14, 1803. 19th Infantry, age 16. Sept. 7, M. Johnston. Died September 97 Brown, A. C., Serg t, G, Aug. 15, Right; flap. Surg. N. R. Moseley, 1864. 25, 1864; pyaemia. 13th Penn. Cavalry, Oct. 20, U. S. V. Died October 29, 1804 ; 124 Porter, W. C., Serg t, F, Right. Died October 10, 1862. age 36. 1864. exhaustion. Spec. 3316. 66th Ohio. 1862. Spc. 553. 98 Cates, .1. J., Pt., I, 4th Sept. 20, Left. Died May 18, 1864. 125 2 Rudolph, J., Pt., E,4th June 3. Left ; ant. post. flap. Surg. J. A. Kentucky, age 22. 1863, Michigan, age 24. Aug. 27, Lidell, U. S. V. (Haemorrhage.) MayG, 64. 1864. Died Sept. 16, 1864 ; exhaust n. 99 Christiana, G., Pt., A, Jiilv 2, Right. Sept. 2, haem.; amputat n 126 Sands, P. E., Serg t, B, May 10, Right ; circular. Surg. O. A. Jud- 120th New York, age Aug. 10, thigh. Died September 25, 63 ; 1st Sharpshooters, nge Oct. 19, son, U. S.V. (Hsemorrh.) Died 36. 1803. exhaustion. 31. 1864. Nov. 4, 1864 ; exhaustion. lOt Conrad, A., Pt., H, 26th May 15, Right ; circular. A. A. Surg. N. 127 Slusser, C. C., Pt., H, May 2, . (June 15, haemorrhage.) Wisconsin, age 22. Aug 3, R. Morris. (Gangrene.) Died 107th Ohio, age 21. June 15, Died June 29, 1863. 1864. August 25, 1864; diarrhoea. 1863. 101 Copeland, A. M., Lieut., Sept. 30, Right. Surg. Z. E. Bliss, U. S. V. 128 Stevens, W. E., Pt., E, July 2, Right. Died September 4, 1863. C, 81st New York, age Nov. 10, (Haemorrhage: ligation.) Died 5th Texas, age 18. Aug. 3, 25. 1864. January 4, 1865. 1863. 102 Craudall, S , Pt., G, 17th July 31, Left ; circular. Surg. A. F. Shel 129 Tanner, N. A., Pt., 1, 2d July 16, Right. (Hasmorrh.; gangrene.) Michigan, age 18. Sept. 1, don, U. S. V. Died September Michigan. Sept. 26, Died October 11, 1803; pyaemia. 1864. 15, 1864 ; exhaust n. Spec. 3126. 1863. 103 Eames, J. E.. Pt., F, Jan. 15, Left ; circular. Ass t Surg. S. 130 Twitchell, S. R., Pt., G, Sept. 17, Left ; flap. A. A. Surg. L. Fisher. 112th New York, age Feb. 28, H. Orton, U. S. A. (Necrosis.) 89th New York, age 25. 1862. (Sloughing; necrosis.) Died 23. 1865. Died March 17, 1865 ; exhaust n. Feb. 15, March 5, 1863 ; pyaemia. Spec. 104 Eubanks, L. M., Pt , I, Nov. 24, Left ; circular. Surg. H. J. Phil 1863. 2067. 30th Alabama, age 33. 1804. lips, U. S. V. (Gangrene.) Died 131 Vogle, F., Pt., G, 74th July 1, Right ; flap. A. A. Surg. A. Hew- November 30, 1864. Pennsylvania, age 28. Aug. 13, son. (Gangrene; haem.) Sept. 7, 105 Frazer, P., Pt., B, 4th April 30, Right. Died September 18, 1863 ; 1863. haem.; lie. femoral. Sept. 19, Artillery, age 24. June 28, diarrhoea. lig. ext. iliac. Died Oct. 6, 1863; 1803. haemorrhage. Spec. 2614. 106 Hand, J. C., Pt., C, 3d July 20, Right; circular. Ass t Surg. T. A. 132 Whistler, R., Pt., H, June 2, Right, (June 2, excision.) Died Mississippi, age 21. Sept. 22, McGraw, U. S.V. (Necrosed; 49th Ohio. July 5, July 14, 1864 ; pyaemia. 1864. gangrene.) Died Sept, 26, 1864 ; 1864. exhaustion. 133 Wilbur, W., Pt,, B, 1st May 8, Right; circular. A. A. Surg. H. 107 Harness, J. C., Pt., A, Aug. 3, Right; circular. Ass t Surg. T. N. York Cavalry, age July 6, B. Butcher. (May 28, Pirogoff s 33d Ohio, age 21. Sept. 22, A. McGraw, U. S. V. Died 27. 1864. amputation : gangrene.) Died 1864. October 4, 1864. July 6, 1804 ; exhaustion. NOKTH (A.), Report of Sixty Cases of Hospital Gangrene, in The American Medical Times. 1863, Vol. VI, p. 255. 2 Lll)El.L (J. A.), Gunshot Wound of Right Ankle Joint involving Tibia and Attragalus, in U. S. Sanitary Commission Memoirs, Surgical Volume . x-.^^t- i Cfrn , im I, New York, 1870, p. 191. 544 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. In five of the one hundred and thirty-three secondary amputations in the upper third of the leg re-amputation in the thigh became necessary; one patient survived and four succumbed to the operation. Secondary Amputations in the Middle Third of the Leg for Shot Injury. -One hundred and seventy-four cases are included in this group; one hundred and thirty-seven terminated successfully and thirty-seven fatally, a mortality rate of 19.7 per cent. In eighty instances the right and in eighty-seven the left limb was amputated, and in seven cases this point was not indicated. Recoveries after Secondary Amputations in the Middle Third of the Leg for Shot Injury. Of the one hundred and thirty-seven patients who survived secondary amputa tion in the middle third of the leg twenty-three were Confederate and one hundred and fourteen Union soldiers. Of the latter one hundred and thirteen became pensioners, but twelve have died since the date of their discharge from the service one of pysemia, one of continued suppuration of the stump, one of exhaustion, one of apoplexy, one of chronic diarrhoea, one of phthisis, and six of causes not stated. CASE 792. Private O. L. Bell, Co. D, 1st Delaware, aged 19 years, was wounded in the right leg, at Antietam, Septem ber 17, 1862, and admitted to hospital at Frederick ten days afterwards. Acting Assistant Surgeon W. S. Adams forwarded the following history : "An examination revealed extensive comminuted fracture of both bones of right leg at the upper portion of the lower third, a transverse fracture at the upper third, and an oblique fracture running down to within two inches of the external malleolus. The limb was in Smith s anterior splint, which had been badly applied; and a piece of adhesive plaster, which had been placed just above the knee, had been allowed to receive the weight of the limb for six weeks. The result was that it cut through the skin, fascia, and to a considerable extent into the muscles, the incision made being seven inches long and at its middle two and a half inches broad. After taking it off the limb was readjusted in the fame splint, in which it remained about three weeks longer, when it was placed in a fracture box. After union the leg showed two inches shortening. The patient s condition had remained good throughout, but on the morning of December 26th he had a severe chill, followed at 10 A. M. by considerable fever. On the next day there was some evidence of ery sipelas on the leg and thigh, and three grains of quinine were prescribed every three hours, also fifteen drops of tincture of chloride of iron every four hours. On the following day erysipelas was very evident and extended from the ankle to the hip ; limb hot and much swollen ; pulse 130 ; tongue furred and bowels constipated. Saline cathartics were now ordered and lead and opium wash was applied. On December 29th the patient was no better and there \vas total loss of appetite. The limb was now suspended in Smith s anterior splint so as to allow a free passage of air beneath and to facilitate the application of local remedies to all parts affected. After this the patient did quite well until January 10, 1863, when there was some evidence of an abscess on the anterior part of the thigh, but no distinct fluctuation could be recognized; patient having no pain and feeling quite well, his appetite having returned for some days. The quinine was now stopped and brandy and tonics were continued. On January 14th an extensive abscess was opened on the anterior part of the thigh and about a quart of pus was evacuated, after which the cavity was syringed with tepid water and a bandage was applied to the entire limb. One week later a solution of zinc was ordered to be used for syringing. Subsequently the patient continued to do well, requiring no treatment, and on February 10, 1863, he was discharged, ihe walls of the abscess having become adherent and the ulcer nearly cicatrized." The man subsequently re-enlisted in the 1st Delaware Cavalry and served for fifteen months, when the wound reopened. He then passed through various hospitals, being ultimately discharged for disability, from Jarvis Hospital, Baltimore, June 15, 1H6.">, and pensioned. Examiner I. Jump, of Dover, Delaware, certified July 1, 1871: "There is a large open sore some four or five inches long and the skin or flesh on most of the leg is very much discolored, the discharge being very offensive except when counteracted by disinfectants. The pensioner had to take to his bed last February, being unable to bear any weight, on the limb and suffering very much with it. His physician, who had served in the army, insisted on taking the leg off. I am of the opinion that it never will be healed; but I have advised that the diseased portions of the bones be removed ; it is barely possible he may FIG. 318. Posterior and anterior views of the bones of the right leg. Spec. 65G9. FIG. 319. Appearance of stump, a photograph.] [From SECT. V.] SECONDARY AMPUTATIONS IN THE LEG. 545 FIG. 320. Bones of the recover." Dr. J. F. M. Forwood, of Chester, Pennsylvania, who subsequently, on August 19, 1872, amputated the leg seven inches below the knee joint, communicated, in connection with the case, that after receiving his final discharge from service the man "roamed about and had one or two operations performed for his relief, staying some fifty days in St. Joseph s Hospital, Philadelphia, and finally drifting here, where I amputated his limb." At an examination of the stump in August, 1879, Examiner Jump reported: "There has been ulceration for ten months continuously, sometimes confining him to his bed." The pensioner was paid March 4, 1881. The amputated bones of the leg (Spec. 6569), together with a photograph of the pensioner, represented in the wood-cuts (FlGS. 318, 319), were contributed to the Museum by the operator. CASK 793. Private W. Holmes, Co. D, 18th Massachusetts, aged 20 years, was wounded in the right leg, at Fredericks- burg, December 13, 1862. He passed from a field hospital to Campbell Hospital, Washington, two weeks after receiving the injury, and six months afterwards he was transferred to Mower Hospital, Philadelphia. Surgeon J. Hop- kinson, U. S. V., in charge of the latter, recorded the following history: "The patient was suffering from a compound comminuted fracture of the tibia and fibula at the lower third. He also complained of diar rhoea, for which chulk mixture and laudanum were administered. Dead bone was discovered by the probe. The leg had been operated on and several pieces of bone removed. At the time of admission, June 20th, it was very much enlarged and disfigured by cicatrices. The wound was dressed with warm- water poultices every hour. On July 15th a large ulcer had broken out on the limb and a large piece of bone was taken away. Warm-water dressings were still continued, and the foot was kept elevated. On the following day the ulcer was found to be extending, and bread and milk poultices were ordered to be applied. Subsequently chlorate of potassa and muriatic disinfecting lotion were used. On July 19th, creasote was applied to the ulcer; warm-water dressings continued; bone now in a sad state. On July 22d the leg was removed by flap operation by Assistant Surgeon C. R. Greenleaf, U. S, A., half way between the ankle and the knee. The flaps were brought accurately together and dressed with water dressing. On the following day the patient felt easy, having slept well during the night after taking a half grain of morphia; pulse 100, full and soft. On July 26th the dressing was removed; stump looking well and patient doing well. Extra diet was given, and porter daily. The stump healed rapidly and the patient s general health was excellent. On September 30th the stump had entirely healed and the patient went home on furlough." He was subsequently transferred to Haddington Hospital, and later to Ladies Home, New York City, where he was supplied with an artificial leg of the "Ely" pattern, and whence he was discharged April 12, 1864, and pensioned. In his subsequent applications for commutation he described the condition of the stump as continuing in a "healthy state." The amputated bones of the right leg" severT monthi leg (Spec. 2594), contributed by the operator, are represented in the annexed wood-cut (FlG. 320) and afterfracture. Spec. 2594. exhibit the seat of the fracture, the fibula being firmly consolidated, and much callus being effused about the tibia, but caries having prevented firm union. The pensioner was paid March 4, 1881. CASE 794. Private E. Collins, Co. A, 3d Mississippi, aged 22 years, was wounded above the right ankle, at Peach Tree Creek, July 20, 1864. He was under treatment at Confederate hospitals until June 7, 1865, when he was admitted to the Marine (Union) Hospital at Mobile. Surgeon S. Kneeland, U. S. V., in charge, contributed the specimen (No. 481), represented in the adjoining cut (FlG. 321), with the following description: "The missile, a mini6 ball, perforated the tibia in its course and lodged in the wounded man s shoe. The wound had never healed, and suppuration and hsemorrhaj. had continued up to the time of the patient s entrance into this hospital. For the last few weeks haemorrhage had been frequent and profuse and it was with difficulty controlled by stuffing the cavity in the tibia, which was large enough to allow the finger to be introduced freely. Suppuration was also profuse, and there was great pain and ssvelling about the lower part of the tibia, the patient being considerably exhausted from these causes. Circular amputation of the leg near the middle was performed on June 8th by Acting Assistant Surgeon R. W. Coale, chloroform being used. The stump at first was disposed to slough, but under a tonic treatment and antiseptic applications it soon assumed a healthy appearance. The subsequent progress was favorable, and by June 30th the stump was nearly well." The records of the hospital show that the patient was discharged on parole July 9, 1865. The specimen comprises the lower portions of the bones of the injured leg, and exhibits the cavity in the tibia as well as external deposit of callus. CASE 795. Private P. Larkin, Co. C, 48th New York, aged 24 years, was wounded during the assault on Fort Wagner, July 18, 1863, by a canister shot, which fractured the right foot. Assistant Surgeon J. E. Semple, U. S. A., reported that the wounded man was conveyed to hospital at Hilton Head, where Pirogoff s amputation at the ankle joint was performed one week after the date of the injury. The patient recovered, and was discharged from service December 4, 1863, and pensioned. Dr. E. D. Hudson, of New York City, who supplied the pensioner with an artificial foot several years after wards, reported that he saw the man some weeks after leaving the service and found that the tibia was extensively necrosed, that numerous pieces had exfoliated, and that there was copious discharge of pus from the leg, which was enlarged about one-third beyond its normal size, an iuvolucrum being present corresponding to the extent of the necrosed bone, and several cloacae having formed. The pensioner subsequently suffered re-amputation of the leg at the middle third (near the junction with the upper third) at the Soldiers Home in Hampton, whence Dr. G. H. Marmion, surgeon in charge, described the case substantially as follows: "After receiving bis discharge I.nrkin was sent to his home in Brooklyn, where he followed his trade as stUCCO-maker, but was com- SUIIG. Ill 69 FIG. a. 1 !. Bones of the right leg ten and a half months after injury. Spec. 481. FIG. 322. Bony stump of right leg, af ter Pirogoft s ampu tation at the ankle 546 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. pelled to desist three months afterwards, necrosis setting iu and continuing pretty much up to the present time. He is a man of apparently good constitution, and should have done well had the leg heen amputated at the junction of the middle and lower thirds. As it was he led a life of suffering and mortification, the odor of his leg completely ostracising him from the society of his fellows. I think the operation of Syme or Pirogoff might be profitably abandoned. The re-amputation was performed by me on May 6, 1879, with the assistance of hospital nurses, none of them being professional men. The stump was kept con stantly wet night and day with a dilute solution of carbolic acid. It healed entirely by first intention, and the patient is now (June 10, 1879) able to walk on crutches a few yards to the hospital piazza. I had some fears of an extension of the disease, but at present there is not nor has there been any indication of the remainder of the tibia being involved. The patient is in excellent physical condition, fat, rosy, and good spirits." The bones of the leg (Spec. 6913), removed at the re-amputation and contributed by the operator, are shown in the wood-cut (FiG. 322 on the preceding page), and exhibit a large involucrum embracing a cylindrical sequestrum of the tibia. The pensioner was paid March 4, 1881. l CASE 796. Private L. V. Grant, Co. M, 8th Illinois Cavalry, aged 23 years, was wounded in the left ankle, at Beverly Ford, June 9, 1863, and entered Lincoln Hospital, Washington, the following day. Assistant Surgeon J. C. McKee, U. S. A., who amputated the injured limb, reported as follows: "The wound was caused by the ball entering the inner malleolus pos teriorly, penetrating the base of the tibia, and remaining embedded on the semi-cylindrical face of the astragalus. Upon taking charge of the hospital (December, 1863) I found the patient s condition as follows: Appetite capricious but well guarded by taking acceptable food; constant pain in left breast, accompanied by headache; eyes constantly suffused and face flushed, wake- fulness, restlessness, and night-sweats; also a strong aortic direct murmur of the heart, with considerable hypertrophy and con sequent labored heart action. He had to be propped up in bed to allow him any rest, his expression being anxious, appetite declining, pain of wound unremitting and excruciating, tissues inflamed and oedematous, and the joint immovable and firmly anchylosed, rendering it impossible for the patient to put his foot on the ground. He begged again and again to have the limb removed. An examination by the probe indicated diseased bone or foreign substance. The opinion of Acting Assistant Surgeon W. F. Peck under whose care he had been for some months as confirmed by the statement of the patient was that the ball had been extracted. Uninfluenced by the patient s constant and urgent solicitation I proceeded carefully to examine the case further; and not being satisfied that I had sufficient authority to remove the diseased and injured joint by amputation, I delayed for accumulative evidence, which was not long in presenting itself. The bad symptoms increasing, it became evident that some measure for relief must be promptly taken to save the life of the patient. Assistant Surgeon R. Bartholow, U. S. A., under whose care the patient had also been for some time, favored immediate amputation, and stated that he had intended to operate before my arrival. Assistant Surgeon H. Allen, U. S. A., was also present and favored the operation. Acting Assistant Surgeon W. F. Peck insisted upon removing the limb some time before I gave my consent; other medical gentlemen present were satisfied that the removal of the limb was called for to rid the patient of a deformity and an encumbrance. Amputation was accordingly performed on December 7, 1863, eight inches below the knee, by circular operation. Sulphuric ether was used and the patient reacted promptly. The stump was left laying open on a pillow and strapped, when the healing process commenced. Simple water dressings were applied. The aggravated symptoms of the heart disease became greatly modified after the operation. The patient s appetite improved, his night-sweats ceased, and he was delighted to be able to sleep and rest, stating that he had not enjoyed any comfort or relief from pain for months before. He obtained an excellent and useful stump. The ligatures came away two weeks after the operation. The patient was furloughed February llth, and subsequently he was transferred to Judiciary Square Hospital to have an artificial limb applied." On September 24, 1864, his term of service expired and he was mustered out. He was a pensioner until August 21, 1865, when he died. The cause of his death has not been ascertained. The amputated part of the wounded limb, longitudinally bisected and exhibiting the place of lodgement of the missile, was contributed to the Museum by the operator and constitutes specimen 1899 of the Surgical Section. fatal Cases of Secondary Amputations in the Middle Third of the Leg for Shot Injury. Thirty-seven operations were performed six on Confederate and thirty-one on Union soldiers. Erysipelas was noted in one, pyaemia in seven, and gangrene in eleven cases; in two instances autopsies were reported. CASE 797. Private D. Bussler, Co. K, 93d Pennsylvania, aged 19 years, was wounded near the left ankle during the engagement near Fort Fisher, before Petersburg, March 25, 1865. Surgeon S. F. Chapin, 139th Pennsylvania, reported his admission to the field hospital of the 2d division, Sixth Corps. Assistant Surgeon H. Allen, U. S. A., contributedthe patho logical specimen, numbered 195 of the Surgical Section, A. M. M., with the following description and result of the injury: "The wound consisted of a compound comminuted fracture of the fibula; a conoidal ball had entered the outer aspect four inches above the external malleolus, and emerged at the inner aspect one and a half inches above the internal malleolus. The patient was admitted to Mount Pleasant Hospital, Washington, one week after receiving the injury. Circular amputation of the leg was performed by Acting Assistant Surgeon H. Craft, on May 6th, at the junction of the middle and lower thirds. Eight liga tures were applied and sulphuric ether was used. At the time of the operation the leg presented a large open surface on the posterior region, extending from one inch below the ankle joint to the junction of the middle and lower thirds of the limb. Several spiculse had been removed previously and there had been gangrene ; the patient had lost his appetite and was very weak ; pulse small. Reaction came on slowly. On the evening of May 9th he had a severe chill; suppurative process not yet estab lished; stump dark looking and flaps somewhat discolored; two ligatures now came away. Tincture of chloride of iron, with stimulants and nourishing diet, were prescribed, also a camphor and opium pill every liquid stool. On the following day there was another chill, followed by profuse cold sweat ; previous treatment continued, and one-half drachm of bi-sulphate of soda dissolved in water was given every two hours. There was very little discharge from the stump, which was dressed with solution of bromine. On May llth there were two chills and the treatment was continued. In the evening the bi-sulphate of soda was SMITH (S.), Amputations at the Ankle Joint in Military Surgery, iu U. S. Sanitary Commission Memoirs, Surgical Volume II, p. 134. SECONDARY AMPUTATIONS IN THE LEG. 547 stopped, but resumed the next morning. Several rigors occurred during the night and a slight chill on the morning of May 1.3th, when the patient had great pain in the stomach, and the bi-sulphateof soda was again stopped and morphia prescribed. In the afternoon the doses of bi-sulphate of soda were again resumed. He suffered great pain in the stomach through the night, and the next day the remedy was again stopped. There were now symptoms of gastritis and the patient was gradually sinking. The slough had all separated from the stump, which looked quite healthy. Poultices of charcoal, flaxseed, yeast, and creasote had been used for several days. On the morning of May 15th the patient was very low and in a dying condition, and all med icines except stimulants and beef-essence were stopped. Death, caused by pyaemia, supervened at 3 P. M. on May 15, 1865. At the autopsy the thoracic viscera were found to be normal with the exception of old adhesions of the right lung. The left lobe of the liver and the spleen contained metastatic abscesses; other abdominal viscera were normal. The stump was in a gan grenous condition. The medulla of the upper third of the femur was greatly inflamed, particularly so about one inch below the great trochanter; cancelli of upper part of femur very vascular; cancellous structure of tibia slightly vascular." The specimen consists of the amputated portion of the fibula, showing the seat of the injury without any attempt at repair. CASE 798. Sergeant J. C. Schmid, Co. F, 1st Rhode Island Light Artillery, aged 26 years, was wounded, before Peters burg, August 10, 1864, by a minie" ball, which took effect above the malleoli of the left leg and implicated the bone. He was admitted to Satterlee Hospital, Philadelphia, one week after receiving the injury. By September 2d the wound had become gangrenous and was sloughing a little, the muscles and bone being exposed at the point of the injury. The patient was thin looking but apparently of good strength and constitution, having good appetite and being in good spirits. The wound became very large and deep, involving most of the muscular structure on the inner and posterior surfaces and extending from the internal malleolus to within two inches of the point of election. On September 22d the leg was amputated by Acting Assistant Surgeon G. P. Sargent just above the point of election, by the circular method, the amesthetic consisting of two parts of ether to one part of chloroform. One week after the operation the patient s condition was weak and his appetite poor, and there was unhealthy inflammation. On October 6th there was gangrene of the stump, the swelling, inflammation, and discolored spots extending to the groin. The patient died at noon on October 7, 1864, having suffered much pain the previous night. The treatment embraced morphine, quinine, iron, and stimulants according to the condition of the patient. Astringent lotions, caustics, and cataplasms of charcoal and linseed meal were used to the wound and lead and opium solution to the thigh. A mixture consisting of one drachm of carbon ate of ammonia, two ounces of syrup of acacia, and six ounces of brandy was administered in tabU-spoonful doses every four hours. The history, together with the amputated portion of the bones of the leg (represented in the annexed wood-cut, FlG. 323), was contributed by the operator. The specimen, No. 3647, shows that the tibia was nearly entirely fractured in the lowest third, a deposit of callus around the orifice, and an extensive loss of substance in the body of the bone, which is carious. CASK 799. Sergeant J. Cannel, Co. I, 124th Ohio, aged 27 years, was wounded near Daltou, May 9, 1864. Surgeon R. D. Lynde, U. S. V., reported his admission to the field hospital of the 3d division, Fourth Corps, with "shot fracture of right leg and flesh wound of left leg." Eighteen days after receiving the injury the patient was transferred to hospital No. 1 at Nash ville, whence Surgeon R. L. Stanford, U. S. V., reported the following: "The wound of the right leg was three-fourths of an inch above the external malleolus and posterior to the tibia, the ball passing inward and downward and emerging three- fourths of an inch below the internal malleolus, having fractured tarsal bones and opened the ankle joint. Circular amputation of the leg at the middle third was performed on June llth by Acting Assistant Surgeon H. C. May, chloroform and ether being used. At the time of the operation the foot was tumefied and inflamed and the wounds were discharging sanious fetid pus. Abscesses existed through the whole region of the joint, with extensive necrosis of bone, and the patient was much emaciated by suppu ration. Thirty-six hours after the amputation the integumentary flaps began to slough so as to expose the bones and face of the stump. Charcoal and yeast poultices were used and stimulants and supporting diet prescribed." The patient died of exhaustion October 4, 1864. Part of the tarsal bones of the amputated limb, somewhat eroded and showing no attempt at repair, were contributed to the Museum by the operator and constitute specimen 3359 of the Surgical Section. TABLE LXXVII. Summary of One Hundred and Seventy-four Secondary Amputations in the Middle Third of the Leg for Shot Injury. [Recoveries, 1137; Deaths, 138174.1 FIR. 323 Lower portions of boues of the left leg one mouth und twelve days after injury. Spec. 3647. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Ash. W., Pt., I, 15th Sept. 20, Right ; circ. Surg. W. C. Otter- 6 Bassett. A., PL, II, 22d Oc.l8. 6:5, Left; *rcular. Dr. W. Green, Ohio, age li). Dec. 18, son, U. S. V. Gangrene. Dis Massachusetts. Nov. 29, Pittsfield, Mass. Recovery. 1863. charged July 25, 1864. 1865. ~ Babb, L., Pt., B, 5th N. April 7, Right; flap. Ass t Surg. G. M. 7 Bell, J. A., Pt., I, 22d De.31, (l2, Left ; flap. Discharged Novem Hampshire, age 43. Aug. 12, McGill, U. S. A. Discharged Indiana. Dec. 17, ber 24, 1863. 1865. October 5, 1865. 1863. > Baker, J., Pt., K, 4th June 30, I^ifht <MIY* T^isfViirfrpfl S**n B Bell, O. L.. Pt., D, 1st Sept. 17, Rigiit Dr J. F. M. Forwood, Penn. Reserves. Au. 2, 62. temb er 26. 1863. Delaware, age 19. 1862. Chester, Penn. (Dec.. 18(i2, limb \ Ball, T., Corp l, B. 54th New York, age 23. July 4, Sept. 26, Right : anterior posterior skin flap. A. A. Surg.W. Balser. Disch d Aug. 19. 1872. united: erysipelas. Discharged Feb. 10. 1863.) Two subsequent 1864. June 24, 1865. operations. Spec. 6569. 5 Barnett, B. \V., Pt., E, 3d New York Light May 16, Aug. 15, Right : double flap. A. A. Surg. E. Seyffarth. Discharged Feb 9 Bennett. F., Pt., G, 57th Virginia. July 3, Aug. 18, . Surg. Carter. Recov ery. Artillery, age 19. 1864. ruary 16, 1865. 1863. 548 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO I NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 10 Blood J. N. Pt. C ICth July 3, 39 Goode S. Pt. K 12th Oct. 12 Sunc 9th N Y Massachusetts. Aug. 27, A. Surg. F. Hinkle. Diach d Virginia Cavalry. Nov. 12, Recovery. 1863. May 3, 1864. Spec. 1712. 1863. 11 Boggs, P. F., Pt., A, 1st July 3. Left. A. A. Surg. B. H. Wash- 40 Grant, L. V., Pt., M, 8th June 9, Left ; circular. Ass t Surg. J. C. N. Carolina Cavalry. Aug. 27, ington, C. S. A. Recovery. Illinois Cavalry, age Dec. 7, McKee, U. S. A. Discharged 1863. 23. 1863. Sept. 24, 1864. Died August 12 Brown, T. D., Pt., K, May 22, Left; circular. Surg. C. T. Alex- 21, 1865. Spec. 1899. 05th Illinois. June 27, i ander, I!. S. A. (May 2"), nnip. 41 Griebe, J., Pt., E, 9th Sept. 30, Right; flap. Surg. II. Buckmas- 1863. ! toes.) Disch d Aug. 12, 1863. Wisconsin. Oct. 31, . ter, U. S. V. Discharged Janu- 13 Bugg, W. T., Serg t, B, July 4, Right. Recovery. I860. uary 8, 1863. 3d Arkansas. Aug.8, 63. 42 Grieff, C. II., Pt.,A,!)6th June 26, Left ; circular. A. A. Surg. S. D. 14 Buisch, G., Pt., C, 160th Se.16, 64, Left; oval flap. A. A. Surg. A. Pennsylvania, age 21. Aug. 1, Gross. Erysipelas ; hannorrh. New York, age 44. Jan. 28, Trau. Disch d May 31, 1865. 1862. Discharged Dee. 5, 1863. 1865. Died July 31, 1876 ; chr. diarrh. 43 Grier, W., Pt,, K, 2d June 27, Left. Discharged November 1, 15 Burbank, B., Pt., H, 95th Jan. 13, Left: flap. Ass t Snrg. J. IIo- Maine, age 38. Aug. 21, 1864. Died August 25, 1865. New York, age 22. April 3, mans, jr., U. S. A. Disch d June 1862. 1863. 2,1863. Died Sept. 17, 1868. 44 Grimes, M., Pt., A, 16th May 28, Right ; lateral skin flap. Surg. 16 Campbell, J. N., Pt., G, Nov. 30, Left; circular. Ass t S urg. G. M. Kentucky, age 21. June 29, C. McDermont, U. S.V. Disch d 2d Michigan Cavalry. 1664, Sternberg, IT. S. A. Discharged 1864. April 1, 1865. age 32. May 22, July 17, 1865. 45 Griswold, D. P., Corp l, J y 1, 63, Left ; flap. Dr. J. D. Trips, Vir 1865. C, 76th New York. May 11, gil, N. Y. (July 5, excis. tibia. 17 Campbell, S., Pt., G, May 9, Left ; flap. Discharged October 1869. Disch d Sept. 23, 1864.) Rec. 26th Illinois, age 22. July 10, 13, 1662. Died April 17, 1870. 46 Growner, H. L., Serg t, Sept. 14, Left. Exchanged December 20, 1862. A, 20th North Carolina, Oct. 18, 1862. 18 Carter, A. L., Lieut., B, July 1, Right ; long posterior flap. Dr. age 33. 1862. 76th New York. 1863, F. Hyde. Cortland, N. Y. (Dis 47 Hafer, W. II., Pt., E, 2d De.31, 63, Right ; flap. Surg. S. P. Smith, April 13, charged November 9. 1863.) Pennsylvania Cavalry, Aug. 4, 2d Maryland P. II. B. Disch d 1865. age 24. 1864. April 10, 1865. 19 Chellis, J. C., Pt., B, 41st Nov. 25, Right ; antero-posterior flap. A . 43 Hendricks, II., Pt., D, May 10, Right ; circular. A. A. Surg. A. Ohio, age 43. 1863, Surg. G. M. Sternberg, U. S. A. 49th Pennsylvania, age 1864, Transue. Discharged May 22, Jan. 7, (Necrosis.) Disch d May 18, 18. Feb.3, 65 1865. 1865. 1865. Spec. 3607. 49 Henry, W. R., Pt., H, De.13, 62 . Recover}-. 20 Clinger, I. W., Pt., 1, 26th Dec. 27, Right; antero-posterior flap. A. 38th Georgia. Feb.3, 63. Ohio, age 20. 1862, A. Surg. J. t). A. Banta. Dis 50 Higinton, J. T., Pt., K, July 4, Left ; circular. To Provost Mar Dec. 18, charged April 10, 1864. 1 Oth Tennessee, age 1 8. A ug". 30, shal November 16, 1864. 18G3. 1864. 21 Collins, E., Pt., A, 3d July 20, Right; circular. A. A. Surgeon 51 Holmes, W., Pt,, D, 18th Dec. 1 3, Right; flap. A. Surg.C. R.Green- Mississippi, age 22. 1864, R. W. Coale. (Haemorrhage.) ; Massachusetts, age 20. 1862. leaf, U. S. A . Discharged A pril June 8, Paroled July 9, 1865. Spec. 481. 1 J y 2, 63. 12, 1864. Spec. 2594. 1865. 52 Horine, W. T., Serg t, July 2, Right; flap. Surg. Z. E. Bliss, IT. 32 Covert, B. C., Pt., B, June 1, Right ; circ. Discharged Sep K, 20th Indiana. Aug . 13, S. V. Discharged July 29, 1864. 67th New York. July 11, tember 7. 1862. 186:!. 1862. 53 House, C., Pt., 1C, 6dth Sept. 15, Left ; flap. Discharged. 23 Cowling, J. R., Pt., A, July 2, Right. Surg. J. Kerr, 62d Penn. Ohio. Oct. 16, 62d Pennsylvania, age 1863, (Primary excis. tibia. Disch d 1862. 21. Sept. 21, July 13, 1864.) Recovery. 54 Honser, W., Pt., D, 5th June 27, Left; flap. A. A. Surg. S. D. 1864. Cavalry, age 29. Aug. 3, Gross. Discharged August 8, 24 Crawford, L. M., Corp !, Aug. 14, Right; circular. Surg. A. F. 1862. 1863. M, 13th Pennsylvania Dee. 23, Sheldon, U. S. V. Discharged 55 Howe, S. O., Pt., K, 57th Mar. 25, Left; circular. Snrg. D.W. Bliss, Cavalry, age 25. 1664. June lit, 1865. Spec. 3536. Massachusetts. June 8, U. S. V. Discharged August 4, 25 Currin, O.. Pt., A, 63d Sept. 17, Right; circular. Discharged Jan 1865. 1865. New York, age OU. Oct. 20, uary 12, 1863. 56 Hubbard, A.. Farrier, July 22, Left; antero-posterior flap. A. 1862. D, 6th New York Cav Sept. 2, A. Surg.W. K. Cleveland. Jim. 26 Davis, T. F., Pt., E, 82d June 1, Left; flap. A. A. Surg. A. Trail. alry, age 32. 1864. 1, 1865, amp. thigh. Diseh d Pennsylvania, age 24. Dec. 14, Discharged April 29, 1865. November 7, 1865. Spec. 278. 1864. 57 Hndler,.T. M., Pt,,D, 4th July 2, Left; sloughing: exfolial n. Dis 27 Dellabella, F., Pt., J>, Sept. 20, Right ; circular. "Medical Cadet Michigan, age 31. Aug. 5, charged May 27, 1864. 2d Missouri, age 28. 1863, C. II. Fisher. (Gangrene ; haem 1863. Mar. 21, orrhage.) Discharged October 58 Ingraham, E., Pt., I, 21st Sept. 20, Right; flap. Ass t Surg. J. C. 1864. 7, 1864. Spec. 2-205. Ohio, age 21. Dec. 14, Patterson, 85th 111. Discharged 28 Dougherty, A., Pt., D, April 6, Left; flap. A. A. Surg. T. B. 1863. June 20, 1864. Died May 3, 44tli Indiana. June 25, Harvey. (Erysipelas.) Disch d 1871 ; consumption. 1862. September 12, 1862. 59 Jones, J. F., Pt,, D, 7th July 3, Left ; flap. Surg. Shivers, C. 29 Douglas, A. L., Pt., H, July 21, Right; flap. Discharged Octo Virginia, age 29. Au. 4, 63. S. A. Exoh d Nov. 12, 1863. 2d Maine. Aug. 21, ber 5, 1861. 60 Jones, J.W., Pt., L, 13th Oct. 28, Left ; anteriorposterior (lap. Dis 1861. Tennessee Cav ry, age Dec. 24, charged June 10, 1865. 30 1 Duff)-, T., Pt., I, 70th June 1, Left; posterior flap. (Primary 21. 1864. New Vork flfiT6 21 . fii Knchor T A Pt P Dec 13 1862. Disch d July 11, 63. Spec. 4312. Dl tlMlrr, J. A., 1 L., I.T, 145th Penn., age 24. 1862," March 25, 1864 . 31 Dunn, T., Fireman, U.S. April 26, Left. Discharged October 24, Mar. 26, Steamer "Juliet," age June , 1864. 1863. 26. 1864. 62 Kelley, W., Pt,, M, 1st April 8, Right; lateral flap. Ass t Surg. 32 Durau, J., Corp l, C, 1 7th May 6, Left ; circular. A. A. Surg. G. E. N. York Cavalry, age May 13, J. \V. Williams, 1 . S. A. Dis Maine, age 38. Aug. 28, Brickett. May 18, 1865, amp. 38. 1865. charged August 14, 1865. 1864. thigh. Disch d August 7. 1865. 63 King, S. ,S., Pt,, G, 13th July 3. Right; flap. A. A. Surgeon !. 33 Duran, J., Pt., D, 1st Oc.27, 64, Left; circular. Discharged Au South Carolina. Aug. 24, Martin. Exchanged March 17. Maine Cavalry, age 48. April 30, gust 12, 1865. Spec. 4231. 1863. 1864. Spec. 2071. 1865. 64 Lackey, G. A., Serg t, May 12, Left; flap. (May 27, amp. foot.) 34 Fagan, P., Pt., B, 170th June 18, Left; flap. A. A. Surg. G. W. D, 58"th Massachusetts. July 27, Dr. C. E. Swann, Easton, Mo. New Vork, age 41. Aug. 10, Miller. (Primary amp. toes. 1864. Discharged March 16. 1865. 1864. Gangrene.) Discharged May 65 Lane, D. C., Pt., A,20th June 30, Left. A. A. Surg. C. J. Morton. 22, 1865. Spec. 3664. Massachusetts, age 37. 1862, Jan. 2. hsem. Disch d August 35 Ferguson, E., Lieut., A, Oct. 8, Right; flap. Drs. T. Hatcbard Jan. 2, 1, 1864. Re-amp. Died Jan. 1st Wisconsin. 1862, and K. B. Wolcott. of Milwau 1863. 20, 1866; pyaemiii. Spec. 861. June 15, kee. Resigned June 17, 1864. 66 Larkin, P., Pt., C. 48th July 18, Right. Dr. G. H. Marmion. (Julv 1863. New York, age 24. 1863, 25, 1863, Pirogoff s amp. ankle. 36 Fleming, A. J., Pt., I, June 27, Left; flap. A. A. Sura:. A. W. May 6, Discharged December 4, 1863. 83d Pennsylvania, age .Tulv 28, Calhoun. Discharged Deeern- 1879. Necrosis.) Spec. 6913. 45. 1862. ber8, 1862. 67 Laws. G. L., Serg t, II. May 5, Left. Ass t Surg. R. Bartholow, 37 Gamble, J., Pt., C, 15th July 24, Right: lateral flup. Ass t Surg. |i 5th Wisconsin. July- 4, U.S.A. Discharged July 29, West Virginia, age 23. Oct. 12, O. M. Mr-Gill, I . S. A. Disrh d 1862. 1862. 1864. April Hi. 1866. Sprr. 2415. 68 Leigh. G., Pt., C , 3d Ar Sept. 24, Right ; double flap. Surg. J. A. 38 Gash, J. R., Serg t, I, July 1, Left. Surg. Massengale, C. S. A. tillery, age 19. 1863, Lidell, U.S.V. (Prim. amp. ank. 16tb North Carolina. Sept. 10, Recovery. Mar. 2!l. joint.) Disch d Sept. 17, 1864. 1863. IP64. Died Sept. 13, 1871. Spec. 2165. STKPHRN SMITH, Amputation* at tht Anklr .Joint in Military toiratry, in f. S. San?7ar.y Commission Mfmmrt, Surgical Volume II, p. 138 SECT. V.J SECONDARY AMPUTATIONS IN THE LEG. 549 Wr NAME, MILITAKY OPERATIONS, OPEHATOKS, Kr NAME, MILITAUY OPEBATIONS, OPERATORS, MO. DESCKIPTION, AND AGE. RESULT,, iiU DESCRIPTION, AND AOK. RESULT. 69 Lewis. R D., Pt., I, 22d Jan. 1, Left ; circular. Surg. T. D. Fitch, 100 Schafer, W. A., Pt., H, Nov. 30, Right : flap. A. A. Surg. W. An Illinois. Feb. 19, 42d Illinois. Discharged April 65th Ohio, age 22. 1864, derson. Ke-amputation. Dis 1803. 23, 1863. Jan. 4, 65. charged June 14, 1865. 70 Livengood, J. D., Pt., B, Sept. 17, Right. Ass t Surg. J. N. Green, 101 Schemerhorn, G. C., Pt., Nov. 27, Left ; circular. Surg. R. R. Tay- 19th Indiana. Nov. , 19th Indiana. Disch d March D, 74th Illinois, age M. 1864, lor, II. S. V. Disch d October 1862. 13, 1865. Aug. (i, 30, 1865. Died November 18, 71 Lyons, J., Pt., K, 9th Aug. 2li, Left ; ant. posterior flap. Surg. 1865. 1807; exhaustion. West Virginia, age 19. Oct. 26, N. F. Graham, 12th Ohio. Dis 102 Schmidt, H., Corp l, B, June 9, Right ; antero-post. flap. Ass t 18(34. charged. 8th New York Cavalry, July 14, Surg. H. Allen, U. S. A. Dis 72 McCarthy, J.,Pt.,F,48th Mar. 2, Right; circ. A. A. Surg. LeR. age 25. 1863. charged Sept. 2, 64. Spec. 1352. New York, age 38. 1864, McLean. (Gangrene ; ligation 103 Schmidtgrieber, J., Pt., Mar. , Left ; circular. Discharged May April 2.), post, tibial artery. Mar. 21, "04, A, 2d Massachusetts. J une 25, 24, 1866. 1865. Chopart s amp.) Disch d June 1865. 10, 1865. Died December 19, 104 Schweitzer, J., PL, I, Jan. 1, Right ; circular. A. Surg. A. C. 1874. Spec. 3007. 6th Kentucky. June 9, Rankin, 88th 111. Discharged 73 McCarthy, J..PI., A, 9th July 1, Left; flap. A. A. Snrg. J. II. 1863. December 27, 1863. Massachusetts. Au. -, 62. Peabody. Disch d June 26, 63. 105 Scoggins, R. W., Pt., F, May 6, Left ; circular. A. A. Surg. U.W. 74 McCosh, R., Pt., 11, 30th Jan. 1, Right; flap. Discharged July 8, 1st Florida Cav ry, age Aug. 30, Coale. Discharged December Indiana. Apr.1, 63. 1863. 19. 1865. 5, 1865. Spec. 1599. 75 McDowell, J., Serg t, K, July 2, Left ; circular. A. A. Surg. B. B. 106 Scott, F., Pt., K, 26th Aug. 28, Left ; circular. A. A. Surg. C. B. lllth N. York, age 39. Oct. , Miles. Discharged April 16, Pennsylvania. Oct. , King. Disch d October 3, 1863. 1803. 1864. Spec. 1731. 1862. 76 McOill,J. H.,Pt.,D,60th May 9, Right. Dr. \V. S. A. Cox, Long 107 Servis, B., Pt., K, 96th May 9, Right; fl;ip. Surg. M. Goldsmith, Illinois, age 24. 1864, Prairie, 111. (Caries: ulcers; Illinois, age 21. July 12, U. S. V. Discharged October Mar. 4, gangrene. Disch d March 14, 1864. 26, 1864. 1867. 1865.) Recovery. 108 Shannon, W., Pt.,C, llth July 2, Right. Paroled November 12, 77 McKelvey, A., Pt., R June 30. Left; short anterior, long post. Georgia, age 25. Au. 8, 63. 1863. 169th N. York, age 20. Aug. 9, flap. A. A. Surg. W. L. Welles. 109 Melton, J.L., Pt.,F,llth July 2, Left, Surg. T. A. Means, C. S. A. 1864. Discharged August 21, 1865. Georgia, age 35. Aug. 3, Retired December 14, 1863. 78 MoKeever, D., Pt., B, Muy 15, Right ; posterior flap. Ass t Surg. 1863. 99th Pennsylvania, age 1864, S. B. Ward, U. S. V. Disch d 110 Sherman, M., Pt, A, 1st Aug. 14, Left ; circular. Snrg. A. F. Shel 40. Ja.24, 65. June 15, 18<i5. Minnesota, age 42. Sept. 24, don, U. S. V. Discharged July 79 McMonigal, N., Corp l, July 9, Left ; flap. A. A. Surgeon J. A. 1864. 24, 1865. Spec. 3258. F, 69th Pennsylvania, 1862, Cross. Discharged August 29, m Shouls, D. L., Pt,, E, 1st Nov. 25, Left; lateral flap. Discharged age 27. Jan. -, 63. 1863. New York Cavalry, 1864, May 28, 1805. 80 Miller, N., Pt., H, 1st June 24, Left ; flap. Surgeon D. P. Smith, age 22. Feb.6, 65. Artillery, age 34. 1864, U. S. V. To regiment June 7, 112 Slater, J. A., Pt., H, 6th July 2, Left ; flap. Ass t Surgeon W. T. M h 1, 65. 1865. Infantry, age 23. Aug. 4, Okie, U. S. A. Discharged Oc 81 Moore, J. E., Pt., C, 73d Oct. 8, 62, Right ; flap. Dr. J. C. Cook, New 1863. tober 17, 1864. Illinois. April 4, port, Ind. Discharged March 113 Smith, A. J., Serg t, I, July 2, Right. A. A. Surg. F. Hinkle. 1864. 17, 1863. 72d New York, age 33. Aug. 21, Discharged July 3, 1864. 82 Moore., W., Pt., G, 1st June 26, Right. Surgeon J. G. Brodnax, 1863. North Carolina. 1862, C. S. A. Recovery. 114 Smith, C.W.,Pt.,A, 10th Se.29, 64, Right ; flap. A. A. Surg. A. H. Ja.13, 63. N. Hampshire, age 20. Nov. 17, Crosby. Discharged May 18, 83 Morris, S. W., Pt., G, July 1, Left ; antero-posterior flap. A. 1865. 1865. Died Nov. 11, 1870. 55th N. Carolina, age Oct. 2, A. Snrg. J. Priestly. To prison 115 Smith, B. M., Pt., K, 13th May 3, . Recovery. 23. 1863. April 20, 1864. South Carolina. Au. 3/63. 84 Moucha, J., Pt., C, 5th July 2, Left; circular. Erysipelas. Ex 116 Smith, M., Pt,, H, 7th May 5, Right ; circular. Surg. E. Bent- Florida. Au. 6, 63. changed November 12, 1863. Wisconsin, age 25. July 12, ley, U. S. V. Discharged Jan 85 O Neill, J., Serg t, E, 1st J y 2, 63, . Surg. G. A. Nott, P.A.C.S. 1864. uary 19, 1865. Sptr. 3341. Louisiana. M h -, 64. Retired January 30, 18G5. 117 Starkey, E., Serg t, H, June 27, Left. Ass t Surg. R. Hartholow, 86 O Ueillv, C., Pt., F, May 18, Right. A. A. Surg. W. Robie. 1st Michigan, age 21. July 28, U. S. A. Necrosis. October25, 164th New York, age Feb. 12, (Prim. amp. ank. joint; S vine s.) 1862. 1863, re-ampntat n. Discharged 23. 1865. Discharged May 31, 1865". December 28, 1864. 87 Palmer, A., Pt., G, 3d July 3, Left ; flap. Sept. 2, haemorrhage ; 118 Stearns, J. P., Lieut., K, July 1, Left ; flap. To Veteran Reserve Michigan, age 37. Aug. 15, ligation anterior tibial artery. : 22d Massachusetts. Oct. 1, 62. Corps. 1863. Discharged May 31, 1864. 119 Streubel, W.,Pt,, K, llth July 21, Left ; circular. Surg. A. B. Mott, 88 Parker, W. B., Pt., G, 2d June 19, Left ; circular. S urg. E. Bentley, ! New York. 1861, U. S. V. Disch d April 6, 1863. Michigan, age 24. Nov. 10, U. S. V. To Vet. RPS. Corps J e20, 62. 1864. February 17, 1865. Spec. 3407. 120 Taft, L., Pt., E, 34th N. Se.17, 62, Right ; flap. Surg. W. T. Hum 89 Parkinson, J. R., Pt., A, May 13, Left : flap. Discharged March York, age 41. Feb. 16, phrey, 149th Penn. Discharged Hlth Illinois. July 13, 28, 1865. 1863. June 30, 1863. 1864. 121 Thomas, E. O., Serg t, E, July 1, Right; flap. A. A. Surg. J. L. 90 Peet, G. H., Pt., E, 5th Aug. 9, Right ; flap. Confederate surgeon. 14th South Carolina. Aug. 3, Whittaker. Exchanged March Ohio. Sept. 17, Discharged February 12, 1863. 1863. 17, 1864. Spec. 2054. 1862. 122 Thompson, A. J., Capt., Nov. 30, Left : circular. Surg. Doyer, 91 Philpot, G., Corp l, I, Deo.9, 62, Right. Ass t Surg. F. L. Town, G, 7th Mississippi, age 1864, C. S. A. To Provost Marshal 8th Kentucky. Jan. , U. S. A. Discharged April 17, 27. Ja.20, 65. March 21, 1865. 1863. 1863. 123 Thorn, F., Pt., D, 63d May5, Left; flap. Dr. R. Faulkner, 92 Potter, J. W., Corp l, C, Sept. 30, Left ; antero-posterior flap. A. Pennsylvania, age 28. Aug. 17, Erie, Penn. (Gangrene. May 1st Michigan Sharp Nov. 4, A. Surg. J. S. Wheeler. Dis 1864. 26, exc. lower 3d fib.) Disch d shooters, age 22. 1864. charged May 9, 1865. />:. 4229. March 18, 1805. Spec. 2"02. 93 Kathlmrn, C.W., Corp l, De. 13, 62, Left ; flap. A. A. Surgeon E. 124 Truel, E. M., Pt., E, July 21, Right ; circular. Surg. J. G. Mil B, 1st Rhode Island Sept. 16, Seyffarth. Discharged J uue 24, 12th Wisconsin, age 23. Sept. 8, ler, llth Iowa. Disch d August Artillery, age 29. 1863. 1864. 1864. 31, 1865. 94 Reed, J., Pt., E, 89th New York, nge 24. Sept. 29, Nov. 5, Left; antero-posterior flap. Surg. G. S. Palmer, U. S. V. Furl d 125 Tuttle, B., Pt., F, 1st Michigan, age 24. Aug. 30, 1862, Right; circular. A. A. Surg. T. H. Allison. Discharged April 1864. April 10, 1865. Ja.22, 63. 10, 1863. 95 Roberts, H., Pt., F, 12th N<>.29, 64, Left : oval flap. Discharged May 126 Walters, M.,Pt.,K, 120th July 2, Left : circular. A. A. Surg. A.W. Kentucky, age 2:?. April 20, 6, 1865. New York, age 20. Oct. 26, Colburn. (Hemorrhage.) Dis 1865. 1863. charged October 14, 1864. 96 Rounds, J. E., Pt., E, 2d May 6, Right ; circular. Surgeon D. W. 127 Warmack, J. W., Pt., H, De.31, 62, Left. Surg. M. P. Scott, P.A.C.S. U. S. Sharpshooters, June 22, Bliss, U. S. V. Discharged May 44th Tennessee. Feb. 5, Recovery. age 25. 1864. 15, 1865. 1863. 97 Ross, J., Pt.. I. 2d N. Y. May 19, Left: flap. Surg. D. W. Bliss, 128 Webb, M., Pt., A, 114th June 25, Right: lateral flap. Ass t Surg. Heavy Artillery, age U. S.V. (Prim. amp. ank. joint.) New York. Aug. 18, W. S. Webster, 156th N. York. 40. 1864. Disch d March 15, 1865. Died 1863. Recovery. Jan.8, 77; apop. andhemiplegia. 129 W T elsch,J. M., Pt.,B, 8th Mav 20, Right ; flap. Surg. G. Derby, 23d 98 Rnmbaugh, W., Pt., D, April 5, Left. Dr. R. WalUice, ItutlerCo., Maine, age 21. 1864, Mass. (Necrosis.) Hsemorrh. 62d Pennsylvania. July 11, 1862. Penn. Discharged Februarys, 1863. Mar. 26, 1865. April 12, 1865, amputat n thigh. Discharged August 25, 1865. 99 Russell, A. K., Pt., II, Mav 19, Left. Surg. C. N. Chamberlain, 130 Wells. G. W., Pt., K, 4th Aug. 16, Right; ant. posterior flap. A. A. 1st Massachusetts Ar 1864. U. S. V. (Primary amputation New Hampshire, age 1864, Surg. J. C. Morton. (Oct. 22, tillery, age 43. ankle joint : Syme s.) Disch d 24. Jan. 16. 1804, Syme s amputation foot.) June 2, 1865. 1865. Discharged January 11, 1865. SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. Sanitary Commission Memoirs, New York, 1871, Surg. Vol. II, p. 136. 550 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITABY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 131 West, J. G., Corp l, H, July 2, Right : flap. A. A. Surg. B. B. 153 Kelly, J. A.. Pt., C, 21st De.31, 62, Left. Died March 23, 1863. 62d Pennsylvania, use Aug. 14, Miles. (Gangrene.) Discharged Michigan. Mar, 19, 19. 163. December 16, 1863. Spec. 1669. 1863. 132 Westfall. H., Pt., D, 9th Sept. 17, Right; anterior post. flap. Surg. 154 Loyd. D.. Capt., E, 121st June 27, Left; flap. A. A. Surg. J. A. Hall. New York, age 28. Oct. 21, T.H. Squire, 89th N.Y. Disch d Ohio, age 33. July 28, Died August 7, 1864 ; pyaemia. 1862. April 8, 1863. Spec. 275. 1864. 133 WheaUrly, J. M., Pt., I, .Sept. -, Right. Surg. Gilmore, C. S.A. 155 Martin, M. V., Pt., C. Nov. 25, Right. A. A. Surg.G. P. Hachen- 13th Mississippi. De.W/62. Recovery. llth Tennessee, age 22. 1863, berg. (Necrosed.) March 21, 134 Whilty. J., Pt., A, 6th May5, 64, Left ; circular. Surg. H. Culbert- Mar. 10. gangrene. Died March 25, 64 ; Wisconsin, age 22. Feb. 8, son. I 1 . S. V. (May 31, 1864, 1864. pneumonia. Spec. 2203. 1865. Syme s amputation ankle joint.) 156 McRae. C.. Pt., A, 27th May 6, Right; anterior post. flap. Surg. Discharged June 26, 1865. Michigan, age 34. June 10, R. B. Bontecou, U. S. V. Died 135 White, M., Pt.. I, 60th Sept. 19, Left ; circular. Surg. J.W. Law- 1864. July 18, 1864. Spec. 3069. Virginia, age 34. Nov. 12, son, P. A. C. S. Exchanged 157 Mickee. J., Pt., 1, 88th May 18, Right. Died July 24, 1864. 1864. February 16, 1865. Illinois. July 18, 136 White, R. H., Pt., D, 9th Dec. 13, Right; circular. May 24, 1864, 1864. N. York State Militia. 1862, re-amputation. Disch d April 158 Miller, J., Pt., H, 26th June 27, Left ; circular. A. A. Surg. J.W. Feb.5, 63. 24, ]863. Ohio, age 18. Aug. 7, Digby. Died August 31, 1864 ; 137 Wright, J.L., Pt.,G, 97th Nov. 30, Left ; circular. Surg. R. R. Tay 1864. exhaustion. Ohio, age 24. 1864, lor, IT. S. V. Discharged June 159 Mitchell, J.. Pt., I. 1st May 16, Night: circular. A. A. Surg. J. Jan.8, 65. 10, 1865. Maine Heavy Artillery, July 6, P. Arthur. Died July 9, 1864. 138 Bennett, C., Pt., D. 9th May 19, Right; circular. A. A. Surg. M. age 45. 1864. N. Hampshire, age 19. Aug. lit, Lampen. (Gang.; sloughing.) 160 Morrnn, J. A., Pt., D, Feb. 3, Right. Died March 31, 1863. 1864. Died August 28. 1864 ; pyaemia. 4th Alabama Cavalry. Mar. 13, Spec. 1036. Spec. 3637. 1863. 139 Brackett, W. H., Corp l, Mar. 14, Left : circular. A. A. Surg. J. B. 161 Nichols, J. B., Pt., A, June 17, Right ; circular. A. A. Surg. W. B, 21st Massachusetts. May 5, Upham. Died May 16, ISfW ; 24th New York Caval Aug. 24, P. Moon. Died Sept. 7, 1864. 1862. exhaustion. ry, age 18. 1864. 140 Bussler, D., Pt., K, 93d Mar. 25. Left; circular. A. A. Surg. H. I|162 O Brien, J., Pt., F, 19th Sept. 20, Right. A. Surg. W. E. White- Pennsylvania, age 19. May 6, Craft. (Spicula rcm.; gangrene.) Infantry. 1863, head, U. S. A. Died January 1865. Died May 15, 186."); pyaemia. Jan. 8, 64. 26. 1864. Spec. 2034. Spec. 195. 163 Penny, W., Pt., G, 2d July 4, Right ; post. flap. A. A. Surg. 141 Cannel, J., Serg t, A, May 9, Right; circular. A. A. Surg. H. Maryland, age ii2. Sep. I, 64. J. Tyson. Died September 29. 124th Ohio, age 27. June 11, C. May. Died October 4, 1864 ; 1864 ; exhaustion. 1864. exhaustion. Spec. 3359. 164 Pero, P., Pt., C, 2d New May 5, Right. A. A. Surg. F. Hassen- 142 Carl, P. S., Corp l, K, Aug 29, . Died October 7, 1862. York Cavalry, age 22. June 20, berg. (May 7, excis. met. and 20th New York State 1864. fragm ts ; hsem.) Died July 15, Militia. 1862. 1864; chronic diarrhoea. 143 Clellar, J. A., Pt., A, April 7, . (Removal of fragments.) 165 RliofJun,}}. .,Pt., F,4th Right : circular. 15th Infantry. 1862. Died May 12, 1862; pyaemia. North Carolina. 144 Deyer, J., Pt., Chicago June 21, Left ; circ. Surg. S. JO. Fuller, 166 Schmid. J. (. ,., .Serg t, F, Aug. 10, Left; circular. Died October 7, Battery, age 27. July 25, U. S. V. Died August 2, 1864 ; 1st Rhode Island Art y, Sept. 22, 1864 ; gangrene. Kpec. 3647. 18fi4. chronic diarrhoea. age 26. 1864. 145 Fern, R, Pt., C, 21st May 17, Right. Died June 26, 1863; 167 Shoemaker, H. E., Pt., May 31, Left. Ass t Surg. W. Thomson. Iowa. June 23, chronic diarrhoea. C, 52d Pennsylvania. July 1, IT. S. A. Died October 9, 1862 ; 1863. 1862. gangrene, Ispec. 4936. 146 Garland, I., Pt., C, 1st June 18, Left. (Gangrenous.) Died Au 168 Smith, II. W., Serg t, K, July 3, Left. Ass t Surg. 1). C. Peters, Maine Heavy Artillery. Aug. 6, gust 10, 1864; pyaemia. lllth N. York, age 20. Aug. 4, U.S.A. Died August 8, 1863. 1864. 1863. Spec. 1607. 147 Gillmore, L., Pt., K, June 3, Left ; anterior post. flap. Surg. 169 Spinklcr, J. If., Pt., I, May 3, Right; circular. Died Septem lllth Pennsylvania. July 8, E. Bentley, IT. S.V. (Necrosis.) 18th North Carolina, Aug. 31, ber. !, 1863; effects (amputation 1864. Died July 16, 1864; pyaemia. age 30. 1863. last resort). Spec. 3352 . 170 Stead, J. W., Pt., K, 3d May 15, Left; flap. A. A. Surg. H. H. 148 Gregg, R., Pt., C, 1st June 18, Right; circ. A. A. Surg. O. W. N. Hampshire, age 24. June 21, White. Died July 16, 1864; Maine Heavy Artillery, July 28, Peck. (July 12, Syme s amp. 1864. irritative fever. age 37. 1864. ankle joint.) Died Sept. 30, 64. 171 Stout, I., Corp l, C, 79th July 20, Left; circular. A. A. Surg. F. C. 149 Sathaway, W. H., Pt..G, Nov. 29, Left: circular. A. A. Surg. C. H. Ohio, age 26. Sept. 10, Leber. Gangrene. Died Sep 33d Alabama, age 44. Dec. 31, Fisher. Died January 31, 1865. 1864. tember 12, 1864. 1864. 172 Troxler, G. S., Pt., A, Mar. 25, Left; circular. A. A. Surgeon J. 150 Ingram, S., Pt., A, 161st April 8, Right ; flap. A. A. Surg. II. La 59th North Carolina, Apr! 129. Morris. Died May 5, 1865; ery New York, age 18. Aug. 14, tham. Died August 29, 1864. age 41. 1865. sipelas. 1864. 173 Wiekson, D. D., Pt., I, Sept. 17, Left ; anterior post. flap. Ass t 151 Jennings, J. T., Corp l. Feb. 6, Left; lat. oval skin flap. A. A. 59th New York. Dec. 1, Surgeon J. B. Brinton, U. S. A. K, 56th Pennsylvania, Mar. 9, Surg. E. G. Waters. (Necrosis.) 1862. Died Dec. 16, 1862. tfpec. 797. age 48. 1865. Died March 22, 1865; pyaemia. 174 Young, W., Pt., G, 8th June 9, Right. Died July 20, 1863. Spec. 152 Johnston, W.,Pt., E, 26th Aug. 29, Right. Died November 5. 1862. Illinois Cavalry. July 10, 1345. Pennsylvania. 1862. 1863. Secondary Amputations in the Lower Third of the Leg for Shot Injury. The num ber of secondary operations in the lower third of the leg is one hundred and twenty-one; eighty-six patients survived the operation and thirty-five, or 28.9 per cent., succumbed. The right limb was amputated in fifty-five, and the left in sixty-two instances; in four cases the side was not specified. Recoveries after /Secondary Amputations in the Lower Third of the Leg. Of the eighty-six operations of this group nine were performed on Confederate and seventy-seven on Union soldiers. The latter were pensioned, and one only has died since the date of discharge from the service. CASE 800. Private W. Nash, Co. C, 187th Pennsylvania, aged 19 years, was wounded in the right foot, before Peters burg, June 18, 1864. Surgeon C. N. Chamberlain, U. S. V., reported his admission to the field hospital of the 4th division, Fifth Corps, "with "severe injury to the bones of the foot, caused by a minie ball." From the field hospital the wounded man passed to City Point, thence to hospital at Alexandria, and subset] uently to Philadelphia. Assistant Surgeon T. C. Brainerd, U. S. A., in charge of Broad and Cherry Streets Hospital, described the injury as a compound fracture of the tarsus, followed SECT, v.l SECONDAKY AMPUTATIONS IN THE LEG. 551 by necrosis of bone, pain in the foot, and free discharge, for which the leg was amputated at the lower third by circular method, on May 8th, by Acting Assistant Surgeon H. M. Bellows. At the time of the operation the patient had become much exhausted from the profuse and continued discharges from the wound. He reacted promptly, ether having been used as an anaesthetic. Dry dressings were applied." The operator subsequently communicated that the stump only required three weeks to heal per fectly. The patient afterwards passed through various hospitals, and was ultimately mustered out at the expiration of his time of service, August 3, 1865, and pensioned. Several years later, when seen and examined by the operator, the pensioner was found in general good health and with a good, round, and entirely healed stump, he being able to walk satisfactorily with the aid of an artificial limb. In his application for commutation, in 1870, the pensioner described the stump as being "not in the best condition;" but in his subsequent statements, five and ten years later, lie reported its condition as "good." The pensioner was paid September 4, 1880. CASE 801. Private D. Dietz, Co. B, 48th Pennsylvania, aged 21 years, was wounded in the left ankle joint, at Spott- sylvania, May 12, 1864. He remained at a field hospital for two weeks and was then conveyed to Washington, where he was admitted to Campbell Hospital. Surgeon A. F. Sheldon, U. S. V., contributed the pathological specimen, No. 4032, repre sented in the annexed wood-cut (FlG. 324), with the following history of the injury: "A musket ball entered the left foot posteriorly, passed forward between the astragalus and tibia, and emerged anteriorly, opposite the point of entrance, fracturing the articulating surfaces of both bones. Circular amputation through the inferior third of the leg was performed by Assistant Surgeon A. Delany, U. S. V., on November 10th, two ligatures being applied and anaesthesia produced by chloroform. At the time of the operation the foot and ankle were enlarged, with numerous openings discharging sanguinolent pus. Hectic irritation, pain, and loss of appetite were rapidly overcoming what little vitality remained. The patient bore the operation well." The patient was subsequently transferred to Judiciary Square Hospital for the purpose of being fitted with an artificial limb, and on May 19, 1865, he was discharged from service and pensioned. In his application for commutation, dated 1870, he described the stump as "healed and well," and subsequently he reported it as being in "good condition." The pensioner was paid June 4, 1880. The specimen consists of the bones com- FIG. 324. Bones prising the ankle of the amputated leg, and shows that large quantities of spongy new bone were thrown out momL^n around the tibia, but the bodies of the bones were destroyed by suppuration. Spec. 4058. CASE 802 Private C. W. Fox, Co. I, lllth New York, aged 18 years, was wounded in the right foot during the engagement at the South Side Railroad, March 31, 1865. He was admitted to Harewood Hospital, Washington, five days after wards, where amputation was performed by Surgeon R. B. Bontecou, U. S. V., who made the following report: "The metatarsal bone of the big toe was fractured and the os calcis severely injured. When admitted the patient appeared to be considerably debilitated; the condition of the injured parts, however, was tolerably good. The parts subsequently became gangrenous, with disorganization of the ankle joint, sloughing of soft parts, and necrosis of bone. Sinuses formed and extended up the leg. The limb was amputated at the lower third by the circular method on May 3d. The patient did well after the operation under simple dressings, aided by a supporting and nourishing diet throughout. The parts had nearly healed when he was transferred to Armory Square Hospital July 20th." About one month later he was transferred to Stanton Hospital, where a second operation became necessary and was performed by Surgeon B. B. Wilson, U. S. V., who describes it as follows: "The first amputation had been performed about one inch above the ankle joint. At the time of the patient s admission to Stanton Hospital the stump bnd entirely healed, but it was swollen and painful and presented evidence of suppurative inflammation within. Poultices were applied and abscesses soon pointed in two or three places, one in or near the cicatrix of the operation and the other* along the lower part of the shaft of the tibia, which, on rupturing, discharged a bloody and ill-conditioned pus pretty freely. Upon examination with a probe the existence of necrosed bone was detected, and at the earnest request of the patient, who desired to get rid of his trouble as quickly and fully as possible, it was determined to re-amputate the stump as far as the sequestrum extended. The operation was performed on September 6th, three inches of the bones being removed by the ordinary circular method and the sequestrum found to extend quite up to the point severed by the saw. The integument was brought together laterally and secured by interrupted sutures and adhesive straps. The patient did well and the healing process progressed rapidly. At the closing of Stanton Hospital, on September 19th, he was sent to Douglas Hospital, where I saw him two weeks afterwards, when the stump was almost entirely healed and looked admirably." In October, 1865, the patient was discharged from service, to date from September 6th, and pensioned, having been previously supplied with an artificial leg. In his appli cations for commutation he described the stump as being in "sound" and "good condition." His pension was paid September 4, 1880. The bones removed at the second amputation were contributed to the Museum by the operator and constitute specimen 2454 of the Surgical Section, exhibiting the fibula in a state of caries and a large spongy involucrum surrounding a small sequestrum of the tibia. fatal Secondary Amputations in the Lower Third of the Leg for Shot Injury. In the thirty-five cases of this class pyaemia was noted in ten, gangrene in ten, erysipelas in two, and secondary haemorrhage in one instance. Nine of the patients were Confederate and twenty-six Union soldiers: CASE 803. Private W. J. Craps, Co. D, 24th South Carolina, aged 33 years, was wounded at Franklin, November 30, 1864, by a musket ball, which entered the external lateral aspect of the left ankle immediately over the malleolus, passed inward, and emerged at the internal aspect in front of the internal malleolus, fracturing the inferior end of the fibula and opening the ankle joint. The man was taken prisoner and admitted to hospital No. 1, at Nashville, four weeks after receiving the injury. The tissues about the ankle joint and dorsum of foot became swollen and infiltrated, which was followed by profuse discharge of carious pus from three fistulous openings. On February 17, 1865, the leg was amputated at the lower third by Surgeon B. B. Breed, U. S. V. The operation was performed by bi-lateral skin flaps and circular section of muscles, two ounces of blood 552 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. being lost and three ligatures applied. Chloroform was used and was followed by prompt reaction. At the time of the oper ation the patient was much exhausted and suffering from obstinate diarrhoea. Disinfectant dressings were used, also tonics, stimulants, and supporting diet. The patient died of exhaustion March 11, 1865. The tarsal and metatarsal bones of the amputated limb, contributed with the history by the operator, constitute specimen 4217 of the Surgical Section of the Museum. The internal and middle cuneiform bones are wanting in the specimen, and the first metatarsal is obliquely fractured. CASK 804. Private S. B. Dudley, Co. B, 97th Indiana, aged 24 years, was wounded at Kenesaw Mountain, June 27, 1864. Surgeon J. M. Woodworth, 1st Illinois Light Artillery, reported his admission to the field hospital of the 4th division, Fifteenth Corps, with "shot fracture of right ankle joint." From the field the wounded man was successively transferred to hospitals at Rome, Chattanooga, and Nashville, and lastly, on November 29th, he entered Crittendeii Hospital at Louisville, where the injured limb was amputated by Surgeon R. R. Taylor, U. S. V., who made the following report: "The wound was caused by a mini6 ball, which perforated the joint anteriorly. The injury resulted in anchylosis and inflammation of the ankle joint, and fistulous openings formed around the joint leading to carious bone. The disease, enkindled in the articulation and adjacent parts, became so extensive that amputation had to be performed through the lower third of the leg on February 18, 1865. Chloroform was used and the operation was done by the circular method, the patient being in good general health at the time. Simple dressings were applied, and for a time the case promised well; but in a few weeks the patient was seized with traumatic erysipelas, which rapidly extended over the entire leg and thigh, and in spite of an energetic supporting treatment he sank rapidly. His deatli occurred February 28, 1865." The bones comprising the injured ankle joint, Spec. 4248, were contributed to the Museum by the operator and are represented in the wood cut (FlG. 325), showing the articulation in a state of anchylosis and exhibiting marked periosteal disturb ance in the shafts of the tibia and fibula for several inches. The specimen also reveals the outer border of the calcaneum to have been grooved and the posterior portion of the astragal us to have been carried away. CASE 805. Private L. Ordway, Co. A, 19th Maine, aged 33 years, was wounded before Petersburg, June 22, 1864, and entered Broad and Cherry Streets Hospital, Philadelphia, eight days afterwards. Assistant Surgeon T. C. Brainerd, II. S. A., reported: "The injury consisted of a gunshot fracture of the left ankle joint, the ball entering directly over the internal malle- olus, fracturing it and a portion of the upper and inner articulating edge of the astragalus. The wound sloughed very badly and the patient became very much emaciated. Amputation was deemed necessary, and was performed by the circular method, at the lower third of the leg, on July 23d, by Acting Assistant Surgeon F. H. Getchell. Chloroform was used. The patient reacted well for one so weak as he was, and the stump looked healthy for two days, after which sloughing set in. Dry dressings were applied and beef-tea, tonics, and stimulants were administered. The patient continued to sink, and died of exhaustion July 28, 1864." The amputated bones of the ankle, carious and showing no attempt at repair, were contributed to the Museum by the operator and constitute specimen 3b 63 of the Surgical Section. TABLE LXXVIII. Summary of One Hundred and Twenty-one Cases of Secondary Amputations in the Lower Third of the Leg for Shot Injury. (Recoveries, 186; Deaths, 87 121. J FIB. 325. The bones of the right ankle eight months after injury. Spec. 4248. No. NAME, MILITARY DESCRIPTION, AND AUE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAMK, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. J Allhands, F. M., Lieut., May 11, Right; flap. A. A. Surg. J. H. 10 Burnett W. July 4, Left (necrosis). Discharged Feb E, 35th Illinois, age 32. July 18, Green. (Synovitis anderysip.) De.24, 63. ruary?, 1864. J864. Discharged January 2, 1865. 11 Burns, C. E., Pt., D, 12th Aug. 29, Right ; double flap. Surg. J. H. 2 Arnett, W. W., Pt., I, Dec. 15, Right ; flap. To Provost Mar Massachusetts, age 24. 1862, Baxter, U. S. V. (Sept. 13, 62, 14th Miss., age 38. 1864, shal May 31, 1865. April 23, Syme s amputation ankle joint.) Jan. 20, 1863. Disch d July 11, 1863. 1865. 12 Burrows, E., Pt., 19th May 1, Right; flap. A. A. Surg. E. L. 3 Bailey D. Pt. G 3d June 10 Riirht Dr T C 1 Huchcc X Y. liutterv ficc 31 Iowa Cavalry, age 26. 1864, (Sloughing: ligation plantar.) 1864! Discharged September 23, 1865. Feb. -, 65. Discuarged Sept. 11, 1865. 13 Burt, F. P., Pt., C, 22d May 8, Right; circular. A. A. Surg. H. 4 Bisbee, N., Serg t, K, June 18, Right ; flap. Surg. A. H. Thurs- Massachusetts, age 19. June 8, B. Knowles. Discharged Sep 89th New York. 1864, ton. U. S.V. (Amputat n toes.) 1864. tember 17, 1864. A p. 3, 65. Discharged May 25, 1865. 14 Guilders, F., Pt., G, 8th April 6, Right.. Surgeon Fish. Dis 5 1 Bralier, II. H., Pt., E, Aug. 30, Right ; Teale s method (circular). , Illinois. May7. 62. charged August 23, 1862. llth Pennsylvania. Oct. 5, 62. Ass t Surg. C. A. McCall, U.S.A.! 15 * 2 Connors, J., Pt., F, 76th July 11, Right ; antero-post. flap. A. A. Oct. 13, re-amputation. Disch d Pennsylvania, age 25. Sept. 27, Surgeon J. M. Fulton. (Syme s September 14, 1863. Spec. 167. 1863. amp. ankle joint.) Discharged 6 Brinson, J., Pt., G, 38th Dec.1, 62, Right; flap. Ass t Surg. A. T. I! August 28, 1865. Indiana, age 42. Feb. 24, Barnes, 98th Illinois. Disch d ! 16 Covell, E. R., Pt., C, May 18, Left; flap. Dr. R. Millar, R. I. 1863. May 21, 1863. 52d New York, age 38. 1864, Hospital. (May 18, 64, Syme s 7 Bromley, H., Pt., 1, 14th May 28, Right: flap. Discharged Janu May5, 69. amputation ankle.) Spec. 4369. Pennsylvania Cavalry, July 12, ary 27, 1865. 17 Crouse, J., Serg t, I, 1st July 2, Left, Discharged May 21, 1864. age &. 1864. New York Light Artil Aug. 2, Spec. 1651. 8 Brouchard, A., Pt., A, April 7, Left: circ. A. A. Surgeon J. M. lery, age 24. 1863. 5th New Hampshire, May 15, Downs. (April 17, excision met. 18 Detwiler, M. L., Serg t, Feb. 5, Right: flap. A. A. Surgeon A. age 31. 1865. bones.) Disch d Aug. 12, 1865. A, 30th Illinois, age 24. Mar. 22, Sterling. Discharged August 1866, am]), knee j t ; amp. thigh. 1864. 30, 1864. 9 Brown, R., Pt., G, 28th Aug. 9, Right: circular. A. A. Surg. S. 19 Diets, D., Pt., B, 48th May 12, Left; circ. Ass t Surg. A. Delany, New York, age 19. Sept. 27, E. Fuller. Disch d October 23, Pennsylvania, age 21. Nov. 10. U. S. V. Discharged May 19, 1862. 1862. Spec. 326. 1864. 1865. Spec. 4052. 1 COUES (E.), Report of some Cases of Amputations and Rejections from Gunshot Wounds, etc., in Med. and Surg. Reporter, 1862-3, Vol. IX, p. 196. 3 SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. Sanitary Commission Memoirs, New York, 1871, Surg. Vol. II, p. 138. * SMITH (S.), Loc. tit., p. 136. SECT. V.] SECONDARY AMPUTATIONS IN THE LEG. 553 .NO. NAME, MII.ITAUV L)K6CUI1 T1O.N, AND AGE. DATKS. OPERATIONS, OPKUATOEB, RESULT. NO. NAMK, MILITARY DKSCUIPTIOX, AND AGE. DATES. Ol KUATlOXS, Ol EHA IOK8, RESULT. 20 Donahue, M.C., Seaman, Jan. 11, Right. A. A. Surg. G. Bigsby. 49 Keen, G., Pt., A, 8th May 23, Left ; circular. Surg.W.Wutson, U. S. Gunboat Baron Feb. 11, Discharged April 30, 1863. Indiana. July 9, U. S. V. Erysipelas. Disch d DeKalb." 1863. 1803. September 15, 1863. 21 Eastman, J. E., Serg t, May 19, Right; skin flap. A. A. Surg. G. 50 Kelsey, A., Pt., D, 53d July 12, Right; flap. Surg. J. T. Ran L, 1st Mass. Heavy July 8, O. Moody. Discharged July Illinois, age 21. Sept. 19, dolph, U. S. A. Discharged May Artillery, age 39. 1864. 12, 1865. 1863. 25, 1865. 22 Egan, ()., I t., E, 17th Feb. 1. Lett; circular. A. A. Surg. J. B. 51 Kock, W., Serg t, A, 1st May 15, Right; anterior flap. Ass tSurg. Massachusetts, uge 27. May 14, Cutter. Gangrene. Discharged Virginia Artillery, age Sept. 25, G. B. Parker, U. S. V. Disch d 1864. August 3, 1864. 28. 1864. May 19, 1865. O i Evans, C., I t., E, 120th Mav 3. Left. Discharged November 16, 52 Lee, D., Pt., B, 37th Mar. 7, Right ; flap. Surg. E. A. Clark, New York. J y , 63. 1863. Spec. 1346. Illinois. June 22, U. S. V. Discharged August 24 Evans, J., I t., 1, 19th May 15, Left ; circular. Discharged Sep 1862. 23, 1862. Michigan, age 40. June 15, tember 13, 1865. 53 Lillibridge, F. W., Pt., June 18, Right. (June 18, Chopart s amp. 1864. B, 2d N. Y. Mounted 1864. foot.) Disch d August 10, 1865. 25 Farren, B., Pt., A, 82d April 8, Right; circular. A. A. Surg. J. Rifles. Circular amput n leg afterward. Pennsylvania, age 49. Oct. 25, B. Roe. Recovered February 54 Long, J., Pt., F, 8th May 22, Right ; flap. Dii^harged Sep 1865. 22, 1866. Indiana. June 23, tember 8, 1863. 26 Finegan, P., Pt., H, 16th Dec. 81, Right. Dr. J. H. Armsby. (Dis 1863. Infantry, age 34. 181)2, charged Feb. 21, 1865; chronic 55 Martin, T. B., Pt., A, July 3, Left ; circular. Surg. Gillett, Feb. , erysipelas of foot. 27th, partial 24th Virginia. Aug. 14, C. S. A. (Haemorrhage.) Re 1866. amputation of foot.) 1863. covery. 27 Foster, T. J., Pt., H, May 12, Left : circular. A. A. Surg. A. F. 56 May, M., Pt., A, 9tfi Sept. 17, Left ; lateral flap. (Primary amp. 140th I cnn., age 21. June 24, A. King. Discharged .Septem New York, age 22. 1862, ankle joint. Disch d Jan. 16, 1864. ber 28, 1864. Ap. -, 63. 1863.) 1870, stump sound. 28 Fox, C. W., Pt , I, lllth Mar. 31, Right ; circ. Surg. R. B. Bonte- 57 McDermott, M., Corp l, Dec. 13, Left. Specimen 263, A. M. M. New York, age 13. May 3, cou, U. S. V. Sept. 7, re-amp. 1st Virginia Cavalry. 1862, 1865. Disch d Sept. 6, 65. Spec. 2454. , 64. 29 Francis. F., l>t., C. 5th July 18, Right ; long post. flap. Surg. 58 Nash, W., Pt., C, 187th June 18, Right ; circular. A. A. Surg. H. New York Heavy Ar Aug. 20, Miller, C. S. A . March 30, 1865, Pennsylvania, age 19. 1864, . M. Bellows. Discharged Aug. tillery, age 17 1864. re-amp. Discharged August J 1, Mav8, 65. :i, 1865. 1865. Specs. 4301, 4327. 59 Newman, L., Pt., A, July 20, Right; circular. A. A. Surg. 30 Fulmer. S. D., Pt., F, July 2, Right ; circular. A. A. Surg. F. 149th New York. Sept. 21, R. McNulty. Discharged 1865. 105th I enn.. age 21. Aug. 21, Hinkle. Discharged Aug. 27, 1864. Re-amputation 1867. 1863. 1864. Spec. 1667. 60 Nutter, S. A., Pt., I, 1st June 7, Left; flap. Drs. A. Towlo and 31 Gallaher, J..Pt.,C, 10th July 2, Left. Exchanged October 2, 63. Maine Cavalry. Sept. 13, J. Sawyer. Biddeford, Maine. Louisiana, age 37. Aug. 24, Spec. 2050. 1864. Discharged July 27, 1865. 1863. 61 Oyler, A., Pt., D, 55th Se.29, G4, Right ; flap. Surg. W. Watson, 32 Gardiner, A., Pt., D, 93d May 5, Right. Surg. N. R. Moseley, U. Pennsylvania, age 30. Jan. 18, 105th Penn. (Gangrene.) Dis New York, age 19. June 21, S.V. June 26, gangrene. Sept. 1865. charged May 25, 1865. 1864. 4, nccro. bone rem d. Disch d 62 Pendleton, K.. Pt., G, Mar. 8, Left; circular. Ass t Surg. E. May 1 1 , 1865. Spec. 2251 . 27th Mass., age 21. April 18, F. Hendriok, 15th Connecticut. 33 Gibbons, J. S., Pt., K, Sept. 16, . Surgeon Jett, C. S. A. 1865. Discharged Nov. 23, 1865. 30th Virginia. 1862, Retired February 15, 1865. 63 Perkins, H., Pt., G, 44th Dec.1, 64, Left. A. A. Surg. J. S. Giltner. June 18, Colored Troops, age 18. Feb. , Discharged January 16, 1866. 1864. 1865. 34 Good, J. P., Pt., K,203d Jan. 15, Left ; circular. Mustered out 64 Peters, H., Pt., A, 59th May 17, Left ; antero-post. flap. March Pennsylvania, age 31 . Feb. 15, May 24, 1865. New York, age 33. Aug. 17, 26, 1865, re-amputat n. Disch d 1865. 1864. June 6, 1865. Spfe. 4335. 35 Grantham, J. W., Corp l, Nov. 30, Right ; antero-posterior flap. A. 65 Pisher, J. H., Pt., C, 38th July 12, Left : flap. Ass t Surg. H. Allen, A, 7th Florida, age 26. 1864, A. Surg. R. McNeilly. Provost Wisconsin, age 30. Aug. 15, U. S. A. Discharged April 8, Jan. 24, Marshal May 6, 1865. 1864. 1865. 1865. 66 Powers, J. W., Pt.,.C, Mav 16, Left ; flap. Discharged Decem 36 Grover, L. G., Corp l, G, April 23, Left; flap. Dr. George Collins, 29th Wisconsin, age 21. Sept. 18, ber 19, 1864. 30th Maine., age 21. Aug. 13, Bethel, Maine. Disch d Jan 1863. 1864. uary 8, 1865. 67 Price, S. B., Serg t, A, May 15, Left ; circular. Surg. R. L. Stan 37 Haslam.J., Pt., H, 129th Dec. 13, Right; flap. Dr. A. H. Halber- 2d Ohio, age 22. June 15, ford, U. S. V. (May 15, Syme s Pennsylvania, age 30. 1862, stadt, Pottsville. Penn. (Dis 1864. amp. ankle joint; gangrene.) Nov. 17, charged May 18, 1863; amp. Discharged October 10, 1864. 1867. toes.) 1868, caries; necrosis. 68 Pyle, G., Pt., D, 15th July 3, Left ; circular. A. A. Surg. C. H. June 25, 1868, re-amputation. infantry, age 19. Aug. 30, Fisher. Disch d July 11, 1865. 38 Hawley, W. S., Corp l, May 19, Left; flap. A. A. Surgeon J. H. 1864. Died March 27, 1870. E, 51st New York, age Oct. 15, Thompson. (May 19, amput n 69 Quinn, J., Serg t, K, Mav 16, Left ; circular. A. A. Surg. J. H. 30. 1864. meta.) Disch d May 21, 1865. 169th New York, age Aug. 19, Thompson. Discharged May 3, 39 Harden, I., Pt., K, 14th Sept. 19, Left; antero posterior flap. A. 21. 1864. 1865. Spec. 3102. Ohio, age 20. 1863, A. Surg. J. H. Drury. Erysip 70 Reizler, C., Pt., B, 7th June 3, Left; lateral skin flap. A. A. June 13, elas. Disch d August 11, i864. New York Heavy Ar July 21, Surg. F. E. Marsh. Discharged 1864. tillery, age 47. 1864. March 31, 1865. 40 Hefferman, P., Pt., H, Aug. 29, Left ; antero-posterior flap. A. 71 Renfro, U., Pt., C, 3d May 20, Right. Ass tSurg. R. B. Maury, 14th Infantry, age 22. 1862, A. Surg. U. J. Levis. (Septem Missouri. 1863, P. A. C. S. Recovery. Oct. 8, ber 9, 1863, Chopart s amputa Feb.1, 64. 1863. tion.) Disch d May 17, 1864. 72 Robinson, T., Pt., II, June 3, Left; flap. (Discharged Novem 41 Henderson, D. H., Lieut., Oct. 4, 62. Left ; flap. Resigned February 81st Pennsylvania. Dec. 7, ber 9, 1864.) C, 12th Iowa. Jan. 26, 16, 1863. 1864. 1863. 73 Schneider, G., Pt., E, Sept. 14, Left ; flap. Discharged October 42 Hoffrichter, H., Corp l Mar. 20, Left ; flap. Surg. B. N. Fish, 4th Pennsylvania. Dec. 16, 14, 1863. G, 46th Ohio, age 23. April 20, 27th Mass. Discharged August 1862. 1865. 12, 1865. 74 Schroeder, J., Pt., C, 2d Oct. 8, Left. Surg. J. G. Hatchitt, U. S. 43 Holden, W. G., Pt., B. Aug. 19, Left ; antero-posterior flap. Dis Missouri. Nov. , V. Discharged February 19, 30th Mass., age 29. Oct. 19, charged June 9, 1865. 1862. 1863. 1864. 7.~> Siddall.J., I t., A, 90th Aug. 30, Left ; flap. Ass t Surg. W. E. 44 Hunt, E. W., Pt., I, 57th Mav 13, Right. Dr. Gage, Worcester. Pennsylvania, age 20. Oct.3, 62. Waters, U. S. A. Discharged Massachusetts. Sep."2, 64. Ga)ig. Sept. 24, re-amputation. February 17, 1864. Discharged June 30, 1865. 76 Snyder, A., Pt., H, 75th May 27, Right ; circular. Discharged Au 45 Johnson. A. W., Pt., K, Dec. 13, Left ; flap. (December 20, 1862, New York. J y -, 63. gust 29. 1863. 64th New York, nge 23. 1862, Syme s amputat n. Discharged 77 Spielman, T., Pt., F, Aug. 30, Right; circular. A. A. Surg. C. Oct. 9, 63. January 29, 1863.) 95th Ohio, age 23. 1862, E. Boyle. (Rom. of os calcis.) 4*5 Johnson, S., Pt., C, 24th Feb. 1, Left; flap (caries). Discharged July 10, (Discharged February 4, 1864.) Missouri, age 25. Mar. 17, May 5, 1863. 1864. 1863. 78 Stackpole. F. A. H., Pt., May 3, Left; circular. Surg. J.A. Lidell, 47 Janus, W., Pt., G. 5th July 2, Left. Surg, C. H. Mastin, C. S. A. A, 6th Maine, age 21. Nov. 24, U. S. V. Discharged June 18, Texas, age 22. Aug. 5, October 18, bone removed. Ex 1863. 1864. Spec. 1847. 1863. changed March 17, 1864. 79 Taylor, J. L., Pt., F, 7th May 5, Left ; circular. Surg. Tucker, 48 Keefer, H.. Pt., K, 74th Feb. 23, Right; flap. Discharged April Wisconsin, age 39. June 5, C.- S. A. Dec. 26, rem. of seq. Indiana. Ap. 7, 63. 26, 1865. 1864. Disch d May 26, 65. Spec. 3697. 1 BUYAX ( J.), Seventeen Additional Cases of Amputations from the Armies of the Southwest, in American Medical Times, 1863, Vol. VII, p. 287. SUUG. Ill 70 554 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAMK, MILITARY DESCRIPTION, AND AGE. DATES. Ol EUATIOVS, OPERATORS, RKSULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPKHATIOXS, OPERATORS, RKSULT. 80 Thomas, T. M., Pt., E. May 24. Left; lateral skin flap. A. A. 101 Kaufman, C. E., Pt., H, Aug. 30, . Died October 9, 1862. 155th Penn., age 23. Aug.5, 64. Surg. F. E. Marsh. Discharged 1st Pennsylvania Res. 62. March 31, 1865. 102 Keneily, A. V., Pt., K, Sept. 17, Right; necrosis. Died Decem- 81 Tuttle, J. B., Pt., F, 14th Sept. 19, Right ; lateral flap. A. A. Surg. Hampton s South Car Dec.2, 62. ber 13, 1862. Spec. 1097. New Hampshire, age 1864, J. Neff. Discharged July 10, olina Legion. 44. Jan. 4, 65. 1865. 103 Mcllale, J., Pt., D, 15th Nov. 25, Left : double flap. Died March QO Verdon, J., Pt., A, 17th .July 4 Left- flap A A Surg.W L Hays Infantry, age 21. 1863, 6. 1864; chronic diarrlui a. Infantry. Aug.6, 63. To Regiment Sept. 28, 1863. Feb.6, 64. 83 Von Schirach, F. C., Aug. 29, Right; flap. Resigned April 26, 104 McMullen, W., Pt., B, Aug. 29, . Died October 13, 1862. Lieut., E, 54th New Nov. 28, 1863. 24th New York. , 62. York. 1862. 105 Nevin, G. M., Pt., F, May 12, : Right ; circular. A. A. Surg.W. 84 White, A. H., Pt., D. Oct.2, 62, Right ; flap. A. A. Surg. W. A. 140th Penn., age 20. Juiie 29, 1J. Morrison. Died July 11, 64 ; 22d Illinois. Feb. 16, Johnson. Discharged May , 1864. typhoid fever. 1863. 1863. 106 Ordway, L., Pt.. A, 19th June 22, Left ; circular. A. A. Surg. F. H. 85 Williamson, J., Pt., B, May 2, Left; flap. Surg. J. H. Baxter, Maine, age 33. July 23, Getchell. Died July 8, 1864; 26th Pennsylvania, age June 2, U. S.V. Discharged June 18, Ifc64. exhaustion. Spec. 3663. 28. 1863. 1864. Spec. 1187. 107 Owens, H. J.. Serg t, I, Sept. 17, Right. Ass t Surg. C. Bacon, U. 86 Wilt, Z., Pt., A, 166th April 18, Left; flap. Discharged July 28, 14th Tennessee. Oct. 21, S. A. Died October 30, 1862. Pennsylvania, age 22. June 11, 1863. 1862. Spec. 364. 1863. 108 Palmer, S. H. A., Pt., I, July 3. Left (also fracture of ulna); gan- 87 Ambrose. H., Pt., H. July 2, Left. Died September 8, 1863; 2d New Hamp., age 35. Aug. 10, grene. Died August H, 1863; 20th Indiana, age 24. Aug. 14, pyaemia. , 63. pyaemia. 1863. 109 Pangh, J. W., Pt., E, 3d April 3, Right ; posterior flap. Died April 88 Ballard, J. H., Pt., E, July 2, Right. Died September 20, 1863 ; W. Virginia Cavalry. J863. 16.1863. Spec. 4276. 28th North Carolina, Aug. 20, pyasnii.i. Spec. 2062. 110 Pepper, G. W., 1 t., C, June 25, ; Left : flap. Surg. N. H. Moseley, age 30. 1863. 2d Pennsylvania H vy Aug. 14. I . S. V. Gangrene. Died A u- 89 Barrett, J. 15., Corp l, C, June 5, Left. Died July 10, 1864. Artillery, age 30. 1864. gust 25. 1864 Spec. 3127. 116th Ohio. J v 8, 64. Ill Perkins, J. C., 1 t., B, June 3, Left; circ. Surg. R. B. liontecou, 90 Beecher, E., Pt., E, 36th Oct. 8, Right. Died November 14, 1862. 81st New York, age 27. July 7, IT. S.V. (Also fract. right ankle Illinois, age 20. , 62. 1864. joint; excised.) Died July 17, 91 Blackwall, C. C., Col., Sept. 19, : circular. Surg.W. S. Love. J864; exhaustion. Spec. 3035. 23d N. Carolina, age Nov. 10, P. A. C. S. Died November 13, 112 Pollard, J. H., Pt., F, Oct. 27, Left : lateral flaps. Surg. T. R. 30. 1864. 1864; exhaustion. 12th Virginia, age 26. Nov. 29, Crosby, U. S. V. Died Decem- 92 Craps, W. J., Pt., D, Nov. 30, Left ; circular. Surg. B. B. Breed, 1864. i ber 2, 1864 ; exhaustion. 24th South Carolina, 1864, U. S.V. Died March 11, 1865; 113 Reynolds, IT. G.. Pt., K, Dec. 15, Left; lateral skin flap. Surg. B. age 33. Fe.17, 65. exhaustion. Spec. 4217. 7th Mississippi, age 23. 1864. B. Breed, U. S. V. Died March 93 Dudley, S. B., Pt., I?, June 27, Right ; circular. Surg. R. R. Tay M hl, 6f). 11,1865; exhaust n. Spec. 4216. 97th Indiana, age 24. 1864. lor, U. S. V. Died February 28, 114 Kicker, B. J., Pt., A, May 18, , Left. A. A. Surg.W. II. Triplett. Feb. 18. 1865; erysipelas. Spec. 4248. 32d Maine. June 28, July 8. re-amp.: gang.: diarrh. 1865. 1864. Died July 11, 1864: pywinia. 94 French, C. H., Pt., G, 2d May 9. Right : circular. A. A. Surg. M. 115 Seawright. W., Pt., 1, May 12, Right; double skin flap. Surg. Indiana Cavalry, age June 14, L. Hcrr. Died September 30, 116th Penn., age 19. June 14, ! J. A. Lidell, U. S.V. Died July 20. 1864. 1864. 1864. 19, 1864; pyaemia. 95 Geffney, T., Pt., D. 74th June 3, Right; circular. A. A. Surg. A. 116 Shroeder. C., Corp l, I, May 13, j Right ; antero-post. flaps. Pro- New York, age 42. J y !>, 64. Ansell. Died August 2, 1864 ; 127th Illinois. June , trading bone removed. Died pyaemia. 1863. September 26, 1863. 96 Gibson, J., Pt, H, 46th May 5, Left; circular. Surg. A. F. Shel 117 ^Street, J. W., , E, 66th Aug. 31, Left ; circular. Ass t Surg. P. H. New York, age 22. June 11, don, U. S. V. Died June 18, Georgia. Oct. 20, Wright, P. A. C. S. Died Octo- 1864. 1864; exhaustion. 1864. ber 28, 1864 ; pysemia. 97 Goodwin, S. M., Serg t, May 23. Left ; posterior Hap. A. A. Surg. 118 Sullivan, J., Pt., C, 56th May 6, Right; circular. A. A. Surg. D. 1, 19th Indiana, age 39. July 19. E. Seyffarth. (June 8, rem d Massachusetts, age 19. June 20, J. Evans. Died August 7, 1864. 1864. carious bone.) Died November 1864. 5, 1864 ; exhaustion. 119 Taylor, S. J., Pt., E, 30th Dec. 16, Left; circular. A. A. Surg.W. 98 Herman, C., Pt., E. 33d May 25, Right; circular: gangrene. Died Alabama, age 21. 1864, M. Rodman (Necrosis.) Died Massachusetts. June 26. August 22, 1864; py;emia. Spec. Jan. 20, April 8, 1865; chronic diarrhoea. 1 864. \ 3356. 1865. 99 Hill, T. J., Corp l, I, 83d June 27. Left. Ass t Surg. R. Bartholow. 120 Wiards. W. C., Corp l, Oct. 4. Left. Died November 13, 1862; Pennsylvania. July 30, U.S.A. Died August 6, 1862. D, 80th Ohio. No. 7, 62. pyremia. Spec. 1034. 1862. Spec. 817. 100 Juda, G., Corp l, F, 8th May 8, Right ; circular. A. A. Surg. C. 121 Williams, J.. Pt., E, 5th June 18, Right; circular. A. A. Surg. F. Pennsylvania Res., age June 13, W. Carrier. Died June 25, 64 ; New Jersey, age 27. July 26, H. Getchell. (Gang.: hasmorr.) 23. 1864. pyaemia. 1864. Died Aug. 19, 1864. Spec. 3661. Secondary Amputations in the Continuity of the Leg, Third not indicated. In six teen of the secondary amputations in the leg the seat of the operation was not specified; eight proved successful and eight were fatal. The right limb was removed in seven, the left in five cases; in lour the side was not indicated. /Successful /Secondary Amputations in the Leg, Third not indicated. The eight oper ations of this group were performed on Confederate soldiers. Meagre histories of the cases are found on the hospital reports: CASE 806. Lieutenant A. Ward, Co. C, 9th Tennessee, was wounded in the right lower extremity at the battle of Chap lin Hills, October 8, 1862. He was taken prisoner and conveyed to the General Hospital at Perryville, whence Surgeon J. G. Hatchitt, U. S. V., reported the following: "On November 2f>th I amputated the right leg on account of gangrene of the foot resulting from gunshot wound of the ankle. The operation was performed by the circular method. The integuments where the incision was made were infiltrated with greenish serum. The patient was much exhausted from diarrhoea. He recovered." The records of Perryville Hospital show that the patient was transferred to Danville as a convalescent. Fatal Cases of Secondary Amputations m the Leg, Third not indicated. Eight oper ations performed on seven patients belong to this sub-division; five were Union and two BRYAN JONES (J.) (J.), Seventeen Additional Cases of Amputations from the Armies of the Southwest, in American Medical Times, 1863, Vol. VII, p. 288. J.), Pytemia Supervening upon Hospital Gangrene, in U. S. Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, p. 444. SECT. V.) AMPUTATIONS IN THE LEG. 555 Confederate soldiers. Pyaemia, secondary haemorrhage, exhaustion, irritative fever, and phthisis were reported as the causes of death: CASE 807. Sergeant J. Erans, Co. I, 29th Colored Troops, aged 33 years, was wounded during the engagement near Richmond, October 12, 1864. Surgeon J. J. Craven, U. S. V., reported his admission to the field hospital of the 3d division, Tenth Corps, with "shot wound of left ankle." Assistant Surgeon E. McClellan, U. S. A., reported the following result of the injury: "The patient was admitted to hospital at Fort Monroe three days after being wounded. His injury consisted of a wound of the foot involving the ankle joint. There was free suppuration and copious discharge of unhealthy pus. The leg was amputated by flap method, on November 17th, by Acting Assistant Surgeon H. B. White. At the time of the operation the patient was in a very weak condition. He died of exhaustion November 19, 1864." TABLE LXXIX. Summary of Sixteen Secondary Amputations in the Leg for Shot Injury, Point of Ablation not specified. [Recoveries, 18; Deaths, 916.] NO. NAME, MILITARY DESCRIPTION, Axn AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 1 \ 1$ lire "M Nov. 25, Left. Dr. R. H. Taylor, of Mem 8 Wright, J. L., Corp l, B, Aug. 22, Right. Ass t Surg.E. A. Drewry, 1863, phis. (Nov. , Piroguff s amp. 15th Alabama. Nov. 21, C. S. A. Recover y. Feb.-, (i4. ankle: gang.: caries.) Recov y. 1862. 2 Sentley, C., Pt., A, 8th June 27, Lett. Recovery. 9 Cain, W. H., Serg t, G. Aug. 16, Left. Sept. 25, haemorrh. Died Louisiana. July 28, 115thN. York, age 23. Sept. 17, Sept. 2(>, 1864; hemorrhage. 1862. 1864. 3 Barter, J, E., Pt., C, 1st Deo. 13, ; flap. Recovery. 10 Calhair, J., Pt., G, 12th Right. Died September 24, 1862. South Carolina, age 2-"). 186J, Mississippi. 1862. April 17, IK Daniel, J. P., Corp l, II, July , Both; irritative fever. Died Sep 1863. 12< llth Virginia. tember 30, 1863. 4 McDaniel, F. H , Ft., C, July 1, . A. A. Surg. B. II. Wash 1863. 26th North Carolina. Oct. 2, ington, C. S. A. Recovery. 13 Evans, J., Serg t, 1,29th Oct. 12, Lefti flap. A. A. Surgeon H. B. 1863. Colored Troops, age 33. Nov. 17, White. Died November 19, 64; 5 Mclntire, B. S.. Pt., K, Jan. 29, . Surg. Reagan, C. S. A. 1864. exhaustion. 10th Tennessee Cav ry. June 29, Recovery. 14 Ilillebraml, M., Pt., 1), Sept. 19, Right. Died November 2, 1863; 1864. 1st Ohio. , 63. pyaemia. 6 Ward, A., Lieut.. C, Oth Oct. 8, Right ; circular. Snrg. J. G. 1I.it- 15 Reach, II., Pt., I, 164th June 3, Right; flap. A. Surg. Gibbs, Tennessee. Nov. 25, chitt, U. S. V. Gangrene. Re New York, age 2 J. J y 5, 64. P. A. C. S. Died Aug. 9, 1864. 1862. covered February 12, 1863. 16 Waters, W. W., Pt., 1), ; erysipelas. Died August 7 Ward, P. If., Pt., B, h June 27. Right. Recovery. 22d Indiana. Aug. 29, 31, 1862; phthisis pulmonahs. Louisiana. Oct. 6, 62. 1862. AMPUTATIONS IN THE CONTINUITY OF THE LEG OF UNCERTAIN DATE. The intervals between the dates of the injuries and operations could not be ascertained in five hundred and seventy cases, either one or the other of the dates and sometimes both having been omitted in the reports. The operations were performed in the upper third in fifty-one, in the middle in forty-seven, and in the lower third in fifty-one instances; in four hundred and twenty-one cases the point of ablation was not recorded. Amputations in the Upper Third of the Leg of Uncertain Date. Of fifty-one opera tions of this group thirty-three proved successful and eighteen were fatal; forty-five were performed on Confederate and six on Union soldiers. The side injured was not specified in fifteen cases; in twenty the right, and in sixteen the left leg was amputated. TABLE LXXX. Summary of Fifty-one Amputations in the Upper Third of the Leg, time of Ablation not specified. [Recoveries, 133; Deaths, 34 51.1 NO NAME, MILITARY DESCItHTIOX, AND AGE. DATKS. OPERATIONS, OPERATORS. RESULT. 1 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Allen, D., Pt., K, 40th Jan. 13, Right. Released June 28, 18G5. 5 Canady. J., Pt., B, 24th Dec. 13, Right. Retired February 17, 65. N. C. Artillerv, age 32. , 05. North Carolina, nge 25. 62, . liallard, I. N., Pt., A, June 22, Right. Discharged October 17. 6 L oppage, K., Pt., I, 30th April , Right. Recovery. Mosby s Cavalry. . (13. 1H63. Virginia. 1865. 3 Beadle, IT. S., Lieut., A, July 9, T.eft. To prison September 21, 7 Cox, H. B., Serg t, D, Dec. 10, Left. Retired February 17, 1865. 12th Ga. Bat v, age 24. . 64. 1864. 48th North Carolina. 64,. 4 Brown, M., Lieut., C, Aug. 16, Left. To Prov.ist Marshal May 8 Critts, I .L., Pt., F,21st Aug. 21, Right. To Prevost Marshal April Cobb s Ga. Legion. , 64. 31, 181).-). Georgia, age 34. , 64. 1, 1865. 1 HOLLOWAY (J. M.), Comparative Advantages of PiuouOKF s, SVME S, and CHOPART s Amputations, etc., in Am. Jour, of Med. Sciences, 1866, Vol. 1.1, p. 85, and SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Comm. Mem.., New York, 1871, Surg. Vol. II, p. 11C. 556 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGK. OPERA Tioss, OPERATORS, , , ..... RESULT. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Fletcher, R. J., Major, July 2, llth Alabama , 63. Frarel, J., 1 t., F. 10th May 2, Virginia, age til. , 63. Freeman, W. It.. Ft., 1C. 46th North Carolina. 1862. Green, W. It., 1 t.. I, 53d .July 14, North Carolina, age 19. , 63. Harrington, J. It., Pt., Aug. 31, C. 41st Miss., age 23. 1864. Howard, I). R., Pt., A, Aug. 19, 2d Maryland. , 64. Isbell, W .H., 1 t., K, 47th July 3, Virginia. , 63. Right. Furloughed 1864. Right. Retired January 16, 1865. . Recovery. Lett. Exchanged March 3, 1864. Right. Retired January 12, 1865. Right. Furloughed October 28, 1864. Left. Gangrene. Discharged October 8, 1864. Right. Exchanged March 17, 1864. Right: circular. Exchanged Jan uary 2d, 1864. Left. Retired. Right. Furloughed November 26. 1864. Right. Furloughed. Left. Retired March 15, 1865. Right. F.xchanged March 3, 64. Left. Furloughed. Eight. Retired March 8, 1865. Amputation of right leg. Dig- charged. 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 ; 46 47 48 49 50 51 Tapp, C. T., Pt., C, 60th Georgia. Tay, S. Z,., Serg t, E, 49th North Carolina, age 35. Watkins, R. U., Serg t, H, 46th Va., age 23. Wilson, S., Adj t, ICth Va. Battery, age 26. Apperson, J. R., Serg t, D, 123d Illinois. Ault, C., Pt., B, 69th Ohio. Bailey, R. M., Pt., D, 31st Mississippi. Bowens, G. B., Pt., F, 13th Georgia. Broivn, E., Pt., E, 49tb Georgia. Corbin, I. D., Ft., 1st South Carolina. Davis, U., Corp l, K, 62d Virginia. Davis, \V. W., Pt., C, 1st Ohio Cavalry, nge 1 9. Foster, R. C., Lieut., I, 5th Alabama, age 40. Gillman, H. T., Pt., H, 8th Michigan. Hancock, J. B., Pt., C, 61st Georgia. Hoover, W. P., Pt., G, 1st Texas, nge 2-5. Love, W., Pt., G, 16th Maine, age l(i. Lynch, J., Pt., A, 1st Louisiana. Oaks. J. A., Pt., B, 58th Virginia. Reid, M. J., Corp l, F, 19th Georgia, age 25. Scales, R. E., Pt., C, 2d Mississippi, age 21. Sell, J. M., Capt., I, 83d Pennsylvania. Nov. 27, 1863. July 9, , 64. June 18. , 64. April 6, , 65. Oct. 8, , 62. May 9. , 64. Right. Furloughed. Right. Retired February 21, 65. Right. To prison September 23, 1864. Left; anterior skin flap. To Bal timore May 10, 1865. . Died October 17., 1862. Left. Died July 7, 1864. Left. Died September 26, 1864. Died July 13 186 py 3d North Carolina. 1863. Ledyard. W.N., Lieut., July, A, 3d Alabama, age 28. , 63. Lemai/, L. A., Pt., II, May 22, 40th Alabama, age 48. , 63. McCall. C. S., Pt., F, 21st Sept. 22, Georgia. 1864. McCarthy, W. E., Pt., K, Sept. 17, 1862. 1862. aemia. . Died May 29, 1864. : circular. Died December 31. 1862. 1863. May 31, 64. Aug. 31, 1862. . Died March 3, 1 864 ; small pox. ; posterior flap. Gangrene. Died June 10, 1864. . Died September 25, 1862. 5th Alabama. , 62. McDaniel, J. J., 1 t., F, Dec. 13, 35th Georgia, age 32. , 62. Miller, J. L., Pt., C, 3()th July , North Carolina. i 1863. Parker. G. W., Lieut., D, Sept. 30, 44th North Carolina. i 1864. Raders, J. P., Pt., A, Oct. 19, 37th Virginia. 1864. 18C2. June 18, 1864. May 10, , 64. 1862. ; posterior fl:\p ; gangrene. Died July 20, 1864. Left: sloughing. Died May 25, 1864; pyaemia. Right. Died May 31, 1863. . Died July 15, 1863. ; circular. Died June 16, 1864. Left ; erysipelas. Died Septem ber 23/1862; diarrhoea. . Died July , 1863. Roberts. J. /.,Pt.,H, 7th Dec. 16, Texas, age 20. 1864. Rossou, jr. B., Pt., K, Aug. 2, 49th Virginia. ; 1864. C. S. A. To Provost Marshal March 7, 1865. Left. Retired February 6, 1865. 1863. July 3, , 63. May 16, 1^64. Virginia, age 24. May 16, 1664. Swartz, J. S., Pt., K. Sth Aug. 19, 8, haemorrhages. Disch d Jan uary 16, 1865. Left. Retired January 30, 1865. 1862. July , 1863. Virginia, age 24. 62, . Amputations in the Middle Third of the Leg of Uncertain Date. Forty-seven*cases belong to this sub-division; thirty-nine were successful and eight fatal. Forty-one of the patients were Confederate and six Union soldiers. The right leg was amputated in twenty- six, the left in nineteen instances; in two the side was not indicated. TABLE LXXXI. Summary of Forty-seven Amputations in the Middle Third of the Leg, time of Operation unspecified. [Recoveries, 139; Deaths, 40 47.] NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 2 3 4 5 6 7 8 9 10 11 12 13 Acree, W. W., Serg t, C, 30th Georgia. Barnett, W.C. D .Corp l, A, 16th Georgia. Barrim, L, Pt., F, llth North Carolina, age 22. Carr, T. A., Pt., G, 3d Georgia. Cherry, M. (i. L., Pt., E, 55th North Carolina. Cline.M.W., Ft., D,48th Alabama, age 38. Cox, E., Ft., I, 15th Ala bama, age 35. Dalton, R., Ft., H, 38th Virginia. Downs, L S., Ft., G, 26th North Carolina. Egan, J. A., Pt., E, 3d Missouri. Garner, M. C., Ft., B, llth Mississippi. Hains, J. 31., Ft., D, 37th Virginia, age 23. Halliburton, C., Pt., E, llth Tennessee, age 24. Left. Furloughed November 13, 1863. Right. Recovery. Left. Exchanged March 17, 64. Right. Furloughed. Right. Furloughed. Left ; gang. Furloughed Sep tember 25, 1864. Left. Released July 17, 1865. Right. Furloughed. Right. Furloughed. . Retired February 6, 1865. Left. Transferred April 9, 1865. Right. Exchanged March 3, 64. Left ; circular. To Provost Mar shal March 7, 1865. 14 15 16 17 18 19 20 21 22 23 24 25 26 Bansbrougli, J. W., Pt., K, 17th Virginia. Harbison, N. J, Pt.. D, llth North Carolina. Hill, W., Ft.,C, Reeves s Ark. Cavalry, age 35. Hunt, F. N.. Ft., G, 47th North Carolina, age 30. Lipscombe, P. E., Pt., F, 9th Virginia Cavalry. Mathias, , Ft., C, 42d 1863. Nov. 30, 64, . July 3, , 63. May 10, 64, . July 1, . 63. Aug. 17, 1864. Nov. 27, 63, -. May 16, , 64. June 2, , 64. Oct. 5, , 64. 1865. July 3, , 63. Nov. 30, , 64. 1861. June 2. >(j4 Sept. 27, 1864. July 3, , 63. Recovery. Right. Furloughed. Left; flap. Oath of allegiance July 7, 18(i5. Left. Exchanged March 17, 64. Right. Retired November?, 64. Right: flap. Recovery. Right. Retired December 30/64. Right. Exchanged March 17/64. Right. Retired December 21, 64. Left. To prison March 3. 1865. Right. Furloughed. Right. Retired January 10, 1865. Left. Retired January 30, 1865. Sept. 17, , 62. June 12, , 64. July 3, 1863. Virginia, age 19. Mayor, S. E., Pt., B, 6th S. C. Cavalry, age 25. McAfee, J. 7 .,Pt., D, 59th Georgia, age 39. J/c#amW,ZA,Pt.,E, 45th Georgia, age 23. Mcllmunay, J., Ft., Mitchell, F. M., Serg t, G, 61st N. Carolina. Monzan, L P., Ft., I, 4th S. C. Cavalry, age 30. Moore, C., Pt., F, Sth Louisiana. Oct. 25, 1864. May 14. , 64. June 24, 64, . July , 1863. SECT. V.) AMPUTATIONS IN THE LEG. 557 No. 27 28 29 30 31 32 33 34 35 36 37 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. JVaZ,j;^.,Pt.,G,18th Virginia. Phittmore, E. K., Pt., A, 27th North Carolina. Poole, F., Pt., E, 20th S. Carolina. Pressley, I., Pt., I, 60th North Carolina, age 44. Roche, F. T., Pt., A, 32d Virginia, age 21. Rodarmel, W. L., Pt., D, April , 1865. Oct. , 14, 63. Aug. 27, 1863. Nov. 30, 1864. Sept. 24, 18C4. Aug. 8, 1862. Nov. 30, 18C4. Mnv Right. Recovery. Left. Forlonghed. Right. Retired February 7, 1865. Right ; antero-posterior flap. To Provost Marshal April 6, 1865. Right. Retired March 4, 1865. Right. Discharged March 30, 65. Left : circular. To Provost Mar shal. Left. Retired April 1, 1865. ; circular. Furloughed Au gust 15, 1864. Left. Kurloughed. Right : gangrene. Recovered. 38 39 40 41 42 43 44 45 46 47 Whittside, J. L., Pi., B, 34th N. C., age 45. Williams ^V.,Pt.,G, 60th North Carolina, age 38. Coupe, /., Lieut., C, 20th Georgia, age 31. Edmonds, J. W., Pt., H, 1st Ohio Lt. Artillery. Green, S. R.. Pt., A, 5th New Hampshire. Honrie, L., Pt., D, 29th Pennsylvania, age 22. Houser, /., Pt., H, 1st N. Carolina Cavalry. Stockton, J. R., Pt., I, 71st Pennsylvania. Storall, J. B., Serg t, F, 15th Georgia. West. P., Pt., K, 42d N. York, age 24. Mar. 25, , 65. Nov. 29, , 64. Right. Released June 28, 1865. Right ; antero-posterior flap. To I rovost Marshal March 7, 1865. Left. Died December 31, 1864. Left. Died July 16, 1863. . Surg. C. S. Wood, 66th New York. Died July 30, 1863. Right : circular. Died August 23, 1864 ; typhoid pneumonia. Left. Sing. J. P. Carroll, ( :. S. A. Died April 2. ]64. Spec. 3155. Left. Died July 12, 1863. Left. Died May 29, 1864; py aemia. Right. Died July 23, 1863. July 2, , %. July 2, , 63. May 15, 1864. July 1, , y 63. July , , 63. 5th Mo. S. M. Cavalry. Shelton, J. A., Pt..A,23d Mississippi, age 23. Smoot, K. W., Pt., A, 1st Va. Cattery, age :!4. Talbt,rt,M.li., Pt., H,7th S. C. Battery, age : ;>. Warren, S., Pt., A, 47th North Carolina. 1 Whitaker, J. F., Pt., K, 8th Tennessee, age 26. 16, 64. June 3, 64, . June 12, 1864. July 2, , 63. Amputations in the Lower Third of the Leg of Uncertain Date. Fifty-one opera tions thirty-four successful and seventeen fatal were performed on forty-four Confederate and seven Union soldiers. The right limb was amputated in twenty-two, the left in twenty-five cases; in four instances the side was not indicated. Gangrene was noted in three, pyaemia and erysipelas in one instance each. TABLE LXXXII. Summary of Fifty-one Amputations in the Lowe) Third of the Leg, time of Operation unspecified. [Recoveries, 134; Deaths, 3551.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPEHATOKS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Beeman, H. C., Lieut., H, May 30, Right. Furloughed. 21 Long, J. F., Corp l, G, Oct. 8, 62. Right. Transferred February 11, 43d North Carolina. , 64. 41st Georgia. 1863. 2 Bland, C. C., Pt., K, 3(ith Jan. 13, Left * circulnr. To Provost Mar- 22 Longshore E. C. Pt. B Left. Furloughed March 14 65. N. C. Artillery , age 18. , 6.J. shal April 8, 1865. 3d South Carolina. 1864. 3 Bradley, J.U., Pt., H, 2d July 1, Left ; circ. Exchanged March 03 Mott, D. W., Pt., D, 13th Jan. 13, Left ; flap. To Provost Marshal Mississippi, age 29. -, f <;3. 3, 1864. N. C. Artillery, age:!9. , 65. April ], 1865. 4 Bradley, J. 11., Pt., G, July], Left. Exchanged March 17, 64. 24 itulley, W., Pt., E, 2d Aug. 30, Right. Retired February 7, 1865. Kith North Carolina. Burlif M Pt lireath- , ^63. of; Virginia Cavalry. , 62. ^^ fj erd s Battery. H.ilfihnn T T>t T 1 n*K Oc.19, 63. Recovery. ttU etc Patterson, i*., Pt., H, 1st Alabama, age 27. Pnttn-n 7 Hf l*t p 1 1 flfVi ISov. 30, , 64. S, ,, ,t Oft Right ; oval flap. i o Provost Marshal April 6, 1865. ! Louisiana. Left. Exchanged March 3, 1864. *^vj ailOli, J . . /..I t.,rv, 1OTU North Carolina, age 17. CJu. (tU, . 63. ig . e ire e ruary , 7 Caldor, P., Pt., E, 4th Left. Furloughed December 9, 27 Remey, S., Pt., H, 5T)th May 31, Right: circular. Disch d July North Carolina. 8 Cheatliam T. B. Pt. H, 1862. 1862. no New York, age 19. 7?/vj*,7e ^ 1-1 I>fr T~l 1 1 tVi , 62. 8, 1863. Ivi ^lit Transferred Alav 1 1865 59th Alabama. 1862. 1862. JltsWiS, o. Z. f JtI.| \J, lltn Alabama. 9 Clarke, N. U.,Pt.,I, 16th Sept. 14, . Discharged December 19, 29 Taylor, J. E., Lieut., E, July 6, Right. Furloughed. Georgia. , 6-2. 1862. With North Carolina. , 64. 10 Dyer, S., Lieut.-Col., 3d Nov. 30, Right : circ. To Provost Mar- 30 Thompson, J. M., Corp l, Nov. 30, Right ; antero-posterior flap. To Mississippi, age 32. , 64. shal March 27, 1865. B, 55th Ala., age 20. , 64. Provost Marshal Feb. 24, 1865. 1 1 Finley, J. \V., Pt., I, 41st Right. Furloughed December 1, 31 2 Underwood, E. E. , Pt . , D, Dec. 13, 12 Alabama. n-ilrlnrt .T R Pt K 1862. Sept. 28, 1862. Left. Retired February 11. 1865. 32 30th Georgia, nge 24. Wasltburne J. A Pt. H , 62. Marshal May 4, 1863. I Kith Mississippi, age21. , 64. llth North Carolina. ig uroug e 13 Goods, D. C.. Pt., E, 12th Mar. 25. Left. Released June 28, 1865. , 33 White, J. R., Pt., C, 3d Jan. 13, Right. Released June 28, 1865. North Carolina, age 18. , ti5. N. C. Artillery, age 26. 1865. 14 Hannah, S. II., Pt., K, Nov. 30, Left ; circular. To Provost Mar- , 34 William*, J., Pt., F, 5th Oct. 8, Left. Transferred March 11, 63. 15th Miss., age 25. , 64. shal May 2, 1865. Arkansas. , 62. 15 Hendcrton, A. R, Pt., B, Feb. 6, Right. Furloughed March 31, 35 Brown, G. W., Pt., D, Left. Died December 1. 1862. 1 ^th North Carolina. , 65. 1865. 10th Georgia. 1862. 16 Ireland, K. S., Pt., H, , . Left. Surg. S. S. Satchell, C.S.A. 36 Edison, E., Pt., C, 39th De.31. C2, Left. Died May 1C, 1864. 7th South Carolina. J e29, 64. Recovery. Alabama, age 26. , 63. 17 Jones. M. M., Pt., G, 14th Sept. 17, Left. Discharged October 17, 37 Estus, B. E.. Pt., Price s April 2, Right. Died May 14, 1865. Alabama. , 62. 1863. Virginia Bat y, age 28. , "65. : 18 Koonce, H. C., Lieut., K, Sept. 30, Left. Furloughed. 38 Forsi/th. I). .R.,Pt.,G,8th Mar. 31, Right. Died May 19, 1865; py filst North Carolina. , (14. Virginia, age 32. , 65. aemia. 19 Larkins, J. P., Pt., B, Oct. 27, Right. Released July 17, 1865. 39 Hardf/rore, W. IT., Pt., Left ; circular. Died December Cobb s Georgia Legion. 1864. A, 19th Virginia. No.18, 64. 11, 1864; gangrene. 20 Leffler. C.,Serg t, D,28th Mar. 22, Right. Released June 28, 1865. 40 Honre. M., Corp l, B, May 27, Right. Died July 3. 1863. North Carolina, age 22. . (;;>. 131st New York. , 63. 1 O KF.KFF, (D. C.), Surgical Cases of Interest treated at Institute Hospital, Atlanta, Georgia, May and June, 1864, in Confederate ^Intrx Medical and Surgical Journal. I?b5, Volume 1J, p. 28. "THOMSON (W.), Report of Cases of Hospital Gangrene treated in Douglas Hospital, Washington, D. C., in American Journal of Medical Science, Vol. XLVII, p. 382. 558 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. 41 42 43 44 45 46 NAME, MILITARY DESCRIPTION , AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. Jones, McG., Pt., G, 67th North Carolina. McCleary, J. L., Serg t, C, 25tb S. Carolina. Moore, D. T., Pt., H, 100th Illinois. Prince, E.S., Pt.,C,45th Alabama, nge 35. Richmond, W. G., Pt., D, 57th N C., age 22. Smith, W.K., Pt., B, 44th Alabama. Right. Died April 5, 1865. Left. Died September 5, 1862. Left. Died December 17, 1863; small-pox. Left. Died February 2, 1865. Left. Died January 8, 1863. Right; circular. Died October 21,1864; gangrene. 47 48 49 50 51 Stewart, J., Corp l, F, 2:id Iowa. Wndsworth, W., Pt., I, 4th Massachusetts. \Vicenga,V., Pt., F, 37th New York. Woolsey, J. B., Pt., A, 7th South Carolina. Young, G. W., Pt., C, 95tb New York. May 17, , 63. June 14, , 63. May 3, , 63. 1862. May 12, , 64. 1865. Left. Died July 24, 1863. Left. Died May 27, 1863. Right. Died December 1, 1862. Left. Died May 27, 1864. 1862. Sept. 19, , 63. Nov. 29, , 64. Oct. 8, 1864. Amputations in the Continuity of the Leg of Uncertain Date and without Indica tion of the Seat of Operation. In lour hundred and twenty-one cases of amputations in the leg neither the interval between the injury arid the operation nor the precise seat of the operation was reported. The operations were performed on four hundred and eighteen patients, in three instances both legs having been amputated. Ninety-six were Union and three hundred and twenty-two Confederate soldiers. One hundred and thirty-nine opera tions resulted successfully, and one hundred and ninety-seven fatally, while the termination of eighty-five cases was not ascertained. The rate of mortality of the cases in which the results were determined was therefore 58.6 per cent. The right limb was removed in one hundred and forty-three, the left in one hundred and fifty -three cases; in one hundred and twenty -five reports the side was not mentioned. As will be seen from the subjoined table, the reports of the cases are very incomplete. TABLE LXXXIII. Summary of Four Hundred and Twenty-one Cases of Amputations in the Leg of Uncertain Date and Seat of Operation. [Recoveries, 1139; Deaths, 140336; Results unknown, 337421.] NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AC;E. DATES. OPERATIONS, OPERATORS, RESULT. 1 2 3 4 5 6 11 9 10 11 12 13 14 15 16 17 18 19 20 Abernathy, M. J., Lieut., , 1st Arkansas. Adair, R., Corp 1, D, 8th Georgia. Akridge, A. W., Pt., H, 3d Florida. Allen, W. A., Pt., Reed s Bat. Artillery. Angling, A. G., Pt., (!, 24th Tennessee. Arent, J. M., Pt., H, 12th North Carolina. Barham, W. It., Pt , F, 1st North Carolina. Bellany L V Pt B July , 1863. 1863. 1864. Sept. 17, , 62. . Transferred June 2(i, 1865. Left. Paroled November 1 2, 63. Right. Furloughed April 21. 63. Right. Retired October 30, 1864. Left. Furloughed January 1, 64. Right. Retired February 3, (55. Both. Furloughed September 23, 1864. Lett. Recovery. Right. Furloughed. . Discharged October 20, 62. 21 22 23 24 25 26 **7 28 29 30 31 *>O 33 34 35 36 37 38 39 Clayton, W. ti., I t., B, 3~d Mississippi. Connor, D. O., Pt., C. Cobb s Legion. Cooper, W. V. L., I t., G, 5th Texas. Currie, D. J., Pt., I), 51st North Carolina. Davis, J., Pt., L, 2d S. Carolina. Davis, J. L., Serg t, G, 46th North Carolina. Davis, T., Pt., 11, 21st South Carolina. Donahoe, A., Pt., Mc Gregor s Battery. Donavan, J., It., 10th Tennessee. Dougherty, J. N., Pt., D, 8th Alabama. Drum, E. J., Pt., C, 28th North Carolina. Duclos, M., Pt., C, 2d Louisiana. Dznne, B. L., Pt., A, 5th Texas. Ellis, P. F., Pt., I, 13th Mississippi. Exter, T. C., Pt., H, 8th Georgia. Fagan, J. B., Lieut.-Col- onel, 15th Alabama. Farthram, A. S., Capt., 1862. Sept. 23, 1863. 1862. 1862. Aug. 25, , 64. 1862. Left. Furloughed February 20, 1863. Left. Recovery. Left. Discharged October 21, 62. . Furloughed August 16, 1864. . Discharged August 6, 62. Left. Retired January 20, 1865. Right. Furloughed July 27, 62. Right. Retired October 13, 1864. . Recovery. Left. Discharged Febiary 2, 1863. Right. Retired February 3, 65. Right. Discharged November 30, 1862. . Discharged December 7, 1863. Right. Discharged September 9, 1862. . Discharged October 31, 1862. Right. To duty March 10, 1864. . Transferred October 11, 1864. Right. To Pro. Marshal March 18, 1865. Lett. Furloughed April 28, 1863. 19th Virginia. Bleavin, C., Pt., A, 36th North Carolina. Bobo, D. P., Pt., D, llth Mississippi. Bossier, S., Pt., I, 9th Louisiana. Bowen, B., Pt., G, Orr s Rifles. Brock, If. C., Pt., C, 48th Mississippi. Brown, H. C ., Serg t, B, Cobb s Legion. Brown, P. \V.,Vt., 1, 15th Mar.9, 63. Feb. 5, , 65. 1862. 1862. Au.25, 64, 1862. 1862. Right. Furloughed December 11, 1864. Left. To be exchanged October 28, 1863. Left. Furloughed February 16, 1863. Left (also amputation arm). Re covery. November 18, 1864. Left. Recovery. Right. Furloughed December 19, 1862. Right. To prison April 22, 1864. 1864. Julv3, , 63. 1862. 1863. Sept. , 1862. * 1863. 1862. 1862. 1863. 1862. 1862. July 1, , 63. Sept. 19, Virginia. Brown, W. J., Serg t, I, 21st South Carolina. Carroll, W., I t., I, 3d Pennsylvania. Cashan, T., Pt., B, 21t Georgia, Clianey, M. M., Lieut., Hart s Regiment. Feltz, C. II., Pt., A, 2d Tennessee. Finley, A., Serg t, D, 5th Arkansas. Dec.7, 64, 1863. SECT. V.) AMPUTATIONS IN THE LEG. 559 NO NAME, MILITARY DESCRIPTION, AND AGE DATES. OPERATIONS, OPERATORS, RESULT. NO 88 89 90 91 92 : 93 94 95 96 97 98 99 100 101 102 103 104 105 106 .107 ;108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 Fisher, E. D., Corp l, G, 16th Louisiana. Flavell, R. 11., Serg t, F, 7th Missouri, age 22. Fowler, L., I>t., I, 34th X. Carolina, age 34. Fulkard, D. A., Serg t, K, 50th Georgia. Garvey, J., 1 t., 0, 18th New York. Goddin, T., Pt., H, 8th Florida. Godfrey, J., Pt., K, 1st South Carolina. Gooding, . .B..Capt., K, 2v!d North Carolina. Goodman, J., Pt., E, 9th Alabama, age 21. Grant, J. M., Pt., I, 1st Louisiana. Griffin, J., Pt., K, 7th Michigan. Gulick D r Pt D 8th Loft. Furloughed April 28, 1 863. Left. Discharged August 8, 63. Right. Retired February 22, 65. Left. Furlonghed February 21, 1863. Right. Discharged March 24, 1863. Left. Paroled August 22, 1863. Right. Furloughed December 19, 1862. Left. Surgeon P. G. Robinson, C. S. A. Recovery. ; circular. Furloughed Sep tember 25. 1862. . Exchanged January 11, 1863. Right. Discharged February 6, 1863. Died March 6, 1870. Right. Recovery, June 3, 1865. Right. Retired February 23, 65. Right. Transferred December 5. 1862. Right. Transferred July 31 , 65. Left. Discharged March 1 0, 64. Right. Exchanged March 26, 1863. Left. Transferred July 26, 1863. Right. Furloughed. Right. Paroled November 12, 1863. Left. Retired January 18, 1865. Left. Paroled October 24, 1863. Right. Exchanged February 14, 1864. Left. Retired January 13, 1865. Right. Transferred on parole. MinUr, T. F.,Pt., D, 26th Virginia. Myers, J. F., Pt., C, 38th North Carolina, age 24. Nichols, M., Pt., E, 27th : North Carolina. Nix, T., Pt., H, 2d Georgia. Page, M. W., Pt., B, 5th Alabama. Parker, M., Pt., H, 35th Georgia. Patterson, W., Pt., A, 20th South Carolina. Peace, J. r., Pt., E, 23d North Carolina. Perry, W. A., Pt., E, 48th Virginia. Pickets, J. P., Pt.,K, 5th Texas. PJeger, J. M., Pt., K, 9th Alabama. Plummer, J, B., Pt., K, 37th North Carolina. Price, J. .<?., Pt., D, 52d Virginia. Proctor, W. H., Capt., F, 13th Virginia Cavalry. PuckfM, U., Pt., A, 28th North Carolina. Ray, J. S.,Lieut.,K, 38th N. Carolina, age 36. Rhom, R., Pt., A, 49th Right. Transferred April 9, 65. Left. Retired January 25, 1865. Right. Furloughed. . Paroled September 12, 63. Right. Furlonghed February 3, 1863. Left. Paroled September 5, 1863. Right. Furloughed January 9 1865. Right. Retired January 28, 1865. 1862. May 12, , 63. June 13, , 64. 1862. June 27, . 62. July 2, 1863. 1865. Dec. 13, 62, Oct. 14, 1863. July , , 63. 1862. Julv , 1863. 1862. Julv 3, , 63. 1864. May 12, , 64. 1862. 1862. July 3, , 63. Right. Transferred September 25, 1863. Right. Furloughed December 19, 1862. Left. Discharged December 4, 1863. Right. Transferred April 8, 65. Retired. Right. Discharged September 10, 1862. Right. To prison September 28, 1863. Left. Furloughed August 13, 1862. Left. Transferred February 14, 1863. Left. Furloughed September 29, 1862. . Discharged December 20, 1862. Left. Retired February 3, 1865. Left. Transferred July 18, 1863. Right. Recovery, February 19, 1866. 1862. Sept. 7, , 62. 1862. Virginia. Hall, J., Pt., H, 14th N. Carolina, age 26. Banks, A. G., Serg t, F, 1st Texas. Harttuan, L., Pt., G, un- assigued, age 23. Hawkins, W., Landsman, U. S. Navy. Hegler, C., Pt., F, 7th North Carolina. Heim, IF, Pt., 1, 7th Vir ginia. Heister, F., Pt., A, 2d Maryland. Henderson, J. T., Pt., K, 7th South Carolina. Hendricks, M. S., Pt., D, 6th Cavalry. Herment, I. A., Capt., C, 12th South Carolina. Hicks, J. V., Pt., A, 56th Georgia. Hinson, W., Pt., F, 17th Tennessee. Humphreys, B. F., S g t, G, 12th Arkansas. Hunter, J. B., Corp l, G, 1st South Carolina. Hutchinson, J. W., Pt., B, 15th Alabama. Ingram, T., Pt., D, 45th Alabama. Jackson,B.F.,P\., Ketch- am s Ala. Battery. Jackson, E. M., Pt., C, 24th Georgia. James, W. F., Serg t, G, 24th Alabama. Jennings, G. IF., Pt., K, 30th North Carolina. Jennings, If. J., Pt., B, 14th South Carolina. Johnson, H. L. W., Capt., C, 12th Arkansas. Jones, J. J., Pt., D, 4th Alabama. Jones, W. C., Serg t, H, 21st Georgia. Justice, J. G., Lieut, and A. D. C. King, T. L., Pt., E, 55th Virginia. Lanier, C., Serg t, L, 2d Florida. Lemmons, A., Serg t, D, 40th Alabama. Lierun, C. T., Captain, Engineer Corps. Lipseij, R.C., Pt.,A, llth Mississippi. Luck, J. W., Pt., Nel son s Artillery. McCann,J. F., Corp l, H, 9th Georgia. McCarthy, T., Serg t, K, 57th Texas, age 29. Manufield, Q. M., Pt., F, 4th Texas. Miller, H. C., Pt., G, 8th South Carolina. Milling, J. H., Pt.. K, 2d Louisiana. 1865. May 3, , 63. Sept. 17, 1862. 1865. Mar. 14, 1863. 1862. Julv 3, 1863. Sept. 13, , 64. July , 1863. June 11, . 64. July , 1863. Nov. , 1863. May 31, 1864. May 27, , 62. July 3, , 63. 1862. North Carolina. Richardson, H. If., Pt., F, 1st Tennessee. Riley. J., Pt., D, 56th North Carolina. Riley, J. 0., Pt., G, 6th Louisiana. Riuell, H. G., Pt., A, 12th North Carolina. Robinson, D., Pt., , 5th North Carolina. Roland, J., Pt., I, 124th Colored Troops, age 35. Ross, J. M., Pt., A, 3d South Carolina. Sample, W. P., Serg t, F, 9th Louisiana. Summons, W. J., Pt., A, 9th Louisiana. Shifflett, J., Pt., C, 4th Georgia, age 29. Slioler, G. W., Pt., A, 7th Confed. States Cav lry. Simmons, A. A., Pt., C, 40th Alabama, age 31. Smith, R. H., Pt., F, 3d North Carolina. Smith, W. M., Pt.,A, 41st Georgia. Snider, T. L., Serg t, C, 25th North Carolina. Stanson, B., Pt., D, 18th North Carolina. Starr, J. T., Pt., I, llth Georgia. Stephens, E., Pt,, A, Hoi- comb s Legion. Stockdell, J., Pt., F, 13th Virginia. Switzer, B. W., Pt., C, 27th Mississippi. Thompson, L., Corp l, C, 16th North Carolina. Tiveman, D., Pt., E, 42d New York, age 36. Ti-ahan, /., Pt., K, 10th Louisiana. Warford, B., Pt., A, 7th Tennessee. Wassum, P. M., Pt., F, 16th Tennessee. Watson, J. A., Pt., A, 4th South Carolina. Watson, L. S., Pt., K, 28th Virginia. Wells, J. J., Pt., E, 27th Mississippi. 1862. 1862. 1862. Aug. 19, , 64. July 2, , 63. June , , 65. 1865. Left. Discharged December 2, 1862. 1863. 1862. 1862. 1862. 1862. 1862. May 11, 64, . 1862. Left. Discharged November 21. 1862. Left. Furloughed June 12, 1862. Right. Furloughed June 1 2, 62. Left. Recovery. Right. Furloughed August 19, 1862. 1862. Sept 19, , 63. 1863, 1862. Right. Retired January 9, 1865. Right. Duty May 13, 1864. Left. Retired November 19, 64. Right. Recovery. Left. Furloughed February 21, 1863. Left. Furloughed September 19, 1862. Nov. 25, 1863. Sept. 17, , 62. 1862. 1862. 1862. 1862. Right. Paroled September 5, 63. Left. Transferred on parole. 1863. 1862. 1863. 1862. 1862. Left. Discharged October 12, 1862. Right. Discharged August 29, 1862. Left. To Provost Marshal April 1, 1863. Left. Paroled September 12, 63. Left. Discharged March 3, 1863. Died February 26, 1864. Left. Transferred. Left. Furloughed April 18, 1863. Right. Furloughed April 18, 63. Right. Duty June 20, 1863. Left. Exchanged June 5, 1865. . To Danville February 12, 1863. 1861. 1861. Left. Discharged November 30, 1862. Right. Retired February 28, 65. Left. Retired November 3, 1864. Left. Discharged November 14, 1862. Left. Exchanged February 14, 1864. Toft Siinrarm HnH f. K A 1862. 1862. Aug. 16, 1864. 1862. 1803. 1862. Oct. 8. , 62. July , , 63. Sept. 17, , 62. May 3, , 63. Mar.2, 61.1 Recovery. 1862. 1862. Left. Retired October 27, 1864. Right. Recovery. Right. Discharged June 22, 63. Right. Discharged November 12, 1862. Left. Furlonghed March 16, 65. Right. Discharged September 18, 1862. July 22, , 64. May 31, , 62. 1863. Oct. 8, , 62. 1862. 2d Mississippi. Wilder, F. W., Pt., A, 59th Georgia. Williams, L., Pt., B, 41st Alabama. 1862. July 5, , 63. Right. Recovery, Octobers, 64. Left. Paroled June 17, 1865. 1862. 1862. 560 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. I 184 185 166 187 188 189 1<IO 191 192 193 194 195 1 196 |197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 ,217 218 219 220 221 222 223 224 225 026 227 228 229 230 231 NAME, MILITARY DESCRIPTION, AND AGK. DATES. OPERATIONS, OPERATORS, RESULT. 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 Wilson, C. H., Lieut., F, 16th Mississippi. Wilt, G. IF., Pt., Brown- er s Virginia Cavalry. Wood, IF. T., Pt.,D,2yth .Georgia. Yawn, N., Pt., H, 5th Florida. Abner, J., Pt., 1, 30th Illinois. Aldtrman, C.. Pt., I, 9th Georgia. Alley, W., Pt., A, 34th Indiana. Alliger, J., Pt., G, 102d New York. Alloway, S., Pt., G, 1st South Carolina. Amos, W., Pt., Peyton s Battery. Anderson, I. R., Pt., I, 17th Mississippi. Angel. J. Q., Pt., I, 21st Iowa. Left. Furloughed December 18, 1862. Left. Furloughed July 10, 1863. Left. Furloughed April 18, 1863. Dodds, J., Pt., G, llth Alabama. Dunham, Z., Serg t, A, 18th Infantry. Earp W R Pt E 7th 1862. 1862. Dec. 31, 62, . 1863. 1862. North Carolina. Fosters, E., Pt., D. 5th South Carolina. Eldin, T., Pt,, K, 1st S. Carolina Rifles. Ellis D Pt F 7th N Right. Died October 19, 1864. 1862. 1862. Right. Died October 12. 1863. Left. Died July 1!>, 1863. Right. Died June 14. 1863. Right. Died November 19, 1862. Right. Died August 10, 1863. 1863. July 3, , 63. May 16, , 63. Sept. 17, , 62. July 2. , f G3. 1862. Kight. Died May 16, 1864. . Died . I une 5, 1864 : tetanus. . Died March 23. 1863. . Died. Right. Died January 13, 1863. Left. Died June 1, 1864. Right. Died August 16, 1864. Right. Died August 14, 1864. . Died. . Died September 30, 1862. Right Died June 1, 1864. York Cavalry, age 24. Epztll, E. J., Pt., B, 51st North Carolina. Etmeir, W., Pt., G, 73d Indiana. Fair, R. H., Serg t, B, 10th Penn. Reserves. Fenton, P., Lieut., B, 19th Georgia. Ferguson, F. F., Pt., G, 6th Virginia. Finlry. A. M., Serg t, E, 55th Alabama. Floyd. C. J., Pt., 11, 18th Alabama. FoosJer, J., Pt., F, 2d South Carolina. Fowler H L Pt E 1864. Dec. 31, 62, . June 27, 1862. 1862. May 17, , 63. Sept 17 Right. Died June 30, 1863 ; diar rhoea and fever. Left. Died October 24, J8o2. . Died June 2. 1863. . Died October 20, 1864. Left. Died June 6, 1863. Right. Died August 28, 1864. 5th Ohio. Arthur, R., Serg t, 15, 22d Iowa. Areritt, A. D., Pt., G, 50th Georgia. Baker, J., Pt., A, 10th Iowa. Barrett, J. M., Pt., G, 51st Alabama. Bartholomew, T. K., Pt., G, i;2d Iowa. Beaver AD Pt A , 62. May 22. , 63. July 3, 63, . May 22, , 63. Hampton s Legion. Fox, J. O., Pt.. K, 115th New York. Frazier, W., Pt., F, 5th New Jersey. Garlick, A. J., Pt., B, 4th Virginia. Gavitt, E. D., Pt., D, 4th Rhode Island. Gee, J., Pt., G, 137th New York. Gifford, L. S., Corp l, B, 22d Illinois. Greenwell, J. R., Pt., 4th Virginia. Gregory, J. T., Serg t, C, 27th Georgia. Good, A. H., Lieut., I, 7th Virginia, age 19. Gottbrecht, A., Pt., B, Kith Iowa. Ilamm J D Pt C 4d Aug. 31, , 62. Died October 20 1864 Mar. 14, , 62. July 2, , N 63. Sept. 19, , 63. Right. Died June 11, 1862. Left. Died July 27, 1863. Left, Died October 8, 18G3. 57th North Carolina. Kendall, B. F., Pt.. F, 53d Virginia. Benham, J., Pt., H, 10th Illinois. Birch, N., Pt., F, 5th N. Jersey, age 33. Boiling, H., Capt., Gen. Chambliss" staff. Bowman, J. T., Pt., I, 16th North Carolina. Boyd, J., Pt., E, 7th Louisiana. Brock, J. H., Pt., I, 43d Alabama. Brockett, W., Pt., K. 35th Illinois. Brown, R., Pt., E, 88th Indiana. Brown, S. H., Pt., C, 81st Illinois. Buckingham, M. D., Pt.. H, 1st Virginia. Buttrich, P. W., Pt., B, 32d Massachusetts. Calvert, W. J., Pt., I, 1st South Carolina. Camp, G. T., Pt., Gra ham s Virginia Bat ry. Campbell, J. R., Serg t, D, ]3th S. Carolina. Campbell, W. W., Pt., I, 8th Florida. Cantwell, I., Pt., C, 7th Ohio. Carrington, W. W., Pt., A, 2d Texas. Chaplain, W. E., Lieut., I, 1st South Carolina. Coe, If. W., Pt.. M, 21st North Carolina. Connelly, B. C.. Corp 1 ], B, 18th Infantry. Coons, A., Pt., H, 49th Ohio. Cooper, G., Lieut., B, 24th Virginia. Coppick, J., Pt., I), 74th Ohio. Couch, II., Pt., F, 89th Illinois. Daum, C., Pt., K, 25th Ohio. Davidson, B. R., Pt., H, 60th Alabama. Dayis. J. K., Pt.,B, 10th Iowa. Dixon, W., Pt., G, 5th North Carolina. July . , 63. Dec. 31, , 62. Right. (Also amp. left forearm.) Died August 6, 1863. . Died March 7, 1863. 1862. SBinia. Left. Died October 18, 1864. Left. Died October 22, 1863. 1862. gangrene and pyaemia. Left. Died June 28, 1864. Left. Died August 29, 1863. Left. Died September 5, 1864. Died June 16 1864 py July , 63. 1863. June 15, , 64. Left. Died June 2, 1864. Right. Died April 14, 1862. Mar. 7, , 62. Dec. 31, , 62. Mississippi. Hammond, J., Corp l, B, 3d Delaware. Handly, P., Corp l, K, 48th Pennsylvania. Harris. J. P. D., Pt., H, 27th Georgia. Harrold, J. J., Pt., A, 59th Georgia. IlawiUe., J. C., Pt., K, 13tb North Carolina. Hay, W., Pt., E, 16th New York. Helmick, J., Pt.,G, 19th Iowa. Beyer, W., Pt., E, 41st Illinois. Biggins, M. P., Pt., F, 8th Georgia. Kittle, G. W., Pt., G, 75th Illinois. Hodge, R., Pt., F, 1st Tennessee. Howlett, ./., Pt., D, 2<>th Virginia. Huggeons, J., Pt., E, llth Virginia. Jackson, J. C., Pt., I, 47th North Carolina. James, W. A., Serg t, K, 14th Alabama. Jenkins, J. S. P., I t.. C, 12th Virginia Cavalry. Jones, G. W., Pt., I, 13th N. Carolina, age 30. Jones, R., Pt., D. 5th North Carolina. Kelley, E., Pt., K, 76th New York. Ktllis, J., Pt., E, 47th North Carolina. Kelly, W. M., Pt., E, 13th Alabama. Kelioe, J. O., Pt., G, 1st Tennessee. June , , 62. aemia. . Died June 211, 1862. Right. Died October 25, 1862. Loft. Died June 8, 1862. Left. Died September 6, 1863. Left. Died June 4, 1863. Right. Died August 1, 1863. 1862. 1863. July 2. , 63. July 2, , 63. 1862. July 3, , 63. Died September 23 1862 June 27, -, 62. Dec. 7, 1862. Feb. 15. 1862. July 3, , 63. Oct. 8, , 62. Oct. 8, ) go_ Right. Died July 18, 1862. Right. Died January 10. 1863. 1862. Left. Died July 16, 1863. Left. Died June 11, 1864. Left. Died November 16, 1863. Left. Died August 23, 1863. Right. Died May 13, 1862. Left. Died. Right. Died September 1 7, 1863 ; chronic diarrhoea. Left. Died September 9, 1863. 1863. April 6, , 62. . Died October 25, 1862. Left. Died May 24, 1863. Died September r > 186 lifly , 63. Oct. 8, , 62. Right. I;i. ,l September 2, 1862. Right. Died February 14, 1863. Left. Died July 27, 1863. 1862. July , 63. Dec. 31, 62, . monia. Left. Died August 22, 1863. Died June 1 1862 py 1863. May 5, 1862. Aug. 30, , 62. July 2, , %3. July 3, , 63. Died June 30 1862 aemia. 1862. Left. Died May 31. 186-1. . Died June 8, 1863. Right. Died July 1! . lHi.3. Died luly 5 1863 May 16, , 63. July 3. , T 63. Right, Died July 25, 1863. 1 SECT. V.J AMPUTATIONS IN THE LEG. 561 No. NAME, MILITARY i T>ATI?R OPERATION S, OPERATORS, DESCRIPTION, AND AGE. RESULT. ! x NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 2t;;i 264 265 266 267 JdS 269 270 271) 272| 273 274 275 276 277 278 279 280 Kenney, J., Pt., I, 157th New York. A irfc, W. S., Pt., C, 4th Texas. Knecht, A. Al., Serg t, K, 12th South Carolina. Laffith, J., Serg t, D, 104th New York. Lamford, P.. Pt., G, 3d South Carolina. Lemon, W., Pt., 1C, 57th Virginia. Lillibridge, D.N.,Pt., F, 12th lowu. Linsley, S., Pt., C, 100th Col d Troops, age 24. Lohmann, C., Lieut., D, 20th New York. Lumsford, H. E., Pt., K, 8th Georgia. Mack, H., Pt., B, 36th Wisconsin. Maltbie, E. P., Pt.,F,2d Conn. Artil ry, age 57. Martin If W. Pt G April 9, , 65. Left. Died September 26, 1865; exhaustion. 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 Rugg, A. J., Pt., Mc- Intosh s Battery. Sanchez, S. J., Pt., B, 2d Florida. Sounders, H., Pt., C, 4th Virginia. Sawyer W. F., Pt., B, 37th Tennessee. Scott. J. B., Pt., G, 4th Texas. Scott, J., Pt., H, 47th North Carolina. Senor, F. H., Corp l, B, 79th Pennsylvania. Shelter, D., Pt., F, 46th Ohio. Sherwood, G. W., Pt., E. 21st Illinois. Shilling, J., Pt., B, 20th Massachusetts. Shrelas, A., Pt., E, 26th North Carolina. Simpson, G., Pt., 21st Wisconsin. Sims, G. T., Pt., I, 12th South Carolina. Singlebush, J. W., Pt., G, 73d New York. Sink, J., Pt., F, 5th Virginia. Smith, J., Pt., H, 3d Delaware. Smith, J.C.,Pt.,C, 112th Illinois. Smith, J., Pt., I, 86th New York. Smith, L. B., Pt., B, llth Mississippi. Smith, R., Corp l, B, 30th Virginia. Snider, )V., Pt., G, 2d N. C. Battery. Sprarllin, W., Pt., H, 20tli Alabama. Steele R C Pt I 7th July 2, , 63. July 21, , 61. Oct. 8, , <i2. A u jr. 16, Right. Died September 9, 1864. , 64. July 2, Left. Died September 6. 18o3. , 63. - . Died September 8, 1861. . Died November 14 862. . Died July 5, 1862. Lett. Died September 19, 1862. Left. Died October 26, 1862. Right, Died April 20, 1862; py aemia. Left. Died October 16, 1863. Righ t . Died November 1 3, 1862. Right. Died July 29, 1863; ex haustion. . Died October 20, 1862. Left. Died September 6, 1864. . Died July 29, 1863. Inlv Left. Died August 24, 1863. . Died October 13, 1862; erysipelas. Left. Died March 10, 1865; phthisis pulmonalis. Right. Died October 9, 1862. 1862. , 63. April 6, , 62. Oct. 8, , 62. April 6, , 62. Sept. 19, , 63. Sept. 17, , 62. July 2, , 63. Oct. 8, , 62. Sept. 17. , 62. 1861. Right. Died June 8, 1864. Right. Died July 2, 1864. 1864. June 1, g4 Sept. 17, , 62. Mar. 7, , 62. 7th Virginia. Martinson, C., Pt., II, 9th Iowa. Mason. A., Corp l, K, 93d Illinois. McCaulty, , Pt., E, 47th Alabama, age 45. McClellan, C. H., Pt.,A, 7th Michigan. MoCloud, IX, Pt., I, 55th Pennsylvania, age 27. McCuny, G. S., Pt., I, 14th South Carolina. McLanghlin, S., Pt., N, 6th South Carolina. MoMichael, C., Pt., II, 17th Iowa. McMurrin, H. S., Pt., K, 2d New York. McMurry, W. B., Lieut.. K, llth Mississippi. Miller. F., Serg t, G, 3d Iowa Cavalry. Miller, J. A., Corp l, F, 93cl Illinois. Moon, R., Pt., C, 2d New York. Morrow, J., Pt., K, 18th Georgia. Morton, F.. Pt., D, 72d Pennsylvania. Mullen," P., 1 t., E, 81st New S ork. Mumford, S., Pt., E, 1st Delaware. Mu-nroe. T. it., Pt., K, 18th North Carolina. Xeal, J. E., Pt., A, 13th Iowa. Oliver, J. J., Serg t, K, 61st North Carolina. Orford, J. M., Pt., A, 33d Mississippi. Passinger, If. &f., Pt., C, 3d South Carolina. Plummer. C. II., Corp l, F, 18th Wisconsin. Praither, L.. Pt., B, 13th North Carolina. Price, R.M., Pt.,B,34th North Carolina. Quack, W., Pt., E, 27th Mississippi. Rash, R. A., Pt., F. 52d North Carolina. Reiche, L. J., Pt.. D, 57th North Carolina. Rhoads, W., Pt., A, 53d Pennsylvania. Roach, T. P., Corp l, K, 6th Maine. Rabbins, J. P., Pt., 53d Virginia. Robinson J. W Pt H . Died March 15, 1862. Right. Died July 30, 1863. . Died September 8, 1864. Right. Died October 7, 1862. Left. Died July 9, 1864. Right. Died September 12, 1863. Left. Died December 28, 1864. . Died July 2, 1863. Right. Died October 26, 1862. Left. Died May 29, 1864. . Died February 25, 1865. Left. Died July 13, 1863. Left. Died November 10, 1862. July 2, , 63. 1863. July , , 63. Sept. 17, , 62. June 18, , 64. July June , , 62. . Died June 29, 1862. Left. Died June 24, 1864. . Died September 10, 1862. 1864. Aug. 30, , 62. , 63. Right. Died June 9, 1864. . Died July 17, 1863. May 16, , 63. Sept, 17, , 62. July 2, , %3. July 3, ,63. Dec. 31, 62, . Right. Died August 29, 1863. . Died January 15, 1863. Left. Died June 1, 1864. . Died September 30, 1862. Left. Died September 16, 1864. . Died January Jl, 1863. July 11, , 64. North Carolina, uge 30. Stevens, A. G., Pt., D, 22d Illinois. Stevens B F Pt K. 1863. Sept. 17, , 62. 38th Virginia. Stever, W. R., Pt., E, 2d Aug. 31, r - 62. Wisconsin. Stewart. J. S., Pt., G, 1st South Carolina. Stribley, W., Serg t, A, 30th Indiana. Summers, W., Pt., D, 17th Iowa. Tarleton, L. V., Pt., G, 47th Missouri. Tatf, E. R.. Pt,, C, 15th Georgia. Theu>, S. B., Serg t, F, llth Georgia. Tliontason, W. A , Serg t, E, 2d S. Carolina. Tomlinson, D., Pt., E, 42d Indiana. Traville, ./., Pt.,D, Hoi- comb s Legion. Trvfsdale, J. C., Pt., I, 12th South Carolina. Tullis. A.. Pt., G, 28th Iowa. Tyler, H., Pt., C, 25th South Carolina. Vanderfard, A. A., Lt., D, 21st S. Carolina. Van Kuren, J., Serg t, H, 21st Iowa. Vaughn, G. W., Pt., B, 1st Tennessee. Walker, J. A., Pt,, K, 45th Georgia. Walker, N. A., Pt., I, Sept. 17, , 62. Right. Died October 14, 1863. De.31, 62, June 26, , 63. Sept. 27, , 64. 1862. Sept. 17, , 62. Left. Died October 18, 1862. Died December 27 1862 Left. Died November 1, 1864. April 6, Left. Died May 4, 1862; haem orrhage. Died October 9 J 864 , 63. July , , 63. . Died August 8, 1863. Right. Died June 1, 1863. 1864. Right. Died August 18, 1864. Right. Died September 5, 1863. Right. Died November 29, 1862. . Died May 24, 1862. Left. Died July 5, 1862. Right. Died December 6, 1862. Both. Died January 8, 1863. Left. Died December 18, 1862. Left. Died October 9, 1862. Right. Died May 28, 1863. . Died July 20, 1863. Left. Died June 26, 1864. Left. Died May 10, 1862. . Died October 2 1862 Oct. 8, July 2, , 63. Oct. 4, , 62. May 5, , 62. Right. Died June 20, 1864. Right. Died July 9, 186;); gan grene. Right. Died June 20, 1864. Left. Died February 28, 1863. Left. Died June 18, 1863. May 16, , 63. Oct. 8, , 62. May], , 63. Sept, 17, , 62. May 3, , 63. July 3, , %. Mar. 7, , 62. De.30, 62, , 63. pyaemia. Left. Died May 26, 1864; py aemia. Right. Died April 2, 1862. Left. Died January 19, 1863. Left. Died December 28, 1862. Right. Died November 2, 1862. Left. Died July 23, 1863. Right. Died October 28, 1864. 9th Iowa. Walter, L., Pt., A, 13th Ohio. Waltz, A., Pt., K, 7th New York. Weber, G., Pt., E, 3d Wisconsin. West A" Lieut K 10th Ohio Artillery. Robinson, T. K., Pt., H, 41st Illinois. Rogan, J. L., Pt., E, 4th Texas. Rosin, W., Pt., C, llth Mississippi. 1864. April 6, , 62. 1862. Sept. 17, , 62. 40th Virginia. Wheatley, F. M., Pt., 2d Maryland. 1862. 562 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGK. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353) 354} 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 Wilkerson, E., Pt., B. llth Georgia. Williver, J., Serg t, H, 44th North Carolina. Winecoff, U. D., Pt., H, 7th North Carolina. Withington, M., Pt., D July Right. Died July 22, 1863. 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 4C6 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 Harris, E. U., Vt., F, 7th Georgia. Harrison, N. C., Pt., F, 44th Georgia. Ifenton, S. C., Corp l, F, 4th (ieorgia, age 24. How, M. D., Pt., E, 20th Georgia. Jackson, If., Pt., D, 35th Georgia. Jacobs, It". /., Pt., F,13th Georgia. Jones, J., Pt., H, 6th Georgia. Jones. W. R., Serg t, A, 13th South Carolina. Koone, G. W., Serg t, D, 16th North Carolina. Langdon, J. J., Pt., E, 48th Georgia. Lewis, A., Pt., I, 49th Georgia. Lewis. J. T., Pt., B, 7th South Carolina. Loeb, H., Pt., A, 22d Mississippi. Mags, W. J., Pt,, K, 3d South Carolina. Mallony, M. M., Pt,, C, 15th Tennessee. McCrary W Pt B 26th Right. Right. Right. Left. Right. Left. Left. High!. Loft. Left. Left. Left. Right. ; flap. Left ; circular. Left. Left. Right. Lett. Left. Left. Right. Right. Left. Right. Left. Left. . 63. 1864. chronic diarrhoea. Right. Died February 14, 1863; pvjfimia and hectic fever. Right. Died October 17, 1863. Left. Died September 2, 1863. Left. Died May 25, 1864. Left. Died May 24, 1864. 1864. July 3, . "(.;!. 50th Georgia. Wood, A., Pt., K, 1st Mississippi. Woodall, K., Pt., B, 12th Georgia. Wright, L. M., Pt., E, 59th Alabama. Wijnn, P. A., Corp l, I, 3d (ieorgia. Alkins, H. O., Pt., D, 13th Col d Troops. Andrews, J. P., Pt., D, 13th Mississippi. Bailey, H. P., Pt., 1st Washington Artillery. Beaufort, J. L., Pt., F, 15th Mississippi. Bell, J, J., Pt., C, 13th Mississippi. Bennett, W. F., Pt., D, 6th Georgia. Bon, F. L., Pt., A, 17th Mississippi. Bridges, J. M.. Pt., I, 38th North Carolina. Brockingtm W J. Pt 1864. 1864. 1864. Aug. It:, 1864. Dec. 16, Left. >g4 i , July 3, Right. 63, . 1862. 1864. Right. Right. Right. Right. Right. Right. 1865. July 3, 63,. 1864. 1865. 1865. July 3, , 63. Au.25, 64. 1864. North Carolina. Melton, B. W., Pt., H, llth Georgia. Mercer, M., Pt., D, 35th Georgia. Miller, W. N., Capt,, H, 31st Georgia. Mizells,J. fe .,Pt., B.llth South Carolina. Murray, W. B., Corp l, D, 5th S. C. Cavalry. Myers, T., Pt,, A, 45th Georgia. Neal H. R. Pt. G Pal 1864. A, 7th S. C. Cavalry. Brown, R. D., Serg t, H, 45th Georgia. Bruce, J. B., Pt., I, 1st Tennessee. Brumfield, J. F., Pt., C, 4Cth Virginia. Bugg, J., Pt., C, 28th Georgia. Butts, W. J., Pt,, B, 60th Georgia. Gamble, T.. Pt,, D, 7th Mississippi. Cameron, J. W., Pt., I, 26th South Carolina. Carpenter, P. J., Pt., D, 13th Virginia. Chamberlain, W. D., Pt.. I, 14th S. Carolina. Chapman, R. F., Lieut,, E, 9th Virginia. Chestnut, F. M,, Pt., F, 8th Arkansas. Clakly,J. T., Pt., A,) Oth Georgia. Cone, L., Serg t, D, 8th Georgia. Conner, J., Pt., G, 7th Louisiana. Cox, J. T., Serg t, D, 28th South Carolina. Craft, J. I., Pt., H, 33d North Carolina. Creak, G. D., Pt., E, 27th Georgia. Davis, G. W., Lieut., H, 6th Virginia. Davis, J. W., Pt., K, 37th South Carolina. Duncan, W. F., Pt., K, 1864. 1864. 1864. Right. Right. Left. Left, Both. Left. Right. Left. Right. Right. 1865. 1862. 1864. 1864. 1864. April 6, 62, . 1864. metto S. S. S. Carolina. Netly, ]., Pt., 1), 1st Tennessee. Nc.wman, W. A., Pt., C, 28th Georgia. Peables, J. C., Pt., H, 28th Alabama. Price, W. K., Pt., K, 44th Tennessee. Reese, T. B., Pt., E, Phil. Legion. 1862. Oct. 8, (J2, . 1862. 1864. July 3, 63, -. 1865. Oct. 8, . 62. 1865. 1864. Oct. 8, 1862. July 2. , 63. 1864. Ruleau, F., Pt., Wash ington Artillery. Sair A G "57th N Left. Left. Left. Left. Right. Right. ; circular. Right. Left. Right. Left. Left. Right. Left. Right. 1864. Left. ; circular. Right. Carolina, age 31. Sawyer, H. A., Capt., C, 2d N. Carolina, age 24. Shuler. P. 11. B., Lieut., A, 2d South Carolina. Smith, I. B., I t., A, 32d Mississippi. Smith, M. B., Pt., F, 2d South Carolina. Stan till, J. W., Pt., A, 20th Georgia. Stewart, A., I t , D, 1st Tennessee. Strane.G.L.,Pt.,J), Hoi- comb s Legion Cav y. Truett, .J. D.. Pt., C, 38th Georgia. Turner, P. S., Pt., A, 44th Georgia. Vause, W. A., Pt., I, 28th Georgia. Wo.ikinx, W. //., Corp l, C, 20th Georgia. Welch. J., Pt., F, 61st Georgia. WMt$eld,W,H.,Pt.,G, 14th Georgia. Willis, R. M., Pt., C, 15th Georgia. Winstead, I., Serg t, D, 1st Tennessee. 1863. 1862. July, , 63. Oct. 8, 1862. Sept. 30, 64, . 1864. Oct. 8, 62, . Left. Left. Right. Left. 1864. 44th Tennessee. Edwards, A. D., Pt.. C, 28th North Carolina. Evans, W. 0., Corp l, E, 18th South Carolina. Foderfteld, JY., Pt., B. 16th Georgia. George, IV., Pt., K, 7th Louisiana. Green, A. J.. Pt., D, 29th Georgia. Grace L Pt A 20th 1864. 1864. 1865. Sept. 19, 1864. 1865. Left. Left. Right. 1864. 1864. Georgia. Gunn,R. G., Pt., A. 17th Mississippi. Harback, C. B., Pt., K, 21st Iowa. Harder, T. D., C apt., H, 9th Georgia. 1864. July 3, 63, . Right. 1865. Oct. 8, , 62. 1864. In one instance (CASE 16, p. 558) the arm, and in a second instance (No. 155, p. 560) the forearm, was amputated at the time of the removal of the leg. This is the last cate- SECT. V.] SHOT FRACTURES OF THE BONES OF THE LEG. 563 gory of the five- thousand four hundred and fifty-two amputations in the leg for shot injury performed during the American civil war. RECAPITULATION. In thirty-nine instances, with nineteen recoveries, .nineteen deaths, and one unknown result, both legs were amputated. The five thousand four hundred and fifty-two (5452) operations were therefore performed on five thousand four hundred and thirteen (5413) soldiers, of whom three thousand nine hundred and seventy-four (3974) belonged to the Union and one thousand four hundred and thirty-nine (1439) to the Con federate armies. Of the operations on the Union soldiers the results were recorded in all but fifteen cases. Two thousand five hundred and seventy-nine (2579) recovered, and one thousand three hundred and eighty (1380), or 34.8 per cent., died. Of the Confederate soldiers the results in one hundred and twenty-two cases remain undetermined; nine hun dred and sixty-three survived, and three hundred and fifty-four, or 26.8 per cent., perished. This favorable percentage of mortality among the Confederates, however, would probably be materially affected had it been practicable to ascertain the results in the one hundred and twenty-two undetermined cases. In fifteen of the five thousand four hundred and fifty-two cases of amputations in the leg, the opposite limb was amputated in one instance at the hip/ in seven in the thigh, 2 in two at the ankle joint, and in five through the foot; re-amputations in the leg for diseased stumps or haemorrhage were performed in one hundred and forty-four cases. In six instances the amputation in the leg was followed by disarticu- lation at the knee, and in seventy-one by ablation in the thigh. The right leg was involved in two thousand three hundred and sixty-nine cases, the left in two thousand five hundred and forty-four, and in live hundred and thirty-nine the side was not recorded. CONCLUDING OBSERVATIONS ON SHOT FRACTURES OF THE BONES OF THE LEG. As already stated, the shot fractures of the bones of the leg number eight thousand nine hundred and eighty-eight (8,988). They form the most numerous group of shot fractures of the long bones of the extremities, comprising nearly one-third of the twenty-nine thousand and three (29,003) cases of this nature recorded during the American civil war, as follows: Shot fractures of the humerus (Second Surgical Volume, TABLE LV, }>. 666) eight thousand two hundred and forty-five (8,245), or 28.4 per cent,; shot fractures of the radius and ulna (Second Surgical Volume, TABLE CXXIV, p. 922) five thousand one hundred and ninety-four (5,194), or 17.9 per cent.; shot fractures of the femur (TABLE XX, p. 175, ante] six thousand five hundred and seventy-six (6.576), or 22.6 per cent.; and shot fractures of the bones of the leg (TABLE LXI, p. 432, ante) eight thou sand nine hundred and eighty-eight (8,988), or 31.0 per cent. It will be borne in mind that cases involving the articulations in the upper as well as in the lower extremities arc not included in these tabular statements. It has been shown in TABLE LXI, page 432, ante, that of eight thousand nine hun dred and eighty-eight (8988) cases of shot fractures of the bones of the leg the bone injured was specified in five thousand and seventy-two (5072) instances; one thousand and thirty- three (1033) were fractures of the fibula, two thousand five hundred and eighty-eight (2588) 1 Case of Private W. Waters, Co. K, 123d New York. CASE 286, page 135, and No. 24, TABLE XV, page 138, ant?. Cases of: Pt. H. Brown, Co. K, 22d Colored Troops, secondary operation, lower third left thigh ; recovered; TABLE XI>. No. 15, page 3~>0, ante.-- Pt. C. I,. Johnson. Co. B , 1st Tennessee, primary operation, lower third left thigh; fatal ; TABLE XXXII, No. 1402, page 261. ante. Pt. J. R. Lewis, Co. H. 53d Georgia, primary operation, lower third left thigh; fatal; TABLE XXXII, No. 1469, page 262, ante.. Pt. S. Banks, Co. C, 43d Colored Troops, primary operation, middle third right thigh ; fatal ; TABLE XXXI, No. 706, page 235, ante. Pt. L. O. Lampbere, Co. G, 21st Connecticut, primary oper ation, lower third left thigh; fntal : TABLE XXXT1. No. 1445, page 262, ante. Sergeant ,T. Fos*, Co. C. 5f)th X. V.. primary amputation thigh; fatal; TABLE XXXIII. No. 1 It;, pago 2<I9, ante. Cook H. Houseley, Co. F, 33d Wisconsin, intermediary operation, linii i third right thigh : recovery ; TABLE XXXVI, No. .)], page 294, ante. 564 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. of the tibia, and one thousand four hundred and fifty-one (1451) of both tibia and fibula. Of the one thousand and thirty-three fractures of the fibula, fifty, or 4.8 per cent., of the two thousand five hundred and eighty-eight cases of fracture of the tibia, four hundred and forty-two, or 17.0 per cent., and of the one thousand four hundred and fifty-one fractures of both bones, one thousand and forty-two, or 71.8 per cent., were amputated. Three thousand nine hundred and thirty-eight (3938), or less than one half of the eight thousand nine hundred and eighty-eight (8988), shot fractures of the bones of the TABLE LXXXIV. Results of Shot Fractures of the Bones of the Leg treated by Conservation on the Occasions named and from the Authorities quoted. OCCASIONS AND AUTHORITIES. CASES. FRACTURES. Tibia. Fibula. Tibia and Fibula. Bone not Specified. "3 o H Recoveries. 1 b Result Undeterm d. Recoveries. 2 "5 fe Result Undeterm d. Recoveries. . "a "3 fe Result Undeterm d. Recoveries. "3 1 Result Undeterm d. Recoveries. Fatal. ~ Result^ Undeterm d. Thirty Yeire War 1618 1648 (SCHMIDT 1 ) 7 5 1 3 7 33 13 54 12 47 1 8 49 58 19 598 508 3 31 1 296 1,030 186 5 5 1 3 ,6 33 10 26 9 28 1 6 27 52 18 429 424 31 1 7 855 125 2 5 1 2 Franco-German War 1671 1678 (PURMANN 2 ) ^ 1 1 Battle of Molwitz 1741 (SciIMUC KER 4 ) " 1 Dettingen, Fontenoy, and Touruay, 1743, 174."), etc. (RAVATON, 5 BOUCHER 6 BOUDEXAVK BAGIKU") 1 ? 1 1 8 1 11 Seven Years War, 1756-1763 (MEHEE, 9 BILGUER, 10 BOURIEXXE 11 ) Napoleonic Wars, 1791-1815 (LAUliEXT, l2 LARRY, 13 HUTIN, 14 GUTHRIE l= FEVECH IC HEVNEX 17 ) 4 3 11 3 19 17 2 6 6 1 3 2 5 4 1 2 1 7 Revolution in Paris, 1830 (ARNAL, 18 JOBEBT DE LAMBALLE, 19 MEMERE 20 LAKRFY") 2 5 2 8 10 French in Algeria 1830 36 (BAUDENS 22 BAGRE 23 ) Spanish Peninsular War, 1836-1837 (ALCOCK 24 ) 28 19 Mexican War, 1845-48 (PORTER 26 ) , 1 1 Revolution in Milan 1848 (RESTELLI 28 ) 20 6 1 169 84 2 1 2 25 12 20 101 1 4 1 2 7 9 1 4 1 Revolution in Paris, 1848 (MALGAIGXE.^GOSSELIN.^HUGUIER, 29 JOBERT, 30 BAUDENS 31 ) 1 20 4 2 3 22 14 2 Schleswig-Holstein War, 1848-50 (STKOMEYER 32 ) o British in India, 1857-58 (WILLIAMSON 33 ) Crimean War, 1854^57 (MATTHEW, 34 CHEXU 35 ) 14 3 62 2 31 28 364 261 3 12 132 ! 74 .... Italian War, 18o9 (CHEXU i6 DEMME 37 ) New Zealand War, 1863-65 (MOUAT 38 ) Danish War 1864 (LUECKK 3!) HEINE J0 OCHWADT 41 ) 8 ! (; i French in Mexico 1864 (BlNTOT 42 ) 1 Austro-Prussian War, 1866 (BKCK, 43 BlEFEL, 44 FlSCHEU (K.), 45 MAAB, 46 STROMEYER 47 ) 37 34 19 -i o 4 1 1 9 1 :i 193 31 34 U. S. Army, 1865-1870 (OTIS 48 ) ... Franco-German War, 1870-71 (GERMANS 49 ) 114 59 3 61 2 285 9 6 26 4 I 35 1 61 4 3 6 3 2 6 188 6 34 20 321 106 48 50 1 Franco-German War 1870-71 (FRENCH 50 ). . . Russo-Turkish War 1876-77 (TILING 51 ) Aggregates 2,989 2.339 534 116 521 i 55 v 614 38 194 23 ~23l 14 / 287 76 v 390 27 1,337 * 1 380 37 Mortality Rate 18.5 perct. 754 leg treated without operative interference give a mortality rate of 13.8 per cent. From the above table (TABLE LXXXIV), in which an attempt has been made to collect as f*ar as 1 SCHMIDT (JOSEPH) (Speculum Chirurgicum oder Spiegel der Artzney. Angspurg, 1656, pp. 155, el seq.) details seven cases of shot fractures of the bones of the leg treated conservatively; five recovered and two proved fatal: Steffan, shot fracture left leg, February 20, 1641>; recovery. H. Bernet, dragoon, shot fracture left leg, May 6, 1648 ; pieces of bone removed; recovery. Lieut. Rossmann, fracture upper third left leg, May 21, 1648 ; recovery. Lieut. L. Kytzinger, aged 60, shot fracture upper third right leg, May 18, 1648; fatal. M. Zorn, shot fracture left leg; recovery. H. J. Buchrer, shot fracture tibia with great loss of soft parts; recovery. F. T. Marin, shot wound of right leg; fatal. 2 PURMAXN (M. G.) (Funfftzig $<mde.r-und Wunder- bahre Schuxxwunde.n Curen, Leipzig, 1701) details five successful cases of shot fractures of the bones of the leg: Obs. IV, p. 53, D. Griesing, wounded during Siege of Stettin, August, 1677; fracture of both bones of leg; recovery. Obs. XIII, p. 113, IT. Rother, shot fracture tibia, Ancklam, 1676; recovery. Obs. XIII, p. 115, C. Wutke, wounded at Stettin, in 1677; shot fracture left tibia; recovery. 06s. XXIX, p, ~". 2, J. Fischer, shot fracture left legandleft SECT, v.] SHOT FRACTURES OF THE BONES OF THE LEG. 565 practicable the cases of shot fractures of the bones of the leg recorded -by military surgeons of other campaigns, it will be seen that the mortality rate of these cases is 18.5 per cent., or 4.7 per cent, in excess of those of the American civil war. Examining the remote effects arm at Stettin, in 1676 ; recovery. 06s. XXXIIX, p. 282, H. H , shot fracture left fibula and right tibia, Ancklam, 1678 ; recovery. 3 CAXNAC (Sar une jambe icrasee par un obus, ou petite bombe, in Mem. de VAcad. Boy. de Chir., 1753, T. II, p. 494) cites the case of an officer wounded at the siege of Douay, in 1710; shot fracture middle third of tibia, removal of spiculse; recovery. 4 8CHMUCKEB (J. L.) (Chirurgische Wahmehmungen, Berlin und Stettin, 1774, B. II, pp. 503, et seq.) records three cases of recovery after shot fractures of the bones of the leg : Cadet von Sasse, fracture lower third of tibia, Molwitz, April 10, 1741 ; spiculae removed ; recovery, with curvature of leg upper part of fibula movable while walking. Captain Graf le Mede, frac ture of tibia, Leuthen, December 5, 1757; recovery, with curvature. Major von Ruitz, fracture of both legs, one in middle and the other in the lower third, Schweidnitz, May 16, 1762; splinters removed; recovery. 6 RAVATON (Chirurgie d armee ou traite des plaits d armes d feu, Paris, 1768) records three cases: Obs. XCII, p. 3G9, Corp l La Joie, Regiment Cond6, fracture of middle third of left tibia and fibula, July 29, 1743; long incisions, removal of splinters; recovery. Obs. XCVI, p. 376, Grenadier A. Riant, fracture of middle third tibia, Nov. 20, 1759; recovery. Obs. CI, p. 387, P. D Amour, shot fracture upper third left tibia, Warbourg, August 7, 1760 ; removal of splinters; recovery, with shortening. 6 BOUCHER (Sur des playes d armes /I feu compliquies sur-tout de fracas des os, in Mem. de VAcad. Roy. de Chir., Paris, 1753, T. II) records, at p. 463, the case of an English volunteer, wounded at Foutenoy, April 30, 1745; shot fractures of head of humerus and middle third of leg; amputation at shoulder joint; recovery; and at p. 474, the case of a soldier of the regiment de la Couronne, wounded at Tournay, in 1745; fracture of middle third of fibula; fatal. BORDENAVE (Precis deplusieun observations sur les playes d armes d feu en diffirentes parties, in Mini, de VAcad. Roy. de. Chir., 1753, T. II, p. 528) cites a case observed by M. TUUSAN of shot fracture of upper third of tibia; the patient recovered. 8 BAGIEU (Examen de plusieitrs parties de la Chirurgie, Paris, 1756, p. 132): Engineer, shot fracture middle third right leg; recovery. 9 MEHEE (J.) (Traite des plaies d armes a feu, Paris, an VIII, pp. 133, 143) records three cases of recov ery following shot fractures of the bones of the leg treated conservatively: Cavalier of the regiment Saint-Jal, shot fracture of both bones of right leg, middle third, Rosbach, November 5, 1757 ; recovered. A soldier of the regiment of Cuirassiers of Gessler, shot fracture of bones of leg ; recovery. M. de Alvensleben, Ensign of the Guards, received a shot fracture of the bones of the leg at Torgau, in 1760 ; recovery. 10 BlLGUER (J. U.) (Chirurgische Wahr- nehmungen, etc., Berlin, 1763, Abth. IV, pp. 4GO, et seq., Obs. 30, 31, 34, 37, 42, 44, 45, 49, 50, 55, 56, 58, 59, 61, 62, 65, 66, 67, 68, 72, 73, 75, 81, 84, 85, 90, 93, 96, 110): 29 cases of recoveries occurring during the Seven Years War, 1756-63; in 4 of the cases the tibia was fractured, in 17 both tibia and fibula, and in 8 cases the location of the fracture was not indicated. " BOURIENXE ( Obs. sur les grands fracas d os a la suite des plaies d armes a feu, in DEHOHNE S Journal de Mid. Mil., Paris, 1782, T. I, p. 214): Soldier, wounded July 10, 1760; shot fracture of tibia and fibula in upper third; recovery in six weeks. "LAURENT (Memoire clinique sur le te.tanos chez les blessis, Strasbourg, an V [1796], p. 61): Lefranc, Sergeant of Grenadiers, shot comminution of leg, 1791(?), tetanus 13 days after injury; recovery. 13 LARREY (D. J.) (Memoires de. Chirurgie Militaire et Campagnes, Paris, 1812, T. II, p. 261): General Baudot, shot fracture of bones of leg, Aboukir, March 8, 1801; gangrene ; death. 14 HUTIN (F.) (Memoire sur la nCcessite d extraire les corps Strangers et les esquilles, dans le traitement des plaies par armes d feu, in Mim. de VAcad. Nat. dt M< d., Paris, 1852, T. XVI, p. 446): Obs. 14, 15, 21, 24, 25, 28, relates six cases of recovery after shot fractures of the bones of the leg during the years 1793 to 1813. In one case (06s. 15) fragments of bone continued to be discharged for 33 years. In one the tibia, in one the fibula, and in four both bones were fractured. I6 GUTHRIE (G. J.) (A Treatise on Gunshot Wounds, London, 1827,3d ed., p. 398): Soldier, wounded at the battle of Rolica, Portugal, August 17, 1808; both bones shattered in two places: recovery 1G FENECH (E.) (Observations recueillies d I armee d Espagne sur les plaies d armes & feu aux extn mites, Paris, 1813, ThSse No. 22, 06*. VII, p. 10, and 06.?. XIX, p. 16): Soldier, 31st Infantry, shot fracture of right tibia, before Almeida, May 5, 1811 ; simple fracture of fibula; fatal. Roques, Lieutenant, 70th regiment, shot in left leg, A ugust 21, 1808, in Portugal ; both bones were fractured in the lower third ; fatal. " HENNEN (J.) ( Principles of Military Surgery, London, 1829, 3d ed., pp. 131, 190): French soldier, wounded in 1814; left tibia fractured, fragment extracted; recovery. Lieut.-Col. H , musket bull partially fractured fibula, Bergen-op-Zoom, March 8, 1814 ; recovered ; limb completely varicosed. 18 ARNAL (Memoire sur quelques partic ularities des plaies par armes d feu, in Jour. univ. et hebd. de mid. et de chir., Paris, 1831, T. Ill, p. 35) records 17 cases of shot fractures of the bones of the leg treated conservatively; in 8 cases the h bula, in 2 the tibia, and in 7 both bones were fractured; no results are given. 19 JOKERT (DE LAJIHALLE) (Plaies d armes A feu, Paris, 1833, pp. 285, et seq.) cites 18 cases, with 1 fatal result ; in 5 the fibula was interested, in 6 the tibia, in 5 (1 fatal) both bones, and in 2 cases the bone injured was not specified. 20 MENIERE (P.) (Li Hotel- Dieu de Paris en Juillet et Aout 1830, Paris, 1830, p. 312); 17 cases (7 recoveries, 10 fatal). 21 LARREY (H.) (Relation Chirurgicale des evtnemens du Juillet 1830, Paris, 1831, p. 119); 2 cases ; recoveries. BAl DEXS (L.) (Clinique des plaies d armes d feu, Paris, 3836, pp. 483, et seq.); 10 cases; 8 of the tibia (5 recoveries, 3 fatal); 2 of the fibula (recoveries). 23 BAGRE (06*. de Chir., recueillies a Vhopital Tare, a Alger; in Rcc. de Mem. de Med. de Chir. et de Phar. Mil., Paris, 1831, T. XXXI, pp. 156, 157, 159): Frac ture of tibia ] (recovery), of tibia and fibula 1 (recovery). 24 Al.cOCK (R.) (Notes on the Med. Hist, and Stat. of the British Legion of Spain, London, 1838, p. 53); 47 cases (28 recoveries, 19 fatal). 25 PORTER (J. B.) (Medical and Surgical Notes of Campaignes in the War with Mexico during the years 1845-46-47-48, in Am. Jour. Med. Sci., 1852, Vol. XXIII, N. S., p. 32); 1 case of fracture of tibia; recovery. ^RESTELLI (A.) (Note et Osserva- zioni cliniche di chirurgia militare, in Annali Vniversali di Mcdicina, 1849, Vol. CXXX, p. 265); 8 cases; fractures of both bones in 2 (1 recovery, 1 fatal), of fibula in 4 (all recovered), of the tibia in 2 (1 recovery, 1 fatal). 27 Des plaies d armes a feu; Communications faites a VAcademie Rationale de Midecine, Paris, 1849, par MM. MALGAICXE, p. 45, 11 cases (5 recoveries, C deaths); 28 GOSSRL1N, ibid., p. 46, 3 cases (1 undetermined, 2 fatal); ^HfGUIER, ibid., p. 131, 9 cases (7 recoveries, 2 fatal); 30 JOBEUT (DE LAMHALLE), ibid., p. 154, 16 cases (6 recoveries, 10 fatal); 3I BAUDEKS, ibid., p. 232, et seq., 10 cases (9 recoveries, 1 undetermined). S2 STROMEYER (L.) (Maximen der Kriegsheilkunst, Hannover, 1855, p. 756), 58 cases: Fractures of both bones in 8 cases (7 recoveries, 1 fatal), of tibia in 27 cases (25 recoveries. 2 fatal), of fibula in 23 cases (20 recoveries, 3 fatal). 33 WILLIAMSON (G.) (Military Surgery, London, 18(>3, p. XXVI), 19 cases: Fractures of both bones in 2 cases (recoveries), of the tibia in 13 cases (12 recoveries, 1 fatal), of the fibula in 4 cases (recoveries). M MATTHEW (T. P.) (Med. and Surg. History of the British Army, etc., London, 1858, Vol. II, pp. 355, et seq.), 102 cases: Fractures of both bones in 59 cases (31 recoveries, 28 fatal), of tibia in 26 cases (20 recoveries, 6 fatal), of fibula in 17 cases (14 recoveries, 3 fatal). ^CHENU (J. C.) (Rapport Medico Cliirurgical sur la Campagne d Orient, Paris, 1865, p. 417); 496 cases (364 recoveries, 132 fatal). ^CllENU (J. C.) (Stat. Meil.-Chir. de la Campagne d ltalie en 1859 et I860, Paris, 1869, T. II, p. 781), 410 cases : Fractures of tibia, 109 (101 recoveries, 8 fatal); of fibula, 64 (62 recoveries, 2 fatal); bone not specified, 237 (184 recoveries. 53 fatal). ^DEMME (II.) (Militar-Chirurgische Studien, WUrzburg, 1861, Zweite Abth., p. 278); 98 cases (77 recoveries, 21 fatal). 38 MOUAT (The New Zealand War of 1863-64-65, in Stat. San. and Sled. Reports, Vol. VII for the year 1865, London, 1867, p. 503); 3 recoveries. 39 LUECKE (A.) (Kriegsclrirurgische Aphorismen aus dem zweiten Schleswig-holsteinischen Kriege im Jalire 1864, in Arcliiv fur Klin. Chir.. Berlin, 1806, B. VII, pp. 50, et seq.); 5 recoveries: Tibia and fibula fractured in 1 case, tibia in 3, fibula in 1. HEINE (C.) (Dit Schussver- letzungen der unteren Extremitdten, Berlin, 1866, p. 294, et seq.); 14 recoveries: Fracture of both bones in 4, of the tibia in 5, of the fibula in 5. 41 OCHWADT (A.) (Kriegschirurgische Erfahrungen, Berlin, 1865, p. 314); 12 recoveries. 42 BlNTOT ( Observations de blessures de guerre, in Rec. de Mem. de Med. de Chir. de Phar. Mil., Paris, 1866, T. XVI, III s6r., p. 240); 1 fracture of fibula; recovery. 43 BECK (B.) (Kriegschirurgische Erfahrungen wahrend de.s Feldzuges 18G6, Freiburg I. Br. 1807, pp. 308, et seq.); 4 cases: Fracture of both bones 1 recovery, of tibia 2 recoveries, 1 fatal. "BlEFEL (R.) (1m Resen-e-Lazareth, in Archiv fur Klin. Chir., Berlin, 1869, pp. 461, et seq.); 25 cases: Fractures of both bones in 11 (8 recoveries, 3 fatal), of tibia in 14 (13 recoveries, 1 fatal). ** FISCHER (K.) (MililairUrztliche Skizzen ems Suddeutschland und Bdhmen, Aarau, 1867, p. 96): 170 cases (122 recoveries, 14 fatal, 34 unknown results). 46 MAA8 (H.) (Kriegschirurgische lieitriige aus dem Jahre 1866, Breslau. 1870, pp. 54, et seq.); 23 cases: Frac tures not specified, 14 cases (11 recoveries, 3 fatal); of tibia. 4 recoveries: of fibula, 5 cases (4 recoveries, 1 fatal). 47 STUOMEYER .!..) (Erfahrungen uber Schusswunden im Jalire 1866, Hannover, J867. p. 59): 74 cases (60 recoveries, 14 fat:il). O ns (G. A.) (Circular No. 3, War Department. S. G. O., 1871, pp. 80-82); 7 recoveries: Fractures of tibia and fibula, 1 case; of tibia, 5 cases; of fibula, I case. ^BECK (B.) (Chirurgie der Scfiussrerletzungen, Freiburg, i. Br. 1872, p. 717); 102 cases (85 recoveries, 17 deaths). BILLROTH (T.) (Chirurgische Brief t aus den Kriegs-Lazartthen in Weissenburg und Mannheim 1870, Berlin, 1872, pp. 234, et seq.); 12 cases: Fractures of both bones in 8 cases (7 recoveries, 1 fatal), of the tibia in 4 cases (3 recoveries, 1 566 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. of the cases treated conservatively, it must be admitted, with Guthrie, 1 that the results ought to have been more successful. The reports of the Pension Examiners regarding the conditions of the preserved limb, even at the present time (1881), are replete with accounts of extensive caries and necrosis with continued discharge, enlargement of the limb, irritable ulcers, overlapping with projection of fractured ends, outward or in\vard curvature, anchy losis of the knee or ankle or of both, contraction of the toes, outward turning of the foot giving the ankle the appearance of being dislocated, extensive and adherent cicatrices, atrophy and weakness, and inability to sustain the Aveight of the body. 2 Pseudarthrosis was noted only in seven of the three thousand two hundred and ninety-six survivors of shot fractures of the bones of the leg treated without operative interference. The difficulties in prescribing rules for the proper mode of treating shot fractures of the bones of the leg seem to have been recognized by writers on military surgery, some advocating immediate operation with many restrictions in favor of conservative treatment; others inclining to conservatism, but citing many exceptions in which they consider imme- fatal). CZEKNY (V.) (Bericht iiber die im College Stanislaus in Weissenburg behandeUen VrnmindKtr.n, in Wiener Med. Wochenschrift, 1870, p. 1357); 3 cases: Fractures of both hones, 1 recovery ; of tibia, 1 recovery ; ] result unknown. KIKCIIKR ((..) (Dorf Floing und ScJiloss I emailles, in Deutsche Zeitschrift fur Chirurgie, Leipzig, 1872, B. I, p. 250); 61 cases: Fractures of both bones in 42 cases (28 recoveries, 14 deaths), of tibia in JO cases (9 recoveries, 1 death), of fibula in 2 cases (recoveries); in 7 cases with unkno-.vn results the bone fractured was not specified. FISCHER (H.) (Kriegschirur- giache Erfahrungen, Krlangen, 1872, p. 198); 33 cases (28 recoveries, 5 fatal). GOI.TDAMMKR (Bericht iiber die ThatigJcr.it des Reserve- Lazaretts des Berliner Hilfsvereins in der Garde-Ulanen-Kaserne - Moabit, in Berliner Klin. Wochenschrift, 1871, V11I Jahrg., p. 151); 14 cases (recoveries). GKAF (E.) (Die Koniglichen Reserve-Lazarethe zu Diisxeldorf n>i ihrend des Krieges 1870-71, Elberfeld, 1872, p. 71); 20 cases ( 1 5 recoveries, 5 fatal). GUTK- KUKST (Bericht iiber die wahrend de,s vorigen Jahrs in den Vertinsspital Ludwigsburg ( Kinder heilanstalt) avfgenommenen Schussverletzunyen und ihre Behandliuig, in Zeitschrift fiir Wundarzte und Gfburtshelfrr, StuMgart, 1871, p. 14">); 1 fracture of tibia; recovery. KlHCHNER (C.) (Aerztlichr.r Bericht iiber das Kortiglich Preussische Feld-Lazareth, u. s. w., Erlnngen, 1872, pp. ti7. 68); 82 cases (74 recoveries, 8 fatal). KOCH (\V.) (Notizen i .ber Schussverletzungen, nach figenen im Feldzuge 1870-71 gemachten Krfahrv.nge.ii, in Arch ir fiir Klin, f hir., Tierlin, 1872, p. 520); 20 cases (19 recoveries, 1 fatal). KUECHLEK (H.) (Analecten aus der Kriegsgeschichte, in Memorabilien, Heilbronn, 1871, Jahrg. XVI, p. 164); 1 fracture of tibia; recovery. LOSSEN (H.) (Kriegschirurgisclie Erfahrungen aus den Barackeiilazarethen :ti, Mannheim. Heiilelberg und Karlsruhe 1870 und 1871, in Dtutschr. Zeil- schrift fiir Chirurgie, Leipzig, 1873. B. II, pp. 138, et seq.); 14 cases (recoveries): 6 fractures of fibula, 8 bone not specified. MAYKlt (L.) (Kriegschi rurgische Mittheilungen aus den Jahren 1870-71, in Deutsche Zeitschrift fiir Chirurgie, Leipzig, 18*3, B. Ill, pp. 50, 52); 9 cases: Fractures of both bones in 5 cases (recoveries), of the tibia in 2 cases (1 recovery. 1 fatal), of the fibula in 2 cases (1 recovery, 1 fatal). MOSETIG (Erinnerungen aus dem deutsch-franzbsischen Kriege, in Der Militaerarzt, with Wiener Med. Wochenschrift, 1872, pp. 11, 22); 8 cases (7 recoveries, 1 fatal). Oil (E.). OESTEULEN und ROMBERG (Kriegschirurgische Mittheitungen nux dem J.udwigsburger Rpsr.n-r.-Spital, Stuttgart, 1871, pp. 45, 47); 10 cases (9 recov eries, 1 fatal). RUPPRECHT (L.) (Militararztliche Erfahrungen, u. s. \v., WUrzburg, 1871, p. 10); 13 cases: Fractures of both bones in 9 cases (6 recov eries, 3 fatal), of tibia in 2 (1 recovery, 1 fatal), of fibula in 2 (1 recovery, I fatal,. SALZMANN (Mittheilungen aus dem Vereinsspital in Esslingen, in Med. Correspondenz-Blatt des Wiirtte.mbergischen iirztUchen Vereins, 1871, B. XLI, p. 161); 6 recoveries: Fractures of both bones in 3 cases, of tibia in 1, of fibula in 2. SCHINZINGER (A.) (Das Reserve- Lazareth Schwetzingen im Kriege 1870 und 1871, Freiburg, i, Br., 1873, pp. 81, et seq.); 46 cases (41 recoveries, 5 fatal). SCflOLLER (M.) (Kriegschirurgisclie Skizzen aus dem, deutsch-franzosischen Kriege 1870-71, p. 16); 1 recovery. SEEGKH (W.) (Die Leistungen der Vereinsspilaler Kleinkinderschule und Diakonenhaus in Ludwigsburg im Jahr 1870-71, in Ze.it. fiir Wundarzte, und GeburtsheJfer, Stutt gart, 1870, B. XXIV, pp. 113, et seq.); 3 cases: Fracture of both bones (1 recovery), of tibia (1 recovery, 1 fatal). SOC1X (A.) (Kriegschirurgische. Erfahrungen, Leipzig, 1872, pp. 140, et seq.); 33 cases: Fractures of both bones in 9 (recoveries), of tibia in 14 (11 recoveries, 3 fatal), of fibula in 10 (8 recoveries, 2 fatal). STEINBERG (Die Kriegslazarethe und Baracken von Berlin, Berlin, 1872, p. 147); 520 cases: Fractures of both bones in 164 (128 recoveries, 16 fatal, 20 unknown results), of tibia in 307 (255 recoveries, 18 fatal, 34 unknown results), of fibula in 49 (41 recoveries, 2 fatal, 6 unde termined results). STOLL (Bericht aus dem Koniglich. Wiirttembergischen 4 Feldspital von 1870-71, in Deutsche Militairarztliche Zeitschrift, 1874, 3. Jahrg. p. 208); 13 cases (9 recoveries, 4 fatal). STUMPF (L.) (Bericht iiber das Kriegs-Spital des St. Georg- Kilter- Ordens zu Neubergliausen im Jalire 1870-71, in AerMiches Jntelligenz-Blatt, Munchen, 1872, No. 50, p. 657); 5 cases (4 recoveries, 1 fatal). M CHIPAUI,T (A.) (Fractures par armes a feu, Paris, 1872, pp. 7, et seq.); 17 cases : Fractures of both bones in 5 cases (3 recoveries, 2 fatal), of tibia in 5 cases (recoveries), of fibula in 5 cases (4 recov eries, 1 fatal), bone not specified in 2 cases (recoveries). CHRISTIAN (J.) (Relation sur les plaies de guerre observees & I ambulancedeBischwiller, 1870-71, in Gaz. Med. de Strasbourg, 1872, No. 24, p. 281); 39 cases (33 recoveries, 6 fatal). COUSIN (A.) (Histoire chirurgicale de I ambulance de I ecole des ponts et chaussies, in L Union Medicate, 1872, T. XIII, p. 114); 11 cases (3 recoveries, 8 fatal). DESPRKS (A.) (Rapport sur les travaux de la 7 ambulance a Varmee du Rhin, etc., Paris, 1871, pp. 46, et seq.); 46 cases (8 recoveries, 17 fatal, 1 unknown result). FELTZ ET GROLLEMUNU (Relation clinique sur les ambulances de Ilaguenau, in Gaz. Med. de Strasbourg, 1871, p. 202); 5 cases: Fractures of both bones in 2 (recoveries), of tibia in 3 (1 recovery, 1 fatal, 1 result unknown). HEYFELDER (O.) (Bericht iiber meine Wirksamkeit am Rhein und in Frankreich wahrend des deutsch-franzosischen Krieges, in . Petersburger Medicinische Zeitschrift, 1871, B. II, N. S., p. 59); 1 fracture of tibia; recovery. JOESSKI, (Ambulances de Haguenau, in Gaz. M d. de Strasbourg, 1871, No. 2, p. 21); 10 cases (9 recoveries, I fatal). MACCOKMAC (W.) (Notes and Recollections of an Ambulance Surgeon, London, 1871, p. 118); 43 cases (29 recoveries, 14 fatal). PAXAS (F.) (Mcmoire sur le traitement des blessures de guerre par la methode antiphlogistique, in Gaz. JJebd. de Med. et de Chir., 1872, T. IX, p. 390): 3 cases (1 recovery, 2 fatal). POXCET (F.) (Contribution a la Relation medicale de la guerre de 1870-71, in Montpellier Medical, 1872, T. XXVIII, p. 41); 3 cases (1 recovery, 2 fatal). VASUX (L.) Etude sur les plaies par armes a. feu, Paris, 1872, pp. 136, etseq.); 8 cases: Fractures of both bones in 1 (recovery), of tibia in 5 (2 recoveries, 3 fatal), of fibula in 2 (fatal). B1 TILING (G.) (Bericht iiber 124 im Serbisch-turkischen Kriege im Baracken-Lazareth des Dorpater Sanitdts-Trainszu Swilainatzbehandelte Srhussverletzungeii, Dorpnt, 1877, pp. 63, et seq.); 12 cases (9 recoveries, 3 fatal). 1 GUTHRIE (G. J.) ( Commentaries on the Surgery of the War, etc., London, 1855, p. 647): " The treatment of gun-shot fractures of the leg ought to have been more successful than it has been, even when both bones were broken ; the want of success may be in part attributed to the remissness which has taken place in supplying the necessary, nay, the essential appliances, by means of which much suffering might have been alleviated, perhaps pre vented, even if cures could not have been effected." 2 BEUTHOLD (Statistik der durch den Feldzug 1870-71, invalid*, gewordenen Mannachaften des 10 Armee-Corps, in Deutsche Militairdrztliche Zeitschrift, 1872, Jahrg. 1, p. 505) notices the frequency of anchylosis of the knee or ankle joints in fractures of the upper and lower thirds of the tibia, and on page 569 remarks, of the cures of fractures in both bones, that "the results were, in genera! very unfavorable, and a higher average of disability shows itself than in fractures of he femui " SECT, v.l SHOT FRACTURES OF THE BONES OF THE LEG. 567 diate amputation indispensable. Thomson, after the battle of Waterloo in 1815, gives four classes 1 of injuries of the leg in which he considers amputation proper; but adds that "it may be doubted whether the practice of immediate amputation would be proper or neces sary in all these cases, could the wounded be conveyed directly into convenient hospitals." Jobert de Lamballe declares conservative treatment and excision alike ineffective in oblique fractures of both bones of the leg in the lower third. 2 Beck, after the European revolutions in 1848, 3 and Schwartz after the Schleswig-Holstein War, 1848-50, 4 advised conservative measures in transverse or slightly oblique fractures of the tibia only, but counselled the removal of the limb in fractures of both bones; but after his experience in the Franco- German War, 1870-71, Generalarzt Beck greatly restricted the number of cases in which he considered amputation justifiable. 5 The conservative views of Guthrie regarding shot fractures of the leg have already been adverted to on page 460, ante. Demme 6 asserts that Guthrie has "too far extended the limits of conservative treatment." Stromeyer, 7 SeMillot, 8 Legouest, 9 and Hamilton 10 agree that in extensive comminution of the tibia, or of both bones of the leg, especially near the knee or ankle joints, it is prudent to amputate. Gross 11 declares that in shot fractures of both bones, "unless the patient is peculiarly fortu- 1 THOMSON (J.) (Report of Observations in the British Military Hospitals in Belgium, after the Battle of Waterloo, Edinburgh, 1816, p. 240): " 1st, In cases in which both bones of the leg have been broken ; 2d, in eases in which the bullets h:ive passed through the ends of the tibia and have fractured this bone near to the knee or ankle joints; 3d, in cases in which a bullet is lodged deep in the tibia; and 4thly, in fractures of the tibia, with wounds of the arteries in the leg." 2 JOHERT (UE LAMHALLK) (Plaies d armes a feu, Paris, 1833, p. 288): " Toutes les fois qu une fracture oblique a eu lieu, vers la region inferieure du inembre, chez un homme dont les forces musculaires sont, puissantes, malgre 1 appareil le plus convenable, malgr6 la demi-flcxion, malgr6 la resection dcs deux extremites de 1 os, pratiqu6e dans le but de ne pas laisser les parties raolles irritees par leurs asperites, toujours, ou presque toujours, la mort est survenue aprds une serie de symptomes formidables, d inflammation, de suppuration, d erysipele et de gangrene, et dans quelques chances que 1 on a appelees heureuses, les tnalades ne se sont sauv6s qu apre^s avoir et6 cent fois au bord de la tombe, et en conservant un meiabre dfeforme." 3 BECK (B.) (Die Schusswunden, Heidelberg, 1850, p. 263): "Is the tibia fractured, and is there only a transverse or slightly oblique fracture, the injury is to be treated as a simple one ; but when there. is great splintering, or when the fracture is considerable, or the bone injured in several parts, or when the soft parts are much implicated, amputation must be performed; when both bones are fractured the wound generally is a serious one, the frac ture is more comminuted, and the limb must be removed; simple fractures only give promise of complete recovery ef the extremity." 4 SCHWARTZ (H.) (Beitrdge zur Lehre von den Schusswunden, Schleswig, 1854, p. 184): "Extensive comminuted fractures in the upper or lower thirds of the tibia always require primary amputation. . . Is the fracture in the middle third, as a rule primary amputation is also to be performed: very favorable circumstances only, as good constitution of the patient, easy transportation, excellent hospital accommodations, large and free wounds of the soft parts, defined limits of comminution, etc., can justify the attempt at conservation;" and on p. 186: "Fractures of both bones, with extensive comminution of both bones or of the tibia alone, require primary amputation. . . Isolated cases of this class, it is true, have been treated ; yet such attempts will only succeed in a few instances, and will, in the majority of cases, result in death, and even in cases of recovery, imperfectly useful limbs will be obtained." 5 BECK (B.) (Chirurgie der Schussverletzungen, Freiburg i. Br., 1872, p. 718): "Since the location of the bones, particularly the tibia, is a very superficial one, since all changes can easily be recognized and operated for, since phlegmon and abscesses are accessible to observation and to the knife from the first moment, and since no particular obstacles are to be met with in the extraction of splinters and dead pieces of bone, there is a large and fruitful field opened to the expectant conservative treatment of shot fractures of this limb." S DKMMK (II.) (Militir-Chirurgische Studien, Wilrzburg, 1861, Abth. II, p. 275): "GUTHRIE has too far extended the limits of conservative treatment. The experiences of the last wars have only too frequently led to the conviction that by sacrificing the limb at the proper time, life may be saved. Here also holds good the general rule according to which especially the comminutions and the extensive lacerations of the soft parts indicate primary amputation. The laceration of the principal blood vessels of the leg come next." 7 STROMEYEU (L.) (Maximen der Kriegsheilkunst, Hannover, 1855, p. S87): "8. Tibia and fibula are fractured by a ball, with extensive splinter ing. Under favorable circumstances the leg may here be preserved. For example, if only one of the bones was struck by the ball and the other was broken by the weight of the body in falling, or when the fissuring is limited. 9. The tibia alone is splintered to a large extent. Here also the preserva tion of the leg is possible, but not probable;" and at p. 742: "Shot injuries of the fibula alone, however extensive, never indicate amputation, providing the tibio-tarsal joint is not implicated. . . Extensive comminutions of the tibia alone, and of the tibia and fibula together, do not per se necessitate amputation, as they do not destroy the vitality of the limb. Experience, however, teaches that in the attempt to save the limb, very readily the life of the patient is lost, especially through pyaemia, and that in cases in which the limb was preserved it was of less use than a wooden leg." 8 SEliIU.OT (Du traitement des fractures dcs membra par armes de guerre, in Archiv Gen. de Mid., I uris, 1871, T. XVII, VI" ser., p. 451): "L am- putation immediate parait, indiquee lorsque les deux os sont brises pres du genou en fragments volumineaux, avec ou sans complication d hmorrhagie et de paralysie, circonstances qui ajoutent encore a la necessity de 1 operation. . . Les fractuies completes des deux os de la jambe au tiers moyen et au tiers infSrieur guorissont sans doute, mais se consolident diffk-ilement et aprs beaucoup d accidents. II semble done prudent quand les 6clats osseux sont considerables, les pertes de substance eternities, les parties molles violemment dechirees e contuses, de se decider u 1 amputation, soil nu tiers supC-- rieur soit jusque clans les condyles du tibia, operation moins sure, pensons-nous. qu au lieu dV lection, mais infiniment preferable au sacrifice de la cuisse." 9 LEGOUEST (L.) (Traite de Chirurgie d Armee, Paris, 1872, 2d ed., p. 531): "Les amputations sont tres-souvent indiquees dans les blessures de la jambe: clles sont indispensables lorsque les deux os de la jambe sont fractures dans une grande Stendue ; lorsque le tibia seul est fracture^ avec 6clats \-olumineux ex perte de substance osseuse considerable." "HAMILTON (F. II.) (A Practical Treatise on Fractures and Dislocations, Philadelphia, 5th ed., 187;>, p. 512): "Gunshot fractures of the shafts of both tibia and fibula demand amputation where the comminution is extensive, or the pulsation of the posterior tibial artery is lost, or the foot is cold and insensible. We do not mean to say that some limbs thus situated have not been saved, but only that the attempt to save such limbs greatly endangers the life of the patient, while amputation at or below the knee is relatively sale." "GROSS (S. D.) (A System of Surgery, Philadelphia, 1872, 5th ed.. Vol. 11. p. 1012): Gunshot fractures of both bones of the leg are also, gen erally speaking, bad accidents ; great swelling followed by diffuse abscess usually rapidly sets in and unless the patient is peculiarly fortunate he will 568 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. nate he will be very apt to sink under the effects of erysipelas, p} 7 8emia, osteomyelitis, or hectic irritation;" while Heine 1 and Ochwadt 2 contend that by proper conservative treat ment happy results may be achieved in many of these cases. In conservative treatment of cases of shot fracture of one or of both bones of the leg all loose spiculse were removed, the fractured ends coaptated, and the leg placed in an easy position or secured in a fracture box or in splints. Among the latter, many of the appli ances referred to on pp. 343349, ante, as used in fractures of the femur, were also employed in fractures of the leg; but Smith s anterior splint and Hodgen s cradle splint seem to have been largely preferred to all others. Of the fracture boxes, that of Petit 3 (FiG. 326), FIG. asti.pBTiT B fracture box. [After PETIT.] so highly recommended by the practical Heis- ter, 4 and later by Stromeyer 5 and Esmarch, 6 was extensively used. In the register of the Nineteenth Army Corps Depot Field Hospital at Winchester, under the charge of Surgeon L. P. Wagner, 114th New York Volunteers, is found a drawing of a fracture box used at that hospital, a copy of which is shown in the annexed wood-cut (FiG. 327). The bot tom of the box was filled with earth, and the heel was kept somewhat raised by strips of adhesive plaster (a a) fastened around the foot and over the foot board, as indicated in the drawing. Extension and counter-exten sion were rarely applied. Generally shot frac tures of the tibia or of both bones healed very slowly. Of the nineteen examples cited on a pen-sketch.] pp_ 433 ^ 444^ fae wounds did not close in two until fifteen, and in one until twelve, years after the injury. In a fourth case (CASE 690, p. 439, ante) a large sequestrum was removed eight months after the injury; the wound closed but broke out again, and the discharge of pus continued for eleven years, and when the wound finally closed the patient s health declined rapidly and he died in about six months. It should be added that in two of these four cases (CASES 680 of Colonel W. F. Lynch and 692 of Major A. J. Bolar) the missile or a portion thereof had never been removed from the leg. The remaining fifteen patients recovered one in one month, three in three months, one in five months, one in six, one in eight, two in ten, three in twelve, one in eighteen, and two in twenty-four months, or at an average, in about ten months. 7 be very apt to sink under the effects of erysipelas, pyaemia, osteomyelitis, or hectic irritation, not to say anything of the danger of mortification, which is often very great, especially when the bones are comminuted at the same time that severe injury has been sustained by the soft parts. Gunshot fracture of the fibula alone is usually much less serious than similar injury of the tibia." 1 HEINE (C.). Die, ftcliussverletzuiigi .n tier unteren Extremitiiten, Berlin, 18fifi, p. 300. 8 OCHWADT (A.), Krie.gschintrgische. Krfahrungr.n, Berlin, 186 5, p. 312. 3 PETIT (JEAN Lotus), Traite des maladies des os, Paris, 1736, T. II, p. 271). The box is figured on p. 285. 4 HEISTEU (D. lj.) Institntiontis Chimrgicx in quibus qin ctjniil ad rem cltirurgicam pertinet, etc., Ainstelapdami, 1739, T. I, p. 21. r ). and Table IX. 6 S I KOMEYER (L.) Krfahrungen uber Sclntsswunde.n im Jalire 1866, Hannover, 1867, p. 50. *E8MAUCH (FKIKDKICH), Handbuch der Kritgschirurgischm Teclinik, Hannover, 1877, p. 88. 7 Surgeon-Major GAUJOT, in his report from the hospitals at Montcnlnaro (J.-C. ClIENU, Stat. Mid.- Chir. de la Camp, d ltalie en 1859 et 1860, Paris, 1869, T. II. p. 778), states that according to his experience comminuted fractures of the leg heal slower than those of the thigh : " II est a remarqurr quo, lors de notre depart, les fractures de la jambe ctaient beaucoup moins avaneees vers la gugrison quo celles de la cuisse. Dans aucun cas il n y avail encore trace de formation du cal, mais, au contraire, une suppuration abondante, des fusses purulentes provoqufees par des esquilles nombreuses, s 61imi- nant diflicilctnent. Nous n ogons avaneer que les d6sordres occasionnes dans les cas de fracture comminutive de la jambe par coup de feu, sont plus FIG. 327. Fracture box used at the field hospital at Winchester. [From SHOT. V.I EXCISIONS IN THE BONES OF TttE LEG. 569 Of the three thousand nine hundred and thirty-eight (3938) patients with fracture of the bones of the leg treated without operative interference, three thousand four hundred and eighty-four (3484) were Union and four hundred and fifty-four (454) Confederate soldiers. Of the former, two thousand nine hundred and fifty-six (2956) recovered, four hundred and forty-six (446) died, and eighty-two (82) results were not ascertained, a fatality of 13.1 per cent. Of the latter, three hundred and forty (340) recovered, eighty-two (82) died, and in thirty-two (32) cases the results remained undetermined, a mortality rate of 19.4 per cent. One thousand five hundred and fifty-five (1555) injuries, with one thousand three hundred and thirty-five (1335) recoveries, one hundred and eighty-nine (189) deaths, and thirty-one (31) undetermined results, were on the right side; one thousand seven hundred and seventy- two (1772), with one thousand five hundred and twenty-nine (1529) recoveries, two hun dred and nineteen (219) deaths, and twenty-four (24) unknown results, on the left side; in six hundred and eleven (611) cases the side was not indicated. Detached splinters and fragments of bone are reported to have been removed in three hundred and forty-seven instances with two hundred and ninety-nine recoveries, forty-two deaths, and six undetermined results. Of the grave complications, pyaemia was noted in eighty-one cases, seventy-five of which terminated fatally; two cases of recovery from tetanus, and twenty-two fatal cases are reported. Of seventy cases of gangrene, thirty had fatal results. There were sixty-five cases of secondary haemorrhage; twenty-four of the patients recovered, the haemorrhage having been controlled in twelve instances by compres sion and styptics, and in twelve instances by ligation; forty-one of the patients died, twenty-seven after treatment by compression, and fourteen after ligation. The femoral artery was ligated in five cases with three deaths, the posterior tibial in nine with four deaths, the anterior tibial in six with three deaths, the popliteal in five with three deaths, and the anterior and posterior tibials in one instance, which terminated fatally. In nine cases -the bleeding vessels were secured jn the wound, and in thirteen at a distance from the injury. Four of the former and nine of tne latter ended in death. Excisions in the Continuity of the Bones of the Leg. An examination of the reported examples of excision in the bones of the leg, whether in the tibia or in the fibula, or in both bones, shows conclusively that in a large proportion of the cases the operation was inju dicious. Not only does the percentage of fatality after excision exceed that of the cases treated by conservation, but the remote results in the cases of recovery in the former were even less satisfactory in regard to usefulness of the limb than those in the latter. The fatality of the conservatively treated fractures of the tibia was 10.3, of the fibula 9.7, and of both bones 20.2 per cent., while that of the corresponding excisions was 25.6, 27.2, and 61.1 per cent., respectively. Excisions in both bones were rarely performed, only eighteen cases of this nature being reported, and the large mortality (61.1 per cent.) following this operation would seem to justify its banishment from military surgery. 1 The excisions per- difficiles a conjurer que ceux que pr6sentent les fractures de la cuisse, et cependant cette remarque ressort des faits observes par nous. Le tibia est souvent fendu en 6cUits dans une grande partie de sa longueur ; ses esquilles se d^tachent lentement ; son tissu spongieux et le canal medullaire suppurent aisfement et la r6paration est extrernement lente." BILLROTH (Tn.) (Cliirurgische Brief e aus den Kricgs-Lazarethen in Weissenburg und Mannheim 1870, Berlin, 1872, p. 272) notes the tedious process of separation of sequestra in shot fractures of the leg. HANNOVER (A.) (Die Danischen Ini-aliden aus dtm Kriege 1864, Berlin, 1870, p. 27) observes that "the separation of necrosed bone frequently was of long duration with persistent fistulae." 1 STUOMKYKR (L.) (Maximen der Kriegsheilkunst, Hannover, 1855, p. 743) remarks of the fractures of the bones of the leg that "the hopes built upon excision in the continuity were found delusive, as well in regard to preservation of life as in regard to usefulness of the limbs preserved by excision." DEMMK (H.) (Aiilitar-Chirurgische Studien, Wtlrzburg, 1801, B. II, p. 27G): Resection of the diaphysis of both bones of the leg was performed several times in Italy. I have to mention four cases of this kind in the hospitals of Brescia, which all proved fatal from continued suppuration and pyaemia. The subperiosteal method was here also tried by LARGHl, but, for the reasons already stated, had no better results. I believe, therefore, that I must join STROMEYER and the majority of the military surgeons in condemning the operation." PlTHA (F. R. VON) (Krankheiten der Extremitdten, Erlangen, 1868): " For resection the log offers an unfavorable field: the operation is. therefore, seldom and with great reserve performed. BECK (B.) (Cltirurgie SCIIG. Ill 7-2 570 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. formed in the tibia exceeded those in the fibula, the former being one hundred and eighty- five, the latter one hundred and eighty-two, with the percentage of fatality slightly in favor of the excisions in the tibia. The results of this operation in European war surgery as exhibited in the following table have been still less satisfactory; of one hundred and fifty- two cases, one hundred and six, or 69.7 per cent., had fatal terminations: TABLE LXXXV. Results of Shot Fractures of the Bones of the Leg treated by Excision on the Occasions named and from the Authorities quoted. OCCASIONS. CASES. TIBIA. FIBULA. TIBU FIB i 1 i AND LJLA. BONE NOT SPECIFIED. "a 15 1 K a Mortality of Det. Cases. Recoveries. Deaths. 1 _4> "C 5 1 M Deaths. Deaths. Recoveries. Deaths. Revolution in Lombardy, 1848 (BECK 1 ) 1 i 100.0 53. 8 1 2 Schleswig-Holstein War, 1848-50 (EsMARCH,* STROMEYER 5 ) Campagnes de Kabylie, 1854 (BEUTHEUAXD 4 ) 13 1 6 7 1 i 3 4 1 1 1 1 1 Crimean War, 1854-56 (MATTHEW, 5 CHEXU 6 ) 2 1 Italian War, 1859-60 (DEMMK, 7 CHEXU 8 ) 16 3 4 12 3 75. . 1 1 1 4 2 7 Danish War, 1864 (LANGENl)ECK, 9 LUCKK, 10 HEINE 11 ) o Austro-Prussian War, 1866 (BECK, 12 FiscilEU, 13 BlEFEL 14 ) 4 11 97 3 1 1 1 8 3 17 80 1 1 25. 3 i 1 United States Army, 1865-70 (OTIS 15 ) 50.0 27.2: 82.4 50.0 13 1 Franco-German War, 1870-71 (GERMANS 16 ) 3 63 1 4 4 1 1 Franco-German War, 1870-71 (FltEXCH 17 ) 17 Turko-Russian War, 1876 (TILING, 18 K AUE 19 ) i Aggregates 152 46 106 69. 7 25 i 71 1 14 20 4 8 ! 3 7 der Schtutverhtfimgm, Freiburg, i. Br., 1872, p. 721): " To saw through the diaphysis in its entire thickness before the necrosed portion has yet demar cated and separated itself completely, I cannot approve of, because, on the one hand, too much is often taken away unnecessarily, thereby giving occasion to too great a loss of substance, to a colossal defect in the bone, and, in consequence thereof, to pseudarthrosis ; and, on the other hand, infectious processes with fatal results are readily caused by again laying open the bony cavity. One may, therefore, quietly wait until sequestrotomy can be performed under more favorable circumstances." Kxcision for shot fracture in the continuity of the bones of the leg, in military surgery, does not seem to have been practised before 1848. In that year B. BKCK (Die Schuss-Wunden, Heidelberg, 1850, p. 338) excised portions of both tibiffl and a portion of the fibula in an Austrian soldier of the Kaiser Franz Josef Regiment, wounded in 1848, near Vienna, by a grape shot. The missile entered the right and passed through the left leg, fracturing both tibiae just below the knee. Amputation of both thighs was advised but not allowed by the patient. A few days later the fractured ends of both tibise were excised, and splints applied; extensive infiltration, fever, and diarrhoea followed, and the patient died on the 7th day after the injury. 2 F. ESMARCH (Ueber Resectione.n nach Schusswunden. Kiel, 1851, p. 28) and 3 L. STUOMEYKR (Maximen de.r Kriegsheilkunst, Hannover, 1855, p. 75(i) tabulate 13 cases of excision in the shafts of the bones of the leg, with 6 recoveries and 7 deaths. Portions of the tibia were excised in 7 (3 recoveries, 4 fatal), of the fibula in 3 (2 recoveries, 1 fatal), and of both bones in 3 (1 recovery, 2 fatal). Detailed accounts of several of these cases are found in ROSS (G.) (Militairarztliches aus dem crsten ScMesswigschen Feldzuge im fSommer 1848, Altona, 1850, pp. 30. 53, 60, 61, and 62): Prussian volunteer J , fracture of head of right fibula with grazing of tibia, Bilschau, April 24, 1848; resection of upper end of fibula by ROSS; pyaemia, death. Prussian Captain v. K , DUppel, JuneS, 1848; ball penetrated the upper third of right tibia; excision of a triangular piece of bone by ROSS ; death June 19, 1848, of pyaemia. J. H. K , Oldenburg Infantry, wounded May 28, 1848; comminution of left fibula: excision of 3 inches by KUHN, June 11 ; recovery. II. G , 31st Prussian Infantry, Dttppel, June 5, 1848 ; fracture of right fibula ; June 0, excision of 6 inches by LANGKXBECK ; June 25, ligation of the crural artery ; recovery; no formation of new bone; limb useless. Captain J. C , Hochtrup, June 7, 1848; comminution of right tibia; June 8, excision of several inches of tibia by LAXGEXBECK; June 22, ligation of femoral; June 24, amputation of leg; death June 24, 1848. Lieutenant II , Schlesswig- Holsteinischen Dragoons, fracture of both bones of leg June 12, 1848; excision of over 3 inches of both bones by LAXGENUECK. June 14 ; death from tetanus June 2-, , 1848. In another instance a considerable portion of the upper third of the tibia was excised : recovery with flexed knee ; leg useless. *BERTHKRAXl> (A.) (Campagnes de Kabylie, Paris, 1862, p. 109): C , llth Infantry; comminuted fracture of right fibula; excision of sharp points of fibula; recovery in less than 6 weeks. MATTHEW (T. P.) (Med. and Surg. Hist. of the British Arm;/, etc., in the years 1854-55-56, London, 1858, Vol. II, p. 3G8) tabulates a successful case of excision of lower end of fibula, but gives no details. "ClIKXU (J. C.) (Rapport, etc., de. la Campagne d Orient, Paris, 1865, p. 505): Th. Duval, 86th line; shot fracture of left leg August 16, 1855; resection of tibia; recovery with flexion of leg upon the thigh. DEMMK (II.) (Mil.-Chir. Studien, WUrzburg, 1861, B. II, p. 278) tabulates 7 (2 successful and 5 fatal) cases: in 4 of the fatal cases both bones were excised. "ClIEXi: (J.-C.) (a<. lUed.-Cliir. de. la Camp, d ltalie en 1859 et 1860, Paris, 186!>, T. II, p. 8JO), 8 cases (1 recovery and 7 fatal). On pp. PIS), 820, he gives details of two <;f the cases: P. Godin, 76th line, aged 24, received at Solferino, June 24, 18511, a shot fracture of the left fibula in its upper third. He was taken to the hospital at St. Mandrier, where, on October 14, Dr. BUISSOX excised the upper third of the fibula; osteomyelitis supervened and death ensued October 18. J. Camboulives, 74th line, shot fracture of lower third of left leg, Montebello, May 20, 1859; Tesection of 5 centimetres of the fibula; anchylosis of the tibio-tarsal articulation, with rigidity of the toes. CHEXU further relates (loc. cit., p. 819) that a resection of both bones of the leg was successfully performed at Brescia on a Garibahlian volunteer by A. BERTAN1, chief surgeon of Garibaldi s corps. 9 LAXGEX1!ECK (1!. v.) (Ueber Resect ion dts Fusxgehnki be. Sc.hussfracturtn desselben, in Jierliner Klin. Wochenschrift, 1865, Jahrgang II, p. 31): Corporal Reiss, 60th Infantry, shot fracture of middle third of left tibia and fibula, April 18, 1864 ; extensive infiltration ; subperiosteal excision of 4 inches of tibia and 1 inch of fibula by LAXGEXhECK. Recovery with 1| inches shortening. The deficiency of bone has been supplied by a voluminous new formation of bone exceeding in thickness the normal size of the tibia. "LOCKK (A.) (Kriegschirurgische Aphorismen aits dem ziveiten ScMesfwig-holiUinsclien Kriege im Jahrt 1864, in Archiv fur Klin Chir., Berlin, 1866, B VII, p. 126)- Heerde, 25th Infantry, shot comminution of right tibia and fracture of fibula, 1J inches SECT. V.J EXCISIONS IN THE BONES OF THE LEG. 571 The amount of bone excised varied from one-half inch to twelve inches, 1 and in one instance the entire fibula, with the exception of about one inch of the external malleolus, was removed (CASE 720, page 457, ante). Forty-nine, or 12.6 per cent., of the three hundred and eighty-seven excisions in the bones of the leg were subsequently followed by ablation of the limb, viz: twenty-one by amputation in the leg, five by exarticulation at the knee joint, and twenty-three by amputation in the thigh. Considering the useful ness of the limb, especially after excision in the tibia, or in both bones of the leg, the results must be regarded as unsatisfactory. In the case of Private J. Hogan, 127th Pennsylvania above ankle joint, in April, 1864. A fenestrated gypsum bandage was applied. Excision of 2 inches of (lie tibia a month after the injury by Dr. LOCKE; recovery. In November, 1864, the patient walked well, extensive new formation of bone, exceeding in thickness the normal tibia. " HKINE (C ) (Dit Schussverletzungen cltr nnteren Extremitliten, Berlin, 1866, p. 311): A Prussian officer, Lieut. R , shot wound of right leg, April 18, 1804, fracturing tibia and fibula in the middle third, and extensively lacerating the soft parts ; free incisions and application of gypsum bandage. June 8, excision of 1 inch of tibia by Dr. LAN OENBKCK ; recovery, with } inch shortening ; according to the latest account no union of bone had taken place. 12 BECK (B.) (Kriegs- chirurgixclif. Erfahrungen viihrend </r.s Feldzugrx 1866. Freiburg, i. Br., p. 34:!) twice successfully excised portions of the tibia, retaining as much as possible of the periosteum. Both patients recovered in a short time, and the deficiency in the bone was supplied by nature in a few weeks. 13 Fl6CHEli (K.) (Militairarztliche Skizzen aus Sildd^utscliland mid Rdhmen, Aartui, 1867, p. 98) states that lie saw an excision of the diaphysis of the tibia per formed by TKXTOII for shot fracture just above the ankle joint, four days after the injury. The lower extremity of the tibia was saved ; the patient did well. I4 BIEKKI. (K.) (Im Reserve-Lazareth. Kriegschirurgische, Aphorismen von 1866, \n Archiv fiir Klin. Chir., Berlin, 1869, B. XI, p. 468): Joh. Drost, shot comminution of tibia and fibula of right leg. June 27, 1866, by canister shot; enormous infiltration ; excision of about 4 inches of both bones August 7, IPfifi; periosteum preserved; death August 27, 1866. l& O ns (G. A.) (Circular No. 3, War Department, R. G. O., Washington, 1871, pp. 227, 228): Pt. W. Hostler, I), 38th Infantry, shot comminution of left fibula, Fort Bayard, New Mexico, July 10, 1868; excision of about 3i inches of fibula and ligation of peroneal artery above and below wound on same day by Acting Assistant Surgeon J. Le Carpentier; death July 12, 1868. Pt. J. Shaw, I), . id Cavalry, shot wound of right tibia, received in fight with Indians October 17, 1867; necrosis; excision of necrosed portion by Assistant Surgeon W. M. AUSTIN". If. S. A., February 2. 1868; recovered and returned to duty. "BECK (B.) (Chirurgie, der Sr.hussverlftzungen, Freiburg i. Br., 1872, p. 90 )): G , artSleryman, fracture of left leg in lower third from canister shot ; immediately after the injury excision of portions of the injured bone was performed ; subsequent amputation of the leg ; recovery. IDEM (Inc. cit., pp. 907, 909, 910) also reports, from hospitals at Rastatt and Strassburg, 5 instances of excisions in the bones of the leg ; 3 were excisions in the fibula and proved successful ; 2 excisions in the tibia were fatal. FISCHER (G.) (Dorf Fining und Schlos.t Verxailks, in Ueutsclie Zei/xrhrift fiir Chirurgie,, Leipzig, 1872, B. I, p. 253): Unknown, shot fracture of both bones in middle third ; 21 days after injury 1 inch was excised from the upper and 2 from the lower ends ; also removal of splinter 3 inches long; patient doing well at the end of six weeks. In another case in which the tibia was extensively splintered a fragment of the bone was extracted on the 12th and 1J inches were excised on the 2 1st day after the injury ; death IS days after the operation. RurrilECHT (L.) (Militiirdrztliche Erfahrungen wahrend des deutsch-franzftsiiichen Krieges im Jahre 1870-71, Wfirzburg, 1871, p. 86) <rites a successful secondary excision in the fibula performed at the Bavarian hospital No. VIII, at Antony and Massy. SOCIN" (A.) (Kricyschirtirgisrhr. Erfahrungen gesammclt in Carlsruhe 1870 und 1871, Leipzig, 1872, p. 141) details 2 cases: H. Scherf, shot fracture of tibia and fibula of right leg in middle third, Toul, August 16, 1870; removal of splinters; resection of pro truding portion of tibia September 15, 1870; recovery, with 8 centimeters shortening ; large callus but no union of bone. Ferdinand Schwand, shot frac ture of both bones of right leg, Worth, August 6, 1870; excision of 3 centimetres of tibia August 17; recovery, with very little shortening and consolida tion of bone. 17 CHKNU (J.-C.) (Aper<;u Hist. Stat. ft din., <<<., pendant la Guerre de 1870-1871, Paris, 1874, B. I, p. 493) tabulates 97 cases of excisions in the continuity of the bones of the leg, in the French army, of which 76, with 13 recoveries and 63 deaths, were in the tibia, and 21, with 4 recoveries and 17 deaths, in the fibula. In the alphabetical enumeration of pensioners after amputations, disarticulations, and resections, in the second volume of Dr. CHEXU S work, the following cases of excision in the bones of the leg are mentioned : J.-B. Bourguignon (p. 21), llth Chasseurs, shot fracture of left fibula, Villorceaux, Dec. 9, 1870; excision of fibula; gangrene; recovery with anchylosis of ankle joint. J.-B. Millot, 23d line (p. 106), comminuted fracture of left leg at Tertre, January 11, 1871 ; resection ; recovery with considerable shortening. P.-A. Originaire (p. 114), 12th Cuirassiers, shot com minution of leg nt Gravelotte; resection of portion of tibia; incomplete consolidation. C.-V. Ridel (p. 128), 82d line, comminuted shot fracture of left tibia, Villorceaux, Dec. 8, 1870; resection ; atrophy of limb. This case is detailed by Cmi AULT. (A.) (Fractures par armes a, feu, Paris, 1872, p. 157), who states that the operation was performed on May 22. 1871, and that 18 centimetres of the tibia were excised. There is regeneration of bone and no apparent shortening of the limb. E.-I. Schneider (p. 136), shell wound of right leg, received at Villiers sur-Marne ; resection of considerable portion of tibia. A. -J.-B. Soviche (p. 139), llth line, comminuted shot fractures of left forearm and right leg, Sedan ; excision in lower third of tibia; atrophy of leg. L.-M.-A. Vedel ip. 147), 7(ith line, shell fracture of right leg. Strassbourg, September 17, 1870; excision of 4 centimetres of both bones; recovery- Besides the cases mentioned by CHEN U, the editor has been able to gather from the sources indicated particulars of the following instances of excision in the continuity of the bones of the leg practised on French soldiers during the Franco-German War, 1870-1871, not detailed by CHEXU: F. Delalande (CniPAUl.T) (A.) (Fractures par armes u feu, Paris, 187;!, p. 173), wounded at Orleans. December 4, 1870, in the lower part of the left leg; no consolidation on December 31, 1870 ; resection of 9 centimetres of the fibula; recovery without shortening. The space between the sawn ends of the bone is filled with a firm substance. Joseph G (A. COUSIN", Hintm rK Cliirurgicale de I ambulance de I ecole des ponts et chaussees, in V Union Midi. cale, 1872, T. XIII. p. 158), shell fracture of left leg. November 29, 1870 ; erysipelas ; gangrene ; excision of about 6 centimetres of tibia ; death December 22, 1870. F. Albertini (O. HKYFKLDER, llericht iiber meine Wirksamkeit am Rhein und in Frankreich wdhrend des Deutsch-franzosischen Krieges, in St. J etersburgrr itrd. Ze.itschrift, 1871, B. II, N. F., p. 59). 3d Voltigeurs, shot fracture of bones of leg, Landonchamp, October 7, 1870; excision of the fractured portion of ihe tibia November 18; recovery without deformity and with new formation of bone. E. Terrier (O. HEYKELDER, loc. cit., p. 59). 62d line, shot fracture of tibia received at Gravelotte; secondary excision of 4 centimetres of the tibia; recovery. M. Maze (T. BlLLIlOTH, Chirurgische Briefe aus den Kriegs-Lazarethen in Weissenburg und Mannheim 1870. Berlin, 1872. p. "234, No. 47, and H. LOSSEN", Kriegschirurgische Erfahrungen aus den Barackcnlazarethen, etc., in Deutsche Zeilschrift far Chirurgie, 1873, B. II, p. 140), , 48th Infantry, shot fracture of both bones of right leg August 4, 1870; ends of tibia excised on the field; loss of 1 J to 2 inches of bone; in March, 1871, the wounds had healed but the parts had not consolidated. "TILING (G.) (Bericht iiber 124 im Serbisch-t&rkischen Krifge im BaracJcen-Lazareth des Dorpater Sanitats- Trains zu Swilainatz behandelte Schussverletzungen, Dorpat, 1877, p. 72): Simeon liaschitseh, aged 40, shot fracture of left tibia, August, 1876; excision of 12 centimetres of tibia, September 7, 187C; ampu tation in lower third of tUigh September 15; death September 1C, 1876. 19 XADE (E.) (Das tempo-flirt Kriegslazareih des Rcssorts der Anstalten der Xaiscrin Maria im Kloster Afariahimmelfahrt bei Sitstowa, in St. J etersburger Medicimsche Wochenschrift, 1877, B. II. p. 385) states that a successful excision in the diaphysis of the fibula was performed in the hospital near Sistowa under his charge. 1 In the 185 excisions in the tibia, 1 J inches were removed in 5, 2 inches in 23, 2.V inches in 8, 3 inches in 26, 3J inches iu 7, 4 inches in 14, 4J inches in 5, 5 inches in 7, 5.J inches in 2, 6 inches in 7, and 7, 8, and 8.J inches in 1 instance each, and in 78 the length of bone removed was not indicated. Of the 182 fractures of the fibula, J-inch was removed iu 3 instances, 1 inch in 2, 1J inches in 6, 2 inches in 22, 2J inches in 10, 3 inches in 33, 3J inches in 7, 4 inches in 20, 5 inches in 7, 6 inches in 3, 6J inches in 3, 7 inches in 1, 8 inches in 2, 12 inches in 1, and in 1 instance nearly the entire fibula ; in 61 fractures of the fibula the amount excised was not stated. In the 18 instances of excisions in both bones of the leg the amount removed varied, according to the nature of the injury in each bone, from to 5 inches in tlit tibia und from 2 to 8 inches in the fibula in 3 instances neither Ihe bone implicated nor the umount excised was indicated 572 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. Volunteers (CASE 703, page 445, ante), Assistant Surgeon W. Thomson, U. S. A., states that "the leg was perfectly helpless, a hiatus of nine or ten inches existing in the tibia, with no hope of any improvement from the lapse of time," and remarks: "no more useless or unphilosophical operation could be devised than the one done in this case." Colonel W. F. Fitch, 29th Ohio Volunteers (CASE 705, page 446, ante), who visited the Army Medical Museum in 1870, six years after the operation, greatly regretted that amputation had not been performed. Three inches of the tibia had been excised and the bone remained ununited; the calf of the leg was atrophied, and the foot swollen and useless. In the case of Lieutenant 0. R. Fyler (CASE 704, page 446, ante), 2d Connecticut Heavy Artillery, Examining Surgeon H. E. Gates reported, in 1877, that "the whole leg and thigh is atro phied. The fibula is bowed outward, and there is partial dislocation of its head. The leg bends easily at the seat of the injury and no weight can be borne upon it. I have no doubt the fibula would instantly give way if the applicant should stand upon it. There is great tenderness at the head of the fibula from stretching of the ligaments, the line of support from the bending of the leg being thrown outward toward this articulation. The pensioner wears an appliance weighing seven pounds, which incases the limb and gives the only support. The disability is progressive on account of displacement and bending of fibula, etc. I consider his present condition worse than if he had amputation above the knee; locomotion is very painful indeed." Pseudarthrosis, rarely noted in the cases treated without operative interference, was recorded in at least twenty-eight of the cases of recov ery after excision in the bones of the leg. 1 In the case of Private J. Lagro, 10th Vermont Volunteers (CASE 719, page 457, ante), Examiner 0. F. Fassett reports that "the bones have never united except by ligament, so that a false joint now exists;" and the same examiner, in 1877, thirteen years after the injury, states: "The wound is still an open, suppurating, and discharging sore, the bone being extensively diseased. The disease is so near the joint that amputation must be above the knee. His condition now is worse than with loss of the leg above the knee. The leg is bent into a curve and greatly deformed." In the cases in which the excision was performed in the continuity of the fibula useful lirnbs were preserved in several instances, but as a rule the foot could not be planted even, as it would turn outward from the want of fibular support. Amputations in the Leg. At the time of the publication of the preliminary report of 1865, 2 the results of two thousand three hundred and forty-eight (2348) amputations in the leg, giving a mortality rate of 26.02 per cent., had been ascertained. Further exam ination of the returns has augmented the number to five thousand four hundred and fifty- two (5452) and has increased the rate of mortality from 26.02 per cent, to 32.9 per cent.; yet the final results, as reported in the preceding pages, compare favorably with the results of amputations in the leg obtained in other wars, as exhibited in TABLE LXXXVI on the opposite page. Of the seven thousand six hundred and thirty-seven cases cited in this table, the final results were ascertained in seven thousand and thirty-eight. One thousand eight hundred and thirty-nine (] 839) were successful and five thousand one hundred and ninety-nine (5199) fatal, giving a death rate of 73.8 per cent. This excessive rate of 1 HEINE (C.) (Die Schussverletzungen dtr imteren Extremitiiten, Berlin, 1866, p. 310), who considers the fracture in the bones of the leg the most favorable field for excision, " as here the reproductive powers of the bony substance, as well as of the periosteum, seem to be especially active and fruit ful," admits, on page 331, that "when the strength of the patient has not suffered too much, it is unquestionably preferable to await the separative process to be performed by nature, as a resection, in every instance, adds a new wound to the old one with new dangers, and finally a condition not too rarely resulting, but which we have as yet not mentioned, must not be overlooked, viz: the supervening 1 of pseudarthrosis." 2 Circular No. G, War Department, Surgeon General s Office, Washington, November 1, 1865, p. 47. SECT. V.] AMPUTATIONS IN THE LEG. 573 mortality is principally due to the deplorable fatality attending the operations among the French troops in the Crimean, Italian, and Franco-Prussian Wars. TABLE LXXXVI. Summary of Seven Thousand Six Hundred and Thirty-seven Amputations in the Leg for Shot Injuries on the Occasions named and from the Authorities quoted. OCCASIONS AND AUTHORITIES. CASES. RECOVERIES. DEATHS. UNDE TERMINED. PARE* - . .... l 4 12 1 159 2 19 22 2 5 12 3 8 4 94 3 10 2,698 21 466 2 12 1 93 9 267 3,704 3 1 o 7 Thirty- Years War, 1G18-1C48 (SCHMIDT) 2 1 5 1 33 1 French Wai s 1740 1756 (BOUCHER DK GARENGEOT FAURE) S Seven Years War 1756-1763 (SCHMUCKKR)* Napoleonic Wars 1791-1815 (LARREY CHAVANE, KLEIN HENNKN GUTHRIE) 8 117 2 8 17 2 2 11 1 7 2 57 2 2 506 21 168 2 8 1 61 6 150 654 2 9 Fort Erie 1814 (TUOWBRIDC.E) 6 Revolution in Paris, 1830 (LARKEY, MENIERE, ARNAL, ROUX, JOBERT) 7 8 5 3 Siege of Antwerp 1832 (LARUET) 8 French in Algiers, 1830-1836 (BAUDEN8, BAGRE) 9 Campaign of Constantine, 1837 (SEDILLOT) 10 3 1 2 1 2 37 1 8 1,617 Spanish Peninsular War, 1837 1838 (ALCOCK)" War in Mexico 1845-1848 (PORTER) 12 Revolution in Paris 1848 (ROUX MALGAIGNE, HUGUIER JOBERT BAUDEN8) 13 Revolution in Milan 1848 (RESTELLI) 14 War in Schleswig-IIolstein 1848 1850 (DjORUP STROMEYER) * Revolution in Baden 1849 (BECK) 16 Bombardment of Sveaborg 1855 (HEYFELDER) 17 . . .. Crimean War, 1854-1856 (CHENU, HUBBENET, MATTHEW) 18 575 British in India 1857 1858 (WILLIAMSON) 19 Italian War, 1859-1860 (CnENU, DEMME GHEREsl) 20 278 New Zealand War, 1863-1865 (MOUAT) 21 . . . . Danish War, 1864 (HEINE, OCHWADT) 22 4 French in Mexico, 1864 (BlNTOT) 2 * A ustro- Prussian War, 1866 (BECK, BlEFEL FISCHER MAA8 STROMEYER) 24 32 106 3,050 United States Army, 1865-1870 (OTIS) 28 .. .. Franco-German War, 1870-1871 (GERMANS) (BECK, BlLLROTH CZERNY etc.) 26 11 Franco-German War, 1870-1871 (FRENCH) (CHENU) 27 Turco-Russian War, 1876 (KADE STEINER TILING) 78 Aggregates 7,637 1,839 5,199 599 Rate of mortality, 73. 8 per cent. As a rule the surgeons of the American civil war amputated in every part of the leg regardless of the point of election, sacrificing as little as possible of the sound portions of An early, and probably the earliest recorded example of amputation in the leg following shot wound is that reported by PARS (A.) ((Euvres de, Paris, 1590, p. 408, Chap. XXII): Captain Francois Le Clerc had his foot carried away just above the ankle by a cannon ball. The wound healed, but the leg became troublesome, and the patient had the limb amputated (he width of five fingers below the knee. He recovered with a serviceable stump. Four examples of amputation in the leg are recorded by 2 SCHMIDT (JOSEPH) (Speculum Chirvrgicum oder Spiegel derArtzney, Augspurg, 1656, pp. 153, 156, 157): 2 were successful, 1 fatal, and 1 result unknown : B. Lundlaw, of the regiment Wallenstein, received, November 22, 1663, a shot fracture of both bones of the left leg; amputation of leg; death November 16. 1663. H. Braunmtiller, Oheim s regiment, shot in the left leg May 23, 1663; amputation of leg; result not recorded. Cavalryman G. Burger, Caselcki s regiment; left leg carried away above the ankle; amputation higher up; recovery. A corporal of von Oelter s Bavarian regiment; left foot torn away; amputation in leg; recovery. BOUCHER (Obs. sur des Playes d armes a feu com- pliqut.es sur tout de fracas des os, in Mem,, de VAcad. de Roy. de Chir., Paris, 1753, T. II, p. 470) cites five amputations in the leg for wounds received at Fontenoy, April 30, 1745: A captain of Hainaut g regiment had the leg amputated in the field; recovered October 26, 1745. In the case of a lieutenant of the regiment Clare, the limb was successfully amputated 6 days after the injury. Of the remaining three, one died from haemorrhage 11 ln-urs after amputation, and the other two survived the operation 16 and CO days respectively. DE GARENGEOT (Moyens de rendreplus simple etplus sure lamputa- tion d, lambeau, in Mtm. de I Acad. Hoy. de Chir., 1753, T. II, p. 262): A soldier of the King s regiment received a shell wound of the right foot with fracture of both bones of the leg ; amputation 8 days after the injury ; healed in 27 days. FAUIiE (L amputation etant absolument necessaire dans Its plaies compliquees de fracas des os, etc., in Prix de VAcad. Roy. de Chir., Paris, 1819, T. Ill, pp. 339, 340) details 3 cases of secondary amputations in the leg, the operation being performed, one on the 46th and two on the 47th days after the injury; all recovered. BAGIEU (Examen de plusieurs parties de la Chirurgie, Paris, 1756, p. 97): Shot fracture of tibia and fibula; primary amputation of leg; fatal. RAVATON (Chirurgie d armee ou traite des plaies d armes a feu, Paris, 1768, p. 372): Shot wound of left leg; amputation 6 weeks after injury: fatal. IDEM (loc. cit., p. 404): Fray, of Schomberg s regiment, shot fracture of left foot in September, 1755: primary amputation ; recovery. 4 ScHMUCKER (J. L.) ( Vermischte Chirurgische Schriflcn, Ber lin und Stettin, 1785, B. I): Captain von Wedel, shot fracture of ankle joint. August 11, 1760; amputation of leg at upper third; fatal. "LAKKEY (D. J.) (Mem. de. Chir. Mil. ft Camp., Paris, 1812, pp. 265, 269): Lieut. Bonichon, 21st Light Infantry, shot wound of left foot, October 7, 1708: tetanus; ampu tation in upper third: recovery. Another amputation for tetanus following shot wound was performed by LARREY on March 21, 1801 ; tetanus subsided, but the patient died 13 days after the operation. IDEM (loc. cit., T. II, p. 195): Captain M , wounded at the second battle of Aboukir, in 1801 ; ampu tation immediately below the knee; recovery. IDEM (loc. cit., T. Ill, pp. 56, 83, 156, 389, 391, and 378) refers to 16 cases of amputation in the leg: Han- 574 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. the bones of the limb. One thousand five hundred and nine (1509) of the five thousand four hundred and fifty-two (5452) amputations were performed in the upper third, one thou sand four hundred and eighty-one (1481) in the middle, one thousand four hundred and seven (1407) in the lo.wer third, and in one thousand and fifty-five (1055) instances the seat nequin, fracture of leg in tipper third, Eylau, February 8, 1807 ; amputation through tuberosity of tibia ; recovery. During the same campaign LAHUKY performed 3 similar operations through the tuberosity of the tibia; the patients recovered. At Ulm, iu October, 1805, an officer received a shot through the ankle ; gangrene and fever; amputation below the point of election; recovery. In Egypt, in 1799, LARKEY twice successfully amputated close to the knee joint, and nearly on a level with the head of the fibula, and at Wagram and Esslingen, in 1809, 9 similar operations were performed by him; but the results are not indicated. Of 3 cases of amputation of both legs performed after Wagram, 1 performed immediately after the reception of the injury proved successful; 2 others were fatal. IDEM (toe. cit., T. IV, pp. 56, 6 9, 156, and 164) details 4 cases of amputation in the leg during the Russian campaign 1812-13: 3 were successful and 1 proved fatal. LARKEY (D. J.) (Clinique Chirurgicale, Paris, 1829, T. Ill, pp. 651, 652, 662, 664, and (i65) cites the cases of Dosmenil, wounded at Wagram, in 1809; amputation in middle third; recovery. Lambels, wounded in the Russian campaign, 1812, amputation in upper third; recovery. General Laferrie re, wounded at Craonne in 1814; amputation in middle third; recovery . An officer, wounded at Moscow in 1812; amputation in upper third; recovery. General Chfimineau, wounded at Lutzen in 1813; amputation in upper third; recovery. Robsomen, wounded at Hanau in 1813; amputation in upper third; recovery. IDEM (loc. cit., T. IV, pp. 279, 282): Gault, an officer of dragoons; shot fracture of upper third of right leg; amputation below the knee; recovery. Colonel d Esclignac, amputation of leg; recovery. ClIAVANE (X.) (Consid erations theo.-prat. sur I amputation d fair e a la suite des fractures comminutives de la jambe, etc., Paris, 1814, Thfise No. 99, pp.7, 9, 10) details:! successful amputations in the leg. KLEIN (D. C.) (Practische Ansichten der bedeutendsten chirurgischen Operationen, Stuttgart, 1815, p. 31) relates a successful case of amputation at the ankle and subsequent ablation iu the leg. HENNEN (J.) (Principles of Military Surgery, 3d ed., London, 1829, pp. 275, 277): Chatelot, wounded in 1815, amputation leg; death. M -, 3d guards, amputation of leg July 11, 1815; death August 3, 1815. GliTHltlK (G. J.) (Commentaries, etc., 6th ed., London, 1855, p. 158) tabulates IK! cases with 23 deaths, after the battle of Waterloo, in 1815; 43, with 7 deaths, were primary, and 50, with 16 deaths, were secondary operations. GUTHUIK (G. ,1.) (-4 J^reatise on Gunshot Wounds, etc., 3d ed., London, 1827, p. 308) reports 28 amputations in the leg performed near New Orleans, from January 8 to April 24, 1815 ; 26, with 3 deaths and 23 recoveries, were primary operations, and 2, both fatal, were secondary operations. G TROWBRIDOE (A.) (<!unxhot Wounds, in Boston Me.d. and Surg. Jour., 1838, Vol. XVIII, p. 342) cites 1 case of amputation of leg and 1 of both legs from the siege of Fort Erie, in 1814 ; both patients recovered. LAKUEY (H.) (Re.l. Cliir. des Evenemens de Juillet 1830, Paris, 1831, p. 122): 6 amputations in the leg (3 successful, 3 fatal). MENIERK (P.) (L Hotel- Dieu de Paris en Juillet et Aout 1830, p. 325): 3 amputations in the leg ; fatal. ARXAL (Mem. sur quelques particular ilex des pi airs par arines a feu, in Jour. Unif. et Hebd. de, M* d. et de Chir. Prat., Paris, 1831, T. Ill, p. 35): I amputation of leg; recovery. ROI X (Plates d armt.s ti feu. Communications, etc., Paris, 1849, pp. 37, 38): 6 amputations of leg (4 recoveries, 2 fatal). JOBEltT (DK LAMHALLE) (P laics d arines <</, Paris, 1833, pp. 303-305) cites 3 amputations in the leg (no results). *LAHRKY (II.) (Hist. Chir. du Siege de, la citadel U d Anvers, Paris, 1833, p. 334): 22 cases; 20 primary (16 recoveries, 4 deaths), 2 secondary (1 recovery, 1 fatal. BAUDEX8 (L.) (Clinique desplaies d armes afeu, Paris, 1836, p. 540): 1 amputation of left leg; recovery. BACiKfc (Obs.de Chir.,recueilUes a I hopital Turc, a Alger, in Bee. de Mem. de Mid. de Chir. et de Phar. Mil., Paris, 1831, T. XXXI, p. 168): 1 amputation; recovery. "SEUll.l.OT (O.) (Camp, de C onstantine de 1837, Paris, 1838, p. 266): 5 amputations iu the leg (2 recoveries, 3 t atal). " ALCOCK (R.) (Notts an the Mfd. Hist, and Stat. of the British Legion in Spain, London, 1838, p. 95): 12 amputations in the leg (11 recovered, 1 fatal); 3 with 2 recoveries primary, unil 9 recoveries were secondary operations. *POKTKK (J. B.) (Med. and Surg. Notes of Campaigns in the War with Mexico, during the years 1845-1848, in Am. Jour. Med. Sci., 1852, Vol. XXIII, N. S., pp. 31, 32): 3 amputations in the leg (1 recovery, 2 fatal). l3 l>es plaies d armes d feu Communications, etc., Paris, 1849, par JIM. Roux (p. 11), 2 amputations (1 recovery, 1 fatal); MAU;AU:NK (p. 4ti), 2 amputations (recoveries); HuouiKR (p. 143), 2 amputations (recoveries); JOBKin (p. 154), 1 amputation (recovery); BAUI>ENS (p. 233), 1 amputation (recovery). I4 RKSJKU,I (A.) (J\ otf. ed Osservaziuni cliniche di chirurgia militorc, in Annali Universali di Medicina, 1849, Vol. CXXX, pp. 243, 244): 4 cases (2 recoveries, 2 fatal). 15 1)JORUP (Bcmaerkninger over de i Krigen 1848-50 foretagne Amputationer i Forbindelse med en Statistik over dein, in Hospitals- Metldtlelxtr, Kjobeuhavn, 1852, B. V, p. 10(i): 48 cases (29 recoveries, 19 fatal). STIIOMKYEK (L.) (Maximen der Kriegsheilkunxt, Hannover, 1855, pp. 756, 757): 46 cases (28 recoveries, 18 fatal). "BECK (B.) (Die Scltuss- wunden, Heidelberg, 1850, Tubellu): 3 cases (2 recoveries, 1 fatal). l7 HEYFE1.U1CK (J. F.) (Die Venvundungen und Operatioiien in Folge des Bumbarde.- ments von Sceaborg vom 9.-1 1. Aug., in Deutsche Klinik, 1855, B. VII, pp. 4; | 5 and 57.">): 10 cases (2 recoveries, 8 fatal). " (MlKNU (J.-C.) (Rapport, tie., pendant la Campagne d Orient, en 1 854- 55- 5ti, Paris, 1865, p. 666): l,30(i cases (368 recoveries, 938 fatal). HttUUKNKT (0. v.) (Die Simitats-VerhdUn-isse. der Russischen Veru undeten wahrend des Krimkrieges in den Jahren 1854-1856, Berlin, 1871, p. 182): 1,286 cases (69 recoveries, 642 deaths, 575 unde termined). MATTHEW (T. P.) (Med. and Surg. Hist, of the British Army, etc., in the years 1854- 55- 56, London, 1858, Vol. 11, pp. 368, 369): 106 cases (69 recoveries, 37 fatal). 19 WILLIAMSON (G.) (Military Surgery, London, 1863, p. XXVII): 21 cases (recoveries). *>CHEXU (J.-CJ (Stat. Med.-Chir. de Camp, dltalie en 1859 et I860, Paris, 1869, T. II, p. 809): 347 cases (116 recoveries, 231 fatal). DKMMK (II.) (Mililar-Cliirurgische Studien, Wiirzburg, 1861, B. II, p. 278): 113 cases (69 recoveries, 44 fatal). GHEUIM (A.) (Rel. chir. dell Ospeilale mil. provisorio di ,S . Filippo. iu Annali Univ. di Mfd., Milano, 1860, Vol. CLXXIII, pp. 419, 420): 6 cases (3 recoveries, 3 fatal). * MOUAT (The New Zealand War of 1863-64-65, in Mat. San. and Med. Reports, Vol. VII, for the year 1865, London, 1867, p. 514): 2 cases (recoveries). w HEINE (C.) (Die Schus&verletzungen der unteren Extremitaten, Berlin, 1866, p. 294): 3 cases (2 recoveries, 1 fatal). OCHWAUT (A.) (Kriegschirurgische Erfahruiigen, Berlin, 1865, tabular statement): 9 cases (6 recoveries, 3 fatal. 23 BIXTOT (Obs. de blessures de guerre, in Rec. de Mem. de Med. de Chir. et de Phar. Mil., Paris, 1866, T. XVI, p. 237): 1 case (recovery.) M BKCK (B.) (Kriegs.-Chir. Erfahnnigen icdhrend des Feldzuges 1866, Freiburg, i. Br. 1867, p. 331): 43 cases (26 recoveries, 17 fatal). BlF.FEL (R.) (Im Rei-crrt- Lazareth, in Archie fur Klin. Chir., Berlin. 1869, B. XI, pp. 465, 474): 4 cases (2 recoveries, 2 fatal). FiscilElt (K.) (Militairarztlicht Skizzen, Aarau, 1867, p. 97): 26 cases (22 recoveries, 4 fatal). MAAS (H.) (Kriegschirurgiichc Beitrdge aus dem Jahre 1866, Breslau, 1870, p. 73): 3 cases (2 recoveries, 1 fatal). STROMEYEIJ (L.) (Erfahrungen uber Schusswunden im Jahre 1866, Hannover, 1867, p. 59): 17 cases (9 recoveries, 8 fatal). M OTIS (G. A.) (Circular No. 3, War Department, S. G. O., Washington, 1871, pp. 196-202): 9 cases (6 recoveries, 3 fatal). K BECK (B.) (Chirurgie der Schussverlet- ziingen, Freiburg, i. Br., 1872, pp. 800, et seq.): 152 cases (91 recoveries, 58 fatal, 3 undetermined). BiLLltOTH (T.) (Chir. Brirfe aus den Kriegs-Laza- rethen in Weissenburg und Mannheim 1870, Berlin, 1872, pp. 232, et seq.): 7 cases (4 recoveries, 3 fatal). CZERNY (V.) (Bericht iiber die im College Stanislaus in Weissenburg behandelten Verwundeten, in Wiener Med. Wochenschrift, 1870, pp. 1355-56): 3 cases (1 recovery, 1 fatal, 1 unknown). FISCHER (G.) (Dorf Floing und Schloss Versailles, in Deutsche Zeitschrift fiir Chirurgie, 1872, B. I, p. 187): IU cases (14 recoveries, 5 fatal). FISCHER" (H.) (Kriegschirurgische Erfahrungen, Erlangen, 1872, p. 213): 8 cases (5 recoveries, 3 fatal). GOLTDAHMEK (Bericht i ber die Thatigkeit des Rest r re- Lazaretts des Berliner Hilfsvereins in der Garde-Ulanen-Kaserne zu Moabit, in Berliner Klin. Wochenschrift, 1871, .Tahrg. VIII, p. 152): 2 cases (1 recovery, 1 fatal). GRAF (E.) (Die Koniglichen Reserve-Lazarethe zu Dusseldorf wahrend des Krieges 1870-71, Elberfeld, 1872, pp. 31, 4P): 9 eases (4 recoveries, 5 fatal). KlKCHNER (C.) (Aerztlicher Bericht iiber das KSniglich Preussisclie Feld-Lazareth im Palast zu Versailles. Erlangen, 1872, pp. 88, 89): 9 cases (6 recoveries, 3 fatal). KOCH (W.) (Notizen iiber Schussverletzungen, in Archiv fur Klin. Chir., Berlin, 1872, B. XIII, p. 574): 12 cases (9 recoveries, 3 fatal). LOS8EN (H.) (Kriegschirurgische Erfahrungen aus den Barackenlazarethen zu Mannheim, etc., in Deutsche Zeitschrift fur Clrir., 1 873, B. II, pp. 138-148): 4 cases (4 fatal). MAYER (L.) ( Kriegschirurgische Mittheilungen avs den Jahren 1870-71 , iu Deutsche Zeitschrift fur Chirurr/ir. 1873, B. HI, pp. 50, 52): 2 recoveries. RUPPRECHT (L.) (Militdrdrztliche Erfahrungen wahrend des Deutsch-Franzozischen Krieges im Jahre 1870-71, Wurzburg, 1871, p. 35): 5 cases (2 recoveries, 3 fatal). SCHINZINGEK (A.) (Das Reserve-Lnzareth Schwetzingen im Kriege 1870 und 1871, Freiburg, i. Br., 187!!, pp. 84, 88): 5 cases (4 recoveries, 1 fatal). SEEGER (W. v.) (Die Leistungen der Vereinsspitaler Kleinkinderchule und Diakonenhaus in Lvd- wirjsburg im Jahr 1870-71, in Zeitschrift fur Wunddrzte und Geburtshelfer, Stuttgart, 1871. B. XXIV, p. 117): 1 case, fatal. SOCIN (A.) (Kriegschirur gische Erfahrungen gesammelt in Carlsruhe 1870 und 1871, Leipzig, 1872, pp. 144, 187): 4 cases, fatal. STEINBERG (Die Kriegslazarelhe und Baracken SECT, v ] AMPUTATIONS IN THE LEG. 575 of operation was not indicated. The fatality of the operations in the upper third was 27.0, in the middle third 20.6, and in the lower third 27.6 per cent. 1 Here as well as in the amputations of the thigh (see TABLE XXIX, p. 213, ante) and in the ablations of the fore arm and arm (see TABLE CXXXII, p. 967), and of amputations in the arm (Recapitulation, pp. 805, 806 of the Second Surgical Volume), the operations in the middle third of the limb were less fatal than those in the upper or lower thirds. It will also be noted that the mortality of the amputations in the lower third slightly exceeded that in the upper third, 2 a result which appears to argue against the operations in the lower third immediately above the malleoli, advocated and practised by Ravaton 3 and White, 4 and later by Lenoir, Goyrand, and others. 5 Furthermore, of the two hundred and twenty cases of re-amputations in the leg, knee joint, or thigh, the amputations had originally been performed in the lower third of the leg in one hundred and two, in the middle third in seventy-five, in the upper third in forty, while in three the seat of the first operation was not indicated; showing that abla tions in the lower third contributed nearly one-half of all the cases of re-amputation. The considerations of greater safety of life, as evinced in the results of amputations of the middle third, and the excellent prothetic apparatus furnished at Government expense to the maimed soldiers, outweigh the objections raised by surgeons to the inconvenience of a projecting limb, necessitated by the use of a peg leg, as well as the question of the greater cost of such apparatus. From the returns it would appear that of the modes of operation the flap method was most frequently employed one thousand six hundred and ninety-eight (1698) instances of this procedure being reported, against one thousand two hundred and six (1206) by the circular, twenty-two (22) by the circular flap, and a few by Teale s 6 and Hey s 7 methods; but in at least two thousand five hundred (2500) cases the mode of operation was not indi cated. Assistant Surgeon J. T. Calhoun, U. S. A., in his narrative of service at the 4th von Berlin, Berlin, 1872, p. 148): 13 cases (3 recoveries, ti fatal, 4 undetermined). STOLL (Bericltt avs dem Koniglich Wiirttembcrgischen 4. Feldspital von 1870-71, in Deutsche Militairdrztliche Zeitschrift, 1874, 3d .lahrg., p. 218): 9 cases (4 recoveries, S fatal). STUMPF (L.) (Bericht i:ber das Kriegs- Spital des St. Georg-Ritter-Ordens zu Nenbergtiausen im Jalire. 1870-71. in Aerztliches Intelligenz-BIatt, Miinchen, 1872, No. 50, p. 657): 3 cases, unde termined. "CHENU (J.-C.) (Apercuhist., slat., et din., etc., pendant la guerre dr. 1870-71, Paris, 1874, T. I, p. 493): 3,704 cases (654 recoveries, 3,050 fatal). ^KADK (E.) (Das tempordre Kriegslazareth des He.ssorts de.r Anstallen dKr Kaiserin Maria im Kloster Mariahimmelfahrt bei Sistou-a, in f>t. Petersburger M(d. Wochenschrift, 1877, I?. II, p. 384): 1 case, recovery. STE1NER (K.) (Aus dem Tagebuctie tines deutsclien Arztes, in Wiener Med. Wochenschrift, 1877, B. XXVII, p. 426): 1 case, recovery. TILIM; (G.) (Bericht iiber 124 im serbisch-tiirkischen h riege im Baracken-Lazareth des Dorpater Sanitdts- Trains zu Stilainatz behandelte Schvssverletzungtn, Dorpat, 1877, p. 77, No. 82): 1 case, fatal. The precise figures are: Upper third 1,509 cases, viz: 1,094 recoveries, 406 deaths, 9 unknown results, mortality 27 per cent. Middle Ihird, 1,481 cases, viz: 1,170 recoveries, 305 deaths, 6 unknown results, mortality 20.6 percent. Lower third, 1,407 cases, viz: 1,011 recoveries, 387 deaths, 9 unknown results, mortality 27.6 per cent. See TAISI.E LXVII, p. 4(il, ante. 2 Staffsurgeon GUO.SSHEI.M (Uebe.r die Schusscerlctzungen des Fussgelenks wdhrend des letzten Kriegcs und die Resultate Hirer Behandlung unter Benutzung officieller QueJlen, in Deutsche Militairdrztliche Zeitscltrift. 1876, Jahrgang V, p. 223, note*) remarks: "The supra-malleolar amputation has given very unfavorable results during- the war 1870-71 ," and. on page 252. gives the ]>ercentage of fatality of the amputations in the lower third of the leg as 53.9 per cent., and adds: "The results of the amputations of the leg in the upper and middle thirds are incomparably better than those in the lower third, their percentages of fatality being only 38.5 and 36.0 per cent, respectively." 3 RAVATON , Sur Vutilite de I amputation faite pres des malleotes dans IKS maladies du pied, et sur une bottine de nouvelte invention, in JKecuil periodique d observations de Medicine, Chirurgie, Pharmacie, etc., Paris. 1757, T. VI, p. 130. 4 WHITE (C.), An Account of a new Method of amputating the Leg a little, above the Ankle Joint, with a Description of a Machine particularly adapted to the Stump, in Medical Obserrations and Inquiries by a Society of Physicians in London. London, 1771, Vol. IV, p. 168. LiENOIH (A.), Quels sont les cas et qurls sont les lie.ux, ou il convient d amputer la jambe, Paris, 1835; ibid, Note sur une modification de la methode circulaire appliquee a Vamputation de la jambe. au dessus des malleoles. in Archives Generates de Medecine, Paris, 1840, 3 e ser., T. VIII, p. 257. GOY- itAND (G.), De I amputation de la jambe, partiquee loin du genou ; nonvel appareil de sustentation, in Journal Hebdomadaire des Progres des Sciences et Institutions Medicales, Paris, 1835, T. II, p. 161. LAliliEY, Amputation Sus-Malleolaire, in Bulletin de V Academic Royale de Medecine, Paris, 1841-42, T. VII, p. 211. AKNAL et MAKTIX, Menioire sur Vamputation sus-malleolaire, in Annales de la Chirurgie Franqaise et trangere, 1841, T. Ill, p. 129. ARNAL (L.), Memoire sur I amputation sus-malleolaire, in Mimoires de I Academic Royale de MCdecine, 1843, T. X, p. 59. KOZE (M. A.), Dr. { amputa tion sus-malli olaire, in Gazette Medicate de Paris, 1847, 3* ser., T. II, p. 987. COOTE (H.), Amputation at the inferior third of the Isg. in the Lnndnn Lancet, 1847, Vol. I, p. 274. BAUXETT (C. V.), Supra-malleolar Amputation. Its relative value, in Transactions of the Medical Society of the State, of New York. 1857, p. 169. LAHORIE, Communication sur Vamputation sus-malleolaire, in Bulletin de la Socifite de Chirurgie de Paris, Paris, 1859, T. IX, p. 198; ibid., in Bulletin de la Societe impt riale de, Chirurgie de. Paris pendant Varmee 1866, Paris, 1867, p. 63. GUYON, Amputation sus-malleolairf par unproced : nouveau. in Bulletin de la Socictt imperiale de Chirurijie de Paris, 1869. 2 SL TIB, p. 334. CHAUVEI., Amputation sus-mall olaire, in Mem. de la Soc. de Chir. de Paris, Paris. 187.3, T. VII, p. 366. GAYKAUD (E.), De I amputation sus-malleolaire, in Montpellier Medical, 1877, T. XXXVIII. p. 120. 6 TKAI.E (T. P.), On amputation by a long and short rectangular flap, London, 1858. HEY (WILLIAM), Practical Observations -in Surgery, illustrated by cases, 3d ed., London, 1814, p. 542. 576 INJURIES OF THE LOWER EXTREMITIES. [CHAi>. X. division, Second Corps hospital, April 1, 1864, prefers the "long posterior flap with a small crescentic anterior flap, and after sawing the bones always removes the sharp projecting angle of the spine of the tibia." Surgeon Burt G. Wilder, 55th Massachusetts Volunteers, in his observations of cases at Judiciary Square Hospital, prefers the circular method in amputations in the lower third. "Here at least, the circular method is superior to the flap, that is, results in the best stump, both in appearance and for an artificial limb; * * it is evidently the best method where the patient is obliged to undergo any subsequent trans portation. The large inferior flap formed from the calf constitutes a very thick cushion at the end of the stump, but the superior edge of the tibia is always thinly covered." Protrusion of the tibia or fibula or both, frequently noted, especially in cases in which the crest of the tibia had not been removed at the time of the operation, was followed by secondary haemorrhage, sloughing, and exfoliation. Surgeon B. Gr. Wilder, 55th Massa chusetts Volunteers, remarks of twenty-seven cases of amputations in the leg, observed at the Judiciary Square Hospital at Washington in 1863: "The crest of the tibia was removed at the time of the operation in four cases, and in none of these did the bone afterwards protrude. In three cases sloughing followed a. previous secondary haemorrhage. In eleven cases the tibia or fibula or both protruded through the flap and exfoliation usually followed. Secondary haemorrhage and sloughing occurred in two, indicating rather a constitutional than a local cause. Omitting these two, there remains nine cases five of them in the middle third of the leg in which the crest of the tibia exfoliated to a greater or less extent for no other evident cause than its non-removal at the time of operation. The exfoliations took place at various periods during the second, third, fourth, sixth, tenth, thirteenth weeks, and in one instance during the fifth month." To prevent as much as possible the protrusion of the bones, which the great weight of the soft parts forming the calf tended to aggravate, Dr. Frank P. Foster, of the New York Hospital, applied with good advantage an apparatus shown in the appended wood-cut (FiG. 329). A piece of adhesive plaster was cut in the shape shown in FIG. 328; the two limbs were / \j\- 7^ ^yjj^; 1 ; ?* * ^^-"-N^ cut through at G C, the surfaces of the end pieces B B reversed, and FIG. 328Adhesive piaster the pieces joined with reversed ends. fI G . 339. Fracture box with stump supported by adhesive plaster, o o at C G with pins. The adhesive surface of the middle portion A was then applied to the posterior surface of the stump and the ends secured to the outside of an ordinary fracture box, as shown in FIG. 329. Traction downward on the fracture box was effected by means of a weight and pulley. SECT. VI.| WOUNDS AND OPERATIONS AT THE ANKLE JOINT. 577 SECTION VI. WOUNDS AND OPERATIONS AT THE ANKLE JOINT. The cases to be considered in this Section are restricted to injuries, by weapons of war, of the bones forming the tibio-tarsal articulation, viz: the lower extremities of the tibia, the fibula, or the astragalus. Injuries of the os calcis and other adjoining bones, unless the ends of the tibia and fibula and the astragalus are likewise involved, are reserved for the next section. Seventeen hundred and twenty-two injuries of the bones forming this articulation were found on the field and hospital returns. All were caused by shot; eleven were contusions, and seventeen hundred and eleven fractures. SHOT CONTUSIONS OF THE ANKLE JOINT. Of eleven shot contusions of the bones of the ankle joint indicated on the records, seven were treated throughout without operative interference; four were followed by amputation in the leg. The latter cases have already been cited in the tables of amputations in the leg, 1 and it remains only to give brief details of the cases treated by conservation. Shot Contusions of the Bones of the Ankle Joint treated by Conservation. The injuries in the seven cases of this group were confined to the malleoli, in three instances the internal and in four the external malleoli being involved. All resulted in recovery. CASE 808. Private J. G. Clayton, Co. I, 24th Eegiment (Confederate), aged 22 years, was wounded in the left ankle, at Drury s Bluff, May 16, 1864. The missile, a ball, impinged upon the lower end of the tibia, glanced downward and passed through the anterior aspect of the ankle joint, lodging under the skin over the neck of the astragalus, whence it was extracted two days afterwards. One week after the injury the foot and ankle were inflamed and swollen and there was excruciating pain upon the slightest motion, while the grating of the inflamed articular surfaces was distinct. After free incisions to favor the escape of confined pus, which was freely mingled with synovial fluid, and the persistent employment of cold irrigation and anodynes, the local inflammation subsided. In the course of several weeks it entirely ceased and the general condition of the patient became much improved. By the following January the wound had closed and the patient was able to walk with the aid of a cane, though motion of the joint was still imperfect. The history of the case was published 2 by Dr. J. M. Hollovvay, late Surgeon P. A. C. S. CASE 809. Private W. Johnson, Co. B, 147th New York, aged 18 years, was wounded at Hatcher s Eun, October 27, 1864, by a minie" ball, which grazed the inner malleolus of the left ankle. He entered Lincoln Hospital, Washington, whence he reported to Elmira for muster out May 27, 186o. Not a pensioner. CASE 810. Corporal A. Daily, Co. A, 42d Illinois, aged 29 years, was wounded in the right ankle, at Murfreesboro , December 31, 1862, by a musket ball, which took effect upon the external malleolus, touching the bone. He was treated at various hospitals, being assigned to the Veteran Reserve Corps November 25, 1863, and ultimately mustered out and pensioned September 8, 1864. Various examining surgeons certify to weakness of the ankle joint, painfulness, and tendency to inversion of the foot in w r alking. He was a pensioner in June, 1880. CASE 811. Private P. McCabe, Co. G, 87th Pennsylvania, aged 23 years, was wounded in the left ankle, before Peters burg, June 23, 1864, by a musket ball, which contused the external malleoltis. He was admitted to Stauton Hospital, Washing- 1 Cases of Pt. P. Reynolds, K, 5th New Jersey, intermediary amputation, lower third of leg; fatal. Spec. 4578, A. M. M. (TABLE LXX1V, No. 300, page 535, antt). Pt. W. Sharp, I, 8th New York Heavy Artillery, intermediary amputation, middle third of leg; fatal. Spec. 3204, A. M. M. (TABLE LXXIII, No. 349, page 527, ante). Pt. J. F. Willetts, B, 1st New Jersey, intermediary amputation, middle third of leg; recovery. (TABLE LXXIII, No. 250, page 526, ante). Pt. C. Bennett, D, 9th New Hampshire, secondary amputation, middle third of leg: fatal. Spec. 3637 (TABLE LXXVII, No. 138, page 550, ante). 2 HOLLOWAY (J. M.), Comparative Advantages of PlKOGOFF s, SYME S, arid CHOl AUT s Amputations, and Excision of the Ankle Joint by HAN COCK S Method, after Gunshot Wounds and other Injuries, etc., in American Journal of Medical Sciences, 1866, Vol. LI, N. S., p. 88. Sriso. ITT 73 578 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. ton, eleven days after the injury, with the limb greatly swollen and intensely painful. An abscess was opened on July 10th, and three weeks later a thin narrow piece of bone, about one inch long, exfoliated from the external inalleolus. Subsequently another small necrosed piece \vas removed, after which rapid and steady improvement began and the pain disappeared. About September 25th the patient began to walk on cnrches. 1 He was mustered out of service October 13, 18fi4, and pensioned. The Pension Examining Board in September, 1877, report a " tender and adherent cicatrix, complete anchylosis of the ankle joint, and some atrophy of the leg. In walking he cannot bring the heel to the ground, but puts his weight on the front part of the foot." He was paid his pension in June, 1881. CASE 812. Private J. Staton, Co. G, 45th Kentucky, aged 17 years, was accidentally wounded, October 24. 1863, by a pistol ball grazing the external malleolus of the right ankle. He was conveyed to the general hospital at Ashland, where simple dressings were applied. The patient was returned to duty December 3, 1863. and mustered out with his command Feb ruary 4, 1865. Subsequently he made an unsuccessful application for pension. CASE 813. Private T. Ingersoll, Co. E, 8th Kansas, aged 20 years, was wounded by a ball striking the internal malle olus of the left ankle, at Chickamauga, September li), 1863. He passed through several hospitals, and was mustered out of service September 19, 1864, and pensioned. Examining surgeons certify to weakness and slight enlargement of the ankle joint. His pension was paid to June, 1879. CASE 814. Sergeant C. Shade, Co. F, 46th Pennsylvania, age 23 years, was wounded, at Peach Tree Creek, July 20, 1864, by a minid ball striking the external malleolus of the left ankle. Simple dressings constituted the treatment. The patient was returned to duty August 13, 1884, and was subsequently promoted to Lieutenant. He ultimately resigned July 1, 1865, and afterwards became a pensioner. Examining surgeons certify that he complains of pain, weakness, and swelling on over- exertion. His pension was paid to December, 1880. SHOT FRACTURES OF THE BONES OF THE ANKLE JOINT. Of one thou sand seven hundred and eleven instances of shot fractures involving one or more of the bones of tlie ankle joint, five hundred and eighteen were treated without operative inter ference; twenty-nine were followed by excision; four by excision at the ankle and subse quent amputation in the leg; fifteen by amputation at the ankle joint; one by amputation at the ankle joint and subsequent amputation in the leg; and one thousand one hundred and forty-four by amputation in the leg, knee joint, or thigh : TABLE LXXXVII. Summary of One Thousand Seven Hundred and Eleven Shot Fractures of the Tibio-Tarsal Articulation. TREATMENT. CASES. SHOT FRACTURES OF LOWER EXT. OP TIBIA. LOWER EXTREMITY OP FIBULA. ASTRAG ALUS. TIBIA AND FIBULA. TIBIA AND ASTRAGALUS. FIBULA AND ASTRAGALUS. TIBIA, FIBULA, BONES NOT SPECIFIED. 3 1 Recoveries. Deaths. Undeterm d. Ratio of Mortality. Recoveries. Deaths. Recoveries. Deaths. ~ ^-_ Recoveries. Deaths. Recoveries. Deaths. Recoveries. Deaths. Undeterm d. Recoveries. Deaths. Undeterm d. Recoveries. Deaths. Recoveries. Deaths. Undeterm d. 518 29 4 15 1 1,083 2 19 11 29 407 19 13 772 2 14 1 7 99 8 1 1 - 1 19.5 29.6 25.0 7.1 0.0 104 2 14 69 i 12 9 2 2 1 i 52 5 i 13 1 3 1 6 2 2 1 2 1 2 1 7 1 ; 154 54 10 I Followed by 7 i 1 1 4 1 Amputation at Ankle Amp. in Leg . . 1 311 28.7 0.0 50 a 14 15 50 i 69 13 26 19 9 6 38 1 20 516 1 168 .. Amputation in Leg Amp. at Knee. . . Amputation in Leg Amp. in Thigh . . 5 10 22 26.3 90 o 1 i | I 1 1 4 3 ] 1 1 2 75.8 3 .... 3 1 1 1 n 2 3 10 .. 1,711 1.S39 457 i: 26.9 157 50 207 94 36 , 131 i 115 V -S 17 9 84 j!8 102 36 V 25 v 62 i " 12 | 11 v 24 i 50 23 73 691 238 12 -v 941 It is to be regretted that in nine hundred and forty-one of the one thousand seven hundred and eleven cases the bones injured were not specified. The internal malleolus was interested in two hundred and seven, the external in one- hundred and thirty-one, the 1 LlDKLL (J. A.), On Contusion and Contused Wounds of Bone, with an Account of Thirteen Cases, in Am. Jour. JUcd. Set s, 18C5, N. S., Vol. L, p. 36 SECT. VL] SHOT FEACTUKES OF THE ANKLE JOINT. 579 astragalus in one hundred and seventy-one, the articular ends of the libiaand fibula in one hundred and two, the tibia and astragalus in sixty-two, the fibula and astragalus in twenty- four, and all three bones composing the joint in seventy-three instances. SHOT FRACTURES OF THE BONES OF THE ANKLE JOINT TREATED BY CONSERVATION. The fact that of the one thousand seven hundred and eleven cases of shot fractures of the ankle joint five hundred and eighteen only, or less than one third, were treated by expectant conservative measures, "would indicate that the surgeons of the American civil war generally adhered to the teachings of the masters of the early part of the present century, Larrey, 1 Thomson, 2 and Guthrie, 3 who considered shot wounds of the ankle joint extremely dangerous and generally requiring amputation. It must be assumed, therefore, that the most propitious cases only were reserved for conservative treatment. Of the five hundred and eighteen cases the results were ascertained in all but twelve; four hundred and seven had successful and ninety-nine fatal terminations, giving a mortality rate of 19.5 per cent. CASE 815. Private J. Dullahan, Co. D, 3d Vermont, aged 24 years, was wounded in the right ankle, at the Wilderness, May 5, 1864. Six days after receiving the injury he was admitted to Harewood Hospital, Washington, and one week later the man was transferred to South Street Hospital, Philadelphia. Surgeon S. J. W. Mintzer, U. S. V., in charge of the latter hospital, recorded a wound of the ankle with compound fracture of the inner malleolus by a mini6 ball, which entered at the inner malleolus and came out just behind the external malleolus. Cold- water dressings were used. On May 23d there was great pain and swelling, and an application oflead water and laudanum was kept wrapped around the limb; morphia, milk punch, and beef essence being administered. Two days afterwards the wounds of exit and entrance were enlarged, after which the foot was again wrapped up in the same application. On May 27th, the pain still continuing, equal parts of tincture of aconite and water were applied, and two days later a plaster of extract of hemlock was made to cover the entire foot. On May 30th quinine pills were prescribed, and another lotion consisting of laudanum and tincture of aconite was ordered to be constantly applied. The entries in the hospital records at this date mention that the patient was evidently sinking. He subsequently mended, however, and became well enough to be transferred to Brattleboro on June 29th. Several months later he was trans ferred to Burlington, where he was assigned to the Veteran Reserve Corps February 21, 1865. The patient was ultimately discharged from service at Sloan Hospital, Montpelier, July 25, FIG 330 A of limb one 1865, and pensioned. Surgeon H. Janes, U. S. V., in charge of the latter, contributed the year after shot fracture of right inner photograph represented in the adjacent cut (FlG. 330), and reported that, according to the malleolus - t From a Photograph.] patient s statement, the lower end of the tibia became necrosed and was gouged out twice at Brattleboro Hospital. At the time of the man s discharge his general health was good and the wound was nearly healed, with ligament ous anchylosis of the joint and very slight contraction of the muscles of the calf of the leg. There was no appearance of caries or necrosis, and he could walk a short distance with a cane, gaining some motion of the joint by exercise. Examiner A. L. Lowell, of Burlington, Ver mont, certified, March 26, 1870: "The cicatrix of entrance is adherent to the bone and healthy, but sensitive to pressure. The inner malleolus is considerably thickened by bony deposit and the new growth is operative in limiting the motions of the foot. The tibio-tarsal articulation is obstructed in its function by false anchylosis. In flexion and extension of the foot the toes describe an arc of but two inches. The foot is inverted to such a degree as to throw the weight of the body on the outer margin of the sole." The pensioner was paid June 4, 1880. CASE 816. Private P. Driscoll, Co. B, 13th Infantry, aged 26 years, was wounded before Vicksburg, May 19, 1863. Surgeon E. O. F. Roler, 55th Illinois, noted his admission to the field hospital of the 2d division, Fifteenth Corps, with "shot wound of right foot." One week after the reception of the injury the wounded man was conveyed to Memphis, where he entered Jefferson Hospital, and six months later was transferred to Marine Hospital, St. Louis. Surgeon A. Hammer, U. S. V., in charge of the latter, described the iujurj n? a "shot fracture of the ankle joint," and reported that the joint being much enlarged and quite painful he lanced the part on June 18, 1864, when several ounces of pus escaped and several sp iculse of bone were extracted. The patient was in good health at the time of the operation. Warm poultices were frequently applied and after wards tincture of iodine. On August 6, 1864, the patient was discharged from service and pensioned. Examining Surgeon A. "LAUREY (D. J.) (Mem. de Chir. Mil. et Camp., Paris, 1812, T. II, p. 4C8): "Lors<iu nn 6clat d obus, un biscayen ou une balle ont fracassS les extr6mites articulaires, surtout cellcs qui forment { articulation du pied on du genou, et que les ligamens qui affermissent cette articulation ont 6te arrachcs ou rompus, 1 amputation immediate devient indispensable. La mSrne indication se presenterait, si le corps Granger s 6tait perdu dans I epaisseurd une dcs cxtremites articulaires, ou se trouvait enclavfi dans 1 articulation, de maniere H ne pouvoir en etro extrait par les procd6s simples et ordinaires. 1 "THOMSON (J.) (Report of Obs.. etc., after the DattU of Waterloo, Edinburgh. 1816, p. 238): " Wounds in which musket balls have passed through, or are lodged in the ankle joint, almost all require immediate amputation. These injuries, by giving rise to high degrees of inflammation and symptomatic fever, not unfrequently prove fatal. Among a great number who had survived the fever, we saw but few in whom secondary amputation was not required; and, in the cases requiring it, this operation was far from l>eing so successful as the primary amputation had been." GUTHRIE (G. J.) (A Treatise on Gunshot Wounds, etc., London, 1827, 3d ed.. p. 31)8): " Wounds of the ankle joint from gun-shot are extremely dangerous, and in general require amputation. 580 INJURIES OF THE LOWER EXTREMITIES. fCHAP. x. W. Woodhull, of Newark, N. J., certified April 9, 1868: "A conoidal ball fractured the lower extremities of the tibia and fibula, also several of the tarsal bones. The joint is anchylosed and the heel is kept five inches from the ground. The os calcis and astragalus were seriously fractured. Several pieces of bone have been lost and there is extensive deformity of the parts," etc. The Dayton, Ohio, Examining Board in subsequent reports states that the pensioner " walks on the ball of the toes" and requires the use of a cane. The pensioner was paid June 4, 1881. In the following instance the missile was firmly wedged into the articulation, and was finally removed by the aid of two trephines used simultaneously, one on each side of the ball: CASE 817. Chaplain J. W. W. Bolton, 5th West Virginia Cavalry, aged 26 years, was wounded at Cloyd s Mountain, May 9, 1864, by a minie ball, which entered the right ankle near the external malleolus and lodged. He remained under treat ment at a field hospital for six weeks and was then transferred to the general hospital at Parkersburg, whence he was reported as having been "returned to duty November 25, 1864." Some weeks afterwards the patient re-entered the hospital, when his case was reported by Assistant Surgeon W. A. Banks, U. S. V., as follows : " From the time of the injury the patient has been subject to formation of abscesses on either side of the ankle joint. The location of the ball was accurately ascertained with a porcelain pointed probe after all other means had failed. On February 3, 1865, chloroform was administered and the missile was extracted. An incision made below the external malleolus, one and a half inches long, exposed the ball lodging in the articulation, its base being one and a half inches from the surface. The missile was so firmly impacted that it could not be removed by any form of bullet forceps, the metal giving away before the teeth of the forceps. It was finally dislodged by means of two trephine elevators, using one on each side of the ball at the same time. The patient was in good general health at the time of the operation. He did well afterwards. Simple dressings were applied. The wound healed and the patient recovered with an immovable joint." He left the hospital three weeks after the operation, his term of service having expired June 14, 1864. Dr. E. D. Safibrd, pension examiner, and formerly Acting Assistant Surgeon at the Pakersburg Hospital, in June, 1872, contributed the following supplementary description of the injury : The ball entered through the external malleolus, into and nearly through the astragalus, where it remained embedded until extracted," etc. "The injury produced extensive inflamma tion, and as a consequence he has nearly complete anchylosis of the joint and one and a half inches shortening." In his original application the pensioner alleged that seventeen pieces of bone were taken out of the wound at different times. Owing to his disability being considered permanent the pensioner has been exempted from further examinations. His pension was paid September 4, 1881. CASE 818. Private F. Lape, Co. K, 34th Massachusetts, aged 20 years, was wounded in the right foot, at New Market, May 15, 1864. He was captured by the enemy and conveyed to hospital at Harrisonburg, where he was seen and examined by Surgeon T. B. Reed, U. S. V., who described the injury as a "wound of the ankle joint ;" also, that an opening was made and the ball was searched for and that poultices were applied. After remaining a prisoner for six months the man was exchanged and conveyed to Camp Parole Hospital at Annapolis, whence he was permitted to leave for his home, on furlough, October 31st. Drs. O. E. Brewster and W. W. Greene, of Pittsfield, Mass., who attended the patient at his home, certified that they removed a detached portion of the astragalus from the wounded foot on February 7, 1865. The patient subsequently returned to Camp Parole, and was discharged from service for disability March 21, 1865, Surgeon W. D. Stewart, U. S. V., certifying to "gun shot wound by a ball, which entered immediately behind the internal malleolus, passed forward and outward and lodged, frac turing the end of the tibia and implicating the joint." Examining Surgeon H. Eastman, of Pittsfield, Mass., reported Novem ber 5, 1873: "From the appearance of the wound of exit I should say that a number of pieces of bone have been removed. The ankle w perfectly anchylosed : the muscles of the calf of the leg are very much atrophied ; the limb is more than one-third smaller than the other and is much lower in temperature. The muscles in the calf are so much contracted that when he is standing the heel is one inch above the floor, obliging him to walk on the anterior portion of the foot." The pensioner was paid September 4, 1881. CASE 819. Private S. Vansiclen, Co. D, 9th New York State Militia, aged 20 years, was wounded at Fredericksburg, December 13, 1862. Surgeon C. J. Nordquist, 83d New York, reported his admission to the field hospital of the 2d division, First Corps, with "shot wound of left ankle." Acting Assistant Surgeon L. Dorsey contributed the following description of the injury: "A rifle ball penetrated the ankle, outer surface, fracturing the astragalus and tibia. The man was admitted to Hare- wood Hospital, Washington, ten days after being wounded. On December 27th he was etherized, when the broken bones were removed from the tibia and astragalus. During the progress of the case it became necessary to make several counter openings. Simple dressings were applied and stimulants and tonics were freely given for a considerable length of time. In May, 1863, the wound had entirely healed and the patient was gradually recovering the use of the -ankle joint. On June 4, 1863, he was discharged from service, having regained considerable motion of the joint." He subsequently became a pensioner and entered the National Military Home in Ohio, where he was examined at successive intervals by the Dayton Pension Board, who certified to the ball having passed through the ankle, and described the foot and ankle as being in very good condition, but the joint as partially anchylosed and about one-half inch shortened. The pensioner was paid December 4, 1880. CASE 820. Private J. H. Noble, Co. A, 20th Massachusetts, aged 32 years, was wounded and captured at the battle of White Oak Swamp, June 30, 1862. lie remained a prisoner for three weeks, and was then exchanged and conveyed to Bnlti more, where he entered Camden Street Hospital. Acting Assistant Surgeon E. G. Waters reported: "The injury was caused by a musket ball, which entered the flexure of the left ankle joint in the median line of the leg, passed downward and backward and emerged posteriorly, to the left and one inch above the insertion of the tendo-achillis. completely disorganizing the joint. The patient was admitted in a very prostrated condition. An anterior splint and water dressings were applied, it being deemed advisable to attempt to save the foot. On August 21st the necrosed extremity of the tibia and upper surface of the astragalus were removed with a gouge. At this time a finger could be pressed through the joint and no cartilage could be felt in the lino of its passage. On October 20th the splint was removed from the leg and poultices were applied to promote exfoliation. On November 1st a part of the calcaneum and astragalus were removed, and a sinus extending downward from the internal malleo- SECT, vi.l SHOT FRACTURES OF THE ANKLE JOINT. 581 lus was laid open. The patient subsequently experienced an attack of erysipelas. There was much thickening, hut it rapidly yielded to camphor and mercurial ointment. By January 22, 1863, all discharge had ceased and the case promised to leave an anchylosed joint but a serviceable foot. Though not more than three or four such cases have been under treatment, it is deemed proper to state that this is the only attempt that has been made in this hospital to save a foot after gunshot comminution of the joint, and it is gratifying to know that it has resulted successfully." The removed portions of the bone, comprising twenty small necrosed fragments, were contributed to the Museum by Surgeon A. B. Hasson, U. S. A., in charge of the hospital, and constitute specimen 424 of the Surgical Section. The patient was discharged from service March 23, 1863, and pensioned. Examining Surgeon O. S. Root, of Pittsfield, Mass., certified November 27, 1863: "The applicant is walking on crutches, his limb being shortened one and a half inches and the ankle stiff. He cannot get the heel to the ground. The wound has recently broken open and many pieces of bone have come out," etc. The Hartford Examining Board described the injury December 1, 1875, and reported: "The great toe drops and the second and third toes override it. He has no power over the great toe; has a very perceptible limp in walking, and is obliged to use a cane. The ankle is completely anchylosed, the leg much atro phied and two inches smaller than the other. The leg swells and is painful after using it." In Septembei-, 1878, the same board reported that the parts "broke out again and discharged last July, confining him to his bed several weeks. The pensioner com plains of more or less constant pain in the leg, and if he uses it much it swells arid becomes painful so that he is unable to sleep. He still has to use a cane. The leg is worse than useless." The pensioner was paid September 4, 1880. CASE 821. Private E. P. Dutton, Co. H, 2d U. S. Sharpshooters (subsequently transferred to the 4th Vermont), aged 18 years, was wounded in the left ankle, before Petersburg, October 13, 1864. He passed through various hospitals, lastly entering Sloan Hospital, Montpelier, on April 30, 1865. Surgeon H. Janes, U. S. V., in charge of the latter, contributed the photograph represented in the annexed cut (FlG. 331), with the following report : "Gunshot wound of ankle joint by a minie ball, which entered two inches posterior to the internal malleolus, wounding the tendo-achillis, passed forward and outward, and lodged (as the field surgeon stated) in the ankle joint. The missile was removed the next day. No fragments of bone came away then or subsequently. For about three months the discharge was profuse, offensive, and at times dark colored, after which it gradually diminished. The original wound healed in about four and a half months. Abscesses formed between the ankle and the tendo-achillis on each side, which continued to discharge after the wound had healed. About January 1, 1865, the parts became gangren ous, which was checked by the use of nitric acid and bromine in the course of a week, the ulcers healing about two months afterwards. When discharged from service, June 14, 1865, the patient was in good health and able to fully extend the foot, but unable to flex it beyond a right angle. He could walk a mile or two without difficulty, but on going too far he felt Fl(} 331- _ Appearance of left leg six pain in the joint. There was also some tenderness at the tibio-tarsal articulation." Exam- months after shot wound of ankle joint, iner L. J. Alleman, of Boone, Iowa, certified to the injury and reported: "Contraction of tendo-achillis und flexor muscles of first and second toes, drawing them inward and upward and deforming the first and second joint of the first toe; indolent ulcer below the external malleolus, and another above the inner malleolus starting from the edge of the wound. Inability to walk on injured foot in consequence of said condition, and disability equal to loss of foot." The pensioner was paid June 4, 1880. CASE 822. Private G. F. Durkee, Co. B, 9th Vermont, aged 28 years, was wounded in the left ankle during the engage ment at Newport Barracks, February 2, 1864, and entered Mansfield Hospital, Moorehead City, four days afterwards. Surgeon J. B. Bellangee, U. S. V., in charge, reported the injury and added that the internal malleolus was fractured; also that he removed the comminuted bone two days after the patient s admission. The patient subsequently passed through various hospitals, and on December 14, 1864, he was assigned to the Veteran Reserve Corps. Surgeon H. Janes, U. S. V., in charge of Sloan Hos pital, Montpelier, contributed a photograph of the case (Card Photographs, Vol. Ill, p. 44), with the following history: "The wound was caused by a mini6 ball, which entered at a point just external and above the internal malleolus, passed directly downward and emerged at the inside of the sole of the foot, fracturing the tibia and opening the ankle joint. The patient stated that a number of pieces of bone were removed at first, and that several necrosed pieces came away afterwards. At the time of the injury he was in excellent health, and his appetite continued pretty good all the time. At first suppuration was profuse; large abscesses formed in the leg and he became much prostrated. Free incisions were made and cold-water dressings were applied. About April 1st the wound began to improve. It gradually but steadily grew better, and finally closed about the middle of July. He was not able to do without crutches until the latter part of September. After being transferred to the Veteran Reserve Corps he never had to be excused from duty on account of ill health or lameness. On September 14, 1865, when discharged from service, he could flex the foot on the leg to a right angle and extend it about ten degrees more. He wan able to walk tour or five miles a day, but the joint would swell after going any considerable distance. There was also some tenderness on pressure about the joint." Various examining surgeons have certified to the injury and have stated that "the ankle joint is restricted in its motion;" also that there is a depression on the inner side of the foot, and that the leg is atrophied and shows several sears from abscesses. The pensioner was paid September 4, 1880. CASE 823. W. H. H. Shaw, a Confederate soldier (regiment not recorded), received a shot fracture of the ankle joint, at Chancellorsville, May 3, 1863. He was admitted to the Richmond Confederate general hospital No. 24, from Camp Winder, August 1st. Two weeks later the wound was in a very bad state of gangrene, and nitric acid was used, also disinfectants, tur pentine, and coal tar, which were applied to the leg every day. Tonics and stimulants were administered. During the night of August 18th haemorrhage took place, the patient losing one pint of blood. On the following day the anterior tibial artery was ligated. By September 8th the patient was improving very fast and the wound was healing. On September 15, 1863, when the patient was furloughed, the wound was nearly healed but he had no use of the foot. 582 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASK 824. Private A. B. McDaniel, Co. I, 7th North Carolina, aged 34 years, was wounded and taken prisoner at Gettysburg, July 3, 1863. He was admitted to Chester Hospital two weeks after the reception of the injury, where the nature of the wound was not recorded. Three months afterwards the patient was transferred to Point Lookout Hospital, whence Act ing Assistant Surgeon R. N. Wright made the following report: "The patient was admitted to this hospital with gunshot wound of left ankle joint. The wound was inflicted by a minid ball, which shattered the joint to a considerable extent, entering just above the external malleolus, passing obliquely downward and forward and fracturing the bones. A number of bony fragments have escaped from the openings and there has been considerable purulent discharge. Erysipelas made its appearance before the patient entered this hospital. At the present time, March 2, 1804, the wounds are healed and the patient is doing well but has very little motion in the joint." The man Avas forwarded to City Point for exchange the following day, March 3, 1864. The man being a Confederate soldier, no further history of the case could be obtained. In the next two cases the joint became firmly anchylosed, causing, in each case, the heel to be raised several inches and compelling the patient to walk on the toes: CASK 825. Sergeant T. B. Sturdivant, Co. B, 21st New York Cavalry, aged 39 years, was wounded in a cavalry skirmish near Halltown, March 24, 1864. Acting Assistant Surgeon J. H. Bartholf reported : "Gunshot fracture of left ankle joint, by a rifled pistol ball, which entered the inner side of the leg five inches above the ankle, going downward and outward and emerging one and a half inches below the ankle. The patient was admitted to Frederick from his regimental hospital at Halltown two days after the injury. His general condition was not good; pulse 140. He had much pain in the ankle, which, with the foot, was much swollen and of a glistening surface. Pus, retained superficially on the inner side of the leg, was emptied by slitting down two inches; and a few small bits of bone about the size of peas, which were felt by the finger within the lower wound, were removed. Pressure over the outer ankle evacuated pus mixed with a yellow, clear, glairy fluid from the lower opening. Poul tices were applied to the wounds and a general supporting treatment was ordered; milk punch and morphia at night. Two days after his admission the patient was better in all respects, and by March 31st he had still further improved, the treatment being continued and good food given. On April 4th the limb as well as the injured joint and the wounds were in a surprisingly good condition; redness and swelling gone; pain and tenderness of joint nearly gone; suppuration slight; nearly a correspond ing improvement in patient s general condition. On April 28th apiece of bone about the size of a bullet, apparently from one of the tarsal bones, was removed, after which the condition of the foot and ankle improved very much. The patient was now able to sit up all day, and from this time he went on exceedingly well, being almost without pain or any trouble in the joint. He walked on crutches up to the time of his furlough on May 25th. When he returned from furlough in July he walked with a cane, the wounds having closed, leaving the ankle joint somewhat stiffened." He was subsequently transferred to Camp Parole, Annapolis, whence he was discharged May 2, 1865, and pensioned, Surgeon W. D. Stewart, U. S. V., certifying to "anchylosis of the ankle joint and extension of the foot" resulting from the wound. Examining Surgeon L. Darling, of Hammond Creek, Pennsylvania, October 7, 1874, certified to contraction of the gastrocnemius muscle and the tipping of the foot upon the toes, and added: "The pensioner s health is very feeble; he is weak and emaciated and has disease of the lungs." Examiner N. Parker, of Wellsborough, Pennsylvania, reported, June 17, 1880: " The injured leg at the calf is three inches smaller than the other; the weight is borne on the anterior part of the foot; pensioner quite lame. He states that nine months ago an ulcer formed at the outer side of the ankle and pieces of bone came out. There is slight inflammation and soreness at the site of the ulcer." The pensioner was paid September 4, 1880. CASE 826. Corporal C. B. Davis, Co. F, 9th New Hampshire, aged 23 years, was wounded and taken prisoner at Poplar Grove Church, September 30, 1864. He remained in captivity for nine days and was then paroled and conveyed to hospital at Annapolis, whence Acting Assistant Surgeon J. S. Fulks made the following i-eport : " The patient came into my ward suffering from gunshot wound of the left ankle joint, inflicted by a minitS ball passing transversely across and producing compound comminuted fracture. Sloughing commenced and continued until the integument over a considerable space around the wound was destroyed. Strong solutions of nitrate of silver and permanganate of potash failed to arrest the sloughing, but this was successfully accomplished by the application of a concentrated solution of nitric acid. The wound is now (December 31st) progressing favorably and the patient will recover with anchylosis of the joint." The patient was subsequently transferred to Webster Hospital, Manchester, where he was discharged from service May 27, 1865, and pensioned. Examining Surgeon T. Sanborn, of Newport, N. H., certified, August 2, 1885 : " The fracture appears to have been a comminution. The tendo-achillis sloughed away and the ankle is anchylosed. The toes point downward and the heel cannot be brought to the ground." Exam iner W. W. Sleeper, of Salisbury, N. H., reported, September 5, 1873: "The ankle joint is deformed and stiff, causing the heel to be raised about four inches and obliging the pensioner to walk upon his toes. There is necrosis about the joint, which has discharged several pieces of bone but is now healed. The muscles of the leg are much diminished." The deformity and anchy losis of the joint continued at the time the last payment was made to the pensioner, on June 4, 1881. Of the ninety-nine fatal cases of shot fractures of the ankle joint treated conserv atively, death was ascribed to pya3mia in twenty-five and to tetanus in five instances: CASK 8 27. "Private J. Jiggen, Co. B, 10th Wisconsin, was wounded at Chickamauga, September 19, 1863, by a mini6 ball, which entered the inner side of the right ankle below the malleolus, passing through the joint and making its exit on the anterior portion of the instep. He was taken prisoner and remained within the enemy s lines until October 2d, when he came through and was admitted into the general field hospital of the 1st division, Fourteenth Corps. The appearance of the wound and limb was then healihy and considered favorable to recovery until October 14th, when the patient was attacked with rigors The limb also commenced to swell about this time, which was accompanied by a cessation of discharge. Poultices were applied to the wound and free incisions were made to favor the exit of pus. A stimulant and tonic treatment was administered and con tinued up to the time of the patient s death, which occurred on October 20, 18b3, with all the symptoms of pyaemia. At the SECT. VI.] SHOT FRACTURES OF THE ANKLE JOINT. 583 post-mortem examination of the limb the astragalus was found to be fractured and the three cuneiform bones in a state of com minution. The articulating surfaces of the tibia and fibula together with that of the astragalus were blackened and eroded, and the cuboid and cuneiform bones with the articulating portion of the astragalus were in a complete state of disintegration." The history was reported by Surgeon W. M. Wright, 79th Pennsylvania, in charge of the hospital. CASE 828. Private J. Conly, Co. A, 90th Illinois, aged 18 years, was wounded in the right leg, at Mission Ridge, November 25, 1863. He remained under treatment at a field hospital for four weeks, and subsequently he was an inmate of the Chattanooga gen eral hospital until the following February, when he was transferred to hospital No. 1, at Nashville. Surgeon C. W. Hornor, U. S. V., in charge of the latter, recorded the follow ing description and result of the injury: "A gunshot fracture of tibia and fibula by a mini6 ball, which entered three inches above the external malleolus, fracturing the bone, and passing downward and inward. The missile was removed at a point one inch internal to the inner malleolus, its presence being suspected only by the formation of an abscess over the seat of its lodgement a few days before its extraction. The patient died March 7, 1864. At the post-mortem examination old and strong pleuritic adhesions were dis covered at the apex of the right lung, which contained a few dormant tubercles; the remainder of the lung tissues were healthy. The bronchial mucous membrane was slightly inflamed. The heart was healthy and contained neither light yellow nor blood clots in its cavities, and the blood in the heart as well as in the vessels was remarkable for its fluidity. The liver was healthy and weighed four pounds and one ounce; spleen very soft and puffy and weighing eleven and a half ounces; kidneys healthy, the right one weighing five and a half ounces and the left one six ounces. The stomach and bowels were in a healthy condition. On examining the cranium the vessels were found very much distended with blood. The arachnoid cavity contained serum; the organs otherwise were healthy." The bones of the injured ankle (Spec. 2188) were contributed to the Museum 33.^ posterior . v Acting Assistant Surgeon H. C. Ma}*, and are represented in the wood-cuts (FlGS. 332, view of the bones ot 333) revealing that the tibia was split into the ioint and showing the fractured portions of the right ankle. Spec. J 2188. FIG. 333. Anterior view of the bones of the right ankle. Spec. 2188. the bones to be carious, the articulation being destroyed by suppuration. CASR 829. Private \V. H. Perry, Co. C, 1st Massachusetts Heavy Artillery, aged 39 years, received a gunshot fracture of the right tibia and fibula, also flesh wounds of both lower extremities, and a wound of the thorax, at Spottsylvania, May 19, 1864. He entered Lincoln Hospital, at Washington, three days afterwards, where he died of pyaemia May 30, 1864. The historv, with the pathological specimen (No. 4580), represented in the accompanying cut (FlG. 335), was con tributed to the Museum by Assistant Surgeon J. C. McKee, U. S. A. The specimen consists of the greater portion of the bones of the right leg, showing the fibula to be transversely fractured in the lowest fourth and the anterior portion of the tibia shattered into the ankle. CASE 830. Corporal M. Martin, Co. D, 28th Massachusetts, aged 27 years, was wounded at Hatcher s Run, March 25, 1865. Surgeon F. M. Hammond, 126th New York, reported his admission to the field hospital of the 1st division, Second Corps, with "shot wound of left foot." Ten days after the reception of the injury the patient was transferred to Douglas Hospital, \Vashington, whence Assistant Surgeon W. F. Norris, U. S. A., contributed the pathological specimen shown in the annexed wood-cut (FIG. 334), with the following history: TheAvound penetrated the ankle joint. The ball entered in front, about midway between the malleoli, and made its exit posteriorly and a little above the external malleolus, comminuting in its course the lower ends of the tibia and fibula. There was marked constitutional disturbance, headache, high fever, rapid pulse, and loss of appetite. But little swelling or inflammation in the joint, however, took place, and not much discharge. The day subsequent to the patient s admission the joint was carefully examined, when both bones were found to be much comminuted and amputation \vas decided as the only resort giving a fair chance of recovery. The patient, however, positively declined all operative interference. Towards evening he had a slight chill. On April 7th there was nausea and vomiting, and on the following day he had three chills, followed by fever and profuse sweats. Nausea and vomiting continued, the fluid ejected being tinged with bile; the discharge from both wounds, however, retained its healthy appearance. On April 9th, 10th, llth, and 12th the patient had a chill each day, and on the latter day there was marked yel lowness of the face and conjunctiva?; slight cough and delirium. ..On April 13th there was another chill; pulse 110, respiration 38; severe pleuritic pain in the right side of the chest. Death occurretl on April 14, 1865. Rigor mortis was well marked at the autopsy, also the yellow hue of the skin and conjunctivae. On opening the thoracic cavity nearly a pint of intensely yellow fluid was found in the right pleural cavity. Each lobe of the right lung presented numerous patches varying in size from halt an inch to two inches in diameter, most of which on incision gave exit to pus; the left lung contained similar patches in both lobes. The spleen was much softened, being almost semifluid in consistence; liver enlarged but apparently healthy; other thoracic and abdominal viscera normal." The specimen (No. 253) consists of the astragalus and the lower halves of the tibia and fibula of the injured limb, the extremities of both bones of the leg being shattered. CASE 831. Private G. Abbott, Co. K, 9th Minnesota, aged 39 years, was wounded in the left foot, at the battle before Nashville, December 15, 1864, and admitted to hospital No. 8 the same da}-. Two days afterwards the patient was placed under the influence of chloroform, when the wound was examined and ascertained to have been caused by a minic ball, which entered at the outer aspect of the instep, passed inward and upward, and emerged one inch below the inner malleolus, badly fracturing FIG. 33J. -Shat tered bones of the left ankle joint. Spec. 253. . Tibia > the right ankle joint. SJKC. 4580. 584 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. the cuboid, scaphoid, and head of astragalus, and channelling a large passage through these bones. The patient being :\ robust man, it was thought advisable to attempt to save the limb and to trust to nature to repair the injury. Irrigation was found serviceable to keep down and control the inflammation, swelling, and pain. The discharge was limited for some days, but pro fuse towards the last. On December 28th an abscess over the inner malleolus was opened, causing a free evacuation of pus. Two days later suppuration was free from the posterior part of the leg as well as about the foot. Lead wash and tight band aging was applied. From December 30th the patient commenced to fail. He became very icteric in appearance, his pulse rapid, and the discharge from the wound unhealthy. On January 2d he was delirious, and on the following day, January 3, 1865, he died. At the autopsy all the internal organs were found remarkably healthy. The ankle joint was filled with pus and there were sinuses extending up the leg. The capsular ligament of the ankle joint was found to be nearly destroyed, and the articu lar extremities and surfaces of the bones were eroded. The history, with the specimen (No. 37f>5), consisting of the calcaneum, the fractured astragalus, cuboid, and scaphoid bones, was contributed by Acting Assistant Surgeon H. C. May. In one of the ninety-nine fatal cases of shot fracture of the ankle joint the tibial artery was ligated, in another the femoral: CASE 832. Private W. Lazier, Co. M, 5th Artillery, aged 25 years, was wounded in the right ankle joint, at Brandy Station, August 1, 1863, by a bullet, which entered close to the anterior edge of the internal malleolus, slightly comminuting it. On the following day he was conveyed to Douglas Hospital at Washington. The missile was supposed to have lodged, there being no external wound of exit and the patient not being aware of it having been removed. On the next day Assistant Surgeon W. Thomson, U. S. A., in charge of the hospital, etherized the patient and explored for the missile, but it could not be found. The comminution was so slight that it was deemed possible to save the foot with the aid of free incisions should they become necessary. A prescription consisting of two drachms of fluid extract of rhubarb, one scruple of quinine, and three ounces of whiskey was ordered, on August 5th, to be given in teaspoonful doses every four hours. Dead bone having been felt with the probe, and the inflammation becoming so extensive and severe as to render operative interference necessary, two large incisions were made at the sides of the internal malleolus on August 8th, by Acting Assistant Surgeon C. Carvallo, and several loose frag ments of bone were extracted. On this day the patient also had a chill of ten minutes duration, and one-half drachm of quinine dissolved in four ounces of whiskey was prescribed to be taken in tablespoonful doses. On August llth the inflammation became erysipelatous, involving the leg below the knee, and there was another chill. The quinine and whiskey mixture was then repeated and tincture of iodine was used to the limb, after which a wash consisting of one-half ounce of muriate of ammonia, ten grains of acetate of morphia, two ounces of sulphuric ether, and one pint of water, was applied over it. On August 13th there was still pain, swelling, and redness, and another chill of fifteen minutes duration took place. Fluctuation was well marked, and incisions were made to give free exit to pus. In addition to the quinine, tablespoonful doses of a mixture of two drachms of muriated tincture of iron, two ounces each of spirit of Mindererus and water, and half an ounce of simple syrup, were administered three times a day. On August 15th, incisions were again required over both malleoli and another on the calf of the leg to allow accumulated pus to discharge. The patient s condition was now too much depressed to allow an amputation. Two days later pleurisy developed, which was treated by counter-irritation of turpentine and alcohol fomentations to the breast, and mustard poultices. On August 18th the limb had grown very red, swollen, and painful as high as the knee, and, fluctuation being felt, another incision was made by Dr. Carvallo, after which the leg was placed in a bran-box, and the wash, with one-half drachm of fluid extract of hyosciamus superadded, was re-applied. Haemorrhage from one of the incisions in the calf of the leg, and sup posed to proceed from one of the muscular branches, came on one-half hour afterwards, when cold water, alum, and compres sion was applied, and Hoffman s anodyne mixed with brandy and water was given every half hour. Haemorrhages recurred in the afternoon and evening, being decidedly arterial, and were checked by persulphate of iron applied with charpie. Though active interference was demanded, the undoubted disease of the lungs caused by metastatic abscesses from pyaemia, together with the very rapid and difficult respiration and the collapse of the patient from the loss of six or eight ounces of blood, made amputation impossible. The only other resort being ligation of the femoral, ether was carefully administered and that operation was per formed at 9 P. M., at the point of election, by Assistant Surgeon Thomson, the leg being so distended with clotted blood as to make any effort to secure the divided vessels abortive. The clots of blood were removed from the leg by compression, and after the operation the case was treated with the largest doses of stimulants, including aromatic spirits of ammonia and fluid extract of senega. Though he reacted from the low state he was in before the operation, the patient gradually sank during the night and died at 8 A. M. on August 19, 1863. At the autopsy both lungs were found to be filled with metastatic abscesses; there was also effusion of serum in both thoracic cavities. No injured artery could be detected, nor could the missile be found. The detailed notes of the case were furnished by the operators. Dr. Thomson also contributed the bones of the injured ankle (Spec. 1682), showing the articular surfaces to be eroded by suppuration and the internal malleolus to be slightly fractured. CASE 833. Private W. Coakley, Co. K, 28th Massachusetts, aged 37 years, was wounded before Petersburg, June 18, 1864, and admitted to the field hospital of the 1st division, ^Second Corps, where Surgeon W. Vosburgh, lllth New York, recorded: "Shot wound of foot." Acting Assistant Surgeon E. C. Manoch reported the following description and result of the injury : "The patient entered the First Division Hospital at Annapolis June 21st. He was wounded by a piece of shell, which struck the inner aspect of the left ankle, fracturing part of the bones forming the joint. When first admitted the wound was doing well. On June 25th he was isolated, at which time he complained of very severe pain over the Avhole foot, which had become very much distended and increased in temperature. I ordered the parts to be painted with muriatic tincture of iron, also the tincture to be given internally, and whiskey and beef-tea. The next day the pain in the foot had grown very intense and the patient s face presented a very anxious appearance, he having passed a very restless night. On June 27th his general condition was the same ; pulse rapid and weak. The skin at the external front of the ankle now presented a, purple appearance, being soft and fluctuating on pressure. An incision gave exit to several ounces of foul pus, after which charcoal and yeast poultices were applied. In the evening the discolored part assumed a decidedly gangrenous appearance. The patient sank rapidly notwithstanding the strong stimulation with plenty of beef-essence, and he died early in the morning of June 29, 1864." AT THE ANKLE JOINT. 585 CASE 834. Dr. D. A. Hoffman, pension examining surgeon at Oskaloosa, Iowa, reports that " Brigadier General S. A. Rice, U. S. V., was wounded at the battle of Jenkins s Ferry, April 30, 1864, a ball entering the external malleolus of the right ankle, carrying with it a portion of his spur and strap, and passing through the ankle joint. I learned from the surgeon who accompanied him that previous to his return home he had several attacks of erysipelas On June 1st I examined him and found him suffering with pyaemia and an unhealthy condition of the system generally, and the wound discharging unhealthy pus. On June 15th the patient had another attack of erysipelas in the wound. During the treatment of the case several pieces of bone were removed. Despite all remedies he gradually grew worse, and died July 6, 1864." EXCISIONS AT THE ANKLE JOINT FOR SHOT INJURY. During the Amer ican civil war thirty-three excisions at the ankle joint for shot injuries were performed. 1 The results in two cases were not ascertained; twenty-two patients survived the operation and nine died, a mortality rate of 29.0 per cent. As indicated in the following table eleven were primary, eight intermediary, and nine secondary operations; in five either the date of injury or operation, or both, could not be ascertained. TABLE LXXXVIIL Numerical Statement of Thirty-three Excisions at the Ankle Joint for Shot Injury. PARTS EXCISED. OPERATIONS. CASES. PRIMARY. INTER MEDIARY. SECONDARY TlMK NOT SECONDARY. SpKCJFIED "a j!_ 12 2 4 > i & 10 2 2 Death. ; Undeterm d. Mortality of determined cases. 3 % u Recovery. J3 rt 01 O ; Undeterm d. Recovery. Death. S 3 O b o> > o 8 g j= 3 A. 1 Recover} . Uudeterm d. End of the Fibula . . 2 16.6 5 o 3 2 2 4 4 2 1 1 .... End of the Tibia 2 50.0 1 I 1 1 1 1 2 1 1 1 i 3 1 3 1 2 1 1 3 1 1 JOO.O 50.0 60.0 1 1 2 5 1 1 2 2 2 1 i ? I 1 1 2 1 1 1 33 22 9 2 29.0 11 8 2 1 8 5 3 9 5 4 5 4 1 It is noticeable that although excision at the ankle joint had been performed in the latter part of the last century by the elder Moreau, 2 and had frequently been repeated, for simple and compound fractures or caries, in the early part of the present century, the operation, prior to the breaking out of the War of the Rebellion in 1861, had only been done three times for shot injuries. 3 The first operation was performed in the English army during the Crimean War; the lower end of the fibula was excised and the case terminated in recovery; no details are recorded. 4 The second was performed, May 30, 1859, by Vori Langenbeck on a Russian General wounded at the Alrna, September 20, 1854, in the left "From the records it would appear that the first excision of the ankle joint during the American civil war was performed by Assistant Surgeon J. S. HILLINGS, U. S. A., on January 6, 1862, for an axe wound involving the external malleolus and the scaphoid bone. The case will be detailed in the nfixt chapter. The first total excision of the ankle joint for shot injury was performed by Surgeon E. BENTLEY, U. S. V., on October 9, 1862, in the case of Private J. Brennan, 16th West Virginia. Details of the case will be given hereafter. 2 JEFFUAY (JAMES), Cases of the Excision of Carious Joints by II. PARK and P. V. MOREAU, with observations, Glasgow, 1806, p. 140, Case V. On April 15, 1792, the elder MOREAU excised the ends of the tibia and fibula and the articulating surface of the astragalus for caries in the case of M. Lucot, who walked without any assistance whatever nine months after the operation. The case related by FAUKE (L amputation etant absolument necessaire dans Its plaits compliquces de fracas des os, etc., in Prix <le V Academit Royale de Chirurgie, Paris, 1811), T. Ill, p. 352) and cited by CULIIRUTSON (Excision of the Larger Joints of the Extremities. Prize Essay. Trans. Am. Sled. Assoc., Philadelphia, 1876, Supplement to Vol. XXVII, p. 280) and others as the first instance of excision at the ankle joint, can only be regarded as an instance of expectant conservative surgery. The articular surfaces of the tibia, fibula, and astragalus were fractured by shot iit the battle of Fontenoy, May 11, 1745, in a soldier named Charles d Amiens. Dr. READ examined the wound and proposed to amputate the leg, but desisted at the urgent request of the patient. He then removed the detached portions of the tibia, fibula, and astragalus, placed the foot in proper position and secured it by a suitable apparatus. The patient recovered with good use of limb in about four months. MATTHEW (T. P.) Med. and Surg. Hist, of the British Army which served in Turkey and the Crimea, etc., London, 1858, Vol. II, in tabular statement on page 368 and brief reference on p. 379. SORG. Ill 74 586 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. ankle; the astragalus and the internal malleolus were removed by subperiosteal resection; the patient recovered without shortening of the limb; the joint became anchylosed. 1 The third was performed on a soldier wounded at Solferino, June 24, 1859. J. Neudorfer, several months utter the injury, excised the roughened bony surfaces and several osteophytes that impeded the motion of the joint; the patient recovered rapidly with a useful limb. 2 Primary Excisions at the Ankle Joint. A complete excision of the ankle joint, in which portions of all the bones forming the articulation were removed, was performed in one only of the eleven primary operations; the patient recovered. The articular end of the fibula was excised in five cases, of the tibia in two, of the tibia and fibula in one, and of the astragalus in one; in the remaining case the portions removed were not indicated. Eight patients recovered, two died; the result in one case could not be ascertained. Details of the cases are subjoined: CASK 385. Private T. Bell, Co. H, 60th Illinois, aged 19 years, was wounded in the left ankle during the engagement near Marietta, July 4, 1864, by a minie" ball, which fractured the lower end of the fibula. He was conveyed to the field hospital of the 2d division, Fourteenth Corps, where the excision was performed. TFie patient passed through different field hospitals and subsequently through various general hospitals. Surgeon B. B. Breed, U. S. V., in charge of hospital No. 1, Nashville, in reporting the case described the operation of excision as having involved the removal of three inches of bone from the fibula. Acting Assistant Surgeon W. Sturgis reported that when the patient entered Camp Butler, December 5th, his general health was bad. Erysipelas supervened, which was treated locally by linseed poultice and iodine, and internally by quinine, tincture of chloride of iron, etc. The patient was ultimately discharged from service June 29, 1885, and pensioned. Examining Sur geon J. Bobbins, of Quincy, Illinois, certified, June 30, 1865: "A ball passed through the leg antero- posteriorly, just above the external malleolus, shattering the fibula and severing the tendo-achillis. Three inches of the lower extremity of the fibula have been removed, and complete anchylosis as well as the loss of bone and tendon render the limb useless." Numerous subsequent examiners have corroborated Dr. Eobbins s certificate. The pensioner was paid September 4, 1880. CASE 836. Private B. B. Evitts, Co. I, llth Connecticut, aged 23 years, was wounded in the left ankle, before Peters burg, June 18, 1864. He was conveyed to hospital at Fort Monroe, thence to McDougall, New York Harbor, and lastly to Brattleboro. Acting Assistant Surgeon N. G. Brooks, in charge of the latter hospital, reported the man s admission, August 6th, with " shot fracture of tibia, followed by excision of the internal malleolus the day after the injury and favorable progress subsequently." The patient was transferred to the Veteran Reserve Corps February 11, 1865, and five months later he was mustered out of service and pensioned. Examining Surgeon C. B. Maltbie, of Falls Valley, Connecticut, June 28, 18(J8, cer tified: "The pensioner was wounded by a minie ball entering the ankle joint from the tibial side and lodging therein, from where it was extracted. The injury rendered the joint stiff and incapacitated the man for manual labor. Use of the limb caused the wound to reopen last season and to discharge freely." No changes were reported at subsequent examinations. This pensioner was killed by falling from a locomotive engine July 19, 1875. CASK 837. Private J. W. Bloyd, Co. H, llth West Virginia, aged 18 years, was wounded in the left ankle during the fight at New Creek, August 4, 1864. He was conveyed to the Post Hospital at New Creek, where partial excision of the joint was performed, on August 5th, by Acting Assistant Surgeon W. B. Grain, who reported the following description of the injury: "A conical ball penetrated the tissues on the outer aspect of the leg, one and a half inches above the external malleolus. fractur ing the fibula and burying itself in the ankle joint between the astragalus and the tibia. The articular surface of the astragalus was considerably comminuted, and that portion of the articular surface and cancellated structure of the tibia external to the groove of the flexor longus pollicis was also badly comminuted. The external surface was apparently uninjured. The opera tion was performed by slightly enlarging the wound on the outer aspect of the leg, where three large spiculse were removed from the fibula. The ball and all the loose fragments were then extracted, and the rough spiculaB of the fractured portion of the tibia and astragalus were gouged and chiseled out. The constitutional state of the patient at the time of the operation was in every respect favorable, and the limb was but little swollen, but very painful. The patient did well until August 27th, at which time he began to suffer very much from pain, owing to a great accumulation of pus in the joint. To relieve this and to insure a free and constant outlet a large-sized seton was introduced into the wound in the outer aspect of the leg, carried obliquely between the articular surfaces of the tibia and astragalus and passed out in front of the external malleolus. An apparatus similar to Smith s anterior splint was also adjusted to the limb in order to insure greater comfort." After he became convalescent the patient was transferred to hospital at Cumberland, where he was discharged from service May 6, 1865, and pensioned. Dr. J. C. Hupp, of Wheeling, and other examining surgeons have, at successive periods, certified to the injury. In 1873, the injured ankle and also the lower third of the leg was reported as being enlarged, the extensors of the foot as acting imperfectly, etc. Subsequently the mobility of the ankle joint was described as impaired. The pensioner was paid June 4, 1880. CASE 838. -Captain A. F. Miller, Co. K. 48th New York, aged 38 years, was wounded in the right ankle, at Cold Har bor, June 2, 1864. He was admitted to the field hospital of the 3d division, Sixth Corps, and thence, several days afterwards, to the Seminary Hospital at Georgetown. Surgeon H. W. Ducachet, U. S. V., in charge of the latter hospital, reported that the patient obtained leave of absence on June 13th and proceeded to his home. On January 13, 1865, the patient was discharged VON LANGENBECK (13.), Utber die Schustfracturen der Gelenke und Hire Behandlung, Berlin, 1868, p. 46, and GUKLT (E.), Die Gelenk-Resec- tionen nach Schussverletzungen, Berlin, 1879, p. 133. 2 NKUD5UFKR (J.), Die Endresultate der Gelenkresectionen, in Wiener Jlfedicinische Presse, 1871, Jahrganff XII, p. 405. SEcrr. vi.J PRIMAEY EXCISIONS AT THE ANKLE JOINT. 587 from service and pensioned. Dr. G. T. Stevens, formerly Surgeon 77th New York Volunteers, subsequently contributed the following description of the injury and resection of the ankle, which he performed: "The wouud was caused by a mini6 bull, which penetrated the ankle, entering just behind the outer malleolus, passing nearly through the bones, and lodging in the inner side of the tarsus. The os calcis and astragalus were badly shattered. Two days after the reception of the injury the patient was brought Jiuler the influence of chloroform with intent to amputate; but after carefully inspecting the wound it was decided to attempt to save the foot. The wound was then enlarged by crucial incision, splinters of bone were removed, and the ball, which laid in the inner side of the ankle, was extracted. The shattered fragments of the os calcis and astragalus were then removed by a gouge and bone nippers, the wound was drawn together and water dressings were applied. On June 6th the patient was transferred to White House Landing in an army wagon, where he remained three days. Thence he was taken to Washington, and a Aveek afterwards he went to his home in Brooklyn. Water dressings were continued. Extensive suppura tion took place, and several deep incisions were made near the ankle. In about four weeks a considerable piece of dead bone came away, after which improvement was rapid. In injecting fluids into the original wound they passed freely through the ankle, coming out at an opening on the opposite side. In the course of eight weeks the patient was able to walk with crutches and from that time his recovery was rapid. He now (March 9, 1808) walks with little difficulty and there is no anchylosis." The Brooklyn and Boston Examining Boards in 1874, 1875, and 1877, respectively, certified to "anchylosis of the ankle joint, tendons bound down/ etc. The pensioner was paid June 4, 1880. CASE 839. Private I. Ostheimer, Co. F, 66th New York, aged 31 years, was wounded in the right leg, at Antietam, September 16, 1862, and admitted to a Second Corps field hospital. Surgeon C. S. Wood, 66th New York, reported: "A miin 6 ball struck the tibia anteriorly about four inches above the malleoli, shattering the bone. The fibula and bones of the foot were uninjured. I performed resection of the lower four inches of the tibia, removing the bone from the articulation, after which splints were applied to the leg; case sent to General Hospital." Acting Assistant Surgeon A. V. Cherbonnier recorded the patient s admission to hospital No. 5, at Frederick, where a large sequestrum was removed on November 22d, also that a large portion of the diseased tibia was resected on December 2d. About two weeks- afterwards the wound assumed a healthy appear ance, and by December 28th it was filling up with healthy granulations, the patient being cheerful and feeling well. On the next day he was transferred to hospital No. 1, where he remained until the following June, when he was sent to Patterson Park (Con valescent) Hospital at Baltimore. On August 10, 1863, the patient was returned to his command for duty, and while in the field he again came under the notice of Surgeon Wood, who made the following supplementary report: "The man laid in hospital for seven months before he could move his leg. Being possessed of a good constitution and no untoward symptoms appearing, at the end of that time he began to Avalk a little, and now eleven months after the reception of the injury he has just been returned to duty. On examination a large cicatrix is found, the bone having refilled its entire length and uniting with the astragalus with a moveable articulation. Although less than usual, the bone is not quite so long as its fellow, allowing the foot to turn slightly inward. Otherwise he has a very useful limb. He cannot endure hard marches as well as formerly, and prob ably never will. Still the case is one of interest, as not one in twenty saves his limb after the receipt of a like injury." Accord ing to information from the Adjutant General, U. S. A., this man has been reported as "missing in action" since the battle of Todd s Tavern, May 8, 1864. CASE 840. Private A. C. Rose, Co. H, 10th Illinois, aged 22 years, was wounded at Bentonville, March 21, 1865. Assistant Surgeon J. W. Brewer, U. S. A., reported his admission to the Seventeenth Corps Field Hospital with " shot fracture of left ankle," for which resection of fibula was performed by Surgeon W. A. Gott, 25th Wisconsin. From the field the wounded man was sent to Foster Hospital at New Berne, thence to McDougall Hospital at Fort Schuyler, and lastly, on August 18th, to DeCamp Hospital, David s Island. On September 23, 1865, the patient was discharged from service and pensioned, Assistant Surgeon W. Webster, U. S. A., in charge of the latter hospital, certifying to the disability resulting from fracture of the fibula. Examining Surgeon I. H. Ruden, of Lacon, Illinois, who examined the pensioner periodically, in 1866 described the injury as having been "followed by gangrene in the wound, which caused necrosis of one-third of the bone. Ankle nearly immovable and painful." Some years later he stated that "about two inches of the bone had been removed. The cicatrix is large and firm, so much so that the circulation of the foot is impeded, causing varicose veins; it is also so tender that he cannot wear a boot or high shoe. The ankle joint is not free in its movements, owing to adhesions of the tendo-achillis to the heavy cicatrix, and becomes swollen and painful when used to any considerable extent. The pensioner was paid June 4, 1880. In the following three cases the limb was subsequently amputated, in two in the middle, in one in the lower third of the leg. Two of the patients recovered, one died: CASE 841. Sergeant M. G. Sparks, Co. I, 10th New Jersey, aged 25 years, was wounded in the right ankle, before Petersburg, April 2, 1865. He entered the field hospital of the 1st division, Sixth Corps, where Surgeon R. Sharpe, 15th New Jersey, recorded the injury as a "shot fracture of the fibula and tarsus," also that "resection of the fibula" was performed. The patient was subsequently transferred to the Depot Hospital at City Point, and from there, on April 12th, to Judiciary Square Hospital at Washington. Surgeon E. Griswold, U. S. V., in charge of the latter, reported that when the patient was admitted his constitutional state was not good and the injured parts were in a bad condition, necessitating amputation, which was per formed by antero-posterior skin flaps at the middle third of the leg, on April 13th, by Acting Assistant Surgeon Z. P. Dennler. Chloroform and ether constituted the anaesthetic. After the amputation simple dressings were used and stimulants, etc., were administered. Subsequently the patient passed through various hospitals, and on February 2, 1886, he was discharged from service and pensioned. He was paid June 4, 1874, since when he has not been heard from. CASE 842. Private S. H. Myers, Co. E, 75th Indiana, aged 20 years, was wounded, before Kenesaw Mountain, June 21, 1864. He was admitted to the field hospital of the 3d division, Fourteenth Corps, where Surgeon F. Lloyd, U. S. V., recorded: "Shot fracture of left ankle; resection of two inches of tibia and fibula." One week afterwards the wounded man was sent to the General Field Hospital at Chattanooga, whence Assistant Surgeon C. C. Byrne, U. S. A., reported that amputation became necessary, and was performed by the circular method at the lower third of the leg by Acting Assistant Surgeon G. E. Stubbs, 588 INJURIES OF THE LOWEK EXTREMITIES. CHAP. X. on June 30th. The patient s subsequent progress was fair, the treatment consisting of water dressings, tonics, and stimulants. About two weeks after the amputation he was transferred to hospital at Nashville, and lastly he was admitted to Ekin Barracks, Indianapolis, where he was discharged from service March 7, 1865, and pensioned. In his application for commutation he stated that the first operation (meaning that of resection) was performed by Surgeon C. N. Fowler, 105th Ohio, five hours after the reception of the injury. The pensioner died April 12, 1872. CASE 843. Private G. W. Velic, Co. C, 24th Michigan, aged 28 years, was wounded at Cold Harbor, June 3, 1864. He entered the field hospital of the 4th division, Fifth Corps, where Surgeon C. N. Chamberlain, U. S. V., recorded: "Severe shell wound of ankle joint; excision of lower end of fibula." Ten days after the date of the injury the wounded man was transferred to Armory Square Hospital, Washington, where Surgeon D. W. Bliss, U. S. V., subsequently amputated the limb and recorded the result of the case as follows: The injury was a lacerated wound of the right ankle, the outer xualleolus being shattered and the joint opened. On June 28th the leg was amputated at the middle third. The circular flap operation was performed, the patient being under the influence of chloroform. On July 3d there was sloughing and sanious discharge from the stump. By July 12th there was hospital gangrene, which rapidly extended to the knee and was treated with nitric acid and yeast poultices. The patient died July 18, 1864." CASE 844. Private J. Durst, Co. D, 148th Pennsylvania, aged 24 years, was wounded in the left lower extremity, at Gettysburg, July 2, 1863, and admitted to the field hospital of the 1st division, Second Corps. Surgeon C. S. Wood, 66th New York, reported: "The lower portion of the fibula was shattered by a mini6 ball, and resection was performed of the articulation of the bone about four inches in length. The tibia remained sound. A splint was applied to the outer portion of the leg, and cold-water dressings. The case continued to do well, with a fair prospect of getting ultimately a very good limb." Three weeks after being wounded the patient was transferred to the Cotton Factory Hospital at Harrisburg, where Acting Assistant Surgeon W. S. Woods noted the case as one of " exsection of the left ankle joint," and recorded the following termination : " The patient, a man of irritable and nervous temperament, was suffering severely from the wound when admitted. There was considerable sloughing of the wound at the time, attended with deep-seated suppuration. Several spiculse of bone were taken out. For a time the leg was placed in a cushioned box splint and the usual simple cerate and cold-water dressings were applied twice each day. The weather becoming unusually warm it was found necessary to suspend the leg in a cot splint, which proved to be far more comfortable. The same treatment was continued, a tonic course and liberal diet being allowed. By August 13th the wound granulated nicely and the patient was considered as doing well. He improved slowly until September 19th, when he had a severe chill, also pain in the inguinal glands, followed by traumatic erysipelas. For the first two days antiphlogistic remedies were advised, which were followed by quinine and whiskey. The leg was washed with glycerine and iodine. The case resulted fatally on October 6, 1863." CASE 845. Private J. Eadford, Co. F, 14th Virginia, received a gunshot wound of the ankle joint May 9, 1864. Excis ion of the joint was performed on the following day, and the patient was subsequently transferred to General Hospital. The report of the case was contributed by Dr. H. L. Thomas, late Surgeon P. A. C. S., who obtained the record of the injury and operation from the notes of Confederate Surgeon J. S. Pride, Battle Hospital, Dublin Depot. Intermediary Excisions at the Ankle Joint. Of the eight excisions of this group five were successful, three -fatal. In one case portions of the astragalus were excised, in one the extremities of the tibia and fibula, in four the extremities of the fibula, and in two the surfaces of the three bones forming the articulation were removed: CASE 846. "Private J. Brennan, Co. K, 16th West Virginia, aged 18 years, was admitted to hospital at Alexandria on October 6, 18S2, with a wound of the right ankle joint, received accidentally the night previous. On examination it was found that a pistol ball had entered the ankle three-fourths of an inch posterior and inferior to the internal malleolus, passed forward and upward, rupturing the capsular ligaments and cutting its way between the articular surfaces of the tibia and astragalus and lodging within the joint. He was in good health at the time of the injury and evidently suffered no great amount of pain. He was freely purged and a light and nutritious diet enjoined. The question of procedure was exceedingly perplexing. The single small bullet hole and the slight local and constitutional symptoms presented a case apparently well adapted to the performance of resection, while the want of success attending this operation was a serious argument against its performance. It was decided, however, to resect the joint, which was done on October 9th. The patient being under the influence of chloroform, two lateral incisions were made about four inches in length, terminating three-fourths of an inch below the malleoli. The lips being drawn asunder, a chain saw was then applied to the tibia and about one-third of an inch of the extremity removed; the extremity of the fibula, on a level with the tibia, was removed through the opposite opening, and through the same aperture a portion of the articular surface of the astragalus was taken away. By this method the division of the extensor tendons and of the anterior tibial artery was avoided. The posterior tibial was uninjured. The incisions were closed with silver wire sutures, and the bones were held in apposition by means of adhesive strips extending down the sides of the leg and embracing the sole of the foot. Lateral splints of binders board were applied. The hemorrhage was trifling, no vessels having to be tied. On the fol lowing day there was considerable febrile excitement; pulse 100; skin hot and dry. Small doses of antimony and morphia were administered. On the next day the patient appeared more comfortable but complained of slight pain; pulse diminished in force and frequency. On October 12th the patient was comfortable; skin cool and moist; pulse 80 per minute. Discontinued the medicine. On October 13th suppuration was established and the patient was comfortable ; limb suspended by means of Smith s anterior splint ; lateral splints retained. From this time the dressings were daily removed. By October 16th the patient was doing well and the wound was discharging freely; diet light, though nutritious. Four days later he began to take solid food. On October 27th the incisions were filled with granulations. The dressings were continued to November 25th, when Smith s splint was removed, the lateral splint being still applied. The patient remained in bed until December 20th, when he SECT, vi.] INTERMEDIARY EXCISIONS AT THE ANKLE JOINT. 589 began to move about on crutches. The lateral splints were removed in the early part of February, at which time he moved about freely and with little embarrassment. In dressing, the toes of the injured side were extended so as to be on a line with those of the sound side. The advantage of this is apparent when a shoe with a high heel is worn. The elasticity of the instep thus brought into play compensates in a great measure for the anchylosis." The case is reported by Surgeon E. Bentley, II. S. V. The subsequent records in the case show the patient was mustered out at the expiration of his term of service, June 16, 1863. There is no record of his ever having applied for pension. CASE 847. Private N. Lloyd, Co. I, 29th Pennsylvania, aged 38 years, was wounded in the left ankle, at Gettysburg, July 1, 1863. He was admitted to the Twelfth Corps field hospital, where Surgeon H. E. Goodman, 28th Pennsylvania, noted that an excision at the lower third of the fibula was performed on July 12th by Surgeon J. A. Wolf, 29th Pennsylvania. Three weeks after being wounded the patient was transferred to Camp Letterman, several months later to hospital at Baltimore, and subsequently to Philadelphia. Acting Assistant Surgeon W. V. Keating reported his admission to Broad and Cherry Streets Hospital, December llth, and described the injury as "a compound gunshot fracture of the external malleolus opening the ankle joint, followed, apparently, by resection of a very small portion of the malleolus. The patient apparently did not get along very well. On his admission the tissues around the ankle joint were considerably swollen and there were symptoms of chronic arthritis. A sinus on both the inner and outer side of the ankle connected with the joint, where the cartilages were found eroded and from which a sanious discharge issued. On January 23, 1864, when the patient was transferred to Mower Hospital, the swelling around the joint had somewhat diminished and the sinus on the inner side of the ankle had healed, while the one on the external side still discharged a slight amount of sanious pus." Surgeon J. Hopkinson, U. S. V., in charge of Mower Hospital, reported the result of the case as follows: "At the time of the patient s admission the wound was nearly closed, the joint stiff, the parts swollen, and circulation in the foot very feeble. The cold douche was used to the foot with marked benefit. By February 16th the foot was much better, the patient being able to place it on the floor and bear some weight on it. One month later the foot was rapidly improving and the treatment was discontinued." On April 20, 1864, the patient was dis charged from service. Examining Surgeon T. B. Reed, of Philadelphia, February 5, 1866, certified to " compound fracture of left ankle, shattering the outer malleolus and requiring exsection of the same. Permanent anchylosis of ankle. The greatly impaired use of the foot has produced subsequent irritation of the knee joint, with rheumatism. Is obliged to use a cane or crutch constantly. Amputation of the foot and the use of an artificial limb would be a great improvement to his present con dition." Subsequent examiners substantially confirm Dr. Reed s report. The pensioner was paid September 4, 1880. CASE 848. Private D. Stottlemeyer, Co. K, 66th Ohio, aged 17 years, was wounded in the right ankle joint, at Cedar Mountain, August 9, 1862, and entered Fairfax Seminary Hospital several days afterwards. Surgeon D. P. Smith, U. S. V., reported that the patient was discharged from service October 9, 1862, by reason of "exsection of lower third of fibula, anchy losis of ankle joint," etc. Examiner S. M. Smith, of Columbus, Ohio, certified, December 22, 1862: "He received a wound in the right ankle, a musket ball entering the outer portion of the joint, embedding itself in the bones of the joint and fracturing them. Eleven days afterwards the missile and portions of bone were removed. At present there is great enlargement of the joint and foot, complete anchylosis of the joint, an open wound and necrosis of bone." Examining Surgeon W. S. Constant, of Delaware, Ohio, November 4, 1880, certified to the injury and reported as its result "an occasional suppurating wound of the ankle, partial anchylosis of ankle joint, and shortening of limb from contraction, so that he can walk only on the ball of the foot. The pensioner cannot walk any distance or do much manual labor." CASE 849. Sergeant A. M. Wright, Co. C, 80th Indiana, aged 23 years, was wounded in the left ankle, at Resaca, May 14, 1864. Surgeon E. Shippen, U. S. V., reported his admission to the Twenty-third Corps field hospital, whence the wounded man WKS transferred to hospital at Chattanooga and afterwards to hospital No. 15, Nashville. Surgeon W. M. Chambers, U. S. V., in charge of the latter hospital, described the injury and reported that "the bone was fractured and necrosed," necessitating " excision of two and a half inches of the lower end of the fibula, which was performed on June 13th by Acting Assistant Sur geon J. J. O Riley. Gangrene ensued the day after the operation, but was stopped by applying bromine. Simple dressings were used and nutritious diet and stimulants were administered." The patient subsequently was transferred to Joe Holt Hos pital, and later to Lincoln Hospital, Washington. In the following March he was returned to duty, and on June 22, 1865, he was mustered out of service. Examining Surgeon H. M. Smith, of Vincennes, Indiana, March 31, 1877, certified: "I find on examination that the applicant received a wound in the ankle joint. The ball penetrated the lower part of the external malleo lus and passed through the head of the tibia, making its exit on the front part of the ankle, at which point a large cicatrix exists as if caused by sloughing resulting in adhesions of the soft parts and partial anchylosis of the joint," etc. The pen sioner was paid June 4, 1880. In the following instance gangrene appeared three months after the excision, and amputation was performed in the middle of the leg: CASE 850. Private F. Thorn, Co. D, 63d Pennsylvania, aged 28 years, was wounded in the left lower extremity, at the Wilderness, May 5, 1864. Surgeon O. Evarts, 20th Indiana, reported his admission to the field hospital of the 3d division, Second Corps. Three weeks after the reception of the injury the wounded man entered Emory Hospital, Washington, where he underwent the operation of excision at the hands of Surgeon N. R. Moseley, U. S. V., who reported that "the injury con sisted of a gunshot wound of the left ankle, the bones being comminuted and the soft parts lacerated, but in a favorable condition. On May 26th chloroform and ether was administered, and resection of the lower third of the fibula was performed. The parts were kept in coaptation by adhesive straps, and cold-water dressings were used." According to a subsequent report the patient obtained a furlough on July 16th and left the hospital for his home in Erie, Pennsylvania, where "Dr. R. Faulkner amputated the leg at the middle third, on August 17th, by reason of gangrene." Several months later the patient, who had in the mean time been assigned to the 105th Pennsylvania Volunteers, returned, and was transferred to Judiciary Square Hospital. After being supplied with an artificial leg he was discharged from service March 18, 1865, and pensioned. He was paid March 4, 590 INJURIES OF THE LOWER EXTREMITIES. [CHAP x. 1880. Five small fragments of the fibula, removed at the first operation by Surgeon Moseley, and contributed by him to the Museum, constitute specimen 2362 of the Surgical Section. Three of the eight intermediary excisions at the ankle joint proved fatal two from pyaemia and one from exhaustion : CASE 851. Private J. Davis, Co. L, 1st Michigan Cavalry, aged 18 years, was wounded at Salem Church, May 28, 1864. Surgeon W. H. Rulison, 9th New York Cavalry, reported his admission to the field hospital of the 1st division, Cavalry Corps, "with shot wound of left foot and hip." Surgeon J. A. Lidell, U. S. V., who operated in the case, made the following report: "The patient was admitted to Stanton Hospital, Washington, June 4th, with a gunshot wound of the left tarsus, inflicted by a mini6 ball, which struck the foot a little below the external malleolus and passed through the tarsus horizontally inward and somewhat backward, escaping a little below and behind the internal malleolus. It occasioned compound comminuted frac ture of the calcaneum, astragalus, and posterior edge of the external malleolns. At the time of the operation, June 10th, the ankle and foot were much swollen, inflamed, and very painful; the leg was also swollen. The edges of the orifices of both entrance and exit were pouting and exhibited no tendency to close ; discharge thin and scanty. Since the patient came to Stanton Hospital the wound had been treated with ice dressings, but was manifestly growing worse. He now had a good deal of constitutional disturbance; pulse quick and ranging from 110 to 120; skin dry and too warm; countenance pinched and anxious; tongue coated, and appetite poor. He was also restless, got but little sleep, and his general condition was daily getting worse. Wishing to avoid secondary amputation of the leg if possible on account of the great fatality which had lately attended it, resection was performed of the anterior extremity and part of the external side of the caloaneum. Some fragments of the astragalus were also extracted, and a splinter from the posterior edge of the external malleolus. The incisions were made on the external side of the foot, from the orifice of entrance, first, to the base of the metatarsal bone of the little toe; second, to the base of the external malleolus; third, to the point of the heel; and fourth, to the dorsum of the foot, two and a half inches. Sulphuric ether constituted the anaesthetic. There was no shock. Ice-water dressings were continued. On June llth the patient was cheerful and free from pain and the swelling and irritative fever had abated. He died of pyaemia on June 20, 1864. Autopsy: The ankle joint contained pus; the bones were partially denuded of their cartilage; muscles of leg infiltrated with pus. The left pleural cavity contained a large quantity of dark-colored effusion, and the left lung was compressed against the vertebral column ; the inferior lobe contained an abscess about the size of an egg, which was filled with dark-colored and offen sive pus. The right lung contained several superficial abscesses and some patches of lobular pneumonia. Thrombi existed in the femoral vein. In his publication 1 of the operation the operator furnished the following supplementary details of the patient s progress, as well as of the autopsy, in addition to his comments on the case: After the operation "the limb was placed upon a wire splint (Smith s) bent to a right angle, which was well padded and npplied to the posterior part of the leg and sole of the foot, where it was properly secured by roller bandages for the purpose of keeping the ankle joint in a fixed position. The wound was plugged with lint and a full opiate was given. The constitutional treatment consisted in the administration of nutrients, tonics, and stimulants. On June 12th the patient had a severe pyaemic chill and sweat, and quinine in full doses was added to the treatment. On the next day he was much worse; wound discharging a thin dark-colored pus; chills and sweats increasing in frequency and severity; complexion assumed a bronzed hue; breath bovine; body exhaling a sweet mawkish smell ; anorexia; debility; diarrhoea set in. Pneumonic symptoms also appeared, and a large proportion of blood was mingled with the sputa. He sank rapidly. At the autopsy the calcaneum was found to be fractured entirely through and its cancfllous structure was gangrenous. The astragalo-scaphoid articulation contained pus and the articulating surface of its bones was entirely denuded of its cartilage. The connective tissue on the front of the leg was infiltrated with pus from the ankle joint upward to the extent of three inches, and the tibia and fibula were denuded of periosteum to the extent of two inches. The liver and spleen were both enlarged and softened, but the kidneys presented a normal appearance. There were clots in both ventricles of the heart. Comments: In this case also osteomyelitis supervened, which was conclusively shown by the gangrenous condition of the can- cellous tissue belonging to the calcaneum, or, rather, the gangrenous condition of the medullary tissue whiph filled the cancelli of that bone. Besides, it is probable that if the interior of the tibia and fibula had been examined the marrow would have been found inflamed at and above the place where those bones were seen to be denuded of periosteum at the post-mortem examination. It is also probable that the medullary tissue of the denuded portion of the tibia contained collections of purulent matter which were produced by the suppurative character of the inflammatory process involving that tissue. Furthermore, it is probable that the inflammatory process had extended to the medullary tissue of the tibia prior to the performance of the resec tion of the tarsus, and if its presence there had then been recognized, it would have contra-indicated that operation and called for amputation far up the limb. The thrombosis of the femoral vein was of recent occurrence. The coagulated blood which filled that vein presented a fresh appearance and had not yet undergone the puriform transformation, nor even become at all softened. It was therefore obvious that the thrombosis had not occasioned the visceral abscesses nor the inflammation of the lungs, since the morbid process in those organs was considerably older than the thrombus of the femoral vein. The thrombosis was a more rtcent event than the pyaemia. This circumstance is important, because it shows that the pyocmic process in this case could not have had its origin in the thrombosis, and that if any relationship or necessary connection existed between them, the pyaemic process induced the formation of the thrombi. The symptoms of irritative fever (or, speaking properly, the surgical fever of an irritative type), which where so strikingly relieved by the operation, had been produced entirely by local causes, namely, the inflammation of the various structures bordering upon and connected with the gunshot wound, such as the connect ive, the fibrous, the osseous, and the medullary tissues. The symptoms of the purulent infection did not make their appear ance till two days after the operation. They presented a marked contrast to those of the surgical fever which preceded the operation. They denoted the occurrence of a poisoned condition of the blood and the whole system, under which the patient sank rapidly, and died on the eighth day after its advent." 1 LIDELL (JOHN A), in V. S. Sanitary Commission Memoirs, Surgical Volume I, pp. 524-C, and CULHEUTSON (H.), Excision of the Larger Joints of the Extremities, in Transactions of the American Med. Association, Philadelphia, 1876, Supplement to Vol. XXVII, p. 314. SECT. VI.] SECONDARY EXCISIONS AT THE ANKLE JOINT. 591 CASE 852. Private J. F. Geer, Co. F, 112th New York, aged 22 years, was wounded at Cold Harbor, June 2, 1864. Surgeon S. A. Richardson, 13th New Hampshire, recorded his admission to the Eighteenth Corps field hospital with "shot wound of left ankle." Surgeon R. B. Bontecou, U. S. V., contributed the following description of the injury and operation in the case, which he performed: "The patient was admitted to Harewood Hospital, Washington, June 15th, suffering from a wound of the left ankle, the ball passing from the inner to the outer sin face, opening the joint. On admission the condition of the injured parts and the constitutional state of the patient was good. On June 25th resection of the injured joint was per formed by lateral vertical incisions over the malleoli, exposing the articulation. The ends of the tibia and fibula were cut off bv the chain saw, and the tipper portion of the astragalus was removed by the cutting forceps. Sulphuric ether was used. Two days after the operation the patient had slight febrile movement and his pulse was a little accelerated. The treatment was supporting; simple dressings were used. Death occurred on July 24, 1864." CASE 853. Sergeant W. Roberts, Co I, 7th New York Artillery, aged 35 years, was wounded in the left ankle, at Cold Harbor, June 10, 1864, by a conoidal ball, which passed from before backward, fracturing the external malleolus and opening the ankle joint. He entered Harewood Hospital, Washington, five days afterwards, at which time his constitutional state was very poor, the injured parts were in a very bad condition, and the wound discharged fetid pus. Resection of the ankle joint was performed on June 24th by Surgeon R. B. Bontecou, U. S. V., who exposed the articulation by incisions over the malleoli and excised the lower articular extremities of the tibia and fibula. Sulphuric ether was used. The patient did well up to July 1st. From that period diarrhoea set in and he gradually sank. There were no pyaemic symptoms. He died July 6, 1864, from exhaustion. The history was reported by the operator. Secondary Excisions at the Ankle Joint. Of nine secondary operations the articular surfaces of the fibula were excised in two, of the tibia and fibula in two, of the astragalus in one, of the tibia and astragalus in two, and of the tibia, fibula, and astragalus in two instances. Five patients recovered, four died. CASE 854. Sergeant C. Barber, Co. E, 86th Pennsylvania, aged 30 years, received a shot fracture of the fibula of the left leg, at Gettysburg, July 1, 1863. From a First Corps field hospital he passed to York and subsequently to Philadelphia. Acting Assistant Surgeon M. K. Knorr recorded the following description of the case at the South Street Hospital, where the patient was admitted August 14th: "The wound was caused by a mini6 ball passing in above the external malleolus, fracturing the bone, and passing through the interosseous space. About August 20th hospital gangrene set in and the wound filled with large sloughs; patient became very weak. Stimulating poultices of yeast and flaxseed were then used, and pulverized persul phate of iron was applied to the slough. After three applications the patient appeared much better and the slough came off. Poultices were now continued for a while, and afterwards stimulating applications. Still the wound was not healing, the dis charge being yet great and the patient s constitutional state extremely low and weak. On examination Surgeon C. N. Cham berlain, U. S. V., found the bone to be necrosed and denuded of perios teum, and concluded to excise the fibula. This operation was accord ingly performed on December 19th, it being deemed necessary to remove three-fourths of the length of the bone, including the external malleolus. The patient rallied from the operation and made rapid improvement. Tonics and stimulants were given and simple dressings used." Surgeon H. Janes, U. S. V., subsequently in charge of South Street Hospital, reported, in April, 1864, that the wound had healed with the exception of the upper part, where a small sinus still existed. The patient was afterwards transferred to Filbert Street Hospital, and on September 17, 1884, he was discharged from service and pensioned. Examining Surgeon H. L. Hodge, of Philadelphia, certified, December 21, 1864 : The limb is now much swollen, the ankle is painful and the foot turned outward. He is very lame and the limb is useless." The Philadelphia Examining Board, April 10, 1872, certified to the injury and operation and described the result as follows: A long cicatrix with musculo- fascial adhesions; a slight varicose condition with tenderness about the ankle joint, and anchylosis of the ankle joint with atrophy of muscles on posterior portion of leg. Increase of pension is recommended on account of increased pain and firmness of anchylosis of the ankle joint." In a communication dated April 18, 1881, accompanying the photographs represented in the annexed wood-cuts (FlGS. 336, 337), the pensioner stated that " the ankle is very painful at present," and added that his disability had obliged him to give up working at his trade of stone cutter. CASE 855. Private W. A. Gavett, Co. K, 141st Pennsylvania, aged 43 years, was wounded in the right ankle during the engagement near Bristoe Station, October 13, 1863, and entered Judiciary Square Hospital, Washington, three days after wards. Assistant Surgeon A. Ingram, U. S. A., made the following report: "The wound was caused by a minie ball, which entered at the internal malleolus, passed into the ankle joint and lodged. The missile was extracted the next day through the wound of entrance. Partial excision of the ankle joint was performed on February 1, 1864, by Acting Assistant Surgeon J. F. Thompson. An incision two and a half inches in size was made on the outer side of the ankle and several pieces of bone were taken out. Part of the internal malleolus was dissected from the integument and removed through the enlarged wound of entrance, and a portion of the astragalus was taken away with the bone forceps. At the time of the operation the patient s general health was excellent, but considerable inflammation existed around the ankle joint and there was great discharge of pus FIG. 33fi. Outer view of left leg 18 years after excision of the lower three- fourths of fibula. [From a photograph.] FIG. 337. Anterior view of the same. [From a photograph.] 592 INJURIES OF THE LOWER EXTREMITIES. [CHAP. FIG. 338. Excision of right ankle joint. Outer view 17 years after opera tion. [From a photograph.] from the wound. A collection of pus had also formed on the outer side at the point of the internal incision. The patient did well for about a month after the operation, at which time both sides had healed. A day or two afterwards an abscess was detected in front of the joint, which, on being opened, discharged considerable pus. Carious bone could be felt by the probe, indicating the necessity of another operation." The patient was subsequently transferred to Philadelphia, where he was admitted to Summit House and afterwards to Satterlee Hospital. On May 6, 1885, he was discharged from service and pensioned. Examining Surgeon C. M. Turner, of Towanda, Pennsylvania, December 27, 1865, certified to the injury and added : " Of course anchylosis has taken place and the tendons of the foot and toes are in a degree contracted and rigid." On August 16, 1869, he reported that the pensioner "walks with difficulty and lias much pain after exercise. The joint is often inflamed, and abscesses form in the integuments, which discharge pus for many days. I do not think the joint is carious," etc. At sub sequent dates the same examiner certified to the heel bone being diminished in size, and to the leg being atrophied up to the knee and shortened two inches. Examiner C. F. Paine, of Troy, Pennsylvania, September 22, 1879, reported "fistulous open ings, constantly discharging portions of bone. The pensioner is compelled to use a crutch or cane for locomotion." The pen sioner was paid June 4, 1880. CASE 856. Sergeant W. H. Gaylord, Co. B, 6th U. S. Colored Artillery, aged 26 years, was wounded at Fort Pillow, April 12, 1864, by a minte ball, which fractured the fibula of the right leg at the lower third. The missile entered above the external malleolus, passed obliquely downward and backward, and emerged below and behind the internal mal- leolus. Four days after the reception of the injury the wounded man was admitted to Adams Hospital at Memphis, where Surgeon J. G. Keenon, U. S. V., on May 21st, excised the external malleolus, the comminuted fragments of the fibula, and the end of the tibia through a semilunar incision two inches long. Chloroform was used and the haemorrhage was slight. The patient s physical condition at the time of the operation, though somewhat emaciated, was fair and his spirits were buoyant. The wound, which had been suppurating freely, was closing by healthy granula tions, but necrosed bone could be distinctly felt. The patient did well after the operation. He was permitted to leave the hospital and go to his regiment on June 7th, before his cure was complete. The history was reported by the operator. Sergeant Gaylord was subsequently promoted to Lieutenant, and remained in the service until March 28, 1865, when he was discharged, Surgeon G. Perin, U. S. A., as a member of an examining board certifying to the injury, and adding that the "wound is healed and ankle joint partially anchylosed. Cannot walk without a crutch." The Cleveland Pension Examining Board, Drs. G. C. Ashmun and P. Roeder, in 1877, add that there is " slight lateral motion of ankle, constant enlarge ment," etc. The pensioner was paid September 4, 1880. CASE 857. Private E. Roberts, 7th Wisconsin Battery, aged 26 years, was wounded in the right foot, at Parker s Cross Roads, December 30, 1862. Surgeon E. D. Kittoe, U. S. V., recorded his admission to hospital at Jackson, and several months afterwards the wounded man was transferred to Jefferson Barracks, whence he was discharged October 6, 1863, and pensioned. Surgeon J. C. Whitehill, U. S. V., subsequently contributed the following report of the case: "Understanding from Surgeon H. W. Davis, 18th Illinois, who was in charge of the General Hospital at Jackson for some time in the early part of 18615, that some doubts had been expressed concerning the removal of the os calcis and astragalus from a patient in that institution, and his recovery with a foot of comparatively good conformation and use of the ankle joint, I desire to set the matter at rest by furnishing a detailed report of the case. In the latter part of March, 1863, while passing through the wards of the General Hospital at Jackson in the discharge of my duties as Medical Director of the district, my attention was called to a case that of Private Roberts, 7th Wisconsin Battery supposed to require amputation. He had been wounded in the heel by a rifle ball, which grazed the posterior tuberosity of the os calcis and passed out through the sole of the foot about two inches forward. Under the usual treatment the wound soon healed. The heel, however, remained tender, and the tenderness gradually increased ; the integuments became oedematous and glazed; the pain more acute and deep seated; constitutional symptoms supervened; the wound re-opened, and in spite of all treatment the patient s condition gradually grew worse. He had now hectic fever, some bronchial irritation, diarrho3a, and impaired appetite; the foot and ankle were swollen ; the integument of the heel was an intense dusky or purplish red, tense, and glistening, and three sinuses over the posterior part of the os calcis, with everted edges, were discharging fetid sanious pus. Through the sinuses the probe readily detected carious or necrosed bone. After a careful exam ination I determined to make an effort to save the foot by removing the os calcis, to which, judging from the location of the sinuses, I was in hopes the disease was yet confined. On April 1st, in the presence of Surgeon Davis in charge of the hospital, Surgeon H. E. Foote, 22d Ohio, the ward surgeons of the hospital, and several other medical gentlemen, the patient was placed comfortably on his side arid anaesthesia was induced, after which I commenced an incision at the margin of the sole immediately behind the plantar artery, carrying it around the heel and along the outer margin of the foot to the tarso-metatarsal articulation, and then keeping the knife close to the bone dissected up the flap thus made and exposed the under surface of the os calcis. There was slight haemorrhage from a posterior perforating branch of the plantar, but this was readily arrested by torsion of the vessel. A perpendicular incision of about two inches was next made over the heel and along the tendo-achillis, the tendon detached from the os calcis, and the lateral flaps and soft parts carefully dissected up so far as the calcaneo-astragaloid articula tion, keeping the edge of the knife close upon the bone to avoid wounding the vessels, and, if possible, to preserve a portion of the periosteum, which was much thickened and in some places thickly studded with minute spiculae of bone. The articulation was then opened, the interosseous ligaments were divided, and the bone readily removed. The articular surface of the astragalus being diseased, the gouge was used for its removal until, finding the greater portion of its structure involved, I decided to remove the entire bone. Keeping the knife close upon the posterior surface of the bone the dissection was continued to the ankle joint, which was opened, when by using the point of the finger as a lever and at the same time as a guide and sheath for the knife, the FIG. 33!). Inner view of the same injury. SECT. VI.] SECONDARY EXCISIONS AT THE ANKLE JOINT. 