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UL 


V 


/  CIRCULAR  No.  3. 


DEP  A.RTMEN  T, 
SURGEON    GENERAL'S   OFFICE, 

WASHINGTON,  AUGUST  17,  1871. 


A   REPOR 


SURGICAL   CASE 


TREATED  IN  THE 


ARMY  OF  THE  UNITED  STATES 


KHOM 


1865     TO     1871. 


WASHINGTON: 

GOVERNMENT     PRINTING     OFFICE. 
1871. 


CIRCULAR  No.   3. 


WAR  DEPARTMENT, 

SURGEON  GENERAL'S  OFFICE, 

Washington,  August  11,  1871. 

The  following  Report  of  Surgical  Oases  treated  in  the  Army  during  the 
past  five  years  is  published  for  the  information  and  instruction  of  Medical 
Officers. 

JOSEPH  K.  BARNES, 
Surgeon  General,  United  States  Army. 


A    REPORT 


OF 


SURGICAL    CASES 


TK HATED    IN 


THE  ARMY  OP  THE  UNITED  STATES  PROM  1865  TO  1871. 


By       GrEORGrE      J\..       OTIS, 

ASSISTANT    SURGEON,    UNITED    STATES   ARMY. 


WAR  DEPARTMENT, 

SUKGEON  GENEKAL'S  OFFICE, 

DIVISION  OF  SURGICAL  RECORDS, 

.    Washington,  August  15,  1871. 

GENERAL  :  In  obedience  to  your  instructions,  I  respectfully  submit  a  report  I  have 
compiled  from  the  returns  and  special  reports  of  medical  officers  of  surgical  cases,  more 
particularly  of  those  pertaining  to  operative  surgery,  observed  in  the  Army  during  the 
past  five  years. 

Although  the  cases  in  each  category  are  not  sufficiently  numerous  to  warrant  any 
very  important  generalizations,  yet  every  such  contribution  must  be  of  value  in  adding  to 
the  mass  of  facts  from  which  important  inferences  may  be  hereafter  deduced. 

I  have  endeavored  to  classify  the  observations  in  the  shape  most  convenient  for  ref- 
erence, to  correct  the  more  obvious  errors  inseparable  from  hasty  composition,  to  provide 
illustrations  on  wood  or  stone  where  requisite,  to  sum  up  the  inferences  and  conclusions 
deducible  from  the  different  series  of  cases,  and  to  be  sparing  in  comment.* 

When  practicable  the  language  of  the  reporters  has  been  followed  textually  ;  but  often 
it  has  been  necessary  to  trace  the  histories  of  cases  through  successive  monthly  state- 
ments, and  to  compile  a  connected  narrative. 

*"  Je  sais  que  la  verite  est  dans  lea  choses,  et  non  dans  mon  esprit  qui  leg  jvye,  et  que  mains  je  inets  du  mien,  dang  les  jvgements  qve  fen  porte. 
plus  je  sui»  stir  d'approcher  de  la  verite."—J.  J.  Itrmsseau's  "KMii.E." 


6  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 


GUNSHOT   WOUNDS. 


The  returns  of  the  Array  for  the  past  five  years  present  a  comparatively  large  num- 
ber of  gunshot  wounds,  received  either  in  Indian  hostilities,  or  accidentally,  or  in  brawls, 
or  attempts  to  evade  or  escape  from  arrest.  The  more  important  of  these  cases  will  be 
enumerated,  as  nearly  as  may  be  in  the  order  of  the  anatomical  regions  in  which  the 
wounds  were  inflicted,  with  such  subdivisions  as  are  most  convenient. 

GUNSHOT  WOUNDS  OF  THE  HEAD. — Pew  of  the  cases  of  this  series  present  peculiari- 
ties, yet  some  of  them  are  not  devoid  of  interest. 

I. — Note  on  a  Case  of  Gunshot  Fracture  of  the  Frontal  Bone.    By  C.  C.  BYENE,  Surgeon,  U.  S.  A. 

Private  Richard  Jenkins,  Co.  B,  82d  United  States  Colored  Troops,  aged  25  years,  was  accident- 
ally wounded,  at  St.  Augustine,  Florida,  on  April  26, 18CG,  by  the  explosion  of  a  fowling-piece.  A 
fragment  of  iron  perforated  both  tables  of  the  frontal  bone.  He  was  admitted  to  the  post  hospital, 
where  the  foreign  substance  was  extracted,  and  cold-water  dressings  were  applied.  He  was 
returned  to  duty  May  25, 1866. 

II. — Report  of  a  Gunshot  Fracture  of  the  Mastoid  Process.    By  A.  A.  WOODHULL,  Assistant  Surgeon, 
U.  S.  A. 

At  Fort  Larned,  Kansas,  Artificer  Charles  Andruss,  Co.  K,  3d  United  States  Infantry,  was 
wounded  November  8,  1868,  near  Fort  Gibson,  Cherokee  Nation,  by  the  accideutal  discharge  of  a 
musket.  The  case  was  reported  in  the  Monthly  Report  of  Sick  and  Wounded,  for  March  last,  from 
which  this  is  an  extract.  The  ball  entered  the  side  of  the  neck,  passed  across  the  mastoid  process, 
and  through  the  external  ear ;  the  bone  was  slightly  injured,  and  the  external  ear  nearly  destroyed. 
He  was  treated  in  hospital  at  Fort  Gibson,  Cherokee  Nation,  until  February  18th,  1868,  when  he 
was  sent  to  join  his  company  at  this  post.  The  wound  has  nearly  healed,  except  a  little  discharge 
from  the  ear.  There  was  partial  deafness.  He  was  discharged  from  service  June  28,  1869. 

III. — Note  of  a  Case  of  Gunshot  Fracture  of  the  Frontal  Bone.    By  J.  H.  PATZKI,  Assistant  Surgeon, 
U.  S.  A. 

Corporal  John  Connor,  Co.  H,  6th  United  States  Cavalry,  aged  25,  was  wounded  in  a  fight  with 
the  Indians,  July  12, 1870,  by  a  conoidal  ball,  which  fractured  the  external  table  of  the  frontal 
bone,  over  the  sinus.  He  was  admitted,  on  July  14th,  to  the  post  hospital  at  Fort  Richardson,  Texas. 
Portions  of  bone  exfoliated,  and  on  August  29th,  fragments  were  removed,  and  the  edges  of  the 
wound  were  freshened  and  united  by  metallic  sutures.  The  wound  healed  readily.  The  corporal 
was  returned  to  duty  on  September  12,  1870. 

IV". — Remarks  on  a  Case  of  Gunshot  Injury  of  the  Head.    By  G.  McC.  MILLER,  Assistant  Surgeon, 
U.  S.  A. 

"  Private  George  Greenland,  Co.  D,  oth  United  States  Infantry,  was  wounded,  at  a  fandango, 
by  a  pistol  ball,  on  the  night  of  October  10,  1808,  near  Fort  Reynolds,  Colorado  Territory.     The 
wa.s  situated  on  the  right  side  of  the  head,  over  the  parietal  bone,  longitudinal  in  direction, 


GUNSHOT  WOUNDS  OF  THE  HEAD.  7 

and  one  inch  and  a  half  long.  It  was  deep,  extending  down  to  the  pericranium.  In  accordance  with 
some  recent  views  aud  results  of  treatment,*  I  united  the  lips  of  the  wound  by  means  of  a  suture,  in 
order  to  effect  a  coalescence  by  the  first  intention,  or,  at  least  without  suppuration,  if  possible.  Cold 
water  dressings  were  applied.  On  the  fifth  day  after  the  injury,  I  removed  the  suture  :  the  lips  of  the 
wound  then  gradually  separated,  until  a  sloughing  sore  was  produced.  The  use  of  the  suture,  how- 
ever, seemed  to  reduce  the  amount  of  sloughing.  On  the  17th,  unexpected  and  alarming  symptoms 
presented  themselves.  The  patient  became  semi-unconscious — unable  to  speak — with  enormously- 
dilated  pupils,  and  a  wild  expression  of  countenance.  These  symptoms,  however,  passed  off  in  an 
hour,  and  did  not  return.  The  sudden  appearance,  brief  duration,  and  sudden  disappearance  of 
this  peculiar  condition  were  quite  singular.  The  wound  being  foul,  I  had  it  washed  with  a  rather 
strong  solution  of  the  sulphate  of  iron.  In  twenty-four  hours,  it  showed  a  healthy  granulating 
surface;  it  continued  to  improve,  and  healed  rapidly,  and  the  patient  was  returned  to  dutj 
November  2,  1868." 

V. — Extract  from  a  Report  of  a  Case  of  Gunshot  Fracture  of  the  Mastoid  Process.    By  DAVID 
WALKER,  Acting  Assistant  Surgeon. 

*  *  *  Private  X ,  Co.  F,  1st  Oregon  Cavalry,  aged  22  years,  was  wounded  Septem- 
ber 0, 18G5,  in  an  Indian  fight  on  the  Little  Malheur  River,  Oregon.  He  came  under  treatment  OH 
September  12th,  at  the  post  hospital  at  Fort  Steilacoom  , Washington  Territory.  It  was  found  that 
he  had  a  gunshot  wound,  the  ball  having  entered  at  the  posterior  head  of  the  sterno-cleido-mastoid 
muscle,  close  to  the  curved  line,  ranging  outward  and  a  little  upward,  and  lodging  in  the  mastoid 
process.  There  was  considerable  haemorrhage  from  the  auditory  canal,  with  temporary  deafness, 
and  paralysis  of  part  of  the  portio  dura  of  the  seventh  pair.  Ultimately  the  recovery  was  complete. 

VI. — Note  of  a  Gunshot  Depressed  Fracture  of  the  Skull.    By  T.  S.  V.  HUTCHINSON,  Acting  Assistant 
Surgeon. 

Private  Romulus  Morris,  Co.  E,  2d  United  States  Infantry,  aged  23  years,  was  wounded  at 
Bowling  Green,  Kentucky,  March  17, 1868,  by  a  rifle  ball;  which  caused  a  depressed  fracture  of  the 
left  parietal  bone,  with  concussion  of  the  brain.  He  also  received  a  contused  wound  of  the  face. 
He  was  taken  to  the  post  hospital,  where  the  depressed  portion  of  the  bone  was  elevated  and  the 
wound  dressed.  He  recovered,  aud  was  returned  to  duty  in  the  succeeding  month. 

VII. — Memorandum   of  a    Case  of  Gunshot  Fracture  of  the  Frontal  Bone.    By    W.  F.  SMITH, 
Assistant  Surgeon,  U.  S.  A. 

Private  J.  Geddes,  Co.  E,  40th  United  States  Infantry,  was  wounded  August  26, 1808,  by  a 
small  conoidal  pistol  ball  over  the  right  eyebrow.  The  outer  table  of  the  frontal  bone  was  slightly 
fractured.  He  was  admitted  into  United  States  Army  post  hospital,  Goldsboro,  North  Carolina. 
August  2Gth,  where  the  ball  was  removed  and  water  dressings  were  applied.  The  wound  healed 
almost  immediately.  The  patient  suffered  no  inconvenience  except  a  slight  headache.  Two  small 
pieces  of  bone  came  away  about  a  fortnight  after  the  receipt  of  the  injury. 

VIII. — Report  of  a  penetrating    Gunshot  Fracture  of  the   Skull.     By    G.   H.   GUNN,  Assistant 
Surgeon,  IT.  S.  A. 

The  body  of  Sergeant  Frank  Tocker,  Co.  D,  6th  United  States  Cavalry,  was  brought  to  post 
hospital  at  Fort  Richardson,  Texas,  at  half  past  seven  of  the  evening  of  October  15, 186!).  The  apparent 
cause  of  death  was  a  penetrating  wound  of  the  skull  from  a  carbine  or  pistol  ball.  The  pupils  were 
widely  dilated,  and  rigor  mortis  well  established,  with  considerable  fetor  from  the  wound.  A  poxt- 


*  See  American  Journal  of  the  Medical  Sciences,  October,  1868,  Vol.  LVI,  p.  585.     Reference  to  a  case  reported  liy 
W.  M.  Kindley,  who  quotes  Professor  Simon,  in  the  British  and  Foreign  Mcdioo-C'liirur^ieal  Review,  for  April,  li-<(!7. 


8  EEPOET  OF  SUBGICAL  CASES  IN  THE  AEMY. 

mortem  examination  revealed  an  extensive  fracture  of  the  skull,  a  transverse  section  of  the  entire 
upper  portion  of  it  having  been  removed.  Two  openings  presented  on  left  side  of  head.  The  anterior 
situated  near  the  coronal  suture,  some  two  inches  from  its  junction  with  the  sagittal;  the  ball 
evidently  entering  the  brain  at  this  point,  and  emerging  some  three  and  a  half  inches  posteriorly, 
Various  spicnlte  of  bone  were  found  imbedded  within  the  brain,  which  was  broken  down  and 
decomposed.  Two  wounds  also  on  right  side  of  head,  one  two  inches  above  the  ear,  the  other  one 
inch  directly  above  the  former.  This  man  was  found  dead  by  the  roadside  leading  to  the  Govern- 
ment saw-mill  near  Hog  Eye,  Texas,  October  35, 1S6!>,  and  was  supposed  to  have  been  murdered. 

IX. — Report  of  a  Case  of  Gunshot  Fracture  of  the  Skull.     By  A.  A.  YEOMAKS,  Assistant  Surgeon, 
U.  S.  A. 

Private  Frank  P.  -  — ,  Co.  I,  24th  United  States  Infantry,  while  attempting  to  escape  from 
the  guard-house  at  the  post  of  Vicksburg,  Mississippi,  July  20, 1868,  was  fired  upon  by  the  sentinel, 
at  a  distance  of  three  hundred  and  fifteen  yards,  the  missile  entering  the  skull  near  the  posterior 
border  of  the  left  parietal  bone,  about  three-fourths  of  an  inch  from  the  lambdoid  sntnre  and 

midway  between  the  sagittal  and  uiasto-parietal  sutures  ; 
passing  forward  through  the  frontal  bone  about  two 
inches  above  the  left  orbit.  About  two  ounces  of  brain 
came  out  of  the  wound  on  the  anterior  aspect  of  the  head, 
and  he  bled  profusely,  sinking  rapidly,  and  dying  about 
two  hours  after  the  reception  of  the  injury.  After  death 
the  skull  was  found  to  be  fractured  in  nearly  every  direc- 
tion from  the  wounds  of  entrance  and  exit,  a  large  num- 
ber of  the  bones  being  involved  in  the  injury,  and  the  left 
hemisphere  of  the  brain  was  completely  demolished. 

The  calvaria  was  forwarded  to  the  Army  Medical 
Museum,  and  is  represented  by  the  adjacent  wood-cut, 
(FiG.  I.).  It  is  remarkable  as  presenting  an  example 

*IG.  1.    Perforation  of  the  Skull  by  a  conoklal  musket  ball. 

spec.  5473,  sect,  i,  A.  M.  M.  °*  "'ficture  ot  the  eight  cranial  bones  by  a  single  missile. 

X. — Report  of  a  penetrating  Gunshot  Wound  of  the  Skidl.  By  C.  T.  ALEXANDER,  Surgeon,  U.  S.  A. 

ON  January  9,  1870,  Private  John  Welsh,  Co.  L,  3d  United  States  Cavalry,  was  wounded  in  a 
drunken  row,  by  a  pistol-shot  from  the  hands  of  some  person  unknown,  at  the  Placer  mines,  twenty 
miles  south  of  Santa  Fe,  and  was  received  into  the  hospital  at  eight  on  the  following  morning. 
The  ball  entered  about  one  and  a  half  inches  behind  the  right  ear,  passing  inward  and  forward ;  death 
ensuing  January  14tb,  at  7  p.  m.  Post  mortem  January  15th  disclosed  that  the  ball  passed  in 
about  two  inches,  lodging  at  the  base  of  the  brain,  but  not  touching  it;  the  man  probably  died  of 
the  shock,  as  the  brain  was  only  very  slightly  softened,  where  it  rested  over  the  ball,  separated  by 
its  membrane.  He  was  conscious  at  the  time  he  entered  the  hospital,  and  easily  aroused  until  a 
short  time  before  death. 

XI. — Report  of  a  Gunshot  Fracture  of  the  SJcull.      By  HENRY  LIPPINCOTT,  Assistant  Surgeon, 
U.  S.  A. 

"  IN  Kansas,  in  October,  1868,  Private  William  Johnston,  Co.  E,  7th  United  States  Cavalry, 
while  hunting  buffalo,  on  the2d  instant,  with  a  party  sent  out  from  this  command  for  that  purpose, 
was  shot  and  killed  by  Indians ;  he  received  two  wounds,  one  entering  the  head,  about  the  middle  <>t 
the  left  parietal  bone,  and  emerging  about  the  middle  of  the  parietal  bone  of  the  right  side.  The 
skull  was  extensively  fractured,  in  all  probability  by  a  blow  dealt  by  the  Indians  after  the  head 
was  pierced  by  the  ball.  He  was  scalped.  He  was  also  shot  in  the  right  leg,  the  ball  entering  about 
four  and  a  half  inches  below  the  knee-joint,  on  the  anterior  surface  of  the  leg,  passing  upward, 
dodged  in  the  head  of  the  tibia ;  the  bone  was  much  fractured.  I  am  unable  to  state  how  long  he 


GUNSHOT  WOUNDS  OF  THE  HEAD.  9 

lived  after  receiving  the  wound,  but  think  that  the  time  was  not  more  than  a  few  minutes.    I  saw 
him  at  the  place  where  he  was  shot  about  two  and  a  half  hours  after." 

XII. — Report  of  a  Perforating  Gunshot  Wound  of  the  Head.    By  J.  V.  DE  HANNE,  Assistant  Sur- 
geon, U.  S.  A. 

Private  Edward  Hogan,  Co.  B,  33d  United  States  Infantry,  was  shot  through  the  head  and 
killed  in  the  city  of  Huntsville,  February  21,  1869,  between  VI  and  1  o'clock  A.  M.  His  remains 
were  removed  to  Chattanooga,  Tennessee,  for  interment  in  the  national  cemetery,  on  February  22, 
1809.  A.  post-mortem  examination  exhibited  a  perforating  gunshot  wound.  The  ball  entered  on  the 
left  temporal  ridge,  one  and  a  half  inches  posterior  to  the  left  temporal  eminence ;  exit  at  the  middle 
of  the  right  lambdoidal  suture,  one  inch  posterior  and  below  the  right  parietal  eminence ;  an  exten- 
sive fracture  of  the  frontal,  left  parietal,  and  occipital  bones. 

XIII. — Memorandum  oj  a  Case  of  Gunshot  Fracture  of  the  Skull.  By  Dr.  A.  JUDSON  GRAY,  Acting 
Assistant  Surgeon. 

Private  Matthew  Began,  Co.  G.  15th  United  States  Infantry,  aged  28  years,  was  accidentally 
wounded  at  Fort  Bayard,  New  Mexico,  January  3,  1870,  by  a  coiioidal  ball,  which  lacerated  the 
scalp  and  fractured  the  cranium.  He  was  admitted  to  the  post  hospital,  where  spiculae  of  bone 
were  removed  and  simple  dressing  was  applied ;  inflammation  of  the  brain  followed,  and  death 
occurred  on  February  10,  1870,  forty-four  days  after  the  reception  of  the  injury. 

XIV.— Report  of  a  Perforating  Gunshot  Fracture  of  the  Skull.    By  BEDFORD  SHARPS,  M.  D.,  Acting- 
Assistant  Surgeon. 

At  Fort  McKavett,  Texas,  December  22, 1809,  Brevet  Captain  Frederick  W.  Smith,  9th  United 
States  Cavalry,  was  killed  by  the  accidental  discharge  of  a  pistol,  in  his  own  hands.  The  ball  entered 
through  the  right  parietal,  and  caused  a  very  extended  fracture  of  exit,  involving  the  occipital, 
left  parietal,  temporal,  and  frontal,  and  making  a  large  aperture,  through  which  over  two  ounces  of 
brain  tissue  escaped.  The  officer  survived  the  injury  about  seven  minutes. 


The  next  four  cases  are  instances  of  almost  immediate  death,  from  perforations  of 
the  skull  by  balls  : 

XV. — Note  of  a  Case  of  Perforation  of  the  Brain  by  a  Musltet  Ball.    By  J.  H.  McMAHON,  M.  D., 

Acting  Assistant  Surgeon. 

Private  Jeremiah  Daniels,  Co.  I,  9th  United  States  Cavalry,  aged  20  years,  was  accidentally 
wounded  at  Fort  Davis,  Texas,  on  January  31,  1808,  by  a  conoidal  ball,  which  entered  the  right 
orbit,  and  emerged  through  the  superior  posterior  portion  of  the  right  parietal  bone.  He  died  in 
three  minutes  from  the  reception  of  the  injury. 

XVI. — Note  of  a  Case  of  Perforation  of  the  SJcull  and  Division  of  the  Carotid  Artery  by  a  Pistol-Ball. 
By  Dr.  WILLIAM  M.  AUSTIN,  Acting  Assistant  Surgeon. 

Private  John  Kimball,  Co.  A,  35th  United  States  Infantry,  died  at  Fort  Bliss,  Texas,  on 
December  5, 1807,  from  the  effects  of  a  pistol-shot  wound,  received  in  an  affray  at  Franklin,  Texas. 
The  ball  entered  midway  between  the  right  angle  of  the  lower  jaw  and  the  lobe  of  the  right  ear, 
passed  forward,  inward,  and  upward  and  came  out  immediately  above  thezygomatic  process  of  the 
left  temporal  bone  midway  between  the  ear  and  the  external  angle  of  the  eye.  The  internal 
carotid  and  jugular  veins  of  the  right  side  were  severed. 
2 


10  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

XVII.— McmorHHihini  of  a  Gunshot  Perforation  of  the  Brain,  fatal  almost  immediately.    By  Dr.  W. 
DEAL,  Acting  Assistant  Surgeon. 

Dorrall  Nalbrow,  a  recruit  of  the  39tli  United  States  Infantry,  aged  21  years,  was  killed  October 
14, 1807,  at  Greenville,  Louisiana,  by  the  accidental  discharge  of  a  musket  in  the  hands  of  a  fellow- 
soldier,  the  missile  striking  the  right  side  of  the  frontal  bone  and  passing  through  the  brain. 

XVIII. — Report  of  a  Case  of  Gunshot  Perforation  of  the  SJeull.    By  JOHN  H.  BAKTHOLF,  Assistant 
Surgeon,  U.  S.  A. 

Private  Robert  F ,  Co.  E,  llth  United  States  Infantry,  was  accidentally  killed  at  Camp 

Grant,  near  Richmond,  Virginia,  on  May  11,  1868,  by  the  accidental  discharge  of  a  breech-loading 
musket,  in  the  hands  of  a  comrade,  at  the  distance  of  six  or  eight  feet.  The  missile,  a  conical  riilo 
musket  ball,  entered  the  face  through  the  upper  lip,  three-quarters  of  an  inch  to  the  right  of  the 
median  line,  taking  a  course  directly  backward,  on  a  line  drawn  immediately  under  the  lobe  of  the 
ear,  emerging  from  the  neck  at  a  point  two  and  three-quarters  inches  back  of  the  lobe  of  the  ear, 
and  two  and  a  quarter  inches  in  front  of  the  posterior  median  line.  The  wound  of  entrance  was 
small,  and  stellate  in  form,  having  three  radiating  lines.  The  wound  of  exit  was  very  large,  half 
an  inch  in  front  of  the  lobe  of  the  ear.  There  was  a  slit  made  by  some  of  the  teeth  and  fragments 
of  bone  forcing  an  exit  there.  On  dissection,  the  superior  maxillary  bone  was  found  torn  to  small 
bits,  but  little  more  than  the  nasal  process  and  the  inner  wall  of  the  autrum  remaining  in  nit  it. 
The  floor  of  the  orbit  was  broken  up ;  the  malar  bone  was  broken,  and  its  body  displaced  outward  ; 
its  frontal  process,  separated  from  the  body,  was  broken  off  from  the  frontal  bone ;  the  inferior  max- 
illa was  fractured  across  the  body  an  inch  anterior  to  the  angle,  and  the  bone  from  there  to  the 
articulation  was  completely  broken  up ;  the  great  wing  of  the  sphenoid  on  the  right  side  was  greatly 
broken ;  the  petrous  portion  of  the  temporal  bone  was  broken  off  and  into  two  pieces,  and  displaced 
backward ;  the  mastoid  process  was  to  a  small  extent  broken,  and  a  fragment  just  internal  to  it, 
about  an  inch  long  and  the  same  in  width,  entirely  detached.  Thus  the  internal  and  middle  ears 

were  quite  broken  open ;  the  occipital  and  right  parietal 
bones  broken ;  a  fragment  two  and  a  quarter  inches  wide 
and  three  inches  long,  involving  these  two  bones  and  the 
posterior  inferior  corner  of  the  temporal,  was  driven  back- 
ward,  leaving  a  fissure  along  one  side  three  inches  long, 
and  more  than  a  sixteenth  of  an  inch  wide.  A  portion 
of  the  right  transverse  process  of  the  atlas  was  broken 
off,  and  the  right  vertebral  artery  was  cut  across.  The 
internal  carotid  artery  was  severed  at  an  inch  and  three- 
quarters  above  its  origin,  and  the  external  carotid  at  a 
point  a  quarter  of  an  inch  higher,  or  just  below  its  bifur- 

l"n;.  2.— Segment  of  the  skull,  showing  gunshot  frac-  ,.          .    , 

t,m.8  of  the  occipital  and  petrous  hones.-«pec.  5335,    cation  into  its  two  terminal  branches,  and  all  the  branches 
sect,  i,  A.  M.  M.  of  the  last-named  vessels  below  the  place  indicated,  except 

the  superior  thyroid  and  the  lingual,  were  divided.  The  internal  jugular  vein  was  cut  off  at  a 
point  corresponding  to  the  division  of  the  internal  carotid  artery  and  the  external  jugular  and  its 
branches.  The  right  pneumogastric  nerve  was  severed  opposite  the  upper  part  of  the  ramus  of 
the  lower  jaw.  The  brain  was  not  touched  by  the  bullet.  The  pathological  specimens  were 
transmitted  to  the  Army  Medical  Museum,  and  are  illustrated  by  the  wood-cut. 

XIX.— Memoranda  of  Three  Cases  of  Fatal  Gunshot  Perforations  of  the  Skull. 

Private  John  Miller,  Co.  H,  6th  United  States  Cavalry,  aged  26  years,  received  gunshot  wounds 
of  the  skull,  right  arm,  and  left  hand,  in  a  fight  with  desperadoes,  near  Sulphur  Springs,  Texas, 
August  14, 1868.  He  was  taken  to  the  post  hospital  at  Sulphur  Springs,  where  he  died  on  August 
15,  18(58.  Acting  Assistant  Surgeon  B.  B.  Miles  reported  the  case. 

Private  William  Fox,  Co.  C,  4th  United  States  Cavalry,  aged  25  years,  was  wounded  accident- 


GUNSHOT  WOUNDS  OP  THE  HEAD.  11 

ally  by  a  Colt's  revolver  bullet,  on  May  29,  1809,  which  entered  the  left  temple,  fracturing  the 
occipital  bone,  then,  forcing  its  way  forward  in  a  vertical  and  slightly  downward  direction,  making 
its  exit  on  the  base  of  the  right  temporal  bone,  immediately  above  the  malar  process,  killing  him 
almost  immediately.  The  case  was  reported  by  Acting  Assistant  Surgeon  Henry  Spohn. 

Private  John  E.  Eenn,  Co.  D,  16th  United  States  Infantry,  aged  21  years,  was  wounded  on 
July  3, 1868,  by  a  conoidal  ball,  which  entered  two  inches  above  the  right  eye,  passed  backward, 
along  the  center  of  the  right  parietal  bone,  making  its  exit  near  the  occipito-parietal  suture.  He  was 
admitted  from  his  quarters  to  the  post  hospital  at  McPhersou  Barracks,  Atlanta,  Georgia,  on  July 
3,  1868.  He  died  on  the  morning  of  July  4,  186S.  The  case  was  reported  by  Assistant  Surgeon 
J.  W.  Williams,  United  States  Army. 

XX. — Memorandum  of  a  Case  of  Fatal  Gunshot  Injury  of  the  Head.    By  G.  H.  GUNN,  Assistant 
Surgeon,  U.  S.  A. 

Private  James  Osbome,  Co.  I,  24th  United  States  Infantry,  aged  21  years,  was  wounded  on 
September  17,  1869,  by  a  conoidal  bullet,  on  the  left  side  of  the  head,  during  a  fracas  outside  the 
limits  of  the  garrison.  He  was  admitted  into  the  United  States  Army  post  hospital  at  Fort 
Richardson,  Texas,  on  September  18th.  His  treatment  consisted  of  stimulation  with  a  nutri- 
tious diet.  He  died  on  September  18,  1869. 

XXI. — Report  of  a  Fatal  Gunshot  Wound  of  the  Brain.    By  J.  P.  WEBB,  Acting  Assistant  Surgeon. 

Private  John  Houle,  Co.  C,  8th  United  States  Cavalry,  wounded  by  Indians  near  Collin's  Ranch, 
La  Paz  route,  Arizona  Territory,  on  July  9,  1869,  was  received  into  the  post  hospital  at  Camp 
Date  Creek,  July  llth,  after  a  journey  of  over  sixty  miles,  under  the  care  of  a  private  physician. 
Very  soon  after  admission  symptoms  of  pressure  appeared,which  passed  away  in  the  course  of  twenty- 
four  hours,  to  be  replaced  by  some  indications  of  cerebral  inflammation — pulse  ranging  from  55  to  60, 
watering  of  the  eyes,  and  redness  of  eyeballs;  restlessness  and  delirium,  which  lasted  a  couple  of 
hours  of  the  afternoon,  and  reappeared  about  the  same  time  for  three  days,  after  which  his  mind 
became  quite  clear,  and  his  speech  was  unaffected.  He  exhibited  some  difficulty  in  protruding  his 
tongue,  which  was  covered  with  a  dirty  white  coating  for  about  a  week,  and  then  became  clean 
and  moist.  During  the  second  week,  -with  the  exception  of  the  slow  pulse,  and  some  restlessness 
occasionally,  there  were  little  or  no  symptoms  to  indicate  the  structural  changes  taking  place 
within  the  cranium  ;  in  fact,  he  presented  inany  appearances  of  convalescence.  About  the  begin, 
iiing  of  the  third  week,  he  complained  of  pain  in  the  right  side  of  the  head,  and  paralysis  of  the  left 
arm  made  its  appearance,  gradually  extending  to  the  lower  extremity.  His  mind  now  by  degrees 
became  more  and  more  obscured,  but  without  delirium,  until  a  gradually-increasing  stupor  was 
merged  in  complete  coma  that  preceded  his  death  for  about  twenty -four  hours.  He  died  on  the  3d  of 
August,  having  survived  the  injury  twenty-three-days.  A  post-mortem  examination  was  made  on 
August  4th.  There  was  a  circular  perforation  of  the  right  parietal  bone,  just  behind  the  tuberosity, 
and  somewhat  in  a  direction  from  behind  forward.  Deeply  imbedded  in  the  brain  were  found  the 
pieces  of  bone  which  belonged  to  the  outer  table,  and  seven  comminuted  fragments  of  the  inner 
table  and  cancellated  structure.  Immediately  beneath  these  was  an  abscess,  perhaps  larger  than 
a  goose's  egg,  filled  with  well-formed  pus,  and  surrounded  to  the  extent  of  about  one  inch  by  brain 
matter  in  a  soft  and  pulpified  condition.  All  the  ventricles  were 
found  filled  with  fluid,  and  the  membranes  were  greatly  congested 
over  the  entire  brain.  The  right  cerebral  hemisphere  was  otherwise 
healthy.  The  most  careful  examination  failed  to  discover  the  ball, 
which,  during  life,  and  almost  up  to  the  last  moment  of  fruitless 
search,  I  had  believed  to  have  lodged  in  the  brain.  Having  in  view 
the  nature  of  the  injury  of  the  cranium,  it  is  to  me  an  entire  mystery 
that  I  did  not  find  it  there.  The  form  of  the  fracture  is  shown  in  the 
wood-cut.  The  treatment,  which,  with  the  exception  of  carbolic-acid 
dressings  to  the  wound,  was  entirely  medical,  was  as  follows:  The  r'G-  :>— ^pressed  gunshot  fracture  of 

'  right  parietal.    Spec.  5707,  Sect.  I,  A. 

bowels  were  thoroughly  cleansed   by  purgatives  and  enemata,  and       M.M. 


12  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

mild  mercurialism  established  by  calomel  and  opium  ;  the  gums  were  kept  just  barely  touched  for 
about  a  week,  after  which  the  action  of  the  bowels  was  maintained  by  purgatives  and  enemata. 
A  strictly  antiphlogistic  regimen  was  enjoined  throughout ;  the  entire  scalp  was  shaved,  and  kept 
constantly  irrigated. 

X  XII.— Memorandum  of  a  Fatal  Gunshot  Wound  of  the  Brain.    By  CARLOS  CARVALLO,  Assistant 
Surgeon,  U.  S.  A. 

Private  Walter  R.  Stone,  Co.  F,  4th  United  States  Cavalry,  aged  22  years,  was  admitted  to 
the  post  hospital  at  Jefferson,  Texas,  March  4,  1869,  with  a  gunshot  wound  caused  by  the  acci- 
dental discharge  of  his  carbine.  The  missile  entered  the  left  eye,  traversed  the  brain,  and  escaped 
through  the  occipital  bone.  He  died  March  4,  1809. 

XXIII. — Note  of  a  Fatal  Gunshot  Wound  of  the  Brain.    By  R.  H.  WHITE,  Assistant  Surgeon, 
U.  S.  A. 

Private  William  J.  Hood,  Co.  K,  2d  United  States  Infantry,  while  attempting  to  escape  from 
a  guard,  was  shot;  at  Mobile,  Alabama,  March  16,  1870,  by  order  of  the  officer  of  the  day.  He 
died  in  a  few  moments. 

/ 

XXIV. — Note  of  a  Fatal  Gunshot  Wound  of  the  Brain,  icith  Wounds  of  the  Lung  and  Chest.    By 
H.  G.  BATES,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Ransom  Shaw,  Co.  E,  3d  United  States  Artillery,  while  attempting  to  escape  from 
prison  at  Fort  Macou,  North  Carolina,  July  2, 1867,  received  three  gunshot  wounds.  A  couoidal  ball 
entered  just  above  the  temporal  ridge,  on  the  left  side  near  the  coronal  suture,  and  lodged  in  the 
brain;  another  entered  the  left  lateral  thoracic  region,  between  the  sixth  and  seventh  ribs,  passed 
through  and  emerged  in  front  between  the  costal  cartilages  of  the  fifth  and  sixth  ribs,  near  the 
sternum;  there  was  also  a  slight  flesh  wound  of  the  chest  in  front  between  the  sixth  and  seventh 
ribs  on  the  side  of  and  near  the  sternum.  Death  resulted  instantly. 

XXV. — Memorandum  of  a  Homicide.    By  R.  M.  KIRK,  M.  D.,  Acting  Assistant  Surgeon. 

Private  James  McDonough,  Co.  B,  6th  United  States  Cavalry,  was  shot  by  a  corporal  of  his 
company  on  the  night  of  March  14,  1868,  at  Austin,  Texas,  the  ball,  a  Remington  carbine  pat- 
tern, passing  antero-posteriorly  through  the  brain,  killing  the  soldier  instantly. 


It  is  impracticable  to  learn  with  precision  the  nature  of  the  next  two  cases.  Compari- 
son of  the  different  reports  would  indicate  that  they  were  examples  of  trivial  gunshot 
scalp-wounds. 

XXVI. — Two  Cases  of  Gunshot  Injury  of  the  Head.  By  JOHN  J.  CULVER,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Ole  Larssen,  Co.  A,  35th  United  States  Infantry,  aged  35  years,  received,  on  Septem- 
ber 6, 1869,  a  wound  of  the  head,  by  a  pistol  ball,  in  a  disturbance  with  Mexicans,  while  tempo- 
rarily at  the  post,  attending  a  general  court-martial.  He  was  admitted  into  Fort  Quitman,  Texas, 
on  September  7,  1869.  Simple  dressings  were  applied  to  the  wound.  He  was  returned  to  duty 
on  November  20,  1869. 

Private  William  Weaver,  Co.  H,  9th  United  States  Cavalry,  aged  35  years,  was  wounded  by 
pistol  balls  in  the  right  hip  and  head,  on  January  16,  1870.  On  the  same  day  he  was  admitted 
into  Foil  Quitmau,  Texas,  from  his  company.  Simple  dressings  were  applied  to  his  wounds,  and 
he  speedily  recovered. 


SUICIDAL  GUNSHOT  WOUNDS  OP  THE  HEAD.  13 

On  page  16,  the  remaining  gunshot  scalp-wounds,  seven  in  number,  that  have  been 
reported  are  noted.  In  battle  such  wounds  are  more  frequent  than  fractures  of  the  skull ; 
but  at  close  quarters,  when  direct  aim  is  taken,  the  fractures  are  more  frequent. 


Eleven  cases  of  suicide  by  gunshot  wounds  of  the  head  are  reported.  Seven  of  these 
unfortunates  perished  almost  instantaneously.  Two  others  lived  from  a  half-hour  to  an 
hour ;  a  third  survived  six  days  ;  and  a  fourth  long  enough  for  a  cerebral  abscess  to  form. 
In  the  four  instances  in  which  the  fatal  issue  was  delayed,  the  pistol  was  employed  as  the 
implement  of  self-destruction ;  in  the  other  seven  cases,  the  regulation  rifled  musket. 

XXVII. — Report  of  Two  Cases  of  Suicide.    By  CARLOS  CARVALLO,  Assistant  Surgeon ,  U.  S.  A. 

At  Jefferson,  Texas,  December  31,  1869,  Lieutenant  E.  P.  Colby,  llth  United  States  Infantry, 
aged  24,  committed  suicide.  He  used  a  small  Derriuger  pistol.  The  ball  entered  the  cranium  about 
an  inch  above  and  behind  the  right  ear,  and  lodged  in  the  brain.  A  protuberance  on  the  oppo- 
site side  of  the  skull  rendered  it  probable  that  the  ball  fractured  the  inner  table  of  the  left  temporal 
bone,  but  did  not  penetrate  it.  Lieutenant  Colby  became  instantaneously  unconscious,  and  the 
wound  proved  fatal  in  about  a  half  hour  after  its  infliction.  He  was  in  articulo  mortis  when  first 
seen  by  me,  and  expired  about  fifteen  minutes  thereafter. 

Private  George  Weiss,  Co.  H,  llth  United  States  Infantry,  aged  32  years,  shot  himself  near 
Fort  Jefferson,  Texas,  on  May  28,  1870,  with  a  rifle,  from  ear  to  ear.  He  was  found  in  the  woods 
half  a  mile  from  camp,  with  his  brain  scattered  a  distance  of  several  yards  from  the  body.  All 
bones  of  the  cranium  and  face,  except  the  upper  and  lower  maxillary,  were  fractured.  (See 
Specimen  5922,  Sect.  I,  A.  M.  M.) 

XXVIII. — Extract  from  a  Report  of  a  Death  by  Suicide.    By  W.  F.  BROWNE,  Acting  Assistant 
Surgeon. 

At  Petersburg,  Virginia,  in  November,  1868,  Private  George  Kerne,  Co.  K,  21st  United  States 
Infantry,  died  on  the  morning  of  the  24th,  by  suicide.  He  fixed  a  gun-strap  on  his  rifle,  so  that 
by  putting  his  foot  on  the  strap  he  could  pull  the  trigger.  He  then  inserted  the  muzzle  of  the  gun 
into  his  mouth,  and  discharged  the  piece.  His  left  jaw  was  broken,  the  occipital  bone  entirely 
carried  away,  and  the  cerebellum  driven  out.  Death,  so  far  as  could  be  ascertained,  was 
instantaneous.  The  man  was  probably  laboring  under  temporary  insanity. 

XXIX. — Report  of  a  Case  of  Suicide  ly  a  Pistol-Ball  through  tJie  Head.  By  PETER  MOPFATT,  Assistant 
Surgeon,  U.  S.  A. 

Private  James  L.  Cummings,  Co.  F,  1st  United  States  Cavalry,  died  on  June  30,  1869,  from  the 
effects  of  a  pistol  shot,  inflicted  by  himself,  with  the  purpose  of  committing  suicide.  The  weapon  was 
discharged  while  the  muzzle  was  inserted  in  the  mouth.  The  bullet  passed  upward  and  forward, 
carrying  away  the  left  eye,  upper  part  of  the  nose,  and  the  anterior-inferior  portion  of  the  base  of 
the  skull,  and  emerged  in  the  vicinity  of  the  frontal  sinuses.  The  anterior-inferior  convolutions  of  the 
brain  could  be  felt  by  the  fingers  introduced  into  the  wound,  completely  denuded  of  all  covering,  to 
the  extent  of  one  inch  and  a  half  to  two  inches ;  but  no  laceration  of  its  substance  could  be 
detected.  Profuse  haemorrhage  ensued  at  the  time  of  the  occurrence.  After  the  immediate  effects 
of  the  injury,  the  patient  remained  conscious  the  greater  portion  of  the  time,  until  within  a  few 
hours  of  death.  Had  it  not  been  for  the  injury  to  the  mouth,  precluding,  almost  entirely,  the 
possibility  of  swallowing,  the  indications  were  that  the  patient  might  have  lived  for  some  time 
longer.  There  seemed  very  little  immediate  cerebral  disturbance.  Death  occurred  on  the 
sixth  day.  Eemorse,  resulting  from  intemperance,  was  the  alleged  cause  of  this  act  of  self- 
destruction. 


14  REPORT  OF  SURGICAL  CASES  IN  THE  AKMY. 

XXX.— Memorandum  of  a   Case  of  Suicide.     By  WILLTAM  A.   BRADLEY,   Assistant  Surgeon, 
U.  S.  A. 

At  Point  San  Jose",  California,  on  September  23,  1868,  Private  Octavius  E.  Daniels  com- 
mitted suicide,  by  placing  the  muzzle  of  his  musket  against  his  temple,  just  anterior  to  the  ear, 
and  pulled  the  trigger  by  means  of  a  poker.  The  ball  entered  at  the  lower  border  of  the  right 
temporal  bone,  on  the  right  side,  and  emerged  on  the  left  side,  through  the  parietal  bone,  about 
one-half  an  inch  posterior  to  the  groove  for  the  middle  meningeal  artery,  and  about  one  inch  below 
the  track  of  the  longitudinal  sinus.  Death  was  almost  instantaneous.  No  autopsy  was  made. 

XXXI. — Extract  from  a  Report  of  a  Case  of  Suicide  by  Shooting  in  the  Head.    By  ROBERT  BURNS, 
M.  D.,  Acting  Assistant  Surgeon. 

At  Frankford  Arsenal,  Pennsylvania,  November  27,  1809,  "Mark  E. 

Richards  died  from  suicide,  by  shooting  in  the  head.  He  was  about  27  years 

of  age,  and  enlisted  as  a  private  at  the  Fraukford  Arsenal,  on  August  13,  1869.  He  came  under 
my  treatment  for  secondary  syphilis,  on  the  31st  of  the  same  month,  and  was  returned  to  duty  on 
the  26th  of  September,  cured  of  the  warts,  but  with  orders  to  continue  treatment.  He  was 
employed  in  the  office  as  commissary  clerk,  about  the  12th  of  November;  but,  in  consequence  of 
intemperate  habits,  he  was  reproved  once  or  more.  On  the  morning  of  November  27th,  he  again 
reported  himself  sick  to  his  commanding  officer,  who  sent  him  to  quarters  to  await  medical  advice. 
About  9  o'clock  A.  M.  a  messenger  came  to  me,  stating  that  Richards  was  shot.  On  arriving,  I 
found  him  lying  in  the  proof-house,  in  the  rear  of  the  barracks,  upon  his  back,  his  head  close  by 
the  sill  of  the  building — his  right  arm  flexed  over  the  head,  the  left  slightly  out  from  his  body ;  the 
head  in  a  pool  of  blood,  cleft  from  the  nasal  bone  to  the  occiput,  and  in  numerous  places  the 
cranium  was  fractured  in  many  fragments,  particularly  the  occipital  bone,  which  appeared  the 
point  of  exit  of  the  ball,  the  muzzle  of  the  gun  being  placed  at  the  inner  angle  of  the  left  eye. 
The  brain  had  been  blown  out;  the  hemispheres  being  apart,  one  about  three  feet  from  the  body, 
the  other  about  a  foot  nearer  to  the  body.  The  Springfield  rifled  musket  was  a  short  distance 
from  him,  with  the  butt  toward  his  person.  The  coroner,  his  physician,  and  jury,  came  from 
Philadelphia  about  4£  o'clock  P.  M.,  and  held  an  inquest,  rendering  a  verdict  of  'suicide  by 
shooting.'"  Witnesses  testified  that  the  man  had  threatened  to  commit  the  deed  before,  and  had 
left  a  note  declaring  his  intention,  his  real  name,  and  the  residence  of  his  family. 

XXXII.— Report  of  a  Gunshot  Wound  of  the  Brain.    By  Z.  H.  POTTER,  M.  D.,  Acting  Assistant 
Surgeon. 

At  Fort  Randall,  Dakota  Territory,  on  September  22,  1867,  about  midnight,  I  was  aroused 

by  the  announcement  that  Lieutenant  Robert  A.  G had  shot  himself.     I  was  soon  by  his 

side.  I  found  him  lying  on  the  floor,  in  a  carotic  state,  with  profuse  arterial  haemorrhage  from  nares, 
mouth,  ears,  and  wound.  The  pulse  was  sixty,  and  full ;  breathing,  stertorous  and  labored,  twelve 
per  minute.  The  edges  of  the  wound,  which  was  circular,  were  blackened,  and  the  skin  somewhat  dis- 
colored by  the  smoke  and  heat  attending  the  discharge.  The  ball  had  entered  at  a  point  just  anterior 
and  superior  to  the  tragus  of  the  left  ear ;  passed  into  the  cranium,  in  a  direction  nearly  perpen- 
dicular to  the  side  of  the  head,  but  inclining  a  very  little  upward  and  backward;  penetrated 
the  cerebrum,  for  a  distance  of  six  inches,  and  evidently  lodged  against  the  internal  inferior 
lateral  portion  of  the  right  parietal  bone.  Prognosis,  death ;  accordingly,  no  effort  was  made  to 
extract  the  ball.  Twenty  minutes  past  twelve:  Pulse  full,  and  eighty;  breathing  sterto- 
rous and  labored,  twelve  per  minute.  Fifty-five  minutes  past  twelve :  Pulse  fluctuating,  occasion- 
ally strong  and  full,  then,  fluttering  and  weak;  breathing  more  labored  and  stertorous,  nine 
per  minute.  Death  occurred  at  1  o'clock  A.  M.  September  23,  1867,  from  the  combined  eflect  of 
shock,  cerebral  laceration,  and  haemorrhage,  either  of  which,  would,  of  itself,  have  proved  fatal. 


SUICIDAL  GUNSHOT  WOUNDS  OF  THE  HEAD. 


15 


XXXIII. — Memorandum  of  a  Case  of  Perforating  Gunshot  Wound  of  the  Head.    By  B.  E.  FRYER, 
Surgeon,  U.  S.  A. 

Private  Daniel  Kaufman,  Co.  E,  7tli  United  States  Cavalry,  aged  23  years,  attempted  to  com. 
mit  suicide  at  Fort  Harker,  Kansas,  by  shooting  himself  in  the  head  with  a  pistol,  the  missile  from 
which  entered  over  the  right  frontal  sinus  and  passed  out  through  the  left  eye,  destroying  the  eye 
and  lacerating  the  lower  lid.  The  treatment  of  the  case  is  not  recorded.  Death  supervened  on 
December  21,  18G7.  At  the  autopsy  the  brain  was  found  congested  and  softened,  and  an  abscess 
in  the  anterior  lobe  of  the  left  hemisphere  containing  two  and  a  half  ounces  of  pus. 

XXXIV. — Note  of  a  Case  of  Suicide.    By  A.  W.  GREANLEAF,  M.  D.,  Acting  Assistant  Surgeon. 

Private  John  Flannery,  Co.  C,  2d  United  States  Infantry,  aged  21  years,  committed  suicide  by 
shooting  himself  through  the  head  with  a  conoidal  musket  ball.  He  was  admitted  into  the  United 
States  Army  post  hospital  at  Montgomery,  Alabama.  He  died  May  20, 1869. 

XXXV — Extract  relative  to  a   Case  of  Suicide,  from  the  Chattanooga   Post  Hospital  Report  for 
October,  18G6.    By  C.  E.  GODDARD,  Assistant  Surgeon,  U.  S.  A. 

Private  Nelson  Lowry,  Co.  D,  Second  Battalion  16th  United  States  Infantry,  aged  25  years, 
while  suffering  under  mental  depression  caused  by  religions  melancholy,  September  25,  1866,  shot 
himself.  The  missile,  a  conical  bullet,  entered  at  the  inner  canthus  of  the  right  eye,  and  passed  out 
at  a  point  midway  between  the  lobe  of  the  right  ear  and  the  occipital  protuberance,  fracturing  in 
its  course  the  lachrymal,  frontal,  parietal,  temporal,  and  occipital  bones.  Death  was  instantaneous. 

XXXVI. — Memorandum  of  a  Case  of  Suicide.    By  E.  H.  WHITE,  Assistant  Surgeon,  U.  S.  A. 

Private  David  Wilson,  Co.  H,  United  States  Infantry,  shot  himself  through  the  head  at  St. 
Augustine,  Florida,  August  8,  1867,  and  died  instantly.  Dr.  Hopkins  made  the  autopsy,  of  which 
no  record  is  preserved. 


Of  the  many  Indian  crania  contributed  to  the  Army  Medical  Museum,  during  the  last 
five  years,  not  a  few  presented  examples  of  gunshot  perforations  of  the  skull,  or  of  depressed 
or  penetrating  gunshot  fractures.  It  is  very  painful  to  observe  that  these  crania,  in  many 

instances,  present  numerous  cleanly-cut  perforations,  from 
small  projectiles  at  close  range,  evidently  inflicted  after  death, 
and  that  this  senseless  vengeance  was  often  wreaked  upon  the 
corpses  of  women  and  children. 

The  wood-cut  adjoining  (FiG.  4)  illus- 
trates this  imitation  of  the  atrocities  of 
the  savages.  It  represents  the  calvaria 
of  a  squaw  of  the  band  of  Sioux  under 
"Little  Bear,"  killed  at  Chug  Water, 
Wyoming  Territory,  in  April,  1870. 
The  skull  was  sent  to  the  Museum  by 
Surgeon  0.  H.  Alden,  United  States  Army. 

The  next  figure  (FiG.  5)  represents  the  cranium  of  a  Cheyenne 
warrior,  with  an  extensive  fracture  of  the  left  upper  maxillary  region, 

mi  •        i  i      •  FIG.  5.— Cranmmof  aClioy. 

and  a  perforation  of  the  frontal  by  a  pistol  ball.     The  missile  made  its    e«no,  perr.,™ted  i.y  «.  ,.ist,,i. 

...  ml  ,.  e  T     -\       ball.    Spec.  SKI,  Sect.  I,  A.  IT. 

exit  through  the  foramen  magnum.     Ihe  preparation  was  forwarded    M. 


li;.  4.— Cranium    perforated  by  carbine 
or  pistol  balls.    Spec.  5695,  Sect.  I,  A.  M.  M. 


16  EEPOET  OF  SURGICAL  CASES  IN  THE  AEMT. 

by  Assistant  Surgeon  H.  E.  Tilton,  United  States  Army.     It  is  a  ponderous  cranium, 
weighing  nearly  two  pounds  avoirdupois.* 

There  were  a  few  cases  of  gunshot  scalp-wounds,  only  noticeable  from  the  prompt- 
ness with  which  the  men  recovered  and  returned  to  duty. 

Private  Robert  Davidson,  Co.  B,  Gth  Infantry,  aged  27  years.  Pistol  wound  of  scalp,  December 
25,  18G8.  Atlanta.  Discharged,  December  28,  18G8,  by  reason  of  expiration  of  term  of  service. 

Private  John  Flannaghau,  Co.  H,  8th  Infantry,  aged  25  years,  near  Columbia,  January  4, 
18G9.  Flesh  wound  of  the  left  temple  by  a  round  ball.  Duty,  January  7,  1869. 

Private  William  Morgan,  Co.  H,  9th  Infantry,  near  Fort  D.  A.  Russell,  September  29,  1870. 
Gunshot  wound  of  the  scalp.  Duty,  September  30,  1870. 

Private  John  Morgan,  Co.  D,  Gth  Cavalry,  aged  23  years.  Near  Fort  Richardson,  July  5, 
1869.  Contusion  of  scalp  from  a  pistol-ball.  Duty,  July  9,  1869. 

Unassigned  Recruit  George  McKinney,  6th  Cavalry,  aged  23  years,  near  San  Antonio,  Decem- 
ber 6,  1866.  Gunshot  wound  of  the  scalp.  Duty,  December  13,  1866. 

Commissary  Sergeant  James  O'Brien,  2d  Battalion,  16th  Infantry,  Nashville,  January  13, 
18GG.  Gunshot  wound  of  the  temple.  Duty,  January  22,  1866. 

Private  Henry  O'Neal,  Co.  K,  6th  Cavalry,  aged  22  years,  near  Sulphur  Springs,  Texas,  Sep- 
tember 12, 1869.  Gunshot  flesh-wound  one  inch  to  right  of  sagittal  suture,  over  the  coronal  suture. 
Duty,  September  29,  1869. 

Laying  aside  the  gunshot  fractures  of  the  Indian  crania,  regarding  the  histories  of 
which  there  are  no  reliable  special  data,  and  the  nine  gunshot  scalp-wounds,  which  are 
comparatively  unimportant,  we  have,  in  the  preceding  abstracts,  memoranda  of  thirty-eight 
cases  of  gunshot  fractures  of  the  skull.  Five  were  received  in  fights  with  Indians ;  four 
in  connection  with  provost  duty  ;  eight  in  brawls  ;  ten  accidentally ;  and  eleven  by  suicide. 
Of  these  thirty-eight  examples  of  gunshot  fractures  of  the  cranium,  there  were  but  seven 
instances  of  recoveries. 


GUNSHOT  WOUNDS  OF  THE  FACE. — This  class  of  injuries  has  been  illustrated  by 
several  cases  that  have  furnished  interesting  pathological  contributions  to  the  Museum, 
and  by  others  that  involve  delicate  points  in  practice. 

XXXVII. —  "Note  of  a  Case  of  Gunshot  Wound  of  the  Face.    By  H.  A.  DuBois,  Assistant  Surgeon, 
U.  S.  A. 

Corporal  Edward  Swords,  Co.  D,  3d  United  States  Cavalry,  aged  26  years,  was  admitted  to 
the  post  hospital  at  Fort  Union,  New  Mexico,  June  7,  1867,  with  a  gunshot  wound  of  the  lace. 
The  ball  entered  the  left  superior  maxilla  one  inch  from  its  junction  with  the  nasal  bone  and  same 
distance  from  the  margin  of  orbit,  and  passed  obliquely  backward  and  a  little  downward,  and 
lodged  behind  the  posterior  fold  of  the  palatine  arch.  The  wound  in  the  face  was  enlarged,  and 
pieces  of  bone  were  removed.  The  ball,  which  could  be  felt  in  its  place  of  lodgement,  was  not  taken 
out,  but  was  swallowed  by  the  patient  during  the  following  night.  On  June  30th,  the  wound  had 
nearly  healed,  but  some  necrosed  fragments  remained.  He  was  discharged  the  service  December 
4, 1867. 

*  Many  illustrations  of  multiple  gunshot  perforations  of  Indian  crania  have  been  brought  to  the  Museum  from 
Sand  Creek,  Colorado,  the  scene  of  the  atrocious  massacre  of  friendly  Indians  l>y  the  troops  under  Colonel  John  M. 
Chivington.  Specimens  9,  10,  11,  12,  Sect.  IV;  and  Specimens  4772,  4773,  and  5535,  Sect.  I,  are  some  of  the  examples.  Bee 
Mr.  Catlin's  article  in  Triibner's  Literary  Record,  vol.  I,  p.  137.—"  Thesaurus  Cranionna,''  by  .).  liarnard  Davis,  M.  D.,  &c., 
&c.  London,  1867 ;  p.  207.— London  Times,  August  8,  1865.— Report  of  the  Joint  Committee  on  Hie  Conduct  of  the  ll'ur,  at  the 
second  session  of  the  Thirty-eighth  Congress,  Washington,  1865,  p.  121. 


GUNSHOT  WOUNDS  OF  THE  PACK.  17 

X  XXVIII. — Note  of  a  Case  of  Gunshot  Wound  of  the  Face.   By  REESE  B.  BERKY,  Acting  Assistant 
Surgeon. 

Sergeant  John  Howard,  Co.  K,  ICth  United  States  Infantry,  was  admitted  to  the  post  hospital 
at  Corinth,  Mississippi,  September  18,  1869,  with  a  gunshot  wound  of  the  face,  received  while  on 
duty,  making  an  arrest.  The  missile,  a  ball  from  a  Navy  revolver,  penetrated  the  left  nasal  bone 
and  emerged  at  a  point  about  one  inch  anterior  to,  and  on  a  line  with,  the  lowest  point  of  the  right 
ear.  Projecting  and  other  loose  fragments  of  bone  were  removed,  the  haemorrhage  arrested,  and 
cold-water  dressings  applied.  The  patient  was  returned  to  duty  October,  18C9. 

XXXIX. — Extract  from  the  Monthly  SicJc  Report  at  Fort  Macon,  North    Carolina,  March,  1809, 
describing  the  peculiar  Course  of  a  Musket-Ball.    By  ELLIOTT  COUES,  Assistant  Surgeon,  U.  S.  A. 

Private  Downie,  Co.  A,  8th  United  States  Infantry,  was  accidentally  shot  and  instantly  killed 
by  a  sentinel  on  guard.  The  autopsy  showed  the  following  singular  course  of  the  bullet:  The  ball 
entered  the  mouth  from  the  left  side,  without  touching  the  lips,  and  impinged  upon  the  inferior 
maxilla  at  about  the  middle  of  the  right  horizontal  ramus,  shattering  the  bone 
into  several  pieces  without  breaking  or  knocking  out  any  teeth.  The  laceration 
of  the  right  side  of  the  tongue  gave  unequivocal  evidence  that  the  ball  impinged 
upon  the  inside  of  the  jaw-bone.  It  then  glanced,  or,  to  speak  in  all  probability 
more  correctly,  rebounded,  and  struck  the  inside  of  the  alveolar  border  of  the 
right  superior  maxilla  somewhat  above  the  level  of  the  teeth.  Still  farther 
deflected  from  its  original  course,  it  then  passed  straight  upward  through  the 
palate  and  nasal  passages  into  and  through  the  left  orbit,  close  past  the  inner 
wall  of  the  latter,  struck  the  orbital  plate  of  the  frontal  bone  into  the  left  anterior  FIG.B.-MUSI<,  i 

,..  ...  .11  r.    •  111  ball    Imttrrrd    liv 

lobe  of  the  cerebrum,  which  was  by  this  means  extensively  lacerated.  It  is  probable  impaot  <>n  bones 

that  the  ball  itself  did  not  enter  the  brain,  its  force  being  by  this  time  expended.  °f  *h»  fiwe-  *«• 

It  was  found  curiously  furrowed  and  distorted,  lying  in  the  left  orbit,  upon  the  ^64'Soot-I'A-M- 
eyeball,  which  had  escaped  laceration.    The  battered  ball  is  shown  in  the  wood-cut. 

XL. — Report  of  a  Gunshot  Wound  of  the  Face.    By  PETER  MOFPAT,  Assistant  Surgeon,  U.  S.  A. 

Private  B—  — ,  Co.  H,  23d  United  States  Infantry,  was  admitted  on  March  2-i,  1870,  to 
hospital  at  Fort  Boise,  Idaho  Territory,  with  a  gunshot  wound  of  the  face.  The  missile  entered  a 
little  to  the  left  of  the  median  line  of  chin,  almost  below  the  angle  of  the  mouth  ;  ranged  almost 
directly  backward,  comminuted  the  lower  half  of  the  inferior  maxillary  bone  without  destroying 
the  continuity  of  the  arch  of  the  jaw,  passed  through  the  soft  parts  below,  and  lodged  at  some 
point  deep  in  the  neck.  He  fainted  from  the  shock  and  loss  of  blood,  but  reacted  and  managed  to 
make  his  way  to  the  hospital.  The  surgeon  enlarged  the  wound  of  entrance  and  removed  fragments 
of  comminuted  bone.  A  portion  of  the  leaden  missile  was  extracted;  but  a  channel  was-found  to 
extend  still  deeper  toward  the  left  side  of  the  cervical  spine.  It  was  not  deemed  safe  to  pursue 
the  remaining  portions  of  the  ball.  A  tent  saturated  with  carbolic  acid  was  introduced,  and 
simple  dressings  were  applied.  The  portion  of  lead  extracted  was  flattened  and  jagged  in  form, 
and  weighed  thirty  grains.  A  ball  of  the  size  of  the  one  by  which  the  wound  was  inflicted 
weighed  eighty  grains,  leaving  a  balance  of  fifty  grains  to  represent  the  portion  still  in  the 
wound.  Considerable  irritation  of  the  larynx,  causing  cough  and  expectoration,  supervened. 
These  symptoms  improved,  and  on  March  30th  the  case  was  progressing  favorably.  No  indication 
requiring  a  search  for  the  ball  arose,  and  in  May,  1870,  the  man  was  returned  to  duty,  the  frag- 
ment of  bullet  remaining  lodged. 

XLI. — Report  of  a  Gunshot  Fracture  of  the  Lower  Maxilla.    By  EDWARD  COWLES,  Assistant 
Surgeon,  U.  S.  A. 

CASE. — Private  Charles  Wicks,  Co.  C,  20th  United  States  Infantry,  aged  20  years,  was  shot 
in  the  face  by  a  Mexican,  at  Brownsville,  Texas,  May  ~>,  1808.    The  ball  entered  a  little  to  the  left 
3 


18  EEPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

of  the  symphysis  of  the  lower  jaw,  and  laid  open  the  lip  from  its  upper  border  nearly  to  the 
lower  margin  of  the  chin,  causing  extensive  laceration.  A  small  external  wound  to  the  right  of  the 
sympliysis  was  probably  made  by  the  exit  of  a  fragment  of  tbe  ball.  The  body  of  the  lower  max- 
illa, to  the  distance  of  about  three-quarters  of  an  iuch  on  each  side  of  the  sympliysis,  with  the  front 
teeth,  was  comminuted  and  carried  away.  Two  large  fragments  of  bone  were  driven  quite  deeply 
under  the  tongue,  and  wedged  in  between  the  opposite  sides  of  the  jaw.  The  patient  was  admitted 
to  the  post  hospital.  Haemorrhage,  which  had  been  quite  profuse,  had  nearly  ceased.  About  forty 
fragments  of  bone,  and  a  portion  of  the  ball  lodged  behind  the  fractured  end  of  the  jaw,  on  the 
right  side,  were  removed.  The  two  pieces  driven  under  the  tongue  were  allowed  to  remain.  The 
wound  was  closed  by  two  harelip  sutures,  and  the  jaw  supported  underneath  by  pasteboard  splint 
and  bandage.  Pieces  of  lint,  moistened  with  a  solution  of  chlorinated  soda,  were  kept  in  the 
wound.  The  wound  of  the  lip  closed  in  nearly  its  whole  extent  by  first  intention,  and  the  harelip 
sutures  were  in  a  few  days  removed.  The  cavity  of  the  wound,  under  the  tongue,  filled  with  gran- 
ulations. The  fragments  of  bone  under  the  tongue  united  with  each  other  and  with  the  jaw  on  each 
side,  bridging  it  across,  and  giving  it  its  natural  firmness,  with  but  little  deformity.  The  man  was 
returned  to  duty  on  June  12,  1868. 