593 FIG. 340. Excision of os calcis and astragalus. [From a photograph taken 18 years after the operation.] bones were sufficiently separated to allow the ligamentous attachments to be divided by a careful application of the point of the knife. The greatest caution was used on the inner side to avoid wounding the plantar vessels and to preserve the periosteum, which, at this point, like that of portions of the os calcis, was thickly studded with minute spiculse or corpuscles of bone. After making a careful dissection to free the bone from its remaining attachments the entire astragalus was removed. Finding the other articular surfaces healthy the wound was carefully cleansed, the parts coaptated, light water dressings applied, and the foot and leg fixed in a position by a suitable splint so arranged as to retain them firmly without interfering with the dressings of the wound. No part of the integument was removed, nor did a single vessel require ligation. Surgeons Davis, Foote, and several other medical gentlemen, by attending to the administration of the anaesthetic and affording other assistance, rendered efficient aid during the progress of the operation, which, from the large amount of careful dissection required, was necessarily somewhat tedious. The subsequent treatment consisted in the main of a careful retention of the parts in position, simple water dressings and a generous diet, with wine, ale, and porter. A free suppuration of healthy pus was established; the redness and tumefaction of the integuments subsided ; the cavity of the wound gradually filled with healthy florid granulations; and when I last saw the patient, two months afterwards, the wound was healed except at its most dependent portion, from which there was a discharge of laudable pus. The conformation of the foot was well preserved and bore but little evidence that so large a portion of its bony structure had been removed. The following extract from a note concerning the case, and received from Assistant Surgeon T. D. Washburn, 126th Illinois in charge of one of the wards of the hospital described the appearance of the foot about that time (June 1st): The patient was not in my ward, but as this was an unusual operation I visited him the more frequently to witness its progress. The parts healed kindly and by June 1st were almost completely closed, and no one would have imagined that so formidable an operation had taken place. The appearance of the foot was natural, a new formation having apparently taken the place of the removed bone, leaving the configuration good; besides, he had some motion of the ankle, and it certainly promised to make a very useful as well as ornamental member of the body corporate. I regret that I had no opportunity of seeing the case at a later date, to ascertain the amount of mobility of the joint retained or the character of the new formation, whether fibrous, osteoid, or osseous. I had hoped by preserving a portion of the periosteum to secure a re-formation in part at least of the bony structure, and I have but little doubt, judging from the amount of reparative effort evinced by the ossific formation found in portions of the thickened periosteum, that such a result was actually obtained. The case presents several points of practical and pathological interest. There can be no doubt that the success of the operation was to some extent dependent on the small amount of interference with the circulation of the part, as already stated, not a single vessel requiring ligation. The granulations by which the cavity of the wound was filled presented a striking resemblance to the medulla of young bone. To what extent was the preserved periosteum concerned in the new formation and what was its ultimate character? The thickening proliferation of the periosteum was by far the greatest in the vicinity of the larger vessels, and the osseous spiculse were most abundant in the same vicinity. The ossific deposits or formation in several places extended some distance into the adjacent soft parts and were sufficiently abundant to produce a grating sensation under the knife. With out entering upon a discussion of the method or methods of the pathological new formation of bone, I will merely add that it does not seem unreasonable to suppose that the new formation in this case was of an ossific character, and that the success attending the case is a strong argument in favor of conservative surgery. In similar cases I should certainly look upon excision as the rational treatment, and amputation as the dernier resort." Various examining surgeons have from time to time certified to the injury and to the disability resulting therefrom. The photograph, represented in the adjacent wood-cut (FlG. 340), was contributed by the pensioner in May, 1881. He states that "the os calcis and astragalus were both removed, which makes the limb two and a half inches shorter. The articulations are now with the tibia, about two inches above the joint." CASE 858. Private R. Fuller, Co. I, 45th Illinois, aged 19 years, was wounded during the siege of Vicksburg, June 20, 1863. Surgeon G. R. Weeks, U. S. V., recorded his admission to the Seven teenth Corps hospital with "shot wound of left ankle." Six weeks after the reception of the injury the wounded man was transferred to Jefferson Barracks Hospital, whence Surgeon J. F. Randolph, U. S. A., reported that "gangrene appeared on August 16th, and was treated by application of nitric acid with favorable result," also that "resection of the external malleolus" was performed. The patient was dis charged from service April 3, 1864, and pensioned. In the following month Examining Surgeon C. Hershe, of Muscatine, Iowa, certified to the injury involving the loss of the external malleolus, causing anchylosis of the ankle joint and leaving the leg "so painful that he cannot put the foot on the ground without enduring pain." The pensioner subsequently re-enlisted in the army and was assigned to the 42d Infantry, from which organization he was discharged March 31, 1869, when he again resumed his place on the Pension Rolls. Examining Surgeon F. Hooper, of Fall River, certified, November 13, 1869 : " The external malleolus is gone, and the astragalus and os ealcis are anchylosed to the tibia. A large cicatrix covers the outside of the ankle. There is some motion between the scaphoid and astragalus, but it produces pain in walking." In Sep tember, 1877, the Cleveland Examining Board reported "partial lateral displacement of foot outward, with anchylosis of ankle joint and deformity of foot," etc. The pensioner was paid June 4, 1880. The photograph from which the wood-cut (FlG. 341) is copied was furnished by the pensioner in 1881. FIG. ankle 1 ion of external mulleolus. [From a photograph.] 1 CULUKUTSON (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. Mcd. Asfociation, 1876, Supplement to Vol. XXVII, p. 314 SURG. Ill 75 594 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Four cases of secondary excisions at the ankle joint proved fatal one from pyaemia, one from gangrene, and two from exhaustion. CASE 859. Private T. Lister, Co. B, 20th Michigan, aged 20 years, was wounded at Spottsylvania, May 12, 1864. Surgeon J. E. Pomfret, 7th New York Artillery, reported his admission to the field hospital of the 1st division, Second Corps, with "wound of foot caused by a musket ball." Surgeon K. B. Bontecou, U. S. V., who operated in the case, described the injury as a gunshot wound of the left leg, lower third, the missile fracturing the tibia, entering about one inch above the ankle joint, and lodging in the head of the astragalus. The wounded man was admitted to Harewood Hospital, Washington, May 26th. On July 5th sulphuric ether was administered, and the lower end of the tibia as well as the head of the astragalus, which had become necrosed, were excised. The constitutional state of the patient at the time of the operation was very poor; the tissues had become infiltrated with pus. Five days after the operation the fibula protruded and was somewhat necrosed, the parts other wise progressing favorably. The treatment was supporting. The result was unfavorable. Death occurred on August 7, 1864." CASE 860. Private A. B. McCool, Co. E, 188th Pennsylvania, aged 21 years, was wounded in both lower extremities, at Cold Harbor, June 3, 1864. Surgeon S. A. Richardson, 13th New Hampshire, recorded his entrance into the Eighteenth Corps field hospital. Secondary resection was subsequently performed at Harewood Hospital, Washington, by Surgeon R. B. Bontecou, U. S. V., who reported that " the patient was admitted June 15th, suffering from gunshot wound of the right thigh and of the left leg at the ankle joint, fracturing the external and internal malleolus. At the time of admission the condition of the injured parts was not good, being oedematous and somewhat infiltrated with pus. Subsequently the parts sloughed exten sively and the bone became necrosed, the patient s strength failing day by day. On July 12th sulphuric ether was administered and the ankle joint was resected, one inch each of the lower end of the tibia and fibula being removed. A severe and prostrating diarrhoea complicated the case, from the consequent exhaustion of which, together with the excessive suppuration, the patient died July 21, 1864. The treatment consisted of stimulants, sedatives, narcotics, and supporting diet." The excised portions of the tibia and fibula were contributed to the Museum by the operator and constitute specimen 3045 of the Surgical Section? CASE 861. Private J. T. McGuiffin, Co. B, 24th Regiment (Confederate), aged 23 years, received a gunshot wound of the right ankle joint, at Drury s Bluff, May 16, 1864. The missile, a mini6 ball, entered in front and on a line with the internal malleolus, passed through the astragalus, and made its exit through the external malleolus, carrying with it a number of frag ments. The injury was followed by the escape of synovia. There was also another wound of the right foot, fracturing the fourth metatarsal bone. Some days after the reception of the wounds the patient came under the care of Surgeon J. M. Hollo- way, P. A. C. S., who thought that amputation of the limb, though advisable as a primary operation, was not then admissible. Smith s anterior splint was applied and cold irrigation. Subsequently poultices, cerate dressings, and bandaging was used. Several abscesses formed and numbers of small fragments of bone were removed on different days. Anodynes, stimulants, and nutritious diet were administered as required. After consultation Dr. Holloway excised the ankle joint by Hancock s method, on June 21st, completing the operation without injury to nerve, vein, artery, or tendon. The patient was not removed from the operating table to his bed until the following day. By the second day the wounds had become unhealthy and gangrene of the toes was in progress. The patient died suddenly and unexpectedly on the morning of June 25, 1864, after his condition had encouraged the hope that in a few days it would be favorable for amputation of the limb. 3 CASE 862. Private J. C. Perkins, Co. B, 81st New York, aged 27 years, was wounded at Cold Harbor, June 3, 1864. Surgeon W. H. Rice, 81st New York, reported his admission to the field hospital of the 1st division, Eighteenth Corps, with "wound of ankles by a minie" ball." Twelve days after the reception of the injury the wounded man was admitted to Harewood Hospital, Washington, where both limbs were operated upon by Surgeon R. B. Bontecou, U. S. V., who made the following report: "The patient was suffering from wounds of the right and left ankle joints, the ball entering above the external malleolua of the right ankle, passing directly through, and entering the internal malleolus of the left ankle. On admission and at the time of the operation the condition of the injured parts was not good. The wounds suppurated freely. There were detached por tions of bone in each joint, and necrosed fragments came away from time to time. The constitutional state of the patient was poor. Resection of the right ankle joint and circular amputation of the left leg at the lower third was performed on July 7th, the anesthetic consisting of sulphuric ether and chloroform. The result of the operation was unfavorable. The stump sloughed and profuse unhealthy suppuration followed the resection, extending in every direction and burrowing up the leg nearly to its middle. The patient became very weak and sank gradually. He died of exhaustion July 17, 1864. The treatment was tonic and supporting throughout." The tarsal bones of the right foot, together with the lower extremity of the tibia, were con tributed to the Museum by Surgeon Bontecou and constitute specimen 3035 of the Surgical Section. Excisions at the Ankle Joint, Time between the Injury and Operation unknown. The five cases of this group would appear to have terminated in recovery, but it has been impracticable to get accurate details of the cases. Two of the operations were performed on Confederate and three on Union soldiers; the names of the latter do not appear on the Pension Rolls. The right ankle joint was excised in two, the left in one instance; in two cases the side was not indicated: CASE 863. Private T. Haley, Co. D, 91st .New York, was wounded at Port Hudson, May 27, 1863. Surgeon T. B. Reed, U. S. V., reported his admission to a Nineteenth Corps field hospital with " wound of foot." Two days after the recep- CULBERTSOX (H.), Excision of the. Larger Joints of the Extremities, in Trans. Am. Aled. Association, 1876, Supplement to Vol. XXVII, p. 312. "CULBEKTSON (H.), Excision of the Larger Joints of the Extremities, in Trans. Am. Med. Association, 1876, Supplement to Vol. XXVII, p. 312. 3 HALLOW AY (J. M.), Comparative advantages of PlUOGOFF s, SYME S, and CHOPAKT S Amputations, and Excision of the AnkU Joint by HAN COCK S Method, after Gunshot Wound* and other Injuries ; with Reports of Cases and the Results ; and proposing another Method for Excision of the Ankle Joint, in American Journal Medical Science, 1866, Volume LI, p. 90. SECT. VI.] AMPUTATIONS AT THE ANKLE JOINT. 595 tion of the injury the wounded man was transferred to University Hospital, New Orleans, where Assistant Surgeon P. S. Conner, U. S. A., recorded: "Gunshot wound of right foot; resection of astragalus. Patient absent without leave from September 7, 1863." There is no record of this man ever having applied for pension. CASE 864. Surgeon E. Andrews, 1st Illinois Artillery, publishes that "J. K , 40th Illinois," in one of the Western campaigns received a compound shot fracture of the os calcis and astragalus, and that both these bones were excised, the opera tion being followed by recovery. CASE 86.">. Colonel Y. M. Moody, 43d Alabama, received a gunshot wound through the right ankle joint on June 16, 1864. He entered Confederate hospital No. 4, at Richmond, whence he was furloughed August 11, 1834. Excision of the lower end of the fibula was performed ; the date of the operation was not recorded. The record of the case was found on the Confed erate hospital registers. CASE 866. Private H. Gregory, Co. B, 35th U. S. Colored Troops, aged 18 years, was wounded at Olustee, February 20, 1864. He passed through various hospitals at Beaufort, one of which was under charge of Surgeon J. Trenor, jr., U. S. V., who reported the patient s admission, August 27th, with "gunshot wound of left ankle; astragalus excised before admission." Assistant Surgeon J. G. Murphy, U. S. V., reported that the patient was discharged from service June 5, 1865, by reason of " anchylosis of ankle joint" resulting from the wound. There is no record of this man ever having applied for pension. CASE 867. "Sergeant P. R. Wright, Co. K, 13th North Carolina, was wounded in the engagement near Williamsburg, May 5, 1862. A conical pistol ball entered on the outside of the os calcis near the sole of the foot, and passed up through the outer portion of this bone and through the astragalus, comminuting the lower end of the fibula and lodging between the tibia and fibula, three inches from their lower extremities. The missile was traced to its lodgement with difficulty. A crescentic incision along the course of the peroneus longus and behind the external malleolus was intersected by a straight incision coming up from the heel, and another crescentic incision was found necessary to be made anterior to the external malleolus. By work ing under the ligaments the loose fragments of bone were removed from the calcaneum and astragalus; the lower comminuted end of the fibula was cut and pulled away by means of the forceps, and the bullet was found in its lodgement between the two bones, about three inches from the joint. While the lateral ligaments were left in position with their superficial connections, their bony attachments were of course disturbed. The granulation and consolidation, which will probably result, must give the joint greater strength against inversion of the foot than it could acquire without them. The opening into the joint was made very free by this operation, which is an advantage. It is now well enough settled that an inflamed and suppurating joint is more likely to result well with a free and external opening than with a limited one. The ase was reported by Surgeon D. Prince, U. S. V.; the result was not ascertained. AMPUTATIONS AT THE ANKLE JOINT. The number of exarticulations at the ankle recorded during the American civil war is one hundred and sixty-one; one hun dred and three were primary, thirty-nine intermediary, and thirteen secondary operations; in six instances the time between the injury and the operation was not indicated. TABLE LXXXIX. Numerical Table of One Hundred and Sixty-one Amputations at tlie Ankle Joint for Shot Injury. OPERATIONS. o Recovery. Death. Undetermined. Ratio of Mortality. METHOD OF OPERATION. PIROGOFF S. SYME S. VAKIOUS METHODS. 1 o Recovery. Death. 8 a Recovery. "S 1 Undeterm d. a O Recovery. Death. Undeterm d. Primary Operations 103 39 6 78 25 4 23 14 1 o 2 22. 7 35.9 7.7 33.3 26 18 4 1 20 10 4 1 6 8 ... 57 19 7 42 13 6 14 6 1 1 20 2 16 3 1 Period of Operation not specified 5 3 2 161 119 1 40 3 25. 1 49 Mortj 35 ility^S 14 5%. 83 61 21 1 29 23 5 1 Mortality 25. 6 %. Mortality 17. 8 %. The results were ascertained in one hundred and fifty-nine instances; one hundred and nineteen had successful, and forty fatal terminations, a mortality rate of 25.1 per cent., or 7.8 per cent, less than the death ratio after amputation in the leg. Primary Amputations at the Ankle Joint. In one instance both feet were removed. The one hundred and three operations were therefore performed on one hundred and two 596 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. FIG. 342.-Stump after PIKOGOFF B amputation at left ankle joint. Spec. 373-2. PIG. 343. Stump after Syme s am putation at unkle. [From a cast.] patients; seventy-eight recovered, twenty -three died, and in two cases the results were not ascertained. Successful Primary Amputations at the Ankle Joint. Seventy-eight operations per formed on seventy-seven patients belong to this group; sixteen were Confederate and sixty-one Union soldiers; the names of the latter were all on the Pension Roll; but six have died since the close of the war in 1865 two of diarrhoea and dysentery, one of apoplexy; in three cases the immediate cause of death is not reported. CASE 888. Private O. Leblanc, Co. E, 2d New Hampshire, aged 20 years, was wounded in the right foot, at Cold Harbor, June 1, 1664, by a shell, which fractured the ftvrsal and metatarsal bones. Assistant Surgeon J. C. McKee, U. S. A., reported that the man was admitted to Lincoln Hospital, Washington, ten days after receiving the injury, also that tbe wounded foot had been removed by Pirogoffs method, on the field, by Surgeon J. M. Merrow, 2d New Hampshire. The patient subsequently passed through various hospitals, and was ultimately discharged from service June 16, 1865, and pensioned, having been previously fitted with a " Palmer" artificial foot. The cast (Spec. 3732), contributed by Acting Assistant Surgeon L. C. Dodge and rep resented in the adjoining cut (FlG. 342), shows an apparently firm cicatrix, but reveals the stump to be a little irregular and without the appearance of being able to sustain decided weight. The pensioner was paid December 4, 1880. CASE 869. Private J. E. Ayers, Co. E, 8th New York Cavalry, aged 19 years, was wounded in the left foot, at Funkstown, July 10, 1863, and entered the General Hospital at Frederick eight days afterwards. Assistant Surgeon R. F. Weir, U. S. A., reported: "The injury consisted of a compound fracture of the tarsus. Syme s amputation at the ankle joint was performed on the field. During the progress of the case sloughing opened the stump, for which nitric acid wash was applied by injecting. Adhesive straps were used to support the posterior flap, and tonics were given internally; generous diet was allowed. The patient recovered with an excellent stump, and was discharged from service October 5, 1863." After leaving the service he became a pensioner, and subsequently he was an employ^ in the Quar termaster General s Office, U. S. A., for a number of years. In 1879 lie received an appointment in the U. S. Treasury Depart ment. On July 8, 1868, when visiting the Army Medical Museum, the pensioner walked remarkably well on an apparatus furnished by Dr. E. D. Hudson, of New York City, and the stump was found to be in good condition. Since then the pensioner has contracted and suffered for a time from frost bite in the stump, but in 1881 the stump was in excellent condition. The Army Medical Museum possesses a cast of the stump (Spec. 6056), represented in FIG. 343. A copy of a photograph of the pensioner, taken in January, 1881, is shown in FIGURE II of PLATE LXXV, 2 on the opposite page. CASE 870. Private H. W. Clark, Co. H, 100th New York, aged 30 years,- was wounded by a shell in both feet, at Drury s Bluff, May 13, 1864. He was admitted to a Tenth Corps field hospital, where the injured limbs were removed. Assist ant Surgeon E. McClellan, U. S. A. ; reported that the wounded man was brought to hospital at Fort Monroe six days after the injury, and that "both feet were amputated" before his admission. About two months after wards the patient was transferred to McDougall Hospital, and subsequently to Central Park Hospital, New York City. Surgeon B. A. Clements, U. S. A., in charge of the latter, reported that " the right foot was shat tered up to the metatarsal articulation, and the left heel with most of the tendo-achillis was carried away. There was no great amount of haemorrhage. The amputations were performed flu the field, while the man was under the influence of chloroform, by Surgeon M. S. Kittinger, 100th New York, the right foot being taken ofF by Chopart s method. His general condition at the time of the operation was good. At first sutures, bandages, and cold-water dressings were applied, and when the patient arrived at Fort Monroe, adhesive strips and band ages were used. Both stumps healed kindly, the right one in eight weeks and the left one in six weeks. At the time of his admission here, on July 26th, both were entirely well, the tendo-achillis of the right stump being considerably contracted." The patient was discharged from service December 13, 1864, and pensioned, and subsequently he was supplied with artificial feet by Dr. E. D. Hudson of New York City. Plaster casts of the stumps of the legs, contributed by Assistant Surgeon J. W. S. Gouley, U. S. A., constitute specimen 28.">7 of the Surgical Section of the Museum. That of the left limb, showing an excellent Syme s stump, is repre sented in the annexed wood-cut (FlG. 344). In his first application for commutation, in August, 1870, the pensioner described the stumps as being "sound and healthy;" but later, in 1880, he reported their condition as "poorly." His pension was paid December 4, 1880. 3 CASK 871. Private A. K. Russell, Co. H, 1st Massachusetts Heavy Artillery, aged 43 years, was wounded at Spottsyl- vania, May 19, 1864, and admitted to Emory Hospital, Washington, three days afterwards. Acting Assistant Surgeon J. E. Janvrin reported: "Gunshot wound of left foot, the ball entering the heel posteriorly, passing forward through the os calcis and astragalus, and making its exit anteriorly on the dorsal surface of the foot. The os calcis and astragalus together with the metatarsal bones were comminuted, and, according to the patient s statement, the soft parts were very much lacerated. Chloro form was administered, and Syme s operation was performed on the day of the injury. When admitted to Emory Hospital the sutures had given way and the flap was pendant, with unhealthy discharges and tendency to slough. Adhesive straps and SMITH (S.), Amputations at the, Ankle Joint in A{i!itary Surgery, in U. S. San. Com. Memoirs, New York, 1871, Surgical Volume II, p. 132. 2 SMITH (S.), Amputations at the Ankle. Joint in Military Surgery, in U. S. Kan. Com. Memoirs, New York, 1874, Surgical Volume II, p. 138. 3 SMlTil (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Com. Memoirs^ New York, 1871, Surg. Volume II, pp. 110. 140. FIG. 344. Stump after SYME S ampu tation at ankle joint. Spec. 257. [From a cast. I M<-d . Sur. Hist, of the War of the Rebellion. Fart ll[.Vol.IU lm|i.X. Ki.y I < ;isc of l.i.-ul \V ( \\Vrk FiLJ . i Case of I l .( 1 1 Shoi I S\-iric s Opciiil ion Kio.iJ. C.-,KI- of I l .1 K.Ayet-M Sviiic s Opi i-iil inn iy -I Cnsr of I l .A K Kus.scll Syilic s Ojicrnl ion SECT. VI. J AMPUTATIONS AT THE ANKLE JOINT. 597 cold-water dressings were applied, and subsequently linseed, charcoal, and yeast poultices were used. Alteratives, tunics, uud stimulants were administered, the patient being much exhausted and suffering from loss of appetite, with derangement of the system generally. On June 3d the parts were thoroughly cleansed, and a flat padded splint was applied to the anterior surface of the leg, extending beyond the stump, after which adhesive straps were passed from beneath the leg across the flap and carried over the end of the splint and fastened. These were gradually shortened as the healing process went on, thus removing the tension and weight of the flap from the anterior edge of the wound. By July 12th the patient was doing well and the granula tions were covering the bone. About August 18th the stump had nearly closed and the patient s general health was good Two weeks afterwards he left for his home on furlough. The success attending this case is attributed in a large measure to the method adopted for supporting the flap." The patient subsequently entered the general hospital at Readville, whence he was discharged from service June 2, 1865, and pensioned. After leaving the service he was furnished with an artificial foot. A photograph of the stump, taken three months after the date of the amputation, and contributed by Surgeon N. R. Mosely, U. S. V., is represented in FIGURE 4 of PLATE LXXV, opposite page 596. The man subsequently underwent a second operation, which was certified to by the Surgeon General of the State of Massachusetts, who communicated the following on January 26, 1871 : "The pensioner lias sustained re-amputation six inches below the knee, which was performed by Dr. C. N. Chamberlain, of Lawrence, late surgeon U. S. V v assisted by Dr. G. W. Garland, the case being at the time under my observation." In his sub sequent application for commutation the pensioner described the stump as being in a good condition. His pension was paid December 4, 1880. CASE 872. Private E. R. Covell, Co. C, 52d New York, aged 38 years, was wounded in the left foot, at Spottsylvania, May 18, 1864, and admitted to the field hospital of the 1st division, Second Corps. Surgeon J. W. Wishart, 140th Pennsyl vania, described the injury as a "shell wound of the tarsal and metatarsal bones," for which he performed "Syme s amputation at the ankle joint." Ten days after being wounded the patient entered Emory Hospital at Washington, and subsequently he was transferred to Central Park Hospital, New York City. Surgeon B. A. Clements, U. S. A., in charge of the latter, reported the following history of the case: "Considerable haemorrhage took place at the time of the injury, and the man s general condition was not very good in conse quence of his suffering from diaiThoea. Amputation at the ankle joint was performed under chloroform six hours after the reception of the injury, the ends of the tibia and fibula also being removed. Sutures, adhesive strips, and cold-water dressings were applied. The parts did not unite by first intention, though there was no sloughing nor necrosis. When the patient \vas admitted to Central Park Hospital, August 17th, the stump had healed with the exception of a small ulcer in the cicatrix near the external angle of the flaps, and his general condition was pretty good, though he still had diarrhoea. By October 2d the stump was entirely healed and the diarrhoea was much improved." The patient was discharged from service November 3, 1864, and pensioned, having been previously furnished with an artificial foot. A cast of the stump (Spec. 4369) was contributed to the Museum by Surgeon J. J. Milhau, U. S. A., and is represented in the adjoining wood-cut (FiG. 345). After leaving the service the stump was re-amputated at the lower third of the leg on May 5, 1869. In his subsequent applications for commutation the pensioner described the condition of the stump as "sound and healthy." His pension was paid September 4, 1881. l CASE 873. Lieutenant W. C. Weeks, 2 Co. I, 5th Michigan Cavalry, aged 28 years, was wounded at Five Forks, April 1, 1865, by a conoidal musket ball, which passed through the left ankle joint. Assistant Surgeon C. A. Leale, U. S. V., reported: "He was immediately conveyed to hospital at City Point, where Surgeon A. K. St. Clair, 5th Michigan Cavalry, performed PirogofFs amputation at the ankle joint the samejlay, removing the articulating surfaces of the tibia and calcaneum and bringing the cut extremities^ into apposition. On April 16th the patient was transferred to Armory Square Hospital at Washington, where he was admitted in a very feeble condition. Erysipelatous inflammation extended from the stump several inches above the knee joint. Extensive suppuration had taken place, and, although fifteen days had elapsed since the operation, the rough edges of the calcaneum could be rubbed against the denuded end of the tibia, proving that no union existed. The integumentary Hap had partially united, thus confining a large quantity of pus in the stump, which prevented the bones from being kept in apposition. Metastatic abscesses had commenced to form along the course of the anterior tibial lymphatic glands, and every symptom prognosticated an unfavorable termination, the only hope being based on the remarkable strong constitution of the patient. The abscess at the stump was freely evac uated, and the metastatic abscesses were freely opened as soon as fluctuation could be detected; the calca neum and tibia were held in proper position by means of adhesive straps after the limb had been thoroughly cleansed with liquor of chloride of zinc. Large linseed poultices were applied over the lower third of the tibia and lead and opium wash over the remaining part of the limb as far as the erysipelas extended; stimu lants and beef tea were administered. The patient gradually improved until April 28th, when he had a chill, which was soon followed by others. Quinine and tincture of chloride of iron was then prescribed and an ounce of brandy was given every two hours. By May 2d the patient had the peculiar sweet odor of breath and the well-marked icteroid hue, especially in the conjunctivas, which were exceedingly yellow. Several chills occurred each day and were followed by considerable febrile movement and great prostration; but by the frequent administration of stimulants and the constant application of artificial heat the patient rallied, after which beef tea was given in quantities as large as could be tolerated. From May 6th he improved, the chills occurring at longer intervals and with less severity until May 12th, when they ceased. A slight diarrhoea at this time was checked by starch and opium injections, after which the patient convalesced rapidly. By June 26th he had entirely recovered, the os calcis having united to the tibia and the wound having closed, leaving a solid, firm stump." A plaster cast of the stump, Specimen 2298 of SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Com. Memoirs, New York, 1871, Surgical Volume II, p. 136. J Circular No. 6, War Department, S. G. O., 1865, p. 47. SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. Sanitary Commission Memoirs, New York, 1871, Surgical Volume II, pp. 116, 132. FIG. 345. Stump after SYME S am putation at ankle joint. Spec. 4369. [From a cast.] FIG. 346. Stump after PIKOGOFF S amputation at an kle joint. [From a plaster cast.] 598 INJURIES OF THE LOWER EXTREMITIES. [CHAT. X. FIG. :i47.-Stump of left leg after PlUOGOFF S am putation at ankle joint. [From a ast.] the Army Medical Museum, is shown in FIG. 346, and a photograph of the patient is copied in FIGURE I of PLATE LXXV, opposite page 59o. Lieutenant Weeks was mustered out of service July 20. 1865, and pensioned, after which time he com menced to wear the "Palmer" artificial foot. In a subsequent report, dated June 28, 1866, Dr. Leale furnished the following information in regard to the case: "I have just received a communication from Lieutenant Weeks (residing at Allegan, Mich igan), in which he states : I am able to do anything that most men can do; my patent foot works like a charm. I am at present engaged in a large flour mill, and my stump has never troubled me but once since I left the hospital, and then it was caused by an accident, which loosened a small splinter of bone. This I had removed at Chicago, since which time it has done well. I adjusted my false foot on October 1, 1865, and never take it off except when I go to sleep. I can easily walk without a cane. " The pensioner was paid September 4, 1881. CASE 874. Private II. Bell, Co. A, 2d New York Artillery, aged 45 years, was wounded in the left foot, at the battle of White Oak Swamp, June 30, 1862. He was conveyed to hospital at Fort Monroe, whence he was transferred to DeCamp Hos pital, David s Island, three weeks afterwards. Surgeon J. Simons, U. S. A., in charge of the latter, recorded the patient s admission with "amputation of foot." Assistant Surgeon J. W. S. Gouley, U. S. A., in charge of Central Park Hospital, New York City, contributed the cast (Spec. 4218), represented in the annexed wood-cut (FlG. 347), with the following description: "This interesting wax specimen, a cast of Pirogoff s operation, I regret to say has an incomplete history. According to the patient s statement he was wounded by a shell, which tore oft" the outside of the foot nearly up to the ankle. He was etherized on the field, and when he awoke he found that he had no foot. When admitted to this hospital, on October 28th, the stump was healed and in the condition represented in the cast. The parts were perfectly consolidated, and the heel was firm and capable of sustaining the weight of his whole body without giving rise to pain or tenderness. The limb was about three- fourths of an inch shorter than its fellow. The patient was furnished with an apparatus by Dr. Hudson, which answered admirably, the heel of the artificial limb being made three-fourths of an inch higher, while the ankle joint was lowered. On the whole it was as shapely as the width of the ankle would allow. The patient was discharged from service July 7, 1863. Before he left the hospital he was able to walk without the assistance of a cane and without causing any irritation to the stump." Examining Surgeon W. M. Chamberlain, of New York City, certified to "loss of most of the left foot. Pirogoff s operation has been successfully performed. A small fragment of the heel only is left, and the pensioner wears an artificial foot." The pensioner was paid March 4, 1871, since when he has not been heard from. 1 CASE 875. Captain J. F. Denniston, Commissary of Subsistence, U. S. V., aged 24 years, was wounded in the right foot, during the engagement at the Weldon Railroad, August 25, 1864. Surgeon N. Hayward, 20th Massachusetts, reported his admission to the field hospital of the 2d division, Second Corps, with "fracture of ankle, 1 followed by "Piro gofFs operation, performed by Surgeon G. Chaddock, 7th Michigan," Surgeon D. W. Bliss, U. S. V., who subsequently re-amputated the limb, reported that "the patient entered Armory Square Hospital, Washington. August 28th. On September 6th haemorrhage ensued, which was controlled by styptics and a compress, but commenced again two days afterwards, when the femoral was held by the attendants for several hours. On September 10th a fresh and copious haemorrhage set in, when, after a thorough examination of the parts, it was deemed proper to amputate at a point about three inches above the ankle, the patient being in good condition at the time. The entire loss of blood probably amounted to a pint, its source being first the anterior tibial and afterwards the femoral artery. The amputation was performed by the circular method and without much shock to the patient s system. The treatment included tonics, stimulants, and nourishing diet. Simple dressings were used. Three weeks after the operation the patient was doing well." The re-amputated stump, showing the soft tissues and the cut surfaces of the tibia and os calcis softened by suppuration, was forwarded to the Museum by the operator and constitutes specimen 3211 of the Surgical Section. In 1881 the soft tissues were removed from the specimen, when it was found that the tibia was fissured to the extent of four inches (FlG. 348). The patient w r as subsequently transferred to the Seminary Hospital, Georgetown, where he obtained leave of absence November 25th, when he started for his home. He was ultimately mustered out of service January 1, 1867, and pensioned. While serving as an officer of the 70th New York, at the battle of Williams- burg, May 5, 1832, Captain Denniston had also been wounded in the right forearm, for which injury he underwent the operation of resection of the continuity of the bones. 2 After leaving the service he obtained an artificial leg from the Pittsburgh Artificial Limb Manufacturing Co., and since then he has continued to report the stump of his amputated leg as being in a "healthy condition." The pensioner was paid September 4, 1881. Fatal Primary Amputations at the Ankle Joint The results in twenty-three primary amputations at the ankle joint were fatal. Syme s operation was performed in fourteen, and PirogofF s in six instances; in three the mode of operation was not indicated. Seven teen of the patients were Union and six Confederate soldiers. In four instances the exarticulations at the joint were followed by amputations in the leg: CASE 876. Private H. E. Boynton, Co. L, 1st Massachusetts Heavy Artillery, aged 18 years, received a shot fracture of the left foot and of the right arm, at Spottsylvania, May 19, 1864, and was admitted to the field hospital of the 1st division, Second Corps. Susgeon J. W. Wishart, 140th Pennsylvania, reported that he amputated the foot by Syme s method on the day of the injury. Three days afterwards the wounded man entered Emory Hospital at Washington, where Surgeon N. R. Moseley, SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. San. Com. Memoirs, New York, 1871, Surgical Vol. II, pp. 117, 134. 2 See Medical and Surgical History of the Mar of the Rebellion, Part II, Volume II, TABLE CXXVIII, p. 957, No. 23. FIG. 348. Bones of the right ankle joint alter PlKO- GOFF 8 amputa tion. Spec. 3211. SECT. VI.] PRIMARY AMPUTATIONS AT THE ANKLE JOINT. 599 U. S. V., excised two inches of the middle third of the fractured humerus. The case resulted fatally on June 22, 1864. The excised portion of the humerus (Spec. 2322) and most of the bone of the amputated foot (Spec. 828) have been contributed to the Museum by the respective operators. The latter specimen consists of the metatarsus, scaphoid, cuboid, and outer two cunei form bones, and shows a large, battered, conoidal bullet occupying the place of the inner cuneiform, the bones adjacent to it being fractured. CASE 877. Private E. P. Hale, Co. I, 1st Minnesota, aged 24 years, was wounded through the left lung and in the left foot, at Gettysburg, July. 2, 1883. He was admitted to the field hospital of the 1st division, Second Corps, where amputation was performed by Surgeon C. S. Wood, 66th New York, who described the injury of the foot as follows: "A mini6 ball entered at the internal malleolus, passed obliquely downward and outward, and emerged about two inches below the external malleolus, comminuting the astragalus and involving the ankle joint. Syme s operation was performed." Five weeks after the reception of the injuries the patient was transferred to Camp Letterman, whence Acting Assistant Surgeon A. B. Shekell reported that the wounds discharged freely and that the patient continued in a weak state, his condition and the stump of the leg improving but slightly, though stimulants, quinine, and iron were freely administered. Simple dressings were applied. On September 2d an abscess was opened on the inner side of the right thigh, which discharged about a pint of pus. The case terminated fatally on September 12, 1863. The leaver extremities of the bones ef the stump (Spec. 1949), showing the articular surfaces to be destroyed by uFceration, were contributed to the Museum. CASE 878. Private G. Harfeter, Co. D, 104th Pennsylvania, aged 22 years, was wounded at Morris Island, September 27, 1863, and was conveyed to hospital No. 5, at Beaufort, the following day. Assistant Surgeon J. S. Smith, U. S. A., reported: "The wound was by a fragment of shell in the left foot, which was amputated the next day by Surgeon E. B. Bontecou, U. S. V., on board of the hospital transport Cosmopolitan. Syme s operation was performed. There was also a slight flesh wound of the right hip and right arm. Simple dressings were used and anodynes were given at night. On October 1st slight haemorrhage occurred, which was easily controlled by slight pressure, about an ounce of blood being lost. Two days afterwards a profuse haemorrhage took place, reducing the patient s vitality to an alarming extent. The stump was then opened for the purpose of securing the bleeding vessel, but it could not be found, and the anterior tibial was ligated two inches above the seat of the haem orrhage. The bleeding did not recur, but the patient gradually sank. He died October 12, 1863." CASE 879. Private F. M. Bland, Co. D, 23d Iowa, aged 22 years, was wounded in the left foot during the engagement at the Black River, May 19, 1863, and entered Adams Hospital, Memphis, several weeks afterwards. Acting Assistant Surgeon B. J. Bristol reported: "Syme s operation at the ankle had been performed the same evening the injury was received. At the time of the patient s admission to Adams Hospital, June 13th, nearly the entire flap had sloughed off and the bones were exposed to view. An abscess had also formed at the middle of the lower third of the leg, and there was periostitis of the tibia and fibula at the same point. The general condition of the patient was low, he having had diarrhoea for four months. He was put upon iron, quinine, stimulants, and astringents. On June 17th his general condition was somewhat improved, the diarrhoea checked, and it was decided to operate. Amputation of the leg was accordingly performed at the junction of the middle and upper third by Acting Assistant Surgeon J. Thompson. I saw the patient for the first time the next day, when, though in a low condition, he seemed to be rallying from the shock of the operation. I administered tonics, stimulants, and beef tea freely, and had water dressings applied to the stump, under which course the general condition of the patient gradually improved. The stump then appeared to do well, but before many days it began to discharge a thin ichorous-looking pus. About June 26th the flaps gaped open, no adhesions having formed in any part of the stump. The flaps soon commenced sloughing, and it was decided that the only chance for the patient laid in another amputation. Accordingly on July 2d the thigh was taken off at the middle of the lower third, which operation the patient seemed to bear well. The tonic and supporting treatment was continued, and as before the patient seemed at first to be doing well ; but the stump soon became gangrenous. An abscess also formed below the clavicle, the edges of which sloughed away, laying bare the thyroid axis, the branches of it too sloughing off. On July 13th the patient was removed to my ward in a rapidly sinking condition. He died three days afterwards on July 16, 1863." The Syme stump (Spec. 1706), removed at the first re-amputation and contributed to the Museum by Surgeon J. G. Keenon, U. S. V., shows the extremities to be necrosed and an absence of reparative action. TABLE XC. Summary of One Hundred and Three Cases of Primary Amputation at the Ankle Joint for Shot Injury. [Recoveries, 178; Deaths, 79101; Results undetermined, 102-103.] NO. NAME, MILITARY DESCKIPTIOX, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION" AND OPERATOR. RESULT AND REMARKS. 1 1 Ayres, J. E., Pt., E, 8th N. July 10, Conoidal ball comminuted left July 10, Syme s amputat n at left ankle Sloughing. Discharged October York Cavalry, age 19. 1863. tarsus. 18C3. joint. 5, 1863 ; pensioned. Spec. 6056, A. M. M. Stump in good con dition in 1881. o Baal, M., Pt., E, 21st Iowa. May 17, Shot fracture of right foot. Mnv 17, Pirogoff s amputation at right Discharged Sept 26, 1863; pen* age 20. 18(13. 1863. ankle joint. sioned. Stump perfectly healed. 3 Barnett, J. B., Pt., E, 191st Mar. 31, Conoidal ball comminuted tar- April 1, Syme s amputation at left ankle April 8, amputation in low. third Pennsylvania, age 33. 1865. sal and metatarsal bones of 1865. joint. Surg. A. A. White, 8th of leg. Discharged June 28, left foot. Maryland. 1865. and pensioned. 4 Bell, H., Pt., Battery A, 2d June 30, Shell fracture of tarso-metatar- June 30, Pirogoff s amputation at left Discharged July 7, 1863: stump New York Artillery, age 45. 1862. sal bones of left foot. 1862. ankle joint; lower portion of finely formed ; pensioned. Able tibia and anterior portion of to walk without aid of cane; (alcaneiim exsected. portion of calcaneum useless. 1 Spec. 4218, A. M. M. SMITH (S.), Amp at the Ankle Joint in Mil. Sury., in U. S. San. Com. Mem., N. Y., 1871, Surg. Vol. II, p. 138. "SMITH (S.), loc. rit., pp. 117, 134. 600 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCIUPTION, AND AGE. DATK OF INJURY. NATURE OF IXJUKY. DAIK OF OPERA TION. OPERATION AND OPERATOR. RKSI -].T AND REMARKS. 5 Blake, H., Pt., I, 37th Mass., June 13, Shot fracture of right tarsus. . . June 13 Pirogoff s amputation at right Discharged December 16, 1864; age 36. 1864. 1864. ankle joint. pensioned. Stump well healed. 6 Blakeman, M. A., 1 t., D, Sept. 22, Conoidal ball fractured the Sept. 22, Amputnt n at right ankle joint Discharged May 8, 1865, and pen 3<:th Ohio, age 36. 1864. right ankle joint. 1864. by Symc s method. sioned. Stump perfectly healed. 7 Blanlcenbecker, G. R., Pt., C, June 24, Cnnoidal ball fractured meta- June 24, Syme s amputation at ankle Sloughing of flaps; a bscesses. 4th Va. Cavalry, age 20. 1864. tarsal bones of left foot. 1864. joint. Furloughed October 30. 1864. 8 Bourkney, N.. 1 t . K, 155th June 16, Shell fracture of right tarsus .. June 17, Amputation at ankje joint by Discharged March 15, 1865, and New York, age 32. 1864. 1864. circular incision. Surgeon N. pensioned. Hayward, 20th Mass. 9 Brewster. J., Pt., I, 29th Sept. 29, Grapeshot wound of left foot, Sept. 29, Syme s amputation at ankle Discharged July 22, 1865, and Conn, (colored), age 22. 1864. fracturing metatarsal bones. 1864. joint. pensioned. Sound stump. 10 Brink. S. S., Pt., B, 3Cth June 18, Conoidal ball fractured left foot. June 18. Flap amputation at ankle joint. Discharged April 25, 1865; pen Wisconsin, age 28. 1864. 1864. Surgeon N. Hayward, 20th sioned. Stump unsound ; bone Massachusetts. diseased. 11 Bunting, J. K., Corp l, I, 8th April 16, Shot comminution of astragalus April 18, Syme s amputation at left ankle Discharged June 27, 1862; pen Michigan, age 28. 1862. and calcaneum. 1862. joint. Ass t Surgeon C. A. sioned. Stump healthy and McCall, U. S. A. useful. 12 Clark, H. W., Pt., H, 100th May 13, Solid shot fractured bones of May 13, Syme s amputation at left ankle Discharged December 13, 1864. New York, age :!0. 1864. both feet. 1864. joint; Chopart s amputation Spec. 2857, A. M. M. right foot. Surg. M. S. Kit- tinger, 100th New York. 13 CoUins, W., Pt., F, 3d Mis July 22, Conoidal ball fractured the arch July 23, Syme s amputation at ankle Recovered. sissippi Battery, age 28. 1864. of the left foot. 1864. joint. 14 2 Connors, J., Pt, F, 76th July 11, Musket ball comminuted the July 12, Syme s antero-post. flap ampu Necrosis of tibia. Sept. 27, amp. Pennsylvania, age 25. 1863. right tarsus. 1863. tation at right ankle joint. lower third leg. Disch d Aug. 28, 1865; pensioned. 15 3 Covell, E. R., Pt., C, 52d May 18, Shell wound, carrying away a May 18, Syme s amput n at ankle joint, Discharged Nov. 3. 1864; pen New York, age 38. 1864. large portion of left foot ; con- 1864. end of tibia and fibula rem d. sioned. May 5, 1869, amput n siderable haemorrhage. Surgeon J. W. Wishart, 140th lower third leg. Spec. 4:J9, A. Pennsylvania. M. M. 16 4 Denniston, J. F., Commis Aug. 25, Conoidal ball fractur dl he right Aug. 25, Pirogoff s amputation at ankle Haem. from ant. tib. and femoral sary of Subsistence, U. S. 1864. ankle. 1864. joint. arteries. Sept. 10, amp. lower V., age 24. third leg. Disch d Jan. 1, 1867, and pensioned. >Spec. 3211. 17 6 Dresser, E. E., Pt., A, 20th June 24, Shell fragm t extensively laoer- June 24, Syme s amp. at ankle. Surg. Fragments of necrosed bone re Massachusetts, age 21. 1864. ated foot and injured tarsal 1864. N. Hayward, 20th Mass. Soft moved. Discharged Dec. 12, and metatarsal bones. parts so much destroyed that 1864. Died Nov. 14. 1870, from flaps wero made from sides of ulceration of bowels. ankle and foot and extcr. sole. 18 Dudley, E. H., Pt., K, 16th July 3, Shell fracture and laceration of July 4, Syme s amputation at ankle. Inflammation : sloughing. July Vermont, age 20. 1863. tarsal bones of left foot. 1863. Ass t Surgeon (!. H. Rich J 8, amp. lower third leg. M. O. mond, 104th New York. Aug. 10, 1863. Amp. up. third leg Dec. 21, 186:t ; pensioned. 19 6 Duffy, T., Pt., I, 70th New June 1, Musket ball fractured tarsal June 2, Syme s amputat n at left ankle Sloughing of flaps. Nov. 6, amp. York, age 21. 1862. and metatarsal bones of left 1862. joint. middle third leg. Nov. 28, se foot. questra removed. Disch d July 11, 1863; pensioned. Healthy stump. Spec. 4312. 20 Foreman, J. Af., Pt., B, 7th May 4, Gunshot wound May 5, Amput n at ankle joint. Surg. Furloughed June 23, 1863. Louisiana. 1863. 18&3. J. B. Davis, C. S. A. 21 Freeman, J. C.. Pt., A, 9th Sept. 17. Shot fracture of left foot Sept. 18, Syme samp.at leftankle. Surg. Discharged December 30, 1862; New York, age 2ii. 1862. 18G2. G. C. Humphreys, 9th N. Y. pensioned. Stump healed. 22) Hicks, II. F., Pt., A, 1st R. Dec. 13, Shot wound of both feet Dec. 1 4. Syme s amput n at right ankle, Discharged September 14, 1863; 93j Island Artillery. 1862. 1862. and Pirogoff s at left ankle. pensioned. 24 7 Holland, K. B., Corp l B, May 3, Shot fracture of tarsus May 4, Pirogoff s amputation at ankle Recovery. 1864, unable to walk 44th Virginia. 1863. 1863. joint. Surg. B. F. Whitehead, without crutches. Parts still C. S. A. swollen and cedematous ; heel drawn upward. 25 Holmes, A. H ., Pt., K, 20th June 19, Shot wound of right foot June 19, Amputat n at right ankle joint. Discharged August 25, 1864. Georgia. 1864. 1864. Surgeon C. Cord, C. S. A. . 26 Hosington, G., Pt., A, 123d June 13, Wound of left foot by conoidal June 14, Amputation at ankle joint by June 21, amp. leg 3 ins. above Ohio, age 36. 1863. ball. 1863. Confederate surgeon. ankle joint. Sept. 17, re-amp, in middle third leg. Disch d May 16, 1 865 ; stump entirely healed ; pensioned. Died Dec. 16, 1866. 27 Humble, T., Pt., G, 24th May 13, Shot wound of right foot Mav 13 Amputat n at right ankle joint. Retired March 2, 1865. Texas. 1864. 1864. Surg. G.W. Lawrence,C.S.A. 28 Hunt, J., Pt., C. 19th Indiana, June 18, Conoidal ball injured right foot. June 18, Syme s amput n at right ankle Discharged May 20, 1865, and age 38. 1864. 1864. joint. Surgeon J. Ebersole, pens d. Stump perfectly healed. 19th Indiana. Declares, in 1875, that his leg is slowly getting weaker. 29 Hunter, A., Pt., F, 140th May8, Shell fracture of all metatarsal May 9, Syme s flap amputation at right Discharged June 1 4, 1 865 ; pen Pennsylvania, age 33. 1864. bones in right foot. 1864. ankle joint. Surgeon J. W. sioned. Wishart, 140th Pennsylvania. 30 Ishain, D. E., Pt., E, 154th May 3, Shell wound, shattering and Mav 4, Chopart s amp. attempted, but Discharged January 22, 1864, and New York, age 19. 1863. carrying away most of left 1863. finding astragalus and cunei pensioned. foot. form injured, Syme s operat n was performed. Surg. C. S. Wood, 66th New York. 31 Jackson, F., Pt., E, 86th Colored Troops, age 32. April 3, 1865. Compound fracture right foot by fragment of shell. April 3, 1865. Syme s amput n at right ankle joint. Surgeon H. Osborne, Discharged Aug. 7, 1865. Stump perfectly healed. 51st Colored Troops. 32 Johnson, F., Capt., K, 26th May 12, Conoidal ball comminuted left May 12, Syme s amputation, left ankle Discharged Nov. 30, 1864 ; pen Michigan, age 2ii. 18 64. tarsus. 1864. joint. Surg. J. W. Wishart, sioned. 3J ins. shortening; flaps 140th Pennsylvania. retracted. Not heard from since September 4, 1870. 33 Johnson, J. M., Pt., C, 3d June 3, Shell wounds of left foot and June 3, Syme s amputation at leftankle Discharged June 8, 1865 ; pen Delaware, age 31. 1864. right leg. 1864. joint : also amp. in mid. third sioned. Small ulcer on stump right leg. Surg. G. W. Met- in 1874. calf, 76th New York. 1 SMITH (S.), loc. tit., pp. 110, 140. SMITH (S.), loc. cit., p. 138. 3 SMITH (S.), loc. tit., p. 136. *Capt. Denniston had received a shot fracture of the bones of the forearm, at Williamsburg, May 5, 1862, for which excision was performed. See Second Surgical Volume, TABLE CXXVIII, p. 957. No. 23. B SMITH (S.), loc. tit., pp. 109, 140. 6 SMITH (S.), loc. til., p. 138. 7 HOLLOWAY (J. M.), Comp. Advantages of PIUOGOFF S, SYME S, and CHOPART S Amp., etc., in Am. Jour. JUed. Sri,, 1866, N. S., Vol. LI, p. 85, and SMITH (S.), Amp. at the Ankle Joint in Mil. Surg., in U. S. San. Co i. Mem., New York, 1871, Surg. Vol. II, p. 134. SMITH (S.), loc. tit., p. 138. SECT. VI.] PRIMARY AMPUTATIONS AT THE ANKLE JOINT. 601 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATK OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS 34 June, J., Pt., E, 43d New May 10, Conoidal ball fractured tarsal May 12, Flap amputation at anklejoint Discharged March 15, 1865; good York, nge 25. 1864. bones, left foot. 1864. by Confederate surgeon. stump. Pensioned. 35 Kilborn, M., Pt,, F, 14th In Nov. 3, Shell wound right foot Nov. 3. Svme s amrmtation. ritrht nnklp Discharged September 16, 1863; fantry, age 29. 1862. 1862. joint. pensioned. 36 King, C., Pt., B, 82d Ohio, Mar. 19, Left foot badly shattered bv Mar. 19, Syme s nmputnt n at left ankle Discharged August 15, 1865, and age 19. 1865. shot. 1865. joint. Surgeon J. Chapman. pensioned. 12Cd New York. 37 1 Le Blanc, L. D., Pt,, Don- - . Shot wound of left foot On field. Disartioulation at anklejoint.. Recovery. aldsonville Artillery. 1862. 38 2 I,e Blanc, ()., Pt,, E, 2d N. June 1, Shell fracture tarsal and meta- June 1, Pirogoff s amputation at ankle Discharged June 16, 1865. and Hampshire, age 20. 1864. tarsal bones, right foot ; great 1864. joint. Surgeon J. M. Merron, pensioned. Stump healed. laceration. 2d New Hampshire. 39 Leigh, G., Pt., C, 3d Artil Sept. 24, Shell carried away portion of Sept. 24, Syme s amputation at right an Flaps sloughed : March 20, 1864, lery, age 19. 1863. right foot. 1863. kle joint. amp. lower third leg. Disch d Sept. 17, 1864. Died Sept. 13, 1871. Spec. 2105, A. M. M. 40 Luyster, T., Pt., B, 10th N. May 10, Conoidal ball comminuted the May 10, Circular amputation at right Discharged April 24, 1865; pen York, age 19. 1864. right os calcis. 1864. ankle joint. Surg. M. Rizer. sioned. 72d Pennsylvania. 41 Lynn, S., Serg t, C, 104th Nov. 25, Conoidal ball fracturing right Nov. 25, Pirogoff smodificat n of Syme s Discharged February 23, 1864, Illinois, nge 28. 1863.- foot. 1863. amputat n at right anklejoint. and . pensioned. Fine round Surg. C. H. Miller, 125th 111. stump. 42 3 Lyon, B., Pt,, C, 12th Mas sachusetts, age 19. Sept. 17, 1862. Solid shot shattered left tarsus and carried away phalanges Sept. 17, 1862. Syme s amputat n at left ankle joint. Surgeon J. McL. Hay- Discharged Oct. 23. 1803. Stump highly serviceable ; 3 inches and metatarsus. ward, 12th Massachusetts. shortening. 43 McConihe, L. A., Pt., F, 3d Aug. 26 Shell wound of left foot A ug. 20, Svme s amp., left ankle joint. Discharged Nov. 5, 1863 ; pen New Hampshire, age 20. 1863. 1863. Surg.A. J. H. Buzzell,3d N.H. sioned. Stump healed. 44 Mclntire, E. P.. Pt., K, 2d May 1, Conoidal ball injured left foot. . May 2, Amputation at left ankle joint. Discharged July 24, 1863; pen Infantry, age 30. 1863. 1803. Surg. G. R. C. Todd. C. S. A. sioned. 45 Mclntyre, N., Pt., F, 10th May 14, Conoidal ball comminuted the May 15, Syme s amputation at left ankle Discharged January 21, 1864, Missouri, age 22. 1863. left tarsus and splintered the 1863. joint, Surgeon H. S. Hewit, and pensioned. astragalus. U. S. V. 46 Maddox. T., Pt., E, 19th May 22, Wound of left foot bv conoidal May 23, Amp. at left ankle joint. Surg. Discharged October 5, 1863; pen Kentucky, age 23. 1863. ball. 1803. W. K. Sadler, 19th Ky. sioned. 47 Marsh, B. F., Pt,, K, 12th Oct. 19 Gunshot wound. Oct. 19, Amputation at ankle joint by Discharged February 1, 1865. Alabama. 1864. 1864. Surgeon Scott. 48 May, M., I t., H, 9th New Sept, 17, Solid shot comminuted the left Sept. 18, Syme s amputat n at left ankle Discb d January 10, 1863; pen York, age 22. 1862. foot. 1862. joint, Surgeon G. C. Hum sioned. April, "1863, amputation phreys. 9th New York. lower third leg. 49 Mentaldo, P., Pt., K, 6th Jan. 2, Conoidal ball fractured meta- Jan. 2, Pirogoff s amputation at the Discharged June 22, 1864, and Ohio, age 33. 1863. tarsal bones, right foot. 1863. right anklejoint. pensioned. Stump healed. 50 Munger, M., Pt., H, 8th May 6, Comp. fracture left foot, just Mav 6, Syme s amp. at left ankle joint. Discharged January 27, 1865. and Michigan, age 19. 1864. below joint, by conoidal ball. 1864. Surg. B. Rohrer, 10th Pa! Res. pensioned. 51 Newell, T. F., Lieut., G, July 2, Fracture of right foot by a frag July 2, Pirogoff s amputation at right Transferred for exchange Sept. 45th Georgia, age 24. 1863. ment of shell. 1863. anklejoint. 27, 1863. Spec. 6688, A. M. M. 52 "O Reilly, C., Pt,, F, 164th May 18, Shell wound of right foot May 18, Syme s amputat n, right ankle. February 12, 1865, amp. of leg at New York, age 23. 1864. 1864. Surg. G. W. Briggs, C. S. A. junc. of lower third. Disch d Mav 31, 1865, and pensioned. 53 Patton, A. G., Pt., I, 139th May 12, Wound of left foot by conoidal May 13, Pirogoff s amputation at ankle Disch d March ]6, 1865. and pen Pennsylvania, age 23. 1864. ball. 18~64. joint, Surgeon S. F.Chapin, sioned. Stump healed soundly. 139th Pennsylvania. 54 Policy, J. B., Corp l, F, 4th Oct. 7, Shot wound of right foot Oct. 7, Syme s amputation at right an Retired January 25, 1865. Texas, age 24. 1864. 1804. kle joint. 55 Porter, A., Pt., K, 106th July 6. Shot wound left foot, destroy July 7, Pirogoff s amputation at left Discharged September 5, 1862; Pennsylvania, age 22. 1862. ing tarsus. 1802. ankle joint. Ass t Surgeon P. pensioned. Died July 10, 1864. Leidy, 106th Penn. 56 Price, S. B., Serg t, A, 2d MavlS, Conoidal ball fractured left foot. May 15, Syme s amputat n at left ankle. Gangrene of stump. June 15. Ohio, nge 22. 1864. 1864. Surgeon B. F. Miller, 2d Ohio. amp. leg at lower third. Dis charged Oct. 10, 1864 ; pens d. 57 Ross, J.. Pt., I, 2d New York Mav 19, Conoidal ball passed through May 19. Syme s amputation at ankle Secondary amput n of leg. upper Heavy Artillery, age 34. 1864. metatarsus from dorsal to 1864. joint. Surg. J. W. Wishart, third. Disch d March 15, 1865. plantar surface. 140th Pennsylvania. Died Jan. 8. 1877; apoplexy and hemiplegia. 58 Russell, A. K., Pt., H, 1st May 19, Conoid, ball lacerated soft parts May 19, Syme s amputation at ankle Discharged June 2, 1865. Ampu Massachusetts Heavy Artil 1864. of left foot and com. os calcis, 1864. joint; sloughing. tation leg at mid. third. Card lery, age 43. astragalus, and metatarsals. Photo s, Vol. 1, p. 45. 59 Smith, G. W., Pt., H, 6th Sept. 15, Shot wound of right foot Sept, 15, Pirogoff s amputation at right Discharged October 17, 1864 ; Illinois Cavalry, age 21. 1864. 1864. ankle joint ; portion of heel pensioned. bone retained. Surg. G. P. Christy, 9th Illinois Cavalry. 60 Smith. S. B., Lieut., D, 3d May 2, Four of left tarsal bones shat May 2. Syme s amputation at left ankle Transferred to V. R. C. July 2, Michigan, age 26. 1863. tered and soft parts extensive 1863. joint. Surgeon C. S. Wood, 1863. Disch d January 1, 1868; ly destroyed. 66th New York. pensioned. Stump sound and healthy. 61 Smith, T. A., Pt., H, llth Penn. Reserves, age 18. Dec. 13, 1862. Wound of right foot by conoid al ball. Dec. 15, 1862. Pirogoff s amputation at right anklejoint. March 14, 1803, gangrene. Dis charged Sept. 11, 1863: pen sioned. 1878, stump tender; cannot wear artificial limb. 62 Smyser, J. W., Pt,, A, 27th June 24, Shot wound of right foot June 24, S3 - me s amputation at right Furlough ed August 6, 1864. South Carolina, age 25. 1804. 1864. ankle joint. 63 Snyder, L., Corp l, F, 71st Penn., age 24. Dec. 15, 1862. Fracture of left foot by conoidal ball. Dec. 16, 1862. Pirogoff s amputation at left anklejoint. Discharged May 17, 1864 ; pen sioned. Stump perfectly healed. 64 Spearman. R. F., Pt., D, May 30, Conoidal ball fractured tarsus. Mav 31, Amput n at ankle joint. Surg. Transferred. 25th South Carolina. 1864. 1864. C. B. Gibson, C. S. A. 65 5 Stetson, A. L., Pt., G, 20th Mav 2, Spiral case shot perforated left Mav 2, Double lat. flap amp. (Syme s Discharged Dec. 29, 1863; pen Massachusetts, age 26. 1863. ank. joint, destroying articula 1863. modified) at left ankle. Surg. sioned. Cicatrization perfect; tion and soft parts about heel. N. Hayward, 20th Mass. 2J inches shortening. 66 6 Stockwell, W. S., Serg t, B, 57th New York, age 23. May 3, 1863. Unexploded shell comminuted phalanges, metatarsal bones, Mav 4, 1863. Syme s amput n at right ankle joint. Sureeon C. S. Wood, Discharged Aug. 24, 1863 ; pen sioned. Very creditable stump. andport n of tarsus, rigfht foot. 66th New York. 67 Thornton, F. C ., Pt,, K, 34th Virginia. July 30, 1864. Greater port n of right foot torn away by fragment of shell. July 30, 1864. Pirogoff s amputation at right anklejoint. Healed bv first intention. Fur- loughed October 23, 1864. 1 FOR.MENTO (P., jr.), Notes and Observations on Army Surgery, etc., New Orleans, 1863, p. 27. SMITH (8.), loc. cit., p. 138. SMITH (S.), loc. cit., p. 136. SMITH (S.), lac. tit., pp. 110, 140. SURG. Ill 76. *SMIT(I (S.), loc. cit., p. 132. * SMITH (S.), loc. tit., p. 138. 602 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITAUY DESCRIPTION, AND AGE. DATE OF IXJUBY. NATURE OF INJUUY. DATK OF OPERA TION. OPERATION- AND OI-KUATOR. RESULT AND REMARKS. GS Townsend, W., Pt., I, 92d Sept. 1, Conoidal ball fractured left foot. Sept. 1, Pirogoff s modificat n of Syme s Discharged June 16, 1865; pen Ohio age 21. 1864. 1864. amputation at left ankle joint. sioned. In 1867, alleged that retained portion of heel was an annoying encumbrance. 69 Treadway, W., Pt., H, 13th April 4, Wound of left foot by conoidal April 5. Svme s amput n at ankle joint. Discharged October 23, 1865; Tennessee Cavalry, age 20. 1865. ball. 186."). Surg R.D.Hamilton. P. A.C.S. pensioned. Sound stump. 70 Unknown, Pt., Nov. 26, Shot wound , involving tarsus. . Nov. 28, Pirogoff s amp. at ankle joint. 1865, recovery: apparently little 1863. 1863. Surg. R. K. Taylor, P.A.C.S. inconvenienced bv loss of foot. 71 Wallace, T. C.. Pt., B. 1st Aug. 7, Conoidal ball perforated tarsal Aug. !>, Pirogolf s modincat n of Syme s Discharged May 29, 1865; pen West Virginia Cavalry, age 1864. bones, left foot. 1864. ainputat nat left ankle. Surg. sioned. An open ulcer extended 20. P. Gardner, 1st W. Va. Cav. to the rear of the ext. malleolus. 7* 1 Weeks, W. C., Lieut,, I, 5th April 1, Conoidal ball perforated left April 1, Pirogoff s amput n at left ankle Discharged July 20, 1865. Good Michigan Cavalry, age 28. 1865. ankle joint. 1865. joint. Surg. A. 1C. St. Glair, solid stump. 18;i(i, small portion 5th Michigan Cavalry. of bono removed. Spec. 2298. 73 Welsh, M., Pt., H, 47th New Oct. 7, Fracture of left ankle joint by Oct. 8, Syme s amputat n at left ankle Disch d May 31 . 1865 ; pensioned. York, age 26. 1864. conoidal ball. 1864. joint. Died Jan. 17. 7(i ; chr. dysentery 74 Wilson, U., Pt., E, 72d Penn June 3, Shell wound of left foot June 3. Disarticulat n at left ankle joint. Discharged May 5, 1865, and sylvania, age 22. 1864. 1864. Surg. M. Ilizer, 72d Penn. pensioned. 75 Wince 1 ., P., Pt., B, 36th Wis June 2, Conoidal ball fractured bones June 3. Antero-posterior flap amputat n Gangrene. Discharged October consin, age 22. 1864. of left foot. 1864. at left ankle joint. 7. 1864. and pensioned. 76 Winters, C. 11., Corp l, F. May 12, Wound of right foot by frag May 12, Syme s amputation at right Discharged December 14, 1864, 110th Ohio, age 30. 1864. ment of shell. 1864. ankle joint. and pensioned. 77 Womack. J. K., Pt., II, 14th July 3, Shot fracture of left foot Julv4, Syme s amputat n at left ankle Paroled Sept. 25. 1863. Stump Virginia, age 21. 18ti3. 1863. joint. sound and good. 78 Yount. J. J/., Pt., G, 52d June 8, Shot wound June 8,* Amputation at ankle joint bv Recovered. Virginia. 1862. 1862. Surg. J. M. Hayes, C. S. A. 79 Birmingham. A.. Lieut., A, Dec. 13, Wound of left foot by conoidal Dec. 13. Pirogoff s amp. at left ankle j t ; Died December 17, 1862. 69th New York! age 20. 1862. ball ; also wound right thigh. 1862. also amputat n of right thigh. 80 Bland, F. M., Pt., D, 23d Mav 19, Shot fracture of left toot Mav H, Syme s amput n at ankle joint : Gangrene of thigh stump. Died Iowa, age 22. 1863. 1863. sloughing. June 17, amp. leg Julv 16, I86:i. Spec. 1706, A. at junc. upper thirds. July 2, M. M. amp. thigh, lower third. 81 Boynton, II. K., Pt., L, 1st May 19, Conoidal ball fractured left tar- May 1!), Symo s amp. at left ankle joint. Two inches of middlethirdof hu- Mass. Artillery, age 18. 1864. sal and metatarsal bones ; also 1864. Surgeon J. W. Wishart, 140th merus excised May 22d. Died fracture of right humerus. Pennsylvania. June 22, 18(i4. Spec.828, A.M.M. 82 Bradshaw, G., Pt., D, 19th Jan. I, Shot wound of left foot. Jan. 1, Pirogoff s amputation at left Died February 4, 1863. Ohio. 1863. 1863. ankle joint. 83 Cecil, 11.. Lieut., 1C, 1st Vir May 24 Shot wound of left tarsus Mav 24, Pirogoff s modificat n of S vine s Sphacelus, necessitating interme ginia Cavalry. 1864. 1864. amputation at left ankle joint. diary amp. log in upper third. Died June 23. 1864. 84 Colbert, E., Pt.. 1C, 170th N. Mav 23, Conoidal ball fractured left foot. May 25. Pirogoff s amputation at left Died June 9, 1864, of tetanus. York, age 34. 186-1. 1864. ankle joint. Surgeon M. F. Regan , 164th New York. 85 Davis, J., Steamer Memphis. Nov. 7, Shot wound of right foot Nov. 9, Syme s amput n at ankle joint. Died February 26, 1862, of pneu 18til, 1861. monia. ,-.; Frank, A. B., Pt., L, 2d N. June 16. Conoidal ball fractured tarsal June 16. Syme s amput n at right ankle Sloughing of flaps. Died July York Artillery, age 30. 1864. and metatarsal bones of right 1864. joint. Surg. J. W. Wishart, 28, 1864. foot. 140th Pennsylvania. 87 Hale, E. P.. Pt., I, 1st Min July 2, Conoid, ball entered at internal Julv 2, Syme s amputat n at left ankle Died September 12, 1863. Spec. nesota, age 24. 1863. mallenlus and emerged 2 ins. 1863. joint. Surgeon C. S. Wood, 1949, A. M. M. below ext. malleolus ; astrag 66th New York. alus comminuted. 88 Harfeter, G.. Pt., D, 104th Sept. 27, Shell wound of left foot : also Sept. 28. Syme s amputat n at left ankle Oct. 1, 3. haemorrhage ; ligation Pennsylvania, age 22. 1863. slight wounds of hip and arm. 1863. joint. Surg. R. B. Bontecou, of anterior tibial. Died October U. S. V. 12, 18G3. 89 Lour, B. F., Pt., A, 140th July 2, Conoidal ball shattered bones July 2, Syme s amput n at right ankle Died August 2, 1863. Pennsylvania. 1863. of right foot. 1863. joint. Surgeon C. S. Wood. 66th New York. 90 Morgan, T., Pt., I, 29th Penn July 20, Shell fracture of right foot July 20, Amputat n at right ankle joint. Died September 11, 1864. sylvania. 1864. 1864. Surg. J.V.Kendall, 14!thN.Y. 91 Oppelt, M., Pt.. 1C, 36th Wis June 6. Conoidal ball fractured the June 6, Amputat n at right ankle joint Died July 11, 1864. consin, age 30. 1864. right foot. 1864. Surg. S. H. Plumb, 59th N. Y. 92 Pope, J.. Pt,, C, 37th Missis Oct. 8, Shot fracture of bones of right Oct. , Primary amput n at right ankle Died Nov. 6, 1862, of pyaemia. sippi, ago 22. 1862. foot. 1862. joint by Syme s method. 93 Porter, G. H., Pt., D, 3d In May 5, Conoidal ball fractured the Mav 5, Syme s amput n at right ankle May 17, amput n lower third leg. diana Cavalry, ago 31. 1864. right foot. 1864. joint. Died Junc 4, 1864, of pyaemia. 94 Shoemaker, J., Pt,, II, 57th Jan. 11, Conoidal ball fractured tarsal Jan. 11, Syme s amputat n at left ankle Jan. 31, amp. leg, lower third. Ohio, age 33. 1863. bones of left foot. 1863. joint. Surgeon J. B. Sparks, March 8, re-amp, leg, mid. third. 19th Kentucky. Died Mar.19, 63: gang, of stump. 95 Smith, H., Pt., G, 12th Mis Nov. 9, Shot fracture of left foot Primary amputation at ankle Died December 1, 1863. souri. 1863. joint by Syme s method. 96 Smith, , , E, 5:M Georgia, All the bones of left foot badly On field. Svme s amput n at ankle joint. He-amputation. Died. age 27. com nuted by shell fragment. Surg. J. J. Knott, 53d Ga. 97 Thurston, L., Pt., H, 2d N. June 16, Conoidal ball shattered the tar June 17, Svme s amputat n at left ankle Died June 28, 1864, of hospital York Heavy Artillery, age 1864. sal bones of left foot. 1864. joint. Surg. J. W. Wishart, gangrene. 25. 140th Pennsylvania. 98 2 Unknown Shot wound . . On field. PirogofT s amp. at ankle joint. Also amputation of other leg by Surg. J. T. Gilmore, C. S. A. Lenoir s method. Died. 99 Unknown (A. .#.), Confed Feb. 16. Tarsal bones of left foot com Feb. 18, PirogofT s amputation at loft Died Feb. 22, 1864, of double erate. 1862. minuted ; soft parts lacerated. 186-J. ankle joint. pneumonia. 100 Watts, W. T.. Pt., G, 4th July 3, Shot fracture left foot, opening July 3, Svme s ampntation at left ankle Aug. 20, sloughing of right foot. Virginia, age 27. 1863. ankle joint ; also fracture of 1863. | joint. Surgeon J. M. Hayes, Died Aug. 29, 1863, of pyaamia. right os calcis. C. S. A. 101 Webb, J. D., Corp l, F, 87th Sept. 19, Shot wound of right foot Sept. 10, Amputat n at right ankle joint. Died Oct. 18, 1863, of wounds. Indiana. 1863. 1863. 102 3 1 , M., . 45th Georgia. Mar. 25, Rifle ball perforated the ankle Mar. 26, Syme s amputation at ankle Forty days after operation dis- 1865. joint. 1865. joint. chargingsinuses indicating dead bone. Result doubtful. 103 Marshall, W. E ., eol d cook, June 8, Wound of right foot by solid Primary amputation in right Result undetermined. Not a pen K, 2d Michigan. 1864. shot. foot at ankle joint. Surg. II. sioner. E. Smith, 27th Michigan. 1 An abstract of this case was published in Circular No. 6, S. G. O., Washington, 1865, p. 47. See Photographs of Surgical Cases, A. M. M., Vol. II, p. 25, and SMITH (S.), Amputations at the Anklt. Joint in Military Surgery, in U. S. San. Com. Memoirs, Surgical Volume II. pp. 116, 132. 2 HOLLOWAY (J. M.), Comparative Advantages of PIROGOFF S, SYME S, and CuOl ART s Amputations, etc., in Am. Jour. Med. Sci., 1866, N. S., Vol. LI, pp. 85, 86. 3 SMITH (S.), loc. cit., pp. 122, 136. SECT. VT.l INTERMEDIARY AMPUTATIONS AT THE ANKLE JOINT. 603 Intermediary Amputations at the Ankle Joint This group comprises thirty-nine cases; twenty-five terminated in recovery and fourteen in death, a mortality rate of 35.9 per cent. Thirty-four were Union, and five Confederate soldiers. Recoveries after Intermediary Amputations at the Ankle Joint. Of the twenty-five successful intermediary amputations at the ankle joint, ten were performed after Pirogoff s and thirteen after Byrne s method; in two cases the mode of operation was not indicated. Of the patients, five were Confederate and twenty Union soldiers. The latter were all pensioned; hut one has since died of phthisis. In seven instances re-amputations in the leg became necessary in two in the lower, in two in the middle, and in two in the upper third; in one the point of re-amputation was not specified. CASE 880. Private P. Carter, Co. I, 7th Michigan, aged 22 years, was wounded at Fmlericksburg, December 11, 1862. Surgeon G. S. Palmer, U. S. V., recorded his admission to the field hospital of the 2d division, Second Corps, with "shot frac ture of right foot. Treatment of simple dressings." Two weeks after the reception of the injury the wounded man was trans ferred to Lincoln Hospital, Washington, where Syme s amputation at the ankle joint was performed, on December 26th, by Assistant Surgeon G. M. McGill, IT. S. A. The patient recovered, and was discharged from service March 2, 1863, and pensioned. Several years afterwards he was fitted with :m artificial foot by Dr. E. D. Hudson, of New York City. Dr. A. B. Ranney, of Bronson, Michigan, testified. June 25, 1875 : "I have been Carter s family physician for the past three years and have examined him to-day. His right leg from the knee down is withered to the bone. The foot, was taken off at the ankle joint, and there was no cushion left for the end of the bone to rest upon. At times the end of the bone is exposed and very painful, and much of the time there is discharge from the stump. I have treated him with poor success at various times during the years 1872, 1873, and 1874, and have advised an amputation of the limb at the knee, as it would, in my opinion, give him less trouble than at present," etc. The pensioner was paid March 4, 1881. A part of the amputated foot (Spec. 4859), showing fracture of the calcaneum and cuboid bone by a conoidal ball, was contributed to the Museum by the operator. CASK 881. Private W. A. Elderkin, Co. C, (ith Maine, aged 24 years, was wounded at Eappahannock Station, November 7, 1863, by a minie" ball, which entered the dorsum of the right foot, fracturing the metntarsal bones, and making its exit at the plantar surface. Two days afterwards he was admitted to Harewood Hospital at Washington, where the wound became gan grenous about November 23d. For this a local treatment of nitric acid and oakum dressing was applied and a constitutional treatment of tonics, stimulants, and beef tea diet was administered. The disease, however, not being arrested and the patient growing weaker, operative interference became necessary, and Pirogoff s amputation w:is performed on December 6th by Surgeon R. B. Bontecou, U. S. V. After the operation the parts were kept properly adjusted and the supporting treatment was continued. About January 4, 1884, the progress of the case was interrupted by erysipelas making its appearance, followed by sloughing of the soft parts to some extent. Tincture of chloride of iron was then prescribed and wheat flour was applied locally. The inflammation was arrested in about two weeks, after which the patient s health improved daily and the wound healed rapidly. He was discharged from service with a useful stump April 23, 1864, and pensioned. The amputated part of the foot (Spec. 2028), contributed with the history by the operator, is represented in the annexed cut (FiG. 349), and shows the metatarsus to have been badly shattered, some of the fragments being necrosed and a slight effusion of callus having occurred in the neighboring parts. After receiving his discharge the patient was supplied with a "Palmer" artificial foot, which, however, did not prove satisfactory, and is reported to have become entirely useless in about two months. The pensioner died December 14, 1866, his physician, Dr. A. G. Peabody, of Machias, Maine, certifying that "death was caused by consumption arising from hardship, exposure, and the loss of the foot, the amputated foot leaving a stump which never thoroughly healed, but remained a constant drain upon- the vital , ^ IG - 3 -Portion of right toot, metatarsus shattered. powers or the man s constitution. Spec. 2028. CASE 882. Private J. H. Short, Co. F, 140th Pennsylvania, aged 19 years, was wounded at Spottsylvania, May 12, 1864. Surgeon J. E. Pomfret, 7th New York Artillery, reported his admission to the field hospital of the 1st division, Second Corps, with "shot wound of left foot." Several days after receiving the injury the wounded man was sent to Washington, where he entered Harewood Hospital and suffered amputation of the foot. Surgeon R. B. Bontecou, U. S. V., who performed the operation, made the following report: "The wound was caused by a ball entering in front of the ankle joint, opening the same, and lodging against the astragalus. On his admission to Harewood Hospital the patient was suffering from irritative fever and the parts above the joint were considerably swollen. Syme s operation was performed on May 25th with favorable result, the patient improving rapidly and making a good recovery. Sulphuric ether constituted the anaesthetic used in the case. Sim ple dressings were used, and the treatment was supporting." The patient was subsequently transferred to hospital at Phila delphia and later to Pittsburgh, whence he was discharged from service November 4, 1864, and pensioned. His photograph, taken at Harewood Hospital and contributed by the operator, is copied in FIGURE 3 of PLATE LXXV, opposite page 596. In his applications for commutation the pensioner continues to describe the condition of the stump as "very good and sound." He was paid September 4, 1880. CASE 883. Private W. Darling, Co. E, 6th Wisconsin, aged 41 years, was wounded in the left foot, at Antietam, Sep tember 17, 1862. He was admitted to hospital at Smoketown, where the limb was amputated three weeks after the date of the 604 INJURIES OF THE LOWF.R EXTftF.MTTTKS. [CHAP. X. FIG. 350. Stump of left leg after BAUDKN .S amputation at the an kle. Spec. 4957. FIG. 351 .Bones of left le after Pi- UOGOFF s amputa tion. Spec. 214. injury. Surgeon B. A. Vanderkieft, U. S. V., who performed the operation, reported that the patient recovered and was dis charged from service January 13, 1863. The man became a pensioner, and was subsequently furnished with an artificial foot by Dr. E. D. Hudson, of New York City, who contributed a cast of the stump (Spec. 4957), represented in the adjoining cut (FlG. 350), with the following description of the case: "The injury consisted of a comminution of the tarsus and calcaneum, and the amputation was performed at the ankle joint by Bauden s dorsal flap, the tibia and fibula being left in their entire length with the exception of the malleoli." In his applications for commutation the pensioner continued to report the stump as being in "good condition." He was paid September 4, 1880. CASK 884.- Private J. Loughlin, Co. K, 67th New York, age 22 years, was wounded in the left foot. :it Malvern Hill, July 2, 1832. He entered Fourth and George Streets Hospital, Philadelphia, several weeks afterwards, whence Acting Assistant Surgeon J. B. Bowen reported the following history: "The injury was caused by a minie" ball, which entered the external portion of the ankle, passing through, fracturing and comminuting the tarsal bones. The man was tak<tfi prisoner and sent to Richmond, where he remained about two weeks. Twelve days after the receipt of the wound a portion of stocking and shoe sloughed out. He suffered great pain and the wound discharged large quantities of purulent matter, also several pieces of bone. When released by the enemy he was trans ferred to a hospital transport, where Pirogoff s operation was performed on July 26th. The patient was received into this hospital the same day. Erysipelas invaded the stump and extended to the knee, and abscesses and sloughing appeared on the posterior surface. Amputation at the upper third of the leg was performed by flap operation on September 16th, by Acting Assistant Surgeon S. D. Gross. Sinc*e then the man has improved and the stump has united. The treatment embraced muriatic tincture of iron, quinine, whis key, and morphine." The patient was subsequently transferred to Hacldington Hospital, whence he was discharged from service July 29, 1863, and pensioned. About one year afterwards he was supplied with an artificial leg by L>r. E. D. Hudson, of New York City. The pensioner was last paid March 4, 1869, since when he lias not been heard from. The bones, forming the Pirogoff stump and including the lower half of the shafts of the tibia and fibula (Spec. 214), were contributed to the Museum by the second operator, and are represented in the annexed cut (FlG. 351), showing the cut extremities of the tibia and calcis to be carious. No union whatever had occurred. The lower extremity of the fibula is also carious, and the upper portion of the shaft is necrosed and enlarged by attempts at an involucrum from the periosteum. Fatal Intermediary Amputations at the Ankle Joint. Fourteen of these operations were recorded, eight by Pirogoff s and six by Syme s method. In one instance exarticula- tion at the ankle joint was followed by re-amputation in the middle, and in two by ablation in the upper thirds of the leg. The fatal issue was ascribed to pneumonia in one, pyaemia in three, tetanus in one, erysipelas in two, exhaustion in four, and typhoid fever in one instance. In one case the right arm had been amputated in the upper third. 1 CASE 885. Private S. Smith, Co. K, 86th New York, aged 47 years, was wounded at the Wilderness, May 10, 1864, by two mini6 balls, one of which passed through the left foot and fractured the tarsal bones ; the other produced a flesh wound of the dorsal region near the spine. Several days after receiving the injury the wounded man was admitted to Harewood Hospital, Washington, where he did well up to May 23d. From that date his mind became wandering and delirious, his left arm and right leg keeping up constant motion. Irritation from the wound was suspected as the cause of this unusual action, and ampu tation was deemed necessary on May 25th. when Surgeon R B. Bontecou, U. S. V., performed the operation by his modification of PirogofF s method at the ankle joint. The patient improved after the amputation, all symptoms of derangement of mind dis appeared, and he became perfectly conscious. Ether was used as the anaesthetic. The patient continued to do well up to June 1st, when pysemic symptoms appeared, the wound ceased to suppurate, and rigors set in ; skin hot and dry. In spite of a sup porting treatment the patient gradually grew weaker. He died July 19, 1864. The tarsal bones, together with the malleoli and a thin section of the tibia, removed at the amputation (Spec. 3054), with the history, were contributed to the Museum by the operator. CASE 886. Private D. C. Hayes, Co. A, 4th New Hampshire, was wounded at the battle of Pocotaligo, October 22, 1862, by a mini6 ball, which struck the dorsum and penetrated to the sole j^f the left foot, passing out nearly opposite the point of entrance without having caused much apparent comminution or splintering of the bone. He was admitted to hospital at Hilton Head the following day, whence Assistant Surgeon J. E. Semple, U. S. A., contributed the pathological specimen (No. 691) with the following report: "We endeavored to save the foot, but the patient became much reduced and mortification set in. Syme s operation was performed on November llth, and death occurred on the following day from exhaustion." Acting Assistant Sur geon T. T. Smiley, who performed the amputation, states in his publication of the case Q that the patient died with all the symp toms of pyaemia, also that the injury produced violent pain and high inflammation, which he ascribed to a longitudinal fracture of one of the metatarsal bones, opening the tarso-metatarsal articulation. The specimen consists of a ligamentous preparation of the scaphoid, cuboid, cuneiform, and metatarsal bones of the amputated foot, the bases of the second and third of the latter exhibiting the seat of the fracture by the bullet. CASE of F. Schoneckles, Private, C, -M Delaware. See CASE 77, TAULE LXXVII, p. 700 of the Second Surgical Volume. SMILEY (T. T.), Twenty Cases of Gunshot Wounds, in Roston Med. cal anil Suryical Journal, 1803, Vol. LXVIII, p. 419. SECT. VI. J INTERMEDIARY AMPUTATIONS AT THE ANKLE JOINT. 605 TABLE XCI. Summary of Thirty-nine Cases of Intermediary Amputations at the Ankle Joint for Shot Injury. [ Recoveries, 125 ; Deaths, 2639.] No. NAME, MILITARY DESCRD?TION, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Atwell, J. J., Pt., A, 8th Vir July 3, Conoidal ball entered instep July 17, Syme s amputation at left an Paroled Nov. 12, 1863; stump ginia, age 20. 1863. and lodged among the tarsal 1863. kle joint. A. A. Surgeon T. healed. bones of left foot. T. Smiley. 2 Bayard, J.. Pt., B, 28th N. July 6, Musket ball passed through in July 11, Syme s amp. left ankle joint. Discharged July 24, 1861 ; pen York, age 28. 1861. step, fracturing tarsal bones of 1861. Ass t Surgs. J. W. S. Goulev sioned. Serviceable extremity. left foot. andW.J. White, U. S. A. 3 Burns, C. E., Pt., D, 12th Aug. 29, Fracture of right foot, involv g Sept. 13, Syme s amputation at right Cushion one inch thick, well uni Massachusetts, age 24. 1862. ankle joint, by musket ball. 1862. ankle joint. Surgeon D. I . ted to tibia, and quite tender. Smith, U. S. V. April 22. 1863, amp. lower third leg. Discharged July 11, 1863; pensioned. 4 Butler, W. M., , K, 7th Sept. 20, Ball passed through right foot. Oct. 3, Pirogoff s amputation at right Haemorrhage from plantar arch. Arkansas. 1863. 1863. ankle joint. Doing well. 5 Carter, P., Ft., I, 7th Mich Dec. 11, Conoidal ball comminuted os Dec. 26, Syme s amputation at right an Discharged March 2, 1863; pen igan, age 22. 1862. calcis and cuboi0bones, right 1862. kle joint, posterior flap. Ass t sioned. Leg withered to knee ; foot. Surg. G. M. McGill, U. S. A. troublesome stump; at times bones exposed and painful. Spec. 4859, A. M. M. 6 3 Clark, F. \V., Pt., B, 12th May 10, Conoidal ball fractured astra May 28, Pirogoff s amputation at ankle Recovered. Heel drawn up ; a Georgia. 1864. galus and third .and fourth 1864. joint. Surgeon C. B. Gibson, tender cicatrix formed part of metatarsal bones. C. S. A. sole o4 stump. 7 Cook, G. L., Pt.. B, 1st Pennsylvania, age 22. June 30, 1862. Conoidal ball passed through right instep, fracturing tarsal July 23, 1862. Syme s amputation at right ankle. Aug. 1, straps tostump. Disch d Dec. 7, 1862; pens d. Stump and metatarsal bones. healed perfectly. 8 Darling, W., Pt., E, 6th Wis Sept. 17, Conoidal ball fractured left Oct. 8, Syme s modified amputation at Discharged January 13, 1863; consin, age 41. 1862. tarsus and calcaneum. 1862. ankle joint, dorsal flap. Surg. pensioned. Spec. 4907, A. M. M. B. A. Vanderkieft, U. S. V. 9 Dickey. W. H., Serg t, A, Dec. 13, Conoidal ball fractured the left Dec. 24, Syme s amputation at left an Abscess. Discharged Dec. 10, 8th Pennsylvania Reserves, 1862. foot. 1862. kle joint. Surg. II. Bryant, 1863; pensioned. Stump per- age 28. U. S. V. fectlyhealed. Spec. 575, A.M.M. 10 Elderkin, W. A., Pt., C, 6th Nov. 7, Musket ball entered dorsum of Dec. 6, Pirogoff s amputat n with Bon- Erysipelas ; sloughing. Disch d Maine, age 24. 1863. right foot, fracturing metatar 1863. tecou s modification. Surg. April 23, 1864. Stump never sal bones. R. B. Bontecou, U. S. V. healed thoroughly, and was a constant drain upon the vital powers. Died Dec. 14, 1866, of consumpt n. Spec. 2028, A.M.M. 11 Forsyth, G., Pt., E, 14th N. May 13, Conoidal ball injured left foot. May 18, Pirogoff s amputation at left Discharged April 6, 1865, and Jersey, age 25. 1864. 1864. ankle joint. pensioned. 12 Gross, D. N., Pt,, E, 8th June 29, Canister shot comminuted the July 22, Syme s amput n at right ankle Necrosis. Discharged December Illinois Cavalry, age 24. 1862. right astragalus and carried 1862. joint. Ass t Surg. K. Bartho- 7, 1863 ; pens d. Good stump. away ends of both malleoli. low, U. S. A. 13 Gurley, W.. Pt,, C, llth In May 12, Conoidal ball entered below ex June 1, Amputat n at right ankle joint. Necrosed sequestra removed at fantry, age 18. 1864. ternal malleolus and crushed 1864. Surgeon D. W. Bliss, U. S. V. different times. Disch d Feb. posterior tuberosity of os cal 7, 1865. Amp. upper third leg cis. Feb. 18, 68. Spec. 2421, A.M.M. 14 Johnson. A. W., Pt., E, 64th Dec. 13, Ball entered between extensor Dec. 20, Syme s amputation at left an Discharged Jan. 29, 1863; pen New York, age 23. 1862. longuspollicis and calcaneum. 1862. kle joint. Surgeon C. Gray, sioned. Oct. 9, 1863, amput n fracturing bones of foot. 7th New York. lower third leg. 15 Larkin, P., Pt., C, 48th N. July 18, Piece of shell comminuted tar- July 25. Pirogoff s amputation at right Discharged Dec. 4, 1863. Amp. York, age 24. 1863. so- metatarsus except calcis, 1863. ankle joint. Ass t Surg. J.W. leg at middle third May 6, 1879, right foot. Apple gate, U. S. V. for necrosis. Spec. 6913, A.M.M. 16 Loughlin, J., Pt., K, 67th July 2, Conoidal ball perforated left July 26, Pirogoff s amputation at left Erysipelas. Sept. 16, amput n of New York, age 22. 1862. ankle, commin^f tarsal bones. 1862. ankle joint. leg, upper third. Disch d July 29, 1863 ; pensioned. Not heard from since March 4, 1869. Spec. 214, A. M. M. 17 Morse, G. F., Pt., K, 16th May 1 Shot fracture of left foot. May 16 Pirogoff s amputation at left Discharged August 4 1862 and Massachusetts, age 19. 1862. 1862. ankle joint. Surgeon C. C. pensioned. Good stump; can Jewett, 16th Massachusetts. bear his weight upon it. 18 Newton, J. W., Pt., E, 14th July 2, Conoidal ball fractured tarsal July 16, Pirogoff s amputation at right July 25, sloughing. August 10, Virginia, age 26. 1863. bones of right foot. 1863. ankle joint. amp. at junction of upper thirds of leg ; stump healed. Exch d November 12, 1863. 19 Ramsdell, J. H., Pt.,C,8th Dec. 7, Conoidal ball passed through Dec. 16, Amputation at left ankle joint Discharged June 4, 1865; pen Minnesota, age 30. 1864. tarsus from dorsum to heel. 1864. by Syme s method. Surgeon sioned. Stump sound and reli S. D. Turney, U. S. V. able for support. 20 Sanford, A. C., Pt., E, 6th Aug. 16, Conoidal ball fractured tarsal Sept. 14, Circular amputation at left an Discharged April 27, 1865, and Connecticut, age 27. 1864. bones of left foot. 1864. kle joint by Svme s method. pensioned. Stump healed. A. A. Surg. E. B. Woolston. 21 Short, J. H., Pt., F, 140th May 12, Ball lodged against astragalus. May 25, Syme s amp. at left ankle joint. Discharged Nov. 4, 1864 ; pens d. Pennsylvania, age 19. 1864. left foot; tarsus comminuted. 1864. Surg. R. B. Bontecou, U. S.V. Card Phot., Vol. I, p. 45. 22 Strout, S.,Capt.After Guard, April 1, Pistol shot wound of right foot. A prillS. Amputat n at right ankle joint. Discharged June 5, 1865; pen U. S. Navy, age 38. 1865. 1865. Surgeon Smith, U. S. N. sioned. Sound stump. 23 8 Unknown, age 24 Nov. 25 Shot fracture of left tarsus ... _ r-i ^^ Intermediary amp. at left ankle January, 1864, complete disinte- 1863. joint by Pirogoff s method. f ration of calcis and endof tibia. Prof. P. F. Eve. eb., 1864, amp. leg. Recov ry. 24 Whitney, P. P., Pt., A, 6th Aug. 5, Shot wound of right foot Aug. 16, Pirogoff s amp. at ankle joint, Discharged Octi.ber4, 1862; pen Michigan, age 24. 1862. 1862. leaving portion of os calcis. sioned. Surg. E. F. Sangcr, V. S. V. 1 SMITH (S.), Amputations at the Ankle Joint in Military Surgery, in U. S. Sanitary Commission Memoirs, Surgical Volume II, p. 136. 2 EVK (P. F.), Cases of Secondary Hemorrhage occurring in the Gate City Hospital (Confederate) after the battle of Chickamavya, etc., in U. S- Sanitary Commission Memoirs, New York, 1870, Surgical Volume I, p. 210. 3 HOU.OWAY (J. M.). Comparative Advantages of PlHOGOFF s, SYMK S, and CHOPART S Amputations, etc., in Am. Jour. Med. Sci., 1866, N. S., Vol. LI, p. 85, and SMITH (S.), Inc. cit., p. 134. 4 SMITH (S.), loc. cit., p. 140. 5 SMITH (S.), loc. cit., p. 140. SMITH (S.), loc. cit., p. 134. SMITH (S.), loc. cit., p. 136. "ITOT.T.OWAV (T. M.) rnrnparatirf Advantages of PIROGOFF S, SYME S, and CHOPART S Amputations, etc., in Am. Jour. Sled. Set ., 1866, N. S., Vol. LI, p. 85, and SMITH (.S.), loc. cit., pp. 116, 132. 606 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 25 Whitty, J., Pt., A, 6th Wis consin, age 22. May5, 1864. Conoidal ball fractured left cal- caneum. May 31, 1864. Syme s amputat n at left ankle joint. Surgeon E. Donnelly, 2d Pennsylvania Reserves. Gangrene in stump. Feb. 8, 1865, amputation at junction of lower third of leg. Discharged June 26, 1865; pensioned. 26 Alley J July 2, Conoidal ball fractured left tar July 15, Syme s amputat n at left ankle Died July 16, 1863, of tetanus. 1863. sal bones ; also flesh wounds 1863. joint. of thigh and shoulder. 27 Bager, A., Pt., K, 2d Mary- l&ncL Dec. 13, 1862. Shot fracture of right foot Jan. 9, 1863. Pirogoff samp, at right ank. j t. A. A. Surg. J. R. Ludlow. Stump done well. Died Feb. 21, 1863, of pneumonia. 28 Gregg, R., Pt., C, 1st Maine Artillery, age 37. June 18, 1864. Shot wound of right foot, with great injury to tarsus. July 12, 1864. Syme s amput n at right ankle joint. A. A. Surgeon O. W. Peck. Sloughing. July 18, 1864, amp. of leg at junction of upper third. Died Sept. 30, 1864. 29 Havens. W., Pt., K, 17th N. June 25, 1864. Conoidal ball injured 2d and 3d toes, right foot. June 25. 64, amp. of injured toes: gang. July 14, 1864. Pirogoff s amp. at right ankle joint. Surg. R. B. Bontecou, U. S. V. Sloughing ; gang. July 19, amputation leg, middle third. Died July 21, 1864, of exhaustion. York Heavy Artillery, age 29. 30 Hayes, D. C., Pt., A, 4th Oct. 22, Conoidal ball fractured 2d meS Nov. 11, Syme s amput n at ankle joint. Died Nov. 12, 1862, of pyaemia. New Hampshire. 1862. atarsal bone and injured tarsal 1862. A. A. Surgeon T. T. Smiley. Spec. 691, A. M. M. articulation, left foot. 31 Haynes, G., Pt., F, 12th N. June 3, Shot wound left foot near mal- June . 30, Joint diseased and cedematous. Died, from typhoid fever, July 9, Hampshire, age 22. 1864. leolus, fractur g tarsal bones; 1864. Syme s amp. at left ankle j nt. 1864. exit near little toe. Surg. R. B. Bontecou, U. S.V. 32 Johnson, H. H., Pt., A, 9th July 9, 1864. Shell fracture 4th and 5tli met atarsal bones ; extensive lacer ation of soft parts. July 12, 1864. SvSe s amp. at right ankle j nt. Ass tSurg. R. F.Weir,U.S.A. Malleoli sawn off; articular July 18, extensive erysipelas, ex tending to abdomen. Died July 28, 1864, of erysipelas. Spec. N. York Heavy Artillery, age 18. surface of tibia left intact. 2281, A. M. M. 33 Lincoln, G., Pt., 9th Illinois, Feb. 15, Rifle ball fractured tarsal and Feb. 25, Pirogoff s amputation at ankle Feb. 25, erysipelas; March 2, age 27. 1862. metatarsal bones. 1862. joint. Dr. T. L. Maddin, of whole body involved. Died Nashville. March 8, 1862, of erysipelas. 34 Phillips, J., Pt., I, 5th Mich May 10, Couoidal ball fract d left tarsal May 17, Pirogoff s amp. at left ankle j t. Died May 28, 1864, of exhaus igan, age 31. 1864. bones, leaving os calcis intact. 1864. Surgeon K. Bentley, U. S. V. tion. 35 Schoneckles, F., Pt., G, 2d Dec. 13, Shot fracture of bones of right Dec. 19, Pirogoff s amp. at right ankle Died. Delaware. 1862. foot; also fracture of right 1862. joint ; also amp. arm at upper humerus. third. Surgs.C. S. Wood. 66th N. Y., and C. Gray, 7tli N. Y. 36 Shook, G. L., Corp l, C, 37th Sept. 19, Conoidal ball fracturedleft foot. Sept. 26, Pirogoff s amp. at left ankle Died October 14, 1864. Massachusetts, age 25. 1864. 1864. joint, leaving a portion of os calcis. A. A. Surg. J. Young- love. 37 Smith, S., Pt., K, 86th New May 10, Conoidal ball fractured tarsal Ma}- 25, Pirogoff s amp. at left ankle j t Died June 19, 1864, of pyiemia. York, age 47. 1864. bones, left foot ; also flesh 1864. with Bontecou s modification. Spec. 3054, A. M. M. wound of back. Surg. R. 15. Bontecou, U. S.V. 38 *Sutton, E. L., Pt., H, 77th Jan. 11, Conoidal ball fractured 2d and Jan. 24, Syme s amputat n at left ankle Died Feb. 3, 1863, of pyaemia. Illinois. 1S63. .id metatarsal bones, left foot. IHlili. joint. A. A. Surgeon T. T. involving tarsal articulation. Smiley. 39 Wilbur, W., Pt., 13,1st New May 8, Shot fracture of 2d and 3d met May 28, Pirogoff s method with Bonte- July 6, amputation of leg, upper York Cavalry, age 27. 1864. atarsal bones of right foot. 1864. con s modification. Surgeon third. Died July 6, 1864, of R. B. Bontecou, U. S. V. exhaustion. Secondary Amputations at the Ankle Joint. Thirteen secondary amputations at the ankle joint were recorded; the mortality rate was 7.7 per cent., only one of the cases having a fatal termination. Of the twelve successful operations four were performed after PirogofF s and six after Syme s method ; in two cases the mode of ablation was not indicated. Eight of the patients were Union and four Confederate soldiers. In one instance the leg was subsequently amputated in the middle third. Of the eight Union soldiers the names of seven were found on the Pension Rolls; two have died since their discharge from the service. In the fatal secondary amputation at the ankle Syme s operation had been per formed; the patient died of exhaustion. CASE 887. Private O. C. Crandall, Co. B, ?th Wisconsin, aged 19 years, was wounded in the right foot, at Gettysburg, July 1, 1863. lie remained at a First Corps field hospital for nearly two weeks and was then removed to Broad and Cherry Streets Hospital, Philadelphia, whence Acting Assistant Surgeon W. V. Keating contributed the follow ing history: "The wound was caused by a minie" ball, which entered on the outer side just in advance of the ankle joint and passed directly across, fracturing the astragalus and lodging beneath the skin on the inner side of the foot, whence it was removed four hours after the reception of the injury. At the time of admission his general condition was broken down, and the foot and ankle were much inflamed, swollen, and painful; the wounds discharging sanious pus. The patient was ordered extra. diet, with tonics, milk punch, and beef-essence, and the foot was enveloped in a fomenting poultice. Five days after admission the wounds commenced to slough and -a large abscess formed on the outer side of the foot above the wound, in its course burrowing the tendo-achillis. At the same time the patient was rapidly growing weaker. On August 1st it was decided, in consultation, that to operate was the only means of saving life, and on the following day, while the patient was under the influence f ether, PirogofF s amputation was performed by Acting Assistant Surgeon A. Hewson. The edges () f tne flaps were brought together by means of lead-wire sutures, and an opening was made along the % . . . .. . , side of the tendo-achillis to prevent the collection of pus. ihe stump was covered with lint saturated fibula astragalus and cal- caneum, from a PiiioooFF amputation. Spec. 2783. (T. T.), Tioenty Casts of Gunshot Wounds, in Boston Med. and Surg. Jour.. 1863, Vol. LXVITI, p. 419. "SMILEY (T. T.), Gunshot Wounds from Arkansas Post, in Boston Med. and Surg. Jour., 1863, Vol. LXIX, p. 159. SECT. VI.] SECONDARY AMPUTATIONS AT THE ANKLE JOINT. 607 with a mixture of laudanum and whiskey, and the limb was kept at perfect rest in a fracture-box. On the third day after the operation sloughing took place to a slight extent on the outer side of the stump in the line of tin? first incision, exposing the lower extremity of the fibula. The stump was then washed with a solution of permanganate of potassa and a fomenting poul tice was applied. The discharge from the stump was very profuse for a few days, but it gradually subsided and healthy granu lations established themselves. The patient continued to do well afterwards, bony union taking place and the case promising a good and useful stump, with the limb one inch shorter than the other. The patient s general condition now was very good. The advantages claimed for the operation in this case were, firstly, that it was less extensive than an amputation higher up in the leg and thereby produced less shock ; secondly, that less blood would in all probability be lost, and the patient would have a greater length of limb for actual use after recovery." The specimen (No. 2783) represented in the adjoining wood-cut (FiG. 352) was contributed by the operator, and consists of the lower borders of the tibia and fibula, the astragalus, and a slice of the upper portion of the calcaneum, all which were removed at the amputation. The astragalus is shown to be fractured and carious, and the tibial articulation is eroded. The patient was subsequently transferred to Mower Hospital, whence he was dis charged June 11, 18> i4, and pensioned. He formerly represented the stump as being in a good state, but at a special examina tion on March 16, 1880, its condition was described by Dr. T. B. Mansfield, pension examiner at Sac City, Iowa, as follows: " I find the claimant suffering from necrosis of the end of the stump of the tibia, also atrophy of the muscles of the lower leg. There is some discharge at present from the wound, and the cicatrices present an unhealthy condition, assimilating senile or dry gangrene. The general appearance and appetite of the pensioner is good. He states that he has constant pain in the wound and constant pain in the knee, and that he is unable to walk but a short distance without experiencing great pain in the stump and entire limb. I think his wound will necessitate another amputation." This pensioner was paid June 4, 1880. CASE 833. Private I. T. Mossup, Co. D, 100th New York, aged 30 years, was wounded in the left foot, during the assault on Fort Wagner, July 18, 1863. He was admitted to hospital at Beaufort on the following day, and several months later he was transferred to McDougall Hospital, at Fort Schuyler, where amputation was performed but not recorded. Subsequently the patient passed to De Camp Hospital, and lastly, on Feb ruary 18, 18o4, he entered Central Park Hospital, New York City. Surgeon B. A. Clements, U. S. A., in charge of the latter, made the following report : " The patient had been wounded by a conical ball, which passed just under the malleoli, fracturing the astragalus and calcaneum. Amputation at the ankle joint was performed at McDougall Hospital, on November llth, by Syme s method, and the result has not been retarded by any accident whatever since the operation, the cicatrix being completely formed when the patient was admitted to Central Park Hospital. He has an artificial foot (from Hudson), and at his own request his discharge has been recommended." A cast of the leg (Spec. 726), made nine months after the amputation, and showing a well- formed and apparently useful Syme s stump, was contributed to the Museum by Assistant Surgeon J. W. S. Gouley, U. S. A., and is represented in the annexed wood-cut (FiG. 353). The patient was discharged from service June 1, 1834, and pensioned. In his applications for commutations, dated 1870 and 1875, he described after .SYME S any the stump as being in "good condition," but five years later he reported it as "painful all the time." The an kle. Spec. 726. pensioner was paid December 4, 1880.- TABLE XOII. Summary of Thirteen Cases of Secondary Amputations at the Ankle Joint for Shot Injury. [Recoveries, 112; Deaths, 13.] FIG. 353. Stump No. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 3 Connolly, P., Corp l, K, 70th Aug. 27, Conoidal ball comminuted left Nov. 19, Foot a large shapeless mass. Discharged Aug. 13, 1863; pen New York. 1862. tarsus. 1864. Syme s amp. at left ankle j t ; sioned. In 1870, stump sound ; tibia sawn through above mal- receives entire weight of body leoli. A. A. Surg. S. Smith. on stump ; 2J ins. shortening. 2 Crandall, O. 0., Ft,, 15, 7th July 1, Conoidal ball fractured astrag Aug. 2, Foot and ankle much inflamed; Limb kept in a fracture-box ; Wisconsin, age 19. 1863. alus and was removed from 1863. slough g ; Pirogoff s amput n. sloughing. Disch d June 11, inner side of foot. A. A. Surg. A. Ilewson. 1864; pensioned. Spec. 2783. 3 Ewing, A. G., Ft., Forrest s July-, Shell fracture of right foot ; ca Aug. , Pirogoff s amputation at right Also partial paralysis from pistol Cavalry. 1864. ries of ends of tibia and fibula. 1865. ankle ioint. Prof. P. F. Eve. ball in spine. Recovered ; caries of ends of tibia and fibula. 4 Griffin, J. B.. Lieut., C, 10th Dec. 31, Shot wound of left ankle joint. Mar. 9, Amp. at left ankle joint. Surg. Recovery. Texas Cavalry. 1862. 1863. F. Hawthorne, P. A. C. S. 5 Johnes, A., Corp l. E, 5th June 27, Conoidal ball passed through Aug. 4, Syme s amputation at right an Erysipelas; stump healed. Dis New York, aged 27. 1862. tarsal bones of tlie right foot; 1802. kle joint. Ass tSurg. K. Bar- charged Dec. 6. 1862. Died sloughing. thoiow, U. S. A. March 28, 1880, of consumption. 6 6 Mossup, I. T., Ft., D, 100th July 18, Conoidal ball fractured left as Nov. 11, Syme s posterior flap amputa Disch d June 1, 1864 ; pensioned. New York, age 30. 18B3. tragalus and calcaneum. 1863. tion. A. A. Surgeon J. B. Two ins. shortening ; limbsome- Cutter. what atrophied, tissue healthy, compact and symmetrical. Spec. 726, A. M. M. 7 O Donahue, M.. Pt., D, 124th i Mav 4, Musket ball injured right foot. Nov. , Pirogoff s amputation at right Discharged Dec. 27, 1864, and Ohio, age 3G. 18fi4. Primary amptit n 3d and 4th 1866. ankle joint. Prof.C. B. Weber, pcns d. Stump healed. Died toes with metatarsal bones ; of Cleveland. April 13, 1873. re-amputation. 8 Porter, I,. S., Pt., F, 49th Dec. 31, Shell fracture of left ankle Feb. 25, Syme s amputation at left ankle Disch d Dec. 6, 1863, and pens d. Ohio, age 32. 1862. 1863. joint. Stump healed, but is trouble some and causes pain. 7 H , F Dec. 9, Musket ball passed through Jan. 20, Svme s amput n at ankle joint. Stump firm and useful. Two 1864. tarsus. 1865. Dr. G. Buck, New York city. inches shortening. SMITH (S.), Amputations 2 SMITH (S.), loc. cit., p. 140. "SMITH (S.), loc. cit., p. 136 at the Ankle Joint in Military Surgery, in TT. S. Sanitary Commission Memoirs, Surgical Volume II, p. 119. s SMITH (S.), loc. cit., pp. Ill, 136. 4 SMITH (S.), loc. cit., p. 119. 6 SMITH (S.), loc. cit., p. 140. 7 SMITH (S.), loc. cit., p. 136. 60S IN.TUETES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAMK, MILITARY DESCRIPTION, AND AGE. DATE OF JX.JURY. NATURK OF INJURY. DATE OF Ol ERA- TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 10 11 Rooney, J. S., Pt., D, 37th Georgia. Taylor J. W I. Pt A 3d Sept. 20, 1863. Sept 20 Shot wound in front of foot. . . . Oct. 26, 1863. A prill 3, Pirogoff samputat n ; resection of tibia and calcis. Disarticulation right foot at the Doing well November 1, 1863. Retired November 30, 1864. 12 13 Arkansas, ag-e 23. Wells, G. W.. Pt., K. 4th New Hampshire, age 24. Frost, E. It., Pt., I. 32d 18ti3. Aug. Hi. 1864. J une 15, Conoidal ball fract d metatarsal bones, right foot. Necrosis of tarsus and metatarsus. Ball entered inner side of right 1664. Oct. 22, 1864. July 18, ankle joint. Syme s amputation at right an kle joint. A. A. Surg. G. A. Chesley. S vine s amputation at right an Sloughing. Discharged Jan. 11, 1865; pensioned. Jan. 16, 1865, amp. of leg at middle third. Gangrene ; haemorrhage. Died Maine, age 44. 1864. toot at mid. of first metatarsal bone ; exit at base of 2d and 3d toes; prim. amp.2dand3dtoes. 1864. kle joint. Surg. R. B. Bonte- coui U. S. V. July 23, 1864, of exhaustion. Spec. 3068, A. M. M. Of three of the cases cited in the preceding table specimens are preserved in the Army Medical Museum. Amputations at the Ankle Joint of Uncertain Date. In six instances the date of the injury, or of the operation, or both were not recorded. Four, it would appear, recovered and two proved fatal. All were Confederate soldiers: TABLE XCIII. Summary of Six Cases of Amputations at the Ankle Joint for Shot Injury of Uncertain Date. [Recoveries, 1 4; Deaths, 5-6.] NO. 1 3 4 5 li N AMK, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. Crenshaw. J. W., Pt., A, 4,")ih Georgia. Lawson, M., Serg t, F. 21st North Carolina. Lloyd, J. T.. Pt.. K, 8th (ieorgia. Oqburn, C. J., Pt., D, 57th June 2, 1864. Feb. 6, 1865. Aug. 13, 1864. May 4, 1863. Shot wound Shot fracture of right foot Shot wound of right foot Amputation at ankle joint Amputation at right ankle joint. Amputation at right ankle joint. Pirogoff s amputation at ankle joint. Amputation at ankle joint Amputation at ankle joint Furloughed July 12, 1864. Furloughed March , 1865. Furloughed October 14, 1864. Furloughed June 12, 1863. Died June 27, 1864. Died September 15, 1862. North Carolina. Clark. A., Pt., D, 6th South Carolina. Rogers, J. M., Pt., G, 48th Georgia. Shot wound of foot 1862. 1862. Sixty-two of the one hundred and sixty-one cases of amputations at the ankle joint recorded in the preceding pages were performed on the right, eighty-two on the left sido; in seventeen instances the side was not indicated. CONCLUDING OBSERVATIONS ON SHOT INJURIES OF THE ANKLE JOINT. As far as the records of military surgery indicate, attempts at conservation of the limb in severe shot wounds of the ankle joint were rarely made during the first half of the present century. In cases in which the joint was opened, or in which the lesion of the bones forming the joint was extensive, amputation in the leg, or, if practicable, exartieula- tion at the ankle, were resorted to, in conformity with the teachings of Desport, Thomson, Hennen, and Williamson. 1 The experience of the surgeons of the American civil war would seem to have led to similar conclusions. Surgeon T. H. Squire, 2 89th New York Volunteers, from his experience in the hospitals after the battle of Antietam, asserts that "every ankle joint opened by a ball, with any considerable injury of articular bones, should 1 DESPORT (Traite desplaies d armes a feu, Paris, 1749, p. 232): "Si la balle passe dans 1 articulation et fracasse les os, I amputation cst n6cessaire, et ne pent etre trop tot faite." THOMSON (J.) (Report of Observations made in the British Military Hospitals in Belgium after the Battle of Waterloo, etc., Edinburgh, 1816, p. 143): " The injuries of the ankle joint might be said to be almost equally severe with those of the knee joint. . . The swell ing of this joint was proportionally greater than even that of the knee. Fungous granulations protruding through the wounds were more common, but the constitutional symptoms, though in particular instances severe, were, in general, far less so than in gunshot wounds of the knee joint." HENNEN (J.) (Principles of Military Surgery, London, 182 J. p. 157): "However desirable it may be to save a hand or a foot, yet, in severe and complicated lacera tions of the wrist and ankle joints, the frequency of tetanic affections should at once lead us to adopt immediate amputation." WILLIAMSON (G.) (Military Surgery, London, 1863, p. 159): When the fracture takes place near the ankle and a fissure extends into the joint, it is rarely that the patient recovers." 2 SQU1UE (T. H.), Field Note Book,- Case Book No. 16, Division of Surgical P.ecords, Surgeon General s Office, p. 59. SECT, vi.] SHOT FEACTURES OF THE ANKLE JOINT. 609 be amputated, and the quicker the better." Surgeon A. J. Phelps, 1 U. S. V., Medical Direc tor of the Fourth Army Corps, declared, after the battle of Chickamauga: "In my mind there is no question upon the necessity of amputation in cases of knee joint injury (gun shot); and it is also my opinion that the same treatment is scarcely less necessary in wounds of the tarsus and ankle joint." Surgeon J. T. Woods, 2 99th Ohio Volunteers, after the battle of Chickamauga "found the early history of these cases exceedingly flattering, and affording ample reason to warrant an effort to save the limb in injuries of this class; but at a later date the incapability of nature s power of reparation became apparent, * * the unwarrantableness of conservatism (?) in these cases is most obvious, every indication pre sented by them warranting the conclusion that, after much suffering and great exhaustion, the choice is still between death and loss of foot." Surgeon H. S. Hewit, 3 U. S. V., in charge of the hospitals at Frederick after the battle of Antietam, expressed the opinion that "amputation of the leg ought to be performed in every case of gunshot penetration and fracture of the ankle joint." A year later, Surgeon Hewit, 4 then Medical Director of the Department of the Ohio, counseled the medical officers under his charge that "amputation was to be employed in almost every penetrating injury of the ankle joint," and made con sultation obligatory in all doubtful cases of this injury. It is therefore not surprising that the number of amputations following injuries of the ankle joint, recorded during the war, is proportionally very large. Of one thousand seven hundred and eleven instances of shot injuries of the bones of the tibio-tarsal articulation, five hundred and eighteen were treated by expectant conservative measures, in thirty-three instances excision was practised, and in one thousand one hundred and sixty recourse was had to ablation of the limb either at the ankle joint, in the leg, or in the thigh. It may be assumed that the five hundred and eighteen cases treated by conservation were, as a rule, instances in which the injury was comparatively slight, and in which the articulation originally was not seriously involved. Of these five hundred and eighteen patients four hundred and seven recovered and ninety- nine, or 19.5 per cent. , died ; in twelve the ultimate result was not ascertained. Free incisions into the joint were frequently made, and in forty-one instances fragments of bone were elim inated; pyaemia was noted in twenty-eight, gangrene in twenty-two, erysipelas in twelve, and tetanus in five instances. Examining the cases of recovery after conservative treatment of shot fractures of the bones of the ankle joint adduced at pp. 579 to 582, ante, it will be seen that the remote results in many instances were less satisfactory than the early progress of the cases had promised. In the case of Private J. H. Noble (CASE 820, p. 580, ante), in January, 1863, six months after the injury, the wound had healed and an anchylosed and serviceable limb was reported ; but nearly a year later the patient was walking on crutches ; the wound had reopened. In 1878, sixteen years after the injury, the pension examining board reported that the "parts broke out again and again, and discharged; the pensioner complains of more or less constant pain in the leg, and if he uses it much it swells and becomes painful, so that he is unable to sleep. He still has to use a cane; the leg is worse than useless." In the case of Sergeant T. B. Sturdivant (CASE 825, p. 582, ante), who was discharged in 1 PllELPS (A. J.), Tlit Battle of Chickamauga, Observations by, in Bound Manuscript No. 11, Div. of Surg. Records, Surgeon General s Office. 2 WOODS (J. T.), Observations of the Surgery of the Battle of Chickamauga, in Bound Manuscript No. 11, Division of Surgical Records, Surgeon General s Office. 3 IlKWIT (H. S.), Report of the Surgery of the U. S. A. General Hospital No. 5, at Frederick, 3fd., in Bound Manuscript, No. 33, Surgeon General s Office, Division of Surgical Records. 4 HEWIT (H. S.), Report on the Military Medicine, Surgery, and General Conduct of the Medical Department of the Army of the Ohio, etc., in Appended Document*, Medical and Surgical History of the War of the Rebellion, Part I, Volume I, p. 311. SCUG. m ?r 610 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. 1865, with "anchylosis of the ankle joint and extension of the foot," an ulcer formed on the outer side of the ankle and pieces of bone were discharged as late as 1880. Private Dutton (CASE 821, p. 581), when mustered out in June, 1865, was able "to walk a mile or two without difficulty," but several years later there were indolent ulcers at the inner as well as the outer side of the joint, and the patient was unable to walk; his disability was then reported as equal to loss of foot. Excision at the Ankle Joint for Shot Injury. The substitution of excision at the ankle joint for amputation effected no saving of life. Of the thirty-three cases in which this operation was practised, the results are known in thirty-one, of which nine, or 29.0 per cent., proved fatal, while the mortality of the cases treated by expectation was only 19.5 per cent, and that of the amputations 25.1. The results of this operation performed in the European wars were even less satisfactory, as will be seen from the appended table: TABLE XCIV. Results of Excisions at the Ankle Joint on the Occasions named and from the Authorities quoted. d "3 a S ~ **> ACTION, ETC. a an S"f 8 o a "S <5 g| g 8 O pj t. ^ O S PH Crimean War, 1854- 57 (MATTHEW, 1 LANGENBECK 1 ) 2 2 Italian War, 1859 (NEUDORFER 3 ) 1 1 Schleswig-Holstein War, 1864 (LANGENBECK, 4 NEUDORFER 5 ) 6 5 1 16 6 Mexican War, 1805 (NEUI)6 UFER C ) 1 Austro-Prussian War, 1866 (BECK, 7 LAUFFS, 8 STROMEYER, 9 LANGENBECK, 10 GURLT") 26 22 4 15 3 Franco-German War, 1870-71, (GURLT, 12 BECK, 13 KRATZ, 14 GOLTDAMMER IS COUSIN 16 ) 104 60 40 4 40 Russo-Turkish War, 1876- 78 (Soc. Otto.du Croissant Rouge, I7 STEIXER, I8 REYHER, 19 TILING, 20 WAHL 21 ) 10 5 4 1 44.4 Aggregates 150 96 49 r 33 7 Considering the remote results in the twenty-two cases of recovery after excision at the ankle of the American civil war, we find that in three instances the operation was fol- 1 MATTHEW (T. P.) (Med. and Surg. Hist, of the British Army which served in Turkey and the Crimea, etc., London, 1858, Vol. II, pp. 368, 379): successful excision of lower end of fibula. 2 LANGENBECK (B. V.) (Ueber die Schussfractvren der Gelenke und ihre Behandlung, Berlin, 1868, p. 40): v. Kwicinsky, Russian Lieutenant General, wounded at the Alma, Sept. 20, 1854, in left ankle; subperiosteal excision of internal malleolus and astraga lus, May 30, 1859, by VOX LAXGENBECK ; recovery without shortening ; anchylosis of joint. 3 NEUDORFER ( J.) ( Die Endresultate der GeUnkresektiimtn, in Wiener Med. Presse, 1871, S. 405): A. Winkler, shot fracture of right ankle joint, Solferino, June 24, 1859; secondary excision of the ankle joint by NEUDORFER; excellent recovery. 4 LANGENBECK (B. v.) (Ueber Resection des Fussgelenks lei Schussfracturen desselben, nebst Vorstellung eines FaJles von subperiostaler Resection der Diaphyse der Tibia und Fibula, in Berliner Klinische Wochcnschrift, 1865, S. 30) performed 5 excisions of the ankle joint in the Schleswig-Holstein War of 1864 : Werkmeister, Tambour, Dtlppel, March 28, 1864 ; fracture of left internal malleolus and astragalus; May 1, 1864, subperiosteal excision of ankle joint; recovery, with useful limb; joint anchylosed. F. Holcke, 7th Brandenburg Reg t, No. 60, April 18, 18(14, before Dflppel ; shot fracture of lower portions of tibia and fibula; excision May 3, 1864 ; death May 14, of pyaemia. Lieut. C. F. Leth, 3d Infantry, Alsen, June 29, 1864. shot fracture of both malleoli of right foot ; excision July 29 ; recovery, with useful liinb. Lieut. Wedell- Jarlsberg, Alsen, June 29, 1804 ; shot fracture right ankle joint ; A ug. 19, subperiosteal excision of lower portion of tibia and part of astragalus ; recovery. Groen, 5th Danish Regiment, Alsen, June 29, 1864 ; shot fracture of left ankle joint ; July 15, subperiosteal excision of tibia, fibula, and astragalus ; recovery, with useful limb. & NEUDORFKU (J.) (Aus dem feldarztlichen Berichte iiber die Verwundeten in Sclileswig, in Archivfiir Klinische Chirurgie, Berlin, 1805, B. VI, p. 559) excised the lower. portions of the tibia and fibula and the head of the astragalus ; the patient recovered with one inch shortening and good use of the limb. (See also Berliner Klinische Wochenschrift, 1865, S. 31.) s NEUDORFER (J.) (Die Endresultate der Gelenkresektionen, in Wiener Med. Presse, 1871, p. 406) excised the ankle joint on May 15, 1865, in the case of J. Kuzelik, wounded at Sayaltepek, April 25, 1865; recovery in five months, with good use of foot. Dr. NEUDORFER (Handbuch der Kriegschirurgie und der Operationsle.hre, Leipzig, 1872, Zweite Halfte, Spec. Theil, Zweite Abth! S. 1003) remarks: "I have performed this resection after shot wounds 14 times, and of these 14 cases I have lost only 2; nil the rest recovered with perfectly useful feet." With the exception of the 3 cases referred to above, the editor has not been able to identify the operations claimed to have been performed by Dr. NEUu5ilFER. 7 BECK (B.) (Kriegs-Chirurgische Erfahrungen wahrend des Feldzuges 1806, in Siidcleutschland, Freiburg, I. Br., 1807, S. 354): L. Finkbeiner, 2d WUrtemberg Infantry, Tauberbischoffsheim, July 24, 1866, through both ankle joints; July 28, excision, by Professor v. Bituxs, of right ankle joint; both joint surfaces were removed; fatal. 8 LAUFFS (LAUREXZ) (Zur Statistik der Fussgelenkresektionen, Inaug. Diss., Halle, 1872, p. 36): C. Rochhardt, Lieut., 1st Austrian Inf., Trautenau, June 27, 1866, shot wound left ankle joint; August 16, resection of ends of tibia and fibula and upper surface of astragalus by Prof. VOI.KMAXN; recovery; shortening 1J inches; walks well with a cane. 9 STROMEYER (L.) (Erfahrungen iiber Schusswunden im Jahre 1866, Hannover, 1867, p. 60): C. Weidemann, 3d Hannoverian Infantry, shot in left ankle joint ; July 10, excision of 1 J inches of tibia and fibula and upper part of astragalus by Dr. STROMEYER ; ball extracted ; July 18, removal of remaining portion of astragalus ; May 21, 1807, amputation upper third of leg; recovery in 4 weeks. 10 LAXGEXBECK (B. v.) (Ueber die Schusxfracturen der Gelenke, etc., Berlin, 1868, p. 47, No. 10): C. Staudinger, 1st Thtlringen Inf.. No. 31, Koniggratz, July 3, 1866; shell wound of right ankle joint; July 31, excision of internal malleolus and joint surface of astragalus by Prof. v. LANGEXBECK; recovery, with 2 centimetres shortening; walks well with an ordinary shoe. LAXGEXBECK (B. v.) (loc. cit., p. 47, No. 11): J. E. H. Pfitzner, 1st Silesian, No. 46, Naehod, June 27, 1866; shell fracture of lower third of leg; resection of internal malleolus SECT. VI.] EXCISIONS AT THE ANKLE JOINT. 611 lowed by secondary amputation, and that in at least nine instances the joint remained pain ful and swollen, compelling the patients to use crutches or canes for support, and unfitting them for manual labor; in several instances the wounds reopened, abscesses formed many years after the injury, deficient circulation and varicose veins followed, and in one case the continued irritation finally extended into the knee joint. In regard to this operation August 7, by v. LAXGEXBECK; shortening 8-9 centimetres; uses a crutch. (See also GUUI.T (E.), Die Gelenk-Resectionen nach Scliussverletzungen; ihre Geschichte, Statistik, End-Resultate, Berlin, 1879, p. 404.) LAXGEXBECK (B. v.) (loc.cit., p. 47, No. 7): A. Thiel, 1st Austrian Infantry, Koniggratz, July 3, 18(56, right ankle joint; July 26, excision of external malleolus and the upper joint surface of the astragalus by Prof. v. LAXGEXBECK; recovery, with anchylosis. GURLT (E.) (toe. cit., p. 489). LAXGEXBECK (B. v.) (loc. cit., p. 47, No. 8): M. Wagner, Austrian Infantry Regiment No. 0, Konig gratz, July 3, 1866 ; shot fracture left ankle joint ; July 26, subperiosteal resection of tibia, fibula, and upper surface of astragalus by Prof. VOX LAXGEX BECK; death August 6. GUHLT (E.) (loc. cit., p. 493). LAXGEXBECK (B. v.) (loc. cit., p. 47, No. 9): Bissig, train-captain, Austrian Infantry No. 55, Koniggratz, July 3, 1866; shot in right astragalus; July 26, excision of lower portion of internal malleolus and of astragalus by VOX LAXGEXBECK; gangrene ; death. GUULT (E.) (loc. cit., p. 493). " GUKLT (E.) (Die Gelenk-Resectionen nach Schussverletzungen, u. s. w., Berlin, 1879, p. 400): R. Witt. Kaiser Alexander Garde-Gren. Reg t, Koniggratz, July 3, 1866 ; shot fracture left ankle joint ; August 20, excision of external malleolus and portion of astragalus by Dr. WAGXER; bony anchylosis ; 6 centimetres shortening; walks short distances comfortably, sometimes even without a cane. GUULT (E.) (loc. cit., p. 401): A. Streese, Kaiser Alexander Garde-Gren. Reg t, Koniggratz, July 3, 1866 ; shot fracture of right ankle joint ; August 31, excision of both malleoli and talus by Dr. WAGXEU; recovery, with 2J inches shortening; new formation of bone; able to walk a mile with the use of a cane. GURLT (E.) (loc. cit., p. 402): Jacob Raecke, 1st Magdeburg Reg t, No. 26, Koniggratz, July 3, 1866; left ankle joint; August 17, excision of 1 inch of tibia and fibula and joint surface of astragalus by Dr. SriEUIXG ; recovery ; walks with apparatus. GUELT (E.) (loc. cit., p. 405): A. Griczka, 7 Pormn. No. 54, Trautenau, June 27; shell wound of left ankle joint; September 19, joint surface of tibia excised and necrosed portions of astragalus removed; recovered ; walks on crutches and with a high heel ; shortening 6 centimetres. GUKLT (E.) (loc. cit., p. 406): A. Bauske, 8th Pommeranian Reg t, No. 61 ; shrapnel shot, July 3, 1866, at Koniggratz, in left ankle; July 29, excision of lower extremities of tibia and fibula and upper part of astragalus by Dr. BUSCH ; recovery, with 9 centimetres shortening ; anchylosis ; walks with a crutch. GURLT (E.) (loc. cit., p. 445): H. Morgenstern, 6th Saxon Infantry, Koniggratz, July 3, 1866; shot wound of left ankle joint; July 28, excision of lower ends of tibia and fibula and the whole astragalus by Prof. BUSCH; Nov. 21, amputation of leg; recovery. GURLT (E.) (toe. cit., p. 445): G. H. Seifert, 13th Saxon Infantry, Koniggratz, July 3, 1866; shot through right ankle joint; July 29, resection of ends of tibia and fibula by Dr. DlEHL; shortening 10 centimetres; little use of ankle and foot. GURLT (E.) (toe. cit., p. 447): A. Seidel, 12th Saxon Infantry, Koniggratz, July 3, 1866; shot fracture of right leg at the ankle joint; July 26, excision of lower end of tibia and of the astragalus by Dr. BUSCH; death July 31, 1866. GURLT (E.) (loc. cit., p. 489): A. Jano, 2d Austrian Infantry, Koniggratz, July 3, 1866; shell wound of left ankle; August 4, excision of left ankle joint with extirpation of astragalus; recovery. GURLT (E.) toe. cit., p. 490): F. Mistelbauer, 6th Austrian Reg t; shot wound of left ankle joint ; resection of left tibia and fibula ; Nov. 27, amputation leg; recovery. GURLT (E.) (loc. cit., p. 490): A. Leitgeb, Austrian Infantry Regiment No. 15; KSniggratz, July 3, 1866; right ankle joint ; July 27, excision of ends of tibia and fibula and astragalus by Professor BUSCH; recovery, with good use of limb. GURLT (E.) (toe. cit., p. 490): G. Bulsoni, Austrian Inf. Reg t, No. 26, July 3, 1866, Konig gratz ; right ankle joint ; August 8, excision of the fractured joint surface of the tibia and removal of the fractured external malleolus by Dr. FIXCKE ; recovery; walks with a cane. GURLT (E.) (toe. cit., p. 490): P. Kanta, 34th Austrian Infantry, Koniggratz, July 3, 1866; left ankle joint; August 3, excision of joint by Dr. HAHX; recovery. GURLT (E.) (toe. cit., p. 490): W. Stelzig, Austrian Infantry No. 42, Koniggratz, July 3, 1866; shot fracture of right ankle joint; July 25, excision of ankle joint by VOX LAXGEXBECK; good recovery. GURLT (E.) (toe. cit., p. 491): J. Bresonelli, 47th Austrian Infantry, Koniggratz, July 3, 1866 ; comminution of right external malleolus ; August 8, excision of end of tibia and upper portion of astragalus by Surgeon FIXCKE; Sept. 3, amputation of leg in upper third; recovery. GURLT (E.) (toe. cit., p. 491): A. Diener, 73d Austrian Infantry, Kor.iggratz, July 3, 1866 ; ankle joint fractured ; Oct. 20, inner surface of external malleolus, portion of astragalus, and part of os calcis removed by Surgeon HECK recovery, with 4 centimetres shortening; able to walk several miles without pain. GURLT (E.) (toe. cit.-, p. 492): F. Dubsky, Austrian Jaeger Batt. No. 17; shell wound of outer malleolus of left foot; August 21, excision of 2J inches of end of tibia by Surgeon GAEHDE; recovery. GURLT (E.) (loc. cit.. p. 492): N. Prymak, Austrian Lancers Reg t No. 11, Koniggratz, July 3, 1866; shot fracture lower end of right tibia and fibula ; July 28, excision of 2 inches of tibia and fibula by Prof. BUSCU ; recovery, with varus position. 12 GUKLT (E.) (toe. cit., pp. 611, et. seq.) details 99 cases of excisions at the ankle joint from the Franco-Prussian War of 1870-71 ; the results in 4 cases are not stated; 57 were successful and 38 fatal, a mortality rate of 40 percent. The operation involved the tibia in 7 (4 recoveries, 2 deaths, 1 unknown result), the fibula in 5 (3 recoveries, 2 deaths), the tibia and astragalus in 7 (2 recoveries, 5 deaths), the fibula and astragalus in 4 (4 recoveries), the tibia and fibula in 22 (14 recoveries, 8 deaths), the tibia, fibula, and astragalus in 38 (24 recoveries, 13 deaths, 1 unknown result), and in 16 instances (6 recoveries, 8 deaths, 2 unknown results) the portions of bone excised were not indicated. In 13 instances, with 11 deaths, amputation was subsequently resorted to. To the 99 cases reported at length by Professor GURLT in his exhaustive work must be added the following 5 cases: 13 BECK (B.) (Chirurgie der Schussverletzungen, Freiburg, i. Br., 1872, p. 881): F , 1 Baden L.-Gr . Reg t, No. 109; comminuted shot fracture of ankle joint; primary excision ; recovery, with anchylosis. BECK (B.) (toe. cit., p. 909): 1 case of resection of internal malleolus; fatal. 14 KKATZ (Besultate der wahrend des letzten Feldzuges ausgef&hrten Gelfnkresektionen, in Deutsche Militai:-; ; -?tliche Ze.itsch.rift, Berlin, 1871, Jahrg. I, p. 596): Saeckel, Jaeger Bat. No. 11 (Prussians); shot fracture left ankle joint; excision of lower portions of DO. = <it leg ; shortening 2J inches, with oedematous swelling ; atrophy of muscles from knee downwards ; active movements of foot weak. I5 GOLTDAJIMEK (Be.richt uber die Thiitigkeit des Reserve- Lazar efts df.s Berliner Hilfsvereins in der Garde-Ulanen-Kaserne zu Moabit, in Berliner IClinische IV ocJtenschrift, 1871, Jahrg. VIII, p. 151): Leclerc, 1st French Engineers, wounded at Worth, August 6, 1870, in left ankle; Sept. 13, excision of astragalus, os calcis, and os navicnlare; recovery, with good use of foot. I6 COUSIX (A.) (Histoire ChirurgicaU de Vambulance de I Ecole des Fonts et Chaussees, in L Union Mtd- icale, 1872, T. XIII, p. 159): Soldier, 110th French line, shot fracture of lower ends of tibia and fibula, November 29, 1870; December, haemorrhage from peroneal, which was ligated ; excision of lower ends of tibia and fibula ; pyaemia ; death December 25, 1870. (GORDOX, Lessons on Hygitne and Surgery from the Franco-Prussian War, London, 1873, p. 167.) " Societe Ottomans de secours aux blesses et malades militaires constitute d apres la Convention Je Geneve. Vol. Ill, Ambulances fixes et mobiles du Croissant rouge, Constantinople, 1878, p. 39, and GUULT (E.) (toe. cit., p. 1153): At the hospital at Beyler- bey, under the charge of Dr. BALDUIAN ; Mehmet, shot wound of ankle joint ; resection ; death from anaemia. 18 STEINER (F.) (Aus dem Tagebuclie eines deutschen Arztes wuhrend der Zeit des Krieges im Oriente 1876, in Wiener Med. Wochrnschrift, 1877, No. 18, p. 426): K. N., aged 29, shell fracture left ankle joint, middle of August, 1876; September 1, excision of 4 inches of fibula; doing well in three weeks. 19 REYHER (CARL) (Dieantiseptische Wundbehand- lung in der Kriegschirurgie, in R. "VOLKMAXX s Sammlung Klinischer Vortrdge, Nos. 142, 143, Leipzig, 1878, pp. 1219 and 1234) tabulates 6 cases (4 recoveries, 2 deaths) of excisions at the ankle joint treated at the Barrack hospital at Swilainatz, but gives no details. The 2 fatal cases are related by G. TlLlXG in his Bericht uber 124 im serbisch-tiirkiscfien Kriege im Bar acken- Lazar eth des Dorpater Sanitdts- Trains zu Swilainatz behandelte ScJiussrerlet- zungen, Dorpat, 1877, pp. 76 and 81: St. Petkowitsch, aged 18, shot fracture of right internal malleolus August 20, 1876; excision of ends of tibia and fibula; September 2, amputation at knee joint ; September 7, secondary haemorrhage and death. O. Uroschewitsch, aged 28, shot fracture of astragalus and os calcis; ankle joint opened; wound received a few days before September 21, 1876; September 21, excision of the astragalus and entire os calcis; September 25, amputation at ankle joint; gangrene ; death September 30, 1876. zo Dr. TlLIXG (toe. cit., p. 80) reports a third fatal case, not included in Dr. REYHER S statistics: G. Konstantinowitsch, aged 56, shot wound of left ankle joint, received in the early part of September, 1876; October 11, excision of articular extremities of tibia and fibula and astragalus: death October 20, 1876. 21 GURLT (E.) (loc. cit.. p. 11. "4) tabulates a successful case of excision at the ankle joint observed by Dr. WAUL at the hospital at Sistowa ; no particulars are given. INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. it is therefore only necessary to reiterate the opinion expressed in the preliminary report, 1 that while the "judicious use of the gouge and bone forceps are admissible in gunshot wounds of the ankle joint, the formal excisions are rarely successful." 2 Recoveries with useful limbs have been claimed for this operation in some instances during the Franco- Prussian War, 1870-71, and later, under antiseptic treatment, in the Russo-Turkish War, 1876-77, 3 but hardly sufficient time has elapsed to judge of the remote effects of the opera tions performed during these campaigns. Amputations at the Ankle Joint. Amputation at the ankle joint for disease had been frequently performed since the middle of the last century 4 in civil practice, but the operation seems not to have been performed for shot injury until about the middle of the present century, during the Schleswig-Holstein War, 1848-1850, in which four exarticu- lations at the ankle are recorded by Professor Stromeyer. That it was not regarded with favor by surgeons of the late civil war is evident from the limited number of cases in which it was performed; and, although the number of operations recorded has increased from sixty-seven cases reported in the preliminary report from the Surgeon General s Office in 1865, 5 to one hundred and sixty-one cases reported here, yet the proportion of exarticula- tions at the ankle joint to the cases of fractures remains very small when compared with the number of amputations in the leg following similar injuries. Of the seven thousand five hundred and forty-three shot fractures of the bones of the foot and ankle joint recorded during the war, one thousand six hundred and twelve, or 21.3 per cent., were followed by amputation in the leg, while only one hundred and sixty-one, or 2.1 per cent., were disartic ulated at the ankle joint. The operation seems to have been selected by the few surgeons who performed it as an "operation of expediency," with a view of falling back, in case of necessity, upon amputation in the leg as a "dernier ressort." 6 It may be assumed, there fore, that only the cases most favorable to such an operation were selected for its perform ance. As far as the mortality rate is concerned, the exarticulation at the joint would seem to have been followed by less loss of life than the amputations in the leg the fatality rate of the former being 25. 1, 7 of the latter 32.9 per cent.; but of the one hundred and sixty- one exarticulations at the ankle, twenty-nine, or 18.0 per cent., required reamputation, while of five thousand four hundred and fifty-two amputations in the leg, in only two hundred and twenty-one, or 4.0 per cent., reamputation became necessary. 1 Circular No. 6, War Department, Surgeon General s Office, Washington, Nov. 1, 1865. Report! on the Extent and Mature of the Materials available far the preparation of a Medical and Surgical History of the Rebellion. 2 Surgeon D. PKIN CE, U. S. V., in his Notes on Surgical Cases and operations at Harrison s Landing, Fa., August 12, 1862, Surg. General s Office, Div. of Surg. Rec., File A, No. 132, remarks: "Any injury requiring n complete exsection of the tibio-astragalean articulation would be almost certain to make amputation a more suitable remedy on account of the thinness of the stratum of soft parts covering the bones." HAMILTON (F. II.) (A Practical Treatise on Fractures and Dislocations, 5th ed., Philadelphia, 1875, p. 513): " Resections at the ankle joint are much more hazardous than amputations, and scarcely to be preferred, in army practice, to attempts to save the foot without surgical interference." AOXEW (D. H.) (The Principles and Practice of Surgery, Philadelphia, Ifc78, Vol. I, p. 254): "Amputation either through the joint, or above in the continuity of the limb, is a much more successful operation than excision, which fact of itself should determine our course where the articulating extremities of the bones are comminuted." SEUILI.OT (Du traitement des fractures des membres par armes de guerre, in Arch. Gen. de M<:d., 1871, T. XVII, p. 457): "Nous la croyons contre indiqu6e par 1 etendue des surfaces osseuses la presence dcs nombreux tendons periarticulaires, le volume et la position superflcielle des os, la difficulte de la contention de la jambe et du pied, et le danger des complications. Nous maintenons cependant nos appreciations sur les avantages de la resection des malleoles." 3 GROSSHEIM, Ueber die Scliussverletzungen des Fussgelenks wdhrend des letzten Krieges und die Resultate Hirer Behandlung unter Benutzunrj ofTicifUer Quellen, in Deutsche Militairiirztliche Zfitschrift, 1876, Jahrgang V, p. 2i7, et seq. 4 The first authentic example of this operation is recorded by BHASDOU (Essai sur les Amputations dans les Articles, in Mm. de I A cad. Rny. rlf Cfiir., Paris, 1774, T. V, p. 771): The foot of a child, 10 years of age, became mortified from some external cause. M. SEIIILIEH. surgeon at Laval, amputated through the ankle joint. The patient apparently suffered little from the operation; there was little inflammation or suppuration; a sound stump ensued, which never reopened during the twelve years which the patient survived the operation. 6 Circular No. 6, War Department, Surgeon General s Office, Washington, November 1, 1865. Reports on the Extent and Nature of the Materials available for the preparation of i Medical and Surgical History of the Rebellion. 6 SMITH (S.), Amputations at tht Ankle Joint in Military Surgery, in V. S. Sanitary Com. Memoirs, Surgical Volume II, New York, 1871, p. 10 J. 7 In Circular No. 6, War Dep t, Surg. General s Office, November 1, 1865, p. 45, the number of exarticulations at the ankle joint was stated as 67 ; 58 recovered and 9 were fatal, a fatality of 13.4 per cent. This mortality rate was ascertained from partial returns, and it was stated at the timo that the records were far from complete. The full returns have augmented the mortality rate to 25.1 per cent., as shown in TABLE LXXX1X, p. 595, ante. SECT. VI.J AMPUTATIONS AT THE ANKLE JOINT. 613 FIG. 354 amputation at the ankle. [After Es- MAItCH.J FIG. 355. PIROGOFF B amputation at the ankle. E8MABCH -l The operations most generally preferred were those of Syme and Pirogoff, but in a few instances the malleoli and the articular surface of the tibia were retained, and in others the malleoli were removed while the articular surface of the tibia was left intact and the bone covered with a dorsal flap. In Syme s operation (FiG. 354) the malleoli and from one-half to one and a half inches of the surface of the tibia were removed; in PirogofT s operation (Fio. 355) the os calcis was sawn through and its cut surface placed in apposition to the sawn ends of the tibia and fibula. In both operations the heel flap was used. The advantages claimed for the Pirogoff operation would seem to be a gain in the length of the stump and the preservation of the heel cushion in its natural condition attached to the os calcis, thus insuring a stump capable of readily sustain ing the weight of the body. The latter ad vantage cannot be denied, provided a firm union of the cut surfaces of the os calcis and the tibia and fibula can be obtained; the additional length of the limb may be con- sidered a substantial gain in unaided loco- motion, but in the application of an artificial limb the Syme stump offers the best facili- J ties, the base of support being on the same [After plane us the natural ankle joint, while, in the PirogofF stump, the base is necessarily on a much lower plane than that of the sound limb, allowing no space for the play of an arti ficial joint. The few surgeons who recorded their views on the relative value of the Syme and Pirogoff operations have expressed themselves in favor of Syme s operation. Surgeon J. Wilson Wishart, in a letter to the Surgeon General dated May 1, 1866, states: "If called upon to choose in a given case, I should prefer Syme s to Pirogoff s." In* a letter to this Office, in 1869, Surgeon 0. S. Wood, who had performed Pirogoff s operation on several occasions, states that he had so much trouble in preventing displacement of the parts to be united that afterwards he always gave Syme s operation the preference. To what extent union of the cut surfaces of the os calcis and of the tibia and fibula has taken place in the cases of recovery after Pirogoff s operation, and whether the union was osseous or only ligamentous, could not be positively ascertained. Of three cases in which the limb was subsequently amputated in the leg, the bony portions removed at the second operations are preserved in the Army Medical Museum. In two of these cases (Captain Denniston, CASE 875, p. 598, ante, and Private Loughlin, CASE 884, p. 604, ante) there were no indications whatever of union after two and three weeks; in the third case (Private Larkin, 48th New York, CASE 795, p. 545, ante) the patient was discharged cured on December 4, 1863, four months and nine days after the operation; but when seen some weeks after his discharge by Dr. E. D. Hudson, to whom he had applied for an artificial limb, the tibia was already extensively necrosed and the leg was enlarged one-third beyond the normal size. The patient led a life of suffering for fifteen and a half years, until re-amputation was performed in May, 1879. In this case union of bone had taken place, as shown in the specimen (No. 6913 Surg. Sect., A. M. M.) represented in the wood-cut, FIG. 32, on page 545. As far as is indicated by the recorded cases, cure followed more speedily after Pirogoff s than after Syme s operation; in twenty-five cases of the former the average time was 2.8, in forty-seven of the latter 3.7 months. 614 INJURIES OF THE LOWER EXTREMITIES. [CHAP X. Judging from the cases before us, the risk of life, in military surgery at least, is some what greater in Pirogoff s than in S vine s operation. Of the eighty-three operations after Syme in the American civil war, the result was not determined in one case, sixty-one were followed by recovery, twenty-one by death, a mortality of 25.6 per cent.; while of forty- nine operations after Pirogoff, thirty-five were successful and fourteen fatal, a fatality of 28.5 per cent. A similar result has been obtained from the cases collected in European and other campaigns, grouped in the following table: TABLE XOIV. Results of Amputations at the Ankle Joint on the Occasions named and from the Authorities quoted. ACTION, ETC. CA6ES. OPERATION. SYME S. PlKOGOFF 8. VARIOUS OPERATIONS. "3 o (H 7 120 o 01 Recovery. C,i t 3 "3 \n Undetermin d. FH i . M >> 5 .2 5 "3 * K 2 o S "5 h 2 Undetermin d. Ratio of mor tality. Recover}-. 3 S &H Undetermin d. Ratio of mor tality. Recovery. "3 a t. Undetermin d. 3 21 2 53 1 20 1 44 Crimean War, 1854-.~>7 (MATTHEW,* CHENU, 4 HUBBKXET 5 ) Bombardment of Sveabor" 1855 (HEYFELDER 6 ) 44 1 1 British in India 1857 58 (Wll 1 1 \MSON 7 ) 1 o 1 2 1 Accidents 1858 59 (GRAY 8 CORVAZ ) o Italian War 1859 CO (CHENU 10 ) 9 4 4 2 5 1 4 5 Danish War 1864 (HEI\E U ) 1 5 1 1 1 1 3 \ustro- Prussian War 186C (FISCHER 1 *) o United States Army 1865 70 (OTIS") 2 105 14 o 17 11 1 1 Franco-German War 1870 71 French (CHEN U 14 ) 88 3 3 14 88 Franco-German War, 1870-71, Germans (BKCK, FISHER, GRAF, KlllDMER RUPPRECHT SCHLXZlVGEli STOI L 1S J ; 6 3 Aggregates . , 271 98 123 50 55.6 11 3 2 21.4 13 5 4 27.7 74 115 44 Of fourteen operations after Syme with determined results, three, or 21.4 per cent., were fatal, and of eighteen after Pirogoff, five, or 27.7 per cent., had fatal terminations. 1 STUOMEYER (L.) (Maximen der Kriegstheilkunst, Hannover, 1855, p. 756) tabulates 4 amputations at the ankle joint by SYME S method during the Schleswig-Holstein War, 1848-50; 2 were successful and 2 fatal. DJORUP (Bem&rkninger over tie i Krigen 1848-50 foretagne Amputationer i For- bindelse med en Statistik over dem, in Hospital s-Mcddtlclser. Kjobenhavn. 1852. B. V, p. 107) reports 3 exarticulations at the ankle joint in the Danish army during the war of 1848-50 ; 2 were successful, 1 fatal ; no details are given. 3 MATTHEW (T. P.) (Med. and Surg. Hist, of the British Army in the years 1854-55-56, London, 1858, Vol. II, pp. 372, 373) tabulates 13 cases of exarticulation at the ankle joint; 11 of the patients survived and 2 died. Details of two of the cases are given by GUTHRIE and STANLEY. GUTHKIE (G. J.) (Commentaries on the Surgery of the Peninsular War, London, sixth ed., 1855, p. 99): British soldier in the Crimea ; round ball lodged against the astragalus but was not removed ; inflammation extended into the ankle joint : flap amputation at the ankle joint and subsequent amputation in thigh ; recovery. STANLEY (Result of Syme s Operation of Amputation at the Anlch Joint, in Tlie Lancet, London, 1857, Vol. II, p. 472): A sailor had his foot shattered by an explosion of a shell before Sebastopol, in April, 1857; SYME S amputation at the ankle joint by a Russian surgeon; October 31, amputation in lower third of leg for painful stump; probably recovered. 4 CHEXU (J.-C.) (Rapport, etc., de Campagne d Orient en 1854-55-56. Paris, 1865, p. 473) records 50 cases of exarticulation at the ankle joint; 35 terminated successfully and 15 fatally; and on pp. 474, 475, gives brief details of the successful operations. Two fatal cases are cited by AROXSSHOX and SALLKUOX. Auoxs- 6HO\ (Obs. d un cos d amputation tibio-tarsienne procede PIROGOFF, in Eec. de Mem. de MM. de Chir. et de Phar. Mil., Paris. 185C, 2 me ser., T. XVII, p. 36(1): J. Sch ; shot wound of right metatarsus June 13, 1855, at Sebastopol; PIROGOFF S operation by AuoxssilON June 18; gangrene; death July 2. SALLERON ( Compte.-Rendu des Amputations Primitives et des Amputations consecutive*, in Bee. de Mem. de Med. de Chir. et de Phar. Mil., Paris, 1858, 2 m s6r., T. XXII. p. 317): Cornand, 20th line regiment, received July 10, 1855, a shot fracture of the three first metatarsal bones of left foot; amputation at the ankle joint July 30. 1855; gangrene; death. S HUBBEXET(C. v.) (Die Sanitdts-Verh dltnisse derRussischen Verwundeten, etc.. in den Jahren 1854-56, Berlin, 1871, p. 182) tabulates 57 amputations at the ankle joint ; the results were ascertained in only 13 cases; 9 were successful, 4 fatal. One of the suc cessful cases is detailed by LEGOUEST (Amp. de Ja partie infcrieure de lajambe dans la region intra-malleolaire. in Gaz. des Flop., 1855, No. 150, p. 597): Russian prisoner G. Gardey, 6th Infantry; shot fracture of right tarsal bones at the Alma, September 20, 1854 ; SYME S operation October 3, 1854; nearly healed in one month : marched well in 3 months. c HEYFELDER (J. F.) (Die Vtrwundungen und Operationen in Folge. des TSomlardements von Sveaborg font 9-11 Aug., in Deutsche Klinik, 1855, 15. VII, p. 531): Officer s servant of the ship "Russland;" shot wounds of right shoulder and left foot and con tusion of chest ; exarticulation of right arm and left foot, the latter by BAUDEX S method ; died one hour after the operation. IDEM (loc. tit., p. 554): W. Xolomagin, sailor, aged 22; shell wound of right foot August 9, 1855; August 25, amputation at ankle joint by a modification of SYME S operation ; pyajmia. and death September 1, 1855. WILLIAMSON (G.) (Military Surgery, London, 1863, p. 214) relates a successful case of amputation at the ankle joint during the mutiny in India in 1857, in a man of the 75th regiment; a very good stump resulted. 8 E. P , aged 29, accidental shot wound of left fbot May 16, 1858 ; integuments and muscles of the sole of the foot ploughed up except at the heel ; the metatarsals fractured ; PlROr.OFF s amputation at the ankle performed by Dr. MASH on the same day: recovery, with a useful stump (J. F. GRAY, in the Medical Times and Gazette, London, 1860, Vol. SECT, vi.] AMPUTATIONS AT THE ANKLE JOINT. 615 Considering the number of re-amputations after Syme s and Pirogoff s operations, Pirogoff s method would seem to be the more successful. Of eighty-three cases of Syme s amputation, twenty, or 24.0 per cent., submitted to re-amputation; of forty-nine PirogofFs operations, eight, or 16.3 per cent., were subjected to re-amputation. Sloughing of the flaps seems to have been the most frequent cause of the re-amputation after Syme s operation, this complication having been given as the cause in twelve of the twenty re-amputations; tender stump is given in one case, and necrosis in another; in six the cause was not stated. In the eight re-amputations after Pirogoff s operation necrosis and caries are stated as the cause in two, sloughing in four, gangrene in one, and secondary haemorrhage in one instance. Deducting the cases in which re-amputations were performed there remain forty-six recov eries after Syme s and thirty after Pirogoff s operation. In sixteen of the forty-six opera- 11, p. 9). 9 CORNAZ (Amputation tibio-tarsienne d apres le precede de PlKOGOFF, in Echo Midical, Sept. 10, 1861, p. 428): J. F. D ; accidental shot wound of left foot, involving tarsus and metatarsus ; PlROFOFF s amputation performed the same day by Dr. CORXAZ ; recovery in about 2 months, with union of sawn surfaces and good use of stump. "CHENU (J.-C.) (Statistique Mid. Chir. de. la Campagne d ltaiie en 1859 et 1860, Vol. II, p. 823) tabu lates 9 disarticulations at the ankle joint, 4 successful, 5 fatal, and gives some details of the 4 successful operations: L. J. Boyer, sergeant, 55th line; shot fracture of right metatarsus, Solferino, June 24, 1859; amputation at ankle joint by Dr. ARLAUD, after September 28; the malleoli were removed Octo ber 8; December 10, recovery. J. Gros, 86th Infantry; shot fracture of left tarsus, Solferino, June 24, 1859; amputation at the ankle joint by Dr. J. ROUX, Aug. 18, 1859; recovery. X. Hecht, 9th Artillery ; shot fracture of right foot, at Solferino ; disarticulation at ankle joint ; recovery. L. J. Paviot, 86th Infantry; shot fracture of right calcaneurn, Solferino, June 24, 1859; amputation at the joint; recovery. "HEINE (C.) (Die Schussverletzungen der Unteren Extremitdten, Berlin, 1866, p. 338) and OCHWADT (A.) (Kriegschirurgische Erfahrungen, Berlin, 1865, Appended Table of Operations, p. XIII. Case 54): Private Chr. L , 3d Danish Infantry ; shot fracture of right astragalus and os calcis, April 18, 1864 ; PIROGOFF S operation was attempted on May 4, but the os calcis being found fissured the operation was finished according to SYME S method by Dr. FISCHER; J inch of the epiphysis of the tibia was removed; several necrosed fragments of the tibia came away; recovery, with a poor stump. In a case at a hospital at Ulderup, Staffsurgeon AHKL performed PlltOGOFF s operation (HEINE, loc. cit., p. 339, and LUCKE (A.) (Kriegschir. Aphorismen in LAXGEXBECK S Archiv fur Klin. Chir., Berlin, 1866, B. VII, p. 19): P. Schlott, 3d Danish Infantry, wounded at Dflppell, April 18, 1864 ; shot fracture of tarsal and metatarsal bones ; PlROGOFK s amputation at ankle joint by Dr. ABKL; pyaemia and gangrene; death May 10, 1864. NEUDORFER (J.) (Aus denifelddrztlichen Berichte fiber die Ver- wundeten in Schleswig, in LAXGEXBECK S Archiv fur Klin. Chir., 1865, B. VI, p. 544): J. Brandner, 9th Chasseurs, at Oeversee, Feb. 6, 1864, received a shot fracture of the right astralagus and internal malleolus; February 24, PIROGOFF S amputation at the ankle performed by Dr. NEUDORFER; April 12, union of os calcis and tibia; May 20, stump healed ; patient able to walk on the stump without pain. NEUDORFER (loc. cit., p. 558) tabulates a second case of amputation after PIUOGOFF, but gives no details or result. 12 FISCHER (K.) (Militairdrztliche Skizzen aus Suddeutschland und Bohmen, Aarau, 1867, p. 99) refers to 2 operations after SYME and 3 after PIROGOFF, performed during the Austro-Prussian War, 1866; the results are doubtful. I3 OTIS (G. A.) ( Circular No. 3, War Dep t, S. G. O., Washington, 1871 : A Report of Surgical Cases treated in the Army of the United States from 1865 to 187J ; pp. 193, 194): H. G. Nims, additional paymaster, admitted into post hospital, Fort Vancouver, Washington Territory, Dec. 25, 1866, with shot fracture and comminution of external and middle cuneiform bones of right foot; Dec. 28, PIROGOFF S amputation at ankle joint by Assistant Surgeon J. E. SEMl LE, U. S. A.; recovered. Private P. Vandel. A. 3d Infantry, accidentally wounded Nov. 5, 1867 ; conoidal ball shattered left os calcis and injured astragalus ; SYME S amputation at ankle joint by Assistant Surgeon A. D. WlLSOX, U. S. A.; recovered. 14 CHEXU J.-C.) (Apercu hist. stat. et din., etc.,pendant la guerre de 1870-71, T. I, p. 493) tabulates 105 instances of amputation at the ankle joint; 17 recovered and 88 proved fatal; and gives details of a few cases of recovery: T. II, p. 31, P. P. F. Chambon, aged 20, 14th Provisionary regiment; shot fracture of left foot. May 26, Paris; amputation at ankle joint; pensioner; p. 55, L. L. Faivre, 7th Artillery, aged 36; shell fracture of left foot, Montbliard, January 15, 1871; amputation at ankle joint ; pen sioner; p. 74, Havart (C. J. M.), 12th Infantry, aged 27; comminuted shot fracture of left foot, received at Saint-Privat ; amputation at ankle joint; pen sioner; p. 75, Hermier (C. A.), 3d Zouaves, aged 33; shell fracture of left foot; amputation at ankle joint; pensioner; p. 99, Mangin (P. G. A.), Captain, 24th Infantry, aged 31 ; shell wound of left tarsal bones, received at Bapaume; amputation at ankle joint; pensioner; p. 100, A. Marchand-Liffoz, 64th Infantry, aged 28; shot wound of left foot, Sedan ; exarticulation at ankle joint; pensioner. Other cases are given in detail by SEDILLOT (Dn traitement des fractures des membres par armes de guerre, in Arch. Gen. de M6d., 1871, VI* ser., T. XVII, p. 458): Louis Charlier, 48th Infantr3 r . aged 21 ; shell wound of foot. Woerth, August 6; PIROGOFF S amputation on the day after the injury by M. SARAZIX; partial gangrene of stump; recovery; walks well ; no consolidation (CHEXU, Apercu hist. stat. et din., etc., Paris. 1874, T. II, p. 32); Jean Barjet. 9th Cuirassiers, aged 26 ; shot fracture of right tarsus and metatarsus, Reichshofen, August 6, 1870; PIROGOFF S operation, August 19, 1870, by M. JOESSEL; abscess; doing well at the end of September; os calcis movable (CHEXU, Joe. cit., p. 8); Fran9ois Berga, sergeant, 50tb Infantry, aged 33 ; fracture of left tarsal bones, Woerth, Aug. 6, 1870; PIROGOFF S amputation performed August 7, by M. JOESSEL; abscess; wound healed September 27; os calcis movable (CHEXU, loc. cit., p. 13). IS BECK (B.) (Chir. der Schussverletz., 1872, p. 838, et seq.) details five cases of amputation at the ankle joint ; one by SYME S and four by PIROGOFF S method: F , 14th Prussian L. W. regiment; shell wound of right tarsal bones; SYME S amputation at the ankle joint; recovery. D , 14th L. W. regiment; severe shot injury of foot, at Strassbtirg; PIROGOFF S amputation; good recovery. P , 14th L. W. regiment; shell comminution of tarsal bones; PIROGOFF S operation; gangrene; septicaemia; death. S , Baden Artillery regiment No. 14; shot wound of tarsal bones, January 1C, 1871; PIROGOFF S opera tion; patient discharged in September, 1871 ; result of operation very favorable. G , 7th L. W. regiment ; wounded February 9, 1871 ; PIROGOFF B amputation at ankle; pyasmia; death 8 days after the operation. FISCHER (G.) (Dorf Floing und Schloss Versailles, in Deutsche Zeitschrift fiir Chir- urgie. Leipzig, 1872. B. I, p. 262), in a case of PlKOGOFF s amputation performed 19 days after ilie injury, received September 1, 1870, the remaining por tion of the os calcis became necrosed and was removed two months after the operation ; the patient then recovered in 3J months. In a case of SYMF. S operation extensive granulations and pus formations retarded the recovery 2J months. GRAF (B.) (Die Konigl Reservelazarethe zu Dussddorf, Elberfeld, J872, p. 50): II. Riemann, 46th Prussian Infantry; comminution of ankle joint, especially astragalus, August 6, 1870; PIROGOFF S amputation Aug. 17; death September 11, 1870, from pyaemia. KIRCIIXER (C.) (Aerztlichcr Bericht iiber das Koniglich Preussische Feld-Lazareth im Palast zu Versailles, Erlangen, 1872, p. 89) tabulates a successful amputation after PIROGOFF for shell wound of the tarsal bones, and a successful SYME S operation for shot fracture of the ankle joint. RUPPRECHT (L.) (Militairdrztliche Erfalirungen wdhrend des deutscJt-franzosischen Krieges im Jahre 1870-71, Wiirzburg, 1871, p. 86) observed a successful operation by NEUDORFER after SYME S method, at the Bavarian field hospital No. VIII. SCHIXZIXGER (A.) (Das Reserve- Lazareth Schwetzingen im Kriege 1870 und 1871, Freiburg, i. Br., 1873, p. 91): Diemenct; shot fracture of left foot, August 18, 1871 ; comminu tion of metatarsals; September 2, PIROGOFF S amputation by Dr. SCHIXZIXGER; good recovery. A. Gluck, 64th Infantry; shot fracture of right ankle joint August 18, 1870 ; September 14, PIROGOFF S operation ; union of the tibia and os calcis, the latter projecting downward like a shovel ; patient cannot walk; February 22, 1871, the remaining portion of the os calcis removed, and ends of tibia and fibula resected; recovery, with useful stump. STOLL. (Bericht aus dem Koniglich Wiirttembergischen 4 Feldspital von 1870-71, in Deutsche Militairdrztliche Zeitschrift, 1874, Jahrgang III, p. 215): Fahnert, 107th Infantry, shell wound of foot, October 30. 1870 ; PIROGOFF S amputation on the day of injury ; necrosis of part of the remaining portion of the os caleis; necrosed portions removed; in the summer of 1871 the patient had good use of his leg. 616 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. tions after Syme s method the stumps are reported as sound and useful, in ten as simply "healed;" in one case the flaps retracted, in two necrosis is diagnosed, and in three the wounds never healed, abscesses continuing for years; in fourteen the remote conditions are not reported. Of the thirty Pirogoff operations nine are stated to have given good and serviceable limbs, four are reported as "healed," in two the remaining portion of the os calcis is drawn upward, in one caries is reported, in two the retained portions of the os calcis are considered hindrances, in three abscesses continued to form. The conditions of nine of the patients could not be traced beyond the time of their discharge from the service. 1 To relieve the tension caused by the weight of the flap and the consequent tendency to sloughing so frequently noted, Acting Assistant Surgeon J. E. Janvrin applied a flat padded splint to the anterior surface of the leg, which extended beyond the end of the stump. Adhesive straps were then passed from beneath the leg across the flap and carried over the end of the splint and fastened. These were gradually shortened as the healing process went on. There seems to have been no foundation for the statement made in the preliminary report, 2 on the authority of Baron von Haurowitz, 3 Surgeon-in-Chief of the Russian Navy (during a visit to this Office in 1865), that Pirogoff had himself abandoned his operation, finding the segment of the os calcis likely to become necrosed. In a letter dated Berlin, March 28, 1866, Professor Pirogoff 4 emphatically denies that he has ever given up this operation, and states that he had not a single case of necrosis of the segment of the os calcis, although he had performed the operation more than sixty times. SCHEDE (Ueber partielle Fussamputationen, in VOLKMANN s Sammlung Klinischer Vortrdge, Leipzig, 1874, Nos. 72, 73, pp. 515, 516) remarks: " The difference of the length of the stumps, further, is a very considerable one, and upon this, other authors to the contrary notwithstanding, I would not place too little weight. PIROGOFF himself estimates the length gained by his method at least 1J inches. According to O. WEBER, the shortening of the leg after PlROGOFF 8 operation amounts to 2.8 ctm. in the average, while in SYME S method the limb loses from 6 to 8 or 9 ctm. Yet the former figure can certainly be still considerably reduced by sawing off the bone obliquely, whereby much more may be preserved, and rotation is rendered easier. Among our patients operated upon there are several on whom no measurable shortening could be shown: as a rule it amounted to about 1 ctm., some times to 2, and only once did it rise to 3 ctm. So little shortening, of course, is very easily counterbalanced by a slight dropping of the pelvis. With a PIROGOFF stump the patient can therefore not only walk very well without an artificial apparatus and simply with a somewhat cushioned lace-boot as our patients learned to do without exception very readily ; but in favorable cases not even an elevated shoe was required. But when an American surgeon and inventor of an artificial leg. Dr. IIUDSOX, rejects PIKOGOFF S operation for the reason that his method results in too long a stump to admit of apply ing a complicated prothetic apparatus with an artificial ankle joint, and therefore prefers SYME S cut, one will be inclined, on the same principle, to the views of another American, Dr. BLY, for whom in turn the SYME stump is too long because it is not adaptable to his artificial apparatus, nnd who, there fore, advises amputations of the leg throughout. We would, therefore, return again lo amputation at the point of election as the only alternative, only with this difference, that in this case a greater portion of his limb be sacrificed and his life be put in greater jeopardy, not in his own interest, but in that of the instrument maker." That the patient s life is not put in greater jeopardy by the PIROGOFF than by the SYME S operation has been shown in the statistics of the American as well as the European campaigns above cited. Great stress is laid by SCHEUF. upon the increased length of stump, enabling the patient to walk very well with a " somewhat cushioned lace-boot " without the addition of a complicated artificial ankle joint, as required after SYME B amputation. But in the former case the surface of the stump, acting as a pivot on the cushioned shoe, is exposed to the danger of continued attrition similar to the irritating friction caused by the heel cap of an ill-fitting boot or shoe. In the artificial apparatus the friction is in the joint, and not on the tender surface of the stump, which is securely encased in the parts fitting to the leg. Moreover, the artificial joint will allow an easier and more graceful movement, which, in point of appearance, is quite a desideratum with the young soldier, and which causes no extra expenditure, as the United States government furnishes him, at reasonable periods (every fifth year), with an excellent apparatus. The writer has seen instances in which it was almost impossible to detect the use of an artificial foot with an articulated joint, even after attention had been called to that fact. Circular No. 6, War Department, Surgeon General s Office, Washington, November 1, 1865. Reports on the Extent and feature of the Materials available for the preparation of a Medical and Surgical History of the Rebellion, page 46. 3 Not Harronwitz, as erroneously printed in Circular No. 6. 4 " Berlin, 28 March, 1866. Sir : Having read in the Circular No. 6, Surgeon General s Office, dated November 1, 1865, page 40, that the Baron von Haurowitz, Surgeon-in-Chief of the Russian Marine, in his recent visit to your office has mentioned that I had myself abandoned my osteoplastic operation of the foot, finding the segment of the os calcis likely to become necrosed, I have the honor to state that I have never given up this operation. I had not one single case of necrosed segment of the os calcis, though I have made this operation more than sixty times, the results of which I published in my Outlines of General Military Surgery (Grundzugt der Kriegs Chirurgie, Leipzig, 1864). With the urgent request that my protest may be made public, I have the honor to be, very respectfully, your obedient servant. N. PlROOOFF." SECT. VILJ WOUNDS AND OPERATIONS IN THE FOOT. 617 SECTION VII. WOUNDS AND OPERATIONS IN THE FOOT. According to the plan pursued in the previous sections of this Chapter, the consider ation of the wounds of the bones of the foot in this section will be restricted to those inflicted by weapons of war. The cases number five thousand eight hundred and sixty ; viz: one bayonet and five thousand eight hundred and fifty-nine shot wounds. BAYONET WOUNDS OF THE BONES OF THE FOOT. A solitary case of bay onet injury of the metatarsal bones is reported from the Fairfax Seminary Hospital: CASE 889. Corporal J. Hough, Co. I, 120th New York, aged 26 years, received a bayonet wound of the left foot on October 10, 1864. He was treated at the Depot Hospital of the Second Corps, at City Point, and subsequently at Fairfax Sem inary Hospital. Surgeon D. P. Smith, U. S. V., in charge of the latter, certified, that the metatarsal bones were injured and that the patient was returned to duty June 20, 1865, to be mustered out of service. The man has not applied for a pension. SHOT WOUNDS OF THE BONES OF THE FOOT. Twenty-seven shot contusions and five thousand eight hundred and thirty-two shot fractures are recorded. Of the former one, and of the latter four hundred and fifty-one proved fatal, a mortality rate of 8.3 per cent. In four hundred and forty cases the results were not ascertained. SHOT CONTUSIONS OF THE BONES OF THE FOOT. Of the twenty seven cases of this group, seventeen are designated as contusions of the tarsals, four of the meta- tarsals, one of the metatarso-phalangeal articulation, and two of the phalangeal bones. In three instances the part injured was not indicated. Twenty-six of the patients recovered and one died of tetanus. CASE 890. Lieutenant W. Stribler, Co. B, G3d Colored Troops, aged 27 years, was wounded in the right foot by the accidental discharge of his pistol, on President s Island, January 14, 1865. He was admitted to the Officer s Hospital at Mem phis the following day, when the ball, which had lodged against the scaphoid bone, was extracted through an incision one and a half inches in length by Assistant Surgeon S. S. Jessop, U. S. V. Partial anaesthesia was produced by chloroform. At the time of the operation the foot had become somewhat swollen and was very painful, but the patient s physical condition was good. Profuse suppuration followed during the first month, and an abscess formed over the internal malleolus without involving the ankle joint. Cold and warm-water dressings and poultices were used and stimulants were administered. The patient recovered and was mustered out of service May 5, 18S5. The history was reported by the operator. Lieutenant Stribler subsequently became a pensioner. On January 26, 1870, he was examined by Dr. W. Jones, of St. Joseph, Missouri, who reported as the results of the injury: "Anchylosis of the ankle joint, with an atrophied and partially contracted condition of the muscles of the foot, causing deformity of a character sufficient to render it very difficult to secure proper appearing covering that can be worn with any degree of comfort. The loss of the use of the ankle joint also greatly interferes with walking and causes his move ments to be imperfect and laborious." The pensioner was paid December 4, 1881. CASE 891. Lieutenant W. C. Hall, Co. K, 136th New York, aged 28 years, was wounded in the right foot, at Resaca, May 15, 1864. From a field hospital of the Twentieth Corps he passed to Nashville, where he entered the Officer s Hospital one week after the reception of the injury. Surgeon J. E. Herbst, U. S. V., described the wound and its result as follows: "The ball passed transversely through the tissues on the plantar aspect, immediately beneath and grazing the under surface of the os calcis. The internal or external plantar nerves, or both, were injured, and no doubt the patient suffered exposure to draughts during his transportation hither. Tetanus in the form of trismus and emprosthotonos ensued on May 24th. The wound was freely incised and cleansed. Purgatives of croton oil were administered, seconded by the use of calomel and opium, the latter SURG. 11178 618 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. in lar^e quantities with little effect. Chloroform had the effect of relaxing the spasms; but notwithstanding all our endeavors rigidity increased and spasms became more violent until the patient was at last overcome by their intensity. Death occurred on May 26, 1864." SHOT FRACTURES OF THE BONES OF THE FOOT. The cases included in this group number five thousand eight hundred and thirty-two (5,832), or only about one-half of the number of shot fractures of the bones of the hand recorded on page 1019 of the Second Surgical Volume. In the following table it has been attempted to group the shot injuries of the foot, as far as possible, according to the different bones implicated. TABLE XCV. Summary of Five Thousand Eight Hundred and Thirty-two Shot Fractures of the Bones of the Foot. TREATMENT. CASES. TAKSAL BONKS. TAHSO- MKTATAKSAL AUTICULA- TION. METATAUSAL BONES. PHALANGES. BONES NOT SPECIFIED. Total Cases. Recoveries. Deaths. Undetermined. h O " c ~ o3 <a K Recoveries. Deaths. Undetermined. Recoveries. Deaths. Undetermined. Recoveries. Deaths. Undetermined. Recoveries. Deaths. Undetermined. Recoveries. Deaths. Undetermined. 3,560 83 1 7 1 1,216 2 1 3,111 69 1 4 1 1,088 1 135 15 314 4 4.1 17.8 671 24 40 3 59 1 38 3 3 2 1 1,238 41 33 7 118 3 725 1 1 10 3 16 439 49 120 Exc. of Bones of Foot and Part. Amp. Foot. Exc. of Bones of Foot and Amp. Leg Exc. of Bones of Foot, Amp. Leg, Amp. at 3 42.8 1 2 3 1 1 23 1 1 105 2.0 50.0 1,088 1 23 1 1 105 Amp. of Toes and Partial Amp. Foot 100.0 100.0 Amp. of Toes, Amp. Ankle Joint, and 1 1 1 Amputation of Toes and Amp. of Leg. . . Amp. of Toes and Amp. at Knee Joint. . . 6 1 4 2 1 33.3 100.0 | 4 2 1 |, 275 1 12 116 25 498 10 4 209 1 11 84 20 50 1C 19.3 100.0 9 3 8 1 1 83 17 3 55 1 3 1 4 54 28 8 Part. Amp. Foot and Amp. at Ankle Joint Partial Amp. Foot and Amp. of Leg 1 31 5 1 1 8.5 26.9 20. 100.0 1 1 4 5 2 3 26 9 7 3 6 4 6 1 ] 47 17 1 1 Amp. at Ankle Joint and Amp. of Leg... Amp. at Ankle J t, Amp. Leg, Amp.Thigh 1 329 5 1 3 169 5 3 3 33.9 m 17 Ti lf> 27 29 1 152 66 Amputation of Leg and Amp. of Thigh . . 50 ,T 2 o 75.0 o 1 1 | 50.0 3 1 1 1 5,832 4,942 450 440 8.3 859 V 121 1,04( PO 98 29 v 129 2 1,404 i 90 ~s 618 124 1,881 V 44 050 125 700 Ki6 1)95 129 The tarsal bones were implicated in one thousand and forty, the tarso-metatarsal articulation in one hundred and twenty-nine, the metatarsal bones in one thousand six hundred and eighteen, and the phalanges in two thousand and fifty cases; in nine hundred and ninety-five instances the parts injured were not indicated. Three thousand five hun dred and sixty were throughout treated by expectation, ninety-seven were followed by excision, and two thousand one hundred and seventy-five by amputation. SHOT FRACTURES OF THE BONES OF THE FOOT TREATED BY CONSERVATION. -- Tll6 shot of the foot treated without operative interference numbered three thousand five hundred and sixty; the results in three hundred and fourteen cases were not ascertained. Of the remaining three thousand two hundred and forty-six cases, three thousand one hundred and eleven had successful, and one hundred and thirty-five fatal terminations, a mortality rate SECT. VII.] SHOT FRACTURES OF THE BONES OF THE FOOT. 619 of 4.1 per cent. A few cases will be detailed to indicate the manner of treatment gen erally pursued, which was similar to that of wounds of the hand discussed on page 1020 of the Second Surgical Volume. Shot fractures of the os calcis even when quite extensive healed, as a rule, without difficulty: CASE 892. Shot fracture of the os calcis. Sergeant D. M. Tarrance, Co. B, 1st Pennsylvania Cavalry, aged 24 yean?, was wounded in the right foot, at United States Ford, May 25, 1863, and entered Harewood Hospital, Washington, three weeks after wards. On September 29th the patient was transferred to Mower Hospital, Philadelphia. Surgeon J. Hopkinson, U. S V., reported: "The patient was wounded by a ball entering outside of the tendo-achillis, passing downward, forward and inward through the os calcis, fracturing the bone, and emerging at the inner margin of the sole of the foot. The heel became very much swollen and painful and pus continued to discharge from both the wound of entrance and exit, all the symptoms of necrosed bone being present. Flaxseed poultices were applied; iron and quinine with wine was administered. On December 1st, another examination having been made, it was decided to cut down and remove the diseased bone, and a crucial incision was made along the internal aspect of the bone, its length parallel with the axis of the bone being three and a half inches, in the opposite direction two and a half inches. The loose pieces were then removed and the necrosed bone was scraped with the gouge, after which the wound was closed with sutures and cold-water dressings were applied. The operation was performed by Acting Assistant Sur geon J. H. Jamar, the patient being in good general condition at the time. He did well afterwards. Small fragments of bone exfoliated and were removed at different intervals. By January 20, 1864, the wound was healing kindly and the patient was allowed to go to his home. About the end of February the wound had healed with the exception of a small point, and the patient dispensed with his crutches and used a cane. He was discharged from service July 8, 1864." Examining Surgeon W. Jewell, of Philadelphia, certified to the injury April 7, 1866, and described the wound as still suppurating. The pensioner was paid March 4, 1871. CASE 893. Shot fractures of scaphoid and cuneiform bones. Lieutenant J. Miller, Co. A, 5th Ohio, aged 26 years, was wounded in the left foot, at Cedar Mountain, August 9, 1862. Acting Assistant Surgeon J. A. Murphy, in charge of Third Street Hospital, Cincinnati, reported: "The ball entered between the scaphoid and internal cuneiform bones and passed out one inch below the external malleolus. The patient was sent to Cliffburn Hospital, at Washington, where Assistant Surgeon J. S. Billings, U. S. A., on August 14th enlarged the wound of exit and removed several pieces of bone. The patient remained in said hospital for three months, when he obtained a leave of absence and came to his home (in Cincinnati). He applied for treat ment in this hospital in December, 1862, when there was still considerable inflammation in the foot. Poultices and cold-water dressings were ordered until the wounds healed. Five small pieces of bone were removed from both the wound of entrance and exit. He is now (April, 1863) able to flex the foot on the leg and walks with a slight halt." Lieutenant Miller was discharged from service June 11, 1863, and pensioned. The Cincinnati Examining Surgeons have certified to the injury from time to time. In 1877 they added that "the cicatrix is small, healthy, and adherent. There is some flattening of the plantar arch; middle tarsal joint very much impaired; motion of ankle good but limited in range." The pensioner was paid March 4, 1881. CASE 894. Private J. A. Lunderman, East Missouri Militia, was wounded in the left foot during a skirmish on March 9, 1863. Acting Assistant Surgeon F. A. Bushey reported: "The wound was caused by a conical pistol ball, which entered at the astragalo-cuboid articulation, comminuted the cuneiform and scaphoid bones, and lodged in the foot. The man entered the General Hospital at Springfield eleven months after the injury, at which time the external wound had healed, but the foot was much swollen; constitutional condition good. On February 10, 1864, Dr. B. A. Barette attempted to extract the ball and made an incision three inches in length along the tibialis anticus muscle, when a quantity of necrosed bone was taken out, but the missile could not be found. Simple dressings were applied after the operation. The patient recovered and was returned to duty March 26, 1864." He is not a pensioner. CASE 895. Shot fracture of os calcis and tarsal bones. Private J. Chew, Co. C, 58th Indiana, was wounded in the left foot, at Chickamauga, September 20, 1863. He was conveyed to hospital at Chattanooga, where Surgeon J. T. Woods, 99th Ohio, recorded the following history: "A m mi6 ball entered one inch below the outer malleolus, ranging slightly forward and comminuting the head of the os calcis and tarsal bones. Careful exploration failed to detect the missile. Several spiculae and one small fragment of lead were removed. On September 26th inflammatory action in the parts had increased and the pain was severe and attended with great restlessness. Irrigation was then applied to the parts and anodynes were freely administered. By September 30th the inflammation was increasing, the pain intense, and several more spiculae were removed. On October 2d an incision was made from the entrance wound forward and inward, opening into the discolored mass freely, after which several pieces of tarsal bone were removed, also a Belgian musket ball from near the internal cuneiform bone. Irrigation to the foot was continued. Three days afterwards the appearance of the parts was better, the pain had decreased, and an anterior splint was applied, elevating the foot. On November 2d part of the tarsal bone from the inner side of the foot was removed." Several days afterwards the patient was transferred to hospital at Murfreesboro and subsequently to Evansville, where he was dis charged from service November 9. 1864, Acting Assistant Surgeon J. A. Jearicon certifying to the use of the foot being com pletely destroyed by the wound. There is no record of the man ever having applied for pension. CASE 896. Shot fracture of tarsal bones. Private J. Campbell, Co. F, llth New York, aged 36 years, was wounded and captured at Bull Run July 21, 1861. Surgeon R. B. Bontecou, U. S. V., reported: "He was admitted to Hygeia Hospital at Fort Monroe, from Richmond, October 21, 1861, with gunshot wound of right tarsus. A ball had passed into the foot in front of the ankle joint and came out at the tip of the heel. The patient was in bad condition when he arrived, and the foot was very much swollen and painful, with profRse discharge from several sinuses. The fistulas were dilated with sponge tents and carious bone was removed. He recovered the use of his foot and went to his home in New York City." The patient was dis charged from service February 16, 1862, and pensioned. The New York City Examining Board certified, November 4, 1874 : 620 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. "The wounds are still open and connect with dead bone; the cicatrices and surrounding tissues are thin, inflamed, and tender; movements of joint limited." In the following year the same board reported that "a portion of the astragalus has been removed. Cicatrices are deep and adherent; wound of exit still open and connecting with dead bone." The pensioner was paid September 4, 1880. CASE 897. Shot fractures of tarsal and metatarsal bones. Private J. E. Chase, Co. F, 1st U. S. Sharpshooters, aged 25 years, was wounded in the right foot, fracturing the bones, at Spottsylvania, May 12, 1864. He passed through several hospitals and was ultimately transferred to the Veteran Reserve Corps, December 4, 1864, by reason of the results of the injury. On August 31, 1866, the man was mustered out and pensioned. Dr. E. D. Hudson furnished the following description of the case: "Compound comminuted fractures of the metatarsus and tarsus were caused by three rifle shots, and were followed by extensive necrosis and exfoliation of the metatarsus. The insertion and function of the tibialis aulicus, peroneus longus, and extensor muscles are destroyed, the plantar aspect of the foot is turned inward and upward, and the patient rests his leg on the outside of the foot, which is turned down, the extensor muscles failing to make the great toe and other parts hug the ground. The limb is not shortened, but there is soreness and stiffness of the foot and considerable anchylosis of the tarsus. An apparatus was applied to antagonize the flexor muscles of the foot and the extensors of the toes, and to reduce the heel and the foot to a normal position." Examining Surgeon L. Richmond, of Troy, Vermont, certified to the injury as follows: "One ball entered between the lower extremity of the tibia and tendo-achillis on the inner aspect, passed outward and downward, and made its exit near the sole of the foot, severely injuring the os calcis. Another ball passed through the foot, severely injuring the three outer metatarsal bones and the tendons; extensive sloughing followed. The third ball entered on the inner side just about the union of the great toe with its metatarsal bone. The pensioner walks partly upon the side of the foot," etc. Examiner J. C. Rutherford subsequently reported that "the foot and leg are atrophied and there is but very little muscle left upon the limb. There is no strength in the ankle. He is obliged to use a mechanical support on the foot and leg to enable him to walk at all. CASE 898. Captain M. D. Bearden, Co. D, 6th Tennessee, aged 34 years, was wounded in the left foot, at the Cliatta- hoochee River, July 1, 1864, and was admitted to Lookout Mountain Hospital near Chattanooga eight days afterwards. Surgeon L. D. Harlow, U. S. V., reported : "A conical ball fractured the cuboid bone and lodged in the centre of the foot under the scaphoid bone. The foot became greatly swollen and inflamed, particularly on the inner side, and the patient, who had been a strong and robust man previous to the injury, grew weak, feverish, and irritable. On August 27th an abscess which had formed on the internal surface was opened, and the ball was extracted through the opening. Chloroform was used during the operation. Rapid improvement followed." The patient subsequently entered the Officers Hospital at Knoxville, where he was mustered out of service April 27, 1865, and pensioned. The Knoxville Examining Board certified to anchylosis resulting from the injury. The Pension Office Examining Board, Washington, D. C., reported the pensioner s condition March 11, 1881, as follows: "This man can do no manual labor. The ankle and leg to the knee are much enlarged, and the lower two-thirds of the tibia and soft parts are much diseased. He has to use crutches at times to walk, and a stout cane at all times. He is very lame, and from the great ulceration of the bone and soft parts must suffer constant pain." CASE 899. Private H. West, Co. L, 7th Illinois Cavalry, aged 22 years, was wounded in the left foot, at Colliersville, October 11, 1863. He remained at a field hospital for some weeks and was then conveyed to Memphis, where he entered Adams Hospital November 17th. Surgeon J. G. Keenon, U. S. V., in charge of the latter, reported: "The patient had been wounded by a ball penetrating the scaphoid bone and carrying with it the tongue of the buckle of a spur, which lodged. After a time a sinus formed in the injured foot, connecting with what appeared to be necrosed bone, but which proved to be perfectly healthy. On March 10, 1864, chloroform was administered, and a vertical incision was made about one and a half inches in length and continued along the track of the ball from within outward, after which the tongue of the buckle was found and removed. The operation was performed by Acting Assistant Surgeon S. S. Jessop, the patient being in good physical condition at the time. He did well until March 30th, when hospital gangrene supervened, which was checked by one application of pure bromine." The patient was ultimately discharged from service May 13, 1865, and pensioned. Examining surgeons have certified to "anchy losis and deformity of the foot," etc. The pensioner was paid March 4, 1881. CASE 900. Shot fractures of metatarsal bones. Private C. S. Wheelwright, Co. M, 1st New Jersey Cavalry, aged 26 years, was wounded on picket duty near Warrenton, January 31, 1864, and admitted to Douglas Hospital, Washington, the following day. Acting Assistant Surgeon C. Carvallo, reported: "The ball entered the external dorsal aspect of the right foot anterior to the fourth tarso-metatarsal articulation, and emerged posteriorly to the metatarso-phalangeal articulation of the big toe, having fractured the fourth metatarsal bone obliquely and passed beneath the others. Water dressings had been applied before admission and were continued. The foot became red, swollen, and painful, and the patient had considerable fever, anorexia, and pain. Epsom salts, weak diaphoretics, and the dressings soothed the symptoms considerably. On February 8th the distal fragment of the fourth metatarsal bone was found to be movable, but still attached by its phalangeal articulation, and an effort to remove it proved impossible without injuring that joint. It was therefore decided to leave its removal to nature, and a seton was conducted through both wounds in order to keep them open and promote suppuration. Subsequently an exacerbation of the symptoms manifested itself, after which the foot showed an erysipelatous tendency by swelling, redness, heat, and puffiness. A solution of nitrate of silver with acacia, constantly applied for forty-eight hours, finally subdued the inflammation, when a profuse discharge of healthy pus followed and gave great relief to the patient. Thenceforward the stimulants were substituted by tonics, and water dressings took the place of all former local applications. In a very short time all the swelling and redness had left the foot, and the wound showed such a healthy appearance and discharged such small quantities of pus that I enter tained hopes the fractured bone would heal without being removed. I then applied Sentin s starch bandage, which the patient still had on when he went home on furlough on March 15th. I afterwards heard that he was attacked with erysipelas and had entered Central Park Hospital, New York City." The patient was discharged at tne latter hospital May 20, 1864, and pen sioned. Examining Surgeon J. T. Burdick, of Brooklyn, N. Y., certified that "the flexor tendons of the middle toes and some of the ligaments of the pedal arch were injured." The pensioner was paid September 4, 1880. SECT, vn.] SHOT FKACTURES OF THE BONES OF THE FOOT. 621 CASE 901. Private I. Parso, Co. F, 21st Wisconsin, aged 25 years, was wounded in both lower extremities, at Chick- amauga, September 19, 1863. The injuries were produced by two musket balls, one of which fractured the first and second metatarsal bones of the right foot, the other fracturing the fibula of the left leg near its lower extremity. The wounded man passed through various hospitals and lastly entered Harvey Hospital, Madison, on July 12, 1864. Surgeon H. Culbertson, U. S. V., who operated in the case at the latter hospital, reported the following result of the injuries: "The patient was assigned to the Veteran Reserve Corps October 7th. The fracture of the metatarsal bone had united with a very large provisional callus, which interfered with the action of the extensor tendons and compressed the tarsus. This growth was mainly developed from the first metatarsal bone, which jutted over the second, the parts being tender and the patient unable to walk without pain. In order to accomplish the chiseling off of the exostosis, if possible, or failing in this, to remove a portion of the first metatarsal together with the diseased bone, an incision was made down to the bone, commencing one-half inch from the metatarso-phalan- geal articulation and extending two and three-quarter inches along the inner border of the first metatarsal. Another incision of two inches was then carried over the dorsum of the foot down to the superficial fasciae and at right angles with the first cut, care being taken not to divide the extensor tendons. The soft parts were now separated with the handle of a scalpel, preserving the periosteum as much as possible, and the bone was sawn through with a metacarpal saw about one inch from the metatarso- phalangeal joint. The old line of the fracture, three-fourths of an inch from the tarso-metatarsal joint, was next separated with a strong narrow knife and removed with the diseased structure. A portion of the exostosis, projecting from the upper fragment and jutting over the second metatarsal bone, was removed with the forceps. No vessels required ligating. The wound was left open for two hours until all bleeding had ceased, after which the edges were brought together and secured with sutures and adhesive plaster. A compress secured by bandages was applied over the seat of the wound for twelve Jiours ; the foot was elevated and cold-water dressings were used. The external wound healed by first intention and the patient progressed well. He was returned to duty February 20, 1865." The removed exostosis, one inch in length, and contributed to the Museum by the operator, constitutes specimen 3694 of the Surgical Section. The patient was mustered out of service August 19, 1865. and pensioned. Dr. J. F. Force, pension examining surgeon at Heron Lake, Minnesota, states that "the great toe was left, but it is so tender that he can use it but little in walking. The left ankle joint is considerably weakened. His bodily health is good." The pensioner was paid June 4, 1881. CASE 902. Surgeon T. H. Squire, 89th New York, records that "Private C. M. Yarnes, Co. F, 89th New York, aged 24 years, was wounded at the storming of a fort on the Nansemond River, April 19, 1863, by a musket ball, which entered the outer margin of the right foot at the root of the little toe and came out on the inner margin of the foot just below the ankle, traversing the whole sole of the foot diagonally and below the bones. I think the phalangeal extremity of the metatarsal bone of the little toe was injured, but not the rest of the bones, and whether any of the vessels were injured or not was more than I could tell, though there had been no haemorrhage. The wound of entrance was small, while that of exit was large, ragged, and pouting. The first day after the injury the foot was hot and painful. I placed it in an easy elevated position, applied wet dressings, and drew blood liberally from the patient s arm, from which time the pain grew less. By April 25th the foot had a good appearance. On June 6, 1863, the patient went home on furlough. He had done well. The wound of entrance had suppurated freely and bone was apparently yet to come out of this opening." He was ultimately mustered out of service August 3, 1865, and pensioned. Examining Surgeon J. G. Orton, of Binghamton, N. Y., December 14, 1872, stated that "the action of the ankle joint is much impah-ed, obliging the patient to walk almost entirely on the heel and always giving him a limping motion. The disability is permanent in its present degree." The pensioner was paid December 4, 1880. CASE 903. Private J. Johnson, Co. D, 4th U. S. Artillery, aged 36 years, was wounded in the right foot, at Drury s Bluff, May 14, 1864. He was admitted to Point Lookout Hospital three days afterwards, where Acting Assistant Surgeon J. Oilman recorded the following: "The wound was from a minie ball, which entered at the dorsal surface and was taken out at the plantar aspect, having fractured the metatarsal bone of the great toe. Gangrene set in, destroying the continuity of the dorsalis pedis artery and necessitating ligation, which was performed on July 20th by Surgeon A. Heger, U. S. A., in charge of the hospital, who enlarged the wound and tied the artery above and below. The case progressed favorably, the gangrene being cured and the wound granulating, when the patient was transferred to Judiciary Square Hospital at Washington on August 6th." He was subsequently transferred to Fort Washington, and on July 16, 1865, he was discharged from service and pensioned by reason of "difficulty in walking in consequence of the wound." Examining Surgeon J. O. Stanton, of Washington, D. C., reported, September 10, 1873: "The cicatrix is large, now open, and discharging. He has no motion of the great toe." The pensioner died at the Soldiers Home, Washington, D. C., November 6, 1878. CASE 904. Private J. T. Bartley, Co. B, 38th Indiana, aged 20 years, was accidentally shot in the left foot, at Nashville, March 3, 1864, the ball passing in at the arch, fracturing the third metatarsal bone, and coming out at the plantar surface. On the following day he was admitted to hospital No. 1, whence he was transferred to Jeffersonville two months afterwards, and subsequently to No. 6, at New Albany. Acting Assistant Surgeon E. S. Crosier, in charge of the latter hospital, reported that owing to troublesome haemorrhage the anterior and posterior tibial arteries were ligated by Acting Assistant Surgeon J. Grant six days after the reception of the injury, also that the parts were attacked with gangrene during the early stage of the case. The patient recovered and was discharged from service April 10, 1865. He is not a pensioner. CASE 905. Shot fracture of toe. Corporal R. Steele, Co. F, 27th Massachusetts, aged 23 years, was wounded in the left foot, during the skirmish at Gum Swamp, May 22, 1863. Surgeon E. P. Morong, 2d Maryland, recorded his admission to Foster Hospital, New Berne, and his return to duty one month afterwards. Surgeon G. A. Otis, 27th Massachusetts, made the following report: "Corporal Steele was sent to me from Foster Hospital June 25th. He had been under treatment for a wound at the phalangeal articulation of the left great toe, caused by an Enfield rifle ball. Dead and detached fragments of tin- distal phalanx could be felt and the wound showed no disposition to cicatrize either on the dorsal or palmar aspect. I laid open the toe and removed the loose fragments, including the entire distal phalanx and part of the proximal phalanx." The man recovered and subsequently continued with his regiment until mustered out September 27, 1864. In 1880 he became an applicant for pension by reason of alleged painfulness in walking. 622 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 906. Shot fracture of tarsal bones; death. Captain C. E. Jennings, Co. G, 26th New York, was wounded in the foot, at Bull Run, August 30, 1862, and was conveyed to Washington. Surgeon C. L. Allen, U. S. V., reported : "The patient was a man about thirty years of age, of a sanguine temperament, and apparently of good constitution and fair health previous to being wounded; while he was at Alexandria, on his way to Washington, a surgeon had declared the necessity of amputa tion; but before the operation could be performed the patient was taken to Washington. The ball had entered on the inner side of the foot and passed through the three cuneiform bones and the cuboid, the wound of exit being upon the external and upper surface of the foot. On September 27th the foot was enormously swollen, and there were five or six openings besides the original wounds discharging large quantities of unhealthy sanious pus. The leg and even the thigh were very much swollen and oedematous, and the lower third of the leg was marked by several long cicatrices, said to be the results of incisions made early in the case for erysipelatous inflammation. His general condition was that of marked hectic and his emaciation was great. He had also considerable dyspnrea and complained of pain in his chest, for which sinapisms were being applied. Compound tincture of cinchona and tincture of cantharides, with brandy and liberal allowance of beef-essence, etc., were now immediately ordered for the patient, hoping but not expecting to raise him to a condition to sustain amputation of the leg. Although crowding the nourishment and stimulants to the utmost he continued to sink, and died on October 1, 1862. No post-mortem examination w r as held. CASE 907 .Shot fracture of first metatarsal bone; death. Private W. S. Hodgkins, Co. A, 14th New York Artillery, aged 27 years, was wounded at Spottsylvania, May 10, 1864, and entered Emory Hospital, Washington, two weeks afterwards. Surgeon N. R. Moseley, U. S. V., reported: "The patient was received with gunshot wound of left foot, fracturing the first metatarsal bone. Cold-water dressings were applied to the wound and alteratives were given internally. This treatment was continued for some weeks, the wound doing well, although the patient s constitutional health was very poor. On June 29th Btimulants with alteratives were ordered, and warm applications were made to the wound, which appeared to be obstinate in healing. On July 20th simple cerate dressings were commenced, the wound appearing healthy in some parts, though peculiarly unhealthy around the edges; internal treatment continued. One month later the wound was erysipelatous in appearance and warm poultices were again applied; patient s appetite still good. By September 9th erysipelas and gangrene had invaded the wound and creasote was added to the poultice; stimulants given internally. In about ten days cold-water dressings were resumed, gangrene having disappeared, but the parts still being unhealthy. On September 27th the patient was attacked with chills followed by high fever, when antiperiodics and tonics were prescribed and warm applications were again used. Several days afterwards the patient began to sink rapidly. He died October 3, 1864, from the effects of irritative fever produced by the unhealthy wound." EXCISIONS IN THE BONES OF THE FOOT. Ablations of one or more of the metatarsals with their corresponding toes have been classified with partial amputations of the foot and will be cited hereafter. The cases to be considered in this group will be confined to excisions of the tarsal bones or of the metatarsal bones without removal of the corresponding toes. Ninety-seven cases of this nature have been recorded. The results in four cases were not determined. Seventy-five were successful and eighteen proved fatal, a mortality rate of 19.3 per cent. Of the ninety-seven operations, thirty-one involved the tarsal bones, five the tarso-metatarsal articulation, fifty-seven the metatarsal bones, and four the metatarso-phalangeal articulation, as indicated in the following table: TABLE XGVI. Numerical Statement of Ninety-seven Cases of Excisions in the Bones of the Foot. CASES. Pi-iMvuY INTER- MEDIAKY. SECm-DAHY. TIME XOT SI ECI- PARTS EXCISED. "3 "S H i c 1 25 3 46 1 Deaths. Undeterm d Percentage of Mortality. 1 y K Deaths. I ~>-,t. Recoveries. Deaths. Recoveries. .1 1 i % 1 8 O K Deaths. Undeterm d. 1 Excision in the Tarsal Bones 31 5 a J8 1 13 1C. C 40.0 14.8 10 1 28 1 40 3 i 2 1 1 i 2 1 5 9 1 ti 1 , Excisiuu in the Turso-Metatarsal Articulat n. 5 Excision in the Metatarsal Bones 57 2 ! ii i 1 : ~> Excision in the Metatarso-Phalangcal Artie- illation 4 Aggregates 97 4 "" U 2 15 1C , 4 1 2 Fifty-three of the ninety-seven operations were primary, twenty intermediary, seven teen secondary, and in seven the intervals between the injury and the operation could not SECT. vn. | EXCISIONS IN THE BONES OF THE FOOT. 623 be ascertained. A few examples of each of these groups will be detailed, and a brief account of all cases given in a condensed tabular statement. PRIMARY EXCISIONS ix THE BONES OF THE FOOT. The results VfeTe ascertained in fifty-one of the fifty-three primary excisions; forty were successful, eleven fatal. In five instances, two successful and three fatal, the limb was subsequently amputated in the leg. CASE 908. Captain A. Badeau, Aide-de Camp on Brigadier General T. W. Sherman s Staff, was wounded in the left foot, fracturing the tarsal bones, before Port Hudson, May 27, 1863. He was admitted to the field hospital of the 2d division, Nine teenth Corps, where he was treated by Surgeon E. F. Sanger, U. S. V., who contributed the following description of the case: "The ball penetrated at the instep and came out below the internal malleolus. I resected the middle cuneiform bone, portions of the internal and external cuneiform, and the proximal end of the second metatarsal, on account of which operation he was sent to New Orleans permanently disabled. I met him during the following fall at Newport, R. I. He was then still lame and went on crutches." About ten months after being wounded, Captain Badeau was promoted and appointed on the Staff of General Grant, in which position he continued up to a short time before being retired from active service on May 18, 1869. In addition to the history of the case, forwarded by Dr. Sanger on February 26, 1878, the operator makes the following mention of the result of the injury: " I learn that the arch of the foot is somewhat depressed by the wound and operation, tending slightly to valgus." CASE 909. Lieutenant L. A. Dubois, Co. E, 120th New York, aged 24 years, was wounded in the right foot, before Petersburg, September 20, 1864. Surgeon O. Everts, 20th Indiana, reported his admission to the field hospital of the 3d division, Second Corps, with "shot fracture of metatarsus, followed by resection." Surgeon H. F. Lyster, 5th Michigan, who performed the operation, reported that the second metatarsal bone was fractured and the posterior tibial artery lacerated, also that the operation consisted of the excision of the distal extremity of the fractured bone and of the ligation of the lacerated artery, and was followed by "recovery with a useful foot." The patient was transferred from the field to the Depot Hospital at City Point, where he obtained a leave of absence on October 8th. On January 10, 1865, he was discharged from service and pen sioned. Various examining surgeons have certified to the injury resulting in considerable " lameness, much pain and difficulty in walking." The pensioner was paid September 4, 1880. CASE 910. Private B. J. Smith, Co. G, 21st Kentucky, aged 22 years, was accidentally wounded in the left foot, and was conveyed to Cumberland Hospital, Nashville, November 28, 1864. Surgeon B. Cloak, U. S. V., reported: "The metatarsal bone of the second toe was fractured, and the adjacent parts were much swollen by irritation from the comminuted bone. Acting Assistant Surgeon T. C. Eakin made an incision on November 28th, two and a half inches in length on the dorsal surface of the foot, and excised two-thirds of the fractured metatarsal bone. Chloroform was the anaesthetic used; the patient was in good health at the time of the operation. Several days afterwards erysipelas of a simple cutaneous character attacked the foot but was easily arrested. About one month after the operation tire patient was progressing favorably." He was subsequently trans ferred to hospital at Louisville, and lastly to Camp Dennison, where he was mustered out of service September 11, 1865. There is no record of his ever having applied for pension. CASE 911. Private J. Leunze, Co. C, 71st Ohio, aged 37 years, was wounded in the right foot, at Campbellsville, Novem ber 26, 1864, and entered hospital No. 1, at Nashville, the following day. Surgeon B. B. Breed, U. S. V., reported: "Gunshot fracture of first metatarsal bone; foot much inflamed and tumefied; tarso-metatarsal articulation opened; patient s constitutional condition good ; secretions natural. Excision of the first metatarsal bone was performed on November 28th, by Acting Assistant Surgeon C. H. Fisher, Avhile the patient was under the influence of chloroform. The treatment consisted of water dressings and nutritious diet. Wound healing kindly when the patient was transferred to Louisville, December 20th." Subsequently the patient was transferred to Camp Dennison, where he was discharged from service May 16, 1865, by reason of "paralysis of foot and toes resulting from the wound." Several years afterwards the man became an applicant for pension and was examined by Surgeon L. Whiting, of Canton, Ohio, who certified, April 29, 1868, as follows: "There is great deformity and disability of the injured foot. A large part of the metatarsal bone of the great toe is lost, and the toe itself is so distorted that it now lies at least an inch posterior to its original locality. * * * The weight of the body in walking is sustained by the heel and a portion of the external border of the foot." CASE 912. Private J. C. Troutman, Co. K, 3d Tennessee, aged 29 years, was wounded accidentally in the left foot, at Kings ton, June 19, 1864. After remaining at a field hospital for over two months he was transferred to Chattanooga, whence Assistant Surgeon C. C. Byrne, U. S. A., described the injury as "a shot fracture of the second and third metatarsal bones. Excision of the fractured bones was performed on the field through an incision three inches in length, chloroform being used. At the time of the operation the parts were inflamed and swollen, but the patient was in good constitutional condition. Cold-water dressings constituted the treatment and favorable progress followed." The patient subsequently passed through other hospitals, and was ultimately discharged from Brownlow, Knoxville, July 8, 1865, by reason of "much impairment of the usefulness of the foot." Two years afterwards he made application for pension and was examined by Surgeon A. B. Tadlock, of Knoxville, who certified to the injury and stated: "The second and third metatarsal bones have been exsected, which permanently damages the arch of the foot and materially obstructs locomotion." Owing to subsequent failures to respond the man s claim was suspended by the Pension Office in 1873. CASE 913. Private P. Pero, Co. C, 2d New York Cavalry, aged 22 yeai-s, was wounded in the right foot, while on picket duty near Alexandria, May 5, 1864. Surgeon C. Powers, 160th New York, in charge of the Alexandria Hospital, made the following report : "The ball entered at the inner side of the middle of the metatarsal bone of the great toe and emerged over that of the little toe. The first, second, third, and fourth metatarsal bones were shattered. The patient suffered considerable pain. Two days after the injury excision of the first metatarsal bone was performed and the shattered fragments of the second, third, and fourth Avere removed by Assistant Surgeon C. H. Andrus, 128th New York. Chloroform was used, and the patient reacted 624 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. promptly. He did well afterwards. Five days after the operation considerable haemorrhage occurred, but was completely arrested by light pressure on the dorsal artery. Simple water dressings were used. The case was still doing well when the patient was, on May 22d, transferred to University Hospital at New Orleans." Surgeon S. Kneeland, U. S. V., in charge of the latter hospital, reported the result of the case as follows : " The whole foot became greatly swollen, purulent inflammation having occurred on the dorsal and plantar surfaces ; several of the bones became disorganized and the tibio-tarsal articulation completely anchylosed; patient greatly reduced by the excessive suppuration; pulse 78; appetite tolerably good. He also suffered from chronic diarrhoea and intermittent fever, from which he had recovered on June 20th, when the leg was amputated at the middle third by Acting Assistant Surgeon F. Hassenburg. Chloroform was used, and the haemorrhage attending the operation was Blight. Under a supporting diet and cool dressings the patient did well up to June 30th. He died from the effects of chronic diarrhoea July 15, 1864." CASE 914. Private J. G. Fowler, Co. K, 42d Illinois, was wounded in the left foot, at the battle before Nashville, December 15, 1864. He was admitted to Cumberland Hospital at Nashville, whence Surgeon B. Cloak, U. S. V., reported : "The metatarsal bone of the second toe was fractured and two-thirds of its tarsal extremity was excised the day after the injury. One week after the operation trismus set in, the patient complaining of stiffness of the jaws, and on the following day the muscles of the neck and shoulders were in a state of tonic spasm. The patient was placed under the influence of chloroform and the wound was thoroughly cleaned out with the knife, after which concentrated nitric acid was applied. Large quantities of opium were administered internally, but without effect. On December 25th opisthotonos ensued, in which condition the patient died at 8 A. M." INTERMEDIARY EXCISIONS IN THE BONES OF THE FOOT. Twenty cases with fifteen recoveries and five deaths, a mortality rate of 25.0 per cent., belong to this group. In two of the fifteen cases of recoveries the patients subsequently submitted to amputations in the leg : CASE 915. Private J. M. Cole, Co. G, 8th Michigan Cavalry, aged 22 years, was accidentally wounded in the right foot, at Waynesboro , November 20, 1864, and entered hospital No. 1, Nashville, eight days afterwards. Surgeon B. B. Breed, U. S. V., who operated in the case, made the following report: "The wound was caused by a ball entering the dorsal surface, fracturing the third and fourth metatarsal bones, and emerging directly opposite on the plantar aspect. The foot became highly inflamed and tumefied; tarso-metatarsal articulation opened; patient suffering much from pain; appetite impaired; bowels constipated. The third and fourth metatarsal bones were excised on November 30th through an incision two and a half inches long ou the dorsal surface. Chloroform was used. Hospital gangrene appeared in the wound five days after the operation and was promptly arrested by one application of undiluted bromine. After this the wound healed rapidly. Cold-water dressings were used and nourishing diet was furnished. On December 21st the patient was transferred to Louisville." He was ultimately discharged from Harper Hospital, Detroit, May 12, 1865, by reason of permanent lameness resulting from the wound. Examiner D. A. West, of Lexington, Michigan, June 13, 1877, certified to the wound, loss of metatarsal bones, etc., and added that "the cicatrix is very sensitive to the touch. There appears to be bulbous extremities of some of the nerves," etc. "A spicula of bone is now troubling the plantar surface and may necessitate removal." The man s application for pension was rejected owing to his inability to produce corroborative evidence as to the cause of the reception of the injury. CASE 916. Private M. H. Hargrave, 8th Indiana Battery, aged 42 years, was wounded at Chickamauga, September 20, 1863. He was admitted to the field hospital at Crawfish Springs, where Surgeon A. Ewing, 13th Michigan, recorded the injury as "a wound of the left foot, the ball entering the centre of the metatarsal bone, going inward and backward through the tarsus, fracturing all the bones in its passage. Resection of the os calcis and portion of the astragalus was performed on September 29th." After passing through other hospitals subsequently the patient Avas transferred to Evansville, March 8, 1864, the wound having healed previous to that date. Ou December 30, 1864, he was mustered out of service and pensioned. Various examining sur geons certified to his inability to walk without crutches. The pensioner died November 16, 1871. His attending physician, Dr. F. W. Billert, testified: "He came under my personal observation when he was discharged from the army; was then very much prostrated, and prostration was succeeded by violent reaction and fever, terminating in general nervous exhaustion. This left him partially paralyzed in the lower extremities, broke down his constitution, and finally generally paralysis, it is supposed, took place, resulting in death." CASE 917. Private M. Goffney, Co. A, 114th New York, aged 27 years, was wounded at Cedar Creek, October 19, 1864. Assistant Surgeon J. Homans, jr., U. S. A., reported his admission to the field hospital of the 1st division, Nineteenth Corps, with a "severe bullet wound of the bones of the left foot." Surgeon T. B. Reed, U. S. V., reported the following result of the injury : " The patient was admitted to Filbert Street Hospital, Philadelphia, five days after receiving the wound. The missile had entered at the insertion of the tendo-achillis and remained hidden among the bones of the foot. Theos calcis and the astrag alus were fractured. After admission the pans commenced to slough ; circulation became feeble ; appetite depraved, and general condition bad. Haemorrhage from the posterior tibial artery to the amount of eight ounces occurred on October 31st, when Acting Assistant Surgeon E. L. Duer ligated the vessel in the continuity behind the malleolus, removed a portion of the os calcis and extracted the ball. Ether was used as the anaesthetic. The patient did not recover from its influence for several hours, then suffered from nausea constantly, became jaundiced, and presented decided pyaemic symptoms. The treatment consisted of mer curials, tonics, stimulants, and nutritious diet. Cups were applied over the liver and nitric acid to the wound, followed by per manganate of potash. Death resulted on November 9, 1864. At the post-mortem examination no metastatic abscesses were found, nor any pus except in the joints of the foot ; liver greatly engorged; blood fluid and dark ; stomach softened ; gall bladder empty." CASE 918. Private W. W. McKeran, Co. H, 3d Michigan, was wounded in the foot, at Fair Oaks, May 31, 1862, by a musket ball, which entered the outer side of the fifth metatarsal bone and made its exit at the first metatarsal just behind the great toe. He was admitted to Judiciary Square Hospital, Washington, four days afterwards, where the wound went on slowly for some days. The foot was probed and portions of the metatarsal bones were found to be bare and broken. There being no apparent natural effort to throw off the fragments, the upper wound was enlarged and one-half the second metatarsal bone, SECT. VII.] EXCISIONS IN THE BONES OF THE FOOT. 625 including the phalangeal articulation, was removed, together with considerable fragments of the third and fourth metatarsals. On the following day there was some pain, but no haemorrhage. On June 26th the patient was much better ; foot a little red ; poultices applied. June 28th, severe chills; quinine administered. June 29th and 30th, patient the same; foot inflamed a little. July 1st, very severe chills and fever; skin and conjunctivas yellow; tongue brown, dry, and horny. July 2d, bad symptoms increased. July 3d, continuous vomiting; jaundice worse; tongue more moist. July 4th, patient apparently a little better. July 5th, fool improved, but general aspect bad. Patient died July 6, 1862. The history was contributed by Acting Assistant Surgeon D. W. Cheever, who also forwarded the removed portions of the metatarsal bones. (Cat. Surg. Sect., 1866, p. 420, Spec. 506.) SECONDARY EXCISIONS IN THE BONES OF THE FOOT. One of the seventeen secondary excis ions in the bones of the foot was followed by death. Of the sixteen patients who survived the operation one subsequently suffered amputation in the leg. The names of twelve are found on the Pension Kolls; one has died since his discharge from the service of Bright s disease of the kidneys. CASE 919. Sergeant T. Barbin, Co. C, 81st Pennsylvania, aged 18 years, was wounded in the right foot, at Fredericks- burg, December 13, 1862. Assistant Surgeon C. R. Greenleaf, U. S. A., contributed the following report of the injury: "He received the wound from a conoidal ball, which passed directly through the boot and entered the heel, passing through the os calcis in an oblique direction from behind forward and from above slightly downward. Considerable haemorrhage attended the wound, and after an attempt at walking the man was carried to a house near by, where a bandage was applied. Two days after wards he was taken to Washington and admitted to Mount Pleasant Hospital, where cold-water dressings were applied. Eight days later he was transferred to Mower Hospital, Philadelphia, where, on examination, the bone was found to be carious, and poultices were ordered. From this date until the time of the operation several pieces of bone were discharged and some small abscesses were opened. As no improvement was observed and the probe could be passed entirely through the bone, showing a considerable loss of substance, it was finally determined to remove the os calcis. On May 16th I proceeded with the operation, being assisted by Drs. J. H. B. McClellan and C. R. McLean (Acting Assistant Surgeons), and the patient being freely under the influence of chloroform. An incision was commenced a little in front of the articulation between the cuboid and calcis and carried around the heel, parallel with the long axis of the calcis, to a point just posterior to the posterior tibial artery; another was made at right angles to this, about two and a half inches in length, through the tendo-achillis. The flaps Avere then dissected back and disarticulation was effected in the manner recommended by Mr. Erichsen, the operation being completed in thirty minutes and no artery requiring ligation being cut. Morisell s solution was used to control the haemorrhage from the smaller arterial twigs and veins. The flaps were accurately brought together and retained in position by silver-wire sutures, an opening being left posteriorly for the escape of fluids. Cold-water dressings were used. One-half grain of morphia was given, and some little febrile action during the next two days was controlled by spirits mindereri. On May 18th, Smith s ante rior splint was applied to the leg and adhesive strips from the toes to a point near the incision. The incisions on the inner side of the foot healed by first intention and the sutures were withdrawn on May 20th, and a sponge tent was ordered to keep open the posterior point of exit, which had closed by granulations. On May 22d all the sutures were removed and adhesive strips re-applied. Large quantities of grumous pus were being discharged. The patient continued to improve, and on the 24th, the splint was removed, a sling made from a sheet being substituted. After this the patient improved rapidly and left his bed on June 12th, the wound having healed with the exception of a slight track at the junction of the two incisions, from which a little healthy pus was being discharged. By June 17th tlie patient could bear his weight on the foot, the sinus having closed. The contour of the foot was not materially altered, the sole being a little flatter than its fellow. He was in excellent health and fine spirits, and felt no pain when bearing his weight on the foot, but said that it felt very springy." In addition to the history, Dr. Greenleaf also stated that as soon as the parts had become a little hardened and accustomed to their new position, a shoe filled with hair at the heel was to be furnished to the patient. The subsequent records of the hospital show that the patient was able to wear his shoe by July loth, and could walk without crutch. Afterwards he was allowed to stay at his home in Philadelphia on furlough, getting stronger every day and his foot being entirely healed. On November 30, 1863, he was discharged from service and pensioned. Examining Surgeon W. Jewell, of Philadelphia, September 14, 1866, certified that "the removal of the os calcis has left the pensioner lame in his gait but not otherwise injured. Other examiners report nothing additionally import ant. The pensioner was paid September 4, 1880. The excised calcaneum, contributed to the Museum by the operator, and exhibiting general caries, constitutes specimen 1286 of the Surgical Section. 1 CASE 920. Private M. Dean, Co. F, 4th Kentucky, aged 24 years, was wounded in the right foot, at Chickamauga, September 19, 18G3. He was sent to hospital at Chattanooga, and thence one month afterwards to hospital No 1, at Nashville. Surgeon C. W. Horner, U. S. V., in charge of the latter, reported: "The wound penetrated the structure of the tarsus and metatarsus. The parts became considerably swollen, painful, and involved in suppurative inflammation. The patient s system was much reduced from irritative fever and nervous disturbance. On December 7th Acting Assistant Surgeon G. P. Hachenberg made an incision about three inches in size and excised the cuboid bone, using two parts of chloroform and one of sulphuric ether as an anaesthetic. The patient improved very slowlv. Tonics and stimulants were administered, and warm-water dressings, and a weak solution of bromine was applied to the wound about two weeks after the operation." Three months after the date of the operation the patient was transferred to hospital No. 7, at Louisville, whence he was returned to duty June, 1864. At the expiration of his term of service, October 25, 1864, he was mustered out of service and pensioned. Various examining surgeons have certified to the injury and to the use of the foot and ankle as being very much impaired. The pensioner was paid Sep tember 4, 1880. 1 A detailed account of this case by Surgeon C. R. GREEXLEAF, U. S. A., will be found on page 389 of Vol. XLVI of the American Journal of the Medical Sciences, Philadelphia, 1863. SURG. Ill 79 626 INJURIES OF THE LOWER EXTREMITIES. [CHAP.X. TABLE XOVII. Summary of Ninety-seven Cases of Excisions in the Bones of the Foot. Primary operations, 153; Intermediary operations, 5473; Secondary operations, 7490; Time of operation not specified, 9197. No NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPEHATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Aldrich, W. S., Pt., B, May 12, c Right; part of os calcis. Disch d 35 Troutman, P., Pt., A, May 27, Right ; os calcis. Surg. S. II. 14th Intantry, age 21. 12, 04. May 20, 1805 ; pensioned. 77th Penn., age 18. 27, 04. Kersey, 30th Ind. Discharged 2 Anderson, F.,Pt.,H, 28th May 25, Left; third metatarsal. June 9, April 1, 1805; pensioned. Pennsylvania, age 40. 25, 64. amputation toe. Vet. Reserve Corps March 29, 1805. 36 Turner, H. A., Lieut, and Q. M., 43d Mass. Nov. , 1862, Right: 3d metatarsal. Surg. A. C. Webber, 43d Mass. Duty 3 Anderson, J.,Pt., F, 70th May 5, Left. Duty December 9, 1864. Primary. December 21, 1802. New York, age 19. 5, 04. 37 Vandcrgriff, J"..Capt., F, ! Right; two metatarsals. Surg. J. 4 Badeau, A., Captain and May 27, Left ; mid. and parts of int. and 53d Georgia, age 28. 1 J. Knott, 53d Ga. Recovery. Aide-de-Camp. 27, 63. ext. cuneiform ; end of 2d met. < 38 Van Gorder, C., Serg t, Oct. 5, Left: internal cuneiform. Surg, Surgeon 10. F. Sanger, U. S. V. i B, 3!)th Iowa, age 27. 0, 04. J. H. /earing, 57th 111. Disch d Retired May 18, I860. June 5, 180. ). 5 Chapman, P., Pt., H, May 19, Right; 2d metatarsal. Disch d 39 Weaver, G., Teamster, July 13, Left ; 2d and 3d metatarsals. Re 38th Illinois, age 36. 19, 04. January 25, 1865; pensioned. 97th New York. , 64. covery. 6 1 C , G., , , age 23. May 12, Right ; whole calcaneum ; amp. 40 Whittier, C., Pt., C, 12th Sept. 17, Left ; large portion os calcis. Dis 12, 64. left leg. Surf . Strait, C.S.A. Massachusetts, age 19. , iy. charged Jan. 13, 03; since died. Recovery. 41 Baumberger, J., Musi Nov. 30, Right; ext. mid. cuneiform and 7 Donohue, M., Pt., G, 7th Dec. 5, Left ; metatarsal. Surg. L. W. cian, H, 50th N. York, Dec. >, scaphoid. Ass t Surgeon J. F. Rhode Island, age 23. 5, 04. Bliss, 57th N. Y. Duty April age 22. 1804. II uber, U. S. V. Died Dec. 26, 28, 1865. 1804 ; pya-mia. 8 Drummond, A. H., Pt., Dec. 13, Right : 3d and 4th metatarsals. i 42 Fowler, J. G., Pt., K, Dec. 15, Left ; two-thirds tarsal and 2d II, 3d Maine, age IS. 13, 02. Disch d June 4, 04; pensioned. 42d Illinois. 10, 04. metatarsal. Died Dec. 25, 1804 ; 9 Dubois, L. A., Lieut., I, Sept. 20, Right ; end of 2d mot. Surg. H. tetanus. 12Uth New York, age 20, 64. F. Lyster, 5th Mich. Disch d! 43 Hall, A. A., Corp l, M, April 2, Left; metatarsal. Surg. J. H. 24. January 10, 1805. 31st Maine, age 18. 2, 65. Kimball, 31st Me. Died April 10 Eggleston, F., Pt., D, Nov. 12, Right; liead 1st phal. great toe; I 15, 1865. 8th New York Cavalry, 12, 64. head 1st met. Surg. N. D. Fer 44 Hanson, N., Pt., C, 38th June 17, Left; metatarsal. Surg. W. B. age 21. guson, 8th N. Y. Cavalry. Mus Wisconsin, age 34. 17, 04. Fox, 8th Mich. Died June 25, tered out June 19, 1865. 1864; wound. 11 Freeman, D. R., Pt., D, May 5, Left ; 4th metatarsal. Disch d 45 Hunt, P., Lieut., A, 1st May 30, Right; os calcis. Surg. G. L. 7th Wisconsin, age 21. 5, 04. May 22, 1805 : pensioned. Rhode Island Artillery. 30," 64. Potter, 145th Penn. Died June 12 Garrtty, P. H., Corp l, H, June 14, Right; 2d metatarsal. A. Surg. 14, 1804 ; pyoemia. 91st New York, age 24. 14, 63. J. T. Myers, 91st N. Y. Duty 46 Jones, J., Serg t, H, 21st May 3, ; os calcis. Septembers, 1805; pensioned, i Georgia. 3, r 03. 13 Goodwin, J. L., Lieut., July 22, Right ; 2d and 3d metatarsals. 47 Judkins, A., Pt., B, 10th May 2, Left; metatar. and phal. of three H, 57th Mass., age 24. 22, 64. Disch d Nov. 29, 1804. Died Maine. 2, 63. mid. toes. Died June 14, 1803 ; Nov. "J2, 1809 ; consumption. gangrene of leg. 14 Greenleaf, B. F., Pt., E, Aug. 15, Left; 2d metatarsal. To Provost 48 Locke, J., Pt., G, 5th July , Left: tarsal and metatarsal. Died 5th Tenn. Cav., age 31. 10, 04. Marshal Nov. Hi, 1864. North Carolina. 1803. July 18, 1803. 15 Harrington, W. C., Pt., April 2, Left ; 5th metatarsal. Disch d 49 Norton, W. A., Capt., I, June 18, Left : 5th metatarsal. Died July C, 1st Vt H. A., age 19. 2, 05. July 0, 1865; pensioned. 100th Penn., age 23. 18, 64. . 21, 1804; exhaustion. 16 Henry, A. R., Pt., 1,12th May 12, Right ; 2d metatarsal. V. R. C. 50 Pero, P., Pt., C, 2d New May 5, Right; 1st metatarsal. A. Surg. i .Massachusetts, age 30. 12, 04. April 28, 1805; pensioned. York Cavalry, age 22. 7, 04. C. H. Andrus, 128th N. Y. June 17 i rfitehcuck. 15. F., Serg t, May 25, Left ; 2d metatarsal. Surg. J. V. 20, amp. leg. Died July 15, F. 14 Jth N. York, age 25, 04. Kendall, 149th N. Y. Disch d 1804; chronic diarrhoea. 24. June 12, 180."); pensioned. 51 Williams. J. M., Capt., June 3, Right, Died June 15, 1804, of 18. Jock, D. B. W., Pt., H, July 1, Left; portion os calcis. Disch d C, 31st Maine, age 47. 3, 04. wound. 104th N. York, age 23. , 63. May 10, 1804; pensioned. 52 Wright. M. F., Major, Dec. 20, Left : tarsal , amputation of leg. 19 Leunze, J., Pt., C, 71st Nov. 20, Right; 1st metatarsal. A. A. 29th Ohio, age 20. 2(1, 04. Died January 7, 1805. Ohio, age 37. 28, 63. Surg. C. II. Fisher. Disch d 53 Young, , Pt., G, 8th May 5. ; distal end 4th metatarsal. May 10, 1605 ; pensioned. Ohio. , V>4. Surg. C. Bowen, (5th Penn. Res. 20 McGlinn, J., Corp l, F, July 28, Right; 1st metatarsal. V. R. C. 54 Arnot, T., Pt., E, 7th Sept. 17, Left: 2d metatarsal. A. A. Surg. 60th Ohio, age 29. 28, 64. November 19, 1804. Michigan, age 28. Oct. 4, J. Dickson. Discharged Nov. 21? Murray, M., Pt., F, 19th July 30, Left ; lower half os calcis. Right ; 1802. 3, 1802 : pensioned. 22$ Colored Troops. Aug. 2, 5th metatarsal. Surg. D. Mac- 5.") Bailey, D., Pt., G, 3d June 10, Right ; 3d and 4th metatarsals. 1804. Kay, 29th C. T.; recovery. Iowa Cavalry, age 20. 14, 64. A. A. Surg. J. N. Sharp, Feb. 23 Nash, C.. Serg t, A, 82d April 4, Right ; 3d metatarsal. Surg. N. . 1805, amp. leg. Discharged Colored Troops, age 21. 4, 05. N. Hoi-ton, 47th C. T. Disch d Sept. 11, 1805. May 30, 1865. 56 Bowen, M., Corp l, H, May 18, Left; portion os calcis. A. A. 24 Phalen, P.,Pt., B, 117th Sept. 29, Left; portion of os calcis. Dis 57th Mass., age 22. 28, 04. Surg. F. G. II. Bradford. Dis New York, age 40. 29, 64. charged July 0, 65; pensioned. charged May 13, 1803 ; pens d. 25 Pickctt, G., Pt., B, 51st Sept. 19, Right; portion cuboid. To prison 57 Brouchard, A., Pt., A, April 7, Left ; 2d and 4th metatarsals. A . Virginia, age 20. 20, 64. February Hi, 1865. 5th New Hampshire, 17, 65. Staff Surg. J. Aiken, U. S. A. 26 Richards, J.. Pt,, D, 5th July 4, Left; 4th and 5th metatarsals. age 34. Disch d Aug. 12, 1865. Amp. Connecticut. 4, 64. July , amp. leg; Aug. 12, leg. Feb. , 1860, amp. knee re-amp, leg. Disch d May 12, .joint ; subsequent amp. thigh. 1805. Died Feb. 24, 1807. 58 Cole. J. M., Pt., G, 8th Nov. 20, Right; 3d and 4th m.etatarsals. 27 Rowell, P., Pt., A. 1st June 23, Left ; 4th metatarsal. Duty June Michigan Cavalry, age 30, 64. Surg. 15. 15. Breed, U. S. V. Dis Maine H vy Artillery. 23, 04. 7, 1805. 22. charged May 12, 1805. 28 Ryan, J.. Serg t. G, 4th Nov. 24, Right ; 4th and 5th metatarsals. 59 Hargrave, M. II., Pt., 8th Sept. 19, Left : portion of os calcis and as- West Va., age 25. 24, 63. Surg. I. N. Barnes, 116th 111. Indiana Battery, age 29, 03. tragalus. Disch d December 30, Disch d July 6. 64 ; pensioned. 42. 1804. Died November Hi. 1871 : 29 Scanlon, B., Pt., K, 103d Nov. 25, Right ; 1st metatarsal. Disch d paralysis. Illinois, age 27. 25, 63. July 5. 1804; pensioned. do Jackson. R. G., Pt.. A, June 3, Rijrht; li in. 3d metatarsal (ery- 30 Shriver, G. A., Lieut., April 2, Right; 1st metatarsal. Disch d !| 8th New York Heavy 9, 04. sipelatous). Ass t Surg. S. J5. B, 119th Penn., age 23. 2, 65. June 19, 1805; pensioned. Artillery, age 23. Ward. IT. S. V. Disch d Oct. 6. 31 Smith, R. J., Pt.. G, 21st Nov. 28, Left; two-thirds 2d metatarsal. 1804 ; pensioned. Kentucky, age 22. 28, 64. A. A. Surg. T. C. Eakin. Kry- 61 Jacobs, W. G., civilian, Sept. 11. ; third of os calcis. Disch d sijielas. Disch d Sept. 11, 1805. age 30. Hi, 02. Dec. 1, 1802; pensioned. 32 Smith, W. A., Serg t, C, Feb. 21, Right; 1st and 2d metatarsals. 6:. Kinscll, G. W., Pt,, D, June 3, Left ; 4th and 5th metatarsals. 7th Infantry, age 39. 22, 62. Disch d Aug. 23, 02 ; pensioned. 184th Penn., age 19. 2". 04. A. A. Surg. E. L. Bliss. Disch d 33 Trennor, J., Lieut., H, June 3, Left; os calcis. Surg. P. E. Hu- May IS, 1805: pensioned. 28th Mass., age 23. 3, 64. bon, 28th Mass. Disch d Oct. 63 McDougal, J., Pt,, E,2d May 20, Right; 3d metatarsal. A. A. Surg. 13, 1804. Died Feb. 8, 1670; 1 N. Y. Cavalry, age 23. 30, 64. R. W. W. Carroll. Discharged consumption. May 22, 1805; pensioned. 34 Troutman, J. C., Pt., K, June 19, Left ; 2d and 3d metatarsals. Dis 64 Myerson,G., Pt., G, 14th Oct. 14, Left ; os calcis. Surg. E. Bentley, 3d Teun., age 29. 22, 64. charged July 8, 05 ; pensioned. Connecticut, nge 24. 18, 63. U. S. V. Disch d Aug. 18, 05. I McGuiRE (H.), Excision of the Os Calcis, in The Philadelphia Medical Times, 1870-71, Vol. I, p. 6. * WEBBER (A. C.), Army Medical Intelligence, in Boston Medical and Surgical Journal, Vol. LXVIII, 1863, p. 164. SECT. VII.] AMPUTATIONS IN THE FOOT. 627 Vr NAME, MILITARY DATFS OPERATIONS, OPEUATOKS, NO. NAME, MILITARY OPERATIONS, OPERATORS, iXU. DESCRIPTION, AND AGE. RESULT. DESCRIPTION, AND AGE. DATKS. RESULT. 65 Sherd, W., Corp l, G, Aug. 16, Left ; 2d metatarsal. A. A. Surg. 80 Fritchman, J., Serg t, E, July 2, Right; os calcis. A. A. Surg. T. llth Maine. , 64. F. Ganntt. Discharged May 105th Penn., age 31. Nov. 1, G. Morton. Discharged Sept. 24, 1865; pensioned. 1803. 4, 1804. 06 Sweeney, B., Pt., B, 7th July 2, Left. A. A. Surg. A. E.Carothers. 81 Gage, C., Pt.. D, 8th May 20, Left; two metatarsal bones. A. Infantry, age 30. 22, V 63. Disch d May 14, 64 ; pensioned. Maine, age 20. 1804, Surg. J. Vansant. Disch d May 67 Young, W. C., Corp l, Nov. 27, Left ; 3d and 4th metatar. Surg. Feb.8, 05. 15, J865; pensioned. H, 24th Mich., age 29. Dec. 9, E. Bentley, U. S.V. Duty July 82 Haws, C. B., Pt., B, 7th Se.l7. 02, Left; portion of cs calcis (necro 1803. 13, 1804. Maine, age 21. Ja.24, 03. sis). Duty June ! . 1803. 68 Zimmerman, B., Pt., B, June 15, Left : 3d and 4th metatarsals. A. 83 Hodges, G., Pt., K, 13th Sept. 20, Right; almost entire os calcis lllth Penn., uge 33. 21, 04. Surg. J. D. Johnson, U. S. V. Michigan, age 19. Dec. 20, (necrosis). A. A. Surg. D. O. Disch d April 11, 1865; pens d. 1803. Farrand. Discharged April 25, C9 Carl, A. J., Pt., C, 5th July 3, Right ; upper half metatarsal of 1804 ; pensioned. Michigan, age 27. 13, V 64. great toe. A. A. Surg. T. T. 84 Irwin, T., Pt., H, llth Se.17, 63, Left ; portion of os calcis. Ass t Devan. Died July 22, 1864; Pennsylvania, age 26. Nov. 3, Surgeon C. H. Alden, U. S. A. pyaemia. 1803. Discharged June 1>. 1804. 70 Gaffnev, M., Pt., A, 114th Oct, 19, ; portion of os calcis. A. A. 85 Shinquin, E., Pt., E, 63d Se. 17, 02, Right ; base of os calcis. Vet. New York, age 27. 31, 64. Surg. E. L. Duer. Died Nov. 9, New York. Ja. 10/63. Kes. Corps June 25. 1803. 1864 : pyaemia. 86 Spielman, T., Pt., F, Aug. 29, Rifflit : os calcis. Surg. J. G. F. 71 Green, T., Pt., I, 9th May 5, Left ; 1st. 4th, and 5th metatarsals 95th Ohio, age 23. 1802, Holston, U. S. V. July 10, 64, Massachusetts. , 64. and mid. cuneiform. A. A. Surg. Se.21, 63. amputation leg; recovery. C. H. Van Tagen. Died May R7 Stroud, D., Pt., B, 3d Nov. 30, Left ; 3d metatarsal. A. A". Surg. 28, 1804. Mississippi, age 41. 1864, W. J. R. Holmes. To Provost 72 King, E.,Pt.,B, 1st Ver Aug. 25, Right; 1st metatarsal. A. A. Jan. 1, 65. Marshal May 6, 1865. mont Cavalry, age 18. 30, 64. Surg. M. J. McHench. Died 88 Tvrigg, 0., Pt., C, 46th Au. 3, 64, Right; 5th metatarsal. A. A. Sept. 11, 1864; pytemia. Ohio, age 23. Feb. 7, Surg. W. H. Drury. Disch d 73 McKenian, W. \V., Pt., May 31, ; half2d metatarsal and parts 1865. June 30, 1865; pensioned. H, 3d Michigan. June 24, of 3d and 4th. A. A. Surg. D. 80 Yax, O., Pt., C, 22d Se. 20, 63, Right ; almost entire os calcis. 1862. \V. Cheever. Died July 6, 1862. Michigan, age 23. Jan. 20, Surgeon C. S. Tripler, U. S. A. Spec. 506. 1804. Disch d May 2, 04 ; pensioned. 74 Albert, J. B., Corp 1, K, Mar. 23, Left ; 1 st metatarsal. A. A. Surg. 90 Freese. J. B., Pt., I, 1st July 2, Left ; os calcis. Died August 15, 110th Penn., age 32. May 2, J. Gibbons, Disch d Oct. 14, Minnesota, age 25. Au. 2, 63. 1863 ; trau. fever and pytvmia. 1862. 1862 ; pensioned. 91 Ferguson. A., Pt., C, 22d July 12, Left ; part of os calcis. Disch d 75 !Barbin, T., Serg t, C, De.13, 62, Right ; entire os calcis. Ass t Kentucky, age 42. , 63. Nov. 21, 1804; pensioned. 81st Penn., age 18. May 16, Surg. C. R. Greenleaf. U. S. A. 92 O Leary, C., Pt., F, 3d July , Left ; portion 1st metatarsal. Dis 1863. Disch d Nov. 30, 63. Spe.c. 1286. Infantry, age 22. 2, 03. charged Aug. 20, 04 ; pensioned. 76 Bennett, T., Pt., E, 5th July 2, Right ; 4th and 5th metatarsals 93 Whitefie ld, N., Pt., B, June 27, Right ; portion of os calcis. Dis Michigan, age 28. Oct. 27, (necrosis). Disch d Dec. 18, 63. 16th Michigan, age 18. , 02. charged Dec. 18, 1862 ; pens d. 1863. Died May 12, G4 ; Bright s dis. 94 Wendell, D. F., Pt,, D, June 17, Left; 2d metatarr.al. Disch d 77 Dean, M., Corp l, F, 4th Sept. 19, Right ; cuboid. A. A. Surg. G. 60th Ohio, age 20. , 64. Feb. 27, 1865. Died August 8, Kentucky, age 24. Dec. 7, P. Hachenburg. Disch d Oct. 1870; consumption. 1863. 25, 1864 ; pensioned. 95 Wood, G.F.,Pt.,E, 24th May 23, Right ; metatarsal. Died June 7- Button, L. N., Serg t, C, De.13, 62, Left; int. cuneiform, portion of Massachusetts, age 19. , 64. 24, 1864 ; pysemia. 3d Vermont, age 20. Jan. 16, metatarsal. Disch d April 1, 96 . Cross, T., Pt., D, 21st Oct. 8, ; 3d metatarsal ; gangrene. 1863. 1863; pensioned. South Carolina. , 64. 79 Fender, B. F., Corp l, B, May 19, Right ; 1J in. 2d and 3d metatar 97 Smith, L. S., Pt., , 2d Aug. 14, Left; metatarsal. 113th Illinois, age 30. Nov. 29, sals (gangrene). Discharged; South Carolina. , 64. 1863. pensioned. The operations were performed in the right foot in forty-four, in the left in forty-eight instances; in five cases the side was not indicated. Eighty-eight patients were Union, seven Confederates, and two unknown soldiers. In seven instances the excision in the foot was followed by re-amputation in the leg, and in one instance re-amputations were per formed in the leg, at the knee joint, and finally in the thigh. Gangrene was noted in eight cases (five recoveries, two deaths, and one unknown result); pyaemia in eight (all fatal); erysipelas in one (recovery); and tetanus in one (fatal) instance. AMPUTATIONS IN THE FOOT. One thousand five hundred and eighteen amputations in the foot were recorded: in eighty-seven the operation was through the tarsal bones; in forty-one through the tarso-metatarsal articulation; in one hundred and thirteen from one to four metatarsals and the corresponding toes were amputated; in fifty cases the operation was simply denoted as "amputation of the foot;" and in one thousand two hundred and twenty-seven instances the operation was confined to the toes embracing the ablation of one toe in one thousand and one instances; of two toes in one hundred and forty-five, of three toes in thirty-one, of four toes in eight, and of all five toes in eighteen instances; in twenty-four cases the number of toes removed was not stated. Seven hundred and fifty were primary, two hundred and sixty-seven intermediary, and ninety-four secondary operations ; in four hundred and seven the time of the operation was not indicated. 1 GREENLEAF (C. R.), Excision of the Os Calcis, in American Journal Medical Sciences, Vol. XLVI, p. 389. 628 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. TABLE XCVIII. Numerical Statement of One Thousand Five Hundred and Eighteen Cases of Amputation in the Foot. METHOD OF OPERATION. CASES. PRIMARY. INTER- j SECOXU- MED1AUY. 1 .A BY. TIME NOT SPECIFIED. 5 S H Kecoveries. Deaths. Undetermin d. Percentage of Mortality. Recoveries. Deaths. Undetermin d. Recoveries. Deaths. Undetermin d. Recoveries. Deaths. Recoveries. Deaths. Undetermin d. 85 24 17 113 1,227 50 72 1 22 11 99 1,093 18 11 1 1 6 9 29 24 81 2 13.2 50.0 57 5 1 1 5 1 6 1 1 q Amputation through tarso-metatarsal articulation (LlSFRANC s) . . Amputation through tarso-metatarsal articulation (HEY s) Amputation of from one to four metatarsal bones and toes 1 5 105 8 4.3 35.2 8.3 2.5 57.1 16 9 52 512 5 1 4 3 18 4 1 59 4 1 24 207 1 1 j 6 5 3 1 19 2 11 3 43 8 54 3 76 1 92 , 9 .... 298 6 11 17 1,518 1,316 121 5.7 651 * 3(1 750 63 243 20 S 267 4 2 , 4 330 03 407 PKIMARY AMPUTATIONS IN THE FOOT. Of the seven hundred and fifty primary opera tions the results were not ascertained in sixty-three; six hundred and fifty-one patients survived and thirty-six died, a mortality rate of 5.2 per cent. One hundred and sixty-one operations were through the tarsal or metatarsal bones; five hundred and eighty-nine were amputations of the toes. CASK 921. Private M. C. Fitxpatrick, Co. H, 2d New York Mounted Rifles, aged 50 years, was wounded before Petersburg, Juue 30, 1864. He was admitted to the field hospital of the 2d division, Ninth Corps, where Surgeon J. Harris, 7th Rhode Island, recorded : Fracture of right foot by mini6 ball, followed \, " - s?M by Chopart s amputation." Several days after the operation I the patient was transferred to Washington, where he entered \ f:, Stanton and subsequently Judiciary Square Hospital. The ! wound was reported ns healing mostly by first intention, leav ing an excellent stump. On April 1, 1865, the patient was j discharged from service and pensioned, having been previously furnished with an artificial foot by the Jewett Patent Leg Co. Examiner H. N. Loomis, of Buffalo, N. Y., September 4, 1869, certified to the loss of the foot and stated : " Wound healed, leaving the ankle nearly powerless and the end of the stump and heel very tender. His general health is very feeble, with harassing cough and night sweats." The history of the case was accompanied by drawings copied in the adjoining wood cuts (FlGS. 356, 357). .The pensioner died of consumption December 28, 1869. CASK 922. Private J. Armstrong. Co. H, 39th Illinois, aged 41 years, was wounded in the left foot, at Morris Island, August 15, 1863. Assistant Surgeon J. Trenor, jr., reported the following history: "A shell struck the phalanges and carried off all the toes except the fifth. Amputation was performed through the metatarsal bones at the centre of their continuity, immediately after the wound was received, by Surgeon C. M. Clark, 39th Illinois. Six days after the operation the wounded man was admitted to hospital No. 4, at Beaufort. The wound was then in a sloughy condition, with an exceedingly offensive discharge and every symptom of constitutional irritation. Cold-water dressings were used. The patient continuing to grow worse, a consultation of surgeons was held five days after his admission, when a second operation was deemed the best plan for saving his life, and Chopart s amputation was resolved upon for the next day. As a last resort, however, to avoid another operation, the dressings were changed to oakum, and in about sixteen hours a change for the better was evident in the aspect of the wound. It steadily continued to improve until the date of the report, August 31st, when there was every prospect that the foot, would have a good cicatrix and a fair support sufficient for the weight of the body." In the following month the patient was transferred to McDougall Hospital, New York, and subsequently he was admitted to Marine Hospital. Chicago, where he was discharged from service November 3, 1864, and pensioned. In March, 1871, the stump was tender, swelling after exercise. CASK 923. Private M. Shauprhnepsv. Co. H. 2d Pennsylvania Artillery, aged 28 years, received a shot fracture of the bones of the left foot, before Petersburg, June 1H. 1864. He was admitted to the field hospital of the 2d division, Sixth Corps, where primary amputation by Chopart s method was performed. Surgeon G. T. Stevens, 77th New York, who performed the operation. Fio. 356. CIIOPART S amputation ; anterior view, f After a drawing.] FIG. 357. CllOl AKT s amputation; view. [After a drawing 1 .] SECT. VII.J AMPUTATIONS IN THE FOOT. 629 reported that "the flap was made from the inner side of the foot, the sole being too much mutilated for Chopart s operation." Two days after the date of the injury the wounded man was transferred to Hampton Hospital, and several weeks later he was transferred to Philadelphia. He was discharged December 10, 1864, and pensioned. In his subsequent application for commuta tion the pensioner reported the stump of the foot as being in good and healthy condition." His pension was paid June 4, 1880. CASE 924. Private J. Miller, Co. E, 6th Pennsylvania Reserves, aged 20 years, was wounded in the right foot, fracturing the bone, at Fredericksburg, Uect mber 13, 1862. He was admitted to the field hospital of the 3d division, First Corps. Surgeon C. Bower, 6th Pennsylvania Reserves, reported that he performed "amputation at the tarsus" on the day of the injury. Acting Assistant Surgeon H. Hirschfield reported the progress of the case as follows : "The patient was admitted to Harewood Hospital at Washington ten days after being wounded. Chopart s amputation had been performed on the field. On December 27th, when the case was first seen by me, there was much suppuration and the wound seemed to be drawn open, by the teudo-achillis. 1 applied a splint to correct the tension and at first used cold wator and afterwards warm dressings ; tonics and stimulants were administered. By January 20, 1863, the wound had nearly healed and dry lint and bandages were used. A small abscess hud appeared at the ankle and had been opened. About February 15th this opening became gangrenous and the leg in this locality swelled up to an enormous size the abscess, which originally was only two inches long, growing into a large sore of circular shape three and a half inches in diameter. All the tissues and even the periosteum were destroyed. Healthy granulations, however, were finally brought out, and the part was healing but could not close up on account of necrosis in part of the tibia- While the healing process of the neighboring parts was progressing favorably, erysipelas set in and spread from the foot to nearly up to the knee, being attended by excessive sloughing of the original abscess. This soon passed off, however, and after a few days the wound again became healthy in appearance, decreased in extent, and the leg resumed its natural size rapidly. Things now went on favorably again for a time, when severe pain indicated another collection of matter above the line of the affected tibia and towards the middle of the leg, which was relieved by an incision two inches in length into the periosteum, giving free exit to the confined pus. This last opening healed up readily, and by June 1st nature had completed the exfoliation of the cortical substance of the tibia, which I removed four inches in length. The wound now healed up very rapidly, but several days afterwards gangrene re-appeared and continued up to June 10th. Poultices were continued in the mean time and the treat ment was adapted to the exigencies of the case. During the progress of the case the patient s general condition, which was very good now, had varied according to the several complications, being sometimes very low and prostrated from hectic and diarrhoea, but always reacting rapidly. On June 14th healthy granulations once more showed themselves, and by July 8th the wound had closed up to the size of a two-shilling piece. Ten days later it was healed entirely, the patient s general condition being excellent." He was discharged from service September 4, 1863, and pensioned, and one year afterwards he was supplied with an artificial foot by the Palmer Arm and Leg Co. of Philadelphia. The pensioner was paid June 4, 1880. CASE 925. Private T. H. Hodgson, Co. F, 67th Ohio, aged 32 years, was accidentally wounded, at Folly Island, June 22, 1863, by a musket ball fracturing the left foot. Amputation by Chopart s method was performed the following day by Surgeon S. F. Forbes, 67th Ohio. The wounded man passed through various hospitals and was lastly transferred to Central Park, New York City, where, as soon as the stump had entirely healed, he was supplied with a " Hudson " artificial foot. Four months later, on August 9, 1864, the patient was discharged from sen-ice and pensioned. The Dayton, Ohio, Examining Board on January 16, 1871, reported a " well healed and very useful stump," and described the operation as very creditable to the operator and to the author of it. A cast of the stump (Spec. 1530), made about a year aftgf the date of the operation and showing a firm and smoothly united cicatrix well up on the anterior face, was contributed to the Museum by Assistant Surgeon J. W. S. Gouley, U. S. A., and is represented amputant n^of "hfhsft in the adjoining wood-cut (FlG. 358). foot. [Prom a cast.] In the succeeding three cases three or more of the metatarsal bones with the cor responding toes were removed. The remaining toes were a constant source of annoyance: CASE 926. Private R. P. Saint, Co. F, 123d Indiana, aged 22 years, was wounded in the right foot by a shell, during the siege of Atlanta, August 4, 1864. Partial amputation of the foot by removing the four outer toes, including the distal extremities of their metatarsal bones, and leaving the great toe intact, was performed on the day of the injury. The wounded man continued under treatment in various successive hospitals until June 11, 1865, when he was discharged from service and pensioned. Examiner G. W. Hears, of Indianapolis, certified, August 23, 1865 : " The wound is now healed, but the foot and ankle are weak. As yet but little weight can be sustained on the foot and crutches are therefore still in requisition. It is, however, improving in strength and will soon be used in walking." On November 17, 1866, the same examiner stated : "What disables the pensioner most seriously is the pain suffered when the foot is much used, the .eschar being yet tender to the touch from imperfect healing and liable to inflammation," etc. Examining Surgeon G. A. Haise, of Russell, Kansas, October 12, 1877, described the great toe of the injured foot as being drawn or lapped across the cicatrix. The pensioner was paid March 4, 1881. CASE 927. Private J. T. Lewis, Co. B, 38th Illinois, aged 21 years, was wounded in the right foot, before Atlanta, August 16, 1834. Surgeon M. G. Sherman, 9th Indiana, reported his admission to the field hospital of the 1st division, Fourth Corps, and described the injury as a "fracture of the metatarsus, followed by amputation of three toes by Surgeon S. H. Kersey, 36th Indiana." The wounded man subsequently passed through various hospitals and was, lastly, transferred to Jeffersonville. Assistant Surgeon A. B. Prescott, U. S. V., in charge of the latter, described the operation as a "flap-amputation of the three lesser toes at the tarso-metatarsal articulation." On June 1, 1865, the patient was discharged from service and pensioned. Examining Surgeon J. Portness, of Xenia, Illinois, certified, April 6, 1866 : " The third, fourth, and last toes with their metatarsal bones have been removed, leaving only the great and second toe. This renders the sole of the foot very narrow and destroys the elasticity of the arch of the foot in a great measure." The reports of subsequent examinations show no additional information. The pensioner was paid December 4, 1878, since when he has not been heard from. 630 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. CASE 928. Sergeant H. S. Carroll, Co. D, 33d Missouri, aged 20 years, was wounded in the left foot, at the battle of Lake Chicot, June 6, 1864, by a shell which destroyed the second, third, and fourth toes. He was admitted to the Sixteenth Corps Field Hospital, where partial amputation of the injured foot was resorted to by Surgeon A. T. Bartlett, 33d Missouri, who described the operation as having been performed through the second, third, and fourth metatarsal bones. From the field the patient was sent to Adams Hospital, at Memphis, where he remained under treatment for four months, when he was returned to duty. He was discharged August 10, 18b o, and pensioned. Various examiners have from time to time certified to "irritation and swelling of the foot when much used;" and Dr. H. E. Jones, of Louisiana, Missouri, added, January 12, 1878, that " the big toe is drawn nearly at right angle with the foot and rests on the little toe." The pensioner was paid June 4, 1881. CASE 929. Private C. L. Daniels, Co. K, 57th Massachusetts, aged 18 years, was wounded before Petersburg, July 20, 1864. Surgeon M. K. Hogan, U. S. V., reported his admission to the field hospital of the 1st division, Ninth Corps, with " shot fracture of the bones of the right foot, treated by Chopart s amputation." Acting Assistant Surgeon F. F. Maury reported the result of the case as follows: "The patient was admitted to South Street Hospital, Philadelphia, July 26th. He stated that he was wounded by a mini6 ball entering the right side of the foot and fracturing the bones to such an extent as to demand amputation on the field. He was sent to City Point and thence by hospital boat to this city. At the time of his admission to this hospital the patient was in a typhoid condition, fretful, irritable, and at times delirious. The stump was in a very good condition, with but a slight tendency to inflammation in the leg. This condition yielded readily to applications of laudanum and leadwater, after which the stump and leg both improved. Compound tincture of cinchonas and afterwards quinine was prescribed; beef tea and milk punch were given. The typhoid fever did not yield to the treatment, the patient continuing to sink until July 29th, when death supervened." The amputated metatarsal and part of the tarsal bones (Spec. 6531), with the bullet attached and showing the seat of the fracture, were contributed to the Museum by Surgeon H. Ludington, 100th Pennsylvania, who performed the operation. A representation of the specimen appears in the wood-cuts (FiGS. 359, 360). CASE 930. Private W. H. Jamison, Co. G, 24th Michigan, was wounded in the left foot, at Fredericksburg, April 29, 1863. Surgeon J. H. Beach, 24th Michigan, described the injury as follows : "A mini6 ball passed through the foot from right to left. All the metatarsal bones were injured and all but that of the second were comminuted fractures. The fractures extended to the tarso-metatarsal articulation in the first and in the fourth. Amputation was performed on May 1st, by Surgeon E. Shippen, U. S. V., at the tarso-metatarsal articulation by Lisfranc s method, a good covering being obtained from the plantar flap. Perfect amesthesia was preserved during the operation by chloroform. The case was left at the First Army Corps Hospital and was doing well at last advices." Surgeon A. W. Whitney, 13th Massachusetts, reported that the patient died at the Fitzhugh House Field Hospital, May 24, 1863, from the result of the injury. The amputated bones of the foot (Spec, 1121) were contributed to the Museum by the operator. In the following table one hundred and sixty-one primary amputations in the tarsal or metatarsal bones are enumerated; space will not permit to cite the amputations of the toes in this and the succeeding three tables: TABLE XCIX. Summary of One Hundred and Sixty-one Primary Amputations in the Tarsal and Metatarsal Bones for Shot Injury. [Recoveries, 1139; Deaths, 140157; Unknown, 158 163. | F , T9 -F tureofuie tarsai bones; dorsal view, No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Adams, J. N., Pt., K, Sept. 17, Left ; Chopart s. Surgeon P. S. 8 Brown, C. W., Pt,, B, Oct. 19, Right ; Lisfranc s. Discharged 31st Wisconsin, age 27. 17, G4. Arndt. 31st Wis. Discharged 3d Vermont, age 23. 20, 64. May 8, 1865. May 13, 18C5; nee. of os calcis. 9 Brown, L. C., Pt., E, Oct. 27, Left ; Chopart s. Disch d June 2 Armstrong, J., Pt., H, Aug. 15, Left ; Hey s ; through the centre of 30th Colored Troops, 28, 64. 22, 1P65; stump not good; 39th Illinois, age 37. 17, 63. continuity of metatarsals. Surg. age 29. heel drawn up." C. M. Clark, U. S. V. Disch d 10 Bumgardner, S., Serg t, Sept. 22, Right; Choparfs; also amp. left November 3, 1864. F, 14th West Va., age 22, 64. leg. Disch d March 4, 1865. 3 Army. A. P.. Pt., H, 52d April 2 Right : Chopart s. Released July 34. * No better thiui if amputated in North Carolina, age 24. 3, (i5. 10, 1865. lower third leg." 4 Avery, J. R., Lieut., B, Oct. 20, Left; Chopart s. Surgeon J. J. 11 Burnside, G. M., Pt., E, June 18, Lett; Chopart s, Surgeon G. T. 53d Georgia, nge 30. , 63. Knott, 53d Georgia. Recovery. 89th N. York, age 21. 18, 61. Stevens, "th X. Y. Disch d; 5 Bean, G. H., Lieut.. H, July 20, Right: 3d and 4th toes and meta stump healod. 2 1st Mass., age 20. 20, 64. tarsal bones. Discharged Aug. 12 Butner. A., Pt., E, 35th Deo. 6, Right: Chopart s. A. A. Surg. J. 30, 1864 ; pensioned. Kansas Cav., age 18. 7, 63. Thome. Disch d May 18, 1864. 6 Dowers, A. M., Lieut., July 1, Left : Chopart s. To prison Oct. 13. Buzzard, A. W., Pt., E, April 6, Left; Chopart s. Released June D. 15th S. C., age 25. 2, 63. 2C, 18f>3; healed. 31st Virginia, age 43. 7, 65. 2 . , 18(>5; "muscles contracted, 7 Bovan, J., Pt., F, fith June 18, Left ; 5th toe and metatarsal ; ne elevating heel." N. Y. Heavy Artillery, 18, 64. crosis. Discharged January 20, 14 Campbell, J., Corp l, 8th May 18, Right ; 5th toe and metatarsal. age 28. 1865; pensioned. Co.,N. Y. S. S., age 24. , 64. JJuty September 12, 1864. SECT. VII.] AMPUTATIONS IN THE FOOT. 631 No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. XO. NAME, MILITARY DESCRIPTION, AXI> AGE. DATES. OPERATIONS, OPERATORS, RESULT. 15 Carlisle, J., Pt., H, 16th July 3, Left; great toe and metatarsal. 51 Hart, J. W., Pt,, H, 22d Mar. 19, Right; Chopart s. Disch d June Vermont, age 22. 3, 63. Discharged August 11, 1863. Indiana, age 18. 19, 65. i 30, 1865. 16 Carroll, H. S., Serg t, D, June 6, Left; 2d, 3d, and 4th toes thro 52 Hawley, W. S., Corp l. May 19, Left ; Hey s. June 9, gangrene. 33d Missouri, age 20. 6, 64. raetatarsals. Surg. A. T. Bart- E, 51st New York, age 19, 64. Oct. 15. amp. leg. Disch d May lett, 33d Missouri. Duty Octo 30. 21, 1865. ber 6, 1864; pensioned. 53 Hazel, P., Pt., G, 9th May 15, Left; 3d toe at tarso-metatarsal 17 Christian, W. T., Pt., Mar. 25, Lett ; Lisfranc s. To Provost New Jersey, age 18. 15, 64. articuUit n. Disch d May23, 65. G, 25th Ala., age 25. 25. 65. Marshal June 13, 1865. 54 Herman, L., Pt., M, 7th June 8. Left ; Hap ; 2d toe at tarso meta. 18 Clark, H. W.. Pt., H, May 13, Right; Chopart s; also amp. left N. Y. Art y. age 18. 8, 64. artic. V. R. C. Feb. 21, 1865. 100th New York, age 13, 64. ankle joint. Surg. M. S. Kittin- 55 Higgins, T., Corp l, H, April 2. Left; Chopart s. Disoh d June 30. gir, 100th New York. Disch d liWd Ohio, age 33. 2. fi5. 23, 1865. ec. 1 3, 64. Spec. 2857. 56 Hodgson, T. H., Pt., F, June 22, Left; Chopart s. Surgeon S. I". 19 Coan. N., Pt., H, 12th May 5, Left ; 4th toe. mid. of metatarsal. 67th Ohio, age 27. 23, 63. Forbes, 67th Ohio. Discharged New Jersey, age 27. 5, 64. Vet. Res. Corps June 19, 1865. August 9, 1864; well healed. 20 Coffin, I., R, D, 69th June 22, Left, Chopart s. Confcd. sur useful stump. Spec. 1530. Pennsylvania, age 21. 22. 64. geon. Disch d June 27. 1865. 57 Horr, D. P., Corp l, H, Dec. 13, Left; Chopart s. Disch d May 21 Collins, J., Pt., 1, 20th Aug. 14, Left; 1st, 2d, 3d, and 4th toes, 17th Maine, age 23. 13, 62. 11, 1863: ".-tump will always Massachusetts, age 26. 15, 64. portion of metatarsals. Surg. be troublesome." N. Hayward, 20th Mass. Dis 58 Rowland, H., Pt., A, 3d June (J, Left: 1st toe at middle of meta charged April 1, 1865. Missouri Cav., age 17. 9. 65. tarsal. Recovery. 22 Cornwall, N. S., Pt., C, May 5, Left: Chopart s. Disch d Janu 59 Hnmbarger, A., Pt., E. Nov. 30, Left ; triangular of 2d toe at tarsal 10th Mass., age 26. 5, 64. ary 7, 1865. 30th Indiana, age 31. Dec. 2, joint. A. A. Surg. M. 1 . \Voolf. 23 Cunningham, D. C., Pt., May 4, Left ; Chopart s. Surg. Strick- 1864. Soldiers Home April 27, 1865. A, 5th Louisiana. 5, fo. len, C. S. A. Disch d Nov. 6, 63. 60 Ireland, J., Pt., H. 8th Aug. 17, Right ; 3d toe, portion metatarsal. 24 Davis, J.. Serg t, A, 12th Dec. 13, Left ; small toe and portion meta N. Y. II. Art y. age 24. 18, 64. Disch d May 30, 1865. Massachusetts. 13, 62. tarsal. Disch d March 27, 1863. 61 Jenks. T. B., Pt., A, July 3, Right ; Chopart s. Surg. C. F. 2u Davis, J. B., Pt.. B, June 7, Left: 3d toe and portion of meta 37th Mass., age 45. 3, 63. Crehore, 37th Mass. Disch d 105th Illinois, age 27. 9, 64. tarsal. A. Surg. A. Waterman, Jan. 20, 64 ; serviceable stump. 105th Illinois. Disch d October 62 Johnson, S. J., Pt., B, Dec. 13, Left ; Hey s. Discharged May 29, 1864 ; pensioned. 31st C. T., age 19. 14, 64. 16, 1865. 26 Dunn. B., Pt., E, 3d July 3, Left. Paroled September 23, 63. 63 Kendig, D. E., Pt., C, April 2, Right ; 3d, 4th, and 5th toes and North Carolina. , 63. 5th Tennessee, age 25. 2, 65. metatarsals. Discharged June OT Dyer. F. A. M., Pt.. F, April 9, Right ; 4th toe and 1 inch meta 18, 1865. 1st West Va., age 35. 10, 64. tarsal. Surg. P. Gardner. 1st 64 King, A., Lieut., K. 62d June 27, Right; mortification; July, 186!>, Va. Cav. D uty Sept. 9, 1864. Pennsylvania, age 25. 28, 62. amp. leg; 18G3, re-amputation. 28 Eddy, W. P., Pt.. E. 1st May 19. Right ; Chopart s ; no motion of os Disch d March 17, 1863. Died Mass. H. Art y. age 29. 19, 64. calcis. Disch d July 22. 1864. July 12. 1872. 29 Elliff, W. W.) Pt., G, May 6, Left; great toe and metatarsal. 65 King, J., Serg t. K, 50th Aug. 21, Right ; Chopart s. Provost Mar 117th Illinois, age 24. 6, 64. Duty July 14, 1864: pensioned. Georgia, age 41. , 64. shal March 8, 1865. 30 l Finnigan,I>., Pt., F, 1st June 2, ; Chopart s. Surgeon C. B. 66 Kingsley, G. H., Pt., A. June 17, Right : Lisfranc s. Discharged Battery. 3, 64. Gibson, C. S. A. August 20, 1st D. C. Cav., age 27. , 64. Dec. 14, 1864; serviceable limb. amp. leg. Transferred. 67 Koon. C., Pt., G, 41st Nov. 5, Left ; Lisfranc s. Surgeon A. G. 31 Fitzpatrick. M. C. (alias June 30, Right; Chopart s. Disch d April Ohio, age 24. 5, 62. Hart, 41st Ohio. Discharged Coots , Pt., H, 2d N. Y. 30, 64. 1, 1865; "an excellent stump." December 31, 1862. M. Rifles, age 44. Died Dec. 28, 1869: consumpt n. 68 Lamb, H., Pt., C, 125th June 27, Left ; 2d toe and portion metatar 32 Forbes, W. E., Pt., H, Aug. 18, Right ; oval ; 3d and 4th toes, Ohio, age 19. 27, 64. sal. Surg. J. B. Burns, :!d Ky. 14th Indiana Battery, 18, 64. portions of metatarsals. Recov Discharged Feb. 20, 1865. age 40. ery Nov. 4, 1864. 69 Langford, J. C.. Serg t, Julv 9, ; great toe and its metatarsal. 33 Franklin, J. W.. Pt., B, June 18, I/eft ; Lisfranc s. Disch d Dec. B, 38th Georgia, age 11, 64. Surgeon C. H. Todd, C. S. A. 8th New York Cavalry, 18, 63. 12, 1863; "painful and difficult 23. Transferred August 25, 1864. age 30. use of limb. 70 Lare, D., Corp l, A, 51st Dec. 2, Right ; 2d toe and metatarsal. 34 Fuller, H. D., Pt., F, Oct. 19, Left: Chopart s. Surg. J. W. H. Pennsylvania, age 23. 2, 63. Disch d Sept. 11, 1864. 28th Iowa, age 16. 20, 64. Vest, 28th Iowa. (Also amp. 71 Lewis, j., Pt,, B, 38th Aug. 16, Right ; flap ; 3 lesser toes at tarso- arm.) Disch d June 21, 1865; Illinois, age 21. 16, 64. metatarsal articulat n. Disch d " better to have removed entire June 1, 1865. foot." Spe.c. 4226. 72 Lewis, J., Lieut., C, 1st Sept. 17, Right : Chopart s (modified). 35 Galvin, D. G., Pt., G, May 5, Left : 2d toe and metatarsal. Dis Delaware. 17, 62. Discharged February 23, 1866 ; 32d Mass., age 26. 5, 64. charged April 1, 1865. "cicatrix under heel; pressure 36 Garvey, P., Pt., E, 3d Dec. 13, Right ; 4th and 5th toes and meta painful. Infantry, age 21. 13, 62. tarsals. Disch d April 2, 1863; 73 Lewis, L., Lieut., A, 5th De.31, 62, Left : Chopart s. Surgeon W. A. pensioned. Confederate States. Jan. 1, 63. Gentry. 17th Tenn. Recovery. 37 Gay, 8. J. J.. Corp l, II, May 1, Left; Chopart s. 74 Lillibridge, F. W.. Pt., June 18, Right; Chopart s. Disch d Aug. 51st Georgia, age 21. 2, 63. B. 2d New York M. R., 18, 64. 10, 1865 ; amputation leg. 38 Gillespie, C., Pt., F, Mar. 13, Left; Chopart s. Surgs. Hum age 18. 94th New York. 13, 65. phrey and Ramsay. Disch d 75 Little, L. B., Capt., A, July 2. Right : 3d toe and metatarsal. May29. 65 ; stnmpbadly formed. 9th N. Hamp., age 24. , ! 64. Disch d Oct. 24, 64 ; pensioned. 39 Gillon, J., Pt., F, 27th Aug. 4, Lett; Hey s. Discharged July 5, 76 Lyford,G. A., Corp l, D, Dec. 13, Left: Chopart s. Surg. A. W. Ohio, age 22. 4, 64. 1865. " 13th Mass., age 24. 13, 62. Whitney, 13th Mass. Disch d 40 Givens, W. W., Pt., D, July 3, Right ; Chopart s. Discharged January 7, 1863. 1st West Virginia Cav. 3, 63. December 3. 1863. McCarty. T., Pt.. B, 4th Feb. 5, Left: 2cl toe at middle of meta 41 Gohl, F., Pt., K, 8th April 5, Right: Hey s; thro" metatarsals. N. Y. Art y, age 32. 5, 65. tarsal. Disch d June 8, 1865. Pennsylvania Cavalry, 5, 65. neartarsal articulation. Disch d 78 McGinley. R., Serg t. II, Sept. 5, Right. Surg. R. W. Hazlett, 2d age 27. September 23. 1865. 2d West Va., age 41. , 61. W. Va. Disch d Nov. 29, 1861. 42 Graham, J., Pt., E, 2d June 18, Left ; 2d toe and portion meta Died Dec. 15, 1866; "absorption Pa. Art y, age 22. 18, 64. tarsal. Surg. G. T. Stevens, of pus from necrosed bone. " 77th N. Y. Disch d Mar. 20, 65. 79 Mann, W., Pt., A, llth May 22, Right; Chopart s. Disch d Aug. 43 Greyer, J., Serg t, G, June 1. : preat toe at tarso-metatar- Illinois, age 32. , 63. 7. 1863; ankle anchylosed. 52d Virginia. , 64. sal articulation. Surgeon C. B. 80 Matthews, J.. Pt,, II, 2d Sept. 23, Right ; Chopart s. Transferred. Gibson. C. S. A. Transferred. North Carolina, age 20. , 03. 44 Gumlerman, S., Pt., F, June 20, Right: Chopart s. Surg. Payne. 81 Manson. J. S., Corp l, G, May 5, Left; 2d toe at middle of metatar 4(Jth Pennsylvania, age 20, 64. Disch d March 6, 1865: "condi 17th Maine, age 21. 5, 64. sal. Duty July 12, 64 ; pens d. 21. tion worse than if amp. in leg. 82 Marsh, F. M., Corp l, B, June 2, Left, 4th toe and metatarsal. 45 Hall, J. L., Lieut., L, June 16, Lett ; 4th and 5th toes and meta 118th Ohio, age 22. 3. 64. Duty December 3, 1864. 1st Mass. H. A., age 16, 64. tarsals. Disch d October 3, 64 ; 83 Martin, J., Pt.. L, 2d N. June 16. Left ; four smaller toes and por 24. pensioned. York Heavy Artillery, 16, 64. tion of metatarsal. Discharged 46 Ball, J. T., Pt., D, 1st Nov. 28, Left ; Chopart s. To Provost age 21 . Nov. 11, 1864. Also amputat n Georgia, age 27. 29, 64. Marshal March 7, 1865. right leg; re-amputation 1865. 47 Hand, E., Pt., K, 2d June 3, Right : great toe and metatarsal. 84 Miller, J., Pt., E. 6th Dec. 13, Right; Chopart s. Surgeon C. Michigan, age 18. , 64. Vet. Res. Corps March 4, 1865. Penn. Reserves, age 22. 13, 62. Bowers, 6th Penn. Res. Exfo 48 Harris, L., Pt., A, 100th Mar. 25. Right : Lisfranc s. Surg. Davis. liation ; gangrene. Discharged Pennsylvania, age 18. 25, 65. Discharged June 19, 1865. September 14. 1863. 49 Harxe.ii, IF., Pt., G, 27th Aug. 21, Left; Chopart s. Furl d March 85 Mitchell, C.,Pt., E, 149th May 3, Left ; 1st toe and metatarsal. Vet. South Carolina, age 27. 21, 64. 17, 1865. New York, affe 19. 3, 63. Res. Corps Dec. 15, 63; pens d. 50 Hart, E., Pt., C, 8th June 22, Left ; Chopart s. Surg. J. L. Bren- 86 Mizen, H., Pt., A, 145th June 18, Left ; 5th toe and metatarsal. Sur Ohio, age 34. 23, 64. ton, 8th Ohio. Disch d Janu Pennsylvania. 18, 64. geon J. W.Wishart, 140th Penn. ary 25, 1865. Disch d Jan. 14, 65; pensioned. SMITH (S.), Amputations at the AnkU Joint in Military Surgery, iu U. S. San. Com. Mems., Surgical Volume II, p. 140. 632 INJUEIES OF THE LOWER EXTREMITIES. [CHAP. X. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. KO. NAME, MILITARY DESCRIPTION, AND AC;E. DATES. OPERATIONS, OPERATORS, RESULT. 87 Myers, S., Pt., D, 2d N. June 3, Right : mid. toe at mid. of meta 123 Stabler, E., Pt., K, 12th June 18, Left ; Key s. Ass t Surg. S. T. York Heavy Artillery, 3, 64. tarsal. Furloughed June 9, 64; Ohio, age 26. 20, 64. Buck, 12th Ohio. Discharged age 24. pensioned. August 18, 1864. 88 Neal, T.,Pt., I, 6th Mich Oct. 18, Left ; Hey s. Discharged June |124 Stead, I. B., Serg t, I, Dec. 13. Right; Chopart s. Disch d Feb. igan Cavalry, age 29. 18, 62. 29, 1864." 136th Penn., age 20. 14, 62. 28, 1863; "no power to move 89 Neile, E. C., Serg t, C, May 23, ; Chopart s. Surg. C. B. Gib ankle except with the hand." 1st Maryland Cavalry. 23, 64. son, C. S. A. Syme s amp. re 125 Strait, O., Capt., E, 41st June 25, Right ; Chopart s. Discharged commended by returning board. Illinois, age 30. 25, 63. August 20, 1864. 90 Nicholson, J.W., Pt,, B, April 2, Right; Hey s; "at middle of met 126 Swain, S. F.,Pt..B, 65th July 20, Left; 2d toe and metatar.; hseiu. 97th Illinois, age 30. , 65. atarsal bones." Surg. C. Davis, Indiana, age 32. 21, 64. Discharged April 1, 1865. 77th 111. Disch d May 26, 1865. 127 Swartz, W. S., Pt., F, Aug. 8, Left : 2d toe and metatarsal. Dis 91 Nicholson, W., Pt.. K, June 22, Right ; 2d and 3d toes, and 1st 107th Penn., age 31. 28, 62. charged Dec. 10, 1864 ; pens d. 191st Penn., age 18. 23, 64. toe and portion of metatarsal. 1128 Taylor, W. J.,Pt.,Norfolk April 2, Right ; Chopart s. Released May Discharged March 2, 1865. Blues Lt. Art y, age 21. 2, 65. 30, 1865. 92 Noyes, D. K., Capt., A, Sept. 17, Right ; Chopart s. Surg. A. J. il29 Thomas, A. P., Lieut.,C, May 11, Left ; 4th toe and half of meta. 6th \Visconsin, age 42. 17, 62. Ward, 2d Wisconsin. Disch d 1st Mich. Sharpshoot 11, 64. Surg. A. F. Whelan, 1st Mich. July 27, 1864. ers, age 27. S.S. Disch d Sept. 13, 64; pen a. 93 Oakley, P., Pt., A, 2d April 20, Left ; 2d toe and metatarsal. A. 130 2 Turd:, E., Pt., E, 7th May 3, ; Chopart s. Surg. F. For- Artillery, age 17. 21,- 64. A. Surg. J. A. Romayne. Duty 5uly 3, 1864 ; pensioned. 131 Louisiana. Vanwagoner, J. H., Pt., , 63. Aug. 10, meato, jr., C. S. A. Recovery. Left ; Lisfranc s. Disch d May 94 O Connor, D., Pt., I. 66th June 22, Right ; Lisfranc s. Confederate B, 31st W T is., age 24. 10, 64. 30, 1865; "better to have re New York, age 22. 23, 64. surgeon. Disch d June 16, 65. moved whole foot ; cannot wear 95 O Donahue, M., Pt., D, May 14, Right ; 3d and 4th toes and meta boot or shoe, etc." 124th Ohio, age 36. 14, 64. tarsal bones. Disch d Dec. 27, 132 Walker, D., Pt., G, 2d Mar. 31, Right; Hey s. Disch d July 6, 1864. Nov., 1866, Pirogoff s New York H vy Artil April 1, 1865; stump unhealed. amputation ; recovered. Died lery, age 20. 1865. April 13. 1873. 133 Walters, M., Lieut., A, Dec. 13, Left ; Chopart s. Disch d June 96 Oliver, A., Lieut., K, Nov. 30, Right; Chopart s. To Provost 3d Penn. Res., age 22. , 62. 30, 1866. Died Dec. 23, 1879; 18th Miss., age 23. 30, 64. Marshal March 27, 1865. consumption. 97 Parkinson, J.,Pt., 1, 103d Feb. 15, Left; Lisfranc s. Surg. B. Bond, 134 Welling, D. C., Lieut., July 19, Left: Lisfranc s. Surg. E. Bat- Illinois, age 29. 15, 65. 25th Mo. Disch d June 15, 65. A, 10th Mich., age 24. 19, 64. well, 14th Michigan. Gangrene. 98 Parmelee, E.A., Pt,, F, Mar. 25, Left; Chopart s. Disch d June Discharged Feb! 22, 1865. 5th Xew Hamp.,age 24. 25, 65. 26, 1865. 135 Williams, H., Pt., K, April 9, Right ; Lisfranc s (also amp. left 99 Quick, S., Pt., F, 28th June 18, Right; 4th toe and metatarsal. 198th Penn., age 23. 9, 65. leg). Surg. H. A. Grim, 198th Kentucky, age 45. 19, 64. Disch d Feb. 8, 1865 ; pension d. Penn. Disch d Oct. 6. 1865. 100 Reid, G., Pt.,L,2dConn. June 1, Right ; 4th and 5th toes at tarso- 136 Williams, J. H., Lieut., July 2, Right; Chopart s. Surg. T. A. Artillery, age 25. 1, 64. metatarsal articulat n. Disch d F, 14th S. C., age 30. 3. (13. Means, C. S. A. Exchanged. January 5, 1865: pensioned. 137 Williamson, J., Pt., D, July 19, Right; Lisfranc s. Surgeon 101 Reilley, C. J., Serg t, K, July 10, Left; Chopart s. Surg.J.A.Wolfe, i 86th Illinois, age 24. 19, 64. Houghton. Disch d March 5, 29th Penn., age 23. 11, 64. 29th Penn. Furl d; killed in a 1865; good stump. railroad accident Sept. 20, 1864. 138 Wilson, T. H., Pt., F, Oct. 7, Left; 5th toe and meta. Disch d 102 Reynolds, D., Pt., M, July 24, Left ; 3d toe and rnetatar. Surg. 4th Mass. Cav., age 19. 8, 64. July 30, 1865. 27th Michigan, age 19. 24, 64. Sherlock. Disc d June 13. 65. 139 Zimmet, T., Serg t. K, June 21, Right ; Lisfranc s. Surg. J. L. 103 Reynolds, S. T., Pt., G, Sept. 3, Right ; three mid. toes near met. lllth Penn., age 26. 21, 64. Dunn, 109th Penn. Discharged 4th Indiana Cavalry, 3, 64. phal. artic. A. A. Surg. M. L. June 29, 1865. age 20. Herr. Duty June 14, 1865. 140 Beck, R. C., Pt., H, 15th June 2, Right; Hey s. Surg. C. B. Gib 104 Robb, G., Pt., D, 2d July 21, Right ; Chopart s. Discharged South Carolina. 3, 64. son, C. S. A. Died July 23. 64. Artillery, age 19. 21, 61. November 17, 1861. 141 Btmiell, L. S., Corp l, D, May 27, Right; Chopart s. Died June 105 Roberts, O. O., Serg t.D, Oct. 19, Left ; Chopart s. Surgeon G. T. 43d New York. 27, 64. 26, 1864. 1st Maine, age 22. 20, l4. Stevens, 77th N. Y. Disch d 142( Carpenter. J.W., Serg t, June 3, Right : 1st metatarsal (Hey s am February 11, 1865. 1435 I, 10th Vermont. 3, 64. putation left foot). Died June 106 Rohm, G. W., Pt., H, May], Left ; Lisfranc s. Disch d Oct. 15, 1864. llth Indiana. 1, 63. 22, 1863; uses crutch. 144 Daniel, C. L., Pt., K, July 20, Right ; Chopart s. Surg. II. Lud- 107 Rosewell, J., Pt.,E, 102d Sept. 19, Right; Chopart s. Surg. S. F. 57th Mass., age 18. 20, ( A. ington, 100th Penn. Died July Penn., age 21. 19, 64. Chapin. 139th Penn. Disch d 29. 64 ; typh. fever. pKC. 6531. April 15, 1865 ; sound stump. 145 Darrow, H. C., Pt., G, May 18, Left ; Chopart s (also exc. elbow; 108 Sadler, A. D.. Serg t, G, Dec. 11, Left (also amp. right log). Surg. 77th New York, age 24. 18, 64. luem.). Died June 23, 1864, 21st Mississippi. 11, 62. Hill. C. S. A. Recovery. gangrene of arm. 109 Saint, R. P., Pt., F, 123d Aug. 4, Right ; four small toes, taking 146 Edgcrton, G. E., Pt., E, May 9, Left. Died June 3, d 4; pyaemia. Indiana, age 22. 4/64. metatarsals obliquely. Disch d 169th N. Y., age 33. 10, 64. June 11, 1865. 147 Folsom, T. T., Pt., E, May 3, Left; Hey s. Died May 26, 63. 110 Sands, J., Lieut., C, 36th May 15, Left; Lisfranc s. Surg. W. P. 5th Xew Hampshire. 3, \13. Illinois, age 26. 15, 64. Pierce. 88th 111. Disch d Feb. 148 Uarrinqtov, G. M., Pt., Aug. 31, Right ; Chopart s. Confederate 17, 1865. A, 66th On., age 20. 31, 64. surgeon. Died Xov. 10, 1864. 111 Schoop, S. I., Capt., I, Oct. , Left ; two toes with metatarsals. 149 Heigans, H., Pt., G, 1st Dec 1 3, ; Chopart s ; tetanus. Died 31st Colored Troops. , 64. Surg. E. Jackson. 30th Colored Delaware. 14, 62. December 25, 1862. Troops. Disch d Dec. 15, 1864. 150 Hintz, C., Pt., K, 35th July 30, Right ; 5th toe and meta. Died 112 Schroeder, H.. Pt., H, Oct. 8, . Recovery Feb. 11, 1863. Massachusetts. 30, 64. Aug. 5, 18G4; congestion lungs. 28th Louisiana. , 62. 151 Jameson, W. H., Pt., C, April 29, Left; Lisfranc s. Surg. E. Ship- 113 Sciter, B., Pt., C, 9th Sept. 17, Right ; three lesser toes and outer 24th Michigan. May 1, pen, U. S. V. Died May 24, New York, age 25. 17, 62. side foot. Surg. Humphreys, 1863. 1863. Spec. 1121. Recovery. 152 Lapham, I. B., Pt., C, June 4, Left ; great toe and meta. Died 114 Shaughnessy, M., Pt.,H, June 18, Left; Chopart s (flap from inside). 9th X. Y. Artillery. 4, 64. June 17, 1864; acute diarrhoea. 2d Penn. H vy Artil ry, 18, 64. Surg. G. T. Stevens, 77th N. Y. 153 Monroe If. B. June 1, Right. Died August 10, 1864 ; age 26. Discharged Dec. 12, 1864. 1, 64. exhaustion. 115 Sliea, J., Letcher s Bat Dec. 13. Left; Cbopart tt. Recovery. 154 Randall, .1., Pt., F, 29th Oct. 27, Left. Surg. A. (, . Barlow. 62cl ! tery, ago 45. , 62. Connecticut. 27, 64. Ohio. Died Nov. 11, 18C4. 116 Sheffield. B., Corp l, B, July 14, Left ; three outer toes and meta 155 Umberger, J.W., Corp l, Dec. 15, Left; tarsal bones sawn through. 61st C. Troops, age 39. 14, 64. tarsals. Duty Dec. 7, 64 ; pens d. 1, 117th Illinois, age 30. 15, 64. Surg. M. Wiley, 117th Illinois. 117 Shelly, M., Pt., C, 28th Oct. 19, Right; Chopart s. Surg. W. A. Gangrene; Jan. 12, 1865, amp. Iowa, age 21. 19, 64. Daniels, 28th Iowa. Disch d leg. Died Jan. 14, 1865; pysBm. April 14, 1865. 156 Whitaker, A. J., Corp l, June 16, Right; Hey s; gangrene. Died 118 Shipley, T., Corp l, F, Aug. 22, Left ; 2d toe, half of metatarsal. A. 66th X. C., age 24. 16, 64. July 18, 1864; gangrene. 1st Maryland, age 29. 22, 64. Surgeon A. A. White, 8th Md. 157 Whitehead, H., Pt., L, June 10, Left. Died July 2, 64 ; wounds. Disch d June 14, 65; pensioned. 16th Michigan, age 32. , 64. 119 Smith, B. H., Capt., 1st Oct. 16, Left ; Chopart s. Surg. Mason, 158 s Everett, W. P., Corp l, May 5, ; Lisfranc s ; excision of tar- Virginia Artillery. 16, 62. C. S. A. Discharged. H, 9th Alabama. 5, 64. sal bones and malleoli. Surg. 120 Smith, A., Serg t, G, Dec. 11, Right ; Lisfranc s. Surg. C. S. D. Prince, U. S. V. 66th New York, age 47. 11, 62. Wood, 66th N. York. Disch d 159 Mitchell, J.. Pt.. A, 90th May 1-1, Left; 4th toe and metatarsal. May 1, 1863. Ohio. 14, 64. Gastner. 121 Smith, N. R., Lieut., F, July 1, Left ; Chopart s. Disch d Sept. 160 Pride. IT., Pt., F, 61st July 31, Right; great toe and metatarsnl. 157th X. Y., Hge 25. 2, 63. 23, 1863 ; stump good. Virginia, age 36. 31, 64. 122 Spencer, D. M., Pt., B, Nov. 8, Left; Chopart s. Surg. N. Barnes, 161 Stillwell, W. K., Pt., I, Oct. 19, Left; Chopart s. Surgeon J. J. 184th X. Y., age 21. 8, 64. J84thN. Y. Disch d June 2, 65. 53d Georgia, age 21. 19, 64. Knott, 53d Georgia. HOLLOW AY (J. M.), Comparative Advantages of PIROGOFF S, SYME S, and CHOPART S Amputations, etc., in Am. Jour. Med. Sci s, Vol. LI, p. 86. 2 FORMENTO (F., jr.), Notes and Observations on Army Surgery, Xew Orleans, 1863, p. 27. SMITH (S.), Amputations at the Ankle Joint, etc., in United State* Sanitary Commission Memoirs, Surgical Volume II, New York, 1871, p. 123. SECT. VII.] INTERMEDIARY AMPUTATIONS IN THE FOOT. 633 INTERMEDIARY AMPUTATIONS IN THE FOOT. Two hundred and sixty-seven operations were followed by recovery in two hundred and forty-three, by death in twenty instances; the result in four cases was not recorded; the mortality rate therefore was 7.6 per cent. Fifty-two were amputations through the tarsal or metatarsal bones and two hundred and fifteen were ablations of the toes. CASE 931. Private C. Craudall, Co. K, 2d New York Artillery, aged 18 years, was wounded in the left foot, at Spott- sylvania, May 18, 1864, and entered Carver Hospital at Washington six days afterwards. Surgeon O. A. Judson, U. S. V., reported: "Gunshot fracture of metatarsus. The injury was caused by a musket ball, which entered the space of the fifth metatarsal bone and emerged at the corresponding point of the second metatarsal bone. On May 29th partial amputation of the foot by Lisfranc s method was performed by Assistant Surgeon H. Allen, U. S. A. The case did remarkably well. By September 30th the stump had entirely healed but was still very tender, the patient being unable to stand on it." He was dischai ged from service December 12, 1864, and pensioned. He died May 12, 1867. CASK 932. Private G. W. Leslie, Co. E, 2d South Carolina Rifles, aged 23 years, was wounded July 8, 1863, by a conoidal ball, which fractured the first and second metatarsal bones of the left foot and produced great laceration of the soft parts. He was conveyed to Confederate hospital No. 9, at Richmond, where amputation by Chopart s method was performed on August 3d by Assistant Surgeon C. W. P. Brock, C. S. A. At the time of the operation the tissues were infiltrated and in a sloughing condition, and the patient was in a debilitated state, having suffered from angeioleucitis and erysipelas. Slight sloughing of the flaps followed, but by September 1st the stump was nearly healed. The patient recovered with a useful limb. CASE 933. Private S. Hacket, Co. F, llth Pennsylvania Reserves, aged 25 years, was wounded in the right foot, at Fredericksburg, December 13, 1862, by a round ball, which entered the sole near the third metatarsal bone, passed through the tarsus, and was extracted just anterior to the internal malleolus. He was admitted to Lincoln Hospital, Washington, ten days after receiving the injury, and Chopart s amputation was performed the following day. The patient s complexion was yellowish, his pulse rapid, and the color of his tongue light red and smooth. On December 29th he had a chill and complained of pain in his hips. There had been a few discharges of laudable pus and the stump looked well. On January 3d an abscess, which had been forming for three days, was lanced and bled profusely. During this time the patient had been costive and continued icteroid, the conjunctiva being of a pearly whiteness and his pulse moderately rapid, full, and regular. The granulations of the sore were more eminent and were bathed in a not unhealthy pus. His tongue on this day was furrowed, and during the morning he had a slight chill. On January 6th he had three chills, and the stump was inactive, the pus being white and cheesy. The abscess over the malleolus was now better, but the patient s skin was very yellow, with a brown tinge; tongue pale; coun tenance anxious. During the next three days he had one or two chills each day, and by this time he had become very feeble and his mind was wandering somewhat; pulse very rapid. The stump did not look very badly, but some hardness was noticed along the track of the vessels. By January llth he was wholly delirious, which continued for two days, when he recovered his consciousness. The left pupil was now more dilated than the right; the stump was looking well, but was more swollen than at first. After this he became extremely exhausted and died January 15, 1863. The autopsy showed much emaciation. On opening the chest a large cavity was found just above the right lung, the top of it being lined with a greyish pus. Pleurisy with firm attachments existed on the right side, and there was partial pneumonia in the posterior lobe. A mass of separating dead tissue partially occupied the excavated space in the upper and anterior portion. The walls were lined with a thick and cheesy pus. Partial pneumonia with small circumscribed collections of pus existed in the lower lobe of the left lung posteriorly, while in the upper lobe anteriorly and at the middle there was a sharp-edged and deep excavation having separated dead tissue in it. The spleen was attached by fibrinous adhesions to the surface of the diaphragm and contained small circumscribed collections of pus. The liver was large, heavy, and mottled, with a distinct rough feel; kidneys natural and a little pale; inguinal glands greatly swollen. Thtre was also a deep abscess below the popliteal space and unconnected with the stump. The amputated portion of the foot (Cat. Surg. Sect., 1866, p. 421, Spec. 4493) was contributed to the Museum by Assistant Surgeon G. M. McGill, U. S. A., who also recorded the history of the case. TABLE C. Summary of Fifty-two Intermediary Amputations in the Tarsal or Metatarsal Bones for Shot Injury. [Recoveries, 136; Deaths, 37 51; Unknown, 52.] NO. NAMK, MILITARY DESCRIPTION, AND AGK. DATKS. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Albright, P. J., Corp l, B, 110th Ohio, age 19. July 9, 22, 64. Right ; great toe and half of met atarsal. Surg. G. S. Palmer, U. 5 Boger, J., Pt., A, 17tb Infantry. June 24, July 9, Left (phagadenic); great toe middle of metatar. A. A. Surg S. V. Disch d Feb. 19, 1865. 1864. J. T. Logan. Duty Mar. 9, 186r> 2 Anderson, F., Pt., 11, May 25, Left (exc. portion 3d met. bone); 6 Burt, C.M.,Pt.,E, 141st Aug. 5, Left ; great toe thro metatarsal 28th Penn., age 40. June 9, amp. 3d toe and metatar. A. A. New York, age 21. 17, 64. A. A. Surg. Ward. V. R. C 1864. Surgeon J. G. Harvey. V. R. C. March 10, 1865. March 29, 1865. 7 Chalton, X., Pt., E, 2d May 31, Right ; 2d toe at tarso-met. nrtic 3 Baskett, J., Pt., G, 146th May 8, Left ; 4th toe and half of metatar- Cavalry, age 25. June 4, Surgeon A. F. Sheldon, U. S. V New York, age 37. 25, 64. sal. A. A. Surg. O. P. Sweet, 18C4. Duty January 25, 1865. 4 Bender, J.,Serg t, 1, 15th Mass., age 23. Sept. 17, 20, 62. Discharged July 6, 1865. Right ; Chopart s. Discharged February 28, 1863. 8 Clarkson, J. N., Pt., E, 93d Indiana, age 18. June 10, 14, 64. Right ; 2d toe and metatar. Surg. J. G. Keenon, U. S. V. Duty March 22, 1865 ; pensioned. SURG. Ill 80 634 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OTKICATOUS, RESULT. No. NAME, MILITAUV DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. Q Cox, S., Lieut., G, 4th Aug. 25, Left; little toe and metatarsal. 30 Marshall. J. S., Pt., B, July 2, Right ; toe at middle of metatar N. Y. Heavy Artillery, 29, 64. Surgeon N. R. Moseley, U. S. V. 131st Co.. 2d Bat. V. R. 20, 63. sal. A. A. Surg. J.A. Buchanan. age 23. Discharged January 18, 1865. Corps, age 29. Duty May 21, 1864. 10 Cmndall, C., Pt., K, 2d May 18, Left ; Listranc s. Ass t Surg. H. 31 Mendenhall. A., Corp l, Aug. 14, Lett ; toe and metatarsal. A. A. N. Y. Heavy Artillery, 29, 64. Allen, U.S. A. Disch d Dec. H, 391h Illinois, age 38. 24, 64. Surg. R. (). Sidney. Disch d age 18. 12. 1864. Died May 12, 1867. April 4. 1865. 11 Dotson. D. N., Serg t, K, Nov. 30, Right ; Chopart s. Snrg. D. J. 32 Quade, C. H.. Pt., F, 8th June 22, Left (erysip.; gang.); 4th and 5th 37th Tenn., age 24. Dec. 5, Roberts. 20th Tenn. To Provo. N. Y. Heavy Artillery, July 16, toes and metatar. A. A. Surg. 1864. Marshal May 6, 1865. age 17. 1864. A. Trau. Disch d Feb. 18, 1865; 12 Gelvair, W., Pt., C, 16th Oct. 27. Right; 3d toe and lower third of pensioned. Penn. Cav., age 26. Nov. 15, metatarsal. Surg. N. R. Mose 33 Rooney, A., Pt., F, 40th Aug. 29, Right ; Lisfranc s. Surg. D. W. 1864. ley, U. S. V. Duty April 20, 65. New York, age 29. Sept. , Bliss, U.S. V. Disch d May 20, .:: George, J. H.,Pt.,1, 49th Jan. 13, Right (gangrene); 2d and 3d toes 1862. 1863. 1879, stump healthy. Illinois, age 20. 25, 64. and metatarsals. A. A. Surg. S. 34 Shearer, A., Pt., A, 6th De. , 64, Left ; thro ant. part cuboid and S. Jessop. Duty June 8, 1804. Colored Cavalry, age Jan. 8, 65. cuneiform bones. Discharged 14 Grimstead, R. T., Pt., I, June 11, Left ; i!d toe and metatarsal. Dis 25. June 12, 1865. 93d Indiana. J y -, 63. charged Dec. 28, 1863. 35 Snyder, B., Pt., F, 129th May 7, Left (gang.); 4th toe at middle of 15 Green, A., Pt., D, 8th June 23, Right; Lisfranc s. A. A. Surg. Pennsylvania, age 24. 15, 64. metatar. Surg. A. F. Sheldon, N. Y. Artillery, age 30. July 18, D. G. Caldwell. Disoh d Sept. U. S. V. Disch d May 26, 1865. 1864. 27, 1864. 36 Watson, J. H., Serg t, G, May 10, Left ; 2d and lid toes and metatar 16 Hansmeier, A., Pt., A, June 10, Right ; Lisfranc s. Discharged 12 1st Penn., age 22. 21, 64. sals. Surg. E. Rentier, U. S.V. 114th Illinois, age 19. 13, 64. June 20, 1865; painful, tender Duty January 30, 1865. cioatrix. 37 Barnes, M., Pt., D, 28th June 4, Right ; 3d toe and metatarsal. A. 17 Hefferman, P., Pt., F, Aug. 30, Left ; Chopart s. Confed. surgeon. Mass., age 34. , 64. A. Surg. J. G. Nelson. Died 14th Infantry, age 20. Sept. 9, Heel drawn up. Oct. 8. 1863, July 6, 1864 ; dysen. and w nd. 1862. amp. leg. Disch d May 17, 64. C8 Bell, B. A., Pt., A, 14th May 10, Left ; Chopart s. Surgeon C. B. 18 Kelton, W., Pt., H, 3d May 6, Right ; 1st toe and metatarsal. Virginia. 19, 64. Gibson. C.S.A. Died May 27. 64. Vermont, age 23. 13, ! 64. Vet. Res. Corps Nov. 25, 1864. 39 Brooks, T. M., Pt., C, Nov. 27, Left ; 3d and 4Mi toes and meta 19 Keyes, C. W., Lieut., K, May 12, Left (gang;. Dr. P. Dyer, Wil 124th N. York, age 19. Dec. 8. tarsals. Surg. E. Bentley, U. S. 32d Maine, age 33. June 8, ton, Me. Gang. .June l2, 3864, 1863. V. Died Dec. 20, 63; pyasrnia. 1864. amput n leg. App t in U. S. A. 40 Decay, S., Corp l, A, June 11, Right ; 1st toe and metatarsal. A. Retired December 31, 1870. 179th New Y ork, age 30, 64. A. Surg. J. G. F. Strowbridge. 20 Knowlton, D., Serg t, M, June 18. Left ; 4th toe and half of meta 35. Pyaemia. Died July 29, 1864 ; 1st Maine H vy Artil July 5, tarsal. A. A. Surg. F. H. Green- excessive suppuration. lery, age 19. 1864. ough. Disch d March 27, 1SC5. , 41 Graham, P., Corp l, K, Sept. 19, Right : Chopart s (also ex. elbow). 21 Lackey, G. H., Serg t, May 12, Left; 1st toe and metalarsal. A. 26th Ohio. 25, 63. Died Oct. 8, 1863. D, 58th Mass., age 24. 27, 64. A. Surg. J. C. Nelson. Erysip.; 42 Hackett, S., Pt., F, lllth Dec. 13, Right ; Chopart s. Ass t Surg. gangrene. July 27, amp. leg. Penn. Reserves. 24, 62. G. M. McGill.U.S.A. Died Jan. Disch d March 16, 1865. 15, 1863 ; pyaemia. Spec. 4493. 22 Landenberger, F.D.,Pt.. Mar. 18, Right ; 2d toe and metatar. Ass t 43 King, E., Pt,, B, 1st Aug. 2."), Right ; 1st toe and metatarsal and B, 6th Penn. Cavalry. 24, 64. Surg. J. W. Williams, U. S. A. Vermont Cavalry, age 30, 64. 3d toe thro 3d phalanx. A. A. age 57. Discharged Sept. 3, 1864. 18. Surg. W. J. McIIenoh. Died 23 Leslie, G. W., Pt., E, 2d July 8, Left; Chopart s. Ass t Surg. C. Sept. 11. 1864; pyaemia. S. Carolina, age 23. Au. 3, 63. W. P. Brock, C.S.A. Recovery. 44 King, S.. Serg t, C, 9th July 20, Right ; 2d toe and part of meta 24 Little, D. H., Pt., G, Nov. 27, Right ; great toe and metatarsal. West Va., age 23. 25, 64. tarsal. Died Aug. 3, 1864. 138th 1 enn., age 20. Dec. 9, Surg. E. Bentley, U. K. V. Dis 45 Linville, A. J., Pt., G, Oct. 30, Left; Chopart s. A. A. Surg. 1863. charged Feb. 27, 64 ; pensioned. 44th Illinois, age 18. Nov. 12, Bell. Died Feb. 10, 1865 ; ex 25 London, J. C., Pt., C, Nov. 27, Left ; 4th toe and metatarsal. 1864. haustion. 90th Penn., age 28. De.15, 63. Transferred May 30. 1864. 40 Lumbard, M., Pt., D, Sept. 20, Left; Chopart s. Died Novem 26 Lovelady, A., Pt.. A. June 10, Right (gangrene); great toe and 15th Ohio. Oc.10, 63. ber 24. 1863. 4th Iowa Cav., age 22. July , metatarsal. A. A. Surg. Slmrpe. 47 Mockler,W., Pt., G, 81st Dec. 13, Right ; Chopart s. Dec. 31, hrem. 1864. Disch d March 29, 1865. Pennsylvania, age 47. 26, 62. Died January 10. 1863. 27 Lynch, A., Pt., C, 29th May 25. Right; Hey s. Confed. surgeon. 48 Xash, J., Pt., C, Mary July 3, Left : tetanus. Died July 16, Pennsylvania, age 39. June 1, Disoh d March 16, 1863; good land Battalion. 14, 63. 1863. ]862. stump. 49 Schmidt, J.. Pt., C, 102d June 5, Left ; great toe and metatarsal. 28 McCarty, J.. Pt., F, 48th Mar. 2, Right; Chopart s. A. A. Surg. Penn.. age 29. 25, 64. Surg. H. Palmer, U. S.V. Died New York, age 38. 21, 64. C. T. Reber. (Mar. 2, lig. post. June 27. 1864: inflam. liver. tibial; gang.) Mar. 23, bones 50 Smith, B.J., Pt..I, 14th June 1, Right. Died, in Libby Prison, removed ; April 25, 1865, amp. N. Y. H. Art v, age 28. 12, 64. July 3, 1864. leg. Disch d June 10, 1865. 51 Whistler, A. W., Pt., I, June 5, Left. Ass t Surg. H. Grumbine, Died Dec. 19, 1874. Spec. 3007. 54th Pennsylvania. 22 64. 20th Penn. Cav. Died August 29 Madison, J., Pt., C, 9th July 16, Right ; 2d toe and part of meta 16, 1864 ; gangrene and hagm. Minn., age 48. 23, 64. tarsal. Surg. J. G. Keenon, U 52 Monrt, G. 11., Pt., , 28th Aug. 25, Left Chopart " Surg D F. S. V. Disch d May 26, 1865. N. Carolina, age 17. 31, 64. Wright, C. S. A. SECONDARY AMPUTATIONS IN THE FOOT. Of ninety-four secondary operations ninety-two were successful and two fatal, a mortality rate of 2.1 per cent. Seventy-six were ablations of the toes, eighteen amputations in the tarsal or metatarsal bones. CASE 934. Private E. McEntee, Co. B, 73d New York, aged 23 years, was wounded in the right foot, at Gettysburg, July 2, 1863. and entered Jarvis Hospital, Baltimore, eight days afterwards. Upon examination a compound comminuted fracture of the tarsal articulation was found, with a musket ball lodging in the foot. Efforts were made to save the limb; but a high degree of suppurative inflammation set in, when it was decided to amputate, and Chopart s operation was performed on August 4th by Assistant Surgeon D. C. Peters, U. S. A. The patient recovered, and was discharged from service December 16, 1863, and pensioned, the stump, though healed, remaining tender and giving indications of remaining unserviceable for a long time, thereby unfitting him for duty in the Invalid Corps. Part of the amputated foot, exhibiting a great effusion of callus and showing necrosis in the track of the missile, was contributed to the Museum, with the history of the case, by the operator, and constitutes specimen 1650 of the Surgical Section. The pensioner was paid September 4, 1880. In his application for commu tation, dated 1870, he described the condition of the stump as still "very tender;" but in subsequent statements he reported it as "pretty good" and "healthy." CASE 935. Lieutenant H. Holt, Co. F, 30th New York, aged 20 years, was wounded in the right foot, at Bull Run, August 30, 1862. Surgeon C. L. Allen, U. S. V., described the injury as follows: "The ball entered at the top of the foot, fracturing the fifth metatarsal bone, and was cut out on the field from the sole of the foot. He went on horseback to Centreville, where during the afternoon of the following day he was placed in an ambulance. The next day he came to Washington, Baking SECT. VII.] SECONDARY AMPUTATIONS IN THE FOOT. 635 the cars at Fairfax Station and entering Emory. Hospital for a day or two, when he removed to a private boarding-house and was attended by a private physician. On September 28th, foot was swollen; abscesses opened, and the original wounds were all discharging freely. The patient was much emaciated, his countenance expressing suffering and showing the strongly marked hectic Hush; appetite gone; thirst considerable; pulse 1150, feeble and fluttering; pain and stiffness in the jaws, with inability to open the mouth more than to admit the tip of the little finger between the teeth. This condition (trismus), he stated, had been coming on for two or three days. Huxham s tincture, brandy, beef-essence, etc., with an occasional full dose of morphia was prescribed. On October 5th another abscess opened. October 9th : The patient has slowly and steadily improved in general appearance since my first attendance; pulse 110 to 116 with more strength. It was thought advisable to put the patient under the influence of ether and examine and perform any operation considered necessary, Surgeons M. Clymer and J. H. Brinton, U. S. V., being requested to see the case. The foot was still enormously swollen, and the probe passed readily from the wound of entrance to the opening below the external malleolus. In the upper opening four inches above the inner malleolus the probe rapped distinctly upon the denuded tibia. Surgeon Clymer made an incision nearly the whole length of the external side of the foot, and removed the fragments of the fifth metatarsal bone together with the little toe. Since it appeared at this stage that all or nearly all the tarsal and metatarsal bones were diseased, as well as the lower third of the tibia, it was decided that amputation was necessary, but that the patient at this time could not endure any further operation. The tonics, stimulants, and nourish ments were now crowded as much as possible. On October 12th the patient had somewhat improved. On the following day tinc ture of cantharicles, in doses of twenty drops every four hours and to be increased if necessary, was prescribed in addition to his other treatment. For three or four days the patient steadily but very slightly improved, after which he evidently failed for a few days. He had taken nearly two ounces of tincture of cantharides and suffered a little of strangury. All remedies except his nourishment and a little brandy were now omitted, and on the following day compound syrup of phosphate of lime and iron was ordered. On October 23d the patient was still very feeble, but looked a little brighter and had a little appetite ; pulse 120 to 130. After this he steadily improved, and by November 1st he had a good appetite, his pulse having gradually lessened to from HO to 90 pt-r minute. On November 8th he was dressed and able to sit in a chair, and about two weeks later he first went down stairs on crutches. The wounds on the external side of the foot had completely healed by December 21st, while the openings on the other side, both above and below the malleolus, were still discharging. All the openings healed up about December 31st, but several days after more swelling appeared toward the toes, and on January 3d an opening occurred over the second meta tarsal bone, near the distal extremity. This discharged freely for several weeks, denuded bone being detected by the probe. On January 29th the patient was able to wear his boot all day, and one week afterwards he walked with a cane. By February 15th the last opening had closed. On March 13, 1863, the patient was mustered out of service, walking with ease by the aid of a cane and without much difficulty without one. He subsequently informed me by letter that he was holding a position on the staff of Brigadier General Pierce in Massachusetts." Lieutenant Holt is a pensioner, and was paid February, 1879. TABLE 01. Summary of Eighteen 1 Cases of Secondary Amputations in the Tarsal or Metatarsal Bones for Shot Injury. [Recoveries, 116; Deaths, 1718.1 NO. NAME, MILITARY DESCIUI-TIOX, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. 1 Carey, J., Pt., E, 149th May 5, Right ; 4th toe and metatarsal. 10 Noll, E., Pt., G, 147th May 25, Right ; 2d toe and portion of met Penn., age 23. June 11, Surg. H. Palmer, U. S. V. Dis Penn., age 22. Aug. 13, atarsal. A. A. Surg. J. O. Con- 1864. charged July 24, 1865. 1864. nell. Disch d Sept. 22, 1865. 2 Finnegan, P.,Pt..H, 16th De.31, 62, Right. Dr. J. E. Pomfret. (Dis 11 Palmer, A. G., Pt., D, May 23, Left (May 29, 3d and 4th toes; Infantry, age 34. Feb. 27, charged Feb. 21, 1865; eh. ery 4th New York Heavy 1864, amp.; necrosis) ; part of 4th and 1865. sipelas of foot.) Feb. , 1866 ; Artillery, age 21 . Jan. 10, 5th metatarsals. A. A. Surg. D. amputation lower third leg. 1865. F. Etter. Disch d May 30, 65. 3 Foss, G. P.,Serg t, K, 1st June 18, Left ; 4th toe and metatarsal. A. 12 Strong, A., Pt., E, 24th J y 2. 63, Left: 1st toe and part of metatar Mass. He:ivy Artillery, Sept. 14, A. Surg. J. H. Gushing. Disch d Wisconsin, age 24. Jan. 20, sal. Surg. E. 13. Wolcot, Wis age 4i>. 1864. June 2li, 1865. 1864. consin. Disch d Oct. 14, 1864. 4 Haslam, J., Pt., H, 129th Dc.l3, <;2, Right : great toe and part of met- 13 Titus, A., Serg t, E, 3d Aug. 9, Left : Lisfranc s. Disch d Nov. Penn., age 30. Feb. 18, atursal (gangrene; March, 1863, Wisconsin, age 28. De. 6, 62. 14, 1862; necrosis. 1864. excis. 2d toe); Nov. 17, 1867, 14 Tooley, P., Pt,, D, 103d De.16, 62, Right : 2d and 3d toes and meta . amp. leg; June, 1868, amputat n New York, age 22. Mav 30, tarsals ; hjEinorrhage. Disch d upper third leg. 1863. Sept. 12, 1863. 5 Lcimond. H.,Pt.,E, 28th J v30, 64, Right : 4th toe and part of meta 15 Williams, S.W., Pt., An Sept. 17, Left ; Hey s ; through metatarsals Mass., age 37. Feb. 28, tarsal. A. A. Surg. J. H. Cutler. drew s S. S. (Mass.), 1862, just ant. to tarsal articulation. 1865. Disch d July 31, 1865. age 31. Jan. 17, Surg. J. Niell. U. S. V. Disrh d 6 McEntee, E., Pt., H, 73d July 2, Right; Chopart s. Ass t Surg. 1863. April 17, 1863; depending on New York, age 23. Aug. 4, D. C. Peters, U. S. A. Disch d crutches. 1863. Dec. 16, 1863. Spec. 1650. 16 Wither, C. E., Corp l, B, May 4. Left ; 1st toe and inetatar. Duty. 7 MeMorran, S. T., Capt., Aug. i>, Left ; 3d and 4th toes and meta- 7th Maine, age 23. J e21, 63. C, 66th Ohio, age 32. Oct. , tarsals. Disch d Jan. 27, 1863 ; 17 Gilman, C. P., Pt., E, 3d May 8, Right ; Hey s. A. A. Surg. G. E. 1862. pensioned. Maine, age 24. June 22, Brickett. (Amp. toe; gangren 8 Merrill, M., Pt., K, 12th Oct. 19, Right ; 3d toe thro metatarsal. 1864. ous.) Died June 30, 64: dipthe. iliiiuc, tt (T c 33. Dec. 19, A A Sura* Tr-in T)ntv Inlv 18 Ryan A. Pt. C 114th Left ; Hey s. Surg. C. T. Simp 1864. 27, 1865. " New York, age 28. Nov. 5, ers, 6th Md! Died Nov. 9, 1864 ; 9 Meyers, J. J.,Pt.,K, 102d June 22, Right; 1st and 2d toes and por 1864. pneumonia. Illinois, age 33. Sept. 7, tions of metatarsals. Disch d 1864. April 4, 1865. AMPUTATIONS IN THE FOOT OF UNCERTAIN DATES. In four hundred and seven instances of amputations in the foot the time between the injury and the operation was not indicated. 1 As in the preceding two tables, amputations of the toes are not included in this table. 636 INJURIES OF THE LOWER EXTREMITIES. [CHAP. X. The results in fifty-four cases were not ascertained; three hundred and twenty ended in recovery and twenty-three in death, a mortality rate of 6.5 per cent. Sixty cases were amputations in the tarsal or metatarsal bones; three hundred and forty-seven were ampu tations of the toes. Few details of the cases were reported. CASE 933. Corporal G. Marsh, Co. G, 17th Iowa, aged 25 years, received a shot wound of the right foot, at Champion Hills, May 16, 1863, and was conveyed to Gayoso Hospital, Memphis, two weeks afterwards. After some time had elapsed in an attempt to save the whole foot an operation was resorted to which involved the four small toes and metatarsal bones. The wound healed kindly, and the patient recovered with a comparatively useful foot. The case was reported by Surgeon J. Bryan, U. S. V. 1 The patient was subsequently transferred to Jefferson Barracks, where he was discharged from service October 6, 1863, and pensioned. Examining Surgeon J. Windle, of Des Moines, Iowa, certified to the loss of the four small toes and meta tarsal bones, "leaving the big toe greatly deformed, the ankle-joint stiff, and the muscles on the sole of the foot contracted so that the toe touches the ground first and causes him to walk with difficulty. The limb is considerably wasted and weak." The pensioner was paid September 4, 1881. TABLE GIL Summary of Sixty Cases of Amputations in the Tarsal or Metatarsal Bones of Uncertain Date for Gunshot Injury. [Recoveries, 132; Deaths, 33 49; Results unknown, 5060.] No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RESULT. No. NAME, MILITARY DESCRIPTION, AND AGE. DATES. OPERATIONS, OPERATORS, RKSULT. Aikins, J. T., Pt., A, Phillip s Legion. Barnes, J. G., Pt., B, 38th Va. Art y, age 19. Berry, H. T., Pt., H, (iCth Alabama. Bisbee, N., Serg t, K, 89th New York, age 43. Blevins, F., Pt., A, 26th North Carolina. Buck, C. jV., Pt., B, 17th Virginia, age 19. Burnett, W. li., Lieut., G, 10th Arkansas. Collins, W. A., Pt., F, 63d Tenn., age 31. Denham, G. D., Corp l, B, 15th Alabama. Caspar, J., Pt., H, 8th Louisiana. Gleason, J., Pt., D, 7th N. C., age 42. Hardy, K. F., Pt., C, 38th Va., age 24. Harvey, S., Pt., A, 2d .South Carolina. Hickman, J. W., Pt., B, 2d Louisiana. Holmes, G. W., Pt., F, 73d Ohio, age 36. Ingle, W. F., Serg t, A, 2d Ind. Cav., age 21. Johnson, G. N., Serg t, B, 154th New York. Johnson, T. T., Pt., K, 59th Georgia. McDonnell, C., Pt., C, Cth North Carolina. Marsh, G., Corp l, G, 17th Iowa, nge25. Miller, M., Pt., G, 10th Louisiana. Morrison, J, G^Aide-de- Camp to General T. J. Jackson. Patrick, W. A., Pt., F, May 3, , 63. April 18, , 64. ; Chopart s. Furloughed. Left. Retired March 22, 1865. Right ; great toe and metatarsal. Furloughed August, 1864. Right ; toes and 3d metatarsal ; April, 1865, amput n leg. Dis charged May 25, 1865. Right; Chopart s. Retired Feb ruary 3, 1865. ; Chopart s. Furlough d Sep tember 15, 1862. . To custody of Provost Marshal. ; 4th toe and metatarsal ; necrosis. Recovery. Left. Furloughed Oct. 3, 1864. Left. Discharged November 19, 1863. Right; Chopart s. Duty Nov. 4, 1863. Left; Chopart s; gangrene. Ex changed March 17, 1864. Left. Sent to Nashville. Left. Discharged January 23, 1863. Left ; great toe and half of meta tarsal. Disch d May 9, 1865. Left: Lisfranc s. Disch d Octo ber 4, 1864. Right ; great toe and metatarsal. Recovery. Right. Paroled September 23, 1863. . Paroled September 12, 63. Right ; four small toes and meta- tarsals. Disch d Oct. 6, 1864. Lett; Chopart s. Furloughed. ; Chopart s. Recovery. T . Paroled August 22, 1863. Left; Chopart s. Retired Feb ruary 14, 1865. Right ; 1st toe at scaphoid, 2d toe and metatarsal. Disch d Aug. 11, 1865; pensioned. Right ; 2d too and metatarsal. Transferred Oct. 27, 1864. Right. Discharged December 1, 1862. Right; great toe, excision 1 st and 2d metatarsals. Recovery. ; 5th metatar. Ass t Surg. J. Murphy. 37th 111. Duty May 5, 1863. Died September, 1864. 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45> 40* 47 48 49 50 52 53 54 56 57 58 59 60 Tedrick, W. L., Pt., F, 149th Penn., age 21. Tilty, J., Lieut., E, 34th North Carolina. Weinlcler, F. E., Pt,, C, 6th Louisiana. Becker, F., Pt., G, 32d Indiana. Colgan. J. A., Corp l, D, 14th South Carolina. Crockett, VV., Pt., B, 19th Maine. Davis, B. M., Pt., B, 20th Georgia. Esley, J. A., Pt., C, 18th Georgia. Freeman, C. D., Pt., F, 4th Massachusetts. Furry, E. M., Serg t, G, 73d Ohio. Gordon, V., Corp l, K, 55th Virginia. Greenwood, E. W., Pt.. G. 53d Mass. Hoffman, A., Aide-de- Camp to Gen. Trimble. Bunnicutt, J. B., Pt., G, 12th South Carolina. Mitchell, W., Pt., E, 25th Virginia. Rowland, S., Serg t, A, 78th New York. Stuart, J. W., Pt., I, 9th Iowa. Wooden, A., Pt., E, 21st Virginia. Wooding, H., Serg t, I, 24th Connecticut. Cannady, J. W., Pt,, I, 3d South Carolina. Colley, T. W., Serg t, D, 1st Virginia Cavalry. Garrison, F. tl., Pt., I, J3th Alabama. Greenwood, A., Pt., C, 55th Virginia. Hendrix, G. A., Pt., E, 2d South Carolina. Herniii. l>. /:., Pt., I, 42d Georgia. Knight, K. H., Pt,, K, 45th Georgia. Landing, J. F., Pt., A, 38th North Carolina. Lindsay, A. T., Pt., F, 6th South Carolina. Linsbay, A, L., Pt., E, 60th Alabama. Powell, R. B., Lieut., C, 2d South Carolina. M y 5, 64, July 3, , 63. July Left; toe and 2d metatar. Dis charged February 10, 1865. Right ; Chopart s. Paroled Oct. 24, 18<i3 ; exchanged. June 18, 1864, , 63. De.31, 62, . Died January 21, 1863. Right. Died September 13, 1864. Right. Died June 8, 1864. . Died September 12, 1862. J y 3, C3, Aug. 3, , 62. 1863. J y31, 64. Sept. 20, , 63. J y 3, 63, 1864. May 6, , *64. 1862. 1862. June 14, , 63. Aug. 31, , 62. Left. Died July 17, 1863. . Died September 23, 1862. Right (gangrenous); erysipelas. Died August 4, 1862. . Died July 6, 1863. . Died August 10, 1863. Left. Died June 27, 1864. Right. Died July 24, 1862. Both. Died June 6, 1863. Left. Died May G, 1862. . Died July 1, 1863. . Died July 23, 1863; diar- rho3a. Left. Left ; grout toe at tarso-metatarsal articulation. Right ; two toes and portions of metatarsals. Right. Right. Left. Dec. 14, , 62. July 3, , 63. 1863. J y31, 62. June 14, , 63. 1863. 1864. 1862. May 3, , ^63. Mar. 7, , 62. 1863. May 24, , 63. July 3 V , TO. 1864. De.28, 64, Jan. 27, , 64. Aug.9, 63. July 3, , " 63. July 3, , ^63. M ylG. fiS. July 2, 63 July 3, , Y 63. Oct. 14. , 03. April 2, 1865, 1864. ICth Georgia. Rogers, J., Pt.. B. 44th North Carolina, ago ilJ. Shaw, L., Pt., K, 6th Vermont, age 41. Simms, W. E., Serg t- Maj ,24th Miss., age 22. Slaiightfr,r>.W.,Vt.,K, 18th Georgia. Smithers. B. G., Corp l, C, llth Mass. Sowle, H., Pt., F, 37th Illinois. 1865. 1865. Se.13, 64, 1863. Left. Right; 2d tue and part of meta tarsal. Left. 1862. Au. 2, 63. 1864. Oct. 3, , 64. BRYAN (JAMES), Seventeen Additional Cases of Amputations from the Armies of the, S"nth-We.ttt, in Am. Me.rl. Times, Volume VII, p. 287. SKCT. VII.] SHOT WOUNDS OF THE BONES OF THE FOOT. 637 Concluding Observations. Less frequent than the shot lesions of the bones of the hand, the shot fractures of the bones of the foot were found more vexatious, 1 not rarely leading to extensive inflammation and accumulations of pus under fascia and tendons, and to tedious exfoliations of fractured bones; and the percentage of fatality of the injuries of the foot considerably exceeds that of the injuries of the hand, the former being 8.3, the latter only 3.1 per cent. In many of the cases of fractures of the tarsal bones detailed on pages 619 to 622, the wounds suppurated for months and even years. In the case of Gamp- bell (CASE 896, page 619, ante), who was shot through the tarsal bones in July, 1861, the pension examiners testified in 1874 that the wound was still open and connected with dead bone; and, in 1875, that a portion of the astragalus had been removed. In the case of Tarrance (CASE 892, page 619, ante), who received a shot fracture of the os calcis in 1863, necrosed bone was removed with the gouge six months after the injury, and the wound was yet suppurating in 1866. In other cases, although the wounds closed, the limbs remained of little service. In Chase s case (CASE 897, page 620, ante) the foot is turned inward and upward, the leg resting on the outside of the foot, and the patient cannot get along without an artificial apparatus. Flattening of the plantar arch was recorded in the case of Miller (CASE 893, page 619, ante), anchylosis of the ankle joint in the case of West (CASE 899, page 620, ante), and swelling of the ankle and leg to the knee with disease of the tibia and soft parts in the case of Captain Bearden (CASE 898, page 620, ante), who either has to use crutches or a stout cane at all times to walk. The treatment generally consisted in the application of cold-water dressings or of poultices. 2 Of the grave surgical complications, pyaemia was noted in fifteen cases, all fatal; tetanus in fourteen, with two recoveries, twelve deaths; gangrene in thirty-seven, with thirty recoveries, six deaths, one unknown result; erysipelas in twenty-three, with twenty recoveries, three deaths; and hemorrhage in twenty-three cases, with nineteen recoveries, three deaths, and one unknown result. ^Excisions in the bones of the foot for shot injuries are of very recent date. The opera tions ascribed by Velpeau 3 and Heyfelder 4 to Formey 5 in the sixteenth century and to 1 RA.VATON (Chirurgie d armee ou traite des plaits d armes d,feu, etc., Paris, 1768, p. 389): "Les coups de feu qui fracturent les os du pied sont tres facheux : on pent les distinguer en ceux qui percent le pied suivant sa longueur d arriere en avant, ou de devant en arriere ; en cenx qui le percent de cot6. plus ou raoine obliquement : en ceux qui ont leur entr6e sur le col du pied, et leur sortie au talon, et par la route la plus courte au tarse, an m^tatarse en fracturant les os des doigts. Toutes ces difTerentes fractures sont toujours accompagnfies de lesion de tendons, et c est la multitude de ces memes tendons qui aggrave la maladie. 1 NKALE (H. ST. JOHN) (Chirurgical Institutes, etc., London, 1805, 2nd ed., p. 256) : "Gunshot wounds of the tarsus, when the bullet remains in its substance, or when it has pierced quite through, are much more dangerous than those of the wrist ; and many reasons mil} 1 be given for this. First, the bones of the tarsus are larger than those of the wrist, and of consequence a greater havock is occasioned here ; secondly, the tendinous parts that cover these bones and tie them together are larger and more numerous. Thus the nervous system suffers more in the injury. Thirdly, the conjoined group of bones in the tarsus form a much thicker body, and therefore we cannot reach them with our incisions to the bottom of the wound, as in the soft fleshy parts. These wounds should therefore be regarded as being of very great consequence, and even it may be said of as great importance as those that pierce a joint quite through. 1 PORTER (J. B.) (Medical and Surgical Notes of Campaigns in the War with Mexico, etc., in A m. Jour. Med. Set., 1852, Vol. X XIII, p. 30) : " Wounds of the foot and leg do not, by any means, recover so readily or so perfectly as wounds of the hnnd and forearm." PlROGOFF (X.) ( Grundziige der Allgemeinen Kriegschirurgie, Leipzig, 1864, p. 823) : " With a wound of the foot the case is different from a wound of the hand. The patient with a wounded hand can stand and go about, and during fair weather can remain in the fresh air the whole day. In shot wounds of the foot on the contrary the patient is confined for half a year or a year to his bed at the hospital, and, in the end, the foot preserved is so crippled that he must have recourse to crutches. THOMSON (J.) {Report of Observations, etc., after the Battle of Waterloo. Edinburgh, 1816, p. 144) : "Various instances presented themselves of gunshot wounds of the foot. In some of these the balls had passed between the soft parts and the bones on the under as well as upper part of the foot. In other instances the balls had passed through the foot in every direction and had fractured the tarsal and metatarsal bones. These fractures were always accompanied with great swelling, which depended on the communication of inflammation from the wound to the contiguous ligaments and articulating surfaces." GUTHUIE (G. J.) (Treatise on Gunshot Wounds, London, 1827, p. 412): "The feet pen rally suffer from wounds of musket balls; and as the parts in the foot, although bearing a general resemblance to the hand, are more complex and difficult of management, so are wounds of the foot more dangerous and more generally followed by defective cures from apparently slighter causes." 2 >STKOMEYEK (L.) (Maximen der KriegsJieilkunst, Hannover, 1855, p. 748) warns against the too early application of cataplasms in fractures of the titrsal bones; but advises their application in fractures of the metatarsal and phalangeal bones, as the cold applications are apt to become harassing. 3 VELPEAU (A.-A.-L. M.), Nouveaux dements de medecine operatoire, Paris, 1839, T. II, p. 660. 4 HEYFEt,DEU (O.), Lf.hrbuch der Resectiontn, Zweiter Abdruck, Wien, 1863. p. 194. S RIVEKIU8 (L.) (Opera Medico, Unirersa, Lugduni, 1679, p. 571, Obs. XIII) cites a case of shot -wound of the calcaneum: the ball had lodged in the calcaneum and was removed by FORMKY with the aid of a trephine: "trepano calcaneum aperui, et in o latentem globulum inveni et extraxi." 638 INJURIES OF THE LOWER EXTREMITIES. [CHAP. x. Morand 1 in the seventeenth, were certainly not excisions, but simply extractions, by the aid of the trephine, of missiles lodged in the calcaneum. An excision of four metatarsals and the cuneiform bone, performed by Langenbeck in 1848, in the Schleawig Holstein war, seems to have been the first operation of this nature for shot injury; and since then only a few cases of excisions of the tarsal or metatarsal bones can be traced, 2 as the surgical histories of the late great European wars barely mention these cases, or include them, without com ment, in the .tabular statements of operations of the foot and toes. As indicated in Table XCVT, page 622, the excisions in the tarsal bones had a fatality of 16.6 per cent., in the tarso-metatarsal articulation of 40.0 per cent., in the metatarsal bones of 14.8 per cent., and in the metatarso-phalangeal articulation of 75.0 per cent., making in the aggregate number of cases a mortality of 19.3 per cent., which slightly exceeds that of the partial amputations of the foot, viz: 18.9. The unfavorable results, especially in the cases in which the tarso-metatarsal or the metatarso-phalangeal articula tions were involved, were found to be due to inflammation of the synovial membranes and the ease with which purulent suppuration extended through the spaces between the adjacent bones. The usefulness of the limb remained largely impaired in nearly all the patients who submitted to this operation. In the case of General Badeau, in which the middle and portion of the internal and external cuneiforms were removed, the arch of the foot remained depressed, 3 and the operation tended slightly to valgus. In Dubois case (CASE 909, page 623, ante), the pension examining surgeons testify to lameness, and much pain and diffi culty in walking; and in Hargrave s case (CASE 916, page 624, ante) it is reported that he was never able to walk without crutches. In the case of Leunze (CASE 911, ante), in which the first metatarsal was removed in 1864, the great toe had become distorted in 1868 and was pushed at least one inch posterior to its original locality; the weight of the body in walking was sustained by the heel and a portion of the external border of the foot. Amputations in the Foot. Amputations were performed in every part of the foot as was deemed necessary from the nature of the injury, thus causing a series of operations 1 MORAXD (Opuscules de Chirurgie, Paris, Secomle Partie, 177:2, p. 248): " J ai vu des balles enclav6es daus les os, et entr6 autres une dans le calcaneum qui ne put ctre tir6e que par 1 application du trepan, en 1 embrassant dans le cercle de la comonne." 2 Ross (G.) (Militairarztliches aus dem ersten Schleswigschen Feldzuge im Sommer, 1848, Altona, 1850, p. 56): L , shot at Diippel, June 5, 1848; ball entered the dorsum of the foot, fractured the metatarsals, and escaped at the sole of the foot; June 15, excision of the four inner metatarsals by LAXGEXliKCK; gangrene ; June 10, amputation in the leg ; also amputation of left leg for shot wound of ankle ; death. MATTHEW (T. P.) (Medical and Surgical History of the British Army, etc., in the years 1854- 55- 56, London, 1858, p. 36) tabulates from the Crimean War a case of excision of the os calcis and part of the astragalus; the patient was invalided. OCHWADT (A.) (Kriegschirurgisclie Erfahrungen, Berlin, 1865, Appended Table, p. XVI, Case No. 65): Private C. L , C-lth Prussian Regiment, was shot in the calcaneum, April 18, 1864; excision of calcaneum was performed by L/AKGENBECK on Muy 24 ; recovery. LOCKE (A.) (Kriegschirurgische Apliorismen aus dem zweiten schleswig-holsteinsclicn Kriege, im Jahrc 1804, in Archiv fur Klinische Chirurgie, Berlin, 1806, 15. VII, p. 12 J): A. Uiep. 24th Prussian Regiment, shot June 29, 1804, through the calcaneum; removal of fragments at various periods; August 2, subperiosteal excision of calcaneum by LfJCKE; August 15, gypsum bandage; recovery"; in December, 1804, there was a moderate amount of new osseous formation. OTIS (G. A.) (Circular No. 3, War Department, Surgeon General s Office, Washington, 1871, p. 227): C. L , 1st U. S. Cavalry, shot wound of calcaneum, at Camp Bidwell, Nov. 3, 1866; caries; excision of portion of calcaneum February 26, 1867 ; good recovery. J. E , 10th U. S. Cavalry, shot through metatarso-phalangeal articulation of left great toe, January 21, 1868, at Fort Riley ; March 1, 1808, excision of phalanx and head of metatarsal bone; periosteum preserved; healed with profuse suppuration; recovery. BECK (B.) (Chirurgie der Schussrcrletzungen, Freiburg,!. Br., 1872, p. 900): Soldier, 3d Baden Infantry, shot through the metatarsals; extensive suppuration; excision of the metatarsal bone of the 5th toe in the third week ; favorable result. IDEM (loc. cit., pp. 907 arid 910) tabulates a fatal case of excision in the metatarsal and another of the oaloanetim from the hospitals at Ttasstatt and Strassbnrg. CHIPAUJ.T (A.) (Fracturf.t p<tr nrnic/s fnt, Paris, 1&70. p. 176): J. S , 41st French Infantry, aged 44; shot wound of left foot; Beaugency, Dec. 8, 1870; February, 1871, extensive suppuration; excision of part of astragalus and the entire os calcis two months after injury; wounds cicatrized and patient walked well in June, 1871 ; in July a fistulous opening discharged fetid pus; death Aug. 18. 1871, of phthisis. IlEYFELDEH (O.) (Bcricht uber meine Wirksamkeit am Iihein,etc., in 1 etcrsburg Med. Zeitschrift, 1871, B. II, p. 61): Bazze, 67th Infantry ; shot wound of os caicis and calcaneum Aug. 16, 1870; December 0, excision of part of calcaneum ; reproduction of bone followed in a few weeks. IDEM (p. 80): French officer, shot through (he os calcis at Sedan(?) ; partial excision of calcaneum by HEYFELDKU ; good recovery. TILING (G.) (Bericht uber 124 im serbisch-tiirkischen Kriege im Barar.ken-Lazareth des Dorpater Sanitats- Trains zu Swilainats bclian- deltc Schussverletzungen, Dorpat, 1877, p. 81): M. G , aged 21; shot fracture of calcaneum in September, 1876; excision of the os calcis; wound nearly healed in October. HAMILTON (F. H.) (A Treatise on Military Surgery and Hygiene, New York, 1865, p. 508): " The tarsal bones constitute a large portion of that important arch upon which the entire bony superstructure rests. The several portions of which it is composed are all alike essential to its perfection, and the removal of any single bone necessarily gives a certain degree of instability to the gait. What, therefore, might be regarded as a success in any other portion of the body must often be regarded as a failure here." SECT. VII.] AMPUTATIONS IN THE FOOT. 639 differing materially from each other. The medio-tarsal operation of Chopart, 1 between the astragalus and scaphoid bone (FiG. 361), was performed in eighty-five instances. In two the results were not determined; seventy-two were successful and eleven fatal. In two instances, with one recovery and one death, the reports merely indicate that the ablation was performed through the tarsal bones; these operations were probably also after Chopart. Lisfranc s 8 amputation through the tarso-metatarsal articulation (FiG. 362) was performed on twenty-four patients; twenty-two recovered, one died, and one result was not determined. Hey s operation, 3 in which the four outer metatarsal bones are exar- ticulated at their junction with the tarsals, and the projecting part of the first cuneiform l.-CHOl-AKT B amputation of the foot. [After bone which Slip- ^ 362 ._ LI8FRAKC , S amputation in the foot . [After ports the great toe ESMAUCH - J is removed, was performed in seventeen cases; eleven were successful and six fatal. In one hundred and thirteen instances from one to four toes, with the corresponding metatar- sals, were amputated, 4 and in one thousand two hundred and twenty-seven cases one or more toes were removed. 5 Of the two hundred and ninety-one patients with amputations in the foot, thirteen submitted to subsequent operations, viz: one to amputation at the ankle joint and twelve to amputations in the leg; one of the latter died. The twelve hundred and twenty-seven amputations of toes were followed by amputations in the foot in two, at the ankle joint in two, in the leg in six, at the knee joint in one instance, making a total of eleven re-amputations following amputations of the toes. In five hundred and fifty cases the amputation involved the right limb, in eight hundred and forty-seven the left limb, and in one hundred and twenty-one the side was not indicated. It is difficult to attain a common standard of the usefulness of the foot after amputa tion, as the patient, according to his individuality, personal vanity, or the necessities of his condition, will insist on diverse requirements; but it is evident that a well-rounded stump is of the utmost importance. A remaining portion of a finger or thumb may be very useful; but a remaining toe will frequently be a source of annoyance and even an inconvenience; will add nothing to the patient s power of locomotion and prove a hindrance to the proper fitting of a shoe. 1 LAFITEAU, Observation sur une amputation pariielle tin pied, in La Mldecine eclairee par les sciences physiques ou Journal des decouvertes, Paris, 171)2, Vol. IV, p. 8.5. 2 LlSFRA.XC (.!.), Noucelle methode operatoire pour V amputation partielle dupied dans son articulation tarso-metatarsiennf, Paris, 1815, p. 17. 3 HlY (W.), Practical Observations in Surgery illustrated by cases, London, 3d ed., 1814, p. 054. 4 Four metatarsals with their corresponding toes were amputated in 3 instances ; three in 7 instances, two in 19 iustances, and one metatarsal and the corresponding toe in 84 iustances. Of the 113 cases, 5 were not terminated, 99 recovered, 9 were fatal. 5 The operation involved one toe in 1,001 cases, two in 145, three in 31, four in 8, and all toes in 18 instances; in 24 cases the numbei of toes removed was not indicated. 640 MISCELLANEOUS INJURIES. [CHAP. II. CHAPTER XI. MISCELLANEOUS INJURIES, In the beginning of this work, in the first chapter on injuries of the head, and to some extent in the second, third, and fourth chapters on injuries of the face, neck, and spine, the miscellaneous injuries, as well as the injuries by weapons of war, were discussed. But as the work progressed it was found advantageous for the compiler as well as the reader to examine the injuries caused by direct impact of weapons of war by themselves, and to reserve the injuries from other causes for a separate chapter. In this chapter will, there fore, be considered the numerous accidents similar to those daily occurring in civil life, and to which the soldier is likewise exposed, such as burns, scalds, contusions, sprains, dis locations, frostbites, simple and compound fractures, punctured and incised wounds not including sabre and bayonet wounds and lacerated wounds. As will be seen from the following tabular statement the number of these injuries was by no means insignificant: TABLE GUI. Summary of One Hundred and Seventy-one Thousand Five Hundred and Sixty -five Miscellaneous Injuries, CLASSIFICATION. TOTAL. Percentage of Mortality. WHITE TROOPS. COLORED Tnoors. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1 3 4 5 6 7 8 9 10 11 12 13 14 Jiurns and Scalds 10, 100 46, 972 98 172 215 17 3 10 53 76 397 163 467 169 110 1,075 0.97 0.36 23.31 27.86 .00 0.33 4.11 1.74 28.95 0.73 3.16 3.13 3.48 7.03 9,487 44, 323 873 61 38,387 2,908 1, 287 4,215 1,316 20, 932 14, 153 4,902 3,087 13, 099 94 161 193 17 3 9 ; 53 61 378 161 459 162 93 1,003 613 2,649 49 4 11 Contusions Concussion of Brain 922 61 42, 704 3,016 1,287 4, 340 1, 371 22, 227 14,748 5, 384 3,154 15, -J73 Compression of Brain Sprains 4,317 108 Dislocations 1 Fractures Simple Fractures 131 55 1,295 595 482 67 2,174 15 19 2 8 7 17 72 Compound Fractures Incised AVounds 1 Lacerated Wounds Punctured Wounds 2 Poisoning Other Accidents and Injuries Aggregates 171, 565 3,025 1.76 159, 030 2,847 12,535 178 1 The entire number of incised wounds as indicated on page XXV of the First Surgical Volume was 22.749. From these have hofn deducted 522 sabro wounds referred to in the preceding ten chapters. 2 The entire number of punctured wounds as indicated on page XXV of the First Surgical Volume was 5,784. From these have been deducted 400 bayonet wounds referred to in the preceding ten chapters. SECT. I.I BURNS AND SCALDS. 641 Besides the number of accidents recorded in the preceding table there were a number of deaths from violence, such as drowning, suicide, homicide, and execution of sentence: TABLE CIV. Summary of One Thousand Three Hundred and Thirty-six Deaths from Various Causes. WHITE Tuoors. COLOUED TKOOl S. t Deaths. Percentage. Deaths. Percentage. ^ Drowning 797 672 84. 32 125 15.68 9 Suicide 278 270 97.12 8 88 3 Homicide 126 114 90.48 12 9.52 4 Execution of Sentence 135 103 76.30 32 23.70 Total 1 336 1,159 177 The total number of troops engaged during the war is estimated (see introduction to First Medical Volume, p. XXXIX) at 2,335,942 men; of these 2,157,047, or 92.34 per cent., were white and 178,895, or 7.66 per cent., colored. It will thus be seen that the percentage of suicides among the colored troops was very small, while the percentages of deaths from accidental drowning and execution of sentence were large. The injuries recorded in the preceding tables are of such frequent occurrence, in daily life, and their treatment is so fully discussed in surgical journals and text-books and in the reports of civil hospitals, that it will only be necessary here to introduce, without com ment, a few of the more serious examples of the different accidents, and to give, in tabular form, a summary of the operations subsequent to these injuries. Burns and Scalds. Injuries caused by the exposure of living tissue to a high degree of temperature are called burns; when the burn is produced by hot or boiling liquid it is called a scald. The pathological conditions and the treatment of burns and scalds are fully described by Dupuytren, Long, Erichsen, Crompton, Ashhurst, Follin, and Legouest and others. 1 The large majority of the ten thousand one hundred injuries of this nature during the war were of an exceedingly trivial nature, only ninety-eight, or 0.9 per cent., proving fatal. Those caused by the action of powder, 2 from explosions of cartridges, caissons, or magazines, were the most serious, and a few instances will be cited. CASE 937. Private G. Witter, 1st Ohio Battery, aged 29 years, was injured by the explosion of a caisson during the action near Winchester, July 20, 1864, and entered the Cumberland General Hospital three days afterwards. Acting Assistant Surgeon M. M. Townseml recorded the following description of the case: "The patient was suffering from burns of his face, arms, and hands. When admitted his appearance was dreadful, the burns involving the whole of the face, the anterior surface of the neck, and parts of the external surfaces of the forearms. On the hands the skin was destroyed in several places at the dorsal surface and ulnar edge. The patient s face was covered with a complete mask of dried pus, oil, and cotton, causing him to look like a negro in the suppurating stage of confluent small-pox. Warm emollient poultices and assiduous washing soon 1 DUPUYTKKX, Des Brulures, in Lemons Orales de Clinique ChirurgicaU, Paris, 1839, T. IV, p. 503. LONG (JAMES), On the Post-Mortcm Appearances found after Bum*, in London Medical Gazette, London, 1640, Vol. XXV, p. 743. ERICHSEN (J. E.), On the Pathology of Burns, in L<mdon Medical Gazette., London 184:i, Vol. XXXI, p. 544. CHOM1TON (SAMUEL), Report on Burns and Scalds, in The Transactions of the Provincial Medical and Surgical Association, London. 1851, Vol. XVIII, p. 1. AsiilluusT (JOHN, JR.), On Burns, in Am. Jour. Med. Sciences, Philadelphia, 1862, Vol. XLIV, p. 82. FOLUN (E.), Brulures. in Trait : Elementaire de. Pathologie Extcrne, Paris, 1869, T. I, page 521. LEOOUEST, Brulure, in Dictionnaire Encyclopedia/lie des Sciences Medicates, Paris, 1870, T. XI, p. 184. MONTGOMERY (J. F.), Burns and Scalds; their treatment, with casrs, San Francisco, 1872, and Pacific Med. and Surg. Journal, San Francisco, 1872, N. 8., Vol. VI, p. 157. 2 Burns by gunpowder have been treated by LOXSDALE (E. F.), in London Med. Gazette, 183:i, XI, p. 69(> ; SCHNEIDER, Verletzungen durch Scliicss- pulver, Gewehre, Zi .ndhutchen und Zunclhiilzchni, in Zeitschrift fur die Staatsarzneikunde, Erlungen, 1851, B. LXI, p. 461 ; DUSCH (W.), Mittel grgctt Schiesspulvcr- Verbrennu-ng, in Arch, fur path. Anat., Berlin, 1858, B. XIV, p. 379 : CAHAS8E, Des brulurcs multiples an 1", 2" et 3 degr s. produites par la deflagration d une grande quantite de poudre, in Gaz. des Bop., Paris, 1867, T. XL, p. 516; HOLLER (A. W.), Ueber Pulver-Verbrennung mit letalcm Ansgartg, Leipzig, 1870; GlLLIAM (D. T.), Extensive powder burn, in Clinic, Cincinnati, 1875, Vol. VIII, p. 30 ; MAISSIN (L.-E.), Quelques cas de brulures causees par la deflagration de la poudre, Paris, 1875; SMART, On Burns by Gunpowder and Scalds by Steam, in Lancet, London, 1876, Vol. II, p. 4 J1 ; DOWNS (S.), Severe Injury from Discharge of Gunpowder, in Toledo Med. and Surg. Journal, 1880, Vol. IV, p. 507; FAIRiiROTHEK, Disfigurement from gunpowder, in St. Louis Med. and Surg. Jour., 1880, Vol. XXXV11I, p. 491. LONGMORK (T.), Gunshot Injuries, London, 1877, p. 171. Srno. Ill 81 642 MISCELLANEOUS INJURIES. [CHAP. xi. removed the offensive incrustations, when a saturated solution of alum was applied with good effect. To the deepest burns on the hands poultices of slippery elm were found to be more grateful and beneficial than the alum and were therefore substituted, being followed three daj-s later by simple cerate. This was continued until cure was complete." On September 5th the patient was transferred to Camdun Street Hospital at Baltimore, where he remained until May 16, 1865, when he was mustered out of service and pensioned. Examining Surgeon J. G. Orton certified to the existence of several extensive scars, the result of burns. One over the posterior part of the left elbow impairs the action of the extensor muscles and renders the joint defective. He also complains of pain in the back and over the bowels, resulting from a fall at the time of the explosion." Subsequent examiners report no additional information. The pensioner was paid September 4, 1881. CASE 938. Private C. H. Shields, 6th Maine Battery, aged 21 years, was injured by the explosion of some cartridges during the battle of the Wilderness, May 6, 1864. Surgeon H. C. Tompkins, 4th New York Artillery, reported his admissisn to the Artillery Brigade Hospital, Second Corps, with "severe burn of face and hands by powder." From the field the injured man passed to Armory Square Hospital at Washington, and thence to Cony Hospital at Augusta, where he was discharged from service for disability June 13, 1865, and pensioned. Examining Surgeon J. B. Bell reported, July 8, 1865, that " the disability results clriefly from disfigurement. Both ears were disagreeably deformed and partially destroyed. The left side of the face is scarred and blackened, and the use of the left hand is somewhat impaired by the scar of the burn." Examiner G. W. Burket, of Tyrone, Penn., certified September 4, 1873: "Both ears were burnt, causing partial deafness from closure of the external meatus of the left ear." Examiner I. E. Oatman, of Sacramento, Cal., September 4, 1879, confirmed the existence of partial deafness, also that the upper and greater portion of both ears were burned off by the explosion. CASE 939. Private C. Withee, 1st Wisconsin Battery, was severely injured by the explosion of a caisson during the battle of Big Black River, May 18, 1863. He was admitted to Union Hospital, Memphis, three weeks afterwards, where Surgeon J. D. Brumley, U. S. V., recorded the following result: " He had been very badly burned over his face, both hands and both arms, by the accident, and when he entered this hospital he was a most pitiful and repulsive looking object > His face was covered with scabs so that the eyes could not be opened. A bullous eruption covered the body and arms, and tetanus caused the left hand and wrist to be so contracted that the finger nails were embedded into the wrist, while the wrist was flexed on the arm to such an extent as to bring its dorsal aspect further down than any part of the hand. Trismus existed, so that a spoon could hardly be introduced between the teeth. By tonics, anodynes, and supporting treatment the patient was relieved sufficiently to enable him to converse and to take food by means of a spoon. His mind, which had been delirious, now became sane, and his left arm was straightened by gradual force, after which splints were applied. On June 15th, however, when taking some drink after having taken hi&.uourishment in the morning as usual he appeared to have difficulty in swallowing, and in half an hour afterwards he died, apparently from suffocation caused by spasm of the epiglottis." CASE 940. Private R. A. Runion, Co. I, 68th Indiana, aged 24 years, had his feet scalded by accident, and was admitted to Hospital No. 13 at Nashville on February 26, 1863. Surgeon E. Swift, U. S. A., contributed the following report of the case: "The injury was caused by the upsetting of a pot of hot coffee, involving the right foot at the heel and toes and affecting the left foot but slightly. No unfavorable symptoms were presented when the patient was admitted. His pulse and respiration were natural ; tongue lightly furred ; bowels rather loose, with a tendency to diarrhrea. The wound was dressed with simple cerate. On February 28th his bowels became more loose, accompanied by slight pain, when pills of blue mass, ipecacuanha, and opium were prescribed. The effect of this seemed to be favorable and indications were generally promising until March 5th, when the bowels became costive, the urine scanty and very highly colored, and the skin yellow, showing all the symptoms of an aggravated case of jaundice. With a view of gently moving the bowels, two compound cathartic pills were then given, followed four hours afterwards by doses consisting of two grains of quinine, three grains of nitrate of potassa, and one-twelfth of a grain of morphia. On March 7th the bowels were still costive and the urine scanty. Indeed all the symptoms were aggravated and the patient had a severe spasm followed by delirium approaching mania. Three pills, each containing five grains of blue mass and one drop of croton oil, were now prescribed, one to be given every three hours until the patient had an operation. He Avas bathed, and warm water was given freely, and corn-meal gruel. On March 8, 1863, the patient died, having been comatose and perfectly unconscious since the spasm of .the previous day. Perspiration and urine became profuse before death. Sectio cadaveris : An incision was made from the ensiform cartilage to the symphysis pubis and transversely to the crest of the ilium. The general appearance of the liver was not marked, though of a rather pale color and tough in texture. The gall bladder contained the usual amount of bile, the hepatic and cystic ducts being perfectly pervious and free. The ileum and jejunum were natural in appearance, but the duodenum gave evidence of being the seat of the disease. It had a soft, doughy feeling, its inner coats being softened down and entirely disorganized; perforation had taken place at a number of places in this part of the intestinal canal. The outer coat was perforated, with sharp well-defined edges, while the inner coats were softened and beveled, and indeed affected in their entire surface. A marked peculiarity was that the disease involved only the duodenum, the other parts of the alimentary canal being in a perfectly normal condition." Contusions and Sprains. Less serious even than the preceding group of injuries were the numerous contusions and sprains. Forty-six thousand nine hundred and seventy-two of the former had one hundred and seventy-two, and forty-two thousand seven hundred and four of the latter had three deaths, a total of eighty-nine thousand six hundred and seventy- six cases, with one hundred and seventy-five deaths, or a mortality of 0.19 per cent. As a rule the patients were returned to duty, no lasting disabilities having followed the injuries. A few of the graver cases will here be cited: CASE 941. Contusion of tJic spine. Private J. Sanford, Co. I, 32d Massachusetts, aged 37 years, was accidentally hurt in the back on September 12, 1862. He was admitted to Fairfax Seminary Hospital the following day, where he was discharged SECT. l.J CONTUSIONS AND SPRAINS. 