XLII. — Memorandum  of  a  Case  of  Gunshot  Fracture  of  the   Upper  Maxilla.    By  B.  C.  FRYER, 
Surgeon,  U.  S.  A. 

Sergeant  Thomas  Logan,  Co.  A,  10th  United  States  Cavalry,  aged  23  years,  was  shot  by  an 
officer  for  mutinous  conduct.  He  was  admitted  to  the  post  hospital  at  Fort  Harker,  Kansas,  Jan- 
uary 6,  1869,  with  a  pistol  wound  of  the  face.  A  conoidal  ball  had  entered  the  left  nostril,  passed 
backward,  and  toward  the  right,  through  the  vomer,  and  had  lodged,  it  was  believed,  under  the 
sterno-cleido-mastoid  muscle,  near  the  mastoid  process.  Simple  dressings  were  applied,  and  the 
patient  recovered  without  a  bad  symptom.  He  was  returned  to  duty  February  2,  18(1!). 

XLIII. — Report  of  a  Gunshot  Fracture  of  the  Lower  Maxilla.    By  JOSEPH  K.  COKSON,  Assistant 
Surgeon,  U.  S.  A. 

Sergeant  Alexander  Brown,  Co.  D,  2d  United  States  Cavalry,  aged  26  years,  was  wounded  in 
a  fight  with  Indians  on  May  4,  1870,  by  a  conoidal  bullet,  which  fractured  the  inferior  maxilla. 
He  was  admitted  into  the  United  States  Army  post  hospital,  Fort  Hi -idger,  Wyoming  Territory, 
from  Camp  Stambaugh,  May  19,  1870.  On  May  23d  the  fractured  bones,  consisting  of  the 
inferior  maxilla,  from  the  ramus  on  the  left  side  to  the  middle  of  the  jaw  on  the  right  side,  were 
removed.  In  September,  1870,  he  was  still  under  treatment.  He  was  returned  to  duty  in  Novem- 
ber, 1870. 

XLl\  .-^Memorandum  of  a,  Case  of  Gunshot  Wound  of  the  Lower  Maxilla.    By  DALLAS  BAOHE, 
Surgeon,  U.  S.  A. 

Sergeant  Washington  Coler,  Co.  C,  9th  United  States  Cavalry  (colored  troops),  aged  24  years, 
•was  admitted  to  the  post  hospital  at  San  Antonio,  Texas,  May  2,  1868,  with  a  gunshot  wound 
received  May  2,  1868.  A  pistol-ball  fractured  the  alveolar  process  of  the  inferior  maxillary, 
knocking  out  two  left  incisors  and  a  canine  tooth.  Simple  dressings  were  applied.  He  was 
returned  to  duty  on  May  25,  1868. 

XLV. — Minutes  of  a  Case  of  Gunshot  Fracture  of  the  Lower  Jaw.    By  WM.  M.   NOTSON  and 
EDWARD  COWLES,  Assistant  Surgeons,  U.  S.  A. 

Private  Franklin  Grey,  Co.  F,  41st  United  States  Colored  Infantry,  aged  23  years,  was  acci- 
dentally wounded  near  Brownsville  on  August  26, 1867,  by  a  conoidal  musket-ball,  which  entered 
the  month,  wounding  the  tongue,  fracturing  the  body  of  the  lower  jaw,  comminuting  the  ramus, 
passing  between  the  internal  and  external  carotid  arteries,  and  emerged  one  inch  below  the  right 


GUNSHOT  WOUNDS  OP  THE  FACE.  19 

ear  and  behind  the  angle  of  the  jaw.  The  bffiinorrhage  was  alarming.  He  was  admitted  into  tlio 
post  hospital  at  Fort  Brown,  Texas,  on  the  same  day.  The  jaw  was  supported  by  a  pasteboard 
splint ;  compresses  were  applied  over  the  carotid  arteries.  The  mouth  was  cleansed  daily  with 
solution  of  chlorinated  soda.  Pieces  of  bone  were  removed.  Liquid  nourishment  was  given  at 
lirst  by  euemata.  He  was  transferred  to  Fort  Coucho,  Texas,  on  March  20th,  and  was  discharged 
for  disability  October  18,  1869. 

XLVI. — Minute  of  a  Case  of  Gunshot  Fracture  of  Lower  Maxilla.    By  H.  B.  TILTON,  Assistant 
Surgeon,  U.  S.  A. 

Private  Martin  O'Brien,  Co.  C,  7th  United  States  Cavalry,  aged  21  years,  was  shot  at  Fort 
Lyon,  Colorado  Territory,  by  the  first  sergeant,  on  January  9,  1808,  for  munitous  conduct;  a 
pistol-ball  entering  left  cheek,  carrying  away  the  angle  of  the  lower  jaw  without  causing  its  com- 
plete fracture,  and  lodging  against  the  cervical  vertebra;.  He  was  admitted  to  the  post  hospital 
at  Fort  Lyon,  Colorado  Territory,  on  January  10,  1808.  Simple  dressings  were  applied.  On 
January  21,  1808,  an  abscess  opened  in  the  neck,  from  which  a  number  of  small  fragments  of 
bone  were  removed.  On  February  14,  1868,  the  ball  was  removed.  The  man  deserted  from  the 
hospital. 

XLVII. — Report  of  a  Gunshot  Wound  of  the  Upper  Maxilla.    By  CHAKLES  K.  WINNE,  Assistant 
Surgeon,  U.  S. A. 

CASE. — Charles  B.  M ,  first  lieutenant  and  quartermaster  10th  United  States  Infantry,  aged 

26  years,  was  wounded  May  21,  1868,  by  a  pistol-ball,  which  entered  in  left  occipital  triangle, 
just  behind  sterno-cleido-mastoid  muscle,  at  junction  of  two  imaginary  lines,  one  horizontal  and 
parallel  with  chin,  the  other  vertical  and  bisecting  mastoid  process  of  temporal  bone;  ball 
passed  inward  and  upward,  then  changing  direction  entered  niouth  through  centre  palate  process 
of  superior  maxillary  bone,  and  finally  buried  itself  in  alveolar  process  of  superior  maxillary  of 
right  side.  The  internal  maxillary  artery  in  its  third  portion,  or  oue  of  its  large  branches,  was 
divided,  as  haemorrhage  was  fearfully  profuse  from  both  openings  of  the  wound,  and  the  patient  sank 
exhausted  before  reaching  the  barracks.  The  haemorrhage  was  checked  by  the  application  of  com- 
presses; patient  exsanguiued  and  suffering  from  the  intense  degree  of  the  shock.  He  vomited  sev- 
eral times,  MThicli  was  followed  by  the  recurrence  of  haemorrhage.  This  immediately  ceased  upon 
injection  of  persulphate  of  iron ;  manual  pressure  applied  as  far  as  practicable  over  track  of 
wound,  then  a  bar-tourniquet  substituted  and  very  slight  pressure  used.  As  it  was  impracticable  to 
secure  the  bleeding  vessel,  it  was  determined,  upon  mature  deliberation,  to  ligate  the  primitive  carotid 
artery  should  hemorrhage  again  occur.  Sulphate  of  morphia,  with  small  quantity  of  stimulants, 
were  administered  every  two  hours,  and  a  diet  of  beef-tea  and  chicken-soup  through  a  tube.  May 
22d,  patient  perfectly  comfortable  in  every  way.  May  27th,  the  bar-tourniquet  was  kept  in  posi- 
tion for  several  days,  though  no  pressure  was  exercised,  then  it  was  removed.  The  wound  of  en- 
trance is  now  suppurating  freely,  considerable  swelling  in  occipital  space.  Delirium  tremens 
manifested  itself,  May  30th.  U  under  the  free  administration  of  narcotics  the  attack  terminated  to- 
day; during  the  last  twenty-four  hours  ext.  cann.  indiccc  was  substituted  for  the  tinct.  «;//< 
deodor.,  with  the  happiest  result,  though  in  this  case  I  am  inclined  to  ascribe  the  eifect  more  to  the 
impression  made  upon  the  disease  by  the  opiate  primarily,  for  I  pushed  it  to  excess,  even,  as  I 
considered  that  a  probable  haemorrhage  caused  by  the  unconscious  and  unruly  movements  of  the 
patient  was  more  dangerous  than  narcotism.  In  the  majority  of  instances,  I  am  opposed  to  such  free 
administration  of  opium.  In  addition,  the  most  nourishing  food,  with  weak  milk-punch,  was  given. 
June  2 :  patient  doing  well  in  every  respect.  He  was  returned  to  duty,  July,  1868. 

XLVIII. — Note  of  a  Case  of  Gunshot  Wound  of  the  Face.    By  A.  A.  WOODIIULL,  Assistant  Sur- 
geon, U.  S.  A. 

Private  George  Bullis,  Co.  C,  3d  United  States  Infantry,  aged  21  years,  was  wounded  on 
August  11,  1870,  by  duck-shot,  at  close  range,  wh'ch  shattered  parts  of  the  malar  bone  and  supe- 
rior maxilla,  destroyed  nearly  an  inch  of  the  condyle  of  the  inferior  maxilla,  and  chiefly  lodged 


20  HE  POET  OP  SUEGICAL  CASES  IN  THE  AEMY. 

against  the  temporal,  partly  escaping,  by  suppuration,  through  the  external  canal.  He  was  admit- 
ted immediately  afterward  into  the  post  hospital  at  Fort  Lamed,  Kansas.  He  had,  during  Sep- 
tember, a  slight  attack  of  erysipelas,  but  is  now  nearly  healed.  He  was  returned  to  duty  October 
I'd,  1870. 

XL1X.— Memorandum  of  a  Case  of  Fatal  Gunshot  Wound  of  the  Face.    By  HENRY  McELDEiiitY, 

Assistant  Surgeon,  U.  S.  A. 

Private  Ferdinand  Schwindig,  Co.  I,  6th  United  States  Cavalry,  aged  30  years,  was  wounded 
on  June  11,  1807,  by  a  conoidal  bullet,  which  entered  the  right  submaxillary  region,  passed 
upward  and  inward,  making  its  exit  at  the  root  of  the  nasal  bones,  fracturing  the  right  superior 
maxillary,  malar,  vomer,  palate,  and  nasal  bones,  and  carrying  away  the  right  side  of  the  tongue. 
He  was  admitted  into  the  United  States  Army  post  hospital  at  Fort  Belkuap,  Texas,  on  the  same 
day.  Stimulants  were  administered,  and  local  applications  of  cold  water  and  of  persulphate  of 
iron.  His  death,  which  took  place  on  June  12,  1867,  was  probably  caused  by  oedema  of  the 
glottis. 

The  following  cases  were  probably  examples  of  gunshot  flesh-wounds  only : 

Private  Peter  Alfonze,  Co.  A,  9th  United  States  Cavalry;  aged  24  years;  Fort  Stockton,  Texas, 
October  24, 1864.  Gunshot  wound  of  left  eyelid.  Duty,  November  1,  1868. 

Private  Jacob  Dubois,  Co.  G,  6th  United  States  Infantry;  Little  Kock,  Arkansas,  December 
17,  1870.  Flesh-wound  through  left  cheek.  Duty,  January,  1870. 

Private  Christian  Fleming,  Co.  C,  40th  United  States  Infantry;  aged  21  years;  Washington, 
December  10, 1866.  Gunshot  wound  of  lip  and  tongue.  Duty,  January,  1867. 

Private  Arthur  J.  Gregory,  Co.  D,  25th  United  States  Infantry;  aged  21  years;  Memphis, 
Tennessee,  July  6,  1868.  Gunshot  wound  of  both  cheeks.  Duty,  July  20,  1868. 

Corporal  Landon  Maitlon,  Co.  H,  128th  Colored  Troops;  aged  40  years;  Charleston,  South 
Carolina,  August  1,  1866.  Gunshot  wound  of  upper  lip.  Duty,  August  10,  1806. 

Private  Charles  Seachrist,  Co.  I,  37th  United  States  Infantry ;  aged  20  years ;  Fort  Dodge, 
Kansas,  July  16, 1867.  Flesh-wound  of  right  cheek.  Duty,  July  28,  1807. 

Private  George  W.  Young,  Co.  H,  9th  United  States  Cavalry ;  aged  27  years;  Fort  Quitman, 
Texas,  October,  1868.  Gunshot  wound  of  face.  Duty,  November  10,  1868. 

Thus,  of  twenty  gunshot  face-wounds,  two  were  fatal.  Fifteen  of  the  patients  were 
returned  to  duty,  two  were  discharged,  and  one  deserted.  In  six  of  the  fractures,  the 
upper  maxillary  or  nasal  regions  were  the  principal  seats  of  mischief;  in  seven,  the  lower 
maxillary  suffered  most. 


GUNSHOT  WOUNDS  OF  THE  NECK. — A  large  mortality  attended -the  injuries  of  this 
class  that  have  been  reported. 

L.— Report  of  a  Case  of  Gunshot  Wound  of  the  Pharynx.    By  C.  H.  ALDEN,  Surgeon,  U.  S.  A. 

Thomas  G ,  a  teamster  in  the  Quartermaster's  Department,  was  admitted  to  the  post  hospital 

at  Fort  D.  A.  Eussell,  Wyoming  Territory,  December  20,  1867,  having  been  wounded  by  another 
teamster  seven  days  previously,  while  on  the  road  from  one  of  the  posts  to  the  northward.  There 
was  a  small  pistol-ball  wound  at  the  point  of  the  chin,  discharging  pus.  The  probe  could  be  passed 
in  toward  the  neck  about  three  quarters  of  an  inch ;  but  the  most  careful  manipulation  failed  to 
discover  the  further  track  of  the  missile.  There  were  no  wounds  of  the  mouth,  tongue,  or  any  of 
the  tissues  in  the  mouth.  The  patient  could  swallow  with  but  very  little  discomfort  or  difficulty. 
His  right  arm  was  paralyzed  almost  completely,  the  only  motion  left  being  partial  prouatiou  and 


GUNSHOT  WOUNDS  OF  THE  NECK.  21 

supination  of  the  fore-arm.  He  was  weak,  but  the  symptoms  named  were  the  only  noticeable  ones. 
Kest  was  ordered,  with  beef-tea  and  milk-punch  at  regular  intervals.  A  few  days  after  his  admis- 
sion, there  was  a  profuse  stringy  discharge  from  the  throat ;  he  remained  in  almost  the  same  con- 
dition for  a  week,  with  the  exception  that  he  gradually  grew  weaker ;  deglutition  became  somewhat 
more  difficult.  Death,  from  seeming  exhaustion,  resulted  December  26, 1867.  Post-mortem  exam- 
ination revealed  a  short  sinus  filled  with  pus,  connected  with  the  external  wound ;  but  a  careful 
examination  of  the  parts  did  not  disclose  the  track  of  the  ball.  The  neck,  toward  the  right  shoul- 
der, was  carefully  dissected,  and  no  lesion  discovered.  The  parts  lying  in  front  of  the  cervical  ver- 
tebra were  then  removed,  down  to  the  oesophagus  and  pharynx,  where  an  opening  was  discovered  in 
the  posterior  wall  of  the  pharynx,  and  beneath  it  the  ball,  embedded  in  the  anterior  surface  of  the 
body  of  the  fifth  vertebra.  The  pathological  specimen  is  numbered  5584,  Section  1,  Army  Medical 
Museum,  and  was  contributed,  with  a  history  of  the  case,  by  Surgeon  C.  H.  Aldeu,  U.  S.  A. 

LI. — Extract  from  Monthly  Report  of  Wounded  of  July,  I860,  of  Detachment  of  1th  United  States 
Cavalry.    By  HENRY  LIPPINCOTT,  Assistant  Surgeon,  U.  S.  A. 

Private  John  A.  Wright,  Co.  I,  7th  United  States  Cavalry,  was  accidentally  shot  on  the  17th  day  of 
July,  1869,  in  a  scout,  near  Fort  Hays,  Kansas.  The  ball  entered  the  throat  at  a  point  corresponding 
with  the  fourth  riug  of  the  trachea.  Passing  upward,  it  destroyed  the  first,  second,  and  third 
ring,  as  well  as  the  fourth.  It  destroyed,  besides  the  portion  of  the  trachea  just  named,  the 
thyroid  cartilage,  and  in  its  ascent  fractured  the  hyoid  bone.  In  addition  to  these  injuries,  the 
inferior  maxilla  was  severely  fractured,  the  ball  emerging  just  in  front  of  the  inferior  incisors. 
The  shock  was  terrible.  With  a  view  to  the  arrest  of  the  hiemorrhage,  too  sudden  and  great 
reaction  was  guarded  against ;  but  the  shock  was  not  neglected.  The  wounded  tissues  were  kept 
apart  to  favor  the  exit  of  accumulating  blood.  After  this  a  silver  tube  was  inserted,  and  seemed 
for  a  time  to  afford  relief;  but  despite  all  attempts  to  avert  the  fatal  issue,  dissolution  took  place 
in  a  few  hours. 

LII. — Note  of  a  Case  of  Fatal  Gunsliot  Wound  of  the  Ned:.   By  C.  L.  HEIZMANN,  Assistant  Surgeon, 
U.  S.  A. 

Private  James  Morrissey,  Co.  B,  34th  United  States  Infantry,  was  shot  through  the  neck  at 
Grenada,  Mississippi,  March  28,  1868.  The  missile  entered  on  the  left  side,  at  a  point  two  and  a 
half  inches  on  a  line  drawn  perpendicularly  to  the  clavicle  from  the  lobe  of  the  ear,  and  emerged 
about  one  and  a  half  inches  from  the  spinous  process  on  the  right  side,  on  a  line  drawn  from  the 
angle  of  the  jaw  to  the  spinal  column.  The  carotid  artery  was  severed,  and  death  was  almost 
instantaneous. 

LIII. — Remarks  on  a  Gunshot   Wound  of  the  Ned:.    By  ALFRED  DELANEY,  Assistant  Surgeon^ 
U.  S.  A. 

At  Fort  Gibson,  Cherokee  Nation,  Private  John  Maybee,  Co.  C,  10th  United  States  Cavalry, 
received  a  gunshot  wound  in  the  neck,  in  a  drunken  brawl,  on  the  morning  of  November  19, 1868. 
He  was  taken  into  hospital  shortly  after  the  accident,  when  he  presented  the  following  symptoms : 
Complete  paralysis  of  both  superior  extremities;  respiration  gasping  and  frequent ;  pulse  about  100, 
and  of  fair  volume  and  strength;  mind  clear;  he  complained  of  some  pain  in  the  hands.  On 
making  a  critical  examination,  the  ball  was  found  to  have  penetrated  the  neck,  on  the  left  side,  at 
the  anterior  border  of  the  trapezius  muscle,  and  about  two  inches  and  a  half  below  the  Inastoid 
process  of  the  temporal  bone;  thence  passed  downward  and  to  the  right  side,  beyond  the  reach 
of  the  bullet  probe,  fracturing  one  or  more  of  the  vertebra).  A  few  accessible  and  loose  fragments 
of  bone  were  removed,  but  the  ball  was  not  discovered.  The  treatment  consisted  in  placing  the 
patient,  supinely,  upon  a  water-bed,  and  the  administration  of  anodynes  to  induce  sleep  and 
relieve  pain.  The  bladder  was  relieved  by  the  catheter.  The  paralysis  of  the  abdominal  muscles 


22  REPORT  OF  SURGICAL  OASES  IN  THE  ARMY. 

allowed  an  accumulation  of  gases  to  take  place  within  the  intestines  to  such  an  extent  as 
greatly  to  augment  the  already  existing  difficulty  of  respiration.  It  was  found  expedient  to 
introduce  an  elastic  tube,  from  time  to  time,  through  which  the  gases  found  vent,  when  pressure 
was  made,  externally,  ou  the  abdomen.  The  paralysis  became  more  profound  from  day  to  day ; 
the  respiration  more  difficult,  inducing  a  slow  asphyxia,  delirium  followed  by  coma  ;  and,  finally* 
death  on  November  28,  1869,  about  eight  days  after  the  receipt  of  this  injury.  The  autopsy 
disdosed  the  following  conditions :— Fracture  of  the  spiuous  process  of  the  last  cervical  vertebra ;  the 
process  had  been  comminuted,  the  fragments  driven  before  the  ball  and  lodged  in  the  surrounding 
soft  parts.  Secondly,  fracture  of  the  lamina?  of  the  first  dorsal  vertebra,  at  the  point  where  they 
join  to  form  the  spinous  process.  This  fracture  opened  the  medullary  canal,  and  ruptured  the  sheath 
of  the  cord.  Several  small  fragments  of  bone  were  found  embedded  in  the  substance  of  the  cord, 
which  was  found  softened  and  bathed  in  pus.  Thirdly,  fracture  of  the  first  rib,  and  the  coracoid 
process  of  the  scapula.  The  ball  was  found  in  the  axilla.  The  lungs  were  deeply  congested,  the 
mucous  coat  of  the  bronchi  also;  and  the  bronchi  themselves  filled  with  a  tenacious  mucus.  Jn 
the  apex  of  the  right  lung  was  found  a  cavity  filled  with  pus,  and  containing  a  fragment  of  bone 
about  the  size  of  a  pea,  probably  a  piece  from  the  first  rib.  Death,  if  not  caused  by  the  inter- 
ference with  the  respiratory  act,  and  the  consequent  slow  asphyxia,  was  doubtless  hastened  by  it. 

LIV. — Extract  from  a  Report  of  a   Gunshot   Wound  involving  the  Carotid  Artery  and  Spine.    By 
W.  E.  BLACKWOOD,  Acting  Assistant  Surgeon. 

In  December,  1867,  at  Rome,  Georgia,  Private  John  Bowen,  Co.  G,  33d  United  States  Infantry, 
was  killed  by  a  musket-ball,  from  a  Springfield  breech-loading  musket,  on  the  morning  of  the  26th. 
He  was  lying  down  at  the  time,  asleep,  having  been  unwell  at  the  morning  sick-call.  The  piece, 
which  was  not  known  to  be  loaded,  was  discharged  while  in  the  act  of  being  covered  with  its  flannel 
case.  It  was  in  the  hands  of  George  Wood,  of  Co.  H.  The  ball,  after  first  passing  through  the 
left  fore-arm,  entered  the  neck,  a  little  to  the  left  of  the  median  line,  at  the  sterno-clavicular 
articulation,  severed  the  carotid  artery,  and  emerged  at  the  fourth  cervical  vertebra,  fracturing  it, 
and  lacerating  the  spinal  cord.  Death  was  instantaneous,  the  men  who  were  standing  around  his 
bunk  not  being  aware  that  he  was  struck.  One  man  was  sitting  beside  him  on  the  bed,  but 
believed  the  ball  to  have  passed  beneath  the  wood-work  of  it.  The  accident  was  not  discovered 
until  dinner-time,  three  hours  after  its  occurrence.  No  post-mortem  examination,  further  than  a 
digital  examination,  was  made. 

LV. — Memorandum  of  a  Fatal  Case  of  Gunshot  Wound  of  the  Neck.   By  W.  F.  SMITH,  Assistant 
Surgeon,  U.  S.  A. 

Private  George  Robinson,  Co.  D,  40th  United  States  Infantry,  was  shot  on  August  26,  1868, 
by  the  officer  of  the  guard,  for  mutinous  conduct  at  the  United  States  Army  post,  Goldsborough, 
North  Carolina,  by  a  Colt's  Navy  revolver,  in  the  neck,  severing  the  carotid  artery.  Death  from 
haemorrhage  resulted  almost  immediately,  September  13,  1868. 

« 

LVL— Note  of  a  Case  of  Gunshot  Fracture  of  the  Spine.    By  IRA  FEREY,  Assistant  Surgeon,  9th 
United  States  Colored  Troops. 

Private  Gustavus  Chase,  Co.  I,  9th  United  States  Colored  Troops,  aged  24  years,  was  shot 
while  walking  from  Brownsville,  Texas,  to  camp,  January  28,  1866.  The  missile,  a  conoidal 
bullet  from  a  Colt's  Navy  revolver,  shattered  the  spiuous  processes  of  the  sixth  and  seventh  verte- 
brae, laid  open  the  canal  between  the  sixth  and  seventh  spinous  processes,  and  lacerated  the  cord. 
He  was  admitted  to  the  post  hospital,  where  fragments  of  bone  were  extracted,  and  simple  cold- 
water  dressing  applied.  There  was  complete  paralysis  below  the  seventh  dorsal  vertebra,  and 
great  pain  in  the  epigastric  region.  On  February  1st  the  bowels  and  bladder  were  completely 
torpid,  the  skin  hot,  the  pulse  at  140.  Death  occurred  February  4,  I860. 


GUNSHOT  WOUNDS  OF  THE  NECK.  23 

LV1I. — Extract  from   Quarterly  Report  of  Wounded  at  Fort  Mason,  Texas,  relative  to  a  Gunshot 
Wound  of  the  Neck.    By  JOHN  J.  HULSE,  Acting  Assistant  Surgeon. 

Major  John  A.  Thompson,  7th  United  States  Cavalry,  was  wounded  by  a  pistol  ball,  while 
engaged  in  suppressing  an  affray  between  a  party  of  soldiers  and  desperadoes,  near  Fort  Mason, 
Texas,  on  November  14,  1807.  The  missile  struck  the  right  malar  bone,  and  emerged  below  the 
lobe  of  the  left  ear,  severing  the  left  carotid  artery.  He  was  taken  to  the  post  hospital,  and  died 
the  next  day  from  haemorrhage. 

LVIII. — Memorandum  of  a  Gunshot  Wound  of  the  Neclc.    By  G.  W.  B.  MINOR,  Acting  Assistant 
Surgeon. 

Private  James  Smith,  Co.  1. 38th  United  States  Infantry,  was  shot,  by  the  accidental  discharge 
of  a  Springfield  musket  in  the  hands  of  Private  Moses  Hunter,  while  standing  in  the  door  of  the 
company  quarters.  The  ball  entered  the  right  shoulder  behind,  and,  passing  through  the  scapula, 
divided  the  subclavian  vessels  and  fractured  the  clavicle.  It  was  turned  from  its  course,  and  ranged 
backward  and  upward  through  the  neck,  wounding  the  sheath  of  the  carotid  vessels,  lacerating  the 
larynx,  almost  severing  the  tongue,  and  making  its  exit  through  the  left  corner  of  the  month. 
The  parts  near  its  passage  were  torn  and  contused  to  a  very  large  extent,  the  calibre  of  the  ball 
being  .50,  and  death  was  almost  immediate. 

LIX. — Note  of  a  Case  of  Gunshot  Wound  of  the  Neclc.    By  EDWARD  COWLES,  Assistant  Surgeon, 
U.  S.  A. 

Private  Leon  Pinel,  Co.  I,  1st  United  States  Artillery,  aged  35  years,  while  escaping  from 
patrols  on  May  23,  1867,  was  shot,  by  the  officer  of  the  day,  with  a  small  bullet  from  a  pistol.  The 
ball  entered  the  middle  of  the  right  shoulder,  immediately  over  the  supra-scapular  notch,  passed 
superficially  upward  and  forward  into  the  neck,  wounding  the  oesophagus  posteriorly,  at  a  point 
opposite  the  thyroid  cartilage,  arid  lodging  in  the  left  side  of  the  neck.  He  had  a  little  haemorrhage, 
but  had  expectorated,  and  probably  swallowed,  much  blood.  He  had  a  constant  desire  to  swallow, 
which  continued  several  days.  He  was  admitted  into  the  post  hospital  at  Brownsville,  Texas,  on 
May  23d,  three-fourths  of  an  hour  after  being  wounded.  Expectant  treatment.  Simple  dressings 
to  the  wound  of  entrance,  which  closed  by  first  intention,  and  in  two  days  there  was  no  remaining 
tenderness  along  the  track  of  the  wound.  The  soreness  and  swelling  of  the  throat  gradually 
increased,  with  difficult  deglutition,  and  expectoration  of  mucus,  occasionally  tinged  with  blood, 
until  May  27th,  when  there  was  great  difficulty  in  swallowing,  increased  fullness  and  swelling  of  the 
left  side  of  the  throat,  and  expectoration  of  a  great  deal  of  mucus  and  pus,  discolored  with  a  little 
disorganized  blood.  There  was  little  dyspnoea,  and  not  much  febrile  reaction,  the  pulse,  naturally 
very  slow,  being  70  per  minute.  Ou  the  28th  the  patient  was  much  better,  swallowing  with  more 
ease,  had  no  fever,  pulse  about  60  per  minute,  and  continued  to  improve  rapidly  to  convalescence, 
with  no  soreness  remaining  about  the  throat.  A  liberal  allowance  of  milk-punch,  beef-essence,  eggs, 
and  fresh  milk.  Gave  tincture  of  sesquichloride  of  iron  three  times  daily,  and  used  a  solution  of 
chlorate  of  potassa  freely  as  a  mouth-wash  and  gargle  ;  also  internally.  He  was  returned  to  duty 
on  June  10,  1807. 

LX. — Report  of  a  Case  of  Gunshot  Wound  of  the  Neclc.   By  J.  W.  WILLIAMS,  Assistant  Surgeon, 
U.  S.  A. 

Private  James  Nixon,  Troop  C,  5th  United  States  Cavalry,  was  shot,  in  a  street  fight  with  a 
policeman,  October  24, 1868,  by  a  pistol-ball,  which  entered  the  neck,  half  an  inch  above,  and  some- 
what external  to  the  greater  cornu  of  the  hyoid  bone  and  lodged.  He  was  retained  in  camp  four 
days,  and  on  the  18th  was  admitted  to  the  post  hospital,  McPherson  Barracks,  Atlanta,  Georgia, 
with  complete  paralysis  of  motion  and  sensation  of  the  lower  extremities  and  the  right  arm.  There 
was  partial  paralysis  of  the  left  arm,  with  spasmodic  movement  when  used.  The  intercostal  mus- 
cles were  paralyzed;  there  was  loss  of  sensation  over  the  abdominal  region,  with  partial  paralysis 


24  REPORT  OF  STIRGTCAL  CASES  IN  THE  ARMY. 

of  the  bowels  and  complete  paralysis  of  tlie  bladder.  His  mind  was  clear,  and  sensation  was  normal 
over  the  face  and  upper  portion  of  the  chest;  respiration  abdominal  and  slow;  pulse  slow  aud  regular. 
Although  the  skin  and  extremities  were  hot  to  the  touch,  the  patient  complained  of  coldness  of  the 
surface.  The  (nick  of  the  bullet  could  not  be  ascertained,  as  the  wound  had  nearly  healed ;  but 
from  the  symptoms  described  above,  which  were  present  immediately  after  receiving  the  wound,  it 
w:is  surmised  that  the  spinal  cord  had  been  injured.  During  the  first  week  of  his  treatment  in  the 
hospital  there  was  no  perceptible  improvement  in  the  paralysis.  A  large  bed-sore  formed  over  the 
sacrum.  Mucus  accumulated  constantly  in  the  lungs,  threatening  suffocation,  which  was  averted  by 
the  use  of  stimulant  expectorants.  The  bowels  were  relieved  by  injections  and  purgatives,  and  the 
bladder  by  the  catheter;  otherwise  the  treatment  was  expectant.  During  the  second  week  there  was 
a  partial  recovery  of  motion  in  the  right  arm,  but  none  of  sensation;  the  patient  could  by  an  effort 
draw  his  arm  across  his  breast;  oedema  of  the  left  leg  set  in,  and  was  managed  by  bandaging. 
During  the  third  week  there  was  no  improvement ;  permanganate  of  potassa,  charcoal,  and  Peru- 
vian bark  poultices  were  applied  to  the  bed-sore,  which  was  large  and  sloughy.  During  the  fourth 
week,  on  the  suggestion  of  Dr.  A.  K.  Smith,  iodide  of  potassium,  and  afterward  tincture  of  ergot, 
were  used,  and  the  patient  improved  perceptibly.  The  mucus  diminished  in  quantity,  expectora- 
tion became  easy,  and  the  appetite  increased.  During  the  first  part  of  the  fifth  week,  improvement 
was  very  encouraging.  The  bed-sores  looked  healthy,  and  improved  under  the  alcoholic  applica- 
tions, the  appetite  remained  good,  bowels  acted  readily,  and  respiration  became  more  normal. 
On  Friday,  November  20th,  the  patient  complained  of  stiff  neck,  headache,  and  extreme  coldness, 
and  toward  night  had  a  slight  fever.  On  Saturday,  the  21st,  the  fever  had  disappeared,  but  he 
still  complained  of  coldness  and  headache,  and  I  diagnosed  that  suppuration  had  set  in.  On  Sunday 
morning  I  found  the  patient  comatose,  with  the  left  pupil  dilated,  and  the  right  pupil  contracted.  A 
blister  was  applied  to  the  nape  of  the  neck,  purgatives,  &c.,  given,  but  to  no  purpose;  the  patient 
died  at  11.15  P.  M.  At  the  autopsy,  fifteen  hours  after  death,  post-mortem  rigidity  present.  On 
dissection  of  the  muscles  of  the  right  side  of  the  neck,  it  was  ascertained  that  the  bullet  had  passed 
directly  from  its  point  of  entrance  toward  the  spinal  column,  crossing  the  carotid  sheath  externally, 
and  just  missing  it.  A  probe  passed  through  its  course,  impinged  against  the  spinal  cord,  through 
the  third  right  condyloid  foramen  of  the  cervical  spine,  which  was  patent,  the  nerve  having  been 
destroyed.  Believing  that  the  bullet  would  be  found  lodged  in  the  canal  between  the  third  and 
fourth  vertebra},  the  cervical  spine  was  opened,  and,  the  bullet  not  being  found,  the  dorsal  and 
lumbar  vertebras  were  also  included  in  the  search,  with  a  like  result.  Search  was  then  made  for 
the  bullet  among  the  muscles  of  the  neck  and  scapular  region,  without  finding  it.  The  possibility 
of  the  bullet  having  lodged  in  the  body  of  one  of  the  vertebra'  was  disproven,  by  boiling  to  free  them 
from  the  soft  structure;  and  a  subsequent  examination  of  the  brain  demonstrated  that  it  had  not 
lodged  in  that  organ.  The  possibility  of  its  having  passed  down  the  canal  into  the  sacrum  was 
not  ascertained.  The  membranes  of  the  cord  and  left  hemisphere  of  the  brain  were  found  extensively 
disorganized  from  inflammation.  Plastic  lymph,  forming  a  continuous  layer,  was  found  effused  on  the 
visceral  surface  of  the  dura  mater  of  the  cord  throughout  its  entire  length.  The  sub-arachnoid 
space  was  distended  with  a  pyoid  serum,  by  which  the  cord  was  compressed  and  softened  opposite 
the  third  and  fourth  cervical  vertebra?,  and,  corresponding  with  their  posterior  faces,  the  dura  mater 
•was  ecchymosed,  and  separated  from  the  bone.  This  was  a  point  of  great  interest,  taken  in  con- 
nection with  the  supposed  course  of  the  bullet.  The  effusion  of  plastic  lymph  had  extended  into 
the  brain,  and,  with  the  exception  of  the  base  of  that  organ,  was  confined  to  the  left  hemisphere. 
In  the  left  anterior  lobe  of  this  hemisphere  circumscribed  softening  was  found,  presenting  the 
appearance  of  an  abscess.  The  base  of  the  brain  was  also  the  seat  of  effusion  of  plastic  matter, 
which  extended  as  far  forward  as  the  optic  commissure.  The  gray  substance  of  the  left  lobe  of  the 
brain  had  evidently  been  involved  in  the  inflammatory  process,  being  changed  in  color  and  consist- 
ence. The  medullary  substance  was  injected,  the  lateral  ventricles  were  marked  by  radiating 
blood-vessels.  The  corpora  striata  and  thalami  optici  were  injected. 

LXL— Memoranda  of  Fire  Cases  of  Gunshot  Wound  of  tite  Nccl;.     (Condensed  from  Reports). 

Private  John  Butler,  Co.  F,  10th  Cavalry ;  Colorado  Territory;  January  9,  1809  ;  gunshot 
flesh-wound  of  left  side  of  neck.    Duty,  February  13,  1869. 


GUNSTIOT  WOUNDS  OF  THE  CHEST.  25 

Private  Henry  Carr,  Co.  K,  25th  Infantry ;  aged  21  years ;  Memphis,  Tennessee ;  February  13, 
1808 ;  gunshot  wound  of  the  nock  on  a  line  with  the  upper  border  of  the  thyroid  cartilage.  Feb- 
ruary 28,  1808,  doing  well.  Duty,  April,  1808. 

Private  William  Genuigs,  Co.  K,  38th  Infantry;  Fort  Harker,  Kansas;  July  15,  18G7;  gun- 
shot wound  of  the  neck  by  pistol-ball.  Duty,  September  19,  1SII7. 

Private  Thomas  Lee,  Co.  D,  9th  Cavalry;  Fort  Stockton,  Texas;  January  17,  1870;  gunshot 
wound  of  the  neck  by  conoidal  ball.  Duty,  February  21,  1870. 

Private  Henry  Spencer,  Co.  B,  80th  Colored  Troops;  aged  29  years;  Shreveport,  Louisiana; 
October  17,  1866;  gunshot  wound  of  the  neck  by  pistol-ball.  Duty,  November  5,  1860. 

The  series  of  sixteen  cases  of  gunshot  wounds  of  the  neck  above  recorded  comprises 
no  less  than  four  instances  of  division  of  the  carotid  and  one  of  the  subclavian  arteries,  and 
five  fractures  of  the  vertebrae.  In  two  instances  the  pharynx  was  wounded,  with  fracture 
of  the  hyoid  bone  in  one  case.  In  the  case  in  which  the  oesophagus  was  wounded,  and  in 
five  others  in  which  no  important  organ  was  implicated,  the  patients  recovered,  but  more 
slowly  than  after  gunshot  flesh-wounds  in  other  regions.  In  the  cases  in  which  the  great 
vessels  were  wounded,  death  was  aknost  instantaneous,  except  in  one,  in  which  there  was 
time  to  ligate  the  carotid  had  surgical  assistance  been  at  hand.  One  of  the  patients,  with 
fracture  of  the  spine,  survived  twenty-eight  days. 


GUNSHOT  WOUNDS  OF  THE  CHEST. — These  may  be  subdivided  into  lesions  affecting 
the  walls  of  the  thorax  only,  penetrating  and  perforating  wounds  of  the  lungs,  wounds  of 
the  heart  and  great  vessels,  and  those  complicated  by  fractures  of  the  vertebrae.  Cases  in 
which  the  diaphragm  was  perforated  will  be  considered  in  the  next  section,  the  wounds 
of  the  abdomen  being  graver  than  those  of  the  chest.  There  were  eleven  cases  of  re- 
covery after  penetrating  or  perforating  gunshot  wounds  of  the  lung,  as  follows  : 

LXII. — Report  of  a  Penetrating  Wound  of  the  Lung,  icith  Lodgement  of  a  Mound  Musket-Sail.    By 
Brevet  Lieutenant  Colonel  J.  E.  GIBSON,  Assistant  Surgeon,  U.  S.  A. 

Lieutenant  Franklin  Yeaton,  3d  United  States  Cavalry,  was  wounded  in  an  encounter  with  Mes- 
calero  Apaches  in  the  Guadalnpe  Mountains,  December,  1809 ;  arrived  at  Fort  Stanton  January  0, 
1870;  was  under  the  care  of  Hospital  Steward  Miller  until  his  arrival  at  this  post.  This  was  a 
bullet  wound,  evidently  from  a  small  round  rifle-bullet,  of  the  left  ulna,  in  immediate  vicinity  of  the 
wrist-joint,  (joint  partially  involved,)  splintering  the  bone,  but  not  completely  fracturing  it.  The 
ball  entered  on  the  dorsal  surface,  emerging  opposite  on  the  palmar  surface  and  an  inch  below ;  theu 
it  entered  the  cavity  of  the  right  chest,  an  inch  from  the  median  line  of  the  j  unction  of  the  cartilages 
of  the  seventh,  eighth,  ninth  ribs,  making  a  track  which  can  be  probed  to  the  extent  of  six  inches,  the 
probe  passing  horizontally  beneath  the  ribs,  and  in  a  direction  toward  their  angles.  The  ball 
lodged,  and  cannot  be  detected ;  no  lung  symptoms  as  yet  have  been  manifested. 

[This  officer  spent  the  winter  of  1870-'71  in  the  West  Indies,  in  delicate  health.  He  returned 
in  the  siting  improved.  He  was  examined  by  Assistant  Surgeons  Woodward  and  Otis,  and  recom- 
mended to  appear  before  the  Retiring  Board  in  session  in  Philadelphia.  No  alteration  of  the 
respiratory  murmur  or  change  in  the  density  of  the  pulmonary  tissue  was  observed.  But  the 
general  health  was  impaired. — ED.] 
4 


26  BEPOBT  OF  SURGICAL  CASES  IN  THE  AKMY. 

LXIII. — Note  of  a  Case  of  Recovery  after  a  Penetrating  Gunshot  Wound  of  the  Thorax.    By  A.  C. 
GIRARD,  Assistant  Surgeon,  U.  S.  A. 

Sergeant  James  Baylor,  Co.  M,  9th  United  States  Cavalry,  aged  26  years,  was  wounded  on  July 
4,  1870,  in  a  fight,  by  a  fellow-soldier.  A  conoidal  ball  entered  the  right  breast,  striking  the  fifth 
rib,  and  penetrating  the  thoracic  cavity,  producing  severe  constitutional  shock.  The  ball  was  not 
extracted  or  found.  He  was  admitted  to  the  post  hospital  at  Fort  McKavett,  Texas,  on  July  4, 
1870,  and  was  treated  by  Acting  Assistant  Surgeon  B.  Sharpe.  Simple  -dressings  were  applied. 
He  was  returned  to  duty  on  September  20,  1870. 

LXIV. — Note  of  a  Case  of  Recovery  after  Perforation  of  the  Chest  by  a  Pistol-Ball,    By  J.  F.  WEEDS, 
Surgeon,  U.  S.  A. 

Private  Walter  E.  Oliver,  Co.  D.  14th  United  States  Infantry,  aged  21  years,  was  wounded  on 
September  11, 1869,  by  a  pistol-ball.  The  missile  entered  between  the  posterior  border  of  the  scap- 
ula and  the  vertebrae,  two  inches  above  the  inferior  angle,  and  escaped  two  and  a  half  inches 
below  the  middle  of  the  clavicle,  passing  directly  above  the  base  of  the  heart.  He  was  admitted 
to  the  post  hospital  at  Nashville,  Tennessee,  on  September  llth,  and  simple  dressings  were  applied 
to  the  wounds.  He  is  still  in  hospital  awaiting  discharge  on  surgeon's  certificate  of  disability. 

LXV. — Report  of  a  Gunshot  Wound  of  the  Chest,  having  a  Successful  Termination.    By  F.  MEACHAM, 
Assistant  Surgeon,  U.  S.  A. 

Private  Thomas  Stewart,  Co.  F,  14th  United  States  Infantry,  a  prisoner  at  Omaha  Barracks, 
Nebraska,  was  shot  through  the  upper  lobe  of  the  right  lung,  while  attempting  to  escape  from  a 
sentinel,  November  7,  1870.  The  ball  entered  near  the  union  of  the. third  rib  with  its  cartilage  in 
front,  and  emerged  between  the  fifth  and  sixth  ribs,  just  below  the  anterior  border  of  the  right  sca- 
pula. When  brought  to  the  post  hospital,  about  half  an  hour  after  the  reception  of  the  injury,  he 
was  suffering  very  severely  from  pain  and  shock,  the  pulse  was  scarcely  perceptible,  feet  and  hands 
cold,  countenance  dusky,  and  the  whole  body  covered  with  a  profuse  cold  perspiration.  Air  was 
escaping  from  the  'anterior  wound  with  every  expiration.  The  sputa  was  streaked  with  blood,  and 
blood  was'escaping  from  the  lower  opening.  The  anterior  wound  was  closed  with  adhesive  plaster 
and  the  posterior  wound  covered  with  lint  to  allow  the  escape  of  blood.  Brandy  and  morphia  were 
freely  administered,  and  hot  applications  made  to  the  upper  and  lower  extremities.  The  patient 
rallied  from  the  shock,  and  slept  well  during  the  night.  On  the  next  day  the  haemorrhage  had 
entirely  ceased,  and  he  was  feeling  very  comfortable.  He  continued  to  improve,  and,  on  Novem- 
ber loth,  was  able  to  sit  up  in  bed.  On  November  29th,  having  absented  himself  from  hospital 
for  several  hours  without  leave,  he  was  returned  to  the  guard-house,  where  the  wound  was  dressed 
daily  for  about  four  weeks,  at  the  expiration  of  which  time  he  had  entirely  recovered  and  was 
returned  to  duty. 

LXVI. — Memorandum  of  a   Case  of  Recovery  from  a  Penetrating  Gunshot  Wound  of  the  Chest.    By 
C.  BACON,  Assistant  Surgeon,  U.  S.  A. 

Private  Henry  Freyer,  Co.  C,  6th  United  States  Cavalry,  aged  20  years,  was  admitted  to 
regimental  hospital  near  Austin,  Texas,  on  June  2,  1867,  with  a  gunshot  penetrating  wound  of  the 
chest,  received  June  2,  1867,  at  the  hands  of  a  citizen.  He  was  transferred  on  the  same  day  to  the 
post  hospital.  He  recovered,  and  was  returned  to  duty  in  July,  1867. 

LXVIL— Note  of  a  Case  of  Gunshot  Wound  of  the  Chest.    By  W.  S.  HENDRICKSON,  Acting  Assistant 
Surgeon. 

Private  Holman  Doleman,  Co.  L,  10th  United  States  Colored  Cavalry,  aged  23  years,  was  acci- 
dentally wounded  on  March  30,  1870,  by  a  round  pistol-ball,  which  passed  below  the  right  nipple, 
penetrated  the  pleural  cavity,  and  lodged  opposite  the  articulation  of  the  sixth  costal  cartilage  with 
the  sternum.  He  was  admitted  to  the  post  hospital  at  Fort  Arbuckle,  Cherokee  Nation,  on  the  same 
day.  The  treatment  consisted  in  simple  dressings.  He  was  returned  to  duty  on  May  26, 1870. 


GUNSHOT  WOUNDS  OF  THE  CHEST.  27 

LXVIII. — Report  of  a  Case  of  Perforating  Gunshot  Wound  of  the  Chest.    By  B.  E.  -FRYER,  Surgeon, 
TT.  S.  A. 

CASE. — Private  Daniel  McDonald,  Co.  B,  38th  United  States  Infantry,  aged  23  years,  was 
admitted  to  the  post  hospital  at  Fort  Harker,  Kansas,  April  28,  1808,  with  a  perforating  gunshot 
wound  of  the  left  chest.  The  ball  entered  between  the  second  and  third  ribs,  live  inches  from  the 
sternum,  and  emerged  posteriorly  two  and  a  half  inches  to  the  left  of  the  spinal  column,  between 
the  fifth  and  sixth  ribs.  Carbolic-acid  dressings  were  applied  to  the  external  wound,  and  the  man 
recovered  without  any  severe  constitutional  disturbance.  The  anterior  wound  closed  May  21st, 
and  the  posterior,  May  29,  18G8.  He  was  returned  to  duty  on  June  24,  1868. 

LXIX — Note  of  a  Case  of  Penetrating  Gunshot  Wound  of  the  Chest.    By  C.  S.  DE  GRAW,  Assistant 
Surgeon,  U.  S.  A. 

Corporal  James  Goodwin,  Co.  B,  7th  United  States  Cavalry,  aged  21  years,  was  wounded  by 
Indians  on  September  20,  1868,  by  a  ball  which  entered  to  the  left  of  the  third  dorsal  vertebra, 
passed  through  the  apex  of  the  left  lung,  and  lodged  below  the  first  rib.  He  was  admitted  into  the 
United  States  Army  post  hospital  at  Fort  Dodge,  Kansas,  on  September  3,  1868.  Discharged 
May  15,  1869. 

LXX. — Extract  from  Case-Book  at  Fort  Hays  Hospital.    By  W.  F.  BUCHANAN,  Assistant  Surgeon, 
U.  S.  A. 

Private  Henry  Harvey,  Co.  E,  38th  United  States  Infantry,  aged  20  years,  was  on  August  14, 
1867,  at  Fort  Hays,  Kansas,  accidentally  shot  while  being  asleep.  The  ball,  from  an  Enfield  rifie, 
struck  the  posterior  surface  of  the  chest  over  the  tenth  rib,  three  inches  to  the  right  of  the  spinal 
column,  fractured  the  rib,  passed  into  the  right  pleural  cavity,  and  came  out  between  the  sixth  and 
seventh  ribs,  two  inches  to  the  right  of  the  spinal  column,  fracturing  the  ribs.  The  air  passed 
freely  out  and  in,  through  both  wounds,  at  every  inspiration  and  expiration.  On  August  18th,  the 
patient  had  a  hacking  cough,  with  a  pulse  at  112 ;  pus  was  flowing  from  both  wounds.  August  25th, 
the  cough  continued,  and  there  was  dullness  in  percussion  over  the  posterior  part  of  the  right 
chest,  with  bronchial  respiration.  On  September  31st,  the  patient  was  emaciated  and  weak.  Air 
no  longer  passed  through  the  upper  wound,  but  continued  to  pass  through  the  lower,  less  fre- 
quently, however,  than  at  first.  On  October  31st,  the  patient  was  much  improved.  Air  no  longer 
passed  through  either  of  the  wounds ;  but  a  purulent  discharge  continued.  Several  spiculae  of 
bone  were  removed.  There  was  a  slight  dullness  on  percussion.  The  patient  was  regaining  strength. 
On  December  22d,  the  patient  was  walking  about  the  ward.  Purulent  discharges  from  lower 
wound  continued ;  the  upper  wound  was  closed.  Spiculae  of  bone  were  removed  from  week  to 
week  during  the  last  two  months.  February  1,  1868,  patient  returned  to  duty.  The  lower 
wound  had  been  a  long  time  in  healing  in  consequence  of  exfoliations  from  the  rib. 

LXXI. — Report  of  a  Case  of  Rapid  Recovery  after  a  Perforating  Wound  of  tlie  Lung.   By  J.  H. 
BAKTHOLF,  Assistant  Surgeon,  U.  S.  A. 

At  Eichmond,  Virginia,  on  March  13. 1868,  Private  William  Caldwell,  Co.  B,  llth  United  States 
Infantry,  received  a  penetrating  wound  of  the  thorax,  by  a  small  rifled  pistol-ball,  fired  at  a  distance 
of  twenty  yards,  by  accident.  The  ball  entered  the  back,  an  inch  and  a  half  to  the  right  of  the 
spinous  process  of  the  sixth  dorsal  vertebra,  passed  upward  and  very  slightly  inward,  toward 
the  median  line.  Its  track  could  be  followed  only  an  inch  and  a  quarter.  Emphysema  appeared 
fifteen  minutes  after  the  reception  of  the  wound,  and  soon  became  very  great  throughout  the 
front  and  side  of  the  neck,  a  little  way  over  the  edge  of  the  lower  jaw,  and  on  the  chest,  two  inches 
down  the  sternum  and  an  inch  below  the  clavicle.  In  four  hours  his  respiration  became  very 
frequent,  short 'and  gasping,  and  very  imperfect;  the  thoracic  walls  scarcely  moving,  and  the 
abdomen  not  much.  Number  of  respirations,  fifty-eight  in  the  minute.  This  condition  of  the 
respiration  continued  five  hours,  and  then  gradually  improved.  On  the  next  morning  his  respira- 
tion was  easy;  twenty-two  in  the  minute.  Pulse,  70.  Ate  a  little,  for  the  first  time.  Emphysema 


28  EEPOET  OF  SURGICAL  OASES  IN  THE  AEMY. 

diminished  a  little  in  volume,  not  in  extent.  Complains  only  of  a  soreness  of  the  wound.  Has 
not  had  hemoptysis.  He  continued  to  improve  rapidly.  Complained,  on  the  seventh  day,  of  a 
stitch  in  his  right  side,  for  the  first  time.  The  emphysema  had  disappeared  by  the  seventh  day. 
Respiration  continued  very  feeble  and  indistinct  nearly  up  to  his  discharge  from  hospital.  He 
recovered  speedily,  and  was  returned  to  duty,  at  his  own  request,  there  being  nothing  in  his  con- 
dition to  coutraindicate  it,  on  March  31st,  eighteen  days  after  the  reception  of  the  wound. 

What  is,  further,  very  noticeable  in  his  case,  is  the  fact  that  there  was  no  suppuration  from 
or  at  the  wound.  There  was  a  slight  bleeding  from  the  wound  at  the  time;  but  a  clot  dried  and 
closed  the  wound,  and  remained  there  until  I  removed  it,  on  the  morning  of  his  discharge  from 
the  hospital,  leaving  a  small,  dry,  white  cicatrix. 

LXXII. Report  of  a  Case  of  Gunshot  Wound  of  the  Chest,  successfully  treated  by  the  Method  of 

"  Hermetically  Healing."    By  H.  S.  SCHELL,  Assistant  Surgeon,  U.  S.  A. 

Musician  George  Wolf,  Co.  I,  18th  New  York  Infantry,  was  admitted  into  hospital,  September 
19, 18G7,  he  having  been  accidentally  wounded  by  a  conical  pistol-ball,  calibre  .22,  that  morning. 
The  ball  passed  through  the  biceps-flexor-cubito  muscle  of  the  right  arm,  and  entered  the  chest 
between  the  fifth  and  sixth  ribs,  under  the  axilla.  The  symptoms,  on  admission,  were  great 
dyspnoea,  extreme  nervous  depression,  and  intense  pain  in  the  right  hypochondrium ;  pulse  85, 
and  very  feeble ;  patient  tossing  from,  side  to  side,  anxious  expression  of  countenance ;  flatness, 
on  percussion,  on  right  side  of  chest,  as  high  as  the  fifth  rib  in  front,  and  anterior  border  of 
axilla,  from  behind  forward,  with  expectoration  of  blood.  Immediately  sealed  the  wound  in  the 
parietes  of  the  chest,  by  means  of  a  dossil  of  cotton  and  Richardson's  styptic  colloid  fluid. 
Administered  morphia,  £  gr.;  vin.  alb.  fl^js. ;  this  was  repeated  in  half  an  hour.  Chloroform, 
confined  by  oil-silk,  was  applied  to  the  right  hypogastrium,  and  its  irritant  effects  allayed  by 
painting  the  surface  with  tinct.  opii.  He  became  quiet,  and  slept  in  the  course  of  an  hour.  6  P.  M., 
pulse  95,  full.  Administered  magn.  sulph.  %j.  September  20th,  8  A.  M.,  pulse  110,  hard.  Re- 
peat magn.  sulph.  fj.;  6  P.  M.,  pulse  115,  hard;  skin  hot;  great  pain  in  right  hypogastrium,  with 
increased  dyspnoea.  Applied  six  cut  cups,  one  ounce  of  blood  extracted  from  each  cup.  Adminis- 
tered ant.  et  pot.  tart.,  gr.  TL  every  hour.  Pulv.  ip.  el  op.,  gr.  xij,  at  taps.  Ten  P.  M.,  much  re- 
fieved  from  pain,  and  slept  all  night.  September  21,  8  A.  M.,  pulse  100.  Feels  somewhat  coin- 
lortable;  continued  tartar  emetic,  and  administered  an  ounce  of  sulphate  of  magnesia.  At  6  P. 
M.  the  epsoin  salt  had  operated  freely;  pulse  110 ;  skin  hot,  and  increased  pain  in  right  hypochon- 
drium ;  applied  two  cut  cups,  and  abstracted  four  ounces  of  blood  ;  continued  ant.  et  potass,  and 
repeated  Dover's  powder.  Ten  P.  M.,  pulse  95,  perfectly  comfortable,  sleeping.  September  22, 8  A.  M., 
feels  comfortable,  very  little  pain  ;  expectoration  of  blood  continues.  Absolute  diet  maintained, 
and  ant.  et  potass,  tart,  continued  for  one  day  longer;  since  which  time  he  has  continued  to  im- 
prove, without  an  unfavorable  symptom.  Wound  in  arm  nearly  healed.  Returned  to  duty  Octo- 
ber 3, 1867. 

The   fatal   cases  of  gunshot  wounds  of   the  lung  reported  were,  of  course,  more 
numerous. 

LXXIII. — Memorandum  of  a  Fatal  Penetrating  Pistol  Wound  of  the  Chest.    By  Dr.  T.  ROOTER, 
Acting  Assistant  Surgeon. 

Private  John  Simmons,  Co.  C,  128th  United  States  Colored  Troops,  received  an  accidental 
pistol-shot  wound  of  the  chest,  on  September  25,  1866.  He  was  admitted  to  the  post  hospital  at 
Charleston,  South  Carolina,  on  the  25th,  and  died  on  the  same  day,  from  internal  haemorrhage. 

LXXIV. — Minute  of  a  Penetrating  Gunshot  Wound  of  the  Chest.    By  C.  BACON.  Assistant  Surgeon, 
U.  S.  A. 

Near  Austin,  Texas,  Private  James  Donnelly,  Co.  B,  Gth  United  States  Cavalry, 
aged  24  years,  received  a  gunshot  penetrating  wound  of  the  left  chest,  on  May  15,  1867,  at  the  hands 
of  the  guard.  He  died  the  same  day,  and  was  taken  to  the  regimental  hospital  for  burial. 


GUNSHOT  WOUNDS  OP  THE  CHEST. 

LXXV. — Memorandum  of  a  Case  of  Penetrating  Gunshot  Wound  of  the  Chest.    By  WILLIAM  S. 
ADAMS,  Acting  Assistant  Surgeon. 

Corporal  William  McLaughliu,  Co.  1, 5th  United  States  Cavalry,  aged  23  years,  was  wounded  ou 
September  10,  1867,  iii  a  drunken  affray,  by  a  conoidal  ball,  which  entered  at  the  junction  of  the 
middle  and  outer. thirds  of  the  left  clavicle,  passed  inward,  striking  its  interior  border,  and  being 
deflected  downward  into  the  cavity  of  the  chest.  He  was  taken  to  the  post  hospital  at  Morgau- 
town,  North  Carolina,  where  death  resulted  one  hour  after  the  reception  of  the  injury. 

LXXVI. — Memorandum  of  a  Gunshot  Perforation  of  the  Chest.    By  JULES  LE  CAKPENTIEK,  Acting 
Assistant  Surgeon. 

*  *  At  Fort  Bayard,  New  Mexico,  Private  George  Stern,  Co.  A,  38th  United  States 
Infantry,  aged  25  years,  was  killed  by  a  round  ball,  in  a  riot,  which  occurred  at  Central  City,  near  by, 
on  the  evening  of  December  24,  1808.  The  missile  entered  the  left  axilla,  and  passed  out  ou  the 
right  side  of  the  neck. 

LXXVII. — Memorandum  of  a  Fatal  Gunshot   Wound  of  the  Lung.    By  J.  K.  GIBSON,  Assistant 
Surgeon,  U.  S.  A. 

Private  Michael  Luther,  Co.  C,  Engineer  Battalion,  aged  26  years,  was  wounded  while  tres- 
passing upon  private  grounds,  in  the  village  of  Whitestone,  Long  Island,  ou  February  3,  18G7,  by 
a  charge  of  bird-shot,  which  penetrated  the  right  lung.  He  was  admitted  on  the  following  day  to 
the  post  hospital  at  Willet's  Point,  and  treated  on  the  expectant  plan.  He  died  ou  February  6, 
1867. 

LXXVIII. — Note  of  a  Case  of  Gunshot  Wound  of  the  Lung.    By  Brevet  Major  W.  M.  NOTSON, 
Assistant  Surgeon,  U.  S.  A. 

Private  William  Leach,  Co.  H,  4th  United  States  Cavalry,  aged  20  years,  was  admitted  to  the 
post  hospital  at  Fort  Concho,  Texas,  on  February  4, 1868,  with  an  accidental  gunshot  wound.  The 
missile  perforated  the  lobes  of  the  left  lung.  He  died  on  February  6,  1868,  from  internal  haemor- 
rhage. 

LXXIX. — Note  of  a  Fatal  Gunshot  Perforation  of  the  Right  Lung.    By  DONALD  JACKSON,  Acting 
Assistant  Surgeon. 

Private  Narcisse  Pochet,  Co.  G,  9th  United  States  Cavalry,  aged  24  years,  received  on  March 
21,  1870,  in  a  brawl,  a  wound  through  the  right  lung  by  a  carbine-ball,  which  entered  below  the 
clavicle  through  the  second  rib,  and  emerged  two  inches  from  the  median  line.  Admitted  to  post 
hospital  at  Fort  Clark,  Texas,  at  5  P.  M.  He  survived  two  hours. 

LXXX. — Memorandum  of  a  Gunshot  Perforation  of  the  Chest.    By  D.  WEISEL,  Assistant  Surgeon, 
U.  S.  A. 

At  Fort  Davis,  Texas,  Private  David  Boyd,  Co.  K,  'Jth  United  States  Cavalry,  was  accidentally 
shot  and  instantly  killed  by  a  conoidal  ball,  ou  March  16,  1870.  The  missile  entered  to  the  left  of 
the  sternum  between  the  fourth  aud  fifth  ribs,  and,  passing  through  the  body,  issued  near  the 
inferior  angle  of  the  right  scapula. 

LXXXI. — Report  of  a  Case  of  a  Pistol  Shot  Wound  of  the  Lung  Through  the  Scapula.    By  SAMUEL 
SANTOINE,  Acting  Assistant  Surgeon. 

Private  Charles  Lehmann,  Co.  B,  35th  United  States  Infantry,  aged  21  years,  was  shot  in  the 
street  on  the  night  of  January  2, 1868.  A  pistol-ball  entered  immediately  below  the  spine  of  the 
scapula,  one  inch  from  its  outer  end  obliquely  toward  the  sternum,  and  remained  in  the  thoracic  cavity. 


30  BBPOBT  OF  SURGICAL  CASES  IN  THE  AEMY. 

lie  was  admitted  to  the  post  hosital  at  Indianola,  Texas,  about  one  hour  after  the  reception  of  the 
injury,  in  a  state  of  intoxication,  walking  supported  by  two  men.  Profuse  haemorrhage  issued 
from  the  wound,  which  rendered  it  unsafe  to  counteract  the  effects  of  intoxication.  Therefore,  no 
attempt  was  made  to  bring  on  reaction.  Cold  water  was  applied  to  the  wound  and  head.  He  did 
not  recover  consciousness  until  five  hours  afterward,  when  he  complained  of  excruciating  pain  in 
the  left  side.  Respiration  was  laborious,  and  there  was  complete  matity  on  percussion,  and  heavy 
crepitating  sound  on  auscultation.  He  expectorated  about  two  ounces  of  coagulated  blood.  A 
powder  consisting  of  a  fourth  of  a  grain  of  acetate  of  lead  and  an  eighth  of  a  grain  of  sulphate 
of  morphia  was  given  every  hour,  for  four  hours,  and  then  discontinued.  The  pulse  was  very  weak 
and  remained  so  until  death,  at  six  o'clock  of  the  evening  of  January  3, 18G8. 

LXXX1I. — Memorandum  of  a  Fatal  Gunshot  Perforation  of  the  Bight  Lung.    By  JULES  LE  CARPEN- 
TIER,  Acting  Assistant  Surgeon. 

At  Fort  Bayard,  New  Mexico,  Farrier  John  A.  Payne,  Co.  E,  3d  United  States  Cavalry,  aged  21 
years,  was  killed,  in  a  riot,  by  a  patrol,  on  the  night  of  December  24, 1868,  at  Central  City,  New  Mexico. 
He  received  a  gunshot  wound  of  the  right  chest.  The  missile  entered  the  back,  and  passed  through 
the  right  lung. 

LXXXIII. — Memorandum  of  a  Fatal  Case  of  Gunshot  Wound  of  the  Right  Lung.  By  E.  COWLES,  Assist- 
ant Surgeon,  U.  S,  A. 

Second  Lieutenant  W.  S.  Alexander,  Co.  A,  8th  United  States  Infantry,  aged  20  years,  was 
wounded  at  Fort  Macou,  North  Carolina,  at  midnight,  on  March  28,  1869,  by  a  conoidal  ball,  which 
penetrated  the  neck  and  chest,  perforating  the  upper  lobe  of  the  right  lung,  comminuting  the  scap- 
ula and  rib,  and  lacerating  the  brachial  flexus  and  veins  at  the  base  of  the  neck.  He  was  admitted 
to  the  post  hospital  at  Fort  Macon,  North  Carolina,  on  March  29,  1869.  Compresses  and  styptics 
were  used.  There  was  no  reaction  after  injury.  He  died  at  1  o'clock  A.  M.,  on  March  30,  1869. 
Death  was  apparently  hastened  by  venous  haemorrhage  within  the  cavity  of  the  thorax. 

LXXXIV. — Memorandum  of  a  Fatal  Gunshot  Wound  of  the  Right  Lung.    By  F.  ME  ACHAM,  Assistant 
Surgeon,  U.  S.  A. 

Private  Jonathan  J.  Johnson,  Co.  E,  4th  United  States  Infantry,  was  shot  through  the  right 
lung  on  December  2,  1869,  by  Indians,  when  about  forty  miles  from  Foil  Laramie,  Wyoming  Ter- 
ritory. He  was  admitted  into  the  post  hospital  at  the  fort,  in  a  moribund  condition,  and  died  in 
about  one  hour  after  his  arrival. 

LXXXV.— Memorandum  of  a  Fatal  Case  of  Gunshot  Wound  of  the  Right  Lung.    By  J.  E.  SEMPLE, 
Assistant  Surgeon,  U.  S.  A. 

Private  John  Halbert,  Co.  L,  2d  United  States  Artillery,  aged  27  years,  was  accidentally  killed 
on  September  13,  1868,  by  fine  shot,  which  entered  the  sternum  between  the  third  and  fourth  ribs, 
and  passed  into  the  right  lung. 

LXXXVI. — Note  of  a  Case  of  Suicide.    By  GEORGE  A.  BENJAMIN,  M.  D.,  Acting  Assistant  Surgeon. 

At  the  island  of  San  Juan,  California,  November  30,  1870,  First  Sergeant  Louis  Miller,  Co.  F, 
23d  United  States  Infantry,  shot  himself  at  eight  o'clock  in  the  morning.  At  this  hour  I  was  called 
to  see  him,  and  found  him  lying  on  his  bed,  with  a  gunshot  wound  one  and  a  quarter  inches  below 
and  to  the  left  of  the  left  nipple,  passing  through  the  lung  on  that  side,  ranging  upward  and  inward, 
passing  out  at  a  point  about  midway  of  the  length  of  the  internal  edge  of  the  scapula  of  the  same  side. 
This  wound  was  inflicted  by  himself  with  a  design  of  destroying  life,  as  was  shown  by  a  written 


GUNSHOT  WOUNDS  OF  THE  CHEST.  31 

communication  left  behind,  and  addressed  to  the  commanding  officer,  and  also  by  the  position  of 
the  gun,  lying  on  the  floor,  with  a  string  attached  to  the  trigger,  suggesting  the  intention  of 
inflicting  the  wound.  The  patient  died  at  half  past  eight  o'clock  in  the  evening.  No  post-mortem 
examination  was  made  in  the  case,  as  it  was  considered  unnecessary. 

LXXXVII. — Remarks  on  a  Case  of  Gunshot  Wound  of  the  Chest.    By  J.  C.  WATKINS,  Acting 
Assistant  Surgeon. 

Sergeant  John  Kelly,  Co.  A,  8th  United  States  Cavalry,  aged  29  years,  was  admitted  on 
April  30,  1868,  to  the  hospital  at  Camp  Winfleld  Scott,  Nevada,  with  a  gunshot  wound  of  the 
chest.  The  bullet  entered  the  left  lung,  just  below  the  first  rib,  injuring  it,  and  deflected  a  little 
downward,  lodged  under  the  skiu  in  the  dorsal  region.  The  left  arm  was  paralyzed,  and  pulsa- 
tion in  the  radial  artery  had  ceased;  but  the  latter  gradually  returned,  and  was  nearly  normal  agaiu 
on  May  4th.  A  flesh-wound  iu  the  outer  part  of  the  right  thigh  was  suppurating,  but  presented  a 
healthy  appearance.  On  June  1st,  the  patient  had  repeated  cold  and  hot  sweats,  with  paroxysms  of 
neuralgic  pains  in  the  left  arm,  but  he  improved  again  until  June  8th,  when  a  commencing  aneurism 
of  the  left  subclavian,  or  a  branch  of  the  superior  thoracic  artery  was  observed.  The  wound  in  the 
back  commenced  to  bleed.  On  June  12th,  the  patient  was  doing  well,  and  the  wound  was  healing 
rapidly.  On  June  21st,  the  aneurism,  which  now  appeared  to  be  a  false  one,  was  increasing. 
Slight  pressure  was  applied,  with  iodide  of  potash  ointment.  On  June  26th,  the  aueurismal  tumor  was 
still  increasing.  Opium  was  given  in  large  doses,  and  chloroform  also  was  administered.  A  care- 
ful examination  of  the  tumor  was  made,  but  the  patient  was  considered  too  weak  for  an  operation. 
On  July  30th,  the  condition  of  the  patient  was  unchanged ;  the  tumor  had  displaced  the  clavicle. 
On  July  16th,  the  patient  had  not  been  allowed  an  operation  from  the  bowels  for  more  than  two 
weeks,  attempting  Valsalva's  method  of  cure.  The  patient  appears  to  gain  a  little  strength.  July 
23d,  severe  pains  iu  arm  and  shoulder;  the  tumor  is  increasing  in  size,  and  appears  to  be  pointing 
at  the  old  wound.  August  13th,  during  a  severe  neuralgic  attack,  the  aneurism  bursted,  and 
profuse  bleeding  ensued.  Bleeding  recurred  at  intervals,  until  August  27th,  when  it  ceased.  The 
patient  improved  until  September  17th,  when  he  became  slightly  delirious.  Bleeding  occurred 
again,  but  the  haemorrhage  was  checked  by  plugging  the  opening  with  dry  lint.  Haemorrhages 
recurred  September  18th,  19th,  and  28th,  and  death  occurred  at  5  P.  M.,  September  28,  1868.  At 
the  autopsy,  the  left  lung  was  found  partially  collapsed ;  one-half  ounce  of  fluid  iu  the  pleural  sac  ; 
the  heart,  right  auricle,  and  ventricle  walls  were  considerably  thickened ;  the  valves,  liver,  and 
kidney  were  normal;  the  spleen  slaty.  The  bellies  of  the  pectoralis  major  and  minor  were 
infiltrated  with  blood,  and  entirely  disorganized.  The  axilla  was  so  much  disorganized  that  it 
was  impossible  to  discover  which  had  been  the  bleeding  artery.  The  ball  had  not  penetrated  the 
lung,  but  had  passed  above  and  back  of  the  pleura.  At  the  elbow,  the  olecranon  and  the  internal 
condyle  of  the  humerus  were  necrosed.  The  wound  of  the  right  thigh  had  entirely  healed. 

LXXXVIII. — Minute  of  a  Case  of  Perforating  Gunshot  Wound  of  the  Thorax.    By  C.  MACFARLINE, 
M.  D.,  Acting  Assistant  Surgeon. 

At  Fort  Ontario,  New  York,  June  17,  1869,  Private  Joseph  Marks,  Co.  A,  1st  United  States 
Artillery,  was  shot  by  a  soldier  of  the  same  company.  The  ball,  a  conical  one,  entered  the  right 
side  at  a  level  of  the  third  rib,  an  inch  and  a  half  from  the  median  line,  and  made  exit  through  the 
spine  of  the  scapula,  near  its  central  portion.  Sulphate  of  morphia,  iu  one-fourth  grain  doses,  was 
given  at  intervals  of  one-half  hour  until  sleep  ensued ;  also  extract  of  ergot  with  digitalis  aud  tannic 
acid  was  given  in  a  mixture,  aud  lemonade  was  allowed.  At  indications  of  sinking,  whiskey  diluted 
with  water  and  beef-essence  were  given  frequently.  He  died  fifteen  hours  after  reception  of  the 
injury,  from  internal  hemorrhage. 


32  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

Five  instances  are  reported  of  gunshot  wounds  of  both  lungs.     They  were  fatal,  and, 
indeed,  I  know  of  no  authenticated  instance  of  recovery  from  such  a  lesion. 

LXXXIX.— Memorandum  of  a  Fatal  Perforation  of  both  Lungs  by  a  Muslcet-Ball.    By  J.  R.  GIBSON, 
Assistant  Surgeon,  U.  S.  A. 

On  his  monthly  report  from  Fort  Stanton,  August,  1869,  Dr.  Gibson  enters  the  following  state- 
ment of  Acting  Assistant  Surgeon  Alward  White,  stationed  at  Fort  Bliss,  Texas :  "  Charles  E. 
Thompson,  Co.  F,  3d  United  States  Cavalry.  The  ball  presumed  to  have  been  discharged  from  a 
carbine,  entered  his  chest  in  front,  in  the  right  side,  in  the  second  intercostal  space,  passed  diagonally 
through  the  upper  lobe  of  the  right  lung,  severing  the  great  vessels  at  the  base  of  the  heart,  and 
thence  through  the  posterior  portion  of  the  middle  lobe  of  the  left  lung,  and  passed  out  at  the 
inferior  angle  of  the  scapula."  The  date  of  the  injury  is  not  recorded.  It  is  found  that  the  patient 
died  August  7, 1869. 

XC. — Extract  from  Remarks  on  Monthly  Report  of  Sick  and  Wounded  from  Fort  Stevenson,  Dakota 
Territory.    By  C.  C.  GRAY,  Surgeon,  U.  S.  A. 

In  October,  1867,  Private  Knowles,  Co.  B,  31st  United  States  Infantry,  was  accidentally  shot 
by  a  comrade.  The  bullet,  from  a  breech-loading  musket,  fractured  the  left  humerns,  and  traversed 
the  apices  of  both  lungs.  This  wounded  man  lived  about  four  hours  after  the  reception  of  the  injury. 

XCI. — Memorandum  of  a  Case  of  Gunshot  Wound,  of  both  Lungs.    By  S.  M.  HORTON,  Assistant 
Surgeon,  U.  S.  A. 

Corporal  Peter  Donnelly,  Co.  H,  27th  United  States  Infantry,  aged  26  years,  received  on 
November  3,  1867,  in  an  attack  by  Indians,  a  gunshot  penetrating  wound  of  the  chest,  through 
both  lungs.  He  was  admitted  to  the  post  hospital  at  Fort  Philip  Kearney,  Dakota  Territory,  on 
November  4,  1867.  Roller-bandages  and  simple  dressings  were  applied.  The  patient  died  on 
November  4,  1867. 

XCII. — Note  of  a  Case  of  Suicidal  Gunshot  Wound  of  both  Lungs.  By  CALVIN  DE  WITT,  Assistant 
Surgeon,  U.  S.  A. 

Sergeant  Jules  Gueree,  Co.  D,  Engineer  Battalion,  aged  30  years,  was  admitted  to  hospital  at 
Willett's  Point  with  a  gunshot  wound  inflicted  by  himself.  The  missile  entered  the  left  side  of  the 
thorax,  fracturing  the  third  rib  near  its  articulation  with  the  sternum,  passed  obliquely  near  the 
edge  of  the  left  lung,  and  traversed  the  vipper  lobe  of  the  right  lung,  and  emerged  midway  between 
the  spinal  column  and  the  lower  angle  of  the  scapula.  He  died  shortly  after  admission,  July  23, 
1867. 

XCIII. — Memorandum  of  a  Case   of  Gunshot  Perforation   of  both  Lungs  and  Aorta.    By  W.  I). 
WOLVERTON,  Assistant  Surgeon,  U.  S.  A. 

Private  Peter  McCabe,  Co.  B,  1st  United  States  Infantry,  aged  29  years,  was  accidently  shot 
by  a  guard  on  June  18,  1868.  The  missile  passed  through  the  lungs  and  aorta.  The  man  died 
instantly. 

XCIV.— Memorandum  of  a  Case  of  Suicide.    By  D.  C.  PETERS,  Surgeon,  U.  S.  A. 

Private  James  Finally,  Troop  D,  3d  United  States  Cavalry,  aged  27  years,  shot  himself  on  May 
19,  1870,  while  on  guard  at  Fort  Union,  New  Mexico.  The  ball  entered  under  the  last  true  rib,  on 
the  right  side,  passed  upward,  wounding  the  lung  and  pleura,  came  out  one  inch  above  right  nipple, 
and  lodged  in  the  right  cheek.  It  also  wounded  slightly  the  right  hand  and  wrist.  He  was  admit- 
ted to  post  hospital,  where  the  missile  was  excised  from  the  right  cheek.  Inflammation  of  pleura 
and  lungs,  with  internal  hemorrhage,  followed,  and  death  occurred  on  May  21, 3870. 


GUNSHOT  WOUNDS  OF  THE  CHEST.  33 

Gunshot  Wounds  of  the  Heart. — Fourteen  instances  of  this  form  of  injury  were 
reported.  Death  followed  very  promptly  in  almost  every  case,  though,  in  one  instance  of 
a  pistol-ball  wound  of  the  right  auricle,  the  patient  survived  fifty  hours.  Eight  were 
examples  of  wounds  from  musket,  and  five  from  pistol  balls.  One  was  inflicted  by  an 
Indian,  two  by  sentinels,  one  accidentally,  two  suicidally,  and  the  eight  other  cases  were 
murders. 

XCV. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Heart.    By  CARLOS  CARVALLO,  Assistant 
Surgeon,  U.  S.  A. 

At  Jefferson,  Texas,  First  Sergeant  Daniel  Murphy,  Co.  I,  llth  United  States  Infantry,  aged 
25  years,  committed  suicide,  on  September  19,  1870,  by  shooting  himself  with  a  small  Derringer 
pistol,  the  ball  penetrating  the  left  lung  and  the  heart.  He  lived  twenty-seven  minutes  after  beiug 
shot. 

XCVI. — Report  of  a  Case  of  Gunshot  Wound  of  the  Lung  and  Heart.    By  A.  W.  WIGGIN,  Assistant 
Surgeon,  U.  S.  A. 

Philip  Curry,  a  citizen,  was  shot  in  a  drunken  row  at  Pond  Creek  Stage  Station,  Kansas,  on 
April  1,  1868.  Saw  him  at  midnight  and  found  a  penetrating  oullet  wound  of  the  right  side  of  the 
thorax;  there  was  no  wound  of  exit.  The  patient  was  taken  to  the  post  hospital  at  Fort  Wallace, 
Kansas,  a  distance  of  four  miles,  being  able  to  get  into  and  out  of  the  ambulance  without  assist- 
ance. He  seemed  quite  stroug  for  an  hour  or  two  after  admission.  After  a  while,  however,  he 
began  to  grow  anxious  and  suffered  much  pain.  He  was  unable  to  retain  nourishment,  and  required 
to  be  kept  in  a  sitting  posture.  He  was  'quieted  by  hypodermic  injections  of  a  solution  of  sulphate 
of  morphia,  the  only  thing  attempted  in  the  way  of  medication.  On  the  morning  of  April  2d,  the 
right  side  of  the  chest  was  evidently  filling  up  with  fluid.  The  heart  beat  irregularly  and  tumultu- 
ously.  Toward  evening  he  became  exhausted ;  sleep  profound,  and  respiratory  efforts  only  five  or 
six  per  miuute;  pulse  feeble  and  fluttering.  He  died  half  an  hour  after  midnight  April  3,  1868, 
twenty-six  hours  after  reception  of  injury.  An  autopsy,  made  fifteen  hours  after  death,  revealed  the 
course  of  the  ball.  It  entered  three  inches  inside  and  one  inch  above  right  nipple,  passed  between 
the  cartilages  of  third  and  fourth  rib  close  to  the  sternum,  through  anterior  margin  of  the  lower 
lobe  of  right  lung  into  the  pericardium,  through  the  right  auricle,  and  entered  again  the  right  pleura! 
cavity,  passing  through  posterior  margin  of  lower  lobe  of  right  lung.  A  coniccil  ball — size  of 
Colt's  Navy  revolver — was  found  in  the  right  pleural  cavity.  The  left  lung  and  cavity  were  perfectly 
normal;  the  right  lung  was  engorged  and  somewhat  compressed  by  coagulated  blood  in  the 
pleural  cavity.  Pericardium  much  distended  and  containing  six  or  eight  ouuces  of  partially 
coagulated  blood.  There  was  a  fibrinous  clot  in  the  left  ventricle. 

XCVII. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Heart,  probably  by  Suicide.    By  F. 
MEACHAM,  Assistant  Surgeon,  U.  S.  A. 

Private  Rollin  Cofcart,  Co.  G,  4th  United  States  Infantry,  left  Fort  Laramie  April  6,  1870,  with- 
out leave.  His  body  was  found  April  7th,  about  twenty  miles  southeast  from  the  post,  under  circum- 
stances that  led  to  the  belief  that  he  committed  suicide.  The  autopsy  was  made  April  7,  1870,  at  5 
P.  M.,  time  after  death  unknown — probably  twenty-four  hours ;  rigor  mortis  strongly  marked ;  a  little 
blood  found  on  face,  about  the  mouth  and  nose.  The  blouse  was  whole,  but  a  hole  was  found  in  both 
shirts,  on  the  left  side  of  the  body.  A  wound  was  found  about  two  inches  below  the  left  nipple, 
passing  backward  and  upward,  and  slightly  inward.  This  wound  was  surrounded  by  a  margin 
of  burned  powder  about  an  inch  wide,  below  the  wound,  from  two  to  four  inches  wide  above  the 
wound,  and  to  its  left.  On  the  back  was  found  a  wound  situated  about  two  inches  to  the  left  of 
the  spine,  and  on  a  plane  with  the  spine  of  the  sixth  dorsal  vertebra.  No  powder  was  found  about 
this  wound.  On  opening  the  thorax  it  was  found  that  the  ball  had  passed  between  the  fifth  and 
sixth  ribs,  outside  and  near  the  junction  of  the  ribs  with  the  cartilage,  then  entered  the  pericar- 
5 


34  EEPOET  OF  SURGICAL  CASES  IN  THE  AEMY. 

dium  at  its  lower  end,  and  on  its  left  side,  striking  the  heart  at  its  apex,  carrying  away  a  portion 
of  the  left  ventricle,  opening  the  cavity— the  wound  in  the  heart  being  two  inches  long,  and  one 
and  one-fourth  inches  wide  at  its  widest  part.  The  part  of  the  left  ventricle  carried  away  was  the 
apex— lower  and  back  part.  The  ball  then  passed  to  the  left  of  the  spine,  fracturing  the  seventh 
rib  near  its  junction  with  the  spine.  This  wound  must  have  caused  almost  instant  death,  and  the 
muzzle  of  the  gun,  when  discharged,  must  have  been  in  close  proximity  to  the  wound.  The  wound 
of  exit  was  on  a  plane  seven  inches  above  the  wound  of  entrance. 

It  is  to  be  regretted  that  in  several  other  cases  of  gunshot  wounds  of  the  heart  that 
came  under  treatment  the  observers  have  failed  to  report  the  duration  of  life  after  the 
reception  of  the  injury,  or  any  particulars  of  the  symptoms. 

XCVIII.— Memorandum  of  a  Gunshot  Wound  of  the  Heart.    By  C.  C.  BYRNE,  Surgeon,  U.  S.  A. 

First  Sergeant  Frederick  Kellner,  Co.  D,  19th  United  States  Infantry,  was  wounded  on 
November  9,  18G9,  by  a  conoidal  pistol-ball,  which  entered  his  back,  between  the  fifth  and  sixth 
ribs,  on  the  left  side,  about  two  inches  from  spinal  column,  and  passing  through  the  right  auricle 
of  heart,  lodged  under  the  skin  over  the  lower  portion  of  sternum.  He  lived  long  enough  to  be 
admitted  to  the  post  hospital  at  Little  Eock,  Arkansas,  and  died  the  same  day. 

XCIX.— Note  of  a  Case  of  Gunshot  Wound  of  the  Heart.    By  J.   A.  TONNEE,  Acting  Assistant 
Surgeon. 

Private  John  Gray,  Co.  D,  26th  United  States  Infantry,  aged  28  years,  was  shot  through  the 
heart,  by  a  pistol-ball,  on  February  9,  1868.  He  was  admitted  into  the  hospital  at  Brownsville, 
Texas,  and  survived  but  a  short  time. 

C. — Mention  of  a  Case  of  Gunshot  Wound  of  the  Heart.    By  H.  E.  TILTON,  Assistant  Surgeon,  U.  S.  A. 

Private  John  B.  Patterson,  Co.  B,  7th  United  States  Cavalry,  while  on  duty  as  sentinel,  at  Fort 
Lyon,  Colorado  Territory,  April  17, 1870,  was  wounded  by  the  accidental  discharge  of  his  carbine, 
the  ball  having  entered  the  right  groin,  and  escaped  through  the  neck  on  the  left  side,  killing  him 
instantly.  The  ball  passed  through  the  bowels,  stomach,  left  lobe  of  the  liver,  right  ventricle  of 
heart,  upper  lobe  of  the  left  lung,  and  carried  away  a  portion  of  the  left  clavicle.  He  breathed 
three  times,  and  then  gasped  and  expired.  No  cry  of  pain  escaped  his  lips. 

CL— History  of  a  Fatal  Gunshot  Perforation  of  the  Thorax.     By  JOHN  B.  WHITE,  Acting  Assistant 
Surgeon. 

Private  Louis  T ,  Co.  K,  40th  United  States  Infantry,  was  mortally  wounded,  Decem- 
ber 15,  1868,  and  admitted  to  post  hospital  at  Ealeigh,  North  Carolina,  in  articulo  mortis,  and  died 

immediately  afterward.  An  autopsy  was  made  one  hour  after  death. 
The  conical  ball,  from  a  Springfield  breech-loader  in  the  hands  of  a 
fellow-soldier,  had  first  passed  through  the  stock  of  the  gun  of  the 
deceased ;  then  entering  the  right  thoracic  cavity  between  the 
second  and  third  ribs,  traversed  the  chest  diagonally  beneath  the 
ascending  aorta,  divided  the  descending  vena  cava,  perforated  the 
superior  lobe  of  the  left  lung,  and,  emerging  from  the  chest  between 
the  third  and  fourth  ribs,  entered  the  cavity  of  the  axilla,  thence 
into  the  left  arm  in  its  upper  third,  extensively  shattering  the  left 
htunerus.  There  was  scarcely  any  haemorrhage  externally.  The 
no.7He.rt.  great  vesseiTTTportion  left  tboracic  cavity  contained  a  large  amount  of  bloody  serum  with 
of  inns  perforated  by  a  musket  bail,  jelly-like  clots.  The  source  of  internal  haemorrhage  was  from  the 

division  of  the  descending  vena  cava.    The  missile  having  traversed 


GUNSHOT  WOUNDS  OF  THF  CHEST.  35 

a  space  of  some  thirteen  inches  from  right  to  left,  from  wound  of  entrance  to  wound  of  exit,  was 
found  in  a  shattered  condition  about  thirteen  feet  from  the  injured  man.  The  pathological  speci- 
mens, consisting  of  the  heart,  perforated  lung,  splintered  humerus  and  ball,  were  forwarded  to  the 
Army  Medical  Museum. 

OIL  —  Note  of  a  Case  of  Gunshot  Wound  of  the  Aorta.    By  W.  J.  PIPER,  M.  D.,  Acting  Assistant 
Surgeon. 

At  Baton  Kongo,  Louisiana,  December  20,  1867,  Private  Herman  Summers,  Co.  B,  20th  United 
States  Infantry,  received  an  accidental  pistol  shot  wound,  the  ball  entering  the  arch  of  the  aorta. 
He  was  admitted  to  post  hospital  immediately  after  the  reception  of  the  injury  and  died  on  the 
same  day. 

CHI.  —  Extract  from  Remarks  on  Monthly  Report  of  Sick  and  Wounded  from  Fort  McKavett,  Texas, 
By  BEDFORD  SHARPE,  Acting  Assistant  Surgeon. 

On  February  2,  1870,  Corporal  Albert  Marshall,  Co.  F,  9th  United  States  Cavalry,  was  murdered 
by  desperadoes,  five  miles  below  Menardville,  thirty-five  miles  below  this  post,  while  guarding  a 
prisoner.  His  remains  were  brought  to  the  post  for  interment  on  the  afternoon  of  the  3d,  when  a 
post-mortem  examination  was  held  at  the  post  hospital.  It  was  conducted  by  Acting  Assistant 
Surgeon  A.  De  Laffre.  The  following  are  the  notes  in  the  case  :  *  *  The  ball,  supposed  to  have 
been  from  a  Winchester  rifle,  entered  the  thoracic  cavity  on  right  side,  about  one  inch  above  the 
right  nipple,  passed  through  the  fifth  rib  at  its  articulation  with  the  sternum,  passing  through 
right  ventricle  of  the  heart  and  through  the  left  fifth  rib,  and  made  an  exit  at  left  axilla,  reentered 
the  left  arm,  fractured  the  humerus  two  inches  below  the  neck,  and  came  out  on  the  other  side- 
uear  the  insertion  of  the  deltoid. 

CIV.  —  Memorandum  of  a  Gunshot   Wound  of  the  Chest.    By  DONALD  JACKSON,  M.  D.,  Acting 
Assistant  Surgeon. 

At  Fort  Clark,  Tessas,  on  August  1,  1869,  Private  James  Matthews,  Co.  G,  9th  United  States 
Cavalry,  aged  20  years,  was  shot  by  a  sentinel,  either  intentionally  or  through  gross  carelessness. 
The  bullet  entered  between  the  third  and  fourth  ribs,  above  and  a  little  external  to  the  left  nipple, 
passing  obliquely  through  the  thorax,  and  lodging  beneath  the  skin  over  the  right  scapula.  Death 
was  instantaneous.  The  heart  or  great  vessels  were  doubtless  wounded.  No  autopsy  is  recorded  . 


.  —  Memorandum  of  a  Gunsliot  Wound  of  the  Heart.  By  WASHINGTON  MATTHEWS,  Acting  Assist- 
ant Surgeon. 

Private  John  T.  Vane,  Co.  I,  22d  United  States  Infantry,  was  shot  by  one  of  a  baud  of  hostile 
Sioux,  about  four  miles  from  Fort  Eice,  Dakota  Territory,  while  on  duty  with  a  party  of  wood- 
cutters, and  at  a  short  distance  from  the  rest.  No  others  were  wounded.  His  death  was  instanta- 
neous. An  autopsy  revealed  that  the  ball  had  entered  the  fourth  intercostal  space  near  the  left 
nipple,  and  pierced  both  ventricles  of  the  heart,  about  midway  between  base  and  apex.  It  did  not 
eft'ect  an  exit  from  the  body. 

CVI.  _  Minute  of  a  Case  of  Gunshot  Wound  of  the  Heart.    By  Dr.  J.  B.  PURCELL,  Acting  Assistant 
Surgeon. 

In  August,  1867,  James  Brown,  Co.  D,  8th  United  States  Infantry,  quartermaster's  sergeant 
of  the  post  at  Wilmington,  North  Carolina,  was  confined  for  stealing  from  the  Government,  and  made 
his  escape  from  prison.  He  was  overtaken  by  a  patrol,  and,  not  surrendering  when  commanded 
to  do  so  several  times,  was  fired  upon  with  fatal  effect.  The  ball  entered  the  right  side  between  the 
fifth  and  sixth  ribs,  traversed  the  body  through  both  lungs  and  the  heart,  passed  out  at  the  left  side, 
entered  at  the  bend  of  the  left  elbow,  destroying  the  joint,  and  lodged  in  the  cellular  tissue  near 
the  external  angle,  spent. 


36  EEPOET  OP  SUKG1CAL  CASES  IN  THE  AKMY. 

CVII. — Minutes  of  an  Autopsy  in  a  Case  oj  Gunslwt  Wound  of  the  Heart.  By  J.  H.  T.  KING,  Assistant 
Surgeon,  U.  S.  A. 

On  the  night  of  April  30,  1869,  John  Ahlfeldt,  first  sergeant  of  Co.  D,  31st  United  States 
Infantry,  was  shot  by  one  of  the  men  belonging  to  his  company,  and  died  instantly.  Seetio 
cadaveris,  fourteen  hours,  post-mortem.  Rigor  mortis  well  marked.  Externally  two  gunshot 
wounds  were  discovered:  one,  the  largest,  anteriorly,  at  the  lower  border  of  the  cartilages  of  the 
ribs  on  the  left  side ;  one  posteriorly  immediately  below  the  inferior  angle  of  the  right  scapula. 
On  opening  the  chest  a  large  quantity  of  blood  was  found  in  the  cavity  of  the  right  pleura; 
tissue  of  lungs  normal ;  inferior  lobe  of  right  lung  wounded.  The  missile  had  traversed  its 
superior  and  internal  portions  horizontally  and  toward  the  left  side,  thus  entered  the  pericardium, 
and  completely  lacerated  right  side  of  the  heart  near  the  right  auriculo- ventricular  valves,  exposing 
the  internal  surface  of  both  right  auricle  and  right  ventricle,  making  its  exit  at  the  wound  on  the 
anterior  surface  of  body  before  described. 

CVIII. — Report  of  an  Autopsy  in  a  Case  of  Gunshot  Wound  of  the  Heart.  By  F.  MEACHAM,  Assistant 
Surgeon,  U.  S.  A. 

On  January  29,  1869,  at  Camp  Douglas,  Utah  Territory,  Hospital  Steward  Lucius  O'Brien, 
United  States  Army,  was  killed  in  the  evening  while  returning  from  the  city  to  camp.  The  autopsy 
was  made  twelve  hours  after  death.  Rigor  mortis  well  marked.  The  wound  was  found  on  a  line 
midway  between  the  left  nipple  and  the  sternal  end  of  the  right  clavicle  near  the  left  border  of  the 
sternum.  On  opening  the  thorax,  it  was  found  that  a  pistol-ball  had  passed  through  the  cartilage 
of  the  third  rib,  near  its  junction  with  the  sternum ;  thence  through  the  right  ventricle  of  the 
heart,  near  the  origin  of  the  left  pulmonary  artery,  passing  through  one  of  the  semilunar  valves ; 
thence  into  the  left  auricle  of  the  heart  through  the  superior  lobe  of  the  left  lung,  and  lodged 
between  and  behind  the  posterior  ends  of  the  ninth  and  tenth  ribs,  from  which  position  the  ball 
was  removed.  The  course  of  the  ball  was  in  a  downward  direction — that  is,  the  point  of  lodgement 
was  on  a  lower  plane  than  the  point  of  entrance.  This  non-commissioned  officer  was  undoubtedly 
murdered. 


Gunshot  Wounds  of  the  Chest  involving  the  Spine. — Eight  fatal  cases  were  reported 
.of  gunshot  chest  wounds  with  injury  of  the  vertebral  column. 

C1X. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Spine  and  Chest.    By  D.  L.  MAGRUDER, 
Surgeon,  U.  S.  A. 

Brevet  Lieutenant  Colonel  David  H.  Buel,  Ordnance  Corps,  was  assassinated  at  the  arsenal, 
near  this  post  (Fort  Leavenworth),  on  the  night  of  the  22d  of  July,  between  the  hours  of  ten  and 
eleven  P.  M.  The  assassin  shot  him  from  behind,  with  a  rifled  breech-loading  musket,  just  after 
his  having  entered  the  yard  in  front  of  his  residence.  The  ball  entered  the  back,  about  two  inches 
to  the  left  of  the  median  line,  and  emerged  on  the  right  side  of  the  chest,  about  four  inches  to  the 
right  of  the  anterior  median  line.  The  spinal  column  was  severed  between  the  sixth  and  seventh 
ribs,  and  the  right  lung  was  torn  by  fragments  of  both  bone  and  ball.  Death  resulted  immediately. 

OX. — Note  of  a  Case  of  Gunshot  Wound  of  the  Spine  and  of  the  Aorta.    By  WILLIAM  J.  WILSON, 
Assistant  Surgeon,  U.  S.  A. 

In  March,  1870,  near  Fort  Brown,  Texas,  private  Thomas  Logan,  Co.  K,  10th  United  States 
Infantry,  is  reported  ashaving  died  from  a  gunshot  wound.  He  had  been  out  in  Brownsville,  without 
permission,  and  when  arrested  by  the  patrol  attempted  to  escape  from  their  custody.  He  was  fired 
at  and  instantly  killed,  the  ball  striking  him  in  the  spine,  about  the  sixth  dorsal  vertebra,  passing 
upward  and  outward,  through  the  arch  of  the  aorta,  and  emerging  about  three  inches  to  the  inner 
side  of  the  left  shoulder.  He  must  have  been  running  in  a  stooping  position  when  fired  at. 


GUNSHOT  WOUNDS  OF  THE  CHEST.  37 

CXI — Extract  from  Remarks  on  Monthly  Report  of  Sick  and  Wounded,  from  Fort  Dodge,  Kansas. 
By  W.  S.  TBEMAINE,  Assistant  Surgeon,  U.  S.  A. 

Private  Thomas  K ,  Co.  A,  3d  United  States  Infantry,  deserted  from  Port  Dodge,  Kansas. 

When  twenty-five  miles  from  the  post  he  met  a  train  with  citizens,  who  attempted  to  capture  him. 
To  prevent  this  he  shot  himself  with  a  revolver.  Was  brought  into  hospital  August  6,  1870. 
The  ball  entered  between  the  fifth  and  sixth  ribs,  one  and  a  half 
inches  below,  and  a  little  to  the  right  of  the  left  nipple,  and  was 
extracted,  together  with  small  fragments  of- bone,  from  the  sub-cuta- 
neous tissue  over  the  ninth  dorsal  vertebra,  through  a  small  incision. 
The  patient  was  paralyzed  below  the  middle.  He  died  four  days 
after  admission.  A  post-mortem  examination  was  made  after  ten 
hours.  The  track  of  the  ball  was  found  to  pass  from  a  point  between 
the  fifth  and  sixth  ribs,  an  inch  and  a  half  below  and  to  the  right 
side  of  the  left  nipple,  grazing  the  apex  of  the  heart,  passing 

through  the  lung,  and  fracturing  the  trans  verse  process  of  the  ninth  FlG  8._Eightlli  niuth,  tollth)  and  a 
dorsal  vertebra.  There  was  pericarditis  and  pneuinonitis.  There  portion  of  the  eleventh  dorsal  vertebra, 
were  decolorized  fibrinous  clots  in  the  heart  and  great  vessels;  ^'ith * bal1  anrt  tt^menta  of  bono  from 

the  ninth  vertebra.     Spec.  5738,  Sect.  I, 

extensive  effusion  in  cavity  of  pleura.    The  missile  was  a  conical    A.M.M. 
pistol-ball  of  the  calibre  .44. 

CXII. — Note  of  a  Case  of  Perforating  Wound  of  the  Left  Lung.    By  J.  H.  PATZKI,  Assistant  Sur- 
geon, U.  S.  A. 

Private  Michael  W.  Keiley,  Co.  D,  Cth  United  States  Cavalry,  aged  22  years,  was,  on  June  19, 
1870,  wounded  and  killed  by  a  conoidal  bullet,  which  penetrated  the  left  arm,  sixth  rib,  and  perforated 
the  left  lung  and  spine  between  the  sixth  and  seventh  dorsal  vertebras.  He  was  brought  into 
hospital  dead  June  19,  1870. 

CXIII. — Memoranda  of  a  Case  of  Gunshot  Penetrating  Wound  of  the  Lung.    By  E.  H.  WHITE,  Assist- 
ant Surgeon,  U.  S.  A. 

Private  Edward  Adams,  Co.  F,  15th  United  States  Infantry,  aged  25  years,  received  a  gunshot 
wound  while  resisting  the  guard  sent  to  arrest  him,  on  May  9,  1868.  The  missile  entered  the 
middle  of  the  left  arm,  producing  a  compound  comminuted  fracture  of  the  humerus,  and  entering 
the  chest  between  the  fifth  and  sixth  ribs  posteriorly,  traversing  the  inferior  lobe  of  the  left  lung, 
and  the  spinal  column  between  the  sixth  and  seventh  dorsal  vertebras,  breaking  up  the  spinal  cord, 
and  passing  through  the  inferior  lobe  of  the  right  lung,  lodged  itself  just  beneath  the  integument 
of  that  side.  He  was  admitted  to  the  post  hospital  at  Mobile,  on  May  9, 1868,  and  death  resulted 
on  the  same  day. 

CTLlV.-*-Note  of  a  Case  of  Perforating  Gunshot  Wound  of  the  Thorax.  By  ALFRED  DELANY,  Assist- 
ant Surgeon,  U.  S.  A. 

Near  Fort  Gibson,  Indian  Territory,  Private  David  Me  Williams,  Co.  H,  6th  United  States 
Infantry,  was  shot  by  a  drunken  Cherokee  Indian,  without  any  apparent  provocation,  on  the  evening 
of  the  llth  September,  1869.  He  was  admitted  to  the  hospital  soon  after,  in  a  profound  shock,  and 
died  twenty  hours  afterward,  only  partial  reaction  having  occurred,  notwithstanding  the  free  use 
of  stimuli,  warmth,  &o.  On  making  a  critical  examination,  post-mortem,  the  ball,  supposed  to 
have  been  from  a  Navy  revolver,  was  found  to  have  entered  the  body  posteriorly,  opposite  the  sixth 
dorsal  vertebra,  passed  upward,  and  to  the  right,  and  emerged  anteriorly,  between  the  first  and 
second  ribs,  one  and  a  half  inches  to  the  right  of  the  sternum,  fracturing  the  right  lamella  and  the 
body  of  the  sixth  vertebra,  the  sixth  rib,  opening  the  medullary  canal,  lacerating  the  cord,  and  per- 
foratiugthe  right  lung.  Fragments  of  the  vertebra  and  rib  were  driven  before  the  ball,  and  lodged 
in  the  lung  and  pectoral  muscles. 


38  REPORT  OP  SURGICAL  CASES  IN  THE  ARMY. 

CXV. — Note  of  a  case  of  gunshot  wound  of  the  Chest  and  Spine.    By  IRA  PERKY,  Assistant  Surgeon 
9th  United  States  Colored  Troops. 

Private  Gustavus  Chase,  Co.  I,  9th  United  States  Colored  Troops,  aged  24  years,  while 
walking  to  camp  from  Brownsville,  Texas,  was  wounded  by  a  couoidal  ball,  which  shattered  the 
spinous  processes  of  the  sixth  and  seventh  vertebrse,  laid  open  tbe  canal,  and  lacerated  the  cord. 
He  was  admitted  to  the  post  hospital  at  Brownsville,  Texas,  January  28,  I860.  On  admission  there 
was  an  expression  of  anxiety,  complete  paralysis  below  the  seventh  dorsal  vertebra,  and  great 
pain  in  epigastric  region.  The  treatment  consisted  of  the  removal  of  fragments  of  bone,  simple 
dressings,  morphia,  catheter,  and  injections.  On  February  1st  the  bowels  and  bladder  were  com- 
pletely torpid ;  great  tympanitis ;  skin  hot ;  pulse  140.  He  died  on  February  4,  1867. 

CXVI. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Chest.    By  HENRY  MCELDERRY,  Assistant 
Surgeon,  U.  S.  A. 

John  J.  Baron,  citizen,  aged  21  years,  was  wounded  on  March  14, 1869,  at  a  place  about  twenty 
miles  from  the  post.  The  missile,  a  conoidal  pistol  ball,  passed  through  the  spinal  cord.  It 
entered  in  the  sub-aspect  of  the  left  side  of  thorax,  two  and  a  half  inches  below  the  lower  border 
of  the  clavicle,  four  and  one-fourth  inches  from  the  median  line  of  the  sternum,  and  passing  inward, 
backward,  and  diagonally  across  the  trunk,  lodged  immediately  beneath  the  integument,  four 
inches  to  the  right  of  median  line  of  the  spine,  and  two  inches  above  the  inferior  angle  of  the  right 
scapula.  He  was  admitted  to  the  United  States  post  hospital,  at  Fort  Griffin,  Texas,  by  order  of 
the  post  commander,  on  March  14, 1869.  He  died  on  March  18,  1869. 


A  number  of  instances  of  gunshot  flesh-wounds  of  the  thoracic  parietes  were  reported, 
but  none  of  them  were  of  special  interest,  except  the  following  case,  in  which  the  wadding 
from  a  pistol  penetrated  the  pectoral  muscles  for  several  inches. 

Private  David  E.  Chase,  Co.  B,  40th  United  States  Infantry,  aged  23  years,  was  wounded 
January  15,  1869,  in  the  right  breast  by  hard  paper  wadding  fired  from  a  revolver,  the  wounded 
man  being  but  a  few  feet  from  the  muzzle  of  the  pistol  when  fired.  Wound  about  four  inches  in 
depth,  in  a  course  inward  and  downward.  He  went  to  the  post  hospital,  and  the  wound  was 
dressed.  He  recovered  rapidly,  and  was  sent  to  duty  January  31,  1869.  J.  T.  King,  Acting 
Assistant  Surgeon,  reported  the  case. 

Private  Henry  Allison,  Co.  F,  33d  United  States  Infantry,  aged  22  years,  Dahlouega,  Georgia, 
January  1,  1868.  Accidental  gunshot  wound  of  the  left  side.  Duty  January  8, 1868. 

Private  William  Christman,  Co.  D,  llth  United  States  Infantry,  aged  24  years,  Jefferson, 
Texas,  May  7,  1869.  Gunshot  wound  of  the  right  buttock,  caused  by  the  accidental  discharge 
of  a  rifle.  Duty,  May  10, 1869. 

Private  John  Donovan,  Co.  A,  18th  United  States  Infanty,  aged  35  years,  near  Peuo  Creek, 
December  6,  1866.  Gunshot  wound  of  back,  to  left  of  spine,  on  a  level  with  the  lowest  rib, 
received  in  an  action  with  Indians.  Duty,  December  31, 1866. 

Private  Henry  James,  Co.  F,  22d  United  States  Infantry,  aged  22  years,  near  Fort  Randall, 
Dakota  Territory,  June  27, 1868.  Gunshot  wound  of  the  skin  and  cellular  tissues,  over  the  lateral 
region  of  the  floating  ribs  of  the  left  side.  Duty,  July  27, 1868. 

Private  Alexander  Kennedy,  Co.  F,  7th  United  States  Cavalry,  aged  19  years,  wounded  Septem- 
ber 13,  1868,  by  Indians,  near  Fort  Dodge,  Kansas.  Gunshot  wound  of  left  side,  over  the  eighth 
rib.  The  missile  made  its  exit  near  the  umbilicus.  Recovered. 


GUNSHOT  WOUNDS  OF  THE  CHEST.  39 

Sergeant  J.  P.  Leonard,  Co.  13,  6th  United  States  Cavalry,  aged  29  years,  Livingston,  Texas, 
May  7,  1869.  Gunshot  wound  of  thoracic  parietes.  Duty,  June  1C,  1869. 

Private  William  B.  Gallagher,  Co.  D,  6th  United  States  Cavalry,  aged  24  years.  Gunshot 
flesh-wound  of  the  left  arm  and  thoracic  parietes  by  a  conoidal  ball,  received  in  an  action  with 
Indians  near  north  fork  of  Little  Wichita  River,  Texas,  July  12,  1870.  Carbolic-acid  dressings. 
Duty,  August,  1870. 

Corporal  Willis  Gibbons,  Co.  A,  117th  United  States  Colored  Troops,  aged  27  years.  Brazos 
Santiago,  Texas,  December  17,  1866.  Gunshot  wound  of  the  left  side,  over  the  sixth  rib,  by  a 
conoidal  ball.  Duty,  January  27, 1867. 

Private  William  Herron,  Co.  F,  38th  United  States  Infantry,  aged  21  years.  Fort  Quitman, 
Texas,  October  17, 1869.  Gunshot  wound  of  the  breast.  Duty,  November  30,  1869. 

Private  George  Lorenzo,  Co.  F,  6th  United  States  Cavalry,  aged  21  years.  Fort  Richardson 
Texas,  March  18,  1869.  Pistol-shot  wound  of  the  back.  Duty,  May  12,  1869. 

Sergeant  W.  W.  McCullough,  Co.  F,  1st  United  States  Cavalry,  aged  30  years.  Camp  Har- 
ney,  Oregon,  May  31, 1868.  Gunshot  wound  of  the  right  side  of  the  chest,  near  and  about  the  level 
of  the  axilla,  by  a  slug.  The  missile  passed  out  on  the  posterior  aspect  of  the  chest.  Duty,  June 
27, 1868. 

Private  Alexander  McLean,  Co.  F,  33d  United  States  Infantry,  aged  21  years.  Dahlouega, 
Georgia,  December  25,  1867.  Gunshot  wound  of  the  right  side.  Duty,  December  28,  1867. 

Private  Edward  Miller,  Co.  B,  10th  United  States  Colored  Cavalry,  aged  26  years.  Near  Fort 
Arbuckle,  Indian  Territory,  December  26,  1869.  Pistol-shot  wound  below  the  left  nipple.  Missile 
passed  round  the  chest,  and  over  the  spine,  whence  it  was  extracted,  January  8,  1870.  Duty,  Feb- 
ruary 14, 1871. 

Private  Alexander  Newell,  Co.  A.  114th  United  States  Colored  Troops,  aged  42  years.  Brazos 
Santiago,  Texas,  April  3,  1867.  Pistol-shot  wound  over  the  ensiform  appendix.  Missile  passed 
upward  and  lodged  one  inch  to  the  left  of  the  right  nipple.  Removal  of  ball  through  incision. 
Duty,  April  14,  1867. 

Private  Wiufleld  Rogers,  Co.  K,  16th  United  States  Infantry,  Corinth,  Mississippi,  December 
8,  1869.  A  pistol-ball  struck  the  sixth  rib,  at  the  point  of  a  line  drawn  directly  downward  from 
the  center  of  the  collar-bone,  penetrated  to  the  bone,  and  then  glanced  off,  making  a  flesh-wound 
merely.  Duty,  December  10,  1869. 

Private  Frederick  Weider,  Co.  A,  16th  United  States  Infantry,  aged  25  years.  Louisville, 
Kentucky,  March  11,  1871.  Gunshot  flesh-wound  of  the  chest,  by  a  small  pistol-ball.  Missile  was 
extracted  from  under  the  skin.  Recovered. 

Private  John  Webb,  Co.  B,  1st  California  Cavalry,  aged  38  years.  Fort  Sumner,  New  Mexico. 
July  2,  1866.  Gunshot  wound  of  the  right  chest  and  right  arm.  Duty,  September  2, 1866. 

Private  Samuel  Wilmare,  Co.  G,  116th  United  States  Colored  Troops,  aged  26  years,  Brazos 
Santiago,  Texas,  July  10,  1866.  Wound  of  trunk  between  the  ninth  and  tenth  ribs.  Missile  lodged 
in  the  intercostal  muscles,  but  was  extracted  from  the  wound.  Duty,  September  26,  186 

Sergeant  William  Winterbottom,  Co.  A,  6th  United  States  Cavalry,  aged  25  years.  Gunshot 
flesh-wound  of  the  left  side  by  a  conoidal  ball,  in  action  with  Indians  near  north  fork  of  Little 
Wichita  River,  Texas,  July  12,  1870.  Carbolic-acid  dressings.  Duty,  August  7,  1870. 


GUNSHOT  WOUNDS  OF  THE  ABDOMEN. — It  will  be  most  convenient  to  cite  first  those 
cases  in  which  the  thoracic  cavity  as  well  was  involved,  and  then,  in  their  order,  those  in 
which  the  symptoms  of  lesions  of  the  stomach,  liver,  spleen,  kidneys,  small  and  large 
intestines,  and  pelvic  viscera  were  most  prominent. 


40  EEPORT  OF  SURGICAL  CASES  IN  THE  AEMY. 

Gunshot  Wounds  of  the  Abdominal  and  Thoracic  Cavities. — There  are  instances  of 
recovery  from  such  injuries,  but  they  are  exceptional.  An  interesting  example  is  recorded 
in  the  surgical  report  in  Circular  6,  Surgeon  General's  Office,  1865,  page  24.  The  nine 
cases  here  recorded  were  fatal.  One  patient  survived  fifty  hours,  three  others  a  few  hours, 
and  the  rest  perished  in  a  few  minutes,  or  instantaneously. 

CXVII. Report  of  a  Gunshot  Wound  of  the  Thorax  and  Abdomen.  By  SAMUEL  S.  JESSOP,  Assistant 

Surgeon,  U.  S.  A. 

At  Chester,  South  Carolina,  Private  George  W.  Dorman,  Co.  K,  Gth  United  States  Infantry, 
was  shot,  November  24, 1867,  at  10  in  the  evening,  while  resisting  arrest,  having  previously  escaped 
from  the  sentinel.  The  missile  was  a  conical  ball ;  the  weapon  a  breech-loading  Springfield  rifle. 
The  autopsy  was  made  twelve  hours  after  death,  and  showed  the  following :  The  ball  entered  on  the 
right  side,  between  the  eighth  and  ninth  ribs,  three  and  three-quarter  inches  below  the  nipple,  and 
five  and  a  half  inches  posterior  to  a  line  drawn  from  the  nipple  to  the  anterior  superior  spinous  process 
of  ilium.  It  made  its  exit  on  the  left  side,  three  and  a  half  inches  below  the  nipple,  and  a  half  inch 
in  front  of  a  line  from  the  nipple  to  the  anterior  superior  spinous  process,  fracturing  in  its  course  the 
eighth  rib,  at  the  point  of  junction  with  its  cartilage.  The  liver  was  the  only  viscus  wounded  by  the 
shot,  which  passed  almost  transversely  through  it.  It  presented  a  very  singular  appearance.  From 
the  point  of  entrance  of  the  ball,  fissures  radiated  in  every  direction,  looking  as  if  the  liver  had  been 
exploded.  Internally,  it  was  completely  disorganized,  being  merely  a  pulpy  mass,  inclosed  by  thin 
fissured  walls.  When  uninjured,  it  was  normal;  there  was  no  degeneration  of  tissue.  The  hrem- 
orrhage  from  the  wound  was  enormous,  and  was  chiefly  external.  The  diaphragm  was  cut  near  the 
point  of  exit  of  the  ball,  and  the  left  lung  was  collapsed ;  the  heart  and  lungs  were  superficially  exam- 
ined ;  the  latter  appeared  to  be  healthy  ;  the  former  was  slightly  fatty.  About  two  ounces  of  fluid 
were  found  in  the  pericardium.  After  leaving  the  body  the  ball  entered  the  left  fore-arm  at  its 
middle  third  dorsal  surface,  fractured  the  ulna,  and  came  out  on  palmar  surface,  then  struck  a 
young  mulatto  man,  who  was,  it  is  said,  about  eight  feet  from  Dorman,  entering  the  abdomen 
about  one  and  a  half  inches  above  the  pubes,  and  one  inch  to  the  left  of  the  median  line,  penetrating 
the  ilium,  where  it  lodged.  It  was  extracted  about  two  hours  afterward,  but  the  mulatto  died 
twenty-three  hours  after  he  was  shot.  Dorman  survived  the  injury  about  twenty  minutes.  The 
soldier  who  shot  him,  and  who  was  the  only  person  who  saw  the  affair,  it  being  a  dark  night,  esti- 
mates that  he  was  about  eight  paces  from  him  when  he  fired. 

CXVIII. — Note  of  a  Case  of  Gunshot  Wound  of  the  Thorax  and  Abdomen.    By  JOSEPH  E.  GIBSON, 
Assistant  Surgeon,  U.  S.  A. 

CASE. — Private  Thomas  McCoy,  Co.  H,  3d  United  States  Cavalry,  shot  himself  by  the  discharge 
of  his  carbine  while  on  duty  as  sentinel  over  a  party  of  prisoners;  the  gun  slipped  from  his  hands, 
and  the  hammer,  catching,  exploded.  The  missile  entered  about  an  inch  toward  the  median  line, 
at  the  junction  of  the  cartilage  of  the  eighth  and  ninth  ribs  of  the  right  side,  ranged  backward  and 
upward,  and  emerged  at  the  back,  near  the  right  scapula,  passing  through  the  right  lung  in  its 
course,  and  probably  through  the  left  border  of  the  liver.  Death  was  instantaneous.  Considerable 
haemorrhage  occurred  after  death. 

CXIX. — Report  of  a  Gunshot  Wound  of  the  Thorax  and  Abdomen.    By  JAMES  F.  WEEDS,  Surgeon, 
U.  S.  A. 

Private  John  Ford,  Co.  G,  45th  United  States  Infantry,  was  shot  in  Nashville,  Tennessee,  on 
the  night  of  February  11,  1869.  The  bullet  passed  through  the  right  arm,  four  inches  above  the 
elbow,  entered  the  side  of  the  thorax,  breaking  the  seventh  rib  in  its  middle  third,  opened  the 
right  pleura!  cavity,  but  did  not  wound  the  lung — penetrated  the  diaphragm,  entered  the  liver  at 
its  right  border,  traversed  this  viscus  from  right  to  left,  impinged  on  the  body  of  a  dorsal  vertebra 


GUNSHOT  WOUNDS  OF  THE  ABDOMEN.  41 

wounded  the  left  lobe  of  the  liver,  and  extensively  lacerated  the  spleen,  and  escaped  from  the  body- 
two  and  a  half  inches  below,  and  one  inch  behind  the  left  nipple,  breaking  the  seventh  and  eighth 
ribs.  He  died  in  a  few  minutes  after  being  shot.  The  contents  of  the  thorax,  abdomen,  and  cra- 
nium were  examined  and  found  in  a  normal  condition,  except  as  regarded  the  traumatic  lesions. 

CXX. — Report  of  a  Case  of  Ounsliot  Wound  of  the  Thorax  and  Abdomen.    By  W.  E.  STEINMETZ, 
Assistant  Surgeon,  U.  S.  A. 

Private  Jackson  Tolliver,  Co.  E,  24th  United  States  Infantry,  aged  21  years,  received  on  Janu- 
ary 23, 1870,  at  Fort  Griffin,  Texas,  two  gunshot  wounds.  One  was  an  inch  below  and  a  quarter  of 
an  inch  external  to  the  inferior  angle  of  the  right  scapula ;  the  other  in  the  posterior  part  of  the 
middle  third  of  the  right  leg.  The  patient  was  admitted  to  the  post  hospital,  and  one  missile  was 
extracted  from  near  the  eusiform  cartilage,  and  another  from  the  muscles  of  the  inner  portion 
of  the  calf.  The  patient  recovered  from  shock  four  hours  after  reception  of  injury,  and  seemed  to 
be  doing  well  until  half  past  11  at  night,  when  internal  haemorrhage  occurred,  and  death  ensued 
shortly  afterward.  At  the  autopsy,  the  thoracic  cavity  was  found  to  contain  about  one  and  a  half 
pints  of  blood.  After  penetrating  the  diaphragm,  the  ball  had  pierced  the  upper  part  of  the.  right 
lobe  of  the  liver,  and,  taking  an  upward  course,  had  buried  itself  under  the  skin,  near  the  ensiform 
cartilage ;  the  lower  edge  of  the  seventh  rib  was  fractured,  and  the  lower  part  of  the  inferior  lobe 
of  the  right  lung  was  perforated. 

CXXI. — An  Account  of  a  Necropsy  after  a  Gunshot  Wound  of  the  Liver.    By  W.  S.  BUCHANAN, 
Assistant  Surgeon,  U.  S.  A. 

Private  Charles  Allen,  Co.  E,  38th  United  States  Colored  Infantry,  aged  21  years,  was 
admitted  to  the  post  hospital  at  Fort  Hays,  Kansas,  on  December  21,  18G7,  with  a  gunshot 
wound  of  the  abdomen,  and  died  in  a  few  minutes.  An  autopsy  was  made  nine  hours  after  death. 
The  missile,  supposed  to  be  a  pistol  ball,  penetrated  the  abdominal  cavity  immediately  below  the 
seventh  costal  cartilage  and  two  inches  to  the  left  of  the  mesial  line,  entered  the  left  lobe  of  the  liver, 
traversed  that  organ  nearly  its  whole  length,  through  the  left  lobe,  crossing  the  longitudinal  fissure, 
reenteriug  the  under  surface  of  the  right  lobe,  and  emerged  at  its  superior  surface  and  near  its 
right  extremity ;  thence  it  passed  through  the  diaphragm  into  the  right  pleura!  cavity  and  passed 
out  at  the  tenth  rib,  which  was  completely  fractured  in  its  middle.  Sixty-four  ounces  of  blood 
were  found  in  the  right  pleural  cavity,  which  had  passed  from  the  abdomen  through  the  aperture 
in  the  diaphragm.  About  twenty  ounces  of  blood  were  found  in  the  abdominal  cavity. 

CXXII. — Case  of  Gunshot  Wound  of  the  Liver,  Spleen,  and  Diaphragm.    By  J.  E.  SMITH,  Surgeon, 
U.  S.  A. 

Private  Eichard  Sledge,  reassigned,  38th  United  States  Infantry,  was  shot  by  the  sentinel  at 
Jefferson  Barracks,  Missouri,  on  the  3d  instant,  while  endeavoring  to  escape  from  the  guard.  The 
ball  entered  the  body  posteriorly,  just  above  the  edge  of  the  left  ilium,  and  midway  the  crest; 
entered  the  abdominal  cavity,  ranging  upward  and  forward,  passed  through  the  spleen  and  the 
diaphragm,  wounding  the  liver ;  and  then  passed  out  anteriorly,  near  the  left  nipple,  fracturing 
the  sixth  rib.  The  man  lived  fifty  hours  after  receiving  the  wound. 

CXXIII. — Pistol-shot  Wound  implicating  both  the  Thoracic  and  Abdominal  Cavities.    By  J.  F. WEEDS, 
Surgeon,  U.  S.  A. 

In  October,  18C9,  at  Nashville,  Tennessee,  Private  Frank  Gibhart,  Co.  D,  14th  United  States 
Infantry,  was  accidentally  shot  by  the  officer  of  the  day,  while  the  latter  was  suppressing  a  dis- 
turbance among  the  prisoners  in  the  guard-house.  The  deceased  was  one  of  the  guard.  The 
bullet  (a  conical  ball  fired  from  a  5-inch  Smith  &  Wesson's  pistol)  entered  the  back  two  and  a 
half  inches  to  the  left  of  the  fourth  dorsal  vertebra  and  lodged  the  same  distance  to  the  right  of 
the  xiphoid  cartilage,  passing  through  the  superior  portion  of  the  right  lobe  of  the  liver,  the  dia- 
phragm, and  opening  the  right  pleural  cavity.  He  died  in  a  few  minutes. 
6 


42  EEPORT  OF  SURGICAL  CASES  IN  THE  AEMY. 

CXXIV. Brief  Report  of  a  Case  of  Gunshot  Wound  involving  both  tlie  Chest  and  Abdomen.    By  J. 

A.  TONNEK,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Michael  O'Callaghan,  Co.  D,  6th  United  States  Cavalry,  was  shot  by  a  citizen  on  Feb- 
ruary 9,  1867,  the  missile,  a  buckshot,  inflicting  wounds  of  the  chest  and  abdomen.  He  was 
admitted  from  camp  to  the  regimental  field  hospital  at  Austin,  Texas,  on  February  10,  18G7.  He 
died  on  the  following  day. 

CXXV. — Note  of  a  Gunshot  Wound  involving  the  Thorax  and  Abdomen.    By  WILLIAM  DEAL,  M.  D., 
Acting  Assistant  Surgeon. 

Artificer  John  Tindolph,  Co.  K,  1st  United  States  Artillery,  aged  21  years,  received  a  gunshot 
wound  of  the  right  side  on  November  22, 18G8,  by  duck-shot,  which  entered  the  right  side,  fracturing 
the  sixth  and  seventh  ribs,  passing  downward  into  the  liver,  lacerating  the  lower  lobe  of  the  right 
lung.  He  was  admitted  to  Sedgwick  Barracks  post  hospital,  at  New  Orleans,  on  November  22d, 
and  died  the  same  day  from  hemorrhage. 

The  injuries  in  the  cases  recorded  in  the  nine  foregoing  reports  were  inflicted,  in  five 
cases,  by  musket  balls ;  in  two,  by  pistol  balls ;  in  one,  by  buckshot ;  in  one,  by  bird 
shot. 


Gunshot  Wounds  of  the  Stomach. — It  is  superfluous  to  remark  on  the  rarity  of 
recovery  from  traumatic  lesions  of  the  stomach.  We  have  to  look  back  to  Dr.  Beau- 
mont's report  of  the  case  of  Alexis  St.  Martin  fora  satisfactory  published  instance,  derived 
from  the  surgical  annals  of  the  Army.  But  one  case  of  gunshot  wound  of  the  stomach, 
coming  under  treatment,  is  reported  in  the  last  five  years. 

CXXVI — Report  of  a  Case  of  Gunshot  Wound  of  the  Stomach.    By  W.  F.  BUCHANAN,  Assistant 
Surgeon,  U.  S.  A. 

Private  James  Brennan,  Troop  F,  7th  United  States  Cavalry,  was  admitted  to  hospital  at 
Fort  Hays,  Kansas,  April  18,  1869,  for  a  gunshot  wound,  from  the  effects  of  which  he  died  on  the 
third  day  after  admission.  At  a  post-mortem  examination,  fifteen  hours  after  death,  it  was  found 
that  a  large  pistol  ball  had  entered  the  back  directly  to  the  left  of  the  spinal  column,  and  had 
passed  just  beneath  the  left  renal  artery  and  through  the  pyloric  extremity  of  the  stomach,  making 
its  exit  to  the  left  and  about  two  and  a  half  inches  above  the  umbilicus.  The  whole  extent  of  the 
peritoneum  and  intestines  was  congested  with  an  extensive  effusion  of  fibrin.  Extensive  internal 
haemorrhage,  most  probably  from  a  branch  of  the  gastro-epiploica  dextra,  had  taken  place,  and  was 
evidently  the  immediate  cause  of  death.  Hemorrhage  from  the  nose,  ears,  aud  mouth  took  place 
immediately  before  death. 