643 from service on December 8, 1862. Surgeon D. P. Smith, U. S. V., certified to the following disability: "An injury of the lumbar vertebrae which has resulted in inflammation of the kidneys and of the tissues of the lumbar region, rendering it difficult for him to stand." The Boston Examining Board reported, November 27, 1862: "Partial paralysis of the superior and inferior extremities, bowels, and bladder frum injury to spine. The paralysis of the inferior extremities is no worse than a year ago, perhaps the legs are a trifle smaller. The paralysis of the arms has increased somewhat. The disability is permanent and incapacitates him for all manual labor." Dr. \V. H. Wallace, of East Boston, testified, March 29, 1880: "The pensioner is suffering from an injury of the spine, partial paralysis of the upper and lower extremities, great irregularity of the bowels sometimes obstinate constipation, at others diarrhoea; also inability to retain the urine and at times inability to pass it. He requires the passing of a catheter once and often twice a week, and is unable to feed, dress, or undress himself fully two-thirds of the time. There is emaciation and loss of sleep from pain in back and legs . He will never be any better." CASK 942. Contusion of the spine. Private R. Clark, Co. D, 6th Ohio Cavalry, aged 54 years, received an injury of the spine during the battle of Bull Run, August 29, 1862, and was treated at St. Aloysius Hospital, Washington. Assistant Surgeon A. Ingram, U. S. A., in charge, reported the man s discharge from service December 18, 1862, by reason of " slight anterior curvature, with much tenderness resulting from the injury." The Chicago Examining Board, September 5, 1873, reported that the man was hurt by falling from his horse, and that "the horse stepped upon his loins, injuring the structure of the spine in the muscular and fibrous portions. There is apparent permanent rigidity of the spinal muscles and great pain on pressure or movement." Examining Surgeon J. F. Daggett, of Lockport, Illinois, May 22, 1877, certified to an injury of the spine, etc., and stated that it is difficult to determine what structural impairment there is, but that the functional derangement is severe and continued, and that there is "anchylosis of the lumbar vertebrae ; brain affected from spinal irritation or other causes; tendency to mental derangement; general health bad." The pensioner died August 24, 1881, from the results of his injuries. CASK 943. Sprain of the back. Private J. B. Saunders, Co. K, 143d New York, aged 47 years, entered Satterlee Hos pital, Philadelphia, December 23, 1862. He had several months previously received a fall against the arm of a seat in a railroad car, straining the small of his back. Since then he had suffered from occasional retention of urine, and his bowels were never moved except by the most powerful cathartics. Pressure upon any of the lumbar vertebrae appeared to give pain, but there was no fracture or displacement to be detected. While the patient remained in Satterlee Hospital large doses of castor oil, with one drop of croton oil added, were administered, and pills of compound extract of colocynth, with one-sixteenth grain of strychnine added, were given. Friction to the spine, with stimulating liniments, was applied. No change took place in the condition of the patient, who was discharged from service January 29, 1863, and subsequently became a pensioner. Surgeon I. I. Hayes, U. S. V., who reported the case, described that there seemed to be a complete paralysis of the muscular coats of the large intes tine and also of the sphincter ani, from which cause an evacuation would take place only when the mass of faeces became so great from natural accumulation or from the action of the cathartics as to no longer leave room in the bowels to contain it, when the fecal matter appeared to pass off by force of gravity and unmolested by the sphincter as soon as it reached the rectum. Exam ining Surgeon A. Otis, of Ellinsville, N. Y., December 8, 1872, certified: "There is great tenderness of the spine, especially of the lumbar vertebrae. His lower limbs are very weak and at times almost paralyzed. He trembles almost continually, has an anxious, waxy, and cadaverous expression of countenance, difficulty in micturition, and is excessively constipated." The pen sioner died from the effects of his injuries December 2, 1875. CASE 944. Contusion of the abdomen. Private A. Bickel, Co. K, 142d Pennsylvania, aged 29 years, entered Satterlee Hospital July 10, 1863, having received a severe injury during the march to Gettysburg. The accident was incurred while a fence was being knocked down for the purpose of facilitating the passage of troops, when he was struck with the butt end of a musket in the lower part of the abdomen, causing a severe contusion of the bowels and forcing the right testicle back into the abdomen. The patient suffered much from pain in the bowels, which were also quite inactive, and his general health as well as his appetite was poor. His treatment consisted of the administration of compound cinchona tincture and of rhubarb, to which subsequently aloes and small quantities of extract of nux vomica and hyosciamus were added. On November 1st, the patient s bowels being still very painful and inactive, the medicines were discontinued and injections of warm salt water were substituted. Very little change in the condition of the patient occurred up to December 16, 1863, when he was discharged from service and pensioned. The history of the case was contributed by Acting Assistant Surgeon D. Kennedy. Examining Surgeon S. L. Beck, of Mifflinburg, Pennsylvania, September 17, 1873, certified that " the stroke produced an injury of the bladder and an abdominal rupture, which causes some pain and other inconvenience, so that he is somewhat disabled in performing manual labor. He will be no better, but may get worse." Examiner T. H. Wilson, of Lewisburg, Pennsylvania, reported, November 14, 1881 : "I find the pensioner has a reducible inguinal hernia in the right side and has been wearing a truss, which, he alleges, does not retain the bowel completely, so that it frequently escapes in spite of the truss," etc. CASE 945. Contusion of the shoulder. Private J. M. Granger, Co. F, 141st New York, aged 26 years, entered Central Park Hospital, New York City, December 17, 1862. Surgeon B. A. Clements, U. S. A., forwarded the following report : " In October, 18G2, the patient was injured at Annapolis by the falling of a heavy piece of timber on his right shoulder, striking upon the superior and posterior aspect over the spine of the scapula. The blow was so severe as to knock him down. He was immediately taken to hospital, where the hand and arm swelled largely and he became unable to use them without great suffering. Five weeks afterwards he entered Trinity Hospital at Washington, whence he was transferred here two weeks later. On examination the patient was found to be well nourished and in general good condition, but his face had an anxious expression, or that of suffering. The right shoulder was swollen, the greatest amount of tumefaction being directly over the supra-spinous region. The whole arm and hand were also swollen and of a purplish color, and the patient was unable to raise them except to a limited degree. By an assistant the arm could be moved with difficulty and the hand might be placed on the top of the head. The patient underwent a variety of treatment, including colchicum, iodide of potassa, liniments, etc., without any appreciable benefit, the condition of the shoulder and arm remaining unchanged, the hand swollen and cold, and the arm quite stiff and useless. When he received his discharge from service December 23, 1863, his general health was not as good as formerly." He subse- 644 MISCELLANEOUS INJURIES. [CHAP. XI. quently made application for pension, and received the following certificate from Examining Surgeon W. M. Chamberlain, of New York City : "There has been a general contusion of the shoulder, followed by inflammatory action about the joint. Depres sion of the shoulder and almost total inability to use the arm is dependent perhaps upon rupture of the musculo-spiral nerve." Owing to the applicant s inability to prove the origin of the injury in the line of duty his claim for pension was rejected. CASE 946. Sprain of both ankles. Private A. Leehaus, Co. K, 4th Ohio Cavalry, aged 39 years, accidentally sprained both ankles severely at Stone Mountain, October 23, 1864. After passing through various hospitals he was transferred to Madison, where he was mustered out of service May 25, 1865. Subsequently his name was admitted on the Pension Rolls. Examining Surgeon J. S. McNeeley, of Hamilton, Ohio, certified July 2, 1873 : " Both ankles are partially anchylosed, the right one to a greater extent, and both are painful when walking, especially at night after having walked much during the day. The pains are influenced by atmospheric changes. The right ankle is always swollen, the left one at times." Other exam iners substantially report the same condition. The pensioner was paid December 4, 1880. Concussion and Compression of the Brain. The nine hundred and eighty-three cases of this group have been considered in detail in the chapter on injuries of the head, and the reader is therefore referred to pp. 35-68 of the Mrst Surgical Volume. Dislocations. The percentage of mortality of the three thousand and sixteen cases of dislocations was 0.33, death having followed the injury in ten cases; but the records of the Pension Office show that the results of many of these injuries were severe and of long continuance, the disabilities frequently increasing with time. The great number of bones, with their projecting processes, which form the vertebral column, the narrow limits to which mobility in the column is confined, the manner in which the articular surfaces are joined, the number and strength of ligaments which hold them together, and of the muscles which enclose them, would seem to preclude the possi bility of displacing any portion of the column without at the same time causing a fracture of the body of the vertebra or of its many processes. A few cases of dislocation of the dorsal or lumbar vertebrae without fracture were recorded, but the correctness of the diagnosis in some of the cases may well be questioned. A case of luxation of the lumbar vertebra is reported by Surgeon E. Bentley, U. S. V.: 1 CASE 947. Dislocation of first lumbar vertebra. Private A. Hoffman, Co. E, 101st New York, sustained a dislocation of the superior lumbar vertebra by the falling of the brick wall of a building at Port Republic, June 1, 1862. He was admitted to Washington Street Hospital, at Alexandria, sixteen days after the occurrence of the accident, there being perfect paralysis of all Instances of dislocation of the lumbar vertebrae are not frequent. HAMILTON (F. H.) (A Practical Treatise on Fractures and Dislocations, Phil adelphia, 1875, p. 541) cites two cases: one from CLOQUET (Obs. d une luxation de la colonne vertebrate comp. de fracture, et suivie de guirism, in Orlhop. Win. sur les Diffbrmitts, parC. A. MAISOXAIJE, Paris, 1834, T. I, p. 453, a second from DUPUYTREN (Lecons Oralesde Clin. Chir., Paris, 1839, T.I, p. 464); both cages were accompanied by fracture. To these may be added instances cited by: PABKICIU8 HlLDANUS (Opera quae extant omnia, Franeofurti ad Moenum, 1646, Cent. V, Obs. 68, p. 459): A farmer, falling from a tree, had one of the lumbar vertebrae forced inward; paralysis of the lower extremities; he survived several years. AUKKAN (Luxation incomplete des vtrtebres, in Jour, de Mid. Chir. Phar., etc., Paris, Decembre, 1771, T. XXXVI, p. 522): A man was forcibly thrown on his seat ; the spinal apophyses of the 2d and 3d lumbar vertebrae became very prominent ; diastasis of the vertebrae ; body bent forward; unable to straighten out ; amelioration in two months. SCHMUCKElt (J. L.) ( Von einer Verrenkung des letzten Riiclcen- und erslen Lendtn- wirbelbeins, vom Htrren RCDIGElt, in Vermischte Chirurgisclie Schriften, Berlin und Stettin, 1776, B. I, p. 286): A wall falling 1 on a soldier caused dislo cation of last dorsal and first lumbar vertebrae, the former being forced outward and to the right to the width of three fingers; recovery. BuCcKMAXN (Btobachtung einer Verrenkung des zweiten Lendenwirbels, in Arch, fur Me,d. Erfahrung. im Gebiete der prakt. Med. CJiir. Geburtsh. und Staatsarz- neikunde, Jahrgang 1825, Berlin, 1825, p. 469): Young man, aged 30, jumped from third-story window ; dislocation of second lumbar; paralysis of blad der; survived the injury eighteen months. LAUKEY (D. J.) (Clinique Ckirurgicale, Paris, 1809, T. Ill, pp. 271-272): A young soldier received a com plete luxation of the first lumbar from a contusion by a cannon ball ; recovery. A young Swiss soldier fell from a third story window ; complete luxation of first lumbar; leg fractured and amputated; recovery. A soldier named Samson received a complete luxation inward of the first lumbar by a fall from a parapet ; spine curved till the head touched the knee ; lower extremities paralyzed ; paralysis gradually diminished ; patient survived. LEBEKT (Luxation simple et incomplete par cause externe de la douzilme vertebre dorsale, en avant de la premiere lombaire, etc., in Hull, de la Soc. Anat. de Paris, Paris, 1836- 37, T. II, p. 238): Deloge, aged 50, received a dislocation of the first lumbar by the fall of a scaffolding ; paralysis of lower extremities ; death in 46 days; at the autopsy the first lumbar was found dislocated downward and inward; there was fracture of the body of the vertebra. MEP.TENS ( General- Bericht des Konigl. liheinischen Med. ColUgii liber das Jahr 1840, Koblenz, 1841, p. 97) successfully reduced a-dislocntion of the third lumbar which projected half an inch. KEU (F6rhadlingar vid Svenska Lakare-Sallskapets sammankomster, 1857-1858, in Hygiea, Stockholm, 1858, B. XX, p. 116) : Sailor, aged 23, January 7, 1858, second lumbar dislocated 7 lines backward, fracture of articular and transverse processes ; death. KUNKLER (G. A.) (Case of Dislocation of Third Lumbar Vertebra, in Cincinnati Lancet and Obs., 1858, Vol. I, p. 212): In 1856, a young man, aged 19, was thrown from a swing ; large depression, fully admitting a pigeon s egg, in region of third lumbar vertebra ; recovery ; depression remaining. VlXCEXT (liulletinx de la SociCtc Anatomique de Paris, Paris. 1850, T. XXV, p. 85), in March, 1850, presented to the Anatomical Society of Paris a specimen of fracture and dislocation of the first lumbar vertebra. Patient had been injured 8 months previously; the fracture had consolidated ; there had been paralysis of the lower extremities and of the bladder and rectum. HOLMES (T.) (Dislocation of tlie Spine in the Dor si- Lumbar Region, in Transact, of the J alh. Soc. of London, 1859, Vol. X, p. 219): Man, aged 19, struck across the loius by a heavy piece of timber on October 30, 1858; paralysis of lower extremities and bladder; died Nov. 22; preparation in St. George s Museum ; the transverse processes of the lumbar vertebra are fractured. RAXKE (H. R.) (Ueber Beugungsluxation der Lendenwirbil. Inaug. diss., Halle, 1873, p. 14): Man, aged 30, fell about 30 feet from a platform ; luxation backward of first lumbar ; paralysis of lower extremities and bladder; compression of spinal cord ; death after 2 months and 11 days. The autopsy showed that there was no frac ture. PORTA (L.) (Delle luisazioni delle vertebre, etc., Oss 7, p. 6): A soldier fell from his horse and dislocated the fourth lumbar forward the width of a SECT. l.J DISLOCATIONS. 645 the parts below the seat of injury. His stools passed off involuntarily, and the urine was drawn off by the catheter. On July 5th he passed his urine freely and some slight sensation was felt in both feet and legs. Erysipelatous inflammation attacked the inguinal region of the right side and resulted in gangrene, terminating in death on August 29, 1862. No autopsy was recorded. In the next case the ninth dorsal vertebra was displaced, allowing two fingers to be inserted between the eighth and the tenth vertebra. CASE 918. Surgeon G. Jewett, 51st Massachusetts, describes a case of dislocation, which occurred at Newberne, May 20, 1863, as follows : " The case was an injury of the spine, not positively diagnosticated. The patient was in a sitting posture when he was crushed to the ground by a great weight from behind applied to his back and shoulders, bending the back nearly double. Within three minutes I examined the back and found a fluctuating tumor occupying the site of the ninth dorsal vertebra. The tenth was very prominent. Two fingers could be inserted between the eighth and tenth. Perfect loss of sensation and motion existed below the injury, with paralysis of the sphincters, and there was considerable shock and violent pain in the epigastrium. The treatment was by rest and opium. Three days after the accident a digital examination showed a reappearance of the lost vertebra, a great difference between the spinous processes still remaining. No crepitus could be discerned at any time. At this date (the eleventh day after the injury) the patient is in General Hospital and the paralysis still continues. My opinion is that there was a luxation anteriorly of the ninth dorsal vertebra." No positive identification of this case has been practicable from the registers of the New Berne hospitals. Corporal J. F. Simpson, Co. I, 51st Massachusetts, is the only member of that regiment who is recorded as having been treated for " paralysis " at the Stanley Hospital from May 25th to July 6, 1863. Three weeks later he was mustered out by expiration of service. He is not a pensioner. Displacement of the eighth dorsal vertebra was accompanied by fracture of the pro cesses in the following case: CASE 949. Private R. L. Root, Co. D, 32d Wisconsin, aged 33 years, was severely hurt in the back while engaged in building fortifications at Decatur, June 20, 1864. About five weeks afterwards he was transferred to Nashville, whence Surgeon R. R. Taylor, U. S. V., reported his admission to hospital No. 8, and described the injury as a "dislocation of the spine." Several months later the patient was transferred to Brown Hospital, at Louisville, where he was discharged for disability November 10, 1864, Assistant Surgeon B. E. Fryer, U. S. A., certifying to " fracture of dorsal vertebra, producing paralysis of the right inferior extremity." Examining Surgeon W. H.Walker, of Fond du Lac, Wisconsin, reported, June 10. 1865: "He was injured by being crushed down under a stick of timber. Fracture of the process of the eighth dorsal vertebra seems to have been produced, which has resulted in extensive forward curvature of the spine. The ligaments of the right hip joint were strained so that they are now relaxed, weakening the joint." Examiner H. Roberts, of Providence, Pennsylvania, December 28, 1868, made a corroborating report of the injury and its results, stating that "a gradual and increasing curvature of the spinal bones in the portion known as the dorsal has been going on for three years. The curve is about eight inches in length and the deviation is now two inches to the right, with a very short convex curve also. For the past year he has had to almost entirely abandon any work which required him to stoop forward and lift an}* light weight." The Philadelphia Examining Board, June 8, 1881, referred to curvature and deformity as being very marked, and added that the pensioner "states that he suffers from numbness in the lower extremities. There is atrophy of the muscles over the buttock. He would have been bene fited by a spinal support, but owing to the want of this he has become so disabled that he can do no labor." As an example of sub-luxation of one of the cervical vertebrae Surgeon J. Tunnicliff, 1st Michigan, has furnished the following notes of an accident which occurred on the Balti more and Ohio Railroad during the month of November, 1861: CASE 950. " The man was standing guard during a gale on an embankment while a lumber train was passing. The wind blew him off the bank down into the cut, by the passing train, and at the same time lifted a quantity of lumber from the cars and piled jt on him. It was about two minutes before the lumber could be removed sufficiently to relieve him. The main injury seemed to be in the cervical vertebrae. Indeed, the force of the blow as well as the weight of the lumber was on the neck. As he was lifted up he said he thought his neck was broken. His head was inclined to one of the shoulders, and for a number of minutes he was utterly unable to raise it up. The pain he represents as having been most excruciating. He persisted, however, in his efforts, with the assistance of one of his comrades, who performed traction by grasping his head, when a sudden snap was felt and heard distinctly by himself and those about him, and his head had resumed its normal position. This was followed by acute pain at the point of the injury to the cervical column, with a most distressing tingling sensation and pain down the brachial plexus, which continued more or less for four weeks after the injury. He was unable to rotate his head one-half inch even after five weeks, and, although improving, he cannot now (December 31, 1661) do it more than two inches, marking at this time about four inches of a segment of a circle with the end of his nose." The name of the soldier could not be learned. finger; no fracture; ligament destroyed. FOWLEK (R. S.) (Dislocation of the Lumbar spirit, in The British Mtd. Jour., 1863, Vol. II, p. 280): Laborer, aged 25, in 18G3; dislocation between 1st and 2d lumbar, the lower vertebra being thrown behind and to the left of that above it ; lower extremities not paralyzed ; death on the following day ; at the autopsy no fracture of the vertebrae was discovered. Clinical Lectures and Reports of the London Hos pital, London, 1866, Vol. Ill, pp. 348, 354: At the Museum of the London Hospital are 3 specimens of luxated lumbar vertebra?; in one the body of the first lumbar lias slipped forward for about half an inch on the surface of the second, crushing the latter. In the second specimen the third lumbar is nearly half an inch in front of the fourth, with only very slight splintering of the edges of the bones. The third specimen shows a clean dislocation of the third lumbar forward without fracture. The articular processes of the third lumbar have completely left those of the fourth and passed forward a third of an inch. There is no important fracture. EULKNBERO (A.) (Luxation und Fractur dei ersten Lumbalwirbels, mit tSdtlicliem Ausgange durch Riickenmarkscompression und secunddre Cystitis und Pyelonephritis, in Archivfiir Klin. Cliir., Berlin, 1866, B. VII, p. 507): A printer, on May 1, 1865, fell a distance of twenty feet; first lumbar dislocated backward J inch : dpath on the following day ; splintering of body of vertebra. 646 MISCELLANEOUS INJURIES. [CHAP. xi. In the following, the sternal end of the clavicle was dislocated upward. As in similar cases cited by Malgaigne and Hamilton, 1 the dislocation could readily be reduced, but it was impossible to retain the bone in its place. CASE 951. Private E. D. Halleiibeck, Co. B, 1st Wisconsin Cavalry, aged 26 years, entered Hospital No. 2 at Nashville on August 12, 1863, having sustained a dislocation of the sternal end of the right clavicle by falling from his horse. Acting Assistant Surgeon E. Jennings, who reported the case, stated that the attempt was made to reduce the luxation, but the bone could not be retained in its place. In the following month the patient was detailed for light duty about the hospital, and on February 6, 1864, he was assigned to the Veteran Reserve Corps. He was ultimately mustered out and pensioned. Examining Surgeon W. A. Knox, of Chicago, Illinois, May 18, 1867, reported the "dislocation still unreduced. The injury being upon the right side materially interferes with his capacity for manual labor." The Chicago Examining Board certified, March, 1879: " He has permanent dislocation of the right clavicle from its sternal articulation upward. The end of the bone lias affixed above its natural position, weakening the part and limiting the power in the right arm." Examples of dislocations of the various joints of the upper and lower extremities will next be adduced. Dislocations at the shoulder and elbow joints were the most frequent: CASE 952. Dislocation at the shoulder. Farrier L. Swafford, Co. G, 9th Indiana Cavalry, aged 36 years, Avas severely hurt at Pulaski, November 8, 1864, by his horse falling and throwing him upon his left shoulder, dislocating the joint. For some weeks he was at the regimental hospital, where ineffectual attempts were made to reduce the luxation, and subsequently he entered Gayoso Hospital, at Memphis. Surgeon F. N. Burke, U. S. V., in charge of the latter, reported that the patient was transferred to the Veteran Reserve Corps May 11, 1865, by reason of disability from chronic dislocation of left shoulder joint." The man was mustered out of service September 4, 1865, and subsequently became a pensioner. Examiner J. Menden- hall, of New Castle, Indiana, reported May 17, 1866: "I suppose the joint has been dislocated; it is now partially anchylosed. He cannot put his hand on top of his head, nor raise the elbow up from the body more than about twelve inches, but can move it better forward than backward. But this motion is limited, though I think it will improve." Examining Surgeon W. H. Boor certified, December 9, 1875: "I find the left shoulder joint anchylosed so that the arm cannot be raised only as the scapula gives it motion. The muscles of the arm and forearm are soft. He says his shoulder is painful." This pensioner was paid December 4, 1880. CASE 953. Dislocation at the elbow. Private H. Mewes, Co. E, 63d Illinois, aged 28 years, had his elbow joint dislo cated by falling from a wagon during the march near Holly Springs, October 20, 1863. He was treated at the regimental hospital, subsequently in Nashville, and lastly in Clay Hospital, Louisville. Surgeon A. F. Watson, U. S. V., in charge of the latter, described the injury as an unreduced " dislocation of the radius." The man was mustered out of service April 11, 1865, and subsequently made application for pension. Examining Surgeon L. W. Low, of Albion, Illinois, reported June 4, 1868: The injury is such that the head of the radius is luxated and again adjusted by rotary motion of the hand and forearm, rendering tire hand and arm yearly useless for labor and weak at all times." Examiner H. C. Reed certified, July 4, 1879: " The ulna is displaced inward, the olecranon resting on the internal condyle. The forearm is quadriflexed and about one-half pronated, there being very little rotary motion retained. The head of the radius could not be located, but a distinct snap could be felt on forcible rotation outward over the normal site." CASE 954. Dislocation at the elbow. Private H. Finley, Co. H, 5th Connecticut, aged 29 years, suffered a dislocation of the right elbow while going to Stevenson, Alabama, October 5, 1864, on a railroad train, which was attacked by the enemy and brought to a sudden stop, causing him to be violently thrown to the ground. He was treated in the field hospitals of the Twentieth Corps until the arrival of the troops at Savannah, when he was placed on board of a hospital steamer and conveyed to McDougall Hospital, Fort Schuyler, New York Harbor. Assistant Surgeon S. H. Orton, U. S. A., certified to the patient s discharge from service March 13, 186,~>, by reason of uselessness of the right arm from an "unreduced luxation of the ulna backward upon the humerus." Examining Surgeon W. W. Potter, of Washington, D. C., March 29, 1869, certified to the following disability: "A fall upon the right elbow while in a semi-flexed position has driven the olecranon process of the ulna upward between the condyles of the humerus, at the same time forcing them apart. Considerable deformity is the result, with inability to flex the forearm beyond a right angle or to extend it perfectly. He has very little strength in the arm; its motions are circumscribed and general usefulness seriously impaired." Examiner M. Burton, of Richmond, Virginia, reported, Septem ber 23, 1873, that "the dislocation still exists, the joint is inflexible and the limb useless for manual labor. The fingers have some power of flexion and extension." This pensioner was paid June 4, 1881. CASE 955. Dislocation at the wrist. Private C. Mesi-rvey, Co. G, 69th Indiana, aged 47 years, received a severe injury of the left forearm and wrist during the battle of Richmond, August 30, 1862. Surgeon M. K. Taylor, U. S. V., reported his discharge from service at the Keokuk General Hospital, March 5, 1863, by reason of the following disability: "Much deformity from an unreduced fracture of the radius and dislocation of the lower end of the ulna." The man subsequently became an applicant for pension, and received the following certificate from Examining Surgeon S. W. Vance, of Connersville, Indiana, on June 18, 1867: "The injury consisted of a fracture of the lower end of the radius about an inch and a half from its articu lation \vitli the semihmar and scaphoid bones, together with a dislocation of the lower end of the ulna. This dislocation and the fracture of the radius just above caused the hand to assume a rather pronated condition, carrying forward with it the lower fragment of tin- radius, which has united to the superior fragment, leaving the bone, however, very crooked at the site of the fracture and the end of the ulna still dislocated. The condition of the bones necessarily renders rotation impracticable, and 1 MAU-AIGXE ( J. F.), Traiti des fracture* et des luxations, Paris, 1855, T. II, p. 426. HAMILTON (FRANK H.), A Practical Treatise on Fracture* and Dislocations, Philadelphia, 1875, p. 561. SECT. I.] DISLOCATIONS. 647 moreover greatly weakens and debilitates the muscles and tendons of the surrounding parts," etc. Examiner A. C. Fosdick, of Brownsville, Indiana, in July, 1875 and 1881, reported no change in the condition of the injured parts. The following is an example of successful reduction of a dislocation of the head of the femur upward and backward into the great ischiatic notch. The thigh had become flexed on the pelvis at nearly right angles, and the limb was well thrown across its fellow : CASE 956. Dislocation at the hip. Lieutenant Colonel W. A. Bullitt, 3d Kentucky, aged 24 years, was wounded at the battle of Rocky Face Eidge, May 9, 1864. He was wounded in two places. The first shot entered at a point five inches below the anterior superior spinous process of the ilium, left side, and did not emerge; the second ball struck the right side between the seventh and eighth ribs and came out about four inches below the point of entrance and two inches posteriorly. An ambulance was obtained and the patient was transported five miles to a field hospital, whence he was taken to Chattanooga the following day. On the ninth day erysipelas commenced in the wound of the right side, which extended all over the body and up to the head, resulting in numerous abscesses in the areolar tissue. On June 3d the patient was transferred to Louisville, where an attack of dysentery came on and reduced him very much. This was in turn succeeded by another attack of erysipelas, extending all over the body as the former had done. About August 7th he began to have a great deal of pain in the left iliac fossa, which at first was paroxysmal and continued a month before the abscess that gave rise to it was detected. This abscess was opened by a deep cut one-half inch to the inside of the anterior superior spinous process and above Poupart s ligament, when a large quantity of pus estimated by the surgeons present at half a gallon escaped. The abscess continued to discharge for about three months. When the pain first commenced the patient, in order to feel relief, would flex his thigh on the pelvis during the paroxysms, which came on about 5 o clock daily; but afterwards he kept the knee closely approximated to the chest and any attempt to extend the limb caused severe pain. About October 20th, while in the act of turning over from his back to his right side, he felt the head of the right femur slip from its position with a severely painful jolt. This occurred almost daily for two weeks, when the attention of the surgeon was called to it and a dislocation was recognized. The patient was etherized and an unsuccessful attempt made to replace the bone. The abscess closed up shortly afterwards. A second attempt at reduction in February, 1865, again failed. A few days later the patient got out of his bed and began to walk about on his crutches. He came to New York City May 24th, where he was admitted to the Central Park Hospital, under the care of Dr. L. A. Sayre, who reports the following: "When I saw him in June his general health was good and he was able to walk about very well on crutches. His left thigh was flexed on the pelvis at nearly right angles and strongly adducted across its fellow, lying on its upper third and compressing the genital organ. The difficulty of urinating was a most serious annoyance. The whole limb was much colder than the other, bathed in perspiration, and much shrunken in size. There was some slight mobility of the hip and of the knee, which was stiffened by a firm contraction of the hamstring muscles. Motion, however, gave pain. On July 20th I determined to attempt reduction by manipulation after the method so well described by Dr. Reed and Surgeons W. J. Sloan, J. J. Milhau, U. S. A. Several bed-quilts were folded and laid upon the floor; the patient was placed thereon and thoroughly anaesthetized by chloroform. After removing my boots I placed one heel on the crest of each ilium, thus holding the pelvis by the weight of my own body, when with some considerable force I succeeded in breaking up the adhesions and obtained tolerable free motion of the limb. The finger was then passed into the rectum as far as the ischiatic notch, and when the limb was moved by an assist ant the head of the femur could be distinctly felt gliding on the finger. This examination was also made by Professor Hamilton, and the diagnosis as to the position of the head of the bone was confirmed. I thereupon stated my intention that, should the attempt by manipulation prove unsuccessful, I would wait some days for the inflammation necessarily produced to subside, then subcutuneously divide the contracted adductor muscles and restore the limb to parallelism with the other, leaving the head of the bone in its abnormal position. By considerable effort I finally succeeded in reducing the limb to parallelism with the other, retaining it there by means of extension with weight and pulley over the foot of the bed and secured to the thigh by means of adhesive plaster and a roller. On account of the long-continued contraction of the hamstring muscles the leg could not be extended from the thigh ; but as the tension had given way somewhat while the patient was under the influence of chloroform, I concluded to try and bring it straight by constant extension, and consequently applied another plaster below the knee, with weight and pulley on the foot of the bed, a little lower than the former one, the thigh being slightly elevated every day until the limb was straightened and the two extending forces acted in the same line. Another weight and pulley was applied at a right angle to the limb, opposite the knee joint, for the purpose of adducting the limb. An irrigating apparatus, from which cold water was constantly dripping, was arranged over the hip joint, and a rubber cloth placed under to protect the bed. For three days the patient suffered great pain and had to use morphine to allay it; but after the third day no anodyne was necessary. No reac tionary fever or constitutional disturbance set in, and at the end of the third week the limb was parallel with the other and of the same length. A line drawn, however, from the center of the pubis to the trochanter major of that side proved to be nearly half an inch longer than measurement on the opposite side, and firm pressure from the foot caused it to ride upon the ilium and become more than an inch shorter than the other. It became necessary, therefore, to devise some plan by which the limb could be extended during walking and the weight of the body borne upon it. I therefore took a plaster cast of the hip in its improved position and on this cast fitted a crutch passing under the pubis and around the gluteo-femoral fold, with a wing hammered out so as to accurately fit the buttock, in which he could comfortably sit. Opposite the tuberosity of the ischium I made a ball and socket joint, from which an iron rod ran down the limb to the ankle joint, being bifurcated at its lower extremity and terminating in rounded knobs, and the main shaft being capable of extension by means of a racket and cog-wheel. A neatly fitting shoe, well padded on the instep to bear pressure, had an iron band secured under the sole, which terminated opposite each side of the ankle in cups or sockets to receive the rounded ends of the rod. With this instrument adjusted and the extension applied the limb was brought to the same length as the other, and the patient could bear his entire weight upon it without pain. The limb, which before the operation had been cold and very much atrophied, now grew rapidly in normal temperature and in October had nearly resumed its natural size." Photographs of the patient, showing the position of the limb before and after the operation, and of the apparatus, applied and unapplied, were forwarded with the history of the case by the operator, who also contributed 648 MISCELLANEOUS INJURIES. [CHAP. xi. two plaster casts, one representing the hip eight months after the luxation and the other the condition of the reduced parts. The caste constitute specimen 4033 of the Surgical Section of the Museum. Lieutenant Colonel Bullitt was mustered out of service October 7, 1865. CASE 957. Dislocation at the hip. Private J. B. Holroyd, Co. C, 15th Illinois, aged 28 years, was captured by the enemy during the Atlanta campaign, October 4, 1864, and for months underwent the hardships of the Anderson ville Prison, where his left hip joint became affected from the exposure and privation. After being released from captivity lie was conveyed to Cumberland Hospital at Nashville, thence to Jeffersonville, and lastly, on July 21, 1865, to Camp Butler. Surgeon A. B. Campbell. U. S. V., in charge of the latter, reported that the patient was suffering from "dislocation of the left hip joint," and that he was mustered out of service August 9, 1865. Examining Surgeon J. G. Hostetter, of Mt. Carroll, Illinois, certified, June 19, 1866: "The ligaments and head of the left thigh bone are diseased, allowing displacement of said bone on making a misstep. He cannot raise his left leg to the height of a stair-step, and drags, as it were, rather than moves his limb in walking." Examiner B. T. Buckley, of Freeport, Illinois, reported, April 7, 1871: "The disability consists in the imperfect use of the left leg, produced by partial dislocation of the hip joint and causing pain and lameness on exercise. The displacement has increased and consequently there is increased inability to use the limb." Examiner II. N. Bradshaw, of Monroe, Wisconsin, stated, Jan uary 10, 1875, that "the region of the joint is flatter than it should be, showing considerable atrophy of the muscular structure; the leg below the hip is smaller than the right one, and the muscles are flabby. The leg cannot be flexed upon the abdomen, and any attempt to place it in that position is evidently attended with much pain." This pensioner was paid September 4, 1881. CASK 958. Dislocation at the knee. S. Chiquoine, a fireman attached to the U. S. Steamer Rudolph, 21 years of age, and of a strong constitution, sustained a dislocation of the left tibia backward during the action in Mobile Bay, April 1, 1865. He was admitted to the Naval Hospital at Pensacola three days afterwards. The luxation was reduced, but there was consid erable swelling of the limb, accompanied by inflammation. The treatment consisted in moulding pasteboard splints to the limb, in keeping the extremities at perfect rest on a double-inclined plane, and in applying water dressings. Ten weeks after his admission the patient was transferred to hospital at New York, where he was discharged for disability June 30, 1865, with probabilities of regaining full use of the limb. The notes of the case were furnished by Passed Assistant Surgeon J. R. Tryon, U. S. N., who supplemented the history with the following remarks: "From the severity of this and other cases I think the dislocation of the tibia in each must have been complete. Considerable deformity about the knee existed for months after the injuries, and the joints in most of them were impaired in some degree by the inflammation, adhesion, etc., which invariably follow." Examining Surgeon L. Jemison, of Bordentown, New Jersey, reported, August 23, 1870: "The bones of the leg now stand a little back from their normal position and the joint seems movable upon the cartilages. He complains when standing any length of time upon his feet, and falls from a slight touch to the limb," etc. The Philadelphia Examining Board in October, 1873, certified to "grating in the knee joint when moved; ligaments relaxed and knee falls back unless supported when his weight is borne upon it," etc. At subsequent dates the same board reported that " the patella projects forward and the internal tuberosity projects inward," also that there is decided crepitus, and that deformity is caused by dislocation of the internal semi- lunar cartilage of the knee. The pensioner was paid June 4, 1881. CASE 959. Dislocation at the ankle. Private J. Reich, Co. K, 21st Illinois, aged 33 years, was severely hurt in the left foot while doing guard duty on the Louisville and Lexington Railroad, June 15, 1864. The accident occurred while he was riding on the cowcatcher of the locomotive, which struck an obstruction on the track and threw him off. He was picked up in a senseless condition and was conveyed to Clay Hospital, at Louisville, where his left ankle joint was found to be much injured. Several weeks afterwards he was transferred to Jefferson Barracks, and lastly he entered the General Hospital at Quincy, where he was discharged December 20, 1864, and pensioned. Surgeon D. G. Brinton, U. S. V., in charge of the latter hospital, reported that the patient was "crippled for life," and described the disability as a " dislocation of the left ankle joint (Pott s fracture) with consequent permanent uselessness of the limb." Examining Surgeon J. H. Maxwell, of Newton, Illinois, September 4, 1873, certified to the disability and stated that "there is great deformity of the foot and ankle in consequence of the dislocation never having been reduced. Walking is very difficult, and if continued becomes painful." Four years later the same examiner reported no improvement in the condition of the limb, stating that "the astragalus is forced below the outer malleolus," that the foot is nearly flat, etc. The pensioner was paid June 4, 1878, since when he has not been heard from. CASE 960. Dislocation of tarsal lones. Private J. Beers, Co. F, 84th Illinois, aged 27 years, while on duty as assist ant teamster, December 23, 1862, was accidentally precipitated to the ground by the slipping of his left foot. He stated that he heard a cracking sound in the foot .and felt something give way about the middle of it. This was attended with intense pain, which subsided in the course of a few weeks. The foot remained swelled about a month, when that also partially subsided, and from that time he has not had pain except when he has attempted to use it in walking. He was present at the battle of Murfreesboro (December 31st), but was unable to participate in that action on account of lameness. After the battle the surgeon applied a roller bandage, but it produced so much pain that lie soon had to remove it. No other application was used. On January 30th the man was brought to Nashville, where he was sent to Convalescent Barracks, and several days afterwards to hospital No. 22. At that time he was in good general health. There was slight tumefaction below the external malleolus and the foot was everted, its inner border being nearly thrown in contact with the ground, giving the foot a splay appearance. Below the internal malleolus a prominence existed corresponding to the rounded head of the astragalus, and great and deep- seated tenderness was experienced on pressure upon the astragalo-scaphoid articulation. The most remarkable circumstance of the case was the very slight inflammation in and around the joint. The case was diagnosed as a luxation of the astragalo- scaphoid articulation, and no treatment was deemed advisable nor reduction attempted for the reason that, having been so long delayed, it would have been necessary to break up the new adhesions, it being feared that the resulting inflammation would prove uncontrollable. Locomotion remained much impeded and the patient s condition continued unchanged up to March 10, 1863, when he was discharged as unfit for further service and returned to his home. The history of the case was contributed by Surgeon L. W. Beckwith, 38th Indiana. There is no record of the man ever having applied for pension. SECT. L] SIMPLE AND COMPOUND FRACTURES. 649 Simple and Compound Fractures. The total number of injuries of this group was seven thousand and four, of which five hundred and twenty-six, or 7.5 per cent., were fatal. Four thousand three hundred and forty-six, with seventy-six deaths, were specified as simple fractures; one thousand three hundred and seventy-one, with three hundred and ninety- seven deaths, as compound fractures; and one thousand two hundred and eighty-seven, with fifty-three deaths, as fractures merely. Instances of fractures of the cranium and of the vertebrae have been cited on pages 42 to 68 and pages 426 to 429 of the First Surgical Volume. Examples of fractures of the bones of the face, of the ribs, the sternum, the clavicle, the scapula, the ilium, and the bones of the extremities will here be detailed. CASE 961. Fracture of the lower jaw from the kick of a horse. Assistant Surgeon S. C. Sanger, 6th New York Cavalry, reported the following history of the case of " a contused and lacerated wound in connection with fracture, which was incurred accidentally. The patient was kicked by a horse. The heel cork or iron projection of the shoe impinged the anterior aspect of the lower jaw a little to the right of the symphysis, and drove inward a large portion of the alveolar process to which six teeth were attached. It was determined to place the fragment in situ. This was difficult because the fracture was impacted at the point where the blow was received and the separated bone was drawn inward by the upper fibres of the genio-hyo-glossus muscles. But the object was finally accomplished by extracting a tooth from the sound portion of the jaw, when the fragment was secured in its place by silk cord and silver wire, two small braces made of cork being placed between the movable teeth and the cor responding ones of the upper jaw. The patient was sent to General Hospital. The accident happened June 19, 1863, and on August 18th the patient arrived back in camp and reported for duty. An examination made showed that the bone had united perfectly and without any perceptible deformity, but little trace of the severe laceration of the soft parts being discerned in the well-shaped and scarcely apparent cicatrix." This case has been identified as that of Farrier J. O. Bivins, Co. B, Gth New York Cavalry, aged 32 years, who entered Emory Hospital, Washington, three days after the date of the injury, and was returned to duty August 13, 1863. He was mustered out of service September 19, 1864, and has since then filed an application for pension. CASE 962. Fracture of the lower jaw by a fall from a horse. Private L. P. Towers, Co. F, 3d Ohio Cavalry, aged 48 years, sustained a simple oblique fracture of the lower jaw by falling from his horse December 1, 1864. The injury was located about an inch to the right of the symphysis, its track being from above downward and forward. Two days after the accident the injured man was admitted to Crittenden Hospital at Louisville. He had lost nearly all his teeth except the incisors, and various surgical dressings were applied to retain the fractured parts in position, but without success. On December 18th Acting Assistant Surgeon A. H. Hoy administered chloroform and made an incision two inches long over the seat of the injury, after which holes were drilled through the fractured ends of the bone and a small iron wire was passed through. The fracture was then reduced and retained in place by twisting the wire, an ordinary retentive apparatus being placed under the chin and fastened over the top of the head. With the help of some little traction the wire came away, bringing with it two small necrosed fragments, on January 7th, at which time not a particle of union had taken place between the parts. Two weeks afterwards the patient was granted permission to leave the hospital for a short time and came back intoxicated. Violent gastritis then supervened, and death resulted on January 24, 1865. At the post-mortem examination a second fracture was discovered, being situated in the left condyle and extending obliquely downward and inward. The mucous coat of the stomach was in a state of intense acute inflammation and some inflammation existed in the duodenum and jejunum. The injured maxilla, contributed to the Museum, with the history of the case, by Surgeon E. R. Taylor, U. S. V., is numbered 4246 of the Surgical Section. The specimen shows a portion of the body of the bone at the seat of the fracture to be wanting, both ends of the fragments being carious and necrosed and both condyles carious. CASE 963. Fracture of the sternum; railroad accident. Private R. Boyle, Co. A, 3d New Jersey, met with a railroad accident on April 3, 1862, and was admitted to hospital at Alexandria several days afterwards. Surgeon J. E. Summers, U. S. A., described the injury as a "transverse fracture of the sternum between the articulations of the third and fourth ribs, with displacement, the fractured ends sliding upon each other and shortening the bone one and a half inches. From the pos teriorly curved condition of the spinal column there is reason to think that there was crushing of the first and second dorsal vertebrae, although there was no paralysis of any of the limbs or organs. The patient is much crippled in appearance, but is evidently recovering, although slowly, with considerable deformity." The patient was discharged for disability resulting from his injury June 16, 1862. He is not a pensioner. CASE 964. Fracture of ribs by a fall from a horse. Lieutenant E. Whitfield, Co. I, 22d New York Cavalry, aged 29 years, was injured in the right side by falling from his horse near Leesburg, July 12, 1864. Acting Assistant Surgeon A. Edelin, who attended him at Washington, reported that the injury involved a "fracture of ribs, which had not yet united on October 19." Several weeks later the patient obtained a leave of absence, and on December 19, 1864, he was discharged from service and pensioned. Examiner J. D. Button, of Auburn, N. Y., certified, February 9, 1870 : " The sixth and seventh ribs on the right side were fractured and dislocated from the sternum, and not being properly adjusted an imperfect cure was the result. There is a projection of two inches outward from the chest at the ends of those two fractured ribs, which are not joined to the sternum. The muscles which move the arm are weakened and exercise causes pain." Subsequent examiners report the exist ence of an ulcer on the left thigh, alleged to be the result of a wound of the knee by a spent ball, which was also corroborated by the Auburn Examining Board. The latter, on December 5, 1877, described the projection caused by the fractured ribs, and added that the pensioner "has an anxious expression of countenance; distended nasal alas; respiration easily disturbed; loud resonance and weak respiration in right lung, indicating emphysematous condition of the lung." The pensioner was paid September 4, 1881. SURG. Ill 82 650 MISCELLANEOUS INJURIES. [CHAP. XI. FlG.363.-Bones of the right fore arm. Spec. 1784. FIG. 364. The left scapula trans- CASE 965. Fracture of ilium from a fall under a, liorse. Major W. E. Bryan, 3d New Jersey, aged 41 years, was injured in the right hip by his horse falling upon him, near Brandy Station, February 22, 1864. Two days after the accident he was conveyed to Washington, where he entered Armory Square Hospital and afterwards Georgetown Seminary. Surgeon D. W. Bliss, U. S. V., in charge of the former, and Surgeon H. W. Ducachet, U. S. V., in charge of the latter, both described the injury as a "fracture of the right ilium/ Subsequently the patient was treated for a time in private quarters, and on June 23, 1864, he was discharged from service, since when he has become a pensioner. The Philadelphia Examining Board, consisting of Drs. J. Collins. T. S. Harper, J. H. Sherwood, and E. A. Smith, certified, February 7, 1872: "The pensioner sustained a fracture of the crest of the right ilium. He complains of constant pain and inability to follow any occupation, looks delicate, and carries the right hip somewhat higher than the left." Subsequent examining boards reported, in 1875 and 1877, that "the hip is flattened and the leg slightly shorter than its fellow. He alleges pain and fatigue in the hip, and has oblique inguinal hernia of right side, well supported by a truss." The pensioner was paid June 4, 1881. CASE 966. Fracture of scapula, humerus, and forearm; railroad accident. John Gazell, a laborer of the Commissary Department, U. S. A., aged 36 years, was run over by a city passenger railroad car at Washington, August 10, 1863, and died at Douglas Hospital one hour after the accident. Acting Assistant Surgeon J. E. Smith made the following report of the injury: "Everything to alleviate his sufferings was done that could be, but the man did not react from the shock in the least. At the autopsy a tumor was observed on the right side of the throat which was supposed to have resulted from the injury, but on cutting down upon it I discovered it to be a pre-exist ing enlargement of the thyroid gland. A section of the tumor displayed fatty degeneration of the greater part with two sacs, each containing about one-half ounce of sero-sanguinolent fluid. The left inferior portion of the tumor was ., T, . ,1-i^ixi x-iij iiij i i verselv fractured. Spec. ItiCl. ossified. Previous to his death the patient had passed bloody urine which could not be satisfactorily accounted for, the kidneys, ureter, and bladder being found apparently uninjured. The right humerus was comminuted, as were also the radius and ulna of each forearm. On the left anterior side the ribs were all broken except the twelfth, and the lung was considerably lacerated; posteriorly the same ribs were fractured except the first, second, and twelfth. The left scapula was transversely fractured below its spine and the left clavicle at its acromial extremity." The injured scapula (FiG. 364, Spec. 1631), humerus (Spec. 1786), and both bones of both forearms (FlGS. 363, 365, Spec. 1784 of the Suryical Section of the Museum), were contributed by Assistant Surgeon W. Thomson, U. S- A., and are represented in the adjoining wood-cuts. The left radius and ulna show an oblique fracture at the junction of the upper thirds, the superior fragments being wanting, while in the right radius a nearly transverse fracture exists in the lower part of the middle third and longi tudinal fractures occupy the lower fragment. The lowest third of the right ulna is comminuted. CASE 967. Fracture of humerus from the blow of a club. Private W. Jordan, 1st Alabama Colored Artillery, aged 27 years, was wounded at the battle of Fort Pillow, April 12, 1864, and entered Mound City Hospital two days afterwards. His injuries consisted of a comminuted shot fracture of the left ankle, flesh wounds of the left arm and right thigh, and a comminuted fracture of the superior portion and head of the left humerus, inflicted by a club. The wound of the ankle became very painful and the soft parts much inflamed. Amputation at the middle third of the leg was performed by Surgeon II. Wardner, U. S. V., on April 15th, chloroform and ether being used and three ligatures applied. The patient was in good condition at the time of the operation and seemed to do well for several days, when haemorrhage took place from the tibial artery, which was checked by the application of persulphate of iron. Death, from pya3mia, took place on April 23, 1864. The upper portion of the injured humerus and the amputated bones of the leg, contributed with the history of the case by the operator, constitute specimens 3311 and 3312 of the Surgical Section of the Museum. A representation of the former appears in the annexed wood-cut (FJG. 366). CASE 968. Fracture of the bones of the elbow; railroad accident. Private P. Stutz, Co. A, 91st Pennsylvania, met with a railroad accident on April 9, 1864, and entered South Street Hospital at Philadelphia, whence Acting Assistant Surgeon J. F. Koerper reported the case as a "compound fracture of the right elbow, cured with partial mobility of the joint. The patient stated that while on his way from Chester to Philadelphia he attempted to alight from a railroad car, when the sudden starting of the train caused him to fall and the wheel to strike his elbow. He was brought to this hospital soon after the accident. The parts were much swollen and contused, and crepitation could be felt around the joint. The wound on the inner side, a little above the joint, communicated with a detached piece of the internal condyle. Haemorrhage, though not very profuse, was controllable only by pressure on the brachial artery. Cold-water applications were used to the joint, and angular splints were applied to the posterior surface of the arm. Ten days after the accident the swelling had become reduced, and by May 15th the wound was healed and slight movements of the arm had been restored. Only simple bandages were now used, and the patient was detailed for light duty. By September 1st the patient had almost recovered the entire use of the arm. He deserted from the hospital on October 11, 1864. CASE 969. Fracture of the bones of the forearm; railroad accident. Private W. Call, a substitute, aged 19 years, was severely injured in the right forearm by a railroad collision at Madison, Wisconsin, December 30, 1864, and entered Harvey FIG. 365.-Boneg of left forearm, obliquely frac tured. Spec. 1784. Fin. 360. Up per portion of left humerus. Spec. 3311. SECT. I.] SIMPLE AND COMPOUND FRACTURES. 651 Hospital the following day. The limb was found to have suffered a compound comminuted fracture of the radius aud ulna at the lower fourth and a simple fracture of the radius at the upper third. The radial and uluar arteries and large nerves were intact. In the course of several weeks inflammation resulted, the arm, forearm, and hand becoming greatly swollen from effusion of serum and blood into the cellular tissue, bullse existing on the dorsum of the wrist, and the skin being very sensitive. Healthy pus was freely discharged from the openings. The patient, though in possession of medium strength and appetite and having a naturally good constitution, was suffering from intermittent fever, deranged secretions, aud much emaciation. On February 11, 1865, Surgeon H. Culbertson, U. S. V., made an incision four inches long over the radius, extending upward from the wrist on the dorsum of the forearm, separated the soft parts down to the ulna and removed five loose pieces of radius and ulna, together with one-quarter of an inch of the lower end of the latter, from the seat of the fracture. An incision was also made through the integuments of the radial and ulnar borders of the dorsum of the hand to liberate the effusion of blood and serum. The lips of the upper wound were then approximated with sutures and plaster, being left open at the seat of the frac ture below and filled with lint, and light poultices were applied over the seat of the fracture as well as over the dorsum of the hand; arm placed in a fracture box filled with tow. One grain of morphia was given immediately after the operation, to be followed with such doses as the patient might need. Whiskey, quinine, and muriated tincture of iron were prescribed, with good diet. About one month after the operation the external wounds were healing up, the swelling having subsided and the patient s constitutional state continuing good. On April 21, 1865, he was returned to the Post Commander, having entirely recovered. The history of the case was reported by the operator. There is no record of Private Call ever having applied for pension. CASE 970. Fracture of the femur from a fall under a horse. Sergeant D. F. Mansfield, Co. F, 91st Pennsylvania, aged 37 years, was admitted to Harewood Hospital, Washington, January 18, 1865, suffering from great deformity of the right thigh, the result of a simple fracture of the femur at the middle third, the injured parts not having been properly adjusted. The injury occurred near the Weldon Eailroad November 29, 1864, by a horse falling upon the man. At the time of admission the deformed limb was of no use whatever to the patient and locomotion was impeded, although the fractured parts were firmly united. The constitutional state of the patient otherwise was good. On January 28th Surgeon K. B. Bontecou, U. S. V., refractured the limb, after which a straight splint and counter-extension were applied. An anaesthetic consisting of chloroform and sulphuric ether was used. The patient did well after the operation, the parts uniting symmetrically. On March 13th the splint and extension were removed, when the fractured parts were found to be firmly united and the limb was placed in a plastic bandage. The patient continued to do well. On April -6th the plastic bandage was removed and the patient was allowed to be up on crutches, the fractured limb being one aud a half inches shorter than the other, but firm and of perfect use. The history was reported by the operator. The patient was discharged from service June 24, 1865, and pensioned. Examining Surgeon O. I. Beach, of Parker- ville, Kansas, May 19, 1873, certified to the injury resulting in shortening of the limb, and added that there is "displacement of the patella downward, causing much weakness in the leg ; muscles placid. Complains of constant numbness and occasional severe pain in the leg, restricting locomotion," etc. The pensioner died of consumption April 17, 1875. CASE 971. Fracture of the femur caused by a fall from a bridge. Private F. Buob, Co. C, 108th Ohio, aged 36 years, was admitted to the Government Hospital for the Insane near Washington on May 16, 1865, his condition being described by the super intendent, Dr. C. H. Nichols, as follows: " The patient s mental condition was that of slight chronic dementia. He was not able to walk up stairs to the ward on account of a lameness of the left hip, the sergeant in charge of him stating that tin s was caused by a fall from a bridge, which had occurred between two and three weeks previous to his admission. His own statement was that in marching across the bridge at night he was accidentally crowded off the side and fell down some distance, striking upon his left hip. As he laid upon his back the injured limb appeared shortened and the toes, turned toward the other foot. By measurement the shortening was found to be three-fourths of an inch. The trochanter was flattened and approximated to the anterior superior spinous process of the ilium. On rotating the limb no point of false motion was discovered and no crepitation. The arc of the movement of the trochanter was less than that of the sound side. W T hen the patient stood erect there was the same shortening and the same in version of the foot. He could limp about a little by the aid of a chair, bearing considerable of his weight upon the injured limb. The diagnosis of the case was that of an impacted fracture of the neck of the femur. The limb improved rapidly, and in a few weeks the patient walked without inconvenience excepting what arose from the shortening. The general appearance of the man, however, led to the suspicion of pulmonary tuberculosis, and a physical examination of the chest confirmed this suspicion. The tuberculosis advanced with the ordinary phenomena of cough, expectoration, some hemoptysis, and occasional pleuritic and pneumonic inflammation. From this disease the patient died January 28, 1866. The post-mortem examination of the bod} proved the correctness of the diagnosis respecting the lung disease. Nothing peculiar was noticed about the acetabulum of the injured side except that the ligamentum teres and the cushion of fat at the bottom were more vascular than on the sound side. The femur presented unmistakable evidence that the injury was an impacted fracture of the neck of the bone, the line of it being partly within and partly without the capsular ligament. By comparison with the sound femur a shortening of three-fourths of an inch was shown, and the impaction was found to be greater anteriorly than posteriorly, thus causing the inversion of the foot. The union of the bone appeared to be firm and sound." Both the injured and the sound femur were contributed to the Museum by the reporter of the case and constitute specimen 2376 of the Surgical Section. CASE 972. Fracture of the patella. Lieutenant J. H. Sullivan, Co. G, 1st Regiment Potomac Home Brigade, aged 27 years, was thrown out of a wagon on July 24, 1864, striking his knee on the stone pavement and fracturing the patella. The bone was split into three fragments, there being one outer lower, one inner lower, and one larger upper piece. The patient was admitted to the General Hospital at Frederick on the day of the injury. Anti-inflammatory treatment, such as ice and evapo rating lotion, was used to the joint, and a straight splint was applied to the back of the limb, coaptation being made by compress above and below the bone, drawn and pressed together by adhesive plaster. The limb was kept elevated during part of the treatment on an inclined plane. After union had taken place a plaster of Paris splint was applied to enable the patient to go about. On October 20, 1864, he returned to his regiment to be mustered out, his term of service having expired. At the time of leaving the hospital the patient had recovered from his injury with short ligamentoua union. The case was reported by Acting Assistant Surgeon J. H. Bartholf. The patient has never applied for a pension. 652 MISCELLANEOUS INJURIES. [CHAP. xi. CASK 973. Fracture of the tibia. Sergeant-Major J. L. Keys, 18th Pennsylvania Cavalry, was admitted to Frederick Hospital July 13, 1804, with a chronjc indolent ulcer of the right leg, the result of an old fracture of the tibia. Assistant Sur geon II. F. Weir, U. S. A., recorded that the ulcer was treated by strap; and stimulant applications and became much diminished in size. On September 25th the patient received a furlough for thirty days, and when he returned he showed evidence of pro tracted intoxication. Symptoms of mania apotu soon after prevailed, and, though subdued for periods by treatment, resulted fatally on October 26, 1864. At the autopsy the body was found to be well nourished, the lungs healthy, and a large deposit of fat on the outer surface of the heart. The liver was much enlarged and decidedly fatty; kidneys fatty; spleen and intestines healtliy; omeutum very large; stomach very much contracted, its coats being intensely thickened, the rugae remarkably prom inent, and the mucous membrane much congested. On removing the calvarium the membranes were found to be much congested, with slight effusion between the arachnoid and pia mater, slight deposit of lymph on the pia mater and consid erable effusion beneath. The substance of the brain was quite firm. A section of the injured tibia was presented to the Museum and forms specimen 3932 of the Surgical Section, showing the old consolidated fracture followed by a spongy and carious condition of the anterior portion of the bone. CASE 974. United fracture of the tibia. Specimen 1057 (FlG. 367) was contributed to the Surgical Section of the Army Medical Museum by Assistant Surgeon E. Coues, U. S. A., and consists of a portion of the shaft of the tibia, exhibiting a simple oblique fracture firmly consolidated. Death occurred from an independent cause. CASK 975. Fracture at the ankle joint. Captain T. M. Howrigan, Co. H, 1st Michigan Cavalry, aged 37 years, suffered a fracture at the left ankle joint while passing through Washington, November 11, 1862. The accident was occasioned by his horse becoming frightened and falling with him, causing his left foot to be caught under the horse and to be fractured. He was discharged for disability June 30, 1863, but re-entered his regiment as Major several months afterwards, and remained in service until ultimately mustered out June 19, 1865, since which date he has become a pensioner. Examining Surgeon J. A. Brown, of Detroit, Michigan, August 11, 1869, FIG 307 Con edified to the fracture and to the tibia being partially dislocated at the ankle, and added that "motion and solidated frac- strength of the foot and ankle are considerably impaired." The Kansas City Examining Board reported, Septem- pi057 " her 4, 1873: "Upon careful examination we find fracture of the tibia and fibula and dislocation of the internal malleolus, it being projected inward and dowmvard, with tumefaction and pain. Close to the femur and femoral vessels at the upper third of the thigh there is found an osseous deposit about six and a half or seven inches long, one and a half inches wide above and tapering off in a wedge-shape below, and one-half inch thick, and just above this there is a smaller deposit, being two inches long and one inch wide. These deposits interfere materially with the circulation and mobility of the limb, which is atrophied and partially paralyzed. General health bad." The same board on September 8, 1877, reported the existence of " large varicose veins of the entire limb. He is feeble, very nervous, and quite lame, being compelled to support himself by a cane in walking. He is much more feeble now than two years ago, and unable to do manual labor." One year later the board reported that the pensioner " is now confined to his bed and has not been able to walk for several months. He has to have constant attendance and is not able to help himself." The pensioner died May 2, 1879. His attending physician, Dr. A. B. Sloan, of Kansas City, testified that death was caused by "exhaustion induced by ossification of the arteries in the lower limbs and the deposit of bony masses in his left thigh, resulting from the injury and exposure in the army." Punctured, Incised, and Lacerated Wounds. Thirty-six thousand nine hundred and seventy-five punctured and incised wounds, not including those caused by sabre or bayonet, were reported; five hundred and thirty had fatal terminations, a mortality rate of 1.4 per cent. The number of lacerated wounds is recorded as five thousand three hundred and eighty-four, of which one hundred and ten, or 2.0 per cent., ended in death. CASK 976. Punctured wound of chest. Private B. McGinnis, Co. H, 7th Kansas, aged 31 years, was discharged from service at the General Hospital at Leavenworth City, December 29, 1863, Acting Assistant Surgeon S. F. Few certifying to the following disability: "He has been under treatment in this hospital since August 18, 1862, for a punctured wound of the right side below the axilla, caused by a knife in the hands of a comrade during a drunken quarrel. Chronic pleurisy exists, accom panied by empyema. The thoracic walls on the right side are much compressed, and there is dullness on percussion and almost entire absence of respiratory murmur in the right lung. There is discharge of fetid matter from a fistulous opening in front of the right axilla, and the patient s general health is much impaired." There is no record of this man ever having applied for pension. CASK 977. Punctured wound of urethra. Passed Assistant Surgeon J. K. Tryon, U. S. N., reports that " J. Welsh, a seaman, aged 43 years, and of strong constitution, was admitted into the Naval Hospital at Pensacola June 29, 1864. He had been admitted on the sick list eight days previously with difficulty of micturition accompanied by inflammation of the spermatic; cord and tunica vaginalis, and on June 28th he had ruptured the urethra by passing a sail needle for a bougie. At the time of the patient s admission to hospital the scrotum and perinaeum were gangrenous, consequent upon extravasation and infiltration of urine in the surrounding cellular tissue, caused by the laceration of the urethra. The buttocks were swollen and inflamed, large quantities of pus escaping on incision. He was weak and faint, unable to void urine, and laboring under all the effects of a severe shock. Upon consultation it was decided that no operation could possibly be of benefit to the patient. A catheter was accord ing!} passed into the bladder after considerable difficulty; tonics and stimulants were freely administered, and the affected parts were dressed with liquor sodae chlorinatis. On June 30th the patient was no better, being hectic and comatose, from which he could be easily aroused. Urine passed freely through the catheter. On July 1st there was no change. During the following night the patient removed the catheter; the scrotum sloughed away entirely and the testicles became exposed, with an ulcerated surface extending over the perineum, and the buttocks filled with maggots, which seemed unavoidable from the extreme difficulty in keeping the parts clean and from the heat of the weather. On July 3d a gum-elastic catheter was again passed into the SECT, i.] PUNCTURED, INCISED, AND LACERATED WOUNDS. 653 bladder. The patient, however, failed rapidly, became fully comatose under all the depressing circumstances, and died in a pitiable condition on the morning of July 15, 1864. The autopsy revealed the stricture and point of rupture just external to the triangular ligaments. The severe symptoms of the case at the time of reception into the hospital render it highly doubtful whether the laceration of the urethra and extravasation of urine could have taken place only the day previous to admission, but under any circumstances should not the treatment in the first instance have been decisive, puncturing the bladder through the rectum (if the catheter could not be introduced) and making numerous and deep incisions into the affected parts?" CASE 978. Punctured wound of knee joint. Private B. F. Carr, Co. G, 2d Minnesota Cavalry, aged 19 years, was wounded in the left knee during the engagement with the Indians near the Little Missouri River, August 8, 1864. He remained at a field hospital for two months and was then transferred to Fort Ridgely. Acting Assistant Surgeon A. Muller, in charge of the latter, certified to his discharge from service, February 1, 1865, by reason of " an arrow wound through the knee immediately below the patella, causing stiffness of the knea joint and considerable limping." Examining Surgeon B. R. Palmer, of Sauk Centre, Minnesota, reported, June 17, 1868: "An Indian arrow passed into the knee joint under the knee pan. There are evidences of extensive inflammation of the joint in numerous cicatrices around the joint. There is no anchylosis, but great irritability in the joint after exercise, and difficulty in walking far or standing long." Examiner J. M. McMasters on Septem ber 6, 1877, made a corroborating report of the nature of the injury, and stated that "an iron or steel arrow penetrated the knee joint. At present there is partial anchylosis of the joint, with dryness of the syuovial membranes, indicated by cracking upon motion, and considerable tumefaction in the popliteal region." The pensioner was paid December 4, 1881. CASE 979. Punctured wound of knee joint. Private T. A. Jackson, Co. H, 1st Rhode Island Cavalry, aged 23 years, is recorded by Assistant Surgeon E. J. Marsh, U. S. A., as having been admitted to Judiciary Square Hospital, Washington, April 29, 1863, with a "perforating wound of the left knee," and as having been transferred to Philadelphia one week afterwards. Acting Assistant Surgeon W. W. Keen, jr., reported the case as a "punctured wound of the knee joint" and described the injury as follows: "The patient was admitted to Satterlee Ho&pital May 7th. He stated that in the previous December he met with a fall from his horse, during which a pair of scissors from his knapsack punctured the knee joint and broke off; that the points were removed three days after the accident, being three inches deep according to the statement of his surgeon, and that severe inflammation followed and a large number of abscesses formed about the joint. At the time of the patient s admission the injured joint was smaller than the sound one, the hamstrings were contracted, and motion was limited from complete flexion to an angle of 135 with the thigh. Crepitation was very marked and motion of the patella much restricted. Just to the inside and above the tubercle of the tibia there was a cicatrix from a wound, and all about the joint old cicatrices from abscesses were found. The evidence was rather in favor of penetration of the joint, both by the position of the cicatrix mentioned and the escape of synovia, which seems probable from his statement, though of this he is not quite confident. The scissors were rusty when he was wounded. He walks about on crutches but is unable to bear weight on the limb." Surgeon I. I. Hayes, U. S. V., reported that the patient was discharged from service June 1, 1863, by reason of anchylosis of the left knee joint resulting from an injury by scissors penetrating the knee joint." The man is not a pensioner. CASE 980. Incised wound of neck. Assistant Surgeon G. W. Hogeboom, 8th Kansas, reports that "Private S. Noyes, Co. K, 13th Wisconsin, was admitted to hospital at Leavenworth, May 28, 1862, with a partially healed incised wound across the throat, running diagonally from left to right and crossing the trachea just below the pomum adami. He was sent here from the Law rence Hospital and no account came with him of the injury, which is said to have been inflicted by himself with a bovvie knife while laboring under a temporary aberration of mind some time in March. When I first saw him the wound was discharging healthy matter and there was some hoarseness of voice and expectoration of considerable quantities of pus at times; pulse 70, full, soft and regular ; general condition of system very good ; mind sound. There was no apparent opening from the external wound into the trachea. It soon, however, became evident that there existed some obstruction to the closing up of the wound by granu lation, and from time to time thorough search was made for any deep-seated abscess and for sinuses connecting therewith. From the character of the sputa at times I feared that there might exist such connections with the trachea internally, but failed in every attempt to find any leading from the external wound. The patient s general condition, though every effort was made to find the true seat of the difficulty, continued much the same until the morning of June 29th, when his hoarseness was a great deal worse and accompanied with great difficulty of respiration and increased frequency of pulse attended with considerable hardness. I immediately put him on calomel and tartar emetic in pretty liberal doses. By 6 P. M. the symptoms were in a measure relieved. The treatment was continued through the night. At 8 P. M. on the following day the dyspnoea was still aggravated and the patient s blood greatly in need of oxj genation. I then sent for instruments for the purpose of performing tracheotomy, but before the operation could be done the patient expired asphyxiated. At the post-mortem examination I found an old sinus communicat ing with the trachea from behind, just below the chordae vocales, leading to an abscess below and immediately behind the opening into the trachea. The trachea was contracted from behind to less than one-third its normal size, and following it closely a very tortuous and small sinus connected the abscess also with the external wound. Sub-acute inflammation extended in a limited degree to the larger bronchia, and patches of false membrane were found on the right side of the trachea. Other organs healthy." CASE 981. Incised wound of abdomen. Private J. Mooney, Co. G, 1st California Cavalry, was stabbed with a knife by a fellow soldier May 18, 1863. He was conveyed to Camp Stanford Hospital at Stockton, whence Surgeon W. W. Hays, 6th California, made the following report: "When first seen, about three-quarters of an hour after the injury, I found a wound in the left side of the abdomen extending from about the centre of the seventh rib three inches diagonally toward the umbilicus, and another in the back, on the left side of the second lumbar vertebra, extending upward and across the vertebral column for about two and a half inches. About three feet of the small intestine, with some omentum, was lying upon the external surface of the abdomen, being partly cold from exposure to the air and distended with gas. By gentle manipulation all was reduced in about half an hour, and the wound was closed by interrupted sutures. The wound in the back bled freely and was only controlled by an injection of sulphate of iron. The treatment consisted of the free use of opium, half a grain being given every hour during the first twenty-four hours, and low diet. On the third day the bowels were opened by an enema and afterward by a full dose of castor oil. Very little inflammation occurred, and that was controlled by opium and cold water. The patient improved rapidly, 654 MISCELLANEOUS INJURIES. [CHAP. XT. and to day (May 31st) he is walking about the camp, although the wound in the back is still discharging slightly." About two months after the occurrence of the accident the patient was admitted to hospital at Camp Drum, whence Surgeon S. S. Todd, 4th California, reported his discharge from service September 6, 1863, by reason of "ventral hernia." CASE 982. Incised wound of knee. Private R. Moody, Co. G, 118th New York, aged 24 years, entered Turner s Lane Hospital, Philadelphia, May 23, 1864, and was discharged for disability seven months afterwards. Acting Assistant Surgeon W. W. Keen, jr., contributed the following history of the case: "The patient had been struck by an axe in the right leg, just below the patella, during the fall of 1862. The axe severed the ligamentum patella, but he states that no synovia escaped and but very little blood. He was sick in bed for five months and then got up, having no anchylosis and the great primary swelling having disappeared. In December, 1863, he enlisted in the army, having good use of the limb, though he could not run nor walk rapidly without care. He states that within the last six weeks the patella has been drawn upward, and that before then it had almost kept its normal position. He now constantly requires a cane and cannot extend the limb by the quadriceps muscle. No anchylosis exists." The cast (Spec. 6692, A. M. M.) was taken by Dr. Keen at the time of the patient s admission to Tumer s Lane Hospital, and shows the position of the patella, also the scar and resulting deformity, the limb being flexed. Some years after his discharge the man claimed a pension for disability from diarrhoea, etc., alleged to have originated in the service, and was inspected by Examining Surgeon T. C. Noyes, of Oshkosh, Wisconsin, who in connection with the case mentioned the condition of the injured limb on August 19, 1880, as follows: "I find the right thigh atrophied from hip to knee, with slight paralysis. Its size above the knee is three inches smaller than the left, somewhat weaker, and uncertain in movement." CASE 983. Lacerated wound of leg. Private J. Farrell, Co. B, 132d New York, aged 21 years, was severely injured by an explosion at Bachelor s Creek, May 26, 1864. Surgeon C. A. Cowgill, U. S. V., reported his admission to Foster Hospital at New Berne with "extensive laceration of the popliteal space of the left lower extremity." Four months after receiving his injury the patient was well enough to leave for his home on furlough. He subsequently entered Ladies Home Hospital, New York City, and lastly McDougall Hospital, whence he was discharged from service June 16, 1865, and pensioned. The New York City Examining Board certified to the injury on November 23, 1870, and stated that "the outer hamstring muscles were carried away, causing partial paralysis of the left foot. The cicatrix is eight inches in length by three in width." Five years afterwards the same board reported that "the strength of the knee joint is greatly impaired; complete paralysis of foot at the ankle joint and also of the toes; foot cold and badly nourished." The pensioner was paid September 4, 1881. CASE 984. Lacerated wound of leg. Private P. Berrer, Co. I, 3d New Jersey Cavalry, aged 26 years, was kicked in the left leg by a horse on March 14, 1864. He was admitted to hospital at Philadelphia, where simple dressings were applied and where he remained until June 19th, when he was transferred to Ward Hospital at Newark. At the latter place the injured limb was operated upon by Assistant Surgeon J. T. Calhoun, U. S. A., who made the following report of the case: "The site of the limb kicked by the horse was on the anterior aspect, at the junction of the middle and upper thirds of the tibia. A lacerated wound was produced and the bone was laid bare. In the course of some months a large and unhealthy ulcer developed itself, covering the whole face of the lower upper third and upper part of the middle third of the tibia and causing profuse suppuration. On November 8th an anesthetic of ether and chloroform was administered and an incision three inches long was made, after which a sequestrum four inches long was extracted with a bone forceps and carious bone was removed by means of a gouge. The patient s general health at the time of the operation was in a fair state. His subsequent treatment consisted of simple dress ings, stimulants, and full diet. The wound did well for a time, but prospects of complete recovery remained remote and indifferent at the time of the patient s discharge from service on April 8, 1865." The Philadelphia Examining Board reported, September 4. 1875: "On the inner side of the injured leg there is an extensive scar, which involves fully one-half of the surface. The tibia is enlarged and the scar is hard and discolored. It has been open recently, but is now nearly healed." Two years later the same board described the scar as discharging pus and the limb as greatly discolored and hypertrophied. The pensioner was paid June 4, 1881. Other Accidents and Injuries. Of fifteen thousand two hundred and seventy-three injuries of various kinds, grouped in this class, one thousand and seventy-five were fatal, a mortality of 7.03 per cent. A large number of these cases were injuries from frostbite. CASK 985. Private A. Zufall, Co. C, 142d Pennsylvania, aged 21 years, had his feet frost-bitten in the field during the month of January, 1863. After undergoing treatment in field hospitals for several months, he was transferred to Washington and subsequently to Philadelphia. Acting Assistant Surgeon K. M. Girvin reported that at the time of the patient s admission to Satterlee Hospital, June 23d, his feet were swollen and purplish looking and he had not been able to wear his shoes for five months. He was doing well and no treatment was required. The patient was returned to his regiment for duty on December 2, 1863. At the battle of the Wilderness, May 5, 1864, he received a gunshot flesh wound in the left thigh, for which injury he was again treated in various hospitals. He was ultimately mustered out of service May 29, 1865, and pensioned. Examining Surgeon II. Brubaker, of Somerset, Pennsylvania, reported, November 4, 1874: "The toes of both feet are stiff and the feet are very tender from the presence of chilblains, which become very troublesome during the winter, when he is unable to wear shoes most of the time." Examiner S. L. Good, of Meyersdale, Pennsylvania, March 15, 1880, certified to "loss of motion of the toes of both feet; cold and imperfect circulation. He states that the feet are numb and get cold easily. He cannot walk much." The pensioner was paid December 4, 1881. CASE 986. Frostbite of both feet. Private L. S. Cronkhite, Co. I, 40th Indiana, aged 46 years, was taken prisoner at the battle of Franklin, November 30, 1864, and had his lower limbs frozen by exposure during his captivity, which lasted for several months. Assistant Surgeon J. A. White, U. S. V., reported that he was admitted as a paroled prisoner to McPherson Hospital at Vicksburg, April 2, 1865, suffering from "frostbite of both feet," subsequent to which date the patient passed through various hospitals until August 31, 1865, when he was mustered out of service. Having made an application for pension, he was examined on December 31, 1880, by Examining Surgeon J. T. French, of Knoxville, Iowa, who described his condition SECT. I.] LIGHTNING STROKE. 655 as follows: "He has suffered from frozen feet. The flesh has sloughed off both the great toes and inner side and bottom of the feet, causing extensive contraction of the tendons. He is unable to walk or attend to ordinary farm labor, rendering his dis ability equal to one-half of total." CASE 987. Struck by lightning. Private S. Millard, Co. K, 52d Pennsylvania, aged 20 years, was struck by lightning while doing guard duty near Port Royal, May 13, 1864. He was treated at the regimental hospital and subsequently at the General Hospital at Hilton Head, whence Assistant Surgeon J. F. Huber, U. S. V., reported the case, stating that " the electric fluid passed down the man s body in a zigzag direction and burned the body in its course." The patient is recorded as having been returned to duty three months after the occurrence of the accident. He was ultimately mustered out of service July 12, 1865, and afterwards allowed a pension. The following detailed account of the case was subsequently contributed by Dr. J. B. Crawford, of Wilkesbarre, Pennsylvania, who at the time of the accident held the rank of regimental surgeon of the 52d Penn sylvania volunteers: "I saw the man about ten minutes after the reception of his injury. He laid upon the ground apparently dead. No pulsation of the heart could be felt, no respiration could be observed, nor could any symptoms of life be discovered. There was complete relaxation of the muscles and the pupils were much dilated. The electric fluid seemed to have first touched the point of the bayonet, about one inch of which was melted. The brass buckle of his belt, his steel watch-chain, and the larger portion of the silver casing of the watch were also melted. The hair was burned from his chest and pubes, and the skin of nearly the whole anterior portion of his body was more or less deeply burned. The injury to the skin was most severe about the pubic region, where some sloughing subsequently took place. Passing down the legs the fluid singed the hair and slightly burned the skin on the anterior surface of each limb. The soles of his boots were completely torn off, and no trace of them, with the exception of a few small portions left attached, could be found. No marks of the electric fluid were made upon either of the upper extremities nor upon the head or the neck. It seemed to have first touched him below the clavicle .and to have descended over the anterior portion of the body, where it left its visible traces. The woolen shirt which he wore at the time was also much burned and was still smoking when I reached him. At first I had no thought of making any attempt at resusci tation, but while awaiting the arrival of a stretcher for the purpose of removing the body I decided to try the effect of artificial respiration. No appliances for this purpose, however, w r ere at hand, and my only resource was to compress and expand the chest, depending on the elasticity of its walls and on the forcible elevation of the arms for means of expansion and inflation, and on direct compression of the chest with the hands for expiration. Being aided by my assistant, Dr. J. Flowers, I proceeded to carry out my purpose, the relaxed state of the muscular system seeming to facilitate the proceeding greatly. Ammonia was applied to the mouth and nose while the forced respiration was being carried on. After continuing this procedure for a quarter of an hour or more, and when about despairing of success, we were rewarded by what seemed to be a faint gasp in our patient so slight, indeed, that we were not quite sure of its reality, yet enough to induce us to persevere in our efforts. We soon saw more unequivocal signs of life, and at the expiration of half an hour we could detect positive evidence of the heart s action, which was feeble and exceedingly slow, not amounting to more than thirty-five beats per minute. After continuing the treat ment for another half hour our patient was so far restored that we had him conveyed to the regimental hospital. As he was yet unable to swallow, ammonia was given by inhalation, and whiskey was freely applied to the surface of the body. After the expiration of some hours the patient became able to swallow small quantities of liquid ; the limbs and organs of speech, however, remained paralyzed. He continued in a similar condition for about five days, the bowels being constipated and the urine passing involuntarily. Sensibility seemed to have been lost. On the sixth day after the injury a slight improvement in all the suspended functions was apparent. The voice gradually returned; movements of the limbs again became possible; the bladder and bowels gradually resumed their wonted action, and sensibility and motion returned by slow and uniform degrees. At the expiration of three weeks I left for the north and lost sight of the patient, who was then able to walk a few rods with the aid of crutches. Some three years afterwards he applied to me for a certificate on which to found a claim for a pension. At that time he had not fully recovered, sensibility and motion being still impaired. His gait was unsteady and his movements tremulous and feeble; his pulse had regained its normal frequency and force. His condition still continued to improve, and at the expiration of another year he was able to attend to some light labor. I again saw the man in July, 1873, when he told me that he had nearly recov ered from his injury and had resumed his trade as wagon-maker. He also stated that he enjoyed tolerable health, and expe rienced none of the 511 effects of his injury except on the approach of and during a thunder storm, at which time he would feel excruciating pains throughout his system," etc. In consequence of adverse reports by the examining surgeons the pensioner s name was dropped from the rolls on March 4, 1869, since when he has made ineffectual attempts to be restored. The Scranton, Pennsylvania, Examining Board certified, on March 7, 1877, to "reflex paraplegia consequent on the general electric shock of such intensity as to disturb the co-relation of the nerve centres. While it did not utterly destroy, it has so far impaired the neural force as to give rise to loss of power by exhaustion more or less complete and to consequent occurring nutritive changes." CASK 988. Struck l>y lightning. Sergeant W. Roberts, Co. C, 56th Ohio, aged 24 years, was struck by lightning while on the march from Jackson to Vicksburg, July 22, 1863. He was conveyed to hospital at Vicksburg, where he was under treat ment for several weeks, after which he received a furlough and was allowed to proceed to his home. Surgeon L. R. Stone, U. S. V., reported that "the man was admitted from his home to the General Hospital at Gallipolis on February 9, 1864. At the time of his admission he could not walk, only shuffle along a few inches at a time, and could stand only when supported on crutches or canes. He showed considerable emaciation; appetite poor; pulse 120 and feeble; skin dry and cool. His mind was not at all affected. According to his account of the accident he had sought shelter in the woods during a heavy thunder storm and was standing under and against a tree, when he was struck senseless to the ground, one or two other soldiers being killed at the same time. He remained unconscious for some hours, but was at last resuscitated by the dashing of cold water and by friction, and was then removed to a hospital as soon as possible. The physician under whose care he was while staying at his home stated that at first he was nearly helpless, and in December there was yet no perceptible improvement in the case, his pulse being 125 and feeble, his emaciation considerable, and the use of his lower extremities being greatly impaired. Nothing was mentioned about the treatment employed. On examination of the patient after his admission here, well marked general paralysis of the motor system was found, particularly of the lower extremities, with some slight insensibility, and a sluggish- 656 MISCELLANEOUS INJURIES. [CHAP. xi. ness of the capillary circulation. There was no oedema nor subsultus tendinum. He could move his toes and partially flex his legs or his thighs, but could not walk. The upper extremities were somewhat affected, but in a much less degree; bowels very sluggish ; no affection of the urinary organs. Though occasionally there were severe paroxysms of pain just below the scapulas, no pressure at any particular point along the spine caused pain. Atmospheric changes affected the patient very much, and when the air was charged with electricity he showed considerable constitutional irritation, with fever, pain in the head and limbs, and nausea. This was followed by two or three days of depression before he would recover his usual condition. The treatment was principally chalybeate, with milk diet. The patient is slowly improving now (May 12th) and able to walk more easily with crutches, but is still quite feeble." At a subsequent date the patient was transferred to Columbus, where he was dis charged by expiration of service on October 27, 1864. On making an application for pension he received the following certificate from Examining Surgeon W. G. Gill, of Decatur, Alabama, dated April 23, 1881 : "I have carefully examined. the applicant. He appears quite nervous, and says his left side gives him great pain when he exercises in attempting to do manual labor; that he has never been able to do a regular day s work since the war, and although partially recovered from paralysis caused by lightning, he still suffers very much. I rate his disability total." CASE 989. Fatal case of sunstroke. Private C. Vaughn, Co. B, 1st Louisiana, aged 30 years, was sunstruck at New Orleans, and admitted to St. James Hospital on September 16, 1863. Acting Assistant Surgeon J. V. C. Smith reported that " the patient was brought to the hospital in a state of unconsciousness. He could swallow nothing and occasionally had spasms of the lumbar muscles. He was carefully watched. Cold-water applications were made to the head, and mustard was applied to the back of the neck and to the soles of the feet. On the following day the patient s jaws were still spasmodically closed and nothing could be forced into his mouth. At 2 P. M. the ice was taken from his head and his whole body was washed in mustard water. His pulse was not much different from that of one in ordinary health. At 3 P. M., by some singular movement which no one saw although he was in a ward of forty-three beds, mostly occupied, and the nurses were but a few feet off he seemed to have rolled over and broken awash-basin, a sharp edge of which cut a gash three inches in length across the masseter muscle of the left side of his face, nearly dividing it, and cutting in twain a branch of the transversalis faciei artery, which bled pretty freely. The artery was secured by a ligature and the wound was stitched and secured by adhesive strips. The patient groaned several times during the operation, but never recovered his consciousness nor took either nourishment or medicine while in the hospital. He died at 10 p. M. on September 17, 18G3." CASE 990. Injury from a scorpion bite. Private J. Sculley, Co. H, 6th New York Cavalry, aged 25 years, was stung by a scorpion on the back of the neck, between the third and fourth cervical vertebrae, while in camp at Fair Oaks, June 27, 18G2. Surgeon A. P. Clark, 6th New York Cavalry, who treated the case, made the following report: "The patient was a man of robust constitution and of good health. I saw him a few minutes after the reception of the wound, which occurred at 10 A. M. There was no swelling of the part, but he complained of intense pain in the back and lower extremities. I cauterized freely. Severe spasms soon came on, producing in quick succession complete emprosthotonos and opisthotonos ; pulse 55 and weak; pupils dilated; voice feeble; face livid; surface cold and bathed in clammy perspiration. He remained in this condition for two and a half hours, when he gradually became insensible, the action of his heart becoming more feeble and irregular. Ten minims of Bibron s antidotal mixture and a tablespoonful of brandy diluted with the same quantity of warm water was administered and repeated every half hour until two and a half ounces of the brandy had been given. During this time hot sinapisms, with diluted acetic acid, were kept applied along the spine and lower extremities. At 12 o clock his face and hands began to swell, the skin of these parts resembling an attack of phlegmonous erysipelas, though of a duskier hue. The swelling continued to increase until about 6 p. M., at which time his head was of an enormous size and his eyes very glassy, appearing as if they would burst from their sockets. The swelling also extended down the neck and chest as far as the lower part of the pectoral muscles, down the arms as far as the insertion of the deltoid, and over the shoulder on either side of the wound; but there was none in its immediate vicinity or below it on the back. The patient still remaining unconscious, I took twelve ounces of blood from the left median cephalic vein and cupped him along the spine and lower part of the thorax, put two minims of croton oil upon his tongue, and administered an enema of warm water and olive oil. Sinapisms were still continued. About 2 A. M. on the follow ing morning signs of returning consciousness appeared, when another enema was given and his feet were put into warm water. In about a quarter of an hour afterwards he had a copious discharge from his bowels, very offensive and of a dark gelatinous character, which AVRS soon followed by the vomiting of a large quantity of matter of a similar but not so offensive nature. After this consciousness returned and the swelling gradually subsided. At 3 P. M. the patient was able to sit and ride in an ambulance. He reached Harrison s Landing on July 1st, when he reported to his company for duty. No untoward symptoms afterwards appeared. During the course of the first day some ten different medical officers saw the patient and none of them entertained any hope of his recovery. I am of the opinion that it was through the action of Bibron s antidote conveyed into the circulation that the virus of the scorpion was neutralized or eliminated from the system, and that the action of the medicine was promoted by the other measures employed." SECT. 11. J OPERATIONS FOR MISCELLANEOUS INJURIES. 657 SECTION II. OPERATIONS FOR MISCELLANEOUS INJURIES. Numerous operations for miscellaneous injuries or diseases, such as excisions, amputa tions, ligations, operations on the eye, the mouth and its dependencies, the air passages, the chest, the genito-urinary organs, etc., were reported during the war. Detailed reports will be given of the more important cases, and all will be cited in condensed tabular statements. EXCISIONS. Forty-five cases of excisions for miscellaneous injuries or diseases were reported. Twenty-five were excisions of the bones of the head, five of the upper extrem ities, and fifteen of the lower extremities. The results are indicated in the following table: TABLE CV. Numerical Statement of Forty-Jive Cases of Excisions following Miscellaneous Injuries or Diseases. EXCISIONS. CASES. FOR INJURY. ji FOR DISEASE. "3 ~C EH Recoveries. Deaths. Undetermin d Results. Recoveries. a 1 Undetermin d Results. Recoveries. Deaths. 1 1 1 1 1 1 9 1 1 1 12 1 12 1 12 1 12 1 1 1 1 1 1 1 1 1 1 1 9 5 4- 1 1 Excision in hones of Leg and amputation of Leg 1 I 9 1 1 1 Excisions at the Ankle Joint ... ... 1 16 45 28 16 1 23 1 5 The twenty-five cases of excisions of the cranial bones for injuries from miscellaneous causes have been detailed in the First Surgical Volume. 1 A few examples of excisions in the extremities will here be cited, and all will be given in tabular form. CASK 991. Excision in the. bones of the leg. Private C. Peasley, Co. A, 10th Massachusetts, was kicked by a mule in the left leg, fracturing both bones, while driving ambulance at Camp Brightwood, August 31, 1861. He was admitted to the Washing ton Infirmary Hospital on the day of the injury. One month after the accident no attempt at union of the bgne had yet taken place, but much suppuration had occurred and the bone had become bare in its whole circumference for the space of two inches. Free 1 Cases of: Citizen J. Berry, p. 316 ; Pt. J. Burns, C. 4th Kentucky Cav., p. 57 ; Pt. W. H. Edwards, D, 3d Jowa Cav., p. 317 ; Corp l A. Gasslein, B, 6th Penn. Cav., p. 51; Pt. P. H. Greene, II, J2f>th X. V., p. 57; Pt. C. Horahan, G, 61st Ohio, p. 57; Pt. J. T. Jenkins, 5th Alabama, p. ">8 ; Pt. W. H. Lowery, C, 6th Tenn. Cav., p. 58 ; Pt. J. McTye, G, 6th Tenn., p. 317 ; Pt. E. Miller, G, 6th Va. Cav., p. 58 ; Pt. N. II. Neodhairi, I, tith Mass., p. 58 ; A. B. Parish, employe Q. M. Dep t., p. 58; Pt. G. W. Phillips, G, 6th Iowa Cav., p. 317; Pt. P . 14th Tenn., p. 59; Pt. J. Rogers, L, 4th Ohio Art y, p. 59; Pt. J. Ruytz, H, 2d Mich., p. 59; Pt. J. C. Shedd, D, llth N. Y. Cav., p. 59; Freedmau J. Smith, p. 59; Pt. W. H. South, H, 168th Penn., p. 60; Pt. C. E. Towns, I, 9th N. H., p. 60; Unknown, 4th II. S. C. H. A., p. 316; Unknown German soldier, p. 316; Unknown negro, p. 58; Pt. C. Vorrist, Signal Corps; and Pt. C. Williams, B, 161st N. Y., p. 60. SURG. 11183 658 MISCELLANEOUS INJURIES. (CHAP. XI. incisions were made anteriorly and posteriorly and resection of the tibia and fibula was performed. Firm union resulted three months after the operation, a gypsum apparatus being used during the last month. The patient was discharged from service December 17, 1861, and sent home. He had urgently requested that amputation be performed, but on careful examination it was deemed more prudent to saw off the dead bone which had not yet been cast off and to resort to amputation only in case of failure of the resection. The excised portion of the tibia (Spec. 340). represented in the adjacent cut (FiG. 368), and measuring one and one-fourth inches in length, was contributed with the history of the case by Assistant Surgeon J. W. S. Gouley, U. S. A. The patient became a pensioner after receiving his discharge. Examining Surgeon II. D. Train, of Sheffield, Massachusetts. September 7, 1872, certified to the injury and resection, "shortening the limb three inches. There is a perfect solidification at the. place of fracture; no motion of ankle and instep After slight exertion or during damp weather he has often severe pain, which prevents any labor. Since his discharge he has been obliged to lead a sedentary life from inability to walk. His general health is fair, but his system is generally weakened and sensitive to cold weather. The foot is gradually perishing, and the pensioner would have been infinitely better off to-day if amputation had been performed." Five years later the same examiner reported that ,i <m fjl bula "eince last examination spiculrc of bone were frequently discharged, the wound breaking out afresh. He cannot walk any distance without crutch or cane. General health poor." The pensioner was paid December 4, 1881. CASE 992. Partial excision at the ankle joint. Private L. Ettinger, 1 Co. K, 58th New York, aged 52 years, was accidentally injured, near Hunter s Chapel, December 6, 18(51, by the blow of an axe, which struck his right foot just below the external malleolus, penetrating the ankle joint. Assistant Surgeon J. S. Billings, U. S. A., who operated in the case, made the following report: The man was admitted to the Union Hotel Hospital, Georgetown, January 1, 1862, being very feeble and emaciated and complaining of great pain in the foot. A large gaping wound existed at the site of the injury, from which sanious fetid pus was escaping and at the bottom of which dead bone could be felt. Sinuses also ran down each side of the tendo-achillis, and the whole integument about the ankle joint was livid and undermined. On January 6th partial excision of the ankle joint was performed by a curved incision three inches long, made just below the external malleolus and including the original wound. The external malleolus, the whole of the astragalus, and a small portion of the scaphoid were found to be carious and were removed by means of the bone gouge and Liston s forceps. The haemorrhage was slight. Simple dressings were applied, and ale and good diet were furnished. By March 1st the wound had entirely healed, the skin had resumed its natural appearance, and the patient could walk with a cane. He was then sent to Philadelphia, where he was discharged from service. I saw him eight months aftenvards, walking with a cane and with but a very slightly perceptible limp. The age and debilitated condition of this patient rendered the expediency of excision very doubtful ; but the result proved entirely satisfactory." The records of South Street Hospital, Philadelphia, show that the patient was discharged September 17, 18(i2, by reason of "anchylosis of the right ankle joint " resulting from the wound. The man subsequently became a pensioner. The nature of his injury and disability has since then been corroborated by successive certificates of various examining surgeons. The pensioner has been for some years an inmate of the hospital for the insane at Randall s Island, New York Harbor. TABLE OVJ. Summary of Twenty Cases of Excisions of the Bones of the Extremities. [ Upper Extremities, 1 5; Lower Extremities, 6 20.] NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY OH DISEASE. NATURE OF INJURY OK DISEASE. DATE OF OPERA TION. OPERATION AND OPERATOR. RKSULT AND REMARKS. 1 Ormsby, M. S.. Pt., D, 8th Abscess on right shoulder from Aug. 15, Portion ol acr. proc. of scapula Discharged Nov. 1, 1862. Claim Infantry, age 20. 1862. pressure of knapsack and ac 1662. excised ; August 22, spine and for pension rejected. Spec. 415, coutrements. Another abscess balance of acr. proc. remov d. A. M. M. &e First Surgical in leg; ulceration. A. Surg. R. Bartholow.U.S.A. Volume, p. 564. 2 Bliss, O. M., Capt.. H. 9th Got. 8, Compound fracture of the left Oct. 9, Excision of upper part left hu Erysipelas appeared ; had nearly Iowa, age 41. 1864. hiunerus. caused by fall of 1864. merus thro a single incision. passed away on Oct. 31, 1864. horse. Surg. A. Goslin, 48th Illinois. Died March 24. 1865. :t Reynolds. T.. Pt.. Perma May 1 1 , Right arm run over by a street Resection of 2 inches of shaft Disch d Mar. 26. 1864. Necrosis; nent Party at Carlisle Bar 1863. car. fracturing humerus. of right humerus. wound re-opened; discharged racks, Peiin., age 27. pus; pensioned; arm impaired. 4 West, \V., It., F, 78th Ohio. Oct. 20, Compound comminuted frac Oct. 22, Excision of condyles of right Erysipelatous inflammat n, which age 39. 1863. ture of the right elbow joint. 1863. humerus. head of radius, and appeared on the 8th day. was Condyles of humerus, head of point of olecranon through an readily subdued. Died June radius, and portion of ulna incision 5 ins. long. A. A. 20, 1864, of mortification of tho crushed by a car wheel. Surg. J. S. Bailv. arm. !t Revnaud, C., Pt., H, 2d Ken May 5, (tight ulna fractured at upper June ). Resection of both ends of bone, Disch d June 13, 65 : pensioned ; tucky Cavalry, age 26. 1864. part by blow from a musket ; 1864. about 3 ins. of shaft removed. anchylosis elbow; good motion both ends of bone denuded. Surg. R. K. Taylor, U. S. V. of fingers. Died Dec. 28. 1870. 6 Taylor. J., Pt., C, 38th Col A log fell upon him, fracturing Oct. 17, Resection of 4 inches of lower Wound sloughing. Died Octo ored Troops, age Hi. 1864. lower third of right femur; 1864. third of shaft of right femur. ber 29, 1864. of exhaustion. necrosis and sloughing. A. A. Surg. O. Shiftier. 7 Burnett, A. J., Pt., (1. 6th Aug. 7, Compound comminut d fracture Aug. 21, Excision of the left tibia Discharged June 27, 64 : anchy East Tennessee, age Mi. 1863. of left leg and dislocation of 1863. losis of the ankle joint. Claim ankle : run over by a wagon. for a pension rejected. H Coburn. S., Pt.. G, 3d Illinois Ulcer of the right leg; perios Second Excision of 3.V inches of the Mustered out July (>, 66; tissues Cavalry, age 38. titis of tibia and inflammation ary. right tibia. inflamed and indurated; ankle : of leg from knee to ankle. partially stiffened. 9 Disney, T. W., It., B. 36th Accidental fracture of the right Sept. 2, Excision of 5 inches of the right Discharged March 8. 1865; pen Massachusetts, age 33. tibia: 3 inches of necrosed 1864. tibia. sioned: two inches shortening; bone exposed. lameness. Died Jan. 31. 1873. 10 Harper. H. S., Pt.. E. 137th Aug. -. Scurvv and ulcer of left leg: Jan. 21, Excision of ](>i inches of left Mustered out Sept. 15, 1865: pen New York, age 35. 1864. tibia extensively necrosed. 1865. tibia through an incision 12 sioned. 1877,parts still discharg inches long. Surg. O. Grant. ing extensively; walks with dif U. S. V. ficulty; limb nearly worthless. CULBERTSON (H.), Excision of the Larger Joints of tlie Extremities, in Trar XXVII, p. 344. Prize Essay. Medical Association, 1876. Supplement to Vol. SECT. II.] AMPUTATIONS FOR MISCELLANEOUS INJURIES. 659 DATE OF - DATE - No. NAME, MILITARY DESCRIPTION, AND AGK. INJURY OR NATURE OF INJURY OR DISEASE. OF OPERA OPERATION AND OPERATOR. RKSULT AND RT.MAHKS. DISEASE. TION. 11 Hickey, T., Corp ], E, 3d Jan. 21, Fracture of bones of right leg ; Mar. 10, Fractured ends of tibia remov d March 19, ligation of post, tibial ; Michigan Cavalry. 1864. kick by a mule; fractured ends 1864. by chain saw. A. A. Surg. metastatic abscess. March 29, overlapped ; gangrene. S. S. Jessop. amp. thigh. Died Mar. HI 186-1. 12 Hughes, J., Contraband, age Comminuted fracture of the Mar. 3, Excision of about 2 inches of March 31, 1865; recov d. Walk- 52. " tibia : necrosis about middle. 1865. tibia at middle third. A. A. ing on injured leg. Surg. H. H. Watts. 13 Mickey, B. F., Unassigned April 6, Comp d comminut d fracture of April 20, Excision of 2 inches of left Absented himself without leave. recruit, age 25. 1865. the lower third of left tibia and 1865. tibia through incision 3 inches : Not pensioned. fibula, caused by leaping from long. Surgeon T. W. Fry, railroad car while in motion. U. S. V. 14 Moulton, A. S., Pt., A, (5th Disease of left leg, caused by July 31, Excision of a portion of tibia. . i Discharged Sept. 27, 1862; pen- New Hampshire. fever ; necrosis of tibia. 1862. | sioned. 1871. leg swollen and painful ; varicose veins. 15 Olds, J. K., Serg t, B, 10th Mav29, Compound fracture of middle Feb. 7, Ends of tibia remo d with chain Discharged June 14, 1865; tibia New York Artillery, age 29. 1864. third of right tibia and fibula; 1865. saw; holes drilled to facilitate ; ununited: limb totally useless. fibula firmly united; no at formation of callus. Surg. O. May, 1877, amputation of leg tempt at union in tibia. A. Judson. U. S. V. below the knee. 16 Peaseley, C., Pt., A, 10th Aug. 31, Comminuted fracture of the Second- Excision of 2 inches of shafts : Discharged Dec. 16, 1861 ; pens d. Massachusetts. 1861. left tibia and fibula by kick of i ary. of tibia and fibula through 1877, no flexion or motion at an- a horse ; no attempt at union ; i anterior and posterior incis ns. kle ; wound breaking out afresh. bone bare for space of 2 inches. Spec. 346, A.M. M. 17 White, H. C., Pt,. C, 40th Necrosis of the right tibia, Second- Excision of (i inches of the right Discharged Oct. 3. 18G5. 1869, New York, age 23. caused by syphilis. ary. tibia, middle third. ! ulcerated surface of limb with indurated and adherent border. 18 !Ettinger. L., Pt., K, 58th Dec. 6, Right foot struck with an axe Jan. 6, Curved incision 3 inches long March 1. entirely healed. Dis- New York, age 52. 1861. jnst below malleolus, pene 1862. juat below external malleolus; charged September 17, 1662; trating ankle .joint ; large gap malleolus. astragalus, and a anchylosis of ankle joint ; pen- ing wound, at the bottom of small portion of scaphoid bone sioned. February, 1881, has which dead bone could be felt. removed by bone gouge and been for the past eight years au Listen s forceps. Ass t Surg. inmate of Hospital for the In- J. S. Billings, U. S. A. sane at Randall s Island. 19 Danbury, E., Pt., K, 14th Oct. 3, Comminuted fracture of the Oct. 10, Excision of entire os calcis. Wound healed but opened again New Jersey, age 22. 1863. right os calcis by a railroad 1863. Surg. A. Treganowau, 14th during march in Wilderness. accident. New Jersey. Transferred for muster out May 23. 1865; not a pensioner. 20 Pettie, H., Pt., K, Tilth New May , Ulcer, causing caries July 2(1, Excision of the first metatarsal Discharged Dec. 19. 1863 : pens d. York, age 22. 1863. 1863. bone of right foot. Assistant 1877, foot partly everted, toe Surg. W. Thomson, U. S. A. retracted, foot weakened. AMPUTATIONS. Seven hundred ami seventy-six cases of amputations in the bones of the extremities are found on the records. One hundred and ninety-rive were in the upper, and live hundred and eighty-one in the lower extremities. Of the former twenty, or 10.5 per cent., and of the latter one hundred and forty-six, or 25.5 per cent., were fatal. AMPUTATIONS IN THE UPPER EXTREMITIES. Si x were amputations at the shoulder joint, forty-four in the arm, thirty-four in the i orea*rm, seventeen of the hand, and ninety-four of the fingers; in one of the latter re-amputation in the forearm became necessary: TABLE OVII. Numerical Statement of One Hundred and Ninety-five Cases of Amputations in the Upper Extremities for Disease or for Injury not inflicted by Weapons of War. AMPUTATIONS. CASE8. Foit INJURY. Foil DISEASE. 3 "5 H Recovery. 73 ta Undetermin d Results. Percentage Fatality. llecovery. 3 T-3 ij Undetertnin d Results. Recovery. ~3 3 fa Amputations at the Shoulder Joint 6 44 34 17 93 1 3 34 28 17 87 3 10 6 50.0 22. 7 17 6 3 33 00 9 Amputations in the Upper Arm 1 6 1 1 Amputations in the Forearm Partial Amputations of the Hand 12 Amputations of Fingers fi 75 6 12 1 3 Amputation of Fingers followed by Amputation in Forearm 1 TOO Aggregates 195 169 20 * 10.5 145 17 6 24 CULBERTSON (H.), Excision <if the. Larger Joints of the Extremities, in Transactions of the. American Medical Association, 1876, Prize Essay, Supplement to Volume XXVII, p. 344. 660 MISCELLANEOUS INJUKIES. [CHAP. XI. CASK 993. Amputation in the arm. A. J. Ross, a civilian, was hurt in the left forearm by a railroad accident at Mound City, April 18, 1863. The injury and its results were described by Surgeon H. Wardner, U. S. V. , as follows : "The radius and ulna were fractured in several places and the superficial muscles of the palmar side of the arm were terrible lacerated, besides which the arm was bruised about the elbow joint. The patient was considerably prostrated from loss of blood, so much so as to cause me to desist from operating when counseled by his attending physicians. Adhesive strips and cold-water dressings were used and the patient was put upon stimulants and tonics. By May 1st much of the superficial muscular substance of the forearm had sloughed away and the olecranon process was exposed and denuded. Flaxseed poultices with charcoal and cinchona were now applied. On June 3d I again visited the patient and urged him to have the limb amputated. The treatment was continued until June 18th, when it was found that the bones would not unite and the patient was on the decline, and I was called by the attending physician for the pur pose of operating. I found the patient quite weak and showing symptoms of epilepsy. I performed the amputation at the middle third of the humerus by circular operation and dressed the stump with simple dressings, which were continued until June 24th, when a portion of the ligatures came away. Two days afterwards the patient was able to walk about the room, and the next day the remaining ligatures came away. On July 4th the patient was attacked with fever and dian-hcca, which continued over two weeks, reducing him very low and seriously retarding the progress of the case. By July 25th, however, he was regaining his strength rapidly and the stump was again improving. In the following month he was able to walk about town and was gaining flesh very fast. On October 13th he was considered cured." The amputated portion of the humerus and the bones of the forearm (Spec. 1770) were contributed to the Museum by the operator and are represented in the cut (FlG. 369). The specimen shows the bones of the forearm to be fractm-ed near the middle and again at their upper extremities, the greater portion of the shafts being necrosed and having slight and imperfect involucra. The fragments of the lower extremity of the humerus are attached to it in irregular positions by callus. CASE 994. Amputation in the forearm. Private N. W. Pelton, 2cl Wisconsin Cavalry, aged 40 years, was admitted to Harvey Hospital at Madison on November 15, 1864, with disease of the right hand, for which amputation was performed by Surgeon H. Culbertson, U. S. V., who reported the following history: "The patient had lost the thumb and index finger of his right hand, which were removed by Dr. K. L. Tolfore, of Lone Rock, Wisconsin, on April 20, 1864, the operation being the result of a felon contracted the previous month. On December 30th, when the forearm vVas amputated, the wrist joint had become par tially anchylosed from ostitis and necrosis of several of the carpal bones, and there was an open sinus on the dorsum of the hand; plastic organized material in the cellular tissues of the fingers, hand, wrist, and along the extensor and flexor tendons; cellular tissues indurated and of a yellow color; periostitis extend ing up the radius and ulna three inches above the wrist joint; structure of ulna somewhat softened and darkened for two inches above its lower extremity; loss of motion in the remaining fingers induced by the organized effusion about the tendons. The patient s system had become impaired from continued pain and discharge. He had recently had an attack of erysipelas in the hand and arm. but had entirely recovered and earnestly desired to have the hand removed. The amputation was performed by the circular method at the lower fourth of the forearm, above the diseased bone, three vessels, the radial, ulnar, and interosseous arteries, being taken up. Chloroform was used with good effect. One grain of morphia was given after the operation, and the wound was closed with sutures, adhesive plaster, and bandage. Fifteen hours afterwards the bandage was removed and cold-water dress ings were applied. The patient died January 7, 1865, of erysipelas, which extended to other parts of the body and was arrested in the arm and stump." The bones of the amputated limb, comprising the lower portion of the forearm, the carpus, and three metacarpal bones, were contributed to the Museum by the operator and constitute specimen 3695 of the Surgical Section. The carpus shows the semilunar bone to be partly necrosed and caries exists in the adjacent bones. CASE 995. Amputation in the forearm. Private F. Schubnel, Co. A, 23d Indiana, aged 37 years, had his right hand poisoned in May, 1864, while engaged in pulling and gathering leaves for bedding for a field hospital during the Atlanta campaign. Surgeon M. Brucker of the regiment certified to the injury, and reported that it produced malignant ulceration, affecting the whole arm. At the expiration of his service, July 28, 1864, the man was mustered out and returned to his home, where amputation subsequently became necessary and was performed four inches below the elbow on September 2, 1864. Dr. D. H. Combs, of Charlestown, Indiana, who performed the operation, certified that when the man came to him "ho was suffering from poison which had affected his system. Gangrene had ensued, the arm was greatly swollen, and there was no remedy but amputation, which was performed. After a time the stump healed well and the patient was in a fair way to recovery, though his system was Aveakened from the effects of the poison; his gums were spongy, tongue flabby," etc. The operator further added that he saw but little of the patient after the stump had entirely healed. In his application for commutation, dated 1870, the pensioner described the stump as being in a "sound condition." No definite cause of his death, which occurred on April 5, 1873, has been reported to the Pension Office. Ninety-three of the one hundred and ninety-five amputations in the upper extremities were ablations of fingers. In the following tabular statement are given condensed accounts of the remaining one hundred and two cases of amputations at the shoulder, in the arm, in the forearm, and in the hand; sixty-seven were for fractures caused by falls, railroad acci dents, etc., six for punctured and incised wounds, eight for burns or scalds, four for poisoning, and seventeen for diseases. FIG. 309. Bones of the forearm, with por tion of humerus. Spfc. 1770. SECT. II.] AMPUTATIONS IN THE UPPER EXTREMITIES. 661 TABLE GVIII. Summary of One Hundred and Two (hses of Amputations in the Upper Extremities for Miscellaneous Injuries or Disease. [Amputations at the shoulder, 1 6; [imputations iu the arm, 7 50; amputations in the forearm, 51 85; amputations in tbe hand, 86 102.] DATE OF DATE Vn NAME, MILITARY DESCRIPTION, AND AOK. INJURY NATURE OF IXJUKY OK OF Ol>ERATlox ANI) QI-ERATOH. RESULT AND REMARKS. OU Ulfcr.ASJi. ! Vrl.KA- DlSEASF.. TION. 1 Armes, A.. Pt., D. TOd New Sept. 20, Right arm crushed bv railroad Sept. 20, Amputation at the shoulder Discharged February 17, 1865; York, age 22. 1804. j cars. 1864. joint; flaps from deltoid mus- : pensioned; good stump. cle and axilla. A. A. Surg. M. Baldwin. 2 Corragin. J.. I J t.. 13th Mich June 19, Right arm carried away by June 20, Ainputat n at the shoulder joint Discharged September 19, 1865 ; igan Battery, age 23. 1865. railroad cars. 1865. by external and internal flaps. pensioned. A. A. Surg. F. P. Foster. 3 Wimderlieh, M.. Pt., H, 1st June 30, Comminuted fracture of right June 30, Antero-posterior flap amputa- Discharged October 27, 1865; not Michigan Artillery, age 20. 1855. arm, caused by a railroad ac 1865. , tion at shoulder joint. A. A. a pensioner. cident. Surg. M. L. Herr. 4 Bowers, (1. W., 1 t., A, 3d Oct. 4, Right forearm and arm crushed Oct. 4, Flap amputation at shoulder Died October9, 1863, of pyaemia. Maryland, age 25. 1863. by railroad cars. 1863. joint by Lisfranc s process. : A. A. Surg. J. Kirker. 5 Hill, I. B. (Rev.). U. S. San- June 15, Left arm crushed by railroad June 15, Amputation at the shoulder Died June 16, 1864, of shock. itary Commission, age 68. 1864. cars. 1864. ! joint. Ass t Surg. C.C.Byrne, U. S. A . 6 Whalen, M., Corp l, G, 32d Sept. 15, Right arm severed and scapula Sept. 15. Amputat n at the shoulder joint Died September 16, 1864. of in Massachusetts, age 38. 1864. fractured by railroad cars. 1864. and removal of fragments and juries. Autopsy revealed also head of scapula. Ass t Surg. fracture of first, second, and C. Bacon, jr., U. S. A. third ribs, etc. 7 Baker, J., Serg t, A, 4Mh Feb. 3, Comp ml comminuted fracture Feb. 3, Circular amputat u of arm near Transferred to Veteran Reserve Pennsylvania. 1864. of left arm and laceration mid 1864. shoulder joint. A. A. Surg. Corps March 3, 1865. dle finger, right hand; rail A. H. Hal berstadt, road accident. 8 Carpenter. J. X., Pt., A, Uth Sept. 24, Railroad injury of right arm. . . Sept. 24, Circular amputation of arm 4 Discharged September 30. 1864. Michigan. 1864. 1864. inches from fold of pectoralis major. 9 Carrigan, F. S., Pt., F, 5th Cavalry. Nov. 21, 1865. Right forearm crushed by being run over by a locomotive. Nov. 21, 1865. Circular amputation of right arm at lower third. Ass t Discharged March 2, i866 ; re jected as a pensioner. Surg. D. Bache, U. S. A. 10 Coleman. J.. Pt., D, 6th Mir , Incised wound of left elbow April 9, Circular amputation at middle Discharged June 6, 1865. Tennessee Mounted Infan- 1865. joint ; gangrene. 1865. 1 third of left arm. A. A. Surg. ; try, age 18. J. W. Taylor. 11 Dilley. A., Gov t employe. June 12. While attempting to get on a Prim ry. Amputation of left arm, 3 ins. Recovery. Wound of left shoul Nashville and Chattanooga 1863. moving train had both arms of bone allowed to remain in der has never healed. May 20, Railroad, age 20. crushed by car wheels ; left stump; also of right forearm 1866, three sinuses in front and humerus crushed to its head. at middle third. Dr. Brand one behind shoulder leading to ish. Nashville. necrosed bone. Oct., 1866, his health is very good. 12 Downey, J., Pt., D, 145th Oct. 28, Comminuted fract. of forearm Oct. 29, Flap amputation at upper third Much sloughing. Disch d Nov. New York, age 40. 1863. and arm, great laceration of 1863. of left arm. Surg. K. S. Ken- 3, 1864; stump healed. soft parts; railroad accident. derdine, V. S. V., and A. A. Surg. D. \V. Hunt. 13 Feigley, J. C.. Serg t Maj. Feb. 24, Compound fracture of left arm; Feb. 24, Amputat n of left arm at upper Discharged June 1, 1864. 31st Ohio, age 25. 1864. railroad accident. 1864. third. Pension Exam. Surg. Hamlin, Newark, Ohio. 14 Freeman, H., Pt., D, 60th Unfavorable result of vacci Sept. 28, Circular amputation of left arm Mustered out July 31, 1865. Illinois, age 21. nation in rebel prison ; gan 1864. near shoulder joint. Confed grenous. erate surgeon. 15 Fuller, A., Serg t, G, 14th June 30, Left arm crushed by railroad June 30, Arm amputated 5 inches from Discharged September 11, 1865 ; Maine, age 24. 1864. cars. 1864. shoulder. Surg. T. F. Perley, stump healed. U. S. V. 16 Funking, H., Pt., D, 5th N. Oct. 25, Comminuted fracture of right Oct. 25, Circular amputation at middle Doing well. Discharged May Y,. 11 vy Artillery, age 23. 1864. arm and left foot; railroad 1864. third of right arm and at low 31, 1865. accident. er third of left leg. Surg. Z. E. Bliss, U. S. V. 17 Loveridge, J., Pt., G, 14th Dec. 18, Injury of the right arm by rail Dec. 18, Flap amputation of right arm, Discharged May 19, 1864. N. Y. Heavy Artillery. 1862. road cars. 1862. upper third. Surg. S. Morse, 14th N. Y. Heavy Artillery. 18 Lowry. P., Pt., C. 21st New June 14, Comminuted fracture of right June 15, Flap amputation of right arm, Discharged November 22, 1865. York Cavalry, age 27. 1865. . humerus, radius, and ulna, 1865. upper third, also of second also of second and third toes and third toes. A. A. Surg. of right foot. H. S. Streeter. 19 Marcy, G. F., Pt., F, 21st Aug. 29, Left arm injured above elbow; Aug. 30, Amputation of arm at upper Discharged January 13, 1862; Massachusetts. 1861. railroad accident. 1861. third. stump good. 20 Meeks, J. C., Serg t., A, 24th July 16, Comminuted fracture of right July 19, Circular amputation at middle Sent to prison February 16, 1865. Georgia, age 22. 1864. elbow joint. 1864. third of right arm. 21 Megans. T., Hospital Stew July 4, Railroad cars completely crush July 4, Circular amputation of right Gangrene. July 10, secondary ard, 90th Penn., age 41. 1864. ed and comminuted right hu 1864. arm at upper third. A. A. haemorrhage. Discharged De merus in lower third. Surg. E. L. Duer. cember 12. 1864. 22 Mitchell, E., Pt., E, 6th In Oct. 30, Right arm crushed and almost Oct. 30, Circular amputation at upper Transferred December 1, 1864 ; diana Cavalry, age 28. 1864. severed; railroad accident. 1864. third of arm. Ass t Surg. W. not a pensioner. H. Jones, 115th Ohio. 23 Murphy. B., Pt., 11, 1st May 14, Fell from caisson and sustained May 14, Flap amputation of arm at up Discharged September 17, 1863; Rhode Island Anil rv. age 1863. compound comminuted frac 1863. per third. stump healed but tender. 46. ture of left arm. 24 Navins, J., citizen July 23, Compound fracture of right ra July 26, Oval skin-flap amputation of Discharged from hospital Nov. 1863. dius and ulna and simple frac 1863. right arm at surgical neck of 15, 1863, perfectly well. Spec. ture of humerus; fall from a humerus, with circular section 1849, A.M. M. | bridge ; sphacelus. of muscles. Ass t Surg. W. Thomson. U. S. A. 25 Ncer, M.. Pt., II. 14th West A prill 4. Left forearm crushed from wrist A prill 4, Antero-posterior flap amputa Haemorrhage on 17th day; no re Virginia, age 29. 1864. to elbow, also fracture of in 1864. tion at lower third of arm. currence. Discharged Septem ferior maxilla; railroad acci Surg. S. N. Sherman, U. S. V. ber 10, 1864 : not pensioned. dent. 26 Newcomb, N. L., Pt., G, May 12, Right arm injured above the May 13, Circular amputation at lower Discharged June 28, 1865 ; stump 174th Ohio. 1865. elbow ; railroad accident. 1865. third of arm. Surg. G. W. sound. Kizer, C. S. A. 662 MISCELLANEOUS INJURIES. [CHAP. XI. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY OR DISEASE. NATURE OK INJURY OR DISEASK. PATK. OPFK\- OPERATION AND OI-KRATOR. TION. RESULT AND REMARKS. 27 Osborne, C., Pt., 28tli New Feb. 24, Compound comminuted frac- Feb. 24, Flap amputation of arm 9 ins. Discharged June 14, 1865. York Battery. 18fi5. Hire of right humerus ; rail- 1865. from shoulder. road accident. 28 Rieman, II., Pt., C, 12th Jan. 16. Injury of left arm: railroad Jan. HI Flap amputat n at middle third Jan. 31 . ligation of axillary. Feb. Maine, age 23. 1P64. accident. 1884. of arm. Surg. O. M. Hum- 17, ligation of subclavian. Gan- plireyB, U. S. v . grenc; necrosis. Disch d July 31, 1865. 29 Romine J Pt F 12d Sent. M. Kiffht arm crushed under car Nov. 1. Flap amputation of arm near Discharged June 20, 1865; good Ohio, age 20. 18(54. wheel. 1864. insertion of deltoid. Surg. T. stump. A. Dargan, P. A. C. S. 30 Ross A. J civilian. AnrillP. Fracture of left radius and ulna, June 18. Circular amputation at middle October 18. 18(i3, cured. Spec. 1863. involving elbow joint; rail- 1863. third of arm. Surg. II. Ward- 1770, A. M. M. road accident. ner. I". S. V. 31 Searv. J., Pt., H, 1st Mis- May 26, Fracture of left arm by being May 2(1, Flap amputation at upper third Discharged . I uly 31, 1864. Died gouri Cavalry, age 26. 1864. thrown from his horse. 1864. of left arm. July 15, 1S68. oo Secor, D., Corp l, A. 56th Julv 12, Comp nd comminuted fracture July 12, Circular amputation of left arm Discharged November 4, 1865. New York, age 32. 18(55. of left arm . railroad accident. 186.">. at lower third. 33 Se.it F., Pt., F, 68th New Sept. !.">, Right arm crushed by railroad Sept. 15, Amputation of right arm about Discharged June 17, 1865; sound York. 1864. accident. i 1864. 3. ins. from shoulder. Surg. stump. L. Sehultz. 68th N. Y. 34 Sunnier, L. G., Pt., 1), 78th Julv 10, Injury of right arm; railroad Twelve Amputation of arm .! inches Discharged January 17, 1863; New York. 185:2. accident. hours from shoulder. Surg. E. P. sound stump. i after. ! Gray, 78th N. Y. 35 Thompson, M., 1 t., C, 1st 1 Jan. 22, Railroad injury of left arm .... Aroputat n of arm below shoul- Deserted July 2, 1865; no pension Penn. Light Art., age 30. i in;5. 1865. der joint. record. 36 Tucker, W. J., Pt., G, llth July 15. Injury <>f right arm above el- July Hi, Flap amputat n at middle third Discharged Nov. 2, 1864; stump Veteran Reserve Corps. lsi>4. bow and dislocation of thigh ; 1864. of right arm. healed. railroad accident. 37 Tuttle. J. H.. Pt., E, 3Kth Mar. 28. Injury of left arm by railroad Mar. 28, Flap amputation of left arm 9 Stump wasted and weak, but Massachusetts. 186.~>. , accident. 1865. inches from shoulder. Surg. healed. Disch d June 30, 186. i. H. Fearn, 175th N. Y. ;jj3 Van Vleck, W., Pt.. II, 125th Oct. ]! , Injury of right arm and right Oct. H), Flap amputation at upper third Discharged November 21, 1862. New York, age 37. 1862. knee; railroad accident. 1862. of arm. Surg. AY. S. Cooper, Died July 28, 1868, of pyiemia. 125th N. Y. 39 Wade. S., Pt., TO, 177th Ohio, Oct. 13, Compound fracture at middle Out. 13, Circular amputation at upper Discharged April 13, 1865; stump age 21. 1864. third of left humerus; rail- 1864. third of arm. A. A. Surg. S. healed. road accident. L. Merrill. 40 Wait, H. I,., Pt., C, 3d Iowa. May 9. Right elbow joint crushed by May 9, Flap amputation 2 inches above Mustered out August 26, 1865. age 25. 1864. railroad car wheel. > 1864. elbow. 41 Clark, J., employe in the Jan. 4, ; Compound comminuted frac- Jan. 4. Amputation of arm by antero- January 22. pyamiic symptoms Quartermaster s Departm t, 1865. ture of left humerus, radius, 186. r >. post, semi-circular flaps. A. set in. Died February 11, 1865, age 30. and ulna ; railroad accident. A. Surg. W. Ualser. of pyaemia. 42) Coker, J., Pt.. C, f,th Ten Jan. - >, Comp nd comminuted fracture Jan. 27, Flap amputation of botb arms In a semi-moribund condition. 43( nessee, age 34. 1865. at upper third of left radius 1865. at middle third. A. A. Surg. Died January 27, 1865. and ulna, also fracture and i II. S. Streeter. dislocation of right elbow. 44 Conway, J. A., Pt., A, 55th May 24. Railroad carscompletely crush- May 24, Circular amputat n.lower third, Died May 28, 1865, of internal Pennsylvania, age 22. 1865. ed left radius and ulna and 1865. i left arm. A. A. Surg. R. M. injuries. right tibia and fibula. ! Kirk. Amp. of right thigh. 45 Dougherty, J., Pt., A, 90th Nov. 11. Compound fracture left radius Nov. 15, Antero-pusterior flap amputa- Died November 18, 1863, of in Pennsylvania. 1863. and ulna, laceration of scalp 1863. tiou at middle third of arm. juries; autopsy. and cone, of brain, fracture A. A. Surg. S. C. King. of 2d and 3d ribs ; gangrene. 46 Enyart, H. D., Pt., G, 23d Oct. 13, Compound fracture of right Oct. 24, Amputation at upper third of Died November 11, 1864, of py Veteran Reserve Corps, age 1864. radius and ulna ; accident ; 1864. right arm. Surg. A. Ham aemia; autopsy. 28. gangrene. mer, U. S. V. 47 Hitehens, C., Pt., C, 2d Ma April 3, Right arm crushed from wrist April 3, Amputation of arm near shoul No reaction. Died April 5, 1863. ryland P. II. B. 1803. to middle of humerus ; rail 1863. der joint. road accident. 48 Ready. P., Pt., E, 13th New June 9, Compound comminuted frac June 9, Flap amputat n at middle third June 13. pva?m. symptoms. Died York Cavalry, age 48. 1864. ture of middle and up. thirds 1864. of arm. Ass t Surg. J. II. June 29 , 1864, of pyaemia ; an- of right radius and ulna, joint Frantz, U. S. A. topsy. destroyed ; railroad accident. 49 Rouse, M., colored woman, Ulcer of left arm and neck re A prill 5, Circular amputation at upper Died April 27. 1865, of diarrhoea. age 23. sulting from frequent attacks 1865. third of arm. Surgeon T. J. of malarial fever; gangrene. Wright, 64th U. S. C. T. 50 Sweeny, J., Pt., E, 70th N. Mar. 28, Comp nd comminuted fracture Mar. 29, Circular amputation of right Rallied to some extent. Died York. 1864. of right humerus, lower third, 1864. arm. A. A. Surg.W. S.Ward. March 31, 1864, from nervous extensive laceration of fore shock. arm ; also compound fracture of left metatarsus and pha langes: railroad accident. 51 Adams, T. B., Pt., A, 6th Scrofula inrlamma n involving Xmnnt ttinn rif rio*lit ff reirm Discharged August 12 1863. Kansas Cavalry, age 39. ligaments, carpal bones, and low. thirds of radius and ulna. 52 Campbell, S., Pt.. II, 2d Ma- - Palmar abscess of left hand; Feb 19, Antero-posterior flap amputa Feb. 23, sec. haem., lig. of radial ryland, age 22. erysipelas. 1863. tion at middle third of forearm. artery. Trans, to V. R. Corps July 10, 1863; stump perfectly healed. Specs.} 184, 1185.A.M.M. 53 Dilley, A., Oov t employe 1 , June 1C 1 . Both arms crushed by car Prim ry. Amputation of right forearm, Recovered. May 20, 1866, three Nashville and Chattenooga 1863. wheels; attempting to get on middle third, and of left arm, sinuses in front and one behind Railroad, age 20. moving train. upper third. Dr. Brandish, shoulder leading to neero. bone. Nashville. Oct., 1866, health very good. 54 Dunlap, O., Capt., I, 26th Deo. 28, Injury of right hand and right Dec. 28, Amputation forearm just above Discharged May 15, 1865. Illinois. r 1864. foot ; railroad accident. 1864. wrist and of leg just above ankle. Surg. O. Hoyt, 30th Wisconsin. 55 Fleming, J.. Corp l, F, Cole s June 20, Left hand mangled and forearm Maryland Cavalry. j 18G4. fractured, also thumb and first June 21, 1864. Circular flap amputat n at low er third of left forearm and Discharged March 11, 1865. linger right hand ; railroad thumb and finger right hand. accident. 56 Fosgate, O., Pt., C, , r >7th - Felon on right index finger; June 16. Circular amputation at lower Transferred to Veteran Reserve Massachusetts, age 43. fissures of hand sloughing ; 1864. third of forearm. A. A. Surg. Corps January 18, 1865; sound Inemorrh. from palmar arch. M. M. Jarratt. stump. 57 Gardner, C. A., Pt., B, 10th Mar., Fever sore Aug. 28, Flap amputation at lower third Transferred to Veteran Reserve New York Artillery. , 1864. 18C4. of left forearm. Dr. Trow- Corps. bridge, Watertown, N. Y. SECT. IT. 1 ] AMPUTATIONS IN THE UPPER KXTRKMITIES. 663 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE or INJURY OR DISEASE. NATURE OF INJURY OR DISEASE. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 58 Gardner, St., It., I, 12th Col Aug. 26. Injury of right hand and foot Aug. 27, Amput n of forearm and leg at Discharged July 18, 1865. ored Troops. 1864. by railroad cars. 1864. lower thirds. Surg. G. Steg- man, 12th Colored Troops. 50) Garrett, E., Pt., A, 43d Col Both limbs injured by falling Circular amputation at middle Discharged August 22, 1865. 60| ored Troops, age 20. into fire. third of both forearms. 61 Glavin, J., Ft., G, 21st New- Jan. 18, Right hand burned, destroying Jan. 18, Amputation at middle third of Discharged March 8, 1866. York Cavalry. 1865. bone and muscles. 1865. forearm. Acting Staff Surg. N. F. Graham. 62 Graeser, W., Pt., I, 42d New Left hand poisoned while a Feb. , Amputation below elbow joint. Discharged Aug. 16, 1865; good York. 1864. prisoner of wa 1865. stump; died since. G3 Gridley, J., Pt., , 9th Mich Sept. 16, Contusion of left forearm by Sept. 17, Flap amputat n at middle third Discharged February 4, 1865. igan, age 3d. 1864. cars. 1864. of forearm. 64 Halbert. J. S., Pt., I, 8th June 24, Injury of left forearm ; railroad June 24, Amputation 2 inches below el Discharged ; stump painful. Illinois Cavalrv. 1865. accident. 1865. bow joint. 65 Hawkins, S., Pt.", A, 9th New Jan. 20, Axe wound in left wrist joint. . Jan. 20, Circular flap amput n at lower Discharged. York Cavalry, age 35. 1865. 1865. third of forearm. Surg. R. Curran, 9th N. Y. Cavalry. 66 Hughes, T., Pt., H, 49th N. Aug. 30, Comp ud comminuted fracture Aug. 30, Circular amputation at upper Transferred to Veteran Reserve York, age 44. 1864. of right radius and ulna ; rail 1864. third of forearm. Ass t Surg. Corps November 27, 1864. road accident. P. C. Davis, U. S. A. 67 Jones, N., Pt., D, 4th Engi Cut by an axe across forearm Double flap amputation at mid Discharged March 10, 1864; ex neers, Colored Troops. and face. dle third of forearm. cellent stump. 68 Kennedy, 1 . A. 13., Pt., B, April , Scrofula. Right wrist joint, Aug. 16, Circular amp. 5 inches below Mustered out September 21, 1864. 3Gth Indiana. 1863. knee, and ankle affected by 1864. elbow. Dr. J. M. Youal, tuberculosis; exten. destruc Indianapolis. (Feb. 25, 1864, tion of bony and soft parts. amp. right thigh, low. third.) 69 Killgore, J. A., Pt., B, 97th Nov. 1, Lower two-thirds of right fore Nov. 1, Circular amputation at upper Rapid recovery ; discharged De Illinois, age 19. 1863. arm bady crushed : railroad 1863. third of forearm. Ass t Surg. cember 9, 1863. accident ; also scalp wound. S. H. Orton, U. S. A. 70 Laviers M II Pt F 26th Tniurpd bv \ tlir tsliino- tmehinp A mnntition it middle third of Discharged October 29, 1864. Michigan, age 30. previous to enlistment. left forearm. 71 Moreland, J., Pt., G, 9th Ohio Mar. 14. Fracture of the right hand : Aug. 15, Amputat n between elbow and Discharged April 21, 1865. Cavalry. 1865. accident ; mollifies of carpal 1865. wrist. Dr. J. Tingle, Cam bones. bridge, Ohio. 72 Osborne, W. L.. Pt., H, 12th C lncpr of left foreirin A TTiDutition foreirm it ui>itpr Discharged April 20, 1864. West Virginia. 1864. third. 73 Pampell, J. E., Serg t, B, 3d Nov. 9, Comp nd comminuted fracture Nov. 9, Circular amputation at middle Healed kindly ; discharged April Maryland, age 23. 1863. left forearm and right middle 1863. third of forearm. Surg. R. U. 11, 1864. finger ; railroad accident. Clark, 34th Mass. Amputat n right middle finger and por tion metacarpal bone. 74 Payne, W. T., Serg t, M, 6th May 3, Right hand and wrist crushed May 3, Flap amputat n at middle third Flaps united by first intention ; Kentucky Cavalry, age 22. 1864. by railroad cars. 1864. of forearm. discharged September 15, 1864. 75 Price, H., Pt., II, 66th New Feb. 6, Fell into fire and burned right Feb. 27, Flap amputation about middle Discharged April 14, 1863 ; excel York. 1863. forearm from elbow to fingers ; 1863. of forearm. lent stump. gangrene. 76 Roller, J., Bugler, 13th New July 13, Right hand crushed; railroad July 13, Antero-posterior flap amputat n Discharged August 4, 1865. York Battery. 1865. accident. 1865. at lower third of forearm. 77 Sehubnel, F., Pt., A, 23d May 14, Right hand poisoned by weeds ; Sept. 2, Amputation at upper third of Discharged July 28, 1864. Indiana. 1864. malignant uleeration, threat 1864. forearm. Dr. D. H. Combs, ening mortification. Charlestown, Ind. 78 Woodfolk, H.. Pt., B. 28th Sept. 1, T?io-]it li iml ininrpfl bv f-illino- Flin minntntinn it miner third Discharged December 30, 1865. Colored Troops, age 22. 1864. into fire. of forearm. 79 Aylmer, E. 1 ., Lieut., 1st June 25, Comminution of right forearm ; June 27, Flap amputation at lower third Died July 13, 1864, of pneumonia. Wisconsin Battery. 1864. run over by a horse-car. 1864. of forearm. A. A. Surg. J. C. Lee. 80 Ball, T. E., Pt., 9th Indiana Jan. 27, Burn and scald of left forearm ; Feb. 15, Circular amputation at upper Sloughing; secondary hsemorrh. Battery, age 40. 1865. explosion of Steamer Eclipse. 1865. third of forearm. Surg. W. Died March 24, 1865, of exhaus Varian, U. S. V. tion and pvsemia. 81 Hede, C., Corp l, E, 32d In June 21, Right radius comminuted at July 15, Circular amput n at the upper Died July 29, 1864, of chronic diana, age 28. 1864. lower third by car wheel. 1864. third of forearm. A. A. Surg. diarrhoea. E. Kramer. 82 Norton, M., employe Quarter Mar. 26, Compound frac. lower third of Mar. 26, Circular amputat n of forearm. Mar. 29, erysipelas. April 2, hiem. master s Department, age 1864. left radius and ulna ; caught 1864. from radial art.: lig. at middle 20. in an engine; skin and muscles third of brachial. Died April torn from hand and forearm. 4, 1864, of haemorrhage. 83 Pelton, N. F., Serg t, 2d Wis Mar. , Felon of thumb and index fin Dec. 30, Circular amputation at lower Died January 7, 1865, of ervsip- consin Cavalry, age 46. 1864. ger of right hand. April 20, 1864. third forearm ; radial, ulnar, elas. Spec 3695. A. M. M. thumb and index finger re and interosseous arteries tied moved : ostitis and necrosis of Surg. H. Culbertson, U. S. V. carpal bones ; erysipelas. 84 Shields, J., Pt., G, 83d Penn Extensive burn of right fore Oct. 31, Circular amputation 2 inches Typhoid pneumonia and diarrh. sylvania. 1864. arm ; extensive slough g and 1864. below elbow. Ass t Surg. H. Died November 4, 1864. of ex suppuration. Allen, U.S. A. haustion : autopsy. 85 Tomlison. J., Pt., A, 120th Dec. 5, Erysipelas of right hand fol Jan. 21, Circular amputation at upper March 3. gang, in stump. Died Indiana, age 4-J. 1864. lowed by gangrene; slough 1865. third of forearm. Ass t Surg. May 23, 65, of acute dysentery. ing. B. Knickerbocker, U. S. A. 86 Davidson, S. H.. Pt., 2dlowa Mar. 22, Bowie knife dividing right ul- A prill 2. Amputation of fourth finger Returned to duty June 8, 1864. Battery, age 19. 1864. nar aitery and opening ulna- 1864. with head of metacarpal bone. See Second Suryiral Volume, p. carpal articulation. Mar. 22, Surg. J. G. Keenon, U. S. V. 436. 1864, ligation of ulnar artery ; dry gangrene. 87 Denmark, J. H., Pt., H, 14th Jan. 12, Punctured wound of right hand. Feb. 20, ! Amputation of little finger and Furloughed Mar. 25, 1865 ; nearly New York H vy Artillery, 1865. 1865. head of metacarpal bone; an- healed. age 19. tero-posterior flaps. 88 Dickey, C. B., Pt., C, 104th July- , Right hand injured bv railroad July 12, All Hie bone of little finger and Recovered. Ohio, age 22. 1864. accident : little finger cut off, 1864. its metacarpal bone removed. q D, ,.ir> f 1 T>t f },! T>n,n-i third and fourth flng rs broken. 1- - CJ <>an, ij., i i., \j, .m i enn. .. vpni o, Res. Corps, age 30. 1864. Railroad car passing over left hand and crushing it. April 5, 1864. Amputat n of fingers, lett hand, through the metacarpus. 90 Doyle, J. 15.. 1 t., 1C, 18th Nov. 23,. Bitten in the middle of third Dec. 7. Oval amputatioaof finger and Recovery. Iowa. 1864. left finger by a comrade ; bone 1864. head of metscarpal bone. denuded and exposed. Sunr. C. E. Swasev, IT. S. V. 91 Ellison, D., colored seaman, Nov. 11, Metacarpal bone of mid. finger Nov. 21. Aiii]>utation of middle finger Ree-ivery. U.S. Steam r Gen. Thomas, 1864. crushed bv machinery. 1864. and metacarpal bone. Ass t age 16. Surg. II. T. Legler, U. S. V. MISCELLANEOUS INJURIES. [CHAP. XI. DATEHK DATE NO. NAMK, MILITARY DESCRIPTION, AND AGE. INJI;KY OR NATURE OF INJURY OR DISEASE. OF OPERA OPERATION AND OPERATOR. RESULT AND REMARKS. DISEASE. TION. 92 Harris, A. W., Corp l, D, 5th Mar. 10, Gangrene of index finger, right April 13, Amputat n of index finger with Returned to duty Aug. 25, 1864. Kentucky. 1864. hand. 1864. head of metacarpal bone. Confederate surgeon. 93 Keeler, J., Pt., JOSth Co. 8d Gangrenous sloughing of left Sept. 18. Amputation left second finger Discharged April 28, 1865. Veteran Reserve Corps, age second finger. 1864. with head of metacnrpal bone. ;;o A. A. Surg. J. \V. Hull. 94 Loveland, A. A., Pt., H, Jst Tumor first finger of left hand, Mar. 26. Amputat n of finger with head Recovery. Conn. Cavalry, age 21. supposed to be fungus h:em- 1864. of metacarpal bone. A. A. atodes. Surg. J, Neff. 95 Luecke, A., Pt., G, llth In June 10, Axe wound of left index finger; June 8, Arnjutat n of index finger with Returned to duty Sept. 11, 1863. fantry. 1862. anchylosis and deformity. 1863. greater portion of metacarpal bone. Ass t Surg. P. Adol- phus, U. S. A. 90 Mansur, J., Pt., H, 8tli Xew Left mid. finger affected with an Oct. 17, Amputation of middle finger Returned to duty Dec. 4, 1804. Hampshire, age 41. ill-oonditioned sore, probabl}- 1864. above head of metacarpal from absorption of unhealthy bone. A. A. Surg. F. Has- pus; erysipelas; sloughing. senburg. 97 Martz, J., Corp l. K, 5th Jan. 1, Comp nd dislocation of second April 10, Amputation of second finger Useful hand. Returned to duly Michigan, age 85. 18(i4. finger, left hand ; extensive 1864. with head of metacarpal bone. July 5, 1H04. necrosis. A. A. Surg. 1). O. Farrand. 98 Peoples. It., Pt., B. 151st Illi Mar. , Lllcerof phalangeal bone of left April 14. Flap amputat n of index finger Discharged June 7, 180."). nois, age 45. 1865. index finger, result of a felon ; 1865. and one half of metacar. bone. extensive slough.: erysipelas. A. A. Surg. W. J. It. Holmes. 99 Taylor, J. T.. Pt.. C, 83d Deo. , Severe burn of right and left Mar. 18, Amputation of fifth finger with Discharged September 9, 1864; Pennsylvania, age 24. 1803. hands; necrosis. 1864. entire metacarpal bone. A. A. stump healed. Surg. J. O. French. (Jan. , 1864, amputation left index and middle fingers.) 100 Tracey. T., Pt., M. 1st Lou Got. 5, Left thumb severely bitten in a Nov. 5, Amp. of thumb and metacarpal Healed. Returned to Provost isiana Cavalry, age 27. 1864. fight : necrosis ; sloughing. 1864. bone at its trapezial attach Marshal November 23, 1804. ment. A. A. Surg. J. C. Lee. 101 Wadley, M., Pt., 11, 9tli X. Nov. 22, Poisoned second finger from Nov. 22, Amputation second finger with Discharged May 29. 1805. Ilami)sliire. age 35. 1864. dressing wounds. 18G4. head of metacarpal bone. 102 Wren. J., employe Military Jan. 9, Left thumb cont. and crushed; Jan. 9, Amputat n of thumb with met Discharged from hospital Janu Railroad, age 18. 1865. accident. 1865. acarpal bone at carpal articu ary 26, 1805. lation. A. A. Surgeon S. T. Buck. AMPUTATIONS IN THE LOWER EXTREMITIES. They comprise five hundred and ninety-seven operations performed on five hundred and eighty-three patients, as follows: TABLE OIX. Table of Five Hundred and Eighty-three Cases of Amputations in the Lower Extremities for Disease, or for Injury not inflicted by Weapons of War. AMPUTATIONS. CASES. FOR INJURY. FOI o> i DlSE ISE. Gj ej S c"3 $T si * P Si a H 2 3 3 b 1-2 3 r PH o K 3 & a E tO O M KTS o S K a a fa 2 ~ l| Amputations at the Hip Joint . . . 1 142 3 1 249 5 5 48 1 122 o i 80 1 17 1 Amputations in the Thigh 56 T 1 39. 4 33.3 50.0 6!) 1 53 3 Amputations at the Knee Joint Amputations at the Knee Joint, Re-amputation in Thigh 1 Amputations in the Leg 174 3 1 10!) 74 2 I 1 29.8 40.0 20.0 8.3 152 3 4 42 1 97 o " 1 4 22 13 1 Amputations in the Leg and Re-amputations in Thigh. . . . Amputations at tho Ankle Joint Partial Amputations of the Foot. . 2 Partial Amputations of Foot and Re-amputation in Leg Amputations of the Toes 6 7 5.2 6 7 12 Amputations of Toes and Re-amputations in Foot Amputations of Toes and Re-amputations in Leg :i 1 2 00.6 ; 2 Amputation of Toes and Re-amputation in Leg and Thigh Aggregates 583 428 147 8 25.5 373 130 7 55 17 1 One hundred and twenty-eight were amputations of the toes, followed in two instances by re-amputations in the foot, in four by amputations in the leg, and in one byre-amputa tion in the thigh. Forty-nine were ablations in the foot with one re-amputation in the leg; five were disarticulations at the ankle joint; two hundred and fifty-four were amputations AMPUTATIONS IN THE LOWER EXTREMITIES. 665 in the leg with five re-amputations in the thigh; four exarticulations at the knee joint with one re-amputation in the thigh; one hundred and forty-two were ablations in the thigh, and one an exarticulation at the hip joint. CASE 996. Amputation at the hip joint. Private ,1. W. Spradling, Co. A, 33d Illinois, was wounded in the right side and back by a shell at Black River Bridge, May 17, 1863. He passed through various hospitals and was lastly admitted to Mound Citv on January 25, 1864. Surgeon II. Wardner, U. S. V., in charge of the latter, recorded the following description of the injury: 1 The missile struck the right side between the ilium and lower rib. inflicting a wound six by nine inches. Cold- water dressings were applied for four weeks, and afterwards simple cerate. The wound healed kindly in about three months. About five or six days after the reception of the wound a bedsore commenced forming on the left hip, which was attacked witli gangrene, causing sloughing of the soft parts and exposure of bone. This continued sore for ten months. By March 22d the sore had entirely healed up, but the patient had no use as yet of the leg, the integuments being adherent to the bone. Feeling in the leg and foot was almost normal; but feeling in the thigh was rather dead, though improving. The patient was able to walk about on crutches." He was discharged from service for disability April 3, 1864, and pensioned in pursuance of a certificate by Examining Surgeon A. H. Kellogg, of Clinton, Illinois, who stated that "the applicant now has partial paralysis of both lower extremities, resulting from the effects of the wound, and incapacitating him for obtaining his subsistence by labor." Examiner J. Wright, of Clinton, reported March 25, 1867: The original wound was in the right lumbar region, which lias healed, leaving a large cicatrix. While being treated in hospital a bedsore formed on the left hip which was attacked by hospital gangrene, destroying the muscles, cellular tissues, periosteum, and injuring the bone. This wound partially healed, leaving four and some times five fistulous openings communicating with the femur, there being also anchylosis of the hip and knee joints. He has been laying on his right side for over three years, being unable to be turned over or to sit up, and requiring a nurse all the time. I amputated the left leg at the hip joint on the 20th day of February, 1867. The wound is nearly healed and will get well, I think. How much the other limb will be worth is more than I can tell now." One year later the same examiner reported that "the right leg is perfectly useless ; he cannot bear his weight on it nor use it with the aid of crutches, and requires an attendant con stantly. At a subsequent date Dr. Wright certified that he continued as the attending physician of the pensioner, who was taken with diarrhoea, and then "dropsy followed and continued off and on until the date of his death on September 28, 1872." CASE 997. Amputation in the thiyh. Private C. W. Barnes, Co. I, 95th New York, aged 23 years, was admitted to Mower Hospital, Philadelphia, May 6, 1863, suffering from osteo-cephalomatous tumor of the right tibia. Surgeon J. Hopkinson, U. S. V., reported : "The history of this patient s case is as follows : While he was assisting in building a wharf at Aquia Creek . about June 20, 1862, he fell and bruised himself over the spine of the right tibia. He was soon able to resume duty, but in about ten days after the accident he noticed a small lump growing on his leg. This gave him no annoyance and he remained witli his regiment until the battle of Bull Run, August 29, 1862, when he was taken prisoner. He remained in captivity until the following December, when he was paroled, sent to Annapolis, and thence back to his command. He now continued to perform the duties of a soldier until February 20, 1863, when he was again excused on account of the swelling, and one month later he was sent to Douglas Hospital, whence he was transferred here. The tumor in the mean time had gradually grown larger, attaining the size of a goose egg by July 29th, when it was decided to remove it, which was accord ingly done by Assistant Surgeon C. R. Greenleaf, U. S. A. In a few days, however, it began to reappear in the wound, and large portions of it were removed on August 20th by the same operator, after which it was not long before it again showed signs of returning, and amputation was decided upon. The limb was taken off, after gaining the patient s consent, on October 17th, at the lower third of the thigh, by Acting Assistant Surgeon J. H. Jamar. But little haemorrhage attended the operation, which was performed by the antero-posterior flap method, four ligatures being applied. Chloroform constituted the anaesthetic ami the patient reacted promptly. The wound united by first intention, and by November 8th the stump had almost entirely healed, there being no indication of reappearance of any tumor. The tumor, when removed, had been examined by Dr. J. M. Da Costa, of Philadelphia, and pronounced to be undoubtedly carcinomatous." The patient was subsequently transferred to Haddington Hospital, where he was sup plied with a "Palmer" artificial limb. He was ultimately discharged from service, at Broad Street Hos pital, December 16. 1864, and pensioned. A wet preparation of the shaft of the tibia of the amputated limb, exhibiting the tumor at the upper third of the bone, was contributed to the Museum by the opera tor, and constitutes specimen 2779 of the Surgical Section. The pensioner was inspected on February 1, 1882, by Examining Surgeon O. Warner, of Paterson, New Jersey, who reported that he found the stump small, shrunken, painful, tender, and sore on the end, so that it is impossible for an artificial limb to be worn with any comfort or benefit." CASE 998. Amputation in the thiyh. Dr. D. Stanton, late Surgeon U. S. V., reports that "John Meyer, who represented himself as a discharged soldier of a Minnesota regiment, on his way to his home, 37Q _ c was left by reason of an attack of remittent fever at New Brighton, Pennsylvania, where, during a fit of comminuted fracture of delirium on January 9. 1866, he jumped from a second-story window to the ground, a distance of twenty feet. When called to see him I found a compound comminuted fracture of the left femur extending about four inches above the condyles, the upper end of the bone protruding through the skin and pantaloons. The condyles were split apart and the patella was slightly fractured. I amputated at the junction of lower and middle thirds of the bone, making anterior and posterior flaps. Two arteries were ligated. Union through almost the entire extent took place by first intention, and in six weeks the stump was entirely healed and of very good shape." The amputated portion of the femur and the patella (Spec. 2455), contributed to the Museum by the operator, are represented in the adjoining wood-cut. (FlG. 370), showing the line of the operation to have 1 WRIGHT (JOHN), Amputation at the Hip Joint, in Cincinnati Lancet and Observer, 1868, VoL XI, p. 257. SURG. Ill 84 Circular No. 2, S. G. O., p. 109. 666 MISCELLANEOUS INJURIES. [CHAP. XI. passed through a small exostosis. No subsequent history of the patient has been ascertained. There is HO record of his ever having applied for pension. CASE 999. Amputation in the thiijft. Private P. O Reilly, Co. F, 5th New York Heavy Artillery, aged 40 years, had both his legs horribly mutilated by the car wheels of a railroad train near Baltimore, November 5, 18G4. He was conveyed to Patterson Park Hospital, where the right thigh was amputated at the middle third by Surgeon T. Sim, U. S. V. The patient then was so rapidly failing that it was considered useless to proceed with any further operation on the other limb. He was insensible at the time of admission and remained so up to his death, which occurred four hours afterwards. The amputated portions of the leg were forwarded, with the history, by the operator, and form specimen 3470 of the Surg. Sect, of the Museum. TABLE (JX. Condensed Summary of One Hundred and Forty-nine Amputations in the Thigh for Miscellaneous Injuries or Diseases. [Recoveries, 1 HO; Deaths, 91149.] NO. NAME, MILITARY DESCRIPTION, AND AGK. DATE OF INJURY OR DISEASE. NATURE OK INJURY ou DISEASE. DATE OF OPERA TION. Oi KKATiox AND OPERATOR. RESULT AND REMARKS. 1 Anders. J. J.. Pt., K, (i5th Oct. 19, Frac. right leg; fall from horse; June 20, Flap amputation at lower third Recovery. (Disch d June 5, 65.) New York, uge 20. 1864. leg shortened and atrophied ; 1868. of thigh. Dr. A. Marsh, Al Died March 3], 1870; absorption toes paralyzed; exostosis. bany, N. Y. of pus. o Anderson. M., I t.. K, 115th Oct. 5, Right leg injured ; railroad Oct. 5, Flap amputation at lower third Discharged. Illinois. 1862. accident. 1862. of thigh. 3 Barnes, C., Pt., I, 95th New- June , Injury of the right leg : osteo- Oct. 17, Antcro-posterior flap amputat n Discharged November 5, 1864. York, age 23. 1862. cephalomutoustuinorof tibia ; 1863. at lower third of right thigh. Spue. 2779, A. M. M. tumor removed. A. A. Surg. J. H. Janmr. Sept. 1 Navy, age 31. 1864. board steamer Alabama. below trochanter" major. puckered and tender. 5 Bergman. J., Pt., 7th New April 30. Comp nd fract. of lower thirds Julv 6, Circular amputation at lower Wound healed, leaving a good York Battery, age 38. 1864. of right tibia and fibula by a 1864. third of thigh. A. A. Surg. stump. Discharged December caisson wheel. E. Curtis. 2, 1864. 6 Bice, J. A., Pt., C, 95th New i Dec., Phlegmonous erysipelas, right May 23. Amputation at middle third of Discharged October 5, 1865. York. 1864 to foot and leg, caused by ex 1865. thigh. Dr. H. B. Salmon, 1865. posure to wet and cold. Stuyvesant, N. Y. 7 Blackburn. J., I t., B, 19th Sept. 17, Right leg mashed from knee to Sept. 17, Amp. at lower third of thigh. Discharged October 4, 1861. Illinois. 1861. ankle; accident. 1861. Dr. R. G. Bogue. Chicago. 8 Boderker. G., Pt., C. 6th Nov. 6, Run over by ammunit n wagon, Jan. 4, Circular amputation at upper Discharged. Missouri, age 39. 1863. fract ur g right tibia at middle. 1864. third of thigh. Surg. N. Gay, Extensive supp. and necrosis. U. S. V. Jan. 3.4, liajm. fr. post. lib. art. 9 Bolton, P., Serg t, F. 51st June 7, Left limb injured by railroad Juno 10, Flap amput n at middle third Discharged. New York. 1863. accident. 1863. of thigh. Surg. J. T. Carpen ter, U. S. V. 10 Bowen. T., Pt., E, 13th New Sept. 8, Fracture of the left leg; rail Sept. 29, Amputation at middle third of Discharged Feb. 16, 1863. Piece York. 1862. road accident. 1862. thigh. A. A. Surg. W. Sar of bone subsequently removed gent. from stump. 11 Bruce, C., Pt.. K, 95th Illi Dec. 19, Compound comminuted frac. at Dec. 19, Circular amputation at middle Discharged. nois, age 37. 1864. upper third of left leg; rail 1864. third of thigh. Surg. S. E. road accident. Fuller. U. S. V. 12 Buekridge. J. N., Pt.. C, 6th Axe wound of right foot, sever Mav 27, Antero-posterior flap amputat n May 30, slight haemorrhages ; re New York Artillery. 1864. ing tarsus and metatarsus; 1864. of thigh nearjunct. of middle covered. erysipelas ; gangrene. and lower thirds. Surg. D. W. liliss, U. S. V. 13 Burgess, O. S., Pt., L, 8th Scrofulous inflammat n of right Nov. 20, Circular amputation at lower Necrosis of stump. Discharged New York Artillery, age 18. knee joint; anchylosis; cartil 18(14. third of thigh. Surg. R. W. May 31. J865. ages disorganized: haemorrh. Pease, U. S. V. 14 Burns. J., Pt., A, 17th New June 20, Right foot and left thigh at June 20, Circular amputation at upper Stumps ulcerated. Discharged York, age 21. 1865. middle third fractured; rail 1865. third of left thigh. A. A. Snrg. November 14, 1865. road accident. R. P. Johnson. Amputation right leg, lower third. 15 Carlisle. J. L., Recruit, 10th Feb. 29, Injury of right knee and frac June 26, Amputation at middle third of Discharged August 5, 1865; re Michigan Cavalry, age 21. 1865. ture of tibia ; railroad aecid t ; 1868. right thigh. Dr. D.W. Flora, covered. inflammation in knee joint. Chicago, Illinois. 16 Cator. A., Pt., G, 48th New Wrenched his right leg; osteo- July 21, Flap amputation at junction of Discharged July 8, 1863. York, age 21. 1861. sarcoma of fibula; leg much 1862. middle and lower thirds. Dr. swollen, red. and tender. W. Parker, New York. 17 Chapman, O.W., Pt., E, 76th Scurvy; extensive ulceration Aug. 20, Amputation at lower third of Discharged July 29. 1865; recov Pennsylvania. of right leg. exposing (i inches 1865. thigh. Dr. A. Strong, Hones- ered, with sound stump. of tibia. dale, Penn. 18 Clarke, T.W., Chaplain, 99th May 10, Injury of left second toe ; de Feb. 7, Amputation at lower third of Disch d Feb. 1 1, 1863. (Nov. 26, New York, age 42. 1862. formity and partial dislocat n. 1872. thigh. Dr. J. Momans, late 1862, amputation toe: Jan. 21, Ass t Surg. U. S. A. 1863, amputat n low. third leg.) , 19 Coe, S., Col d Pioneer Corps. Aug. 11. Falling tree crushed the left Aug. 11, Flap amputat n at middle third Returned to regiment September 1863. leg. 1863. of thigh. 22. 1863. 20 Collier, L.. Pt.. I, Oth Mis Sept. 25, Right thigh crushed by a Oct. 4, Flap amputat n at middle third Transferred to Veteran Reserve souri, age 17. 1861. wagon. 1861. of thigh. Corps. 21 Concannon. E. C., Corp l. H, May 4, Fracture left tibia and fibula ; May 4, Antero-post. flap amputat n at Discharged January 27, 1865; 9th Veteran Reserve Corps. 1864. laceration lower third of right 1864. junct. of mid. and lower thirds stump very well shaped. Spec. age 24. thigh ; railroad accident. of left thigh. Surg. E. 15ont- 2550, A. M. M. ley, U. S. V. 22 Dillon, K., Pt.. ! , 5lh New Nov. 23, Injury of right knee by fall of ! Second Flap amp. at upper third thigh. Discharged December 13, 1862. York. 1861. a fence. ary. Surg. G. Taylor, II. S. A. 23 Drysdell. H.. I t., E, 71st Sept. 28, Railroad cars crushed the right Sept. 28, Antero-posterior flap amputa n Discharged. I Pennsylvania. 1863. leg. 1863. at lower third of thigh. M Duncin* O W I t I* 1 h t Pennsylvania Cav.. ago 10. large amount of pus deeply JUD6 i.*, 1864. Circular amputation at lower third of thigh. Ass t Surg. iteeovereo. seated in the joint; necrosis C. Wagner, 1 . S. A. of external condyle. 25 Dunn, \V. F., I t.. I, 192d Ana. 12. Right leg crushed: railroad ac- Jan. 1. Amp. of thigh at lower third. Discharged. Pennsylvania, age -, 0. 1864. i cident. Aug. 12. amputation 1865. A. A.Siir-r. F. F. Maurv. Icy ; stump diseased. 1 KENNEDY (J. T ), Amputations of Thigh, etc., in American Mtdical Wmes, Volume V, 186J, p. JUJ SECT. II. 1 AMPUTATIONS IN THE THIGH. 667 No. NAME, MILITARY DESCRIPTION, AND ACE. DATE OF . INJURY NATURE OF INJURY OR OR DISEASE. DISEASE. BATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. Ofi Fl^n irv T Pt 13 5th VCTV Hydnrthru*- of left knee joint Anril 9fi Flap amput n at middle third of Dischar ed *JO York Heavy Artillery. ! 1865. thigh. Medical Cadet Stille. large 27 Gallagher, L.. Pt.. A. 69th : Jan. 31, Comp nd comminuted fract. of Jan. 31, Flap amp. at lower third thigh. Disch d March 2. 1866. (Ampu Ohio a"e 18. 1865. right leg; railroad accident. 1865. Surg. C. McDermont, U. S.V. tation left arm Sept. 2, 1864.) -co l_rleeson, ri., i i., -\. 1 iuin New York, age -. 7. 1864. in mortification. 1865. thigh. Dr. A. M. Leonard, August 29, 1865; stump healed Lockport, N.Y. June 7, 1865, but tender. amputation left leg. 2!) Godfrey. T.. 1 t., II. 22d Ken- Feb. 26, Fract. of leg ext. into knee j nt Mar. 29, Circular amputation at lower Discharged June 11. 1864. tucky Artillery, age 35. 1864. and comp nd fract. ankle j t ; 1864. third of thigh. A. A. Surg. crush, bet. ferryboat and dock. N. F. Marsh. on : n /" i.^ r :..* T-* l K*K Tninrv of ri<rht " leo 1 bv ft f lll Oct. 7, A mr>ntMtion ot thiirh 6 inches Recovered bone tilted nnward West Virginia, age 43. lameness. Must, out June 10, 1863. from hip. Dr. J. Suinburn. and forward by action of mus 1863. Enlargement of artery Albany, N. Y. cles in stump. behind knee ; gangrene. 31 H i"pcll F Pt 1) 3 Hh llli Oct. 17, Discharged Dec. 22, 1863. Re nois, age 39. necrosis of femur and tibia ; 1867. thigh. Dr. J. II. Thompson. covered. diseased bones fractured by surgeon at Soldiers Home. accident. Milwaukee. Wis. 32 Hooks, H. A.. 1 t.. <;, 78th Sept. Oil, Right tibia, fibula, and patella Sept. 29, Circular amputation at lower Discharged February 15, 1865. Pennsylvania. 1864. fractured; railroad accident. 1864. third of thigh. A. A. Surg. S. T. Williams. 33 Hornbeek. S. S., Pt.. F, -,>8tli Aug. 15, Injury of left limb; railroad Aug. Hi, Amp. at middle third of thigh. Discharged September 25, 1863. Kentucky. 1862. accident. 1862, Surg. G.W. Ronald, 34th Ky. 34 . Mutcliinsoii. A., contraband. Mar. 5, Thigh crushed by a falling tree. Mar. 10, Post, flap amp. at upper third Discharged from hospital Nov. ape 5."). 1864. 1864. thigh. Surg. K. K. Piquette, 27. 1861. 86th Colored Troops. 35 Jacks.m, K. II.. Serg t, I), 2<1 Sept. 1, Left tibia injured by chafe of Jan. 14, Amp. at lower third thigh. Dr. Mustered out August 17, 1865. Michigan Cavalry, age 31. 1864. stirrup: disease inv. knee j nt. 1869. A. K. Bliss, late Surg. U. S.V. Recovered. 36 Kalbfleish. .1.. I t. A. 116th Feb. 24, Compound tract, of right tibia. Feb. 24, Antero-posteriorflapamputat n Discharged May 15, 1865. Ohio, age 27. 1864. fibula, and ankle; crushed by 1864. lower third thigh. Surg. T. car wheel. J. Shannon. lltith Ohio. 37 Keller, F.. I t.. E. 18th Ohio. Jan. 24, Fracture middle third of right : Feb. 25, Circular amputat n upper third Discharged September 29, 1865; age 21. 1865. femur; railroad acoid t ; morti 1865. of thigh. Dr. H. Tappan, stump healthy. (Also a shot fieation. Steubeuvillc. Ohio. wound of right leg Dec., 1864.) 38 Kennedy, I . A. I?., 1 t.. I!, 36th Indiana. Scrofula; r t ankle, knee, and Feb. 2."", Amputation at lower third of wrist affected by tuberculosis. 1864. right thigh. Di J. M.Youant, August 16, 1864, amputation of right forearm. Mustered out Destruct. bony and soft parts. Indianapolis. September 21, 1864. 39 Kennedy, W.. I t., ( , 37th Jan. 5, Leg broken by accident Mar. i>, Flap amputat n at upper third Discharged June 14, 1864. Illinois. 1863. 1863. of thigh. Ass t Surg. S. D. Carpenter, I . S. V. 40 Lambert. H. M., Serg t, D, Oct. 10, Comminuted fracture of right Nov. 10, Double flap amputat n at lower Disch d July 30, 64. Specs. 1744, 12th Illinois Cav., age 29. 1863. leg at middle third by fall of 1863. third. A. A. Surgeon W. II. 1879, A. M. M. (Oct. 25, 1863, horse. Ensign. amp. leg : Nov. 8, 26, hasinorrh.) 41 | Lewis. P.. Musician, G, 183d July 20, Fracture of right leg; railroad July 20, Flap amputat n at middle third Recovery. Ohio. 1865. accident. 1865. of thigh. 42 : Lindsay, W., Corp l, I, 81st Mar. 20, Accid tal injury left knee joint ; Aug. 12, Circular aniput n at lower third Discharged December 4, 1865. Colored Troops, age 35. 1865. pus in and around joint ; in- 1865. 1 thigh. Surg. F. E. Piquette, rtammatien. 86th Colored Troops. 43 Little, T. W.. Pt., L, 10th May 5, Compound fracture of left tibia May 26, , Flap amputation at lower third Discharged October 16, 1864. Indiana Cavalry. 1864. and fibula : railroad accident. 1864. of thigh. Surg. C. N. Hoag- land, 71st Ohio. 44 Long. S.. Pt.. E, 5th Ken June 24. Left leg fractured: fall of horse; Oct. 27, Circular amput n middle third Discharged July 11, 1864. tucky Cavalry, age 40. 1863. erysipelas ; gangrene. 1863. thigh. Ass t Surg. J. E. Link, 21st Illinois. 45 Lynch, H., Pt., G, 15th Con Aug. 28, Injury of left knee by a fall; Jan. 24, Amputat n at lower third thigh. (Discharged September 13, 1863.) necticut, age 35. 1862. periostitis and ostitis; enlarge 1865. Dr. F. Bacon, of the Conn. Recovered. ment of head of tibia. State Hospital. 46 McCabe. J.. Pt.. A, 23d Illi Sept. 20, Left limb injured by railroad Sept. 20, Flap amputation at upper third Discharged September 30, 1863. nois, age 33. 1862. accident. 1862. of ihigh. 47 McLay, \V., Pt. G, 12th Bones of right le fractured by Jtin. 15 Lateral flap amputat n at lower Discharged July 5, 1864. (Nov. Illinois. 1856. machinery ; necrosis and dis 1864. third of thigh. Surg. J. G. 3, 1863, amputation leg; gang.) placement of fractured ends. Keenon, U. S. V. 48 Marcellus L. Pt. 15 94th Gangrene of right leg and foot April 30, Circular amputation at lower Discharged November 3, 1805. New York. from exposure. 1865: third of thigh. 49 Marshall. W., Pt., A, 55th Aug. 4, Sprain of right ankle ; disor Mar. 4, Circular amputat n lower third Mustered out August 26, 1863. Pennsylvania. 1863. ganization of tibia and astrag 1865. of thigh. Dr. T. St. Clair, Recovered. alus. Blairsville, Penn. 50 Martindale, L., Pt.. K, 54th Nov. 1, Leg crushed, extending into Nov. 1, Circular amputation at lower Discharged December 15, 1863. Indiana, age 25. 1863. knee joint; femur obliquely 1863. third of right thigh. Ass t fractured : railroad accident. Surg. J. Homans, jr., U. S. A. 51 M lV New York. tibia; inflamm. of knee joint. 1865. of lower thirds of thigh. Dr. Todd, Tarrytown, N. Y. 52 Meyer, J., discharged soldier, Jan. 9, Compound comm. fract. lower Jan. 9, Antero-post. flap amp. at June. Stump entirely healed in six Minnesota regiment. 1866. third left femur into knee j nt ; 1866. of lower thirds of thigh. Dr. weeks. Recovered. Spec. 2455, jumped from 2d story window. D. Stanton, late Surg. 1 . S.V. A. M. M. 53 Morton, C. L., Pt., I, 4th Oct. 14, Right knee: kicked by a horse. Oct. 14, Flap amp. low. third thigh. Dr. Discharged February 27, 1863. Michigan Cavalry. 1862. 1862. E. Thorn, Constantine, Mich. 54 Mill-dock, G., Pt.", A, 23d May 16. Severe contus. left leg ; accid t; June 6, Circular amputation at lower Progress steady but slow. Mus Illinois, age "ft. 1864. sloughing; gang, of foot; pus ; 1864. third of thigh. A. A. Surg. tered out June 24, 1865. burrowed along popliteal vein ; R. N. Isham. and in it. 55 Myers, J.. Pt.. L, 4th Ohio June 6, Injured by railroad accident . . June 6, Amputation at lower third of Discharged January 7. 1865. Cavalry. 1863. I 1863. right thigh. 56 O Brien, F., Pt.. A, 4th New Feb. , Axe wound of the left knee; Second Amputat n at middle third of Discharged April 28, 1863. Spc.c. York. 1862. necrosis. ary. thigh, lateral flaps. Surg. G. !>19, A. M. M. (CASE 524, p. Taylor, V. S. A. 362, ante.) 57 Pflueger, F., Pt.. H, 8th N. July 21, Injury of left knee joint by fall ; July 7, Circular amputat n at middle Discharged September 5, 1861. York, age 37. ! 1861. caries of cartilage of knee. 1863. third left thigh. A. A. Surg. Recovered July, 1865. C. F. Heuser. 58 Phillips. J., Pt.. A. 1st Mich- April 10, Contusion, result gin synovitis Nov. 20, Circular amput n middle third Recovered. (Discharged Jan. 11, igan Cavalry. ; 1864. left knee. 1866. of thigh. Dr. D. O. Farrand, 1866.) Detroit. Mich. 59 Pierce, A., Pt., C. S. Engi- Aug. 2, Injury of right leg; boiler ex- On field. Amputation at middle third of Discharged from hospital Novem ueers, age 45. 1864. plosion, Steamer Anna Lyon. thigh. ber 2, 1864. 668 MISCELLANEOUS INJURIES. [CHAP. XI. DATE OF DATE No. NAME, MILITARY DESCRIPTION, AND AGE. INJURY OK NATURE OF INJURY OK DISF.ASE. OF OPERA OPERATION AND OPERATOR. RESULT AND REMARKS. DISEASE. TION. 60 Pittmau W\ H Pt E 4th f Allir 7 Amputation lo\ver third of left Discharged June 16, 1865; bad Teiin. Cavalry, age 38. 1864. resulting from imprisonment. rtllg. *.!, 1865. thigh. Dr. J. D. Ketchcrside, stump; bone protruding. Re Ducktown, Tenn. covered. 61 Powell, .1., I t., K, 28th Penn- Jan. 5, Fell from horse and injured r t July 6, Teale s rectangular flap amp. Discharged December 12, 1862. sylvania. 1862. leg: caries of tarsus, tibia, and 1862. at middle third thigh. Ass t fibula : erysipelas ; abscesses. Surg. R. Bartholow, U. S. A. 62 Putmm C A Pt F k \l \iichvl sis lct l knee- chronic Mar 17 Klup nmputntion jit lower third. Discharged February 13, 1864. Colorado Cavalry, age 24. enlargement of knee joint. 1867. of thigh. Dr. T. B. Dearborn, Recovered. Hillsborough, N. H. 63 f)t i T* t f ^ ! 1 or* ^rn fill infll nmltinn Hisnr Sept. 3 AtnrHit n it lower third tlii/^h Healed by first intention. Re Home, age 54. 1862. ganizitig right knee ; abscess. 1804. Surg.R. B. Bonteeou, U. S.V. turned to Soldiers Home cured. 64 Randolph, W. M., Pt., A, July;?, Right lower limb kicked by a April 8, Double flap amput n at middle Discharged May 27, 1865. 10th Missouri Cav.. age 21. 1864. horse ; extensive suppuration; 1865. third of thigh. Surg. J. R. knee joint disorganized, with McClurg, U. S. V. ulceration of bones. 65 Roberts. 10., Pt., G, 13th Wis May 2, Right leg injured; railroad ac May 2, Flap amput n low. third thigh. Discharged Mar. 24, 1865. Specs. consin, age 24. 1864. cident. 1804. June 18. 3 ins. bone removed. 2990, 3098. A. M. M. 06 Robinett. M. B., Musician, 11. April 11. Railroad cars crushed the left A prill!. Amputation at lower third of Discharged August 19, 1864. 2d Maryland P. H. B. 1863. leg- 1863. thigh. Surg. S. P. Smith, 2d Maryland P. H. B. 67 Scoville, I-:., Pt., E. 123d N. Dec. 20, Contusion from full of tree ; ne Feb. 18, Circular amput n at lower third Discharged August 5, 1865. York, age 20. 1864. crosis left tibia. 1805. of left thigh. Surg. J. Reily, 33d N. J. 68 Sealey. I). K.. Pt., C. 74th Oct. 7, Fracture both legs ; bad conun. Oct. 25, Circular amputation at lower Discharged February 28, 1865. Illinois. 1864. of right leg; railroad accid t. 1804. third of right thigh. 69 Sheuermaii. J.. Pt., 1C, 10th May 1, Right femur crushed by rail May 11, Flap amputat n at middle third Discharged August 22, 1805. Ohio Cavalry, age :!4. 1805. road accident. 1805. of thigh. 70 Smith. R. H., Pt., D, 3d W. July 24, Compound comminuted fract. July 25, Antero-post. flap amputation at August 1, haemorrhage; ligation Virginia, age 38. 1864. right leg ; railroad accident. 1804. lower third of thigh. Surg. of popliteal artery. Mustered S. N. Sherman, U. S. V. out September 3, 1864. 71 Oct r ) age 14. part of right thigh and knee. 1864. of thigh. Surg. H. Wardner, femur removed. July 31, 1865, U. S. V. stump healed. Left for home. 72 Sowle H A Pt G . r >th Oct 18 I )i^< h tr <r ed Oct 2 186^ unible Michigan Cav., age 28. defective circulation and in- 1862. third. Dr. C. w! Topping, to wear artificial limb. nervation. DeWitt, Mich. 73 Spragg, Or., I t., G, 1st Kan Mar. 12. Left knee cut just above joint About Amputation at middle third of Discharged April 19, 1863. 1870, sas, age 33. 1862. by an axe. April 12, thigh. Surg. H.Nauman, 9th stump sound and healthy. 1862. Wis.; subsequent operation. 74 Stauber, W., Pt., L, 14th Feb. 20, Erysipelas resulting from cold. April 4, Amp. at middle third left thigh. Discharged December 4, 1863. Illinois Cavalry. 1863. 1803. A. A. Surg. E. Andrews. Died September 10, 1872. 75 Straw, P., Pt., ( ,. 203d Penn Mar. 3. Left leg, kicked by a horse. . . . Mar. 20, Flap amputation at lower third Mustered out June 23, 1865. sylvania. 1865. 1805. of thigh. 76 Sullivan, E. O.. Serg t. K. Oct. 14, Fract. middle right femur; ac July 1, Flap amputation at mid. third (Mustered out February 27, 65.) 18th Missouri Mounted Vol 1803. cident ; limb shortened and 1805. of thigh. Recovered. unteers, age 38. flexed at knee. 77 Tanner. D. B.. Pt.. 1). 1st R. Oct. 0. Right leg fractured by a kick Second Amputation at middle third of Discharged April 7, 1862. Spec. Island Light Art., age 26. 1861. from a horse ; erysipelas. ary. thigh. Ass t Surg. J. W. S. 21, A. M. M. in j Gouley, U.S.A. 78 Tanvater, H. C., Pt., C, Gist Jan. 20, Injury of left ankle joint, fract. Feb. 6, Circular amputation at lower Discharged May 16, 1865. Tennessee, age 24. 1805. external malleolus ; contusion 1865. third of thigh. Ass t Surg. of foot; erysipelas. C. Bacon, jr., U. S. A. i Trowbridge, L. M., Corp l, Oct. 24, Left leg entirely severed at Oct. 24, Flap amputation at mid. third Gangrene. December 11, 1864, F, 6th West Virginia, age 1864. knee, severe burn over sacrum, 1864. of left thigh. Snrg. S. N. 2 inches of protruding bone sawn 28. . nates, and both thighs ; rail Sherman, U. S. V. off; recovered. road accident. 80 Tscholl, J., Pt.. D, 12th Mis Oct. 1, Fracture of left femur ; railroad Oct. 1, Circular amputation at upper Mustered out August 15, 1864. souri, age 28. 1803. accident. 1863. third of thigh. Died Jan. 25, 1808, of phthisis pulmonalis. 81 Utter, J., Drummer. F., 5th Oct. 0. Injured by a railroad accident. Oct. 6, Amputation at upper third of Discharged January 30, 1804. Ohio. 1863. 1803. left thigh. 82 Van Inwagen, A., Pt., B, Oct. 12, Left tibia and fibula fractured Oct. 23, Antero-posterior flap amputat n Carious bone remov d from stump. lllth New York, age 37. 1864. at lower third ; railroad acci 1864. at lower third of thigh. Surg. Discharged September 4, 1865. dent. W. O Meagher, 9th N. Y. 83 Van Nordstrand. 1)., Wagon Oct. 9, Injury of left lower extremity; Jan. 24, Flap amputation at mid. third Discharged May 25, 1865. er, H, 12th Indiana Cav. 1804. railroad accident. 1865. of thigh. Dr. J. N. Green, South Bend, Indiana. 84 Webber, C., Pt., 8th Co. X. Axe wound 2 inches above pa Oct. 4, Amputat n at junction of lower Discharged. Spec. 2004, A. M. M. York Ind. Vols. 1863. tella, suppuration extending 1863. thirds of left thigh. Surg. D. (CASE 8, p. 8, ante.) into knee joint. P. Smith, U. S. V. 85 Weiser, A., Pt., A, 65th Illi- Aug. 17. Foot fractured and tibia split Aug. 17, Circular amputation at lower Discharged April 23, 1804. 11O1S. 1803. into knee joint; railroad acci 1863. third of thigh. Ass t Surg. dent. T. Brown, 65th Illinois. 86 Welch. .1. M., Serg t. A ,24th Feb. 8, Sprain of left leg; ulceration Aug. 1, Circular amp. low. third thigh. Discharged Marcli 20, 1803; re Massachusetts. 1802. of knoe joint. 1803. Dr. H. J. Bigelow, Boston. covered. 87 i Wheeler, C., Pt., I, 2d Ohio ! Heavy Artillery, age 18. Jan. 29, 1805. Comp d comm. fract. mid. third left thigh : railroad accident. Jan. 30, 1865. Flap amp. at upper third thigh. A. A. Surg. T. \7. Baugh. Feb. 8 and 14, haemorrhage. Dis charged June 2. 1805. 88 W ilkmson, J. W., Pt., 1), 6th New Hampshire. May 29, 1802. Accidental injury right leg and knee ; i n flam. and sup. kneej t. Sept. 29. 1863. Flap amp. at upper third thigh. Dr. T. Haynes, Concord, N.H. Discharged September 22. 1862; recovered. 89 Williams, K. A., Pt., V, 184th Pennsylvania, age 19. Typhoid fever, resulting in ul ceration of right leg and dis June 16, 1864. Flap amputation at mid. third of thigh. Dr. J. B. Mitchell, Discharged October 9, 1866. ease of bone. l.ellefonte, Penn. 90 Zachman, S., Pt., I), 82d Oct. 2, Left thigh crushed ; railroad Oct. 2, Flap amputation at junction of Discharged. Ohio. 1863. accident. 1803. uppcrand mid. thirds of thigh. Dr. .1.0. Reeve, Dayton, Ohio. 91 Allee, M. J., Corp l, I, 33d June 17, Punctured wound of right knee July 31 , Amputation at middle third of Died Aug. 11. 1865, of diarrhoea. Indiana, age 22. 1805. joint by the point of an axe ; 1865. right thigh. A. A. Surg. D. See p. 302, ante. synovitis. J. Griffiths. 92) Allen, , contraband, age 23. Nov. 10. Comminuted fracture of both Nov. 11. Circ. amp. at middle third left Died November 11, 1864. from 93 f 1804. knee joints by railroad acci 1864. thigh; flap amp. right thigh shock, four hours after operat n. dent. at low. third. Ass t. Surg. H. T. Legler, U. S. V. 94 Anderson, D., Conductor U. May 28. Comp d com. fract. of left tibia May 28, Circular amputation at middle Died June 25, 1865, of exhaust n. S. Mil. Railroad, age 25. 1805. and fibula; railroad accident. 1865. third of left thic-h. 95 Ashenhnrst, J. D., Pt., H, 8th Sept. , Axe wound of left thigh and Sept. 22, Circular amp. at middle third Died September 30, 1864, of ex Kansas, age 22. 1864. knee, opening joint; gangrene. 1864. of thigh. Ass t Surg. T. A. haustion. McGraw, U. S. V. SECT. II.] AMPUTATIONS IS THE THIGH. 669 No. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY on DISEASE. NATURE OF INJURY OR DISEASE. DATE OF OPERA TION. OPERATION AND OPERATOR. RKSULT ANI> RKMARKS. 96 Bowns, \V. A., Quartermas May 21, Comp d comm. fracture middle May 21, Circ. amp. at upper third of left Died May 21, 1865. ter, 15th Conn., age 26. 1865. third left femur and mid. third 1865. thigh ; amp. right leg. Surgs. right tibia and fibula ; railroad C. A. Cowgill, U. S. V., and accident. N. Meyer, 16th Conn. 97 Brown, G., Pt., C, 34th Illi Sept. 24, Fracture of right leg; railroad Amputation at middle third of Died December 4, 1864. nois. 1864. accident. 1864. thigh. 98 Caringer J L Pt G 141st Accidental incised wound left .Tnn 94 Circular amp. at low. third left Died January 25, 18f>5. New York, age 43. foot ; gangrene ; sloughing. 1865. thigh. Surg. G. Grant.U.S.V. 99 Cavanry. W., Pt,, , 10x!d June 14, Fracture of right femur by fall ; June 15, Autero-posterior flap amputat n Died June 15, 1864, of concussion. Pennsylvania. 1864. knee joint involved. 1864. at middle third of thigh. A. A. Surg. S. G. Minassian. 100 Cochnin, M. F., Teamster, H, Nov. 15, Fracture of right knee joint ; Nov. 15, Amputation at middle third of Died Dec. 8, 1863. of pyaemia. 70th New York, age 34. 1863. run over by a wagon. 1863. thigh. 101 Conway, J. A.. Pt., A, 55th May 24, Comp dcomminut dfract. right May 24, Circular amp. at lower third of Died May 28, 1865. From effects Pennsylvania, age 22. 1865. tibia and fibula and left radius 1865. right thigh and of left arm. of internal injuries. and ulna; railroad accident. A. A. Surg. H. S. Streeter. 102 Curgill, W.. Pt.. . 90th Oct. 29, 1864. Left foot, leg. and lower third Oct. 29, of right thigh crushed; rail- ; 1864. Amp. right thigh at lower third and left leg. Ass t Surg. C. Died October 29, It64. New York. road accident. Bacon, jr., U. S. A. 103 Draper. B. F.. Serg t. F, 1st Mar. 30. Both bones of left leg fractured May 8, Circular amputation at lower Died May 27, 18<c . Rhode Island Artillery. 1862. by kick of a horse. 1862. third thigh. 104 Dunn. J . Pt., G, 20th"Con- Nov. 4, j Comp d comm. tract, left thigh Nov. 4, Amputation at lower third of Died November 5. 1863. nectieut. 1863. into knee : railroad accident. 1863. thigh. 105 Ely, J. R., Corp l, 11. 12th Fall upon right knee caused Sept. 8, Antero-posterior flap amputat n Died September 14. 1864. Infantry, age 24. scrofulous disease of joint. 1864. at upper third of thigh. A. A. Surg. O. D. Norton. 106 English. P.. U. S. Railroad April 11. Right leg crushed ; railroad April 12, Amput n at lower third thigh. Died April 20, 1865. employe, age 25. 1865. accident. 1865. A. A. Surg. S. T. Buck. 107 Foley. M., Pt., G, Marine Sept. 6, Loft tarsus lacerated ; explos u Sept. 14, Circular amputation of thigh Died October 3, 1862, of tetanus. Artillery, age 28. 1862. of gunboat Picket ; gang. 1862. immediately above knee. 108 Frazer, H. C., Pt.. A. 40th June 20. Axe injury of left knee joint; Aug. 14, Antero-post. flap amputat n of Rapidly sinking. Died Aug. 14, New York. 1862. gangrene. 1862. thigh 6 inches below trochant- 1862." Ante. p. 362. ers. Brig. Surg. J. C. Dorr. 109 Furgerson,M. A., contraband. Nov. . Injured bv a fall ; gangrene Feb. 15. Circular amputation at lower Gang, again set in; gangrenous 1863. from below knee to foot ; tibia 1864. third of thigh. Surg. D. O. inflammation of throat. Died exposed and partly destroyed. McCord, 9th Louisiana C. T. March 4, 1864. 110 Good. H. J., Serg t, L. 10th May 5. Comp d fracture of lower third June 24. Flap amp. middle third thigh. Died June 27, 1864, of pya mia. Indiana Cavalry, age 29. 1864. of femur; pytemia; gangrene. 1864. Surg. C. N. Hoagland, 71st O. 111 Harmer. S.. Pt.. 0, 98th May , Fracture of right leg ; run over June . Amp. of thigh just above knee. Abscesses forming. Died Aug. Pennsvlvania, age 18. 1864. by cars. 1864. (May , 1864, amp. of leg.) 30, 1864, of epilepsy. 112 Hartz. T., Pt.. G, 7th Iowa, Nov. 4, Comm. of right femur at mid. Nov. 10, Flap amputation of thigh. A. Died December 12, 1864, of gan age 41. 1864. third by railroad accident. 1864. A. Surg. A. Robillard. grene. 113 Hickey. T., Corp l. K. 3d .Ian. 21, Bones of right leg broken by Mar. 29, Lateral flap amputation lower (March 10. excis. tibia; Mar. 19, Michigan Cavalry. 1864. kick of a mule ; gangrene ; 1864. third thigh. A. A. Surg. S. S. ligation posterior tibial artery. fractured ends overlapping. Jessop. Died Mar. 31, 64, of exhanst n.) 114 Hofer F. Hospital Steward CumnoiiTid r ncture of knee i t- \mputation of thigh . Died NoA ember 22, 1865. U. S. A. accident. 115 Hume. C. M.. Pt., A, 3d Dec. 11, Fract. both legs, dislo. r t ankle, Dec. 14, Flap amputation at junction of Died December 24, 1 864. Iowa Cavalry. 1864. injury face and chest : explo. 1864. lower thirds right thigh. A. steamer Maria ; mortifi. r t leg. A. Surg. T. F. Rumbold. 116 Irmer, C., Pt., , 86th Ohio, Sept. 23. Third and 4th met. bones and Oct. 10, Antero-posterior flap amputat n Oct. 19, haem.; ligation of artery. age 2:!. 1864. little toe r t foot crushed and 1664. at lower third right thigh. A. Died Oct. 29, 1864, of py;emia. heel lacerated : railr daccid t; A. Surg. C. E. Boyle. Autopsy : saphenousand femor slough g of foot and leg ; in al veins full of pus. flammation of thigh. 117 Jennings. D.. Pt., C, 37th Aug. 13, Fracture of left tibia ; railroad Aug. 25, Circular amputation at upper Gangrene of stump. Died Sept. Iowa, age 52. 1864. accident ; abscesses ; mortifi 1864. third of thigh. A. A. Surg. 2, 1864, of pyaemia. cation. R. W. Coale. 118 Jones, H., Pt., D, 1st New Mar. 13, Left leg crushed and right foot Mar. 13, Double flap amputation lower Died March 28, 1865. York Cavalry, age 17. 1865. contused ; railroad accident. 1865. third of left thigh. Act. Staff Surg. N. F. Graham. 119 Kellins, D. II., .Serg t, G, Sept. 24, Fracture of left leg, including Sept. 28, Double flap amputation middle Died October 1, 1864. 81st Indiana, age 30. 1864. ankle joint : railroad accident. 1864. third of thigh. A. A. Surg. J. B. McPherson. 120 King, F. J., Pt., C, 6th Ten Jan. 26, Comp d comminuted fracture Jan. 27, Circular amp. at middle third Semi-moribund. Died January nessee, age 22. 1865. right tibia, fibula, and lower 1865. of thigh. A. A. Surg. H. S. 27, 1865. third femur; railroad accid t. Streeter. 121 Iving J freedman Mar. , Right leg run over by a dray ; May 28, Circularamp. lowerthird thigh. Died June 4, 1864. 1864. gangrene. 1864. A. A. Surg. B. E. Dodson. 122 Kitteredge, A., Pt., H, 4th Jan. , Subcutaneous cellular inttam. Mar. 18, Circularamp. lowerthird thigh. Died March 19, 1864, of shock Vermont, age 56. 1864. left foot and leg ; gangrene. 1864. Ass t Surg. A. Ingram, U.S. A. and exhaustion. 123 Leeds, A. P., Pt., H, 10th May 5, Laceration of foot around heel May 10, Flapamputation thigh at lower Died May 12, 1864, from effects Indiana Cavalry, age 24. 1864. and up tendo-achilles: railr d 1864. third. Surg. C. N. Hoagland, of gangrene. - accident : gangrene in leg. 71st Ohio. 124 Lindsley, E. D., Pt., D, 114th Scrofulous abscess involving Mar. 16, Lateral flap amp at lower third Died March 20, 1864, of exhaus Illinois. left knee joint. 1864. thigh. A. A. Surg.J. E.Wilson. tion. 125 Lucas, S., colored employe May 9, Comp d comminuted fracture of May 9, Antero-posterior flap amp. at Sloughing. Died July 1, 1864, Quartermaster s Dep t. 1864. right tibia and fibula ; railroad 1864. lower third of thigh. A. A. of diarrhoea. accident. Surg. B. P. Brown. 126 Matthews, A.. Serg t, 82d Co. May 22. Comp d fracture of left leg near June 4. Circularamp. lower third thigh. Haemorrhage. Died June 1 9, 64, 2d Vet. Res. Corps, age 31. 1864. ankle bv railroad cars. 1864. A. A. Surg. G. P. Norris. of pysemia. 127 Miller. M. G., Pt., F, 87th N. Aug. 16, Contusion resulting in slough- Sept. 1, Amputation at middle third of Oct. fi, hsem. Died Oct. 11, 1862, York, age 23. 1862. ing ulcer. 1862. thigh. of marasmus. 128 Moore. M. B.. Pt., B, 6th Dec. 3, Injured by railroad accident. . Dec. 25, Amputation at juncture lower Died Dec. 30. 1864, of pyremia. Maryland, age 22. 1864. 1864. thirds of right thigh. 129 O nei llv, P.. Pt.. F, 5th N. Nov. 5. Both lec-s mutilated by railroad Nov. 5. liiCflit thigh amput dat middle Died November 5. 1864. Spec. York H vy Art., age 40. 1864. nn rft 1864 third Sur". T. Sim, 1 . S. V. 3470. A. M. M. 130 Providence, T., Pt,, B, 55th July 4, Fract. r t femur and extensive July 5. i Circularamp. at up. third thigh. Died July (i, 1805. from effects of Ohio, age 25. 1865. lacerat nthiffh : railr d accid t. 1865 | A. A. Surg. I). J. Griffiths. i shock. 131 Reams, (>. F.. Pt.. 15, U. S. Mnr. 12, Axe wound of right knee joint. April 24. Lateral flap amputation upper Died May 1. 1S6-I. of pyaemia. Engineers, age 23. 1864. 1864. third thigh. Surg. E. Bent- Spec*. 2234, 22o3,A.M.M. CASE ley, IT. S.V. 529. p. 363. ante. 132 Robinson, S.. I>t., C, 15th Nov. , Necrosis of tibia from a bruise ; Jan. 0:1, Circular amputation at lower Died February 13, 18155, from Pennsylvania Cav., age 22. 1864. periosteal inflam. Jan. 13. 1865. third of right thigh. Ass t exhaustion. 1865, portion of tibia removed. Surg. J. C. Thorpe, U. S. V. 133 Rose, J., Pt., B, 119th Illi Simple fracture of lower third Sept. 5, Circ. amp. at lower third thiffh. Died September 7, 1864. nois, age 35. 1864. 1 of right tibia ; gangrene. 1864. Surg. J. F. Randolph, U. S.A. ! i 670 MISCELLANEOUS INJURIES. [CHAP. XT. NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE or INJURY OR DISEASE. NATURE OF INJURY OK DISEASE. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT ANI> REMARKS. 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 Searle, T. E.. Lieut., G, 1st New York Artillerv. Smith, M. V., Ft., A. llth West Virginia, age 24. Smith, O. F., Serg t, F, 69th Ohio, age ~ 8. Storey, R. G., Pt., K, 95th Illinois, age 44. Strouse. A., Pt., G, 174th Oct. 31, 1864. Sept. 19, 1864. June 11, 1865. Dec. 19, 1864. Nov. 24. 1863. A 32-pounder gun crushed right thigh. Contusion of left knee joint and fracture of patella; fall from a horse. Comp d comin. fnict. heads of right tibia and fibula and obi. fract. of int. condy le of femur; r t hand injured ; railr dacoid. Comp d comminuted fract. of right leg: railroad accident. Abscess of right thigh ; gan grene. Axe wound of right knee joint ; sloughing; joint extensively opened. Contusion left foot, fracture os calcis. and injury of ank. joint by a fall ; gangrene. Fract. left leg, rupture femoral artery; limb tumefied; rail road accident. Accidental injury Oct. 31, 1864. Nov. 7, 1864. June 11, 1865. Dec. lit, 1864. Feb. 6, 1865. Jan. !5, 1864. May 13, 1864. Nov. 3, 1864. Mar. 8, 1864. Oct. 18, 1864. Jan. 4, 1865. Oct. 13, 1864. April 26, 18ii4. Nov. !>. 1863. Dec. 2.1, 1 863. Amputation at upper third of thigh. Amp. middle third thigh by lat. oval skin flaps, circ. sec. muse. A. A. Surg. J. Xeff. A ntero- posterior flap amp. of right thigh by transfixion. Flap amp. at lower third thigh. Surg. S. E. Fuller, U. S. V. Amputation at middle third of thigh. Circular amputat n at junction of lower thirds. Surg. S. T>. Turney, U. S. V. Antero-posterior flap amputa tion of thigh. A. A. Surg. F. F. Maury. Flap amputation at junction of middle and lower thirds. Amputation of left thigh Lateral flap amputation lower third of thigh. Surg. H. W. Owiugs, 2d E. S. Maryland. Circular amp. at middle third of thigh. Ass t Surg. R. F. Weir. U. S. A. Circular amputation at middle third of thigh. A. A. Surg. J. C. Morton. Circular amputation at upper third of thigh. Surg. J. C. Whitehall, 1!. S. V. Lateral Hap amputation lower third of thigh. Surg. .1. I!. McClurg, U. S. V. Flap amputation at upper third of thigh. A. A. Surgeon I). Cummins. Flap amputation at lower third of thigh. A. A. Surg. J. C. Marr. Died November 1. 1864. Died December 4. 186-1. of ex haustion. Died June 30, !S6:>, of pyaemia. Died December 20, 1864, of shock. Died Feb. 16, 1865, of pyaemia. Died January 7, 1864, of exhaus tion. CASE 527, p. 360, ante.. Died May 13, 1864, from shock. Died November 3, 1864, of ex haustion. Died July 9. 1863. Secondary haamorrage from fem oral artery. Died March 28, 1864, of haemorrhage. Died October 24, 1864, of pyaemia. CASE 528, p. 363, ante. (Dec,. 25, 64, amp. at knee.) Jan. 6, 65, liaem.; lig. femoral artery. Ohio, age 20. Swift, K. B., Pt., H. 1st Mich igan, age 23. Taylor. T.. Pt., D, 5th Penn sylvania Res., age 36. Thomas. J. I,., Pt.. E, 12th Missouri, age 25. Tinkler, F.. Pt., A, 18th Illi 1864. Nov. 1, 1864. nois. Towne, W. H., Pt., A, 18th Connecticut, nge 30. Turner. R. H.. Corp l. E, 1st Maryland, age 23. Urban, H., Serg t, F, 20th Massachusetts, age 2J. Vigor, J. H., Pt., I), n.lth Ohio, age 18. Walton, J.. Pt., C, 72d Ohio, age 43. Wilkins. K., Pt.. H. 8th Iowa, age 24. Wilson. T.. Pt.. C. 7th Yet. Reserve Corps, age 41. Nov. 17. 1863. Oct. 3. 1864. Feb. . 1864. Oct. 13, 1864. April 7, 1864. Oct. 20, 1863. Right ankle crushed by railr d accident. Nov. 18, 1863, amp. leg: necrosis of tibia. Incised \v nd, adze penetrating left knee joint. Chronic ulcers of left leg ; gan grene; flaps sloughed and condy les protruded. Comp d coinm. fract. right tibia, fibula, and femur: knee joint involved: railroad accident. Compound fracture right ankle joint; railroad accident : ery sipelas. Right leg crushed: railroad ac cident: gangrene involving knee joint. Contusion of leg : ant. surface a Mack slough from ankle to Died October 14. 1864, of shock. Died May I , . lti(14, of pyiemia. 1 >ied January 24, 1865, of chronic diarrlitea and bronchitis. Varioloid and pleuro-pneumonia. Died March 13, 1864, of pneu monia. Exarticulations at the Knee Joint. Four amputations at the knee joint for miscel laneous causes were reported; two proved successful, two fatal. In one instance amputation in the thigh was subsequently performed: CASES 1000-1003. Private G. Brown, K, 34th Illinois, aged 54, had his right leg crushed in a railroad accident, .Septem ber 24, 1864; circular amputation at the knee joint was performed on the same day, the condyles of the femur being sawn off; gangrene appeared hut was checked by the application of bromine; the patient recovered. Private H. Gertjahr, D, 82d Penn sylvania, aged 45, had the left leg removed at the knee joint by Surgeon E. Bentley, U. S. V., on March 7, 18G5, for necrosis of the middle third of the left tibia. He was discharged the service June 4, 1805. Sergeant J. Shearer, A, llth Maryland, aged 28, received, on May 20, 1805, several kicks from a horse which caused compound comminuted fractures of both legs: excessive haemorrhage followed. On May 21st the left leg was amputated through the knee joint, retaining the patella and condy les of femur; the right leg was removed at the upper third by the an tero- poster! or Hap method; Assistant Surgeon G. M. McGill, U. S. A., performed both operations. The patient died May 22. 18i>5. Sergeant H. Urban, F, 20th Massachusetts, aged 22, suffered from chronic ulcers of the left leg ; gangrene set in and the lower part of the tibia became exposed and necrosed. Act ing Assistant Surgeon J. H. Parkard, on December 25, 18G4, amputated the limb at the knee joint, removing the patella; the flaps sloughed and the condyles protruded, and on January 4, 1865. circular amputation of the thigh at the middle third was performed by Acting Assistant Surgeon J. C. Morton ; haemorrhage subsequently occurred, and on January 6th the femoral artery was ligated in continuity. The patient died on January 7th, of recurring haemorrhage. Amputations in the Leg. Of two hundred and fifty-nine amputations in the leg the results were determined in all but one case; one hundred and eighty were followed by recovery and seventy-eight by death, a mortality rate of 30.2 per cent. One hundred and forty-seven were for fractures, forty-four for frostbites, seventeen for gangrene, and the remainder for various accidents and diseases. CASE 1004. Amputation in the ley. Private C. 0. F. Clark, Co. G, 1st Oregon, aged 35 years, was frost-bitten in his feet and hands while on march between Owyhee and Malheur rivers, Idaho, December 17, 1865. He was conveyed to Camp Auburn, where portions of the lower limbs were amputated by Acting Assistant Surgeon M. V. Amen on January 17, 1866. The patient recovered, and was mustered outof service April 14, 1866, and pensioned. Having been sent East, after receiving his discharge from service, for the purpose of being provided with artificial limbs, he was admitted to the Post Hospital at Washington on February 2, SECT. II.J AMPUTATIONS IN THE LEG. 671 1867, whence Assistant Surgeon W. Thomson, U. S. A., described the case as follows: "The operation seems to have been Chopart s, on the right foot, which had entirely healed when the patient was admitted. The stump was firm and well formed, but so sensitive for the space of one and a half inches from the cicatrix that the man desired the limb to be removed at a point above the ankle. The amputation of the left leg had been performed about six inches above the ankle and had failed to close from the presence of a ligature. After this was removed the stump healed entirely. The patient had also lost portions of the phalanges of both hands from the same cause. On May 22, 18(57, lie was furnished transportation to New York City to be fitted with artificial limbs." These were supplied by the firm of Monroe and Gardiner. Ke-amputation of the stump of the left leg subsequently became necessary and was performed by Professor F. H. Hamilton, at Bellevue Hospital, on November 9, 18b 8. Several years later, when the pensioner was supplied with artificial limbs by D. W. Kolbe, of Philadelphia, both stumps were reported as being in a sound condition. The pensioner was paid December 4, 1881. Casts of the stump of the foot and of the leg were prepared at the Arrny Medical Museum, and constitute specimens 4128 and 4191, respectively, FlG 37i._stmnp after of the Surgical Section. The latter is represented in the annexed wood-cut (FiG. 371) and apparently posterior flap amputation shows the amputation to have been performed by the posterior flap-method. 1 TABLE CXI. Condensed Summary of Two Hundred and Fifty-nine Amputations in the Leg for Disease or Miscellaneous Injuries. [Recoveries, 1180; Deaths, 181258; Result undetermined, 259.] No. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY OR DISEASE. NATURE OF INJURV OR DISEASE. DATE OF Ol ERA- TIO.V. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Aylesworth, F. P., Serg t, E, Oct. , Typhoid fever, resulting in hos Jan. 4, Amp. right leg, middle third, Discharged February 27, 1862. 5th Vermont. 1861. pital gangrene. 1862. circular, and all toes left foot. 2 Baker, C. R.. Pt., E, llth May , Scrofulous ulcers from chafing Den. , Amp. left leg, lower third, flap. Discharged April 18, 1865. Massachusetts. J ne, 64. of boot during marching. 1866. Dr. J. H. Bigelow, of Boston. 3 Banks, A. M., Pt., H, 13th Running sores of leers, the re- June 3. Amp. left leg, upper third. Dr. Must d out Aug. 6, 1861. Stump Pennsylvania, age 32. 1861. suit of fever; necrosis of both 1869. J. VV. King, Covington, Ky. healed; right leg improved af tibias. ter amputation of left. 4* Bates, C.. Corp l. E, 20th Jan. , Frostbite and gangrene in both April 25, Amp. both legs, lower thirds, Discharged Oct. 21, 1865: sound 5j Maine, age 31. 1865. feet, contracted in rebel prison. 1865. antcro-posterior flap. A. A. stumps. Surg. A. J. Smith. 6 Bell, W. H., Pt., I), 3!!d July 20, Comp d fracture lower third by Aug. 8, Amput n right leg, upper third, Discharged December 15, 1863. Kentucky. 1863. wagon wheel; severe injury 1863. flap. Dr. Moore, Greensburg, to ankle joint ; mortification. Kentucky. 7 Best, R., Pt.. D, 1st N. Y. Dec. 1, Disorganization of right foot May 1, Amp. right leg, upper third, bi Discharged October 14, 1865. Mounted Rifles, age 41. 1864. and ankle joint from burn. 1865. lateral flap. A. A. Surg. L. McLean. 8 Bishop, R.. Government em Aiiff. 17, Right ankle joint crushed by Aug. 17, Amput n right leg, lower third, Recovered September 25, 1864; ploye, age 28. 1864. railroad accident. 1864. posterior flap. Snrg. J. L. stump entirely healed. Roe, 137th Indiana. 9 Bond, J., Pt., A, 149th Illi Feb. 26, Right leg crushed by railroad Feb. 26, Amp. right leg, middle third, Discharged July 25, 1865. nois, age 20. 1865. accident. 1865. circular. Surg. J. H.Phillips, U. S. V. 10 Bond, J., Pt,, K, 150th Illi May 5, Hight leg injured by railroad Amputation right leg, middle Discharged July 25, 1865. nois. 1865. accident. third. 11 Boon, N., Pt., E, 2d Colored Scrofulous disease, involving Dec. 11, Amp. right leg, junction upper Discharged July 14, 1866; sore Cavalry. bones of right leg. 1865. and mid. thirds. A. A. Surg. stump. A. McLetchie. 12 Bouchsein, T. E.. Pt.. A, May 2, Com. fracture of left foot and May 3, Amp. left leg. upper third, flap. Discharged October 12, 1864. 68th New York. 1864. ankle joint by railroad aceid t. 1864. Surg. L. Schultz, 68th N. Y. 13 Branson, D. A.. Pt.. C. 73d Afar. , Erysipelas, gang., abscesses, Jan. 10, Amp. right leg, lower third. Discharged July 19. 1865: stump Illinois, age 25. 1805. and diseased bone from abra 1866. post. flap. Dr. R. H. Buck. healed. sion of foot. late surgeon 13th Ind. Cav. 14 Brazier, J., unassigned Re Mar. 28, Injury to right leg by railroad Mar. 28, Amp. right leg, middle third, Discharged July 19, 1865. cruit, Vet. Vols., age 22. 1865. accident. 1865. flap. Dr. W. \V. Rutherford, Harrisburg, Penn. 15 Brockwav, M., Pt , I. 47th June 22, Comminuted fracture right leg June 22, Amp. right leg. middle third. Discharged May 8, 1864. Ohio. 1863. by falling tree. 1863. Surg. S. P. Bonner,47th Ohio. 16 Brown, A. R., Pt,, I), 3d Dec. 5, Opening in right ankle joint Jan. 3, Amp. right leg, junct. middle Must d out July 27, 1865; stump Vermont, age 20. 1863. and ill-conditioned leg from 1866. and lower thirds, circ. Dr. L. healed. Died April 10, 1867. a misstep. Richmond, Derby, Vermont. 17 Brown, C., Pt., H. 9th Mis April 15, Left leg fractured by railroad April 15, Amputation left leg, upper Discharged November 17, 1865. souri. 1865. accident. 1865. third, flap. 18 Brown, C. E., Pt.. G, 1st Jan. 3, Frostbite of left foot followed Mar. 15, Amp. left leg, lateral skin flaps Discharged May 16, 1865. Massachusetts Heavy Artil 1865. by ulceration. 1865. and circular section muscles. lery, age 22. A. A. Surg. B. B. Miles. 19 Brown, R.. Pt., G, 31st Ohio. Feb. 1. Left leg crushed by railroad Feb. 1, Amp. left leg, upper third, ant. Discharged September 24, 1864. 1864. accident. 1864. posterior flap. 20 Buckner, A. J., Pt., E, 4th July 19, Axe wound, fraet g phalanges Dec. 10, Amp. right leg, lower third, Discharged August 7, 1865. Iowa Cavalry, age 27. 1864. and met. bones 3d toe, r t to jt : 1864. flap. Surg. M. K. Taylor, ulceration .and sloughing. U. S. V. 21 Burns, J., Pt., A, 17th New June 20, Coinp d tract, right foot with June 20, Amp. right leg. lower third, Discharged November 14, 1865. - York, age 21. 1865. great destruction of soft parts, 1865. circular, and left thigh in up and comp. fracture left thigh, per third. A. A. Surg. R. P. mid. third, by railr d accid t. Johnson. 22 Burns, J., Pt., ( ,. 30th Penn. Jan. 28, Right leg injured by railroad Jan. 2?, Amputation right leg, upper Discharged. Cavalry, age 18. 1864. accident. 1864. third, flap. 23 Callaway, A. K.. Pt.. A, 115th Sept. 9, Fracture of left leg above an Sept. 9, Amp. left leg, upper third, flap. Discharged March 25, lP6. r >. Illinois, age 22. 1863. kle by railroad accident. 1863. Ass t Surg. J. A. Jones, 115th Illinois. 24 Carson, E., Pt., 1st Kentucky Sept. 12, Right leg crushed by cannon Sept. 12, Amp. right leg, flap, mid. third. Discharged December 2. 1862. Battery. ISC. 1 . wheel. 1862. Ass t Surg. R.F.Weir.U.S.A. 672 MISCELLANEOUS INJURIES. [CHAP. XI. DATE OK i DATK NO. NAME, MILITARY iNjt-RY NATURE OF INJURY OR or OPERATION AMI Ol KRATOU. RESULT ANIt REMARKS. DESCRIPTION, AND AGE. OR DISEASE. OIT.IJA- DlSEASE., TION. 23 Caton, G. W.. Pt.. M, 2d E. July 25, Left foot and ankle crushed by July 25, Amp. left leg 3 inches above Gangrene. Discharged April 24, Tennessee Cavalry. 1863. railroad cars. 1863. ankle, circular. Surg. W. 1865. Hobbs, 85th Indiana, 26 Christoflerson. J.,Pt.. E, 10th July 10, Left leg torn off and left thigh July 11. Amp. left leg. upper third, circ. Discharged. Veteran Reserve Corps. 1864. fractured by railroad accid t. 1864. Dr..). Evans, Havre-de-Grace, Maryland. 27 Clark, C. O. I- ., Pt., G, 1st Dec 17 Frostbite of both feet Jan. 17, Amp. left leg, mid. third, and Disch d April 14, 1866. 1870, Oregon. 1865. 1866. right foot. A. A. Surg. M.V. sound stumps. Specs. 4128 and Aman. Nov. 9, 1868, re-amp. 4191, A.M. M. in upper third. 28 Clark, T. W., Chaplain, 99th May 10, Injury of left 2d toe, resulting Jan. 21, Amputation left leg, low. third, Disch d Feb. 11, 18(53. (Nov. 26, New York, age 42. 1862. in painful deformity and par- 1863. flap. 1862, amp. left 2d too.) Feb. 7, tial dislocation. 1872, amp. thigh, lower third; recovered. 29 Collins. P.. Pt., I. 29th In July 2. Left leg injured by railroad un July 2, Amp. left leg, low. third. Surg. Recovered Aug. 13, 1865. (Dis diana, age 28. 1865. cident. 1865. F. B. Kimball, 3d N. H. charged soldier.) :io Conn, S.. Pt., G, 18th Mis Jan. 17, Comp d fracture left leg by a Feb. 1, Amput n left leg, middle third. Discharged April 10, 1862. souri, agO 2-. . 1862. fa 11 from a wagon. 1862. Surg. W. Varian, U. S. V. :; Connell, J.. Pt.. A. 51st Illi- Oct. 31, Left leg injured l>v railroad ac- Oct. 31. Amp. left leg. mid. third, flap. Discharged Mar. 23. 1865. (Also inns, ago 135. 1664. cident. 1864. Dr. J. Northrup, Woodstock, wound right thigh.) Illinois. :K Cranc. !., Pt., E, 89th Illi Jan. Hi, Axe wound of right foot : ery- Mar. 5. Amput n right leg, lower third, Discharged June 14, 1864. nois, age 30. 1864. sipelas ; necro. of tarsal bones. 1864. antero-post. skin flap. Surg. H. T. Legler. U. S. V. 33 Cummins, J. W.. Pt., L, 5th Feb. , Slough g and unhealthy condi- May 10 Amputation of both legs, lower Discharged Aug. 2, 1865. (Fob.. 34) Michigan Cavalry, age 22. 1865. tion of stumps following amp. 1865. thirds, flap. A. A. Surg. E. 1865, amputation both feet at of both feet at ank. j t on ace. Seyffarth. ankle joint.) of scurvy contracted in prison. 331 Dougherty. B.T., Pt., K, 31st Gangrene of both feet follow- April 17, Amp. both legs, lower thirds, Discharged October 13, 1865. 36} Illinois, age 22. ing frostbite while prisoner of 1865. circular. A. A. Surg. F. E. war. Martindale. 37 Davis. J.. Pt., B, 31st Wis Mar. 2, Left leg injured by railroad Mar. 2, Amput n left leg, upper third. Discharged August 29, 1863. consin. 1863. accident. 1863. :$8 Dees, G. W.. Pt., E, 13th Doe. 13. Frostbite of both lees Dec. 16, Amp. both legs, lower thirds. Discharged June 2, 1866. 39 Missouri Cavalry, age 23. 1865. 18, 1865. Ass t Surg. D. G. Wilson, 1st Michigan Cavalry. 40 Do Long. U. 1.., Pt., 15, 5th Mar. 24, Comp d fract. both bones right Mar. 24, Amp. right leg, junct. middle Discharged November 4, 1865. Vermont, age 20. 1864. leg by railroad accident. 1864. and lower thirds, flap. 41 Dor.nis, F.. Pt.. K. 98th Illi- Sept. 8, Left leg injured by railroad Sept. 8, Amput n left leg, upper third. Discharged July 30, 1863. imis. | 1862. accident. 1862. i - J.J Devine. P., citizen, age 17... Sept. 14. Comp d comminuted fracture Sept. 14. Circ. amp. both legs, low. th ds. Gangrene. Recovered June 24, 4.} . 1863. of bones of both legs. 1868. A. A. Surg. T. H. Stillwell. 1864. Spec. 1844, A. M. M. 44 Dohertv. E., Pt., D, 9th Mas Feh ( omn d coin, t nie.ture of bones Feb. 24, Amput n right leg, upper third. Mustered out June 21, 1864. sachusetts, age 40. 1864. right leg by kick of a mule. 1864. Surg. J. F. Sullivan. Oth Mass. 45 Dolaway, 11., Pt.. D, 50th Aug. 15. Comp d coin, fracture of left Aug. 15. Antero-posterior flap amp. left Discharged June 28, 1865. Spec. Pennsylvania, age 17. 1864. foot by railroad accident. 1864. leg, lower third. A. A. Surg. 251, A. M. M. W. C. Merrillat. 4M Douglas. S., Governrn t em- Dec. 20 Frostbite of both feet F eD . Circular amput n of both limbs Recovery slow. 47) plove. age 3:i. 1863. 1864. 1 inch above ankle joint. 48 Doyle, T., Pt., G, 14th Con April 24, Comp d com. fracture left leg April 24, Flap amp. left leg 2 ins. below Discharged August 1. 1865. necticut, age 28. 1864. by railroad accident. 1864. knee. Surg.Z.E. Bliss, U.S.V. 49 Dunlap, O. , Capt., I, 26th Dec. 28, Injury of right foot and right Dec. 28, Amput n of right leg at lower Discharged May 1 5, 1 665. ( A Iso Illinois. 1864. hand by railroad accident. 1864. third. Surg. O. Hoyt, 30th nmput n right forearm.) Stump Wisconsin. well healed. 50 Dunn. W. F . Pt.. I, 192d Aug. 12, Fracture mid. third right tibia Aug. 12, Circular amputation mid. third Jan. 1, 1865, amp. in right thigh, Pennsylvania, age 20. 1864. and fibula by fall from a rail 1864. right leg. lower third. Feb. 22, ligatiou way ear. femoral artery; recovery. 51 English, C.. Pt., C, 12th N. Nov. 30, Compound fracture of right Nov. 30, Flap amputation of leg at junc Discharged June 7, 1865. Y. Cavalrv, age 33. 1864. leg. 1864. tion of upper and mid. thirds. 52 Faulkner, j., Pt., B, 13th April 21, Compound fracture right foot- May 19, Flap amputat n of leg at lower Discharged May 30, 1 866. Infantry. 1865. by railroad accident. 1865. third. 53 Feelv, M.. Pt,, C, 38th New May 27, Left leg fractured by a falling May 27, Amputat n in middle third leg. Discharged December 29, 1862. -.A I Yofk. 1862. tree. 1862. Surg. A. J. Berry, 38th N. Y. 55 Ferguson, J. C., citizen Nov. 18. Comp d com. fract. both legs. Nov. 18. Circ. amp. both legs, low. third. Transferred. ) 1863. lower third, by railr d accid t. 1863. A. A. Surg. T. 11. Stillwell. 56 Fink, J., Pt., G, 1st Mary Aug. 30, Right leg and left foot man Aug. 31, Amputation right leg 1J ins. Discharged Oct. 24, 1864. (Also land P. 11. B., age 30. 1862. gled by railroad accident. 1862. below tuberositv of tibia. A. loss of great and 2d toes <;f left A. Surg. J. II. Bartholf. foot.) 57 Fitzgerald, W., Pt., A, 103d , Frostbite of left leg in rebel Amputation of leg at middle Mustered out August 15, 1865. Illinois, age 29. 1865. prison. 1865. third. 58 Fitzmier, F.,Pt., D, 3d New Dec. 13, Frostbite of both feet Amputation of right leg, lower Amp. of right foot at met. phal. Jersey Cavalry. 18G4. third, after discharge. art., andgreattoe. left foot, Dec. 20, 1864. Disch d July 5, 1865. 59) Flack, M., Pt., B, 135th Penn Jan. 28, Injury to both legs by railroad Jan. 28, Amputation right leg 5 inches Discharged ; sound stumps. 60) sylvania. 1863. accident. 1863. below knee, and left leg 4 ins. below knee. (11 Ford, T., Corp l, F. 1st Ala- Scrofulous disease of right foot, June 30, Antero-post. flap amp. of leg at Discharged November 4, 1865. bania Cavalry. contracted in Andersonville 1865. upper third. A. A. Surg. J. prison. D. Skeer. 62 Freeland. J. J.. Corp l, I, 74th Oct. 18, Right foot crushed Oct. 18, Flap amputation of leg, lower Discharged February 1, 1865. Indiana. 1864. 1864. third. Dr. B. Larrimer, Mil- lersburg. Indiana. 63 Funking, 11., Pt,, D, Oth N. Oct. 25, Comp d fracture left foot and Oct. 25, Circular amp. of leg. low. third. Disch dMay31. 1865. (Alsoeire. Y. Artillery, age 23. 1864. right arm by railroad accid t. 1864. Surg. Z. E. Bliss, U. S. V. amputation arm. middle third.) 64 Gainey, J., Pt., C, ISth New May 10. P.ight leg fractured by fall of May 10, Flap amputation of leg. middle Mustered out in 1865. York Cavalry. 1865. horse. 1865. third. Surg. A. C. Walker, 18th N. Y. Cavalry. 65 Gardner. M., Pt., I. 12th Aug. 26. Injury .f right foot and hand Aug. 27. Flap amput n right leg, lower Disch d July 18, 1865. (Also Colored Troops. 1864. j by railroad accident. 1864. third. Surg. G. Stegman,12th amputation right forearm, lower Colored Troops. third.) Stumps healed. 66 Garrett, J. W., Pt.. B. 1st Sept. 4, , Comp d tract, of bones of right Sept. 4, Circular amputation leg in up Discharged. Ohio Artillery, age 27. : 1864. leg by railroad accident. 1864. per third. 67 Gates, I,., Capt., H, 7th In- Sept. 15. Left leg crushed by railroad Sept. 15. Flap amp. of leg. upper third. Haemorrhage; gangrene. Dis diana. age 24. 1864. accident. 1864. Surg. W. M. Wright, 79th Pa. charged May 15, 1865. 68 Geary, J., Pt.. K, liilst New _ _ Extensive necrosis of tibia and Mar 23, Circular amp. upper third leg. Disch d October 9, 1863. Spec. York, age 53. large sloughing ulcer from 1863. Surg. J. J. Reese, U. S. V. 2793, A. M. M. injury by falling. SECT. II ] AMPUTATIONS IN THE LEG. 673 I NO. NAME, MILITARY DEBCUIl TION, AND AGE. DATE OF INJURY OR DISEASE. NATURE OF INJURY ou DISEASE. DATE OF OPERA TION . OPERATION AND OPEKATOI;. RESULT AND REMARKS. 69 Gilbert, J. X.. Serg t, B, 4th Feb. 4, Fracture of right leg by kick April 5, Amputat n of leg, middle third. Discharged August 3, 1863. Michigan Cavalry. 1863. of a mule. 1663. Ass t Surg. C.C.Gray, U.S.A. 70 Glecson, H., Pt., A, 140th Scurvy, resulting in mortifica June 7, Amputat n upper third left leg. (April 25, 1865, amp. right thigh, New York, age 27. tion, contracted while a pris 1865. Dr. A. M. Leonard, Lockport, mid. third.) Disch d Aug. 29, oner of war. New York. 1865; stumps healed. 71 Glover, W. A., 1 t., B. 18th Tubercular synovitis of left May 5, Flap amp. leg at lower third. Discharged June 17, 1865; stump Indiana. ankle joint. 1865. A. A. Surg. S. A. Cummins. entirely healed. 12 Grady, M., Pt., A, 48th Ohio. A tiff. 9, Left ankle joint fractured by June 13 Flap amp. leg, lower third. Dr. Discharged ; good stump. 1863. explosion of steamboat. 1867. W. H. Mussey. Cincinnati. 73 Griffin, K. D.. Pt., B, 40th Oct. 26, Right leg crushed by cannon Oct. 26, Flap amput n leg, upper third. Discharged February 23. 1862. Illinois. 1861. falling on it. 1861. Surg. S. W. Thompson, 40th Illinois. 74 Griswold, F. N., Saddler. G, May 1, Sprain of right ankle; inflam- Dec. 26, Flap amputation of leg at up Mustered out \ov.8, 1865. Died 2d New York Cavalry, age 1665. mat n of synovial membrane ; 1867. per third. June 18, 1870, of consumption. 21. carious bone. 75 Hassett, J., Pt., 1, 13th Mary Mar. 25, Comminuted fract. of os calcis April 9, Amp. of leg, upper third, lateral Discharged August 5, 1865. land P. H. B. 1865. android, cuneiform bone.right 1865. flap of skin, circ. sect, of muse. foot, by railroad accident. A. A. Surg.M B. McCausland. 76 Hatch, G., Pt., M, 14th Col d May 22, Lower third right leg crushed May 24, Circularamp. leg at junction of Discharged; gtump healed. Heavy Artillery, age 23. 1865. b} railroad accident. 1865. upper and middle thirds. A. A. Surg. D. Shephard. 77 Hearn, J. M., Pt., A, 7th Ten May, Burn of left leg, at Anderson- Sept. 9, Flap amp. of leg, lower third. Discharged July 13, 1865. nessee Cavalrj . 1664. ville prison. 1864. Drs. Elon and Pelat, C. S. A. 78 Hockathorn, , Pt., E, 100th (Edema of right foot from May 2, Amp. of leg at mid. third. Dr. Must d out July 19, 65; healthy Pennsylvania. sprain : mortification. 1866. M. P. Barker, Newcastle, Pa. stump. 79 Hoblitt.W. S., Pt., 82d Ohio, Nov. 7, Comp d fracture of left ankle Nov. 8, Antero posterior flap amput n Mustered out June 9, 1865. ag-e 35. 1864. by railroad accident. 1864. leg at middle third. 80 Houghtaling, H., Pt., B, 8th Sept. 20, Necrosis following sprain right April 20, Ant. flap amp. of leg. low. third. Discharged August 12. 1865. Michigan, age 22. 1864. ankle. joint. 1865. Surg. R. B. Bontecou, U. S.V. 81 Housefelter, J., Pt., M, 6th Nov. 15, Diffused aneurism left post. tib. Dec. 7, Amputation leg at junct. lower Discharged March 3, 1863. New York Artillery. 1862. artery near int. mal., inj. to 1862. and middle thirds. Surg. J. artery by broken glass ; haem. G. Wood, 6th N. Y. Artillery. 82} Hurley, T., Pt,, K, 8th Ten Mar. 7, Injury of both legs by railroad Mar. 7, Amp. right leg, upper third, Mustered out July 17, 1865. 83 J nessee Cavalry. 1865. accident. 1865. left leg, middle third. Drs. L. C. Brown and E. B. Root, Painesville, Ohio. 84) Hnv.ird. A..Pt..f!.l22d Penn- Feb. 10, Frostbite of both feet Mar. 10, Amp. of both legs. mid. third. Discharged August 11, 1863. *" I 85] sylvania. 1863. 1863. A. Surg. E. Marshall, 124th New York. 86 James, H., Pt., G, 6th Penn. May 28, Bones of right leg comminuted May 28, Antero-posterior flap amp. leg, Discharged September 7, 1865. Cavalry, age 25. 1865. at middle third by railroad 1865. upper third. A. A. Surg. H. accident. M. Bellows. 87 Johnson,O., Pt., B, 44th Wis Mar. 28, Left inter, malleolus and pos Mar. 28, Flap amput n leg, lower third. Mustered out July 29, 1865. consin, age 44. 1865. terior tibial artery severed by 1865. A. A. Surg. J. K. Simmons. an axe. 88 ( Jones, J., Pt., H, llth Penn. Typhoid fever ; disease of both Mar. 22, Left leg at up. third, right leg Disoh d May 27, 1865. (Sabre 89$ Cavalry, age 30. limbs, resulting in gangrene. 1865. at lower third, circular. A. A. cut in lumbar region October 1 7, Surg. A. Claude. 1864.) SO Jones, S., 1 t., I, 30th Iowa, Disease of both feet, ending in Oct. 16, Flap amputation of left leg Nov. 6. Chopart s amp. right foot. age 21. 1863. gangrene. 1863. near upper third. Surg. N. Nov. 11, int. plantar artery tied. Gay, U. S. V. Discharged June 3, 1865. 91 Josephus, M., Government July 23, Left foot crushed by a wheel ; Oct. 20, Oval amp. leg at junct. middle December 31, 1864; nearly well. teamster, age 25. 1863. gangrene. 1864. and lower thirds. Surg. T. J. Wright, G4th Col d Troops. 92 Keffe, J., Pt., D, 12th Massa Aug. 14, Compound fracture right ankle Aug. 14, Posterior flap amp. of leg at Discharged October 19, 1863. chusetts. 1863. joint by railroad accident. 1863. junction mid. and lower thirds. 93 Keller, J. C., Pt., I, 49th Mar. , Frostbite toes of left foot; gan Nov. , Flap amput n leg, lower third. Discharged May 15, 1865. Pennsylvania. 1864. grene. 1864. Dr. B. F.Wagonseller, Selin s Grove, Pennsylvania. 94 Kelly, U. F., Serg t, B, 28th June 10, Right foot and leg crushed by June 10, Amp. leg in upper third. Surg. Discharged July 10, 1862. Kentucky, age 19. 1862. railroad accident. 1862. A. H. Thurston, U. S. V. 95 Kelsey, j .. Pt., I, 18th In Nov. 15, Axe wound of right foot ; caries Sept. 26, Amputation at middle third of Discharged Dec. 10, 1863; stump diana, ago 24. J862. extending to tarsus. 1863. leg. healed. 96 Kenyon, G. \V., Pt., H, 46th Aug. 18, Right foot fractured byrailroad Aug. 18, Flap amp. of leg at lower third. Mustered out July 16, 1665. Penn., age 25. 1864. accident. 1864. Surg. S. Hart, U. S. V. 97 Kier, I., Pt., A, 99th Colored July 14. Right foot injured by railroad July 15, Flap amp. of leg, lower third. Discharged. Troops. 1864. accident. 1864. Surg. H. E. Huberich, 99th Colored Troops. 98 Lambert. II. M., Serg t, D, Oct. 10, Comp nd comminuted fracture Oct. 25, Double flap amputation of leg HiRin. Nov. 10. amp. thigh, low. 12th Illinois Cav ry, ago 30. 1863. right leg by fall of a horse. 1863. in upper third. A. A. Surg. third. Disch d July 30. 1864. W. H. Ensign. Specs. 1744 and 1879, A. M. M. 99 Lasbander. J. B., Pt., L. 4th June 3, Loft ankle run over by wagon ; June 3, Amput n of leg at lower third, Discharged November 3, Ib65. New York Heavy Artillery, 1865. tibia dislocated and low. third 1865. skin flaps and circ. section of ge 19. of fibula and internal malle muscles. A. A. Surg. A. W. olus broken. Merrill. 100 Leonard, J. S., Pt., B, 1st N. May 28, Loft leg run over by a wagon ; Mar. 15, Antero-post. flap amp. of leg at Mustered out, Spec.2403,A.M.M. Jersey Light Artillery, age 1864. sloughing and necro. of tibia. 1865. junct. upper and mid. thirds. 45. A. A. Surg. U. B. Watson. 101 Lewis. C., Pt., B, llfith Col June , Sprain in right instep Feb. 1, Flapamp. of log at lower third. Discharged May 5, 1866. ored Troops, age 22. 1865. 1866. ,A. Surg.G. M. McGill,U.S.A. 102( Lowe, G. S., 1 t. F, 35th Ilosiut il vinfr of both limb 1 ? Jan. 12 Cironl ir ininiit ition of both Dischar"ed May 2, 1863. Died 103J Massachusetts. 1863. legs at lower third. August 5, 1867. 104 Md ann. 1!.. 1 t.. D, 92d Illi- June 2, Comp d fracture right tibia and June 2, Antero-posterior flapamputat n Discharged June 28, 1865. nois, age 43. 1864. fibula by falling timber. 1864. leg. Surg. C. Helm, 92d Ills. 105 McDonald, \V. 11., Pt., F, Dec. 1 1, Right foot and leg crushed by Dec. 11, Amputation of leg in middle Discharged February 5, 1864. 60th New York. 1862. railroad accident. 1862. third. 100 Mclntyre. J., Pt., A, 3d Mar. 18, Left foot injured by railroad Mar. 18. Flap amp. of leg. lower third. Discharged. Pennsylvania. 1865. accident. 1865. Dr. A. B. Carr, St.Clnir.Penn. 107 McLnv! W., Pt., G, 12th Comp nd comminuted fracture Nov. 3, Antero-post. flap amp. right log, Gangrene of stump. Jan. 15, 64. Illinois. of bones of right log by ma- 1863. junct. upper and middle thirds. amputation of thigh, low. third. chinery. A. A. Surg. W. P. Sweetl.iml. Discharged July 5, 1864. 108 McQnade, T., I t.. F, 69th July 26, Comminuted fracture left ankle July2(i, Circular amputation of leg at Mustered out August 3, 1861. New Yi.rk. 1861. .joint by railroad accident. 1861. middle third. 109 Magly. A., J t., F. 66th Ohio. Oct. 29, Comminuted fract. both bones Oct. 30, Antero-posterior flap amput n Discharged May 17, 1865. age 37. 1664. i of loft leg: railroad accident. 1864. of log in upper third. 110 Mahafley, S., Pt., H, 30tli June 8, , Right leg crushed by railroad Juno H, Flap amp. of leg. middle third. | Mustered out. Iowa. 1865. accident. 1865 Surff. S. G. U<urers.30th Iowa, i 1118,-) 674 MISCELLANEOUS INJURIES. [CHAP. XI. NO. NAME, MILITARY DESCRIPTION, AXU AGE. DATE OF INJURY OR DISEASE. NATUKE OF INJURY OR DISEASE. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. Ill Manson, M., Pt., F, 21st Periosteal inflam. of left ankle June 15, Flap amputation of leg, lower Disch d January 12, 1863. Died Maine. and caries of tarsal bones. 1867. third. Dr. G. E. Brickett, Jan. 4, 1874, of typhoid fever. 112 Manuel, J., Contraband, age Feb. 4, Comp d com. fracture of leg 4 Feb. 5, Posterior flap amputat n of leg. Feb. 20, ligation of anterior tibial 10. 1864. inches below knee joint by 1864. A. A. Surg. C. Pelaez. artery for haemorrhage. Dis railway cars. charged December 15, 1864. 113 Marshall, J., Corp l, B, 4th Jan. 1, Fracture of both bones of left Feb. 10, Flap amputation of leg, middle Discharged May 23, 1865. 114 Ky. Cavalry, age 25. Mason, G., Pt.. C, 12th Vet. 1864. May 10, leg by fall. Left foot crushed by railroad 1864. May 15, third. Circular amp. of leg at junct. of Discharged July 19, 1865. Re- Reserve Corps. 1864. accident. 1864. middle and lower thirds. A. amputation 4 ins. higher Sept. A. Surg. J. B. Cutter. 26, 1865. Died Dec. 24, 1868. 115 Mern-ii), D. G., Pt., B, 44th Phagedenic ulcer of right leg ; Jan. 7, Antero-post. flap amp. of leg, Jan. 9, haemorrhage. Discharged Wisconsin, age 40. sloughing of soft parts. 1865. upper third. Ass t Surg. J. C. May 31, 1865. Thorpe, U. S. V. 116) Miller, D. W., Pt., A, 13th Dec. , Loss of both feet from frostbite. May 13, Amp. left leg at junct. mid. and Discharged January 14, 1865. 117} Kentucky Cavalry, age 18. 1863. 1865, lower thirds ; amp. right leg Feb. 1, at junct. of middle and lower 1866. thirds. Dr. H. Owens. " - i Monran M Pt H 3d Col Jan. 1 Frostbite of both feet . . . Jan. 25, Amput n of left and right legs Discharged May 9, 1865. 111* [ ll Jl ored H vy Art., age 19. 1864. 29, 64. at middle thirds. Surg. H. 11. Hood, 3d Colored H vy Art. 120 Mullally, J., Pt., C, 49th Dec. 8, Right leg injured by railroad Dec. 9, Amputat n of leg at mid. third. Discharged June 18, 1865. Mass., age 18. 1862. accident. 1862. Dr. W. J. Gilfillan, Brooklyn College Hospital. 1O1 Nash J. Pt. H 5th Penn. Scrofulous caries right tibia, Jan. 8, Circular amputation of leg at Discharged June 18, 1864. l-wl Cavalry, age 31. the result of an old fracture. 1864. middle third. Ass t Surg. C. A. McCall, U. S. A. 122 Ohring, C., Corp l, F, 42d Dry gangrene of left leg Sept. 9, Flap amp. of leg, upper third. Discharged May 10, 1864. Spec. I llililUl. l. ilfifG 2L. 1863. A. A. Surg. H. M. Lilly. 1921, A. M. M. 123 Older, B., Pt., I, 68th Ohio, Fob. , Camp fever and disease right April 1, Amp. of leg in middle third. Discharged August 19, 1862. age 22. 1862. foot ; excessive ulceration. 1862. A. A. Surg. W. R. Burke. 124 Olds, J. K., Serg t, B, 10th May 29, Coinp ndfract. mid. third right May , Amputation of leg below knee. Discharged June 14, 1865. (Feb., N. Y. Artillery, age 29. 1864. tibia and fibula by a blow 1877. 1865, ends of tibia removed.) from a cable. 125 Orne, W. H., Corp l, D, 16th Sore on left leg, followed by Mar. , Amputation leg in mid. third. Discharged Aug. 20, 1863. Died New Hampshire. disease of bones of foot after 1870. Dr. T. Haynes, Concord, N.H. Jan. 5, 1874, of chr. diarrhoea. debility and intermittent fev. 126 Peaceley, C., Pt,, B, 49tb May 1 5, Compound fracture left ankle May 15, Circular amputat n of leg, low. Extensive sloughing. Mustered Indiana, age 26. 1865. by railroad accident. 1865. third. Surg. J. G. Hatchitt, out August 7, 1865. U. S. V. 127 Peck, S., Pt.. C, 184th New Sept. 17, Lacerated wound left ankle, Sept, 17, Flap amp. of leg, lower third. Discharged July 18, 1865. York, age 37. 1864. opening joint, by railr d acci 1864. Dr. D. T. Krebs, Watsontown, dent. Penn. 128 Penny, L., Pt., E, llth Ohio, Mar. , Right foot and leg crushed by Mar. , Flap amp. of leg at mid. third. Discharged June 26, 1865. age 22. 1864. railroad accident. 1864. A. A. Surg. R. Wirth. 129 Perrigo, C. M., Pt,, I, 143d Oct. 20, Necro. of left ank. j t and wast Sept. 24, Flap amp. of leg, middle third. Discharged September 17, 1863. New York. 1862. ing of leg, the result of sprain. 1863. Dr. F. Hyde, Courtland, N.Y. 130) Pcttibone, S., Pt., D, 33d Mar. 2, Both legs injured by railroad Mar. 2, Flap amp. of both legs in mid. Discharged August 4, 1865. 131 j Illinois. 1865. accident. 1865. third. Surg.G.P.Rex, Ski 111. 132 Peuschke, A., Corp l, K, Sept. 30, Right leg injured by railroad Sept. 30, Flap amputation of leg, middle Discharged June 7, 1865. 145th New York. 1863. accident. 1863. third. 133 Pike, P., Pt., D, 1st Colorado Nov. 21, Compound fracture of left leg Jan. 29, Amput n of leg in upper third. Discharged. Cavalry. 1864. by a fall from a horse. 1867. Dr. J. W. Hamilton, Colum bus, Ohio. 134 Poole,R. \V., Pt., 15th Ohio, June 3, Left leg injured by railroad June 4, Double flap amp. of leg, mid. Mustered out June 8, 1865. age ] 9. 1865. accident. 1865. third. A.A.Surg.C. E.Boyle. 135 Quaid, W. II., Pt., L, 5th July 29, Left leg injured by horse fall July 29. Flap amputation of leg in mid Discharged September 21, 1865. Pennsylvania Cavalry. 1865. ing on it. 1865. dle third. : .u Redfuot, G., Corp l. K," 106th Feb. 20, Frostbite of left foot in rebel Aug. 11, Circular amp. of leg, low. third. Discharged December 12, 1865. Pennsylvania, age 29. 1865. prison. 1865. A. A. Surg. E. DeWitt. 137 Row, M. D., Corp l, E, 5th Aug. 15, Amp. of leg, mid. third. Dr. Discharged June 29, 1865. New York Cavalry. vy contracted in rebel prison. D. Prince, Jacksonville, 111. 138 Richardson, J., Contraband. Dec. 2, Necrosis of lower end of tibia Mar. 15, Posterior flap amp. of leg, upper Good result. 1864. and sloughing ulcer involving 1865. third. Surg. F. E. Piquette, foot, after injury. 86th Colored Troops. 139) Robinson, A., Pt., I, 8th Col Dec. 18, Frostbite of both limbs Feb. Amput n of both legs in lower Discharged Juno 7, 1865 ; sound 140J ored Troops, age 26. 1864. 1865. third. stumps. 141 Rumpf, J., Serg t, B, 75th Mar. 15, Injury to right leg by railroad Mar. 15, Flap amputation of leg at mid Discharged June 19, 1865. Pennsylvania. 1865. accident. 1865. dle third. 142 Scott, M., Pt., I, 14th Ohio. Irritative fever, debility, and April 19, Flap amput n of leg in middle Mustered out March 8, 1865. gangrene of right foot, result 1865. third. Dr. S. F. Forbes, To ing from imprisonment. ledo, Ohio. 143 Severy, W. F., Pt., I, 3d Dec. 25, Left leg jammed by boat against Dec. 25, Circular amp. of leg, mid. third. Discharged October 31, 1862. Vermont, age 25. 1861. wharf; bones of foot crushed. 1861. Dr. S. Cabot. Boston. 144 Shanger, R., Pt., 4th New Julv27, Left leg crushed by wagon; Oct. 27 Flap amp. of leg, upper third. Discharged October 21, 1865. Jersey Lt. Battery, age 20. 1864. gangrene ; necrosis of tibia. 1864. A. Surg. T. Calhoun, U.S.A. 145 Simmons, W., Substitute, Mar. 4, Right foot and ankle crushed Mar. 4, Circular amp. of leg, mid. third. Discharged July 8, 1665. age 32. 1865. by railroad accident. 1865. A. A. Surg. J. C. Morton. 146 Skillin, W. E., Pt., H, 15th Jan. 17, Left leg cut off by railroad ac Jan. 17, Circular amput n of leg. Ass t Discharged. Maine. 1865. cident. 1865. Surg. G. Z. Higgins, 15th Me. 147 Slater. C. H., Pt., D, 27th Dec. 28, Axe cut of left foot Jan. 8, Circ. amp. of leg, middle third. Mustered out May 25, 1863. Died New York. 1862. 1863. Surg. H. Bryant, U. S. V. January 8, 1872. 148 Smith, J. D., Pt., C, 74th Nov. 7, Left leg injured by railway ac Nov. 7, Flap amputation of leg in mid Discharged April 25, 1865. Illinois. 1864. cident. 1664. dle third. 149 Smith, R., Pt., E, 100th N. Sept. 13, Fracture of right foot by rail- Sept. 13. Flap amp. of leg, lower third. Discharged December 4, 1864. York. 1864. road accident. 1864. Surg. Hiland, C. S. A. 150 Smith, T., Contraband, age Nov. , Comminuted fracture of leg ; Jan. 25, Circular amp. of leg in upper Recovered in 30 days. 33. 1864. railway collision. 1865. third. Ass t Surg. T. A. Mc- Graw, U. S. V. 151 Snyder, J., Pt., B, 51st New Oct. 4, Comp nd fract. left ankle and Oct. 4, Circ. amp. left leg, lower third. Discharged July 2G, 1865. Spec. York, age 27. 1864. foot by railroad accident. 1864. A. A. Surg. L. Curtis. 3676, A.M. M . 152 Stacy, A., Pt., H, 12th Kan Mar. 20, Axe wound of left foot ; necro Aug. 15. Amput n at lower third left leg Discharged December 31, 1864. sas, age 51. 1864. sis of bone. 1864. by Dr. Clark. 153 Stevens, J. A., Pt., E, 1st , Erysipelas of right foot Tnlv 7 T ost fl irt imt>ut ilion ri^ht Iftr Discharged September 8, 1865. Wisconsin Cavalry. a *i.) *- * , 1865. A. A. Surg. .1. D. Skeer. 154 Stone, I. M., Pt., M, 1st Illi Oct. 21, Commin ution of lower end right May 22. Short ant. and long post, flap Discharged December 28, 1864. nois Artillery, age 24. 1863. tibia and astragalus by fall- ! 1864. amp. of leg, up. third. Surg. Spec. 2422, A. M. M. ing timber. H. Culbrrtson, V. S. V. SECT. II.] AMPUTATIONS IN THE LEG. 675 NO. NAME, MILITARY DESCRIPTION, AND AGE. DATE OF INJURY OR DISEASE NATURH OF INJURY OR DISEASE. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMAKKS. 155 Stoner, F., Pt., K, 57th Penn Dec. 22, Right foot fractured by railroad Dec. 22, Circular amputation left leg, Discharged July 7, 1865. sylvania. 1864. , accident. 1864. middle third. 156 St. Ong, M., Pt., B, 7th Ohio, age 34. Sept. 20, Left foot and ankle crushed by 1863. railroad accident. Sept. 20, 1863. Antero-post, muse, flap ampu tation of leg, middle third. Discharged January 23, 1864. 1571 Storer, L., Pt., F, 105th Illi Sept. 24, Both legs injured by railroad Sept. 24, Flap amp. right leg. Surg. J. Discharged December 15, 1863. 158J nois. 1863. accident. 1863. Bennett, 19th Mich. Circ., left leg. Ass t Surg. J. K. Link, 21st Illinois. 159 Taylor, G. H., Pt., H, 1st Sept. 23, Fracture of left tibia and fibula Sept. 23, Amputation of leg Transferred to prison December N. C. Cavalry, age 22. 1863. by fall of horse. 1863. 15, 1863. 160 1 Taylor, H., Serg t, B, 30th May 2, Fract. of left leg, lower third; May 18, Double flap amp. leg, upper Discharged August 9, 1863. Illinois. 1863. basin.; lig. ant. tibial artery, j 1863. third. A. A. Surg. L. Dyer. 161 Thomas, J. C.. Pt., I, 8th N. Dry gangrene of right leg from April 5, Flap amp. leg, up. third. Dr. Discharged October 3, 1865. Y. H vy Artillery, age 19. exposure in rebel prison. 1865. M. W.Townseml, Byron, N.Y. 162 Thompson, H., Corp l, G, 5th Mar. 20, Comp d dislocation right ankle \ April 13, Flap amp. leg, middle third. Discharged June 2, 1865. Tenn. M t d Inf.. age 20. 1865. outward by railroad accident. 1865. A. A. Surg. A. S. Austin. 163 Thompson, W., Boatswain s Oct. 27, Right foot contused by recoil Oct. 28, Amputat n of leg, middle third. Discharged Jan. 19, 1865. Died Mate, U. S. N. 1864. of gun. 1864. May I, 1874. 164 Troutman. J. W., Corp l, F, Sept. 16, Fracture of right leg by acci- Sept. 16, Flap amp. of leg, mid. third. Discharged April 1, 1863. 40th Indiana. 1862. dent. 1862. Dr. D. Funkhouber, Indian apolis. 165 Trueheart, G. W., Pt., F, June 15, Fracture of right leg by rail June 15, Circular amp. of leg, mid. third. Discharged May 30, 1865. (May 67th New York, age 20. 1864. road accident. 1864. A. A. Surg. W. C. Merrillat. 12, 64, amp. arm, lower third.) 166 Underwood, J., Pt., I, 103d June 6, Compound fracture of left leg July 2, Amputation of leg below knee. Haemorrhage. Discharged Nov. Illinois, age 24. 1863. by railroad accident. 1863. A. A. Surg. J. Thompson. 18, 1863. Spec. 1704, A. M. M. 167 Wallace, B., Freedman, age Old ulcer of right heel, extend July 14, Oval amptat n leg. upper third. Did well. 35. ing up leg ; gangrene. 1864. Surg. T. J.Wright, 64th C. T. 168 Ward, W., Pt., B, 60th New May 10, Left leg injured by railroad May 10, Flap ampt n leg, middle third. Discharged September 16, 1862. York. 1862. accident. 1862. Surg. J. S. Gale, 60th N. Y. 169 Watkins, E. D., Pt., H, 5th Feb. 21, Frostbite of both feet ; amput n Mar. 18, Amputation right leg 6 inches Recovered. Kentucky Cavalry, age 30. 1864. both feet April, 1865. 1866. below knee. 170 Watson, R., Pt., E, 10th Oct. 24, Left leg fractured by railroad Oct. 24, Amputation of leg, mid. third. Discharged. Tennessee, age 23. 1864. accident. 1864. 171 Watt, P., Pt., A, 28th Mas Jan. 11, Left leg injured by railroad Jan. 11, Flap amp. of leg, lower third. Discharged. sachusetts. 1862. accident. 1862. Jan. 14, 1864, re-amputation. 172 Watts, A., Pt., E, 73d Illi Erysipelas and disease of bone Nov. 20, Circular amp. leg. lower third. Gangrene. Discharged March nois. 1863. from a sprain. 1863. Ass t Surg.B.E.Fryer,U.S.A. 15, 1865. 173 Way, C., Pt., H, 47th Iowa. Sept. 18, Left foot injured by railroad Sept. 18, Circ. amp. leg at low. third. Dr. Discharged. 1864. accident. 1864. Cherry, Bloomington, 111. 174 Weed, E. D., Pt., I, 128th Oct. 11, Right leg crushed by railroad Oct. 11, Amp. leg, middle third. Dr. T. Mustered out May 24, 1865. Indiana. 1864. accident, 1864. Higday, Rolling Prairie, Ind. 175 Weidle, J. P., Pt., G, 29th Feb. 13, Right ankle dislocated and tib. Feb. 13, Teale s rect. flap amp. A. A. Discharged September 29, 1864. Ohio, age 40. 1864. and fibula fractured by falling 1864. Surg. A. F. Johnson ; gang.; building. re-amputated May 7. 176 Wellirs, W., Pt., K, 60th Illinois. June 15, 1865. Fracture of bones of left leg by railroad accident. July 30, 1865. Amp. leg, junct. upper thirds. Dr. Owens, St. Luke s Hos Mustered out July 31, 65. Died Nov. 29, 1874, of consumption. pital, Chicago. 177 Werner, A., Pt., 101st Penn Mar. 11, Right leg injured by railroad Mar. 11. Amputation leg in middle third. Discharged June 27, 1865. sylvania. 1865. accident. 1865. Surg. S. J. Mintzer, U. S. V. 178) Williams, B., Pt., I, 3d Col Jan. 1, Both legs frostbitten Jan. 25, Oval amp. of both legs at junc Discharged May 9 1865 * stumps 179/ ored Heavy Artillery, age 1864. 1864. tion lower thirds. Surg. H. H. healed. 14. Hood, 3d Col d H vy Art, 180 Wilson, J., Government em Necrosis of right tibia of four Aug. 20, Flap amput n leg, upper third. Convalescent. ploye, age 23. years standing. 1864. Surg. E. A. Clark, U. S. V. 181 Aenishield, L., Corp l, H, Mar. 30, Right foot cut by an axe ; swell April 19, Flap amput n leg, upper third. Died April 20, 1865. 66th Illinois, age 19. 1865. ing and inflammation. 1865. A. A. Surg. R. J. Lulder. 182 Black H Pt D 3d Maine Disease of left foot necrosis of July 3 CircuUir Jimp, leer lower third. Died July 8, 1864. age 20. metatarsus. 1864. A. A. Surg. W. B. Carey. 183 Buchanan, D., Pt., F, 12th July 13, Contusion of left foot by fall Aug. 6, Circularamp. leg, middle third. Died Aug. 6, 64 ; shock and loss Penn. Cavalry, age 17. 1864. from horse ; necrosis. 1864. A. A. Surg. A. R. Gray. of blood. Spec. 1839, A.M. M. 184) Black, J., Pt., I, 16th Conn., April 24 Died April 27 1865 of pxhiust n O-VJ^ F 185 j age 33. captivity. 1865. third . A. A. Surg. E. DeWitt. 186 Bowns, W. A., Lieut, and May 21, Comp d com. fract. right tibia May 21, Circ. amp. mid. third right leg Died May 21, 1865. Quartermaster, 15th Conn., 1865. and fibula, middle third, and 1865. and up. third left thigh. Surgs. age 26. left femur, middle third, by C. A. Cowgill, U. S. V., and railroad accident. Surg. N. Meyer, 16th Conn. 187 Bryant, B., Pt., B, 2d East Sept. 1, Right leg inj. by falling down June 8, Amputation of leg at upper June 11, hamorrh. Died June Tennessee Cavalry. 1862. an embankment : necrosis. 1863. third. 16, 1863, of pyaemia. 188 Bucke, N. F., Serg t U. S. Dec. 17, Left leg fractured by railroad Dec. 17, Amputation of leg in upper Died December 17, 1861. Spec. Marines. 1861. accident. 1861. third. 20, A. M. M. 189) Coleman, R., Pt. B 83d Nnv Frostbitft of both fppt mortifi A mnntltinn ttf Vrth Ipcrfi }iAlmv Died January 2 1 865 190J Pennsylvania. 1864. cation. knee. 191 Column, M., Pt., F, 103d Senile gangrene, left foot, from Nov. 9, Antero-post. flap amp. leg at Died November 12, 1803, of ex Illinois, aged 42. 1863. scorbutus. 1863. middle third. A. A. Surg. R. haustion. H. Brown. 192 Creek, J. W., Pt., D, 91st T^lopr of Ipft Ipr^ PYrtOfiinir ti Vtii June 29 Arrmiititum nf Ion 1 nnnprthirfl Died July 5 1864. Indiana, age 21. 1862. from injury by fall. 1864. 193 Curgill, W., Pt., 90th New Oct. 29, Left leg and foot and right thigh Oct. 29, Amp. left leg at tuber, of tibia Died three hours after operation. York. 1864. crushed by railroad accident. 1864. and right thigh at low. third. Ass t Surg. C. Bacon, U. S. A. 194 Davis, D., Pt., L, 2d N. Y. Scald of left ankle by boiling T^OO 17 Died December 17 1864. Heavy Artillery, age 23. 1864. coffee; gangrene; hamorrh. 1864. Ass t Surg. J. T. Calhoun, U. S. A. 195) Dawson. W., Serg t, B, 1st April 14, Fractured bones of both legs ; April 16, Amputation both legs in upper (Also disl. left shoulder and other 196| Kentucky Cavalry. 1863. dislocation both ankles. 1863. third. injuries.) Died April 18, 1863. 197 ! Dennis. J., Pt., Signal Corps, April 20, Gangrene; ulccrat n following Sept. 26, Circular amp. leg at up. third. Died Oct. 1, 1804, of exhaustion. 1 age 19. 1864. injury by kick of a mule. 1864. A. A. Surg. C. Bausch. 198 Dunham, M.. Pt., D, U. S. Jan. 24, Necrosis following axe wound June 6, Amputation of leg, upper third. Died June 18, 1864, of pyoDmia. Engineers, age 23. 1864. of left ankle. 1864. Surg. E. Bentley, U. S. V. 199 Flenner, L. G., Pt., I, ]61st July 10, Accidental contusion right foot; Avig. 3, Circular amp. of leg. up. third. Died Aug. 8, 1864, of exhaustion. Ohio, nge 45. 1864. extensive sloughing. 1864. A. A. Surg. M.B.McCausland. 200 Garrett. G., Pt., F, 16th Col Sept. 26, Comp d fract. tibia and lacera- j Oft. 1, Circ. amp. leg at lower third. Died December 4, 18G4. ored Troops, age 28. 1864. tion foot by railroad accident. 18li4. Surg. II. B. Johnson, 115th O. 201 Gellison. G., Pt., E, 65th Fr iptiirp of bones of \cff b\ r A mr,nt -iiirm ^f lor Died August 12, 1863. Illinois. railroad accident. 1 BRYAN (J.), A *W/ account of the "3/ary Ann" Hospital, Grand Gulf, Miss., in Am. Med. Times, 1863, Vol. VII, p. 5. 676 MISCELLANEOUS INJURIES. [CHAP. XI. NO. NAME, MILITARY DESCRIPTION, AMD AGE. DATE OF INJURY OH DISEASE. NATURK OF INJURY OR DISEASE. DATE OF OPEBA- TION. OPERATION AND OPKRATOH. RESULT AND REMARKS. 202 Gilchrist, J., Pt., I, 31st In Chronic ulcer of left leg becom April 20, Amputation left leg. Surg. F. Died April 26, 1863, of gangrene. diana. ing gangrenous. 1863. Irish, 77th Pennsylvania. 203 Gilchrist, W., Corp l, H, 2d May 16, Left leg kicked by horse; ex Julv 10, Circ. amput n leg, junction of Chills and fever and diarrhoea. Maine Cavalry, age 24. 1864. tensive gangrene overdorsuin 1864. upper thirds. A. A. Surg. G. Died July 22, 1864. of foot. E. Bricket. 204 Glasgow, G., colored conk, Dec. , Feet frostbitten ; sloughing of Feb. 3, Amput n left leg, middle third. (Jan. 11, 1865, amp. of toes, both F, 3d New Jersey Cavalry. 1864. toes, exposing bones. 1865. A. A. Surg. S. T. Buck. feet sloughing.) Died Feb. 7. 1865, of traumatic pneumonia. 205 Graham, D., Pt.. I. 51st N. July 17 Comp d com. fract. of bones of July 20, \mputation of leg Died July 24, 1864. of nervous Carolina. 1864. leg by railroad accident. 1864. shock and pyaemia. 206 Hurmer, S., Pt., E, 98th Muy Compound fracture right leg May Amputation of right leg. . June. 1864, auiput n thi^h above Pennsylvania, age 18. 1864. by car running over it. 1864. knee. Died August 30, 1864, of epilepsy. 207 ( Hart, J., Pt., E, 140th New Mortification of both feet from Jan. 4, Circ. amp. both legs, low. third. Died January 16, 1863. 208 i York, age IP. exposure to cold. 1863. Surg. J. H. Baxter, U. S. V. 209 Henry, W., frccdinan, age May 8, Left ankle crushed by railroad May 8, Amputation of leg, lower third. Died May 19, 1864, of gangr.-ne. 22. 1864. accident. 1864. A. A. Surg. B. E. Dodson. 2101 Holloran, J., Pt., D, 140th Mortification of both feet, ex Jan. 7, (Jirc. ump. l)otli It* ""s low. third. Died Feb. 18, 1863. of pysemia. *,*.\j i 211 1 New York. tending above ankle joint. 13, 63. Surg. .). H. Baxter, U. S. V. 212 Hutchison, S., Pt., A, 5th Mar. JO, Lett leg crushed by railroad Mar. 11, Amp. leg. upper third, lateral Died March 15, 1864. Maryland, age 27. 1864. accident. 1864. skin flaps and circ. sect. muse. Surg. Z. E. Bliss, U. S. V. 2131 214/ Ivory, J., Pt., D, 2d Tenn. Cavalry. Frostbite of both feet; gan grene. April 2, 1864. Flap amp. both legs, low. third. A. A. Surg. F>. Herwig. Died AprilSO, 1864, of congestive fever. 215 Jackson, J., Pt., K, 9th Mas Oct. 15, Left leg injured by railroad ac Cvi, 17, Flap amputation of leg. A . A . Died October 19, 1864. sachusetts. 1864. cident. 1864. Surg. T. B. Townsend. 216 Kappelman, W., Pt., G, 17th Nov. 8, Left leg fractured by wagon Nov. 8, Amputation of leg, low. third. Died May 14, 1864, of acute plen- Missouri. 1863. wheel. 1863. ritis. 217 Kennioott, E. S., Pt., D, 31st Oct. 27, Accidental compound fracture Oct. 27, Circular amputation of leg, up Gangrene. Died Dec. 1, 1864, of Iowa, age 28. 1864. of bones left leg. 1864. per third. typhoid fever. 218 King, J., Pt., 2d Battalion April 27. Right foot and leg comminuted April 27, Circular amp. of leg. Surg. R. Died May 5, 1864, of tetanus. Yet. Res. Corps, age 55. 1864. by railroad accident. 1864. S. Kenderdine, U. S. V. 219) Kirk, M., Pt., E, 10th Vpt. May 20, Both legs badly crushed by May 20, Circular amp. of both legs, mid. Died May 21, 1865, of shock. aao; Keserve Corps. 1865. railroad accident. 1865. third. Dr. W. H. White. 221 Kries, F., Pt., H, 1st Missouri Jan. 6, Frostbite of left foot Jan. 12, Circ. amp. leg 4 inches above Died January 18, 1864, of tetanus. State Militia, age 41. 1864. 1864. ankle. A. A. Surg. L. H. Callaway. 222 Lahay, J., Pt., K, 46th Illi Feb. 3, Right leg injured by railroad Feb. 2, Amputation of right leg Gangrene. Died Feb. 19, 1865. nois, age 16. 1865. accident. 1865. 223) Lee, L., Pt., A. 12th Colored Dry gangrene both legs Nov. 25, Circ. amp. both legs. up. third. Died Jan. 13, 1865, of gangrene. 224, Troops, age 11). 1864. A. A. Surg. J. S. Giltner. 225 Level 1, L., Pt., , 1st Mich. Necrosis of right tibia ; gang. Sept, 25, Flap amp. of right leg below Died September 26, 1864, of ex Lt. Artillery, age 52. caused by injudicious appli n 1EG4, tuberosity of tibia. Surg. S. haustion. of tourniquet to suppress hasm. D. Turney, U. S. V. 226 Loyd, E., Pt., E, 2d Mary Idiopathicphlegmonous erysip Dec. 28, Amputation of leg, lower third. Gangrene; tetanus. Died Fnb- land, age 2.5. elas of right foot. 1864. Surg. D. W. Bliss, IT. S. V. niary 3, 1865. 227 McAllister, J., Pt., I, 3d Illi May 20, Fract. of right leg and os calcis May 21, Amp. right leg, mid third, and Chronic bronchitis. Died May nois Cavalry. 1863. of both feet by a fall. 1863. Syme s amput n at left ankle. 23, 1863. ^c McElroy, D., , age 27 June 19, Comm n met. bones ri;ht foot ; June 24, Lat. skin flap amp. leg. Dr. T. Diarrhoea. Died Aug. 28, 1862. 1862. gangrene; railroad accident. 1862. M. Markoe. New York. 229 McQuaid, R. D., Lieut., K, Jan. 11, Comp d com. fract. right tibia, Jan. 11, Flap ampnt n leg. upper third. Died Jan. 19. 1865, of exhaustion. 29th Michigan, age 30. 1865. upper third, with dislocation. 1865. Surg. J. E. Herbst, F. S. V. 230 Marks, J. H., Pt., G, fith Dec. 24, Compound fracture left leg by Amputation of leg Died January 6 1 863. Pennsylvania Cavalry. 1862. wagon wheel. 231 May, W. A., Pt., H, 7th N. Oct. 17, Compound com. fracture left Oct. 18, Circ. amp. of leg, upper third. Sloughing. Died Oct. 25, 18(54. Carolina, age 23. 1864. leg by railroad accident. 1864. Surg. W. D. Baylor, C. S. A. 232 Meador, F., Pt,, K, 2Cth Mar. 18, Frostbite left foot and two mid April 16, Amp. left leg, junct. up. thirds. Died June 23, 1864, of pyaemia. Colored Troops, age 40. 1864. dle toes right foot. 1864. and Cd middle toes, right foot. A. A.Surg. E. DeWitt. 233 Miller, D., Pt., 145th New Oct. 17, Right foot fractured by railroad Oct. 19, Amputation of leg, lower third. Died October 24 , 1 862. Spec. 781 , York. 1862. accident. 1862. A. M. M. 2341 Mulhatlan, P., Pt., B, 150th Oct. 8, Both legs crushed by railroad Oct. 8, Doub. flap amp. left leg, junct. Died October 8, 18(54, of shock 235} Pennsylvania. 1864. accident. 1864. up. thirds, and right leg just and loss of blood. below tub. of tibia, skin flap and circ. sect, of muse Ass t Snrg. H. S. Sehell, U. S. A. 236 Murphy, E., Pt., D, 143d N. Oct. 12, Right tarsal bones comminuted Oct. 17, Lateral flap amp. leg at middle Gangrene: diarrhoea. Died De York, age 21. 1862. in attempt to jump from rail 1862. third. Dr. G. A. Pe.ters, New cember 1, 1862. way car : gangrene. York City Hospital. 6 237 Newton O., Pt., K, 10th N. ; Erysip. inflam. of right leg and ! July 15, Circ. amp. of leg, lower third. Died Aug. 24, 1864. of dysentery. York H vy Art., nge 40. foot, resulting in gangrene. 1864. A. A. Surg. A. Van Cortlandt. 238 Pale, J. H. N., Pt., C, 97th Nov. 1, Compound fracture right leg, Nov. 16, Flap amputation of leg, upper Nov. 18, haem ; lig. post. tib. art. Illinois, nge 36. 1863. mid. third, by railroad accid t. 1863. third. Surg. F.Bacon, U.S.V. on face of stump. Died Nov. 25, 1863, of pyaemia. 23) End" ? L H Corp l H 1st July Tirifli Ifirra inin,ii^ Vnr voilYV-ioil A mnnt ition if both leo*<* Died July 17, 1863. 240) New York Artillery. 1863. accident. i -o 241) Sanders, B., Corp l. 3d Md. - Mortification of both legs to Feb. 1 6, Amput n through middle third. Died March 12, 1865. (May 13, 242J Battery, ago 37. junction of middle and lower 1865. both legs. Surg. B. B. Breed, 1864, shot fracture upper third thirds. U. S.V., and A. A. Surg. L. femur.) Sinclair. 243 Shearer, J., Serg t, A, llth May 20, Comp d com. fracture middle May 21, Ant. post, skin flap amp. right Feeble reaction after prolonged Maryland, age 28. ; 1865. third right leg, and double 1865. leg and amp. thro left knee primary shock. Died May 22, ciiinpimnd fracture left leg in joint, leaving patella and con- 1865. middle and upper thirds, by ; dyles, by Ass t Surg. G. M. horse kicks. McGill, U. S. A. 244 Sligh, J. W., Capt., F, 1st Oct. 23, Com. fractur: right leg and Nov.- , Amp. right leg 4 inches below Died November 15, 1863. Spec. Michigan Engineers. 1863. simple fracture "left leg by 1863. knee. Surg. B. Woodward, 2077, A. M. M. railroad accident. 22d Illinois. 245 Smith, J., Lieut., I, 65th June 2, Comp d com. fracture left ankle June 2, Amputat n of leg. lower third. Acute meningitis. Died June 10, Ohio. 1865. joint and injury of spine. 1S65. Sursr. E. B. Click. 40th 1ml. 1865. 24G I Smith. W. W.. I t.. I. 17th Dec. 1. KrostbitP of tops i,f buth feet "\T;ir. <> Finn ninnntntion rio-ht IPO- in (Feb. 11, 1865, 1st 4 toes right foot Alabama, age 19. 1864. : mortification of parts. , 18(i5. middle third. Ass t Surg. J. and 1st 3 toes left foot nmput d.) C. Thorpe, IT. S. V. Died June 16, 1865, of exhaus. 247 Sorter. J. D.. Pt,, E, 16th Abscess of foot; gangrene and July 18, Oval flap amp. of log, lower Gangrene. Died Aug. 11, 1HM. Vet. Kr.s. Corps, age 31 . ropputpil lui-iunni isiil. third. A. A. Surg.W. C.Wey. 248 Thirlway, J., I t., I, 60th N. Dec. 26, Frostbite of right foot: gang. . Feb. 17, Circ. amp. of leg. lower third. Died February 25, 1865, of ex York, age 18. ; 1 864. 1865. A. A. Surg. C. F. Trautman. haustion. SECT. fl.J AMPUTATIONS IN THE LEG. 677 NO. NAME, MILITARY DESCRIPTION, AND AE. DATE or INJURY OB DISEASE. NATURE OF INJURY OR DISEASE. DATE OP OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 249 Thompson, J.W., Pt., A, 5th Jan. , Frostbite of feet ; gangrene Feb. 17, Amp. left leg, lower third, semi- Died February 20, 1864, of ex Colored Troops, age 22. 1864. 1864. circ. method above, flap from haustion. below. A. A. Surg. B. T. Crooker. 250 Towue, W. H., Pt., A, 18th Nov. 17. Comp d ci >m. fract. right ankle ; Nov. 18, Flap amputat n lower third leg. March 8, 1864, amp. ! -wr third Conn., age 30. 1863. crushed by railroad care. 1863. Surg. H. W. Owings, 2d E. S. thigh. Died March 28, 1804, Maryland Vols. of secondary haemorrhage. 251 ( Weber. J.. Pt., E, 7th New Jan. , Frostbite of both feet ; tetanus. Feb. 10, Amp. both legs, lower third. Died February 11, 1865. 2o2$ York, age 60. 1865. 1865. with lateral closure of stumps. Ass t Surg. H. Allen, IT. S. A. 253 Westfall L. Pt. M 24th N. Jan. 19 York Cavalry, age 17. left leg, exposing tibia. 1865. Surg. R. B. Bontecou, U. S.V. haustion. 254 \Vilmot. W.. Musician, E, Gangrene of right foot to ankle Feb. 8, Ant. post, flap amp. right leg. Died March 11, 1865, of exhaus Nth Illinois Cav ry, age 51. and of toes of left foot, from 1865. lower third, and all toes of left tion. exposure. foot. Ass t Surg. W. S. Tre- maine, U. S. V. 2551 Wood. W.. Pt., A, 102d N. Sept. 14, Both legs injured by railroad Prim ry. Amp. of both legs, mid. third. Died September 17, 1864. 256j! York. 1864. accident. A. A. Surg. C. C. Lee and Dr. W. C. Way, of Elmira. 2:.? Woody, B. C., Pt., E, 14th July 15, Right leg crushed from ankle July 15, Ant. post, flap ump. of leg at Died July 26, 1864, of traumatic Penn. Cavalry, age 18. 1864. to middle by railroad accid t. 1864. iunct. of upper thirds. Surg. gangrene. S. N. Sherman. U. S. V. 258 Vai.crum, F., Pt,, E, 9:id May 10, Fracture bones of right leg at June 13, Amputation of leg at up. third. Died June 27, 1865, of pyaemih. Pennsylvania, age 34. 1864. junction of lower thirds by 1865. A. A. Surg. G. K. Smith. Spec. 4242. A. M. M. mule kick; gangrene. 259 Michel, , Lieut., 14th La.. Gangrene Airiputiition of l6ff Result unknown. Of fifty-one partial amputations of the foot for miscellaneous injuries or disease, forty- seven were followed by recovery and four by death : TABLE OXII. Condensed Summary of Fifty-one Partial Amputations of the Foot for Miscellaneous Injuries or Disease. [Recoveries, lr-47; Deaths, 48 51.] ,0. NAME. MILITARY DESCRIPTION, AND AGE. DATE OP INJURY ou DISEASE. NATURE OF INJURY OH DISEASE. DATE OF OPERA TION. OPERATION AND OPERATOR. i 1 4 5( 65 7 8 9 10 11 12 13) 14/ 15 16J W 18 19) 201 21 22 ( 23 24 ( 25$ 26 Earner, J., Pt., G, 178th New York. Banihart. M.. Pt., H, 50th Pennsylvania, age 28. Bickel, J., Pt., H, 22d Ohio. Butler, J. R., Pt.. H, 10th Kansas, age 13. Charles, M., Pt,, B, 10th N. Jersey. Clark, C. O. F., Pt., G, 1st Oregon. Conklin, J., Pt., F, 1st Ohio Cavalry, age 18. Corcoran, C., Pt., G, 1st Mas sachusetts, age 22. Counter. O. R., Pt.. , 4th New Hampshire. Dennison. C. W., Pt., B, 2d Rhode Island, age 18. Downey, J., Pt., B, 12th Illi nois Cavalry, age 34. Dukes, J. It., Serg t, E, 87th Indiana. Fletcher. J., Pt., D, 1st Col ored Troops, age 25. Gardner, J., Pt., F, 65th In diana. Harris, T., Pt., C, 27th Col ored Troops, age 25. Hawkins. E.. Pt., B, 9th In Partial amputat n of both feet. Amputation great toe and met atarsal bone. Surg. G. L. Pancoast, U. S. V. Chopart s amputation left foot. Amp. 1st, 2d. and part 3d met. bones left foot, and great toe and head met, bones right foot. Surg. A. C.Van Duyn, U.S.V. Lisfranc s amputat n right foot. A. Surg. B. E. Fryer, U. S. A. Chopart s amp. right foot and amp. left leg at middle third. A. A. Surg. M. V. Amen. Amputat n through metatarsal bones, flap from sole of foot. Oval amp. of great toe and met. bone. A. A. Surg. J. Murray. Amp. left foot thro met. bones and of right fifth toe. Disarticulatiori of met. bones of left foot. Surg. St. J.W. Mintzer, U. S. V. Amp. of both feet thro tarso- metatar. articulation. A. A. Surg. R. N. Isham. Chopart s amput n of left foot. A. A. Surg. F. Rectanus. Amp. both foet thro met. bones. A. A. Surg. C. B. Fry. Modification of Chopart s amp.; the proximate half scaphoid bone allowed to remain. A. A. Surg. J. G. Harvey. Amp. at tarso-met. articulat n. Surg. E. Bentley, U. S. V. Amputation at tarso-metatarsal articulation. Amputation of both feet thro metatarsal bones. Flap amp. right foot at mid. of metatarsus, and of toes and heads of met. bones left foot. Ass t Surg. A. Ingram, U.S. A. Circular flap amp. 4th and 5th toes at tarso-metatarsal artic ulation. Left foot frozen ; slough, of toes. Nov. 22, 64, amp. of toes ; ne crosis of met. bone of great toe. Injury of left foot ; railroad ac cident. Feet frozen ; toes slough d from left foot except 5th and one phalanx of 4th. Frostbite both feet ; gangrene. April 28, 62, Syme s amputa tion at left ankle joint. Frostbite both feet Mar. 27. 1865. Sept. 15. 1864. Mar. 20, 1864. May 4. 1862. Jan. 17, 1866. 1864. Sept. 15, 1864. Jan. 7, 1864. Dec. 17, 1865. July 10, 1864. Nov. 13, 1864. Feb. 10, 1865.- Deo. , Ie63. Jan. 1, 1864. Nov. 1, 1862. Dec. , 1863. April 2, 1864. Oct. , 1864. Mar. 17, Fract. of metatarsal bones of right foot ; railroad accident. Phalanges of great toe cut by an axe ; necrosis. Feb. 14, 1865. Mar. 4. 1865. Sept. 17. 1864. April 15, 1864. Feb. , 1863. Jan. 22, 1864. June 5, 1864. Jan. 19, 1865. Mar. 17. 1865. Mar. 3. 13, 6:i. Feb. 9, 1864. July 21, 1864. Frostbite of both feet ; loss of all toes. Sept., 1864, left foot contused. Severe frostbite both feet ; ca ries of metatarsal bones. Freezing of both feet; gan grene. Laceration of left tarsus and fracture of metatarsus; rail road accident. Gangrene both feet from wear g tight shoes: toes dry and hard. Com. met. bones and lac. soft parts left foot ; railr d accid t. Frostbite of both feet; gang, and mortification. Both feet frozen ; line of demar cation well defined. Comp d com. fract. 4th and 5th metatarsal bones right foot ; railroad accident. diana, nge 21. Hayes, J. S., Pt., I, 21st N. Jersev. Hirsch^ P.. Pt.. D, 98th Penn sylvania, age 38. Human. W., Pt.. H, 18th Kentucky, age 45. 1865. Jan. , 1863. Jan. 1, 1864. July 21, 1864. RESULT AND RKAIAKKS. Discharged Oct. 16, 1865: feet blue and cold. Discharged Aug. 10, 1865. Amp. left ring finger for shot fracture. Discharged Nov. 15, 1864 ; stump remaining sore. Discharged March 7, 1865. Discharged August 11, 1862. Disch d April 14, 66. Nov. 9, 68, re-amp, left leg. 1870, stump sound. Sprcs. 4128,4191. A. M.M. Discharged March 25. 1865. Mustered out June 27, 1865; do ing well. Discharged July 11, 1865. Discharged July 5, 1865. Discharged June 20, 1864 ; good stump. Discharged February 15, 1863. Discharged February 7, 1865. Mustered out June 22, 1865, with excellent stump. Discharged September 2, 1865: ends of bone well covered. Mustered out September 28, 18fir>. One foot healed, small ulcer on the other. Discharged. Stump healed and promised to be useful. Discharged September 22, 1864. Transferred to Veteran Reserve Corps May 4, 18ti.">. 678 MISCELLANEOUS INJUEIES. [CHAP. XI. No. NAME, MILJTAKT DESCRIPTION, AND AGE. DATE OF INJURY OR DISEASE. NATURE OF INJURY OH DISEASE. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 27 28 29 30 ( 3lf 32 33 1 34j 35 36{ 375 38 39 40 41 42 43 44? 45$ 46> 47$ 48? 49J 50 51 Jones, S., Pt., I, 30th Iowa, age 23. Langan, J., civilian, Quarter master s Dep t, age 25. Leichley, S., H., I, 178th N. York, age IP. Messer, G.. Pt., B, 7th New York, age 27. Metzger, A., Pt., B, 19th Penn. Cavalry, age 17. Mitchell, D., Pt., C, 7th N. York, age 25. Norcross, J. H.. Pt., H, 2d New Jersey Cavalry. Pollard, R., Pt., D, 21st Ken tucky, age 27. Quillain, J. W., Pt., I, 27th Pennsylvania, age 31. Shadel, J., Pt., G, llth Wis consin. Shauley, W. F., Pt., K, 37th Sept, 30, 1863. July 18, 1865. Dec. 30, 1864. Dec. , 1864. Dec. 31, 1863. Jan. , 1864. Dec. , 1863. Jan. 24, 1865. Sept. 5, 1863. May 2, 1864. April 30, 1863. Feb. 28, Bone scurvy and hospital gan grene, causing loss of use of both feet. Incised wound thro metatarso- phalangeal joint left 5th toe, extending to tarsalarticulat n. Frostbite of left foot ; necrosis. Frostbite of both feet Nov. 6, 1863. July 18, 1865. April 30, 1865. Jan. 1, 1865. Jan. 25, 1864. Feb. 1, 1864. Chopart s amp. of right foot. Surg. J. Andrews, yd Mich igan Cavalry. Amp. of 5th toe at tarso-met. artic. A. A. Surg.W. Balser. Flap amputation at tarso-meta- tarsal articulation. Chopart s antero-posterior flap amputation of both feet. Flap amp. at tarso-met. artic. Surg. H. Wardner, U. S. V. Chopart s amp. both feet. Surg. J. E. Pomfret,7th N.Y.H.Art. Amp. left foot thro met. bones, also right great toe. A. Surg. D. G. Hetzell, 34th N. J. Flap amp. both great toes and metatarsal bones, also of left third metatarsal bone. Amp. 1st, 2d, and 3d toes with portion 1st and 2d met. bones. Amputation of 2d toe and re moval of 2d, 3d, 4th, and 5th metatars l bones in continuity. A. A. Surg. S. S. Jessop. Chopart s amputation of right foot. First met. bone and phal. of 3d toe exart., middle of 2d mat- atarsal bone sawed through. Chopart s amputation of the left foot. Amp. 1st, 2d, 3d, and 4th toes left foot at 2d joint, and 5th toe at tarso-met. artic. Amp. both feet through meta tarsal bones. Surg. Geo. C. Underbill, llth Ohio Cavalry. Hey s amp. both feet, tuberos- ity right os calcis removed. A. A. Surg. H. McElderry. Amputation of both feet across instep. Dr. N. L. Folsom, Portsmouth, N. H. Amput n of right foot at tarso- metatarsal articulation. Circular amp. of foot through metatarsal bones. Oct. 16, amp. left leg. Nov. 10, 1.1, hsem.; inter, plantar artery tied. Disch d June 3, 1805. Returned to duty Aug. 27, 1865. Discharged February 15, 1866. Discharged May 22, 1865; stumps healed. Disch d June 4, 65 : good stump, excellent motion of ankle joint. Discharged October 14, 1865. Discharged June 29, 1864. Died January 9, 1871, of disease. Discharged July 2, 1865; almost entirely healed. Discharged August 16, 1864; per manent lameness. Discharged October 20, 1864. 1877, foot contracted to a point ; walks quite lame. Discharged Aug. 24, 1863. Died Oct. 20. 1865; clironic diarrhoaa. Discharged October 25, 1864. Discharged February 25, 1865. Parts healed kindly. Sent to military prison May 18, 1864. Left for his home September 5, 1865. Discharged Dec. 6, 1865. March 18, 1866, amp. right leg. 1877, stump of foot still ulcerating. Discharged February 24, 1863. Died February 27," 1863; con gestion of bowels. Died Sept. 30, 1864, of chronic diarrhoea. Died August 26, 1864, of general debility. Toes of left foot frozen ; gang, and sloughing. Both feet frost-bitten ; mortifi cation. Both feet frost-bitten ; slough ing. Compound fracture of toes of right foot by street cars. Contusion of left foot and comp. fract. of 4th toe; railr daccid t. May 3/64, amp. 4th toe ; gang. May 15, amp. 3d and 5th toes. Wound of right tarsus and met atarsus by wheel of a wagon. 1st, 2d, and 3d toes of left foot crushed and sole lacerated ; railroad accident. Left foot injured by railroad accident. Hospital gangrene of both feet from erysipelas. Both feet frost-bitten ; slough ing. Frostbite of both feet Jan. 24, 1865. 1863. May 30, 1864. _ May 13, 1863. Feb. 28, 1864. Massachusetts, age 42. Sickler, J., Pt., H, 8th Illi nois Cavalry, age 35. Stephens, J., Serg t, G, 10th Indiana Cavalry. Stone, W., Pt., E, 10th Ten nessee, age 40. Sutton. F., Pt., H, llth Ohio Cavalry (disch d soldier), age 27. Watkins. E. D., Pt., H, 5th Kentucky Cavalry, age 30. Parks T B Pt K 13th 1864. Mar. 31, 1864. Mar. 1, 1864. Mar. 28, 1865. April , 1865. Feb. 26, 1863. Feb. , 1864. April 2, 1864. Jan. 7, 1864. Feb. 21, 1864. Frostbite of both feet; gan grene. Both feet frost-bitten New Hampshire. Tucker, A., Pt., B, 7th In diana Cavalry. Williams, H., Pt., B, 59th Colored Troops. Feb. , 1864. Frostbite of light foot ; gan grene of toes. One hundred and twenty-two amputations of the toes for miscellaneous injuries were recorded; the results in seven cases were not ascertained; one hundred and nine recovered, six died. An instance of amputation for dry gangrene is here cited: CASE 1005. Amputation of toes. Hospital Steward R. Schofield. 69th Pennsylvania, aged 49 years, had both his feet frost-bitten while with his regiment in the field near Stevensburg, January 1, 1864. Surgeon R. B. Bontecou, U. S. V., in charge of Harewood Hospital, Washington, gives the following history: "The patient was a man of temperate habits and of good constitution. The tent in which he was sleeping in the field was blown down during the night, when his feet became exposed, the other parts of his body remaining well protected. Although the weather was intensely cold, he slept well during the night, and on waking up in the morning found the forepart of botli his feet frozen. He received no treatment until admitted to this hospital on February 1st. At the time of his admission the patient was found to be suffering from dry gangrene of the toes of both feet, resulting from the freezing, and extending to the metatarsal bones of the left foot, with destruction of the soft parts. The patient was in good spirits, and although he was doing well it was deemed ^^pBP . \ advisable to disarticulate the toes. Nourishing diet and stimulants were administered and simple dressings were used." The amputated toes, contributed to the Museum with the description of the case by Surgeon Bontecou, constitute specimen 2163 of the Swrgical Section, and a representation of the diseased feet appears in the adjoining wood-cut (FlG. 372). The patient was discharged from service for disability January 27, 1865, and pensioned. The Philadelphia Examining Board on November 7, 1877, .,. , A ,, . , ,... ,, FIG. 372. Dry gangrene of both feet after frostbite. certified to the pensioners condition as follows: He lias had all the toes of the right foot amputated through the metatarso-phalangeal articulation except the little toe, which is drawn into the cica.trix. The foot is defective in circulation and there are chronic ulcers of the leg extending from the ankle to within Spec. 2163. SECT. II.] LTGATIONS. 679 four and a half inches below the knee, being very offensive and requiring constant care and attention. This condition no doubt is due to anaesthesia of the foot and leg. The cicatrices extend around the leg and are constantly scaling. There is also varix above to a slight extent. The toes of the left foot were amputated at the tarso-metatarsal articulation, the stump showing a good horny cicatrix ; hypersesthesia of foot or stump; atrophy of leg; stump alleged to be painful during changes of weather," etc. The pensioner was paid September 4, 1881. LIGATIONS. Eighteen instances of ligations of the larger vessels were reported. The injuries in eight cases were incised wounds, in two punctured wounds, and in five aneurisms; in three cases the nature of the injury was not specified. Four of the opera tions were on arteries of the neck and trunk, four on vessels of the upper and ten on arteries of the lower extremities. Seven were fatal, viz: a ligation of the primitive carotid, of the external and common carotids, of a branch of the mesenteric. of the radial, two of the femoral with subsequent ligations of the external iliac, and one of an artery of the dorsum of the foot. Ten of the cases are here detailed : CASE 1006. Amputation in the arm. Ligation of the axillary and subsequently of the subclavian artery. Private H. Rieman, Co. A, 12th Maine, aged 21 years, had his left arm crushed by a railroad accident near New Orleans, January 1C, 18G4, and suffered amputation at the middle third of the humerus. Surgeon J. B. G. Baxter, U. S. V., reported that the man was conveyed to Barnicks General Hospital, where "the axillery artery was ligated, by reason of secondary haemorrhage from the brachial artery, on January 31st. On February 7th another haemorrhage supervened and the subclavian was ligated in the third portion, at its point of exit from behind the scalenus anticus muscle. The probable loss of blood amounted to two quarts. The subsequent treatment included tonics, stimulants, and diet as nourishing as possible. Some pyaemia did supervene, but haemorrhage did not again recur. By February 29th the ligature had come away and the wounds were healing rapidly, the patient s appetite being good and his condition presenting every prospect of recovery. The operations were performed by Surgeon O. M. Humphrey, U. S. V." The patient was subsequently admitted to Central Park Hospital, New York City, where he was discharged from service July 31, 18G5, and pensioned. Several months after receiving his discharge he was furnished with an artificial arm by the firm of M. Lincoln, of Boston. The pensioner was paid September 4, 1881. Stump in good condition. CASE 1007. Ligation of primitive carotid for aneurismal tumor. Acting Assistant Surgeon W. P. Moon reports the follow ing history of "Private H. Cater, Co. C, 106th New York, aged 37 years, who was admitted to Mower Hospital, Philadelphia. September 12, 18G4, on account of a tumor of the neck, situated in the upper portion of the right great anterior triangle and being about an inch and a quarter in diameter. The tumor had first been noticed about a year before, growing slowly, and for two or three months the patient was subject to paroxysms resembling asthma, relief being obtained by inhalations of ether. His general health was good, but the mass was evidently encroaching upon the larynx and oesophagus latterly, and after consultation it was decided to attempt the removal of the tumor. The patient was first allowed a furlough to go home and consult his friends, after which, finding his case growing rapidly worse, he finally consented to submit to an operation. Accordingly, on December 13th, he was thoroughly etherized, and I made an incision over the centre of the tumor down to the cyst. The enveloping membrane was found to be very vascular and the tumor had the feeling of the fibroid class. While we were examining the mass, having partly enucleated it and getting down to its attachment, the patient was seized with vomiting and two superficial veins were ruptured by the retching. As soon as these were tied another seemed to give way, the retching increased, and the hfemoi-rhage became so profuse that we were compelled to desist from all further efforts for the time being and decided to close up the wound after ligating the open vein, hoping for a favorable termination by suppuration. For some days the case did so well that we had strong hopes of a favorable result. Drs. D. H. Agnew, E. R. Fell, and others were present at the operation, and the patient was carefully attended by Dr. Fell. Two days afterwards the case had become complicated by erysipelas, involving the chest and right side of neck, but being readily controlled by tincture of iodine externally, and tincture of chloride of iron, Dover s powder, etc.. internally. On December 18th the wound had closed except at the upper and lower points of the incision, from which openings healthy pus was discharged; but there was an unpleasant odor which excited suspicion; patient s tongue white in centre, but moist. No untoward symptoms exhibited themselves until December 26th, when secondary haemorrhage suddenly set in to the amount of some thirty ounces, being arrested by charpie and compress. After the wound was opened and a careful examination had been made by Dr. T. G. Morton and myself, we could not determine distinctly from what vessel the haemorrhage came, owing to the altered condition of the tissues, and therefore concluded to ligate the right primitive carotid as the most likely means to prevent a recurrence of the haemorrhage. The ligature was applied about an inch and a quarter above its origin from the innominata. The tumor was found to have nearly disappeared, and what remained consisted of a calcareous deposit attached to the thyroid cartilage the veins covering it, with the entire cyst, having sloughed away. On the next day the patient was apparently doing well; wound dry but disposed to slough; very little pus forming. The parts were dressed with diluted chlorinate of soda. On December 29th there was partial paralysis of the left side; wound showing some disposition to clean out; pulse 108; tongue dry and coated; nausea, with some vomiting; slight delirium, with some tendency to diarrhoea, which was controlled by an enema. Wound dressed with solution of permanganate of potassa. On December 30th the patient seemed to improve taking his cream, beef-essence, and brandy without difficulty, and having no vomiting nor diarrhoea ; pulse 90 ; wound cleaning out. On the following morning the wound presented healthy granulations, but the patient had a rigor, followed by fever and perspiration, precursors of pyaemia. From this time a decided change for the worse became evident and the patient continued to sink until the morning of January 5, 1865, when he died. The wound was healthy at the time of death. The post mortem examination revealed the ordinary condition of a pyaemic patient, and showed that pus had dissected down the sheaths of the vessels nearly to the pericardium. An organized clot was found above as well as below the ligature. The former 680 MISCELLANEOUS INJURIES. [CHAP. xi. extended down to the point of the ligation, and the latter was found occupying the carotid to within a few lines of the innoininnta and extending up an inch and a half above the bifurcation. The ligature had ulcerated through the carotid." CASK 1008. Ligation of brachial for aneurism. Corporal R. L. Phillips, Co. M, 1st Wisconsin Cavalry, aged 44 years, admitted into City Hospital, St. Louis, September 15, 1862, with an aneurism of the brachial artery, caused by a sprain; had been increasing gradually. October 2cl, ligation of artery by Surgeon J. T. Hodgen, U. S. V. October 24th, coldness in hand ; ligature removed. Returned to regiment November 20, 1862, quite well; aneurism nearly same size, but no pulsation. CASE 1009. Ligation of brachial for incised wound. Private W. Stewart, Co. G, 1st Connecticut Cavalry, aged 23 years- admitted to Douglas Hospital, Washington, July 31, 1865, with an incised wound of the internal aspect of the lower third of the left arm. inflicted with a penknife. July 31st, ligation of the brachial artery (supposed) at its bifurcation in continuity by Sur geon R. B. Bontecou, U. S. V. The radial pulse was almost if not quite as full as on the right side, leading to the conclusion that either the brachial had not been tied er that the bifurcation was high up in the arm. August 6th and 8th, ligatures came away. August 25th. wound entirely healed; slight pain in forearm. Transferred to New Haven August 31, 1865. CASE 1010. Ligation of femoral followed by ligation of external iliac; death. Private W. P. Webb, Co. H, 4th Maine, ageu 1 21 years, was admitted to Master Street Hospital, Philadelphia, August 12, 1862, suffering from an abscess resulting from a contusion. Acting Assistant Surgeon P. B. Goddard reported that "the injury was located at the outer and anterior part of lower third of the right thigh, and was inflicted by a blow with the butt end of a musket. The abscess was followed by caries of the femur, and the patient was much debilitated when admitted, but improved until secondary haemorrhage set in at the seat of the abscess. In order to control this Acting Assistant Surgeon D. Gilbert was obliged to ligate the femoral artery above the profunda on September 21st. The patient did well until the ligature cut through on September 25th, when from the aplastic condition of the blood no coagulation had taken place in the calibre of the vessel and violent haemorrhage from the divided femoral artery was the consequence. This was controlled by the ligation of the external iliac below the origin of the deep epigastric by Acting Assistant Surgeon W. H. Pancoast on September 25th. The haemorrhage, however, reappeared at the seat of the first ligation on September 30th, when Dr. Pancoast was obliged to enlarge the former incision, and finding that the lifting up of the external iliac on the groove director just below the bifurcation controlled the bleeding entirely, he ligated the artery at that point. The patient lived several days after the operation; but he could not recover from the effects of the haemorrhages and sank away gradually till October 3, 1862, when he died. The temperature of the leg continued good after the operation." CASE 1011. Ligation of femoral followed by ligation of external iliac. Private D. Brittou, Co. C, 5th Indiana Cavalry, aged 34 years, entered hospital No. 2, at Nashville, on September 19, 1864. He was admitted on account of femoral aneurism, located in Scarpa s triangle, for which pressure had been applied, producing an extensive gangrenous slough below Poupart s ligament. Surgeon J. E. Herbst, U. S. V., who described the case, reported that he ligated the femoral artery three-fourths of an inch below Poupart s ligament on October 2d, and that haemorrhage to the amount of forty-eight ounces occurred four days afterwards, when the external iliac artery was ligated by Acting Assistant Surgeon M. N. Benjamin. Death occurred on Octo ber 7, 1864, from exhaustion resulting from the haemorrhage. CASE 1012. Ligation of femoral artery for popliteal aneurism. Private J. Fleming, Co. C, 157th Pennsylvania, aged 47 years, was admitted to Cuyler Hospital, Philadelphia, June 6, 1864, with aneurism of the popliteal artery of the right leg. Assistant Surgeon H. S. Schell, U. S. A., reported that "when first seen the tumor was about the size of a duck s egg; pulsa tion strong and diffused; bruit loud, but thrill not very well defined. The patient kept his leg in a semi-flexed position and complained of constant pain proceeding from the tumor and ankle of the same side. Below the seat of the aneurism the limb was somewhat cedematous, dusky, and slightly pitting on pressure. He stated that he first observed the tumor some months previously, after a severe exertion in lifting heavy stones, that it gradually though slowly increased in size, and that latterly the pain in the limb had increased in intensity. According to his statement the only treatment to which he had been subjected before his admission to Cuyler Hospital consisted of the application of an ointment and of a liquid, which from his description was tin- tincture of iodine. Physical examination showed the heart to be perfectly healthy and there appeared to be no disposition to disease of the arteries in any other part of the body. Bearing in mind Mr. Syme s case in which coagulation and a spontaneous cure was effected by the simple application of a bandage to the limb, this plan was tried and the patient was strictly confined to his bed. No success followed this method, and forced flexions were next employed, the leg being bent upon the thigh and firmly fixed by numerous turns of a figure of eight bandage. This mode of treatment likewise proving unavailing, pressure by means of an instrument resembling Signorini s tourniquet was resorted to, but was found equally as ineffective as the means previously employed. Meanwhile the aneurism was steadily enlarging and the risk of venous obstruction became more imminent daily. It was accordingly resolved to tie the femoral artery at the lower angle of Scarpa s space, which was done in the usual manner on June 16th by Acting Assistant Surgeon J. Ashhurst, jr. Anaesthesia was induced by the use of ether, and the vessel was reached by an incision abtjut three inches in length. The haemorrhage during the operation scarcely exceeded a fluid drachm ; pulsation ceased instantly upon the tightening of the ligature. The edges of the wound were then brought together by hare-lip pins and several points of the interrupted suture (lead wire being the material employed), after which a light dressing of dry shdfct lint was applied and the entire limb below the wound was enveloped in carded cotton. The temperature of the limb was at first slightly above that of the other, but it soon became normal and remained so. When the state of anaesthesia passed off the patient complained of a burning pain in the heel and ankle. The tumor (which in a few days became hard, showing that a clot had been formed) gradually diminished in size, no recurrent pulsation taking place at any time. The wound healed almost throughout by adhesion. The application of cotton to the limb was discontinued on the fifth day; the ligature came away on the seventeenth day, and the progress of the patient afterwards to recovery was uninterrupted." The patient was subsequently transferred to Mower Hospital, whence he was discharged July 5, 1865, and pensioned. The Philadelphia Examining Board reported, December 7, 1S70: "We find the aneurism entirely cured by a ligation of the right femoral artery at Scarpa s space; limb somewhat atrophied and numb; use and power of limb impeded." Several years later the same board certified that the pensioner " complains of numbness down the whole surface of the thigh and leg. There is, however, no evidence of want of SECT. II. OPERATTOXS ON THE EYE OR ITS APPENDAGES. 681 bJood-supplv in the leg; nor is there nny atrophy of the limb. There is no pulsation in the artery below the seat of the liga- tion." The pensioner was paid December 4, 1879. CASE 1013. Ligation of femoral artery. Private Jerry Hart, Co. B, 2d Kentucky, was admitted into hospital No. 9, Nashville, with an injury received in a quarrel at Shiloh, Tennessee. Femoral artery Hinted. Discharged January 30. 1863. CASE 1014. Liyation of superior profumla for incised wound. Private J. Shaw, Co. D, 4th Minnesota, aged 23 years, was admitted into Crittenden Hospital, Louisville, June 26, 1865, with an incised wound of left arm, inflicted with a knife. The superior profunda was ligated in the wound. He was mustered out July 19, 1865. CASE 1015. Liyation of an artery of tJic foot. Surgeon T. H. Squire, 89th New York, reports: "Private T. P. Barrows, Co. G, 35th Massachusetts, aged 18 years, accidentally wounded by an axe, which slipped from the handle while he was using it, making a transverse cut across the dorsum of the left foot, injuring the metatarsal bones, dividing the tendons and one artery, which required a ligature. The wound has been painful, the foot is badly swelled, the wound is ugly, and, for aught I know, the boy will eventually lose his limb or life from it; now being poulticed. Died November 1, 1862." Details of the remaining eight cases of ligation belonging to this group have already been given in the preceding chapters. 1 OPERATIONS ON THE EYE OR ITS APPENDAGES. Seventy-six operations for diseases or injuries of the eye were reported. They include operations on the conjunctiva, for pterygium, symblepharori, anchyloblepharon, gonorrhoea! ophthalmia; on the cornea, for staphyloma and leucoma; operations on the iris and the ciliary body; operations for cata ract, for strabismus, for lacrymal fistula, and, on the eyelids, for blepharitis, entropion, ectropion, etc. In seven instances the eyeball was extirpated. Brief abstracts of all the cases are given in the appended table: TABLE OXIII. Condensed Summary of Seventy-six Operations on the Eye or its Appendages. NAME, MILITARY DESCRIP TION, AND AGE. INJURY on DISEASE. 1 Adams, J.,Pt.,B, 1st Louisiana, age :i5. 2 i Anderson, G. II., Pt., D, 15th . Vet. Reserve Corps, age 22. 3 ! Barry, C., Pt., H. 58th Illinois, j g<= - 4 I Beach, J. W., citizen, age 47.. 5 i Bemlon, T., Serg t, D. 170th Now York, age 26. G Blakeman, A., Pt., A, 10th j Wisconsin, age 2K. 7 Boas, H., Pt., B, 8th Veteran Reserve Corps, age 20. 8 j Brandy, F. M., Corp 1, C, 42d Indiana, age 31. 9 Brown, B. L., Pt., II, 84th Illi nois, age 25. 10 : Butler, H., Seaman, Gunboat j Mound City, nge 23. 11 Callaghan, j., Pt., C, 45th Illi- 1 nois. nge 21 . 12 Chandler, T., Ft.. E. 7th Illi nois Cavalry, age 33. Cornell, R. A.. Pt.. H, 103d Illinois, age 25. 14 Crippen. J. H., Pt.. E, 161st New York, age 26. 15 ! De Areey, J., Pt., I, 1st Michi gan Engineers, age 30. 186!), inflammation right iris, encepha- loid tumor size of horse-chestnut. August, 1864, staphyloma involving entire cornea of right eye, result of variolous postules. Attachment of fold of conjunctiva to cornea, right eye; nebulous and im perfect condition left cornea, result of ophthalmia, March, 1863. Lenticular cataract on both eyes, pro ducing total blindness. May, 1864, injury left side of head ; staphyloma of left cornea. November, 1863, staphyloma of left cornea. Central leucoma of left eye, result of gonorrhoea! ophthalmia; vision null. Pterygium of right eye Large pterygium of both eyes Penetrating wound of left eyeball ; large protrusion of humor. Severe strabismus, sing, convergence. result of cereb. aft ect. in childhood. Leucoma of both eyes from purulent ophthalmia. 18(>3. entropion left eye, result of gran- ularophtlinlinia : lashes in perpetual contact with the globe. Cornea right eye ulcerated; slightly panniform and somewhat anaesthetic; .neuralgic pains. Cornea of both eyes ulcerated ; pan niform and anaesthetic ; repeated paracentesis on both eyes without relieving pain. OPERATION AND OPERATOR. June 8, 1863, removal of eyeball and contents of socket by knife. Rapidly increasing- in size. Nov. 20, excision of staphyloma. Surg. J. S. Hildreth, U. S. V. Oct. 13, 1864, flap dissected. Staphy loma involved whole cornea. Dec. 31, excision staphyloma right eye. Feb. 16, iridec.tomy. Surg. J. S. Hildreth, U. S. V. Oct. 19, 1864, incis n thro left cornea, forming semi-lunar flap ; capsule of lens opened and lens extracted. A. A. Surg. F. Strube. Jan. 10, 65, removal of whole cornea; a portion of humor evacuated. Aug. 10, 1864, operation for staphy- lorna. Surg. A. Hammer, U. S. V. June 3, 1865, artificial pupil at upper and int. margin of cornea. Surg. J. S. Hildreth. U. S. V. Dec. 24, 1864. Desmarres s process. Surg. J. S. Hildreth, U. S. V. March 4, 1865, Desmarres s method. Surg. J. S. Hildreth, U. S. V. Sept. 15, 1862, extirpation of ball of eye. Surg. E. C. Franklin, U. S. V. Dec. 19, 1863. strabotomy. Surg. M. K. Taylor, U. S. V. March 11. 1865. iridectomy by pro cess of deehirement ; both eyes. Surg. J. S. Hildreth, U. S. V. May 6, 1865, elliptical section of ex ternal integument of upper lid; new position maintained bv three sutures. Surg. J. S. Hildreth, U. S. V. April 17. 1865, division of ciliary mus cle. Surg. J. S. Hildreth, U. S. V. May 19, division of ciliary muscles of both eyes between external and in ferior recti-muscles. Surg. J. S. Hil dreth. U. S. V. RESULT AND REMARKS. Recovery in three months. Disch d Jan. 2, 1864. Died in 1866. Discharged July 22, 1865; pens d. Discharged April 13, 1865; pens d. Total loss of sight of right eye; disease of left eye, resulting in al most total loss of sight. Eyes closed with plaster and band age. Oct. 25, able to read with a bicornons lens. Recovery Novem ber 2, 1864. Discharged May 17, 1865 ; received artificial eye. Disch d Oct. 13, 1864; loss of sight left eye. threatened loss right eye. Recoverv of vision of large objects. Discharged July 2, 1865. Adherent in a few days. Disch d August 7, 1865. Flap united, pterygium disappeared. Disch d April 13, 1865: pensioned. Duty Dec. 7, 1862 ; pens d. " Sym pathetic affection of right eye." Accord of optics nearly normal. Discharged November ID, 1864. Can see large objects. Discharged June 17, 1865; totally blind; pen sioned. Complete remedy, eyelashes all pre served and in their proper position ; eyes weakened. Disch d June 6, 1865; pensioned. Pain relieved, ulceration speedily modifying. Discharged June 19, 1865. Disch d Sept- I, 1865; pain relieved, condition of eyes improved ; right eye permanently destroyed ; pen sioned. 1 l or a ligation of the thoraciea longa for an incised wound see First Surgical Volume., page 556, case of D. Hughes, 13th N. Y. Artillery. The instance of ligation of the branches of the mesenteric artery for a punctured wound will be found on page 62, CASE 206, of the Second Surgical Volume. Details of a case of ligation of the radial and also one of the ulnar artery, for incised wounds, are given on page 436 of the same volume ; and three cases of ligation of the tibial artery are cited on page 7, CASES 5, 6, 7 of this volume. For ligation of iliac see CASE 978, p. 336, Second Surgical Vol. SURG. Ill 86 682 MISCELLANEOUS INJURIES. [CHAP. XI. NAME, MILITARY DESCRIP TION, AND AGE. Doran, J. E., Pt., E, 3d Illinois Artillery, age 17. Dunlap, G. S., Pt., B, 1st Mis souri Cavalry, age 21. Edward, J., contraband, age 25. Elliott, J. M., Pt., H, 30th Ken tucky, age 29. Ellsworth, J., Pt., A, 1st Mich igan Artillery, age 24. Essing, R., Pt., B, 58th New York, age 40. Finn, A., Pt., A, 8th Veteran Reserve Corps, age 23. Flint, J. D., Pt., K, 13th Wis consin, age 20. Frank. P., Pt., E, 58th Illinois, age 33. French, D. S., Pt., A, 70th New York, age 39. Furrow, W. P., Pt., E, 51st Illinois, age 29. Garrett, D. J., Serg t, C, 9th Iowa, age 24. Getz. B., Pt., L, 4th Cavalry, age 24. Grieshaber, U., late Pt,, K, 30th Missouri, age 37. Haight, F. G., Corp l, K, 15th Vet. Reg. Corps, age 26. Hamilton. W. W., Pt, A, 95th Illinois, age 21. (Discharged soldier.) Hayne, P., Serg t, C, 60th New York, age 33. Hicks, W., Pt., 1, 107th Illinois, age 30. Hixon, H. A., Corp l, H, 18th Massachusetts, age 23. Hoffstetter, J., Pt., 48th Co. Vet. Reserve Corps, age 34. Howard, M. H., Serg t, C, 1st Missouri Cavalry. Hughes, J. C., Pt., C, 1st Mis souri Engineers, age 23. Johnson, H. J. N.,. Pt., K, 14th Illinois Cavalry, age 19. Kennedy, J. M.. Pt., K, 119th Illinois, age 23. Kenner, J., civilian prisoner, age 19. Knapp, C., Pt, K, 65th Illinois, age 56. Lamont, J., Pt., K, 8th Veteran Reserve Corps, age 49. Long, Z. V., Pt,, D, 9th Illinois Cavalry, age 22. Mernin, J., Pt., F, 7th Minne sota, age 43. Merritt, J. A. J., Corp l, I, 6th Florida. Morris. O., Pt,. F, 5th Maine, age 26. INJURY OR DISEASE. Purulent ophthalmia witli moderate chemosis of both eyes. Central leucoma of both eyes, caused by ophthalmia; right eye quite use less. Protrusion and destruction of eyeball by sharp edge of hoe. Pannus covering cornea of right eye; total obscurity of vision. Gonorrhoeal ophthalmia with large chemosis of both eyes. Entropion ; both low. lids well marked. Purulent ophthalmia with chemosis of both eyes. Entropion caused by superabundance of integument. Trichiasis right upper lid, caused by blepharitis andgranularophthalmia. Double entropion, caused by catarrhal inflammation of eyes. Cornea panniform and superficially ulcerated. Staphyloma Staphyloma left eye, result of gonor- rhceal ophthalmia; leucoma of right, result of purulent ophthalmia. Artificial pupil of right eye; com plete blindness. Aug., 1864, purulent ophthalmia with chemosis of both eyes. August, 1865. central hernia iris, left eye, from sloughing of cornea, re sult of purulent ophthalmia. Defective vision right eye from cen tral albugo, result of ulceration fol lowing fever. Large pterygium left eye Strabismus interims (double); bleph aritis, granular lids. Glaucoma of both eyes Small vascular tumor, upper eyelid. Irido-cboroiditis right eye ; permanent contraction of pupil. Partial Staphyloma of right cornea from ulceration following erysipelas of face. January, 1864, panniform cornea, sur face covered with exudations. Disorganization of right eye Moderate sized pterygium returned after previous operation. Cornea of left eye ; ulceration; pain, which was not relieved by repeated paracentesis, etc. Ant. chamber both eyes nearly oblit erated ; irides attached to capsules, result of ophthalmia. Spurious cataract and occlusion of pupil right eye; total blindness. Complete Staphyloma of cornea, result of confluent small-pox. November 4, 1863, splinter perforated cornea and wounded lens, left eye ; splinter extracted. OPERATION AND OPERATOR. Aug. 29, 1864, division of ciliary mus cle, righteye. Surg. J. S. Hildreth, U. S. V. Dec. 31, 1864, operation for artificial pupil. Feb. 25, 1865, iridectomy of both eyes. Operator: Surg. J. S. Hildreth, U. S. V. Feb. 2, 1864, excis. eye ball, edges of palpebral wound brought together by sutures. A. A. Surg. C. Pelaez. Aug. 25, syndectomy. Pannus con necting necessitated re-operation. Sept. 9, disease reproducing itself. Hancock s operation performed Oct. 7. Surg. J. S. Hildreth, U. S. V. Jan. 21, 1865, division of ciliary mus cles of both eyes. Surg. J. S. Hil dreth, U. S. V. Feb. 4, 1865, excision of triangular flap on both eyes. Surg. J. S. Hil dreth, U. S. V. Oct. 19, division of ciliary muscle. Surg. J. S. Hildreth, U. S. V. April 18, 1865, removal of integument beneath lower lid right eye. A. A. Surg. M. L. Herr. Sept. 9, 65, transposit n " by a new pro cess adopted for the first time, so far as known, in this case." Snrg. J. S. Hildreth, U.S. V. Trichiasis left up. lid ; same operation, same operator. Oct. 4, 1863, Janson s operation, Des- marres s modification. Surg. J. S. Hildreth, IT. S. V. April 13, 1865, division of ciliary mus cle left eye. Surg. J. S. Hildreth, U. S. V. May 1, operated on by A. A. Surg. Biickhalm. July 25, 1864. exc. of Staphyloma, left eye. Jan. 7, 65, iridectomy of right eye, Desmarres s method ofdechire- ment. Surg. J. S. Hildreth, U. S. V. July 12, 1864, operation for artificial pupil. Surg. A. Hammer, U. S. V. Oct. 2, 1864, division of ciliary mus cle of right eye. Surg. J. S. Hil dreth, U. S. V. Sept. 16, 1865, iridectomy by d6chire- ment. Oct. 11 . Hancock s operation. Surg. J. S. Hildreth, U. S. V. Feb. 11, 1864, excision of portion of iris. Surg. J. S. Hildreth, U. S. V. Jan. 14, 1865, Desmarres s operation. Surg. J. S. Hildreth, U. S. V. Sept. 16, 1863, Graefe s operation on rectus internus dexter. Dec. 1, 63, same operation on sinister. Surg. J. S. Hildreth, U. S. V. Iridectomy both eyes. Surg. J. E. McDonald. U. S. V. May, 1863, tumor exc., its bed plugged with lint saturated with liq. ferri per- sulp. Surg. H. Culbertson, U. S.V. March 11, 1865, division of ciliary muscle. Surg. J. S. Hildreth, U.S.V. Oct. 15, 1864, excision of Staphyloma, leucoma followed. March 4, 1865, iridectomy by process of dechire- ment. Surg. J. S. Hildreth, U. S.V. April 13, 1865, divis. of ciliary muscle. Surg. J. S. Hildreth, U. S.V. Feb. 5, 1864, extirpation of right eye. Surg. . I. H. Curry, U. S.V. Feb. 4, "65, Destnarres s meth. on left eye. Surg. J. S. Hildreth, U. S. V. April 26, 1865, divis. of ciliary muscle. May 13. operation repeated. Surg. J. S. Hildreth, U. S. V. May 6, 1865, attempted excision of irides; division of ciliary ring of each eye ; excision impracticable. Surg. J". S. Hildreth. U. S. V. Nov. 10, 1864, operation for artificial pupil by Surg. A. Hammer, U. S.V. May 11, 1864, removal of eye RESULT AND UKMARKS. Nov. 21. fragments of crystalline ex tracted, protruding parts of iris ex cised. Surg. .7. S. Hildreth, U. S.V. Cornea improved for a few days and then sloughed away; cornea of other eye also destroyed; blind. Discharged Aug28, 1865. Disch d April 13, 1865; has good vision. Recovery March 6, 1864. Left hospital Oct. 16, 1865; pens d. Totally blind ; complete opacity and Staphyloma of both cornea. Discharged July 28, 1865 ; vision of right eye good, left eye lost from central leucoma. Discharged May 17, 1865; defective vision ; lids entirely recovered, natural condition. Cornea sloughed away. Discharged Jan. 23, 1865; total loss of sight left eye ; pensioned. Discharged Nov. 28, 1865 ; claims pension for moon-blindness and loss of sight of right eye. Disch d Nov. 11, 1865; pensioned. Deformity and induration of both upper lids. Disch d March 14, 1864; pensioned. Structural changes left eye, caus ing almost total loss of vision. Disch d June 19, 1865; eye greatly improved ; pens d. Loss of sight of left eye. Discharged Feb. 28. 1866; pens d. Total blindness left eye." Discharged Aug. 10, 1865; pens d. Total loss of left eye, imperfect vision of right eye. Sight partially restored. Cornea destroyed by ulceration. Disch d June 4, 65; sight ot right eye lost, left eye impaired. Nov. 8, 1865, extent of opacity of cornea disappearing; pens d. To tal loss of left eye. March 15, 1864, vision improving, Pterygium entirely displaced. Dis charged May 22] 1865. Strabismus not completely corrected. Transferred March 9, 1864. July 27, 1865; doing well. Duty June 7, 1863. Discharged June 19, 1865; claim for pension rejected. Disch d May 25, 1865; sight very imperfect, owing to atrophy of optic nerve; pensioned. Blind in right eye. left impaired. Disch d June 27. 1865; panniform condition to a great extent disap peared ; pens d. Defective vision. Escaped Feb. 24, 1864. Movement of muscles of eyeball preserved. Pterygium entirely displaced. Dis ch d Mar. 1 5, 65, cornea nebulous ; pensioned. Impairment of sight. Cornea clean and in good condition ; an artificial pupil will give him an excellent vision. Discharged June 2, 65; total blind ness both eyes ; pensioned. Disch d June 2, 1865; complete and permanent loss of vision from oph thalmia and iritis; pensioned. Recovery, with good stump for arti ficial eye. Transferred March 15, ]864; form of eye well preserved but vision lost. SECT. 71. ] OPERATIONS ON THE EYE OR ITS APPENDAGES. 683 65 66 67 68 69 70 71 72 73 74 75 76 NAME, MILITARY DESCRIP TION, AND AGE. Myers, F. .!., Pt., K, llth N. Y. Cavalry, age 22. Neville, C. W., Pt., E, 21st Missouri, age 17. Nichols, A., Pt., L, 3d Michi gan Cavalry, age 30. O Brien, 1). J., Pt., C, 2Stu Massachusetts. Oliphant, W. J., Pt., B, 132d New York, age 16. Oppelcust. G., Pt., K, 112th Illinois, age 35. Patterson, S. B., Pt., G, 8tU Vet. Reserve Corps, age 34. Pemberton, J., Pt., A, 5th Ken tucky Cavalry, age 29. Plowman, A. J., Pt., A, 6th Maryland, age 27. Scheming, A., Pt., G, 8th Vet. Reserve Corps, age 20. Shafer, W., Pt., F, 123d Illi nois, age 39. Smith, A., Pt., F, 8th Veteran Reserve Corps, age 25. Street, G. S., Pt.. M, 1st Conn. Artillery, age 34. Sullivan, J., Pt., G, 2d Mass. Cavalry, age 21. Tibbitts. \V., Pt., H, 147th X. York, ago 25. Toomey, J., Pt., G, 18th Mis souri, age 21. _ Ulrich, H., Pt., K, 63d Illinois, age 25. INJURY OR DISEASE. Unknown . Unknown . Van Curen, C.. Pt., E, 17th Wisconsin, age 46. Van Tassel, E., Pt., A, 120th New York, age 19. Vosbnrp. J.. Pt., K, 3d Minne sota, age 43. \Velch. J.. Pt., B. 17th Mich igan, age 43. Welsh, P., Pt., D. 28th Ken tucky, age 35. Whipple. H. L., Pt., E. 77th New York, age 30. Williamson, J.. Pt., D, 174th New York, age 20. Wycoff. D. E., Serg t, F. 108th Now York, age 20. Young. A. W., Serg t, L. 12th Tennessee Cavalry, age 29. Curtis, J., Pt., E, 12th Indiana, age 42. Wolf, J. H., Musician, E, 12th Penn. Reserve*, age 26. Gonorrhoeal ophthalmia of both eyes, uleeration, chemosis. Staphyloma March, 1864, ectropion of right eye. OPERATION AND OPERATOR. RESULT AND REMARKS. Congenital convergent strabismus of right eye. Double divergent strabismus Staphyloma both cornea, and iris of right eye, from ophthalmia. Chronic choroiditis of both eyes Irido-choroiditis of right eye. Pterygium, double at internal angle of either eye. Purulent ophthal mia with chemosis of both eyes. Purulent ophthalmia, large chemosis of both eyes. Nebulous condition of cornea of both eyes. Excessive myopia of both eyes Staphyloma of cornea and iris, result of uleeration. Staphyloma of cornea of left eye; catarrhal ophthalmia. Internal strabismus . . . Purulent ophthalmia ; large chemosis of both eyes. Chronic inflammation of lachrymal sac, with mucous discharge. Chronic inflammation of lachrymal sac attended with mucous discharge. Staphyloma cornea ; sight obliterated. Fistula of lachrymaTIs left eye ; ab scess at internal canthus. April 6, 1864, purulent ophthalmia; large chemosis of both eyes. Large uleeration of cornea following chronic ophthalmia; sloughing. Entropion left eye, upper lid Cataractous lens dislocated into ant. chamber of left eye; blow, Septem ber, 1862. Symblepharon left lower lid with cornea. Anehyloblepharon both eyes from in flammation of lids. Large central leucoma both eyes, re sult of purulent ophthalmia; only a small part of each cornea remained transparent. Sarcoma, right eye entirely destroyed, inflamed, ulcerated, and protruding from orbit. Pterygium, double. July 25, Hancock s operation ; divis. of ciliary muscle. Surg. J. S. Hil- dreth, U. S. V. Extirpation left eye July 12, operation by Surg. A. Ham mer, U. S. V. June 8, 1863, operation by A. A. Surg. J. W. Gushing. Division of both extern! recti. A. A. Surg. J. H. Hinton. Sept. 10, 65, exc. of Staphyloma, right eye, Desmarres s process. Surg. J. S. Hildreth. U. S. V. April 26, 1365, division of ciliary mus cle, right eye. June 17, same oper ation on left eye. Surg. J. S. Hil dreth, U. S. V. March 8, 1865, division of ciliary mus cle, right eye. Surg. J. S. Hildreth, U. S. V. Deo. 11, 1863, displacement rigrht eye by Desmarres s process. Feb. 11, 1864, same operat n on left eye, using one stitch only to maintain position. Surg. J. S. Hildreth, U. S. V. Aug. 29, 1864, division of ciliary mus cle, left eye ; abscess ; cornea finally sloughed away. Jan. 7, 05, staphy- loma excised. Aug. 23, 65, iridec- tomy of right eye. Surg. J. S. Hil dreth, U. S. V. Sept. 2, division of ciliary muscle of right eye. Surg. J. S. Hildreth, U. S. V. March 8, 1865, iridectomy of both cornea. Surg. J. S. Hildreth, U.S. V. June 15, Hancock s operation, right eye. Surg. J. S. Hildreth, U. S. V. Feb. 2, 1864, excision of tumor with Staphyloma. Surg. J. S. Hildreth, U. S. V. June 1, cornea removed by Surg. J. E. McDonald, U. S. V. May 6, 1865, Graefe s operation, sep arating digitations of tendons from sclerotic. Two-thirds of error cor rected. Surg. J. S. Hildreth,U.S.V. Sept. 25. 1864, division of ciliary mus cles of both eyes. Feb. 11, 65, ex cision Staphyloma, left eye. Surg. J. S. Hildreth, U. S. V. May, 1863, sac opened and tent intro duced to obliterate sac and set up new action in lining membrane. Surg. II. Culbertson, U. S. V. May , same operation as in case 64. Surg. J. H. Culbertson. June 27, division of cornea with cat aract knife, removal of lower section with scissors. Surg. H. C. Culbert son, U. S. V. Feb. 5, ISM. introduction of style by the usual method. A. A. Surg. J. M. McGrath. Oct. 7, division ciliary muscle, right eye. Surg. J. S. Hildreth, U. S. V. Dec. 31, 64, divis. ciliary muscle, left eye. Surg. J. S. Hildreth, U. S. V. Dec. 30. 1863. excision of oval piece of integument sutures. A. A. Surg. G. P. Hackenburg-. Dec. 29, 1862, lens extracted by supe rior section of cornea. Surg. D. P. Smith. U. S. V. Nov. 2, 63, symblepharon dissect, up, conjunctiva of globe drawn together bysutures A. A. Surg. J. IF. Hinton. Jan. 25, 1864, separation of iids from globe of right eye with probe-pointed scissors. Feb. 24, same operation on left eye. Surg. J. S. Hildreth, U.S.V. July 27, 1865, iridectomy both eyes by profess of d6ehirement. Aug. 25, operation on left eye to enlarge pupil. Surg. J. S. Hildreth, U. S.V. May 15. 1865, whole diseased eye re moved with bistoury. A. A. Surg. E. Seyffarth. Dec. 11, 1863, displacement of ptery- i gium. right eye. Desmarres s meth- \ od. Surg. J. S. Hildreth. U. S. V. Discharged Feb. 6, 1864. Pen. Er. 1881, sight greatly impaired, etc. Contracted small-pox ; remain g eye ulcerated, sloughed away. Disch d Jan. 26, 64; pens d; totally blind. Duty Sept. 12, 1864 ; claims pension for disease of eyes resulting from measles. Result good; Veteran Res. Corps. Discharged December 13, 1864. No change by operation ; Veteran Reserve Corps January 31, 1864. Disch d Oct. 16, 1805 ; pens d. Oper ation of no benefit ; can distinguish nothing. Died Sept. 11, 76; ch. diar. Discharged July 3, 1865: defective vision; pensioned. Discharged June 17, 1865; affected with granular ophthalmia ; pens d; blind in left eye. March 15, 1864, recovery; about J disappeared from right eye ; left eye much more satisfactory owing to absence of second stich. Discharged Aug. 26, 1866, and pen sioned; no vision in left eye; right eye affords enough sight to enable him to go about alone. Discharged March 6, 1865; pens d. Right eye totally blind, left eye can only discern light. Disch d May 24, 65. Sight improv g, bids fair to become good enough to enable him to read fine print. Myopia disappeared. Disch d Dec. 13, 1863; pensioned. Amblyopia; right eye useless, sight feeble. Disch d August 12, 1864. Loss of vision of left eye ; sight of right eye impaired: pensioned. Discharged July 19, 1865; pens d. Loss of sight o f left eye. Operation on other eye will correct deformity. Discharged July 24, 1865. Discharged April 27, 1865. Loss of sight left eye, cornea of right eye nebulous; pensioned. Doing well. Doing well. Active conjunctivitis and comeitis resulted. Duty Nov. 28, 1 864 ; pensioned. Loss of left eye and chronic ophthalmia right. March 6. active inflam. set in; style removed, tinct. chlor. iron injected. Discharged July 31, 1865. Cornea sloughed away. Discharged June 13, 65: sight of right eye lost, central nebulosity of left : pens d. Discharged June 28, 1865 ; pens d. Sight of left eye lost. Duty, and discharged Feb. 8, 1865; pensioned for wounds. Disch d March 23, 1863. Very tol erable vision ; pension claim reject ed. Spec. 1195. Duty January 6, 1865. Recovery, with ability to use eyes and read some. Disch d Aug. 12, 1864: pensioned. Died April 9, 1866: phthisis pulmonalis. Vision of both eyes improving. Dis charged October 20, 1865; pens d. Nearly blind. No pain after operation. June 30, eye healed. Died July 5, 1865; debility. Doing well ; injured in a street affray and died December 27. 1863. 684 MISCELLANEOUS INJUEIES. [CHAP. XI. OPERATIONS ON THE MOUTH AND ITS APPENDAGES. Three plastic opera tions for disease have been detailed in the First Surgical Volume. 1 One operation for hare-lip will be added: CASE 1016. Private Morell Seely, Co. F, 103d Ohio, aged 21 years, was admitted into Cumberland Hospital, Nashville, March 7, 18b 4, with gunshot wound of left leg, middle third, with injury to tibia. Patient also had congenital hare-lip. On March 15, 18G4, Surgeon C. McDermotit, U. S. V., operated for hare-lip, without anaesthesia. Two interrupted sutures, one uniting mucous membrane on inner border of lip, used with dressings of adhesive plaster. Union by first intention within five days; patient fed on liquid food. The wound of the leg did well. The patient recovered and was furloughed April 13, 1804. OPERATIONS ON THE AIR PASSAGES. To the six cases of laryngotorny for disease, recorded on page 417 of the First Surgical Volume, should be added a fatal opera tion performed for sore throat following typhoid fever, making seven cases of this operation with only one recovery: CASE 1017. Private Samuel Mitchell, Co. C, 12th Infantry, was admitted into hospital No. 1, Frederick, September 19, 1862. Acting Assistant Surgeon W. W. Keen, jr., reported: "Had had typhoid fever followed by sore throat. On October 5th, 3 P. M., the respiration became somewhat embarrassed and grew rapidly worse, till at 4 P. M. Dr. G. L. Potter, the officer of the day, was hurriedly summoned. The neck was observed to be swollen, especially on the right side; there was great dyspnoea, botli in inspiration and expiration, coldness of the extremities, and insensibility. Laryngotomy, on examination of the epiglottis, was immediately resolved upon, but the patient revived scarcely at all, although the respiration through the artificial opening was free, and in about fifteen minutes ceased to breathe. Post-mortem twenty- four .hours after death: The tonsils are deeply eroded, the epiglottis erect and firm, not from oedema but from effusion of lymph about the vocal cords. There is a marked plastic eft usion, especially on the right side. The lungs are congested and somewhat filled with oedema; other organs healthy, save Peyer s patches, which are ulcerated to some extent." OPERATIONS ON THE CHEST AND ABDOMEN. For the cases of thoracentesis, herniotomy, and paracentesis, the reader is referred to pp. 573-598 of the First, and pp. 187-191 of the Second Surgical Volume. OPERATIONS ON THE GENITO-URINARY ORGANS. With the exception of ten instances of removal of testes, the operations on these parts have been fully discussed in the Second Surgical Volume! 2 Two of the ten cases proved fatal: CASES 1018-1027. Removals of the testes. Private J. B , Co. F, 77th New York, age 23; bruise oT right testicle against pommel of saddle, September 1, 1864. Testicle and spermatic cord greatly enlarged; three fistulous openings through scrotum discharging pus. December 10th, right testicle removed by Acting Assistant Surgeon H. Pearce. Returned to duty March 19, 1865. Private ./. S. D , conscript, C. S. A., age 33. October 28, 1863, incision at superior portion of scrotum, testicle forced through the aperture and exscinded by himself. November 2d, serious haemorrhage, which recurred on November Gtli, when artery was ligated. Furloughed November 23, 18(53 Private E. G , Co. H, 30th Illinois, age 24. January H, 1864, excision of left testicle by Assistant Surgeon W. Feland, 30th Illinois, on account of scirrhus. Gangrene, secondary haemorrhage from spermatic artery. June 30th, wound nearly healed and doing well. Mustered out September 8, 1864. Lieutenant G. W. H . 173d Ohio, age 28; sarcocele of right testicle of nine months duration; tumor a little larger than an ordinary goose egg. Feb ruary 6, 1865, testicle removed by Acting Assistant Surgeon J. A. Hall. Mustered out May 15, 1865. Private D. P. H , Co. E, 30th Colored Troops, age 20; chronic orchitis; right testicle much enlarged and painful. Testicle removed and spermatic artery tied by Acting Assistant Surgeon O. Shittler. Dischai ged July 31, 1865. Private J. M. J , Co. D, 146th New York, age 24; injury to right testicle by fall from horse. Excision of right testicle. Discharged September 25,1865. Captain G. McP , 8th Tennessee Cavalry, age 36; cystic sarcocele: right testicle enlarged to the size of a goose egg. July 7, 1864, right testicle removed by Surgeon J. E. Herbst, U. S. V. Returned to duty August 10, 1864. W. S , colored civilian, age 50; left testicle enlarged to the size of a small cocoanut; dragging pain when walking. November, 1864, removal of left tes ticle by Assistant Surgeon S. J. Bumstead, 29th Illinois. The organ when removed weighed two and a quarter pounds. It was contributed to the Army Medical Museum by the operator, and is numbered 3(554 of the Suryical Section. The patient recovered. Private J. C , Co. B, 3d East Tennessee Vols.; cystic enlargement of left testis. March 29, 1864. extirpation of left testicle by Assistant Surgeon B. E. Fryer, U. S. A. Erysipelas attacked the parts, extending to the abdomen. Died May 31, 1864, of peritonitis. Captain E. D. L , 43d Wisconsin, age 32; sarcocele of right testicle, the result of injury. March 16, 1865, removal of right testicle by Surgeon J. E. Herbst, U. S. V. Furloughed April 9, 1865. Died June 2, 1865, cause not stated. Cases of E. E. Sadler, Co. C, 9th Iowa Cavalry, p. 3u J ; H. Kennedy, citizen, p. 370; and Pt. C. Burgan. Co. B, Purnell Legion, p. 375. Cases of lithotomy, pag-e 282 ; operations for fistula ani, page 3:21 ; operations for removal of piles, page 3:>2; operations for phymosis, page 343; external perineal nrothrotoiny, page 400 ; operations for hydrocele, page 4iM. Two cases of extirpation of the testes on account of contused wounds have been cited: P. W. Lucas. 1st Virginia Battalion, page 414, and Recruit H. D. Tuner, page 418. CHAP. XII.] SABRE AND BAYONET AND SHOT WOUNDS. 685 CHAPTER XII. WOUNDS AND COMPLICATIONS. The subject of injuries affecting the several regions of the body having been thoroughly discussed throughout the preceding portions of this history, the present chapter will be devoted to a general consideration of wounds and complications, in the course of which the endeavor will be made to use, to the best advantage, the large amount of material accumu lated during the late war, illustrative of facts of general interest and of statistical value relating to wounds; of the nature, peculiarities, and effects of missiles and projectiles used in warfare; of the conditions affecting the course and result of wounds, with especial refer ence to the graver complications of secondary haemorrhage, erysipelas, pysemia, gangrene, and tetanus. During the late war there were treated two hundred and forty-six thousand seven hundred and twelve (246,712) cases of wounds by weapons of war. Of these, two hundred and forty-five thousand seven hundred and ninety (245,790) were shot wounds, and nine hundred and twenty-two (922), or 0.37 per cent., were sabre and bayonet wounds. The average percentage of sabre and bayonet wounds in the European Wars during the last twenty years was 2.4, as shown in the following table: TABLE CXIV. Frequency of Sabre and Bayonet and Shot Wounds on Occasions named and from Authorities quoted. OCCASIONS. INJURIES. Percentage of Sabre and Bay onet Wounds. Total. Sabre and Bayonet. Shot. Knfrlish in the Crimean War 1854 57 (MATTHEW 1 ) 10,129 26, 811 15, 966 18, 521 281 3,232 85 1,697 2,903 8,527 54, 268 158 818 565 543 54 61 19 56 92 333 786 9,971 25, 993 15, 401 17, 978 227 3,171 66 1, 641 2,811 8, 194 53, 482 1.5 3.0 3.5 2.9 19.2 1.8 22. 3 3.3 3.1 3.9 1.4 French in the Crimean War 1854 57 (CHENU 2 ) .- French in the Italian War 1859 (ClIENU 3 ) A ust nans at Verona 1850 (RicHTF.it 4 ) Austrian s at Montebello IPS ) (RlCHTFH 6 ) Germans in Schleswig-Holstein W:ir 1804 (LOKFFLEK 6 ) French in Mexico 1804 (BiXTOT 7 ) . .... Six Weeks War in Germany I860 Bavarians (RlCHTER 8 ) Six Weeks War 18(!G Italians (COItTKSE 9 ) Franco-Prussian War 1870 71 Germans (FISCHEK 11 ) 142, 420 3, 485 138, 935 2. 4 In comparison with the large number of shot wounds, the number of sabre and bayonet wounds seems insignificant, offering a striking commentary upon the advance of 1 MATTHEW (T. P.), Medical and Surgical History of the British Army which served in Turkey and the Crimea, etc., London, 1858, Vol. II. pp. 257, 259. 2 CIIENU (J.-C.), Rapport auConseil de Sant> des Armecs, etc... pendant la Campagne d Orient en 1854-18-35-1856, Paris, 1865, p. 627. 3 CllENU (J.-C-), Statistiffue M6d, Chir, de la Campagne d Jtalie en 1859 et 18CQ, Paris, 1869, T. 11; the figures here given were obtained from a compilation of the 686 WOUNDS AND COMPLICATIONS. (CHAP. XTT. modern military science, and showing that with the general adoption of long-range repeat ing fire-arms the sabre and bayonet are rapidly falling into disuse, and that the time is coming, if it has not already arrived, when these old and honored weapons will become obsolete; 1 and when such wounds from these sources will be regarded rather as incidents of battle than as the results of regular tactical manoeuvres. SABRE AND BAYONET WOUNDS. Of the nine hundred and twenty-two (922) cases of these injuries reported in detail throughout the history, and grouped together in the following table, a large proportion had their origin in private quarrels or broils, or were inflicted by sentinels in the discharge of their duty: TABLE CXV. Summary of Nine Hundred and Twenty-two Sabre and Bayonet Wounds recorded during the American War, 1861-65. SEAT OF INJURY. TOTAL NUMBER OF CASES. SABRE. BAYONET. o Recoveries. "3 ~a PM Undetermined Results. Mortality. | c: O Recoveries. "5 03 PH Undetermined Results. Mortality. 300 55 64 9 38 18 10 7 9 34 149 7 9 7 198 7 1 282 49 37 5 9 o 1 4 1 13 80 4 6 7 22 276 36 3:S 4 8 6 13 1 2. 1 2fi. 5 2.9 18 6 27 4 29 16 9 3 8 21 16 1 22 3 18 16 G 6 21 o 5 1 1 9 11.1 83.3 43.4 25.0 33.3 3 1 4 1 11.1 2 1 100.0 50.0 3 1 2 33.3 33.3 25.0 1 13 75 4 6 6 1 4 1.3 69 3 3 61 3 3 1 7 1.6 Sabre and Bayonet Wounds of Elbow Joint Sabre Wounds of Bones of Forearm 1 14.2 176 7 1 171 7 1 5 2.8 13 922 522 488 20 8 5.0 400 357 30 7.7 The fatality of these wounds as indicated in the table is small, perhaps exceedingly so when it is considered that these injuries derive their importance from their tendency to excite inflammatory action in deep-seated tissues and cavities, with the danger of forma- tabular statements on pp. 424 to 836 of the second volume of Dr. CHEXU S work; the summary on p. 849 of his work includes the injuries of a miscel laneous character, which have been eliminated in this calculation. 4 RICHTER (E.), Chirurgie. dt,r Schussverletzungcn im Kriege, etc., Breslau, 1874, I, Theil, I Abth., p. 905. 5 RICHTER, Inc. cit., p. 905. 6 LOEFFLER (F.), General- Veridit ilber den Gesundheitsdienst im Feldzttge gegen Danemarli, 1864, Erster Theil, Berlin, 1867, p. 36. 7 BlNTOT, Observations de BUssures de Guerre, in Rec. de Mem. de Sled, de Chir. et de 1 har. Mil., 1866, 3" s6r., T. XVI, p. 42. 8 RlCHTER (E.), Inc. cit., p. 905. 9 COKTKSE (F.), UJtfrinri ragrjuagli siilJe perdite delV escreito italiann snffe.rte. nrUa rampagna del 1866, in Annali Unive.rsa.li di Mcdicina, Milano, 1868, Vol. CCV, p. 506. 10 RlCHTEli, loc. cit., p. 905. n FiscilEU (G.), Statistik der in dem Kriege 1870-71, vnrgeknmmenen Verivundungen itnd Todtungen, etc., Berlin, 1876, p. 7. The total number of sabre and bayonet and shot wounds cited by FISCHER is 61,959 ; but this number includes 7,691 killed on the battlefield, which have been dropped in this tabulation, as the killed are not included in any of tho authorities quoted. 1 The following is an extract from a letter on file in this office from General ROBERT WILLIAMS, Assistant Adjutant General, in reply to inquiries made by the late Surgeon G. A. OTIS, U. S. A.: "ADJUTANT GENERAL S OFFICE, WASHINGTON, March 24, 1868. "DEAR DOCTOR: Yours of the 18th instant, containing certain queries, has been received ; in reply to your questions I would say . . . hand to hand skirmishes between cavalry during the late rebellion were not at all infrequent; but the pistol and carbine were more commonly relied upon. Sabre wounds were slight and generally harmless, as the sabre was in few instances sharpened, and the men were almost totally uninstructed in its use. Hand to hand combats between cavalry mounted and infantry were, 1 believe, of rare occurrence ; in almost every case the cavalry was dismounted and fought as infantry. . . . Owing to the present long-range and repeating weapons, with which both cavalry and infantry are now armed, it is my belief that the lance may be regarded as obsolete and that the sabre will soon become so. Yours truly, ROBERT WILLIAMS, Ass t Adjutant General," CHAP, xn.] SHOT WOUNDS. 687 tion and confinement of pus; from the chances of injury to blood-vessels, nerves, and viscera, and the possibility of pyaemia, gangrene, and tetanus. As might be anticipated, wounds by the sabre involve chiefly such parts of the body as are especially exposed to blows in the ordinary use of this weapon; thus injuries of the head and upper extremities are more largely represented, while wounds from the bayonet show a decided preponderance in the lower extremities. 1 Wounds from sabre blows 2 were not of a grave character, except in cases involving the cranial cavity, where the mortality attained its highest percentage. Seven cases recorded in previous chapters of the history show fractures of one or both bones of the forearm by sabre blows; in one case primary, and in another secondary amputation became necessary. 3 One fatal case of tetanus is reported as following an incised sabre fracture of the cranium; also one case of pyaemia from a similar cause. Epilepsy, insanity, loss of vision and hear ing, and impairment of mental faculties seem to have been among the remoter effects of injuries of the cranium from this cause. The fatality of bayonet wounds exceeds that of sabre wounds by 2.7 per cent., and is chiefly due to injuries of viscera and large blood-vessels. The heart, lungs, diaphragm, liver, stomach, jejunum, and spleen are noted as having been punctured; and of the blood vessels, the common iliac, femoral, internal pudic, and brachial were involved. The fatal cases of bayonet wounds of the lower extremities, five in number, resulted from gangrene in three cases, and from primary haemorrhage and pyaemia in one instance each. The median and sciatic nerves were lacerated in two cases, and the penis punctured in one. No case of tetanus is reported as following a bayonet wound. SHOT WOUNDS. The consideration of generalities on shot wounds, their nature, frequency, fatality, and principal complications will be preceded by a tabular summary of all shot wounds of which records are found in this Office. In the introductory memoran dum of the Second Surgical Volume and in the various sections throughout the work the total number of wounds of the portions of the body under consideration, so far as known at the time, were indicated. Since then additional reports and records of hospitals, especially field hospitals, frequently subjected to the varying fortunes of a successful or unsuccessful campaign, records which in some instances were supposed to have been lost or destroyed, have been received at this Office, as the work on the surgical history progressed, increasing somewhat the total number of injuries. There undoubtedly remain, even at the present time, quite a number of casualties of which there are no histories on file, especially of the early part of the war in 1861, when each regiment and sometimes each detachment of troops, before the establishment of base and general hospitals, continued to find shelter for its more seriously injured patients in tents or buildings temporarily occupied which offered no facil ities for keeping records, and when volunteer officers and also enlisted men were allowed to proceed from the battle-fields to their homes to be treated by their family physicians. A few special reports of some of the most interesting of these cases have been received at this Office; but undoubtedly quite a large proportion failed to be recorded at all. Further more, after general engagements many circumstances interfered with the efforts of medical 1 Of 522 sabre wounds, 368 were wounds of the head and 97 of the upper extremities, making a total of 465, or 89 per cent, of the whole number. Of 400 bayonet wounds, 184, or 46 per cent., were in the lower extremities. 2 Examples have been cited in the First Surgical Volume, on pp. 1 to 30, of sabre wounds of the head ; on p. 322, of the face ; on p. 399, of the neck ; in the Second Surgical Volume, on pp. 3, 4, of the abdominal parietes ; on p. 32, of simple perforations of the abdominal cavity without visceral injury ; on pp. 61, 62. of the small intestines ; on p. 76, of the large intestines ; on p. 129, of the liver; on p. 429, of the back; on pp. 435, 436, of the upper extremities ; on p. 473, of the clavicle and scapula; on pp. 828, 829, of the elbow joint ; and in the Third Surgical Volume, on p. 7, of sabre flesh wounds of the lowel extremities. 3 CASES: 1845, 1846, on page 919, Second Surgical Volume, of Privates William Billows and Corwin Davis. 688 WOUNDS AND COMPLICATIONS. [CHAP. XIL officers to obtain accurate details of the number of wounded, and no record could be made of the wounded among those reported as captured and missing. The shot wounds now recorded number two hundred and forty-five thousand seven hundred and ninety (245,790). They have been grouped in three tables, the first containing shot wounds of the head, face, and neck, the second those of the trunk, and the third those of the extremities: TABLE CXVI. Tabular Statement of the Shot Wounds of the Head, Face, and Neck recorded during the American Civil War. NATURE AND SEAT OF INJURY. . Totals. RESULTS. 8 K ;d o> >> J>3 i c~ 11 | SHOT INJURIES OF THE HEAD.* < SHOT INJURIES OF THE FACE. 2 SHOT INJURIES OF THE NECK. S < r Flesh Wounds of the Scalp 7,739 328 4, 865 162 273 55 2,712 3.2 Hi. 7 138 20 19 2,911 3G4 486 73 9 128 10 1 19 12 7 9GO 1, 82(5 232 129 84 402 17 5fi 1)5. .% . 7 Fractures without known depression Fractures with depression 1-25 (15. 5 3 : 35.7 7li. 7 ! 100.0 1 1 50. Total Shot Injuries of the Head 12, 089 4,914 4, 502 9, 4 Hi (i, 573 2, r,7tJ 3, 7()ti 58 3, 700 404 7, 40(i 4(i2 2, 840 28. 9 1,150 1.5 398 9. 8 1,5-18 5.8 Total Shot Injuries of the Face 4,789 41 30 13 10 4 2 1 1 4, 895 3, 450 570 19 21 10 10 5 7 4 (i 4 7J9 M.I 1 5-. . 5 10 50.0 1 5H. 3 (il). Wounds inju ing Trachea and Larynx MIO.O 1 1 T 100.0 Total Shot Injuries of the Neck. . . 3, 49fi til" 781 15. n Aside from flesh wounds of the scalp, and slighter forms of contusion and fracture, shot wounds of the head were of a very fatal character, the ratio of mortality following closely upon the degree of injury inflicted upon the brain and its appendages. Fractures of the inner table of the cranial bones were of difficult diagnosis, and could in general be substantiated only after post-mortem inspection. Perforating gave slightly more favorable results than penetrating fractures; this may have been clue to the fact that less vital por tions were involved, or that these wounds were more satisfactorily treated, being freed from the complications attending the lodgement of foreign bodies. The results of shot injuries of the face confirm the opinion that these wounds commonly do well, notwithstanding the amount of destruction apparent at the time of injury. The records have furnished sufficient I See First Surgical Volume, p. 308, TAULJJ V1J. 2 See first Surgical Volume, p. 382, TABLE XIV. 3 See First Surgical Volume, p. 414, TAliLB XVIJ. CHAP. XII. ] SHOT WOUNDS. 689 material, already alluded to in a previous chapter, to show a remarkable degree of success in the treatment of such cases. The high mortality of shot wounds of the neck is almost necessarily to be expected from lesions of parts of great vital importance, placed in close relation with the great nervous and vascular trunks found in this region. TABLE CXVII. Tabular Statement of the Shot Wounds of the Spine, Chest, Abdomen, Pelvis, and Back recorded during the American Oivil War. NATUHE AND SEAT OF 1NJUHY. Totals. RF.6U1.T6. Percentage of Ka- talitv. 8 % J3 1 1 tindeterm d Results. SllOf WOI XHS OV THE Sl INK SHOT WOUNDS OF THE CHKBT... . < 91 137 149 3 27 50 79 1 63 ft"* 66 1 129 1 70.0 63.5 45.5 50.0 100.0 51.3 4 260 122 <i 14 642 279 349 55.5 11,549 446 8, 269 20, 264 10,778 362 2,781 13, 921 113 68 5,192 5,373 658 16 296 970 1.0 15.8 65. 1 27.8 SHOT WOUNDS OF THE AUDOMKN ... SHOT WOUNHB OF THE PELVIS , SHOT WOUNDS OF THE BACK Total Shot Injuries of the Chest 4,469 238 41 19 79 653 173 29 5 78 54 1 2,599 2,881 120 21 12 19 118 62 o 1 26 7 253 5 20 7 60 484 108 27 4 51 47 1 1,3:!5 113 8.0 4.0 48.8 36.8 75.9 89.4 63.5 9ai 80.0 66.2 87.0 100.0 92.2 Wounds of the Stomach 51 3 1 Wounds of the Blood-vessels, Omentum, and Mesentery 186 2,226 187 8,438 3,455 3, 293 1, 6i0 48.7 1,494 38 185 8 103 179 309 105 586 32 120 :!, i5<) 3, 486 990 098 7,507 12,681 918 25 89 4 59 94 268 83 520 30 104 , , 194 544 13 96 4 44 85 41 66 13 930 32 .37.2 34.2 51.8 50.0 42.7 47.4 13.2 21.9 11.2 6.6 11. 1 29.7 Wounds of the I rothni Wounds of tho Spermatic Cord Wounds of the Genital Organs indefinitely described Total Shot Injuries of the Pelvis 3 35 Reported as Shot Wounds of tlio Back 3,024 886 620 6,353 172 51 51 526 290 53 27 628 5.3 5.4 7.6 7.6 Specified as over the Posterior Tlionirii Region - . . 1 Specified as over the Posterior Alidoininal Uegion . Total Shot Injuries of the Back 10, 883 800 998 6.9 SURG. Ill 87 690 WOUNDS AND COMPLICATIONS. [CHAP. XII. The great fatality of undoubted shot penetrations of the abdomen alluded to on page 204 of the Second Surgical Volume is apparent in the preceding table; of three thousand four hundred and eighty-nine (3,489) determined instances of such lesions, three thousand and thirty-five (3,035) had fatal terminations, a mortality rate of 86.9 per cent., exceeding that of the shot fractures of the cranium with penetration of the brain, which, as indicated in TABLE CXVI, was 82.7 per cent.; even the large fatality of shot fractures of the hip, 84.7, in the succeeding table, is in some measure due to complications with injuries of the viscera of the abdominal cavity. TABLE CXVIII. Tabular Statement of the Shot Wounds of the Upper and Lower Extremities recorded during the American Civil War. NATURE AND SEAT OF INJURY. 3 1 RESULTS. Percentage of Fa tality. Recoveries. Deaths. Undeterm d Results. SHOT WOCXDS OF THE UPPER EXTREMITIES. SHOT WOUNDS OF THE* LOWKK EXTKKMITIKS. 54, 801 2,280 1,378 201 8,245 2,678 138 5,194 1,496 13 11,369 J 53, 095 t 66 1,936 916 32 6,249 2, 130 81 4, 636 1,292 13 9,644 1,634 6 314 449 43 1, 639 513 19 482 193 2.9 8.3 13. 9 32.8 57.3 20.7 19.4 19.0 9.4 12.9 30 13 126 357 35 38 76 11 Fractures of the Bones of the Shoulder Joint in Confederate Army (excisions) 6 Fractures of the Bones of the Elbow Joint in the Confederate Army (excisions) 8 Fractures of the Bones of the Wrist Joint in the Confederate Army (excisions) 11 316 1, 409 3.1 87, 793 80, 090 5, 608 2, 095 6.5 59, 139 386 162 6, 57G 43 3. 355 183 8,988 f 55, 914 1 305 59 120 2,995 24 1,542 157 6,334 8 1,239 26 4,942 2,788 132 327 42 3,392 19 1,800 26 2,. 376 3 457 1 450 4.7 30.2 84.7 25.9 53.1 44.1 53.8 14.2 27.2 27. 2 26.9 3.7 8.3 Fractures of the Shaft of the Femur 7 189 13 278 15 440 11 1,711 O*7 5,832 86, 413 73, 665 11,813 935 13.8 With two exceptions the generally accepted rule in fractures of the extremities, that the ratio of fatality diminishes with increased distance of the injury from the trunk, is Aote 1, page 435, Second Surgical Volume.. 2 Page 502, Second Surgical Volume. 3 TAliLE XVI, page 474, Second Surgical Volume. 4 On page 503, Second Surgical Volume, 505 shot fractures of the shoulder joint treated conservatively are accounted for. To these should be added 640 cases <>f excisions after fractures of the shoulder joint (not 670. as erroneously stated on page 519, as 245, not 215, were for fractures involving the humen the shoulder joint) and 203 instances of amputation following fractures of the shoulder joint. The total number of amputations at the shoulder \v; but of this number only 203 were for fractures of the bones of the joint. The remaining 649 cases were : 621 for fractures of the arm (TABLE I A , p. 17 for fractures of the elbow (TABLE CV, p. 829), 6 for fractures of the forearm (TAHLK CXXIV, p. 922), 3 for fractures of the wrist (TABLE CXI. I. p and 2 for fractures of the hand (TABLE CXL1V, p. 1019). "Page 601, Second Surgical Volume. "TABLE LV, p. 666, Second Surgical Volume,. 7 TABl.K CV, page 829, Second Surgical Volume. 8 TAliLE CXIX, pp. 898-9, Second Surgical Volume.. "TABLE CXXIV, page 922, Second Surgical Volume. 10 TABLE CXIJ. page 996, Second Surgical Volume. " Pages 1012-13. Second Surgical Volume. "TABLE CXUV, page 1019, Second Surgical Volume. 1 3 Pages 8-60, a nte. ""Pages 24-32, ante. "TAISLK IX. page 65, ante. 6 TABLE XIX. page 170, ante. " TABLE XX, page 175, ante. > Pages 363-3G7, ante. l9 TABLE LII, page 367, ante. w Pages 427-432, ante. 2I TAWLK LXT, page 432, ante. Pages 577-578, ante. 23 TABLE I^XXXVII, page 578, ante. "Pages 617-619, ante. TABLE XCV, page 619, ante. CHAP XT!.] SHOT WOUNDS. 691 verified in this table. In the upper extremities the fractures of the wrist had a greater fatality than those of the forearm (12.9 and 9.4 per cent, respectively), and in the lower extremities the results of the injuries of the knee joint were slightly less favorable than those of the femur, the fatality rate being in the former 53.8, in the latter 53.1 per cent., although the difference 0.7 per cent, is very trifling. That the wounds of the joints are of a more serious nature than those of the long bones immediately above them has been shown in numerous tabular statements throughout the preceding volumes, yet the percent ages of fatality do not seem to have been proportionally increased. But the joint wounds were far more frequently followed by excision and amputation, and it would seem therefore that the increased ratio of operation had tended to reduce the percentage of fatality. Longmore 1 cites from Albinus, Liharzik, Marshall, and from measurements of the Pythian Apollo and Farnesian Hercules, the relative amounts of superficial area presented by the principal divisions of the human body, and gives as the mean of these measure ments the following percentage of the whole target area of the body: For the head, face, and neck, 8.51 per cent.; for the trunk, 28.91; for the upper extremities, 21.14; for the lower extremities, 41.41. If battles were fought and decided on level and unobstructed ground we might find that the percentages of the injuries inflicted on the various sections of the human body would correspond with the proportional percentage of the area; but it is evident that the nature of the field of operations, whether fortified places or the open plain or rolling wooded districts, must necessarily change the relative regional frequency of injuries. Of the wounds that came under treatment in the American civil war, as shown in the following table, 10.77 per cent, were injuries of the head, face, and neck, 18.37 of the trunk, 35.71 of the upper extremities, and 35.15 of the lower extremities. TABLE OXIX. Table indicating Percentage of Fatality and Relative Frequency of Shot Wounds recorded during the War of the Rebellion. o 8 RKSUI.TS. | . Is Relative Fre S Recoveries. Deaths. Undeterm d Results. o,* K quency. 12 089 6,573 2,676 2,840 28.9 ri4.91 9,416 7,406 462 1,548 5.8 10.77-; 3.87 4,895 3,496 618 781 15.0 ( 1.99 642 79 349 14 55.5 0.26 20, 264 13, 921 5,373 970 27.8 8.24 8.438 3, 455 3,293 1,690 48.7 18.37-, 3.43 Shot Injuries of the Pelvis 3,159 2, 194 930 35 29.7 | 1 1.28 12 681 10, 883 800 998 6.9 I 5.16 87 793 80 090 5, 608 2, 095 : 6.5 35.71 86 413 73, 6f>5 11,813 935 13.8 35.15 245, 790 201, 962 31, 922 11,906 13.6 00.00 1 According to this tabular statement the injuries of the extremities form 70.86 per cent, of the total number of wounded, and the proportion of the wounds ot these parts would therefore appear disproportionately large. But it must be borne in mind that the figures here given only constitute a portion of the injuries received, as the large number ol killed are not included in these calculations. The records in this Office show the seat of LOMi.MOi;i: t l ). liijiinen, London, 1877, page 595. 692 WOUNDS AND COMPLICATIONS. [CHAP. xn. injury in only one thousand one hundred and seventy-three cases of soldiers killed on the battle- field. Of these, four hundred and eighty-seven (487) were of the head and neck, six hundred and three (603) of the trunk, thirty (30) of the upper extremities, and fifty-three (53) of the lower extremities. In the Introductory to the First Surgical Volume, at page XXVI, it has been stated that the total number of killed, according to the Adjutant Gen erals Report, w.as not less than forty-four thousand two hundred and thirty-eight (44,238). Applying the proportions of the one thousand one hundred and seventy-three (1,173) cases, viz: four hundred and eighty-seven (487) of the head, six hundred and three (603) of the trunk, thirty (30) of the upper extremities, fifty-three (53) of the lower extremities, to this total of forty-four thousand two hundred and thirty-eight killed, we would have eighteen thousand three hundred and sixty-seven (18,367) killed from wounds of the head, twenty- two thousand seven hundred and forty-one (22,741) from injuries of the trunk, one thousand one hundred and thirty-one (1,131) from wounds of the upper extremities, one thousand nine hundred and ninety-nine (1,999) from casualties in the lower extremities. Adding to these the cases of wounded according to the above table, viz: twenty-six thou sand four hundred (26,400) of the head, forty-five thousand one hundred and eighty-four (45,184) of the trunk, eighty-seven thousand seven hundred and ninety-three (87,793) of the upper extremities, eighty-six thousand four hundred and thirteen (86,413) of the lower extremities, we have a total of injuries according to regions of body, including killed and wounded, of forty-four thousand seven hundred and sixty-seven (44,767) head, sixty-seven thousand nine hundred and twenty-five (67,925) trunk, eighty-eight thousand nine hun dred and twenty-four (88,924) upper extremities, eighty -eight thousand four hundred and twelve (88,412) lower extremities; or, according to percentages, of 15.44 per cent, injuries of the head, 23.42 per cent, injuries of the trunk, 30.66 per cent, injuries of the upper extremities, 30.48 per cent, injuries of the lower extremities, making a total of 61.14 per cent, of injuries of the extremities. Whether we take into consideration the percentage of the injuries of the upper extrem ities derived from the total wounded and killed, 30.66 per cent., or that obtained from the number of soldiers treated for wounds only, 35.71, the regional proportion of these injuries is very large. The same is to be said of the relative frequency of the wounds of the head, face, and neck, amounting to 10.77 per cent, of the wounded and 15.44 per cent, of the wounded and killed. But the protection afforded to the lower extremities and the trunk in the many siege operations, by parapets, and in field operations, especially during the severe and extended campaign beginning with the battles of the Wilderness, Spottsyl- vania, Cold Harbor, and ending with the siege of Petersburg, by trenches, ditches, behind trees, etc., screened those parts to a large extent from injury, while the head and upper extremities were continually exposed to the practised eye of a vigilant foe. The influence exerted by the nature of the military operations on the regional per centage of injuries is well illustrated in the next table, in which it has been attempted to give the proportions of the injuries of the head, face, and neck, the trunk, and the extrem ities, from the most reliable accounts of European and other campaigns. The percentages of the injuries of the head varies from 20.2 per cent, among the French in the Crimean campaign in 1854-57, to 6.4 per cent, in the Revolution in Paris in 1830; the percentage of the trunk from 31.2 in the New Zealand Campaign in 1863-65, to 9.3 in the Mutiny in India in 1859; the percentages of the upper extremities from 39.3 per cent, in the Russo- Turkish War, 1876-77, to 18.8 in the campaign in the Kabylie in 1854-57; and the CHAP XII. 1 SHOT WOUNDS. 693 percentages of the lower extremities from 48.2 in the same campaign, to 27.1 in the New Zealand War in 1863-65, and it will be noted that the fluctuations are the largest in cam paigns confined to a limited territory. But of the entire number of two hundred and sixteen thousand three hundred and forty-eight (216,348) cases here referred to, thirty-one thousand one hundred and eighty-four (31,184), or 14.4 per cent., were injuries of the head, face, and neck; forty-five thousand five hundred and eighty-three (45,583), or 21.1 per cent., injuries of the trunk; sixty-six thousand four hundred and seventy-five (66,475), or 30.7 per cent., injuries of the upper, and seventy-three thousand one hundred and six (73,106), or 33.8 per cent., injuries of the lower extremities, nearly approaching the percentages derived from the injuries of the American civil war. TABLE CXX. Tubular Statement of the Relative Frequency of Shot Wounds of the Different Regions of the Body. OCCASIONS AND AUTHORITIES. g 3J o HEAD, FACE, ! T AND NECK. , UPPEH EXTREMITIES. LOWER EXTREMITIES. Cases. Percentage. Cases. Percentage. Cases. Percentage. Cases. Percentage. Revolution in Pari< 18 30 (MKXIERF JOHERT (DE LAMB U.LE 2 ) 627 413 6,355 9,971 25, 993 1,422 558 17,095 15, 401 48 66 3, 171 2,282 2,811 108 387 53, 482 40 46 949 2,000 5,263 220 60 2,050 1, 514 8 11 458 218 333 17 63 7,880 611 9,376 47 6.4 11. 1 14.9 20.1 20.2 15.5 10.8 12.0 9.8 16.7 16.7 14.4 9.5 11.8 15.8 21.4 14.7 14.1 13.1 12.7 117 77 1,006 1,500 4, 937 249 52 3,750 2,265 15 10 614 410 529 16 145 8,835 772 20, 243 41 18.7 18.7 15.8 15.0 19.0 37.5 0. 3 21.9 14.7 31.2 15.1 19.4 18.0 18.8 14.8 37.5 16.5 17.8 28.4 11.1 193 116 1,804 3,089 8,238 267 212 6,047 5,378 12 20 925 591 761 40 79 17, 795 1,174 19, 588 146 30.8 28.1 28.4 31.0 31.7 18.6 38.0 35.4 34.9 25.0 30.3 29.2 25.9 27.1 37.0 20.4 33.3 27.0 27. 4 39.3 277 174 2,596 3,382 7,555 686 234 5,248 6,244 13 25 1,174 1,063 1,188 35 80 18, 972 1,787 22, 236 137 44.1 42.1 40.9 33. 9 29.1 48.2 41.9 30.7 40.6 27.1 37.9 37.0 46.6 42.3 32.4 20.7 35.5 41.1 31.1 36.9 Revolution in Paris, 1848 (BAUDKXS, HUOUIEI:. JOBEKT (DE LAMBALLE 3 )... Schleswig-Holstein War 1848 51 (SIMON * DJORUP 6 ) Crimean War 1854-57 English (MATTIIKW 6 ) Campaign in the Kabylif 1854 57 (BKRTHEliA\li) s Mutiny in India, 1858-59 (WILLIAMSON 9 ) Campaign in Italy 185 l > Austrian (DEMME 10 ) Campaign in Italy, 1859, French (CHENU 11 ) . Campaign in New Zealand 1863 65 (MOUAT 12 ) French in Mexico 1864 (BlNTOT 3 ) . . . Schleswig-Holstein War 1864 (LOEFFLER 14 ) Austro-Prussian War, 1866, Germans (MAAS. 15 , BlKFEL, 16 STROMEYEK, 17 BECK 18 ) Austro-Prussian War, 1866, Italians (CORTESE 19 ) Revolt in Montenegro 1869 (RlEDL and EliNER 20 ) U. S. Army 1865-70 (OTIS 21 ) .. Franco-German War, 1870-71, Prussians (FISCHER 22 ) Franco-German War, 1870 71, Bavarians (BECK 23 ) 4, 344 Franco-German War, 1870-71, French (CHENU 24 ) 71, 443 371 Russo-Turkish War 1876 77 (TILING 2S KADE 26 ) Totals 216, 348 245, 739 31,184 26,400 14.4 10.7 45, 583 45, 184 21.1 18.4 66, 475 87, 793 30.7 35.7 73,106 86, 413 33.8 35.1 War of the Rebellion in United States of America 1861-65 462, 087 57,584 12.5 90,767 19.6 154, 268 33.3 159,519 34.5 The excessively large percentage of wounds of the hands and fingers, frequently noticed by writers on military surgery, was also observed in the American civil war. Of thirty- 1 MENMERE (P.) (V Hotel-Dim de Paris en JuilUt et Aout, 1830, Paris, 1830, pp. 273 to 339) records 272 cases ; 33 of head and neck, 80 of trunk, 51 of upper and 108 of lower extremities. * JonEUT (A.-J. DE LAMDALLE) (Plaies d Armes J Feu, Paris, 1833) records, according to the tabular statement of L. SKUHIER (Traite de la nature, des complications et tin traitement, des plaies d armes ufeu, Paris, 1844, p. 30), 7 cases of head and neck, 37 of trunk, 142 of upper and 169 of lower extremities; total 355. 3 Ves plaies d armes d feu. Communications faites a V Academie Rationale de M tlecine, Paris, 1849: lUL DEXS (pp. 224 et seq.), head and neck 15, trunk 26, upper extremities 40, lower extremities 51 ; total, 132. HUGUIKK (p. 131). head and neck 24, trunk 31, upper extremities 36, lower extremities 41 ; total 132. JOBEKT (A.-J. DE LAMBALLE) (p. 150), head and neck 7. trunk 20, upper extremities 40, lower extremities 82 ; total 149. 4 SIMON (G.) ( Ueber Schussivunden, G iessen, 1851, p. 3), wounds of head and neck 15, of trunk 24, of upper extremities 37. of lower extremities 80 ; total 156. 8 DjOlJUP (M.) (Om den relative Hyppighed af deforskjellige Skudsaar efter deres Sxdf, og om dere.s Dodelinlieds- Fnrliold, in Hofpitals-Meddelelser, Kjobenhavn, 1850, Bind V, pp. 360-363), head and neck 934, trunk 982, upper extremities 1,7( : 7, lower extremities 2.516 ; total 6,109. 6 AlATTHKW (T. P.) (Medical and Surgical Hist, of the British Army, etc., in the years 1854-55-5C), London, 1858. Vol. II. pp. 257, etc.), and McLEOD (G. H. B.) (Jfote.it on the Surgery of the War in the Crimea, London, 18."8. p. 414). CllKXU (,I.-C.) (Rapport, etc.. pendant la. Campaign* d Orient en 18.j4-5."i-."6, Paris. 1865. p. 0:7). LOXGMOUE (Gunshot Injuries. London, 1877. p. 607) erroneously cites the number of shot injuries of the lower extremities among the French in the Crimean War as 11,413, and of the upper extremities as 8,803; these numbers include shot 694 WOUNDS AND COMPLICATIONS. (CHAP. xii. throe thousand and sixty-four (33,064) instances of fracture and contusion of the upper extremities, including the articular portions of clavicle and scapula, eleven thousand three hundred and sixty-nine (11,369), or above one-third, were fractures of the bones of the hands and fingers. It has already been stated in Note 4, on page 435 of the Second Surgical Volume, that 27.8 per cent., or over one-fourth of the fifty-four thousand seven hundred and twenty-nine (54,729) shot flesh wounds of the upper extremities, were flesh wounds of the hand. It is possible that this large percentage 1 is due to the increased exposure of the hand from almost constant movements over a considerable area, thus increasing the chances of intercepting missiles in their flight. DEFINITION OF SHOT INJURIES. All injuries caused directly or indirectly by missiles and projectiles impelled by the force of gunpowder or other explosive compounds have been included in the term "shot" injuries. They differ from the accidents common to ordinary life not so much in their essential character as in the peculiarity of the conditions and cir cumstances attending them, and on this account invite especial attention to the producing causes, to the dangers and complications liable to arise -in their course, and to their man agement and treatment under conditions generally less favorable than are found in the practice of civil surgery. A gunshot wound is essentially a contused wound, yet the character of the missile and the circumstances relating to the individual at the time of injury may impress upon it the additional features belonging to incised, lacerated, and penetrating wounds. In degree, it may range from trivial simplicity to all the terrible gravity of injury seldom seen but on the battle-field, yet in all its phases, simple or complicated, the application of the sound prin ciples of general surgery forms the basis for treatment and marks the advance in the surgical science of the present day. The great superiority of the rifled arm and cylindro-conoidal projectile, as compared with the smooth-bore arm and round ball, had been fully established by the experience of foreign nations in the great wars of Europe between the years 1 848 and 1860. An inter esting field of inquiry had thus been opened to the military surgeon regarding the modifica tion of the nature of wounds resulting from the use of the improved firearms, and quite an extensive bibliography 1 on this subject had already been presented to the European pro as well as miscellaneous injuries. 8 P>EUTHEUAXD (A.) (Campagnes de Kabylie, Paris, 1862. p. 314). 9 WILLIAMSON" (G.) (Military Surgery, London, 1863, pp. XXIV-XXVI). ">DEMMK (II.) (Militdr-Chirurgische. Studien, Wiirzburg, 1861, pp. 19, 20). " CHKXU (J.-C.) (Statislique Med.-Ckir. de la C ampagne d ltalie en 1859 et 18(10, Paris, 1869, T. II). The figures here given were obtained from a compilation of the tabular statements on pp. 424 to 836 of the second volume of Dr. CHEXU s work; the summary <in p. 849 of his work includes the injuries of a miscellaneous character, which have been eliminated in this calculation. -MOUAT (The New Zealand War of J863-G4-f5, in Stat. San. and Med. Reports, fur the year 18(i5, London, 1867, Vol. VII, p. 477). 13 BIN*TOT (Observations de blessures de guerre, etc., in Recueil de, Memoires de Mede.cine de Chiruryie et de Pharmacie Militair^s, Paris, 1866, T. XVI. p. 42). I4 LOEFFLEH (F.) (General Bericht iiber den Gesundheitsdievst im Feldzuge grgen Ddnemark 1864, Berlin, 1867, Krster Theil, p. 54). 1S MAA8 (H.) (Kriey&chirurgische Beitrdge atts dem Jalire 1866, Breslau, 1870, p. 72), head and neck 12, trunk 41, upper extremities 50, luwer extremities 109; total 212. 10 BIEFEI, (R.) (Im Kf.xf.rve- Lazaretk. Kriegschirurgische Aphorismen von 1866, in L,AXGEXl!ECK S Archie fur Klin. Chir., Berlin, 1869, P.. XI, p. 371 ), head and neck 38. trunk i7, upper extremities 82, lower extremities 185 ; total 382. l7 STKOMEYEH (L.) (Erfalt- rungen iiber Schitsswunden im Jalire 1866, Hannover, 1867, pp. 10. 11). head and neck 139, trunk 50, upper extremities 392, lower extremities f>10; total 1,391. 18 BECK (B.) (Kriegschirurgische Erfahrungen wiihrend des Feldzvges 1866 in Siiddeutschland , Freiburg I. Br., 1867, pp. 25, 26). "COUTESK (F.) (Ulleriori ragguagli sulle perdite deliescreito italiano sofferte. nclla campagna del 1866. in Annali fnir. di filed., Milano, 1868, Vol. CCV, p. 506). 20 PvIEUL und EBXEU (Aus dem. K. K. Truppen-Sjntal in Cattaro, in Wiener Med. Wochenschrift, 1870, p. 155). 2I OTIH (G. A.) (Circular No. 3, War Department, Surgeon General s Office, Washington, 1671, p. 86). TlSCIlEK (G.) (Statistik der inde.m Kriege 1870-71, etc., Berlin, 187(5. p. 64) tabulates the seat of injury in 61,146 killed and wounded. To make a fair comparison with the statistics here cited it will be necessary to deduct the number of killed, 7,664, leaving 53,482 cases to be considered here. 23 BECK (B.) (Cliirurgie der Schussrerletzungen, Freiburg i. Br., 1872, p. 160). M CHEXU (J.-C.) (Apercu hist. stat. et din., etc., pendant la guerre de 1870-71, T. I, pp. XX VII, XXVIII, XXIX, XXX). 2S Tll,IXG (G.) (Bericht iibe. 124 im Serbisch-tiirkischen Kriege im Baracl;en-Lazare,th des Dorpater Sanitats- Trains zu Stvilainatz behandeltf Scliussuerletzungen, Dorpat, 1877, pp. 18-97). head and neck 10, trunk 21, upper extremities 31, lower extiemities 62; total 124. 26 KAI)E (E.) (Das temporZre Knegslazareth der Anstalten der Kaiserin Maria im Kloster iiariahimmelfahrt bei Sistowa, in fit. 1 etersburger Medicinische Wochcnsclirift, 1877, No. 45, p. , i83), head and neck 37 trunk 20, upper extremities 115, lower extremities 75 ; total 247. 1 Des plaies d armes a. feu. Communications faites a V Academic Nationale de Affdecine, Paris, 1649. This volume contains articles by BAUUE.NS, Koux, MALGAIGXE, AMUSSAT, BLANUIX, PIOUHY, VELPEAU, HUGUIEU, JOBERT (DE LAMBALLE), BEGIN, Rocnoux, and DEVKUGIE. SIMON, Utber Schusswunden verbunden mil einem Berichte iiber die im grossherz. Militair-Lazaretli zu Darmstadt behandelten Verwundeten vom Sommer 1849. CHAP. XII.] FIREARMS AND THEIR PROJECTILES. 695 fession. American surgeons had had but little opportunity to familiarize themselves with the active practice of military surgery, and were obliged to draw upon the authorities abroad for their early information, upon which was largely based the practice of the later surgery of the vf dr. FIREARMS AND THEIR PROJECTILES. The reports of medical officers on the early engage ments of the rebellion allude to the great diversity of missiles, 1 showing that every avail able weapon had been seized upon to arm the troops hastily thrown into the field; this was especially true of the Confederate troops. The northern forces were, perhaps, from the beginning, better, or at least more uniformly armed. Previous to the war a rifled musket adapted to the use of the minid projectile had been issued to the troops of the regular army, and distributed among the arsenals in the several sections of the country. Many of these fell into the hands of the Confederate government on the commencement of hostilities, and were appropriated to the use of their troops. Large numbers of arms of modern manufac ture were purchased from abroad, principally of the Austrian, Belgian, and Enh eld pattern, but inventive ingenuity, roused by the exigencies of war, soon superseded these by arms of domestic manufacture of great power and precision, among which breech-loading and magazine guns occupied prominent positions. 2 Giessen, 1851. KESTKLLI (ANTONIO), Note ed Osservazioni cliniche di chirurgia- Militare, in Annali Universali di Medicina, 1849, Vol. CXXX, Faso. 389, p. 2->5. WATERS (E. ), Observations on Gunshot Wounds, made in Paris during the Summer of 1848, in Monthly Journal of Medical Science, Edin burgh and London, 1849, Vol. IX (N. S., Vol. Ill, pp. 251, 309, 353). ALQUI (A.), Chirurgie. Conservatrice, et mnyens de restreindre I utilil des opera- tions, Montpellier, 1850. BECK (B.), Die Schuss-Wunden, Heidelberg 1 , 1850. Ross (G.), Militairirztliches aus dem ersten Schleswigschen Feldzuge im Sommer 1848. Altona, 1850. BKUTHEUAND (A.). Des panseme.nts des plaies, Paris. 1851. IDEM. Des plates d armes a feu de I orbite, Paris, 1851. ESMAUCH (F.), tlber Resectionen nach Schussivunden, Kiel, 1851. DJiiuur (M.), Oin de.n relative Bypighed af de forskjellige Skudsaar efter deres Ssede, og om deres Dodeligheds-Forhold, in Hospital s-Meddelelser, 1852. Bind V, p. 349. IDEM, Bemxrkninger over de i Krigen 1848-50 foretagne Ampu- tationer i forbindelse med en Statistik over dem, in Bospitals-Medddelser, 1852, B. V, p. 99. HuTTX (M. F.), Memoire sur la necessit . d extraire les corps etrangers et les esquilles, dans le traitement des plaies par armes u feu, in Mem. de V Academie Nationale de Medecine, 1852, T. XVI, p. 407. BAUDKN8, M moire sur le traitement des plaies d armes ^ feu, in Recueil de Memoires de Medecine, de Chirurgie. et del harmacie Militaires, 1853, 2 ml! ser., T. X,p. 98. SCHWAUTZ (H.), Be.itrage zur Lelire von den Schusswunden, Schleswig. 1854. BALI.INGAU. (Sir GEOEGE), Outlines of Military Surgery, 5th ed., Edin burgh ami London, 1855. GUTllUIE (G. J.), Comment, on the Surgery of the War in J ortugal, France, and the Netherlands, etc., 6th ed , London, 1855. HKYFELDEit (J. F.), Die Verwundungen und Operationen in Folge des Bombardements von Sv aborg vom 9-11 Aug., in Deutsche Klinik, 1855, B. VII, p. 553. STUOMEYKU (L.), Maximen tier Kriegslieilkunst,Ha.nnn\er, 1855. VALETS K, Documents pour servir a la solution de plusieurs questions relatives au traitement des plaies par projectiles de guerre, in Jie.rue.il de Mem. de M d. de Chir. et de 1 har. Mil., 1855, 2 me se>., T. XV, p. 204. QUESXOY (M. F.), Notice Medico- Chirurgicale sur I armee d Orient, iu Recueil de. Mem. de Mid. de Chir. et de 1 har. Mil., 1857, T. XX, 2"" ser., p. 241. SCIUVE (G.), Relation medico chirurgicale de la Campagne d Orient, etc., Paris, 1857. AltMAND (A.), Histoire Medico-cliirurgicale de la guerre de Crimee, etc., Paris, 18.~i8. BAUDEXS (L.). La Guerre de Crimee, etc., 2d ed., I aris, 1858. MATTHEW (T. P.) Medical and Surgical History of the British Army which se.rred in Turkey and the Crimea during the War against Russia in the years 1854-55-5*), 2 volumes, London, 1858. MACLEOD (G. H. B.), Notes on the Surgery of the War in the Crimea, etc., London, 1858. SALLEKON, Compte- Rendu des Amputations 1 rimitives et des Amputations Consec- utives in Recueil de Mem. de Med. de Cliir., et de I har. SHI., 1858, J . XXI, p. 283, ct T. XXII, p. 239. Ari lA (L.), Le Chirurgien a V Ambulance, etc., Paris, 1859. BlLLKOTll (T.), Historische t-tudie.n iiber die Jleurlheilung und Behandluvg der Schusswunden vom XV Ja.hr undert bis auf die neueste Zeit, Berlin, 1859. FltASEU (P.), A Treatise upon Penetrating Wounds of the Chest, London. 1859. LKCOUEST (L ), La chirurgie militaire contem- pornine, in Archives gen rales de Medecine, Paris. 1859, V ser., T. XIII. pp. 78, 201, 462. LOEFFLEll (F.), Grundsdtze und Regeln fur die Behandlung der Schusswunden im Kriege, Berlin. 1859. LOIIMEYEU (C. F.), Die Schusswunden und Hire Be.handlung, Gottingen, 1859. WILLIAMSON (G.), Notes on the Wounded from the Mutiny in India, etc . London, 1859. BEUTHEUAND (A.), Campagne d Italic de 1859, Paris. I860. LANUA (N.), La Campana d<: Man-items Memorias de nn medico-mil., Madrid, 18(iO. I AKAVICINI, L ospitale Militare a Santa Maria di Loreto, etc., in Annali Universalidi Medicina, Milano, 1800. Vol. CLXXI, p. 36 5, and Vol. CLXXII, p. 191. liOl X (J.), De Vosteomy lite ft des amputations secondaircs la suite des coups defeu, etc., Paris, 1800. IDEM, Desarticulation de la cuisse d apres des observations recueillies a iiaint Mandrier, in M m. lu ,1 I Acad. des Sciences, le 16 Avril, 18(10. 1 Appended Documents, Part I, Vol. I, p. 7; Assistant Surgeon C. C. Gray, U. S. A., in report of services at the first battle of Bull Run, Va.. July 18, 1861, says : "The greater number of our wounded were injured by round musket balls : the wounds indicted on the Confederates were of a graver character, a large proportion of them being caused by conoidal rifle balls and canister shot." At p. 10, Surgeon C. F. II. Campbell, U. S. A., iu record of services at Falling Waters, Va., July 2, 18(il. says: "Wounds were all from gunshot and prineipally of the lower extremities, produced by round musket balls, buckshot, and in one or two instances by sphero-conoidal balls." At p. 15, Assistant Surgeon Philip C. Davis, U. S. A., in report relative to the battle of Wilson s Creek. Mo., August 9, 18(il,says: "The fire to which our men was exposed was principally from musketry at short range. The Confederates used the mini6 rifle, while the Missouri State Guards and the irregular troops were armed with smooth-bore muskets, western rifles, and double-barreled shot-guns the last being very effective at short range." At p. 12, Surgeon A. B. Crosby, U. S. V.. in report of the engagement at Ball s Bluff. Oct. 21, 18o l, says: Their [Confederate] can ridges generally contained a round ball and three buckshot." At p. 12. Surgeon J. A. Lidell, U. S. V., in a report of the same engagement, says: " The enemy had no artillery, and most of the wounds of our men were inflicted by round musket balls." At p. _ - , Surgeon H. P. Stearns, U. S. V., iu a report of the battle of Belmont, Mo., Nov. 7. 1861, says: " The enemy used both the smooth bore muskets with round ball, shot guns with ball and buck, and also rifles with conoidal ball. At p. 31, Surgeon J. H. lirinton. U. S. V., in an account of the cam paign of the Army of the Tennessee from February to June. 1801, including the battle of Shiloh, says : " The nature of the wounds caused by the fire to which the troops were exposed at the battle of Shilnh was of the most varied kind: at times they were exposed to that of artillery both light and heavy, from which almost every species of projectile was thrown solid shot, round and conical, grape and canister, spherical case and shell; at other times the fire was from musketry. The small arms used by the enemy were the improved rifle throwing conical balls, the western rifle, and the old fashioned smooth bore musket :. the cartridges for the latter were generally composed of ball and buckshot." "The collection of missiles in the Army Medical Museum at Washington indicates the progress made in th United States duirng the years of the war iu the improvement of firearms. Though by no means complete, the series of unused missiles and projectiles on exhibition affords an interesting and WOUNDS AND COMPLICATIONS. [CHAP. XII. For the purpose of this history, projectiles common to warfare may be divided into thoso. used with small arms, as rifles, muskets, pistols, etc.; those discharged from heavy ordnance, as cannon, both rifled and smooth-bore, mortars, torpedoes, etc.; those which acted indirectly in the causation of injury, as splinters, stones, and fragments, detached or set in motion by projectiles in their flight, and missiles of an unusual or eccentric character. By far the larger number of shot injuries were inflicted by missiles from small arms, as indicated in the following table: TABLE GXXI. Table indicating the Seat of the Injury and Nature of the Projectile in the Cases of Shot Wounds reported during the War. SEAT OF INJURY- Solid Shot. Fragments of Shell. Grape, Canister, etc. Conoidal Ball. Round or Musket Ball. M 3 O o "o s Explosive Mus ket Balls. Nature of Missile not ascertained. I otal Cases. Shot Flesh Wounds of Scalp 3 867 15 2 612 51 119 o 3 600 7 73") q 567 27 1 437 506 66 3 I 735 4 350 5 572 19 2 632 2% 160 31 1 19 ( ) 4 914 1 190 "0 1 845 309 65 q 2 063 4 502 Shot Flesh Wounds of Neok 5 171 Tl 1 982 343 84 2 301 4 845 1 59 5 380 108 16 J 72 64" 7 1 034 11 163 911 106 1 6 486 11 549 4 35 i 250 (IS 3 70 446 10 148 23 2 873 1 789 134 5 3 89 8 69 10 270 21 1 836 375 51 2 185 ) 748 3 G4 g 1 17 "17 67 1 113 3 690 4 78 15 7;i8 269 13 377 1 494 Shot Flesh Wounds of Oenito-Urinary Organs 47 6 589 144 37 842 1, 665 Shot Flesh Wounds of Back * 5 1 798 50 7 260 1 080 140 o 2 346 12 681 18 1 660 180 2 023 868 625 27 27 400 54 801 5 160 19 1 236 18 569 2 280 6 79 17 822 131 12 1 511 1 579 8 40] 83 4 156 599 56 9 2 913 8 45 g 101 12 930 175 12 1 578 2 816 Shot Injuries of the Itadius and Ulna 14 206 25 1 803 391 32 7 2 656 5, 194 4 29 12 285 61 g 1 110 1 509 g 079 47 2 699 549 74 2 7 711 11 369 Shot Flesh Wounds of the Lower Kxtremities 0.) 2 150 215 33 301 2 474 880 20 21 077 59 13!) 1 4 185 104 6 66 386 Shot Injuries of the Shaft of the Femur 28 1(14 63 2 4 )6 567 19 4 3 397 6, 738 27 201 54 1 725 48 5 1 883 3 398 79 593 86 4 968 634 81 2 730 9 171 Shot Injuries of the Bones of the Ankle Joint 26 177 32 570 152 13 3 749 1 722 20 400 36 3 167 346 89 1 801 5 859 Aggregates 359 12 50 1 153 108 049 16 742 3 008 130 103 829 245 790 The nature of the missile was ascertained in one hundred and forty-one thousand nine hundred and sixty one (141,961) cases, of which one hundred and twenty-seven thousand nine hundred and twenty-nine (127,929), or 90.1 per cent., were caused by missiles from small arms. The projectiles or missiles used with small arms resolved themselves into spherical balls, usually discharged from smooth-bore muskets, and those of an elongated form, adapted to rifled arms; the latter were either conical, cylindro-conoidal, or ovoid, vary ing in size, weight, and volume. The materials composing the missiles were usually lead instructive study us to their varying forms, size, weight, and volume: this in connection with a series of over 500 projectiles extracted from wounds, together with the numerous preparations of fractures and wounded viscera in which the missiles producing the injuries have been preserved, affords oppor tunity f..r a comparison <>f the effects of the several missiles as well as for the study of the modification in gunshot wounds resulting from modern Improvement* in ordnance. CHAP. XII. FIREARMS AND THEIR PROJECTILES. 697 or lead hardened by an alloy of tin or antimony. The superiority of the elongated missile thrown from the rifled barrel over the spherical ball rests upon the Tact that the elongated bullets usually have an expansive base, either plain or hollowed, which by the explosion of the charge is intended to rill the grooves of the rifle and-give the projectile, as it is driven forward, rotation on its long axis, thus increasing its range and precision. The cuts appended (FiG. 373) are designed to illustrate the general appearance of the more common and typical varieties of small-arm missiles used during the war by both contending parties; 1 , weight 3,7 grains; 1. Buck and ball, calibre .69, weight of ball 387 grains : c. Springfield rifled The large projectiles used with ordnance may also be classified under the headings spherical and elongated, the former being generally used with smooth-bore, the latter with rifled guns. Round shot are solid spheres of cast-iron vary ing in size and weight. A grape-shot (FiG. 374) is composed of a number of cast-iron balls (in the U. S. service generally nine) arranged in layers of three each and kept in position by a series of tables or plates which are held together by a vertical rod secured by nuts on each end; these missiles vary in calibre to fit guns of various sizes; at the discharge the several parts become separated and each part acts as a dis tinct projectile. Thev have a considerable range. A canister shot is a projectile made by enclosing a large number of iron or leaden balls of less size than grape in a cylinder of tin, which is torn asunder at the discharge of the gun; the contents are scattered, assuming in their onward course something of the area of a cone; when used against masses of troops and at short range the canister shot is very destructive. Shrapnel shots are spherical or elongated. 1 The number of varieties of missiles and projectiles on exhibition in the Army Medical Museum exceeds one hundred, embracing specimens of nearly all the latest inventions. Some of these were tested in actual warfare, while others, although constructed upon theoretical principles, were laid aside after a few trials ; a detailed description of all these would be impracticable. SURG. Ill 88 374. Grape shot. fyec. 450*!. 698 WOUNDS AND AMPUTATIONS. [CHAP XII. Fl( . :mi ._ The simi( , s;nvu n , |,. llf showing the bullets ^composition. Spec . according to the character of the gun in which they are used, and when adapted to smooth bores they are designated spherical case shots. They are shells of considerable thickness, filled with nmskft balls consolidated into mass by a composition of sulphur and resin (Fios. 375,376. 377), and are exploded by a charge of powder fitted into their inte rior. which is ignited, as may be desired. by a time or percus sion fu/< . They have a long effective range and are calculated to inflict serious injury by the great number Fl<;. 37.x A l-J-pouml-r sph.-ri.-al case-shot. outer ami * mlgmentS Set lOOSe at their explosion. The projectiles used in rifled guns exclusively combine with the properties and char acter of the projectiles just described those which pertain particularly to guns constructed on the rifled principle; they differ greatly in size and weight; their velocity varies with the calibre from 1,100 to 1,550 feet per second, and their range has exceeded five miles. The 10-pounder percussion Parrot case-shot illustrated in FIG. 378 is a missile of this nature. By the explosion the shell is rent into many fragments, varying in * / O v O weight from a few grains to many pounds; these fragments are driven in all directions with great force and inflict injuries of the gravest character. The Museum collection is particularly rich in specimens of fragments of exploded shells of all sizes and descriptions, showing the great diversity of shape and form which these fragments may take. Rifled projectiles are also cast solid, and are used for breaching or battering purposes. Bolts, so called, are solid metal projectiles of elongated form, with surfaces so cut as to fit corresponding surfaces in the barrel of the gun : they are made to fit with great exactness, so that a greater proportional effect is attained with a smaller charge of explosive compound. The Whitworth gun and projectile may be taken as the type of this class. Its projectile has been thrown nearly six miles. It is prob- c a se. S hot atn,,.. ;l 1(> tll:lt tll(1 fxtremo care necessary to pre- ,] r> , ,1 i -i i serve the surfaces ol the gun and missile clean and smooth will render it practically less effective than many of the ordinary patterns of rifled ordnance which possess almost equal power, range, and precision. AVith this general knowledge of the more common forms of ordnance projectiles it will be unnecessary to enter more fully into a detailed account of the improvements made from time to time with the object ot perfecting these agents of destruction. F,, ; .;!77.-A ped for howitzer or <f tin. Siifc. 4W2. l- Ii;. I57H. A 1(1 poiimh i- cussion I aiTot ruse-shot , 4587. FIREARMS AND THEIR PROJECTILES. 699 Shells thrown from mortars differ little if any from ordinary spherical shells except in size and in the manner of projection. Their use is generally restricted to sieges. Under the same circumstances hot solid shot were used during the war, but with the intention of destroying property rather than human life. Hand grenades (Fio. 379) are small iron shells tilled with powder and discharged by percussion ; they were used in sieges and assaults at close quarter, and their effects are similar to ordinary shells; as their name indi cates, they are carried and thrown from the hand. Torpedoes, or more properly fougasses, were largely used as a means of defence during the late war; they were, as a rule, simplv large shells arranged with levers connected with a percussion fuze and sunk below the surface of the ground in the supposed path of an assailing party. A pressure of the foot upon the concealed lever was sufficient to explode the shell, resulting in effects similar to the bursting of a like projectile under ordinary circumstances. Torpedoes of more complicated construction and of far greater power were employed in the defence of rivers and harbors and proved important and effective agents of destruction. In an article on torpedo wounds, Dr. S. W. Gross 1 describes a formidable engine of this character, containing about sixty pounds of gunpow der and capable of being exploded by a pressure of four pounds only. Dr. Gross adds that its effects can readily be imagined. Surgeon J. B. Brown, U. S. A..~ Medical Director of the Fourth Army Corps, in an extract from a narrative of his service at Wil- liamsburg, Virginia, reports that the enemy "had planted torpe does in the works and along the road leading to Williamsburg, designing that they should explode by the pressure of the foot of those passing over them. A casualty occurred in General Casey s division from the explosion of one of these torpe does and one man was killed and five wounded. The wagon track and the side paths for a mile were studded with these buried shells; but they were guarded, as soon as discovered, by men detailed to remain near them to point them out to passing troops. I passed near several of them and observed the ingenuity with which they were concealed. Surgeon D J J o W. Hand, U. S. V., :! in an extract from a report relative to operations in North Carolina, relates that on June 4, 1864, two large torpedoes were accidentally exploded at Bachelor s Creek, an outpost of New Berne, instantly killing thirty-six soldiers and eight, negroes and seriously wounding twenty-nine men attached to the 132d New York Volunteers." A bridge torpedo, devised by McCallum, designed to be placed in an auger hole in the beam of a bridge, is represented in FIGURE 380. The two sections are joined by a percussion cap connected with a lever placed under one of the planks of the bridge; slight pressure is sufficient to explode the torpedo. In a third division of missiles and projectiles are included such as cause wounds and injuries indirectly: splinters, stones, fragments, or foreign bodies set in motion or driven by the force of projectiles in their course, and which frequently by their action or lodgement Fin. 37!). Krtclanu s 1 -pound hand grenade. Spec. 4593. GKO88 (S. AV.), On Torpedo Wounds, in American Journal Medical Science, 1866, Volume LI, page 370. * APPKSIIIX to 1 urt I, Vol. I, Medical and Surgical History of the War of the Rebellion, page 67. " APFKMUX to 1 art I, Vol. 1 : Medical and Surgical History of the War of the Rebellion, page 239. 700 WOUNDS AND COMPLICATIONS. (OHA1>. XJI. complicate direct shot wounds, and which are themselves sources of danger and of uncer tainty in diagnosis. The most common examples of this class are fragments of stone and splinters of wood torn from the earth or from trees, and from structures forming defensive works, scraps of iron or metal from ordnance, firearms, or from articles of equipment; or indeed from any object with which projectiles come in contact. In the class of unusual or eccentric projectiles the missile illustrated in FIGURE 381 may be placed; it is a conoidal leaden shell two inches in length, one and a half in calibro, weighing nine and three-quarter ounces. The missile was cut out of a horse killed while the rider was reconnoitering with General Kearney on the day of the second battle of Bull Run. No report was heard from the direction in which it came. It was subsequently learned that such mis siles were fired from globe-sighted rifle-guns of some thickness. FIGURE 382 represents what is known as a ricochet shell, picked up on the battle-field of the Wilderness in 1865 by Gap- tain James M. Moore, U. 8. A., and presented to the Army Medical Museum ; it is of peculiar form, weighing nine and one-half pounds; it has a shallow narrow excavation at the head, ap parently designed for a charge and percussion cap, which charge seems to have proved insuf ficient to burst the missile. They are said to have been commonly used by the Confederates at the battle of Fredericksburg, at the battle of the Wilderness, and on other occasions. It is stated that railroad iron cut into suitable lengths, spikes, and scrap-iron \\viv used by the Confederates in lieu of regular projectiles. No specimens of such missiles are in the Museum collection to substantiate this statement. Shaler s sectional bullet, represented in FIGURE 383, is drawn of natural size and weighs 608 grains; it is designed to part in its flight, forming three separate missiles; whether it was over used on the field is not known. The ordinary "buck and ball," FIGURE 373, b, p. 697, a compound missile, was very extensively used during the early part of the war; it consists simply of the ordinary round ball, calibre .69, and three buckshot enclosed in the same cartridge. Cartridges made up en tirely of buckshot were common and at close range made very effective missiles. Slugs and fowling-piece ammunition are also noted as having been occasionally used. A peculiar missile, said to have 1 , ,i , FIR. 384. Bullet with a-niding (?) attachment : actual size. been thrown into the prison camp at Johnson s Island with a message attached, is shown in FIGURE 384. It is a conoidal bullet with a spade-shaped appendage twice its length, designed to render the course of the projec tile more accurate. It is believed to be a pattern rejected by the Ordnance Department about the year I860; its history is not positively known. If!. 381. Leaden li incheiilil.re. wei<rh 3C>94. l\"atiiral size.) FIG. 383. Sha- ler s sect i DII al ball. Spec. 4621. No. 36. CHAP. XII.) EXPLOSIVE BALLS. . 701 "Greek fire" for incendiary purposes was employed, probably by both sides in a few instances. It was used at the siege of Charleston, in 1863; 1 but its employment led to such representations respecting its barbarity that the use of it was but little resorted to, if at all, during the remainder of the war. A small quantity of composition, a portion of the contents of a fire-ball used by the Confederates and captured at Morris Island, was contributed to the Army Medical Museum by Acting Assistant Surgeon H. K. Neff. It is specimen 572 of the Surgical Section, and is described as "a mixture of nitre, sulphur, and antimony, and when used is made into a paste with sand and rosin. The missile was wrapped on the outside with three layers of heavy canvas, tarred and pitched without, with a network of twine over it. The bottom was cast-iron covered only with pitch. Within the ball was a tin cup to which the canvas and twine were fastened, and which contained the composition, and near the base was embedded a 6-pounder shell. Three pins in the top are withdrawn before loading in the gun to allow ignition previous to its exit from the muzzle. The composition burns slowly with intense heat. The missile was designed to be thrown from a mortar." Except in the instances quoted it is doubtful if the use of this agent was at all common. EXPLOSIVE BAIXS. The subject of the employment of explosive missiles in warfare between civilized nations has been largely discussed from an ethical point of view, partic ularly since the civil war in the United States. While their use is acknowledged to savor of barbaric warfare, there is still a manifest reluctance to place them entirely beyond the pale of legitimate employment. By an agreement between the principal nations of Europe, signed by their representa tives at an international military conference held at Saint Petersburg in October, 1868, it was resolved to abstain from the use of explosive projectiles under the weight of four hundred grammes. In commenting on this agreement, Dr. Longmore 2 remarks that "not withstanding the International agreement just referred to, there is great misgiving on the part of many as to the abandonment of explosive bullets in time of war. The government of the United States has not joined the convention, and the treaty is only obligatory upon the contracting parties when at war between themselves; it also ceases to be obligatory in case of a power which has not joined the convention allying itself to either one or other of the belligerents. The English government of the day was greatly blamed by the press and by many military men for joining the treaty." 3 One hundred and thirty cases of wounds attributed to explosive missiles were recorded on the returns (TABLE CXXII, page 696, ante). The records of the Ordnance Office, U. S. Army, show that thirty-three thousand three hundred and fifty (33,350) Gardner s " explo sive bullets" or "musket shells" were issued to the troops in the early part of the war; that I.OXfiMOKE (T.), Trratiseon Gunshot n nvnds, tlieir history ami treatment, London, 1877, page ) I. 2 Ibid, page 48. 3 For the information of those who have never seen the treaty alluded to above the text is here reproduced from the work just quoted : "Consider ing that the progress of civilization ought to have the effect < f lessening as much as possible the calamities of war: That the only legitimate object that states ought to propose to themselves during war is to weaken the military strength of their enemies: That for this purpose it is sufficient to put hors-de combat the greatest number of men possible: That this end would be overpassed by the employment of arms which would uselessly aggravate the wounds of men placed hors-ile-combat or that would render their death inevitable: That the employment of such arms would be consequently contrary to the laws of humanity : The undersigned having received the orders of their governments in this respect are authorized to declare as follows : 1. The contracting powers mutually bind themselves to renounce, in ease of war among themselves, the employment by their land or sea forces of all projectiles charged with explosive or intlammable matters .f a less weight than 400 grammes ?. They will invite all the states which have not sent delegates to the mil 5.4. It to the c every t ary international commission at St. Petersburg to accede to the present engagement. :t. This engagement is only obligatory upon the contract- .ceding parties in case of war between two or more of themselves : it is not binding in regard to parties who have not joined the convention. ill equally cease to be obligatory from the moment when in a war between powers which have joined the convention, another power, not a party nvention, shall join one of the belligerents. 5. The contracting and acceding parties will come to a further understanding among themselves ne that a precise proposition shall be made on the subject as regards future improvements that science may make in the arms of troops, so that the principles which they have laid down for reconciling the necessities of war with the laws of humanity may be maintained." WOUNDS AND COMPLICATIONS. [CHAP. XII. . 3P5. Gard ner s explosive ball. /?/<- . 4621. ri<;. 38(5. Explosive bull extracted from thigh. ,Vp<r. 4561. of these over ten thousand (10,000) were abandoned on the field for want of transportation. It is probable that the latter fell into the hands of the Confederates, accounting in a measure, for the wounded before alluded to; but many reports of wounds attributed to explosive balls were made in which it is doubtful if the missile was really of this nature, as under certain circumstances the ordinary ball is capable of great distortion and of inflicting severe injury. The extent of the damage from explosive missiles is greater than that ordinarily caused by the simple projectile; bony structures are more extensively shattered and the area of destruction in soft parts is larger; hemorrhage, both primary and secondary, is more com mon; extensive sloughing follows, and the course of repair is slow and tedious. The Gardner "explosive bullet" or "musket shell" (FiG. 385), referred to as having been issued to the United States troops, is a cylindro-conoidal projectile of lead, made in two sizes; the larger of calibre .58, weighing 451 grains, the smaller of cali bre .54, weighing 363 grains. Within the interior is placed an accurately fitting acorn-shaped chamber filled with fulminate, and commu nicating with a one and one-quarter time-fuze, which is exposed to the charge at the rear of the missile; the fuze is ignited by the dis charge of the piece. The bursting charge is sufficient to rend the bullet and transform it into a jagged dangerous missile. Should it have penetrated the body before exploding its effects are still more destructive. It is claimed that other forms of projectiles of this nature were used provided with a percussion cap which would explode upon contact with even soft tissues. No specimens of tins kind are found in the collection of the Army Medical Museum. 1 The appearance of an exploded musket shell extracted from the thigh of a private of the 120th New York Vol unteers is shown in FIGURE 386. The wound resulting was a flesh wound of the muscles of the thigh, and the bullet was removed by enlarging the opening of entrance. " Six well authenticated cases of injuries from explosive balls have already been cited; 3 accounts of sixteen cases of alleged injuries from similar cause are here appended: CASES 1028-1043. Private .Tospli Baker. Co. B. 29tli New York, \vounded at Bull Kim, August ->S. lsf>t>. Acting Assistant Surgeon AV. L. Hammond reported tlie patient s admission into Baptist ( lnm-li 1 lospital, Alexandria, September 1 , 1H(5\J, 1 There aic, however, on exhibition several specimens of centre-tire metallic cartridges for a breech loading ritte .:!."> calibre, loaded with explosive bullets, contributed by Major-General M. C. MKICS, Quartermaster General V . S. A., and Surgeon H. H. Tll.TON. U. S. A., and found in the camp of Chief Joseph s band of Nez Perces, in 1877, after their surrender to General Miles. The projectile is represented in Kl<;. :is7. A copper shell nearly three fourths of an inch in length, loaded with fulminate, is enclosed in a boring at the head of the bullet : the end of the shell projects sufficiently to act as a percussion cap by which the missile is exploded. Tin following extracts from a letter from Surgeon II. 1!. Tll.TON. V. S. A., give sonm interesting facts in connection with this and another form of explosive missile : " Fort Kiley, Kansas, April 3, 11-81. Surgeon 1). I,. Hl N I IX(;TOX, I . S. A., Washington. I). C. DKAIt DocKii; : In reply to your note of enquiry about explosive balls used by the Nez Perces, I will give you such information as I have. During the siege, which lasted five days. I \s disposed to doubt that the Nez Perces had any explosive balls, although several men insisted that they had been struck by them, as they distinctly heard the explosion. One man of the 9th Cavalry was shot through the thigh in front of the femur: the skin was dis colored, and the hole was large enough to admit the thumb: there was only a bridge of skin. After the surrender and discovery of explosive balls in the village. I was convinced that a number of the wounds had been caused by explosive balls. . . I was curious to know how the Indians had obtained these explosive balls, and heard upon enquiry that in passing through Idaho they had made a raid upon a ranch of an Englishman who had hunted in all parts of the world, and who was well supplied with rifles and ammunition including explosive balls, and the Nez Perces had captured his outfit although he escaped. ... I have an impression that explosive balls, like other balls, cause a larger wound at the point of exit than at the point of entrance, although explosive balls and Express rifle balls greatly lacerate the tissue before their exit. My attention having been drawn tffthe subject. I found that a citizen employe with the 7th Cavalry had explosive balls for use in hunting. The Winchester rifle ball was cast with a cavity of proper size to receive a .22 calibre cartridge in its apex ; the .22 calibre cartridge required a portion of its ball to be removed in order to fit into the .44 calibre ball. I saw the effect of these on antelope, and the laceration was beyond the point of entrance. Very respectfully, H. It. Tll.TOX, Surgeon I". S. A." .*The case has already been referred to, as a case of flesh wound of the lower extremities, in jYote 1 of page 24, ante. 3 See Cases of: Pt. W. Gritzmacher, C. 5th Wisconsin; Spotlsylvania, May la, 1804 ; explosive musket ball struck frontal bone and fractured outer table ; recovery : First Surgical Volume, p. 129. Pt. J. F. Singer. K, 24th Wisconsin ; Dallas. Ga., May 27, 1864 : explosive bullet fractured external table of the occipital bone : recovery ; idem, p. 217. Lieut. T. E. Maley, Tith Cavalry; Deep Bottom, July 28, 18(>4 : ball exploded in left antrum of Highmore : recovery ; idem, p. 352. Pt. P. T. White. I, 7th Michigan ; Antietam, Sept. 17, 1862 ; ball exploded in belly of pectoral muscle : recovery : idem. p. 4 J4. Corp l A. Burlingame. 64th New York; Fair Oaks. June 1. 1862: missile exploded in left forearm; recovery: ftfrrmil Surfiical Vnlttme, p. !)23. Corp l S. P. Keller, 1st Maryland; Weldon Railroad, August 18, le 64 ; missile completely shattered right knee; recovery; Third liuryical Volume, i>. 250. CHAP. XH.J EXPLOSIVE BALLS. 703 with n wound of the right thigh, inflicted by an explosive ball, which entered the intem;vl femoral region, centre of the middle third, fracturing and comminuting the femur; ball extracted on the battle-field, under the fascia lata. between the rectus and the vustus externus, almost in the line of its direction. Treated in Smith s anterior splint ; union of bones with considerable curvature externally; limb shortened 2$ inches and foot inverted. Discharged February 29, 186:5. Lieutenant C. M. Ball, Co. G, 14lst Pennsylvania, aged 35, wounded at Chancellorsville, May 3, 1833, by what lie thought was an explosive ball, which entered the left leg in the upper portion of its lower third, inner and posterior aspect, and produced two wounds in its exit, one on the posterior and the other on the anterior aspect of the leg ; fragments of bone discharged. This officer was discharged from service December 9, 1863, and pensioned, and paid in September, 1866, since which time he has not been heard from. Private M. Con ner, Co. D, 102d Pennsylvania, aged 30, wounded at Cold Harbor, June 3, 186-1, by an explosive ball, which injured the right malleolus; extraction of missile; admitted into Third Division Hospital, Alexandria. Discharged from service Jan. 7, 1835. Private W. Bohmer, Co. D, 26th Wisconsin, wounded at Resaca, June 22, 1864, by an explosive ball, causing transverse frac ture of alveolar process of superior maxilla, removing teeth of left side to molar and on right to bicuspids; fistulous opening into nose. Treated at Harvey Hospital, Madison, and returned to duty November 19, 1864. Sergeant D. S. Durell, Co. E, 3d New Jersey, was admitted into Turner s Lane Hospital. Philadelphia, August 28, 1833, with a wound of the right leg, caused by an explosive conical ball, at Chancellorsville, May 3, 1833. The ball struck the upper third of the right tibia anteriorly, making but one orifice. Portions of the missile were said to have been extracted in camp at Washington and at West Philadel phia hospital. Discharged from service January 23, 1864. Reported by Acting Assistant Surgeon George Hutton. Sergeant J. L. Fenton, 9th Massachusetts Battery, aged 28, was admitted into Jarvis Hospital, Baltimore, July 10, 1863, with a wound of the right leg, inflicted by an explosive ball at Gettysburg. Acting Assistant Surgeon B. B. Miles reported that when admitted the patient had typhoid symptoms, and on the night of July 27th had a slight haemorrhage. He died on July 28, 1833, with supposed pyaemia. An autopsy revealed the knee joint and thigh infiltrated with pus, and a compound comminuted fracture of the tibia. The specimen of the upper third of the right tibia, showing superficial necrosis around the injury on its posterior aspect, was contributed to the Army Medical Museum by Assistant Surgeon D. C. Peters, U. S. A., and is numbered 1613 of the Suryical Scrtifjii. Sergeant 0. V. Gingrass, Co. A, 29th Missouri, wounded at Ringgold, Georgia, November 24, 1863. At the general field hospital at Chattanooga the wound was recorded as a gunshot fracture of left malar bone and superior nasal bone by a conoidal ball. lie was subsequently treated at hospitals in Nashville and Louisville, and on June 25, 1864, was admitted into the hospital at Jefferson Barracks, Missouri. Surgeon J. F. Randolph, U. S. A., reported that an explosive ball entered two inches forward and one and a half inches above angle of inferior maxilla, emerging at nose, exploding as it passed out, tearing away body of superior maxilla and entire nose and destroying left eye. The patient was transferred to St. Louis and discharged July 14. 1835. Private Charles G. Hall, Co. G, 5th Maine, aged 36, was wounded at the Wilderness, May 10, 1864. On May 14th he enteied Carver Hospital, Washington. Surgeon (). A. Judson, U. S. V.. reported: "Gunshot wound of left side of pelvic region, flesh. Explosive ball entered body near anterior inferior spinous process of ilium and lodged in the same side near the sacrum. May 10th, extraction of ball on field ; simple dressings. Doing well June 26, 1864, when he was returned to regiment to be mustered out." Acting Assistant Surgeon D. C. Owen reported that Private James Kenney, Co. I, 100th Illinois, aged 18, was admitted into the hospital at Quincy, Illinois, December 26, 1863, with a gunshot wound of the right shoulder by explosive ball, received at Missionary Ridge, November 25, 186 >. Ball entered half way between the shoulder joint and neck and penetrate! the flesh two and a half inches; extracted from place of entrance; wound healed. Returned to duty February 16, 1864. Private T. P. McElroy, Co. F, Hist Pennsylvania, aged 46, wounded at Spottsylvania. Ma}- 12, 1864. Treated in Washington and Annapolis hospitals, and admitted, on August 18, 1834, into hospital at York, Pennsylvania. The following record of the case appears upon an unsigned case-book: "An explosive ball struck the lower jaw on the left side of the chin, bursting and comminuting the bone. The ball was removed by Dr. Vanderkief t, surgeon-in-charge of the Naval Academy Hospital, on May 21, 1864. Several fragments of bone were removed at the same time and several had come away before. The wound is now healed externally but discharges slightly into the mouth." McElroy deserted from hospital October 14, 1834. Private P. F. Moore, Co. B, 83d New York, aged 40, wounded at Tolopotomy Creek, Virginia, May 30, 1864. On June 4. 1834, he was admitted into Mt. Pleasant Hospital, Washington, where the injury was diagnosed as "arm poisoned by explosive ball." He was afterwards treated in hospital at Bristol and Philadelphia, but no subsequent allusion is made to the character of the missile. Medical Cadet E. D. Mitchell reports: "Bugler Jack Robinson, 1st U. S. Cavalry, was killed at Brandy Station. August 1, 1863, and by order of General Buford his body was sent to Washington for interment. Autopsy August 2d, one hour after admission into Douglas Hospital. The ball entered over inner third of right clavicle, fracturing it, wounding the apex of the right lung, and passed out obliquely, striking the seventh cervical vertebra, and was cut out underneath the skin near the inferior angle of the scapula. The lung was too much decomposed to make a preparation of. The ball had evidently exploded after it struck him. There was a great amount of haemorrhage, but the body was too much disorganized to allow of finding its seat. The specimens are the clavicle and ball." The specimens were received at the Army Medical Museum, and the clavicle is numbered 1644 of the Suryical Section, but the missile is not attached and a carefid search failed to discover any tracv of it. Private John Ryan, Co. E, 114th Illinois, aged 21, wounded at Guntovvn, Mississippi, June 10, 1864, and admitted into Adams Hospital, Memphis, June 13th. Surgeon J. G. Keenon, U. S. V., reported: A lacerated wound, from explosive shot, of calf of right leg. June 17th, extraction of ball through extension of opening; calf of leg appeared as if peppered by buckshot. Ball had exploded after entering limb. June 30th, gangrene attacked the wound and was checked with bromine. On August 25th the patient was transferred to Quincy, Illinois, and discharged June 22, 1835." Private W. II. Stanley. Co. C, 1st Maine, aged 21, was admitted into Chestnut Hill Hospital, Philadelphia, June 7, 1864, with a gunshot wound of left foot, received at Spottsylvania May 19, 1864, said to have been inflicted by an explosive ball. Simple dressings were applied, and the patient was returned to duty July 11, 1864. Acting Assistant Surgeon Louis Fassitt reports: "R. C. Wright, 1st U. S. Chasseurs, was wounded on the skirmish line at Malvern Hill, July 1, 1862, by an explosive ball, which entered about the middle of the right clavicle, fracturing the bone, passed through the cavity of the thorax, and was extracted four days after below the spine of the right scapula. Large amount of haemorrhage from the lungs. Sensation at the time of receiving the 704 WOUNDS AND COMPLICATIONS. [CHAP. XII. wound was like tliat of a blow from a man s fist. Admitted into hospital at Chester, Pennsylvania, July 29th. Several pieces of brass were extracted by me from the anterior wound near the clavicle, and others from the posterior wound near the scapula. (He had no scales on his shoulders or any metal about his person ) These form a portion of an explosive cap attached to a conical ball, which I have no doubt ignited at. the moment it struck the clavicle, and these fragments were driven through the lung." Wright was discharged from service November 30, 186:2. Private A. Farcy, Co. C, 183d Pennsylvania, aged 3f>, wounded at Cold Harbor, June 3, 1864. Acting Assistant Surgeon J. A. McArthur reported from South Street Hospital. Phil adelphia: Wounded by an explosive ball, which entered the right side of the thorax one and a half inches from the acromion. On June 12th a large abscess which had formed over the biceps muscle was opened and the ball extracted." Erysipelas attacked the wound and the patient died July 22, 1864. At the autopsy the ball was found to have passed through the glenoid cavity of the scapula, partially fracturing the head of the humerus, and passing around the bone lodged beneath the fascia covering the biceps muscle. The upper half of the right humerus was forwarded to the Army Medical Museum by Dr. McArthur, and con stitutes specimen 3669 of the Surgical Section. There is a double longitudinal partial fracture of five inches on the inner side of the shaft. The head is carious, and necrosed bone borders the lines of separation in the shaft. EFFECTS OF LARGE PROJECTILES. The effects of these projectiles depend on their weight, size, and momentum. At high velocities they virtually encounter no resistance from a single human body and their force is but slowly expended on masses of soldiery. Their form is of little importance, as similar results follow the use of spherical and elongated solid shot and shell; their impact is followed by instant death or by wounds of great severity. When the injury is not immediately fatal, as is not rarely the case when a limb is carried away by a projectile of considerable size striking directly, the surface of the stump will be found to be somewhat "cleanly cut," the skin and muscular tissues contused and dark with but little retraction; the bone fractured with not much splintering or comminu tion above the seat of injury; the arteries retracted and the haemorrhage slight. If the projectile strikes obliquely or with somewhat diminished force, the resulting wound resembles a deeply grooved furrow corresponding to the size of the projectile and influenced by its direction; the skin, fasciae, and deeper soft parts are extensively lacerated or removed entire, the surface is covered with blood clots and shreds of connective, muscular, and aponeurotic tissue ; if penetrating cavities, disorganization and destruction of the parts will follow, resulting in death either immediately or in a very short time. Should a large, pro jectile come in contact with a limb under these circumstances, it may carry it away entire or leave it partially attached by fragments of skin and muscular tissue; in its midst will be found fragments of shattered bone, the whole forming a mass devoid of form and life. An illustration of a laceration of the leg from a cannon ball is given in PLATE LXXVI, opposite page 478, ante. The lithograph is copied from a sketch made on the field. A solid projectile whose velocity is so greatly diminished as to seem harmless is still capable of doing great damage through its acquired momentum; it may not possess the force necessary to carry away any part of the body, but a contusion or wound resulting from its impact is generally serious and not infrequently fatal. It may be that no outward evidences of injury are manifest beyond some discoloration, but subsequent symptoms indicate the existence of grave internal lesions, rupture of viscera, concussion of the brain or spinal cord, and sometimes fracture of bones with extensive comminution and disorgan ization of the surrounding soft parts. The following case of fracture of the humerus in three places, leaving the skin intact, taken from a report of his personal service at the battle of Bull Kun, is related by Assistant Surgeon B. E. Fryer, U. S. A.: CASE 1044. "A Sergeant of Eickett s Battery walked from the field to the hospital after having been struck by a round shot, en ricochet, on the arm, fracturing the humerus in three places and producing great contusion without breaking the skin. The case is interesting from two facts the great injury to the bone without laceration of the surrounding soft parts, and from the fact that disorganization of the tissues did not take place in this, as it, nearly always does in all parallel cases. The result of the treatment of this man was doubtful, and the question of amputation was raised by the other medical officers of the hospital, but I strenuously opposed it, and had the satisfaction of seeing this useful soldier recover and return to duty with no other deformity than a slight shortening, and with a perfect use of the arm. The treatment in this case was to lay the arm on a pillow; cold water until all swelling had subsided, after which I ordered a plaster of Paris splint." CHAP. XII.] EFFECTS OF LARGE PROJECTILES. 705 In the next case the femur was fractured at the neck and the soft parts were severely bruised, but the skin was not broken: CASK 1045. Surgeon James T. Stewart, 64th Illinois, aged 40 years, was wounded at Decatur, Georgia, July 19, 1864. The following history of his case was kindly furnished hy this officer: "While acting in the capacity of Surgeon-in-Chief of the 4th division, Sixteenth Army Corps, near Decatur, I was struck hy a spent shell on the right hip. The shell came from the side, struck me fairly on the hip and fell down, not exploding. It crushed the soft parts dreadfully and broke the thigh bone in the neck. The skin was not broken, but everything underneath it was bruised into a jelly. I was laid on my left side as I could not lie on my back, the wounded leg resting on the sound one with a pad between them. In this position I lay for two or three months, with no extension or counter extension or apparatus whatever, as I could not bear any. I remained on the field for three days and was sent in an ambulance to the field hospital a distance of about four miles. I lay then? three or four days, and had to be moved about four miles further to the right. Tin* time four men carried me on my cot, and while on the way the end of the cot came oft suddenly and threw me off in the road. I survived the shock, but it was all I could do ; I lay in this field hospital perhaps about ten days, when I was put in an ambulance and carried back to Marietta, some twenty-two miles. Here I lay, I think, about a month. At the end of this time, there being no union of the bone whatever, I prevailed on them to start me for St. Louis for the purpose of getting under the care of Professor Pope. I went as far as Nashville, but could ride no firther, hence I was put in the hospital there. After a week they put me on a train for Louisville. In consequence of exhaus tion I was obliged to stay in Louisville, in hospital, probably ten days, when I was put on a steamboat for Cairo, but the boat was stopped at Evansville in consequence of a raid the Rebels had made on the river below; but after a week or so went on, and finally arrived safely at Cairo, was transferred to another boat, and eventually reached St. Louis. Professor Pope examined the leg, and told me the bone was uniting and that he would not advise any change in the treatment. On this advice I came to Peoria. As to the result, the leg is shortened one inch. There is quite a hollow where the trochanter major should be. The leg is weak and most of the time sore and tender in the hip. It does not often give me pain. I can walk with a cane pretty well, but without a cane it gives out in a few squares. For six or seven years after the injury it improved, since then it has rather grown worse and gives me more trouble now than it did ten years ago." Dr. Stewart was mustered out December 22, 1864, and pensioned. Examiner G. L. Lucas, of Peoria, reported September 4, 1877: "That no improvement had taken place since last examination. Slighter contusions very generally destroyed the vitality of the skin and soft tissues and resulted in extensive sloughing and slow repair. The occurrence of simple fracture and dislocation was noted, but these complications were infrequent. Probably the largest class of injuries attributable to heavy projectiles is that resulting from fragments of exploded shells. The nature and character of these wounds are largely influenced by the weight, form, and velocity of the fragments. Pieces of great weight moving with high velocities inflict injuries similar to and not less severe than those caused by the large projectiles already mentioned. As their velocity diminishes, which is rapidly the case, owing to the great resistance offered by the air to the passage of irregularly shaped bodies as well as to gravitation and modification of the original impetus, the factor of weight alone assumes importance, as even with slow motion the momentum of such masses is almost irresistible. Form may determine the severity of a wound especially when the fragment is of a small size, the sharply outlined edges becoming sources of danger to blood vessels, nerves, and viscera. Wounds from large shell fragments are attended with great laceration and destruction. When the force has been insufficient to carry away a portion of the trunk or an extremity, the resulting wound is deeply contused with ragged and irregular edges; there may be a loss of more or less substance; bony structure exposed to the force of the blow is shattered and comminuted; not infrequently the missile will be found lodged in the wound. In other cases a large fragment will pierce the skin without destroying the vitality and sink deep into the cavities or soft parts; the skin retracting will present so small an opening as to obscure the diagnosis until subsequent symptoms disclose the true nature of the injury. As in cases of solid shot, contusions of little or no outward significance beyond slight bruising, but attended with extreme internal disorganization, are met with. Shell fragments striking obliquely, as often happens when the missile explodes on the ground, generally produce superficial wounds only, though covering an extensive area. A curious case ot SCRG. 11189 706 WOUNDS AND COMPLICATIONS. [CHAP. xn. lodgement of a 12-pound unexploded shell in the gluteal muscles appears upon the records of the field hospital of the Eighteenth Army Corps: 1 CASE 1046. Private B. D. Thayer, Co. D, xioth Massachusetts, aged 21 years, was wounded at Petersburg, June 30, 1864, and was taken to a field hospital of the Eighteenth Corps, where it was reported that Surgeon H. N. Small, 10th New Hampshire, removed a 12-pound round shell from the left gluteal region, the patient surviving the operation some forty-eight hours. The missile, which was retained by the operator, was entirely concealed behind the gluteal muscles. Wounds by grape-shot partake of the general nature of injuries from cannon balls. The velocity of these projectiles is, however, generally lower, and their weight less, so that their destructive power is somewhat limited. Case and canister shot, as well as small frag ments of shell, produce effects not materially differing from those of small-arm missiles. The effects resulting from the explosion of torpedoes, though somewhat dependent upon their size, nature, and proximity, are extremely terrible. Not only is the violent action of fragments and splinters hurled at their initial velocity to be considered, but also the con sequences of exposure to the flame and gas of the exploding charge. Should life be not immediately extinguished, fearful mangling and mutilation results, and limbs may be entirely torn away or shattered almost beyond recognition, while the presence of burns and the effects of the inhalation of gases serve to complicate and obscure the condition. Although it has been previously stated in this history (see Second Surgical Volume, page 28) and elsewhere that "reports of alleged traumatic effects from the wind of balls * * * do not seem to merit serious consideration," it would appear by the number of reports of cases of this character during the late war, that there is still a lingering belief that injuries from this source are not of infrequent occurrence. After a careful consideration of these reports the evidence unmistakably points to effects produced by actual contact of the missile causing severe concussion, or to the accident known as the " brush of a ball," in which the missile passes so near as to actually touch the clothing or skin without tearing the one or the other, and producing apparent paralysis, swelling, inflammation, and sloughing. The several theories of vacuum, 2 of foreign bodies carried along with the ball, 3 and of electricity, 4 which have from time to time been suggested to support the idea of injuries Descriptions in detail of injuries caused by solid projectiles or large fragments of shell, together with illustrations, have been given in the preced ing parts of the history. On page 91 of the First Surgical Volume it was pointed out that, " without any attendant injury to the skull or concussion of the brain, the scalp may be wounded by the largest projectiles from artillery," and that "cleanly-cut furrows were made ... by fragments of shell in rapid flight." A case of contusion of the occipital by a 6-pound iron cannon ball is cited on page 99, and instances of crash or smash produced by cannon balls or explosion of large shells are given on pp. 212-214. On pp. 476-477, remarks on and cases of injuries to the contents of the chest by large spent shot and fragments of shell will be found ; see also case of II. B , on p. 487, and on p. 486 the case of C. P. Belts, injured \>y grape-shot. In the Second Surgical Volume visceral injuries without external wounds are referred to on pp. 15-S8. The cases of Howard, p. 1C ; Charles G , p. 18 ; Lioveland and Dulepohn, p. 20; five cases on p. 21; cases of Bishop, Bence, Brown, Rand, and Bowditch, on p. 23; of Williams, on p. 24; and the cases on pp. 25, 26, were all from solid shot or shell fragments. Case 649, p. 223, of fracture of the os innominatum by a shell fragment, is illustrated by a plate. Specimen 4457, a fragment of shell extracted from the ischiatic region, is illustrated by a wood-cut and referred to at p. 240. An illustration of a shell fragment extracted from the sacrum is given on p. 250, CASE 732. A portion of hand grenade, extracted from bladder by lithotomy, is illustrated in PLATE VII. 2 FORBK8 (P.) (Observations on the Cause of Death from what is called the Wind of a Ball, in The Edinburgh Medical and Surgical Journal, 1812, Vol. VIII, p. 310) is of the opinion "that there is a mechanical cause for the effects produced by a ball passing close to the human body which will sufficiently account for them. This is the vacuum produced by the rapid motion of the ball through the air, which though of itself partial, yet when we combine with it the condensation of air taking place immediately before the ball, may, I suppose, have fully the same effect as if the vacuum behind it were complete. When a ball then passes close to the stomach, there is, in the first place, a great addition to the pressure on that viscus from the condensa tion of the air ; as soon as the ball is passed, this pressure, with a great part of that of the atmosphere, is taken off; the consequence of which is a sudden expansion of all the fluids in the stomach and the blood in its blood-vessels, and the rupture of both. The rupture of the stomach is the cause of death, and the extravasation of the blood, of the black appearance, externally, ... on the same grounds an easy answer is afforded to the question pro posed by Dr. SPEXCE, why the passage of ball has not always the same effect in battle ? This arises from want of the necessary velocity to produce the condensation and vacuum which has been considered as the cause of the effects produced, as great velocities we know from the experiments made with cannon balls are rapidly destroyed by the resistance of the air." 3 SPENCE (J.) (Observations on those Accidents commonly ascribed to Hie Wind of a Ball, in London Medical and Physical Journal, 1812, Vol. XXVIII, p. 142) states that "there are many substances, comparatively light of themselves, on board ship, such as canvas, rope-yarns, part of the bedding, etc., which, when carried along with the velocity of a ball, or even driven but a short way with that force, are apt to do considerable injury by hitting the body, and, by occupying a large or small bulk, may or may not produce external marks of injury. 4 El.l-18 (D.) (Observation* on the Mature and Cause of certain Accidents which sometimes occur in battle and hare been usually ascribed to Hie, wind of a Ball, in Edinburgh Medical and Surgical Journal, 1812, Vol. VIII, p. I) says that it is sufficiently proven that the peculiar facts ascribed to the wind of n ball are likewise occasioned by the varied operation nf atmospheric electricity, for, in both cases persons are suddenly struck down with loss of sense and motion, vision is impaired or irreparably injured, the body is discolored, the nerves paralyzed, the bones broken, and even life destroyed without any visible external injury or breach of parts, or any appearance of the body from whence the injury proceeded." CHAP, xii.) EFFECTS OF LARGE PROJECTILES. 707 from the "windage of balls," have all been disproved, and it is now conceded by modern surgeons that without the .actual contact of the projectile injuries cannot occur; on the other hand it is admitted that slight contact from the "grazing" or "brushing" of a projec tile, or the rolling motion of a cannon ball over the surface of the body, may, by the weight and momentum, aided by the elasticity of the skin, effect most serious results, while little or no external evidence of such contact is left. 1 Instances of injuries attributable to the explosion of shells near at hand, without wound or contusion, -are numerous, and generally well authenticated. They are, 2 for the most part, cases of partial or complete paralysis, deaf ness, blindness, loss of voice, rupture of superficial blood-vessels, and mental prostration. 3 CASE 1047. Private William C. Goodell, Co. A, 6th Vermont, aged 37 years, was admitted into Satterlee Hospital, Philadelphia, August 12, 1862, suffering from shock resulting from the explosion of a shell at White Oak Swamp, Virginia, June 30, 1862. The missile exploded a few feet behind the patient, the fragments tearing off his knapsack and the clothing from the upper part of his body, but producing no visible wound. The shock was very severe, producing a sensation of "sinking into the earth," followed immediately by total loss of power and consciousness, which, however, lasted but for a short time. Upon their return he found himself unable either to hear or speak. Immediately after the reception of the injury he was sent to Harrison s Landing, and thence to Satterlee Hospital, where he came under the care of Acting Assistant Surgeon Francis West, who reports: "On examination no external lesion of the head or spine was discoverable, and he had no paralysis anywhere of ordinary motion or sensation. He could move his tongue perfectly in every way, but he could not speak, and he was totally insensible to all sound ; he was, in a word, simply deaf and dumb. He complained of some uneasiness in his head, which was hot and his face flushed. His pulse was active but not very full. Respiration very little if at all disturbed ; no vomiting, bowels regular. The case was regarded as one of probable congestion of the brain at or about the point from which the proper nerves of speech and hearing arise, or, if more general in its character, manifesting itself by particular pressure at the deep origin of these nerves; in other words, that the part of the fourth ventricle giving rise to the glosso-pharyngeal and auditory nerves was compressed, and thus the functions of speech and hearing destroyed. The treatment employed was depletory and revulsive. Blood was taken by cups applied to the nucha and behind the ears, and active purgation was kept up by calomel and other cathartics. Cold applications were made to the head with derivatives to the feet, and a low diet was enjoined. This plan of treatment was pursued for several days, and until all evidence of local or general excitement had disappeared. The only mani festation of disease which then remained was the deaf-dumbness, which did not in any degree diminish. A blister was now applied to the nucha and a discharge kept up for several days. No change was observable in the deaf-dumbness, but the patient was otherwise doing well. Still viewing his disease as dependent upon local hypersemia, or perhaps non-inflammation of the brain at the point already indicated, which after some weeks of primary treatment had refused to yield, it was determined to try the alterative effect of small doses of calomel. This was given in quantities of an eighth of a grain every three or four hours and continued for several days. No better success was the result. After a short time the calomel was repeated and pushed to a slight ptyalism, but still without any favorable effect. The strength of the patient in a short time began to decline, but without any change in his intelligence or spirits, which all along had been remarkably good. Communication with him was kept up by means of a slate. Quinine in moderate quantities was given, and his general health seemed to improve, but still the deaf-dumb ness remained. On mentioning his case to some of my colleagues it was suggested that, as the patient might possibly be feigning an inability to hear or speak, it would be well to render him unconscious by etherization and then test his powers in these respects. The operation only confirmed the reality of the symptoms. Electricity was also tried, but without any good effect. On December 10th, just four months after admission, it was noticed that the left leg had not full power of motion, and that the face was somewhat drawn to the right side. On the 12th of the same month he was seized with a convulsion which lasted for 1 In Note 2, on page 28 of the Second Surgical Volume., a supposed case of the "capability of compressed air or wind from a missile to bruise or iufliot visible injury" is referred to. The case is reported by Surgeon B. Rhett in the Am. Jour. Sled. Sci., N. S., 1873, Vol. LXV, p. 92: "After a skirmish upon John s Island, in which the besieging gunboats took part, a private entered the Marine Hospital of Charleston, of which I was then surgeon, to be treated for discoloration of the skin, a purple, yellow, and green bruise, extending from the mamma to ilium of right side and from the umbilicus to the dorsum. The discoloration precisely resembled such as I have seen in scorbutic patients among the Andersonville prisoners, an ecchymosis. But the man was in perfect health, no signs of scurvy. I give his account of the cause of the injury : He was standing with his rifle held by the ban-el at arm s length and the butt resting on the ground, when a large shot or shell passed between himself and his rifle without touching either or moving him from his position. Immediately after he observed the discoloration, and was sent to the hospital for fear of internal injury. The case rests upon my evidence of the injury and upon the soldier s account of the cause." 2 Three Cases of Injuries of the Nervous Centres from Explosion of Shells, without Wound or Contusion, are given by G. BUUR, in New York Med. Jour., 1865, Vol. I, p. 428, and Five Cases of Injury to the Nervous System, by the Explosion of Shell, by B. RHETT, in Am. Jour. Med. Sci., 1873, Vol. LXV, p. 90. Dr. Rhett s fifth case, with his comments thereon, are as follows: "CASE V. The private injured in the gun chamber with Lieut. Poor was brought into the hospital a frightful object, bleeding at mouth, nose, and ears, his eyes protruding from their sockets. The sutures of the cranium parted, ono parietal bone overlapping the other, and the sutures with the occipital and frontal bones loosened. The head dislocated from the neck, the latitude of motion showing either a parting of the ligaments or that the base of the occiput was broken up. The thoracic and cervical regions were bloated, blown up with an escape of air into the cellular tissue; emphysema; yet there was no external wound or injury. The place and time did not admit of a post-mortem examination. Now the question arises whence this extensive disorganization ? I offer the following suggestion, not professing to affirm its correctness : I think the man was driven by the force of the explosion head foremost into the earthwall of the gun chamber; that the cervical verfebne were driven through the fractured occiput, and the sutures were forced asunder from within by pressure upon the cranial contents." 3 One hundred and thirty cases appear upon the field casualty lists of compression of the brain stated to have been caused by the explosion of shells. Twenty-three were discharged. Of this number deafness is alleged in one case, irritability in one, meningitis in one, paralysis of limbs in one, paralysis of optic nerve in one, insanity in two, and spinal affection and nervous prostration in one case each. Seventy-one patients returned to duty. Among these cases the early symptoms were temporary deafness in five cases, momentary loss of sight and hearing in one, loss of speech in one, and cephalalgia in one. Ono patient deserted, and in thirty-five cases the results could not be ascertained. 708 WOUNDS AND COMPLICATIONS. [CHAP. xn. nearly half an hour, and was followed by stupor, accompanied at short intervals by startlings of an indistinct gutteral sound. On the next day these symptoms had entirely disappeared and his intelligence was found to be perfectly rational, as it had always been during the whole course of his disease, although he retained no recollection of what had occurred during the previous twenty-four hours. He could only protrude his tongue with great difficulty, and it was drawn, in a marked degree, to the right side. The occurrence of this latter train of symptoms was sufficient to satisfy me of the correctness of my early views of tlie pathology of his affection. The indications were clear that the original hyperfemia and inflammatory conditions had resulted in softening of the cerebral tissue at about the origins of the proper nerves of audition and speech in the floor of the fourth ven tricle. From the period of the subsidence of the graver symptoms just enumerated his condition has been variant from day to day. Sometimes he seems to be better, and then suddenly his symptoms become aggravated, with complaint of severe pain in his head. During the last month he has recovered sufficiently to be able to occupy himself in some trifling mechanical work, but still he remains perfectly deaf and dumb. The only other manifestation of paralysis is a slight loss of power, with stiffness in his right leg. His intelligence, spirits, and general health are quite good." Goodell was discharged for disability, February 4, 1863, and pensioned. Examiner 0. G. Dyer, of Brandon, Vermont, reported, January .M, 1870: "The pensioner has com plete loss of speech and hearing, the result of an injury sustained upon the upper middle third of the spinal column. At this point there is an angular curvature of the spine, and to the right/ on a line with the spine of the scapula, between it and the vertebral column, a large circumscribed tumefied swelling, tender and painful on pressure, but without heat or redness. The tenderness and pain also extends to and involves the angle of curvature. Pensioner also has partial loss of sensation of both hands and feet. He has also hectical symptoms and is now totally incapacitated from all labor, requiring the aid of an attendant to supply his daily wants. On September 4, 1877, Dr. Dyer reported that the patient " is quite lame and gets about with difficulty. The proportion of cases of deafness among officers of the artillery arm, as well as among the carmoniers, has been, since the war, a frequent subject of remark, 1 and on page 385 of the First Surgical Volume allusion is made to the frequency of rupture of the membrane of the tympanum from "propinquity to artillery fire." An illustration of the serious injuries sometimes inflicted by the discharge of heavy artillery on soldiers in the near vicinity is given in the following case: CASE 1048. Corporal John S. Terhune, Co. K, 32d Illinois, was admitted into the hospital at Evansville, Indiana, in August, 1862. Assistant Surgeon W. D. Turner, 1st Illinois Artillery, reported : " Case of aneurism of abdominal aorta. Traces his injury to the 1st of March, 1862. While on the gunboat Lexington he was leaning over the side of the boat immediately above an 84-pound gun, when it was discharged. Another man was standing behind him and leaning most of his weight on htm. The shock from the discharge caused them both to fall, or threw them back about seven or eight feet. It felt like an electric shock. On the same night he commenced discharging arterial blood from the bowels, which continued about four weeks. He was treated by Dr. Christy, 32d Illinois; took pills of opium. The discharges ceased in the beginning of April, when he first perceived a fluttering above the umbilicus, which has been increasing in extent and severity. It extends at present from four inches above the umbilicus to the bifurcation of the aorta below. He was dizzy part of the night when hurt, but was on picket duty part of the same night at Savannah, Tennessee. Present appearances: Anxious, uneasy; is a tall man, six feet three-fourths inch high; is losing flesh. Has, as he sajs, a sinking in his stomach. Appetite is very poor. Has orthopncea, dyspnoea, tinnitis aurium, and throbbing in right side of head and neck and in right hypochondrium. Has considerable tender ness over spine at lower dorsal vertebra and to the right side a space of about the size of the palm of the hand. Bowels at times are costive, at present lax. The last blood he passed was very black. Has sensations of numbness when he lies on his back. Feet do not swell. Sleeps at night but two or three hours. Has bad dreams at night of falling off precipices and into water. In the supine position the abdominal aorta is felt to the left and partly over the spine, and is much increased in size. The pul sations at and immediately below the umbilicus for one-half inch are much stronger than at the apex of the heart. The same extends to about one and one-half inch above in the mesial line. One-half an inch above the umbilicus is the most powerful pulsation. Pulse 80, and very weak, feeble, and compressible. Extremities cold and numb. Circulation very defective ; least noise causes violent excitement and palpitation. Has paralysis agitans almost constantly; sometimes cannot hold a pen from trembling in his hand. There is general numbness in right side; in stepping on any elevation always puts the left foot forward, as the right is deficient in power. Treatment : Purgatives, rest, anodynes." This man was discharged October 2, 1862, for "aneurism of the abdominal aorta; by compressing the aorta above, the tumor becomes soft and also is reduced in size." He was pensioned. Examiner J. W. Lee, of Majority Point, Illinois, August 9, 1871, certified to diaphragmatic hernia with con siderable tenderness on pressure, with slight rupture of the abdominal artery, causing an enlargement of the capillary blood vessels of the right leg. He is very much emaciated, presenting the appearance of one whose nervous system Avas gradually giving way, rendering him unfit for manual labor." Dr. W. H. Edson, of Willow Hill, Jasper County, Illinois, states that, Terhnne died June 24, 1877, from inflammation of the lungs superinduced by his internal injuries. No autopsy. EFFECTS OF MISSILES AND PROJECTILES FROM SMALL ARMS. By reference to TABLE GXXT. p. 696, it will be seen that of the aggregate of shot wounds reported during the war. by far the greater number was due to projectiles from small arms. In considering the effects of large projectiles, size, weight, and velocity constituted the principal factors; in the case of missiles and projectiles from small arms, form, both original and that acquired by 1 LONCMOHE, in his treatise upon Gunshot Injuries, etc., London, 1877, p. 118 e.l seq., graphically describes the effects produced by a terrific, explo sion of the French and Knglish magazines of gunpowder and munitions of war during the Crimean campaign in 1855. CHAP xii ] EFFECTS OF PROJECTILES FROM SMALL ARMS. 709 accidental causes, assumes importance, as well as the relation of the individual injured to the impinging projectile, the direction of the ball, position, structure, and power of resist ance of the parts, and course of missile through the tissues. With reference to the projec tile itself, form and velocity are of principal importance; size, weight, and volume modify the character and extent of the wound, while the remaining factors have an especial sub jective relation. The great disparity in the number of wounds by round balls as compared with those by conoidal balls, indicated in TABLE CXXI, on page 696, shows that the greater effectiveness of the latter was early recognized by the combatants in the late war. Aside from the influence which the improvements in modern small arms may have had in increasing the general effectiveness of projectiles, the adaptation of the conoidal missile to the rifled gun has unquestionably wrought a change in the surgical relations of wounds, the opinion being generally expressed by surgeons that wounds caused by the elon gated missile are more severe and dangerous than those resulting from the spherical ball. The cylindro-conoidal projectile attains a great range with effective power; it opposes less frontage to the resistance of the air and its velocity suffers. less retardation than that of the spherical ball. Rotation upon its long axis tends to give it a steadier flight and a more direct course. Its pointed apex, aided by its rotation, gives it the mechanical advantages of the wedge and screw, enabling it to pierce more easily the structures of opposing bodies while it suffers a proportionately less diminution of force; adding the factor velocity, we have a missile endowed with tremendous force, maintaining for a long time and over great distances a steady flight, not easily deflected, piercing and rending opposing obstacles, and preserving, even at immense range, a momentum sufficient to render it deadly in its effects. It is probable that the effects produced by round bullets at very close quarters are equally if not more destructive than those produced by elongated missiles; the initial velocity in the two cases does not vary greatly, and, in short distances, the advantage of form as a destructive element is on the side of the round ball; but as the peculiar power of the rifled bullet mainly lies in its destructive effects at long range, the change of military tactics, based on this fact, has compelled the general use of weapons of greater power and has thus lessened the opportunities for comparison on any extended scale. The size and weight of small-arm missiles vary within such narrow limits as to make practically but little difference in the effects produced by them, though, in the question of the extraction of a ball from between bones or in joints, dimension may be of importance, as well as in the consideration of the gravity of penetrating wounds of the chest, as pointed out on page 615 of the First Surgical Volume. Missiles from carbines, pistols, and from fowling pieces, when used as weapons of war, produce injuries very analogous to those of the ordinary small arms; but, being of smaller size and impelled with less force, their wounding power is generally less: CASK 1049. "Sergeant Stephen M. Harper, Co. D, 4th Ohio Cavalry, aged 25 years, while acting as a picket guard, uirie miles from Nashville, February 28. 1862, was wounded by seven different bullets, fired simultaneously from a rebel ambush. The missiles were buckshot qf the largest size. One shot passed through the biceps muscle of the right arm, entering the skin three lines outside of the cephalic vein, passing upward and inward, and emerging just anteriorly to the nerves and to the bi achial artery. Another entered the right deltoid muscle, passing backward, and emerging at a point over the scapula two- thirds of the distance between the acromion process and the inferior angle of the bone. Another grazed the skin two inches above the insertion of the left. /fearer biceps cubiti. Another entered the flesh over the seventh intercostal space, on a line perpen dicular from the left nipple, and, passing backward and outward three inches and three-fourths, emerged through the skin over the ninth intercostal space. Another entered over the ninth rib at a point on a line drawn from. the right nipple to the right anterior superior spinous process of the ilium. This ball glanced around the body under the integuments, and was arrested by contact with the right lateral surface of the spinous process of the second lumbar vertebra, from which place it was afterwards removed through an incision made for the purpose. Another entered the right thigh two inches below Poupart s ligament, at the WOUNDS AND COMPLICATIONS. [CHAP. xii. outer margin of the quadriceps extensor muscle, and emerged over the posterior superior spinous process of the ilium upon the same side. The seventh grazed the skin over the body of the hyoid bone. The quantity of blood lost was inconsiderable. Only water dressings were applied to the wounds. There was very little ecchymosis and swelling. Suppuration was slight. The wounds were all healed by the 1st of April; but an attack of diarrhoea, which supervened while in the hospital, so depressed the general health of the patient that he was unable to resume active service after i-ecovery from his wounds." Surgeon E. Swift, U. S. A., reported the case. The patient died in hospital No. 8, Nashville, on April 6, 1862. At close range the "buck and ball," used extensively in the late war, was considered very effective, for, besides the effect of the round ball, the buckshot had sufficient force to place a man, temporarily at least, hors du combat. The accidental forms and distortions which leaden projectiles are liable to assume by contact with opposing obstacles both within and without the body form a curious and inter esting feature in the study of inissiles and their effects. The illustrations given in PLATE LXXVIII, opp., are taken from the collection of missiles in the Army Medical Museum. 1 If the distortions of bullets were of all imaginable forms, their courses were frequently no less erratic, as shown in the following example: CASE 1050. Private John R. Smith, Co. G, 22d Illinois, was wounded at Belmont, November 7, 1861. Surgeon J. H. Brinton, U. S. V., who saw this soldier at the time of being wounded on the field, describes the erratic course of the missile as follows: "A small conical ball entered behind the left shoulder and passed underneath the skin across lower part of left side of neck, across median line, and then upward immediately beneath the base of jaw of right side, emerging just below the angle of the maxilla. The man was shot in front of a fence, and the ball lodged in the fence and was removed and returned by his comrade. It was probably a small rifle projectile, or possibly, although unlikely from the time and circumstances, a revolver projectile. The track was superficial, for days discolored olive and yellow, as if painted by a camel s-hair pencil ; there was little extravasation and almost no pain; no injury to either clavicle or maxilla. On the 26th of November, nineteen days after the injury, the patient was discharged from the hospital well. I could not obtain the ball. I watched this case almost from the moment of wounding." Smith was promoted sergeant and lieutenant, and mustered out July 7, 1864, at the expiration of his term of service, and pensioned. Examiner T. S. Hening, of Springfield, reported, July 8, 1864: "Smith received a gunshot missile beneath the jaw on the right side; it crossed the median line to the left side and then down the neck and outward to the acromial extremity of the vertebral portion of the spine of scapula. Considerable injury was done to the tissues of the left shoulder, the motion and power of which, together with those of the elbow joint, are much impaired. The left arm is somewhat wasted and its circulation defective." Examiner J. Bowman, of Flora, Illinois, certified, March 31, 1880: "Physical signs of disability are loss of hearing in left ear, paralysis of left arm and hand, extreme tenderness of left scapula and clavicle in fact the whole left shoulder is disabled. Applicant states that the whole left shoulder and left arm have no power of feeling except a constant tingling and numbness of the muscles of left shoulder and arm, and that he is not able to perform any kind of manual labor." This pensioner was paid to March 6, 1881, and since reported "dropped from Roll because of death." 1 Ot the 20 missiles in PLATE LXXVI1I, 15 are cunoidal and 5 round balls. Brief abstracts of the conditions under which the missiles were found will be given ; fuller details of the cases will be found in the Catalogue of the Surgical Section of the U. S. Army Medical Museum, Washington, 186 li : Spec,. 45:37 (Cat., p. 607), a couoidal ball split and flattened by the inferior maxilla; nearly one-third of the body is smoothly and obliquely split off from the upex and turned back, forming a plane surface with ragged edges. Spec. 209 (Cat., p. 614), a couoidal ball with the base split on the tibia into three equal parts, two of which arc curled outwardly upon themselves. The second groove is almost obliterated. Spec. 427!) (Cat., p. 614), a conoidal ball split on the tibia from the apex to the second rim, with the two halves turned backward. The bullet lodged astride of the middle third of the tibia, and was discovered by the X61atou probe after an unavailing search by ordinary means. Spec. 4403 (Cat., p. 612), the greater part of a conoidal ball which entered the meatus auditorius externus of the left ear to the depth of an inch and lodged in the mastoid process, whence it was extracted nearly three months after the injury. Spec. 4483 (Cat., p. 605), a conoidal ball much distorted and curved against a vertebra: the apex is obliquely flattened; a piece of bone is held in the base. Spec. 4411 (Cat., p. 611), a conoidal ball flattened by contact with the femur. The apex is undisturbed in shape; impact evidently occurred when the ball was revolving on its short axis, and probably at a low velocity. Spec. 4400 ( Cat., p. 604), a conoidal ball, slightly rounded at the apex, with a deep longitudinal groove its entire length, from contact with a clavicle. Spec. 2645 (Cat., p. 610), a conoidal ball extracted from the sole of the foot, laterally ami smoothly flattened somewhat like a fan. The smooth surface has a multitude of shallow parallel grooves. Spec. 69 ! (Cat., p. 606), a conoidal ball flattened from the apex backward, with b<.dy curved over the base to a diameter of nearly an inch and one-fourth ; ball entered the front of the knee below the patella and passed upward and inward through the inner condyle of the femur. Spec. 1236 ( Cat., p. 609), a conoidal ball removed from the knee joint, apparently split longitudinally and expanded and flattened laterally ; the missile probably struck in the act of longitudinal rotation. Spec. 4558 (Cat., p. 606), a conoidal ball detected by NEI.ATON s probe and extracted, 20 months after injury, from the sternum. The missile is flattened upon itself from the apex to the second ring, with jagged borders. Spec. 4151 (Cat., p. 593), an elongated rifle ball, very little disfigured, with an ordinary military coat button inverted, together with the cloth to which it was sewn ; the missile had passed through the liver and lodged beneath tho diaphragm. Spec. 2241 ( Cat., p. 615), a conoidal ball with the apex somewhat driven into the body, and the whole laterally compressed with a flattened fragment projecting from one side. The missile was found lodged against the femur behind the trochanter major. Spec. 3028 (Cat., p. 595), a conoidal ball, beaten into nearly a triangular pyramid with very sharp edges, extracted from the lower third of the thigh. It probably ricochetted from a stone before wounding. Spec. 44 _3 (Cat., p. 612), a conoidal ball smoothly flattened over a surface of one by one and a hall inches by contact with femur, with out producing fracture. The flattening is lateral, us if by being rolled out after splitting. Spec. 2813 ( Cat., p. (iOO). a spherical bullet flattened and half way split, with ragged edges, removed from near the fifth lumbar vertebra. Spec. 4564 (Cat., p. 600), a spherical ball, somewhat flattened and smoothly split Dear the centre, with the smaller portion bent down at right angles; extracted from above the coudyle of the humerus. Spec. 4533 (Cat., p. 591), a flattened round ball, which passed subcutaneously from one thigh to the other. Spec. 4435 ( Cat., p. 600), a round ball, grooved in one side to the depth of a quarter of an inch, wilh a fragment bent outwardly, removed from the superior maxilla. It had penetrated the brain through the opposite temple. Spec. 4565 (Cat., p. 600 1, n spherical ball, irregularly flattened on one side, in which is embedded a fragment of an iron n:iil ;ts though from the heel of the shoe: missile was extracted from against the bone near the centre of the plantar surface of the loot. ui-j. lli.-l.ol the War of the Keln Iiioii. Part III, Vol. II CluipXII Spec 4537 Spsc 209 Spec 4403 Spec 4+83 Spec 4+11 Spec 4400. Spec 26+5 ; pec 693. Spec. 1236 Spec 4558 Spec. 4151. Spec 2241 Spec. 2813 Spec 443S Spec 4565 PLATE LXXVIII . DISTORTED BULLETS S|> ciin iis in Ilic Army McclK. il Musrtitii. T >imhur a roii .lilli Philu. CHAP, xir.] ENTRANCE AND EXIT WOUNDS. 711 Entrance and Exit Wounds. Small projectiles impinging upon the human body and penetrating the skin inflict what is known as the wound of entrance; if preserving sufficient force to perforate, the opening last made is called the wound of exit. These wounds of entrance and exit, which have for years been the subject of lengthy discussions, are believed to possess certain diagnostic values, as indicating in a general way the form and variety of missile, its velocity, its probable course through the tissues, and, to some extent, the nature and character of the wound. Under the force of ever varying conditions they are very diverse in appearance and extent, and their significance is largely dependant upon the experience and acuteness of the observer. In general, a bullet preserving its integrity, impinging at ordinary range and at a right angle upon a portion of the body well covered with soft tissues and not unnaturally put upon the stretch, leaves, as it passes through the skin, an opening more or less regu larly rounded in form, often perhaps a little less in diameter than the missile, with the edges inverted and livid in hue, due to the contusion and to the discoloration from the burned powder carried upon the missile. In the case of a spherical ball. there is generally some loss of substance, a portion of the integument being carried away before its obtuse surface. A cylindro-conoidal bullet will probably cause a more irregularly outlined open ing, ejther stellate or slit-like, with serrated edges. The wound of exit may closely resemble that of entrance, but is usually larger and more irregular, with everted edges, bearing fewer evidences of contusion, but often showing a greater loss of substance. From this simple uncomplicated form of -wound we find an almost infinite variation, dependent upon the peculiar circumstances which impress their characteristics upon each case. If the missile has carried before it a foreign body, or has become distorted before impact, or has suffered a diminution of velocity and force, the wound of entrance will be modified accordingly. The resistance offered by the tissues to the passage of a missile through any part of the body and the reciprocal effect of the tissues upon the missile will largely influence the character of both entrance and exit wounds. Obliquity of the course of a projectile to the plane of the surface of the body will result in merely a superficial grazing of the skin or penetration and perforation, in which case the appearance of the wounds of entrance and exit will depend on the angle of impact. Fragments of shell pro duce irregularly shaped wounds, with contusion and considerable loss of substance; should their force be sufficient to perforate a part, the wound of exit is lacerated and ragged, with portions of muscular and connective tissue thrust out of the opening. The differential diagnosis between these and bullet wounds is usually not difficult. A single wound of entrance may have two or more wounds of exit; as, for example, when a missile is divided upon a bone. A projectile may be split into fragments before striking the body, in which case the fragments may each enter and leave separately, or one or more fragments may lodge. Multiple wounds of entrance and exit are common, resulting from a missile perforating two or more parts of the body successively, as two arms, two legs, the body and one or more extremities, or parts of the same extremity when flexed. Cases are recorded in which the projectile has entered and made its exit by the same opening. Plate XXXIX, opposite p. 712, and PLATE XL, opposite p. 714, give typical repre sentations of wounds of entrance and of exit made by spherical and conoidal balls and small fragments of shells under varying circumstances. The drawings were made from 712 WOUNDS AND COMPLICATIONS. [CHAP. xn. recent wounds, at field hospitals, during the war, by the late Hospital Steward E. Stanch, U. S. A., and present faithful delineations of the early appearances of these wounds. 1 EFFECTS OF PROJECTILES ON MuscTiLAR TISSUE AND TENDONS. The differences of structure and density of the muscular tissues of the body encountered by a missile in its passage are found to influence the directness of its course, unless its velocity, i. e., force, is sufficiently great to overcome the resistance offered, as in the case of conoidal missiles at high velocities, the course of which is generally direct. Bound balls presenting an obtuse frontage part more easily with their force, and are readily deflected by fasciae and aponeurotic expansion, pursuing curious and devious courses until they either find exit or make lodgement: CASE 1051. Corporal S. S. Walker, Co. F, 51st Illinois, aged 26 years, was wounded at Chickamauga, September 19, 1863. He was treated in hospitals in Nashville and Louisville, and on December 2d was admitted into the hospital at Quiucy, Illinois. Acting Assistant Surgeon F. K. Bailey reported: "A round leaden bullet entered one inch to the right of the third dorsal vertebra and gives no indication of having passed out, but seems to have passed round the body and lodged in the pector- alis muscle; wound healed." He was returned to duty March 9, 1864, and discharged from service June 16, 1865, and pensioned. Pension Examiner T. S. Hening, of Springfield, Illinois, reported, August 22, 1865 : " Applicant received a ball on the right side of the second dorsal vertfbra, which entered the back, lodged, and is concealed in the tissues, probably on the inner side of the front portion of the right third rib, where there is tenderness, though the ball did not, I think, pass through the lung; complains of pain in chest and difficult breathing on exertion and in damp weather; also weakness of the right arm and muscles between the shoulders. Has also a buckshot lodged over the right parotid gland, and one on the outside of the left shoulder which only produces slight soreness." The pension examining board at Springfield report, under date of February 18, 1880: "Ball remains unextracted." His pension was paid June 4, 1881. The effects of missiles of different character upon muscular structures are not dissim ilar; the track of a small conoidal ball passing swiftly through a muscle is generally more cleanly cut than that made by a large or round ball; but in all shot wounds there is usually found an irregular channel with contused and lacerated walls, more or less devitalized by contact with the missile, the area of injury gradually shading off by concentric layers until lost in healthy tissue; there is always more or less loss of substance dependent somewhat upon muscular tension or relaxation, also upon the direction of the missile through the muscle, whether transversely or obliquely to its long axis. Fascia? and aponeurotic tissues are torn and lacerated or simply perforated, according to their condition of tension at the time; their openings seldom correspond with the openings in muscular tissue, owing to the ever constant change in the relations of parts due to movement and muscular action. Hence it is frequently difficult, to follow the course of the missile with accuracy; when, for the pur- 1 The drawings in 1 LATE XXXIX represent : Flos. 1 :ind 3, the entrance and exit wounds of the left foot and the right thigh in the same subject by a conoidal bullet. The soldier at the time of the injury was in a sitting posture on the ground, with the left leg well flexed. The left drawing of Vic,. 3 shows the wound of entrance just behind the joint of the great -toe; the right drawing the wound of exit diagonally below ; the upper sketch of FlG. 1 shows tin- entrance wound of the right thigh, in which the ball lodged ; the missile after inflicting the wound of the foot had probably lost part of its force and hart possibly suffered some change in rotation, not striking the thigh directly with its apex. The lower drawing of FlG. 1 shows the entrance wound inflicted by a conoidal ball that flattened on the right clavicle and lodged beneath the scapula. FlG. i represents the wounds of entrance and exit in a shot fracture of the ankle joint by a conoidal ball ; entrance wound to the left, exit to the right. Fin. 4. a penetrating wound of the abdomen by a. conoidal ball ; the upper drawing shows the wound of entrance, the lower the wound of exit. FIG. 5, simple flesh wound of thigh by spherical ball; upper drawing represents the wound of entrance, lower, that of exit. FIG. (i. a simple flesh wound of lower third of arm by a conoidal ball ; wound of entrance to the left, exit to the right. FIG. 7. flesh wound of arm by a small fragment of shell ; wound of entrance to the left, exit to the right. FIG. 8, shot wound of neck by a conoidal ball ; wound of entrance to the left, exit to the right, by a missile travelling with high velocity. FIG. 9, shot wound of thigh by a minie ball, large calibre; entrance wound to the left, exit to the right. FIG. 10, flesh wound of hand by fragment of shell. FIG. 11, flesh wound of shoulder by a fragment of shell. FIG. U>, slight flesh wound <.f leg by fragment of shell. FIG. 13, gunshot wound through body from right to left, between ninth and tenth ribs, by a conoidal ball ; the figure represents the wound of entrance. Fin. 14, shot wound of left thigh, frac turing trochanter. from a spherical musket ball. The wounds on PLATE XL represent : FIG. 1, shot wound of left hand, fracturing bone, by a conoidal ball ; wound of entrance to left, of exit to right both very characteristic. FIG. 2, shot wound of foot, fracturing bone, by a conoidal ball ; wound of entrance to left, i.f exit to right. FIG. 3, flesh wound of right arm, making exit from forearm, by conoidal ball ; left drawing represents wound of entrance, right, wound of exit somewhat oblique. FIG. 4, flesh wound of shoulder by a conoidal ball ; upper figure shows wound of entrance, lower of exit. Fir.. 5, shot wound of leg, involving bone, by conoidal ball; here the right figure represents the wound of entrance and the left the exit wound. FIG. (i, shot wound of foot by conoidal ball ; left figure wound of entrance, right, of exit. Fin. 7, shot wound of left shoulder, fatal, by conoidal ball ; entrance to left, exit to right. FIG. 8, shot fracture of ilium by conoidal ball ; entrance wound to left, exit to right. FIG. 0, flesh wound of leg by conoidal ball ; entrance wound above, exit below. Fin. 10, shot wound of arm, involving bones, by u conoidal ball; entrance to left, exit to right. FIG. 11, shot wound of left leg, fatal, by a conoidal ball ; entrance to left, exit to right. FIG. 12, shot flesh wound of foot by conoidal ball ; entrance wound to left, exit right a typical representation of the effects of a conoidal ball at high velocity. 05 t V CHAP, xil.l EFFECTS OF MISSILES ON BONY STRUCTURE. 713 pose of diagnosis, it becomes necessary to do so, the relation of the individual to the imping ing projectile becomes of great importance. Contusions of muscular tissue are found as the result of the impact of "spent balls," or where the force of the missile has been retarded upon some obstacle, as on a part of the equipment, or on objects upon the person, as books, money, buttons, etc. The contusion may present all degrees of severity from simple ecchymosis to the loss of vitality of the part struck ; this may be limited to the skin, in which case an eschar of rounded form and of about the size of the missile is thrown off, or it may affect deeper structures, as the contents of the great cavities. 1 Contusions result more frequently from round than from conoidal balls. Wounds by distorted bullets, by fragments of shell, by foreign bodies, or by elongated bullets revolving on their lesser axis, are more destructive in their nature than the usual wounds from intact balls; the irregularity of a bullet track, due to the causes mentioned, constitutes one great source of danger in flesh wounds. The cavities and irregular pouches formed along the track give lodgement to foreign matters driven in with trie missile, as shreds of clothing, etc., causing irritation, inflammation, and abscess, with the retention and burrowing of purulent accumulations, and exposing the patient to the danger of septi- csemia, or, at least, prolonging convalescence and retarding cicatrization. Many cases attended with extensive destruction of skin, muscular tissue, tendons, and ligaments resulted fatally or in very serious disability from contraction and rigidity of parts, and from the formation of extensive cicatrices impairing motion and becoming the seat of pain and inconvenience. Gangrene, tetanus, and pyaemia were not infrequent complications, and in a number of lesions of the muscular structure of the extremities life was only preserved by recourse to amputation. Instances of this nature have been cited among the flesh wounds of the extremities. A few instances of repair of shot wounds of muscles by first intention have been noticed, but they were very rare and presuppose a cleanly cut wound, a sound constitution, and a temperate habit of life. EFFECT OF MISSILES AND PROJECTILES ON BONY STRUCTURE. Tll6 effects ot llllSSlleS aild projectiles upon the bony structure of the human body have been so thoroughly illustrated in their practical relations that little more than a brief general consideration of the subject is here necessary. Gunshot injuries of bones may be classified as contusions, simple fractures, partial fractures, penetrations, perforations, and complete fractures, with varying degrees of com minution and destruction of substance. Nearly every form of gunshot missile and projectile used in warfare is liable to cause these various injuries. The properties inherent to the missile, as velocity, size, form, and weight, and the conditions pertaining to the individual at the time, as posture, part wounded, etc., will determine the nature, extent, and severity of the injury. Slight forms of injury may result from the impact of a solid shot, a fragment of shell, or from a leaden bullet; injuries of the gravest character may equally be inflicted by these missiles. Between the extremes are found wounds of all degrees arid grades, but they are all simply the manifestation of mechanical force acting in accordance with established laws. A soldier found nn iron breast-plate, probably thrown aside by some Confederate, on the field at Kingston, N. C., and put it on. I In was struck by aminifi ball >n the breast-plate over the region of the third rib and severely contused. He expectorated a full pint of blood and suffered from dyspnoea; the next day he was able to walk about. Since the reception < f the wound a round excavation about the size of a Relgian minie bullet has sloughed out at the point where he was hit, laying bare the rib. The same breast-plate was worn by another soldier at Whitehall, with less fortunate result. A mini6 ball struck it near its lower border and passed through it, carrying fragments of it into his abdomen, causing death. SURG. 11190 714 WOUNPS AND COMPLICATIONS. [CHAP. XII. Discussion upon the comparative effects of round and conoidal missiles has been virtually put at rest by the general adoption of arms of precision and some form of elon gated conoidal bullet. Writers on modern military surgery agree in conceding to the conoidal missile greater force and more destructive power. 1 There is no doubt that at very close range the damage inflicted by the round ball is hardly less than that resulting from the conoidal bullet, but beyond this point, and to extreme ranges, the conoidal missile is by far the more efficient engine of destruction: CASE 1052. Private G. R. Packard, Co. F, 3d Maine, aged 21 years, was wounded at Fair Oaks, May 31, 1862. Acting Assistant Surgeon S. Teats contributed the following history: "The patient, a farmer l>y occupation, of temperate habits, having no strumous or other hereditary disease, was wounded by a round ball and buckshot, both coming from the same musket at close range, the ball fracturing the left humerus and the buckshot wounding the left shoulder. The arm was amputated about the middle, a few hours after the injury, on the field. On admission to DeCamp Hospital, June 8, 1862, the whole stump*was swollen and painful; the end was nearly cicatrized. Anteriorly, just below the left clavicle and at its external third, there was a small opening from which thin bloody pus was discharging ; posteriorly, on the same side, at about the lower angle of the scapula, there was a circular cicatrix the size of a buckshot. About the cicatrix there was a fluctuating tumor, with heat and pain of the part. No aneurismal thrill or bruit. He was much debilitated and anaemic. On passing an exploring needle into this tumor no pus could be detected. July 1st, arterial haemorrhage to the amount of one pint from the anterior wound, which ceased spontaneously, after which pus was again discharged. July 20th, haemorrhage again about the same amount as before, again followed bv discharge of pus. July 28th, haemorrhage again amounting to one and a half pints, but this time it did not cease spontaneously as in the two previous cases. On consultation it was decided to ligate the axillary artery. This was done by enlarging the wound and passing the ligature around it near its origin, without, however, seeing the artery, the pulsation of the vessel beinff the guide. The haemorrhage ceased as soon as the ligature was tightened. With eacli occurrence of haemorrhage the tumor posteriorly diminished in size somewhat. Some two or three days after the operation an organized clot was discharged from the wound about the size of a hickory nut. Two days after this another clot of like size and appearance was discharged. Subsequent to this laudable pus was discharged until August 5th, when the patient died from another recurrence of haemorrhage. The ligature could not be found; it was supposed that during sleep he had pulled it away. Autopsy sixteen hours alter death : On tracing up the axillary artery it was found that about two inches of it had almost entirely disappeared. Commencing just below the first rib a cavity, containing several ounces of more or less organized clot, existed around this deficiency of the artery, which cavity extended downward into the axilla and backward under the scapula. No pus was found in the shoulder joint. The head of the humerus was very soft, and on cutting through the softened articular cartilage a pasty substance was found beneath it. taking the place.of much of the spongy extremity of the bone. This pasty substance was the broken down spongy structure. Other organs normal. In the specimen it will be seen that about one-third of the border of the cartilage of incrus tation is detached from the bone. This is due to manipulation and maceration." The specimens were forwarded by Dr. Teats, together with a wet preparation, hi two portions, of parts of the aorta, innominata, left common carotid, subclavian and axillary arteries. (See Ca . Kury. Sect., 1866, p. 459, Spec. 4339.) Contusions of bone more commonly result from the impact of missiles under low velocity, as a spent ball or fragment of shell, or when the force of the missile has been nearly expended in overcoming the resistance of overlying tissues, or when the line of direction has been oblique to the bone, causing a glancing or grazing blow. Round balls, parting rapidly with their force after their initial velocity is diminished, will generally con tuse rather than fracture; the same is true of shell fragments, unless their weight is sufficient to cause fracture by crushing. Contusions of bone may be followed by no very serious results; such cases undoubtedly occurred during the late war, and recovery followed with out bad symptoms. Instances of this nature have been reported on pp. 817 and 920 of the Second Surgical Volume. In many cases the contusion was at first unrecognized, until tardy and faulty cicatriza tion and discharge of bone proved the existence of caries and necrosis: CASE 1053. Private C. C. Mulford, Co. K, 6th New York Artillery, aged 42 years, was wounded in the right thigh, at Spottsylvania, May 19, 1864, and entered Fairfax Seminary Hospital six days afterwards. Assistant Surgeon H. Allen, U. S. A., conico-cylindrical ballet produces the most destructive effects; not only comminuting the part struck, but often splitting 1 up the shaft of the bone by its wedge-like action, in fissures many inches long leading into contiguous parts. MACLEOD (G. II. B.) (Notes on the Surgery of the War in the Crimea, London. 1838, p. i)8) asserts that : "The greater precision in aim. the immensely increased range, the peculiar shape, great force, and unwonted motion imparted by the new rifles to their conical balls, have introduced into the prognosis of gunshot wounds an element of the utmost importance." Asil- IIUKST (J., jr.) (The Principles and Practice of Surgery, Philadelphia, 1871, p. 158) finds that : Bullet wounds have increased greatly in severity since the introduction of rifled muskets and of conoidal balls. The old round musket ball, fired from a smooth-bore, produced a comparatively slight wound. CHAP, xn.] EFFECTS OF MISSILES ON BONY STRUCTURE. 715 described the injury as follows: "The wound was caused by a musket ball, which entered at the upper part of the middle third of the thigh and lodged. The case was treated as a simple flesh wound ; patient doing well. On June 14th the missile was found and extracted. A severe diarrhoea came on June 19th and continued till June 25th, when it was controlled. Four days afterwards diarrhoea again appeared, and brandy and opium were prescribed. During the night of June 30th the patient had a severe chill, followed by fever, dry tongue, and collections of sordes upon the teeth. I saw the patient for the first time on July 1st, when he was in a dying condition, being bathed in a copious clammy sweat, though his mind was quite clear, and he com plained of no pain. There was discoloration of the skin. He died on the following day, July 2, 1804. Autopsy: Emaciation extreme; afi ected thigh very little swollen: wound open, and the integuments for some distance above and below it of a purplish red color; femoral vein entirely healthy; internal organs healthy. The bone was found to have been grazed by the ball. Upon removing the femur its walls immediately opposite the track of the ball were found to be stripped entirely of periosteum, and that covering the bone above and below this region was thickened and stained of a grayish hue from contact with a dark colored offensive pus, which laid both in the wound and around the bone. At the great trochanter an abscess of about the size of a hen s egg was discovered. This was entirely distinct from the collection before mentioned, being separated from it by a track of com paratively healthy tissue. The pus contained therein was more laudable than that found elsewhere. When the bone was sawed open, which was accomplished with some difficulty on account of the increased thickness and density of its walls, its entire interior was found filled with pus, the fluid being of an ochre-yellow, with large oily globules floating upon the surface. No trace of the original structure could be seen anywhere. The spongy tissue at the head of the bone Avas completely discolored with a uniform grayish yellow stain, while that of the condyles was perfectly healthy. The walls of the bone were of great thickness and the sawn surface presented a white, glistening, ebnrnated appearance. No vascularity was seen, and the haversian canals were found not to be enlarged." The greater portion of the injured femur, contributed to the Museum by Surgeon D. P. Smith, U. S. V ., constitutes specimen 2675 of the Surgical Section, showing necrosis at the point of contusion on the inner surface in the middle third, above and below which the bone is greatly roughened by suppuration in nearly its whole extent. Unhappily a very considerable percentage of cases of contusions of bone proved to be far from innocent, and were followed by a train of most serious complications. In discussing shot contusions of the cranial bones in the First Surgical Volume, at page 101, haemorrhage, gangrene, periostitis, and exfoliation were mentioned as early complications, and among the later results vertigo, chronic irritation of the brain, mental imbecility, and impairment of the special senses. Surgeon John A. Lidell, U. S. V., in an article on shot contusions of bones 1 enumerates ecchymosis of the osseous tissue, ecchymosis of the medullary tissue, osteomyelitis of a simple character, necrotic osteitis, and suppurative osteomyelitis, as con sequences of contusion of bone, and says: "Any injury of bone in the nature of a bruise, however trivial it may appear to be at the time of infliction, may be followed by serious consequences, which it is the duty of the surgeon to anticipate and ward off if possible." Stromeyer 2 describes contusions of bones as follows: "They [bullets] strike the bone without breaking it and flatten themselves against its surface; the bone struck becomes necrotic from the destruction of its periosteum. In crowded hospitals such injuries of the larger long bones cause suppuration of the medullary canal, which extending itself, at last by the passage of pus into the veins, gives a fatal termination. In the autopsy (the bone being sawn in its long axis) the marrow is found filled with pus from the wounded part upward, and the same morbid product in the neighboring large veins; as in the femoral vein after contusion of the femur. The spot struck by the ball is colorless and exsanguine; in its circumference appears the commencement of a line of demarcation. Contusions of this kind, which up to the present time have been little attended to in the long bones, are well known in the bones of the skull, where caused by a blow or fall they have the same dangerous consequences if not properly treated, as suppuration occurs in the diploe and purulent inflammation in the sinus, with its usual results." Dr. Lidell 3 is of the opinion that, owing to their better blood-supply and consequent greater vitality, shot contusions of upper portions of the body give more favorable results than similar lesions of the lower extremities. The results as tabulated on the next page from the records of this Office seem to favor this conclusion. 1 LlUlit.L (J. A ), On Contusion and Contused Wounds of BOM, with an Account of Thirteen Cases, in Am. Jour. Mcd. <Sci., 1865, Vol. L, p. 17. 2 S"ll .OMKVF.li (L.), On the Fractures of Bones occurring in Gunshot Injuries, STATHAM S translation, London, 1856, page 2. 3 I,ID .!.!. (.1. A.), On Contusion and Contused ]\ uunds of Hone, etc., in American Journal of Medical Sciences, 18G5, Volume L, page 20. 16 WOUNDS AND COMPLICATIONS. [CHAT. XII. TABLK CXXTI. Numerical Statement of Shot Contusions of the Jlones of the Head, Trunk, and Extremities. SEAT OF INJURY. CASKS. Unknown. Percentage of Fa tality. TKEATKH HY Cox- TUEATEIJ HY 6EHVAT1OX. EXCISION. TltEATEU BY AMPUTATION. C* o ~ * ^ 5 8 5 C 1 3 fri 1 PS 1 fc Recovery. "3 ca fe \ 1 I & c P j3 ^5 Recovery. 03 i. 328 - 73 55 30 25 3 22 18 4 10 8 2 205 144 61 I M Kio 2<J i Hi. 7 261 25 18 7 140 157 26 6154 51 3 4 1 46 15 1 12 4 2 : 10.7 18.1 o 20.0 1 15 14 29. 7 4 8 : 17.5 g 27 26 J :j. 7 81(5 659 155 2 19. J21 2 ! 13 4 12 :<o Structure has undoubtedly a great influence in determining the severity ol the effects of contusion. Such lesions in the spongy bones or cancellated portions of long bones, attended with extravasation of blood, are very liable to result in extensive and dangerous necrosis, inasmuch as the blood confined within the unyielding structure interferes by com pression with the nutrient blood-vessels, or acting as a foreign body destroys the .vitality of the bone by setting up inflammatory action. CASK 1054. Private J. Tetlow, Co. F, 23d New Jersey, was wounded at Fredericks burg, December 13, 1862. Surgeon G. Burr, U. S. V.. reported his admission to the field hospital of the 1st division, Sixth Corps, with shot wound of leg." Acting Assistant Surgeon G. F. French reported the following result of the injury : "The patient was admitted to hospital at Alexandria on December 19th. lie had been wounded by a ball entering on the outer side of the right popliteal space and not emerging. He was a strong and healthy man, his pulse being 90 and full; appetite fair; knee tender, very little inflamed, and slightly swollen By December 22d the inflammation about the knee was increasing: pulse 98; appetite flagging. On the next day there was high constitutional fever with great swelling and pain about the knee; patient hectic and had a chill. On Decem ber 24th a round ball was found lying loose in the wound and was extracted without incision ; under portion of internal condyle felt to be bare. December fc9th. knee more inflamed and swelled; constitutional fever about the same; pulse ICO and weak. Pus was detected and let out by a free incision, giving much relief. Egg-nog ordered for the patient. On the following day he was more comfortable but seemed exhausted, and was delirious at times; pulse weak. On December 31st he had a chill with pain in the stomach, and two days afterwards he was delirious; pulse very feeble and slow. His death occurred at 5 1 . M. on January 2, 1863. Autopsy : External condyle bared of periosteum; joint full of pus; external portion of articular surface of tibia bared also; lower third of femur dissected up with pus; periosteum gone on the inner side and end of internal coudyle; bone beginning to necrose. The missile had impinged upon the under side of the internal condyle, doing no further injury to the bone than killing the periosteum over a space the size of a half dime." 1 CASE 1055. Private S. F. Blanchard, Co. D, 17th Michigan, aged 25 years, was wounded in the left knee, at the battle of Antietam, September 17, 1862. He was conveyed to the Big Spring field hospital, near Sharpsburg, where Surgeon T. H. Squire, 89th New York, recorded the following description and result of the injury: "The wound was caused by a musket ball which struck just at the inner side of the triceps extensor of the left knee, passed backward, grazing the side of the inner con dyle in its course, and came out between the tendons of the inner hamstring. In an early examination of the joint it would have been possible for a good surgeon to conclude that the cavity of the joint had just escaped; but at this date (October 16th) there are all the bad symptoms of such cases pus in the joint and up the thigh, hectic, diarrhoea, etc. The case presented but little encouragement for the knife since the time I first saw the patient, though he had scarcely failed any for some days. His death occurred on November 1, 1862." The bones of the wounded knee, contributed by Surgeon Squire, and exhibiting destruc tion of the joint by ulceration, constitute specimen 3580 of the Surgical Section of the Museum. The following case of simple osteomyelitis affords an illustration of one of the frequent and grave results of bone contusions observed during the late war: CASE 1056. Private John Anderson, Co. G, 76th New York, aged 30 years, was wounded at Cold Harbor, June 6, 1H64. He was at once conveyed to the depot field hospital of the Fifth Army Corps, and on June 12th was transferred to Stanton Hos pital, Washington. Surgeon John A. Lidell, U. S. V., reported: "Was admitted for a gunshot wound of the left thigh in the 1 An abstract of this case was published by J. 15. BKI.LANOKK (Itrptirt of Jive cases of Gunshot Injury qf lite Knee Joint) in American Journal Medical Sciences, New Series, 1863, Vol. XLVI, p. 44. CHAP, xii.] EFFECTS OF MISSILES ON BOXY FTRrCTUUF. 717 upper third, inflicted by ;\ conical musket ball, which penetrated the front of the limb at the inner side of the femoral vessels, and, passing backward and outward through the limb, lodged beneath the skin. It WHS extracted by an incision from behind. When he came to the hospital, six days after the injury, it was thought that the wound was only a flesh one. His general con dition was fair, or rather below par at that time. Simple dressings to wound were ordered, and nutrients and stimulants were allowed. Subsequently the wound did well, and he appeared in a fair way to recover for a time. July 1st, it was observed that he was failing in strength and emaciating. Stimulants and the supporting treatment were continued with tinct. ferri muriat. Afterwards he sank into a typhoid condition, the skin becoming warmer than natural, but without sweats, the pulse frequent iind feeble, the tongue dry and red, with almost entire loss of appetite. He also became somnolent, and toward the last it was difficult to rouse him. He did not have any chills. He died July 18th. The amount of discharge from the wound was at no time great, but the thigh remained swelled and inflamed all the while. On making an autopsy it was found that the bullet, had struck the shaft of the femur on its postero-inner side, two or three inches below the trochanter, grazimj and bruishifj it. The aperture of exit had healed. There was an abscess about the place of injury of the bone as large as an orange, and pus had also burrowed among the muscles of the thigh. There was a large deposit of new bone about the contused portion of the femur. A longitudinal section was made with a saw. New osseous tissue was also found deposited in the medullary canal. The marrow presented the red inflammatory appearance described by Virchow. There was no thrombosis, nor any lesion whatever of the veins and arteries. The cadaver was considerably emaciated and resembled in its general appearance that produced by typhoid fever. There was no lesion of the intestines or any other of the internal organs. For an account of the autopsy and for much other interesting information concerning this case, the writer 1 is indebted to Assistant Surgeon George A. Mursick, II. S. V." A. case of gangrenous osteomyelitis following shot contusion of the femur has been riteri on page 171. ante, and a similar case is here detailed: CASE 10 t7. Private G. Cole, Co. A, 91st New York, aged 35 years, was wounded in the right thigh, at Petersburg, March 31, 1865. From a field hospital he passed, on April 3d, to the Fifth Corps Depot Hospital at City Point, and two days later lie was transferred to Washington. Assistant Surgeon W. F. Norris, U. S. A., contributed the following history: "The patient was admitted to Douglas Hospital, April 6th, with a wound inflicted by a minie ball, which caused a severe contusion of the femur at the middle third without producing fracture. His constitutional condition at the time of Us admission was good and the wound looked healthy. On April 12th a very much flattened bullet was extracted by Acting Assistant Surgeon H. Gibbons. On the 17th, erysipelatous inflammation appeared about the wound, which increased on the following day in spite of the application of poultices and tincture of iodine. On the 20th there was a slight attack of erysipelas of the nose, and the following day the patient had two severe chills, which were repeated on the 22d, 23d, and 24th. On the 25th he again had two chills, and one on the next day. The conjunctiva; now had assumed a yellow tinge, and he had pain in the chest; pulse 132. On the 27th there was another chill, the constitutional condition remaining as before, and on the following day there was one more repetition, and secondary involvement of the knee joint manifested itself. The skin and conjunctivas were now deeply jaundiced, and the discharge from the wound unhealthy, fetid, and bloody. On the 29th there was hiccough, delirium, and vomiting, and the patient sank rapidly. He died on the following day April 30, 1865. At the autopsy, both lungs were found to be covered posteriorly with an offensive greenish flak} lymph and to contain a number of small py:mic abscesses. There was about five ounces of effusion in the thoracic cavities. The other organs were but slightly affected. On removing the femur the periosteum was found to be wanting for five inches in length and one-third of the circumference of the bone, the part so bared showing evidence of absorption of its tissue except at the point struck by the bullet. On sawing open the shaft of the femur longitudinally the lower half was discovered to be in a gangrenous condition, the medulla being greenish, soft, and offen sive, and the cancellated structure of the condyles presenting the same appearance. There was about two ounces of thin brownish-yellow fluid in the knee joint, and the femoral vein near the joint as well as the small articular veins were filled with clots, their inner coats in some places being reddened and in others of a greenish hue." A leaden bullet coming in contact with a bone presenting a smooth flat surface, as one of the faces of the tibia, may flatten itself against it, contusing without fracturing the bone: CASK 1058. Private W. B. Donkersley, Co. I, 2d New Jersey, was wounded at Chancellorsville, May 2, 1863. He was admitted, on May 8th, into Douglas Hospital, Washington. Acting Assistant Surgeon Carlos Carvallo reported: "This patient received a flesh wound of the right inguinal region; ball extracted on field; doing well, wound suppurating." At the end of a week Donkersley was transferred to Satterlee Hospital, Philadelphia, whence Acting Assistant Surgeon J. H. Hutchinson reported: "This man received a wound from a conical ball which entered the right groin and flattened itself on the bone without producing fracture. He lay upon the field all night, and was removed Sunday morning and the ball extracted. From the time of the wound on Saturday afternoon until Sunday morning he was entirely insensible, and remembered nothing from the time of receiving the shot until he roused to consciousness in an ambulance on Sunday. After reaching this hospital on May 17th, he did well, and went on duty as clerk in the Commissary Department on June 1, 1863." The patient was transferred to the Veteran Reserve Corps in September, 1863, and discharged from service May 31, 1864. He is not a pensioner. In the next case a conoidal ball struck the angular surface of the tibia with full force. The missile split to within a few lines of its base without seriously contusing the bone: CASE 1059. Private Henry C. Mallory, Co. G, 36th Indiana, aged 20 years, was wounded at Murfreesboro , Tennessee, December 31, 1862. He was admitted, on January 3, 1803, into hospital No. 3, Nashville. Surgeon Alexander Ewing, 13th Michigan, reported: "Was struck by a large conical leaden bullet, at about the distance of two hundred yards, at the battle of Stone River, on the 31st day of December, 1862. He was standing in an open plain in the act of loading his trun. The interest in the case is that the centre of the apex of the bullet struck directly on the spine of the right tibia, between the middle and T,IL>H 1. (.! A.), On Contusion and C lntusul \Younrlsof Bonr, etc., in Am. Jnur. Med, Sci., ItttM, Vol. L, p. 20. 718 WOUNDS AND COMPLICATIONS. [CH,\r. xii. lower thirds, and split the missile to within a few lines of its base, overlapping the bone, where it was firmly held by the tissues. Kemarkable as it may appear, the bone was not injured, and in a very short time the wound healed up. It was evident, as well from the distance as the injury done to the bullet, that it struck with full force." Mai lory was discharged from service September 21, 1864, and pensioned. Examiner H. H. Deming, of Pana, Illinois, reported, June 23, 1879: "Call struck tibia on anterior surface, splintering it so that quite a large piece of bone came out. There is left quite a depression and a very large tender cicatrix. If he walks too much the leg swells up. The pain at, times is severe." Instances in which the missiles split upon the bones of the forearm and on the zygoma are here adduced : CASE 1060. Private A. Wilson, Co. L, 1st Minnesota, aged 30 years, was wounded at Antietam. September 17, 1862. He was treated in Carver Hospital, Washington, and on December 12th was admitted into Satterlee Hospital, Philadelphia. Surgeon I. I. Hayes, U. S. V., reported: "The ball, the precise character of which is unknown, struck at the outer side of the lower part of the left arm; part of it passed through the member and came out at the posterior surface. Next day a portion of the ball, about the size of a dime, was cut out from the front part of the arm toward the inner side. On his admission into this hospital his arm seemed nearly well, but a small ulcer, scabbed over, marked the point of entrance of the ball, and a probe passed into this discovered a sinus extending several inches upward, a piece of metal being discovered and clearly felt at its upper extremity. His general condition was perfectly good. January 3d, having administered chloroform, I laid open the sinus before mentioned for about three inches and readily extracted a piece of ball. Its concave surface was closely applied to the outer edge of the lower flat portion of the humerus; the bone beneath was roughened and apparently bare of periosteum. On several subsequent occasions I convinced myself that the bone was dead and looked for a tedious process of exfoliation ; but on January 15, 1863, thinking to pass a probe, I found the wound firmly united, and the healing process has gone on most favor ably. There is no swelling, no tenderness, no orifice through which the smallest probe could be inserted, and the wound has the aspect of a healthy and rapidly healing ulcer." Wilson was returned to duty April 22, 1863, and discharged from service November 24, 1865, and pensioned. The Williamsport Examining Board reported, July 6, 1881: "The projectile penetrated the left arm at the insertion of the triceps and passed inward and upward. Fragments were extracted from two places in the belly of the biceps. Some fragments of bone were removed. The arm has every motion free except tensile strength." His pension was paid December 4, 1881. CASE 1061. Corporal Julius Relham, Co. K, 1st Kansas, aged 21 years, was wounded at Wilson s Creek, August 10, 1861, and entered the "House of Refuge" Hospital, St. Louis, on August 16th. Assistant Surgeon S. M. Horton, II. S. A., reported : "The following is an interesting case of a mini6 ball splitting in two by the resistance offered by the zygoma of the left side of the face. One-half of the ball was found embedded in the corresponding cheek beneath the middle portion of the masseter muscle; the other half was found and extracted from beneath the outer portion of the platysma myoides of the same side. The zygoma was not broken. The case was that of Corporal Julius Relham, of Co. K, of the 1st Kansas regiment, who was wounded at the battle of Wilson s Creek, August 10, 1861. He left the hospital for his regiment, well, November 15, 18(51. The inertia of a spongy zygoma splitting a minie ball of lead is similar to that of a tallow candle resisting the woody fibres of a pine board when shot through it from a gun." Relham was mustered out May 31, 1864, and pensioned. Examiner W. Jewell, of Philadelphia, reported, December 27, 1864 : " Ball passed through his left cheek, lodging near the angle of the lower jaw. The ball was extracted. The wound continues to discharge and is probably connected with the duct of Steno. The jaw is con tracted, preventing the opening of the mouth more than half an inch." The Philadelphia Examining Board, January 3, 1872, certified : "Ball entered through middle of superior maxillary bone of right side; a part of it was extracted in the mouth and another part in the neck below the angle of the lower jaw. All the back teeth of upper jaw of right side decayed in consequence. He has occasional discharge from wound through mouth and nose. Motions of jaw limited and painful; can chew on one side only." The same board reported, September, 7, 1877: "Scar of entrance is puck ered to a point and adherent. Exit is fast to muscles of neck and drags badly." CASE 1062. Captain James Ferguson, Co. I, 4th Ohio, was admitted into Seminary Hospital, Georgetown, December 20, 1862, with a shot wound of the left forearm, received at Fredcricksburg. Surgeon J. H. Brinton, U. S. V., who examined this officer s injury, reported: "A conical ball entered below the inner condyle of the humerus, traversed the forearm obliquely downward and outward and split on the radius, one portion emerging on either side." Four and one-half inches of the left ulna were removed by A. A. Surgeon II. W. Ducachet. FIG. 388. Captain Ferguson was attacked with confluent small-pox and removed to Kalorama Hospital, Washington, Feb- bruken upon ruary 8, 1863. Acting Assistant Surgeon R. J. Thomas, U. S. A . reported: "The condition of the arm when ! After "BIHX- a d n tte <l was bad; no disposition to heal, with strong gangrenous tendency. He died February 15, 1863." Sur- TON.] geon Brinton furnished a drawing of the divided missile, which is copied in the wood-cut (FiG. 388). Tn other cases bullets wore found wedgod between bones without serious injury. Simple Fractures, following shot injuries, are infrequent, and generally result from the impact of projectiles of the larger class, as solid shot, grape-shot, or large shell frag ments of which the momentum is nearly expended. The examination of the cases of shot injuries of the lower extremities has confirmed the opinion expressed on page 815 of tlu> Second Surgical Volume, "that shot fractures of the long bones without injury of the soft parts are more infrequent than visceral ruptures without external wounds." Hamilton 1 observes: : When the bones of a limb are broken by a solid shot and the HAMILTON (F. II.), Treatise <m Military Surgery, Philadelphia, 16K), p. 194. CHAT XH.J PARTIAL FRACTURES PENETRATIONS. 710 integuments are not torn the fracture is seldom simple, but almost always the comminution is excessive. Five cases of simple fractures have been reported on pp. 815, 816 of the Second Surgical Volume, and three cases are given on p. 440 (CASE 693) and pp. 704, 705 (CASES 1044, 1045) of this volume. To these may be added the following: CASE 1063. Private H. Emerson, Co. I, 88th Illinois, aged 34 years, was wounded at the battle of Franklin, Novemlx-r 30, 1864, and was admitted to Cumberland Hospital at Nashville the following day. Surgeon B. Cloak, U. S. V., recorded that "the patient stated that he was struck by a spent cannon ball. There was no external indication of the injury except a small bruise on the left knee and a general ecchymosed condition of the surrounding part. The skin was not broken, but the limb was very much swollen, with pulsation in the popliteal region. The patient s general health was good. The limb was amputated on December 1st, at the lower third of the thigh, by the circular method, by Acting Assistant Surgeon J. C. Thorpe, when it was found that the popliteal artery had been ruptured at its lower portion and that the condyles of the femur, tibia, and fibula were fractured. The patient seemed to do well for twenty-four hours after the operation, when the wound became unhealthy and gangrenous irritative fever set in ; pulse 130, skin dry and jaundiced. He continued to sink, and died on Decem ber 13, 1834." Partial Fractures. Several instances of partial fracture of bone in which a portion of its substance had been cut without complete solution of the continuity were met with. This lesion is more commonly seen in spongy bones or in the parts of long bones well supplied with cancellated structure. In Specimen 1998 (FiG. 389) the external portion of the surgical neck of the left humerus is partially fractured, but the continuity of the bone is not destroyed. The patient, Private John Gr. Levering, Co. A, 5th Michigan, was wounded at Mine Run, November 27, 1863. On account of the extremely unhealthy condition of the soft parts, the head of the humerus was excised December 14th by Surgeon D. P. Smith. U. S. V. Profuse suppuration followed; the patient died of pneumonia January 3, 1864. Specimen 1991 (FiG. 390) shows a compara- Spec . tively clean-cut passage in the outer and upper portion of the in ternal condyle of the right femur. Private F. Johnson, Co. A, 10th New York, aged -15, wounded at Reams s Station, August 25, 1864. On August 30th symptoms of inflammation of the knee joint presented themselves, and the limb was ampu tated at the lower third by Surgeon iN. R. Moseley, U. S. V.; death from exhaustion and diarrhoea occurred on January 23, 1865. In the following case a conoidal ball had gouged out the anterior surface of the left tibia: CASE 1064. Private Joseph Stacey, Co. I, 27th North Carolina, was wounded at Antietam. September 17, 1862, receiving a compound fracture of the left tibia; conoidal ball entered inner side of s] ine of tibia and emerged one and a half inches below on the outer side. Patient had double pneumonia and pericarditis. Stimulants and supporting treatment; large bedsore. Died of exhaustion November 13, 1862. lost-mortcm: Left lung almost altogether involved, the lower and middle lobes returning to the first stage; lower lobe of right lung congested. The specimen, consisting of the upper portions of the bones of the left leg, was contributed to the Army Medical Museum, with the notes of the case, by Assistant Surgeon Philip Adolphus, U. S. A. The missile has gouged out the anterior surface of the tibia just below the tubercle. The specimen is numbered 815 of the Surgical Section, and is figured in the wood-cut (FlG. 391). Penetrations of Pone. Small missiles, as bullets and small fragments of shell, often penetrate a bone and ivmain fixed, with little splintering and h ssurino;. Instances of KIG. 392.-Hrmiofnffiiti.u- merus with symmetrical bul- tliis nature are met with in spongy bones or in parts of bones < g ri > (ive - s i> fe - - " whose structure is cancellated. A unique illustration of such an injury is found in Specimen 2590 ( FIG. 392). An excavation at the base of the great tuberosity of the humerus. the shape and a little greater than the size of a conoidal ball, one inch deep, extends into the head ot the boiH-. The walls of the cavity are perfectly smooth, as if formed by design, and there is no Fir,. 3S9. Head and 1J ins. of_left humerus. 1998. FIG. 390. Lower rd of right femur. tc. 1991. Soec 813 720 WOUNDS AND COMPLICATIONS. [CHAP. XII. FIG. 394. View of Spec. 3540, after bisection. fissuring or comminution connected with the injury. The case has been detailed on page 543 of the Second Surgical Volume (CASE 1513), accompanied by a cut which only imperfectly indicates the nature of the penetration. In FIGURE 392 the nature and depth of the excavation are more clearly illustrated. In the following case the missile lodged in the cancellated structure of the femur, but no fissuring or splintering were observable: CASK 1055. Private J. Gleason, Co. 13, 5Jd New Hampshire Heavy Artillery, aged 18 years, was accidentally wounded at Washington, May 10, 1864, by a pistol ball, which entered the upper third of the left thigh anteriorly. He was conveyed to Douglas Hospital, where pya-mia subse quently appeared, the first chill occurring on MaySGtl), uid being preceded by marked icterus Tin ball could not lie discovered. Secondary haemorrhage from the femoral artery to the amount of fourteen ounces occurred on May 31st. and to the amount of fifteen ounces on the next day, still further adding to the patient s depression. His death occurred on June 1, 1864. At the autopsy the whole body was found to be Fifi. 393.-Onter view of upper third of left ^P j tinged with bile. No metastatic femur. Spec. 3.14U. abscesses were discovered. The knee joint was found to be disorganized, as was also the hip joint on the wounded side, and a large dark-colored cavity existed in the injured thigh, which had been an immense abscess. No secondary deposits were seen in the lungs. On dividing the femur longi tudinally, the medullary canal and cancellated portion of the bone were found in a diseased condition. The medulla was softened, of a dark red color, and in the early stage of that change which is seen in well- marked cases of pyaemia after amputation, when this material is found of a dark green color and iti a state of advanced decomposition. Before death the patient had wandering delirium for days, profuse perspiration, chills, a rapid feeble pulse, and icteroid hue. The upper third of the injured thigh, longitudinally bisected, and showing an impacted pistol ball, which penetrated the base of the neck and lodged in the cancellated portion, consti tutes specimen 3540 of the Surgical Section of the Museum (FiGS. 393, 394), and were contributed, with the history of the case, by Assistant Surgeon W. Thomson, U. S. A. More frequently penetrations were accompanied by fissur ing and splintering. Specimen 406 (FiG. 395) represents the lower third of the left femur with a conoidal ball embedded just above the patella. A fissure extends upward three and a I m. 3 js.-Lower third half inches, and another and independent fissure occupies the of left femur. Spec. 406. ~. ~ , ,,. r TV r Spec. 403. outer surface. Ihe patient, a Confederate soldier of Mor gan s Cavalry, had been wounded in a skirmish in front of Winchester by a minie! ball, which perforated the quadriceps femoris close above the left patella and lodged one inch above the articular surface of the knee joint. The limb was amputated by Dr. V. B. Thornton. The patient recovered. Specimen 405 (FiG. 396) shows the lower third of the right femur with a conoidal ball embedded, point down ward, in the anterior surface, just above the articulation; a fissure extends upward the length of the specimen. Pri vate Joseph J. Shelley, 2d Tennessee (Confederate), was wounded at the battle of Middle Creek, Kentucky, January 10, 1862; the limb was amputated by Dr. G. H. Higgins, in the lower third of the thigh. The patient died a few 7. i.nver hours after the operation from loss of blood. In those two Fw . m _ Lowere]rtrein . instances as well as in specimens 4179 and 3228 (FiGS. i <y fle "- ur - *~ 397, 398), received without history, the former from the battle-fields of the Wilderness, the latter from in front of Petersburg, the fissures do not extend into the knee joint, although (HAP. XII.] PERFORATIONS OF BONE. 721 Fl<;. 399. Section of left lemur. Sjifc. 70ti9. FIG. 400. Upper portion of left tibia perforated. Spec. 1662. t.lie point of impact was close to the articulation. Illustrations of similar injuries in the humeru> will be found on page 584 of the Second Surgical Volume, FIGURES 461 and 462. Perforations of Bone. The illustrations show the manner in which bones may be more or less cleanly pierced. When shafts of long bones are perforated there is commonly much splintering, as illustrated in Specimen 7069 (FiG. 399*). A Colt s revolver ball passed through the upper third of the femur from behind forward, comminuting the femur; amputation was performed about twelve hours after the injury; death three hours alter the operation. In Specimen 1662 (FiG. 400), the tibia had been perforated below the head, causing longitudinal fissures: Private Frank B. Robinson, Co. II, 7th New Hampshire, wounded at Fort Wagner, Morris Island, July 11, 1863. The posterior tibial artery was injured. Secondary haemorrhage ensued, and on August 1 st the limb was amputated in the lower third by Surg. K. B. Bontecou by the circular method. The patient died August 11, 1863. In the follow ing case the perforation was in the lower third of the femur, with fissures extending upward: CASE 1066. Private S. S. Kopp, Co. E, 10th Pennsylvania Reserves, aged 21 years, received a shot fracture of the right femur, at Bull Run, August 28, 1862. He was admitted, one week after the injury, to Judiciary Square Hospital at Wash ington, where, the thigh was amputated at the middle third by Surgeon C. Page, IT. S. A., on September 20th. The patient survived the operation two days. The amputated portion of the femur, perforated just above the patella by a musket hall, was contributed by tlw operator, and forms specimen 76 of the Suryical Section. It is represented in the wood-cuts (FlGS. 401, 402); two longitudinal fissures extend upward and a slight one enters the joint. In the next case the shaft of the femur is perforated in its centre. A longitudinal fissure on the anterior surface extends into the joint and for four inches upward, ending in a slight transverse fissure; on the posterior surface an FIG. 401 .Lower third i T fs g *c 7o m r erf " rated - oblique fracture runs upward for nearly four inches. I11CI1 . CASK 1067. Private Reuben Donnelly, Co. A, 25th Ohio, was wounded at Bull Run, August 30, 1862. Acting Assistant Surgeon Thomas C. Barker reported: H entered King Street Hospital, Alexandria, on September 3d, suffering with a wound of the right thigh. A round ball entered the front part of the thigh just above the patella and passed directly through the limb from front to rear, dividing the condyles and splitting the bone up the shaft several inches. On September f>th Surgeon J. E. Summers, T. S. A., amputated the thigh at the junction of the lower and middle thirds by the antero-posterior flap operation. The case progressed favorably. Union had taken place throughout the whole of the Haps, with the exception of one point, about one-eighth of an inch in diameter, over the end of the bone, which lay at a depth of three-fourths of an inch below the orifice of the aperture. Patient s health, appetite, and general vigor had been good up to the night of October 3d. when, during a cold rain, he was attacked with a severe chill. The next day. in the afternoon, he had another chill, and although tonics and stimu lants were sedulously used with him, he sank in general vigor and his appetite failed. Absorption of the new granulations took place around the aperture which had remained nnunited, and the opening increased to nearly an inch in diameter, the integuments retracting and leaving the end of the bone nearly on a level with the external surface. Suppuration occurred in the medullary canal of the bone. Emaciation was extreme; debility was rapidly increasing, with indisposition and incapacity of taking and retain ing food, or even stimulants to any appreciable amount; and the patient gradually KH,. 40:1. Shot per sank, and died of exhaustion and debility October 20, 1^62." The specimen, consist- flTeriorvLw g1lt ^ n 3 l l<)! "-- " t t1 " 1( Wl st tllil (1 (lt t1 " ri .- nt * "" perforated by a round ball directly through -,, the centre of the shaft, just below the upper margin of the patella, was forwan td to the .Museum by Dr. Barker, and is represented in the wood-cuts (Kios. 40:?, -40-1). The shaft is split longitudinally in its ante rior surface for four indies, and posteriorly obliquely for the same distance. The condyles are also separated by a fissure. SURG. Ill 91 FIG. 402. Posterior view of the same sped FIG. 404. Posterior view of the same speei- 722 WOUNDS AND COMPLICATIONS. [CHAP. XII. TlG. 405. Posterior view of upper portion right tibia. Spec. 1444. FIG. 406. The same specimen ; lat eral view. In a case of transverse perforation of the tibia just below the head no fissuring was noticeable six months after the injury, when the patient died from exhaustion: CASK 10(38. Private J. W. Sailor, Co. K, 48th North Carolina, aged 23 years, was wounded in the right leg, at Hatcher s Run, March 13, 18f).~>. lie was treated in Confederate hospitals until May 6th, when he was admitted into hospital at Point Lookout. Subsequently he was transferred to Armory Square, and lastly to Douglas Hospital, Washington. Assistant Surgeon W. F. Norris, U. S. A., in charge of the latter, made the following report: "The wound was caused hy a ball perforating the tibia at the upper third without involving the knee joint. The patient was cachectic and much emaciated, the wound indolent and discharging a thin unhealthy pus. Stimulants, tonics, and good nutritious diet were freely exhibited. On September 3d the wound was care fully examined and a considerable quantity of carious bone was removed. On the next day the patient had a severe chill which recurred on the (5th. He had been subject to periodical chills and fever, and this attack of intermittent yielded readily to a full dose of quinine. On September 10th slight diarrhoea came on and continued for nine days, the patient growing much weaker. The wound, which had improved in appearance after the removal of the dead bone, again looked unhealthy, small abscesses having formed along the line of the tibia, which, when opened and examined by the probe, showed extensive necrosis of the bone. Subsequently the patient had a slight chill, which was followed by an attack of erysipelas of the leg, and from this period he steadily declined. He died, apparently of exhaustion, on October 1, 1865. The autopsy showed a dirty yellowish clay color of the skin. The thoracic and abdominal organs were apparently healthy, except the liver and the spleen, the former being enlarged and the latter much softened and weighing fourteen ounces." The perforated tibia, contributed with the his tory by Assistant Surgeon Norris, and constituting Specimen 1444 of the Surgical Section of the Museum, exhibits the deposit of a large quantity of callus on the outside of the bone, and shows the cavity of the passage of the ball to be enlarged by ulceration, the lower portion of the shaft being super ficially necrosed. Posterior and lateral views of the specimen are copied in the wwod-cuts (FlGS. 40,">, 40G). Complete Fractures. In by far the greater number of shot fractures of bones the solution of continuity is complete, the degree of comminution depending upon the attend ing circumstances. In rare instances fractures, transverse or oblique, but simple as regards comminution, occur. They are commonly due to the impact of partly spent missiles or to glancing or grazing blows. Specimen ] 148 (FiG. 407) shows an oblique fracture in the upper third of the left femur, with a minute fissure extending to the lesser trochanter and a small portion chipped from the anterior surface at the point of impact. The case has been fully detailed on page 131 of this volume. Speci men 1210 (illustrated in the Second Surgical Volume on page 475, and a history recorded, in detail, on page 482 of the First Surgical Volume] shows the left clavicle transversely fractured r lu. -iu<. r raoture ol -, -, , i 11 rrn the upper third of the chrQctly m the middle without comminution. The missile, left femur by a conoidal * . .. , which is attached, was a conoidal ball which entered near the Spec - u third dorsal vertebra, fractured the corresponding rib at its angle, and was found after death encysted immediately beneath the fractured point of the clavicle. Another illustration of this rare fracture is given in FIGURE 408. The Specimen, number 1412, shows the lower half of the right humerus apparently amputated for a nearly transverse fracture through both condyles; it was received without history from Surgeon G. S. Wood, 66th New York. In these cases the missile is usually found in close apposition to the fractures. A form of injury is referred to in Circular No. 6, 1 in which the bones are fractured and comminuted, though less than common at the point where the ball impinged, while at a short distance above or below this point an oblique or transverse fracture is produced. When point of impact is above the middle of the bone, the fracture is below; when below OTIS (G. A.), Circular A o, 6, War Department, Surgeon General s Office, Washington, November 1, 1865. FIG. 408.- Trans verse fracture in lower luimerus. CHAP. XII.] COMPLETE FRACTURES. 723 Fin. 410. Lon-er half of left femur. Spec. 1064. the middle, the oblique fracture is found above. Specimen 4703 (FiG. 409) shows a nearly transverse fracture in the middle of the left tibia, communicating with the point of impact by a longitudinal fissure. Specimen 1064 (FiG. 410) exhibits the lower portion of the left femur, amputated in the middle third for a perforation with oblique fracture above the seat of injury: Lieutenant F. M. Wells, Co. D, 132d Pennsylvania, received, at Chancellorsville, May 2, 1863, a comminuted fracture of the left femur just above the condyles. He was at once removed to the field hospital, and on May 6th was transferred to Washington and admitted into Armory Square Hospital. Shortly after admission he was placed under the influence of chloroform and the injured limb examined. It was decided to amputate the thigh at the middle, which opera tion was performed by the antero-posterior flap method, by Assist ant Surgeon C. C. Byrne, U. S. A. The patient gradually sank, and died June 2, 1863. In the following case the transverse fracture is connected with the point of impact by several fissures. Fractures of this nature are principally found in the long bones of the lower extremities, and are probably the result of the direct impact of a missile at high velocity upon the bones somewhat firmly fixed by the weight of the body: CASK lUijy. Private J. Scanton, Co. A, 3d Maryland, was wounded at Cedar Mouu- Utin, August 9, 18b 2, by a musket ball, which entered above the external condyle of the left femur and passed directly through from front to rear, badly comminuting the shaft to the extent of tour inches. He was admitted into the Mansion House Hospital at Alex andria several days afterwards. Infiltration of the soft parts from the anterior superior spinous process of the ilium to the spine of the tibia, followed the injury. Amputation of the thigh at the middle third by the circular method was performed by Assistant Surgeon P. Adolphus, U. 8. A., on August 15th. and the case resulted fatally on August 20, 1862. The history of the case, with the amputated portion of the femur, was contributed by Surgeon J. E. Summers, U. S. A. The bone is numbered specimen 42 of the Suriiiral Section of the Museum, and exhibits an extensive longitudinal ..... . . ,. . , , ,,. fracture implicating the joint, and being complicated with an oblique fracture in the lowest third (riG. 411). Commonly a bone is broken into many fragments, some of which are entirely detached and driven into the surrounding tissues, while others remain connected with one or more of the fragments by shreds of periosteum. Over and above this shattering and comminution, effects common to all forms and varieties of missiles, the extensive splinter ing and fissuring so often found is unquestionably due to the wedgelike form and great force of the conoidal bullet: CASE 1070. Corporal S. Forrester, Co. E, 67th New York, aged 37 years, was wounded in the left leg, at the battle near Winchester, September 19, 1864. He was admitted into the Sixth Corps hospital several days afterwards, whence Assistant Surgeon J. G. Thompson, 77th New York, described the injury as follows : "A minie" ball entered the posterior edge of the outer tuberosity of the tibia, taking a down ward direction through the medullary canal, comminuting the bone and becoming impacted beneath its anterior surface, at the junction of the middle and upper thirds. On the morning of September 24th I performed amputation through the lower third of the thigh, being assisted by Acting Assistant Surgeons W. L. Hammond and W. I). Henderson. The operation was done by a modification of the ordinary flap method, making the incision the same as for skin flaps, as described in Smith s Operative Surf/cry, which obviates the redundancy of muscle characteristic of the ordinary Hap method, and still gives enough to preserve the even contour of the stump. The patient suffered considerable pain previous to the operation, which was subsequently relieved, and by September 28th he was doing well, the stump healing by first intention. Toward October 8th, however, traces of phlebitis appeared in the stump, thrombosis in the femoral and internal saphenous vein, and the patient was troubled with hiccough and vomiting. Stimulants, tonics, and nutritious diet were administered. Death resulted from pyaemia on October 13, 1864. At the autopsy Upper half of left tibia. Spec. 4T():i. F1G - 411 - Lower half of left femur. spec. 42. Fl<;. 412. Hones of left leg shattered by a coiioidal ball. .Spec. 3L 7:i. FiG. 413. Same speci men ; posterior view. 24 WOUNDS ASD COMPLICATIONS. [CHAP. XII. FIG, 414. Uppe portion of left humer us. Spec. 1726. the face of the stump was found to be granulating and surrounded with provisional callus; femoral vein filled with thrombus: pus oozing from both the femoral and iliac veins; metastatic abscesses under the integument covering the lower portion of the pectoralis major muscle; fatty degeneration of the liver. In the left ventricle of the heart an embolism was found adherent 1<> the valves." The bones of the amputated leg. contributed to the Museum by the operator and shown in the wood-cuts (FiGS. 412. 413), constitute specimen H27!> of the Suryical Section. When the shaft of a long bone is fractured about equidistant from the epiphyses the fissures extend upward and downward in about equal proportion; but as the point of frac ture approaches the ends the tendency is to split in the direc tion of the longer fragment. This is particularly noticed in o O I J fractures of the humerus near the head, where the general tendency of fissuring is downward. Specimen 1726 (FiG. 414) is the excised portion of the left humerus, including tlie head and four inches of the shaft. The fracture is at the surgical neck, and extends with comminution obliquely down the shaft. Excision of the head and four inches of the shaft was per formed and the specimen contributed by Assistant Surgeon George M. McGill, U,S. A. Specimen 2160 (FiG. 415) shows the upper half of the right femur; the missile struck the ante rior surface of the bone a little below the trochanter minor and shattered and fissured the femur downwards. In Speci men 2176 (FiG. 416) the comminution extends upward and portio n of right femur. Spec. 2160. downward in about equal proportion. The weapon was dis charged at close range. The soldier, John Watson, Co. F, 83d Indiana, while on duty at Convalescent Camp, Nashville, became enraged from some cause, threw his musket from him, causing its discharge. The missile, a mini^ ball, entered the right thigh, greatly lacerating the soft parts and extensively comminuting the femur. He died on the same clay. The specimen is a fair illustration of the effects of a conoidal ball at short range. From a careful examination of a large number of specimens of long bones in the collection of the Army Medical Museum it would seem that the statement made by Esmarch is correct, that "in comminution of along bone the fissures almost never extend into the epiphyses; in the same manner injuries of the epiphyses. only in rare cases, extend into the shaft, unless the bullet strikes the adjoining border of both parts, in which case both are usually more or less severely comminuted.". This is probably due, in the greater number of cases, as Esmarch says, "to the soldier being generally young and the parts not consolidated." The Museum possesses several speci mens showing this kind of injury, some of which have been illustrated on the preceding pages (see FIGURES 409, 410). The few exceptions to this rule seem to be cases in which the consolidation is complete, or in which the direction of the missile was such as to necessarily cause this effect, as in Specimen 2564 (FiG. 417), where fissures extend through the head and into the shaft. It has been shown that cases of penetration and perforation of bones may occur with out complete fracture; but the contrary is the more general rule, and even in spongy bones, KJ ( ;. 417. Upper third of CHAP. XII] EFFECTS OF MISSILES ON NERVES. 725 where we naturally look for such lesions, it will usually be found that complete destruction of the bone has resulted. EFFECTS OF MISSILES AND PKOJECTLLES ON NERVES. Shot wounds and injuries of nerves afforded a wide field for study and observation during the late war. Wounds of this class, not implicating the great nerve centres and not complicated by severe lesions of other tissues and parts, show a very small percentage of mortality, but comprise a class of injuries which result too often in great and permanent disability, attended with intense suffering and misery, and are often but little amenable to treatment. In May, 1863, under the direction of the Surgeon General, U. S. A., a hospital for the treatment of diseases and injuries of the nervous system was organized in Philadelphia, under the charge of Acting Assistant Surgeons S. Weir Mitchell, George R. Morehouse, and W. W. Keen, jr., U. S^A. 1 The results of the experience of these gentlemen in the study and treatment of the large number of cases under their charge have been incorporated by them in several pub lications which form most valuable contributions to the literature of a much neglected subject, and constitute an admirable digest of the typical forms of nervous lesions resulting from shot injuries. 2 The immediate effects of shot injuries of nerves were pain not generally felt locally, but at some point in the distribution of the nerve in completely divided nerves; total loss of sensation in the parts supplied by it; shock more or less profound, proportionate to the reflex disturbance; and paralysis of motion and sensation, complete or partial. Of forty- eight cases of severe gunshot injuries of nerves selected with a reference to the study of the immediate effects of injuries, Drs. Mitchell, Morehouse, and Keen (loc. cit., p. 14) found that "by far the larger number felt, when shot, as though some one had struck them sharply with a stick," and that "about one-third experienced no pain nor local shock when the ball entered. * : : More rarely, the pain of the wound was dagger-like and intense, while a few, one in ten, were convinced for a moment that the injured limb had been shot away; * * in two instances of neck wounds the pain at the moment of wounding was intense, and was referred to the insertion of the deltoid muscle." In a case of shot wound of the leg the patient felt no pain, but had so vivid an "impres sion " of a wound in the other leg that he found it difficult at first to get rid of the erroneous idea. With reference to the shock from wounds of nerves the same authorities (loc. cit., p. 15) say: "Every case of wound of nerve trunks in the legs fell instantly, and not one of the whole twelve lost consciousness; yet in gravity and in the size of the nerves injured these were among our worst cases. Of the remaining thirty-one, seven fell instantly, uncon scious; one only of these bled very largely. All of the seven were wounded in the neck, face, or arms. Of the total number of arm cases (eighteen in all) two were of the class described above as falling; senseless. Of the remainder, two onlv fell, but with entire con- o / 1 The following is a copy of the order organizing this hospital: " SUKGEON GENEUAI/8 OFFICE, May 23, 1863. Surgeon W. S. KDCG, U. S. A., Medical Director, Philadelphia. Sill: The Surgeon General directs that a ward be set apart in either the South or Christian Street Hospital for the exclusive treatment of diseases of the nervous system, and that contracts be made with Doctors S. \V. MITCIIKI.L and MOUEHOUSE, and that they be assigned to the charge thereof. . . . Very respectfully, your obed t serv t. By order of the Surgeon General. J. K. SMITH, Surgeon U.S.A. Acting Assistant Surgeon W. W. KEEN, jr., U. S. A., was subsequently assigned to duty at this hospital as resident physician, and the scope of the hospital enlarged to include patients suffering from injuries of the nerves. MITCHELL (S. W.), MOUEHOUSE (G. U.), and KEEN (W. W.) (Gunshot Wounds and other Injuries of Xcrres. Philadelphia, 1864, p. 9) remark upon the number and variety of the cases presented for treatment in the Philadelphia hospital as follows : " Among them were representatives of every conceivable form of nerve injury from shot and shell, from sabre cuts, contusions, and dislocations. So complete was the field of study that it was not uncommon to find at one time in the wards four or five cases of gunshot injuries of any single large nerve. It thus happened that phenomena, which one day seemed rare and curious, were seen anew in other eases the next day, and grew commonplace as our patients became numerous." 726 WOUNDS AND COMPLICATIONS. [CHAP. xn. sciousness and in full possession of their senses; fourteen continued standing, or walked away. * * Of the wounds of the lower neck and axilla, brachial plexus, or axillary nerves, one fell senseless, four fell conscious, and the remaining eight suffered no imme diate fall. * * If, then, we regard the fall with loss of consciousness as the most marked expression of the condition known as shock, we shall have some right to infer that it is most likely to be severely felt in wounds about the upper third of the body." In paralysis of nerves, motion is more frequently impaired than sensation. Mitchell, Morehouse, and Keen remark (loc. cit., p. 18): "It would be natural to suppose that a ball striking a nerve, or passing near it, would equally damage its motor and sensory fibres. Practically, it is the motor filaments which suffer most severely, most often, and most extensively. Nor is this less true of the case in all stages, for we find that the lesions of motion are always the least readily relieved and the last to improve." Of the forty-eight cases studied by these gentlemen (loc. cit., p. 17) with reference to paralysis, five were rejected as being wounds affecting nerves of single function; of the remaining forty-three, "thirty-two exhibited total loss of motion with defective sensation or entire loss of that function. In the remaining eleven there were partial loss of motion and usually slight loss of sensation." In defining total loss of motion "it is to be under stood that the whole limb became powerless at once." Of injuries resulting from shot wounds of the great centres, those of the cranium have been fully considered in the previous parts of the history; it may bo stated in general terms that the greater percentage of such injuries proved fatal at once or within a short period. Those who survived the original injury most generally became the victims of insanity, epilepsy, or chorea. 1 CASE 1071. Private W. T. White, Co. D, 84th Indiana, aged 20 years, was wounded at Chickamauga, September 19, 1863. Surgeon W. M. Chambers, U. S. V., noted his admission into hospital No. 15, Nashville, with "gunshot wound of upper jaw, with injury of infra-orbital nerve; simple dressings applied." The patient was discharged from service at Madison, Indiana, May 1G, 1864, and pensioned. Examiner George W. Mears, of Indianapolis, reported, June 21, 1864: "Ball entered left side of nose one-half inch below the inner corner of the eye, and ranging backward and outward escaped on the posterior and outer or left side of the neck two inches from the ear. The wound is healed except at a point forward of the ear, where an abscess formed. The sight of the left eye is nearly extinct. The under lid is somewhat deformed and the cheek much swollen. There is also a constant discharge of saliva from the left corner of the mouth, which is also slightly deformed." Examiner J. C. Helm, of Muncie, Indiana, reported, November 10, 1868 : "The sight of the left eye is much injured, and what there is, is in my opinion worse than useless, as the eyeball is so much turned outward as to destroy the axis of vision and confuse the mind with other objects. The ball passed through the base of the skull, evidently injuring the cerebellum, and as a consequence he suffers from vertigo, dizziness, blindness, faintness, etc., and has frequent spells of severe pain in the head, which are increased by exercise or excitement. These symptoms are growing worse, and he is in great danger of insanity, which I fear will ultimately be his lot. The deformity is also growing worse; the eyeball is turned out and is constantly red, part of the face is paralyzed and twisted over so as to be quite hideous, and is getting worse, as are all these symptoms, so that altogether his disability is equal to or worse than the loss of a limb." Later reports do not show any improvement in the condition of the pensioner. The pen sioner was paid December, 1881. A reference to TABLE CXVII, page 689, ante, will indicate the large number of wounds recorded as affecting in some manner the spinal column and its contents. The percentage of mortality will afford some evidence as to the varying extent and gravity of these wounds. Where the spinal cord was severed or involved, a fatal issue seems to have ensued more or less remotely. Aside from these there were innumerable cases of lesions in which it was evident that there had been damage done to the nervous centres by concussion, compression, or contu sion, or in which were presented the phenomena of reflex paralysis. Instances of epilepsy following injuries of the skull will be found in the First Surgical Volume, at pp. 02, 48, 50, 54, 55, 59, 118, 119, 176, 177, 187, 193, 194, 196, 198, 215, 218, 221, 228, 230, 235, 237, 238, 257, 270, 282, 284, 287, 288. 289, 293, 319, and 341, and of impairment of tbe mental faculties at pp. 12, 30, 53, 117, 118, 119, 120, 164, 166, 171, 172, 173, 174, 175, 176, 181, 185, 193, 194,217, 221, 226, 228, 231, 232, 234, 230, 237, 238, 244, 253, 294, 310, 340, 350. CHAP. XTI.] EFFECTS OF MISSILES ON NERVES. 727 The following oases will serve to illustrate these lesions and injuries of the spine: CASE 1072. Private C. C. Thomas, Co. A, 2d Wisconsin, aged 23 years, was wounded at Gettysburg, July 1, 1863. He was admitted into the hospital at York, Pennsylvania, on July 17th. Surgeon H. Palmer, U. S. V., reported: "Mini6 ball entered the back at the point of the right shoulder blade, passed across, and was extracted three inches below the left shoulder blade, deeply situated. Patient complains of numbness and loss of power of the legs. There is no displacement or tenderness of the spinal column. Cold-water dressings; orifice of entrance filled with granulations, that of exit discharging some pus." He was discharged from service January 6, 18G4, on account of partial paralysis of the lower extremities, the result of the injury, and pensioned. Examiner L. 8. Thompson, of Shackopee, Minnesota, reported, September 23, 1875 : "Ball entered just below inferior angle of right scapula, and passing across the back lodged about two inches below the inferior angle of the left scapula, from whence it was removed. The missile injured the spine to such an extent that the patient has but a limited control over the inferior extremities, and from this cause, together with the consequent weakness of the spine, he is incapacitated for all manual labor. 1 Examiner H. H. Kimball, of Minneapolis, reported in September, 1877, that the pensioner "has only partial control over the bladder and rectum." CASK 1073. Lieutenant J. F. Moreland, Co. C, 17th Indiana, was wounded at Hoover s Gap, Tennessee, June 23, 1863. Assistant Surgeon S. J. F. Miller, 5th Kentucky, reported, from the Officer s Hospital, Murfreesboro , Tennessee: "The patient entered this hospital June 27th, wounded by a mini6 ball. It struck him two inches to the left of the spinal column, opposite the first lumbar vertebra, and followed up the spinal column until it reached the spinous process of the first cervical vertebra, when it turned to the left, and was cut out just beneath the skin over the middle third of the sterno-cleido mastoideus muscle; the lower half of his body was paralyzed. He passed his feces unconsciously and we had to draw his urine with a catheter. He died July 12, 1863; for want of time no autopsy was performed." CASE 1074. Color Sergeant James S. Schermerhorn, Co. F, 127th Illinois, aged 33 years, was wounded at Vicksburg, May 19, 1863. He was treated in the field and at Webster Hospital, Memphis, and Marine Hospital, Chicago, and discharged from service December 9, 1863, for "gunshot wound of spine with fracture of the spinous and transverse processes of the ninth, tenth, and eleventh dorsal vertebne. There is partial paralysis, but also severe pain of the whole column, producing severe nervous spasms." Examiner J. P. Lynn, of Chicago, reported, January 23, 1864: "The ball struck the crest of the left ilium three inches back of the anterior superior spinous process, passed through near the sacrum and lumbar vertebral articulation, and was cut out two inches to the right. The wound of entrance is discharging, the other is healed, but an opening over the spine is discharging pieces of vertebra and pus. There is nearly complete paraplegia." On July 24, 1865, Dr. Lynn reported : " Since he received his wound he has been and is now wholly deprived of the use of his legs. His bladder is paralyzed and his urine has to be drawn by a catheter. He has also only partial use of his arms, and is unable to sit upright." Being an applicant for a chair in which to propel himself, he was examined at Chicago by Assistant Surgeon Thomas J. Asch, U. S. A., January 17, 1871, who states: "There is complete paralysis of the lower extremities below the seat of the injury; locomotion is utterly impossible, and the trunk cannot be maintained in an upright position except with the aid of a supporting apparatus consisting of two steel rods with crutch-shaped extremities to support the arms, fastened to a belt buckled around the body. * He was confined to his bed from the date of his wound until the Spring of 1870, during which time portions of the vertebrae were removed by Dr. Isham of this city. Examiner L. H. Kobbins, of Lincoln, Nebraska, reported, August 5, 1874 : "The pensioner is wearing an apparatus to support the upper part of the body, without which he has no power to sit erect. The legs are wholly useless. He requires the regular personal aid and attendance of another person." The pensioner was paid December 4, 1880. In the next case 1 it is supposed that the spine was wounded or that the missile lodged within the vertebral column in such close proximity to the nerve centres as to cause com pression of the anterior branches: CASE 1075. "Private S. Johnson, Co. I, 8th Pennsylvania Cavalry, aged 18 years, enlisted in August, 1861. Health good previous to enlistment, except a typhoid fever four years before. Six months after enlisting he had a fever, probably of a malarious character. Three weeks before he was wounded lie suffered with pain in the right leg, made worse by movement, but unaccompanied with any rheumatic swelling of the joints. May 3, 1863, he was wounded by a small ball in the left cheek while riding at a trot. It entered at the middle of the ramus of the jaw a little below the level of the teeth. From his position as well as the after evidence, it seems that the ball passed backward and inward and finally lodged in the spinal column. The edge of the jaw was somewhat injured, and probably was the source of the small fragments of bone which afterward escaped from the neck. When shot the man fell forward on his horse s neck; says he was confused though conscious, and felt as if he had been struck in the ear and then lifted up in the air. He also felt instant pain in the back of his neck and in all of his limbs. There were no spasms. He was removed from his horse and carried to ahou.se near by. The motion increased his pain, especially any movement of the neck. He now became aware of the total motor paralysis of the arms and legs. He is not sure whether sensibility was also extinct or not. Two days after being wounded he became delirious, but gradually recovered his senses after three or four days. He was finally sent to Douglas Hospital. Washington, then under charge of Assistant Surgeon W. Thomson, U. S. A., and was transferred to our own wards July 1!>. 18(53. The wound healed in nine weeks, after the dis charge of a few small fragments of the jaw. Meanwhile his left ley improved slightly. July 19, 1863; present state: A more wretched spectacle than this man presents can hardly be imagined, lie lies in bed motionless, emaciated to the last degree, and with bedsores on both elbows and both hips. His hands lie crossed on his chest, perfectly rigid, the fingers extended, the skin congested ;md thin, the nails curved, false anchylosis of all the joints of the upper limbs, the head and neck rigid, with acute pain in these parts on movement. The right leg has motion of a feeble nature in all of the joints; the left only very slight vol untary movement. The hands, the appearance of which has been already alluded to, present certain characteristics which belong MITCHELL, MORE11OU8E, nud KEEN, Gunshot Wounds and Other Injuries of Nerves, Philadelphia, 1864, p. 22 728 WOUNDS AND COMPLICATIONS. [CHAP. XII. usually to cases in which there have been wounds of the brachial nerves. In the present instance, as in many others, these peculiarities have been modified by the long continued rest of the limbs in one posture. The results of the nerve injury and its consequent effects on the nutrition of the part may, however, be partially discriminated, so that what is due to them and what is due to mere rest may be discerned to some extent. Thus, the shining palm, the slight eczema, the burning pain, the atrophy, and the swollen joints, whose appearance simulates subacute rheumatism, these, with the contraction of certain muscles, are all owing to the nerve lesion; while the anchylosis and the peculiar flattening of the hand are perhaps owing to this and to the long rest and disuse, the arms meanwhile lying crossed on the chest, the fingers in extension. The disuse alone would have caused anchylosis, but never to such a degree as occurs when the joints have been subacutely inflamed at the same time. The loss of the lateral palmar arch is owing to both causes, and the monkey-like appearance of the hand, the thumb rotated outward, and its nail looking upward and even toward the forefinger, is caused first by the subluxation of the metacarpo-phalangeal articula tion, and secondly by the weakening and atrophy of the adductor and short flexors of the thumb. The nerve lesion, affecting the muscles and the general nutrition of the part, has so relaxed the unused tissues of the limb as to make the pressure of its own weight an effective aid in thus altering its form. Specimen 6693 of the Army Medical Museum represents casts of both arms, and exhibits admirably their condition soon after they began to improve. Sensation: Tactile sense enfeebled equally in both arms, worse in the left. Feeble in both legs, worse in the left. Confused power of localizing sensation in the legs. Mis takes right for left, but not left for right. There is muscular hypenesthesia of the upper members, shoulders, and neck; none in the legs. The left brachial plexus is sensitive to pressure and this causes pain in the left arm and hand. The palms prickle and burn a little, the feet not at all. Every attempt at passive motion causes exquisite pain in the arms, hands, and shoulders; but most of all the back of the neck, about the first and second vertebne. This is due, first, to the hyperaesthesia of the muscles, and secondly, to the state of false anchylosis, owing to rest in one fixed posture. He either is too weak to move the body or is really paralyzed in the spinal muscles. The biceps flexors and wrist muscles are very rigid as well as the trapezius, and the atrophy of the muscles throughout the upper limbs is singularly well marked. His condition was too grave to allow of an electric examination. There was no inflammatory swelling about the neck, and it was therefore resolved to treat him with free passive motion, breaking the adhesion and forcing him to exert himself as far as he could. Tonics, porter, and liberal diet were ordered, and the shampooing and passive movement was vigorously carried out, despite his pain and most earnest supplications to be let alone. The bedsores were treated with alternate applications of iced water for ten minutes, followed by a poultice as hot as could be borne. This local means, recommended by Brown -Sdquard, succeeded marvelously, as it always does, the bed sores healing easily within ten days. August 25th, still losing flesh; great pain in the neck ; moves head and legs a little better; no change in the arms. Despite his prayers and protestations the shampooing was continued, and on October 15th he was greatly improved. He is fatter; the legs can be voluntarily crossed ; appetite voracious. December 7th, great gain ; can move right arm freely; can raise his head, bend and turn the neck; sits up daily. December 29th, motion returning iu right hand; no gain in left; but in both the malpositions have been relieved and the hypera;sthesia reduced. From this time the improve ment was manifest and rapid. On January 7, 1864. the case was carefully reviewed with the following results : Nutrition: Much fatter; atrophy lessened. The hands have lost their smooth, shining look, so expressive to us of a nerve lesion. The nails are less curved. The temperature is better. Sensation: Eight arm and hand, tactility and localizing sense good; left arm rather less perfect; tactility and localizing sense in legs normal or nearly so. Sense of pain more perfect than at first, but even now u pinch causes a feeling of prickling only, rather than the usual sensation. There has been some burning of the right face, neck, and arm within the past week. Voluntary motion: Left leg normal in extent of action, but still feeble; right leg healthy. The right iirm has regained all the shoulder and elbow motions except that, owing to a remnant of contraction in the biceps, exten sion is not quite entire. Flexion, pronation, and supination are perfect. Extension of wrist incomplete, owing to contracted state of flexors. Flexion of wrist perfect. The thumb has lost abduction, owing to contraction of the abductor. Fingers, extension perfect, as also flexion of first phalanges; the joints being still stiff and swollen, the second and third joints possess but two-thirds of their healthy extent of flexion. Left arm: For ten days past the shoulder has begun to exhibit voluntary power; elbow, no movement; pronation and supination slight; flexion and extension of wrist also slight; fingers, feeble, trem ulous movements. For the first time we now examined the electric state of the muscles. The electro-muscular contractility was good in the right biceps, feeble in the left; good in the right supiuator longus, feeble in the left; good in the extensors of both hands ; good in the flexors of the right hand, feeble in the left. The interossei on both sides showed great loss of this property. The abductor policis on the left had no electro-muscular contractility. As a rule, this property was lessened in the left arm and shoulder, while the electro-muscular sensibility was scarcely altered in the two members, except, perhaps, some diminution in the thumb muscles of the left hand and in the flexor group of the left forearm. The whole left arm was still very stiff. Ordered the patient to be etherized daily, and the adhesions to be forcibly broken. Passive motion to be continued, and the limbs to be faradized daily. The future progress was inconceivably rapid. On January 20th he could rise to his feet, and by February 20th could walk a few steps. March 20th, walks well without a cane or any aid; the left hand alone has not gained to any great extent, although the malposition of the hand has been much relieved. The patient was discharged in March, slightly shuffling in his walk, but with nearly entire use of all his limbs except the left hand and forearm." Johnson was pen sioned. The Philadelphia Board of Pension Examiners reported, October 23, 1873: "Total paralysis of left leg so as to cause foot to trip at times." In November, 1877, the same board reported: "Suffers no pain in arm, but has to move arm in different positions. Is anchylosed at shoulder and partially so at elbow. Toes are drawn up and use impaired; paralyzed. Has evi dently progressive nerve trouble from ball, no doubt, lodged near spine in cervical region. Has weakness of hand, right side, and is cold almost all the time. There is atrophy of arm, forearm, and leg, left side." The following case illustrates what is known as concussion or "commotion" of the spine; it is not supposed that any large nerve could have been touched: CASE 1076. Thomas Carroll, aged 21 years, plumber, of New Jersey. Enlisted November, 1863, in Co. D, 3d New Jersevy Cavalry. Healthy to date of wound. December 15, 1863: While seated on a fence rail, a pistol ball, accidentally fired, took CHAP, xii.) REFLEX PARALYSIS. THE RESULT OF SHOT WOUNDS. 729 effect on the back of his neck. It entered at the middle line, exactly over the interspace between the spinus of the sixth and seventh cervical vertebrae, and was cut out on the left side of the neck one inch below the angle of the jaw. No bone escaped at any time, and the surgeon who explored the wound at the time of the injury felt assured that there was no fracture. The patient thinks that he was looking to the left when hit, but is not sure. If lie be correct as to his position, the ball could have come near to no part of importance except the spine, and, in any case, it would be difficult to assert that it could have wounded the cervical and still less the brachial plexus. He fell senseless, was removed to a hospital tent, and finally recovered his reason within two hours. As he became aware of his condition he found that although he could talk, see, and hear, he had neither motion nor feeling in any of his limbs. The trunk was equally powerless. He describes himself as at first unable to feel the bed upon which he lay, but as having good feeling in the head and face. About the second day he had severe pain and tender ness in the right shoulder and neck. Gradually, sensation first, and then voluntary power, returned to the whole right side. Within a month the left side also improved, with the exception of the left arm. Within two months the right side was well and the left leg nearly so. About May 1, 1864, he began to be able to stir the left thumb. Present state, May 14, 18G4 (admitted May 1 2, 1864): General loss of flesh. Left arm exhibits marked atrophy. Measurements : Left biceps, 8J inches; right biceps, 9 inches. Forearm, left, 8-J- inches; right, 9f inches. Legs, no notable difference. The left shoulder muscles are fearfully atrophied, especially the deltoid. The arm has dropped, owing to want of support, so that a thumb may be laid in the furrow between the head of the humerus and the acromion process. This subluxation of the bone increases the apparent length of the left arm nearly half an inch. Casts of both shoulders, which exhibit well the deformities, were sent to the Army Medical Museum at Washington. There are no contracted muscles. The hand is swollen and congested, the cuticle thickened and hanging in yellow scales. Nails not curved. No acid sweat. Slight burning of the left palm a recent symptom. Tactile sensation and sense of pain absent in left ulnar distribution, and defective everywhere else in the arm below the shoulder. Normal in right arm. Sensation alike in the legs, and normal in both. The right arm is weak ; the left arm powerless, except slight ability to abduct the thumb. The left leg is weaker than the right, and his gait is awkward, from his swinging his right leg outward and forward. As the subject of reflex paralysis is one of great interest in tlie study of spinal injuries, and lias been thoroughly and exhaustively treated in Circular 6, B. G. 0., March 10, 1864, it is deemed proper to reproduce the Circular at this point: "CIRCULAR No. G. "SURGEON GENERAL S OFFICE, "WASHINGTON, I). C., MdTfh 10, 1864. "The following 1 paper on Reflex Paralysis, the result of gunshot wounds, founded chiefly upon cases observed in the U. S. General Hospital, Christian Street, Philadelphia, by S. Weir Mitchell, M. D., George R. Morehonse, M. D., and William W. Keen, jr., M. D., is published for the information of Medical Officers, in the belief thai immediate and practical benefit may be derived from it: "JOS. K. BARNES, "Acting Surgeon General." Since the establishment, in May, 18G3, of a Special Hospital for the treatment of diseases and injuries of the nervous system, a vast number of cases of gunshot and other injuries of nerves have been studied by the authors of this paper. "The great mass of these will be considered in a future essay, upon the history, results, and treatment of gunshot wounds of nerves. We have judged it wise, however, to report separately a class of very infrequent cases, in which paralysis of a remote part or parts has been occasioned by a gunshot wound of some prominent nerve, or of some part of the body which is richly supplied with nerve branches of secondary size and importance. " So far as we are aware, the Medical Histories which we are about to record stand alone as the tirst reports of sudden reflex paralysis from mechanical injuries. How they differ from the paralytic affections which result from disease of organs, and which have been so ably treated of by numerous authors, we shall presently consider. That they have thus far escaped notice may be easily accounted for. In the first place they are rare; among some sixty or more carefully studied instances of wounds of nerves, we have met with only seven cases of reflex paralysis of remote organs, in which the influence was prolonged or severe. In the majority of cases the reflex effect is either very slight or very transient, and for one or both of these reasons unlikely to attract notice from surgeons on the battle-field, or in division or Corps hospitals, where their brains and hands are taxed to the utmost by the palpable misery of wounds in the early stages of treatment. Had it been otherwise, we do not doubt that numerous cases of reflex paralysis from injuries to nerves would have been recorded. SURQ. Ill 92 730 WOUNDS AND COMPLICATIONS. [CHAP. XII. "The various effects produced upon the nervous system by gunshot wounds have received, it seems to us, far less attention and far less study than their interest and importance appear to call for. Among them are some which must clearly be classified with the results illustrated by the cases reported in this paper; but there are also others which are far more numerous, in tact very common, and which are signally exemplified on every battle-field. These have been more or less vaguely treated of as shock, commotion, stupor, etc. The larger part of those, who receive flesh wounds involving no important organ, are but little affected at the time, or may even be uncon scious of having been hit, and at all events exhibit no well-marked immediate constitutional dis turbance. In other cases, and particularly in wounds of graver nature, the patient instantly falls senseless, and so remains during a few minutes, or many hours, reviving again either completely, or suffering from a continued state of depression known as the result of shock, and marked by the usual features of great weakness, feeble circulation, pallor, etc. In other cases these last- named symptoms come on at once, and without the intervention or accompaniment of unconscious ness. These very interesting states of system may be due, it seems to us, either to an arrest or enfeeblement of the heart s action through the mediation of the medulla oblongata and the pneu- mogastric nerves, or to a general functional paralysis of the nerve centres, both spinal and cere bral, or finally to a combination of both causes. Arrest of the heart movements is producible, as is now well known, by any violent irritant directly addressed to the trunks of the pneumogastric nerves, or to the medulla oblongata, and it is conceivable that such an effect may be brought about by any. very severe injury of an external part. "In fact, it has long been known that the sudden crushing of a limb in inferior animals will stop the heart or make it act slowly for a greater or less length of time. Now if we add to this M. Bernard s experiments, in which he showed that irritation of the posterior roots of spinal nerves suddenly checks the cardiac motions for a time, and that like irritation of the anterior or motor roots gives rise to no such result, we shall be able to see how it is possible that a gunshot wound of a large limb may be competent to effect a like result. We should remember, too, that in nearly all of these cases the hasinorrhage from large vessels, such as are usually opened by accidents of this nature, is sufficient, even during syncope, to add to or deepen, so to speak, the effects of the reflected nerve impression. Where small vessels only have been wounded this might not occur, but it is proper to state that men who have fallen senseless at the instant of the wound, frequently awaken after a time to find themselves drenched with blood. Supposing such an arrest of the heart movements to have taken place, a continuance of their stoppage, even for a brief period, would naturally give rise to cerebral anaemia, pallor, unconsciousness, and the remaining phenomena of shock. ".Again, as we have said, a severe injury, as a gunshot wound of a limb or the neck, may produce its effects of unconsciousness and loss of power by greatly weakening or for a time destroying, with various degrees of completeness, the functions of all the nerve centres and of their conducting cords. "The influence of shock in thus causing temporary paralysis of nerve trunks is very well known to every experimenting biologist. Thus, after opening the spinal cavity, it is very common to discover that the sensitive nerves are for a time unimpressible by stimuli. But, as a general thing, this is not so as regards the nerve centres within the skull, which are rarely so disturbed by the operation of uncovering them as to refuse all reply to irritations. "The majority of physicians will no doubt be disposed to attribute the chief share in the phenomena of shock in its various forms to the indirect influence exerted upon and through the heart. There are, however, certain facts, which, duly considered, will, we think, lead us to sup pose that in many cases the phenomena in question may be due to a temporary paralysis of the whole range of nerve centres, and that among these phenomena the cardiac feebleness may play a large part, and be itself induced by the state of the regulating nerve centres of the great circu latory organ. "The loss of consciousness, and the appearance of a state outwardly resembling syncope, prevent us in most cases from feeling sure that the great nerve centres suffer loss of function pri marily and not through want of nutrition from feeble or arrested heart action. But there do exist certain cases, more rare, it is true, in which singular affections of the nerve centres, other than those of the heart, occur as a consequence of wounds. These are well described by Legouest in CHAP, xil.] REFLEX PARALYSIS, THE RESULT OF SHOT WOUNDS. 731 his Svrgcn/ of the Crimean War, page 219, and in somewhat varied shapes must have been seen by all who are familiar with the early history of gunshot wounds. The patients to whom we refer do not fall when struck, but become insanely excited or almost hysterical. The author above alluded to supposes that this form of nervous excitement occurs chiefly among those who are already excited by immediate conflict and who are actively engaged. "One well known instance has been related to one of the authors of this paper as having taken place in the Mexican War, in 1846. An officer of well known courage was wounded in the heel, and was thrown at once into a state of alarm, which caused him to exhibit signs of the utmost trepidation. His character for courage was such that the favorable verdict of a subsequent Court of Inquiry was scarcely needed. No cases, such as the above, or such as Legouest has related, have been met with by us, so that they must be of very exceptional occurrence; yet as they show the possibility of cerebral disturbance without precedent or accompanying feebleness of the heart, it is enough to prove that they do now and then take place. We are tempted to add the following case as a still better proof that cerebral disturbance, the result of a shock other than traumatic, may give rise to the most profound prostration, without any prolonged continuance of cardiac weakness: A well known apothecary in Philadelphia was making a mixture of certain medicines in a large mortar, when they exploded with such violence as to break the windows of the store, crack bottles and jars, and deeply indent the board on which stood the mortar. Both he and his assistant were thrown down. Both suffered rupture of the tympana I membrane of the right and left ear. The assistant felt no marked constitutional effects, and got well with good hearing, but with a constant buzzing in the left oar. Tho apothecary himself, of a more nervous temperament, and perhaps, also, because he was standing nearer to the point of explosion, was, he thinks, insen sible for a moment. When seen by one of ns a few minutes later he was lying on a bed, with a pulse of rather remarkable strength, but now and then losing a pulsation, and altogether irregular as to rhythm, beating seventy one minute and eighty the next. His manner was excited and hysterical. He talked incessantly, and his limbs were in continual agitation, with occasional twitching of the facial muscles. Tho tympanal membrane was split across in his left ear, and on the right side presented a triangular opening. He had no headache, but complained of the roar ing, hissing, etc., which seemed to be sources of the utmost annoyance. Despite his desire to move about, his muscles were extremely feeble, and for twenty-four hours he was unable to walk without aid. He recovered readily, both membranes healing completely, and his hearing none the worse for the accident. The patient, it should be noted, was not injured by his fall, and as we have seen, showed no signs of concussion. He, as well as his medical attendant, attributed the phenomena which he exhibited to the shock given to the auditory nerve. This opinion has since been confirmed by the cases reported by M. Browu-Sequard and others. "Further on we shall show that in rare cases gunshot wounds cause partial or very general paralysis of gr.ive type and prolonged duration in parts not directly injured; we shall also show that these protracted paralyses must be due to an equally permanent affection of the nerve centres. Now, if this be possible, there is every reason to believe that a temporary, though general, paraly sis may take place in a large number of gunshot wounds. When the cardiac centres feel the shock most severely the feebleness will of course be greater; but there is much reason to suppose that the cerebral and spinal centres in general suffer en masse in every case of loss of consciousness from shock. "As we proceed we shall have occasion to discuss the mechanism of the more permanent forms of reflex paralysis. Here we desire only to show that the effect of grave wounds is to cause a condition of the centres which gives rise to a general and profound feebleness, and that in rare cases the central effect is so intense as in some way to cause paralysis, which may last for hours, days, or months. "Another class of nerve affections demands some notice before we discuss the undoubted instances of reflex paralysis from wounds which have fallen under our notice. These are what the French writers call cases of injury from commotion. They differ from those we have described in being due to the mere mechanical effect produced upon the neighboring parts. If, for example, a ball passes near the spinal column, it is conceivable that the roll of its motion and the resist ance of the tissues may determine in the spine a brusque and sudden oscillation of the contents sufficient to cause very grave results. 732 WOUNDS AND COMPLICATIONS. [CHAI>. xii. "We have sometimes seen this illustrated in a very interesting shape and in a less danger ous form. Thus, in the case of a soldier who was shot at Gettysburg, July 3, 1363, the ball entered the cheek, and passing outside of the ramus of the jaw was cut out of the trapezius muscle. It struck the ramus, but did not fracture it or interfere with the act of mastication. In October, one or two very minute morsels of bone escaped from the neck in front of and four inches below the jaw. The only injury to the jaw bone must have been on its exterior surface, from which the pieces of bone alluded to worked down the tissues of the neck. The shock caused complete paralysis of the inferior dental nerve, with absolute anesthesia, analgesia, and loss of sense of temperature in the lower lip and chin of the injured side. The sensation was for the most part rapidly restored by the use of cutaneous faradization after the nerve had been allowed time to recover from the results of the shock it had sustained. A portion of the lip. the skin below it, and the mucous membrane within still remain rebellious to treatment. "The other case of mechanical shock to a nervous structure we shall report more at length. It is one as to which there may reasonably exist some doubt whether to call it an instance of com motion of the spinal cord from injury of neighboring parts, or to regard it as an impression made upon the spinal centre through the injured nerves, and resulting in a paralysis, as the reflected result of the state into which the centres were thus thrown. It is impossible to be sure that both sets of causes may not have been at work. " Flesh Wound of Back of Neck ; entire Aphonia and Paralysis of all four liinbs ; speedy recovery, t/te r vjhi arm remaining weak. "Morgan Emory, aged 20, farmer, born in New York, enlisted September, 1861, in company C, 9th New York Cavalry, a healthy man. August, 1862. had typhoid fever, but recovered perfectly. On the seventh of July, 1863, he was wounded at Williamsport. The ball passed through the neck from side to side, posterior to the vertebra?, entering the left side one-half inch below the level of the angle of the jaw and two inches from the posterior middle line of the neck, and emerging on the right side at one-fourth of an inch lower down and two and a half inches from the same middle line. No bone has been discharged from the wound, nor is there any evidence of injury of the spinous processes of the vertebrae. Effect of wound. He fell from his horse, striking upon his right shoulder and bruising it slightly. He was speechless for fifteen minutes, and could neither stand nor move either arm. He acquired partial use of his left arm and of his legs in three or four days, and in a week could walk; his right arm improved very little. September 21, 1863; present condition. With the exception of slight numbness of the left hand, his right arm is his only trouble. He has no power to move the right shoulder and elbow joints; the wrist and fingers he can move slightly. He has a burning pain in the fingers, most marked when the hand is cold. Sensation of touch is generally good. The circulation in both hands is bad the right is colder than the left the right biceps and pectoralis major are hyper- iesthetic. Caleanic test. Electro-muscular contractility and electro-muscular sensibility slightly diminished in all the muscles of the right arm. The shoulder joint is susceptible of passive movement, and seems not to have been injured permanently by the full; the shoulder muscles are not wasted. It seems that for some days after the wound his skin was hyperassthetic from the level of the wound down to the waist, so that a fly on the skin gave pain, although deep pressure did not. The muscular hyperaesthesia is of later date. Treatment. Douche to arms; passive motion and electricity to right arm and shoulder. Three weeks later the electro-muscular contractility of the shoulder muscles was as good as on the other side. In the triceps the electro- muscular properties were lessened; in the forearm and hand both were as usual. Continued to faradize daily. The faradization was used up to November 1st, when he was furlonghed. At this time the electro-muscular contractility and sensibility of the muscles were as good on the right side as on the left. He has recovered all the motions of the elbow, wrist, shoulder, and hand, but all are more feeble than those of the left arm, which is still a little numb, although far less so than when admitted. The burning pain which at first annoyed him is now rarely felt, and the hyperaosthesia of the muscles is nearly gone. On his return from fin-lough he was still better, and within a month was returned to duty. The fall upon the shoulder was incompetent to cause all of the symptoms here described, and since, in other cases where this element of doubt was absent, we have seen paralysis caused by commotion, therefore we see little reason to hesitate in assigning it as the producing cause of the paralysis in the present case ; moreover, there was no paralysis of cerebral nerves, and the loss of power lay chiefly in the range of those nerves over whose spinal origin the ball passed. "In many of the cases of injuries of the brachial plexus which we have observed it was quite impossible that the nerve tissue could have been directly injured by the ball, and in some of these at least the resultant paralysis must have be*en due to brief compression of their trunks during the movement of the missile or to agitation of the nerves through the tearing of tissues more or less remote. "As we shall return to this subject in a future essay, it is only necessary here to describe cases of commotion so as to separate them from those of true reflex paralysis, with which they might easily be confounded. We have met with another and very interesting form of paralysis which might possibly be mistaken for reflex paralysis by a superficial observer. Men who are forced to use crutches, and to bear heavily upon them, are sometimes affected with numbness of one or both hands, and even with loss of motion in these members. This result is due to pressure upon the axillary nerves. It is most apt to occur in emaciated persons and those of large frame. Where it presented itself early in the case, as it may do, it might readily be attributed to reflected irrita tion. It is then easily relieved by laying aside the crutches, or by padding them and adding a handle by which to support the weight of the body on the hands. When the cure is delayed, faradization always affords prompt relief. CHAP, xil.} REFLEX PARALYSIS, THE RESULT OF SHOT WOUNDS. "733 "We have seen that in all probability the state of shock from gunshot injuries is a state of general paralysis. We have also seen that in the great mass of cases it is temporary. We have now to show that in rare instances the paralysis continues as a more or less permanent evil after the general depression has passed away. When, therefore, a wound occurs, and the patient sur viving the first effect is found to have paralysis of a distant limb or limbs, it is impossible to deny to such cases the title of reflex paralysis. All of the following instances seem to us to have ful filled every condition which would entitle them to be so considered: "CASE I. Ball Wound of Eight Side of the Neck, probably involving no important nerve directly ; fracture of hyoid bone ; wound of throat. Reflex paralysis of left arm; probable reflex paralysis of right arm; early recovery of left arm; partial and remote recovery of right arm. "Captain R. N. Stemble, U. S. N., aged 49. While commanding the ram Cincinnati, May 10, 1862, the ship was attacked by two rebel rams. Captain 8. was aiming a pistol when a hall entered his right neck, broke the hyoid bone, and traversing the neck emerged three and a half inches from the middle line, above, and to the right of the superior angle of the scapula, through the edge of the trapezius muscle. He fell half conscious and confused, but, soon reviving, felt that both arms were paralyzed. Mis first impression was that he was shot through both arms. He was carried below in great pain and spitting blood freely. The pain in the arms was made w r orse by movement and by passive motion. Pressure gave him pain in the right arm and shoulder only, and in the right chest. Sensation was never entirely absent from either arm, but was dull in both. His medical attendant, Dr. Judkins, of Cincinnati, who took charge of his case on the 19th of May, 1<%:J, writes as follows: When first- seen by me the anterior wound was discharging mucus and pus with saliva. His voice was hoarse; deglutition, which returned in part on the third day, was still difficult and painful. He experienced severe pain in the supra-hyoidean group uf muscles and in the pharynx. His left arm was still slightly paralyzed, having rapidly improved. On the right side the deltoid, biceps, triceps, and brachialis anticus were completely paralyzed, and up to the date of this account, July 9, 1862, have improved very little. The muscles of the right forearm are nearly as much paralyzed as those of the arm, and the sensibility of the right arm has become painfully acute. Captain S. seems also to have lost to a great degree the use of most of the shoulder muscles on the right side. The left arm was nearly well in four weeks, the sensibility and movements of both improving equally, so that now, July 18, 1863, he has no loss of function in the member except slight want of tactile sensation in the ultimate distribution of the ulnar nerve. The right arm was but little better at this date, but the forearm had acquired every movement except supination, which seemed to be limited about one-half, not by paralysis, but by contraction of the opponent group of pronating muscles. At this period sensation was entire in the right limb, but there was soreness on pressure in all the anterior arm muscles, and neuralgia in the arm and forearm. The nutrition of both arms was good, but the right was the smaller, measuring nt the biceps 9f inches, while the left measured lOf inches. During the slow progress of his case Captain Stemble lost several small pieces of the hyoid bone, and although hoarse for many months has recovered his voice without serious change in its tone or power. His convalescence, interrupted by many accidents and by an attack of pneumonia, continued up to the summer of 18B3, and was largely due to the skill and care of his able medical attendant, Dr. Judkins. When placed under treatment, in Phil adelphia, by Dr. Mitchell. July 18, 1863, Captain S. was still suffering from constant pain in the right arm. The left was well except as to the trifling loss of sensation mentioned above. The right forearm, though weak, possessed every movement except supination. as did also the hand, but the arm hung at the side useless, because there was scarce any abducting power and very little flexion at the elbow, both the biceps and long supinator being greatly enfeebled, and the former muscle, as well as the brachialis anticus, almost entirely atrophied and lost to view. Excepting the trapezius and rhomboid muscles, all the shoulder group was nearly useless and partially wasted. From July 18th to September 9th he was faradized, at first every day, and then every third day. Active and passive movements which had already been employed being of course continued The result was a steady gain, ending in a cure as complete as could be hoped for in a case so severe. He regained every lost motion, .and could raise his hand to his chin and abduct the arm about fifty degrees. The pronators alone remained intractable, despite every effort, but as the supinators and biceps developed themselves largely, even pronation gained somewhat, though not to such an extent as the other movements. The pain and hyperscsthesia diminished, but the former still exists. It is believed that a second course of similar treatment, about to be instituted, will further amend this case, in which all other means had utterly failed. Dr. Judkins is of opinion that the entire paralysis was due to reflected irritation. We incline to this belief for anatomical reasons, but even though we admit that the paralj-sis of the I ight arm may have been caused by commotion of the brachial plexus, it is impossible to suppose that the loss of power in the left member could have been similarly produced. The only permanent lesion on that side was the loss of feeling on the ulnar side of the palm und fourth finger. With this exception it regained its normal functions within three or four weeks. Whatever may have been the cause of injury to the right arm, it appears to have involved more or less nearly all the strands of th plexus, which is unusual in cases of traumatic injury from a ball. Its results were also more lasting than in the other arm. A year and two months after the accident the right arm was a useless member. Farardization of the muscles affected restored their power very rapidly, so that the patient regained every movement of the limb, which is still improving, electricity having been temporarily laid aside in September, 1863. "CASE II. Flesh Wound of Right Thigh, without wound of any large nerve.; complete paralysis of all four limbs ; speedy recovery of the left arm, tardy recovery of the other limbs, subsequent analgesia of the right side. "Jacob Demmuth, aged 21, Swiss, enlisted July, 1861, company D, 108th New York Vols., a man somewhat below the average standard of height, of lymphatic temperament and moderate intelligence. Reports himself as healthy up to the date of his wound, which took place at Fredericksburg, December 13, 1862. He was marching at double-quick, when a fragment of shell as large as a musket ball struck his right thigh at the junction of the upper and middle thirds, directly over the femoral artery. The fragment did not enter deeply, but merely lodged in the leg, and was removed a day later without injury to the vessel. Effect of wound. lie fell half conscious, and although aware that he was wounded, he could not fix on the sitt^ of the injury until he had examined the limb. He felt instantly a burning pain in both feet, in front of the right chest and in the right arm, and in the right thigh about the wound. At first he was entirely powerless, but after a few minutes the power of the left arm returned, leaving him paralyzed as to motion in the right arm and in both legs. He lay on the field twenty-four hours, the weather being very cold. Sensation was defective in all the parts paralyzed as to motion. He had no pain in the back, but the burning pains alluded to above continued for a long time, and were always eased by cold applied to the wound. While the wound was healing he had headache and difficult, painful micturition. The wound closed in four weeks. During this period he regained the power to move the right arm, feebly and slowly, although perfectly as to extent. The pain in the side and feet also diminished, and the former disappeared altogether at a later period. He could not stand, however, or lift his legs from the bed at the time the wound healed, but there was then no headache or difficulty with the bladder or rectum. January .28, 1863, he was sent to Washington, where he improved so as to be able to walk with the help of a cane. His subsequent transfer to West Philadelphia caused a relapse; the pains returned, the paralysis increased, and he walked with difficulty on crutches. June 4, entered Christian Street Hospital. Present state : Movement. The patient is partially paraplegic. He has some power to move the thighs when lying down, but cannot lift the legs from the bed. Below the knee all motion is lost, except a slight power of WOUNDS AND COMPLICATIONS. [CHAP. xu. flexing the smaller toes in both feet. Pressure upon the cicatrix causes feeble twitching of the anterior muscles of the right thigh ; both legs are subject to cramp and twitchings, which increase at night. The left arm is strong, the right arm has all the normal movements, but all are slowly and feebly executed. Sensation. He has shooting pains, which start from the seat of the wound and dart down the thigh to the knee. No other pain exists at, present, but there is still a good deal of burning sensation in both feet alike. Localizing sensibility perfect everywhere. Tactile sensation normal, or very nearly so, in all parts of his body; no loss of sense of pain in the skin. Pressure or pinching of the muscles gives him more than the usual pain, so the muscles (of both legs, especially below the knees) may be regarded as affected with hyperiesthesia of common sensation. The left arm is in all respects normal; the right arm is also free from lesions of sensibility. Nutrition. There is no special atrophy of individual groups of muscles, but both legs are slightly wasted, the right arm not at all so. The legs below the knees are relaxed and cold; the feet are congested, but not swollen to any marked extent. Along the edges of both soles there are singular purple and blue anottled spots, which he says existed from the time his boots were first taken off, twenty-four hours after he was wounded. It is possible that these marks are due to frostbite. The muscles of the legs are about equally irritable to induced electric currents. Unfortunately, no very perfect electric examination of their condition was made at this period. Treatment. Regarding the case as one of reflex paralysis chiefly, he was ordered to have rough frictions, with cold to the spine, and to take the twentieth of a grain of strychnia three times a day. Under this treatment the cramps and twitchings increased, so that after three weeks the strychnia was abandoned. Every future attempt to repeat its employment caused the same increase of annoyance, without correspondent benefit, so that it was finally laid aside as useless or worse. About the middle of August a blister was placed on the cicatrix, with the effect of greatly relieving the burning in both feet. At the same time he was ordered to use the hot and cold douche to the spine alternately, and faradized daily. The electricity was persistently employed during two months, and a month later he was also treated with iron and quinine, porter and liberal diet. The electric treatment caused a rapid amelioration of his case, so that he soon left his bed and began to walk on crutches. Early in November he ceased to improve, and the treatment was abandoned. At this time he could use his right arm well and quickly, and walked unaided, although with a little unsteadi ness of gait. No close examination was made as to his sensibility until December 3, 1863, because during this time he had been able to give aid in the wards, and made no complaint, except of more or less constant aching in the dorsal and lumbar regions of the spine. About December 3d he was closely inspected for discharge, when the following notes were taken : Motion. Good in left arm; not so perfect in right arm. Both legs somewhat weak, so that lie shuffles a little in walking, the worst movement being that of extension in the toes of the right foot. Sensation. Tactile sensibility feeble in the right leg and right arm, but nowhere entirely lost; it is normal in the left leg and left arm. The sense of touch is first found to be feeble below the navel on the right side. It lessens in perfection to the knee, and is better below that part, especially on the inside of the calf, being worse in the foot. Tickling the sole causes no sensation of tickling on either side. 1 ain. There is absolute loss of sense of pain in the right leg, belly, chest and arm, with somewhat lessened sensibility to pain on the left side also. In many localities he was able instantly to tell by the altered sensibility when the needle point crossed the median line; in others, this was more difficult. So complete was this analgesia that the most intense faradization of the nails of the right hand or of the right nipple caused not the least sensation. The penis remained sensitive, but all over the right side he could be cut or stuck full of needles without evincing the least consciousness of anything but a touch. The sense of temperature was good in the left leg, confused and uncertain at the upper third of the right thigh, and lost below the knee, where a heat of 110 Fahrenheit was felt as a touch only when the sponge wetted with hot water was applied. On the foot of the right side this degree of heat was unfelt in any form. Higher heat caused reflex movements, which did not tend to remove the limb from the irritant, but were merely convulsive in their character. Intense cold also gave rise to these irregular movements. Electric examination, There was some difficulty in determining the state of the muscles as to their electric sensibility, owing chiefly to the want of intelligence in the patient and to the fact that he spoke an impure German patois, which made it no easy task to obtain from him a clear statement of his feelings. The electro- muscular contractility is slightly diminished in the right leg and arm; it is much impaired in the extensors of the toes on both sides; everywhere the muscles respond slowly. The patient wu.s discharged December 14, 1863. "CASK III. Wound of Right Thiyh, with yrol>al>le commotion of right sciatic nerve ; partial paralysis of r ujht ley ; reflex paralysis of rigid arm ; speedy recover >j of arm ; history unfinished. "William W. Armliu, aged 23, born in New York, farmer, enlisted August, 1862, in company D, 134th New York Yols. Healthy before enlisting, and, except a slight typhoid fever in the fall of 1802, healthy up to the date of the wound, July 1, 18b 3. at Gettysburg. While kneeling on the left knee, the right knee bent at a right angle, he was shot in the right thigh on a line with the internal condyle of the femur, ten inches above it, and a little anterior to the artery. The ball passed upward, backward, and outward, and emerged two inches below the tuber ischii, and one and a quarter inches external to it, just above the fold of the nates. Dropping his musket lie fell on his face, weak, but not insensible; the right leg violently flexed for a moment. He felt very feeble, but especially so in the right arm, with which he vainly tried to aid himself. After a half hour the bleeding, which was not excessive, ceased, and he was able to stand on the left leg, but not on the right leg, and had scarcely any use of the right arm, which, it should be noted, was in no way hurt when befell. He managed to bind up the wound with a water dressing, and, occasionally renewing it, lay two days on the field. When hit he perceived no pain, but within an hour a burning attacked his instep, and has never left it, remaining neither worse nor better. Sensation, he is sure, was unaltered except on the sole; motion improved slowly, except in the flexors and extensors of the foot and toes. To his surprise the feebleness of the right arm increased after he was put in bed, and indeed notably after the second day. Up to October 28th it improved slowly, but at this time he went home on furlough, and began to use a crutch, which again so weakened the arm as to alarm him and deprive him, as at first had happened, of the power to feed himself. Rejecting a crutch on this side, he used a liniment on the arm, and it has now gained so much as to have about one-fourth the force of the left arm. It did not lose sensation at any time. Present state. December 14, 1863. General health good. Nutrition. Wounds healed. Leg below knee wasted, foot swollen, toes blue. Contraction of great toe in flexion. Measurements, 8f inches above internal condyle the thigh measures, right 16, left 17| inches; middle calf, right 11J, left 13 inches. Voluntary motion. He lifts the right thigh well, but complains of its weight. Knee motions very fair; has no extension or flexion of the foot or toes. Sensation. Tactility absent in sole of right foot, feeble in second toe on its dorsal face, absent on top of third toe, but elsewhere complete. Localization extremely confused, so that a touch on the toes is felt, but is referred to the instep. Surface analgesia of the sole, but deep pricking with a needle is felt in the sole. Hypersesthesia of the posterior thigh muscles to a slight degree; marked soreness on pressure in the calf muscles, the short extensors of the foot, and its whole dorsal surface as well as the inside of the sole. Pain. The pain lies deep in the calf and extends outside, under and in the peroneal muscles, down the front of the leg, and over the dorsum of the foot, and to the external side. It is intense in the dorsum, but nearly absent in the sole. Water does not seem to ease the pain, which is of a burning character Mike mustard. Hitherto nothing has aided it. Electric test. The thigh muscles respond well. The right tibfalis anticus has no electro-muscular contractility, but its electro sensibility is highly exalted, as is the case in all the muscles down to the foot. In the foot the electro-muscular contractility and sensibility are both lost, except that in some parts of the dorsum the sensibility cannot be tested readily for various reasons. It is certainly lessened. The right arm is still very feeble, especially below the elbow, and has lost in size. It measures comparatively as follows: Dec. 20th, right forearm 8f inches, right, arm 9 inches; left forearm 9 inches, left arm 9f inches. He is not left handed. The arm is improving; the leg has remained unchanged during some time past. Ordered, first, a blister over the whole dorsum pedis. Dec. 23d. This has caused great relief and is to be repeated. The complete history of this case will be detailed elsewhere. Up to this present date, February 1, 1864, the burning pain in the foot has been relieved, and the hand and arm have entirely recovered under the use of the douche, active exercise, and electricity. CHAP. XII.J EEFLEX PARALYSIS, THE EESULT OF SHOT WOUNS. 735 "The following cases are equally instances of reflex paralysis. We regret that, owing to circumstances not under our control, they are less complete as to their symptoms and history than we should have desired: CASE IV. A Sergeant was shot, during the battle of Malvorn Hill, in the right testicle. This organ was nearly entirely destroyed by the ball. He fell without pain, believing himself wounded in the back. A few moments later he became senseless. Recovering after a few minutes he discovered that he could walk, but that the right foot dragged when he attempted to lift it during the effort to get to the rear. This weakness remained permanent for several months, and was relieved by faradization, and shampooing soon after the testicle healed. The flexors of the foot on the left leg were completely paralyzed to voluntary control, but responded to the irritation of the induced electro-magnetic currents. There was no loss of sensibility. " The next case was observed by one of us in the U. S. A. General Hospital, Sixteenth and Filbert Streets. Unfortunately no notes were taken at the time, which will account for the brevity of the details: "CASE V. An officer w r as struck by a small fragment of shell upon the external side of the left thigh. He felt pains of a smarting character in both thighs at or about the same spot, and was impressed for a time with the conviction that he had been shot through both thighs. The shell wound healed in the course of three or four months. During this time he had occasional smarting on the outside of the sound thigh. This gradually disappeared, and at length he noticed accidentally that there was a space of skin about five inches square, on the outer part of the sound thigh, in which there was neither sense of touch nor of pain. When examined by us, he could indicate the boundaries of the anaesthetic space very readily by the loss of tactile sensations when a body, moved while in contact with his skin, was made to cross the line on to the numb parts. These bounds were always very accurately the same. He returned to his regiment without any improvement having taken place in regard to anresthesia. It is difficult, as it appears to us, to refer either this case or the last to any cause except a reflex effect. The interest of the case just now recorded lies partly in the fact that at the time of the wound the patient felt a sensation which he referred to the part which afterward became deprived of sensation. " The following case is a still more remarkable instance of the same peculiarity, and is also instructive from its resemblance to Case III, that of Armlin, in whom a gunshot wound of the right leg also caused reflex paralysis of motion only in the arm of the same side : "CASE VI. Gunshot Wound of Right Thigh; lesions of motion and sensation; reflex paralysis of right arm as to motion. "Daniel Kent, aged 24; Pennsylvania!!; farmer. Enlisted August, 1862, company B, 145th Pennsylvania Volunteers. Healthy until wounded. At Gettysburg, July 2, 1863, while charging at a full run, the leg raised up, he was shot in the right thigh 10| inches above the edge of the patella, directly over the rectus. The ball made its exit on the postero-internal surface of the thigh one inch below the fold of the nates. It seems to have passed inside of the bone and could not have hit the sciatic nerve. He fell at once, quite conscious, and feeling an instant stinging pain all over the right side of his body, and especially ii! the arm. He lost a great deal of blood, and found that he could not sit up without giddiness. His wound was dressed in six hours, and he was on the field thirty-six hours. The leg lost all motion and some sensation, and the tingling pain in the arm left him within twelve hours. He remained in bed six weeks, and then was able to walk on crutches. The sense of touch changed but little during the time which has since elapsed, and the power of movement in the leg has remained unaltered since August 1, 1863. The wound healed in October, with some previous loss of bone. Since October the wounds have twice reopened to give exit to small pieces of bone. Except an attack of ague in October, his general health has been good. Present condition, December 26, 1863: Nutrition. The leg is healthy in color; the foot swells when hanging down. The right thigh, eight inches above the patella, measures 19 inches in circumference; the left measures 19 inches. The right calf measures 14 inches; the left calf measures 15 inches. Sensation. No pain anywhere; tactile sensibility entire; sense of locality healthy. Motion. The thigh is voluntarily flexed very slightly, and only through the agency of the psoas muscle, the anterior thigh muscles refusing to obey the will; abduction and adduction of the thigh normal; extension of the thigh is normal; extension of leg noue. The foot is almost moveless, except that the will can cause feeble flexion of the toes and slight eversion and inversion of the foot. Electric examination. The rectus muscle has its electro-muscular contractility somewhat lessened; that of the two vasti muscles is lost until the wet conductors reach the upper parts of the muscles (three inches above the wound), where this properly becomes normal. The sartorius has its electric contractility diminished. Below the knee the peroneus longus responds very well, but, with this exception, none of the leg muscles stir under the most powerful induced currents. The short extensor of the toes and the interossi still possess some power to contract under electrical stimulus. Throughout, the electro-muscular sensibility is diminished in all the muscles which have suffered in their contractile power, and the sense of pain seems also to be materially lessened since dry electric conductors, with strong currents, cause no pain when applied to the bones or nails of the foot. The history of the arm, which was reflectively paralyzed, has been reserved for separate detail here. After three days from the date of the wound the right arm, which had remained feeble, became so completely paralyzed that the patient could no longer raise it to his lips; under the use of a stimulating liniment it grew better until he used crutches. Prob ably owing to their employment he became much worse, but gradually improved again up to this present date of January 6, 1864. The right and left arms measure nearly the same; power of right arm one-fourth that of left. Electric examination. Electro- muscular contractility normal ; electro-muscular sensibility somewhat lessened. Treatment. Faradization of arm daily ; alternate hot arid cold douche, and active motion. On close examination, soon after admission, some evidence of tubercle was found in the right lung, and the patient was therefore ordered to be discharged January 20, 1864. "CASE VII. Wound of Eight Deltoid; sensory altd slight motor paralysis of right arm; speedy recoreri/. "Michael Farrell, aged 28; farmer; born in New York; enlisted September, 1861, company I, 20th New York Vols.; a vigorous, healthy looking man was well up to date of enlistment. At Fredericksburg, December 13, 1862, he was shot in the left shoulder while lying down. * The ball entered the erector spinse mass of muscles on the left side on a level with the lower angle of the scapula, and passing upward and outward, lodged under that bone ; the wound healed readily, the ball remaining. February 3d, went to duty. July 1, 1863, a small ball passed through the right deltoid muscle three inches above its insertion into the humerus. The ramrod fell from his hand and the arm dropped. He retired to a hospital, and on examination found that although he had all the movements of the arm he had no sensation. During the next four days he was exposed to the sun a good deal, and the arm, being bare, was blistered, which, he says, to a great extent restored its feeling, which has since gone on improving. There is now, July 25, 1863, some slight paralysis of motion, but all the movements are feeble, and those of the arm painful, owing to the contractions about the ball track ; the arm improved, and the man was returned to duty Oct. 22, 1863. "Before proceeding to discuss the causes which give rise to reflex paralysis, it will be useful to analyze the symptoms of the preceding cases so as to learn how they differ and in what respect thev resemble one another. 736 WOUNDS AND COMPLICATIONS. K-IIAF. XII. "Relation of the seat of the icound to the part or parts paralyzed. "CASE 1. The wound involved the muscles of the neck or throat, and the hyoid bone. Result: Paralysis of both arms and of the neck. CASE II. Fragment of shell ; wound of mus cles over and external to the right femoral artery. The injury may have caused concussion of the crural nerves, and thus much of traumatic paralysis. Result: Reflected paralysis of the right arm and leg and the left leg. "CASE III. Probable injury of the sciatic nerve (commotion). Result: Reflex paralysis of the right arm. CASE IV. Ball wound of right testicle; paralysis of right anterior tibial muscles and peroneus longus. CASE V. Wound by fragment of shell in external side of left thigh; paralysis of tact on a corresponding part of right thigh. CASE Vf. Ball wound, probably involving the crural nerves. Result: Paralysis of right arm. CASE VII. Ball wound of deltoid muscle; sensory and slight motor paralysis of same arm. There is no evidence in this case that the ball struck the bone or directly injured any large nerves, since even the deltoid itself had nearly full power when the patient was first examined by us. In three of these cases the leg was hit, and the arm of the same side was paralyzed. In three cases the paralysis affected the opposite side of the body; and in one the paralysis of tact and pain was observed to have fallen upon a space symmetrically related to the wounded spot as regards posi tion. No general law, therefore, can be deduced from these records, nor, from what we see in the causation of reflex paralysis from disease, should we expect to find any inevitable relation between the part injured and the consequent paralysis. The constitutional condition at the time of the wounding, as to excitement, mental and physical, may possibly have to do with causing the resultant paralysis. u Of the seven cases above reported, two were in active movement, two were standing about taking aim, one was kneeling, and of two we have no information as to this point. It may prove, upon examining a larger number of cases, that a man wounded when moving violently, or when excited, is more than another liable to reflex paralysis, but as yet we are not entitled to such an inference. In most of our cases the constitutional effects were instant and severe, and could not therefore have been due to the loss of blood, which in some of them was copious. Four of f he seven cases had stinging, smarting, or burning pain in the part paralyzed reflectively. The pain was an early symptom, which disappeared in all of them after a time. In three cases no such pains were complained of. "The after history of these cases is extremely curious. However grave the lesion of motion or sensation, it grew better early in the case, and continued to improve until the part had nearly recovered all its normal powers. In almost every instance some relic of the paralysis remained, even after eighteen months or more from the date of wounding. In some the part remained weak, in others there was still left some slight loss of sensibility, and in two the loss of power and of sensory appreciation was very considerable. In a case of reflex paralysis from a wound we have, therefore, some right to expect that the patient will recover rapidly up to a certain point; then in most cases a small amount of loss of power or sensation may remain. The future history of our own or other cases may determine hereafter whether the recovery is ever quite complete. In CASE I, the more prominent results were only the continued lesions which had been noted early in the case. In CASE II, the permanent lesions were chiefly of secondary character, and were at all events additions to those which were first observed. In no other case were similar phenomena noticed. In two of the seven cases there were lesions of sensation and motion; in three, motion alone was lost; and in two the sense of tact and pf pain were affected without other loss of func tion. The extent and duration of the induced paralysis have already been considered. "Of the treatment we have very little to say. In Captain Stembel s case the left arm recov ered without treatment in four weeks, leaving only a slight loss of touch in the terminal distribu tion of the ulnar nerve. The right arm, which we also regard as reflectively paralyzed, recovered sensation early, but was useless as to motion, until it was treated and cured by faradization eighteen months after it was first injured. "Demmuth, CASE II, came under our care seven months after he was wounded; as to his pre vious treatment we know nothing. In our hands strychnia not only failed to aid him, but did harm. He was rapidly relieved by faradization, active and passive movement, and the douche, with iron, quinine, and liberal diet. CHAP. Xll.] REFLEX PARALYSIS, THE RESULT OF SHOT WOUNDS. 737 " Arinlin, CASE III, used a liniment on the paralyzed arm with some improvement. Faradiza tion has restored it completely. CASE IV. Relieved by faradization. CASE V. Xo treatment; lesion of sensation only. CASE VI. Kent. A stimulating liniment applied upon the arm seems to have been of use. As in Case III, the employment of crutches caused a relapse. CASE VII seems to have been accidentally benefited through the blistering to which the arm was subjected after exposure to the sun a useful hint in like cases. No other treatment was employed. Although long periods had elapsed in every case before we examined them, in only one, that of Arinlin, Case III, was there any very notable wasting. And even in this patient the loss was generally through out the member, and may be readily ascribed to mere lack of use. In none was there atrophy, such as characterizes lesions of nerves, and certain rheumatic and other palsies, save, perhaps, in the doubtful instance of the right arm in CASE I. "The electric examination was made at periods so variable in the several cases as not to permit of any useful comparison of results, and has been stated in each case merely for future use and reference when more cases have been reported. In only one case did the muscles display great loss of contractility when faradized, and in this, No. 1 of the series, the limb in question was the right arm, as to which alone some doubt may exist concerning the cause of the paralysis. The ultimate causation of these very singular and hitherto undescribed affections is the last point which we shall consider. The problem before us may be simply and briefly stated; its solution is a task less easy. "A gunshot wound occurs, involving large nerves or not, and we have instantly a paralysis of motion and sensation, or of either alone, in some part of the body more or less remote. How shall we explain this? Although we have long been aware that certain forms of disease are capa ble of causing paralysis of distant organs, of altering secretions and affecting nutrition, we have had no plausible theory of the causation of these effects until M. Brown-Se"quard attempted to account for them in a manner equally simple and ingenious. Recalling the fact that irritation of the vaso-inotor nerves is capable of producing contraction of the blood-vessels, he inferred that when an external nerve is violently or permanent^ excited it may be able to produce contraction of the capillary vessels of the nerve centres and thus give rise to paralysis. It seems unlikely, even if we admit his explanation, that the capillaries could remain contracted for any great length of time. But it is possible that the alteration of nutrition, which this temporary anaemia causes, may give rise to one of two results either a continued disturbance of nutrition, which, however slight, would occasion grave results if it existed in a nerve centre, or secondly, to a paralysis of the capillaries of the nerve centre involved. "We suppose, first, the existence of an exterior nerve lesion; secondly, a consequent irrita tion of the vase-motor nerves in a limited part of the spine; contraction of its capillaries, anaemia, nutritive changes, and finally, a relaxation of these vessels, which would be more apt to be a last ing condition, and would in fact constitute congestion. Such a series of consequences may very possibly occur, and would no doubt be competent to cause a paralysis whose site, extent, and character would depend upon the part of the nerve centres affected by the excitation. With so satisfactory an hypothesis before us in this modified shape, it would seem needless even to suggest any other explanation. But in a region of research so little explored, it may be allowable to point out the fact that another mode of explanation is at least possible, and the more so, since there exist certain objections to M. Browu-Stiquard s manner of viewing the subject. It is to our minds improbable that contraction of the capillaries can continue for any great length of time. There is no experiment on record to show that this can be, or that it ever occurs in a nerve centre. We have therefore added the suggestion of consequent, and why may we not say primary, paralysis of these vessels. Here we have firmer ground for opinion, since it has been most distinctly shown that in section of the sympathetic nerve this result does take place, and is singularly persistent. But whether the blood-vessels remain contracted or dilated, nutritive changes would occur, and these the pathologist has failed to find. If now we ask ourselves the question whether it may be possible to blight or exhaust utterly the power of a nerve centre, without the intervening mechanism of contracted or dilated blood-vessels, we are tempted to think that such a result may be producible. "It appears to us possible that a very severe injury of a part may be competent so to exhaust the irritability of the nerve centres as to give rise to loss of function, which might pi-ove SUHG. Ill 93 738 WOUNDS AND COMPLICATIONS. [CHAP. xii. more or less permanent. A strong electric current, frequently interrupted, is certainly able to cause such a result in a nerve trunk, while a general electric shock, as a stroke of lightning, is, as we well know, quite competent to destroy the irritability of every excitable tissue in the economy. Now if the former of these results can occur in a nerve so insulated as practically to have no cir culation, the loss of irritability cannot be set down as due in such a case to a defect of circulation. Eeflecting then upon the close correlation of the electrical and neural force, it does not seem improbable that a violent excitement of a nerve trunk should be able to exhaust completely the power of its connected nerve centre. The central change thus brought about would no doubt involve the consequent or immediate occurrence of chemical nutritive changes, which would grad ually yield as time went on. While this view seems to us adequate to explain the facts, the notion of vaso-motor irritation and capillary contraction (Brown-Se"quard) does not appear to be compe tent to cover all the facts. We have pointed out that no one has ever shown that capillary con traction can exist as a permanent state in a nerve centre; while, on the other hand, it has been proven that section of a sympathetic nerve involves permanent dilatation of blood-vessels; but in the brain, which is supplied by the sympathetic of the neck, division of this nerve gives rise to no disturbance, although the side of the brain on which the section occurs grows warmer. However, it is probable that the whole supply of vaso-motor nerves to the brain does not come from the neck, while other organs, whose whole supply we can cut off, as the kidneys, do certainly suffer nutritive changes as a consequence of such sections. " One or other of the two theories we have offered must therefore be called 011 to explain the central changes which give rise to reflex paralysis. Either the shock of a wound destroys directly the vital power of a nerve centre, or it causes paralysis of the vaso-moter nerves of the centre, with consequent congestion and secondary alterations. But there is no reason why, if shock be competent to destroy vitality in vaso-motor nerves or centres, it should be incompetent so to affect the centres of motion or sensation. Until the causation of these cases is better understood, it is vain to speak confidently as to treatment founded on a conception of the mode of their production. Experience has shown that the removal of the first cause, and in some instances The application of alteratives, as blisters to the cicatrix, prove valuable in relieving such induced pain as may exist. Further, that stimulating liniments or blisters to the affected member are useful, and that the local application of induced electric currents to the muscles is of the utmost service. The question of the use of internal remedies has yet to be decided by larger clinical experience. We, ourselves, have been unfortunate in that no chances have presented themselves of treating these cases in their early stages, when the causes which first produce the paralysis are present and before those later nutritive changes occur which, as we presume, are essential to the continued existence of the state of palsy. We have endeavored to show in this report that the condition called shock is of the nature of a paralysis from exhaustion of nerve force; that it may affect one or many nerve centres, and finally, that it may be so severe as to give rise in certain cases to permanent central nerve changes, productive of paralysis of sensation and motion, or of either alone. "S. W T EIR MITCHELL, u GrEO. E. MOREHOUSE, " W. W. KEEN, jr., "Act. Ass t Surgeons, U. S. Army." The number of recorded cases of wounds of nerves of special sense caused by missiles is small. The following case of shot wound of the neck is interesting, and is regarded as a case of injury of the sympathetic nerve: 1 CASE 1077. Edward Mooney, aged 24 years, enlisted July, 1861, Co. C, 110th Pennsylvania. He was perfectly healthy before and after enlisting, until wounded at Chancellorsville, May 3, 1863. He was standing erect and was looking toward the left side, when a ball entered his right neck one and a half inches behind the ram us of the jaw, at the anterior edge of the Bterno-cleido mastoid muscle. The ball passed across the neck, rising a little, and emerged immediately below and a half inch in front of the angle of the jaw on the left side. He fell senseless, and, judging from the movements of his regiment, may have so remained during half an hour. On awaking, he found his mouth full of clotted blood, which he pulled out. The bleeding did not continue. After a short rest he was able lo walk nearly three miles to the rear, where his wounds were dressed with cold water. On his way he discovered that his speech had become hoarse, difficult, and painful, and that deglutition gave rise 1 MlTCHEU., MOUEIIOUBE, and KKEN (loc. cit., p. 44) are of the opinion that this is a "case of injury of the sympathetic nerve, and if so, that it \s the only one on record." CHAP, xii.] SHOT "WOUNDS OF NERVES. 739 to great uneasiness and to burning pains. He says the sensation of pain was felt as though behind the pomum adami. After five days of great suffering and utter inability to swallow, he obtained some relief, but, for a month or more, was forced to swallow a mouthful of water after every mouthful of solid food. The power to swallow gradually improved, and is now as good as it ever was. A week after he was wounded he became able to articulate without pain, although still hoarsely. This difficulty also lessened by small degrees. At present, July, 1863, his voice is still a little hoarse. During his recovery, which was rapid, the wounds healing within six weeks, he had a good deal of pain in the back of the neck. He says that he had headache when ever, after the injury, he attempted to walk far or exert himself; but he describes the headache as chiefly behind the ear and in the back of the head, with some frontal pain. About one month after he was hurt a comrade noticed the peculiar appearance of his right eye and called his attention to it. A little later it began to be troublesome in bright lights, and has remained so ever since, with of late some change for the better. July 15, 1863: The pupil of the right eye is very small, that of the left eye unusually large. There is slight but very distinct ptosis of the right eye, and its outer angle appears as though it were dropped a little lower than the inner angle. The ball of the right eye looks smaller than that of the left. These appearances existed whether the eye was opened or closed, and gave to that organ the look of being tilted out of the usual position. The conjunctiva of the right eye is somewhat redder than that of the left, and the pupil of the right eye is a little deformed, oval rather than round. In a dark place, or in half-lights, the difference in the pupils was best seen ; but in very bright light, as sunlight, the two pupils became nearly of equal size. The left eye waters a good deal, but has the better vision, the right eye having become myopic. In sunlight he sees well at first, but, after a time, observes red flashes of light in the right eye, and finally, after long exposure, sees the same appearances with the left eye also. He complains a good deal of frontal headache at present, and thinks that since the injury his memory has been failing, although of late it has improved. Has lost flesh and strength since he was wounded. About the 30th of August the patient rode to the office of Dr. Dyer, who examined his eyes with the ophthalmoscope, but found no abnormal retinal appearances. Mooney walked from Dr. Dyer s office to the hospital, an unusual exertion, as he was weak, and avoided exercise on account of the headache it caused. An orderly who was with him on this occasion remarked to one of the hospital staff upon the singular appearance which his face presented after walking in the heat. It became distinctly flushed on the right side only, and pale on the left. This fact was afterward observed anew by one of us. The patient had used exercise and had just come in. The right half of the face was very red. The flush extended to the middle line, but was less definite as to its limit on the chin and lips than above these points. He complained of pain over the right eye and of red flashes in that organ. A careful thermometric examination, made during repose, showed no difference in the heat of the two sides within the mouth or the ear. We regret that it did not occur to us to repeat this wben the face was flushed by exertion. Under a tonic course of treatment he gained ground rapidly. The eyes became less sensitive, the pupils more nearly alike, the line of the lid straighter. He had several attacks of fainting after exposure to the sun, and these, with occasional diarrhoea, retarded his recovery. He was at last able to return to duty, and left for that purpose in October, 1863, nearly all of his peculiar symptoms having disappeared and his general health having been altogether recovered. A case of neurosis, involving different brandies of the sympathetic nerve, is reported by Acting Assistant Surgeon L. K. Baldwin: CASE 1078. Private Hiram Voight, Co. E, 13th Massachusetts, was admitted into ward O of the West Philadelphia Hospital on December 16, 1862, with a cicatrized shot wound of the right arm, producing paralysis of the ulnar nerve. Soon after admission he had congestion of the kidneys, with scanty acid urine, which he passed with difficulty. Of this he was soon relieved by acetate of potassa with sweet spirit of nitre, conjoined by demulcent drinks and fomentations to the spine. On January 16, 1863, he was attacked with palpitation of the heart and violent dyspnoea, coming on in paroxysms, chiefly during the night. He was of German birth, medium sized, with dark complexion and good physical organization, about 24 years old. After the exhibition of a mild laxative he was put upon the use of tincture of assafoetida, with the application of a bella donna plaster to the cardiac regions. No tenderness of the spine was manifested upon pressure. Tincture of valerian was given along with the assafcetida upon the recurrence of the dyspnoea, which resembled spasmodic asthma, and this plan of treatment was pursued for several days. On February 14th the impulse of the heart was so considerable that five drops of tincture of veratrum viride" were given; but its discontinuance was soon demanded, and the antispasmodic treatment, with tincture of valerian in addition, was resumed. On February 17th the dyspnoea was less violent and of shorter duration; but he began to complain of general tremulousness with great nervous irritability. The tongue became furred and yellowish, with slight head ache and feverishness, which were relieved bv the use of five grains of blue mass at night and slight laxatives in the morning. On the 20th he had great cardiac agitations with some dyspnoea and general nervous tremulousness. His strength was also failing. Pills containing one grain of sulphate of quinine and two grains of extract of hyoscyamus were given four times daily, with a teaspoonful of compound spirit of sulphuric ether at times of paroxysms. On the 24th he felt better, but a repetition of the mercurial was demanded by the state of the tongue, etc. Still had paroxysms of dyspnoea at night, with twitchings of facial muscles and great nervous agitation. Mental functions were also somewhat disturbed. On the 27th he was attacked with vomiting, which caused him great distress. He had no appetite and his stomach rejected everything. His pulse was moderately full and regular, but his countenance and general movement indicated great malaise, and he seemed almost as if insanity were impending. His face became flushed, with general heat of skin, and thirst, and a recurrence of the furred tongue, with constant vomiting. He was again put upon the use" of blue mass with aromatic syrup of rhubarb, which soon produced a favorable change of the gastric symptoms as well as his general condition. Paroxysms of dyspnoea had now in a great measure passed away. The pulse had become regular and firmer ; but still his stomach remained irritable and non-retentive. On March 5th his symptoms had a little improved, but he was very restless at night, and still gave evidence of great nervous irritability, which were thought to be clearly traceable to an affection of the ganglionic centres of the sympathetic nerve. Endermic applications of morphia to the epigastrium was tried for the relief of gastric irritability, but without apparent benefit. The stomach remained rebellious to the reception of everything which was taken into it, and could not be subdued by any medicinal or dietetic measures which were prescribed. Notwithstanding the obstacle to proper nutrition, his strength was quite well maintained and no 740 WOUNDS AND COMPLICATIONS. [CHAP, xn particular emaciation was observed. Being a German, lager beer and bock wine were temptingly offered bim; but witb no successful result. In this way be continued for several days longer, being fortunately, however, now relieved of all pulmonary aud cardiac symptoms. All medicine was suspended, and on March 30th be first expressed a desire to be discharged and sent home. This wish was acquiesced in, and he was discharged from service April 18, 1863, and pensioned. Examiner G. S. Jones, of Boston, reported, December 21, 18G7: "He now has partial paralysis of his left hand, which impairs its power and usefulness. There is no evidence of nervous debility or softening of the brain." The following two cases of shot wounds of the portio dura nerve, seventh pair, are copied from Mitchell, Morehouse, and Keen, pp. 47, 51 : CASE 1079. Private John C. Dyre, Co. E, 71st Pennsylvania, aged 19 years, was wounded at Gettysburg, July 3, 1863. While aiming, a ball entered just behind the left ear at the level of the meatus. It broke the mastoid process slightly, and was said to have gone forward and downward. It has not been found. He fell unconscious, and reviving within about two hours at a hospital, where he had been carried, he found that he could not use the jaw, owing to pain in the ear. There was also pain in the left cheek and brow, left neck, shoulder, arm, and hand, together with the left chest. The left arm was weak for several days. He may have fallen upon it. The pain was a neuralgic ache, not the pain of a bruise. Water dressings were used after a vain search for the ball. Within two days he had pain in the lower teeth and jaw on the left side. After five weeks all the pains grew better rapidly, and at the same time the motions of the jaw returned. The ear was deaf from the first; but he does not know whether blood flowed from it or not, or when pus first came from it. Present state, February 14, 1864, ciyht months after reception of wound : The features are slightly drawn to the right in repose, and excessively so during laughter and speech. Specimen 1567, in the Army Medical Museum, is a cast of his face in repose. The left side is absolutely paralyzed. The inner canthus of the left eye is a little rounder than that of the right eye. The tears overrun the lid at times. Inability to close the lids on the left side, owing to which he has formed the habit of rolling the eyeball upward so as to cover it with the passive lid. He then supposes that he has closed the eye. Chewing on the left side causes pain in the teeth, which endures for some time. Sensation is perfectly normal on the paralyzed side. Motion is of course utterly lost in all the muscles of expression. Electric test : Not the slightest contractility exists in any of the muscles of expression on the left side, with a curious exception. The muscular layer of the orbicularis oris in the upper and lower lips still responds to the current, but more remarkably below than above. There, is, however, no voluntary control over these parts. The buccinator alone of the masticating muscles seemed to have its electric contractility enfeebled but not wholly lost. Examination of Special Senses Tonyuc Motions : The upward and backward motion of the base of the tongue is awkwardly performed. In most of its movements the tongue inclines slightly to the right side, and is capable of being drawn to the left side. The palate hangs a little to the right and acts imper fectly, so that/oo(Z is apt to enter the nose. There is some further loss of power in the other muscles of deglutition, for he is often troubled by food entering the glottis, while at times it is thrust back again into the mouth. Speech : He pronounces many letters with difficulty or imperfectly, so that his speech may be said to be a little thick, and he so describes it, referring the trouble to his lips and tongue. The labials are of course affected, but the guttural sounds arc also imperfectly executed. Taste is appa rently impaired over the entire left tongue. It was examined by comparing its appreciations with those of the other side. Electric state of Tongue : No loss of its electric properties was detected. Hearing on the left side was destroyed. The back part of the bony meatus was carious and the membrane absent, perhaps from inflammation consequent upon the wound. Treat ment : The patient was industriously faradized for several months without the least gain in any respect. The nerve may have undergone such changes as might make it impossible to restore to the muscles their lo.st properties. Dyre was discharged from service July 2, 1864, and pensioned. Examiner T. F. Harper, of Philadelphia, reported, January 30, 1869: "A gunshot wound in -petrous portion of temporal bone of left side of head, causing superficial fracture followed by some exfoliation of bone. Tlftre has resulted a paralysis of seventh nerve, occasioning an impairment of vision of left eye; also a great deformity of the face, it being much contorted and twisted to the right by loss of power in the muscles of the left side of the face." The Philadelphia Examining Board reported, September 13, 1877: "Paralysis of left side of face, with loss of hearing, left oar, and defective sight in left eye. Deformity, overflow of tears, and inability to close eyelids. Ball sup posed to be in temporal bone." CASE 1080. J. Gager, Co. M, 14th New York Heavy Artillery, aged 4:2 years, wounded at Spottsylvania, May 12, 1864. The ball entered the left posterior neck one and three-quarter inches from the spine of the third cervical vertebra, and was cut out immediately behind and below the left ear, about two and a half inches below meatus and a quarter of an inch behind the jaw. Its track is unknown, except that it injured the ear and paralyzed the portio dura of the seventh nerve and splintered the edge of the ramns of the jaw. His head, at the time he was shot, was thrown forward and downward He fell, conscious, bleeding freely from the ear only. After two minutes he arose and walked away, the blood still spoutiny out from the ear, until it was checked by a bandage over that organ. He had no pain until the next day, when he had the usual inflammatory pains. His eyesight is said to have become affected on the second day, when there was, according to his account, a distinct difference against the left eye. Things appeared hazy to the left eye. This remains the same. The paralysis of the muscles was imme diate, and his speech was made difficult. This seemed to him to come from a defect in the tongue and lips. Hearing was lost at once in the left ear. Present state, June 8, 1864 : The pains in the face and the swelling, which was never great, arc now better. The wounds are open but healing. The nutrition is unaltered. The lines of the face are lost, the tip of the nose and the lower mobile portions of the face are drawn to the right. The left eyebrow has fallen a little. The tears run over the edge of the lid. The tongue is perfectly movable and under entire control of the will. Speech perfect, except a slight difficulty in articulating the gutturals, and still more as to the labiale. Special Senses : The left eye sees only one-third as well as the right. Hearing is lost in the left ear. On washing out the pus a mass of granulations was seen at the bottom of the ear. Possibly the bony meatus may have been fractured by the ball, but no bone escaped except pieces of the jaw, which came out with the ball. Taste : There seems to be no marked loss of gustation. Taste is dulled a little on the left side. Tactility is equally good on the two sides, both in the tongue and face. June 20th, the sight is becoming worse. Dr. Dyer is of opinion that it was affected before he received his wound. Induced electric currents give rise to slight movement in the left eyelid and the elevator of the h- o I CO z o h z Ul D O u OD Z o o CO o X X X UJ h < _l Q_ CHAP, xn.] SHOT WOUNDS OF NERVES. 741 angle of the mouth. A rapid recovery was predicted, and, in fact, within three days later voluntary power returned in the orbicular muscle of the eye. By July 27th, every motion had been re-acquired. An illustration of paralysis of the facial nerve with distortion of the face is given in PLATE XXXVIII, opposite. The patient suffered from loss of sight in the left eye and of hearing in the left ear. Nerve trunks may be completely severed by a missile, or they may be partially divided and lacerated. They may be injured by the near passage of a missile causing concussion or "commotion," or they may be contused by a missile which has insufficient power to divide or lacerate, or which has expended its force on neighboring tissues. As in the case of arte ries, their position and surroundings tend to protect them, and it is probable that their mobility and form may enable them to slip aside and escape damage from a passing missile. Mitchell, Morehouse, and Keen (op. cit., chap. 5, p. 55) add to the above more com mon forms of shot injury those from cicatricial pressure, and those from the extension of diseased processes from wounded nerves to those which are healthy. The same authors consider injuries by contusion of a nerve to be those "most apt to be permanent and serious." The following case, taken from their work, illustrates the result of a contusion: CASE 1081. James Walton, aged 47 years, Ireland, sailor; enlisted June, 1862, Co. A, 115th Pennsylvania. At the second Bull Run battle, August 30, 1862, while lying on his belly in the woods, a shell, exploding in the air, cut off a large branch, which, falling, struck him on the left shoulder, or rather across the base of the neck. He grew dizzy, felt stunned, and lost consciousness. When he revived he had sharp pains down the arm to the hand. It was totally paralyzed as to sense and motion. Up to September 15, 1862, he was a prisoner. At this date, when exchanged, sensation was still absent, but motion was improving slowly. It gained, however, at the same time that atrophy was taking place in the very muscle whose power was returning. From September, 1862, to September, 1863, the motions grew better, with one exception; sensation returned to a perfect extent, and the muscles ceased to waste. January, 1864: The arms measure alike. The right forearm measures 10 J inches, the left 9-f inches. The supinator longus and the extensor mass of muscles in the forearm are wasted, having lost about one-third of their bulk. The flexor group is still more wasted, and is hard and contracted Tact and localization normal. All the movements of the fingers normal, except extension, which is incomplete, owing to the contraction of the flexors and also to partial paralysis of their extensors. The wrist has loss of extension and of lateral movements, and the thumb has also defective extension. The patient was discharged from service October 3, 1865, and pensioned. Examiner W. Jewell reported, August 16, 18G6 : " Paralysis of left hand ; it is entirely useless, and, at his age, irrecoverable." A case illustrating an injury of nerve trunks owing to their being involved in a cica- trix has been detailed at page 462 of the /Second /Surgical Volume, and an example of the extension of disease along a nerve trunk to others, with consequent paralysis and atrophy appearing at points of distribution remote from the original injury, is here adduced: CASE 1082. Stephen Warner, Co. A, 151st New York, 1 aged 33 years, farmer, New York ; enlisted August, 1862. Healthy to day of wounding. At Locust Grove, November 27, 1F63, a ball entered the left chest below the first rib, half an inch below the clavicle and two and a half inches from its sternal end. Passing probably under the arch of the snbclavian artery, it went backward and downward and made its exit two inches below the inferior angle of the left scapula, three and a quarter inches from the spine. The ball was fired by a skirmisher not twenty yards distant, and was received while the patient was in the act of bending forward to aim. He fell, giddy but conscious; ti ied to move, but failed, and fainted from IOPS of blood. After several hours he revived and discovered that the left arm and hand were sensitive throughout. On the radial side of the forearm there was slight numbness, a condition compatible with perfect tactile sensibility ; motion appears to have been lost, or greatly lessened during some hours, and within a day to have become restored entirely. No doubt exists as to this point. No dressing was used until the third day, when water was applied. At this date the arm motions were complete below the shoulder, and there had been no pain. Soon after the cold dressing, to which he attributed the segment symptoms, he was seized with neuralgic pain, which was principally in the median nerve distribution, but also on the outside of the arm and shoulder, with a spot of intense pain at the deltoid insertion. The pain was darting and prickling in its nature. Coincidently with the pain the joints of fingers swelled and became sore, and this was especially the case with the thumb and the fore and second fingers. At the same time the shoulder muscles grew weak, flexion of the fingers grew feeble, and the flexion of the forearm was affected. All of those defects increased for several months, and the flexor group in the foreaitn wasted so much as to attract attention. The biceps, brachialis anticus, and coraco-brachialis were in like manner atrophied. The pectoralis major was also thus altered at a still earlier period. Up to the eighth day the patient spat blood freely. Then it ceased, and he has had no pulmon ary difficulties of any kind since his admittance on February 19, 1864. Nutrition : Atrophy of pectoralis major great, of shoulder muscles slight, wasting of biceps and other anterior and internal arm-muscles considerable. Arm at biceps measures left, 10 inches; right, 11 J inches. Foream left, 10 inches; right, 11 inches. Left hand congested, dark, and cold. It grows cold easily. Sensation perfect. The neuralgia has nearly disappeared, except in bad weather, and about the insertion of the deltoid, 1 Not 18th Pennsylvania Volunteers, as reported by MITCHELL. MOREHOUSE, and KEEN, lac. cit., p. 64. WOUNDS AND COMPLICATIONS. fCll.\p XH. where there is great tenderness, and ;v good deal of hardening and deposit in the subcuticular tissues and over the bone. The only muscle which is hypersesthetic to any marked degree is the biceps. The course of the musculo-cutaneous and the median nerves is acutely tender upon pressure. Motion: None in the pectoralis major, scarcely perceptible in the biceps, the supinator longus alone Hexing the forearm. Extension of forearm perfect. The fingers act in flexion feebly, but are improving. The thumb motions are also weak but not lost. Motion is now most limited by the state of the linger joints, which, although no longer tender, are stifl and enlarged. So much improvement has taken place very recently that we cannot be sure as to what motions were lost. Probably the principal nerves of the external cord of the plexus, namely, the musculo-cutaneous and the median, were those chiefly affected ; certain filaments of the posterior strand, as the circumflex, also sharing in the diseased condition. * The case was improving when admitted, and it gained ground with increased speed under a course of baths, gymnastics, and faradization. Examiner D. Clarke, of Flint, Michigan, reported, September, 4, 1877: "Suffers most from an affection of the nerves, causing partial paralysis of the arm, and of late extending to the leg, with darting pains. Pressure on the front cicatrix produces numbness, with a prickly sensation down the arm. Same effect produced by rubbing the spine." lu March, 1882, the pensioner was an applicant for increase. The immediate effects of injuries by gunshot missiles upon nerve trunks are charac terized by shock, pain, and partial or complete loss of motion or sensation, the latter symp toms being peculiar and diagnostic of such lesions. The persistence and severity of these symptoms and the extent of loss of function vary within very wide limits, and seem to indicate, in some degree, the remote effects generally to be expected. CASK 1083. Captain Charles P. Johnson, 17th Iowa, aged 21 years, was wounded, on May 14, 18G3, at Jackson, Miss., by a spherical musket ball, which entered the buttock at the left side on a level with the great trochanter, passed through the great sacro-ischiatic notch, traversed the sacrum, and made its exit on the right side through the right great sacro-ischiatic notch one inch above the right great trochanter, cutting the rectum, together with many blood-vessels, nerves, and muscles which supply the pelvis and lower extremities. At the time of the injury he was in perfect good health, weighing 200 pounds, and measuring six feet one inch in height. He fell and was earned to a house near by, where he was taken prisoner, and sent, a month later, to Atlanta. He remained a prisoner for seventeen months, until liberated by General Sherman in 18C4. He was then sent to Beuton Barracks, and mustered out of service in 1865. He then moved to Alton, Illinois, and finally came to Garden Grove, Iowa. During all this time he was never able to stand erect or turn upon his back or either side ; but lay prone upon his face, passing his life upon a couch, from which he could never by any voluntary effort move. Assistant Surgeon John V. R. Hoff, II. S. A., who made a careful examination of the patient in February, 187(5, reported : " The following tissues must have been involved to a greater or less extent, either in the wound itself or in the inflammation consequent upon it : most of the muscles arising from posterior aspect of pelvis, external and internal ; several branches of external iliac artery; great sciatic nerve and numerous smaller nerves arising from it, and the sacral plexus; also some of those of the sympathetic system, and finally the rectum. I could not discover that any osseous tissue had been primarily involved. The patient remarked that small pieces of what appeared to be dead bone had occasionally been discharged while the wound was open, and from the fact that it re-opened several times it is reasonable to suppose that there was a certain amount of necrosis ; but from the direction of the wound, and the fact that no history of bone trouble is given by his medical attendants, I take it that, if there was necrosis, it was due to inflammation, and not to the primary effects of the wound. For six weeks immediately following the injury the faeces v^ure passed through both orifices of the wound, and not at all by the natural opening. After that they were evacuated both by wound and anus ; then by anus alone ; then from time to time, as the wound re-opened, again by wound ; till finally, in 1672, the fistulae healed entirely and spontaneously. The treatment of this case consisted solely in the administration of anodynes, tonics, and laxatives. No surgical procedure has been attempted further than to keep the wound in the most favorable condition for healing. Much of the time patient has been without professional advice, and while a prisoner often wanted for the bare necessities of life. Present condition : Mr. Johnson informs me that since being wounded his health was best two years ago, from which time it has gradually failed. The face is pale and emaciated, body shrunken till little is left but skin and bones; the muscles of the gluteal region have almost entirely disappeared, giving a peculiar flattened appearance to the buttock. The lower extremities are almost entirely devoid of motion, and, except anterior of the thighs, of sensation; they are cold to the touch, and have little muscular or adipose tissue; leg at lower third measures six inches in circumference; thigh, middle third, twelve inches; joints all stiff (doubtless from want of use). Upper extremities comparatively well developed, due to constant exercise: I judge the: weight of body would not exceed seventy pounds. Patient rests alternately on breast and elbow (the body as stated being horizontal, face downward), sleeping in the former position, eating, reading, etc., in the latter. Spinal cord is very sensitive to pressure throughout its whole extent ; pain is constant, referred to sacral region, and is only rendered bearable by the habitual use of anodynes. Patient is generally neuralgic. Skin pale but natural in appearance and feeling (at upper portion of the body) ; perspiration free, sometimes copious; pulse weak and irregular ; heart action irregular, with ansomic murmur; respiration normal ; tongue coated and fissured ; appetite for both solids and fluids capricious ; bowels constipated. This has been the case since 18G7, necessitating the habitual use of laxatives (probably in a measure due to the opium habit) ; previous to that time, more especially while a pris oner, there wan constant diarrhoea, the dejections often passing involuntarily; now, under the influence of cathartics, the move ment* are regular, but always accompanied by moi*e or less pain referred to the rectum, especially when the fteces are in the least degree hard, at which time the rectum seems without expulsive power. The rectum has partially recovered its integrity, the wounds (about five inches above the anus) have closed, leaving a slight cicatricial contraction and a certain amount of torpidity, which may be an additional cause of constipation. The sphincter ani muscle is normal. Bladder is somewhat irritable, but when not allowed to become over distended is entirely under control. Other viscera than those mentioned were not examined, for the reason that any movement caused suffering. The patient has several times, with assistance, attempted to stand erect and to change his position to the back and sides ; but never succeeded, and has given up all hope of ever recovering the use of his lower extremities. CHAP, xir.] SHOT WOUNDS OF NERVES. 743 He has consulted eminent surgical authority, and was advised against resorting to any operative interference, as such offered little promise of successful results." Captain Johnson died in 1879. In a subsequent report, dated December, 1879, Dr. Hotf states : "The general clinical features of this case, so far as I could ascertain, remained unchanged from date of examination up to the autumn of 1877, when, while out driving, Captain Johnson was overtaken by a severe rain storm, from the effects of which, his wife says, he never fully recovered. The exact immediate condition obtaining after this exposure, I regret to say, could not be learned, as the case at that time did not fall under observation of a physician, and the attendants descriptions were vague and general. I infer that there was no pulmonary complication ; in fact, it was stated that the lungs remained remarkably healthy. The exposure to storm seemed to precipitate a condition of general asthenia; patient lost all ambition and hope, refused to take accustomed exercise (in carriage), and failed perceptibly. The circulation in lower extremities, heretofore weak, now became deficient ; the limbs were benumbed, and the toes, to borrow the patient s own expression, seemed as though they were breaking off. Pain was always present, and in greater degree after the exposure of 1877. From this time his appetite became more capricious, though digestion was apparently good, there being nothing, his attendant said, that he could not eat at times. The bowels were constipated, the result of causes already described. Micturition frequent and painful, the quantity of secretion estimated as less than normal (no chemical examination of urine was made). There was marked change in the patient s psychi cal condition: memory failed, he became exacting, demanded constant attention, though not irritable, and suffered continuously from insomnia. In July, 1878, an eczematous eruption appeared on the genitals, spreading upward and downward to epigastrium and knees, covering the entire abdomen. This lesion discharged a copious and exceedingly offensive secretion, continued acutely for nine weeks, and never entirely disappeared. The greatest difficulty was experienced in treating the cutaneous lesion, on account of the necessarily prone position of the patient. A physician, Dr. Todd, was called and attempted to remove pressure by propping the patient on his side with pillows. This posture very soon became unbearable, and the patient urgently demanded to be returned to what he called his natural position, which was done. The eczema, joint offspring of the general asthenia and local nervous conditions, probably excited by the difficulty of absolute cleanliness, added impetus to causes already hastening the final result. After the appearance of the eruption, says Dr. Todd, there was a gradual though well-marked decline of powers, the digestive organs losing tone, and vomiting was not infrequent. The wound never re-opened; there was no abscess and no observable fever. Pain in sacral region, as always, was severe, and in the latter months of life this extended to the lumbar region, causing intense suffering. Alcohol and anodynes were used extensively throughout the whole course of the case morphia being taken to the average extent of 8 J grains per diem. No post-mortem examination was made." Instances of immediate death from injuries of nerve trunks are probably rare, though it is not difficult to conceive of such disturbance of central ganglia as may induce a fatal result. The records of this office indicate the frequency with which tetanus developed itself in the early progress of wounds of nerve trunks, and how generally fatal it proved. Nervous spasms were of frequent occurrence, but were, as a rule, easily controlled. The important labors of Mitchell, Morehouse, and Keen in the vast field presented by the organization of a hospital for diseases and injuries of nerves cannot be seen to better advantage or be better appreciated than in their clinical observations upon the remote effects of nerve injuries. 1 "Most of the cases presented phenomena which are rarely seen and which were naturally foreign to the observation even of those surgeons whose expe rience was the most extensive and complete. Nowhere were these cases described at length in text-books, and, except in a single untranslated French book, their treatment was passed over in silence, while even in the volume in question but a limited class of nerve lesions was discussed. In the great monographs on military surgery this defect is still so complete that wounds of nerves are there related rather as curiosities, and as matters for despair, than with any view to their full clinical study and systematic treatment." In cases of nerve injury, immediate symptoms, when not severe, may pass away, leaving the patient uninjured, but by far the more common result is that, while there may be a temporary improvement, there is a permanency of certain symptoms, especially those of paralysis of movement and sensation. As time progresses others are added which give the case a hopeless aspect, viz: altered nutrition, changes in calorification, persistent pain, and other sensory phenomena. On the subject of altered nutrition, Mitchell, Morehouse, and Keen (loc. cit., p. 69) remark: "Atrophy of the muscles of an entire member is sure to follow complete division of its nerves when there is no subsequent repair. In this case the muscles waste alike, the areolar tissue shrinks, the vessels fade from view, and the pulse becomes feeble and MITCHELL, MOIUCUOUSE, and KEEN, Gunshot Wounds and Other Injuries of Nerves, Philadelphia, 18(J4, page 10. 744 WOUNDS AND COMPLICATIONS. [CHAP. xn. small. The rate at which this process goes on varies greatly, but it begins very early in extreme cases, and continues until nothing is left but bone and degenerated areolar structures, covered with skin, whose altered surface tells of the singular blight which has fallen upon the member. * * * Partial atrophy is due, of course, to partial nerve lesions. The filaments which supply a group of muscles may have suffered, or only those of one or more muscles, or, finally, a part only of the nerve fibres of one muscle. In some cases the loss is equal throughout a muscle; in others it affects a lateral or longitudinal part of a muscle. Among the injuries which fail to palsy a limb at once and completely, those which bruise a nerve have seemed to us to be the most likely in the end to cause atrophies." The effects of altered nutrition upon the skin and appendages are thus described by Mitchell, Morehouse, and Keen (loc. cit., p. 77): "Early in the case it is found associated in most instances with oedema of the part, and is one of the remotest effects of the loss of nervous influence. The skin becomes thickened and dry, the epithelium hangs in patches here and there and is yellow or even pale brown in tint. These peculiarities are in part owing to mere disuse; but this in no way applies to the changed form of the nails, which become curved as in tubercular disease, although to a less degree than in the other form of cutaneous affection, which is caused by partial injuries of the nerves. In fact, it may be stated as a rule, that the skin and subcuticular tissues are less strikingly altered in entire paralysis than in cases of lighter nature." A second form of altered nutrition of the skin was not infrequently seen; it has been noticed by Paget: 1 "Glossy fingers appear to be a sign of peculiarly impaired nutrition and circulation due to injury of nerves. They are not observed in all cases of injured nerves, and I cannot tell what are the peculiar conditions of the cases in which they are found; but they are a very notable sign, and are always associated, I think, with distressing and hardly manageable pain and disability. In well-marked cases, the fingers which are affected (for this appearance may be confined to one or two of them) are usually tapering, smooth, hairless, almost void of wrinkles, glossy, pink or ruddy, or blotched as if with permanent chilblains. They are commonly also very painful, especially on motion, and pain often extends from them up the arm. In most of the cases this condition of the fingers is attended with very distinct neuralgia both in them and in the whole arm, and its relation to disturbance of the nervous condition of the part is, moreover, indicated by its occasional occurrence in cases where neuralgia continues after an attack of shingles affecting the arm. In two such cases I have seen this same condition of the fingers well marked, and only very slowly subsiding, and seeming unaffected by the ordinary treatment of neuralgia." Mitchell, Morehouse, and Keen state that out of fifty partial nerve lesions under their charge, this condition existed in nineteen, and their description of the symptoms agrees with that of Paget just given. An instance has been cited on page 1020 of the Second Surgical Volume (CASE 2046), and the appearance of the hand and fingers is faithfully shown in PLATE LII, opposite page 1020 of the same volume. This condition seems to have occurred in cases of injury in which there was not complete destruction of the nerve and during healing. Its duration was variable, in favorable cases disappearing after a few weeks. Pain was an invariable attendant upon these cases. Eczematous eruptions were a frequent accom paniment of this condition of the skin. In many cases of altered nutrition the hair was observed to disappear from the affected region, and a remarkable alteration in the nails was noticed, which is thus described by Mitchell, Morehouse, and Keen (loc. cit., p. 81): "They 1 I AGKT, Clinical Lecture on Some Cases uf Local I aralysis. in Medical Timts and Guz/tte, London, March x. b, 1BG4, Vol. I, p. U32. CHAP. XII.] SHOT WOUNDS OF NERVES. 745 [the nails] suffer only in the fingers the neural supply of which has been interfered with, so that the nails in the median distribution may be contorted and those in the little finger be unaffected. The alteration in the nail consists of a curve in its long axis, an extreme lateral arching, and sometimes a thickening of the cutis beneath its extremity. In other instances a change takes place which is quite peculiar, and which, to us at least, was new. The skin at that end of the nail next to the third finger joint becomes retracted, leaving the sensitive matrix partly exposed. At the same time the upper line of union of skin and nail retreats into or under the latter part, and, in place of a smooth edge, is seen through the nail as a ragged and notched border. The patient who presented these changes in the most striking form had also lateral arching of the nail, but no longitudinal curving. It was a case of the most terrible suffering, from a combination of burning pain in the hand and neuralgic pain in the forearm. * * * When the nails of the toes have been attacked, and they are very rarely so, the curving is less marked, but a distressing ulceration is apt to occur at their angles, and to break out again and again, despite of every care and attention." Of altered nutrition of joints, Mitchell, Morehouse, and Keen (loc. cit., p. 84) observe.: "It consists essentially in a painful swelling of the joints, which may attack any or all of the ar.ticulations of a member. It is distinct from the early swelling due to the inflamma tion about the wound itself, although it may be masked by it for a time; nor is it merely a part of the general cedema which is a common consequence of wounds. It is more than these, more important, more persistent. Once fully established, it keeps the joints stiff and sore for weeks or months. When the acute stage has departed, the tissues about the articulations become hard, and partial anchylosis results, so that in many cases the only final cause of loss of motion is due to this state of the joints. Of all the agencies which impede movement it is the most difficult to relieve." It was found in the cases of wounded limbs that after complete division of nerves the secretions of the skin were generally absent, while incomplete division led to variable con ditions of this function. In some cases there was excessive sweating, which was limited to the area of the surface affected. There were also noted cases of perverted secretion, as acid sweating and perspiration of a disgusting odor. The following cases well illustrate the con dition above described: CASK 1034. Kilian Grim, aged about 20 years. German, enlisted August, 1861, Co. B, 121st Pennsylvania. Healthy until wounded, but exhausted and ill-fed for three days before being hurt. At Fredericksburg, December 13, 1862, a ball passed through the lower third of the thigh, entering externally four inches above the upper border of the patella, and emerg ing two inches lower on the inside. It went behind the bone, entered the right leg below and behind the knee, and, traversing the calf obliquely downward, made its exit on the other side. In the right leg no large nerves were injured. In the left the sciatic must have been slightly affected. He was able to walk several miles with his limbs thus wounded. The chief difficulties in his case, when we examined him in July, 1863, were severe burning on top of the left foot, congestion and eczema, without marked redness or thinning of the skin, but accompanied with ulceration on the edges of the nails. This existed also in the great toe of the right foot, which had defective sensibility. He had complete paralysis of all the flexors of the foot, partial of the/ecr. com. dig. pedis and of the calf muscles. He could walk, but dragged the foot, or else carried it in a long sling. All of these muscles improved under treatment ; the burning grew better, and the eczema left his foot, but the ulcers proved unman ageable. After five months treatment he was discharged, with more or less volitional control over all the muscles affected. At no time had he any marked atrophy. CASE 1085. Admitted about the same time as the last was another instance of ball wound close to the sciatic nerve. Here also was burning on top of foot. Defective sensation of touch on the outside of the foot and the leg, in the sole and the toes, and part of the instep. Loss of power in the flexors of the foot complete. Eczema coming in crops about every two weeks as high up as to the knee, and with relief to the burning. Foot swelled when dependent, and this increased the pain to an unbearable degree. Nearly total relief of all the symptoms in five months, when he was transferred to the West. Cessation of the electricity at this time. Partial relapse as to movement. No further history. CASK 1086. Austin Lawton, machinist, aged 20 years, enlisted April, 1861, Co. A. 4th Ohio. Wounded at Chaneellors- ville, May 3, 1863, by a piece of shell, which fell on the inside of the arm just below the axilla. The skin waa torn slightly and the parts severely bruised. His fingers clutched the ramrod, which he was using, and required force to unlock the grip. Pain SURG. Ill 94 746 WOUNDS AND COMPLICATIONS. [CHAP. xn. in the hand, of a burning character, came on, he says, within a few minutes, and has remained ever since. So severe was it that he was in bed on account of the paiii alone for nine weeks. The hand is now kept in a sling and constantly covered with wet cloths. Sensation impaired in the back of the forefinger and thumb and in the radial half of the palm. The tlexor profun- dtis digitorum and the flexor subl. d uj. were both very feeble, but they soon regained power when faradized, during a few weeks. It was then perceived that the real difficulty lay in the stiffened and painful state of the joints at the second and third digital articulations. Passive motion and the usual treatment of the burning were ordered, with almost total return of normal move ment, but without any ease to the burning. After two months he preferred to return to his regiment for light duty as orderly to the colonel. Besides illustrating the phenomenon of excessive skin secretion, the following case presents with unusual clearness the group of symptoms which may attend lesions of nerve trunks; in many cases one or two of these symptoms may predominate; but here they all seem to be strongly marked, as pain and burning hyperaesthesia of the skin, partial paraly sis of sensation and motion, excessive skin secretion and commencing impairment of nutrition. In addition reflex action is well shown. CASE 1087. Private William A. Sturdy, Co. I, 18th Massachusetts, aged 22 years, was wounded at Bull Run, August 30, 1862, receiving an injury of the right arm. He was admitted, on September 2d, into Camdeu Street Hospital, Baltimore, and on September 19th was transferred to West s Buildings Hospital. Here he remained until April 29, 18(53, suffering from neural gia. He was afterwards treated in Lovell Hospital, Portsmouth Grove, and on May 23, 1863, was admitted into Central Park Hospital, New York. Acting Assistant Surgeon M. G. Echeverrio reported: "The ball entered the posterior and superior part of the outer face of the right arm and came out through the union of the two inferior with the superior thirds of the inner border of the biceps brachialis. There was scarcely any inflammation of the wound upon its infliction; the arm became numb, and the first night after he was wounded he had severe pain in the hand which has continued ever since, existing principally in the thumb, index and middle fingers. Sensibility has been impaired in the forearm and hand. Electricity was applied in the beginning for a period of three or four weeks, with very little success. August 16, 1863 : There is now hyperaesthesia, and the skin of the hand is constantly wet with perspiration. Pressure of the wound produces a burning pain in the three fingers affected ; their movement is likewise very much impeded and the nutrition of their muscles has been diminished; they exhibit a beginning of atrophy The temperature of the hand is not different from that of the other hand, nor does the pulse in the right forearm exhibit any marked difference to that of the left. The touch of a rough surface with the left hand produces, by reflex action, a more or less severe pain in the paralyzed fingers of the right hand. This phenomenon may be repeated several times, and when discontinued a great deal of the left hand is wet. An ointment composed of four grains each of aconitine and atropine to an ounce of cerate has brought about great relief of the neuralgic pain, but the paralytic condition of the fingers remains always the same." This soldier was discharged from service August 16, 1863, for "neuralgia of right hand, the result of gunshot injury," and pensioned. Examiner J. 13. Chase, of Taunton, Massachusetts, reported, May 16, 1877 : " The bullet struck the right arm near the junction of the upper and middle thirds of the humerus, on the outer and posterior surface of the arm (it being raised at the time), and passed directly through on the inner side of the humerus without injuring the bone, and emerged near the head of the biceps muscle, injuring the brachial nerve. The circumference of the right arm is 10| inches, of the left arm 11 inches; of the right forearm 10 inches, of the left 10J inches. The radial nerve is partially paralyzed. The muscles of the right thumb, particularly the abductor, are very much smaller than those of the left, and the forefinger is smaller than the left. He cannot fully rotate the forearm nor fully extend the elbow. He says his right forefinger and thumb are very weak, and alleges pain in the thumb, index, and side of mid dle finger next the index, and that they are cold. Pressure at place of exit of bullet causes pain along the course of the radial nerve." Lesions of sensation were always present in some degree. Hyperaesthesia and anaes thesia were commonly observed. The following case shows how sensation may be pre served while motion is largely impaired : CASE 1088. Corporal B. Graham, aged 22 years, enlisted September, 1861, Massachusetts Artillery, 5th Battery. Pre viously healthy. On May 12, 1864, he was struck on the back and outside of the right arm by a piece of shell which denuded but did not break the humerus. The wound lay immediately below the deltoid insertion, and was five inches wide as it stretched across the arm, and three inches in diameter from above downward. The arm dropped and he had sharp pain in the wound, se that he cried aloud. The after pain was trifling. As he went to the rear he examined the limb and found that he could move his fingers a little, but that there was no notable loss of feeling. The wound healed rapidly, and is now, June 10, 1864, level with the skin. Nutrition is unimpaired. The right forearm measures 9| inches, the left 9| inches. Outside of the elbow, for a short space, tactility is enfeebled. In the radial distribution touch is slightly less perfect than usual; elsewhere there is no lesion of sensation. The supinator longus muscle, supplied by the musculo-spiral, acts pretty well. The extensors of the wrist and thumb and the extensor communis are completely paralyzed. The interossei act well. The triceps extensor is healthy. The muscles above named as paralyzed have no electric contractility, the currents applied to them always causing contraction of the flexor group. He was discharged September 14, 1864. Neuralgia was of great frequency and of great persistence, stubbornly resisting treat ment. Its favorite seat seems to have been the hand and foot; other parts of the body were rarely attacked. Severe neuralgia was in some instances due to the presence of CHAP, xn.) SHOT WOUNDS OF NERVES. 747 foreign bodies, such as fragments of lead from a bullet, splinters of wood, iron, or bone pressing upon or embedded in a nerve trunk; the pain resulting from such causes were always more acute -and persistent. "The intensity of neuralgia varies from the most trivial burning to a state of torture which can hardly be credited, but which reacts on the whole economy, until the general health is seriously affected." (Mitchell, Morehouse, and Keen, op. cit., p. 102.) The temperature of affected parts was found to be higher than that of surrounding or corresponding portions of the body. The following case illustrates this painful condition: CASE 1089. J. H. Corliss, late private, Co. B, 14th N. Y. S. M., aged 27 years, shingle dresser, enlisted April, 18G1, in good health. At the second Bull Run battle, August 29, 1862, he was shot in the left arm three inches directly above the internal condyle. The ball emerged one and a quarter inches higher, through the belly of the biceps, without touching the artery, but with injury to the median and ulnar nerves. He was ramming a cartridge when hit, and "thought he was struck on the crazy-bone by some of the boys for a joke." The fingers of both hands flexed and grasped the ramrod and gun tightly. Bringing the right hand, still clutching the ramrod, to the left elbow, he felt the blood and knew he was wounded. He then shook the ramrod from his grasp with a strong effort, and unloosened with the freed hand the tight grip of the left hand on the gun. After walking some twenty paces he fell from loss of blood, but, still conscious, attempted to walk several times and as often failed. He was finally helped to the rear, taken prisoner, lay three days on the field without food, but with enough water to drink, and had his wounds dressed for the first time on the fourth day, at Fairfax Court House. On the second day the pain began. It was burning and darting. He states that at this time sensation was lost or lessened in the limb, and that paralysis of motion came on in the hand and forearm. His statement is unsatisfactory and indistinct. Admitted to the Douglas Hospital, Washington, D. C., September 7, 1862. The pain was so severe that a touch anywhere, or shaking the bed, or a heavy step, caused it to increase. The suffering was in the median and ulnar distribution, especially at the palmar face of the knuckles and the ball of the thumb. Motion has varied little since the wound, and as to sensation he is not clear. Peter Pineo, Surgeon, U. S. V., now Medical Inspector U. S. A., exsected two or three inches of the median nerve at the wound. ( See Army Medical Museum Specimen No. 959.) The man states, very positively, that the pain in the median distribution did not cease nor imme diately lessen, but that he became more sensitive, so that even the rattling of a paper caused extreme suffering. He "thinks he was not himself" for a day or two after the operation. It seems quite certain that the pain afterward gradually grew better, both in the ulnar and median tracts. Meanwhile the hand lay over his chest, and the fingers, flexing, became stiff in this posi tion. About a week after he was shot the right arm grew weak, and finally so feeble that he could not feed himself. He can now, April, 1864, use it pretty well, but it is manifestly less strong than the other. The left leg also was weakened, but when this began he cannot tell. He gives the usual account of the pain, and of the use of water on the hands and in his boots, as a means of easing it. Present condition, April, 1864: Wound healed; cicatrix of the operation two and a half inches long over median nerve. The forearm muscles do not seem to be greatly wasted. The interosseal muscles and hypothenar group are much atrophied, and the hand is thin and bony. The thenar muscles are partially wasted. The skin of the palm is eczematous, thin, red, and shining. The second and third phalanges of the fingers are flexed and stiff; the first is extended. Nails extra ordinarily curved, laterally and longitudinally, except^ that of the thumb. Pain is stated to exist still in the median distribu tion, but much less than in the ulnar tract, where it is excessively great. He keeps his hand wrapped in rags wetted with cold water and covered with oiled silk, and even tucks the rag carefully under the flexed finger-tips. Moisture is more essen tial than cold. Friction outside of the clothes, at any point of the entire surface, "shoots" into the hand, increasing the burning in the median sometimes, and more commonly in the ulnar distribution. Deep pressure on the muscles has a like effect, and he will allow no one to touch his skin with a dry hand, and even then is careful to exact a tender manipulation. He keeps a bottle of water about him and carries a wet sponge in the right hand. This hand he wets always before he handles anything; used dry, it hurts the other limb. At one time, when the suffering was severe, he poured water into his boots, he says, to lessen the pain which dry touch or friction causes in the injured hand. So cautious was he about exposing the sore hand that it was impossible thoroughly to examine it; but it was clear to us that there was sensibility to touch in the ultimate median distribu tion, although he describes sensation as somewhat lessened in this region, and states that he has numbness on the inner side of the palm and in the third and fourth fingers (ulnar tract). When the balls of the first and second fingers were touched he said lie felt it; but, on touching those of the third and fourth fingers, he refused to permit us to experiment further, and insisted on wrapping up and wetting the hand. He thus describes the pain at its height: "It is as if a rough bar of iron were thrust to and fro through the knuckles, a red-hot iron placed at the junction of the palm and thenar eminence, with a heavy weight on it, and the skin was being rasped off his finger ends." (Mitchell, Morehouse, and Keen, loc. cit,, p. 109.) The following informa tion was received from Douglas Hospital, under charge of Surgeon Peter Pineo, U. S. Vols.: "The ball passed through the inner and anterior part of the arm at the junction of the middle and upper thirds, apparently involving the median nerve. He entered this hospital September 1, 1862, suffering excruciating neuralgia of the palmar portion of the hand and fingers. The wound healed kindly, but the pain in the hand continued in its intensity, yielding to no treatment, though nervous remedies, both local and constitutional, were resorted to. The extreme suffering produced an exalted sensibility of the entire nervous system which manifested itself in an extraordinary excitability of the patient, he complaining bitterly at the least jar or noise in the ward. This sad condition increased in severity until December 9, 1862, when the operation of resection of the median nerve was performed by Dr. Peter Pineo, in charge of the hospital. The patient being etherized, about two inches of the nerve was removed and the wound closed by adhesive strips. After the effect of the ether passed off the patient still complained of much pain in the hand, but seemed to think it was not so intense as before the operation. The patient s appetite continued good through all this suffering, and he was allowed a liberal diet, For several days after the operation the patient was allowed sulphate of 748 WOUNDS AND COMPLICATIONS. [CHAP. xn. morphia ; . but it was soon entirely withdrawn. The wound healed by first intention, but there seemed to be no positive improve ment in regard to the neuralgia until December 14th, five days after the operation, when he was moved to a separate room; after which the hypersesthesia seemed perceptibly to subside. February 14, 1863, the patient was discharged from the service at his own earnest solicitation. At this time he was able to walk about the room at night, but still suffered very much from the slightest excitement." Examiner J. T. Burdick, of Brooklyn, reported, October 23, 1866: "A ball perforated the arm three and a half inches above the condyles, injuring the median and ulnar nerve trunks. He alleges that two inches of the median nerve were excised by the surgeon; the existence of a longitudinal eschar three inches in length tends to confirm the statement. The fingers are rigid^- flexed into the palm. The arm and hand are atrophied. In my opinion the disability is equal to the loss of the arm. The Brooklyn Examining Board, Drs. McCollom and Leighton, reported, September 18, 1873: "Contraction of thumb and fingers into palm of hand. Extreme sensitiveness of the fingers. Arm and hand useless." Paralysis of motor nerves from gunshot injury was found to vary in all degrees of severity and completeness, resulting from blows, wounds, concussions, arid from transferred irritation. In the following instance a slug remained in the left shoulder for twenty years, when it was accidentally disturbed in its resting place by a fall of the patient. Paralysis of the left arm and left leg ensued, but was completely relieved by the removal of the slug: CASE 1090. Sergeant C. A. Norton, 1st Maine Cavalry, aged 22 years, while out with a scouting party was wounded, August 7, 1862, by a rebel hid in a cellar, by three leaden slugs, one striking the right hip, another the right arm, and the third lodging in the left shoulder. The wounds in the hip and arm were slight and occasioned but little pain and healed in twenty days; the wound in the left breast and shoulder was deep and produced peculiar sensation. The slug entered just over the third left rib about on a line with the middle of the clavicle, and passed upward and backward, lodging in the deep muscles. When hit the patient instantly fell forward but did not become unconscious, although it was some moments before he could speak. The mind was unusually active and incidents of his childhood, long forgotten, passed rapidly in review. The pain at first was of a sharp tingling kind, accompanied by a beating, throbbing sound in the left ear, and the eyes became very sensitive to the sun light. All these symptoms gradually disappeared, and in two months he rejoined his command. In about a year his eyesight had so failed that he was compelled to use positive glasses, and he also had frequent attacks of neuralgia of the heart. These conditions remained unchanged for twenty years; the wound in the shoulder occasioned no further inconvenience until May, 1882. But he could at any time, by simply striking the heel of the left foot smartly on the ground, produce a numb feeling on the left side of the body, including the arm and head. In May, 1882, he fell down a flight of steep stairs, striking the left shoulder in the fall. At first he had a faint deathly feeling at the stomach, and a sharp smarting pain in the left hand and arm and down the spine. These symptoms gradually wore off, and the next morning he only felt a slight soreness from the bruise. About noon the day after the fall, while writing, he found he had suddenly lost the power to move the fingers of the left hand, and in a moment the arm became useless. He was writing at the time with the left hand, having lost the right arm at Fort Fisher in 18u5. He could not rise from his chair, for the left leg was also powerless. lie was at once removed to his home, where it was found that he had paralysis of the whole left side, with complete loss of sensation, not being able to feel the deep prick of a pin. The eyes were very sensitive to the light, and the voice was weak and tremulus. In four days he so far recovered as to be able to walk, but the arm and hand remained almost useless. Feeling that the slug in the lefy shoulder was the cause of this trouble, he had it remove*! in June, 1882, twenty years after receiving the wound. It was about as large as a common lead pencil, three quarters of an inch long, flattened at both ends, and weighed at the time of removal 129 grains. After the removal of the slug the numbness and coldness gradually disappeared from the hand and arm, and in three weeks he could hold a pen and write a few moments at a time, and in six weeks, with the exception of a slight weakness, the hand and arm were as well as ever. The eyesight, which for nineteen years had compelled the use of glasses, improved so much that the glasses were not needed or used, and the neuralgia of the heart, of which he had so long suffered, had not made its appearance in September. In the work of Drs. Mitchell, Morehouse, and Keen, so freely quoted, the diagnosis and prognosis of this class of injuries are succinctly stated (op. cit., p. 120): The diagnosis of this paralysis is of course easy. A ball cuts a nerve, or, as is more common, stuns or contuses it, and we have certain muscles made powerless. In a few days, if the nerve injury has been partial, some of these muscles improve or recover entirely. In other cases, weeks or months go by without change for the better, and the muscles fall victims to atrophy and contraction." As to prognosis: "Of course every case of partial loss of function is more likely to recover than one of total loss, and if the will has any control over the muscle after the injury we may reasonably look for an increasing gain. But there are varieties of mus cular injury outside of the mere palsy of volitional control. Early loss of tone in the muscle is a bad sign; rapid shrinking in size is another; and contraction, when this is a nutrient change and not pure spasm, is worse still. They are all due to lesions of nutritive fibres, and are ominous of ultimate deformities and of permanent loss of power. But these signs, already fully discussed, arrive late in the case. It is possible, at a very early date, CHAP. XII.] SHOT WOUNDS OF NERVES. 749 usually within two weeks of the injury, to make a very complete prognosis, by means of electricity, as to the extent of the motor palsy and the probability of its remaining intract able to treatment or not. As results of motor paralysis are found loss of motion from alterations of joints, con tracted muscles, spasmodic affections and tremors. The following cases show the condi tion and phases of injuries affecting motor nerves: CASE 1091. Private Patrick H. Mahoney, Co. H, 13th Iowa, aged 38 years, was wounded at Shiloh, April 6, 1862. On May 7th he was admitted into the hospital at Quincy, Illinois. Surgeon R. Niccolls, U. S. Vols., reported: "Wounded in the left arm; the ball entered near the insertion of the pectoralis major, traversed the axilla^and came out at the lower angle of the scapula, evidently dividing some of the branches of the axillary plexus. Ever since admission he has complained of violent neu ralgia of the wounded arm, and especially of the hand, together with exalted sensibility of the whole surface, so that he starts and complains of pain when touched anywhere. His face is Hushed. Narcotics seem to make but little impression upon him. September 3d : Neuralgia now confined to the hand. Flush and sensibility of surface nearly gone. Bowels regular; sleeps well. Pulse 112, full and strong. Muscles of forearm somewhat atrophied, of hand completely so. Flexors and extensors of fingers contracted so as to bend the fingers like the letter S. Skin of hand bright red, partially from the constant use of water dressings. Has very little motion of the fingers. The galvanic battery was tried at one time, without effect. September 15th : The pains appearing to be somewhat periodical, a mixture containing quinine 30 grains, tincture of aconite 40 drops, strychnia grain, aro matic sulphuric acid q. s., and water 4 ounces, was given in tablespoonful doses every six hours. This prescription seemed to aggravate his pain and was discontinued on the 17th." Mahoney was discharged September 22, 18G2, and pensioned. Exam iner W. H. Walker, of Fond du Lac, Wisconsin, reported, March 15, 1867 : " He was wounded through the upper third of the left arm, injuring the axillary nerve and artery. Hand and arm atrophied and entirely useless for practical purposes. He can use the hand as a dead weight to hold a paper when writing. Cannot hold his fork to cut his meat. Cannot take his hat off with the hand ; it is absolutely useless for manual labor." He was paid December 4, 1876. CASE 1092. J. S. L. Scott, aged 31- years, farmer, New York, enlisted August, 1862, Co. F, 121st New York. Wounded May 3, 1863, at Chancellorsville. The ball entered the right leg a little below its middle, in front of the fibula three-fourths of an inch, and emerged one inch and a fourth behind the tibia, on the same level, without injury to the bones. Total loss of motion below knee; slight of sensation. Pain only on the second day, from inflammation. The after history doubtful, except that sen sation improved. Present condition, September 12, 1863 : The patient walks with a crutch, the foot being suspended in a long sling, in extension, and quite useless. Attempts at flexion resisted by the pinning of the cicatrix and by shortening of the soleus chiefly. (See Specimen No. 6682, in the Army Medical Museum, a cast of the foot and ankle.) Sensation impaired slightly in the foot, but nowhere lost. The leg and thigh muscles slightly tender on pressure. The foot feels warm, the toes are cold and purple. No burning. Treatment : Alternate cold and hot douches ; splint to correct malposition ; faradization daily. October 26, 1863, re-examined: Tactility and localization nearly perfect; cold and heat are appreciated correctly, although slowly; sensibility to pain much impaired below the knee, but lost at the outer head of the gastrocnemius and on the outside of the foot ; volitional control lost from the knee downward ; electric contractility feeble in the tibialis anticus, extensor longus digitorum com., and extensor proprius pollicis ; it is best, though weak, in the peroneus lougus. In none of these, nor elsewhere, are the contractions sufficient to stir the parts. None of the calf muscles respond at all, and electro-muscular sensibility is absent in all except at the upper end of the external origin of the gastrocnemius. Withal, there is no atrophy. The electric brush gives little or no pain on the dried skin. The muscles, or, at all events, the subcuticular tissues, are sore when firmly pressed, especially the great toe and the inside of the plantar arch. It is difficult to reconcile this with the analgesia so evident where a needle is used. It is remarkable, but in accordance with M. Duchenue s experience, that above the wound the muscles in general have lost electric contractility as well as below it. December 20, 1863 : The anterior muscles have regained sensibility to electricity. A club- foot apparatus was used to flex the foot. January 1, 1864 : Contractility under electricity returning in anterior muscles and calf. No voluntary power. January 20, 1864 : Calf muscles begin to respond to will. Electro-muscular contractility well marked in tibialis anticus, peroueus longus, common extensor, and interossei. Volition good as to calf muscles ; none as to anterior group ; but the foot is now flexed to over a right angle, and when it is cased iu a stout gaiter he can walk well with a cane ; for, although he has no volitional flexion, the weight of the body on the toes and ball of the foot serves to antagonize the calf. The man is anxious to be discharged, although, from the return of electric properties in the tibial group, we feel sure of ultimate cure with the aid of electricity. Under the circumstances we do not feel that it is proper to retain him. Discharged February 12, 1864, and pensioned. Pension Examiner Lanning reported, February 4, 1874, that paralysis of the foot and toes was nearly complete. The pensioner s condition was unchanged in 1876. Carefully conducted experiments on the condition of calorification in injuries of the nerves were made by Drs. Mitchell, Morehouse, and Keen. The results in a number of grave cases are summed up as follows (op. cit., p. 135) : " It was observed that the member the nerves of which were affected was nearly always colder than the other, whether the nerve lesion was extensive or trifling. In two cases there was no difference. One of these was an instance of total motor palsy below the knee, with good tactile feeling preserved and without atrophies. The other was a wound of the portio dura of the seventh nerve ; the motor palsy complete, sensation perfect. Five cases had a higher temperature in the 750 WOUNDS AND COMPLICATIONS. [CHAP. xil. wounded limb than in the sound member. Of these, one was an ordinary nerve wound, with slight loss of sensation and with a good deal of motor paralysis. All of the others were cases of the burning pain so often alluded to. The examination in these was limited to the spot affected. At the time of these observations we had no wounds in which com plete division of all the nerves of a part had occurred ; and in fact this is a rare accident. The sole exceptions were wounds of the seventh pair. One of these we examined as to temperature, but with no notable result. There was no difference between the two sides." EFFECTS OF MISSILES AND PBOJECTLLES ON BLOOD-VESSELS. WoUllds of blood-VCSSCls, the effect of missiles and projectiles, were few in comparison with the total number of shot wounds recorded during the war. In the general consideration of these injuries the question as to the particular character of the missile does not appear to assume much practical importance ; in fact, it is difficult to distinguish the effects of injuries inflicted by one or the other form of more common forms of bullets. It is probable, from the general nature and conditions pertaining to missiles, that a round ball will more frequently contuse than divide a blood-vessel, while the contrary may be expected to result from an injury by a conoidal bullet ; but perforations by round balls have also been noted, as in the following case : CASE 1093. Private Henry Owens, Battery A, 5th U. S. Artillery, aged 23 years, was wounded at Suffolk, Virginia, April 15, 1863, by the bursting of a shell over his head. Surgeon T. H. Squire, 89th New York, reported : "A flesh wound, a mere graze across the right ramus of the lower jaw, near the chin ; a second wound, penetrating, a slit three-fourths of an inch across the side of the neck, over the middle of the sterno-cleido-mastoid muscle, the opening being near three inches from the median line in front. April 18, 1863, the right side of the neck, extending down toward the subclavicular region, is swelled and somewhat emphysematous to the touch. There is some pain in the chest in the region of the mediastinum ; some dyspnoea and cough, and a little spitting of blood on one occasion. Respiratory murmur very distinct, and percussion resonant over the front of both lungs. He died on April 19, 1863. Post-mortem examination at 1 o clock P. M. on April 19th : Countenance livid ; mottled appearance of skin on the right shoulder, arm, and chest; frothing at the lips ; all of the right chest, save a hand s breadth immediately beneath the clavicle, dull on percussion ; left chest resonant on percussion in front. Made one incision through the skin and areolar tissue from the point of the thyroid cartilage down to the umbilicus ; one from the point of commencement, about four inches long, just below the ramus of the under jaw ; and a third at right angles with the first, from the umbilicus, about six inches to the right. Dissected back this whole flap, including skin, superficial fascia, and pla- tysma myoides. Areolar tissue of the whole right side of the neck injected with dark blood. Discovered the opening caused by the missile to be nearly in the centre of the sterno-cleido-mastoid muscle ; the omo-hyoid muscle was also injured by the ball. Sterno-hyoid and sterno-thyroid uninjured, being toward the median line from the wound. Thyroid gland quite large. Arrived at this point, discovered that the ball had passed through the internal jugular vein about two inches above the clavicle, the wounds of entrance and exit being on the anterior and posterior walls of the vein, the outer and inner third being entire. The vessel from this wound, upwards in the neck, was occupied with a large clot of blood ; par vagum and carotid uninjured ; scalenus anticus perforated, the direction of the ball being downward and toward the spine. On opening the chest a great deal of scrum escaped from the right pleural cavity. There was extensive adhesions of recent false membrane over the whole of the right lung, or the greater portion of it. The ball, after going through all the soft parts, as narrated, struck and fractured the neck of the first rib, also the neck of the second rib, and finally found a lodgement by the right side of the body of the third dorsal vertebra, in the posterior mediastinum. From the right cavity of the chest, after the lungs were removed, the ball could easily be felt with the fingers, lying in the place where its motion was arrested, with nothing but the costal or mediastinal pleura intervening between it and the cavity of the chest. The ball evidently bruised the mediastinal pleura, injured it, but did not make an opening in it. The lung was not inflamed. The ball was round, the size of a common musket ball, and battered on one side. It may be well enough to remark that there was never any bleeding to speak of in this case. By a further and more careful examination of the injury to the vein I find that the ball actually perforated the vessel instead of biting out a piece on one side/ The wounded portion of the right internal jugular vein was forwarded to the Army Medical Museum by Dr. Squire, and is numbered Specimen 1055 of the Surgical Section. A part of the parietes of the vein is carried away, and in the posterior portion an orifice is seen, through which the contributor considers the missile passed. Distorted balls, pieces of shell, fragments of stone and iron, and splinters follow the general rule common to all missiles, by contusing, cutting, and puncturing blood-vessels. The graver lesions due to the impact of large projectiles are so manifest in their charac ter as to need no comment. The position of the larger trunks of the principal blood-vessels tends to give them CHAP XII.] EFFECTS OF MISSILES ON BLOOD-VESSELS. 