Gunshot  Wounds  of  the  Small  Intestines. — Twenty  cases  were  reported.  They  were 
all  fatal.  Seven  were  complicated  by  wounds  of  large  vessels,  and  the  patients  died 
almost  immediately.  Ten  other  patients  died  within  forty  hours,  from  internal  haemorrhage 
mainly.  As  nearly  as  can  be  ascertained  most  of  these  died  in  a  very  few  hours.  Three 
patients  survived  three,  five,  and  twenty-nine  days,  respectively,  and  succumbed  to  peri- 
tonitis. 


GUNSHOT  WOUNDS  OP  THE  ABDOMEN.  43 

CXXVII. — Report  of  a  Case  of  Perforation  of  the  Duodenum  by  a  Pistol  Ball.    By  C.  H.  ALDEN, 
Surgeon,  U.  S.  A. 

Lieutenant  George  F.  Mason,  5th  United  States  Cavalry,  was  shot  in  a  quarrel  with  a  citizen, 
near  Fort  D.  A.  Russell,  Wyoming  Territory,  on  March  1, 1870.  The  ball  was  from  a  Colt's  Navy 
revolver,  and  entered  about  two  and  a  half  inches  above  the  umbilicus,  a  little  to  the  right  of  the 
median  line,  ranged  downward  and  backward,  perforating  the  duodenum  a  short  distance  below 
the  stomach,  dividing  the  inesenteric  vessels  in  several  places,  and  passed  out  about  two  and  a  half 
inches  to  the  left  of  the  median  line  posteriorly  and  opposite  the  fourth  lumbar  vertebra.  Inter- 
nal hemorrhage  was  the  immediate  cause  of  death,  which  took  place  soon  after  the  reception  of 
the  injury,  March  1,  1870. 

CXXVIII. — Memorandum  of  a  Fatal  Case  of  Gunshot  Wound  of  the  Small  Intestines.    By  JAMES 
SAUNDEKS,  M.  D.,  Acting  Assistant  Surgeon. 

Private  John  Hoffman,  Co.  A,  6th  United  States  Cavalry,  aged  28  years,  was  wounded  in  a 
skirmish  at  Farmersville,  Texas,  on  November  19,  1868,  by  a  couoidal  ball  which  perforated  the 
jejunum.  The  treatment  consisted  of  stimulants  and  anodynes.  He  died  on  November  20,  1868. 

The  skirmish  occurred  about  twenty-five  miles  from  Pilot  Grove,  Texas,  and  the  case  was 
treated  by  Dr.  Netherby,  of  that  place.  His  remains  were  brought  to  the  post,  where  they  were 
interred. 

CXXIX. — Report  of  a  Fatal  Gunshot  Wound  of  the  Small  Intestines.     By  H.  H.  SMITH,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Joseph  Clark,  Co.  C,  14th  United  States  Infantry,  was  shot  by  Indians  four  miles 
from  Camp  Yerde,  Arizona  Territory,  on  May  6, 1809.  The  ball  entered  just  over  the  anterior  superior 
spinous  process  of  the  ilium  on  the  left  side,  and,  passing  across  and  upward,  lodged  in  the  right 
hypochondrium,  after  perforating  the  peritoneum  and  small  intestines.  He  ran  or  walked  half 
way  into  camp,  and  was  carried  the  remainder  of  the  way  on  a  hand-litter.  He  never  recovered 
from  the  shock,  and  his  stomach  was  so  irritable  that  he  vomited  frequently  and  could  retain  nothing. 
At  length,  being  able  to  retain  a  dose  of  morphia  which  was  administered  in  a  small  powder  with 
a  few  grains  of  prepared  chalk,  he  slept  a  considerable  portion  of  the  night.  Toward  morning  he 
took  and  retained  wine  and  water,  and  later  was  able  to  retain  brandy  and  water ;  but  he  could 
not  be  induced  to  take  food  in  any  form.  He  had  a  passage  of  feces  and  blood.  There  were 
slight  spots  and  streaks  of  blood  in  the  vomited  matter.  The  patient  died  on  the  morning  of 
May  7,  1869. 

CXXX. — Minute  of  a  Case  of  Gunshot  Wound  of  the  Ileum  and  Jejunum.    By  WILLIAM  A.  CANT- 
EELL,  M.  D.,  Acting  Assistant  Surgeon. 

Corporal  James  Dunn,  Co.  C,  28th  United  States  Infantry,  was  brought  to  the  post  hospital  at 
Little  Rock,  Arkansas,  on  the  night  of  March  6,  1868,  in  an  intoxicated  condition,  having  received 
a  wound  of  the  abdomen  by  the  accidental  discharge  of  a  small  pocket-pistol,  in  his  own  hands, 
while  resisting  the  efforts  of  a  policeman  to  disarm  him.  Death  resulted  on  the  morning  of  March 
7th.  At  the  autopsy  the  ball  was  found  to  have  entered  a  little  above  and  to  the  right  of  the 
umbilicus,  passing  backward  and  to  the  left  through  the  convolutions  of  the  ileuin  and  jejunum, 
cutting  some  of  the  branches  of  the  superior  mesenteric  vein,  and  to  have  lodged  on  the  left  of  the 
spine.  The  abdominal  cavity  was  filled  with  clotted  blood. 

CXXXL— Abstract  of  a  Case  of  Gunshot  Wound  of  the  Small  Intestines.    By  WILLIAM  M.  NOTSON, 

Assistant  Surgeon,  U.  S.  A. 

Private  Edward  Stuvan,  Co.  G,  4th  United  States  Cavalry,  aged  29  years,  was  wounded  in  a 
drunken  scuffle  on  June  19,  1870,  by  a  couoidal  ball,  in  the  abdomen.  He  was  admitted  on  the 
same  day  to  the  United  States  post  hospital  at  Fort  Coucho,  Texas.  There  was  no  treatment, 
d«ath  being  almost  instantaneous  from  internal  hemorrhage. 


44  REPORT  OF  SUEGICAL  CASES  IN  THE  ARMY. 

CXXXII. — Remarks  on  a  Case  of  Gunshot  Wound  of  the  Jejunum.    By  ALBERT  NEUMAN,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Samuel  G.  Martin,  Troop  D,  14th  Missouri  Cavalry,  was  admitted  to  hospital  at 
Lawrence,  Kansas,  June  23d,  having  received  a  wound  about  au  hour  before  by  the  accidental 
discharge  of  a  Remington  revolver.  The  ball  entered  the  right  side  near  the  lower  lumbar  verte- 
bra;, and  lodged  under  the  skin  about  an  inch  above  the  internal  abdominal  ring,  whence  it  had 
been  removed  by  incision  before  admission.  He  was  suffering  great  pain,  and  there  was  great  ten- 
derness of  the  abdomen.  There  was  a  constant  and  intense  desire  to  urinate  with  inability  to  do 
so,  and  he  begged  to  have  his  urine  drawn  off.  An  anodyne  was  administered,  and  cold-water 
dressings  applied.  On  the  25th,  faecal  matter  was  discharged  from  the  wound  in  front.  On  the 
20th,  he  complained  of  no  pain  ;  he  became  slightly  delirious,  and  vomited ;  pulse  108.  July  4th: 
Easy ;  faecal  matter  discharged  from  the  wound  in  the  back ;  a  dark  slough  protruded  from  the 
wound  in  front ;  pulse  9C ;  treated  expectantly.  July  5th :  Suffered  much  pain  in  the  night ;  had 
four  discharges  per  anum,  and  fecal  matter  discharged  from  both  wounds.  July  Gth  :  Symptoms 
increased,  with  considerable  tenderness  over  the  whole  abdomen.  July  14th  :  Patient  much  pros- 
trated ;  back  and  sides  of  the  trunk  covered  with  small,  irregular  purple  spots  and  lines ;  lividness 
of  the  hands  and  feet.  The  symptoms  gradually  grew  worse,  and  by  July  21st  the  pulse  was  104, 
and  small;  the  lividness  had  increased,  and  purple  spots  covered  both  legs.  Death  occurred  July 
22d.  A  necroscopic  examination,  three  hours  after  death,  revealed  the  usual  characteristics  of 
peritonitis.  The  small  intestine  was  completely  divided,  the  lower  portion  being  contracted  almost 
to  the  size  of  a  goose  quill.  Communicating  with  the  wounds  of  exit  and  of  entrance,  and  surround- 
ing the  right  psoas  muscle,  was  a  cavity  of  sufficient  size  to  hold  a  quart,  separated  by  adhesions 
from  the  remainder  of  the  abdominal  cavity.  The  upper  portion  of  the  small  intestine  opened  into 
this  cavity,  which  was  half  full  of  fecal  matter. 

CXXXIII. — Memorandum  of  a  Gunshot  Wound  of  the  Abdomen.    By  G.  A.  JAMESON,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  John  Hynds,  Co.  D,  17th  Regiment  Veteran  Reserve  Corps,  was  wounded  by  an  asso- 
ciate at  Ekiu  Barracks,  Indianapolis,  Indiana,  on  July  22,  1865 ;  death  resulted  on  July  23d,  nine 
hours  after  the  reception  of  the  injury.  At  the  post-mortem  examination,  the  ball  was  found  to  have 
entered  the  abdomen  three  inches  to  the  left,  and  a  half  inch  above  the  umbilicus ;  and  the  adipose 
tissue  around  the  orifice  made  by  the  ball  to  be  infiltrated  with  blood  from  one  to  two  inches  in 
every  direction.  Upon  laying  back  the  flaps  made  by  the  incision,  the  peritonaeum  was  found  to 
be  more  red  and  swollen  than  common.  In  the  abdominal  cavity  were  three  pints  of  blood,  which 
must  have  been  effused  from  the  small  mesenteric  vessels  broken  by  the  ball. 

CXXXIV. — Penetrating  Gunshot  Wound  of  the  Abdomen.    By  B.  A.  CLEMENTS,  Surgeon,  U.  S.  A. 

Private  Michael  Ford,  Co.  E,  19th  United  States  Infantry,  received  August  9,  1870,  a  gun- 
shot wound  of  the  abdomen.  He  was  admitted  to  the  post  hospital  at  Jackson  Barracks,  Louisi- 
ana, on  the  same  day.  Simple  dressings  were  applied.  He  died  August  14,  from  the  immediate 
effects  of  internal  haemorrhage  and  peritonitis. 

CXXXV. — Note  of  a  Gunshot  Perforation  of  the  Small  Intestines.     By  JOHN   RIDGELY,  M.  D., 

Acting  Assistant  Surgeon. 

Private  Bernard  Curry,  Co.  B,  Gth  United  States  Cavalry,  was  admitted  into  the  post  hospital 
at  Austin,  Texas,  on  August  23,  1868,  Avith  a  gunshot  wound  of  the  abdomen,  from  the  effects  of 
which  he  died  on  the  same  day.  At  the  autopsy,  the  missile,  which  was  supposed  to  have  been  a 
pistol  ball,  was  found  to  have  entered  the  cavity  of  the  abdomen  about  two  and  a  half  inches  below 
and  to  the  left  of  the  umbilicus;  to  have  passed  transversely  through  each  fold  of  the  intestines, 
tearing  them — in  some  places  destroying  the  continuity— and  to  have  emerged  immediately  above 
i.  the  crest  of  the  left  ilium. 


GUNSHOT  WOUNDS  OF  THE  ABDOMEN.  45 

CXXXVI. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Jejunum.  By  H.  A.  DuBois,  Assistant 
Surgeon,  aud  D.  C.  PETERS,  Surgeon,  U.  S.  A. 

Private  Antoine  Seeberger,  Troop F,  3d  United  States  Cavalry,  aged  28  years,  was  admitted  to 
post  hospital  at  Camp  Union,  New  Mexico,  June  30, 18G7,  with  a  penetrating  gunshot  wound  of  the 
abdomen.  The  missile,  a  conoidal  ball,  entered  midway  between  the  umbilicus  and  the  border  of 
the  costal  cartilages,  left  side,  and  emerged  two  and  a  half  inches  on  the  left  side  of  the  spinous 
process  and  at  the  lower  margin  of  the  ribs.  Hypodermic  injections  of  morphia  were  tried,  but  the 
patient  died  July  1, 1867.  At  the  post-mortem  examination  the  ball  was  found  to  have  pierced  the 
jejunum  in  the  left  lumbar  region,  and  to  have  grazed  the  left  kidney.  The  portion  of  the  small 
intestine  above  the  point  of  injury  contrasted  with  the  portion  below,  which  was  contracted  and 
pale. 

CXXXVII. — Note  of  a  Case  of  Traumatic  Peritonitis.      By  THEODORE  ATTVOOD,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  William  Linnahan,  Co.  I,  7th  United  States  Infantry,  aged  21  years,  received  a  wound 
of  the  abdomen  from  a  slug  while  ou  patrol  duty  February  22,  1809.  He  was  admitted  to  the  post 
hospital  at  Jacksonville,  Florida,  ou  the  same  day,  and  died  of  traumatic  peritonitis,  February  25, 
18G9. 

CXXXVIII. — Remarks  on  a  Case  of  Gunshot  Wound  of  the  Ileum.    By  F.  W.  ELBREY,  Assistant 
Surgeon,  U.  S.  A. 

Franklin  A.  Dennis,  Co.  1, 5th  Cavalry,  accidentally  shot  himself  on  the  5th  of  November,  while 
with  an  expedition  to  the  forks  of  the  Republican  River,  and  died  half  an  hour  after  the  occurrence. 
The  expedition  being  on  its  return  to  Fort  McPhersou,  Nebraska,  and  distant  only  one  day's  march, 
the  body  was  transported  for  interment  there.  The  autopsy,  which  was  made  at  the  post  hospital, 
showed  that  a  carbine  ball  had  entered  the  right  iliac  region,  perforating  in  its  course  the  ileum  two 
inches  from  the  ileo-crecal  valve,  and  the  external  iliac  vein  near  Poupart's  ligament.  It  then 
struck  the  body  of  the  pubic  bone,  which  it  fractured,  and,  being  thence  deflected,  took  its  course 
along  the  inner  side  of  the  right  leg  and  lodged  at  the  side  of  the  tendo  Achilles. 

CXXXIX. — Remarks  on  a  Case  of  Gunshot  Wound  of  the  Abdomen.    By  D.  WEISEL,  Assistant  Sur- 
geon, U.  S.  A. 

Private  Anderson  Merryweather,  9th  United  States  Cavalry  Band,  was  shot  by  parties 
unknown  on  October  14,  1870,  at  Fort  Davis,  Texas,  from  the  effects  of  which  he  died  Octo- 
ber 16,  1870.  Upon  examination,  immediately  after  the  receipt  of  injury,  it  was  found  that 
he  had  been  shot  by  a  small  bullet,  which  had  entered  the  abdomen  at  and  penetrating  the  pos- 
terior part  of  the  crest  of  the  left  ilium,  passing  upward  and  outward  aud  lodging  upon  the  anterior 
portion  of  the  ensiform  cartilage,  from  which  it  was  extracted  by  cutting  down  upon  it.  The  next 
day  the  patient  complained  of  severe  pain  aud  soreness  of  the  bowels  with  the  abdomen  much 
swollen,  and  upon  going  to  stool  the  pain  was  intense,  with  large  quantities  of  blood  passing 
from  him.  An  autopsy  upon  his  body,  six  hours  after  death,  revealed  a  large  quantity  of  blood  in 
the  cavity  of  the  abdomen,  the  bowels  congested,  and  the  small  intestines  penetrated  by  the  bullet 
four  times. 

CXL. — Note  of  a  Case  of  Gunshot  Wound  of  the  Abdomen.    By  EGBERT  McCRACKEN,  M.  D., 

Acting  Assistant  Surgeon. 

At  Baton  Rouge,  Louisiana,  August  15,  1868,  Acting  Assistant  Surgeon  C.  B.  Braman,  aged 
27  years,  was  killed  by  a  pistol  ball.  The  missile  entered  the  back,  near  the  left  side  of  the  spine, 
passed  through  the  body,  aud  lodged  in  the  muscular  tissues  of  the  anterior  part  of  the  left  chest, 
in  its  course  cutting  the  ascending  cava.  Death,  consequently,  was  almost  instantaneous. 


46  REPOET  OF  SUEGICAL  CASES  IN  THE  AEMY. 

CXLL— Memorandum  of  a  Wound  of  the  Abdomen  by  a  Musket-Ball.    By  JOHN  EIDGELY,  M.  D., 

Acting  Assistant  Surgeon. 

*  *  At  Austin,  Texas,  April  1, 1868,  Private  William  Burke,  Co.  B,  6th  United  States 
Cavalry,  aged  21  years,  received  a  wound  of  the  abdomen  from  a  conoidal  bullet.  He  was 
admitted  to  the  hospital  at  Austin,  Texas,  and  died  on  the  same  day. 

CXLII.— Note  of  a  Case  of  Perforation  of  tlie  Abdomen  by  a  MusJcet  Ball.    By  J.  C.  LAMONT,  M.  D., 

Acting  Assistant  Surgeon. 

Private  Thomas  Baker,  Co.  K,  24th  United  States  Infantry,  aged  25  years,  was  accidentally 
wounded  on  February  20, 1870,  by  a  conoidal  ball,  which  entered  midway  between  the  anterior 
superior  spinous  process  of  the  right  ilium  and  the  linea  alba,  passed  downward,  and  laterally, 
traversing  the  abdominal  cavity,  and  emerged  four  inches  below  the  crest  of  the  left  ilium,  and 
one  inch  from  the  junction  of  the  sacrum  with  the  ilium.  He  was  admitted  to  the  United  States 
post  hospital  at  Fort  Duncan,  Texas,  on  the  same  day.  He  died  on  February  21, 1870. 

CXLIII. — Minute  of  a  Penetrating  Wound  of  tlie  Abdomen.    By  W.  M.  NOTSON,  Assistant  Surgeon, 
U.  S.  A. 

Private  John  Gourjan,  Co.  G,  4th  United  States  Cavalry,  aged  22  years,  was  accidentally 
wounded  while  on  picket,  in  the  abdomen,  on  June  6,  18G8,  by  a  conoidal  bullet.  He  was  admitted 
into  the  United  States  Army  post  hospital  at  Fort  Coucho,  Texas,  on  June  7, 1868.  Water-dress- 
ings were  applied  to  the  wound.  He  died  on  June  8,  1868. 

CXLIV. — Memorandum  of  a   Perforating   Gunshot  Wound  of  Abdomen.    By  J.  HAKVEY,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Thomas  Brown,  Co.  C,  5th  United  States  Cavalry,  was  wounded  by  a  conoidal  pistol 
ball,  on  May  13,  1868,  which  entered  the  back  near  the  tenth  dorsal  vertebra,  and  emerged  through 
the  abdomen  just  above  the  umbilicus,  causing  almost  instant  death. 

CXLV. — Minute  of  a  Fatal  Case  of  Gunshot   Wound  of  Abdomen.     By  J.  A.  TONNER,  M.  D., 
Acting  Assistant  Surgeon. 

Corporal  Thomas  Casey,  Co.  M,  6th  United  States  Cavalry,  received,  near  Austin,  Texas,  a 
gunshot  wound  of  the  abdomen  by  a  couoidal  ball.  He  was  admitted  from  camp  to  the  regimental 
field  hospital  on  February  7, 1867.  He  died  February  8,  1867. 

CXLVI. — Minutes  taken  from  Monthly  Report  of  Wounded  from  Fort  McKavett,  Texas.  By  E.  SHAKPE, 
M.  D.,  Acting  Assistant  Surgeon. 

At  Fort  McKavett,  February  3,  1870,  an  autopsy  was  made  on  the  person  of  Private  Charles 
Murray,  Co.  F,  9th  United  States  Cavalry,  who  was  murdered  by  ruffians  while  on  guard  over  a 
man  (Jackson)  accused  of  murder.  The  post-mortem  notes  are  as  follows :  A  rifle  ball  had  entered 
the  right  side  about  three  inches  above  the  crest  of  the  ilium,  perforated  the  vena  cava  asceudens, 
and  lodged  under  the  cuticle  of  the  left  side  about  one  inch  above  the  anterior  superior  spinous 
process  of  the  ilium.  This  man  was  wounded  on  February  2,  1870,  and  died  almost  immediately. 


Gunshot  Flesh  Wounds  of  the  Abdomen  — Several  of  the  gunshot  wounds  of  the 
abdominal  walls  that  were  reported  were  of  a  serious  nature. 

CXLVII. —  Memorandum    of  a    Case    of    Gunshot    Flesh -Wound    of    the   Abdomen    with    other 
Injuries.    By  H.  J.  SMITH,  Assistant  Surgeon,  5th  United  States  Volunteer  Infantry. 

Sergeant  Little  Priest,  Co.  A,  Omaha  Scouts,  was  wounded  near  Camp  Connor,  Dakota  Terri- 
tory, in  a  fight  with  Sioux  Indians,  in  November,  1865,  receiving  four  gunshot  wounds.    The  first 


GUNSHOT  WOUNDS  OP  THE  ABDOMEN.  47 

ball  was  received  in  the  epigastric  region  anteriorly,  about  two  inches  above  the  umbilicus  and  to 
the  right  of  the  median  Hue.  As  he  did  not  arrive  at  post  until  some  time  after  the  irritative  fever 
had  set  in,  it  was  hard  to  ascertain  the  direction  of  said  ball,  but  the  best  diagnosis  that  could  be 
made  in  the  case  was,  that  it  had  passed  between  the  intestines  and  abdominal  walls,  passing  over 
the  crest  of  the  right  ilium,  and  lodging  in  the  gluteal  muscles.  The  second  ball  passed  in  posteri- 
orly to  the  left  of  the  right  scapula,  and  traveling  through  the  superficial  fascia  and  cellular  substance 
covering  that  bone,  lodged  in  the  substance  of  the  right  deltoid  muscle.  The  third  ball  was  a  glancing 
shot,  making  a  lacerated  wound  of  the  pectoralis  major  muscle,  near  its  insertion  into  the  anterior 
bicipital  ridge  of  the  humerus.  The  fourth  ball  entered  posteriorly  the  triceps  muscle  of  the  left 
arm.  The  track  and  lodgement  of  this  ball  are  still  unknown.  At  the  end  of  the  month  the  patient 
was  doing  well,  with  good  hope  of  his  speedy  recovery.  [He  was  returned  to  duty  December, 
1865.— ED.] 

CXLVIII. — Note  of  a  Gunshot  Flesh-  Wound.    By  HARVEY  E.  BROWN,  Assistant  Surgeon,  U.  S.  A. 

Private  Daniel  McCarthy,  Co.  D,  24th  United  States  Infantry,  aged  22  years,  received  a  gun- 
shot wound  from  a  conoidal  pistol  bullet,  on  March  25, 1869.  The  ball  entered  one  inch  below  the 
anterior  superior  spinous  process  of  the  left  ilium,  and  made  its  exit  midway  between  the  crest  of 
the  ilium  and  the  tuber  ischii.  He  was  admitted  to  the  post  hospital  at  Galveston,  Texas,  on 
March  25,  1869.  Cold-water  dressings  were  applied.  He  was  returned  to  duty  in  April,  1809. 

CXLIX. — Note  of  a  Gunshot  Flesh-  Wound  of  the  Abdomen.    By  BEDFORD  SHAKPE,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  William  L.  Jones,  Co.  P,  35th  United  States  Infantry,  aged  24  years,  received  a  gun- 
shot wound  of  the  abdomen.  He  was  admitted  into  the  United  States  Army  post  hospital  at  San 
Antonio,  Texas,  from  field  hospital,  on  December  11, 1866.  The  treatment  consisted  of  simple 
dressings.  He  was  returned  to  duty  on  December  22, 1866. 

CL. — Note  of  a  Gunshot  Flesh-  Wound.    By  JOHN  BROOKE,  Assistant  Surgeon,  U.  S.  A. 

Lieutenant  G.  A.  H.  Clements,  Co.  H,  44th  United  States  Infantry,  aged  24  years,  received  on 
May  19, 1868,  a  gunshot  wound  of  the  abdomen,  by  the  accidental  discharge  of  his  pistol.  He  was 
admitted  to  the  post  hospital  at  Washington,  D.  C.,  on  May  24,  1868.  The  ball  was  extracted  pre- 
vious to  admission.  Simple  dressings  were  applied.  He  was  transferred  to  quarters  on  June 
8,  1868. 

CLI. — Memorandum  of  a    GunsJiot  Flesh- Wound.     By  P.  SUHRING,  M.   D.,    Acting  Assistant 
Surgeon. 

Private  Thomas  Marrion,  Co.  I,  16th  United  States  Infantry,  was  wounded  near  McNutt,  Mis- 
sissippi, while  assisting  the  deputy  sheriff  in  making  an  arrest.  The  ball  entered  the  lower  part  of 
the  left  iliac  region,  and,  passing  to  the  right,  lodged  in  the  lower  part  of  the  right  iliac  region, 
immediately  under  the  skin.  After  being  wounded,  the  patient  started  on  horseback  for  his  sta- 
tion, a  distance  of  about  thirty-one  mileSj  and  on  his  arrival  did  not  seem  to  be  seriously  injured. 
After  some  time,  however,  severe  vomiting  and  great  prostration  followed,  which,  after  several 
days'  duration,  yielded  to  the  administration  of  counter-irritants  and  proper  diet.  Constipation 
was  easily  overcome  by  a  few  doses  of  castor  oil.  The  utmost  rest,  and  light,  digestible  food — as 
peritonitis  had  set  in — was  ordered.  The  wound  was  treated  lirst  with  cold-water  dressings;  after- 
wards with  warm  poultices  of  slippery  elm  and  hops.  The  visceral  peritoneum,  it  seems,  had  been 
injured  to  some  extent.  The  patient  was  convalescent  at  the  date  of  this  report,  January,  1870. 


48  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

Gunshot  Wounds  of  the  Large  Intestine. — Such  injuries  are  dangerous,  but  far  less 
so  than  those  of  the  small  intestines. 

CLIL— Memorandum  of  a  Gunshot  Wound  of  the  Large  Intestine  recovering  under  Simple  Treatment. 
By  W.  S.  MINEER,  M.  D.,  Acting  Assistant  Surgeon. 

Private  J.  D.  Morgan,  Co.  H,  23d  United  States  Infantry,  aged  25  years,  was  shot  by  a  com- 
panion in  a  dispute  on  July  15,  1867.  A  revolver  ball  entered  the  abdomen,  passing  through  the 
colon,  and  was  extracted  just  above  the  right  ilinm.  He  was  admitted  to  the  post  hospital  at  Fort 
Boise,  Indian  Territory,  on  July  15,  18C7.  Simple  dressings  were  applied.  He  was  returned  to 
duty  on  September  30,  1807. 

CLIII. — Memorandum  of  a  Gunshot  Wound  of  the  Colon.    By  S.  S.  BEACH,  M.  D.,  Acting  Assistant 

Surgeon. 

Private  Octavio  Dussett,  aged  23  years,  was  wounded  in  a  quarrel  with  a  comrade,  on  June  23, 
18G8,  at  Atlanta,  Georgia.  A  pistol  ball  entered  above  the  crest  of  the  right  ilium,  passed  through 
the  transverse  colon  longitudinally,  and  made  its  exit  two  and  a  half  inches  above  the  left  ilium. 
He  was  sent  to  the  post  hospital  at  McPherson  Barracks.  Water-dressings  were  applied.  He 
died  on  June  27,  1808,  from  peritonitis,  ninety-six  hours  after  the  reception  of  the  injury. 

CLIV. — Report  of  a  Case  of  Gunshot   Wound  of  the  Abdomen  icith  Protrusion  of  the  Omentum. 
By  S.  H.  HOKNEB,  Assistant  Surgeon,  U.  S.  A. 

Private  Charles  Morris,  Co.  C,  2d  United  States  Infantry,  was  admitted  to  the  post  hospital  at 
Lonisville,  Kentucky,  August  2,  1800,  with  a  gunshot  wound  of  the  abdomen,  received  in  an 
attempt  to  escape  from  arrest.  A  conoidal  ball  entered  the  right  side  posteriorly,  grazing  the 
posterior  superior  spinous  process  of  the  ilium,  emerging  at  a  point  one  inch  to  the  right  and 
above  the  umbilicus.  When  admitted  he  was  suffering  from  great  pain,  continual  vomiting,  rest- 
lessness, and  excessive  thirst.  His  pulse  was  70,  and  very  feeble ;  skin  bathed  in  cold  clammy 
perspiration.  About  eight  inches  of  the  omentum,  which  protruded  through  the  anterior  wound, 
was  washed  and  returned.  The  wound  was  then  closed  with  a  suture,  and  cold-water  dressings 
applied.  Stimulants  and  anodynes  were  freely  given,  but  the  patient  continued  to  sink,  and 
expired  at  1  o'clock  P.  M.  on  the  same  day.  At  the  post-mortem  examination,  the  ball  was  found 
to  have  traversed  the  colon  in  two  places,  lacerating  the  omentum ;  the  peritoneum  was  somewhat 
thickened  and  inflamed ;  the  vessels  of  the  omeutum  and  mucous  membrane  of  the  colon  were 
highly  engorged,  and  the  abdominal  cavity  contained  a  considerable  quantity  of  dark  bloody  fluid 
mingled  with  faecal  matter. 

CLV. — Remarks  on  a  Case  of  Gunshot   Wound  of  the  Abdomen,  followed  by  Faecal  Fistula.    By 
H.  S.  SCHELL,  Assistant  Surgeon,  U.  S.  A. 

Private  Richard  Broad,  Co.  F,  2d  United  States  Cavalry,  was  wounded  July  3, 1807,  at  Fort 
Laramie,  Dakota  Territory,  by  a  conoidal  ball  from  a  Remington  revolver,  Army  pattern.  The 
ball  entered  on  the  left  side  of  the  abdomen,  its  lower  edge  grazing  the  centre  of  Poupart's  liga- 
ment, and  ranging  backward,  inward,  and  slightly  upward,  emerged  one  inch  to  the  left  of  the 
spinous  processes  of  the  sacrum.  He  was  admitted  to  the  hospital  the  next  morning,  put  in  bed. 
absolute  rest  and  diet  enjoined,  and  cold-water  dressing  applied.  Opium  was  given  in  full  doses, 
to  obtain  quietude  of  the  bowels,  which  were  disposed  to  diarrhoea.  On  July  6th,  all  the  symptoms 
of  peritonitis  making  their  appearance,  six  cut  cups  were  applied  to  the  abdomen,  and  ten  ounces 
of  blood  abstracted.  Warm-water  dressing  and  light,  hot  fomentations  were  applied,  with  relief 
of  all  untoward  symptoms.  On  July  8th,  tea  and  toast  diet  was  allowed.  On  July  llth,  free  dis- 
charge of  frecal  matter  from  both  anterior  and  posterior  wound.  This  discharge  continued  for  three 
days,  then  ceased.  More  liberal  diet  was  then  allowed,  and  by  August  12th,  both  wounds  were 
entirely  healed. 


GUNSHOT  WOUNDS  OP  THE  ABDOMEN.  49 

Gunshot  Wounds  of  the  Liver,  Spleen,  and  Gall- Bladder. — Wounds  of  the  liver  are 
oftener  followed  by  recovery  than  is  generally  supposed.  The  great  fatality  of  wounds  of 
the  spleen  must  be  confessed,  and,  in  presence  of  gunshot  perforations  of  the  gall-bladder, 
we  may  admit,  with  M.  Legouest,  that  the  surgeon  must  lay  down  his  arms.  Yet  of  the 
cases  of  gunshot  wounds  of  the  liver  here  recorded,  four  had  a  successful  issue,  and  one 
of  these  that  Dr.  Patzki  has  reported,  though  not  in  detail,  was  a  recovery  from  a  wound 
of  the  gall-bladder. 

CLVI. — Abstract  of  a  Case  of  Gunshot  Wound  of  the  Liver,  treated  at  the  Post  Hospital,  Cape  Dis- 
appointment, Washington  Territory.    By  W.  E.  WHITEHEAD,  Assistant  Surgeon,  U.  S.  A. 

Francis  H.  V s,  a  citizen,  aged  22  years,  was  wounded  by  a  slug  from  a  pistol,  on  June  3, 18G7. 

The  missile  was  shot  from  behind,  and  entered  about  four  inches  from  a  line  drawn  from  the  nipple 
of  the  right  side  to  the  superior  spiuous  process  of  the  ilium,  and  about  six  inches  from  the  right 
nipple,  below  and  posterior  to  the  nipple.  The  slug  was  removed  by  an  incision  through  the  skin, 
at  a  point  two  and  a  half  inches  from  the  median  line,  and  three  and  a  half  inches  below  the  left 
nipple.  At  the  time  of  injury  he  bled  very  freely  from  the  wound  of  entrance,  continuing  to  lose 
blood  and  bile  till  daylight  next  morning,  when  the  haemorrhage  ceased,  but  the  flow  of  bile  con- 
tinued. When  seen  on  June  4th,  the  patient  was  quite  feeble  from  loss  of  blood ;  his  respiration 
was  rapid,  with  slight  spasm  of  the  diaphragm ;  pulse  small  aud  frequent,  and  120 ;  tongue  coated ;  skin 
of  a  yellowish  tinge,  and  the  extremities  cold.  On  June  7th,  he  was  sent  a  distance  of  fifteen 
miles  in  a  boat,  aud  was  admitted  into  the  hospital  of  the  post.  Upon  admission,  he  was  some- 
what excited  and  fatigued ;  there  was  pain  and  tenderness  of  the  abdomen,  the  contents  of  the 
stomach  with  bile  were  persistently  vomited,  and  serum  passed  freely  from  the  wound.  An 
anodyne  was  prescribed ;  the  wound  was  dressed  with  dry  lint,  and  the  patient  was  kept  cool  aud 
quiet.  June  8th,  patient  more  quiet ;  bowels  constipated ;  urine  high-colored.  The  anodyne  was 
continued  every  three  hours;  two  grains  of  calomel  with  four  grains  of  Dover's  powder  were  given 
morning  and  evening,  and  a  light  but  nutritious  diet  was  allowed.  By  June  10th,  there  was  con- 
siderable improvement,  but  there  occurred  from,  the  wound  a  discharge  of  blood-clots,  bile,  and 
serum.  Slight  ptyalisin  taking  place  on  the  llth,  the  calomel  was  reduced  to  three-fourths  of  a 
grain,  and  the  Dover's  powder  to  five  grains,  which  was  directed  to  be  taken  daily  at  bed-time.  The 
patient's  faeces  were  clay-colored ;  his  countenance  was  of  an  icteroid  hue.  After  his  gums  were 
touched,  there  was  an  increased  discharge  of  bile  from  the  wound.  By  June  18th,  improvement  hav- 
ing taken  place,  the  mercurial  was  stopped,  but  the  solution  of  morphia  was  continued.  The  patient 
had  so  far  improved  by  June  29th,  as  to  be  able  to  sit  up  several  hours  daily,  and  on  July  4th  was 
able  to  walk  in  the  open  air  once  or  twice  a  day.  On  July  15th,  when  the  patient  left  the  hospital  for 
a  farm-house  by  the  sea-shore,  the  wound  was  healthy,  aud  discharged  less  than  an  ounce  and  a  half 
during  the  twenty-four  hours.  The  discharge  consisted  of  free  bile,  also  bile  mixed  with  thick 
purulent  matter.  When  last  heard  from,  July  27, 1867,  the  patient  was  improving  finely  in  flesh 
and  strength.  The  discharge  from  the  wound  was  about  the  same  in  quantity  and  quality. — See 
A.  M.  M.  Photographic  Series,  Nos.  39  and  40  of  Surgical  Card  Photographs,  vol.  2,  p.  39. 

CLVII. — Report  of  a  Case  of  Gunshot  Wound  of  the  Liver,  terminating  in  Recovery.    By  J.  COOPER 
McKEE,  Surgeon,  U.  S.  A. 

Commissary  Sergeant  Edward  Zimmer,  37th  United  States  Infantry,  aged  36  years,  was 
wounded  at  Santa  Fe",  New  Mexico,  in  a  drunken  brawl,  on  March  8,  1868,  by  a  conoidal  ball  from 
a  Colt's  revolver,  which  entered  the  centre  of  the  right  hypochondriac  region  three  inches  from  the 
cartilages  of  the  ribs,  and  four  and  one-half  inches  from,  and  on  the  line  with,  the  lower  edge  of  the 
sternum,  between  the  eighth  and  ninth  ribs,  passed  through  the  liver  and  intermediate  interposing 
tissues,  and  emerged  between  the  seventh  aud  eighth  ribs  on  the  left  side,  four  inches  from  the 
interior  edge  of  the  sternum  in  the  left  hypochondriac  region.  He  was  admitted  to  the  post  hos. 
7 


50  EEPOET  OF  SURGICAL  CASES  IN  THE  AEMY. 

pital  at  Santa  Fe"  on  the  same  day.  The  collapse  following  the  injury  was  of  a  very  severe  kind, 
lasting  nearly  all  night.  Alcoholic  stimulants,  hot  sinapisms,  and  chloroform  were  freely  used. 
After  reaction  he  had  severe  pain  in  the  region  of  the  wound,  and  dyspnoea.  Sulphate  of  morphia, 
in  one  half-grain  doses,  was  given  hypoderiuically,  and  repeated  in  two  hours.  Warm  poultices 
were  applied  over  the  wound  and  abdomen.  His  condition  at  this  time  was  unfavorable  and 
discouraging;  pulse  frequent  and  feeble.  He  had  great  pain  on  inspiration  and  an  anxious  expres- 
sion of  countenance.  There  was  no  external  haemorrhage.  On  March  15th,  having  had  no  move- 
ment of  the  bowels,  an  enema  was  given,  which  acted  on  the  next  day,  after  which  his  condition 
improved.  On  the  next  day,  he  ate  some  vegetable  soup,  by  mistake,  which  brought  on  a  profuse 
diarrhoea  accompanied  by  intense  teuesmus.  Considerable  blood  was  found  in  the  last  two  opera- 
tions. By  March  19th,  the  diarrhoea  was  checked,  and  he  again  commenced  to  improve.  On  the 
20th,  he  complained  of  great  pain  over  the  seat  of  the  left  lobe  of  the  liver;  there  was  dullness  on 
percussion,  extending  as  high  as  the  fourth  rib,  and  two  inches  below  the  lower  boundary  of  the 
right  hypochondriac  region.  During  the  night  the  wound  of  entrance  discharged  two  ounces  of 
pus  commingled  with  bile,  which  was  evidently  from  the  right  lobe  of  the  liver.  The  patient  was 
much  relieved ;  pulse  100 ;  respiration  26.  On  March  28th,  the  wound  commenced  discharging  daily 
about  two  ounces  of  pus  intermingled  with  bile  and  shreds  of  liver.  He  continued  to  improve, 
and  on  April  13th,  was  able  to  sit  up  two  or  three  hours  a  day.  Nourishing  diet  and  stimulants 
were  continued,  and,  on  April  24th,  he  returned  to  his  quarters.  He  recovered,  and  was  returned 
to  duty  June  11, 1868. 

CLVIII. — Note  relative  to  a  Case  of  Gunshot  Wound  of  the  Liver.    By  FREDERICK  HASSIG,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Thomas  Eiley,  Co.  E,  25th  United  States  Infantry,  aged  26  years,  was  wounded  in 
an  affray  near  Paducah,  Kentucky,  on  February  29, 1868,  by  a  conoidal  ball,  which  entered  between 
the  sixth  and  seventh  ribs,  about  one  and  a  half  inches  from  the  spinal  column,  passed  through  the 
liver,  and  lodged  two  inches  under  the  right  nipple.  There  was  profuse  bleeding  from  the  wound 
of  entrance.  The  ball  was  cut  out  the  same  day.  On  March  1st,  the  patient  was  sent  to  Paducah. 
The  wound  rapidly  healed.  He  was  returned  to  duty  in  May,  1868. 

CLIX. — Memorandum  of  a  Case  of  Recovery  after  Gunshot  Wound  of  the  Gall-Bladder  and  Liver. 
By  Assistant  Surgeon  J.  H.  PATZKI,  U.  S.  A. 

At  Fort  Eichardson,  Texas,  Private  John  Murphy,  Co.  M,  6th  United  States  Cavalry,  aged  25 
years,  received  in  an  affray  a  gunshot  wound  of  the  abdomen,  penetrating  the  right  lobe  of  the 
liver  and  the  gall-bladder.  He  was  admitted  to  the  post  hospital  November  27,  1870,  one  day 
after  the  reception  of  the  injury.  Water  dressings  were  applied  locally,  and  morphine  was  giveu 
internally.  He  recovered,  and  was  discharged  the  service  December  27,  1870. 


The  four  following  reports  relate  to  fatal  gunshot  wounds  of  the  liver,  and  with  the 
preceding  reports  on  the  subject,  and  two  reports  among  gunshot  wounds  of  the  spleen, 
furnish  a  total  of  fifteen  cases  of  gunshot  wound  of  the  liver,  with  four  recoveries : 

CLX.— Report  of  a  Gunshot  Wound  of  the  Liver  and   Colon.    By  CALVIN  DEWiTT,  Assistant 
Surgeon,  U.  S.  A. 

Private  Joseph  Darragh,  Co.  E,  1st  United  States  Cavalry,  aged  21  years,  was  wounded 
December  10, 1869,  in  a  personal  encounter  with  an  Indian  during  an  attack  on  a  baud  of  Apache — 
Mojaves  met  by  a  scouting  party  under  command  of  Captain  George  B.  Sauford,  1st  United  States 
Cavalry.  The  ball  was  shot  from  a  Spencer  carbine  in  the  hands  of  a  comrade  who  attempted  to 


GUNSHOT  WOUNDS  OF  THE  ABDOMEN.  51 

shoot  the  Indian  in  whose  embrace  Darragh  was  locked  and  from  whom  he  was  struggling  to  free 
himself.  The  Indian  was  killed,  but  it  was  impossible  to  determine  whether  he  or  his  antagonist 
was  first  struck,  as  they  were  rolling  over  each  other.  The  ball  entered  Darragh's  body  in  the 
right  hypochondriac  region,  just  in  front  of  the  space  between  the  eleventh  and  twelfth  ribs,  passed 
obliquely  downward,  backward,  and  inward,  through,  it  is  believed,  the  anterior  edge  of  the  right 
lobe  of  the  liver,  the  transverse  colon,  among  the  folds  of  the  small  intestines,  and  emerged  one 
inch  to  the  right  of  the  eleventh  dorsal  vertebra,  fracturing  the  transverse  process.  There  was 
some  paralysis  of  motion  of  the  right  lower  extremity  and  urinary  bladder,  due,  doubtless,  to  the 
shock  sustained  by  the  spinal  cord  from  the  ball  striking  and  fracturing  the  transverse  process  of 
the  eleventh  dorsal  vertebra.  But  little  external,  and  a  small  ainount  of  internal,  haemorrhage  was 
evident,  and  although  he  grew  faint  the  tendency  to  collapse  was  small,  as  he  rallied  from  the 
shock  in  two  or  three  hours,  being  quite  strong  and  cheerful,  notwithstanding  he  was  told  the 
wound  would  in  all  probability  prove  fatal  in  a  few  hours.  Opium  was  given  to  him  immediately, 
and  a  temporary  hand-litter  was  constructed  on  which  he  was  carried  over  a  rough  country  more 
than  half-way  to  Camp  McDowell,  Arizona  Territory,  until  the  party  was  met  by  an  ambulance. 
He  arrived  at  that  post  on  December  llth,  twenty-six  hours  after  the  occurrence  of  the  injury,  and 
was  immediately  taken  to  the  post  hospital,  where  he  was  made  as  comfortable  as  possible.  His 
wounds  were  dressed,  and  a  pint  of  auimoniacal  urine  was  drawn  from  his  bladder  by  the  catheter, 
and  a  small  injection  of  warm  water  was  given  to  unload  the  rectum,  the  patient  having  been 
somewhat  constipated.  Opium  was  given  to  relieve  the  constantly  increasing  pain,  and  barley- 
water  ordered  as  a  drink.  A  more  careful  examination  discovered  that  general  peritonitis  had  set 
in,  and  that  though  apparently  strong  he  was  almost  pulseless.  Death  occurred  at  8  o'clock  of  the 
evening  of  December  11, 1869. 

CLXI. — Report  of  a  Gunshot  Wound  of  the  Liver. — By  C.  W.  KNIGHT,  M.  D.,  Acting  Assistant 
Surgeon. 

Brevet  Major  William  Eussell,  jr.,  Second  Lieutenant  4th  United  States  Cavalry,  was  shot  by 
Indians  at  Mount  Adam,  Lampasas,  Texas,  at  2  P.  M.,  on  the  14th  of  May,  1870.  He  was 
first  seen  by  the  writer  at  9.30  P.  M.,  on  the  day  of  the  shooting,  at  Grimes's  Ranche,  about  five 
miles  from  the  scene  of  action,  and  some  fifteen  miles  from  'the  post  of  Lampasas.  The  ball,  from 
a  Remington's  revolver,  entered  just  beneath  the  tenth  rib  of  the  right  side,  and  about  four 
inches  from  the  vertebral  column.  The  ball  lodged  immediately  beneath  the  integument  of  the 
epigastrium,  from  which  position  a  citizen  extracted  the  ball  by  incision  some  two  hours  before 
the  writer  arrived  upon  the  spot.  There  had  been  extensive  hemorrhage,  with  much  prostra- 
tion. Major  Eussell  died  at  midnight,  May  15th,  and  in  the  line  of  duty.  An  autopsy  was  imprac- 
ticable ;  but  it  is  quite  certain  that  the  liver  was  penetrated  by  the  missile.  The  immediate  causes 
of  death  seemed  to  have  been  the  shock  of  the  injury  and  the  haemorrhage. 

CLXII. — Memorandum  of  a  Case  of  Ounshot  Wound  of  the  Liver.    By  F.  L.  TOWN,  Surgeon,  U.  S.  A. 

Private  Joseph  Phelan,  Co.  K,  13th  United  States  Infantry,  aged  22  years,  received  a  gunshot 
wound  of  the  liver.  He  was  admitted  to  the  United  States  post  hospital  at  Fort  Shaw,  Montana 
Territory,  on  April  3, 1870.  The  treatment  consisted  of  simple  dressings.  He  died  on  April  4, 1870. 

CLXIIL— A  Case  of  Gunshot  Wound  of  the  Liver.    By  D.  L.  MAGRUDEE,  Surgeon,  U.  S.  A. 

Private  James  Stainbrook,  19th  Kansas  Volunteers,  being  confined  in  the  guard-house  at  Fort 
Leavenworth,  Kansas,  under  a  charge  of  desertion,  attempted  his  escape  about  1  o'clock  in  the 
afternoon  of  September  4,  1869.  Refusing  to  halt,  he  was  fired  on  by  the  sentinels,  and  when 
in  the  act  of  crossing  a  high  fence,  two  hundred  yards  distant,  one  of  the  shots  took  effect.  A 
ball  entered,  fracturing  the  crest  of  the  right  ilium,  and  passed  upward  and  inward,  traversing  the 
liver  and  intestines,  making  its  exit  three  inches  above  and  a  little  to  the  left  of  the  umbilicus. 
Profuse  internal  haemorrhage  set  in,  and  the  patient  died  at  C  o'clock  the  same  evening,  Septem- 
ber 4,  1869. 


52  REPORT  OP  SURGICAL  CASES  IN  THE  AEMY. 

Gunshot  Wounds  of  the  Spleen — One  complicated  case  has  been  reported  on  page  41. 
The  three  following  reports  refer  to  similar  injuries.  All  of  the  four  cases  had  a  fatal 
result.  Wounds  of  the  spleen  uncomplicated  by  lesions  of  the  intestines,  or  kidneys,  or 
larger  arteries,  are  so  uncommon  that  the  symptoms  of  its  injury  are  almost  as  obscure  as 
the  nature  of  its  functions. 

CLXIV.— Memorandum  of  a  Gunshot  Wound  of  the  Spleen.    By  F.  A.  WILLIAMS,  M.  D.,  Acting 

Assistant  Surgeon. 

Corporal  Allen  Davis,  Co.  B,  17th  United  States  Infantry,  aged  35  years,  was  wounded  by  a 
round  bullet  on  December  25,  1868.  He  was  admitted  to  the  United  States  post  hospital  at  Fort 
Breuham,  Texas,  on  December  26,  1868.  The  missile  entered  the  left  side  of  the  chest  near 
the  ninth  rib,  passed  through  the  front  wall,  through  a  portion  of  the  spleen,  diaphragm,  and 
pleura,  and  emerged  at  the  back  of  the  chest.  The  treatment  consisted  of  Simple  dressings.  He 
died  on  December  28, 18C8. 

CLXV. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Liver  and  Spleen.    By  S.  A.  Dow,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Patrick  Behn,  Co.  A,  34th  United  States  Infantry,  was  instantly  killed  at  Columbus, 
Mississippi,  on  the  morning  of  September  6,  1867,  by  a  ball  from  a.  musket  in  the  hands  of 
one  of  his  fellow-soldiers.  At  the  autopsy,  the  missile  was  found  to  have  entered  the  body  on  the 
left  side  between  the  tenth  and  eleventh  ribs,  passing  through  the  spleen  and  liver,  and  to  have 
lodged  in  the  adipose  tissue  beneath  the  lower  edge  of  the  seventh  rib,  just  at  the  right  of  the 
ensiform  cartilage.  The  spleen  was  torn  into  three  pieces,  and  the  right  and  left  lobes  of  the  liver 
completely  separated. 

CLXVI. — Account  of  an  Autopsy  following  several  Gunshot  Wounds.    By  JOHN  EIDGELY,  M.  D., 

Acting  Assistant  Surgeon. 

Private  Daniel  O'Conner,  Co.  B,  6th  United  States  Cavalry,  was  admitted  into  the  post 
hospital  at  Austin,  Texas,  August  23,  1868,  at  7.30  A.  M.,  in  a  moribund  state  from  the  effects  of 
four  gunshot  wounds,  more  particularly  described  hereafter,  of  whicli  he  died,  at  9  o'clock  A.  M., 
August  23,  1868. 

Wound  first:  Gunshot,  left  arm,  lower  third,  flesh-wound. 

Wound  second:  Gunshot,  one  inch  and  a  half  to  the  right,  and  above  left  nipple,  entering 
the  thorax  between  the  third  and  fourth  ribs,  two  inches  from  sternal  articulation ;  reflected 
across  the  pericardium,  passing  downward,,  traversing  the  lower  lobe  of  left  lung,  and  lodging 
beneath  the  skin  at  intercostal  space  of  sixth  and  seventh  ribs.  It  was  extracted  by  Acting 
Assistant  Surgeon  R.  Gale,  on  the  morning  of  the  injury,  prior  to  his  admission  into  the  post 
hospital.  The  missile  was  a  small- sized  pistol-ball.  The  wound  was  not  necessarily  mortal. 

Wound  third :  Gunshot,  the  missile  entering  the  cavity  of  the  abdomen,  about  three  inches 
to  the  right  and  above  umbilicus,  passed  through  the  right  lobe  of  the  liver,  thence  proceeding 
transversely,  tore  the  large  intestines.  The  missile  was  not  found,  being  probably  thrown  away 
with  intestines  after  their  removal.  This  wound  was  necessarily  mortal. 

Wound  fourth  :  Gunshot,  missile  entered  the  cavity  of  abdomen,  three  to  four  inches  upward 
and  to  the  left  of  umbilicus,  passing  transversely  through  the  stomach  downward,  and  laterally, 
through  the  spleen  and  the  kidney  toward  the  bladder.  Time  and  circumstances  caused  the 
examination  to  be  closed  at  this  stage. 


GUNSHOT  WOUNDS  OF  THE  PELVIS.  5 

GUNSHOT  WOUNDS  OF  THE  PELVIS. — Detailed  reports  of  eight  grave  cases  of  this 
class  were  transmitted,  and  memoranda  of  a  few  slighter  cases,  which  will  be  noted  among 
the  fash  wounds  of  the  trunk  further  on.  Seven  of  the  grave  cases  were  fatal. 

CLXVII. — Report  of  a  Case  of  Gunshot  Fracture  of  the  Pelvis.    By  J.  T.  SCOTT,  M.  D.,  Acting 

Assistant  Surgeon. 

Private  Isam  Davis,  Co.  D,  9tli  United  States  Cavalry,  in  a  quarrel  with  a  comrade  at  Fort 
Stockton,  Texas,  July  4, 1868,  was  mortally  wounded  by  a  ball  from  a  carbine.  The  ball  entered  the 
iliac  region,  above  Poupart's  ligament,  ranging  downward  and  backward,  striking  the  ilium  on  the 
pectineal  line,  shattering  the  acetabulum  and  the  head  of  the  femur,  audlodgingiu  the  anterior  muscles 
of  the  thigh.  As  there  was  no  hope  of  preserving  his  life,  only  palliative  treatment  was  resorted  to. 
He  died  July  21,  1808,  of  pyaemia. 

CLXVIII. — Memorandum  of  a  Case  of  Gunshot  Fracture  of  the  Pelvis.    By  WILLIAM  SHACKLE- 
FORD,  M.  D.,  Acting  Assistant  Surgeon. 

Private  James  Johnson,  Co.  F,  23d  United  States  Infantry,  aged  28  years,  was  accidentally 
wounded  by  the  discharge  of  a  carbine,  in  the  hands  of  a  man  who  was  cleaning  it,  on  November  25, 
18C7.  The  missile  entered  to  the  right  of  the  symphisis  pnbis,  over  the  right  spermatic  cord, 
lacerating  the  sheath,  and  bruising  the  vessels  seriously,  passed  downward  and  backward,,  divid- 
ing the  penis  in  front  of  the  prostate  gland,  and  passed  out  through  the  left  nates.  At  the  time 
of  the  reception  of  the  injury  he  was  in  a  thin  and  anaemic  condition.  Haemorrhage  was  slow  at  first, 
owing  probably  to  a  greater  quantity  of  blood  being  caught  in  the  scrotum  than  passed  out  of  the 
months  of  the  wound.  The  wound  was  more  lacerated  than  usual,  owing,  as  was  afterward 
ascertained,  to  the  ball  having  struck  his  cartridge  box,  flattening  itself  upon  another  ball  before 
entering  the  body.  The  haemorrhage,  though  slow,  continued  some  time,  until  the  man  was  con- 
siderably weakened,  but  finally  ceased  without  any  dangerous  symptoms  arising  from  this  cause. 
Serious  trouble  was  apprehended  from  the  mass  of  blood  collected  in  the  scrotum,  and  also  from 
the  urine  that  must  empty  there.  He  was  admitted  into  the  hospital  at  Camp  Watson,  Oregon,  on 
the  same  day.  Stimulants  were  freely  given,  collections  of  clothing  taken  in  by  the  ball  were 
removed,  and  sulphate  of  morphia  was  given  in  half-grain  doses.  After  he  had  recovered  and 
become  quiet,  a  catheter  was  introduced,  and  a  puncture  was  made,  with  a  trocar,  in  the  scrotum 
to  remove  the  blood  collected  there.  There  was  then  forced  a  stream  of  warm  water  into  the 
scrotum,  through  the  catheter  in  the  penis,  passing  out  both  through  the  wounds  and  scrotum. 
The  morphia  was  discontinued  at  night,  but  whiskey  was  given  freely,  and  diet  ad  libitum 
as  his  appetite  returned.  26th :  Patient  as  well  as  could  be  expected ;  passed  a  tolerably  quiet 
night;  scrotum  much  distended  and  black.  Considerable  clotted  blood  was  removed  by  suck- 
ing it  into  the  catheter.  Fomentations  were  applied.  His  diet  consisted  of  chicken  broth, 
soft-boiled  eggs,  tea  and  toast,  whiskey  in  small  quantities.  27th :  He  is  in  the  same  condition, 
excepting  a  pain  in  the  right  iliac  region  and  small  of  back ;  treatment  continued.  28th:  He  is  in  a 
great  deal  of  pain.  The  scrotum  is  very  much  distended.  There  has  been  no  movement  of  bowels 
or  bladder  since  the  day  of  wound,  (before  wound.)  An  injection  of  warm  soap  suds  was  ordered ; 
this  produced  a  free  evacuation  of  the  bowels,  after  which  the  urine  passed  off  through  the  scrotum 
and  wound,  though  none  through  penis.  29th:  He  is  not  so  well  to-day,  discoloration  extending  up 
the  abdomen,  together  with  swelling  and  increase  of  pain,  also  loss  of  appetite.  Diet  continued, 
but  whisky  changed  for  sherry  wine.  30th:  He  is  peevish,  appearance  haggard,  scrotum  very  much 
swollen  and  painful,  abdomen  hard  and  swollen,  urine  still  passing  away  through  scrotum  and 
wound.  One-fourth  of  a  grain  of  morphia  was  given  every  four  hours,  beef-tea  every  half  hour. 
December  1st:  He  is  in  the  same  condition  as  yesterday,  with  the  addition  of  vomiting.  Continued 
the  application  of  warm  water,  but  administered  no  medicine  to-day.  2d,  there  are  symptoms  of 
peritonitis,  the  abdomen  presenting  the  appearance  of  that  of  a  corpse  inflated  with  gas.  Singul- 
tus  set  in.  He  continued  to  take  both  stimulants  and  chicken  broth,  but  retained  nothing  within  the 


54  EEPOET  OF  SURGICAL  CASES  IN  THE  AEMY. 

stomach.  Three  to  five  drops  of  chloroform  were  given  every  ten  minutes,  arresting  for  a  short 
time  the  hiccough.  The  warm  applications  were  continued.  3d :  He  is  gradually  sinking;  nothing 
remains  in  his  stomach  five  minutes  at  a  time.  Treatment  continued.  4th:  He  is  aware  that  he 
cannot  recover,  and  requests  particularly  that  no  autopsy  shall  be  made.  He  died  at  11  A.  M.,  on 
December  5, 1807. 

CLXIX.— Minute  of  a  Fatal  Gunshot  Wound  of  the  Pelvis.    By  JOHN  J.  HULSE,  Acting  Assistant 

Surgeon. 

Sergeant  John  McDougall,  Co.  H,  4th  United  States  Cavalry,  was  wounded  near  Fort  Mason, 
Texas,  on  November  14,  1867,  while  endeavouring  to  suppress  an  affray  between  a  party  of  soldiers 
and  desperadoes.  The  missile,  a  pistol  ball,  entered  the  right  ilium,  wounding  the  bladder,  and 
lodged  in  the  pelvis.  He  was  admitted  to  the  United  States  post  hospital  at  Fort  Mason.  His 
death  took  place  from  internal  hemorrhage,  on  November  14,  1867. 

CLXX.— Note  of  a  Case  of  Gunshot  Wound  of  the  Pelvis.    By  MILTON  A.  BOACH,  M.  D.,  Acting- 
Assistant  Surgeon. 

Private  Timothy  O'Shaughnessy,  Co.  E,  15th  United  States  Infantry,  aged  27  years,  was 
wounded  on  August  24, 1868,  by  a  pistol  ball,  which  entered  the  right  hip  at  crest  of  ilium,  passed 
obliquely  downward  and  lodged.  He  was  admitted  from  boat  while  en  route  with  his  regiment  to 
Marshall,  Texas,  on  the  same  day,  to  the  United  States  Army  post  hospital  at  Shreveport,  Louisiana. 
Simple  dressings  were  used,  and  the  ball  was  removed  from  seat  of  lodgement,  one  inch  from  the 
right  side  of  the  anus,  previously  to  admission  to  hospital.  He  was  returned  to  duty  on  September 
4,  1868. 

CLXXI. — Report  of  a  Gunshot  Wound  of  the  Abdomen,  in  a  Patient  with  Chronic  Orchitis.    By 
H.  E.  TILTON,  Assistant  Surgeon,  U.  S.  A. 

Private  Patrick  W ,  Troop  D,  2d  United  States  Cavalry,  while  confined  in  the  guard-house 

at  Fort  Lyon,  Colorado  Territory,  was  wounded  February  25,  1868,  by  the  accidental  discharge  of 
a  Spencer  rifle.  The  missile  having  passed  through  the  side  of  the  frame  guard-house,  and  the  left 
arm  of  a  prisoner,  entered  the  right  thigh  of  Wogan,  six  inches  below  the  anterior  superior  spiuous 
process,  passed  under  Poupart's  ligament,  two  inches  from  the  anterior  superior  spinous  process, 
and  lodged  in  the  left  iliacus  muscle;  he  was  in  a  sitting  posture  at  the  time  of  the  reception  of  the 
injury.  He  was  immediately  carried  to  the  hospital,  and  complained  of  intense  pain  in  the  abdo- 
men, which  was  partially  controlled  by  morphia  in  one  half-grain  doses.  In  the  course  of  the 
evening  he  voided  his  urine,  which  was  natural  in  color.  He  vomited  several  times.  His  pulse 
increased  to  100,  with  tumultuous  action  of  the  heart.  He  passed  a  very  uncomfortable  night, 
having  to  be  frequently  propped  up  in  bed  to  get  his  breath ;  pulse  scarcely  perceptible  at  wrist. 
Heart  beating  rapidly  and  with  little  force.  Death  resulted  at  nine  o'clock 
of  the  morning  of  February  26,  1868.  An  autopsy  was  made  six  hours 
subsequently.  On  opening  the  abdomen  a  great  quantity  of  bloody  serum 
escaped ;  large  clots  of  blood  were  found  in  the  hypogastric  region,  and 
there  was  general  peritonitis.  The  ball  was  found  in  the  left  iliac  fossa, 
just  above  the  external  iliac  artery ;  by  tracing  its  course  it  was  found  to 
have  passed  four  times  through  the  small  intestines,  making  seven  open- 
ings, three  times  through  the  mesentery  and  once  through  the  mesocolon. 
Wogan  had  suffered  a  long  time  with  gonorrhoaal  orchitis  of  the  left 
testicle.  The  tunica  vaginalis  was  found  considerably  thickened  and 
adherent  to  the  lower  portion  of  the  testicle,  while  there  was  hydrocele 
of  the  cord.  There  were  also  two  abscesses  in  the  lower  portion  of  the 

FIG.  9.    Testis    enlarged   and  .  . 

indurated  by  inflammation,  it    testicle,  a  part  of  which  adjacent  to  the  epidulymis  and  to  the  abscesses 
i«  iaia  open  to  show  the  cheesy    having  undergone  fibroid  degeneration.    The  testicle  was  forwarded  to 

absn '.-vsrs    that     have     formed.       4.1  „     *  nr    j-       i  ~\T 

spec.  5730,  sec.  i.  A.  M.  M.    tbe  A*m*  Medical  Museum. 

[Haii 'tiu-  natural  size.)  [Its  pathological  condition  is  imperfectly  represented  in  the  adjoining 

wood-cut. — Ed.] 


GUNSHOT  WOUNDS  OF  THE  PELVIS.  55 

Three  examples  of  division  of  the  external  iliac  artery  were  reported.  The  reader 
will  observe  here,  as  elsewhere,  the  very  large  proportion  of  gunshot  wounds  of  arteries  in 
accidents,  assassinations,  and  suicides,  in  comparison  with  those  received  in  battle.  In 
other  words,  that  the  great  arterial  trunks  are  often  divided  at  very  close  range  by  the 
small  projectiles,  but  very  rarely  at  long  range. 