751 immunity from accident. They are deeply placed, sheltered by the bony frame-work, protected by soft parts and by fasciae capable of deflecting the course of a missile ; their investing sheaths and coats are strong and tough ; having a certain degree of freedom of motion they are enabled to slip aside and elude a passing missile ; their tubular form and easily compressed fluid contents are also elements of safety. All of these conditions may have their influence in contributing to the many fortunate escapes from severe, perhaps fatal, injury common to the experience of every military surgeon. CASE 1094. Private Michael Hussey, Co. D, 37th New York, aged 32 years, was wounded, while on picket, at Occoquan, Virginia, February 24, 1862. Surgeon W. O Meagher, 37th New York, reported: 1 " The hall entered the right thigh near the lower angle of Scarpa s space, eluded or pushed aside the femoral vessels, passed upward, and escaped posteriorly in the gluteal furrow. Very little haemorrhage occurred, though he walked a considerable distance back to the picket station. A plug of scraped lint was inserted into each opening and a roller bandage applied, this being kept wet with an evaporating lotion. Next day he was removed to the regimental hospital, and for two weeks following little more was done except to apply a poultice. By this time he was able to walk about, no bad symptom having occurred to rnar his speedy convalescence." On March 5, 1862, he was transferred to the Mansion House Hospital, Alexandria, whence he was returned to duty August 7, 1862. He continued in service until June 8, 1865, receiving at Petersburg, on May 9, 1864, a shot wound of the forehead. In February, 1882, Hussey was an applicant for pension. In the case of Private William McDonald (First Surgical Volume, page 39^7), Go. F, 51st New York, a musket ball lodged between the carotid artery and the jugular vein, pressing the vein forward to such an extent that the vessel was collapsed and little or no blood passed through it. In the case of Captain J. N. Lake (First Surgical Volume, page 412), a musket ball passed on a level with the pomum Adami, between the jugular vein and the carotid artery, without injuring either vessel. Aside from the injuries of large trunks which are immediately fatal, it would appear that the number of cases of wounds of important blood-vessels is small. In the preliminary report (Circular No. 6, Surgeon Generals Office, 1865, page 38) it was stated that " in the campaign of the Army of the Potomac from the Hapidan to the James, in May, June, and July, 1864, of a total of 36,508 gunshot wounds only 27 belonged to this category." Dr. Longmore 2 says: " Out of 4,434 wounds detailed in the British returns of the Crimean War, only 15 wounds of arteries were registered." Surgeon M. Goldsmith, U. S. V., "desiring to learn whether external primary haemorrhage often occurs as the instant result of shot wounds," placed himself "near the line of battle, and observed only one case, a soldier struck in the neck, severing the carotid," and fatal before he could reach him. In the following case the common carotid artery was perforated from before back ward ; death ensued very rapidly : CASE 1095. Lieutenant Colonel E. A. Kimball, 9th New York, aged about 40 years, of well-knit frame and in good health, was shot at Suffolk, Virginia, at about 4 o clock A. M. on April 12, 1863. Surgeon T. H. Squire, 89th New York, reported : "It is said that Lieut. Colonel Kimball uttered a brief ejaculation after he was shot and died almost instantly. A pistol was the arm used ; the person firing was on horseback, the person shot standing on the ground very near him. I examined the body at 3 o clock P. M. Blood was dried on the clothes on the front of his person from the throat to the boots. An opening half an inch in diameter existed in the front of the neck, the edge of it only about a quarter of an inch to the right of the median line, and the centre of the opening being about three-quarters of an inch below the prominent point of the thyroid cartilage. No other open ing existed; but the ball was felt beneath the skin just over the posterior border of the scapula. Here I made an incision and removed it with forceps. Putting my finger in the opening I found that the ball had just made a notch in the border of the blade at the point corresponding to the termination of the spine of the scapula. From the point of entrance the ball took its course downward and backward, but nearly in a direct antero-posterior direction. I made one incision in the medium line from the thyroid cartilage to the top of the sternum, another from the point of commencement toward the angle of the jaw about two and a half inches, and a third from the bottom of the first in the direction of the clavicle about two inches. 1st, Laid back the skin and superficial fascia; 2d, the platysma myoides muscle (the areolar tissue was dark with suffused blood near the wound) ; 3d, divided the lower attachment of the sterno-cleido-mastoid and carried the muscle up and laid it on the reflected skin ; the ball went just to the inner edge of this muscle ; 4th, divided the omo-hyoid and turned it away ; 5th. cut the upper attachment of the EH (W.), Cases in Military Surgery; Gunshot Wound of Thirjh, narrow escape of Femoral Vessels, in American Medical Times, 18fi2, Vol. IV, p. 205. 2 LONGMOUE (T.), Gunshot Injuries, etc., London, 1877, page 150. 752 WOUNDS AND COMPLICATIONS. [CHAP. XII. sterno-hyoid and turned it down (the ball hole was right through the middle of the muscle), and also cut the lower attachment and then the muscle away; 6th, did the same thing with the sterno-thyroid ; 7th, discovered that the ball had made a notch in the edge of the thyroid gland ; 8th, cleared away areolar tissue dark with suffused blood ; 9th, found the common carotid artery absolutely perforated from before backward, there being a roundish opening in the anterior and a somewhat longitudinal one in the posterior wall, the two lateral portions of the tube being entire; 10th, the par vagum and the vein uninjured ; llth, this ball hole in the carotid was used, without any alteration, to insert the syringe pipe to inject arsenic to preserve the body; 12th, the ball was conical and quite a size larger in diameter than the diameter of the artery." The passage of a missile through any part of the body will necessarily divide and lac erate many small blood-vessels, but serious results seldom follow, as permanent retraction of the injured vessels takes place at once. When an artery of size is completely divided by the impact of a large or small pro jectile at high velocity there may be a gush of blood; but the immediate retraction of the inner and middle coats and the formation of a coagulum will generally prevent further haemorrhage and secure the patient for the time at least. In eighty-four of one hundred and eighteen cases of complete division of the larger arteries no primary bleeding was observed, while in thirty-four cases, or 28.8 per cent., the injury was followed by primary hemorrhage. i TABLE OXXIII. Summary of One Hundred and Eighteen Cases of Complete Division of the larger Blood-vessels } indi cating the number of cases in which primary bleeding occurred. ARTERIES. CASKS. RESULTS. PKIMARY BLEEDINGS. NO PUIMAKT BLEEDING. 8 I 1 tf & Recoveries. 1 r- Recoveries. i A Complete division of Common Carotid. 2 1 i i 5 4 2 13 12 15 1 1 6 15 10 fi :n 20 24 3 1 Complete division of Axillary 6 1 o 10 5 <; 4 4 2 5 26 f, 14 (i 18 1 2 3 3 1 1 3 7 3 3 4 3 6 1 Complete division of Radial Complete division of Ulnar Complete division of Femoral 13 o 3 1 Complete division of Popliteal Complete division of Tibials Complete division of Peroneal Aggregates .... 118 :J8 80 11 23 27 57 The proportion of primary bleedings to the number of cases in which the blood-vessels were completely divided is rather larger than that observed by Dr. Lidell, 1 who found that in twenty cases the bleeding ceased spontaneously in all but three. In the following case, in which the posterior tibial was severed, haemorrhage did not occur until thirteen days after the injury: CASE 1096. Sergeant Z. H. Mather, Co. M, 5th Michigan Cavalry, aged 27 years, was wounded near Funkstown, July 8, 1863. He was treated in a field hospital, and was admitted on July 17th to hospital No. 1, Frederick, Maryland. Acting 1 Dr. JOHX A. LlPELL (Surgical Memoirs of the. War of the Rebellion, collected and published by the United States Sanitary Commission, Surgical Volume I, p. 2ti), in commenting- upon twenty cases in which important arteries were completely divided, says: "In all but three of these twenty cases the primary bleeding ceased spontaneously. . . Of the twenty cases wherein the wounded vessel was completely divided by the bullet, the femora! artery was the seat of the injury in five instances, of which all died; the popliteal in four instances, f which two died and two recovered; the posterior tibial in twoi nstances, of which both died ; the axillary in four instances, of which two died and two recovered ; the brachial also in throo instances, of which one died and two recovered ; the internal mammary in one instance, which proved fatal ; and the external carotid in one instance, which recovered. Of the thirteen fatal cases in which the artery was severed, two died of primary haemorrhage, two of secondary haemorrhage, five of gangrene, one of gangrene and secondary haemorrhage, one of pyaemia, and two of exhaustion. . . The analysis of these twenty cases shows that gunshot wounds dividing large arteries are not only very dangerous to life, but that they occasion death in certain determinate ways, the most important of which are primary htemorrhagp, secondary hemorrhage, and conserutive gangrene. CHAP. XII.] EFFECTS OF MISSILES ON BLOOD-VESSELS. 753 Assistant Surgeon W. S. Adams reported : "Wounded by a minid ball, which entered the outer and lower border of the popliteal space, passed inward and downward, and lodged beneath the skin on the opposite side, from which point it was cut out upon the field. Patient s condition fair, and wounds present a healthy appearance. Ordered full diet. July 21st, 6 P. M., haemorrhagf has just taken place from the wound of entrance to the extent of about eight ounces. Compression of the femoral was instituted bv the patient, and when I reached there the haemorrhage had ceased. A compress of dry lint was placed over the wound anl a nurse directed to watch it. At 1 A. M. slight oozing commenced at wound of exit, and at 4 A. M. it gushed out in a consi;! erable stream, but was again controlled by compression of the femoral artery. At this time about four ounces were lost, and, us no bleeding vessel could be observed, a tourniquet was placed over the femoral artery, but not tightened. July 24th, the com presses have been removed from day to day and the wounds dressed, but there has been no recurrence of haemorrhage. Tin- patient is taking tonics and generous diet. July 2(5th, haemorrhage has just recurred. Compression of the femoral controls ii. This time the* patient lost about six ounces. He was etherized, and upon thorough examination it was found th.it the ball h;id severed the popliteal artery and also wounded the posterior portion of the tibia near its articular surface. Taking into consid eration the wound of the bone so near the joint, if not actually involving it, together with the destruction of the soft parts along the track of the ball, it was deemed advisable to amputate rather than ligate the femoral, which would be more than equivalent to a second ligation of the artery. Amputation of the thigh at its lower third was done by flaps of skin and circular of muscles. The patient being quite weak was ordered brandy and beef tea every half hour. July 27th, slept well last night, pulse 120 and quite nervous; has but little disposition to take nourishment; ordered milk punch, iron, and quinine. July 28th, had a slight chill last evening; pulse 125 this A. M.; discharge from stump somewhat unhealthy; syringed it out with acid wash (muriatic acid, one-half ounce to pint of water). July 31st, healthy granulations are being thrown out. The acid has very much improved the appearance of the stump ; general condition improving; is very despondent. August 5th, pulse 120 and feeble. Has trouble some diarrhoea; appetite poor; stump discharges quite profusely. Ordered opiate injections after each evacuation, and a wine- glassful of milk punch every hour. August 8th, diarrhoea still obstinate and is running the patient down. Ordered Monsel s solution, fifteen drops four times per day. Continued injections and other treatment. August 10th, diarrhoea slightly improved. August 15th, patient has had a troublesome hacking cough for some days; skin is becoming sallow. Has evidence of pyaemia, but has had no chills. August 17th, evidently failing fast; raises pneumonic sputa; countenance anxious, mind wandering. Died August 19, 18G3. As the friends wished to embalm the body no post-mortem could be obtained." Portions of the femoral, popliteal, anterior and posterior tibial arteries and popliteal vein constitute Specimen 3963 of the Army Medical Museum, and were contributed by Dr. Adams. The specimen shows a large well-organized clot near the orifice of the posterior tibial, which is severed at its origin. In the cases in which the division of the blood-vessel is followed by primary haemor rhage it is possible that some foreign body may be thrust into the open lumen of the artery which will prevent retraction while insufficient to act as a plug; or that there may be paralysis of the nerves of the arterial coats, preventing their retraction : CASE 1097. Major W. F. Smith, 1st Delaware, received a shot flesh wound of the right thigh, at Hatcher s Kun, Vir ginia, October 27, 1864. Surgeon A. N. Dougherty, Medical Director Second Army Corps, reported : "Among the wounded I noticed Major Smith being conveyed on a stretcher to the rear, evidently, from his ghastly pallor, severely hurt, and probably suffering much from loss of blood. I accompanied him as far as the ambulances, where, with the assistance of Surgeon J. M. McNulty, U. S. V., and Assistant Surgeon C. Smart, U. S. A., Medical Inspector, I examined the wound and did what seemed necessary. The ball (minie") passed through the right thigh behind the os femoris, a little below the middle, severing the femoral artery but not injuring the bone. Haemorrhage had already been profuse, but was partially restrained by a handkerchief and a leather strap which some one had applied. On consultation it was thought imperatively necessary to cut down upon and tie the vessel in the wound, which I accordingly tied with the assistance above mentioned and that furnished by regimental medical officers in compressing the artery at the groin. The enlarging of the wound quickly brought the upper cut end into view and enabled me to cast a ligature around it; but in order to secure the lower end it was necessary to cut across the sartorius muscle. The femoral vein also required tying. There was still considerable haemorrhage of a dark venous character, which, as its source could not be brought into view, it was judged best to arrest by sponge compresses, the lowest one dipped in solution of per sulphate of iron, after which it ceased completely. A bandage was applied and he was sent in an ambulance to the Gurley House, which he reached without molestation. Up to this time (October 30) there has been no return of the haemorrhage. The pulse, which was scarcely perceptible at the wrist, was quite good yesterday. The leg and foot are pale and cold, with some mottling about the instep, and sensibility is quite wanting below the calf. I directed artificial heat, wrapping in flannel and cotton bat ting, frictions, etc." An entry on the register of the hospital shows that amputation in the middle third of the thigh was after wards performed, and that the patient died November 6, 1864. In the following case the complete division of the femoral artery was followed by severe primary hemorrhage, but the bleeding ceased spontaneously: CASE 1098. Private E. H. Clarendon, Co. I, 26th Massachusetts, aged 22 years, was wounded in action at Opequan Creek, September 19, 1864, by a mini6 ball, which passed through the fleshy part of the left thigh and slightly wounded the right thigh. The wounded man was brought to hospital at Winchester on September 22d. Severe haemorrhage occurred at the time of receiving the wound, which ceased spontaneously. About eight days after the date of the injury serious haemorrhage took place, wholly venous in character. After that time there was no recurrence, but a constant and free discharge of dark bloody |>us. The patient became anaemic, feverish, and at times delirious, until he sank at length with evident manifestations of pyaemin. He died October 17, 1864. The post-mortem examination disclosed a large dissecting abscess beneath the fascia and among the muscles of the anterior portion of the thigh. The missile had entered about the junction of the upper and middle third of the Ill 95 754 WOUNDS AND COMPLICATIONS. [CHAP. XII. limb, severing the femoral artery and wounding the femoral vein. Both the proximal and distal portions of the artery were filled with firm coagnla. and for about half an inch from the torn extremity of each there was a hard cartilaginous formation surrounding the vessel, which was indeed nearly osseous in character. The crural nerve was inflamed in the track of the ball, but not otherwise injured. The femoral vein was filled with a very thick pus, reaching from the wound to a point sonic two inches above Poupart s ligament. Above this and to within about an inch of its junction with the internal iliac the vein w;is filled with a firm coagulum of lymph. The distal portion of the vein contained very little pus. Purulent or lymphatic deposits were found on the peritoneum, covering the hepatic vessels ; also on the anterior edge of the right lobe of the liver. Purulent deposits were also found in the spleen, and a small abscess existed at its superior edge containing bloody pus. The treatment of the patient had been of a tonic and stimulating character. The history of the case, together with portions of the injured femoral artery and vein, was contributed to the Museum by Surgeon C. H. Andrus, 176th New York. A wet preparation of the vessels constitutes Specimen. 3794 of the Surgical Section. Cases of partial division of vessels more frequently came under the observation of the surgeon. In these cases it was usually found that only a portion of the calibre of the vessel was carried away or that perforation of the vessel had taken place. Under such condi tions the retraction of the vessel is rendered impos sible, and haemorrhage ensues proportionately to the size of the artery and of the wound. A case of shot perforation of the carotid has been cited on page 751, ante (case of Kimball) ; and a perforation of the right primitive iliac by a pistol ball is shown in FIG. 418. The injured man died in twelve min utes. A partial division of the femoral vein is shown in FIG. 419. Profuse haemorrhage followed immediately after the injury, which was with diffi culty arrested by compression. Details of this case are given on page 304 of the Second Surgical Vol- FIG. 419. shot /r\ OfO\ Tr j.1 1 il 1 tion of right femoral vein. ume (L/ASE obo). It the artery is large the hsemor- spec. 2094. rhage will be profuse, and attended with speedily fatal results unless help is near at hand, as in the case of Assistant Surgeon R. S. Vickery, detailed on page 16, ante. The follow ing additional data, furnished by Dr. Vickery in a letter to the editor, dated April 5, 1882, will be found of interest : CASE 25 (Cont. from p. 16). "A partially spent rifle bullet struck me on the front of the left thigh. Profuse luemorrhage ensued and I fell fainting. Recovering consciousness I found myself lying on a stretcher, with the artery secured by a tourniquet. It must have been done promptly, as several surgeons of the brigade and the hospital steward of the regiment were within a few feet of me when I fell, and but for that prompt and timely assistance the haemorrhage would probably have been fatal. 1 was then carried by stretcher and ambulance to the division hospital, about three miles to the rear. There, as the operating surgeons were all very busy, I was placed in charge of one of the assistants, to watch that the haemorrhage was kept in control, until the afternoon, when, having placed me under the influence of chloroform, Surgeon W. B. Fox, of the 8th Michigan Volunteers, cut down in the opening, enlarging it, and ligated the femoral artery above and below the injured part. The wound, fortunately, was well situated for ligation of the artery, being about four inches below Poupart s ligament and about an inch below the pro- funda, the ball entering in front, passing back close to the bone but not injuring it, and lodging in the muscles of the posterior part of the thigh about an inch below the surface, from which it was extracted at the time. The ligatures came away on the thirteenth day. On the. eighteenth day, while at stool, a secondary haemorrhage came on to the amount of eight ounces. It ceased with the aid of compression and quiet, and there was no return of it. The wound was completely healed by November :<<!. On the fifteenth day I was moved from field hospital to City Point by ambulance, and eight days afterwards placed on board steamer and carried to a northern hospital. Some branch of the anterior crural nerve, probably the internal saphe- nous, must have been injured by the ball, as I suffered severe pain in the wound and along the leg for some days. This caused a want of sensation of the skin of the inner side of the leg from the knee down, which was greatest in the foot, and from the deficient innervation and bad nutrition of the skin gave me much trouble for years, and though it has now much improved it is the chief cause of the lameness which still continues. On March 11, 1865, seeing that I would not be able to resume my duties, I was honorably mustered out of the service at my own request, and returned to Ireland to visit friends there. When the wound healed the muscles of the knee remained contracted, so that when standing erect I could only touch the toes to the ground, and had to use crutches. As this condition did not improve by the modes of extension employed, on June 15, 1865, FIG. 418. Shot perforation of right primitive iliac. Spec. 6336. CHAP, xil.j EFFECTS OF MISSILES OIS* BLOOD-VESSELS. Drs. Daniel Donovan and David Hadden divided the hamstring tendons of the leg subcutaneoualy and forcibly extended the limb. In a few months I was able to get about without crutches. The leg now remains weak, and hats not regained its former size or strength ; but it has never, during my service in the army, kept me a day off duty." Ill the case of Booth, 7th Indiana Cavalry (CASE 21, page 14, ante), the femoral artery was perforated. Copious haemorrhage ensued at once, which was arrested by the applica tion of a tourniquet. Haemorrhage recurred on the sixth day, which was again arrested by pressure; the wound became unhealthy, and the patient died on the tenth day after the injury. Prompt operative interference would undoubtedly have afforded a chance of life. Sometimes haemorrhage will continue though it may be retarded by the formation of a coagulum in the track of the wound, but the tendency is to form a, diffuse traumatic aneurism, which, untreated, will exhaust the patient by frequently recurring haemorrhage. In the case of Melley, 2d West Virginia (CASE 13, page 555,Jtf,rst Surgical Volume), the axillary had been almost entirely divided; an enormous tumor of coagulum formed in the axilla. Hem orrhages recurring, the axillary was ligated; but during the operation the subclavian vein was accidently opened and death ensued in less than ten minutes. The greater number of cases of injury to blood-vessels were caused by contusion. Missiles with low velocities, or those whose force is partially expended upon tissues previous to striking the artery, seldom divide or penetrate, but contuse the arterial coats, destroying or impairing their vitality, and establishing inflammatory action which results in the removal of a slough at definite periods, accompanied by profuse secondary haemorrhage. In some cases the resulting inflammation or the injury to the vasa-vasorum effects a partial or com plete occlusion of the arterial tube ; if the collateral circulation becomes well established recovery may take place ; but fatal gangrene of the extremity, deprived of its blood supply, very commonly supervenes. CASE 1099. Private Henry Knoble, Co. D, 149th New York, was wounded at Ringgold, November 27, 1863. Assistant Surgeon Norman Teal, 88th Indiana, reported: Wounded in superior regions of both thighs and posterior part of neck; mini6 ball entered left thigh on outer anterior aspect six inches below superior spinous process of ilium, dipped beneath the integu ment and deep fascia, and emerged on inner surface of thigh four inches below pubis; the wound of the right thigh was sup posed to have been made by the same ball after passing through the left. I saw the case for the first time on December 11, 18(53; removed the ball from the wound of the neck. On examination found the left foot in a state of humid gangrene, with aline of demar cation encircling the ankle at the malleoli. On inquiry learned that this soldier had been brought hither from the battle-field after suffering considerable exposure to cold on the battle ground and during transition ; that the foot was cold and insensible at the time of the patient s admission into hospital ; that he arrived here hungry and cold on the morning of November 28th, the next day after the injury; that he had diarrhoea at the time the wounds were received, and that he had suffered from this disease more or less during his sojourn in hospital. Know nothing of the treatment previous to December llth. After this time opiates were exhib ited to control the bowels and tonics and stimulants to invigorate and support the system. Amputation of the leg at the junction of the middle with the lower third was performed on December 14th; artery controlled by thumb alone. Very little haemor rhage ; parts at point of section flabby. Treatment mentioned above continued ; alcohol, full strength, applied to stump freely from the first ; but little inflammation occurred, and but feeble efforts at reparation were made. Granulation sparse and flaccid through out ; appetite pretty good. My connection with this case ceased about the last of December. Dr. Kilbotirne then assumed charge. Death took place January 14, 18(i4, on the 48th day after the injury and the 31st after amputation. Autopsy : Wound in left thigh closed; track of ball occupied by an abscess containing thin fetid pus. The course of the ball appears to have been posterior to the artery, impinging upon its sheath, for the wall of the artery at this point is thickened, of a brownish color, and its calibre diminished one-half. A firm coagulum fills the sheath for one inch below the track of the ball. Bones protruded between the flaps, which were lined with an ash-gray slough. The elaborate post-mortem examination in this case is omitted as unnecessary to the description of the specimen, illustrating as it does death by pyaemia. The gangrene in this case was clearly due to the diminution of the calibre of the artery and to the cold and exposure to which the man was subjected ; neither cause sufficient of itself to have produced the result." Specimen 2114, Section I, Army Medical Museum, consists of a wet preparation of the upper portion of the left femoral artery, with the walls much thickened by a coagulum in the sheath. It was contributed by Dr. Teal. 1 Not unfrequently spiculse of bone driven before a missile puncture blood-vessels, and though jdiey may not be productive of instant trouble, they set up inflammatory action, resulting in ulceration and sloughing attended with secondary haemorrhage. An example of division of the intercostal artery by the fractured end of a rib has been 1 An abstract of this case was published by Dr. JOHN A. LlUELL in U. S. Sanitary Commission Memoirs, New York, 1870, Surgical Vol. I, p. 27, 756 WOUNDS AND COMPLICATIONS. [CHAP. xn. cited on page 551 (Case of Butterfield) of the First Surgical Volume, and an instance of rupture of the popliteal by a fragment of bone is here adduced : CASE 1100. Private Jonathan Wining, Co. A, 125th Ohio, aged 25 years, was wounded at Kesaca, Georgia, May 14, 1864. He was at once admitted into the field hospital of the 2d division, Fourth Corps, where the injury was recorded as a flesh wound of the left thigh. He was subsequently treated in hospital at Nashville, and on August 25, 1864, was transferred to "Joe Holt" Hospital, Jetfersonville, Indiana. Surgeon H. P. Stearns, U. S. V., reported: "Compound fracture of lower third of femur by conoidal ball. October 12th : Patient enfeebled and anaemic by constant discharge of pus. Pulse frequent and soft, tongue moist and clean, appetite good, bowels regular. Femur much shattered; ends overlapped and partially united. Soft parts destroyed by gangrene, exposing blood-vessels; rupture of popliteal artery by a fragment of bone. Chloroform admin istered and antero-posterior flap amputation of the middle third of the thigh performed by Dr. Stearns. The flaps subsequently sloughed, exposing an inch of the femur ; repeated haemorrhages also occurred. Quinine, opium, and whiskey administered and cold-water dressings applied. December 17th : Every indication of recovery ; flaps nearly healed. The man is in fine health and spirits; all medicines have been suspended and nourishing diet alone depended upon." Wining was transferred to Cleve land, Ohio, March 24, 1865, and discharged from service May 20, 1865. He is a pensioner. Wounds closely resembling incised wounds frequently are caused by sharp-edged shell fragments flying with great velocity; but a certain amount of contusion and laceration, always present, separates them from the class of purely incised wounds. Missiles and foreign bodies lodging sometimes act as plugs, restraining for a time hemorrhage from a wounded blood-vessel. An interesting case of occlusion of the common carotid by an impacted ball is related by Surgeon John A. Lidell: 1 CASE 1101. "At the Washington Infirmary, August 15, 1861, through the kindness of Dr. J. W. S. Gouley, then attached to the medical service of the U. S. Army, the author had an opportunity to examine a very interesting preparation of the left common carotid artery and the parts adjacent to it, which had been obtained on the previous day at the autopsy of u soldier who had died from secondary haemorrhage following a gunshot wound of the left side of the face and neck. The ball, which, by the way, was nearly spent, struck the lower jaw well forward and was deflected downward, backward, and a little outward in such a manner as to pass obliquely through the left common carotid artery, and to lodge in the tunics and sheath of that ves sel underneath the omo-hyoid muscle, pressing somewhat upon the par vagum, and occluding completely the proximal end of the divided artery. It was a round ball. The haemorrhage occurred fourteen days after the wound was inflicted and two or three days after his admission into the infirmary. It came on suddenly, without warning, and was very profuse. The patient lost more than a quart of blood, which flowed in a great stream from his mouth. On the supposition that the haemorrhage proceeded from a lesion of some of the carotid vessels, an effort was made to tie the common carotid above the omo-hyoid muscle, but it had to be abandoned on account of the great profuseness of a flow of blood which took place in the wound of operation, and did not permit the search to be continued in order to secure the bleeding vessel by ligature at the place of injury. It was believed by all the surgeons present that the patient was now so much exhausted by the loss of blood as to make it useless to attempt to tie the common carotid artery below the omo-hyoid muscle, and the next morning he died. Moreover, the source of the haem orrhage was very obscure until it was revealed at the autopsy. It was then found that the divided carotid artery was still occluded on the side of the wound toward the heart (proximal) by the impacted ball ; that a false aneurism as large as a filbert and elongated in shape had been formed at the distal extremity and on the inner side of the wounded artery just above the omo-hyoid muscle ; that the hcemorrhage occurred from rupture or spontaneous opening of the sac of this traumatic aneurism; that the hemorrhage was not direct, but recurrent in character; and that it could not have been arrested without the application of a ligature to the vessel on the distal side of the wound in it. The ligation of the common carotid below the omo-hyoid muscle would, therefore, not have done any good, unless the vessel had been tied at the same time at some point beyond the spot where it was wounded and where the traumatic aneurism was situated. A remarkable and, so far as the writer knows, an unique feature of this case was, that the trau matic aneurism was formed in connection with the distal end of the divided common carotid artery, the occurrence of which appears to have been favored by the free anastomosis which exists between the terminal branches of both the external and inter nal carotid arteries of the two sides of the body." The above has been identified as the case of Corporal Jonathan Calef, 2d New Hampshire. An abstract of this case has been published by Medical Cadet L. H. Bodman, U. S. A., 2 who states that the man was injured by a sentry, August 7, 1861. There was considerable haemorrhage at the time of the accident, but when admitted to the hospital a few hours afterwards he was in a comfortable condition, bleeding having entirely ceased. No search was made for the ball, but the edges of the fractured bone were retained in apposition by means of a suitable bandage, and quiet enjoined. Diet consisted of nutritious soups and beef tea. The patient continued in good condition until the afternoon of the 13th, nearly a week after the reception of the injury, when, lying quietly in bed, he was seized with violent arterial haemorrhage. The blood poured from his mouth, welling up with each pulsation of the heart. Compression over the carotid was instantly resorted to, but a quart of blood had escaped before the haemorrhage was controlled. The patient being now very weak, stimulants were administered and directed to be given frequently through the night. Continuous compression was kept up over the artery. Bleed ing recurred twice during the night and was controlled with great difficulty. He sank rapidly, and died on the morning of August 1 4 . 1861, by syncope, in another and terrible attack of haemorrhage. CASE 1102. Private John Jones, 187th New York, aged 27 years, was admitted into Jarvis Hospital, Baltimore, Feb ruary 11, 1865, with a gunshot wound of the mouth and throat, received at Hatcher s Run, Virginia, on February 6th. The 1 Surgical Memoirs of the War of the Rebellion, collected and published by the U. S. San. Comm.. New York, 1870, Surgical Volume I, page 172. 5 BOPMAM (L. H.), Gtmshot Wound of Carotid Artery Secondary Hemorrhage, in American Medical Times, New York, 1862, Vol. IV, p. 67. LODGEMENT OF MISSILES. 757 patient, at the time of admission into the hospital, was able to walk about, and a casual observer would have thought him to be in nowise a dangerous condition. The musket ball had entered directly the mouth and in its progress carried away the upper and lower incisors and canine teeth, and passing backward lodged, but where was not discovered until the post-mortem revealed the fact. The index finger inserted into the mouth found that it had wounded the right side of the tongue, and from thence the track ran to the right side of the neck and backward through the pillars of the fauces and then could not be further traced. The patient himself thought that he had swallowed the ball. The only inconvenience he suffered was in either talking or swallowing, and when resting on his back ; and being so apparently comfortable it was not thought best to trouble him, but orders were given to the nurses to watch him closely. An examination externally revealed no signs of injury, and the only symptom there marked was tenderness over the upper vertebra and general soreness of the muscles of the neck. He had not the least sign of paralysis, and the day previous to his death he was walking about his ward, and even requested his medical attendant to extract for him a tooth which was almost detached by the ball and was giving him some annoyance. On February 12th (six days after the injury was received), at 5.30 P. M., a most furious arterial secondary haemorrhage occurred through and out of his mouth. Before assist ance could reach him (although close at hand) he had bled so copiously as to be in a state of syncope, and while bleeding he had two convulsions, one of which was quite violent. During the active haemorrhage pressure was made over the common carotids, yet it did not seem to control it to any great extent, and notwithstanding various expedients were employed it only stopped when syncope came on. It is proper to state, also, in this connection, that pressure from within by the fingers did not stay the haemorrhage, but to his detriment increased the suffering of the patient. The exhausted condition of the patient at this time rendered it inexpedient to resort to any operative interference. The haemorrhage having entirely ceased through this effort of nature, it was ordered that diffusible stimulants be freely given in such quantities as the stomach could bear, and that ice should be constantly kept applied to the parts, and under this treatment he slowly rallied and rested quietly until 5 o clock on the fol lowing morning, when a gush of blood took place from the patient s mouth and he expired. An autopsy was made twenty-four hours after death, and the track of the wound was thoroughly explored, after both common carotids had been injected with a suitable material, which, on cooling, hardened and distended the principal arteries of the head and neck. On the plan of operating recom mended by Mr. Guthrie on the living subject, an angular flap of the integuments was made corresponding with the ramus and body of the lower maxillary bone, and this integument was turned back, and by the saw the bone was divided near the first lower molar tooth and the upper fragment raised. By a little dissection the wound was fully exposed and the first vessel wounded was ascertained to have been the right internal carotid, which was converted into a traumatic aneurism for near its entire length, and its position was occupied by an extensive clot of blood. On introducing the finger into the track of the wound at this point and carrying it almost directly backward and inward, the ball was found loosely resting against the transverse process of the first cervical vertebra, and was easily extracted without the aid of forceps. By further careful exploration of the parts adjacent to where the ball was arrested in its progress it was ascertained that the right vertebral artery had been exten sively lacerated at the point where it passes through the foramen of the transverse process of the atlas, and that the ball resting there had probably acted as a plug in preventing haemorrhage from that artery, and in proof of this assertion no clots of blood were discovered here. The right transverse process of the atlas was completely fractured and comminuted, and the fragments were readily removed en masse simply with the fingers and without any force. This fracturing of this process of the atlas was, on further investigation, found to extend through the ring down to the spinal cord, yet the fragments were not driven in upon, or were they apparently causing any pressure on the cord. On examining the brain, heart, and lungs they were found healthy and in a normal condition, but were exsanguinated. Assistant Surgeon D. C Peters, U. S. A., 1 who transmitted the above report, remarks : "It is somewhat remarkable that this soldier was not killed outright, or having lived so long he should not have suf fered from paralysis in some form, and, in fine, that his terrible wound should have given him so little trouble up to the time of his first haemorrhage. In my humble opinion operative interference at any stage of the treatment would not have saved nor even prolonged his life." In many cases where both artery and vein are divided the injury of the vein assumes less practical importance at the time from the more serious lesion of the artery; but cases of secondary haemorrhage from veins which have been contused and subsequently slough are found to be not infrequent, as will be seen hereafter. LODGEMENT OF MISSILES AND PRO jECTiLEs. Cases of lodgement of missiles, projectiles, and foreign bodies in the persons of the wounded were of extremely frequent occurrence during the late war. Although it is not possible to give with any accuracy the frequency of such lodgements, it can be confidently stated that the percentage was very large. Round balls are more prone to lodge than those of a conoidal form, as would naturally be inferred from the rapidity with which the former lose their initial velocity and the resistance offered to their passage through the tissues of the body. Conoidal balls at ordinary range preserve sufficient force to perforate the body; but at long range, or with velocity diminished by contact with intervening objects before reaching the body, or when the posture is such as to compel a long course through the tissues, lodgement very commonly occurs. As a general rule the lodgement of conoidal missiles is deeper than that of round balls. 1 An abstract of this case was also published in the A merican Journal of Medical Sciences, 1805, Vol. XLIX, p. 373. 758 WOUNDS AND COMPLICATIONS. [CHAP. XII. Instances of the lodgement of the larger class of projectiles, as solid cannon halls, grape-shot, and fragments of exploded shell, have been cited on pages 240 of the Second Surgical Volume, on page 746 (CASK 1040) of the present volume, and elsewhere. The collection of the Army Medical Museum furnishes many specimens, not only of missiles and projectiles proper removed from the persons of soldiers, but also of foreign bodies, as buttons, coins, pieces of pocket-knives, shreds of clothing, portions of the accou trements of the soldier, and fragments from objects torn off by a missile in its course, as iron wire from the bail of a tin bucket, a portion of a ramrod, a tompion nearly entire, etc. Not infrequently pieces of bone or teeth from a wounded comrade driven before a missile became themselves wounding missiles. Splinters of wood and iron, stones, and debris from artillery caissons and carriages, from breastworks and defenses, acted in a similar manner. All parts of the body share the liability to lodgement. The direct effects of lodgement are those common to the presence of foreign bodies generally in the tissues of the human structure; they become the centres and sources of irritation, liable to be followed by symptoms of every degree of severity in nature s effort to rid herself of the offending matter. These symptoms largely depend upon the size, nature, and form of the intruding body; also upon the region of the body involved. The most serious results follow the lodgement of missiles and foreign bodies in joints and cavities of the body, or in organs necessary to life; even small missiles, with qualities the least irritating, may be the cause of great mischief by the production of tetanus and haemorrhage, when lodged where they may cause pressure upon nerves or blood-vessels. Passing from the more immediate or primary effects of irritation and inflammation resulting from the lodgement of foreign bodies, we find that the usual tendency of their o o o */ continued presence is to prevent or retard the course of healing. Cicatrization is slow and liable to be interfered with by any aggravation of the primary irritation ; the wound takes on a condition of chronic inflammation, sinuses form with purulent discharges, sapping and undermining the strength and vigor of the patient, opening the way for the invasion of any of the surgical complications which may be near at hand. Especially does this seem to be true of substances of organic nature, as shreds of wool or cotton, or splinters of wood. Until such substances are removed by nature or art the progress of the case toward health is usually entirely held in abeyance. Foreign bodies of a metallic nature, particularly those with smooth surfaces, seern to act more kindly; they frequently permit the closure of the wound; but if their location is subject to frequent movements the wound is liable to reopen; this process may be repeated until the offending body is removed or discharged. In many cases of lodged missiles the tendency to move or change place is observed ; slowly and gradually the substance will work to the surface of the body, where it will often form an abscess and be discharged, or it may tend toward the internal surfaces of the great cavities, where its presence may be productive of great harm ; or, on the other hand, it may be harmlessly ejected from the body. Thus balls lodged in or about the abdominal region and of which the exact position had not been ascertained have finally been passed by stool per via* naturales. Scraps of iron and lead have been known to work their way through the coats of the bladder, where they became the nuclei of vesical calculi which were subsequently removed by lithotomy. The collection of the Army Medical Museum contains several specimens of this nature ; also of portions of bullets and shell fragments which have been similarly lodged in the bladder and removed by operation. Cases of this nature have been recorded on pages 269276 of the 8cc<>n<l ftu.ryical Volume. The Museum collection CHAP, xii.] PRIMARY SYMPTOMS OF SHOT WOUNDS. also contains missiles which had for years lodged within the cranial bones. The least harmful effects of lodgement are seen in the cases of balls lodged in the muscular or cellu lar tissues of the body and in regions of little vital importance. Musket balls have remained, encysted for years, causing but little trouble or inconvenience. At the Soldiers Home, near Washington, it is not uncommon to find old soldiers who have carried encysted bullets for long periods in their persons with little more inconvenience than slight neuralgic pains during damp and unpleasant weather. The writer has in mind the cases of two soldiers, one wounded in the lower maxillary region during the Mexican war, the other in the gluteal region during the late war, in both of whom the balls are firmly encysted; the missiles give so little trouble that the suggestion of removal is not received with favor. A most remark able instance of the encysting of a ball is that of Lieutenant E. B. Blake (CASE 552, on p. 372, ante), who carried for fifteen years a full-sized conoidal bullet in the cancellated structure of the condyles of the femur, experiencing but little trouble. PRIMARY SYMPTOMS COMMON TO GUNSHOT WOUNDS. The immediate symptoms common to shot injuries are pain, shock, and haemorrhage. To be duly appreciated in their primary state they must be seen on the battle-field, as they are speedily evanescent, fatal, or merge themselves into conditions pertaining to the later stages of shot injuries. Shock. Severe shot injuries, particularly those involving the larger bones and the more important organs and cavities, are followed by a train of phenomena known as " shock," or a general perturbation of the nervous system. Upon the reception of such injuries the person affected turns suddenly pallid, trembles, and, may perhaps fall to the ground; the surface of the body is cool and bathed in profuse perspiration; the features indicate anxiety and distress, the respiration is labored and sighing, the circulation is feeble, the mental condition is often one of agitation resembling fear, or there may be an entire loss of self-control ; at times, in severe cases, consciousness is lost, and finally death may ensue without reaction. The degree of shock seems to bear some relation to temperament, to physical condi tion, and to the region of body affected. Equal degrees of injury seem to affect individuals differently. While some are apparently overwhelmed by the shock, others maintain their self-control and composure ; m some, shock seems to heighten the excitement under which the individual is laboring during a battle ; in others, the effect is to produce a sense of fear and panic. As a rule, the more severe the injury the greater will be the degree of shock. Injuries caused by the larger projectiles, as the loss of a limb near the trunk, is generally followed by depressing shock, and this independent of any loss of blood. Generally, shock is more profound and persistent in grave wounds of the abdomen than in wounds of any other part of the body. Profound and even fatal shock has been the occasional consequence of shot contusion of the parietes of the abdomen, as in the case of Major King, British Fusi- leers, 1 who was killed at the battle of New Orleans, January 8, 1815, by a musket-ball, "which struck him on the pit of the stomach, leaving only the appearance of a contusion, apparently in the same manner as a blow from the hands of a pugilist in the same part." Wounds producing great splintering and comminution of long bones are generally followed by a severe degree of shock. The duration of shock is very variable, sometimes lasting but a few minutes; at other times showing great persistence, and continuing for hours or days. Here, too, individual temperament and idiosyncracy seem to exert a large Ll. .1 7 ;v/i> i,n f.-uiifliot Wounds, etc., London, M edition, 1847. j.. 5. 760 WOUNDS AND COMPLICATIONS. (CHAP. xn. influence. When shock is very persistent the prognosis is to be very guarded, as its persist ence may depend upon some severe or fatal injury, as was probably the case in the following- instance, reported by Surgeon E. Swift, U. S. Army: CASE 1103. Private A. P. Pringle, Co A, 25th Louisiana, aged 24 years, temperament bilious, occupation farmer: wounded at the battle of Stone s Eiver, near Murfreesboro , Tennessee, December 31, 1862, by a minie" ball under the left shoulder, through pectoralis major. The shock knocked him down and he fell across the railroad track on his left hip. He complained more of this than of the wound; suffered intensely from pains in his hip, back, and leg; quieted pains with morphine, and was obliged to use a catheter twice daily as long as he lived. The wound healed very well, but he never recovered from the shock of the fall. He had no appetite from the first. All the nervous symptoms increased in intensity; he had no rest except from morphine, and for two or three days before his death he could not move at all. Died January 11, 1863. Shock may be the actual cause of death of many cases on the battle-field, especially in severe injuries of the abdomen. Of twenty-seven fatal cases of shock fourteen were found to be shot wounds of the abdomen and eight of the femur. Fatal shock is more frequently a sequel of wounds by large projectiles than by bullets. Longmore 1 found that out of twenty- two deaths from shock only eight were caused by bullets, and in all of these the cavity of the abdomen had been penetrated by the projectile. In the remainder the injuries were from gunshot, shell, or grape. Pain. Pain as a primary symptom of shot injury is rarely absent. In degree it may be slight or severe according to the locality of the wound, its nature, and the mental condition of the individual. In simple flesh wounds it is commonly described as stinging or cutting. as from a blow by a cane ; it is sometimes likened to the passage of a hot wire through the part; by others it is described as dull, like the blow from some heavy body. When nerves are injured or contused the pain is usually severe, but is commonly referred to parts sup plied by the nerve. In some cases the pain is referred to parts distant from the seat of injury, as in the case of Lieutenant William F. Goodwin, 16th U. S. Infantry, who was wounded at Chickamauga, September 19, 1863, by a conoidal ball, which caused a severe flesh wound of the left thigh. He felt no pain of moment in the wounded limb, but had a firm impression that the wound was in the right limb. The case is referred to by Mitchell, Morehouse, and Keen (loo. cit., page 14). When large nerve trunks are divided there is momentarily intense pain, immediately succeeded by loss of sensation in parts depending upon the nerve trunk. In severe wounds generally the pain which accompanies them is lost in the anaesthesia of the shock which soon follows. Pain resulting from shot contusions of bone is often severe and widespread, especially if the injury is insufficient to cause unconsciousness. CASE 1104. Captain A. L. Dearing, Co. H, 5th Maine, aged 28 years, was wounded at Chancellorsville, May 3, 1863. He was admitted into Seminary Hospital, Georgetown, on May 8th. Surgeon H. W. Ducachet, U. S. V., reported : "Gunshot wound of left thigh bone." The following account of the case was furnished by the patient: "I was wounded, says this officer, "on Sunday, May 3d, by a round musket ball in my left thigh, very near the hip joint, the enemy being fifty or sixty yards distant. The sensation produced when the ball struck me was as though a ball of glass had been thrown with irresistible force and shivered to atoms against the bone of my thigh. This sensation was very distinct, and no other was felt for the instant. 1 have no recollection of falling; but found myself lying on my left side, with a strange feeling of numbness rushing through the entire leg. This lasted but a few moments; the blood flowing freely, this active numbness soon died away. I believed myself mortally wounded, as I had no doubt the bone was shattered to the hip joint. Dreading to fall into the hands of the enemy I dragged myself from the battle-field about two hundred yards, when some of our men carried me to a place of safety. Taken to the hospital at Falmouth on the 4th, my wound was probed by Surgeon N. S. Barnes, 27th New York, on the morning of the 5th. The probe struck the bone and followed the wound a short distance around it on the inside, without feeling the ball. Sur geon Barnes decided that the ball struck the bone, and, without injuring it, glanced to the right, passing around to the opposite side from which it entered, and probably lay deep in the groin; but my thigh was so much swollen that the ball could not "be found. On May 8th I reached Seminary Hospital, Georgetown. At length, after the swelling had subsided considerably, the ball was found near the groin and near the surface. It was extracted by Surgeon Ducachet on May 18th, but this ragged, mis shapen piece of lead was so light that doubts were expressed as to its being a whole ball. The wound seemed to be doing well; there was considerable yet no very severe pain, the severest and most continuous being in that region where the ball entered and I.OXGMOUE (T ) Gunshot Injuries: their history, etc., London, 1877, p. 150. CHAP yi 1. 1 PRIMARY SYMPTOMS OF SHOT WOUNDS. 701 struck the bone. On May 27th a small piece of bone was discharged from the wound, indicating that the bone was more or less injured. On May 28th I was attacked with a most intense pain on the inside of the thigh, midway between the wound and the opening where the ball had been extracted. This pain brought on fever and a severe headache. Chloroform liniment was freely applied and alleviated the pain. On May 31st a piece of lead made its appearance at the opening where the ball had entered, and was extracted by Dr. Miller, and proved to be very nearly as large as that extracted on the 18th. This second piece of lead is very ragged, and holds a portion of the cloth which it had carried into the wound. About the first of June the nerves of my left foot, mostly in the toes, commenced troubling me, causing many sleepless nights and restless days for two weeks. It was like a continuous nervous toothache. A powerful chloroform liniment was freely applied, but it proved less effectual than cold water in easing the pain. This pain was not constant, but would burn my toes as with boiling water for ten or fifteen minutes, then ease away somewhat for a few minutes, and then return in full force. On June 12th a course of vigorous rubbing with a coarse towel was commenced on the foot and leg to the knee. On the third day the pain began to yield, and has now, June 24, 1863, almost ceased. My leg remains as yet almost perfectly helpless. It cannot support its own weight. My general health is very good." The patient was discharged from service September 15, 1863, and pensioned. The Hartford examining board reported, August 7, 1872: "Ball entered at middle of left nates and passed forward; part of the ball was removed at the junction of the upper and middle thirds of the left thigh at the outer border of the sartorius muscle. In its passage the ball struck the inner side of the femur, and in consequence of which portions of bone, with the remainder of the ball, were discharged through the point of entrance in the nates. The knee becomes swollen and painful from slight use." Under the stimulus of great excitement, as that prevailing during an active engage ment, men may receive wounds without being aware of the fact until their attention is drawn to the blood flowing from the wound, or until they are affected by faintness from the loss of blood. Race and temperament undoubtedly exert a modifying influence on the degree of suffering. The white races, as a rule, seem to be more susceptible to pain and to suffer more acutely. The negro soldiers engaged in the late civil war bore their suffer ings with great fortitude and patience ; but it is questionable if the actual degree of suffering was as great as that of the white soldiers. The nervous and sanguine temperaments show a greater capacity for suffering than the lymphatic or lethargic temperaments. Primary Hcemorrhac/e. Primary haemorrhage, or the loss of blood immediately upon the receipt of an injury severing or wounding a blood-vessel, has been alluded to as causing speedily fatal results, or as ceasing spontaneously by the retraction of the coats of the bleeding vessels, by syncope, or followed by such retardation of the flow of blood as to allow assistance to reach the wounded man, rendering him secure for a time at least. As a result of the experience of the late war it may be stated that primary haemor rhage, within the bounds of possible succor, was infrequent ; yet without doubt many wounded men perished through lack of self-possession, want of coolness, or of sufficient knowledge to save themselves. It is probable that a large percentage of the "killed in battle" were cases where primary haemorrhage followed the division of important vessels, death ensuing instantly or before help could be procured. Surgeon John A. Lidell, U. S. V., 1 was convinced, from his own observation, "that a large proportion of the persons killed in battle perish directly from loss of blood: On the 25th of March, 1865, I examined the bodies of forty-three soldiers as they lay dead where they had fallen on the field of combat at Fort Steadman, in the lines before Petersburg. Of them 23 were wounded in the cranium, 15 were wounded in the thorax, 5 were wounded in the abdomen. The blanched and exsanguinated appear ance of the cadaver in every case wounded in the abdomen denoted clearly that death had been produced by haemorrhage, and the extreme rapidity with which that result had taken place implied that some large blood-vessel had been injured. In all but two or three of the cases wounded in the thorax the body presented a blanched and exsanguinated appear ance, occasioned by hemorrhage. There was much blood in the clothing and on the ground where they had fallen in most of the cases wounded in the trunk. This fact shows that the fatal haemorrhage generally took place externally. There were, however, some cases wherein 1 LIDELL (J. A.), On the Wounds of Blood-vessels, Traumatic Hemorrhage, etc., in U. S. Sanitary Commission Memoirs, Surgical Volume I, p. 12. SUKG. Ill 96 WOUNDS AND COMPLICATIONS. !< HAP. xn. death had boon produced by internal haemorrhage. While the bodies of those were pallid and wax-like, there was but little blood in their clothing and on the ground where they lay. All the wounds appeared to have been inflicted by cylindro-conoidal bullets." Primary haemorrhage from wounded veins is generally regarded as of less imminent importance than that from wounded arteries. It was stated in the preliminary report (Circular No. 6, 1865, p. 39) that "no cases have been reported in which the bleeding could not be controlled by pressure." A further examination of the material at hand makes it necessary to somewhat modify this statement. Primary haemorrhage from large trunk veins lying in cavities and beyond the roach of ligatures appear to be as fatal as that from arteries. A case of this nature is reported on page 71 of the Second Surgical Volume. A colored teamster shot in the abdomen died forty-two hours after the injury. At the autopsy the abdomen was found distended with clotted blood from one of the mesenteric veins which had been cut. Primary haemorrhage from the jugular and femoral veins would appear to be less amenable to treatment than that from others which yield to pressure or cease spontaneously. A case illustrating primary haemorrhage from the femoral vein is reported on page 338 of the Second Surgical Volume (CASE 981): a private of the 110th Ohio was wounded at Fort Steadman, March 25, 1865; the ball entered the right thigh, cutting across the femoral vein, and lodged in the gluteal muscles; haemorrhages followed continuously, which were at times checked by styptics. Death occurred April 11, 1865. Early in the war it was recommended that each soldier should have in his possession some simple form of tourniquet, and in many instances the recommendation was carried out ; how far they were of use is not known, as no cases are recorded of life being saved by them; but it is probable that they were little used, and it is very doubtful if, in the excitement and confusion of battle, they could have been applied with any efficacy. Later in the war experience taught the older and more experienced troops to do all that could be done in cases of emergency. HAEMORRHAGES AND LIGATIONS. Of the many complications of shot wounds, perhaps none plays a more important part than haemorrhage. Injuries, apparently trivial, prove fatal in the most unexpected manner, as the lesion to the artery causes at first little or no disturbance; or haemorrhages occur in cases in which, judging from the direction of the ball, no injury to a blood-vessel could have been surmised. Thus the prognosis of the shot wound becomes exceedingly proble matical, and the surgeon not infrequently is suddenly roused from a feeling of security and brought face to face with an unexpected and serious complication, which, under the peculiar necessities of war, is of difficult treatment; and the results thus far have been by no means as satisfactory as could be wished. Too often the surgeon is induced to await develop ments rather than to resort to prompt action. It has therefore been thought desirable to give in the following pages as complete a summary of the cases of haemorrhage, whether primary or secondary, as space would allow. Details of many cases have appeared in this and the preceding volumes, and in a few instances partial tabular statements of ligations of the more important, blood-vessels have been adduced. But during the progress of the work many additional cases were ascertained and additional data were found of cases already reported ; all will here be grouped together in as concise a manner as possible to aid the student interested in the investigation of this CHAP. XII.] HEMORRHAGES AND LTGATIONS. 763 important branch of military surgery in his researches in this direction. As already stated in the consideration of the effects of missiles and projectiles on blood-vessels, it is difficult to distinguish the injuries inflicted by one or another of the more common forms of bullets; but it would seem, nevertheless, from the large series of bleedings reported during the war, that the introduction of the elongated bullet, thrown from a rifled weapon, has largely increased the number as well as the gravity of the injuries to blood-vessels. The injuries of the arteries will be first considered, and those of the veins unattended by lesions of the accompanying arteries are reserved for a special subsection. . ARTERIES. The number of arterial haemorrhages found on the records of the field and general hospitals was three thousand two hundred and forty-five (3,245). One thou sand six hundred and forty-nine of these bleedings occurred in the lower extremities, eight hundred and seventy-eight in the upper extremities, two hundred and ninety-one were haem orrhages of the head, face, and neck, and four hundred and twenty-seven of the trunk. Of the three thousand two hundred and forty-five cases recorded, the blood-vessels involved were not named in one thousand and ten instances; and as the details of these cases are not as complete as those of the remaining two thousand two hundred and thirty-five, in which the bleeding vessels were definitely ascertained, the former will be dropped in the further discussion of the subject. The cases have been grouped in a tabular statement, adducing : First, the bleedings of the ramifications of the ascending aorta in the chest, neck, head, and upper extremities ; and next, those of the descending aorta in the abdomen, pelvis, and lower extremities; and lastly, the few examples of pulmonary haemorrhages. The tables also indicate the number of cases in which pyaemia, erysipelas, tetanus, and gangrene were recorded as complications, the number of cases in which death was ascribed directly to haemorrhage, and the propor tion of cases in which primary injury to vessels and primary bleedings were observed: TABLE CXXIV. Summary of Two Thousand Two Hundred and Thirty-five Cases of Arterial Haemorrhages of the Head, Neck, Chest, Trunk, and Upper and Lower Extremities, in which the bleeding vessels were indicated by name. ARTERIES. CASES. IlKSl LTS. PHIMAKY INJI : RY. I KIMAKY BLEKDI.NG. PYAEMIA. CrANGUENK. EUYKH KLAS. TETANUS. DEATH FHOM 11 JEM. Reo. Fat. Rec. Fat. Rec. Fat. Rec. Fat. Rec. Fat. 41 (i ; 3 1 1 5 9<; 12 3 7 13 3 30 21 4 4 24 ia o 75 8 1 3 5 1 fi 9 31 fi o 1 o 1 5 4 1 6 4 1 ! 1 1 Occipital 1 3 1 1 1 3 1 1 Facial 1 1 14 8 11 1 223 r> 4 1 - 02 8 4 9 8 5 Middle Menlngeal Internal Carotid 1 Frontal 131 17 Zl 3 1 (ii 1 2 3 , 4 7(5 WOUNDS AND COMPLICATIONS. tCHAi . XII. ARTERIES. 00 ! O RKSULTS. PRIMARY INJURY. PRIMARY BLEEDING. PYAEMIA. GANGHKNE. ERYSIPELAS. TETANUS. *1 W S fi fe 76 32 2 1 5 1 13 Rec. Fat. Rec. Fat. Ren. .| RPO. 4 1 Fat. Rec. Fat. 223 62 2 1 9 2 37 3 1 12 87 10 13 32 r> 92 10 131 52 2 1 7 2 86 1 1 1 7 76 9 9 12 2 99 o 6 8 35 3 12 9 7 61 12 1 17 1 1 6 3 3 4 1 8 3 T 1 1 11 O 1 1 4 o 1 1 J 1 5 11 1 4 20 1 26 3 56 6 5 7 2 33 1 5 6 8 4 1 6 1 1 y 2 2 Cir tnflex 1 1 1 1 1 1 201 4 14 9 111 4 49 42 23 2 1 1 10 2 1 lew 8 1 76 1 37 33 16 2 1 1 8 73 22 25 1 18 11 7 4 1 7 2 1 1 2 32 1 7 5 5 6 4 3 1 Ulnar 1 1 6 5 1 1 7 5 2 PI . 2 1 2 o 2 1 1 7 7 1 18 8 3 1 23 1 2 2 1 2 2 ff 2 1 1 1 2 2 1 2 7 7 1 22 8 4 1 2G 13 551 1 60 10 7 6 54 105 8 270 6 :i 8 17 3 1 1 1 2 1 1 1 1 3 6 1 12 4 3 1 7 Gluteal 4 2 1 1 3 1 1 3 2 119 1 18 2 4 6 1 2 2 3 43:> 3 194 103 27 2 48 11 53 2 1 2 42 3 (j 39 79 5 142 o 1 1 6 o 2 2 25 4 1 2 1-2 32 4 46 1 1 1 13 12 15 26 ;i 128 r 3 6 7 o 46 1 7ii 1 5 o 24 1 28 1 2 Popliteal . ... . 9 1 Tibial 14 29 19 3 3 3 1 1 2 10 3 1 1 1 4 5 1 1 1 2 1 1 148 23 11 Affereirates . . . 2.235 855 1.380 485 110 5 177 80 16 653 CHAP XII. 1 H.EMOBKHAGES ANP LIGATIONS. 765 The number of cases of primary lesions of blood-vessels was quite large, comprising four hundred and eighty-five, or nearly one-fourth of the two thousand two hundred and thirty-five cases. Of these, one hundred and ten were immediately followed by haemorrhage. To what extent the injuries to arteries influenced the mortality rate among the wounded will be seen from the fact that of the two thousand two hundred and thirty-five instances in which bleedings formed an important element, one thousand three hundred and eighty, or 61.7 per cent., proved fatal, while, of the total number of shot wounds, as indicated in TABLE CXIX, page 691, ante, only 13.6 per cent, ended in death. Nor can this high rate of mortality be attributed to the presence of other complications, such as pya3mia, gangrene, erysipelas, tetanus, etc., as the fatality of the cases in which these diseases occurred com prised only 20.5 per cent, of the whole number of deaths, while in six hundred and fifty- three instances, or 47.3 per cent., death was ascribed directly to haemorrhages, and in 22.2 per cent, to exhaustion following severe or continued loss of blood. Of the two thousand two hundred and thirty-five cases of haemorrhage in which the bleeding vessels were specified, one thousand one hundred and fifty-five were followed by ligation. Many of these instances of ligation, especially of the larger arteries, have already been cited in this and the preceding volumes, sometimes in detail, sometimes in partial tabular statements. For the convenience of the reader all have here been grouped together in a numerical statement, which will be followed by nominal lists arranged according to the various blood-vessels operated upon. TABLE CXXV. Tabular Statement of One Thousand One Hundred and Fifty-five Legations for Shot Injuries. ARTERIES LIGATED. CASES. RESULTS. ARTERIES LIGATED. RESULTS. Rec. Fat. J Eec. Fat Common Carotid 82 7 1 1 5 1 18 8 1 51 2 19 4 1 1 4 1 14 5 1 10 63 3 1 4 3 41 2 4 Brought forward 529 281 4 4 2 2 1 1 1 1 4 3 5l 3 6 2 2 26 3 374 93 1 1 22 5 6 24 6 36 3 1 7 4 40 22 1 1 2 1 48 - 3 2 4 1 1, 155 471 248 1 5 3 4 2 23 1 281 17 (i 18 28 o 3 18 1 19 1 3 External Carotid Arch Vol Profundi Temporal . .1 Common Iliac Facial Gluteal Intercostals 6 2 1 1 1 1 2 2 49 7 1 Superficial Cervical 42 1 1 1 51 2 2 1 14 2 3 External Pudic A xillary Perforating Arteries Acromial Thoracic (Branch) 2 . 1 IS 11 1 Popliteal Circumflex Mnr.iila.r T?rjirh Brae-trial 170 3 7 1 119 1 5 47 J Anterior Tibial. ... . ) ( Muscular Branch Profunda Anastomotica Magna Posterior Tibial Radial 59 22 9 45 20 6 TTlnar Aggregates Forward . . . 684 529 281 248 766 WOUNDS AND COMPLICATIONS. [CHAP. XH. Four hundred and seventy-one eases terminated in recovery, and six hundred and eighty-four in death, a mortality rate of 59.2 per cent. legations of the Common Carotid. Eighty-two cases 1 of ligation of the common carotid were reported; nineteen recovered and sixty-three proved fatal, a mortality of 76.8 per cent. The operations were performed for haemorrhages from the common carotid in four cases two recoveries, two fatal ; for haemorrhages from the internal carotid in four cases- all fatal; for injuries of the external carotid in eleven cases one recovery, ten fatal; and in twenty-eight instances, with eight recoveries, for haemorrhages from branches of the carotids the lingual in seven, the auricular in one, the temporal in two, the facial in five, the maxillary in eleven, the middle meningeal in two cases. In one case it was found at the autopsy that the haemorrhage had occurred from the vertebral artery. In the following the bleeding occurred from the internal carotid on the eighth day: CASK 1105. Sergeant P. I?. Messenger, Co. A, lllth Pennsylvania, aged 33 years, was wounded at Lookout Mountain, November 24, 1863. He was admitted to a field hospital of the Twelfth Corps and transferred to the General Hospital at Tulla- lioma five days afterwards. Surgeon B. Woodward, 22d Illinois, in charge of the latter, described the case as follows: "The injury consisted of a compound comminuted fracture of the right lower jaw, the ball passing in at the angle of the mouth, going backward through the neck, and making its exit close by the cervical column. Water dressings were applied and opiates were administered. By December 2d the wound was discharging freely, no attempt having been made to remove any portion of the fractured bone by reason of the great amount of swelling. At noon the patient fed himself with soup; but at 1.30 P. M. I was called to him and found four quarts of blood collected in a large tin basin. Arterial blood was also pouring in torrents from his mouth. On introducing the finger it was found that the internal carotid had sloughed, when I pressed lint soaked with solution of persulphate of iron firmly back against the bleeding artery, and, holding it there with my finger, directed Assistant Surgeon II. Pearce, 150th New York, to cut down and take up the common trunk, which he did. Before the artery was taken up the patient had a severe convulsion from the loss of blood, rendering the operation very difficult. The lint was left in situ, though the blood ceased to pour from the artery immediately after the operation; pulse at the wrist imperceptible; breathing gasping. The patient was allowed to lie on the table for four hours, being wrapped in hot blankets. At 9 P. M. the pulse was perceptible but very weak; patient made to swallow pure extract of beef in teaspoonful doses every fifteen minutes and through the night. After he was removed to his bed extreme vigilance was kept up, and at 11 P. M. I gave him one-fourth of a grain of morphia. The following morning his pulse was 160 and very feeble. He had not slept any, but his bowels had moved well and he had urinated. There had been no bleeding, and at 10 A. M. the lint was removed and his mouth cleaned out. By 8 P. M. he had slept two hours, his pulse was 130 and fuller, and he was given one drachm of wine with two drachms of extract of beef every two hours. During the next night he slept well; pulse 120 and growing fuller; no haemorrhage; wound in neck suppurating well ; patient sitting raised in bed and takes nour ishment freely; feels well but weak ; no cerebral symptoms; bowels moved; urinates freely. At 2 P. M. his pulse was 110 and he felt well enough to dictate a letter to his wife. At 8 P. M. on December Gth he was still doing well, his head feeling clear; pulse 98 and growing full; appetite good; craves oysters, which are given as freely as he wishes. No change took place until the night preceding December 8th, when his pulse become 120 and very soft ; evidences of cerebral symptoms beginninir to show themselves, such as hebetude and listlessness; breathing very feeble; slight but perceptible divergence of the right eye. His appetite, which had been good, was now failing. At 5 P. M. there was great hebetude and he could hardly be roused, though rational when roused; eyes winking; pulse 120, very soft and feeble. Coma came on at 8 P. M. and complete paralysis of the left side. Death occurred at 1 A. M. on December {), 18(53. The autopsy showed every part of the brain to be covered with lymph. The right side seemed to be more pallid than the left, though this might be imaginary. Dissecting out the carotid from its origin at the innominata to its entrance into the skull we found a firm clot at the point of the ligation, extending Fn; 4-^if one-half inch below and one and three-fourths inches above the ligature. The internal carotid was completely Right common filled with a firm fibrinous clot as far as the entrance of the skull, so that in no event could haemorrhage have I inches below taken place. The jaw was a mass of putrilage and pus had followed down the sheath of the common trunk, c" U fH)fo on hathing all the parts to a full inch below the ligation and dissecting out the descendens noni nerve." In addition to the history of the case Surgeon Woodward has contributed a wet preparation of the ligated artery (tiprc. 2018), a representation of which appears in the adjoining wood-cut (FlG. 420). Reviewing the above case Surgeon Woodward remarks: "Here was a case in which, according to Guthrie, 2 the internal carotid should have been ligated in the back of the throat. If allowed to differ from so great an authority, I say it could not have been done. 1 Professor D- HAYES AGXKW (The Principles and Practice of Surgery, Philadelphia, 1878, Vol. I. p. 6:iO) states that "(luring the War of the Rebellion there were llfi ligations of the common carotid for wounds of the face and the neck, 81 of which died, and gives as his authority the Surgical Hixtory <if iht. War. Part 1. The eminent professor evidently overlooked the fact that the cases given in detail are also included in the tabular statements. On page 4JU of the fir.it ijargical Volume the number of ligations of the common carotid, as then ascertained, was stated to be 75. On page 45(> of the same volume another case was subsequently added, making a total of 7<i cases. Since then (i additional cases have been found, making a total of 82. CiUTllltIK, (<!. J.). Commentaries, London, 18r>5, Sixth Edition, p. U53. LIGATIONS OF THE COMMON CAROTID ARTERY. 767 In the first place, the jaw was shattered, pieces of which had been removed before he came to this hospital [Tullahoma]. The face and neck were enormously swelled, and a large quantity of flowing pus from a great suppurating surface blinded every view of the parts. Again, when the haemorrhage came on, it was in such a torrent that there was no time for a nice dissection, such as Guthrie advises in his theoretical operation." CASK 1103. Corporal J. Quick, Co. G, 38th New York, aged 21 } r ears, was wounded in the face, at the, battle of Fred- erieksburg, December K>. 18;>2. a ball passing behind the left, condyle of the lower jaw and making its exit on the left side of the nose. The wounded man was admitted to Eckington Hospital, at, Washington, five days after receiving his injury, his fact; being very much swollen on the left side and the left eye being closed but uninjured. The treatment consisted of rest, aperients, low diet, and lead-wash locally. No fever ensued, the. swelling abated, and the patient did very well until December 25th, when secondary 1 feinorrhage occurred at 4 r. M. The blood gushed from his mouth and left nostril, amounting to a quart in a few minutes. Acting Assistant Surgeon H. N. Fisher, assisted by Acting Assistant Surgeon A. Edelin, quickly plugged the nares with bits of muslin strung on threads and thrust into the nostiil, which promptly stopped the haemorrhage. It occurred again, however, and was controlled by thrusting in more of the tampon. The patient slept pretty well all night, being carefully watched and having his head well elevated. At 10 A. M. on December 26th he commenced bleeding again, the blood spouting from the wound at the side of the nose. A compress then applied over the orifice, and snugly bandaged, controlled the haemor rhage. On the morning of the following day the patient had another free attack of haemorrhage, but it was promptly checked by increased pressure on the compress, after which, on consultation, it was determined to tie the common carotid artery. Acting Assistant Surgeon Fisher accordingly ligated that vessel just above the omo-hyoid muscle, the patient not being etherized. The plugs were then removed from the nostril and the compress from the face, and no haemorrhage recurred. The patient was put to bed, and the face and fresh wound were dressed with cold water. With the aid of an anodyne the patient slept well during the following night. The next morning his pulse was 120, a very slight pulsation being detected in the left temporal artery and that side of the head preserving its warmth. He was now also afflicted with diarrhoea, the discharges being thin and light colored. Beef tea and stimulants were ordered. On December 30th the pulse had increased to 150; patient s mind wandering; very restless; diarrhoea still continuing. Opium pills were now prescribed and the stimulants continued. On January 2, 1863, the patient was quite insensible, but gave answers when aroused; diarrhoea still continuing; stools frequent and involuntary; skin cold; pidse 140 and weak; wound looking sunken and glassy. In addition to opiates vegetable astringents were now ordered. Being unable to swallow solids and feeling choked by swallowing liquids, he Avas ordered oysters, which he ate greedily and swallowed readily. On January 4th the patient was still in a stupor; skin cold; pulse p] G 421 146; some little redness about wound of face; wound of neck suppurating. In the afternoon a <anious discharge Left com- ! ... . c i TIM p i i mon euro- came on from the place of operation, giving reason to rear haemorrhage from the artery. Ihe oozing from the neck tid; ulcer- continued, and the patient s condition was about the same on the following dav until 2.30 P. M., when the attending "tionornrt- B J ery witli- surgeon was called in haste and found that the carotid had given way and the blood was gushing per saltum from out forma- the wound. Death supervened in a few minutes. At the post-mortem examination the artery was found to have spec* K)8 ulcerated through anteriorly where the ligature was applied. No attempt at union of the inner coats of the vessel was discovered, and no fibrinous deposit was found on the cardiac side, it having doubtless been forced out by the haemorrhage. The distal side was, however, occupied by a plug extending up to the bifurcation of the vessel. The history of the case, together with the injured portion of the ligated artery (tfper. 898), represented in the annexed cut (FlG. 421), was contributed to the Museum by the operator. TABLE CXXVI. Condensed Summary of Eighty-two Cases of Ligations of the Common Carotid for Shot Injuries. [Recoveries, 1 H): Deaths, 2082.] No. NAME, AUK, ANI> MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF H.KMOU- KHAQE. PROBABLE SOURCE OF HJEMOIUUIAGE. DATE OF OPERA- TION. OPERATION, OPERA TOR. RESULT. 1 Ames, J. F., Pt., G, Mar. 31, Fracture left nasal Apr. 5, Branch of internal Apr. 5, Left ; in upper 3d, in Discharged July 3, 91st N. Y., ago 24. 1865. and superior max- 1865. maxillary artery. 1865. cont. Surg. T. R. 1865. illary bones. Crosby, TT.S.V. 2 Andrews, W. C., Pt., Dec. 28, Shell wound left tern- Jan. 18, Middle meningeal Jan. 18, Left; in continuity. Discharged May 28, A,30thIo\va,agelO. 1862. poral region. 1863. arterv. 1863. Ass t Surp. C. T. 1803. Alexander, F. S. A. 3 Beamenderfer.C.W., May C, Fracture left lower . May 12, Carotid artery May 12, Left; in continuity, Discharged Nov. 29, Pt., A, 84th Pa., 1864. maxilla; excision. 1861. 1861. just above clavicle. ! 1864. ago 20. 4 Heard, ./. J., Lieut., Aug. 13, Fracture of inferior Aug. 21. Common carotid ... Sept. 4. ; in continuity. Recovered. B. 19th Va. Cav., 1804. i maxilla. Sept. 4, 1864. Surg. W. S. Lov o, ; ape 28. 1864. 1 . A. U. S. 5 Brooko, J.,Pt.,1, 57th May 6, , Fracture left tempo- June , Temporal artery ; June 20, Left; in continuity. Discharged June 8, Pa., age 17. 1864. rnl bone. 1864. June 18, lig. temp. 1864. Sure. T. K. Crosby, 1865. U.S. V. Aug. 15, re- . , ligation below omo- hyoid. Cox, I)., Pt., F, 15th Nov. 25, Fracture left lower Nov. 25, Subliugual artery . Nov. 29, Left; in continuity. December 3, left ca- Indiana, age 25. 1863. maxilla. 1863. 1863. Surz. A.McMahon, rotid ligated. Dis- U. S. V. charg. June 2. ., 1804. WOUNDS AND COMPLICATIONS. [CHAP. XII. No. NAME, AGE, XXD MILITARY DESCRIPTION. DATE OF INJURY. NATURE OK INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 7 8 Fugleson, C., Serg t, E, 4th Ohio, age 35. Hayden J S Pt D Mav 12, 1864. Feb li Flesh woundoflower jaw. June 25, 1864. Mar. 8 ligation facial artery. Julv l, 1864. Mar 22 Right; in continuity. Surer. D. W. Bliss, U.S.V. Discharged October 27, 1864. Discharged July 23, 9 10 11 12 11 2(1 Iowa. Hisgins, P., Pt., K, 56th New York Klingenberg.C., Pt., F. 7th New York Artillery. Malev, T. E., Lieut., 5th Cavalry, age 29. Merchant, G. B., Serg t, K, 4th Ohio, age 33. Murrav J. L. Pt. B 186- . May 31, 1862. Juno 3, 1864. July 28, 1864. Mav 10, 1864. Oct. 14 bone. Fracture lower jaw. . Fracture lower jaw. . Fract bones of face . Fract inferior max illa. 1862. May 31, 1862. June 9, 1864. Aug. 18, 1864. Mav 15, 1864. Oct. 25 Sublingual artery . Internal maxillary artery. Internal maxillary artery. 1862. May 31, 1862. June 9, 1864. Aug. 24, 1864. May 15, 1864. Oct. 25 J. Moore, U. S. A. Right; in continuity. Surg.Z.E. Bliss, U. s.v! Right; in continuity. Surg. D. P. Smith, u.sTv. Right; in continuity. Surg. A. B. Mbtt, U. S. V. Right; in continuity. Ass t Surgeon W. Thomson, U. S. A. 1862. Discharged Sept. 21 , 1862. Discharged Feb. 20, 1805. Retired December 15, 1870. Returned to duty June 19, 18G4. Discharged Feb. 13, 14 42d N. Y., age 32. Flasket J. Pt., A, 1863. Sept. 9 ilia. Fracture of bones of 1863. Sept. 9 1863. Sept. 9 Surg. E. Bentley, U. S.V. Carotid ; in continu 1864. Transfer dtoV. B.C. 15 120th New York. Reed J K F Ser^ t 1864. Sept 17 face. 1864. 1864. Sept 28 ity. Surg.W.B.Rev- iiolds, 2d.U. S. S. S. May 4, 1865. 16 IT Ifl 19 D, 13th Mass. Salmon. G.E.,Pt, I, 207th Pa., age 26. Sandv.N.B., Ft., G, . id W. Va,, age 19. Shockey, D., Pt., I, 101st Jnd., age 22. 1862. Apr. 2, 1805. Aug. 30, 1862. Sept. 19, 1863. Mav 27 face, right side. Fracture right infe rior maxilla. Fracture left inferior maxilla. Fracture left lower jaw Apr. 10, lf-65. Sept. 6, 1862. Sept. 25, 1863. May 31 Right common ca rotid. Through mouth .. Haem. recur. Sept. 30, Oct. 6, 9, 10. 1862. Apr. 11, 3865. Sept 6, 1862. Oct. 14, 1863. Right; in continuity. Right; in continuity. A ss t Surg. P. Adol- phus, U. S. A. Left; in continuity. Confederate surg. 1862. Discharged May 18, 1865. Discharged October 10, 1862. Discharged June 24, 1865. Recovered. 20 ?1 49th Mass. Ashley, J. J., citizen, age 63. Backus, J. W., Pt., 1863. Oct. 16, 1864. July 9, bones. Wound of left ear, sloughing. Fracture right infe 1863. Oct. 29, 1864. July 20 Temporal artery . . Facial artery 1863. Oct. 29, 1864. July 25, Surg. F.C.Greene, 30th Mass. Left ; in cont. A. A. Surg. N. A. Robbing. Right; in cont. Ass t Died November 2, 1864. Died September 1, 22 23 *>4 A, 12th Ga. Batt y, age 20. Baine, H., Pt., C, 188th Pa., age 19. Beare, J., Pt.,G, llth Pa., age 34. Bowles, G.W., Serg t, 1864. June 3, 1864. Mav 10, 1864. July 3 rior maxilla. Wound left side of face. Injury com. carotid artery and external jugular vein. 1864. June 15, 1864. May 10, 1864. July 9 Internal maxillary artery. Common carotid . . 1864. June 16, 1864. May 15, 1864. July 10 Surg. R. F. Weir, U. S.A. Aneurism ;re- lig. above and below aneurism, Aug. 30. Left; in continuity. Surg. N. R, Mose- ley.TJ. S. V. Left ; in cont and ext. jug. vein. Surg. E. Bentley, U. S. V. 1864. Died June 26, 18(54; exhaustion. Died May 21, 1864; pysemia. Died July 13, 1863. 25 26 ?7 I, 42d Fa,, age 25. Bovts, H., Ft., A, 142d Pa., age 18. Brown, G, Ft., I, 25th Mass., age 41. Burns, R., Ft., 10th 1863. Aug. 21, 1864. Dec. 14, 1862. May 31 ilia. Fracture left tempo ral region. Fract. malar, temp., and max. bones. 18S3. Aug. 26, 27, 1864. Jan. 7, 9, 1863. External carotid. . . 1863. Aug. 27, 1864. Jan. 9, 1863. Left; in continuity.. Right; in continuity In continuity ; lin Specs. 3969, 3902. Died Sept. 2, 1864. Spec. 3179. Died Jan. 18, 1863; exhaustion. Died Juno 19, 1862; 28 ?ft Massachusetts. Clark, J., Pt., H, 57th Pa., age 21. Copeland, W. Ji., Pt, 1862. Sept. 30, 1864. Sept. 19 neck. Fracture right upper jaw. Wound left side of Oct. 13, 1864. Oct. 7 External carotid. . . 1862. Oct. 13, 1864. Oct. 7 gual also tied. Right; in continuity. A. A. Surg. J. H. Packard. Ri ir ht- in continuity. exhaustion. Died Oct. 22, 1864, of haemorrhage. Ha3m. recurred; died 30 B, 61st Ala., age 34. Oreecy, B., Pt., F,42d 1864. May 3, face. Shot wound of lar 1864. May 12 1864. Mav 12, Surg. W. S. Love, F. A C. S. Ri^ht in continuity. Oct. 8, 1864. May 15, left; in cont. 31 rt? Va. Cronin, M., Pt., F, 95th N. Y., age 19. Darnabv, E., Ft, H 1863. June 19, 1864. Apr. 12 ynx. Wound right side of face. 1863. July 1, 1864. Internal maxillary artery. 1863. Julv 4, 1864. Surg. R. Murdock, P. A. C. S. Right ; in continuity ; religated July 6. Died May 20, 1863. Died July 6, 1864; haemorrhage. Died May 5, 1805, of 33 34 35 1st Maine Cav., age 19. Deibold, C., Lieut., D, 82d Ohio. Dougherty, J., Ser geant, B, 69th N.Y., age 23. Felix. W.,Pt,H, 9th W. Va., age 18. 1865. May 8, 1862. May 13, 1864. Aug. 25, 1861. ang. jaw ; carotid artery wound. Shot wound of neck Fracture right pa rietal. Fracture right lower jaw. May 23, 1862. May 16, 1864. Sept. 3, 1864. External carotid sloughed. Middle meningeal artery. Lingual artery Mav 24, 1862. May 16, 1864. Sept. 3, 1864. ing Staff Surgeon N. F. Graham. In continuity. Surg. J. Y. Cantwell, 8*1 Ohio Right; in continuity. Surg. E. Bentley, U. S. V. Left; in continuity. Ass t Surg. R. F. Weir, U.S. A. haemorrhage. Died June 19, 1862. Died May 26, 1864, of exhaustion. Died Sept. 4, 1864, of haemorrhage. 36 Fisher, "W., Lieut., Oct. 7, Facial and carotid Facial and carotid Oct. 9, Left; in continuity. Died Oct. 10, 1864. 37 H, 99th Pa. Fonderan, A.,Serg t, 1864. June 24, arteries severed. Fracture lower jaw July 7 arteries. 1864. July 8 Surg. W. B. Rey nolds. 2d U. S. S. S. Right -in continuity ; Died July 10, 1863, 38 39 40 D, llth Indiana, age 25. Gardner, J. B., Pt, F, 5th Louisiana. Guthi-ie, W. T., Pt, F, 38th Va., age 30. Harrington, M., Ft., 1863. Feb. 7, 1865. Mav 16, 1864. Julv 24, right side. Ball entered anterior to left ear. Wound of face Wound through neck 1863. Feb. 17, 1865. June 19, 22, 1864. Aug. 9 Recur. 20th, 21st, and 22d. Superior maxillary 1863. Feb. 22, 1865. June 23, 1864. Aug. 10, religated at bifurc. ext. and int. car. ; inc. in ligature. Left; in continuity. Surg. W. F. Rich ardson, P. A. C. S. Left; in continuity.. Left in continuity, from exhaustion. Specs. 1635,1636. Died Feb. 22, 1865. Died June 25, 18f.4 ; exhaustion. Died Aug. ft), 1864. 41 L, 21st N. Y. Cav., age 19. Reiser, J., Oorp l, 1, 53d Fa., age 27. 1864. Aug. 14, 1864. Shot wound of face. . 1864. Aug. 24, 25, 1864. Inferior maxillary artery. 1864. Aug. 25, 1864. Surg. J. B. Lewis, U. S. V. Aug. 14, lig. right com. car. In cont Surg. N. R. Moseley, U. S. V. Died Aug. 30, 1864; exhaustion. C1IAP. XII.] LIGATIONS OF THE COMMON CAROTID ARTERY. 769 No. NAME, AGE, AND MILITARY DATE OF NATURE OF INJURY. DATE OF 1 IjKMOU PROBABLE SOURCE DA OPEUATIOX OrEUA . RESULT. DESCRIPTION. INJURY. RHAGK. HEMORRHAGE. ^JQ!^" 42 Herman, H., Pt., I, Sept. 17, Wound of neck ; ball Sept. 29, Carotid artery ; an- i Sept. 30, Right ; both ends in Died Oct. 1, 1802. 12th Pa. Res., ago 1862. lodged in spinal 1862. curism. 1862. wound. A. Suiir. 23. cord. R. F.Wcir, T. S. A. 43 Houston, J. C., Pt., Apr. 9, Fracture tight malar May 6, Branches external May 7, Left; in continuity. II&iu. recurred; died I), 2(1 Ala,, age 18. 1865. bone. 7,1865. carotid. 1865. Surg. A. McMaho u, May 26, 1865. U. S. V. 44 Hughes, D. C., Pt.. M:iy . Woun.l nt neck Left* in cout. May Died May 17, 1862. F, llth Virginia. 1802. 17, lig. ofrightcom. carotid. 45 Uutchins, H., Pt., I, Dec. 9, Fracture inf. max- Dec. 18. Lingual artery Dec. 18, In cont. A. A. Surg. Died Dec. 27, 1864 ; 2oth Ohio, ago 25. 1864. ilia. 1864. 1 1864. S. Hendrickson. haemorrhage. 46 Huttx, J/., Pt., C. S. Fractuie lower jaw June 7 Juno 7 Ixi 4f l)t in continuity Died J une 8, 1863. A. , ago 35. 1863. 1863. 47 Jones, E., Pt,,D,29th July 4, Fracture left inferior July 18, Brach., facial, and July 18, Left; in continuity . . Haem. recurred ; died Iowa. 1863 maxilla. -1863. lingual arteries. 1863. July 26,186:;. 48 Junes, J. P., Pt., E, May 3, Fracture left supe- June 3, Slough, rcc. 5, 6, 7. June 7, In continuity Died Juno 7, 1863; ex 21st Miss., ago 30. [ 1863. rior maxilla. 1863. 1863. haustion. 49 Juugk, J. G., Serg t, Sept. 3 ), Fracture right upper | Oct. 7, | External carotid Oct. 7, Right :incont. A. A. Died Oct. 12, 1864, of F,46thX.Y.,age30. 1864. jaw. 18C4. artery. 1864* Surg.G. A.Chcsley. haemorrhage. 50 Keiflin, V. L., Serg t, July 2, Fracture right arch July 12, Internal carotid ... July 13, Right, in continuity. Died July 14, 1863. K, 105th Pa. 1863. of atlas. i 1863. 1863. Surg. H. Palmer, U. S. V. 51 Kenrick, A. F., Pt,, June 2, Wound of face .... June 17, Recurred 18th and June 19, Left ; in continuity . . Died June 22, 1864. A, 16th Kv., age 24. 1864. 1864. 19th. 1864. 52 Kilburu.D. W.,Pt,,I, May 19, Wound of face and May 29, Facial and exterior May 29, Right ; in cont. A. Died June 2 1864, of 1st Maine, ago 22. 1864. neck. , 1864. carotid arteries. 1864. A. Surg. J. C. Nel asphyxia. j son. 53 Klink,N., Pt.,K,95th M;iv 3 Wound ri <r ht side of May 14, . . . TVT:iv1fi ! Hir^ht.. in coiitimiitv Died May 20, 1863. Pa., ago 26. 1863. face. 1863. 1863. I 54 Lilley, E. F., Pt., G, Max- 9 Wound of face M.ivifi M:i v Ifi Right; in continuity . Died May 16, 1864. 8th Texas, age 24. 1864. 1864. 1864". 55 McGuire, J. H., Pt., Sept, 26, Fracture left inas- Oct, 10 Left; in continuity. - Died Oct. 24, 1863. K, 24th Miss. 1863. toid process. 1863. 56 Mcllroy, J. P., Pt., June 3 Fract. inf. maxilla ... I.Tiinttlft Tn cunt. A A Snr<r Died Juno 19, 1864; C, 4otii Pa. 1864. int. max. art. ini. 1864. j J. H. York. haemorrhage. 57 Melunis, S., Pt., A, May 22, ! Fracture lower jaw ; May 31, External carotid . . < May 31, In cont, Surg. E. M. Died Juno 7, 1863. llth Illinois, age 27. 1863. i right side. 1863. 1863. Powers, 7th Mo. 58 McIntoah,T., Pt.,A, Nov. 25 1 Fract. frontal l>mn< Tiff Ifi Dec. 16 Rio lit,- in <*,nnt,inuitv Died Dec. 19, 1863 ; 40th Ind., age 18. 1863. 17,1863. 1863. exhaustion. 59 McKenney, E., Pt., Jan. 1, Wound through left Jan. 1, Aneurism Feb. 26, Left ; in cont. Ass t Died April 6, 1863. 6th Pa. Cav., age 26. 1863. side neck. 1863. 1863. Sui g. R. F.Weir.U. S. A. 60 Martin, T.B.,Pt.,E, Sept. 20, Fract. orbital plate Oct. 8, Ophthalmic artery ; Nov. 11, Riuht; in cont. A. Died Dec. 19, 1863. 96th 111. 1863. and nasal bones. 1863. haemorrhages Oct. 1863. A. Surg. J. H. Coo- 23 and Nov. 7, 10. ver. 61 Messenger, P. B., Ser Nov. 24, Fracture right lower Dec. 3, Internal carotid . . . Dec. 3, Right; both ends in Died Dec. 8, 63. Spec. geant, A, lllth Pa. 1863. jaw. 1863. i 1863. wound. Assistant 2018, A. M. M, Surgeon H. Pearce, 150th N. Y. 62 Moore, J. G., Corp l. Feb. 6, Wound left side of | Feb. 15, Internal carotid. . . Feb. 15, Left; in continuity. Died Feb. 25, 1865. B. 110th Pa., age 20. 1865. head. 1865. 1865. Feb. 21, religated. 63 O Connor, P., Pt,, H, Sept. 20, Fracture left inferior Oct. 2, Facial art.; Oct. 4, Oct. 23. Right; in continuity. Died Oct. 25, 1863, of 18th Inf. 1863. maxilla. 1863. ligature ext. caro 1863. Surg. L Moses, TJ. exhaustion. Spec. tid. Surg. P. H. S.V. 2133. Cleary, U. S. V. 64 Peckham, A. J., Cor Jllllt^ ** Fracture cranium .Tnn 8 Right; in continuity. Died Juno 13, 1864; poral,!, 115th N.Y., 1864. 1864. Surg. E. Bentley, exhaustion from age 30. U. S. V. continued haem. * 65 Phillips, G., Corp l, Oct. 27, Left inferior maxilla. Nov. 4, Lingual Nov. 6, Left; in continuity. Died Nov. 18, 1864, of H, 91st Pa., ago 28. 1864. 6, 1864. 1864. Surg. N. R, Mose- exhaustion. Spec. ley, U. S. V. 3409. 66 Pvle, L. A., Serg t, Aug. 25, Ball impinged on Sept 7, Post, auricular ar Sept. 9, Right; in continu Died Sept. 20, 1864 ; A, 8th N. Y. Art., 1864. temporal bone. 9, 1864. tery. 1864. ity. A. A. Surgeon haemorrhage. Spec. ago 21. "W. W. Valk. 3252. 67 Quick. J.. Corp l, G, Dec. 13, Fracture left lower Dec. 25, Recurred 26th and Dec. 27, Left; in cont, A. A. Died January 6, 1863. 38th N.Y., age 21. 1862. jaw. 1862. 27th. 1862. Surg". H. N. Fisher. Spec. 8G8, A". M. M. 68 Reeves, W., Pt., C, May 6, Fracture of inferior May 12, Lingual and inf. May 12, Left ; in cont. A. Died May 13, 1864; 761 h N. Y., age 22. 1864. maxilla. 1864. dental arteries. 1864. Surg. G. A. Mur- exhaustion. sick, U. S. V. 69 Ritisran, J., Pt., B, May 6, Fracture of inferior May 14, Carotid artery ... May 31, Right; in continuity. Died June 1, 1864 ; C3d N. Y., age 30. 1864. maxilla. 1864. 1864. Surg. G. L. Pan- prostration. Specs. coast, U. S. V. 2481, 2482, A. M. M. 70 Robinson, J. W., Cap June 19, Wound left side of June 19, Internal carotid. . . Juno 19, : Left; in cont. July Died July 5, 1861. tain, C, 27th Geor- 1864. neck. 1864. 1864. 3, relig. below omo- eia, age 21. hyoid. 71 lioUin, J. N., Pt., I, Oct. 19, Ball entered hack of Oct. Nov. 9, Tn cont, A. A. Surf. Died Nov. 9, 1864 ; 1st N. Carolina, age 1864. neck ; fracture ver 1864. 1864. G. G. Brewer. exhaustion. 2K. tebra. 72 Schcnck, W., Pt,, F, June. 15, Fracture sup. max July 6, Superior maxillary July 10, In cont. A. A. Surg. Died July 24, 1864; 119th N.York, age 18. 1864. illa. 1864. artery. 1864. D.J. Griffiths. exhaustion. 7. J Schlicher, J., Corp l, July 1, Fracture left supe- July 8, Recurred lOtli and July 16, Left; in cont. A. A. Died Aug. 23, 1863. C, 20th Mass.. age 33. 1863. rior maxilla. 1863. 16th. 1863. Surg. W. W. Keen. Spec. 4428. A.M. M. 74 Sheppard, P., Pt., K, Aug. 1, Fracture nasal, ma- Aug. 29, ! Internal maxillary A us. 30. Right; in continuity. Died Aug. 30, 18C4 ; 42d Indiana, age 34. ! 1864. 1 :ir, and inf. max- 1864. artery. ; 1864. Surg. 13. B. Breed, haemorrhage. illary bones. TJ. S. V. 75 Smith, W. W.. C. S. May 5, Wound of head and May 12, May 21, In continuity . . Died May 22, 18H4. A. 1864. neck. 1864. i 1864. 76 Spacht, M., Pt., D, May 31, Fracture sup. in;\\- Juno 13. . June 14, Left ; in cont. A. A. Died June 24. 1862. 52d Pennsylvania. 1862. i ilia. 14.1862. 1862. Surg. D. W. Chee- Spec. 508, A. M. M. ver. 77 Stie-nberger, S., Pt., May 5, Fracture lower iaw MavlS, Vertebral artery. Mav 16, In cont, Surg. R. B. Died May 23, 1862; 1st Cavalry. \ 1862. and 3d cervical ver 1862. 1862. Bontecon, U. S. V. haemorrhage. tebra, 78 Theilman, II., Pt., K, Juno 19, Wound left side face; July 6, Left ; in cont. A. A. Died July 12. 1864; 15th New York Ar- 1864. fracture. 1864. Sura. O. W. Peck. exhaustion. tillury. age 37. SURG. 11197 770 WOUNDS AND COMPLICATIONS. [CHAP. XII No. 79 80 81 82 NAME, AGE, AND MILITARY DESCRIPTION. DATE OP INJURY. XATURE OF I.VJUUY. DATE OF HJEMOR- KHAGIi. PROBABLE SOURCE OF HEMORRHAGE. DATE OF Ol ERA- TION. OPERATION, OPERA TOR. RESULT. Thomas, G., Pt., C, 82d Pa., age 22. Trabey, H., Pt., L, 5tb.Pa.Cav., ace 26. Ward, P. H., Pt., B, 24th Wisconsin. Winter, F.,Pt.,A,3d Illinois Cav., age 24. May 10, 1864. May 8, 1804. Dec. 30, 1862. Aug. 21, 18G4. Fracture infer r and superior maxillae. Shot- wound of face. Fracture inf. max illa. Fracture upper and lower jaws. June 2, 1864. June 26, 1864. Internal maxillary June 2, 1864. June 27, 18G4. Jan. , 186. !. Sept. 6, 1864. Left ; in cont. A. Sure. W. Thomson, U. S. A. Int. jug. vein also tied. In cont. A. Surg. W.Webster,TJ.S.A. Right ; in continu ity. Lei t ; in cout. A. A. Surg. J. Z. Hall. Died June 3, 1864. Spec. 3542, A. M. M. Died July 5, 1864. Died Jan. 15, 1863. Died Sept. 7, 1864; exhaustion. Inferior maxillary artery. Internal maxillary artery. Sept. 4, 1864. legations of the Internal Carotid Artery. Instances of this operation are rare, 1 and no cases were reported by the medical officers of the Union army. Jjigations of the External Carotid. Of seven cases, four recovered and three were fatal. The bleedings were from the internal maxillary in two, from the carotid in four instances ; in one case the source of the haemorrhage was not indicated. TABLE OXXVII. Condensed Summary of Seven Cases of Jjigations of the External Carotid Artery for Shot Injuries. [Recoveries, 1 4; Deaths, 5 7.1 No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. DATF, NATURE OF INJURY. Hj * OK . KIIAGE. PROBABLE SOURCE ^Q^ & HEMORRHAGE. , ,^ OPERATION, OPERA TOR. RESULT. 1 2 3 4 5 6 7 Bryant, W., Pt., B, 17th Indiana. Diss, C. A., Pt., D, 30th Ohio. Henderson, G.,Serg., F, 7th Wisconsin. Thompson, L. 0.,1 t., S, 1st Texas, age 20. Godfrey, A., Pt., U, June 25, 1803. Sept, 14, 1802. Sept. 14, 186. . Dec, 14, 1864. Juno 18, Ife64. June 6, 1864. June 3, 1864. Fract. left malar and maxillary bones. Fract, superior max illa. Fract. inferior max illa. Fract. inferior max illa. Wound of external carotid. Fracture of zygoma. Fract. right orb. and zygomatic arch. July 5, 8, 63. Sept. 22, 1862. Sept, 15, 1862. Dec. 14, 1864. June 27, 18G4. June 7, 1864. June 15, 1864. External carotid . . Internal maxillary and carotid. External carotid . . Internal maxillary. External carotid . . Internal maxillary. July 8, 1863. Sept. 22, 1802. Sept, 15, 1802. Dec. 14, 1804. June 27, 1864. June 7, 1864. June 16, 1864. One end in wound . . . In cont. Surg. H. S. Howit.TJ. S. V. In continuity Returned to duty June 11, 1864. Discharged Nov. 24, 1862. Discharged Oct. 25, 1802. Recovered Juno 14, 1865. Died Juno 30, 1864. Died June 10, 1864. Died June 16, 1864, of exhaustion. In cont. Surg. J. C. Jones, 4th Texas. Both ends in wouud. Surgeon G. L. Pan- coast, U. S. V. 14th X. Y. Art y, ago 16. Nelson, G. TF., Pt.,K, 12th Georgia. Whitney, F. L., Pt., D, 3Uth Massachu setts, age 24. In continuity. A. A. Surg. W. H". Ensign. Thirty-five examples of ligations of minor branches of the external carotid were reported. They comprise one ligation of the superior thyroid, one of the lingual, five of the occipital, 1 On the Confederate side a case is related by Dr. W. H. BRAMLETTE. It will be found on page 194 of the Medical Record, New York, 1869-70 Vol. IV : Captain H , 5th Georgia State Reserves, aged 47, was wounded December 10, 1864, by a mini6 ball, which comminuted the malar bone, and ranging- backward, impinged against the base and inner border of the mastoid process, passing out at back of neck. lie was sent to a hospital at Macon, where the fractured bone was removed; secondary haemorrhage occurred on the tenth day from wound of entrance, which was controlled by pressure on common carotid until the arrival of the surgeons. The ordinary incision was made and the internal carotid ligated, as was believed, about three-fourths of an inch above the bifurcation ; haemorrhage from wound ceased ; ligature came away on 14th day without haemorrhage. On the follow ing day an alarming haemorrhage recurred from a small opening in the line of the incision of the neck ; the common carotid was then ligated below the omo-hyoid muscle ; haemorrhage continuing through the reflow of the blood through the external carotid, the latter was ligated, as also the superior thyroid. The ligatures separated and came away without haemorrhage that of the common carotid about the 18th day ; but a few hours afterwards haemorrhage recurred while straining at stool. This time the haemorrhage was arrested by styptics and pressure. No further luemorrhages occurred. The wounds healed ia three weeks, and the patient was furloughed and went home. Since the war a case in which ligatures were placed around the internal as well as the external and common carotid for shot injury is reported by W. U. BYKD (Ligation. of the Common, External, and Internal Carotid Arteries for Gunshot Injury Death, in New York Medical Journal, 1876, Vol. XXIV, p. 174): A policeman, shot by thieves at Quincy, Illinois, May 29, 1876. Wounds of lip, chin, and fracture of jaw ; ball split in three pieces, one of which split the external cnrotid artery, with the point impinging upon and entering the left internal carotid a half inch above the division of the left common carotid. Profuse haemorrhage. May 30, 1876, common carotid ligated just below bifurcation, and internal and external carotids just above points of injury ; died 20 minutes after operation. The first ligation of the internal carotid seems to have been performed by KEITH, in 1850, who, while removing a foreign body, accidentally cut the internal carotid : KEITH ( W.) (Case of Wound of the. Internal Carotid Artery, inflicted while operating from within the Mouth for the, removal of a foreign body deep in the Neck Ligature, of the Internal Carotid Hxmorrhage controlUd by a Single Ligature, and Cure, in The Monthly Journal of Uedical Science, Edinburgh, 1851, Vol. XII, p. 435). Two operations fi.r punctured wounds, and one after disarticulation of the lower jaw for malignant tumor, have been reported by : LEWIS (M.), Double Ligation of the Internal Carotid Artery in 1869, by Dr. A. T. LEE, deceased, formerly of Kingston, Temt., in Am. Jour. Med. Sci., 1879, Vol. LXX.VII, p. 142. BRIGGS ( W. T.), Traumatic Aneurism of the Internal Carotid Artery, the remit of a Puncture Ligation of the. Internal Carotid at the seat of the Injury, in Nashrillc Journal of Sled, and Surgery, 1874, Vol. XIII. p. 119. SANDS (H. B.), A Case of Ilxmorrhage from the Internal Carotid Artery treated successfully by the Ligature, in New York Medical Journal, 1871, Vol. XIX, p. 34. CHAP. XII.] LIGATIONS OF THE TEMPORAL ARTERY. 771 one of the auricular, eighteen of the temporal, eight of the facial, and one of the submental arteries. The results are indicated in TABLE CXXV, on page 765. Liyation of Superior Thyroid. CASE 1107. Private G. Atwoocl, Co. H, 142d New York ; shot injury of inferior maxillary region, October 27, 1864. Haemorrhage occurred from branch of superior thyroid November 7, 18G4. Ligation of both ends in wound November 7, 1864. Discharged April 19, 1865. Liyation of Lingual Artery. CASK 1103. Private P. Everson, B, 1st Minnesota; shot through base of tongue; jaw fractured, July 2, 18G3. Haemorrhage from both linguals occurred July 14th; both arteries tied en masse in wound on the same day. Discharged June 12, 18G4 ; unable to eat other than liquid food. Lirjations of Occipital Artery. CASES 1109-1113. Private L. C. Adzcr, K, 9th Louisiana, aged 20, wounded atMonocacy Junction July 9, 1864; shot penetration of neck; occipital artery severed; July 19, haemorrhage, 16 ounces, from occipital; both ends of artery ligated in wound by Surgeon C. H. Todd, C. S. A.; recovery. Sergeant D. Holliday, B, 26th Pennsylvania; flesh wound of neck. July 2, 1863; haemorrhage, 32 ounces, occurred July 25; both ends ligated in wound 011 the same lay; haemorrhage recurred on the 2?th, but ceased spontaneously; duty May 3, 1834. Private R. Norris, C, 1st Cavalry, wound of right side of head and neck, May 8, 1864 ; May 19, haemorrhage from occipital ; May 25, 1864, ligation by A. A. Surgeon F. G. H. Bradford; discharged July 25, 1864. Private D. H. Roberts, E, 118th New York; wounded October 17, 1864; fracture of external table of occipital bone; November 7, haemorrhage from occipital; ligation, both ends in wound, on same day; dis charged April 20, 1865. Private J. Horton, D, 57th Massachusetts ; wounded May 18, 1864 ; ball lodged in first dorsal vertebra; May 31, haemorrhage from occipital; artery ligated in wound by Surgeon R. B. Bontecou, U. S. V.; haemorrhage recurred; artery re-ligated June 2; death June 2, 1864. Liyation of Auricular Artery. CASE 1114. Private C. Wagner, L, 1st New York Cavalry, aged 25 years; fracture of temporal bone by pistol ball June 26, 1865 ; ligation of posterior auricular on the same day by Surgeon D. W. Bliss, U. S. V. Discharged October 12, 1865. Ligations of the Temporal Artery. There were eighteen cases of ligations of the temporal artery ; fourteen were successful and four were fatal ; the haemorrhages in fifteen instances were from the temporal, and in three from branches of this artery. TABLE OXXVIII. Condensed Summary of Eighteen Cases of Ligations of the Temporal Artery for Shot Injuries. [Recoveries, 114; Deaths, 1518.] No. 1 2 3 4 5 C 7 8 9 10 11 12 13 14 13 1G 17 18 NAME, AGE, AND MILITARY DESCRIPTION. DATE OP INJURY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OK HJEMORRIIAGE. DATE OI<" OPERA TION. OPERATION, OPERA TOR. RESULT. Faucett, E., Pt., B, feth Michigan, ago 45. Fobes, J., Pt., L, 1st Vt. Cavalry, age 19. Fuller, B., PL, H, 7tli Iowa. Gilrnore, H., Lieut., A, 17th Vermont, Hartly F. C.,Vt.,G, 4 Jth Virginia. Jones, D., Pt.,B, 1st Massachusetts, ago 26. Kullman, IT., Corp l, I, 37th Wis.,age 24. Miller, L.,Pt,D,4Gth New York, age 34. Mullen, J., Pt, A, lUOth Pennsylvania. Reese, H., Pt.,I, 53d Pa., age, 18. Smith, A. U. C., Lt, E, 12th X. H. Talmadge, A. S., Corp l, E, llth New Jersey, age. 32. Taylor, J. C., Corp l, 1), 5th N. J., age 44. Wheeler, W., Pt. B, 91st N. Y., age 37. Dimbar, II., Serg t. B, 19th Mas*. Jones, L., Pt, C, 115th X. Y., age 23. Newcomb, J. S., Pt., E, 50th New York. Taylor, K. I., Pt,, F, 1st Maine H. Art, age 25. Mav 6, 1804. June 24, 1864. Oct. 3, 1862. Mav 12, 1864. May 31, 1864. Mav G, 1864. July 30, 1864. June 30, 1864. Nov. 30, 1863. July 2, 1803. June 3, 1864. July 3, 1863. June 1, 1862. April 1, 1865. Oct. 14, 1863. Feb. 20, 1864. Sept. 18, 1861. Mav 19, 1864. Fract. of right mas- toid process. Scalp wound of fore head. Flesh wound ; tempo ral artery severed. Flesh wound of scalp . May 19, 18C4. Small branch of right temporal. Mav 19, 1864. Pros, end in wound. Surg. I. I. Hayes, TJ. S. V. Hi "lit Transferred to V. R. C. Jan. 23, 1865. Retur d to dutv Sep tember 2s), 1864. Discharged January i:, 1863. Retur d to duty Sep tember 6, 1864. Recovered Recovered Ri" it- li^ated May 21, 1864. Temporal artery . . Branch of tempo ral. Temporal artery . . Temporal artery . . Mav 21, 1864. Juno 5, 1864. May 24, 1864. Aug. 14, 18G4. July 28, 1864. Nov. 30, 1863. July 13, In continuity, by A . A. Surgeon F. AV. Kelly. Ligated Left; in cent., by A. A. Surg. S. D. Mar shall. In cont., by Surg. R. l!.Bontee ou,U.S.V. Left; ligated In cont., by Surg. G. B. Coggswell, 29th Massachusetts. One end in wound- . . Wound of scalp Wound of scalp and right ear. Fracture of parietal, temp., and frontal. Wound of scalp; tem poral art y severed. Flesh wound of scalp; right. Scalp wound ; tempo ral artery severed. Flesh wound of left temple. Shot wound of scalp Fracture of temporal bone; right side. Fracture of left fron tal eminence. Flesh wound of scalp Scalpwouud; tempo ral artery torn. Fracture of loft tem poral bone. May 24, 1864. Aug. 14, 1864. July 28, 1864. Nov. 30, 1863. July 13, 1863. Juno 3, 1864. July 14, 18G3. Juno 4, 1862. Apr. 22, 1865. Nov. 6, 1863. Feb. 27, 1864. Sept. 18, 1801. June 3, 1864. Mustered out May 30, 1865. Discharged July 25, 1865. Returned to duty. Retur d to duty Dec. 7, 1863. Discharged June 21, 1865. Retur d to duty Mar. 24, 1864. Retur d to duty Aug. 19, 1862. Discharged June 29, 1865. Died November 29, 1863. Spfe. 1951. Died Oct. 15, 1864. Died September 21, 1861. Died June 5, 18G4. 1863. June 3, 1864. July 14, 1863. Juno 4, 1862. Apr. 22, 1865. Nov. 0, 1863. Feb. 27, 1864. Sept. 18, 1861. June 3, 1804. Ligated. Sursr. I. I. Hayes, U. S. V. In continuity Temporal and pos terior auricular. Temporal Anterior temporal Ono end in wound. .. In wound In wound In continuity Temporal 772 WOUNDS AND COMPLICATIONS. (CHAP. XII. Ligations of the Facial Artery. Eight cases were reported; five of the patients recov ered and three died one from haemorrhage, one from tetanus, and one from the severity of the injuries to the bones of the lower portion of the face. TABLE CXXIX. Condensed Summary of Eight legations of the Facial Artery for Shot Injuries. (Recoveries, 1 5; Deaths, f 8.] NAME, DATE D ^T PROBABLE SOURCE No. AGE, A*Z> MILITARY | OF NATURE OF INJURY. : r. OF OPFP TOP DESCRIPTION, i INJURY. I HEMORRHAGE. : KIIAGE. TIOX. RESULT. Bessel. A. J., Serg t 14th Michigan. Corwell, J., Pt., D, 4th Pa. Cavalry. Gaincs, W., Pt., C, 5th Colored Troops, age 20. McOray, J. A., Pt., 14otU Pennsylvania. AVoodward.C. L.,Pt., I,2d Vt-.,age 19. Button, A. H., Col. 21st, Conn., ago 25. Foot. ]<., Pt., I. 4th C. Troops, agi* 22. Parks, J. D., Pt., A, 29th Conn., age 30. July 5, 1864. Oct. 18, 1861. June 18, 1864. May 12, Mav 3, 1863. Mav ^0, 1804. June 15, 1804. Oct. 27, 1864. Fracture of inferior maxilla. Fracture of left in ferior maxilla. Fracture of superior and inferior max illa. Fracture of lower jaw. Fracture of lower maxilla. Fracture of lower maxilla. Fracture of superior maxilla. Fracture of body of inf/maxilla. Oct. 19, 1861. June 25. 1864. June 4, 1864. Facial Oct. 19, 1861. Juno 25, 1864. June 4, 1864. Facial artery May 31, 1864. June] 5, 22, 64. Facial June 2, 1864. June 23, 1864. Ascending pala tine artery. Facial ligated in con- Discharged January tinuity. j 4, 1865. Ligated Discharged January 9, 1862. In continuity. A. A. Recovered. Surg. C. C. Ela. One end in wound. . . Recovered. Left; ligated in Returned to duty wound. Feb. 19, 18C4. One end in wound... Died June 4, 1864; tetanic symptoms. In continuity. A. A. Dud Jmm 2;i, 18G4, Surg. C. C. Ela. | from haemorrhage. Ligation of facial ... I Died November 6, 1804. Liyqtion of Submental Artery. CASE 1115. Private J. Ketcham, Co. F, 5th Michigan, received at Gettysburg, July 2, 1863, a shot wound of left cheek, severing the submental artery. The vessel was tied on the field. The patient was returned to duty on December 5, 1863. Ligations of the /Subclavian Artery. Fifty-one cases of ligations of the subclavian artery for shot injuries were reported, of which ten terminated in recovery. In ten cases the operations were performed for aneurism, either diffused or circumscribed. In seventeen instances amputation had been performed prior to the ligation in seven cases at the shoul der joint, in ten in the arm. In the remaining twenty-four cases the bleeding was from the brachial in three, the posterior circumflex in one, the axillary in eight, the subscapular in one, and the subclavian in five instances; and in six cases the source of hemorrhage was not indicated. In the following case, of which the specimen is preserved in the Army Modi- cal Museum, the subclavian was ligated in its third portion after the arm had been ampu tated in the upper third: CASE 1116. Private S. R. Peterson, 60. D, 14th Infantry, aged 27 years, was wounded at Chancellorsville, May 3, 1863, and received into Second Division Hospital, Fifth Army Corps. Assistant Surgeon C. Wagner, U. S. A., noted: "Gunshot wound of arm. Amputation by B. Howard, Assistant Surgeon, U. S. A." From the field hospital the patient was, on June 14th, admitted to Douglas Hospital at Washington, and several days afterwards he was transferred to Satterlee Hospital at Philadelphia. Acting Assistant Surgeon D. Kennidy contributed the speci men (Cat. Surf/. Sect., 1866, p. 458, Spec. 2607) with the following minutes of the case: "Patient was wounded by a shell in the left arm, rendering amputation near the shoulder necessary. The operation was performed upon the battle-field, about fifteen minutes after he received the wound, without the administration of anaesthetics. At the time he was transferred to this hospital he had erysipelas of left side of thorax and back. He was immediately placed on tinctura fcrri chlor. <jlts xx every three hours, and unyucnt. fcrri. sulpk. used locally. The stump, which suppurated freely , was dressed with a poultice. He began to improve, and by June 30th the erysipelas had disap peared and he was fast gaining strength. July 5th : Had slight diarrhoea ; prescribed astringents. July 6th : Not so well ; very weak. Ordered beef essence and wine whey. July 8th : Bled about a pint from the stump; ice-water and compress applied. July Dili: Had another haemorrhage early in the morning; subclavian artery ligated at its third part. Present at the operation : Drs. Hayes, Schell, Baldwin, and Roe. Prescribed brandy, one-half ounce every two hours. July 10th : Feels stronger and pulse good ; ordered sulphate of quinine, yrs. ii, three times a day. He FIG. 4H. Portions of the aorta, continued to do well until the 16th, when he had a haemorrhage from the artery where it had Lr ciaviantt"S^So7: bet n "8*** > bled about a pint ; digital pressure applied. July 17th : No bleeding. Early in the morning of the 18th he lost some blood while changing the fingers. His pulse had bc< n very weak since the 16th, and he was fast losing strength. About 10 o clock on the morning of the 18th of July he died. The sj uciinen CHAP. XH.) LIGATIONS OF THE SUBCLAVIAN ARTERY. 773 consists of a, wet preparation of the arch of the aorta, the innoiniuata, left common carotid, and aubclavian rfrteries, terminating at the point of ineffectual ligntion of the left subclavian in its third portion, showing the separation of the coats with no forma, tion of clot. TABLE CXXX. Condensed Summary of Fifty-one Cases of legations of the Aubclavian Artery for Shot Injuries. [Recoveries, 110; Deaths, 1151.] No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HJ.MOR- RHAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 2 3 4 5 6 7 8 9 10 Jl 12 13 14 15 1C 17 18 19 20 tol 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Cauqkman, O. M., K, Jnly 3, Shot through chest ; July, 1863. July 17, 1863. Sept. 5, 1864. Sept. 19, 1864. Jan. 11, 1863. Aug. 8, 1864. Aug. 2, 1803. Apr. 14, 1862. Sept. 26, 1864. Mav 7, 1865. July 27, 104. May 29, 1864. May 30, 1865. June 17, 1804. Dec. 16, 1803. May 26, 1864. May 31, 1864. Sept. 1, 1864. Nov. 5, 1864. Aug. 10, 1864. Apr. 20. 18C2. Julyl, 1804. Dec. 16, 1804. June 30, 1864. Aug. 18, 1863. June 23, 1862. Oct. 22, 1862. Feb. 27, 1864. Juno 7, 1862. June 18, 1864. July 14, 1863. Julv 23, 1864. Oct. 11, 1803. Oct. 13, 1804. Ligated in third por tion in continuity. In cont. in third por tion; lig. subscap. In cont. in t bird por tion Surg. A. B. Recovered ; arm par alyzed. Furloughed August 31, 1803. Discharged October 4, 1864. IStli S. C., age 25. Endy, J. T., Ft, F, 5th N. C., age 23. Herman, A., Pt., C, 18th N. Y., age 42. Hiclcey, J., Serg t, M, 1st N. Y. Cav., age Hurst,C., Pt.,C, 16th Ohio. Kellogg, E. 8., Pt., A, 89th, N. Y., age 21. Kitrell, J. H.,Pt.,D, 3d Tennessee. Palmer, D. J.,Corp l, C, 8th Iowa, age 20. Plielps, J. T.. Pt., D, 24th Mass., age 32. Wiggins, C., Ft., G, 9th N. Y. A., ago 21. Andrews, M., Ft., E, 17th Vt,ago22. Averitt, W. S., Pt., 11, 14th Tennessee. Brannon, B., Pt., B, Olst N. Y.,age 22. Broderick,W., Cor l, C, 199th Pa., age 39. Buzzell, H., Serg t, D, 12th N. H., age 21. Click, J. B., Pt,, G, 5th Virginia Cav. Conant, A. E., Pt., K, 8th Maine, age 22. Contorman, T. J., Pt, G, 48th X. Y., age 21. Denton, F. M., Ft., H, 4th S. U. Cav., age 34. Dow, S. E., Color Sorg t, 4th N. Y., age 21. Downing, S., Pt,, C, 9th 111. Cav., age 21. Everly.K. M., Pt.,G, 17th Kentucky. Gates, E. O., Serg t, M,4thN. Y. H. A.. ago 22. Graves, IL, Pt., B, 5th Pa. Cav., age 25. Grimm, A., Pt, D, 7th Conn., age, 21. Grothenn, H., Serg t. K, 5th Cav., age 28. Henderson, J. H., Pt,*\ 57th Pa. Kites, J., Pt, C, 7th Iowa, agt; 19. Holshowes, W. W., Serg t, 3dS. C.Bat. Howard, A. O., Con federate. Ingalls, D. W., Pt, B, 6th Conn., age 35. Jordan, J. F., Ca.pt., B, 13th Va. Cavalry, ago 31. Eahea, E. P., Pt, B, Jeff. Davis Legion, age 29. King, J. TT., Pt., C, 29th N. Carolina. Klechner, G. M., Cor. D, 93d 111., age 23. 1803. July 2, 1863. Feb. 20, 1864. June 5, 1864. Dec. 29, 1862. June 18, 1864. Julv 12, 1863. Apr. 7, 1862. Aug. 16, 1864. Mar. 25, 18G5. May 12, 1864. Aug. 9, 1862. May 8, 1864. Apr. 2, 1865. June 3, 1864. Nov. 8, 1863. May 20, 1864. May 9, 1864. May 28, 1864. Oct. 27, 1864. Julv 14, 1804. Apr. 7, 1862. Juno 4, 1864. Oct. 7, 1864. June 9, 1864. Juno 9, 1863. May 31, 1862. Oct. 3, 1862. Nov. 30, 1863. May 31, 1862. Mar 20, 1864. June 21, 1863. June 14, 1864. Sept. 19, 1863. Oct. 5, 1804. subclav n wounded. Ball entered below scapnla and lodged. Shot fracture of right humerus ; excision. Ball entered below right clavicle. Fract. right hutne- rus; amputation. Fract. left hnmerus; amputation arm. Fract. right hume- rus; amp. arm. Wound of left axil lary artery. Fract. left shoulder ; amputation. Ball perforated be low right clavicle. Fract. right hume- rus; amp. at sh. Fract. left arm; am putation. W o u i) d of right shoulder and arm. Left shoulder below clavicle. Wound right shoul der. Wound in right ax illa ; lesion axillary artery. Fracture head left humerus ; amp. at shoulder joint. Wound in right ax illa. Flesh wound shoul der and chest. Shot wound of chest. Fracture right arm ; amputation. Fract. right humor us; amp. at sh. jt. Flesh wound of right .arm. Wound left side of neck. Fracture right clavi cle. Right shoulder ; axil lary artery wound. Flesh wound left arm Wound in right axilla Wound left lung Left shoulder; inj. spine. Wound of chest July 16, 17, 63. Sept, 5, 1864. Jan. 11, 1863. July 25, 1804. Julv 26, 28, 63. April 8, 1862. Sept. 26, 1864. Mav 7, 1865. Julv 23, 1864. Mav29, 1864. Apr. 17, 1865. Posterior circum flex. Axillary aneurism . Brachial on face of stump. Axillary ligated in stump. Haemorrhage from stump, Aug. 2. Aneurism Mott, U. S. V. Ligated in continu ity by Surgeon F. H. Gross, TLS.V. In cout. by Asst. Surg.W. D.Turner, 1st Illinois Art. In continuity in third portion by A. A. Surg. R. J. Kevis. In continuity in third portion. In cont. by Surg. T. F. Azpell, U. S. V. In cont. by A. A. Surg. J. C. Morton. Both ends in wound . Lig. by A. A. Surg. J. B. Crandall. Ligation of subcla vian. In cout. by Surg. A. V. Sheldon, U. S. V. In continuity in outer third. Right ; in continuity. Surg. N. R. Mose- loy, U. S. V. Right; in continuity. Asst. Surgeon J. C. Baylor, C. S. A. Left; in continuity. A. A. Surgeon T. Liebold. Right; in c jntinuity. A. A. Surgeon G. F. Shrady. Left ; in continuity. A. Surg. J. C. Mc- Kee, D. S. A. Right; in continuity. Assistant Surgeon H. Allen, U. S. A. Right; in cout. A. A. Siirg. J. N. Sharp. Right; in continuity. Right; in continuity. A. A. Surgeon T. G. Morton. Left; in continuity. Asst. Snrg. VV. E. Day, 117th N. Y. Right; in continuity. Right; in cont. Surg. It. H. Coolidge. Left; in continuity. . R t ; in cont. Surg. J. S.Hodgden.U.S.V. Loft ; in cont. Surg. B. B. Breed, U.S. V. Left; in continuity.. Ligation; in continu ity. Left; in cont. Surg. J.A.Lidell.U.S.V. Left ; in continuity. Surg. W. Seldon, C. S.A. Right; in continuity Left ; in cont. Surg. J. H. Grove, U.S. V. Discharged May 30, 1865. Discharged March 7, 1863. Hjern. Aug. 15. Din- charged April 6, 1865. Furloughed Septem ber 3, 1863. Discharged Septem ber 6, 1802. Discharged Decem ber 13, 1864. Discharged August 3, 1865. Died July 28, 1864. Died January 26, 1863. Died June 19, 1864; bnem. rec d. Died Juno 11, 1865. Died Juno 29, 1804, ofhaem. Spec. 2812, A. M.M. Died Dec. 17, 1863. Died May 29, 1804 ; exhaustion. June 2, br. ax. plex. veiuslig. DiedJune 2,1804. Spec. 4331. Amp. at shoulder. jt. Died September 2, 1864. Died November 18, 1864; haemorrhage. Died August 30, 1864. Axillary artery Axillary (?) Subclavian Axillary aneurism . Large aneurismal tumor. Axillary May 24, 25, 64. May 27, 30, C4. Aug. 28, 1864. Nov. 5, 1864. Aug. 8, JO, 64. Apr. 20, 1862. June 25, 1864. Dec. 14, 1804. June 28, 1864. Aug. 18, 1863. June 19, 1862. Oct. 22, 1862. Fob. 27, 1864. Subscapular arter y and axillary vein. Axillary aneurism . Subclavian Spec. 2508. Died April 20, 1862 ; exhanstiou. Died July 1, 1864. Spec. 2545. Died December 18, 1804. Died July 9, 1804. Died Aug. 18, 1803. Spec. 2009, A. M. M. Died June 27, 1802; pva3tnia. Died Oct. 31, 1802. Died March 11,1865; pyjemia. Died June 8, 1802. Died June 24, 1804; pyaemia. Spec. 4089. Died Aug. 29, 1863. Spec. 1684, A. M. M. Died July 31, 1864. Died Oct. 21, 1863. Died Oct. 13, 1864. Brachial ; axillary ligated. Subclavian artery. Aneurism Axillary artery Branches axillary. Left axillary artery divided. Through left axilla, sov. axillary artery. Fracture head ; right humerus. Loft arm and chest. . July 12, 1863. Julv 10, 1864. Oct. 10, 11, 63. Aneurism ^^ 4 / 74 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OP INJURY. NATURE OF INJURY. DATE OF II.EMOR- UHAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 36 L Aimee A. B. Pt. Mar. 14 Fracture ri ir ht hu- Mar. 29 Stump Mar. 29, Right; incont. Surg. Died April 5, 1862; G,51stN.Y.,age2i . 1802. merus ; amp. arm. 18G2. 1862. G.Derby, 23d Maes. pvicmia. 37 McMichael, H., Pt., Nov. 30, Wound chest, inj. Dec. 11, Axillary artery Dec. 11, Right; in rout. Surg. Died Dec. 16, 3804. A 57th Iiid. <i <r e 19. 1804. axillary artery. 1864. 18(i4. SfE. Fuller, TJ.S.V. 38 Maiort,E.,Pt.,K,62d April2, Fracture right hu- April 18, Brachial artery April 18, Right; in continuity. Died April 20, 1865. Ohio, age 28. 1865. merus; excision. 1865. 1805. 39 Moore, W. E.,Pt,,E v Oct. 8, Fracture right hu- Nov. 21, Axillary artery . . Nov. 21, Right; in continui Died November 27, 57th Mass., aye 23. 1864. merus; amputat n 1864. 1864. ty. Asst. Surg. C. 1804. at shoulder .joint. Waguer, U. S. A. 40 M^owrcv TT, B. Oor- Sept. 17, Fracture left humer- Sept. 26, Sept. 20, Left; in continuity. Amputat n at shoul poral, B, Cth Pa. 1862. U8. 1862. 1862. Surg, A. B. Hasson, der i t. Died Sep lies., age. 20. U. S. A. tember 27, 1802. 41 Peterson S E Pt May 3, Left arm shattered; July 8 Stump July 9, Left; in continuity. Died July 18, 1863. D, 14th Inf. 1863. amputation arm. *9, 63. 1863. A. A.Sutg.D.Ken- Spec. 2607, A.M. M. iiidy. 42 Pfluzi-r, E., P(., H, June 27, Fracture right scap July 14, ; lig. axillary July 25, Eight; in continuity. Died August 10, 1864. 2d Pa. Art., age 28. 1864. ula. 1864. artery. 1864. 43 j Reed, A.. Pt., B, 6th Jan. 30, Fracture right arm ; Feb. 6, Axillary artery . . . Feb. 7, Eight; incont. Asst. Died February 27, Massachusetts. 1803. ainputat n at shoul 1863. 1863. Surg. O. M. Hum 1803. der ioint. phrey, 6th Mass. 41 Sli icf^pll \V Spnuf. Nov. 15, T<V;int,nrp i-irrlit. pljivi- Dec. 14, Right; in continui Died December 14, 1864. cle and rib. 1864. ty. A.sst. Surtr. S. 1804. Spec. 4729, C. Ayres, U. S. V. A. M. M. 45 Smith, A. H., Pt..F, Jan. 11, Fracture right el April 4, Brachial artery April 6, Right; iu continui Died April 14, 1863. 25th Iowa, age 30. 1803. bow joint; ompa- 6, 63. 1863. ty. Surg. O. T. talion arm. Alexander, IT. S. A. 46 Smith, P.,Sergt.,E., Sept. 30, | Flesh wound right Oct. 12, Brachial artery ; Oct. 21, Eight; in continui Died November 22, 84th Pa., age 33. 1864. arm. 1864. artery ligated. 1804. ty. A. A. Surg. J. 1804; pyaemia. C. Morton. 47 Stainca, S., Pt,, C., July 2, Flesh wound right July 23, Brach. artery lig. ; Aug. 23, Right; in continuity. Died September 2, 53d Pa., age 25. 1863. arm. 1863. Aug. 2, amp. arm. 1863. 1863. 48 Stihvell, J., Pt., I, Aug. 16, Fracture head; left Sept. 21, Axillary artery. . . . Sept 21, Left; in continuity. Died September 23, 1st Maryland Cav 1864. hninorus; Sept. 21, 1864. 1864. A. A. Surg. J. C. 1864. alry, age 21. excision. Morton. 49 Ward, T., Corp l, C, June 25, Wound in left axilla Mar. 14, Aneurism Mar. 15, Left; in continuity. Died March 17, 1863. 2d Pa. Res. 1862. 1863. 1863. Prof. S. D. Gross. 50 Wisser, H. H., Cor June 15, Left arm shattered; July 13, Stump ; axillary Aug. 6, Left; in continuity.. Died August 17, 1804. poral, F, 27th Mas 1864. amputat n at shoul 1864. ligated. 1864. sachusetts, age 34. der joint. 51 Wright, S. A.,Capt., April 6, Fracture left humer- May 9, Axillary artery May 9, Loft; in continuity.. Died May 12, 1862. F, 55th Illinois. 1862. us; wound of hip. 1862. 1862. Twelve cases of ligations of branches of the subclavian were reported. Two were ligations of the internal mammary, six of the intercostals, one of the thyroid axis, one of the superficial cervical, and two of the suprascapular arteries. The two operations on the internal mammary and two of the ligations of the intercostal artery were fatal: Lvjatlons of the Internal Mammary. CASES 1117-1118. Private A. Campbell, Co. A, 2d Pennsylvania Heavy Artillery, wounded near Petersburg, June 29, 18G4; penetration of chest near second rib; haemorrhage July 13; ligation of internal mam mary by Surgeon O. A. Judson, U. S. V.; death July 19, 1864. (First Surg. Vol., p. 548.) Private J. Gallin. F, 65th New York, aged 30; wounded at Spottsylvania May 8, 18G4; penetration of chest and wound of internal mammary; haemorrhages; ligation of artery May 19, 1864. by Surgeon E. B. Boutecou, U. S. Vols.; death May 24, from recurring haemorrhage. (First Sury. Vol., p. 548.) Ligations of Intercostals. CASES 1119-1124. Private R. Morris, K, 142d Pennsylvania, aged 25; shot wound of chest, Fredericksburg, Dec. 12, 18i)2; haemorrhage January 20, 1883; ligation of intercostal, one end in wound; discharged from service June 13, 1863. (First. Surg. Vol., p. 550.) Private S. Scofield, D, Gth Connecticut, age 21; shot wound of chest. Drury s Bluff, May 14, 1864; haemorrhage May 27; ligation of intercostal artery by Asst. Surg. W. H. Gardner, U. S. A.; ligature passed around rib; no recurrence of haemorrhage; discharged September 3, 1864. (First Surg. Vol., p. 550.) Private J. B. Bruce, C, 31st Alabama, aged 17; shot fracture of ninth rib, at Shiloh, April G, 1862; April 29, haemorrhage from intercostal; both ends ligated in wound by Asst. Surg. B. Howard, U. S. A.: ligature included rib; death April 29. from haemorrhage. (First Surg. Vol., p. 550.) Private J. H. Butterfield, F, 3d Vermont, wounded in chest, at Lee s Mill s, April 16, 1862; haemorrhage April 25; ligation of intercostal artery; haemorrhage recurred April 27; artery religated; death May 4, 1862. (First Surg. Vol., p. 551.) Private J. Mahew, D, 100th Pennsylvania; shot fracture of rib May 24, 1864; ligation of intercostal; death May 26, 1864. (First Sury. Vol., p. 551). Private P. F. Wilson, A, 33d Ohio; penetrating wound of chest, Chickamauga, September 20. 1833; haemorrhage October 4; ligation of intercostal October 5; death October 30, 1863. (First Sury. Vol., p. 551.) Ligation of Thyroid Axis. CASE 1125. Private A. P. Dunem, Co. H, 1st New Jersey Cavalry, aged 46; shot wound of right shoulder, ball passing over clavicle, June 3, 1864; June 30th, haemorrhage of thirty ounces from thyroid axis; artery ligated on the same day, one end in wound; returned to duty December 7, 1864. Ligation of Superficial Cervical Artery. CASE 1126. Private J. H. Potter, F, 15th Massachusetts; shot wound of left posterior triangle of neck June 18, 1864; July 13, haemorrhage from superficial cervical; one end ligated in wound on the same day; transferred to V. R. C. May 16, 1865. Ligations of Suprascapular Arteries. CASES 1127-1128. Corporal T. Barrick, 44th New York, age 25; shot wound of side of neck July 2, 1863; haemorrhage from suprascapular July 21st; artery ligated on same day by A A. Surgeon D. Kennidy; discharged March 26, 1864. (First Surgical Volume, p. 422.) Private S. Sickles, H, 14th New Jersey, age 27; shot penetration of chest and fracture of scapula July 9, 1864; haemorrhage, probably from diffuse aneurism, August 1, 1864; both ends of suprascapular artery ligated; no recurrence; discharged July G, 1865. (First Surgical Volume, p. 541). ) CHAP. XII.] LIGATIONS OF THE AXILLARY ARTERY. 775 a rnor- Ligations of the Axillary Artery. The total number of ligations of the axillary artery reported is forty-nine; of these seven recovered and forty-two proved fatal, tality rate of 85.7 per cent. The operation was on the right side in seventeen, on the left in twenty-five instances; in seven the side was not stated. In fifteen instances amputation of the arm had been performed. In four of these fifteen cases re-ligation of the artery was performed on the face of the stump, and in eleven in the continuity. In one instance only was the artery ligated on the field immedi ately after the injury, for primary bleeding. Of the forty-nine operations, haemor rhages recurred in twenty-one, only one of which terminated in recovery after ampu tation of the arm. Four operations were performed for aneurism. The specimen (No. 3630, Surg. Sect.} of one of these cases is preserved in the Army Medical Museum and is shown in FIG. 423. It is a wet preparation of the axillary artery, and shows loss of substance by sloughing; slight haemorrhage occurred on the seven teenth day, which was controlled by pressure; severe haemorrhage followed on the nineteenth day; an immense aneurism formed, which was opened, and ligatures placed on both sides of the injury; mortification supervened; the arm was ampu tated at the shoulder, but death ensued several hours after the operation. The reported in detail on page 443 of the Second Surgical Volume (CASE 1255). case is TABLE CXXXI. Condensed Summary of Forty -nine cases of Ligation of the Ax dlery Artery for Shot Injuries. [Recoveries, 17; Deaths, 849.] No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJUKY. NATURE OF INJURY. DATE OF H^MOR- RIIAGE. PEOBABLE SOURCE OF HEMORRHAGE. DATE OF Ol ERA- TIOX. OPERATION, OPERA TOR. RESULT. 1 Coolream, P., Ft., B, Mav 8, Fract head right May 24, May 24, Eight; in continuity- Discharged October ?, Cist N. Y., age 45. Cutler, F.K., Ft,, K, 1864. Sept. 17, hum.; excision. Fract. right hum. 1864 Oct. 19, Axillary 1864. Oct. 20, Eight; in cont. Surg. 13, 1865. Disch. Aug. 10, 1864. 3 72d Pennsylvania. Flics, A., Corp l, E, 18G2. Sept 19 ampt nat sh d r j t. Fract. ri"ht hum. ; 1862. Nov. 8, 1862. Nov. 9, II. S.Hewit.U. S.V. Right; in cont. Surg. Died May 11, 1873. Discharged April 18, 4 100th 111., ago 26. James, W., , D, 83d 1863. July 2 amputation arm. 9, 1863. July 14 1863. Julv 14 A. McMahen, 64th Ohio. 1864. 5 6 7 PH., age, 20. Sobbey, W., Pt,, G, 51st J a.,nge 29. Vancellette, T., Pt., L, 3d Vt,ago21. Williams, A. E., Pt, 1863. Julv 12, 1804. Apr. 16, 1862. Julv 2, border axilla. Flesh wound right arm. Fk-sh wound left arm. 1863. Julv 23, 24, 1864. Apr. 18, 23, 1862. Brachial Brachial 1863. Julv 24, 1864. April 23, 1862. Aug. 4 Right; in continuity Left; in cont. Surg. R. B. Bontecou, U. S.V. Recovered. Apr. 25; ampt narm. Disch. Jan. 13, 1863. 8 9 B, 7th Mich., age 27. Aldrich, A., Pt., F, 25th Mass., age 25. liaqgs, W. A., Pt., E, 1803. June 3, 18G4. arm. Wound in left axilla 1863. June 15, 1864. June 23 Small artery liga ted. 1803. June 17, 1864. June 25, wound. Left ; in continuity. . Artery Heated 25, 1864. Died June 17, 1864. Spec. 2576, A. M. M. Died June 28, 18C4. 10 1] 2uth Geo) gia Cav. Corrio, J. is., Serg t, A, llth Mo., aye 25. Davis. H. J., Pt., G, May 22, 1863. June 21 shoulder. Fracture left hum. ; anipt u at sh d r j t 24, 1864. Juno 6, 7, 1863. June 22 Posterior circum flex. 1864. Juno 7, 1803. Juno 22 Left; in continuity; recurred. June 8, br.-. acrom. thor.lig. Died June 9, 1863. Hseru. July 3 Died 12 13 14 5th N. C., age 41. Daw-son, M. M., Lt. Col., 100th Pennsyl vania. a<:e 38. Downing, W.E.,Pt., J, loth Pennsylva nia Cavalry, ago 19. Dnuu,N.,Pt ,11, 38th 18Gi. Juno 17, 1804. May 28, 1864. Apr. 2, IT18. Flesh wound left shoulder. Wound through left axillary space. 1864. Juno 27, 1864. June 12, 1864. Axillary artery . . . Axillary artery . . 1864. Juno 27, 1864. June 15, 1864. Mav 4, amputation arm. Left; both ends in wound. Left; both ends in wound; vein also tied. Loft; in cont. Ass t July G, 18G4. Efem recur d. Died June 30, 1864. Died June 28, 1804. Died May 8, 1865; ex 15 16 Wisconsin, ago 19. Folev, M., Pt., K, llth 111. Cav., ago 20. Friedeboldt, F., Pt, 1865. Mar. 3, 1864. Mav 31, ru s. Wound right arm; cutting axillary. Flesh wound arm in Mar. 3, 1804. Axillary Brachial 1865. Mar. 5, 1864. Juno 10, Surg. O. P. Sweet, U. SV. One end in wound. A. A.Surg.W.B.Trull. In cont. A. A. Surg. haustion. Religated. Died March 10, 1864. Died July 14, 1802. 17 K, 5th Michigan. Gillies, P., Pt, H, 1862. Oct. 19, jury brachial ait. Fracture head left Oct. 26 1862. Oct. 31, C. C. Page; subscap. artery also tied. Loft; on face stump Died Nov. 1, 1864, of 18 131st N. Y., age 25. Goodheart, J . F., Pt, 1864. May 10, humerua. Fracture left arm 1864. tation sh cl r j t. 1864. Juno 4, Left; in continuity. . rec. haemorrhage. Died June 5, 1864. 19 F, 88th Pa,, age 29. Ilall.W., Pt , H, 15th 1864. Jan 11, amputation arm. Jan 11 1864. Jan. 22 Ki"ht. A. A. Surg. Died Jan ry 22, 1866. 20 Infantry, age 19. Ilankin, J., Pt, IT, lstMich.S.S.,agel7. 1866. June 17, 1864. fractured rib. Fract. head of right humerus; excision. 20, 1866. July 23, 1864. Axillary 186(5. July 23, 1864. R. W. Coale. Right axillary art y ligated. Spec. 2674. Died July 24, 1864; hffimorrhage. h^"/" / 76 WOUNDS AND COMPLICATIONS. [CHAP. XII. NAME, No. AGE, AND MILITAKV DESCRIPTION. Herpst, H., Serg t, H. 119th Pa., age 25. Hills, J. W., Ft., A, 145th Pa., age 24. Hongard, J., Pt, E, 137th Ills., ago 20. Hollingshead, A., Corp l, H, 12th Ky. Hurd, F., Corp l, F, 8th Maiue, age 24. Leddie, J., Pt., E, 118th New York. Lightfoot, J., Pt.,E, 25th Mass., ago 28. McTonrjh, J. H., Pt., 1, 45th Ga., age 23. Maokey.J., Serg t, I, 50th Pa., ago 23. Marquis, W. II., Pt., K, 85th Pa., age 20. Mclle.v, E (;., Pt.,K, 2cl West Virginia. Miller. K. IX, Pt., F, 90th Pennsylvania. Moore, H. O., Pt,, A, 2Cth Georgia. Morgan, W., Pt., F, l. Otli N. Y., ago 22. Morgan, W. B., Pt., F, 17th Connecti cut, ago 24. Moser, J., Pt., B, 51st 111., age 18. Oldfield, T., Sergt., D, 10th Michigan, age 33. Oni ish. P.. Sergeant, E, 32d Massachu setts, age 11). Packard, G. R., Pt., F, 3d Mo., age 21. Paper, U r ., Pt., G, 5th N. C. Richards, S., Corp., M, llth Pa., age. 25. DATE OF INJURY. NATURE OF Ix.n KY. May 5, 1864. Dec. 13, 1802. Au<r. 21, 1804. June 21, 1864. May 16, 1804. Aug. 10, 1804. May 3, 18d3. May 25, 1864. Aug. 27, 1863. Nov. 6, 1863. Auar. SO, 1862. May 12, 1804. July 2. 1803. July 3, 1863. Nov. 30, 1804. July 20, 1864. May 30, 1864. May 31, 1862. May 5, 1802. DATE OF , HAEMOR RHAGE. PliOBABLE SOURCE OF HAEMORRHAGE. Fract. r t huinerus; amputation arm. Wound through left axilla. F:act. right huine rus : amp. sh. joint- Wound in upper 3d right arm. Flesh wound of left arm. Flesh wound of left arm. * Flesh wound of left shoulder. Fracture hnmerus: amp. at sh. joint. Wound left arm, div. axillary artery. Fracture right arm ; amp. at sh. joint. Wound of chest Flesh wound of arm. inj.brachial art. Flesh wound, left arm. June 13, 1864. Dec. 23. 1862. Sept. 9, 3864. June , 1864. May 21, 1864. June 30, 1864. Aug. 27, 29, 1864. May 27, 1863. Sept, 12, 1863. Nov. 18, 1863. Sept. 5, 1862. May 19, 1864. Axillary Subscapular art y. Brachial Braehial aneurism Brachial; art. tied ; ha3in . rec. May 25, June 1. Brachial DAII: OF OPERA TION. Juno 13, 1864. Dec, 23, 1862. ! Sept. 9, 1864. : June 24, Fracture huinerus ; July 19, amputation sh.jt. j 18G3. Fracture left arm;! July 20, amputation arm. ] 1803. Fracture right stap- Dec. 12, ula. i 180 1. Flesh wound left arm . . Fract, left huinerus ! May 31,- ; 1864. Fract. left humerus; July 1, amputation arm. 1862. Flesh wound right Juno 13, arm. ! 1862. 1864. June 1. 1864. June 30, 1864. Sept. 17, 1864. May 27, 1863. June 5, 1864. Sept. 12, 1863. Nov. 19. 1803. Sept. 6, 1862. May 19, 1804. July 19, 1803. July 20, 1863. Enlarged vessel, ! Dec. 14, collateral circula. I 1864. Aug. 10, 1864. Axillary May 31, | 1864. ..[July 28, 18G2. June 13, 1862. Axillary ; diffused aneurism. Axillary artery . . . Axillary Brachial Aneurism Brachial ._. Axillary Axillary Aug. 25, ; Flesh wound left arm Sept, 6, Brachial 1864. 1804. Sawyer. D.. Pt., D, July 30, 31st Mo., ago 33. 1804. Sheppnrd, J. F., Pt., July 2, A, 18th Mass., age j 1803. Fracture head left!. Aug. 8, hum.; amp. sh.jt. I 9,1864. Wound through left ! July 14, axillary space. i 1863. 44 : Smith. D., Pt, E, 6th Penn. Cavalry, age 29. Stetson, S. M., Pt., 15, 32d Me., age 19. June 12, : Flesh wound left arm 1804. May 31, Fracture right arm; June 22, 1804. amputation arm. j 1804. Tighe, C., Pt., F, JunelG, 50th J Mass , age 18. i 1864. I VanGaslinck,W. A., June G, Pt,, llth Xcw York : 1864. Battery, age 23. Walsh, D., Pt., D, , Oct. 19, 106th N. Y., age 23. ; 1864. Yoho, P., Corpl., F, Sept, 19, 116thOhio,age37. ] 1804. Aneurism ; brach. ; lig. twice ; amp. at shoulder joint. Wound left chest and ! July 1, i Axillary arm. 1804. , Fiact. left humerus ; June 12, amputation at sh. : 1864. joint. wound left shoulder. Nov. 3, 1804. Flesh wound left arm Oct. 4, I 1864. Sept, G, 1864. Aug. 8, 9, 1864. July 14. 1863. Aug. 7, 8, 1864. June 22, 1864. July 2, 1864. June 18, 1864. Axillary art. and ! Nov. 3, vein. I 1864. Brachial | Oct. 7, ; 1864. OPERATION, OPERA TOR. RESULT. Right; incont. A. A. Surg. J. C. Nelson. Left; in continuity.. Right; in cont inuity : relig. Sept, 11. Right; both ends in wound. Surg. E. Shippen, U. S. V. Loft; incont. A. A. Surg. J. H. Jamar. Left; iu cont. Surg. T. H. Squire, 89th New York. Left; both ends in wound. A. A. Snrg. L. K. Baldwin. Ligated on face of stump. Left axillary. A. A. Surg. H. Craft. Right: on face of stump. Right axillary tied. Surg. S. N. Sherman. Axillary tied in con tinuity. Left axillary tied Axillary tied in con tinuity. Left ; in continuity. Aug. 3, religated. Right ; in continuity Left; in continuity. A. A. Surg. J. C. Thorpe. Left; incont,, June.7, relig. A. Surg. G. A. Mursick, U. S. V. Left; incont. A. A. < Surg. S. Teal. Right; in continuity. Surg. R. B. Bonte- j con. U. S. V. Left: incont, A. A. ! Surg. W. P. Moon. Relig. Sept. 11. Left; tied 3 times on face of stump. Left; in continuity; religated July 19, 23. Left; in cont. Asst. Surg. H. S. Schell, U.S.A. Religated. Right ; in cout. A. A. Surgeon J. K. Thompson. Axillary tied. Surg. R. B. Bontecou, U. S.V. Left; in continuity ; religatccKTuuo 23. Died Juue 15, 1804. Spec. 2463, A. M. M. Died Dec. 29, 1862. Hsem. Died Sept. 12, 1804, Died June 26, 1864. Died June 1. 1864. Died July 2, 1804. Sept, 19, amp. atsh. j. Died Sept. 19. 1864. Spec. 3030. Died Juno 3, 1863. Died JuneS, 1864. Died Sept, 12, 1863. Died Nov. 19, 1863. Died Sept. 12, 1802. May 23, amputation at shoulder joint. Died May 23. 1864. Died July 19, 1863. Died Aug. 16, 1863. Hsem. rec. Dec. 19. i Died Dec. 21, 1804. Died Aug. 10, 1864; irritative fever. June 8, amputation shoulder it. Died June 8, ] 804. Died Aug. 5, 1862; re current hcL m. Died Juno 14, 1862. Died Sept. 18, 1804. Died Aug. 9, 1804; asthenia. Died July 24, 1863. Died Aug. 8, 1804. Died Juno 22, 1864; exhaustion. Died July 4, 1804; cx- haustiou. Died Juno 23, 1864; exhaustion. Left; axillary artery Hrem. recurred Nov. andvein ied. A. A. ; K, 15. Died Nov. Surg. E: L. Duer. | 15 1804. Left; in cont. A. A. 1 Died Oct. 22, 1864; Surg. W. L. Wells. pyremia. Spec. 3079. Twenty-two ligations of branches of the axillary were reported : one (fatal) of a branch of the acromial thoracic artery ; two (one recovery, one fatal) of the subscapular ; eighteen (eleven recoveries, seven fatal) of the circumflex; and one (fatal) pf the muscular branch. Liyation of Branch of the Acromial Thoracic Artery. CASE 11 29. Lieutenant A. Stephens, C. 121st Ohio, wounded at Chickamauga September 19, 1863, in right chest ; haemorrhage October 6th ; October 10th, ligation of branch of acromial thoracic in wound; haemorrhage. recurred; death October 22, 18G3. Liyations of Sulscapular Artery. CASES 1130-1131. Private E. Burk, I, 81st Pennsylvania, age 20; fracture of head of left humerus May 12, 1864; May 20, excision; May 23, haemorrhage from subscapular; ligation in wound on the same day; hremorrhage recurred May 28; death from pyaemia June 28, 1864. Private J. Stottlemeyer, C, Cole s Maryland Cavalry; fracture of spine of left scapula Juue 6, 1864; June 19, 20, haemorrhages ; July 24, ligation of subscapular in continuity; returned to duty December 3, 1864. CHAP. LTOATIONS OF THE BRACHIAL ARTERY. I i Ligations of Circumflex. Of eighteen cases, eleven recovered and seven were fatal. TABLE OXXXII. Condensed Summary of Eighteen Ligations of the Circumflex Artery for Shot Injury. [ Recoveries, 111 ; Deaths, 1218.] No. NAME, AGE, AN1> MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF ILEMOK- UIIAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 Boothman, W., Pt., Jnnel4, Fracture right shoul June 25, Circumflex artery . June25, Right ; both ends in Discharged Jan. 31, B,17;ki;s"-.Y.,aol8. 1863. der : excision. 1863. 1863. wound. 1864. 2 Detweiler, ,Corp l, Mar. 20, Wound right arm . . . Apr. /Posterior circum- Apr. , Posterior circumflex Discharged June 10, G. 198th Pa., ago 18. 18G5. 1865. flex. 1805. ligated. 1865. 3 Gear, S., Corp l. IT, Dec. 16, Fracture right hu- Dec. 26, Posterior circum- Dec. 26, Right ; one end in Discharged June- 29, 19th Ohio, ago IS. 1864. merus; excision. 1864. Ilex. 1864. wound. A. A. Surg. 1865. S. M. Blackwood. 4 Howard, J.R.,Pt.,B, Xov. 7, Fracture humerus ; Xov. 24, Anterior circum- Nov. 24, Ligated on face of Discharged June, 7th Iowa. 1861. amputation arm. 1861. flex. 1861. stump. 1863. 5 1 Irvine, S., Corp l, I, Sept. 22, Right arm, injured Oct. 28, Anterior circum- Oct. 28, Right anterior circ. Amp.atsh.it. Dis. 67th Pa., age 23. 1864. huiucrus. 1804. flex artery. 1864. artery ligated. Sept. 9, 1865. 6 Sharp, H. J., Serg t, Aug. 29, Flesh wound of left Sept. 8. Posterior circura- Sept. 8, Left ; both ends in Vet. Reserve Corps F, 6th N. Y. Car., 1864. shoulder. 1864. : flex artery. 1864. wound. Feb. 10, 1865. ago 21. 7 Smith, S., Pt., H, MavlO, Fracture right lui- Mav26, Posterior circum- May 28, Right; in wound.... Discharged Jan. 7, 150th Pa., age 36. 1864. ruerus ; excision. 28,1864. flex artery. 1864. 1865. 8 Sprav, J. C., Pt., G, Dec. 16 "Frnrtnrn ridit, lin- .Tnn 10 Jan. 10, THrht- nnst. r.ire. Jan. 22, amputated 71st Ohio, age 22. 18C4. merus ; excision. 1865. 1865. Surg. J. H. Grove, arm. Discharged U. S. V. May 16, 1805. 9 Wager, S., Pt., B, 1st June 3, Fracture light hit- June 10, Circumflex June 10, Right; on face of Disch. Mar, 16,1865. Art. 1864. merns; amp. sh.it. i 1864. 1864. stump. Died Dec. 31, 1868. 10 Ward, A. D., Corp ), July 2, Flesh wound of left Julvl3, Posterior circum July 13, Left; one end in Discharged July 28, F.I 5th Mass., age~25. 1863. shoulder. 1863. flex artery. 1863. wound. 1804. It Yarick, R., Pt., G, June 3, Flesh wound. left arm July 14, Anterior circuiu- July 14, Left; one end in Vet. Reserve Corps 1st Mich., age 27. 18C4. 1864. flex artery. 1864. wound. Feb. 10, 1865. 12 Beekwith, R.J.,Pt., Mar. 9, Fracture head right May 8, Posterior circum- May 8, Right ; in continuity Died May 12, 1865 ; j B, 12th Xew York 1863. humerus j excision. 1865. flex artery. l8"65. pyaemia* ! Cav., ago 28. 13 Lvon, Z. S., Pt., I, ; Apr. 2, Fract. r t scapula ; Apr. 14, Brs. circumflex ar- Apr. 16, Several small brs. Died April 21, 1865. 17th Vt., age 20. 18(55. ball lodged in lung. 1863. tery. 1865. circumflex ligated. 14 Moiiahan, J., Corp l, May 5, Frait.rt. hum.; exc. ; Sept. 19, Anterior circum- Sept. 19, Right ; in continuity Amp. sh. jt. Died E, 22dMass.,age38. 1864. amputation arm. 1864. flex. 1864. Sept. 26, 1864. Xpec. 3331, A. M. M. 15 Sanford, J. E.,Ft.,D, May 6, Fracture right hu- June 7, Circumflex artery. June 7, Right ; one end in Haein. recnr d. Died 7th Mass., age 24. 18 04. merus ; excision. 1864. 1864. wound. June 16, 1864. 1C Stoutenberg," M., May 5, Fracture left hnme- Juno 15, i Posterior circum- June 16, Left. Surg. H. Pal Died June 18, 1804. Scrg t, C, 148th X. 1864. rus. 1864. flex artery. 1864. mer, U. S. V. Y., age 24. 17 Welch^E. A., Scrg t, An"-. 25 Fract. left hum. ; ex- Sept. 24, Stump Sent. <U Anterior and poste Died Oct. 11, 1864. H. 1st D. 0. Cav., 1864. cision ; amputation : 1864. 1864. rior circumflex on Spec. 3675, A. M. M. age 20. at shoulder .joint. face of stump. 18 Zwick, G. T., Scrg t, May 12, Flesh wd. left shoul- July 2, Posterior circum- July 2, Left ; in wound Died July 15, 1864; I,27thMich.,age27. 1864. der. 1864. flex artery. 1864. exhaustion. Ligation of Muscular Branch of Axillary. CASK 113 2. Private E. Draper, A, 3d Delaware, aged 23; shot flesh -wound of axilla; axillary artery divided March 31, 1665; amputation at shoulder April 9. 1865; haemorrhage from muscular branch April 16th, ligation on face of stump; no recurrence of haemorrhage; death from exhaustion April 16, 1865. Ligations of the BracMal Artery. One hundred and seventy cases of ligation of the brachial artery were reported; one hundred and nineteen were successful and fifty-one were fatal, a mortality rate of 30.0 per cent. TABLE CXXXIII. Summary of One Hundred and Seventy Cases of Ligations of the Brachial Artery. [Recoveries, 1119 ; Deaths, 120170.1 NAME, No. I AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HJEMOR- RIIAGK. PROBABLE SOURCE OF HJBMOKRHAGK. DATK OF OPEHA- TION. OPERATION. OPEHA- TOK. RESULT. 1 B;ibcock, F.. Serg t, M, fith 111. Cav. 2 Bal)COck,O.P.,Sers t, U, 207th Pa., age 25. Becker, "W., Serg t, B, 98th Pennsylvania. 4 Bergner, F., Pt,, B, Feb. 21, 1864. April 2, 1865. July 2, 1863. May 25, JTlesh ; left hand . . Fracture left radius, upper third. Fracture left wrist . . Flesh ; left arm, mid 1864. Apr. 12, 1865. July 14, Aug. 30, 31, 1863. Juno 13 Palmar arch Rec. branch radial. Ulnar radial Brachial Mar. 14, 1864. Apr. 12, 1865. After Aug. 31, 1863. June 11, In continuity. A. A. Surg. A. Sterling. In continuity, lower fourth. A. Surg. H. Allen, U. S. A. In continuity Both ends in wound. Duty, July 13, 1864. Discharged June 2, 1865. Discharged August 17, If 64. Duty. 121st Pa., age 21. "> Berry, P., Corp l, G, 1864. June21, dle. Fract. left hnmerus- 1864. July 1, 13, 1854. July 1 A. A. Surg. E. Do Witt. On face of stump . . Discharged Decem 23d Illinois, age 27. 1864. elbow joint amp. 1861. 1864. ber 5, 1864. MOON (W. P.), Amputation of Right Shoulder Joint, in Am. Jour. Med. Set., 1866, Vol. LI, p. 143. SURG. Ill 98 WOUND? AND COMPLICATIONS. [CTIAP. XII No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATUKE OF INJURY. ^nv S PROBABLE SOURCE OF ?^^f" HEMORRHAGE. KoAulS. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 6 7 8 9 10 11 1-2 13 14 15 10 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 :.-, 38 ^9 40 41 42 43 44 45 4G Bettenhauser.C., Pt,, I, GlstX. Y., age 22. Bird, W. A., Pr,.. G, 68th Ind., age32. Bowman. G, W.,Pt, C, 107th Illinois. Bovuton. A. J., Ft,, II, 13th Wis., age 23. BrannagRn, T., Pt., B,22dMa88.,agel9. Brooks, J., Pt,, E, 22d Mass., ago 18. l Jiroom, J ., Serg t , A. 48th X. C. Budd, J.,Pt.,F, 100th Pa., age 22. Carton, L., Pt., C, 8th July 2, 1803. Aug. 14, 1864. Aug. 6, 1864. Nov. 21, 1864. Juno 18, 1861. July 2, 1863. Aug. 25, 1864. Mar. 25, 1865. Juno 16, 1864. Aus. 16, 1864. Feb. 6, 1865. July 2, 1863. June 20, 1864. May 6, 1864. July 9, 1864. May 22, 1863. Dec. 7, 1862. Oct 16, 1864. Aug. 18, 1864. July 30, 1864. Feb. 20, 1864. May 12, 1864. June 18, 1864. June 3, 1864. Mav 3, 1863. Aug. 1, 1863. June 9, 1863. June22, 1864. Apr. 6, 1862. Feb. 25, 1864. Dec. 16, 1864. Mar. 21, 1865. Dec. 13, 1862. Jan. 29, 1864. Aug. 24, 1864. June 25, 1864. Mav 16, 1864. JuiselG, 1864. July 1, 1862. Aup. :?0, 1862. Jan. 1, 1862. Aug. 12, : Brachial Aug. 12, 1863. Sept, 9, 1864. Aug. 6, 1864. Dec. , 1864. July 24, 1864. July 15, 1863. A us. 30, 1864. Apr. 3, 1865. July 2, 1864. Aug. 16, 1864. One end in wound. . . In continuity ; haem. Sept 15. Both ends in wound . In continuity One endin wound. A. A. Surg.H. Sanders. In continuity In continuity. Stirg. P.Wright P.A.C.S. In cont Surg. N. 11. Moseley, U. S. V. One end in wound. A. A. Surg. W. Hooper. In continuity; Sept. 1, 13, religated. In continuity, mid dle third. In continuity, mid dle third. In cont. A. A. Surg. D. J. Griffith. One end in cont A . A. Surg. F. G. H. Bradford. In cont. A. A. Surg. A. H. Hoy. On face of stump In continuity In cont,, mid. Surg. P. Harvey, U. S. V . Both ends in wound In continuity, upper third. In cont., mid. A. A. Surg. J.T. Kennedy. Both ends in wound. A. A. Surgeon E. G. Waters. In cont. A. A. Surg. G. E. Brickett. V. R. C. May 13, 1864. Sept 15, amp.; dis charged November 26, 1864. Discharged April 11, 1865. Discharged April 8, 1865. V. It. C. May 2, 1865. Recovery. Recovery. Discharged June 27, 1865. Duty January 15, 1865. Discharged October 31, 1865. Discharged Septem ber 9, 1865. V. It. C.Feb. 24, 18C4. July 13, amp.; disch. Sept. 23, 1864. Discharged July 28, 1864. Discharged. Discharged Sept. 19, 1863. Discharged Feb. 27, 1863. Discharged May 31, 1865. Discharged July 2, 1865. Recovered Jan. 19, 1865. Duty Apr. 24, 1864. Discharged Jan. 10, 18G5. Discharged June 3, 1865. July 21, amputated ; disch. Oct. 11,1864. Discharged Aug. 29, 1863. Duty Oct. 10, 1863. Discharged Jan. 16, 1864. Discharged Dec. 23, 1864. Discharged July 2, 1862. Discharged Dec. 7, 1864. Duty Sept. 5, 1865. Hocm. rec. ; May 14, amputated ; disch. Juno 27, 1865. Furloughed. Discharged Nov. 14, 1864. To prison Feb. 5, 1865. Discharged May 16, 1865. Discharged Sept. 23, 1864. Discharged Feb. 6, 1865. Discharged Dec. 9, 1862. Discharged Nov. 10, 1862. Recovered March . 1862. Fract. left humerus, lower third. Left elbow, cut brach- ial artery. Fract left humerus ; Nov. 22, amp. arm. 1863. Sept, 9, 15, 1864. Aug. 6, 1864. Dec. 4, 7, 1864. July 20, Humeral Brachial Brachial Fract. left humerus ; amp. arm. Mid. finger left hand Fract.righ t humerus, lower third. Fleshjright arm, mid dle. Brachial artery, right arm. Fract. left radius, up. third, wd. radial. 24/64. July 15, 1863. Brachial Palmar arch Apr. 2, 1865. July 2, 1864. Superior prof unda Minor profunda . . . Now Jersey, age 19. Callahan, P., 4th N. J. Battery, age 26. Canning, \V. J., Pt, D, 95th Pa,, age 24. Carnaghan, J., Pt.,C, 29th Pa., age 21. Carr, S. H., Pt,, C, 90th Ohio, age 21. Carroll. J., Pt, E, 39th X. Y, age 28. Clark, O. A., Serg t, D, 21st Ohio, ago 31. 2 Cloud, A., Pt, H, 22d Iowa, ago 41. Cole, N., Lieut, 20th Wisconsin. Daniels, I)., Pt.,C, 3d Wis. Car., age 30. David, W., Pt, D, 107th Illinois. Davis. J. H., Pt, E, 39th C. T., age 21. Davis, W., Pt,E, 3d Artillery, age 24. Donnelly, J., Pt, D, 16th Mass., age 41. Downey, J. N., Pt, Cth Maine Battery, age 21. Dutfv, II.. Lieut, D, 155tii N. Y., age 46. Ellis, D., Pt.. A, 12th N. U.. age 34. Eils, W.. Pt, K, 9th Radial July 21, 1863. July 12, 13, 1864. May 12, 1864. July 24, 1864. Aug. 17, 1863. Repeat ed. Superficial palmar arch. Brachial July 21, 1863. July 12, 1804. May 12, 1864. July 24, 1864. Aug. 17, 1863. Dec. 16, 1862. Oct. 28, 1864. July 31, 1864. Mar. 7, 1864. Mav 12, 24, 64. July 6, 1864. July 13, 1864. June29, 1863. Aug. 12, 1863. June 19, 1863. On tield Apr. 21, 1862. Apr. 21, 1861. Dec. 23, 1864. Apr. 23, 1865. Jan. 13, 1863. Feb. 11, 1864. Sept. 7, 1864. Sept, 15, 1864. June 21, 1864. July 4, 1864. July 9, 1862. Sept, 26, 1862. Jan. 23, Mar. 1, 1862. Flesh ; left arm, low. third. Right brachial ar tery, high up. Flesh ; left arm. mid dle. Fract. left humerus, lower third, amp. Bracbial artery, left arm. Flesh ; right forearm Brachial artery, bend of left elbow. Brachial Diffused aneurism . Brachial Flesh ; left forearm . . Flesh ; left arm, up per brachial artery. Mar. 7, 1864. May 24, 1864. TJlnar and interos- seous. Brachial artery, left arm. Right elbow ; amp. arm. Flesh ; left arm, low er third. Flesh; right hand. .. Flesh ; right arm Flesh; left hand Fracture left carpus Left arm, upper third. Flesh ; left arm, mid dle third. Fracture left wrist joint. June 29, 18B3. Aug.ll, 12, 63. Junel3, 1863. On field Apr. 20, 1862. Mar. 25, 1864. Apr. 23, 1865. Jan. 13, 1863. Brachial Branch brachial . . Palmar arch ; lig. radial Juno 13. In continuity, high up. In cont. A. A. Surg. J. E. Smith. N. Y. Cav., age 20. Estes, 11., Pt, H, llth Ky., age 18. Fisher, A., Corp l, G, 30th Mass. Flewellen, A.,Pt, I, 29th Ind., ago 20. Ford, I. C., Pt, C, 10th Mich., age 21. Frnnk,P.,Pt,D,5th Minnesota, ago 27. Fritschey, W., S gt, M, 12th Pa. Cav., age 24. Gates, It., Pt , 1, 4th N.Y., age 19. Grilboa,A.,Pt.,C,8th Mich. Cav.., age 27. Giltaril, M., Pt,, K, 16th Miss., age 27. Girrbaeb, A.,Pt,,B, 5th Penn. Cav., age 26. Goodwin, A.K.,Pt. I, 4th N. H., age 23. Gradv,J.,Pt.,C,lC4th N. Y., age 47. Graham, It., Pt, B, 81st Penn., age 43. Griggs, E. P.,Pt, F, 14th Inf., ago 21. 3 Hamilton, J.,Pt, I, 51st Penn., ago 22. Ligation April 20, 21, recur red. In continuity, lower third. A. A. Surg. D. O. Farraud. Ligation In cont. Surg. J. B. Lewis, TJ. S. V. In cont. at bend of elbow. Both ends in cont. A. A. Surg. H. C. May. Both ends in wound. A. A. Surg. J. Morris. In continuity, mid. A. Surgeon J. H. Merriam, U. S. V. Both ends in conti nuity. Both ends in wound. Assist. Surgeon II. S. Schfll, U. S. A. In continuity, lower third. Radial, ulnar, and brachial in cont. In continuity Ulnar Flesh ; through bi ceps. Flesh; right wrist.. Right arm fractured amp. Sept. 5, Ulnar ligated Sept. 14, 64. 5. June 21, Brachial 1864. Radial artery, left forearm, up." Fractured metacar- pal, right hand. Left hand, fract met. Jan. 1, excision. 4, 1864. P r i m. Radial and re- ! currinz. Sept.26, 1862. Jan. 10, Palmar arch ; lig. 15, Mar. radial Jan. 10. 1, 1862. WRIGHT (D. F.), The Effects of the Hunterian Method of Ligation on Inflammation, in Confederate States Medical and Surgical Journal, 1864, Volume I, p. 178. 2 LLOYD (D. C.), Report of Five Cases of Hospital Gangrene, in Am. Hied. Times, 1863, Vol. VII, p. 267. 3 SQUIRE (T. H.), Report of Stiryical Cases at Roanoke Island, in Boston 2Ii-d. and Surf/. Jour., 1862, Vol. LXVI, p. 176. CHAP. XIT.l LTGATION8 OF THE BRACHIAL ARTERY. 779 Itfo NAME, AfiE, AND MILITARY DATE OF NATURE OF INJURY. DATE OF PROBAHLE SOURCE OF DATE OP OPERATION, OPERA- RESULT. DESCRIPTION. INJURY. RHAGE. HEMORRHAGE. TION. 47 Hammond R Pt G Dec. 7 Brachial art y, tipper Dec. 7 Brachial Dec. 7 48 8th Minu. Hardv M II "en"! 1864. third, right arm. Fractured right ra 1864. 1864. Surgeonll. B.John son, 15th Ohio. Ligation 18G5. Discharged Feb 9 6 49 service. Hastings C. S. Tt. Is62. May 2, dius, mid. Fractured right carp. June 29 Palmar arch June 29, In cont. at elbow. 1863. 50 E, 2dU. S. S. S.,age 21. Hatmaker, J.,Cnpt., 1863. Nov. 24, and met.; excision. Right arm 1863. Nov. 24, 1863. Nov. 24, Surg. D. P. Smith, U. S. V. discharged Oct. 9, 1863. Discharged Oct. 4, 51 B, 51st Obio. Hawkins, A. P.,Lt., 18C3. Aug. 25, Fractured left hum., 1863. Sept. 1, Brachial 1863. Sept. 10, In continuity 1864. Discharged Jan. 26 5^ E, 8th New York Artillery, age 20. 1804. Dec. 13 elbow; exc., amp. 10, 64. Dec 31 Brachial 18G4. Jan. 1 Ligated 1865. Spec. 2010. Discharged Oct 30 53 Corporal,B,4thVt,, age 19. Uolokor R. Pt. G 18G2. Nov. 25, Brachial tirtery left 18G2. Brachial 1863. Dec. 6 Both ends in wound 1863. Died Aug. 10, 1869. M 65th Ohio, a;:e 25. Henby, J. R., Pt.,F, 1863. Au". 14 arm. Rio ht huruerus el Au" 29 Brachial .... 1863. Aug. 29 In continuity . 1864. Discharged April 25 55 51st ind., age 22. Henderson, D. D., 1864. Feb. 12, bow. Flesh- left brachial Sept. 3, 1864. Feb. 24 Brachial Sept. 3, 1864. Feb. 24, Both ends in wound. L865 56 57 Pt., I, 15(h Miss., aso 21. 1 Heiidorson,"W.,Pt., E, 115th Poiin., age 37. Henninfer, J.,Pt. H. 1865. Julv 2, 1863. May 20, artery. Fracture left ulna . . . Flesh ; ri< r ht arm 1865. Aug. 8, 1863. July 24 Ulnar branches Brachial 1865. Aug. 8, 1863. July 24, Surg. B. B. Breed, U. S. V. In continuity. A. A. Surg. J. Ashhurst, jr. Both ends in wound. Veteran Res. Corps May 12, 18G4. Discharged Juno 28 >; G7th Ohio, age 18. Hereford, J., Pt., L, 18G4. Oct. 22, lower third. Ri^ht arm, brachial 1864. Aneurism . 1864. Nov. 27 Surgeon A. Heger, U.S.A. Both ends in wound. 1865. r Discharged June 23 59 Gth Kansas Cav ry, ago 18. ? Herring, Isaac, Pt., 1864. Nov. 25, artery. Flesh left hand Palmar arch 1864. Nov. 29 Surg. A. C. Van- duyn, U. S. V. In continuity 1865. April 24 1864 haem no C, 53d C. S. A. Hinckman, W., C pl, 18G3. Aug. 19, Fractured left ulna 18G3. Sept. 24, In continuitv. A. orrhage; recovery. Sept. 14 64 amp. 01 B,5thN.T.,age25. Hubn 11., Lit-uf. K 18li4. Tune 27 mid. June 27 1864. June 9 7 A. Surg. A. Ansell. In continuitv disch.May 11, 1865. 62 63 64 44th 111., age 24. Huntlev, W." F., Pt., F, 5th Vt., age 26. Hurley, It., Pt., H, 159th New York. ^Kennedy, M. J., Pt., 1864. Mav 5, 1864. Sept. 19, 18C4. Au<r. 29, artery. Flesh ; right brachial Right arm, middle. . . Flesh ; ri^ht arm, 18G4. May 5, 1864. Sept. 27, 28, 1864. Brachial Brachial Aneurism 1864. Mav 5, 1864. Sept. 28, 1864. Apr. 7, Both ends in wound. Surg. A. N. Dough erty, U. S. V. In continuitv, upper third. In continuity. Surg. 18G4. Discharged Feb. 22, 1865. Oct. 9, amp. forearm. Disch dMar. 27, 65. Recovery. 65 fifi U, Gth La,, age 24. Lastofka, \V., Pt.,I, JGth Wia., ago 19. Leichfield, J. N.. B 18G2. Mav 3, 1863. Mav !> middle. Fract. r t humerus ; May 15, amp. sh. jt. June 1, 1863. May 24 Brachial Radial 1863. June 1, 1863. F. For men to, jr. On face of stump . . . In continuity Discharged Aug. 13, 1863. 67 20th Ind., age 21. LcttiTman, II., K 1864. 31, June 7, 1864. July 13 Radial 18G4. Julv 14 In continuity 1864. " 68 67th I enu., age 36. Little, .1. H., Serg t. 1864. .Tune 3, Fracture rinht ulna, 1864. 18G4. June 14, In cont. A. A. Surg. 18G5. Duty Jan. 26, 1865. 69 70 72 73 I, 32d Maine. Lusc, J. 15., Pt., C, 125th Ohio. Malier. T., Pt., E, 5(jth Mass., age 17. Martin, T. A.,Pt,,G, 91st N. Y., ii!_ r e 22. Mav, A. L>., Corp l. Hi 33d Ind., age 22. McAllister, "W., S gt, 1864. Julv 18, 1864. June 17, 1864. Mar. 31, 1865. Mav 15, 1864. Mav 10, lower; excision. Fract. radius; July 23, excision. Left hnmerus, mid dle. Fracture right fore arm. Fracture right ulna, middle. Aug. 1, 4, 1864. Julv G, 1864. Apr. 16, 1865. Mav 24, 26,27/64. May 21 Radial ; brachial. Aug. 2, amp. arm. Brachial Radial Ulnar or interosse- ous. Brachial 1864. Aug. 4, (1864. July 6, 1864. Apr. 16, 1865. Mav 27, 1864. May 21, J. A. McArthur. On face of stump In cont. , upper third. A. A. Surg. H. M. Dean. In cont., f lower third. In cout., at elbow. A. Surg. H. T. Leg- ler, U. S. V. One end in wound ; Discharged Apr. 11, 1865. Recovered Sept. 24, 1864. April 18, amputated. Disc hAug. 17, 1865. Discharged Mar. 6, 1865. 74 75 F, 9Gth Pa., age 30. McClinty. G., Pt., F. 17th S. O. C., age 17. McGraw, T. n..C p], 18G4. Aug. 27, 1864. July 21, lower. Right elbow joint ... Left arm, fracture; 1864. Sept. 20, 18G4. Au". 30, Brachial Brachial 1864. Sept. 20, 1664. Au". 30. relig. June 6. Surg. E.Bentley, U. S.V. Both ends in wound. In cont., upper third, 1864. Exchanged Oct. 17, 1864. Discharged Sept. 27 7fi A, 9th Me., age 18. Mclntire. A.,Pt.,M, 18G4. Juno 3, primary amp. Ri lit forearm 1864. 1864. June 15, near stump. In cont. Surg. T. R. 1864. Discharged Dec. , 77 78 2d N. Y. Art., age 22. McMillan, S. L., Pt., C, 40th Ohio, age 21. Moore, A. A., Pt., C, 1864. Sept. 20, 1863. Julv 21, Fracture right ulna . Nov. 5, 1863. Brachial 1864. Nov. 5, 1863. Oct 1 Crosby, U. S. V. 1864. Duty May 26, 1864. 79 80 81 82 83 53d Ind., age 21. Morris, R., Pt,, A. 149th Penn., aee25. Mullen, 11., Pt., E, 36th Illinois. Myers, H., Serg t, A, 23tl Illinois. Noyes, E., Corp., C, ll th Maine, airo 21. O Covle, 1)., Pt., K, 1864. Oct. 27, 1864. Dee. 31, 1862. Mav 3, 1803. Aus. 16, 18G4. July 27, Flesh; right forearm, upper. Lett arm ; March 12, amputation. Brachial artery near elbow, left. Right arm Interosscous artery Nov. 13, 1864. Mar. 26, 31, 1863. Mav 3, 1863. Sept. 3, 1864. Radial Brachial 1864. Nov. 14, 1864. Mar. 31, 1803. Mav 3, 1863. Sept, 3, 1864. Morgan, 29th Mo. In cout. Surg. N. R. Moseley, U. S.V. In cont.; slight hem orrhage. Ligation. A. A. Surg. J. Kirker. In cont. A. A. Surg. E. B. Woolston. In continuity, near 1865. Discharged April 26, 1865. Discharged June 27, 1863. Discharged July 24, 1865. Amputated Sept. 10; disch. Jan. 27, 1865. 84 85 1st Wis. U., !!!_ 021. Owens, E. G., Pt,,U, 13th \V~.Va., age 19. Parrett,W.B.,Pt.,D, 5th Iowa, age 20. 18Gi Oct. 19, 1864. Sept, 19, 1862. right forearm. Left arm, lower third. Left arm Oct. 27, 1864. Oct. 3, 1862. Brachial Oct. 27, 1864. Oct. 3, 1862. elbow. Both ends in wound Ligation 25, 1862. Vet. R. C. May 26, 1865. Discharged January 7, 1863. Asiiiit R&T (J.), Surgical Cases, in Am. Jour. Med. Sci., 1864, Vol. XL VII, p. 144. 2 HOLI.OWAY (J. M.), Consecutive and Indeterminate Hcemorrhage from Large Arterien after Gunshot Wounds, etc., in Am. Jour. Med. Sci., 18G5, Vol. L, p. :U2. s Fou.MENTO (F.), Xotcs and Observations on Army Surgery, New Orleans, 1863, p. 56. WOUNDS AND COMPLICATIONS. rcHAP. xn. No. 86 87 88 89 00 91 92 93 94 95 96 97 98 99 100 101 102 103 104 103 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 jl21 122 NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF H.S:MOR- KIIAGE. PKOBAHLE SOUKCE OF RfiMOBBHAGB. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. Pepper, E., Pt., B, 18th Inf., age 35. Pel-man, M., Pt,. V, 2d N. J. C., age 33. Philbrick, C.W , Pt, F,3dN. H., age 22. Pierce, G. W., Corp., D, 20th Ind., age 22. Potter. E., Pt,, H, 86th N. Y., age 29. Powers, C. C., Pt., A, 40th Iowa. Price., E., Corp l, B, 39th N. Y.,age 22. Quinn, J.,Pt,,C, 18th Infantry. Reede, ., Pt,, C. 18ith Pennsylva nia, age 21. Reese, 0., substi tute, age 20. Reese, R., Pt., H, 1115th Ohio. Rice, J. H., Pt, A, 20th Conn., age 22. Root, E. C., Lieut, D, 2d New York Artillery, age 29. Schrichfield, J. H., Pt, B, 20th Indi ana, age 21. Shook, J., Pt, G, 27th Ohio, ago 21. Sipes, J., Serg t, K, 32d Ohio, age 24. Smith. T.. I., Pt, E, 6th Iowa, ago 22. Smith. U. A., Pt,C, Dec. 31, 1862. Mav 2, 1864. May 15, 1864. Aug.29, 1862. Mav 6, 1864. Juno 13, 1865. April 2, 1865. Dec. 31, 1862. Aug. 14, 1864. Oct. 17, 1863. Oct. 8, 1862. Mar. 19, 1865. Mav 19, lt 64. May 12, 1864. July 4, 1864. Julv 16, 1865. April 6, 1862. Au g. 14, Fracture right ulna, upper third. Fract right radius, middle. Fract. left hnnierus ; May 15, amputation. Lacerated wound of left hand. Flesh; left arm; in jured artery. Fracture left radius, middle. Elbow; iu jury to bra- cbial artery. Flesh ; middle third aim. Left, forearm, near elbow. Fracture left radius and artery. Fracture ulna Right bracbial ar tery. Fracture left fore arm, upper third; excision. Jan. 8, 10, 1863. June21, 1864. June 1, 1864. Sept 9, 10, 1864. May 17, 1864. Jan. 10, 1863. June21, 1864. June 1, 1864. Sept. 10, 1802. May 17, 1864. June 17, 1865. April 6, 1865. Jan. 23, 1863. Sept 7, 1864. Oct. 17, 1863. Oct. 22, 1862. Mar 19 In continuity; Feb. 10, hffimor. rec. In cont, mid. third. Ass t Surg. J. C. G. Happersett, U.S.A. On face of stump In continuity . . Feb. 12 , amputated. . Dis. April 21, 1863. Discharged Septem ber 5, 1864. Discharged August 18, 1864. Discharged Febru ary 11, 1863. Discharged March 12, 1865. Recovery. Discharged July 27, 1865. V. R. C. July 8, 1863. Discharged Dec. 26, 1864. Jan. 7, 1864, amp. Disc. Nov. 28, 1864. Hem. cont by exci sion. Discharged Jan. 27, 1863. May 7, amp. Disc. Oct. 18, 1865. Dismissed Jan. 25, 1865. Discharged July 29, 1864. Discharged May 25, 1865. Discharged Sept. 27, 1865. Discharged Mar. 19, 1863. Discharged Dec. 6, 1864. " Discharged Jan. 23, 1863. Hffim. September 29. Discharged Fob. 3, 1865. Discharged June 28, 1864. April 25, 1865, hrem. Recovery. Discharged May 23, 1865. Discharged Feb. 28, 1865. July 26, slight hrem. Recovery. Discharged 1862. Discharged Septem ber 19, 1864. Discharged Decem ber 29, 1864. Discharged June 29, 1865. Duty Octobcrl6, 1862. Duty April 26, 1865. Discharged Januarv 11,1864. Discharged January 13, 1865. Died Juno 1, 1804. Died September 17, 1862. Died July 2, 1864, py- remic pneumonia. Radial Brachial . . . In continuity, mid. Assistant Surg. W. Thomson, U. S. A. In continuity. Ass t Surg. J. C. Miles, U. S. V. Ligat u brachial and ulnar. Ligation in continu ity, upper third. Both ends in wound. A. A. Surg. W. H. Ensign. In continuity. A. A. Surg. A. Hewson. In contiuuitv. Surg. W. Varian, U. S. V.; ineffectual. April 6, 1865. Jan. 10, 22, 1803. Sept, 2, 7, 1864. Uluar, recurrent . Ulnar ligated Sep tember 2. Oct. 38, 1862. Mar. 19, 1865. June 1, 15, 1864. Mav 24, Radial and branch profunda. Radial 1S6:>. Juno 1, 15,1864. June 7, 1864. July 18, 1864. Julv 17, 1865. Apr. 24, 1862. Aug. 14, 1864. Dec, 18, 1862. Sept. 17, 1864. In cont. 1st Surg. H. W. Ducachet, U. S. V., and 2d A. A. S. J. O. Stanton. In continuity, lower third. Ineont n ty. Surg. J. H. Grove, U. S. V. Ligation. Surg. R. R.Taylor, U. S. V. Ligation ; in conti nuity. Ligation in upper third. In continuity near elbow. Ligat n. Surg.N. R. Moseley, U. S. V. Left forearm, upper third. Right humerus, inv. brachial artery. Fract right radius Ri^ht arm, upper 31, June 7, 1864. Apr. 24, 1862. Radial Brachial Brachial Brachial 15th Iowa, age 29. Stevenson, T. J ., Pt., G,. 02d Ohio, age 30. Sweeny, P., Pt,D, 2d New York Heavy Artillery, age 40. Thompson, W. M., Serg t, E, 99th Ohio. Tobert, L. C., Serg t, C, 2d Alabama, ago 18. Trask, T., Pt, F, 2d New York M. R., ago 16. Tmtle, F.M., Pt,B, 44th 111., age 23. 2 Ward, C. O., Pt , G, 66th North Caro lina, age 25. Warren, S., Pt., A, llth Maine. Welch, E. F., Pt, 57th New York, age 20. Whaley, I., Corp., II, 54th Alabama, White, A. B., Pt., D, 1st D. C. Caval ry, age 22. White, E. B., Pt., F, 19th Maine, age 21. Williams, J., Pt., A, 6th Pennsylvania Cavalry, age 26. Wilkinson, E. W., Serg., G, 42d New York. Wiltse, M. II., Pt, G, 1st U. S. Signal Service, age 25. Winnemore,E.,Mu8., K, 88th Pennsyl vania, ago 21. Barker, J. H.,Corp., E.14 2dPenn.,n{re25. Beaver. T , Pt, II, 2d Wisconsin, age 30. Bcvei!y,W.J.,i t,C, 17th Maine, age 27. 1864. Dec-. 10, 1862. Aug. 14, 1864. Nov. 25, 1863. April 9, 1865. June 3, 1864. June 27, 1864. June 30, 1864. Mav 31, 1862. June 16, 1864. Julv 28, 1864. Juno 16, 1864. Mar. 31, 18G5. Sept. 20, 1862. May 10, 1864. Mav 3, 1863. June 26, 1864. Mav 12, 1864. Aug. 27, 180i>. May 5, 1864. third brachial art. Dec. 18 Left arm 1862. Sept. 17, Brachial Fracture elbow, sev. brachial artery. Flesh ; left arm, el bow. Left forearm, radial and ulnar arteries. Flesh ; left forearm Fracture left meta- carp. Flesh; leftarm, near elbow. Left arm ; fracture ; amputated. Fracture right sh. joint; excision. Flesh ; upper third, right aim. Flesh ; right arm, inj. brachial artery. Lei t arm ; div. bra chial artery. Fract. ulna ; lacera d brachial artery. Fracture right ulna, upper third ; exc. Right forearm, up per third. Fraet. left humerus ; amputated. Fract right humer us; excision. Flesh, elbow ; brach. artery severed. 1864. Brachial Apr. 17, 1865. June 20, 1864. Julv 17, 1864. Julv 6, 1864. Aug. 11, 12,1864. Julv 6, 1864. Apr. 12, 1855. Sept.20, 1862. Mav 10, 1864. Mav 15, 1863. Aug. 8, 1864. June 1, 1864. Sept. 1, 18G2. Mav 2.1, 24, iS(J4. Brachial Apr. 17, 1865. June 20, 1864. Julv 19, 1864. Julv 16, 1864. In continuity, lower portion. Surg. A. McMahon, U. S. V. In cont. Surg. X. R. Moseley, U. S. V. In continuity, lower third. In cont Asst Surg. O Leary, C. S. A. Radial Ulnar ligated Sloughing Brachial .... Julv 6, 1864. Aug. 12, 1864. July 6, 1864. Apr. 12, 1865. Sept.20, 1862. May 10, 1864. May 26, 1863. Aug. 8, 1864. June 1, 1864. Sept.l, 1862. May 24, 1864. On face of stump. Surg. R. B. Bonte- cou, U. S. V. In wound Both ends in wound. A. A. Surg. J. M. McGrath. In cont., mid. A. A. Surg.W. H. Ensign. In wound, both ends. Asst, Surg. J. W. S. Gouley, U. S. A. In cont. (ulnar also). Surg. J. M. Burr, 4 Jd New York. In continuity, near elbow. In cont , mid. third. A. A. Surg. W. P. Moou. In continuity . . In wound Both ends in wound. Asst. Surg. G. A. Mursick, U. S. V. Deltoid branch .... Brachial Post, interosseous. Ulnar Braehiul Brachial Brachial SIIRADY (J.), Ligature of lirachial Artery, in American Medical Times, 1863, Vol. VI, p. 173. 2 WRIGHT (D. F.), The Effects of the Hunter-ion Method of Ligation on Inflammation, in Confederate States Medical and Surgical Jour nal, 1864, Vol. I, p. 177. CHAP. XII.J LIGATIONS OF THE BRACHIAL ARTERY. 781 Xo. NAME, AGE, AXI) MlLlTAUY DESCRIPTION. DATE OF IXJUUY. NATURE OF INJURY. DATE OP ILEJIOR- KHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF Ol F. RA TION. OPERATION, OPERA- TOB. RESULT. 123 V>4 Blakeloy, A., Pt., I, 3d Michigan Cav alry. Bohiicr W Pt TI June 16, 1803. An" 19 Left arm July 8, 9, 10, 1863. Sept, 5 Brachial July 10, 1803. Sept. 5 Incont; ineffectual. Surg. B. A. Vander- kieft, U. S. V. Amp. arm, sh. joint; hacm. recur d, amp. Died July 26, 1863. Died October 3 1861 125 3dOhioCav.,ago20. Brick ett E. .T. Pt. 1804. July 2 lower third. 1864. July 23 Brachial 7, 8, 10, 1804. July 23, J. L. Eaton. In continuity . Died Au" 10 1863- 126 A, 7th Michigan Cavalry, ace 19. Print J , Corp., F, 1863. Au". 5 per third ; amp. 1863. Sept. 13 Brachial 1863. Sept.13, Both ends in cont. pyajrnia. Sept. 23 amp. died 127 128 120 130 14th Ohio, ago 27. Broolis,G., Pt.,I,9th \V. Virginia, age 20. Burnham, L. M., Corp.,D,132dPenn- svlvunia, iigo 22. CliiH-, C. 11., Pt., D, 71 h W. Va., age 2K 1804. Aug. 26, 1804. Sept, 17, 1802. June 1, 1864. May 6 bow; gangrene. Flesh ; middle right arm ; part, severed brachial artery. Fract. left radius; amp. forearm. Flesh; right brach. artery injured. 1804. Sept. 5, 9864. Oct. 30, 1862. JtinelS, 1864. May 16 Brachial Slough, stump Brachial ....... .. Radial 1864. Sept, 5, 1804. Xov. 4, 1862. June 15, 1801. May 19, Sept. 16, relig. Both ends in wound. A. A. Surg. T. J. Dunott, In continuity Lig. A. A Surg. H. D. Vosburgh. Oct. 12, 1864; pv. Died Sept. 10, 1864; gangrene. Died Xov. 15, 1862. June 23, amp. ; died June 25, 1864. Died May 31 1664- 131 148thPenu., age 27. 1854. May 12 turo; excision. 1!>, 1864. Brachial 1864. June 1, per third. pyasmia. Died June 2 1864. 13 10th La., age 27. Donnelly E Pt C 1804. Sept 17 amputation. Flesh left arm 1864. Oct 3 5 18G4. Oct. 6 Died Xov 7 186 m SlstX. Y., age 29. Evors, W. , E, 9th 1802. 6, 1862. 1802. Xov., Oct. 7, amputation. In continuity pyaemia. 134 Wisconsin. Fitzgerald .T P Pt May 18 May 22 1862. May 2 ~> lig. of aneurism. Died June 4 1864 133 G, 52dX.Y.,age37. Greaf A Corp l P 1804. amputation. 1864. July 23 Radial 1864. July 23 Ass t Surg. G. A. Mursick, IT. S. V. pyrcrnia. Died July 25 18/54 136 40th X. Y., age 37. llamlin F X. Lt 1864. May 5 right forearm. 1804. 1864. lig. radial). exhaustion. Died June 25 1864- 137 138 K, 147th X. Y., ago 32. ^Hardy,F.S., Pt., B, 30tli X. U., age 22. Ileatheilv .T., Pt., 1864. July 12, 1864. Oct 28 arm, uluar artery divided. Fracture left ulna and light radius. 1804. Aug. 13, 1804. Dec 10 Right brachial .... 1864. Aug. 13, 1864. Dec. 19 ulnar. Surg. II. W. Dncachet, U. S. V. In cont ty; slough.; hann. recurred. exhaustion. Died Aug. 14, 1864; exhaustion. 139 E, llth W.Va,, age 35. Heudrix A , P( , C 1804. July 2 arm, upper third; Oct. 29, excision. 10, 19, 1864. July 26 1864. Au". 4, bifurcation; liitm. recurred. tion. Died Jan. 24; pyaemia. Died Au". 18 1863 140 140th X. Y. Howard G., Pt., H 18U3. joint. Aug. 2, 1803. June 29 1863. Juue 29 rhage recurred Aug. 14, 16. Both ends iu wound Died July 1 1864- 141 8th X. Y. Heavy Artillery, age 20. Her, \V. S., Easier, 1864. May 27 arm. 1804. Sept. 6 1864. Sept. 6, On face of stump . . . exhaustion. Died Sept. 16 1864 14 D, 10th Ohio, age 22. 1804. July 4 elbow; amp. 1864. July 30 1864. An" 5 Died Au" 13 1863 1-1 t 33d Iowa. Jones, J., Pt, A, 1863. Jiiiy 1 arm. Frac. ri"ht wrist; Alice. 5, 1803. July 17 1803. July 17, In continuity Died July 18 1863. 144 145 143d I enii., ago 28. Kane, J. F., Pt., D, 27th Georgia. 1803. Juno 1, 1864. Xov 27 amputation. Fracture hunierus, upper third; ampu- tion. 1863. Juno 13, 16, 1864. Brachial 1863. June 15, 10, 1864. Dec. 15 In continuity Died June 16, 1864. Died .Dec V 5 1863 146 M7 A, 14thX.J.,age44. Laniareaux, A... Cor poral, E, 14th X. Y., age 20. Lanoui, C. Pt. I 181)3. April 1, 1805. Sept 13 rus; amp. Fracture left radial, upper third ; radial artery severed. 1863. Apr. 9, 12, 15, 1865. Oct 10 1863. Apr. 15, 1805. Oct. 10 24, lig. sup. prof. In continuity Died April 16, 1863 ; exhaustion. Spec. 4186. Died Xov 13 1864 148 141 9th X. H., ago 23. Marshall, H., Pt., E, 1st Mich. C., age 20. MrCridcn B. Pt ,D 1864. May 28, 1804. June 16 Flesh ; right arm 1804. June 19, 1864. June 29 Radial and ulnar . . 1864. June 19, 1864. June 29, A. Surg. G. Sweet. In continuity; haem orrhage recurred. Li"ation chronic diarrhoea. June 24, 1864, amp. Died July 11, 1864 ; pyaemia. Died July 8 1804 150 151 1V> 03d X. Y., age 30. Morgan. L., Pt, D, 14th Mich, ago 22. Mullau, P., diseh d soldier, a^e 30. Xash. J. E., Pt,, B, 1864. Mar. 25, 1863. J;m. 29, 1862. July 9 rus; 23d, exc. sh. jt. Flesh ; left arm, mid dle third. Inj. humerus and thoracic parietes. 1804. April 8, 1805. Oct. 20, 186- . Ail". 2 Brachial Brachial 1864. April 8, 1865. Oct. 20, 1802. Aug. 2, Both ends in wound. Ligation On face of stump . . Died April 13, 1803; pyaemia. Oct. 21, amputated ; died Xov. 5, 1862. Died Au". 7 1864- 153 154 9th N.Y. A., age 23. A tinn, T. P., Pt., F, 12th Ga. Palmer, U., Pt., B, 1864. July 1, putation. Right elbow, cutting brachial. Left arm 1864. July 12 Brachial; July 12, 1804. July 16, In continuity On face of stump .... pneumonia. Died June 20, 1864. Died July 21 1864. 155 4th Art. 1 armenter, II. B. , Pt., 1803. Dec. 10, Left hand 16, 1864. amp. arm. 1804. Dec. , In continuity near Died Jan. 1, 1863; 100 157 A,2lBtMich.,age32. llea. J. H., Pt,7 II, 102d I enn., age 17. Reagles, L., Pt., A, 1802. May 5, 1864. Oct. 14, Leftarm, upperthird. Oct 18 Brachial 1802. May, 1864. Oct. 18, elbow. Ligatiou In continuity at ax mortification. May 17, amputated ; died Dec. 1, 1864; phth. and diar. Died Oct. 20 1864 ir.s C4th X. Y., age 20. Rees, G. W., Pt, G, 1804. April 1, at middle; ampu tated in u piper third Fracture left radius, 1864. Apr. 12 Radial . 1804. Apr. 12, illa. A. A. Surg. C. P. Bigelow. In cont. A, A. Surg. recur, of haeni. Died April 26 1S05; i,-ft 20th Pa. C., ago 22. Richardson, O. B., 1805. June 3, middle third. Fracture right ra 1805. July 1 1865. July 5, J. Morris. Both ends in cont. pneumonia. July 15, amputated; 100 1(51 Serg t, E, 32d Me., age 21. Roberts, J., Corp l, H, 24th X. Y. Cav. Satterfield, K., Pt., F, 12 tli W. Va. 1864. June 3, 1864. Apr. 2, 1804. dius. Right, arm, lower third. Left elbow joint; am putation arm. 1864. Aug. 6. 1804. Brachial 1SC4. June 28, 1864. Aug. 6, 1864. Surg. E. Russell, Farmington, Me. Ligated On face of stump. . . . died Aug. 23, 1804. Died July 8, 1864; pyaemia. Died August?, 1S64; . pyaemia. 1 LEAVITT (T. L.), Tenacity of Iluman Life as seen in Gunshot Injuries, in Medical and Surgical Reporter, Philadelphia, 1865, p. 299. WOUNDS AND COMPLICATIONS. [CHAP. xn. No. 1C2 163 164 165 166 167 168 169 170 NAME, AGE, AND MlUTAKY DESCRIPTION. DATE OK IXJUKY. NATURE OF INJURY. DATE OF H^EMOU. It HACK. PUOBAIU.E SOUKCE OF HJBMOBBHAGE. DATE OF Ol EHA- TION. OPERATION, OPEUA- TOK. EESULT. Slater, J., Corp l, K, 7tli Now York Ar tillery, ago 20. Tipton, J., Pt., C, 78th Illinois, ago 30. Urmston, J., Pt., K, 8Cth Indiana. Vander.slico, J., Pt., D, 9Ctli Ponnsylva- nia, age 49. Waite, \V., Ft., E, 53d Ohio. Walker, H. H., Pt., A, 27th New York, age 29. WaUeer, W., Pt., C, 18th Georgia. "Williamson. J., Cor poral, F, lllth Illi nois, age 26. Wolfe, F., Pt., N, 9th Now York Ar tillery, age 28. Juno 16, 1864. Sept. , 1862. Sept. 19, 1863. June 3, 18(54. May 31, 1864. Juno27, 1862. 1863. Dec. 13, 1864. Oct. 19, 1864. Fracture right radi us and ulna, mid. ; amputation. June 30, 1864. Oct. 15 Radial and ulnar . . June 30, 1864. Oct. 15, 1862. Out. 20, 1863. June 14, 1864. May 31, 1804. Alirr 3 In continuity . . Died July 8, 1864. Spec. 2700. Disch g d : died Nov. 30, 1802; lung foyer. Died Uctober21, 1863. Died July 16, 1864; pyaemia. Died May 31, 1864; efl ect of ehlorof m. Died August 3, 1862. Died December 11, 1863. January 7, amputa tion. Died Febru ary 1, 1805 ; pyaemia. Died November 14, 1864, of pyinmia. In continuity; Oct. 17, amputation. In continuity at low er third. One end in wound. A. A. Surg. D. Keu- edy. Ligatod. Surg. J. N. liarues, 116th Illi nois. Thro carpus right hand ; amputation. 1862. Juno 14, 1864. May 31, 1864. Aug. 3, 1862. Brachial Brachial Flesh; right arm, upper third; brach- ial artery cut. Flesh; middle third arm. 18(52. Ligation ; hsern. rec. December 10. In continuity. A. A. Surg. H. Leaman. Jan. 6, re-ligated. Both ends in wound. A. A. Surg. 11. L. Suyder. Right forearm, in juring ulnar artery. Flesh ; injuring bra- chial artery. Dec. 30, 1864. Oct. 29, 1864. Ulnar Jan 2, 1863. Oct. 29, 1864. Brachial Of the one hundred and seventy cases amputation of the arm had been performed in twenty-nine, and the subsequent ligations were on the face of the stump in ten and in the continuity in nineteen instances. Haemorrhages recurred after ligations in thirty-eight instances, causing fatal terminations in sixteen cases. Ligations of Branches of the Brachial Artery. These include three cases of liga tions of muscular branches (one recovery, two fatal), seven ligations of the profunda (five recoveries, two deaths), and a fatal case of ligation of the anastomotica rnagna: Ligations of Muscular Branch of BracJiial Artery. CASES 1133-1135. Private R. Eichards, G, 4th New Hampshire, aged 29; shell wound of right elbow February 21, 1865; amputation of arm on same day; haemorrhage March 27; muscular branch ligated on face of stump; discharged June 11, 1865. Private W. Fitzgerald, B, 1st U. S. Sharpshooters, age 19; shot fracture of elbow joint November 7, 1863; excision November 8, 1863; amputation of arm November 12th; haemorrhage November 24th from muscular branch; ligation on face of stump by Assistant Surgeon W. F. Norris, U. S. A.; death from pyaemia November 29, 18(53. Lieut. D. A. Walbridge, A, llth Vermont, age 31; shot fracture of right humerus June 4, 1864; amputation of arm on same day; haemorrhage June 18th; ligation of muscular branch on face of stump; haemorrhage recurred ; artery re-ligated; death June 19, 1864, from exhaustion. Lifjatiovs of Profunda Arteries. CASES 1136-1142. Private G. C. Figgens, 8th Illinois, age 25; right shoulder joint April 9, 1865 ; excision of neck of humerus same day ; haemorrhage from profunda May 9th ; ligation in wound May 9th ; no recurrence ; discharged July 22, 1865. Private E. Getchell, C, 3d Maine, age 29; shot fracture of left arm May 5, 1864; amputation of arm May 6th; haemorrhage from profunda May 9th; ligation on face of stump; discharged December 13, 1864. Private G. Johnson, I, 9th U. S. Colored Troops; shot fracture of right humerus September 29, 1864; haemorrhages October 16-20; excision of head of humerus and ligation of profunda; discharged December 9, 1865. Corporal A. C. Vantiue, B, 123d Ohio, age 23; shot wound of right elbow September 22, 1864; amputation of arm October 12th ; haemorrhage from profunda October 16th; ligation on face of stump; no recurrence; discharged February 21, 1865. Private L. G. Williams, II, 84th Illinois, age 30; llesh wound of arm September 19, 1863; haemorrhage from profunda October 8th; ligation of cardiac end in wound October 8th; no recur rence; discharged February 28, 1865. Private J. P. Wells, E, 104th New York, age 19; flesh wound of arm July 1, 1863; haemorrhage from profunda July 7th; ligation July 9th; death July 20, 1863. Private J. Woods, C, 85th Pennsylvania, age 23; fracture of left humerus September 2, 1863; amputation of arm September 9, 1803; haemorrhage from profunda September 12th; artery ligated on face of stump; death September 17, 1863, from exhaustion. Ligation of Anastomotica Magma. CASK 1143. Corporal J. Foster, K, 38th Illinois; flesh wound of arm September 19, 1863; haemorrhage from anastomotica magna September 29th; wound enlarged and artery ligated same day; gangrene October 7th; death from exhaustion October 9, 1863. Ligations of the Radial Artery. Fifty-nine cases with forty-five recoveries and four teen deaths were reported, a fatality rate of 23.7 per cent. In four cases, of which one proved successful and three fatal, the ulnar artery was also ligated. The ligation was per formed after amputation in the forearm in seven instances ; in three cases of recovery on the face of the stump; and in four cases, with two recoveries and two deaths, in the con tinuity. In four instances primary ligation was performed on the field; all recovered, CHAP, xil.] LIGATIONS OF THE RADIAL ARTERY. TABLE GXXXIV. Condensed Summary of Fifty-nine Ligations of the Radial Artery for Shot Injury. [Recoveries, 1 45; Deaths, 46 59.] 783 No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HjEMOR- KHAGB. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 !J J 23 24 25 2G 27 L. 1 " 29 30 31 32 33 34 35 36 37 Blackney, J.,Pt., G, 63d Penn., age40. Brown, P., Pt,I,7th "West Va. Cavalry. Clongh, A., Pt., C, 31st Maine, age IS. Cottrell, C.H., Pt., I, 7th X.J.,agol8. Dieffenbach, H.,Lt, I, lllth Pa., age 30. Engle.G. D.,Pt.,A, 28th Mich., age 18. Fair field, E. F., Corp l, D,74thN.Y. Fisher, R., Pt., K, 121st N. Y., age 18. Gaunt, B., Pt., A, 12thN. J., age 26. Gracev, A., Pt., E, 52d Ohio, age 40. Greenly, H., Pt,, K, 34th New York. Hakes, A., Pt., A, 32d >, . Y., ago 23. Hull, J. M., Pt., E, 20th Illinois. Hannaherry, W. A., Pt., A, 26th Penn., age 20. Harding, H.S.,Capt., A, 122d Ohio, ago42. Hart 15., Pt., D, 28th Mrs?., age 38. Hathiway, L., C p l, I, 25th Mass., age 25. Ilavden, J., Corp l, H,17thWis.,age25. Hnlse, S.,Pt.,I, 84th Penn., ago 27. Lamper, C.. Pt. F, 82d Peun.,age21. Lewis, E.H.,Pt.,E, June 16, 1864. Nov., 1864. June 3, 1864. May 12, 18(54. July 20, 1804. Mar. 10, 1865. Aug. 29, 1862. Mav 10, 1864. June 5, 1864. July 1, 1864. June 30, 1862. Sept, 17, 1862. April 6, 18G2. July 2, 1863. June 3, 1864. July 3, 1863. June 2, 1864. Aug. 22, 1864. May 15, 1804. June 1 1864. Dec. 13, 1862. May 10, 18(54. Sept. 18, 1864. May 20, 1864. July 11, 1864. June 30, 18(54. July 3, 1863. Aug. 19, 18(54 Fracture right ra dius. June 28, 1864. Radial artery. June 28, 1864. Nov., 1864. June 8, 1864. July 20, 1864. Mar. 18, 1865. June 7, 1864. June 30, 1864. July 20, 1864. July 18, 1862. Oct. 9, 1862. Right; both ends in wound. Act. Asst Surg.C. Eberhardt Left ; radial ligated. Right ; both ends in cont. Act. Asst. Surg.C. Eberhardt. Left A. Surg. H. M. Sprague,U.S.A. Right. Surg. A. K. Fifield, 29th Ohio. Left ; radial ligated . . Rad. and ulnar art. in cont. , lower third. Right ; both ends in wound. Act. Asst Surg. A. A. Smith. Right ; on face stump. Left; both ends in wound. Right; in continuity. Right; one end in wound. Right; radial ligated. Left; one end in wound. Left ; on field. Right ; in continu ity. Left ; in cont. Surg. E. Bentley, U. S. V. Left; in cont. Surg. J. G. Miller, llth Iowa. Right; in cont.; both ends. Act Asst. Surg. J. Evans. Left; both ends in wound. Act. Asst. Surg. \V. F. Atlee. Left; in continuity. . Radial ; both ends in wound. Act. Asst. Surg.W. R. Dunton Right; both ends in wound. A. A. Surg. J. M. McGrath. Left ; both ends in wound. A. A. Surg. T. Liebold. Right ; in continuity. Aug. 1, 2, haern. , palm. arch. Left; both ends in wound. Asst.Surg. E.Curtis, U.S. A. Left; in continuity.. Left; in continuity.. Left; both ends in wound. Left ; on face of stump Right; in wound; one end. One end in wound. A. A. Surg. W. P. "VVolhaupter. Right ; in cont. A. A. Surg. J. Stearns. Left, A. A. Surg. J. Grant. Left radial artery lig Right; in wound Right; both ends in wound. Discharged July 7, 1865. Mustered out Aug., 1865. Veteran Reserve C. Feb. 18, 1865. Duty Oct. 17, 1864. Discharged Nov. 3, 1864. Discharged July 20, 1865. Discharged Oct. 31, 1862. Discharged Dec. 10, 1864. Discharged Oct. 26, 1864. July 22, amp. arm. Disch d May 2, 1865. Discharged Jan. 10, 1863. Duty Feb. 13, 1863. Discharged Aug. 28, 1862. Discharged Feb. 9, 1864. Discharged Oct. 27, 1864. Discharged Feb. 28, 1864. Discharged Oct. 27, 1864. Discharged May 5, 1865. Deserted October 16, 1864. Discharged May 17, 1865. Discharged Juno 13, 1864. Duty Aug. 12, 1864. Oct. 91, amputation forearm. Disch d Aug. 21, 1865. Vet. R. Corps April 12, 1865. Aug. 2, amputation forearm. Disch d May 18, 1865. Aug. 2, amputation arm. Discharged Feb. 11, 1865. Discharged May 16, lt-64. Discharged Jan. 17, 1865. Duty Jan. 26, 1865. Discharged Sept. 9, 1865. Discharged July 2, 1865. Duty July 12, 1864. Discharged. Duty Sept 7, 1864. Discharged June 6, 1S65. Duty Nov. 1), 1862. Discharged Dec. 7, 1862. Fracture right ra dius. Fracture left radius . Fracture right ra dius ; excision. Fracture left radius ; excision. Fracture loft hand; amputation finger. Flesh wounds right forearm and arm. Fracture right fore arm ; amputation. Flesh wound left forearm. Shell wound right wrist. Fracture right ra dius. Fracture right ra dius. Fracture left ulna. . . Fracture left radius. Fracture bones right hand. Flesh wound left forearm. Fracture left hand and wrist. Flesh wound, injur ing right rad. art Fracture left ulna. . . Frac. left carpus, j t ; excis. ; amp. forearm. Flesh wound left forearm. Fracture right carp, bones. Flesh wound left forearm. Wound right wrist, rad. art severed. Flesh wound left forearm. Fracture left ulna. . . Fracture left wrist; June 8, 1864. July 20, 1864. Mar. 18, 1865. June 7, 1864. June 30, 1864. July 20, 1864. July 15, 1862. Oct. 9, 1862. Radial artery . Radial Radial :. Radial Radial.. Radial Radial artery July 19, 1863. June 3, 1864. July 4, 18(53. June 6, 1864. Sept. 9, 1864. May 26, 1864. July 27, 1864. Mar. 7, 1863. May 24, 1864. Oct. 18, 1864. Radial artery . July 19, 1863. June 3, 1864. July 4, 1863. Juno 13, 1864. Sept. 9, 1864. Mav 26, 1864. July 27, 1864. Mar. 7, 1863. Mav 24, 1864. Oct. 18, 1864. June 12, 1864. July 11, 1864. July 15, 1864. July21, 1863. Oct. 9, 1864. July 22, 1S64. Junel6, 1865. Sept 10, 18G4. Apr. 7, 1864. Nov. 20* 1863. Oct. 26, 1863. Mar. 20, 1865. Oct. 4, 1862. Get 20, 1862. Radial artery Radial artery Radial artery Radial artery . Radial artery - Radial artery Radial artery 145th Peiin., age 18. Melsaars, J., Corp l, G, 5th Mich., age 21. MeMullin, S., Serg t, A, 14tli Penn. Cav alry, age 43. Miller. I., Pt., K, 97th Penn., age 25. Kevins, H. M., Serg t E, 25th Xew York Cavalry, age 23. O Brien, M., Pt., I, l(59th N. Y., age 24. O I)onnel],E.,Pt.,C, 3d Pa. Art, ago 20. Perkins, G. W., Pt., G, 8tnMich.,age25. Ray, D., Pt., I, 5th Conn , age 22. Reielmeider, P., Pt, H, 28th IV-nii., a:ro 24. Richards, G-TV^Pt., A, Vet. Res. Corps. Rose, G. M., Pt., G, Oth Cavalry, age 22. Smith, J., Pt., K, ll Jth Pa., ago 22. Smith, S., Pt. II, 74th Ohio, ago 3(5. Swords. J. W., Serg t, H, 2lith Iowa, Tate, W. C., Pt, B, With Illinois. Tli-.ina.s. J., Pt., G, 7.")tli Illinois, age 22. Radial artery July 11, 1804. July 14, 18(54. July21, 18(53. Oct. !), 1801. July 2 2, 18(54. June 16, 1865. Sept, 10, 1804. Apr. 2, 1864. Nov. 20, 18(53. Oct. 26, 1803. Oct. 4, 1862. Oct. 20, 1862. Radial artery Radial artery Radial artery Radial artery Muse, branch ra dial artery. Radial artery . Radial artery Radial artery Radial artery Radial artery Radial artery Radial artery May 25, 180*. July 20, 1864. Sept, 3, 1804. Mar. 29, 1864. Nov. 7, 1>63. Oct. 2, 1863. Mar. 20, 18(55. Oct. 4, 1862. Oct. 8, 1862. Flesh wound left forearm. Fracture left wrist .joint; amputation; forearm re-amp. Fracture right wrist and hand ; ampu tation forearm. Fracture ulna, ra dial artery injured. Fracture right rad. at wrist. Fracture left radius. Fracture left radius; resection. Flesh wound right foro m, rad. art. sev. Flesh ; right forearm. 734 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. XATUBE OF INJURY. DATE OF ILEMOR- K11AUE. PUOliABLK SOL KCE OF HJEHORBHAGK. DATE OF OPERA TION. OPERATION, OPERA- TOB. RESULT. 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Thompson, W. M., I t., E, 1st Mary land, age 24. Van Kirk, P., Pt., A, 26th Penn., ae 21. Washington, M.,Pt., K, 8th Co lore il Troops, a ire 30. White. P. , Pt., B, 22d Mass., airo 42. Wiseius, H., Pt., I, 20th Mass., age 31. Woodruff, J., Pt., A, 27th Mich., age 33. Wright W. C June 3, 1864. Julv 2, 1863. Aug. 16, 1804. Julv 2, 1863. Feb. 26, 1863. Juno 18, 1864. Julv 20 Flesh ; left forearm, inj. rad. art. Fracture left ulna . . Fracture left wrist.. Flesh wound left hand. Fracture left carpus; exeis. Fracture lingers left hand; amputation. Flesh wound riuht June 11, 1864. July 22, 1863. Sept. 9, 1864. Julv 10, 1863. Mar. 9, 1863. Julv 3, 1864. Radial June 12, 1864. Julv 22, 1863. Sept. 9, 1864. July 10, 1863. Mar. 12, 1863. Julv 3, 1864. Auir. 5, 1864. June 28, 1864. Jan. 10, 1865. Left; both ends in wound. Surg. E. Bentley, U. S: V. Left; one end in wound. Rad. tied in wound Left ; in continuity . . Left ; in continuity . . Left; on face stump Right ; iu wound. A. A. Surg. S. W. Blackwood. Left; one end in wound. Right : rad. and uln. arteries tied, one end in wound. A. A. Surg. J. Sloan. Left; both ends in wound. Left; rad. art. and muse. branch. A. A. Snrg. A. A. Smith. Left; one end in wound. Left ; in continuity . Left ; in continuity . . Left; 0110 end in wound. Left; both ends in wound. Left ; both ends in wound. Surg.N.R. Moseley, U. S. V. Left; in continuity.. One end tied in wound. Right ; radial ligated Left; radial and ul nar arteries in con tinuity. Right; radial and ul- iiar arteries ligated. Duty Sept. 19, 1864. Duty May 3, 1864. Discharged May 26, 1865. Recovered. Killed June 3, 1804. Discharged Dec. 29, 1863. Transferred Julv 2^, 1804. Duty July 13, 1865. Furloughed Aug. 19, 1864. Died Jan. 27, 1865; jaundice, etc. Died April 12, 1865, of asthma. Died Sept, 3, 1864; pharyngitis. Died Oct. 26, 1864. Died June 8, 1804. Feb. 21, amp. fore arm. Died Aprils, 1865; pyasmia. Julv 24, amp. arm. Died (Jet. 11,1861; diarrhcoa. July 29, amp. fore arm. Died August 19, 1863; pyasmia. Specs. 2615 , 2610, 2773, A. M. M. July 0, amp. forearm. Died Sept. 7, 1864; pyaemia. Spec. 2810. A*. M. M. Xov. 6, amp. arm. Died Xov. 15, 1864 ; exhaustion. July 29, am]), fore arm. Died July 31, 1863. Died July 21, 1863. Died Dec. 3, 1862; pviemia. Spec. 217, A". M. M. Oct. 26, amp. fore arm. Died Oct. 29, 1863; pyaemia. Radial artery Radial artery Dorsal artery Recurred March 10, 11, 12. Radial Radial Corp l, F, 107th X. York, age 21. Wrightman.G.,Sgt,, L, 6th Mich. Cav., age 23. Beach, H. M., Serg t, 0, 51 h Minn., age 31. Daniels, L., Pt., B, 09th X. Y., age 26. Fiantz, P., Corp l, H., 148th Peim, age 21. Grundv. J.X.,Corp., F, 98th X. York, age 21. Humphrey, J. M., I t., B, 183d Pcnu., age 32. Jackson, T., Pt,, B, 95th X. Y., age 19. Knock, A., Serg t, B, 84th 111., age 26. Kuhn, .T. G., Pt.. G, 75th Pa., ago 42. McCready, J. S., Captain, H, 126th Ohio, age 35. Morrick. T., Sorg t, F, 10M 111., age 35. Palmer, A., Pt., K, 73d Ohio, age 40. Pohlman, W. 11., Ad jutant, 59th X. Y. Strickland, M. L ., , 1864. May 28, 1864. Dec. 16, 1864. * Mar. 25, 1865. Mav 10, 1864. Sept, 29, 1864. Mav 18, 1864. Feb. 7, 1865. June 27, 1864. July U, 1863. Mav 10, 1864. Oct. 20, 1864. Julv 3, 1863. Julv 3, 1863. Sept. 14, 1802. Sept 19, 1863. forearm, rupturing radial artery. Flesh wounds left hand and thigh. Flesh wound right arm, inj. rad. and uln. arteries. Flesh wound left forearm and chest. Fracture left fore arm. Flesh wound left arm. Wound left hand; amp. fingers. Fracture left radius ; wounds both hands. Flesh wound left forearm. Fracture left hand ; amp. fiiig. Fracture left ulna; exc. ulna May 20. Fracture left radius ; wound left hip. Flesh wound forearm Wounds r t foreaain and left shoulder. Fracture left radius ; amp. forearm. Fracture met. bone right thumb; amp. June 27, 28, 64. Jan. 10, 1865. Radial artery .... Radial and ulnar arteries. Radial artery Radial artery Radial and inter, arteries. Radial artery May 30, 1864. Oct. 16, 1864. Mav 23, 1864. Feb. 21, 1865. Julv 22, 1864. July 24, 1863. May 20, 1864. Xov. 6, 1864. Julv 29, 1863. July , 1863. Oct. 20, 1802. Oct. 3, 1863. Oct. 9, 13, C4. May 23, 1864. Feb. 21, 1865. Julv 22, 1864. July 24, 1863. Mav 19, 1864. Xov. 6, 1864. Julv 29, 1863. Radial artery Radial artery Radial artery.. .. Radial artery Radial Oct. 20, 1862. Oct. 3. 1863. Radial and uluar arteries. G, 50th Ga., age 22. Washburn, J., Pt., H, 38th Ind. Ligations of the Ulnar Artery. There were twenty-two cases of ligation of this artery with two deaths, the fatal issue being ascribed to haemorrhage in one instance and to exhaustion following haemorrhage in the other. In a case of aneurism of the ulnar artery both ends of the vessel were ligated in the wound ; the bleeding did not recur, and the patient recovered without further untoward accident. TABLE CXXXV. Condensed Summary of Twenty-two Ligations of the Uhnr Artery for Shot Tnjiii icx. [Recoveries, 120: Deaths, 21 ->:. .] S T O. NAME, AGE, AND MILITARY DESCRIPTION. DATE * OF : NATURE OF IXJUIIY. INJURY. DATE OF ILKMOU- PROBABLE SOUHCK OF rLEMOUBHAGE. DATE OF OPERA- OPERATION, OPEKA TOR. RESULT. 1 Black, J. A., Capt, 1 Mav 23, Fracture left ulna; M;iv , Mav 28, Discharged Julv 1 B. 50th Pa., age 36. 1864. i excision. 1804. 1804. 1805. 2 Booth. G. W., I t,. F, AU-. 21, Flesh wound; left Sept, 6, Aneurism of ulnar Sept. 7, Left; both ends in Discharged Feb. 25, 1st Mich., age 26. 1804. ! foreami. 7, 64. artery. 1804. wound. A. Surg. 1805. II.Allen.U.S. A. CHAP. XII.) LIGATIONS OF ARTERIES OF THE HAND. 785 No. NAME, A(JK, AND MlLITAKT DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF H-KMOR- RHAGE. PROHAUI.E SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 3 4 Bruso. T., Ft, A, 121st N. Y., age 21. Cirter J Pt D Apr. 6, 1865. May 16 Fracture left radius. May 14, 1865. Ulnar artery May 14, 1805. June 2 Left; both ends in wound. Discharged Aug. 1, 1865. 5 6 llth Conn , age 22. Copley, J. G., Capt., E, 86th N. Y. Ci anshaw S PI ~B 1804. .May 6, 1864. May 31, forearm. Fract. left forearm: excision. Fracture left radius 1864. May 22, 1864. Ulnar artery 1864. May 22, 1?64. A. Smg.O.W.Peck. Left ; in wound 1864. May 23, amp. arm. Disch. Sept. 19,1864. 7 70thN. Y.,age,45 Eiger J H Pt F 1864. May 6 and ulna ; excision. Fracture left baud. May 21, 1864. May 21 same day. 1864. 8 9 28th Mass., ago 20. Fallen, P., Pt., I, 146th N. Y., age 22. Foid M Pt. G 51st 1864. Dec. 13, 1862. Sept. 17, Wound of wrist joint . Fracture of ulna .... 1864. Dec. 24, 1862. Oct. 2, Ulnar artery Ulnar artery 1864. Dec 24, 1862. Oct. 3, cision. Left; in continuity. . Disch. Apr. 16. 1865. Spec. 2477, A.M.M. Discharged Apr. 23, 1863 Discharged Feb. 2 10 N.Y..aM28. Fox W. H., Pt F 1862. Aug. 20, Fracture of left ulna - 1862. 1862. wound. Ligation of ulnar 1863. Discharged Mar. 22, 11 161 h Wis.,as:ol8. 1864. Sept 19 Sept. 19 Ulnar Sept 19 1865. 12 H, 58th V a., age 36. Harbison G Pt L 1864. Sept 29 arm, ulnar severed. 1864. Nov. 1 1864. C.W.Todd,13thv7i. 1864. Duty Dec 22 1864 13 14 15 2dPa. H. A., age 32. Harrison, "W. II.. Pt., M, 1st U. S. Art, age 22. Howell,S. TF.,Pt.,E, 6th N. C., age 20. Kripps J B Pt E 1864. Feb. 20, 1864. July 3, 1863. Sept. 29 arm. Fracture of left ulna Fracture of ulna . . . Fracture of ulna 1864. Mar. 1, 1864. July 13, 1863. Oct. 8 Distal end of ulnar . Ulnar artery 3, 64. Mar. 1, 1864. July 13, 1863. Oct. 8 cont. A. Surg. W. S G.Elliott,U.S.V. Both ends in wound. Sure. C. L. Allen, U. S. A. Left ; nlnar ligated . . Duty July 12, 1864. Recovery. Returned to duty 16 17 18 2<1 Pa, Art., age 40. McColliff, J., Pt., B, 2d 111. Cav., age 28. Price, L. II., Pt., G, 86th N. Y. Shaw G. W , Pt. H 1864. Aug. 11, 1864. Aug. 30, 1862. May 20 Fracture of radius. . . Fracture of ulna Wound of left arm 1S64. Aug. 24, 1864. Sept. 15, 1862. June 12, Ulnar artery; 40 oz Ulnar artery; 18oz. 1864. Aug. 24, 1864. Sept. 15, 1862. June 12, wonnd. One end in w d. Surg. D.C. Jones, 2dIll.U. In continuity Ligation. Act. Asst. Mar. 31, 18G5. Returned to duty Nov. 25, 1864. Discharged Dec. 29, 1862. Discharged Nov. 12, 19 20 21 85th Pa., age 42. Waitenbee, W. D., Pt., 100th O., ago 23. Wood, D. E., Pt.,K, 64th N. Y., age 33. Bell, G. L., Ser"" t, E 1864. Feb. 20, 1865. July 3, 1863. Dec. 15, gangrene. Flesh wound right forearm. Fract. of right ulna. . Flesh wound ri^ht 1864. Mar. 26, 1865. July 24, 1803. Dec. 27, Ulnarartery ; 20 oz . Ulnar artery ; 8 oz . 16 oz 1864. Mar. 26, 1865. July 24, 1863. Dec. 27, Snrg. W.C. Fryer. Both ends in wound. A.A.Stirg.G.Byers. Both ends in wound . In continuity; also 1864. Discharged July 5, 1865. July 29, exc. Disch. Dec. 31, 1863. Died March 11, 1863. f> 10th Conn., age 34. Clapper, J. D., Pt. 1862. July 12, forearm. Left forearm 1862. Aug. 8, Ulnar artery ; 6 oz. 1862. Aug. 8, amp. arm. Both ends in wound Died Sept. 14, 1864. G,43dN. Y., age 22. 1864. 1864. A. A. Surg. W. F. Atlee. 1864. Of the branches of the ulnar artery the interosseous was ligated in nine instances, of which three, or 33.3 per cent., proved fatal: Ligations of the Interosseous Artery of Forearm. CASES 1144-1152. Private J. J. Boden, B, 45th Pennsylrania; shot fracture of lower extremity of radius September 14, 1862; October 17th, excision of pieces of radius; haemorrhage; ligation of anterior interosseous in wound by Assistant Surgeon E. W. Brennermann, U. S. A.; discharged, April 18, 1863. Private I. B. Flint, K, 1st Massachusetts Artillery, age 21; shot fracture right radius May 18, 1864; removal of ball and section of radius on May 28; haemorrhages May 28, 30, June 1st; ligation of interosseous, June 1, in the wound; no recurrence ; duty February 16, 1865. Private T. Hart, C, 145th Pennsylvania, age 25 ; shot wound of third finger of left hand June, 1864 ; amputation of finger; gangrene; interosseous tied to prevent haemorrhage; duty March 14, 1865. Private S. W. Howell, E, 6th North Carolina, age 20 ; minie" ball entered posterior part of left forearm two and a half inches from wrist joint, fractured the ulna and passed through, July 2, 1863; haemorrhage July 13, 1863; ligation by A. A. Surgeon J. H. Bartholf; no recurrence of haemorrhage ; transferred August 10, 1863. Private D. McKemu liy, G, 10th Kentucky; shot fracture metacarpal bones of right hand September 19, 1863; September 28th, amputation, three fingers ; October 29th, amputation forearm; November 4th, haemor rhage from interosseous; ligated on face of stump; transferred to V. R. Corps August 20, 1864. Corporal I. Martz, B, 184th Pennsylvania, age 39; shot fracture of middle finger of right hand June 3, 1864; amputation of finger June 3; gangrene; flap amputation of forearm at lower third; whole stump became diseased June 30, 1864; haemorrhage from interosseous in July ; ligation of artery on face of stump; circular amputation of arm at lower third April 9, 1865; discharged July 26, 1865. Private J. Archibald, 33d New York, age 50; comminuted fracture of lower extremity of left radius and carpal bones December 13, 1862; amputation of forearm at upper third January 8, 1863; haemorrhage from interosseous January 10th; artery ligated on face of stump same day; haemorrhage recurred January 13, artery re-ligated; death from pyaemia January 29, 1833. Private J. Bowman, K, 20th Indiana, age 25; shot fracture of forearm; haemorrhages July 16th, August 4th; ligation ; September 5th, amputtition of arm; death of diphtheria and gangrene September 6, 1863. Private J. A. Forsyth, G, 9th Maine, age 21; flesh wound of left wrist June 30, 1864; July 19th, haemorrhage from branch of interosseous; July 20th, ligation of both ends in wound by Assistant Surgeon E. Curtis, U. S. A.; August 13th, haemorrhage recurred; death ensued on August 13, 1864, from secondary haemorrhage. Ligations of Arteries of the Hand. Of twelve cases, four were ligations of the palmar arch, two of the dorsalis and radiaUs indicis, one of the dorsalis carpi, one of the arcus volaris profundi, and four of the digital arteries. One only terminated in death, from pyasmic irritation of the system. SURG. Ill 99 786 WOUNDS AND COMPLICATIONS. [CHAP XII. TABLE OXXXVI. Condensed Summary of Twelve Cases of legations of Arteries of the Hand. [Recoveries, 111 ; Death, 12.] No. NAME. AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HJEMOU RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. l A chuff, H. N., Pt., May 3, Fracture 3d finger June 4, Deep palmar arch . June 4, Branch deep palmar Recovered. K, 27th Pa., age 20 1863. right hand. 1863. 1863. arch ligated. 2 Gantt, Z.,Tt.,G, 27th June 15, Wound right hand. . July 20, Digital artery July 20, One end 3d digital Recovered. S. C., age 30. 1864. 1864. 1864. in wound. A. Surg. E. Curtis, U. S. A. 3 Gripping, I. G..Pt., July 3, Fracture 2d met. July 30, Superficial palmar July 30, Branch superfi. pal- Discharged January Oneida N. T. Cav., 1863. boue right hand. 1863. arch. 1863. mararch in wound. 4, 1804. age 45. 4 Holdridge, H., Pt., May 12, TVound both hands; May 21, May 21, Both ends arch vol. Discharged Septem A, 6th O. Cav age 1864. fracture fingers. 1864. 1864. prof, tied in wd. A. ber 9, 1864. 28. A .Surg. T.Liebold. 5 Loland, J.,Pt..4thN. June 16, Fracture right met July 17, Dorsalis indicis ar July 19, Dorsalis carpi, both Discharged June 16, Y. Art,, age 17. 1864. acarpus. 1804. tery ligated. 1864. ends in wound. 1865. 6 McNaraara, P., Pt., June 16, Fracture met .a c a r- July 1, Digital artery July 1, One end dig. art. tied Aug. 11, amp. fore A, 2d N. Y. Art,, 1864. pus bone left little 1864. 1864. in wound. Haetn. arm. Disch. Mar. 27, ago 30. finger; amputation. rec. July 6, 8, Aug. 5. 1865. Spec. 2450, A. M. M. 7 Mullin, D., Pt., K, May 8, Fract. 1st 3 met. bones May 29, May 29, Right dorsal indices Duty September 3, 16th Mass , age 24. 1804. right hand ; amp. 1864. 1864. on face stump. 1864. 8 Roberts, R. D., Pt. Mar. !), Flesh wound right Mar. 22, Superficial palmar Mar. 27, Right; snperfi. pal Discharged January F, 72d 111., ago 49. 1864. forearm and hand. 164. arch. 1861. mar arch tied. 26, 1865. 9 Sylvester. H., Pt., May 4, Fract. 2d phal. right May 17, May 18, Right radialis indi Trans. Provo Mar G,91stN.Y..ag( 23. 1803. iud. finger ; amp. 1863. 1863. cis on face stump. shal May 27,1863. 10 Tucker, N. J., Pt., Sept. 2, Fracture fingers left Sept, 25, Superficial palmar Sept, 25, Left; superfi. palmar Duty December 7, E, 17th Ky., age 23. Ifc64. hand; amputation. 1861. arch. 1861. arch, both ends in 1864. wound. 11 Turner, J. W., Pt., May 12, Flesh wound right May 21, Digital artery May 22, Both ends dig. art. Veteran Reserve A, 126th Ohio, age 1864. hand. 1864. 1864. t d in wound. Surg. Corps January 17, 24. N. R. Moseley, U. 1865. S.V. 12 Moynehan, W., Pt., July 9, Fracture bone left July 18, Digital artery July 18, Digital artery tied Amp. fing. Au. 1 hae. F, 122dOhio,age40. 1864. hand. 1864. 1864. in wound. Died Aug. 15, 1864. Ligations of the Common Iliac Artery. Four cases of ligations of the common iliac artery following shot injuries, and one following a bayonet stab, were reported during the war. 1 TABLE OXXXVII. Summary of Five unsuccessful Cases of Ligation of the Common Iliac Artery. No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF H^MOR- RHAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 Boner, J., Pt.,I, 48th May 31, Flesh wound of both June 10, From small ves June 22, Ligation of common Death June 22, 1804. Pennsylvania, age 1864. thighs. 15, 1864. sels; ligation of 1864. iliac. Seep.3i ,an<e, CASE 19. femoral June 15; 82. haemorrhage Jun. 22. 2 Hardy, John, Pt, H, 95th N. Y., age 25. Aug. 20, 1864. Shot wound of left gluteal region; ball lodged against right Sept, 5, 1864. Gluteal artery; haemorrhages re curred Sept. 6, 8, Sept. 12, 1864. Ligation of common iliac by Asst. Surg. J. Cooper McKee, Death Sept, 14, 1864. See Sec. Surf]. Vol., p. 334, CASE 976. wall of pelvis. 11 ; Sept. 12, liga U. S. A. tion of internal iliac. 3 Preston, J. E., Cor May 4, Shot injury of ant. May 5 May 14 Dr. F. H. Hamilton. Death M y 14, 64. See poral, G, 119th Penn. 1864. sup. spin, processof 1864. 1864. p. 39, ante, NOTE 1. left ilium. 4 Scott, J. R., Col., 19th Illinois. Dec. 31, 1862. Shot wound of groin, ball grazing inside Apr. 9, 10, 1863. Arrested by com press over femo Apr. 10, 1863. Ligation of common iliac by Dr. Brain- Death July 8, 1863. See CASE 975, Sec. of femur. ral; haemorrhage ard. Surg. Vol., p. 333. recurred ; liga tion of external iliac April 10; bleeding contin ued. 5 Tapka, A., Pt., H, 35th Wisconsin, age Mar. 18, 1864. Bayonet stab in glu teal region. Oct. 2, 1864. Diffuse aneurism. . Oct. 7, 1864. Ligation of common iliac by A. A. Surg. Death Oct. 11, 1864. See CASE 977, p. 3:io 25. R. N. Isham. of the Sec. Surg. Vol. In one of the five cases the external and in another the internal iliac artery had been ligated without arresting the bleeding. Ligations of the Internal Iliac Artery. Three cases were reported ; all terminated fatally, from recurring haemorrhage. 1 A sixth case of ligation of the common iliac (case of Private G. W. Clark, I, 4th New Jersey) for aneurismal varix has been referred to in the preceding chapter, iu the foot-note on page 681, and has been detailed on page 336 of the Second Surgical Volume. CHAP. XII.] LIGATIONS OF THE INTERNAL ILTAC ARTERY. 787 TABLE OXXXVITT. Condensed Summary of Three Ligatiom of the Internal Iliac Artery. No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATUKE OF INJURY. OF HJEMOU- HHAGE. PROBAIILE SOURCE OF HJSMORBHAGE. I_) ATK OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 Fonda, E. R.,Serg> Mav 7, Shot through right June 12, Sciatic artery June 17, Int. iliac above, I ou- Died July 2?. 1W4. Major, 115th N.Y., 1804. gluteal region. ]5, 17, 18154. pai t s lig t. Surg. Sec. Surg. Vol.. p. age 28. 1864. A. 15. Mott, U. S.V. 332, CASK <J7:t. 2 Hardy, John, Pt., H, Aug. 20, Shot wound of left Sept. 5, Gluteal artery . . . Sept. 12, Lig. of internal iliac. Sept. 12, ligaiion of 95th N. Y., age 25. 1864. gluteal region; ball 6, 8. 11, 1864. Surg. J.Coo per Mc- com n iliac. Death lodged against right 12, .864. Kee, U. S. A. Sept. 14, 1X04. See. wall of pelvis. Surrf. Vol., p. 3i!4, CAbE 970. 3 P , Thomas, Pt., July 10, Shot penetration of July 26, Gluteal artery .... July 26, Ligation of internal Aug. 1, sudden ha?m- 16th Tenn. Cav. 1864. left buttock. 1864. 1864. iliac. Dr. S. N. Den- orrhagi; follow d by ham. death in a few rain utea. Sec. Surg. Vol., p. 33. , CASE 972. Eight cases of ligations of branches of the internal iliac comprised six ligations of the gluteal and two of the sciatic arteries ; four of the former and one of the latter were fatal. Ligations of the Gluteal Artery. In four of the six cases the bleeding was the result of the shot injuries. In two instances the gluteal was accidently cut in one while search ing for the missile, in another while excising the head of the femur. TABLE OXXXIX. Summary of Six Ligations of the Gluteal Artery. [Recoveries, 12; Deaths, 36.] No. NAME. AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF ILEMOR- KHAGE. PROBABLE SOURCE OF HJEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 Warner, A. J., Col., Sept, 17, Shot perforation of Feb 6, Gluteal cut while Feb. 6, Lig. cardiac end in Discharged and pen 10th Penn. Res. 1802. right ilium. 1863. searching for ball. 1863. wound. Surg. J. H. sioned. Sec. Surg. Brinton, U. S. V. Vol., pp. 232, 329, CASE 678. 2 West, R., Pt.. B, Au. 7, Flesh wound of right Sept. 19, Gluteal artery Sept, 19, Cardiac end ligated Discharged Feb. 7, 104th 111., age 31. 1864. buttock. 1864. 1864. in wound. 1865. Sec. Surg. Vol., p. 329, CASE 961. 3 Davidson, Ti.C., Pt., April 2, Shot wound of right Apr. 13, Gluteal artery Apr. 16, In continuity. Surg. Death April 19, 1865. K, 6th Md., ago 16. 1865. hip, fract. of ilium. 15, 16, 1865. E. Bentley, U. S. Sec. Surg. Vol., p. 1865. Vols. 330, CASE 964. 4 Johnson, O. M. W., Feb. 15, Shot wound of left Mar. 12 Gluteal artery ; 25 Mar. 12, Ligated Death March 24, 1862. Pt., I, 32d Tenn., 1862. hip. 1862. ounces. 1862. Sec. Surg. Vol., p. ago 20. 329, CASE 962. 5 Melcar, I., Pt., 8th Nov. 16, Shot fracture of head Nov. 16, Gluteal cut while Nov. 16, Cardiac end ligated. Died Dec. 2, 1863. Michigan, age 18. 1863. and neck of femur. 1863. excising head of 1863. Surg. J. S. D. Cul- See CASE 232, p. 97, femur len, P. A. C. S. ante. 6 Morrison, J., Serg t, May 15, Shot wound of both June 17, Gluteal artery; Juno 17, Ligation of gluteal. Death from pyaemia A, 102d 111., age 27. 1864. buttocks. 1864. left. 1864. Ass t Surgeon B. E. July 3, 64. Sec. Surg. Fryer, U. S. A. Vol. p. 329, CASE 963. Ligations of /Sciatic Artery. The two cases of ligations of the sciatic artery proved fatal, one on the first the other on the third day after the operation. CASES 1153-1154. W. E. Carrington, H, 2d South Carolina, wounded at Cedar Creek October 19, 1864; comminution of transverse portion of sacrum; admitted on the next day into Prisoner s Hospital at Winchester; haemorrhage from sciatic artery occurred on November 3d; artery ligated and missile extracted by Dr. Duval (Confederate); death November 4, 1864. Private H. C. Leslie, M, 7th New York Artillery, aged 18 years, received a shot wound of nates, injuring the sciatic artery, by a mini6 ball, at Cold Harbor, June 3, 1864. The patient was removed to a field hospital of the Second Corps, and on June 8th was sent to Washington and admitted into Columbia Hospital; haemorrhage to the extent of twenty-five ounces from the sciatic artery occurred on June 16th ; ligation of the artery on the same day ; death from gangrene June 19, 1864. Ligations of the External Iliac Artery. Of twenty-six cases of ligation of the external iliac artery twenty-three had fatal terminations, a mortality rate of 88.4 per cent. Six were ligations after amputations one on the face of the stump, five in the continuity (four after amputations in the thigh and two after amputations at the hip) ; haemorrhage recurred in six cases, and in one instance the common iliac was afterwards ligated. 788 WOUNDS AND COMPLICATIONS. TABLE CXL. Summary of Twenty-six legations of the External Iliac Artery. [Recoveries, 13; Deaths, 426.] [CHAP. XII. No. 1 2 3 4 5 G 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 NAME, AGE, ANL) MILITARY DESCRIPTION. DATE OF INJURY. NATURK OF INJURY. DATE OF ILEMOR- KHAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. Locke, H.,Pt,n,Gth Vermont, age 23. Smith, E. E , Pt., A, llth Maine, age 19. Zeiders,J.K.,Serg t, I. 53dPeim.,agel9. iBrown, B. B., Pt., C,9th Va. Cav.,age 2 Corn well, R. B.,Pt, 25t h Ohio, age 2:i. Dsgolia, J. S.,Pt.,A, 76th Penn., age 32. Dougherty, M., Pt., E, 49th Pa,, age 35. 3Gatewood,J.H.,Vt., F, 21st Ga., age 32. Gentle, G. "W., Pt., E, 5th Ohio. Hambrecht, C., Pt., E, 4th New Jers 1 v. Hearv, P., Pt., E, 73d Ohio, age 25. Husk, G. W., Pt,, F, 1st Maryland Cav- alrv, age 49. *Langford,J.lt.,Pt., F, 10th Ga., age 19. McQuilbn.J.A., Lt., I, 38th Ohio, ago 25. Mm shall. W. L.,Pt,, E, llth Pa., age 20. O Neil, M, Pt., E, 58th Mfiss.. age W. Ridge, J., Lieut., B, 13th Iowa. 5 Scott, J. R., Col., 19th Illinois. Seaburn, A., Pt,, G, 97th Peuns\ Ivania. Sears, L. C., Sergt. maj.,5thN.H.,age22. Shields, P. J., Pt,, D, GlhWis., age 20. Smith, H. F., Corp., 1st \Vis., age 25. 6 Spaulding, J. R., Pt., F, 112th New- York, age 23. Teel. M.,Pt., C, 73d Indiana. Vogel, F., Pt., G, 74th Penn., age 28. Tockev, P., Pt., D, 29th Ohio, age 29. Mav 5, 1864. Ang.16, 1864. July 3, 1863. June 24, 1864. Sept. 14, 1862. May 16, 1864. Sept. 19, 1804. Aug. 28, 1862. Sept. 17, 1862. Sept, 14, 1862. Mar. 11, 1862. Aug. 16, 1864. Sept.. 17, 1862. Aug. 17, 1804. June 27, 1862 June :!, 1804. July 21, 1864. Dec. 31, 1862. July 30, 1864. Dec. 13, 1802. Apr. 29, 1863. Mar. 24, 1802. Jan. 15, 1865. Dec. 31, 1802. Julv 3, 1863. July 22, 1864. Flesh -wound right thigh. Fract. head rt. tib.; amp. thigh. Flesh wd. rt. thigh ; Aug. 4, fern. art. lig.; Aug. 11, religated. Fract. ramus pubis.. "Wound right thigh, inj. femoral art. Flesh wounds right hip and left t high Fracture left knee ; amputation thigh. Flesh wounds left hip and right thigh . Fracture right fe mur. Fract, os pubis and neck femur. "Wound in iliac re gion. Flesh wound right thigh. "Wound in rt. groin, injuring fern. art. Flesh wound right thigh. Flesh, right thigh, inj. fern. art. Fract. right femur; amp. at hip joint. Wound in left iliac region. Wound in thigh, inj. fern, artery. Fract. left femur; amp. thigh. Flesh wound right thigh; profundainj. Fract. left knee jt.; amp. thigh. Fracture left femur. . Flesh wound left thigh. Fract. ri< r ht thigh May 32, 1864. Oct. 17, 1864. Oct. 8, 1863. July 14, 1864. Sept, 21, 1862. Mav 24, lt-64. Nov. 4, 1864. Femoral art. liga- ted ; lia in. rec. Femoral lig. Jan. 19, 1865; amp. at hip joint ; hasm. Mav 16, 1864. Jan. 27, 1865. Oct. 8, 1863. July 18, 1864. Oct. 30, 1862. May 29, 1864. Mar. 26, 1805. Jan. 31, 1864. Oct. 27, 1862. Oct. 18, 1862. Mar. 27, 1862. Nov. 10, 1864. Nov. 6, 1862. Sept. 26, 1804. Sept, 5. 1862. Aug. 20, 1864. Aug. 30, 1864. April 10, 1863. Sept, 25, 1864. Jan. 8, 1863. June 9, 1864. Mar. 30, 1862. April 2, 1865. Jan , 1863. Sept, 19, 1863. Right; in continuity. Ext. iliac tied. A. A. Surg. J. C. Morton. Right ; in continuity. Leftjincont. Ass t Surg. J. C. Baylor, C. S A. Right; in continuity. Left;incont. Surg. J. H.Thompson, U. S.V. Left; in continuity; haern. recurred. Right; in continui ty. Surg. J. Cham- bliss, P. A. C. S. Right ext. iliac tied. . Ext. iliac and fern, arts. tied. Ext. iliac tied in continuity. Right; in cont. A. A. Surg. J. C. Mor ton. Right; in continuity. Right ; in continuity. Right ; in continuity. Right ; in continuity. Left; in continuity . . Ext. iliac tied. Dr. D. Brainard. Lft ; in cont. Surg. E. Bentley, U. S. V. Right ; in cont. Surg. T. Antisell, TJ. S. V. Left; in continuity.. Left ; in cont. Surg. A. H. Thurston, U. S.V. Left; in cont. Ass t Snrg. S. H. Orton, U. S. A. Right ; in continuity. Right; iu cont. A. A. Surg. A. Hew- son. Right ; in cont.; fern, art. prev. tied. V.R.C. Decembers, 1864. Discharged May 27, 1865. Spec. 3709, A. M, M. Discharged May 14, 1864. Died Aug. 22,1864; exhaustion. Died Nov. 3, 1862. Died June 1, 1864; gangrene. Died April 8, 1865. Died Feh. 17, 1864. DiedOot.28, 62. Sp 758, 894, A.M. M. Died Oct. 18, 1862. Died April 26, 1862 ; pyaemia. Died Nov. 17, 1864; haemorrhage. Died Mar. 15, 1863. Spec. 3986. Died Oct. 2, 1864. Died Sept, 16, 1862. Died Sept, 2, 1864. Spec. 3098. Died Oct. 4, 1864 ; pyaemia. Common iliac tied. Died July 8, 1863 ; diarrhoea. Died Oct. 9, 1864. Spec. 3282. Died Jan 11, 1863. Died June 19, 1864. Spec. 1143. Died Mar. 30, 1862. Died June 15, 1865. Died Jan. 19, 1863. Died Oct. 4, 1863 ; haemorrhage. Died April 23, 1805 ; diarrhoea. Femoral aneurism r Aneurism ; femo ral artery ligated. Fern oral artery tied. Femoral artery ligated 3 times. Femoral aneurism . Oct 2, 3, 1862. Oct. 18, 1862. Mar. 27, 1862. Nov. 10, 1864. Nov. 6, 1862. Sept. 20, 1804. Aug. 23, 1862. Aug. 20, 1864. Aug. 26. 29, 64. April 5, 9, 1863. Sept, 22, 1864. Dec. 22, 1862. June 1, 1863. Mar. 30, 1862. Mar. 23, 31, 1865. Femoral artery .... Femoral aneurism. Femoral art. tied September 20. False aneurism ; femoral tied. Femoral artery Epigastric artery.. Profunda artery. . . femoral artery tied. Stump ; fern. art. tied and relig. Femoral arttry . . . . Fract. rt. fib.; hm.; amp. leg. Fract. right femur ; amp. thigh; reamp. Sept. 8, 1863. Stump ; fern. art. tied Sept. 8. Ligation of the Spermatic Artery. The only instance of ligation of this artery has been detailed on page 337 of the Second Surgical Volume: CASE 1155. Color-Sergeant E. W. Crippen, C, 27th Illinois, aged 29, was wounded at Missionary Ridge November 25, 1863; the left testicle was shot away, leaving a ragged wound of the scrotum, also wound of ankle. On November 28 the spermatic artery was ligated and the debris of the testicle removed. Hemorrhage, which ceased spontaneously, occurred on December 14; on December 19 haemorrhage from wound of ankle, arrested by persulphate of iron; death on the same day. Ligatwns of the Femoral Artery. Three hundred and seventy-four cases, including ninety-three recoveries and two hundred and eighty-one deaths, are comprised in this group, giving a mortality rate of 75.1 per cent. In one hundred and seventy-nine cases amputation BROWNF, (P. F.), Ligation of the External Iliac for Traumatic Aneurism of the Femoral Artery, in Confed. States Med. and Surg. Jour., 1804, Vol. I, p. 163. "HEARD (L.), Wound of the Femoral Artery, in Am. Med. Times, 1862, Vol. V, p. 337. 3 CHAMi3Liss (J.), Case of Traumatic Femoral Aneurism, etc., in Confederate States Med. and Surg. Jour., 1864, Vol. I, p. 97. 4 Noi4TH (A.), Report of Sixty Cases of Hospital Gangrene, in American Medical Times, 1863, Vol. VI, p. 256. s Bl{AlNARt) (D.), Ligature of the Common Iliac Artery, in Chicago MedicalJournal, 1864, Vol. XXI, p. 97. "LinELL (J. A.), Gunshot wound of thigh; Secondary Harmorrhage , Ligation of External Iliac Artery, in United States Sanitary Commis sion Memoirs, Surgical Vol. I, p. 231. CHAP. XII.] LIGATIONS OF THE FEMORAL ARTERY. 789 in the thigh had been performed prior to the ligation; in eighty-two of these cases the vessel was ligated on the face, and in ninety-seven in the continuity of the stump. In nineteen cases, with five recoveries and fourteen deaths, the ligations were followed by amputation. TABLE GXLI. Summary of Three hundred and Seventy-four Liyalions of the Femoral Artery. [Recoveries, 1 H3; Deaths, 94374.] No. NAME, AUK, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HJEMOR- RHAGK. PKOHAUI.E SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 Askey, J., Pt., F, Mar 25, Fract. r t knee joint; Apr. 11, Femoral artery. . .. Apr. 11, Right; in continuity. Disch d July 28, 1865. 200th Peun.,age 18. 1865. March 28, amputa 1865. 1865. Act. Assist. Surg. j. Specimen 3997, A. tion thigh. Tyson. M.M. j Alcbison, J. N.,Pt, Aug. 27 Fract. left femur; Sept. 3, Femoral artery Right; in continuity. Discharged June 3, F, 2d N. J.,age. 28. 1802. primary amputa 1862. Surg. E. Bentley.U. 1863. tion thigh. S. V. 3 Austin, A.H.,Pt.,B, Apr. 20, Kract. left leg; amp. Juno 7, Femoral artery . . . June 7, Left; in continuity; Discharged August lOtith K. Y. 1863. thigh May 22. 1863. 1863. hsein. rec. Juno 11. 23, 1863. 4 Barkftloo.J.T ,Pt ,M, July 19, Flesh wound right July 19, Popliteal artei j*. . . July 19. Right; in continuity. Amp. thigh. Disch d 2<1 Ohio Cav., age 2 1863. thigh. 1863. 1863. March 17, 1865. 5 Bluke, G., Pt., I, 3d Aug. 27, Flesh wound left Sept. 9 Sept. 9 Left; in continuity. Discharged Novem- W. V.i. Mtd. Inf. 1863. thigh, severing pop- 1863. 1863. Surg. W. D. Stew- her 12, 1863. lit eal artery. ait, U.S. V. 6 Brannan, J., Pt., C, July 2, Fracture right leg; July 12, Post. lib. art. ; art. July 15, Right; in continuity; Recovered. 44tb X. Y., age 26. 1863. prim. amp. leg. 1863. tied. 1863. in Scarpa s space. 7 Brown, J., Pt., D, May 28, Flesh left leg . . . June 9 June 10 Left -in cent. bur. J. Fui lou "bed July 31 120th Ohio. 1863. 10, 63. 1863. D. Brumley. U.S.V. 1863. 8 Brown, W., Serg t, Dec. 10, Flesh wound left Femoral artery tied. Detailed Mar.16.1864. 1st Mil. Art. 186. !. thigh. 9 Btigbee, S., Corp., E, Oct. 27, Wound right knee Nov. 8 Stump . Nov. 12, Right; on face stump. Discharged August 14th Conn., ago 24. 1864. joint; prim. amp. 1864. 1864. Surg. W. L. Baylor, 23, 1865. thigh, lower third. C. S. A. 10 Cheany, W. W., Lt, July 4, Wound right knee; An<r. 17, Femoral artery Ausr. 17, Right; in continuity. Transferred to pri^- B, 3()t h Ark. 1863. prim. amp. thigh. 1863. 1863. on April 21, 1864. 11 Check, J/.,Pt.,I, 61st July 30, Flesh wound thigh. Aug. 3, Femoral artery Aug. 3, Femora] tied, in con Furloughed August N. C. 1864. 1864. 1864. tinuity. Sur. D. F. , 1864. Wright, P.A.C. S. 12 Cleggett, T., Pt, D, Apr. ?, Fracture right knee May 2, Femoral artery May 2, Ligation in contin Discharged July 22, 76fh C olored troops, 1865. joint; amp. thigh, 1865. 1865. uity, iu upper third. 1865. ago 45 lower 3d, April 24. 13 Clover, B., civilian, Aug., Flesh wound thigh, Sept, 1, Aneurism of femo Sept. 1. Ligation in cout. just. Recovered. age 16. 1864. femoral injured. 1864. ral. 1864. above profuuda. 14 Coble, J. A., Pt., F, Nov. 27, Flesh wound of left Jan. 23, Aneurism of femo Jan. 23, Both ends in wound. Recovery. 45th N. C., ago 20. 1863. thigh, lesion of fem 1864. ral. 1864. Surg. J. G. Dudley, oral. C. S.A. 15 Cockburn, W. , Serg t. Dec. 28, Shot fracture left Jan. 7, Femoral artery. . . . Jan. 7, Three consecutive Mustered out May ii, 2d New Jersey 1864. knee joint; amp. 1865. 18, 23, ligations in conti 11, 1865. Cav., nge 38. Dec. 29. 1865. nuity. 16 Collins, if., Pt., K, Dec. 7, Left knee joint; amp. Dec 25, Femoral artery. . . . Dec, 25, In cent, in middle.. Discharged May 13, 1 3th Kansas, age 27. 1802. thigh Dtc. 10 ISiii 1862. 1864. 17 Cnthbort, T., Serg t, Oct. 27, Leftkneejoint ; prim. Nov. 21, Femoral artery . . Nov. 21, In continuity, just Discharged July 18, G, 8th New York 1864. amp. thigh; gan 1864. 1864. above profuuda. 1865. H. Art , age 44. grene. Surg. Gibus, C.S.A. IS Danlbrtli, H. J., May 18, Right knee joint; May 26, Femoral artery. . . . May 26, On face of stump. . . Discharged Aug. 11, Coip l, A, 8th New 1864. prim, amputation 1864. 1864. 1865. York H. Art, thigh, lower third. 19 Darling:, It. A., Pt., MavSl Fracture right thigh; June 14, Femoral Junel4 Femoral ligated .... Discharged Aug. 9, 11, 67th New York. 1862. amp. low. 3d Juuc3. 1862. 1862. 1862. 20 Dassel, T., Pt., G, Jan. 11, Right leg: tibia and Feb. 20, Anterior tibial ar Feb. 20, Femoral, in cont; in Discharged Dec., 60th Indiana, age 25. 1863. arteries injured. 1863. tery. 1863. Scarpa s triangle. 1863. 21 Davis, A. A.,Pt,K, Mar. 31, Right knee joint; Apr. 4, Profunda feinoris . Apr. 4, In cont. Surg. N. R. Discharged Sept. 14, 6th Wis.. age 32. 18C5 prim. amp. thigh. 1865. 1865. Moscley, U. S V. 1865. 22 Dow, G. E., Pt., G, Juno 3, Left leg amputated June23, Popliteal artery. .. Juue24, Femoral artery. A. Discharged Nov. 18, 12th N. H., ago 22. 1864. at knee joint June 18C4. 1864. A. Surg. W. H. 1864. 3. Ensign. 23 Downs, T., Pt., F, Sept.17, Fracture knee joint ; Sept.29, Femoral artery .... Sept.29, Femoral, in continu Discharged Mar. 13, 88th N. Y., age 38. 1862. amputation thigh. 1862. 1862. ity. Surg, H. S. 1863. Hewit, U. S. V. 24 Dunn. G. K., Serg t, May 16, Upper third of right May 29, Femoral artery .... May 29, Femoral above origin Furloughed July 23, E, 2:>th S C., age 20. 1864. thigh. 1864. 1864. of profunda; in cont, 1864. 25 Ellis, II. H., Cuip l, May 3, Left knee joint ; amp. May 20, Profuuda May 21, Femoral, in continu Discharged Oct 26, I, 16th N. Y., age 23. 1863. thigh. 1863. 1863. ity; hffim. recurred. 1863. 26 Ferguson, D., Lieut., Jan. 11, Left Knee joint-, amp. Feb. 20, Femoral artery. . . Feb. 20, Femoral, in continu Discharged Sept. 13, A, 113th 111 , age 27. 1863 thigh. 1863. 1863. ity; hceni. recurred. 1863. 27 GardinT, Ii.,Capt., I, Nov 24 Ri^ht knee joint; Ligation in cont. ; in Discharged Aug. 18, 100th 111., ago S3. 1863. amp. thigh, middle Scarpa s triangle. 1864. third. 28 Gardner, R. F., Pt, July 2, Tin ough both thighs; July 23 Femoral July 23, In continuity . Exchanged Oct. 28, A, 1st Maryland 1863. gangrene. 1863. 1863. 1863. Battery, age 19. 29 Goodman, W., Pt., May 5, Left thigh and le<* June 5 June 5, In cont. ; below Pou- Recovered. Clark s X. C. Art. 18C4. 1864. 1864. part s ligament 30 Graham, R. P., Pt, Oct. 5, Right knee joii.t ; Nov. 17, Femoral; 16ounces No v.l 7, Femoral, on face of Discharged May 22, ll,7ih 111. .ago 23. 1861. amp. thigh Nov. 9. 1864. 1864. stump, lower 3d. 1865. 31 Ha ihaiiL h, H., Serg t, July 2, Left thigh; slough Sept. 12, Profunda Sept. 13, Femoral; gangrene.. Discharged July 21, i K, 7th Wis., age 22. 1863. ing. 1863. 1863. 1864. 32 IlHi-tiunn, J., Pt, A, June 19 Upper third tibia ; June 26, Femoral June 27 In cont., in upper Discharged Aug. 14, 37th Wis., age 10. 18H4. prim. amp. thiirh. 27, 1864. 1864. third. Surg. N. R. 1865. Moseley, U. S. V. 31 Harvey, R., Pt, E, July 1, Fract. of left femur; Aug. 12, Femoral ...... Aug. 12, Femoral, in contin Discharged Oct. <j, 3lst Penn., ago 20. 1862. Aug. 1, amputation. 1862. 1862. uity. 1863. 34 Houser,! ., Serg t, II, All" 10 Flesh wound of left Sept. 10 Femoral Sept. 10 In continuity. A. A. Discharged May 20, 76th Penu., age 27. U64. thigh. 18C4. 1864. Surg.J.n. Packaul. 1865. 1 W RIGHT (D. F.), The Effects of lite Uunterian Method of Liyation on Inflammation, in Confed. States Med. and Surg. Jour., Vol. I, p. 177. 790 WOUNDS AND COMPLICATIONS. [CHAP. XH. No. NAME, AGE. AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURT. DATE OF H;EMOU- RHAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 35 36 Hubner, J., Pt, K, 5th Mich., ago 29. Hunt J L Pt G May 31, 1802. May 5 Flesh wd. of thigh.. June 27, 1862. July 9 Copious haemor rhage. June 27, 1862. July 9 In continuity. Snrg. T. M. Markoe. -Discharged Oct. 1, 1862. 37 57th N. Y., ago 41. 1864. Sept. 17 thigh. 1864. Nov. 24 1864. Nov 24 grene of toes ; amp. toes. 1865. 98 Pt.,D,7thS.C. Jordan W H Capt 18G2. prim. amp. thigh. 1862. June 28 1862. June 28 stump. April 27, 1863. W 9th Infantry. Knrlinver F Pt. K, 3.862. June 1, Flesh wd. of thigh 1862. June 9 1862. triangle. In cent. Surg. E. Discharged May 20 40 48th N. Y., age 37. Kelly F Pt 10th 1864. Phalanx of left foot 1864. 1864. Bentley, U. S. V. 1865. 41 Louisiana. Klein I) Pt C 64th July 22 Fract of left femur Aug 3 Auf 3 4? Illinois, age 26. Lahany, P., Corp l, 1861. April 2, prim, amputation. Fract. of left fibula 1864. April 9, 1864. April 9, Surg. "W. C. Jacobs, 81st Ohio. In Scarpa s triangle. 1866. Discharged Aug. 14 43 44 G, 5th Vermont, age 21. Lee, J. A., Pt., I, 17th Miss., age 25. Lenne |T han, P., S g t, 1865. July 2, 1863. April 6, Upper third of left leg. 1865. July 18, 20, 1863. Apr 20 Posterior tibial ar tery. Femoral 1865. July 21, 1863. Apr 20 Surg. D. P. Smith, U. S. Vola. Femoral, at upper third. 1865. Recovery. Discharged July 26 4f> B, 88th New York, age 30. Lesler, J., Pt., H, 1865. June 3, thigh. Flesh wound of left 1865. July 24 Femoral 1865. July 24 ing Staff Surg. J. Aiken. In continuity. A. A. 1865. HaBm.rec. reli^ated. 46 148th X.Y., age 48. Linehan, T., Pt , D, 1861. May 31, thigh. 1864. June 27 Femoral 1864. June 27 Surg. W. P. Moon. On lace of stump. Disch. Jan. 117 1865. Discharged Sept. 26 47 37th X. Y., age 19. Lyon, A. E., Pt., E, 1862. Ang. 8, femur: June 27, amp. thigh. Fracture of right os 1862. Aug. 17 Femoral ... 1862. Au" . 17 Surg. R. Bartho- low, U. S. A. In continuity 1862. Discharged Au r . 13 48 37th Iowa, age 23. McGonagle,C.,C p l, 1864. Oct. 19, calcis; amp. thigh. Fract. condyle ri^ht 1864. Oct. 23 Femoral 1864. Oct. 23 On face of stump . . . 1865. Discharged Mar. 31 49 C, 36th Ohio, age 24. McLin, V., Pt., H, 1864. July 1, femur; prim. amp. Fracture right knee 1864. Aug. 16, Femoral 1864. Aug 20 On face of stump. 1865. Discharged Sept. 6 S!) 7th Wis., age 24. McMullen, B. T., Pt., 1863. May 3, joint; Aug. 3, amp. thigh. Fract. of leg ; Mav 5, 20, 63. June 5, Femoral 1863. June 7 Asst. Surg. J. 1). Johnson, U. S. V. Femoral, in cont. ; in 1864. Furloughed Aug. 4 51 I, 4th Ga., age 20. McNallv, J., Pt., G, 1863. Juno 16, amp. at knee ; 27th, re-amp, in thigh. Middle third, right 1863. July 4, Femoral 1863. July 4 Scarpa s triangle. In continuity. A. A. 1863. Furloughed Nov. 1, m 09th N" Y., age 24. Malloy M.. Pt. fl, 1864. Sept. 17, thigh. 1864. Oct 4 1864. Oct 4 Surg. O. P. Sweet. 1864. 53 69th "New York. Meildo D., Pt., B, 1862. Aug. 30, Sept. 27, amp. thigh. 1862. Oct 4 1862. Oct 7 Surg. A. EL Smith. 1863. 54 llth Massachusetts. Miller, C.,Pt.,G, 9th 1862. June 30, at knee Sept. 28. Fracture of left le"- 1862. Auf 14 recurred Oct. 7. 1862. Au"- 14 Femoral in continu 1862. 55 Penn., age 19. Minehau, A., Corp l, 1862. Aug. 21, Sept. 30, amp. leg. Fract. ri"ht. knee j t 1862. Femoral 1862. Sept 25 ity. In continuity; thigh 18G3. Sfi F,27thMich.,age31. Monroe, H., Pt., I, 1864. June 22, prim. amp. thigh. Right leg ; amp. leg, 1861. July 10, From stump Ir64. July 10, re-amp. Oct. 19,1864. In cont. ; July 17, in 1805. Discharged January 57 20th Maine, age 25. Moor, IF., Pt., G, 5th 1864. Oct. 19, upper third. Wound of femoral 1864. Oct. 20 Femoral 1864. Oct. 20 Scarpa s triangle. In wound. Surg. 13. 1865. Died 1870. Exchanged Feb. 10 58 59 on N.C., age 27. Moore, J. W., Pt., I, 13th Miss., ago 23. Moore, L. J., Lieut., 10th Penn. Res., age 26. Morris, J., Pt., H, 1864. July 3, 1863. June27, 1862. Aug. 30, artery. Middle third, right leg. Fract. of left femur; July 24, amp. lower third. Left femoral injured 1864. July 13, 17, . July 31, 1862. Aug. 30, Ant. tibial artery. . Branch of femoral ; recurred Aug. 2. 1864. July 17, 1863. Aug. 2, 1862. Aug. 30 Pearson, 5th N. C. Femoral, in continu ity. In Scarpa s triangle. Surg. R. B. Bonte- cou, U. S. V. Ligated on field 1805. Transferred for ex change Oct. 5, 63. Resigned January 21, 1863. Discharged Novem 61 14th U. S. Inf. Moss, B. F., B. 101st 1862. July 20, Flesh wound of left 1862. Dec. 15 Femoral 1862. Dec. 15 Left; in continuity, ber 7, 1862. Discharged June 26, 6?, Illinois, age 43. Palmer, J. C., Pt., G, 1864. April 2, leg ; gang. ; amp. leg; amp. thigh. Flesh wound of righ t 1864. Apr. 10, Femoral 1864. Apr. 10, high up. Both ends in wound . 1865. Mustered out July 63 10th Conn., age 18. Paschal, J., Pt,, I, 2d 1665. Auc. 16 thigh. 1865. Aug 27 1865. Au" 27 In Scarpa s triangle. 5, 1865. Retired February 22, 64 N. C. Cav. Perkins, L. A., Corp l, 1864. Sept. 19, thigh; gangrene. Fract. ri<*ht femur 1864. 1864. Surg. D. F.Wright, C. S. A. Femoral li <r ated 1865. Recoveiy April 1, 65 D, 50th Va., age 19. Picket, J., Pt., F, 8th 1864. June 20, prim. amp. thigh. June 20 from sloug. stu p. Femoral ligated 1865. Discharged June 9, 66 Illinois Cav., age 21. Robert son, T.\V,,Lt., 1863. June 16, Left knee joint 1863. July 8 Anterior tibial 1863. July 8 Femoral, in continu 18C4. Resigned March 6, 67 7thN.Y.,:igc26. Poss, A. G., Corp l. I, 1862. Oct. 19, Ri^ht femoral artery 1862. 1862. ity. Fern, ligated; amp. 1863. Retired March 14, 68 13th Miss., age 21. Rowe, J. B., Pt., G, 1864. May 14, wounded. Middle third right June 12, Femoral June 12 right leg Nov. 8. Both ends in wound. 1805. Discharged June 5, 69 70 71 72 12th N. H., age 22. Sassaman, L. H., Pt., E, 12th Penn. Kes., ago 24. Scott. A. J., Pt., A, 9th Maine, age 24. Sharren, J., Pt., E, 170th N. Y., ago 46. Sboffer, G. W., Pt., 1864. May 8, Ib64. Aug. 16, 1864. May 24, 1864. May 24, thigh. Upper third of leg; injury of ant. tibial. Head of right tibia. . Right femur, middle; Oct. 1, amp. thigh Flesh wound of left 1864. June 2, 1864. Dec. 17, 1864. Oct. 8, 1864. May 24, Anterior tibial Anterior tibial .... Femoral 1864. June 4, 1864. Dec. 17, 1864. Oct. 13, 1864. May 24, Surg. A. Heger, U. S.A. Femoral, in Scarpa s triangle. A. A. Surg. J. S. Cohen. Femoral, in continu ity. A. A. Surg. J. C. Morton. In cont., in Scarpa s triangle. Femoral ligated 1865. Mustered out June 28, 1865. Discharged Juue 6, 1865. Discharged August 15, 1865. Discharged January 73 C, 5th U.S. Art. Short, S. A., Serg t, 1864. July 20, thigh. Fract. kneej t; .amp. 1864. Aug. 14, Femoral 1864. Aug. 14, Right femoral liga 30, 1865. Discharged January 74 75 A, 73d 111., age 26. Simmons, H. H., Capt., F, 21st Miss., ago 24. Smith, F. A., Pt.,G, 1864. July 2, 1863. July 2, thigh; sloughing. Fracture right leg; prim. amp. leg, up. third. Fracture lower third 1864. July 28, 1863. July 2, From stump 1864. July 30, 1863. July 2 ted in continuity. Femoral, in continu ity. Femoral ligated on 18, 1865. Sent to Provost Mar shal March 17, 1864. Transferred for ex 4th Ala., age 24. 1863. of femur. 1863. 1863. field. change Apr. 27, 64. CHAP. XII.] LIGATIONS OF THE FEMORAL ARTERY. 791 No. NAME. AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATK OP HAEMOR RHAGE. PROBABLE SOUIJCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 76 Smith E E Pt A Aug.16 Fracture right tibia; Oct. 17, Femoral Oct. 17, 77 78 llth Maine, age 19. Smith, H., Pt., F, 21st Va.,age41. Sock-well C L Pt 1864. Oct. 19, 1864. May 6 Sept. 12, amp. thigh. Both thighs; right femoral severed. 1864. May 6 1864. Mav 6 hip joint "Jan. 19; lig. of ext. iliac Jan. 27, 1865. Femoral ligated 1865. Spec. 3709, A. M.M. Returned March 14, 1865. 79 80 K, 12thN.J.,age22. Spivey, D., Pt., 5th N. C., age 46. Surface W. J. Pt. 1864. May, , 1863. Au<*. 9 Left thigh, femoral wounded. 1864. June 11, 1863. Nov. 19 Aneurism from fe moral. Femoral 1864 July 8, 1863. Nov. 19 ha3in. rec d May 31. In Scarpa s triangle. Surg. E. 15. Hay- wood, C. S. A. In continuity. .. . 1865. Recovered. 81 F, 7th Indiana. 1862. Mav 5 15, amp. at thigh. Right thiwh; femo 1862. Mav 19 Femoral . 1802. May 19 In continuity 27, 1862. m St>rg t,D, 12th Mass. 1864. July 14, ral artery injured. Fracture of upper 1864. Femoral 1864. Femoral ligated . . . 1864. 83 Van Lear A. Q. L., 1864. Mav 3, third of femur. Right knee ; prim. Mav 15, Femoral May 15, In continuity Removed. 84 Pt. t K, 5th Virginia. Vearin", W., Pt , G, 1803. Mav 22, amp. at thigh. Wound of right It 63. June 22, Femoral . . . 1863. June 22, Femoral li< r ated July 1 venous ha-ni. 85 12th Mo., age 30. Vickery, R. S., Ass t 1863. July 30, thigh. Flesh wound left 1863. July 30, Femoral 1863. JulvSO, Both ends in wound. Duty Dec. 16, 1863. Discharged March 86 87 Surg., 2d Michigan. Wilder, E., Corp l, A,100thN.Y.,agel9. Williams, B. F., 1864. Aug.16, 1864. June 20, thigh, upper third. Left leg; sloughing . Fracture left thigh ; 1864. Sept. 21, 1864. July 4, Posterior tibial ar tery. 1864. Sept.21, 1864. July 4, Surg. W. B. Fox, 8th Mich. Fern., in continuity. A. A. Surg. J. C. Morton. Femoral, in contiuu- 11, 1865. Recovered. Discharged May 29, 88 Serg t,E:,40thOhio, age 23. Wilson, J.,Pt., 27th 1864. May 26, prim, amputation. Left thigh, middle 1864. July 16, Aneurism 1864. July 16, ity. Both ends in wound. 1865. Returned to duty. 89 90 N. T. Batt., age 26. Winchell, C. D., Pt., K, 38th W is., age 19. Winchester D. W. 1863. Apr. 2, 1865. May 19 third. Upper third of left thigh. Middle third of left 1863. Apr. 11, 1865. Mav 28 Branch of femoral. Femoral. 1863. Apr. 12, 1865. May 28 A. A. Surg. G. B. Hammond. Femoral, H inches below Poup art s lig. In Scarpa s trian"le. Discharged July 3, 1865. 91 Pt., I, 1st Me. Ar tillery, age 21. Winston D S Pt. 1864. Sept. 29, thigh. Right knee joint 1864. Sept. 26 1864. Sept. 26 Surg. T. R. Crosby, U. S. V. On fico of stump. 1865. 92 F, 117th N. Y., age 23. Wood W. Corp l H 1864. Dec. 31 prim. amp. at thigh . Rio-fat thi^h 1865. 1863. 1865. A&s t Surg. J. U. Armsby, U. S. V. Femoral, in continu 93 81st Indiana. Wrio-ht M. Pt. F, 1862. Dec. 11 Jan. 2 Jan. 9 ity- In Scarpa s triangle. June 22, 1863. Discharged July 8 94 95 96 25th Ind., age 18. Ackland, G., Corp l, H, 21st Mo., age 25. Allen, E. S., Serg t, D, 3d Me., age 36. Ambrose J.G. Chap. 1864. April 4, 1865. July 2, 1863. July 25 femur. Fracture left ankle joint ; Apr. 24, amp. leg. Fracture left log; prim. amp. thigh. Upper part rt. (hi ir h 1865. April 27, 1865. July 21, 1863. Aug. 15 Posterior tibial . . Femoral Femoral . . . 1865. April 27, 1865. July 21, 1863. Aug. 15 A. A. Surg. E. L. Mola. In cont., Scarpa s sp. A. Surg. E. McClin- tock, U. S. V. Ligatiou In cont., one end; 1865. Died May 1, 1865. Died August 7, 1863 ; hsern. Died August 20, 1864. 97 12th N. H., age 35. 1864. Sept 14 inj. femoral, &c. 1864. 1864. Sept 29 Aug. 2V, lig. of prof. Died Sept 30 1862 98 99 Georgia. Archibald, T., Pt.,G, 24th Mass., age 18. Armstrong, F., S g t, 1862. April 2, 1805. June 3 Flesh, right thigh, injured femoral Fract. left knee j t; April 12, 1865. June 26 Femoral 1862. April 12, 1865. June 26 In wound, one end . . . In continuity, upper Died April 26, 1865. Julv 17, lui in. pro 1(10 A, 58th Massachu setts, age 30. Atkins, W. H., Pt., 1864. July 1, prim. amp. thigh. Fract. lower third 1864. Au"-. 10 Femoral 1864. Aug. 11, third. In continuity, near funda. Died July 18, 1864. Died Aug. 12, 1862; 101 1, 10th Mass., age 20. Atkinson, J. M., Pt., 1862. Mav 12, right femur ; amp. Fracture femur, 1862. 1862. May 25, It-moral ring. In continuity. A. A. exhaustion. Juno 2, amp. Died 10? A, 3d Indiana Cav- ali v, age 23. Atw ood, L. D.. Pt., 1864. Sept. 30, right. Flesh, middle, left Oct. 31 Femoral 1864. Oct. 31, Surg. T. Liebold. Both ends in wound. June 7, 1864; pya> rnia. Died Nov.9, 1864; ar 103 B, 32(1 Mass. Ayres, B., Pt., A, 1864. May 19, thigh. Flesh, left thigh, 1864. May 31, 1864. June 1, In continuity. tery had sloughed. Died Juno 1, 1863. 104 5th Iowa, ago 40. Bailey, J., Pt., I, 1863. June 18, femoral vein inj d. Flesh, left thigh .. June 1, 1863. July 9 Femoral 1863. July 9, In continuity below Spec. 2085. Died July 10, 1864. 105 55th Pa., age 20. Ball, C. E., Pt., F, 1864. 1864. Juno 23 1864. Juno 23 profunda. On face of stump. Died June 29, 1863. li 53d Mass., age 20. Banfill, T., Serg t, C, 1863. Mav 12 lower third amp. 1863. 1863. Juno 12 In cont., in Scarpa s Died June 12, 1864; 107 19th Ind., age 20. Barnes, C., Pt, D, 1864. Mav 5 left thigh. Fract. right knee June 16 1864. June 17 triangle. Surg. T. R. Crosby, U. S. V. On face of stump. pyaemia. Hammer, rec. Died 108 40th N. Y., age 21. Bauer, P., Pt., B, 9th 1864. Feb. 14, prim, amputation. Fracture ri <r ht pa 17, 64. Mar 23 Femoral 1864. Mar. 23 On face of stump. June 19, 1864. Died Mav 5, 1862; ex 109 110 Illinois. Baxter, S., Serg t, C, 68th <J. T., age 39. Bearly.J. H., Serg t, 1862. April 1, 1865. Sept. 1, tella ; Mar. 15, amp. Fract. tibia, inv. kneejt.; Apr. 12, am. Fracture right fe 1862. April22, 1865. Sept. 17, Femoral Femoral 1862. April 22, 1865. Sept. 17, lu continuitv, upper third. On face of stump. haustion. DiedJune2, 1865; ex haustion. Died Oct. 31, 1864. 111 1, 101st Ohio. Bedingfleld, J. 1 ., 1864. Mar. 25 mur; Sept. 8, amp. 1864. 1864. In cont., Scarpa s sp. 22(1, ha?m. Died Apr. 112 113 Capt., G, 60th Ga., age 25. Bell, T. C., Pt., E, 34th Iowa, age 23. Bell, R. H.,Capt., F, 1865. April 6, 1865. May 7, third. Left post, tibial ar tery. Left knoe j t ; prim. 1865. April 15, 1865. June 10, Left post, tibial. . . Femoral ... 1865. April 17, 1865. June 10, A. A. Surg. N. A. Robbins. In cont., Scarpa s. Surg. A.McMahou, U. S. V. On face of stump. 25, 1865. Ham. ; amp. Died April 23, 1865; ex haustion. Died June 20, 1864; 114 7th N. Y. H. A., ago 37. Benn, J. H., Pt., E, 1864. May 6, amputation thigh. Flesh, both thighs. 1864. May 28 1864. May 28 One end in wound . exhaustion. June 14, ha. in. Died 45th Pa. 1864. 1864. 1864. June 14, 1864. 792 WOUNDS AND COMPLICATIONS. [CHAP. xu. No. XAMK, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF II-iEMOB- KHAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 115 116 117 118 119 120 121 122 123 124 125 12G 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 111 145 146 147 148 149 150 151 Borkev, C.. Pt., A, 10th Pa. lies., age 24. Bibb, W. J., Pt.. G, 32d Tennessee. Bicklev, II., Pt., E, 10 th N. J., ago 21. Bills. C.,Pt. K, 17th N. Y. Bloomer, J., Pt., K. 170th N". Y., .12041. Buozer, F. S., Pt., K, 5thS.C.,age37 Bout on, H. S., Pt., K, 5Uth Va. Bowser, J.F.,Pt., B, llth Pa., age 18. Brandon, E.E., Pt., K, 14th Va,., ago 23. Brassiir.;ton, J., Pt., H, 9oth Pa., age 32. Briscoe, M., Pt., G l.joth N. Y., age 42. Brittou, M., Corp l, F, 7th Pa. Res., age 21. Brooks, A.M., Lieut , A, 26th Va. Brooks, J. H.,Pt, E, IstMd.Cav., age 37. Brown, S., Pt., G, 131th N. Y.,age Iti. Brown.W. C., Serg t, G, 51st N. Y., age 21. Burke, P., Pt., G, 10th Infantry. Cain, W. H., Serg t, I, 115th N. Y., age 23. "Cameron, D. H.,Pt., C,4lhR. I., age 24. Campbell. J. lV.,Sgt, A, 17thVa,,age23. Campbell, S., Pt., H, 140th Pa., age 30. Campbell, S. G., Pt,, F, 58th Va., age 31. Carroll, R. A.,I>t.,F, 3d Ala., ago 19. Carter, C. S., Pt, D, 50th Pa., age 22. Chase, J. B., Pt.,K, 24th N.Y. Cavalry, ago 49. Clark, W. L , Pt.,K, 25th N. C., age 20. Clavpole. S., Pt., I), 62d Pa., age 27. Clelland, W., Pt., H, 8th N. Y., ago 18. Cleveland, J. L.,Pt, G, ICthMe., age 25. Clymer, J., Ft, B, i04th Pa. Coder, D., Corp l, F, 10th Pa. Cavalry, ago 23. Coleman, G., Pt, F, 91th N.Y., ago 19. Colgau, W., Pt, C, 2a Mass. Cavalry, age 21. Conliu, J. S., Pt., I, 5th Michigan. Council, M., Pt, K, 2d K. Y. H. A., age 34. Coultes, W. II., L t, C, Gist N. Y. Councell, E. G., Col., IGth Miss., ago 32. Aim. 30, 1862. MavlS, 1804. May 14, 1864. Aug. UO, IS, 2. Aug. 25, 1864. May 28, 1864. Mar. 30, 1865. May 10, 1864. May 13, 1864. June 3, 18G4. Doc. 13, 1862. Apr. 0, 186 ). Aug. 16, 18W. Aug. 30, 1862. May 11, 1864. Aug. 30, 1862. Ausr. 16, 1864. Mar. 14, 1802. Aug. 4, 1864. May 29, 1864. May 31, 1864. July 2, 1863. May 12, 1864. June 16, 18b4. April 1, 18U5. May 30, 1864. Juno 1, 18 J4. Dec. 13, 1802. May 31, 1862. Mav 28, 1864. Aug. 29, 1862. Sept, 14, 18G4. Mav 31, 1862. April 7, 1865. June 1, 1862. Aug. 21, 1864. Dividing of left pop liteal. Riiiht knee.j t fraet; prim, amputation. Flesh, mid., left leg; Aug. 3, ampt n leg. Right lh:gh, iuv. pro- fuuda artery. Fracture upper 3d of right leg. Flesh, near groin. . . . Sept 11, 13, 14, 1862. Sept. 14, 1862. Aug. 14, In continuity, Scar- pa s space. On face of stump. . . . September 15, hsem. ; 18, amp. Died Sep tember 18, 1862. Died September 23, Aug. 23, 1864. Sept. 13, 15, 22, 1862. Sept 17, 1864. Femoral 1861. Aui;. 23, 1864. Sept. 20, 1862. Sept. 17, 1864 July 3, Oil f.iee of stump . . . Incont; ()e. 3, ha-m.; unsuccessful att pt to relig. In contain Searpa s triangle. In cout. A. Surg. J. C. McKee, U. S. A. Ligation On face of stump. A. Surg. W. F. Norris, u. s: A. On face of stump . . . On face of stum p. A. Sui g. W. F. Norris, U. S. A. In cont. Surg. N. II. Moseley, D. S. V. In continuity. Surg, E. Bentley, U. S. V. In continuity, below profuuua. lu cont. A. A. Surg. E. B. Woolston. In cont, low. 3d. A. Surg. \V~. A. Con- over, U. S. V. On face of stump . . . In continuity In continuity In continuity In continuity, Scar- pa s space. In continuity. Asst. Surg. W.Thomson, u.s: A. On face of stump. .. In continuity . On face of stump . . . In continuity, Sear- pa s. A. A. Sing. W. H. Ensign. In continuity, above profunda. A. A. Surg. J. Morris. In continuity, Scar- pa s. A. Surg. W. P. Norris, U. S. A. One end in wound, mid. On face of stump . . . In continuity, Scar- pa s. A. A. Surg. NV. K. Cleveland. In continuity. Ast Surg. W. Thomson, U. S A. In continuity 1864. Died August 21!, 1864; exhaustion. Died October -i. 1862. September IS, amp. Died Sept, 21. 1864. Died July 20, 1864. Died June lit, 1864 ; exhaustion. Died May 21, 1865; pyaemia. Died June 24, 1864; exhaustion. Died June 7, 1804; exhaustion. Ilwm. recur. 1) i e d June 17, 1864. Died Jan. 12, 1863. Died April 20, 1865. Sept 28, amp. Died Oct. 17, 1864; exh n. Died Dec. 7, 1862; pvjcmia. Spec. 1024, A. M. M. Died July 11, 1864. Died Sept. 14, 1862 ; exhaustion. Died September 26, 1864. Died April 6, 1862. Died August 13, 1864; exhaustion. Died Juno 13, 1864; exhaustion. Spec. 3557, A. M. M. Died Juno 23, 1864; pyicmia. Died February 17, 1864; pysemia. Died Juno 2, 1864. Died July 9, 1864. Gangrene. Died Apr. 19,1865. Hccm. recur d. Died August 4, 1864; as thenia. Died July 24, 1864. Died December 31, 1862; exhaustion. Died Juno 16, 1862. Died Juno 10, 1864 ; asthenia. Died December 3, 1862; pyaemia. Hiinnor. recurrent. Died September 28, 1864. Relig. profunda. Died Juno 17, 1862. Died Juno 16, 1865; exhaustion. Died June 23, 1862. September 10, luem. Died Sept. 10, 1864. Post. tiuial Groin and testicles. . Right tibia, head; Apr. 11, amp. thigh. Frac. up. 3d right tib. May 1!), amp. thigh. Right tibia, Uneej t; May 30, ainp. Loft knee joint ; June 28, amputation. Bones, v tfoot; Dec. 26, amp. knee.j t. Fract right femur, inj. pop. artery. Fracture left fibula. . Post, tibial artery. . . Fract. r t thigh, low. ; j d ; primary amp. Right knee.j t; Sept 11, amp. thigh. Injuring right tibia; Sept. 17, amp. leg. Condyles r t femur; prim, amputation. Apr. 17, 28,1865. May 25, 1864. June 5, 1864. June 15, 16, 1864. Jan. 7, 1863. Sept 11, 1864. Nov. 14, 28, 18n2. May 21, 1864. Sept. 13, 1862. Sept. 25, 1864. Apr. 5, 1862. Au-. 13, Femoral 1864. June 19, 18G4. Apr. 28, 1865. May 25, 1864. Juno 5, 1864. June 16, 1864. Jan. 7, 1863. Apr. 17, 1865. Sept, 11, 1864. Nov. 28, 1862. Mav 21, 1864. Sept 13, 1862. Sept, 25, 1864. Apr. 5, 1862. Aug. 13, 1864. June 13, 1864. June 21, 1864. Dec. 23, 1863. May 28, 1864. Julv 7, 1864. April 10, 1865. June 8, 1864. July 24, 1864. Dee. 30, 1862. June 16, 1862. Juno 9, 1864. Dec. 3, 1862. Sept, 27, 1864. June 10, 1862. Juno 15, 1865. June 18, 1862. Sept. 3, 1864. Femoral Femoral Stump Popliteal Femoral Post, tibial Femoral Femoral Fract. middle third right femur. Left knee joint; pri mary amputation thigh. Flesh, right leg; sec ondary amputation thigh: Right leg; amputa tion thigh. Fracture left tibia and lib.; prim. amp. knee joint. Flesh, right thigh, femoral artery. Flesh, right leg Flesh.left thigh, uiid- dlrt. Primary amp. thigh, lower t bird. Popliteal space. Trochanter minor, right thigh. Upper third femur . . Flesh leftthi- h .. 1864. Juno 10, 13, 64. June 20, 18b4. Dec. 9, 23, "63. Mav 28, 1864. July 6, 1864. April 10, 1865. June 8, 1864. July 24, 1864. Dee. 30, 1862. Juno 15, 16, 62. Juno 8, 9, 64. Dec. 3, 1862. Profunda ligated . . Femo l and branch profuuda. Anterior tibial . . Femoral Popliteal Femoral In continuity, four inches below pro funda. In cont. ; also lig. profunda. Surg. R. B. Bontecoii, U.S.V. In continuity, one end. A. A. Surg. P. Sweet. Both ends in wound. A. Asst. Surg. W. Hunt. On face of stump. . . . Right femoral art ery, middle. Flesh, middle, right thigh. Middle of thigh, in jury femoral ar tery. Fracture right leg near knee; Aug. 21, amp. knee joint. Juno 10, 1862. Femoral sloughed Femoral Juno 18, 1862. Sept. 2, 1864. Femoral 1 THOMPSON (J. II.), Report of the wounded at the battle of Xew- Berne, in American Medical Time*, Vol. 5, p. 6 CHAP. XII. | LIQATION.S OF THE FEMORAL ARTERY. 793 No. 15_> 153 154 155 156 157 158 159 160 161 162 163 164 165 1G6 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 18S 189 190 191 NAME. A<;E. AND MIUTAUY DESCKU TION. DATK OF INJUKV. NATUUE OF IXJUKY. DATE OF H.EMOK- HHAGE. PliOKAllLK SOUKCK OF HEMORRHAGE. L)ATK OF OFKUA- TIOX. OPERATION, Ol F.KA- TOtt. EKSULT. Cox, T. C , Pt., G, 88th Now York. Coy, J., Serg t, K,6th Maine, age 28. Crews, M. A., Pt, F, 2dS.C.,age36. Crowder D. J., Pt., Dec. 13, 1862. Nov. 7, 1863. June J, 1864. Dec. 10, Fr. left fern., up. th d, femoral injured. Left thi r h middle Jan. 9, 10, 63. Jan. 10, 1863. Nov. 24, 1863. June 19, 1864. Jan. 9, 1865. Mav 25, 1864. Died Janua y 10,1863. Died Dec. 23, 1863; recurring haini s. Died October 25, 1864; tuberculosis. Died Feb. 3, 1865. Died May 29, 1864. Jan. 12, gangrene. Died Jan. 29, 1863. Died Jan. 25, 1863; exhaustion. Dec. 22, haem. Died Jan. 26, 1865. Died July 31, 1864. Recurring haemor rhages. Died June 3, 1864; exhaust n. Amputation thigh. Died May 26, 1864. Gaug ne. Died June 5, 1863. Amputation thigh. Died Aug. 7, 1864; pyaemia. Died July 10, 1864; exhaust u, pyaemia. Died Oct. 21, 1863. Died March 10,1865; exhaustion. Died March 4, 1863; pyaemia. Died June 29, 186 I; pyaemia. Died April 8, 1865. Amputation thigh. Died June 6, 1864; exhaustion. Sept 8, haem. Died April 13, 1864. Died Sept. 13, 1862. Died May 26, 1864. Died July 11, 1863. Died April 2r<, 1865. Died June 21, 1864. Died Oct. 2, 1864. Died Jan. 29, 1863. Spec. 1140, A. M. M. Died Dec. .9, 1864; pya inia. Died Oct. 18, 1862. Died Sept. 24, 1862. U;em. ree. Died June 25, 1864. Died Nov. 24, 1862. Hu inor. recurred. Died A prill 8, 1865. Died June 8, 1864. Died May 27, 1864; pyaemia. Died Aug. 9, 1863. Died Aug. 8, 1863. Died June 15, 1864. Died July 12, 1864. In continuity ; reli- gated Dec. land 13. Oil face of stump. . . . In continuity, mid dle. A. A. Stirg. D. D. Talbot In continuity, above profunda. In cont, in Scarpa s Fracture right leg; primary amputa tion thigh. Fleah, lower third 1863. June 19, 1864. Popliteal Stanuard s Batt ry, age 23. Ciimmings, H., A, 7th W.Va., age21. Cummings, f. M.. Pr., D, 49th Ind. Cummins, A. H..Pt., K, 34th New York, age 25. Cunningham, S., Pt., D, 13th Ind. Cav alry, age 29. Curtis, J. J., Serg r, A, 13th New Hamp shire, age 20. Dal*, J., Serg t, K, 82d N. Y., ago 27. Darling, S. G., Pt., D, 32<1 Me., age 19. Day, If . Corp l, A, 6th Alabama. Delamater, M., Cor poral, G, 7th Mich. Cav., age 20. Delanev, J , Pt., G, C7th New York, age 20. Deminsr. J.C., Corp l, A, 11 1th XewYork, age 20. Detweiler, C.,Pt.,C, 47th Pa., age 24. Dier, \V., Corp l, A, 129th Pa., age 23. Dougherty, J. H., Pt., G, t6th New York, age 35 Dougherty, M., Pt., E, 49th Pa., age 35. Doyle, L., Pt., K, 8th Maine, age 34. Dunn, 15. M., Pt., D, 1st Louisiana. Eddy, G., Pt., E, 7th Wisconsin, age 24. Edson, lF.,Pt.,I, 5th K. C., age 22. Edwards, R., Pt., G, 98th Illinois. Edwards, J. W., Pt., B, 28th III., age 18. Elliot, E., Pt., H, 118th Pa., age 21. Faust, P. L , Pt. A, 7llth Pa., age 26. Ferguson, J., Pt., G, 142d Pennsylvania. Firth, 11. E., Pt., A, 157th N. Y., age 23. Fliege, II., Corp l., F. 7th Michigan. Flowers, M., Pt, II, HUstN. Y., age 26. Floyd, J., Sergeant, 13th Pa. Cavalry. Freeman, A., Pt, H, 61st New York. Freeman, C. A., Sergeant, B, 37th Mass., ant- . 2. Geitz, H., Pt, C, l. .th N. Y., age 20. Gilley, M.,Pt.,G,9th N. Y. Vols.,a<re 27. Goodman, E., Pt., D. 27th Pa., age 17. Goodwin, A. B., 2d New Hampshire. Graham, J. A., Ser geant, 11, 116th Pa. Gray, J., Pt, D, 2d Pa. H. Art, age 17. 1864. May 8, 1864. Dee. 28, 1862. Dec. 13, 1862. Dec. 4, 1864. June 15, 1864. May 6, 1864, May 5, 1864. May 3, 1803. Mav 28, 1864. May 6, 1864. Oct. 12, 1863. Oct. 19, 18C4. Dec. 13, 1862. June 3, 1864. Sept 19, 1864. May 20, 1864. July 2, 1863. Aug. 30, 1862. Mav 12, 1864. June 25, 1863. Mar. 26, 18G5. June 3, 1864. Aus. 10, 1864. Dee. !3, 1802. Dec. 6, 1864. Sept. 17, 1802. A u iz.30, 1862. May 28, 1864. Sept. 17, 186. . Apr. 6, 1865. Mav 18, 1864. May 5, 1864. May 2, 1863. July 2, 1863. June 1, 1864. June 17, 1864. thigh. Ei fht thi"-h May 9 5 Eight thigh, cutting femoral artery. Left tibia, np. third; Dec. 26, amp. thigh. Eight knee joint; primary amputat n thigh. 1864. Femoral Jan. 3, 1863. Dec. 9, 1864. Femoral Jan. 3, 1863. Dec. 9, 13, 20, 1864. Julv 31, 1864. May 20, 1864. Mav, 1864. May 28, 1863. July 10, 1864. July 4, 1864. Oct. 21, 1863. Mar. 10, 1865. Feb. 22, space. In continuity, high up. On face of stump, in continuity. Both ends in wound ; also int. cir. A. Surg. E. Curtis, U. S. A. In cont., Scarpa s. A. Surg. W. F. Nor- ris, U. S. V. In co tinuity, below profunda. lu continuity In cont; July 12, hrem. popliteal. On face of stump. Surg. E. B. Bonte- cou, U. S. V. Li r atiou ... . Femoral Fracture left fibula . . Severing femoral, rt. thigh, lower third. Eight leg, fracture fibula. Richt thigh, lower third. Fracture head left tibia ; May J7, amp. thigh. Left pelvic bone, fe moral artery. Fracture left femur, middle third. Left popliteal space. Fracture left knee joint ; June 9, amp. thigh. Fracture left knee; amputation thigh. Flesh, middle, right thigh. Fract. right femur, severing femoral. Fracture right leg; prim. amp. thish. Fract. low. third left femur: amp. thigh. Flesh, both thighs. Right leg, upper fin., third. Flesh wound mid dle third right th. Fracture left knee; prim. amp. thigh. Upper third right leg. Left knee joint; Dec. 10, amp thiL h. Eight knee joint; Oct. 9. sunn. tbii;h. Wound of thigh ; Aug. 30. amputated. Fracture ot lef t femur Fracture of left femur Flesh wound of left thigh. Fracture of right femur. Wound of thigh... May 20, 1864. May, 1864. May 26, 28/63. Post tibial Post, tibial July 3, Itf64. Oct. 21, 1863. Mar. 5, 9, 65. Feb. 22, 1863. Juno 20, 21, 64. Nov. 4, 1864. Ext. circumflex ; lig. profuuda. Both ends in wound, Scarpa s triangle. Li<*ation . . 1863. June 21 On face of st.nnin . Femoral 1864. Nov. 4, 1864. June 1, 1864. July 2, 1863. Sept 13, 1862. May 24, 1864. July 8, 1863. Apr. 20, 1865. June 13, 1864 Sept 15, 1864. Jan. 25, 1863. Dec. 19, 1864. Oct. n, 1862. Sept. 20, 1862. June 19, 1864. Nov. 3, 1862. Apr. 15, 1865. Mav 30, 1864. May , 1864. June 18, 1863. July 20, 186:!. June 8, 1864. Juuo30, 1864. Femoral; March 26, 1865, external iliac ligated. Both ends in wound. Surg. A. Heger, U. S. A. In cont., in Scarpa s space. In continuity July 2, 1863. Sept. 10, 13. 62. Mav 24, 1864. July 6, 8, 1863. Apr. 15, 20, 65. June 13, 1864. Sept. 15, 1864. Jan. 23, 24,25/63 Dee. 17, 19, 64. Oct. 11, Ir62. S,-pt.20, 1802. June 19, 1864. Nov. 3, 1862. Apr. 15, 1865. Mav 29, 30, 64. Mav Femoral Femoral Femora 1 In continuity, one end. Lower portion Scar- a s space. A. A. urg. H. B. Cole. Femoial, one end in wound. A. Snrg. A. Allen. U. S. A. On face of stump Femoral, in Scarpa s triangle. Femoral, in continu ity. Femoral ligated Femoral ligated, in cont. Fern, above origin of profuuda. A. A. Surg.J.Newi omb !. Femoral ligated . In Scarpa s triangle. Surg. B. A. Vaiidcr- kieft, U. S. V. In continuity. Surg. D.W. Bliss, IT. S. V. Femoral ligated . . Femoral ligated ... Both ends in wound Femoral, two inches above the profunda. In cout. Snrg. N. E. Moseley, U. S. V. Posterior tibial ar tery. Femoral Popliteal Branch of fi-moral. Femoral From stump Femoral Profuuda Femoral Shot wound ; ampu tated thigh. Left thigh Eight thigh Upper third of left thigh. 1864. June 18, 1863. July 20. 1863. June 8, 1864. June 30, 1864. Femoral Profuuda; pro- funda ligated. SURG. Ill 100 794 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OP INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. Griffitbs, H., Ft, E, 8th N. Y. Cav. Gross, C., Pt., 6th Penn. Cavalry. Hagan, J., Pt., G, 76th Pa. Ham, J. C., Serg t, B, 87th Pa. Hamilton, E., Capt, G,15thN. J., ago 19. Harper, J., Pt., B, ICth Inf. HaiTiman, R. C.,Pt, F, llth Me., ace 39. Harrington, W. J., Pt.,C, 16th Wis. Harris, J.M.,Corp l, C, 14th Iowa, age 20. Harrison, E., Color- Serg t, B, lOthN. Y. Haskoll, A. M., Corp l, K, 12th Me., age 23. Haskins, "W. H., Pt., K, 39th Massachu setts, ago 23. Hayden, G-, Pt., B, 1st Maryland Bat., age 22. Heath, L., Serg t, D, 2d Mich., age 22. Hershay, C., Serg t, F, 25th Iowa,age21. Hickey, T. G., 73d Pa., a go 53. Horn, S.,Pt.,H, 53d North Carolina. Horton, A., Pt, I, 48th N. T.,agc 19. Hubbs,J. B., Pt., B, 142d Pa , age 20. Huggins, W., Serg t, G, COth Illinois. Hulbert, G. D., Pt., G, 109thN.Y.,ago37. Hyatt, J., Pt., E, 2d Ohio, age 30. Johns, J. M., Pt., G, 5th Florida. Johnson, F. B., Pt, E, 16th Maine. Johnson, P. L.. Pt., U, 25th Va., age 22. Johnson, V., Pt, I, 13th Iiid., age 22. Johnston, J., Pt.,B, 27th Connecticut. Jones, W. U., Pt,, C, 14thN.Y.A.,age24. Jones, W. W., Ensign, Thomas s Legion, age 25. Judrt, J. E , Lieut, K, 49th Mass., age 25. Kane. W. H., Serg t, 1, 115th New York, ago 23. Keaton, J. M.,Pt,D, 19th Ind., age 19. Keeler, J.,Pt.,D,5th Ohio Cavalry. Keese,W..Co rp l, G, 74th N. Y., age 31. Keller, H.H.,Pt.,B, 7th Michigan Cav. Kelley, J. A., Lieut , C, 9th Missouri. Kennedy, J. J., Ser geant, G, 155th N. Y., age 29. Kimler. W. O., Pt,, D, 3Gth 111., age 33. Kiusev, R. C., Pt., K, 104th Pa. Kitzing, A., Pt., H, 57th N. Y., age 40. Knapp, C. A., Pt, B, 6th Vt, age 20. Sept. 17, 1862. May 30, 1804. July 17, 1864. Oct. 19. 1864. May 6, 1864. Dec. 31, 1862. Aug. 16, 1864. July 5, 1864. July 15, 1864. May 10, 1864. Oct. 19, 1864. May 10, 1864. July 3, 1863. June 18, 1804. Mar. 19, 1865. Aug. 30, 1802. Mar. 25, 1865. June 3, 1864. Dec. 13, 1862. Mar. 16, 1865. May 17, 1864. May 15, 1864. Sept. 17, 1862. Dec. 13, 1862. May 3, 1863. May 10, 1864. Dec. 13, 1862. June 9, 1864. Sept. 19, 1864. May 27, 1864. Aug.16, 1864. May 12, 1864. Apr. , 1802. July 23, 1863. May 6, 1864. July 4, 1863. Aug.14, 1864. Nov. 29, 1864. Juno 1, 1862. Dec. 13, 1862. May 10, 1864. Left femur, knee; Nov. , amp. thigh. Left thigh, femoral divided. Right thigh, femoral divided. Left knee joint; Oct. 29, amp. thigh. Right thigh, femoral divided. Fracture of thigh Head of left tibia; Sept. 16, amp. thigh. Flesh wound of left thigh. Lower third right thigh. Right thigh, femoral artery severed. Right knee ; Nov. 15, amp. thigh. Left ankle joint; May 18, amp. thigh. Left knee joint; July 8, amp. thigh. Right tibia; July 7, amp. thigh. Rigut femur; Mar. 20, amp. thigh. Middle third of right thigh. Flesh wound of left thigh. Right knee j t ; prim, amp. thigh. Fracture right leg; Dec. 26, amp. thigh. Right thigh Flesh w ds of both thighs. R ttuigh ; balllodg d in pelvic cavity. Left knee; prim, amp. thigh. Right knee; prim, amp. thigh Right leg; May. 23, amp. thigh. Wounds of both thighs, frac. of left Right tib. and fib. ; Dec. 23, amp. thigh. Flesh wound of right thigh. Flesh wound of thigh, femoral injured. Injury to coats of fe moral artery. Left tibia; Sept. 17, amp. at knee joint. Left knee j nt; prim, amp. thigh. Wound of left thigh. Left knee, j nt; prim, amp. thigh. Right femur ; prim, amp. thigh. Fracture of left fe mur. Right thigh and left groin. Flesh wound of right thigh; gangrene. Right leg; Juno 8, amp. leg. Through popliteal hpace, arteries wounded. Left knee joint; May 29, amp. thigh. Nov. 19, 1862. May 31, 1864. July 23, 1864. Oct. 28, 1864. May 15, 1864. Sept. 23, 1864. July 16, 1864. July 27, 1864. May 10, 1864. Nov. 21, 1864. May 24, 31, 64. July 13, 1863. July 12, 1864. April 14, 1865. Sept 27, 1862. July6,9, 1865. June 12, 1864. Dec. 29, 1862. April 3, 1865. June 8, 1864. May 28, 1864. Oct. 3, 1862. Dec. 25, 1862. May 26, 1863. May 19, 1864. Dec. 31, 1862. July 5, 1864. Branch of femoral . Nov. 19, 1862. May 31, 1864. July 23, 1864. Oct. 28, 1864. May 15, 1864. Sept. 23, 1864. July 16, 1864. July 27, 1864. May 10, 1864. Nov. 21, 1864. May 31, 1864. July 13, 1863. July 12, 1864. April 14, 1865. Sept. 27, 1862. July 9, 1865. Juno 12, 1864. Jan. 9, 1863. April 5, 1865. June 8, 1864. May 28, 1864. Oct. 3, 1862. Dec. 25, 1862. May 26, 1863. May 22, 1864. Dec. 31, 1862. July 5, 18u4. Oct. 2, In Scarpa s triangle. Surg. H. S. Hewit, U. S. V. Bothends in wound ; haem. recurred. One oud in wound . . On face of stump ... In Scarpa s triangle. Surg. H. W. Duca- chet, U. S. V. Femoral ligated In continuity. A. A. Surg. J. C. Morton. In continuity. Surg. G.F.Frenc h.TJ.S.V. Both ends in wound. Surg. J. G. Keenon, U. S. V. Femoral ligated on field. Femoral, ou face of stump. Femoral, on face of stump. Femoral ligated in continuity. In Scarpa s triangle. Femoral, on face of stump. Femoral, in continu ity. In cont. A. A. Surg. J. Morris. Femoral, on face of stump. In Scarpa s triangle Femoral, just below Poupart s ligament. Femoral, in continu ity. Femoral, in Scarpa s triangle. A. A. Surg. H. C. May. Femoral, in Scarpa s triangle. On face of stump . . On face of stuiup . . Femoral above pro- fuuda, in cont. Femoral, iii Scarpa s triangle. Femoral, above pro- f umla. iu wound. Femoral ligaled ... Died Nov. 19, 1862. Died June 8, 1864. Died of gangr. July 27, 1864. Died Oct. 28, 1864. Died May 16, 1864. Died Feb. 14, 1863. Died Sept. 26, 1864. Died July 21, 1864; gangrene. July 27, amp. Died Augusts, 1864; py aemia. Died May 22, 1864. Hsem. Nov. 27, 28, 30. Died Dec. 1, 1864. Died May 31, 1864. Died Sept. 23, 1863. Died July 28, 1864; pyaemia. Died April 15, 1865. Died Sept 27, 1862. Died July 14, 1865; haemorrhage. Hffim. rec. June 16. Died June 23, 1864 Died Jan. 12, 1863. Spec. 652. Died April 8, 1865. Died June 8, 1864. Died Juue 2, 1864. Died Oct. 5, 1862. Died Dec. 25, 1862. Died June 2, 1863. Died May 26, 1864. Died Jan. 5, 1863. Spec. 982, A. M. M. Died Sept. 25, 1864. Died Oct. 6, 1864. Died June 13, 1864. (Vein also tied.) Died Sept. 26, 1864. Died June 12, 1864; pyaemia. Died May 4, 1802. Died May 8, 1864. Died June 25, 1864; pyaimia. Died July 13, 1863. Died Aug.22, 1864. Died June 26, 1865. Died June 14, 1862. Amp. thigh Dec. 23. Died Jan. 12, 1863. Died June 4, 1864. Femoral, 32 oz Br ch of profunda Femoral Traumatic aneur ism. Femoral From stump Femoral ; lig. muse, branch May 24. Femoral artery Femoral artery . . Femoral artery From stump Femoral; haem. re curred. Prof da; prof, lig- ated. Profunda Profunda From .stump From stump From stump Profunda; prof, lig din continuity. From stump Femoral artery June 12, 1864. Sept. 25, 1864. May 25, 1864. May 1, 1862. Aug.14, 25,1863. May 20, 1864. July 12, 13, 63. Aug.22, 1864. Jan. 20, 1865. June 14, 1862. Dec. 20, 1862. May 31, 1864. Femoral 1864. June 12, 1864. Sept, 25, 1864. June 2, 1864. May 1, 1862. Aug.25, 18S3. May 28, 1864. July 13, 1863. Aug.22, 1861. Jan. 20, 1865. June 14, 1862. Dec. 20, 1862. May 31, 1864. Both ends iu wound. Medical Inspector P. Pineo, U. S. A. Femoral, in continu ity. A. A. Surg. J. C. Morton. On face of stump ; relig. in Scarpa s triangle. Surg. T. R. Crosby, U. S. V. Femoral, in continu ity. Femoral, in continu ity; rearnp. Femoral, iu continu ity. Femoral, in continu ity. Femoral, below Pou- part slig. A. Sursr. A. Delany, U. S. V. Both ends in continu ity. Femoral, in continu ity. Femoral, in continu ity. Surg. J. P. Prince, 36th Mass. In continuity; suc cessive ligations. Femoral artery . . Femoral From stump ; re curred May 28. Profunda Femoral artery Femoral CHAP. XII.) LTGATTONS OF THE FEMORAL ARTERY. 795 No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROIIABLK SOURCE OF HAEMORRHAGE. DATE OK Ol F-RA- TION". OPERATION, OPERA TOR. RESULT. 233 224 235 236 237 238 23!) 240 241 242 243 244 245 246 247 248 249 2oO 251 252 253 254 255 256 257 258 259 260 261 262 203 264 J05 2C6 267 268 -.09 270 271 272 273 274 Kuecht, M., Pt., K, July 10, 1863. June 16, 1864. Mar. 31, 1865. Julv 10, Fraet, of left femur, popliteal artery wounded. Left knee ; amputa tion at knee joint. Right leg ; amputa tion at knee joint. Right thigh; prim, amputation. Left thigh, middle third. Head of tibia ; Mar. 2, 1863, amp. thigh. Right thigh; ampu tation. Right leg, inner side Left thigh, femoral artery cut. Left leg; amputation of leg. Left knee j nt; Sept. 26, amp. thigh. Flesh, lower third right thigh. Fracture right ankle Julv 28, 1863. Julv 3, 4, 64. June 18, 1865. July 21, 1863. Oct. 9, 1864. Mar. 4, 1863. Mav25, 1864. April 12, 13, 65. Aug. 11, 1864. Julv 18, 20, 63. Oct. 1, 1864. Aug. 17, 18, 63. Popliteal ; hsem. Aug. 3, popliteal lig.; rec. 5, 9, 10. Femoral Aug.10, 1863. July 4, 1864. June 18, 1865. Julv 21. 1863. Oct. 9, 1864. Mar. 4, 1863. Mav 26, 1864. April 13, 1865. Aug. 11, 1864. Julv21, 1863. Oct. 1, 1864. April 25, 1865. Aug. 18, 1863. Femoral above an- astomotica magua. On face of stump. Surg. R. B. Bonte- con, CT. S. V. On face of stump ; re- lig. June 23. On face of stump. . . . Both ends in wound . On face of stump .... Ligation femoral Femoral, in Scarpa s triangle. Femoral. A. A. Surg. J. M. Browne. Femoral, in contiuu ity. On face of stump Artery and vein. A. A. Surg. J. Morris. In cent. A.Surg."W Thomson, U. S. A. Died Aug. 12, 1863. Died July 12, 1864. Died June 24, 1865; gangrene. Ha3m. rec. Died Oct. 22, 1863. Died Oct. 28, 1864; pyaemia. Died March 6, 186!. Died May 26, 1864. Died April 15, 1865. Died August 11, 1864. Died August 20, 186.1 Died October 4, 1864. May 6, lig. above profuu. Died May 7,1805; exhaustion. Died Aug. 19, 1863; pynsmia. Died May 20, 1862. Died Dec. 5, 1864; haemorrhage. Died March 31, 1863. Specs. 748, 3818, 3983. Died Jan. 31, 1863; rec. haemorrhage. Died May 26, 1865. Died Aug. 23, 1864; pyaemia. Spec. 3592, A. M. M. Died December 22, 1862. Died June 7, 1865; exhaustion. Hsem. recurred. Died Nov. 13. 1864. Died July 8, 1863. Died Jan 3, 63; gan grene. Died Oct. 16, 1862. Htcui. recurred. Died Sept. 17, 1864; hasm. Died Oct. 28, 1862; ex haustion. Died Sept. 28, 1862. Hajm recur d. Died Oct. 9, 62;exha st n. Died Sept. 28, 1862. Died Oct. 27, 1864. Died Oct. 28, 1862. Hsem. recurred. Died Sept. 12, 1862. Died May 29, 65; ex haustion. Died May 15, 1864 ; ex haustion. Died Juno 6, 1863; pyaemia. Haem. recurred. Died Juno 10, 1863. Died Feb. 17, 1864. Died May 2?., 1863. Died June 19, 1862. Died July 25, 1864; gangrene. Died July 2, 1864. 4th Ohio Cavalry. Koch, J. R., Serg t, F, 69th Pa., age 22. Krowlow, H.,Pt., A, With N. Y., ago 18 Lackev M., Pt. K Femoral 6th Vermont. Landon, L., Lieut., H, 6th Col. Troops, age 20. Lane, W., Pt., I, 1st East Tcmi., age 20. Lautair, S. P.,Pt., A, 1863. Sept. 29, 1804. Dec. 31, 1862. May 5, 1864. April 2, 1865. July 20, 1864. July 1, 1863. Sept, 19, 1864. April 6, 1865. Aug. 1, 1863. May 5, 1862. Nov. 30, 1864. Sept. 17, 1862. Dec. 14, 1862. April 2, 1865. July 30, 1864. Dec. 13, 1862. April 9, 1865. Oct. 1, 1864. May 23, 1863. Dec. 13, 1862. Sept, 17, 1862. Aug.19, 1864. Sept, 14, 1862. Sept. 14, 1862. Sept. 14, 1862. Aug.30, 1862. Sept. 17, 1864. Sept,14, 1862. Aug.29, 1862. May 3, 1865. Apr. 23, 1864. May 3, 1803. May 18, 1863. Jan. 16, 1864. May 3, 1863. June 1, 18S2. June 17, 1864. May 19, 1864. Aneurismal tumor . Femoral From stump Posterior tibial ar tery. Femoral 37th Mass., a<re 40. Lang, W. M., Pt,, C, 40; h N. T.. age 34. Lapp, C., Pt., I, 22d Wisconsin, age 21. LaraV>ee, J., Pt., E, 75th Ohio, age 19. Liiwson, L. B., Pt., F, 128th New York. Layne, J. H., Pt., B, 19th Virginia, age 18. Lazier, W., Pt., M, 5th Cav., age 25. Leake,W.G.,Pt,,K. 6th New Jersey. Leline, G., Serg t, C, 8th Mich., age 27. Liuii, H., Pt.. A, 6th Pennsylvania Re serves, age 25. Loetsch, H., Pt.. G, 9th N. J., age 56. Loutz, J., Pt., D, 94th New York, age 17. Lund, E. F., Pt., C, 4ih New Hamp shire, age 20. Lutz, J., Pt., B, 1st Pa. R., age 17. Lvun,J. B., 83d Ohio, age 19. McCarthy. J.,Corp l, E, 76thN. Y.,age31. Me Daniel If., Pi., K, 48th Virginia. McGuire. T., Pt., D, 53d Perm., age 19. McMahon, J.,Pt., A, 61st New York. McReynolds, J., Cor poral, 9th Co., 60th Ohio, age 20. Madden, C. B., Pt., 3dS. C. Bat., age 17. Martin, , C, 16th Ga. Mask. M., Pt., A, 23d N. C.. age 24. Mason, J. W., Pt., I, 12th N. Y., age 21. Maxlielil. D., Pt., E, !)7i hN. Y., age 20. Mellott.F. L., Pt,,K, l 2lh Penn. Meranville.R.E., Cor poral, F, 2d N. Y. C. Posterior tibial ar tery. From stump Femoral vein Tibial Flesh, right thigh, femoral artery. Left fibula; Dec. 3, exc.; 4th, amp.; Jan. 15, amp. thigh. Fracture right knee ; 14th, amp. thigh. Fracture lower third left femur; amp. Flesh, left thigh, right knee joint. Fracture left femur; 20th, amp. thigh. Fracture righttibia, knee ; May 30, amp. Neck of right femur Fractured leg ; June 9, amputation leg. Fractured left leg, upper third. Fractured left knee ioint; Sept., ampu tation thigh. Both thi< T hs Dec. 5, 1864. Feb. 4, 1863. Jan. 17, 1863. May 19, 1865. Aug. 12, 1864. Dec. 22, 1862. June 5, 1865. Nov. 5, 1864. June 27, 1863. Dec. 31, 1862. Oct. 3, 1862. Sept. 5, 1864. Oct. 15 In cont. A. A. Surg. S.T.Williams. Jan. 14, 17, 63. In cont. Snrg.C.A. Cowgill, U. S. V. On stump; May 25, relig. in cout. A. A. Surg. H.M. Bellows. Both ends in wound. A. Surg. W. Thom son, U. S. A. On face of stump Aug. 12, 1864. Dec. 22, 1862. June 5, 1865. Nov. 5, 1864. Femoral Femoral Profunda In continuity, below Poupart s lig. In continuity Dec. 31, 1862. Post, tihial In continuity ; two ligatures; excision. Ligation In continuity. A. A. Snrg. H. B. Mabeu ; Sept, 11, relig. In continuity Fract d right knee; Oct. 2, amputation. Upper part of thigh. Right thigh; Sept. 20, amputation. Shot wound Head left tibia ; Oct. 22, amputat n thigh. Fractured left knee joint. Thigh ; primary am putation. Left knee joint ; 4th, amputation. Left thigh ; Apr. 29, amputation. Fract d cond. right femur ; 14th, ampu tation. Right thigh, profun- da artery. Left femoral artery. Right knee joint; 14, amputation thigh. Fract d left femur; June 9, amp. thigh. Fractured left leg ; 17, amputation leg. Fracture right leg ; primary amputa tion thigh. Oct. 15, 1862. Femoral 1862. Sept. 28, 1862. Oct. 6 In wound, both ends On face of stump . . Oct. 6, 1862. Oct. 25, 1864. Femoral 1862. Oct. 25, 1864. Sept. 16, 1862. Sept. 7, 1862. May 4, 1865. Mav 15, 1864. May 28, 1863. June 3, 1863. Ligation of femoral . . In continuity In continuity, to pro- vent inflammation. In continuity, above profuuda. On face stump ; two muscular branches also tied. In continuity, Scar- pa s space. In continuity Sept. 5, 6, 1862. May 4, 1865. May 25, 1863. June 3, 1863. Feb. 7, 1864. Mav 16, 18, 186:5. June 15, 1862. Julv 20, 1864. June 12, 1864. Meiriott, E., Pt., D, 6th Mo C. S. M., ago 23. Metzer,W., Serg t, E, 1st La., ago 26. Miller,A.,l t,,E,95th Penn., age 18. Miller, G. H., Pt., F, 3d Iowa, age 23. Mills, J., Pt., D, 4th Missouri Cav. Moan, F. H., Corp l, F, 6th Me., age 22. Mohre, A., Pt., K, 104th Penn. Monaghan,M.,Pt.,C, 2d Mich., age 43. Morris, W. G., Pt., Femoral In continuity, above profunda. Ligation Stump Tibial. May 18, 1863. June 15, 1862. Julv 20, 1864. June 29, 1864. In continuity Ligation In continuity. A. A. Surg.W. H. Ensign. On face of stump E, 4th Alabama, age 24. 796 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. NAME, AGK, A-VD MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY DATE OF HJEMOR- UHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 275 270 277 278 279 280 281 282 283 284 2iO> 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 Moscrip, W. S., Serg t, 19th Wis consin, agi< 33. Mullin, F. U., Pt,, F, 3d Penn., age 17. Muiphv, I)., Pt., F, 62(1 Penn., age 18. Ml/era, 0. K., Pt, E, Cth Va. Cavalry. O Keefo. J., M aj., 2dN. Y. C., age 24. Osgood, T. J., Pt., A, 39th 111., ago 20. Pack, J. R., Pt, D, 39th N C , age 17. Paddock, D. G.,Pt, G, 83d Penn., age 21). Padcn, W., Corp l, G, 10th Penn. He- serves, age 22. Parker, J., Corp l, II, 58th Mass., age AS. 1 Parker, N., Corp l, B, 51at (?) Parks, J., Pt, E, 91st Penu.,ase38. Parrv, T., Serg t, D, 16th Mich., age 30. Payne, D.,Pt,H, 2d Conn. H. A., age 25. Payne, G. II., Pt,, K,64th New York, age 18. Pencil, E., Pt, H, 93d Pennsylvania. " Peters, "W. C., Pt., C, 68th Penn. Pope, P. P., Pt., M, 67th Ohio, ago 22. Pope. W., Pt, I, 2d N. Y. A., age 19. Pulheiiius, J., Pt., E. 1st Mich., age 20. Rairdon, "W., Pt., I, 40th Ind.,age,35. Rapp, D., Pt.,K, 7th Indiana, age 20. Kayncr, G. W., Pt., G, 12th Alabama. Reed,.!., Pt.,C, 15th W. Va., age 20. Keed, J. P., Pt,, B, L9th Ala .ago 20. Reed, W. H., Pt., H, 10th Vt.ageSl. Reigle, J., Pt, A, 88th Penn., ago 23. Riley, E., Pt.,G, 98th Illinois. Ringer, O, Pt., C, 60th Ohio, ago 21. Roberts, J., Serg t, 9th W. Va.,ago31. Roberts, A., Pt, I, 127th 111., age 20. Robinson, J.,Pt, D, 12th Conn., ago 34. Robinson, S., Sorg t, 3d N. U., age 23. Rodgors. S. J., Pt.,* A, 2d Mich., age 21. Roe, J., Pt., B, 42d New York. Root, .1. L., Pt, H, 77th New York. Rope, S., Pt, A, 140th Penii., age 43. RoseniVlt, N., Serg t, D, 26th 1 a., ago 22. Ruhlinz, F. J., S g t, E, llJth New York, ago 29. Sager,"W., Serg t, E., 188th N. Y., age 19. Aug.22, 1864. Nov 14, 1863. Dec. 13, 1862. 1864. Apr. 1, 1865. Aug. 16, 1864. Apr. 8, 18G5. May 8, 1864. May 23, 1864. June 3, 1804. May 16, 1864. June 18, J864. Sept, 30, 1864. Oct. 19, 1864. Oct. 12, 1864. May 31, 1862. July 2, 1863. May 9, 1864. June 3, 1864. Dec. 13, 1862. June 27, 1864. Nov. 30, 1863. Apr. 6, 1865. June 18, 1864. Apr. 6, 1862. Oct. 19, 1804. Mav 8, Ifc64. June 25, 1863. July 6, 1864. July 20. 1864. Mav 19, 1863. Oct. 19, 1804. May 12, 1864. Juno 17, 1864. Sept. 17, 1862. Oct. 19, 1864. June 16, 1864. July 2, 1863. June 1, 1864. Apr. 1, 1865. Flesh, middle third left thigh. Muscles of r t thigh, severing femoral. Right knee-joint; int. amp. thigh. Left knee joint; amp. thigh. Flesh, right popli teal space. Fracture head right tibia; Sept. 15, am putation thigh. Flesh, right thigh, lower third, injur ing artery. Fracture right kneo j t ; 16th, amp. ; lig. muscular branches. Popliteal space, right thigh. Fracture middle third left femur. Fracture left tibia; May 29, lig. post, tibial. Fracture, and amp. up. third loft leg. Flesh, right thigh . . Left knee jt; Nov. 2, amputation thigh. Fracture lei t fibula; 21st, lig. popliteal. Femoral artery Aug. 27, 1864. Jan. 4, 1863. Apr. 1, 1865. Sept. 23, 1864. Apr. 20, 27, 1865. May 23, 1864. May 29, 31, 1864. June , 1864. June 1, 1864. June 30, 1864. Nov. 19, 1864. Nov. 13, 1864. Oct. 28, 1864. Femoral Aug. 27, 1864. Nov. 14, 1863. Jan. 4, 1863. Oct. 8, 1864. Apr. 1, 1865. Sept. 23, 1864. Apr. 27, 1865. May 24, 1864. May 31, 1864. June 27, 1864. Juno 1, 1864. June 30, 1864. Nov. 19, 1864. Nov. 13, 1864. Oct. 29, 1864. June 16, 1862. July 15, 1863. May 21, 1864. June 20, 1864. Dec. 30, 1862. July 23, 1864. Dec. 9, 1863. Apr. 27, 1865. NoV. 1, 1864. May 29, 1862. Oct. 24, 1864. Juno 12, 1864. July 8, 1863. Aug. 22, 1864. July 29, 1864. June 5, 1863. Nov. 11, 1864. May 29, 1864. July 26, 1864. Oct. 30, 1862. Oct. 19, 1864. July 26, 1864. Aug. 14, 1863. Juno 14, 1864. Apr. 22, 1865. In continuity, Scar- pa s triangle. Ligatiou On face of stump .... Ligatiou Sept, 8, hm. Died Sept. 14, 1864; ex haustion. Died Nov. 14, 1863; nervous depression. Died January 4, 1863 ; exhaustion. Oct. 9, ham. Died October 10, 1864. Died May 31, 1865. Died September 28, 1864 ; exhaustion. Died April 27, 1865 ; congestive chill. Died May 24, 1864; exhaustion. Gangrene ; amputa tion leg. Died Juno 26, 1864. Died Jul> 12, 1864. Ha5m. ; amputation. Died June 2, 1864. Died July 12, 1864. Died November 21, 1864; exhaustion. Died Nov. 17, 1864. October 29, amputa tion. Died Dec. 4, 1864 ; exhaustion. Died July 5, 1802; pyaemia. Died July 13, 1863. Died May 22, 1864; exhaustion. Died June 24, 1864. Died Jan. 15, 1863; nervous prostration. Died July 23, 1864; exhaustion. Femoral vein also li- gated. Died Dec. 13, 1863 ; gangrene. Died May 6, 1865 ; exhaustion. Died Nov. 14, 1864 ; exhaustion. Died June 30, 1862. Died Nov. 21, 1864 ; pyaemia. 24th, religatfd. Died .1 uno 24, 1864. Died July 11, 1864. 23d, hseiu. Died Aug. 25, 1864. Aug. 4, haem. Died August 24, 1864. Died Juno 7, 1863. Died Nov. 23, 1864. June 1, hasin. Died June 2, 1864; htem. Died July 30, 1864 ; lliBIU. Died Oct. 30, 1862; exhaustion. Died Nov. 1, 1864. Died Aug. 10, 1864 ; exhaustion. Died Oct. 2, 1863. Died July 8, 1864; gangrene. Died April 29, 1865; pyaemia. Femoral . . . Femoral Femoral "Within adductor mag. ; i elig. in cont. Ligaled by A. A. Surg. J. C. Morton. In cont, in Scarpa s space. A. A. Surg. H. B. Cole. In continuity, below Poupart s ligament. In continuity. Surg. G. L. Pancoast, U. S.V. Ligation In continuity whoro it passes under sar- torious. In continuity ; re- ligated July 6. Both ends in wound. A. A.Sirrg. G. R.B. Robinson. On face of stump In continuity, low down. In continuity, four inches below Pou part s ligament. Ligation Femoral Popliteal Sloughing Stump Femoral Femoral Flesh, left thigh, lower third. Flesh, right thigh... Flesh, lower third left thigh. Fract. tib. ant. tibial artery; 26th, hrein.; amp. thigh. Fracture right foot ; July 9, amp. thigh. Flesh, left thigh, fom. art. and vein. Fracture left femur; April 17th, amp. Left kneoj nt; 20th, amp. thigh. Right thigh Right knee j nt; 21st, amp. thigh. Right knee ; 28th, amp. thigh. Flesh, both thighs. Right thigh ; flesh. Upper third femur July 15, 1863. May 21, 1864. June 20, 1864. Dec. 30, 1862. July 23, 1864. Dec. 9, 1863. Apr. 27, 1865. Nor. 1, 1864. May 29, 1862. Oct. 24, 1864. June 8, 12, 1864. July 6, 8, 1863. Aug. 22, 1864. July 29 Femoral Femoral Femoral One end in wound . . On face of stump. . . Femoral Both ends in wound. A. Surg. W. Thom son, U. S. A. On face of stump. . . . On face of stump; Nov. 8, hsem.; amp. Ligation Ligation ; hceni. re cur. Oct. 29. In cont.; h;em. June 16, 24. In continuity, oue end. In cont , one end. A. A. Surg. J. F. Holt, Ligation. Surg. J. B. Lewis, U. S. V. In continuity, upper third. On face of stump . . In cont. J inch be low Poupart s lig. In cont, both ends. A A. Surg. O W. Peck. Ligation Femoral Femoral . . . Flesh, left popliteal space. Right knee joint. ; Jsov. 4, amp. Left hip and root of penis. Mid. right thigh 1864. June 3, 1863. Nov. 11, 1864. May 28, 29, 1864. Popliteal Femoral Profunda, or pudii; Aneurism Fract. low. left fern.; October 27, amp. Fracture left femur Frac. left leg ; 17th, amp. thigh. Head of flbala ; 19th, amp. Left tibia knee joint ; llth, amp. thigh. Flesh, middle, right thigh. Oct. 29, 30, 1862. Ligatiou July 20, 1864. Aug. 13, 14, 1863. Juno 1 1 , 14, 1864. Apr. 15, 20. 21, 22, 1865. In cont., in Scarpa s space. Surg. II. B. Bontecoii, U. S. V. On face of stump . . On face of stump ; June 17, religation in continuity. Both ends, in cout. A. Surg.W. F. Nor- ris, U. S. A. Femoral Mus. branch and femoral. Femoral 344. Hoi.LOWAY (J. M.), Consent live and Indeterminate Ilcemorrhage from Large Arteries, etc., in American Jour. Med. Sci., 1865, Vol. L. p. See also U. S. Sanitary Commission Memoirs, Surg. Vol. I, p. 188. CHAP. XII.) LIQATIONS OF THE FEMORAL ARTERY. 797 No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. XATUBE OF INJURY. DATE OP HAEMOR RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 315 Salzm.in, C., Pt., K, Dec. 27, Tract, left leg; Jan. Jan. 10, Femoral branch . . . Jan. 12, In continuity Died Jan 13 1866 310 2(1 Inf., age 31. Scanlan P. Pt., G 1865. Dec. 14, 3, 1866, amp. thigh. Lodged in r t knee 12, 1866. Jan. 1, 1866. Jan. 6 317 63d X. Y.. age 34. Scott J Pt. F, 1st 1862. May 31, joint ; 26th, amp. th. Fract. left leg; June 6, 1863. Juno 16, 1863. triangle. Jan. 14, 1803. Died June 16 1864 318 X. Y. Diag, age33. Scott J., Pt., F 69th 1864. July 24, 1, amp. knee joint. Injury lower third 1864. Aug. 6, Femoral 1864. Aug. 6 Moseley, U. S. V. collapse. Died Au" 21 1864 319 X. Y., age 30. 1 Seever, A., Serg t, 1864. Sept. 1, left thigh. Grazing middle left 1864. Sept. 11, 1864. Sept. 14 H. M. Dean. Lig. in mid. third pyaemia. Died September 18 320 C, 16th Illinois. Self I Pt. H llth 1864. femur. Upper third thigh. 14, 1864. July 9 1864. July 11 Surg. E. Batwell, 14th Michigan. 1864. Died July 11 1862- T>1 Alabama. Sexton, J., Pt., A, 4th 1862. July 9, Fracture right fern., 11, 1862. Aug. 5, Femoral 1862. Aug. 5, In cont. ; An 1 . 6 re- exhaustion. Died August 6 1864- iw Va. Cav., age 22. Shaffer,T.W.,Pt,, F, 1864. Sept. 2, middle third. Frac. left, flesh right 1864. 1864. lig.profunda. A. A. Surg. J. H. Coover. Ligation right femo exhaustion. Died Oct. 20 1863. 323 324 22d Mich. Sharpe, A., Pt, D, llth Pa. 2 Sbaw M., Pt. I 1863. June 21, 1864. Sept. 1 thigh. Flesh, thigh Flesh, right thigh . June 21, 1864. Sept 12 ral. Both ends in wound . . Died June 26, 1864. 325 17th N. Y. Shav M., Pt. B 61st 1864. Sept. 17, Low. third r t fern. ; 1864. Xov. 20 Surg. E. Batwell, 14th Michigan. 1864. 326 N. Y.,ajre JO. Sheafter C. Pt. D 1862. June 5, Xov. 15, amp. Ri"ht thigh, inv. fe 1862. July 8 1864. Sp s 1096. 853. Died July 21 1864 37 1st X. Y. Cavalry. Shields, P. J., Pt. D 1864. Apr. 29 moral artery. Left knee jt. ; amp. June 1, 1864. pa s. Surg. Bald win, C. S. A. Died June 19 1863 T>8 6th Wis.,age20. Shock, W. Corp l K 1863. Aug. 9, thigh April 29. Head left tib. ; 16th, 1863. Aug. 29. 1863. Aug. 29 stump ; June 9, lig. of ext. iliac. Died Sept. 2 1864 46th Pa. 1864. amp. thigh. 1864. 1864. A. Surg. J. B. Brin- Spec. 50, A. M. M. T Q Sbugert J.L Corp l Apr. 1, Flesh, right knee ; May 24, Femoral May 24 ton, U. S. A. On face of stump Died May 25 1865- 330 I!, 49th Pa., age 20. Simmons, T., Pt. F 1865. Juno 18, May 20, amp. Flesh, upper third 1865. July 27, 1865. July 27 In wound exhaustion. Died Augusts 1864- 331 971 h N. Y., age 20. Singer, L, Pt. F, 1864. July 11, left thigh. Fracture left femur; 1864. July 17, Femoral 1864. July 17 In continuity gangrene. Died July 17 1863. 332 174th X. Y. Six, I., Pt., K, 14th 1863. July 20, 13th, amp. Fract. 1 t knee joint ; 1863. Aug. 3, Femoral 1863. Aug. 3 On face of stump DiedAugustI4 1864- ,t;<3 W. Va.,age 16. Smith, D. U., Pt., I, 1864. Xov. 25, July 26, amp. thigh. Fract. right femur . . 1864. 1864. On field. Li gated. Surg. J. L. haemorrhage. Died Dec. 5, 1863. 334 93d Illinois. Smith, J. , D, 97tb 1863. May 18, Flesh, right thigh, May 30, Circumflex June 2 Prout, 26th Illinois. In cont. | inch be Hfem. recur d. Died 335 Pa., ago 22. Smith, It. W.,Lt..F. 5th Pa, Res., age 24. 1804. Aug. 30, 1862. upper third. Flesh, thigh, femo ral artery. 1864. Sept. 7, 1862. Femoral ; aneur ism. 1864. Sept, 7, 1862. low Ponpart s lig. lu continuity; un successfully. June 5, 1864. Died Sept. 7, 1862. Spec. 509, A. M. M. Tlfi Smith, W. F., Maj., Oct. 27, Sev. femoral artery, Oct. 27, Femoral Oct. 27 Both ends in wound ; Ha3tn.; amp. Died T17 1st Delaware. Stark, O. 11., Serg t 1864. Sept, 29, middle. Right leg; Dec. 25, 1864. Jan. 3, Femoral 1864. Jan. 3 vein also tied. On face of stump .... Xov. 6, 1864. Died Jan. 13, 1865; 338 T>Q 11, 13th N. K., ago 30. Steele, G. S., Pt., P, 126th N. Y., age 23. Story, F., Pt., E, 1804. June 22, 1864. July 23, amp. leg; Jan. 3, 186.i, amp. knee. Fracture left knee j t; 23d, amp. thigh. Flesh, in Scarpa s 1865. Julv23, 1864. Sep. 8,9, Femoral Femoral 1865. July 23, 1864. Sept. 9 On face of stump. . . Both ends in wound pyremia. Hsetn. recur d. Died July29, 1864; exh n. Died* Sept. 10, 1864. 340 341 342 341 38th Ohio, ace 22. Stowell, F. M., Pt., D,70thN.Y.,agfi28. 3 , A., i> t ., 37th X. C , age 33. Tafr, G. K., Oapt., A, 53d Mass. Thorn, H. C., Pt., I, 1864. July 2, 1803. May 3, 1863. June 14, 1863. July20, space, right. Fracture left tib. and fib.; 31, amp. thigh. Lac. femoral artery, middle third. Right leg; June 14, am p. leg. Flesh wound right 1864. Aug. 1, 1863. May 10, 1863. June 21, 1863. Aug. 7, Muscu. branch of femoral. Femoral Femoral 1864. Aug. 1, 1863. May 10, 1863. June 21, 1863. Aug. 7 On face of stump. . . . Lig. in middle third. . Lig.; bsem. recurred ; Died Aug. 3, 1863. Died June 5, 1863. Died July 2, 1863; pyaemia. Died Aug. 12, 1864. 344 14th W.V.i., age 19. Thorp, E., Pt., G, 1st 1864. Aug. 4, thigh. Left knee j t; Aug. 1864. Aug. 9, 1804. Aug. 9 amp. thigh. In cont. below prof. Died Aug. 12, 64. Sp. 34 r i Penn. Art., age 20 TompkLs, G., Pt., 1864. July 3, 5th, amputated. Tib. and fib.; July 4, 1864. July21, Femoral 1864. July 21 J.H. Coover, A.A.S. On face of stump . . . 3929, 3960, A. M. M. Died July 26, 1863; 346 K, 1st New York Art., age 40. Tompkins J., sub- 1863. July 28, amp. leg; 17th, amp. thigh, upper third. Right leg 1863. 1863. July 9 9 pyjemia. Died Au-. 4, 1863; 347 348 3-1 9 sti nte, atre 21. Tracy, A. L., Pt.,K, 141st Penn., aue 35. Truex, J. B., Corp., F..14thX. J., age 22. Unknown 1863. July 2, 1803. May 31. 18(54. Sept. 17, Right knee ; July 5, amp. thigh. Fracture right knee joint; Juno 14, amp. Femoral artery ... July 12, 1863. June 19, 1864. Sept, 22, Femoral Femoral Femoral 1863. July 12, 1803. June 19, 1864. Sept. 22 On face of stump . . . On face of stump . . One end in wound tetanus. Died July 22, 1863 ; exhaustion. Died June 20, 1864 ; pyiemia. Died Sept. 22, 1862. 350 3..1 352 353 Van Wie, S., Sen:., B, C2d Ohio, age 25. Vcrmillve, J. C.. Pt., K, 124th New York, age 24. Wakeham, J. E. . Corp., E, 19th Vir ginia, age 27. Walter, V., Pt , E, 18C2. Aug. 16, 1804. May 12, 1864. Mar. 31, 1865. May 10, Frac. left femur Left leg; May 20, amp. thigh. Flesh, inj. femoral artery. Fract. upper third 1862. Sept. 28, 1864. May 25, 1864. Apr. 15, 21,25, 1865. June 7, Femoral Femoral 1862. Sept. 28, 1864. May 25, 1864. Apr. 10, 25, 1865. In cont. A. A. Surg. J. C. Mot ton. On face of stump .... Scarpa s space, in cont. A. A. Surg. J. Morris. Relig. Died Sept. 29, 1864; exhaustion. Died May 28, 1864; exhaustion. Hseiu. recur d. Died Apr. 28, 1865. Died June 17, 1864. 354 8 ill Ohio, age 24. Wells, L. D,Pt.,D., 1804. Sept. 20, femur. Right knee 1864. 1864. Xov. 17, funda. lu cunt.. Scarpa s. Died Dec. 1,1863; re 35:> 74th I ml., age 22. Wendt. C., Pt., E, 15;d Xi-w York. 1M3. Oct.. 19, 1864. Shattering right knee ; 20th, amp. Oct. 27, 1864. 1863. Oct. 27, 1864. Surg. \V. C. Otter- son, U. S. V. Ligation mittent haera. ant. tibial. Died Xov. 5, 1864; exhaustion. BATWELL (E.), Secondary Hcein or rharje following Gunshot Wound of Thigh, in U. S. San. Com. Hem s, Surg. Vol. I, p. 186. 2 BATWELL (E.). Cane* from the A ote Book of an Artny Surgeon, in Med. and Swy. Rep., 1865, Vol. 13, p. 50. 3 New Orleans Medical and Surgical Journal, Vol. 9, p. 71. 798 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. 356 357 3C8 B5fl 360 361 362 363 364 365 366 367 369 370 371 372 373 374 NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. Wesley, D. T.,Corp., K, 128th New York. Wetherall, J. H., Capt.,C,10th Mass.. age 39. Whallon, W. M.,Pt., C. 129th Pa , ase 21. Whitaker. D., Serg t, A, 88th Pa., age 20. Wilbur. J. F.,Corp , I, 29: h Ohio, age 24. Williams, C., Pt., F, 5th C. T., ago 23. Williams, G., Corp., E, 9th N. Y. H. A., age 30. Williams. L., Pt,, C, 26th Mich., age 23. Willis. A., Pt., I, 7th II. I., age 25. Wilson, C. "M., Pt., F, 4lhN. Y., age 35. Wilson, G. S., Adj. 17th N. Y.,age 24. Wilson, J , Pt,, B, 5th Texas, age 32. Wipfclder, F., Pt , C, 52d N. Y. Withani. A., Pt., A, 1 st Maine Heavy Artillery, age 20. Woolsey, A., Pt., H, 20th N. Y. S.M. Worlev. S., Pt,, A, 139th Penu., age 20. Wynne. W. G.. Pt., F, 661 h New York. Yockev, P., Pt,, D, 29th Ohio, age 29. Young, A.,Pt.,F, 1st Oct. 19, 1864. May 5, 1864. Dec. 13, 1862. Apr. 1, 1*65. Mav 3, 1863. Sept. 29, 1864. July 9, 1864. Mav 12, 1864. Dec. 13, 1862. May 5, 1864. Dec. 13, 1862. July 2, 1863. June 1, 1862. Mav 19, 1864. Aug. 30, 1862. Mav 5, 1864. Sept. 17, 1862. July 22, 1864. Apr. 26, 1863. Right knee joint ; 20th, amp. lo. third. Right knee; 19th, amp. thigh. Left knee joint; 18th, amp. lower third. Right knee joint; prim. amp. Fracture left knee joint; 8th, amp. th. Flesh, left thigh, up per third. Left thigh, upper third, flesh. Left knee; June 13, amp. thigh, middle. Femoral artery Lower 3d left femur ; June 2, amputation. Right knee joint ; Jan. 3, amputation. Fracture right fern.; July 4, amp. thigh. Fracture right fern.; 2d, amp. middle. Flesh, left thigh, up per third. Left knee; Oct. 1, amputation thigh. Ri"ht thigh Oct. 28, 1864. May 24, 1864. Dec. 24, 1862. Oct. 28, 1864. Mav 24, 1864. Dec. 24, 1862. Mav 15, 1863. Oct. 15, 1864. Aug, 3, 1864. July 19, 1864. Dec. 25, 1862. Juno 5, 1864. Jan. 12, 17, 1863. July 15, 1863. On face of stump In continuity, Scar- pa s triangle. In continuity, Scar- pa s space. In continuity On stump; May 17, lig. profuuda. Both ends in wound. A. A. Surg. 0. War ner. In cont, below prof. A. A. Surgeon J. C. Shimer. On face of stunip. . . . Died Nov. 1, 1864; exhaustion. Died June 20, 1864; pyasmia. Died Jan. 4, 1863; pysemia. Died Apr. 20, 1865; pyaemia. Died May 17, 1863. Hajm. recur d. Died Oct. 21, 1864; phle bitis. Died Aug. 4, 1864; exhaustion. Died July 19, 1864. Died Dec. 28, 1862. Died Juno 5, 1864; exhaustion. Died Feb. 17, 1863; pyremia. HiBii). recur d. Died July 23, 186 1. Died June 17. 1862. Died July 2, 1864. Died Oct. 5, 1862 ; ex haustion. Died June 2, 1864. Died Nov. 3, 1862. Spec. 746, A. M. M. Femoral Femoral Femoral May 15, 1863. Oct. 15, 1864. Aug. 3, 1864. July 18, 1864. Dec. 22, 25, 1862. June 5, 1864. Jan. 12, 1863. July 15, 1863. Juno 9, 1862. June 29, 1864. Oct. 2, 1862. Femoral Femoral; recurred Femoral In continuity above profunda. On face of stump ... In continuity, Scar- pa s space. Femoral 1862. June 29, 1864. Oct. 2, 1862. May 20, 1864. Oct. 25, 1862. May 17, 1863. In cont. just below Poupart s lig. A. A. Surg. J. Newcombe. In continuity, Scar- pa s triangle. Ligatiou FVacture left knee ; Oct. 16, amp. thigh. Fract. right femur; prim. amp. thigh; reamp. middle. Lower 3d, left thigh, flesh. May 11, 1863. In continuity, Scar- pa s triangle. Ligation of femoral ; subsequent lig. of external iliac. Both ends in wound . From stump Died April 23, 1865. Died May 20, 1863. Missouri Cavalry. .Of the branches of the femoral artery the external pudic was ligated in one, the pro funda in twenty-two, and the perforating artery in six instances. Liyation of the External Pudic Artery. CASE 1156. Sergeant J. H. Warford, A, 124th New York, age 23, was wounded at Sailor s Creek, Virginia, April 6, 1865, in the right thigh about two-inches below Poupart s ligament; June 12th, hremorrlmge from external pudic artery ; ligation of artery in wound ; no recurrence of hsemorrhage. Patient was discharged August 26, 1865. (Second Surg. Vol., page 326, CASE 940.) Ligation of the Profunda Femoris. Twenty-two cases, with five recoveries and seven teen deaths were reported. Fourteen were ligations, after amputations, on the face of the stump. TABLE OXLII. Summary of Twenty-two Cases of Ligations of the Profunda Femoris. [Recoveries, 15; Deaths, 622.] NO. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 2 3 4 Bedinn field. R. W., Serg t, I, 60th G;i., age 18. Casey, P., Pt., H, 1st Col. Troops. Crawford, E.,Pt., F, 10011] Ohio, age 20. Michaelis T. Corp l July 9, 1864. July 10, 1863. Sept. 19, 1803. Mav 8 Flesh wounds of both thighs. Fracture of right fe mur; prim. amp. Right ankle jt. ; Oct., amp. leg; Aug. 5, 1864, amp. thigh. Ril ht thi"h upper Aug. 16, 1864. July 16, 21,25,26, 1863. Aug. 14, 15. 1864. July 4 False aneurism r t thigh. From stump From stump Profunda Aug. 10, 1864. July 26, 1863. Aug. 15, 1864. July 4, Profunda, both ends in wound. A. A. Surg.J.U.Bartholf. Ou face of stump. A. A. Surgeon J. C. Shinier. Profunda on face of stump. Profunda, proximal Exchanged October 25, 1804! Discharged Decem her 10, 1863. Discharged Mar. 18, 1865. Discharged May 31 "> 3, 140th New York, age 27. Shaw go G Pt A 1864. Apr 1 third. 1864. Apr. 7 1804. Apr. 7 end in wound. 1865. 6 7 121stPenn.,age21. Bodley. E., Pt..39th Indiana, age 28. Carlton.C. C., Pt., B, 1st Massachusetts Artillery, age 35. 1865. Sept, 19, 1863. May 19, 1864. amp. thigh. Left leg; amputation thigh September 21. Left knee joint ; am putation t high May 22. 1865. Sept. 28, 1863. Mav 26, 1864. Profunda Anastomotic 1865. Sept. 28, 1863. May 27, 1864. Profunda on face of stump. Profunda on face of stump. 1865. Died September 28, 1863. Died May 30, 1864. ( HAP. XII.] LIGATIONS OF BRANCHES OF THE FEMORAL ARTERY. 799 No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. g Clark J Pt H 7th June 27 June 27 Died October 9 1864 Q N. Y. Heavy Artil lery, age 24. 18C4. Oct 19 primary amp. thigh. 1864. Oct 26 Profuuda 1864. Oct 26 stump. 10 11 12 I, 1st Cavalry, age 24. Doty,N., Pt., E, 102d Penn., age 33. Folensbee.C. M.,Pt., B, 157th New York, age 16. Galiger M Serg t 1864. Sept, 19, 1HC4. Dec. 6, 1864. July 2 joint ; Get. 22, amp. thigh. Condyle of left fern. ; Sept. 28, amp. thigh. Right knee joint; Dec. 9, amp. thigh. 1864. Sept. 30, 1864. Dec. 19, 1864. July 6 Branch of profunda Branch of profunda 1864. Sept. 30, 1864. Dec. 19. 1864. July 6 stump. Ligated on face of stump. Artery tied on faco of stump. 1864. Died November 7, 1864. . Died December 26, 1864. Died July 8 1863 13 14 G, 73d N.Y., age 22. Gibson, E. H.,Pt., A, 14th New jersey, age 15. Gilkey, E., Pt., C, 1863. July 8, 1864. June 19, July 5, amp. thigh. Fracture of right fe mur, upper third. Right thigh, upper 1863. July 19, 1864. JulyS Circumflex 18U3. July 19, 1864. July 5 stump. Circumflex branch of prof., both ends in wound. A. A. Surg. T. J. Dunott. Died July 20, 1864. Vein also lig. Died T> 17th Maine, age 27. Jenkins, J.H., Serg t, 1864. Feb. 25, third. Left knee j t; amp. 1864. Mar. 12 Profunda 1864. Mar. 12 Ass t Surg. A. De- lauy, U. S. V. July 7, 1864 ; recur rence of haem. Died March 16, 1864 ; 16 17 B, 89th Ohio, ago 24. Labrie, O., Pt., H, 126th Ohio, age 23. Lowe, J. T., Lieut , 1864. July 9, 1864. Oct. 14, thigh February 29. Left thigh ; amputa tion July 12. Wound of left thigh 1864. July 15, 1864. Branch of profunda 1864. July 15, 1864. stump. On face of stump . . Profunda, both ends pytemia. Died July 22, 1864. Died October 30, 1863. 18 D, 12th N. Jersey. Murphy M. Pt. G 1863. Nov. 25 Left thigh flesh Jan 26 Jan 26 in wound. Died Jail 27 1864 19 ?0 5th Kentucky. Pattison, T., Corp l, D,5thMich.,age32. Sturgis. J., Corp J, G, 1863. May 5, 1864. Aug. 16, gangrene. Flesh wound of left thigh. Both thighs, right 1864. July 13, 1864. Nov. 1, Branch of profuuda Profunda 1864. July 13, 1864. Nov. 1, A. H. Stephens, 6th Ohio. One end in wound ; hrem. recurred. Profunda, in conti Died July 20, 1864. Died November 6, 21 flfl 85th Pennsylvania. Weiler, J., Corp l, K, 40th N. Y., age 20. Wells, E.,Pt., 1, 12th 1864. May 24, 1864. Dec. 16, femur injured. Fracture right thigh ; prim, amputation. Right knee ; amp. 1864. MavSl, 1864. Dec. 21 Branch of profunda 1864. May 31, 1864. Dec. 21, nuity. A. A. Surg. J. C. Morton. On face of stump . . . On face of stump . . . 1864. Died May 31, 1864. Died December 21, Iowa. 1864. thigh Dec. 16. 1864. 1864. 1864. Of the branches of the profunda the perforating arteries were ligated in six instances; all the cases terminated in death: CASES 1157-1162. Private T. B. Benedict, D, 7th Connecticut, age 32; received a shot flesh wound of right thigh May 10, 1864; haemorrhage occurred from one of the posterior perforating arteries on June 9th, which was ligated; no recurrence of haemorrhage; death May 3, 1865, of pneumonia, Lieutenant J. Coote, F, 10th Alabama; wounded May 5, 1862, through left knee joint; May 20th, amputation of thigh; May 23d, haemorrhage from branch of inferior perforating artery; vessel ligated; death May 25, 1862. Private T. Hagleman, D, 41st Ohio, age 49; wound of right thigh December 16, 1864 ; haemorrhage from superior perforating artery December 29, 1864; vessel ligated at proximal end by A. A. Surg. S. W. Black wood; died January 15, 1865. Private J. J. Smith, F, llth Virginia; fracture of left femur October 19, 1864; amputation of thigh October 20th; November 1st, secondary haemorrhage; perforating artery ligated on face of the stump on the same day; death November 9, 1864. Surg. H. S. Wheeler, B, 2d Connecticut H. Artillery, age 29; fracture of condyle of femur October 19, 1864 ; amputation October 26th; haemorrhage November 1st from perforating artery, which was ligated on face of the stump; death November 11, 1864. Private W. F. Young, A, 114th New York, age 26; wound of left knee October 19, 1864; amputation on same day; October 30th, haemorrhage from inferior perforating artery ; October 31st, ligated on face of stump ; died November 27, 1864. Twenty-four cases of ligations of muscular and other minor branches of the femoral artery were reported ; twenty-two were ligations on the face of the stump. TABLE GXLIII. Summary of Twenty-four Ligations of Muscular and other small Branches of the Femoral Artery. [Recoveries, 1 6; Deaths, 7 24.] No. NAME, ;E, AND Mn DESCRIPTION. Iowa, ago 20. Schrabasliie. B. 183d Pen nia, ago 46. LITARY ION. DATE OF INJURY. NATURE OF INJURY. DATE OF H.EMOK- RHAGE. PROBABLE SOURCE OF HAEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. Serg t, July 27, Right knee j t; prim. Ang. 2, Muscular branch . . Aug. 2. Muscular branch Discharged in 1865. as, age 1864. amputation thigh. 1864. 1864. tied on face of stump. F, 120th July 2, Right leg : prim, am July 11, Muscular branch . . July 11, Muscular branch on Discharged April 20, age 24 1861!. putation leg. 1803. 18(13. face of stump. 1864. Pt,, I, July 30, Right thigh ; prim. Nov. 22, Branch of femoral . Nov. 2i, Branch of femoral ou Discharged May 15, ge 24. 1864. amputation. 1864. 180 4. face of stump. 1865. t., I, 2d Nov. 19, Through left knee; Lee. 3, Dec. 3, Branch of femoral . . Discharged April 20, 1804. Nov. 28, amp. thigh. 1864. 1864. 18G5. M.,Pt., Apr. 1, Through right patel June 7, June 7, Muscular artery tied. Recovered. nsylva- 1865. la; April 8, ampu 1866. 1866. tation thigh. 800 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OK HJEMORRHAOK. DATE OF OPKRA- TION. OPERATION, OPERA TOR. RESULT. 6 Swavne.W., Colonel, Feb. 2, Right knee; prim. Feb. 13, Branch of femoral Feb. 13, On face of stump Recovered. 43(t Ohio, acre 30. 1865. amputation thigh. 1865. 1865. 7 Anderson, W. G., Pt., Dec. 13, Right knee j t; Jan Jan. 13, From stump Jan. 17, Muscular branch on Died Jan. 17, 1863. G, 114th IVnnsylva- 1862. uary 11, amp. thigh. 15,17, 1863. face of stump. nia, ago 16. 1863. g Carroll, L , Serg t. Oct 27, Fracture femur, up Branches of femoral ; November 11, amp. H, 1st Delaware, 1864. per third. ba-morrhage. at hip. Died Nov. age 3:! 19, 18B4. 9 Davis, H. C., Pt., I, May 1, Fract of femur, pro- Mav 17, From stump May 17, Small branch on face Died May 18, 1863. 46th Indiana. 1803. funda injured ; amp. 1863. 1863. of stump. 10 Fisher. G. A.,Pt., A, June 2, Right knee j t ; June June 22, Muscular branch.. June 22, On face of stump. Died June 23, 1864; 8th New York Ar 1864. 15, amputa n thigh. 1*64. 1864. A. A. Surg. D. L. pyremia. tillery, age 19. Haight. 11 Foster, R., Cant, K, Mav 10, Left knee joint; May June 4, Muscular branch . . June 4, On lace of stump. Died Juno 14, 1864. 1st New Jersey, 1864. 27, amputa n thigh. 1864. 1864. A. A. Surg. F. H. age 39. Colton. 12 Faust, J., Pt, N. C. Mar. 27, Left knee; -rune 17, June 17, From stump June 17, Small branch on face Died July 25, 1865. Artillerv, age 37. 1805. amputation thigh. 1865. 1865. of stump. 13 Geller, M., Pt., D, June 30, Left knee j t; July 4, Aug. 5, Muscular branch . . Aug. 5, Muscular branch on Died August 29, 1864. 48th N. Y., age 37. 1864. amputation thigh. 1864. 1864. face of stump. 14 Hammond, A., Pt , Apr. 2, Left knee joint; Apr. Apr. 11, Muscular branch.. Apr. 11, Muscular branch on Died April 16, 1865; H, lllth New York, 1865. 6, amputat n thigh. 1865. 1865. face of stump. pysemia. age 47. 15 Hayer.G., Pt,, K, 6tb May 19, Left knee j t ; June June28, Muscular branch . . June 28, Muscular branch on Died June 29, 1864; New York Heavy 1864. 16, amputa u thigh. 1864. 1861. face of stump. pytcmia. Artillery, age 27. 1C Havs, A. H , Pt., B, Dec. 13, Fracture left tibia; Jan. 7, Branch of femoral . Jan. 7, Small branch on face Died January 10, 142dPenn.,age23. 1862. Dec. 25, amp. thigh. 1863. 1863. of stump. 1863. 17 Knowlton,A.W.,Pt, Mav 5, Left knee joint; May June 1, Muscular branch. . June 1, Ou f.ice of stump. Died June 4, 1864; F,93dN.Y., age 22. 1864. 14, amputa n thigh. 1864. 1864. Ass t Surg. W. F. pyajmia. Nori is, U. S. A. 18 Mars.H., PI.,G,5th Mar. 31, Right knee joint; Apr. 10, Muscular branch. . Apr. 10, Muscular branch on Died April 22, 1865 ; New York, age 24. 1865. Apr. 9, amp. thigh. 1865. 1865. face of stump. pvaimia. 19 Michaelis, S., Pt, E, June 25, Flesh wound of both July 30, Branch of femoral . July 30, Both ends in wound. Died August 4, 1864. 9th Maine, ago 21. 1864. thighs. 1864. 1864. Ass t Surg. E. Cur tis, U.S. A. 20 Spencer, J., Pt., G, Mav 9, Right knee j t ; May May 24, From stump Mav 24, Branches ligated on Died May 31, 1864. 48th Penn.,age 19. 1804. 16, amputa n thigh. 1864. 1864. face of stump. 21 Sterling, E.E.,Corp l, May 9, Right leg; May 10, Mav 22, Branch of femoral. Mav 22, Small branch on face Died Aug. 12, 1864 ; E, 143d Pennsyl 1864. amputation thigh. 1864. 1864. of stump. pyseinia. vania, age 32. 22 Townsend.E., Pt, F, June 2, Left knee j t; June June 4, Small branch of June 4, On face of stump . . . Died July 1,1864. 5th N. H., age 35. 1864. 21, amputa n thigh. 1861. femoral. 1804. 23 Weisrailler, C., Pt., Dec. 13, Head of left tibia; Dec. 26, Branches of fem Dec. 26, Branches ligated on Died December 27, B, 12th Peun. Res., 18B2. Dec. 25, amp. thigh. 1862. oral. 1862. face of stump. 1862. age 22. 24 Yeagher. F., Corp l, June 17, Right knee joint; July 2, Muscular branch. . July 3, On face of stump Died July 5, 1864. C,26thMich.,age44. 1864. prim. arnp. thigh. 1864. 1864. legations of the Popliteal Artery. Thirty-six cases, with eight recoveries and twenty- eight deaths, a mortality rate of 77.7 per cent., were reported. Six of the operations were performed, after amputations, on the face of the stump. TABLE CXLIV. Summary of Thirty-six Ligations of the Popliteal Artery. [ Recoveries, 1 ; Deaths, 936.] No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HJSMOR- BHAGR. PKOBAHLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 1 Ditters. "W., Pt., H, May 14 Right popliteal space June 6, Popliteal June 6 Both ends in wound. Discharged August 42d Illinois, age 27. 1864. 1864. 1864. Asst Surg. B. E. 16, 1865. Fryer, U. S. A. 2 Fields. B., Pt. C, 27th N. C., age 21. Sept. 17, 1862. Fracture right leg ; Nov. 28, amp. leg. Dec. 1, 1862. Popliteal Dec. 1, 1862 On stump. Surg. 11. S. Il.-witU. S.V. H.Bni. recur d. Exch. February 28, 1863. 3 Kansche. G. D., 20th Sept. 17, Shot laceration of Sept. 17 Popliteal ... Sept. 17, Card, end in wound ; Discharged August New York, age 35. 1862. popliteal space. 1862. 1862. hajms. rec d. 13, 1 863. 4 Kracher, J. P., Pt., Juno 1, Grapeshot, left thigh, July 24 Popliteal July 24, One end ligated in Discharged March D,6thN.Y.H. Art, 1804. near knee. 1864. 1864. wound; no recur- 15, 186.~>. age 35. Fence. 5 Lo f z, J.,Pt, 1, 105th Mar 25, Fracture of left fibu- Apr. 7, Posterior tibial and Apr, 12, Pop. above its bifur Discharged August Pa., age 26. 1865. la. 10.11,12, poroneal. 1865. cation. Surg. 15. 15 4, 1865. 1865. Wilson, U. S. V. 6 Maher, C., Pt, A, Mar. 25, Upper third of tibia, Apr. 5, Posterior tibial . . Apr. 5, Popliteal, in cont. Discharged October 64th N. Y.,age 20. 1865. post, tibiiil injured. 1865. 1865. Surg. T. R. Crosby, 4, 1865. U. S. V. 7 Smith, P. D., Pt, C, Mai-. 19, Right ankle; gan- May 6, Posterior tibial Mav 6, In lower portion pop- Discharged March 8th Iowa. 1864. greue iu wound. 1864. 1SU4. liteal, iu cont. A. 21,1865. A. Surg. D. McLean. 8 Taft, E. P., Lt Col., July 9, Tibia and fibula, mid- July 24, Popliteal Julv 24, Popliteal, on face of Mustered out No 9th N. Y. H. Art, 1864. die third; July 22, 1864. 1864. stump. vember 28, 1864. age 32. amputation leg. 9 B(irtlioloin6W J. C. May 16 ESflrttnvn of Iwff. lotr \fn\r Ifi PnY^lit^al May 16 Popliteal Died May 29, 1864; Lieut, K,2utuind , 1864. 1864. 1864. tetanus. age 30. CHAP LIGATIONS OF THE ANTERIOR TIBIAL ARTERY. 801 No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJUKT. NATURE OF INJURY. DATE OF ILEMOR- RHAOE. PKOBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. 10 11 JBernhard, A., Pt.,K, 4thOhioCav.,age35. Feb. 25, 1864. Oct. 27, Fracture right leg; ptim amp. leg. Cond. of femur and Mar. 5, 1864. Nov. 10 Anterior tibial Popliteal . . . Mar. 5, 1864. Nov. 14 Popliteal, in middle. A. Surg. J. G. Bu chanan, 125th Ohio. Died March 22,1864; pyaemia. Died Nov 25 !>>f>4 12 A, 10th Va., ago 29. Burnham, IF., G, 8th 1864. Oct. 19, right pop. artery. Right tibia 1864. Oct. 19 Popliteal 1864. Oct 19 A. A. Surg. C. Ebcr- hardt. during amp. thigh. 13 Louisiana, ago 33. Cornwall, 11. McQ., 1864. May 12, Right tibia, anterior 1864. May 18, Popl iteal 1864. MaylS amp. thigh. On face stump. Surg. 1864. Died Mav 28 1W4 14 15 Major, 9tli N. Y. Cav., ago 27. Elliott, J. E., Coip l, E, I a. Cav., age 24. Fletcher, J.M.,C p l. 1864. Apr. 2, 1863. June 18, tibial injured ; amp. at knee, prim. Through left leg ... Flesh wound of right 1864. Apr. 19, 1863. Aug. 14, Recurred 5 times. Popliteal 1864. Apr. 29, 1863. Aug. 14, A. Heger, U. S. A. Popliteal ; hsem. re curred ; amp. thigh. Both ends in wound. Died May 5, 1863. Died An". 14, 18C4 16 17 C, 39th Mass., age 28. Gmy,W.,E, 18th In fantry, age 26. Gwinn E , Pt, B, 1864. Dec. 30, 1802. July 9 knee. Popliteal region .... 1864. Jan. 12, 1863. Julv 22 Popliteal artery . . 1864. Jan. 12, 1863. July 22 A. A. Surg. J. M. McGrath. Both ends in wound typhoid fever. Died January 22, 1863. Died Julv -" J8G4- IS 138th Pa., ago 21. Knight, A. Pt, L,2d 1864. May 4, 12, amputation. Left femur, pop 1864. Sept 6 1864. Sept 10 stump. Popliteal both emls pyasnria." 19 20 *>1 111. Cav., age 24. Lee, A. F., Corp l, A, 24th Ohio, ago 22. Leonard, J., Pt.. L, 7th N. T. H. Art., ago 21. Lynch. J., Corp l, K, 1862. Feb. 25, 1864. May 30, 1864. May 10, liteal wounded. Upper third right tibula. Flesh wound upper portion of left leg. Flesh w d popliteal 1862. Mar. 1, 2, 1864. July 3, 1864. May 17, Peroneal artery . . . Posterior tibial . . . 1862. Mar. 2, 1S64. Julv 3, 1864. Mav 17 in wound. Pop. ligated. A.S rg. T. A. McGraw. Popliteal ; haemor rhage recurred. Poplit l lif d. ^ss t 1862. Ri lig. Mar. 5. Died Mar. 8, 1864; gang. Amputation thigh. Died July 23, 1864. Died May 23 1864- 23 i46th N. Y., age 34. McNnlty, J., Pt, E, 1864. Sept 20, region left leg. Both knee joints .... 1864. 1864. October Surg. C. A. McCall, U.SA. Poplit l and branch, pyaemia. Died October 15 1863. 23 9 4 22d Michigan. Mathews. S., Pt., A, 93d Pa,, age 28. Powers. T., Pt, G, 1863. Mav 15, 1864. May, Left leg; prim. amp. at knee joint Right leg and left Mav 30, 1864. May, Repeated hsem. to June 12. 1863. Juno 12, 1864. Mav with popliteal vein. Popliteal ligated on base of stump. Popliteal ligated in Died June 17, 1864; pyaemia. Died May 14 1864. ? 140th New York. Reynolds. H. H., Pt., 1864. Sept 4, foot, Left knee j nt ; Sept. 1864. Sept 19, Popliteal 1864. Sept 19, cont. Popliteal on face of Died September 30 26 27 ?8 P, 1st Mich. Cav., age 25. Seldon, U.,Pt.H, 9th Virg. Cav., age 23. Sharon, P., Pt,I,153d New York. Smith, A. M.,Serg t, 1864. July 8, 1863. Sept 19, 1864. May, 18, amp. thigh. Popliteal space, pop liteal artery divi ded; left " Fracture of head of tibia. Popliteal art y w ded 1864. July 17, 27, 1863. Oct. 1,5, 12, 64. May, Popliteal artery... Anterior tibial .... Popliteal . 1864. July 27, 1863. Oct. 12, 1864. May, stump. Proximal end iu w d. A. A. Surg. W. S. Adams. Popliteal; hii-in. re curred. Popliteal ligated on 1864 ; pyaemia. Died August 2, 1863 ; pyaemia. Oct 18, amp. thigh. Died Oct. 18, 1864. Died May 22 1864. 29 30 <n F, 20th Maine. Smith. F., Pt., B, 1st Mass. Art., age 28. Taber, J. A., Pt, E, 5th Mich., age 23. Thompson, J. A., 1864. May 23, 1864. Mar. 31, 1865. Aug. 3 Right leg and left thigh. Right leg in middle third. Left \&f- Sept. 3 1864. June 17, 1864. Apr. 10, 1865. Oct. 4 Post, tib.; art y li gated; haem. re curred. Post. tib. or inter- osseous. 1864. June 29, 1864. Apr. 12, 1865. Oct 4 field. Poplit l. A. A. Surg. H. M. Dean. Poplit l lig d ; haem. recur d. Surg. J. C. McK.ee, F. S. A. Died June 29, 1864. Died April 18, 1865. Died Oct 4 1864 39 Corp l, K, 10th In diana, age 27. Vaun. D., Pt, B, 1864. June 3, amp. upper third. Left knee, popliteal 1864. . 1864. June 16, nuity. Popliteal. Surg. R. June 20, amp. thigh. 33 8th N. Y. H. Art., age 18. "Walker, M. K., col 1864. June 3 artery injured. June 25 1864. June 26 B. Bontecou, U. S. V. Died June 22, 1864. Died July 3 1864 34 ored servant, 58th Pa., age 13. Wick, J. C., Pt., C, 1864. Mar. 25, liteal art. wounded. Flesh wounds of both 26, 64. May 23, Popliteal 1864. Mav 23, wound. Surg. R. B. Bontecou, U.S.V. Both ends iu wound. June 14, amp. thigh. 31 155th Penn., age 22. Wild, C. B., Corp l, 1865. Sept. 19 thighs. 1865. Oct I 1865. Oct. 1 Ass t Surg. A. De- lany, TJ. S. V. Popliteal; haem. rec. Died June 20, 1865. Oct. 12 amp. thigh 3G E. 114th New York. Wilkins, T. E., Corp l, A, 49th Virginia. 1864. Oct. 19, 1864. Fracture of fibula, tibial arteries iuj d. 1864. Ant tibial; tibial ligated. 1864. Oct 12. Popliteal lig. ; amp. thigh Oct. 23. Died Oct. 13,1864. Died Nov. 12, 1864. Of the branches of the popliteal the articular artery was ligated in three instances; two of the cases terminated in death: Liyations of the Articular Branch. CASES 1163-1165. Private A. Shaw, I, 16th Massachusetts, aged 19, wounded May 3, 1863; ball entered external condyle of right femur and was cut out at a point three inches above; haemorrhage ; June 11, ligation of articular branch; admitted into Armory Square Hospital, Washington; discharged December 14, 1863. Sergeant J. W. Long, I, 8th Kansas, aged 23; shot fracture right leg, December 16, 1884; Dec. 17, amputation at knee joint; Dec. 18, haemorrhage from internal articular artery ; ligation on face of stump on same day; Dec. 25, haemorrhage external articular; death Dec. 26, 1864. Private S. Lyon, C, 84th Indiana, age 23; shot fracture of right tibia, Chickamauga. September 19, 1883; haemor rhages October 2d, 3d, probably from popliteal artery; ligation of articular branch October 3; great prostration from extensive loss of blood; gangrene; October 6, amputation of thigh at junction of middle and lower thirds; death October 8, 1863. Ligatwns of the Anterior Tibial Artery. Forty-seven cases come under this group; twenty-six patients survived the operation, twenty-one perished, a mortality rate of 44.6 per cent. In seven cases with four recoveries and three deaths the posterior tibial artery was likewise tied. Fifteen were operations on the face of the stump after amputation in the leg. SURG. Ill 101 802 WOUNDS AND COMPLICATIONS. [CHAP. XII. TABLE CXLV. Summary of Forty-seven TAgations of the Anterior Tibial Artery. I Recoveries, 126; Deaths, 2747.] No. 1 2 3 4 5 6 7 8 !i 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 04 35 36 37 NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJUKY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATF. OF O I K RA TION. OPERATION, OPERA TOR. RESULT. Bartley,J.P.,Pt,B, 38th Ind., age 20. Boelmie, C., Pt., E, 52d N. Y., age 33. Brewster, C. C., Capt,, D. 10th Conn., age 45. 1 Bullet, R. W., Pt., H, 22d N. C. Condon, T., Corp l, C, 2d New York Artillery, age 21. Elmer, A., Pt , I, 6!)th Pa., ape 21. Furrow, G., K, 10th Mass., age 20. Galliger. M., Ft, L, 1st W.Va. Cav.,age 31. Goodrich, L. H., Pt., B, 6th Vt., age 30. Gould, J., Pt., C, 105th Pa. Hoar, J., Pt., G, 144th N. Y., age 17. Johnson, "W. H., Capt., F, 144th New York, age 27. McCracken, R. W., Serg t, C, 170th New York, age 32. Mangan, J., Pt., F, Olst Ohio, age 28. Matters, B.. Pt., A, 108thN. Y., age 18. Palmer, A., Pt., G, 3d Mich., age 34. Renshaw, J. L., Pt., H, 2dPa.R.,age28. Rilev, S., H, 92d Pa., age 19. Sampson. I., Corp l, F. 1st Mass. Cav., age 35. Sargent, C., Pt, B, 4th Vt., age 24. Saulsbury. W., Pt., K, 3JthC. T., age 36. Schmidt, C., Corp l, K, 39th N. Y., age 36. Smith, H., Pt, E, llth Vt.. age 19. Stabeufe d, J., Pt, A, 3d Wis., age 30. Suiumeis, P., Pt., A, 2d Vermont, age 29. Weaver, L., Pt, G, 4th Virginia, age 23. Babcock, E , Pt., K, 1st Mich. C., age 39. Boobar, J., Pt, K, 8th Maine, age 49. Bromnn:l,W..E, 15th N. Y. Art,, age 3D. Bumpus, M., Pt., A, 5th Alaine, ago 29. Clark, E. J., Pt. I, 8tl) Mich., ago 30. Clark. J. \V., St-rg t, J, 129th Ind., age 37. Dener, C.,Pf., B.Oth Connecticut, age32. Gla.ss,M.C.,Serg t.F, Kith Mich., age 24. Hardf.-lter. G., Pt, D, 104th Pa. Jom-H J., Pt., I, 27th Ind. .Kane, J. A., Corp l, C,6thC. T., age 33. Mar. 3, 1864, Apr. 2, 1865. May 16, 1864. May 23, 1864. Aug.16, 1864. June 18, 1862. May 5, 1804. Apr. 6, 1865. May 4, 1863. July 30, 1864. July 24, 1863. Feb. 10, 1865. June 17, 1864. July 20, 186*. July 3, 1863. July 3, 1803. June 24, 1864. June 1, 1864. May 11, 1864. Dec. 13, 1862. July 30, 1864. May 5, 1864. Sept. 13, 1864. Sept, 17, 1862. May 5, 1864. July 2, 1863. July 3, 1863. May 20, 1864. Mar. 31, 18G5. May 10, 1864. May 10, 1804. July 19, 1864. Juno 3, 1864. Feb. 17, 1865. Sept.27, 1803. Aug. 9, 1862. Sept. 29, 1804. Fracture bones left foot. Fracture left aukle ; 4th, amp. leg. Flesh, left leg Fracture right foot ; gangrene. Flesh, right leg, mid dle third. Fract. tibia, ant. tib- ial artery divided. Fracture right tibia, middle third. Right ankle Mar. 9, 1864. Apr. 11, 1865. May 21, 1864. June 3, 1864. Aug. 26, 1864. Ant. and post, tibial. A. A.Surg. J. Grant. Both tibials, on face of stump. Anterior tibia], one end in wound. Ant tibial in wound. A.Surjf.R. O Leary, P. A. C. S. Anterior tibial, both ends iu wound. A. A.Surg.W.F.Atlee. Anterior tibial . Discharged Apr. 11, 1865. Discharged Nov. 14, 1865. Discharged Sept. 19, 1864. Recovered July 23, 1864. Discharged July 26, 1865. Discharged Jan. 7, 1865. Discharged Dec. 6, 1864. Discharged Aug. 25, 1865. Discharged Mar. 19, 1864. Discharged Mar. 18, 1865. Duty Apr. 11, 1864. Haemorrhages recur red ; Feb. 23, amp. Disch.Mayl5, 1865. Discharged Jan. 20, 1865. Discharged 1865; re- amputation 1806. Discharged Nov. 3, 1864. Discharged May 31, 1864. Discharged May 18, 1865. Discharged Feb. 9, 1865. Discharged Oct. 16, 1864. Discharged Aug. 25, 1863. Haim.; Jan. 9, 1865, amputation. Dis- ch ged May 26, 1865. 1865, amputation leg. Disch. July 14, 1865. Gangrene. Disch ed Sept, 14, 1865. Discharged March 6, 186;!. Discharged May 13, 1865. Paroled Nov. 12, 1863. Died Oct. 19, 1863. Spec. 2611, A.M. M. Died Aug. 28, 1864. Died May 2,1865; haemorrhage. May 24. amputation. Died May -9, 1864 ; toxajmia. HOMII. Died June 16, 1864; luem.; gang. Gangrene, Died Sept. 1 J, 1864. H;t m.; am p. of thigh. Died June 18,1864; exhaustion. Died Feb. 28, 1865; haemorrhage. Died Oct. 12, 1863. Died Aug. 20, 1862. Died Oct. 13,1864. Apr. 10, 11,1865. May 21, 1864. June , Anterior tibial Amterior tibial . . . June 8, 9, 1864. Anterior tibial June 9, 1864. Apr. 20, 1865. May 10, 1863. On field. July 31, 1863. Feb. 17, 1865. June 22, 1864. Aug. 15, 1864. July 10, 1863. Sept. 2, 1863. Aug. 2, 1864. July 8, 1864. June 28, 1864. Feb. 7, 1863. Anterior tibial, both ends in wound. Ant. tib., one end in wound. A. A.Surg. J. Sweet. Ant. tibial, on face of stump. Fract. left leg, mid dle ; 7th, amp. May 10, 1863. Fracture right foot. . Left external malle- olus. Right fibula, lacera tion anterior tibial artery; excision. Flesh, left leg; 22d, amputation. Fracture right ankle joint; 4th, amp. Fracture left ankle ; Aug. 15, amp. Flesh, left leg Left leg, upper third. Right leg; gangrene Fracture middle third tibia; Dec. 14, amp. Flesh, lower third right leg. Right tibia, middle third. Left leg; prim. amp. Fracture right foot; Oct. 3, amp. leg. Fracture tibia, right. Both legs (also face) . Fract. fibula, left; excision; gangrene. Middlethird, leftfib- ula. Left leg, flesh, lower third. Right ankle joint. . . . Fracture left foot; June 4, amp. leg. Fracture left leg; prim. amp. upper third. Fracture right leg. . . Right anterior tibial artery. Foot; prim.; Syme s amputation. Fracture left leg; Aug. 13, amp. Lower third, right fibula. July 31, 1863. Feb. 17, 1865. Both tibials. Ass t Surg. "W. Thomson, U. S. A. Ant. tib., in continu ity. Asst. Surg. J. G. Murphy. T7.S.V. Anterior tibial liga- ted ; July 25, slight haemorrhage. Ant. tibial, on face of stump. Ant. tibial, on face of stump. Ant. tibial, on face of stump. Both ends in wound. Ant. tibial, in wound . Both ends in wound. A. A. Surg. T. Lie- bold. On face of stump . . . One end iu wound; religation. Anteriortibial. Surg. E. Bentle.v, TJ. S. V. Anterior tibial, on face of stump. On face of stump . . . One end in wound. A. A. Surg. J. F. Strawbridge. Both ends in wound. Both ends in wound. A. A. Surg. J. H. Jamar. Both ends in w d. A. A. Surg. T. Liebold. Anterior tibial. A. A. Surg. S. \V. Brigg.s. Ono end in wound . . . On face of stump . . . Anterior tibial, on faceot stump. Surg. A.M.TVilder.U.S V. One end in wound. A. A. Surg. S. Co- loosdian. In continuity In continuity, two inches above stump. Anterior tib., and iu- terosseous, on face of stum p. Both tibials, both ends in wound. A. A. Surg. O.Warner. Anterior tibial July 8, 1863. Sept. 2, 1863. Aug. 2, 1864. July 8, 1864. June 28, 1864. Feb. 7, 1863. Sept. 10, 1804. Anterior tibial Anterior tibial Anterior tibial Both tibials Anterior tibial . . May 23, 1864. Sopt,26, 1864. Oct. 8, 1862. June 26, 1864. July 14, 1863. Oct. 19, 1863. July 10, 1864. Sept.26, 1864. Oct. 8, 1862. June 26, 1864. July 14, 1863. Oct. 19, 1863. July 10, 1864. Anterior tibial Anterior tibial . . Anterior tibial .... Anterior tibial; sloughed. Anterior tibial Anterior tibial .. May 19, 1864. June 6, 1864. July 19, 1864. June 12, 1864. Feb. 20, 1865. Oct. 3, 1863. Aug. 18, 1862. Oct. 8- 12, 1864. Branch tibial Anterior tibial May 19, Ie64. Junel6, 1864. July 19, 1864. Junel2, 1864. Fob. 20, 1865. Oct. 3, 1863. Aug.18, 1862. Oct. 12, 1864. Anterior tibial Ulceration anterior tibial. Anterior tibial Anterior tibial; in- terosseous. Anterior and pos terior tibials. 1 Confederate States Mudical and Surgical Journal, Volume I, p. 177. CHAP. X1I.J LIGATION OF THE POSTERIOR TIBIAL ARTERY. 803 No. NAME, AGK, AND MlLITAKY DESCRIPTION. BATE OF INJURY. NATURE OF INJUKY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATE OF OPERA TION. OPERATION, OPERA TOR. RESULT. ?fl Kercher J., D 7th July 2, Right leg, wound of July 29 Until tibial arteries 39 40 41 Mich. Cav. McCauley, S. E., Pt., n, 28th Iowa, age 19. Partridge, G. V., Saddler, B, 4th Mas sachusetts Cav., age 21. Poctcn, W. F., Pt., C, 1863. Oct 19, 18G4. April 2, 18G4. Nov. 30, both tibial arteries. Fracture right tar sus; Nov. 7,amp.leg. Fracture left tibia, and injury ant. tibial artery. Eight tibia, middle Nov. 11, 1864. April 9, 1864. Mar. 23, Anterior tibial ar tery. Anterior tibial Anterior tibial .... 1663. Nov. 11, 1864. April 9, 1864. Mar. 23, ligated. On lace of stump In wound, one end: April 27, haemor rhage recurred. On face of stump . . Died Ang 10, 1803. Du-d Nov. 19, 1804; haetno- rhage. Died May 2, 1864; haemorrhage; py aemia. March -4 1805 amp 42 4T 9th Miss., age 24. Robhins, E. H., Cor poral, F, 15th Mass achusetts, age 29. Scbreiber, A., Pt., A, 1864. May 6, 18C4. Mav 10, third; Mar. 19, 65, amputation. Fracture fibula, inj. ant. tibial artery. Fracture right tibia. 18C5. Mav 31, 1804. Mav 19, Anterior tibial 1865. May 31, 1864. May 19 In continuity. A. A. Surg. J. Ransom. thigh. Died April 20, 1865. June 2, amputated thigh. Died July 15,1864. 44 45 50th Peun., age 17. Skiffington, J., Pt., I, 2d New York H. A., age 28. Wilkins, T. -E.,Corp l, 1804. June 10, 1864. Oct. 19, Flesh, right leg Fract. fib., sev. ant. 1864. July 28, 1864. Anterior tibial . . . 1864. Julv 28, 1864. Both ends in wound. A. A. Surg. W. F. Atlce. Both tibials- Oct 31 Died June 9, 1864 ; pyaemia. Died Aug. 29, 1864; pyaemia. Died Nov I 1 1804- 46 47 A, 49th Virginia. Williams, E., Pt. F, 136th Penn., age 45. Williams, II. H., Pt., D, 19th Maine. 1864. Dec. 13, 1862. July 2, 1863. and post. lib. arts. Ant. tibial art.; Dec. 28, haem.; amp. Fracture tibia and lib., lower third. Jan. 1, 1863. July 12, 1863. Anterior tibial Anterior tibial Jan. 1, 1803. July 12, 1863. amputated thigh. On face of stump In continiiitv. A. A. Surg.F. T.ilaury. haemorrhage. Died Jan. 1, 1803; pyaemia. Died July 18, 1863. Ligations of the branches of the anterior tibial artery were reported one of the dorsalis pedis and two of the interosseous ; one of the latter was fatal: CASES 1166-1168. Private J. Johnson, D, 4th U. S. Artillery, age 36; fracture of metatareal bone of great toe May 14, 1864 ; gangrene ; July 20th, ligation of dorsalis pedis, both ends being tied in wound by Surgeon A. Hegner, U. S. A. Sergeant H. S. Foster, E, 104th New York, age 22; fracture of left os calcis July 1, 1863; amputation of leg July 8th ; haemorrhage from interosseous July 10th; interosseous ligated on face of stump; discharged March 22, 1864. Captain J. Brown, H, 92d Ohio ; shot wound of right foot September 19, 1863 ; amputation of leg September 27th ; haemorrhage from interosseous Septem ber 29th; artery ligated on face of stump on the same day; died October 5, 1863, from effects of haemorrhage. Ligations of the Posterior Tibial Artery . Forty-eight cases were reported in which the posterior tibial artery alone was ligated; twenty-nine ended in recovery, nineteen in death, a fatality rate of 39.5 per cent. Ten were operations on the face of the stump after ampu tation of the leg. TABLE CXLVI. Summary of Forty-eight Ligations of the Posterior Tibial Artery. [Recoveries, 129 ; Deaths, 30 48.] No. 1 2 3 4 5 6 7 8 9 10 11 NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF HEMORRHAGE. DATS OF OPERA TION. OPERATION, OPERA TOR. RESULT. Ball, J. D., Corp l, A, 125th N. Y., age 24. Bowers. G., Pt., B, 77th N. Y., age 31. Brazzle, J., Pt., G, 23d Mo., age 18. Buckner, J. F., 1st C. S. A., age 21. Cashdollar, L. W., Pt., C, 128th N. Y., age 21. Clark, P., Pt., D, 140th X. Y., age 28. Collins. O., Pt,, D, 151st N. Y., age 32. Copas, W. A., Serg., B, 30th Ohio, nge 28. Dorr, J. A., Pt.. E, 136th X. Y.,age 20. Du Bow, L. A., Lt., 1. 120th X. Y., age 21. Emorv, R., Pt., D, 5th Vt., age 33. May 18, 1864. Sept.19, 1864. Sept. 1, 1804. Apr. 6, 1862. Sept. 19, 1864. July 2, 1863. Nov. 27, 1863. Sept. 19, 1864. May 20, 1864. Sept.20, 1861. Mav 5, 1864. Flesh, right leg, di viding post, tibial. Fract. right fibula; excision. Fractured left fibula. Ri^ht le" 1 Mav 28, 1864. Nov. 13, 1864. Jan. 1,3, 9, 1865. Apr. 16 Post, tibial Mav 28, 1864. Both ends in wound. Asst. Surg. A. IL- gram, U. S. A. Ligation bv Asst. Surg.R.F. Wier.U. S. A. One end in wound. A. A. Sing. A. A. Greene. Li"utiou Discharged Dec. 29, 1864. Discharged June 5, 1805. Discharged July 26, 1865. Recovery. Discharged May 30, 1865. Recovery. Discharged Feb. 25, 1865. Discharged Juiio 5, 1865 Discharged Juno 13, 1865. Discharged Jan. 10, 1865. Discharged Dec. 16, 1804; Aug., 1865, uiup. Jan. 9, 1805. Apr. 10, 1802. Oct. 27, 1864. Jnlv 10, 1863. Dec. 9, 1863. Oct. 27, 1864. Mav 20, 1864. Sept.20, 1864. Aug. 4, 1804. Fract d right tibia; 20th, amputated. Right ankle ; 3d, am putated. Fracturd left fibula; excision. Fract. middle, right leg ; Oct. 26, amp.- Right ankle, sever ing post, tibial art. Right foot, lacerat ing post, tibial. Left leg; gangrene.. 1862. Oct. 27, 1864. July 10, 1863. Dec. 9, 1863. Oct. 27, 1804. On face of stump On face of stump In wound, both ends. Surg. E. Bent ley, TJ. S. V. On face of stump .. Below int. mallolus. Surg I. N. Himos, 73d Ohio. Ligation. Stuj.H.F. Lyster, 5th Mich. Both ends in wound. A. A. Surg. J. B. i niudnll. Post, tibial Post, tibial Post tibial Post, tibial Post, tibial Aug. 4, 1864. Post tibial 804 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 NAMB, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF HAEMOR RHAGE. PROBABLE SOURCE OF H-KMOKRHAOE. DATE OF OPERA TION. OI-E RATION, OPERA TOR. RESULT. Gilmore, M , Pt., B, 96th 111., age 22. Hagoy, J. D., Pt,, I, 138th Pa., ago 24. Ingalls. H. B., L, 1st Me. Oav., age 25. Johnson, A. J.. Corp., A, 19th Intl., age 25. Johnson, H. C., Sgt, C, 28th Ky., age 25. Jones, S. W., Corp., A, 4th Del., age 29. Leichty, J., Pt, F, 8th Pa. C., age 21. Lowth, J.. Sgt,, M, 4th Wis. C., age 26. McCartv, J., Pt., F, 48th N. Y., age 38. Moran, M., Pt., A, 2dN. J. C., age 20. Poole E E. Pt.,E, Aug. 3, 1864. Apr. 2, 1865. Mar. 31, 1865. July 1, 1863. Feb. 4, 1864. Oct. 8, 1864. May 11, 1864. Ausr.24, 1864. Mar. 2, 1864. Feh. 11, 1864. Nov. 30, Flesh, left leg, inv. post, tibia). Flesh, left leg, artery opened. Middle, right leg, flesh. Fr. left fibula, mid.: gangrene. Left ankle ; Feb. 25, amp. leg, lower 3d. Fract. left fibula .... Aug. 3, 1864. Apr. 21- 28, 1865. Apr. 7, 9, 1865. Nov. 23, 1863. Feb. 25, 1864. Aug. 3, 1864. May 8, 1865. Apr. 9, 1865. Nov. 23, 1863. Feb. 25, 1864. In field. Ligation. Surg. S. H. Kersey, 36th Ind. One end in wound. A. A. Surg. H. M. Bellows. Ligation. Surg. E. Griswold, U. S. V. One end in wound. A. A. Surg. J. H. Janiar. Oii face, in stump . . . Post, tibial and pero- neal. Surg. A. A. White, 8th Md. Discharged Jan. 10, 1S65. May 9, 1865, amp. leg. Discharg d July 26, 1865. Discharged Aug. 12, 1865. Discharged Mar. 30, 1864. Discharged Dec. 16, 1864. Discharged June 22, 1865. Discharged Jan. 11, 1865. Gang. ; amp. thigh. Discharg d July 17, 1865. Amp. foot ; amp. leg. Discharg d June 10, 1865. Died in 1874. Discharged Oct 21, 1865. To Provost Marshal. Furloughed Aug. 11, 1864. Discharged July 27, 1866. Discharged Feb. 6, 1865. Duty March 30, 1865. Discharged Aug. 4, 1865. Discharged Nov. 17, 1863. Discharged Oct. 27, 1863. Died July 28, 1862. Died July 7, 1864 ; pyaemia. Died Feb. 14, 1865. Died June 15, 1865; erysipelas. Disch. Aug. 31. Died Nov. 17, 1863. Died June 17, 1864 ; exhaustion. Died June 13, 1864. Died Nov. 9, 1864. Died Aug. 8, 1864. Died Nov. 23, 1864. Died April 19, 1865. Died Jan. 11, 1863. Died October 1,1862; exhaustion. Died June 30, 1864. Haem ge ; gangrene. Died Sept. 25, 1803. Died March 23, 1865 , exhaustion. Died Nov. 22, 1864. Died Aug. 30, 1865 ; exhaustion. Amp. leg. Died May 28, 64; ex n and py. Post, tibial Branch post, tibial Post, tibial Fract. left fibula; ex cision. Fr. up. third right fibula; May 27/65, rxcis. Fr. foot, dorsal pedis and int. plant, ar teries. Right leg, middle, flesh; gangrene. Frac. middle, right femur. Flesh, left leg Flesh, left leg, upper third. Flesh, right leg Right leg, middle Severing post, tibial artery, right leg. Flesh, right leg Left leg, fract lower third; 5tb. amp. Fract left fibula .... Flesh, right leg Fract. right tib., lac. post. tib. artery. Left leg, lower third, inj. post. tib. artery. Fr. tib. and fiUbla; prim. amp. right leg. Fr. low. third rtfib.; June 9, exc. Fract. tibia Post, tibial May 27, 1865. Mar. 2, 1864. Feb. 27, 1864. Mar. 1, 1865. July 3, 1864. April 6, 1865. July 25, 1863. Oct 14, 17, 19, 64. May 27, 1865. Mar. 2, 1864. Fob. 27, 1864. Mar. 1, 1865. July 3, 1864. April 7, 1865. July 25, 1863. Oct. 19, 1864. On field. Sept 23, 1863. May 12, 1863. July 10, 1862. June 10, 1864. Dec. 27, 1864. In continuity, upper third. In cont. behind int. malleolus. In wound. A. A. Surg. S. S. Jessop. In wound, both ends. Surg. B. B. Breed, T7.S V. Ligation Ligated by Surg. G. L. Pancoast, U. S. V. Both ends in wound. Both ends in wound. A. A. Surg. J. W. Kerr. Ligation Post, tibial Post, tibial 17th Ala., age 18. Rigsbv, T., Pt, C, 9th N. H., age 23. Ritter, D. T.,Corp l, F, 208th Pa., age 19. Sheridan, J., D, 68th Pa., age 31. Thompson, S., Pt., E, 4th N. J., age 23. Trask.H.V., Ft, G, 120th N.T., age 27. Trowbvidge, D. A., L, 5th III. Cav. Valentino, L. W., Pt., K, 6th Maine. Adams, M.J.,Pt.,D, 20th Indiana. Brown, W.H., 5th N. J. Battery, age 25. Cramp, T., Pt,G, 5th Minn., age 33. Flannigan, H. A., Scrg t H, 16th Pa. Cav., age 25. Fogle. M. P., Corp l, A, 133d N. Y., age 3L Freeman, G. B., Pt, F, 58th Mass., age 32. Fuller C. E. Pt. D 1864. June 20, 1864. Mar. 25, 1865. . July 3, 1863. Sept. 22, 1864. Mar. 25, 1865. July 8, 1863. May 3, 1863. June 25, 1862. May 24, 1864. Dec. 16, 1864. April 7, 1865. June 14, 1863. June 3, 1864. June 3, 1864. Oct. 19, 1864. July 9, 1864. Oct. 1, 1864. Mar. 25. 1865. Dec. 13, 1862. Sept. 14, 1862. May 27, 1864. July 2, 1863. Mar. 8, 1865. Aug. 3. 1864. Apr. 1, 1865. May 5, 1864. Post, tibial Post tibial Sept. 23, 1863. May 12, 1863. July 10, 1S62. June 10, 1864. Dec. 27, 1864. May 14, 1865. June 23, 1863. June 9, 1864. Post tibial In wound On face of stump Ligation Ligation Both ends in wound. A. A. Surg. S. W. Blackwood. In cont, mid. third . . On face of stump Ligated Post, tibial Post tibial June 23, 1863. On field. Oct. 31, 1864. Aug. 5, 1864. Oct. 29, 1864. Apr. 5, 1865. Jan. 2, 1863. Oct. 2, 1862. June 22, 1864. July 24, 1863. Mar. 8, 1865. Oilfield. Apr. 26, 1865. May 23, 1864. 36th Wisconsin. Gaffnev. M., Pt., A, H4th N.Y., age 27. Hoasch, G., Pt, E, 110th Ohio, age 45. Hodgkius, F., G, 1st Mass. C., ago 29. - Jones, W. H., Pt., E,G5th.V.Y.,age26. McCluskev, P., Sgt, F,26thN .Y.,age27. 3 Matht-rson, R.,Col.. 32d New York. Miller, H. L., Pt.,B, 9i!d Ohio, ago 27. Moore, C., Serg t, D, 42d N. Y., age 40. Oakley, C.N.,Pt,A, 85th N. Y.,age 32. Tyler, C., Lieut., D, 1291 h Indiana. Vaughn, N., Pt, H, 1st Va., age 30. Wright. E., Pt, F, 119th Pa., age 18. Bones left foot Oct. 31, 1864. Aug. 4, 5, 1864, Oct. 29, 1864. Apr. 3, 1865. Jaii. 2, 1863. Sept 20, Oct. 1, 1862. July 19, 24, 63. In cont., low. third. A. A. Surg. E. L. Duer. On face of stump . . . One end in wound . . . Both ends in wound . On face of stump Both ends in wound. Surg. G. Burr, U. s.v! Ligation Ligat n. Aug. 1, 63, amp. leg. Lig. post, tibial and peroneal arteries. Both ends in wound On face of stump. . . In wound; May 25, haem. rec d. Both bones left leg; llth, amp. leg. Post tibial Left fibula, post, tib ial artery cut. Fract. left leg ; prim, amp. upper third. Fr. right fibula and inj. post, tibial. Fract. middle third right fibula. Fracture left ankle . . Lac. flesh left leg . . Post, tibial Post, tibial Post, tibial Post, tibial Os calcis and post, tib. artery. Fr. left aiikle joint, April 20, amp. leg. Post, tibial artery of right leg. Apr. 26, 1865. May 22, 23, 64. Post tibial ........ Post, tibial The plantar branch of the posterior tibial was ligated, in three cases, on the face of the slump after partial amputations of the foot; one case resulted in death: 1 LIDELL (J. A.), On the Wounds of Blood-vessels, etc., in U. S. Sanitary Commission Memoirs, Surgical Volume I, p. 262. "LiDELL (J. A.), On the Wounds of Blood-vessels, etc., in U. S. Sanitary Commission Memoirs, Surgical Volume I, p. 223. 3 American Medical Times, Vol. VI, p. 101. U. S. Sanitary Commission Memoirs, Surgical Volume I, p. 46. CHAP. XII.J HAEMORRHAGES AND LIGATIONS CONCLUDING OBSP^RVATIONS. 805 Lifjations of Plantar Arteries. CASES 1169-1171. Private D. Bailey, G, 3d Iowa Cavalry, age 26; shell wound of right foot June 10, 1864 ; June 14th, removal of metatarsal bones; external plantar ligated by A. A. Surgeon J. N. Sharp; February, 1865, amputation of leg at lower third ; discharged September 11, 1865. Private J. Belts, K, 2d New Hampshire, age 25 ; wound of toes of left foot May 27, 1864 ; May 28, amputation of three toes ; June 9, haemorrhage from plantar ; vessel ligated on face of stump ; returned to duty July 4, 1864. Private W. Mockler, G, 81st Pennsylvania, age 47; shot fractune of right foot Decem ber 13, 1862 ; December 26, Chopart s amputation ; December 31, haemorrhage from external and internal planter arteries; liga- tion on face of stump on the same day; death January 10, 1863. Of four ligations of the peroneal artery three had fatal terminations; the operation was on the face of the stump after amputation in the leg in one case. Ligations of the Peroneal Artery. CASES 1172-1175. Private O. F. Nash, K, 12th Wisconsin, age 21 ; shot wound of leg August 23, 1864; August 27, resection of four inches of middle third of left fibula; artery ligated by Surgeon A. J. Miller, 13th Iowa; discharged June 30, 1865. Private J. E. DeWitt, A, 9th New York Cavalry, age 23; shot fracture of fibula June 21, 1864; bleedings from peroneal June 24, 25; June 25, fractured portion of fibula excised and peroneal artery ligated by A. A. Surgeon O. P. Sweet; death June 25, 1864. Private C. E. Eastman, F, 9th Maine; shot fracture of left leg July 18th; ampu tation of leg July 23d; sloughing; haemorrhage from peroneal; artery ligated on face of stump by Surgeon D. Merritt, 55th Pennsylvania. Private S. Mitchell, D, 188th Penn., age 23 ; shot fracture of left fibula June 3, 1864 ; haemorrhage from peroneal June 27th; ligation of peroneal and removal of two inches of fibula by A. A. Surgeon A. W. Merrill; death August 17, 1864. General Remarks on Haemorrhages and Ligations. It has been found most con venient in dealing with the cases of hemorrhage to classify them simply as primary and secondary. While undoubtedly some of these bleedings occurred a short time after the injury and before the period of suppuration had commenced, it was found impossible, from the nature of the records, to eliminate these cases with certainty and accuracy; and inasmuch as such haemorrhages partook more or less of a primary or secondary character they have been assi gned to one or the other of these groups. In the following table are indicated the days on which ha3morrhage first occurred : TABLE OXLVII. Table indicating the days on which the first haemorrhage occurred. Day after injury on which the haemorrhage occur red. V Head, chest, and up per extremities. Abdomen, pelvis, and lower extremities. Day after injury ou which the haemorrhage occur red. O Head, chest, and up- per extremities. Abdomen, pelvis, and lower extremities. Day after injury on which the htemorrhage occur red. o 3 ty Head, chest, and up per cxtromities. Abdomen, pelvis, and lower extremities. 1st day 153 68 85 Forward 788 425 363 Forward 1,166 644 522 2d day 17 5 12 15th day 51 36 15 27th day 13 8 5 3d day . - - 17 6 11 16th day 40 21 19 28th day 17 12 5 4th day 26 n 9 17th day 41 20 9 1 29th day 13 8 5 5th day 24 15 9 18th day 39 24 15 30th day ... 5 3 2 6th day 37 90 15 19th day 33 19 14 31 to 40 days 102 51 51 7th day 62 36 26 20th day 20 9 11 41 to 50 days . 57 25 32 8th day . 58 34 24 21st day 35 23 12 51 to 60 days 40 15 25 9th day 68 35 33 22d day 34 16 18 61 to 70 days 21 6 15 10th day 71 37 34 23d day 28 17 11 71 to 80 days 10 1 9 llth day 44 27 24th day 23 15 g 81 to 90 days 8 3 5 12th day C8 43 25 25th day 14 (5 8 91 to 100 days - ... 6 G 13th day 64 33 31 26th day 20 13 7 4 18 1,166 644 522 1,480 780 700 The number of bleedings on the first day was one hundred and fifty-three (153), of which one hundred and ten (110) were haemorrhages immediately following the injury (strictly primary, see TABLE CXXIV, p. 763), while forty-three (43) occurred at some period within the first twenty-four hours succeeding the injury. Should it be deemed desirable to make a group of intermediary cases, these forty-three cases with those occurring on the second and third days should probably be so classified. Those of the first day undoubtedly 806 WOUNDS AND COMPLICATIONS. [CHAP. xn. partook of the character of primary haemorrhage and were results of reaction ; as to those of the second and third days the data are insufficient to determine their proper classification. By the fourth day sufficient time had elapsed to allow such changes as result from inflamma tory action and which are recognized as productive of secondary haemorrhage, and it will be noticed that from this day the bleedings perceptibly increase and steadily maintain an upward tendency until the tenth and eleventh days, when the greatest number of haem orrhages occurred. From this point their frequency gradually and somewhat regularly diminishes until the thirtieth day; after this time they lose their regularity and occur at various intervals, subject to infectious diseases or other peculiar conditions attending each case. Examples of long-deferred hsemorrhages were not rare. In the case of Mullan, cited in TABLE XLIX, on page 650 of the Second Surgical Volume, haamorrhage did not occur until the 264th day, and in the following case the first bleeding took place on the 122d day: CASE 117G. J. Brazzle, Co. G, 23d Missouri, aged 18 years, was wounded in both legs, at the battle of Jonesboro , Sep tember 1, 1864. He passed through several hospitals, lastly entering No. 8, at New Albany, on December 2d. Assistant Sur geon S. M. Horton, U. S. A., in charge of the latter, reported: "The wound was caused by a minie ball, which entered the left leg at the inner edge of the gastrocnemius muscle, three inches below the knee joint, and passed out at the opposite side of the leg, splintering the fibula in its course. No haemorrhage took place at the time the wound was received, but three attacks occurred in this hospital, the first on January 1st, the second on January 3d, and the third six days later. The entire loss of blood amounted to about a quart, and its source was the posterior tibial artery, the cardiac extremity of which was ligated at the bottom of the wound, on January 9th, by Acting Assistant Surgeon A. S. Greene. Chloroform constituted the anajsthetic. At the time of the operation the wound was in a healthy condition and the patient was in good health, but looked exsanguineous from the repeated losses of blood. No recurrence of haemorrhage followed after the operation. Erysipelas, in a mild degree, subsequently attacked the leg, leaving it wdematous. By March 31st the wound had not yet healed, but was* discharging unhealthy pus, giving evidence of caries of fibula at the site of the wound." The patient was subsequently transferred as a convalescent to Joe Holt Hospital, and on July 26, 1865, he was discharged from service and pensioned. Examiner G. W Newman, of Bethany, Mo., May 8, 1867, certified to the injury, and added: "From appearance there is yet some detached pieces of the fibula in the wound. The wound is running, the leg is considerably enlarged, and the gastrocnemius muscle con tracted so that he cannot bend the foot forward, and walks with difficulty." Two years later the same examiner stated: "The wound has not discharged for ten or twelve months. I think the leg will gradually improve," &c. Examining Surgeon J. Walker, at subsequent dates, reported the wound of the right leg, made by the missile passing through the calf of that limb before entering the left leg, produced no disability, but that the left leg is wasted and its motion much impaired, flexure being confined to a right angle, and the limb requiring to be bandaged to prevent swelling. In May, 1877, the exit wound was reported to be suppurating occasionally. The pensioner was paid September 4, 1880. In another instance a case of fracture of the humerus haemorrhage from sloughing did not occur until the one hundred and twenty-ninth day, necessitating, at that late period, amputation of the arm: CASE 1177. Sergeant M. Bumgardner, Co. B, 9th Iowa, was wounded in the right arm during the assault on Vicksburg, May 22, 186:5. He was treated at a field hospital for some weeks, and subsequently at JeS ersou Barracks. Surgeon J. F. Randolph, U. S. A., in charge of the latter hospital, made the following report: "The injury consisted of a fracture of the humerus, lower third, and was caused by a round ball. The wound became gangrenous and sloughing, causing haemorrhage from the biachial artery to the amount of thretj pints on September 28th. The bleeding was checked, but recurred on October 9.