CLXXII. — Note  of  a  Gunshot  Wound  of  the  Abdomen,  with  Lesion  of  the  External  Hiac  Artery.    By 
W.  H.  HOPPER,  M.  D.,  Acting  Assistant  Surgeon. 

Private  John  Gerhardt,  Co.  K,  2d  United  States  Infantry,  aged  22  years,  received  on  January 
9, 1809,  an  accidental  gunshot  wound  of  the  groin.  He  was  admitted  to  the  regimental  hospital 
at  Lebanon,  Kentucky,  immediately  after  reception  of  the  injury,  and  died  one  hour  afterward 
of  haemorrhage,  from  a  wound  of  the  external  iliac  artery. 

CLXXIII. — Remarks  on  a  Case  of  Gunshot  Wound  of  the  Large  and  Small  Intestines.    By  A.  F. 
FITCH,  M.  D.,  Acting  Assistant  Surgeon. 

Corporal  Eobert  Ash,  Co.  E,  38th  United  States  Infantry,  aged  35  years,  was  admitted  to  the 
post  hospital  at  Fort  Hays,  Kansas,  on  October  21,  1867,  in  an  intoxicated  condition,  with  a  gun- 
shot wound  of  the  abdomen.  His  pulse  was  small  and  feeble,  and  skin  cold.  He  was  very  restless, 
and  soon  after  being  put  to  bed  vomited  several  times.  Morphine  was  administered,  and  he  soon 
became  comparatively  quiet.  Death  resulted  at  2  o'clock  on  the  morning  of  the  22d.  At  the  post- 
mortem examination,  thirty-six  ounces  of  fluid,  tinged  with  blood,  were  found  in  the  abdominal 
cavity,  together  with  a  quantity  of  coagulated  blood  and  some  faecal  matter.  The  ball,  on  entering 
the  cavity,  wounded  the  small  intestines  in  two  places,  passed  downward  and  backward  through  the 
sigmoid  flexure  of  the  colon,  severed  the  external  iliac  artery  completely,  and  the  vein  partially, 
then  passed  through  the  ilium  immediately  below  its  anterior  inferior  spinous  process,  fracturing 
the  acetabulum,  and  was  found  lodged  in  the  gluteal  muscles. 

CLXXIV. — Mention  of  a  Gunshot  Wound  of  the  Abdomen,  followed  by  instant  Death.    By  B.  A. 
CLEMENTS,  Surgeon,  U.  S.  A. 

Private  Winny  Abbott,  Co.  K,  25th  United  States  Infantry,  committed  suicide  at  Jackson 
Barracks,  New  Orleans,  Louisiana,  August  8,  1869,  by  shooting  himself  with  his  own  musket.  The 
ball  entered  the  abdomen  two  inches  above  the  pubis,  and  one  inch  to  the  left  of  the  linea  alba, 
passing  through  the  rectus  abdominalis  muscle,  cutting  off  the  bowel,  severing  the  left  external 
iliac  artery,  and  passing  out  posteriorly  through  the  os  innouiinatum.  He  expired  immediately 
after  receiving  the  wound. 


CLXXV. — Memorandum  of  a  Case  of  Double  Gunslwt  Perforation  of  the  Abdomen,  icith  Recovery. 
By  L.  Y.  LORING,  Assistant  Surgeon,  U.  S.  A. 

Private  Charles  Allen,  Battery  K,  1st  Artillery,  received,  in  a  scuffle  at  Fort  Kiley,  Kansas, 
August,  1869,  two  pistol  balls  in  his  left  side ;  one  entered  five  and  a  half  inches  left  of  the  umbili- 
cus and  two  inches  above  crest  of  ilium,  and  made  its  exit  two  inches  above  the  crest  of  the  ilium 
on  a  line  with,  and  two  inches  from,  the  fourth  lumbar  vertebra.  The  other  ball  entered  four  inches 
below  and  to  the  rear  of  the  left  nipple,  making  its  exit  four  inches  directly  below  point  of  entrance. 
In  their  passage  these  balls  did  not  wound  or  pass  through  any  of  the  viscera  of  the  abdomen. 
With  the  exception  of  the  traumatic  fever,  there  was  no  disturbance  in  the  health  of  the  patient. 
The  wounds  have  now  almost  healed,  and  there  remains  some  contraction  of  the  abdominal  mus- 
cles concerned  in  the  wounds. 


56  KEPOET  OF  SUEGICAL  OASES  IN  THE  ARMY. 

GUNSHOT  WOUNDS  OF  THE  GENITO-UKINARY  ORGANS. — The  returns  refer  to  two  cases 
of  gunshot  wounds  of  the  bladder,  and  to  several  of  the  scrotum  and  testes.  One  of  the 
cases  of  wounds  of  the  bladder  has  been  reported  with  the  gunshot  wounds  of  the  pelvis. 
(Report  GLXIX.)  On  page  53,  a  gunshot  wound  of  the  penis  is  noted. 

CLXXVL— Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Bladder.    By  JULES  LE  CARPENTIER, 
M.  I).,  Acting  Assistant  Surgeon. 

Private  Frank  Stewart,  Co.  D,  38th  United  States  Infantry,  aged  24  years,  was  wounded  in  a 
riot,  at  Central  City,  December  24,  1868,  by  a  pistol  ball  which  passed  through  the  right  thigh  and 
lacerated  the  bladder.  He  was  admitted  into  the  post  hospital  at  Fort  Bayard,  New  Mexico,  on 
the  same  day.  Simple  dressings  were  applied.  He  died  on  December  29,  1868,  in  consequence  of 
urinary  infiltration,  producing  peritonitis  and  sloughing. 

CLXXVIL— Report  of  a  Case  of  Oumliot  Wound  of  the  Scrotum.    By  S.  M.  HORTON,  Assistant 
Surgeon,  U.  S.  A. 

Private  Louis  Waffler,  Co.  E,  18th  United  States  Colored  Troops,  aged  22  years,  was  accident- 
ally wounded  at  Fort  Philip  Kearney,  Dakota  Territory,  April  14,  1867,  by  a  conoidal  ball,  which 
entered  the  scrotum  in  front  near  the  middle  line.  He  was  admitted  to  the  post  hospital.  No  clew 
to  the  course  of  the  ball  could  be  found,  the  infiltrated  loose  tissue  of  the  scrotum  preventing  the 
probes  from  entering  the  channel.  There  was  no  tenderness  on  pressure  in  any  of  the  adjacent 
parts.  Two  weeks  after  the  reception  of  the  injury  the  missile  was  excised  from  its  place  of  lodg- 
ment, close  behind  the  trochauter  major.  The  patient  recovered,  and  was  returned  to  duty  on 
May  27, 1867. 

CLXXVI1L— Account  of  a  Gunshot   Wound  of  the  Testicles.    By  W.  N.  McCoY,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Frank  Meyer,  Co.  E,  14th  United  States  Infantry,  aged  24  years,  was  wounded  in  a 
brawl  on  February  3, 1870,  by  a  pistol  bullet  which  passed  through  the  testicles.  He  was  admitted 
to  the  post  hospital  at  Jeffersonville,  Indiana,  on  February  4th.  Simple  dressings  were  applied. 
He  was  returned  to  duty  on  February  21, 1870. 

CLXXIX. — Remarks  on  a  Case  of  Gunshot  Wound  of  the  Testicles.    By  L.  W.  GOLDSBOROUGH, 
M.  D.,  Acting  Assistant  Surgeon. 

On  the  monthly  report  of  sick  and  wounded  at  Camp  Schofield,  Lynchburg,  occupied  by  Com- 
panies A  and  I  of  the  17th  United  States  Infantry,  is  noted  a  case  in  which  the  patient,  whose 
name  is  not  given,  was  accidentally  wounded  by  a  musket  ball  which  passed  through  both  thighs 
and  both  testes,  making  very  ugly  wounds,  particularly  in  the  left  thigh  and  testicle.  The 
scrotum  being  much  lacerated  on  both  sides,  and  torn  portions  of  the  testicles  protruding  through 
the  openings,  much  sloughing  was  apprehended.  The  portions  of  the  testicles  were,  however, 
returned,  and  the  edges  of  the  wounds  of  the  scrotum  were  brought  together  by  sutures,  leaving 
space  enough  for  matter  to  escape.  Cold-water  dressings  were  applied  for  two  or  three  days. 
When  the  discharge  was  beginning  to  be  offensive,  a  weak  solution  of  carbolic  acid  was  applied, 
which  was  continued,  either  dissolved  in  water  or  mixed  with  flax-seed  oil  in  various  proportions, 
the  whole  time  of  the  recovery ;  and  so  admirably  did  it  answer  the  purpose,  that  at  no  time  was 
there  any  unpleasant  odor  scarcely  perceptible,  and  then  only  when  one  was  immediately  at 
the  bedside  and  the  wound  exposed.  But  that  was  not  all ;  not  only  did  the  carbolic  acid  correct 
any  offensive  exhalations,  but  it  certainly  contributed  to  the  patient's  recovery  by  preventing 
sloughing  and  excessive  discharge  of  matter. 


GUNSHOT  FLESH-WOUNDS  OP  THE  TRUNK.  57 

GUNSHOT  FLESH- WOUNDS  OF  THE  TRUNK. — The  cases  reported  were  not  very  impor- 
tant and  the  special  reports  forwarded  not  numerous. 

CLXXX. — Note  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Trunk.    By  J.  P.  ARTHUR,  Assistant 
Surgeon  36th  United  States  Colored  Troops. 

Private  Samuel  Willmare,  Co.  G,  HGtli  Colored  Troops,  aged  26  years,  received,  on  July  10, 
1866,  an  accidental  gunshot  flesh-wound  of  the  right  hypochondriac  region.  A  conoidal  ball  had 
entered  between  the  ninth  and  tenth  ribs.  He  was  admitted  to  the  post  hospital  at  Brazos  San- 
tiago, Texas,  on  July  10,  1866.  The  ball  was  found  lodged  in  the  intercostal  muscles,  and  was 
extracted.  Simple  dressings  were  applied.  He  was  returned  to  duty  on  September  26,  1866. 

CLXXXI. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Buttock.    By  L.  W.  HAYES,  M.  D. 

Acting  Assistant  Surgeon. 

At  Camp  Winfleld  Scott,  Nevada,  April  29,  1868,  Lieutenant  Pendleton  Hunter,  8th  Cavalry, 
was  wounded  in  a  fight  with  Indians.  The  bullet  entered  the  outer  part  of  the  right  buttock,  and 
passed  in  the  direction  of  the  pelvic  viscera.  He  also  received  a  slight  flesh-wound  of  the  right 
fore-arm.  No  serious  complications  followed,  and  the  oflicer  was  returned  to  duty  in  March,  1868. 

CLXXXII. — Minute  of  a  Gunshot  Flesh- Wound  of  the  Abdomen.    By  J.  P.  KING,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Hermon  W.  Seyforth,  Co.  C,  8th  Infantry,  aged  28  years,  received  a  gunshot  wound 
of  the  abdominal  walls,  on  May  6, 1870,  from  a  conoidal  revolver  bullet.  He  was  admitted  from  his 
company  on  the  same  day  to  the  post  hospital  at  Spartanburg,  South  Carolina.  Cold-water  dress- 
ings were  applied,  and  anodynes  were  administered.  He  was  returned  to  duty  on  June  3,  1870. 

CLXXXIII. — Note  of  a  Gunshot  Flesh-  Wound  of  the  Abdomen.    By  J.  W.  WILLIAMS,  Assistant 
Surgeon,  U.  S.  A. 

Private  Julius  Cooper,  Co.  A,  21st  Colored  Troops,  aged  20  years,  was  wounded  in  a  riot  at 
Hilton  Head,  South  Carolina,  on  April  1,  1866,  by  a  pistol  bullet  which  penetrated  the  parieties  of 
the  abdomen,  and  lodged.  He  was  admitted  into  the  United  States  Army  general  hospital  at  Hil- 
ton Head,  on  April  2d.  Simple  dressings  were  used.  He  was  returned  to  duty  on  April  14, 1866. 

CLXXXIV.— Report  of  a  Case  of  Gunshot  Wound  of  the  Pubes.    By  S.  T.  WEIRICK,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  David  W.  Jones,  Co.  A,  16th  Infantry,  aged  27  years,  received  on  March  6, 1869,  a 
gunshot  wound  immediately  above  and  to  the  right  of  the  penis,  striking  the  pubis  and  ranging 
to  the  right  and  downward  into  the  thigh,  the  parts  being  very  much  contused.  He  was  treated  at 
the  regimental  hospital  of  a  detachment  of  the  16th  Infantry.  The  surgeon  removed  fragments  of 
cloth,  thread,  &c.,  and  applied  cold-water  dressings.  The  ball  was  not  found.  The  wound  healed, 
and  the  man  was  returned  to  duty  on  March  25, 1869. 

CLXXXV— Memorandum  of  a  Gunshot  Wound  of  the  Lumbar  Region.    By  SAMUEL  S.  JESSOP, 

Assistant  Surgeon,  U.  S.  A. 

Private  Hugh  Monanghan,  Co.  E,  8th  Infantry,  aged  21  years,  was  accidentally  wounded  at 
Chester,  South  Carolina,  on  October  14,  1866,  by  fragments  of  a  ball  which  entered  the  right  lum- 
b;i  r  region,  one  piece  grazing  the  posterior  crest  of  the  ilium,  passing  out  and  perforating  the  fleshy 
part  of  the  fore  arm  on  the  iilnar  side,  while  the  other  entered  a  little  below  the  former  and  lodged 
under  the  integument.  He  was  admitted  to  the  post  hospital  October  14, 1866,  and  portions  of  the 
ball  and  pieces  of  clothing  were  extracted  on  the  same  day. 
8 


58  EEPOET  OF  SURGICAL  CASES  IN  THE  AEMY. 

CLXXXVL— Memorandum  of  a  Gunshot  Wound  of  the  Lumbar  Region.    By  M.  F.  BOWES,  M.  D., 

Acting  Assistant  Surgeon. 

Private  John  Cosgrove,  Co.  F,  8th  Infantry,  aged  23  years,  was  wounded  on  March  17,  18G9. 
A  conoidal  bullet  entered  the  right  side  of  the  back,  near  the  fifth  lumbar  vertebra,  passed  for- 
ward and  outward,  and  made  its  exit  immediately  over  the  anterior  superior  spinous  process  of  the 
ilium.  He  was  admitted  to  the  post  hospital  of  Columbia,  South  Carolina,  on  March  18,  18G9. 
Simple  dressings  were  applied.  He  was  returned  to  duty  in  April,  1809. 


GUNSHOT  WOUNDS  OF  THE  UPPER  EXTREMITIES. — The  reports  are  classified  according 
as  the  lesions  involved  the  scapula,  clavicle,  humerus,  bones  of  the  fore-arrn,  hand,  or  prin- 
cipal joints.  The  reports  of  cases  in  which  operations  were  performed  are  reserved  for  the 
next  chapter. 

Gunshot  Wounds  of  the  Shoulder. — Eighteen  special  reports  relate  to  four  cases  of 
fracture  of  the  scapula,  one  of  the  clavicle  and  scalpula,  one  of  the  clavicle,  one  fatal 
from  profuse  haemorrhage,  ten  cases  of  flesh-wounds,  and  one  wound  of  the  joint  with 
fracture  of  the  humerus. 

CLXXXVIL— Report  of  a  Case  of  Gunshot  Wound  of  the  Shoulder.    By  F.  DAEEOW,  M.  D.,  Acting 

Assistant  Surgeon. 

Private  Martin  Moulton,  Troop  E,  8th  Cavalry,  aged  22  years,  was  wounded  on  April  16, 18G9, 
near  Camp  Willow  Grove,  Arizona  Territory,  by  a  conoidal  ball,  which  entered  the  right  shoulder 
in  front,  striking  the  neck  of  the  scapula  immediately  under  the  clavicle,  passed  downward,  back- 
ward, and  then  upward,  making  seemingly  a  circuit  around  the  neck  of  the  scapula,  and  lodged  in 
the  infra-spinous  fossa  close  to  the  gleuoid  cavity.  He  was  admitted  to  the  post  hospital.  On 
April  19th,  the  wound  had  become  painful,  and  somewhat  inflamed,  and  the  patient  was  unable  to 
move  the  right  arm  or  hand.  The  ball  was  cut  down  upon,  and  removed.  On  May  8th,  the 
wound  was  suppurating  freely.  On  May  12th,  a  rough  and  shelly  piece  of  lead  being  dis- 
covered in  the  incised  wound,  was  taken  out,  and  oil  May  30th,  a  small  piece  of  necrosed  bone  came 
away.  On  June  20th,  the  wound  had  healed,  and  on  June  30th,  there  was  partial  use  of  arm. 

CLXXXVIII. — Mention  of  a  Case  of  Gumliot  Wound  of  the  Scapula.    By  A.  C.  GIEAED,  Assistant 
Surgeon,  U.  S.  A. 

Private  William  H.  Goldsborough,  Co.  D,  24th  Infantry,  aged  24  years,  was  wounded  on  July 
4, 1870,  by  a  sentinel  on  duty.  A  conoidal  bullet  passed  obliquely  through  a  panel-door,  entering 
the  soldier's  right  shoulder  at  the  upper  portion  of  the  deltoid,  and  passing  backward,  and  slightly 
upward,  fracturing  in  its  progress  the  acromion  process,  lodging  against  the  scapula.  Ball  not 
found.  He  was  admitted  to  the  post  hospital  at  Fort  McKavett,  Texas,  on  July  4,  1870.  Simple 
dressings  were  applied.  He  was  returned  to  duty  on  September  22,  1870.  He  was  treated  by 
E.  Sharpe,  Acting  Assistant  Surgeon.  This  man  wheii  returned  to  duty  was  detailed  on  daily 
duty  in  the  post  library.  So  far  he  has  no  use  of  his  right  arm. 

CLXXXIX. — Mention  of  a  case  of  Gunshot  Wound  of  the  Scapula.    By  S.  M.  HOETON,  Assistant 
Surgeon,  U.  S.  A. 

John  Montague,  citizen,  aged  20  years,  was  wounded  while  sitting  at  a  camp-fire,  just  outside 
the  stockade  of  the  fort,  by  Indians,  on  November  2,  1800,  by  a  missile,  supposed  to  be  a  slug 
from  a  shot-gun,  which  fractured  the  spine  of  the  left  scapula,  and  wounded  the  left  cheek.  He 
was  admitted  to  the  post  hospital  at  Fort  Philip  Kearney,  Dakota  Territory,  on  November  2,  18GG. 
Simple  dressings  were  applied  to  the  wound.  He  was  discharged  from  hospital,  cured,  on  Decem- 
ber 2, 1866. 


GUNSHOT  WOUNDS  OF  THE  UPPER  EXTREMITIES.  59 

CXC. — Memorandum  of  a  Case  of  Gunshot  Fracture  of  the  Acromion  Process  of  the  Scapula.    By 
A.  A.  YEOMANS,  Assistant  Surgeon,  U.  S.  A. 

Private  Henry  Allison,  Co.  I,  16th  Infantry,  aged  26  years,  was  wounded  July  25,  1870,  by 
a  couoidal  ball,  which  entered  one  inch  below  the  coracoid  process  of  the  scapula ;  the  ball  passed 
backward  and  upward,  fractured  the  acromion  process,  and  made  its  exit  posteriorly.  He  was  at 
once  admitted  to  the  post  hospital  at  Grenada,  Mississippi.  All  foreign  substances  were  removed 
from  the  wound,  and  cold-water  dressings  applied;  the  right  arm  was  put  in  a  sling,  and  the 
patient  kept  as  quiet  as  possible.  When  suppuration  ensued,  flaxseed  poultices  were  applied,  and 
afterward,  resin  cerate.  He  was  transferred  to  Jackson,  Mississippi,  and  returned  to  duty  in 
December,  1870. 

CXCI. — Mention  of  a  Case  of  Gunshot  Fracture  of  the  Clavicle.    By  ELLIOTT  COUES,  Assistant 
Surgeon,  U.  S.  A. 

Private  Daniel  Eyau,  Co.  C,  8th  Infantry,  aged  21  years,  was  admitted  to  the  post  hospital  at 
Columbia,  South  Carolina,  on  November  17,  1868,  with  a  gunshot  compound  comminuted  fracture 
of  the  clavicle.  The  missile,  which  lodged  somewhere  in  the  muscles  of  the  back  or  side  of  the 
neck,  could  not  be  found.  Excellent  results  have  been  obtained  by  adaptation  of  bandages  to 
this  special  case. 

CXCII. — Memorandum  of  a  Case  of  Gunshot  Fracture  of  the  Clavicle  and   Scapula.     By  H.  S. 
SCHELL,  Assistant  Surgeon,  U.  S.  A. 

Private  Moses  Vetzstiue,  Co.  I,  18th  Infantry,  aged  20  years,  received,  in  a  brawl  on  August 
21, 1867,  a  gunshot  wound  by  a  conoidal  ball,  which  penetrated  the  right  shoulder,  fracturing  the 
clavicle  and  scapula.  He  was  admitted  to  the  post  hospital  at  Fort  Laramie,  Dakota  Territory, 
on  the  following  day.  Splints  and  bandages  were  applied.  The  man  was  returned  to  duty  January 
1, 1868. 

CXCIII. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Shoulder.    W.  A.  CANTEELL,  M.  D., 
Acting  Assistant  Surgeon. 

Private  John  O'Brien,  Co.  B,  28th  Infantry,  of  a  constitution  injured  by  the  habitual  use  of 
alcoholic  stimulants,  was  wounded  July  24,  1868,  by  buckshot,  which  entered  the  left  shoulder. 
He  was  immediately  admitted  to  the  post  hospital  at  Little  Bock,  Arkansas,  prostrated  from 
haemorrhage.  The  treatment  consisted  of  styptics  and  simple  dressings.  He  died  iu  a  few  hours 
after  admission  to  the  hospital. 

CXCIV.— Note  of  a,  Case  of  Gunshot  Flesh-Wound  of  the  Shoulder.     By  JULIUS  H.  PATZKI, 
Assistant  Surgeon,  U.  S.  A. 

Private  Benjamin  Amey,  Co.  H,  6th  Cavalry,  aged  26  years,  received  a  gunshot  flesh-wound 
of  the  right  shoulder,  by  a  conoidal  ball,  in  action  with  Indians  near  the  North  Fork  of  the  Little 
Wichita  Eiver,  Texas,  July  12,  1870.  He  was  admitted  to  the  post  hospital  at  Fort  Eichardson, 
Texas,  on  the  14th,  where  carbolic  acid  dressings  were  applied.  He  was  returned  to  duty 
on  the  18th. 

CXCV.— Note  of  a    Gunshot    Wound  of  the  Shoulder.     By  J.  B.   CRANDALL,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Thomas  Nolan,  Co.  I,  37th  Infantry,  aged  27,  was  wounded  on  September  24, 1867, 
by  a  conoidal  ball,  in  the  left  shoulder.  He  was  admitted  from  the  field  on  September  25th.  Simple 
dressings  were  applied  to  the  wouud.  He  was  returned  to  duty  in  September. 

CXC VI.— Mention  of  a  Gunshot  Flesh-Wound  of  the  Shoulder.    By  J.  W.  WILLIAMS,  Assistant 
Surgeon,  U.  S.  A. 

Corporal  Edward  Nolan,  Co.  C,  5th  Cavalry,  was  admitted  to  the  post  hospital  at  Atlanta, 
Georgia,  on  January  9,  186!),  with  a  gunshot  wouud  of  the  left  shoulder,  received  in  a  brawl  on 
January  2d.  .Simple  dressings  were  applied.  He  was  returned  to  duty  ou  January  28th. 


60  REPORT  OP  SUEGICAL  CASES  IN  THE  ARMY. 

CXCVIL— Account  of  a  Gunshot  Flesh- Wound  of  the    Shoulder.     By  J.  JET.  PATZKI,  Assistant 

Surgeon,  U.  S.  A.  . 

Private  Samuel  Wagoner,  Co.  A,  6th  Cavalry,  aged  24  years,  received  a  gunshot  flesh-wound 
of  the  left  shoulder,  by  a  couoidal  ball,  in  action  with  Indians,  near  North  Fork  of  Little  Wichita 
River,  Texas,  July  12,  1870.  He  was  admitted  to  the  post  hospital  at  Fort  Richardson,  Texas, 
on  the  14th,  where  simple  dressings  were  applied.  He  was  returned  to  duty  on  August  3d. 

CXCVIIL— Report  of  a  Gunshot   Flesh-  Wound  of  the  Scapular  Region.     By  EDWAKD  COWLES, 
Assistant  Surgeon,  U.  S.  A. 

Corporal  John  Pilot,  Co.  L,  9th  Cavalry,  aged  26  years,  was  shot,  by  a  sergeant,  on  December 
27, 1867,  by  a  con'oidal  carbine  bullet  which  caused  a  flesh-wound  of  the  right  scapular  region,  and 
inside  of  the  right  arm,  below  the  axilla.  He  was  admitted  into  the  post  hospital  at  Browns- 
ville, Texas,  on  December  27th.  Simple  dressings  were  applied.  He  was  returned  to  duty  in 
February,  1868. 

CXCIX. — Account  of  a  Gunshot  Wound  of  the  Slwulder.      P.  MIDDLETON,   Assistant   Surgeon, 
U.  S. A. 

Private  William  McCulla,  Troop  E,  1st  Cavalry,  aged  22  years,  was  wounded  in  a  drunken 
row  at  Prescott,  Arizona  Territory,  December  18,  1867,  by  a  conoidal  ball,  which  entered  at  the 
centre  of  the  belly  of  the  biceps  muscle,  passed  upward  and  inward  toward  the  shoulder-joint, 
thence  beneath  the  scapula,  and  lodged  under  the  deep  muscles,  about  two  inches  from  the  first 
dorsal  vertebra.  He  was  admitted  to  post  hospital  at  Camp  Whipple,  Arizona  Territory.  On 
December  26th,  I  made  an  incision  and  removed  the  ball.  Healthy  suppuration  then  followed,  and 
the  patient  did  well.  On  February  5, 1868,  he  was  transferred  to  Camp  McDowell,  where  his  com- 
pany was  stationed. 

CC. — Report  of  a  Case  of  Gunshot  Flesh-Wound  of  the  Shoulder.    By  F.  GEISDORFF,  M.  D.,  Acting 
Assistant  Surgeon. 

Corporal  Merritt  E.  Brown,  Co.  A,  27th  Infantry,  aged  22  years,  received  on  August  4,  1868, 
an  accidental  gunshot  wound.  A  bullet,  ploughing  the  skin  and  muscles  underneath,  caused  a 
wound  five  inches  long,  two  inches  wide,  and  one  inch  deep,  superior  and  parallel  to  the  spine  of 
scapula  of  the  left  shoulder.  He  was  admitted  to  the  post  hospital  at  Fort  Philip  Kearney,  Dakota 
Territory,  on  the  same  day.  Cold-water  dressings  were  applied.  He  was  transferred  to  the  field 
hospital  of  a  detachment  of  the  27th  United  States  Infantry,  nearly  recovered. 

CCI. — Memorandum  of  a  Ca#e  of  Gunshot  Flesh-Wound  of  the  Shoulder.    By  J.  H.  PATZKI,  Assist- 
ant Surgeon,  U.  S.  A. 

Private  Albert  Ford,  Co.  H,  6th  Cavalry,  aged  42  years,  received  a  gunshot  flesh-wound  of  the 
left  shoulder  by  a  conoidal  ball,  in  an  action  with  Indians,  near  the  North  Fork  of  Little  Wichita 
River,  Texas,  July  12, 1870.  He  was  admitted  to  the  post  hospital  at  Fort  Richardson,  Texas,  on 
the  14th,  and  carbolic  acid  dressings  applied.  He  was  returned  to  duty  on  August  19th. 

CCII. — Note  of  a  Case  of  Gunshot  Wound  of  the  Shoulder  and  Thigh.    By  R.  POWELL,  Assistant 
Surgeon,  TJ.  S.  A. 

At  Camp  Warner,  Oregon,  December  3,  1867,  Private  John  Ryan,  Co.  B,  23d  Infantry,  aged 
20  years,  was  accidentally  wounded  by  the  discharge  of  his  own  pistol,  while  stumbling  and  falling 
over  rocks.  The  missile,  a  couoidal  ball,  inflicted  a  wound  of  the  left  shoulder  and  thigh,  and 
remained  in  the  shoulder  behind  the  head  of  the  humerus.  He  was  admitted  to  the  post  hospital 
on  the  same  day,  where  the  ball  was  excised.  Cold-water  dressings  were  applied.  He  returned 
to  duty  January  20, 1808. 


GUNSHOT  WOUNDS  OF  THE  UPPER  EXTREMITIES.          61 

CCIII. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Shoulder.    By  THOMAS  S.  TUGGLE, 
M.  D.,  Acting  Assistant  Surgeon. 

At  Columbus,  Georgia,  January  7,  1868,  Private  Dnrant,  Co.  G,  16th  Infantry,  received  a 
pistol  wound  in  the  fleshy  part  of  the  right  shoulder  by  a  round  ball.  lie  was  admitted  into  the 
post  hospital  on  the  same  day,  where  the  ball  was  excised  and  simple  dressings  were  applied.  Ho 
was  returned  to  duty  January  19,  1868. 

CCIV. — Abstract  of  a  Report  relative  to  a  Gunshot  Wound  of  the  Shoulder-Joint.    By  B.  B.  WILSON, 
M.  D.,  late  Surgeon  and  Brevet  Lieutenant  Colonel,  U.  S.  V. 

Private  James  Curry,  Co.  M,  20th  Pennsylvania  Cavalry,  was  discharged  the  service  on 
surgeon's  certificate  of  disability,  June  28,  1865.  He  had  been  wounded  in  the  late  war  by  a 
conoidal  bullet,  which  fractured  the  upper  extremity  of  the  humerus,  involving  the  surgical  and 
probably  the  anatomical  neck,  and  had  lodged  upon  the  external  margin  of  the  scapula.  The 
missile  having  been  retained  in  that  position  for  more  than  three  years,  and  the  patient  having 
become  exhausted,  nervous,  and  irritable  from  pain  and  suppuration,  was  induced  to  have  the  ball 
removed.  On  November  27,  1867,  he  presented  himself  at  the  Howard  Hospital,  Philadelphia. 
There  was  complete  anchylosis  of  the  shoulder-joint,  with  enlargement  of  the  upper  portion  of  the 
humerus ;  several  cicatrices  existed  in  the  region  of  the  joint  and  scapula,  and  a  fistulous  orifice 
at  the  inferior  angle  of  the  scapula  discharged  tolerably  healthy  pus.  Examination  with  a  Nelaton 
probe  revealed  the  presence  of  the  ball;  the  sinuous  orifice  was  enlarged,  and  the  ball,  which 
clung  with  tenacity  to  the  edge  of  the  scapula,  was  extracted.  The  fistulous 
orifice  closed  immediately  after  the  removal  of  the  missile.  At  the  time  of 
this  report,  April,  1868,  the  patient  had  a  very  useful  arm,  the  great  mobility 
of  the  scapula  seeming  to  compensate  for  the  anchylosis  of  the  shoulder- 
joint.  The  missile,  a  conoidal  ball  split  by  contact  with  the  humerus,  and 
rig.  10.  conoidal  bail  havjng  adherent  small  portions  of  bone,  is  represented  in  the  wood-cut, 

grooved  by  impact  upon  the 

iiiinii THS.  spec.  5257.  sect,    and  was  presented  to  the  Army  Medical  Museum,  with  the  history,  by  the 
L,  A.M.M.  operator. 


GunsJiot  Wounds  of  tjie  Arm. — Special  reports  were  received  of  four  cases  of  gunshot 
fractures  of  the  humerus. 

CCV. — Mention  of  a  Gunshot  Fracture  of  the  Humerus.  By  T.  M.  CHANEY,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Samuel  Bailey,  Co.  C,  128th  Colored  Troops,  was  shot  by  a  sentinel  on  March 
7,  1867,  causing  a  compound  comminuted  fracture  of  lower  third  of  the  right  humerus.  The 
ball  entered  at  the  point  of  the  external  condyle,  traversed  the  arm,  making  its  exit  one  inch 
above  the  internal  condyle.  He  was  admitted  to  the  post  hospital  at  Fort  Macon,  North  Carolina, 
on  March  8,  1867.  Simple  dressings  were  applied.  He  was  discharged  the  service  May  21,  1867. 

CCVI.— Report  of  a  Gunshot  Fracture  of  the  Neck  of  the  Humerus.    By  H.  G.  TIEDMAN,  M.  D., 

Acting  Assistant  Surgeon. 

Private  James  Sumuer,  Troop  G,  1st  Cavalry,  was  wounded  in  an  action  with  Apache  Indians, 
in  Chilicowley  Mountain  Pass,  Arizona,  October  8,  1869.  The  missile  entered  under  the  scapu- 
lar clavicular  articulation,  passed  through  the  deltoid  downward,  shattered  the  neck  of  the 
humerus,  barely  avoidiug  the  brachial  artery,  and  forced  its  way  out  of  the  triceps  muscle.  Two 
pieces  of  the  neck  of  the  humerus  were  extracted  on  the  field.  On  October  9th,  he  was  admitted 
to  the  hospital  at  Camp  Bowie,  Arizona  Territory,  where  another  piece  of  bone  was  extracted.  He 
was  returned  to  duty  in  November,  1869. 


62  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCVIL— Mention  of  a  Gunshot  Fracture  of  the  Humerus.    By  B.  E.  FEYER,  Assistant  Surgeou, 

U.  S.  A. 

Private  Frank  Crith,  Co.  G,  38tli  Infantry,  was  accidentally  wounded  on  September  4, 1867, 
by  a  conoidal  ball  which  fractured  the  right  humerus  at  the  middle  third.  He  was  admitted  into 
the  post  hospital  at  Fort  Harker,  Kansas,  on  September  5th,  from  the  garrison.  Simple  dressings 
were  used,  and  angular  splints  were  applied.  He  was  returned  to  duty.* 

CCVIII.— Note  of  a  Case  of  Gunslwt  Fracture  of  the  Humerus.    By  J.  V.  D.  MIDDLETON,  Assistant 
Surgeon,  U.  S.  A. 

At  Austin,  Texas,  June  24,  18G9,  William  Bently,  a  citizen  prisoner,  aged  38  years,  was 
shot  while  attempting  to  escape.  The  missile,  a  conoidal  ball,  fractured  the  left  arm.  He  was 
admitted  to  the  post  hospital  on  the  same  day.  Splints  and  bandages  were  applied.  He  was 
discharged  from  further  treatment  on  October  17,  1869. 


Gunshot  Wounds  of  the  Elbow. — Besides  reports  of  cases  requiring  operations,  four 
special  reports  were  made  of  gunshot  wounds  of  the  elbow,  two  referring  to  cases  in 
which  the  articulation  was  opened. 

CCIX. — Account  of  a  Case  of  Gunshot   Fracture  of  the  Humerus.    By  W.  H.  HOPPER,  Acting 
Assistant  Surgeon. 

At  Lebanon,  Kentucky,  August  21,  1869,  Private  Alexander  C.  Moore,  Co.  I,  14th  Infantry, 
aged  23  years,  was  wounded  by  a  conoidal  ball,  which  passed  through  the  inferior  extremity  of 
humerus,  splitting  off  the  external  condyle,  and  lodged  in  the  muscular  tissue  on  the  anterior 
surface  of  the  arm.  He  was  admitted  to  the  regimental  hospital.  Simple  dressings  were  applied 
and  the  wound  was  daily  injected  with  solution  of  carbolic  acid,  and  covered  with  lint  saturated 
with  the  same.  September  30th,  union  of  the  fractured  ends  had  taken  place,  and  the  wound 
healed  with  scarcely  any  suppuration.  He  was  discharged  January  2 1 ,  1870.  There  was  partial 
anchylosis  of  the  elbow-joint. 

CCX. — Mention  of  a  Gunshot  Wound  of  the  Elbow-Joint.    By  J.  O.  D.  CREAGHE,  Acting  Assistant 
Surgeon. 

Private  Willis  Graves,  Co.  F,  19th  Infantry,  aged  18  years,  received  on  August  29, 1866,  at 
Camden,  Arkansas,  a  penetrating  gunshot  wound  of  the  left  elbow-joint.  He  was  at  once  admitted 
to  the  post  hospital.  The  bullet  had  passed  through  the  upper  part  of  the  articulation,  shattered  the 
whole  of  the  external  coudyle  of  humerus,  and  passed  out  posteriorly.  Acting  Assistant  Sur- 
geon J.  O.  D.  Creaghe  enlarged  the  posterior  orifice,  and  removed  all  fragments  of  bone.  Septem- 
ber 30th,  the  wound  was  nearly  healed.  He  was  discharged  October  30,  1866,  his  disability  being 
rated  one-third. 

CCXI. — Account  of  a  Gunshot  Wound  of  the  Elboic-Joint.    By  J.  O.  D.  CREAGHE,  Acting  Assist- 
ant Surgeon. 

At  Camdeu,  Arkansas,  December  14,  1866,  Private  Robert  Clarke,  Co.  B,  28th  Infantry,  aged 
22  years,  received  a  wound  from  a  conoidal  pistol  ball,  which  penetrated  behind  the  internal  con- 
dyle of  left  humerus,  and  passing  in  front  of  elbow-joint  made  its  exit  external  to,  and  a  little 
below,  the  head  of  the  radius.  He  was  admitted  to  post  hospital  December  18,  1866.  Simple 
dressings  were  applied.  He  was  returned  to  duty  in  January,  1867. 

*  Nearly  a  year  later,  iii  August,  1868,  this  soldier  entered  the  post  hospital  at  Fort  Hays,  aud  underwent  an  excision 
of  the  shaft  of  the  humerus.    The  further  history  will  he  given  in  the  chapter  on  operations. — ED. 


GUNSHOT  FEACTUEES  OF  THE  TJPPEE  EXTREMITIES.  63 

CCXIL— Report  of  a  Fatal  Case  of  Gunshot  Wound  of  the  Elbow-Joint.    By  W.  E.  EAMSEY 

Assistant  Surgeon,  U.  S.  A. 

Private  George  Fray,  Co.  E,  36th  Infantry,  aged  21  years,  was  wounded  at  Fort  San- 
ders, Dakota  Territory,  February  22,  1808,  by  the  accidental  discharge  of  a  musket  in  the 
hands  of  a  comrade.  The  missile  passed  through  the  elbow-joint.  He  was  admitted  to  the  hos- 
pital in  a  very  feeble  condition ;  there  was  haemorrhage  from  the  wound,  which  it  was  difficult  to 
control  by  digital  compression,  as  the  artery  rolled  under  the  finger  on  account  of  the  size  of  the 
biceps.  At  11  P.  M.  the  haemorrhage  ceased  by  coagulation,  and  the  patient  reacted  gradually, 
but  continued  weak.  He  remained  in  the  same  condition  until  February  25th,  when  he,  for  the 
first  time,  asked  for  something  to  eat.  He  seemed  restless,  and  complained  of  being  sick  at  the 
stomach  and  of  pain  in  the  arm.  On  the  evening  of  February  24th,  he  had  a  chill  and  tympanites 
appeared  shortly  afterward.  He  died  on  February  25th.  From  the  sudden  change  on  the  even- 
ing of  the  day  previous  to  his  death,  and  from  the  prevalence  of  intermittent  fever  at  the  time, 
the  case  was  supposed  to  be  one  of  congestive  chill.  There  was  no  indication  of  pyaemia. 


Gunshot  Wounds  of  the  Fore-arm. — Twelve  special  reports  relate  to  cases  of  this 
class.  Two  of  these,  resulting  from  the  premature  explosion  of  cannon,  terminated  fatally; 
three  patients  were  discharged  for  disability,  and  seven  returned  to  duty. 

CCXIII. — Mention  of  a  Gunshot  Fracture  of  the  Radius  and  Ulna.    By  O.  SMITH,  M.  D.,  Acting 
Assistant  Surgeon. 

Corporal  James  Bohan,  Co.  H,  4th  Cavalry,  aged  27  years,  was  shot  by  a  drunken  sol- 
dier, November  9,  1870.  The  ball  struck  the  right  fore-arm  and  fractured  the  radius  completely 
and  the  ulna  partially.  He  was  admitted  to  the  field  hospital  on  the  same  day,  when  Acting 
Assistant  Surgeon  Orsamus  Smith  removed  all  detached  pieces  of  bone,  and  applied  splints.  The  case 
progressed  favorably,  and  on  November  11, 1870,  the  patient  was  transferred  to  Fort  Eichardson, 
TexasQ_He  was  sent  to  his  company  at  Fort  Griffin. 

CCXIV. — Mention  of  a  Gunshot  Fracture  of  the  Left  Radius.    By  P.  J.  A.  CLEARY,  Assistant 
Surgeon,  U.  S.  A. 

Private  Christopher  Boats,  Co.  D,  9th  Cavalry,  aged  21  years,  was  wounded  by  a  weapon  in 
the  hands  of  a  fellow-soldier.  The  missile,  a  conoidal  ball,  caused  a  compound  comminuted  frac- 
ture of  the  radius  of  the  left  arm  at  the  middle  third,  then  struck  the  tenth  rib,  and  passed  under 
the  integuments,  and  lodged  two  inches  to  the  left  of  the  spine.  He  was  admitted,  on  June  27, 
1870,  to  the  post  hospital  at  Fort  Stockton,  Texas,  where  the  ball  and  some  small  spiculre  of 
bone  were  removed;  chloride  of  lime  and  water  dressings  were  applied  to  the  wounds,  and 
splints  to  the  fore-arm  with  a  view  to  save  the  limb.  He  was  returned  to  duty  in  September, 
1870. 

CCXV.— Mention  of  a  Gunshot  Fracture  of  the  Radius.    By  G.  W.  TowAR,  M.  D.,  Acting  Assist- 
ant Surgeon. 

Private  Thomas  Hubbard,  Co.  C,  2d  Cavalry,  aged  22  years,  was  wounded  in  a  fight  with 
Indians  on  May  17,  1870,  by  a  rifle  bullet,  which  struck  the  left  fore-arm  near  the  wrist,  fracturing 
the  radius.  He  was  admitted  from  the  field  on  May  17,  1870,  to  Camp  Biugham,  Little  Blue  Kiver, 
Nebraska.  The  treatment  consisted  of  simple  dressings,  with  splints.  He  was  transferred  to  the 
hospital  at  Omaha  Barracks  on  June  7,  1870,  and  returned  to  duty  during  the  same  mouth. 


64  BEPOET  OF  SURGICAL  CASES  IN  THE  AEMY. 

CCXVI. — Mention  of  a  Gunshot  Fracture  of  the  Radius.    By  F.  GEISDORFF,  M.  D.,  Acting  Assist- 
ant Surgeon. 

Sergeant  Edward  Oliver,  Co.  A,  27th  Infantry,  aged  25  years,  received,  on  August  4,  18G8,  an 
accidental  gunshot  wound.  A  rifle  ball  had  entered  the  right  fore-arm  anteriorily  one  inch  above 
the  wrist  joint,  fracturing  the  radius,  and  made  its  exit  two  inches  above  the  joint.  Wound  of 
entrance  four  lines  in  diameter ;  of  exit,  sixteen  lines ;  area  of  wound,  12.56,  176  in  square  lines. 
He  was  admitted  to  the  post  hospital  at  Fort  Philip  Kearney,  Dakota  Territory,  on  the  same  day. 
Cold-water  dressings  were  applied.  He  was  transferred  to  the  field  hospital  of  a  detachment  of  the 
27th  Infantry.  He  was  discharged  February  27,  18C9,  for  anchylosis  of  right  fore-arm. 

CCXVII. — Note  of  a  Case  of  Gunshot  Fracture  of  the  Ulna.    By  J.  W.  WILLIAMS,  Assistant  Sur- 
geon, U.  S.  A. 

Private  John  Tracey,  Co.  B,  16th  Infantry,  was  admitted  to  the  post  hospital  at  Atlanta, 
Georgia,  on  November  28,  1868,  with  a  pistol  shot  wound  of  the  right  fore-arm,  fracturing  the 
ulna,  received  November  27th.  He  was  transferred  to  his  company  at  Dahlouega,  Georgia,  on 
January  28, 1S69. 

CCXVIIL— Report  of  a  Gunshot  Fracture  of  the  Ulna.    By  B.  EOCTOE,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Thomas  Trowell,  Co.  G,  128th  Colored  Troops,  was  wounded  in  a  mutiny  on  Folly 
Island,  South  Carolina,  July  19,  1866,  by  a  pistol  ball,  which  fractured  the  ulna  of  the  left 
arm.  He  was  admitted  to  the  post  hospital  at  Charleston,  South  Carolina,  the  same  day,  and 
returned  to  duty  August  22d. 

CCXIX.— Report  of  a  Case  of  Gunshot  Wound  of  the  Fore-Arm.    By  W.  H.  SMITH,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Welcome  Joseph,  Troop  B,  8th  Cavalry,  aged  18  years,  was  wounded  May  6,  1869, 
in  a  fight  with  Indians  near  Camp  Verde,  Arizona  Territory.  The  ball  fractured  the  radius,  pass- 
ing through  the  left  fore-arm  between  the  radius  and  ulna,  diagonally  from  the  end  of  the  elbow  in 
front  to  the  middle  of  the  fore-arm  behind.  He  was  admitted  to  the  post  hospital,  where  the  frac- 
tured bone  was  set.  Small  pieces  of  bone  were  from  time  to  time  removed,  and  on  June  17th,  a 
large  piece,  grooved  by  the  ball,  was  cut  down  upon  and  taken  out.  On  June  30th,  the  wound  was 
healing  rapidly,  the  limb  promising  to  be  serviceable,  and  without  deformity. 

CCXX. — Mention  of  a  Gunshot  Fracture  of  the  Ulna.    By  E.  TANSZKY,  M.  D.,  Acting  Assistant 
Surgeon. 

Sergeant  George  Smith,  Troop  A,  9th  Cavalry,  aged  21  years,  was  wounded  at  Fort  Stockton, 
Texas,  December  26,  1868,  by  a  pistol  ball,  which  fractured  the  ulna  of  the  left  fore-arm.  He  was 
admitted  to  the  post  hospital,  where  foreign  bodies  were  removed  from  the  wound,  and  cold-water 
lotions  were  applied.  He  was  returned  to  duty  in  February,  1869. 

CCXXL— Report  of  a  Gunshot  Wound  of  the  Fore-Arm.    By  F.  MEACHAM,  Assistant  Surgeon, 
U.  S.  A. 

Private  Edward  Jones,  Co.  G,  36th  Infantry,  aged  22  years,  and  of  scrofulous  diathesis,  was 
wounded  at  Camp  Douglas,  Utah  Territory,  on  March  4,  1868,  by  a  conoidal  ball  which  entered 
near  the  lower  third  of  the  right  ulna  on  the  inner  side,  passed  through  the  flexor  muscles  of  the 
carpus  and  of  the  hand,  injured  the  ulnar  nerve,  and  emerged  near  the  internal  condyle  of  the 
humerus.  He  was  admitted  to  the  post  hospital  at  Camp  Douglas,  Utah  Territory,  where  water- 
dressings  were  applied.  The  case  did  well  until  April  22d,  when  eczema  set  in,  which  gave  way 
to  appropriate  treatment.  On  July  27,  1868,  he  was  discharged  from  service :  there  was  considera- 
ble loss  of  motion  in  the  elbow  and  wrist-joint,  with  loss  of  sensation  in  the  little  finger  and  outside 
of  the  ring-finger. 


GUNSHOT  WOUNDS  OP  THE  UPPER  EXTREMITIES.  65 

CGXXII. — Note  of  a  Case  of  Premature  Discharge  of  a  Cannon.    Right  Fore- Arm  carried  away. 
By  WILLIAM  CRAIG,  M.  D.,  Actiug  Assistant  Surgeon. 

Sergeant  John  Southwood,  Co.  K,  40th  Infantfy,  aged  39  years,  was  wounded  May  1,  18G7,  by 
the  premature  discharge  of  a  cannon,  which  carried  away  the  left  fore-arm,  eight  inches  below 
the  elbow,  and  severely  contused  the  left  breast  and  shoulder.  He  was  admitted  to  the  post 
hospital  the  same  day.  Stimulants  and  tonics  were  administered,  and  cooling  lotions  applied 
externally.  He  died  May  13th  from  pneumonia. 

CCXXIII. — Memorandum  of  a  Case  in  which  the  Fore-Arm  was  torn  off  by  a  Large  Projectile.    By 
WILLIAM  CRAIG,  M.  D.,  Actiug  Assistant  Surgeon. 

Sergeant  Charles  H.  Peterson,  Co.  K,  40th  Infantry,  aged  25  years,  was  wounded  May  1, 
1867,  by  the  premature  discharge  of  a  cannon,  which  carried  away  the  right  fore-arm,  six  inches 
below  the  elbow,  and  severely  contused  the  right  breast.  He  was  admitted  to  the  post  hospital 
at  Fort  Caswell,  North  Carolina,  the  same  day.  Stimulants  were  administered,  and  olive  oil  and 
lime  water  applied  externally.  He  died  May  1st,  from  the  great  shock. 

CCXXIV. — Note  of  a  Case  of  Gunshot  Fracture  of  Radius  and  Ulna.    By  G.  H.  GUNN,  Assistant 
Surgeon,  U.  S.  A. 

Private  Thomas  Poster,  Co.  I,  9th  Cavalry,  aged  24  years,  was  wounded  August  24,  1870,  by  a 
conoidal  ball,  which  fractured  both  bones  of  the  right  fore-arm.  He  was  admitted  to  the  post  hos- 
pital at  Port  Quitman,  Texas,  on  the  same  day.  The  treatment  consisted  of  splints  and  simple 
dressings.  On  December  10th  he  was  discharged  from  service  on  surgeon's  certificate  of  disability. 


Gunshot  Wounds  of  the  Hand. — Special  reports  were  made  of  twenty  cases.     Sev- 
enteen patients  went  to  duty,  and  three  were  discharged. 

CCXXV. — Note  of  a  Gunshot  Wound  of  the  Hand.    By  P.  MIDDLETON,  Assistant  Surgeon,  U.  S.  A. 

Sergeant  P.  W.  Bryant,  Co.  G,  14th  Infantry,  aged  21  years,  was  wounded  at  Camp  Whipple, 
Arizona  Territory,  on  December  17,  1868,  by  the  accidental  discharge  of  a  pistol;  the  ball  entered 
to  the  right  of  the  median  line,  midway  between  the  metacarpo-phalangeal  articulation  and  the 
articulation  of  the  first  and  second  phalangeal  bones,  and  emerged  directly  opposite,  fracturing 
the  first  phalangeal  bone  without  injuring  the  tendons.  He  was  admitted  to  the  post  hospital, 
where  the  finger  was  placed  in  a  splint  and  cold-water  dressings  applied.  He  recovered  and  was 
returned  to  duty  in  February,  1869. 

CCXXVI. — Report  of  a  Gunshot  Wound  of  the  Hand.    By  A.  C.  GIRARD,   Assistant  Surgeon, 
U.  S.  A. 

Private  Martin  Cramer,  Co.  A,  19th  Infantry,  aged  24  years,  was  accidentally  wouded  at 
Baton  Rouge,  Louisiana,  April  23,  1870,  by  a  conoidal  ball,  which  caused  a  partial  fracture  of 
middle  finger  of  left  hand.  He  was  admitted  to  the  post  hospital,  where  several  small  splinters  of 
bone  were  extracted.  The  wound  suppurated  freely,  and  had  healed  on  May  16, 1870,  when  the 
patient  was  returned  to  duty. 

CCXXVII. — Mention  of  a  Case  of  Gunshot  Wound  of  the  Hand.    By  E.  COWLES,  Assistant  Surgeon, 
U.  S.  A. 

Private  Bernard  Cunningham,   Co.  K,  4th  Cavalry,   aged  27  years,   was  accidentally  shot 
on  September  15,  1808,  at  Brownsville,  Texas,    A  ball  entered  the  volar  surface  of  the  left 
hand,  and  fractured  the  second  and  third  metacarpal  bones,    There  was  considerable  Iwmorrhage 
9 


66  REPORT  OF  SUEGICAL  CASES  IN  THE  ARMY. 

from  small  vessels,  and  the  wcmnd  of  exit  was  considerably  lacerated.  He  was,  on  September 
Kith,  admitted  to  post  hospital.  Several  fragments  of  bone  were  removed,  and  cooling  lotions 
applied.  October  1st:  The  hand  and  fore-arm  t  were  much  swollen,  and  almost  in  a  sphacelated 
condition.  The  patient  was  greatly  depressed,  and  suffered  from  hectic  fever  and  diarrhu'a. 
Liberal  diet  was  given,  and  a  gradual  improvement  took  place.  During  the  first  quarter  of  1809, 
the  wound  remained  open,  there  being  necrosis  of  carpal  and  metacarpal  bones.  Sequestra  were 
removed,  and  on  March  31,  18G9,  the  patient  was  doing  well.  He  was  returned  to  duty  in 
July,  1869. 

CCXXVIII.  —  Account  of  a  Gunshot  Wound  of  the  Hand.    By  W.  PORTER,  M.  D.,  Acting  Assist- 
ant Surgeon. 

Sergeant  Thomas  Downey,  Co.  C,  7th  Infantry,  aged  37  years,  received  a  gunshot  wound 
of  the  left  hand,  on  February  3,  1808,  at  Gainesville,  Florida,  while  quieting  a  riot  among  civilians. 
The  ball  passed  into  the  palm  of  the  hand,  and  fractured  the  metacarpal  bone  of  middle  finger. 
The  ball  was  taken  out  from  under  the  skin  at  the  back  of  the  hand.  He  was  admitted  to  the 
post  hospital,  where  chloroform  and  ether  were  administered,  and  several  pieces  of  fractured  bone 
were  removed.  He  was  returned  to  duty  February  23,  1808. 


of  a  Gunshot  Woitnd  of  the  Hand.    By  C.  E.  GODDARD,  Assistant  Surgeon, 
U.  S.  A. 

Private  Martin  Flannery,  Co.  E,  2d  Battalion,  16th  Infantry,  aged  28  years,  was  wounded 
(by  himself)  on  December  20,  1866,  by  a  conoidal  bullet,  which  passed  between  the  index  and 
second  fingers  of  the  right  hand,  near  their  phalangeo-metacarpal  articulation,  injuring  both  joints, 
and  the  periosteum  of  the  phalangeal  bones.  He  was  admitted  into  post  hospital  at  Chattanooga, 
Tennessee,  on  the  same  day.  Simple  dressings  were  applied.  He  was  returned  to  duty  in 
February,  1867. 

CCXXX.  —  Report  of  a  Case  of  Gunshot  Fracture  of  the  Metacarpal  Bone.    By  H.  8.  SCHELL, 
Assistant  Surgeon,  U.  S.  A. 

Private  Andrew  Likarte,  Co.  A,  2d  Cavalry,  aged  20  years,  received  a  perforating  gunshot 
wound  of  the  hand,  at  Fort  Laramie,  Dakota  Territory,  March  1,  1867,  by  a  conoidal  ball, 
which  fractured  the  fourth  metacarpal  bone.  He  was  admitted  to  the  post  hospital  March  3d. 
Lead-water  and  laudanum  dressings  were  applied.  He  was  returned  to  duty  March  29,  1867. 

CCXXXI.  —  Note  of  a  Gunshot  Wound  of  the  Carpus.    By  JAMES  P.  KIMBALL,  Assistant  Surgeon, 
U.  S.  A. 

Private  William  Lavelle,  Co.  F,  7th  Infantry,  aged  21  years,  accidentally  received  on  June  7, 
1870,  a  gunshot-wound  of  the  left  wrist,  the  ball  passing  through  the  center  of  the  carpus.  He 
was  admitted  to  the  post  hospital  at  Fort  Buford,  Dakota  Territory,  where  fragments  of  bone 
were  removed  from  the  wound,  and  the  injury  was  dressed  with  carbolic  acid.  He  was  discharged 
November  30,  1870. 

CCXXXII  __  Account  of  a  Gunshot  Wound  of  the  Hand.    By  H.  MCELDERY,  Assistant  Surgeon, 
U.  S.  A. 

Private  William  F.  Leete,  Co.  K,  6th  Cavalry,  aged  24  years,  was  accidentally  wounded  on 
December  26,  1867,  by  a  conoidal  ball,  which  entered  one  half  inch  above  the  second  phalango- 
metacarpal  articulation  of  the  left  hand,  and  emerged  on  the  dorsal  surface,  comminuting  the 
metacarpal  and  first  phalangeal  bone  of  that  finger.  He  was  admitted  into  the  post  hospital 
at  Camp  Wilson,  Texas,  on  October  27,  1867.  The  treatment  consisted  of  cold-water  dressings, 
isinglass  plaster,  solution  of  muriatic  acid,  and  ointment  of  subnitrate  of  bismuth  ;  anodynes  and 
tonics  were  administered  internally.  He  was  discharged  March  5,  1868, 


GUNSHOT  WOUNDS  OF  THE  UPPER  EXTREMITIES.  67 

CCXXXIII. — Note  of  a  Gunshot  Fracture  of  the  Metacarpus.    By  CHARLES  C.  FURLEY,  M.  D.,  Act- 
ing Assistant  Surgeon. 

Private  Christopher  0.  Minnigan,  Co.  E,  41st  Infantry,  aged  27  years,  accidentally  received  a 
gunshot  wound  of  the  left  hand,  by  an  Enfleld  rifle  ball.  He  was  admitted  from  his  regiment  on 
June  30,  1867,  to  the  post  hospital  at  Brownsville,  Texas.  At  the  time  of  the  admission  he  had 
nearly  recovered.  Simple  dressings  were  used.  He  was  returned  to  duty  in  July,  18G7. 

CCXXXIV. — Report  of  a  Gunshot   Wound  of  the  Hand.    A.  L.  FLINT,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  John  Murphy,  Co.  C,  5th  Cavalry,  aged  24  years,  was  wounded  October  15,  1868,  in 
a  street  brawl,  by  a  conoidal  ball,  which  injured  the  bones  of  the  left  hand.  He  was  admitted  to 
Camp  Emory,  Atlanta,  Georgia,  on  the  16th.  Simple  dressings  were  applied.  He  was  returned 
to  duty  on  the  27th. 


CCXXXV. — Report  of  a  Gunshot  Wound  of  the  Hand.    By  J.  F.  BOUGHTON,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Brice  Perkins,  Co.  D,  22d  Infantry,  aged  20,  was  wounded  at  Fort  Dakota,  Dakota 
Territory,  on  April  5,  1868,  by  a  pistol  ball,  which  entered  the  outer  border  of  the  palmar  surface 
of  the  index  finger  of  the  left  hand,  and,  traversing  around  more  than  half  the  circumference  of  the 
second  phalanx,  made  its  exit  at  the  inner  border  of  the  dorsal  surface,  near  the  second  joint. 
Very  little  haemorrhage  occurred.  He  was  admitted  to  the  post  hospital  at  Fort  Dakota,  wheu 
water-dressings  were  applied.  He  was  returned  to  duty  on  April  30,  1808. 

CCXXXVL— Report  of  a  Gunshot  Wound  of  the  Hand.    By  E.  C.  Fox,  M.  D.,  United  States 
Colored  Troops. 

Private  Breboy  Reed,  Co.  G,  128th  United  States  Colored  Troops,  aged  22  years,  was  wounded 
in  a  mutiny  on  Folly's  Island,  South  Carolina,  July  19, 1866,  by  a  pistol  ball,  which  entered  the 
dorsal  aspect  of  the  left  hand  near  the  metacarpal  bone  of  the  index  finger.  He  was  at  once 
admitted  to  the  post  hospital,  where,  on  July  31st,  the  ball  was  extracted  from  near  the  uluar 
artery.  He  was  returned  to  duty  October  12,  1866. 

CCXXXVII. — Memorandum  of  a  Case  of  Gunshot  Fracture  of  the  Metacarpal  Bone.    By  G.  H.  GuNN, 
Assistant  Surgeon,  U.  S.  A. 

Private  Felix  Ross,  Co.  H,  9th  Cavalry,  aged  25  years,  was  wounded  November  16, 1870,  by  a 
couoidal  ball,  which  fractured  the  metacarpal  bone  of  the  second  finger.  He  was  admitted  to  the 
post  hospital  at  Fort  Quitniau,  Texas,  on  the  18th,  Simple  dressings  were  applied.  He  was 
returned  to  duty  in  February,  1871. 

CCXXXVIIL— Report  of  a  Gunshot  Wound  of  the  Hand.    By  C.  S.  DsGRAW,  Assistant  Surgeon, 
U.  S.  A. 

Private  George  Overtoil,  Co.  K,  10th  Cavalry,  was  accidentally  wounded  January  19, 1869,  by 
a  conoidal  ball,  which  fractured  the  second  metacarpal  bone  of  the  right  hand.  He  was  admitted 
to  the  post  hospital  at  Fort  Dodge,  Kansas,  on  May  18,  1869.  Simple  dressings  were  applied. 
Several  small  pieces  of  bone  were  discharged  from  the  upper  wound.  He  recovered,  and  was 
returned  to  duty  in  June,  1869. 


08  EEPORT  OF  SURGICAL  OASES  IN  THE  AKMY. 

CCXXXIX.— Mention  of  a  Gunshot  Wound  of  the  Sand.    By  BEDFORD  SHARP,  M.  D.,  Acting  Assi  sl- 
ant Surgeon. 
Private  Philip  Reese,  Co.  D,  4th  Cavalry,  aged  19  years,  received  a  gunshot  wound  of  the 

metacarpal  bone  of  the  left  hand.    He  was  admitted  from  field  hospital  to  the  post  hospital  at  San 

Antonio,  Texas,  on  December  18,  1806.    Simple  dressings  were  applied  to  the  wound.    He  was 

returned  to  duty  in  March,  1867. 

CCXL.— Report  of  a  Case  of  Pistol- Wound  of  the  Left-Hand.— By  REESE  B.  BERKEY,  M.  D.,  Acting 
Assistant  Surgeon. 

At  Humboldt,  Tennessee,  February  5,  1871,  Private  John  Dotzel,  Co.  G,  16  Infantry,  aged  23 
years,  accidentally  shot  himself  with  a  pistol  in  the  left-hand.  The  charge,  birdshot,  entered  the 
second  finger  of  the  left-hand,  injuring  the  first  metacarpal  bone.  He  was,  on  the  same  day,  ad- 
mitted to  the  post  hospital.  The  shot  and  pieces  of  bone  were  extracted  from  the  wound,  and  cold 
water  dressings  were  applied.  The  man  was  returned  to  duty  February  1C,  1871. 

CCXLI. — Mention  of  Four  Cases  of  Gunshot  Wounds  of  the  Hand.     By  W.  T.  HENDRICKSON, 
M.  D.,  Acting  Assistant  Surgeon. 

CASE  1. — Private  George  Thompson,  Co.  C,  10th  Cavalry,  aged  23  years,  was  accidentally 
wounded  by  a  conoidal  carbine  ball  which  passed  through  the  second  phalanx  of  the  middle  finger 
of  the  left  hand,  destroying  the  bone.  He  was  admitted  on  December  13,  1869,  from  post  hospital 
Fort  Sill,  Indian  Territory,  to  the  United  States  Army  post  hospital  at  Fort  Arbuckle,  Cherokee 
Nation,  Indian  Territory.  Simple  dressings  were  used.  He  was  discharged  from  the  service  on 
June  20,  1870,  on  surgeon's  certificate  of  disability. 

CASE  2. — Private  Albert  Tasker,  Co.  M,  10th  Cavalry,  aged  25  years,  was  accidentally  wounded 
on  July  28,  1869,  by  a  conoidal  carbine  ball,  which  destroyed  the  second,  ring,  and  little  fingers  of 
the  left  hand.  He  was  admitted  from  company  quarters  to  the  post  hospital  at  Fort  Arbuckle, 
Cherokee  Nation,  Indian  Territory,  on  May  8, 1870.  Simple  dressings  were  used.  He  was  returned 
to  duty  in  May,  1870. 

CASE  3. — Private  Charles  Stanton,  Co.  M,  10th  Cavalry,  aged  25  years,  was  accidentally 
wounded  on  February  11,  1870,  by  a  conoidal  carbine  ball  which  passed  between  the  second  and 
third  phalanges  of  the  middle  finger  of  the  left  hand.  He  was  admitted  from  company  quarters  on 
the  same  day  to  the  United  States  Army  post  hospital  at  Fort  Arbuckle,  Cherokee  Nation,  Indian 
Territory.  The  treatment  consisted  of  cold-water  dressings  and  poultices.  He  was  returned  to 
duty  on  May  10, 1870. 

CASE  4. — Private  Lyman  Tasker,  Co.  M,  10th  Cavalry,  aged  20  years,  was  accidently  wounded 
by  a  conoidal  carbine  ball  between  the  third  and  fouth  metacarpal  bones  of  the  right  hand,  distal 
end.  He  was  admitted  from  post  hospital  Fort  Sill,  Indian  Territory,  on  December  13,  1869. 
Simple  dressings  were  used.  He  was  returned  to  duty  on  April  27,  1870. 


Gunshot  Flesh- Wounds  of  the  Upper  Extremities. — Special  report  of  twenty-one  cases 
of  this  class  were  made.  Twenty  of  the  patients  recovered  and  returned  to  duty ;  one 
recovered  and  was  discharged  for  disability.  Seven  were  cases  of  wounds  of  the  arm,  five 
of  the  fore-arm,  and  nine  of  the  head. 

Private  John  Connelly,  Co.  H,  5th  Cavalry.    Fort  McPherson,  Nebraska,  November  20,  1870. 
Gunshot  flesh-wound  of  the  right  arm.    Duty,  December  22,  1870. 

Private  Thomas  Gavin,  Co.  I,  37th  Infantry,  aged  24  years.    Near  Fort  Dodge,  Kansas,  Sep- 
tember 29,  1867.    Gunshot  flesh-wound  of  the  left  arm.    Duty,  October,  1867. 


GUNSHOT  WOUNDS  OF  THE  UPPER  EXTREMITIES.  G9 

Private  Charles  Hall,  Co.  K,  9th  Cavalry.  Near  Fort  Davis,  Texas,  November  17,  1809. 
Gunshot  flesh-wound  of  the  left  arm,  near  the  elbow.  Duty,  January  20,  1870. 

Private  Wardlow  Irving,  Co.  D,  9th  Cavalry.  Gunshot  flesh-wound  of  the  arm ;  received  in  a 
fight  with  Indians,  near  Fort  Stockton,  Texas,  September  10,  1868.  Removal  of  ball.  Duty, 
November  8, 1868. 

Private  Benjamin  Jones,  Co.  H,  10th  Cavalry.  Near  Fort  Harker,  Kansas,  August  29,  1807. 
Gunshot  flesh-wound  of  the  right  arm.  Duty,  October  1,  1807. 

Private  Anthony  Lambert,  Co.  A,  Gth  Cavalry,  aged  49  years.  Gunshot  flesh-wounds  of  the 
arm,  hand,  and  leg  by  buckshot;  received  in  a  skirmish  with  Indians  at  Farmersville,  Tex:i,s, 
November  19,  18G8.  Duty,  December  17,  1808. 

Private  Michael  Welsh,  Co.  L,  Gth  Cavalry,  aged  25  years.  Gunshot  flesh-wound  of  lower 
third  of  the  left  arm.  Fort  Richardson,  Texas,  May  9,  1870.  Duty,  June  14,  1870. 

Private  Walter  H.  Clapp,  Co.  K,  Oth  Cavalry,  aged  22  years.  Fort  Belknap,  Texas,  June  20, 
18G7.  Gunshot  flesh-wound  of  the  middle  third  of  the  left  fore-arm.  Discharged  February  4, 
1808,  on  account  of  partial  paralysis  of  hand  and  finger. 

Private  Peter  Dunn,  Co.  E,  33d  Infantry,  aged  21  years.  Near  Fort  Macon,  Georgia,  March 
14, 1868.  Gunshot  flesh-wound  of  the  right  fore-arm  by  a  pistol  ball.  Duty,  April,  1868. 

Sergeant  James  Stevenson,  Co.  F,  10th  Cavalry.  Gunshot  flesh-wound  of  the  left  fore-arm 
and  left  £high.  Near  Fort  Lyon,  Colorado  Territory,  March  10,  1869.  Duty,  May,  1869. 

Private  Robert  Stuart,  Co.  H,  Oth  Cavalry,  aged  32  years.  Guiishot  flesh-wound  of  right  fore- 
arm; received  in  an  action  with  Indians  near  the  North  Fork  of  the  Little  Wichita  River,  Texas, 
July  12, 1870.  Carbolic-acid  dressings.  Duty,  August  6,  1870. 

Private  Frederick  Smith,  Co.  E,  19th  Infantry,  aged  23  years.  Camden,  Arkansas,  September 
27, 1806.  Gunshot  wound  of  the  fore-arm  and  hand  by  buckshot.  Duty,  October,  1866. 

Private  Alfred  Brown,  Co.  L,  10th  Cavalry,  aged  20  years.  Gunshot  flesh-wound  of  fingers 
of  the  left  hand.  Fort  Arbuckle,  Cherokee  Nation,  December  19,  1869.  Duty,  March  9, 1870. 

Private  Nathan  Dedman,  Co.  B,  41st  Infantry,  aged  23  years.  Point  Isabel,  Texas,  December 
27,  1867.  Gunshot  flesh-wounds  of  the  third  and  fourth  fingers  of  the  left  hand.  Duty,  January, 
1808. 

Private  James  Downs,  Co.  K,  1st  Artillery,  aged  38  years.  New  Orleans,  Louisiana,  June  11, 
1868.  Laceration  and  dislocation  of  the  second  phalanx  of  the  left  thumb  by  the  premature 
discharge  of  a  cannon.  Duty,  August,  1868. 

Private  Joseph  Lather,  Co.  C,  117th  Colored  Troops.  Brazos  Santiago,  Texas,  Jauuary  17, 
1867.  Gunshot  flesh-wound  of  the  left  hand.  Duty,  February  26,  1867. 

Private  James  Mitchell,  Co.  I,  13th  Infantry,  aged  24  years.  Fort  Shaw,  Montana  Territory, 
April  3, 1870.  Gunshot  wound  of  the  right  fore-finger.  Duty,  June  4, 1870. 

Sergeant  Moses  Morris,  Co.  D,  38th  Infantry,  aged  21  years.  Central  City,  New  Mexico, 
December  24,  1868.  Slight  flesh-wound  of  the  finger.  Duty,  January,  1869. 

Corporal  M.  Reinhold,  Co.  H,  17th  Infantry,  aged  23  years.  Brenham,  Texas,  February  26, 
1867.  Gunshot  wound  through  flexor  brevis  pollicis  muscles.  Duty,  May  16,  1867. 

Private  William  Thompson,  Co.  C,  9th  Cavalry.  Near  Fort  Davis,  Texas,  February  18, 1870. 
Gunshot  wound  of  ring-finger  of  the  left  hand.  Duty,  April,  1870. 

Private  James  Wilson,  Co.  H,  10th  Cavalry.  Fort  Harkcr,  Kansas,  September  17,  1867. 
Gunshot  flesh-wound  of  the  left  hand.  Duty,  October,  1867. 


70  REPORT  OF  SURGICAL  CASES  IN  TIIE  ARMY. 

GUNSHOT  WOUNDS  OF  THE  LOWER  EXTREMITIES. — The  reports  of  many  cases  will 
be  found  in  the  next  chapter.  Only  those  relating  to  cases  treated  without  operative 
interference  will  be  recorded  here. 

Gunshot  fractures  of  the  Femur. — The  nine  following  reports  give  the  particulars  of 
three  fatal  cases  of  fracture  of  the  upper  third  of  the  femur,  one  involving  the  hip-joint — 
of  three  cases  of  fracture  of  the  middle  third,  with  one  recovery — and  of  three  fractures  oi 
the  lower  third,  all  terminating  favorably : 

CCXLII. — Report  of  a  Fatal  Case  of  Gumliot  Fracture  of  the  Right  Femur.    By  J.  BASIL  GIRARD, 
Assistant  Surgeon,  U.  S.  A. 

Private  Emmet  Smith,  Co.  B,  7th  Infantry,  aged  23  years,  was  wounded  on  May  6, 
1870,  by  a  musket  ball  from  a  Remington  breech-loader.  The  missile  entered  the  right  thigh 
anteriorly  some  four  or  five  inches  below  the  anterior  superior  spinous  process  on  the  right  side, 
fractured  the  femur,  and  lodged  in  the  limb.  The  patient,  a '  Frenchman,  enlisted  under  an 
assumed  name,  and  to  all  appearances  not  over  18  or  19  years  of  age,  was  conveyed  to  Fort  Steele, 
a  distance  of  about  thirty-eight  miles.  When  admitted  to  the  hospital  he  was  in  a  state  of  col- 
lapse, and  suffered  acute  and  severe  pains.  Stimulants  were  given  every  half  hour  during  the 
following  night,  until  reaction  took  place.  On  May  7th,  chloroform  was  administered.  The  ball 
was  found  under  the  skin,  two  or  three  inches  back  of  the  great  trochauter,  and  was  removed 
through  a  small  incision  through  which  I  introduced  a  finger  in  each  wound.  The  femur  ^ras  found 
shattered  to  a  fearful  extent.  The  incision  for  the  extraction  of  the  ball  was  then  enlarged 
upward  and  downward,  thus  making  an  opening  four  inches  in  length,  crescendo  in  shape,  with 
the  concavity  forward,  and  the  soft  tissues  were  separated  from  the  bone.  This  opening  was 
intended  as  part  of  the  incision  necessary  in  extracting  the  head  of  the  femur,  should  that  opera- 
tion become  necessary,  or  as  a  free  passage  for  sloughs  and  pus  during  after  treatment.  The 
examination  disclosed  a  fracture  just  below  the  trochanters  and  almost  horizontal.  The  upper 
fragment  was  tilted  forward  and  a  little  outward  by  the  action  of  the  flexor  and  rotator  muscles. 
No  fracture,  communicating  with  the  joint,  could  be  detected.  Accordingly  the  operation  was 
confined  to  the  removal  of  foreign  materials  and  loose  fragments  of  bone,  a  number  of  which  were 
extracted.  No  ligation  was  required.  The  wound  was  plugged  with  lint  saturated  with  a  solu- 
tion of  persulphate  of  iron.  After  the  operation  the  patient  remained  for 
a  long  time  unconscious,  cold  and  almost  pulseless,  and  when  reaction  set 
in,  he  was  restless  and  appeared  delirious.  Opiates  were  given,  but  with 
%.J  little  effect.  He  suffered  from  intense  thirst  until  the  large  quantity  of 
"•^&&^s  water  drank  brought  on  vomiting.  The  wounded  limb  was  disturbed  by 
//  severe  spasms,  for  which  bromide  of  potassium  was  given  in  ten-grain  doses 

every  half  hour.  At  ten  o'clock  P.  M.  he  became  quiet,  and  died  on  May 
9, 1870,  at  1  A.  M.  At  the  autopsy,  a  line  of  fracture  was  found  extending 
into  the  hip-joint,  but  owing  to  it  being  only  a  partial  rent,  I  had  failed  to 
discover  it  at  my  first  examination.  Had  I  been  aware  of  that  fact  at  my 
first  examination,  I  would  have  excised  the  joint,  but  very  probably  with 
the  same  result,  as  the  patient  doubtless  died  of  nervous  shock  and  ex- 
haustion. The  fatal  issue  in  the  last  five  mouths  of  two  such  cases,  both 
treated  expectantly,  as  well  as  the  recovery  of  Private  Erne,  at  Fort 
Fiji.  11.  upper  third  of  right  Laramje  in  whose  case  excision  was  performed,  suggest  in  my  mind 

femur  fractured  by  a  colloidal  ball.  ,.         ... 

spec.  5091.  sect.  i.  A.  M.  M.         the  query  whether,  when  the  femur  is  shattered  so  near  the  joint,  and 

the  upper  fragment  with  its  pointed  spicula  is  thrust  among  the  mus- 
cles, nerves,  and  bloodvessels  of  the  anterior  part  of  the  thigh,  the  patient  would  not  be  exposed 
to  local  irritation,  muscular  spasm,  and  secondary  haemorrhage  ;  in  short,  whether  he  would  not 
stand  a  better  chance  of  recovery  if  that  fragment  was  extracted.  At  any  rate,  should  he  re- 
cover under  the  expectant  treatment,  it  is  very  doubtful  whether  union  would  be  very  firm,  with 


GUNSHOT  WOUNDS  OF  THE  LOWEK  EXTKEMITIES.  71 

the  lower  fragment ;  it  would  at  least,  certainly  be  very  tedious,  if  not  imperfect.  It  seems  to  me 
from  what  little  experience  I  have  had  in  the  West,  that  in  this  dry  and  bracing  climate  where 
wounds  generally  do  well,  excision  of  the  hip-joint  in  cases  like  the  present,  would  benefit  the 
patient  far  more  than  expectant  measures.  If  another  case  of  this  kind  comes  under  my  care,  I 
will  be  strongly  tempted  to  excise.  The  specimen  is  figured  in  the  adjoining  wood-cut,  (FiG.  11.) 

CCXLIIL — Report  of  a  Fatal  Case  of  Gunshot  Fracture  of  the  Right  Femur.    By  Dr.  C.  C.  BAD- 
MORE,  114th  Eegiment  of  Colored  Troops. 

Private  Henry  Jefferson,  Co.  F,  19th  Colored  Troops,  of  a  delicate  constitution,  was  admitted, 
August  30,  1865,  to  the  post  hospital  at  Brownsville,  Texas.  The  patient  had  accidentally 
received,  two  weeks  before  his  admission,  a  severe  gunshot  wound,  which  was  found  upon  examina- 
tion that  the  ball  had  entered  about  two  inches  anterior  and  inferior  to  the  trochanter  major,  pro- 
ducing a  compound  comminuted  fracture  of  right  femur.  The  ordinary  dressings  were  applied,  and 
the  patient  seemed  to  be  doing  well  during  the  first  two  weeks  of  his  stay  in  the  hospital.  On 
September  20th,  it  was  deemed  necessary,  in  consequence  of  the  profuse  suppuration  and  extensive 
•sloughing  of  the  muscular  structures  of  adjoining  parts,  which  had  set  in  a  few  days  previous,  to 
cut  down  upon,  and  examine  the  condition  of  the  wound.  A  free  incision  was  consequently  made, 
and  a  few  small  spiculse  of  bone  removed,  and,  after  a  careful  examination  of  the  parts  was  made, 
was  unable  to  find  the  location  of  the  ball,  yet  nothing  presented  itself  to  warrant  an  unfavorable 
issue.  The  same  profuse  suppuration  continued,  notwithstanding  the  free  use  of  tonics  and  stimu- 
lants, together  with  good  nutritious  diet*  The  patient  continued  to  sink,  and  died  November  17, 
1865,  being  two  months  and  eighteen  days  from  receipt  of  injury.  Sectio  cadaveris  24  hours  after 
death.  The  body  considerably  emaciated.  On  examining  the  fractured  limb,  found  an  oblique 
fracture  to  exist  extending  across  the  inter-trochanteric  line,  one-half  inch  inferior  to  the  trochan- 
ter major,  with  two  radiating  fractures  extending  from  the  main  fracture  in  a  superior  direction 
within  the  capsular  ligament.  The  ball  must  have  fractured  itself  in  two  pieces  as  soon  as  it  came 
in  contact  with  the  bone,  as  each  piece  was  found  to  be  firmly  embedded  in  each  end  of  the  frac- 
tured bone,  and  distant  from  each  other  about  half  an  inch,  with  no  prospect  of  reunion  taking 
place. 

CCXL1V.— Report  of  a  fatal   Case  of  Gunshot  Fracture  of  the  Femur.    By  WM.  M.   NOTSON, 
Assistant  Surgeon,  U.  S.  A. 

Haller,  a  citizen,  aged  about  21  years,  had  a  gunshot  fracture  of  the  femur,  in  the  upper  part  of 
the  middle  third,  caused  by  the  accidental  discharge  of  a  pistol  in  the  hand  of  a  soldier,  on  the 
evening  of  August  25,  1870.  The  parties  were  hunting  about  fifteen  miles  from  Fort  Coucho, 
Texas.  Upon  reception  of  the  injury,  he  was  assisted  into  the  river,  and  sat  in  the  water  all  night, 
for  the  purpose  of  keeping  off  insects,  and  to  relieve  the  pain.  He  was  brought  to  the  post  the 
next  day  in  a  wagon.  It  was  determined,  on  account  of  his  youth  and  temperate  habits,  to  make 
an  effort  to  save  the  limb.  Being  wearied  from  his  journey  and  exposure,  he  was  placed  in  a  com- 
fortable position,  and  an  anodyne  administered ;  the  next  morning  a  wire  splint  was  applied,  and 
an  examination  of  the  parts  made,  some  spiculae  of  bone  removed,  and  an  operation  determined  on ; 
the  intervening  time  was  occupied  in  arranging  permanent  appliances  for  the  continued  use  of  the 
anterior  splint.  August  28th,  11  A.  M.,  an  incision  was  made  through  the  wound,  and  the  loose 
fragments  of  bone,  and  portion  of  the  ball  removed,  and  the  extremity  of  the  broken  bone  cut  off 
with  bone  forceps,  until  about  two  inches  had  been  removed.  Opportunity  was  afforded  for  free 
drainage,  and  carbolized  water  dressing  applied.  The  next  day  pointing  being  noticed  in  the 
under  portion  of  the  thigh,  it  was  opened,  and  the  remainder  of  the  ball  removed.  This  being  a 
favorable  direction,  the  track  of  the  ball  was  kept  open  by  a  tent  until  suppuration  was  freely 
established.  The  patient  was  placed  in  the  ward  under  the  charge  of  Acting  Assistant  Surgeon 
J.  A.  McCoy,  by  whom  the  surgical  dressing,  treatment,  and  care  of  the  case  was  efficiently  carried 
out.  On  the  twenty-sixth  day  after  the  operation,  some  union  being  evident,  on  account  of  much 
fever  of  a  typhoid  character  being  in  the  hospital,  and  the  exhausted  and  debilitated  condition  of 


72  KEPOKT  OF  SUHG1CAL  CASES  IN  TILE  AltMY. 

the  patient,  he  was  removed  to  a  bed  arranged  for  him  in  a  wheeled  litter,  and  the  leg  placed  on 
an  inclined  plane.  On  the  thirty-fifth  day  this  was  changed  for  a  starch  bandage.  He  died  on  the 
forty-first  day  after  receiving  the  injury,  from  pyjemia.  The  discharge  the  day  preceding  the 
application  of  the  starch  bandage  had  changed  from  its  healthy  hue  and  consistence  to  a  grumous, 
fetid  character.  The  post-mortem  revealed  considerable  attempt  at  union,  and  the  limb  in  nearly 
the  natural  position.  It  is  thought  more  favorable  results  would  have  been  attained  except  for 
the  moral,  and  perhaps  physical,  effects  of  the  surrounding  disease. 

CCXLV. — Report  of  a  Case  of  Gunsliot  Fracture  of  the  Femur,  with  Fatal  Result,  treated  at  Fort 
Fetterman,  Wyoming  Territory.    By  J.  BASIL  GIKABD,  Assistant  Surgeon,  U.  S.  A. 

Private  John  W.  Keller,  Co.  H,  4th  Infantry,  aged  21  years,  of  temperate  habits  and  fair  con- 
stitution, was  wounded  in  the  left  thigh,  on  December  22,  18G9,  by  the  accidental  discharge  of  a 
Springfield  musket  in  the  hands  of  a  comrade.  At  the  time  of  the  accident  he  was  sitting  on  the 

(5dge  of  his  bunk  in  the  company  barrack-room,  with  his  right 
thigh  flexed  at  right  angles  with  the  trunk  and  sustaining  the 
weight  of  the  body,  and  the  left  limb  stretched  and  half  flexed 
at  the  hip  joint.  The  shot  was  fired  from  behind,  at  a  distance 
of  about  five  yards,  the  ball  entering  the  liinb  on  the  outside 
of  the  gluteal  region,  five  inches  from  the  anterior  superior 
spinous  process  of  the  ilium,  and  issuing  on  the  front  of  the 
thigh,  seven  inches  below  the  same  process,  fractured  and  com- 
minuted the  femur  in  its  course.  The  man  was  immediately 
brought  to  the  hospital  in  a  collapsed  state,  suffering  acute 
pain  from  the  action  of  the  sharp,  pointed  spiculse  of  the  shat- 
tered bone.  Upon  examination  the  hemorrhage  was  found  to 
have  been  moderate,  but  owing  to  the  prostrate  condition  of  the 
patient  further  proceedings  were  postponed  until  the  next  day ; 
Kg.  ia— Gun-shot  fracture  ot  the  upper  third  in  the  meantime  he  was  put  to  bed,  a  sufficient  dose  of  mor- 
of  the  1Ur.  spec.  5G03,  sect,  i,  A.  M.  phia  administered  to  allay  suffering,  and  one  ounce  of  brandy 

ordered  every  hour  until  reaction  was  brought  about.    When 

seen  again,  late  in  the  afternoon,  he  had  fully  reacted,  felt  quite  strong  and  comfortable,  and  spoke 
confidently  of  his  future  recovery.  He  slept -well  during  the  night  and  awoke  in  excellent  condi- 
tion. On  the  morning  of  the  23d  an  anaesthetic  was  administered  and  the  wound  examined.  The 
orifice  of  entrance  was  sufficiently  enlarged  to  allow  the  passage  of  the  index  fingers  from  each 
orifice  down  to  the  broken  bone.  The  comminution  was  very  great  along  the  track  of  the  ball. 
The  lower  fragment  presented  an  oblique  line  of  fracture  and  moved  in  accordance  with  all  the 
motions  impressed  to  the  limb,  showing  that  the  injury  did  not  extend  further  downward.  The 
upper  fragment  was  immovable,  contained  both  trochauters,  and  did  not  appear  to  be  broken  or 
fissured  in  any  way.  Having  removed  all  the  loose  fragments  of  bone  and  foreign  substances, 
among  which  was  a  piece  of  the  ball  weighing  seventy  grains,  the  administration  of  chloroform 
was  stopped,  the  patient  placed  on  a  bed  with  an  unyielding  bottom,  and  weight  and  pulley  exten- 
sion applied  to  the  limb,  counter-extension  being  made  by  raising  the  foot  of  the  bed  four  inches. 
The  thigh  itself  was  left  free  from  splints  or  bandages  so  as  not  to  interfere  with  future  swelling 
and  discharges.  Cold-water  dressing  was  applied  to  the  wound.  The  patient  bore  the  action  of 
the  chloroform  well,  and  was  quite  comfortable  the  rest  of  the  day.  His  condition  varied  but  little 
until  the  evening  of  the  29th,  when  he  complained  of  great  pain  in  the  wounded  limb.  The  wound 
commenced  to  discharge  fetid  pus  in  large  quantity.  He  was  very  restless,  and  disarranged  the  limb, 
on  account  of  which  his  bed  was  thoroughly  cleaned  and  newly  arranged,  and  a  long  side  splint 
applied  from  the  lower  ribs  down  to  the  foot,  in  order  to  retain  the  limb  on  a  line  writh  the  body. 
Brandy  and  morphia  were  administered.  He  slept  well  during  the  night,  but,  on  the  morning  of 
the  29th,  a  profuse  haemorrhage  occurred,  and,  before  it  could  be  stopped,  from  two  to  three  pints 
of  blood  were  lost.  Compresses,  wet  with  liquid  persulphate  of  iron,  finally  arrested  the  bleeding. 
Stimulants  were  given  freely,  but  the  patient  sank  and  died  in  one  hour  after  the  occurrence  of  the 


GUNSHOT  WOUNDS  OF  THE  LOWER  EXTREMITIES.  73 

haemorrhage.  A*  post-mortem  examination  was  made  four  hours  after  death.  The  body  was  found 
in  good  condition  and  well  nourished,  very  little  emaciation  having  taken  place.  An  artery,  with 
a  diameter  of  one-sixteenth  of  an  inch,  probably  a  branch  of  the  profunda,  if  not  the  profunda 
itself,  was  found  with  its  orifice  patulous.  The  hip  joint  was  totally  uninjured.  The  pathological 
specimen,  consisting  of  the  head  and  fragments  of  the  femur,  is  represented  iu  the  opposite  wood- 
cut. Fig.  12. 

CCXLVI. — Report  of  a  Case  of  Compound  Comminuted  Fracture  of  the  Femur,  treated  by  the  Anterior 
Suspensory  Apparatus.    By  CAKLO'S  CABVALLO,  Assistant  Surgeon,  U.  S.  A. 

Private  William  S.  Smith,  Troop  D,  6th  Cavalry,  aged  31  years,  was  wounded  on  March 
30,  1868,  by  a  conoidal  pistol  ball,  which  entered  the  anterior  internal  aspect  of  right  thigh  at  the 
lower  third,  and  emerged  on  the  opposite  side,  not  far  from  the  popliteal  fold.  On  admission 
to  hospital,  at  Fort  Richardson,  Texas,  an  examination  revealed  a  compound  comminuted  fracture, 
but  on  account  of  the  swelling  it  could  not  be  ascertained  whether  any  fragments  were  detached. 
Smith's  anterior  splint  was  applied,  and  sulphate  of  morphia  was  administered.  On  the  next  day, 
the  leg  becoming  painful,  the  splint  was  removed  and  afterwards  reapplied,  when  the  pain  ceased. 
On  April  1st  the  wound  was  again  exposed,  and  syringed  with  a  solution  of  carbolic  acid.  The 
slightest  motion  would  cause  pain,  indicating  displacement  of  bony  fragments.  On  April  2d,  the  wound 
began  to  discharge  freely,  and  the  patient  improved  steadily.  On  May  13th,  the  splint  was  removed ; 
the  femur  had  united  with  only  one  inch  shortening.  On  the  following  day  a  bandage,  supported 
by  binders'  boards  at  the  fracture,  was  applied  to  the  limb.  On  May  20th,  a  pocket  of  pus  on  the 
inner  side  of  the  thigh  was  discharged  from  the  wound  of  entrance.  On  May  21st,  the  wound  was 
examined,  and  but  one  small  piece  of  dead  bone  could  be  detected.  A  few  days  later  the  limb 
began  to  swell  again,  but  a  solution  of  chlorinated  soda  was  applied,  and  the  swelling  readily 
subsided.  On  August  10th,  the  patient  was  returned  to  his  quarters,  able  to  walk  on  crutches. 
November  1st,  he  was  able  to  walk  with  a  cane ;  the  right  knee  was  still  swollen,  and  became  painful 
in  cold  or  damp  weather.  The  knee  could  be  flexed  to  an  acute  angle  only,  and  was  turned  inward ; 
the  right  ankle,  though  pliable,  would  flex  but  little ;  the  motions  of  the  hip  joint  were  normal,  but 
the  right  hip  was  lower  than  the  left.  The  patient  suffered  from  intermittent  fever  and  a  bed-sore 
while  under  treatment.  He  was  returned  to  duty  (police  duty  in  quarters)  on  December  16,  1868. 

CCXLVIL— Report  of  a  Gunshot  Fracture  of  the  Femur.    By  JOHN  CAMPBELL,  Surgeon,  U.  S.  A. 

Private  Thomas  Tooher,  Co.  H,  42d  Infantry,  aged  25  years,  received  a  comminuted  fracture 
of  the  femur  above  the  knee-joint  on  July  11,  1867,  from  a  conoidal  bullet.  He  was  admitted  from 
his  company  to  the  Madison  Barracks  post  hospital  at  Sackett's  Harbor,  New  York,  on  July  11, 1867. 
His  leg  was  placed  on  a  double  inclined  plane.  Simple  dressings  were  applied.  In  September, 
1867,  union  of  bone  had  taken  place,  but  wound  was  still  open ;  fragments  of  bone  were  still  being 
removed  therefrom. 

CCXLVIII. Report  of  a  Case  of  Gunshot  Fracture  of  the  Femur.    By  A.  B.  CAMPBELL,  Assistant 

Surgeon,  U.  S.  A. 

Private  James  Soohen,  Co.  E,  13th  Infantry,  aged  23  years,  was  accidentally  shot  in  the  upper 
portion  of  middle  third  of  thigh.  The  femur  was  fractured  and  comminuted,  the  femoral  artery 
ruptured.  He  was  admitted  to  the  post  hospital  at  Camp  Cooke,  Montana  Territory,  on  November 
5  1868.  Brandy,  morphine,  and  tincture  of  caunabis  ludica  were  administered,  and  the  wound  was 
dressed  with  creosote  water.  The  patient  died  comatose  on  the  afternoon  of  November  7,  1868. 

CCXLIX.— Account  of  a  Gunshot  Wound  of  the  Thigh.    By  J.  W.  BREWEE,  Assistant  Surgeon, 

U.  S.  A. 

Private  John  Thomas,  Co.  L,  lOtli  Cavalry,  aged  22  years,  was  accidentally  wounded  on  July 
1, 1868,  by  a  conoidal  carbine  ball,  which  passed  through  the  lower  third  of  the  left  femur,  implicating 
10 


74  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

the  bone.    He  was  admitted  from  the  post  hospital  at  Fort  Sill,  Indian  Territory,  on  December  13, 

1869.  The  treatment  consisted  of  simple  dressings  and  poultices,  and  removal  of  fragments  of 
bone.    He  was  discharged  from  service  on  surgeon's  certificate  of  disability,  on  March  11,  1870. 

% 

CCL. — Report  of   a   Case  of   Gunshot   Fracture   of   the   Femur.      By   G.   H.   GUNN,    Assistant 
Surgeon,  U.  S.  A. 

Private  Joseph  Phillips,  Co.  H,  9th  Cavalry,  aged  26  years,  was  wounded  September  22, 

1870,  by  a  conoidal  ball,  which  fractured  the  left  femur,  at  middle  third.    He  was  admitted  to  the 
post  hospital  at  Fort  Quitmau,  Texas,  soon  after  the  reception  of  the  injury.    The  limb  was  placed 
in  a  fracture-box,  until  November  26th,  and  simple  dressings  were  applied.    At  the  date  of  this 
report  the  case  was  doing  well. 


There  were  twenty-three  special  reports  of  gun-shot  flesh  wounds  of  the  thigh,  all  the 
cases  resulting  favorably,  and  five  reports  of  grave  and  fatal  lesions  of  the  great  vessels 
or  nerves. 

CCLI. — Account  of  a  Gunshot  Wound  of  the  Thigh.    By  B.  E.  FRYER,  Assistant  Surgeon,  U.  S.  A. 

Musician  William  Corin,  Co.  B,  38th  Infantry,  accidentally  received,  on  September  17,  1867,  a 
slight  gunshot  wound  of  the  right  thigh  from  a  conoidal  ball.  He  was  admitted  from  the  garrison 
on  the  same  day  to  the  post  hospital  at  Fort  Harker,  Kansas.  The  treatment  consisted  of  simple 
dressings.  He  was  returned  to  duty  on  October  1, 1867. 

CCLII — Account  of  a  Gunshot  Flesh-Wound  of  tJie  Thigh.     By  W.  E.  SAVAGE,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  George  Coleman,  Co.  G,  117th  Colored  Troops,  aged  25  years,  was  accidentally  wounded 
on  August  3,  1867,  by  a  conoidal  pistol  ball,  in  the  centre  of  the  vastus  externus  muscle  of  the 
right  leg.  The  missile  passed  upward  and  backward  forty-five  degrees,  and  lodged  in  the  centre  of 
the  adductor  longus  muscle,  from  which  place  it  was  cut  out.  He  was  admitted  from  Brownsville, 
Texas,  to  the  post  hospital  at  Brazos  Santiago,  on  August  11, 1867.  Simple  dressings  were  applied 
to  the  wound.  He  was  mustered  out  of  the  service  on  August  14,  1867. 

CCLIII. — Mention  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Thigh.    By  JOHN  T.  KING,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Elias  Simpson,  Co.  B,  40th  Infantry,  aged  23  years,  received  a  gunshot  wound  on  Feb- 
ruary 13, 1869.  A  small  conoidal  ball  entered  the  posterior  portion  of  the  thigh,  passed  in  a  direct 
course  almost  entirely  through.  He  was  admitted  to  the  post  hospital  at  Goldsborough,  North  Caro- 
lina, on  February  13,  1869.  Ball  extracted  through  counter  opening.  He  was  discharged  April  2, 
1869. 

CCLIV.— Mention  of  a  Case  of  Gunshot  Wound  of  the  Thigh.    By  W.  R.  STEINMETZ,  Assistant  Sur- 
geon, U.  S.  A. 

Corporal  Henry  E.  Taylor,  Co.  E,  24th  Infantry,  aged  22  years,  received  a  gunshot  wound  of 
the  lower  third  of  the  right  thigh,  on  December  24,  1869.  He  was  admitted  from  quarters,  on 
December  25th,  to  the  post  hospital  at  Fort  Griffin,  Texas,  and  was  returned  to  duty  on  February 
2, 1870. 


GUNSHOT  WOUNDS  OP  THE  LOWEK  EXTREMITIES.  75 

CCLV. — Memorandum  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Thigh.    By  B.  E.  FBYER,  Assistant 
Surgeon,  U.  S.  A. 

Private  Andrew  Warner,  Co.  E,  38th  Infantry,  on  July  10, 18G7,  was  accidentally  wounded  by 
a  pistol  ball  in  the  right  thigh.  On  the  same  day  he  was  admitted  into  the  post  hospital  at  Fort 
Marker,  Kansas,  from  the  garrison.  Simple  dressings  were  applied  to  the  wound.  He  was  returned 
to  duty  on  July  12,  1867. 

CCLVL— Report  of  a  Gunshot  Flesh-  Wound  of  the  Thigh.    By  H.  E.  TILTON,  Assistant  Surgeon, 
U.  S.  A. 

Private  Anthony  Welber,  Co.  I,  3d  Infantry,  received  an  accidental  gunshot  wound  of  the 
right  thigh  on  May  4,  18G9.  A  rifle  ball  entered  the  front  of  the  thigh  at  the  middle  third  exter- 
nally to  the  femur,  and  lodged  in  the  biceps  muscle.  He  was  admitted  to  the  post  hospital  at  Fort 
Lyon,  Colorado  Territory,  on  May  G,  1869.  On  May  8th,  the  ball  was  removed  by  a  counter  open- 
ing, and  simple  dressings  were  applied.  On  May  20,  an  abscess  was  opened,  and  a  short  time 
afterward  a  piece  of  cloth  was  removed  from  the  wound.  By  June  loth,  the  wounds  were  entirely 
healed.  He  was  returned  to  duty  July,  1869. 

CCLVIL— Report  of  Gunshot  Flesh-Wound  of  the  Thigh.    By  W.  J.  WILSON,  Assistant  Surgeon, 
U.  S.  A. 

Sergeant  John  Mullins,  Co.  K,  4th  Cavalry,  aged  31  years,  received  a  wound  of  the  thigh  from 
a  pistol  ball  on  February  16,  1870.  He  was  admitted  from  his  quarters  into  hospital  on  February 
17th.  Water  dressings  were  used.  He  was  returned  to  duty  on  March  14, 1870. 

CCLYIII. — Report  of  a  Case  of  Gunshot  Wound  of  the  Thigh.    By  A.  C.  GIRARD,  Assistant  Surgeon, 
U.S.  A. 

Private  James  Smith,  Co.  F,  19th  Infantry,  aged  29  years,  was  wounded  on  February  8,  1870, 
while  leaving  a  steamboat  on  his  arrival  at  Baton  Eouge,  Louisiana.  The  shot  was  fired  from 
above,  and  the  weapon  was  said  to  be  a  pistol.  The  ball  entered  over  the  trochanter  of  the  left 
thigh,  took  a  direct  downward  course  between  the  aponeurosis  and  skin,  and  made  its  exit  ten 
inches  lower.  Some  part  of  the  underclothes,  being  carried  into  the  canal,  were  extracted,  and  a 
free  suppuration  was  established.  The  missile  could  not  be  found.  During  the  inflammatory  stage, 
cold  applications,  with  solution  of  carbolic  acid  at  57°.  After  suppuration  was  established,  poultices 
of  linseed,  with  the  same  solution,  and  finally  a  carbolic  cerate.  Convalescence  was  slow.  He  was 
admitted  to  the  post  hospital  at  Baton  Eouge  on  February  8, 1870,  and  was  returned  to  duty  on 
March  20, 1870. 

CCLIX.— Account  of  a  Gunshot  Flesh- Wound  of  the  Thigh.    By  F.  G.  H.  BRADFORD,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Charles  Osborn,  Co.  E,  1st  California  Veteran  Volunteers,  was  wounded  at  Los  Pinos, 
New  Mexico,  on  June  21, 1866,  by  a  pistol-ball,  which  entered  the  left  thigh  two  inches  anterior, 
and  a  little  below  the  great  trochanter,  and  passed  slightly  inward,  upward,  and  backward, 
between  the  tensor  vaginae  femoris,  and  sartorius  muscles.  He  was  at  once  admitted  to  the 
post  hospital.  The  track  of  the  ball  could  not  be  traced  with  a  probe  beyond  three  inches.  But 
little  pain  was  experienced  by  the  patient  on  examination  of  the  limb.  Water  dressings  were 
applied.  Five  days  after,  the  ball  was  found  lodged  in  the  gluteal  muscle,  two  inches  to  the  left 
of  the  anus,  being  plainly  felt  through  the  skin,  and  was  removed  by  an  incision  three-quarters 
of  an  inch  long.  The  ball  was  considerably  flattened,  having  struck  the  femur  in  its  passage. 
On  June  27th,  the  patient  was  doing  well,  and  the  wound  healing  kindly. 


76  REPORT  OF  SUBGICAL  CASES  IN  TEE  ARMY. 

CCLX.— Report  of  a   Gunshot  Flesh-Wound  of  the  Thigh.     By  JAMES  F.  WEEDS,   Surgeon, 
U.  S.  A. 

Private  Walter  R.  Oliver,  14th  Infantry,  aged  21  years,  received  a  gunshot  wound  on  July 
15,  1809,  from  a  conoidal  ball,  which  entered  at  the  front  of  the  left  thigh,  and  passed  directly 
through  the  limb  on  the  inner  side  of  the  bone.  He  was  admitted  to  the  post  hospital  at  Nash- 
ville, Tennessee,  on  the  same  day.  Simple  dressings  were  applied.  He  was  returned  to  duty  on 
August  21, 1809. 

CCLXI. — Report  of  a  Case  of  Gunshot  Flesh-Wound  of  the  TJiigh.    By  W.  S.  TREMAINE,  Assistant 
Surgeon,  U.  S.  A. 

Private  Peter  Badamy,  Co.  D,  25th  Infantry,  aged  18  years,  received  in  a  street  fight  on 
February  18,  1868,  a  slight  flesh-wound  of  the  anterior  aspect  of  the  left  thigh,  from  a  conoidal 
pistol-ball.  He  was  admitted  into  the  hospital  at  Memphis,  Tennessee,  on  February  18,  1868. 
The  treatment  consisted  of  simple  dressings.  He  was  returned  to  duty  on  February  21,  1868. 

CCLXII. — Report  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Thigh.    By  J.  B.  BROOKE,  Assistant 
Surgeon,  II.  S.  A. 

Private Herrarra,  Co.  B,  1st  New  Mexican  Infantry,  was  admitted  to  the  post  hospital  at 

Fort  Sumner,  New  Mexico,  July  18,  1866,  with  a  pistol-shot  wound  of  the  right  thigh,  received 
accidentally.  Simple  dressings  were  applied.  He  left  the  post  with  his  company  on  September 
2, 1866. 

CCLXIII. — Report  of  tico  Cases  of  Gunshot  Wounds  of  the  Hip.    By  W.  M.  NOTSON,  Assistant 
Surgeon,  U.  S.  A. 

CASE  1. — Private  Henry  Johnson,  Co.  E,  9th  Colored  Cavalry,  aged  26  years,  received  a 
gunshot  wound  of  the  left  hip,  on  June  28,  1869,  by  a  conoidal  ball.  He  was  admitted  from  Fort 
Stockton,  Texas,  into  the  post  hospital  at  Fort  Concho.  The  treatment  consisted  of  cold  applica- 
tions. He  was  returned  to  duty  on  August  18,  1869. 

CASE  2. — Private  James  Feaster,  Co.  F,  41st  Infantry,  aged  24  years,  received  a  gunshot 
wound  of  the  left  thigh,  in  a  scuffle  with  a  comrade,  on  July  14,  1869,  by  a  conoidal  ball.  He  was 
admitted  to  the  post  hospital  at  Fort  Concho,  Texas.  Cold  applications  were  made  to  the  wound. 
He  died  on  July  16,  1869. 

CCLXIV.— Report  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Thigh.    By  J.  W.  BEEWER,  Assistant 
Surgeon,  U.  S.  A. 

Private  James  Shields,  Co.  M,  10th  Cavalry,  aged  25  years,  was  shot  on  October  15,  1865, 
through  the  fleshy  part  of  the  middle  third  of  the  right  thigh,  on  the  mail  route  between  Fort  Sill. 
Indian  Territory,  and  Fort  Arbuckle.  He  was  admitted  to  the  post  hospital  at  Fort  Arbuckle, 
Cherokee  Nation,  ludiau  Territory,  on  October  16, 1869.  The  treatment  consisted  of  cold-water 
dressings  and  poultices.  He  was  returned  to  duty  on  December  12,  1869. 

CCLXV. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Thigh.    By  C.  S.  DE  GRAW,  Assistant 
Surgeon,  U.  S.  A. 

Private  Charles  Kennedy,  Co.  F,  1st  Artillery,  aged  22  years,  was  accidentally  wounded  at 
Madison  Barracks  post  hospital,  New  York,  May  6,  1870,  by  a  pistol  ball,  which  entered  the  right 
thigh,  middle  third,  and  lodged.  He  was  admitted  to  the  hospital  the  same  day.  Carbolic  acid, 
half  an  ounce  to  one  pint  of  water,  was  applied  freely  to  the  wound.  He  died  October  30,  1870,  of 
typhoid  fever. 


GUNSHOT  WOUNDS  OF  THE  LOWER  EXTREMITIES.          77 

CCLXVI. — Report  of  a  Case  of  Gunshot  Flesh- Wound  of  the   Thigh.    By  J.  RIDGELY,  M.  D. 
Acting  Assistant  Surgeon. 

Sergeant  John  Cappings,  Co.  H,  26th  Infantry,  aged  27  years,  received  a  wound  of  the 
right  hip,  from  a  conoidal  musket  ball,  on  September  20,  1867.  He  was  admitted  from  hospital  at 
Waco,  Texas,  to  hospital  at  Austin,  on  March  20,  1808.  He  was  returned  to  duty  on  May  1,  1868. 

CCLXVII. — Report  of  Two  Cases  of  Gunshot  Flesh  Wounds  of  the  Thigh.    By  JULES  LB  CABPEN- 
TIEE,  M.  D.,  Acting  Assistant  Surgeon. 

CASE  1. — Private  James  Francis,  Co.  A,  38th  Infantry,  aged  23  years,  while  on  a  scout  on  Sep- 
tember 24,  1868,  received  a  gunshot  flesh-wound  of  the  inner  and  upper  portion  of  the  left  thigh  by 
a  round  ball.  He  was  admitted  into  the  post  hospital  at  Fort  Bayard,  New  Mexico,  on  October  9th. 
Simple  dressings  were  applied  to  the  wound.  He  was  returned  to  duty  on  November  16,  1868. 

CASE  2. — Private  Logan  Goodpastor,  Co.  A,  38th  Infantry,  aged  22  years,  received  a  slight 
gunshot  flesh-wound  of  the  thigh  from  a  pistol  ball  on  December  24, 1868,  in  a  riot  at  Central  City. 
He  was  admitted  into  the  post  hospital  at  Fort  Bayard,  New  Mexico,  on  December  25th.  Simple 
dressings  were  used.  He  was  returned  to  duty  in  January,  1869. 

CCLXVIIL— Report  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Thigh.    By  L.  G.  HOLMES,  M.  D., 
Acting  Assistant  Surgeon. 

Lieutenant  D.  W.  Walcott,  1st  Cavalry,  aged  34,  was  wounded  by  the  accidental  discharge  of 
his  pocket  pistol  while  riding  on  horseback  near  Camp  Logan,  Oregon,  August  16,  1868.  The  ball 
entered  the  thigh  on  the  outside,  one  inch  posterior  to,  and  three  inches  below,  the  trochanter 
major,  passed  downward  and  inward  and  lodged  in  the  belly  of  the  adductor  muscles.  He  was 
admitted  on  the  same  day  to  the  post  hospital  at  Camp  Logan,  where  all  foreign  substances  which 
could  be  detected  were  removed,  and  an  anodyne  administered.  On  the  18th,  slight  inflammation 
set  in,  which  increased  until  the  23d,  when  some  fluctuation  was  detected  on  the  inside  of  the 
thigh.  An  incision  was  made  over  the  point  of  fluctuation,  and  the  ball  was  found  and  removed. 
On  August  24th,  the  leg  was  greatly  inflamed  and  painful.  The  pulse  was  weak  and  the  wound 
discharged  considerable  pus.  Under  the  application  of  cold  to  the  limb  and  stimulants  internally, 
the  patient  commenced  to  improve,  and  on  the  27th,  the  swelling  had  somewhat  subsided.  On 
September  23d  the  patient  was  dropped  from  the  sick  report,  the  wound  being  completely  healed. 
There  was  slight  lameness  from  contracted  tendons,  which  was,  however,  gradually  lessening. 

CCLXIX.— Memorandum  of  a  Case  of  Gunshot  Flesh-  Wound  of  the   Thigh.    By  H.  R.  TILTON, 
Assistant  Surgeon,  U.  S.  A. 

Private  Robert  Garnet,  Co.  K,  10th  Cavalry,  aged  18  years,  received  October  9,  1808,  while 
on  the  march,  a  wound  of  the  left  thigh,  by  a  conoidal  ball  from  a  pistol  in  the  hands  of  a  sergeant 
which  entered  two  inches  from  the  great  trochanter.  He  was  admitted  to  the  post  hospital  at  Fort 
Lyon,  Colorado  Territory,  on  November  llth,  where  the  ball  was  extracted  from  the  point  of 
entrance.  The  patient  was  returned  to  duty  February  7,  1869. 

CCLXX.— Note  of  a  Case  of  Gunshot  Flesh-Wound  of  the  Thigh.    By  JOHN   B.  WHITE,  M.  D. 
Acting  Assistant  Surgeon. 

Private  Patrick  Burke,  Co.  B,  17th  Infantry,  aged  21  years,  was  wounded  at  Raleigh,  North 
Carolina,  in  a  street  affray  between  the  police  of  the  city  and  men  of  the  above  command,  by  a 
conoidal  pistol  ball,  which  entered  and  lodged  in  the  thigh.  He  was  admitted  to  the  post  hospital 
at  Raleigh,  North  Carolina,  April  14, 1870.  Simple  dressings  were  applied.  He  was  returned  to 
duty  on  May  10,  1870. 


78  EEPOET  OF  SUEGICAL  CASES  IN  THE  AEMY. 

CCLXXI. — Report  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Thigh.    By  H.  S.  SOHELL,  Assistant 
Surgeon,  U.  S.  A. 

Colonel  Henry  B.  Carrington,  18th  Infantry,  was  accidentally  wounded,  on  February  5,  18G7, 
by  a  coiioidal  ball,  which  entered  the  apex  of  Scarpa's  triangle,  and,  passing  obliquely  downward 
and  outward,  glanced  from  the  bone  and  lodged  under  the  skin  on  the  outside  of  the  thigh.  He 
arrived  at  Fort  Laramie,  Dakota  Territory,  on  February  9th.  The  limb  was  swollen  and  inflamed, 
and  there  was  partial  loss  of  sensation  in  the  lower  part  of  the  thigh  and  leg.  The  patient  Avas 
feverish  and  suffered  much  pain.  On  February  10th,  having  administered  ether,  I  made  a  linear 
incision,  and  removed  the  ball.  The  inflammation  subsided,  and  the  wound  of  incision  healed 
rapidly.  On  February  21,  1867,  the  patient  had  sufficiently  recovered  to  resume  his  journey  to 
his  station,  Fort  McPherson. 


The  three  following  reports  relate  to  cases  of  wounds  of  the  great  vessels  or  nerves 
of  the  thigh,  and  two  reports  that  have  come  to  hand  while  these  pages  were  passing 
through  the  press,  which  should  have  been  placed  here,  will  be  found  near  the  close  of 
the  chapter. 

CCLXXII. — Report  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Thigh.    By  C.  E.  GEEENLEAF,  Assist- 
ant Surgeon,  U.  S.  A. 

Henry  C.  Clinton,  Artificer,  Co.  C,  2d  Infantry,  was  shot  in  a  street  brawl,  at  Louisville, 
Kentucky,  on  October  19,  1868,  through  the  right  thigh,  by  a  round  pistol  ball,  which  passed 
obliquely  through  from  behind,  severing  the  femoral  artery  and  vein,  at  the  point  where  the 
artery  passes  through  the  adductor  inaguus.  Death  occurred  in  a  few  minutes,  from  haemorrhage. 

CCLXXIII. — Report  of  a  Case  of  Gunshot  Wound  of  the  Thigh  and  Leg.    By  S.  M.  HOETON,  Assistant 
Surgeon,  U.  S.  A. 

Thomas  Carnovan,  citizen,  aged  17  years,  was  wounded  by  Indians,  at  night,  while  sitting  by 
a  camp  fire,  just  outside  the  stockade  of  Fort  Philip  Kearney,  Dakota  Territory.  The  missiles 
were  supposed  to  be  slugs  from  a  shot-gun.  Two  of  them  entered  the  inner  side  of  the  right 
thigh,  in  the  middle  third,  two  inches  apart,  and  passed  through  just  behind  the  femur.  Two  others 
passed  through  the  calf  of  the  leg  of  the  same  side;  another  comminuted  the  bones  of  the  second 
joint  of  the  forefinger  of  the  right  hand.  He  was  admitted  to  the  hospital  of  the  post  on  Novem- 
ber 2, 1866.  Simple  dressings  were  applied,  and  liquor  of  the  persulphate  of  iron  was  used  to  arrest 
venous  hitmorrhage.  The  patient  died  on  November  6th  from  shock,  venous  haemorrhage,  and 
gangrene  of  the  leg.  An  autopsy  revealed  laceration  of  the  femoral  nerve,  and  injury  to  the 
femoral  vein. 

CCLXXIV. — Report  of  a  Case  of  Gunshot  Wound  of  the  Tliigh.   By  E.  SHAEPE,  M.  D.,  Acting  Assist- 
ant Surgeon. 

Private Williams,  Co.  D.,  24th  Infantry,  was  accidentally  wounded  by  the  discharge  of  a 

rifle  in  the  hands  of  another  soldier,  March  25,  1870,  on  the  North  Llano,  Texas,  while  in  the  line 
of  duty.  The  wound  was  dressed  on  the  spot,  and  the  patient  was  brought  to  hospital  at  Mc- 
Kavett  next  day.  The  ball  was  found  to  have  entered  the  left  thigh,  externally,  at  about  the 
upper  third,  and,  emerging  almost  opposite,  had  entered  the  right  thigh,  and  made  its  final  exit 
about  four  inches  below  the  anterior  superior  spiuous  process  of  the  ilium,  on  outer  surface  of 
limb,  the  ball  in  its  passage  just  grazing  both  femoral  bones.  Immediately  after  the  accident  he 
complained  of  a  feeling  of  numbness  of  the  left  leg,  and  was  unable  to  move  it  or  the  foot.  The 


GUNSHOT  WOUNDS  OF  THE  LOWEE  EXTEEMITIES.          79 

wound  was  dressed  with  a  solution  of  permanganate  of  potash,  and  opium  was  given.  The  patient 
was  tolerably  comfortable  till  April  1st,  when  he  complained  of  much  pain.  He  rested  badly  at 
night,  pulse  almost  imperceptible ;  left  leg  much  swollen,  and  temperature  diminished,  giving  the 
premonitions  of  gangrene.  Ordered  morphine,  egg-nog,  and  beef-tea,  and  warm  applications  to  leg. 
Eleven  A.  M.:  Patient,  after  taking  a  spoonful  of  egg-nog,  vomited.  Twelve  M.:  Eapidly  grow- 
ing worse,  and  died  at  2  P.  M.  Autopsy  by  Dr.  De  Loffre.  Much  effusion  of  serum  in  areolar 
tissue  of  left  leg;  gangrene  of  the  large  muscles  around  the  wounds.  Great  sciatic  nerve  much 
contused  by  ball ;  not  otherwise  injured.  All  the  internal  organs  healthy.  Large  clots  of  blood  iu 
the  aorta  and  iu  the  right  auricle. 


Gun-shot  wounds  of  the  Knee-joint. — There  are  four  reports  of  cases  of  recovery  after 
gunsliot  wounds,  believed  to  have  involved  the  knee-joint.  The  details  of  evidence  will 
hardly  satisfy  skeptical  military  surgeons. 

CCLXXV. — Report  of  a  Case  of  Gunsliot   Wound  of  the  Knec-Joint.    By  H.  E.  TILTON,  Assistant 
Surgeon,  U.  S.  A. 

Private  Thomas  Murray,  Co.  B,  7th  Cavalry,  who  was  shot  through  the  knee-joint  at  Fort 
Lyons,  Colorado  Territory,  in  January,  1867,  recovered  without  an  unfavorable  symptom.  He 
could  move  the  joint  slightly  on  the  4th  of  February.  February  19th,  just  four  weeks  from  the 
date  of  the  injury,  he  was  able  to  stand  on  the  foot  and  walk  a  few  steps  without  crutch  or  cane- 
At  present,  in  walking,  he  has  to  keep  the  joint  stiff,  but  eventually  there  will  be  very  good  motion, 
and  little  inconvenience  from  the  injury.  At  the  time  Murray  was  shot,  January  22, 1867,  the  only 
probe  which  I  used  was  the  end  of  my  little  finger.  I  was  satisfied  that  the  ball  had  not  passed 
around  the  joint.  No  benefit  would  have  been  derived  by  the  patient  by  making  further  efforts  to 
determine  the  exact  course  of  the  ball.  I  was  under  the  impression  that  it  had  passed  through  the 
head  of  the  tibia.  I  am  satisfied  by  the  result  that  it  could  not  have  done  so  ;  but  the  ball  could 
open  the  synovial  membrane  and  pass  through  the  joint  without  injury  to  either  the  femur  or  tibia. 
The  result  is  remarkable.  He  was  returned  to  duty  on  March  4,  1867,  but  riding  caused  the  knee 
to  swell.  He  was  returned  to  duty  again  iu  March,  1867,  able  to  attend  to  any  duty  except  riding. 
I  remember  a  case  in  the  Vicksburg  campaign,  where  the  ball  struck  the  patella  without  fracturing 
it  or  opening  the  joint,  and  passed  up  the  thigh  superficially,  escaping  four  inches  above,  and  yet 
the  man  died  of  inflammation  of  the  knee-joint. 

CCLXXVI. — Report  of  a  Case  of  Gunsliot  Wound  of  the  Knee-Joint.    By  JOSEPH  KUGLER,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Charles  Willis,  Troop  G,  3d  Cavalry,  was  wounded,  October  3,  1866,  in  an  engagement 
with  Ute  Indians  at  Purgatory  Creek,  Colorado  Territory,  by  a  rifle  bullet,  which  entered  a  little 
above  the  external  condyle  of  the  right  femur,  fractured  the  patella,  opened  the  knee-joint  and 
lodged,  it  is  supposed,  in  the  internal  condyle.  He  was  admitted  to  the  post  hospital  at  Fort 
Garland,  Colorado  Territory,  on  October  12th,  having  been  carried  in  an  ambulance  from  Trinidad, 
over  a  very  rough  mountain  road.  When  admitted  he  was  in  such  a  weak  and  exhausted  condition 
that  it  was  thought  inadvisable  to  submit  him  to  an  operation ;  his  system  being  very  irritable,  the 
wounded  part  painful,  and  dreading  symptoms  of  pyaemia,  he  was  put  on  nutritious  diet,  with 
stimulants  and  narcotics,  together  with  soothing  and  emollient  applications  to  the  knee.  Although 
several  abscesses  formed,  and  the  discharge  was  very  plentiful,  he  seemed  to  be  in  a  much  better 
condition  on  October  31st  than  when  he  entered  the  hospital.  His  situation  was  still  very  critical, 
but  it  was  thought  he  might  so  far  improve  as  to  make  it  possible  to  save  his  life  by  an  operation, 
even  should  the  limb  have  to  be  sacrificed.  In  December,  1866,  Willis  was  reported  as  still  con- 
fined to  his  bed,  and  despite  the  greatest  care  taken  to  prevent  them,  suffered  from  bed-sores.  Some 


80  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

of  the  old  abscesses  were  of  an  erysipelatous  character,  and  formed  above  and  below  the  knee,  dis- 
charging a  great  quantity  of  purulent  matter,  which  gradually  became  healthier.  lie  evidently 
guttered  from  pyaemia,  and  an  abscess  of  the  right  lung  was  suspected.  The  treatment  consisted 
of  tonics  and  stimulants.  In  January,  1807,  he  was  doing  well,  and  was  able  to  sit  up  several 
hours  each  day.  During  this  month  the  missile,  or  one  and  a  quarter  ounce  lead  slug,  was  ex- 
tracted, after  which  all  the  abscesses  but  one  healed  kindly.  lie  gained  strength  daily  until 
attacked  with  influenza.  The  ultimate  termination  of  the  case  does  not  appear,  but  he  most  prob- 
ably recovered,  as  he  does  not  appear  upon  the  report  of  sick  and  wounded  for  February,  1867. 

CCLXXVII. — Report   of  a   Case  of   Gunsliot   Wound  of  the  Knee-Joint.    By  FERDINAND    AXT, 
Assistant  Surgeon,  U.  S.  A. 

At  Rattlesnake  Station,  Nevada,  on  September  16,  1867,  Sergeant  Patrick  Corcoran,  Co.  D, 
8th  Cavalry,  was  shot  through  the  upper  part  of  the  left  knee,  the  ball  entering  on  the  outer  side, 
and  passing  out  on  the  inner  side  apparently  through  the  anterior  and  upper  segment  of  the  inner 
coudyle  of  tlie  femur.  He  was  conveyed  to  the  hospital  at  Camp  McDermit,  Nevada,  a  distance 
of  sixty  miles,  over  a  rough  road.  It  was  supposed,  from  the  nature  of  the  discharge,  that  the 
wound  communicated  with  the  knee-joint.  The  treatment  in  the  case  is  iiot  recorded.  In  No- 
vember, 1868,  Corcoran  was  returned  to  duty. 

CCLXXVIII. — Memorandum  of  a  Case  of  Gunshot  Wound  of  the  Knee-Joint.  By  J.  V.  D.  MIUDLETON, 
Assistant  Surgeon,  II.  S.  A. 

At  Austin,  Texas,  March  29, 1869,  John  Glascock,  citizen  prisoner,  aged  30,  shot  himself,  while 
being  arrested,  inflicting  a  wound  of  knee,  involving  the  joint;  the  missile,  a  conoidal  ball,  lodged. 
He  was  admitted  to  the  post  hospital.  Cold  water  dressings,  poultices,  carbolic  acid  and  oil  were 
applied.  He  was  discharged  from  further  treatment,  October  17, 1869. 


Gunshot  Wounds  of  the  Leg. — The  seven  following  reports  describe  gunshot  fractures 
of  the  tibia  in  five  instances,  of  the  fibula  in  one,  and  of  the  tibia  and  fibula  in  one. 
All  of  the  cases  had  favorable  terminations. 

CCLXXIX. — Report  of  a  Case  of  Gunshot  Wounds  of  the  Thigh  and  Leg.    Condensed  from  detailed 
Reports  by  Acting  Assistant  Surgeon  IKYING  C.  ROSSE,  M.  D. 

Major  George  A.  Forsyth,  9th  Cavalry,  received  two  severe  and  dangerous  wounds,  in  a  fight 
with  Indians,  at  Dry  Forks,  Republican  River,  Kansas,  on  September  17,  1868.  The  first  wound 
was  caused  by  a  Henry  rifle  ball,  which  entered  the  left  leg  posteriorly  about  the  centre,  and,  passing 
directly  through,  fractured  and  crushed  the  tibia  on  the  aspect  of  entrance,  transversely  fracturing 
it  anteriorly.  The  second  wound  was  caused  by  a  similar  missile,  which  entered  the  right  thigh  at 
the  outer  anterior  aspect  at  the  juncture  of  the  upper  with  the  middle  third,  penetrated  to  the  deep 
fascia,  ranged  thence  upward  and  inward  across  the  centre  of  Scarpa's  triangle,  and  lodged  deeply 
on  the  inner  aspect  of  the  thigh,  severely  contusing  the  right  testicle.  The  circumstances  attend- 
ing the  wounded  after  this  engagement  were  exceedingly  unfavorable.  They  were  not  relieved 
until  the  evening  of  the  ninth  day  after  the  fight ;  the  weather  at  first  was  very  warm,  and  the 
men  lay  in  the  sand  beside  their  dead  horses,  subjected  to  noisome  gases  and  swarms  of  flies.  Two 
cold,  rainy  nights  occurred  on  the  22d  and  23d ;  they  were  without  surgical  attendance,  dressing, 
&c.,  the  surgeon  having  been  killed  in  the  fight  ;*  and  their  only  diet  was  the  limited  and  offensive 
flesh  of  their  dead  animals.  The  dangerous  nature  of  the  wounds  mentioned  above  rendered  the 
drain  upon  Major  Forsyth  more  severe  than  on  others.  He  was  taken  with  other  wounded  to  Fort 
Wallace,  distant  one  hundred  and  thirty  miles,  the  journey  taking  nearly  four  days.  On  arrival 

*  John  H.  Moore,  Acting  Assistant  Surgeon,  was  mortally  wounded  at  Arickareo  Fork  of  the  Republican  River, 
September  17,  1868,  aud  died  on  the  morning  of  September  20,  1868.— ED. 