<\, when circular amputation of the arm was performed at the upper third by Assistant Surgeon II. E. Tilton, U. S. A. Equal parts of ether and chloroform were used as an anaesthetic, from which the patient reacted tardily. At the conclusion of the operation hut little hope was entertained of his recovery, and for several days afterwards he continued very weak. Under a treatment, however, of tonics and stimulants, and cold water applications to the stump, the patient subsequently rapidly improved." On December 3, 1863, he was discharged from service and pensioned, and subsequently he was supplied with an artificial arm of the "Lincoln" pattern. In his application for commutation the pensioner described the stump as being in a sound condition. The pensioner was paid June 4, 1881. Not unfrequently the haemorrhage following immediately upon the injury ceased spon taneously only to return at a later period, generally in the evening or during the night, at times when the reactionary process, or the wound fever, were most pronounced : CASE 1178. Sergeant Christian Geisel, Co. II, 6th Pennsylvania Cavalry, aged 25 years, was wounded at Spottsylvania, May 12, 1864. On May 16th he was admitted into Hammond General Hospital, Point Lookout, Maryland, whence Surgeon A. Heger, U. S. A., reported: " Gunshot wound right side of chest; ball entered in front near the armpit, fracturing the right shoulder blfi de at the middle ; the missile was cut out on May 16th. Secondary haemorrhage occurred on May 27th, to the extent of eight ounces, from the axillary artery. The fractured lower angle of the shoulder blade was removed. The htemorrliage did not come from the subscapular artery; the operation to ligate the axillary artery was therefore commenced May 27th, but he CHAP, xii.] HEMORRHAGES AND LTGATIONS. 807 died before it was finished. His comrade said that hemorrhage to the amount of a gallon occurred immediately after being wounded, but that it ceased spontaneously ; the pulse was very low before the operation was commenced ; he lost no blood during the operation. Though lie was very carefully and slightly put under the influence of chloroform, the same may have hastened hie end. No post-mortem examination was made; the body was given to his father." In several instances one or more slight bleedings "warning bleeding"- preceded the actual haemorrhage, as in the case of J. Lightfoot, 25th Massachusetts, detailed on page 443 of the Second Surgical Volume, and in the example here adduced: CASE 1179. Private A. M. Buzhardt, Co. K, 14th South Carolina, aged 23 years, received a shot fracture of the upper third of the right femur at the battle of Malvern Hill, July 28. 1864. He was captured and conveyed to hospital at City Point, whence he was transferred to hospital at Alexandria on August 10th. Surgeon E. Bentley. U. S. V., recorded the following result of the injury: "The fracture was very high up and the femur was much shattered. The limb was placed upon a double- inclined plane and the fragments were placed in apposition as nearly as possible. The patient was worn out with exposure and anxiety and had some diarrhoea. Slight haemorrhages occurred on September 4th and 7th, which readily yielded to pressure. On September 8th a severe haemorrhage took place, exhausting iu amount, from which the patient sank rapidly, and died the same day. The post-mortem examination showed the heart to be exsanguineous and without clot; pus in body of the sternum; lungs sound; liver pale and anaemic; other organs sound. Evidences of haemorrhage from branches of the profunda artery were found." Instances of haemorrhage from the distal ends of arteries after ligations of the cardiac end are reported and will be referred to hereafter; but there were also a few instances in which the bleeding occurred from the farther extremity of the wounded blood-vessel, either as primary or secondary haemorrhage, before operative interference. In the case of Harrison (Second Surgical Volume, p. 926, CASE 1869), haemorrhage from the distal end of the ulnar artery was noted on the tenth day after the injury. In the following case bleeding from the distal end of the anterior tibial artery occurred on the seventh day after the injury: CASE 1180. Saddler G. V. Partridge, Co. B, 4th Massachusetts Cavalry, aged 21 years, was wounded iu the left leg during a skirmish near Jacksonville, April 2, 1864. The missile, a ball, passed directly through from back to front, fracturing the tibia, comminuting a portion of the internal surface of the bone, and cutting the anterior tibial artery at the middle of the limb. Five days after being wounded the man was admitted to hospital No. 3, at Beaufort, where haemorrhage occurred to the amount of four ounces from the distal end of the injured vessel on April 9th, on which day the fractured bone was excised and the artery was ligated. The operation was performed by Acting Assistant Surgeon W. A. Greenleaf, who made an incision five inches in length along the line of the internal surface of the tibia and removed eleven pieces of bone, cutting off the points with the chain-saw. At the time of the operation the edges of the wound looked dry and red, and the parts were swollen, very painful, and discharging some. The patient Avas in good spirits and had a good appetite, but was exhausted from previous loss of blood; pulse 65. Only the lower extremity of the anterior tibial artery was ligated, the vessel having been so extensively destroyed that it was impossible to reach the upper end. Chloroform was used during the operation, from which the patient reacted well. He did well for three days, when chills came on and the wound sloughed. On December 17th sloughing ceased, healthy granulations appeared, and pus discharged freely. Stimulants were duly administered. On April 20th chills were more frequent and at times severe. Decided symptoms of pyaemia developed on April 27th, when a slight haemorrhage also recurred from the superficial arteries, which was easily controlled by pressure and the application of persulphate of iron. Death resulted from pyasmia May 2, 1864. The history of the case was reported by Assistant Surgeon J. F. Huber, U. S. V. In the case of Calef, 2d New Hampshire (see CASE 1101, page 756, ante), in which a round ball had occluded the proximal end of the divided carotid artery, a false aneurism formed at the distal extremity. The form of haemorrhage known as capillary or parenchymatous was occasionally seen, and was marked by a steady leakage of blood from the capillary vessels, often great in amount and frequently resulting in syncope or exhaustion. The discharge had neither the bright scarlet of arterial nor the darker hue of venous blood; it flowed without jets and was often difficult to arrest. When observed as a primary condition, or after a primary operation, it was generally the result of what is known as haemorrhagic diathesis. In other cases it was due to paralysis of the capillary vessels from inflammatory action. It was most frequently noticed as an accompaniment of pyaemia and osteomyelitis, and was caused by interrupted venous circulation, assisted by the leucothycemic condition of the blood in such cases. Fifteen cases of this form of haemorrhage were reported. In the cases of recovery 808 WOUNDS AND COMPLICATIONS. [CHAP. XII. the bleeding was comparatively slight, and easily controlled by cold, compression, or styptics. Of the nine fatal cases death occurred either as a direct result of the haemorrhage or from the complications which probably gave rise to the bleeding, as pyaemia, gangrene, erysipelas, and diarrhoea. Of the fifteen cases, capillary haemorrhage followed amputation in seven instances with three .recoveries and four deaths; and excision in six cases r with one recovery and five deaths. Four cases of medullary hemorrhage were noted. Two, occurring from medullary arteries of stumps in pysemic cases, resulted in death. One appears to have been a case of recurring haemorrhage from medullary artery of tibia of a patient much debilitated who finally recovered. The fourth was a case of osteomyelitis of tibia and fibula further com plicated by diarrhoea; it ultimately terminated in recovery. Traumatic, A?ieurism. In seventy-four cases the injuries were followed by traumatic aneurism. Twenty-three cases terminated in recovery and fifty-one in death, a mortality rate of 68.9 per cent. Thirty-four, or nearly one-half of all the cases, were aneurisms of the femoral or axillary arteries twenty of the former and fourteen of the latter. TABLE CXLVIII. Summary of Seventy-four Cases of Traumatic Aneurism. ARTERIES. O Recoveries. Deaths. TREATMENT. ARTERIES. 1 u Recoveries. ,0 Deaths. oo TREATMENT. Ligation. No ligation. Ligatiou. , No legation. Recoveries. Deaths. Recoveries. Deaths. 00 ff. _o. _t : OD a* \- a fc .3 O *J C *; : g 2 K a , 6 17 4 11 ! i 5 1 3 1 4 1 3 1 1 1 3 Carried forward ... 38 1 1 j 10 1 External Carotid Subclavinn 3 Internal Iliac . ] i i Suprascapular . 2 14 1 1 3 1 11 1 1 2 1 10 Sciatic i 1 1 ] 20 ] 2 5 1 15 5 11 4 1 Acromial Thoracic . . . Pudic 1 7 1 1 2 1 Brachial 5 1 1 2 3 2 1 1 Popliteal . . 1 7 2 1 1 Tibials : 5 2 5 Radial and Uluar Forward 3 2 1 1 Peroneal > . . Aggregates 38 10 28 6 17 4 11 74 2. i 51 l. i 20 10 22 The aneurisms were either diffuse or circumscribed, and in one instance, the case of Click, detailed on page 541 of the First Surgical Volume, time had been given for anas- torn otic communication. In the case of Hickey (First Surgical Volume, page 539), in which ligation of the subclavian was performed for aneurism of the axillary, an aneurism again developed after his discharge from the service; the man is a pensioner and was living in April, 1882; the last report of the pension examiners, in September, 1877, states that he has now "aneurism, involving the innominate artery; the thrill is very distinct; radial pulse cannot be felt; he suffers from pain in the chest and can do no labor." Forty-two of the seventy-four cases were treated by ligation, of which thirteen recovered and twenty-nine died. In the following interesting case of shot wound in the axillary region unattended by fracture, an aneurism appeared three months after the injury, which increased very rapidly. The subclavian was ligated, but on opening the sac the tissues were found infiltrated with blood and disorganized, and the arm was amputated at the Tl x T. < J. A - C - -I - o _ > r Z x m ~-_ c CHAP, xil.] CAUSES OF HEMORRHAGE. 809 shoulder joint. In PLATE LXXVII, opposite page 808, the anterior as well as the posterior appearance of the tumor is illustrated after a photograph contributed bj the operator, Assist ant Surgeon J. C. McKee, U. S. A. CASE 1181. Private F. M. Denton, Co. H, 4th South Carolina Cavalry, aged 34 years, was wounded at Hanovertown, May 28, 1864. Surgeon L. W. Read, U. S. V., reported the patient s admission into the field hospital of the 3d division, Fifth Corps, with "gunshot wounds of abdomen and arm; sent to general hospital." On June 5th he was admitted into Lincoln Hospital, Washington. Assistant Surgeon J. C. McKee, U. S. A., reported: "Minie ball entered three inches below left shoulder joint anteriorly, passed through the axilla under the scapula, and emerged one inch to the right of the vertebral margin. July 1st, suffers much pain in the hand and region of the wound. July 4th, arm easy; hand very painful. The daily use of hypodermic injections of morphia, etc., relieved the pain a little. August 28th, swelling in region of wound, extending over pectoral and axillary regions, to vertebral border of scapula, left side, continuing to increase from day to day. Upon consultation it was determined to be an aneurismal tumor, and pressure by spiral bandage advised, which was continued until September 1st, when the tumor increased very rapidly. The patient was quite irritable and weak. Chloroform was administered and ligation of the isubclavian artery was performed. On opening the sac the tissues were found so diffused with blood and disorganized that amputation at the shoulder joint was advised and performed. Two ligatures were placed on the external jugular vein and three at the shoulder. About eighty ounces of blood, mostly coagulated, were removed from the aneurism. After the operation the patient rallied considerably. He died September 2, 1864, at 10 o clock A. M., from exhaustion." The operator, Dr. McKee, contributed to the Army Medical Museum photographs of the anterior and posterior appearances of the aneurismal swelling, which have been accurately copied in PLATE LXXVII. Causes of Haemorrhage. The earlier cases of hemorrhage were due to the force of the blood current in the returning circulation during reaction; to commencing inflammatory action in which the swelling had been sufficient to force out the protective coagulum; to weakened arterial walls, and to a depraved condition of the blood in persons suffering from exhn listing or depressing diseases. Not unfrequently the hemorrhage of the earlier days had its source in the injury of some vessel of considerable size unnoticed in the primary examination of the wound. Cases have been cited in which no excessive hemorrhage was noticed until attempts were made to effect the removal of a lodged missile or foreign body which had prevented bleeding by acting as a plug or tampon. Regarding secondary hemorrhage in its usual acceptation, as embracing all cases of bleeding from wounded vessels occurring after the establishment of suppuration, including cases of rupture of the sacs of traumatic aneurisms, we find that by far the greater num ber are due to the separation of a slough, the result of a contusion of the walls of the vessel and the inflammatory action consequent upon it. The time required for this process varies within very wide limits, as shown in TABLE CXLVII, p. 805, and appears to be dependent upon the size of the artery, the extent of the contusion, and somewhat upon its proximity to the heart. Ulcerative action extending from neighboring parts may attack a vessel with similar results. Scorbutic diathesis, fevers, gangrene, pyemia, osteomyelitis, and all conditions which lower the vital forces or alter the elements of the blood as well as the general condition of the patient and his physical health largely influence this complication. Hygienic surround ings must also be taken into consideration as playing an important part in the maintenance of a good physical status and enabling the wounded man to successfully resist the insidious attacks of disease. Thrombosis of veins will cause great pressure on the arteries of wounded parts and re-open vessels temporarily closed: CASE 1182. Private J. A. Campbell, Co. H, 81st Illinois, was wounded during the Vicksburg campaign, May 22, 1863, receiving a gunshot wound of the left hand. He was admitted into Church Hospital, Memphis, whence Acting Assistant Sur geon C. II. Cleaveland reported: "Patient of a nervous, bilious temperament; had gangrene of left hand and arm. He was very deaf, and no particulars could be obtained from him except that his hand was bruised by a cannon shot. An ulcer had formed at the wrist just above the annular ligament; another in the palm of the hand, commencing one inch below the wrist, laying opeil almost the entire palmar surface of the hand and fingers; the first and second fingers hung only by shreds from their articular surfaces, the whole surface being covered with foetid sloughs, which were removed as effectually as possible and 111102 810 WOUNDS AND COMPLICATIONS. I CHAP. Xfl bromine applied at once. A subcutaneous cavity was also found extending from the wound to near the elbow; the integument was divided upon a director and bromine freely applied. August 10th, wound cleaning rapidly at both extremities; patient troubled with anorexia and diarrhoea. At two A. M., August 14th, haemorrhage to the extent of thirty ounces occurred from the radial artery while the patient was asleep, and soon resulted fatally. The autopsy revealed thrombi of various sizes in the circulating vessels leading both to and from the heart." Diseases of the coats of the arteries, as atheroma, etc., will hasten haemorrhage, and in such cases the conditions will render operative interference doubtful or uncertain. Transportation of the wounded during the process of suppuration has been mentioned as a not infrequent cause of haemorrhage by surgical writers, and cases recorded in the late war justify its enumeration as an exciting cause: CASE 1183. Private W. F. Lepper, Co. H, 148th Pennsylvania, was wounded at the Wilderness, May 6, 1864, receiving a gunshot compound fracture of the right knee joint. Surgeon J. "H. Brinton, U. S. V., referring to this case, 1 remarks: "I amputated at the knee joint, at a hospital in Fredericksburg. This man did well for three days. At the expiration of this time orders were received to remove all patients from the temporary hospitals and to vacate Fredericksburg. I was subsequently informed that as this soldier was being lifted into the ambulance for transportation to the boat a sudden and uncontrollable haemorrhage occurred, which proved almost immediately fatal. Owing to the pressing exigencies of the occasion, opportunity was not aflbrded for an examination of the stump after death." Accidental causes will be found to be not uncommon, as falling out of bed, the pulling off of ligatures during delirium, falling upon stumps, and spasmodic twitchings of muscles: CASE 1184. Sergeant Foster Hudson, Co. B, 132d New York, aged 24 years, was wounded near Kinston, North Caro lina, March 7, 1865. Surgeon C. A. Cowgill, U. S. V., reported from Foster Hospital, New Berne: "Admitted March 8, 1865, with a gunshot wound, shattering the tibia of the left leg and opening the knee joint. On March 9th Assistant Surgeon E. F. Hendricks, 15th Connecticut, amputated the thigh at the lower third. There was extensive shattering of the head of the tibia, and the soft parts were much infiltrated with blood and serum. The pulse was weak at the time of the operation. Simple dressings were applied to the wound and stimulants administered. The posterior flap sloughed away on the eighth day, but the interior was healthy and covered the stump. On the tenth day the ligature came away, but the stump looked well. Pulse weak, appetite poor. Twelfth day, severe chill, followed by delirium, drowsiness, and spasmodic twitching of muscles. On March 21st, haemorrhage, amounting to one quart, occurred from the femoral artery. He died March 23, 1865, from secondary haem orrhage, probably induced by convulsive movements of patient and stump." The records of the war show a large number of haemorrhages subsequent to excisions, probably due to the engorged condition of the vessels in the neighborhood of the injury which were cut or injured during such operation. Treatment. Of the two thousand two hundred and thirty -five cases of haemorrhage, two hundred and ninety-four were followed by amputation; seven hundred and eighty-six were treated by compression, styptics, etc., or ceased spontaneously; and in one thousand one hundred and fifty-five cases the bleeding vessels were ligated. TABLE CXLIX. Summary of Two Thousand Two Hundred and Thirty-five Cases of Haemorrhage, indicating Mode of Treatment. TREATMENT. CASES. RECOVERY. FATAL. PEUCEXT- AGE OF FATALITY. Haemorrhage followed by Amputation 294 122 172 58.5 Haemorrhage ceased spontaneously or was arrested by Compression and Styptics 786 262 524 66.6 Haemorrhage followed by Legations 720 328 392 54.4 Haemorrhage followed by Ligations and subsequent Amputation 87 34 53 60.9 Haemorrhage from Stump after Amputation (ligated) 348 109 239 68.6 AgTog^ites 2 235 855 1 380 61.7 Amputation was resorted to for the purpose of saving life in cases of uncontrollable haemorrhage, both primary and secondary: In primary bleeding, where the original injury 1 IJRrNTO.\ (J. H.), On Amputation at Hit Knee Joint and at the Knee., in Am. Jour. Med. Set., 1868, Vol. LV, p. 316. CHAP. XII.) TREATMENT OF HEMORRHAGES. 811 was so far destructive to the parts as to render ligation unavailing; in secondary bleeding, in cases of traumatic aneurism, with great infiltration of tissue; in gangrene following division or ligation of the principal artery; and in cases where ligation had failed to arrest bleeding, and where more radical measures were demanded to prevent a further loss of blood. Of two hundred and ninety-four cases thus treated by amputation, one hundred and twenty-two recovered and one hundred and seventy-two died, a fatality of 58.5 per cent. Of the remaining one thousand nine hundred and forty-one cases of haemorrhage, seven hundred and eighty-six were treated by compression, styptics, etc. The fatality of these cases, as indicated in TABLE CXLIX, on the preceding page, was large, exceeding that of ligations 12.2 and that of ligations and subsequent amputations 5.7 per cent. In a number of cases digital compression was employed as a temporary measure, and in a few instances steadily continued compression appears to have been rewarded with favorable results. Gen erally the tourniquet v:as carefully and judiciously used, although, in a few instances, a resort to operative procedure would have been much better for the patient: CASE 1185. Sergeant T. A. Polleys, Co. H, 6th Wisconsin, aged 25 years, was wounded before Petersburg, June 18, 1864, by a musket ball, which fractured the right thigh. He was admitted to the field hospital of the 4th division. Fifth Corps, where amputation at the lower third of the femur was performed by Surgeon J. H. Beach, 24th Michigan, on the follow ing day. Acting Assistant Surgeon H. E. McCartin reported the following result of the case: "The patient entered Baptist Church Hospital, at Alexandria, on June 28th. The amputation had been performed by the posterior flap method. When received into hospital the stump was found strangulated by a tourniquet placed around it to compress the femoral, and the flap was gangrenous and sloughing extensively; patient s condition very low. Tonics, stimulants, and nutritious diet failed to pro duce any improvement. Haemorrhage to the amount of thirty-two ounces from the femoral artery occurred on June 28th ; the patient died on June 29, 1864." Cases of troublesome bleeding from the posterior auricular, occipital, or temporal arteries, or their branches, are reported where the haemorrhage was controlled by compres sion by a clamp tourniquet, or by bandage and compress, or by a compress consisting of a metallic disk. In one such instance transverse division of the wounded artery was suffi cient to secure complete retraction of the coats. No cases of acupressure, after the method of Sir James Y. Simpson, appear on the records, though it would seem probable that many wounds must have presented themselves where this measure would have been found convenient, speedy, and effectual. Torsion was employed to secure arteries, a few cases of this procedure being reported ; and Surgeon H. S. Hewit, U. S. V., mentions a case where the actual cautery was resorted to for the arrest of troublesome bleeding. Two cases of transfusion of blood are found on the records; one, a successful operation, was performed by Surgeon E. Bentley, U. S. V.; the other, a fatal case, by Assistant Surgeon B. E. Fryer, U. S. A. Both are here detailed: CASE 1186. Private G. P. Cross, Co. F, 1st Massachusetts Heavy Artillery, aged 19 years, was wounded in the right leg, before Petersburg, June 16, 1864, and entered the Grosvenor Branch Hospital, Alexandria, two weeks afterwards. Surgeon E. Bentley, U. S. V., who operated in the case, made the following report: "The injury consisted of a flesh wound on the posterior aspect of the leg. At the date of the patient s admission he was exsanguineous from previous loss of blood. Owing to his condition no operative measures were adopted, but his languishing vital powers were sustained by stimulating treatment combined with highly nutritious diet. Under this method he slightly improved in strength, but the circulating fluid was so impoverished in quality and reduced in quantity that the face of the wound looked pnle and bad, and ultimately, on August 12th, it assumed a gangrenous aspect. Local applications, such as creasote, charcoal poultices, nitric acid, etc., were applied to combat this condition. These means failed to arrest its onward progress, the leg presenting in a short space of time a mass of gan grenous sloughs, horribly fetid. Hasmorrhage from the posterior tibial artery again commenced on the afternoon of August 15th, when it was deemed advisable to amputate to prevent further loss of blood. The operation was accordingly performed just at the tubercle of the tibia, the condition of the parts not allowing a flap to be made below that point. Not more than two table- spoonsful of blood was lost ; but the patient not seeming to rally, it was determined to test the method of transfusion of blood as recommended by Brown-Scquard. Blood having been obtained from the temporal artery of a strong healthy German, an attempt was made to penetrate the internal saphenous vein, but was unsuccessful on account of its small size; after which au 812 WOUNDS AND COMPLICATIONS. [CHAP, xn opening was made into the median basilic, and about two ounces were transfused by meansofaTiemann s syringe. Immediately after the injection a marked difference was noticed in the patient s pulse, which became stronger and firmer. He was then removed to his bed and generous diet was administered, together with stimulants and tonics, under which treatment he gradually improved, his appetite became better, his strength increased, and the stump assumed a healthy aspect. On October 20th the stump had healed and the patient had so far improved as to be able to be furloughed. At its expiration he returned, and, finally, he was transferred to Webster Hospital, Manchester, January 13, 1865, cured." The patient was ultimately discharged from Central Park Hospital at New York City, June 9, 1865, and pensioned, and afterwards he was supplied with a "Hudson" arti ficial limb. This pensioner died August 24, 1867. CASE 1187. Private J. Mott, Co. E, 105th Illinois, aged 37 years, received a flesh wound in the upper third of the left leg, at Kenesaw Mountain, June 26, 1864, by a musket ball, which lodged between the tibia and fibula. He entered Brown Hospital, at Louisville, nine days after receiving the injury, the missile having been extracted and the wound looking unhealthy and sloughing. During the night of July 24th the patient had a copious haemorrhage from what was supposed to be the anterior tibial artery, which was arrested. On July 26th bleeding again commenced, the blood welling up from between the bones and from the tissues posterior to them. It was then deemed necessary, in order to save life, to amputate, which was done through the upper third of the leg by the circular method, by Assistant Surgeon B. E. Fryer, U. S. A. Ether was used as an anaes thetic, and three ligatures were applied, the patient reacting very slowly. On the following day it was determined to transfuse some blood into the patient, for which purpose, in the absence of any other suitable apparatus, an ordinary gutta-percha syringe was used, the nozzle of which was filed to fit a small tube having a stop-cock through its centre. The right cephalic vein having been selected, an opening was made carefully into it, and the syringe having been warmed and filled with blood from a healthy man, a little of which was allowed to flow from the syringe before forcing its nozzle tightly into the tube in order that any air might be driven out, the tube was introduced and the stream of blood was slowly and carefully forced in. About sixteen ounces were thus transfused. The first effect upon the patient was to increase respiration from about fifteen to twenty-eight per minute, though it soon returned to its normal number of about sixteen. The pulse ran up from one hundred to one hundred and thirty, which, however, also soon returned to what it had been. The man s general condition was greatly improved. His pulse became fuller and slower; he slept well; his stomach retained food, and altogether the prognosis became more favorable. On August 4th haemorrhage commenced from the face of the stump, the whole surface of which appeared to be involved. From the effects of this, and from chronic dysentery, the patient died on the following day, August 5, 1864; although his condition, from the effects of chronic dysentery and of the haemorrhage at the time of the transfusion, was such as hardly to expect his recovery, the improvement was such as to show that the operation was not only justifiable, but that it was to all intents a success. The history of the case was reported by the operator. Styptics were very commonly used. The persulphate of iron in powder or in solution was placed in every knapsack and pannier, and was found at every hospital. In addition to these we find mention of the nitrate of silver, gallic and tannic acids, alum, and turpen tine as having been employed. While it is possible that in many cases the use of styptics may have been ill-advised, and while it may be admitted that in the hands of the timid or ignorant surgeon they may furnish an excuse for procrastination or for deferring opera tions imperatively demanded, still the evidence as to their usefulness during the late war is not altogether unfavorable, and should lead to some modification of the views previously expressed in this history. The experience of surgeons in the Confederate Army was much to the same point, and Dr. Ohisolm observes that "iron styptics will control the most annoying haemorrhage." Instances in which this class of haemostatics was successfully used, even in bleeding from larger vessels, are not wanting: CASE 1188. Captain E. H. Davis, Inspector General, aged 32 years, was wounded at Fort Steadmau, March 25, 1865, by shrapnel, which fractured and comminuted the bones of the right arm and forearm. Surgeon J. M. Holloway states l that ampu tation of the arm was done on the morning of the 26th, supposed to be at the anatomical neck. Repair of the wound was very rapid and unaccompanied by unpleasant symtoms other than occasional nervous twitching in stump. On April 19th he took a long walk ; at that time the wound was nearly closed externally. On April 20th he experienced a tingling sensation in the arm, which was immediately followed by a gush of blood. Medical aid was speedily obtained, the dressings removed ; a small clot near the lower edge of the incision was removed, and, after exposing the parts for a short time to the air, a compress was secured in the axilla by means of a roller. The patient informed me subsequently that for three days before the haemorrhage the dis charge, which before that had almost entirely ceased, increased in quantity and was darker, and accompanied by a constant aching pain in stump. From this it was concluded that ulcerative destruction of the tissues was going on, which in the end invaded the artery. Haemorrhage recurred at 8 and again at 6 o clock of April 21st. Upon removing the dressings, extensive extravasation of blood was discovered in the axilla and anterior thoracic region. Diaynosis : Indeterminate haemorrhage from an aperture in the axillary artery, occasioned by ulcerative destruction of the coats of the artery and the newly formed tissues surrounding. April 21st, 10 A. M., pulse frequent and feeble; cheeks blanched from loss of blood; mind clear and calm; fully aware of the danger of his condition. He was placed upon the operating table, a full stimulant was given, compression with the finger and key was made in the subclavian triangle, aud the careful administration of chloroform was commenced. Before Hor.LOWAY (J. M.), Consecutire and Indeterminate Haemorrhage from Laryr. Arteries after Guiifhot Wounds, etc., in American Journal Medical Sciences, 1865. Vol. L, p. 348. CHAP. XII.] LICfATIONS. 813 he became fully anaesthetized the dressings were removed and the cicatrix laid freely open. The opening was then enlarged hy an incision at right angles to this, extending obliquely downward and inward through the skin and great pectoral muscle. A number of large clots were turned out, and, the cavity being empty, pressure upon the subclavian was removed to secure a jet of blood to guide to the bleeding point; the jet was easily obtained, and the blood welled up from the bottom of the cavity, which extended high up under the clavicle. Such was the disorganized condition of the surrounding tissues that no artery could be seen, and it was decided, without delay, that the search should not be prolonged, and that the best chance for the patient would be to plug the cavity with successive layers of lint saturated with a strong solution of persulphate of iron, well packed in, and secured by a figure-of-eight bandage. This was done. Prescribed two grains of opium and ten grains of quinine to be taken at once. April 22d : Has reacted fully; shows loss of blood; slight increase of heat in stump; slept well all yesterday and a* night under the influence of the opium and quinine. April 24th, attacked with colic last evening, which was soon relieved by a large enema; annoyed also by uneasiness in the stump. Disorganized blood still exuding. On April 26th the sponge that was placed over the plugs was removed by saturating it with water, after which slight capillary oozing occurred. On April 27th he was seized with a slight rigor, followed by fever, which broke up in a short time, leaving him with a moist skin. On April 29th the largest and most superficial plug came away without force, in the evening; another at 12 P. M. The patient gradually and steadily improved until the morning of May 5th, when he was seized with severe lancinating pain in the right side, which persisted, with distressing nervous symptoms, throughout the day. Physical exploration of the chest could detect no lesion of the lung; strong suspicion of pyaemia was entertained; had suffered with severe pain in the muscles of the jaw during mastica tion for several days. The patient subsequently suffered from colliquative sweats; the pain and stiffness of the muscles of the jaw increased and interfered with his relish for food. On May loth the last wad was removed, and the channel soon after closed. The use of ice and cold was very general and was very favorably regarded. Internal hsemastatics were used to some extent, but little can be said decisively in their favor from the records of cases in which they were used. Of those most frequently used may be men tioned tannic and gallic acids and ergot, generally in the form of the fluid extract. These remedies were especially employed in cases where the vital powers were much depressed and where the coagulative elerneats of the blood were deficient. Ligatio7is. In one thousand one hundred and fifty-five cases of haemorrhage recourse was had to ligations, embracing nearly all the principal arterial trunks and their branches. Of these, four hundred and seventy-one recovered and six hundred and eighty-four died. The fatality in these cases, as well as in the cases of haemorrhage followed by amputation, was principally due to exhaustion following excessive loss of blood previous to the opera tions, to recurring haemorrhages after operations, or to complications, such as gangrene, erysipelas, and especially pyaemia, as indicated in TABLE OXXIV, pp. 763, 764. Five hundred and forty-one of these operations, with two hundred and ninety-two recoveries and two hundred and forty-nine deaths, a -mortality of 46.0 per cent., were per formed in the upper circulatory system, and six hundred and fourteen, with four hundred and thirty-five deaths, a fatality of 70.8 per cent., in the lower circulation, thus confirming the general opinion that proximity to centre of circulation favorably influences the final issue. Three hundred and forty-eight were ligations after amputations; of these, one hundred and fifty-seven, with fifty -two recoveries and one hundred and five deaths, were ligations in the continuity of the stump, and one hundred and ninety-one, with one hundred and thirty- four deaths, ligations on the face of the stump. It is probable that the ligation in con tinuity was frequently the only alternative, and perhaps a greater saving of life would have resulted had the operation been more generally performed in the continuity, as bleedings from the stump were generally found in patients of low vitality and where but little was to be expected from any operation in the immediate proximity to diseased tissue. Of the remaining eight hundred and seven cases, two hundred and thirty-six were ligations in the wound, five ligations above and below the wound, and four hundred and thirteen ligations in the continuity; in one hundred and fifty-three instances the mode of ligation was not indicated. It is probable that the large majority of ligations of the last group were opera tions in the coatinuity. The various modes of ligations with their respective mortalities are indicated in the following table: 814 WOUNDS AND COMPLICATIONS. [CHAP. XII. TABLE GL. Table indicating the various Modes of legations and their Fatality. ARTERIES. TOTAL CASES. LlGA- | T1ONS IN CONTI NUITY. LlG. BE- LOW AND A1JOVE WOUND. LIGATIONS IN Wouxu. MODE OF LlG. NOT INDI CATED. AFTEK AMPUT N. ONB END. BOTH ENDS ! NOT INDl- CATEI1. IN CONTI NUITY. O FACE or STUMP. & > 29 5 5 66 11 2 28 3 3 1 Recovery. I Recovery. 1 Recovery. "n 4J * 9 O U 1 3 CB P* Recovery. I Recovery. I Recovery. 3 at to 124 63 71 181 102 43 427 39 101 4 66 29 17 17 2 24 91 10 5 5 4 3 5 9 2 1 2 7 1 4 2 o 4 1 10 2 4 5 2 3 17 22 3 1 4 6 5 3 2 3 12 3 3 3 1 8 1 3 15 14 1 1 9 10 4 8 4 2 9 4 12 10 10 3 5 64 1 9 7 1 21 2 16 7 7 I 101 5 12 1 134 *m 1 3 1 6 1 11 23 4 8 2 6 5 2 2 14 1 16 1 28 7 10 2 33 1,155 152 * * 63. 261 "l% 4 v 20 1 "0% 38 1 v 44 30 1% 67 . 44 54 6% 28 v 40 19 4% 73 I 80 52.2% 52 66 105 8% 57 * 70 The fatality after ligations in the continuity was 63.1 per cent., after ligations in the wound 43.6 per cent. The necessity of ligating both ends has been shown in numerous instances in the preceding volumes. In the case of Lieutenant Colonel M. M. Dawson, 100th Pennsylvania Volunteers (CASE 1251, page 442, /Second /Surgical Volume), the cardiac end only of the axillary was tied for haemorrhage occurring on the tenth day after the injury; the haemorrhage continued, and the distal end was secured by tying the brachial. In Private G. Harbison s case (Second Surgical Volume, page 451) a ligature was placed on the proximal end of the ulnar artery; but haemorrhage recurring on the next day, the distal end was ligated, and no further bleeding occurred. In the following instances of ligation of the femoral artery haemorrhages from the distal ends occurred on the second, fourth, and sixth days after the ligation: CASE 1189. Private J. Sesler, Co. H, 148th New York, aged 28 years, was wounded in the left thigh, at Cold Harbor, June 3, 1864. From the field he passed to Mount Pleasant Hospital, at Washington, and thence, on June 15th, to Mower, Philadelphia. Surgeon J. Hopkinson, U. S. V., in charge of the latter, made the following report: "The injury was caused by a musket ball passing through the inner aspect of the lower third of the limb. There was profuse discharge and extensive sloughing, extending down to and ulcerating through the femoral artery, and causing haemorrhage to the amount of from four to six ounces on July 24th, when the vessel was ligated in its continuity, at the middle third of the thigh, one inch above the wound. Bleeding recurred to the extent of from six to eight ounces from the lower end of the artery on July 28th, when the distal end of the vessel was ligated in the wound. The operations were performed by Acting Assistant Surgeon W. P. Moon, chloroform being used in the first and ether in the last, and both being followed by prompt reaction. The patient did well after wards. The subsequent treatment consisted of simple dressings, tonics, and stimulants." The patient was discharged from service on January 11, 1865, and pensioned. Examiner R. C. Dunham, of Seneca Falls, New York, certified, August 7, 1877, to the injury, and added that the muscular structures and integuments on the inner side of the limb have sloughed out, and that the remaining structures have healed to the bone ; also that " the leg is swelled below the knee and is sore and tender to the touch; knee partially anchylosed. Some important nerves must have been wounded and are healed in the structure with the cicatrix, as the leg below the wound is very numb and weak. He cannot walk but a very little distance at a time," etc. The pensioner was paid March 4, 1882. CASE 1190. Private C. Berkey, Co. A, 10th Pennsylvania Reserves, aged 24 years, was wounded at the bat tie of Manassas, August 30, 1862, and entered Filbert Street Hospital, Philadelphia, four days afterwards. Acting Assistant Surgeon A. D. Hall reported the injury as a "wound of the popliteal artery," and described the case as follows: "A round ball passed through the lower third of the left thigh, entering on the inner side one inch or so above the condyles, and making its exit at the opposite side in the direct course of the popliteal artery. The case was treated by simple dressings until the occurrence of arterial haemorrhage on September llth from both wounds, which amounted to about sixteen ounces, and was checked by compression with tourniquets until September 13th, when it recurred twice to the extent of eight ounces. Compression by means of Petit s tourniquet over the CHAP, xii.) LIGATIONS. 815 femoral, Skey s below the wound, and graduated compresses over the course of the vessel proving unsuccessful, and several attacks of haemorrhage, though small in amount, occurring on the next day, the femoral artery was ligated at 10 p. M., at the middle third of the thigh, after the method of Hunter. The ligature controlling the Weeding, all compresses were removed after the operation. On September 15th there was slight oozing of bloody serum from the old wounds, and at 11 P. M. another haemor rhage occurred from the inner wound to the amount of three ounces, which ceased after the application of the tourniquet to the femoral where it crosses the brim of the pelvis. There was no return of haemorrhage until the morning of September 17th, when it recurred to the amount of six ounces. The question of ligating the popliteal was now discussed, and after consultation it was decided to cut down upon the artery, upon doing which the whole popliteal space beneath the external muscles was found to be in a sloughing state and filled with broken down masses of clot and grumous matter. A cavity was formed by the sloughing tissue that dissected up the muscles of the thigh and laid bare the lower part of the femur. The bullet appeared to have grooved the under surface of the femur in its passage, producing some comminution and opening the cancellated structure of the bone. Under these circumstances it was considered that amputation, although almost certainly fatal, would afford the only chance for the patient. Ether was accordingly given, and the operation was performed by the circular method at the upper part of the middle third of the thigh. There was no reaction, the patient continuing to sink, and dying at 1 A. M. on September 18, 1862. At .the post-mortem examination the popliteal artery was found to be opened for about one-sixth of an inch at the middle of the popliteal space, in a direction parallel to the axis of the artery. The popliteal vein was filled to distension by a firm clot. The track of the wound was found to have entered through the external hamstring tendon, channelling the under surface of the femur and emerging through the inner hamstring tendon. The popliteal artery was not obliterated, and the haemorrhage must have occurred, after the ligation, from the lower end of the vessel through the recurrent circulation. The femoral artery was found to be ligated about four inches below the origin of the profunda, a clot extending from the point of the ligature about one-fourth of an inch up to the first small artery above." CASE 1191. Private M. Knecht, Co. K, 4th Ohio Cavalry, was wounded in the left thigh, July 1, 1863, by a musket ball, which entered at the lower and external side above the condyle of the femur, and made its exit at the inner condyle near the attachment of the hamstring muscle. He was admitted to hospital at Murfreesboro nine days after the injury, where Assist ant Surgeon W. P. McCullough, 78th Pennsylvania, recorded the following treatment: "The limb was bandaged from foot to hip and ice was applied to the knee. Haemorrhage occurred on July 28th and 31st to the amount of about twenty ounces, and was controlled by compression. On August 3d there was another haemorrhage, amounting to twelve ounces, and ligation of the popliteal artery was performed by enlarging the opening of exit. Two days later haemorrhage again occurred from the wound, and a large anastomotic branch was tied. No further attack followed until August 9th, when profuse bleeding set in from the lower end of the wounded artery, and the femoral was ligated in the middle third. Stimulants were given freely and artificial heat was applied to the foot and leg. The patient died of exhaustion August 14, 1863." The lower third of the shaft of the femur of tlie injured thigh, showing the outer and posterior border of the bone to be perforated above the condyle by the missile, the seat of injury being carious, was contributed to the Museum by Surgeon I. Moses, U. S. V., and constitutes specimen 1757 of the Surgical Section. Two hundred and sixty-one of four hundred and thirteen ligations in the continuity had fatal terminations, a mortality rate of 63.1 per cent., exceeding the fatality of ligations in the wound nearly 20 per cent. ; but it will be observed that, with the exception of the femoral, the large vessels, as the carotid, subclavian, axillary, iliac, and popliteal arteries were, as a rule, tied in the continuity. It is to be regretted that ligations of both ends in the wound were not more generally practiced. Lidell records, 1 as his personal observation after several severe battles, that he had not met "with a single case of primary hemorrhage which required a surgical operation, such as the application of a ligature for its suppression." Neudorfer and Richter, 2 expe rienced European military surgeons, have never been called upon to control primary haemor rhage after injuries of blood-vessels by ligature on the battle-field or the first place of dressing. But a number of such operations were performed during the war of the rebellion, and the results of these operations seem to have been quite successful. Thus, for instance, of thir teen ligations of the femoral performed on the battle-field, seven proved successful ; of ten ligations of the tibial arteries, seven terminated in recovery; and of fourteen ligations of the brachial only one had a fatal termination, although several of these cases were compli cated by fractures. In the case of A. Elmer, 69th Pennsylvania (CASE 679, page 435, ante), the tibia was fractured and the anterior tibial artery divided; the latter was secured by a ligature on the field; the patient recovered. A case of shot fracture of the lower third 1 LIPEI.L (J. A.). On the Wounds of Blood-vessels, Traumatic Hxnwrrhage, Traumatic Aneurism, and Traumatic Gangrene, etc.., in United Slate* Sanitary Commission Memoirs, Surgical Vol. 1, New York. 1870, p. 12. "HiCHTKK (B.), Chirurgie der Schussverlttzungen im Kriege mit besonderer Btriicksiclitigung Kriegschirurgischer Statistik, Breslau, 1877, p. 346, WOUNDS AND COMPLICATIONS. [CHAP. XII. of the left femur, in which the femoral artery was severed and successfully ligated on the field, is cited in TABLE XLIX, on page 353, ante, CASE 2. VEINS. Haemorrhage from wounded veins is generally regarded as of less practical importance than that from wounded arteries. It is stated in a previous portion of the history that "no cases have been reported in which the bleeding could not be controlled by pres sure." An examination of the cases in the following table shows that in five instances at least ligation of veins was resorted to : TABLE OLI. Summary of One Hundred and Six Cases of Hcemmorrhage from Veins. VEINS. <e M 01 RESULTS. CAUSES OF DEATH. LIGATION. REMARKS. Recovery. Death. 3 a 8 to a a a O Erysipelas. Haemorrhage. Not stated. Kecovery. 3 1 Parietal . . 1 1 2 15 6 3 2 2 1 7 1 2 1 2 15 C 2 1 7 5 17 7 1 1 1 I 3 1 1 1 Longitudinal Sinus ... 1 14 3 2 2 1 i 8 2 5 1 typhoid pneumonia. i 2 Brachial 2 1 1 . Vena Cava . . 7 1 1 1 2 13 5 2 5 51 peritonitis. 1 perf. liver and asc. vena cava. 1 Gluieal ... .. 1 1 Hffimorrhoidal i Intemal Iliac 2 Femoral . . . 2 1 3 1 4 1 5 1 1 1 1 Profunda . 2 Popliteal 1 3 1 1 1 Subsequent amputation. Upper extremities, vessel not named. Trunk, vessel not named 4 4 16 7 1 1 8 3 3 Lower extremities, vessel not named. From Stump 6 4 1 2 1 dysentery. 1 diarrhoea. 1 Totals 106 20 86 17 5 1 47 9 3 2 Among the instances of wounds of the arteries considered in the preceding pages were quite a number in which the veins were likewise injured. These cases have not been included in this statement of one hundred and six (106) venous haemorrhages, of which eighty-six (86), or 81.1 per cent., proved fatal. From the number of venous vessels, and from the fact that they are less liable to evade a projectile in its course than the arteries, it would seem that injuries and haemor rhages of the veins should have been more frequently noted. Statistics on the relative frequency of injuries of the arteries and veins are nowhere found in military surgery. Richter 1 suspects that many soldiers perish on the battle-field from injuries of these vessels. It remains a fact, however, that hemorrhages from veins come far more rarely under the observation of the surgeon than those of arteries ; but that their fatality is equally as great, if not greater, than that of arteries, is clearly proven in the above tabular statement. Wounds of large veins lying in cavities and beyond the reach of ligation seem to be as 1 RlCHTBlt (E.), Chir. tier Schussverlclzungen tm Kriege mit besnnderer Beriicksichtiguny Krirrjschir. Statistik, Breslau, 1877, 1 Theil, p. 357. VENOUS HAEMORRHAGES. 817 fatal as those of arteries. The femoral and jugular veins would appear to be less amenable to treatment than others which yield to pressure or cease spontaneously. In forty-seven (54.6 per cent.) of the eighty-six fatal cases, death was ascribed to secondary haemorrhage occurring at various dates ; next in order we find pyaemia and gangrene as causes of death, especially in wounds of the lower extremities. Among the one hundred and six cases of haemorrhage from veins were twenty cases of primary injury. Of these fifteen, or 75 per cent., were followed by primary bleeding, while in the arteries only one hundred and ten of four hundred and eighty-five, or 22.7 per cent., were succeeded by immediate haemorrhage. Secondary haemorrhage from veins occurred at irregular intervals from one to seventy days ; in one instance the bleeding did not take place until the one hundred and thirty-seventh day; and in another, a case of shot wound of the buttock, uncontrollable venous haemorrhage occurred from a persistent fistula three years after the injury: CASE 1192. Private W. H. Marsh, Co. K, 13th Illinois, aged 23 years, was wounded at Chickasaw Bayou, December 29, 1862, by two musket balls, one entering the upper part of the left thigh and the other passing into the hip. He was taken prisoner and remained for a time in the hands of the enemy. In May, following, he was conveyed to Memphis, where he entered Overtoil Hospital, and remained for four weeks, after which he was transferred to Lawson Hospital, at St. Louis. Surgeon C. T. Alexander, U. S. A., in charge of the latter, reported that "the wound of the thigh, which is now quite healed, was treated by a Confederate physician as a fracture of the femur, which does not seem to have existed. The patient avers that the other ball, which entered the gluteal region close to the tuberosity of the ischium, is still there, though it cannot be felt by the probe. There is a sinus, however, extending six inches into the muscles of the buttock, and from the nature of the discharge it is probable that there is a foreign body of some kind in the wound." Acting Assistant Surgeon F. K. Bailey reported the subse quent history of the case, as follows: "The patient was admitted to hospital at Quincy on July 17th, being very feeble and pale and appearing to have lost a great deal of blood. He could not stand on his left lower extremity, and pus was still escaping from the orifice, which was near the coccyx. Good nourishment and laxatives, when necessary, were given, witli morphia pro re nata. Solution of morphia was also used in poultices and dressing. Two months after his admission he complained of pain in the hypogastric when passing urine, in connection with which he stated that while he was at Vicksburg it was necessary to use the catheter. In October he had neuralgic pains in the left side of the pelvis and in the thigh, and there were indications of miasmatic chills; wound still discharging freely. Quinine was then prescribed, and subsequently small doses of strychnine were added. On October 27th a probe was passed into the opening at the ischiatic region to the depth of three inches toward a point one inch above the crest of the ilium. There was still free discharge of pus, but the patient felt much better than he did a month previously. On October 29th tincture of iodine was injected into the wound, subsequent to which he complained of severe pain along the track of the fistulous opening, accompanied by spasmodic jerking of the wounded extremity. On Novem ber 1st a small piece of woollen cloth came out of the opening, which was followed by another, one and one-half inches square, the next day. By November 15th the wound had nearly healed, very little pus was escaping, and the patient was improving in strength but could not yet step upon the injured limb. On November 24th he had some fever, with dysuria, when sweet spirits of nitre was ordered in addition to the quinine. About December 1st the patient was able to stp a little and was improving finely. During the next month no change occurred in the condition of the patient, who still complained of pain in the affected side from the orifice through to the crest of the ilium, and also in the inguinal region ; pus still escaping, and occasion- all} a shred of clothing. By March 18, 1864, a probe could still be passed in the direction of the crest of the ilium. On June 6, 1864, the patient was discharged from service for disability, being barely able to walk with the aid of a cane, and his wound not having healed." The ultimate result of the case was communicated by Dr. Bailey several years later: " In November, 1865. I returned to 11131 former home in Joliet, Illinois, where I was called upon to examine the patient, who had returned there after receiving his discharge. The fistulous opening of his wound, which for a long time had been an exit for pus, had become gan grenous during the previous month, and about November 10th inflammation began to extend to the peritoneum, involving the bladder and causing characteristic symptoms of peritoneal inflammation through the lower part of the abdomen. Extensive venous haemorrhage occurred about twenty-four hours before death. There was no post-mortem examination held." The records of the Pension Office show that death took place on November 20, 1865. In the next two cases death was ascribed to the sudden entrance of air into the veins: CASE 1193. Corporal A. M. Delano, Co. E, 1st Maine Heavy Artillery, aged21 years, was wounded at Spottsylvania, May 12, 1864, by a minic" ball, which entered just back of the left ear, fracturing the mastoid process of the left temporal bone, passed downward and forward and lodged just anterior to the artery at the angle of the lower jaw. On May 22d he was admitted into Emory Hospital, Washington, where, on the same day, the missile and a fragment of the cranium were removed. On May 25th haemorrhage to the extent of twenty ounces occurred from the internal jugular vein. He died suddenly on May 25, 1834. Air was supposed to have passed into the vein. The autopsy revealed the jugular vein to be in process of ulceration two inches of its length, with its tissues severed from before backward, except a few fibres on its posterior surface. Surgeon N. E. Moseley, U. S. V., reports the case. CASE 1194. Private B. Y. Brown, Co. C, 22d Massachusetts, aged 23 years, was admitted into Kmory Hospital, Washington. May 13. 18i>4, with gunshot wounds of the thigh, leg, and neck, received at the battle of the Wilderness, May 7, SUHG. ill 103 818 WOUNDS AND COMPLICATIONS. [CHAP. xn. 1864. The thigh had been amputated on the field on May 7th, in the lower third, hy lateral flaps. A ball had entered the neck below the angle of the jaw, passed through the larynx, and lodged near where the carotid crosses the omo-hyoid muscles. On May Kith the hall was extracted from its position against the carotid by an incision one and a half incites long, one inch below the mastoid process of the temporal bone, by Acting Assistant Surgeon W. H. Ensign, U. S. A. At this date the thigh was healing kindly hy first intention. The wound of the neck had an extraordinary appearance. The patient s constitution was slender but not much impaired. Some trouble in swallowing and breathing ; cheerful, sleeps well, shows little signs of distress ; pulse 90, bowels regular. No medicine given; but good liquid diet with local water dressings. Food has to be administered with a stomach pump. On May 17th haemorrhage to the amount of one quart occurred from the internal jugular vein. Air was supposed to have passed through the vein into the heart. A post-mortem examination showed the cause of haemorrhage to be ulceration of the anterior surface of the internal jugular vein. The case is reported by Surgeon N. R. Moseley, U. S. V. In a third instance (Case of E. C. Melley, page 555, First Surgical Volume] the sub- clavian vein was accidentally cut while searching for the axillary artery. The .entrance of air caused syncope, and death ensued in less than ten minutes. In the accompanying chromo-lithograph (PLATE LXXIX, FIG. I) the appearance of the femoral vein removed from a stump twelve hours after death from pyaemia (Case of Sailor, No. 469. page 289, ante) is faithfully represented. The end of the vein, well sealed up in the stump, was empty, and collapsed from the end up to the valve of the first anastomosing branch, a distance of about six inches. The vein in this situation was about as large as the artery, the walls being much thickened and about the thickness of those of the artery; the lining membrane looked velvety, wrinkled, and dirty-gray in color; there was no pus in the vein. From the valve above mentioned up to the mouth of the vena profurida, a distance of about two and a half inches, the femoral vein was filled to distension with fetid broken-down liquefied blood, its lining membrane dirty-gray colored in this situation, and its walls somewhat thicker than natural; no pus was found in this locality by the microscope. At the mouth of the vena profunda the femoral vein was plugged up with yellowish-white fibrine; the vena profunda and many of its branches were filled and knotted with recent coagulum; the femoral vein was also filled with recent coagulum above the mouth of the pro funda to a distance of about two and a half inches; the lining membrane of the profunda and of the part of the femoral vein last mentioned were stained dark red, and the walls of the vessels somewhat thickened in the same locality. A thin dark colored recent coagulum, not filling the calibre, extended the whole length of the external iliac vein. TETANUS. Considering the number of injuries, the proportion of cases of tetanus is not large; of the two hundred and forty-six thousand seven hundred and twelve (246,712) injuries by weapons of war, five hundred and five (0.20 per cent., or a little over two in a thousand) were followed by tetanus. In the cases in which this complication was observed the seat of the injury was: in the head, face, and neck in twenty-one instances, in the trunk in fifty-five, in the upper extremities in one hundred and thirty-seven, in the lower extremi ties in two hundred and ninety-two instances. The preponderating frequency of tetanus in the lower extremities, observed by Beck 1 and others, was very marked, over one-half of all the cases having occurred after injuries in this portion of the human structure, due undoubtedly to the massive layers of muscles and soft tissue, which prevent the surgeon frequently from clearing the track of the wound of foreign bodies and other obnoxious influences. Of the two hundred and ninety-two cases of tetanus in the lower extremities, the injuries were in the hip in two instances, in the thigh in ninety- nine, in the knee in seventeen, in the leg in ninety-five, in the ankle in twenty-two, and in the foot in fifty-seven instances; of the one hundred and thirty-seven instances in the upper extremities the injuries were in the hand 1 BECK (R.), Chirurgie der Schussverletzungen, Freiburg, i. Br., 1872, p. 331. CHAP. XII.) TETANUS. 819 in thirty-seven, in the arm in thirty-four, in the shoulder in thirty- one, in the forearm in twenty-four, in the elbow in seven, and in the wrist in four instances. The belief that shot wounds of the foot and hand are particularly apt to cause tetanus is not confirmed by the rases recorded during the war. In the lower extremity, especially, this complication is found most frequently in injuries of the thigh and the leg. In one hundred and thirty-one instances tetanus followed closely upon operations in the extremities, viz, in one hundred and sixteen cases after amputations and in fifteen cases after excisions. The rarity of tetanus as a complication of chest wounds has been noted on page 635 of the First /Surgical Volume, and it may here be added that in all but one of the seventeen cases there referred to the complication was due to simultaneous injuries of the scapula, shoulder joint, or arm. Of the five hundred and five cases, four hundred and fifty-one, or 89.3 per cent., ended in death, as follows : TABLE CLII. Summary of Five Hundred and Five Cases of Tetanus, indicating Seat of Injury and Result. SEAT OF INJUEY. TOTAL CASES. RECOVERIES. DEATHS. RATIO OF MORTALITY. Head Face, Neck - - - 21 1 20 95.2 Trunk - 55 5 50 90.9 137 18 119 86.8 292 30 262 89.7 505 54 451 89.3 The recoveries after tetanus appear to have chiefly occurred in the cases of slighter or tetanoid forms, or in those in which the disease took a chronic course, and it is possible that the early application of powerful narcotics interrupted the progress of the malady in a few cases of acute form. From an examination of these cases it may be concluded that the later the occurrence of the disease after an injury, the better was the chance of recovery; arid also, that the longer the duration of the affection after its inception, the greater was the chance of life. (See TABLE CLIV, on page 820.) In the following table are indicated the days after the injury or after amputation on which tetanus made its first appearance: TABLE GLIII. Statement indicating the day after Injury or Amputation on which Tetanus appeared. a a 3 o 367 Days after the Injury or Amputation on -which Tetanus appeared. 2 !;< 5 fi 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 to 30 Above 30 i 899 19 30 23 37 24 27 25 20 17 12 6 7 11 5 4 4 3 1 3 3 3 7 23 In twenty-seven cases tetanus appeared on the first day; but twenty-one of these were cases of tetanus following amputations, so that in reality it only appeared in six cases within the first twenty-four hours after the original injury, and it may here be stated that, with the exception of a small number of cases, tetanus in cases of amputations invariably followed within a few days after the operation. Few cases occurred on the second, third, and fourth days after the injury; but from the fifth day, when sufficient time had elapsed for inflammatory action to establish itself, the number of cases rapidly increases until the 820 WOUNDS AND COMPLICATIONS. [CHAP. XII. eighth, when it gradually diminishes again until the fourteenth, after which period tetanus appear irregularly, in one instance the malady not making its appearance until seven months after the injury. As the causes of this fatal malady are cited : excessive heat, exposure to cold and damp air, draughts, neglect of thorough and early cleaning of the wound channel, pressure of missiles and bone splinters and of bandages on nerves, injuries to nerves while searching for foreign bodies or while performing ligations and excisions. The duration of the disease is indicated in three hundred and fifty-eight cases, of which twenty-one ended in recovery and three hundred and thirty-seven in death, as follows: TABLE CLIV. Numerical Statement of Results of Three Hundred and Fifty-eight Cases of Tetanus in which the dura tion of the disease was reported. EKSULT. Totals. Days of Duration of Tetanus. 1 1 eg 2 3 4 5 6 7 8 10 1! 12 13 It 15 16 18 19 20 21 23 24 20 27 29 33 37 39 48 49 21 337 1 ,-:; 1 r. i 6 1 ? 1 1 3 3 1 i * 1 2 1 1 1 1 > 1 Deaths 19 :;i 22 L9 1 1 7 t 2 3 1 1 1 1 j 358 7U 84 I . :n 22 1:1 M 7 7 3 2 5 2 1 1 1 1 1 In two hundred and three, or more than one-half of the cases in which this point was ascertained, the duration of the malady did not exceed three days, and of these only two recovered; in the remaining nineteen cases of recovery the disease lasted from nine to forty- nine days, while the longest duration in the fatal cases was only twenty-seven days. In several cases the removal of the missile or of foreign bodies, as pieces of bone, seem to have quieted the threatening symptoms; in one instance they were relieved by the loosen ing of a bandage pressing on the brachial plexus, and in another by the removal of a neuroma : CASE 1195. Private Oscar C. Romaine, Co. I, 145th New York, aged 20 years, was wounded in the right index finger October 25, 1862. The finger was amputated near the base of the first phalanx on October 30th. The part healed readily, but was very tender and often painful. In this condition he was admitted into Lincoln Hospital, Washington, January 18, 18b 3. Acting Assistant Surgeon B. P. Brown reported : "Nothing special transpired until March 20th, when, on attempting to swal low, he was seized with pain and stiffness in the neck and was unable to speak. Soon there was a heaving up of the chest and the head was rapidly thrown from side to side; the jaws closed, the angles of the mouth were drawn back, the eyebrows knit, and the countenance of a ghastly appearance. For a moment there would be partial remission, when the patient would complain that he could not bear to have any one touch him, as it caused the most severe suffering. Suddenly another paroxysm would come on more severe than the former, and then an interval, which, however, would be very short. This state of things continued from four o clock P. M. till one o clock A. M., when it was decided upon to open the wound and search for the cause. The part being laid open, a neuroma somewhat larger than a buckshot was found intimately incorporated with the hard cicatrix and tightly adherent to a spiculum of bone beneath. The tumor was removed, also the bony portion to which it had been attached. The parts were then brought together by adhesive straps, and the patient rested well, having but one more spasm about four o clock A. M., and that very light. He is now quite recovered and enjoying better health than for some months past." He was discharged from service June 19, 1863. He is not a pensioner. In the following case an incision down to the nerve temporarily relieved the symp toms of trismus, caused by the contraction of the cicatrix. As the symptoms reappeared with increased vehemence, a portion of the nerve was dissected out, and, no relief being afforded, amputation remained the only alternative : CASE 1196. Private John C. Marks, Co. D, 149th Pennsylvania, aged 28 years, was wounded at the Wilderness, May 10, 1864. On May 13th he was admitted into Stanton Hospital, Washington, whence Surgeon John A. Lidell, U. S. V., reported: "Flesh wounds of both arms by a musket ball, which, after passing through the left arm, entered the right near the inner edge of the biceps muscle, and passed through obliquely, outward and downward. At the end of about six weeks both wounds had healed; the cicatrix was firm. The medial nerve was evidently included in the cicatrix of the wound of the right arm, as he suffered intense pain in the course of it, especially in the fingers, which were stiff and extended. The nutrition of the arm CHAP. XII.] TETANUS. 821 was also impaired. He suffered great nervous irritation. September 16th, the pain in the forearm and hand is very severe; lie has also partial trismus; his jaws are stiff, but he can open them to the extent of about an inch. He has failed in strength and appetite and is emaciated." Dr. Lidell made an incision about two inches in length through the cicatrix down to the nerve, which was loosened and laid bare to the extent of the incision. The old cicatrix was also removed. The nerve did not appear to be injured in any way. The pain was apparently caused by compression of it by the contraction of the cicatrix. The wound was left open to heal by granulation. He had been treated to date of operation by subcutaneous injections of morphia, which relieved the pain temporarily. September 17th, pain is slight, trismus lessened; passed a comfortable night. September 18th, pain continues, trismus subsided. The injections of morphia were continued at night, and a grain of sulphate of zinc ordered thrice daily. September 30th, treatment continued to date. The operation has only afforded partial relief. The pain continues quite severe. October Gth, the wound of the previous operation has entirely healed, but he cannot use the hand in consequence of the exalted sensibility of it; the pain in it is very severe, and he is suffering much from want of sleep. He has had several paroxysms of severe tetanic irritation, with some stiffness of the jaws, one of which occurred this morning. Assistant Surgeon George A. Mursick, U. S. V.. made an incision through the cicatrix of the previous operation and dissected out the median and excutaneous nerves, which were found lying in close apposition, and resected three- fourths of an inch of each of them. They were both involved in the new cicatrix. October 19th, the operation of resection did not avail anything, and his condition is as bad as ever. The pain is now so severe as to deprive him (if all rest, and the sensibility of the hand is so great that he will not allow anything to touch it. His general health is suffering severely. His countenance expresses great anxiety and his appetite has failed. Surgeon John A. Lidell, U. S. V., administered chloroform and amputated the right arm at the junction of the upper with the middle third by anteror posterior flaps. Marks recovered, and was discharged May 27, 1865, and pensioned. Including the case just detailed, amputation was resorted to in twenty-nine instances after incipient tetanic symptoms; ten of the cases resulted favorably, and in several instances it is noted that the symptoms ceased after the operation. A few of these cases are here cited in detail: CASE 1197. Private D. E. Isham, Co. E, 154th New York, aged 19 years, was wounded in the left foot, at Chancellors- ville, May 3, 1863, and was admitted to a field hospital of the Second Corps. Surgeon C. S. Wood, 66th New York, made the follow ing report: "The injury was caused by the explosion of a shell, which carried away most of the foot and shattered the cuneiform bone and the astragalus, leaving the foot hanging by the integument of the plantar surface. There was but little haemorrhage, but the shock was excessive and tetanic symptoms were present; in other words the case admitted of no delay. If I remember right the patient had lain out all night. Not knowing the extent of the injury I performed Chopart s amputation, but discover ing the cuneiform and astragalus bones to be so much injured I proceeded, while the patient was still under chloroform, to perform Syme s operation." The patient was subsequently transferred to hospital at Alexandria, and later to Washington, where he was discharged from service January 22, 1864, and pensioned. CASE 1198. Sergeant T. Lewis, Co. E, 5th Michigan, aged 26 years, was wounded in the right forearm, at Gettysburg, July 2, 1863, by around ball, which entered on the ulmar side just above the styloid process, passed obliquely across, and came out on the radial side about two inches above the joint, comminuting both bones in its course. He was admitted to Broad and Cherry Streets Hospital, Philadelphia, July 13th, at which time his general health was not very good, the wound being inflamed and very painful. Several fragments of bone were removed, flaxseed poultice was applied, and the forearm was placed in Bond s splint. Under a treatment of tonics, with opium at night, the patient slowly improved until August 25th, when he was sud denly seized with a chill followed by threatening tetanus. In consultation the next day it was decided to amputate the fore arm as a means of saving life. The operation was performed by Teal s method, at the middle third, by Acting Assistant Surgeon A. Hewson, while the patient was under the influence of ether. He reacted readily. The stump was dressed with solution of lead and laudanum, being slightly elevated on a pillow. The wound granulated rapidly, and by September 20th cicatrization was almost complete, leaving a good stump without adhesion of flaps to the bones. A slight exfoliation from the end of the radius occurred during the progress of the case. The carpus and amputated portions of the bones of the forearm were forwarded to the Museum, with the history of the case, by Acting Assistant Surgeon W. F. Keating, and constitute specimen 2794 of the Suryical Section. The patient was subsequently transferred to Mower Hospital, where he was discharged from service April 20, 1864, and pensioned. CASK 1199. Corporal P. Nelson, Co. K, 139th Pennsylvania, aged 19 years, was wounded at the Wilderness, May 5, 1864, by a muskst ball, which shattered the radius and ulna of the right forearm for two inches at the junction of the middle and lower thirds, also wounding the ulnar nerve. One week after receiving the injury the man entered Finley Hospital, Washington, where he did well until June 9th, when the arm became much swollen and symptoms of tetanus ensued, including stiffening of the jaws, great pain and restlessness, and irritable pulse. On June llth circular amputation of the arm at the middle third was performed under chloroform by Acting Assistant Surgeon D. P. Wolhaupter. All symptoms of tetanus disappeared after the operation and the patient rapidly recovered. He was ultimately discharged from service July 27, 1865, and pensioned. The two lower thirds of the bones of the fractured forearm were contributed, with the history of the case, to the Museum by Surgeon G. L. Pancoast, U. S. V., and constitute specimen 2586 of the Surgical Section. CASK 12CO. Sergeant A. Smith, Co. G, 66th New York, aged 47 years, was wounded at Fredericksburg. December 11, 1862, by a shell which carried away a large portion of the right foot. Partial amputation of the foot was performed in the field by Surgeon C. S. Wood, 63th New York. The peculiarities in the case were that symptoms of tetanus were quite marked, with great exhaustion, and that relief was afforded temporarily by chloroform, and permanently by the amputation. The patient continued to do well afterwards. He was discharged from service May 1, 1863, and pensioned. The history of the case was reported by the operator. y22 WOUNDS AND COMPLICATIONS. I CHAP, xn CASK 1201. Captain F. Schaefer, Co. I, 73d Pennsylvania, aged 28 years, was wounded at Mission Ridge, November 25, 1863, by a musket ball, which fractured the left foot and lodged. The missile was extracted the fifth day after the injury, which was followed by extensive inflammation. On December 9th symptoms of tetanus ensued, which were relieved by active purgatives, calomel, etc. Three days later the symptoms returned, and on December 13th tetanus supervened in its usual form. On December 18th the leg was amputated at the middle third, after which the tetanus subsided and the patient made a rapid and good recoverv. Surgeon 13. L. Hovey, 136th New York, who performed the operation, reported: "I believe, with other sur geons, that amputation cured this man of tetanus." Captain Schaefer resigned the service July 5, 1864, and subsequently became a pensioner. CASK 120J. Sergeant J. Henderson, Co. A, 12lith New York, aged 29 years, was wounded in the right knee, at Spottsyl- vania, May 10, Ido4, by a musket ball, which shattered the head of the fibula and the posterior surface of the tibia, lodging between the gastrocnemins and soleus muscles. lie was admitted to Finley Hospital, Washington, two weeks after the injury. the wound appearing healthy and his general condition being good. A day or two afterwards the patient complained of soreness in the throat, and on May 29th marked symptoms of tetanus, such as rigidity of the muscles of the jaw and difficulty of masti cation and deglutition, existed. On May 30th circular amputation at the lower third of the thigh was performed by Acting Assistant Surgeon F. G. H. Bradford, immediate relief seeming to be afforded by the operation. The following day the rigidity of the muscles had partly disappeared and improvement continued until the patient was entirely relieved. Further progress in every respect continued favorable and the stump healed. The probable cause of the appearance of tetanus was owing to a slight laceration of the external popliteal nerve, produced by the ball in its passage through the limb. On August 1, 1865, the patient was discharged from service and pensioned, having been previously fitted with a " Jewett" artificial limb. The upper portion of the bones of the amputated leg, showing the seat and extent of the injury, were contributed to the Museum, with the history of the case, by the operator. CASK 120.5. Corporal II. Kampp, Co. A, 113th Illinois, aged 20 years, was wounded in the right forearm, before Vicks- burg, May 19, 18(53. lie was conveyed to hospital at Memphis, and subsequently to St. Louis, where he entered Lawson Hos pital one month after the date of the injury. Surgeon C. T. Alexander, II. S. A., in charge of the latter, made the following report: "The injury consisted of a compound fracture of the radius and ulna near the wrist, and was produced by u conical ball. Both bones were necrosed, and the wound was in a very bad condition at the time of the patient s admission. Numerous pieces of bone were impacted into the surrounding fleshy tissue, and pus of a fetid and unhealthy character was flowing from both wounds very abundantly. According to the patient s statement he was first taken with trismus about a week before his admission here, while he was in hospital at Memphis, though it did not appear that lie had been exposed to anything unusual. As he was certainly getting worse every day it was decided to amputate as a last resort. Accordingly, on June 28th, the opera tion was performed about four inches below the elbow joint, the patient seeming to stand the shock very well and to gradually improve from that time. The treatment at first had consisted of a narrow blister applied along the whole length of the spine on each side, brandy and chloroform being administered every two hours. These last two remedies not appearing to do any good, one-half drachm of tincture of cannabis indica was tried every two hours, under which the patient slowly improved. An enema of beef tea and quinine had also been given three times a day from the first." The patient entirely recovered, and was dis charged from service September 1, 1853, and pensioned. The treatment of this affection was empirical to the last degree, and the formidable list of remedial agents employed in combating it presents a curious study of the diverse pathological and therapeutical views entertained by the medical profession on this subject. In the cases of recovery it is impossible to say how far any individual or class of thera peutical remedies was of avail. Chloroform, ether, opiates, stimulants, and external irritants, embrocations and fomentations, were mainly relied upon. In some instances the symptoms disappeared so speedily and permanently as to raise the question whether the same result might not have occurred spontaneously. In the fully developed cases all remedial measures failed and the cases ran on unchecked to a fatal termination. The following are the remedies which are recorded to have been used by the medical officers: Tincture of valerian, bromide of potassium, extract of cannabis indica, yellow jasmine, woorara, extract of nux vomica, tincture of aconite, assafoetida, belladonna, chlorodyn, conium, strychnia, solution of permanganate of potassa, hyoscyarnus, chlorate of potassa, tartrate of antimony, Hoffmann s anodyne, chloric ether, chloroform, camphor, quinine, hyposulphites of soda and lime, nitric acid, mercurialization, castor oil, turpentine, and croton oil; stimu lants and opiates were given with all of these preparations. Of external applications the following were used: Blisters, emollient poultices, warm fomentations, turpentine, ice, olive oil, creasote, warm baths, electric currents, chloroform liniment, powdered lime and opium poultice, vapor baths, powdered morphia locally, snow and salt bagged and applied to seat of injury, hyoscyarnus ointment, and saturated solution of chlorate of potassa in wound. CHAP. XII.] GANGRENE. 823 Injections were given of sulphate of atropia and sulphate of morphia hypodermically, opiates, tobacco, turpentine, castor oil, soap and water, milk of assafcetida, vinegar, and brandy. In the Army Medical Museum is preserved a specimen (No. 3538, Surgical Section) showing a shot laceration of the crural nerve in a patient who survived the injury twenty- five days and died of tetanus. The specimen and its history were contributed by Dr. William Thomson. On page 339 of the Second Surgical Volume a drawing illustrating its pathological histology was promised, but a careful microscopical examination of the specimen failed to indicate any abnormal conditions: CASE 1*^04. Private Alexander Fletcher, Co. F, 31st Maine, aged 21 years, was wounded at the Wilderness May 6, 1864. He was removed to the field hospital of the 2d division, Ninth Army Corps, and was transferred on May 12th to Douglas Hos pital, Washington. Assistant Surgeon W. Thomson, U. S. A., reported: "Gunshot flesh wounds of left arm, and side over lower ribs. On May 20th tetanus in the form both of trismus and opisthotonos appeared. Equal quantities of laudanum and tincture of valerian were given in teaspoonful doses every two hours, which alleviated the symptoms somewhat. Death resulted on May 31, 1864, from tetanus. At the autopsy it was found that the ball had entered over the lower ribs and passed down between the muscles of the abdomen over Poupart s ligament and under the femoral vessels, wounded the crural nerve, and lodged near the middle third of the femur." The specimen of the lacerated crural nerve was contributed to the Army Medical Museum by Dr. Thomson, and is numbered 3538 of the Suryical Section. In crowded field and general hospitals neither time nor opportunity was found for microscopical examination of minute structural changes, and the post-mortem examinations are therefore incomplete and give only negative results; no anatomical lesions of the medulla oblongata, the cerebellum, or the spinal cord in such cases were noted. Sixteen, or 3.1 per cent., of the five hundred and five instances of tetanus were found among the colored troops, who furnished 2.7 per cent, of the total number of shot injuries. GANGRENE. "The necessity of the careful definition of such terms as mortification, gangrene, sphacelus, dry gangrene, moist gangrene, hospital gangrene, and gangrenous phagedsena," urged by Joseph Jones in his article on hospital gangrene, 1 has become apparent from the examination of the reports of cases of gangrene recorded during the war. According to the conception or predilection of the surgeon, these terms, in many instances, seem to have been used indiscriminately, and it has been found utterly impossible to determine with accuracy the cases of traumatic gangrene, hospital gangrene, dry gangrene, etc. For instance, there were reported, as will be shown hereafter, eight hundred and forty-six (846) cases of gangrene during the years 1862 and 1863, of which, on the hospital records, only one hundred (100) were designated as hospital gangrene, and yet Surgeon M. Goldsmith, U. S. V., in his special report on the subject, in the spring of 1863, gives a tabular state ment of three hundred and forty-three (343) cases of hospital gangrene observed in the hospitals of Louisville alone during only parts of the years 1862 and 1863. An attempt to separate the various forms of this disease according to the descriptions of symptoms and treatment noted in each case failed, and it has therefore been deemed advisable to include in one tabular statement all cases of gangrene observed after shot wounds and to illustrate the various forms by examples or special reports. The total number of cases of gangrene reported was two thousand six hundred and forty- two (2,642). Of these, sixty (60) were observed after wounds of the head, two hundred and sixteen (216) after wounds of the trunk, and two thousand three hundred and sixty-six (2,366) after wounds of the extremities, as follows: JO.VES (JOSEPH), Investigations upon the Xature, Causes, and Treatment of Boxpital (Sanr/rene. as it prevailed in the Confederate Armies, 1861- 18G5, in (fnite.d States Sanitary Commission Memoirs, New York. 1871, Second Surgical Yulumu, !> 1"4. 824 WOUNDS AND COMPLICATIONS. [CHAP. xn. TABLE CLV. Summary of Two Thousand Six Hundred and Forty-two Cases of Gangrene, indicating the Result and Relative Frequency. SEAT OF INJURY. RECOVERY. FATAL. UNDETERMINED. TOTAL. Cti PER CENT. OF RELA TIVE FREQUENCY. 5 7 12 58.3 1 32 16 48 33.3 I . . 60=2. 2% Flesh Wounds of Trunk 36 32 7 75 47.0 J ) 44 97 141 68.7 I... 216=8. 2% J 47 50 12 109 51.5 1 476 245 14 735 33.9 125 127 92 344 50.3 1 2, 366=89.6% 596 568 U 1,178 48.7 Aggregates ... 1 361 1,142 139 2,642 45.6 Thus it will appear that 89.6 per cent, of all the cases of gangrene were observed in wounds of the extremities, 8.2 per cent, in wounds of the trunk, and only 2.2 per cent, in wounds of the head, face, and neck, although the proportion of injuries of the three regions, as shown in TABLE CXIX, page 691, ante, is 70.86 per cent, for the extremities, 18.37 per cent, for the trunk, and 10.77 per cent, for the head, face, and neck. Nearly two-thirds one thousand five hundred and twenty-two (1,522) of two thousand three hundred and sixty-six (2,366) cases of gangrene in the extremities occurred in the lower extremities, while, as has been shown before, the total number of injuries of the upper extremities slightly exceeded that of the lower extremities. The results in one hundred and thirty-nine (139) of the two thousand six hundred and forty-two (2,642) cases of gangrene were not ascertained; one thousand three hundred and sixty-one (1,361) terminated in recovery, and one thousand one hundred and forty-two (1,142) in death, a mortality rate of 45.6 per cent.; but in a large number of these cases death was ascribed either to the injury itself or to other complications such as pyaBmia in one hundred and fifty-two (152), hemorrhage in forty-seven (47), exhaustion in one hun dred and eight (108), tetanus in eleven (11), erysipelas in two (2), and pneumonia, typhoid fever, diarrhoea, and other diseases in seventy-seven (77) instances. In three hundred and thirty-nine (339) cases the immediate cause of death was not stated. In four hundred and six (406) of the one thousand one hundred and forty-two (1,142) deaths the fatal issue was directly ascribed to gangrene. A peculiar feature in the above table is the fact that with the exception of the penetrating wounds of the trunk the percentage of fatality of the cases of gangrene after flesh wounds is larger than that after fractures. The death rate of the cases of flesh wounds of the head, face, and neck complicated by gangrene is 58.3 per cent., while that of the fractures is only 33.3 per cent.; likewise the death rate of the flesh wounds of the upper extremities attacked with gangrene is 51.5 per cent., while that of the fractures complicated with gangrene is only 33.9 per cent. In the lower extremities the mortality after gangrenous flesh wounds is 50.3, while that of the fractures is 48.7 per cent. In wounds of the trunk alone the mortality of the fractures and penetrations exceeds that of the flesh wounds, the former being 68.7, the latter 47.0 per cent. CHAP. XII.) GANGRENE. 825 Of the two thousand three hundred and sixty-six (2,366) instances of gangrene in the extremities, one hundred and eighty-five (185) were cases of gangrene following excisions, and in forty-six (46) of these cases amputation of the limb had to be resorted to. The great liability of excisions to this complication will be referred to hereafter. In eight hundred and ninety-eight (898) instances gangrene was noted on the face of the stump. In a few of these cases the complication was caused by strangulation of the stump by tourniquet. In the following instance the gangrenous condition of the limb was ascribed to the tight application of bandages: CASK 1^05. Captain J. Phinney, Co. K, 86th New York, aged 28 years, received a gunshot fracture of the left forearm, lower third, at Spottsylvania, May 10, 1864. When he was admitted to Seminary Hospital, Georgetown, four days afterwards, he was in a rapidly sinking condition, and the injured limb was gangrenous from the elbow down, owing to the circulation having been stopped by applying bandages too tight on the field. On May 15th the arm was amputated above the elbow joint by Surgeon H. W. Ducachet, U. S. V., who performed the operation by skin flaps and circular section of muscles. Chloroform constituted the anaesthetic. The patient began to improve within forty-eight hours after the amputation, and, with the exception of .the formation of two abscesses in the stump, his improvement continued slowly afterwards. About June 30th he was able to walk about, and three weeks later he left the hospital on leave of absence. The history of the case was reported by the operator. The Adjutant General, U. S. A., reports that Captain Phinney died August 10, 1864. But the large majority of the cases were instances of hospital gangrene caused by the crowded condition of the hospitals and the bringing together of many cases of extensive fractures and large operation wounds. How far the frequency of the occurrence of gangrene was influenced by the season of the year cannot be ascertained from the nature of the reports; it can only be stated that in nine hundred and eighty-three (983) of the two thousand six hundred and forty-two (2,642) cases the month was not indicated; that eighty-seven (87) cases were recorded as having occurred in January, forty-eight (48) in February, forty-three (43) in March, sixty- four (64) in April, one hundred and seventy-five (175) in May, three hundred and one (301) in June, two hundred and ninety-four (294) in July, two hundred and twenty-five (225) in August, one hundred and ten (110) in September, ninety-eight (98) in October, eighty-nine (89) in November, and one hundred and twenty-five (125) in December; the highest number having been observed in June, July, August, May, and December; the lowest in March and February. The frequency of gangrene according to the different years of the war is indicated iri the following table: TABLE CLVI. Indicating the Years in which the Gangrene occurred. SEAT OF INJURY. TOTAL. 1861. 1862. 1863. 1864. 1865. NOT STATED. 12 3 | 9 Fractures and Penetratin r Wounds of Head, Face, and Neck 48 3 13 31 1 75 5 23 1 34 8 5 141 13 42 78 G > 109 3 27 69 r, 4 735 2 37 144 510 32 10 Flush Wounds of the Lower Extremities 344 35 117 163 16 13 1 178 2 127 254 717 07 11 AgTefates ... 2 642 4 223 623 1 611 135 46 Only four cases of gangrene were recorded for the first eight months of the war in 1861 ; but it must be remembered that the medical reports for this period are very incomplete. In the following year, 1862, the number of cases of gangrene increased to two hundred and twenty-three. A few sporadic cases occurred in the hospital at Fort Hamilton, New York, SURG. Ill 104 826 WOUNDS AND COMPLICATIONS. (CHAK xii. in the early part of September, among men wounded in McClellan s Peninsular Campaign in June and July, 1862. Of the three cases reported at that hospital by Surgeon B. Randall, U. S. A., one, at least, was that of a prisoner who had been carried to Richmond and had then been paroled. It was after the battles of South Mountain and Antietam, in September, 1862, that serious outbreaks of hospital gangrene occurred at the hospitals at Frederick and at West Philadelphia. The cases were carefully observed by Acting Assistant Surgeon W. W. Keen, whose report is here given: "After the battles of South Mountain aud Autietain, September 14th and 17th, 1802, an immense number of patients was accumulated in the hospitals at Frederick, Maryland. The old general hos pital (No. 1), which had contained six hundred beds, was so crowded with patients that one thou sand were of necessity placed in the wards, and one thousand eight hundred men were fed at its tables aud slept somewhere. The hospital consisted of five old barracks of inferior character, a tine new one (built very much after the style of our wards at this place [West Philadelphia], with ventilation at the ridge-pole, either continuous or interrupted), together with a large, substantial old stone building of Revolutionary times, better ventilated by its fire-places than by its windows. To these were soon added two large new barracks, finely ventilated. Each of these buildings was entirely detached from the others, and would accommodate some eighty patients, with about six hundred and forty cubic feet, of space to each in the old barracks and one thousand two hundred aud fifty cubic leet in the new. Besides these, about thirty hospital tents, with eight beds in each, were pitched at various points. Here the allowance of air was only about one hundred and seventy- five cubic feet. The hospital was situated on a hill on the outskirts of the town and in a mountain ous region. This, with the distribution of the buildings, procured the amplest circulation of pure fresh air. "About the middle of October the number of cases in Barrack E, of which 1 had charge, was diminished from one hundred to seventy-eight. Excepting four or five, they were all severe surgi cal cases, a number of them being amputations, resections, or compound fractures of the thigh, and the wounds were suppurating freely. Every means to insure cleanliness and pure air was taken. Each patient had his own sponge. Oakum was largely used as a dressing, and chlorinated soda freely used on the dressings and the floor. " Preceding October 19, 1862, three or four days of cold rainy weather set in, which occasioned the closing of the doors aud windows to keep both warm and dry. On the second or third day I noticed three cases of decided hospital gangrene, all in the lower extremity; about twelve or fifteen wounds also, which had been progressing finely, stopped cicatrizing and assumed an unhealthy appearance. They were red and punctated; in some small new vessels were seen; they bled freely on removing the dressings; the parts already cicatrized became bluish red, and, in the worst looking cases, an areola of an inflammatory nature, red color, and with a hard base, was observed. The cases of decided gangrene were removed to a tent, with six beds and an allowance of space of two hundred and thirty-two cubic feet, where, under treatment, they rapidly recovered. Sixteen beds were removed and the barrack still more carefully ventilated. The weather became tine, and in two days the unhealthy sores recovered their original healthy appearance, and no more cases occurred. Two other outbreaks of the disease occurred in this barrack, one on November 8th and another early in December, running precisely a similar course. During the last an attempt was made to treat the cases in the ward without isolation, but it only ended in an utter failure, and they were again removed. Four days before it made its appearance in Barrack E the disease appeared in Barrack B, where its history was an exact counterpart of the one already related. From these two barracks, the most overcrowded and, by the way, the only ones in which erysipelas had appeared, the disease spread to all the others, in most cases, apparently, by contagion, in some clearly by infection, through the careless use of sponges, etc.; and yet, strange as it may seem, but one case appeared among the patients in the tents. They were, it is true, far lighter cases of wounds; but they were, apparently, much more exposed by the small allowance of space and by their greater proximity to the gangrene tents. When 1 left Frederick, December llth, about fifty cases in all had occurred, of which some eight or ten were still under treatment and progressing favorably. Two cases had proved fatal, but by reason, it seemed, of other organic complications. CHAP. XII.] HOSPITAL GANGRENE. 827 "On December 23, 1862, fifty patients were admitted to Ward No. 1, and one hundred each to Wards Nos. 2 and 3, U. S. A. General Hospital, West Philadelphia. Of these, twenty-five in Ward No. 1, eighty in Ward No. 2, and fifteen in Ward No. 3, one hundred and twenty in all, were gunshot wounds. There were at the same time two thousand three hundred and eighty-four patients in the hospital, of whom rather more than two hundred were wounded. The allowance of space in these three wards, which are contiguous, is nearly twelve hundred cubic feet to each man. But few of these new wounds were discharging freely, and scarcely any were more than flesh wounds of no great severity. At the time and after the admission of these patients, who were the first occupants of the wards, says Dr. Lewis in his report for Ward 1 for January, 1863, kindly placed at my disposal by Mr. Knorr, the weather had been for some days unusually cold and blus tering, and this portion of the hospital was so arranged as to afford no protection against draughts of air proceeding directly from the outside through open doors communicating with the passage way leading to the ward. "One week after their admission, L e., December 30, 1862, I observed two cases of decided hospital gangrene, both of the thigh, in my own ward, and at the same time eight or ten of the other wounds began to look unhealthy. The cases of decided gangrene were immediately vigor ously treated by nitric acid, but were not removed from the ward, and the fullest precautionary measures were taken to prevent the further progress of the disease. Since the patients could not be removed, I resolved to put the ward in as favorable a condition as possible. I ordered every other window on both sides to be lowered both day and night, and put a reliable patient in charge of the matter; I obtained a sponge for each man, directed the nurses to dress the gangrenous and unhealthy sores last of all, and to wash their hands carefully in dilute chlorinated soda afterward ; used no dressing or bandage a second lime, and had the soda freely used on the floor near those suffering from the disease. On the 31st no new cases appeared. On January 1st four more were observed, and from the 2d to the 18th nine more. In Ward 3 no cases whatever have appeared ; in Ward 1 three cases appeared respectively on the 4th, 5th, and 8th of January. In Ward L, far removed from Wards 1, 2, and 3, one case broke out on January 17th. These, as far as I know, are all the cases that have occurred. They number nineteen in all : ten in the lower extremities, five in the upper, and four in the trunk. A marked contrast is thus seen to exist between the disease as seen at Frederick and at West Philadelphia. At Frederick it was notably contagious and spread widely and to every bar rack; in West Philadelphia, although probably contagious, it did not invade many wounds in the same wards, nor did it spread widely to adjoining wards. There the patients were isolated, here they were retained in the wards ; there all attempts to treat them successfully in the barracks failed, here it has been perfectly successful ; there nitric acid was used as an escbarotic, here both that and the acid nitrate of mercury. It should also be noted that both attacks followed a few days of bleak, cold, and rainy weather; that both occurred where a number of wounds were collected together; that in individual symptoms both were precisely alike, and that they improved imme diately on the setting in of fine weather and under appropriate treatment; that simultaneously with the outbreak of the disease a number of wounds assumed an unhealthy appearance, which quickly disappeared under proper hygienic treatment and good weather. "The disease, as I have observed it, is ushered in by from one to three days of unhealthy action such as already described, accompanied in some cases with marked fever, coated tongue, and prostration, but in by far the majority of cases with simply sleeplessness and general malaise. The patient complains of sharp, burning, pricking or stinging pain in the wound, sometimes so severe as to make him cry out, the suffering being intense ; at others feeling rather as if the part had been asleep. If the surgeon now examine the wound he will find a layer of ash-colored matter, which, as Guthrie describes it, covers the face of the ulcer and adhers so firmly as not to be readily removed; or, if separated, shows that it is a substance found upon the surface and constituting a part of the granulations themselves; the edges rugged, everted, or, more commonly, undermined, or violet or livid in color; a marked areola, almost erysipelatous, surrounding the wound, an indu rated base feeling very like that of a hard chancre; the discharge thin, watery, bloody, ash-colored or darker, and the wound considerably enlarged, and enlarging with aggravated symptoms, day by day, regardless of Nature s best efforts; and benevolent Art now interferes to relieve the oft-time wretched sufferer. The smarting pain and the extension of the wound (usually conjointly, but 828 WOUNDS AND COMPLICATIONS. (CHAP. xn. sometimes separately) I have found to be the most distinctive characteristics of the disease. The enlargement is usually confined to the skin and superficial fascia; occasionally, however, it extends to the intennuscular cellular tissues, and, in rare instances, to the muscles themselves; arteries, large nerves, and bones resist its destructive tendency with great perseverance. The following case will illustrate the disease : "CASE 120G. Corporal H. H. Kuhn, Co. A, 10th Pennsylvania Reserves, aged 23, was admitted to Ward No. 2, West Philadelphia Hospital, December 23, 1862. lie had been wounded ten days before at Fredericksburg, by a ball which had passed through the right thigh postero-anteriorly and inflicted a superficial wound, the openings being about two and a half inches apart. The wounds looked well. Ordered cold-water dressings. December 30th : The wound has done well up to this date, and sulph _ ing the wound hard, the areofa marked both in color and size; the pain sticking or pricking, and quite severe; the surface ashy gray and punctated; it bleeds freely on removing the dressings; the two openings are coalescing, and the intervening sound Hesh is unhealthy and partially destroyed. I opened it thoroughly, cut away the intervening unhealthy flesh and applied strong nitric acid to the entire surface, the patient being under ether; ordered flaxseed and laudanum poultice covered witli oiled silk, times a day : still no constitutional symptoms are seen. January 9th : The slough is all gone, and fine healthy granulations are found covered with thick yellow pus; ordered the acid wash to be reapplied. January llth: Again slightly unhealthy; ordered acid wash continued, adding five drops of nitric acid to the ounce. He now did finely, and the acid wash was gradually diluted and then simple cnrate substituted until January 23d. Two or three days of stormy weather having occurred, the wound again looks unhealthy. The cicatrix is invaded at one point and looks bluish, and the discharge is less in amount and rather unhealthy in character. There is, however, no pain nor ashy surface; no areola, and no extension other than that noticed. Ordered tin foil to be applied. January 25th : The wound is vastly improved, so that I ordered the foil discontinued. January 30th : Left on thirty days furlough, doing finely. "The question has almost uniformly been raised by authors, whether the disease is consti tutional or local. Without quoting particular authorities, suffice it to say that rather the larger number regard it as a local disease, sometimes, in the language of Guthrie, preceded by and accom panied with constitutional symptoms. But the concurrent constitutional symptoms are no proof of a similar character in the disease, for the removal of a benign tumor, an amputation, or a gun- shot wound is followed by the same. No one as yet has ever seen the disease originate constitu tionally, but always locally. Wounds may become gangrenous; but hospital gangrene never gives rise to ulcers. Even where the constitutional symptoms are present, as I have seen the disease, they have been very slight, and rarely exceeded anorexia, sleeplessness, and a slight irritative fever. Of the fifty cases in Frederick I have statistics of twenty -five. In these the constitutional symptoms preceded the disease in but five cases, accompanied it in four, leaving sixteen unaffected constitutionally. Of the nineteen cases here seen there were two in which they preceded and four in which they accompanied the disease, leaving thirteen with no constitutional disturbance. The following is a case in which the constitutional symptoms were first manifested and then the local: "CASE T307. Private William P. Trump, Co. D, 8th Pennsylvania Reserves, miner, aged 22, was admitted to Ward No. 2, West Philadelphia Hospital, December 23, 1862, having been wounded on the 13th at Fredericksburg. The ball grazed slightly the right shoulder, and the wound did finely under cold-water dressings. January 2d: An active fever has set in, with loss of appetite, coated tongue, and costiveness; ordered three compound cathartic pills, and tartar emetic one-eighth of a grain three times a day. January Gth : The constitutional disturbance is about the same, but local trouble has manifested itself. The usual symptoms of hospital gangrene have become developed, the wound is enlarging, and the pain is so great as to deprive him of all rest and to cause him to disturb the whole ward with his outcries. I cauterized the wound freely with nitric acid and ordered a poultice with morphia sulph. gr. one-quarter h. s. The pain ceased from that moment; he slept well; in three days the slough separated. I applied the acid wash, and he soon recovered sufficiently to desert." "The offensive odor I have observed but in four cases, two at Frederick and two here. In cases so severe as those observed by Macleod and others, in which death occurred in sixteen hours, it was, no doubt, one of the most marked and disgusting symptoms. The case in Ward L, bed 7, was so offensive that its odor could readily be observed in the corridor, and one of those in Ward 1 was no less so. The experience of Dr. Lewis in Ward 1, as detailed in his cases, gives the most marked efficiency to the permanganate of potash in ten grains to the ounce as a deodorant. It controlled the odor when charcoal and fomenting poultices of porter and corn meal seemed to have not the least effect. It deserves further trial. "The circular form, also alluded to by other writers, is by no means so frequent in these lighter cases; nor have I yet seen a case of secondary haemorrhage, although I have seen the ante rior tibial and the femoral itself pulsating at the base of such gangrenous sores, and in one case at Frederick, of ligation of the external iliac, the disease being communicated by a sponge, attacked the wound ; and yet the artery resisted both the disease and the remedy. Should such a misfortune occur, I should unhesitatingly ligate higher up, and with the greatest precaution against, infection. 1 should, if disease attacked the new wound, apply the escharotic immediately. But it will not CHAP. XII.J HOSPITAL GANGRENE. 829 always attack every sore, and this is a serious argument in favor of its local character. I have often seen it attack a wound of entrance or of exit, and leave the other free; I have seen it attack an abrasion over the head of the fibula and leave untouched a compound fracture of the same thigh ; attack an ulcer on a leg, and pass by the granulating stump, three inches lower down. I have yet to learn of a single case occurring among patients in the field a fact fully corroborated by other surgeons who have had greater opportunities in the field than myself, and which I can only explain by the reason that the patients are usually placed in houses, or on the field itself, where free ventilation is attained, and are speedily removed into hospitals. "As to the treatment it has been pretty fully illustrated in the cases cited. As soon as the disease is recognized I have applied either nitric acid or the acid nitrate of mercury. The former, alone, was used at Frederick; but here I have used the acid nitrate of mercury in six cases, and with the most favorable results. I prefer it, now, to the nitric acid, since it causes less pain indeed, often it saves time vastly by requiring no anaesthetic to be used; the pain continues for a shorter time, the slough appears to be more thoroughly destroyed and disintegrated, and it separates in from twelve to thirty-six hours sooner than that from the acid. I have not yet met with a case of ptyalism from its use. The relief obtained from the severe stinging pain is often almost instan taneous, and if the disease has been thoroughly checked it does not recur. Should I have any other cases, I should also desire to make trial of a forty-grain solution of corrosive sublimate to an ounce of glycerine. But whatever escharotic be used, I cannot insist too strongly upon the neces sity of its thorough application. The disease, especially in the milder form noticed here, can be eradicated by this, and by this only. It must be unsparingly applied to every spot and surface involved. Stumps must be laid bare and apparently ruined ; sinuses must be fully exposed, and the disease relentlessly pursued to its furthest refuge. The timid hand, according to DeQuincey the opprobrium of our profession, will not do here. The work must be thorough and complete and the remedy applied everywhere not only to the surfaces diseased, but also to those laid bare by the knife, and even somewhat to the sound parts beyond, or the disease will spread inevitably, and kindness well meant will be really unintentional cruelty. I generally used, as a means of application, a stick rather than a mop, since, if sharp pointed, it penetrates to places which will remain untouched if a mop is used. I have then usually applied a flaxseed poultice with one drachm to a half-ounce of laudanum till the slough has separated. Poultices of meal and yeast or porter are also good. Then, if any unhealthy spots were still seen, and especially if the stinging pain had not subsided, I again made use of the escharotic, followed by a poultice. As soon as a healthy surface is obtained I began with a stimulating lotion such as the acid wash already alluded to, varying its strength to the necessities of the case. Under this they have usually made a rapid recovery. In five cases I have used tin-foil applied directly to the wound, surrounded with charpie, for purposes of cleanliness, and have found it a most excellent remedy where wounds have refused to respond to other stimulants. U I have scarcely ever used the escharotic unless the two principal symptoms, viz, the peculiar pain and the enlargement of the wound, were both present, along with the unhealthy condition of the sore. On inspection I have often been tempted in several cases to apply the acid ; but finding the one or the other absent I have refrained and applied vigorous stimulation, as, e, #., the l acid wash, sometimes further fortified by some little nitric acid, and I have been gratified to find a successful result. Tin-foil itself will sometimes alone change their character vastly for the better. " The constitutional treatment is, I take it, of far less importance than the local, just as the constitutional symptoms are less grave than the local. Frequently they will subside entirely after the vigorous local treatment advocated. The fever will abate, the patient will sleep well, the tongue clean, the bowels relax, and he will tell you the next morning that he has eaten an excel lent breakfast and feels first rate. If fever sets in, I treat it as usual in any irritative fever; if the appetite and strength fail, by tonics and stimulant s and good diet. The tincture of iron, quinine, milk punch, and beef tea are the most valuable auxiliaries in such cases. " Hospital gangrene, the typhus of wounds, is, in its most marked form, a fearful and unwelcome guest in any hospital, most of all in a military hospital. It claims many victims in its fierce attacks, and often puts to naught all the resources of the most skilful surgeon. But in its milder forms, such as I have seen it, and such as I have attempted to describe, the means already indicated will, I feel confident, arrest its progress and baffle its worst endeavors." 830 WOUNDS AND COMPLICATIONS. [CHAP. xn. The next appearance of hospital gangrene, more serious in its character than that observed at Frederick and West Philadelphia, was at Annapolis. It appears from the report of Surgeon J. H. Brinton, U. S. V., who had been sent there to "inquire into the origin of the affection and the means which had been adopted for its treatment and for checking its progress," that on January 11, 1863, one hundred and fifty-three (153) patients were brought to Annapolis from Richmond. Very many of these men were wounded, and all had been closely confined in the prisons and prison hospitals of that city. Of these one hundred and fifty-three men, four had hospital gangrene at the time of admission and thirty- one contracted the disease within a short time. On January 29th four hundred and twenty- one additional patients were admitted from the same place and under the same circum stances; of these, gangrene existed in fourteen at the time of their admission. By February 7th the number of affected patients amounted to sixty. All cases in which the process of destruction was advancing, or in which reparation and cicatrization had not fairly set in, were collected in special wards isolated from all other buildings, and special bedding, blan kets, utensils, sponges, surgical dressings, and instruments were provided for them. In this manner the disease remained almost entirely confined to the paroled prisoners. All agreed that the origin of their sores must be referred to their confinement in the Libby Prison at Richmond and the adjacent hospitals. In the prison they were much crowded, and the majority were unprovided with beds or cots, sleeping on straw which was foul and affected with vermin. Their diet, although sufficient, was of poor quality. In the hospital they received better care and every medical attention possible under the circumstances. In both prison and hospital gangrene was prevalent; many cases were said to have died, and others were stated to be in such condition from their sores as to forbid removal. The paroled prisoners who had been taken on western battle-fields referred the development of their gangrenous ulcers to tedious and painful transportation from the West to Richmond. The cars used were closely boxed; the food on the road was deficient and miserable; many of them had been altogether deprived of food for two or three days. The treatment adopted in the Annapolis Hospital seems to have been judicious and successful. It consisted chiefly in the limitation of the ulcerative process by the applica tion of fuming nitric acid to the edges of the sore, to its surface, and especially to the healthy integument beyond the line of diseased action. In some cases nitrate of silver had been successfully applied. The cleansing means employed during the separation of the slough were chiefly Labarraque s solution, creasote and vinegar washes, yeast, cinchona, and charcoal poultices, etc. The patient s constitution at the same time had been supported by the internal administration of muriate tincture of iron and quinine, and by the free use of stimulants, malt liquor, beef tea, and a general nutritious diet. A few weeks after the appearance of the disease at Annapolis, Assistant Surgeon .1. J. Woodward, United States Army, was sent there for the purpose of examining into the microscopical appearances of hospital gangrene. His observations are embodied in the following report: "Arriving at Annapolis I visited thej)atients affected with hospital gangrene on the morning of February 18, 1803. I found that the progress of the disease was not yet arrested, and that one or two new cases were occurring almost daily. No one had, however, suffered from it except returned prisoners from Richmond, and the affection was proving much less fatal than European experience would cause us to anticipate. The patients were isolated from the rest of the hospital, in separate buildings. The number of cases in which the characteristic appearances of the earlier CHAP. XII.] HOSPITAL GANGEENE. 831 stages of the disease could be observed was only three or four, and about the same number pre sented vast sloughing excavations, which were still enlarging in spite of treatment. In all the other cases granulating surfaces of various sizes, and in various stages of the reparative process, indicated the former extent of the disease. As the description, history, and treatment of these cases has been made the subject of special observations which will be duly reported to the depart ment by Surgeon J. H. Brintou, U. S. V., I shall limit myself as much as possible in this report to pathologico-histological considerations. " In its destructive progress hospital gangrene, as observed by me in these cases, appears to follow at least two diverse modes of extension, which, however, are frequently combined in differ ent portions of the same excavation. " I. On the one hand the tissues immediately adjacent to the slough, which have been slightly reddened without being increased in thickness, become greenish-brown, or black ; the slough steadily progressing in this manner into the sound tissues, from which it is not separate! so long as it continues to extend by any pus-producing or ulcerative action or any true. line of demarcation.. " II. On the other hand the tissues about to be invaded become not only reddened, but hard and swollen, elevating the edges considerably, and causing, therefore, the cavity to appear deeper than it really is. This thickened mass breaks down rapidly into a fetid yellowish ichor and is thus quickly eroded, but in such a manner that the subcutaneous connective tissue is more speedily destroyed than the skin which overhangs, therefore, the jagged, irregular underminings of the morbid process. The sloughs in this case are ash-colored, yellowish, or greenish-yellow, occasionally brownish or blackish, in which latter case it will generally be found that the dark color is due to the putrid mass drying into a species of scab. " In both these varieties the slough attacks chiefly the skin and subcutaneous connective tissue and adipose layer. The second variety, however, more frequently than the first, may penetrate beneath the deep fascia of the part, still affecting especially the connective tissue septa, dissecting thus profoundly between the muscles and tendons, which resist longer the destructive process, and retain often their general form and appearance even after they have been completely undermined and separated, except at their extremities, from their normal connections. " In the first variety an examination of the slough as close as possible to the living tissues showed nothing but the normal form elements of the affected part in various stages of putrefactive decomposition. None of the lymph or pus-forms which usually result from inflammatory action could be observed. The small vessels and capillaries of the living tissues near the slough were gorged with blood, which, in the vessels immediately adjacent to the dead parts, was completely stagnant. In proceeding in the investigation of the sloughs of this character from the living tissues through the slough to the central cavity exposed by the disease, the elementary forms were found to be more and more completely obscured by the putrefactive changes until a granular opaque mass remained in which no form elements could be observed, except perhaps a few yellow elastic fibres which had resisted decomposition. Associated with these changes was a tendency to break down into a fetid, diffluent semi-liquid, and thus to leave a cavity which in this class of cases was usually bounded below by the superficial surface of the muscles of the part. In these cases it was generally observed that while the disease continued to spread peripherally, a line of demarca tion was formed by a true ulcerative action with pus-formation between the superficial slough and the subjacent muscles, the pus being formed in at least some of the cases at the expense of the muscular tissue, as will be seen in the sequel. "In the second variety an examination of the thickened and hardened edges into which the eroding process was extending showed the tissues to be transformed into a mass of cell forms, of which the most numerous were spherical granular cells, quite identical in individual aspect to ordi nary pus corpuscles, but embedded in a granular mass, and thus constituting what has been variously called croupous fibrine, croupous lymph, and corpuscular lymph. This is the condition described by Rokitansky as the death of textures replete with fibrin o-croupous exudates, to which category he refers hospital gangrene. Embedded in the same mass can also be seen occasion ally connective tissue cells in various stages of enlargement and multiplication by division. By the liquefaction of the granular mass in which these elements are embedded they float out free, forming a scanty ichorous pus. The process, therefore, in this variety consists of two stages: In 832 WOUNDS AND COMPLICATIONS. [CHAP. xii. the first there is an extremely rapid cell multiplicatiou, resulting in the formation of the innumerable cells of croupous lymph with which the tissues are crammed; in the second the death of the infarcted tissues occurs either gradatim as an eroding ulcer or in mass as a bulky slough. "In cases of either variety in which a favorable termination is attained after the sloughs are thrown off, granulations sprout from the bottom and sides of the cavity and gradually fill it up. In one or two cases in which this process had advanced to commencing cicatrization nothing was observed different from what may be seen in the healing of ordinary ulcers of considerable size. In many favorable cases, however, granulations sprout from the exposed muscles at the bottom of the excavation even before the extension of the sloughing at the margin is arrested. I found in these cases, as well as in the ulcerative process previously mentioned, by which the black sloughs of the first variety are separated from the subjacent muscles, a good opportunity to study the pro cess of pus-formation iu the muscular tissue. The observations made here confirm precisely, as do many others made by me heretofore, the opinion that the muscular tiJbre, when involved in the inflammatory process, contributes its share to the formation of the products of inflammation. The form elements involved especially are the so-called nuclei of the sarcolemma, concerning which there is a difference of opinion as to whether they are to be regarded as an anatomical portion of the muscular fibre or as belonging to delicate connective tissue cells wound spirally around it. These, whatever their nature, enlarge, elongate, multiply by division, and produce broods which encroach on the proper substance of the fibre. The transverse striae become pale, indistinct, and at length are replaced by a granular appearance. Finally the whole substance of the fibre is occupied by spherical granular cells, the destiny of which may be on the one hand to develop into granulations, or, on the other, to be set free as pus by the liquefaction of the matrix in which they are embedded. "With regard to the constitutional conditions present in these cases of hospital gangrene the patients were pale, the countenance anxious, the pulse frequent, small, feeble, the bowels some times affected with diarrhoea but in other cases constipated. The appearance of the patients in some cases indicated the presence of a scorbutic taint. In other cases the yellow complexion and the enlarged spleen indicated constitutional disturbances due to malarial poisoning. In all it was observed that a needle inserted into the finger to obtain a drop of blood lor examination required to be carried deeper than usual to obtain it. The blood thus obtained presented in every case a noticeable increase in the proportional number of white blood corpuscles, which were also, as a rule, larger than normal (^- 8 V^ to ^STJT f an i ucu i 11 diameter). This condition was developed in some cases much more than in others, but in none attained to an exquisite degree. The red blood corpuscles were scanty, pale, and showed less tendency than iu healthy blood to aggregate into nummular rolls. "If now, in appreciating the foregoing observations, an attempt be made to recognize the etiology of the affection, we shall seek for the efficient causes in the exposures, the privation, the want and depressing agencies to which these men had been exposed in the crowded prison hos pitals of Richmond. It was there that the affection originated, and although new cases still from time to time occur in Annapolis, it will be borne in mind that, as previously stated, these cases occur only among the wounded of the returned Richmond prisoners. The escape of these unfor tunates to the open wards, the generous treatment and good diet of the United States General Hospital, will account for the small mortality that has occurred. "In conclusion, an allusion may be made to the idea that the peculiar characteristics of this disease are due to the local presence of microscopical fungi. This idea is not borne out by facts. Accurate examination with a high magnifying power of cases in every stage, both where nothing but an ordinary water dressing as well as iu cases in which various forms of antiseptic and caustic washes had been employed, utterly failed to demonstrate any cryptogarnic organisms except the ordinary bacteria which are to be observed in every decomposing animal substance." While, at Annapolis, the cases of hospital gangrene had been produced by infection, the disease at Nashville, where it appeared a month or two later, in April, 1863, was undoubt edly of an indigenous origin. Thirty-eight cases occurred at hospital No. 8 within a few days, and Surgeon M. Goldsmith, U. S. V., who had been sent there to look into the origin and progress of the disease, found that "1. All of the cases occurred in Ward No. 1. II. All the cases occurred in the row of beds CHAP. xil.J HOSPITAL GANGRENE. 833 next the windows opening upon an alley. III. All the cases occurred prior to the 24th of April, or during the time when the external atmosphere was colder than that of occupied houses, enclosed cellars, or underground drains. IV. The cellar under the hospital had passing under and opening into it by several apertures the common sewer of that part of the city. V. The soil pipes from the privies of the several wards traversed this cellar and emptied without a trap into the common sewer. VI. This soil pipe was made of tin and leaked badly. VII. In wet weather the cellar bottom was overflowed by the contents of the soil pipes and sewer. VIII. This cellar had but two openings, one in the front of the building and one on the alley. IX. The alley was long, narrow, and high (five stories). X. The area of the adjacent building received the drainings of the garbage of the kitchen, and this area formed a part of the alley. XI. Ward No. 1 derived its ventilation almost entirely from windows opening on the alley. On the opposite side there was but one opening, a door, leading to a hall which had no window. On the end next the street there were but three win dows. XII. The prevailing winds during cold weather sweep the street on the front of the build ing, leaving the atmosphere in the alley almost still. XIII. The emanations from the area of the adjoining building, as well as those from the cellar, were most offensive at all times, and were dis gustingly perceptible in the evening when the external atmosphere began to grow cool. XIV. No cases of hospital gangrene occurred after the weather grew so warm that the outer air was warmer than the air in the cellar and sewer (after April 24th). XV. The building on the opposite side of the street (the alley running through only one square) prevented any wind from sweeping it below the second story. " In the early part of the season one patient was brought into the ward with hospital gan grene. In a few hours six other cases were developed in wounded men laying adjacent to him. The disease did not spread, and with the termination of these cases disappeared for a season. When it broke out again it attacked those who came into the ward without any appearance of a gangrenous condition in their wounds at the time of their admission. It will appear from the fact related that the miasm generated by putrefying animal matters in the cellar, and perhaps in the area, are given off at all seasons, and that just during that season when, from the relations of temperature, the atmosphere of the cellar would ascend in the alley and the currents would enter the wards most constantly i. e., when it was necessary to heat the ward with stoves, the cases of gangrene occurred; and that they occurred in just that locality in which the gases would impinge upon the patients in most concentration; and that when the uiiasin of the cellar would How down ward, i. e.j when the external air was warmer than the air of the cellar, and when from the extinc tion of fires no air was drawn in at the windows, the disease ceased. "The testimony of the surgeon having the ward and cases in charge is all the more valuable that he did not anticipate or interpret the facts. He noticed, without peculiar interest, the occur rence, and, as he expressed himself to me, supposed that by some singular accident the patients having the lowest vitality were placed in that row of beds; and he marveled greatly that the cases should occur when the ventilation was best, because the windows in the alley were the only available outlets for air in the whole ward, and were opened fully and diligently four times a day in even the coldest weather, and some part of the windows were kept open all the while. "I think that the records of surgery do not afford a more unique or striking example of one of the methods of the production of hospital gangrene, or afford a more pertinent commentary upon the use of buildings constructed in utter disregard of all hygienic rules. It is due to the Medical Director at Nashville to state that he had closed this hospital, and reopened it only when the crowd of patients coming from the front was so great that they could not be accommodated other wise, either in Nashville or at Louisville, and also to state that the attention of the Quartermas ter s Department had been called to the condition of the building. "I found some cases of hospital gangrene in process at the field hospital at Murfreesboro , Tenn. The wounds in the same and adjoining tents had an unhealthy look, and some were attended with profuse and unhealthy suppuration. A few of the cases were already laboring under the ichorous infection (pyaemia). The general police and attention to sanitary regulations were good except in one particular a particular to which, I fear, but little attention is commonly paid 1 refer to the privies. The tents are arranged on two sides of the square, end to end, along parallel streets laid out in squares, each row, I believe, being regarded as a ward. The privies are placed along a middle line bisecting a square, and distant, as near as my memory serves, about twenty or SUBG III 105 834 WOUNDS AND COMPLICATIONS. [CHAP. xn. thirty yards from the tents. These privies are opeu sheds placed over shallow sinks, nowhere deeper than aii ordinary field latrine. The flooring 1 is so loose that the whole arrangement is the equivalent of three square, large tield latrines, with only this difference, that in the field they can be policed by throwing in earth, while, in the present case, they were broad and shallow pits filled almost to the surface with a pestilent semi-fluid mass, the excrement of men affected with typhus, dysentery, diarrhoea, etc., etc., and incapable of the ordinary treatment of field latrines. At the time of my visit the streets surrounding the square were filled with the odor of these sinks an odor such as is only to be perceived in the neighborhood of such collections a nauseous odor, not mere ammoniacal odors, but a sickening phosphorescent odor. For some days prior to the appear ance of the hospital gangrene the atmosphere had been remarkably still and damp and the weather warm and cloudy; what little wind there was had been from the east. The tents holding the wounded were at the westward of the privies. I state these facts not for the purpose of intruding upon the province of the medical inspectors, or as a text for any comment other than that in them I can see clearly the operation of causes proverbially potent in giving rise to hospital gangrene, erysipelas, and congeners. "In Nashville I found a few sporadic cases of hospital gangrene, some of which had been treated with bromine unsuccessfully. In examining, the methods of applying the remedy I found that the applications had not been properly made. I requested permission to show the surgeons my methods on one of the cases. I dressed the first case in the presence of a number of medical officers. This method was applied to all the other cases in the city on the same afternoon, and I had the satisfaction of seeing that every one of them yielded to a single application of bromine, aud in less than forty-eight hours were granulating throughout the whole extent of the diseased surface. The affair of these cases, I am informed, has settled all doubts lingering in the minds of some of the surgeons on duty at that place in regard to the efficacy of the bromine treatment of hospital gangrene." As a prophylactic against this disease, Medical Director M. Goldsmith, U. S. V., ordered the following compound solution: "Bromine, one Troy ounce; bromide of potassium, one hundred and sixty grains; distilled water, enough to make four fluid ounces of the entire mixture. At the same time printed directions for its use were issued as follows: "1. For Fumigation: Place vessels containing one ounce of the solution at different points of the ward, and in number sufficient to secure in the latter the constant presence of the, odor of bromine. It should be borne in mind that if the vapor of bromine comes in contact with the vapor of water, hydro-bromic acid is formed; therefore, when there is much of the vapor of water dis engaged in the apartment the quantity of the vapor of bromine must be correspondingly increased. " 2. Topical application of the vapor : A piece of dry lint is to be placed over the diseased j >art ; over this is to be placed another piece of lint moistened with the solution of bromine; over this, a, third piece spread with simple cerate; the whole to be covered with oiled silk and bandage, so arranged as to retain the vapor in contact with the diseased surface as long as possible. The solu tion is to be renewed as often as it becomes exhausted by evaporation. "3. The solution, in substance, as a direct application in Hospital Gangrene, Diphtheria, Gangrene of the Tongue, and other diseases of this nature: The parts are first to be dried by the- application of charpie; then the sloughs, if thick, should be trimmed out with forceps and scissors as much as possible, for the thinner the slough the more effective is the remedy. The parts having again been dried, the solution is applied by means of a mop, or a pointed stick of wood, in quantity sufficient to saturate the sloughs. If the sloughs undermine the skin, or dip down into intermuscular spaces, the solution must be made to follow, with the pointed stick or by means of a glass syringe with a long nozzle. If the application has been effectual, all odor from the diseased surface ceases and the sloughs become somewhat hardened. The remedy should be reapplied every second hour as long as any odor of putrefaction is present, or as long as the sloughs appear to be diffluent. It is not always necessary, especially when the sloughs are diffluent and thin, to use the solution in its full strength; it may be weakened by the addition of water as the disease subsides. "The points to be especially attended to, in the use of the solution of bromine, are two: 1. The solution should be applied in strength and frequency sufficient for the impregnation of the whole of the sloughs. 2. To secure this end, the application should be made by the surgeon himself ) CHAP. xn. | HOSPITAL GANGRENE. 835 and never be trusted to a nurse. If the sloughs are thick and cauuot well be trimmed, the bromine may be introduced into the thickness of the slough by means of a hypodermic syringe. After the topical application of the solution the parts, when so situated as to render it practicable, should be subjected to the influence of the vapor. (See par. 1.) Surgeons will do well to bear in mind that bromine is a new remedy for the purposes indicated above. The directions for its use, given here, are those followed in the military hospitals of this city; it may be found advisable to modify them as experience with the remedy accumulates. It is, therefore, earnestly recommended that the subject be studied diligently, that the effects of the remedy be carefully watched, and that the application be varied as new facts are developed in its use." The action and influence of bromine thus employed will be best understood from the reports made to Surgeon Goldsmith by several surgeons in charge of hospitals under his direction in which the disease occurred. Surgeon B. Woodward, in charge of the Park Barracks Hospital, Louisville, Kentucky, reported: u In hospital gangrene the most remarkable effects of the use of bromine have been seen. At hospital No. 7 there is one case of gunshot wound of the foot in which the gangrene included the whole upper part of the foot from the toes to the tarsus. The integuments and muscles had all sloughed away, leaving the extensor tendons bare and isolated. The local use of the bromine had arrested the slough, and the line of demarcation was well marked. Another was at the same hospital of wound of the leg by a piece of shell ; the gastrocnemius and soleus were bared for a space of eight inches by three inches ; after the direct application of bromine the line was well marked, and the wound took on healthy action. In a third case at the same hospital the tibia was bared and denuded of periosteum, but the same good results were had from the use of bromine. At hospital No. 3 I was shown two cases of gangrene ; in one the slough had destroyed not only the muscles of the right arm, but the humeral artery had sloughed and had been ligated. Another and perhaps the worst case at the same hospital, where the slough had carried away integument, obliquus externus and obliquus internns, so that for a space of eight by five inches there was nothing left but the tendons of the obliquus interims and the peritoneum, the sloughing had been arrested, and the whole wound was covered with healthy granulations. In all these cases the peculiar fetor of gangrene had disappeared. All these cases were mixed in with sick and badly wounded men, and yet there had not been an instance in which others had taken the disease. All of these cases were gangrenous when they were brought from the front to this city, and I cannot find an instance in which it has originated here. This, as Dr. Goldsmith, in charge of hospital No. 7, said, can only be attributed to the prophylactic power of the vapor of bromine in the wards, and, to use his own words, we are doing with the greatest impunity what, a year ago, we should not have dared to do, viz, putting these cases in the wards with other wounded men. " Surgeon Thomas H. Mercer, U. S. V., records in detail in the following case the man ner in which bromine was employed at hospital No. 13, Louisville: "CASE 1208. Corporal Jesse Havens, Co. F, 69th Regiment Ohio Volunteers, was admitted to hospital No. 13, Louis ville, Kentucky, January 14, 1863, having been wounded at the battle of Murfreesboro , December 31, 1862, by a conical ball in the anterior tibial region, lower third of leg; flesh wound. The wound did not bh?ed at all at the time of the injury, but appeared to remain from that time until January 13th in about the same condition, with no disposition to granulate or heal. At that time, or very soon after, the edges of the wound and flesh in the vicinity began to assume a purplish hue and unhealthy look. Water dressings used up to February 1st; wound and surroundings growing worse daily. The wound then commenced sloughing and extending, with a dark gray and blackish appearance. At this stage of the disease was commenced the antiseptic treatment, the yeast poultice with cinchona and charcoal; after a few days nitric acid, diluted one-half, applied directly to the wounded surface and gangrenous surroundings, with some slight improvement. This was continued for several days. Bromine was then commenced, twenty drops to one ounce of alcohol, as a substitute for the acid, with the cinchona and yeast poultice applied imme diately after the use of the bromine. Up to this time, February 20th, Acting Assistant Surgeon John Logan had the care of the case; the treatment constitutionally was sustaining. The gangrenous sloughs were becoming detached and the surface of the wound was looking well, but very pale after removal of the sloughs. February 21st : Wound cleaning; some soft, pultaceous sloughs remaining on the inferior third of the ulcerated surface. This wound, not exceeding a twenty-five-cent piece in si/e when the patient was admitted, now extends some seven inches inferiorly and superiorly, and about five inches two and a half on either side of the leg; applied the bromine twice a day over the surface of the wound and around the edges for an inch or more. Ale. sulph. ferri gr. 1 every four hours; diet generous. February 22d: Soft pultaceous masses of slough removed with forceps and scissors. Bromine, ale, and iron continued. Appetite improving. Yeast and cinchona poultice as usual. February 23d: Pearly edge developing around the nicer; pulse 92; general surface of the wound looking well, and some disposition to granulation. Tongue slightly furred, appetite pretty good; patient more cheerful. Ale, iron, etc., continued. February 24th: Tongue improved, pulse 90; improvement in general appearance. Skin clear, mind tranquil, granulations appearing over the entire surface of the wound, except a irangrenous spot about the size of a dime on the inner surface of the tibia, about the cen tral portion of the wound, involving the periosteum. Appetite improving. Bromine, ten drops to the ounce of alcohol, proves as much as he can bear. Continue treatment as before. Generous diet. February 25th : Tongue clean, pulse 90, appetite good: 836 WOUNDS AND COMPLICATIONS. [CHAT. XII. gangrenous spot lessening; granulations increasing; surface ulceration improving in color; treatment the same as before. Feb fuary 26th : Tongue clean, pulse 96, appetite good; gangrenous spot lessening in width, slightly increasing in length; wound still improving and filling up with fine healthy granulations. February 27th : Feels better; tongue clean, pulse 88, appetite good ; gangrenous spot about the same; granulations improving all the time; feels cheerful and hopeful. February 28th : Pulse 84, tongue slightly furred; application of bromine quite painful for an hour or so after its use. March 1st: Pulse 84, tcngue cleaner, wound looking well; bowels in good order throughout since February 20th, previous to which time he had frequently suffered from sharp attacks of diarrhoea. March 2d: Tongue clean, pulse 86, wound filling with fine healthy granulations; bowels not so easy; some griping pains in epigastrium ; countenance, however, cheerful. Gangrenous spot entirely devoid of the soft pulta- ceous mass, leaving the periosteum exposed about the size of a five-cent piece and black as ink. Appetite not so good; ordered wine to substitute the ale ; diet generous. March 3d : Pulse 88, tongue slightly furred, wound improving, bowels better ; cheerful and hopeful: appetite good ; treatment continued. March 4th : Pulse 86, wound about the same; tongue clean, bowels in good condition ; gangrenous spot still the same. Diet generous and full. March 5th : Pulse 88. tongue slightly furred, appetite good, wound gradually and steadily improving. Application of the bandage to the foot up to the edge of the wound to prevent burrow ing. March 6th : Pulse 88. Complains of some pains in the right side of the chest on taking a long breath. Wound still improving, appetite good.. Ordered mustard sinapism to chest, and Dover s powder, grains 15, at night. March 7th: Pulse 90. tongue clean; pain in chest relieved; appetite good as usual; wound still improving. March 8th: Pulse 108, tongue coated; pain returned to the right side; not as well to-day; spirits depressed, appetite still good, bowels regular. Mustard sinapism to chest ; pulv. Dover!, grains 25, in four powders, one every three hours; same treatment of wound. March 9th : Pulse 96, tongue about the same; general condition much improved; pain inside relieved, appetite good, and in good spirits; wound healing. March 10th: Pulse 88, tongue cleaning, wound painful, but improving in appearance; appetite good. Treatment the same. March llth: Pulse 96; condition about the same as yesterday. Treatment and diet continued; wound healing rapidly and pret tily. Bromine has acted like a charm, and still possesses a biting character when applied, from which he suffers for an hour or so after its use." Surgeon Goldsmith gives a statistical summary of three hundred and thirty-four (334) well authenticated cases of hospital gangrene treated at the military hospitals at Louisville, Kentucky, Nashville and Murfreesboro , Tennessee, and New Albany, Indiana, and remarks that the testimony of these cases will establish the value of bromine in hospital gangrene sufficiently at least for the purpose of challenging investigation. TABLE OLVII. Summary of Three Hundred and Thirty-four Cases of Hospital Gangrene, giving Treatment and Results. TREATMENT. TOTAL CASKS. RECOVERED. a I AMPUTATIONS. AVERAGE DURATION j OF TREATMENT. PERCENTAGE OF Moi IALITY. , Treated with Bromine in different ways 152 148 4 Treated with Pure Bromine exclusively 27 25 2 Treated with Pure Bromine in solution exclusively .... 86 84 2 Treated with Pure Bromine after the solution failed 8 8 2.6 Treated with Pure Bromine after Nitric Acid failed 23 22 1 Treated with Bromine after other remedies failed g 8 Treated with Nitric Acid exclusively 13 5 g 3 davs 14g hours 61 5 Treated with other remedies exclusively 13 7 5 1 38 4 Treated with other remedies after Bromine failed 4 4 Aggregates 334 311 21 9 C 2 Surgeon J. H. Brinton, U. S. V., who had examined the outbreak of hospital gangrene at Annapolis, reports of the cases at Nashville that "Although of an analogous form the disease did not appear to me to be of so virulent a grade; whether this was due to the original character of the affection, or to the effect of the reme dial measures employed, I am not prepared positively to decide. Nearly all the cases observed by me were in the stage of reparation, and but very few iu the period of progress. The shape of the ulcers was characteristic, as was also the appearance of the gray slough, but the tendency of the sores to burrow deeply and to extend rapidly was not well marked at the time J examined the cases, some thirty in number. The treatment almost universally adopted in the Louisville hos pitals is that origiuated and introduced by Surgeon Goldsmith, TJ. S. V. It consists in the direct local application of bromine, either pure or in solution, to the surface of the sloughing sore. Due care is always first taken to remove as thoroughly as possible the sloughs, so that the agent may act on the living tissues and permeate them to some extent. In cases in which the burrowing is so extensive and deep seated as to render the application of bromine difficult or incomplete, Dr. Goldsmith resorted to hypodermic injections of bromine at the circumference of the sore. The CHAP, xii.] HOSPITAL GANGRENE. 837 punctures with the point of the syringe are made at intervals of from one-half to three-fourths of an inch, and one drop of the pure bromine is thrown into the tissues at each application. The mode of dressing the surfaces of the sores with the bromine was exhibited to me by Dr. Goldsmith. From my observation of the immediate effect of the reagent upon the diseased tissues, and of the condition of the sores upon which it had been previously applied, I am inclined to look upon the remedy as one of great value and well deserving of a fair and extended trial. * * I would here remark that in the Louisville hospitals but little tendency has been observed in the disease to spread from bed to bed, although isolation of the gangrenous patients has not been enforced. In my own judgment the absence of this tendency to infection tells strongly against the supposed virulence of the affection, and would ever throw doubts on its true nature at all events in some instances. Assuming the disease, however, to be the veritable hospital gangrene, the facts con nected with its origin were peculiar. The disease occurred almost always in patients who had been wounded at the battle of Murfreesboro , and who had been retained for some time in crowded hos pitals previous to their transportation to Louisville. I am informed by Surgeon Thurston, U. S.V., Medical Director of the Nashville hospitals, that no one upon whom the gangrene had already appeared was ever sent from Nashville, and yet many were so infected when admitted to the Louis ville hospitals. The development of this disease on the route seems to have been owing to the fact that the transportation of the wounded was effected by means of crowded and illy ventilated boats, and that the trip by the Cumberland and Ohio rivers frequently occupied several days. During this time these patients, who had already undergone much suffering, were exposed to all the influence. most apt to engender this disease. In contrast with this fact it was found that as soon as the Louisville and Nashville Kailroad was opened so that the wounded could be conveyed from city to city in hospital trains in one day, all importations of gangrenous sores into Louisville ceased. The development of hospital gangrene during the boat transportation is a noticeable fact, and is strikingly analogous with the same phenomena observed among our paroled wounded prisoners from Richmond received into the Annapolis general hospitals some months since." It is well to state here that a few at least of the surgeons at Louisville and elsewhere did not entertain the favorable opinion in regard to the use of bromine in cases of hospital gangrene expressed by Drs. B. Woodward and M. Goldsmith. Acting Assistant Surgeon John E. Crowe, in charge of General Hospital No. 4, Louisville, reports in July, 1863, that it was efficacious in "very superficial wounds attacked with hospital gangrene; but when the disease attacks a large or deep-seated wound it has failed, after repeated trials, to exert any beneficial influence. Greasote is superior to it in this class of cases; yet creasote has failed in several instances." Dr. W. W. Keen considered bromine a poor agent, painful, inconvenient; the suffocating fumes preventing a close inspection of the wound. Surgeon J. E. Summers, Medical Inspector, Department of Tennessee, believed that there was a "tendency on the part of surgeons interested in the bromine treatment to regard every slough as gangrene." In February, 1863, a number of cases of hospital gangrene occurred at the Douglas Hospital, Washington, D. G., and were observed by Assistant Surgeon William Thomson, U. S. A., who, in a special report to the Surgeon General, gives the following interesting account of the pathology and treatment of the cases. In several instances later information has been added to the cases cited by Dr. Thomson : l "The victims of this disease were wounded at Fredericksburg, December 13, 1802. For several weeks previous to this battle the army had been resting on the Kappahanuock and had been exposed to no great hardships. It had been amply supplied with good and varied food, mid the men were free from any scorbutic or other cachectic taint. "It is well known that the fullest preparations had been made by Surgeon Letterman for that engagement. The operations were performed promptly, and the wounded probably received better care than ever before in the historv of the war. 1 The report has been published in the American Journal Medical Science* for April, 1864. Vol. XLV1I, p. 378. 838 WOUNDS AND COMPLICATIONS. [CHAP. XII. "Ou the 26th of December, 1862, about two hundred wounded from the battle of Fredericks- burg were received into the Douglas Hospital. "I cannot speak of their treatment, medical, surgical, or hygienic, as at that time I was not connected Avith the hospital. I am, however, aware that the building in which the gangrene appeared contained fifty badly wounded and recent cases; that there was a deficiency of medical officers and dressers to insure the necessary cleanliness, and that the sanitary condition of the ward was far from perfect. "This hospital consists of the three brick houses known as Minnesota Row, and two large wooden pavilions, each divided into two wards. The ward in which this disease originated is one hundred and forty-three feet in length, twenty-three feet in breadth, and sixteen feet in height (eighteen feet at the cone and fourteen at the eaves of the roof), and contains beds for fifty patients, thus giving 1,050 cubic feet of space for each bed. There are two rows of windows, the lower of which contains two-, the upper one sash each; the upper windows so constructed as to be opened by means of a cord, but when opened directing a current of cold air immediately downward upon the beds beneath. "On the 16th of Feburary, 1863, I took charge of the hospital, and found the ward mentioned in the following condition: There was no ridge ventilation, nor was there any egress for foul air except through two large wooden shafts connected with two of the stoves, which had been placed there only a few days previously. The ward was heated by ordinary sheet-iron radiating coal stoves, and no provision had been made, until a few days before, to introduce any supply of fresh air. It contained from forty to fifty patients, all wounded, many of them very severely. The police was not unexceptionable, too little attention having been paid to the removal of offensive discharges. The medical officer in charge preferred to water as a dressing either simple cerate or mutton tallow, which had been issued to the hospital, and which had become rancid. The attend ants were, from a want of strict discipline, careless and inattentive. There was a perceptible and offensive odor in the ward, which felt close and badly ventilated; and this condition of the atmosphere seemed to have a marked effect on the spirits of the men; they were all gloomy, des pondent, and homesick. "On February 17th, when making my first visit with the officer in charge of the ward, I discovered : "CASE I. Sergeant Otto Kosaek, Co. K, 2d Maryland, who had been struck by a shell, December 13, 1862, which made it necessary to amputate his left leg at the middle. The operation was done ten minutes after the injury. He was received here on tin- 2!>th of December. The stump closed by granulation, a small portion of the tibia having been removed by exfoliation. The cicatrization had been almost complete, when, a few days previous to the 17th, the still open wound commenced to slough. He was anaemic, very pallid, haggard, and with an expression of great depression in his features ; his pulse was very feeble and rapid ; he had been feeling very badly for several days, and complained of a burning pain in the stump. -On the outer side of the tibia there was an ulcer one inch in diameter, covered with a yellowish-gray pultaceous slough, and a serous and very fetid discharge ; the edges were thickened and everted, and an areola of purple livid congestion extended for half an inch from the margin, which was undermined. This sore was at once treated with pure nitric acid, applied both to the ulcer and to the areola ; the ulcer was dressed with an antiseptic solution of creasote, and citrate of iron and quinine, with stimulants and nutrients, were freely given. On the 18th the sloughing had extended to the border of yesterday s livid areola, but was now more superficial, and the areola, which had likewise invaded the surrounding skin, was more florid. The ulcer was now two inches in diameter. As there was some doubt as to its specific character, the patient was not removed from the ward until the 23d, when he was trans ferred, with several others, to a small ward prepared in the brick building, and completely isolated from the other wounded men. The iron and quinine were found to disturb his stomach and destroy his appetite, and was replaced by a mixture of nitro- muriatic acid and tincture of opium. March 3d : The sore was now perfectly healthy and was granulating rapidly. [The patient was discharged June 15, 18(54, and was a pensioner in 1882. A plaster cast of the stump is preserved in the Army Medical Museum and is numbered 6706 of the Sunjicul Section. ] "This was a mild case, treated in its iucipieucy with nitric acid most thoroughly. The ulcer- ation had not extended so deeply, nor so far beneath the margin of the skin, as to make it almost impossible to reach every portion of the diseased surface. There was no scorbutis. The gums were firm and hard. The patient was very pallid, his heart feeble, and his pupils dilated. The mucous membranes were very pale, and the expression of the face haggard and anxious. He recovered rapidly with a good stump, and was seen, several months after, walking with great ease on an artificial leg. "CASE II. L. D. Thurston, Private, Co. A, IGtli New Hampshire, aged 42 years, was struck- by a fragment of shell on December 13, 1862, at Fredericksburg, which caused a severe but superficial wound of the integuments on the outer side of the left thigh. When seen, February 17, 1863, there was a wound at the middle of the thigh, on its outer aspect, three and a half inches long by two and a half wide, expos-ing the muscular tissue slightly, the surface of which was glazed and dry. On the 10th of February it had been found desirable to open an abscess three inches below the left greater trochanter. On the 13th this had assumed an unhealthy look, and when I saw it on the 17th the incision made by the lancet, half an inch in length, was sur rounded by a border of spbacelus one inch in width, and by an areola of purple congestion, in which there seemed to have occurred a complete stasis of the circulation. There was no pus, but a discharge of very fetid dark-colored serum. There was CHAP, xn ] HOSPITAL GANGRENE 839 no swelling, ulceration, or aversion of edges of the incision, which, although mortified, remained as sharp as when first made. There was profound nervous prostration, which was indicated by his rapid, feeble, and irritable pulse: by his sallow hue; his haggard and anxious expression of countenance; his weary and helpless decubitus and great mental despondency. He was treated internally with stimulants, the most condensed and nourishing food, and citrate of iron and quinine; nitric acid was applied locally, followed by a weak solution of creasote, three drops to the ounce of water, as an antiseptic dressing. The sphacelus extended in all directions rapidly, unchecked by this treatment, from which I hoped little, since it was impossible to bring the acid into contact with the diseased tissues, although it was injected into the incision. The constitutional symptoms also became more grave. On the night of the 20th there was quite a severe haemorrhage from the incision, oozing slowly, and very difficult to restrain, since it was caused by the erosion of vessels at a distance from the small incision. There was now a circular patch of sphacelus surrounding this small incision, three inches in diameter. On February 23d he was removed to the ward in the brick building. The original wound, hitherto unaffected, now began to be black and offensive. The sphacelus extended from these two centres at the rate of one inch daily, preceded by the above-mentioned areola of purple stasis. No treatment, local or constitutional, produced the least effect. Stimulants were given in every possible form, until the stomach refused to retain them. Pure nitric acid was freely applied to the diseased surfaces with no benefit. He fell into a typhoid condition, with muttering delirium, subsultus tendinum, etc., and finally expired February 28th. The sphacelus then extended from the trochanter major to three inches above the outer condyle, and from the median line in front to a corresponding point behind. There had never been any ulceration, but the tissues seemed to perish en masse. The incision made by the lancet was yet plainly seen in the cen tre of any extensive surface of mortification. This man was 42 years old, had had chronic diarrhoea, and was in a feeble state of health when wounded. No benefit was observed from any treatment. He took in addition to the nutrients and tonics the acid mixture with tincture of opium. [A wet preparation of the thigh, exhibiting the ravages of hospital gangrene, is Specimen 1001 of lln- 8urr/ical Section, A. M. M.] * * * "CASK V. 1 Isadore Wick, Co. D, 1st New York Artillery, aged 32 years, had his right thigh amputated on the field, for comminuted fracture of the tibia, received December 13, 1862, at Fredericksburg, caused by a minU: ball. He was admitted December 26th. I regret that I can give no account of his progress, but I learn that the flaps had been insufficient, and that the stump had been closing by tedious granulation. There had been a free discharge, and his general condition was, therefore, unfitted to withstand the depressing influence of hospital gangrene. His bed was on the same side of the ward, and in close proximity to the first case reported. The operation had been a circular one; the granulation had entirely covered the end of the bone, and there was, when seen on the 18th of February, only a narrow strip, not yet cicatrized between the margins of skin. This was now covered with a gray slough and had the characteristic fetid odor. It was dressed simply with the creasote solu tion, my faith in the acid treatment having been shaken by the reports of medical officers who had visited the cases at Annapolis. February 23d : The case was now considered an unequivocal one of hospital gangrene, and was removed to the ward selected for such cases. The cicatricial tissue had all yielded to the sloughing, and the subcutaneous connective tissue had been destroyed for two inches beneath the skin at the outer angle of the original incisions. No change was made in the local treatment, as the creasote was a perfect deodorant, and as good results were hoped for from its local use, as had been reported from Annapolis. The destruction was limited to the connective tissue until March 9th, when there was a margin of sphacelus half an inch wide in the true skin. The constitutional symptoms had been growing more grave. His mental despondency was most marked, his face pale and anxious, his pupils dilated, his pulse 100 per minute and feeble, and his skin very moist; a free diarrhoea had also commenced. The tonics and stimulants, having produced anorexia and nausea, were replaced by a mixture of tincture of opium and hydrochloric acid in such proportions that he took gtt. xvi of tr. opii and git. iv of acid, hydrochlor. every fourth hour. Beef essence and milk punch were given as freely as his stomach would tolerate them, llth : As his general condition became less favorable the local action was changed from molecular death to sphacelus. The whole face of the stump has now a margin of black mortification of the skin, outside of which was the usual areola of purple congestion the complete stasis of to-day becoming the sphacelus of to-morrow. The end of the femur, protected by rosy granulations, now protrudes from the black mass of sphacelus. the integument having become loosened by the destruction of the subcutaneous connective tissue and retracted. The presence of this mass of putrefaction seems to add to the nervous prostration, if indeed the absorption of such peccant material is not its sole cause. Pure nitric acid had been applied several times, but it had been found impossible to convey it into the depths of the ulcer. 21st : No change except for the worse had occurred. Stimulating poultices of cinchona, ginger, and flaxseed had been used locally, but with no benefit. Antiseptics, such as the solutions of chloride of soda, creasote, and per manganate of potash, were necessary to purity the ward and render it endurable for his attendants. Nutrients and stimulants had been pushed to the last extent, and opium had been largely given for its supposed specific effect in the disease as well as to allay suffering. The symptoms had been typhoid for several days; emaciation had gone on rapidly ; there had been subsultus tendinum and muttering delirium with extreme prostration until this date, when death occurred. The limb was removed after death and the specimen sent to the Army Medical Museum. [Specimen 1000, >S /m/. Sect ] The sphacelus had involved all the tissues for five inches above the divided bone, and there seems to have been a faint effort to form a line of demarcation. "This was, at first, a very mild case, with no very decided constitutional depression until the system seemed to be poisoned by the absorption of the products of the gangrene, when the ulcer- ation became more rapid, and was finally, as the strength succumbed, converted into uncontrollable and rapidly extending sphacelus, accounting satisfactorily for the unfortunate result. The treat ment locally had been, first, weak solution of creasote, made soluble by one drachm of alcohol, four drops to one ounce of water; and second, strong nitric acid, never fully applied, however, to the depths of the diseased tissues. The constitutional treatment was stimulating, sustaining, and tonic. " CASK VIII. John Jordan, Private, Co. H, 2d Maine, aged 20 years, was struck at Fredericksburg, December 13, 1852, by a fragment of shell, which passed across the right thigh below Poupart s ligament, through the scrotum, destroying the right testicle, and behind the left thigh, producing in its course very extensive but superficial wounds of the anterior portion of right and posterior portion of left thigh. He was admitted December 26, 1882, and placed in ward No. f>. February 27, 1863, he had febrile disturbance and anorexia, a yellow, furred tongue, an anxious, restless expression of countenance, and a burning pain in his left thigh. There was on the right thigh a granulating surface three by two inches in dimensions, level with the integument, and cicatrizing rapidly. A smaller, equally healthy surface remained unheuled on the scrotum, while on the pos terior portion of the upper part of the left thigh an ulcer three by two inches in extent was found, oval in shape, covered with an ashy gray slough, with its margin thickened and everted, surrounded by a livid areola, and, instead of normal pus, dis charging a thin fetid serum mixed with debris. He was at once removed to the house ; the whole diseased surface was touched with pure nitric acid and dressed with the creasote lotion ; stimulants and the best extra diet, with beef essence and milk punch at short intervals, and citrate of iron and quinine three times daily, were ordered. March ">th: The attempt to push the nutrients and stimulants produced, as it generally does, anorexia, nausea, vomiting, and diarrluEa. The tongue became thickly coated with a yellow fur and dry and red at the tip; and so great was the gastric disturbance that all medicines were discontinued ami the stomach allowed to recover its tone by rest, no longer being teased either by drugs or excessive and undesired nutriment. No benefit followed the local application, and the ulceration had extended in every direction. There was the characteristic margin, Spare will not permit to introdure all oases rited l>y Or. THOMSON . CASKS III. IV, VI. and VII have boon omitted here. 840 WOUNDS AND COMPLICATIONS. [CHAP. xn. preceded by the areoln of livid stasis, preparing the tissues for their rapid destruction. The connective tissue beneath the skin had been destroyed, so that the skin for one inch from its margin was perfectly movable. The muscles separated from each other by the death of their connective tissue lay in the wound bathed in its discharge, but rosy and florid, and resisting the advance of the disease. This sore was so unmistakably hospital gangrene that several pictures of it were taken by direction of Surgeon Brinton, which represent well the surface of the ulcer dripping with its thin serous discharge, mingled with threads of dead connective tissue, its piled-up, thickened, and everted margin surmounted by a thin line of vivid redness, and its broad zone of purple congestion shading away into a bronze hue, the depth of color in the areola indicating the engorgement of the small vessels and its line the feebleness and slowness of the movement of the blood. It was determined to try the opium treatment, with hydrochloric acid as a tonic, and this mixture was given in the proportion of 16 drops of tincture of opium with four drops hydrochloric acid every three hours. The sore was dressed with a stimulating poultice composed of Ilaxseed, cinchona, and g iiiirer mixed with porter. Under the use of the acid internally the tongue has become clean and moist, the tone of the digest ive Apparatus improved, and a fair quantity of food had been taken. Porter and ale had been given as the stomach would retain them. But little change had taken place in the character of the ulcer, which was eight inches in length by seven in breadth, extending to the perineum, and irregularly oval in shape. The muscles exposed (the semi-membranosus and biceps) had yielded and were now almost divided. The sores on the right thigh and scrotum had not been in the least affected, but were cicatrizing rapidly. The entire surface of the gangrenous sore was now thoroughly cleaned, all sloughs and shreds removed with forceps and scissors, was well dried with lint and carefully painted with pure nitric acid. The brush, charged with acid, was passed beneath the excavated margin in some places more than an inch. The patient was etherized, and this acid application was made most carefully and completely. This was considered a dernier resort, for although the capacity for taking and assimilating food seemed to have been increased by the acid treatment internally, yet his strength was daily diminishing from the exhausting discharge and from the absorption of the products of the gangrene. On the succeeding day an entire change in the sore was observed; there had been no extension of the gangrene, the fetid odor was gone, and the discharge was more consistent and less serous. In a few days more all the shreds of dead fascia were removed, and the surface was found to be perfectly healthy. The contrast between the ragged, offensive, yellow-colored ulcer before the last application of acid, and the florid, perfectly normal granulating surface which replaced it, was as gratifying as it was surprising. With the local there was also a constitutional improvement. The appetite became voracious, the patient slept well ; there was no pain, and the process of repair was very rapid. The acid was continued internally. April 1st: The sore was now two by three inches in extent and cicatrizing rapidly ; but a small surface yet remained annealed. The patient was in perfect health, had gained flesh very rapidly, and was now on crutches. There was some contraction of the flexors, as the biceps and semi-membranosus were both involved in the destruction. [Jordan was dircharged June 9, 1863, and pensioned. Examiner J. C. Weston reported, Septem ber 11, 186U : "At the biennial examination in 1865 atrophy and increased weakness of right thigh and leg had occurred. His gait is always affected ; he has severe pain in region of cicatrix of left thigh ; this cicatrix is six by tln-ee inches, is depressed, indurated, adherent to muscles, and sensitive on account of rigidity and emaciation ; he cannot fully extend the leg." His con dition had not improved when examined in 1873.] "The most remarkable circumstance in this typical case is the fact that when the gangrene attacked the granulating surface of the left thigh the equally large granulating surface of the right thigli was unaffected; and that while the gangrene was ravaging the left thigh the rapid cicatriza tion of the right proceeded uninterruptedly. The discharge from the left thigh was so profuse that no precaution would have prevented the virus from coming in contact with the excoriated surfaces of the scrotum and right thigh. If, therefore, the disease be propagated by inoculation, all the circumstances were favorable; since the proximity of the thighs at their upper part, and a denuded surface on the scrotum, that might act as a link, render it certain that a portion of the great discharge from the left must frequently have been placed in contact with both of the other sores. If, on the other hand, the gangrene be not a local but a constitutional disease, why should it spend itself on one granulating surface when there were two others equally obnoxious ? The con trast between these sores was marked ; for while the tissues of the left thigh were melting away under one s very gaze, the process of repair in the scrotum and right thigh was progressing as rapidly as under the most favorable circumstances. In its earlier stages this case was twice treated with nitric acid, and perhaps imperfectly, from its not having been carried into the recesses of the ulcer. The system of urging nutrients, stimulants, and tonics irrespective of the natural desires of the patient is, I am satisfied, pernicious. The vital energy being depressed, the digestive organs are enfeebled; and the introduction of milk punch, beef essence, eggnog, and with stimu lants porter, ale, etc., into an unwilling stomach, simply produces anorexia, nausea, vomiting, and diarrhoea. The tongue became furred and dry, and there was a perfect disgust for all food. The hydrochloric acid was given to correct this condition ; and whether its action was confined to the stomach in rendering soluble the aliment given in very small quantities, or whether its action was catalytic or eliminative, I shall not pretend to state, but under its influence the tongue became moist and clean and tlie patient made known his desire for food. Nutrients were then given more freely as his appetite returned. The recovery of this man is due, firstly, to the thorough applica tion of nitrid acid to every portion of the ulcer, which changed its specific nature immediately; and, secondly, to the combined effect of acid and opium internally. After the last complete appli cation of acid the sore was changed in character, the areola disappeared, the surface became clean, the margins lost their elevated appearance, the serous discharge became purulent, and the offensive odor was entirely destroyed. An equally marked improvement occurred in his general condition. CASE IX. George Zilch (Zuelch). Sergeant, Co. K, 7th New York, aged 25 years, had his left leg amputated at its upper third for a bullet wound received at Fredericksburg, December 13, 1862. He was admitted to Douglas Hospital December 26th, CHAP. XIT.] HOSPITAL GANGRENE. 841 and placed in ward No. 5. The stump had closed slowly by granulation until there remained an ulcer as large as a half dime on its face. April 14, 1863, this ulcer was inflamed around its edges and covered with a white pultaceous slough; there was no constitutional disturbance, and the patient was allowed to remain on his crutches. The ulcer was cauterized with nitric acid and dressed with solution sodre chlorinatse. 18th : The ulceration and areolaare both enlarged, and the slough, yet very tough, is thicker. Acid was again used locally. 21st: He is feverish and inclined to nausea; his pulse 120, skin hot. and tongue thickly coated. The ulcer is extending in depth, and he was removed to the gangrene ward. 22d: The solution of bromine was applied to the sore after cleansing the surface as much as possible of the tenacious slough. His general condition was unfavor able, and there was a tendency to diarrhoea and perspiration. Internally he took muriatic acid, with extra diet and stimulants. 24th: Bromine was again applied to the surface and used in the form of vapor. The ulcer was now three inches in diameter, irregularly circular in form, with ragged, everted, and thickened edges, and surrounded by a purple areola. The slough was one inch in thickness, and resisted the action of the bromine. 2Gth: The sore is looking better; it has been disinfected since the first application of bromine, and the constitutional symptoms are better. 2?th : A pointing in oil was made to-day by Surgeon Brinton s direction, which would be pronounced a good representation of hospital gangrene. 28th: The slough is much thinner to-day, and the granulations are showing the thin gray covering. 29th: The sore is much better, is becoming covered with granulations, and has lost almost entirely its specific appearance. There is no constitutional disturbance, no fever, no headache, the tongue is cleaning oft , and there is a return of the appetite. The bromine vapor was discontinued, and sol. sod. chlorinat. substituted. 30th : The livid areola has been changing daily in hue under the bromine treatment, has now entirely disappeared, and the sore is perfectly healthy. May 6th : He is still improving, and is taking tonics and nutrients. 20th : The sore is reduced to half its original size and is now cicatrizing rapidly. 24th : There is now a surface as large as a penny unhealed ; health is very good; he is about the ward on crutches, and is no longer considered an interesting case. This man steadily improved; recovered with a good stump, and was finally sent to New York to be mustered out of service. He was discharged May b, 1863, and died July 2, 1878, of valvular disease of the heart and cardiac asthma. We Lave in this case another instance in which the acid, locally used, proved useless, and in which the solution of bromine caused an immediate improvement. It was found necessary to apply the caustic solution to the ulcer three times, owing to the thickness of the slough, which was too closely attached to be removed by spatula or forceps. Its action here seemed to correct the fetor at once, to check the molecular death, and to change the hue of the areola, by causing a more healthy action in the capillaries. The gnawing burning pain was relieved, and the patient was able to sleep in comfort. The absorption of the virus produced in the ulcer was prevented by its destruction, and the nervous system quickly regained its tone. I will conclude this brief his tory by a short summary. u Etiology. This disease made its appearance in a wooden pavilion containing fifty beds, most of them occupied by very seriously wounded men unable to leave the building, with a cubic capa city of 1050 feet to each bed, heated by ordinary radiating coal-stoves, devoid of any system of ven tilation, and having no ingress for pure air nor egress for foul, except through the windows and doors. This want of pure air was combined with a want of strict police and a careless and unscien tific method of dressing the wounds, rancid ointments being largely used instead of the ordinary water dressing. No case of gangrene was received as such into the hospital, nor is it probable that it was otherwise introduced. Although a majority of the cases in this ward escaped gangrene, yet there was evidently some depressing agent at work, since but few wounds healed rapidly. The patients seemed also dispirited, homesick, and moody. Those who were attacked were removed to a ward in the brick house, where they were isolated and at the same time placed under better hygienic influences. Two shafts for foul air, connected with the stoves, which withdrew the foul air from near the floor, had recently been placed in the ward by order of the Surgeon General. This was not considered sufficient, and the long doors of these foul-air shafts were kept constantly open. Strict attention to cleanliness and careful dressing was enforced, and what might have been a very severe epidemic was confined to few cases. The upper row of windows were rehuug in such a manner as to direct the currents of cold air admitted in a line with the roof, and, to crown all, the ridge ventilation was applied to the pavilion. These precautions, and an improvement in the diet of the house, giving more vegetables and antiscorbutics, enabled me to prevent any further serious manifestations. "There were three other wards of like construction with Ward No. 5, but two of them were unoccupied and the third one contained fewer and less serious cases. The table on the next page indicates that of the nine unmistakable cases reported, eight appeared in Ward No. 5; and that of these eight, five occurred on the west and three on the east side of the ward. Although these facts would suggest the probability of inoculation, yet I cannot but remember that there were at least thirty-five other wounded men in this ward who escaped, although the disease had been in exist ence several days before February 17th, when I took charge, and no precautions against contagion had been employed. I shall not attempt to argue here the long-disputed point of contagion or non- contagion, but simply state it as the result of my observation that I saw no well-marked instance of inoculation, while I did see many wounds escape this influence where inoculation was not only possible but probable. Nor was it necessary to invoke the aid of any specific virus, since the SURG. Ill 106 842 WOUNDS AND COMPLICATIONS. [CHAP. XII. TABLK OLVJTT. Summary of Nine Cases of Hospital Gangrene, showing Date of Attack and Grade of Disease- NAMES. WAKD. SIDE. DATE OF ATTACK. GKAUE OK DISEASE. RESULT. TREATMENT. 1 Otto Kossack 5 o 5 3 5 5 5 1 5 West West "West East February 15, 1863. February 15, 1863. February 18, 1863. February 20, 1863. February 28, 1863. March 6, 1863 February 27, 1863 March 9, 1863 April 14, 1863 Ulceration C ured . Sphocelus Death . Ulceration Cured . . Ulceration, mild Cared . . Sphaeelus Death . . Nitric Acid. Nitric. Acid. Nitric Acid. Nitric Acid. Nitric Acid. Nitric Acid. Nitric Acid. Bromine. Bromine. 5 J f.T 1 Wick West West East Ulceiation Cured . . Ulceration Cured . . 8 R W I lummer Building . . East Ulceration ! Cured . . Ulceration . Cured . 9 Geor ir e Zilch NOTE. Space would not permit to give the details cited by Dr. Thomson of the cases of Thurston, Fossett, Morrissey, and Plumuier, referred to in this table. unfavorable hygienic influences which had surrounded these men from the date of injury, Decem ber 13th, and the date of admission into hospital, December 26th, 1862, to February 15th, 1863, were sufficient to produce, in all the cases treated in Ward 5, a well-marked cachexia neither scorbutus nor anaemia, but more unmanageable than either, and due, most probably, to the absence simply of fresh pure air in sufficient quantities. With no further improvements than those men tioned, a marked change for the better took place in the other inmates of this ward. Their wounds became healthy and healed rapidly, and their spirits became cheerful. It will be observed from the table that I have described two grades of hospital gangrene, the one mild, generally man ageable, and characterized by ulceration or molecular death of the tissues, spending itself gen erally in the subcutaneous and intermuscular connective tissue; the other, more rapid in its course, more fatal, less amenable to treatment, and distinguished by sphacelus or mortification en masse of the invaded tissues. It will be seen that, of the nine cases, seven are described as ulceration and two sphacelus, and the latter both fatal. These two cases last mentioned were entirely unin fluenced by the treatment employed. The rapid invasion and advance of the mortification, and the impossibility of reaching it with nitric acid to influence it locally, left but little to do but to observe its profoundly depressing effect on the vital forces. Bromine may prove the antidote in such cases, but its virtues were then unknown to me. Treatment: Recognizing the depressed condition of the first few cases, I endeavored to remedy it by giving, at short intervals, nutrients and stimulants, with such tonics as seemed proper; and milk punch, alternating with beef essence, porter or ale, and eggnog was at first given, regardless of the desires of the patient. The citrate of iron and quinine with sherry wine was given in doses of 6 to 10 grains three times daily. This system was found injudicious, since it overpowered the feeble digestive organs and caused nausea, vomiting, and diarrhoea; it was suspended, and four drops of hydrochloric, acid, in combination with 16 drops of tincture of opium, were given every three hours. Under this treatment the tongue became moist and clean, and the appetite returned sufficiently to cause the patient to ask for and enjoy a reasonable quantity of food. The opium was given to allay the gnawing pain and to give rest and sleep, as well as to obtain any specific influence over the disease which it might possess as claimed for it by the older writers. The local treatment consisted at first in the use of undiluted nitric acid freely applied to the entire surface of the ulcer. The table indicates the success of that treatment. Of the nine cases, all were treated with the acid in the early stages.. Of these, two were fatal and two resisted the acid or, in other words, in four cases it was useless. Of these four, the two fatal cases were not treated otherwise, while the other two were treated with success with bromine. The five cases treated successfully with acid are marked ulceratiou, and were milder than those that proved fatal or those that were treated with bromine successfully. The dressing, after the use of the acid, was an antiseptic wash, either creasote or liq. sod. chlor. in a dilute solution of bromine in water and bromide of potassium, proposed by Surgeon Goldsmith, U. S. V. Two cases were treated with this agent, in both of which nitric acid had failed. One of these would, doubtless, have proved fatal, while the other was progressing rapidly, although the acid had been used several times without benefit. "The action of the bromine is that of a caustic,; all the necrosed tissues are converted into CHAP. XII.] HOSPITAL GANGRENE. 843 tough yellow shreds and are perfectly deodorized. The ulceration seems to be checked at once, while the nervous system, no longer depressed by the absorption of the fetid products of the mor tification, soon recovers from its depression. The areola loses its livid hue, becomes more crimson, and finally disappears ; the sloughs are rapidly thrown off and a rosy, florid surface appears beneath. The bromine was also used in the form of vapor, confined to the surface by oiled silk. Its antiseptic influence is very powerful, since not the least odor could be perceived oij dressing these gangre nous sores, even when they had been covered closely with oiled silk for twelve hours. From its antidotal efficacy in these two cases I have formed a high opinion of its value in the local treatment of this disease. " Microscopy. The discharges from several of these cases were examined to ascertain whether some of the speculative views in regard to the presence of fungi and their influence in producing the disease could be sustained, but no fungi were found. The discharge consisted of fluid, granular matter, and debris. The connective tissue seemed to have been broken down into unrecognizable granular material. The fibrous tissue was softened and easily teazed out, and in the muscular tissue the striated appearance was lost before the fibrous. "jSTo evidence of textural growth was found in the discharges, although the piled up and thickened margins of the ulcers would probably reveal, on examination, a multiplication of the con nective tissue-corpuscles, as reported in a similar group of cases at Annapolis by Assistant Sur geon Woodward, U. S. A. Since the preceding report was drawn up four other cases of hospital gangrene have been observed, occurring sporadically, and treated with success with bromine. Their clinical histories are very briefly offered for consideration, in addition to those already sub mitted. No other cases have occurred in this hospital. It will be observed that three of these four cases were fully treated with pure nitric acid without benefit, and that the four did yield event ually to the local application of bromine. Where that remedy has required heretofore several repetitions, it would now be used more energetically. The diseased surface would be thoroughly cleansed of all sloughs by removing those portions dead, yet tenaciously adherent, with the forceps and scissors, and pure bromine would be freely used by means of a glass pipette or a syringe. A. number of the cases reported I am now satisfied would have proved fatal but for this local treat ment, and it will be a proud satisfaction to Surgeon Goldsmith to know that he has not only already been instrumental in preserving so many valuable lives, but that he has provided the military sur geons with a defence against one of the most deadly and obdurate of his antagonists." Sporadic cases of gangrene had occurred in the hospitals at Memphis, Tenn., in May, 1863, and during the latter part of this month the number of cases increased so rapidly that, on June 19th, an order was issued for the organization of Church Hospital for the special care of patients afflicted with this complication. The hospital was placed under the charge of Acting Assistant Surgeon C. H. Cleveland, whose detailed report of the pro gress and treatment of the disease is here appended: "General History : Although 1 have been at no inconsiderable pains to obtain a history of hospital gangrene as it has appeared in the military hospitals of this city, I am convinced that I have been unable to collect all the facts necessary for a complete history, and therefore shall con- tine myself mainly to such as fell under my own observation. "The first cases of this disease which came under my notice were those of Lieutenants Albau, Dallmyer, Letner, and Davis, who were brought to Officers Hospital, of which I then had charge. They were received from the hospital boat on the evening of May 27, 18G3, and each had gan grene of several days standing when admitted, and were expected to survive but a few hours. In fact, Lieutenant Letner, who had gangrene of the stump of the left leg, died on the 29th, the second day after admission. Although the flaps sloughed away from the stump of Lieutenant Dallmyer so as to leave the bone uncovered for at least two inches, still, the periosteum remained vitalized. The gangrene was quickly arrested by the application of Labarraque s chlorinated soda solution, under the vigilant care of Cadet Randall, who attended to the dressing of the patient. Granula tions sprang up all over the surface of the bone, a tine conical stump was formed, and on the 12th of June, about a fortnight after admission, he was dismissed on leave of absence, and went to his Lome. About this time, and later, a number of cases occurred in the different hospitals, but their 844 WOUNDS AND COMPLICATIONS. [CHAP. xn. nature was not always understood by attendant surgeons. When attention was especially called to this disease by Surgeon Irwiu, Superintendent of Military Hospitals here, cases were found in the Union Hospital to the number of twelve (12) June 25th; and soon thereafter at the Jackson, Gayoso, and Overtoil hospitals. The surgeon in charge of Adams Hospital reports the case of a man who came from the vicinity of Vicksburg on the 18th of February. He says that is the only case which has occurred in that hospital this year a statement evidently erroneous, as Corporal Fuller was sent here, from there, with gangrene of right ankle, on the 9th of August. A similar error occurred in the report of the surgeon in charge of the Webster Hospital, who says but one case has occurred in his hospital; and yet he has sent to us Privates Alt, McEvoy, Cloud, McClure, and Butler, all with unmistakable gangrene. From the Overtoil Hospital we have received fif teen (15) patients, and how many more have had the disease in that hospital I am unable to determine, as I get no response to my applications for information. From the Jackson Hospital we have received eleven (11) patients; but from that hospital also have been unable to obtain any further information. " Up to the first of September forty-six (46) patients have been sent to us, from other hospitals, having gangrene, which I have reason for supposing are not more than half the cases that have occurred in the hospitals. I know of seven (7) cases occurring at the Officers Hospital which were retained there for treatment, as we have no special accommodations for officers. "Not only have there been manifest errors in the reports from different hospitals in regard to the number of patients who have had gangrene, but the date of its appearance has been incor rectly reported. Early in the mouths of June the wards of Union Hospital were filled with patients from down the river, and immediately Cadet liandall reported to me that gangrene was among them. Surgeon Irwin states that, according to information in his possession, gangrene appeared first in the Union, then in the Jackson, the Gayoso, and the Overton hospitals; and his order for organizing and opening Church Hospital was issued on the 19th of June, one week before the disease was reported to have appeared in Union Hospital. The order for establishing and opening this hospital was issued on the 19th of June; yet, owing to delays in the Quartermaster s Depart ment, no patient was received until the 30th of July, and the two days of that month are included in the report for the month of August. During its organization and until the 7th of August I was in charge of this hospital, when Surgeon George K. Weeks was assigned to its temporary charge for the special purpose of testing the use of bromine in the treatment of gangrene. Until Surgeon Weeks came we had no bromine; one ounce had been furnished to the hospital, but after the dressers had used it once it unaccountably disappeared. After that time reliance was placed mainly on the local use of Labarraque s solution of chlorinated soda applied in its full strength, although nitric acid, acetic acid, sulphate of zinc, and muriated tincture of iron were used in some cases. " The favorable result which followed the chlorinated soda preparation in the case of Lieu tenant Dallmyer at Officers Hospital gave me considerable confidence in it, both in gangrene and erysipelas, which confidence is shown by the hospital records not to have been misplaced, as every case of erysipelas sent to us was cured by it alone in from three to five days. Private Samuel Arbothnot was sent here from Jackson Hospital, with gangrene in the palm of the left hand, July 3()th, and was returned cured of the gangrene August 8th. Robert Graham was admitted from Union Hospital on the 31st of July, with gangrene of the right arm, and returned with no vestige of gangrene remaining on the 4th of August. Private William Goff was admitted from Union Hospital, August 1st, with gangrene of the right leg, and returned cured August 4th. Private T. L. Twiman was sent here from the Overton Hospital on the 31st of July, with gangrene of the right thigh, and returned cured of gangrene on the 5th of August, Private Fred. Louis came from Jackson Hospital, with gangrene of the right hand, on the 30th of July, and was returned cured on the 4th of August. Other similar cures have followed the persistent use of this remedy since that date. "On the 8th of August, when Surgeon Weeks took charge of the treatment, he brought from. Surgeon Irwin five ounces of pure bromine, which supply was exhausted on the 16th of August, and no more has been had since. On the 20th of August, Dr. Warriuer, agent U. S. Sanitary Commission, gave to the hospital five bottles of Professor J. Lawrence Smith s compound solution CHAP xil.! HOSPITAL GANGRENE. 845 of bromine, which is now used in place of the pure article, but not to the satisfaction of any one connected with the hospital, it evidently being by no means equal in efficiency to the bromine in full strength. During the week that pure bromine was applied it was found, as the records show, that usually a single application sufficed to completely eradicate the gangrene. In cases of appar ent failure it was afterwards found that there were some parts, deep between muscles, under the integuments, or in sulci or sinuses, which the bromine did not reach. While we had no bromine, and also when we had only the Smith s compound solution, we found it mucli more difficult, and in some cases quite impossible, to eradicate the disease, mainly from the impossibility of bringing the remedies directly in contact with the entire affected surface. Up to the 1st of September forty-six (4G) cases of genuine hospital gangrene have been treated in this hospital. Of that number thir teen (13) died, but none directly from the gangrene. During the month fifteen (15) have been cured and transferred to the hospitals from which they came. Eighteen (18) still remain under treatment, most of whom are entirely free from gangrene, but are not restored in health sufficiently to leave the hospital. Some of these will die from the effects of gangrene on the system. "Diagnosis. Hospital gangrene, as it has been presented to us at this hospital, has assumed a great variety of appearances. In the earlier stages it has appeared as a dusky, almost black, mass of dead and rotten flesh, occupying the seat of the disease, surrounded by a reddish ring of slightly swollen integuments, which ring varies from one to five lines in breadth, while the adjacent tissues do not appear to be affected by the disease, except that they, as well as the whole body, contain less heat than is natural in healthy structures. Often the disease has burrowed under the integu ments bordering a wound, and when the skin dies it loses its epidermis, the true skin becomes red dish, greenish, purplish, or black. When a surface already divested of its skin is affected with the disease (and most of the cases at this hospital are truly traumatic), the first invasion appears by giving to the surface an ashy-gray color, with a pultaceous consistency, and the peculiar odor of spoiled meat, by which the disease is readily recognized. This pultaceous ashy appearance of the surface wounds presents itself when the areolar tissue alone is attacked. When the muscular tissue becomes affected, and when small blood-vessels have become ruptured, a dark, grumous, almost black, dirty appearance of the diseased surface is presented, accompanied by a powerful fetid odor, and, usually, with an invasion of the disease under the skin, and between muscles and ten dons in the connective tissues much beyond the boundary of the disease as it appears on a superficial examination. In the case of Private Milseps, who was wounded at Port Hudson, on the 27th of May, with a inini6 ball in the right thigh (the ball not being extracted till he came here), the disease burrowed in the fascia of the thigh until his whole thigh appeared gangrenous in the deep-seated parts, and he died suddenly from arrest of circulation. Post-mortem examination revealed a detached thrombus in the left auricle of the heart, plugging up the artery, which weighed four hundred and eighty-two (482) grains. One patient, Private T. D. Eiggs, who was wounded high up in the right calf by a musket ball, at Helena, on the 4th of July, and brought here on the 31st, had the disease following down the tendon to the os calcis, which was necrosed. Although the entire extent of the leg was laid open it was too late to save the patient, who has since died (Sept. 2d) from the absorp tion of gangrenous matter. I removed from his thoracic duct a thrombus nearly six inches in length. These two cases are but extreme illustrations of the tendency of the disease to extend itself in the areola tissue, along plains, and between more solid organs and structures. But muscles, vessels, nerves, tendons, periosteum, and bone are often invaded, when the part affected turns dark, emits a peculiar (gangrenous) odor, dies, softens, and finally liquefies when not removed in the form of slough or by the dresser s instruments. "Preparation of Wound. I am convinced that many surgeons have failed in the treatment of hospital gangrene because they have not fully perceived the necessity of thoroughly cleansing the wound of all dead and diseased matter previous to the use of any local application. Private James McEvoy. who was wounded at Raymond, on the 12th of May, and had his right arm ampu tated near the elbow, had gangrene of the stump about the 20th of June, and was sent here on the 10th of August, with a statement that bromine had been applied, daily, for eight days. On exami nation it was found that there were at least two -inches in extent of dead structure on the end of the stump, and the bromine had been applied to that, and not to the live tissue. All the dead and dying structures were carefully dissected from the surface of the stump, removing a large quantity 846 WOUNDS AND COMPLICATIONS. (CHAP. xn. of putrescent matter, and then bromine in full strength was cautiously applied to the entire surface, and the disease was at once arrested. He remained ten days, and then was returned to Webster Hospital. "When patients are first brought here it is often necessary to place them under the influence of chloroform while their wounds are being prepared, and obtund the pain caused by the remedies applied; aud afterward it is not refused them if the dressing is likely to be very painful. The wound is washed by means of a stream of water projected from a syringe; all the pultaceous and gangrenous matter removed with soft cloths; the more tenacious diseased portions taken away with forceps, the scissors, and scalpel ; and finally, all blood, water, moisture, aud semi-fluid mat ters under the skin, or between muscles or tendons, are removed with a little swab made by winding a strip of soft cloth around a stick. . If the disease has burrowed under the skin it is better to at once open up all such retreats, as well as to carefully pare off the diseased portions of the skin on the edges of the wound, that the agent applied may come directly in contact with the vitalized structures in the parts affected. If, through carelessness or oversight, this thorough preparation of the wound is not attended to, the progress of gangrene is not likely to be stayed whatever the remedy applied. "Soapsuds as a wash does not answer for gangrenous ulcers as well as pure warm water. It appears to combine with the fluids of the surface, producing a slimy mixture which it is difficult to remove. A diluted solution of Labarraque s chlorinated soda has been found to answer admirably in these cases, for when applied in a gentle stream from a syringe it can be made to penetrate into all the recesses of the disease, destroying all odor and dissolving aud removing some of the dead matter attached to the surface of the ulcer. At about the strength of sea water it seems to prop erly stimulate the structures as well as cleanse them. An ordinary hard-rubber syringe with the little swabs (already described) have been found preferable to sponges or cloths for cleansing ten der and delicate surfaces. "Local Applications. Any substance which has the chemical power of decomposing the specific virus of gangrene so that it no longer exists as gangrene must possess the property of a curative agent in this disease, provided it can be brought in sufficient quantities in direct contact with every atom of gangrene matter; and provided also that it does not possess sufficient power to overcome and destroy the vitality of such still vitalized structures and tissues as we wish to preserve. We have made trial of nitric acid until we have become satisfied of three things iu regard to it: It will destroy all gangrenous matter with which it is brought in contact in its full strength. It is, however, extremely difficult in many cases to apply it in full strength, as in sinuses and sulci, where the moisture in those parts may so dilute it as to render it inefficient. It is unsafe, as, if brought in contact with the fine tissues, nerves, vessels, periosteum, or bone, it is almost certain to cause destruction to the parts and produce irreparable injury. "Sulphate of zinc in solution does not appear powerful enough to arrest the disease in many instances. Acetic acid has not been applied in a sufficient number of cases to have led to any posi tive conclusion. The same may be said of the solution of the chloride of zinc. The muriated tincture, as well as the solution of the persulphate of iron, have both been used, but principally on bleeding surfaces and to check haemorrhage from ruptured vessels; and while they may have a curative power, such property has not been so manifest as to give us much confidence in them as arresters of gangrene. "Labarraque s chlorinated soda solution has proved quite efficient, applied in its full strength, as an arrester of gangrene. In all cases where the liquid could be thoroughly applied to all of the affected parts, one, or at most two or three, applications appeared to eradicate the disease. But it could not always be applied to deep-seated parts, or within sulci, without becom ing diluted with the fluids already there, aud so much of the solution seemed to be demanded that it was liable to flow beyond the ulcer and the healthy skin be blistered by it. But, during nearly one-half the time this hospital has been open, we have placed our main reliance on this agent, and our confidence has not been shaken. In all cases of ulceration, where no gangrene remains, we wash the surface once or twice a day with this solution, diluted, and saturate the dressings with it as often as they get dry, or once in two hours, and are well pleased with the result. "Bromine in its full strength, however, is the agent which has given us the most satisfaction. This does not appear caustic enough to destroy healthy tissues, but is of sufficient strength to CHAP, xii.] HOSPITAL GANGRENE. 847 unite with arid change all the parts affected with disease. Of course a few drops will uot unite with or change a large amount of gangrenous material, but in all cases under my observation where the dead matter had been properly dissected away and the wound cleansed of its pultaceous and other dead matter with the syringe, the forceps, and the swabs, and the surface dried with soft cloths, one application, or at most two or three, has obliterated all traces of gangrene and left the wound a simple ulcer. As has been observed, the wound must be thoroughly and carefully prepared before the bromine is applied. Even if all other necessary conditions are complied with, should moisture be allowed to remain in the deeper parts of the sore, that moisture may so dilute the bromine as to render it inefficient, or it may protect the subjacent parts from the remedy, and a point of gangrene will remain to infect the whole sore. Bromine can be conveniently applied by means of little swabs, like those used in cleansing the wound. First, there should be prepared and at hand a cloth spread with simple cerate, large enough to more than cover the affected surface. The ulcer should be cleansed and dried, and then an attendant, standing near the patient, holds the phial of bromine, from which he removes the stopper just long enough to allow the surgeon to insert into it a little swab, saturating it with the bromine, which is at once applied to the ulcer. This operation is to be repeated until all parts of the sore are touched with the bromine; and to parts beyond the reach of the swab bromine should be injected by means of a glass P. P. syringe, when the sore should be immediately covered with the cerated cloth to prevent evaporation of bromine and to protect the ulcer from the atmosphere. Then the part may be dressed with cloths and bandages the same as for simple sores. "The pain which attends and follows the application of bromine is quite severe, but not more severe nor of longer continuance than follows the application of milder agents. The sense of pain appears even somewhat obtunded by the action of it, and after a short time patients express them selves as being much easier than they have been for days. "To surgeons and attendants bromine, when incautiously used, proves very disagreeable, and this fact, doubtless, has prevented its use in many cases. If the vapor of bromine is allowed to come in contact with the eyes and air passages such parts suffer severely from irritation for several minutes, then all unpleasant effects pass away. But, with proper precaution, these parts need not be exposed to the vapor, and ten or twenty patients may have bromine applied to them in a morning without much discomfort to the surgeon. "Whatever agent is applied to a gangrenous surface it does not appear desirable to disturb the dressing more than once a day. When bromine is used it is usually necessary to wait two or three days for the surface of the sore to become thoroughly cleansed before it is again resorted to; but if there remains a decidedly gangrenous odor on the second day, or if it appears at any future time, the parts should be carefully examined and bromine applied to all affected surfaces. Gan grene can be detected by the trained sense of smell more readily than in any other way, and for several days after the disease has disappeared wounds should be examined in this manner, as well as by the eye, and all appearance of taint followed to its source and the disease eradicated. "On the second day, usually, after bromine has been applied the surface of the ulcer looks dark and charred; on the third day the dead portions begin to liquefy; and the fourth day the surface appears studded with healthy granulations. After the gangrene is subdued the wounds are dressed as simple ulcers, but in most cases the dilute chlorinated soda solution is constantly applied, both as a slight stimulant to the newly formed tissues and to protect it from the virus which may be in the atmosphere of the hospital. I have made considerable use of oakum, wet with a solution of chlorinated soda or of the chloride of lime, to gangrenous ulcers the day after the application of bromine, and to the ulcer after the wound is freed from gangrene, and am satisfied that, in general, it is preferable to lint. It is easy of application, readily absorbs the excretions, and is easily removed when the wound again requires dressing. A very convenient way of apply ing moisture to the sore is by means of a hard-rubber syringe. The solution may be drawn into the syringe, the pipe of which can readily be inserted under the bandage and the liquid applied directly to the oakum, filling and covering the ulcer and moistening the entire dressing. The com pound solution of bromine has been extensively used by us since our stock of pure bromine became exhausted, but we do not consider it a good substitute. It does not appear to be active enough to readily destroy the gangrene. It has been applied day after day carefully, thoroughly, and faith fully, with the swab and the syringe, into parts where the gangrene has burrowed under fascia and 848 WOUNDS AND COMPLICATIONS. [CHAP. xn. along tendons, as it is very apt to do, and directly to the walls of such extensions, when they have been laid open, by means of pledgets of lint saturated with it, as well as in the same manner to the original ulcer, and yet we have sometimes failed for days to arrest the disease. I have made careful trial of both the compound solution of bromine and Labarraque s solution of chlorinated soda, and cannot discover that the bromine preparation possesses any valuable properties which the chlori nated soda has not. Both destroy the disease when applied to it, but the compound solution of bromine causes more pain, does not appear to be any more active than the chlorinated solution in full strength, and very readily loses its bromine by evaporation if not quickly and cautiously covered with a cerated cloth. "Pure unadulterated bromine seems to possess special properties which entitle it to more confidence than any other agent with which we are acquainted. The liquid readily vaporizes in the atmosphere and the vapor is easily absorbed by fluids. The vapor when brought in contact with the odoriferous emanations of gangrene at once destroys their odor, and probably their spe cific gangrenous character. When thoroughly applied in sufficient quantity to a gangrenous sore it at once obliterates all gangrenous odor, and no gangrene appears afterward, unless the wound receives new infection. Its ready vaporization permits its application to the bottom of sinuses and sulci which cannot safely be laid open with the knife, and which are very common in the patients of this hospital; its prompt, almost instantaneous, action precludes the necessity for a prolonged use of the remedy; while sufficient experience in its use shows that it may be applied directly to the covering of a nerve, or the periosteum, without destroying their vital integrity. " Contagiousness. Hospital gangrene is produced by infection upon an exposed surface. Several cases have come to us with the disease following the application of a blister. It has also appeared in bed-sores. One case, where the arm had been broken, badly adjusted, and splints caused abrasion, gangrene followed. A man acting as nurse to his captain who had gangrene, had small spots of inflammation on his ankle, caused possibly by mosquito bites, which he had rubbed the skin from; he also had little scratches on his fingers; gangrene set in at all these points, and he may yet lose his life as the result. In Officers Hospital, an officer with gangrene occupied a room alone; the carpenters wished to put a water-pipe in it, and he was removed to a room in which were three other officers with wounds not then gangrenous; all four had their wounds exposed and dressed, and the gangrenous odor pervaded the apartment. Although the officer was returned to his own room in an hour, the next day gangrene appeared in the wounds of the three others who had been exposed to the infection. "Instances have occurred in this hospital where wounds which had been free from gangrene for several days became again diseased, and doubtless from renewed infection received from others laboring under the disease. To guard against infection we have made free use of chlorinated soda, chloride of lime, a solution of the permanganate of potassa, chlorinum, and bromine, and the most scrupulous cleanliness and free ventilation. Each patient is supplied with his own drinkiug-cup and other utensils, and his own sponges ; if he has two wounds and only one is gangrenous, each wound has its sponge, and all are kept as clean as possible. If the nurses, dressers, or surgeons have wounds or abrasions on their hands, bromine is applied and their hands exposed to the virus without fear. In cleaning a very bad gangrenous sore the scissors were found to be dull, and while sharpening them I cut out the ball of my left fore-finger; I applied bromine, and the wound healed kindly and readily. Nearly every day I have had either cuts, pricks, scratches, or other abrasions on my hands, which are freely exposed in dressing the wounds and in the dead-house, with no unpleasant consequences. I have always applied bromine to the denuded surface before exposure, and am convinced that the virus of the dead-house, as well as other animal poisons, is entirely destroyed by the action of bromine. "General Treatment. The constitution seems to require much more than the ordinary amount of nutriment in this disease, and it is only after considerable poison has been absorbed, and the heart and lungs have become affected, that digestion and assimilation are deranged. It is true that the temperature of the entire body is, almost invariably, below the normal standard. During the mouth of August the thermometer ranged, in the wards of this hospital, at 2 o clock P. M., at from 98 to 103, and yet the average temperature of the patients at the same hour, as indicated by the thermometer in their axillae, was but 89. The average daily temperature of Sergeant CHAP. XII.] HOSPITAL QANQEENE. 849 Wilkie, who died from pyaemia after secondary haemorrhage, was only 74; and that of Private T. D. Riggs, who had gangrene of the right calf extending down the tendon to the heel bone, was only 84. The pulse of the former averaged 114. the latter 88 beats in a minute. This low state of temperature led us to very free use of alcohol in the various forms of ale, porter, whiskey, and brandy, usually given once in two hours, and as much nutriment, beef, eggs, etc., as the patient would take. A very marked desire for acids prevailed, which was gratified by giving pickles, citric acid drinks, and acid fruits. After the disease had progressed to the serious invasion of the general system (and most of our patients were old cases, brought from other hospitals) a very per sistent diarrhoea was common, and that was about the only condition that demanded active medica tion. We carefully avoided the use of cathartics and opium, and as a soother to nervous and febrile excitement used Hoffman s anodyne. In some cases, distinctly complicated with miasma, (and many of the patients came from the vicinity of Vicksburg, where they had been exposed for months), we gave sulphate of quiniae one or two doses of ten grains each were usually sufficient. " Conditions favoring the appearance of Gangrene. While no certain cause for the disease except contagion has been determined, it is evident that a depression of the vital forces has been favorable to its accession. Fourteen (14) out of forty-six (46) cases of our patients were secession prisoners, and I think that all the seven at Officers Hospital were also prisoners a much larger number than a fair proportion, proving that exposure, privation, and a consequent depression of vital forces is a condition favoring the appearance of the disease. "Post-mortem Appearances. The tables compiled from the hospital records, and the reports of individual cases furnished by Cadets Gunn and Lloyd, together with the learned and able report on the pathology of the disease by Surgeon Weeks, who has had unusual opportunities for the study of gangrene at Louisville, Vicksburg, and this place, obviate the necessity of extended remarks on this branch of the subject. With one or two exceptions we have made examinations in every fatal case and have observed a very uniform set of conditions. In all we have found thrombi in the heart, some of which have been very large. In one we found a thrombus in the thoracic duct, and I regret that we did not examine that passage in the preceding cases. In one case of long standing the heart thrombus was softening, and the walls of the heart were tainted with gangrene. In another case, where the disease was of still longer duration, the heart thrombus was considerably broken down and liquefied, and the walls of the heart very much softened, flabby, and decidedly gangrenous. The lungs in every case were spotted with dark specks, and, being cut into, it was found that the smaller arteries were often filled with thrombi and dark matter, evidently the debris which had been washed away from a thrombus in the heart and become lodged in the smaller vessels. The disease in this case was unusually malignant and rapid. In no case have I perceived any collection of pus or softening of matter, such as is said to have been observed in the lungs of those who have died of gangrene elsewhere. "Curability of Gangrene. This disease, like syphilis in its earlier stages, seems to be entirely local, and completely curable when the parts affected are not vital organs, which has never been, primarily, in any case coming under my observation, and when all the parts affected can be reached by direct application of the remedy. But the secondary affections, as the thrombi in the heart, the pulmonary complications, and the change in the fluids, which is sometimes called pyaemia, are con ditions which do not seem controllable by remedies. We have often had cases recover after the heart, the lungs, and the blood had become seriously implicated. But gangrene can be considered certainly curable only in cases where the system has not become seriously affected by disease. In all simple cases gangrene seems as curable as a burn, scald, or any other serious wound. "General Treatment. No remedy has yet been presented to us that has apparently any marked or positive curative power over the constitutional and organic derangements produced by the absorption of the poison of gangrene. We saturate the air of the wards of this hospital with chlorine, and we have given bromine internally for days and weeks; and while we do not know of a certainty that this course has proved beneficial to our patients, we should hesitate to deprive them of even the possible benefits arising therefrom. Pure air, full nutrition, alcoholic prepara tions repeated as often as once in two hours, hope, cheerfulness, and immediate removal of all causes of distress and fretfuluess (for gangrenous patients are very childish), with perfect cleanli ness of the bed and the person, seem preferable to any form of perturbative medication." SURG. Ill 107 850 WOUNDS AND COMPLICATIONS. [CHAP. XII. The largest number of cases of gangrene (1,611) occurred in 1864, when the terrible battles of Grant in Virginia, and of Sherman in Georgia, filled the hospitals to overflow- ino-- but the disease seems to have lost its terror to the medical officers. The cases were o quickly isolated in hospitals or wards specially assigned to this purpose, and under the various treatments described in the preceding pages the larger proportion of the cases were brought to successful terminations. The proportion of cases of gangrene to the number of troops engaged or to the wounded treated in hospitals during the six months of 1865 was very small, only one hundred and thirty-five (135) being found recorded on the registers. Illustrations of hospital gangrene will be found on the plates opposite pp. 739 and 928 of the Second, and on PLATE XXVII, opposite p. 53, of the Third Surgical Volume. Instances of Dry Gangrene, the result of shot injuries, were rare. A case of this nature has been detailed on page 310 of this volume (Case of E. Green), and another (Case of H. Strauss) has been referred to in Note 2, on page 351 of the Second Surgical Volume. The appearance of the feet in the latter case is shown in the chromo-lithograph opposite. In these, as well as in the following seven instances, the gangrene was due to impaired arterial circulation : CASE 1209. Private W. Steel, Co. G, 70th New York, aged 26 years, was wounded in the left leg, at Manassas Gap, July 23, 1863, and entered Lincoln Hospital, Washington, one week afterwards. Assistant Surgeon H. Allen, U. S. A., recorded the following description of the injury : " The ball struck on the outer side of the leg, passing in a straight line inward through the upper part of the belly of the gastrocnemina, and coming out on the inner side of the calf. The bleeding was copious. Immediately after the reception of the wound the man experienced a severe pain in the ankle and was totally unable to walk, only dragging the limb after him. When admitted into Lincoln Hospital the foot had become bluish, which appearance the patient stated had come on two days previously. The pain in the ankle passed off the first evening, but when the blueness com menced the pain reappeared and continued to increase in severity until the date of amputation. The color of the foot was that of bluish stone, but not shrivelled, the toes being of a deeper hue than the rest. This appearance gradually increased up to the ankle, and then ran up posteriorly to the lower third of the leg. Amputation through the wound was performed by flap method on August 3d. After the operation the constitutional symptoms, such as pale and tremulous tongue, quick and feeble pulse, con tinued about the same. The flaps were pale and rather flabby, but not gangrenous. A diarrhoea set in, which was checked by August 25th ; appetite capricious. By October 20th had entirely recovered, the stump having healed without exfoliating any bone." On January 30, 1884, the patient was discharged from service and pensioned, and subsequently he was furnished with a "Palmer" artificial leg. In his application for commutation the pensioner describes the stump as being in a healthy condition. He was paid December 4, 1880. A representation of the gangrenous limb is given in PLATE LXXIX, opposite p. 818. CASE 1210. M. A. Gammel, Co. G, Arkansas Kegiment, aged 23 years, wounded at Antietam, September 17, 1862, by a fragment of shell just above left ankle. Leg was amputated about two weeks afterwards. On October 28th he was admitted into hospital at Frederick, Maryland. Patient suffered from a large bed-sore, and sloughing of the flaps allowing the bones to protrude; he had also a violent diarrhoea. These complications were alleviated by treatment, but his general condition continued very poor; the discharge from the stump became thin, watery, and dark colored. On December 2d dry gangrene set in, in the great toe of the right foot and also in the second toe. Pulse very feeble and rapid. General condition bad. December 4th : Gangrene involved all the toes ; no constitutional symptoms developed ; strength vei-y feeble. The patient died December 5, 1862. CASE 1211. Private Charles Hanford, Co. I, 14th Ohio, was wounded at Chickamauga, September 19, 1863. The mis sile entered over the anterior border of the sterno-mastoid of the right side opposite the larynx, passed backward and inward, striking the spine and comminuting its processes at that point. Another ball passed through the right hand at the middle of the carpo-metacarpal articulation. A few spicula3 were removed from the wound in the neck. He was admitted on September 30th into the hospital at Chattanooga, Tennessee. There was complete paralysis of the lower extremities and of the right arm ; unpromising case. Simple dressings were applied and anodynes given. October 3d : Large slough of skin on dorsal aspect of left foot; dry gangrene of toes of same side. No other change. Right carotid seen pulsating through wound ; little reduction of general heat of body. No trace of motion in extremities and right arm ; slight in leg, but being pricked with a pin said it was water falling on the part. October 6th : Motion slight in both extremities and right arm ; sensibility increased ; can detect pricking in leg and feet. Gangrene of toes progressing slowly; ball of right toe involved; right hand and arm swollen. Patient died October 6, 1863, with tetanic symptoms. CASE 1212. Walter Hill, freedman, was admitted into Freedmen s Hospital, Vicksburg, Mississippi, April 26, 1865, with a gunshot wound of the left leg, accidentally inflicted on April 15th. A conical ball entered the left popliteal space and lodged in the deep-seated tissues of the joint. Simple dressings were applied. The bullet was cut out on April 26th. Patient died May 20, 1865, of chronic diarrhoea and dry gangrene of the leg. CASE 1213. Private W. J. Logan, Co. K, 9th Pennsylvania Reserves, aged 23 years, received a shot wound of the left foot, at Bull Run, August 30, 1862. The bullet entered the front of the heel and passed directly upward through the top of the foot. Many pieces of bone were extracted. The patient was discharged from service at Carver Hospital, Washington, November 5 ; 1862, and pensioned. Dr. John Kirker, of Pittsburg, reported, April 15, 1870, that on December 23, 1869, he "amputated the DRY GANGRENE OF THE FEET CHAP, xil.l TEAUMATIO ERYSIPELAS. 851 V left leg at the junction of the upper and middle thirds because of dry gangrene of the foot produced under the following circum stances : He received a gunshot wound of the foot which so injured it as to compel him to rest chiefly on the heel in walking, causing, in my judgment, aneurism, which gradually developed during the summer of 1869. Dr. A. M. Pollock operated for aneurism in my presence. Dry gangrene resulted from impaired arterial circulation, it commencing in the original wound, and had involved the whole foot at the time the operation of amputation was performed." The pensioner was paid in June, 1876. CASE 1214. Private Peter Mon, Co. E, 2d Massachusetts, aged 27 years, Avas wounded at Chancellorsville, May 3, 1863. On May 7th he was admitted into Douglas Hospital, Washington. A minitS ball had entered the internal portion of the calf of the right leg, lacerated the posterior tibial vessels, comminuted both bones, and lodged in the gastrocnemius muscle. When admit ted to the hospital his general condition was tolerable, and the injury to the vessels Avas not detected, as the heat and appearance of the foot Avere good. On May 9th it Avas noticed that dry gangrene Avas beginning in the foot, and, after free stimulation during that day, a circular amputation Avas done in the lo\ver third of the thigh by Assistant Surgeon W. Thomson, U. S. A. The patient reacted Avell and had no bad symptoms from the moment of the amputation. The ligature around the femoral artery separated on the tenth day, and by May 22d nearly one-half of the flap had united. A slight tendency to diarrhoea Avas readily checked by laudanum enemata. The patient Avas discharged August 26, 1863; stump quite Avell; patient strong and hearty. CASE 1215. Private W. Thompson, Co. H, 69th NBAV York, aged 19 years, was admitted into Armory Square Hospital, Washington, April 1, 1865, with a shot wound of the posterior aspect of the right leg, receiA ed at Hatcher s Run, March 25, 1865. The ball passed upward and made its exit over the tibia five inches beloAV the knee joint. Dry gangrene existed at the time of admission, oAving to the circulation to the foot being cut off. On April 2d Surgeon D. W. Bliss, U. S. V., amputated the limb at the lower third of the thigh. Pyaemia supervened on April 12th, and the patient died from exhaustion April 15, 1865. In all these cases the feet or the toes were the parts affected. As already stated, interference with the arterial circulation was the cause of the gangrene, although the man ner of this interference may not be so clear in one or two of the cases. In the cases of Steel, Thompson, Mon, Hill, and Green, the arteries of the affected limb had been injured. In the case of Logan (CASE 1213), dry gangrene developed upon the formation of an aneur ism following a shot wound of the dorsum of the foot. In Hauibrd s case (CASE 1211) com plete paralysis of the lower extremities and dry gangrene of the toes of the left limb were the results of a shot injury of the neck with lesion of the spine. In the case of Strauss, phlebitis and dry gangrene ensued after a shot perforation of the pelvis with injury of the urethra. Gammel (CASE 1210) received a shell wound just above the. left ankle; the leg was amputated; sloughing of the flaps and bed-sores followed, and thirty -five days after the operation dry gangrene appeared in the toes of the right foot. The patient died. In five of the nine cases of dry gangrene here cited, amputation was performed after the appearance of the affection; four recovered. The remaining four cases, in which no operative interference was resorted to, proved fatal. TRAUMATIC ERYSIPELAS. Less frequent than the instances of gangrene were the cases complicated by traumatic erysipelas. Under traumatic erysipelas have here been considered the cases in which inflam mation of the skin, originating from a wound, quickly extended over the surrounding parts, ending in rapid resorption, while the progress was accompanied by an exceedingly high fever. Cases of acute suppuration and diffuse inflammation, or of diffuse acute osteomyelitis, which have sometimes been classed with erysipelas, are not considered in this group. The total number of cases of traumatic erysipelas was one thousand and ninety-seven (1,097), or only 0.4 per thousand of the two hundred and forty-five thousand seven hundred and ninety (245,790) cases of shot wounds recorded during the war. With regard to the various regions of the body, the cases were distributed as indicated in TABLE CLIX, on the next page. The percentages there given, viz: 14.0 per cent, for the head, face, and neck, 5.2 for the trunk, 41.7 for the upper extremities, and 39.1 for the lower extremities, only indicate the relative percentage of the frequency of the disease in the four subdivisions of the body in regard to each other. The liability of the various portions of the body to this infection 852 WOUNDS AND COMPLICATIONS. [CHAP. XII. TABLE OLIX. Numerical Statement of One Thousand and Ninety-seven Cases of Traumatic Erysipelas. Q M g PM M SEAT OF INJURY. <o 1 o J H i i 2 w m o H C5 u 4 M <j H O K pr. & * a dNeck 154 107 44 3 14.0 57 23 33 1 5.2 457 259 180 18 41.7 429 229 193 7 39.1 450 1,097 C18 29 is shown by comparing the number of wounds of each region with the number of cases of erysipelas reported therein. In twenty-six thousand four hundred (26,400) cases of shot wounds of the head, face, and neck, erysipelas was noted in one hundred and fifty-four, or in 5.8 per one thousand; in forty-five thousand one hundred and eighty-four (45,184) wounds of the trunk, in fifty-seven, or in 1.2 per one thousand; in eighty-seven thousand seven hundred and ninety-three (87,793) wounds of the upper extremities, four hundred and fifty-seven, or in 5.2 per one thousand; and in eighty-six thousand four hundred and thirteen (86,413) wounds of the lower extremities, in four hundred and twenty-nine, or in 4.7 per one thousand. It would seem, therefore, that erysipelas occurred most frequently in wounds of the head, face, and neck, next in wounds of the upper extremities, then in wounds of the lower extremities, and least frequently in wounds of the trunk. The pre vailing opinion that erysipelas is most frequently found after wounds of the head and face is here corroborated; the frequency of erysipelas after wounds of the upper extrem ities has also been noted by Socin, who was unable to assign any plausible cause therefor. The average duration of the disease was eleven days; 1 in 31.7 per cent, it subsided in from one to five days, in 31.7 per cent, in from six to ten days, in 19.4 per cent, in from eleven to fifteen days, and in 17.2 per cent, the duration of the disease exceeded fifteen days, as in the following case, in which it continued for about four weeks: CASK 1216. Private G. Walker, Co. A, 9th Louisiana, was wounded at Gettysburg, July, 1863, and was admitted on July 18th into the Louisiana Hospital at Richmond; a mini6 ball fractured the crest of the left ilium; the ball remained embed ded in the bone and was extracted. On admission the wound had a healthy appearance and the general condition of the patient was good. On the 22d and 25th of July several loose spiculae were extracted. On July 28th erysipelas appeared around the wound and gradually spread upward and downward until the whole abdomen, back, and chest were invaded. It there seemed to limit itself. At the first manifestation of the disease an active purgative was administered, and immediately after tincture of iron was given, twenty drops every two hours. An ointment of sulphate of iron, a drachm to an ounce of lard, was used morn ing and night on the whole surface affected with erysipelas. In spite of this treatment the disease, which seemed to have stopped spreading, extended to the neck, arms, and thighs. The fever increased considerably and was accompanied with delirium and great restlessness, soon followed by coma and prostration ; there was also some diarrhoea; two blisters were applied to the inner part of the thighs; carbonate of ammonia, camphor, and bark, with astringent enemata prescribed in addition to the tinc ture of iron. In order to check the progress of the erysipelas, which threatened to invade every part of the body, a bracelet one and a half inches wide was made by cauterizing with nitrate of silver around the forearms and upper part of the legs. This treatment seemed to check the disease. August 25th : The erysipelas did not spread beyond the line of cauterization, and did not invade the head. Consciousness returned; the bowels became more regular, and the patient, after having been in a very critical condition, and although now (August 25th) very weak, is gradually but steadily recovering; the wound has a healthy appear ance and discharges but moderately. 2 1 SOCIN (A.) (Kriegschirurgische Erfnhrungen gesammelt in Carlsruhe 1870 und 1871, Leipzig, 1872, p. 34) found that the average duration of the cases observed at Carlsruhe in 1870- 71 was 10 days, and LOSKEX (H.) (Kriegschirurgische Erfahrungm aus den Barackenlazarethen zu Mannheim, Hei delberg und Carlsruhe 1870 und 1871, in Deutsche Zeitschriftfur Chirurgir., Leipzig, 1872, B. I, p. 544) states that at Mannheim the mean average was 9 days 2 FOKMEXTO (F., jr.), Notes and Observations on Army Surgery, New Orleans, 1863, p. 57. CHAP. XII.] TRAUMATIC ERYSIPELAS. 853 A first attack of erysipelas by no means secured the patient against a second, and as a rule it would seem that the later attacks were the more virulent. On page 433 of this volume has been detailed the case of Private $. Prillaman (CASE 674), in which the patient had nine separate attacks of erysipelas, and in the two following cases repeated attacks of the disease were noted : CASE 1217. Private H. B. Williams, Co. G, 2?th Indiana, received a shot wound of the left wrist, at Antietam, Septem ber 17, 1862. He was admitted on the next day into hospital at Frederick. Acting Assistant Surgeon W. S. Adams reported : "Wrist joint much disorganized; ball passed through left wrist, comminuting the small bones ; finger readily passes through the opening. September 20th : Extensive erysipelas from elbow to fingers ; made a free incision along the arm to the wrist and two incisions along the dorsum of the hand. Ordered lead and opium wash to be freely applied and to take fifteen drops of tincture of iron every three hours, two ounces of brandy every two hours, and three grains of quinine every three hours; gen erous diet. In the course of three or four days the patient passed into other hands, and I saw no more of him until November 19th, when he again came under my care. He stated that he had had a second attack of erysipelas some time in October. At this date, November 19th, there is felt evidence of a third attack; pulse 120, feeble; some diarrhoea; tongue red and glassy. Iron, quinine, brandy, and generous diet ordered. November 20th : Patient worse ; erysipelas has extended to face, which is much swollen; 21st, eyes nearly closed; treatment continued; affected parts kept continually wet with opium wash; 22d, swelling diminishing and parts assuming a darker hue; 24th ; swelling almost entirely gone; appetite improving; brandy and quinine continued, but iron omitted on account of diarrhoea; 26th, diarrhoea checked; cod-liver oil ordered; 28th, stomach tolerated the oil ; appetite improving ; pulse 120, and small. December 2d : Erysipelas has again set in on the arm ; lead and opium resumed ; 3d, made several free incisions and evacuated considerable pus ; 6th, patient has several unmanageable bed sores, and was to-day placed on a water-bed. On December 10th diarrhoea again set in ; he gradually failed, and died Decem ber 27, 1862. Post-mortem : On opening the chest the right lung was found to be firmly adherent to the diaphragm and pleura costalis. Its middle and upper portions were thickly studded with miliary tubercles, and the upper portion of the middle lobe was in a state of diffused suppuration. But few tubercles could be found in the left lung. On examining the arm the integu ment over the external condyle was found to have sloughed away and the bone was in a state of necrosis ; the elbow joint contained pus; the inferior extremity of the ulna had ulcerated; the carpal bones were comminuted and carious. Carpal extremities of second, third, and fourth metacarpal bones near joints were in a necrosed condition and the joints opened. The lower extremity of the radius was comminuted : there was also union of an oblique fracture at its middle third." The bones of the right forearm and parts of the carpus and metacarpus were sent to the Army Medical Museum by Dr. Adams, and form Specimen 3838 of the Surgical Section. CASE 1218. Lieutenant N. Austin, Co. E, 14th South Carolina, aged 30 years, was wounded at Gettysburg, July 3, 1863. Acting Assistant Surgeon J. T. Laning reported: "Wounded in the upper part of the right thorax, causing a fracture in both the clavicle and scapula. Admitted into the Cavalry Corps hospital on July 14th. On the evening of July 17th the patient was taken with a chill, and on the 18th erysipelas developed itself on the right arm. Tincture of iron was applied to the part and given internally. By July 23d the arm was much swollen, discolored, and ecchymosed. On the 24th a free incis ion was made in the middle of the arm, from which a great quantity of very unhealthy pus was discharged. The patient was greatly prostrated, but improved quickly under tonics and generous diet. On August 5th erysipelatous inflammation set in over the right hip, accompanied with great swelling, but soon disappeared. On August 12th the disease appeared in the forearm, to which wet bandages were applied. On the 19th erysipelas manifested itself in the shoulder above the incision, and was com bated with tincture of iodine and wet cloths to the parts." The patient was transfeiTed on August 21, 1863, and paroled. Generally the disease confined itself to the parts first infected, and thence extended in a centrifugal manner, showing that, as Socin expresses it, "the matter causing the inflam mation spread itself abroad more by the way of imbibition than in the direction of the larger venous and lymphatic vessels;" however, swelling and abscesses in the axillary and inguinal regions were not infrequent. In the case of Pease (CASE 263, p. 114, ante) large inguinal and popliteal abscesses were noted after the attacks of the disease. Sometimes the disease spread itself over the neighboring parts and affected nearly the whole body. Gases are on file in which the erysipelas made its appearance in the head and extended down the neck and chest to the pelvis, or in which the disease originated in a wound of the hand and spread over the arm and trunk and even the face; or where it A first showed itself in the toes and attacked the leg, thigh, and lower portion of the trunk. In the case of Walker, cited on the opposite page, the crest of the left ilium was fractured; the disease spread from the wound first over the entire trunk, and then over the neck, thigh, and arms. In the case of Williams, 27th Indiana, cited above, erysipelas followed a shot wound of the wrist and extended to the face. Erysipelas in the upper and lower extremities seems to have been equally liable to attack the trunk. 854 WOUNDS AND COMPLICATIONS. [CHAP. XII. CASK 1219. Private Jesse Massey, Co. A, 129th Illinois, received a shot wound of the left hand, at Resaca, Georgia, May 15, 1864. The index finger was removed at the field hospital. On May 2lst he was admitted into the field hospital at Bridge port, Alabama. Soon after admission erysipelas affected the hand, the whole arm and trunk in succession. Several abscesses had to be opened. Iodine was applied externally. The patient recovered and was furloughed June 28, 1884, at which date the wound had healed; there was some contraction of the fingers, caused by erysipelas. CASE 1220. Private George Lincoln, 9th Illinois, aged 27 years, was wounded at Fort Donelson, February 15, 1832. A rifle ball passed from side to side through the arch of his foot, comminuting the anterior portion of the tarsus and the metatar- sal bones. The patient was conveyed to the Academy Hospital at Nashville, where Dr. T. L. Madden, of Nashville, amputated the foot, after the method of Pirogotf, on February 2.~>th. Erysipelas appeared upon the stump on March 2d, and extended thence over the greater portion of the body, causing death on March 8, 1862. The case is reported by Surgeon E. Swift, U. S. A. CASK 1221. Assistant Surgeon A. K. Smith, 1st Michigan Cavalry, remarks, on the monthly report of sick and wounded of the 1st Michigan Cavalry, near Fort Scott, Virginia, for January. 1863: "The case of traumatic erysipelas supervened on a gunshot wound of the foot received on January 9, 18b :5. The ball entered the dorsal surface between the last phalanges of the second and third toes, and passed out on the plantar surface an inch posterior to the commissure of the toes. The last phalanx of the second toe was shattered and the metatarso-phalangeal articulation opened. The case was not seen until the 14th. The wound and foot were then considerably inflamed, tense, and painful. Amputation was not then thought advisable in the then condition of the parts. Water dressings with cold irrigation were employed, but the wound did not assume a healthy appearance. The track of the ball did not slough; healthy suppuration did not take place, and there was no granulation. The wound con tinued to look drv, purple, tumid, and the slight discharge that took place was of a serous or semi-sanguinolent character. Tin- general health, however, seemed good. On January 20th an erysipelatous blush first appeared around the wound, and in a few hours an erysipelatous inflammation of the cellulo-cutaneous variety was fully established, accompanied with febrile symptoms of an irritative type. The erysipelas spread rapidly up the limb until, on January 30th, it had reached the body. The limb was much swollen, tense, of a dusky red color, and covered in patches with vesicles. The foot was greatly swollen, tense, boggy to the touch, of a purplish hue, and covered with blebs. The wound was livid, dusky, emitting a sanious offensive secretion. Thus matters went on until January 2oth, when there seemed to be great danger of gangrene of the wound and foot. The erysipelas was still spreading upward ; the constitutional symptoms were becoming serious ; the parts contiguous to the wound were dark, boggy, almost insensible, and the discharges from the wound were offensive. Amputation of the second toe, at the metatarso-phalangeal articulation was resolved upon, notwithstanding the condition of the parts and the general symptoms. This was done on January 25th. Two reasons led to this course. First, it was thought the incisions would be beneficial by relieving the tension of the parts and by affording a free outlet for the secretions of the wound and the inflammatory effusion ; and, second, it would remove a source of irritation in the fractured and shattered phalanx. The operation did not aggravate any of the symptoms but rather mitigated them. They remained about the same for four days, when a general amendment began, which lias continued up to this time, February 5th. The inflammation of the leg has subsided, desquamation taking place. The swelling of the foot, though still considerable, is much reduced; the wound has put on a healthy character and is now secreting healthy pus and showing healthy granulations ; the febrile symptoms have subsided and the patient s general condition is rapidly improving. He is convalescent. The treatment has been isolation, that the other wounded men might not be endangered, good ventilation, nutritious animal diet, muriated tincture of iron, and wine; locally a solution of lead wash to the limb and a solution of chlorinated soda to the wound." Four hundred and fifty of the one thousand and ninety-seven cases of erysipelas proved fatal, a mortality rate of 41.0 per cent. TABLE CLX. Numerical Statement of One Thousand and Ninety-seven Cases of Traumatic Erysipelas, indicating the Results and Causes of Death, H DEATHS AND CAUSES OF. M D & H 6 a REGION". 8 S| tt o i go O < H O | S rt a p to n t-t .2" o 8 n >.. o H M PH O H H ft W Shot TVounds of Head Face Neck 154 107 3 1 1 4\ 8 30 Shot AVounds of Trunk 57 23 1 3 1 4 G 19 128 56 n n 1 1 5 11 . 37 81 49 G 1 2 3 4 10 ( Amputation 248 154 7 25 1 5 20 17 19 200 109 7 4 1 1 6 48 24 25 15 2 2 2 ! 4 204 105 14 3 4 2 22 35 19 1,097 618 29 GO 8 5 12 06 131 1G8 CHAP, xu.l TRAUMATIC ERYSIPELAS. 855 In sixty cases death was ascribed to pyaemia, in eight to gangrene, in five to tetanus, in twelve to haemorrhage, and in sixty-six to other diseases. In one hundred and sixty- eight instances only was the fatal issue directly attributed to erysipelas, making a fatality of 15.3 per cent, in the one thousand and ninety-seven cases attended by this complication. Erysipelas made its appearance under the most favorable hygienic conditions. Surgeon D. Morgan, U. S. V., in the latter part of April and in May, 1862, reports from hospital No. 3, at Evansville, which was located on high ground, free from moisture, and with nothing to interfere on either side with the free circulation of air, that he had "no epidemic disease unless it be erysipelas which followed some of the wounds." It was observed that the disease prevailed less extensively in tents than in hospital buildings. Generally the disease occurred in crowded hospitals with illy- ventilated rooms and rapidly spread from one wounded patient to another. This was the case in Louisville in November and December, 1862, where the progress of the affection, although quite virulent, was successfully checked by the use of bromine. In their reports Surgeons M. Goldsmith and B. Woodward, U. S. V., speak enthusiastically of this agent as a prophylactic against erysipelas. Surgeon Woodward remarks that "since the use of bromine in vapor not one case originated in the crowded wards of the barracks [Park Barracks Hospital, Louisville], in which, before its use, from five to eight cases of erysipelas a week had occurred." In the application of bromine in erysipelas two different methods were employed: first, by the action of the vapor of bromine on the affected part; second, by a direct application to the erysipelatous surfaces of a solution of bromine of varying strength. In the first method, the part affected was enveloped in dry lint; a cloth saturated with pure bromine was then applied Over this, and the whole dressing covered with a piece of oiled silk. The only objection to this treatment was the tendency of the bromine to blister the skin by soaking through the intervening layer of dry lint. The other mode of using the bromine was to apply directly to the inflamed integument a solution of the bromine and bromide of potassium of the strength of from fifteen to forty drops of the former to the ounce of water. The treatment of erysipelas with bromine was principally confined to the hospitals at Louisville, under the supervision of Medical Director M. Goldsmith. At other hospitals the patients were at once isolated, or sent to separate wards, where disinfectants were freely used. In the great majority of cases the disease yielded readily to a local application of tincture of iodine and cloths saturated with a solution of creasote, the former to the wound and inflamed surface, the latter a little more extensively to the neighboring parts. The internal treatment consisted of tincture of muriate of iron in small doses, often repeated, with quinine, etc., and good diet. In severe cases evaporating lotions of ether were applied to the worst points and numerous incisions or scarifications made to relieve the tension, as in CASE 78, page 37, ante. Opinions differ greatly as to the origin and mode of infection of traumatic erysipelas. Billroth, in 1863, l believed that it might "result from retention of the secretion of a wound, and consequent reabsorption of a slight amount of putrid substance, in which case it is so much like lymphangitis that at the commencement it is often difficult to distinguish the two diseases. In many sporadic cases no definite cause can be found; in other cases epi demic influences seem to come into play, for at the same time a large number of wounded patients are attacked by the disease. Crowding such patients in badly-ventilated places BILLROTH (T.), General Surgical Pathology and Therapeutics, translated from the fourth German edition by CHARLES E. HACKLKY, New York, 1671, p. 313. 856 WOUNDS AND COMPLICATIONS. [CHAP. xn. also develops a contagion, concerning which we are doubtful if it acts only on wounds, or, being taken in by the lungs, may induce erysipelas in the wound; the latter is not very probable." Socin 1 claims that the originally pure local inflammation may generate sub stances of a peculiar nature, which have the faculty of spreading very rapidly over the neighboring parts, causing similar inflammation, while at the same time the deleterious matter passes into the blood and produces high fever; or that the disease may be caused by the import of a specific agent virus, if you wish it of the nature of which we know very little; but it may be stated that "it must be of a very perambulating kind; that it does not necessarily depend on the presence of pus or infiltration; that it is by no means present in every case of pus or infiltration; that it maintains itself for a long period outside of the body without losing its efficacy, and finally that we know of no remedy which will thoroughly exterminate it." After his experience in the Franco-German War, 1870- 71, Billroth abandoned the idea of septic infection and ascribed the disease to specific con tagion: 2 "Since I have conducted operations with disinfectants and the utmost cleanliness I have had no further cases of septic erysipelas, none but cases of erysipelas occasioned by contagion, and nearly all were observed in cases of wounds with healthy granulations. I now believe that I have inoculated the disease, in the patients who shortly after the operation were attacked by erysipelas, by sponges, bandages, etc. Whenever in the last few years cases of retention of decomposed blood or secretion occurred a matter which can not be always avoided I noticed no erysipelas, but only a simple form of inflammation of the areolar texture. Genuine erysipelas can be carried into the wound at every stage ; it has nothing to do with the reparative process of the wound, and is always an accident intro duced from without. * * * That among the one hundred and thirty-two wounded treated by me at Weissenburg only one, and at Mannheim only a few isolated cases occurred, certainly proves that retention of secretion itself does not produce erysipelas. * * * Immediate isolation of the cases, as well as thorough ventilation of the barracks, prevents the further propagation of this fatal wound complication." Very recent wounds were attacked by erysipelas, and again the disease occurred in wounds with perfectly healthy granulations, or which were well advanced in cicatrization, as in the following: CASE 1222. Private Arthur Farey, Co. C, 183d Pennsylvania, aged 35 years, was wounded at Cold Harbor, Virginia, June 3, 1864. He was admitted into the hospital of the First Division, Second Corps, and on June llth was transferred to Philadelphia and entered South Street Hospital. Acting Assistant Surgeon J. A. McArthur reported: "Wounded by an explo sive ball, which entered the right side of the thorax one and a half inches from the acromion. At date of admission the wound of entrance had entirely healed. The right arm was very much swollen and inflamed. A large abscess formed, situated imme diately over the biceps muscle; general condition poor. On June 12th I opened the abscess and extracted the ball and ordered that the wound caused by opening the abscess be freely injected three times a day with a solution of chlorate of soda; painted the whole arm and forearm with tincture of iodine and applied a bandage. Flaxseed poultice, mixed with lead-water, to be applied to the wound. Four bottles of porter were given daily, and a mixture composed of sulphate of quinine one drachm, tincture of muriate of iron one drachm, water six ounces, and simple syrup two ounces, Avas given in tablespoonful doses four times a day. June 20th: The pain and swelling of the arm have almost disappeared; wound discharging healthy pus; general health good. Injections kept up and poultice and iodine discontinued. July 18th : From the last date the patient continued steadily improving till the present time. He is again suffering from erysipelas over the whole of the right arm. The wound over the biceps is very unhealthy and discharging a large quantity of sanious pus. Abdomen tympanitic, pulse fluttering, legs cedematous. July 20th : Gradually sinking, pupils very much contracted; semi-comatose; able to pass his urine and faeces prop erly. Died July 22, 1864, at 3 p. m. Autopsy: Brain healthy; heart contained two clots (fibrinous), one lying loose in the left ventricle and one occupying the right auricle and extending into the pulmonary artery. There was about six ounces of effusion in the pericardium. Stomach and small intestines healthy; about two quarts of effusion in the peritoneal cavity, and large deposi tions of lymph on various parts of the intestines. Liver cirrhosed. Upon laying open the wound made by the ball discovered that, the missile had passed through the glenoid cavity of the scapula, partially fracturing the head of the humerus, and passing 1 SOCIN (A.), Kriegschirurgische Erfahrungen gcsammelt in Carlsruhe 1870 und 1871, Leipzig, 1872, p. 31. a Dlu.nOTiI (T.), Chirurgischc Brirfe aits den Kreigs-Lazarrthen in Weissenburg und Mannheim. 1870, Berlin, 1872, p. 97. CHAP. XII.] PYAEMIA. 857 around the bone lodged beneath the fascia covering the biceps muscle." The upper half of the rig-lit humerus was forwarded to the Army Medical Museum by Dr. McArthur and constitutes Specimen 3669 of the Surgical Section. There is a double longitu dinal partial fracture of five inches on the inner side of the shaft. The head is carious, and necrosed bone borders the lines of separation in the shaft. A brief abstract of this case was given among the alleged instances of injuries by explosive bullets on page 702, ante. CASE 1223. Sergeant M. V. B. Carr, Co. K, 104th New York, aged 25 years, received a shot wound of the left leg, at Gettysburg, July 1, 1863, and on July 19th entered the hospital at York, Pennsylvania. A mini6 ball entered the outer aspect of the upper third of the left leg, passed downward and backward, and emerged on the posterior part three inches below the popliteal space. On admission the parts were swollen and the discharge of pus abundant. Simple dressings applied. On October 12th the wounds were still open; condition good. The patient was furloughed on October 28th and readmitted on December 6th. The wound of entrance became unhealthy, and on January 15, 1864, was four by two inches in extent; granu lations flabby, not disposed to cicatrize, leg swollen but not painful. The parts were touched with solid nitrate of silver daily and simple cerate applied. By March 1st the wound was nearly closed though three inches deep. April 1st: Wound closed; no swelling of part, nor pain; leg lame. April 10th: Wound of entrance reopened; discharge slight. May 1st: External part of leg red, painful, and swollen for several days ; abscess discharged. Wound of exit reopened May 19th ; wound of exit nearly closed; leg less swollen and painful. On May 21st the patient was transferred to Ladies Home Hospital, New York. Acting Assistant Surgeon G. M. Smith reported that "on admission the wound was healed, but the p atient was quite lame. He was soon after attacked with erysipelas of the left leg. A lotion composed of three ounces of spirit of mindererus, one of alcohol, and twelve of water was applied to the limb, and muriated tincture of iron given internally. In the subsidence of the erysipelas he soon regained his general health. He was discharged from service July 23, 1864. The wound in the left leg had healed, but the limb was purple and cedematous and the patient quite lame." Erysipelas was noted in four hundred and fifty-two cases of amputations and in one hundred and six cases of excisions. Of the four hundred and fifty-two amputation cases the disease occurred in one hundred and fifty-one instances before, and in three hundred and one after the operation. Of the one hundred and six cases of excisions the complication made its appearance in all but four cases after the operation, and here again the liability of this operation to be complicated by erysipelas will be noted. Regarding the years in which the erysipelas was recorded, it can only be stated that the disease was most frequent in periods in which the number of wounded under treatment was the largest. Five cases were noted in 1861 , one hundred and forty-three in 1862, three hundred and one in 1863, four hundred and forty-nine in 1864, one hundred and thirty- two in 1865, and in sixty-seven cases the year was not stated. The same may be said of the seasons of the year, although it was generally more frequent in cold and damp seasons and at times when it was necessary to keep the doors and windows of hospital buildings closed. Thirty-nine cases originated during January, twenty-nine in February, thirtv- eight in March, seventy-seven in April, one hundred and thirty-one in May, one hundred and twenty-four in June, one hundred and seven in July, seventy in August, fifty-nine in September, fifty-seven in October, thirty- five in November, thirty-six in December, and in two hundred and ninety-five cases the month in which the disease manifested itself was not recorded. The wounded among the colored troops seem to have been seldom affected by this dis ease, as only eleven were attacked by it; but five of the eleven cases proved fatal four in consequence of erysipelas, and one of pleuritis and erysipelas. PY^MIA. The terms septsemia, septicaemia, ichorrhamiia, pyaemia, pyohsemia, toxaemia, etc., found on the surgical reports of the war, were probably used by the surgeons as expressing, in their opinions, certain degrees or phases of blood poisoning, intelligible to themselves, but which the descriptions of the cases fail to reveal, and which, therefore, have not been adhered to here. Nor have the many careful investigations since the war enabled writers on surgery to reconcile the differences of their views. Lidell 1 believes that pyaemia is the LlDELL (J. A.), On Pyscmia, in United States Sanitary Commission Memoirs, New York, 1870, Surgical Volume I, page 511. SUKG. Ill 108 858 WOUNDS AND COMPLICATIONS. fCHAP. xu. "variety of septsemia in which some local suppuration constitutes the primary focus or source of infection. In the other varieties of septic blood poisoning the source or focus from which the poison proceeds, and the symptoms, or secondary disturbances and struct ural lesions induced by it in distant organs, are of quite a different nature, as, for example, we may see, in cases of dissection wound, gangrene from injury of blood-vessels, senile gan grene, spreading inflammatory gangrene, and hospital gangrene." Hueter declares that the "first wound fever is essentially a septicaemia fever. * * In the course of a few days the wound fever gradually loses the character of the simple septicsemic fever, and with the appearance of suppuration changes into a septico-pyaemic fever; and, finally, with the extinction of the putrescent process and the continuance of suppuration into a simple pyaemic fever." Socin claims that the various forms of the primary wound fever caused by the recep tion into the blood of putrid fermentative products should be designated as septicfflmic fevers, and those caused by the resorption of certain pyogenic products of pus as pysemic fevers. 2 Billroth contends that septicaemia most frequently appears in the first days after severe injuries, at a time when pus has not yet formed in the wound, and that pyaemia is found after local suppuration has been established, and adds: "I have not seen a single instance of this disease in which there was not found, either on the living subject or on the cadaver, a deposit of pus or ichor, from which it had originated." 3 A similar fact was noted by Lidell. In not one of the fifty-seven cases observed by him at the Stanton Hos pital did "pyaemia make its appearance previous to the establishment of local suppuration." 4 Arnold, who cites detailed accounts of numerous post-mortem examinations in cases of traumatic pyaemia, discriminates between simple septicaemia and septico-pysemia accom panied by metastatic abscesses, which latter he designates as pyaemia. 5 The reports of the cases of blood poisoning of the American civil war are not suffi ciently clear and indicative to follow the hypothetical discriminations pointed out by the authors cited, and the entire series will here be considered under pyaemia. The total number of cases of pyaemia after shot wounds was two thousand eight hun dred and eighteen (2,818), of which seventy-one (71) recovered, and two thousand seven hundred and forty-seven (2,747) terminated in death a mortality rate of 97.4 per cent. In twenty-one (21) only of the two thousand seven hundred and forty-seven (2,747) fatal cases were other causes than pyaemia mentioned as having influenced the fatal issue, viz: haemorrhage in seven, gangrene in six, tetanus in two, erysipelas in one, peritonitis in one, and typhoid pneumonia in four. In the remaining two thousand seven hundred and twenty- six (2,726) fatal cases death was ascribed to pyaemia. Whether in the cases attacked by pyaemia the wounds were in the head, the face, the neck, the trunk, or the extremities; whether the injuries were only flesh wounds or accompanied by fractures; or whether they were treated conservatively or by operative interference, seemed to be immaterial; all were alike fatal, as shown in TABLE CLXI, on the opposite page. Over one-half of all of the cases of pyaemia were found after wounds of the lower extremities; in eighty-six thousand four hundred and thirteen (86,413) injuries of this class, one thousand five hundred and sixty-four (1,564, or 18.1 per thousand) cases of 1 HUETER (C.), Die chirurgische Behandlung der Wundjleber bet Schusswunden , in VOLKMAXX S fiammluny Klinischer Vorlrdye in Verbindung mil Deutschen KHnikern, No. 22, p. 101. 2 SOCIN (A.), Kriegschirurgische Erfahrungr.ngesammf.lt in Carlsruhe 1870 und 1871, Leipzig, 1872, p. U7. S BILLKOTII (T.), Chirurgische Briefe aus den Kricgslazarelhen in Weissenburg und Mannheim 1870, Berlin, 1872, pp. 108, 109. 4 LIDELL (J. A.), On Py&.mia, in United States Sanitary Commission Memoirs, New York, 1670, Surgical Volume I, p. 511. 5 AUN OLr> (J.), Anatomische Deitrdge zu der Lfhre von den Schusswunden, gesammelt wiihrend der Krieyxjahre 1870 und 71 in den Reserve- laiarethen zu Heidelberg. Heidelberg. 1873, p. 194. CHAP. KIT. PYAEMIA. 859 TABLE GLXT. Summary of Two Thousand Eight Hundred and Eighteen Cases of Pycemia, indicating Location of Injury and Resull, SEAT OF INJURY. i o RECOVERIES. DEATHS. DEATH RATE. 66 3 03 95.4 270 g 262 97 338 8 330 97 6 165 3 162 98.2 415 9 406 97 8 709 24 685 96.6 55 <) 53 96.3 800 14 786 98.2 2 818 71 2 747 97.4 pyaemia being reported. Of eighty-seven thousand seven hundred and ninety-three (87,793) injuries of the upper extremities, nine hundred and eighteen (918, or 10.4 per thousand), of forty-five thousand one hundred and eighty-four (45,184) injuries of the trunk, two hundred and seventy (270, or 5.9 per thousand), and of twenty-six thousand four hundred (26,400) injuries of the head, face, and neck, sixty-six (66, or 2.5 per thousand), were followed by this complication. In one thousand seven hundred and twenty-one (1,721) cases the day of the appear ance of the pysemic symptoms after the injury was noted as follows: On the 2d day iii 5 cases. 12th day 13th day n 50 cases. 4th day iu ... 13 cases. 14th day n 54 cases. 5th day in Cth day in . - 16 cases. 15th day 16th day n . - 60 cases. 76 cases. 17th day 8th day iu. 29 cases. 18th day n ... 70 cases. 38 cases. 19th day 66 cases. 10th day in 20th day llth day in 37 cases. 21st day n 56 cases. 22d day in 55 cases. 23d day in 42 cases. 24th day in 40 cases. 25th day in 42 cases. 26th day in 50 cases. 27th day in 31 cases. 2fth day in 36 cases. 29th day in 31 cases. 30th day in 20 cases. 3 1st to 35th day in 135 cases. 35th to 40th day in... 89 cases. 41st to 45th day in. .. 55 cases. 46th to 50th day in... 42 cases. 51st to 100th day in... 151 cases. 101st to 150th day in.. . 30 cases. 151st to 200th day in. . 8 cases. 201st to 250th day in. . 9 cases. 251st to 300th day in ... 5 cases. Ahove 300th day in 4 cases. Total 1,721 cases. From the second day after the injury the number "of cases increases gradually and almost regularly until the sixteenth day, on which the highest total, viz, seventy-six, is recorded; from the seventeenth to the thirtieth day after the injury the number decreases; after that period the disease appeared at desultory intervals, in some instances as late as two hundred and three hundred days, and, in one case, a case of recovery, the pysemic infection was ascribed to the wound over four and a half years after the injury. In the above statement the days of appearance of the pyaemia after the injury are given; but frequently the disease was not noted until excision or amputation had been per formed, and it is safe to say that in many, perhaps in the large majority of these cases, the pyaemic infection was induced or influenced by the operative interference. In TABLE CLXII, on page 860, the day of the appearance of the disease is indicated in the conservatively treated cases from the day of the injury- this includes a number of cases in which pyaemia existed at the time operative interference was decided upon; in the cases of excision and amputation, from the day of the operation. In the cases treated without operative inter ference the disease most frequently appeared from the tenth to the twentieth day, while in the cases of excision and amputation by far the larger number occurred from the first to the sixth or seventh day. 860 WOUNDS AND COMPLICATIONS. [CHAP. XII. TABLE OLXII. Indicating day of Appearance of Pycemia after Injury and after Operation. g 9 g o > a z g S * a 5 "S 1 cfi a a a DAY OK APPEARANCE. | 3 k! B DAY OK APPEARANCE. V I Pi S DAY OK APPEARANCE. I t) PI a a U ") a W *4 a W 4 o (N h b H a M * 1 5 1 O a M 1 c 1st . 7 37 13th 28 r 18 25th 20 12 2d 3 10 33 14th 27 1 35 26th 17 10 3d 4 11 45 15th 30 4 18 27th 10 16 4th S 12 37 16th 34 5 28th 11 3 5th 7 8 34 17th . .... 30 2 28 29th 11 5 6th 8 7 32 18th 34 2 20 30th g 9 2 7th 18 5 31 19th 33 4 19 31st to 35th 67 4 94 8th 18 C 21 20th 37 5 28 36th to 40th 36 17 9th 19 5 27 21st 29 3 17 41st to 45th 25 9 11 10th 25 26 22d 22 1 19 46th to 50th 19 4 llth 21 4 23 23d 17 3 18 51st to 100th 80 1 12th 24 3 32 24th 13 3 A Above 100th 8 9 The duration of the pyaemia from the day on which the first symptoms were observed to the day of death was reported in one thousand six hundred and eighty-seven cases. The deaths occurred on the 1st day 2d day 3d day 4th day 5th day 6th day 7th dav it 71 cases. 8th day iu 123 cases. 15th day in 24 cases. 26th to 30th day in 18 cases. n 96 cases. 9th day hi 92 cases. 16th day in 17 cases. 31st to 35th day in 12 cases. u 172 cases. 10th day in 81 cases. 17th day in 21 cases. 30th to 40th day in 11 cases. 11 171 cases, llth day in 64 cases. 18th day iu 14 cases. 41st to 45th day in 3 cases. n 204 cases. 12th day in 50 cases 19th day in 12 cases. 46th to 50th day in lease. 11 161 cases. 13th day in 41 cases. 20th day in 15 cases. Above 50th day iu 3 cases. u 148 cases 14th day in 29 cases. 21st to 25th day in 33 cases. About two-thirds of the cases died within the first seven days; the largest number of deaths was recorded on the fifth day; in eighty-one only of the one thousand six hundred and eighty-seven cases did the patients survive the twentieth day after the appearance of the disease. Traumatic pyaemia was seldom noticed unless the bony structure was injured. Of one hundred and sixty-five thousand eight hundred and twenty-one (165,821) wounds without lesion of the bones, only five hundred and sixty-four (564), or 3.4 per thousand, were fol lowed by pyaemia, while of the seventy-nine thousand nine hundred and sixty-nine (79,969) shot fractures, two thousand two hundred and fifty-four (2,254), or 28.1 per thousand, were followed by this complication. Very little is to be said of the treatment of pyaemia; tonics, stimulants, and a support ing diet were given, but, as has already been seen, with very little effect, as 97.4 per cent, of all the cases proved fatal. In the early stages of the disease sulphate of quinine in large doses would greatly reduce the temperature; but the improvement seemed to be only tem porary unless the .treatment was continued for some time, which, frequently, the patients were unable to bear. The disease appears to have been controlled in this manner in the following case: CASE 1224. Private George Leigh, Co. C, 3d Artillery, aged 19 years, was wounded at Robinson s Ford, September 23, 1863, by a shell fragment which carried away a portion of the right foot. Amputation at the ankle joint was performed on the field by a modification of Syme s method. The heel being injured, the flap was taken from the dorsum of the foot. On Septem ber 25th he was admitted into Stanton Hospital, Washington. Surgeon John A. Liclell, U. S. V., reported: "His general con dition was then far from satisfactory, as he was pale and very feeble. He was put upon the use of stimulants, tonics, and a good diet. Simple dressings were applied to the stump and he was directed to take an anodyne at night. September 29th : Half of CHAP. X11.J PYAEMIA. 861 the flap sloughed off; granulations pale; discharge thin and serous; Labarraque s solution, diluted, was applied to the stump. October llth : had a severe chill this morning, and complains of a good deal of pain in the right knee ; twenty grains of sulphate of quinine and an ounce of whiskey were given every six hours. 12th : had another severe chill ; knee red, hot, and very much swollen, pulse frequent and weak, tongue dry and coated, complexion assuming a bronzed hue ; quinine repeated, and five grains of citrate of iron and quinine, in pill, ordered to be given night and morning. A lotion of acetate of lead and opium was applied to the knee and lime water to the stump. 13th: had another chill to-day, but it was not so severe as the others; temperature of inflamed knee lessened; had slept well during the night; no change in the treatment. 14th: swelling of the knee much less; treatment unchanged. 15th : had a slight chill about noon, but his general appearance is much better; same treatment continued. 18th: had vomiting, produced apparently by the large doses of sulphate of quinine, which were discontinued; but the other treatment was continued. 20th: bowels constipated; five grains aloes and fifteen of rhubarb were ordered. 25th: swelling dis appearing from knee rapidly; stump looks much better; granulations more fluid and healthy; discharge more laudable. October 30th : decided daily improvement; continued the stimulants, together with the citrate of iron and quinine, and the lead and opium lotion to the knee and lime water to the stump. The knee joint remained slightly swollen, hot, and tender for a long time; indeed, the symptoms of inflammatory action in it did not entirely disappear till about the first of February, 1864. February 20th : the amount of mobility at the knee is small (false anchylosis); patella now adherent; knee natural in size and shape. Stump sore on account of having bruised it recently; general condition excellent. March 29th: the stump has refused to heal; there is an indolent excavated ulcer about the size of a franc piece situated at the posterior part of the face of the stump. The stump is otherwise unserviceable on account of the delicate character of its covering, which had been taken from the dorsum of the foot. There being now no prospect that it would ever become useful, the leg was reamputated about the junction of the middle with the inferior third by the double-flap method, the anterior flap being considerably shorter than the posterior one. The tibia was sawn off obliquely, as directed by Sanson ; anaesthetic sulphuric ether. April 18th : patient s general condition excellent." This soldier was discharged September 17, 1864, and pensioned; he died September 13, 1871. The amputated stump was contributed to the Army Medical Museum by Dr. Lidell, and is numbered 2165 of the Surgical Section. In the well established cases of pyaemia all remedies were found ineffective. In wounds of the extremities amputation has been recommended for the removal of the infection when first observed; but even this extreme remedy seemed to be of little avail. Three or four cases are reported in which limbs were removed while the patients were in a pysemic con dition, and from the successful issue it may be presumed that the removal of the infectious focus had a beneficial influence, as in the following cases, in which chills had occurred shortly before the operation: CASE 1225. Corporal C. Killan, Co. H, 2d Michigan, received a shot wound of the right elbow joint, at Fair Oaks, May 31, 1862. He was admitted on June 2d into hospital at Annapolis, Maryland. Surgeon T. A. McParlin, U. S. A., reported : "The ball entered close to the external condyle of the humerus, fractured the olecranon process of the ulna, and passed out just below the internal condyle of the humerus. On admission the arm was much tumefied; intense inflammation. Constant appli cation of iced water was made to the parts for two days by means of a syphon; the inflammation having somewhat subsided, an attempt was made to save the arm by making a crucial incision and removing the olecranon process by means of a metacarpal saw. All splinters were removed and the parts brought together with sutures and adhesive straps. The joint was kept from the air by means of an albumen scab. The arm was kept at perfect rest by a splint, and water dressings used. For ten days the arm did well, when sudden tumefaction of the entire limb supervened, with intense inflammation. The dressings were removed, save such as were required to keep the wound from the air. A heavy chill with evidences of pyaemia came on. The patient was stimulated and supported by generous diet, but the evidences of inflammation were so marked thaf the arm was amputated at the lower third." Killan was discharged August 15, 1862, with a good stump, and pensioned. Iii a case of shot wound of the knee with pyaemic symptoms, in which the lymphatic glands of the knee were greatly enlarged, amputation at the junction of the middle and lower thirds of the femur was performed and the patient recovered with a fine stump: CASE 1226. Private Joseph Jones, Co. K, 13th Tennessee Cavalry, aged 26 years, was wounded at Morristown, Tennes see, November 13, 1864, in the right knee. The ball entered near the upper edge of the patella, passed upward and backward, grazing the patella, and emerged two inches above the inner condyle of the femur. He was admitted on the same day into Asy lum Hospital, Knoxville. The early progress of the case is not recorded. On May 10, 1865, a condition of pyaamiu existed ; the patient was scarcely more than skin and bone. The -lymphatic glands in the groin were greatly enlarged; appetite nearly entirely gone; tongue dry, hard, and glassy; pulse about 120, weak; nausea and occasional vomiting. Knee and leg very much swollen; discharge very profuse and extremely offensive; soft structures of joint nearly entirely destroyed, articular surfaces very much corroded, and pus burrowing extensively about and below the knee. Acting Assistant Surgeon T. W. Baiigh ampu tated the thigh, at the junction of the lower and middle thirds, by the circular operation. The case progressed nicely; a drachm of bisulphite of soda was given each day for the first five days, together with whiskey. After this the bisulphite was decreased to a half drachm, and quinine, iron, and whiskey added. The patient recovered with a beautiful stump. He was discharged from service August 22, 1865. The case is reported by Surgeon F. Meacham, U. S. V. From the numerous autopsies reported in cases of pyaBmia the following have been selected as indicating the conditions of the different organs in the fatal cases of this disease: 862 WOUNDS AND COMPLICATIONS. [CHAV. xn. Condensed Summary of Forty-eight Post- No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 NAME, INJURY, ETC. LUNGS AND PLKURAL CAVITY. LIVER. KIDNEYS. Pt. J. Brown, H, 4th Mich., age 35. Wounds of back ami hand. Pt. G. H. Guernsey, E, 17th Conn., age 33. Flesh wound elbow; amputation. Pt. X. Young, B, 108th N. Y. Fracture knee joint. Corp l D. "Ward, H, 13th Vir ginia ; age 19. Fract. femur; amputation. Pt. "W. Fader, A, 140th New York, age 20. Fracture sa crum. Pt. G. Shaumway, C, 10th New York Heavy Artillery. Cent, wound over right eye ; age 28. Corp l N. M. Hildreth, B, 94th New York, age 21. Fracture femur; amputation. Capt. W. Bogardus, G, 86th Illi nois, age 43. Wound over right sacroiliac symphysis. Pt. E. Satterfield, F, 12th West Virginia, age 40. Fracture elbow joint; amputation arm. Pt. M. McColligau, C, Stith Mass., age 17. Fract. hum. ; amp. at shoulder joint. Pt. A. H. Comiiis, K, 34th New York, age 25. Fract. fib.; amp. thigh ; lig. femo. art. in cont. Pt. E. Gallagher, F, 69th New York, age 37. Fract. ankle joint; amputation leg. Pt. J. Brown, F, 5th New York Cavalry, age 34. Fracture wrist joint; amputation fore arm; reauip. arm. Pt, C. T. Munu, G, 77th New York, age 22. Fracture sca pula. Corp l C. Putnam, E, 64th New York, age 27. Fracture left knee joint; amputat n thigh. Corp l J. Crowley, A, 7th New York, age 25. Fracture knee ; amputation thigh. Pt. S. Hackett, F, 11 th Penna. Kes., age 25. Fracture tars, bones; Chopart s amput n. Pt, A. Hammond, H, lllthNew York, nge 47. Fracture left knee joint; amput n thigh. Pt. C. Rhodes, C, 2d Massachu setts Cavalry, age 20. Frtic- ture right ulna. Pt. S. H. Stevenson, E, 34th Ohio, age 26. Wound of r t second finger. Capt. G. Reis, C, 15th Missouri, age 31. Fracture forearm ; amputation arm. Pt. J. Stuart, C, 8th Michigan, age 30. Fracture 8th rib. Blood effused in tissue of lungs in spots; no abscesses ; costal pleura strongly injected. A few inflamed, indurated, suppurating lob ules in lower lobes of lungs. R t lung compressed; upper and middle lobes studded with abs. ; left tilled with abs. ; cavity of lymph J inch thick on pleura. Lungs; lower lobe left carnified; hypostatic congestion in right; pleuritic effusion in left sac. Lungs; left, inf. lobe congested, both lobes in- filt. with serum ; masses of fib. matter in up per and lower lobes; light, same condition. Left, 22 oz., right, 24 oz. Some congestion both lungs; small nbscesses in left; old pleuritic adhesions. Right, 22 oz., left, 14 oz.; eft usiou. Metastatic abscesses iu both lungs. Left lung weighed 1 Ib. 12J oz. Lungs congested; portion lower lobe right r.ol- lapsed and carnified ; metast. deposits in low. and masses of white substance in up. and low. lobes left lung. Weight, left, 18 oz. 4 dr., right, 18 oz. 3 dr. Lunys flaccid nnd speckled ; small yellow mass es in left. Weight, right, 2 Ibs., left, 1 Ib. 10 oz. Both lungs collapsed aiid coutaiuiug abscess es; pleunil adhesions. Lungs dark colored posteriorly; numerous ab scesses iu diseolored portions; ribs of pig mentary matter iu upper lobe. Weight, r t, 10J oz., left, 9ioz. Right lung adherent to thorax ; low. lobe of k-ft conges., red col d; tatty secretion with blood exuded ; upper lobe dull slate col d ; copious frothy dirty-white secretion exuded. Low. lobe right lung consolidated and partly hepatized ; hard tubercles in apex and inferior portion third lobe; second lobe left lung con solidated, parenchyma unhealthy. Weight, right, 35J oz., left, 25J oz. Right lung adherent between lobes and to right costal pleura; organ somewhat pueu- monic and infiltrated with pus; left lung healthy. Pya3mic patch in posterior lobe of left lung; lungs otherwise healthy | no pleuritic- adhe sions. Lungs adherent to pleura and diaphragm, and interspersed thickly with pysemic abscesses. Metastatic abs. in lungs; large excavations partially occupier! by dead tissue above right lung; pleuritic adhesions. Posterior lobes of both lungs solidified and collapsed. Lungs filled with circumscribed abscesses; pleura covered with broken down lymph; effusion in left pleural cavity. Posterior lobes of lungs congested ; tubercles in both, abscess in left; effusion in each pleurae. Both lungs gorged with dark venous blood . . . Abscesses in lungs; left pneumonic and hepa tized; old pleuritic adhesions in right; effu sion in cavity. Flabby, ochre and slate col ored on surface ; homoge neous and spot d on sect n. Large, pale, clay colored, and somewhat fatty. Large abs. Sa middle lobe cont. 4 oz. pus; tissues around indurated. Enlarged, heavy, light col ored, finely granulated in appearance and quite solid. Healthy Healthy Natural in size, light in color. Normal; rather pale. Ri t, 7 oz., left, 7 oz. Small masses white sub stance in both. Weight of each, 6 oz. Light colored, flexible, and easily torn; no abnormal ity observed. Weight of each, 7J oz. Yellow tinged. Weitiht, left, 5 oz. 3 dr., right, 6 oz. Supra-renal capsules distended with bloody fluid. Mottled, flabby, light col ored on section. Weight, right, 7 oz., k-ft, 8 oz. Healthy ... No apparent disease; gall perfectly black. Weight, 27 oz. Abscess in right lobe; or gan light colored, mot tled, and finely congested on surface. W t, 5J Ibs. Reddish brown externally, bile tinted on section ; friable and nutmeged. Weight, 3 Ibs. 14 oz. 4 dr. Large, mottled externally, soft and congested; un pleasant odor. Weight, 7 Ibs. 1 oz. Normal Light reddish brown, hard, and full of blood. Weight, 78 J oz. Upper half of right lobe studded with small ab scesses. Thick, firm, acini well marked; imtmegged ap pearance; blackish color externally; no gall in bladder. W t, 63 oz. Eularg d, yellowish br wu, soft, flabby, and fatty. Normal si/e, .yellow, gran ular, mid brittle. Contained several indura ted spots supposed to be pyaemia. Large, heavy, and mot tled; rough to the touch. Softened ; no abscesses ... Congested; large abscess in superior lobe opening into peritoneal cavity. Much enlarged and very soft. Enlarged and congested . . Enlarged, soft, and yellow ; fatty. Congested. AVeiuht, rig t, 7 o z., left, 6 oz. Reddish buff and mottled on surface; flabby and fatty. Healthy ... Small and apparently soft er than usual. A little pale but natural. . . Softened; no abscesses Natural size and healthy.. Enlarged ; the two w g d 21J oz. Mottled; capsule peel ed readily ; cort ical port n thickened; pale yellow. CHAP. XII.] PYJEMIA. mortem Examinations in Cases of Pywmia. 863 No. SPLEEN. INTESTINES. JOISTS. BLOOD VESSELS. REMARKS. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Large, 7x4, and flab by- Healthy Healthy No inflammation of neighboring veins observed. Axillary veinthick d ; clot partially brok u down into puruloid matter. Veins of pia mater cov. cerebral filled with blood; white elas ic thromb. 2 in. long in ex. fem. vein. Heart large and flabby. Recent pleuritis of right side; thin pseudo-membrane formed on lung, not adherent to costal pleura Heart healthy ; wound gangrenous. Cyst on right side containing 2 quarts se rum, one on left containing a pint. Heart normal. Fibr. clot in vcntr. of heart extend ing from auricle adh. to valve; clot in left ventr. near valve ; clot "< lines long in femoral ar tery; brain, slight opacity of arachnoid; some congestion. Stomach abnormally large. White fibrinous clots in heart. Weight, 11J oz. Pancreas much enlarged and red dened. Clots in heart ; blood generally fluid; some conges, of brain ; abs. between left supra renal capsule and kidney; pancreas en larged. W t, 4oz. Congestion of fundus of stomach. Clots in ventricles and auricles of heart. W t of organ, 7J oz. Brain, clear serum in both lateral ventricles. Weight, 3 Ibs. 9 oz.; pancreas normal. Heart, clots in both auricles and ventricles. Weight, 9 oz. Brain, serum in arachnoid and lateral ventricles ; some congestion. W t, 3 Ibs. 7 oz. Gall bladder contained IJoz. viscid tenacious bile; pancreas nor mal. Heart, large, flaccid, and containing clots. Weight, 1 Ib. Brain, surface exsanguine, organ flabby. Serum in lateral ventricles. Weight, 3 Ibs. 2 oz. Pancreas. Weight, 3 oz. Stomach large, mottled in fundus. Large abscess in parietes of abdomen at in sertion of rectus muscle. Heait surrounded by adipose tissue; 5oz. fluid in pericardia! sac. On opening skull large quantity of blood escaped ; 2 clots ad herent to bone internally ; inguinal glands enlarged. Heart 5J in. wide, "> in. thick, weighed 17J oz. Brain normal; diaphragm dull slate colored, with spots of lobular pneumonia arid copious frothy secretions. Fibriiious clot in both sides heart; oeso phagus pale and yellow ; trachea purple and yellow ; pancreas moderately soft ; pale white color. Heart large and flabby; left ventricle di lated ; white fibrinous clot in right ventri cle and pul. art. Several abscesses in both upper extfeinities. Heart; large clot in r t ventricle, extended into auricle, inf. and sup. cavae, and pul monary art. and branches; clots in left ventricle; bladder contracted to size of walnut; abs. in thigh. On section of right femur cavity found nearly filled with pus; extensive inter- muscular abscess in thigh. Abscess through both hemispheres of brain; inguinal glands greatly swollen; deep abscess below popliteal space. Clots in right side ot heart; medulla and cancellated structure of left, and medulla of r t femur red and disorganized ; no ab scesses in viscera. Walls of heart thin and flabby ; valves like finest tissue paper; 2 oz. yellow serum in Sericardium ; brain soft; serum beneath ura mater and pia mater, and in lateral sinuses; absces-* on back of left hand. Pericardium distended with serum. Fore arm and hand infiltrated with pus; gan grene ; abscess on dorsal aspect left hand. Heart flabby and pale; right ventricle filled and soaked with blood. Large thrombi in right ventricle and au ricle of heart ; small thrombi in left side of organ. Sli ir ht patches of in flammation in lower part small intestine. L ge abs. comin. with kneej t; syn.memb. soft and brok u down by ulceration. Dark purple, twice natural size; 2 fib. masses at mid. post, border; pus in low. border. Discolored interiorly, and easily pulpitied. Weight, 22 oz. Light colored along exterior and ante rior border. W t, 1 Ib. Light colored, flexi ble, and speckled on section. Weight, 12 oz. Dark colored exter nally and internally. Weight, 9 oz. 4 dr. Large, flabby, light colored, and soft. Abscesses in poste rior superior surface. Dark colored, solid, and quite full of blood. Weight, Hi oz. Natural Several meseuteric glands rnlarged; in testinal canal natu ral. Discolored; odor pu trefactive. Weight, 5 Ibs. Portions of ileum and large intestine con gested ; jejunum dis colored. A few blood spots and some thinning of mucous membrane; otherwise natural. Weight, 4 Ibs. Large intestine gen erally dark colored and containing patches of lymph; same in jejunum. Jejunum tinted gray, mottled, speckled, and hypersernic ; ile- uni congested; large intestine dark col d and hypersemic. Normal Clot in femoral artery of stump ; another in femoral vein. Axillary vein clotted ; contained pus and oil globules; no pus in femoral vein. Fem. art. and vein dis eased and eroded be low lig.; vein inflam ed above and cont d purulent matter. Apparently healthy. Omentum extended way to pubis. In testines weighed 49 oz. Right knee joint filled with apparently healthy synovia. P yarthrosis left elb w Dark mulberry color, and softened. Wt, 11J oz. Large and flabby, con taining about a doz. small puruloid foci. About the normal size, but softened. Enlarged, and almost of the consistence of pulp. Normal in appear ce; attached to diaph m and containing pus. Softened; no abscess es. Fairly congested Soft and enlarged .... Inflated with gas. . . . Healthy joint ; pus in cavity ; articular surface partly denuded of cartilage. Veins of both upper extremities healthy. Pus formations in r t hip joist. Right hip joint liter ally filled with pus. Seemingly healthy - - - Veins of stump near end loaded with d rk soft clots ; higher up fil 1 d with pus nearly to Poupart s lig. 3 oz. pus in right hip joint. Right, elbow joint rilled with pus; pus in right shoulder joint. Left femoral vein filled with clots up to ext. iliac; fem. art. healthy. Congested; someadh. of transverse and as cending colon, and ulceration of small intestine. Normal .... Veins leading from forearm and hand diseased. Pulmonary veins fill ed with tough cord- like clots of fibrin. Considerably eularg d but without structu ral change. Enlarged ; more than J normal size; pale blue, and soft. Mucous liu g of intes- tin lcau l d k venous col d; ecchymoses. 864 WOUNDS AND COMPLICATIONS. [CHAP. XUL No. 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 NAME, INJURY, ETC. LUNGS AND PLEUKAL CAVITY. LIVER. KIDNEYS. Pt. P. Ostre, H, 72d New York, age 21. Fracture ankle; am putation at knee. Pt. J. Davis, L, 1st Michigan Cavalry, age 22. Fracture tarsus; resection. Serg t W. Norton, I, 5th Wis consin, age 20. Fracture neck right troch. major of femur. Pt. J. Thompson, D, 9th Vir ginia, age 21. Flesh wound left thigh. Serg t D. A. Lent, A, 6th New York Heavy Artillery, age 24. Flesh wound right leg. Pt. J. P. Yocum, A, 89th Illi nois. Fracture left thigh ; excision. Pt. J. Wallace, F, 21st Georgia, age 38. Fracture femur; ex cision. Corp l A. W. Davis, F, 14th N. C., age 24. Fracture tars, and met. ; amputation leg. Corp l H. Darragh, K, 106th Penna , age 40. Fracture r t shoulder joint; excision. Pt. J. F. Bowser, B, llth Penn sylvania, age 18. Fracture right knee joint; amputation thigh. Pt. J. D. Crowter, D, 4th New York Heavy Artillery, aee24. Fracture right ankle joint; amputation leg. Pt, C. Smith, B, 7th Maryland, age 21. Fracture left fibula. Pt, C. W. Allen, C, 1st Maine H. A., age 23. Fracture left elbow; amputation arm. Pt. J. Files, I, 1st Nebraska, age 20. Fracture left radius; amputation arm. Pt. F. Guthberlet, K, 27th Mas sachusetts, age 26. Fracture right elbow; exc. ; amp. arm. Pt. P. Scanlan, G, 69th New York, age 34. Fracture knee joint; amputation thigh. Pt. G. Laforce, E, 26th New Yerk. Wounds arm and knee joint; amputation arm. Pt. J. Moore, E, 8th Pennsylva nia Reserves, age 20. Frac ture leg; amputation. PtS.McCan. F, 1st U.S. Cav alry, age 23. Fracture right ulna. Pfc. C. Crealman, H, 118th Penn sylvania, age 21. Fracture right humerns. Corp l J. H. Higley, A, 96th Pennsylvania, ago 20. Frac ture upper third femur. Pt.J. Morrow, D, 12th Massa chusetts, ago 31. Fracture knee joint; amputation thigh. Pt. J. Somers, E, 64th New York, age 21. Fracture knee joint; amputation thigh. Pt, M. Casey, K, 7th Veteran Reserve Corps, age 25. Frac ture right carpus. Pt. G. McCoy, E, 6 2d Pennsyl vania, age 32. Fracture foot ; amputation leg. I t. W. Rimsey, H, 6th Vir ginia, age 19. Numerous small abscesses and patches of lobu- lar pneumonia in both lungs. Abscess in left lung filled with dark fetid pus; small abscess in right lung; effusion in left pleural cavity. Nearly whole of left lung inflamed Several abscesses in left lung: right lung healthy ; 12 pints pus in left plenral cavity. Lungs congested ; largo abscess in upper lobe right lung filled with thick pus. Left lung hepatized ; 6 oz. pus in pleural cavity. Lungs adherent and studded with pya3mic patches; serous effusion in left pleural sac; pleurocollesis both sides. Small abscesses in lower lobes both, and upper lobe right lung. Weight, right, 13* oz., left, lljoz. Right lung adherent to walls of thorax and dia phragm ; frothy fluid exuded from lobes on sec tion; left lung healthy. Weight, right, 21 oz.; left, 11J. Lungs adherent; lower lobe, right, pneumonic and studded with hardened pyannic patches ; patches contained no pus; slight congestion left lung; effusion in right side. Lungs; lower lobes carnifled; adherent to sur rounding tissue; large pyyeinic patch in up- perlobe. left; about 20 abscesses in lower iobe, right; effusion in each side of cavity. Lungs; lower lobes hepatized and dotted with pyaemic patches; recent adhesions about right; 20 oz. effusion. Lungs slightly adherent to thorax ; right lung considerably congested and containing a small abscess. Weight, right, Hi oz., left, 9J oz. Lungs ; lower lobes studded with metastatic abscesses; recent deposit of lymph on both pleural surfaces. Pyretnic abscesses in lungs; left collapsed; both congested and adherent to pleura. Lungs, strongly marked carbonaceous deposit on; lower aud posterior parts engorged; right congested and containing abscesses; pleu ritic adhesions on left side. Lungs black, mottled, and reticulated; me- lanic deposit. Lungs slightly congested ; melanic matter pre sent; abscesses in both. Weight, left, 22J oz., right, 15J oz. Lungs congested and coated with broken down lymph ; right filled with small abscesses ; effu sion in left pleural cavity ; each weighed 25 oz. Lungs contained numerous abscesses; both partially adherent and hepatized ; pleura broken down and adherent to lungs ; effusion in cavity. Right weighed 25J oz., left 19 oz. Lungs congested ; recent indurations as large as an egg in middle part of both near base ; not converted into pus. Two abcesses, size grain of maize, in apex left lung; surroundings of abscesses for about J inch of a dark pink color and denser than surrounding tissue. Abscesses in both lungs; left compressed, ad herent, nnd carnified ; right pneumonic; co pious effusion in pleural cavities. Pyajmic patchetfin lower lobes of lungs; large abscess in posterior lobe of right ; slight ad hesions; no effusion in c.ivities. Enl g d. pale, yellow, fatty, and softened. No abnormal appearances. No abscesses ; fatty No abscesses ; fatty Abscesses in both kidneys ; pus in both ureters. Small abscess in cortical portion of each ; pus in ureters. Healthy but somewhat soft. Normal Healthy Healthy. Weight, right, 8Joz., left, 7| oz. Small, contracted, mottled, and convoluted ; resem bled brain more than liver. Weight, 51 oz. Soft and fatty Decidedly fatty Enlarged J ; in a state of fatty degeneration; gall bladder nearly empty; stricture near middle. Apparently healthy Somewhat fatty . . Abscess in right lobe filled with creamy pus. W t, 59 oz. No abscesses in liver Apparently healthy No abscesses in kidneys .. Decomposed abscess in left lobe size of a small shot. Enlarged, adherent to dia phragm, stomach, and trans v se colon ; abs. in r t lobe and on up. and r tside. Large and finely mottled.. Light coffee colored, finely mottled, and large. W t, 82J oz. Three abscesses in, con taining 2 oz. pus each. Weight, 5 Ibs. 2 oz. Enormously enlarged, and containing numerous ab scesses. Nutmeg appearance on sec tion ; no abscesses in. Healthy Enlarged, pale, and indura ted. Large and pale Kidneys. Right weighed 6 oz., left, 6J oz. Supra renal capsules much en larged. W t, both, J oz. Congested. Weighed 6oz. Both contained abscesses ; cortical substance con gested ; left enlarged; right weighed 7$, Ieft9oz. Contained no abscesses Pale, firm; cortical sub- stanco same hue as py ramidal. Healthy In a state of acute hepa titis and quite friable. Lunus slightly congested at posterior lobes; small pysemic patch in right inferior lobe of right. In a state of putrid decom position. CHAP. XII.] PYAEMIA. 865 NO. SPI.KEX. INTESTINES. JOINTS. BLOOD VESSELS. REMARKS. 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 Not enlarged; paler than natural, and softened. Enlarged and soft ened. Not enlarged or soft ened. Largo abscess in ; dis charging pus into abdomen ; organ en larged. Normal . Thrombus of superf. fern., profunda, and external iliac veins. Femoral vein throm- bosed. Large thrombus in right ventricle and au ricle of heart; small ones in left. Muscles of thigh infiltrated with pus. Clots in both ventricles of heart: cancel- lous structure of calcaneum gangrenous ; osteomyelitis. No chills occurred although tho disease lasted 42 days. Heart healthy; 3 oz. serum in priicar- dinm. Abscesses in and pus at points of right cerebrum. Pus burrowed among ; muscles of thigh from knee to hip. Heart; right ventricle filled wiih a semi organized clot. Pancreas and stomach nor mal. Parotid gland enormously enlarged and distended with pus; cartilaginous but no ossific union of fracture. Heart healthy; brain, large amount of se rous subarachnoid effusion. Lymphatic glands, left groin, enlarged. Small clot in right side heart. W t, OJoz.; tissues of stump in sloughing condition; structures of bones full of oil globules. Heart ; fibrinous clot in both ventricles. W t, 9 oz. Ann and wound gangrenous. Marrow of femur red and soft; in portion gangrenous, and entirely gone for 3 inches in lower end. Abscesses between muscles of stump; 2 small ones near bone. Large fibrinous clot in left auricle and ventricle, and long thin clot in right au ricle extending into pulmonary artery. Large fibrinous clot in right side heart ; extremity of median nerve bulbous; small abscess throughout tissues of slump to shoulder joint. Fungous mushroom protrusion of medulla and other marks of osteomyelitis. Heart normal; stump oedematous and filled with serum ; bone semi-purulent through out. Heaitlivid in colorand flabby ; clotsin right and left ventricles; dura mater tense; coats of stomach pale, soft, and injecied in spots. Bronchial glands enlarged and as black as ink ; gall bladder light colored. Brain ; effusion of serum into lateral ventri cles; large abscess with black walls about middle third femur ; medulla of tibia soft ened. Heart healthy. Weighed 7 oz. Clot in left, and abscesses in r t ventricle of heart; trach. and bron. tubes congested; cardiac orifice of stomach congested; pan creas broken down and softened. Abscess below knee broke, discharging offensive matter. Medullary subst. yellowish, ochre-colored, and protruding from femur; no inflamma tion in thigh, or any of tho organs ; muscles attached to femur healthy ; periosteum firmly adherent. Entire exterior of femur in a gangrenous condition. Soft parts of forearm, except vessels, thor oughly disorganized. Pericardium filled with serum ; 2 oz. serum in lateral ventricles of brain ; no pus, but an unusual amount of serum in all the se rous cavities. Fibrinous clot in right ventricle of heart ; pyramidal bodies becoming invisible. Pus in ankle joint; also in astragalo-sca- phoid articulation. Hip joint and parts infiltrated with a dark thin fetid pus. Left knee and wrist joints examined ; no pus. Pus in right knee and wrist joints; none in ankle. Veins as far as exam ined healthy. Enlarged but not soft ened. Soft and pulpy. W t, 12i oz. Much enlarged, firm, not pulpy. Weight, 9 oz. Healthy Old, partially disinte grated blood clots in fern, vein; walls of vein thickened; fe moral art. healthy. Crocuni congested; otherwise healthy. Contained no pus Knee joint not in volved. Femoral vein inflam d and filled with dark clots ; art. healthy. Pus in one of the veins; clots in the others. Dark clot partly tilled femoral vein ; inside coat of vein red and inflamed; post. tib. art. oblite d in w d. Arteries and veins of stump healthy. Closure of vein about li inches from ex tremity of bone. Ves ls of arm normal ; firm black clot filled axill y vein ; no pus. Vessels of dura mater congested. Considerably soften ed, and dark colored. Healthy Apparently healthy.. Apparently healthy. "Weight, 9 oz. No abscesses in spleen A grumous dark pur ple mass ; very soft ; complet ly disorg d. Enlarged, softened, dark purple, and ad herent to diaphragm and peritoneum. Enlarged, hard, and very light colored. Weighed 4 J oz Apparently healthy . . Fluid resembling pus in left shoulder joint. Normal Large abscess in shoulder joint ; pus healthy. Transverse and de scending colon and rectum reduced in calibre. Full of gas ; colon es pecially distended Inflated, mottled, and streaked. Fibrinous, flaky, tena cious pus to hip j t; abscesses extended to knee j t; cartila ges of knee j t erod d. Pus in left knee joint ; synovial membrane destroyed; cartilage eroded: pus in r tsh. j t; none in hip j ts. Carpus filled with pus. Phlebitis with total disorganization of fern, vein; bel. knee vein occupied by tube filled with pus. Much congested. Weighed 10 oz. Soft, and of dark brown hue. W d 8 oz. Many small abscesses in spleen ; not much enlargement. Dark purple color, faintly granulated ; not very firm. About the usual size and consistence. Healthv Small intestines some what congested ; cae cum sphacelous throughout. Vessels of fractured arm healthy. Thrombi in smaller veins from side near est broken bone ex tend into fern. vein. Femoral vein filled with a grayish black clot ; artery fi 1 1 e d with partially de composed clot. Femoral vein fi 1 1 e d with partially soft ened clots nearly to Ponpart s ligament. No rJots discovered . . Suppurative inflam mation of veins of leg. Thick creamy pus from face of stump toPoupart s liga ment in fern. vein. Healthy Normal Formation of pus in left shoulder joint. No pus in the joints Decidedly softened SURG. 111109 866 WOUNDS AND COMPLICATIONS. [CHAP. xii. Abstracts of forty-eight -post-mortem examinations are recorded in the preceding table. Metastatie abscesses were found in the lungs in thirty-five, in the liver in nine, in the kidneys in three, in the spleen in four instances, and in sixteen cases pus was found in the joints. The lymphatic glands of the groin wen- swollen in three- cases, and in a case of a fracture of the femur (No. 2S. p. 8(>4), the parotid gland was enormously enlarged and distended with pus. Several other instances of swelling of the parotid glands were recorded in cases in which no autopsies were made: CASK 1227. Private Henry M. .Smith. Co. G, 82d Pennsylvania, aged 2s years, received ut Amelia Springs, Virginia, April 6, 18t>.~>, a compound comminuted fracture of the right knee. His right thigh was amputated in the middle third, by lateral Haps, April tith. He \vas admitted to division No. 1, Annapolis General Hospital, April 15th, from City Point. When first seen, on April 28th. l>y Surgeon U. A. Vanderkieft, V. S. V.. who reports the case, the patient was in a state of great debility, with delirium and other symptoms of py;vmia. The stump wis in a very unhealthy condition, the discharge of pus sanious, and the end of the femur protruding an inch. The stump was kept clean by the use of soap and water, and oakum dressings were applied. Tonics and stimulants were administered internally. On May 2d the pysemic symptoms were still more- fully devel oped, the skin having assumed a yellow hue. The right parotid gland was swollen, and its external appearance indicated that an abscess had formed. The patient now lay in a lethargic state, the discharges from the bowels became involuntary, and he gradually sank. He died May 7. 1865. No post-mortem examination was made. CASE 1228. Corporal Hubert A. Whecdu-n, Co. K. 47th North Carolina, aged 24 years, received a compound comminuted fracture of the right thigh, at the battle of Gettysburg. July 3, 1863. Amputation was performed in the hospital of the 2d divis ion, First Corps, July 7th, at the upper third of the thigh. On July 12th secondary haemorrhage occurred, supposed to proceed from a large muscular branch; was arrested, after about four ounces of blood had been lost, by elevating the stump and making pressure over the femoral artery. Pyaemia was recognized July 16th. An abscess developed in the region of the left parotid gland, which was incised July 21st. when a slight discharge of pus oozed from the incision. Quinine, stimulants, and nourish ing diet were employed. The patient died July 23. 186?. No post-mortem examination was made. The case is reported by Surgeon W. B. Chambers, 97th New York. CASK 1229. Private John Kreps, Co. C, 29th Iowa, aged 16 years, received on April 30. 1864, a shot wound of the right thigh ; the femur was fractured at the junction of the lower with the middle thirds, and the bone was splintered to the knee joint. He was admitted to hospital at Little Rock. Arkansas, on May 3d. The ends of the bone at the point of fracture became carious, and on July 9th amputation was performed at the junction of the upper and middle thirds of the thigh by the antero-posterior flap method; there was little haemorrhage; chloroform was used. The patient did well till the 20th day, when abscesses formed in the stump and in the parotid gland. The patient died of pyaemia August 8, 1864. No autopsy was held. The case is reported by Assistant Surgeon E. A. Clark, U. S. V., who performed the amputation. CASK 1230. Private J. F. Smith. Co. C. 61st New York, aged 17 years, received, at Burksvillo, Virginia. April 8, 186 ), a shot fracture of the right knee. On the following day (April 9th) amputation through the lower third of the thigh was per formed. He was treated in field hospital, and subsequently, on May 14th, lie was admitted to Armory Square Hospital at Wash ington. The symptoms of the case are briefly noted on the bed-card by Acting Assistant Surgeon C. H. Urown : Metastatic abscesses of surface; swelling of joints; icteric tinge of skin and conjunctiva of eye: swelling of submaxillary, sublingual. and parotid glands; joints painful? chills, and change of chill to that of burning heat; profuse diarrhoea; nausea, headache, and delirium. Death on May 24, 1865, of pyaemia and exhaustion. No autopsy was made. CONCLUDING OBSERVATIONS ON SHOT WOUNDS. The details of the treatment of special shot injuries and of the most serious complica tions have been fully described under the proper headings in this and the preceding volumes, and it is, therefore, only necessary here to allude briefly to the immediate care of the wounded after battles and engagements, and to a few points of a general character appli cable to shot wounds. Slight wounds were examined and dressed at the primary stations; those of greater severity received such care as their condition demanded, and we re at once sent by the ambulance wagons to the field hospitals. The importance of an early and complete exam ination of the wounded seems to have been fully real i /eel by the surgical staff. This examination was generally conducted under the influence of anaesthetics for the purpose of accurate diagnosis; in its course, balls and foreign bodies were extracted, bleeding vessels secured, and splinters of bone removed; upon its conclusion such operations were performed as in the judgment of the surgeon were necessary. In determining the extent of injury it- was not unusual to enlarge the wound caused by the missile, especially in cases where the CHAP. XII.] CLIMATIC, HYGIENIC, AND MORAL INFLUENCES. 867 advent of swelling caused difficulty or uncertainty of touch, or where it became necessary to remove splinters or foreign bodies. In the examination of a wound experience confirmed the common view that the finger is the surest and most intelligent probe. With regard to the removal of splintered bone and foreign bodies, experience seems to warrant all reason able means for their removal, since they are liable to become sources of irritation and danger. The ends of splinters of bone still attached may be cut off, but forcible detach ment must be avoided. Missiles should be extracted if they can be readily found and it can be done without risk to vital parts; but it should also be borne in mind that they may become encysted, giving no further trouble. The primary dressing of wounds and operations was always of the simplest character; a piece of lint or linen held in place by the turns of a roller bandage and kept well moist ened with water. Instances have been cited of great inconvenience and even of serious o complications, such as gangrene and tetanus, being caused by tight bandaging. The pres ence of maggots in wounds, in the field and camp hospitals, was frequently an annoying complication. After protracted battles, such as the fighting on the Peninsula in June and July, 1862, and after the Wilderness and Spottsylvania, in 1864, when the means of trans portation were not sufficient to move the wounded rapidly to permanent hospitals, and when the number of attendants was entirely inadequate to the demand, maggots were found in abundance in and beneath the dressings and in the wounds. Surgeon D. Prince, U. S. V., cautions "against the use of too much dressing, as the impression that the work of flies will be frustrated thereby is erroneous. While the dressings are wet flies will deposit their eggs through several thicknesses of muslin, and also along the border of the dressings, and once hatched the little ravenous maggots will insinuate themselves among all the layers of dressings and under them into the wound itself. Nothing but frequent dressing will keep them from developing in the wound. Oil of turpentine and infusions of tobacco were used to kill these pests. Petroleum or kerosene oil was tried in some cases with markedly good effect, but the most effectual remedy was a thorough examination of the dressing every two or three hours." In well established general hospitals the presence of maggots was rarely noted. Climatic, Hygienic, and Moral Influences. Of the effects of climate on the treatment and result of wounds the reports of the war afford but little information. Casual remarks were occasionally made by medical officers that in certain climates and localities wounds "did well," or otherwise; but so vague a statement proves of little value, as it is more than probable that insufficient consideration was given to other closely related conditions which may have exerted a stronger influence than climate itself. The change of climatic conditions experienced by our armies during the operations of the war in a sudden tran sition from the cool and more healthy regions of the north to the warm semi-tropical and malarious climates of the south could not fail to make itself felt on the general organism, aside from any of the concurrent exposures, hardships, or privations incident to the soldier s life. To what extent the health, vigor, and efficiency of the troops campaigning in the southern regions was impaired by causes due to climatic origin is shown in the medical portion of this work. Suffice it to say that under these acquired conditions wounds and surgical diseases suffered a corresponding modification. Laying aside the consideration of other factors, it seems that continuous dry heat is not unfavorable to the satisfactory pro gress of gunshot wounds; the same may be said of the same quality of cold both probably 868 WOUNDS AND COMPLICATIONS. [CHAP. XTI. act as tonics to the system at large. Moist climates with continuous heat are relaxing and weakening, rendering the body less capable of resisting the onset of prevailing diseases, and cannot be considered advantageous. It has been claimed, however, that the moist climate of parts of the southern seacoast was exceedingly favorable to the healing process of wounds; it may be that the especial qualities of sea air afforded a desirable element. The pure bracing air of the highlands of Virginia, Tennessee, and Georgia were, without doubt, especially favorable to the recovery of the wounded. The successful results of wounds and operations in General Sherman s campaign from Atlanta to the sea was espe cially marked, though it must be admitted that very important factors other than that of mild equable climate had their full influence upon the men of that command. Sudden and extreme variations of temperature and humidity were decidedly prejudicial to the course of wounds, and seem especially to favor the access of tetanus. Prolonged cold and moisture were generally regarded unfavorably as favoring the presence of surgical complications, as erysipelas and gangrene, though here the probable explanation is that these diseases were engendered by the want of free ventilation. The subject may be briefly summed up in the statement that those conditions of climate, wherever found, which allow the fullest and freest exposure to pure fresh air, are undoubt edly those most favorable to the rapid and uncomplicated recovery from wounds, while such conditions as tend to prevent a free out of door life, or compel the exclusion of large quan tities of free air from the wards of hospitals and from barracks and tents, or such as favor the rapid decomposition of vegetable and animal matter, are to be considered as more or less prejudicial and harmful to the course and treatment of wounds. The influences of hygienic conditions, food, and concurrent diseases, upon the results of shot injuries in time of war are similar to those observed in cases treated in time of peace in civil hospitals. The influence of the mental condition on the results of wounds is undeni able. All reports agree that the wounded of victorious troops, elated by the successes achieved by their own bravery and that of their comrades, did better than those of defeated armies. The most striking example of this influence of the mental condition on the success ful treatment of wounds in modern times is the fearful mortality among the French, after shot wounds of all kinds, in the war of 1870- 71. The excessive mortality of that cam paign, repeatedly pointed out in the chapters on special wounds, was undoubtedly largely owing to the mental depression caused by a succession of reverses rarely met with in the history of warfare. Multiple Wounds. There is no doubt that in a large proportion of the killed on the battle-field death was caused by several wounds simultaneously received; but many cases of recovery after multiple wounds have also been recorded. It is impossible to give even an approximate estimate of the frequency of the cases in which several wounds were found in the same individual. The cases were classed with those injuries which seemed to be the gravest. In the following instance there were no less than twenty-six wounds of entrance and exit. The patient died twenty-eight days after the receipt of the injuries: CASK 1231. Private Franz Metzel, Co. A, llth Massachusetts, aged 31 years, was wounded at Spottsylvania. May 12, 1864. On May 25th he was admitted into Armory Square Hospital, Washington. Surgeon D. W. Bliss, U. S. V., reported: " This soldier accidentally got between or in the range of cross-firing and received twenty-six separate wounds of entrance and exit, and when admitted was sufficiently strong to converse and relate his sad fate. The wounds were by minid balls, as fol lows: 1st entered just anterior to external malleolus of left ankle and emerged about the middle of the sole of the foot; *2d entered left leg just above external malleolus, passed upward, and emerged five inches above the heel; 3d ball entered left leg six inches jvbove external malleolus, and made its exit on the inner side four inches below the knee joint; 4th entered just below the head of the left fibula, and emerged on the internal aspect nearly opposite point of entrance ; 5th entered left thigh exter- CHAP, xn.] CONSERVATION, EXCISION, AMPUTATION. 869 nally. three inches ahove knee, and emerged on inner side opposite point of entrance; 6th entered left thigh on the external and middle part, passed through, and emerged opposite point of entrance; 7th entered just above the coccyx and remains in parts unknown; 8th entered the back three inches above left hip, and remains; 9th entered just below inferior angle of left scapula and remains in parts unknown ; 10th, left arm, two wounds below and three above the elbow, the bones above and below being fractured: llth entered right leg above the middle and made its exit on the calf opposite point of entrance; 12th entered about three inches below the right knee, a little internal, and remains; 13th entered right thigh externally, about the middle, and made its exit on the inner side opposite point of entrance; 14th entered upper third of right thigh, on the external side, and remains in parts unknown. He died May 30, 1864." In the following case the patient made a good recovery after receiving four shot wounds, three of which were of a serious nature : CASE 1232. Private Charles Sebring, Co. F, 48th Indiana, was wounded at luka, Mississippi, September 19, 1862, and admitted into hospital at Jackson, Tennessee, September 19th. Assistant Surgeon J. P. Wright, U. S. A., reported : " He was first disabled by a musket ball, which passed through the hamstring muscles of the left thigh; and in this helpless condition, stricken down in the thickest of the fight, he received three other wounds from musket balls one ball impinging upon the left parietal bone and furrowing the scalp without causing fracture; another passing through the left forearm, in its lower third, fract uring and comminuting both bones; and a third passing through the middle third of the right arm and emerging on the posterior and inner aspect, causing a comminuted fracture of the humerus. The flesh wound in the thigh healed rapidly; the wound in the left forearm continued to discharge for four months, and, after the removal of several fragments of bone, ultimately healed with loss of pronatiou and supination, and with contraction of the flexor tendons; it seemed, however, to cause little constitu tional disturbance. The fracture of the left humerus gave to the case its peculiar interest. In November, 1862, when the case first came under my own supervision, the arm was much swelled and very intolerant of manipulation ; there had been no attempt at bony union, and the exsanguineous and emaciated condition of the patient augured a speedy and fatal issue. There was a pro fuse discharge from both orifices of the wound, the character of which, however, was healthy ; light dressings were applied and a nourishing diet enjoined. Two weeks later the limb was seized with phlegmonous erysipelas; the pain was excessive and the swelling so great that the tense and glistening integument threatened to burst. Great constitutional disturbance ensued; the stomach rejected everything that was offered, colliquative diarrhoea supervened, a harassing cough racked the patient s frame, already reduced to a skeleton by months of suffering and exhaustive suppuration, the conjunctiva became icteroid, and profuse sweats by day and night gave additional evidence of the great prostration of the vital powers. No pus was detected in the alvine evacuations; but it was strongly suspected in the sputa, and indicated by every test attainable. The local treatment adopted was scarification of the affected part, followed by warm fomentations of infusion of elm and laudanum, in which the whole limb was enveloped. The constitutional treatment was mainly supporting. About four days from its inception the erysipelatous action showed signs of abatement, attended with marked improvement of the constitutional symptoms. This favorable change continued for about three weeks, and the improved appetite and cessation of diarrhosa and exhaustive sweats again aftbrded encouragement. But the condition of the arm was not promising; the discharge had become very fetid, and the tissues, to the fingers ends, infiltrated with serum. With the limb in this condition, the most favorable result to be anticipated from a second attack of erysipelas would be gangrene of the extremity; and yet, although about this period the morbid action returned, scarcely less threatening in character than before, it yielded promptly to free scarification followed by warm fermentations, the only inconvenience resulting therefrom being a considerable amount of sloughing of the integument. On the subsidence of this second attack the utter prostration of the vital powers seemed almost to preclude the hope of recovery. A stimulating and nour ishing diet was enjoined, ale or milk punch, according to the patient s wish, being administered several times daily, together with compound tincture cinchona, which was exhibited continuously for many weeks. From this period convalescence began." Sebring was discharged from service April 8, 1863, and pensioned. In May, 1863, his left arm was amputated near the shoulder, 1 at his home, by Drs. Grimes and Badger. He was last paid in September, 1881. CONSERVATION, EXCISION, AMPUTATION. The shot wounds of the extremities number one hundred and seventy-four thousand two hundred and six (174,206), or over two-thirds of the total number of shot injuries. Of these, one hundred and forty thousand one hundred and twenty-four (140,124) were treated without operative interference, four thousand six hundred and fifty-six (4,656) were followed by excision, and twenty-nine thousand four hundred and twenty-six (29,426) by amputa tion. To the cases of amputation should be added three hundred and five (305) amputa tions following excisions, and two hundred and forty-nine (249) re-amputations, 2 making the total number of amputations twenty-nine thousand nine hundred and eighty (29,980). The tables on the next two pages contain numerical summaries of the shot fractures of the See TABLE LXXXIV, No. 104, page 778, Second Surgical Volume. 2 In the Surgical portion of this work the extremities have been subdivided as follows : Upper Extremities hand, wrist, forearm, elbow joint, shaft of humerus, and shoulder joint; and Lower Extremities foot, ankle joint, leg, knee joint, thigh, and hip joint. Under re-amputations, here referred to, are understood cases in which, for instance, the original amputation was in the leg and the subsequent operation at the knee joint, thigh, or hip joint It was impossible to indicate in this TABLE the cases of re-amputations in the same subdivisions; as, for instance, amputations in the low* third of the thigh, with re-amputatiou in the middle or upper; and likewise in the leg and arm and forearm, although a great number of such instances are reported. 870 WOUNDS AND COMPLICATIONS. [CHAP. XII. TABLE Tabular Statement of Eighty-seven Thousand Seven Hundred and Ninety-three Cases of Shot 1 S i 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 SEAT OF INJURY. CASKS. TUF.ATED BY CONSERVATION. TREATED HY EXCISION. I Recovery. I Undeter. Percent, of Fatal. g I Recovery. 3 Undeter. 3 o H Recovery. 3 <S pq Undeter. 54,801 11, 369 1,509 5,194 2,816 8,245 1,579 2,280 53, 161 9,644 1,305 4,636 2,211 6,249 948 1,936 1,640 316 193 482 532 1,639 492 314 1,409 11 76 73 357 139 30 2.9 3.1 12.9 9.4 19.4 20.7 34.2 13.9 54,719 3,092 716 2,971 938 2,960 541 2,196 53, 118 2,781 653 2,740 828 2,385 383 1,876 1,601 59 54 191 96 444 149 295 252 9 40 14 131 9 25 116 109 1,019 731 947 835 84 104 94 883 518 653 432 60 10 15 114 159 264 277 19 2 22 54 30 126 5 Contusions and Fractures of Wrist Contusions .and Fractures of Forearm . . Contusions and Fractures of Elbow Contusions and Fractures of Arm Contusions and Fract. of Shoulder Joint Contusions and Fract. of Clav. and Scap. Total 87, 793 Hand 80, 090 5,608 2,095 6.5 68, 133 64,764 2,889 480 3,841 2,744 858 239 Amputations following Excisions of the Amputations following Excisions at the Amputations following Excisions in the Amputations following Excisions at the Amputations following Excisions in the Re-amputations following Amputations Re-amputations following Amputations z Re-amputations following Amputations \ Wrist Forearm Elbow Arm .... - >f Hand t Wrist n Foreai m ... Total Amputations and Re-amputa TABLE Tabular Statement of Eighty -six Thousand Four Hundred and Thirteen Cases of Shot Injuries Number. SEAT OF INJURY. CASES. TREATED BY CONSERVATION. TRE 3 o H ATED BY EX CISION. >> 1 "1 O H 2 1 | Percent, of Fatal. 3 o H o "S +5 OJ rt w f*-i Undeter. Recov y. ej a Undeter. 1 2 3 4 5 6 7 - 9 10 11 12 13 14 15 16 17 18 19 20 59, 139 56, 219 5, 859 4, 968 1, 722 1, 247 9, 171 6, 491 3, 398 1, 566 6, 738 3, 115 386 59 2,920 451 440 460 15 2, 402 278 1,819 13 3, 434 189 327 4.9 8.3 26.9 27.0 53.7 52.4 84.7 58, 938 3,587 525 4,116 901 3,620 304 56,150 ; 2,788 3, 137 136 414 99 3, 442 539 360 532 1, 800 1, 719 55 249 Contusions and Fractures of the Foot 314 12 135 9 101 97 33 388 56 186 55 75 22 276 9 55 2 18 9 108 44 123 53 4 2 4 3 Contusions and Fractures of the Leg Contusions and Fractures of the Knee Joint. . . Contusions and Fractures of the Thigh Contusions and Fractures of the Hip Joint Total ... 86, 413 73, 665 11, 813 935 13.8 71,991 65, 358 6, 062 571 815 439 355 21 Amputations followin <T Excisions of the Foot Amputations following Excisions at the Ankle Amputations followin" Excisions in the Le 01 Amputations following Excisions at the Knee Amputations following Excisions in the Femur Re-amputatious following Amputations of Toes Re-amputations following Amputations of Foot Re-amputations following Amputations at Ank Re-amputatious following Amputations in Leg Re-amputatious following Amputations at Knee Re-amputatious following Amputations in Thig ::.::::::::::.^t*3! A (ij V ^ V ^ ^L ~ " t T V 1 *** JlW &SS# . . .. >i^<up* ^z**^- Total Amputations and Re-amputations CHAP xir.J CONSERVATION. KXOTRTON. AMPUTATION. OLXIII. fnjnricH of Hie, Upper Extremities, indicating Seat of Injury, Mode of Treatment, and Final Result. 871 FOI.I.OWKII 11 Y AMITTATIOX. ^ C -~ <U i i w ,0 I" *~ a 1 S s So i. S fc ! H - ^ p 1 82 43 30 AMPUTATIONS Oi HAND FINGER 1 r- u *- AND AT THE IN THE FUKK- s. WRIST. AitM. o "3 li fe -2 -3 : o 2 "* -2 ** 11 3 AT TH ELROV 8 3 ^ cs K r 4 Undeter. Recovery. M <" * *s s Fatal. 3 t> - - K i - S Undeter. AT THF SHOULDF C o 5 <~ a 5 9 jg ; ! Cndeter. 2 8,161 (i, 759 247 ; 1, 155 3 084 558 1"4 " 6, 551 198 1,153 38 4 19 3 ! 151 28 1 507 93 772 101 1 1 11 19 17 1 28 26 4 26 5 4 1,204 1,013 177 14 5 1, 147 805 277 5 4,338 3,211 931 190 7 20! 133 60 4 8 .. 2 1 213 72 2 847 272 1 5 2,777 780 175 2 2 ... 13 4 ... 434 151 21 133 66 4 ...|... ! 6, 551 13 9 15, 819 12,582 : 1,801 1,376 10 9 72 198 1, 153 57 7 1 :, 1,441 225 7 2 35 3 1 3, 911 1, 194 183 587 234 25 11 13 9 4 6 2 3 2 12 70 50 25 ; 1 13 04 39 25 ! 17 3 33 22 1 i 39 25 14 04 37 27 33 16 15 7 4 11 2 15 71 51 20 3 i 30 13 1 10 i 10 1 4 2 9 4 1 17 15 12 3 11 3 i 1 ; eo 7 3 1 25 18 10,147 12,799 1,971 1,377 1 6, 551 198 1,153 1 | 1,503 245 13 36 4, 054 1, 273 183 596 245 i GLXIV. of the Lower Extremities, indicating Seat of Injury, Mode of Treatment, and Final Result. Number. AMPUTATIONS OF TOES. OF FOOT. AT ANKLE. IN THE LEG. KNEE J T. IN THE THIGH. HIP J T. >, 1 *i i ti * /^ a/ ," a - > - ! P- - -g -2 0:51-2 S -V O i< AH 0) a a H PH &H , p W PH P Recov y. 1 Undeter. V _ O r" g 53 . , ^ s I 1 i a \ o a Undeter. Recov y. 1 Undeter. Recov y. 13 "S Undeter. Recov y. 1 1 2 3 4 5 6 7 8 9 10 11 L2 13 !t 15 16 37 18 L9 20 "! l> o) o:) 132 l i i 30 33 1 i 5 : 1 3 i 1 10 43 64 29 24 1 1 37 3 347 1,168 1, 257 94 3 22 447 1,219 1,560 2,175 1,750 297 122 1,093 29 105 221 1 1(54 811 352 1 ! .. I.....I 51 16 104 37 1 334 174 14 1 1 780 319 9 f!S:t 1 544 138 4 6(57 * 773 1 755 13 ) 41! 1 197 1 243 1 2 93 1 00 I 502 80 80 3 26 2 25 5 51 13,007 7,808 5,390 ! 343 1,094 29 105 11 8 3 ! 221 51 16 118 38 2 3, 536 1, 770 5 3 138 75 106 1 2 2, 819 1 3, 351 80 4 3-1 3 1 50 >! 23 ! 15 6 2 3 10 1 2 . 14 6 4 7 1:6 ... 7 2 5 1 ! ! i 12 5 7 : 1 ! 1 1 2 4 3 1 13 12 1 1 11 1 28 21 7l... ! 21 6 1 30 5 73 42 31 . 4 1 38 7 12 7 51 9 3 ... 6 3 55 52 16 13, 833 8, 002 5, 488 343 1, 094 29 105 223 119 40 2 3, 595 1, 790 138 82 111 2 2,878 3,411 80 11 872 WOUNDS AND COMPLICATIONS. [CHAP. xn. upper and lower extremities, indicating the seat of injury, mode of treatment, and termina tions of cases. Eighty-seven thousand seven hundred and ninety-three (87,793), with eighty thousand and ninety (80,090) recoveries, five thousand six hundred and eight (5,608) deaths, and two thousand and ninety-five (2,095) unknown results (a mortality rate of 6.5 per cent.), were shot injuries of the upper extremities. Of these, thirty-two thousand nine hundred and ninety-two (32,992) were wounds complicated by fracture, and fifty-four thousand eight hundred and one (54,801) were flesh wounds; of the latter, eighty-two (82) were followed by amputation. Of the thirty-two thousand nine hundred and ninety-two (32,992) shot fractures of the upper extremities, three thousand eight hundred and forty-one (3,841), or 11.6 per cent., were followed by excision, fifteen thousand seven hundred and thirty-seven (15,737), or 47.7 per cent., by amputation, and thirteen thousand four hundred and four teen (13,414), or 40.7 per cent., were treated without operative interference beyond the removal of bone splinters, of missiles, or other foreign substances. Eighty-six thousand four hundred and thirteen (86,413) were shot injuries of the lower extremities; the results were not ascertained in nine hundred and thirty-five (935) cases; seventy-three thousand six hundred and sixty-five (73,665) resulted in recovery, and eleven thousand eight hundred and thirteen (11,813) in death a fatality rate of 13.8 per cent. Fifty-nine thousand one hundred and thirty-nine (59,139) were flesh wounds, of which two hundred and one (201) were followed by amputation. Twenty-seven thousand two hun dred and seventy-four (27,274) were shot injuries involving the bones of the lower extrem ities; of these, eight hundred and fifteen (815), or 3.0 per cent., were treated by excision, thirteen thousand four hundred and six (13,406), or 49.1 per cent., by amputation, and thirteen thousand and fifty-three (13,053), or 47.9 per cent., without operative interference. In reality the percentage of cases treated by amputation in the upper as well as in the lower extremities was somewhat larger than here stated, as in three hundred and five (305) instances (two hundred and twenty-six in the upper extremities, ninety-two in the lower extremities) the excisions were subsequently followed by amputations, as is indicated in the tabular statements on the two preceding pages. In the upper extremities 11.6 per cent, of the total fractures were treated by excision; in the lower extremities only 3.0 per cent. There is little difference in the relative per centage of amputation in the upper and lower extremities (in the first 47.7, in the second 49.1 percent.); the proportion of cases of conservative treatment in the lower extremities exceeded that in the upper 7.2 per cent., being 47.9 in the former and 40.7 per cent, in the latter. It is difficult to account for this larger percentage in the attempts at conservation in shot fracture of the lower extremities, unless it be due to the instructions given during the progress of the war by medical directors of the armies that amputations in the thigh should riot be performed on the battle-field, and that by the time such patients reached general hospitals the favorable time for operative interference had passed. It is a curious anomaly that in the upper extremity conservatism was more extensively employed in the part most distant from the trunk, while in the lower extremity the reverse was the case. Of eight thousand two hundred and forty-five (8,245) shot fractures of the humerus, two thousand nine hundred and sixty (2,960), or 35.9 per cent., and of five thou sand one hundred and ninety-four (5,194) shot fractures of the bones of the forearm, two thousand nine hundred and seventy-one (2,971), or 57.2 per cent., were treated by con servative measures throughout. In the lower extremities the percentage of cases of fracture CONSERVATION, EXCISION, AMPUTATION. 