GUNSHOT  WOUNDS  OF  THE  LOWER  EXTREMITIES.  81 

there  every  facility  in  the  way  of  hospital  accommodation  was  afforded  by  Dr.  T.  H.  Turner,  U.  S. 
A.  A  few  days  afterward,  decided  symptoms  of  septicaemia  manifested  themselves  with  the 
wounded,  more  especially  with  Major  Forsyth.  The  symptoms  were  excessive  irritability  or 
nervousness,  a  hectic  form  of  fever,  diffuse  abscesses,  &c.,  from  which  he  became  rapidly  reduced 
iii  flesh  and  strength.  An  abscess  under  the  scalp,  anterior  to  the  vertex,  resulted  in  the  death  of 
a  small  portion  of  both  tables  of  the  skull,  which  was  thrown  off  by  exfoliation.  Indications  of 
necrosis  of  upper  part  of  the  lower  half  of  tibia  came  on  in  November;  but  all  interference  \v;is 
avoided  until  January  20,  when  loose  bone  being  detected,  fragments  of  the  tibia,  to  the  extent  of 
nearly  three  inches,  were  removed.  After  this  operation  the  patient  improved  rapidly,  the  wound 
filling  up  with  new  material  of  a  cartilaginous  nature.  About  the  last  of  January  he  was  lifted 
from  his  bed  for  the  first  time  in  four  months,  and  had  his  first  airing  in  a  Tompkins's  wheel-litter. 
A  few  days  afterward  he  used  crutches,  and  got  about  feebly.  This  case  was  treated  by  first 
placing  the  leg  in  a  common  fracture  box;  then  in  a  suspension  splint  of  leather  and  telegraph 
wire;  next  in  a  double  inclined  plane,  made  light,  and  suspended;  lastly,  in  a  "Smith's  anterior," 
modified.  Quinine  and  tincture  of  iron  were  administered  in  small  doses  for  some  three  months, 
and  decided  benefit  was  derived  from  fifteen-grain  doses  of  hyposulphite  of  soda.  On  February 
18th  he  was  transferred  to  Fort  Leaven  worth,  Kansas,  415  miles  by  rail,  where  he  yet  more  rapidly 
gained  in  flesh  and  strength,  his  wounds  filling  up  and  the  leg  acquiring  some  solidity.  On  April  8th, 
he  reached  Chicago,  entering  there  upon  his  duty  as  military  secretary  to  General  Sheridan. 

Assistant  Surgeon  J.  A.  Fitzgerald,  U.  S.  A.,  who  furnished  most  of  the  above  particulars,  stated, 
under  date  of  August  25,  1869,  that  it  was  not  until  about  May  10, 1869,  that  he  first  became  con- 
vinced of  a  real  bony  union.  In  the  latter  part  of  April  he  applied  a  new  splint  in  the  form  of 
long  upholsterers'  needles,  applied  as  follows :  First.  Applied  two  roller  bandages  from  toes  to  knee, 
then  introduced  the  long  needle  interruptedly  by  catches  one  or  two  inches  apart,  putting  alternate 
needles  in  the  intervals  of  preceding  catches.  In  this  manner  were  applied  three  externally  and 
two  internally  to  the  leg,  over  which  another  roller  was  closely  applied,  and  lastly  a  firm  elastic 
stocking.  When  this  was  applied  there  was  no  discharge  whatever,  and  with  it  he  could  get  about 
on  crutches  with  facility.  When  he  left  him  on  May  13,  1869,  he  walked  about  five  squares  twice 
daily,  and  to  his  office  in  a  third  story.  He  could  bear  considerable  weight  on  the  leg  without  pain 
at  that  time.  Dr.  Fitzgerald  also  states  that  he  heard  from  his  patient  about  four  weeks  previously, 
and  that  he  expected  to  be  walking  by  September  1, 1869.* 

CCLXXX. — Mention  of  a  Case  in  ichich  there  teas  Removal  of  a  Portion  of  the  Fibula  after  a  Gunshot 
Injury.    By  H.  R.  TILTON,  Assistant  Surgeon,  U.  S.  A. 

Private  Thomas  Kelly,  Co.  B,  5th  Cavalry,  aged  22  years,  received  an  accidental  gunshot 
wound  of  the  left  leg,  on  November  15,  1868.  The  ball  entered  the  inner  side  of  leg,  two  and  a  half 
inches  below  the  tibia,  and  passed  out  at  the  middle  third  of  the  leg,  externally,  fracturing  the 
fibula.  He  was  admitted  to  the  post  hospital  at  Fort  Lyon,  Colorado  Territory,  on  April  30,  1869. 
The  patient  states  that  a  portion  of  the  fibula  was  removed  by  Assistant  Surgeon  Turner,  U.  S.  A. 
The  wound  was  nearly  healed.  The  patient  was  in  hospital  only  two  days  when  the  5th  Cavalry 
left  the  post.  [He  was  returned  to  duty  on  May  2, 1869. — ED.] 

CCLXXXI.— Mention  of  a  Gunshot  Wound  of  the  Leg.    By  B.  E.  FRYER,  Surgeon,  U.  S.  A. 

Private  Peter  Eustace,  Co.  H,  5th  Infantry,  aged  26  years,  was  accidentally  wounded  on  Feb- 
ruary 23,  1868,  by  a  small  conoidal  ball,  which  fractured  the  right  tibia  and  fibula  at  the  lower 
third.  He  was  admitted  from  Fort  Hayes,  on  April  28,  1868,  to  the  post  hospital  at  Fort  Harker, 
Kansas.  The  wounds  had  healed,  and  the  bones  had  united  prior  to  admission.  Some  little  lame- 
ness still  exists.  There  is  no  shortening  or  other  deformity.  He  was  returned  to  duty  in  May,  1868. 

*  In  May,  1871,  Major  G.  A.  Forsyth  met  Assistant  Surgeon  General  Craue,  and  boasted  of  tbe  perfection  of  his 
cure,  gpeftkiog  in  enthusiastic  terms  of  army  surgery,  and  the  skill  of  his  attendants,  complimenting  partienhirly  Drs. 
Kit/gcrulil  and  Asch,  with  endless  grateful  expressions  toward  the  former,  who  had  charge  of  the  case  at  first.    There 
was  no  apparent  shortening  of  the  limb. — El). 
11 


82  EEPOET  OF  SUEGICAL  CASES  IN  THE  ARMY. 

CCLXXXIL— Report  of  a  Gunshot  Wound  of  the  Leg.    By  J.  M.  BEST,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  James  Farrall,  Co.  E,  2oth  Infantry,  was  wounded  in  a  street  fight,  on  December  1, 
1868.  The  ball  entered  the  integuments  on  the  anterior  and  inner  part  of  the  upper  third  of  the 
tibia  of  left  leg,  passed  out  about  two  inches  from  the  place  of  entrance,  in  an  almost  transverse 
direction,  burying  about  half  the  width  of  a  small  ball  in  the  substance  of  the  tibia.  He  was 
admitted  to  the  post  hospital  at  Von  Schrader  Barracks,  Paducah,  Kentucky,  on  the  same  day. 
Simple  dressings  were  applied.  He  was  returned  to  duty  on  January  8,  1869. 

CCLXXXIII. — Memorandum  of  a  Case  of  Gunshot  Fracture  of  Tibia  and  Ulna.    By  W.  H.  HOPFEB, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  John  McWilliams,  Co.  I,  14th  Infantry,  aged  23  years,  received,  near  Somerset,  Ken- 
tucky, February  16,  1870,  five  balls  in  his  body,  the  first  causing  a  flesh-wound  in  the  right  shoul- 
der, the  second  on  the  left  side,  just  above  the  crest  of  the  ilium,  the  third  in  the  left  arm,  just 
below  the  elbow,  the  fourth  in  the  right  arm  below  the  elbow -joint,  fracturing  the  ulna,  and  the 
fifth  in  the  right  leg,  about  four  inches  below  the  patella,  shattering  the  tibia.  On  April  9th  he 
was  admitted  to  post  hospital  at  Lebanon,  Kentucky.  A  ball  which  had  been  overlooked  was 
now  cut  out.  The  first  three  wounds  had  healed  before  his  admission.  The  fourth  healed  rapidly, 
leaving  perfect  anchylosis  of  the  joint.  The  fifth  wound  was  still  open,  and  slightly  suppurating, 
June  30,  1870.  He  was  sent  to  his  regiment  on  October  24,  1870. 

CCLXXXIY. — Memorandum  Relative  to  a  Gunshot  Wound  of  the  Leg.    By  W.  M.  AUSTIN,  Assistant 
Surgeon,  U.  S.  A. 

Private  Joseph  Shaw,  Co.  D,  3d  Cavalry,  was  wounded  on  October  17,  1867,  in  a  fight  with 
Indians,  by  a  ball  which  caused  a  wound  of  the  right  tibia.  He  was  admitted  at  Fort  Bliss  and 
Camp  Coucordia,  Texas,  on  October  25, 1867.  On  February  2, 1868,  the  necrosed  bone  was  excised. 
He  was  returned  to  duty  on  March  9, 1SC8. 

CCLXXXV. — Memorandum  of  a  Case  of  Gunshot  Fracture  of  the  Bight  Tibia.    By  J.  F.  HAMMOND, 
Surgeon,  U.  S.  A. 

Private  Eobert  Burgi,  Co.  H,  4th  Cavalry,  aged  23  years,  received  a  gunshot  wound  of  the 
right  leg  by  a  conoidal  ball,  June  13,  1870,  while  on  his  way  to  supper,  from  a  soldier  who  was 
standing  in  the  door  of  a  tent,  ten  yards  distant,  the  ball  striking  the  posterior  aspect  of  the 
limb  in  the  median  line,  three  inches  below  the  knee-joint,  passing  horizontally  through  the  leg 
and  comminuting  the  tibia  in  its  transit.  He  was  admitted  to  the  post  hospital  at  Austin,  Texas, 
the  same  day.  Treatment  consisted  of  lead-water,  solution  of  permanganate  of  potassa,  poultices, 
and  solution  of  carbolic  acid.  The  man  was  still  under  treatment  January  1,  1871.  He  was  dis- 
charged April  30,  1871. 

Special  reports  were  made  of  nineteen  gunshot  flesh-wounds  of  the  leg.  In  four 
instances  foreign  bodies  were  extracted.  Seventeen  patients  went  to  duty ;  one  was  dis- 
charged and  one  died  of  pyaemia. 

CCLXXXVI. — A  Case  of  Gunshot  Wound  of  the  Leg.    By  FERDINAND  AXT,  Assistant  Surgeon, 
U.  S.  A. 

Private  John  Welsh,  Co.  E,  23d  Infantry,  aged  34  years,  was  admitted  to  the  post  hospital  at 
Camp  McDermit,  Nevada,  July  23,  1868,  with  a  gunshot  wound  of  the  left  leg.  The  ball  entered 
on  the  inside  of  the  middle  of  the  leg,  traversed  the  cellular  tissue  posterior  to  the  tendo  Achillis, 
and  emerged  on  a  level  with  the  upper  end  of  the  malleolus.  Chloroform  being  administered,  a 
large  number  of  minute  shreds  of  clothing  were  removed  from  the  wound.  Ice-water  dressings 
were  applied.  The  patient  was  discharged  from  hospital  September  13, 1868.  The  wound  had 
nearly  closed  and  the  movement  of  the  foot  was  not  impaired. 


GUNSHOT  WOUNDS  OP  THE  LOWER  EXTREMITIES.          83 

CCLXXXVIL — Report  of  a  Case  of  Gunshot  Flesh-  Wound  of  the  Eight  Leg.    By  WILLIAM  THOMSON, 
Assistant  Surgeon,  U.  S.  A. 

Private  John  Conroy,  Battery  D,  4th  Artillery,  aged  40  years,  received  at  Washington,  D.  0., 
July  4,  I860,  a  gunshot  wound  of  the  upper  third  of  the  right  leg,  by  the  bursting  of  a  rifle.  He 
was  admitted  to  post  hospital  July  5th.  A  piece  of  cast  iron,  one  and  a  quarter  inches  long  and 
one-half  inch  wide,  was  impacted  near  the  internal  surface  of  the  tibia  near  the  insertion  of  the  sar- 
torius  muscle.  On  July  llth,  I  enlarged  the  wound  by  a  crucial  incision,  and  extracted  the  iron  with 
bone  forceps ;  water  dressing  was  then  applied  to  the  knee-joint  for  two  days,  when  the  wound  was 
poulticed.  September  6th,  the  wound  had  healed,  and  on  September  13,  I860,  the  patient  was 
returned  to  duty. 

CCLXXXVIII. — Account  of  a  Gunshot  Flesh-  Wound  of  the  Leg.    By  J.  B.  CRANDALL,  M.  D., 
Acting  Assistant  Surgeon. 

Private  James  Collins,  Co.  F,  37th  Infantry,  aged  23  years,  received  a  gunshot  flesh-wound  of 
the  right  leg,  in  a  fight  with  Indians,  on  July  19,  1867.  He  was  admitted  from  the  field  into  the 
post  hospital  at  Fort  Dodge,  Kansas,  on  July  20th.  Simple  dressings  were  used.  In  Septem- 
ber the  wound  had  healed,  and  he  was  awaiting  transportation  to  his  company. 

CCLXXXIX. — Mention  of  a  Case  of  Gunshot  Woimd  of  the  Leg.    By  G.  GWYNTHEE,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Aaron  Smith,  Co.  C,  23d  Infantry,  aged  25  years,  shot  himself  accidentally  at  Camp 
McDermit,  Nevada,  October  25,  1868.  The  missile  entered  on  outer  aspect  of  calf  of  right  leg, 
took  a  superficial  course,  and  lodged  immediately  under  the  skin  on  the  astragulus.  He  was 
admitted  to  the  post  hospital,  where  the  ball  was  extracted  through  a  longitudinal  incision  by  Act- 
ing Assistant  Surgeon  George  Gwynther.  The  wound  healed  rapidly,  and  the  patient  was  dis- 
charged November  9,  1868. 

Fifteen  other  cases  of  gunshot  flesh-wounds  of  the  leg,  in  which  special  reports  were 
made,  presented  no  peculiarities  of  moment,  with  one  exception,  in  which  pyaemia  was 
developed,  and  the  medical  officer  omitted  to  make  notes  of  the  autopsy. 

Private  William  Barry,  Co.  G,  6th  Cavalry,  aged  30.  Jefferson,  Texas,  May  7, 1869.  Gunshot 
flesh-wound  of  the  right  leg.  Duty,  June,  1869. 

Private  Herman  S.  Brown,  Co.E,  17th  Infantry,  aged  21.  Fort  Stephenson,  Dakota  Territory, 
July  20, 1870.  Gunshot  flesh-wound  of  left  leg.  Duty,  November,  1870. 

Corporal  James  Burnside,  Co.  F,  114th  Colored  Troops,  aged  26.    Accidental,  December  25, 

1866.  Gunshot  flesh-wound  of  right  leg.    Duty,  April,  1867. 

Private  George  Cox,  Co.  H,  8th  Cavalry,  aged  36.  Fort  Union,  New  Mexico,  December  9, 
1870.  Gunshot  flesh-wound  of  right  leg.  Missile  extracted  December  10.  Duty,  December  31, 
1870. 

Private  James  Davis,  Co.  C,  5th  Cavalry,  aged  29.  Atlanta,  October  15, 1868.  Gunshot  flesh 
wound  of  right  leg.  Duty,  October  29, 1868. 

Sergeant  William  Gleason,  Co.  I,  37th  Infantry,  aged  29.    Fort  Dodge,  Kansas,  September  29, 

1867.  Gunshot  flesh-wounds  of  right  knee,  left  leg,  and  scalp.    Duty,  October,  1867. 

Private  Martin  McMahon,  Troop  E,  1st  Cavalry,  aged  27.  Prescott,  Arizona  Territory,  De- 
cember 18, 1867.  Gunshot  flesh-wound  of  right  leg.  Duty,  January,  1868. 

Private  Charles  Michael,  Co.  A,  38th  Infantry,  aged  23.  Central  City.  New  Mexico,  December 
24,  1868.  Gunshot  flesh-wound  of  left  leg.  Duty,  January,  1869. 

Sergeant  Joseph  Myers,  Troop  L,  3d  Cavalry,  aged  21.    Fort  Wiugate,  New  Mexico,  May  5, 

1868.  Gunshot  flesh-wound  of  right  leg.    Duty,  June  6, 1868. 


84  EEPOET  OF  SUEGICAL  CASES  IN  THE  ARMY. 

Private  John  Mann,  Troop  B,  3d  Cavalry,  aged  24.    Port  Bayard,  New  Mexico,  November  12, 
1869.    Gunshot  flesh-wound  of  right  leg.    Duty,  February  24, 1870. 

Private  Isom  Paine,  Co.  H,  24th  Infantry,  aged  25.    Fort  Quitman,  Texas,  November  16,  1869. 
Gunshot  flesh-wound  of  right  leg.     Duty,  February  13, 1870. 

Private  Gnstavus  Smith,  Troop  H,  6th  Cavalry,  aged  26.    Little  Wichita  Eivcr,  Texas,  July 
12,  1870.    Gunshot  flesh-wound  of  the  right  leg.    Duty,  August  9,  1870. 

Private  Eobert  Smith,  Troop  L,  10th  Colored  Cavalry,  aged  20,  Fort  Arbuckle,  Indian  Terri- 
tory, February  21,  1870.    Duty,  April,  1870. 

Private  John  Turner,  Co.  H,  9th  Cavalry,  aged  23.    Fort  Quitman,  Texas,  August  17,  1870. 
Gunshot  wound  of  left  leg.    Died,  September  2,  1870,  of  pyremia. 

Private  George  W.  Youngs,  Troop  H,  9th  Cavalry,  aged  27.    Fort  Quitman,  Texas,  June  20, 
1869.    Gunshot  flesh-wound  of  right  leg.    Duty,  October  31,  1869. 


Gunshot    Wounds  of  the  Foot. — Six  special  reports  were   transmitted  of  cases  of 
fractures  belonging  to  this  class.     They  all  resulted  favorably  under  simple  treatment. 

CCXC. — Mention  of  a  Case  of  Gunshot  Wound  of  the  Foot.    By  A.  A.  WOODHTJLL,  Assistant  Sur- 
geon, U.  S.  A. 

Corporal  Patrick  Dwyer,  Co.  K,  3d  Infantry,  aged  31  years,  accidentally  discharged  his  car- 
bine ;  the  missile,  a  conoidal  bullet,  passed  through  the  iirst  metatarsal.  He  was  admitted  from 
the  field,  fifty  miles  distant,  to  the  post  hospital  at  Fort  Larned,  Kansas,  on  September  15,  1870. 
The  treatment  consisted  of  simple  dressings.  He  was  returned  to  duty  in  October,  1870. 

CCXCI. — Remarks  on  a   Case  of  Gunsliot  Wound  of  the  Left   Second  Toe.     By  E.  TANSZKY, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Taliaferro  Hall,  Co.  E,  9th  Cavalry,  aged  21  years,  was  accidentally  wounded  near 
Fort  Stockton,  Texas,  August  20,  1868,  by  a  conoidal  ball,  which  shattered  two  phalanges  of  the 
second  toe  of  the  left  foot.  He  was,  on  August  30th,  admitted  to  post  hospital.  The  foot  was 
very  much  swollen,  the  wounded  parts  being  osdeinatous  with  threatening  gangrene,  and  discharg- 
ing ichorous  and  fetid  pus.  On  August  31st,  Acting  Assistant  Surgeon  E.  Tanszky  removed  the 
shattered  portions  of  bone,  and  applied  antiseptic  lotions.  A  new  phalanx  formed.  The  first  joint 
is  auchylosed,  but  in  other  respects  the  toe  is  in  the  same  condition  as  before  the  accident.  Hall 
was  returned  to  duty  October  4,  1868. 

CCXCIL— Report  of  a  Case  of  Gunsliot  Wound  of  tlie  Foot.    By  C.  E.  McCnESNEY,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Charles  Green,  Co.  D,  7th  Infantry,  aged  21  years,  was  admitted,  on  July  20,  1870,  to 
the  post  hospital  at  Fort  Buford,  Dakota  Territory,  with  a  gunshot  wound  of  the  left  foot.  Frag- 
ments of  bone  were  removed  and  carbolic  acid  dressings  applied.  He  was  discharged  from  service 
December  18, 1870. 

CCXCIII. — Account  of  a  Gunsliot  Wound  of  tlie  Foot.    By  D.  HEKSHEY,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  John  Huff,  Co.  C,  25th  Infantry,  aged  26  years,  accidentally  shot  himself  in  the  left 
foot,  at  Fort  St.  Philip,  Louisiana,  on  March  30, 1870.  The  ball  entered  over  superior  surface  of 
second  joint  of  great  toe,  and  escaped  on  under  surface,  fracturing  both  phalanges.  He  was 
admitted  to  the  post  hospital,  where  spiculrc  of  bone  were  removed.  He  recovered,  and  was 
returned  to  duty  in  May,  1870. 


GUNSHOT  WOUNDS  OF  THE  LOWER  EXTREMITIES.  85 

CCXCIV.— Mention  of  a  Case  of  Gunshot  Wound  of  the  Foot.    By  JOHN  T.  KING,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  J.  H.  Lewis,  Co.  B,  40th  Infantry,  aged  21  years,  received,  on  January  17, 18G9,  a  gun- 
shot wound  of  the  right  foot,  from  a  revolver  fired  from  his  own  hand,  while  carelessly  handling  it. 
The  ball  entered  the  plantar  surface  of  the  foot,  and  became  firmly  imbedded  in  one  of  the  tarsal 
bones.  He  was  admitted  to  the  post  hospital  at  Goldsborough,  North  Carolina,  on  January  17, 
1809.  The  ball  was  permitted  to  remain.  He  was  returned  to  duty  on  March  31,  1869. 

CCXC  V.— Report  of  a  Gunshot  Wound  of  the  Foot.    By  H.  R.  TILTON,  Assistant  Surgeon,  U.  S.  A. 

Private  James  Wilmot,  Co.  M,  5th  Cavalry,  aged  18  years,  received  an  accidental  gunshot 
wound.  A  carbine  ball  passed  by  the  inner  side  of  the  right  patella,  producing  a  flesh-wound,  and 
then  between  the  great  and  second  toes  of  the  right  foot,  wounding  both,  and  fracturing  the  second 
phalanx  of  the  second  toe.  He  was  admitted  to  the  post  hospital  at  Port  Lyon,  Colorado,  Terri- 
tory, on  January  23,  1869.  Simple  dressings  were  applied.  He  was  returned  to  duty  on  March 
17,  1869. 

There  were  also  special  reports  made  of  seven  cases  of  flesh-wounds  of  the  foot.  The 
patients  returned  to  duty  a  few  weeks  after  the  reception  of  the  injuries,  and  their  cases 
presented  no  particulars  of  special  interest. 

Private  Henry  Clay,  Troop  M,  10th  Colored  Cavalry,  aged  22  years.  Fort  Arbuckle,  Indian 
Territory,  February  27,  1870.  Gunshot  flesh-wound.  Duty,  April,  1870. 

Private  Alexander  Gordon,  Co.  A,  38th  Infantry,  aged  22  years.  Central  City,  New  Mexico, 
December  24, 1868.  Slight  flesh-wound  of  foot.  Duty,  January,  1869. 

Acting  Assistant  Surgeon  G.  W.  Hatch,  aged  36  years.  Little  Wichita  River,  Texas,  July  12, 
1870.  Gunshot  flesh-wound  of  left  foot.  Furloughed,  August  20,  1870. 

Private  Henry  Hight,  Troop  H,  9th  Cavalry,  aged  21  years.  Fort  Quitman,  Texas,  November 
6,  1868.  Gunshot  flesh-wound  of  right  foot.  Duty,  January,  1869. 

Private  Thomas  Navin,  Co.  H,  18th  Infantry,  aged  19  years.  Fort  Philip  Kearney,  Dakota 
Territory,  October  14, 1866.  Gunshot  flesh-wound  of  great  toe,  right  foot.  Duty,  October  23, 1866. 

Private  William  O'Neal,  Co.  B,  5th  Cavalry,  aged  21  years.  Fort  Lyon,  Colorado  Territory, 
March  16,  1869.  Gunshot  flesh-wound  of  foot.  Duty,  April,  1869. 

Private  William  Wilson,  Co.  H,  18th  Infantry,  aged  23  years.  Fort  Philip  Kearney,  Dakota 
Territory,  October  9, 1866.  Gunshot  flesh-wound  of  right  foot.  Duty,  October  25,  1866. 

There  were  also  two  reports  of  gunshot  lesions  of  the  femoral  vessels,  received  too 
late  to  be  inserted  in  their  proper  place  after  report  CGLXII. 

CCXCVL— Report  of  a  Gunshot  Wound  of  the  Femoral  Artery  and  Vein.    By  R.  TANZKY,  M.  D., 
Acting  Assistant  Surgeon. 

Private  William  Neff,  Troop  B,  9th  Cavalry,  was  admitted  to  hospital  at  Fort  Stockton,  Texas, 
in  a  moribund  condition,  having  nearly  bled  to  death  from  the  effects  of  a  gunshot  wound  of  both 
thighs.  A  tourniquet  was  put  over  each  femoral  artery,  and  carbonate  of  ammonia,  with  other 
stimulants,  administered,  but  the  latter  were  immediately  rejected  by  the  stomach.  The  condition 
of  the  patient  precluded  an  operation  for  ligating  the  injured  vessels.  The  autopsy  showed  the 
femoral  artery  and  vein  to  be  severed. 


86 


REPORT  OF  SUEGICAL  CASES  IN  THE  ARMY. 


CCXGVII.— Report  of  a  Gunshot  Wound  of  the  Femoral  Vein.    By  P.  M.  HOLLY,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  John  Eberhardt,  Co.  A,  17th  Infantry,  aged  21  years,  was  shot,  on  October  29,  186S, 
at  Belton,  Texas,  while  an  attempt  was  being  made  by  a  party  of  eight  men  to  arrest  a  desperado. 
A  ball  from  a  Colt's  Navy  revolver  entered  the  right  thigh  three  inches  below  Poupart's  ligament, 
internal  to  sartorius  muscle,  passed  backward  and  slightly  upward,  nearly  severing  the  femoral 
vein,  grazed  the  femur  internally  at  the  junction  of  the  shaft  and  neck,  passed  through  the  gluteal 
muscles,  and  lodged  under  the  cuticle  opposite  the  great  ischiatic  notch.  The  patient,  unaware  of 
being  wounded,  continued  walking  or  running  until  he  fell  faint  from  loss  of  blood.  He  was  seen 
some  fifteen  or  twenty  minutes  after  the  occurrence,  when  the  ball  was  removed  from  its  place  of 
lodgement,  an  efficient  compress  placed  over  the  wound,  and  stimulants  administered.  Reaction 
never  took  place.  The  patient  died  in  about  two  hours  from  haemorrhage. 


ANALYTICAL   REVIEW. 

The  two  hundred  and  ninety-seven  preceding  reports  furnish  more  or  less  complete 
data  respecting  three  hundred  and  eighty-seven  patients  with  gunshot  wounds.  The 
results  appear  in  the  following  statement : 

Tabular  Statement  of  the  Results  of  Three  Hundred  and  Eighty-seven  Cases  of  Gunshot  Wounds. 


Nature  of  injury. 

<s 

£ 
£ 

Discharged. 

rd 
B 

s 

Fractures  of  the  Skull.  ...  .  .  ,  .  

38 

6 

1 

31 

Scalp  Wounds  

9 

9 

Fractures  of  Bones  of  the  Face  .  .  ....  .  ..  

13 

8 

3 

2 

Flesh-Wounds  of  the  Face  ..  .  ...  .  

7 

7 

Wounds  of  the  Neck                                        .         .                  .                .         ..  ..  

16 

6 

10 

Wounds  of  the  Chest                          .                                                            ...     .  

75 

28 

3 

44 

Wounds  of  the  Chest  and  Abdomen                  .           -              .     ..       .  ..   

9 

9 

Wounds  of  the  Abdominal  Cavity  

37 

6 

1 

30 

Flesh-Wounds  of  the  Abdomen                                ..               ..       ...     ..  ....  

5 

5 

Wounds  of  the  Pelvis                                             .               .   .     .     ...  

8 

1 

7 

Wounds  of  the  Genito-Uriiiary  Organs                          .       .     ..  .   ...     .     ..  .  .. 

4 

3 

1 

Flesh-Wounds  of  the  Trunk    .           .                  ...         

7 

7 

Fractures  of  the  Upper  Extremities            ..              .  .   .  -.  .  . 

45 

36 

7 

2 

Flesh-Wounds  of  the  Upper  Extremities    .                .  .  

34 

31 

2 

1 

Fractures  of  the  Lower  Extremities    .         

26 

18 

3 

5 

Flesh-Wounds  of  the  Lower  Extremities  

54 

43 

3 

8 

Totals  

387 

214 

23 

150 

The  mortality  rate  of  the  cranial  fractures  is  very  large,  but  the  fatal  cases  were 
nearly  all  examples  of  perforations  of  the  brain,  at  short  range.  The  large  proportion  of 
cases  of  suicide  is  noticeable  and  lamentable.  It  is  interesting  to  note  that,  except  to 
remove  detached  spiculae,  operative  interference  was  not  attempted  except  in  a  single 


ANALYTICAL  EEVIEW.  87 

case — one  of  the  cases  of  recovery — where  it  was  necessary  to  extract  a  piece  of  iron 
that  had  penetrated  the  cranial  cavity.  The  two  instances  of  recovery  after  fracture  of 
the  mastoid  process  are  uncommon,  and  the  case  reported  by  Assistant  Surgeon  Patzki, 
(III,  p.  6),  in  which  the  yielding  integument  of  the  forehead  was  pared  and  approximated 
by  sutures,  suggests  an  expedient  which  may  be  of  occasional  utility. 

The  fatality  of  the  wounds  of  the  face  was  unusually  small ;  while,  as  has  been 
already  remarked,  the  mortality  rate  in  wounds  of  the  neck  was  excessive. 

The  reports  of  wounds  of  the  chest  indicate  that  depletory  measures  in  gunshot  inju- 
ries of  the  lung  have  quite  fallen  into  desuetude  in  our  army  practice. 

The  wounds  of  the  abdomen  and  pelvis  include  some  remarkable  examples  of 
recovery  from  accidents  of  the  gravest  nature;  but  the  general  mortality  is  so  very  large 
as  to  furnish  an  additional  argument  in  behalf  of  M.  Legouest's  proposition  to  incise  the 
abdominal  walls,  and  explore  the  track  of  the  projectile,  in  certain  gunshot  penetrating  or 
perforating  wounds  of  that  cavity.  Thus  only,  in  many  cases,  can  the  patient  exchange  the 
probability  of  inevitable  death  for  the  possibility  of  recovery,  either  through  the  preven- 
tion of  extravasation  by  enterorrhaphy,  or  the  bringing  of  the  wounded  viscus  into  apposi- 
tion with  the  abdominal  walls.  For  one,  I  am  free  to  assert  that  where  there  is  evidence 
that  internal  haemorrhage  or  faecal  extravasation  is  going  on,  what  may  be  termed  the 
"ostrich  plan"  of  giving  opium,  and  "making  the  patient  comfortable,"  should  be  aban- 
doned. And  I  believe  that  prejudices  similar  to  those  that  ovariotomy  has  successfully 
overcome  in  the  last  quarter  of  a  century,  will  be  dispelled  by  the  results  of  exploratory 
incisions  in  gunshot  wounds  of  the  abdomen,  before  many  years  have  elapsed. 

The  most  curious  and  interesting  feature  in  this  series  of  reports  of  gunshot  wounds 
is  the  large  proportion  of  instances  of  wounds  of  arteries.  Leaving  out  of  view  the 
wounds  of  the  aorta  and  pulmonary  vessels,  there  were  not  less  than  twenty  cases  of 
division  of  the  carotids,  subclavian,  axillary,  external  iliac,  and  femoral  arteries.  Those 
familiar  with  field  surgery,  are  aware  how  rarely  such  lesions  came  under  the  observation 
of  medical  officers  in  campaigns.  This  is  partly  explicable  by  the  fact  that  men  may 
bleed  to  death  in  battle  before  the  hospital  attendants  can  reach  them.  Yet  an  examina- 
tion of  the  dead  on  battle-fields  shows  a  very  small  proportion  of  wounds  of  the  secondary 
arterial  trunks.  I  believe  that  the  proportionately  large  number  of  such  cases  contained 
in  the  reports  of  garrisons  is  explained  by  the  fact  that  the  wounds  observed  are  generally 
inflicted  at  short  range,  and  by  small  projectiles,  and  that  a  musket  or  pistol  ball,  moving 
with  great  velocity,  will  cut  or  divide  an  artery,  which,  at  a  greater  distance,  would  only 
be  contused,  or,  by  its  resiliency,  might  escape  injury  altogether. 


88  EEPORT  OP  SURGICAL  CASES  IN  THE  ARMY. 


INCISED  AND  PUNCTURED  WOUNDS  AND  CONTUSIONS. 


The  number  of  incised  and  punctured  wounds,  lacerations,  and  contusions  reported 
is  very  large  in  proportion  to  the  mean  strength  of  the  Army,  as  will  be  apparent  from 
the  tabular  statement  presented  further  on.  The  extraordinary  proportion  of  such  casual- 
ties may  be  ascribed  partly  to  the  fact  that  the  troops  were  generally  posted  where  the 
population  was  most  lawless  and  turbulent,  and  partly  to  the  laxity  of  discipline  which 
was  generally  noticed  for  several  years  after  the  close  of  hostilities. 

A  few  reports  illustrating  the  different  forms  of  incised,  punctured,  lacerated,  and 
contused  wounds  will  be  cited. 

INCISED  WOUNDS. — Several  reports  of  remarkable  cases  are  given,  and  other  cases 
are  quoted  simply  as  examples  of  the  accidents  likely  to  be  observed  in  the  garrison 
routine.  The  total  number  of  incised  wounds  reported  was  nearly  seven  thousand. 

CCXCVIII. — Mention  of  a  Sword  Cut  of  the  Skull    By  RICHABD  POWELL,  Assistant  Surgeon, 
U.  S.  A. 

At  Camp  Warner,  Oregon,  December  25,  1867,  Private  Michael  Gillaney,  Co.  D,  23d  Infantry, 
aged  29  years,  received,  in  a  brawl,  a  sword  cut  of  the  cranium,  directly  over  the  right  frontal 
protuberance,  slightly  incising  the  bone.  He  was  admitted  to  the  post  hospital  on  the  same  day. 
and  the  wound  was  stitched  together.  Cold-water  dressings  were  applied.  The  wound  healed 
promptly,  and  the  man  returned  to  duty  January  21,  1868. 

CCXCIX. — Account  of  a  Penetrating  Wound  of  the  Occipital  Bone.    By  W.  R.  D.  BLACKWOOD, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  John  O'Niel,  Co.  I,  2d  Infantry,  aged  35  years,  was  wounded  December  16, 1870,  by 
a  knife  which  penetrated  the  occipital  bone,  severing  the  left  occipital  artery.  He  was  admitted  to 
the  post  hospital  at  Patona,  Alabama,  soon  after  the  reception  of  the  injury.  The  person  who  was 
called  in  neglected  to  ligate,  or  to  employ  any  other  means  than  adhesive  strips  to  control  the  haemor- 
rhage. No  medical  officer  was  present,  and  the  patient  lost  a  large  quantity  of  blood  by  repeated 
hemorrhages.  Dr.  Burke,  of  Jacksonville,  late  Surgeon  U.  S.  V.  assisted  by  Dr.  McMahou,  of 
the  Selma,  Rome  and  Dalton  Railroad,  finally  stopped  the  loss  of  blood  by  compresses  dipped 
in  the  persulphate  of  iron,,  two  days  after  the  reception  of  the  injury.  The  man  was  returned  to 
duty  January  12, 1871. 

CCC. — Note  Relative  to  an  Incised  Wound  of  the  Eye.    By  D.  D.  THOMPSON,  M.  D.,  Acting  Assist- 
ant Surgeon. 

Private  William  Hobin,  Co.  E,  25th  Infantry,  aged  31  years,  received,  while  intoxicated,  Feb- 
ruary 2,  1869,  an  incised  wound  by  a  knife,  resulting  in  the  entire  loss  of  the  left  eye,  cutting 
through  the  cornea  and  iris  to  the  posterior  chamber,  allowing  the  escape  of  the  aqueous  humor. 
The  wound  was  obliquely  from  within  out,  entirely  across  the  cornea.  He  was  admitted  to  the 
post  hospital,  Von  Schrader  Barracks,  Paducah,  on  the  following  day,  where  simple  dressings 
were  applied.  The  patient  recovered,  and  was  returned  to  duty  in  April,  1869. 


INCISED  AND  PUNCTURED  WOUNDS.  89 

CCCI. — Mention  of  an  Incised  Wound  of  tJte  Face.    By  C.  H.  ROWE,  Assistant  Surgeon,  U.  8.  A. 

At  Galveston,  Texas,  June  2,  1867,  Recruit  John  Barney,  Gtli  Cavalry,  aged  20  years,  received 
an  incised  wound  of  the  lower  lip,  which  was  followed  by  profuse  hemorrhage,  which  had  con- 
tinued to  the  date  of  his  admission  to  hospital,  on  June  4,  1807.  Solution  of  persulphate  of  iron 
was  applied  to  the  wound,  and  the  haemorrhage  being  controlled,  the  parts  were  brought  together, 
and  the  patient  was  returned  to  duty  on  the  following  day. 

CCCII.— Report  of  an  Incised  Wound  of  the  NecTc.    By  J.  P.  WRIGHT,  Surgeon,  U.  S.  A. 

Private  Patrick  Pender,  Co.  H,  22d  Infantry,  received  a  fatal  stab  in  the  neck,  from  a  soldier, 
on  the  evening  of  November  15, 1870,  at  Fort  Sully,  Dakota  Territory.  The  man  was  dead  when 
first  seen  by  the  post  surgeon.  The  internal  margin  of  the  wound  was  two  inches  from  the  median 
line  of  the  neck.  It  was  rather  more  than  an  inch  long,  the  slit  in  the  integument  extending  in  a 
direction  outward  and  backward.  The  wound,  upon  dissection,  was  found  to  have  passed  abruptly 
backward,  downward,  and  inward,  into  the  thoracic  cavity,  penetrating  in  its  course  the  sterno- 
cleido-mastoid  and  the  deep  cervical  fascia  and  platysina.  The  deep  veins  of  the  neck  were  found 
to  have  been  deeply  incised  at  a  point  corresponding  with  the  junction  of  the  internal  jugular  and 
left  subclavian  vein.  Immediately  posteriorly,  the  left  subclavian  artery  was  found  to  have  been 
partially  divided  in  that  portion  of  the  vessel  interior  to  the  insertion  of  the  scalenus  anticus. 
The  left  lung  was  penetrated  antero-posteriorly  through  the  apex  of  the  upper  lobe.  The  pene- 
trating instrument  was  finally  arrested  by  impinging  upon  the  vertebral  column,  at  a  point  corre- 
sponding with  the  third  costo-vertebral  articulation,  or  with  the  union  of  the  second  and  the  third 
dorsal  vertebra?.  The  depth  of  the  wound  from  the  surface  was  four  inches,  dividing  the  structures 
above  mentioned,  in  a  direction  downward,  backward,  and  inward.  The  left  lung  Avas  found  to  be 
entirely  collapsed  and  floating  in  a  large  quantity  of  coagulated  blood  and  serum.  The  greater 
portion  of  this  fluid  was  removed,  and  measured  five  pints. 

CCCIII. — Note  Relative  to  Incised  Wounds  of  the  Neck  and  of  the  Arm.     By  C.  R.  GREENLEAF, 
Assistant  Surgeon,  U.  S.  A. 

Private  John  Cogan,  Co.  P,  2d  Infantry,  aged  21  years,  was  admitted  to  the  post  hospital  at 
Taylor  Barracks,  Kentucky,  May  20, 1868,  with  an  incised  wound  four  and  a  half  inches  long  in 
the  posterior  cervical  region  in  a  direct  line  between  the  two  mastoid  processes.  He  also  received 
a  stab  in  the  lower  third  of  the  left  arm.  The  wounds  were  dressed  with  interrupted  sutures  and 
adhesive  plaster.  He  was  returned  to  duty  June  13,  1868. 

CCCIV. — Account  of  a  Self-inflicted  Wound  of  the  Neck.    By  J.  W.  WILLIAMS,  Assistant  Surgeon, 
U.  S.  A. 

Private  Peter  Jennings,  Co.  G,  6th  Infantry,  while  in  a  drunken  fit,  at  Raleigh,  North  Caro- 
lina, attempted  suicide  by  stabbing  himself  with  a  clasp  knife  in  the  region  of  the  neck.  The 
knife  entered  one  inch  below  the  cricoid  cartilage,  in  the  median  line  of  the  trachea,  and  took  a 
direction  downward  and  toward  the  left  lung,  the  apex  of  which  it  penetrated.  At  first  the 
haemorrhage  was  very  violent,  both  from  the  mouth  and  the  wound,  inducing  prompt  syncope,  and 
apparent  death,  leading  the  attending  surgeon  to  believe  death  had  actually  occurred.  The  patient 
slowly  revived,  however,  after  a  time,  under  the  stimulating  effects  of  strong  ammonia.  The 
haemorrhage  was  arrested  by  the  prompt  action  of  the  steward,  who  injected  a  solution  of  persul- 
phate of  iron  into  the  wound  and  applied  a  compress  over  it.  Emphysema  ensued,  and  extended 
over  the  whole  body  in  spite  of  careful  bandaging.  The  resulting  inflammation  of  the  lung  was 
easily  subdued  by  cyanide  of  potassium,  which  had  also  the  effect  of  arresting  a  troublesome 
cough.  The  emphysema  has  now  completely  subsided,  except  in  the  scrotum,  and  the  patient  is  in 
a  fair  way  of  recovery.  [He  returned  to  duty  June  17,  1808. — ED.] 
12 


90  REPORT  OF  SURGICAL  CASES  IN  THE  ARMT. 

CCCV. — Report  of  Several  Incised  Wounds  Inflicted  with  a  Razor.    By  Dr.  C.  B.  BRAMAN,  Acting 
Assistant  Surgeon. 

Private  McManus,  Co.  A,  20th  Infantry,  while  a  prisoner  in  the  guard-house  at  Baton 
Rouge,  Louisiana,  in  May,  1868,  was  cut  in  the  hip,  shoulder,  and  throat  by  a  razor  iu  the  hands  of 
a  drunken  comrade.  The  first  wound  was  slight;  the  second,  a  deep  flesh-wound  over  the  trapezius 
muscle ;  the  third  extended  from  the  right  sterno-cleido  mastoid,  midway  upward  to  the  angle  of 
the  jaw,  and  downward  to  the  raphe  of  the  trachea.  The  external  jugular,  the  thyroid  and  facial 
arteries  were  severed.  I  did  not  find  it  necessary  to  ligate,  but  was  able  to  check  haemorrhage  by 
lint  and  persulphate  of  iron  in  powders,  with  compression.  After  fourteen  hours,  I  closed  the 
wound.  The  patient  recovered,  and  was  returned  to  duty  May  14, 18G8. 

CCCVI. — Report  of  a  Suicide  from  an  Incised  Wound  of  the  Throat.    By  J.  H.  BARTHOLF,  Assist- 
ant Surgeon,  U.  S.  A. 

Private  John  Cody,  Co.  C,  llth  Infantry,  committed  suicide  at  Camp  Grant,  Virginia,  on  the 
night  of  September  3,  18G7,  at  11  o'clock,  by  cutting  his  throat  with  a  razor,  half  severing  tbe  left 
internal  jugular  vein,  and  cutting  the  larynx  through  the  crico-thyroid  to  the  mucuous  membrane 
at  the  back  part  of  the  cartilage.  A  second  cut  was  made,  diverging  a  little  from  the  middle  of 
the  first,  and  going  to  the  same  depth.  These  two  very  thorough  gashes,  made  with  energy,  were 
the  extent  of  the  suicidal  effort.  Death  ensued  in  a  few  moments. 


CCCVII. — Remarks  on  the  Monthly  Report  of  Siclt  and  Wounded  at  Camp  Lincoln,  California,  for 
February,  18G8.    By  Dr.  F.  KNOX,  Acting  Assistant  Surgeon. 

The  case,  entered  under  the  head  of  convulsions,  and  resulting  iu  death,  was  that  of  Private 
Gustavus  Louiston,  Co.  G,  9th  Infantry.  He  was  relieved  in  three  hours  by  venesection  and  sinapisms. 
After  four  hours  of  quiet  sleep  he  appeared  perfectly  rational  and  quiet,  but  with  evidence  of 
inflammation  of  the  brain.  A  ten-grain  dose  of  calomel  was  administered.  About  five  hours  after 
he  got  a  razor  and  cut  his  own  throat,  completely  severing  all  the  integuments  to  the  spinal 
column.  The  razor  passed  through  the  larynx  at  the  front,  but  within  an  inch  passed  above  it. . 
The  oesophagus  could  be  plainly  seen,  entirely  divided.  He  lived  ten  days.  The  treatment  was 
solely  to  alleviate  suffering. 

CCCVIII. — Account  of  an  Incised  Wound  of  the  Head  and  Tliorax.    By  F.  A.  WILMANS,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  J.  W.  McClinchey,  Co.  E,  17th  Infantry,  aged  21  years,  received  on  August  12,  1868, 
an  incised  wound  of  the  head  and  right  side  from  a  knife  blade,  which  penetrated  the  lung,  letting 
the  air  escape  freely.  The  wound  on  the  head  was  three  and  a  half  inches  long,  exposing  the 
right  parietal  bone.  On  the  following  day  he  was  admitted  to  the  post  hospital,  Brenham,  Texas, 
Avhere  sutures  and  simple  dressings  were  used,  and  on  September  26th,  he  was  returned  to  duty. 

CCC1X. — Report  relative  to  Two  Incised  Wounds.    By  DONALD  JACKSON,  M.  D.,  Acting  Assistant 
Surgeon. 

i 
First  Sergeant  John  Jones,  Co.  C,  24th  Infantry,  aged  21  years,  was  wounded  June  14,  1870, 

in  a  brawl,  by  a  pocket  knife,  which  entered  in  front  of  acromiou  process,  passing  directly  down- 
ward two  inches  deep.  Also  an  incised  wound,  three  inches  below  the  left  axilla,  two  inches  long, 
penetrating  to  the  ribs.  He  was  admitted  to  the  post  hospital  at  Fort  Clark,  Texas,  on  the 
following  day.  Dilute  carbolic  acid  dressings  were  applied.  He  recovered,  and  was  sent  to  duty 
July  7, 1870. 


INCISED  AND  PUNCTU11ED  WOUNDS.  <J1 

CCCX. — Report  of  an  Incised  Wound  of  the  Heart.      By  DALLAS  BACHE,  Assistant  Surgeon, 
U.  S.  A. 

Artificer  Thomas  Dardis,  Co.  F,  10th  Infantry,  was  stabbed  with  an  ordinary  jack-knife,  in  the 
hands  of  a  comrade,  on  September  19, 1809,  at  San  Antonio,  Texas.  Upon  being  wounded  he  ran 
probably  thirty  yards,  with  his  arms  folded  across  his  chest,  and  then  fell.  Ho  was  instantly 
removed  to  the  barracks,  where  respiration  ceased  in  twelve  minutes  after  the  reception  of  the 
injury.  A  post-mortem  examination,  made  fifteen  hours  after  death,  disclosed  three  wounds  upon 
the  anterior  parietes  of  the  chest — one  superficial  over  the  lower  third  of  the  sternum;  the  second, 
two  and  a  half  inches  in  length,  dividing  the  cartilage  of  the  sixth  rib  and  penetrating  the  thoracic 
cavity,  without  however  wounding  the  lung;  the  third  and  fatal  wound,  two  and  a  quarter  inches 
in  length,  two  inches  below  the  left  nipple,  opened  the  pericardium,  and,  splitting  across  the  apex 
of  the  heart,  made  an  opening  in  the  right  ventricle  sufficiently  large  to  admit  an  ordinary  silver 
probe.  The  clothing  on  the  left  side  and  below  the  wound  was  soaked  with  blood. 

CCCXI. — Report  of  an  Incised  Wound  of  the  Sternum  and  Heart.    By  C.  S.  DE  GRAAV,  Assistant 
Surgeon,  U.  S.  A. 

At  Fort  Dodge,  Kansas,  on  the  night  of  June  2, 1867,  a  quarrel  arose  between  two  men,  one 
known  as  Buckskin,  in  Government  employ  at  the  post,  the  other  an  employe"  of  the  Santa  Fe 
Mail  Stage  Company.  Both  men  were  under  the  influence  of  liquor.  From  words  they  came  to 
blows,  and  during  the  fight  Buckskin  drew  a  knife,  with  which  he  inflicted  several  superficial  cuts 
upon  the  other,  who  at  last  succeeded  in  catching  Buckskin,  by  the  wrist  of  the  hand  holding  the 
knife,  and,  turning  it  upon  him  still  holding  it,  drove  it  with  great  force  against  his  breast. 
Buckskin  fell  at  once  to  the  ground.  Upon  being  summoned,  and  reaching  the  spot  a  few  minutes 
after,  I  found  Buckskin  dead.  Upon  inquiry,  I  learned  that  after  falling  he  had  continued  to 
breathe  from  five  to  eight  minutes.  A  post-mortem  examination,  held  the  next  morning  by  Acting 
Assistant  Surgeon  J.  B.  Crandall  and  myself,  demonstrated  the  wounds  as  shown  by  the  specimens. 
The  knife  is  a  case-knife  such  as  is  in  common  use  among  men  on  the  plains.  [The  specimens, 
Nos.  4869,  4870,  4871,  Section  I,  A.  M.  M.,  are  the  heart,  with  an  incised  wound  of  the  right 
auricle;  the  sternum,  with  an  incision  obliquely  downward  from  right  to  left  through  the 
gladiolus;  and  the  knife  by  which  the  wounds  were  inflicted. — ED.] 

CCCXII. — Account  of  a  Penetrating  Wound  of  the  Thoracic  and  Abdominal  Cavities.    By  W.  D. 
WOLVERTON,  Assistant  Surgeon,  U.  S.  A. 

Private  Bernhard  Kelly,  Co.  C,  1st  Infantry,  aged  20  years,  received  July  23,  1868,  a  wound 
by  a  case-knife  in  the  hands  of  Private  Kennedy,  Co.  A,  1st  Infantry,  which  penetrated  the  left 
side  between  the  seventh  and  eighth  ribs,  grazing  the  left  lung,  passing  through  the  diaphragm 
downward  into  the  stomach,  causing  peritonitis  and  death,  which  resulted  on  the  2Gth. 

CCCXIII. — Note  of  a  Penetrating  Wound  of  the  Abdomen  and  Thorax.    By  C.  E.  GODDARD,  Assistant 
Surgeon,  U.  S.  A. 

Sergeant  William  Tynes,  Co.  E,  16th  Infantry,  aged  21  years,  was  wounded  by  a  dagger  during 
an  encounter  with  Private  Barlow  of  the  same  regiment,  on  November  16,  1866.  The  weapon 
penetrated  the  abdomen  and  thorax.  The  patient  was  admitted  to  the  post  hospital  at  Chatta- 
nooga on  the  same  day,  and  simple  dressings  were  applied.  Death  resulted  on  the  day  of 
admission. 

CCCXIV. — Report  of  a  Case  of  Incised  Wound  of  the  Stomach,  Terminating  in  Recovery.    By  B.  A. 
CLEMENTS,  Surgeon,  U.  S.  A. 

George  Smith,  an  unassigned  recruit,  aged  22,  a  robust  German,  was  stabbed  in  the  abdomen, 
during  an  altercation  at  Jackson  Barracks,  Now  Orleans,  on  the  evening  of  January  2,  1870.  He 
was  at  once  brought  to  the  post  hospital.  Upon  examination,  a  clean  incised  wound  was  found, 
inflicted  with  a  dirk,  the  blade  of  which  entered  two  and  a  quarter  inches  to  the  left  of  the  median 


92  EEPOKT  OF  SUEGICAL  CASES  IN  TUB  ARMY. 

line,  on  a  level  with  aline  drawn  transversely  two  inches  above  the  umbilicus.  The  wound  w;is 
one  inch  in  length,  its  long  axis  being  nearly  parallel  to  the  long  axis  of  the  body.  On  inserting 
the  finger  into  the  wound,  it  was  found  that  the  wall  of  the  abdomen  was  entirely  penetrated, 
beyond  which  the  finger  passed  without  resistance,  obliquely  through  another  layer  of  tissue,  into 
a  cavity  which  was  believed  to  be  the  left  end  of  the  stomach.  He  complained  mainly  of  pain  in, 
the  left  shoulder,  and  vomited  freely  of  recently  ingested  food  unmixed  with  blood,  and  was  some- 
what agitated.  The  wound  bled  but  slightly,  and  was  at  once  closed  by  two  silver  sutures  and 
adhesive  plaster,  the  patient  having  previously  been  turned  on  his  abdomen,  without  any  dis- 
charge of  blood,  beyond  a  few  drops,  taking  place.  He  was  placed  in  bed,  and  ordered  to  have  no 
food  or  drink.  During  the  night  he  vomited  twice,  throwing  up  in  all  a  pint  of  dark  semi- 
coagulated  blood.  His  pulse  was  84,  and  small,  though  he  appeared  unwilling  to  take  a  full 
inspiration.  He  complained  of  a  "cramp-like"  pain  in  the  fore  part  of  the  left  shoulder,  and 
also  of  some  pain  at  the  epigastrium,  especially  about  the  ensiform  cartilage.  There  was  some 
tumefaction  at  the  seat  and  in  the  vicinity  of  the  wound,  and  a  crackling  sensation,  as  well  as 
gurgling,  was  perceived  on  palpitation.  An  incised  wound  of  the  stomach,  with  infiltration  of 
gas  or  air  into  the  areolar  tissue  about  the  wound,  was  diagnosed.  He  was  allowed  to  rinse  his 
month  with  water  under  the  supervision  of  the  unrse,  and  to  assume  such  position  in  bed  as  he 
preferred.  On  the  afternoon  of  the  next  day  he  was  quiet  and  uncomplaining,  but  the  pulse  was 
120  and  wiry,  and  the  face  rather  pallid.  He  had  not  vomited  since  daylight,  but  felt  nausea  all 
the  time,  and  thought  he  would  feel  better  could  he  vomit.  He  spat  up  freely,  without  vomiting, 
a  mucilaginous  coft'ee-colored  fluid,  evidently  altered  blood.  The  abdomen  was  tsomewhat 
tympanitic,  and  the  bowels  had  not  moved.  A  cathartic  enema  was  given,  which  operated  slightly 
in  the  evening.  On  January  4,  the  patient  lay  quietly  in  bed  on  his  back;  his  countenance  was 
pale,  but  not  indicative  of  distress;  pulse  112,  small,  wiry,  and  feeble;  respiration  normal,  and 
tongue  clean.  The  whole  abdomen  was  somewhat  distended  and  resonant,  and  he  complained  of 
slight  pain  at  the  epigastrium.  The  emphysema  in  the  vicinity  of  the  wound  had  not  increased, 
and  the  gurgling  was  no  longer  perceptible.  During  the  night  he  vomited  three  times,  throwing 
up  iu  all  about  one  quart  of  blood,  much  of  which  was  coagulated  and  thrown  up  in  mass.  The 
vomiting  gave  him  much  relief.  An  injection  of  beef  essence  was  given  every  three  hours,  and 
flannel  wet  with  the  spirits  of  turpentine  applied  to  the  whole  abdomen.  In  the  evening  he  again 
vomited  a  full  pint  of  dark  semi-coagulated  blood.  An  anodyne  injection  was  administered,  and  he 
rested  quietly  during  the  night.  He  continued  to  spit  up  freely,  and  at  times  to  vomit  the  same 
mucilaginous  dark-looking  fluid,  which  was  evidently  blood  altered  by  admixture  with  the  fluids 
of  the  stomach.  The  injection  of  beef  essence  was  continued  until  January  7th,  when  beef  tea 
was  given  every  alternate  hour  by  the  mouth.  He  ceased  to  spit  up  the  dark  fluid,  and  did  not 
vomit  during  the  night.  On  the  llth,  he  complained  of  pain  at  the  seat  of  the  wound,  and  that 
he  could  feel  a  swelling  there  on  sitting  up.  He  was  examined  in  a  standing  posture,  but  no 
bulging  or  protrusion  could  be  felt,  but  the  abdomen  had  become  generally  tympanitic,  and  his 
bowels  did  not  move.  A  cathartic  was  at  once  ordered,  which  moved  the  bowels  during  the  night, 
and  on  the  next  day  the  tyrnpauitic  distension  had  disappeared.  Somewhat  above  and  outward 
from  the  wound  there  was  a  decided  diffused  swelling,  which  was  red  at  one  point,  and  very 
tender  to  the  touch.  He  was  not  allowed  to  take  any  food  by  the  mouth,  only  water  by  the 
wineglassful,  with  an  injection  of  a  teacupful  of  beef  essence.  On  the  morning  of  the  13th,  the 
swelling  had  plainly  diminished,  and  was  not  so  tender.  In  consequence  of  sickness,  I  did  not  see 
him  until  the  16th,  when  I  found  the  tumefaction  near  the  seat  of  the  wound  was  much  greater, 
being  as  large  as  half  an  ordinary-sized  orange,  very  red,  and  tender  to  the  touch,  and  seemed 
resonant  on  percussion  and  quite  tense.  The  swelling  continued  to  increase  until  the  morning  of 
the  17th,  when  a  sudden  discharge  of  thin  offensive  pus  took  place  through  the  original  wound, 
amounting  in  all  to  about  eight  ounces,  that  which  flowed  last  being  creamy,  and  streaked  with 
blood.  There  were  some  shreds  of  semi-decomposed  coagulated  blood  passed  out  with  the  pus 
first  discharged.  The  swelling  at  once  greatly  diminished ;  a  light  broad  poultice  was  applied  to 
the  wound  without  pressure,  and  he  was  ordered  to  lay  on  his  side.  During  the  evening  he 
expressed  himself  as  feeling  greatly  relieved.  On  the  19th,  his  pulse  was  regular  but  feeble, 
and  he  was  quite  pale.  The  swelling  had  entirely  disappeared.  There  was  no  discharge  from  the 
wound  except  from  the  small  granulating  surface,  which  had  assumed  by  ulceration  a  triangular 


INCISED  AND  PUNCTUltED  WOUNDS.  93 

shape.  Meat  and  soup  were  ordered  for  the  first  time,  but  no  vegetables.  He  gradually  improved, 
and  on  the  31st  was  able  to  walk  about.  He  complained  of  being  weak,  and  of  having  pain  in  the 
left  shoulder,  and  also  "  inside"  about  the  wound  when  he  attempted  to  lift  anything.  There  was  a 
slight  soft  painless  swelling  a  little  to  the  left  of  the  wound,  but  the  color  ol  the  skin  over  it  was 
entirely  natural.  He  was  retained  in  hospital  until  he  regained  his  strength,  and  was  returned  to 
duty  iii  February,  1870. 

CCCXV. — Report  of  a  Case  of  Incised  Wound  of  the  Abdomen  with  Puncture  and  Escape  of  the 
Intestines,  followed  by  Traumatic  Peritonitis.    By  W.  H.  DOUGHTY,  M.  D. 

I  was  called  at  midnight  of  June  11, 1808,  in  Augusta,  Georgia,  to  see  Private  James  Merchant, 
Co.  I,  IGth  Infantry,  who  had  just  received  the  following  wound,  in  a  street  altercation  with  a  negro : 
As  first  seen  in  the  street  he  was  laying  upon  his  back,  with  the  abdomen  exposed,  and  covered  with 
the  largest  mass  of  protruding  intestines  that  I  ever  saw,  almost  the  entire  region  being  thus 
covered.  Having  been  removed  to  the  barracks  near  by,  with  the  assistance  of  Dr.  John  S.  Cole- 
man  of  this  city,  I  proceeded  to  examine  and  dress  the  wound.  The  intestines  were  covered  with 
sand  and  grit,  derived  from  contact  with  the  ground  and  clothes  of  the  man,  and  the  small  intes- 
tines (ilium)  incised  at  one  point,  and  scratched  by  the  passing  knife  at  another.  This  incision,  being 
about  an  inch  in  length,  was  closed  with  a  single  stitch  of  silk  thread,  and  after  thorough  cleans- 
ing the  whole  mass  was  with  great  difficulty  returned  to  the  abdominal  cavity.  In  this  hernial 
protrusion  we  recognized  four  or  five  feet  of  the  ilium,  the  caecum  with  its  appendix,  part  of  the 
ascending  'colon,  with  corresponding  portions  of  the  mesentery,  the  distribution  of  the  superior 
mesenteric  artery  to  these  several  portions  made  more  apparent  by  its  living  pulsation,  was  more 
beautifully  displayed  in  the  series  of  its  successive  arches  than  in  any  dissection  that  I  ever  wit- 
nessed, liaising  the  mass,  I  found  that  the  wound  in  the  peritonaeum,  through  which  it  had  escaped, 
was  about  two  and  a  half  inches  in  length,  and  tightly  embraced  its  neck  ;  with  the  hips  of  the 
patient  raised  higher  than  the  chest  so  as  to  favor  the  gravitation  of  the  viscera,  it  was  replaced  in 
the  abdomen,  whereupon  was  disclosed  an  incision  commencing  two  inches  below  the  umbilicus,  and 
two  inches  to  the  left  of  the  linea  alba,  running  horizontally  above  the  crest  of  the  ilium,  nearly 
to  the  spine,  fourteen  inches  long,  opening  the  abdomen  near  its  inner  or  anterior  extremity,  and 
severing  the  muscular  parieties  as  far  back  as  the  thick  muscles  of  the  lumbar  region.  Kelaxiug  the 
abdominal  walls  as  far  as  possible,  the  wound  was  accurately  closed  with  hare-lip  pins,  and  annealed 
wire  sutures.  Suitable  compresses  were  applied  and  a  roller  firmly  encircling  the  body.  v  There  was 
also  a  superficial  wound  upon  the  chest,  six  inches  in  length,  extending  obliquely  from  right  to  left. 
The  shock  from  these  wounds  was  very  severe  indeed,  the  patient  at  one  time  becoming  pulseless.  We 
were  apparently  dressing  the  wounds  of  a  dying  man.  Whiskey  and  laudanum  were  administered, 
and  next  morning  the  patient  was  comparatively  comfortable,  reaction  being  complete.  Perfect 
quiet  and  isolation  in  a  dark  room  were  enforced ;  two  grains  of  powdered  opium  were  administered 
every  four  hours;  ice  was  given  to  quench  thirst;  poultices  of  the  same  were  applied  to  the 
abdomen,  and  the  left  thigh  was  kept  permanently  flexed.  On  June  IGth  the  pulse  and  tempera- 
ture being  very  high,  the  patient  became  delirious,  aud  it  was  necessary  to  restrain  him  by 
force.  Bromide  of  potassium  and  whiskey  were  freely  administered.  Failing  to  induce  sleep  they 
were  discontinued,  and  one-third  of  a  grain  of  morphine  was  administered  hyperdermically,  which 
caused  sleep  in  half  an  hour,  and  deeply  narcotized  the  patient.  Next  day  all  the  symptoms  were 
much  improved;  medicine  was  discontinued,  and  a  stimulating  and  nutritious  diet  allowed.  The 
local  applications  were  continued.  Hyperdermic  medication  was  again  resorted  to  on  the  next 
evening.  On  the  19th  a  very  decided  improvement  had  taken  place ;  the  ice  poultices  were  dis- 
continued, and  a  more  liberal  diet,  with  stimulants,  allowed.  The  wound  was  subsequently  dressed 
with  adhesive  strips  and  a  solution  of  carbolic  acid.  On  Juue  21st  he  continued  to  improve. 
Muriated  tincture  of  iron  was  prescribed.  By  the  23d  granulation  had  begun.  Between  this  date 
and  the  26th  the  temperature  remained  normal.  At  the  latter  date  the  patient  was  doing  well,  and 
the  wound  granulating  finely,  when  he  was  transferred  to  Acting  Assistant  Surgeon  Petard.* 

*Dr.  Felix  Petard  takes  vip  this  case  ou  his  June  report,  and  in  July,  1868   reports  one  case  of  ntlnnx 
returned  to  duty.— ED. 