873 of the femur treated conservatively exceeded that of the fractures of the bones of the leg; in the former three thousand six hundred and twenty (3,620) out of six thousand seven hundred and thirty-eight (6,738), or 53.7 per cent., being treated without operative inter ference, in the latter four thousand one hundred and sixteen (4,116) out of nine thousand one hundred and seventy-one (9,171), or 44.8 per cent. 1 One hundred and thirteen thousand nine hundred and forty (113,940) shot flesh wounds of the extremities, including cases of injuries of arteries and nerves in which no lesions of bone were reported, gave four thousand five hundred and sixty (4,560) fatal results, a mortality rate of 4.0 per cent., of which fifty-four thousand eight hundred and one (54,801) of the upper extremities, with one thousand six hundred and forty (1,640) deaths, gave a mortality rate of 2.9 per cent., and fifty-nine thousand one hundred and thirty-nine (59,139) of the lower extremities, with two thousand nine hundred and twenty (2,920) deaths, a fatality rate of 4.9 per cent. Of the former in eighty-two (82), and of the latter in two hundred and one (201) cases, amputation was resorted to, generally on account of haemorrhage, aneurisms, or extended sloughing or suppuration; less frequently on account of pyaemia, gangrene, and erysipelas, and, in a few instances, on account of lacerations of nerves. Sixty thousand two hundred and sixty-six (60,266) of the one hundred and seventy- four thousand two hundred and six (174,206) shot wounds of the extremities were compli cated by injuries of the bony structure. Forty-four thousand three hundred and seventy- five (44,375) recovered, twelve thousand eight hundred and sixty-one (12,861) proved fatal, and the result in three thousand and thirty (3.030) cases was not recorded, a mor tality rate of 22.4 per cent. Thirty-two thousand nine hundred and ninety-two (32,992) were fractures in the upper, and twenty-seven thousand two hundred and seventy-four (27,274) in the lower extremities: TABLE CLXV. Summary of Sixty Thousand Two Hundred and Sixty-six Shot Fractures of the Extremities, showing Treatment and Results. MODE OF TREATMENT. O Recovery. i I Undetermined. Percentage of Fatality. UPPER EXTREMITIES. LOWER EXTREMITIES. Recovery. "3 1 Undeter mined. Percent, of Fatality. Recovery. i Undeter mined. Percent, of Fatality. Conservation . . .... 26, 467 4,656 29, 143 20,854 3,183 20, 338 4,562 1,213 7,086 1,051 260 1,719 17.9 27.5 25. 8 11,646 2,744 12, 539 1,288 858 1,822 480 239 1,376 9.9 23.8 12.6 9,208 439 7,799 3,274 355 5,264 571 21 343 26.2 44.7 40.2 Excision ... Amputation Aggregates ... .... 60, 266 44, 375 12, 861 3,030 22.4 26, 929 3,968 2,095 12.8 17, 446 8,893 935 33.7 1 Twenty-six thousand four hundred and sixty-seven (26,467), or 43.9 per cent., were treated conservatively; four thousand six hundred and fifty-six (4,656), or 7.7 per cent., were followed by excision; and twenty-nine thousand one hundred and forty-three (29,143), or 48.4 per cent., were followed by amputation. Of the conservatively treated cases, 17.9 per cent, proved fatal; of those followed by excision 27.5 per cent., and of those by ampu- J It might be claimed, in a comparison of this nature, that the cases of excision would be more fairly classed with the cases treated by conservation in contradistinction to the cases treated by amputation. While this would somewhat change the relative percentages in the two groups of the upper and lower extremities, the conclusion arrived at above would remain the same, thus: Fractures of humerus, 8,245; treated by conservation or excision, 3,907, or 47.4 per cent.; fractures of bones of the forearm, 5,194 ; treated by conservation or excision, 3,956, or 76.8 per cent.; in the lower extremities, fractures of the femur, 6,738; treated by conservation or excision, 3,806, or 56.4 per cent.; and fractures of the tibia and fibula. 9,171 ; treated by conservation or excision, 4,326, or 49.1 per cent. SfRG. Ill 110 874 WOUNDS AND COMPLICATIONS. [CHAP. xn. tation 25.8 per cent., showing that the fatality after excision exceeds that after amputation in the whole series of cases 1.7 per cent., although over three-fourths of the excisions were operations performed in the upper extremities, where the results of operative interference are less serious than in the lower extremities. The greatest fatality after shot injuries of the extremities with lesion of bone was observed in shot injuries of the hip joint, where the fatality reached 84.7 per cent. Next came the injuries of the knee joint, with a mortality of 53.7 per cent.; then those of the thigh, of which 52.4 per cent, perished. Then come the injuries of the shoulder joint with 34.2 per cent, mortality, of the leg with 27.0, of the ankle joint with 26.9, of the arm with 20.7, elbow with 19.4, wrist 12.9, forearm 9.4, foot 8.3, and finally the shot injuries of the bony structure of the hand with 3.1 per cent, fatality. A reference to TABLES CLXIII and CLXIV, ante, shows a percentage highly flatter ing to the efforts of conservation; but it must be borne in mind that the cases reported as treated conservatively were cases selected as specially adapted to this mode of treatment, and probably were the least serious. Moreover, there were many cases in which conserva tive treatment was abandoned and intermediary or secondary excisions and amputations were resorted to cases which helped to increase the mortality rate of these operations, but which should properly be charged to the attempts at conservation. On the other hand, many operations were performed in the field, where the appliances and necessary rest of conservative surgery could not be had, and where frequent transportation for considerable distances was unavoidable, in which in general hospitals an attempt might have been made to save the limb. The disposition towards conservation developed itself rapidly as medical officers became familiar with serious cases of shot injuries, and it is safe to say that in the later stages of the war many limbs were saved which at an earlier period would have been sacrificed. Especially was this the case in the upper extremities, where the preservation of the hand, or even of portions of the same, was considered most important for the well being of the individual. An examination of the many cases thus treated, as described in previous sections of the history, will show the formidable risks taken to attain this end. There was a decided growth in the disposition to save in shot injuries of the lower extremities, especially in those of the femur, and the many favorable results leave beyond doubt the wisdom of the course. Still there was a wide difference of opinion on this point, particularly between field surgeons and those in charge of general hospitals at the rear a difference that can only be reconciled by viewing the subject from the standpoint of each. Probably the least satisfactory ultimate results of conservative treatment were those in the foot and ankle, which, while successful in saving life, render it doubtful, in the light of their ultimate condition, whether conservation was the wisest course. EXCISIONS. The consideration of this operation at this point is restricted to the excisions in the bones of the extremities; the three hundred and fifty cases of excisions in the bones of the head, face, and trunk, including two hundred and twenty instances of trephining, have been considered in the First Surgical Volume. Of four thousand six hundred and fifty-six excisions, three thousand eight hundred and forty-one, or over four-fifths, were in the upper extremities, and eight hundred and fifteen in the lower extremities. The excisions at the hip joint lead with the largest mortality, 90.9 per cent.; next come the excisions at the knee joint with 81.4 per cent.; the excisions in the shaft of the EXCISIONS. 87. r > femur have a fatality of 69.4 per cent.; the excisions at the shoulder of 36.6 per cent.: at the ankle joint of 29.0 per cent.; in the shaft of the humerus of 28.6 per cent.; in the tibia and fibula of 28.2 per cent.; in the bones of the foot of 19.3 per cent.; at the wrist joint of 13.8 per cent.; in the bones of the forearm of 11.3 per cent.; and in the bones of the hand of 9.6 per cent. With the exception of the elbow the excisions in the joints show TABLE CLXVI. Numerical Statement of Four Thousand Six Hundred and Fifty-six Excisions in tlie Extremities. SEAT OF OPERATION. CASES. PRIMARY. INTERMEDIARY. SECONDARY. PERIOD OF OPERA TION UNKNOWN. 3 o H Recoveries. Fatal. Unknown. Percentage of Fatality. Recoveries. 3 Unknown. Percentage of Fatality. Recoveries. 3 & a t o a ,M P 15 Percentage of Fatality. Recoveries. 3 1 Unknown. Percentage of Fatality. Recoveries. 1 Unknown. Percentage of Fatality. Clavicle and Scapula Shoulder Joint 84 1,086 696 764 986 109 116 66 175 57 387 33 97 4,656 60 603 477 856 94 103 6 51 10 275 22 75 19 5 348 135 191 28 165 48 109 21 15 .... 11 2 60 .... 116 8 44 3 108 4 9 2 18j 4 24.1 36.6 28.6 23.0 11.3 13.8 9.6 90.9 69.4 81.4 28. 2 29.0 19.3 27 376 326 288 589 55 58 1 20 4 148 8 40 9 185 145 75 71 7 6 32 65 26 67 2 11 3 91 16 33 6 2 1 2 25.0 32.9 30.7 20.6 10.7 11.2 9.3 96.9 76.4 86.6 31.1 20.0 21.5 12 124 64 152 120 18 15 2 9 1 58 5 15 6 113 29 74 29 6 2 20 39 12 29 3 5 33.3 47.6 31.1 32.7 19.4 25.0 11.7 90.9 81.2 92,3 33.3 37.5 25.0 8 69 36 57 36 15 6 a 15 4 42 5 16 13 34 51 54 111 6 24 4 21 12 8 5 2 25 12 10 16 23.5 38.1 19.0 12.9 4.3 29 4 5 .... 8 .. 4 ... 2 .... 29.5 12.1 12.3 10.0 11.7 Elbow Joint. Radius and Ulna Wrist Joint Bones of Hand 3 2 11.1 Hip Joint 8 3 3 8 4 1 .. 72.7 Shaft of Femnr 1 16.6 j 42. 8 .... 16.0 44 4 7 1 27 A 9 3 4 1 56.2 1 75.0 4 12.9 Knee Joint Tibia and Fibula. . Ankle Joint Bones of Foot . 5.8 4 1 2 20. Aggregates 3,183 1, 213 260 27.6 1,940 2 701 v 800 159 27.0 595 367 ~982~ 20 38. 1 312 V 75 *v 392 5 _* 19.3 ! 336 v 70 -v 482 76 17. 2 larger mortality rates than those in the osseous structures immediately above the joint; the fatality of the operations in the knee joint exceeds that in the shaft of the femur 12.0 per cent.; in the ankle joint the fatality is 0.8 per cent, greater than in the leg, and in the wrist joint 2.5 per cent, greater than in the bones of the forearm; the excisions at the elbow joint, on the contrary, show more favorable results than those in the arm, the death- rate being 5.6 per cent, less in the former than in the latter. The percentage of fatality in the entire series of excisions in the extremities is dis appointing, especially when it is considered that over four-fifths of the excisions were performed in the upper extremities, where the chances for success must be considered the brightest. It disproves the opinion held by the advocates of this operation that excision involves less loss of life than amputation. That it might be possible to obtain better results in well-appointed and less crowded hospitals is not denied; and the many excellent results obtained in civil practice should encourage the military surgeon to persevere in his efforts m this direction in suitable cases and under favorable circumstances. As to whether the effort made to secure, a useful limb by excision compensates for the formidable risk which must be encountered in military practice, can be best determined by the reader by an examination of the analyses of the cases in the various sections of the extremities, as given previously under their appropriate headings. In brief, it may be stated that the results after excisions in the long bones and in the knee and ankle joints were little less than disastrous, and the ultimate conditions of many of these cases, although considered successful shortly after the operation, proved to be deplorable. 876 WOUNDS AND COMPLICATIONS. [CHAP. XII. The results in excisions of the shoulder and elbow joints and, to some extent, in the wrist joint have been more encouraging, as useful limbs were preserved after many of these operations. In the excision at the wrist the patient generally recovered with anchylosis and extreme deformity of the hand and stiffness of the fingers; but such is the adaptability of the hand to all pursuits in life, that even with these disadvantages it remained a useful member to the patient. In three hundred and five cases the excision was followed by amputation of the limb, in two hundred and twenty-six in the upper, in seventy-nine in the lower extremities. The operations have been grouped into primary, intermediary, and secondary. The primary operations contain the excisions performed within the first three days; the inter mediary those from the fourth to the thirtieth day, inclusive; and the secondary those performed more than thirty days after the date of injury. As indicated in TABLE CLXVI, the ratio of fatality after primary operations was 27.0 per cent., after intermediary 38.1, and after secondary 19.3 per cent. The results of the secondary operations were the most favorable ; but it must always be remembered that this group embraces the cases only which had successfully resisted the attacks of the inflammatory period. It will be noticed in the detailed histories of cases of excisions that the period of treatment extended over a long time, even months and years, and that these cases appeared to be particularly prone to consecutive haemorrhage, gangrene, and pyaemia (see pages 808, 810, 825, and 857, ante). Towards the latter part of the war the most thoughtful surgeons found it necessary to exercise a careful discrimination in the selection of cases for excision, and to refuse to operate in many instances in which, early in the contest, this operation would have been favored. A table indicating the different months in which the operations were performed is here appended. The highest rate of mortality it will be noticed occurred in June, the lowest in November; but as regards the influence of season on the operations seemingly no points of value can be deduced from the tabular statement: TABLE GLXVII. Tabular Statement of Excisions, indicating the Months in which the Operations were performed. SEAT OF INJURY. JAN. FEB. MAK. APRIL. MAY. JUNK. JULY. AUGUST. SEPT. OCT. Nov. DEC. Recoveries. 1 Recoveries. Fatal. Reaoveries. $ A Recoveries. 1 Recoveries, "3 a * Recoveries. "a 2 Recoveries. 1 h Recoveries. Fatal. Recoveries. 1 Recoveries. 3 Recoveries. \ Recoveries. 1 a ft. Shoulder Joint 10 12 12 7 2 2 5 3 3 1 1 1 2 16 8 6 12 1 5 7 2 2 2 1 2 1 11 18 17 22 4 2 1 2 1 10 1 1 3 3 5 1 4 8 2 26 20 15 30 2 3 4 1 13 2 4 126 33. 1 21 7 9 3 6 6 2 8 1 109 113 143 195 24 32 7 2 56 14 81 43 43 31 1 1 12 28 15 22 5 94 70 74 101 12 15 73 42 37 24 5 2 5 82 66 67 114 14 5 44 34 19 10 3 2 5 46 22 23 15 33 5 47 4 :..:. . 10 54 47 37 37 7 . 10 1 2 26 1 7 25 12 13 y 1 7 9 4 1 45 27 53 43 6 5 2 3 24 2 4 20 10 17 I 1 5 8 4 3 1 43 33 25 " 1 2 3 16 14 8 3 6 1 2 2 5 32 30 26 41 6 7 4 1 16 1 14 6 1 6 6 9 Elbow Joiiit Hand 1 5 30 4 8 21 3 " 3 9 31 3 7 11 2 11 4 o 4 5 .... 1 12 4 1 .... 3 2 Knee Joint 10 6 4 1 1 Foot 5 ^ 10 5 3 Aggregates Prr ct. of Fatality. CO 23 56 18 27. 7% 24. 3% 89 V 28 35 2% 63 3% 699 282 28?7% 473 V J4 252 398 v < 7% 27. 153 7%~" 175 ; 69 28. 20/ 229 25. 79 6% 214 25. 72 1/T 171 19. 41 3% 169 24. 55 5% CHAP. XII.] AMPUTATIONS. 877 AMPUTATIONS. The total number of amputations reported on the records in this Office is twenty-nine thousand nine hundred and eighty (29,980); but the whole number of amputations performed for injuries received during the war would undoubtedly exceed that number. During the first eighteen months of the strife few or no reports were made of the wounded in the various engagements, and the hospital reports for this period were found to be very meagre. Furthermore, a number of amputations performed on officers treated in private quarters, and sometimes by their own family physicians, is unavoidably omitted in this summary, as no reports of these operations were ever sent to this Office. Another class of operations only partially included in this summary are late amputations, performed after the soldiers were discharged from service for wounds received during the war. Of the twenty-nine thousand nine hundred and eighty (29,980) amputations the results were ascertained in all but one thousand seven hundred and nineteen (1,719), as shown in the following tabular statement: TABLE CLXVIII. Tabular Statement of Twenty-nine Thousand Nine Hundred and Eighty Amputations, indicating Seat of Operation and Results. AMPUTATIONS. CASES. Totals. Recoveries. Deaths. Results Unknown. Percentage of Fa tality. Upper Extremities . . Lower Extremities... Amputations of the Hand or Fingers 7,902 68 1,761 40 5, 510 86fi 1,519 161 5,523 195 6,369 66 6,551 CO 1,503 36 4,054 596 1,317 119 3,595 82 2,878 11 198 24:> 3 1,273 245 81 40 1,790 111 3, 411 55 1,133 1 13 1 183 121 2 138 2 80 2.9 10.4 14.0 7.6 23.8 29.1 5.7 25.1 33.2 57.5 54.2 83.3 Amputations of the Wrist Joint ... Amputations in the Forearm Amputations at the Elbow Joint. .... . Amputations in the Upper Arm Amputations at the Shoulder Joint - - . ( Amputations of the Foot or Toes Amputations in the Leg Amputations at the Knee Joint Amputations in the Thigh Amputations at the Hip Joint Aggregates 29, 980 20, 802 7,459 1,719 26.3 Of the one thousand seven hundred and nineteen (1,719) undetermined cases, one thousand one hundred and fifty-three (1,153) were amputations of the hand or fingers, and but for the want of time and sufficient clerical assistance the results in nearly all these cases could have been ascertained. As it is, the number of cases in which the ultimate results are known is sufficiently large to determine the ratio of mortality attending the amputations in the various sections of the extremities. As in the excisions the operations at the hip gave the largest ratio of mortality, 83.3 per cent.; next come the amputations through the knee joint with 57.5 per cent., those of the thigh with 54.2 per cent., of the leg with 33.2 per cent., of the shoulder joint with 29.1 per cent., of the ankle joint with 25.1 per cent., of the arm with 23.8 per cent., of the forearm with 14.0 per cent., of the wrist with 10.4 per cent., of the elbow with 7.6 per cent., of the foot with 5.7 per cent., and of the hand with 2.9 per cent. 878 WOUNDS AND COMPLICATIONS. [CUM . XII. It will be noted that with the exception of the amputations at the elbow and those at the knee joint the ratio of mortality in the upper extremities as well as in the lower decreases with the increasing distance of the point of ablation from the trunk. No sufficient reason can be assigned for the exceptionally favorable results in amputations at the elbow; while the gravity of injuries as well as of operations in the knee has been repeatedly pointed out in this volume. Comparing the mortality rate after amputations with that of excisions in the same portion of the extremities, we find the following results : TAHLK OLXIX. Table indicating the Rate of Mortality after Amputations and Excisiom in the Extremities. UPPER EXTREMITIES SEAT OF OPERATION. RATIO OF M< Amputation. )KT. AFTER Excision. 2.9 10.4 14.0 7.6 23.8 29.1 9.6 13.8 11.3 23.0 28.6 36.6 Elbow Arm Shoulder RATIO OF MOUT. AFTER LOWER EXTREMITIES SEAT OF OPERATION. Amputation. Excis .on. 5.7 19.3 25. 1 29 Lea . . 33.2 28.2 57.5 81.4 54.2 69.4 83.3 90.9 With the exception of the operations in the bones of the forearm and those in the bones of the leg, the excisions are uniformly followed by larger percentages of fatality than the amputations, the excisions of the knee joint especially showing an exceedingly large excess in the mortality rate over the amputations at the knee. The favorable results after excisions in the bones of the forearm and leg are due to the fact that in many of these cases only portions of one or the other of the two bones comprising them were excised, thus lowering considerably the percentage of fatality of the operation. For instance, as shown on page 445, ante, the fatality after excisions in the fibula was 27.2, after those in the tibia 25.6, and after those in both bones was 61.1 per cent., while the average fatality of all the excisions in the bones of the leg is only 28.2 per cent. Similar results were obtained in the excisions of the bones of the forearm, the mortality after excisions of both radius and ulna exceeding those of the radius or ulna alone. The necessity for a uniform system of classification of the amputations in order that the results of operations performed at different periods could be compared is self evident. All operations performed within forty-eight hours after the injury have here been grouped as primary, as the commencement of inflammatory symptoms rarely falls within this period. In the amputations at the hip joint alone the primary period has been restricted to twenty- four hours, as it is believed that in those cases the inflammatory period is hastened by the gravity of the injury. In the second or intermediary group have been placed the cases in which the operation was performed in the interval from the third to the thirtieth day (both inclusive) after the injury; this class consists mainly of the operations performed during the inflammatory stage. The third group comprises the operations performed after the thirtieth day from the date of the injury, or at a period when the inflammation had abated or entirely subsided. Of the twenty-nine thousand nine hundred and eighty (29,980) amputations, the date after the injury on which the operations were performed was recorded in twenty-three thou sand nine hundred and ninety-three (23,993) cases. Of these the results were not ascer- AMPUTATIONS. 879 tained in two hundred and thirty-one (231), leaving twenty-three thousand seven hundred and sixty-two (23,762) cases in which the results as well as the dates of operation and injury were recorded. Sixteen thousand two hundred and thirty-eight (16,238) amputations belong in the group of primary operations performed within the first forty-eight hours; of these, three thousand nine hundred and ninety-two (3,992), or 23.9 per cent., terminated in death; five thousand five hundred and one (5,501) were intermediary operations; of these, one thousand nine hundred and eighteen (1,918), or 34.8 per cent., proved fatal; and two thousand and twenty-three (2,023) were secondary operations, performed after a lapse of thirty days from the date of injury, of which five hundred and eighty-four (584), or 28.8 per cent., had fatal terminations. The primary operations gave the best chance for life. The operations per formed during the intermediary or inflammatory period were the most unfavorable in their results: TABLE GLXX. Summary of Twenty-three Thousand Seven Hundred and Sixty-two Amputations, indicating the period of the Operation. SEAT. CASES. PRIMARY. INTERMEDIARY. SECONDARY. i o H Recoveries. 3 ,* PH Recoveries. 48 5 97 1 603 117 36 23 1, 032 57 1,951 22 Percentage of Fatality. Recoveries. i & Percentage of Fatality. Recoveries. a w Percentage of Fatality. a 2 Si- ~ S p I wl- r ^ Amputations of Hand or Fingers 4,501 07 1,655 35 4,626 722 1,045 153 4,900 189 5,803 66 4,412 60 1,420 33 3,581 505 987 115 3,350 79 2,715 11 89 7 235 2 1,045 217 58 38 1,550 110 3,088 55 3,179 50 911 27 2,659 369 651 78 2,309 50 1, 960 3 1.4 9.0 10.6 3.5 18.4 24.0 5.2 22.7 30.8 53.2 49.8 88.0 1,059 350 5 615 86 243 25 690 16 488 41 109 3.7 14.2 23.7 174 159 1 307 50 93 12 351 13 267 8 Amputations at Wrist Joint 1 29 1 122 22 2 1 136 16 244 10 584 23 20.0 15.4 50.0 28.4 30.5 2.1 7.6 27.9 55.1 47.7 55.5 Amputations at Elbow 320 78 20 14 382 37 893 23 34.2 47.5 7.6 35.8 35.6 69.8 64. 6 100.0 Amputations at Shoulder Amputations at Ankle Joint Amputations at Knee Joint . . Amputations in Thigh Amputations at Hip Joint . Total 23, 762 17, 268 6,494 12,246 3,992 16, 238 23.9 3,583 1,918 , 501 34.8 1,439 .- 2, < 28.8 Primary operations were the rule, over two-thirds of all the amputations belonging to this group. Tn the field, where few of the appliances of conservative surgery can be had, and where, moreover, the chances of properly applying them are uncertain, where, further more, transportation for considerable distances is unavoidable, frequently amputations are necessary where at least an attempt at conservation might be made in a general hospital. Nearly all the surgeons of the war agreed that the decision in regard to amputation should be made at the time of the injury and should be followed by immediate operation. In this connection Surgeon H. S. Hewit, U. S. Y., observed that shock to the extent of forbidding surgical interference, even in cas.es of considerable gravity, is much less common than generally thought. The experience with intermediary operations was so discouraging that when the time for primary operation had passed the operation, if possible, was deferred until the inflam mation had subsided and the lesions had become local and analogous to chronic disease. 880 WOUNDS AND COMPLICATIONS. [CHAP. Xll. Of the different modes of operation each method had its advocates; but the flap operations were more frequently used, especially in amputations in and near the joints. Of eleven thousand and fifty-three (11,053) cases of major amputations in which the method is specified, six thousand two hundred and forty (6,240) were flaps, and four thousand eight hundred and thirteen (4,813) circular operations. A multitude of varieties of the flap operation were recorded; instances have been cited of the use of the anterior, posterior, antero-posterior, lateral, bilateral, external, internal, oval, circular, U-shaped, rectangular, and skin or muscular flap. In regard to the last two modifications it seems to have made little difference whether a thick covering of muscular tissue was used or a skin flap, for, as a rule, the stumps became conical sooner or later; short stumps sometimes remained well- rounded, long stumps rarely; but when they remained full it was often due to osteophytes, which in time became troublesome. The advocates of the circular operation claimed for this mode that it required little time and care in dressing, was easily handled, that it seldom sloughed, that its discharges were less, and that it was less frequently followed by haemorrhage than the flap operation, while the latter mode would not stand transporta tion unless very carefully supported, and was considered, altogether, too nice an operation for the flurry of a battle-field. As far as the stumps are concerned, handsome rounded stumps were achieved by either method, as has been illustrated in PLATE LXXIII, oppo site page 356, and conical stumps were noted after the circular as well as after the flap operation. The side upon which the operation was performed was recorded in eighteen thousand seven hundred and eighteen (18,718) cases. The amputations on the left side exceeded those on the right by 3.4 per cent. the operations on the left side being nine thousand six hundred and eighty-three (9,683), or 51.7 per cent., on the right nine thousand and thirty- five (9,035), or 48.3 per cent, of the cases in which this point was recorded. This is in accordance with the facts pointed out throughout the preceding volumes, that, with a few exceptions, the shot injuries of the left side were more numerous than those of the right. TABLE CLXXI. EXTREMITY. Total Cases. RIGHT SIDE. LEFT SIDE. 1 H Recoveries. Percentage of Fatality. "3 1 H Recoveries. "3 "8 Percentage of Fatality. Amputations in the Upper Extremities 7,628 11,090 3,655 5,380 2,845 j 810 3, 138 2, 242 22.1 41.6 3,973 5,710 3,127 3, 326 846 2,384 21.2 41.7 Amputations in the Lower Extremities ... Aggregates 18, 718 9,035 5,983 3.052 33.7 9,683 6,453 3,230 33.3 Whether the seat of the injury was on the right or the left side seems to have had no influence on the ratio of mortality. In the upper extremities the fatality is slightly larger in the amputations on the left side; in the lower, in those of the right; but the difference in the rate of mortality of the two sides in the whole number is only 0.4 per cent. The number of double amputations performed on account of shot injuries was one hundred and seventy-two; of these, both upper extremities were amputated in forty-seven, one upper and one lower in forty-three, and both lower in eighty-two, as follows: CHAP. XII.l DOUBLE AMPUTATIONS. 881 TABLE OLXXII. Numerical Statement of One Hundred and Seventy-two Cases of Double Amputations for Shot Injuries. a < CO K D H S O ^ EXTREMITY. U a W B K gg |J J O 8 H H E- M O H P4 fc PH Both Amputations in the Upper Extremities 47 31 16 34 One Amputation in Upper one in Lower Extremities 43 21 21 1 50 Both Amputations in the Lower Extremities 82 31 50 1 61 7 172 83 87 2 51 1 The mortality rate of the cases in which both the upper members were removed is 34.0 per cent., of those in which one of the upper and one of the lower extremities were amputated, 50.0 per cent., and of those in which the two operations were performed in the lower members, 61.7 per cent. Brief accounts of these cases will be found in the following table : TABLE CLXXIII. Condensed Summary of One Hundred and Seventy-two Double Amputations after Shot Injury. No. NAME. MILITARY DESCRIP TION, AND AGE. DATE OF INJURY. NATURE OF THE INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 1 Warner, G. W., Pt., B, 20th Jnly 3, Right arm severed from body Julv 3, Amputation of right arm at Discharged October 7, 1863. Connecticut, age 32. 1863. 4 inches below shoulder, 1863. shoulder and left arm in and left forearm fractured lower third. and lacerated by shell. 2 Fuller, D., PL.G, 53dPenn- Sept. 17, Shell wound, botli arm.s .... Sept. 17, Amputation at right shoul Discharged Dec. 17, 1862; sylvania. 1862. Oct. 5, der joint and in upper both stumps heajthy and 1862. third of left forearm. healed. 3 Mark, F., PL, A, 2d Mis Mav 26, Both arms torn off by acci May 26, Amp. at left shoulder joint Discharged August 12. 1861; souri Light Artillery, age 1861. dental discharge of a can 1861. and in right forearm 3 ins. stumps in good condition. 20. non. below elbow. Dr. Schmidt. 4 Hodgdou, J. F., PL, I, 1st June 14, Both arms torn off to elbow June 14, Circular amputation of both Discharged August 5, 1863. Mass. Heavy Artillery. 1863. and burner! fractured in 1*63. arms in upper third. Sur several places from prema geons M. F. Bowes, 12th ture explosion of cannon; Pennsylvania Cavalry, and great laceration. T. C. Smith, 116th Ohio. 5 Sergeant, W., PL, E, 53d June, 1, Shot fracture of both arms June 1, Circular amputation left arm Disch d November 19, 1864; Pennsylvania, age 18. 1802. and wound of nose. July , in middle and right arm in sound stump. 1802. upper thirds. 6 Stratton, A., PL, C 147th June 18, Solid-shot fractures of both June 18, Flap amputation both arras Discharged October 3, 1864 ; New York, age 17. 1864. elbow joints; laceration. 1864. through mi idle. Surgeon good stump. Died June A. S. Coo, 147th New York. 3, 1874; consumption. 7 Bacon, B.W., CapL,G,74tli June 27, Shot fracture of right radius July 14, Flap amp. middle third right Died July 21, 1864, of pyae Illinois, age 40. 1864. and ulna, and of left radius. 19, 1864. arm. Surg. J.E. llcrbst, U. mia. S.V. In lower third I t arm. A. A. Surgeon J. 11. Green. 8 Bawn, W., PL, G, 16th Me., Dec. 13, Fracture of right arm by Dec. 14, Amputation of both arras at Died February 22, 1863. age 26. 1862. shell, and left arm by con- 1862. junction of upper and mid oidal ball. dle thirds. 9 Clarke, R., PL, E, 13th Col Dec. 10, Shot wounds of both arms, Dec. 16, Right, upper third, flap ; left, Died December 19, 1864. ored Troops, age 18. 1864. lower thirds; great de 1864. middle third, flap. A. A. struction. Surgeon J. S. Giltner. 10 Haltzee, F., Pt., F, 16th N. Sept. 1, Both forearms carried away Sept. 1, Amputation in middle third Died October 9, 1864; ex Y. H. A., age 21. 1S64. by a cannon ball. 1864. of both arms. Surgeon M. S. Kittinger, 100th N. Y. haustion. 11 Lacbine, L., Pt., 1), 1st N. June 18, Hands blown off, eyes de Juno 18, Amputation of both arms . . . Died June 20, 1864. York Artillery. 1864. stroyed, humerus and fore 1864. arm fractured ; premature discharge of cannon. 12 McHugh, O., PL, D, 37th Dec. 13, Shot fracture of both arms . . Dec. 13, Amputation of both arms . . . Died. New Fork. 1862. 1802. 13 Ruth, J., PL, H,6th Arkan Nov. 30, Shell fracture of both elbow Dec. 1, Right, ant. post, flap, lower Gangrene. Died March 26, sas. 1864. joints. 1864, third; left, ant ero- pos 1865. Jan. 2, terior flap, upper third. 1865. Surgeon Cooper. C. S. A. 14 Savage, G., PL, A, 2d Con Juno 1, Shot fracture of both arms On field. Amputation ol both arms . - Died June 4, 1804. necticut Artillery. 1864. by bullet. lo Tanner, T. B., PL, B, 3d July 10, Wound of both arms by pre Julv 10, Amputation of both arms . Aug. 5, haemorrhage. Died Rhode Island Artillerv. 1863. mature explosion. 1863. August 9, 1863. 16 Vanatta, J,., I t., A, 23d Jan. 11, Wound of both arms Jan. 11, Amp. of both arms. Surg. J. Die. (March 0,1863. Wisconsin. 1863. 1863. W. F. Gerrish, 67th Ind. SURG. Ill 111 882 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. NAME, MILITARY DESCRIP TION, ASD AGE. DATE OF INJURY. NATURE OF THE INJUUV. DATE OF OPERA TION . OPERATION AND OPERATOR. RESULT AND REMARKS. 17 Benrry. J. H., Pt., K, 5th Julv 3, Right forearm and left arm July 3, Flap amputation of left arm Discharged May 26, 1864; Art illery. 1803. atlowcrthird carried away 1863. at upper third and right sound stumps. by premature discharge of forearm nt middle third. cannon: fracture of j.iw. 18 Conner, J., Pt., F, 3d Del Feb. 2, Compound fiacttire of right Feb. 2, Amputation right forearm; Disch d Xovember 12, 1863; aware, age 15. le 63. forearm, wound of left arm, May 20, dissecting aneurism of left healthy stumps. ami \v< muds of breast; acci 1803. brachial artery; amp. left dental discharge of gun. arm. upper third. Surg. E. | Wolfe and Asst. Surg. J. M. Houston, 3d Delaware. 10 Duey. M., Pt., K, 97th Jan. 13, Shell fracture of riiiht arm, Jan. 16, Cir. amp. of right arm, upper Disch d October 21, 1865; Pennsylvania, age 21. 1805. middle third, ;m<l left fore 1865. third ; left forearm at.junct good stumps. arm by conoidal ball. upper and middle thirds. 20 Hill, W., Sergt, A, 7Gth Apr. 4, Fracture of right elbow and Apr. 4, Flap amputation right arm, Discharged July 22, 1865. Colored Troops, ago 20. 1865. lett forearm by a shell 1865. lower third. Surgeon N. fragment. N. Ilorton, 47th C. T. Flap amputation left forearm, upper Third. Asst. Surg. B. F. L.sford, 68th C. T. 21 Maher, M., Corp l, Detach ment of Ordnance. Sept 19, 1863. Injured by explosion of a shell. Sept, 19, 1863. Amp. right arm, upper third ; flap at middle third of left Discharged February 8, 1864; sound stumps. forearm. Surg. E. H. Aba- die and Asst. Surg. H. L. Sheldon, IT. S. A. 22 Plunket, T.. Serg t, E, 21st Dec. 13, Shell wounds of b;jth arms . . Dec. 13, Flap amputation right arm Discharged, March 9, 1864. Massachusetts. 1S62. 1862. near shoulder, and left fore arm in middle third. 23 Price, I.. Corp l, F, 15th Oct. 13, Shell fractures of both arms Oct. 14, Amputation of right arm, Discharged June 9, 1865. West Virginia, age 34. 1804. and tlesh wound of thigh. 186 J. lower third, and left fore- a ui, upper third. Surg. W. S. Walsh, 15th W. Va. 24 SLippcn, S. C., Pt, D, 3d Rhode Island Heavy Ar July 10, 1863. Both arms mangled by pre mature discharge of gun ; Julv 10,- 1863. Amputation right arm near shoulder, and lelt forearm Discharged October 19, 1863. tillery. loss of i ight eye. near wrist. Asst. Surg. 11. S. Lamson, 3d R. I. Art. 25 Young, A. H., Pt., A, 6th Sept. 17, Shot wounds of both arms .. Sept. 17, Amp. in upper third of left Disch d November 16, 1863. Wisconsin. 1862. 1862. arm. and flap am p. in upper third right forearm. Surg. J. McXulty, TJ. S. V. 20 Chatiield, J., Pt., E, 6th June21, Shot compound fracture of July 14, Amputation at lower third Died July 14,1863. Ohio Cavalry, age 32. 1863. left ratlins and right car 18B3. of left arm and lower third pal and metaearpal bones of right forearm. 27 Colwell, A. N., Pt., E, 1st Nov. 7, Fracture of both forearms Nov. 7, Amp. in lower third left, arm Died :<"ovember 7, 1863. Rhode Island Artillei-y. 1863. by premature discharge of 1863. and upper third right fore cannon. arm. Asst. Surgeon H. G. Taylor, 8th N. Jersey. 28 Ferris, G. W., Corp l, A, May 27, Shell wounds of left arm, May 27, Circular amp. left arm, mid Died June 17, 1864, of pyae :itilh Wisconsin, age 34. 1864. right hand, and left thigh. June. 12, dle third; circ. amp. right mia. 1804. forearm, upper third. A. A. Surg. W.B.Dick. 20 Walker. P., Pt., I, 104th June 18, Shot fracture right himierus June 18, Muse, flap ainp. at surg. neck Died July 9, 1864, of exhaus New York, age 40. 1H64. and left forearm by cannon 1864. right huiueius, and circ. of tion. ball. lelt forearm in upper third. 30 McDonald, J., Pt., G, 85th July 29, Shell wounds of right arm July 29, Amp. right arm near shoul Discharged March 7, 1864; Pennsylvania. 1862. and left hand. 1802. der, and amp. at left wrist sound stumps. joint. Surg. S. A. Green, 34th Mass. 31 Stanford. V. B., Pt, A, 1st May 15, Mutilation of hands by pre May 15, Amp. at mid. third right arm Died June 4, 1864. Ohio L. A. 18U4. mature discharge of gun. 1864. and left wiist joint. Surg. E.B.G lick, 40th Indiana. 32 Cassidy, J. E., Pt, K, 4th Mar, 31, Left hand blown off ami right Mar. 31, Ov;il flap amp. light forearm Discharged July 21, 1865; Artillery, age 33. 1865. wrist .joint comm. by explo 1865. at mid. th d and left forearm both stumps perfectly sion of camion; fare and in upper third. Surg. W.S. healed. breast burned. Thompson, U. S. V. 33 Decker, S. H., Pt,, I, 4th Got 8. Wounds of both forearms by Oct. 8, Amputation both forearms Discharged Nov. 3, 1862; Artillery. 1862. premature discharge of can 1862. six inches from elbow. good stumps. non. 34 Latham, E. P., Pt, 9th Bat June 19, IJoth hands blown off by pre- June 19, Amp. right and left forearms Discharged Nov. 20, 1862; tery Ohio Light Artillery. 1862. 11 aturo discharge of can 1862. in upper third. Surgs. J. C. left stump sound, right non. McPheeteis, 33d Ind . and withered. C. W. Millen, 2d Tenu. 35 Lewis, W. H., Pt, C, 5th June 7, Compound fracture both fore- June 7, Flap amp. upper third right Discharged April 29, 1865; Artillery, ago 22. lr:64. arms by explosion of a 1804. forearm and lowerthird left stumps healed. shell. forearm. 36 Minor, E., I t, F,Ind. Oatt. Sept. 28, Injured by premature explo- Sept. 28, Ant. post, flap amp. low. th d Recovered. Stumps healed. Minnesota Cavalry. 1864. siou of a cannon. 1S04. both forearms. Drs. Sow- art and Murphy. 37 Shelby, T.,Pt.,E, 1st Ohio Heavy Artillery. A pr. 10, 1K65. Comminution of both fore- Apr. 10, arms, premature discharge 1865. Circ. amp. left, aiid flap amp. right forearm. A. A. Surgs. Discharged June 22, 1865. of cannon. C. F. Thomas and W. Tib- belts. 38 Tucker, J. B.. Serg t, B, Julv 4, Severe injury both forearms July 4, Circ. amp. right forearm near July 11, ream p. left forearm Green River B-Ut u Hen- 1865. and hands by ramrod from 1865. elbow and left near wrist. 4 inches below el bow. Dis tacky State Militia. cannon. Asst, Surg. C. !. Ulricli, charged August, 23, 1865; :)0 \Vallace, 11.. Pt,, F, 33d May 18, Shell wounds of both hands; May 18, Kentucky State Militia Amp. light forearm in mid stumps healed. Died on hospital steamer. Missouri. 1864. great mutilation. 1864. dle and left in lower third. Asst. Surg. C. H. Andrus, 128th New York. 40 Magoonaugh, I!., Pt, Ord May 4, Wounded while filing a sa- May 4, Circ. amp. mid. third right Duty October 16, 1865. nance Corps, age- 23. 1865. lute. 1865. foreaiui, and flap amp. at left wrist A. A. Surgs. E S. Snow and D. O. Farrand. 41 Thompson. T. M., Pt , 1st Jan. 14, Left hand torn off above, and Jan. 14, A mp. left forearm 3 inches be Discharged May 10, 1863; Maine Battery. 1863. right below, wrist; prema- ! ]863. ture discharge of cannon. low elbow and at right wrist joint. Surg. M. D. Bene stumps partially healed, but painful. dict, 75th N. Y. CHAP. XII.] DOUBLE AMPUTATIONS. No. NAME, MILITARY DESCRIP TION", AND AGE. DATE OK IXJUllY. NATURE OF THE INJURY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 42 Colvin, R. J., Pt,3d Xcw Oct. 1, Compound fracture lower end Oct. 2, Flap amp. lower third right Discharged Feb. 20, 1805. York lud. Butt., ago 22. 1804. right forearm, involving 186 J. forearm and left, little lin wrist, joint, and of lifth me- ger with part of mctacm pill tatarsal bone left hand. bone. A A. Surg. E. Ohlcii- schlagcr. 43 Eil ward s, M., Pt, M, 3d July 13, Right and left hands hlown July 13, Flap amp. low tl ird left fore Discharged Apiil 13, 1805. New York Art., ago JO. 1804. off at wrist joint by explo 1804. arm and of right thumb, in sion of shell; flesh wound dex iiiid mill, lingers with of side. metacarpal bones. 44 Harris, M., Pt, G, 32th Apr. 17, Shot wounds of hoth hands. . Apr. 25, Oval ani|). right 3d finger, Returned to duty Dec. 17, New York Cavalry, age 1804. May 3, low. third met. bone. A. A. 1864. 19. 1864. Surg. 1 . C. Porter. Circ. skin (lap amp. up. third left forearm. Surg. C. A. Cow- gill, U.S. V. 45 "Warren, M. C., HUB., A, Mav 3, Injured hy the bursting of a Mav 3, Amputation of both hands Discharged Jan. 20, 1865. 20th Maine. 1863. musket in his own hands. 1803. at wrist joints. 4G Ciirrico, A., Pt, H, 39tli Apr. 5, Accidental shot wounds of A pr. 5, Amp. right and left index Discharged Jan. 13, 1665; Ohio, ase 31. 18C4. hoth hands. 1804. fingers with met. bones. healed. 47 Dnrdtnsrer, J. S., Pt, A, Julvll, Both hands partially hlown Amp. index, mid , ring, and Discharged Nov. 26, 1803. llth West Virginia. 1803. off firing a salute. Jittlo lingers through met. bones and port, thumb left hand, and r t hand through met. bones except thumb. 48 Rand, W. J., Pt., K, 45th Dec. 14, Left arm near shoulder and Dec. 14, Amp. at left shoulder j t and Died January 24, 1863, of Massachusetts, age 25. 1862. lower third right femur 1862. mid. third r t thigh Surg. pyaemia. crushed hy solid shot. I. F. Galloupe, 17th Mass. 40 Marquis, "W. II., Pt., E, 83d Aug. 27, Shell compound fracture Aug. 27, Amputation at right shoul Sept. 12. ha;m. from brachial Pennsylvania, age 20. 1803. right arm and left leg. 1863. der joint and at lower third art.; lig. of axillary. Died left leg. Sept. 12, 1863. 50 Gallagher, L.,Pt, A, 09th Sept 1, Shot fracture left humerus Sept. 1, Circ. amp. upper third left Discharged March 2, 1866; Ohio, age 18. 1864. and wound right forearm. 1864. arm. Surg. L. Slugger, 09th stump perfectly healed. Jan. 31, Wound of right leg by rail Jan. 31, Ohio. Flap amp. low. third 1865. road accident. 1805. right thigh. Surg. C. Mc- Dermott, U. S. V. 51 Kircher, H., Capt, E, 12th Nov. 27, Shot wound left leg and right Nov. 27, Flap amp. right arm at mid. Mustered out Nov. 14, 1864. Missouri. 1863. arm. 1863. third and of left thigh four inches above knee. Surg. J. Spiegel halter, 12th Mo. 52 Kreig, P., Pt., C, 40th New Auir.21, Compound comminuted Aug. 21, Flap amp. left arm, up. third, Discharged April 27, 1865. York, age 28. 1804. shell fractures left arm 1864. and left thiirh at mid. third. and thigh. Surg. W. B. Fox, 8th Mich. 53 Lovely, C., Pt, I, llth Ver June 1, Shot fractures left elbow and June 1, Double flap amp. at mid. th d Union of both stumps by mont, ago 38. 1864. right knee joint. 1864. left humerus and mid. third first intention. Disch d right thigh. Fob. G, 1865. 54 Rose. F., Pt, D, 57th New Oct. 14, Shell compound comminuted Oct. 14, Circ. amp. left arm 1 inch Aug. 9, 18U4, rem. of seques York, age 20. 1S63. fractures left humerus and 1863. from shoulder and of right trum. Discharged Oct. 13, right knee joint. thigh at lower third. Surg. 1864. Spec. 3104, A. M. M. W. H. Potter, 57th N. Y. 55 Schmidt, H., Pt, G, 57th Oct. 3, Shot wounds right leg and Oct. 4, Amp. in upper right arm. Discharged December 18, Illinois. 1862. light arm. 28, 1862. Confed. surg n. Flap amp. 1803. upper right thigh. Surg. J. R. Zeariug, 57th 111. 50 2 Weeks, J. D., Pt, G, 3d Nov. 14, Comminuted fracture left fe Nov. 14, Ant-post flap amp. middle Discharged July 27, 1865. Colored Troops, age 20. 1863. mur, middle third, and left 1863. third left arm; oblique flap elbow ; lacerated wound of amp. of upper left thigh. side; explosion of shell. Surg. S. W. Gross, U. S. V. 57 Wiun, J. J., Quartermas Apr. 22, Shell wounds left arm and Apr. 22, Amp. left arm, upper third, Discharged November 17, ter, U. S. S. Oneida, age 1862. thigh. 1862. and left thiizh at junction 1862; thigh stump un 33. of upper and middle thirds. healthy. 58 Arms, A. J., Pt, H, 71st July 2, Shot fracture right arm and July 2, Amputation of right arm Died July 3, 1803. Now York. 1863. middle third femur. 1863. and of thigh. 59 Cramer, S., Pt., B, 142d July 1, Shot wounds left arm and July 1, Amputation left arm and Died July 9, 1863. Pennsylvania. 1863. thigh. 1863. thigh. 60 Jackson , II., Pt, E, 4th Sept. 20, Shot wounds left arm, lower Sept, 20, Amputation lower third left Died October 11, 1864, of ex Colored Troops, age 23. 1804. third, and left thigh, mid 1864. arm and middle third left haustion. die third. thigh. 01 Xickinson, A.. Pt., G, 52d July 3, Comminuted fracture middle July 3, Amp. arm at junction upper Died July 19, 1863. North Carolina. 1883. third humerus and lower 1863. and middle thirds; thigh third tibia and fibia; con- at lower third. Sure:. C. S. oidal ball. Wood. 66th New York. 62 Reed, F., Pt., A, 53d 111... July 12, Shot injury of left arm and Amputation left arm and Died August 12, 1803. 1803. knee joint. thigh. 03 Thorn, T., Lieut., D, IGth July 3, Shot wounds of right thigh July 4, Amputation of right arm Died July 30, 1S63, of py- Norih Carolina, ago, 30. 1803. and light arm. 1863. and right thigh. scmia. 64 Wilson. J., J t, 2IstN. Y. Mar. 27, Shot fracture left femur and Primary. Amputation left arm and Died March 27, 1865. Battery. 1805. left humerus. left thigh. Surg.C.Winue, 77th Illinois. 05 Bierce, P.. Pt., A. 1st Ohio Nov. 13, Shell wounds left elbow joint Nov. 13, Flap amputation left arm at Discharged August 29, 1864 ; Artillery, age 20. 1863. and left leg; also wounds 1863. middle third and left log good stump in 1870. right leg and left thigh. at upper third. Surg. G. H. Bane, 115th Illinois. 66 Martin, L., Pt, E, 29th July 30, Shot fractures left leg, right July 31, Flap amp. at upper third of Disch d December C, 1865; Colored Troops. 1804. arm, left shoulder, and 1864. right arm, and circ. atlow r sound stumps. face, by conoidal balls. third of left lets. Surg. D. MacKay. 29th ( . T. 07 Part tan, J., Pt., D, Philip s Mav G, Shot fracture right arm and May 6, Amp. middle third right arm Recovered. Georgia Legion. 1804. right leg. 1804. and lower third ri;;ht log. 68 Smith, II., Pt., E, 11 Ver Sept. 13, Shell fracture left elbow joint Sept. 13, Flap amputation loft arm at Sopt. 20, secondary haem.; mont, age 19. 1861. and left leg; both limbs 1864. lower third and left log at ant. tib. art. lig. Disch d almost shot off. upper third. Surg. C. B. September 14, 1865; good Park, llth Vermont. stumps. 1 GALLOUPE (T. F.), Army Medical Intelligence, in Boston Medical and Surgical Journal, 1803, Volume xviii, p. 205. 2 GROss (S. W.), Original communications in American Medical Times, 1804, Volume VLU, p. 122. 884 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. NAME, AGE, AND MILI TARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA OPERATION, OPERATOR. RESULT AND REMARKS. TION. 69 Thornton, J/. L., Pt,, E, Oct. 19, Shot comminution right el Oct. 19, Amp. at middle third right Transferred to Provost Mar 31st Georgia, age 22. 1804. bow and right ankle joints. 1804. arm, and circular amp. at shal April 8, 1865. lower third leg. Surg. G. G. Button, 81st Georgia. 70 Bryan, M.W., Pt., , llth Aug. 7, Shot fracture right foot and Aug. 7, Amputation of right leg and Died September 6, 1864. Michigan. 1804. arm. 1804. arm. 71 Crowuirigshu lds.L. C.,Pt., Dec. 25, Shot fracture left arm and On field . Amputation left arm and Died January 11, 1865. G, 142d New York. 1804. i ight leg. right leg. 72 Grossman, W., Pt., C, llth May 8, Shell wounds right arm and Primary. Amp. right arm and right leg. Died August 3, 1864. Pennsylvania, ago 23. 1804. right leg. Surg. W. Lyons, llth Pa, Res., and B . Rohrer, 10th Pa. Res. 73 Jullivett, N., Pt., D, 98th Sept. 29, Shell wounds left arm and Sept. 30, Amputation left arm near Died October 9, 1864, of ex New York, age 18. 1804. right leg. 1804. shoulder and right leg in haustion. middle third. Asst. Surg. J. A. Bigelow, 8th Conn. 74 Piuney, A. N., Capt., II, July 30, Shot fracture of right hu- July 30, Circular amputation of arm Died August 8, 1864. 27th Colored Troops. 1804. morus and right leg. 1804. in middle third and leg. Surg. G. J. Potts, 23d C.T. 75 Pool, J., Pt., B, 16th Ga.. . July , Shot wounds of leg find arm Amputation of leg and arm. Died Julv 6, 1803. 1803. 70 Ray, S.. Sergt , D, 84th Sept. 2, Shot fracture leg and arm . Sept. 2, Amp. of leg and arm. Surg. Died September 6, 1864. Illinois. 1804. lf-04. T. M. Cook, 101st Ohio. 77 Taylor, S. J., Pt., E, 30th Alabama, age 22. Dec. 10, 1804. Shot fracture right humerus and elbow joint and left Dec, 17? 1804, Ant.-post. flap amp. at lower th d of arm. A. A. Surg. E. Died April 8, 1865, of chronic diarrhoea. tarsus. Jan. 20, AVoodruff. Circ. amp. at 1865. lower third of leg. A. A. Surg. W. M. Hodman. 78 Brown, P. W., Pt., I, 15th Sept., Shot wounds left leg and Amputation of Irft le <r and Virginia. 1802. arm. arm. 79 Schouc.-kles, F., Pt., G, Dec. 13, Comminuted fracture upper Dec. 19, Amp. in upper th d ri t arm, Died. 2d Delaware. 1802. third light humerus and 1862. and Piroiroff s amp. at ri t bones right foot by can ankle joint. Surgs. C. S. non ball. AVood, 00th New York, and C. Gray, 7th New York. 80 Fuller, II. D., Pt., F, 28th Oct. 19, Shell wounds left forearm, Oct. 20, Flap amp. at lower third left Discharged June, 21, 1805. Iowa, ago 16. 1864. upper third left foot, and 1864. aim, and Chopart s amp. Spec. 4226, A. M. M. right tibia, middle third. of left foot. Surg.J.AV. H. Vest, 28th Iowa, 81 Wimpfler, S., Pt., C, 9th Nov. 25, Shot wounds left forearm Primary. Amp. at left dhow joint and Died December 9, 1863. Ohio. 1863. and left foot, at lower third of left let?. 82 Clark, G. W., Pt., E, 12th May 9, Fragment of shell commi May 9. Amputation in right fore Discharged June 2, 1865. New Hampshire, age 25. 1804. nuted right forearm and 1804. arm and in middle third lower third right femur. of right thijjh. 83 Costdlo, 1 ., Corp l, E, 83d June 10, Shot wounds right thigh and June 12, Amputation right forearm 1 J Mustered out Aug. 10, 1805. Indiana. 1804. right foreaim. 1804. inch above wrist and of right thigh 4 inches above knee. Confederate surgeon. 84 Fay, J. S., Pt., F, 13th Massachusetts. Apr. 30, 1803. Shell fractures i ight forearm and right knee. Apr. 30, 1803. Amputation mid. th d right forearm and low. th d ri-jht Disch d September 9, 1803; stumps sound in 1SGG. thigh. Surg. A. W. AVhit- ney, 13th Massachusetts. 85 Kretzler, A., Corp l, D, June 14, Sh ell fractures righ t forearm . June 14, Flap amp. low. 3d light fore Disch d Aug. 29, 1863. Died 162d New York. 1803. right knee, and lower jaw. 1803. arm and ant. post, flap low. July 8, 1876. of phthisis. th d light thigh. Surg. W. B. Eager, 102d New York. 86 Lawrence, C., Corp l, E, June 10, Shell wounds, fracture left June 10, Circular amp. mid. third left Discharged Nov. 21, 1803. 9oth New York. 18t3. ulna and fifth metacarpal 1803. forearm and lower th d left bone and opening left knee thigh. Surg. E. S. Hoff joint. man, 90th New York. 87 Jecko, P., Serg t, D, 15th Nov. 29, Shot fractures right wrist Nov. 29, Circ. amp. lower third right Discharged July 31, 18G5. Missouri, age 29. 1804. joint and lower third right. 1864. forearm, and flap amp. mid. leg. third r t leg. Surg. Graves, Gth Arkansas, C. S. A. 88 Bendall, B. F., Pt., F, 53d July, Shot wounds left forearm and Amputation in left forearm Died August 6, 18C3. Virginia 1803. right, leg. and right leg. 89 Price, II., Pt.., B, 1st New Jersey Artillery, age 25. Julv 3, 1803. Shot fractures nght forearm and right leg. July 4, 1803. Amputation hi upper third right forearm and lower Colliquat i ve diarrhoea. Died August 23, 1803, of exhaus third right leg. tion. 90 Kearney, J., Serg t, I, 70th July 2, Shell shattered lower th d ri t July 2, Circular amp. June. mid. and September 25, gangrene in New York, age 30. 1803. thigh and carried away r t 1803. lower thiid r t thigh and 1st stum]). Discharged July G, thumb, fracturing metacar metacarpal bone at middle. 1804. Spec. 4366, A. M. M. pal bone. Surg. G. AV. Metcalf, 76th New York. 91 Waters, W., Pt., K, 123d New York. MavlS, 1864. Large, fragment of shell car ried away left thigh and May 15, 1804. Amputation at. left hip joint and in middle third right Survived but a short time. Died May 15, 1804. (See fractured right leg. leg. Surgeon J. AV. Brock, CASE 280, p. 135, ante.) CGth Ohio. 92 Allen, S..Pt,,G, 59th Mas June 17, Conoidal ball comminuted June 17, Amputation in lower third Flabby granulation; profuse sachusetts, age 1!). 1804. both knee joints. 1804. both thighs. suppu n. Died June 27, 64. 93 Baglry, S., Pt., B. 5th New Anr. 7, Conoidal ball comminuted Aprils, Circular amp. mid. th d right Julv 5, pus burrowing about Hampshire, age 21. 1865. both condyles right femur June 3, thigh. Sur.W. O Menglier, both thighs Died July 10, and head left tibia. 1805. G9th N. Y. Ant.-post. tlap 165, of exhaustion, tipec. amp. left, thigh, juuc. lower 4232, A. M. M. and middle thirds. Surg. O. A. Judsou, U. S. V. 94 Dowd, T., Serg t, C, 2d Julv 30, Shot wound both thighs. Julv 30, Amputation mid. third both Died July 3 1,1864. Michigan. 1864. 1864. thighs. Surg. AV. B. Fox, 8th Michigan. 95 Good well, S., Pt., G, 29th Mar. 30, Shot fracture both thighs. . . Mar. 30, Amput n both thighs. Surg. Died March 31, 1865. Illinois. 1865. 1865. W. D. Murray, 101st N. Y., and J. W. Aiigel, -Jlid Wis. 90 Earner, n., Pt,, 4th Vir July , Wounds of both thi rr hs Amputation of both thighs. Died July 6, 1863. ginia. 1863. 97 Michael, U. S., Pt,, A, 105th July 3, Shot wounds of both legs .. Julv 3, Amputation in lower third Died July 10, 1863. Pennsylvania. 1863. 1803. both thighs. CHAP. XII.] DOUBLE AMPUTATIONS. 885 No. NAME, AGE, AND MILITARY DESCRIPTION. DATE OF INJURY. NATURE OF INJURY. DATE OF OPERA TION. OPERATION, OPERATOR. RESULT AND REMARKS. 98 Mills, \V. F., Pt., E, 8th June 16, ! Shot fracture of right femur June 16, Amp. both thighs, lower Died June 23, 1864. New York Heavy Artil 18G4. and left knee joint 1864. third. Surg. S. H. Plumb, lery, a< o 42. Sid N. Y. 99 Moore, J., Pt., E, 4Gth Aug. 9, Fract. int. condyle right fe Aug. 15, Double flap amputation low. August 26, nervous shock Pennsylvania. 18U2. mur, and right leg below 1862. third both thighs. Surg. from fright. Died 1 hour joint also wou ds 1 t thi^h. J. E. Summers. IT. S. A. afterward. August 2(i. 1S62. 100 Myer, C., Pt., F, 30th Mis June 4, Couoidal ball fractures both June 4, Double flap amputation both ! Died June 5, 18G3. souri. 1803. thighs. 18C3. thighs. Surg. M. W. Rob- bins, 4th Iowa. 101 Nicholson, D.. Pt., H, 22d May 10, Shot wounds of both thighs May 10, Ant. post, flap amput n both Stumps unhealthy, tendency Massachusetts, age 23. 1864. by conoidal ball. 1864. thighs at low. third. Surg. to slough. Died May 28, J. Thomas, 118th Penn. 1864. Spec. 2966. A. M. M. 102 Nuncngrr, G., Pt., A, 58th Shot fracture both thigh? - . . . Amputation of both thighs. . Died August 17, 1862. 103 Virginia. Rabbitt, E. C., Serg t, B, 10th Missouri. Nov. 24, 1803. Shot wounds of both knee joints. Nov. 25, 1863. Amputation lower third both thighs. Surg. E. J. Buck, Died December 26, 1863. 18th Wisconsin. 104 Stewart, ,T., Pt., D, 77th Mar. 25, Shell fracture both legs Mar. 25, Amputation in lower third Died April, 1865; pya3mic in New York, age 38. 18G5. 1865. both thighs. toxication. 105 Tieman, H., Pt., C, 119th June 21, Shot wounds of both thighs. . June 21, Amputation of both thisrhs. Died July 3, 1864. New York. 1864. 1864. Surgs. G. P. Oliver, lllth Penn., and J. V. Kendall, 149th New York. 106 Wallace, D, Pt,, I, 5th Ar July 1, Conoidal ball shattered pa July 4, Circular amputation lower Died August 2, 1863. Specs. tillery. 1863. tella of right and coudyles 1863. third both thighs. 1383, 1384, A. M. M. of left knee joint. 107 Whelpley, J., Lieut., D, 1st Mar. 25, Solid shot carried off both Mar. 25, Amputation in lower third Died March 25, 1865. AT iiiio * 1865. lo tr s. 1865. both thighs. 108 Woodwortb, J. W., Corp l, Nov. 7, I Shot compound fracture mid. Nov. 7, Amputation at middle third Died November 8, 1863. H. llth Infantry. 1863. third both thighs. 1803. both thighs. 109 Dunn, M., Corp l, II, 4<ith May 25, Grape shot passed through May 26, Amputation both thighs, low. August, 1864, re-amp, right Pennsylvania, ago 21. 1864. both legs just below knee 27, 1864. third. A. A. Surg. S. Teats. thigh, mid. third. Disch d joint. Aug. I , 18G5. Died Oct. 23, 1877. Spec. 3193, A. M. M. 110 Parker. J.A., Pt.,L Cobb s June 24 Shot wounds of both thighs Amputation of both thighs . . Furloughed August 2, Ifc64. Georgia Legion. 1864T 1111 Rush, r. G.,Pt.,G, 21 Geor Mar. 25, Shell comminution left knee Mar. 25, Ant. post, flap amp. low. th d Released Aug. 2, 1865. Spec. gia, ago 22. 1865. joint and right leg. 1865. both thighs. Surg. L. W. 3998, A. M. M. Bliss; 51st New York. 112 Laphani, C. N., Corp l, K, Julv 8, Both legs carried away by July 10, Ant. post, flap amp. middle Discharged August 25, 1864. 1st Vermont Cav., age 23. 18ti3. solid shot; extensive com 1863. third right thi ih and at left minution. knee joint. Surgeon L. P. Woods, 5th New York Cav. 113 Barker, J., Pt., I, 5Sth June 17, Conoidal ball wounded right June 17, Oval flap amp. lower third Died June 27, 1864. Massachusetts, atre 42. 18G4. knee-joint and left leg. 1864. rig t thigh and 1 t knee j nt. 114 Smith, H., Pt., 1, 14th New June 7, Shot wounds right thigh and June 7, Flap amputations at lower Died June 17, 1864. Jersey, ago 24. 1864. left leg. 1864. third right thigh and at left B knee joint. 115 Brown, 11.. Pt., K,22d Col July 30, Shell fracture both legs . . . July 30, Amputation right leg in up- Discharged March 20, 1865. ored Troops, age 19. 1864. 1864, per third ; double flap am Died July 14, 1872. Mar. 19, putation left thigh, lower 1865. th d A.A.Surg.O.Shittler. 116 Housley, H., Cook, F, 33d Apr. 2, Shell fracture right kaee Apr. 11, Amp. right thigh, lower th d, Sent home July 23, 1865; Wisconsin, ago 20. 1865. joint and left leg, mid. th d. 1865. and left leg in upper third ; not a pensioner. antero-post. skin flaps and circ. sect, muse. Surg. F. E. Piquette, 86th C. T. 117 Banks, S., Pt., C, 43d C. T. July 30, Conoidal ball fractured left Julv 30, Amp. mid. th d r t thigh and Died July 31, 1864. 1864. leg and right thigh. 1864. of left lesr, lower th d. Surg. D. MacKay, 29th C. T. 118 Bradley, P., Serg t, C, IGth Aug. 21, Shell fracture left knee joint Aug. 21, Amp. lower third left thigh Died September 16, 1864. Michigan. 1864. and right leg. 1864. and upper third right leg. 119 Foss. J., Serg t, C, 50th N. Sept. 17, Shot wounds both legs and Sept. 17, Amputation of thigh and Died September 21, 1862. York. 18G2. left arm. 1862. leg. 120 Hess, T. W., Pt., K, 8th Sept. 30, Kluit f r:u t,iirr>s lpfY, Iprr and Amputation of left leg and Died October 7, 1864, of irri North Carolina. 1864. right thigh. of right thigh. tative fever. 121 Johnson, C. L., Pt., B, 1st Au;r. 6, Compound shot fracture left Aug. 6, Amputation in low. third left Died August 21, 1864. Tennessee. 1861. leg, inv. knee joint, and 1864. thigh and upper third right riiiht leg, lower third. leg. 122 Lamphere, L. O., Pt., G, June 30, Shell comminution lower end June 30, Amp. lower third left thigh Died July 22, 1864,of tetanus. 21st Connecticut. 1SG4. left femur and right foot 1864. and lower third right leg. and ankle. 123 Lewis, J. K., Pt., H, 53d Julv , Shot wound left knee joint July , Amp. left thigh, lower third ; Died July 10, 1863. Georgia, age 32. 18G3. and fracture right leg. 1863. ri t leg at point of election. Surg. J. J. Knott, P. A. C. S. |124 Birmingham, A., Lt., A, Dec. 13, Shot wounds right knee and Dec. 13, Amp. right thigh, and Piro- Died December 17, 1862. 69th New York. 1862. left foot. 1862. gotf s amp. left ankle joint. 125 Alexander, J. W., Corp l, Dec. 11, Shot fracture both legs Dec. 11, Amputation of both legs. Recovered. K, 13th Mississippi. 1862. 1862. Surgeon Gilmore, C. S. A. 120 Hartram, W. H., Pt., F, 1st Sept 17 Shot fracture both legs . 1 Amputation of both logs . . Furloucrhed Sent. 23. 1864. North Carolina. 1862. 127 Fisher, E. II., Lieut.. A, Oct. 20, Wound of both legs by ex- Oct. 20, Amp. both legs. Surg. E. 1 Discharged November 20, 21st Indiana. lb 62. plosion of a shell 1862. Bead, 21st Indiana. 1863. 19Q 1JO Gordon, J., Teamster, Q. Aug. 30, Shell wounds both legs, low. Sept, 1, : Amp. both legs, lower third. Recovered. M. I) , age 38. 1862. third. 18G2. ! A. A. Surg. M. J. Davis. 129 Higginbotham, E. U., 1 t., Mav 12, Shot fracture of both legs... I May 13, Amp. mid. third, both legs. Recovered. F, 38th Georgia, 1864. 1864. Surgeon Arrington,C. S. A. 130 Kopp, E., Pt., K, 12th New Mar. 25, Shot fracture, of hoth tibiae Mar. 26, Flap amp. low. third right April 1G, protruding bones Jersey, age 32. 1865. and left ankle joint, 27, 1865. and mid. third left leg. Sur removed from stumps. ge on s A.. Sat terth wait e, Discharged Oct. 3, 1865. 12th N. J., and W. J. Burr. 131 l Lorence, J., Corp l, K, 9th Fob. 8, Shot wounds of both legs by Feb. 8, Flap amputation both legs, Discharged September 30, Now Jersey, age 35. 1862. cannon ball. 1862. up. third. Surgeons J. H. 1862; 1875, knee joints Thompson, U. S. V., and II. without motion, stumps | ! W. Rivers, 4th R. I. very tender. 1 THOMPSON (J. II.), Report of cases occurring at the battle of Roanoke Island, Va.; in Am. Mcd. Times, 1802, Volume IV, p. 199. 886 WOUNDS AND COMPLICATIONS. [CHAP. XII. No. NAME, MILITARY DESCRIPTION, AXD AGE. DATE OF IXJUIIY. NATURE OF IKJUUY. DATE OF OPERA TION. OPERATION AND OPERATOR. RESULT AND REMARKS. 132 Lee, D., Pt., G, 2d N.Y. June 1C, Shell injury of hoth legs . . June 16, Circ. amp. lower third, both Disch d May 31, 1865 ; died H. A., aj;e 20. 1804. 18Ct. legs. Ass t Surgeon 0. S. September 25, 1874. Paine, 2d N. Y. Art. 133 Page,P.,Pt. 1 K,3ilMicb .. Apr. 1C, Shell wounds of hoth legs. Apr. 1C, Circular amp. at lower third, Discharged August 16, 1802. 18G2. 1802. both legs. 134 Scott. J. G., Pt., D, 77th May 6, Shell fracture of both legs . . . May 6. Flap amp. both legs. Snr. Disch d Nov. 3, 64; 79, rig t New York, age 23. 1H61. 186.4. E. B. P. Kelly, 95th Pa. leg ream putated. Spc. 513. 135 Smith, A. A.,Pt,, A, 3d R. Apr. 8, Fracture of both lesrs by ex Apr. 9, Flap am p. upper th d left leg. Discharged August 25, 1804. Island Art., age 23. 1S63. plosion of magazine stmr. July 31, Surgeon F. L. Dibble, 6th Spec. 1103, A. M. M. G. Washington. 1863. Conn. Circ. of right leg. A. A. Surg. J. W. dishing. 136 Snettings, E. A., Pt., Not- June22, Shot fracture both le^s ..... June 22 Amp. mid. th d left, and low. Recovered. taway s Artillery. 1864. 1864. th d right leg. Confed.surg. 137 Starin, F.,Pt., C, 43d Wis Nov. 5, Shell wounds mid. th d right Nov. 5, Flap amp. upper third right Discharged July 2, 1865. consin, age is*. 18G4. and low. third left leg. 1864. and lower th d left leg. 138 Stewart, T. B., Pt., 0, 2d Sept 19, Shell wounds both feet, com- Sept. 23, Circular amputation lower Discharged August 17, 1865. Conn. H. A., age 31. 1864. minut gall thetarsal bones. 24, 1864. th d both lesis. Ass t Sursr. !. G. Thompson, 77th N. Y. 139 Tanner, J., Corp i, C, 87th Ann. 30, Shell wounds both legs Ausr.30, Flap amputation upper th d Discharged Oct. 15, 1802. New York, age 18. 1802. 1802. both legs. 140 Trim, S. H., Pt,, B, 41st Mav 21, Both legs torn off near ankle Mav 21, Circ. amp. both lesrs. Surg. July 13, 1864, recovered ; Alabama, age 19. 1861. by explosion of shell. 1864. D. Jackson, 44th Tenn. furloughed. 141 Troy, B. F., Pt., G, 10th May 1C, Shot wounds both legs May 16, Amp. right leg 4 inches, and Discharged Sept. 3, 1803 ; Iowa. 1803. 1863. left leg 8J ins. below knee. sound stumps in 1870. 142 Willson, S. L., Pt, D, 72(1 July 2, Shot fracture both legs, lower July 3, Flap amp. up. third both legs. Discharged May 31, 1805. New York, age 18. 1803. third, by conoidal hall. 180!. Surg. C. K. It-win, 72d N. Y. 143 Albeit, I., l t.,F, 91st New- Oct. 12, Shot wounds of lower third Oct.. 19, Amputation in upper third Died November 4, 1804, of York, age 19. 1804. both legs. 1864. both legs. pytemia. 144 Anderson, D., Corp i, II, Au"-.21, Shell wounds both le^s Aug. 21, Amp. both legs. Surg. W. C. Died October 1, 1804. 7th Maryland, age 41. 1804. 1804. Shurlock, 51st Penn. 145 Arkerson, A., Pt., D, llth June 17, Shot fracture both legs June 18, A mputation of both legs . Died June 19, 1864. Infantry. 1804. 1M54. 140 BT iukmann, A., l t.,G,79th Aiisr. 11, Shot fracture both le^s An". 11. Amputation of both legs. . . . Died August 12, 1864. Pennsylvania. 1804. 1804. 147 Cookscy, A. J., Pt, D, 3d Dec. 15, Shot wounds of both legs . . Dec. 16, Circular amputation in mid Died January 2, 1865, from Mississippi, age 35. 1864. 1864. dle third both legs. exhaustion. 148 Daniel, J. P., Coip l, H, Shot wounds of both ankles. Second Amputation of both le^s Died September 30, 1803. llth Virginia. ary. 149 Flciuming. C., Pt., A, 35th Dec. 13, Shell fracture both legs Dec . 13, Amputation of both legs . Di:d December 21, 1862. New York. 1802. 1862. 150 Luallen, J., Pt., D, 13th Jan. 15, Shot fracture of both legs. . . Jan. 15, Amp. of both legs. Surg. L. Died January 23, 1865. Indiana. 1865. 1865. Barnes, Gth C. T., and As sistant Surg. n. C. Merry- weather, 5th C. T. 151 MoCurdle, J., Pt., E, 2d July 2 Shell injury both le^s July 2 Amp. left leg near knee and Died July 3, 1864. Penn. Artillery, ago 23. 1804. 1804. light leg near ankle. 152 Manson, J. P., Pt., A, 121st Dec. 13, Shot fracture of both legs . . Dec. 13, Flap amputation both legs Died December 25, 1862. Pennsylvania. 180:?. 1802. below knee. 153 Nason, ll.,Pt..C, 1st Khode Nov. 30, Cannon ball took off both legs Dec. 2, Circularamp. lower ri^ht 3d; Died December 21, 1803, of Island Artillery, ago 38. 1803. just above ankles. 1803. flap at middle 3d left leg. pyajtnia. 154 Nock, P., Pt,, E. 1st La., Mav 27, Both feet carried away by May 27, Both legs amputated Died May 27, 1803. att ch d to 1st Me. Batt v. 1803. cannon bull. 1863. 155 Paine, A., Pt., 42d New July 2, Fracture of both feet by solid July 3, Amp. low. 3d both legs. S g. Died July 23, 1863. York. 1863. shut. 1863. H. M. Me A bee, 4th Ohio. 150 Randell, A., Pt., C, 35th Dee,. 13, Shell fracture both legs Dec. 13, Amputation of both legs . . . Died December 15, 1862. New York. 1802. 1802. 157 Rath, 11. A.. Pt., F, 52d Shot wounds both le^s ..... Amputation of hoth logs. . . . Died January 8, 1803. North Carolina. 158 S B Corp i 3d Md Shot fracture upper third left Feb. 10 Amp. throu (r h middle third Died March 12, 1805. Battery, age 37. femur; mortification. 1805. of both legs. 150 Shearer , F., Pt., A, I!5th Dec. 15, Shot fracture both legs Dec. 15, Amputation of both legs Died December 16, 1804. Indiana. 1804. 1861. 100 Smith, 1 ., Serg t, K, GDth AiiL .lC, Shot wounds of both feet by Sept, C, Circ. amp. both leus, lo r 3d. Died Oct. 11). 18(54, of exhaus New York, aste 30. 1804. conoidal ball. 1864. A.A.Surg J. A.IIutchinson. tion. Spec. 3li44, A. M. M. 101 York. M.,I t.,E, 12UthNew July 2, Cmiiiidal ball fractured both Julv27, Amp. both legs. A. A. Surg. Died August 8, 1>-03. Spec s York, nj-e 20. 1803. ankles. 28, 1803. F. llinklo. 1005,1601), A.M. M. 162 Carpenter, J . J.. Pt., D, Shot wounds both legs Amputation of both legs intli Viruini i. 103 Johnson, J. M , Pt,, C, 3d June 3, Shell wounds right leg and June 3, Amp. mid. th d right leg, and Discharged Juno 8, 1805. Delaware, age. 31. 1801. left foot. 1804. Svine s amp. 1 ft ankle i t. Surg. D. E. Wolfe, 3.1 Del. 104 1 Unknown, C. S. A Shot wounds of both legs . . . Primary Lenoir s am. in leg, and Piro- Flaps of ankle joint; stump goff samp, in. therankle j t. sloughed. Died. Surg. J. L 1 . Gilmore.C. S. A. 105 Bums.ir.lnor, S., Serg t, F, Sept. 22, Shot wounds of both feet . . . Sept. 23, Amp. left leg, mill, third, and Disch d November 4, 1805; 14l h \V. Virginia, r.ge 35. 1804. 1*04. r t ft by Ch(ip:irt smethod. tender stumps. ICC Martin,.!., 1 t., L, 2d N. Y. June 10, Shell wounds right leg and June 16, ( ire. amp. mid 3d r t. leg and Disc-h d November 11, 1804. 11. A., age 21. 1MJ4. left, foot. 1804. four toes of left foot. Mav, 1805, reamputation right leg. 167 Sadl y, A. D, Serg t, G, Dec. 11, Shut fracture right leg and Dec. 11, Amp. of right le<r and left Recovered. 21st Mississippi. 1802. left foot. 1*02. foot. Surg. Hill. C. S A. 1G8 Williams. U., Pt ,K. 198th Apr. 9, Shell wounds left leg and Apr. 9, Circ. amp. low. third left leg, Discharged October G, 1805; Pennsylvania, ago 2J. 1805. right foot. 1805. and List ranc s amp. r t foot. parts entirely healed. Surg. II. A. Grim, 198th Pa. 109 Hicks, 11. F., Pt., A, 1st R. Dee, 13, Shot wounds of both feet . . . Dec. 14, S.vmo s amp. at r t and Piro- Disch d September 24, 1803. Isl.ind Artillery. ISO. . 1802. goff s at left ankle joint, 170 Chirk, II. W..PL n, 100th May 13, Solid shot fractured both May 13, Syme s amp. left ankle, Cho- Disch d December 13, 1801. New York, age 3U. 1804. feet. 1804. part s amp. r t font. Surg. Spe. 2857, A.M. M. M. S. Kittinirer, imith X. Y. 171 Carpenter. J. AV., Serg t, I, June 3, Conoidal hall injured both June 3, Hey s amp. left- foot, anil 1st Died Juno 15, 1801. 30th Vcvmout. 1X04. feet. 1804. toe and met. bone r t foot. 172 Rowland, S , Serg t, A, 48th Mav 3, Shot wounds of both feet Amputation of both leet Died Juno C, 1803. New York. 18C3. 1 IIoi-LOWAY (J. M ), Comparative Advantages of PlUOGOFF s, SYME S, and CIIOPAUT S Amputations, etc., in Am. Jour. Mcd. ScL, 1805, Volume LI, pp. 85, 8(5. 2 Slimi (S.), Amputations at the Ankle Joint in llilitarg Surgery, in TJ. S. San. Com. Memoirs, 1871, Surg. Vol. II, pp. 110, 140. CHAP, xm.] ANAESTHETICS. 887 III. It was impracticable to determine the total number of cases in which anaesthetics were employed during the war, but as near as can be ascertained they were used in no less than eighty thousand (80,000) instances. Time and clerical assistance did not allow of the examination of this enormous number of cases in detail, and in treating of this subject we must confine our remarks to the number of major operations in which the agents used were definitely ascertained. Of eight thousand nine hundred cases chloroform was used in six thousand seven hundred and eighty-four, or 76.2 per cent., ether in one thousand three hundred and five, or 14.7 per cent., a mixture of chloroform and ether in eight hundred and eleven, or 9.1 per cent. These percentages differ somewhat from the percentages given in the preliminary report, 1 where it was stated that chloroform was used in 60 per cent., ether in 30 per cent., and ether and chloroform in 10 per cent.; but at that time the per centage of the different agents had been principally derived from the reports of general hospitals, and in which ether was frequently used. When, afterwards, the operations performed in the field hospitals were examined, where chloroform was almost uniformly used, the percentage of the cases in which the latter agent was employed increased to 76.2 per cent., as above indicated, while the number of cases in which ether or the mixture of ether and chloroform was used was proportionally decreased. The inestimable value of the use of anaesthetics in military surgery will hardly be denied at this date, although it has been claimed that the effect of anaesthetics in the treat ment of shot injuries are deleterious, inasmuch as they add to the depression caused by the shock, and retard union by first intention, and predispose to haemorrhages and pyaemia. It is possible that in two hundred and fifty-four cases in which it was asserted that no anaes thetic was given the surgeons were actuated by such objections, as no reasons have been assigned why anaesthetics were not administered. How far the use of anaesthetics has con tributed to the saving of life during the late war it is impossible to say, as we have no statistics to make this comparison. It maybe stated, however, that their use has undoubt edly influenced the favorable percentages of mortality after major operations pointed out in different sections of this and the preceding volumes. From the rapidity of its effects, and from the small quantity required qualities which can only be appreciated at their proper values by the field surgeon when surrounded by hundreds of wounded anxiously awaiting speedy relief chloroform was preferred by nearly 1 Circular Xo. (i, War Department, Surgeon Ot iienil s Oflico, Washington, November 1, 16Cd. ANAESTHETICS. [CHAP, xiii all the field surgeons, and their testimony as to its value and efficacy is almost unanimous, although all recommend the greatest care in its administration. It is, perhaps, best to allow the different medical officers to speak for themselves on this subject: Surgeon G. J. Walton, 21st Kentucky, administered "chloroform in every painful operation, but did not keep the patients under its influence longer than was absolutely necessary, withdrawing it as soon as the cutting was completed. * * * While I could not dispense with chloroform, I must protest against the extravagant and indiscreet use of it. It is a most potent agent, and should be used with the utmost caution. In no case were we displeased with its effect." Surgeon B. B. Breed, U. S. V.: "Chloroform was almost universally employed as an anaes thetic, and without bad effect in any case. Whenever practicable, I employed ether in preference to chloroform, preferring, both from personal experience and observation, the delay and discomfort in its administration to the possible danger from the use of the latter. On the field of battle, however, chloroform is the safe and preferable agent." Assistant Surgeon C. Bacon, jr.: "The anaesthetic I have seen used has invariably been chloroform. Among the great number of cases in which I have witnessed its administration I have seen but one death resulting from its use. I have, however, frequently seen cases in which its use required extreme care, and, at times, have been obliged to desist in its administration in cases of great exhaustion consequent upon long-established injuries. I have frequently seen the use of chloroform attended with bad results when improperly administered. As an anaesthetic I think chloroform should be given in prompt and efficient dose. The desired effect being attained, its administration should be discontinued; in this mannerless chloro form is required, thereby avoiding to a great extent its toxical effect." Surgeon D. P. Smith, U. S. V.: "I have in every instance but one, in the army, employed chloroform, and in but one case have I had reason to believe its use disastrous. In this instance it was given too profusely by an entirely incompetent person (since then dismissed from the medical corps) while I was amputating at the knee joint. The patient never reacted from the shock, but died about twelve hours subsequently." Assistant Surgeon J. T. Calhoun, U. S. A.: "I have always used chloroform as an anaesthetic, have given it, and have seen it given under my direction, and in the practice of other surgeons in an immense number of cases, and never saw a death from it, or, in army practice, even an alarming symptom. I am inclined to believe that in general practice the chief danger of choloform is that in its admin istration care is not taken to let the patient inhale sufficient air with it (a fact often due to the desire to be economical in its use), and the patients die, not from the chloroform, but from the want of oxygen." Surgeon U.S. Hewit, U. S. V.: "Chloroform was used freely with out any fatal accident. But I conceived that those cases did not finally do so well who were kept under its influence for a length of time; and I am of the opinion that when used the patient should be kept under its influence merely long enough to last through the severest part of the operation. I believe that when a patient is kept under its influence for a long time his chances of recovery are thereby lessened." The serious results following the use of chloroform, when "improperly" or "too long" administered, or when administered by "incompetent persons," referred to by several of the operators, will hardly be charged to the agent itself. In the reports of the surgeons in charge of base hospitals, sometimes the use of ether, sometimes of chloroform alone, or a mixture of both, is advocated. The most convenient and common form of administering anaesthetics was a cloth or paper folded in the shape of a cone, with a sponge in the apex. It was placed at some distance CHAP. XIII.] ANESTHETICS. 889 over the nose and mouth of tho patient to allow the first inhalations to become diluted with air, and then gradually advanced to the nose until anaesthesia was produced, when the inhalation was suspended. The method of Marshall Hall, by placing a double fold of mus lin over the mouth and nose of the patient and simply dropping the chloroform on it drop by drop, was found to be tedious, and inoperative in the open air, where many of the operations were performed, owing to rapid evaporation. In the southern armies, where chloroform was scarce, Surgeon J. J. Chisolm, find ing that much chloroform was wasted by these methods, employed a flattened cylinder two and a half inches long and one inch wide in its broadest diameter, having in one of its broadest surfaces a perforated plate. Attached to the cover are two nose pieces. When the instrument is not in use these projections can be pressed into the cylinder, thus diminishing the size of the instrument. In the interior of the cylinder is found a piece of sponge, or what is much better, a FIG. 424.-cms. bent wire, over which is folded a piece of cotton cloth. The chloroform when spec. 4910. dropped through the perforated plate is received upon the sponge or folded cloth, which offers an extended surface for evaporation. In reference to the propriety of giving alcoholic stimulants prior to the administration of ether and chloroform, the records of the war supply little definite information. They give simply the number of cases in which anaesthesia was induced, and frequently not even the name of the anaesthetic employed. In cases in which the effect of the anaesthetic was believed to have led to a fatal result special reports were made. These special reports throw little light on the question, since they include, in almost equal proportion, cases in which stimulants had, or had not, been administered prior to the inhalation of the anaes thetic. Some surgeons advise the use of stimulants prior to anaesthesia uniformly; others deprecate the practice except in rare cases, and others again discard it altogether. When there is extreme depression, alcoholic stimuli will of course be employed, in conjunction with other restoratives, to bring about reaction. But when the patient is in a fit state to undergo a major operation, a stimulant should not be given with especial -reference to the anaesthesia about to be induced, as it would seem that in the practice of surgeons who habitually employed the stimulants the patients were less readily anaesthetized. It would be better to reserve the stimulant as a restorative in the course or on the completion of the operation, that it may aid in reducing reaction instead of retarding the induction of anaes thesia. It has been stated that the nature of the anaesthetic employed was indicated in eight thousand nine hundred cases, viz: chloroform in six thousand seven hundred and eighty- lour, ether in one thousand three hundred and five, and chloroform and ether in eight hun dred and eleven cases. Of the six thousand seven hundred and eighty-four cases in which chloroform was used, death was ascribed to this agent in thirty-seven, or 5.4 per thou sand; L of the one thousand three hundred and five cases in which the anaesthesia was induced by ether, four deaths, or 3.0 per thousand; and of the eight hundred and eleven cases in CmsOLM (J. J.), (.1 Manual of Military Surgery for the use of Surgeons in the Confederate States Army, Columbia, 1864, pp. 429-30): ; Of the ; ny thousand instances of its administration since the war between the Confederate States and United States began, but two fatal cases from chloroform 1 ahition have been reported. In one, the patient died in a few minutes after inhalation was commenced. In the other, the patient did not die for several i irs. The case was that of a healthy young soldier who had a mini ball embedded under Hie scapula, and who, while en route to rejoin his command, c ppud at a hospital and desired its removal. The operation was very tedious, and he was kept under the influence of chloroform for one and a half 1 i irs. Although he regained his consciousness when the administration was stopped, his pulse never reacted, notwithstanding* the liberal use of brandy. A few hours after the operation was completed there appeared an increasing disposition to sleep, which gradually ended in coma, the pulse becoming more and more feeble. lie died thirty-two hours after the inhalation. As the operation affected no vital part, and us the health of the patient was good, his death could be attributed to no other cause than the inhalation of the chloroform." SUKG. Ill 112 890 ANESTHETICS. [CHAP. xm. which a mixture of chloroform and ether had been employed, two deaths, or 2.4 per thou sand, were charged to the anaesthetic. Brief abstracts of the fatal cases are given. Deaths from Chloroform. Thirty-seven cases were reported: CASE 1233. Surgeon M. K. Hogan, U. S. V., reports that Private Sylvester Anninger, Co. F, 147th New York, aged 27 years, received u shot fracture of the left leg, at Spottsylvania, May 12, 1834. He was at once carried to the field hospital of the 3d division, Ninth Corps. He died May , 1864, "under chloroform." CASK 1234. Corporal - - Ballon, Co. E, 14th Pennsylvania Cavalry, fracture of bones of right, hand, April, 1863. Operation for removal of fingers October 12, 1863. Chloroform inhaled without unpleasant symptoms ; upon removing index finger pain was evinced; small additional portion given and operation recommenced, when patient struggled violently; arterial haemorrhage ceased to How; tongue found to not have fallen back upon rima glottidis; usual means of exciting respiration applied; good current of fresh air; patient rolled from side to side; artificial respiration resorted to; spirit of ammonia applied to nostrils and cold water dashed on chest and face, without effect. In the opinion of Surgeon W. B. Wynne, 14th Pennsyl vania Cavalry, the operator, the patient was not under the effects of the anaesthetic five minutes before life was extinct. At the autopsy the lungs were found to be perfectly healthy; the heart presented some appearance of slight ossification. CASE 1235. Private J. Bradley, Co. D, 25th North Carolina; slight wound of patella; admitted into Chimborazo Hospital, Richmond, June 25th ; necrosis and gangrene. July 18th, amputation at junction of upper and middle thirds of thigh. There was but little blood lost, but the patient sank under the operation and expired a few minutes after its completion. It is remarked, upon an unsigned case-book, that "the chloroform may have, by its depressing effect, contributed to this unfavorable result, for it caused him to vomit freely, and he was unable to retain any stimulants in the stomach." CASE 1238. Private G. Budlinger, 76th Ohio, aged 30 years, admitted into hospital of 1st division, Fifteenth Corps, with a shot wound of hand; placed upon operation table and about a drachm of chloroform sprinkled upon four folds of patent lint applied to face, space being given for the free admission of air. After breathing it for a few moments quietly without any apparent effect, more chloroform was added and reapplied by a nurse in attendance (the surgeon having stepped aside for a moment), when, after six or seven respirations, the patient drew up his legs and arms convulsively, and heavy stertorous breathing came on. Chloroform removed immediately, and a few moments given him to resume his regular breathing, but the difficulty increased ; frothy exudation from mouth not caused by excess of saliva; respiration became more and more incomplete, pulse small and imperceptible, veins of neck and face prominently distended; heart action ceased before respiration had entirely stopped. Friction to extremities, cold water dashed in face, jugular vein opened, artificial respiration, without relief. The surgeons of the hospital reported, as the result of an autopsy, that "being unable to discover any other abnormal condition, and in the absence of further evidence, it may be proper to conclude that this is a case of apoplexy induced by chloroform." CASE 1237. Private J. G. Clarkson, Co. A, 35th Massachusetts, age 40 years, is reported by Surgeon F. M. Lincoln, 35th Massachusetts, to have died in hospital at Falmouth, Virginia, "from the inhalation of chloroform administered for the performance of an amputation," January 20, 1863. CASE 1238. Private J. Conley, Co. A, 90th Illinois, aged 18 years; shot fracture left ankle joint, Mission Ridge, Novem ber 25, 1853 ; ball lodged ; admitted into hospital No. 1, Nashville, February 4, 1863. Surgeon R. L. Stanford, U. S. V., reports that the patient "died from the effects of the chloroform at the time of the operation of extraction of the ball," and forwarded the specimen of the lower portions of the left leg, the astralagus, and calcaneum ; they constitute Spec. 3360 of the Suryical Section. CASK 1239. Private P. Conlin, Co. G, llth New Jersey; shot perforation knee joint, popliteal artery cvit ; Ream s Station, September 17, 1884 ; considerable haemorrhage ; patient in a very nervous state and having great fears of the result. Stimulants were given, and after he had rallied a little he was placed upon the table and chloroform administered. Plenty of fresh air was allowed during the administration and he passed through the usual stages necessary to insensibility, but died before the contem plated operation was commenced, having just reached the point of insensibility. The only observable symptoms which were unusual were the high state of nervous excitement while the chloroform was being administered and the very small quantity required to render him insensible. Methods for resuscitation freely used for half an hour without effect. A post-mortem exam ination revealed nothing abnormal in the size or appearance of the organs. CASE 1240. Sergeant S. Crumlaler, Co. A, 35th Virginia Cavalry, aged 44 years, was admitted into the Confederate hospital at Charlottesville in May, 1864, with a pistol ball perforation of the head of the humerus, received at the Wilderness, May 6th. On May llth chloroform was administered and the head of the humerus was excised. He is reported to have died May 16, 1884, "from the effects of the chloroform." CASE 1241. Private T. Donaldson, Co. E, 13th Ohio Cavalry, aged 19 years; shot injury left humerus, Poplar Springs, Virginia, October 8, 1884 ; admitted into hospital at Beverly, New Jersey. Necrosis of humerus. October 29, 1864, amputa tion of left arm at shoulder by antero-posterior flaps by Acting Assistant Surgeon J. C. Morton; chloroform used. Patient " died from the effects of the chloroform and nervous shock to the general system." The upper part of the humerus was for warded to the Museum by Assistant Surgeon C. Wagner, U. S. A., and is numbered Specimen 3708 of the Sunjlcal Section. CASK 1242. Private 1"). Flynn, Co. A, 18th Infantry, admitted into hospital No. 19, Nashville, January 5, 1863, with a compound fracture of fingers of right hand, received December 31, 1862. January 8th, chloroform administered with a due proportion of atmospheric air; patient was rather troublesome, struggled, etc. A relaxation of the muscles testifying to anaes thesia, the chloroform was suspended and the operation commenced; just after the formation of the anterior flap the patient commenced to breathe stertorously, and at that instant the brachial pulse suddenly ceased; there was an up and down movement of the thyroid cartilage, a swelling out almost to bursting of the external jugular veins, blue lips, a pupil insensible to light, and an ashy paleness. Cold water dashed in face, aqua ammonia to nostrils and upon thorax, tongue drawn forward with tenaculum. CHAP. XI;T 1 DEATHS FROM CHLOROFORM. 891 artificial respiration kept up, and the principles of Marshall Hall s method of respiration put into requisition, but without effect; patient expired after one or two long-drawn sighs. Amount of chloroform expended was about two drachms. No autopsy possible. CASE 1243. Private R. Gormley, Co. I, 7th New York Artillery, admitted into McClellan Hospital, Philadelphia, June 13, 1864, with a shot wound of the lower third of the right leg; ball lodged. On November 29th chloroform was administered with a view of removing the ball. The anaesthetic was given with great caution, and inhaled with perfect facility until the operation was nearly completed. Acting Assistant Surgeon W. E. Ely stated that "the patient s pulse continued good, and nothing of unusual interest presented itself until the incision had been made, when I was suddenly deterred from proceeding in search of the ball by a spasmodic rigidity of the muscles, such as generally occurs immediately before the point of complete anaesthesia is attained. The patient, who had up to this time appeared perfectly sensible of external objects, suddenly threw his head back and almost immediately expired. Cold water was dashed into his face, ammonia was applied to his nostrils, his mouth was kept open, and his tongue drawn forward, while Hall s ready method of artificial respiration was kept up for nearly an hour, but only with the effect of producing three or four long inspiratory efforts, when life became entirely extinct." Dr. Ely was assisted by Acting Assistant Surgeon A. S. Uhler. CASE 1244. Private Thomas Hamilton, Co. A, 1st Maryland Infantry, aged 31 years, admitted into Patterson Park Hos pital, Baltimore, June 25, 1864, with a gunshot wound of the hand. September 3, 1864, patient placed on table to undergo an operation for necrosis of the carpal bones. A sponge wet with chloroform was carefully held at first some three or four inches from the face, and at no time less than two or three inches. The patient inhaled for about five minutes and still remained con scious, frequently making some remark. He soon, however, commenced muscular efforts, such as are quite common with patients inhaling chloroform, except that the muscular contractions were more violent than usual. Before the contractions ceased the pulse grew feeble and the chloroform was withdrawn for two or three minutes; the breathing continued regular, only that the patient occasionally took a deep inspiration and expired forcibly, Ihen the muscles became relaxed; the operation was commenced; but the respiration soon commenced to fail and the pulse became imperceptible; the operation was stopped. All known means for resuscitation were resorted to, but life had fled. The friends of the deceased could only be persuaded to allow an examination of the heart. The organ was found of normal size and appearance; both auricles were distended with venous blood, but the ventricles were empty. A clot of white fibrin, streaked in some places with coagula of blood, was found in each auricle. CASE 1245. Private Robert Harris, Co. G, 132d New York, was admitted into Ward Hospital, Newark, New Jersey, May 4, 18(54. Surgeon George Taylor, U. S. A., reported that the patient died on May 20, 1864, while under the influence of chloroform administered for the purpose of amputating the leg. CASE 1246. Private John Johnson, Co. B, 2d Pennsylvania Heavy Artillery, a patient in Mower General Hospital, near Philadelphia, expired suddenly on May 13, 1865, while inhaling chloroform preparatory to undergoing a surgical operation. The case is reported by Surgeon J. Hopkinson, U. S. V. CASE 1247. Private John Kroft, Co. D, 7th New York, shot fracture leg, Petersburg, September 16, 1864. Admitted into hospital at Beverly, New Jersey, September 28th. Amputation of leg October 8th. On November 16th a second amputa tion was found necessary; at the previous operation sufficient chloroform was administered to produce complete anaesthesia without unpleasant effect. On the latter date chloroform was administered on a sponge, from one drachm to a drachm and a half in all not over an ounce was given. He had been upon the table about fifteen minutes when fatal symptoms were mani fested, and he died in from five to six minutes. An autopsy revealed no pathological lesions sufficient to account for death. Assistant Surgeon C. Wagner, U. S. A., reported the case. CASE 1248. William Laws, Co. E, 23d North Carolina, aged 24 years, shot wound of groin, fracturing tuber ischii; admitted in*o hospital No. 1, Frederick. October 28th, chloroform was administered to remove the fragments of the ischium. The chloroform was administered on a pocket handkerchief which was pressed firmly against the mouth of the bottle which was then inverted. Plenty of air was given, and the handkerchief was wet with chloroform but once. About a minute after the administration was begun almost complete relaxation was produced, and two stertorous respirations were observed, when the handkerchief was immediately removed. The pulse up to this time was undisturbed; the patient then took some ten or twelve deep and rather rapid inspirations, with quickened pulse, when respiration suddenly ceased; the pulse continued for six or eight beats, which were slower and feeble, and then suddenly ceased. Artificial respiration was immediately resorted to by Marshall Hall s ready method, which produced distinct respiration, but no pulsation. Having kept it up for about twenty minutes without result, the case was given up as hopeless. An account of the post-mortem appearances, together with other details of the case, will be found in CASE 703, page 242, Second Surgical Volume. CASE 1249. Colonel McGilvray, Chief of Artillery of the Tenth Corps, was slightly wounded in the forefinger of the left hand, at Flussus Mills, August 17, 1864. Excision of the joint was advised, and, on September 4th, chloroform was admin istered; about a drachm of the anaesthetic was poured on a sponge enclosed in a towel folded funnel-shaped. The patient came very kindly under its influence, about two drachms of chloroform in all being used. The period of excitement did not last over a minute and a half. The operation was commenced; the pulse was then beating steady and firm at about 65, respiration slow and regular; at the time the inhalation of the chloroform had been discontinued for at least two minutes; at the moment of the first incision the pulse and respiration at the same moment ceased without the slightest warning. The face flushed for a moment, and then became pallid ; the eyes were fixed and not suffused. About half a minute after the cessation of respiration the patient made one or two spasmodic attempts at respiration and then was still. Artificial respiration was commenced and kept up for an hour, but in vain. The heart and lungs were examined on the next day, but did not indicate the cause of death. The particu lars of the case were communicated by Surgeon A. M. Clark, U. S. V. CASK 1250. Sergeant George S. Moss, Co. C, 125th New York, received a shell wound of the penis, scrotum, and thigh, at Gettysburg, July 3, 1863; the missile lodged among the muscles of the back of the thigh. The patient desired to have the 892 ANESTHETICS. [CHAP. xm. missile removed, but positively refused to be touched without the administration of chloroform. On August 8th a stimulant was given and the anaesthetic was administered; in one minute the patient came under its influence, the shell fragment was removed in less than half a minute, and additional stimulant administered; pulse became suddenly weak, and the patient died almost instantly. It was the opinion of surgeons present that the patient died from valvular affection of the heart. CASE 1251. Private Patrick Murphy, Co. 13, lllth Pennsylvania, aged 22 years, admitted into hospital at Murfreesboro , Tennessee, October 28, 1863, with shot wounds of right knee joint and in centre of forehead, received at Brown s Ferry, Ten nessee, on the same day. On admission patient was wild, delirious, and unruly, but a few hours afterwards seemed partially to recover his senses. On October 30th amputation of the thigh was performed. On loosening the tourniquet no blood escaped from the vessels, and the patient was observed to be in a state of collapse. Stimulants were freely given, but without avail. He died on the table soon after the operation, probably from the effects of chloroform. A section of the anterior portion of the cranium, showing a partial fracture and depression of the centre of the frontal bone, was forwarded to the Museum by Assistant Surgeon John C. Norton, U. S. V., and is numbered 2139 of the Surgical Section. CASK 1252. Private C. M. Odell, Co. I, 36th Wisconsin, received a shot fracture of the head and shaft of the humerus, at Cold Harbor, June 3, 1864. Amputation was deemed necessary; his pulse was good, and he walked to the operating table unassisted. Chloroform was given until complete relaxation of the voluntary muscles was produced; the amputation was per formed, the arteries ligated, and the flaps were about to be closed, when respiration suddenly and quietly ceased. Artificial respiration was set up, but without success. The autopsy showed the heart much enlarged, without thinning of the walls, and distended on both sides with a grumous fluid and tough grayish clot, which extended into the great vessels. CASE 1253. Surgeon J. F. Patterson, 131st New York, states that "on June 11, 1803, the 114th New York was ordered to take a position in front of our line, and while advancing to execute the order one of the privates shot himself in the foot and was carried to the field hospital for treatment. An ampliation being deemed necessary, chloroform was administered by the assistant surgeon of the 1st Louisiana in such a manner that death almost immediately ensued. The surgeon of the 114th, whose name I believe was Wagoner, opened the chest of the cadaver about fifteen minutes after death, and finding the lungs lying on the back of the chest announced that death was occasioned by collapse of the lungs." The case of William Eathbone, Co. K, 114th New York, who received a gunshot wound of toe of left foot at Port Hudson, Louisiana, and who died, is reported by Surgeon L. P, Wagner, 114th New York, but no details of the case are furnished. CASE 1254. Surgeon S. A. Eichardson, 13th New Hampshire, in a special report of the surgical operations performed at Flying Hospital, Twenty-fourth Corps, March 30th to April 9, 1865, remarks : "Manuel Silver, Private, Co. F, 10th Connecticut, gunshot comminuted fracture of the left humerus by conoidal ball. Flap amputation left arm in middle third by Surgeon H. C. Levensaler, 8th Maine, April 2, 1865 (primary operation). Died during the operation, from effects of chloroform given by Sur geon De Landre, 158th New York. Was brought under the influence of chloroform with difficulty." CASE 1255. Sergeant Major Adolphus Spaeth, 9th Ohio, was admitted into Cumberland Hospital, Nashville, September 24, 1863, with a shot fracture of the right wrist. The ball passed upward on the palmar aspect of the forearm nearly to the bend of the elbow, but so deeply embedded as not to be found. He had violent erysipelas of arm and great constitutional dis turbance. Three orfour days afterwards the ball was removed from the deep layer of muscles opposite the upper third of the radius, palmar aspect. His general condition continued bad. On October 17th he was placed upon the table for amputation at the middle third of humerus. During the administration of chloroform death took place with scarcely a premonitory symptom. The post-mortem exhibited venous congestion of both lungs, evidently produced by the chloroform, the lungs being otherwise perfectly healthy. The quantity of chloroform inhaled did not exceed two drachms. CASE 1256. Private George E. Stannard, Co. G, 14th Connecticut, admitted into Finley Hospital, Washington, with a shot fracture of left ulna, received at Fredericksburg December 31, 1862. Patient was a perfectly healthy, robust man, of lively temperament, rather pale in color. On January 28, 1863, chloroform was administered for the purpose of removing the loose pieces of bone. About two drachms of the anaesthetic were sprinkled on a towel and placed to the nose ; in about five or six minutes he came under its influence; the usual struggle came on just preceding complete anaesthesia, when he suddenly ceased to breathe and his pulse failed. Every effort to resuscitate him failed. The history of the case, together with the specimen of the lower extremity of the left ulna, was contributed by Surgeon I. Moses, U. S. V.; the Specimen is numbered 859 of the Suryical Section of the Museum. CASE 1257. Corporal C. F. Tarbell, Co. D, 21st Maine, aged 19 years, shot wound of left thigh, at Port Hudson, May 27, 18:5:5. He was removed to the regimental hospital, where it was found necessary to amputate the thigh in the middle third. Surgeon G. E. Brickett, 21st Maine, reports that the patient died May 27, 1803, from the effects of the chloroform. CASE 1258. Private G. N. Titus, Co. G, 8th Vermont, was admitted into regimental hospital at Algiers, Louisiana, August 21, 1862, with a wound of one of his toes. Chloroform was administered by Surgeon II. H. Gillett and Assistant Surgeon S. H. Currier, 8th Vermont, for the purpose of amputating the injured toe. The patient expired suddenly, before the operation was commenced. Assistant Surgeon L. C. Herrick, 4th U. S. Colored Cavalry, reports the case. CASE 1259. Surgeon Edwin Bentley, U. S. V., reports that a Confederate soldier, a large, robust, muscular Noi th Caro linian, after the battle of Hanover Court House, May 29, 1862, underwent amputation of the thigh. The operation was per formed in the open air and very little blood was lost. A large amount of chloroform had been administered without the patient becoming at all unconscious, when the surgeon forced him to large and free inspirations and he became immediately under its influence. Just after the completion of the operation the pulse sank rapidly, and he appeared to cease to breathe simultaneously with the effects of the anaesthetic. CASE 1260. Surgeon John A. Lidell, U. S. V., in his report of the operations of the medical staff of General Sedgwick s division of the Second Corps, at Fair Oaks, states: "A soldier of General Eichardson s division was placed on the table and CHAP. xm.J DEATHS FROM CHLOROFORM. 893 chloroform administered for the purpose of amputation of the thigh for gunshot comminuted fracture of the femur in the neigh borhood of the knee joint. While inhaling the chloroform he suddenly became pale, pulseless, and ceased to breathe, dying on the operating table while the amputation was going on." CASE 1261. Private J. W. Whitlock, Co. K, lllth Illinois, gunshot wound of left elbow joint, Dallas, Ga., May 31, 1864. Admitted into hospital of 2d division, Fifteenth Corps, same day; chloroform administered for the purpose of operating, but he died from its effects. An autopsy revealed extensive adhesions of the pericardium and hepatization of the right lung. The case is reported by Surgeon J. B. Potter, 30th Ohio. CASE 1262. Unknown soldier, with a shot injury necessitating amputation at the knee joint; chloroform was admin istered, and the patient died while the operation was being performed. Surgeon D. P. Smith, U. S. V., the operating surgeon, states that the anaesthetic was administered too profusely by an entirely incompetent person, who was subsequently dismissed from the service. CASE 1263. Corporal A. Wilde, Co. H, 61st New York, wounded at Deep Bottom, August 19, 1864 ; distal phalanx of thumb shattered; admitted into hospital of 1st division, Second Corps. Assistant Surgeon C. Smart, II. S. A., reports that chloroform was given, and after about three drachms had been taken the patient became much excited and passed into a violent convulsion, in the midst of which he died. At the autopsy the heart was found small and firmly contracted, its walls being in contact and the cavities obliterated. CASE 1264. Private Lewis Winters, Co. I, llth Michigan, aged 40 years, Atlanta, August 7, 1864; conoidal ball in upper third right thigh. Admitted into hospital No. 8, Nashville, August 20th ; gangrene. October 27th, preparatory to cleaning and burning the wound Acting Assistant Surgeon R. W. Forrest commenced to administer chloroform from a sponge surrounded with a napkin, plenty of atmospheric air being admitted. Not more than half an ounce of chloroform was poured upon the sponge. His pulse was good, and he was judged to be a healthy man. After inhaling the chloroform for about three minutes a very severe spasm came on; his head was thrown violently back, his body arched, resting on top of head and feet, the arms were drawn up, and the hands violently clenched. The chloroform was withdrawn; the spasm relaxed in a few seconds; his head and face became very much congested. Cold water was instantly dashed over his face and chest and ammonia applied to the nostrils, and every means that could be devised to resuscitate kept up for more than an hour without effect. Autopsy: Five points of cicatrization from scarification for cupping; considerable serous effusion under arachnoid and filling sulci; vessels on surface of brain much congested; pleuritic adhesions very firm on both sides; left lung deeply engorged with dark blood, frothy serum exuding from cut surface, and numerous small chalk-like deposits found near the surface; heart normal in size and appearance. CASE 1265. D. ZebrisTce, Co. I, 12th Alabama, admitted into hospital No. 5, Frederick, October 18, 1862, with a shot flesh wound left hip, traversing deep portion of gluteal muscles; Antietam, September 17, 1862; ball lodged. October 19th, chloroform administered with a view of removing missile. No unusual symptom was observed; but while the operation was in progress and the patient not in the act of inhaling the vapor, it was discovered that he had ceased to breathe. The autopsy threw no light on the cause of death. The subject was anaemic, and exhausted by hardship and depleted by suppuration. The report of the case was made by Surgeon H. S. Hewit, U. S. V. CASE 1266. Private G. G. Allison, Co. A, 6th New York Artillery, aged 43 years, admitted into hospital at Beverly, New Jersey, July 7, 1864. On February 7, 1865, he was placed upon the table to be operated on for fistula in ano. Chloroform was administered in the ordinary manner; room was well ventilated and the vapor of the chloroform freely diluted with atmospheric air ; full anaesthesia was produced, when the pulse rapidly failed, and in a very brief period death took place. The quantity of chloroform inhaled did not exceed two drachms. Every effort was made to restore life by artificial respiration, ammonia, stimu lants, etc. An autopsy was made twelve hours after death; the brain, thoracic and abdominal viscera were very carefully examined, but nothing detected sufficient to account for death; the brain was very slightly congested. Assistant Surgeon C. Wagner, U. S. A., reported the case. CASE 1267. Private Francis Heward, Co. F, 1st New Jersey, was admitted into Fairfax Seminary Hospital, April 5, 1862, with a dislocation of left humerus forward and inward of a few hours standing. Surgeon Henry A. Armstrong, 2d New York Artillery, reduced the bone without assistance. On May 6th Acting Assistant Surgeon H. W. Ducachet discovered that the bone was again out of place in the same direction. The patient was chloroformed and reduction attempted with the heel in the axilla, but without success. On the 9th pulleys and counter-extending bands were obtained and adjusted. Chloroform was again administered, a drachm being poured upon a piece of lint about two inches square and held about three inches from his face, a towel being thrown over the head of the patient and hand of the operator, and which was removed from time to time to admit air. Some time elapsed before the muscles became relaxed, when the chloroform was removed. There was no stertorous breathing, choking, or struggling, nor was there occasion to use force to keep him down, as at the previous administration. There was, as there always is, congestion of the conjunctiva and vessels of the neck, but not as much, certainly not more, than when the chloroform was administered on the 6th. Reduction was being attempted when symptoms of asphyxia were noticed; the pulleys were instantly relaxed, the tongue drawn forward, and artificial respiration resorted to, but everything failed. No autopsy was made. The report of the case is signed by Surgeon H. A. Armstrong and Acting Ass t Surgeon H. W. Ducachet. CASE 1268. T. A. Leaning, Co. H, 76th New York, a patient in Eckington Hospital, was troubled with stricture of the urethra. An attempted examination by the catheter was so painful that chloroform was administered on a handkerchief, pains being taken that the patient had plenty of air by holding the handkerchief far enough away from the face. In a few minutes the rigidity of the muscles yielded, but only partly, and two or three stertorous respirations were taken. The chloroform was immediately suspended and the examination by the catheter commenced. The instrument had only been introduced to about the membranous urethra when an involuntary evacuation of both bladder and bowels took place; the patient at that moment ceased to breathe and his face grew purplish. The action of the heart could not be observed at this time, since the administrator 894 ANESTHETICS. [CHAP. XIII. had not his finger on the pulse. On being immediately observed, no pulsation could be felt at the wrist nor observed on auscul tation over the heart. The tongue was immediately pulled forward with a tenaculum, but as no respiration succeeded, Marshall Hall s ready method of artificial respiration was immediately commenced. The temporal artery was also instantly cut, but only a few drops of blood escaped. Eespiration incomplete and obstructed by eructation; passive vomiting, with friction of the surface by the hand and by a stiff brush, and stimulating injections of ammonia and turpentine were kept up for over two hours with no favorable result, and the attempt at resuscitation was then given up. Acting Assistant Surgeon W. W. Keen, jr., who reports the case, remarks of the autopsy that "almost the only things strictly abnormal were the enormous congestion probably passive of the heart, fluidity of the blood, and the absence of rigor mortis." CASE 1269. Surgeon J. R. Weist, 1st Colored Troops, reports: "A death from chloroform occurred in hospital No. 12, Nashville, in 1882. The hospital was then under the charge of Surgeon Frederick Seymour, U. S. V. I supposed that he had reported the case. I cannot now obtain the name of the soldier, but there can be no mistake about it, as I administered the chloroform myself. The patient was a United States soldier (Irish), suffering from anal fistula, and the chloroform was carefully administered from a towel folded in the shape of a cone preparatory to an operation. The patient was in a well- ventilated room. About two drachms of the anaesthetic had been used, when death suddenly occurred without any warning. Autopsy revealed fatty degeneration of the heart. Nothing else abnormal found." Considering the great number of eases in which chloroform was applied, principally during and after the exciting circumstances of a battle, when expedition was a matter of necessity, it is remarkable that not more cases of death from this agent have been recorded. With what justice the fatal issues in the cases here cited are chargeable to the anaesthetic the reader must judge for himself. Deaths from Chloroform and Ether. Two cases were reported. In one case, although the patient s condition would appear to have been favorable, no efforts at resuscitation seem to have been made; in the other case it is doubtful whether death was due to the severity of the injury or the anaesthetic: CASK 1270. Private Henry Jefferson, Co. E, 19th Colored Troops, aged 20 years ; shot fracture of femur two inches below trochanter major. August 14, 1865; doing well until October 16th, when the pus became rusty. November 17th, Acting Assistant Surgeon H. Raphael, at the post hospital at Brownsville, Texas, administered an anaesthetic of two parts of ether and one part of chloroform with the intention of excising the ends of the bone; but after inhaling two minutes the patient began to sink pulse failed, spasms occurred, the head was drawn back and hands and feet were in a tremor; the sponge was removed, and the patient rallied; but upon re-administration spasms immediately returned, the pulse stopped, and the patient was dead. CASK 1271. Lieutenant Colonel J. C. Hodges, 44th Indiana, was injured on the railroad, September 27, 1864. The right femur was fractured and the soft parts lacerated; the left os calcis was also fractured; considerable haemorrhage. At the patient s urgent request a mixture of chloroform and ether was administered. The pulse improved slightly, and amputation of the thigh was decided upon. Five minutes before the conclusion of the operation the breathing was noticed to be stertorous and soon intermitting, with flagging pulse. Artificial respiration was immediately resorted to by posture and by compression of chest at intervals, while the tongue was drawn forward by an assistant. This procedure gave much encouragement for a long time indeed, for two hours the indications of returning .vitality and consciousness seemed to depend entirely upon the vigorous- ness of the efforts at artificial respiration, but every effort failed to restore life. Deaths from Ether. Four cases were reported. In three cases death was probably due to the shock and the effects of the ether combined; in one an overdose was administered: CASE 1272. Captain John Brennan, Co. A, 16th Virginia, shot wound, right thigh, lower third, Weldon Railroad, October 27, 1864. Admitted into Harewood Hospital October 3 1st. The condition of the wound was good, but haemorrhage occurred November 10th, from the popliteal artery, by which ten ounces of blood were lost. The artery was ligated in popliteal space, and the patient did well until November 2lst, when the limb became oedematous. November 25th, haemorrhage recurred to th amount of twelve ounces; it could not be controlled, and the limb was amputated; the patient died on the operating table from the shock and effects of ether. At the post-mortem no abnormities could be discovered, with the exception of slight venous con- jestion of the rijrht lung and old adhesions of the left. The case is reported by Surgeon R. B. Bontecou, U. S. V. CASE 1273. An unknown soldier received, in 1862, a shot fracture of the condyle of the femur. The patient was stout and exhibited no symptom of exhaustion or severe shock; his heart acted with uniformity and strength; amputation was decided on and ether was administered, which produced insensibility in about ten minutes. As soon as the operation was begun the patient seemed to be regaining consciousness; but it required only a few seconds to restore complete anaesthesia. The assistant then removed the ether from the patient s face, but was ordered by the operating surgeon to renew the application. After one or two inspirations the patient ceased to breathe. The saw had not been applied nor the use of the knife been finished when death occurred. The case is reported by Dr. Walter Burnham. 1 CASE 1274. Private John Maxwell, Co. E, 159th New York, was wounded before Port Hudson, May 27, 1863, just below the knee, implicating the joint. He lay on the field of battle until midday of the 28th. His pulse was small and feeble and his 1 BURNHAM (W.), (Death from the Effectt of Sulphuric fther [in an overdose. ED.], in The Boston Mt.d. and Surg. Jour., 1870, Vol. VI, p. 377. CHAP. XIII. | ANAESTHETICS. 895 nervous system much prostrated. He was fed on beef tea and stimulants. He was brought to the field hospital, and three hours later ether was administered to him with a view of amputating the wounded leg. After being partially anaesthetized he was removed from where he had been lying and placed upon the operating table. More ether was then administered, and as soon as the patient appeared to be sufficiently narcotized a circular incision was made just above the knee joint. The assistant holding the pulse remarked that the circulation was failing, and efforts were immediately made to induce restoration of the vital energies by drawing out the tongue, throwing back the head, artificial respiration, and dashing of cold water. All was in vain, and the patient died May 23, 1833. The case is reported by Surgeon C. A. Robertson, 159th New York. CASE 1275. Private Henry S. Ware, Co. K, 38th New York, aged 23 years, was struck by a shell in the upper part of the right leg, at the battle of Williamsburg, May 5, 18G2, for which injury the limb was removed on the field, at the middle third of the thigh. He was admitted into the general hospital at David s Island, New York Harbor, on June loth, and came under the care of Acting Assistant Surgeon E. B. Root on June 2Gth, at which time his general condition was bad. He was suffering from diarrhea and a very large bed-sore. The wound had nearly united but the bone was denuded. The constant discharge from the stump necessitated the removal of the necrosed bone. On October 9th the patient was placed under the influence of ether and an inch of bone removed with the chain saw, and then two inches of the bone with its iuvolucrum. During the opera tion the femoral artery was divided, but not much blood was lost. Although it was found that more of the shaft was involved, further operative interference was deemed unnecessary. The patient was removed to his bed, when severe vomiting commenced which continued to the time of his death, seventy-two hours subsequently. The post-mortem examination showed all the viscera healthy. Surgeon S. W. Gross, U. S. V., ascribes the death to th effects of the ether superadded to the previous exhausted condition of the system. The constant vomiting and retching could not be arrested. A few instances are recorded in which suspended animation was restored by energetic and prompt interference. The following two may serve as examples: CASE 1276. Private A. Boyd, Co. C. 38th Georgia, received a shot fracture of the right elbow joint, at Gettysburg, July 1, 1863, and was admitted to hospital at Frederick five days afterwards. Water dressings were applied until July 18th, when considerable oedema of the limb having become apparent, with redness about the joint, a resection of the injured parts was decided upon. The patient having been brought to the operating room, ether was administered by a Medical Cadet for fifteen or twenty minutes without producing anaesthesia, when from one and a half to two drachms of chloroform was added to the sponge and closely placed over the patient s mouth and nose. In the course of thirty or forty seconds stertorous breathing was pro duced, whereupon Assistant Surgeon R. F. Weir, U. S. A., in charge of the hospital, proceeded to operate and commenced the incisions. About this time, however, pulsation in the brachial artery was noticed to be running down rapidly, and the respira tory movements of the chest and abdomen were observed to have ceased, when one of the attending surgeons was instructed to examine the patient s tongue, and finding it had not fallen back, "Marshall Hall s" ready method was proposed and instantly applied. After this had been kept up for about half a minute and no respiratory effort had been observed, the operator immedi ately proceeded to open the larynx, when, after artificial respiration by means of compressing and relaxing the chest and abdominal walls for the period of about two minutes, natural breathing was re-established and pulsation of the radial artery could be felt. There was scarcely any haemorrhage from the incision, and none, perhaps, entered the trachea. The edges of the wound were drawn together by adhesive straps. It not being thought proper to proceed with the operation of excision, the patient was returned to his ward and stimulants ordered to be given freely, also generous diet. He rested fairly and took broth very freely the next morning; pulse 130 and quite feeble; respiration quite easy. During the next night and for several days afterwards the patient had a daily chill, and there was considerable cough, with well marked capillary bronchitis throughout the whole extent of the left lung; tongue coated and brown ; wound of elbow but little disposed to suppurate. These symptoms continued to grow worse, and subsequently there were several slight haemorrhages from the incision over the olecranon process. During the last few days the patient s swallowing became very difficult, and beef tea and whiskey were administered by means of clysters. Death supervened on July 23, 1863. The post-mortem examination disclosed a small abscess on each side of the sternum, just beneath the pleura-costal is and about one and a half inches below the clavicles, and confirmed the existence of capillary bronchitis. The history of the case was furnished by Acting Assistant Surgeon W. S. Adams. The lower third of the injured humerus and a wet preparation of the upper portion of the trachea, the cricoid cartilage, and larnyx. showing the incision made, were contributed to the Museum by the operator, and constitute Specimens 3901 and 4080, respectively, of the Surgical Section. CASE 1277. Private S. R. Green, Co. A, 5th New Hampshire, was wounded in the leg, at Gettysburg, July 2, 1863, by a mini<5 ball, which fractured the tibia and fibula. Amputation at the middle third of the leg was performed at a field hospital by Surgeon C. S. Wood. 6Gth New York, who made the following report : Out of the hundreds of cases in which I have admin istered chloroform this is the only one accompanied by any unpleasant symptoms; here the patient sunk under its use, was apparently dead, and respiration and circulation both ceased. But by the continual use for some ten or fifteen minutes of Marshall Hall s ready method he was restored and the operation was proceeded with. The cause was evidently inattention on the part of the administrator." The patient subsequently died at the Seminary Hospital at Gettysburg on July 30, 1863. The reports of the surgical operations of the war are very deficient in regard to the quantities of the anaesthetic used, the manner in which it was administered, the time required to produce insensibility, the period during which it was maintained, or the unfavorable symptoms following its application; the reports of the medical officers of the army after the war were somewhat fuller on these points; but to make them as complete as possible, the following order was issued in 1876 from the Surgeon General s Office: 896 ANESTHETICS. ICHAP. xin. WAR DEPARTMF.NT, SURGEON GENERAL S OFFICE, CIRCULAR ORDERS. No. 2. WASHINGTON, October 2, 18?<">. With a view of collecting precise data relative to the effects of chloroform and ether, Medical Officers are instructed to record, during the year 1877, the cases in which recoui-se is had to anesthetics, noting the following particulars : Name and age of subject; nature of the anaesthetic ; the quantity used in maintaining anaesthesia; the time required to induce complete insensi bility; the time the anesthetic influence was maintained; the mode of administration; whether vomiting, excitement, or great prostration was observed during or after the administration. These memoranda will be transcribed and returned on the Quarterly Reports of Wounded for March, June, September, and December, 1877. BY ORDER OF THE SURGEON GENERAL: C. H. CRANE, Assistant Surgeon General, V. S. Army. As the number of cases in which anaesthesia was employed during the year 1877 was limited, the order was continued in force by the following: WAR DEPARTMENT, SURGEON GENERAL S OFFICE, WASHINGTON, May 20, 1878. CIRCULAR ORDKRS, No. 1. Circular Orders No. 2, of October 2, 1876, from this Office, will be hereby continued in force until further orders. Med ical Officers will render reports accordingly. BY ORDER OF THE SURGEON GENERAL: C. H. CRANE, Assistant Surgeon General, U. S. Army. The information thus obtained is here briefly given : The total number of cases since the close of the war. in I860, in which anaesthesia was produced, is one thousand two hun dred and ten (1,210). Of these chloroform was used in three hundred and fifty-five (355), ether in five hundred and eighty-seven (587), and ether and chloroform in two hundred and sixty-eight (268) cases. In the cases reported previous to the issue of Circular Orders No. 2, Surgeon General s Office, 1876, the data are, like those of the war, very incomplete, and we will therefore confine ourselves to the consideration of the cases reported since the issue of that order. They number five hundred and ninety-seven (597); in one hundred and fifty-seven (157), or 26.3 per cent, of these, chloroform; in one hundred and eight (108), or 18.1 per cent., chloroform and ether; and in three hundred and thirty-two (332), or 55. 6 per cent., ether was administered. In three of the cases death was ascribed to the anaes thetic to chloroform in one, to chloroform and ether in one, and to ether in the third. The smallest quantity of chloroform used to induce anaesthesia was three-fourths of one drachm, of chloroform and ether one drachm, and of ether two drachms; the largest quan tity of chloroform ninety-six drachms, of chloroform and ether one hundred and thirty drachms, and of ether two hundred and fifty-six drachms; the average amount of the agents used was chloroform eleven, chloroform and ether thirty-two, and ether fifty-one drachms. The average time in which insensibility was induced by chloroform was nine minutes, by ether and chloroform seventeen minutes, and by ether sixteen minutes, as shown in the following table: TABLE GLXXIV. Statement of Five Hundred and Ninety-seven Cases of the Employment of Anaesthetics, showing Quantities used, Time to induce Ancestliesia, and Period during which it was maintained. ANESTHETIC AGENTS EMPLOYED. CASES. QUANTITIES USED. TIME TO INDUCE ANESTHESIA. ANAESTHESIA SUSTAINED. Small Qnant. Large Qtiiint. Average Quant. Drachm. 11 32 51 1 Shortest Time. Longest Time. Minutes. 35 60 55 Average Time. Shortest Time. Longest Time. Average Time. 157 108 332 Drachm. J 1 2 Drachm. 96 130 256 Minutes. 1 1 1 Minutes. U 17 16 Minutes. 1 I 1 MinuU S. 180 130 235 Minutes. 22 26 26 Chloroform a ad Ether ... Ether CHAP. XIII.] ANESTHETICS. 897 The rapidity of the effects and the saving in quantity in the use of chloroform, so important to the field surgeon, especially after large battles, is at once apparent. There is hardly any difference in the average time required to produce" anaesthesia by ether or by chloroform and ether. Vomiting was recorded in twenty-three (23), or 14.6 per cent., of the one hundred and fifty-seven (157) cases of chloroform; in thirty-two (32), or 29.6 per cent., of the one hundred and eight (108) cases of chloroform and ether; and in ninety-eight (98), or 29.5 per cent., of the three hundred and thirty-two (332) cases of ether, the relative frequency being nearly the same in the cases in which ether or ether and chloroform was used, and less in the cases of chloroform, as well as less copious: TABLE OLXXV. Statement showing the Frequency of Vomiting, Excitement, and Prostration in Five Hundred and Ninety- seven Cases of Ancesthesia. ANESTHETIC AGENT EMPLOYED. i o VOMITISO. EXCITEMENT. PKOSTEA.TION. 1 i a Copious. a s to Marked. Violent. fc 1, 7. Marked. Chloroform ... 157 108 332 134 70 234 20 25 83 3 7 15 113 68 202 23 24 85 9 10 31 12 C 14 136 95 295 11 11 24 10 2 13 Chloroform find Ether Ether Excitement was likewise reported less frequently in cases in which chloroform was administered than in those in which chloroform and ether or ether was used, the percentages being 28.0 in chloroform, 37.0 in chloroform and ether, and 39.1 in ether; but, as the figures in the table indicate, it seems to have been somewhat more violent in the cases of chloroform narcosis, although in one case in which ether was employed the excitement was so intense that the use of the anesthetic was abandoned and the operation completed with out anaesthesia. Prostration was reported in twenty-one, or 13.3 per cent., of the cases of chloroform; in thirteen, or 12.0 per cent., of the cases of chloroform and ether; and in thirty-seven, or 11.1 per cent., of the cases of ether. In four of the one hundred and fifty-seven cases in which chloroform was used slight disturbance of respiration was noted, and in two cases respiration ceased and the pulse stopped, but life was restored after prolonged efforts. Pulse and respiration were likewise suspended in two instances in which ether and chloroform, and in one in which ether alone, had been used; they also were brought back to consciousness. In three cases death was ascribed to the anaesthetic. A case of death from chloroform is reported by Assistant Surgeon R. Barrett, U. S. A.: CASK 1278. Private A. L. Bruce, Co. G, 13th Infantry, aged 26 years, suffered from bleeding internal piles, and deriv ing no benefit from a palliative treatment it was decided to relieve him by operation. After abstaining from solid food for six teen hours the patient was, on August 23, 1877, placed on the operating table and the administration of chloroform was com. menced. The inhaler used was a towel folded cone-shaped, with an inch aperture at the apex. Fearing that this opening \vns not sufficiently large to admit of the free access of atmospheric air, the inhalation was discontinued and the opening enlarged to twice its former size. The inhalation was then resumed, the patient at this time lying on the table and quietly observing the operations going on around him. I am thus minute as I wish to show that the patient was perfectly conscious when the second inhalation began. He took the anaesthetic kindly for about a minute, when he suddenly sat upright and asked if his piles wer*> out. I replied "No, lie down; he said All right doctor, I have the utmost confidence in you." His head had hardly touched the table when his radial pulse ceased and his face became intensely congested ; his breathing was stertorous and a large quan tity of froth appeared on his lips. I directed the attendants to seize his heels and hold him up, head down, at the same tim<- SURG. Ill 113 89S ANAESTHETICS. [CHAP. xm. applying aqua ammonia to the nostrils. His respiration was now reduced to an occasional gasp, and finding the Nelaton posi tion of no benefit I had him laid on the table, and drawing forward his tongue with a forceps introduced a large gum catheter into the trachea and gently blew air into the lungs; this was repeated several times, the air being forced out after each infhlion by pressing on the thorax. While attempting artificial respiration I ordered an enema of whiskey, which was retained, but v as immediately followed by a copious discharge of urine. This was the last act of the patient s life, for he was now dead, an 1 I reluctantly discontinued my efforts to revive him. I have estimated the quantity of chloroform used as about two drachn s. Death no doubt occurred from paralysis of the heart, as there was no evidence of a pulse after it first ceased at the wrist. Afti r the patient s death I learned that he had stated that he had heart disease and expected to die under the operation. Assistant Surgeon 0. E. Price reports a case of death from the administration of ether; the case was hopeless before the operation was begun : CASE 1279. A. J. Moore, aged 50 years, suffered for about six years from the results of a contusion of the knee. The joint became swollen and painful, and an examination in May, 1878, showed that the bone had become diseased. Amputation or resection was advised, but the patient refused to be operated upon, and gradually became worse until July llth, when he finally consented to an amputation. He was then put on a generous diet with stimulants. However, he grew rapidly worse. The urine had only a trace of albumen, but there was rodema of the lungs with evidence of great effusion in the pleural cavity. His breath began to be labored, and there were large, coarse, moist rales in both lungs, while the effusion almost destroyed all movement in the left lung and impaired that of the right. He became greatly alarmed, as in two or three coughing spells he was nearly strangled to death. He now begged me to operate, and said he was sure to die very soon if I did not. When I explained the dangers of the operation he said he knew it all, but that it gave him a possibility of life. Having no assistant of any kind, I called upon Lieut. Halloran, 12th Infantry, who had on several occasions attended to the administration of an anaesthetic for me. I read to Lieutenant Halloran and gave him to study the instructions as given in Ashhurst s and Erichseii s Surgery, MM! explained to him the importance of closely watching the effects of the anaesthetic. I had but six ounces of ether (Squibb s), so I took the bottle of chloroform for use in case the ether should prove insufficient. With Lieutenant Halloran to attend to the anaesthetic and two soldiers for assistants I began. At first I attended to the anaesthetic myself. After a few breaths of the ether I said: "Moore, do you feel it ?" He said : "A little." A few more breaths and he said : " Wait a minute and give me a rest;" I replied "all right," but kept along with the ether. After a few moments more I gave the sponge to Lieutenant Hal loran and began applying an Esmarch s bandage. I had wrapped it up to the lower part of the swelling about the knee when I looked up and said to Lieutenant Halloran "take away the sponge," and noticed that his breath had stopped. Lieutenant Halloran replied : "His pulse is good," but by the time I felt it it had disappeared. I instituted artificial respiration at once, applied nitrite of amyl to his nostril, and injected ammonia into a vein of the arm. I kept up artificial respiration after Sylves ter s method for three-quarters of an hour, but it was of no avail. In the chest a large effusion was found in the pleural cavity, with stringy pus and bands of adhesion in many places. The upper and middle portions of the left lung were thickly filled with points of caseous deposit, and in many of these spots were deposits which were as hard as and seemed to be solid limestones. The right side of the heart was dilated and nearly full of clotted blood; the left side was nearly empty. The details of a case in which first ether and subsequently chloroform were administered are given by Assistant Surgeon P. J. A. Gleary, U. S. A.: 1 CASK 1280. Private H. D. Bradfield, Co. H, 19th Infantry, aged about 33 years, large and robust, addicted to liquor, Avas admitted to hospital December 3, 1878, suffering with an injury of the middle finger, right hand, resulting in gangrene of the seoond and third phalanges, and in consequence it was decided to amputate at the metacarpal articulation. For this purpose a mixture of equal parts of ether fortior and chloroform was administered. About ten minutes previously two ounces of whiskey were given. I examined his heart and found it normal in every respect. The anaesthetic was administered on a piece of lint, covered with a small towel, held square in contradistinction to cone-shaped. I personally administered the mixture while the steward observed his pulse. The cloth was held so as to allow a free admixture of air. He inhaled freely. About two drachms were first poured on the cloth, but had no apparent effect. Shortly after about the same quantity was poured on; he observed that "he did not feel it." After a time about the same quantity was again poured on, and, as I turned to look at some instru ments, ho requested me not to begin yet to cut him. A further quantity was now poured on the cloth, when he began to laugh ; this was followed by attempts to articulate, then, as is common, by strong gesticulations of his arms, to stop which the steward forcibly pressed down one arm, holding him by the wrist, while an attendant did likewise with the other. He was now passing to a state of unconsciousness, and in reply to my inquiry the steward said he could not feel the pulse, but added that his arm was somewhat twisted, which prevented his perceiving the pulse. I therefore felt for the pulse at the other wrist, but could not perceive it. Just as I felt, the muscles of his arm and neck, which had been strongly in action, suddenly relaxed; his breathing, however, was very good and such as would in no wise have attracted attention. At once I removed the anaesthetic and dashed some cold water in his face. The pulse did not return. He continued to breathe freely for a little time longer, then his breathing became labored, and then suddenly stopped. The action of the heart had previously stopped, and the man was dead. I will add that everything I ever heard of, saw, or read, appropriate for such cases, was done, but to no effect. The mixture consisted of chloroform and ether fortior; amount used exactly one ounce; time in using it, fifteen minutes. Cause of death, paralysis of the heart. Of the entire amount used one-half only was chloroform, i. e., half an ounce. Of this amount a large proportion was wasted over the cloth and which lie never inhaled; the inhalation of the remainder occupied fully fifteen minutes. 1 The case has been reported in the Philadelphia Medical Times, 1879, Volume IX, age 280. CHAP. XIV.] THE MEDICAL STAFF AND MATERIA CH1RURGICA. CHAPTER XIV. THE MEDICAL STAFF AND MATERIA CHIRURGICA. Previous to the outbreak of the rebellion the regular army numbered one thousand one hundred and seventeen (1,117) commissioned officers and eleven thousand nine hun dred and seven (11,907) enlisted men. The Medical Department was composed of one Surgeon General with the rank of Colonel; thirty Surgeons with the rank of Major, and eighty-four Assistant Surgeons holding for the first five years the rank of 1st Lieutenant, and subsequent to that period, until promotion to Surgeon, the rank of Captain. The offi cers of the Medical Department formed a portion of the General Staff of the army ; were not permanently attached to any regiment or command, but were subject to duty wherever their services were needed. Experience had demonstrated this system to be the best for the necessities of an army widely scattered over an immense area of territory, serving in commands of less than regimental strength, while it possessed the advantage of increasing the efficiency and value of the medical force in a professional point of view. At the beginning of hostilities, in 1861, large forces of State troops, or militia, responded to the several proclamations of the President calling for aid in suppressing the rebellion. Each regiment was provided with a Surgeon and an Assistant Surgeon commissioned by the States in which the troops had been enlisted. These officers were borne on the muster-rolls and permanently attached to the regimental organization, being seldom detached except for urgent reasons. During the early military operations the administrative duties pertaining to the Med ical Department were performed by officers of the regular medical staff, detailed for the purpose, or by volunteer Surgeons appointed as Medical Directors of Divisions, as allowed by the President s proclamation of May 3, 1861. On the 22d of July, 1861, Congress passed an act authorizing the President to raise a force of volunteers, not exceeding 500,000, and prescribing the organization of this levy into divisions of three or more brigades, and that "each brigade shall be composed of five or more regiments, and shall have one Brigadier General, two Aids-de-Camp, one Assistant Adjutant General with the rank of Captain; one Surgeon; one Assistant Quartermaster, and one Commissary of Subsistence." The Surgeons authorized by this act were known as Brigade Surgeons, and were borne as such on the official army registers of September, 1861, and January, 1862; they held the rank of Major. The duties, prerogatives, and responsibilities of Brigade Surgeons being somewhat vaguely defined, the following bill was passed by Congress on July 2, 1862: "From and after the passage of this act Brigade Surgeons shall be known and designated as Surgeons 900 THE MEDICAL STAFF AND MATEKIA CHIRUEQICA. [CHAP. xiv. of Volunteers, and shall be attached to the general medical staff under the direction of the Surgeon General; and hereafter such appointments for the medical service of the army shall be appointed Surgeons of Volunteers." The Brigade Surgeons, or Surgeons of Volunteers as they were henceforth called, were assimilated to those of the regular staff, holding equal rank with the latter under commis sions conferred by the President and confirmed by the Senate. They became eligible to all the duties and prerogatives pertaining to the medical officers of the army, whether in the field as Directors of Armies, Corps, or Departments, or in charge of hospitals, etc. From time to time, by acts of Congress, additions were made to the regular and volunteer corps, and such changes effected as were necessarily demanded. The act of April 16, 1862, was one of the most important of these acts, wherein the rank of Brigadier General was con ferred upon the Surgeon General. Provisions were also made in this act for an Assistant Surgeon General and a Medical Inspector General, both with the rank, pay, and emolu ments of Colonel of Cavalry, and for eight Medical Inspectors with the rank, pay, and emoluments of Lieutenant Colonel of Cavalry, also for Medical Purveyors and Medical Cadets. The text of the act is here inserted : "AN ACT TO REORGANIZE AND INCREASE THE EFFICIENCY OF THE MEDICAL DEPARTMENT OF THE ARMY. "Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That there shall be added to the present medical corps of the army ten Sur- geous and ten Assistant Surgeons, to be promoted and appointed under existing laws; twenty medical cadets, and as many hospital stewards as the" Surgeon General may consider necessary for the public service, and that their pay and that of all hospital stewards in the volunteer, as well as the regular service, shall be thirty dollars per month, to be computed from the passage of this act. And all medical cadets in the service shall, in addition to their pay, receive one ration per day, either iii kind or commutation. "SEC. 2. And be it further enacted, That the Surgeon General to be appointed under this act shall have the rank, pay, and emoluments of a Brigadier General. There shall be one Assistant Surgeon General and one Medical Inspector General of Hospitals, each with the rank, pay, and emoluments of a Colonel of Cavalry, and the Medical Inspector General shall have, under the direction of the Surgeon General, the supervision of all that relates to the sanitary condition of the army, whether in transports, quarters, or camps, and of the hygiene, police, discipline, and efficiency of field and general hospitals, under such regulations as may hereafter be established. " SEC. 3. And be it further enacted, That there shall be eight Medical Inspectors, with the rank, pay, and emoluments each of a Lieutenant Colonel of Cavalry, and who shall be charged with the duty of inspecting the sanitary condition of transports, quarters, and camps, of field and general hospitals, aiid who shall report to the Medical Inspector General, under such regulations as may be hereafter established, all circumstances relating to the sanitary condition and wants of troops and of hospitals, and to the skill, efficiency, and good conduct of tho officers and attendants connected with the medical department. "SEC. 4. And be it further enacted, That the Surgeon General, the Assistant Surgeon General, Medical Inspector General, and medical inspectors, shall, immediately after tho passage of this act, be appointed by the President, by and with the advice and consent of the Senate, by selection from the medical corps of the army, or from the surgeons in the volunteer service, without regard to their rank when so selected, but with sole regard to qualifications. "SEC. 5. And be it further enacted, That medical purveyors shall be charged, under the direction of the Surgeon General, with the selection and purchase of all medical supplies, including new standard preparations, and of all books, instruments, hospital stores, furniture, and other articles required for the. sick and wounded of the army. In all cases of emergency they may pro vide such additional accommodations for the sick and wounded of the army, and may transport such medical supplies as circumstances may render necessary, under such regulations as may here after be established, and shall make prompt and immediate issues upon all special requisitions CHAP. XIV.J THE MEDICAL STAFF. 901 made upon them under such circumstances by medical officers; and the special requisitions shall consist simply of a list of the articles required, the qualities required, dated, and signed by the medical officers requiring them. "SEC. (>. And be it further enacted, That whenever the .Inspector General, or any of the medi cal inspectors, shall report an officer of the medical corps as disqualified, by age or otherwise, for promotion to a higher grade, or unfitted for the performance of his professional duties, he shall be reported by the Surgeon General for examination, to a medical board, as provided by the seven teenth section of the act approved August third, eighteen hundred and sixty-one. U SEC. 7. And be it further enacted, That the provisions of this act shall continue and be in force during the existence of the present rebellion and no longer: Provided, however, that, when this act shall expire, all officers who shall have been promoted from the medical staff of the army under this act shall retain their respective rank in the army, with such promotion as they would have been entitled to." Approved April 16, 1862. Beside the medical officers of the regular and volunteer staff, and the medical officers of regiments, there was a class designated as Acting Assistant Surgeons, who were private physicians, uncommissioned, serving under contract to do duty with the forces in the field or in general hospitals. This class was very large and embraced in its number some of the most eminent surgeons and physicians of the country. The Medical Cadets were gener ally young men, students of medicine, who were assigned to duty in general hospitals as dressers and assistants. The Medical Department was still further increased by a number of Hospital Stewards, who were enlisted as needed, and who performed the duties of druggists, clerks, and storekeepers. During the years of the war the organization of the Regular Staff had been increased so as to number one Surgeon General, one Assistant Surgeon General, one Medical Inspector General, sixteen Medical Inspectors, and one hundred and seventy Surgeons and Assistant Surgeons; there had been appointed five hundred and forty-seven (547) Surgeons and Assistant Surgeons of Volunteers ; there were mustered into service between April, 1861, and the close of the war, two thousand one hundred and nine (2,109) regimental Surgeons, three thousand eight hundred and eighty-two (3,882) regimental Assistant Surgeons. Dur ing the same period there were employed eighty-five (85) Acting Staff Surgeons and five thousand five hundred and thirty-two Acting Assistant Surgeons. 1 To the fidelity and efficiency of this vast body of professional men the Surgeon Gen eral, in his annual report of 1865, bears the following well-deserved tribute: "I desire to bear testimony to the ability, courage, and zeal manifested throughout the. war by the officers of the Medical Department under all circumstances and upon all occasions. With hardly an exception they have been actuated by the highest motives of national and pro fessional pride, and the number who have been killed or wounded bear honorable testimony to their devotion and duty on the field of battle." The following record of casualties of the Regular and Volunteer Staff during the war shows well for the honor of those who are erroneously supposed to escape the dangers and chances of war: "Thirty-two (32) were killed in battle, or by guerillas or partizans, and nine (9) by accidents; eighty-three (83) were wounded in action, of whom ten (10) died; four (4) died in rebel prisons, seven (7) of yellow fever, three (3) of cholera, and two hundred and seventy-one (271) of other diseases, most of which were incidental to camp life or the result of exposure in the field." 2 Bnowx (H. E.), The Medical Department of the United Statin Army f rum 1775 to 1873, Washington, Surgeon General s Office, 1873, p. 245. * BROWN (II. E.), (toe. cit.), p. 040. 902 THE MEDICAL STAFF AND MATERIA CHIRURGICA. [CHAP. xtv. Of the amount of labor performed by the Medical Staff during the war some idea may be obtained when it is stated that 5,825,480 cases of wounds and disease occurred among the white troops and 629,354 cases among the colored troops. 1 "The cost of maintaining the Medical Department formed no small portion of the total expenses of the war, and it is a matter of just pride that it can be said that the medical disbursing officers performed their duties faithfully and honestly, and that the immense quantities of medical supplies distributed all over the country were almost without excep tion properly accounted for. The expenditures on behalf of the Medical Department to the close of each fiscal year, on the 30th of June, from 1861 to 1866, were as follows: 1861 $194,126.77 1862 2,371,113.19 1863 .... 11,594,650.35 1864 11,025,791.33 1865 19,328,499.23 1866 2,837,801.37 making a total of $47,351,982.24 expended during the war (exclusive of salaries of com missioned officers) for the benefit of the sick and wounded soldiers of the nation." 5 After the organization of the forces raised for the suppression of the rebellion was per fected, the medical service in the field was based upon an independent hospital and ambu lance establishment for each division of three brigades. The personnel of the division hospital consisted of a Surgeon in charge, with an Assistant Surgeon as executive officer and a second Assistant Surgeon as recorder, an operating staff of three Surgeons aided by three Assistant Surgeons, and the requisite number of nurses and attendants. The division ambulance train was commanded by a First, Lieutenant of the line, assisted by a Second Lieutenant for each brigade. The enlisted men detailed for ambu lance duty were a sergeant for each regiment, three privates for each ambulance, and one private for each wagon. The ambulance train consisted of from one to three ambulances for each regiment, squadron, or battery, a medicine wagon for each brigade, and two or more supply wagons. The hospital and ambulance train were under the control of the Surgeon-in- Chief of the Division. The division hospitals were usually located just out of range of artillery fire. Sometimes three or more division hospitals were consolidated under the orders of a Corps Medical Director, who was assisted by his Medical Inspector, Quarter master, Commissary, and chief ambulance officer. The medical officers not employed at field hospitals accompanied their regiments and established temporary depots as near as practicable to the line of battle. As soon as possible after every engagement the wounded were transferred from the division or corps hospitals to the base or general hospitals, which at one time numbered 205 ; these were under the charge and command of the Regular or Volunteer Staff, assisted by Acting Assistant Surgeons, Medical Cadets, and officers of the 2d Battalion of the Veteran Reserve Corps. The following extracts of reports are presented to show the system of the medical organization in one of the corps of the Army of the Potomac. The reports, which give in detail the specific duties of each class of officers, were made in accordance with the follow ing circular letter of Surgeon T. A. McParlin, Medical Director of the Army of the Potomac : 1 BKOWN (II. E.), The Medical Department of the United Stales Army from 177A to 1873, Washington, Surgeon General s Office, 1873, p. 246. M5UOWN (II. F,.). the. cit.), p. 24(i. CHAP. xiv.| THE MEDICAL STAFF. 903 "HEADQUARTERS ARMY OF THE POTOMAC, "MEDICAL DIRECTOR S OFFICE, " September 28, 1864. " Surgeon J. J. MILHAU, U. S. Army, "Medical Director Fifth Army Corps. " DOCTOR: You will require from one of each of the following named officers a detailed written report of their duties, both sedentary and active, the reports they make and receive, their duties and positions before and after engagements and on the march: 1. Medical Director of Corps. 2. Medical Inspector of Corps. 3. Surgeou-iu-Chief of Division. 4. Surgeon-in-Chief of Brigade. 5. Surgeon in charge of Division Hospital. 6. Recorder of Division Hospital. 7. Attending or Prescribing Surgeon of Division. 8. Operating Surgeon. 9. Surgeon of Regiment. 10. Assistant Surgeon of Regiment. 11. Division Hospital Commissary. 12. Chief Ambulance Officer of Corps. 13. Chief Ambulance Officer of Division. 14. Ambulance Officer of Brigade, who will also specify the duties of the non-commissioned officers and privates under him. The reports when rendered you will forward to this office. "Very respectfully, your obedient servant, (Signed) "THOMAS A. McPARLIK, " Surgeon U. S. Army and Medical Director Army of Potomac." The responses to this circular were collected by Surgeon J. J. Milhau, U. S. A., and by him transmitted to the Medical Director, T. A. McParlin. Omitting; the official verbiage J o o and forms the substance of the reports is here given: " Duties of the Medical Director of a Corps: The Medical Director of a Corps is the head of the Medical and Ambulance Departments of the corps, and he is held responsible by the Corps Com mander that they be properly and effectively managed under all circumstances. It is therefore impossible to specify definitely his duties in every case. He should possess the confidence of his Commander and ask for instruction in all cases of doubt. He should have an office and at least two clerks, of whom one should be a Hospital Steward. The following books should be kept, viz: 1st, a Register of all Medical Officers and regular Hospital Stewards belonging to the Corps; 2d, an Endorsement Book ; 3d, a Record of Certificates of Death, and action thereon ; 4th, a Letter and Order Book ; 5th, a Blotter, in which are checked oft the regular requisitions and Monthly Reports of Sick and Wounded as received; 6th, a Manifold Writer. The following regular reports are received: 1st, Daily Report of the Medical Inspector of the Corps ; 2d, the Weekly Report of Sick and Wounded ; 3d, the Weekly Report of the Ambulance Corps (in duplicate) ; 4th, the Weekly Report of Brandy and Whiskey received, issued, etc., from each Brigade and from each Hospital; 5th, the Monthly Returns of Medical Officers from Divisions and Brigades; 6th, the Monthly Returns of Hospital Stewards, TJ. S. A.; 7th, the Monthly Returns of Ambulance Officers (in dupli cate) ; 8th, Statement of Hospital Fund from each Hospital. After engagements are to be trans mitted to the Medical Director of the Army: 1st, Nominal Lists of Wounded, for transmittal; 2d, Classified Returns of Injuries and Wounds (in duplicate); 3d, Aggregate Mean Strength of Command (per regiment); a Report of the Operations of the Ambulance Corps. The following Consolidated Reports for the Corps are made at stated periods to the Medical Director of the Army : 1, Weekly Report of Sick and Wounded; 2d, Monthly Return of Medical Officers; 3d, Monthly Return of Hos pital Stewards, U. S. A.; 4th, Statement of Balance due Hospital Fund; 5th, Record of Certificates of Disability, and action thereon. All other reports are simply transmitted without consolidation, including certificates of death. The following papers are referred, by order of the Corps Com- 904 THE MEDICAL STAFF ANT) MATERIA CHIRURGICA. [CHAP. xrv. mander, to the Medical Director for approval, recommendation, expression of opinion or disapproval, viz: All tenders of resignations on account of disability; all applications for leaves of absence; all certificates of disability for discharge, and invalid rolls when doubtful ; all recommendations and complaints referring to the Medical and Ambulance Departments or affecting the health and well being of the troops ; all applications for leave of absence or resignation of Medical or Ambulance Officers in fact, all papers relating to the Medical Department are referred to the Medical Director prior to the action of the General Commanding. The following papers require to be examined and acted upon by the Medical Director: All requisitions for Medical and Hospital Supplies, and all requisitions and estimates for supplies for the Ambulance Corps. Written circulars and instruc tions from the Medical Director of the Army and from the Surgeon General should either in whole or part be promptly published to the Surgeons-iu-Chief of Divisions and Surgeons-in-Chief of sep arate commands. The health and welfare of the troops, as well as the comfort and proper care of the sick and wounded, should receive the unceasing attention of the Medical Director. It therefore becomes his duty to ascertain, through the Medical Inspector, the Surgeons-in-Chief of Divisions, and, from his own observation, the existence of irregularities and of deficiencies in the hospitals or in the command, and he must issue the necessary instructions to have the one corrected and the other supplied. In matters of defective police, bad drainage, unhealthy camp grounds, insufficient shelter, improper or damaged food, etc., etc., he should first call the attention of the Medical Offi cers to the fact and suggest remedies; but if these suggestions be not promptly attended to, a written report with recommendations should be made without delay to the Corps Commander. Special attention must be given to the keeping up of supplies, both medical and hospital. Circu lars should be issued from time to time, giving information to the medical officers as to what articles can be obtained, specifying the manner of obtaining them. The Ambulance Corps being under the direction of the Medical Director, the ambulances and everything connected with them claim a fall share of his attention. In conjunction with the Chief Ambulance Officer he must therefore see that nothing is neglected to render them efficient in every respect and the intention of the law be carried out. The Surgeous-in-Cbief of Divisions look to the Medical Director for orders, instruc tions, and suggestions in reference to the fitting up of the different hospitals; he should therefore instruct them as to the number of tents to be pitched, and as to whether it is desirable to construct fire-places, erect bunks, dig wells, etc., etc. As a general rule, verbal orders will be sufficient. When a movement is ordered, the Medical Director should ask for instructions in reference to the sending off of sick and wounded, the breaking up of the hospitals, the number of ambulances and wagons allowed to march with the troops, and the number to be sent to the rear, and on receiving them will give the necessary orders in writing, specifying the number of tents and flies to be carried, as well as the amount of hospital supplies, medical stores, clothing, and rations, and directing the Sur- geous-in-Chief of Divisions to see that the "hard bread" is put up in the ambulance boxes, and the field companions and hospital knapsacks are filled. Orders should be given to the Chief Ambulance Officer in reference to the position of the stretcher bearers; as a general rule they should all march with their commands, with stretchers. When only a limited number of ambulances accompany the troops, all the stretchers should go to the front strapped on the ambulances. Orders should be given to have the water-kegs filled. On the march the Medical Director accompanies the Staff, acquaint ing himself as far as practicable with the nature of the country passed over, the general direction and condition of the roads, the position of the houses, streams, woods, etc., etc. This knowledge will materially assist him in the selection of hospital sites. When an engagement commences the Medical Director should ascertain the position of the troops, and should immediately communicate with the Surgeons-in-Chief of Divisions, directing the establishment of field depots for the wounded at such points as will be most convenient for collecting them and where the ambulances can come up. In locating these depots special care must be taken to have them as near the line of troops as possible, so as to diminish the distance of stretcher transportation. Ravines and woods should be taken advantage of as a protection against the enemy s fire; if necessary, a breastwork can be thrown up by the attendants. An occasional bullet or an occasional shell is not sufficient to war rant Medical Officers in leaving their posts. If practicable, the Medical Director should himself visit and inspect these depots, and give orders that will insure the object of their establishment ; he should also consult with the Chief Ambulance Officer as to the best roads, everything considered, to be taken by the ambulances. Should the enemy fall back these depots should be removed CHAP, xiv.] THE MEDICAL STAFF. 905 farther to the front; should our own troops yield the ground, the depots must be moved farther to the rear. The moment the number of wounded warrants the establishment of Division Hospitals the Corps Commander should be consulted as to the locality of these hospitals, in a military point of view. The Medical Director then selects the site himself, or designates some one to do it in his name. Orders should be immediately given to the Surgeon s-iii-Chief of Divisions and to the Chief Ambulance Officer, designating the locality chosen. Should a lull occur in the firing or the enemy be driven back, orders must be immediately given to advance the field depots and to take all the available ambulances to. the front to pick up the wounded as rapidly as possible, and to convey them to the hospitals. During an engagement the duty devolving upon the Medical Director of a Corps to select a site for the different hospitals of the Corps is not always an easy one. As a gen eral rule they should be placed near the most practicable roads, in rear of the centre of the troops, and sufficiently to the rear to be out of the ordinary range of the enemy s guns; suitable ground, good water, and plenty of fuel must of course decide the choice of locality. During the action the Medical Director must keep himself thoroughly acquainted with the movements of the troops and act accordingly. The Corps may take up a new position with a different front; sometimes a part or even the whole of a Corps may meet a superior force and be repulsed; under such circumstances the Medical Director should be ready to act promptly, and to transfer his wounded to a safer locality. Should the Corps Commander be present he will advise his Medical Director of the state of affairs and give orders in reference to the removal of the hospitals. There are times, however, in which the Director is called upon to act upon his own responsibility. Should it become necessary to leave the wounded in hospitals in the hands of the enemy, the Medical Director will see that they are properly sheltered, that a sufficient number of Medical Officers, Hospital Stewards, and attend ants remain with them, and that an ample supply of medical and hospital stores, dressings, and provisions be left for their comfort. After an engagement, the Medical Director of the Army should be communicated with as to the means of transportation for the wounded to General Hospital; he should be informed of the number and of the time at which they will be ready for such transit; on receiving instructions the necessary orders are given. The Medical Inspector generally attends to the shipment of wounded. During action the duties of a Medical Director require his preseuce at Corps Headquarters, where he can be found, and where he can obtain the earliest information and receive orders and reports. As a general rule, therefore, he cannot stop to operate during an engagement; he should remember that he is responsible for all the wounded, and that there are occasions in which the delay of half an hour will result in the loss of his hospitals. The Corps Commander should be kept informed of the operations of the Department both during and after engagements, and should always be consulted in matters of importance. As it is necessary for the Medical Director to visit his hospitals and field depots from time to time, he should always leave a competent Medical Officer at headquarters to represent him. When practicable, the hospitals of the different Divisions should be located near together each one, however, to be kept perfectly independent and distinct in its management. This will much facilitate the operations of the Ambu lance and Medical Departments, enabling the divisions to assist each other in taking care of the wounded. For instance, should one Division suffer more than another, an operating staff, or more if necessary, with the Auteurieth wagon, can be ordered to the suffering Division ; again, should one Division be deficient in shelter or supplies, they can be obtained from the other Divisions; another advantage is the facility given for inspection, and for giving instruction, and in distributing the wounded as they come in; for instance, all available ambulances are used when wanted, with out reference to their Divisions. An ambulance reaches the hospital containing wounded of different Divisions, no difficulty is experienced in distributing them, each to his own Division Hospital, thus enabling them to be treated by their own Medical Officers and to be registered in their own Divisions. Again, in sending off the wounded to General Hospital, the loading of the wagons will be much facilitated and a corps train readily found. When avoidable, the wounded should not be sent off from the field Division Hospital until they have been operated upon, properly dressed, fed, and have obtained some rest, and have somewhat recovered from the shock. In sending sick and wounded off to General Hospital the Corps Director gives the necessary orders to have the wagons or cars properly bedded with brush or hay, specifies the number of rations to be taken, and the number of Medical Officers, Stewards, and attendants that should accompany the train, giving any instructions that he may deem important in reference to the roads, camping, etc. When the troops SUKG. Ill 114 906 THE MEDICAL STAFF AND MATEEIA CHIRURGICA. [CHAP. xiv. remain in camp some time, it will be found convenient to bave near each Division a few ambulances, with horses hitched up ready to convey a patient to the hospital. These are known in the Corps as picket ambulances, and are relieved every twelve hours. At this post there should be a medi cine wagon, under the charge of a Steward, to issue medicines to the regimental Surgeons. The post should be marked by an ambulance guidon ; this wagon to be relieved as often as emptied. As a large number of stretchers and lanterns are always broken or lost during an engagement, orders should be given after an action to have the deficiencies supplied as early as possible. ". Duties of the Medical Inspector of a Corps: A Medical Inspector of a Corps has but few spe cific duties assigned to him, and these, with one exception, are such as the Medical Director may direct to facilitate the management of the Medical Department and keep him informed of the defi ciencies which need correcting and errors that should be rectified; as his relative position to the Medical Director is analogous to that occupied by an Assistant Adjutant General to his Command ing General, any authority he may exercise in the discharge of duty is entirely delegated power. The only reports made to him are the daily morning reports of each hospital from which the Corps report is made. A monthly report of the inspection of troops has been used, but since that has been abandoned reports, not in tabular form, have been made of the condition of the troops only to the Medical Director, calling his attention to any violation of sanitary rules that may have been observed. Previous to an engagement, or march, he sees that the direction of his superior officers relative to the proper disposition of the flying hospital and medicine wagons are obeyed, and that they are in readiness to accompany the troops. The principal duty devolved upon him during an engagement has been to represent the Medical Director at the hospitals, to see that the men are properly provided for, and when instructed to send wounded to the rear to assist the Chief Ambu lance Officer in the proper apportioning of the means of transportation, to make the detail of Medi cal Officers and attendants to accompany the train, and ascertain that they are provided with stimulants and other essentials to render the patients confided to them as comfortable as possible. " Duties of the Surgeon-in- Chief of a Division: 1. The Surgeon in-Chief of a Division promul gates to Surgeons-in-Chief of Brigades all orders, circulars, and communications that are received from the Medical Director of the Corps, also all orders, circulars, and communications pertaining to the Medical Department that emanate from Division Headquarters. 2. He receives all reports that are made by the Surgeons-in-Chief of Brigades and consolidates them before forwarding them to the Medical Director of the Corps, except the Monthly Keport of Sick and Wounded fur nished by the regimental Surgeons, and the weekly report of Brandy and Whiskey furnished by the Surgeons-in-Chief of Brigades: these are forwarded without any action from him. The only reports made directly by him are the Monthly Return of Medical Officers of the Division, which he forwards to the Medical Director of the Corps, and the Personal Report to the Surgeon General from the post at which he is serving. 3. All requisitions for medicines and hospital supplies, made by the Surgeons-in-Chief of Brigades, are received by him and forwarded to the Medical Director of the Corps, without any action from him except Special Requisitions, which are either approved or disapproved before being forwarded. 4. All applications for leave of absence and resignation on Surgeon s certificate, and all Certificates of Disability for discharge of enlisted men, are forwarded from their regiments through the regular military channel and referred to the Surgeon in-Chief of the Division by the Assistant Adjutant General of the Division; each case is personally exam ined by the Surgeon-in-Chief and the action indorsed on the official paper. Applications for leave of absence of Medical Officers are referred to the Surgeon-in-Chief by the Assistant Adjutant Gen eral for his action. 5. All details of Medical Officers and enlisted men for duty at Division Hos pitals are made by the Assistant Adjutant General, to whom the names, rank, regiment, and com pany are furnished by the Surgeon-in-Chief. 6. The Surgeon-in-Chief of a Division has no official relation with any Staff Officers except the Assistant Adjutant General. 7. A detail of one Medical Officer as Officer of the Day is made each day by the Surgeon-in-Chief, with instructions to visit each regiment of the Division and inspect carefully its hygienic and sanitary conditions, also to visit the Division Hospital and see that proper attention is given to cleanliness and to the comfort of the patients; examine the cooking and whether the attendants perform their duties faithfully. A written report to be furnished of these investigations. 8. Before an engagement the detail for the Field Hospital is announced by the Surgeon-in-Chief of the Division: the Surgeon in charge of the Division Hospital remains in charge and has control of all the shelter; the officer detailed CHAP, xiv.j THE MEDICAL STAFF. 907 as Hospital Commissary provides the food; the records are kept by a Hospital Steward, U. S. A. Three (3) Surgeons are detailed as operators, and three (3) Medical Officers are assigned to each operator as Assistants. One Cook, two Nurses, and one Hospital Steward are taken from each regiment for the Field Hospital. 9. The Medical Officers who remain on the field at the time of and after an engagement are instructed to form their depots and locate them by Brigades, and are to select their positions in compliance with instructions of Circular from Headquarters, Army of the Potomac, Medical Director s Office, dated October 30, 1862, and to examine each man before he is put in an ambulance. 10. The position of a Surgeon-iu-Chief of a Division during an engage ment is, first to locate the Field Hospital and see that the details are properly filled, then to visit the front and confer with the Ambulance Officer of the Division, ascertain that the depots are properly located and that the Ambulance Sergeants have been notified of their positions, then to report to the General Commanding and receive any instructions he may have; afterwards to return to the hospital and assist in making the wounded comfortable. 11. On the march the Surgeou- in-Chief of a Division remains with the General Commanding. " Duties of a Surgeon-in-Chief of a Brigade: 1. The Surgeou-in-Chief of a Brigade has under his charge all the medical supplies allowed to his command. He draws once a month from the Medical Purveyor of the Army all needed to bring what he has on hand up to the requirements of the supply table, and in case of emergency can, during the month, make special requisitions for necessary articles. He issues to Medical Officers in charge of regiments only what they want for immediate use. By this excellent arrangement the Army has been relieved from the encum brance of the large supplies formerly allowed to regiments and the transportation of the Medical Department is greatly reduced. Under two orders from Surgeon Letterman, Medical Director of the Army of the Potomac, Brigade Surgeons were forbidden, for more than a year, to take receipts from regimental Surgeons for supplies issued to them, and the Brigade Surgeon was ordered to expend them on his annual returns. This proving unsatisfactory to the Treasury Department, a circular from the Surgeon General directed a return to the requirements of Army Regulations in the transfer of all property. As medicines and other expendable articles are issued continuously, and in very small quantities, it is unavoidable for the Surgeon-in-Chief of a Brigade to be forced to expend, on his returns, much property really issued to regimental Surgeons. The transporta tion granted to each Brigade for its entire medical supplies, including the desks and medicine chests of regimental Surgeons, consists of one Army and one Auteurieth or Perot medicine wagon. In addition, however, to the articles carried in the wagons, the boxes of the ambulances are filled with the material necessary to establish a temporary field hospital in case the supply train during a movement is inaccessible. This arrangement is one of the greatest advances made during the past two years in providing for the wounded as the conveyances bringing them in have all that is absolutely required to feed them, and the hospital tent and fly generally carried in the ambulance gives sufficient shelter. In the construction of new ambulances it would be desirable to increase the width and depth of the box so that larger camp kettles could be carried, the present only admitting the smallest sized kettle. The Surgeon-iu-Chief of a Brigade furnishes the material carried in the ambulance boxes, and assures himself by weekly inspections of them that each box contains all required by the supply table and other orders. He also draws from the Medical Purveyor and is responsible for the stretchers carried on the ambulances. 2. The Surgeou- in-Chief of a Brigade is the Medical adviser of a Brigade Commander in all professional ques tions affecting the command. Applications for leave of absence, discharge, and invalid rolls, grounded on the certificates of regimental Surgeons, are submitted to him for his opinion of their propriety, to be based on an examination of the applicant. It is the duty of the Surgeon-in-Chief of a Brigade also to keep careful watch over the health of the Brigade, pointing out and endeavor ing to correct all infractions of hygienic laws. He receives every Saturday, from each Medical Officer in charge of the regiments constituting the Brigade, a weekly Report of Sick and Wounded of his regiment and of the anti-scorbutics issued to it. Whenever a regimental Medical Officer leaves or returns to his command he should furnish the Surgeon-in-Chief of the Brigade with a copy of the order under which he acts. The Surgeou-in-Chief consolidates the regimental weekly reports of sick and wounded and of anti-scorbutics, and forwards them to the Surgeon-in-Chief of his Division. He sends, at the same time, a report of the liquors drawn and issued by him during the week. He makes also, to the Surgeon-in-Chief of the Division, a monthly return of the Medi- 908 THE MEDICAL STAFF AND MATERIA CHIRURGICA. [CHAP. xiv. cal Officers of the Brigade. After a battle he sends to the Surgeon-in-Chief of the Division a report of the aggregate strength for duty and names of Medical Officers present for duty, and the killed, wounded, and missing in action, according to the reports received from regimental Surgeons. The losses in skirmishing in the intervals between the battles have been reported weekly. "Duties of the Surgeon-in-Charge of a Division Hospital: The duties of a Surgeon-in-Charge of a Division Hospital arc somewhat varied, depending upon the season of the year and the state of military operations, whether the Army is in winter-quarters or engaged in an active campaign. In one case more permanent arrangements are made with a view of remaining undisturbed for several mouths; in the other all the appliances of a Division Hospital are arranged and managed to meet certain conditions, definite transportation, general mobility, and despatch in its construction and removal. Procuring all the necessary supplies for the sick and wounded, superintending the care and treatment which they should receive, organizing the hospital attendants, keeping the necessary and suitable records, causing reports to be made, and receiving orders from his superior officers and complying with them, are briefly in the aggregate the duties of the Surgeon-in-Charge of a Division Hospital. On the march the sick and wounded on hand are placed in ambulances, and a Medical Officer connected with the hospital is assigned the duty of keeping with the ambulance train and rendering such assistance on the journey as the wants of the sick, etc., may demand. In the evening, or at the close of the day s march, the Surgeou-in -Charge will make the necessary arrangements for sheltering and furnishing the sick, etc., present, with food and medical attend ance. This is often accomplished in this manner: The Medical Director of the Corps indicates to the Ambulance Officer the place he desires the ambulances to park. The Surgeon-iu-Cbarge then proceeds to pitch a sufficient number of tents, directs the cooks to provide beef tea, hot coffee, etc., orders sinks to be dug, sees that the sick and wounded are unloaded and taken care of, thus affording them attentions and comfort consistent with the nature of circumstances. On the following morn ing, after food has been served to all, a Sick Call is held, and all that require medicine receive it. Soon after, a morn ing report is made, signed by the Surgeon-in-Charge, and sent to the Surgeon-in- Chief of the Division. Thereafter, if it is intended to resume the inarch, the sick and wounded are reloaded, the tents are struck, and everything packed. Thus the routine continues from day to day as long as the march may last. In the event of an engagement, the Surgeon-in-Chief of the Division indicates to the Surgeon in charge of the hospital the place selected for the location of the Division Hospital. The latter then directs the pioneers or fatigue party to police the ground and pitch the tents, establishes the kitchen, appoints a chief cook and a cook for special diet, organizes the nurses and other attendants, unloads the ambulances of the sick, provides operating tables and all necessary appliances for surgical operations, such as chloroform, stimulants, dressings, etc., orders sinks dug, sees that a sufficient supply of water is near, either by opening springs or by digging wells, etc. Thus accommodations are made for the sick on hand as well as for the wounded that may be brought in from the battle-field. The Surgeon-in-Charge selects a Medical Officer to superintend unloading and disposing of the wounded as they come in. Such as require operations are taken to the tables and receive the attention of the Surgeons. Very often comfortable and convenient beds are made by filling sacks with hay or straw, raising them from the ground on crutches or cross-pieces. The Recorder s attention is then called to the wounded, and he takes down their names, rank, regiment, and character of injury, and, in order to prevent confusion, often finds it necessary to attach a small piece of bandage to the button-hole of the wouuded man that he may be assured afterwards that his name, etc., has been registered. It is the duty of the Surgeon- in-Churge to see that the records are at the amputating tables and properly kept, specimens preserved and labelled, etc. He selects either a Medical Officer or a Hospital Steward to have immediate supervision of the kitchen, diet, and feeding of the men. He sees also that the wounds of all the wounded men are examined and dressed, and in order to secure this a sufficient number of Medical Officers are assigned to wards as dressers, and a Medical Officer, Surgeon, or Assistant Surgeon appointed each day to act as officer of the day. He is required to be on duty at night, also to attend to any emergency that may arise sudden hemorrhage, prostration, etc. The dead likewise require the duties of the Surgeou-in-Charge. He selects a suitable location for a cemetery and here inters the dead, giving them a Christian burial by the presence of a Chaplain to officiate and attend to the funeral obsequies. The graves are marked by a head -board, written or inscribed on it the name, rank, company, and regiment of the deceased. His effects are preserved and at a CHAP. XIV.] THE MEDICAL STAFF. 909 convenient time disposed of according to the requirements of the Army Regulations. His duties consist, likewise, in making out provision returns and drawing from the Commissary of Subsistence a sufficient number of rations for the sick and wounded, as well as for the hospital attendants present. He should see to it that an abundant supply of chloroform, stimulants, beef-stock, blankets, bed-sacks, bandages, dressings, shirts, drawers, and socks is on hand to meet almost any emer gency that may occur. When the sick and wounded are ordered to be sent to the Depot Hos pital a list of them will be made out complete, which, when approved by the Medical Director of the Corps, will be sent with the Medical Officer who accompanies them. A proper entry of the disposition of these will be made in the register. The supervision of the Hospital Fund made from the savings devolves upon the Surgeon in-Charge. He will keep a correct account of it, and authorize the purchase from it of such delicacies as are needed for the comfort of the more serious cases in the hospital. The Surgeon in charge of the hospital is immediately subject to the orders of the Surgeon-in-Chief of the Division, and such other orders as may come through him from higher authority Medical Director of Corps and Army. His reports should be made through the same channel, also the requisitions for Medical Supplies, requests for details, etc., and in fact all official communications whatever, except property returns, which go directly to the Department of the Surgeon-General. The following is a list of reports, requisitions, etc., made by the Surgeon in charge of the hospital: A Weekly Report, Monthly Report, Report of Sick and Wounded, Cer tificates of Death, Requisitions for Medical and Hospital Stores, Morning Reports, etc. The fol lowing is a list of the books and registers kept on hand: Morning Report Book, Register, Pre scription Book, Case Book, Letter and Order Book. "Duties of the Medical Recorder of a Division Hospital: 1. During a battle the names of all wounded admitted to the hospital are carefully entered in the prescribed forms: Lists of Wounded, giving Rank, Company, Regiment, and Corps; also the nature of the missile or weapon causing the injury, when wounded, its nature (slight or severe) and the treatment pursued in each case. On this form are also entered all amputations and operations and deaths. After the engagement is over a Classified Return of Wounds and Injuries is prepared from this list. 2. At the operating table an assistant prepares all specimens of interest for preservation in a specimen jar. Here, likewise, the name and designation of the patient is noted down, with a full detail of the injury and the operation performed, with the name and rank of the operator. When the specimen is ready to be deposited in the jar it is labelled and the number on the label written opposite the patient s name. As soon as possible afterwards, a complete list is made of all the operations during the engagement, giving, as it were, a history of each case, the number opposite the patient s name cor responding with the number of the specimen in the jar. After a battle a report of aggregate strength of men and names of Medical Officers present for duty is also made out. "Duties of the Attending or Prescribing Surf/eon of a Division Hospital: 1. To visit his ward regularly twice each day, or as often as the condition of his patients may require. 2. To examine and make proper diagnosis of patients as they may be reported to him, either for wounds or disease; to make and keep a correct register of all patients, with their treatment, and daily to report them to the Surgeon in charge of the hospital. 3. To prescribe suitable remedies and to see that they are regularly administered by the attendants. 4. To inspect the diet of the men and see that proper food is given them. 5. To attend strictly to the sanitary condition of his ward and surroundings, and compel those whose duty it may be to remove everything offensive or detrimental to health. G. To assist in all surgical operations, or operate, as he may be required by the Surgeon assigned to that duty. 7. To see that the men under his care are as comfortable as circumstances will admit. "Duties of the Operating Surgeon: 1. The Operating Surgeon shall select steady and reliable attendants, give them clear and explicit instructions relative to their respective duties, and assign to each his proper place. 2. He shall see that all the necessary appliances be at hand required in performing operative surgery, that the instruments are in good order and in their proper places, and that a good and sufficient supply of lint, bandages, ligatures, sponges, plaster, etc., be con. venieutly placed and ready for use. 3. He should take charge of all patients that in the opinion of the Prescribing Surgeon require surgical attention, make a minute and thorough examination of each case and determine whether surgical aid is necessary; judge of the best manner of benefiting the patient, taking into consideration the relation of important organs, vessels, and nerves in 910 THE MEDICAL STAFF AND MATEEIA CHIRUEGICA. [CiiAl>. xiv. proximity to the wound, what bearing they may have in the preservation or loss of the patient s life, and to use every preservative means within the reach of surgical science to save the life of the patient with as little impairment of all his functions as possible. 4. An operation beiug deter mined upon, he should have the patient properly placed upon the table and should judge of the practicability of administering anaesthetics, and if their use is found necessary should superintend the administration. 5. The patient being etherized, the Surgeon proceeds with the operation that the case requires in the most expeditious and scientific manner compatible with the nature of the injury, endeavoring to preserve the usefulness of the parts operated upon to the greatest extent in operations on the extremities preserving as great a length of bone as possible and securing sufficient integument to give a liberal covering to the stump. "Duties of the Regimental Surgeon: The first duty of the day is that of the Morning Sick Call, when the sick and disabled, as well as those who are neither sick nor disabled, present them selves for treatment. The Surgeon is called upon to exercise his judgment in determining the character and gravity of their ailments. If he had none to deal with but those who were really sick, his task would be plain, simple, and easy; but, unfortunately, many of the cases are feigned, and he is required to discover and overcome the means brought into requisition by a skulker s ingenuity to carry out his deception. Presuming that the Surgeon is fortified by skill and experience suf ficient to detect these, and has a just sense of responsibility to the United States Government (for he really regulates the strength of the command ), his examinations will be made without partiality and regardless of position or prejudice, and in his report he will assign to duty those who are fit for duty, the sick to quarters for treatment, or send them to hospital, and recommend the perma nently disabled for discharge or the Veteran Eeserve Corps. It may be added that in cases having slight symptoms of diseased action, insufficient to indicate position and unmistakable disease, humanity would dictate, and authority sanctions, that they be placed off duty, and that they may have the benefit of the doubt and time for development of disease. Having concluded his work thus far, the Surgeon will see that a copy of his report is forwarded to the Adjutant, who deducts all excused from duty from the mean strength present in the regiment; and the available strength of the command is obtained, which forms the basis for all details and assignments that may be made in the regiment. Should the regiment be filled up by conscripts, substitutes, or enlisted men, .the Surgeon is required to examine each one carefully and report on their fitness for service, rejecting all those who, by reason of infirmity, are unfit, and recommending for reception such as he thinks will be able to discharge the duties of a soldier. That the duties imposed upon the Surgeon are important is obvious to any one, and should be particular^ so to an officer who has recorded his obligation to subserve the interest of the United States. If the Surgeon indulges the men and reports them off duty when they are not sick, he imposes additional labor on the faithful men who bear the heat and burden of the day, and virtually offers a reward to the faithless; or in examin ing recruits admits any who are physically disqualified, he acts in bad faith to all and in the end unwarrantably weakens the command, defrauds the Government, and may be the cause of render ing an important engagement abortive. If he conducts his examinations carelessly, the men will soon avail themselves of the chance to escape duty, and in great numbers report themselves sick; the Surgeon loses his influence for good, and he sinks into disrepute and merited disgrace, which does not terminate with his service in the Army, but will follow him throughout all time. After Sick Call the Surgeon should visit the sick in quarters, prescribe for them, and see that suitable food is provided and their quarters made as comfortable as possible, inspect the camp daily, see that it is well drained by proper ditching through which all superfluous or surface water may be carried off, that all filth or anything likely to produce disease is removed or corrected, that the quarters of the men are swept and aired and their bedding exposed to the sun whenever practicable, that the sinks are covered with dirt or ashes (the latter preferable), that the food of the men is of good quality and sufficient quantity (reporting any error in either), and that the cooking is judi ciously done. These duties are essential and should receive daily attention, as the neglect thereof will decidedly increase the sickness of the regiment and consequently impair its efficiency. Should a soldier die in camp or regimental hospital, the Surgeon should notify his Commanding Officer and forward to him an inventory of his effects, with the disease from which he died and the date of death, select a place for burial and see that he is decently buried and his grave carefully marked. The duties thus far pointed out are obligatory, and no excuse can be made for their uon-perform- C11A1-. xiv.] THE MEDICAL STAFF. 911 ance iu camp. There are many other acts of kindness, more correctly denominated favors, that can be" extended by a Surgeon without detriment to himself, that will have a good effect upon the soldier in leading him to believe that his life and comfort command the Surgeon s consideration; these being done willingly will have the effect of improving the morale of the command and useful ness of the Surgeon. When a inarch is likely to be made the Surgeon is directed to send his sick to General or Division Hospital. Again he is called upon to make a careful and rigid examination to avoid imposition ; for the terrifying effect of a prospective battle will cause men to limp who never limped before, and many hitherto good soldiers will make an effort to escape it. The Sur geon completes his list and forwards a copy by name, rank, and compau} , regiment, and disease, with descriptive lists of each man; when he loads his men, providing sufficient food for the time required to reach the hospital. Having provided the requisite quantity of medicines, etc., to fill the hospital knapsack or field companion, he gives them to his hospital attendants, and when the regiment moves the Surgeon, Hospital Steward, and attendants take their position in the rear. If any of the command take sick or are wounded on the march, the Surgeon is notified and is pre pared to prescribe medicines or suitable dressings, and furnishes a pass for ambulance transporta tion (a duplicate of which he retains), or directs them to walk leisurely in the road, being governed by the severity of the diseases or wounds, and being careful that no deception is practised by men that are not sick, recording each case in his Field Register, with character of disease or wound. Having thus carefully discharged his duties during the day, and though the march has been a long and laborious one, he should, after arriving iu camp, visit and prescribe for the sick, and endeavor to make them as comfortable for the night as the means at hand will permit, before his day s work is done. Again, in the morning, before the regiment moves, he should see them and prescribe medicines for the day, select such cases as require wagon transportation, see that they are loaded, and those able to march started before he leaves the carnp. From day to day these duties should be performed. Although trying on the strength of the Surgeon he should not fail to do them, as, sooner or later, a day of rest will come and he will be able to recuperate. During an engage ment the Surgeon, if not detailed on the operating staff at the hospital, should report with his assistants and attendants to a point selected in the rear of his command, either by brigade or regiment, and notify the sergeant in charge of the stretcher bearers thereof, that the wounded may be carried to said point, to whom he should give such medicines and apply such dressings as their wounds may require, to afford comparatively comfortable transportation to the hospital of their Division, where each case receives minute examination and further attention. Should the Surgeon be placed on the operating staff, his duty, in connection with other members, is to examine care fully every wounded man and determine the extent of his wound, the parts involved, and the neces sity for and kind of operation his case may demand. Should he be selected to perform the operation he should endeavor to do it as scientifically and with as much despatch as the nature of the case and safety of the patient will admit, and in all cases apply appropriate dressings m such a manner that they will not become detached in transportation to General Hospital. He may be thus employed for an indefinite length of time; he should therefore feel it incumbent on him to labor as long as there are any cases requiring attention, until all have had the advantage of primary opera tions and are relieved from the excessive pain of undressed wounds and increased mortality attend ing secondary operations. The duties of the Surgeon in every position may be summed up in one sentence: He does not rest until everything is done that can contribute to the comfort of the wounded. After a battle the Surgeon will report to his regiment, unless otherwise ordered, and resume the charge thereof, and will perform such duties as are mentioned in describing those in camp, etc., previously procuring the names of the men killed in the action, and of the wounded, the nature of their wounds and character of the missile inflicting them, together with all statistics required in reports he may have to make. The reports required of a Surgeon of a regiment are the Morning Report to the Adjutant, the Weekly to the Surgeou-in-Chief of the Brigade, and the Monthly. It is altogether necessary that a medical officer should so conduct his depart ment that he may secure the confidence of the officer in command of the regiment to which he is attached, that said officer may receive his reports and rely on their correctness. If both military and medical officers are sincerely interested in the health of the regiment and act in concert, much can be done to promote order and discipline. The necessity for this can be discovered when the opposite is experienced. The Surgeon cannot have an order issued or carried into effect without 912 THE MEDICAL STAFF AND MATERIA CHIRURGICA. [CHAP. xiv. great difficulty, and if the variance should continue the intercourse will be so unpleasant that the command eventually suffers in consequence. The officers are mutually responsible and should be mutually respectful. "Duties of the Assistant Regimental Surgeon: The duties of an Assistant Surgeon when in charge of a regiment or hospital are identical with those of a Surgeon in the same position. If he be acting under a Surgeon in charge he will perform such share of the Surgeon s duties in the case of the sick as the Surgeon may assign to him. The sick in the ambulances on the march are usually put in charge of an Assistant Surgeon, one or more, whose duty it is to accompany the ambulances and see that such medicines are administered as the patients may require; usually he both prescribes and dispenses. He decides also what patients must be carried, and when they are well enough to walk or to rejoin their companies. Beef stock, tea, and sugar are carried in each ambulance for the use of the sick, subject to the order of the Assistant Surgeon in charge, and to be prepared by the ambulance meu belonging to each ambulance. When an action is about to take place the Surgeons with the regiments are usually ordered to the Division Hospital, while the Assistant Surgeons are left to establish regimental field hospitals or depots, where the wounded come or are brought by the stretcher bearers to be dressed. Sometimes a Surgeon is left in charge of the Assistant Surgeons of a Division with orders to select the places for the field hospitals. A depot of this kind should be in some comparatively safe place, but not too far from the regiment, and where the ambulances can have a good chance to conic without being in great danger from the enemy s fire; it should also be convenient to good water, which will be needed for dressing the wounded. If the place is too much exposed the stretcher men will not be likely to bring the wounded, nor will wounded men wish to be left where they may get more wounds while being dressed or waiting their turn to be attended to; but will prefer to go farther to the rear. If the ambulances cannot come to the depots where the men are brought to be dressed, a sudden change in the lines may cause some men to be left on the field who were waiting to be attended to, and who might have been carried off in a very few moments if necessary, even though they were not dressed, were the ambulances there. Still, although perfectly safe places can seldom be found near where the fighting is going on, especially where the ground is comparatively even, the Assist ant Surgeon should not allow his fears to induce him to remain too far away from his men. and they should be kept advised of his whereabouts; hence, when a regimental field hospital has been established it should not be moved unless it is absolutely necessary to do so. . Assistant Surgeons on the battle-field should be furnished with the ordinary Surgeons dressing case of instruments operations requiring other instruments than these are usually of too severe a character to be attempted on the field. He should be accompanied by one or two nurses with plenty of lint, bandages, isinglass plaster, water, sponges, and a few of the most frequently required medicines. After dressing the men the Surgeon should see that they- are properly placed in the ambulances, and give the direction for their care until they reach the Division Hospital duties often of great importance to the patient. When it can be done conveniently it is better that the Assistant Sur geons of several regiments or of a Brigade be together on the field, as they will often be enabled to assist and advise each other. An Assistant Surgeon in the field has very little opportunity for observing severe surgical cases; after the first dressing he very rarely sees or hears anything of their further treatment or termination. So far as practicable the Assistant Surgeon in the field should keep a memorandum of the names of the men he dresses, their companies and regiments, also the character and severity of their wounds; this will be of much service in making the required reports and in answering the inquiries of anxious friends. Of the relative position of an Assistant Surgeon very little is to be said. He seems to be subject to the orders of the commander of his regiment, brigade, etc., whether he be colonel or corporal, and to those of the Surgeon of his regiment, brigade, division, etc., and has command only over those of inferior rank in his own department. So far, however, observation leads to the belief that regimental commanders seldom interfere with the duties of their Assistant Surgeons. "Duties of the Commissary of Subsistence of a Division Hospital : The Division Hospital Com missary is under the immediate direction of the Surgeon in charge of the hospital ; he makes reports to him and receives his orders. His duties while in camp are to draw at stated intervals from the commissary officer, authorized to issue to the hospital, such stores as are required for the use of the sick and wounded, stewards, and authorized attendants, on provision returns approved CHAP. XIV.J THE MEDICAL STAFF. 913 by the Surgeon in-Charge. He is required by existing orders to keep on band at least one thousand rations of bread, sugar, coffee, tea, pork, and from six to ten head of beef-cattle. He makes a daily inspection of the stores on hand in order to keep np the necessary amount of supplies, so as to be ready at all times for a rapid movement or an engagement. It is also his duty to make out the provision returns, having them agree with the morning report of sick and wounded ; the names of all the hospital attendants to be written on the back of each return. He superintends the purchase of such articles as are not furnished by the Government, and which the Surgeon-in-Charge consid ers necessary for the use of the sick and wounded. He also keeps an account of the savings of the hospital, and makes a monthly report of the state of the hospital fund to the Surgeon-iu-Charge. He has, in conjunction with a medical officer, charge of the cooking and preparation of the food, seeing that there is no unnecessary waste, and that the place in which the stores are kept and food prepared is properly policed daily. When orders to move are received he attends to the packing of the supplies in the wagons assigned for that purpose. He also sees that there is a sufficient number of cooking utensils on hand, and that they are kept clean and in good condition. On the march he is required to keep his wagons with the hospital department, or wherever they may be ordered, also to have the beef-cattle up with the wagons, so that if necessary they can be slaughtered and prepared for food in the evening, or whenever a halt is ordered. He selects a proper place for cook ing purposes, unloads such stores as are required for the occasion, and, if within reach of the supply train, gets his stock replenished. On the approach of an engagement it is his duty to have hot coffee, tea, beef-soup, and other necessary articles of diet ready for the wounded as soon as they may be brought in from the field. When the wounded are being sent to the depot hospital he furnishes each man with sufficient rations to last him until he reaches his place of destination. When men are returned to duty from the hospital he also furnishes them with rations. " Duties of the Chief Ambulance Officer of a Corps: In addition to the regular monthly returns of Quartermaster s property the Chief Ambulance Officer of the Corps receives and makes the fol lowing reports: 1, Daily Wagon and Forage Report; 2, Weekly Ambulance Report; 3, Monthly Report of Transportation ; 4, Monthly Report of Officers in Quartermaster s Department of the Ambulance Train and the time to which they have made their property returns ; 5, Monthly Report of all Quartermaster s property received and issued during the month; G, Monthly Report of Offi cers serving in the Ambulance Train. When not on the march the Chief Ambulance Officer of the Corps inspects the ambulance train every Sunday morning with the object of correcting all abuses and of promoting the efficiency of the train. Before a move he should give timely notice to the Division Ambulance Officers, so that they may have everything packed up and ready to start at the appointed hour. It is his duty to regulate the order of march of his train, select suitable camping grounds, and see that his train is at all times ready for active service. Before an engagement he informs himself as well as possible about the country, roads, etc., sees that his train is well up and together, so that as soon as the lines of battle are established he can park his whole train in some central position from which to send picket ambulances as near the lines of each Division as possible. An officer is always placed in charge of the main park of ambulances, one in charge of the picket ambulances of each Division, and the remainder of the officers are instructed to take charge of the stretchers, men, and sergeants. It is also necessary to leave an officer in charge of the hospital train of the corps. The Chief Ambulance Officer must personally superintend the working of his train so as to see that every one does his duty, that the drivers do not become stampeded, and that the wounded are transferred to the hospital as quickly and easily as possible. It is also his duty to see that the stretcher men do not carry the wounded farther than is necessary. When in camp, and it is necessary to send off sic-k or wounded, the chief Ambulance Officer orders the proper num ber of ambulances and details an officer to take charge of the train ; one ambulance officer from each Division superintends the loading of the ambulances at his Division Hospital. When in camp, the stretcher men are used in the hospital when needed. It is also necessary that the Chief Ambulance Officer should see that the ambulances are not improperly used. It being desirable to receive orders as early as possible, the Chief Ambulance Officer finds it best to have his quarters at Corps Headquarters. "Duties of the Chief Ambulance Officer of a Division: He should be the receipting officer for all Quartermaster s property belonging to his Division, and be responsible for all deficiencies. He should make all necessary returns required by the Quartermaster s Department, Commissary SURG. Ill 115 914 THE MEDICAL STAFF AND MATERIA CHIRURGTCA. [CHAP. xiv. Department, and Ordnance Department, viz: Monthly returns of property to the Quartermaster s Department, Quarterly return of Ordnance, usual Ration return to Commissary Department, also the daily Forage Report, the Weekly report of Ambulance Department, Monthly report to Quar termaster s Department, and Monthly report of Officers. When on the march he should attend to the running of his train, see that forage is drawn from the nearest post, and a sufficient quantity kept constantly on hand; properly park his train at night according to orders from the Chief Am bulance Officer of the Corps; necessary sentries posted so that horses may not stray away or be stolen, and be ready to move at short notice. Before an engagement it is his duty to see that the Brigade Officers are with their Brigades, and that they have the sergeants and stretcher bearers well up with their regiments, have his train so parked that it will be easy of access, and so near that the stretcher men will not have any farther than actually necessary to carry the wounded, and at the same time protect his horses from unnecessary exposure; and after an engagement to assure himself that all the wounded of the Division have been removed from the field; also to assist the Surgeons when a train of sick and wounded is to be sent to Base or General Hospital. ^Duties of the Chief Ambulance Officer of a Brigade; 1. While in camp one Brigade Officer of each Division train is constantly with the troops, and in case of any movement reports the fact at once to the Chief Ambulance Officer of his Division. He should see that the drivers and stretcher men are at the established posts, and that all orders from Surgeons for ambulances or stretchers for the transportation of sick or wounded men are promptly attended to. 2. When not on duty with the troops he will see that the ambulances are properly parked, and that the drivers attend faithfully to the feeding and grooming of their horses, the cleaning of the harness and ambulances, and to the policing of the stables and grounds of the park; also that the kegs are kept constantly filled with fresh water. Stretcher men will assist in the policing when not on duty at the Division Hospital. 3. A suitable non-commissioned officer will be selected to have the direct supervision of the ambulances of the Brigade, and another of the stretcher men. The rest of the nou commis sioned officers will have charge of the stretcher men of their respective regiments under the one in charge of the stretcher men of the Brigade. 4. On the march (unless otherwise directed) Bri gade Officers remain with the headquarters of their Brigades, and in case of an engagement select a spot as near the line as possible, with a reasonable degree of safety to the horses, and as central to the lines of the Brigade as possible. 5. The Brigade Officer will cause a small number of ambu lances to be brought to the spot selected, and others to be sent to fill their places ; and as fast as they are filled to send to the place selected for the hospital. The stretcher men will be informed of the position of the ambulances, and will bring to them as fast as possible any man that may be wounded and unable to walk, until all the wounded men are carried fiom the field. 6. The Brigade Officer should inform himself of the shortest and best roads to the Division Hospital, and see that the drivers take them, driving carefully, and avoiding the bad places as much as possible on an uneven road. A good non-commissioned officer should remain constantly with the advanced ambu lances to see that the wounded men are loaded carefully and speedily and the drivers do not get demoralized. 7. No written reports are made by Brigade Officers. They report verbally to the Division Officer any breach of discipline or neglect of duty that may require his attention. 8. He receives only such orders as come through the Chief Ambulance Officer of the Corps or his Division, or some medical officer. It is only necessary to point to the manifold functions required of the medical officers in the foregoing reports to see that their duties were arduous and responsible, calling, aside from professional ability, for the exercise of firmness combined with tact and moderation to do justice to the sick and wounded entrusted to their immediate care, and at the same time to avoid complications with clashino- interests 1 O MATERIA CHIRUKGTCA. At the beginning of the war each regimental Surgeon was furnished with a suitable equipment, for his regiment for field service, consisting of medicines, stores, instruments, and dressings, in quantities regulated by the Standard Supply Table. 1 In action he was 1 See Standard Supply Table for field Service, in Jlm frrl Jlrgulatinnsfnr the Arm;/ of tlir. United State*, 18(51, p. 304. CHAP. XIV.] MATKRIA CHIRURGICA. 915 accompanied by a hospital orderly, who carried a knapsack containing a limited supply of anaesthetics, styptics, stimulants, and anodynes, and material for primary dressings. This hospital knapsack had been recommended for adoption by an army board in 1859; it was made of light wood, 18 inches in height, 15 inches wide, and 7 inches deep, but subsequently FIG. 425. Hospital knapsack of wicker-work, covered with enamelled cloth. FIG. 426. Regulation hospital knapsack of 1862. wicker-work, covered with canvas or enamelled cloth, was substituted for the wood; its weight when filled was 18 pounds. This knapsack (FiG. 425) was in general use in the first year of the war and served an excellent purpose. In 1862 it was changed for what was known as the new regulation knapsack, in which the arrangement and character of the sup plies were modified. The new pattern was 16 inches high, 12i inches wide, and 6 inches deep; the contents were packed in drawers, which were more accessible than in the old style and less liable to become disarranged or broken. 1 The weight when packed was nearly 20 pounds (Fro. 426). Notwithstanding its convenience and general adaptability it was too heavy and cumbrous to be carried by the Surgeon himself, and, when entrusted to other hands, was liable, in the vicissitudes of battle, to be lost. In the early part of 1.S63 Medical Inspector R. H. Coolidge, U. S. A., arranged a field case or com panion 2 (FiG. 427) to take the place of the knap sack. It was something after the plan of the one used in the British service, and was intended to be carried by the Surgeon himself, if necessary. The "companion" is a leather case 13 inches long, 6 inches wide, and 7 inches deep; it is supported by a strap passing over the shoulder, and is provided with a waist strap to steady it when carried. The hospital medicine chest, mess-chest, and bulky hospital supplies were transported in wagons of the supply train and were often inaccessible when required. To obviate this 1 The contents of the knapsack were : One piece of white wax, 8 oz. simple cerate, 12 oz. chloroform, 5 yds. adhesive plaster, 2 yds. isinglass plas ter, 1 oz. persulphate of iron, 100 compound cathartic pills, 150 blue mass pills, ISO opium pills, 100 opium and camphor pills, 150 quinine pills, 8 oz. aromatic spirit of ammonia, Ifi oz. brandy, 4 oz. laudanum, 10 bandages, 10 binder s boards, 4 oz. charpie, 2 medicine glasses, 1 (spirit) lamp, 12 oz. lint, 1 box matches, 1 paper of pins, 1 spool of surgeons silk, 4 pieces of sponge, 4 (Dunton s) field tourniquets. 2 spiral tourniquets, 1 piece of tape. 1 spool of lead wire. 1 spool of silver wire, and 1 spatula. 2 The contents of the Surgeon s Companion were : 6J oz. chloroform, 2 oz. fluid extract of ipecacuanha. oz. fluid extract of ginger, 2 oz. solution of persulphate of iron. 24 oz. of whiskey, 2 oz. tincture of opium, 144 compound cathartic pills, 144 colocynth and ipecacuanha pills, 144 sulphate of quinine pills, 144 opium pills, 1 yard isinglass plaster, a medicine cup, scissors, teaspoon, pins, thread, 4 oz. lint, a towel, 2 doz. bandages, muslin, and corks. FIG. 427. Surgeon s Field Companion. 916 THE MEDICAL STAFF AND MATEBJA CHIRURGICA. [CHAP. XIV. inconvenience panniers were provided containing the most necessary medicines, dress ings, and appliances; they were designed to be carried on the backs of pack-animals, but were found to be inconveniently heavy to be transported in this manner, and were more generally carried in one of the ambulance wagons and filled from the medicine chest as required. FIGS. 428, 429 represent the pan nier arranged for army use by Dr. Squibb, of Brooklyn, N. Y.; it consists of a wooden box strongly bound with iron, 2H inches in length, lit inches in breadth, and 111 inches in depth; it weighs, when filled,. 88 pounds. The medicines are well packed in japanned tin bottles and boxes, and room is left for an adequate supply of dressing material. The pannier had two compartments. 1 In the early part of the war medical sup plies and instruments had been carried in FIG. 428.-Medicine pannier, heavy army wagons. In March, 1862, a medicine wagon was constructed by E. Hayes & Co., of Wheeling, Virginia, in accordance with plans and instructions of Surgeon Jonathan Letterman, U. S. A. Details of the inter nal arrangement of this wagon could not be obtained. A Board, consisting of Brigade Sur- u oon William Hayes and Assistant Surgeons Hammond and Dunster, U. S. A., on April 17, 1862, examined the wagon and reported as fol- . 429. upper tray of medicine pannier. lows : "The merits of this dispensary wagon are so apparent, when compared with the old method of packing medicines and instruments in unwieldy boxes and transporting them in the heavy army wagons, that the Board unani mously approves of the same, and recommend that it at once be sent into the field where it can be practically tested. The adoption of a vehicle of this or some similar construction for the transporting of medicines, etc., in the field would be an actual saving in transporta tion over the present plan, as a three months regimental supply can be carried with ease in a single wagon dispensary. The advantage accruing from the prevention of loss by wastage, and breakage, the convenience of having the whole together and unencumbered by other baggage, and the readiness of access to medicines, instruments, and dressings in case of an emergency, are so palpable that it is only a matter of surprise that some such plan has not been previously adopted." In November, 1862, Mr. J. Dunton proposed a medicine wagon, a drawing of which is shown in FIG. 430. It was examined by Medical Inspectors T. F. Perley and J. M. Cuyler and Surgeons J. Simpson and J. H. Brinton, who reported, on November 3, 1862, that it was questionable whether it would answer the purpose for which it was designed, as it was faulty in construction, and its capacity insufficient to accommodate the entire hos- The upper compartment contained 24 roller bandages, 1 yd. of isinglass plaster, 1 paper of pins, 2 yds. bleached muslin, and 1 pair of scissors. In the lower compartment were 6J oz. purified chloroform, 2 oz. fluid extract of ipecacuanha, 2 oz. fluid extract of ginger, 2 oz. liquor of persulphate of iron, 12 doz. compound cathartic pills, 12 doz. quinine pills (3 grs. each), 12 doz. opium pills, 12 doz. pills of compound extract colocynth (3 grains) and ipeononanha (J grain), S4 oz. whiskey, 2 oz. tincture of opium, i Ib. patent lint, 1 medicine glass, 1 tinned iron teaspoon, 1 small piece fine sponge, J 07. ilk for ligatures, 1 towel, and G corks. CHAP XIV. 1 MATERIA CIIIRURGICA. 917 pital supplies for a regiment for three months." The wagon could be elongated at both ends, or closed, as was desired, and was arranged so as to be opened on the side. 1 FIG. 430. DUNTON s regimental medicine wagon. As the organization of the medical staff was perfected, the cumbrous regimental sup plies were curtailed and the brigade supplies augmented. Each brigade was provided with a "medicine wagon," which was furnished not only with drugs but with ample provis ion of stores, dressings, fur niture and appliances, an am putating table, and a limited amount of bedding. The con tents of the medicine wagon O were constantly replenished from the stores of the medi cal purveyors who accom panied each army. FIGURE 431 represents the medicine wagon of Perot .~ While the internal fixtures and arrange- pro. 431. PEROT S medicine wagon. ments tor transporting sup plies in this wagon were excellent and convenient, the cost of furnishing it was very great, and on the recommendation of a Medical Board consisting of Surgeons C. H. Crane, R. O. 1 This medicine wagon is erroneously designated by Professor T. LONGMOUE (A Treatise on the Transport of Sick and Wounded Troops, London, IStiy, page 38G> as a United States Sick Transport Wagon with side and end openings. * CONTESTS OF PKKOT S MKDICIXE WAGON. Drawer 1 contained an oval keg for 6 galls, of whiskey, with a cock on top and bottom, on to let in air, the other to draw from. This keg is on a skid and can be drawn out and filled at the bung. Drawer 2 : Stronger ether for anaesthesia, 32 oz.; sweet spirit of nitre, 32 oz.; solution of ammonia, 32 oz.; turpentine, 1 qt.; castor oil, 4 qts.; brandy, 6 qts.; olive oil, 2 qts.; purified chloroform, 32 oz.i copaiba, 02 07..: sulphate of quinia, 10 07.; syrup of squill, 4 Ibs. (part in Drawer !>). lrawer 3 : 1 sponge-holder for throat, 12 probangs, 1 hinged tongue depres- 918 THE MEDICAL STAFF AND MATERIA CHIRURGICA. [CHAP. XIV. FIG. 432. AUTENRIETH medicine wagon. Abbott, and Charles Sutherland, U. S. A., in June, 1864, the Autenrieth pattern 1 (Fios. 432, 433) was furnished to the army. An improved wagon, recommended by the Medical Department and constructed at the Government shops, was adopted during the last year of the war. Surgical instruments were fur nished by the Government, each medical officer making requisition for his equipment, receipting for it and becoming responsible for its condition while in his possession; no transfers were allowed, and an annual return was required to be made to the Surgeon General. On leaving the service it was turned in to the nearest medical purveyor, who receipted for the same. The instruments intended for surgeons o and assistant surgeons of the regu lar and volunteer staff were com prised in three cases one for capital operations, containing amputating, trephining, and nor, 4 single trusses, 2 bottles ink, 1 bottle mucilage, 1 U. S. Dispensatory, 1 portfolio (cap size), 2 quarto blank books, 1 order and letter book, 4 quires writing paper, 1 register of patients, 1 Gray s Anatomy, 1 Erichsen s Surgery, 1 Packard s Minor Surgery, 1 Longmore on Gunshot Wounds, 1 tooth- extracting case (army pattern), 1 8-oz. hard-rubber syringe, 1 self-injecting rubber syringe, 2 thumb lancets, 12 hair pencils, 2 scarificators. Drawer 4 : Closet for 3 gall, can of alcohol, and a vacant drawer for any articles desired. Draiver 5: 1 set splints (6 forearm, 4 leg, 6 large coaptation, 4 small coaptation), 2 papers pill boxes (turned wood), 1 pair pliers, 1 gimlet, 1 tape measure, 8 pieces binder s board (4x17 inches), 8 pieces binder s board (2J x 12 inches), razor strop in case, 1 file, 6 glass penis syringes, 1 corkscrew, 1 set Aiken s tool pad, 8 oz twine (J coarse), 1 hone, 1 razor. Drawer 6 : 2 quires wrapping paper (white and blue), 2 oz. ligature silk, 1 oz. linen thread (unbleached), 2 papers pins, 4 pieces cotton tape, case containing 25 needles, 1 spool cotton and thimble, 1 yard gray silk for shades, 8 field tourniquets, 2 screw tourniquets with pad, 12 cupping tins, 2 scissors (large and small), 1 pocket case, 1 box for sundries, 100 printed envelopes, 1 traveller s inkstand, 24 steel pens, 2 pen-holders, 6 lead-pencils No. 2, 1 stick sealing wax, 1 sheep-skin (dressed). Drawer 7, Dispensing Case: 1 Wedgewood mortar, 2 doz. vials (6 6-oz., 12 4-oz., 3 2-oz., 3 1-oz.), 1 pill tile (6x8 inches), 8 oz. fine sponge (small pieces), 1 tin funnel (pint), 5 yds. adhesive plaster, 4 Ibs. patent lint, pestle for mortar, 4 yds. red flannel (all wool), 2 medicine measur ing glasses, 2 yds. gutta-percha cloth, 5 yds. isinglass plaster, 8 doz. assorted corks, 1 glass graduated measure (4 oz.), 1 minim measure, 10 yds. bleached muslin, 2 cotton bats, 1 sheet cotton wadding, 1 set prescription scales and weights, 2 spatulas (3 and 6-inch), 2 glass urinals, 8 suspensory bandages, 2 Ibs. scraped or picked lint, 2J yds. oiled silk, 2J yds. oiled muslin, 16 doz. roller bandages, assorted (2 doz. 1 inch by 1 yd., 4 doz. 2 ins. by 3 yds., 4 doz. 2J ins. by 3 yds.. 2 doz. 3 ins. by 4 yds., 2 doz. 3i ins. by 5 yds., 1 doz. 4 ins by C yds., 1 doz. 4 ins. by 8 yds.), 10 Ibs. pressed tow, 1 doz. towels, aromatic sulphuric acid, tannic acid, spirit of nitrous ether, stronger ether (for anaesthesia), strong alcohol, alum, aromatic spirit of ammonia, purified chloroform, Dover s powder, sulphate of morphia, olive oil. castor oil, laudanum, paregoric, acetate of lead, bicarbonate of potassa, creasote, fluid extract of colchi- cum seed, fluid extract of aconite root, fluid extract of ipecac, fluid extract of seneka, tincture of chloride of iron, solution subsulphate of iron, pure glycerin, chlorate of potassa, iodide of potassium, bicarbonate of soda, whiskey, syrup of squill, blue mass, citrine ointment, powdered squill, Hoffman s anodyne, carbonate of ammonia, solution of ammonia, camphor, collodion, copaiba, sulphate of copper, alcoholic extract of belladonna, fluid extract cin chona (aromatic), fluid extract ginger, mercury with chalk, oil of turpentine, croton oil, permanganate of potassa, Fowler s solution, chlorinated solution soda, solution chloride zinc, resin cerate, simple cerate, powdered gum arabic, nitrate of silver (crystals), fused nitrate silver, sulj.nate cinchona, citrate iron and quinia, powdered subsulphate iron, iodide of iron, powdered ipecac, powdered opium, pills of camphor (2 grains) and opium (1 grain), compound cathartic pills, opium pills, pills of sulphate of quinia (3 grains), sulphate of quinia, powdered Hochelle salts, sulphate zinc, blistering cerate, powdered compound extract colocynth. Drawer 6 : 8 oz. Fowler s solution, 8 oz. aromatic sulphuric acid, 8 oz. fluid extract ipecac, 8 oz. fluid extract seneka, 8 o/. tincture chloride of iron, 8 oz. pure glycerin, blue mass, empty bottles, 8 Ibs. sulphate magnesia, 8 Ibs. flaxseed meal, 10 Ibs. farina, 12 Ibs. white crushed sugar. Drawer 9: 16 oz. Hoffman s anodyne, 16 oz. fluid extract ginger, 10 oz. laudanum, 16 oz. paregoric, 16 oz. chlorinated solution of soda, 16 oz. solution chloride zinc, 4 Ibs. syrup of squill (part in Drawer No. 2). 8 oz. powdered tartaric acid, 16 oz. subnitrate bismuth, 8 oz. ground cayenne pepper. 16 oz. powdered Rochelle salt, 8 oz. alum, 8 oz. mercury with chalk, 8 oz. powdered ipecac, 8 oz. Dover s powder, 8 oz. acetate lead, 8 oz. bicarbonate potassa, 8 oz. chlorate potassa, 8 oz. iodide potassium, 8 oz. bicarbonate soda, 8 oz. nutmegs, 8 oz. powdered gum arabic, 8 oz. carbonate ammonia, 8 o/. camphor, 8 oz. powdered opium, empty bottles, 8 Ibs. castile soap. Drawer 10: 2 tin basins (small, for dressers), 3 wash-hand basins, 2 vacant boxes for sundries, 1 metal bed-pan. Drawer 31:3 Ibs. simple cerate, 24 oz. sulphate cinchona, 16 oz. mercurial ointment, 1 smoothing plane, 1 saw, 1 hatchet, 1 nutmeg grater, 4 oz. white wax, 6 Ibs. ground black mustard seed, 5 Ibs. black tea, 1 box for sundries, 2 Ibs. candles (half length). Drawer 12 : 2 doz. planed splints, 20 gray blankets, 2 blanket cases (canvas), 8 gutta-percha bed-covers, 15 bed sacks, 15 pillow cases (white), 2 leather buckets, 1 coffee mill. The wagon also contained an amputating table, 3 box lanterns, and 2 camp stools, and four hand litters were attached outside. 1 CONTENTS OF THE A UTEXKIETH MEDICINE WAGON. First Case: Tannic acid, 1 oz. ; aromatic sulphuric acid, 8oz. ; powdered gum arabic, 6 o/.; stronger ether, 2 Ibs.: Hoffman s anodyne, 1 lb.; alcohol, 64 oz.; alum, 8 oz.; solution of ammonia, 32 oz.; carbonate of ammonia, 8 oz.; aromatic spirit of ammonia, 4 oz.; tartar emetic, 1 oz.; nitrate of silver, 1 oz.; fused nitrate of silver, 1 oz.; subcarbonate of bismuth, 4 oz.; camphor, 8 oz.; simple cerate, 2 Ibs.; cerate of cantharides, 8 oz.; resin cerate, 1 lb.; pure chloroform, 32 oz.; collodion, 4 oz.; copaiba, 16 oz.; creasote, 4 oz.; sulphate of copper, 2 oz.; fluid extract of aconite root, 4 oz.; extract of belladonna, 1 oz.; fluid extract of cinchona, aromatic, 16 oz.; fluid extract of colchicum seed, 4 oz.; compound extract of colocynth, 8 oz.; fluid extract of ipecac, 8 oz.; fluid extract of ginger, 8 oz.; tincture of chloride of iron, 8 oz.; citrateof iron and quinine, 2oz.; solution of persulphate of iron, 4 oz.; powdered subsulphate of iron, 2 oz.; glycerin, 8 oz.; calomel, 8 oz.; blue mass, 8 oz.; mercurial ointment, 16 oz.; citrine CHAP, xiv.] MATERIA CHIRURGICA. 919 forceps, the field FIG. 433. AUTEXiUKTii medicine wagon side view. resecting instruments; 1 one for general and minor operations, 2 composed of knives, catheters, etc.; and a pocket case. 3 For regimental surgeons and assistant surgeons case 4 was issued ; this con tained mucli the same as sortment of instruments as those already mention ed, but were somewhat more closely packed and more easily transported. Teeth -extracting instru ments and dissecting cases were also furnished to reg imental and general hos pitals. Great liberality was shown in providing special instruments and appliances, and every ef fort was made to render the surgical equipment as perfect as possible. At the beginning of the war it was the general custom to secure possession of buildings, such as churches, mills, and dwelling houses, for hospital accommodations; but the hygienic evils growing out of such occupancy soon led to the use of tent hospitals for the wounded, and finally, under the excellent organization of the field hospitals, tents were almost uni versally used by our armies in campaigns as well as in periods of inactivity. The prin cipal tents used were the Hospital and the Sibley tent. ointment, 4 oz.; Dover s powder, 8 oz.; flaxseed, C Ibs.; flaxseed meal, 12 Ibs.; morphia, J oz.; olive oil, 2 qts.; castor oil, 4 qts.; oil of turpentine, 1 qt.; croton oil, 1 oz.; powdered opium, 8 oz.; tincture of opium, 16 oz.; paregoric, 16 oz.; pills of camphor (2gr.) and opium (Igr.), 12 doz.; compound cathartic pills, 16 doz.; pills of compound extract of colocynth (3 gr.) and ipecac ( gr.), 16 doz.; opium pills, 10 doz.; sulphate of quinine (3 gr.) pills, 12 doz.; chlorate of potassa, 8 oz.; acetate of lead, 8 oz.; bicarbonate of potassa, 8 oz.; permanganate of potassa, 32 oz.; iodide of potassium, 8 oz.; sulphate of quinine, 8 oz.; soap, 8 Ibs.; syrup of squill, 3 Ibs.; powdered black mustard, 9 Ibs.; bicarbonate of soda, 8 oz.; solution of chlorinate of soda, 32 oz.; Kochelle salt, 16 oz.; sweet spirit of nitre, 2 Ibs.; solution of chloride of zinc, 1 lb.; sulphate zinc, 1 oz.; sulphate cinchona, 2 oz.; arrow root, 10 Ibs.; extract of beef, 16 Ibs.; brandy, 6 qts.; farina, 10 Ibs.; nutmegs, 4 oz.; sugar (white, crushed), 15 Ibs.; extract of coffee; black tea, 10 Ibs.: whiskey, 6 qts.; patent lint, 6 Ibs.; scraped lint, 2 Ibs.; roller bandages (assorted), 32 doz.; suspensory bandages, 8. The wagon also contained surgical instruments, books, and stationery, prescription furniture and utensils, bed-pans, urinals, tow, coffee mill, rubber buckets, tin basins, wash-hand basins, blankets, gutta percha bed-covers, lanterns, and a hatchet. The medicines were arranged in slides ; the hospital stores, dressings, furniture, utensils, etc., were arranged in drawers or on shelves. 1 The Capital Operating Case contained: 2 amputating knives (one long, one medium), 2 catlings (one long, one medium), 4 scalpels, 1 cartilage knife, 1 capital saw (long, bow, two blades), 1 metacarpal saw, 1 chain saw, 1 Hey s saw, 1 trephine (conical), 1 trephine (small crown), 1 bone forceps (I.iston s lng, sharp, spring handle), 1 bone forceps (broad edged, slightly curved, spring handle), 1 bone forceps (gnawing, spring handle), 1 bone forceps (sequestrum, spring handle), 1 artery forceps, 1 artery needle, 1 artery needle key, 12 surgeon s needles, 1 tourniquet screw with pad, 1 tenaculum, 1 scissors, 1 chisel, 1 gouge, 1 mallet, 4 drills (with one handle), 2 retractors, 1 raspatory, 1 elevator, 1 brush, 12 yards suture wire (iron), J oz. ligature silk. oz. wax, 1 mahogany case (brass bound, slide catch), 1 leather pouch. 2 The Minor Operating Case contained: 1 amputating knife, 3 scalpels, 2 bistouries, 1 hernia knife, 1 finger knife, 1 artery forceps, 1 ball forceps, 1 gullet forceps, 1 dressing forceps, 1 dissection forceps, 1 artery needle, 1 artery needle key, 12 surgeon s needles, 1 tenaculum, 2 scissors, 1 trocar and canula. 1 Belloc s canula, 1 bullet probe, 1 director, 1 cutting pliers (small), 6 steel bougies (silvered, double curve, Nos. 1 and 2, 3 and 4, 5 and 6, 7 and 8, 9 and 10, 11 and 12), 3 silver catheters (Nos. 3, 6, and 9), 6 gum-elastic catheters (Nos. 1, 3, 5, 7, 9, and 11), 24 suture pins (silvered), 6 yards suture wire (iron), J oz. ligature silk, J oz. wax, 1 mahogany case (brass bound, slide catch), 1 leather pouch. 3 The rocket Case contained : 1 scalpel, 3 bistouries, 1 tenotome, 1 gum lancet, 2 thumb lancets, 1 razor (small), 1 artery forceps, 1 dressing forceps, i artery needle, 6 surgeon s needles, 1 exploring needle. 1 tenaculum, 1 scissors, 1 director, 3 probes, 1 caustic holder, 1 silver catheter (compound), 6 yards suture wire (iron), J oz. ligature silk, J oz. wax, 1 liussiu leather case. 4 The Field Case contained: 2 amputating knives (one long, one medium), 2 catlings (one long, one medium), 3 scalpels, 2 bistouries, 1 hernia knife, 1 finger knife, 1 capital saw (long, bow, two blades). 1 metacarpal saw, 1 lley s saw, 1 trephine (conical), 1 bone forceps (broad edged, slightly curved, spring handle), 1 bone forceps (sequestrum, spring handle), 1 artery forceps. 1 ball forceps, 1 dressing forceps, 1 dissection forceps, 1 artery needle, 1 artery needle key, 12 surgeon s needles, 1 tourniquet screw with pad, 1 tenaculum, 2 scissors, 2 retractors, 1 trocar and canula, 1 raspatory, 1 elevator, 1 brush, 1 bullet probe, 1 director, 6 steel bougies, silvered, double curve (Nos. 1 and 2, 3 and 4, 5 and 6, 7 and 8, 9 and 10, 11 nnd 12), 3 silver catheters (Xos. 3, 6, and U), 6 gum-elastic catheters (Xos. 1, 3, 5, 7, 9, 11), 12 yards suture wire (iron), J oz. ligature silk, J 07. wax, 1 mahogany case (brass bound, slide catch), 1 leather pouch ; pocket case the same as allowed to staff surgeons. 920 THE MEDICAL STAFF AND MATERTA OHIRURGICA. [CHAP. XIV. FIG. 434. Regulation hospital tent. The hospital tent 1 in use previous to the war was 24 feet in length, 14 feet 6 inches in breadth, and 11 feet 6 inches high; it was bulky, heavy, and difficult to pitch in windy weather. By the action of an army board in 1860 its size was reduced, the general form being retained. Its general appearance will be seen in FIG. 434, and its dimensions were: length 14 feet, breadth ] 4 feet 6 inches, height 11 feet (centre), with a wall 4i feet, the whole covered with a "fly" 21 feet 6 inches by 14 feet. The weight of this tent, includ ing its poles and pins, was 217 pounds. Each tent had at one end a lapel to admit of two or more tents being joined and thrown into one ward. Each hospital tent was designed to accommodate comfortably eight patients. This tent has been found in practice to answer every necessary purpose. By the Army Regula tions three hospital tents were assigned to each regiment, also one Sibley tent and one common wedge tent. The Sibley tent (PiG. 435) is con ical in shape, 18 feet in diameter at base and 12 feet high, with an opening at the apex, to which is fitted a hood which may be closely fitted or removed at pleasure. The absence of any wall renders it inconvenient and illy adopted to hos pital purposes, and the want of a fly renders it almost intolerable on account of heat in mid summer, while the centre pole curtails the avail able space and interferes with the free move ments of the medical officers and attendants. It was not used to any very great extent for hospital FIG. 435.-sit>iey tent. purposes. The wedge tent was still less adapted to hospital purposes though found convenient as an adjunct to field hospitals. The hospital tent "fly" alone was found to answer an admirable purpose in sheltering the wounded in mild weather or when it was inconvenient or impracticable to pitch the entire tent. Surgeon A. P. Meylert, U. S. V., treated about eighteen hundred (1,800) patients in a field hospital of the Army of the Ohio constructed of tarpauling, such as was used by the Quartermaster s Department for covering stores and forage, and remarks: "The chief cause of success in this hospital, I believe, was in the mode of shelter adopted. The difficulty in obtaining quarters for the sick and wounded, which in the outset I regarded as the greatest possible calamity, was no doubt of the utmost advantage, since it led to the adoption of those cool, clean, and airy wards, in which I am satisfied the patients improved more rapidly and surely than in either wall or hospital tent or in ordinary buildings. Whenever it was practicable, board floors were placed in the tents, resting on sleepers placed directly on the ground. A trench from 6 to 8 inches in depth, dug around the base, and loose earth thrown around the lower edge of the tent wall in cold weather, completed the arrangement." 1 In October, 1809, a board of medical officers, consisting of Surgeons C. A. Finley, R. S. Satterlee, C. S. Tripler, J. M. Cuyler, and Assistant Sur geon R. H. Coolidge, had recommended for the army the following allowance of tents for the sick and wounded and their attendants : For one company, 1 Sibley tent and 1 common tent ; for three companies, 1 hospital tent, 1 Sibley tent, and 1 common tent ; for five companies, 2 hospital tents, 1 Sibley tent, and 1 common tent ; for ten companies, 3 hospital tents, 1 Sibley tent, and 1 common tent. CHAP, xiv.] MATERIA CHIRURGICA. 921 The bedsteads used in the hospital tents were cots of a light frame-work of stout wood, provided with four folding legs and furnished with a jointed support near the head. The whole frame-work was covered with sacking, and throughout the war proved a most useful and satisfactory hospital cot. It was light, strong, easily transported, and was comfortable to the patient. Various modes were employed for heating hospital tents in the field. Wood-burning stoves were largely used, their chief objection being the difficulty of transportation. The plan which was most generally in vogue, particularly in the Army of the Potomac, and which gave the utmost satisfaction, was that known as the California plan. A pit was dug about two-and-a-half feet deep outside the door of the hospital tent; from this a trench passed longitudinally through the tent, terminating outside its farther or closed extremity. At this point a chimney was formed by barrels placed one upon the other, or by some other simple plan. The joints and crevices of this chimney were cemented with clay. The trench in the interior of the tent was roofed over with plates of sheet-iron issued for that purpose by the Quartermaster s Department. A fire was built in the pit, and the resulting heat, radiating from the sheet-iron plates, kept the interior of the tent warm and comfortable even in the coldest weather. In the western armies, in the trench in the interior of the tent, railroad iron was placed in regular layers and covered with iron plates when possible to procure them, or with stone slabs. Occasionally funnel-shaped stoves, open at the bottom, resting upon the ground, and provided with a short pipe, were used. These were, however, objectionable. The wood fire burned out rapidly, and although an intense heat was cre ated while it lasted, after its extinguishment the atmosphere soon chilled, exposing the men to rapid and uncomfortable changes of temperature. From an examination of the records and reports in this office it would appear that the first regular tent field hospital was organized during the battle of Shiloh, April, 1862, by Dr. B. J. D. Irwin, U. S. A., Medical Inspector of the 4th Division, Army of the Ohio. His interesting description is here given : "During the military movements of troops during the battle of Shiloh," Dr. Irwin says, "one of the operating hospitals was moved forward to a deserted farm-house situated on an open level piece of unbroken ground. The presence of a spring of cool potable water and the nearness of the building to a branch of the creek were advantages that were promptly recognized, and but a short time elapsed ere these valu able desiderata were utilized in providing shelter and other comforts for the large number of wounded of our own division and those disabled on that part of the field in the preceding day s conflict, pertaining to both of the contending parties, left on the field without assistance some twenty-four to thirty-six hours. The proximity of this field hospital to the recaptured camp of a division of our troops defeated and made prisoners the preceding day, suggested the utilization of the abandoned tents for the benefit of the wounded; and as soon as the battle ceased the hospital tents, commissary tents, and wall tents pertaining thereto were accordingly taken possession of, and in a short space of time were removed to and pitched in regular order on the level ground by which the house was surrounded. The building afforded an operating room, dispensary, office, kitchen, and dining-room. Long into the night the ambu lances continued to bring in the wounded, who, after receiving the necessary professional attendance, were made as comfortable as possible by being supplied with an abundance of warm food, good bedding, and shelter from the inclement weather. Next day the hospital camp was enlarged so as to accommodate some 300 patients, and the tents were system atically arranged; all bedsteads, cots, bedding, cooking and messing utensils, hay and SlTKG. ill 110 922 THE MEDICAL STAFF AND MATERIA CHIRURGICA. [CHAP. XIV. straw found in the abandoned camp were taken possession of, and on the evening of the 8th the Division Medical Purveyor reached us with our medical supplies and hospital stores. By this time the hospital had assumed the proportions and discipline of a well regulated army camp, arranged with a view to meet the special wants of those for whom it had been estab lished. Some mattresses were secured, and the bed-sacks, filled with hay and straw, were placed on cots, bedsteads, or improvised bunks, so that almost every patient was provided with comfortable sleeping accommodations. A suitable number of attendants of each class was detailed for duty in the establishment, which was placed under the charge of Surgeon Menzies, 1st Kentucky Volunteer Infantry, so that the invalids were promptly and regu larly supplied with abundance of properly prepared nutritious food, and even a fair supply of extra diet and delicacies were served to the inmates requiring special attention. It soon became manifest that the wounded in this improvised field hospital were better provided for and more comfortable in every way than those who were moved aboard the hospital transports. * * * In illustration of how the efforts made to ameliorate the condition of the wounded were appreciated the following official communication was published, viz: " HEADQUARTERS FOURTEI DIVISION, ARMY OF THE OHIO, FIELD OF SHILOH, April 12, 1862. " Col. J. B. FRY, Assistant Adjutant General, Chief of Staff. " SiR: I desire to call the especial attention of the General commanding this Army to the admirable hospital accommodations adopted by Dr. Irwin, U. S. A., Medical Inspector of the Division, during the battle of the 7th iiist. They will be found as nearly perfect as the circum stances would allow. The wounded in the Division did not suffer from the inclement weather ; they were all promptly sheltered and cared for. I beg to recommend Dr. Irwin to the favorable con sideration of his superiors. "Very respectfully, (Signed) <"W. NELSON", " Brigadier General." 1 "Thus was established ihe first tent field hospital of any magnitude for the reception and treatment of the wounded on the field of battle. In the movements of the armv following ./ O Shiloh and culminating in the siege of Corinth, Miss., the utility of large field hospitals was recognized, and soon developed into a system which became general in the combined armies engaged in the investment of that place. * * :;: Further experience in the treatment of the sick and wounded under canvas demonstrated the many great advantages possessed by such hospitals over those established in churches, houses, and other structures temporarily used as hospitals, such as the wooden and iron huts used by the allied armies in the Crimea, or those established in large buildings, especially when not constructed in accordance with modern sanitary science. Numerous tent hospitals of much greater capacity were estab lished and kept in successful operation during the last two years of the war, it having been satisfactorily shown that the wounded who were treated under canvas did better in every way, and recovered sooner than those treated in the large permanent hospitals." The consideration of the construction, organization, and administration of permanent or general hospitals is deferred to thoT]nrd JVfpdical Volume of the Medical and Surgical History of the War. ([UNIVERSITY)) CHAP. XV.] TRANSPORTATION OF THE WOUNDED. 923 CHAPTER XV. TRANSPORTATION OF THE WOUNDED. The first removal of the wounded from the battle-field was generally effected by means of hand litters. The number of litters issued during the war exceeded fifty thousand 1 (50,000). From the Purveyor s Office at New York, Brigadier General R. S. Satterlee reports that from April 1, 1861, to August, 1865, sixteen thousand eight hundred and seven (16,807) hand litters were issued. At the Medical Purveyor s Depot at Louisville, from November, 1863, to August, 1865, seven thousand and ninety-eight (7,098) hand stretchers were issued, and Surgeon D. L. Magruder, U. S. A., estimated that four thousand seven hundred and thirty-two (4,732) had been given out before November, 1863. The Medical Purveyor s Office at Philadelphia issued, from January, 1863, to August, 1865, five thousand five hundred and forty-eight (5,548), and the Office at New Orleans, from September, 1864, to the end of the war, eight hundred and thirty-five (835) stretchers. 2 In the beginning of the war the Satterlee, or U. S. Regulation litter (FlG. 436), was sup plied to the regiments. It weighed twenty -four and one-half pounds and was twenty-seven inches wide. The canvas consisted of two-pieces, five feet ten inches long, sewed in the centre with a flat seam, and with a hem on either side seven and one- half inches wide, through which the poles were passed; there was an inch and a half hem on each end; on one end were three tarred rope loops to put over the pins on the cross-bar, The Records of the Property Division of the Surgeon -General s Office show that from 1861 to 1865 fifty-two thousand four hundred and eighty-nine (52.489) litters of various manufacture were purchased and issued to the troops. 2 Extemporaneous modes of conveying wounded from the field of battle can only be briefly alluded to. Stout sticks or muskets may bo passed through the sleeves of a coat, or rolled into the edges of blankets and a litter thus be formed. Hurdles, gates, or ladders, with blankets or straw thrown over them, have made useful stretchers. Poles interlaced with ropes or telegraph wire have been found to answer the purpose of a litter. The editor was once oblisred to transport a soldier, wounded in the abdomen, a distance of twelve miles along the narrow bed of a creek filled with boulders and obstruc tions : "I was fortunate enough to find two ash saplings which, with a blanket stretched across, made, an improvised litter, on which my patient was borne by relays of men with comparative ease ami com fort. At another lime a man belonging to a small detachment sent out from a scouting parly was wounded in the leg by the accidental discharge of a musket. Finding it impossible to place the man on horseback, and unsafe to detach a small paity to seek the main command, his comrades carried him a distance of about three miles by forming a scat with their hands and arms similar to the chairs made by children in their games (Fig. 437). During the late war I saw a soldier who had been wounded nt some distance from his command conveyed to a place of safety by laying him prone across a saddle, the stirrup of one side being sufficiently lengthened to afford support for one foot. The horse with his burden was then led quite a distance. I am familiar with another instance where a man, badly wounded, was conveyed about a three-days journey in a cot or hammock formed by securing a blanket to two lariat ropes ; the ends of the ropes were gathered and carried by his comrades on horseback. All military surgeons know of instances where wounded men have been carried from the battle-field on muskets with an overcoat laid upon them for a bed. Under the urgent demands of necessity the fruits of ingenuity are snre to come to the rescue." (See Circular No. 9, On tJie Transport of Sick and Wounded by Pack-Animals, Washington, 1877, p. 27.) FIG. 436. SATTEHLEE or Regulation hand litter. 437 _ Seat made by clasping hands. 924 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. and two five-inch drilling loops for pulling the canvas over the poles; at the other end were three eyelet-holes, with a piece of rope three feet long and spliced into one of the holes for fastening the canvas to the pins on the other cross-bar. The poles were made of seasoned red ash, were one and one-half inches in diameter and eight feet nine inches long. Sixteen inches from either end of the poles were wrought-iron bands three-sixteenths of an inch thick and three-fourths of an inch wide, and riveted to the poles as shoulders for the cross-bars to strike against. The cross-bars weighed six and one-fourth pounds; they were made of seasoned white ash, one and one-half inches thick by twenty-four inches long. A piece of wrought-iron, six feet long by one inch wide and one-fourth of an inch thick, was so curved as to form the legs 1 and sockets on either end of the wooden cross-bar for the poles to pass through, and was fastened by two rivets, one at each end; the pin in the centre, on which the canvas was looped, was used as a third. The three pins in each cross-bar were made of half- inch iron, and projected one inch, with heads to keep the loops from slipping off. The shoulder straps weighed one and one-half pounds, were made of leather two inches wide, five feet eight inches long, with a three and one-half inches loop at one end and a buckle at the other end for adjustment on the handles of the stretcher. One objection to the Satterlee litter was its bulk, which seriously interfered with its conveyance in large numbers. The Halstead 2 litter, a stretcher of lighter and more compact pattern (FiG. 438), soon superseded the Satterlee. It weighed twenty-three and three-fourths pounds and was twenty - ^ three and one-half inches wide; the length of the canvas (unbleached) was five feet eleven inches, being M ^ fastened on the outer side of the rave FIG. 438,-HALSTEAu s litter. w ith six-ounce tacks. The poles were made of seasoned white ash, eight feet long and one and five-sixths inches square, with thirteen inches at one end and twelve inches at the other, extending beyond the canvas, and rounded off for handles. The legs, which were also made of seasoned white ash, were four teen and one-half inches long, one inch thick, one and seven-eighths inches wide at the top, and tapering to one and three-eighths inches at the bottom. They were fastened to the poles with screw bolts, washers under the heads of the bolts, and rivets through the upper end of the legs to prevent them from splitting. The braces to hold the stretcher open, one (on the under side) at either end, consisted of two pieces of wrought-iron one inch wide by three- eighths of an inch thick; one piece was fifteen inches and the other twelve inches in length, hinged in the centre of the stretcher, the longer one overlapping the shorter three and one- half inches, and, when open, shutting on a bolt or pin, forming a stiff shoulder for the hinge and preventing the stretcher from accidentally closing. The braces were fastened on with heavy screws, with pieces of common hoop iron underneath the brakes to prevent them from wearing the wood. The shoulder straps weighed eight ounces, and were made of striped cotton webbing two and one-half inches wide by fifty inches long, with a five-inch loop at one end and a leather strap twenty-two and one-half inches long by one and one-sixth inches wide, with buckle, at the other end to loop around the handles of the stretcher at any length desired. A hair pillow covered with canvas accompanied this stretcher, which 1 Professor LOXGMORK in his Treatise on the Transport of Sick and Wounded Troops, London, 1800, p. 129, has probably mistaken the iron feet for yoke pieces, as he speaks of the absence of feet in the litter. 2 In the preliminary report, Circular No. 6, S. O. O., 1805, p. 81, this litter is erroneously called the Smith hand litter ; the litter there designated as the Halstead litter was a stretcher issued by the Sanitary Commission. It is to be regretted that these errors have misled Professor LOXOMOKE, who iu his excellent Treatise on the Transport of Sick and Wounded Troops, p. 141, reproduced the wood cuts from Circular No. 6. CHAP, xv.] LITTEES. 925 Fio. 439. Sanitary Commission litter. gave great satisfaction, and out of the litters (16,807) issued by the New York Purveying Depot twelve thousand eight hundred and sixty-seven (12,867) were of this pattern Of the litter shown in FIG. 439 and known in New York as the San itary Commission litter, few were issued ; it was too fragile for the hard usage of actual warfare. A drawing of the litter used in the Confederate armies is shown in FIG. 440, and has been copied from Chisolm. 1 Its construction was very simple and, with the exception of the mode of securing the duck cloth, or sacking, to the frame, needs n o explanation: "A groove three-quarters of an inch wide and five-eighths of an inch deep is cut out in the length of the frame. The cloth is tacked FIG. 440. Confederate litter. FIG. 441. SCHELL B litter. in this and secured by a lath which fits accurately the groove and which is nailed in, covering the cloth. The tension upon the cloth is not borne by the tacks, but is uniformly sup ported by the entire lath, and therefore never rips off." A litter to be used as a bedstead was proposed by Assistant Surgeon Henry S. Schell, in 1862, in a letter to Medical Inspector Vollurn, U. S. A.: "I beg leave to suggest that the hand litter at present in use be somewhat modified, so that it may be arranged as a bedstead in the hospital tent when it is desirable to have a large number of beds quickly made up. It generally takes a day, perhaps more, to prepare bedsteads, or rather to build them, so that they may be elevated from the damp and uneven surface of the ground. The present stretcher cannot be used to make two rows of beds, with a passage from door to door between them in the usual manner, because of its length. The litter (FiGS. 441, 442) which I would propose is constructed of two parallel bars, each six feet two inches long, connected by a strong canvas, and separated by a jointed iron rod about six or eight inches from each end, somewhat similar to those on the litter now in use. To the ends of each of the parallel wooden bars a shorter one, ten inches long, is joined by a strong hinge placed underneath. This latter bar constitutes the handle when used as a stretcher, or the leg when used as a camp bedstead. It is retained in the upright position by a short iron stay, as seen in the figure. I have long felt the want of such an arrangement when arriving in camp and wishing to pitch the hospital tent immediately. The hinge will be found to last much longer than the canvas. As each ambulance carries two stretchers, a hospital may be improvised from these very readily." 1 CHISOLM ( J. JULIAN 1 , .1 Manual of Military Surgery for the Use of Surgeons in the Confederate States Army, Columbia, 18fv, :td edition, page 530. and PLATK 1. FIG. 442. SCHELL 8 litter used as a cot. 926 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. Fir,. 443. Hand-litter carriage scale J inch to the foot. In the last year of the war an order was issued for the construction of a form of litter 1 on wheels (FiG. 443), similar to one used advantageously in the Danish war of 1864, but there are no reports /\ that indicate its prac tical utility. The modes of carry ing wounded men on horse or mule litters during the war have been fully described in Circular No. 9, Surgeon General s Office, March 1, 1877, and we cannot do better than to repro duce, with a few addi tional remarks, the ac count given there by the author, the late Surgeon George A. Otis, U. S. Army: "In the Revised Regulations for the Army of the United States for 1861, Paragraph 1298 reads: Horse litters may be prepared and furnished to posts whence they may be required for service on ground not admitting the employment of two-wheeled carriages; said litters to be composed of a canvas bed similar to the present stretcher, and of two poles, each sixteen feet long, to be made in sections, with head and foot pieces constructed to act as stretchers to keep the poles apart. There is no record that these litters were used during the war. 2 "During the progress of the late war in this country a number of persons, actuated by motives of patriotism, humanity, or interest, devised and brought to the notice of the War Department forms of Flo. 444. United States Army regulation two-horse litter. [From a sample in the Army Medical Museum.] nr\r\ veVanCC for tll6 sick and wounded in localities impracticable for wheeled vehicles, that were represented as improvements upon existing patterns. Several of these were apparently suggested by the descriptions of Delafield 3 and McClellan 4 of the horse litters and cacolets they had observed in the Crimea. In October, 1861, W. C. H. Waddell forwarded to Secretary Cameron a proposal to construct cacolets and litters for army use, accompanied by drawings (FiGS. GUULT (E.), Militdr-chirurgische Fragmente, Berlin, 18G4, p. G. XEUDOKFER (J.), Handbuch der Kricgschirurgie, etc., Leipzig, 18G4. 2 Professor T. LOXGMOIIE, in his excellent Treatise on the Transport of Sick and Wounded Troops, London, 1809, p. 292, thus refers to this form of litter: "It is necessary to notice another form of wick-transport litter issued for use in the early part of the late war in the United States, in which, instead of two litters being suspended across one horse or mule, one litter was suspended between two horses. This is a very ancient form of litter in Europe. Frequent notices of it occur, showing its common use on occasions of state and ceremony, as well as its employment for the carriage of sick persons, in the records of our own country prior to the introduction of coaches. It seems curious that its use should have been revived in modern times in America." In a note it is added: " This form of litter is referred to as late as the reign of Charles II. A quotation introduced into the first volume of Knight s London, pp. 24 and 25, mentions that Major General Skipton, coming in a horse-litter to London when wounded, as he passed by the brew house near St. John street, a fierce mastiff flew at one of the horses and held him so fast that the horse grew mad as a mad dog: the soldiers were so amazed that none had the wit to shoot the mastiff; but the horse-litter, borne between the two horses, tossed the major-general like a dog in a blanket. " 3 Rppprt on the Art of War in Europe in 1854, 1855, and 1856, by Major KlCHAKD DELAFIEI.D, Corps of Engineers, from his Xotes and Observa tions made as a member of a Military Commission to the Theatre of War in Europe," Washington, I860. 4 Report of the Secretary of War, communicating the Report of Captain GEORGE B. McCr.K.l.LAN ( First Regiment United States Cavalry), one of the officers sent to the Seat of War in Europe in 1855 and 1856, AVashington, 1857. CHAP. XV.) CACOLKTS. " 927 446, 447) copied from Delafield s report, and suggested some trivial modifications. In November, 1861, Mr. G. Kohler offered to furnish rnule litters and chairs of patterns imitated from those used in the Crimea. In July, 1862, three hundred of these litters were purchased. In April, 1862, Surgeon Glover Perin, U. S. A., and Assistant Surgeon Benja min Howard, U. S. A., reported to Surgeon General C. A. Finley the results of their inspection of cacolets and litters devised by Mr. Charles Proal, of Louisville. 1 News paper descriptions, almost textually quoted from Delafield s report, with figures of these appliances, were transmitted. -Mr. Proal claimed to have improved upon the French patterns by diminishing the weight and cost of construction. Messrs. Lawrence, Bradley & Pardee, of New Haven, Connecticut, in 1861, applied for a patent for a cacolet of cum brous pattern, weighing 131 pounds. The chairs could not be detached from the saddle. A. sample, figured in the adjoining wood-cut (FiG. 445), was sent, in 1867, to the Army Medical Museum, and is numbered 824 in Section VI. It combines, in an unusual degree, the undesirable qualities of weight, weakness, and inconvenience. On September 25, 1862, a board of officers of the Quartermaster s Department examined cacolets submitted by Dr. 1 . 1 VlC*. 44.~>. Cacoiet of Lawrence, Bradley & Pardee. Spec. blade Davis, and reported ~ that, as compared with 884, SECT, vi, A. M. M. others that had been purchased for the service, the only advantage of this form of cacolet was its lightness. It was thought that those already on hand were as light as was consistent with the requisite degree of strength. Mr. E. P. Woodcock, 3 of New York, in November, 1863, patented a pack-saddle with wooden outriggers from the pommel and can tie for the suspension of litters. By securing litters to the -projecting parts by straps, and protecting the sides of the animal by pads, it was designed to carry two patients in the recumbent position. This contrivance was exhibited by the United States Sanitary Commission at the Exposition in Paris in 1867, but met with no more approval abroad than at home. Mr. J. Jones, 4 of New York, in December, 1862, proposed to the Surgeon General of the Army a mule litter for carrying two persons either in a sitting or recumbent position, the litters being designed to serve also as efficient hand stretchers or hospital-beds. The exceeding light ness, strength, and simplicity of these conveyances were insisted on. The saddle with Extract from a communication to Surgeon General C. A. FIXLEV, by Surgeon G-. PEKIN aud Assistant Surgeon B. HOWARD, dated Louisville, April 2, 1862: " Tl:e undersigned would respectfully state that Mr. CHARLES PROAL, of this city, has submitted to our inspection a saddle ambulance, which has been fairly tested by us in the open field. Its chief excellences, compared with other saddle ambulances, ^ire that it is lighter, is more easily adjusted, and combines both the litter and the chair, both of which can be packed away in a very small compass when the pack-saddle to which they belong is required for other purposes. The weight of the entire ambulance, with saddle, etc., is about seventy-four pounds, that of the French being about one hundred and forty -two pounds. The mode of adjustment is such that two litters, two chairs, or one, chair and one litter, can bo used at the same time, .at discretion, each of which may be affixed to or detached from the saddle, while the patient remains undisturbed. The harness appears to be very complete, the breeching and breast-band preventing motion backward or forward, while the surcingle, by being attached to the bottom of each chair or litter, prevents either undue oscillation or shifting, which would be otherwise consequent upon any inequality in the weight of the two patients being carried . . . The price of the ambulance and appurtenances completed is about $50." 2 A board of officers, consisting of Colonel D. H. RUCKEK, Quartermaster, Captain J. J. DAXA, A. Q. M., and Captain E. E. CAMP, A. Q. M., was convened at Washington, September 25, 1862, to "examine a cacolet to be presented for inspection by Dr. SLADE DAVIS, and to report its opinion of the cacolet, as compared with other patterns which have been purchased for the service. The board reported that " in their opinion the cacolet presented by Dr. SLADE DAVIS possessed an advantage over those furnished by Mr. KOIILEK (three hundred in number, all of which are now on hand) in lightness only. Those made by Mr. KOHLEU are constructed in a strong and desirable manner, and are as light as is consistent with the requisite degree of strength. No call has yet been made, either for those first purchased or for those furnished by Mr. KoiiLEii, which cost $21,000. We would not recommend the purchase of an additional number from any source." 3 Compare LOXGMOUE (Treatise on the Transport of Sick and Wounded, etc., op. cit., p. 290) : Subject-matter, Index of Patents for Inven tions, Washington, 1874, Volume 1H, p. 1232; and SfciamiER (Conferences Internationale des Societe* avx Rlesses Militaires des Armeen de Terre et de Her, tcnues <i Paris, cu 1867, T. I, p. 47). Manuscript Records of War Department for 1862. 928 TRANSPOETATION OF THE WOUNDED. [CHAP. XV. two litters, girths, bridle, and other appurtenances weighed only 62 pounds, and could, prob ably, be reduced to 60 pounds. In September, 1863, a board of medical officers \v;is con vened in Washington to examine into the merits of an adjustable ambulance and pack- saddle, submitted by Spencer, Nichols & Co. Lightness, strength, simplicity, efficiency, adjustability, and cheapness were the merits claimed for this contrivance." 1 Shortly after ward (December 1, 1863) another medical board assembled in Washington to inspect and report on a mule litter submitted by Messrs. Pomeroy & Co., which was found to possess some good and some objectionable features. 2 In addition to these essays in invention, cacolets and litters were submitted to the Quartermaster s Department that purported to be constructed simply in accordance with drawings in General Delafield s report. 3 August 20,1861, Messrs. Lutz & Bridget, harness-makers, furnished twenty such sets, with pack- saddles and harness. These drawings, which are copied, of a reduced size, in FIGS. 446 and 447, though prepared by so distinguished an artist as Professor Weir, do not accu rately represent the mechanical details of either the French or British Crimean litters and cac olets, and the ambulance equip ments made in imitation of them did not prove to be of utility. Early in the war, how ever, probably as early as May, 1861, the Quartermaster s Department had purchased a number of cacolets and mule litters of the pattern used in the French army, and in July, 1861, engaged Tiffany & Co., of New York, to construct others, and employed a French agent to give instruction in the 1 The board, consisting of Surgeon T. H. BACHE, U. S. V., Surgeon C. ALLEN, TJ. S. V., and Assistant Surgeon W. Moss, U. S. V., reported, September 16. 1863 : 1. That the cacolets weighed 55J pounds, and the saddle-girths and other equipment 38 pounds ; 2. The saddle tree was jointed so that by turning screws it could be adapted to animals of different sixes ; 3. As to simplicity, the saddle was provided with projecting crane-like supports of hickory, covered with raw-hide, which were connected either with a flat framework of hickory for packs, or with litters for patients ; 4. As to strength, the saddle easily sustained two barrels of flour; but when two soldiers, one of them a heavy man, mounted on the litters there was a "slight yielding ; " but the board considered the litters "strong enough to bear any load that a horse or mule could carry." Finally, the board considered the pattern submitted as "comfortable as such a conveyance can be made." 2 The board consisted of Medical Inspector J. M. CUYLEU, U. S. A., Surgeon O. A. JUDSON, TJ. S. V., and Assistant Surgeon C. A. McCALL, TJ. S. A. The report is unaccompanied by a description or drawing of tbe conveyance, but states that it was simple in construc tion, with unusual capacity for providing for the comfortable carriage of two wounded men. Some modifications were suggested, such as strengthening the attachments of the litters by substituting chains for straps ; of supplying means for rendering their framework rigid, so that they might be used temporarily as stretchers ; of arranging that they might bo detached from the saddle ; of having rings and hooks for attaching necessary articles to the pack-saddle, and particularly a vessel for water. The board was unwilling to decisively approve of the conveyance until these alterations had been effected and a trial in actual service had been successfully made. 3 DELAKIELU (R.) (Report on the Art of War in Europe, 4-to, Washington, 1860, p. 73) makes the following observations on mule litters and cacolets : "The requisites for an ambulance should be such as to adapt it to the battle-field, among the dead, wounded, and dying; in plowed fields, on hill-tops, mountain slopes, in siege batteries and trenches, and a variety of places inaccessible to wheel carriages, of which woods, thick brush, and rocky ground are frequently the localities most obstinately defended, and where most soldiers are left for the care of the surgeons. These difficulties were felt in a great degree by all the armies allied against Russia in the siege of Sebastopol, and the consequence was that the English, French, and Sardinian armies adopted finally, in part or altogether, pacJc-mules carrying litters or chairs. The careful and sure-footed mule can wind its way over any road or trail, among the dead, dying, ijnd wounded on any battle-field, as well as in the trench and siege battery. It required but suitable arrangements to support the wounded from the mule s or horse s back to attain the desired object, and this the allied armies finally accomplished and put in practice. The merit of the plan renders it worthy our consideration, particularly so in our Rocky Mountain and other distant expeditions." Further on he remarks: "... I witnessed the transport of one hundred and ninety-six sick and wounded French soldiers, with their arms, accoutrements, and knapsacks, on the route from the Tchernaya to Kamiesch Bay, cm these litters and chairs. Fifty -two-of them were on twenty-six mules in the horizontal litters, and one hundred and forty- four seated in chairs on seventy-two other mules. A driver was provided for every two mules or four wounded men. The appearances, with such an examination as I gave the whole equipment, were so favorable as to recommend it for trial in our service. To make the system better understood I annex two additional figures (Flos. 446 and 447), showing the animal, the equipment, and position of the soldier, for which compilation and drawing 1 am indebted to Professor WEIB." FIG. 446. British Crimean mule litter. [After WEIR.] CHAP. XV. J MULE LITTERS AND CAOOLETiS. 929 FIG. 4-17. British Crimean cacolet. [After WEIR.) use of these cacolets and litters, and purchased animals specially adapted for their transport. The Quartermaster General has remarked that these horses and mules were gradually appro priated as draft animals, and that the litters and cacolets were, for the most part, con demned as unserviceable. The French litters and cacolets were what is known as the old pattern, such as the French used in Algeria and the Crimea. They are figured in the surg ical report in Circular 6, S. G. 0., 1865, at page 82. Surgeon General Longmore correctly observes (op. cit., p. 291) that the same drawings may also be seen in Chapter XX of M. Legouest s Traite de Chirurgie d Armee, Paris, 1863, pp. 968-9. I ventured to copy the drawings because they well represented the identical cacolets and litters issued in our army, and through an inadvertence, which must be conceded to be unusual in me, I neg lected to acknowledge my indebtedness to my honored friend and master. I trust this explanation will convince him and every one that I had no surreptitious design in using the cuts. In the mule litters and cacolets now issued in the French army there are improve ments providing for making the sections of the litter rigid, so that it can be used temporarily as a hand-stretcher, for reduction in weight, and for greater compactness in packing. 1 The mule chairs and litters now issued by the British Royal Carriage Department are lighter and more convenient than those used in the Crimea. I take the liberty of copying Sur geon General Longmore s drawings o cacolet FIG. 448) and littf-r (FiG. 449) now em ployed m the British serv ice. 2 The only reference I find of the act- PIG. 448. British mule chair orcaeolet, open for use and packed for traveling. [After LONGMOKK.] Pl<-- 441). British army mule litter attached to the pack-saddle. [After LoN(;MOKF -l ment in battle, during the late war in this country, of horse litters or cacolets. is made by Professor F. H. Hamilton. He mentions that, at the battle of Fair Oaks, May 31, 1862, when he was Medical Director of the Fourth Army Corps, eight pack-saddles, pro- 1 M. BOUDIN states (Systeme d ambulances des armies Fran$aise et Anglaise, 1855. p. H5) that the cacolet weighed something over 1!) kilogrammes the pair. The pair in the. Army Medical Museum weighs 40 pounds. Including the pack-saddle. Professor LONGMORE says a pair weighed in the Crimea was found to be 89 pounds and 12 ounces. 2 The weight of a pair of English litters used in the Crimea was 138 pounds 12 ounces without the pack-saddle. The present pattern weighs 84 pounds without bedding or pack-saddle. With palliasses and pack-saddle the weight is 107 pounds. SUKG. Ill 117 930 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. vided with a litter on one side and a cacolet on the other, were provided as a part of the ambulance outfit of that corps, and were used only on the first day of the battle, proving utterly unserviceable. 1 Notes are found in the War Department of the transmission, August 26, 1861, of twelve of the mule litters and cacolets made by Tiffany & Co., to the army in the Shenandoah Valley, commanded by General Banks. A supply of litters and cacolets was provided for the advance of the Army of the Potomac from Yorktown toward Rich mond, in May, 1862. There were forty, at least, in store at White House, 2 but there were no trained animals to bear them. Moreover, the subordinate quartermasters and medical officers appear generally to have regarded the experiment with little favor. Medical Director Tripler, who, in 1859, in a report on the needs of the ambulance service, had urged the importance of supplying horse litters to troops serving in regions impracticable for wheeled carriages, made several efforts to secure suitable equipment and proper animals 3 for this purpose, but without much success. His successor also, Medical Director Letterman, enter tained similar views, in correspondence with the opinions of European authorities; and persevering, though ill-arranged, efforts were made to give the -system a fair trial. In July, 1862, the Surgeon General requested the Quartermaster s Department to provide three hun dred litters, and this number was purchased of Mr. G. Kohler. 4 Prior to the battle of Antietam Medical Director Letterman asked for a supply of mules equipped with cacolets and litters. 5 The Quartermaster s Department had an ample supply of the French patterns, which were beyond all question the best that had been devised at that time. But there were no trained animals to bear them, and few, if any, available skilled packers. September 1, 18G2, the Surgeon General requested that a hundred mule litters should be sent to Medical Inspector R. H. Coolidge. A few weeks after the battle of Antietam a hundred and fifty mules were sent to the Army of the Potomac for ambulance service, but they were so unruly that it was thought unwise to pack them with their equipment, and the litters and cacolets were sent along in wagons, and, as far as can be learned, never found their way to the backs of the mules. 6 Little could be anticipated from such essays. In November, 1862, the Sur- 1 HAMILTON (F. H.) (.4 Treatise on Military Surgery and Hygiene, 1865, p. 162): "Just before the battle of Fair Oaks, eight were sent to us for the use of the 4th corps. They were only employed, however, on the first day of the battle. The horses were found to be impatient and restless under them, and six of the eight were soon broken and rendered unfit for use. Mules are better than horses for this purpose ; they are not so high, and arc less restive under the pressure of heavy weights upon their backs; but even mules require to be trained especially to this kind of service before they can be rendered useful or safe." 2 From a telegraphic order of May 27, 1862, recorded on the files of the War Department, and addressed from the Headquarters of the Army of the Potomac, by Lieutenant Colonel J. A. HARDIE, to Colonel S. VAN VLIET, Quartermaster, at White House on the Parnunkey, it appears that a certain num ber of cacolets were at that depot prior to the battle of Fair Oaks. The dispatch reads : " The Commanding General directs that you furnish the forty cacolets at the White House, belonging to the Medical Department, with horses, and report to the Medical Director here the moment they are ready." Doubtless the eight cacolets sent to the Fourth Corps were supplied from this source. 3 March 13, 1862, on receiving the papers regarding Mr. KOHLER s request for an examination of his litters and cacolets, Medical Director TuirLER makes the indorsement that: " there are sufficient horse litters for this army in the possession of the Quartermaster s Department. All we want now is horses or mules properly trained to carry them. On April 25, 1862, Dr. TRIPLER stated that there were some 200 or more cacolets furnished by the Quar termaster s Department, and that he made every effort to have horses trained to carry them with their loads; that orders to that effect were issued by General McClellan, but were not executed. 4 June 17, 1862. Colonel RUCKER advises the Quartermaster General that he has advertised for proposals for mule litters, and that the only proposal received is from Mr. G. KOHLER, and that the litter he proposes to furnish seems to be very high priced : " It is intricate and cumbersome in construction, and, in my opinion, inferior to those now in Captain DANA S store-house" [the French cacolet and litidrel- July 26, 1862, Surgeon General HAMMOND states, in reply to a letter from the Quartermaster General concurring in Colonel Rucker s opinion : . . . "The litter presented by Mr. KOHLER has been examined by myself and a board of officers, who agree that it possesses sufficient merit to entitle it to trial in the field. I.therefore request that three hundred of the mule litters presented by Mr. KOHLER be purchased for the use of the army." Quartermaster General MEIGS replies, July 29, 1862, that "inasmuch as the Surgeon General adopts and requests that these litters be constructed, though in the opinion of the Quartermaster s Depart ment they are not as good as those already on hand, they will be contracted for under the proposal of Mr. KOHLER. The price bid is understood, as in other cases, to include the whole set, namely: head-stall, harness, saddle, and two litters for each mule." As early as December 9, 1861, this pattern of mule litter had been reported on by a board convened by General McCLELLAX, consisting of Colonel D. H. UrcKEIt, Surgeon C. H. LAUIS, and Surgeon J. R. SMITH, it is presumed unfavorably, as further action was not had at the time. 6 The records of the Property Division of the Surgeon General s Office show that during the period from 1861 to 1865, nine hundred and eighteen horse or mule litters were purchased and distributed by the Medical Department. Of these, 417 were manufactured in the depot at New York, and the rest were purchased from Tiffany & Co., of New York, Wyeth & Brother, of Philadelphia, A. F. Coldeway, Louisville, Ky., and Suire & Eckstein, of Cincinnati, Ohio. 6 In October, 1862, the Surgeon General again made requisition on the Quartermaster s Department for one hundred and fifty mules provided with mule litters, to be sent to Dr. JONATHAN- LETTEUMAN, Medical Director of the Army of the Potomac. In reference to delay in compliance with this AMBULANCE CORPS. 931 geori General made another requisition for a hundred and fifty mules with drivers, with a view of having them drilled with cacolets in the field by Dr. Slade Davis; but this, liko previous experiments in this direction, proved abortive; and the ambulance material for transport by pack-animals, accumulated at no inconsiderable cost, was never really tested in the field. 1 There seems to have been a widespread distrust of the system on the part of officers of the Quartermaster s and the Medical Departments. "In a letter of March 20, 1863, Surgeon George Suckley,U.S.V., Medical Director of the Eleventh Corps, wrote from the Army FIG. 450. French litifire folded. [After LEGOUEST.J - of the Potomac, near Fred- FIG. 451. French cacolet unfolded. [After LEGOUEBT.] ericksburg, to Surgeon J. H. Brinton, U. S. V., at Washington: There are no cacolets in this corps, and I want none. Three hundred and fifty pounds weight is too much for a mule s back over rough ground, encumbered by bushes, stones, logs, and ditches. Among trees, cacolets will not answer at all; although used in European services and in Algeria, they have there been employed under some favorable circumstances, either on plains or on open rolling country. Here they would prove, I sincerely believe, only a troublesome and barbarous encumbrance, cruel alike to the wounded and the pack-animals." AMBULANCE CORPS. The necessity for a drilled and instructed corps for the transportation of wounded from the field is apparent to every one who will consider the subject. The importance of having the wounded rapidly removed from the scene of strife must be conceded, not only on the score of humanity, but also as a military necessity. Without a detachment whose service requisition Captain J. J. DANA, A. Q. M., reported October 17, 1862, as follows: "The order was given by me October 3d, immediately on its receipt, for one hundred and fifty mules and litters to be made ready for service. At that time we had no mules sufficiently well broken for the purpose. I directed fifty of the best to be taken from the ambulance train, the litters to be fitted upon them, and the mules drilled daily until they were fit to go into the field. On the SHh of October fifty mules, with litters upon them, were started for Dr. LKTTEHMAN. Much difficulty was experienced in getting the mules fur- ward, as they were, many of them, inclined to lie down, and were otherwise unruly. Among a lot of mules received oifthe 10th instant we found one hundred which were, to some extent, suitable for the purpose, and were sent forward on the llth instant, the litters being sent by wagons in order to expedite the matter." October 3, 1862, Quartermaster General MEIGS, in transmitting this report to Surgeon General HAMMOND, stated: "I desire respectfully to call your attention to the fact mentioned in the report: that there are a large number of cacolets now in the possession of the Government which appear to have been overlooked by the officers of your Department, and to suggest the expediency of directing their availing themselves of them as occasion may arise. General McCl.ELLAX issued orders, a year ago, for drill and practice of ambulance men, including, as I understand, the use of the mule litters, of which, of French and American manufacture, there were then a considerable number provided by the Quartermaster s Department. Those lately purchased from Mr. KOHLER, on the requisition of the Surgeon General, cost 21,OCO and are still in store." 1 "From the papers laid before the Quartermaster General to-day, there appears an expenditure for purchase of cacolets and litters in 1861 and!8C2 for the army, partly upon requisitions from the Surgeon General, partly from orders originating in this office, of over 120,000. To this, if the cost of animals and use of men, of forage, etc., supplied by this Department for the experiment of introducing these litters and cacolets, it would be found that not less than 10(1.000, and probably more, has been expended in an experiment which was, so far as information in this office goes, entirely unsuccessful. There never was, to the knowledge of the Quartermaster General, a requisition from any military commander. All the requisitions came from the Sur geon General s Office. It is not known to this office that these mule litters ever were used in service, and the Quartermaster General believes that no wounded man was ever placed upon one of them. While the wheeled ambulances and hand litters provided for the hospital equipments were in constant and useful use, the litters burdened the trains, and the mules were, by the ordinary accidents of service, taken for the ambulances and wagons. He believes that no better cacolets or mule litter will be constructed than the French cacolet and litter, ordered at the beginning of the rebellion ; and these, which though in his judgment inferior, were, at a later period, bought at the urgent requisition of the then Surgeon General. He is, therefore, of opinion that any further expenditure by this Department in this line of experiment will be a waste of public money, and he will not. therefore, unless under order of higher authority, expend money or make reports upon any models thus far submitted to him- Mem. of QuAUTE-UMASTEll GEXEUAL, December 23, 18C3- 932 TRANSPORTATION OF THE WOUNDED. [CHAP. xv. it is to attend to this duty, the natural impulse of sympathy will draw men from the ranks to assist their fallen comrades, while the pretext is a temptation to the faint-hearted to shirk the perils of their position. Moreover, the courage of troops under fire would be sustained if they were assured that reliable men would be ready to bear them rapidly from the vicissitudes of a conflict and to tender them early assistance. No organized ambulance corps 1 existed in the army at the beginning of the war, but the necessity of such an organization under the control of the Medical Department was 1 Propositions were made by citizens early in the war to aid in the establishment of an ambulance corps. In May, 1801, Dr. J. O. Buox- BON", of New York, urged upon General Winfield Scott the formation of an organization to consist of a surgeon-in-chief, with aids, nurses, and an efficient body of men to attend upon the ambulance and litters. The letter was referred by General Scott to the Surgeon General, but no further action seems to have been taken. On September 19, 1861, the Surgeon General of Pennsylvania, Dr. H. H. SMITH, wrote to Surg. C. S. TRIPLKR, U. S. A., Medical Director of the Army of the Potomac: "I shall have at Camp Curtin, near Harrisburg, in a few days, fifteen of your ambulances, thirty of those of Coolidge, and fifteen transport carts, with harness complete, ready to semi to the Pennsylvania Reserve Corps. I should like to enlist, if authorized, and drill for one week at this camp, teamsters as drivers, with non-commissioned and commis sioned officers, at the same pay as similar grades in the Army. The corps would consist as follows: One driver to each carriage GO drivers; one corporal, mounted, to fifteen carriages 4 corporals ; one sergeant, mounted, to a division (20 carriages) 3 sergeants ; two second lieu tenants 2 officers; 67 men. This company would have its motions in transportation directed by the lieutenants, who would be commanded by the surgeon of brigade, etc.; the officers and drivers dismounting to lift wounded men, and, whilst carriages went to a hospital and back, could ride round and give temporary assistance with tourniquets, canteens, etc. This may suffice to show my general ideas, which can readily be made to conform to Army Regulations when I am authorized to do so. Not knowing who to apply to, I place the matter in your hands, asking a prompt reply, that no time, may be lost, especially if wanted. Such a corps would servo to drill and form ethers. When not acting with ambulances the corps could attend to general police of sinks, stables, water, fuel, etc., aided by guard-house prisoners, and relieving guard of such duties, or act as extra nurses, cooks, wardmasters, etc., of regimental hospitals. Many volunteer regiments are deficient in these men those having them could organize an ambulance corps readily." Surgeon TRIPI.EU forwarded this letter to the honor able Secretary of War with the following endorsement: "The plan suggested by Dr. SMITH, if authorized to be carried out, would meet a pressing want that of having properly instructed men to handle the wounded. The only difficulty in the way is that medical officers are not now authorized to command lieutenants. The necessity for that authority, however, becoming daily more apparent, it is hoped it may be granted, at the next session of Congress, to the same extent as in the other staff departments. The whole plan of Dr. SMITH is, therefore earnestly recommended to the favorable consideration of the honorable Secretary of War." No action was had on this recommendation. lu the early spring of 1862 a plan was submitted to the Secretary of War by Mr. CHAKLKS PFIUSCIIIXG : "To every division of the army a company shall be attached which will follow it immediately into action on the day of battle for the purpose of taking up all its wounded and carrying them back to the ambulances, or to the points where the regimental surgeons have taken position. Each man of this company should be armed and equipped in the following manner: Two navy revolvers, carried in the cartridge-box belt; a hatchet, carried on the left side of the cartridge-box belt ; a cartridge-box on a leather belt ; a knapsack half filled with his own things, while the other half is appropriated to a stock of bandages, linen, lint, etc., as they may be necessary for a bandage to prevent the death of the wounded before he obtains the assistance of the surgeon. Besides some prepared sticking plasters, etc., and some" bottles with stimulating essences to recall the spirits of the wounded, or to enable him to bear the pains of his wound and of the transportation, a large canteen with water, to which some vinegar or pure brandy may be added for the use of the wounded ; a tin tumbler with it ; a small canteen for the man s own use ; a small box on the cartridge-box belt, with lint, bandages, a small bottle of vinegar for immediate use, so that he has not to take off his knapsack; the half of a litter of my own invention. Two men of this company always keep together, and by means of their two halves they form a litter on which they carry the wounded from the battle-field to the ambulances, or to the places where the regimental surgeons have established them selves. Every man has a broad bandoleer of black leather from the left shoulder to the right hip, and one from the right shoulder to the loft hip, with a sling to each to put the ends of the litter through, so that the weight of the load rests on it, and that the men may have one or both hands free if fhey should be obliged to make use of their weapons. Each man should have a small whistle to give signals to other members of his company. Each company should have one first and one second lieutenant, and as many non-commissioned officers as there are regiments in the division. If brigades or regiments should be detached from the division, a corresponding number of platoons would bo detached from the ambulance companies with them. All ambulance companies of the army should be under the command of a colonel. The men would be instructed in a particular drill for their particular duties x>n the battle-field. The two or four wheeled ambulances would then be stationed on a convenient place in the rear of the different regiments, and with them might be stationed the regimental .surgeons to give the wounded the first regular assistance before they are sent farther back. By this arrangement not only a great deal of pain and suffering might be spared to the wounded, but a great many lives might be saved also. In an economical point of view a saving would also bo made, for the ambulances would last a good deal longer than at present. All the confusion with the wounded at present on the battle-fields would be avoided ; the ranks would not be broken by men who want to assist their wounded comrades, or who use this excuse to cover their cow ardice. The men of the ambulance companies would be detached from the different regiments of every division, say one man from every company. I am willing to undertake the formation and instruction of these companies, and to take the command of them. (Signed) CHAKLKS PFIBSCHING." The Secretary of War directed, on March 3, 1862, Surgeon-General C. A. FIXLEY to examine, or cause to be examined, this plan, and report. Surgeon General FIXLEY sent the paper to Surgeon CHAULKS S. TUIPLER, F. S. A., Medical Director of the Army of tho Potomac, requesting his views with regard to its adaptability to the service and with regard to the question whether the proper organization of the bands in the field would not obviate the necessity for the proposed organization. The report of Surgeon Tuil i.EU is appended : "Head quarters Army of the Potomac, Medical Director s Office, Washington, March 6, 1862. Sir: I have the honor to report that, in obedience to your instructions, I have examined the plan of organization of an anbulance corps submitted by CHAKLES Pi- lRSCinxr,. However desirable a regularly organized ambulance corps may be for an army, it is too late now to raise, drill, and equip so elaborate an establishment as this for our service. There is nothing new in this plan, nothing that has not been thought of and well weighed years ago in connection with our own organization, unless it be the arsenal of pistols and hatchets with which the men are to be loaded. As wo have no ambulance corps proper, an attempt has been made to instruct a certain number of men in each regiment in tho duties appertaining to such a corps. An order pro viding for the drilling of ten men and the band of each regiment to the ambulance service was issued from these headquarters on the 3d of October, 1801. This has been generally faithfully done, and we now have a tolerably well instructed body of men for this duty. Instruc tions for the distribution and employment of these men during an action have been prepared by me and even submitted to General Williams, Adjutant General of the Array of tho Potomac, for the action of General McClellan, some ten days ago. I hope they will soon bo printed and circulated. When that is done all necessary and practicable arrangements for the transportation of our wounded will have been made. I am, therefore, of opinion that the plan of Mr. PEIUSCHING is neither needed nor available for our service at tho present time. Very respect fully, your obedient servant. (Signed) CHAS. S. TKIVLER, Surgeon and Medical Director, Army of the Potomac." Tho report of Surgeon TKIPLER was returned, on March 7th, to the Secretary of War by the Surgeon General, who fully endorsed the views of Surgeon TKIPI.ER. CHAP. XV.] AMBULANCE CORPS. 933 early recognized by the medical officers, and already in April, 1862, Medical Director Tripler, of the Army of the Potomac, called attention to the absolute necessity of having an experi enced quartermaster arid assistant commissary of subsistence attached to the command of the Chief Medical Officer of an army in the field: "I find it impossible to secure either transportation or subsistence for the men thrown upon my hands without tedious delays and much unnecessary suffering. Time, which is so valuable to me now, is taken up and wasted in endeavors, too often unsuccessful, to get together ambulances and wagons 1 to have these trains properly and economically conducted, to have boats prepared and in position, to procure buildings for hospitals, to get subsistence for the sick and wounded, and, in short, doing the duty assigned to quartermasters and subsistence officers. It seems to me that to bring this evil to the notice of the Secretary of War will be sufficient to cause its instant remedy; at all events, I protest beforehand against the Medical Department being held responsible for evils they have no possible means of obviating. My experience in this cam paign has taught me that without an executive officer of these two important departments under my command, more time is lost in negotiating through second and third parties, with an even chance of not getting at all what is wanted, and a certainty of not getting it in time, than would be required in procuring what is necessary and having it in the right place if these officers were placed at my disposal." On August 21, 1862, Surgeon General W. A. Hammond, U. S. Army, in a letter to the Secretary of War, urged the necessity for such a corps: "SURGEON GENERAL S OFFICE, "WASHINGTON, August 21, 1862. "Honorable EDWIN M. STANTON, Secretary of War. "SiR: In accordance with your verbal permission, I have the honor to submit to you the inclosed project for an Hospital Corps, and to ask your favorable consideration for the same. The plan is merely submitted as a basis on which the corps can be organized; much will remain to be done by regulations, and I propose, should you approve the inclosed outline, to ask for a board of medical officers to perfect the organization. I have not considered it necessary to enter into details ; the first thing essential is to obtain your sanction to the organization of such a corps. The need for it is most urgent. In no battle yet have the wounded been properly looked after; men under pre tence of carrying them off the field leave the ranks and seldom return to their proper duties. The adoption of this plan would do away with the necessity of taking men from the line of the army to perform the duties of nurses, cooks, and attendants, and thus return sixteen thousand men to duty iii the ranks. lu view of these facts, and many others which could be adduced, I respectfully ask your approval of the inclosed project. *I am, sir, very respectfully, "Your obedient servant, (Signed) "WILLIAM A. HAMMOND, "Surgeon General." To this the following answer was received: "WAR DEPARTMENT, "WASHINGTON CITY, D. C., August 29, 1862. "SiB: The Secretary of War directs me to acknowledge the receipt of your communication of the 21st instant, submitting a project for a Hospital Corps, and to inform you that the subject was referred to the General-in-Chief, whose views, ad\ 7 erse to the project, are expressed iu the fol lowing words: Our army trains are already much too large and very seriously impede the move ments of our troops in the field. The enemy have great advantages over us in this respect. To 1 It will be shown hereafter that the importance of having the ambulance wag-ons under the control of the Medical Department had, before the war, been pointed out by a board of medical officers consisting of Surgeons U. S. SATTKUL.EK, C. M. I.Al B. and Assistant Surgeon C. H. CHANK, V. S. A., who, in March, 1858, had been appointed a board to examine and report upon the Moses ambulance wagon. 9B4 TRANSPORTATION OF THE WOUNDED. [CHAP. xv. organize such a medical force as is here proposed would, besides involving enormous expenses, greatly increase this evil. Moreover, the presence of non-combatants on, or near the field of bat tle, is always detrimental, as most panics and stampedes originate with them. Medical soldiers would not obviate the necessity of sending fighting soldiers from their ranks with their wounded, for the former would seldom be near enough to the enemy to perform that duty. The soldier can be very much relieved by hiring cooks, nurses, and attendants in hospitals, whenever the circum stances will permit; but I can see no advantage in having them enlisted for that special purpose. All persons so employed are, by law, subject to Army Regulations. I regard this project as one calculated to increase the expenses and immobility of our army by adding to it a large corps of non-combatants, without any corresponding advantages. I therefore report against its adoption. "Very respectfully, your obedient servant, "SURGEON GENERAL, (Signed) "P. H. WATSON, Washington, D. C. r "Assistant Secretary of War. A second appeal was made to the Secretary of War on September 7, 1862: "SURGEON GENERAL S OFFICE, "WASHINGTON CITY, D. C., September 7, 1862. "SiR: I have the honor to ask your attention to the frightful state of disorder existing in the arrangements for removing the wounded from the field of battle. The scarcity of ambulances, the want of organization, the drunkenness and incompetency of the drivers, the total absence of ambulance attendants, are now working their legitimate results, results which I feel I have no right to keep from the knowledge of the Department. The whole system should be under the charge of the Medical Department; an ambulance corps should be organized and set in instant operation. I have already laid before you a plan for such an organization, which I think covers the whole ground, b*ut which I am sorry to find does not meet with the approval of the General-in- Chief. I am not wedded to it. I only ask that some system may be adopted by which the removal of the sick from the field of battle may be speedily accomplished, and the suffering to which they are now subjected be, in future, as far as possible avoided. Tip to this date six hundred wounded still remain on the battle-field in consequence of an insufficiency of ambulances and a want of a proper system for regulating their removal in the Army of Virginia. Many have died of starvation, many more will die in consequence of exhaustion, and all have endured torments which might have been avoided. I ask, sir, that you will give me your aid in this matter; that you will interpose to prevent a recurrence of such consequences as have followed the recent battle, consequences which will inevitably ensue on the next important engagement, if something is not done to obviate them. "I am, sir, very respectfully, "Your obedient servant, "Hon. E. M. STANTON, (Signed) "WILLIAM A. HAMMOND, Secretary of War." "Surgeon General, U. 8. A. This also was referred to the General-in-Chief and returned endorsed as follows: "HEADQUARTERS OF THE ARMY, "WASHINGTON, September 15, 1862. " I am informed by the Quartermaster General that every effort is being made to supply a large number of ambulances. It is proper to remark, however, that the enemy have provided for their wounded on every battle-field with not one-half the ambulances and other facilities provided for our armies. I do not perceive how the drunkenness and incornpeteucy of drivers are likely to be prevented any more by putting the ambulances exclusively under the direction of the Medical Department. It is the duty of all officers to furnish fatigue parties, properly officered, on the requisi tion of medical officers, for the care and removal of the wounded, and it is the duty of all medical officers to make such requisitions, and if not filled, to report the neglect. No such neglect has been reported by medical officers on the recent battle-fields. My objection to the proposed organi zation of a separate non-combatant corps to be attached to the Medical Department were set forth in my endorsement upon a former letter of the Surgeon General. (Signed) "H. W. HALLECK, Oeneral-in- Chief? CHAP. XV.] AMBULANCE CORPS. 935 Owing to the opposition of the General-in-Chief, no further steps were taken in this direction at this time. In the meantime the medical officers in the field had been com pelled to devise the best means they could for the immediate care of the wounded after battles. At the suggestion of Medical Director Tripler, the following order was issued in the Army of the Potomac on October 3, 1861 : "HEADQUARTERS ARMY OF THE POTOMAC, "WASHINGTON, October 3, 1861. " GENERAL ORDERS No. 20. ******** "VI. The hospital attendants, to the number of 10 men to a regiment, and the regimental bands, will be assembled under the supervision of the brigade surgeons, and will be drilled one hour each day, except Sunday, by the regimental medical officers, in setting up and dismantling the hand-stretchers, litters, and ambulances; in handling men carefully; placing them upon the litters and ambulance beds ; putting them into the ambulances, taking them out, etc.; carrying men upon the hand-stretchers (observing that the leading bearer steps off with the left foot and the rear bearer with the right) ; in short, in everything that can render this service effective and the most comfortable for the wounded who are to be transported. ******** "BY COMMAND OF MAJOR GENERAL McOLELLAN: (Signed) "S. WILLIAMS, "Assistant Adjutant General." Similar plans were adopte.d in other armies, but the first and most complete ambu lance system 1 was that established in August, 1862, at the instance of Surgeon Jonathan Letterman, U. S. A., Medical Director of the Army of the Potomac. The plan is clearly set forth in the accompanying order: "HEADQUARTERS ARMY OF THE POTOMAC, "CAMP NEAR HARRISON S LANDINGS, VA., August 2, 1862. " GENERAL ORDERS No. 147. "The following regulations for the organization of the Ambulance Corps and the manage ment of ambulance trains are published for the information and government of all concerned. Commanders of Army Corps will see that they are carried into effect without delay : " 1. The Ambulance Corps will be organized on the basis of a captain to each Army Corps as A crude draft of a plan for the establishment of an ambulance corps* had, on July 15, 1862, been submitted to the Surgeon General by Surgeon B. A. VAXDEUKIEFT, IT. S. V., as follows: "Each division shall be provided with a special corps under the name of Division Ambulance Corps. This corps will be under the immediate orders of the Division Medical Director. This corps will be composed of one hundred private soldiers and four non-commissioned officers, under the orders of a medical officer with the rank of surgeon, who will be aided in his duties by an assistant surgeon ; both being detailed from respective regiments, and being exempt from all duties save those connected with the above mentioned corps. The non-commissioned officers attached to this corps will have the rank and pay of hospital stewards, and the privates will receive the additional pay of hospital attendants. Among the privates four will be detailed to act as cooks. One blacksmith shall be attached to the corps. The four non-commissioned officers to be mounted. The men composing the Division Ambu lance Corps will be selected from the different regiments forming the division ; and preference will be given to hospital attendants recom mended by their respective surgeons as being competent, intelligent, and of unimpaired physique. As means of transportation there will be required : 12 four-wheeled four-horse ambulances ; 12 two-wheeled one-horse ambulances for transportation of sick and wounded ; 1 four- wheeled two-horse ambulance, containing the medical stores on hand and serving as an ambulating surgery ; 2 four-wheeled four-horso transport wagons, for transporting medical stores and provisions. The corps, having no permanent place of settlement, should always bo provided with a few days rations for attendants and patients. Rations and forage should bo drawn by the medical officer in charge from the division commissary. Every man belonging to this corps shall be instructed, if possible, four hours each day in the following exercises: Transportation of sick and wounded ; removing sick and wounded in ambulances from the field of battle ; attendance of the wounded on the field before the arrival of the surgeon, such as applying tourniquets and bandages to prevent fatal bleeding, etc. The building of provisional hospitals (abris), where no other means offer, and the construction of impromptu bunks and litters will also form part of the instruction of attendants, to make them more thoroughly efficient for their position. Each man shall be provided with a bag containing a tourniquet, lint, linen, bandages, and a few haemostatic and stimulant medicines, the use of each having been explained. During and after a battle or engagement, the surgeon in charge shall always superintend the transportation of the wounded, not only by his own corps, but even by the different regimental ambulance corps. In cases where it may be absolutely required, operations on the field should oven be performed by the surgeon in charge or his assistant surgeon, but only in the absence of the proper regimental surgeon, such privilege belonging properly to him. After an engagement the division ambulances shall be used for transporting the sick and wounded to the central hospitals ; and when the division is only moving they shall assist the different regiments in the transportation of the sick, thus preventing the numerous stragglers arising from insufficient means of regimental transportation. When the corps has attained a certain degree of proficiency, the men composing it may be gradually returned to the departments from which they have been taken, and new ones detailed who shall be instructed in the same exercises. The division ambulance corps is thus not only intended for the transportation of sick and wounded, but to be a school of instruction to form well-disciplined hospital attendants." 936 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. the Commandant of the Ambulance Corps, a 1st lieutenant for a Division, 2d lieutenant for a brigade, and a sergeant for each regiment. "2. The allowance of ambulances and transport carts will be: One transport cart, one4-horse and two 2-horse ambulances for a regiment; one 2-horse ambulance for each battery of artillery, and two 2-horse ambulances for the Headquarters of each Army Corps. Each ambulance will be provided with two stretchers. "3. The privates of the Ambulance Corps will consist of two men and a driver to each ambu lance, and one driver to each transport cart. " 4. The captain is the commander of all the ambulances and transport carts in the Army Corps, under the direction of the Medical Director. He will pay special attention to the condition of the ambulances, horses, harness, etc., requiring daily inspections to be made by the commanders of Division ambulances, and reports thereof to be made to him by these officers. He will make a personal inspection once a week of all the ambulances, transport carts, horses, harness, etc., whether they have been used for any other purpose than the transportation of the sick or wounded, and med ical supplies; reports of which will be transmitted through the Medical Director of the Army Corps to the Medical Director of the Army every Sunday morning. He will institute a drill in his corps, instructing his men in the most easy and expeditious method of putting men in and taking them out of the ambulances, taking men from the ground and placing and carrying them on stretchers, observing that the front man steps off with the left foot and the rear man with the right, etc. He will be especially careful that the ambulances and transport carts are at all times in order, provided with attendants, drivers, horses, etc., and the keg daily rinsed and filled with fresh water, that he may be able to move at any moment. Previous to and in time of action he will receive from the Med ical Director of the Army Corps his orders for the distribution of the ambulances and the points to which he will carry the wounded, using the light two horse-ambulances for bringing men from the field, and the four-horse ones for carrying those already attended to farther to the rear, if the Med ical Director considers it necessary. He will give his personal attention to the removal of the sick and wounded from the field and to and from the hospitals, going from point to point to ascertain what may be wanted, and to see that his subordinates (for whose conduct he will be responsible) attend to their duties in taking care of the wounded, treating them with gentleness and care, and removing them as quickly as possible to the places pointed out; and that the ambulances reach their destination. He will make a full and detailed report after every action and march of the operations of the Ambulance Corps. "5. The 1st lieutenant assigned to the Ambulance Corps of a Divisou will have complete con trol, under the Commander of the whole Corps and the Medical Director, of all the ambulances, transport carts, ambulance horses, etc., in the Division. He will be the Acting Assistant Quarter master for the Division Ambulance Corps, and will receipt and be responsible for the property belonging to it, and be held responsible for any deficiencies in ambulances, transport carts, horses, harness, etc., pertaining to the Ambulance Corps of the Division. He will have a travelling cav alry forge, a blacksmith, and a saddler, who will be under his orders, to enable him to keep his train in order. He will receive a daily inspection report of all the ambulances, horses, etc., under his charge from the officer in charge of Brigade Ambulance Corps, will see that the subordinates attend strictly to their duties at all times, and will inspect the corps under his charge once a week ; a report of which inspection he will transmit to the Commander of the Ambulance Corps. "6. The 2d lieutenant in command of the ambulances of a brigade will be under the imme diate orders of the commander of the Ambulance Corps for the Division, and have superintend ence of the Ambulance Corps for the brigade. " 7. The sergeant in charge of the Ambulance Corps for a regiment will conduct the drills, inspections, etc., under the orders of the Commander of the Brigade Ambulance Corps, and will be particular in enforcing rigidly all orders he may receive from his superior officers. The officers and non-commissioned officers of this corps will be mounted. "8. The detail for this corps will be made with care by Commanders of Army Corps, and no officer or man will be selected for this duty except those known to be active and efficient; and no man will be relieved except by orders from these Headquarters. Should any officer or man detailed for this duty be found not fitted for it, representations of the fact will be made by the Medical Director of the Army Corps to the Medical Director of this Army. CHAP, xv ] AMBULANCE CORPS. 937 "9. Two medical officers from the reserve corps of surgeons of each Division, and a hos pital steward who will be with the medicine wagon, will be detailed by the Medical Director of the Army Corps to accompany the ambulance train when on the march, the train of each Division being kept together, and will see that the sick and wounded are properly attended to. A medicine wagon will accompany each train. " 10. The officers connected with the corps must be with the trains on the march, observing that no one rides in the ambulances without the authority of the medical officers, except in urgent cases ; but men must not be allowed to suffer, and the officers will, when the medical officers cannot be found, use a sound discretion in this matter, and be especially careful that the men and drivers are in their proper places. The place for the ambulances is in front of all the wagon trains. " 11. When in camp the ambulances, transport carts, and Ambulance Corps will be parked with the brigade, under the supervision of the commander of the corps for the brigade. They will be used on the requisition of the regimental medical officers, transmitted to the Commander of the Brigade Ambulance Corps, for transporting the sick to various points and procuring medical sup plies, and/or nothing else. The non-commissioned officer in charge will always accompany the am bulances or transport carts when on this or any other duty, and he will be held responsible that they are used for none other than their legitimate purposes. Should any officer infringe upon this order regarding the uses of ambulances, etc., he will be reported by the officer or non-com missioned officer in charge to the commander of the train, all the particulars being given. " 12. The officer in charge of a train will at once remove anything not legitimate, and if there be not room for it in the baggage wagons of the regiment, will leave it on the road. Any attempt by a superior officer to prevent him from doing his duty in this or any other instance he will promptly report to the Medical Director of the Army Corps, who will lay the matter before the commander of that corps. The latter will, at the earliest possible moment, place the officer offending in arrest for trial for disobedience of orders. 11 13. Good, serviceable horses will be used for the ambulances and transport carts, and will not be taken for any other purpose, except by orders from these Headquarters. "14. The uniform of this corps is: For privates, a green baud two inches broad around the cap, a green half chevron two inches broad on each arm above the elbow, and to be armed with revolvers. Non-commissioned officers to wear the same band around the cap as a private, chevrons two inches broad, and green, with the point toward the shoulder, on each arm above the elbow. " 15. No person will be allowed to carry from the field any wounded or sick, except this corps. "16. The Commanders of the Ambulance Corps, on being detailed, will report without delay to the Medical Director at these Headquarters for instructions. All Division, Brigade, or Regimental Quartermasters having any ambulances, transport carts, ambulance horses or harness, etc., in their possession, will turn them in at once to the Commander of the Division Ambulance Corps. "BY COMMAND OF MAJOR GENERAL McCLELLAN: (Signed) "S.WILLIAMS, " Assistant Adjutant- General." The advantages accruing from this organization became speedily manifest. At the battle of Antietam, in September, 1862, by the active and energetic exertions of the mem bers of this corps the disabled of the right wing of the army (there was no ambulance system on the left) were rapidly conveyed from the scene of conflict to the hospitals in the rear. The train of ambulances plied incessantly between the battle-ground and the field hospital. During the night of the battle all of our wounded in the widely extended field were removed to shelter and received the necessary surgical attention. Different members of the corps behaved with the utmost gallantry, passing freely under fire in their search of the fallen, and advancing at times to the extreme verge of the enemy s pickets. All of our wounded having thus been collected at the temporary depots, such as were deemed best able to undergo further transportation were carefully selected. These, during the following two or three days, were then conveyed by the ambulance train to Frederick City, Md., the nearest point of railway connections. At the first battle of Fredericksburg the results SURG. Ill 118 938 TRANSPORTATION OF THE WOUNDED. [CHAP. xv. of the persevering endeavors of the Ambulance Corps were not less happy. During the night following the battle all of the wounded remaining on the ground not absolutely in the hands of the enemy were safely conveyed to the city of Predericksburg and its neigh borhood. When it subsequently became necessary to evacuate the city of Fredericksburg for military reasons, the wounded were again placed upon the train and safely reached the opposite bank of the river. These fortunate results were, however, obtained at the expense of the Ambulance Corps, which experienced a loss of one officer and several privates killed, besides others who were captured during their humane efforts to remove their fallen coun trymen. In the Army of the Tennessee, with the exception of General Sherman s Corps, no system for the formation of an ambulance train, for confining ambulances to their proper use, or for the ready removal of wounded had existed prior to March, 1863, when Medical Inspector E. P. Vollum, U. S. A., urged upon General Grant the necessity of establishing an ambulance corps. The proposition was cheerfully entertained, and on March 30, 1863, the following order was issued from the Headquarters of the Department of the Tennessee : "HEADQUARTERS DEPARTMENT OF THE TENNESSEE, "YOUNG S POINT, LOUISIANA, March 30, 1803. " GENERAL ORDERS No. 22. " Ariny Corps Commanders will at once enforce the following regulations : " 1. All ambulances with the Army in the field will be turned in to Division Quartermasters, each Division retaining all the ambulances it now has. " 2. Division ambulance trains will be formed in charge of one commissioned officer for each Division, one non-commissioned officer for each brigade, and one driver and two enlisted men for each ambulance, to be detailed for that purpose, who will be subject to the direction of the Chief Surgeon of the Division. "3. The officers in charge of Division ambulance trains will have direct military control over all the non-commissioued officers and privates of their respective trains, and will see that the am bulances are only used for conveying sick or wounded, carrying provisions for hospitals when neces sary, and other purposes connected with the relief of sick and wounded. "4. In removing sick and wounded the enlisted men detailed to attend ambulances, as above directed, will nlone be permitted to accompany them, and that they may be recognized as having been appointed for this purpose, each of them will wear a white badge on the left arm above the elbow, the same to be provided by the Medical Department.- "5. Division Quartermasters will be responsible for all public property connected with said Division ambulance trains, and will exercise authority over all matters pertaining to the parking and preservation of the same. " G. Army Corps commanders and Medical Directors of Army Corps will make such regula tions for the removal of wounded and sick as will, in their judgment, best secure the end desired to be attained under this order. " By order of Major-General TJ. S. GRANT. (Signed) "JNO. A. RAWLINS, 11 Assistant Adjutant General" Actual experience in the field suggested various changes in the original plan adopted in the Army of the Potomac, and on August 22, 1863, Surgeon Letterman laid before the General Commanding revised regulations, which wore published in General Orders No. 85, Headquarters of the Army of the Potomac, August 24. 1863: "The following revised regulations for the organization of the Ambulance Corps and the management of the ambulance trains are published in lieu of Special Orders No. 147, Headquarters Army of the Potomac, August 2, 18G2, for the information and government of all concerned. Com manders of Army Corps will see that they are carried into effect. CHAP, xv.] AMBULANCE CORPS. 939 " 1. The Army Corps is the unit of organization for the Ambulance Corps, and the latter will be organized upon the basis of Captain as the Commandant of the Corps, one 1st Lieutenant for each Division, one 2d Lieutenant for each brigade, one sergeant for each regiment. "2. The privates of this corps will consist of two men and one driver to each ambulance and one driver to each medicine wagon. "3. The two-horse ambulances only will be used, and the allowance until further orders to each corps will be upon the basis of three to each regiment of infantry, two to each regiment of cavalry, one to each battery of artillery, to which it will be permanently attached, and two to the Headquarters of each Army Corps; and two army wagons to each Division. Each ambulance will be provided with two stretchers. U 4. The captain is the commander of all the ambulances, medicine, and other wagons in the corps, under the immediate direction of the Medical Director of the Army Corps to which the Ambulance Corps belongs. He will pay special attention to the condition of the ambulances, wagons, horses, harness, etc., and see that they are at all times in readiness for service, that the officers and men are properly instructed in their duties, and that these duties are performed, and that the regulations of the corps are strictly adhered to by those under his command. He will insti tute a drill in his corps, instructing his men in the most easy and expeditious method of putting men in and taking them out of the ambulances, lifting them from the ground, and placing and car rying them on stretchers, in the latter case observing that the front man steps oif with the left foot and the rear man with the right, etc.; that in all cases his men treat the sick and wounded with gen tleness and care; that the ambulances and wagons are at all times provided with attendants, dri vers, horses, etc.; that the vessels for carrying water are constantly kept clean and filled with fresh water; that the ambulances are not used for any other purpose than that for which they are designed and ordered. Previous to a march he will receive from the Medical Director of the Army Corps his orders for the distribution of the ambulances for gathering up the sick, and previous to and in time of action he will receive orders from the same officer where -to send his ambulances, and to what points the wounded are to be carried. He will give his personal attention to the removal of the sick and wounded from the field in time of action, going from place to place to ascertain what may be wanted, to see that his subordinates (for whose conduct he will be responsible) attend faithfully to their duties in taking care of the wounded and removing them as quickly as may be found con sistent with their safety to the field hospitals, and see that the ambulances reach their destination. After every battle he will make a report, in detail, of the operations of his corps to the Medical Di rector of the Army Corps to which he belongs, who will transmit a copy with such remarks as he may deem proper to the Medical Director of this Army. He will give his personal attention to the removal of sick when they are required to be sent to general hospitals, or to other points as may be ordered. He will make a personal inspection at least once a month of everything pertaining to the Ambulance Corps, a report of which will be made to the Medical Director of the Corps, who will transmit a copy to the Medical Director of this Army. This inspection will be minute and made with care, and will not supersede the constant supervision which he must at all times exercise over his corps. He will also make a weekly report according to the prescribed form to the same officer, who will forward a copy to the Medical Director of this Army. "5. The 1st lieutenant assigned to the Ambulance Corps for a Division will have complete control, under the captain of his corps and the Medical Director of the Army Corps, of all the am bulances, medical and other wagons, horses, etc., and men in that portion of the Ambulance Corps. He will be the Acting- Assistant Quartermaster for that portion of the corps, and will receipt for and be responsible for all the property belonging to it, and be held responsible for any deficiency in anything appertaining thereto. He will have a travelling cavalry forge, a blacksmith, and a saddler, who will be under his orders, to enable him to keep his train in order. His supplies will be drawn from the Depot Quartermaster upon requisitions approved by the captain of his corps and the Commander of the Army Corps to which he is attached. He will exercise a constant supervision over his train in every particular, and keep it at all times ready for service. Especially before a battle will he be careful that everything be in order. The responsible duties devolving upon him in time of action render it necessary that he be active and vigilant, and spare no labor in their execution. He will make reports to the captain of the corps upon the form prescribed every Saturday morning. 940 TRANSPORTATION OF THE WOUNDED. [CHAP. xv. " G. The 2d lieutenant will have command of the portion of the Ambulance Corps for a brig ade, and will be tinder the immediate orders of the commander of the ambulances for a Division, and the injunctions in regard to care and attention and supervision prescribed for the Commander of the Division he will exercise in that portion under his command. " 7. The sergeant will conduct the drills, inspections, etc., under the orders and supervision of the commander of the ambulances for a brigade, be particular in enforcing all orders he may receive from his superior officers, and that the men are attentive to their duties. The officers and non commissioned officers will be mounted. The non-commissioned officers will be armed with revolvers. "8. Two medical officers and two hospital stewards will be detailed daily by roster by the Sur- geon-in-Chief of the Division, to accompany the ambulances for the Division when on the march, whose duties will be to attend to the sick and wounded with the ambulances and see that they are properly cared for. No man will be permitted by any line officer to fall to the rear to ride in the ambulances unless he has written permission from the senior medical officer of his regiment to do so. These passes will be carefully preserved, and at the close of inarch be transmitted by the senior medical officer with the train, with such remarks as he may deem proper, to the Surgeon-in-Chief of his Division. A man who is sick or wounded, who requires to be carried in an ambulance, will not be rejected; should he not have the permission required, the Surgeon of the regiment who has neglected to give it will be reported at the close of the march by the senior Surgeon with the train, to the Surgeon-in-Chief of his Division. When on the march, one-half the privates of the Ambu lance Corps will accompany on foot the ambulances to which they belong, to render such assistance as may be required. The remainder will march in the rear of their respective commands to conduct, under the orders of the medical officers, such men as may be unable to proceed to the ambulances, or who may be incapable of taking proper care of themselves, until the ambulances come up. When the case is of so serious a nature as to require it, the Surgeon of the regiment or his assist ant will remain and deliver the man to one of the medical officers with the ambulances. At all other times the privates will be with their respective trains. The medicine wagons will on the march be in their proper places in the rear of the ambulances for each brigade. Upon ordinary marches the ambulances and wagons belonging to the train will follow immediately in the rear of the Divis ion to which it is attached. Officers connected with the corps must be with the trains when on the march, observing that no one rides in any of the ambulances except by authority of medical officers. Every necessary facility for taking care of the sick and wounded upon the march will be afforded the medical officers by the officers of the Ambulance Corps. " 9. When in camp the ambulances will be parked by division. The regular roll-calls, reveille, retreat, and tattoo will be held, at which at least one commissioned officer will be present and receive the reports. Stable duty will be at hours fixed by the captain of the corps, and at this time, while the drivers are in attendance upon their animals, the privates will be employed in keep ing the ambulances to which they belong in order, keeping the vessels for carrying water filled with fresh water, and in general police duties. Should it become necessary for a regimental medical officer to use one or more ambulances for transporting sick and wounded, he will make a requisition upon the Commander of the Ambulances for a Division, who will comply with the requisition. In all cases when ambulances are used the officers, non-commissioned officers, and men belonging to them will accompany them; should one ambulance only be required, a non-comrnissioued officer as well as the men belonging to it will accompany it. The officers of the Ambulance Corps will see that ambulances are not used for any other purpose than that for which they are designed, viz : the transportation of sick and wounded, and in urgent cases only, of medical supplies. All officers are expressly forbidden to use them, or to require for them to be used for any other purpose. When ambulances are required for the transportation of sick or wounded at Division or Brigade Headquarters they will be obtained as they are needed for this purpose from the Division train, but no ambulances belonging to this corps will be retained at such headquarters. " 10. Good, serviceable horses will be used for the ambulances and medicine wagons, and will not be taken for any other purpose except by orders from these Headquarters. "11. The corps will be designated, for sergeants, by a green band 1 inches broad around the cap, and chevrons of the same material, with the point toward the shoulder, on each arm above the elbow. For privates, by a band the same as for sergeants around the cap, and a half chevron of the same material on each arm above the elbow. CHAP. XV.] AMBULANCE CORPS. 941 "12. No person except the proper medical officers or the officers and non-commissioned officers and privates of this corps will be permitted to take or accompany sick or wounded to the rear either on the march or upon the field of battle. " 13. No officer or man will be selected for this service except those who are active and efficient, and they will be detailed and relieved by Corps Commanders only. "14. Corps Commanders will see that the foregoing regulations are carried into effect. "BY COMMAND OF MAJOR GENERAL M.EADE: (Signed) "S. WILLIAMS, " Assistant Adjutant General? The establishment of a. uniform system of ambulance corps in the armies of the United States was not, accomplished until the spring of 1864, when Congress 1 passed the following act, which was approved by the President on March 11, 1864, and promulgated by the Secretary of War in General Orders ~No. 106, War Department, A. G. 0., Washington, D. C.. March 16, 1864: "Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That the medical director, or chief medical officer of each army corps, shall, under the control of the medical director of the army to which such army corps belongs, have the direction and supervision of all ambulances, medicine and other wagons, horses, mules, harness, and other fixtures appertaining thereto, and of all officers and men who may be detailed or employed to assist him in the management thereof, in the army in which he may be serving. " SEC. 2. And be it further enacted, That the commanding officer of each army corps shall detail officers and enlisted men for service in the ambulance corps of such army corps, upon the 1 A copy of the bill as originally introduced in Congress in the winter of 18G3 to 3864, was submitted by the Committee on Military Affairs of the Senate to Surgeon LETTEKMAN fur recommendations and suggestions, and was returned by him with the following letter : "HEADQUARTERS ARMY OF THE POTOMAC, "MEDICAL DIRKCTOH S OFFICE, January*, 1864. ; DEAR SIR: As desired by the clerk of the Committee on Military Affairs in the Senate, from whom, since I took the liberty of addressing you on the 3Ist nit., I received a copy of the bill in reference to an Ambulance System, I have the honor to submit for your consideration the following sug gestions, viz: In SECTION 1, line 2, after the word shall insert the words under the control of the Medical Director of the Army to which such Army Corps belongs. This suggestion is made because it is considered necessary that there should be one, officer who shall have the control and supervision of the Ambulance Corps throughout an army, and as the Medical Director of an army is held responsible for the care (in the widest meaning of the word) of the wounded and sick in that army, it is necessary that he should control the subordinate officers in his department, and his authority be commensurate with his responsibility. SECTION 1, line 4, after the word medicine insert the words and other. This will make the provisions of the bill harmonize. SECTION 2, line 2. after the word detail insert the words officers and enlisted men. SECTION 2, line 2, after the words Army Corps insert the words upon the following basis, viz. These alterations will, I think, clearly show that the officers and men are detached from their regiments, brigades, etc , and the Ambulance Corps in each Army Corps considered a unit, and as belonging not to any particular regiment, brigade, etc., but to the Army Corps at large, a feature very essential to the proper working of the system. SECTION 3. Strike out all after the word furnished, in line 1, to the word and, in line 7, and insert the words to each Army Corps two-horse ambulances upon the following basis, viz: three to each Regiment of Infantry ; two to each Regiment of Cavalry ; one to each Battery of Artillery; to which it shall be permanently attached. The ground-work of the organization is to take from regiments the direct control of the ambulances and form them into trains under proper officers and men. Unless they are so they cannot be wielded with facility, kept in order, or be properly supervised by the superior medical officers. It has been found when ambulances are attached to regiments that they are of very little use, especially upon a march or in time of action the regimental medical officers under such circumstances cannot, from the nature and pressure of their duties at such time, control them. The proposed alteration will harmonize with the provisions of SECTION 8. It is proposed to attach the ambulance to each battery, as the latter has no fixed position and is liable to constant change. I regard the last three suggestions as of vital importance to the successful working of the system. SECTION 3, line 8, after the word division insert the words train of ambulances. SECTION 5. Strike out all after the words Army Corps, in line 15, to the words and it shall, in line 18, and insert previous to a march, and previous to and in time of action, or whenever it may be necessary to use the ambulances, to issue the proper orders to the captain for the distribution and management of the same; for collecting the sick and wounded and conveying- them to their destination. SECTION 5, line 21, strike out all after the words Surgeon General to the end of the section, and insert instead or the Medical Director of the Army; and all reports to higher authority than the Commanding Officer of the Army Corps shall be transmitted through the Medical Director of the Army to which such Army Corps belongs. The Medical Director of an Army having, under the Commanding General, the control of the Ambulance Corps in all Army Corps, military subordination and discipline require all correspondence and reports to pass through him. The words that are proposed to be stricken out are not necessary, as the Commanding Officer of an Army Corps has all in his Corps under his supervision. SECTION 6. Strike out in line 7 the words of their respective regiments and insert the words under his orders. This is suggested that the different sections may be in harmony, and to reject the idea of the ambulances being attached to regiments. SECTION 8, line 3, strike out the word officers and instead of it insert the word persons. I have made the above suggestions freely and without reserve, as I believe you desire, and it is in accordance with my own wishes that my views be plainly given on the subject. The manner in which the ambulance trains are now established and conducted in this army permits the formation either of Corps, Division, or Regimental Hospitals, or the change from one to the other as the exigencies of the service may require at any time, without delay or inconvenience, and to the great advantage of the sick and wounded, and I am fully convinced from my experience that when properly carried into effect this system can be managed without trouble, and the sick and wounded, by their own officers, be promptly, carefully, and efficiently cared for, and thus, in no small degree, contributing to the efficiency of the army in which it is properly administered. "I am. sir, very respectfully, your obedient servant, (Signed) "JONATHAN LETTERMAX, "Hon. HEXRY WILSON, "Medical Director. " I . S. Senate. It will be noted that the suggestions of Dr. LETTEKMAN were incorporated in the bill. 942 TRANSPORTATION OF THE WOUNDED. [CHAP. xv. following basis, viz: one captain, who shall be commandant of said ambulance corps; one first lieutenant for each division in such army corps ; one second lieutenant for each brigade in such army corps; one sergeant for each regiment in such army corps; three privates for each ambu lance, and one private for each wagon; and the officers and non-commissioned officers of the ambu lance corps shall be mounted: Provided, That the officers, non-commissioned officers, and privates so detailed for each army corps shall be examined by a board of medical officers of such army corps as to their fitness for such duty ; and that such as are found to be not qualified shall be rejected, and others detailed in their stead. U SEC. 3. And be it further enacted, That there shall be allowed and furnished to each army corps two-horse ambulances upon the following basis, to wit : three to each regiment of infantry of five hundred men or more; two to each regiment of more than two hundred and less than five hundred men or more ; and one to each regiment of infantry of less than two hundred men : two to each regiment of cavalry of five hundred men or more; and one to each regiment of cavalry of less than five hundred men; one to each battery of artillery to which battery of artillery it shall be permanently attached; to the headquarters of each army corps two such ambulances; and to each division train of ambulances two army wagons; and ambulances shall be allowed and furnished to division brigades and commands not attached to any army corps upon the same basis, and each ambulance shall be provided with such number of stretchers and other appliances as shall be prescribed by the Surgeon General : Provided, That the ambulances and wagons herein mentioned shall be furnished, as far as practicable, from the ambulances and wagons now in the service. " SEC. 4. And be it further enacted, That horse and mule litters may be adopted or author ized by the Secretary of War, in lieu of ambulances, when judged necessary, under such rules and regulations as may be prescribed by the medical director of each army corps. "SEC. 5. And be it further enacted, That the captain shall be the commander of all the ambu lances, medicine and other wagons in the corps, under the immediate direction of the medical director, or chief medical officer, of the army corps to which the ambulance corps belongs. He shall pay special attention to the condition of the ambulances, wagons, horses, mules, harness, and other fixtures appertaining thereto, and see that they are at all times in readiness for service; that the officers and men of the ambulance corps are properly instructed in their duties, and that their duties are performed, and that the regulations which may be prescribed by the Secretary of War, or the Surgeon General, for the government of the ambulance corps are strictly observed by those under his command. It shall be his duty to institute a drill in his corps, instructing his men in the most easy and expeditious manner of moving the sick and wounded, and to require in all cases that the sick and wounded shall be treated with gentleness and care, and that the ambulances and wagons are at all times provided with attendants, drivers, horses, mules, and whatever may be necessary for their efficiency; and it shall be his duty also to see that the ambulances are not used for any other purpose than that for which they are designed and ordered. It shall be the duty of the medical director, or chief medical officer, of the army corps, previous to a march, and prev ious to and in time of action, or whenever it may be necessary to use the ambulances, to issue the proper orders to the captain for the distribution and management of the same, for collecting the sick and wounded and conveying them to their destination. And it shall be the duty of the cap tain faithfully and diligently to execute such orders. And the officers of the ambulance corps, including the medical director, shall make such reports, from time to time, as may be required by the Secretary of War, the Surgeon General, the medical director of the army, or the commanding officer of the army corps in which they may be serving; and all reports to higher authority than the commanding officer of the army corps shall be transmitted through the medical director of the, army to which such army corps belongs. " SEC. 6. And be it further enacted, That the first lieutenant assigned to the ambulance corps for a division shall have complete control, under the captain of his corps and the medical director of the army corps, of all the ambulances, medicine and other wagons, horses, mules, and men in that portion of the ambulance corps. He shall be the acting assistant quartermaster for that portion of the ambulance corps, and will receipt for and be responsible for all the property belonging to it, and be held responsible for any deficiency in anything appertaining thereto. He shall have a travelling cavalry forge, a blacksmith, and a saddler, who shall be under his orders, to enable him to keep his train in order. He shall have authority to draw supplies from the depot quartermaster, CHAP. xv.J -AMBULANCE CORPS. 943 upon requisitions approved by the captain of his corps, the medical director, and the commander of the army corps to which he is attached. It shall be his duty to exercise a constant supervision over his train in every particular, and keep it at all times ready for service. "SEC. 7. And be it further enacted, That the 2d lieutenant shall have command of the por tion of the ambulance corps for a brigade, and shall be under the immediate orders of the 1st lieutenant, and he shall exercise a careful supervision over the sergeants and privates assigned to the portion of the ambulance corps for his brigade ; and it shall be the duty of the sergeants to conduct the drills and inspections of the ambulances, under his orders, of their respective regi ments. "SEC. 8. And be it further enacted, That the ambulances in the armies of the United States shall be used only for the transportation of the sick and wounded, and, in urgent, cases only, for medical supplies, and all persons shall be prohibited from using them, or requiring them to be used, for any other purpose. It shall be the duty of the officers of the ambulance corps to report to the commander of the army corps any violation of the provisions of this section, or any attempt to violate the same. And any officer who shall use an ambulance, or require it to be used, for any other purpose than as provided in this section, shall, for the first offense, be publicly reprimanded by the commander of the army corps in which he may be serving, and for the second offense shall be dismissed from the service. "SEC. 9. And be it further enacted, That no person except the proper medical officers, or the officers, non-commissioned officers, and privates of the ambulance corps, or such persons as may be specially assigned, by competent military authority, to duty with the ambulance corps for the occasion, shall be permitted to take or accompany sick or wounded men to the rear, either on the march or upon the field of battle. " SEC. 10. And be it further enacted, That the officers, non-commissioned officers, and pri vates of the ambulance corps shall be designated by such uniform or in such manner as the Secre tary of War shall deem proper. Provided, That officers and men may be relieved from service in said corps and others detailed to the same, subject to the examination provided in the second sec tion of this act, in the discretion of the commanders of the armies in which they may be serving. "SEC. 11. And be it further enacted, That it shall be the duty of the commander of the army corps to transmit to the Adjutant General the names and rank of all officers and enlisted men de tailed for service in the ambulance corps of such army corps, stating the organizations from which they may have been so detailed; and, if such officers and men belong to volunteer organizations, the Adjutant General shall thereupon notify the governors of the several States in which such organizations were raised of their detail for such service; and it shall be the duty of the com mander of the army corps to report to the Adjutant General from time to time the conduct and behavior of the officers and enlisted men of the ambulance corps, and the Adjutant General shall forward copies of such reports, so far as they relate to officers and enlisted men of volunteer organ izations, to the governors of the States in which such organizations were raised. " SEC. 12. And be it further enacted, That nothing in this act shall be construed to diminish or impair the rightful authority of commanders of armies, army corps, or separate detachments, over the medical and other officers and the non-commissioned officers and privates of their respect ive commands. "Approved March 11, 1864. r By the passage of tins act the authority of the Medical Department over the Ambu lance Corps was fully established. How effectually, and at the same time how considerately, the medical officers availed themselves of the power thus conferred upon them is strikingly shown in the systematic manner with which the immense number of wounded after tire battles of the Wilderness, Spottsylvania Court House, Cold Harbor, Petersburg, and of the campaign in Georgia and the Carolina^, were cared for on the battle-field, were removed to field and base hospitals, and were finally distributed in general hospitals throughout all parts of the United States. Notwithstanding the opinion of General H. W. Hal lock, no panics or stampedes were reported as having been caused by the presence of the non-combatants of the ambulance corps. 944 TRANSPORTATION OF THE WOUNDED. [CHAP. xv. AMBULANCE WAGONS. Ambulance wagons, or wagons especially designed for the transport, of sick and wounded, had not been in use in the armies of the United States until a year or so before the outbreak of the War of the Eebellion. Transport carts, army wagons, ox teams, in fact anything that could be made available for the purpose, had been employed. In the War of Independence, in April, 1777. the Congress of the United States passed a bill "devising ways and means for preserving the health of the troops" which contained the following paragraph: 1 "That a suitable number of covered and other wagons, litters, and other necessaries for removing the sick and wounded, shall be supplied by the Quarter master or Deputy Quartermaster General ; and in case of their deficiency, by the Director or Deputy Director General." There is no record that such vehicles were supplied. During the war with Great Britain, in 1812- 14, there were evidently no ambulance wagons in the United States army, as Surgeon James Mann, 2 in his report of that campaign, is found to make the request that, "to facilitate the movement of the hospital department attached to an army, it should be furnished with a number of wagons and teams, so as not to be imme diately dependent on the Quartermaster s Department, when requisite either to take the wounded from the field of battle, or transport the sick in case of a retrograde march, or remove invalids after having recovered from wounds to a remote hospital. The flying machines called volantes, drawn by horses (an improvement of Larrey, Chief Surgeon of the French army), are useful in open countries, where a corps is assigned to accompany them on the field of battle, upon Larrey s plan." The same author (loc. cit., p. 126) relates that he transported, in February, 1814, four hundred and fifty sick men from Malone to Plattsburgh and Burlington, a distance of seventy miles, in sleighs, losing six patients by death. In the Florida war, in 1838, ambulance wagons are mentioned by Surgeon R. S. Satterlee, U. S. A., Medical Director south of Withlacoochee, in a report from Fort Brooke, Tampa Bay. dated January 5th: "I found the ambulances very serviceable, but as some of the wounded could not be transported in them, on account of the roughness of the road, between thirty and forty of them were brought a part of the way on litters between two horses." Surgeon Satterlee probably had reference to the ordinary transport wagons used on this occasion for conveying sick and wounded. In the General Regulations for the Army of the United States, Washington, 1847, page 123, paragraph 704, it was ordered that: "For the accommodation of the sick and disabled, a wagon will be attached to the rear guard, when necessary and practicable, and a surgeon will attend to give assistance, and to see that no improper persons are suffered to avail themselves of the accommodation." No ambulance wagons were attached to t he- American army in Mexico in 1846 48, or to the expeditions in Indian territories before the outbreak of the war. In 1858 an ambulance wagon (Fios. 452, 453) had been proposed by Dr. I. Moses, of New York, and on March 2, 1858, a Board of Officers, consisting of Surgeons R. S. Satterlee, C. H. Laub, and Assistant Surgeon C. H. Crane, had been appointed to examine and report on its merits. The report of the Board is appended : "The ambulance resembles an omnibus, is entered by two steps in the rear, contains seats for eighteen persons fourteen inside and four on the front seat. By raising the flaps of the inside seats and supporting them by the 1 BROWN (H.), The Medical Department of the United State* Army from 1775 to 1873, Washington, 1873, page 36. 2 MANN (JAMES), Medical Sketches of the Campaign* of 1812-13-14, Dedham, 1816, page 250. CHAP. XV.l AMBULANCE WAGONS. 945 uprights attached, and removing the cushions from the backs of the permanent seats, a bed is arranged which will accommodate one, two, or, on an emergency, three men lying down. With one man in a recumbent position, room for twelve men seated remains; with two men lying down, room for eight, and with three men lying down, room for six remains. A FIG. 452. The "MOSES" ambulance wagon front view. FIG. 453. The "MOSES " ambulance wagon rear view. canvas, stretched and suspended by cords from the top, will accommodate two men lying down where the roads are rough. A close-stool is provided in the vehicle. Two seats, separated from the rest, next to the door, are provided for the hospital steward and attend ant. Two movable chests are placed under these seats to contain what may be required for daily use. The movable door closing the ambulance may become, by change of position, a table for writing or dispensing medicine. The interior is closed entirely by curtains of prepared canvas, or partly by curtains and Venetian blinds for free ventilation windows admitting suffi cient light when entirely closed. Under the front seat are placed two store chests. Underneath the carriage, on either side of the door, are two five-gallon kegs for water. Un- FlG. 454. The "MOSES ambulance wagon and tent. der the body of the vehicle are hooks for camp kettles, pails, and cooking utensils. Two drawers are arranged on each side, between the wheels and under the carriage, which may be used as panniers when necessary. On the hooks surrounding the ambulance, five feet from the ground, canvas is stretched, extending ten feet on each side of the carriage, the front and rear being protected in the same manner, which forms a comfortable and ample tent protec- SURG. Ill 119 A \ 946 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. tion for thirty sick men, and which may be arranged in a few minutes after arriving in camp by one or two men. In more permanent encampments, or in hot weather, this canvas may be fastened to hooks around the top of the ambulance wagon (FiG. 454), serving a better purpose by giving more space and freer ventilation. It is suggested that a light iron rail ing, about four inches in height, should surround the top of the ambulance, where, by having a suitable canvas cover, blankets and other indispensable articles might be securely carried. A lantern suspended over the front seat may be removed to the rear of the car riage, at will. It will admit of sufficient accommodation in the way of transportation arid provide tent shelter for the sick of a regiment on marches. The dimensions are: extreme length, thirteen feet eight inches; height of floor from ground, three feet three inches; height of top from ground, eight feet four inches; height of inside, five feet; width, four feet four inches. Weight, two thousand one hundred and fifteen (2,115) pounds. When loaded with men, medicines, tent canvas, etc., it can be readily drawn by six horses or mules. The size of the wheels and the track of the same correspond with those of the government wagons. After a close examination of the ambulance, the Board is of the. opinion that it is well adapted for field and frontier service, and for the comfortable trans portation of sick and wounded -men on long marches; that the tent arrangement forms a valuable, useful, and comfortable shelter for hospital patients. On marches it does away with the use of hospital tents, is easily arranged, keeps the hospital separate, and requires no detail of pioneers or extra duty men to pitch and arrange it. In submitting this opinion the members of the Board must also express their views, based upon their own individual experience, that to be made thus available and useful for the comfort and well-being of the sick the ambulance should be the property of the Medical Department, and that the team, harness, etc., should be under the exclusive control and direction of the medical officers under all and every circumstance." ~No action seems to have followed the recommendations of this Board, and no ambulances were built. In October, 1859, a Board of Medical Officers, consisting of Surgeon 0. A. Finley, R. FIG. 455. The "FINLEY" two-wheeled ambulance wagon front view. FIG. 456. The "FINLEY" two- wheeled ambulance wagon side view. 8. Satterlee, C. S. Tripler, J. M. Ouyler, and Assistant Surgeon K H. Goolidge, had recom mended: 1st, that ambulance transportation ought to be furnished for forty men per thou sand twenty lying extended and twenty sitting; 2d, that both two and four-wheeled CHAP. XV.J AMBULANCE WAGONS. 947 ambulance wagons are necessary for the hospital service; 3d, that a two-wheeled ambulance wagon is the best for the conveyance of dangerously sick or wounded men * * *; that to each company one two-wheeled ambulance wagon, to a battalion of five companies one four-wheeled and five two-wheeled ambulance wagons, arid to a regiment two four-wheeled and ten two-wheeled ambulance wagons be allowed ; and that for hospital supplies to commands of less than three companies one two-wheeled transport cart, to commands of more than three or less than five, or five companies, two, and to a regiment four two-wheeled transport carts be assigned ; and that the transport carts be made after the models of the two-wheeled ambulance wagons (their interior ar rangement for the sick excepted) . The same Board selected, from a number of the most approved plans laid before them, the two-wheeled wagons designed FIG< 457 The "COOLIDGE" ambulance wagon, by Surgeon C. A. Finley and Assistant Surgeon R. H. Coolidge. The bottom of the body of the Finley pattern (FiGS. 455, 456) was divided into two compartments, each containing a movable mattress frame or stretcher; four longitudinal pieces either in or upon the frame work were grooved on their upper surfaces so as to receive the rollers in the mattress frame. The body of the wagon rested on four elliptical springs fastened upon the shafts, which extended the whole length of the body, crossing, and connected with the axle. The body Fm. 458. The " TRIPLER" ambulance wagon side view. FIG. 459. The same rear view. of the Coolidge cart (FiG. 457) was hung on platform springs. The body was seven feet long, four feet wide, and one foot and eight inches deep, covered with a ribbed frame-work five and a half inches above the floor. Upon the relative merits of the two patterns of two- wheeled ambulance carts the Board hesitated to express an opinion, and therefore recom mended "that one of each pattern be sent to the respective Military Departments of Texas, New Mexico, Utah, California, and Oregon, and two of each pattern to Fort Leavenworth, and that they be placed in service at the scene of Indian hostilities and on marches across the plains, in order that their practical advantages might be ascertained." The Board con- 948 TRANSPOKTATION OF THE WOUNDED. [CHAP. XV FIG. 460. The "TRIPLER" ambulance wagon longitudinal section. sidered the two-wheeled cart as the most convenient for the conveyance of dangerously sick and dangerously wounded men. A number of these two-wheeled carts 1 were furnished to __^_ the troops in the early part of the war, but expe rience soon proved them useless ; their motion was intolerable and excru ciating; wounded men begged to be taken out, wounded officers insisted upon leaving them, and they were supplanted by four-wheeled vehicles, the earliest of which was the Tripler ambulance wagon recommended by the Medical Board of 1 859 (Flos. 458-460). It was constructed to carry ten men, 2 four lying at length and six seated, and required four horses. The body of the wagon was ten feet long, four feet wide, and the sides three feet high. Upon the floor were permanently laid four parallel iron rails seven feet long and one- fourth of an inch wide and high, with con vex faces. Two spring mat tresses were run in upon these rails. Twenty-two inch es above the sur faces of these mat tresses another set of rails was fitted to the wagon , upon which another set of mattresses was run. In front of the wagon was a chest intended for instruments, dressings, etc., which, when closed, formed a seat for three persons. At the tail of the carriage was another seat for three persons. All or any part of the interior of On May 20, 1861, Acting Surgeon General R. C. WOOD wrote to the Secretary of War: "It is highly important that provision be made for the safe and comfortable transportation of the sick and wounded, and in conformity with the recommendations of a Board of Medical Officers convened by the Secretary of War, and their report approved by him in General Orders No. 1, January 19, I860, I have to recommend that . . . two hundred of the two-wheeled ambulances be immediately constructed by the Quartermaster s Department. The recommendation was approved by the Secretary of War and the wagons were constructed and sent to the troops." 2 LONOMORE (T.) (4 Treatise on the Transport of Sick and Wounded Troops, London, 1801), page 382) erroneously states that this wagon was constructed to carry eight men, all lying down. FIG. 461. The "WHEELING" or "ROSECBANS" ambulance wagon. CHAP. XV.] AMBULANCE WAGONS. 949 the wagon was arranged so that it could be removed at pleasure, making it available for the transportation of hospital supplies. The cover of the wagon was of heavy duck supported on five hoops. The carriage was hung on plat- _ form springs, and underneath the body was sus pended a water-butt three feet six inches long and fourteen inches in diameter. This wagon was O extensively used and answered the purpose, although it was cumbrous and very heavy. 1 The Wheeling or Rosecrans ambulance wagon (FiGS. 461, 462) was also used in the early part of the war. It was built in the Government work shops after a design of General W. S. Rosecrans, IT. S. A. It was lighter than the Tripler or the Coolidge, could be readily drawn by two horses, and would accommodate eleven or twelve sitting or two recumbent and two or three sitting pa tients. Two cushioned benches were attached to the two sides of the interior of the wagon, running ^ along its whole length. From the edge of each FIG. 462. -rue same-rear view. of these benches, fastened by hinges, depended a cushioned seat the length of the benches. These seats could be readily brought on a level with the benches, and when thus elevated could be secure ly fixed by iron feet, folded in the suspended seat. For the ends of the iron feet receptacles were fitted in the floor of the wagon. When both seats were raised they met in the middle of the carriage and made one continuous bed for two patients. ide view. OIll V Ore * 1G< *^ ^ ew COOLIDGE ambulance wagon- seat was raised it formed a bed for a recumbent patient, while the other bench, with its suspended seat, allowed space for at least four sitting patients. A water-tank, capable of holding five gallons, was stored away under the seats in the rear end of the ambulance wagon ; not unfrequently stretchers took the place of one of the water-tanks. In front of the benches a transverse seat, accommodating the driver and two or three patients, was 1 1 ictailrd specifications | ..T the Tlill l.KU ambulance wagon will be found in a Re/wl <,f a Hoanl of O;/<vrs to ilecitle njxm <i / attcru uf Ambulance \\ <ig<> j or Arm;/ CV. Washington, 1878. page 50. 950 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. FIG. 464. New COOLIDGE ambulance wagon arranged for two recumbent patients perpendicular section. provided. Under the seat was a box for medicines and other articles for field use. Accurate specifications for the building of this ambulance will be found on page 59 of the Report of a Board of Officers to decide upon a pattern of ambulance wagon above referred to. The body of the wagon rest ed upon four elliptical springs, two placed trans versely (one on the front and one on rear axle), and two on the rear axle running lon gitudinally. A frame of light wood, with canvas cover, pro tected the patients against the inclemencies of the weather, and on the sides curtains of canvas could be closely buttoned to the top and the body. At the rear of the wagon was a step to assist patients and bearers in lifting in the wounded. The weight of the wagon was between seven hundred and eight hundred pounds. A four-wheeled ambulance wagon (Fias. 463, 464) , designed by Assistant Surgeon R. H. Coolidge, was very little used. The sills of the wagon were ten feet four inches long, and the body rested between two semi-ellip tical springs seven feet nine and three- quarter inches in length (FiG. 463). It was intended to ac commodate two patients in re cumbent and four in sitting postures, two with the driver on the front seat, and two at the end of the wagon, one on each side (see FIG. 465). The beds for the two prone patients FIG. 465. New "COOLIDGE" ambulance wagon arranged for sitting patients perpendicular section. CHAP. XV.] AMBULANCE WAGONS. were so arranged that they could be changed into seats, as shown in FIG. 465, when the wagon would accommodate ten patients and the driver. Detailed specifications of this ambulance wagon will be found on page 61 of the Report of a Board of Officers to decide upon a pattern of ambulance wagon already referred to. Other plans for ambulance wagons were proposed during the war, and for the informa tion of those interested in this subject we will here refer to such as were submitted to boards of medical officers for examination and report. In June, 1863, A. W. Siis (Subject- Matter Index of Patents for Inventions issued by the United States Patent Office, Wash ington, 1874, Vol. I, page 14, No. 39,595) exhibited a wagon intended to carry four severely wounded men in a recumbent position. A Medical Board (Medical Inspectors E. P. Vol- lurn and W. H. Mussey, and Surgeon J. H. Brinton, U. S. V.) considered an "increase in the carrying capacity advantageous and feasible," but was not prepared to endorse the plan of Mr. Siis in all its details. The Board was of the opinion that the Wheeling ambu lance wagon, then largely in use in the army, could readily be altered to carry four patients in a lying position, as in Mr. Siis s plan. Mr. Siis, in April, 1864, offered an improved plan, which was, by order of Surgeon R. 0. Abbott, Medical Director, Department of Wash ington, inspected by Assistant Surgeon W. E. Waters, U. S. Army, who reported, on June 2, 1864: "These improvements consist in adapting the ambulance for the conveyance of four patients lying down, instead of two, as with the present arrangement, while, at the same time, the carrying capacity for such as can sit up is not at all interfered with. The improvement is effected by having the seats fastened with hooks to the side of the ambu lance so that they can be detached and put upon the floor, thus forming a bed, on which the patient can lie with full as much comfort, as regards position, as with the present arrano-ement, while they are made more comfortable by the addition of elastic springs within the cushion." Surgeon Waters report was approved by Medical Director Abbott, who recommended that ten or twelve ambulances fitted with these improvements be sent to the field for trial. In April, 1864, G. W. Arnold (Subject- Matter Index of Patents, etc., page 14, No. 45,152) brought to the notice of the Surgeon General an ambulance wagon for which he claimed advantages over the Wheeling ambulance wagon in the arrangements of the seats or beds. The Board (Surgeon 0. A. Juclson and Assistant Surgeon W. Thomson) to whom the examination of the vehicle was referred reported, on April 5, 1864, that "the only advantages it possessed over the Wheeling model was that its litters could be removed from the wagon, the patient placed upon them, and then easily returned; but that the capacity for carrying men was diminished, and that the litters accompanying the wagon were too heavy, weighing about seventy pounds each, and would add, with their apparatus for suspension, nearly two hundred pounds to the weight of the ambulance wagon." On October 11, 1864, E. R. McKean patented an ambulance wagon (Subject- Matter Index of Patents, etc., page 14, No. 44.643) with litters or beds suspended by rubber rings. Surgeons R. 0. Abbott, 0. Sutherland, and Assistant Surgeon William Thomson inspected the wagon and reported, on March 25, 1865: "The principle of suspending the stretcher upon which the patient lies by rings of India rubber, in lieu of the springs of steel usually placed beneath tho body of the wagon, is the main difference between this and the ambulance now in gen eral use. However valuable this principle may be, the mechanical contrivances by which it is obtained in the wagon submitted are, in the opinion of the Board, too complicated, wanting in solidity and durability, and too liable to the loss of detached pieces, to render this ambulance lit for the severe test of field service." In September, 1865, an India rub- 952 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. ber spring ambulance wagon, by Perot & Co., was brought to the attention of the Surgeon General by Brigadier General C. H. Grossman, U. S. Army. Surgeons C. McDougall, John Campbell, and A. "K. Smith, and Assistant Surgeon C. H. Alden. appointed a Board to examine the rubber spring wagon, reported, on October 26, 1865 : "The Board is very favor ably impressed with the plan proposed, and as its peculiarities are best shown by contrast, would state the following as some of the particulars in which it is thought the India rubber spring is superior to the ordinary steel spring. It more perfectly controls the movements of the body of the ambulance in every direction, either upward, downward, or laterally, rendering the motion of those seated or lying within steadier and more equable. It is better adapted to carrying weights in the ambulance, acting with nearly the same effect with a light or heavy load. It is believed to be more durable. An ambulance built upon this plan was shown to the Board, belonging to the West Philadelphia Fire Company, which had been in use for several years, and which showed but little evidence of wear in the springs. It is easily repairable, as a spare spring can be readily carried in the ambulance wagon, and can be substituted for a broken one with but little delay and trouble. The India rubber springs weigh thirty-five and three-quarter pounds, which at seventy-five cents per pound would amount to $26.81. Steel springs of the same power would weigh about two hundred pounds and cost about $50.00." The most serviceable ambulance wagon used during the latter part of the war was that designed by Brigadier General D. H. Rucker, and built at the Government repair shops at Washington. It accom modates patients either in the sitting or lying postures. On the floor of the vehicle are two stretchers suitable for carrying one patient each, and each divided by a longitudinal hinge- joint. These stretchers have the usual handles, and run on elastic rollers so as to move readily longitudinally in the bottom of the wagon. When required as seats, the joints of the FlG. 4GC.-Tbe " RUOKEII" ambulance wagon. ers are bent, and the two parts are made to assume (see FIG. 469) a position at right angles to each other, the half which has the horizontal position being hooked to the sides of the vehicle, the other part forming the support or leg for the front of the seat. When the lower bed or stretcher is thus bent to form a seat, the upper beds are turned down to make backs for the lower seats (see FIG. 469). These backs are only joined to the sides of the wagon by hinges at their upper edge, and the lower edge can be raised upward and inward, toward the middle of the carriage. When thus elevated the two backs meet in the middle of the carriage and are there supported by iron supports, which, being hinged to their under sur faces, can be readily lowered for the purpose. In the floor are springs for the reception of CHAP. XV.] AMBULANCE WAGONS. 953 the iron supports. A platform is thus built on which two patients, on stretchers, can be laid (FiG. 468). These stretchers ordinarily are suspended from the roof of the carriage, each stretcher being slung with one side to the middle of the roof and with the other to the bend of the arched roof (see FIG. 469). The space be tween the upper surface of the lower and the lower surface of the upper stretchers was about twenty-one inches. This space was ventilated by lattice open ings on each side of the body of the ambulance wagon, as indicated in FIG. 466. The body rested on platform springs, and the fore wheels were smaller than the hind wheels. The water-cask was under the driver s seat, and the spigot projected slightly through the side of the body. The weight was about one thousand one hundred and twenty pounds, exceed ing that of the Wheeling, which only weighed from seven to eight hundred pounds, but the Rucker wagon was somewhat longer and broader. Detailed specifi cations of this ambulance wagon will be found on page 48 of the Report of a Board of Officers to decide upon a Pattern of Ambulance Wagon for Army Use, Washington, 1878. In October, 1864, Assistant Surgeon B. Howard, U. S. Army, constructed an ambu lance wagon (FiGS. 470, 471) for which he claimed many advantages. A full description, with illustrations, will be found on pages 981994 of The Sanitary Commission Bulletin, Vol. I, 1866; an extract, omitting some of the minor details, is here reproduced: "To enable the badly wounded to be easily loaded and unloaded, two litters or beds are provided, made of wood, like an ordi nary shutter, with sli ding handles at each corner. Upon this the patientis easily shifted, and without any dis turbance. The litter is slid into the ambu lance wagon on rollers. FIG. 467. The same rear view. J I In the same way the FIG. 408. The same arranged for four recumbent FIG. 409. The body of the RuCKEll" ambulance patients. patient is removed On wa S u arran S ed for ordinary use. arrival at the hospital, and without being disturbed until he reaches his bed. If part, or all the patients are able to sit up, one or both of the litters can be slid into a compartment provided for that purpose under the floor of the vehicle. There are six permanent seats, each situated transversely, and each a corner seat with back and cushioned seats. This gives a comfortable purchase, secures the patients against much of the usual jolting, and prevents them being driven against each other in going over rough roads. The sides of the SiriJG. Ill 1-,>0 954 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. ambulance wagon, as also both sides of the back of the driver s seat, and the inside of the upper section of the tail-board, are cushioned, while the middle seats have for a back a leather strap, like that used in stage coaches; thus each seat is rendered very comfortable, and being transverse instead of longitudinal is in every respect easier for the patient. In order to diminish the motion of the body of the wagon and prevent rolling and pitching, so intolerable in the ordinary ambulance wagon, semi- elliptical springs have been substituted for the elliptical ones.. In order that the limited motion . 470. i lie IluWAKD iiiubulaiioe wagon. FIG. 471. The same rear view. thus obtained be so modified as to give least jar to patients, internal counterpoise springs are used, the delicacy of which may be modified to any extent desired. The platform or frame on which the seats and beds rest is as long but not so wide by about two inches as the inside of the body of the wagon. Between the inside of the body and the frame of the platform is an interspace; this is occupied by two lateral semi-elliptical steel springs on either side, fastened at the centre of their arc to the inside of the body of the vehicle, i i ^ I| ~i ^ ie ^ ee ^ ^ wn i cn pl av upon iron plates on the outside of the frame. Opposite the centre of the arc on the frame i s fi xe( ] a b] oc ], O f goft ru bber, so that on the application of much force it should be received by the rubber blocks, which thus act as buffers. The platform or frame on which the seats and beds rest stands upon four iron stanchions, each of which rests on springs like the lateral springs described above, but much stronger, as seen at FIG. 472, the iron stanchions resting on steel springs, the feet of which play upon iron plates let into the floor of the ambulance wagon. The spring is restrained in its motion upward by an iron staple, and when, by an unusual weight, it is heavily pressed down, the force is received by a block of soft India rubber enclosed within the staple. An impulse communicated to the floor of the wagon, instead of being propagated to the beds or seats, causes a counteraction downward of the spring, which, if the force be very great, spends itself upon the block of rubber. In this way, both laterally and perpendicularly, a constant poise is preserved, and what would otherwise be a very violent jar is reduced to little more than a vibration. The steadiness of the entire vehicle is preserved by the stout semi-elliptical spring beneath the body, and the delicacy regulated to any degree by the internal counterpoise springs within the body. That the water may be carried securely, immobility of the vessel containing it during transportation is neces- CHAP. xv. AMBULANCE WAGONS. 955 sary. This is effected by substituting for the casks in ordinary use a tank, which slides into a grooved bed and is secured by an ordinary fastening. In a military point of view it pos sesses a great advantage in this: that besides the prescribed articles which may be carried in the driver s box, a large amount of medical supplies may be carried in the body of the ambulance wagon without interfering with the comfort of badly wounded patients. There being but four stanchions, and these being close up to the side of the vehicle, the entire body beneath the platform is free for transportation of supplies. There is an arrangement for suspension of fractures of the lower extremity, which is very grateful to the patients. Two parallel iron bars are attached to the roof of the ambulance wagon longitudinally over each bed, between which runs a roller with a dependent hook. The fractured limb being placed in a double-inclined plane or other splint, a bandage is passed through terrestra of the box splint and then carried over the hook from which the limb is suspended. In this way, instead of the jolting and jarring so commonly experienced, simple oscillation is sub stituted, or, if desired, guys of bandage may be so extended to the uprights of the ambulance as to render the limb nearly motionless during transportation." The weight of the Howard ambulance wagon was twelve hundred and thirty-two pounds. The plan of this wagon, with recommendations of some twenty officers of the Army of the Potomac, was submitted for examination by Surgeon T. A. McParlin, -Medical Director of the -Fifth Army Corps, to a Board of Medical Officers, consisting of Surgeon .1. J. Milhau, U. S. A., Surgeon L. W. Read, U. S. V., and Assistant Surgeon George A. Mc.Grill, U. S. A., who reported, on October 6, 1864, that: "the ambulance wagon meets the approbation of the Board as one presenting some decided advantages over that now in use. It is recommended further that at least two to a division be furnished, so that a fair trial can be made of such vehicles." A number of the old pattern ambulance wagons were there upon altered according to the plans submitted by Assistant Surgeon B. Howard, U. S. A., at the Government repair shops at Washington. But it seems that after nine months experience in the field these ambulance wagons failed to meet the expected advantages. In a letter dated Medical Director s Office, Headquarters Fifth Corps, June 29, 1865, Surgeon Charles Page, U. S. A., remarks: "There have been two of the ambulance wagons in each division train of the corps, and for ease to the patient the report is universal in their favor. They are apt to get out of order, and being heavy cannot be carried where the other ambu lance wagons can go. For marches I think the Howard ambulance wagon is superior; but for field work, in time of action, I would prefer the present Rucker pattern of ambulance wagon." In a reply to a note of enquiry from the Surgeon General dated June 29, 1865, Surgeon T. R. Spencer, U. S. V., from Headquarters of the Fifth Army Corps, takes a sim ilar view: "So far as I can learn in this corps, it is not regarded as an improvement upon the old one. It is so heavy as to require four horses, else it rapidly destroys two. It is so complicated as to be continually getting out of order. As now constructed the ambu lance wagon does not ride as easy over all roads as the old one. The only advantage it seems to possess is in the greater convenience of loading and unloading; this soon results in the loss of the bed, as officers will not consent to be removed from the bed during trans portation. Once lost, or taken from the ambulance wagon, the bed is never returned, and the wagon is henceforth useless." In the winter of 1864 65 an ambulance wagon, proposed by Dr. I. Langer, was used at the Fifth Army Corps Depot Hospital before Petersburg. It was arranged to accom modate eight persons, four in sitting and four in recumbent positions, or six in sitting 956 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. and two in recumbent, or all eight in sitting postures. The advantages claimed were, greater seating capacity, greater facilities for loading and unloading, greater comfort to patients, offering easier access to each single patient, superior ventilation, and that it had apparatus for suspending two patients with compound fractures of the thigh. In April, 1865, a Board was convened, consisting of Colonel R. 0. Abbott and Assistant Surgeons Flu. 473. Au army wagon fitted up us an ambulance wagon. [After LANU J. J. Woodward and William Thomson, U.S.A., to examine and report on this ambulance wagon.- The Board considered seriatim the advantages claimed by Dr. Langer, basing its opinions on comparisons with the Wheeling and the Rucker patterns then most generally in use: "The model examined is altered from a Wheeling ambulance wagon; the changes O O o ^- - --.-- -,-., ^ ----- ,, are radical and the additions numerous. So f^ ingeniously complicated are the appliances, and so multitudinous the objects to be obtained, that the wagon would fail to meet the test of field service. The probable loss of its numerous detached pieces would rob it of all its special advantages, and leave it less useful than the Wheeling and Rucker wagons. In comparison with the former it hfis some advantages; but it fails to compete in practical usefulness with the ambulance wagon devised by Brigadier Gen- R uc k er> " With reard to tlie a Fic,. 474.-The Confederate field ambulance wagon. [After CHISOUJ.J for the purpose of transporting two thigh fractures the Board find: "The novelty of the method and the uncertainty of its practical value would not warrant the alteration of all the ambulance wagons in the service to fit them for transporting in this manner an occasional fractured femur." The Board refused to recommend the introduction of the Langer ambu lance wagon into the service in preference to those then in use. At the same time Dr. CHAP. XV.] RAILWAY TRANSPORTATION. 957 Langer submitted to the Surgeon General for inspection an army wagon (Fio. 473) which had been fitted up with twelve beds for transporting patients. Dr. Langer claimed "that this change of the army wagon would not interfere with its design of conveying forage or other articles to and from a camp; that when the wagon is used for carrying forage the twelve beds are packed under a movable bottom, and the railing supporting them is stowed away on the sides, so that the capacity of the wagon box is not impaired; that in ten minutes after the wagon is unloaded it is changed into an ambulance wagon with all the equipments for transport six patients in a sitting posture , six in a lying, two of which, if necessary, suspended on fracture beds of Dr. Langer s pattern; that there is room for all the equip ments of the patients, for a water-keg, and for boxes with provisions and bandages, and that the wagon can be loaded from the front as well as the rear." As far as can be ascer tained the experiment was tried but once. A drawing of the Confederate field ambulance wagon is copied from Chisolm 1 in FIG. 474. No description of the vehicle could be obtained. RAILWAY TRANSPORTATION. The facilities afforded by railroads for the movement of troops and material to the theatre of warfare have formidably augmented the destructive power of armies; but they have also offered useful and most effective means of saving lives and alleviating suffering by the speedy removal of the sick and wounded from the scene of active operations. After the battle of Gettysburg, in July, 1863, for instance, twenty thousand three hundred and forty-two wounded came under the care of the medical officers of the Army of the Potomac, and in two weeks fifteen thousand four hundred and twenty-five had been forwarded to Baltimore, York, Harrisburg, and New York City. Of the remainder a large proportion was unable to bear the fatigues of a protracted journey. After the bloody battles of the Wilderness and Spottsylvania the distribution of the wounded was even more rapidly effected, and, with a few exceptions, the fallen were, within a few days, comfortably sheltered in the hospitals at Alexandria, Washington, Baltimore, Philadelphia, and New York. By rapid dispersion of the disabled the fighting force is less diminished than by any other plan. Fewer combatants are withdrawn from their proper duties to attend their sick and wounded comrades. With proper inspection of those sent to the rear, and such enforce ment of discipline in the base hospitals as will ensure the prompt return of convalescents, the number of sick and wounded engaging in fresh active service will be greater than by any other arrangement; and a less- proportion of division, brigade, and regimental medical officers and hospital attendants need be detached from the marching columns, which, in the exigencies of actual battle, are rarely adequately supplied with surgical assistance. Large accumulations of medical and hospital supplies with the army become superfluous. The depot hospitals, frequently great lurking places for malingerers, may be reduced to the smallest compass. If, without changes, the wounded can be directly placed in a fixed hospital not too distant, many primary mutilations may be justifiably avoided, with a view of employ ing more delicate special operations when the patients arrive at a safe place of rest. Lastly, the most important consideration is the most obvious, the distribution of the sick and wounded prevents the generation of those pestilences that are the greatest scourge of armies. The sick and wounded avoid infecting each other, and those who are well escape contagion. In a report published from this office 2 on the subject of transportation of wounded by 1 UfllSOLM (J. J.), A Manual of Military Surgery, Columbia, 1864. PI.ATF. I. 2 OTIS (GEOKGE A.), A Report on a Plan for transporting Wounded Soldiers by Railway in Kme of War, Washington, War Department, JSurgeun Ueucrul s Oflice, 1875, 958 TRANSPORTATION OF THE WOUNDED. (CHAP. XV. Fir;. 475. Interior of an improvised hospital car. railway, the means employed have been considered at length, and as there is very little to be added to that report, it is deemed best to reproduce such portions of the report as refer to railway transportation during the late war: "After the action at Wilson s Creek and minor engagements in central Missouri, in August, 18C1, the severely wounded fell into the hands of the enemy. They were soon paroled and con centrated at Kolla, the southwestern terminus of the St. Louis railroad, whither two hundred less grievously injured, and carried oft by the retreating army, had previously been sent. Here, the freight cars available were fitted up for the transportation of this large body of wounded to the hospitals established at St. Louis. Various expedients were employed to adapt the cars to the requirements of the different classes of patients. * * * Seasoned tent-poles were shaved down to give them as much elasticity as was compatible with requisite strength, and secured transversely near the roof, passing through holes in the side studs of the car. Ropes attached to these poles and also to the floor suspended two tiers of field stretch ers, on which pallets were laid. With this plan a feeling of insecurity was common to the patients and attendants, and additional lashings and constant inspections were necessary to prevent accidents. Another method con sisted in placing a double row of upright stanchions, which were erected on either side of the car (FiG-,475), connecting the floor and roof, at intervals of seven feet lengthwise. To these firm posts tiers of two or three litters were securely lashed. In other cars rough wooden bunks were built along the sides of the vehicle and filled with straw, and made more comfortable by being floored by narrow elastic slats. In all cases large window spaces were sawn out of the ends and sides of the car to afford ventilation. There was often cause to remark on the great ingenuity displayed, on this and other similar occa sions, by the line officers, quartermaster s men, and the soldiers themselves, in improvising various contrivances for the comfort of the wounded subjected to these rough modes of transportation. With an intelligent adaptation of the means at hand it was found practicable to make the con dition of the wounded on freight cars very tolerable with the aid of articles belonging to the field equipment alone. * * * "After the Army of the Potomac left the vicinity of Washington the sick and wounded were removed mainly by the hospital transport steamers on the Potomac, Ivappahannock, York, and James rivers. The short lines from Savage s Station to White House, on the York, and from Aqnia Creek to Fredericksburg, were largely utilized, however, for the same purpose; and when the theatre of hostilities was transferred to Maryland and Pennsylvania numerous railway lines became available. Medical Director J. Letterrnan recorded the transfer 1 of no less than nine thousand sick and wounded over the Aquia Creek road on June 12th, 13th, and 14th, 1863, when the army moved northward after the disasters of Chancellors ville. All patients that would be injured by sitting up were carried by hand to the railway on the beds they occupied in hospital, the beds being placed on hay-covered floors in freight cars. "The following year, when this army was massed before the entrenched line at Petersburg, a large depot hospital was erected at City Point, the base of supplies, at the junction of the James and Appomattox rivers. This depot was connected with the positions of the several army corps by a railroad with branches, and the sick and wounded from the division hospitals were brought to the depot chiefly in the box-cars which had carried forward supplies for the troops, and were transferred to hospital steamers, or retained at City Point for treatment, at the discretion of the medical director for transportation, Surgeon E. B. Dalton, U. S. V. There were at first two, and, subsequently, a larger number of passenger cars converted into hospital cars by the erection of rows of stanchions, to which litters were suspended by elastic rubber rings, each car having accommodation for thirty recumbent patients. The box-cars, with door-ways at the sides 5 feet in width and an interior height in the centre of feet 9 inches, had a floor space of 25 feet 2 LKTFEKMAN (J.), Medical Recollections of the Army of the. I otomac, New York, 1866, p. 150. CHAP. xv.| RAILWAY TRANSPORTATION. 959 inches in length by 7 feet 8 inches in breadth, or about 192 square feet. They afforded comfortable accommodation for nine recumbent patients, but were sometimes packed with as many as twenty. When the floors were covered with a thick bed of fresh straw or hay, on which well-filled bed- sacks or mattresses could be laid, the concussions from the motion of these rough cars were so much deadened as not to be intolerable even to severely wounded men. There was a great advan tage in carrying the wounded on the beds or litters on which they lay through the wide door ways of the box-cars, and unloading them, in like manner, at the depot hospital or the wharves of the transport steamers at City Point. It was, however, very difficult to obtain an adequate supply of straw or hay when, after a general engagement, train after train was sent in rapid succession, and recourse was sometimes had to bedding of dry leaves or evergreen boughs. In one of the reports to Medical Director T. A. McParlin 1 it is stated that it was necessary to empty the bed- sacks of the field hospitals of a corps in order to obtain sufficient bedding for the box-cars of a train of wounded. "In the summer and autumn of 1802, and during the two succeeding seasons, four large bri gades stationed at New Berne suffered from malarial fever to that extent that general hospitals, or rather sanitaria, of great capacity, were established on the sea-coast at Carolina City, near Fort Macou, the former connected with New Berne by a railway forty miles long. The patients were conveyed in freight cars, for there were no others available. The floors of the cars were covered with dry pine tags supplemented by a layer of loose hay or straw when it could be procured. The patients were laid upon bed-sacks on this substratum, and even those most gravely ill were transported with comparative comfort. Medical Inspector E. P. Vollum, U. S. A., has recorded 2 that after the battle of Gettysburg, July 1-3, 1863, over fifteen thousand wounded were sent from the field hospitals prior to July 22d, nearly all by railway to Baltimore, York, Harrisburg, and Philadelphia. They were transported, in large proportion, in the box-cars of the returning supply trains. Each car was supplied with a sufficient quantity of hay, and, on the longer routes, water- coolers, tin cups, bed-pans, and urinals were placed on them. After the battle of Olustee, Febru ary 20, 1804, where the wounded of the Union side numbered over eleven hundred, Assistant Surgeon John H. Janeway, U. S. A., states that the grave cases of compound fracture and of penetrating wounds of cavities, and, indeed, all the more seriously wounded, were transported on the Mobile Eailway on freight cars bedded with pine boughs, palmetto leaves, and a small allow ance of straw, covered with blankets. The trains moved slowly from Sanderson to Jacksonville, on the coast, a distance of nearly fifty miles, and patients who had undergone amputation, and others severely wounded, complained but little of the rough method of transit. In the campaigns about Chattanooga, also, Medical Director G. E. Cooper, U. S. A., reported that in emergencies, when the regular hospital trains were overcrowded, recourse was often had to transport by freight cars bedded with dry leaves. "In a letter to the Surgeon General, dated Philadelphia, January 7, 1803, Surgeon A. K. Smith, U. S. A., describes a car recently fitted up by the Philadelphia Railroad Company for the better conveyance of the worse class of sick and wounded. * * * The internal arrangements are similar to those of sleeping cars, with the exception that the berths slide in and out, and two men can carry each, with its patient, to the ambulance wagon or the nearest hospital, the berths being, in fact, comfortable stretchers. The car has fifty-one of these berths, and a seat at each end for an attendant. It is provided with a stove, on which soups can be cooked, a water-tank and locker, and a convenient water-closet. It is proposed to use the car with the regular passenger trains, and to bring to Philadelphia cases of a more serious nature than can be selected for transfer by the ordinary mode of travel. This arrangement is entered into with great zeal by Mr. Felton, president of the road, the plan being in a great measure due to the efforts of Mr. William Welsh. If proved to work well, I am satisfied in saying that more cars will be similarly constructed for the purpose of bringing the seriously sick and badly wounded from Frederick and Harper s Ferry. This proposition was warmly seconded at Washington, and a number of passenger cars, converted to hospital requirements, and hospital cars also of special construction, were soon in operation on the railway lines connecting the theatre of hostilities with Baltimore, Harrisburg, Philadelphia, and New Yoik. They wore not fitted up on a uniform plan, but under the auspices of different A Ueport frmn the Fifth < <>rjw headquarters by Assistant Surgeon (, . K. WlXXE, U. S. A. -Yoi.u M (E. P.), Report <i the Transportation of the Wounded after the Battle of Gettysburg; in Appendix to J art I, Medical and Surgical Uistory of the War of the Rebellion, Washington, 1870, p. 143. 960 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. benevolent associations; but all secured a comparatively comfortable mode of transport for recum bent patients, and rendered almost inestimable service in relieving the crowded hospitals near the scene of hostilities. The hospital cars fitted out by the United States Sanitary Commission are understood to have been arranged in accordance with plans furnished by Dr. Elisha Harris. 1 A model of one of these cars was exhibited at the Paris Exposition of 1867 (see FIG. 476). These cars were about fifty feet in length. A passage-way extended through the middle to the doors at either FIG. 476. Longitudinal section of a passenger car fitted up as a hospital car. [After EVANS.] end. On either side of the passage-way were eight upright wooden posts, three inches square, con necting the floor and ceiling, and so placed that the distances apart should correspond with the length of a field stretcher. At a distance somewhat less than the width of a field stretcher, opposite each pillar, another post of like dimensions was placed next the side of the car; thus one side-pole of a stretcher was attached inside the wall-pillar and outside the pillar next the passage-way, and its suspension was rendered easier than if it was confined between the rigid pillars. Wooden pegs inserted in the posts served for the attach- : ^fgjjy Hy ! - - - ment of large rubber rings (FiG. 477), which received and sustained the ends of the stretcher poles. Thirty-two litters could be suspended, leaving a space in the middle for a stove and seats for attendants or wounded who could travel in a sitting posture. It is stated 2 that some of the india-rubber rings that had been in use in these cars were exhibited in Paris in 1867, and were still in perfect order. I have been informed that these cars had doors of three feet in width; but even this space would be insufficient, if the litters were as wide as represented by Dr. Evans. The ordinary field stretchers No. 3 FIG. 477. Mode of suspension of litters by rubber rings in the "Harris car." 1. Vertical view; ~. Lateral view ; 3. Enlarged view of one of the rings. [After EVAAB.) used in the United States were uniformly 24 inches wide, and it was this form of stretcher that was generally employed upon the hospital trains. Although the advantage of caoutchouc rings for the suspension of litters was generally conceded, and the inventor and exhibitor were rewarded with medals, many objections were raised to the arrangements of the car exhibited in Paris. Dr. Lreffler 3 declared that the inconveniences attending the transport of wounded iu tiers of three superimposed berths were so considerable that the project must be abandoned. Professor Gurlt 4 referred to the danger of the frequent jolting of the car, striking the poles of the stretchers against the posts and communicating concussions to the litters and the patients, which may have the gravest consequences for the latter. Professor Billroth 5 objects to these and all other arrange ments for the railway transport of wounded that cannot be extemporized. "STILLE (C. J.), History of the U. S. Sanitary Commission, Philadelphia, 1866, p. 161; HAMILTON (F. H.), A Treatise on Military Surgery and Hygiene, New York, 1865, p. 168; and EVA\S (T. W.), La Commission Sanitaire des iStats- Unis, Paris, 1865, p. 133, et Planche IV. A letter on file in the Office of the Quartermaster General indicates that Dr. HAUUIS invited General MEIGS to inspect one of these hospital cars as early as March 20, 1863. 2 LONGMORE (T.), A Treatise on the Transjiort of Sick and Wounded Troops, London, 1868, p. 476. *LCEFFLEE (F.), Das Preussische Militar-Sanitdtswesen, untl seine Reform nach der Kriegserfahrung von 1866, Berlin, 18G9, B. II, 8. 251. 4 GURLT (E.), Abbildungen zur Krankenpjlege im Felde, u. s. w.. Berlin, 1868, s. 5, Taf. II. *BILLUOTH (TH-), Chirurgisclte Brief e. uus dc.n Krier/s La:arctlicn, u. s. w., Berlin, 1872, B. 71. CHAP. XV.] RA ILWAY TRANSPORTATION. 961 "When the Army of the Potomac advanced to the line of the Rapidan, the Medical Director of the Department of Washington, Surgeon Robert O. Abbott, U. S. A., recommended that an hospital train of twelve cars, one fitted up as a dispensary and store-room for supplies, one for the surgeon in charge and attendants, and ten for the sick and wounded, should be constructed on plans and specifications prepared by the Assistant Superiutendaut of Military Railroads, J. Me Crickett, 1 remarking that during the past year two or three cars somewhat similarly fitted up, provided with medical officers, nurses, and the proper medical appliances, have been running, under my direction, between this city, Philadelphia, and New York, and I make this request upon my experience of their practical working and the satisfaction they have given to patients, their friends, and this office. At present, the sick and wounded are transported in cars illy adapted for the purpose, and with difficulty spared from the other pressing demands, and lives are lost on the route, not infrequently, which in all probability might be saved by a more comfortable and easy method of transportation. These considerations and the extended facilities such cars will give for transportation of the wounded particularly, will, in my opinion, justify the expense of construction. It was designed that this hospital train should ply between the advance of the army, near Culpeper, and the base hospitals at Alexandria and Washing ton, and should supplement or supersede the freight cars bedded with straw or hay that had been hitherto in use. The Surgeon General and Quartermaster General cordially endorsed this pro ject, and several complete hospital trains were soon in operation on this line. "FIGURE 478 is a reduction from Mr. McCriekett s end ele vation of the hospital car, showing the litters in place, and the mode of hanging them. The bottoms of the permanent couches, two and a half feet wide, are made either of wooden slats or of canvas, with mattresses laid upon them. For the second and third tiers, ordinary field stretchers are used. The inside poles of the litters are suspended by a leathern strap or by strong webbing, the strap secured to a carling of extra strength; the outside handles of the litters are supported by hooks of spring steel. There should be some space between the inside litter handles and the side of the car to prevent concussions ; FIG. 4T8. Transverse section of hospital car on the Orange and Alexandria railroad. I f*f\ .. Y^" : 1 " ; F ^ 1 - f " 1 li J ^- A jF I G fobt I*< X ^^^-1 : | 1 %*, \ (l \\ Lvvisd J FIG. 479. Horizontal section of hospital car on the Alexandria railway. /\ Stoves. C Wash Basin. E Chair. G Tiers of couches. 1 Wood Box. B Water-cooler. D Lounge or couch. F Table. H Water-closet. K Surgeon s office. the hooks so constructed as to act as springs. The litters of the second and third tiers, when not in use, can be taken down and folded under the permanent couches. The straps also can betaken down or rolled up; there will then be no obstacles in the way when loading the cars with patients. A door three feet and a half wide, at one end? gives ample room for ingress and egress of loaded stretchers. The aisle is three feet and a half wide and can be occupied by folding chairs for those who can travel in a sitting posture, the chairs being stored under the permanent couches. The Mr. J. McCKICKKTT estimated that the twelve cars could be built in thirty days, at an expense not exceeding $30.000, if the task of construction was divided among the factories at Wilmington, York, Ilarrisburg, Philadelphia, and Springfield, Massachusetts. He thought it "much better in many respects to have the cars made to order than to buy them at second-hand and .have them altered, since railroad companies can ill spare any of their rolling stock at this season, and would sell only worn-out or condemned cars, the alteration and fitting up and repairs of which, added to the prime cost, would demand a greater sum than would be required for new hospital cars." It is impracticable to ascertain from the records of the Bureau of Construc tion of Military Railways whether a full train was built in accordance with the plans and specifications of Mr. McCuiCKETT, prepared in consultation with Surgeon E. BEXTLEV, U. S. V. It is known that the construction of a number of hospital cars was authorized about this time, at different car-shops, and that several hospital trains were soon in operation on the Orange and Alexandria line ; but they were not of uniform patterns. In many of them, tlm litters wore suspended by india-rubber rings. It is probable that the cars constructed under the direction of the Sanitary Commission and those built by Government order would often be connected or separated on the different lines as the exigencies of the service required. 2 At the other end, represented in the elevation (Fin. 478), the door opening into flit- attendant s room is only two feet wide. SURG. 111121 962 TRANSPORTATION OF THE WOUNDED. [CHAP. XV FIG. 480. Lateral elevation of a part of one of the cars on the Alexandria line. capacity of the car, which measures inside eight aiid a half feet in width, forty-five and a half feet in length, and six feet eight inches in height, permits the transportation of fifty or sixty patients- thirty in couches and the others in chairs. FIGURES 479 and 480 explain themselves. "With the addition of special cars fitted up with rooms for kitchens, dispensaries, store closets, quarters for the employe s of the train, offices for the executive officer, etc., a well-organized railway ambulance train became a nearly complete movable hospital establishment, with every reasonable appliance for the sustenance, dressing, nursing, and medication of the patients. The hospital trains of the armies in the East traversed railways within the Union lines, and were seldom molested. They were moved generally at a low rate of speed. They were distinguished by displaying the yellow hospital flag near the engine, and by the inscrip tion U. S. Hospital Train painted in large letters on the panels of the cars. "The hospital cars prepared under the supervision of the Government officials and those arranged under the direction of the agents of the Sanitary Commission were usually passenger cars converted to hospital use, although the kitchen and executive cars, and a few of those for the conveyance of the sick and wounded, were built specially for the purposes they were designed to subserve. There was great variety in the details of the internal arrangements; but nearly all con formed to the general plan of securing berths in tiers to rows of uprights. The cars constructed by different builders varied in dimensions. The longest were 58 feet in length including the plat forms. The usual interior length was 45 to 50 feet, which afforded space for five or six sections of stretchers on each side, and space for stoves, lavatories, water-closets, and seats for attendants. The height at the sides was 6J feet, the roof sloping upward to 7 feet, and being surmounted by a clear story of 2 feet provided with windows and ventilators. "It was in General George H. Thomas s Army of the Cum berland, of which Surgeon George E. Cooper, U. S. A., was ]\ledical Director, its long line of communication extending hun dreds of miles away to its base of supplies, that the utility of railway transport, in relieving the army of its disabled men, was most conspicuous. Although freight cars were used for very severe cases, several trains of hospital cars of special construc tion were prepared at the Government work-shops for the con veyance of patients in the recumbent posture. In 1864 there were three hospital railway trains, each consisting of ten or twelve cars, with several freight or baggage cars attached some times, connecting the advance of the army with Nashville and Louisville; one train, at least, daily leaving the vicinity of the field hospitals. In each train one car was fitted up exclusively as a kitchen and store-room, and another as a dispensary, with accommodation for the medical officer in charge, and an ample supply of medicines, stores, instruments, and appliances. Sur geon Cooper reported that upon his arrival in the Department a train of passenger cars fitted up for the transport of sick and wounded by Acting Assistant Surgeon J.P.Baruum was already in operation on the line, a hundred and eighty-five miles in length, between Louisville and Nashville. This train had been prepared at Nashville under the direction of the Western Sanitary Commission. Each of the cars accommodated thirty-three recum bent patients. The pallets were placed in tiers of three, supported by iron brackets attached to the sides of the car, and swung on india-rubber springs (FiG. 481). The bed-frames, Surgeon Cooper remarks, resemble stretchers with a portion of the handles sawn off. This style of car is objection- FIG. 481. Transverse section of n passenger car fitted out by Acting Assistant Surgeon J. P. Bar- num, and known as the "IIAUUIS Car." CHAP. XV.] RAILWAY TRANSPORTATION. 963 able on account of the surgeon being unable to manipulate the wounds, when they require dressing, without great inconvenience to himself. The space between the beds is too contracted, and causes much complaint from the wounded. There is too much motion in the beds, and altogether the car is not a good one. Dr. Barrium states that during his connection with the railway hospital service he supervised the transportation of 20,472 patients and lost but one, who, despite the advice of his surgeons, implored that he might be taken to die in the bosom of his family. * "The cars thus arranged, and others in which litters were suspended by india-rubber rings from pegs inserted in upright posts, as in the Eastern hospital trains, were alike known at the West, under the designation of the Harris car. Dr. F. L. Town, U. S. A., in a report to Assistant Sur geon General E. C. Wood, refers to them as follows: Other ways of securing the beds have been tried. The Harris car is in use, with beds arranged in three tiers, each bed resting on stretchers, suspended by four rubber rings, between uprights. Each rubber ring encircles a pin in the upright FIG. 482. Reduced plan of a horizontal section of one of the cars of Dr. Barnaul s train, showing the positions of thirty-three litters, the wash-room, and water-closet. [ From a drawing furnished by Medical Director COO1 J EU.J and holds up one end of the lateral bar of the stretcher. This arrangement has one advantage the stretcher can be unshipped, and, if necessary, the occupant can be borne away without disturb ing him. A ward in the Harris car contains thirty-three or thirty-six beds. The removal of one section of the tiers, that is, three litters, affords room for a stove in cold weather. The Harris car has not worked well in prac tice. The elasticity of the rub ber bands keeps the bed in con stant vibration while the car is in motion, to the great annoy ance of the patients, who com plain of reclining on what they term a capering bed. Severe cases are now conveyed in the cars to be hereafter described. "FIGURES 482 and 483 further illustrate, by horizontal and lateral views, the arrangement of one of the hospital cars of Dr. Barnum s train. They are reductions from drawings prepared for Dr. Cooper by a draughtsman of the Nashville Car Manufactory. Some further particulars respecting the method of suspending litters by rubber tugs or rings, and. the means of obviating the excessive oscillation often complained of as a grave objection to this system, will be noticed further on. "Medical Director George E. Cooper preferred the arrangement of the ordinary first-class passenger cars on the plan indicated in FIG. 484. The cars of this class were usually fifty-five feet long and nine feet four inches wide, with a doorway twenty-two inches wide at either end, a passage way of equal width through the middle, and, on either side, a row of fourteen double seats. Dr. Cooper describes- the arrangement ( FIGS. 479, 480) he commends as follows : The cars thus prepared have a capacity for thirty-three patients. The beds are made by removing the alternate seats, and connecting the remaining seats with slats of ash or some other springy wood. Two bed-sacks are laid on the slats. The wounded are carried on the slats covered with bed-sacks, and are placed 1 EVANS (T. W.), La Commission Sanitaire des tals Unis, Paris, 18(53, p. 133. Medical Director COOPER doubts Ihis remarkable immunity from deaths in transit on the hospital trains directed by Dr. BAKXUM, while testifying to the indefatigable zeal and efficiency of the latter during his protracted service. "Acting Assistant Surgeon J. P. BAUXUM," remarks Dr. TOWN, "had charge of the first hospital train built at Nashville. He studiously labored to improve and systematize its working, and devised many expedients looking to the comfort of tue patients in days when tho theory of hospital trains was not so well understood as now." Fio. 483. Lateral view of half of a hospital car of Dr. Barnum s train, showing the arrangement of the litters and the wide side door. [ From a drawing from Dr. COOPEE.J 964 TRANSPORTATION OF THE WOUNDED. ICHAP. xv. two on each bed. The upper beds are framed as stretchers, and are hooked to the side and ceiling of the car and covered with a mattress. On this upper tier the less gravely wounded are carried. This plan was found to be the best, the least expensive, and the most comfortable to the patients of all the hospital cars in use. The medical attendants could dress wounds in these cars without much inconvenience. 1 On the drawings sent with this description Surgeon Cooper annotates : This is the simplest and best form. " Dr. F. L. Town, U. S. A., gives the following description of five of these cars which he inspected : Each ward contains about twenty-four beds, arranged lengthwise along either side of the car, in two tiers ; the upper bed exactly above the lower. In the lower tiers the bed is fixed firmly upon the car-seats; the backs of these [and an intervening seat] are removed. Its width is that of the car-seat [about forty-four inches], and its distance from other beds is the space between adjacent seats. In the upper tier the beds are about two-thirds as wide, and are on stretcher-frames, attached firmly on the outer side to the wall of the car, and suspended on the inside by two iron bars from the roof. Each upper bed thus stands or hangs immovably in its place. The wide beds in the lower tier are considered double, and, on short routes, are often occupied by two patients regarded as mild cases. The American railway companies appreciate economy of space in their sleeping cars, and the plan of trans porting two persons in one bed is not claimed as original in hospital trains. The hospital car is supported on trucks with elliptical steel springs, as is usual in passenger cars, and, in addition, india-rubber springs are so arranged as to equalize the motion and deaden the jarring of the car. This is a very valuable improvement and adds much to the comfort Of the patients. In the wards above described the patients ride with much ease and every possible provision for their comfort. FIG. 485 shows the horizontal plan of one of these cars. "These cars were fitted up under the immediate supervision of Medical Director Cooper and of Surgeon O. O. Herrick, 34th Illinois Volunteers. The latter was at one time in charge of one of the trains, and is officially reported as having rendered signal service in devising expedients for Fir,. 484. Transverse section of hospital oar of the Army of the Cumberland. ^Pattern of l>rs. Cooper and Herrick. I ! !<;. -185. Horizontal plan of one of the hospital cars of the. Army of the Cumberland. facilitating the safe transport of wounded and in promoting the organization and administration of the system. General Thomas accorded the fullest authority to Medical Director Cooper to select for the hospital trains the best locomotives and cars to be found among the rolling stock, and to have new cars fitted up whenever necessary, and caused to be detailed for the hospital serv ice the most experienced conductors, engineers, and other employes of the several railway lines. Medical Director Cooper informs the reporter that the smoke-pipes of the locomotives of the hos pital trains were painted of a brilliant scarlet; the exterior of the hood, and of the tender car with water and fuel, were of the same conspicuous color, with gilt ornamentation. At night, beneath the head-light of the engine, three red lanterns were suspended in a row. These distinguishing signals were recognized by the Confederates, and the trains were never fired upon or molested in any way. Dr. Cooper was informed by wounded Confederate officers in Nashville, who were cap tured at the battle near that place, of the stringent orders given his troopers by General N. B. Forrest for the non-interference with and protection of the U. S. A. hospital trains, by giving C HAP. XV. 1 RAILWAY TRANSPORTATION. 965 L FIG. 486. Side elevation of one of the hospital cars constructed under Dr. Cooper s supervision them timely warning in the event of the railway being obstructed or torn up. The partisan troops of Colonel John Morgan s command had similar instructions. It is related that on one occasion Colonel Morgan s scouts stopped the train directed by Dr. Baruum, and having switched it off upon a siding, after inquiring if there were sufficient stores on the train for the sick and wounded, they tore up the main track, and then rifled and destroyed five supply trains that successively arrived at the point where the line was interrupted. Ventilation without exposure to drafts was well provided for in these cars by windows in the elevated part of the ceiling ________ and by valvular openings near the roof (FiG. 48C). Dr. Town comments 0:1 the admirable manner in which the apparatus for lighting and heating were made also to promote ventila tion. He refers to many other details, which there is not space to notice here, and concludes that the conception of a com plete hospital, with all its ap pliances and means of comfort, propelled by steam, was first carried into practical operation in the medical department of the West, and its perfect success was most gratifying to all. In visiting these hospital trains, the air is found sweet and pure, the wards neat and inviting, and it may unhesitatingly be said that men on hospital trains are often as comfortable, and better fed and attended than in many permanent hospitals. Besides Drs. Baruum and Herrick, Medical Director Cooper men tions Surgeon L. J. Dixon, 1st Wisconsin Volunteers, and Assistant Surgeon E. J. Darken, U. S. A., as having super vised hospital trains with great skill and devotedness. Of the Medical Director himself, Dr. Town observes: Colonel George E. Cooper has made the study of hospital railway trains his pride. All of the western trains have been in the Department in which he directs the medical service, and many of the cars have been fitted up under his supervision. * * * He has just cause to be proud of his hospital trains. As far as the records of the Assist ant Surgeon General s Office show, the first official step toward organizing hospital cars was a letter written August 11, 1803, from that Office by Surgeon Joseph P. Brown, U. S. A. (during the temporary absence of the Assistant Surgeon General on other duty), directing the Medical Director of the Army of the Cumberland to take immediate measures to fit up a special train for hospital purposes, with every possible comfort, to run between Nashville and Louisville. " When General Sherman s army was before Atlanta, until the lines of communication were destroyed prepara tory to the march to the sea, hospital cars ran regularly from the front to base hospitals, some of which were four hundred and seventy-two miles distant. 1 "The difficulty of introducing loaded stretchers or litters through the narrow end doors of the converted passenger cars was obviated, in the train prepared under the supervision of Drs. Cooper and Herrick, by leaving the middle section on one side free from beds, removing two win dows and the paneling beneath, and introducing a sliding door, six feet in width, affording an ample space for the ingress and egress of litters with the most severely wounded patients. Descrip- Surgeon F. L. TOWN S report. Fir.. 487. Uprights and elastic ring couplings for suspend ing litters in hospital cars. B. The upright post next the passage-way: C. The fellow-post next the side of the car; F. Oblique view of the coupling by rubber bands; D. Lat eral view of the coupling by rubber bands. [After HAKKIS.] 966 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. FIG. 488. The "free" or inside method of suspending litters by rubber rings. [After HARRIS.] tions of the kitchen, office, and dispensary cars, which added greatly to the efficiency of these trains, are omitted here. A further description of the hospital trains of the Army of the Cumber land has been given by Dr. Dallas Bache, U. S. A. 1 In addition to the illustrations that were published with his paper, it may be useful to add diagrams explaining the details of the arrange ments for suspending litters from upright posts in adapting cars for hospital purposes (FiGS. 487, 488, 489) that were planned by Dr. Harris in December, 1802, and successfully put in practical operation in the Spring of 1803. It has already been shown that the adaptation of cars to hospital pur poses by securing field stretchers to rows of stanchions was practised from a very early period of the late war; but the merit of devising a simple and effective method of suspending the stretchers by rubber rings was exclusively due to Dr. Elisha Harris, who, moreover, pro moted Avith great earnestness, during the war, the establishment and organization of railway transport for the sick and wounded. A brief and somewhat inaccurate account of this system was published in 1805 by Professor F. H. Hamilton. 2 The plan was cursorily alluded to the same year in a surgical report from this Office, 1 and more fully described in a work by Dr. T. W. Evans, of Paris. 4 "Dr. Harris proposed to suspend three tiers of litters from upright oaken stanchions 4 inches wide by 2 inches thick, extending from, the floor to the roof of the car, which gave a length of about 6 or GJ feet (FiG. 487, B and C). The stanchions were placed in pairs, the fellow posts 22 inches apart, and 6 feet distant from the next couple (FiG. 492). The stanchions at the end of each row of uprights were perforated to receive on the broad face three hickory pins an inch in diameter, and three on the narrow face; the other stanchions, each pair contributing to the support of two tiers of litters, were provided with twelve pins (FiG. 487, B, C), six termed holder or loop-pins, and six arresting- pins or stops (FiG. 487, F, D), designed .to prevent the undue descent of the litter. Around the pins on the broad face of the pillars were placed loops or tugs of vulcanized india-rubber 3 inches broad, J inch thick, with 4 inches aperture, and weighing 9 ounces Troy. The handles of the stretchers, sawn off at 7i inches from the margins of the canvas, were inserted in the rings, which were put upon the stretch by the weight of the patient. Too great oscillation was prevented by the stopping-pins or by substituting more massive rubber rings. The holder-pin for the lower stretcher was inches from the floor, the stop-pin three inches. The space between the upper and middle and the middle and lower stretchers was about 19 inches. The inside length of the cars fitted up varied from 41 to 47 feet, and would accommodate four or five tiers of litters on either side, with space reserved for seats, closets, and offices at the ends. The inside width of the cars was 8 or 8 feet, and as the two series of berths occupied but 2 feet 4 inches on either side, a passage way of 3 feet 4 or 10 inches was left in the middle. The end doors, usually opening 2 feet, were widened to 2i, or, in the best models, to 3 feet. Hair pillows (FiG. 489) were attached to head-boards of finch light wood, and secured by straps to the litter poles. Dr. Harris proposed a modification of this plan, designed to afford greater elasticity to the litters for the transport of severe cases. The inner edges of the upright stanchions were placed 26 inches apart, and the handles of the litter were hung between the posts (FiG. 488, M); a wooden or iron traverse was substituted for the stop-pins, and the mode of insertion of the pins in the uprights was altered (FiG. 488, E); larger rubber rings, weighing 12 ounces, were used. On experiment this Fir.. 489. Pillon-s for stretchers. [After HAlt- KI8.J Fin. <T)0. Hospital railway ear rear elevation. ers arc sn-i">nded en loops mtulc ot gutta-percha." n singularly unsuitable material. 1. ()., Washington. I?fi5. Rzportt on the. Extent and Xatitrc. of /;: MihrMs available, for the reparation of a Medical and he Rebellion, Surgical Report. r . 81. Diagrams were given (Flos 88, W. !)0), from a photograph by Gardner, of the working draw- first hospital car exhibited by Dr. HARMS in Washington in March. 18fi3. I found the photograph on file, but, at that time, could obtain no precise information of its origin. * EVANS (T. W.). La Commission Sanitaire des lats-Unis, etc., Paris, 1805. CHAP. XV.] RAILWAY TRANSPORTATION. 967 plnn was found inferior to the first. Most of the cars were provided at one end with a wash-room and water-closet (FiG. 491), and at the other end with a couch and seats for attendants, a stove, and a small closet for a few essential medicines and dressings, and a copper boiler with an alcohol lamp. This brief statement of details applies to many of the- long passenger cars fitted up for hos pital purposes upon specifications supplied by Dr. Harris. This original design of Dr. Harris was Fin. 491. U. S. Army Hospital railway oar used at the East side elevation. not, however, limited to transforming passenger cars to hospital use; 1 and the adaptation of elastic rubber rings 2 to the suspension of litters, though valuable, was not the most important and enduring part of his system. There will probably be many changes and improvements in the methods of moving wounded men by railway, but the idea of utilizing the ordinary field stretchers for railway transport, keeping the patients upon them until they reach a fixed hospital, will not soon be aban doned. This expedient had been already resorted to in isolated instances, but Dr. Harris proposed its systematic adoption and devised a feasible method for its accomplishment. The system was much commended in Europe. 3 u At the close of the war there w e re in u s e thirtj -nine cars that had been fitted out under the supervision of the Sanitary Commission. _*J ( p. u u -r- )EO irr .$ Jv/ 1 ri* o i o o & n n n n l_ Fir,. 492. Hospital railway car used at the East ground plan. Except in a few instances, however, the Government had reimbursed the Commission for the original cost and the expenses of the outfit." tn the fall of 1863 and winter of 1864 the chief army of the West was concentrated 4 principally along the line of railroads leading from Nashville, Tennessee, southwest via Chattanooga. Tennessee, and stretching on toward Atlanta, Georgia. Heretofore such sick o o and wounded, on railroad lines, as could bear transportation were taken to points in the rear and north l>y ordinary passenger cars. Severe cases could not be removed at all and had to remain in the nearest hospital depots. Those w transitu often suffered from being delayed on the route by accident, or by the immense supply trams destined tor the army constantly passing over the road. Xot unfrequently the delay was at points where no rations could be drawn, and if they were to be had no means were at hand for cooking them, or feeding the men, or of making them comfortable. Hence the idea of a hospital train, an ambulating hospital, an independent hospital organization, which could furnish pencil-sketch; the details of a complete ambulance car were arranged the last week in December. 1862. and the first ear fitted up. the pioneer, w s the favorite old 51 -feet ear that was mutilated, when occupied by the fith Massachusetts Volunteers, in the Baltimore riot of April. 18(>1 . The elasticity of the rubber rings was objected to by some surgeons. Assistant Surgeon F. L. Tmvx. I". S. A., remarks: "The Hnrris ca docs not work well in practice: the elasticity of the rubber rings keeps the bed in constant vibration while the car is in motion. This greatly anno s the patient, who objects to riding a capering bed." MlAVKOWITZ (H. v.), Das tlilitarsanitiitsweien. 18f~.ti. S. 87. 4 For the account of the management of the hospital trains of the Department of the Cumberland alluded to here, the editor is largely indebted to a manuscript report of Assistant Surgeon F. L. TOWN, I . S. A. 968 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. each sick and wounded patient with a comfortable bed, feed and care for him en route, the same as if in a general hospital, without regard to time or distance. Such hospital trains were in successful operation during the last eighteen months ot the war. A hospital train, when complete, is made up of ten cars, and accommodates from one hundred and seventy-five to two hundred patients comfortably. The arrangement of the train is as follows: One box car, one kitchen car, an ordinary passenger car with seats, five cars with beds, i. e., hospital wards, an office car. and a con ductor s car. The forward box car is fitted up as a storeroom and carries provisions, hospital stores, bedding, etc. The drawings and brief descriptions of this as well as of kitchen and surgeon s cars of the Army of the Cumberland Fir;. 493. Baggage and commissary car of the Army of the Cumberland horizontal plan. r FIG. 4i)4. Baggage and commissary car of the Army of the Cumberland longitudinal section. FIG. 495. The same transverse section. were furnished by its Medical Director, Surgeon George E. Cooper, U. S. A. The baggage car ( FIG. 493) contained three closets to store rations; the centre open space was intended to carry barrels and large stores. The two bunks shown in the transverse section (Fio. 495) k X i> am . / 9 d ! B 3 A. c ~~~, a z> =,*,l=^== L\^=v*A=3ZZ> _f ^^ ; _- =^=*W===m* ! ==*m- mZL. J=u FIR. 49C. Kitchen car of the Army of the Cumberland horizontal plan. were for the attendants belonging to the car. The kitchen car (FiGS. 496. 497) was divided into three compartments, the dining-room, storeroom, and kitchen proper. The storeroom occupied the centre portion of the car, leaving a passage-way from the kitchen to the dining- room. The kitchen proper was furnished with a small range with boilers, etc., complete. There were stands, tables, and a closet for kitchen utensils in the kitchen proper. The letters indicate: A, kitchen, a, cooking range; b, sink; c, cupboard; d, table and shelves. B, store-room; e, ice-box; /, shelves for provision. C, dining-room; g, table, surrounded by benches, This apartment contained also a stove and wood-box. The car answered well tin- purpose required and gave perfect satisfaction. Tho p-issongpr car with seats was occupied by those not confined wholly to their beds, CHAP. XV KATLWAY TRANSPORTATION. 969 and others, men furloughed from general hospitals, etc.. who did not ordinarily require them at all. The five bed-cars were first-class passenger cars transformed into hospital wards. The surgeon s car was an ordinary passenger car with the seats removed and with par titions and fixtures introduced for the accommodation of the surgeon in charge of the train and his medical assistant; there was also a small .dispensary and an office for the transac- Pio. 497. Kitchen car of the Army of the Cumberland longitudinal secti tion of business ( FIGS. 498, 499). The letters indicate: A, dispensary and steward s quar ters: a, desk and book-case; />, shelves for medicines. This apartment contained also a revolving chair at the desk and a bed for the steward. B, surgeon s sitting-room ; d, lounge ; Fio. 498. Surgeons car of the Army of the Cumberland horizontal plan. e, water-closet; /, clothes closet. C, surgeon s bedroom; c, bed. D, office; g, lounge: h, water-cooler; /, wood-box and stove. E, wash-room, with water basin, tank, and dressing FIG. 499. Surgeons car of the Army of the Cumberland longitudinal section. locker. F F, passage through car. G, water-closet. The conductor s car in the rear was similar to the car so called attached to freight trains on ordinary railroads. It was appro priated to the use of the conductor and the citizen employes running the train. The hospital cars were warmed and lighted in the winter in the same way as passenger cars on our railroads. The same means were adopted in some cars as were in use in general hos pitals, combining warming and ventilation. The hospital wards were originally those cars in which the central portion of the roof was raised considerably above the general plane: >pening the windows occupying the space between the planes very perfect ridge ventila tion was obtained. The wards had also such other means of ventilation as were in use in Sl RG. Ill l J2 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. first-class passenger cars. If necessary, except in the coldest weather (and the seasons were mild in this climate), the car doors could be thrown open for a few minutes, at intervals, which rapidly supplied a fresh atmosphere. The surgeon in charge of a hospital train was its sole head, the same as on a hospital transport or in a general hospital. He had a citizen conductor and engineers, firemen, and brakemen, employed by the Quartermaster s Department, who, under the immediate con trol of the conductor, moved the train when and wherever he ordered it. Unlike the chief medical officer of a hospital transport, he was not required to act as a commissary of sub sistence or an assistant quartermaster. He drew his rations from time to time as in a general hospital. One medical assistant and one hospital steward was ordinarily all that were required on a train. Enlisted men were detailed as cooks, nurses, and hospital attendants. Only a limited number of the latter were required, and those not on duty occupied beds, if necessary, kept vacant in one of the wards. The needful washing of bedding, etc., was done at one of the termini of the route. In the spring of 1864, and during the advance of General Sherman s army on Atlanta, Georgia, and while that place was occupied by General Sherman previous to his cutting loose from all communication with the north and striking across the country to Savannah, three hospital trains ran regularly between Louisville, Kentucky, and Atlanta, Georgia, a distance of four hundred and seventy-two miles, viz: Train No. 3, from Louisville. Ken tucky, to Nashville, Tennessee, distance one hundred and eighty-five miles; train No. 2, from Chattanooga, Tennessee, to Atlanta. Georgia, distance one hundred and thirty-six miles. These trains passed over the road once every day down one day and returning the it/ */ O next, Train No. 1 connected with No. 3 at Nashville, and with No. 2 at Chattanooga, on FIG. 501. Kitchen and dispensary car. Army of the Potomac longitudinal view. alternate days. A time-table was prepared by which the running of the hospital trains was regulated which was adhered to for some time. Sick and wounded in the sanguinary engagements of this eventful campaign were taken from the large hospital depots at Atlanta, Marietta, Kingston, and Rome, Georgia, to the permanent hospitals at Chattanooga and Nashville, Tennessee, and Louisville, Kentucky. Some men were brought directly through CHAP. XV.] WATER TRANSPORTATION. 971 from Atlanta, Georgia, to Louisville, Kentucky, over this long span railway line, stretching south four hundred and seventy-two miles to the distant army. If necessary, a ward in one train was uncoupled and attached to the connecting train without disturbing the patients. The ordinary modus operandi in railroad transportation was to empty the hospitals at Nash ville and Chattanooga of men partially recovered, and who would not be injured by moving, and take them up to Louisville. The beds thus vacated at these points were filled from below. In the Army of the Potomac the complete hospital train consisted of twelve cars one for the surgeon in charge, one for the kitchen and dispensary, and ten for the sick and wounded. The cars fitted up for the carrying of patients have been described on page 961. The kitchen and dispensary (FiGS. 500, 501) car was built according to plans prepared by the Assistant Superintendent of Military Railroads, J. McCrickett. The car was divided into two compartments. The dispensary contained a stove, A; a water-closet, B; cases for shelves, C; cases of drawers, D; wood-box, E; table or desk, F; couch, G; wash-basins, H. In the kitchen, P, were: C, cases of shelves; D, cases of drawers; I, water-cooler; J, refrig erator; K, sink for washing dishes; L, table; M, pantry; N, wood-box; 0, cooking-stove. WATER TRANSPORTATION. The military operations in the western departments in the spring of 1862 embraced a large extent of territory and necessitated the moving of large bodies of men from point to point. As a result, the fresh unacclimated levies fell victims to malignant fevers, diar rhoea, dysentery, etc. The resources of the Medical Department under these circumstances were entirely inadequate to the pressing necessities. It became evident that to disem barrass the medical officers and to have them in readiness for the exigencies of battles, which all knew were impending, the sick must be removed to points remote from the scene of operations. For this purpose the large rivers of the Western States, especially the Mississippi, offered the best facilities. But there were no transports at the disposition of the medical officers. In order to send a single sick soldier it was necessary to apply to the quartermaster of the army, who naturally gave the preference to his immediate duties, and even when, after much circumlocution, a boat was secured and partly filled with patients, it was frequently delayed until the demands of other departments were complied with. The necessities of the sick and wounded were of a secondary consideration, and the surgeon who exerted himself in the interest of common humanity was regarded as asking favors for himself. The fact that the efforts of the Medical Department were thus paralyzed was brought to the notice of the General Commanding by Surgeon J. Simons, U. S. A., Medical Director, who recommended that a suitable number of boats be taken and fitted up comfortably with beds, cooking apparatus, surgeons, and nurses, etc. The appeal was favorably received, and several steamers were chartered and placed under the charge of medical officers. We will quote from the excellent report of Surgeon A. H. Hoff, U. S. V., master of hospital transportation on the Mississippi, made in September, 1863: "The City of Memphis, a very large and fine steamer, was chartered, and Assistant Surgeon W. D. Turner, 1st Illinois Light Artillery, placed in charge. The steamer City of Louisiana was also chartered and fitted up under the control of Assistant Surgeon C. Wagner, U. S. A., and, with the City of Memphis, was at once employed in the carrying of sick and wounded. About the 1st of April, 1862, after the experiment had been made and proved successful, 972 TRANSPORTATION OF THE WOUNDED. [CHAP. xv. % Surgeon Simons requested that boats be purchased and fitted up as floating hospitals. On his report and the co-operation of Mr. Yeatman, the President of the Western Sanitary Commission, the steamer D. A. January was purchased and placed in my charge. This boat, on account of her light draught and airy cabin, was well suited for the purpose. There was no time to make more than temporary arrangements, and she was not recon structed until September, 1862, when she was fitted up with every convenience as a hospital. These boats proving inadequate to supply the amount of transportation required, two of the largest steamers on the river were chartered (the Empress and Imperial) and temporarily fitted up, and Surgeons T. F. Azpell and J. H. Grove, U. S. V., were placed in charge of them. The transportation still being insufficient, the steamers Stephen Decatur and J. S. Pringle were added to the list, and these, together with the several boats sent by different states, made quite a formidable fleet; yet they all had plenty of employment, as sick and wounded had to be transferred to the number of thousands. These boats, as they ceased to be needed, were discharged, leaving the D. A. January alone. As the hospital accommodations at Pittsburg Landing were very imperfect, Medical Director Charles McDougall, Surgeon, U. S. A., requested the construction of a floating hospital, which could be towed from point to point, to be used as a receiving hospital, from which the transports could load and in which the sick and wounded could be placed and made comfortable in the absence of the transports. In this he was finally successful, and the hulk of the steamer Nashville was purchased and fitted up so that she would be able to receive in an emergency one thousand men, and Surgeon Strawbridge, U. S. V., was placed in charge. She was towed to Milliken s Bend, La., and was of great service, as the submerged condi tion of the country made it impossible to care for the sick on shore. Up to this time, although the Assistant Surgeon General, on taking charge of the Western Department and visiting the scene of active operations, repeatedly urged the purchase of more steamers for hospital purposes, for some reason, unknown to him as well as to others, he was unsuccess ful; but the unsuccessful attack on Vicksburg, in December, the battle of Arkansas Post, and the advance of the whole army in the direction of Vicksburg made it necessary to again resort to chartering transports. The City of Memphis and City of Alton were again temporarily fitted up, and with the D. A. January transferred the sick and wounded from Milliken s Bend, Young s Point, and Sherman s Landing, to Memphis and St. Louis. In the meantime, however, several boats had been taken the steamers Von Phul and J. C. Swon, in fact at least one-fourth of the returning transports without a single comfort for the sick and wounded on board, were made use of to transfer them to the general hospitals North. Under such circumstances the suffering was terrible and the mortality frightful. I am not disposed to find fault, nor do I wish to censure any one, but I feel it my duty to remark that the Medical Department did everything in their power to correct this matter, with but poor success. The Assistant Surgeon General, never tiring in his determination to push this matter, finally succeeded in getting the City of Louisiana pur chased and fitted up in a most comfortable manner, with good accommodations for four hundred, with every improvement that a year s experience could suggest. During this time the Navy had fitted the Red Rover in a most elegant and substantial manner; the Marine Brigade also fitted the Wooclford as a hospital with every comfort that could be made available. The U. S. Hospital Steamer D. A. January having run for a year and a half it became necessary to repair her, and upon examination new boilers were found to be necessary. As we came m possession of more of the Mississippi additional accommoda- CHAP. xv.J WATEE TRANSPORTATION. 973 tions for the comfort of the sick and wounded were required. Under these circumstances the January was reconstructed, better ventilation secured, better and more convenient arrangements for cooking were made, and a fan, one hundred and sixty feet long and pro pelled by machinery, was placed in the main ward for the purpose of cooling the atmosphere and as a means of ventilation. It answered an admirable purpose and did away with the necessity of covering the decks with an awning, which was not only difficult but a verv expensive matter. After her reconstruction her name was changed to Charles McDougall, in honor of Surgeon McDougall, U. S. A., who had interested himself when Medical Director of the Department in securing proper transportation for the sick and wounded, and by whose request she was finally fitted with all the conveniences for a hospital transport. "It would be impossible for me, not being in possession of records, to give any idea of the number of sick and wounded transferred nor do I believe it would be possible, from the fact that emergencies required boat after boat to be made use of where no record was kept to give the exact figures suffice it to say that the U. S. Hospital Steamer Charles McDougall (D. A. January) carried from April 5, 1862, to September 12, 1863, twelve thousand two hundred and ninety-nine sick and wounded to the several general hospitals, she being constantly employed. A fair average may be made by taking into calculation the time the other boats were employed, most of them probably carrying more at each load. The use of steamers for hospital purposes being a new thing, changes in the arrangements were required as the necessities became apparent. Orders were made by the chiefs of the several Departments of such a character as would secure prompt attention on the part of all their subordinates and at the same time place the surgeons in charge in such a position that the least possible delay should occur. Believing it to be of interest and forming a part of the success of the subject to which this history relates, I will append these orders as they were made from time to time. The first great difficulty to be overcome was to do away with the idea that as these boats were for the transportation of the sick and wounded they were the vehicles for carrying not only all the friends of the sick and wounded, but every man, woman, and child who became impressed with the slightest inkling that their hearts contained one particle of sympathy for the poor soldier; curiosity seekers, sanitarians, state agents, sutlers, committees from various associations, one and all concluded they had a right to transportation on such a boat. This of course was out of the question, as it pre vented the employe s from properly cleaning the boat and took up room required for patients. More than this, it used up the subsistence which belonged to the hospital fund, which was used to buy so many things necessary for the diet of the sick. It was annoying to the surgeons, it was in the way of all discipline, and in fact disagreeable to every one. Under these circumstances Major General Halleck issued the following order: 1 HEADQUARTERS, DEPARTMENT OF THE MISSISSIPPI, PITTSBURG LANDING, TENNESSEE, April 20, 1862. Surgeon Simons has authority to prevent persons from travelling ou hospital boats. BY ORDER OF MAJOR GENERAL HALLECK: (Signed) A. C. KEMPER, Assistant Adjutant General. No person will hereafter be permitted on floating hospitals except by permission of the Surgeon in charge. (Signed) J. SIMONS, Surgeon of Army, Medical Director. This left the Surgeon in charge an opportunity of using his discretion in reference to who should travel on his boat, and, I think, in most instances it has been confined to medical officers who could assist instead of being in the way. 974 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. 11 The next important step was to be arranged with the Subsistence Department. This was surrounded with some difficulties, as there was no room on board for a commissary. The difficulty was soon remedied by making the Surgeon in charge an Acting Assistant Commissary of Subsistence, thereby enabling him to receive subsistence from any com missary by invoice and receipt, and to purchase such articles as the sick required. CAIRO, ILLINOIS, April 7, 1863. SIR : By authority from Major General Halleck, commanding the Department of the Mis sissippi, Surgeons in charge of hospital boats will act as A. A. C. S., so far as receiving and issuing stores for the hospital under their charge is concerned. Respectfully your obed t servant. B. Du BARRY, Capt., &c., C. 8., U. S. A, To Surgeon in charge of hospital boat D. A. January. "By a similar order the surgeon was held responsible for all the property belonging to the Quartermaster s Department in his charge, and required to receipt for it. This, of course, was an anomaly in departmental matters, but one that was required for the proper adminis tration of the affairs of the floating hospitals ; without such an arrangement the unavoidable delays would have destroyed their efficiency. The Medical Department is much indebted to Major Generals Halleck and Grant for the kindness shown and interest taken by them in this branch of the service. We are also indebted to Quartermasters, Brigadier General Allen and Colonel Myers, and to Colonel Parsons, in charge of the river transportation, for their uniform kindness and assistance in the purchase and reconstruction of the boats; also to Colonel Haines, Chief Commissary, for the liberal manner in which the boats have been supplied with subsistence, and, through his orders, the little delay occasioned in receiving supplies. In fact, all have wished us a God speed in a work which has been the means of relieving so much distress and probably of saving many lives." /Steamer City of Memphis. The first boat chartered on the western rivers for the transportation of wounded was the steamer City of Memphis, which was taken into the service as a hospital boat at Fort Henry on February 7, 1862, by order of Major General U. S. Grant, and placed under the charge of Assistant Surgeon W. D. Turner, 1st Illinois Light Artillery. She was fitted out as thoroughly as circumstances permitted. Spring mattresses were placed on the floor of the upper deck and saloon; the state-room was rearranged, and medicine and commissary stores supplied. Her length was three hundred and thirty feet and her beam seventy feet; her main deck was large and roomy, and her saloon of great length, and she was capable of carrying comfortably seven hundred and fifty wounded men. From February 7th to 18th she was used as a receiving boat, conveying a large number of sick and wounded from Fort Henry and transferring them to other boats. No record of this work was kept; but the number thus transported is estimated at two thousand. On February 18th she left Fort Henry with four hundred and seventy-five sick and wounded for Paducah, Kentucky, where she arrived on February 19th; the patients were transferred to the general hospitals, and the boat left for Fort Donelson the same day and arrived there on February 21, 1862. The boat was discharged from the hospital service in July, 1862, by Medical Director McDougall, of the Army of the Ten nessee, but re-engaged and employed in carrying wounded from the vicinity of Vicksburg during Grant s campaign. No record of the number transported during her second engage ment is found. CHAP. XV.] WATER TRANSPORTATION. 975 From February 18th to July 19th, 1862, the boat made fourteen trips and conveyed seven thousand two hundred and twenty-one sick and wounded men, as follows: TABLE CLXXVI. Tabular Statement of Trips made by the Steamer City of Memphis from February 18 to July 19, 1862. Ko. OF TKIP. DATE OF DEPARTURE. PLACE OF DEPARTURE. DATE OF ARRIVAL. PLACE OF ARRIVAL. Xo. SICK AND WOUNDED. 1 2 February 18, 1862 February 22, 1862 March 6, 1862 Fort Henry, Tenii February 19. 1862 Paducah, Ky Fort Donelson, Term February 23, 1862 Mound City, 111 Fort Donelson Tenn March 8 1862 Mound City HI 475 600 400 410 8GO 1,093 413 520 400 400 350 400 550 350 3 4 March 14, 1862 April 6 1862 Savannah, Tenu March 18 186 9 Snint T.rmia Mr. 5 Sliilnh TATITI : Anrilfi 18R9 Savannah, Tenn Mnnnd flifT "HI 6 April 9, 1862 Pittshiirw Landing TMITI ! Ar>ril 12 18fi2 7 April 15, 1862 April 21, 1862 Pittsburg Landin" Tenn April 18 1862 8 New Madrid, Mo April 23, 1862 Pittshnrf Trindimr Tp.rm "M"n,v 1 IRK 1 * 9 April 27, 1862 10 May 13, 1862 Pit,t,shnr<r T.-iiulintr Tpnn ATnv 18 1Kfi9 11 June 2, 1862 June 15, 1862 July, 1862 Pittsburg Landing, Tenn June 5, 1802 Pittsburg Landing, Tenn . June 20, 1862 Louisville, Ky "PTpnknl^ Tnwa 12 13 Paducah, Ky July 10 1862 14 July 16, 1862 Helena, Ark July 17 1862 Memphis, Tenn Total 7,221 Steamer Louisiana, afterwards named R. C. Wood. The fast steamer Louisiana was chartered on March 12, 1862, and placed under the charge of Assistant Surgeon C. Wagner, U. S. A., who mainly furnished the data here adduced. The boat was immediately sup plied with bedding and the necessary hospital commissary stores; the Western Sanitary Commission very liberally supplied many articles not procurable at the time from the Medical Purveyor. The boat was- divided into four wards, two on the lower deck and two on the upper or boiler deck, each of which had a medical officer, a wardmaster, six perma nently detailed male nurses, and one female nurse. The nurses were relieved from duty every six hours, day and night. Upon the lower deck was the kitchen, commissary, store room, bakery, and ice-house; upon the upper deck the captain s office was converted into the office of the Surgeon in charge, and the bar-room into a dispensary, the barber-shop and wash-room into a kitchen for low and half-diet patients under the supervision of a female nurse. The bulkheads between the state-rooms were removed, improving the ven tilation and rendering access to the patients more easy. Beds were also placed on the guards of the boat, tarpaulins being stretched to protect the patients from the inclement weather. The texas upon the hurricane deck was used as quarters for the hospital attend ants and the boat s crew. An oven was on board capable of baking bread for a thousand men daily. In admitting as well as in removing the patients a systematic arrangement was adopted. A medical officer was stationed at the gangway to receive them, one on the boiler, and another on the lower deck. Each wardmaster remained in his ward, and a sufficient number of nurses was detailed to carry the patients on or off the boat. By this arrange ment all confusion was avoided; no one was admitted as a patient except upon a written order from the Medical Director. The boat at this time had accommodations for four hun dred patients. She carried, in less than four months, about three thousand patients from Pittsburg Landing and other points on the western rivers to northern hospitals, and was released from service during the summer of 1862. An account of the trips is taken from the report of Assistant Surgeon C. Wagner, U. S. Army: 976 TRANSPORTATION OF THE WOUNDED. [CHAP. XV TABLE OLXXVII. Tabular Statement of Trips made by the Steamboat Louisiana from March 33 to June 14, 1862. No. OF TRIP. DATE OF DEPARTURE. PLACE OF DEPARTURE. DATE OF ARRIVAL. PLACE OF ARRIVAL. No. SICK AND WOUNDED. 35 280 310 325 306 328 340 325 350 400 1 9 Island No 10 Teiin ) March 28, 1862 $ April 8, 1862 April 14, 1862... April 24, 1862 May 3, 1862 May 9, 1862 May 17, 1862 June 2, 1862 June 14, 1862 Cairo, 111 March 2 r > 1862 Mound City, 111., and Paducab, Ky - ) Crump s Landing, Tenn Cincinnati, Ohio 3 4 5 6 April 6, 1862 Saint Louis, Mo Saint Louis, Mo April 20, 1862 May 1 1862 . . Savannah, Tenn Pittsburg Landing, Tenn Pittsburg Landing, Tenn Savannah, Tenn Hamburg, Tenn Hamburg Tenn Cincinnati, Ohio Saint Louis, Mo Saint Louis, Mo 7.... 8 9 May 7, 1862 May 15, 1862 May Cl 1862 Saint Louis, Mo Paducah, Ky 10 June 13 186 Total 2,999 In April, 1863, the boat was purchased by the Government and remodelled as a perma nent hospital boat, with beds for four hundred and fifty patients, and was named the K. C. Wood, in honor of the Assistant Surgeon General of the United States Army, to whose wisdom, humanity, and constant foresight many of the improvements in the hospital arrange ments were due. Surgeon T. F. Azpell, U. S. V., was placed in charge. Her state-rooms were removed, the whole upper deck was made into one large ward, with abundant light and excellent means of ventilation, with ample provisions of bath-rooms, hot and cold water, cooking apartments, nurses rooms, dispensary, laundry, and many other conveniences. 1 Her length was two hundred and fifty feet, beam forty feet, hold seven feet. From April, 1863, to April 11, 1865, this boat made thirty-three trips, travelled thirty-four thousand eight hun dred and five miles, and carried eleven thousand and twenty-four (11,024) sick and wounded, as follows: TABLE OLXXVIII. Statement of Trips made by the Hospital Steamboat R. C. Wood from April 1, 1863, to April 11, 1865. No. OF TRIP. DATE OF DEPARTURE. PLACE OF DEPARTURE. PLACE OF ARRIVAL. April 1, 1863 1 Milliken s Bend May 26, 1863 June 2, 1863 June 8, 1863 June 23, 1863 July 4, 1863 Saint Louis Memphis . . . Memphis . . . Memphis . . . Memphis . . . July 8, 1863 ! Memphis Saint Louis July 25, 1863 August 8, 1863 [ Saint Louis August?, 1863 ! Memphis 1 August 28, 1863 . . Keokuk September 19, 1863 Saint Louis October 2, 1863 Memphis October 24, 1863 Saint Louis February 6, 1864 Saint Louis February 28, 1864 Saint Louis March 14, 1864 i Memphis March 19, 1864 j Nashville April 14, 1864 I Louisville April 22, 1864 Louisville Saint Louis Chickasaw Bayou and Memphis . Chickasaw Bayou and Memphis . Chickasaw Bayou and Memphis . Vicksburg and Memphis Helena and Memphis Vicksburg and Saint Louis Vicksburg and Saint Louis Vicksburg and Memphis Vicksburg and Keokuk Vicksburg and Saint Louis Vicksburg and Memphis Saint Louis Vicksburg and Saint Louis Natchez and Saint Louis Vicksburg and Memphis Nashville . . . Louisville Cairo and Louisville Alexandria and New Orleans Carried forward. No. SICK AXU WOUNDED. 107 425 410 459 397 360 371 389 330 412 355 418 387 178 303 349 240 120 213 fi, 2. 3 1 See Report of the Western Sanitary Commission f<jr the year ending June 1, 1863, St. Louis, Mo., 1863, page 18. CHAP. XV.] WATER TRANSPORTATION. ^Tim 1 DATE OF DEPARTURE. PLACE OF DEPARTURE. No. SICK PLACE OF ARRIVAL. AND WOUNDED. 6 2 3 Jl May 3 1864 New Orleans Louisville 292 22 May 18 1864 .. Lou sville Evansville and Louisville 366 ^3 September 1 1864 24 September 1 1864 Lon sville Evansville and Louisville 114 25 November 13 1864 26 November 30 1864 Lou sville Mound City 485 Moi ml Citv Clarksville and Louisville 134 28 December 13 1864 Cairo and Louisville 610 2!) December 30 1864 Lou sville Nashville and Louisville 705 30 March 1 1865 Keokuk and Mound City 333 31 March 14 1865 Moi nd Citv Saint Louis aud Louisville 163 3 March 24 1865 Vicksburg and Saint Louis 459 33 April 11 1865 Vicksburg and Saint Louis 370 Total 11, 024 With the two thousand nine hundred and ninety-nine (2,999) patients carried during her first engagement, from March 23d to June 14, 1862, the boat altogether conveyed four teen thousand and twenty-three (14,023) sick and wounded from the scene of action to northern hospitals. Perhaps the most perfect of the western hospital boats was the steamer D. A. Jan She was purchased on April 1, 1862, and placed under the orders of Assistant A. H. Hoff, U. S. A. She had been built at Cincinnati in 1857. She was a side- uar. no. 502. U. S. Army Hospital Steamer D. A. January. wheel steamer of four hundred and fifty tons burden, two hundred and thirty feet in length, thirty-five feet beam, and sixty-five feet extreme width. She had two high-pressure engines, with cylinder twenty-two inches in diameter and seven feet stroke. As a precautionary measure against accident bv fire, she had a small steam fire engine, which worked hide- O / pcndently. and was supplied with sufficient hose. During the summer of 1862 the boat carried patients from Pittsburg Landing, Paducah. and Helena, to St. Louis, Keokuk, New Albany, and Cincinnati. In the fall of 1862 she was entirely remodelled under the super vision of Assistant Surgeon A. II. Hoff. to whom the department is indebted for many important, suggestions, especially in the earlier days of hospital transportation. On the Ill 123 978 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. hurricane deck (FlG. 503). the roof of the boat, was the texas, on top of that the pilot house. The staterooms were taken out nnd the whole cabin deck converted into one spa- D il f~ 1 L L , \ A ^ C ( I K 1 ^ v_ ^ r |i \ _> 7f 1 Fir.. 503. Upper deck, or texas, of U. S. Hospital Steamer D. A. January. A A Projections of lower deck. B Q Hoof. C C Cabin roof above skylights. D D Smoke-stacks. E Water-closets. F Wash-house. G G Wheels. H H H Water-tanks. I Captain s room. J Social hall. K Texas dining-room. L L L Rooms for steamboat officers. cious ward ( FIG. 504). Long windows were placed on all sides of this ward, attached by butts alori"- the centre of the ward. About the centre of this deck, on one side, was A A Projections of lower deck. F F D Office. G G C C Private rooms. H H D Front stairs. I E E Texas stairs. J Fir,. 504. Cabin deck of I". S. Hospital Steamer D. A. January. Steamboat chimneys. K K Bath-rooms, hot and cold. Stoves. L L Steamboat s wheels. Middle ward stairs. M M Water-closets. Nurses dining-room. N Private room. Kitchen. O Drug-store. P Surgery. Q Linen-room. R Space occupied by the mirror. S S (. old-water pipes. a nurses dining-room, a bath-room, and water-closet, and on the other a special diet kitchen. bath and wash-room, and water-closet. Away aft there was on one side a drug-shop and steward s room, on the opposite side a linen-room, in the centre an operating-room. Drink ing-water throughout the ward was drawn from faucets placed at convenient distances. The bath-rooms were supplied with water from a large tank on the hurricane deck, filled A A Lower deck. B B B Hatchways. C Boilers. DDEE Middle deck. F F Space fur sick. G G Nurses quarters. H H Cold water. Side or middle deck. , ( Stairs to lower deck. ) Stairs to upper deck. K K Water-closet-.. L Nurses stairs from cabin deck. M M Nurses stairs to lower deck. with water by steam-power. The drinking-water arrangement was a refrigerator on a large * L O O O O scale. Pipes ran from the tank on the hurricane deck into two large ice-chests in the hold 1 O of the boat, one on each side. In these chests were large worms through which the water O D CHAP. XV.] WATKK TRANSPORTATION. 979 passed and was carried through the different wards, furnishing iced water, or water cool enough for all purposes. By this plan a large amount of ice was saved, as the chests were seldom opened. Between the main and the boiler decks, on the middle deck ( FIG. 505). where the wood-racks used to be, two wards, one on each side, were arranged, containing thirty beds each, with water-closets, wash-troughs, and faucet for drinking-water. The wards were low. but the bulkheading was composed almost entirely of windows, so that plenty of air could circulate. On the lower deck ( FIG. 506) there was a comfortable ward for one hun- FIG. 50(5. Lower Boiler Deck of the U. S. Hospital Steamer D. A. January. A Foot of stairs. E B B Space for wood and coal. F C Boilers. G D Stores. H Pastry room. Kitchen. Carpenter s shop. Blacksmith s shop. I Engines. J Donkey engine. K K Wheels. L Washstancts M M Water-closets. N N Main deck. O Stoves. P P Cold water. dred beds, water-closets, and wash-troughs; a large kitchen connected with the wards on the upper decks by a dumb-waiter; a bakery on one side, a blacksmith shop, carpenter shop, and commissary room on the other. Through the whole length of the main ward ran a fan, worked by steam from below (it made about ninety revolutions a minute), and as the tran som windows opened just above it, at the sides, it created a pleasant current of air and kept out all flies and mosquitoes. This boat carried from April, 1862, to August, 1865, alto gether twenty- three thousand seven hundred and thirty-eight patients, as follows: TABLE GLXXIX. Trips made by the Hospital titeamer D. A. January from April, 186%, to August, 1865. NO. OF Tiur. DATE OF DEPARTURE. April 11, 1862 April 18, 1862 PLACE OF DEPARTURE. DATE OF ARRIVAL. PLACE OF ARRIVAL. May 2. 1862 Pittsburg Landing May 10, 1862 . . Pittsburg Landing. . June 9, 1862 Pittsburg Landing.. June 19, 1862 Pittsburg Landing. . July 0, 1862 Paducah July 17, 1862 Helena July 25. 1862 | Paducah August 4, 1862 ; Paducah August 20, 18G2 Helena August 23, 1862 Paducah September 29, 1862 Helena October 7, 1^62 Helena October 12, 1862 \ Columbus Pittsburg Landing April 14, 1862 Saint Louis Pittsburg Landing April 23, 1862 Keokuk May 4, 1862 New Albany May 6, 1862 Cincinnati-. err .-rA. . . May 14, 1862 ! Jefferson Barracks June 12, 1862 Jefferson Barracks June 20, 1862 Paducah June 22, 1862 Jefferson Barracks June 23, 1862 Keokuk July 7, 1862 Evansville ^ July 8, 1862 Louisville $ July 21, 1862 Jefferson Barracks July 27, 1862 Jefferson Barracks August 6, 1862 Saint Louis August 23, 1862 Mound City August 23, 1862 Mound City October 3, 1862 Saint Louis October 10, 1862 St r T. L. McGill, Columbus October 15, 1862 Saint Louis "No. SICK AND WOUNDED. 431 284 300 284 375 287 317 298 -1U 100 30 Carried forward 4,400 980 TRANSPORTATION OF THE WOUNDED. [CHAP. XV Trip F DATE OF DEPARTURE. PLACE OF DEPARTURE. DATE OF ARRIVAL. No. SICK PLACE OF ARRIVAL. ASU WOUNDED. B btf d j 4,400 16 October 1 1802 Columbus October 23, 1862 Mound City 88 Keokuk 378 17 October 30 1862 Columbus November 4, 1862 Columbus November 21, 1862 Columbus November 30, 1862 Helena December 16, 1862 18 November 18, 1862 19 November 28, 1862 20 December 9 1862 Jefferson Barracks ... . 435 Saint Louis 440 Memphis . . . > 21 . . January 14, 1863 \ January 18 1863 Arkansas Post r ftm ,rv 2* 1863 > 432 f March 1863 1 r March, 1863 ) f 1,174 Transferred to other hos-j 1,460 pital steamers. 736 1,195 Saint Louis 378 1 ADril 1863 Served as receiving hos- A ^ 18JJ3 1 May 1863 f pital at Milliken s Bend, -I 1 June 1863 J Louisiana. I June, 1863 J 23 August 11 1863 Milliken s Bend August 18, 18G3 21 August 27 1863 Vicksburg August 31 1863 Memphis 387 25. September 5, 1863 26 September 15, 1863 27 .... September 29, 1863 2S.... October 28, 1863 29 ... November 23, 1863 .... Vicksburg i September 8, 1863 Vicksburg September 18. 1863 Vicksburg October 7, 1863 New Orleans Novernlx r 2, 1863 ( November 25 1863 Memphis 377 Memphis 244 Memphis 78 Cairo 100 Cairo . . . ) Memphis 345 30 December 9, 1863 31 February 11 1864 < 1 1 November 27 "8 1863 Nashville December 12, 1863 New Albany... .) Evansville 344 February 15 1864 32 March 18 19 1864 Louisville ... ^ Madison, Ind 463 Madison 382 Memphis ^ Louisville March 19, 1864 33 April 7, 1864 < Louisville ) New Albany > April 8 1864 34 April 27, 1864 Jeffersonville .... J Vicksburg May 1, 2 1864 35 Mayl, 1864 36. May 3, 1864 Memphis : May 3 1864 Cairo Cairo May 8, 1864 V 398 Louisville 37 May 3, 1864 Mound Citv May 9 1864 New Albany J 38 May 14, 1864 Mound City May 17 1864 39 May 22, 1864 40 June 10, 1864 41. . June 21, 1861 .. 42. .. June 22, 1864 Nashville May 26, 1864 Mound City . June 12 1861 .. New Albany 239 Jefferson Barracks 120 Louisville June 22 1861 Evansville Evansville June 25 1864 498 43. .. August 10, 1864 44.... August 22, 1864 45 .... September 2. 1864 46 September 19, 1864 ... 47 September 20, 1864 Memphis ... August 16 1864 Jefferson Barracks 345 Memphis . . August 27 1864 Jefferson Barracks . 309 Helena September 9, 1 864 Helena . September 24, 1864 Memphis > Jefferson Barracks 332 Jefferson Barracks 229 Mound City 4()7 Jefferson Barracks Cairo . .... 127 48 October 12, 1864 49 November 3, 1804 50 November 10, 1864 t October 19, 20, 1864 . . Duvall s Bluff . . ( October 22, 1864 Mouth of White Iliver November G 1S64 Mouth of White River November 14 1861 Mound Citv 48 51 November 25, 1864 52 December 1, 1861 53 December 19, 1864 .. . Nashville . November 29 1864 Nashville December 5, 1864 Louisville ) Jefferson Barracks 416 Cincinnati > 545 December 21, 1864 I Jeffersonville ^ 54 December 26, 1864 j Louisville ) { > December 27, 1864 Jeffersonville . > ( Louisville January 8, 1865 Cairo . . . . ) 55 January 5, 1865 January 27, to > ( Jeffersonville January 9 18G5 426 Eastport February 5, 1865 1 February 4, 1865 \ \ 57 February 12, 1865 Waterloo February 8, 1865 Memphis \ 58. .. February 14, 1865 59 .... . February 14, 1865 60 February 16, 1865 Waterloo 1 }> February 19 1805 318 Johnsouville 61. .. March 12, 19, 18G5 62 .. April Ki, 18G5 63 April 17 18 18G5 Chickasaw March 23, 18S55 New Orleans April 14, 1865 \ April 21, 1865 St rE. Carroll, N. Orleans. 1C9 I ! April 25, 1S65 C.irried foi war.i. 21, 534 CHAR XV. WATER TRANSPORTATION. 981 NO. OF TRIP. DATE OK DKI-AUTUUE. PLACE OK DEL AIU UKK. DATE OF AUUIVAL. PLACE OK AUKIVAL. No. SICK AND WOUNDED. Brought forwr.rd 21 534 64 May 6 1865 65 May 8 1865 Mobile May 15 1865 66 May 9, 1865 Fort Games . . - I Mav 25 1865 389 67. May 18 1865 i May 31, 1865 New Orleans 08 .. 09 .... Juno 2, 1865 June 5, 1865 New Orleans VicUsburg June 8, 1865 June 10 1865 Memphis . . St r W. Butler at Cairo J 560 70. June 20, 1865 June 28, 1865 Cairo ) 72 ... Juno 23, 1865 June 29, 1865 Jefferson Barracks ) 229 73 July 17 1865 July 24 1865 . ... 74 Julr 18, 1865 328 July 26 1865 75 July 24 1865 76 ... August 3, 9, 1865 August 16, 1865 Cairo ... . ) 77 August 10, 1865 Baton Rouge . . > 439 August 18, 1865 Jefferson Barracks ) 78 79 August 12, 1865 August 26 1865 Vicksburg i Cairo ) 80 .. August 27 1865 259 September 4, 1865 Jefferson Barracks ^ 81 August 28, 1865 Vicksburg j Total 23 738 Steamer Empress. The steamer Empress was chartered on April 10, 1862, and placed in charge of Surgeon Thomas F. Azpell, U. S. V. Being built expressly for a cotton boat, and said to be the largest engaged in that trade, she was found to be admirably adapted to hospital purposes. Her capacious dimensions and the unusually large area on each deck, which, could be used for beds, rendered her accommodations for the sick unsurpassed. Her cabin was small, containing only forty state-rooms, which were principally used by the hospital corps in consequence of their imperfect ventilation. Canvas flies on the upper and tarpaulins on the lower deck completely protected the guards from the weather. Her length was two hundred and sixty-six feet, width of beam forty-five feet, depth of hold eight feet three inches. Her carrying capacity was five hundred patients, but this number could be largely increased in mild weather. The largest number she carried on one trip was eight hundred and seventeen. The Empress made six trips, but her draught of water was such as to render her unfit for the navigation of the Tennessee and Cumberland rivers during their low stage. She was therefore discontinued as a floating hospital in June, 1862. Steamer Imperial. On April 10, 1862, the steamer Imperial, a new and very large boat, was fitted up as a transport for sick arid wounded by Surgeon J. H. Grove, U. S. V. She made four trips, carrying one thousand seven hundred and eighty-one (1,781) patients, but her services were discontinued on May 17, 1862, as her draught of water was too great for the low state of the Tennessee River during the summer season. O O Other steamers employed on the western waters were the City of Alton, the Baltic, the Ginnie Hopkins, the Mercury, Woodford, Decatur, Pringle, Nashville, etc. Space will not permit to enter in detail into a description of these boats or the nature of their service. In the eastern armies, although many boats were temporarily employed for the purpose of conveying sick and wounded, few were fitted up as regular hospital transports. In the early summer of 1862, when the scene of active operations was transferred from the interior of Virginia to the eastern seaboard on the Peninsula, it became evident that unusual means would be required to remove the sick and wounded as fast as possible from these malarial 982 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. districts to healthier localities. The boats used for the transport of troops were all under the immediate direction of the Quartermaster General. On application to the Secretary of War quite a number were turned over to the medical authorities, but these boats were desti tute of all conveniences. Perhaps the earliest boat thus assigned in the latter part of April, 1862, was the Daniel Webster. She was entirely without mattresses, bedding, medicine, and surgical appliances, but was hastily fitted up by the Sanitary Commission, filled with patients, and, on May 1st, left the York River for New York. The Ocean Queen, a large, commodious vessel, capable of carrying comfortably one thousand patients, was, a few days later, also turned over to the Medical Department and fitted up by the Sanitary Commission. When received there was not a bunk nor an article of food on board. The Ocean Queen took about nine hundred patients to New York, but, on her arrival there, was withdrawn from the hospital service and sent with troops to the Gulf of Mexico. The principal boats employed in the eastern waters, besides the two already mentioned, were the Connecticut, State of Maine, Western Metropolis, De Molay, Spaulding, Baltic, Atlantic, J. K. Barnes, Commodore, Cosmopolitan. Knickerbocker/ Elm Flo. 507. U. S. Hospital Steamship J. K. Barnes. City, etc. The capacity of the Connecticut was four hundred patients. She made altogether forty-seven trips and conveyed eighteen thousand nine hundred and nineteen (18,919) patients. The capacity of the State of Maine was three hundred patients, and she carried in forty-eight trips fifteen thousand seven hundred and eleven (15,711) patients. The capacity of the Western Metropolis was four hundred and fifty patients, of the De Molay three hundred, of the Baltic five hundred, and of the Atlantic five hun dred patients. Some of these boats were employed on the inland waters, others, like the Western Metropolis, De Molay, Cosmopolitan, and Baltic, conveyed the wounded from all points along the Middle and Southern Atlantic; coast to Philadelphia. New York, and points in the North and East. Of the latter class was the J. K. Barnes, fitted up CHAP. XV.] WATER TRANSPORTATION. 983 in New York city during the latter part of 1864, under the supervision of Assistant Surgeon A. H. Hoff, U. B. A., to whose large experience in the transport of the sick and wounded iu western waters we have had occasion to allude. The J. K. Barnes was two hundred 2 y i - i c =U ^T \ rf~~l^ 9 I k U n n i j r 1 1 1 . 5 c j Ji 3 ^J } v ar ! y nn- I d ij i 1 1 k I i n 1 Tl 7 i. ^ FIG. 508. Spar deck of the I . S. Army Hospital Steamship J. K. Barnes. a Forecastle. </ Officers mess. m Saloon. b Table. h Galley. n n Wine-room and office. c <: Hatches. i Ice-house. o Table. d d d Mess tables and mess-room. fcfcH A- Quarters of medical officers, qq Heaters. ee Pantries. II Linen-room. r Bath-room and water-closet. i >t Water-closets. t < Guard -rooms. Ward A 1, 2, 372 bunks. and twenty-three feet in length, thirty-five feet two inches beam, and twenty-two feet nine inches depth of hold. In fitting her up an orlop deck was introduced and a mess-room was built on the forward deck in front of the galley. The arrangement of the bunks is shown FlG. 509. Gun deck of U. S. Army Hospital Steamship J. K. Barnes. a Commissary storeroom. 6 Engine. c c Hatches. ddddd Ventilators, e f Wash-tables. f f Water-closets. til/ Closets. Ward C (midships), 2, 2, 4, 4 42 bunks. li h h h Steam heaters. Ward D (aft), 1, 2, :? (!:) bunks. Ward (forward), 1 . 2, 3, 4, 5, 6, 7 138 bunks. in FIG. 509. On the completion of the Barnes, Assistant Surgeon Thomas McMillin, U. S. A., was assigned as Surgeon-m-charge, and, on December 23d, was ordered to report to the. Medical Director of the Department of the South, at Hilton Head, Bouth Carolina, Ull | Ward FIG. !">10. Orlop deck of I*. S. Army Hospital Steamship .T. K. Banif a Quarters for nurses. c Baggage-room. b Knapsack-room. d Ventilator. Want E. 1. a, : 48 bunks. where she took her first load of sick on board on January 1. 1865. Bhe continued on this service until November, 1865, during which time she carried three thousand six hundred and fifty-five (3,655) patients, as follows: 984 TRANSPORTATION OF THE WOUNDED. [CHAP. XV. TABLE CLXXX. Statement of Trips made by the U. S. Army Hospital Steamship J. K. Barnes, from January 1st to November 2, 1865. I !i?\ OF DATE OF DEPARTURE. PI.ACB OF DEPARTURE. DATE OF ARRIVAL. A RIP. PLACE OF ARRIVAL. No. SICK AND WOUNDED. i 2 3 4 5 6 7.... 8 9 10 .... 11 12 .... 13 14 15 Hilton Head and Beaufort . . New Orleans January 5, 6, 1865 De Camp General Hospital, David s Island, N. Y. Grant General Hospital, Wil- let s Point, N. T. Beaufort, S. C 368 119 Q 68 :i20 439 449 385 375 217 25 845 338 198 January 31, 1865 February 25, 1865 February 26, 1865 March 14 1865 February 9 1865 February 26, 1S65 February 27 1865 Beaufort, S. C Beaufort, S. C i St r Northern Light, Port Royal, S. C. MeDougall General Hospi tal, Fort Schuyler, N. T. De Camp General Hospital, David s Island, N. Y. De Camp G. H., David s Island, N. Y., Grant G. H., Willet s Point, N. Y., McDougall G. H., Fort Schuyler, N. Y. Washington, D. C March 19 1865 March 15, 1865 April 5 1865 Beaufort, S. C [ Steamers Spaulding and 1 April 11, 1865 Wilmington and Morebead City, N. C. Beaufort, New Berne, and Morehead City, N. C. Hilton Head and Beaufort, S. C. Savannah, Ga., and Hilton Head, S. C. New Orleans, La April 24 25 1865 Apiil28, 1865 ... May 11 1865 May 19, 1865 Juno 9, 1865 July 8 ISCi Alexandria, Va June 17, 1865 July 16 1865 Philadelphia Pa New York City August 5 1865 Key West Fla ] Auo-ust23 1865 De Camp General Hospital, David s Island, N. Y. De Camp General Hospital, David s Island, X. Y. De Camp General Hospital, David s Island, N. Y. August 10 1865 Barrancas aud Fort Pick- ens Fla August 12 1865 16 17.... 18... 10 20 .... 21.... 22 23 24 .... 2V .. 1C ... 27 28. .. August 16, 1865 Beaufort, S. August 17, 186"> ... TTiltnn llpnd S. P, October 1 1865 August 19, 1K65 August 21, 1T> September 19 1865 Charleston, S. C . . . . Morehead City and New Berne N C New Oi leans, La 1 Savannali, Ga > Hilton Head, S. C J September 26. 1865 September 27 1865 November 4 1865 October 23 1865 October 25, 1865 Pensao.ltt Fla I October 27, 1865 . Key West Fla October 30, 1865 Savannah, Ga [ OctoberSl, 1865 Hilton Head S P November 2, 1865 Morehead City, N. C J Total 3,655 One of the greatest difficulties that the Medical Department had to contend with in the early part of the war was its want of control over the hospital transports. Many boats were assigned for the conveyance of wounded, but no sooner had they been fitted up and had made a few trips than they would be claimed by the Quartermaster s Department, by which they had originally been chartered, as transports for troops. When they were finally returned to the Medical Department they had been stripped of all the appurtenances for the comfort of the sick, thus necessitating their refitting at enormous costs. This anom alous condition continued until November, 1863, when the hospital steamer Cosmopolitan, which had been used in transporting sick from one point to another in the Department of the South, was taken away from the Medical Department and turned back to the Quarter- CHAP. XV. J WATER TRANSPORTATION. 985 master s Department by order of Major General Gilmore. The Acting Surgeon General requested the return of the steamer to the Medical Department, which being rei erred to General Gilmore for remark, he replied that the vessel was only temporarily loaned to the Medical Department, and that "as commanding officer of the department I hold myself responsible for the administration of its internal affairs, and consequently assume the right to apply its resources as the exigencies of the service may seem to require." To this endorsement the Acting Surgeon General replied, on December 25th, in the following letter to the Secretary of War : "SURGEON GENERAL S OFFICE, "December 25, 1863. "Sra: I have the honor to acknowledge the receipt of Major General Gilmore s endorsement upon my application for the restoration of the steamer Cosmopolitan to the Medical Director, stating that the steamer Cosmopolitan belongs to the Quartermaster s Department, and was placed at the disposal of the Medical Director for temporary purpose by orders from these headquarters. " In the request of November 24th no question was made of the power of the general com manding the department to dispose of the steamer, but the necessity for her services was stated as a reason for her restoration. The Cosmopolitan was selected by the then Medical Director, under orders from Major General Hunter, and by his orders was fitted up and especially assigned to the Medical Department as a hospital steamer, and not as a temporary transport. All hospital steamers are owned or employed by the Quartermaster s Department, but their outfits and move ments are under charge of the Medical Department. Upon the only occasion of emergency when Major General Hunter used the Cosmopolitan as a dispatch boat he did so after advisement with his Medical Director * * * * a Very respectfully, your obedient servant, (Signed) "J.K.BARNES, "Acting Surgeon General." The Secretary of War directed the steamer to be returned to the Medical Department, which was accordingly done; but in the following June she was again taken from it by O *i O cj J General Hatch, and much suffering to the sick and wounded resulted. A similar interfer ence with the Medical Department in the case of the hospital steamer Spaulding was reported to the Surgeon General by Medical Inspector G. H. Lyrnan, in December, 1864. This report was forwarded to the Secretary of War with the following endorsement: "Respectfully forwarded to the Honorable Secretary of War, with the urgent request that orders may be issued prohibiting interference with hospital transports by other departments. "The hospital transport Spauldiug has just been fitted up at great expense, and was dis patched to meet General Sherman s army upon notification of its arrival at Savannah. To divert it to other purposes entirely cripples this Department in its efforts to provide properly for the sick and wounded, and subordinates all its interests to the caprice or whim of local commanders. (Signed) " J. K. BARNES, " Surgeon General? " S. G. O., January 3. 18U5." On January 23, 1865, the Surgeon General addressed a further letter to the Secretary of War on this subject, of which the following is a copy: " SURGEON GENERAL S OFFICE, "January 23, 1865. " SIR : From the nature of the service upon which they are employed it is absolutely essential that hospital transports and hospital boats should be exclusively under the control of the Medical Department, and not, under any circumstances, diverted from their special purposes by orders of local commanders or officers of other departments. I have, therefore, the honor to request that BKOWN (II. E.), Tlu Medical Department of the United States Armyfrom 1775 to 1873. Washington, D. C., 1 873, page 243. SURG. Ill 124 986 TRANSPORTATION OF THE WOUNDED. [CHAP. xv. orders to this effect be issued, and that the hospital steamer Cosmopolitan be restored to the Medical Department and placed under the immediate control of the Medical Director, Department of the South, at Hilton Head, South Carolina, to be used as a hospital tender for the troops opera ting under Major General Sherman in that department. "Very respectfully, your obedient servant, (Signed) "J. K. BARNES, "Surgeon General." In accordance with this request the following order was issued on February 8th: "WAR DEPARTMENT, ADJUTANT GENERAL S OFFICE, " WASHINGTON, February 8, 1865. " GENERAL ORDERS No. 18. "Hospital transports and hospital boats, after being properly assigned as such, will be exclu sively under the control of the Medical Department, and will not be diverted from their special purposes by orders of local or department commanders, or of officers of other staff departments. " BY ORDER OF THE SECRETARY OF WAR. (Signed) "E. I). TOWNSEND. "Assistant Adjutant General. This order effectually ended the interference of local or department commanders and vested the control of the hospital transport steamers where it properly belonged- i. e., in the Medical Department. LIST OF PLATES. 1. PLATE XXVIII, facing p. 18. GANGRENE FOLLOWING A SHOT LACERATION OF THE FEMORAL ARTERY. Case of G. "VV. Gardner, page 18. (Chromolithograph.) 2. PLATK L VI, facing p. 27. DRY TRAUMATIC ARTHRITIS OF THE RIGHT Hi P. Specimen 5518. Case of Albert McGee, page 27. ( Heliotype.) 3. PLATK XXVII, facing p. 53. EFFECTS OF HOSPITAL GANGRENE. Case of C. II. Dudley, page 5:>. (Chromolithograph.) 4. PLATE LVII, facing p. 68. GUNSHOT FRACTURE OF THE RIGHT ACETABULUM AND THE HEAD OF THE FEMUR. Case of Jame>? C. Strong, page 08. (Lithograph.) 5. PLATE XXXIII, facing p. 74. CONSOLIDATED GUNSHOT FRACTURE OF THE FEMUR. Case of Philip Sweeny, page 74. (Lithograph.) 0. PLATE LIX, facing p. 178. CONSOLIDATED GUNSHOT FRACTURE OF THE FEMUR. Two figures. FIG. 1, case of W. Rigney, page 178. FIG. 2, case of T. Crassley, page 182. (Lithograph.) 7. PLATE LVIII, facing p. 180. CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR. Two figures. FIG. 1, case of D. Lewis, page 179. FlG. 2, case of A. F. Dinsmore, page 179. (Lithograph.) 8. PLATE LV, lacing p. 182. Two VIEWS OF A UNITED SHOT FRACTURE OF THE UPPER EXTREMITY OF THE RIGHT FEMUR OVER 11 YEARS AFTER INJURY. Case of E. L. Postley, page 182. Specimen 659b . (Lithograph.) 9. PLATE XXV, facing p. 184. SECONDARY INFLAMMATION OF THE KNEE JOINT. Case of William Ziliox, page 18f>. (Chromolithograph.) 10. PLATE LX, facing p. 188. CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR. Two figures. FIG. 1. case of J. Buckley, page 188. FIG. 2, case of J. Hamilton, page 188. (Lithograph.) 11. PLATE LXI, facing p. 190. CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR. Two figures. FIG. 1, case of A. Ryder, page 188. FIG. 2, case of T. Miller, page 190. (Lithograph.) 12. PLATE LXI I, facing p. 192. CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR. Two figures. FIG. 1, case of H. E. Gumberts, page 192. FIG. 2, case of H. Shelter, page 192. (Lithograph.) 13. PLATE XXIV, facing p 194. OSTEOMYELITIS IN A FRACTURED FEMUR. Case of Tobias Sever, page 193. Specimen 2167. (Chromolithograph.) 14. PLATE LXIII, facing p. 19,!. CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR. Two figures. FIG. 1, case of J. Durst, page 194. FIG. 2, case of M. Burns, page 195. (Lithograph.) 15. PLATE LXIV, facing p. 198. CONSOLIDATED GUNSHOT FRACTURES OF THE FEMUR. Two figures. FIG. 1, case of R. Hanlon, page 198. FlG. 2. case of J. O Connor, page 190. (Lithograph.) 10. PLATE XXX, facing p. 204. OBSTRUCTED FEMORAL VEIN. Case ut Jonathan Wallace, page 204. (Chromolithograph.) 17. PLATE LXIX, facing p. 224. TUBULAR SEQUESTRA FROM AMPUTATIONS OF THE FEMUR. Four figures. FIG. 1, case of II. H. Ellis, page 288, Specimen 1853. FlG. 2, case of J. Nash, page 288, Specimen 144. FIG. 3, case of J. Glassie, page 288, Specimen 3100. FIG. 4, case of J. McMahon, page 223, Specimen 4281. ( Lithograph.) 18. PLATE XXXII, facing p. 226. DISEASED STUMP OF FEMUR. Case of John Sproul, page 225. (Chromolithograph.) 19. PLATE XXXI, facing p. 228. GANGRENE OF THE MEDULLA. Case of John Sproul, page 225. (Chromolithograph.) 20. PLATE LXX, facing p. 242. INVOIUCRA OF THE FEMUR. Four figures. FlG. 1, case of W. Vannatta, page 287, Spec imen 2602. FlG. 2, case of J. Miller, page 241, Specimen 1094. FlG. 3, case of J. Wearing, page 224, Specimen 4196. FIG. 4, case of L. C. Griffin, page 293, Specimen 3141. ( Lithograph.) 21. PLATE XXVI, facing p. 278. OSTEOMYELITIS OF FEMUR. Case of Clark Chase, page 279. Specimen 6715. (Chromo lithograph.) 22. PLATE XLII, facing p. 280. ROUND MUSKET BALL IN THE MEDULLARY CAVITY OF THE FEMUR. Case of E. Kirby, page 280. Specimen 1076. (Lithograph.) II LIST OF PLATES. 23. PLATE XLIII, facing p. 290. RESULTS OF OSTEOMYELITIS. Five figures. FIGS. 1, 2, and 3, case of W. Sailor, page 289. FJUS. 4 and 5, case of J. X. Saxtoii, page 290. (Chromolithograph.) 24. PLATE XXI. facing p. 292. GANGRENE OF A THIGH STUMP. Case of lt r . E. Davis, page 291. (Chromolithograph.) 25. PLATE XX, facing p. 294. FEMORAL ARTERY AND FEMORAL VEIN AFTER AMPUTATION. Two figures. Case of D. A. Baruett, page 292. Specimens 3991 and 2246. (Lithograph.) 26. PLATE LXVI, facing p. 30o. SHOT FRACTURE OF THE MIDDLE THIRD OF THE FEMUR. Case of John Pool, page 306. Specimen 2229. (Chromolithograph.) 27. PLATE XXIII, facing p. 312. SEPARATION OF PERIOSTEUM IN OSTEOMYELITIS. Case of E. W. Cappt, page 312. (Chromolithograph.) 28. PLATE XLIX, facing p. 314. MEDULLARY ABSCESSES OF THE FEMUR. Case of E. W. Capps, page 312. (Chromo lithograph.) 29. PLATE LXXII, facing p. 317. INVOLUCRA OF BONKS OF THE LEG. Two figures. FIG. 1, case of Oliver Payne, page 528, Specimen 4740. FIG. 2, case of W. H. Miller, page 317, Specimen 4172. (Lithograph.) 30. PLATE LXXIII, facing p. 35(>. THIGH STUMPS. Six figures. Specimens 367, 417, 4317, 3022, 3513, 2306. (Chromo lithograph. ) 31. PLATE LXVIII, facing p. 370. RKSULTS OF SHOT INJURIES OF THE KNEE JOINT. Two figures. FIG. 1, case of T. W. Robertson, page 378. FIG. 2, case of P. Stuck, page 370. (Lithograph.) 32. PLATE LXVII, facing p. 372. BALI. LODGED IN OUTER CONDYLE OF LEFT FEMUR OVER 15 YEARS. Case of E. B. Blake, page 372. Specimen 6812. (Lithograph.) 33. PLATE LXV, facing p. 386. SUCCESSFUL EXCISIONS OF THE KNEE JOINT AFTER SHOT INJURY. Two figures. FIG. 1, case of C. Knowlton, page 391. FIG. 2, case of A. Rider, page 386. ( Lithograph. ) 34. PLATE LXXI, facing p. 428. TUBULAR SEQUESTRA AND PIECES OF NECROSFD BONE FROM TIBIA. Four figures. FIG. 1, case of H Rail, page 428. FlG. 2, case of J. Walker, page 435. FIG. 3, case of O. M. Armstrong, page 529. FIG. 4, case of G. Cullom, page 520. (Lithograph.) 35. PLATE LXXIV, facing p. 434. UPPER PORTION OF RIGHT TIBIA SAWN LONGITUDINALLY. Case of Colonel W. F. Lynch, page 435. Specimen 0734. (Lithograph.) 36. PLATE LXXVI, facing p. 478. LACERATION* OF RIGHT LEG BY SOLID SHOT. Case of D. Jerman, page 478. (Chro molithograph.) 37. PLATE LXXV, facing p. 596. AMPUTATIONS AT THE ANKLE JOINT. Four figures. FIG. 1, case of W. (J. Weeks, page 597. FIG. 2, case of J. E. Avers, page 59<>. FIG. 3, case of J. H. Short, page 603. FIG. 4, case of A. K. Rus sell, page 596. ( Lithograph ) 38. PLATE LXXVIII, facing p. 710. DISTORTED BULLETS. Figures of twenty specimens in Army Medical Museum. (Lith ograph.) 39. PLATE XXXIX, facing p. 712. EARLY APPEARANCES OF ENTRANCE AND EXIT SHOT WOUNDS. Tioenty-three figures. (Chromolithograph.) 40. PLATE XL, facing p. 714. EARLY APPEARANCES OF ENTRANCE AND EXIT SHOT WOUNDS. Twenty-four figures. (Chromolithograph.) 41. PLATE XXXVIII, facing p. 741. FACIAL PARALYSIS CONSEQUENT ON SHOT INJURY. Case of Dr. R. D. Murray. 42. PLATE LXXVII, facing p. 808. TRAUMATIC ANEURISM. Case of Francis M. Denton, page 809. (Chromolithograph.) 43. PLATE LXXIX, facing p. 818. FIG. 1, THE LEFT FEMORAL VEIN AFTER DEATH FROM PYAEMIA; caseot W. Sailor. page 289. FIG. 2, GANGRENE OF FOOT AFTER SHOT WOUND OF LEG ( UPPER THIRD); case of W. Steel, page 850. (Chromolithograph.) 44. PLATE XXIX, facing p. 850. DRY GANGRENE OF THE FEET. Case of H. Strauss, see page 850. (Chromolithograph.) LIST OF OPERATORS AND REPORTERS. Page. ABADIE, E. H 882 ABBOTT, C 225 ABBOTT, N. W 93 AD AMS, E 217 ADAMS, H. N 526 ADAMS, 483 ADAMS, O. H 472 ADAMS, S 243, 464, 470, 474, 482, 489 ADAMS, W. S 29, 37, 50, 244, 245, 248, 257, 206, 276, 294, 298, 434, 462, 465, 476, 544, 801 , 853 ADAMS, Z. B 361, 485 ABLER, J. M 253 ADOLPHUS, P. . .2(13, 286, 315, 664, 719, 723, 768 AGNEW, D. H 148,149,156 AIKEN, J 48, 281, 286, 454, 471, 626, 790 AINSWORTH, F. L 260 ALBRIGHT, F. G 500, 527, 542 ALDEN, C. H 106,627 ALEXANDER, C 212,234 ALEXANDER, C. T 75, 429, 548, 767, 774, 817, 822 ALEXANDER, J. W 472,481 ALLEMAN, L. J 581 ALLEN, A 793 ALLEN, A. L 321 ALLEN, C. G 222 ALLEN, C. H 286, 469 ALLEN, C. L 86, 183, 622, 634, 780 ALLEN, D. B 477,502 ALLEN, G. T 361 ALLEN, H 17, 47, 85, 109, 112, 185, 283, 300, 312, 379, 406, 442, 456, 459, 546, 549, 553, 633, 634, 66:3, 677, 714, 773, 777, 784, 850 ALLEN, J 6 ALLEN, S. J 87,141 ALLEN, W. J 501 ALLEN, W. W 228 ALLISON, T. H 549 ALTMAN, W 498 AMEN, M. V .670, 672, 677 ANAWALT, J. W 222, 262, 451, 469, 472 ANDERSON, H. P 534 ANDERSON, W 519,549 ANDREW, A. D 533 ANDREWS, A. W. K 276, 531 ANDREWS, E 314, 342, 595, 6C8 ANDREWS, J 678 ANDRUS, C. II 227,234,236, 238, 251, 260, 276, 450, 467, 623, 626, 754, 882 ANGELL, J. W 269, 884 ANSELL, A 312, 316, 321, 534, 554, 779 ANTISELL, T 42, 170, 282, 382, 470, 788 APPLEGATE, J. W 467, 605 APPLET, W 220 ARMSBY, ,T. H 17,187,235, 278, 295, 309, 429, 446, 529, 553, 791 ARMSTRONG, D. II 495, 502 ARMSTRONG, J. A 269, 371, 517 ARMSTRONG, O. H 468,501 A RNDT, P. S 468, 488, 489, 495 ARNOLD, A. E 248 ARNOLD, J 352 ARRINGTON, W. J 479, 484 ARTAUD. T 459 ARTER, J. R 209, 388 Page. ARTHUR, C. S 260 ARTHUR, J. P 55, 57, 58, 526. 550 ASH, J 217, 248, 489, 727 ASHHURST, J., jr. .23, 43, 126, 129, 173, 680, 779 ATKINS, F. H 435 ATKINSON, A 315, 455, 536 ATLEE, W. F 51, 52, 174, 783, 802, 803 ATWOOD, A. A 471 AUSTIN, A. S 675 A VENT, B. W 74 AVENTS, J 280 AVERDICK, II. G 222 AVERY, G. W .... 106, 112, 157, 216, 219, 232, 235 A VERY, J 256 AYERS, J. H 472 AYRES, D. C 471, 484, 492, 495, 523 AYRES, S. C 11, 55, 58, 234, 774 AZPELL, T. F 36,773 BABCOCK, W. A 489,497 BACHE, D 70, 66 1 BACHE, T. H 37,443,536 BACON, C.,jr 322,455, 473, 534, 554, 661, 668, 669, 675 BACON, F 106, 279, 286, 516, 541, 667, 676 BADGER, G BAGULEY, D 469. BAILEY, A. W BAILEY, E. I BAILEY, F. K 712, BAILEY, J. C BAILEY, J. R 271, BAILEY, J. S 197, BAILEY, T. P BAILEY, W. W BAINE, G. H BAKER, J. W. H... BAKER, L. H BALDWIN, L. K 374,739, BALDWIN, M BALDWIN, R. F 48, BALDWIN, R. T BALDWIN, W. H BALEY, G. D BALL. A 135, 296, BALL, C. E 78, BALLOU, L. T BALSER, W 276, 2<J8, 527, 547, 662, BANCROFT, F. J 133, 138, BANE, G. II BANKS, W. A BANNISTER. T. O 47,181,196,299,392, BANTA, J. Q. A BARBARIN, F. S BARBER, J BARETTE, B. A BARKER, T. C BARLOW, A. C. . .264, 390, 450, 472, 498, 500, BARNARD, C. F BARNES, A. S BARNES, A. T 483, 518, BARNES, F BARNES, F. N 250, BARNES, I. N 231,450, 470, 482,. 626, BARNES, L 253, 487, 510, B ARNES, N. R 245, 250, 502, 55 496 386 [39 81 ; 314 V, 5 .M I? 259 883 58 S47 776 66] 536 53] 585 301 1 16 381 L98 678 01 580 54 ; 18 450 619 721 632 55 357 552 298 266 780 886 632 Page. BARNES, N. S 73, 243, 246, 481, 760 BARNEY, L 220 BARR, R 217, 389, 457 BARRY, W. A 3:;, 234, 248, 251, 254, 277, 297, 298, 3C2, 479, 480, 487, 499 BARTHOLF, J. H 19,29,30,49,205. 238, 274, 280, 301, 383, 446, 521, 524, 527, 582, 651, 672, 785, 798 BARTHOLOMEW, J. H 11 BARTHOLOW, R 70, 81, 117, 119, 209, 210, 314, 321, 322, 448, 517, 523, 524, 541, 543, 546, 548, 549, 554, COS, 607, 658, 668, 790 BARTLETT, A. T 235, 245, 452, 475, 497, 508, 630, 631 BARTON, E 180 BARTON, M. H 524 BARTRAM, T. S 541 BARUCH, S 531 BASCOM, J. B 179 BATEMAN, R. T 139,144,296 BATES, C. C 374 BATES, J. A 284 BATTEY, R 247, 470, 541 BAT WELL, E 48, 172, 203, 219, 209, 247, 248, 281, 356, 449, 467, 482, 487, 488, 632, 797 BAUDUY, J. K 6 BAUER, H 234 B A U E R, L 55, 56, 1 57 BA UGH, T. W 314, 668, 861 BAUSCH, C 519, 675 BAXTER, A. J 370 BAXTER, J. B 296 BAXTER, J. B. G 506,518,525,679 BAXTER, J. H 207,321, 522, 524, 532, 535, 552, 554, 676 BAXTER, M. L 534, 535 BAYLES, G 139 BAYLOR, J. C 773,788 BAYLOR, W. L 87, 251, 253, 254, 300, 676, 789 B A YNE, J. H 154 BEACH, J. N 235,262,264 BEAKS, G. M 251,266 BEATTY,J.E 240 BECK, E. W. H 251,485,495 BECK, S. L 643 BECKET, T 320 BECKWITH, E. W..., 247 BEEBE, G. D 232,340 BEEBE, O. 1 651 BEECH, G. W 236 BEECH, J. H 203, 232, 235, 264, 265, 294, 467, 471, 520, 525, 630, 811 BELDEN, A. P 429 BELL, D. C 320 BELL, D. H 297, 535 BE LL, J 69, 375 BELL, J. B 642 BELLANGEE, J. B 286,581 BELLOWS, C. J 228, 482, 496 BELLOWS, H. M 23, 51, 224, 551, 553, 673, 795, 804 BELTON, T. F 299, 492 BENEDICT, A. C 228 BENEDICT, M. D 70, 230, 314, 388, 391, 882 BENJAMIN, M. N 524,680 BENNETT, J 233, 253, 255, 257, 259, 484, 675 [V LIST OF OPERATORS AND REPORTERS. Page. BENNETT, J. H 542 BENNETT, \V. C.233, 242, 255, 270, 488, 501, 503 BENSON, J 69 BENSON, W. K 230 BENTLEY.E 8, 48, 54, 55, 56, 58, 70, 78, 61, 84, 130, 144, 145, 150, 151, Kit, 162, 176, 180, 182, 183, 191, 215, 222, 233, 245, 252, 2G5, 273, 275, 277, 2SO, 281, 28- , 283, 284, 285, 286, 29C, 297, 298, 299, 300, 302, 303, 313, 31 4, 315, 316, 322, 323, 363, 381, 393, 394, 4C4, 405, 406, 407, 441, 448, 455, 456, 465, 518, 522. 524, 526, 527, 531, 532, 533, 534, 535, 549, 550, 585, 589, 006, 626, 627, 634, 644, 666, 669, 670, 675, 676, 768, 769, 779, 783, 784, 787, 788, 789, 790, 792, 802, 803, 807, 811 BERRY, A. J 68,672 BERRY, W 486 BEUST, B 375,532 BIBB, O. K 542 BIGELOW, C. P 299, 519, 781 BIGELOW, H. J 297, 542, 668, 671 BIG ELO VV, J. A 295, 302, 490, 884 BIGELOW, J. K 115, 119, 218, 227 BIGSBY, G 553 BILL, J. H 71,77, 104, 111 BILLERT. F. W 624 BILLINGS, A. J . -177 BILLINGS, J. S .. 94,105, 108, 111, 112, 154, 203, 233, 281 , 283, 297, 29! . 406, 488, 505, 523, 527, 54::, 585, 619, 658, 659 B1R. IIETS, T. C, .... 4:!3 BISSELL. E. L... . 517 BLACK, H ....523 BLACK, W . :,;!i BLACKMAN. G. C . . . ... 97, 100, 104,112, 114, 142, 144, 14i:, 151, 162, 314, 395 BLACKWOOD, S ... ...50,210 BLACKWOOD, S. \V 531 , 777, 7*4, 799, 804 BLACKWOOD, W. K.I) 229 BLAIR, W. W . . 343 BLANCIIARD, C. S . . . . 486 BLANCK, O 525 BLAND, D. W 496 BLANDRY, U. H . . .300, 320 BLANEY, J. B. X . . 30 BLICKIIAHN, G. H .. . 482 BLISS, C . 157 BLISS, D. W 8, 26, 31, 32, 47, 54, 58, 84. 1 10, 112, 180, 190, 278, 280, 281, 282, 283, 284, 285, 86, 293, 294, 295, 296, 305, 308, 31J, 313, 314, 315, 321, 353, 365, 390, 435, 439, 518, 522. 523, 524, 525, 527, 529, 531, SK>, 534, 535, 54 1 , 542, 543, 548, 549, 588, 598, 605, 634, 650, 666, 768, 771, 851, 868 BLISS, E.L 626 BLISS, L. W... 239,243, 246, 254, 255, 260, 266, 484, 489, 510, 626, 885 BLISS, Z. E 84. 195, 282, 431, 438, 483, 516, 518, 527, 534, 535, 541, 543, 548, 661, 667, 672, 676, 768 BLOUNT, J 515 BLUNDELL, W 469 BLUNT, X. F 245, 495, 498 BOARDMAN, H 409 BOBBS, J. S 115 BOCKEE, J 182, 281 BODMAN, L. H 756 BOGUE, R. G : C6G BOISNOT, J. M 459, 505 BOND, B. N 225, 250,251, 259, 267, 269, 283, 452, 475, 499. 501, 508, 6:72 BOND, R. C 282 BONINE, E. J 181,219,250 BONNER, S. P 22 7) 233 245, 247, 249, 250, 253, 268, 534, 671 Page. BONTECOU, R. B 14,27, 31, 32, 36. 44, 47, 50, 51, 53, 54, 55, 56, 58, 74, 75, 78, 118, 119, 133, 152, 171, 173, 178, 182, 183, 188, 190, 193, 210, 244, 253, 256, 283, 284, 285, 286, 289, 295, 297, 298, 299, 300, 301, 302, 303, 321, 322, 371, 374, 379, 386, 387, 392, 393, 399, 406, 407, 40!), 430, 433, 434, 438, 455, 456, 490, 493, 518, 531, 535, 550, 551, 553, 554, 591, 594, 599, 602, 603, 604, 605, 606, 608, 619, 651, 668, 673, 677, 678, C80, 721, 769, 771 , 775, 776, 780, 790, 792, 793, 795, 796, 801 BOONE, J 235 BOONE, J. H 459 BOOR, W. H 646 BOOTH, D. S 281 BORCK, E : 459 BOUCHER, J. H 143 BOULWARE, W. P 373 15OURNONVILLE, A. C 84, 186, 197, 394 BOWDITCH, II. I DO WEN, C. II 58, 318 BO WEN, G. W 466 BOWEN, J. B 365,367,604 BO W ER, C 218, 220, 226, 232, 236, 245, 254, 262, 470, 472, 484, 494, 626, 629, 631 BOWES, M. F 84,281,881 BOWIE. A 496 li< >WLBY, W. W 252, 393 BOWLES, B. F 276 BOWMAN. E. H 517 P.O W.MAN, .1 710 BOYD, S. S 308,519 BUYER, P. C 513 BOYLE, C. E 516, 553, 669, 674 BRADFORD. F. G. II 294,298, 2H9, 304, 322, 456, 626, 771, 778, 822 BRADLEY, E 12, 72, 378 BRADLEY, O. II 542 BRADSHAW, II. N 648 BRADT, J. G 218, 220, 466, 473, 483, 488 BRADY, J 253 BRADY, J. W 401} BRAINARD, D : 39, 44 BRAINERD, T. C 224, 321, 428, 463, 550, 552 BRAMLETTE. W. II 770 BRANCH, T. W 55 BRAUX, L 466 BRECK, W. G 543 BREED. B. B 56,155,208,221, 315, 321, 322, 526, 5-11, 551, 554, 586, 623, 624, 626, 676, 769, 773, 779, 804 BREXNAN, G. M 481 BREXNEMAX. E. I) 195,226,785 BRENT, C. P 231 BRENTOX, J. L 220, 256, 271, 508, 631 BREVARD, E. L 296, 298 BREWER, G. ft 769 BREWER, J. W 587 BKEWSTER, O. E 581 BRICKETT, G. E 58, 248, 294, 320, 548, 635, 674, 675, 778 BRIDGE, W. W 381, 523 BUIGGS, C. E 470 BRIGGS, G. W 489, 601 BRIGGS, L 542 BRIGGS, S. W 51,802 BRIXTOX, D. G 648 BRINTOX, J. B 286, 315, 394, 480, 518, 523, 533, 550, 797 BRIXTOX. J. H 18,46,80, 282, 291, 339, 347, 381, 402, 403, 405, 480, 491 , 492, 495, 635, 710, 718, 787, 810, 830, 831, 836 BRISTOL, B. J 319, 599 BROCK, C. W. P 321, 323, 633, 634 Page. BROCK, J. W 135, 138, 222, 232, 246, 884 BROCKWAY, A.X 302 BRODIE, R. L 96 BRODXAX, J. G 549 BRONSOX, J. R 315, 431 BROOKE, J 184 BROOKS, G. W 518 BROOKS, N. G 586 BROWER, D. R 27,201, 301, 322 BROWX, B. P 669, 820 BRO WX, C. H 866 BROWX, F. H 301,527,531 BROWX, H 249 BROWN, H. E 54,95,253,322 BROWX, H. W 325 B RO W X, J. A 52, 652 BROWX, J. B 78, 699 BROWX, J. J 310 BROWX, J. M 48, 293, 298 BROWN, J. T 281,495 BROWN, L. C 673 BROWX, R. B 254 BROWX, R. H 675 BROWX, W. W 249 BROWXE, J. M 795 BROWXE, R. K 133, 376 BROWXELL, W. R 254 BRUBACKER, H 370, 654 BRUCE, J. S 247 BRUCKER, M 267, 482, 484, 660 BRUMBAUGH, A. B 447 BRUMLEY, J. D 514, 642, 789 BRUNDAGE, A. H 246,247 BRUXER, J. F 295, 297 BKUXS, J. D 82 BRYAN, J ... 26, 636 BRYAX, S. P ...516 BRYAXT, II 294, 296, 297, 299, 300, 408, 531 , 605, 674 BRYANT, W. G 250,298,314,450,488 BUCHANAN, . I. A 634 BUCHANAN, J. G 801 BUCHANAN, W. F.. 121 BUCK, D 519 BUCK. E. J 55, 229, 264, 267, 270, 885 BUCK, G 152, 158, 159, 408, 409, 607 BUCK, R. H 671 BUCK, S. S 511 BUCK, S. T 632, 664, 669, 67(5 BUCK, W 470 BUCKLEY, B. T 648 BUCKLEY, W. B. 310 BUCKMAN, J. II 250, 263, 482, 499 BUCKMAN. J. W 246,482 BUCKMASTER, II 548 BUFFIXGTOX, A. L 410 B UI S T, J. R 135, 1 38, 302 BULLARD, G. B 437 BULLEX, c. F 298, 302, 535 BUMSTEAD, s. J 684 BURBECK, C. H 264 BURDETT, ft. M 55, 263,405, 519 BURDICK, J. T 154, 620, 748 BURGESS, W. J 249 BURKE, F. X 14, 211, 212, 046 BURKE, G. W 210, 222, 234, 293, 321, 542 BURKE, W. R 674 BURKET, G. W 642 BUUMEISTER, F. F . . 1 34, 266, 283, 301 , 527, 529 BURNS, J. B 54,631 BURNS, W. W 69 BURR, ft 323, 716, 804 BURR, W. J 206,250,261. 283, 285, 318, 402, 451, 465, 466, 471 , 473, 477, 485, 498, 510, 51 1, 780, 885 BURR1TT, H. L. W 54, 301, 379 LIST OF OPEEATOES AND REPORTERS. Page. BURT, J. C 70 BURT, S. S 378 BURTON, M 646 BURTON, W. II 507 BUSH, J. F 373 BUSHEY. F. A 281, 619 BUTCHER, B. F 32, 58, 273 BUTCHER, H. B 543 BUTLER, J. II 320 BUTLER, W. H 469, 518 BUTT, II. F 471 BUTTERBAUGH, J 458 BUTTON, G. B 884 BUTTON, J. I)..- . 649 BUZZELL, A. J. H 256,601 BYERS, G 10,785 BYINGTON. W. C 249 BYRNE, C. C 26,301,302, 405, 455, 51 7, 525, 532, 535, 587. 623, 661 , 723 CABELL, J. G... 95 CABOT, S 320, 674 CADWALLADER, D. W 428 CADY, C. E 219 CADY, W. F 258 CAIN, J. S 485 CAKE, W. M 387 CALD WELL, D. G 517, 634 CALHOUN, A. W 548 CALHOUN, J. T 24, 133, 232, 234, 239, 250, 402, 475, 483, 536, 575, 654, 674, 675 C ALLA WAY, L. H 676 C AMAC, W 22 CAMERON, C. D 2C8 CAMPBELL, A 225, 239, 517 CAMPBELL, A. B 647 CAMPBELL, C. M 217, 251, 256 CAMPBELL, II. F 506 CAMPBELL, J... .... 498 CAMPBELL, W 268 CAMPBELL, W. F .. 35 CANTWELL, J. Y 207, 247, 708 CAPERS, L. G : 250, 472 CAREY, E. R 308 CAREY, M. T 95,99,221 CAREY, W. B 266,675 CARHART, G. L 231, 239, 248, 452, 480 CARLE, C 216,485,502 CARLTON, S.T 446 C ARNOCHAN, J. M 134, 138, 162 C AROTHERS, A. E 130, 282, 339, 627 CARPENTER, H. W 252, 467, 499 CARPENTER, J. T 27,74,666 CARPENTER, S. D 607 C ARR, A. B 673 CARR, G. W 206, 251, 401 CARRIER, C.W 315, 554 CARRINGTON, W. A 542 CARROLL, J 282,557 CARROLL, R. W. W . . 286, 353, 456, 519, 523, 626 CARROLL, T 524, 531, 535 CARROLL, \V 253, 284, 285, 296 CARSON, W 14 CARTER, N. M 228 CARTER, R. K 157, 159 C ARVALLO, C 106, 258, 291, 298, 526, 584, 620, 717 CASE, M 229 CASEY, W. B 58, 322 CASS, J 20, 82, 286, 301, 321, 519 CASSELBERRY, I 313,430 CASWELL, E. T 300 CH ADDOCK, G IPS, 228, 260, 262, 264, 271 , 450, 469, 474, 484, 496, 598 CHAMBERLAIN, C. N 32, 195, 202, 255, 257, 261, 435, 466, 492, 549, 550, 588, 591, 597 CHAMBERLAIN, D. A . . . .73, 245, 248, 456, 501 Page. CHAMBERLAIN, W. M 195, 598, 644 CIIAMBERLIN, D. P 472 CHAMBERS.S.R 532 CHAMBERS, W. B 56, 228, 250, 452, 483, 496, 524, 866 CHAMBERS, W. M 589, 726 CHAMBLISS, J 39, 788 CHANCELLOR, J. E 507 CHANDLER, C. M 229 CHAPEL, A 69, 70, 75, 82, 297, 450 CHAPIN, A. B 284 CH APIN, J. B 447 CHAPIN, S. F 82, 84, 262, 443, 470, 474, 546, 601, 632 CHAPMAN, J 218, 231, 251, 256, 259, 449, 486, 498, 601 CHASE, E. G 137, 138, 275, 482, 487, 503 CHASE, H. M 70 CHASE.J.B 746 CHEANEY, S. L 506, 509 CHEARS, B .. 506 CHEEVER, U. W 516, 624, 627, 769 CHERBONNIER, A. V. . 56, 71, 72, 212, 258, 280, 318, 322, 458, 459, 527, 537, 540, 542, 543, 587 CHESLEY, G. A 298, 608, 769 CHILD, W. A... 194,491,497 CHILD, W 356 CHISOLM, J. J 35, 341 CHRIST, T 238, 487 CHRISTY, G. B 601 CHRISTY, II. C 245 CHRITZMAN, H. G... . 401 CHURCHILL, A 234,239 CHURCHMAN, H. J 285, 286, 339, 343, 349 CLAIBORNE, J. H 408 CLAPP, W. A 528 CLARDY, S.F 203 CLARK, A. M 237, 249, 251, 467, 504, 516 CLARK, A. P 95, 100, 227, 253, 256, 402, 481, 495, 656 CLARK, C. C 481 CLARK, C. M 55, 95, 98, 99, 100, 201, 203, 206, 218, 222, 228, 232, 233, 234, 240, 246, 249, 252, 261, 494, 496, 502, 627, 630 CLARK, E. A .- 285, 308, 504, 553, 675, 866 CLARK, E. P 400 CLARK, H. K 472 CLARK, R. R 218,262,481,663 CLARK, W. R. S 308 CLARKE, D 742 CLARKE, W. E 527 CLAUDE, A 673 CLE AVELAND, C. H 809, 843 CLEEMAN, R. A 542 CLELLAND, H. A 181 CLEMENTS, B. A . .57, 106,110, 112, 282, 289, 300. 462, 463, 479, 520, 526, 538, 596, 597, 607, 643 CLEMMER, W. L 542 CLEMONS, P. H 489 CLENDENIN, W 16,389 CLEVELAND, J. F 487 CLEVELAND, W. K 44,47, 283, 284 ; 286, 316, 548, 792 CLIPPINGER, G. W 115, 517 CLOAK, B 11, 323, 361, 538, 623, 624, 719 CLYMER, M 434, 536, 635 COALE, R. W 18, 47, 58, 301, 394, 518, 548, 549, 669, 775 COCHRAN, M. B 485 COCKRELL. J. J 299, 301 COE, A. S 26, 238, 247, 252, 261, 472, 480, 502, 528, 881 COFFMAN, V. II 471 COGGSWELL, G. B 219, 221, 230, 248, 254, 326, 485, 486, 501, 771 COGSWELL, M. F 36 Page. COHEN, J. S 48,790 COLBURN, A. W 458, 549 COLHY, G. W 232 COLE, H. B 47, 48, 793, 796 COLEM AN, R. T 55 COLGAN, J. P 233 COLLAMORE, G. A 256, 340, 341, 474 COLLINS, G 553 COLLINS, J 76,650 COLOOSDIAX, S 284, 297, 519, 802 COLTON, C. M 104, 137 COLTON, F. II <J80, e5, 294, 296, 298, 387, 518, 531 , 800 COLTON, W. S ;J74 COMBS, D. H 660, C03 COMFORT, J. J 232, 257, 270, 401, 501 COMINGTON, J. A 251., 482 COMPTON, W. M 132, 134, 138, ](!2 CONNELL, J. O... 635 CONNER, P. S 58, 176, 284, 454 CONNOR, W. A 47 CONOVER, W. A 44,792 CONSTANT, W. T 589 COOK, A. P 278 COOK, C 227, 230, 480 COOK, G. W 17, 73, 433 COOK, J. C 549 COOK, T.M . .259,261,266,511,884 COOLE Y, F 373 COOLIDGE, A 308 COOLIDGE, R. H 524, 773 COONS, I. A 372 COOPER, G. E . 135 COOPER, G. F 507 COOPER, S 495 COOPER, W. S 218, 228, 230, 255, 288, 295, 450, 481, 487, 489, 662 COOVER, J. H 50, 31 5, 354, 533, 769, 797 COPELA ND, O. S -. . . . .219, 256, 449, 500 CORD, C 600 COREY, G. W 313, 383 CORNICK, W. F 59 CORNISH, T. O 301 CORSON, T. F 245 COTES,.!. R 228 COUES, E 652 COULTER, J. P 313 COVENTRY, C. B 188 COVERTON, W. H 321 COWAN, L. M 54 COWEN, J. M 229 COWGILL, C. A 7, 210, 260, 275, 301 , 355, 453, 455, 504, 654, 669, 675, 795, 810, 883 COWLES, C 09 COX, A. L 135, 257 COX, W. S. A 549 CRAFT, H 17, 56, 546, 550, 776 CRAFTS, A. P 4C5.534 CRAIG. G.G 514 CRAIG, W. H 75, 182 GRAIN, W. B 296, 4CO, 586 CRANDALL, J. B 51, 773, 803 CRAXE, C. E 220,491 CRARY, C. W 247 CRAVEN, J. J 555 CRAWFORD, G.G 232 CRAWFORD, H. M 470 CRAWFORD, J. B 65. CRAWFORD. J. S 375 CRA WFORD, S. K 046, 452, 490 CREHORE, C. F . . . . . 498, 631 CROMBIE, J. H 13 CROMWELL, J. B. M S5, 208 CROOKER, B. T 302,677 CROSBY, A. B 232, 412, 505 CROSBY, A. H 55, 54a VI LIST OF OPERATORS AND REPORTERS. Page. CROSBY, T. R 47, 49, 208, 28-, , 301, 30;!, 308, 366, 535, 554, 767, 779, 791, 794, SCO CROSIER, E. S 621 CROSS, J. A 549 CROWE, J. E 54, 837 CROWELL, B. M 482 CRUMIT, C. K 39G CRUTHERS, J. H 25, 295 CRYMES, A. C 143,144 CULBERTSON, H 114, 204, 206, 235, 309, 314, 320, 354, 396, 458, 459, 492, 550, 585, 621, C51, 660, 663, 674, 682, 683, 787 CULLEN. J. S. D 97, 100 CUMMINS, D 670 CUMMINS, S. A 673 CUMM1NSKEY, J 76, 437 CUNDIFF, W.H.H 295 CURRIER, C. B 434 CUNNINGHAM, J. L 481 CURRAN, R 253, 663 CURREY, J. H 682 CURTIS, E .... 50, 322, (i66, 783, 785, 786, 793, 8CC CURTIS, J 133 CURTIS, L 674 CUSH1XG, J. W .59, 543, 635, lib3, 880 CUTLER, J. H 635 CUTTER, J. B 7, 39, 543, 553, 007, 674 DA COSTA, J. M 665 DAGGETT, J. F . 643 DALUYMPLE, A.P 299 DANIEL, J. M . 543 DANIELS, W.A . 632 DANIELS, W. C 2^3 DARBY, C. E. C . :,15 DARE, G. H 275, 459, 517, 532 DARGAN, T. A M2 DARLING, L 283, 299, 477, J82 DARRACH, M og ;3 DARROW, W. H . * 246, 451 DAVID, \V. G . . . : 514 DA VIES, R . 382 DAVIS, C 475, 632 DAVIS, C. W 135, 138 DAVIS H. W 592 DAVIS, J. B GOO DAVIS, J. D 55 DAVIS, M. J 497,885 | DAVIS, P. C 281 , 287, 295, 296, 339, 663 j DAVIS, W. G ]78 DAY, B.I 430 DAY, H. B 10 DAY, J. F 4^ 5->4 DAY.W.E 773 DEAN, H. C 188 DEAN, H. M 7 0i 17 o 284, 298, 299, 312, 516, 518, 523, 779, 801 DEARBORN, T. B GG8 DEARING. T. II 366,532 DE BENNEVILLE, J. S 297 DE BUULER, J. P 140 144 DEEM Y, E. K 276, 297, 532 DE LANDRK, G 257 i DELANY, A 50, 56, 277, 281, 298, 4CG, 456, 516, 52G, 528, 533, 551, 552, 794, 799, 801 DE LONG, 1). L . . . .471^ 471 DEMENT, J. J ...92,99 DEMING, H. H . ~7 18 DENHAM, S. N... . 757 DENIG. C. E . eg, DENISE, J. C ...255,283,494 DENNLER, Z. P 294, 300, 525, %7 DERBY, G 250,254 258, 296, 320, 321 , 482, 486, 525, 54l, 774 DEVAN, S. T. T . i;7 DE WITT, E 48, 196, 674, 675, C7fi, 777 DE WITT, W. R.,jr ....&7, 171, 180 DEXTER, J. E 55 Page. DE YOUNG, H 380 D1I5I5LE, F. L 133, 221), 473, 479, 68- : DICK, W. B 882 DICKEY, J. L 55, 253 DICKIE, J. W 12 DICKINSON, W 234, 281, 315 DICKSON, J 38, 516, 532, 626 DIFFENBECHER, P. L 75 DIGBY, J. W 283, 523, 535, 550 DILTS, G. S 470 DISBRO W, R. r, 450 DIXON, L. I 232, 483 DIXON, W. C 13, 276 DODGE, J. L 468 DODGE, L. C 298, 527, 596 DODSON, B. E 669,676 DODSON, N. M 71 DODSON, R. A 247,469 DOLSON, J. S 499 DO NNELLY, E 313, 320, 322, 406, 006 DORR, J. C 281, 295, 362, 404, 669 DORRAN, W. M 35, 212, 285 DORSE Y, F 482 DORSE Y, L 580 DOUGHERTY. A. N . . .49, 56, 240, 250, 258, 271, 277, 283, 2!;5, "02, 369, 429, 471, 492, 753, 779 DOUGLAS, F 450, 500 DOUGLAS, J. A 267 DOUGLAS, J. C 525 DOWLING, J. P 478 DOWNS, J. M 197, 453, 552 DRANE, H. A 51, 58 DRAPER, J. A 406,409 DRAPER, L. J 285 DREWRY, E. A 555 DRURY, W. H 56,553,627 DUBOIS, H. A 84,116, 119, 150, 151, 276, 313, 505 DUBOIS, J. C 148 DUCACHET, H. W 47, 58, 188, 280, 283, ^96, 302, 453, 455, 534, 586, 650, 718, 700, 780, 781, 794, 825 DUDLEY, F. A 245, 246, 247, 254 DUDLEY, J. G 47, 29G, 525, 532, 789 DUER, E. L 552, 624, 627, 661, 776, 804 DUFF, H. M 495, 498, 518 DUFFELL, C. L 488 DUFFIELD, J. T 265, 471, 484 DUFF Y, C 507 DUGAN, J. B 92 DUNCAN, T. F 467 DUNHAM, R. C 463,814 DUNKLEY, C. L 313 DUNN, J 35 DUNN, J. L . . . 249, 251, 252, 254, 267, 451 , 476, 632 DUNOTT, T. J 2U4, 298, 301, 354, 781, 799 DUNTON, W. R 783 DURANT, II. R.. 48G DURHAM, B 264 DUVAL, 141,238 DWINELLE, J 232, 237, 251, 25- , 295, 302 DWYER. J 295 DYER, J. F 82, 86, 87, 203, 258, 435, 522 DYER. L 55,259,276,307,675 DYER, O. G 708 DYER, R. F 525,533 EAGER, W. B 250, 884 EAKIN, T. C 488, 623, 626 EALY, J. H 255 EAMES, W. M 446 EARL, C 301,457 EAST. W. A 103 EASTMAN, G. W 230, 471 EASTMAN, II 580 EATON, J. L 7Bi EBERIIART, C 297, 298, 783, 801 Page. EBERSOLE, J 227, 234, 236, 237, 240, 253, 300, 401, 402, 406, 440, 473, 484, 488, GOO ECHEVERRIO, M. G 740 EDDY.W 526 EDELEN, J. B 507, 531, 649, 767 EDGAR.W.S 488 EDMANSON, J. A 525 EDSON, P. O M 264 EDSON, W. II 708 EDWARDS, G. W 72, 284, 302, 534 EDWARDS, L. A 538 I EDWARDS, T. O 25 ; ELA, C. C 302, 772 ELLINWOOD, C.N 455 ELLIOTT, T. H 12 ELLIOTT, W.N 219 ELLIOTT, W. S. G 785 ELLSWORTH, P. W 280 ELY, W. S, 53, 273, 298 EMANUEL, L. M 472 EMMERSON, J. S 470, 541 EMMONS, F. A 73 EMERY, A. G 480 EMORY, A. W 55,320,516 ENSEY, J. B 286,489 ENSIGN, W. H 18, 23, 55, 205, 284, 298, 320, 406, 456, 667, 673, 770, 780, 789, 792, 795, 818 ERICKSON, J. P 282 ETTER, F 635 EVANS, D. J 53, 282, 554 EVANS, E 282 EVANS, J 469,501,672,783 EVANS, O. J 238, 483 EVANS, T. A 232 EVE, P. F 134, 135, 137, 531, 534, 605, 607 EVERETT, R. A 209, 48G EVERHART, J. R 133, 231, 494 EVERLETH, F. M. . . .206, 261, 389, 471, 475, 483 EVERTS, O 30, 84, 133, 225, 262, 279, 481, 589, 023 E WING, A 496, 624, 717 EWING, J. S 295 FA1LOR, B. M 254 FARLEY, C. F 492 FARLEY, J. M 232, 280, 487, 502, 523 FARNSWORTH, P. J 71 FARRAND, D. O 30, 56, 361, 459, 487, 628, CG4, 667, 778, 882 FARRLNGTON, J. M 538 FAR WELL, E. J 56 FASSETT, O. F 457, 572 F ASS1TT, L , 532, 708 FAULKNER, R 549,589 FAULKNER, W 277 FAUNTLEROY, A. M 143, 152, 157, 162 F AVILL, J 310 FAY, G. W 29G FE ARN, H 220, 497, 662 FELAND, W 634 FELL, E. R 535, 679 FELTON, R. A 143,144 FENNER, E. T 533 FERGUSON, J. F 72, 378 FERGUSON, N. D 485, 626 FERRIS, O 256 FEW, S. F 652 FIFIELD, A. K 217, 218, 222, 257, 44G, 447, 450, 451, 473, 485, 516, 783 FILLMORE, C. W 295 FINCH, C. M 215 FINLEY, J. Y 409, 495, 542 FINN, W. II 229, 473, 516 FISH, B. M 553 FISH ER, C. H 432, 548, 550, 553, G23, 626 FISHER, G. F 428 FISHER, H. N 767, 769 FISHER, L 405,539,543 LIST OF OPERATORS AND REPORTERS. VII Page. FITCH, C 248 FITCH, E. P 298, 315 FITCH, T. D 313,481,523,549 FLANDRAU, T. M 137,181, 188, 229, 234, 236, 388, 488, 494 FLEMING, R 485 FLINN, \V. D 208 FLOOD, P. H 201,473,483,494 FLOR EU, T. AV 284, 299, 468, 666, 710 FLOWERS, .T 473,635 FLYNN, A. T 506 FOLSOM, N 216,222 FOLSOM, N. L 078 FOLWELL, M. B 68 FONTAINE, J. B 2C8 FOOTE, H. E 592 FORBES, S. F 629, 631, 674 FORBES, W. S 147, 151, 258, 542 FORCE, J. F 021 FORD, C. M 282, 517 FORDYCE, B 50, 238, 252, 501 FOREMAN, E. K 239, 466 FORMENTO, F. 275, 632, 779 FORREST, R. W 54 FORWOOD, AV. H 155, 323 FORWOOD, J. F. M 545,547 FOSDICK, A. C 501,647 FOSSARD, G. H 181 FOSTER, F. J 229 FOSTER, F. P 46, 55, 661 FOUTS, L. C 468 FOWLER, C. N 206,251, 467, 470, 488, 496, 588 FOWLER, H. B 482 FOX, AV. B 16,49,217,218,219,220,221, 226, 228, 230, 231, 236, 238, 245, 248, 249, 256, 257, 258, 200, 201, 202, 267, 449, 466, 469, 481, 483, 485, 491, 495, 499, 500, 626, 754, 883, 884 FOYE, J. AV 80 FRANKLIN, E. C 237,262,276, 281, 283, 284, 285, 286, 295, 296, 298, 299, 300, 485, 486, 518, 681 FRANKLIN, G. S 136 FRANTZ, J. H 54, 56, 522, 523, 662 FREEMAN, J. A 57, 227, 236, 256, 281 FREEMAN, J. N 494 FREEMAN, O. R 230 FREEMAN, S. D 459 FREIOT, C 314 FRENCH, G. F. . . .47, 366, 395, 522, 527, 716, 794 FRENCH, J. O 294,300,664 FRENCH, J. S- 220 FRENCH, J. T 654 FRENCH, S. S 231, 235, 237, 239, 240, 255, 260, 265, 286, 402, 470, 474, 490, 503 FRICK, A. P 284, 302 FRINK, C. S 206, 218, 257, 263, 490, 524, 535 FRITZ, AV 54 FROTHINGHAM, W 468 FRY, C. B 677 FRY, T. W 140, 659 FRYER, B. E 50, 55, 58, 527, 542, 045, 075, 677, 684, 704, 787, 800, 811, 812 FULKS, J. S 582 FULLER, C 170 FULLER, G. E 395 FULLER, S. E 54,276,321,323,515, 518, 523, 550, 552, 666, 070, 774 FULLER, AV 96, 100 FULTON, J. M 552 FUNKHOUBER, D 675 GABRIEL, J. F 407 GALE, J. S 675 GALEN, G. E 57 GALL, A. D 524 GALLOUPE, I. F . .54, 195, 232, 239, 249, 517, 883 GARCELON, A 236, 267, 297, 504, 516, 533 GARDNER, P 228, 246, 602, 031 STJRG. TIT 125 Page. GARDNER, T. S 218 GARDNER, AV. H , 54,774 GARLAND, G. W 597 GARLAND, J. B 102 GARNETT, A. Y. P 275 GARRETT, H. F 523 GARRISON, H. D 38, 494 GASTON, J. M 234 GATCH, J. D 218, 245, 473 GATES, H. E 446, 572 GAUNTT, C. S 627 GAY, N. . . .58, 220, 250, 295, 297, 497, 526, 606, 673 GEMRIG, J. M 190 GENTRY, AV. A 251,631 GERRISH, J. W. F 881 GESNER, B 153, 488, 495 GETCHELL, F. H 57,253, 297, 322, 533, 552, 554 GIBBON, R 467 GIBBON, AV. H 247, 254, 532 GIBBONS, H., jr 279, 300, 370, 524 GIBBONS, J 627 GIBBONS, T. B 377 GIBSON, C. B 97, 98, 100, 101, 104, 112, 116, 143, 218, 236, 246, 249, 251, 258, 285, 298, 391, 402, 403, 404, 406, 452, 468, 469, 474, 475, 501, 527, 536, 601, 605, 631, 632, 634 GIBSON, J. R 122, 125, 399, 501 GIBSON, O. W 387 GIDD1NGS, E 516 GILBERT, D 080 GILBERT, R. H 316 GILFILL AN, W. J 674 GILL, H. Z 70,130,138,217, 218, 219, 232, 254, 255, 256, 264 GILL, W. G 656 G1LLIAM, F 507 GILMAN, J 55, 621 OILMAN, J. H 54 GILMORE, J. T 94, 100, 132, 137,138, 162, 208, 488, 505, 506, 508, 512, 517, 602, 886 GILROY, P 275, 323 GILTNER, J. S 239, 249, 257, 466, 471, 476, 477, 481, 490, 491, 553, 676, 881 GINKINGER, W. H. H 281 GIRARD, J.B 120 GIRVIN, R. M 654 GL1CK, E. B 206,265, 266, 451, 467, 476, 502, 670, 882 GLOCKER, T. W 157,109 GOBRECHT, AV. H 283 GODDARD, P. B 22, 75, 320, 361, 680 GOFF, J. N 524 GOLDSBOROUGH, C. E 519 GOLDSBOROUGH, J 531 GOLDSMITH, M 34, 104, 105, 227, 357, 549, 751, 823, 832, 834, 835, 836, 837, 842, 855 GOLDSMITH, W. W 70 GOOD, D. R 79,321 GOOD, S. L 654 GOODALL, F. W 443 GOODBRAKE, C 217 GOODMAN, H. E 14,54,76,215, 218, 232, 233, 236, L 38, 245, 295, 450, 470, 472, 487, 497, 525, 589 GOODRICH, B.F 399 GOODAVIN, D. M 141, 144, 219, 230, 407, 498 GOODAVIN, R. I. P 54 GOODAVIN, AV. C 525 GOODAVIN, AV. F 532 GORDON, J 20 GORDON, S. C 474 GORE, J. R 496 GORGAS, A.C 130,138 GOSLIN, A 239,240,486,499 GOSS, S.N 314 GOTT, W. A GOULD, J.B 60 GOULEY, J. W. S 95, 100, 283, 357, 425, SCO, 513, 517, 596, 598, 605, 007, 029, 658, 608, 756, 780 GRAFF, M. B 531 GRAHAM, N. F 2!), 55, 294, 389, 480, 549, 663, 669, 768 GRAHAM, S 26,389 GRAHAM, AV 206, 478, 508 GRANGE, H 500 GRANT, G. . . . 58, 229, 315, 320, 309, 658, 069, 802 GRANT, J 021, 783 GRANT, J. F 93, 100, 137, 138 GRANT, J. T 482 GRAVES, AV. L 484 GRAY, A. R 246, 294, 296, 298, 302, 535, C75 GRAY, C 203, 218, 266, 488, 518, 605, 606 GRAY, C. C 301,430,073 GRAY, E. P 140, 144, 662 GRAY, J. W 503 GRAY, W. M 219, 234 GREELEY, G. P 236, 450 GREEN, E 70 GREEN, J. H 236, 238, 518, 552, 881 GREEN, J. N 549,668 GREEN, J. W 219, 230, 466 GREEN, S. A 219,252, 283, 474, 497, 523, 532, 882 GREEN, W 547 GREEN, AV.F 233 GREEN, W. J 467 GREENE, A. S 803,806 GREENE, D.C 374 GREENE, F 489 GREENE, F.C 768 GREENE, J. B 219 GREENE, J. M 132 GREENE, J. McC 501 GREENE, M. L 457 GREENLEAF, C. R 545, 548, 625, 627, 665 GREENLEAF, D.C 470 GREENLEAF.E. G 485 GREENLEAF, AV. R 456, 807 GREENOUGH.F. B 634 GREGG, P 514 GREGG, V. H 270,473 GREGORY, E 516 GREGORY, F. R 472,507 GRIBR, M. J 364 GRIFFIN.P 268 GRIFFITH, C. G. M 409 GRIFFITH, D. J 302, 498, 068, 669, 769, 778 GRIM, H. A 140, 632, 886 GRIMES, W 227, 232 GRIMES, AV. S 517 GRISWOLD, C. A 71 GRISWOLD, E 51, 142, 144. 194, 284, 288, 297, 302, 485, 587, 804 GROSS, F. H 108, 112, 245, 525, 773 GROSS, S. D 25, 35, 142, 315, 365, 542, 543, 548, 604, 774 GROSS, S. W 16, 44, 66, 67, 70, 219, 233, 264, 488, 500, 699, 883 GROVE, J. H 271,360,773,777,780 GROVER.H.C 254 GRUMBEIN, AV 634 GUELICH, E 219, 295, 4S7 GUNKLE, AV 524 GUNN.M GUSTINE, J. AV - 252 HABERSHAM, S. E 240 HACHENBERG, G. P 550,025,627,683 HAGEN, C. AV 293,485 HAIGHT, D. L 295, 524, 532, 800 HAILE. G. W HAINES, A. B - 484 HAISE, G. A 629 HALBERSTADT, A. H 553,601 VIII LIST OF OPERATOKS AND REPORTERS. Page. HALDERMAN, D 347,25), 387, 449, 450, 452, 471 HALL, A. D . . . . . ... 58, 54:5, 814 HALL, E 194 HALL, F 321,390,533 HALL, J. A. 431 ,550, 084 HALL, J. . - . -47, 259, 482, 770 HALL, J. W. .004 HALLER.J .- 2-17, 388, 484 HALSEV, C. C... ... 433 HAM, L. J 233 HAMILTON, A. A... HAMILTON, C. A .... . 295 HAMILTON, F. II. . . .17, 39, 04, (17, 134, 13(5, 152, 154, 158, 228, 285, 301), 341, 412, 483, 5->6, 071 HAMILTON, J. W 074 HAMILTON, R. D 002 HAMILTON, W 217, 501 HAMLIN, N. S 275 HAMMER, A 59, 308, 579, 002, 681, 082, 083 HAMMOND, E. 15 59 HAMMOND, F. M 17,182,183, 195,583 HAMMOND, G. B . . .49, 791 HAMMOND, J. F 370 HAMMOND, T. H 283, 458 HAMMOND, W. A 322 HAMMOND, W. L 301, 702, 723 H ANA WALT, G. P 297 HAND, D. W 099 i HANSON, Z. P 250 j HAPPERSETT, J. C. G 251, 302, 534, 780 HARD, A 230,230,314,471,477,480 HARD, C 195 HARDING, H. W .... 524 HARDING, P.H 155,371 HARDY, J. G 500 HARLAN. G. C 321,469 HARLO W, L. D 247, 305, 458, 020 HARPER, C. W 301 HARPER, T. S 050, 740 HARRINGTON, J. 15 26 HARRIS, G. F 70 HARRIS, J 39, 152, 170, 279, 451, 470, 028 HARRIS, J. L 485 HARRISON, E 408,469 HARRISON, J 482,497 HARRISON, W. 15 .. 487 HART, A. G 502,631 HART, D. A 313 HART, S 340,486,673 HARTM A N, W. B 254, 265, 299, 477 HARTSHORN, D. W 212 HARTSHORNK, E 543 HAUTSUFF, A 28, 295, 297, 300, 307, 308, 310, 535 HART WELL, S. C 513 HARVEY, II. M 190 HARVEY, J. G . . . 222, 003, 077 HARVEY, I 259, 275, 294, 300, 301 , 472, 778 HARVEY, T. 15 548 HARVEY, W. A ... . . 50, 382, 405, 532 HASSE, H. E... ...217,403,472,477,489 HASSENBEKG, F 152,158, J59, 2:;e, 2 ( .i7, 550, 024, 004 HASSON, A. 15 542,581,774 HASTINGS, J. W 257, 489, 499 HATCHITT, J. G 20, 212, 249, 309, 314, 323, 553, 554, 555, 674 HAUSEN, J 474 HA WES, M 4&7 HAWLEY, S. B . . .231, 252, 520 HAWTHORNE, F 007 HAYDEN, F. V 479 HAYES, C 53, 70, 75 HAYES, I. 1 10, 37, 153, 304, 378, 408, 522, 538, 043, 053, 718, 771 HAYES, J. A 206 Page. HAYES, J. M - <W2 HAYES, T. R 70 HAYNES, C. F - 533 HAYNES, T 008, 074 HAYS, D. S 222, 225, 227, 234, 250, 409, 501 HAYS, W 54,82 HAYS, W. L 554 HAYS, W. W - 653 HAY WARD, J. M 253, 293, 001 II AY WARD, N 48, 206, 227, 229, 231, 251, 203, 204, 390, 402, 403, 435, 470, 473, 478, 481 , 495, 490, 499, 504, 516, 523, 533, 598, 000, 001, 031 HA Y WOOD, E. B 49, 517, 791 IIAZLETT, R. W 231 250, 254, 293, 408, 490, 031 HEAD, J. F 399 HEAD, M. H 203, 500 HEARD, L 42, 431 HEATH, D. L 219, 239, 258, 205, 471, 503 HEATH, W. II 450 HEGER, A 42, 47, 48, 55, 70, 184, 294, 353, 3! 3, 400, 021, 779, 790, 793, 800, 803, 800 HEILNER, H. C 284,294 HEISE, A. W 229, 283, 339, 342 HELM, J. C 726 HELMER, A. M 481 HELMER, J. II 10 HELMS, C 469, 473, 673 HELSBY, T. H 514 HELWIG, T. A 231,468 HENDERSON, C. L 252 HENDERSON, D. W 268,723 HENDERSON, F. B 92 HENDERSON, F. W 69 HENDERSON, J. M 295 HENDERSON, P. P 507 HENDRICKS, E. F 261, 300, 534, 553, 810 IIENDRICKS, J. G 70 HENDR1CKSON, S 769 HENKLE, C. C 489,502 HENNING, T. S 74,710,712 HERBST, J. E 50,200, 440, 535, 017, 670, 680, 684, 881 HEREFORD, F. M 469 HERMAN, A. F 500 HERNDON, C. B 277 HERNDON, E. S 518 HERR, A. J 239 IIERK, M. L 56, 212, 220, 259, 261, 308, 321, 322, 431, 450, 456, 519, 542, 554, 632, 661, 682 HERRICK, H 275, 524 HERSCHE, C 593 I1ERW1G, E 676 HESS, J. F 249,524 HETZELL, D. G 078 IIEUSER, C. F 607 HEWETT, J. D 452,519 HEWIT, H. S 55, 71, 72, 77, 94, 100, 140, 173, 283, 285, 297, 308, 313, 318, 322, 340, 342, 392, 393, 411,414, 420, 526, 527, 532, 533, 535, 537, 540, 001, 609, 770, 775, 789, 794, 800, 811, 879 HEWSON, A 42, 543, 006, 607, 780, 788, 821 HICKS, R, J 498,500,507 HIGD AY, T 675 HIGG1NS, G. II 322,720 HIGG1NS, G. Z 074 HIGG1NS, R. T 405, 430 HILDRETH, J. S 081,682,683 HILDRET H, T 19, 237, 238, 483 HILL, 15. F 483 HILL, E. L 468 HILL, F. H 288, 294 HILL, J. S 54, 296, 301 HILL, L 484 HILL, R. E 482 HILL, R. J 236,258,269 Page. HILL, S. V. D 494,501 HILL, T. C 481 , 500 HIMES, I. N 51,403,497,803 HINDS, VT. H. W 450 H1NES, ILL 484 IIINES, M 495 HINES, W. M 308 IIINRLE, F. . .282, 314, 390, 519, 524, 535, 548, 549 H1NKMO, J. B 494 HINSEY, J. C 4&0 H1NTON, J. II 083 HIRSCHF1ELD, H 629 HITCHCOCK, II. O 52,181 HOADLEY, W. J 305 HOAG, W. H 475 HOAGLAND, C. N 50, 470, 667, 669 HOBBINS, J 374 HOBBS, W 672 HODGE, H. L 70, 591 HODGEN, J. T 48, 283, 339, 3 10, 345, 347, 357, 361 , 390, 680, 773 HODGES, R. M 66 HOFF, A. H C8, 238, 245, 299, 339 HOFF, J. V. R 123, 124, 125, 126, 742 HOFFMAN, E. S 182, 251, 258, 200, 499, 884 HOGAN, M. K 72,187, 205, 224, 374, 378, 400, 464, 514, 630 HOGEBOOM, G. W 535,653 HOGG, A. J 121 HOKES, D. F 228 HOLBROOK, L 228, 235, 489, 497 HOLBROOK, W 248, 483 HOLLEY, P. R 292, 296 HOLLEY, S. J 257, 264, 295, 517, 525, 526, 527 HOLLO WAY, J. M 472, 577, 94, 812 HOLMES, F. S 488, 516 HOLMES, W. J. R 315, 320, 482, 027, 664 HOLSTON, J. G, F 222, 230, 234, 250, 271, 027 HOLT, A 497 HOLT, J. F 48,790 HOLT, L 489, 496 HOLT, W. A 69,486 ROMANS, J., jr 182, 210, 212, 227, 230, 239, 251, 254, 283, 388, 517, 548, 024, 000, 667 HOOD, C. II 497 HOOD, H. H 074, 075 HOOPER, F 593 HOOPER, W 778 HOOTON, M. M Ill, 230, 485 HOOVER, G. W 389 HOPE, R. II 10 HOPKINS, IX S 228, 203, 438 HOPKINS, G. H 29 HOPKINS, H. R 08 HOPKINS, T 299, 534 HOPKINSON, J . . .457, 463, 545, 589, 019, 005, 814 HORN OR, C. W 430, 437, 583, 025 IIORTON, N. N 407, 020, 882 HORTON, S. M 373, 718, 800 HOSTETTER, J. ( J 048 HOTALING, J. M 527 HOUSTON, D. II 29,218,428 HOUSTON, J. M 882 HOUTS, S. B 520 HOVEY, B. L 228, 247, 525, 822 HOW, J. C 234, 230 HOWARD, B 00,137, 138, 225, 233, 230, 239, 250, 275, 270, 277, 280, 294, 296, 303, 304, 350, :551 , 402, 404, 400, 507, 512, 510, 519, 520, 530, 772, 774 HOWARD, E. L 494, 497 HOWARD, T. H 543 HO WE, J 239 HOY, A. II 049,778 HOYT, C. S 402 HOYT, O. 232, 248, 002, 072 HOYT, W. D 71 LIST OF OPERATORS AND REPORTERS. IX Page. HUBBARD, G. H 302,360 HUBBARD. H. H 469,485,507 HUBER, J. F 189, 526, 626, 655, 807 HUBERICH, H. E 673 HUBON, P. E 219, 221, 236, 237, 239, 248, 250, 254, 260, 265, 2Cfi, 271, 288, 450, 474, 477, 481, 489, 491, 500, 626 HUDSON, A. T 227, 230, 236, 238, 245, 247, 253, 254, 265, 269, 277, 472, 477, 483, 486, 501, 509 HUDSON, D 11 HUDSON, E. D 8, 59, 122, 131, 154, 162, 180, 189, 202, 216, 224, 243, 263, 288, 305, 408, 446, 447, 457, 479, 528, 545, 596, 603, 604, 613, 620 HUDSON, W. M 518 HUDSON, W. O 467, 498 HUFF.S.W 266 HUGER, H 531 HUGHES, J. C 552 HUMPHREY, O.M 662,679,774 HUMPHREY, W. F 219, 220, 256, 263, 265, 450, 467, 468, 500, 549 HUMPHREYS, G. H 249, 268, 600, 601 HUNT, D. W 447 HUNT, S. B 59 HUNT, W 22, 47, 156, 197, 299, 792 HUNTER, W. G 233, 251, 293, 494, 499 HUPP, J. C 27, 71, 586 HURD.Y.G 253 HURSAM, N. A 219,258,489 HURT, L. V 230, 249 HUTCHINS, C. B 454, 469, 523 HUTCHINSON, E 235, 267, 494, 502 HUTCHINSON, J. F 218, 233, 261, 498 HUTCHINSON, J. H 230, 249, 256, 266, 300, 522, 527, 717, 886 HUTCHISON, J. H 503 HUTTON, G 703 HYDE.F 548,674 HYDE, M. J 485 HYDE, W. C 25 IDELER, H... 471 INGALLS, W 230, 260 INGRAM, A 39, 51, 56, 58, 109, 111, 141, 144, 276, 282, 294, 295, 300, 308, 323, 447, 44<>, 591, 643, 669, 677, 803 IRISH, F 285, 676 1RWINE, C. K 133, 248, 254, 462, 474, 524, 886 ISHAM, R. N 31, 39, 69, 321, 667, 677, 786 JACKSON, D 886 JACKSON, E 261,483,484,632 JACKSON, G. W 154, 248 JACKSON, J. D 96, 461. , 474 JACKSON, J. S 255 JACKSON, R. D 506 JACKSON, R. M. S 57 JACOBS, W. C 252, 256, 2u3, 264, 450, 498, 790 JAMAR, J. II 323, 619, 665, 666, 776, 802, 804 JAMES, H. H 56, 58 JAMISON, J. S. 19,215,218,262,488,525 JANES, H. .26, 42, 70, 75, 82, 87, 183, 187, 211, 255, 437, 443, 457, 462, 494, 520, 525, 579, 581 , 591 JANE WAY, J. H 27, 134 JANVRIN, J. 596, 616 JARROTT, M. M 662 JEARICON, J. A 619 JEFFREY, T. R. W 228 JEMISON, L 648 JENNINGS, E 482, 646 JENNINGS, II. P 255 JENNINGS, R. G 22 JESSOP, S. S 18,51, 235, 617, 620, 634, 659, 669, 678, 804 JESSUP, R. B 49! JEWELL, W 619, 625 Page. JEWETT, C. C 133, 138, 476, 486, 605 JEWETT, D. L 266, 504 JEWETT, G 645 JEWETT, P. A 50,314,478 JOHNSON, A. F 675 JOHNSON, C. M 216 JOHNSON, D 483 JOHNSON, G 71, 72 JOHNSON, G. K 402 JOHNSON, H. B 259, 296, 475, 675, 779 JOHNSON, J. D 533, 627, 790 JOHNSON, J. J 227 JOHNSON, P. H 276 JOHNSON, R. P 666,671 JOHNSON, T. D 129, 130 JOHNSON, W 308 JOHNSON, W. A. 554 JOHNSON, W. E 246 JOHNSON, W. L 52C JOHNSTON, E. M 543 JOHNSTONE, T. S 10 JONES, C. H. .300, 301, 320, 321, 517, 522, 524, 526 JONES, C. W 23,55,241,301,331,322,542 JONES, D. C 785 JONES, E/L 524 JONES, G. S... 740 JONES, H. E 630 JONES, J 33, 35, 292, 322, 823 JONES, J. A 671 JONES, J. C 770 JONES, J. W 471 JONES, N. M 114 JONES, R. C. C 322 JONES, R. K 379 JONES, T 232, 447, 450, 524 JONES, \Y 617 JONES, W. B 437 JONES, W. H 661 JORDAN, R. H 498 JOSLIN, C. C 294 JUDKINS, A 234 JUDKINS, D 411 JUDSON, A. B 378 JUDSON, O. A 86, 276, 283, 285, 295, 297, 299, 300, 301, 315, 374, 454, 456, 464, 515, 519, 520, 524, 531, 533, 543, 633, 659, 703, 774, 884 JUMP, 1 544 KEABLES, B. F 483,498 KEARNEY, T. H 227, 253, 408, 409 KEATING, W. V 42, 589, 606, 821 REEFER, H. G 240 KEEN, W. W.,jr 9,12,300,357,361, 382, 383, 429, 525, 653, 654, 684, 769, 826, 837 KEENEY, C. C 391 KEENON, J. G 18, 47, 55, 56, 283, 285, 319, 459, 592, 599, 620, 633, 634, 663, 667, 703, 794 KEIR, W. G 260 KELLER, J. M 141 KELLOGG, A.H 665 KELLY, A 206 KELLY, E. B. P 404,446,473,500,886 KELLY, F. W : 207, 208, 771 KELSEY, C. T - 488 KELSEY, D. E - - .218, 467 KEMBLE, G. S - 210 KEMPSTER, W 55, 297, 455 KENDALL, J. V 203, 218, 231, 237, 246, 251, 261, 500, 602, 626, 885 KENDERDINE, R. S 321, 408, 409, 661, 676 KENNEDY, D 283, 643, 772, 774, 782 KENNEDY, J. T 75, 778 KENNEDY, L. W 260, 261, 263, 451, 516 KENNEDY, T 70 KENNEDY, V. B 247, 264, 483, 487, 496 KENNON. J. C. W 47 KERR, J- 466,497,548 Page. KERR, J. W 51, 804 KERSEY, S. II 51,206, 249, 265. 485, 490, 497, 626, 629, 804 KESSLER, A 30 KETCHERS1N, J. 1) . . .668 KIBBEE, A. D )7 KILBOURNE, H. S 276 KILB Y, J. T . . .263, 264, 285 KIMBA LL. F. IS. . .230, 232, 238, 247, 472, 502, 672 KIMBALL, II. H 727 KIMBA LL, J. H 249, 295, 626 KIMBL Y, J. T i>40, 489 KING, A. F. A 525,553 KING, C. U 287, 458, 549 KING, D. H ^86 KING, J. E 375 KING. J. W 671 KING, S.C 662 KING, W.N 534 KINGER, S. O 516 KINGSTON, S. T 383 KINLOCH, R. A 142,144,375 KINSMAN, J. H 297 KIPP, C. J 436 KIRBY, H 257 KIRK, R. M 662 KIRKER, J 542,661 KITCHEN, J. M 190 KITCHEN, J. T 219 KITTINGER, M. S 220, 259, 390, 471, 476, 483, 487, 495, 498, 523, 596, 600, 631, 881, 886 KITTOE. E. D 249, 592 KIZER, G.W 661 KNAUSS, J 227 KNEELAND, B. F 206,545 KNEELAND, S 158, 624 KNICKERBOCKER, B 663 KNIGHT, J. H 483 KNIGHT, L. M 516 KNORR, M. K 591 KNOTT, J. J 254,262, 389, 473, 476, 602, 626, 630, 632, 885 KNOWLES, H. B 527, 535, 552 KNOWLSON, J 229 KNOX, W. A 646 KOECHLING, C. W 243 KOELER, R 321 KOERPER, E. A 115, 241 KOERPER, J. F 650 KRAMER, E 663 KREBS, T. D 674 L ABAR, F. C 543, 550 LADD, C. H 96,100, 217, 267, 386, 463, 474, 476, 507 LA FORCE, D. A 470 LAISY, J 114 LAMBERT, A 20 LAMBERT, J 4?J LAMBERT, W. S 264 LAMONT, J. C 314 LAMPEN, M 58, 550 LAMSON, H. S b 82 LANDIS, A.H 440 LANE, S. G 252 LANEY, T. M 173 LANGDON, H.H 230 LANGENBECKER, C 84 LANGER, 1 349 LANNING, J. T 482, 853 LANNING, S 136, 138 LARKIN, J. B 314 LARRIMER, B 672 LATHAM, II 550 LAUB, C. H 95,121,154 LAWRENCE, C. W 299, 320 LAWRENCE, G. W. . . . 600 LIST OF OPERATORS AND REPORTERS. Page. LAWSON, II.M 282 LAWSON, J. \V 240, 283, 466, 486, 518 LA WTON, J. W. . 230, 261, 451, 452, 477, 504, 550 LAY, B. D 135, 138, 143, 144, 161, 466 LEALE, C. A 182, 277, 439, 597 LE AMAN, H 211, 212, 298, 315, 452, 456, 782 LE AVITT, D. F 227, 470 LEAVITT, P. C 26 LEAVITT, T. L 315 LE BLOND, J. B 486 LECONTE, J. L 539 LEE, C. C 313, 366, 400, 401, 407, 44 1 , 526, 677 LEE.J.C 663, 664 LEE, J. H 233, 261 LEE, J. W 708 LEET, J. M 473 LEGLER, H. T 58,447, 585, 533, 663, 668, 672, 779 LEIDY, P 236, 261, 401, 47J, 483, 518, 601 LEIGHTON, N. W 231 LEISENRING, P. 8 436 LEIT, N. Y 93, 100, 201, 232, 245, 255, 259, 475 LE MOYNE, F 32, 203, 218, 234 LENCE, \V. C 70 LEONARD, A. II 667, 673 LEONARD, W. H 480, 513, 518, 523 LEONARD, W. L 248 LEVENSA LER, H. C 217, 232, 248, 256, 517 LEVIS, R. J 252, 287, 317, 320, 321, 374, 464, 553, 773 LEWIS, E.H 437 LEWIS, G. R 440, 466 LEWIS, J. B 49, 5fi, 172, 236, 302, 303, 315, 321, 322, 540. 768, 778, 796 LEWIS, J. D 538,542 LEWIS. R. A 281 , 483 LEWIS, R. 8 35 LIDELL, J. A 6,11,16,40,44,46,47,49, 54,75, 83, 148, 173, 191, 193. 209, 276, 281, 287, 289, 290, 301, 306, 308, 320, 369, 380, 438, 443, 519, 521, 527, 530, 534, 539, 542, 543, 548, 553, 554, 590, 715, 716, 752, 756, 761, 773, 820, 860 LIEBOLD, T 52, 283, 298, 321, 393, 400, 773, 783, 786, 791, 802 LILLY, H. M 7, 320, 793, 507, 674 LINCOLN, N. S 152,153,159,321 LINDSAY, C. A 519 LINDSAY, W. D 324 LINDSLE Y, C 57, 58 LINK, J. E. . . .220, 236, 309, 314, 302, 459, 667, 675 LIPSCOMB, W. H 4C8 LLOYD, F 587 LOGAN, J 835 LOGAN, J. E 499 LOGAN, J. T G33 LOGAN, S 388,390 LOMAX, W 238, 248, 260, 452, 476, 494 LONG, J. W 215 LONGENECKER, J. H 440 LONGSHORE, W. R 235 LOOMIS, II. N 028 LORD, C. H 215,217, 220, 222, 258, 276, 322, 446, 45!), 453, 518 LORD, J 409 LORD, J. J. II 033 LOUGHR AN, R 275, 403 LOVE. W. S. . .228, 230, 324, 48(5, 467, 554, 707^ 7C8 LOWE, L. W 040 LOWELL, A.L 115,198,579 LUC A S, G. L 435, 481 , 497, 542, 705 LUDINGTON, H 465, 466, 470, 482, 630, 632 LUDLOW.J. R 220,260. 203, 267, 285, 208, 308, 507, 606 LULDON, R. J 075 LUTZE, J. J 46 LYFORD, B. F 256,882 LYMAN, J. W. 87, 225, 2:58, 239, 292, 495 Page. LYMAN, W. C 73 LYNCH, J. E 286, 403, 481 LYNDE, R. D 547 LYNN, J. P 727 LYON, E. B 245 LYONS, H. M 475 LYONS, W. B 239, 884 LYSTER, H. F 220, 223, 227, 233, 238, 247, 248, 251, 256, 257, 258. 259, 261, 263, 469, 489, 497, 623, 626, 803 LYTLE, F.W 87,247 [ MABIN, H. B 48,55,795 MACDONALD, J. E 83, 445, 682, 683 \ MACKAY, D 235,255, 476, 483, 490, 495, 498, 499, 502, 626, 883, 885 MACKENZIE, T. G 295,297 ; MADDIN, T. L 15,606,854 1 M ADILL, W. A 501 j MAGEE, T. L 236, 238, 245 1 MAGUIRE.S 474 1 MALTBIE.C. B 586 MALLOCH.E.C 584 | MANFRED, H 296 j MANGER.L 218 1 MANOWN, J. H 231 : MANSFIELD, T. B 607 ! MANSOX, J.C 56 i MARION, A 33 MARKfE, T. M 46, 48, 676, 790 ; MARKS, J.J 219 MARKS, S 253, 254, 467, 501 MARMION, G.n 543,545,548 MARSH, A 666 MARSH, A.F 264,293 ! MARSH, E. J 55, 298, 299, 387, 653 : MARSH, F.E 553,554 : MARSH, II 301 MARSH, M. M 307 ! MARSH, N. F 667 MARSH, W. R . . .257, 260, 480, 483, 490, 508, 530 MARSHALL, D.M 86 MARSHALL, E 438,673 MARSHALL, S. D 771 MARSHALL, S.W 240 MARTIN, C. M 216 MARTIN, G 548 MARTIN, II. A 172, 203, 255, 499 MARTIN, J.C 300 MARTIN, J. S 218, 229 MARTIN, J. W 435 MARTIN, N.F 316 MARTIN, O 313 MARTINDALE, F.E 527,672 MASON, E 409 MASS, A 314 MASSER, G. M 69 MASTIN, C. H 92, 140, 280, 281, 553 MATCIIETT, W. H 206, 296 M ATHERSON, A 488 MATLOCK, W. II 314, 501 MATTISON, W. E 254 MAUGHS, G. M. B . . . 339, 324 MAULL, D. W 188, 217, 202, 239, 251 , 252, 259, 450, 482, 483, 497, 542 MAURY, F. F 246, 630, 666, 670, 803 MAURY, R. B 553 MAURY, T. F 71 MAY, J. F 42 MAY, II. C 56, 241, 247, 285, 314, 456, 527, 535, 547, 550, 583, 584, 778, 794 MAYER, N 255 MAXWELL, D. A 506 MAXWELL, J. H 648 McABEE, II. M 263, 264, 266, 209, 286, 486, 494, 504, 509, 511, 512, 518, 886 Me ALPINE, J 486 Page. Me ARTHUR, J. A 190, 543, 704, 779, 856 MCBEAN, A 435 McCALL, C. A 25, 50, 54, 107, 112, 276, 286, 303, 313, 441, 521, 528, 534, 552, 600, 674, 801 MCC ALLA, J. M 456 MCC ANDLESS, J. N 264 MCCANDL1SS, R. R 481 McCANN, J 485 MCC ARTIN, H. E 811 MCCAUSLAND, M. B 253, 300, 673, 675 McC A Y, R. B 376, 505 MCCHESNEY, W. F 217 McCLANAHAN, J. P 494 MCCLEERY, B. N 285, 459 McCLELLAN, E 50,52, 57, 80, 83, 98, 139, 216, 390, 429, 455, 555, 596 MCCLELLAN, j 228 MCCLELLAN, j. H 625 McCLELLAN, S 295 MCCLELLAN, w 203 McCLINTOCK, E 506, 791 MCCLURE, J. D 26 MCCLURE, R. L 261, 262, 284, 286, 502, 518, 525, 531, 534 MCCLURE, s. M 295 McCLURG, J. R 34, 54, 668, 670 MCCOLLUM, W 188 MCCOOK, G 25, 27 McCORD, D. O 308,669 MCCORMICK, C 391 McCORMICK, J. J 74 MCCOY, II. W 15 MCCUEN, E 474 McCULLEY, W. A 469 McCULLOCH, J 447 McCULLOUGH, W. P 81, 365, 815 MCCUNE, G. W 222, 263 MCCURDY, J 469 McDERMONT, C 153, 215, 548, 667, 684, 883 MCDONALD, G 48i MCDONALD, w. o 233, 235, 252 254 257 296 378 MCDONNELL, E 350, 472, 506 MCDOWELL, G.M 526 MCELDERR Y, H 317, 320, 410, 678 MCFALLS, D 227,250,481 MCGAVRAN, W. B 476 McGEE, J. W 268,467 McGEE, T. L 516 McGILL, G. M 56, 93, 173, 192, 275, 286, 314, 316, 399, 401, 403, 478, 515, 531, 532, 543, 547, 548, 603, 605, 634, 670, 673, 724 McGIRR, J. E 325 McGOORISK, E. J 270,482 MCGO WAN, R 409 McGRATH, J. M 50, 683, 780, 783, 801 McGRAW, T. A 320, 517, 518, 525, 531, 533, 542, 543, 668, 674, 801 MCGREW, J. S 252, 257 McGUIRE, II 27, 94, !)7, 100, 134, 138, 217, 228, 240, 240, 248, 320, 412, 501, 507 McGUIRE, J. M. G 249, 255, 303, 496 MCHENCH, W. J 54, 627, 634 MCIIENRY, II 206,467,471 McINTYRE, J. II 293,488,496 MCKEE, J. C 26, 33, 39, 4<>, 50, 59, 79, 147, 150, 151, 225, 243, 245, 263, 266, 285, 311, 312, 314, 315, 318, 301, 379, 434, 518, 527, 546, 548, 583, 596, 676, 773, 786, 787, 792, 801, 8C9 MCKELVEY, A. J 3<il McKENNAN, II 235, 230, 247, 269, 270, 472 MCKIM, W.J 281,308 MCKINNEY, D. F 267, 296 MCLANE, II 252, 529, 531 MCLAUGHLIN, c.c 251 MCLEAN, c. R 625 MCLEAN, D .. so.eoo LIST OF OPERATORS AND REPORTERS. XI MCLEAN, L 133,138,549,071 MCLETCHIE, A 58, 315, 430, 071 McMAHOX, A 47, 82, 105, 108, 111, 112, 11G, 119, 257, 301, 481, 7G7, 768, 775, 780, 791 MCMASTERS, J.M 053 MCMILLAN, c. w 200, 239, 25C, 259, 473, 495, 882 MCMILLAN, T 302, 523 MCNAUY, R. B 498 MCXEELY, J. s 440, G44 McNEILL, D 408, 489 MCNEILL Y, R . . . .237, 302, 315, 520, 533, 541, 553 MCXULT Y, J 98, 99, 100, 230, 753, 882 McNULT Y, R 533 MCPARLIN, T. A 53, 54, 349, SGI MCPHEETERS, J. G esa MCPHERSON, j. B 533, oca McREYNOLDS, W. H 480 MCRUER, D 282 ME ACH AM, F 120, 121, 125, 210, 861 MEANS, T. A 549, 632 MEARS, G. W 629, 72G MEEKER, D 488 MEEKS, J. A 296 MEIGS, J. J 247, 293, 484 MELCHER, S. H 517 MENDEXHALL, J G4G MENDENHALL, W. T 275 MENZIES, S. G 93 MERCER, T. II 835 MERRI AM, J. H 778 MERRILL, A. W 4G4, C73, 805 MERRILL, C. S 518,531 MERRILL, G. V. R 501 MERRILL, H. W 45G MERRILL, J. H 280 MERRILL, L 662 MERUILLAT, W. C 072, 075 MERRITT, D 469, 496, 525, 526, 531, 805 MERRITT, J.K 463 MERRON, J. M . . . . 229, 487, 524, 596, 601 MERRYWEATIIER, H. C 233,236, 256, 4G9, 473, 474, 480, 48G, 510, 886 MESSENGER, A. C 219, 220, 221, 222, 228, 235, 237, 240, 251, 253, 254, 256, 262, 265, 267, 272, 452 METCALF, G. W 44, 230, 234, 239, 246, 201, 477, 600, 884 METCALF, R. L 255 MEYER, N 069, 075 MEYERS, L. G 296 MICHEL, W. M 391, 536 MIDDLETON, P 314, 317, 532 MILES, B. B 67, 156, 293, 295, 301, 303, 308, 314, 315, 320, 321, 339, 523, 527, 53D, 534, 549, 550, 671, 703 MILES, J. C 780 MILHAU, J. J 104, 242, 597, 047 MILLAR, R 245, 253, 552 MILLER, A. C 232 MILLER, A. F 232 MILLER, A. J 455,805 MILLER, B. F 230,601 MILLER, C 508 MILLER, C. H 601 MILLER, G. L 245, 499, 524, 534 MILLER, G. W 470, 548 MILLER, I. V 532 MILLER, J. G 549, 783 MILLER, J. W 219 MILLER, L. D 295 MILLER, M. L 440 MILLER, S. J. F 727 MILLER, T. W 283 MILLIGAN, F. H 322,503 MILLS, A. C 484 MILLS, C. H 250, 496 Page. MILLS, W. W 525 MIXASSIAX, 8.G G69 MIXER, J. F 08 MINOR, W. C 303 MINTZER, ST. J. W 314, 400, 472, 500, 579, G75, G77 MITCHELL, E. D 703 MITCHELL, J. B GC8 MITCHELL, J. D 246, 475, 502, 533 MITCHELL, J. W 219, 228, 231, 236, 24G, 247, 275 MITCHELL, S. B. W 18, 29, 75, 205 MITCHELL, S. W 9, 491 MITCHELL, T. E 197, 29G, 526, 534 MIX, H. A 218 MOHR, R. J 253, 256, 480 MOLA, E. L 353,523,526,791 MONEYPENXY, J 300, 516 MONOHAX, A. B 217, 233, 248, 250, 252, 260, 263, 265, 463, 468, 473, 480, 483, 486, 496 MONROE, A. L 170 MONTGOMERY, H. F 46 MOODY, G. O 553 MOODY, S 282 MOON, W. P 48,55, 315, 353, 459, 534, 550, 079, 776, 780, 790, 814 MOORE, C. D 230,236,255,449 MOORE, J 124, 413 MOORE, J. M 700,768 MOORE, N. K 542 MOORE, S 517 MOREHOUSE, G. R 9 MORGAN, D 855 MORGAN, J. C 206,207, 220, 258, 284, 285, 300, 467, 531, 779 MORGAN, W. P 434 MOROXG, E. P 20, 407, 500 MORRIS, F. D 440 MORRIS, J 47, 48, 49, 54, 315, 550, 778, 781, 792, 794, 795, 797 MORRIS, X. R 543 MORRIS, R .237, 260, 451, 485, 48C MORRISON, A.M 500 MORRISON, F. W 475 MORRISON, T 233, 525 MORRISOX, W. B 301, 523, 554 MORSE, S 661 MORTOX, C. J 305,308, 322, 548, 074, 773, 79G MORTOX, J. C 39, 49, 155, 172, 296, 321, 378, 549, 670, 774, 788, 790, 791, 794, 797, 799 MORTOX, T 497 MORTOX, T. G 59, 130, 147, 149, 152, 156, 159, 100, 162, 104, 407, 409, 627, 079, 773 MOSELEY, E. B 163 MOSELEY, N. R 23, 36, 47, 205, 208, 276, 284, 285, 288, 293, 294, 297, 298, 299, 302, 314, 315, 321, 378, 392, 453, 455, 519, 523, 525, 526, 531, 534, 541, 543, 553, 554, 589, 597, 598, 022, 634, 719, 768, 709, 773, 778, 779, 780, 784, 786, 789, 792, 793, 797, 817, 818 MOSES, 1 81, 210, 283, 300, 309, 339, 381, 409, 413, 455, 473, 769, 815 MOSHER, M. A 2GO MOSS, S. C 474, 497 MOTT, A. B 12,28, 152, 154, 158, 159, 162, 285, 304, 308, 315, 459, 517, 519, 524, 526, 549, 7C8, 773, 787 MOTT, V 13 MOULTOX, A. A .... ... 133, 134 MUDGE, C 488 MULFORD, J. L 494, 499 MULFORD, W. C 275, 286, 315, 321, 533 MULLEX, I. V MULLER. A C53 MULLINS, W. H 249 Page. MUXGER.M. J 524 MUXN, C. E 47 MUNSON, A.W 46C MUXSOX, C 217, 283, 473, 485, 511 MURDOCH, R 768 MURDOCK, T. F 55, 302 MURPHY, J 036 MURPHY, J. A 371, 619 MURPHY, J. B 58 MURPHY, J. G 524, 535, 802 MURPHY, R. R 507 MURRAY, J 077 MURRAY, J. H 507 MURRAY, W. D 239, 269, 473, 500, 525, 884 MURSICK, G.A 102,103, 111, 209, 276, 289, 299, 301, 302, 406, 531, 535, 717, 709, 776, 780, 781, 821 HURT A, J. E 247,294,435,487 MUSCROFT, C. S 227, 245, 4G9, 486 MUSGRAVE, J. F 239, 261, 451 MUSSEY, W.H 673 MYERS, J. T 246, 260, 401, 626 MYERS, T. N 142 NAGLE, J. P 276 NAPHEYS, G. H 370 NASH, A 227, 294, 488 NASH, W. M 246 NAUMAN.H 068 NEFF, H. K 701 NEFF, J 276, 321, 519, 524, 554, 664, 670 NEIL, J 183 NE1LL, J 23, 24, 74, 199, 314, 374, 407, 635 NELSON, A. W 20, 43 NELSON, J. C . . . .293, 298, 518, 519, 634, 7C9, 770 NEW, G. W 217, 219, 235, 255, 503 XEWCOMBE, J 49, 186, 276, 353, 793, 798 NEWELL, A.E 435 NEWELL, W. D 501 NEWLAND, B. J 253 NEWMAN, G. W 806 NEWTON, M. T 470 NEWTON, W. S 232,469 NICCOLLS, R 71, 84, 354, 749 NICHOLS, C. H 121, 651 NICHOLS, G 473 NICHOLS, J 16, 20, 303 NICHOLS, T. B 199 NICHOLS, W. T 371 NIDET, S.L 525 KIMS, E. B 239, 285 NOBLE, H. B 82 NORDQUIST, C. J 216, 389, 515 NORRIS, B 221, 245, 265, 280, 285, 295, 308, 313, 314, 321, 323, 482, 580 NORRIS, G. P 669 NORRIS.S.L 256 NORRIS, W. F 47, 48, 54, 106, 112, 152, 171, 204, 225, 279, 285, 297, 298, 299, 300, 302, 435, 444, 526, 527, 535, 583, 717, 722, 782, 792, 793, 796, 800 NORTH, A 40, 276, 308, 314, 319, 458 NORTHRUP, J C72 NORTON, J. C 301, 472 NORTON, O. D 54, 181, 241, 069 NOSSIXGER, F. B 173, 266 NOTSOX, W. M 28, 86, 285, 526 XOTT, G. A 499, 549 XOTT, J. C 409 XOYES.G.H 4!)7 NOYES.T.C G54 NUGEXT, W. G 227 OAKES, T. F 220, 221, 222, 223, 232, 233, 247, 258, 2GO, 261, 262, 285, 468, 472, 475, 476, 489, 495, 500 OAKLEY, L. W . . . 103, 232, 313, 315, 321, 517, 525 XII LIST OF OPERATORS AND REPORTERS. Page OATMAN, I. E 642 O CONNELL, P. A 10, 87, 13:!, 134, 226, 442 O CONNOR, J 541 ODIORNE, G. G 254 O DOHERTY, F 96 O DONNELL, J. S 219, 254, 472 O HAGAN, C. J 96, 485 OHLENSCHLAGER, E 883 OHR.C.H 299 OKIE, W. T 549 O LEARY, C 314, 341 O LEARY, R 802 OLIVER, G. P 220, 237,250, 256, 271, 295, 29!>, 300. 302, 303, 450, 477, 517, 518, 519, 523, 524, 885 OLIVER, J 92, 265, 283, 284, 532 O MEAGHER, W 206, 229, 235, 236, 293, 300, 466, 485, 500, 668, 751, 884 O REILLY, J. J 589 ORSAY, D 285,296 ORTON, J. G 12,621,642 ORTON, S. H 40, 58, 59, 293, 301, 3L6, 320, 321, 513, 541, 542, 543, 646, 663 OSBORNE, B. E 472 OSBORNE, C. H 05, 299, 527, 530, 535 OSBORNE, H 240, 477, 800 OSBORNE, J. D 230 OSBORNE, W. F 227 OTIS, A 643 OTIS, G. A 7, 8, 24, 25, 56, 68, 89, 152, 154, 159, 162, 338, 247, 4C6, 482, 502, 503, 621 OTTERSON, W. C 366,547,797 OTTMAN, R 302, 454, 515, 518, 526 OULD, E. R 10 OWEN, D. C 703 OWENS, H 074 OWENS, 1 245 OWENS, J 247 OWENS, J. R 247 OWINGS, H. W 670, 677 PACKARD, J. H 48, 152,155, 159, 162, 262, 670, 708, 789 PADDOCK, J 523 PAGE. C 187,281,282,284,296, 298, :(00, :!0l, 308, 524, 534, 541, 721 PAGE, C. G 255,775 PAGE, J. H 525 PAGE, J. R 524 PAGE, W. H 52 PAINE, C. F 592 PAINE, O. S 498, 686 PAINE, R. T 252, 494 PALMER, A. D 248, 50, 255, 294 PALMER, B. R 653 PALMER, C. D 142 PALMER. G. S 38,284, 301, 454, 5;!0, 549, 603, 633 PALMER, H 48,74,208,211, 294, 314, 543, 634, 635, 727, 769, 777 PALMER, J. C 488 PALMER, J. M 236, 542 PANCOAST, G. L. . . .21 , 4P, 51, 58, 323, 362, 455, 514, 517, 527, 077, 709, 770, 796, 804, 821 PANCOAST, J 156 PANCOAST, W. II 680 PARCHER, G 155 PARK, C. B., jr 217, 233, 250, 252, 253, 467, 473, 4s 2, 489, 495, 497, 501, 883 PARKS, W. H 249 PARKER, G. B 258, 349, 553 PARKER, M. P 673 PARKER, N 582 PARKER, O. F 314 PARKER, W 315, 370, 378, 666 PARKS, G. H 494 PARMELEE, S. L . . 187 Pnge. PATTERSON, C 247 PATTERSON, 1>. C 466 PATTERSON, J. C 548 PATTERSON, J. E 283, 490, 532, 533 PATZKI, J. H 410 PAULLIN, G. M 56,79,185, 235, 258, 297, 299, 468, 518 PAYNE, H. R 219 PAYNE, O. B 294 PE ABODY, A. G 603 PEABODY, J. H -.517.549 PE ABODY, O 252 PEACHY, ST. G 35,143,144,516 PEARCE, H 278,684,766,769 PEARSON, C. B 453 PEARSON, I. F 48,487 PEASE, P. C 238 PEASE, R. W. .73, 206, 295, 296, 301, 302, 495, 666 PECK, W 48, 504, 534, 550, 606, 769, 785, 796 PECK, W.F 527,546 PECK, W. L 494 PEEBLES, R. S. J 497 PEETS, G. H 248, 268 PEGG, C. H 255, 468, 488, 496, 535 PEIRCE, W. P 217, 251, 254, 255, 403, 450, 451, 473, 488, 496, 497, 632 PELAZE, C 674,682 PEMBERTON, O 54 PEPPER, W 149 PERCIVAL, G. P 140 1 ERIN, G 82, 121, 447, 592 PERKINS, E. T 481 PERKINS, J 80 PERLEY, T. F 661 PERRY, D. O 280 PERRY, J. O 32 PERRY, M. S 59, 409 PERRY, W. G 59,70 PETER, P 314,321 PETERS, D. C 73, 79, 202, 339, 340, 351, 396, 523, 527, 529, 550, 634, 635, 703, 757 PETERS, G. A 676 PETICOLAS, A. E 35,143 PETTIS, C. V 103 PHELPS, A. J 339, 342, 355, 413, 609 PHELPS, B. E 320 PHELPS, O. J 352 PHILLIPS, E 249, 255, 293, 496 PHILLIPS, G. W 233 PHILLIPS, J 191,283,284 PHILLIPS, J. A 140, 276, 516 PHILLIPS, J. H 42, 362, 525, 543, 671 PHILLIPS, M 254 PHILLIPS, W. H 297 PHILLIPS, W. W. L 218,228,233,483 PHILPOST, W. H 254 PHILSON, J. R 232 PHINNEY, L 472 PIERCE, B. G 489 PIERCE, J. W 320 PIERSON, W 103 PINEO. P 48, 99, 100, 141, 144, 161, 518, 794 PINKNEY, H... . 281 PINKNEY, N 227 PIQUETTE, F. E 293, 294, 295, 296, 300, 517, 531, 533, 534, 536, 541, 067, 674, 885 PITKIN, J 285, 299 PLUMB, II 229, 251, 446, 450, 470, 482, 495, 496, 503 PLUMB, S. II 206, 231 , 2:57, 250, 252, 258, 270, 468, 469, 472, 477, 484, 491, <1!!5, 496 504, 508, 511, 519, 602, 885 PLUMMER, S. C 222, 490, 510 POGUE, J 220, 233, 253, , 58, 207, 401, 497, 503 POLLOCK, A. M 851 POMERE NE, .1 . . 253, 254, 255. 056, 480, 485, 489 Page. POMFRET, J. E 236, 249, 254, 311, 458, 481,503, 541, 594, 603, 635, 678 PORTER, C. II 75,182 PORTER, F. G 263 PORTER, H. P 133 PORTER, J. B 67 PORTER, P. C 285, 455, 521, 523, 883 PORTNESS, J 629 PORTEOUS, J. G 472 POST, W. H. B 266, 527 POTTER, G. L 154, 219, 221, 230, 234, 237, 239, 240, 247, 248, 251, 255, 256, 257, 258, 260, 261, 265, 403, 451, 452, 468, 475, 476, 477, 47S, 481, 482, 484, 489, 497, 499, 542, 626, 884 POTTER, H. S 295 POTTER, J. B 238 POTTER, W. H 883 POTTER. W. W 70, 253, 646 POTTS, G. J 248,481,501,511,884 POTTS, R 140,144 POWELL, A. H 542 POWELL, E 173, 227, 323, 497 POWELL. W. P 283 POWERS, C 265, 388, 489, 623 POWERS, E. M 38,284,285,769 PRATT, F 467 PRAY, O. M 212 PRENTICE, F 133,405 PRESCOTT, A. B 629 PRICE, M. F 57,280,297, 480, 490, 527, 532, 533, 534 PRICE, R. E 456 PRICE, W. B 476 PRIDE, J. S 588 PRIESTLEY, J 58, 316, 549 PRIETO, J 281, 284 PRINCE, D 276, 294, 366, 595, 632, 674, 867 PRINCE, J. P 170,228, 247, 253, 254, 283, 357, 445, 450, 451, 482, 489, 495, 497,500, 501, 507, 794 PROUT, J. S 354,448,480,797 PROVOST, W. Y 261 PRYER, W. C 276,785 PUGH, T. C 468 PUGSLEY, E. G 293 PULLEN, G. W 25 QUICK, L H QUIDOR, J. E 518 QUINAN, P. A 297 QUINN, J. P 136 RADCLIFFE, S. J RADZINSKY, L. D RAE, R RATHER, C. A RAINE, J. R RAMSAY, G. M 208,230, RAMSAY, J. A 233,239, RAMSEY, A. H. . . RAMSEY, J. R RAMSEY, J. W RA.MSE Y, W. R 179, 210, 515, RANDALL, 15 RANDALL, P. R RANDOLPH, J. F 308, 553, 593, 669, 703, RANDOLPH, W. H 283,322,501, RANKIX, A. C RANXELS, D. V RANNEY, A. B... 2o;> 431 295 246 250 542 313 525 826 511 806 527 549 230 603 RANSOM. .1 301,803 RAPPOLD, J. C 248 RAUCH. J. H 380,383 RAVENOT, P. F 93 RAWLINGS, J. W 496 RAYMOND, M. II 253, 262 READ, E 462, 408 LIST OF OPERATORS AND REPORTERS. XIII Page. READ, J. B 10J, 111, 116, 118, ] 19, 391 READ, L. W 37, 53, 192, 206, 256, 351, 428, 447, 478, 484, 809 REAGAN, A. W 200, 203, 246, -181, 482, 534 REAMER, F. C 96,100,471,501 HE AMY, T. A 69,191 REAT, J. I, 252 REBER. C. T 256,407,634 RECK ARD, F. A 435 RECTANUS, F 677 REDDEN, J. W 15 REDF1ELD, J. S 517 REED, C R 25 REED. H. (J 646 REED, J. A. E 20 J. 252, 448, 552, 468, 5:t3 REED, J. W 257,258 REED, T. B 176, 508, 580, 589, 594, 624 REEDER, G 501 REESE, J. J 672 REEVE, J. C 5:58, 542, 668 REEVE, J. T 233, 498 REEVES, J. S 227-, 229, 245, 266 REGAN, M. F 255, 497, 602 REILEY. J 228,254,451, 481 , 482, 496. 500, 504, 668 REINHOLDT, J. K 26 REX, G. P 218,231,674 REYBURN. R 212, 280, 298, 519 REYNOLDS, B. O 275 REYNOLDS, F 217,228 REYNOLDS. H. A . . 480 REYNOLDS, L 486,523 REYNOLDS, W. B 495, 768 REZNEK, W. B 250 RICE, C. D 284 RICE, D. B 227 RICE, J. B 258, 476 RICE, P. L 58,313, 315 RICE, W. H 2! 8, 232, 269, 494, 594 RICH, T. C 76 RICHARDS, C. B 221, 223, 233, 234, 239, 254, 257, 260. 451, 473, 474, 476, 477. 486. 490, 497, 499 RICHARDS, G. R 230, 501 RICHARDSON, S. A 31,591.594 RICHARDSON, T. G 143, 218 RICHARDSON, W. F 19. 97. <:8, 104. 220, 221. 230. 237, 276, 315. 353, 505, 530, 542, 768 RICHMOND, C. H 523, 6CO RICHMOND, L 620,071 RITCHIE, A. J 280 RITTER, H. P 269, 296 RITTER, J. A 484 RIVERS. H. W 206, 462, 470, 518, 885 RIZER, M 47, 220, 228, 239, 245, 246, 250, 263, 264, 294, 323, 402, 450, 466, 48!, 482, 500, 601, 602 ROBARTS, J 470,491 ROBBINS, H. A 180, 187 ROBBINS. J 586 ROBBINS, L. H 727 ROBBINS, M. W 245, 270, 271. 489, 885 ROBBINS, N. A 47,518,527,768,791 ROBERTS, D. J 634 ROBERTS, H 645 ROBERTS, H. C 58, 139, 144,518,519 ROBERTS, 1 20 ROBERTS, W. E 533 ROBERTSON, C. A 23S, 255, 487, 512 ROBERTSON, W. A 252, 507, 532 ROBIE, J. W 447, 549 ROBILLARD, A 669 ROBINSON, G. R. B .. - - -48, 796 ROBINSON, J. H 455 ROBINSON, P. G . 481 ROBINSON, R. H 206, 228, 250 ROBINSON, W. C 453 Page. ROBISON, J. D 389 ROCHE, E. P 230, 245, 253, 263, 471, 501 RODGERS, J. H 227, 251, 253, 254, 255 RODMAN, W. M 554,884 ROE, J. B 154, 5a% 553 ROE, J. L 671 ROGERS, C 255, 400, 402 ROGERS, D. L 377 ROGERS, E. M 261, 270, 271, 471, 484, 503 ROGERS, S. G 673 ROHRER, B 140, 144 236, 239, 450, 452, 484, 487, 489, 490, 509, 884 ROLER, E. 0. F 73, 253, 483, 579 ROLLS, A 235,477, 517 ROMAYNE, J. A 535, 632 RONALD, G. W 667 ROOT.E. B 673 ROOT, J. P 232, 286 ROOT, 0. S 580 ROOT, W. W 234, 254 ROSE, F. M 232, 234, 249, 250, 255, 468, 516 ROSS, J. C 249 ROSS, J. S 228, 239, 240, 245, 247, 259, 261 , 263, 270, 511, 542 ROWLAND, C 182,360 ROWLAND, M. C 281,466,507 ROY, G. G 268 208 195 583 590 669 531 52fi 781 IVi 620 671 466 ROYAL, W. W ROYSTON, R. Y RUDER, I. H RULISON, W. H 227, 302, 389, RUMBOLD, T. F RUSH, D. G 139, 202, 393, 494, 504, RUSSELL, C. P 286, RUSSELL, E RUSSELL, W. P... RUTHERFORD, J.C. RUTHERFORD, W. W RYAN, J SAAL. G-... SABIN, S. A SABINE, A.. 451,466, 217, , 257, 482, SADLER, W. K... SAFFORD, E. D .. SALMON, II. P.... SALTER, F SANBORN, T SANDERS, H SANDERS, J.. I SANDS, E. H SANDS, II. B SANGER, E. F S ANGER, S. C SARGENT, G. P SARGENT, W SATCHEL, S. S SATTERLEE, D SATTERLEE, R. S SATTERTHWA1TE, A. 623 224, 231 . .365,923, 219, , 485, 495 SAUNDERS, D. D SAUNDERS, F. W SAUNDERS, L. L SAWIN, W. J SAWYER, J SAWYER, S. H SAYERS, S. R SAYRE, L. A SCARLOCK, W SCHAFHIRT, F SCHELL, H. S 209, 676, 680, SCHELDT, O. F SCHEXCK, B. F SCHENCK, W. L SCHIJCHARD, G. W . . 180,467, ....260, ...440, 776, 778, ...526 69 472 223, , 483 601 580 666 498 582 778 298 54 152 626 ,649 547 666 557 .234 946 234, ,885 140 59 485 ,476 553 308 ; :.. I : g ! ; ; ; 35 70 Page. SCHULTZ, L 494,662,671 SCOTT, 1 379, 463, 465, 494 SCOTT, M. P 549 SCOTT, N. B 482 SEABROOK, E. M 26,73,268 SEARLE, I. II 284, 526 SEELEY, E.M . 474 SELDEN, W 773 SEMMES, A. J 71,487 SEMPLE, G. W 235, 500 SEMPLE, J. E 16, 219, 542, 545, 604, 615 SEYFFARTH, E 286, 459, 527, 532, 5i1, 547, 549, 554, 672, 683 SEYMOUR, F 70, 314, 315, 542, 894 SIIACKELFORD, A. P 5l(i SHANNON, T. J 667 SHAPLEY, W. W 58 SHARP, J 05 SHARP, J. N 322, 626, 773, 805 SHARP, S 136 SHARPE, R 171, 188, 496, 502, 528, 587, 634 SHAW, B. S 320 SHEFFIELD, M 299 SHEKELL, A. B 599 SHELDON, A. F 207,210, 275, 276, 283, 285, 286, 296, 2117, 298, 299, 302, 315, 322, 354, 355, 390, 524, 525, 526, 527, 528, 531, 533, 543, 548, 549, 551, 554, 633, (r34, 773 SHELDON, II. L 8ft, 882 SHELTON, C. S 227 SHELTON, M.P 321,485 SHENK, O 498 SHEPPARD, D 285, 323, 673 SHERMAN, B. F 429 SHERMAN, M. G 28, 231, 413, 629 SHERMAN, S. N 59,60,70, 246, 248, 259, 516, 526, 5:53, 661, 668, 677, 776 SHERWIN, O. W 188 SHERWOOD, J. H 650 SHIELDS, J 54 SHIMER, J. C 30, 44, 47. 49, 259, 260, 276, 285, 301 , 31 1 , 494, 531, 798 SHINDLE, Y 180 SHINDLE, D. W 457 SH1PMAN, A. 1! 308 SHIPPEN, E 131,136,138,140. 144, 162, 220, 308, 403, 475, 589, 630, 632, 776 SHITTLER, O 58, 318, 320, 40! , 658, 684, 885 SHOVE, S 321 SHOYER, C. C 541 SHRADER, J. C 470 SHRADY, G. F. . . .216, 244, 462, 479, 520, 538, 773 SHRADY. J 83, 283, 302, 534 SHULTZ, S. S 511 SHURLOCK, W. C 223, 246, 253, 256, 259, 271, 450, 451, 464, 472, 473, 474, 482, 483, 486, 488, 495, 497, 498, 500, 886 SICKLER, P. E 499 SIDNEY, R. O : 297, 531, 634 SIGLER, W. F 230 SILL, R. T 282 SIM. T . . . . 95, 242, 252, 254, 314, 321, 402, 525, 666 SIMMONS, F. A 396 SIMMONS. J. K 496,673 SIMONS, J 80, 179, 457, 598, 669, 973 S1MONSON, J. C 255 SIMPERS. C. T 254,499,635 SIMPSON, J 916 SIMPSON, S. A 473 SINCLAIR, L 264, 452, 524, 534, 535, 676 SINNETT, E Ill, 112 SKEER, J. D 672, 674 SKILLERN, S. R 282,523 SKINNER, J. O 246 SKINNER, S. W . . 232 SLEEPER, W. W 582 SLOAN, A. B 65J XIV LIST OF OPERATORS AND REPORTERS. Page. SLOAN, J 294, 784 SLOAN, W. J 647 SLOANAKER, L. M 496 SLOAT, G. E 246, 2-17, 252, 320, 481 SLUSSER, L 234, 249, 255, 543, 883 SMALL, H. N 229, 238, 706 SMART, C 753, 893 SMILEY, T. T 498, 503, 530, 534, 604, 605, 606 SMITH, A. A 783, 784 SMITH, A.,H 300, 357, 51(5, 790 SMITH, A." J 54, 527, 671 SMITH, A. K 378, 854, 952, 959 SMITH, C 526 SMITH, D. P 8, 55, 113, 119, 140, 144, 299, 302, 308, 390, 404, 406, 420, 443, 458, 523, 549, 589, 605, 617, 643, 668, 683, 715, 719, 768, 779, 790, 888, 893 SMITH, E. A 24, 211, 404, 650 SMITH, E. P 540 SMITH, G. C 147,250 SMITH, G. K 106,110,112, 179, 188, 189, 190, 194, 195, 196, 204, 439, 677 SMITH, G. M 857 SMITH, H - 346, 532, 541 SMITH, II. E 229, 450, 484, 488, 498, 602 SMITH, H. H 61 SMITH, H. M 589 SMITH, I.P 320 SMITH, J. B 241 SMITH, J. E 288, 294, 650, 778 SMITH, J. F 508 SMITH, J. J 232 SMITH, J. R 469, 515, 524 SMITH, J. S 263, 501, 599 SMITH, J. T 25G, 499 SMITH, J. V. C 656 SMITH, J. W 221, 238, 498 SMITH, N 497 SMITH, O 499 SMITH, S 57, 250, 607 SMITH, S. M 191, 589 SMITH, S. P 548,668 SMITH, T. C . . . 258, 881 SMITH, T. F 72,196,429 SMITH, W. A 6 SMITH, W. F 235, 249, 257, 470 SMULL, W. G 179,478,482 SM YSER, E. M 115, 251, 261, 449 SXELL1XG, F. G 220,281,510 SXIVELY, J. N 321 SXO W, C. E 378 SNOW, G. W 93, 100, 204, 234, 2>(5, 261, 4G8, 484, 485, 499, 503 SNOW, N. L 230, 252, 487 SNYDER, ILL 782 SONN1CK, P. L 253 SOURELL, F 340 SOUT11ALL, R. G 436 SPARKS, J 253 SPARKS, J. B 250,602 SPARROW, W. E 517 SPAULD1NG, A. M 321 SPEER, A. M 25,58,275 SPENCE, W. A 471, 482 SPENCER, I 10 SPENCER, .1. A 221,451,476,499 SPENCEU, T. R 28, 87, 225, 1)55 SPIEGELHALTER, J 50, 256, 483, 491, 5C8, 535, 883 SPINZIG, C 218, 488, 502 SPOONER, II. K 58, 254,314, 494, 502 SPRAGUE, A.G 235 SPRAGUE, G 230 SPRAGUE, II. M 47,54,259, 262. 203. 296, 321, 498, 517, 520, 523, 526, 783 Page. SQUIRE, T. H 6, 79, 218, 221, 227, 228, 238, 246, 252, 254, 255, 256, 259, 266, 2(58, 285, 299, 340, 411, 476, 513, 532, 550, 608, 621, 681, 716, 750, 751, 776 STAEHLY, B. F . . . 234 STANFORD, R. L 34, 320, 547, 553, 890 STANTON, D 371, 665, 667 STANTON, J. O 301, 455, 456, 621, 780 STAN WAY, T. S 197 ST. CLAIR, A. K 227, 495, 597, 602 ST. CLAIR, T 667 STE ARXS, H. P 140, 263, 315, 524, 75fi STEARNS, I. H 468, 483, 503 STEARNS, J 783 STEBB1NS, R 315 STEDM AN, C. E 55 STEELE, A 200 STEELE, A. H 200 STEELE, J. E 54, 321, 457, 459, 542 STEGMAN, G 663, 672 STEIN, C 229 STEINER, J. M 163 STEPHENS, A. H 49, 799 STEPHENSON, B. F 206, 231, 255, 469, 486 STERLING, A 210, 212, 525, 526, 552, 777 STERLING, E 114, 1J9 STERLING, R. H 516, 527, 532, 534 STERNBERG, G. M 320,410,548 STEVENS, G. T 222, 229, 230, 233, 235, 245, 246, 247, 248, 251, 254, 257, 259, 2(50, 262, 265, 266, 285, 286, 301, 449, 451, 466, 470, 471, 474, 475, 481, 482, 484, 4S5, 487, 488, 489, 495, 497, 499, 500, 504, 512, 518, 587, 628, 630, 631, 632 STEWART, A. B 231 STEWART, J. D 133,498 STEWART, J. L 314 STEWART, J. T 705 STEWART, W. D 47, 57, 580, 582, 789 STICKNEY, H. G 133 STILLMAN, W 322 STILLWELL, J. A 397, 485, 486 STILLWELL, T. H 672 STIMMEL, M. M 480 STIXSON, C. W 221,314,504,519 STOCKER, A. A 247 STOCKER, A. E 506 STOCKYELL, D. L 517 STONE, A. R 485 STONE, B 186, 276, 316, 409, 517 STONE, H 252 STONE, J. C 447 STONE, L. R 655 STONE, S.E 525 STONE, W 279, 282, 514 STONEY, R. Q 470 STORROW, S. A 12 STORRS, M 92, 99, 232, 250, 480, 517 STOWE, C. H 533 STRAITH, J. A 248 STRATTOX, B. II 23 STREETER, B. G 230, 249, 255, 261, 499 STREETER, II. S 661,662,669 STRICKLAND, D. II 515 STRODE, A 666 STRONG, II 254, 281 STRONG, II. P 494 STROTIIER, C. G 2G9 STROW BRIDGE, J. G. F 634, 802 STIIUBE, F C81 STUBBS, G. E 78, 532 STUDY, G. M 18, 36, 234, 394, 477 STULL, T. W 220, 253 STURDEVANT, S. B 487 STURGIS, W 5E6 SUCKLEY, G 191,931 SULLIVAN, G. R 203, 204, 206 SULLIVAN, J. F... . 672 Page. SUMMERS, J. E 286, 296, 297, 298, 300, 496, 515, 517, 649, 721, 723, 685 SUTHERLAND, C 918, 951 SUTTON, G. L 182, 258 SUTTON, W. T 487 SWAIN, D 282 SWAN, J 466 SWANN, C. E 548 SWASEY, C. E 84, 221, 222, 245, 252, 300, 314, 504, 510, 663 SWEENEY, R. L 428 SWEET, J 518, 532, 781, 802 SWEET, O. P 47, 48, 454, 456, 520, 525, 534, 633, 775, 790, 792, 805 SWEETLAND, W. P 314, 319, 321, 673 SWIFT, D. D 255 SWIFT, E . . 15, 28, 376, 470, 490, 642, 710, 760, 854 SWINBURNE, J. .231, 281, 339, 347, 498, 523, 667 SYMPSON, J 218 TADLOCK, A. B 623 TALBOT, D. D 47,240,315,322,793 T ALLEY, A 35 TAPPAN, B 667 TAYLOR, D. W 431 TAYLOR, E. F 184 TAYLOR, G 362,666,667,891 TAYLOR, G. K 395 TAYLOR, II. G 882 TAYLOR, J. B. 532 TAYLOR, J. II 36,228,318 TAYLOR, J. S 218, 247, 258, 294, 524 TAYLOR, J. W 321, 661 TAYLOR, J. Y 220 TAYLOR, M. K 69,233,646,671,681 TAYLOR, R. H 555 TAYLOR, R. K 602 TAYLOR, R. R 230, 405, 406, 493, 549, 550, 552, 554, 645, 649, 658, 780 TAYLOR, \V. E 122, 125 TE AL, N 320, 755 TEATS, S 57, 243, 289, 403, 479, 714, 776, 885 TELFAN, R. S 660 TERRILL, R. M 250 TERRY, J. W 219, 498 TESSON, L. S 121 THAYER, W. II 484 TIIOM AIN, R 209, 210, 515, 523, 525 THOMAS, C. F 882 THOMAS, II. L 391,588 THOMAS, J 06, 228, 231, 256, 264, 470, 471, 498, 532, 885 THOMAS, K. G 251 TIIOM AS, M. S 506 THOMAS, M. W 231, 260, 480 THOMAS, R. J 718 THOMAS, R. P 29, 186, 408 THOMPSON, E. A 451, 510, 522 THOMPSON, G. F 285 THOMPSON, H. W 507 THOMPSON, J 319, 322, 518, 599, 675 THOMPSON, J. F 56, 109, 112, 283, 320, 406, 522, 591, 776 THOMPSON, J. G 282,284,285, 295, 297, 298, 480, 488, 501, 528, 723, 886 THOMPSON, J. II 40,230,233, 276, 280, 281 , 284, 285, 295, 297, 299, 302, 308, 301, 449, 402, 519, 527, 534, 553, 667, 788, 885 THOMPSON, J. W 412, 449 THOMPSON, L.S 727 THOMSON, W 34, 44, 46, 48, 52, 85, 87, 109, 111, 126, 152, 170, 183, 203, 206, 276, 279, 280, 283, 280, 288, 291, 292, 295, 297, 299, 300, 301, 302, 300, 350, 35:i, 365, 400, 434, 430, 44 1 , 444, 445, 516, 517, 527, 530, 535, 550, 570, 584, 650, 659, 661, 671, 720, 727, 7U8, 770, 780, 792, 795, 796, 802, 823, 837, 851, 951, 956 LIST OF OPERATORS ANt> REPORTERS. XV Page. THOMPSON, S. \V 54,253,673 THOMPSON, W. 8 882 THOMSON, W. II 307 THORN, E GG7 THOKN, S. S ... 191 THOHNDIKE, W. H 320 THORNE, J 203, 208, 394, 39G, 630 THORNE, W. H 82, 362, 486 THORNHILL, G. W 281 THORNTON, V. B 283,720 THORPE, J. C 215, 217, 259, 320, 321, 322, 323, 455, 482, 504, 510, 542, 543, 669, 674, 676, 719, 776 THRALL, W. R 248 THRECKELD, W 26 THURSTON, A. H 55, 104, 112, 314, 543, 552, 673, 788 THURSTON, W. T 275 TIBBETT, J. C 188 TIBBETTS, W 882 TILTON, H. U 313, 541, 806 TINGLE, J 663 TIPTON, R. H 266 TITUS, A 481 TODD, C. H 261,262, 263, 476, 481, 489, 516, 631, 771 TODD, C. W 785 TODD, G. R. C 217,601. TODD, S. S 654 TOLMAN, M. C 140 TOMPKINS, II. C 234, 246, 252, 642 TOOKER, R. W 518 TOPPING, C. W 668 TORRE Y, W 533 TOWARD, J. W 375, 538 TOWLE, S. K 516, 523 TOWLE, W. C 482 TOWLES, C. J 496 TOWN, F. L 82, 352, 549, 963, 964 TOWNSEND, E. P 79, 186, 436, 530 TO WNSEND, M. M . 54, 302, 533, 641 TOWNSEND, 51. W 675 TOWNSEND, T. B 55, 322, 676 TOWNSEND, W. E 20, 516 TOZIER, L. L 12 TRACY, J. W 474 TRACY, L. E 11,58,517 TRAPTON, C. L 231 TRAIN, H. D 658 TRANSUE, A 528, 533, 548 TRAU, A 542, 548, 634, 635 TRAUTMAN, C. F 285, 297, 322, 676 TREGANOWAN,A 659 TREMAINE, W. S 270, 435, 677 TRENOR, J., jr 595, 628 TRIPLER, C. S .28, 459, 627, 946 TRIPLET ! , W. H 554 TRIPS, J. D 548 TROWBRIDGE, G. M 233, 258, 265, 504 TROWBRIDGE, S. T 482 TRUE, W. H 246,488,535 TRULL, W. B 11, 55, 58, 236, 245, 260, 284, 296, 459, 535 TRYON, A. W 526 TRYON, J. R 529, 533, 647, 652 TUCKER, M 264 T UNNICLIFFE, J. W 230, 234, 645 TURNER, C. M 592 TURNER, T. J 523 TURNER, W. D 406, 456, 708, 773, 974 TURNEY, S. D 284, 362, 605, 670, 676 TUTHILL, R. K 232 TUTTLE, II. B 254 TWIFORD, W. H 206,208, 232, 234, 264, 266, 355, 519 TYSON, J 275, 285, 550, 789 SUKG. Ill 12(3 Page. UHLER, A. S 891 UHLER, J. R 264, 265, 295, 2 J9, 503 ULRICH, C. F 882 UMBERGER, E. R 466, 469, 497 UNDERBILL, G. C 678 UPHAM, J. B 14,550 UPSHUR, J. N 27 URQUHART, G 435 VALK, W. W 315, 518, 769 VAN BUREN, W. H 542 VANCE, S. W 646 VANCE, W. 525 VAN CORTLANDT, A 676 VANDERKIEFT, B. A 26,47,53,70, 192, 202, 210, 218, 253, 274, 300, 356, 357, 425, 454, 456, 516, 526, 604, 605, 703, 781, 793, 866 VAN DEVERE, A 221,265 VAN DUYN, A. C 55,677,779 VAN METER, J. N 261 VAN NORDEN, T. L 525 VAN NOSTRAND, A. H 235, 388, 516 VANNUY, S. C 70 VANS ANT, J 56, 117, 119, 297, 302, 627 VANSLYCK, D. B 477 VAN SLYCK, D. C 298, 390 VARIAN, W 275,320,663,780 VARNE Y, R. W 248 VEST, J. W. H 470, 631, 884 VICKERY, R. S 16, 754 VIGAL, J. A 229, 234, 481 VOGEL, E 56, 320 VOLLUM, E. P 365, 959 VON HARLINGER, R. L 222,261,475 VONTAGEN, C. H 627 VOSBURGH, H. D 276, 781 VOSBURGH, W 247, 256, 269, 496, 584 VOSE, E. H 378 VOYLES, D. W 234, 275 WADE, C. H 281, 302 WADE, J. L 486 WAFER, F. M 250 WAGGONER, J. S 320, 518, 527 WAGNER, C 39, 42, 118, 11 9, 137, 151 , 155, 270, 378, 409, 472, 526, 541, 666, 772, 774, 890, 891, 893, 971, 975 WAGNER, F. R 215 WAGNER, L. P 182, 239, 266,302,476,511,524, 892 WAGONSELLER, B. F 673 WALKER, A. C 672 WALKER, F. A 502 WALKER, G. S 217,248 WALKER, J 288, 806 WALKER, W. II 354, 645, 749 WALLACE, J. D 143 WALLACE, R 549 WALLACE, T. C 450 WALLACE, W. H 643 WALLS, I. W 254,389,392 WALSER, J. W 39 WALSH, J 18 WALSH, R. S. L 186 WALSH, W. S 469, 882 WALTON, C. J 231, 235, 237, 245, 246, 248, 253, 257, 260, 261, 263, 265, 284, 296, 508, 519, 525 WARD, A. J. .190, 203, 294, 403, 480, 496, 632, 888 WARD, E. F 500 WARD, J. R - 501 WARD, S. B 282,284,302,406, 409, 456, 526, 531, 542, 549, 626 WARD, T. B 496 WARD, W. S 275, 321, 541, 662 WARDNER, II 231, 286, 316, 473, 519, 527, 650, 660, 662, 665, 668, 678 Page. WARNER, A. S 481 WARNER, C. A 527 WARNER, J. E 524 WARNER, O 49, C65, 798, 802 WARNER, W. II 302, 517 WAEREN, E 35,143, 144 WARREN, J.C 14 WARREN, J. M 10, 26, 372 WARREN, L. P 507 WARREN, W. C 483 WARWICK, J. B 233 WASHBURN, C. E 254 WASHBURN, T. D 593 WASHINGTON, B. H 548,555 WASSON, J 475 WATERMAN, A 631 WATERMAN, L. D 397,470 WATERMAN, W. B 467 WATERS, E. G 71, 156, 158, 209, 282, 294, 295, 298, 301, 339, 375, 433, 550, 580, 778 WATERS, E. M. . . 485 WATERS, W. E 42, 315, 506, 553, 951 WATKINS, J 485 WATSON, A. T 646 WATSON, R. B 673 WATSON, W 254, 298, 503, 514, 520, 525, 532, 533, 535, 553 WATTS, H. H 659 WATTS, R 501 WAY, W. R 240 WEAVER, J. M 247 WEBB.G.W 57 WEBB, N... . 315 WEBBER, A. C 626 WEBER, C.E 607 WEBSTER, J. O 182 WEBSTER, W 87, 180, 184, 189, 195, 202, 216, 297, 320, 361, 457, 522, 533, 534, 535, 587, 770 WEBSTER, W. S 549 WEEDS, J. F 538, 542 WEEKS, G. R 34,593,844 WEEKS, J. F 231 WEIDEXBACH, A 248 WEIDMAN, W. M 251, 266 WEIR, R. F. .28, 40, 41, 44, 73, 79, 84, 86, 148, 151, 185, 244, 249, 251, 274, 276, 284, 285, 295, 308, 315, 319, 357, 363, 462, 465, 493, 514, 517, 521, 537, 540, 596, 606, 652, 670, 671, 768, 769, 895 WEISEL, D 186,303,516,519,531,535 WEISSE, F. D 58 WELBORN, W. P 483 WELCH, A 73 WELCH, J. C 489, 503 WELCH, S. A 524 WELCH, W. B 139, 141, 144 WELCH, W. M 241, 309, 436 WELD, F. M 222, 267, 451, 477, 496, 503 WELLES, W. L 280, 286, 299, 314, 321, 535, 549, 776 WELLING, E. L 235, 388 WEST, C. P 542 WEST, D. A 624 WEST, F 707 WEST, G. S 97,99,496,501 WEST, W. F 280,282,481 WESTERLIXG, R 55 WESTFALL, J 485 WESTMORELAND, W. F 495, 525 WESTON, J. C 840 WEY, W. C 54, 676, 677 WH ALEY, S. O C9 WHARTON, J. T 222 WHEELER, J. S 549 WHELAN, A. F 227, 229, 234, 236, 276, 401, 402, 403, 441, 452, 470, 477, 495, 496, 505, 632 WHIMPER, D. W.... --. 75 XVI LIST OF OPERATORS AND REPORTERS. Pace. WHISTON, E. A 133 WHITAKER, J. L 208, 286, 549 WHITBECK, J. F 468 WHITCOMB, J. 13 152, 157, 159, 229, 247 WHITE, A. A 93,99,217,221,231,239, 246, 248, 249, 250, 265, 390, 401, 402, 403, 450, 477, 481, 501, 504, 527, 599, 632, 804 WHITE, C. B 95 WHITE, E. M 234,488 WHITE, H. B 280, 283, 286, 296, 550, 555 WHITE, J. A 654 WHITE, W. H 218,281,676 WHITE, W. J. H 605 WHITE, W. V 92,99,228,239,256, 266, 267, 314, 485, 494, 495, 498, 504 WHITEHEAD, P. F 282, 485, 489, 507, 531, 532, 600 WHITEHEAD, W. E 218,320,550 WHITEHILL, J. C 592, 670 WH1TFIELD, G 485 WHITFORD, J. H 263 WHITING, L 623 WHITMAN, F 467 WH1TNEV, A. W 248,295, 473, 474, 486, 630, 631, 884 WHITNEY, J. J 238,257,448 WH1TON, II. B. . .217, 218, 235, 237, 238, 451, 503 WHITTINGHAM, E. T 496 WICKES, S 103 WIGHT, C. M 481 WIGHTMAN. J 518 WILBU R, J. G 483 WILBUR, W. II 472 WILCOX, T. E 121 WILD, T 237 WILDER, A. M 136, 222, 223, 236, 247, 249 257, 466, 469, 470, 503, 504, 524, 802 WILDER, B. G 576 WILEY, M 632 WILKERSON, W. W 48 WILKINSON, T. B 507 WILKINSON, W. G 196 WILLARD, J 238, 276, 286, 527 WILLIAMS, B 57 WILLIAMS, J. W 218,2:13,264,548,634 WILLIAMS, P.O 205 WILLIAMS, S. T 48,295,462,667,795 WILLIAMS, T. B 223,228, 230, 251, 252, 474, 481, 484, 494 Page. WILLIAMS. W. H 535 WILSON, A 232, 248, 253, 256 WILSON, A. D 615 WILSON, B 58 WILSON, B B. . . . 102, 178, 428, 474, 492, 551, 800 WILSON, C.I 217 WILSON, C. L 218,230,524 WILSON, D. C 395 WILSON, D. G 672 WILSON, J 221, 464, 476 WILSON, J. C 246 WILSON, J. E 669 WILSON, J. H 322 WILSON, P 58 WILSON, T. H 643 WILSON, W. R 484, 497 WINDELL, J 636 WINNE, C 253, 271, 322, 883 WINNE, C. K 74 WINSLOW, G. F 516 WINSLOW, J 286, 298 WIRTH, R 229, 255, 674 WIRTZ, H. R 508 WISE, J 485 WISHART, J. W 134, 138, 217, 218, 220, 221, 222, 231, 232, 235, 236, 237, 239, 240, 249, 252, 255, 256, 257, 202, 264, 265, 266, 267, 271, 284, 300, 469, 470, 471, 472, 473, 474, 475, 476, 484, 488, 490, 495, 496, 499, 500, 502, 503, 597, 598, 600, 601, 602, 613, 631 WITHAM, J 520 WITSELL, C 315 WITT, W. B 248, 282, 294 WOLCOTT, E. B 310, 548, 635 WOLF, F 265, 469, 480, 483, 510, 523, 526 WOLF, H. S 75 \VOLFE, D. E 484,497,882,886 WOLFE, J. A 26,232,233, 249, 387, 452, 456, 466, 482, 589, 632 WOLHAUPTER, D. P 783, 821 WOLVERTON. W. D 459 WOOD, A 231, 486 WOOD, C. S 55, 220, 221 , 222, 238, 239, 248, 256, 262, 267, 273, 275, 276, 277, 281 , 284, 297, 300, 388, 402, 466, 468, 470, 472, 474, 477, 478, 481, 485, 487, 504, 515, 525, 527, 532, 534, 557, 587, 588, 599, 601, 602, 606, 613, 632, 722 821, 883, 884, 895 WOOD, E. H 273 Page. WOOD, J. G 679 WOOD, J. R 439 WOODBURY, H. E 535 WOODHULL, A. A 377 580 500 WOODHULL, A. W 103,394, WOODMAN, L. C WOODRUFF, E 534, WOODS, J. T 82,227,339,350,: 383, 401, 412, 415, 470, 477, 609, WOODS, L. P 224,248, WOODS, P. N 205,323, WOODS, W. S 195, 227, 255, WOODWARD, B 206, 676, 766, 835, 837, WOODWARD, J. J 317, 830, WOODWARD, W WOOD WORTH, J. M 437,480, WOODWORTH, M. C 480, WOOLEN, G. V 237, WOOLEY, D.F WOOLF, M. P WOOLSTON, E. B 301 , 523, 605, 779, WOOSTER, S. R WORKMAN, W. G WRIG HT, C. B WRIGHT, D. F 47, 48, 034, 789, WRIGHT, J 164, WRIGHT, J. P WRIGHT, P WRIGHT, P. H WRIGHT, R. N WRIGHT, T. J 662,673, WRIGHT, W. M . . 183, 383, 482, 483, 510, 583, WYER, J. P W YLIE, F W YNKOOP, A 294, WYNNE,.! J... WYNNE, W. B 219,484, YANDELL, D. W 135, YANDELL, H YATES, P. C YORK, I. II YOUAL, J. M 603, YOUNG, D. S 229, 253, 255, 294, 485, 480, YOUNG, H. N YOUNG, J. A YOUNG, S.J YOUNG, W. P 481,483,504, YOUNGLOVE, J 265, ZEARING, J. R. . . .84, 240, 245, 275, 484, 026, 564, 619 885 490 588 855 956 252 552 525 309 52 631 792 218 523 519 790 665 869 778 554 582 675 672 380 501 519 92 890 138 75 sa3 769 667 524 501 197 281 524 606 883 SUBJECT-MATTER INDEX OF THE MEDICAL AND SURGICAL HISTORY OF THE WAR OF THE REBELLION. Abdomen, injuries of, II. 1-208; III, 689. Parietal wounds, II, 3; punc tured and incised wounds, II, 302; sabre wounds, II, 3, 8; III, 686; rupture and protrusion of intestines after sabre wound, II, 3; bayonet wounds, II, 3, 8; III, 686; other punctured and incised wounds, II, 4, 8; III, 653; lacerated and contused wounds, II, 4, 8; rupture of muscles, II, 5. Shot flesh wounds, II, 6 ; III, 689 ; mortality rates of, II, 7; tabular statement of injuries of parietes, II, 8. Complications of parietal wounds, II, 8; haemorrhage. II, 8; foreign bodies, II, 11; gangrene, II, 8, 12; hernia, II, 13; nervous disorders, II, 13; tetanus, II, 14. Shot contusions, III, 689. Visceral injuries without external wounds, II, 15-28; III, 689; tabular statement of, II, 26; diagnosis and treatment of, 11,27-28; ruptures of liver, II, ]6; of spleen, II, 18; of kidney, II, 20; of stomach, II, 22; of intestines, II, 22; of omentum and mesentery, II, 23; of blood-vessels, II, 24; of diaphragm, II, 25. Penetrating wounds. II, 29; 111,689; penetrations without visceral injury, II, 29-40, 202; by bayonet, II, 31-33,39; by arrow, 11,33; by ramrod, II, 33 ; shot wounds, II, 34-39 ; III, 689 ; autopsies, II, 32, 36. Diagram of subdivisions of abdominal region, II, 97. Injuries of abdomen involving-stomach, see Stomach; involving intestines, see Intestines; involving liver, see LJver; involving pancreas, see Pancreas; involving spleon, see Spleen; involving kidneys, see Kidneys; involving suprarenal capsules, see Supra Renal Capsules ; involving omentum, mesentery, and blood-vessels, see Omeiitum, Mesentery, and Klood-vessels. Complications of penetrating wounds of the abdomen. 11,176; haemorrhage, II, 176; foreign bodies, II, 179; visceral protrusions, II, 180; hernia, II, 184; abdominal effusions, II, 188; air or gases, II, 198; traumatic peri tonitis, II, 199. Frequency of wounds of abdomen, II, 201 ; mortal ity, II, 202 ; diagnosis and treatment, II, 20C.-207. Abdominal Effusions, II, 188; of blood, II, 189, 190; of bile, II, 192; of urine, II, 193; of faeces, II, 194; of pus, II, 197. Abscess, in shot wounds of head, I, 127; in cerebrum, I, 327 ; air passing through opening in abscess of neck, I, 360; abscess around balls, I, 404 ; metastatic abscesses of lung, I, 626, 628; II, 841, 844, 920; III, 431, 455; of liver, I, 443, 585; II. 216, 772, 781, 843; III, 431, 547; of spleen, II, 151, 813; III, 547; of kidney, II, 171. Acetabulum, shot fractures of, II, 179; III, 05, 68, 78-79, 80, 81. Acromial Thoracic, aneurism of, III, 8C8; haemorrhage from, II, 459; III, 704 ; ligation of branch of, II, 632; III, 765, 776. . Actual Cautery in haemorrhages, II, 320, 456, 736; III, 811. Acupressure, III, 811. Air, accumulation of, in abdomen, II, 19?. Air Passages, operations on, I, 415; III, 684. Amaurosis in wounds of head, I, 38, 116, 178, 208, 228, 232, 289; pro duced by wind of shell, I, 344. Ambulance Corps, III, 931-943; officers of, III, 913, 914; plans for organization of: by Dr. H. H. SMITH, III, 932; Surgeon B. A. VAN- DERKIKFT, III, 935; C. PFIRSCH1XO, 111,932; organization and man agement of, III, 935, 938, 939, 941 ; act of Congress establishing, III, 941, 943. Ambulance Train, III, 902. Ambulance Wagons, III, 944-957; MOSES, III, 945-946; FIXLEY, two-wheeled, III, 946; COOLIDGE, two-wheeled, III. 947; TniPl.EK, III, 947; ROSECRANS, III, 948; COOLIDGK, four-wheeled, 111,949; St)s, 111,951; ARXOLU, III, 951; MCKEAX, III, 952; I F.KOT & Co., 111,952; RUCKER, III, 952; HOWARD, III, 953; LAXGER, III, 955; Confederate, III, 956. Amputations, analysis of total number of, III, 877-886; mortality rates of, III, 678 ; primary amputations, III, 879 ; intermediary, III, 879 ; secondary, III, 879; methods of. III, 880; double amputations, III, 880. See Shoulder Joint, Arm, Elbow Joint, Forearm, "Wrist Joint, Hand, Fingers, Hip Joint, Thigh, Knee Joint, Leg, Ankle Joint, Foot, Toes, Penis. Anaesthetics, III, 887-898; number of cases of, III, 887; agents used, 111,887; mode of administering, III. 889: MARSHALL HALL S mode, III, 889; administered by CHISOLM s inhaler, III, 889; deaths from, III, 890-895; restoration of animation suspended by anaesthetics, III, 895; cases of anesthetics in the U. S. Army since the war, III. 896; chloroform, III, 897; ether, III, 897; chloroform and ether, III, 897; prostration following anaesthesia, III, 897: excitement, III, 897; vomiting, III, 897. Anal Fissure, treated by incision or by rupture of the sphincter, II, 321. Anal Fistula, number of instances of. II, 321 ; treatment of, II, 321. Anaplasty, cases of, II, 77, 79, 91 ; unnecessary and ineffectual, II, 111. Anastomotica Magna of brachial, wounds of, II, 457; III, 764; liga tion, II, 454; III, 765, 782; of femoral, haemorrhages from, III, 764. Anchyloblepharon, operation for, III, 683. Aneurism, traumatic, III, 808; of acromial thoracic, III, 808; aorta. II, 189; axillary, 11,468; 111,808; brachial, II, 4fi3, 468; III, 680,808; carotid, II, 499; 111,679,808; circumflex, 111,808; femoral, III, 38, 39. 40, 42, 45, 46, 808 ; iliac, III, 808 ; innominata, III, 808 ; intercostal, 11,597; interosseous, III, 808; superior mesenteric, II, 2o; peroneal, 111,808; popliteal, III, 14,680, 808; profunda, III, 49, 808 ; pudic, II, 252; III, 808; radial, 11,969. 1010; 111,808: sciatic, 111,808; sub- clavian, II, 632, 634, 635 ; III, 808 ; suprascapular, III, 808 ; tibial. Ill, 55, 673, 808 ; diffuse traumaticaneurism, 1, 446, 555 ; III, 755 : following 1 bayonet wounds, II, 323, 335. Ankle Joint, wounds and operations of, III, 577-61G; shot injuries of, 111,577, 608-610; periarticular wounds of, III, 31, 690; shot con tusions of, III, 577, 690, 716; shot fractures of. III, 578, 690, 870; treated by conservation, III, 579; treated by excision, III, 585, 610- 612; primary excisions, III, 586; intermediary excisions, III, 588; secondary excisions, III, 591; autopsy, III, 590; treated by amputa tion, III, 595, 608, 612, 616; primary amputations, III, 596, 598; intermediary amputations, III, 603; secondary amputations. III, 606; SYME 8 operation, cases of, III, 596-615; PlROGOFF s operation, cases of, III, 596-615; BOXTECOU S modification of PntOGOKF, cases of, III, 604, 605, 606 ; BAUDEX S operation, cases of, III, 604 : modifi cation of SYME, cases of, III, 601 ; amputations following excisions, III, 870; re-amputations following amputations at ankle. III, 870; miscellaneous injuries of ankle joint, dislocations, III, 648; fractures, III, 652; excisions of, III, 657-658, 659; amputations at, III, 664. (XVTl) XVIII SUBJECT-MATTER INDEX. Antiseptic treatment of wounds on field of battle, III, 418, 419. Anus, abnormal, II, 100; instruments for destroying- septum: DUPUYTEEX s enterotome, BLASIUS* intestine pincers, Gnoss 8, REYBAKD S instru ments, II, 110, 111 ; DESAULT S operations on abnormal anus, II, 113; PAI.FYX S method, II, 114, 280 ; artificial unus, II, 109, 113 ; operation to produce artificial anus, II, 84 ; prolapsus of, II, 254. Aorta, aneurism of, II, 189; ball encysted between aorta and vena cava, II, 135 ; wounds of, I, 519 ; ecchymosis of arch of, I, 572; exposed to view in shot wound of chest, I, 487, 597; haemorrhage from descend ing, III, 7C4. Aphonia in shot wounds of cranium, I, 47, 108, 266, 283, 338, 382; voice restored after hoemorrhage from fauces, I, 46 ; restored during vomit ing, I, 635. Apparatus, for excisions of head of humerus, II, 5G8, 5C3, 580, 594 ; for excisions in shaft of humerus, II, 075 ; for excisions at elbow, II, 849, 907, 9C8; for double amputation of forearm, II, 9C8; for dangle wrist, II, 1015 ; for amputation at the hip, III, 131, 1C2 ; for excision in shaft of femur, III, 202; for amputation of both thighs, III, 224; for frac tures of femur, III, 343-349. Arachnitis after bayonet wound of cranium, I, 32; after shot wounds of cranium, I, 53, 113, 125, 298. Arm, shot injuries of, II, 807-815; carried away by missile, II, C20, 622, 623, 625, 628, 629, 031, 632, 633, 034, 636 ; amputation of, for shot flesh wounds, II, 400, 470; amputations of, for shot fractures, II, 697; pri mary amputations of, 11,697-750; autopsies, II, 717, 736, 748; inter mediary, II, 752-775; autopsy, II, 772; secondary, II, 775-792; autopsy, II, 781 ; mortality of amputations of, II, 805-807, 824 ; large mortality in amputations in lower third, II, 824 ; ages of patients in amputations of, II, 806; amputations of arm in eastern and western armies, II, 807. Arnold s ambulance wagon, III, 951. Arrow Wounds, of cranium, I, 34; penetrating abdomen, II, 33; of blad der, II, 276; of knee joint, III, 653. Arteries, statistics of wounds of, III, 763; frequency of hemorrhages from, III, 763; erysipelas, gangrene, pyaemia, and tetanus in injuries of, III, 763; primary injuries of, II, 621, 622, 025, 026, 027; III, 763-705; primary haemorrhages in wounds of, III, 763,764,765; enlargement of arteries, III, 007; ossification of, III, 652; torsion of, II, 842; athe- roma of, III, 810; ligation of, to control inflammation, III, 377, 383; transportation in cases of wounded arteries, III, 810 ; occlusion of, by impacted ball, III, 756 ; ligations of, III, 765. See the several arteries, Aorta, etc. Arteriotomy in concussion of brain, I, 37. Arthritis, traumatic, I, 1 16 ; II, 490, 493 ; HI, 27, 28, 54, 287, 290, 552. Articular Arteries of popliteal : haemorrhages, III, 764 ; ligations, III, 765; primary injury of, III, 704. Artificial pupil, operations for, III, 681, 682. Ascites, paracentesis abdominis in cases of, II, 191 ; in wound of bladder, II, 273. Asphyxia, in wounds of face, I, 350; of neck, I, 417,418,419; of chest, I, 516; of spine, I, 427, 452. Astragalus, excisions of, III, 585, 587, 588, 591, 595, 624. Atheroma of arteries, III, 810. Auricular Artery, hemorrhages from, I, 101, 224, 393; III, 763; liga tions of, I, 233 ; III, 705, 771; primary injury of, III, 763; primary haemorrhage from, III, 703. Axillary Artery, aneurisms, I, 528,539, 541, 542, 543, 545; II, 443, 455, 468, 572, 650 ; III, 808 ; wounds of, I, 538, 539, 553 ; II, 443, 454 ; III, 764; primary haemorrhages of, III, 704; ligations of, I, 553, 556; II, 442, 444, 468, 042-644, 047, 780 ; III, 511, 6U2, 679, 705; summary of cases, III, 775; limits of, II, 444; days intervening between injury and haemorrhage, II, 442. Axillary Pad, STROMEYEU S, II, 517. Axillary Vein, wounds of, I, 539, 542, 555; II, 640; ligations of, 1, 539, 555. Back, bayonet wound of, I, 356; II, 429; III, 686; incised wound of, III, 653; punctured wounds of, II, 429; shot flesh wounds of, II, 427, 428, 429-432; III, 689; gangrene in wounds of, II, 432. Balls, varieties of, III, 697; with guiding attachment, III, 7CO; balls lodged in brain, I, 251,252,255,258; in face, I, 316; in ilium, II, 216, 222; in bladder. II, 271, 272, 273, 286; innocuously in knee joint over fifteen years, III, 372; between innominata and vena cava, I, 534; against innominata, I, 521; embedded in parotid gland, I, 305; con cealed under petrous bone, I, 367; held in folds of omentum, II, 147; ball encysted: in brain, I, 204,302; near lung, I, 587; between vena cava and aorta, II, 135; in mesenterio pouch, II, 179; in thigh, II, 100, 425; in penis, II, 345; ball pressing on nerve, I, 410; balls ex tracted, I, 309, 316; II, 11, 12, 218, 235, 283; by trephine, I, 366; balls ejected in coughing, I, 329, 342, 404, 4C5, 431, 596, 598, 629; ball ulcer ating into cavity of lung, I, 493; ball inverting in wound, I, 532; II, 619; acting as plug in injured bleed-vessels, III, 750; balls voided at stool, I, 515, 584, 598; II, 36, 37, 70, <:9-101 ; erratic course of, II, 134, 368,487; brush of, III, 706, 707; windage of, I, 344, 385; III, 706, 707; ball flattened by contact with bone, III, 717; balls split: on cra nium, I, 180-182; on bones of face, I, 338; on bones of chest, I, 503, 570, 577, 593; on ilium, II, 232; on tibia, III, 717, 718. See Co- noidal Balls, Musket Balls, Explosive Balls, Missiles. Bandaging, results of injudicious, II, 513, 517; III, 867. SEUTIN S starch bandage, III, 020. Battles and Engagements, chronological summary of, I, xxiii-clv. Bayonet "Wounds, III, 085, 686, 687; relative percentage of, to sabre and shot wounds, III, 685, 687; of scalp, I, 30, 31; of cranium, I, 31-34; efface, I, 323, 324; of neck, I, 400; of chest, I, 467, 470, 599; of heart, I, 468; of abdomen, II, 3, 4, 31, 32, 323, 335; of flesh wounds of lower extremities, III, 5,6; of knee joint, III, 300; of foot, III, 017. Bed-cards, form of, I, xviii. Bile, extravasation of, II, 192, 193 ; escape of, in shot wounds of liver, II, 142, 143. Bladder, injuries of, II, 202-303; ruptures of, II, 203; punctured, incised, and lacerated wounds of, II, 203; arrow wound of, II, 270; concus sions of, II, 264; shot wounds of, II, 264; frequency and fatality, II, 264; III, 689; diagnosis and treatment, 301, 302; opium, 303; autop sies, II, 268, 291, 292, 293, 295, 296; foreign bodies in, II, 208; autopsy, II, 425; clothing removed from, II, 280; bone removed from, II, 277, 278, 279; missiles removed from, II, 270-281; puncture of, II, 305, 370, 381, 385. See Lithotomy. Bleeding from injured artery arrested by lodgement of ball, III, 750; pri mary, III, 703, 764. Blepharoplasty, I, 368. Blood, extravasation of: in contusions of cranium, I, 03, 112; in fractures of cranium, I, 67; in brain, I, 332; in abdomen, II, 189,190,191; in pelvic cavity, II, 220; transfusion of, II, 042; III, 811. Blood-vessels, injuries of, by round ball, III, 750; by conoidal ball, III, 750; by fragments of shell, III, 75(i; by spiculte of bone, III, 755, 756; shot contusions of, III, 755; complete division of, III, 752; par tial division of, III, 754; retraction after injury of, III, 752, 754; pri mary injury of, III, 763, 764; primary bleedings from, III, 7ti3, 704; of abdomen, II, 24, 174, 175, 202; III, 689; of chest, I, 650; ligation of, I, 521, 525. See Arteries, Veins, Bone, early removal of fragments of, I, 598; II, 235; III, 416,807; union of, III, 203, 208, 211, 212; formation of new, III, 182, 223; wiring of, II, 819, 820; III, 212; drilled to facilitate formation of callus, III, 659; osteitis in contusions of, II, 818; fragments of, removed from bladder, II, 277, 278, 279. Bone Forceps, II, 256, and plate opposite. Bougies, II, 405. Brachial Artery, aneurisms of, II, 444, 463, 468, 470; III, 080, 808; in cised wound of, III, 680; punctured wound of, II, 430; shot injuries of, I, 553; II, 445,455,027, 074; III, 704; primary haemorrhages from, III, 764, 765; obliteration of, II, 407; ligations of, I, 553; II, 446, 650, 700, 763, 764, 709, 773, 774, 785, 840, 843, 920, 955, 958, 959, 980, 1010; III, 663, 680; summary of cases, III, 705,777-782. Brachial plexus of nerves, wounds of, I, 409, 410, 401, 402. Brachial Vein, haemorrhages from, III, 810; wounds of, II, 430; liga tions of, II, 436, 446, 448. Brain, shot concussion of, I, 37, 65-67; treatment by cannabis indica, 109, 113, 118, 121, 122, 125, 308; compression of, after shot wounds, I, 18, 21, 38, 67, 126; after miscellaneous injuries, III, 640; loss of substance of, I, 208,210, 218, 235, 241, 242, 257, 260; laceration of, I, 37, 39, 40,67; pus in, 1, 126; inflammation of, I, 111; exposure of, I, 40, 133, 102, 170, 199; ball encysted in, I, 204, 302. See Cerebral Hernia. Bromine in cases of gangrene, III, 292, 634. Buccal Cavity, shot wounds of, I, 392. Buck and Ball, III, 7CO; injuries by, III, 710,714. Burns and Scalds, III, 641. Bushe s Compressor for haemorrhage in rectum, n, 320. Buttocks, flesh wounds of, II, 428. SUBJECT-MATTEE INDEX. XIX Cacolets, III, 926-931; caoolets of: KoHLEii; PUOAL; LAWRENCE, BRADLEY & PARDEK; DAVIS; WOODCOCK; JOXE8; SPENCER, NICHOLS & CO., and POMEBOY & CO. Calcaneuin, injuries of, see Os calcis. Calculi, vesical, II, 269-283; around foreign bodies, II, 298; formed on projectiles, II, 27], 272, 273, 274, 275, 276; on hair, II, 281 ; passed by urethra, II, 376; instruments for crushing, II, 378-379; renal, III, 540. Canister-shot, nature of injuries by, III, 696,706; description of, 111,697. Camiabis Indica in cerebral disturbances, I, 58. Carditis in shot wounds of chest, I, 622. Caries in shot contusions cranial bones, I, 106, 128. Carotid Artery, aneurisms of, I, 355; 11,499,500; 111,679,808; wounds of common, I, 350, 352, 353, 412, 416, 420, 421 ; II, 500 ; III, 679, 751 ; of external, I, 347, 421 ; of internal, I, 432, 456 ; occlusion of com mon, by impacted ball, III, 756; rupture of common, during cough ing, I, 350 ; haemorrhages from, III, 763 ; ligations of common, I, 421; 111,766,767-770; disadvantages of AXEL S operation. I, 423; ligation of external, III, 765, 770. Casualties among army surgeons, I, xxx-xxxii. Cataract, traumatic, I, 193, 340, 345; operation for, III, 681. Catheters, II, 380-384 ; of SQUIRE, II, 302 ; of GAUJOT and SPILLMAX, II, 381; catheter found at Pompeii, II, 382; curved gum-elastic, II, 382; of IIEISTER, II, 382; of BOYER, II, 386; catheter gouge, II, 384; unsuccessful attempts to introduce, II, 352, 365, 370, 373 ; broken in dilating stricture, II, 376; broken in wound, II, 379; use of, causing fistulas, II, 3G3 ; essential in wounds of urethra, II, 351, 354; in wounds of penis, II, 348. Cerebral Artery, haemorrhage from, I, 269; III, 764. Cerebral Hernia, after sabre fractures, I, 27; after bayonet fractures, I, 32: after miscellaneous injuries, 1,44, 58, 60; after shot contusions cranial bones, I, 123; after shot fractures cranium, I, 206, 210, 211, 212, 249, 260 ; excisions of, I, 294-298, 302, 303 ; summary of opera tions, 1,309,317,318. Cervical Artery, Superficial, hemorrhage from, III, 764 ; ligations, III, 765, 774. Cervical plexus of nerves, wound of, I, 405. Cheek, shot wounds of, I, 387. Cheiloplasty, I, 374. Chest, injuries of, 465-650; frequency of, I, 509, 600, 602, 603; mortality in, I, 604-611. Miscellaneous injuries of, I, 460 ; punctured wounds of, I, 599 ; incised wounds of, I, 470, 471, 534, 599 ; incised wound of ster num, I, 534. Sabre wounds of, I, 466, 471, 599; III, G86. Bayonet wounds of, I, 467, 470, 599 ; autopsy, I, 468. Contused wounds of, I, 471,599. Shot wounds of, I, 472-050; III, 689; shot flesh wounds of, I, 470, 473, 599 ; 111,089; shot penetrations of, I, 599, 600, 606 ; per forations of, I, 600; fractures without penetrations of, I, 473, 474-476; autopsies, I, 474, 475, 470; internal without external injuries of, I, 470, 477; penetrations of, without fracture, I, 478-482; penetrations of, with fracture, I, 482-495; with fracture of scapula, I, 483, 484, 486, etc.; of ribs, I, 482, 484, 485, etc.; of clavicle, I, 482, 484, etc.; of ster num I, 480, 488, etc.; penetrations involving lung, I, 492-497, 634 ; her- metical sealing, 1,497-514; involving blood-vessels, I, 519-528; per icardium and heart, I, 5J8-530; mediastinum, I, 486, 530, 535, 589; thoracic duct, I, 535; lodgement of missiles in, I, 606, 617; haemor rhage in wounds of, I, Oil ; complications in wounds of, I, 472, 631, 633, 634-638; treatment of wounds of, I, 042; operations on, 537. Chisolm s Inhaler, III, 889. Chloroform, percentage of surgical operations in which it was used. Ill, 887; value and efficiency of, III, 888; deaths from, III, 890-894; HALL S method of artificial respiration, II, 242 ; quantities required to induce anaesthesia, III, 890; period during which it was main tained, III, 8:J6; vomiting, excitement, prostration after administra tion of, III, 897; use of stimulants prior to administration of. Ill, 889; larynx opened to restore life after administration of, II. 841. Chloroform and Ether, III, 8S8; deaths from, III, 8!)4 ; time to induce anasstbcsia, III, 800; period during which it was maintained, III, 890; vomiting and excitement after administration of, III, 897. Circumcision for phiinosis, II, 301, 374. Circumflex Artery, of axillary, aneurism of, III, 808 ; incised wound of, II, 498 ; shot wound of, II, 557; III, 704 ; ligations of, I, 557 ; II, 454, 408, 498, 525, 551, 590, 605, 629, 649, 682; III, 705, 777;- circumflex of femoral, haemorrhage from, III, 704 ; circumflex of iliac, II, 324 ; III, 764. Civiale s Uthotrite, II, 378. Clavicle, sabre fractures of, II, 474; III, G8G; bayonet fractures of, II, 474 ; III, C6G ; shot fractures of, II, 474 ; III, 690, 870 ; autopgiei, II, 491 ; excisions in, I. 557-562, 598; II, 477, 489, 497-499; III, 870; sim ple fracture of, from fall, I, 562. Climate, effects of, on treatment of wounds, III, 867, 808. Coccyx, shot fractures of, II, 252; treatment, II, 253. Colica Media Artery, haemorrhage from, III, 704 ; wound of, II, 69. Colon, punctured wounds of, II, 70; incised wounds of, II, 76; shot wounds of, II, 77-105, 155, 179, 288, 309, 318, 331. Compression, for hemorrhage, II, 9, 10, 320, 922, 932 ; III, 515, 537, 509, 810; in wounds of abdominal parietes, II, 9, 10; in scalp wounds, I, 16. Compressor, BL SHK S, for haemorrhage in rectum, II, 320. Confederate hospital records. I, xx. Conoidal Rails, injuries by, III, 090 ; effectiveness of, III, 709 ; range of, III, 709; appearance of injuries by, III, 711; varieties of, III, 697; power of penetration, III, 757. Contre-Coup, I, 214, 304, 305, 306. Contusions, shot, of bone, III, 716; of blood-vessels, III, 755. Contusions and Sprains, III, 642. Coxitis, traumatic, III, 9, 25, 26, 27. Cranium, sabre fractures of, I, 16-28; of frontal bone, I, 16, 18, 19, 20, 21, 22; of occipital, I, 17, 18, 20, 21, 23; of parietal, I, 16, 17, 18, 19, 20, 21, 22, 23; of temporal, I, 21, 23; of sphenoid, I, 33; exfoliation of cranial bones after sabre fractures of, I, 17, 20, 21, 24 ; necrosis of, I, 18, 21; trephining after sabre fractures of, I, 17, 22, 23, 24; pyaemia after sabre fractures, III, 687. Bayonet fractures of, I. 31-34, 308 ; of frontal, I, 32, 33; of parietal, 31, 32, 33; treatment of bayonet frac tures of, I, 34. Sabre and bayonet fractures of, III, 686, 687. Miscel laneous injuries of: railroad accidents, falls, blows, falling trees, kicks, I, 35-69, 305, 308; fracture external table only, I, 54, 55, 68; bone removed, I, 55, 57, 09 ; trephining of cranial bones, I, 57-60, 69 ; III, 657. Shot contusions: frontal, parietal, temporal, and occipital bones, I, 95-128, 308; III, 088; exfoliation of, after shot contusions, I, 102, 103-106, 114, 119, 122, 123, 127 ; removal of exfoliation, I, 103, 104, 105, 114; trephining for shot contusions of, I, 122-126; balls lodged in, I, 96, 101, 102, 103, 105, 109; balls removed from, I, 97, 101, 102, 103, 105, 109. Shot fractures of external table alone, I, 128-H1, 307 ; III, 688 ; of temporal bone, 1, 131, 132, 130, 137 ; frontal, I, 128-139; of occipital, I, 134, 135, 138, 139; of parietal, 1,132, 133, 134, 137, 138; exfoliation removed, I, 132; bone removed, I, 129, 130, 134, 135; ball lodged in, I, 130, 131, 136 ; ball removed from, 1, 130, 131, 136. Shot fractures, inner table alone, I, 141-159, 307, III, 688 ; trephining for shot fractures of inner table, I, 148, 149. Shot frac tures of both tables, 1, 159-214 ; linear or capillary fissure, 1, 159-160 ; autopsies, I, 159-160; III, 688. Shot fractures of both tables, with out depression, I, 101-167; III, 688; numerical statement of cases of, I, 307; mortality of, I, 307. Shot fractures of both tables, with depression, I, 167-190; III, 688; balls splitting on the cranial bones, I, 180-182; balls lodged, I, 169, 179, 180, 182, 184; balls removed from, I. 168, 170, 175, 177, 178, 181, 383, 190; numerical statement, I, 307. Shot penetrating fractures, I, 190-206, 307; III, 688; balls lodged within the cranial cavity, 1, 191, 192, 193-196, 200, 201, 202, 203, 204, 205, 206; missiles extracted from within the cranium, I, 191, 190-200, 201, 203; exfoliations, I, 192, 190. Shot perforations, I, 206-212, 307; III, 688; exfoliations after shot perforations, I, 208; ecrasemeut, crash or smash. I, 213-214, 307; III, 688. Removal of fragments, I, 215-261 ; lodgement of foreign bodies, I, 230, 237, 251 ; exfoliations, I, 215, 223, 227, 2C8, 231, 240. Trephining after shot fractures, I, 261-293, 299, 316, 317, 319, 320. Contre-coup, I, 304,306, 307; III, 688. Tabular statement of operations on cranium, I, 309. Crural Nerve, shot wounds of, I, 440 ; II, 400; III, 9, 74, 823. Cuboid Bone, excision of, III, 625. 626, 627. Cuneiform Bone, excision of, III, 623, G2fi, 627. Cutaneous Nerve, external, injurj of, II, 404, 470; excision of, II, 470; internal, wound of, II, 462, 463, 928; excision of, II, 462. Cystitis, II, 221, 238, 239, 267, 287, 309, 356, 370. Deglutition, difficulty of, in shot wounds of nock. T. 403. 405. 411, 413; in shot wounds of cranium, I, 263. Dental Artery, haemorrhage from, I, 340, 353. Diaphragm, bayonet wounds of, I, 467, 409 ; punctured wound of. II, 76 ; shot wounds, I, 536, 606, 634 ; ball lodged in, I, 480; rupture of, with out external wound, II, 25; hernia of, I, 515, 516. XX SUBJECT-MATTER INDEX. Diastasis of crauial bones, J, 213. Digital Arteries, injuries of, II, 459; III, 764; ligationsof, II, 454; III, 765, 785, 786. Dilatation, in strictures of urethra. II, 368; instruments for, by PEKUEVE, II. 387; by SHEl i AUD, II, 388; by WAKLKY, II, 388; by MALLKZ, II, 389; by MlCHELEXA, II, 389; by RIGAUO, II, 389; by MATH1EU, 11,389; bySEGALAS, II, 390; by HOLT, II, 390; by VOILLEMIEli, II, 390; by GOULEY, II, 390, 391; by DUCAMF, II, 391; by TEEVAX, II, 391. Diphtheria, operations for, I, 418. Dislocations, following shot wounds : at the hip, III, 67, 68, 69, 70, 71, 76, 83; at the knee, III, 373 ; of patella, III, 273; after excisions of bones of leg, III, 446, 447 ; for miscellaneous injuries, III, 644. Division Hospital, personnel of, III, t:02; duties of recorder of, III, 909. Dorsalis Carpi Artery, haemorrhage from, III, 764; ligationsof, III, 765, 785, 786. Dorsalis et Kad. Intl. Artery, III, 764 ; ligatioiis of, III, 7U5, 785, 786. Dorsalis Peclis Artery, haemorrhage from, III, 53, 7G4 ; ligatious of. III. 621, 765, 803. Double Amputations for shot wounds, III, 880; mortality, III, 881. Drainage Tubes, in cases of empyema, I, 580; SMITH S watch-spring dilator for sinuses, I, 580. Drowning, summary of cases of, III, 641. Dry Gangrene, II, 351; III, 850, 851; after ligation of ulnar artery, II, 436; after shot wounds, II, 351; III, 310, 314, 542; for frostbite, III, 678; due to impaired circulation, III, 850. Duodenum, shot wounds of, II, 67, 68, 134, 147. Dyspiicea, in wounds of chest, I, 638; in wounds of spine, I, 432, 434, 449, 454. Ear, wounds of, I. 384 ; rupture of membrane of, by explosion, I, 385 ; total loss of, I, :587. Ecchymosis, I>umbar, as a sign of penetrating wound of chest, I, 575. Ectropion, operation for, III, 683. Effusions, SMITH S apparatus for, in plural cavity, I, 627. Elbow Joint, wounds and injuries of, II, 827; bayonet wounds of, II, 827; III, 686 ; sabre wounds of, II, 827; III, 686 ; shot wounds of, II, 828 ; III, 690; shot fractures of, in Confederate army, III, 690; shot fract ures of, treafed by conservation, II, 830, 915; III, 870; autopsies, II, 841, 843, 844; excisions at, II, 845; III, 870; primary excisions, II, 845; intermediary excisions, II, 864; secondary excisions, 11,884; excisions at, followed by amputation, III, 870, 871 ; excisions at, for miscellaneous injuries, III, 657, 658; excisions at, in Confederate service, II, 896, 897, 899, 900; extent of bone removed in excisions at, II, 906; mode of operation, II, 906. Splints used in fractures of: ESMAUCH 8, II, 835, 888; AHL S, II, 888; BOXD S, II, 897; HEATH S, j II, 905; HODGEN S wire suspension, II, 904 ; VOLKMAXX S wire splint, 11,904; BAUKtt s, II, 835. Apparatus for excision at: HUDSON S, 11,907; LAXCEXBECK S, II, 907; Socix s, II, 907; amputations at, 11,909; 111,871; primary disarticulations at, II, 910; intermediary, II, 912; secondary, II, 913; mortality of amputations at, II, 909; dis location at, II, 827, 837. Electricity applied to wounded nerves, I, 387, 409; II, 1020; III, 9. Emphysema in wounds of the neck, I, 415; of the chest, I, 493, 579, 590, 613-15; II, 145, 160. Einpyema in wounds of the chest, I, 470, 472, 490, 529, 578, 627; II, 290. Encephalitis, in shot contusions of cranial bones, I, 111, 112; in fractures of cranium, I, 205, 257. Endocarditis, I, 533. Enterorrhaphy, II, 112, 124, 128; methods of, PALFYX, II, 114; LAl EY- KOXIE, II, 115; KKYHARD, II, 115; LEDKAX, II, 115; the four mas ters, II, 116: DEXAXS, II, 116; RAMDOIIU, II, 117; JOHEKT, II, 118; LEMBERT, II, 119; GEF.Y, II, 119; EMMEUT, II, 121 ; BAUDF.XS, II, 122; SrlLI-MANN, II, 122; VEZIEX, II, 121; BOUISSOX, II, 122; BEU- AXGEK-FeuAUi>, II, 122; advocated by LARKEY, BAUUEXS, PIKO- GOFF, LOHMEYEIi, etc., II, 124-126; opposed by F. H. HAMILTOX, j etc., II, 124. Entrance and Exit Wounds, II, 258; III, 711. Entropion, operations for, III, 681 , 682. Epididyniitis, II, 248. Epigastric Artery, wounds of, II, 175; h;emorrhage from, II, 9, 103, 178; III, 764; ligation of, II, 186; III, 40; ligation of superficial epigastric, III, 40. Epilepsy in shot wounds of cranium, I, 118, 119, 176, 177, 229. Erysipelas, traumatic, in scalp wounds, I, 77, 78, 79, 82; in wounds of the face, III, 852; in wounds of neck, I, 402, 404, 408, 412, 413 in shot wounds of upper extremities, III, 852; in wounds of chest, I, 634; of the back, II, 432; in flesh wounds of lower extremities, III, 37; in fractures of thigh. III, 352; of the knee joint, III, 408, 416; in shot wounds of the lower extremities, III, 852 ; frequency of, III, 851, 852; fatality. III, 854; regional frequency, III, 852; duration of, III, 852; repeated attacks of, III, 853; causes of, III, 855, 856; treatment of, III, 855; following excisions, III, 857; following amputation, III, 857; among white and colored troops, III, 857; idiopatln c, III, 676. Ether, in major operations, III, 887, 897: deaths from, III, 894, 895; autopsies in cases of death from, III, 894, 895, 898. Excisions of the bones of the head, see Trephining; of the bones of the face, I, 383, 398 ; of portions of the spine, I, 463, see Vertebras ; of the bones of the chest, I, 557, 598, 616, see Clavicle, Kibs, Scap ula, Sternum; of pelvic bones, II, 255; in the extremities, III, 874-876; for specific operations see parts excised. Excitement during anaesthesia, III, 897. Execution of Sentence, III, 641. Explosive Balls, I. 494 ; II, 923; III, 24, 176; injuries by, III, 696, 701, 702-704. Extirpation of eye, for ihot injury, 1, 199, 217, 330, 345; for miscellaneous injuries or diseases, III, 681, 683. Extravasation of blood in shot contusions of head, I, 38, 63, 67, 110, 112, 120, 125; in fractures of cranium, I, 332; in wounds of abdomen and pelvic, cavity, II, 176, 177, 194, 220; of fascal matter, in wounds of stomach, II, 42, 48, 57; of bile, II, 192. 193; of urine, II, 193; incis ions for, II, 206. Extremities, shot flesh wound of, 873; shot fractures of , III, 873; treated by conservation, III, 869-874 ; by excision, III, 869, 870, 871, 872, 874- 876; by amputation, III, 869, 871, 872, 877-886; by excision and sub sequent amputation, III, 869, 870, 871 ; by amputation and re-amputa tion, III, 869, 870, 871 ; upper extremities, punctured flesh wounds of, II, 435; sabre and bayonet wounds of, III, 086; shot flesh wounds of, II, 435; III, 690, 870, 871 ; mortality, III, 690: gangrene in wounds of, III, 824; erysipelas, III, 852; pyaemia, III, 859; tetanus, III, 819; excisions in, III, 870, 871 ; amputations in, III, 870, 871 ; lower extrem ities, punctured flesh wounds of, III, 5 ; sabre and bayonet wounds of, III. 686; shot flesh wounds of, III, 690, 870, 871 ; shot fractures of, III, 690; fatality, III, 690; complications in shot wounds of: gangrene, 111,824; erysipelas, III, 852; pyaemia, III, 858; tetanus, III, 819; amputations for miscellaneous injuries in, III, 664. Eye, punctured wound of, I, 386; shot wounds of, 1, 325; destruction of both. I, 325, 342, 343, 345; destruction of one eye, I, 329, 343; balls lodged in orbit. I, 340, 342; should be extracted, I, 345, 385; incisions in ophthal- mitis, I, 345; extirpation of eye, I, 199, 217, 330, 345; artificial eyes, I, 345, 387; operations for miscellaneous injuries and diseases of, III, 681. Eyelid, excision of tumor of, III, 682. Face, injuries of, I, 321-398 ; mortality, I, 382: miscellaneous injuries of, I, 324; punctured wounds of, I, 324; incised wounds of, I, 324; lacerated wounds of, I, 324; sabre wounds of, I, 321-323; III, 686; bayonet wounds of, I, 323, 324; III, 686; shot wounds of, I, 325-398; III, 688; fatality of shot wounds of, I, 325; shot flesh wounds of, I, 383; III, 688; shot contusions of, III, 324; shot fractures of, I, 381; III, 688; balls extracted, I, 383; removal of fragments, I, 383; excisions of bones of, I, 383, 398; complications in shot wounds of: gangrene, III, 824; erysipelas, III, 852; pyaemia, 111,859; tetanus, 111,819; plastic operations III, 369, 380-383. Facial Artery, shot wounds of, I, 350, 353, 397, 420; haemorrhage from, I, 346, 348; ligations of, I, 374, 422; III, 765, 772; ligation of, for in cised wound, III, 656. Facial Nerve, wounds of, I, 387; treatment of, by electric currents, I, 387 Fiecal Fistula, II, 24, 49, 113, 2"-2, 253, 277; plastic operation for, 1 f, 7!), 84, 85. Fieces, extravasation of, II, 61, 77-97, 194, 195; fa>ces vomited in shot wounds of intestines, II, 79, 184, 189; involuntary evacuation of: in fractures of cranium, I, 19,45,124,146; in wounds of spine, I, 431, 432, 461, 462. Faradization, II, 342; III, 9. Femoral Artery, aneurisms of, III, 808; bayonet wound of, III, 6; in cised wound of, III, 197; t-hot wounds of, III, 135, 160, 764 ; shot perfo ration of, III, 755; haemorrhages of, III. 764; primary bleedings of, ITT, 764; obliteration of. III. 45,56: occlusion of, III, 13; emboli in, III, 14,191; ligationsof, III, 765,788,789,798. SUBJ ECT-M ATTKR IN DEX . X XI Femoral Vein, shot injuries of, III, 43, 44; partial division of, 111,754; hemorrhages from, HI, 757,810; primary bleedings of, 111,762; liga- tions of, 111,44,47,48,40,56; thrombi in, III, 79, 191,5!>0; removal of darning needle from sheath of, III, 43. Femur, shot contusions of, III, 109,710; amputations in eases of, III, 172; shot fractures of, III, 174; shot fractures treated by conservation, III, 170: in upper third, III, 177; in middle third, III, 187; in lower third, III, 194; partial shot fractures of, 111,175; perforations of, 111,721; sim ple shot fractures of, 111,705; pseudi .rthrosis after fractures of, III, 174, 175, 170 , 198, 199; extension and counter-extension in fractures of, III, 343; side fractured, III, 352; complications of fractures of: pyaemia, III, 352; tetanus, III, 352; gangrene, III, 352; erysipelas, 111, 352; haemorrhage, III, 352; lengthening and shortening of, III, 351 ; ever- siou of foot in fractures of, III, 180, 195, 198, 199; inversion of foot, 111, 187; treatment of fractures of, III, 338; mortality in Union and Con federate armies, III, 355; splints and apparatus fur fractured, III, 342: DKSAULT S, III, 343; SMITH S anterior, III, 345, 346; HODGKX S, III, 346,347,348; SWINIJURNE S, 111,347; PHVSICK S, III, 343; GORDON BUCK S, III, 348; L ANGER S, III, 349; BKLL S double-inclined plane, III, 345; HUDSON S, III, 180; HOWARD S wire suture, III, 350, 351; fracture of, treated by excision, III, 199; primary excisions, 111,200; intermediary excisions, 111,207; secondary excisions, 111,210; results of excisions discouraging, III, 199; excisions for miscellaneous inju ries, III, 657; amputations in femur, see Thigli. Fibula, shot fractures of, III, 432,564; treated by conservation, III, 437; excisions of, III, 445; fractured by patient s weight after excision oi tibia, III, 464, 480. Field Companion, surgeon s, III, 915. Field Hospitals, III, 920-922. Field Kegister, form of, I, xiv. Fingers, amputations of, for shot injury, II, 1019; for miscellaneous inju ries, III, 659. Fire-balls, III, 701. Firearms, rifled, superiority of, over smooth-bore, III, 694; firearms used during the war, III, 695-704. Fistula, anal, II, 321; gastric, II, 45-48; case of Alexis St. Martin, II, 55; thoracic, I, 6:iO, 479, 480, 488, 490, 502, 577; urethral, II, 360-371; non- truumatic urinary. II, 368, 387, 400; traumatic urinary, II, 403; recto- vesical, II, 309,310,313; lachrymal, I, 329,358; salivary, I, 330, 368, 387. Foot, bayonet wounds of, 111,617; shot wounds of, III, 617; shot contu sions of, III, 617, 690, 716, 870; shot fractures of, III, 618, 690,870 treated by expectation, III, (118; treated by excision, III, 622, 627, 637 638; primary, III, 623: intermediary, III, 624; secondary, III, 025 excisions in bones of foot for miscellaneous injuries, III, 657; amputa tions of, 111,027; primary, III, 028; intermediary, III, 633; second ary, III, 634; Cuoi AUT s operation, III, 039; LiSFKANc s, III, 039 IlKY s, III, 039. Forearm, II, 917; punctured and incised wounds of, II, 918; sabre wounds of, 11,918; III, 686; shot wounds of, 11,919; III, 690, 870; shot flesl wounds of, 11.917; amputations following shot flesh wounds of, II 471; shot contusions of, II. 919; III, 716; partial shot fractures of 11,921; shot fractures of, treated by expectation, II, 922; III, 870 mode nf treatment, II, 092: splints for shot fractures of: IlEWlT s 11,932; .SWIFT S, II, 932; VEUDlCK s, II, 932; carried away by shot 11, (125,02(1,647; crcisions in, for shot injury, II, <:33, 066; III, 870 primary, II, 033; intermediary, II, 953; secondary, II, 961; ampu tations following excisions in, III, 870, b71 ; amputations for shot in juries of, II, 907, 993; III, 871; primary, II. 007; intermediary, II 980; secondary, II, 987; re-amputations in, III, 870, 871; amputation for miscellaneous injuries, III, 650, 602; apparatus for double ampr tation of forearm, II, 908. Foreign Bodies, lodged in chest, I, 582, 584, 500, 5! 8, 017; extracted froi chest, I, 590-593,595,508; removed from abdominal parietes, If, 11 12, 89, 90, 93, 146, 148; removed from flesh wounds, lower extremities III, 21,22; removed from stomach, II, 52; early removal of, advisee 111,807; removed from bladder by lithotomy: clothing. II, 280; hail II, 281; arrow-head, II, 270; bone, II, 277-L79; portion of bayone scabbard and of bayonet extracted by incision in perin;eum, II, 245 lodgement of foreign bodies, III, 758. Fougasses, III, 699. Fracture-bed, LANGEU S, III, 349; I ETIT S, III, 508. Fractures, simple shot. Ill, 704, 705; of humerus, II, 815, 810; of femiu III, 705; without flssnring, III, 719; with flssuring. Ill, 720; perfi rating, III, 721. "roiital Artery, haemorrhage from, I, 81; III, 763. rostbitc, HI, 071; amputations for, III, 671, 672, 673, 674, 675, 070, 077. tall-bladder, shot wounds of, II, 136, 137,140; shot rupture of, II, 19o < a Ivan is in to revive patient asphyxiated by ether, II, 187. ungrene, frequency of, III, 824; fatality and causes of death, III, 824; frequency of, after excisions, 111, 825; after amputations, III, 825; influence of season on, III, 825; j-ears in which the disease occurred, 111,815; at Frederick, 111,826; at West Philadelphia, III, 820; at Annapolis, III, 830; symptoms of, III, 827; contagion by, III, 826, 827, 848; microscopical appearance of, III, 830; characteristics of, III, 827, 828, 830, 840; treatment of, III, 826-830; treatment by bromine, III, 834-837; following strangulation by tourniquet, III, 825; caused by tight bandaging. III, 825; in scalp wounds, I, 79, 80; in wounds of the face, III, 824; in wounds of spine, II, 109; in chest wounds, I, 472, 034, in wounds of abdomen, 11,8, 10, 12; in wounds of back, II, 432; in wounds of upper extremities, III, 824; in wounds of lower extremities, III, 352, 509, 824; haemorrhage in cases of, III, 763, 764; senile, III, 675. See Dry Gangrene. rases in penetrating wounds of stomach, II, 198. lastric Artery, branches of, severed in shot wound of pancreas, II, 160. iastric Fistula in shot wounds of stomach, II, 45-48, 50, 52, 53, 54, 56; case of Alexis St. Martin, II, 55. Gastro-epiploic Artery, bayonet wound of branch of, ligated, II, 42. Gastroraphy, II, 58, 59, 113. Genioplasty, I, 375. Genital Organs, injuries of, II, 343; shot wounds of, III, 689; opera tions on, for miscellaneous injuries, III, 684. See 1 enis, Urethra, Testes, Scrotum. Glands, inflammation of prostate, HI, 81 ; enlargement of inguinal, HI, 225; ball embedded in parotid, I, 305; wound of parotid, I, 406, 411. Glottis, eedema of, I, 404, 417, 418. Gluteal Artery, wounds of, II, 328, 330, 331, 334; cut during operation, III, 97; haemorrhages from, II, 327,328, 329,330; III, 764; ligations of, II, 329, 330, 332; HI, 97, 765, 787. Gluteal Vein, injuries of, II, 338 ; III, 816. Grape-shot, description of, III, 697; nature of injury by, III, 706; parts injured by, III, 696. Greek Fire, III, 701. Haematemesis, in rupture of stomach without external wound, II. 22; in wounds of stomach, II, 41, 42, 47, 57 ; in wounds of intestines, II, 67, 88; in wounds of neck, I, 403, 413; of spine. I, 445. Hjematocele, II, 364. Haematuria, II, 167, 108, 169, 179, 284, 290, 294, 335. Haemoptysis, not a certain sign of wound of lung, I, 636; eases, 1, 482, 507; I, 145, 146. Haemorrhage, arterial, summary of cases of. Ill, "i63; fatality of, HI, 705; days on which first haemorrhage occurred. Ill, 805; long deferred, 111,800; recurrent, III. 806 ; warning bleedings, III, 807; from distal ends of arteries, III, 807; capillary, III, 807; parenchymatous. III, 193, 807; medullary, III, 808; treated by compression and styptics, III, 810,811 ; by ligation, III, 810; by ligation and subsequent ampu tation, III, 810; acupressure in, III, 811; actual cautery in, Hi< 811; treated by application of ice and cold, III, 813: primary haemor rhage, III, 701, 703, 704; after complete divisions of large arteries, HI, 752;. proportion of killed in battle caused by, III, 761 : from shot wounds of head, III, 703; I, 127, 256; of face, III, 763; I, 390, 303, 306, 397; of neck, III, 763; of trunk, III, 763; I, 472, 519-528, 611-613, 638, 642; II, 89, 18. 57. 150. 154, 159, 170-170, J90, 3-H); upper extremities, 111,703; II, 472,928, 932; lower extremities. HI, 763; in shot flesh wounds, III, 37; in shot fractures, III, 410. 448; transportation as cause of, HI, 810; treatment of. III. 810; venous, see Veins. Hsemorrhoidal Artery, haemorrhage from, HI, 704: II. 316, 320. Haemorrhoids, operations for, II, 322; SMITH S clamp in, II, 32" Haemothorax, I, 624-626; II. 155, 173. Hall s mode of administering chloroform, IIT, 889. Hand, shot fractures and contusions of bones of. Ill, 600, 870; fractures .. bones of hand treated by expectation, II. 1020; III. 870; by excision. II. 1019: III, 870; by excision and subsequent amputation, III, 870, K71 : by amputation, II, 1021; III, 871: amputations for miscel laneous injuries of, III, 659, 663, 664. Harelip, operation for, III, 684. XXTT SUBJECT-MATTER INDEX. Head, wounds and injuries of, 1, 1-320; incised nud punctured wounds of, I, 1-34 ; sabre wounds of, 1, 1-28; other incised wounds of, I, 28-30; bay onet wounds of, I, 31-34 ; miscellaneous injuries of: railroad accidents, falls, blows, falling trees, kicks, I, 35-69; gunshot wounds of, 1, 70-320; III, C88 ; complications in wounds of: gangrene, III, 824 ; traumatic erysipelas, III, 852; pyaemia, III, 859; tetanus, III, 819. See Cra nium, Scalp. Heart, shot wounds of, I, 530, 613, C23 ; II, 51; incised wounds of, 571, 534 ; bayonet wounds of, I, 468 ; action of, visible through wound, I, 535, 597; autopsies in shot wounds of, I, 530, 531, 532; cardiac diseases from wounds of, I, 533; congenital malposition of, III, 437. Hemiplegia, I, 316 ; II, 32. Hepatic Duct, wound of branch of, II, 139 ; III, 764. Hepatitis, seldom induced by shot wounds of liver, II, 139 ; case of, II, 148. Hermetical Sealing in shot wounds of chest ; HOWARD S method of, I, 497-514 ; II, 32 ; autopsies in cases of, I, 503, 504, 505. Hernia, abdominal, following bayonet and sabre wounds, II, 3, 4 ; fol lowing lacerated wounds, 11,5; following incised wounds, II, 129; III, 654 ; following shot wounds, II, 46, 47, 184, 185 ; operations for radical cure of, II, 186; diaphragmatic, I, 515, 516; II, 185; inguinal, I, 596 ; II, 474, 852 ; III, 650, 653 ; double inguinal, II, 227 ; of lung, I, 514, 515, 517, 518, 617; II, J47; phrenic, II, 25; scrotal, II, 288, 347, 368, 419 ; ligation of hernia, I. 516. See Cerebral Hernia. Herniotomy, II, 186, 187, 271. Hip Joint, periarticular wounds of. III, 24, 690; shot fractures of, III, 65, 690, 870 ; treated by conservation, III, 66 ; excisions of, III, 89, 870 ; primary excisions, III, 92; intermediary excisions, III, 101 ; secondary excisions, III, 113; amputations at, III, 127, 871 ; primary amputations, III, 131 ; intermediary amputations, III, 139; secondary amputations, III, 145 ; amputations at, for disease, III, 665. Holston s Chisel for removal of depressed bone, I, 320. Homicide, cases of, during war, III, 641. Hospital, special, for the treatment of injuries and diseases of the nerves, III, 729. Hospital Cars, improvised from railway freight cars, III, 958 ; from rail way passenger cars, III, 960; HARHIS cur, III, 960; McCRICKETT s car, III, 961 ; car of the Army of the Cumberland, III, 965; U. S. Army hospital car, III, 967. Hospital Commissary, duties of. III, 912. Hospital Gangrene, diagnosis of, III, 845; conditions favorable to accession of, III, 849 ; microscopical appearance of, III. 830-833, 843 ; at Nashville, 111,832; at Annapolis, III, 830, 836; at West Phila delphia, III, 825; at Frederick, III, 826; at Douglas Hospital, Wash ington, III, 837; at Memphis, III, 843; in shot flesh wounds of lower extremities, III, 33, 35; in shot fractures of knee joint, III, 416; treatment of, by bromine, III, 834-837, 842-848. Hospital Knapsack, description and contents of, III, 915. Hospital Steamers, or floating hospitals, in Western waters, III, 972-981; City of Memphis, III, 974; Louisiana, III, 975; R. C. Wood, II, 975; D. A. January, III, 977; Empress, III, 981 ; in East ern waters, III, 981; Daniel Webster, III, 981; Connecticut, III, 981 ; State of Maine, III, 982; J. K. Barnes, III, 982. Hospital Tents, III, 920 ; mode of heating of, III, 921. Hospital Trains, of the Army of the Potomac, III, 961 ; of the Army of the Cumberland, III, 962 ; commissary car, III, 968 ; baggage car, III, 968; kitchen car, III, 968, 969, 970; surgeon s car, III, 969. Howard s wire sutures in fractures of femur. III, 350 ; in excisions of shaft ofhumerus, 11,820; method of hermetioal sealing, I, 497; bone drill, II, 801 ; ambulance wagon, III, 903. Humerus, shot contusions of, II, 607, 817 ; III, 716 ; partial shot fractures of, II, 668; simple shot fractures of, II, 815; complete shot fractures of, II, 669, 826 ; 111,690; treatment of, II, 811; by splints of; WELCH, II, 811; HAMILTON, II, 811 ; PIIYSICK, II, 812; ROSE, II, 812; KIRK.BRIDE, II, 812; VEDDEF., II, 812; SWINBURNE, II, 812; by CLAKK S method of extension, II, 813; by LAWSOX S method of extension, 11,825; excisions in shaft of, II, 675, 819-822, 820; primary excisions, II, C75; intermediary excisions, II, 686; metallic sutures in cases of excision of, II, 820; excision of, for miscellaneous injuries and diseases, III, 658; secondary excisions, II, 6!)0; for amputations in shaft of humerus. See Arm. Hydrarthrus of knee joint, amputation in thigh for, II, C67. Hydrocele, II, 420, 421. Hydrothorax, I, 472, 624 ; III, 430. Hygienic Influences, effect of, on the treatment of wounds, III, 867, 868. Hyoid Bone, fracture of, in hanging, I, 400. Hyperostosis in shot contusions of cranial bones, I, 127. Hypospadia, II, 387 ; III, 73. Ileum, rupture of, II, 22, 205 ; shot wounds of, II, 70, 71, 72, 109, 190 ; protrusion of, II, 62; enterorrhaphia in shot wounds of, II, 72. Iliac Artery, common, aneurism of. III, 39; wounds of, II, 333, 335, 336; shot perforation of, 11,754; haemorrhage from, III, 764; ligation of, III, 765, 786; II, 333, 335, 336; III, 39: external, aneurism of, III, 239; haemorrhage from, II, 10; III, 764 ; ligations, summary of, III, 765,787; cases, II, 10, 333, 336; III, 39, 77, 84; internal, bayonet wound of. II. 335 ; shot wounds of, II, 330, 331 ; ligations of, III, 765, 786. Iliac Region, penetrations of, mistaken for wounds of abdomen, II, 213, 214. Iliac Vein, internal, injuries of, II, 190; III, 111, 816; external, emboli in, III, 191. Ilio-l,umbar Artery, haemorrhage from, II, 218, 327; III, 764. Ilium, shot fractures of, II, 212-237 ; liability to pyaemia in, II, 212 ; danger of purulent infiltration in, II, 212; shot fractures of both iliac bones, II, 215, 216 ; excisions of portions of, II, 230-233. Impalement, II, 204. Incised "Wounds (not sabre), III, 640, 652; of head, I, 28-30, 308; of neck, I, 400; of spine, I, 424; of chest, I, 470; of abdomen, II, 4, 31, 61, 76, 129 ; of pelvic cavity, 263, 343; of lower extremities, III, 7, 361. Inflammation controlled by ligation of femoral artery, III, 377, 383. Inhaler, ClllSOLM s, for the administration of chloroform, III, 889. Innominate Artery, wound of, I, 521, 606; aneurism of, I, 521 ; II, 808; haemorrhage from, I, 520; III, 763. Insanity, in fractures of cranium, I, 237, 238; in amputation of thigh, III, 229; in amputations of leg, III, 295, 486, 518. Instruments, contents of pocket case of, III, 919; of field case of, III, 919; of operating case of, III, 919; for resection, II, 256, aid plate opposite; HEINE S osteotome, MOLLET s saw, gnawing bone forceps, LEGOUEST s curved gouge and chisel, U. S. A. gouge and chisel, NELATOX s bone forceps, II, 256. Intercostal Artery, aneurism of, II, 597; wounds of, I, 525, 526, 606; ligations of, III, 765, 774 ; I, 550, 551, 552. Interosseous Artery, of forearm : aneurism of, III, 808 ; wounds of, II, 456, 469, 911 ; accidentally wounded during operation, II, 954 ; haem orrhages from, III, 764; ligations of, JJ, 454, 961, 988, 1004 ; III, 765, 785; of leg, haemorrhage from, III, 528, 764; ligation of, III, 518, 765, 803. Intestines, shot wounds of, III, (iS9 ; large, punctured and incised wounds of, II, 76; shot wounds of, II, 76; small, punctured and incised wounds of, II, 61 ; shot wounds of, II, 64 ; of duodenum, II, 67 ; of jejunum, II, 68; of ileum, II, 70; rupture of intestines, II, 3, 22, 26; operations on large intestines, II, 109; anaplasty, II, 111 ; enterorrhaphia, II, 112; protrusion of, II, 32, 34, 62, 72, 73, 75, 183, 260 ; protruding intestines returned, II, 62, 73, 260; worms in wounds of, II, 95. Involucra of bones of the leg, III, 478, 492, 539, 545; of the femur. III, 189, 196, 198, 226, 241, 256, 293, 310, 317, 319. Iridectomy, III, 681, 682, 683. Ischium, contusion of, II, 254; shot fractures of, II, 241-245,255; excisions of portions of, II, 245. Jaundice, in shot wounds of abdomen and pelvic cavity, IT, 1H8, 145, 160, 291, 304. Jejunum, rupture of, II, 22, 23; bayonet wound of, II. 42; punctured wounds of, II, 61 ; protruding after bayonet puncture, II, 61, 62; shot wounds of, II, 6?, 69, 72. Jugular Vein, external, injuries of, I, 407, 411, 412, 491; III, 816; inter nal, injuries of, I, 383, 302, 397, 420; III, 750, 816; accidentally cut during operation, I. 392, 397; 1-gation of, I, 383, 392, 397. Kidney, shot wounds of, II, 163-172, 202 ; III, 689 ; autopsies, II, 168, 169, 170; rupture of, II, 20, 21, 26. Knapsack, Hospital, description and contents of, III, 915. Knee Joint, periarticular wounds of, III, 24-32, 690; bayonet wounds of, III, 360, 686; punctured and incised wounds of, III, 6, 359; arrow wound of. III. 653: miscellaneous injuries of. Ill, 360: incised wounds of. followed by amputation of. III. 362; shot contusions, III, 364. 690, SUBJECT-MATTER INDEX. XX TIT Knee Joint [Continued. 716, 870; shot contusions of. followed by amputation, III, 363; shot fractures of, Til, 367, 870; sHot fractures of, treated by conservation, III. 368, 384, 411, 417,418, 419, 870; by excision, III, 384,419-422; pri mary excisions, 111,386; intermediary excisions, III, 391 ; secondary excisions, 111,394; by amputation, 111,397-407; primary amputations, III, 398 ; intermediary amputations, III, 40-1 ; secondary amputations, III, 407; amputations following excisions, III, 870; re-amputations in amputations at knee joint, III, 871; modes of amputation : Hoix s, L,EVEII,LE S, N. SMITH S, VELPEAU S, BAUDEXS , Rossi s, PAX- COAST S, SYME S, CARDK.X S, MEI.CHIORJ S, STOKES modification of GRITTI S, III, 424-426; shock in wounds of, III, 412; perforation of, without lesion of bones, III, 415, 416; missile lodged in knee joint, III, 372, 416; antiseptic treatment of fractures of, on field of battle, III, 418, 419; GKITTI S osteoplastic operation, III, 263, 424. Lachrymal Canal, destruction of, I, 345. 368, 370. Lachrymal Fistula, I, 329, 358. Lachrymal Sac, operation on, for chronic inflammation, III, 683. Lance Wounds, I, 34; II, 34. Langer s Ambulance Wagon, HI, 955, 956. Laryngotomy, I, 415, 418; III, 684. Larynx, incised wound of, I, 400; shot wounds of, I, 40G; III, 688; death caused by clot of blood in, I, 354 ; opened in suspended animation following administration of chloroform, II, 841. Leg, punctured flesh wounds of, III, 6, 7; shotjlesh wounds of, III, 8 ; shot contusion* of bones if, III, 427, 090, 716, 870; shot contusions followed by amputation, III, 430 ; shot fractures of bones of, III, 432, 690, 870 ; treated by conservation, III, 432, 564 ; treated by PETIT s fracture box, III, 568; by splints, III, 568; treated by excision, III, 444, 570, 870; primary excisions, III, 445; intermediary excisions, III, 453; second ary excisions, III, 456; excisions in the bones of the leg followed by amputation, III, 870; amputations in, III, 460, 572, 871; primary amputations, III, 491 ; intermediary amputations, III, 512 ; secondary amputations, III, 537; re-amputations after amputations in leg, III, 870, 871; protrusions of bone after amputations, III, 576; amputations for miscellaneous injuries of, III, 670; excisions for miscellaneous injuries of, III, 657, 658, 659. See Fibula, Tibia. Ligations of arteries in shot wounds, III, 765, 813; percentage of fatality in, III, 813; ligations in continuity, III, 814; above and below wound, III, 814; in wound, III, 814; ligations in stump. HI, 814; rarely required on field of battle. Ill, 815; of veins in shot wounds, III, 816; ligations for miscellaneous injuries, III, 679; ligations in wounds of the head, I, 160, 225, 241, 244, 255, 269, 288, 298, 313, 315; of the/ace, I, 332, 339, 346, 347, 349, 350, 367, 396, 397; of the neck, I, 419; of the spine, I, 455 ; of the chest, J, 537-556 ; of the abdomen, II, 191 ; of the pelvis, II, 326, 327, 330, 333, 337 ; of the upper extremities, II, 436, 442-454; of the lower extremities, III, 7, 38-52, 172, 353. See Aorta, etc. Lightning Stroke, III, 655. Lingual Artery, haemorrhages from, III, 763; wounds of, 1,351, 421; III, 763; ligations of, I, 397, 421 ; III, 765, 771. Lithotomy, II, 269-299. Lithotrite, CIVIALE S, II, 378. Litters, III, 923; SATTEULEE S, III, 923; HALSTEAU S, III, 924; SAXI- TARY COMMISSION S, III, 925; CONFEDERATE STATES , III, 925; SCHELL s, III, 925; litter carriage, III, 926; mule litter: BRITISH, III, 928; FRENCH, III, 931 ; two-horse, III, 926; litters suspended in hospital cars, III, 958. Liver, ruptures of, II, 16 ; bayonet wound of, I, 46!) ; punctured and incised wounds of, II, 129; shot wounds of, II, 131; III, 689; metastatic abscesses of, II, 133; escape of bile from, II, 142, 143. Lumbar Kcchymosis as a sign of penetrating wound of chest, I, 575. Lumbar Nerve, shot wound of, II, 330. Lumbar Vertebrae, miscellaneous injuries of, I, 426; shot injuries of, I, 441-449, 451, 458-462, 584 ; II, 36, 48, 72, 155, 168, 170. Lumbrici, escape of, in wounds of abdomen, II, 42, 64, 68, 71, 94, 195. Lung, sabre perforation of, I, 466, 467 ; bayonet wound of. I, 467, 468, 469, 470 ; knife wounds of, I, 470. 471 ; shot wounds of, I, 491 ; shot wounds of both, I, 495, 634; autopsies in wounds of, I, 492, 494, 497 ; collapse of, I, 631, 632; balls lodged in, I, 489, 505, 552, 585; ball removed from, I, 32, 585 ; foreign bodies lodged in, I, 493 ; fragments of cloth ing expectorated after wound of, I, 584. Maggots, in wounds, III, 867; precaution against, III, 867; cases of, I, 241, 348; II, 754; III, 20, 454, 530; in stump, III, 269. SURG. 111127 Malar Bone, shot fractures of, I, 345, 381 ; excisions of, I, 383 ; miscel laneous injuries of, I, 324. Malleolar Artery, external, wounds and haemorrhages of, III, 764. Malleolus, external, excisions of, III, 589, 593 ; internal, excisions of. Ill, 586, 591. Mammary Artery, external, shot wounds of, I, 519, 523, 524 ; on ligation of, I, 524; internal, shot wounds of, I, 523, 524, 548; III, 764: on ligations of, 1, 548 ; II, 177 ; III, 76:>, 774. Materia Chirurgica, III, 914 ; hospital knapsacks, Id, 914 ; field com panion, III, 915; medicine pannier, III, 916; medicine wa^mis of: E. HAYES & Co., Ill, 916; of J. DCXTOX, III, 916; of PKitor, III. 917; of AUTEXRKITH, III, 918. Surgical instruments: capital opera ting case, III, 919; minor operating case, III, 919 ; pocket cae,.IIT, 919; field case, 111,919. Tents: hospital, III 920; Sim.EY, III, 920. Maxilla, upper, miscellaneous injuries of, I, 324 ; shot fractures of, I, 381; excision of, I, 348, 354, 383, 398; lower, miscellaneous injuries of, I, 324 ; shot fractures of, I, 381 ; excisions of, I, 347, 351, 3(52, 383; splints and apparatus in treatment of shot fractures of lower, I, 391. Maxillary Artery, shot wounds of internal, I, 346, 351, 352, 360; haem- orrhnges from, III. 763. Median Nerve, bayonet wound of, II, 827; III, 687 ; shot wounds of, I, 479 ; II, 447, 946, 1020 ; excisions of, II, 461, 464, 470, 778. Mediastinum, shot wounds of, I, 486, 535, 589. Medical Department, expenditures of, during the war, III, 902. Medical Descriptive List, form of, I, XVII. Medical Director of corps, duties of, III, 903-906. Medical Inspector of corps, duties of, III, 906. Medical Staff, III, 899; casualties among, I, XXX-XXXII; III, 901. Medicine Panniers, III, 916. Medicine Wagons, III, 917; PEROT S, III, 917; DUXTOX 8, 111,917; AUTEXRIETH, III, 918. Medio-tarsal amputations, III, 628. Medullary Artery, haemorrhage from, III, 224. Medullary Canal, of femur, ball lodged in, III, 176; gangrene of, III, 225. Meloplasty, I, 369. | Meningeal Artery, ruptures of, II, 49, 54, 60, 125 ; wounds of, I, 229 ; haemorrhage from, III, 763. Meningitis, Spinal, cases of, I, 439, 444. Mercurial Poisoning, I, 375. Mesenteric Artery, punctured wound of, II, 62; aneurism of, II, 25: shot wound of, II, 155: haemorrhage from, III, 764: ligations of branches of, II, 62. Mesentery, ruptures of, II, 23, 24 ; shot wounds of, II, 174, 175 ; III, 689 ; ball lodged iu, II, 179. Metacarpal Bones, shot fractures of, II, 1019. Metallic Sutures, iu excisions of shaft of humerus, II, 820. Metastatic Abscesses, in lung, I, 628, and plate opposite; in liver, II, 133. Metatarsal Bones, bayonet wound of, III, 617, 686; shot fractures of III, 618; excisions of, III, 622. Miscellaneous Injuries, III, 640 ; operations for, III, 657. Missiles, nature and seat of injury of, in shot wounds, during the war, III, 696; small arm missiles, round ball, III, 697; more prone to lodge than conoidal, III. 757: buck and ball, III, 697 ; rifle balls, III, 697; slugs, III, 700 ; from fowling pieces, III, 700 : SHAl.KR s sectional bullet, III, 700; erratic course of small missiles, III, 7H>; effects of small missiles. Ill, 709, 710; distortions of small missiles, III, 710; large missiles, III, 697; shrapnel shots, III, 697; spherical case shot, III, 698: bolts, III, 698; rifled shot: WHITWORTH, I ARROT, III. 698; shells. Ill, 699; milroad iron as missiles, III, 697; effects of missiles on blood-vessels, III, 750; on bony structure. III. 713; lodgement of. HI, 757 ; early extraction of, III, 867 ; encygtinent of, III, 867. Moral Influences, effects of, on the treatment of wounds, III, 86" Mouth and Appendages, operations on, for miscellaneous injuries nn-J diseases, III, 684. Mule Litters, III, 928. Multiple Wounds, case of, I, 334. 340 : II, 017, 241, 408 ; III, 37?, 409, 868. XXIV SUBJECT-MATTEE INDEX. Muscular Tissue, effects of gunshot projectiles on, III, 712; repair of shot wounds of, III, 714 ; pyaemia in shot lesions of, III, 713. Musculo-spiral Nerve, shot wounds of, II, 464 (note), 673 (note), 861 ; rupture of, III, 644. Nasal Bones, shot fractures of, I, 381 ; miscellaneous injuries of, I, 324. Neck, sabre and bayonet wounds of, I, 399, 400 ; III, 68C ; miscellaneous injuries of, I, 400; III. 653; shot injuries of, I, 401-424; III, 688 ; wounds of, by conoidal balls, I, 402; lodgement of missiles in, I, 403; extraction of missiles from, 1, 405 ; torticollis in shot wounds of, I, 405; wounds of the larynx and trachea, I, 40C ; aphonia in. I, 407; wounds of the pharynx and cesopha jus, I. 408 ; paralysis in, I, 408 ; complica tions in shot wounds of: haemorrhage, I, 411 ; traumatic erysipelas, I, 412; 111,852; sloughing and gangrene, I, 413; 111,824; pysemia, I, 413; III, 859; tetanus, III, 819; operations on the, I, 415. Nerves, shot wounds of, III, 725 ; effects of missiles and projectiles on, III, 725, 726, 730, 742; paralysis following shot wounds of, III, 726; wounds of nerves of special sense, III, 738 ; concussion 6r commotion of, III, 741; contusion of, III, 741; cicatricial pressure on, III, 741; tetanus following wounds of, III, 743; immediate deaths from injuries of, III, 743; altered nutrition following injuries of, III, 743, 744; excessive skin secretion following injuries of, III, 746; neuralgia fol lowing injuries of, III, 746; motor paralysis, III, 748; wounds of nerves of the neck, I, 423; of the chest, I, 634; of the pelvis, II, 339, 342, 423; in flesh wounds of the upper extremities, III, 461-468; of the lower extremities, III, 9; ball pressing on, I, 410; involved in cicatrix, II, 736; excisions or removals of portions of nerve, II, 461, 462, 618, 736, 747, 970, !73; III, 11, 492, 495, 820; electricity in injuries of, I, 387, 409; II, 461, 1020; III, 9; nerve included in liga- tion of subclavian, I, 540; special hospital for treatment of injuries and diseases of, III, 729 ; wounds of: axillary plexus, I, 410 ; II, 461, 492 ; brachial plexus, I, 409, 410, 478, 522, 560 ; cervical plexus, 1, 405; crural nerve, I, 446; II, 339, 400; III, 10, 74, 823; cutaneous nerve, II, 4t>2, 463, 464, 470, 928; III, 9, 11; excision of cutaneous nerve, II, 462, 470; dental nerve, I, 358, 362, 397, 398; facial nerve, I, 117, 302, 387; lumbar nerve, II, 330; median nerve, I, 479; II, 447, 461, 464, 469, 470, 778, 827, 946, 1020; III, 687; excision of median, II, 461; musculo-spiral nerve, II, 461, 464, 673, 861; III, 644; optic nerve, I, 326, 327, 335, 344; peroneal nerve, III, 492, 495; plantar nerve, III, 617; pneumogastric nerve, I, 357; popliteal nerve, III, 9, II, 55, ;">6. 95, 103, 173; radial nerve, II, 452, 467, 925, 938; sacral nerve, I, 449: II, 261 ; sacral plexus, II, 232, 253, 254 ; saphennus, long, nerve, III, 9, 10, 11 ; sciatic nerve, II, 323, 327, 339, 340, 346, 354, 366, 406; III, 9, 10, 22, 56, 196, 311, 687. Spinal nerves, I, 577, 584; II, 163, 340; necrosis involving sympathetic nerve, II, 466; thoracic nerve, I, 536 ; tibial, II, 412 ; anterior tibial, III, 7, 9, 11, 55; posterior tibial, III, 9, 11, 12, 20, 54, 56 ; excision of posterior tibial, III, 58; ulnar, II, 461, 465, 466, 469, 843, 861. Neuralgia, traumatic, I, 478; probably caused by lodgement of ball, II, 232 ; relieved by removal of ball, II, 236 ; treatment of, II, 342. Nervous Anxiety, in shot wounds of chest, I, 638. Neuroma, II, 463, 465, 466, 623, 628, 699 ; III, 624. Neurotomy, II, 465, 623, 628, 699. Nose, wounds of, I, 386 ; protracted discharge from wounds of, I, 387. Occipital Artery, wounds of, I. 80, 82, 83, 124, 132, 456; haemorrhages from, III, 763; ligations of I, 456 ; III, 765, 771. CEdema of Glottis, I, 404, 417, 418. OEsophagus, incised wound of, I, 400 ; shot wounds of, I, 536, 606, 634 ; III, 618. Oinentum, ruptures of, II, 23; shot wounds of, II, 36, 174; III, 689 ; ball held in folds of, II, 174; protrusion of, I, 449; II, 32, 33, 34, 169, 175, 180, 182, 183; removal of protruding, II, 32, 77, 91, 181, 182; slough ing of, I, 516. Ophthalmitis, general, incisions in, I, 345. Opium, use of, in injuries of abdomen, II, 17, 27, 207. Optic Nerve, shot wound of, I, 326, 327, 332, 335, 344. Orthopnooa, in chest wounds, I, 480, 505, 529; in wounds of the abdomen, II, 135, 155. Os Calcis, shot contusion of, III, 617; shot fractures of, III, 618, 619; excisions of, III, 624, 625, 626, 627. Osteoplasty, in wounds of the testes, II, 410, 416. Osteomyelitis, following injuries of the upper extremities, II, 648, 715, 754, 788; of the lower extremities, III, 146, 148, 149, 152, 153, 156, 157, 193, 223, 280, 281, 290, 297, 301, 312, 315, 442, 590; resulting from shot contusions of femur; simple, 111,716; gangrenous, III, 171, 717. Osteophytes, in shot, contusions of cranial bones, I, 127; in injuries of the femur, III, 31, 202, 225, 291. Osteo-sarcoma, amputation of thigh for, III, 666. Palate Bone, shot fractures of, I, 381. Palatine Artery, haemorrhage from, I, 346. Palmar Arcli Arteries, incised wound of, II, 437; haemorrhage from II, 437, 448, 449, 459; III, 764; ligations of, II, 454; III, 765, 785. Pancreas, shot wounds of, II, 158. 159, 130. 161, 202; III, 089; ball lodged in, II, 159, 100; protrusion of, II, 158; excision of, II, 158. Paracentosis, thoracis: for hydrothorax, I, 573; for metastatic abscesses and empyema, I, 573; for idtopathic pleurisy, I, 573; for effusions fol lowing perforations of the chest, I, 574 ; abdominis, for ascites, II, 191, 192; natnralis, I, 576. Paralysis, after shot fractures of cranium, I, 226, 227, 228, 229, 230, 278, 287; after wounds of neck, I, 409, 410: after wounds of chest, I, 478, 479; after wounds of abdomen, II, 14; of bladder and rectum, II, 252, 229, 247, 248 ; relieved by removal of ball, I, 424 ; electricity in, I, 442. Parotid Gland, wounds of, I, 406, 411; ball embedded in, I, 305. Patella, shot fractures of, III, 367; shot perforations of, III, 371, 373, 380; percentage of fatality of shot injuries of. Ill, 416; shot contusions of, III, 364; bayonet wound of, III, 360; miscellaneous injuries of, III, 651. Pelvis, sabre and bayonet wounds of, III, 686; punctured and incised wounds of, II, 323, 326, 335, 336, 423; shot contusions of, III, 716: shot fractures of, II, 211-254, 424-426; III, 689; excisions of pelvic bones, II. 255. See Ilium, Pubis, Ischium, Sacrum, Coccyx, shot injuries of parts contained in pelvis, II, 257-406. Penis, incised wounds of, II, 343, 344; bayonet wounds of, II, 344; shot wounds of, II, 345-349; laceration of, II, 374; ball encysted in, II, 345; ball lodged in, II, 345, 346; ball extracted from, II, 345, 346; use of catheter in wounds of, II, 348; amputation of, II, 347, 349. Perforating Arteries, haemorrhages from, III, 50, 239, 267, 764; liga tions of, III, 50, 239, 267, 765, 799. Periarticular Wounds, of the shoulder joint, II, 502 ; of the elbow joint, II, 829; rarity of, in wounds of the wrist, II, 995; of the hip joint. Ill, 25; of the knee joint, III, 28; of the ankle joint, III, 31; summaries of, III, 690. Pericarditis, in wounds of the chest, I, 529, 530, 578, 587, 622. Pericardium, wounds of, I, 528, 529, 606 ; ball lodged in, I, 528 ; autop sies in wounds of, I, 528, 529. Perinaeum, shot wounds of, II, 243, 244, 399 ; ball extracted from, II, 399 ; lacerated wound of, II, 402. Perineal Fistula, after shot wounds, II, 365. Perineal Section (perineotomy), ball removed by, II, 260; fragment of bone removed by, II, 399, 400; portions of bayonet scabbard and of bayonet removed by, II, 245. Periostitis, in shot contusions of cranial bones, I, 102, 127; of scapula, I, 564; in wounds of hip joint, III, 79; in fractures of bones of lower extremities, III, 183, 310, 313, 314, 428, 455, 515, 518. Peritonitis, traumatic, in wounds of spine, I, 427, 444, 440, 449 ; in wounds of chest, I, 586; in wounds of abdomen, II, 5, 7, 12; general observa tions on, II. 199, 200, 207, 208. Peroneal Artery, traumatic, aneurism of, III, 808 ; wounds of, III, 456 ; haemorrhage from, III, 515, 764 ; ligations of, III, 51, 450, 456, 526, 765, 805. Peroneal Nerve, excisions of, III, 492, 495. Phalangeal Bones, of hand, shot fractures of, II, 1019; of foot, shot fractures of, III, 618; excisions of, III, 626. Pharyngitis, in wounds of the neck, I, 350, 416. Pharynx, shot wounds of, I, 414; III, 688. Phlebotomy, in shot wounds of chest, I, 649. Phrenic Artery, haemorrhage from, II, 177; III, 764. Phimosis, operations for, II, 343, 361, 374 ; non-traumatic, II, 386. Plantar Artery, haemorrhage from, IIT, 764; ligations of, III, 552, 673, 678, 765, 804, 805. Plantar Nerve, shot injury of, III, 617. Plastic operations, in injuries of the face, I, 368-380; for fecal fistula, II, 79. Pleural Cavity, incisions into, after empyema, I, 581 ; apparatus for effu sions in, I, 627. SUBJECT-MATTER INDEX. XXV Pleurisy, traumatic, in penetrating wounds of chest, I, 617, 618: cases of, ; 470, 492, 574, 576. Pneumogastric Nerve involved in wound, I, 337. Pneumonia, traumatic, in penetrating wounds of chest, I, 619-622; II, 493, 486, 499, 500; in shot wounds of the back, II, 432. Piieumotliorax, in shot wounds of chest, I, 633 ; cases of, I, 493, 494, 520. ! Poisoned Wounds, III, 640, 656, 663. Popliteal Artery, wounds of, III, 14, 17, 18, 47, 51, 56, 173, 226; haem orrhages from, III, 764; aneurisms of, III, 14, 54, 55, 58, 542, 080, 808; occlusion of, III, 14, 18, 388; ligations of, III, 14, 50, 51, 54, 175, 383, 404, 569, 765, 800. Popliteal Nerve, shot injuries of, III, 9, 11, 55, 56, 173. Popliteal Vein, injuries of, III, 55; haemorrhage from, III, 816 ; ligations of, III, 383. Priapism, persistent, 1, 209 ; 11,303 (note): 111,81. Profunda Artery, of arm : injuries of, II, 448, 585, 049, 736 ; haemorrhages from, HI, 704 ; aneurism of, 111,808; ligationof, 11,454, 681,736; III, 765, 782; of thigh: injuries of, 111,47,49,55,172; haemorrhages from III, 704; aneurisms of, III, 49, 808; ligations of, 111,44-49,172,233, 236, 765, 798, 799 ; re-ligations of, III, 44-47, 48. Projectiles used during the war, III, 695-704 ; effects of large, III, 704. See Missiles, Balls. Prostate, shot wounds of, II, 303, 304, 313, 423; III, 689; autopsy in shot wounds of, II, 304 ; ball lodged in, II, 304. Prostration after anaesthesia, III, 897. Prothetic Apparatus, in excisions at the shoulder joint, II, 568, 573, 580, 594 ; in excisions in shaft of humerus, II, 675; in excisions at elbow joint, II, 849, 907, 908 ; in amputations in forearm, II, 968; in fractures or excisions at wrist or ankle joint, II, 1015; for amputations at hip joint, III, 131, 162 ; in amputations in the thigh, III, 224. Pseudartnrosis, after fractured jaw, 1,361; in shot fractures of the hu merus, II, 673, 676, 680, 682, 087 ; frequency of, after excisions in shaft of humerus, II, 696; after excisions of elbow, II, 853, 854, 856, 858, 877, 890 ; after excisions in forearm, II, 934, 940, 945, 963, 964 ; in peri- articular wounds of hip joint, III, 25 (note) ; in fractures of femur III, 186, 198, 199; after excisions in shaft of femur, III, 202; after ex cisions in bones of leg, III, 447, 450, 456, 457, 459, 460 566, 572. Pterygium, operation for, III, 681, 682, 683. Ptosis, in shot wounds of cranium, I, 115, 186, 358. Pubic Bones, shot fractures of, II, 237-240; table of cases of, II, 255; autopsies after shot fractures of pubic bones, II, 238, 239, 240. Pudic Artery, traumatic aneurism of, III, 808 ; wound of, II, 357 ; haemor- ] rhages from, III, 764 ; external, II, 326; III, 764 ; ligation of, II, 186, I 326; III, 765, 798; internal, aneurism of, II, 252; haemorrhage from, II, 324, 327; wound of, II, 304 ; bayonet wound of branch of, II, 323. Pulmonary Artery, thrombi in, II, 967 ; haemorrhage from, III, 764. Punctured Wounds, number of, during the war, III, 640 ; of scalp, I, 30; of cranium, I, 31; of face, I, 321,323,324; of neck, I, 399; of chest, I, 460, 407,599; of abdominal parietes, II, 3; of abdominal cavity without visceral injury, II, 31, 202; of jejunum, II, 42; of stomach, II, 42,43,44,57; of small intestines, II, 61 ; of mesenteric artery, II, 62; of large intestines, 11,76; of diaphragm, II, 76; of colon, II, 76; of liver, II, 129; of spleen, II, 149; of kidney, II, 162; of bladder, II, 203 ; of urethra, III, 052 ; of blood-vessels of pelvis, II, 323; of pudic artery, II, 323; of iliac artery, II, 335; of penis, II, 344; of back, II, 429; of upper extremities, II, 435; of brachial artery, II, 430 ; of clavicle or scapula, II, 473, 474 ; of elbow joint, II, 827; of metatarsal bones, III, 017; of lower extremities, III, 5; of femoral artery, III, 6; of knee joint, III, 359, 653; of leg, III, 6. Pus, extravasation of, in shot wounds of abdomen, II, 197; cases of, II, 24, 67, 104, 135, 130. Pysemia, tabular statement of cases of, III, 858 ; percentage of fatality in cases of, III, 858; complicated with other diseases, HI, 858; time of appearance of, after injury, III, 859, 800; duration of, III, 800; after shot flesh wounds, HI, 800 ; after shot fractures, III, 800 ; treat ment of, III, 860, 861; in shot lesions of muscular tissue, III, 713; post mortem appearances in cases of, III, 802-866; after shot fractures of cranium, I, 250 ; of the face, III, 859 ; after shot wounds of the neck, I, 412, 413; III, 859 ; after shot wounds of the spine, I, 454 ; of chest, I, 472; after shot fractures of pelvis, II, 212,231,239, 247; in fractures of upper extremities, III, 859 ; in fractures of forearm, II, 932; in fractures of lower extremities, III, 838, 659; in flesh wounds of lower extremities, III, 32, 33; in fractures of femur, III, 352; in fractures of knee joint, III, 410; in fractures of leg, III, 569. Pyohnemia, III, 857. Radial Artery, incised wound of, II, 436; shot wounds of, II, 452, 455, 409, 840, 914; haemorrhages from, II, 452,453; III, 704; aneurism* of, II, 969, 1010 ; III, 808 ; ligations of, II, 430, 452, 453, 469 ; III, 705, 782; summary of ligations of, III, 783; shot wound of radial and uliuir, HI, 704. Radial Nerve, shot injuries of, II, 452, 467, 925, 93d. Radius, shot fractures of, 11,922; treated by expectation, 11,927-932: followed by excision, II, 936. Radius and Ulna, shot fractures of, II, 923. Railway Transportation of wounded, III, 957-971. Ramrod, abdominal cavity transfixed by, without injury to viscera, II, 33; missile extracted by, II, 251. Re-amputations, III, 870,871. Recto-vesical Fistula, after shot wounds, II, 309, 310, 313. Rectum, shot wounds of, II, 305; III, 689; lesions of, without injury to other organs of pelvis, II, 423; autopsies in shot wounds of, II, 316. 317, 318 ; foreign bodies removed from, II, 322. Rectus Muscles, rupture of, in lacerated wound of abdomen, II, 5. Reflex Paralysis in shot wounds, III, 726, 729-738. Remote Results of wounds and injuries, sources from whence obtained, I, xir. Report of surgical operations, form of, I, xvi; of wounded, form of, I, xvi. Resections, instruments for, see plate opposite II, 256. See Kxclsions. Rliinoplasty, I, 372. Ribs, shot fractures of, I, 488,560; III, 689; shot fractures of, without le sion of thoracic cavity, I, 446; fractures of, not shot, I, 599; excisions of, portions of, I, 566, 570, 598. Rifle-balls, of Springfieldmusket, III, 697; of Enfield musket, III, 697; of Austrian musket, III, 697 ; of Burnside rifle, III, 097 ; of Spencer rifle, 111,697; of Sharp s carbine, III, 697; .of Green s rifle, III, 697; of Colt sarmy pistol, III, 697; superiority of, over round ball, III, 094, 697. Rucker ambulance wagon, III, 952, 953. Sabre Wounds, of scalp, I, 1, 308; fracturing cranium, I, 16, 308; of foce, I, 321, 382; of neck, I, 399, 400; of chest, I, 466, 471 ; of ab dominal parietes, II, 3, 8; penetrating abdominal cavity, II, 32, 202; of small intestines, II, 61; of large intestines, II, 76; of liver, II, 129; of urethra, II, 374; of back, II, 429; of upper extremities, II, 435, 436; of scapula, II, 473; of elbow joint, II, 828; of forearm, II, 918; of lower extremities, III, 5, 7; summary of sabre wounds, III. 685, 686 ; mortality of sabre wounds, III, 686. Sacral Nerves, wounds of, I, 449; II, 261 ; wounds of plexus of, II, 232, 253, 254, 341. Sacro-luinbsvr Nerves, shot injury of, II, 340. Sacrum, shot fractures of, II, 246-251 ; excisions of portions of, II, 251 ; portion of, removed by trephine, II, 251; lodgement of 12-pound shell in, II, 248. Saliva, profuse escape of, in shot wounds of face, I, 369, 370, 371, 372, 37, Salivary Fistula, cases of, I, 330, 368, 369 ; treatment of, I, 380, 387. Saplienous Nerve, injury of long, III, 9, 10, 11. Sarcocele, II, 418. Scalds and Burns, cases of, during the war, III, 641. Scalping, I, 315. Scalp, injuries of, I, 1-10, 28-31, 35, 70-95, 308; sabre wounds of, 1, 1-16; summary of cases of, I, 16, 3C8 ; sutures in scalp wounds, I, 1-16, 25; adhesive plaster in, I, 15, 16 ; other incised wounds of, I, 28-30, 308 ; bayonet wounds of, I, 30^, 31 ; contusions and lacerations of, I, 35, 38, 39-42, 43, 45, 47, 51 ; FltIAU 8 balsam in scalp wounds, I, 04 ; edges of wound approximated by tying hair, 1, 64 ; interrupted sutures in scalp wounds, I, 04 ; sabre nnd bayonet wounds of. Ill, 686; shot wounds of, I, 70-95; III, 688 ; tabular statement of shot wounds of, I, 70 ; scalp wounds complicated with intcrcurrcnt diseases, I, 85-88 ; compression of brain in scalp wounds, I, 75, 76 ; coma, I, 75, 76 ; ball extracted from scalp, I, 92 ; foreign bodies lodged in, I, 92 ; seton wounds of scalp, I, 90, 91, 95. Scapula, sabre wounds of, II, 473; III, C86; punctured fractures of, II, 474 ; shot fractures of, II, 474-481 ; III, 690, 870 ; remarkable fisstiring of, II, 488 ; exfoliations of, II, 482, 487; autopsies in shot fractures of II, 488, 489, 490; excisions of portions (if, I, 562, 566; II, 49 490, 497 ; III, 657, 658 ; excision of entire, II, 49D (note) ; trephining of portion of, II, 492. XXVI SUBJECT-MATTER INDEX. Sciatic Artery, shot wound of, II, 326 ; haemorrhages from, II, 326, 327; III, 764 ; aneurism of, III, 808 ; ligations of, II, 326, 765, 787. Sciatic Nerve, bayonet wounds of, II, 323; III, C87; shot wounds of, II, 100, 179, 252, 339, 340, 3o5; III, 9, 10, 22, 56, CO, 139, 196, 311. Scrotum, shot wounds of, II, 419; ball extracted from. II, 419. Septicaemia, II, 351 ; III, 857, 858. See Pyreinia. Sequestra, removal of, II, 715; III, 212, 224, 439, 459, 520, 522. Seton Wounds, in injuries of the scalp, I, 90, 91, 95 ; in injuries of the ilium, II, 213, 227. Shells, injuries by, III, 696; appearance of injuries by, III, 711 ; lodge ment of, III, 705. 706 ; lodgement of 12-pound shell in sacrum, II, 248. See Missiles. Shock, in shot wounds of chest, I, 639 ; in shot wounds of the abdominal parietes, II, 13; in penetrating wounds of abdomen, II, 30 ; as a pri mary symptom of shot wounds, III, 759; death from shock of wound or operation, II, 490,541, 642, 644, 760, 979, 990 ; III, 298, 299, 300, 301, 302, 308, 315, 321, 322, 459, 661, 662, 669, 670, 676. Shot Wounds, number of cases of, treated during the war, III, 685, 688; regional frequency of, III, 691, 692.- relative frequency of, III, 691, 692; definition of, III, 694; primary symptoms of: pain, III, 760; shock, III, 759; haemorrhage, III, 762; entrance and exit wounds, III, 711 ; early examination of, III, 867; early treatment of, III, 867 ; primary dressing of, III, 867 ; maggots in, III, 867 ; multiple wounds, III, 868, 869 ; influence of hygienic and moral conditions on treatment of, III, 868 ; effects of climate ou treatment of, III, 867. See shot wounds of: Head, Face, Neck, Chest, Spine, Abdomen, Pelvis, Back, Upper and Lower Extremities ; fur shot contusions, see Contusions ; fur shut fractures, see Fractures. Shoulder Joint, shot fractures of, II, 502; III, 690, 8";0; periarticular wounds of, II, 502 ; III, 690 ; shot fractures of, treated by expecta tion, II. 502-519, 656 ; III, 870 ; hemorrhage in shot fractures of, II, 513, 514; autopsies in shot fractures of, II, 510, 511,512, 513; shot fractures of, treated by excision, II, 519-613, 664 ; III, 870 ; treated by amputation, II, 613, 655 ; III, 871. Sibley Tents, used as hospital tents, III, 920. Simple Dressings in shot wounds of chest, I, 642. Simple Shot Fractures, III, 704, 705; of the humerus, II, 815; of the radius, II, 929 ; of the tibia and fibula by cannon ball, III, 440. Skin Grafting, in shot wounds of back, II, 430, 431. Small Arms, projectiles from and seat of injury in wounds by, III, 696; effects by missiles from, III, 708, 709. See Missiles. Solid Shot, summary of injuries by, III, 696. Spermatic Artery, haemorrhage from, II, 337 ; III, 764 ; ligations of, II, 337 ; III, 684, 765, 788. Spermatic Cord, shot wounds of, II, 417 ; III, 689 ; cases of, II, 339, 413, 415. Sphincter, division of, for fistula, II, 315, 321; stricture of, after shot wounds, II, 312, 314, 315; paralysis of, II, 310, 312. Spinal Canal, incised wound of, I, 425; shot wounds of, II, 154, 155; balls lodged in, I, 435, 436, 438, 439, 440, 443, 444, 447, 449, 452, 453, 457 ; perforation of, I, 444, 447 ; ball extracted from, I, 444. Spinal Cord, laceration of, I, 426, 427, 431, 433, 435, 436, 438, 440, 443, 444, 447, 458; perforation of, I, 437, 446, 452; severed, I, 439, 444; II, 339 ; compressed, I, 426, 438 ; gangrene of, II, 169 ; exposed, II, 229. Spine, miscellaneous injuries of, I, 426-429; III, 643, 649; incised wounds of, I, 425; shot wounds of, I, 430-460; III 689; concussion of, I, 427, 427, 429,465; III, 643; foreign bodies in, I, 437,438, 444; excisions, trephining of, I, 4G3-465; balls lodged in, I, 430. 432, 435, 436, 437, 439, 441, 447, 453, 459, 460; balls extracted from, I, 430,442,443,446,452, 456, 460, 462; absence of paralysis after shot wounds of, I, 431, 442, 443, 444, 446, 447, 449, 451 ; tetanus, dyspnoea, pyaemia, dysphagia, costive- ness, and priapism after injuries of vertebrae, I, 454. See Vertebrae, and Cervical, Dorsal, and Lumbar. Spleen, ruptures of, I, 38, II, 18, 19, 26; punctured wounds of, II, 149; shot wounds of, II, 149-157,202; 111,689; protrusion of, in penetrating wound of abdomen, II, 151; extirpation of, II, 150. Splenic Artery, wound of, II, 159 ; haemorrhage from, III, 764. Splenitis, traumatic, II, 19, 157. Splenotomy, II. 149, 254. Splints, AHL S felt, II, 822,888; BAUER S, II, 835; BOND S, II, 897; DE- SAULT S, III, 343; ESMARCH S, II, 835, 888; GURDON BUCK S, III, 348; HODGEN B, II, 904; III, 346, 347, 348; HARLAN S bracketed, II, 509, 517, 562; MARTIN S, II, 822; PHYSICK S, III, 343; SMITH S an terior, III. 345, 346; VOLKMANN s wire, II, 904; HEATH S, II, 905; in excisions of the sho aider joint, II, 509, 517; in excisions of the humerus, II, 822 : in shot fractures of the elbow, II, 835; in excisions at the elbow, II, 888; in fractures of the femur, III, 343. Sprains and Contusions, III, 642. Staphyloma, operations for, III, 681-683. Staphylorraphy in wounds of upper jaw, I, 378. Sternum, shot fractures of, I, 486, 504, 525; excisions of portions of, I, 571. Stimulants, in shot wounds of the chest, I, 647; prior to the administra tion of anaesthetics. Ill, 889. Stomach, rupture of, without external wound, II, 22 ; punctured and in cised wounds of, II, 42, 56; treatment of, by ligature, II, 44; shot wounds of, II, 45-60, 154, 160, 202; III, 689; autopsies in cases of, II, 42, 48, 50, 51 ; escape of lumbricoid worms in wound of, II, 42. Stomatoplasty in shot wounds of mouth, I, 370. Strabotomy, cases of, III, 681, 682, 683. Stricture, Traumatic, in shot wounds of urethra, II, 351-358, 365, 368, 372, 397 ; after laceration of urethra, III, 652. Stromeyer s Axillary Pad in wounds of shoulder joint, II, 517. Stumps, after amputations in thigh, by the anterior, posterior, antero-pos- terior, lateral, and circular methods, III, 356, and plate opposite. Styptics, use of, in hemorrhage, III, 812; in wounds of scalp, I, 64; of face, I, 346; injected into wounds of chest through female catheter, I, 544; danger of their falling into the pleural cavity in chest wounds, I, 550; discouraged in wounds of the abdominal parietes and abdomen, II, 9, 10, 177, 179; no reliance to be placed on the use of, II, 460. Subclavian Artery, shot wounds of, I, 479, 521, 522, 5fiO; haemorrhages from, III, 764; aneurism of, I, 44; II, 621; III, 808; ligatious of, II, 440, 449, 468, 632, 648, 716; III, 662; analysis of ligations of, 111,772. Subclavian Vein, shot wound of, I, 560; haemorrhage from, III, 816; accidentally opened while searching for artery, I, 555; rupture of, I, 527. Sublingual Artery, wounds of, I, 347, 353, 394. Submental Artery, injury of, III, 763; ligations of, III, 765,772. Subscapular Artery, injuries of, I, 351, 519, 596; II, 484; III, 764; ligations of, II, 443, 484, 585; III, 765, 776. Subsultus Tendinum, in shot injuries of cranium, I, 160, 162, 299. Suicides, number of cases of, during the war, III, 641. Sunstroke, fatal case of, III, 656. Supra-renal Capsules, shot wounds of, II, 173, 202; III, 689; autopsy in wound of, II, 173; ball encysted in II, 173. Suprascapular Artery, wounds of, II, 490, 642; haemorrhages from, I, 539; II, 496; III, 764; aneurism of, III, 808; ligations of, I, 538, 549; III, 765, 774. Surgeons, duties of, as surgeons in chief: of a division, III, 906; of a brigade, III, 907; in charge of division hospital, III, 908; as attend ing or prescribing. Ill, 909; as operating, III, 909; as regimental, III, 910 ; as assistant regimental, III, 912. Surgeon s Field Companion, III, 915. Sutures, in wounds of the eyelids, I, 388; in incised wounds of the abdom inal parietes, II, 4 ; in punctured and incised wounds of the stomach, II, 44; in shot wounds of the stomach: JOHERT S, LEMBKRT S, II, 59; LEDRAX S, BERTRANLH S, 11,44; in wounds of the small intestines, II, 72, 73, 76, 112, 124, 128; PALFYN S, BELL S, II, 114; LEDRAN S, BEK- TRANDI S, II, 115; JOBERT S, II, 118; LEMBERT S, GELY S, 119; EM- MERT s, VEZIEN s, II, 121; the continued, the Glover s, IF, 122; BOSEMAN S button, II, 183; HOWARD S metallic, in excisions of the shaft of humerus, II, 820. Symblepharon, operation for, III, 683. Sympathetic Nerve involved in wound, II, 466. Syndectomy, III, 682. Talipes Equinus, resulting from shot fractures of knee joint, II f, 371, 394, 395. Target Area of different portions of the human body, III, 691. Tarsal Bones, shot fractures of, III, 618; excisions of, III, 622, 623; nin- putation through, III, 628, 631, 632, 636. Tarso-metatarsal Articulation, shot fractures of, III, 618; exclsioni of, III, 622. SUBJECT-MATTER INDEX. XX VII Temperature, great diminution of, in shook attending wounds of the Tourniquet, distribution to each soldier, 111,762; use of, III, 811; injn- abdomen, II, 30; in traumatic peritonitis, II, 200. dicious use of, resulting in necrosis, III, 676; in gangrene, III, 625; Temporal Artery, wounds of, I, 188, 352; division of, I, 160; hsBmor- LEE and LAMBERT S, II, 825; MORBL B, II, 992; PETIT *, II, 992. rhages from, I, 288, 338; III, 763; ligations of, I, 101, 215, 241, 244, j Trachea, shot wounds of, I, 414; III, 688. Tracheotomy, I, 415, 418. Transfusion of blood, IT, 642; III, 58, 811. 256, 310; III, 765; analysis of cases of, III, 771. Tendons, effects of projectiles on, III, 712. Tenotomy, III, 59. Testes, shot wounds of, II, 405-418, 423; III, 689; excisions of, for shot injury, II, 409 ; III, 154 ; excisions of both, II, 4 14 ; suicidal tendency after loss of, II, 416; traumatic displacement of, II, 418 (note); sutures in removal of, II, 337, 410, 416; miscellaneous injuries of, I, 39; III 643, 684. Tetanus, number of cases of, III, 818; location of injury in cases of, III, Transportation of Wounded: by hand litters, III, 923; by wheel litters, III, 926; by mule litters and cacolets, III, 926; by ambulance wagons, HI, 944; by railway, III, 957; by water, III, 971. Trephining, in sabre fractures of cranium, I, 22, 23, 24; for miscellaneous injuries, I, 57; for shot fractures of cranium, I, 261, 277, 317, 318, 319, 320; summary of cases of, I, 309; in injuries of spine, I, 463; missile extracted by, II, 251; bone extracted by, II, 251. Trichiasis of the eyelid, operation for, III, 682. 818, 819; preponderating frequency in injuries ot lower extremities, | III, 8 18 ; after operations in the extremities, III, 819 ; ratio of mortality ] Trocar, FLURANT S, II, 385. in, III, 819 ; date of appearance of, after injury, III, 819; causes of, III, \ Tromatopnoea in wounds of chest, I, 635; for cases see I, 480, 484, 576 < 820; duration of, III, 820; treatment of, I, 454 ; III, 820; amputation I II, 53, 144. to relieve, III, 820; tetanus among colored and white troops, III, 823; j Tubular Sequestra of femur, III, 224, 241. frequenay of, in wounds of the nerves, III, 743 ; in lesions of muscu- ! Tympanitis, after rupture of abdominal viscera, II, 22, 26, 166, 200; m lar tissue, III, 713; in contusions of cranial bones, I, 122; in injuries traumatic peritonitis, II, 200. of the face, III, 819; in injuries wf the neck, III, 819; in injuries ot | the chest, I, 472, 635- in injuries of the abdomen, II, 14, 432, 464; in Tympanum, destroyed by shot wound, I, 384; rupture of membrane of, injuries of the upper extremities, II, 772, 932, 1020; III, 819; in froln propinquity to artillery fire, 111,708. Ulna, shot contusions of, 886; shot fractures of, II, 922; shot fractures of, treated by conservation. II, 925; treated by excision of portions of, II, 934 ; excisions of entire, II, 860 ; excisions of. for miscellaneous injuries, III, 657. wounds of the lower extremities, III, 35, 352, 380, 400; 416, 442, 569. Thigh, amputations of, for shot contusions of femur, III, 172; for shot fractures of, III, 213 ; primary amputations of, III, 214 ; intermediary amputations of, III, 272 ; secondary amputations of, III, 304 ; sum mary of amputations in, III, 870, 871 ; amputations in the, followed by amputations at the hip, III, 870, 671 ; amputations in, compared with amputations in arm, III, 331 ; seat of original injury in cases of, III, 332 ; percentage of fatality in amputations in upper, middle, and Ulnar Artery, incised wound of, II, 436; III, 663; shot wounds of, II, 451, 453, 469, 470; III, 764; haemorrhages from, III, 764; aneurism of, II, 451 ; III, 808; ligations of, III, 765, 784. Ulnar Nerve, shot wounds of, II, 466. lower thirds of, III, 333; amputations in both, III, 333; table indi- Uret hra, punctured wounds of, III, 652; other injuries of, not caused by siting ages of patients in amputations of, III, 358; influence of size of limb on mortality rate in amputations of, III, 357; methods of amputations in, III, 355; periosteal flap operation, III, 317 (note); OEITTI S method of, III, 357; treatment of retracted flaps in amputa tions of, III, 357; amputations of, for miscellaneous injuries, III, 664, 666. Thoracentesis, for idiopathic pleurisy, I, 573 ; for hydrothorax, I, 573 ; for empyema and metastatic abscesses of lung, I, 573; summary of cases of, I, 598. Thoracic Artery, wounds of, II, 457 ; haemorrhage from, III, 764 ; supe- shot, III, 375 : sabre wound of, II, 374 ; shot wounds of, II, 351, 380 386, 404, 423; III, 689; incisions in, to prevent urinary infiltration, II, 380. 385; foreign bodies in, II, 375; instruments for removal of foreign bodies from, II, 375; foreign bodies escaping by, II, 276, 279, 280, 284, 285, 294, 379 ; foreign bodies extracted from, II, 352, 379 ; incisions in, for removal of foreign bodies. II, 378, 400; use of catheter in wounds of, II, 352 ; strictures of, II, 386; treatment in strictures of, II, 386 ; dilatation of, II, 368, 388 ; instruments for dilatation of, II, 388 ; operations on, II, 376-404. Urethra! Fistules, causes and diagnosis of, II, 360 ; cases of, II, 360, :i69. rior thoracic, II, 817 ; thoracica longa, ligation of, I, 556. Thoracic Duct, wounds of, I, 535, 634. Thoracic Fistula in penetrating wounds of the chest, I, 630. Thoracic Nerves, wounds of, I, 536. Thyroid Artery, shot wounds of, I, 411 ; thyroid axis, haemorrhage from, Urethritis, caused by frequent catheterization, II, 387. Urethroplasty, 11,401. 402. Urethrotomy, II, 392 ; internal, II, 392 ; instruments for internal, II, 392, 394, 395, 396 ; external perineal, II, 396, 397, 398. Urinals, for urethral fistules, II, 403 ; GARIEL 8, II, 403. Ill, 764; ligations of, 765, 774; superior thyroid, shot wound of, I, ! Urinary Fistules, II, 164, 386, 387, 400; apparatus for, II. 403; PEM- 353 ; haemorrhages from, III, 763 ; ligations of, I, 383, 387 ; III, 765, BElJTOX s canula for, II, 403; foreign bodies escaping through, II, 265, 771 ; inferior thyroid, haemorrhages from, III, 764. 273, 285. Tibia, shot contusions of, III, 428; shot fractures of, III, 432; shotperfora- | Urinary Infiltration as cause of death in shot wounds of bladder, II, tion of, III, 722; shot fractures of, treated by conservation, III, 438, 563; hypertrophy of, III, 436 ; excisions of portions of, III, 445, 569, 570 ; excision in, a useless operation, III, 572 ; pseudarthrosis in excis ions of, III, 572. Tibial Arteries, wounds of, III, 764; haemorrhages from, III, 764; anterior: incised wound of, III, 7; shot wounds of, III, 20, 48, 52, 55> 400; haemorrhages from, III, 366, 378; ligatious of, III, 765, 801-803; posterior: punctured wound of, III, 7; shot wounds of, III, 20, 47, 50, 51, 320; aneurism of, III, 7, 673, 808; ligations of, III, 765, 803-804; anterior and posterior : wounds of, III, 52; aneurism of, III, 55, 808; ligations of, III, 52, 569, 621, 765. .Tibial Nerve, anterior: incised wound of, III, 7; shot wounds of, HI, 9, 296. Urine, extravasation of, as cause of death in shot wounds of bladder, II, 296; absence of extravasation in wounds of kidney or ureter, II, 193 ; treated by free incisions, II, 373; escape of. through wound, II, 304 ; incontinence of: in shot wounds of cranium, I, 31, 187, 252; in wounds of the bladder, II, 267, 271, 272 ; of the urethra, II, 353, 354, 355 ; retention of : in shot fractures of cranium, I, 37, 187, 300 ; in injuries of the spine, I, 425, 426, 431, 432 ; in wounds of the stomach, II, 42 ; in wounds of the intestines, II. 68. Valgus, after excision of bones of foot, III, 623. Varicocele, as a disability for military service, II, 422 ; operations for, II, 422. 11, 55; posterior: shot wounds of, III, 9, 11, 20, 54, 58; excision of Varix, aneurismal, II, 336; cases of, II, TOO; III, 69, 170, 196, 373; fol- portions of, III, 11, 58. lowing ligation of femoral vein, II, 354. Tonsils, excisions of, for disease, I, 415, 419. Torpedoes, nature of injuries by, III, 706; McCALLUM s bridge torpedo. Ill, 699. Torsion of arteries, HI, 811. I, 539, 555 ; basilic, wound of, II, 637 ; brachial. punctured wound of, II, 436; haemorrhages from, III. 816; ligations of. II, 436, 446, 448; cava, bayonet wounds of, I, 468; shot wounds of, I, 520, 606; II, 139: hsemorrlmges from, III. 816 ; femoral, wounds of, II, 304, XXVIII SUBJECT-MATTER INDEX. Veins- [Continued. 338, 339; III, 13, 15, 43, 44, 47, 48; haemorrhages from, III, 757; partial division of, III, 754 ; primary bleeding from. III, 762; ligation of, III, 44, 47, 48, 49 ; III, 54 ; thrombi in, III, 79, 191, 590 ; darning needle removed from sheath of, III, 43; varix after ligation of, III, 354; glutcal, injury of, II, 338; haemorrhages from, III, 816; hsemor- rhoidal, injury of, II, 338; haemorrhages from. III, 816; iliac, external, injury of, III, 191 ; thrombi in, III, 191 ; internal, injuries of, II, 190; III, 111; haemorrhages from, III, 816 ; intercostal, haemorrhage from, III, 8)6; jugular, external, injuries of, I, 407, 408, 411, 412, 491; haemorrhages from. III, 816; internal, wound of, I, 421; perforation of, III, 750; haemorrhages from, I, 420; III, 816; ligations of, for accidental cutting of. during operation, I, 392, 397 ; ligations of, for shot injury, I, 383; lateral sinus, rupture of, I, 201; longitudinal sinus, wounds of, I, 176, 203, 275; haemorrhages from, III, 816; median cephalic, wound of, II, 536; haemorrhages from, III, 816; mesenteric, haemorrhages from, III, 816 ; omo-hymd, shot wound of, I, 457; parietal, haemorrhages from, III, 816; popliteal, injuries of, III, 55; haemorrhages from, III, 816; ligations of, III, 383; profunda femoris, haemorrhages from, III, 816; saphennus wounds of, III, 15, 55; haemorrhages from, III, 816; ligation of. Ill, 52 ; subclavian, shot wound of, I, 560; haemorrhages from, III, 816; accidentally opened while searching for artery, I, 555 ; ruptured, I, 527 ; temporal, haemor rhage from, 111,816; tibial, punctured wound of. III, 7; shot wounds of, III, 54 ; wounds of veins of the pelvic cavity, II, 338. Vena Cava, bayonet wounds of, 1,468; shot wounds of, I, 520, 606 ; II, 139; haemorrhages from, III, 816. Venesection, in penetrating wounds of the chest, I, 643-645; in wounds of the abdomen, I, 207; cases of, I, 280, 483, 485; II, 76, 138, 155. Vertebrae, incised wound of, I, 425 ; contusions and miscellaneous injuries of, I, 426; shot fractures of, I, 430; shot fractures of cervical, I, 430; of dorsal, I, 433; of lumbar, I, 441 ; summary of shot fractures of, I, 452 ; III, 689. See Spine. Vertebral Artery, shot wounds of, I, 417, 421; coat of, injured by ball lodging against it, I, 355; haemorrhages from, III, 764. Visceral Protrusions, after penetrating wounds of abdomen, II, 180, 182, 183, 184; excision of, II, 7li; return of, II, 94. Volar Arteries, haemorrhages from, III, 764 ; ligations of. III, 765, 785, 786. Vomiting, from the effects of anaesthetics, III, 897. Wheel Litters, III, 926. Windage of Balls, alleged traumatic effects of, III, 706, 707; to bo dis missed from the domain of surgery, I, 344, 385; II, 28. Wire Sutures, HOWARD S, after excisions in shaft of humerus, II, 819; in shot fractures of femur, III, 350 (note), 351. Worms, Liumbricoid, escape of, in wounds of abdomen, II, 42, 64, 68, 71, 94, 195. Wounds, of entrance and exit, III, 711; caused by weapons of war, III, 685; complications of, III, 762; effects of climate on the treatment of, III, 867. 868. See Incised, Punctured, Sabre, Bayonet, and Shot Wounds. Wrist, shot fractures of, H, 995 ; III, 690, 870, 871 ; treated by conserva tion, II, 996; III, 870; followed by excision, II, 999; III, 870; ampu tations following excisions at the, III, 870, 871 ; amputation at, for shot fracture, II, 1017 ; III, 871 ; artificial apparatus in fractures of, II, 998; after excisions, 11,1012, 1014, 1015; dislocations after shot fractures of, II, 1002, 1005. o o :R:R i G- :m nsr D .A. . Page 2, fifteenth line, for 454, read 434. Page 8, forty-third line, for farroughed, read furrowed. Puge 24, sixth line, for XI, read XII. Page 24, ninth and tenth lines of Note 1, for A. G. D., read A. J. D. Page 24, tenth line of Note 1, for 1862. read 1861. Page 26, first line of Note 1, for shussverletzungen, read schiissrerJttzwnge.n. Page 27, first line of Note 2, dele comma after anatomie. Page 47, transpose Notes 2 and 3. Page 50, TABLE IV, No. 15, for CASE 107, read CASE 110. Page 58, TABLE VIII, No. 32, for amputation left thigh, read amp. left leg. Page G2, fifty-fourth line of Note 1, for p. 16, read p. 316. Page 63, eighth nonpareil line, for 26, read 36. Page 03, ninth nonpareil line, for 16, read 26. Page 82, thirty-ninth lino, for meager, read meagre. Page 87, fifty -fifth line, for J. F. Smith, read H. P. Smith. Pago 88, eighth line, dele the hyphen between the words forty and days. Page 102, ninth line, for 87th New York, read Sth New Jersey. Page 104, description of FIG. 55, for right, read left. Page 128, sixty-ninth line, for 1848, read 1851. Page 130, fifty-sixth line, for Dominico Ludovess, read Boaiso Dominica. Page 130, first line, for for wounds, were, read were for wounds, and dele the comma after the word wounds. Page 142, first line of Note 3, for Kinlock, read Kiriloch. Page 151, TABLE XVII, No. 9, for C. Warner, read C. Wagner. Page 152, eighteenth line of Note 1, for Coxe s, read Cox s. Page 153, description of FIG. Ill, for Spec. 5614, read Spec. 5684. Page 156, first line of Note 1, for p. 26, read p. 17. Page 103, first line, dele the word or after Williamson. Page 108, thirty-ninth line of Note 2, for rezection, read rejection. Page 171, first line of Note 3, for Case 340, read Case 338. Page 174, first line of Note 3, for siege, read siige. Page 179, Case 363, seventeenth line, for W. S. Small, read W. G. Small. Page 181, Case 368, thirty-third line, for O. H. Hitchcock, read H. O. Hitch cock. Page 186, Case 379, second line, for B. Brinton, read B. Stone. Page 188, eleventh line, for McCollom, read McCollum. Page 190, sixteenth line, for J. M. Gemrig, read J. H. Geinrig.- Page 191, thirty-eighth line, for eighty-six, rend sixty-eight. Pago 192, twenty-fifth line, insert after Lidell a reference to Note 1 . Page 194, Case 397, third line, for W. A. Childs, read W. A. Child. Page 195, Case 399, fourth line, for Brenneman, read Brencman. Page 208, TABLE XXV, No. 7, for Mosely, read Moseley. Page 209, seventh line, for T. Fitzgerald, read P. Fitzgerald. Page 210, TABLE XXVI, No. 35, for Thomaine, read Thomain. Page 214, Note 2, sixth line, for L. Johnson, read C. L. Johnson. Page 215, second line of Case 429, for Jameson, read Jamison. Page 220, TABLE XXX, No. 295, for L. Barney, =d L. Barnes. Page 222, TABLE XXX, No. 509, for N. Falf;.n, read N. Folsom. Page 228, TABLE XXXT, No. 119, for J. M. Rizer, read if. Rizer. Page 232, TABLE XXXI, No. 437, for J. F. Galloupe, read /. F. Galloupe. Page 232, TABLE XXXI, No. 407, for J. H. Beach, read J. H. Beech. Page 234, TABLE XXXI, No. 564, for D. S. Hayes, read D. S. Hays. Page 235, TABLE XXXI, No. 663, for J. H. Beach, read J. H. Beech. Page 235, TABLE XXXI, No. 684, for G. W. Simple, read G. W. Semple. Page 235, TABLE XXXI, No. 703, for Spec. 4332, read Spec. 4232. Page 236, TABLE XXXI, No. 790, for W. 0. Meagher, read W. O Meagher. Page 237, TABLE XXXI, No. 854, for H. C. Messenger, 56th Ohio, read A. C. Messenger, 57th Ohio. Page 239, TABLE XXXI, No. 1049, for A. Surg. M. Rizer, read Snrg. M. Rizer. Page 240, TABLE XXXI, Nos. 1116 and 1119, for Surg. C. M. Clarke, read Surg. C. M. Clark. Page 240, TABLE XXXI, No. 1121, for Snrg. W. R. Wray, read Surg. W. R. Way. Page 240, TABLE XXXI, No. 1122, for Surg. A. M. Dougherty, read Surg- A. JV. Dougherty. Page 240, TABLE XXXI, No. 1140, for J. F. Kimbly, read J. T. Kimbly. Page 243, forty-fourth line, for middle, read lower. Page 244, descriptions of Figs. 186 and 187, for Spec. 1966, read Spec. 2966- Page 246, TABLE XXXII, No. 140, for H. Taylor, read J. H. Taylor. Page 247, TABLE XXXIT, No. 173, for J. Owens, read J. Owen. Page 257, TABLE XXXII, No. 1052, for Spec. 3882, read Spec. 3832. Page 276, TABLE XXXIV, No. 95, for Spec. 3895, read Spec. 3875. Page 276, TABLE XXXIV, No. 105, for Spec. 4280, read Spec. 4820. Page 277, TABLE XXXIV, No. 142, for Left, read Bight. Page 281, TABLE XXXV, Nos. 55, 56, transpose the remarks in the third column opposite these numbers. Page 285, TABLE XXXV, No. 390, dele comma after word ./Zap*. Page 286, TABLE XXXV, third column heading, for opeeators, read operators. Page 288, Case 405, line thirty, for p. 63, read p. 53. Page 288, Case 466, second line, for C. W. Chamberlain, read C. N. Cham berlain. Page 290, Case 470, first line, for J. JV. Saxon, read J. JV. Saxton. Page 295, TABLE XXXVI, No. 140, for Spec. 182, read Spec. 1882. Page 296, TABLE XXXVI, No. 198, for Vannetta, read Vannatta. Page 296, TABLE XXXVI, No. 236, for 116th Pennsylvania, read HCth Ittinoit. Page 298, TABLE XXXVI, No. 364, for Right, read Left. Page 301, TABLE XXXVI, No. 571, for Saxon, read Saxton. Page 309, third line of Case 484, for Hatcbett, read Hatchitt. Page 313, TABLE XXXIX, No. 11, for Disch d April 12, 1865, read Disch d August 12, 1865. Page 314, TABLE XXXIX, No. 92, for Vanvourst, read Vanvorst. Page 318, line four of Case 492, for J. M. Burr, read W. J. Burr. Page 336, TABLE XLVIH, 7th line, for 1739, read 1743. Page 337, forty-ninth nonpareil line, for 1876, read 1871, and for B. XXIII, read B. XXIV. Page 348, second line of Note 1, for Schrady, read Shrady. Page 351, second line of Case 497, for L. W. Reed, read L. W. Read. Page 372, descriptions of Figs. 223 and 224, for Schenk, read Schenck. Page 373, thirteenth line, for 272, read 372. Page 449, TABLE LXIII, No. 1, third column, strike out the words leg useful. Page 45?, first line of Note 2, for middle, read upper. Page 459, TABLE LXV, No. 47, for large portion of tibia and fibula, read small portion of fibula above malleolus. Page 464, sixth line of Case 727, for Spec. 4081, read Spec. 4018. Page 477, TABLE LXVIII, No. 999, for Walters, read Waters. Page 586, for Case 385, read Case 835. Page 658, description of Fig. 368, for fibula, read tibia. Page 838, sixteenth line, for Feburary, read February. SURG III-128 RETURN ALLf Rene RETURN TO the circulation desk of any University of California Library or to the NORTHERN REGIONAL LIBRARY FACILITY Bldg. 400, Richmond Field Station University of California Richmond, CA 94804-4698 ALL BOOKS MAY BE RECALLED AFTER 7 DAYS 2-month loans may be renewed by calling (415)642-6233 1-year loans may be recharged by bringing books to NRLF Renewals and recharges may be made 4 days prior to due date DUE AS STAMPED BELOW MAR 01 WAY 14 1983 JUN291993 -1 1NTERUBRARYLOAN APR* flF CALIF., BERK. SEP 23 1991 UNIVERSIH FORM NO. DD4 BERKEL^CA 94720