94  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

In  connection  with  the  above  report,  we  may  be  allowed  to  call  attention  to  the  peculiar  method 
employed  in  the  application  of  cold  for  the  abatement  of  local  inflammation,  particularly  its  appli- 
cability to  the  management  of  wounds.  Without  presuming  to  call  the  attention  of  the  Department 
to  a  subject  with  which  all  medical  men  are  more  or  less  familiar,  we  may  yet  be  pardoned  for  offer- 
ing a  few  reflections  prompted  by  this  particular  mode.  A  military  experience  of  more  than  three 
years  has  made  us  familiar  with  the  great  need  for  improved  methods  of  applying  cold  for  the 
reduction  of  inflammation,  and  with  that  afforded  with  the  use  of  ice  poultices  in  this  case,  we  can 
readily  recall  occasions  where  such  an  application  would  have  been  embraced  with  delight.  Cold 
water,  properly  employed,  is  the  "  sine  qua  nori"  in  inflamed  wounds.  Its  interrupted  application,  as 
by  cold  cloths,  frequently  changed,  is  always  troublesome  where  long  continued,  and  more  or  less 
partial  in  its  effects,  if  not  judiciously  used.  It  is  well  known  that  water  dressings  may  increase 
local  heat  by  retaining  a  moist  surface  in  contact  with  a  heated  body.  Irrigation,  when  practica- 
ble, is  a  decided  improvement  upon  this,  well  adapted  to  wounds  of  the  extremities  and  head,  but 
not  so  much  so  to  those  of  the  trunk.  Besides  this,  we  have  all  the  inconveniences  of  a  special 
apparatus  for  applying  it.  The  flow  of  water  from  the  irrigated  surface  must  also  be  provided  for 
as  well  as  other  things  needless  to  mention.  Again :  Ice-bags  or  bladders  are  too  intense  in  their 
effects— always  painful  upon  prolonged  contact  with  the  part,  and  dangerous  to  its  vitality ;  and 
when  brought  in  simple  proximity  to  the  part,  they  involve  too  much  inconvenience  for  permanent 
and  satisfactory  use.  Ice  poultices,  properly  made,  combine  all  of  their  advantages  with  none  of 
their  disadvantages,  being  safe,  convenient,  and  producing  a  permanent  uniform  reduction  of  the 
temperature.  They  cause  no  pain,  no  chillness,  no  inconvenience  from  their  weight,  and  admit  of 
easy  application  to  wounds  of  the  trunk  as  well  as  the  extremities;  do  not  endanger  the  integrity 
of  the  part,  do  not  require  removal  ofteuer  than  two  or  three  hours  ;  do  not  saturate  the  clothes  of 
the  patient  with  superflous  water,  and  require  no  special  arrangement  for  their  employment. 
Hence,  so  far  as  the  local  abstraction  of  the  heat  tends  to  arrest  inflammation,  they  are,  par  excel- 
lence, the  remedy.  To  Maisonneuve  we  ascribe  the  credit  of  their  suggestion,  from  whom  the  fol- 
lowing directions  for  their  manufacture  are  taken  in  substance.  We  saw  a  notice  of  them  in  one 
of  the  periodicals  of  this  year,  to  which,  however,  we  cannot  now  refer  directly  :  Take  of  linseed 
meal  a  sufficient  quantity  to  form  a  layer  from  three-quarters  to  an  inch  thick  ;  spread  on  a  cloth 
of  proper  size ;  upon  this,  at  intervals  of  an  inch  or  more,  place  lumps  of  ice  of  convenient  size — 
of  a  Mg  marble — then  sprinkle  them  over  lightly  with  the  meal,  cover  with  another  cloth,  folding 
in  the  edges  to  prevent  the  escape  of  the  mass,  and  apply  the  thick  side  to  the  surface  or  wound. 
Closely  enveloped  with  the  meal,  the  exclusion  of  air  retards  the  melting  of  the  ice,  and  the  thick 
layer,  intervening  between  it  and  the  surface  prevents  painful  or  injurious  contact.  The  linseed 
meal  is  better  than  bran  or  similar  materials,  because  its  mucilaginous  properties  render  it  somewhat 
tenacious  and  adhesive.  Then  there  you  have  a  uniform  abstraction  of  heat.  In  the  case  reported 
we  made  special  inquiry  of  the  soldier  as  to  the  comfort  of  the  application,  with  a  response  always 
favorable ;  we  felt  the  under  surface  of  the  poultice,  and  found  it  always  cool;  we  took  the  temper- 
ature with  the  thermometer,  which  stood  at  or  about  8G  degrees ;  we  continued  them  seven  days 
without  intermission,  and  firmly  believe  that  the  favorable  progress  of  the  case  was  in  no  small 
degree  attributable  to  their  judicious  employment.  It  is  always  unsafe  to  draw  inferences  for  gen- 
eral application  from  a  few  cases,  and  the  blind  man's  rule,  " post  hoc,  propter  hoc,"  recurs  with 
this  thought;  and  yet  we  may  not  ignore  the  value  of  individual  cases,  and  may  err  by  pushing  our 
skepticism  to  a  fallacious  extreme.  We  look  to  our  personal  experience  with  this  eligible  mode  of 
applying  cold  for  interrupting — perhaps  controlling — the  inflammatory  process,  as  derived  from 
this  case,  with  peculiar  satisfaction,  and  hopefully  await  opportunities  for  its  confirmation  in  other 
similar  ones.  Possibly  it  may  occur  to  some  that  the  non-union  in  the  wound  was  referable  to  the 
application.  When  we  discovered  the  want  of  reparative  force,  we  thought  of  this,  but  happily 
the  wound  upon  the  chest,  to  which  they  had  not  been  applied,  set  aside  the  objection,  for  it  also 
failed  to  unite,  thus  clearly  indicating  where  the  defect  existed,  namely,  in  the  general  system. 
The  habitual  use  of  alcohol  had  produced  a  pathogenetic  state  of  the  system  ;  hence  the  delirium 
tremens,  and  the  want  of  reparative  power  in  the  wounds. 


INCISED  AND  PUNCTUKED  WOUNDS.  95 

CCCXVI. — Account  of  a  Wound  of  the  Abdomen  followed  by  Peritonitis.    By  E.  A.  KOERPEII 
Assistant  Surgeon,  U.  S.  A. 

Private  John  Gill,  Co.  H,  19th  Infantry,  aged  21  years,  was  admitted  to  the  post  hospital  at 
Baton  Eonge,  November  9,  1869,  having,  a  few  minutes  before  admission,  received  a  wound  of  the 
abdomen,  inflicted  with  a  pocket-knife.  The  wound  was  on  the  median  line,  on  a  line  between  the 
hypogastric  and  umbilical  regions,  and  was  two  and  a  half  inches  long  in  a  transverse  direction. 
At  each  inspiration  a  copious  stream  of  blood  escaped  from  it.  A  portion  of  the  omentum  pro- 
truded. There  was  no  escape  of  the  contents  of  the  stomach  or  bowels.  A  cautious  examina- 
tion did  not  reveal  any  lesion  of  the  -intestines.  The  omentum  was  replaced,  the  wound  sewed  up 
externally,  ice  applied  to  the  abdomen,  and  opium  given.  Patient  vomited  soon  after.  The  pulse, 
which  had  been  very  high  and  excited,  became  almost  imperceptible,  and  death  was  expected  to 
take  place.  In  three  hours,  however,  he  rallied  and  became  extremely  restless.  Peritonitis,  with 
high  pulse,  set  in,  and  he  complained  of  much  pain.  Blood  continued  to  escape  between  the 
sutures.  The  ice  and  opium  were  kept  up,  and  small  pieces  of  ice  were  given  to  allay  thirst.  The 
most  alarming  symptoms  gradually  subsided,  and  the  colon  was  emptied  after  six  days  by  an 
injection.  Encouraged  by  this,  citrate  of  magnesia  was  given  on  the  following  day,  bringing 
away  a  great  quantity  of  fajces,  without  blood  or  any  appearance  of  lesion  of  the  intestines.  He 
continued  to  improve,  and  on  December  31st  he  could  sit  up  half  an  hour  at  a  time,  but  was  very 
much  emaciated  and  suffered  from  pain  in  the  abdomen.  He  was  returned  to  duty  in  January, 
1870. 

CCCXVII. — Account  of  an  Incised  Wound  of  the  Abdomen.  By  J.  P.  A.  CLEARY,  Assistant  Surgeon, 
U.  S.  A. 

George  Adams,  Co.  A,  9th  Cavalry,  aged  23  years,  of  healthy  constitution,  while  in  a 
quarrel  with  another  soldier,  at  Fort  Stockton,  Texas,  in  September,  1870,  received  two  cuts  with 
a  knife;  one  extended  from  the  right  elbow  to  within  a  few  inches  of  the  wrist;  the  other  com- 
menced on  a  line  with  the  sternal  end  of  the  ninth  rib,  and  running  in  a  horizontal  direction,  ter- 
minated within  half  an  inch  of  the  linea  alba,  being,  altogether,  two  and  a  half  inches  long.  He 
was  wounded  about  3  o'clock,  on  the  4th,  and  I  saw  him  about  ten  minutes  after.  Condition 
when  brought  to  the  hospital,  ten  minutes  after  receipt  of  wound :  Almost  the  entire  stomach 
protruded  through  the  wound,  and  about  18  inches  of  the  transverse  colon,  with  a  considerable 
amount  of  omentum.  He  was  in  collapse,  covered  with  profuse  cold  sweat ;  pulse  weak  and  130 ; 
constant  vomiting.  Treatment :  Endeavored  to  replace  the  protruded  mass,  having  first  admin- 
istered an  ounce  of  whiskey.  Failing  in  this,  the  wound  was  extended  about  half  an  inch  toward 
the  linea  alba,  but  the  mass  could  not  be  returned ;  frequent  vomiting  to  considerable  extent  pre- 
vented its  return,  and  forced  faecal  matter  into  the  protruded  intestine.  The  wound  was  then 
slightly  extended  at  its  other  extremity,  and  by  a  little  manipulation  the  entire  mass  was  returned 
and  the  wound  closed  by  three  suture-pins  and  one  common  suture  at  either  end  of  the  wound ; 
cold-water  dressings  were  applied.  The  wound  in  the  arm  was  treated  with  five  sutures  and 
strips  of  adhesive  plaster  and  cold  water.  He  was  kept  under  the  influence  of  opium,  combined 
with  calomel,  from  the  date  of  admission  to  the  7th.  He  slept  well  every  night,  and  at  no  time 
did  he  suffer  severely  with  abdominal  pain,  though  he  complained  frequently  of  tenderness  over 
right  hypogastric  region.  Sutures  removed  on  7th;  bowels  moved  once  on  the  7th,  the  first  time 
since  he  was  wounded.  He  convalesced  rapidly  and  was  soon  able  to  walk  about  the  camp.  He 
was  returned  to  duty  in  October,  1870. 

CCCXVIII. — An  Indued  Wound  of  the  Abdomen,  through  which  protruded  a  Portion  of  the  Colon,  the 
entire  Stomach,  and  nearly  all  of  the  Small  Intestines,  together  icith  Mesentery  and  Omentum.  By 
F.  BABNES,  Acting  Assistant  Surgeon. 

Edward  Brown,  colored,  aged  25  years,  was  admitted  to  the  Freedmeu's  Hospital,  New  Orleans, 
May  15,  1868.  About  10  o'clock  on  the  night  of  May  14,  I  found  the  patient  in  a  cab,  about  to  be 
removed  from  the  first  district  lock-up,  and  ordered  him  back  that  his  wound  might  be  dressed.  I 


96  EEPORT  OF  SURGICAL  CASES  IN  THE  A-KMY. 

found  eight  inches  of  the  colon,  all  of  the  stomach,  and  nearly  the  whole  of  the  small  intestines, 
together  with  the  mesentery  and  oineutnm  protruding  through  a  wound  in  the  left  epigastrium. 
About  two  and  a  half  feet  of  the  small  intestine  having  a  whitish  color,  appeared  filled  with  food, 
and  had  much  the  characteristic  feeling  of  a  sausage.  The  rest  of  the  small  intestines  being  col- 
lapsed, had  a  dark  brown  color.  The  stomach  and  colon,  distended  with  gas,  were  leaden  colored. 
The  viscera  had  been  out  and  exposed  to  the  atmosphere  for  over  an  hour.  Having  nothing  but 
cold  Mississippi  water  to  wash  them  with,  I  preferred  returning  them  without  any  effort  at  removing 
blood  and  dirt,  further  than  wiping  with  a  cambric  handkerchief  and  trusting  to  the  stripping,  if 
I  may  so  term  it,  that  they  would  naturally  be  subjected  to  while  being  returned  through  the 
wound  by  which  they  were  tightly  packed  and  almost  strangulated.  In  about  ten  minutes,  I  had 
returned  them  all,  carefully  examining  inch  by  inch  for  a  wound  or  tear  in  them,  but  finding  none. 
The  first  portion  returned  was  the  ilium,  next  the  jejunum.  The  stomach  required  the  gas  to  be 
gently  pressed  out  before  it  was  returned,  as  was  the  case  with  the  colon,  which  I  presume  was 
the  first  to  escape  from,  as  well  as  the  last  to  be  put  back,  into  the  abdomen.  The  food  in  the  jeju- 
num had  also  to  be  partially  manipulated  out  of  it  before  it  could  be  returned.  The  wound  exter- 
nally was  three  inches  long,  and  nearly  perpendicular.  The  internal  opening  was  nearly  at  right 
angles  with  it,  and  allowed  easily  the  introduction  of  three  fingers.  The  conjoined  cartilage  at  the 
end  of  the  seventh  rib  was  also  divided.  The  oinentum,  although  frequently  returned,  could  not  be 
made  to  remain  in  the  cavity  of  the  abdomen,  and  must  still  form  a  plug  in  the  internal  wound. 
The  instrument  inflicting  the  wound  was  said  to  be  a  cotton-hook.  Three  silver  sutures  through 
the  skin,  with  long  adhesive  straps,  kept  the  edges  of  the  wound  together.  A  compress  over  the 
wound,  and  a  bandage  eight  yards  long  and  six  inches  wide,  was  tightly  applied  around  the  epigas- 
tric region.  Two  persons  were  ordered  to  keep  watch  over  the  patient,  who  was  not  removed  from 
the  table  upon  which  his  wound  was  dressed  that  night.  He  went  to  sleep  as  soon  as  his  wound 
was  dressed,  and  slept  soundly  all  night,  and  in  the  morning  was  admitted  as  before  stated.  During 
his  stay  in  the  hospital  he  never  had  a  single  bad  symptom.  As  a  proper  precautionary  treatment, 
however,  he  was  allowed  no  food  for  four  days.  Some  toast- water,  and  a  moderate  quantity  of  mor- 
phine was  given  him  to  keep  his  bowels  at  rest  and  allay  pain.  His  food  was  gradually  and  cau- 
tiously increased  after  that  date,  until  it  appeared  that  extra  diet  agreed  with  him.  He  had  no  opera- 
tion of  the  bowels  until  the  22d  instant,  when  he  passed  a  healthy  stool  without  medicine.  He  was 
discharged  on  May  24th,  the  wound  being  entirely  healed,  and  no  other  apparent  difference  exist- 
ing from  that  of  a  state  of  health,  except  that  the  cartilage  of  the  rib  had  not  reunited.  He  wu.s 
directed  to  wear  his  bandage  and  compress  for  a  mouth. 

CCCXIX. — Account  of  an  Incised  Wound  in  the  Hypogastrium.     By  SAMUEL  W.  BLACKWOOD, 
Surgeon,  81st  U.  S.  Colored  Troops. 

Sergeant  Edward  Thompson,  Co.  A,  81st  Colored  Troops,  received  an  incised  wound  in  the 
hypogastric  region,  at  New  Orleans,  on  October  25,  1865.  The  wound  was  two  and  a  half  inches 
long,  and  perforated  the  small  intestines  at  five  points  from  which  its  contents  escaped.  These 
were  closed  by  the  interrupted  suture.  Upon  attempting  to  return  the  bowels  the  abdominal  cavity 
was  found  to  be  filled  with  arterial  blood,  which  issued  from  a  wound  in  the  mesentery,  the  artery 
of  which  was  tied.  Brandy  and  opium  were  exhibited.  The  wounded  man  survived  twelve  hours. 

CCCXX.— Report  of  an  Incised  Wound  of  the  Arm.    By  W.  H.  EIPPAED,  M.  D.,  Acting  Assistant 
Surgeon. 

The  incised  wound  mentioned  in  this  report  was  a  wound  of  the  brachial  artery,  made  by  a 
disreputable  practitioner  of  medicine  while  in  a  state  of  intoxication,  in  attempting  to  abstract 
blood  from  the  median  basilic  vein.  The  coats  of  the  artery  were  not  quite  cut  through,  as  the 
artery  did  not  commence  to  bleed  for  two  hours  after,  when  the  patient,  while  romping  in  the 
quarters,  noticed  the  blood  oozing  through  the  bandage.  His  comrades  brought  him  to  the  dispen- 
sary, where  the  steward  proceeded  to  take  off  the  bandage.  Blood  immediately  gushed  out  in  jets 


INCISED  AND  PUNCTURED  WOUNDS.  97 

about  as  thick  as  a  quill,  and  spirted  to  a  distance  of  over  two  feet.  A  compress  of  lint  soaked  in 
solution  of  persulphate  of  iron  was  immediately  applied  to  the  wound,  while  an  assistant  applied 
the  tourniquet.  The  arm  was  then  bound  up  very  tightly  in  a  roller  bandage.  About  an  hour  after- 
wards the  tourniquet  had  to  be  removed,  owing  to  the  intense  pain  and  swelling  in  the  fore-arm  and 
hand.  When  the  tourniquet  was  removed,  the  radial  pulse  was  very  weak,  and  continued  so  for 
twenty-four  hours,  after  which  it  gradually  increased  in  strength ;  there  was  no  after  hemorrhage, 
and  in  ten  days  the  bandage  was  removed,  when  the  wound  was  found  to  be  entirely  healed.  Pa- 
tient is  entirely  well  now,  except  a  slight  stifi'ness  of  the  muscles  of  the  arm,  which  is  being  relieved 
by  manipulation  and  friction.  The  man  was  returned  to  duty  in  July,  1809. 

CCCXXI. — Account  of  an  Incised   Wound  of  the  Fore-Arm.    By  C.  CATJGHILL,  M.  D.,  Acting 
Assistant  Surgeon. 

Corporal  Gustave  Mueller,  Co.  1, 19th  Infantry,  was  admitted  to  the  post  hospital  at  Dover, 
Arkansas,  April  10,  1868,  having  been  accidentally  struck  on  the  back  of  the  fore-arm  with  an  axe, 
in  the  hands  of  a  comrade,  while  in  the  act  of  chopping  wood.  On  examination  the  extensor 
carpi  nlnaris,  communis  digitorum,  carpi  radialis  brevior,  and  ossis  metacarpi  pollicis  muscles  were 
found  divided,  making  an  incision  about  three  and  a  half  inches  long.  The  posterior  interosseous 
recurrent  artery  and  one  of  its  principal  branches  were  severed.  The  radius  was  fractured  at  its 
middle  in  three  pieces.  The  patient  was  extremely  weak  and  very  much  exhausted  from  loss  of 
blood.  I  immediately  proceeded  to  ligate  the  severed  arteries  and  extract  the  loose  pieces  of  bone ; 
the  lips  of  the  wound  were  then  brought  together  by  an  interrupted  silk  suture  and  the  two  edges 
of  the  bone  in  apposition ;  splints  were  applied  on  the  anterior  and  posterior  surfaces  of  the  fore-arm. 
While  the  arteries  were  being  ligated  and  bones  brought  in  apposition,  chloroform  was  adminis- 
tered. At  9  o'clock  P.  M.,  the  patient  was  suffering  extreme  pain.  An  anodyne  was  adminis- 
tered and  quiet  enjoined.  He  was  doing  well  until  midnight  of  the  12th,  when  the  arm  commenced 
swelling  rapidly  and  he  seemed  to  experience  intense  pain.  On  the  next  day  the  arm  was  much 
inflamed ;  wound  suppurating  slowly,  and  extreme  heat  extending  up  to  the  shoulder-joint.  At 
12  M.  the  patient  had  a  chill,  attended  with  little  or  no  fever.  His  appetite  was  good.  The  pos- 
terior splint  was  removed,  together  with  the  dressings.  The  anterior  splint  was  kept  under  the 
arm  without  being  bound  to  it;  pulse  90.  Cold  applications  were  made,  and  stimulating  diet 
given,  and  on  April  IGth  the  inflammation  had  subsided  to  a  great  degree.  At  6  o'clock  P.  M. 
arterial  haemorrhage  took  place  from  a  branch  that  had  evidently  become  enlarged  from  the  colla- 
teral circulation.  I  immediately  cut  down  and  ligated  it,  and  applied  persulphate  of  iron  to  the 
wound  to  check  the  capillary  bleeding,  the  arm  being  very  vascular.  The  patient  lost  about 
twelve  ounces  of  blood  and  was  very  much  weakened.  After  ligating  the  artery  the  arm  became 
considerably  engorged,  and  he  experienced  intense  pain.  On  April  17th  the  collateral  circulation 
throughout  the  arm  was  thoroughly  established.  Under  the  administration  of  stimulants  and 
nutritious  diet  his  condition  improved,  the  inflammation  subsided  and  healthy  granulations  sprang 
up.  The  wound  filled  up  rapidly,  and  on  May  31st  had  entirely  closed,  leaving  a  very  deep  scar. 
He  was  discharged  from  service  November  1C,  18C8. 

CCCXXII.— Account  of  an  Incised  Wound  of  the  Thigh.    By  E.  ALEXANDER,  M.  D.,  Acting  Assist- 
ant Surgeon. 

Private  Joseph  B.  Smith,  Co.  G,  25th  Infantry,  aged  21  years,  was  admitted  to  the  post 
hospital  at  Fort  Jackson,  Louisiana,  on  January  18,  1870,  with  a  cut  four  and  a  half  inches  long, 
inflicted  with  a  razor,  about  the  middle  of  the  thigh,  cutting  deeply  the  adductor  longus,  sartorius, 
and  part  of  the  rectus  muscles.  There  was  little  haemorrhage,  although  some  veins  seemed  to  be 
torn.  The  lips  of  the  wound  were  brought  together  in  accurate  contact,  and  secured  with  sutures, 
adhesive  straps,  and  roller  bandages,  interspaces  being  left  for  the  purpose  of  drainage.  There 
was  little  tendency  to  suppuration,  but  the  discharges  were  frequently  removed  with  a  soft  sponge 
saturated  with  a  solution  of  .carbolic  acid.  He  recovered,  and  was  returned  to  duty  in  March, 
1870. 

1,3 


98  EEPOET  OF  SUEGICAL  CASES  IN  THE  AEMY. 

CCCXXIII. — Account  of  an  Incised  Wound  of  the  Thigh  and  Femur.    By  J.  n.  BARTHOLF,  Assistant 
Surgeou,  U.  S.  A. 

At  Camp  Grant,  near  Bichmoud,  Virginia,  on  January  4, 1868,  Private  John  Joye,  Troop  F,  5th 
Cavalry,  aged  22  years,  received  a  blow  with  an  axe,  in  the  hands  of  a  comrade,  on  the  outer 
aspect  of  the  right  thigh,  chipping  up  and  nearly  severing  a  portion  of  the  femur  an  inch  and  a 
half  in  length,  an  inch  and  a  half  wide,  and  about  a  quarter  of  an  inch  thick,  the  instrument 
entering  two  inches  below  the  tip  of  the  trochanter  major.  He  was  at  once  conveyed  to  the  post 
hospital.  The  end  of  the  cut  bone  protruded  from  the  wound,  which  gaped  very  much.  The 
piece  of  bone  adherent  at  the  upper  end  was  pushed  back  into  its  place,  as  nearly  as  possible,  and 
two  sutures  were  applied,  leaving  an  opening  at  the  most  dependent  point.  On  January  17th,  two 
pieces  of  bone  becoming  loose  were  removed  from  the  wound.  The  patient  made  a  good  recovery, 
and  was  returned  to  duty  March  1,  1868. 

CCCXXIV. — Remarks  on  Monthly  Report  of  Kick  and  Wounded  at  Fort  Abercrombie,  Dalcota  Territory, 
for  May,  1868.    By  W.  H.  GARDNER,  Assistant  Surgeon,  U.  8.  A. 

The  incised  wound  reported  in  tabular  statement  was  situated  over  the  inner  and  anterior 
aspect  of  the  right  knee-joint.  It  was  immediately  sealed  hermetically  with  fine  gauze  and  collodion, 
and  cold  dressings  continuously  applied,  and  by  the  fifth  day  was  entirely  healed  up.  He  was 
allowed  to  sit  up  that  day  for  the  first  time,  but  abused  the  privilege,  and  walked  about  so  much 
that  at  night  the  joint  was  inflamed  and  painful,  and  the  next  day  acute  syuovitis  was  declared. 
The  cicatrix  opened  and  pus  flowed  freely  from  the  cavity  of  the  joint.  Treated  by  absolute  rest, 
nutritious  diet,  tonics,  and  the  hyposulphite  of  soda,  and  is  at  this  date  in  a  fair  way  to  recover, 
with  good  motion  of  the  joint.  [This  man  was  discharged  from  service  September  21, 1868,  for 
' '  false  anchylosis  of  the  right  knee-joint,  following  acute  synovitis."  Disability  was  rated  one-half. 
—En.] 

CCCXXV. — Extract  from  Monthly  Report  of  Sick  and  Wounded  at  Fort  Gaston,  California,  May, 
1866.    By  PETER  MOFFATT,  Assistant  Surgeon,  U.  S.  A. 

The  case  reported  as  a  suicide  was  one  of  the  most  deliberate  attempts  at  self-destruction 
ever  witnessed.  The  subject,  a  private  of  Co.  K,  9th  Infantry,  was  returned  to  duty  from  the 
hospital  on  the  morning  of  May  12,  1866,  and  at  the  time  was  observed  to  be  laboring  under 
dejection  of  spirits.  At  evening  roll-call  he  was  absent,  and  it  was  then  noticed  by  his  comrades 
that  he  had  not  been  present  at  either  dinner  or  supper.  Between  sundown  and  dark  he  was  found 
at  some  distance  from  the  quarters,  in  a  secluded  place,  among  some  bushes,  cold,  almost  lifeless, 
and  covered  with  blood.  I  was  immediately  sent  for,  and  upon  my  arrival  at  the  place  found  the 
man  lying  on  the  ground  in  a  nicely  shaded  spot,  his  coat  regularly  folded  beneath  his  head,  his 
shirt,  vest,  and  trousers  smeared  with  blood,  partially  dried  and  stiffened,  the  surface  of  the  body 
cold,  the  limbs  almost  rigid,  and  the  pulse  imperceptible.  On  the  inner  side  of  each  leg,  between 
the  knee  and  ankle,  were  two  transverse  gashes  through  the  skin  and  cellular  tissues,  so  that  the 
muscles  lay  exposed,  and  completely  severing  the  superficial  veins.  The  prominent  places  of  the 
veins  had  evidently  been  selected.  On  each  arm  the  operation  was  repeated ;  the  lower  transverse 
incision  just  above  the  wrists  were  not  sufficiently  deep  to  injure  the  radial  artery,  nor  the  tendons 
of  the  flexor  muscles;  but  just  below  the  bend  of  the  elbow,  at  the  point  usually  selected  for 
venesection,  a  deep  gash  was  inflicted  in  each  arm,  partially  severing  some  of  the  flexor  muscles. 
I  found  a  razor,  covered  with  dried  and  hardened  blood,  lying  by  the  man's  side,  and  a  small 
memorandum  book,  upon  the  first  leaf  of  which  were  a  few  lines  written  in  lead  pencil,  and  giving 
reasons  for  the  deed  he  was  about  to  commit.  Upon  the  administration  of  brandy  and  water,  and 
other  restoratives,  and  the  application  of  heat  internally,  the  patient  gradually  recovered  strength. 
So  completely  had  the  system  been  depleted  of  blood  that  the  least  elevation  of  the  head  and 
shoulders  was  immediately  followed  by  convulsions.  As  soon  as  consciousness  was  restored  the 
sensations  usually  experienced  in  cases  of  great  and  sudden  depletion  were  urgent,  and  the  first 
words  were  "  water,  water."  The  man  is  still  in  hospital,  but  has  almost  regained  his  former 
strength. 


INCISED  AND  PUNCTUKED  WOUNDS.  99 

COCXXVI. — Mention  of  an  Incised  Wound  of  the  Foot.    By  A.  L.  BUPFINGTON,  M.  IX,  Acting 
Assistant  Surgeon. 

Private  Fontanice  Singleton,  Co.  D,  20tli  Infantry,  aged  20  years,  was  admitted  to  the  post 
hospital  at  Jefferson,  Texas,  on  December  3,  1867,  with  an  incised  wound  upon  the  dorsal  surface 
of  the  left  foot,  inflicted  with  an  axe.  The  parts  were  retained  in  apposition  by  adhesive  plaster. 
He  was  returned  to  duty  December  11, 1867. 


PUNCTTJEED  WOUNDS. — A  few  of  the  reports  of  the  more  important  punctured  wounds 
may  be  cited.  The  most  interesting  injuries  of  this  class  were  those  inflicted  by  arrows. 
These  will  be  considered  in  a  separate  section. 

CCCXXVII. — Mention  of  a  Bayonet  Wound  of  the  Scalp.    By  E.  ALEXANDER,   M.  D.,  Acting 
Assistant  Surgeon. 

Corporal  Alexander  Kay,  Co.  D,  39th  Infantry,  aged  28  years,  was  wounded  October  7,  1868, 
by  a  bayonet,  which  entered  the  scalp  between  the  sagittal  suture  and  the  left  parietal  protuber- 
ance, making  a  wound  about  two  inches  long.  He  was  admitted  to  the  post  hospital  at  Fort  St. 
Philip,  Louisiana,  on  the  same  day.  Haemorrhage  occurred  to  the  amount  of  fifteen  or  twenty 
ounces.  The  wound  was  carefully  explored,  but  no  injury  of  bone  could  be  detected.  The  treat- 
ment consisted  in  cold  applications  to  the  head  and  a  brisk  cathartic.  No  compresses  of  any  kind 
were  used  for  several  days,  but  the  pus  that  formed  was  frequently  pressed  out.  After  this  a  few 
adhesive  straps  were  applied  twice  daily,  and  the  wound  healed  kindly.  Ou  November  3,  1868,  the 
patient  was  returned  to  duty. 

CCCXXVIII. — Mention  of  a  Sword  Wound  of  the  Eye.    By  BICHARD  POWELL,  Assistant  Surgeon, 
U.  S.  A. 

At  Camp  Warner,  Oregon,  December  25, 1867,  Private  John  Waltsh,  Co.  D,  23d  Infantry,  aged 
36  years,  received  in  a  brawl  a  punctured  wound  of  the  right  eye  from  a  sword,  which  penetrated 
the  cornea  and  iris.  He  was  admitted  to  post  hospital  December  27, 1867.  Cold-water  dressings 
were  applied  to  the  eye,  cantharides  plaster  was  placed  behind  the  right  ear,  and  saline  cathartics 
were  administered.  He  returned  to  duty  April  12,  1868. 

CCCXXIX. — Note  Relative  to  a  Bayonet  Wound  of  the  Lower  Jaw.    By  C.  E.  GODDARD,  Assistant 
Surgeon,  U.  S.  A. 

Private  John  Fry,  Co.  E,  16th  Infantry,  aged  21  years,  received  a  bayonet  wound  at  the  hands 
of  the  sergeant  of  the  police  guard,  while  resisting  arrest,  November  23,  I860.  The  bayouet 
thrust  fractured  the  lower  jaw.  The  wounded  man  Avas  admitted  to  the  post  hospital  at  Chatta- 
nooga, on  the  next  day,  and  the  fracture  was  coaptated,  and  retained  in  position  by  splints  of 
binder's  boards.  [The  man  was  returned  to  duty  in  December,  1866. — ED.] 

CCCXXX. — Mention  of  a  Bayonet  Wound  of  the  Thorax.    By  JOHN  B.  WHITE,  M.  D.,  Acting 
Assistant  Surgeon. 

In  the  case  of  Private  Hilary  Herbert,  I  would  state  that  at  the  post-mortem  examination, 
fourteen  hours  after  death,  the  autopsy  being  limited  to  the  cavity  of  the  thorax,  there  was  nothing 
of  additional  interest  elicited,  other  than  the  facts  communicated  in  my  report  of  April  5,  1868,  in 
which  I  stated  "  that  he  received  a  stab  by  a  bayonet  upon  the  inner  or  thoracic  side  of  the  left 


100  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

arm,  which  passed  into  the  cavity  of  the  axilla,  and  also  entered  the  cavity  of  the  thorax,  pene- 
trating the  superior  lobe  of  the  left  lung,  and  terminating  by  a  small  opening  into  the  aorta,  a  few 
lines  without  the  pericardia!  sac."  An  interesting  feature  of  this  case  was  the  rapid  cooling  of 
the  body,  after  the  stab,  to  the  temperature  of  the  surrounding  medium,  arising  from  the  rapid 
and  profuse  loss  of  blood,  both  externally  aud  internally.  [This  man  died  April  4,  1868. — ED.] 

CCCXXXI. — Minute  of  a  Bayonet  Wound  of  the  Pectoral  Muscles.    By  J.  F.  WEEDS,  Surgeon, 
U.  S.  A. 

Private  Hugh  McClinty,  Co.  H,  45th  Infantry,  aged  30  years,  was  wounded  on  January  3, 
1869,  by  a  bayonet,  which  entered  the  left  side  of  the  thoracic  parieties,  one  and  a  half  inches,  at  a 
point  two  inches  above  the  nipple,  passing  upward  and  outward,  and  did  not  enter  the  thoracic 
cavity.  He  was  admitted  to  the  post  hospital  at  Nashville,  on  the  same  day,  and  was  returned  to 
duty  January  6,  1869. 

CCCXXXII. — Mention  of  a  Penetrating  Wound  of  the  Lung.    By  C.  C.  BYRNE,  Surgeon,  U.  S.  A. 

Private  John  Tobin,  Co.  C,  19th  Infantry,  received,  April  14,  1870,  a  penetrating  wound  of 
the  lung,  by  a  pocket  knife.  He  was  admitted  to  the  post  hospital  at  Little  Eock,  Arkansas,  on 
the  following  day.  Simple  dressings  were  applied.  He  died  on  the  18th,  from  haemorrhage. 

CCCXXXIII. — Account  of  a  Suicide  from  Stabbing  the  left  Chest.    "Hermetically  Sealing"  unavail- 
imjly  employed.    By  J.  JORGENSON,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Ambrose  Zepp,  Co.  I,  21st  Infantry,  on  January  18,  1868,  while  in  an  intoxicated  con- 
dition, attempted  to  commit  suicide  at  Fariuville,  Virginia,  by  stabbing  himself  with  a  sharp, 
long-bladcd  knife,  in  the  left  side  of  the  chest,  between  the  fourth  and  fifth  ribs,  about  an  inch  to 
the  left  of  the  nipple,  perforating  the  pleura!  cavity.  There  was  very  little  bleeding  from  the 
orifice  of  the  wound,  and  no  expectoration  of  blood.  The  wound  was  closed  and  hermetically 
sealed;  but,  in  the  course  of  three  or  four  days,  it  was  found  necessary,  on  account  of  accumula- 
tion of  pus,  to  reopen  the  wound.  Until  six  weeks  ago  he  seemed  constantly  to  improve.  The 
inflammation  of  the  pleura  was  reduced,  aud  he  suffered  very  little  from  cough.  At  that  time 
diarrhoea  set  in,  and  he  died  on  July  18th. 

CCCXXXIV. — Report  of  a  Punctured  Wound  of  the   Stomach,  with  oilier  Injuries.     By  EDWIN 
BENTLEY,  Assistant  Surgeon,  U.  S.  A. 

Corporal  George  Williams,  Co.  B,  12th  Infantry,  aged  24  years,  a  strong  and  robust  man, 
received  a  punctured  wound  of  the  left  side,  in  an  encounter  with  a  comrade,  near  Russell  Bar- 
racks, at  Washington.  A  physician  applied  a  roller  bandage  around  the  chest,  and  had  the  man 
conveyed  to  the  post  hospital  twenty  minutes  after  the  reception  of  the  injury.  He  had  been 
eating  and  drinking  freely,  and  when  admitted  was  suffering  the  most  excruciating  agony.  He 
was  immediately  put  under  the  influence  of  chloroform  aud  the  wound  was  examined.  An  inci- 
sion about  three  and  half  inches  in  length  was  found  between  the  sixth  and  seventh  ribs,  on  the 
anterior  portion  of  the  left  side.  Through  this  opening  nearly  a  handful  of  the  greater  omentum 
was  projecting.  In  replacing  this,  two  fingers  were  found  to  readily  pass  into  the  stomach,  without 
enlarging  the  wound.  The  anterior  portion  of  the  stomach  was  drawn  through  the  wound,  and 
a  portion  of  its  engorged  contents  was  taken  out.  A  branch  of  the  right  gastro-epiploic  artery 
was  ligated.  The  incision  of  one  and  a  half  inches  in  length  was  closed  by  the  glover's  stitch, 
and  the  organ,  with  its  omeutum,  was  replaced  aud  the  external  wound  closed  by  suture  and 
pledgets  of  lint.  A  bandage  was  then  applied.  He  was  kept  perfectly  quiet  and  sufficiently  easy 
to  obtain  several  hours  sleep,  by  the  hypodermic  use  of  a  solution  of  morphia.  He  was  allowed  no 
nourishment  but  milk,  a  few  teaspoonfuls  of  which  relieved  his  throat  and  the  inflammation  of  the 
stomach  very  satisfactorily,  much  better  even  than  ice,  pieces  of  which  he  was  allowed  to  have  con- 


INCISED  AND  PUNCTUEED  WOUNDS.  101 

tintially  in  his  month  if  he  desired.  He  retained  his  reason  perfectly  and  lived  nearly  thirty-six 
hours  after  being  wounded,  death  resulting  on  September  14,  1807.  The  post-mortem  examination 
showed  three  wounds  in  the  left  side  of  the  chest :  one  in  the  infra-clavicular  region,  about  half  an 
inch  in  length  and  non-penetrating;  one  in  the  infra-scapular  region,  also  non-penetrating,  and  an 
extensive  wound  betweeen  the  sixth  and  seventh  ribs,  passing  through  the  lower  and  anterior  por- 
tion of  the  left  pleural  cavity,  perforating  the  diaphragm,  and  entering  the  stomach  near  the  middle 
and  lower  side  of  the  anterior  surface  to  the  right  of  the  spleen.  The  wound  in  the  stomach  had 
contracted  very  much  since  the  injury,  as  also  the  organ  itself.  The  left  cavity  of  the  chest  con- 
tained twenty  ounces  of  serum  and  flocculeut  lymph,  and  a  deposit  of  coagulated  lymph  lined  the 
pulniouic  and  costal  pleurae.  The  left  lung  was  partially  compressed ;  all  the  other  organs  were 
healthy,  except  the  spleen,  which  was  enlarged  and  softened,  and  contained  four  masses  of  cheesy 
tubercle. 

CCCXXXV.— Report  of  a  Punctured  Wound  of  the  Stomach.    By  A.  J.  HOGG,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Maynard,  9th  Infantry,  just  after  eating  a  hearty  dinner,  was  stabbed  oh  June  7, 1870, 
near  Looking-glass  Creek,  Nebraska,  with  a  common  pocket  knife,  the  blade  of  which,  four  inches 
in  length  by  one-half  inch  in  breadth,  cut  through  the  cartilage  of  the  ninth  rib  of  the  left  side, 
and  penetrated  the  stomach.  The  shock  lasted  about  six  hours,  and  was  followed  by  moderate 
reaction.  About  four  hours  after  the  receipt  of  the  injury,  he  threw  up  the  contents  of  his  stomach, 
consisting  of  what  he  had  eaten  for  dinner  and  several  ounces  of  clotted  blood.  The  treatment 
pursued  was  very  simple ;  the  wound  of  the  integument  was  closed  with  an  adhesive  strip  and  a 
compress  applied.  Nothing  was  given  him  for  the  first  forty-eight  hours  but  pounded  ice.  On  the 
third  day  he  was  allowed  a  small  quantity  of  boiled  sago;  on  the  fifth  day  he  was  permitted  to 
walk  about,  and  on  the  thirteenth  day  after  the  receipt  of  the  injury  was  returned  to  duty. 

CCCXXXVL— Report  of  a  Punctured  Wound  of  the  Abdomen.    By  J.  H.  BARTHOLF,  Assistant 
Surgeon,  U.  S.  A. 

Private  William  Patterson,  Co.  A,  29th  Infantry,  aged  23  years,  received  a  punctured  wound 
of  the  abdomen  in  a  drunken  brawl  at  Lynchburg,  Virginia,  October  21,  1807.  After  being 
wounded  he  walked  a  distance  of  half  a  mile  to  camp,  when  he  was  admitted  to  hospital.  Upon 
examination,  a  wound  one-half  inch  in  length,  such  as  would  be  inflicted  by  a  common  clasp-knife, 
was  observed  one-half  inch  from  the  mesial  line  and  two  and  one-half  inches  above  the  crest  of  the 
pubis.  A  portion  of  the  omentum,  about  the  size  of  a  large  walnut,  protruded  from  the  wound. 
This  was  at  once  passed  within  the  abdominal  walls  and  the  wound  brought  together  and  united 
by  three  interrupted  sutures.  Shortly  after  dressing  the  wound  the  bowels  moved,  followed  imme- 
diately by  vomiting.  There  was  extreme  tenderness  on  pressure  over  the  entire  abdomen,  particu- 
larly over  the  left  iliac  region.  There  was  general  peritonitis;  pulse  120.  A  narcotic  was  admin- 
istered, and  he  slept  during  the  night.  Vomiting  occurred  during  the  night  of  October  23d.  He 
continued  to  fail  and  died  at  4  o'clock  on  the  morning  of  October  24, 1807.  At  the  autopsy,  on 
opening  the  cavity  of  the  abdomen,  about  one-half  gallon  of  bloody  serum  was  found ;  the  usual 
characteristics  of  serous  inflammation  were  observed.  An  examination  of  the  intestines  revealed 
the  fact  that  the  knife  inflicting  the  wound  had  passed  directly  through  the  ilium,  causing  a 
double  wound. 

CCCXXXVII.— Note  of  a  Punctured  Wound  of  the  Abdomen.    By  JOHN  T.  KING,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  William  Moller,  Co.  C,  8th  Infantry,  aged  24  years,  was  wounded  by  a  knife,  May  15, 
1870,  which  penetrated  the  abdominal  walls,  just  below  the  umbilicus.  He  was  admitted  to  the 
post  hospital  at  Spartauburgh,  South  Carolina,  the  same  day.  Interrupted  sutures  and  anodynes 
were  used,  and  on  June  3d  he  was  returned  to  duty. 


102  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCXXXVIII.— Note  of  a  Punctured  Wound  of  the  Abdomen.    By  C.  W.  YOUNG,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  John  Carey,  Co.  G,  10th  Infantry,  was  wounded  in  a  quarrel,  November  26, 18C9,  In  a 
pocket  knife,  which  entered  the  left  side,  penetrating  the  abdominal  cavity.  He  was  admitted  to 
the  post  hospital  at  Helena,  Texas.  Simple  dressings  were  applied,  and  the  man  was  returned  to 
duty  January  16,  1870. 

CCCXXXIX. — Beport  of  a  Bayonet  Wound  in  the  Hypochondriac  Region.    By  J.  W.  WILLIAMS, 
Assistant  Surgeon,  U.  S.  A. 

Private  William  H.  Huber,  Co.  K,  5th  Artillery,  was  stabbed  with  a  bayonet  on  the  night  of 
November  21, 1870,  at  Fort  Sullivan,  Maine.  The  point  of  the  bayonet  entered  the  left  hypochon- 
driac region,  between  the  eleventh  and  twelfth  ribs,  and  from  before,  backward  and  below,  upward, 
apparently  injuring  the  spleen.  The  patient  lost  about  twenty  ounces  of  blood  in  a  few  minutes, 
from  which  he  fainted.  Dark-colored  blood  continued  to  issue  from  the  wound  for  two  days.  The 
abdomen  was  considerably  distended  with  blood,  but  no  evident  symptoms  of  peritonitis  set  in  at 
any  time.  The  patient  was  kept  under  full  doses  of  opium.  At  the  date  of  this  writing  the 
patient  is  convalescent.  [He  was  returned  to  duty  in  December,  1870. — ED.] 

CCCXL. — Notes  of  two  Cases  of  Lance-Wounds.    By  J.  H.  McMAHON,  M.  D.,  Acting  Assistant 
Surgeon. 

CASE  I. — Private  John  Foster,  Co.  K,  9th  Cavalry,  received  a  punctured  flesh-wound  of  the  right 
gluteal  region,  by  a  lance,  September  12, 1868.  He  was  admitted  to  the  post  hospital  at  Fort  Davis, 
Texas,  on  the  14th.  Simple  dressings  were  applied,  and  he  was  returned  to  duty  on  September 
18,  1868. 

CASE  II. — Private  Gilbert  Colyer,  Troop  F,  9th  Cavalry,  was  wounded  at  the  battle  of  Horse- 
Head  Hills,  Texas,  September  12,  1868,  by  a  lance  which  penetrated  the  thorax,  entering  on  the 
right  side,  seven  inches  from  the  spine,  between  the  sixth  and  seventh  ribs.  The  lung  was  unin- 
jured. Simple  dressings  were  applied  to  the  wound.  He  recovered  and  was  returned  to  duty  in 
.October,  1868. 

CCCXLI. — Note  of  Punctured  Wounds  of  the  Arm   and   Shoulder.     By  G.  H.  GUNN,  Assistant 
Surgeon,  U.  S.  A. 

Private  Samuel  Ridley,  Co.  I,  9th  Cavalry,  aged  24  years,  was  wounded,  October  22,  1870,  by 
a  knife,  which  entered  the  superior  and  inner  angle  of  the  scapula  and  middle  of  right  arm.  He 
was  admitted  to  the  post  hospital  at  Fort  Quituian,  Texas,  the  same  day.  Simple  dressings  were 
applied.  He  died  on  October  30th,  from  hemorrhage. 

CCCXLII. — Note  of  a  Punctured  Wound  of  the  Thigh.    By  AARON  ANSELL,  M.  D.,  Acting  Assistant 
Surgeon. 

At  Fort  luge,  Texas,  August  4, 1867,  Lieutenant  N.  J.  McCatt'erty,  Co.  K,  4th  Cavalry,  received 
a  punctured  wound  of  the  thigh,  penetrating  the  femoral  artery  (sic).  He  was  admitted  to  the  post 
hospital,  where  simple  dressings  were  applied.  The  lucuiorrhage  was  controlled,  and  the  officer 
returned  to  duty,  August  17,  1867. 

CCCXLIII. — Report  of  an  Incised  and  Punctured  Wound  of  tlie  Knee- Joint,  having  a  Fatal  Result.    By 
CALVIN  DEWITT,  Assistant  Surgeon,  U.  S.  A. 

Corporal  Henry  Atley,  Co.  E,  3d  Cavalry,  received  an  incised  and  punctured  wound  of  the 
right  knee-joint,  on  April  10,  1870,  while  on  escort  duty  near  Camp  McDowell,  Arizona  Territory ; 
his  horse  becoming  restive,  crowded  his  right  leg  against  the  saddle-bags  of  a  comrade,  from  which 
a  largo  knife  was  protruding.  The  knife  entered  at  the  outer  side  of  the  popliteal  space,  passed 
obliquely  upward  and  inward,  struck  the  head  of  the  tibia,  from  which  it  glanced,  and  entered  the 


LACEEATED  AND  CONTUSED  WOUNDS.  103 

cavity  of  the  knee-joint.  The  hemorrhage  was  very  severe,  but  was  finally  controlled  by  cold 
water.  He  was  admitted  on  the  next  day  to  the  hospital  at  Fort  McDowell,  where  the  limb  was 
bandaged,  constant  applications  of  cold  water  ordered,  and  absolute  rest  enjoined.  On  April  12th, 
the  bandage  becoming  tightened  from  swelling,  was  removed.  The  knee  was  painful.  The  wound 
was  dressed  with  carbolic  acid  and  olive  oil,  and  the  limb  was  placed,  slightly  bent,  in  a  cradle ;  the 
application  of  cold  water  was  continued,  with  nourishing  diet  and  opiates  at  night.  No  improve- 
ment having  taken  place,  on  April  ICth,  the  administration  of  Gross's  antimonial  and  saline  mixture 
was  directed,  with  continuance  of  the  dressings,  and  application  of  cold  water.  Tonics,  with  beef- 
tea  and  wine,  were  given  at  regular  intervals  during  the  day.  Improvement  was  manifest,  and 
continued  until  May  23d,  when  blisters  and  tincture  of  iodine  were  applied,  and  subsequently 
iodide  of  potassium  was  administered  to  encourage  absorption,  which  took  place  slowly.  By  May 
23d,  the  knee  was  reduced  to  its  normal  size,  and  almost  all  evidence  of  inflammation  had  disap- 
peared, and  the  patient's  condition  was  most  satisfactory,  the  wound  having  healed,  except  on  the 
surface,  over  which  the  new  skin  was  closing  rapidly.  On  the  night  of  May  28th,  notwithstanding 
stringent  directions  had  been  given  that  the  leg  must  not  be  moved  unless  permission  was  given, 
the  patient  bent  the  knee  "  in  order  to  try  it,"  as  he  said.  The  result  was  manifest  the  next  day ; 
inflammation  set  in  ;  the  knee  became  hot,  swollen,  and  painful,  and  in  a  few  days  there  was  effu- 
sion in  the  knee-joint,  and  constitutional  sympathy.  He  gradually  lost  his  appetite  and  strength. 
The  wound  reopened,  and  in  two  weeks  suppuration  commenced  and  pus  was  discharged.  Tonics, 
stimulants,  and  nourishing  diet  were  given,  but  without  effect.  He  wasted  rapidly  until  June  12, 
when  a  severe  diarrhrea  set  in,  which  increased  in  violence  until  June  23,  when  he  died  from 
exhaustion. 


LACERATED  AND  CONTUSED  WOUNDS. — The  reports  usually  contain  a  rather  large  pro- 
portion of  cases  of  bruises  and  lacerations.  A  few  instances  may  be  cited,  among  them 
two  interesting  examples  of  laceration  of  internal  organs  without  breach  of  continuity  in 
the  integument. 

CCCXLIV. — Note  relative  to  a  Wound  of  the  Scalp.    By  CARLOS  CARVALLO,  Assistant  Surgeon, 
U.  S.  A. 

Private  George  T.  Atwood,  Co.  K,  5th  Cavalry,  aged  22  years,  admitted  to  hospital  at  Sedg- 
wick  Barracks,  Washington,  on  September  20,  1867,  with  a  triangular  lacerated  wound  of  the  scalp, 
received  in  a  fracas  with  a  policeman,  in  Washington,  the  previous  day.  The  gaping  wound  was 
drawn  together  with  adhesive  strips,  and  on  the  21st,  proud  flesh  appearing  on  the  edges  of  the 
wound,  it  was  cauterized.  The  wound  healed  rapidly,  and,  on  October  Cth,  the  patient  was  returned 
to  duty. 

CCCXLV. — Note  relative  to  a  Wound  of  the  Scalp.    By  JAMES  F.  WEEDS,  Surgeon,  U.  S.  A. 

At  Ash  Barracks,  Nashville,  February  1,  1870,  Frank  Morton,  corporal,  Co.  K,  14th  Infantry, 
when  intoxicated,  received,  by  falling  from  a  railroad  tressel-work,  on  a  rough  stone,  a  severe 
wound  on  the  left  side  of  the  head,  six  inches  long,  over  the  parietal  and  temporal  bones.  He  was 
admitted  to  post  hospital  the  next  day,  and  a  lotion  of  a  solution  of  carbolic  acid  on  lint  was  applied. 
He  recovered  and  returned  to  duty  February  24,  1870. 

CCCXLVI. — Mention  of  a  Contusion  of  the  Scalp.    By  D.  McLEAN,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  John  Eiley,  Co.  F,  19th  Infantry,  aged  27  years,  received  a  contusion  of  the  scalp  over 
the  left  parietal  bone,  by  a  fall  on  a  steamer  when  returning  from  absence  with  leave,  from  New 
Orleans,  on  November  9,  1870.  He  was  admitted  to  the  post  hospital  at  Fort  Pike,  on  the  same 
day,  and  cold-water  dressings  applied.  He  was  returned  to  duty  on  November  14th. 


104  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCXLVII.— Note  of  a  Case  of  Contused  Wound  of  the  Forehead.    By  DANIEL  MCLEAN,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Eugene  Navarra.  Co.  F,  19th  Infantry,  aged  33  years,  received  a  lacerated  wound 
over  the  frontal  bone,  by  a  blow  of  the  butt  of  a  inusket,  in  a  quarrel  in  company  quarters,  on 
December  13,  1870.  He  was  admitted  to  the  post  hospital  at  Fort  Pike,  the  same  day.  The 
edges  of  the  wound  were  brought  together  by  adhesive  strips,  compresses,  and  bandages.  He 
was  returned  to  duty  on  December  17,  1870. 

CCCXLVIII. — Note  of  a  Lacerated  Wound  of  the  Head.    By  AAEON  ANSELL,  M.  D.,  Acting 
Assistant  Surgeon. 

First  Lieutenant  N.  J.  McCafferty.  Co.  K,  4th  Cavalry,  aged  27  years,  received,  by  falling 
from  a  horse,  a  lacerated  wound  of  the  head,  severing  the  left  ear  from  above  to  the  lobe,  at  Fort 
Inge,  Texas,  on  June  2,  1867.  He  was  admitted  to  the  post  hospital  on  the  same  day.  Simple 
dressings  were  applied.  He  rapidly  recovered,  and  returned  to  duty  on  June  9, 1807. 

CCCXLXI. — Mention  of  Scalp  Wounds  with  Laceration.    By  "W.   H.  HOPPER,   M.  D.,  Acting 

Assistant  Surgeon. 

Private  Dennis  G.  Milane,  Co.  I,  14th  Infantry,  aged  26  years,  received,  by  a  club,  lacerated 
and  contused  wounds  of  the  scalp,  at  Lebanon,  Kentucky,  April  16,  1870.  He  was  admitted  to 
the  post  hospital  on  the  same  day.  Simple  dressings  were  applied.  He  returned  to  duty  on 
June  20,  1870. 

CCCL. — Remarks  on  a  Case  of  Wound  of  the  Scalp.    By  JOHN  B.  WHITE,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Andrew  Lewis,  Co.  B,  40th  Infantry,  appears,  in  the  report  for  December,  1868,  from 
the  post  hospital  at  Raleigh,  as  having  received  a  wound  of  the  scalp  over  the  left  of  the  frontal 
bone,  extending  from  the  median  line  to  the  centre  of  the  orbital  arch,  dividing  the  integument  to 
the  bone.  The  injury  was  inflicted  by  a  brick,  in  the  hands  of  one  of  his  comrades.  Symptoms 
of  concussion  were  present  from  the  first.  Careful  attention  was  directed  to  the  open  wound,  the 
edges  of  which  were  secured  by  sutures  and  adhesive  strips.  Irrigation  was  kept  up  for  about 
twelve  hours.  Patient  made  a  good  recovery,  and  was  returned  to  duty  in  three  weeks  from  the 
reception  of  the  injury. 

CCCLI. — Report  of  a  Contusion  of  the  Head.    By  B.  A.  CLEMENTS,  Surgeon,  U.  S.  A. 

Sergeant  M.  Dougherty,  Co.  G,  6th  Cavalry,  aged  28  years,  was  injured  January  31,  18G8,  at 
New  Orleans.  While  mounting  his  horse  he  received  a  violent  fall  upon  a  stone  pavement,  in 
consequence  of  the  parting  of  the  girth,  the  horse  having  started  at  full  speed.  The  scalp  was 
coutused  and  lacerated  at  the  vertex  of  the  cranium,  three-quarters  of  an  inch  long,  but  not 
extending  down  to  the  bone ;  there  was  also  a  severe  contusion  of  the  forehead.  He  was  stunned 
by  the  fall,  but  did  not  become  insensible.  He  was  at  once  sent  to  the  post  hospital  at  Jackson 
Barracks,  New  Orleans,  where  he  was  visited  by  Surgeon  B.  A.  Clements,  United  States  Army, 
and  Acting  Assistant  Surgeon  Payne,  within  a  few  hours  after  the  occurrence  of  the  injury 
He  was  sensible,  though  somewhat  slow  in  speech;  pulse  64,  full,  but  rather  weak;  respiration, 
unaffected,  and  skin  cool;  he  vomited  at  frequent  intervals,  and  complained  only  of  pain 
in  his  head,  both  at  the  vertex  and  in  the  forehead;  the  pupils  were  perhaps  dilated  to  a 
slight  extent,  but  readily  contracted  on  exposure.  The  case  had  been  considered  one  of  depres- 
sion, and  probable  fracture  of  the  skull,  but  there  were  no  evident  signs  of  such  an  injury.  The 
next  morning  the  pulse  was  56,  skin  still  disposed  to  be  cool,  pupils  still  slightly  dilated;  had 
continued  to  vomit  occasionally  during  the  night.  In  order  to  determine  with  accuracy  the  state 


LACERATED  AND  CONTUSED  WOUNDS.  105 

of  the  cranium  at  the  seat  of  the  wound,  and  feeling  some  assurance  there  was  no  fracture,  Surgeon 
Clements  made  an  incision  at  the  seat  of  the  wound,  and  introducing  a  finger,  found  no 
evidence  either  of  fracture  or  depression ;  there  was  no  effusion  beneath  the  scalp.  Bowels 
moved  freely ;  there  was  a  purplish  ecchymosis  at  the  inner  angle  of  both  eye-lids,  not  extending 
to  the  mucous  membrane  of  the  eye  or  eye-lids,  and  some  tumefaction  of  the  skin  of  forehead. 
He  was  quiet  and  disposed  to  sleep ;  patient  improved,  and  by  February  15th,  the  wound  of  scalp 
had  entirely  healed ;  he  complained  at  times  of  acute  pain  at  the  seat  of  the  wound,  otherwise  he 
was  quite  well.  He  was  returned  to  duty  February  27, 1868,  and  advised  not  to  ride  on  horseback 
for  a  month,  and  to  be  temperate.  He  still  at  times  had  a  rather  acute  pain  at  the  seat  of  the 
wound  of  scalp.  One  point  of  interest  in  this  case  was  the  character  of  the  ecchymosis  around 
the  eyes,  which  might  have  been  confounded  with  that  which  is  seen  at  times  in  fracture  of  the 
base  of  the  skull,  but  for  its  superficial  character. 

CCCLII. — Remarks  relative  to  a  Case  of  Contusion.    By  P.  J.  A.  CLEAR  Y,  Assistant  Surgeon,  U.  S.  A. 

Private  Daniel  Sullivan,  Co.  E,  45th  Infantry,  was  admitted  to  the  post  hospital  at  Chatta- 
nooga, November  25,  1867,  having,  while  intoxicated,  been  engaged  in  a  fight.  His  face  was  cov- 
ered with  blood  and  bruises.  On  washing  away  the  blood,  a  flesh-wound  was  found  over  the  left 
eye,  about  an  inch  in  length,  and  another  on  the  left  side  of  the  head,  about  an  inch  and  a  half 
from  the  median  line,  commencing  at  the  coronal  suture,  and  passing  downward  and  inward  for 
two  inches.  This  wound  had  evidently  been  made  with  a  blunt  weapon,  probably  brass  knuckles. 
On  examination,  the  lower  part  of  the  wound  was  found  to  extend  to  the  bone,  which  was  denuded 
of  its  periosteum  to  the  extent  of  about  half  a  square  inch,  but  neither  depression  or  fracture  could 
be  detected.  He  also  complained  of  severe  pain  in  the  back  from  a  kick.  There  was  discoloration 
over  the  third  and  fourth  lumbar  vertebra?,  with  great  tenderness  on  pressure.  The  patient  was 
fully  conscious,  but  very  restless.  Cold  applications  were  made  to  the  head,  and  Hoffman's  ano- 
dyne administered.  Patient  slept  well  during  the  night,  and  the  next  morning  felt  much  relieved. 
He  continued  to  improve,  and  on  December  13th  was  returned  to  duty. 

CCCLIII. — Xote  of  a  Case  of  Contusion  of  the  Chest.    By  W.  T.  HYSON,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  John  Delaney,  of  Battery  F,  5th  Artillery,  aged  24,  while  at  drill  on  November  6, 
1867,  at  Camp  Williams,  near  Eichmond,  Virginia,  was  knocked  down  by  the  wheel  of  the  limber, 
aiul  immediately  run  over  by  the  gun-carriage,  the  wheel  passing  transversely  over  his  thorax, 
immediately  above  the  nipples.  Incredible  to  say,  he  was  not  killed  by  the  immense  weight  of  the 
gun  (a  three-inch  Hodman  rifle),  but  was  not  even  hurt  seriously.  He  rode  from  the  drill-ground 
on  the  caisson-box.  The  track  of  the  wheel  was  distinctly  shown  by  discoloration  on  the  left  side 
and  front  of  the  thorax.  On  the  following  day,  November  7th,  he  was  well,  except  a  slight  sore- 
ness in  the  region  of  the  bruise.  On  the  second  day  he  was  returned  to  duty,  well,  and  continued 
so  at  the  date  of  this  report. 

CCCLIV. — Report  of  a  Case  of  Contusion  followed  by  Pleuritis  and  Hepatitis.    By  D.  MERRITT, 
Surgeon,  4th  Veteran  Volunteers. 

Lieutenant  Daniel  K.  Springer,  4th  Veteran  Volunteers,  was  taken  with  a  severe  pain  in  the 
right  side,  in  the  region  of  the  liver,  the  symptoms  being  those  of  acute  inflammation  of  that  organ. 
He  was  admitted  on  August  8,  1865,  to  the  hospital  at  Camp  Chase,  Ohio.  An  abscess  soon  after 
formed  in  the  right  hypochondriac  region,  the  tumefaction  spreading  toward  the  epigastrium,  and 
between  the  floating  ribs  and  liver.  Poultices  of  flaxseed  meal  were  applied,  and  the  tumor  was 
opened,  giving  exit  to  more  than  two  quarts  of  bloody  pus  of  a  very  unhealthy  character.  Gan- 
grene soon  after  supervened ;  then  extensive  sloughing,  involving  a  portion  of  the  rectns  abdomi- 
nis  muscle,  and  causing  an  opening  into  the  transverse  colon,  through  which  fa?cal  matter  escaped 
until,  by  enemata,  it  was  passed  through  the  natural  way.  The  gangrene  was  arrested  by  appli- 
14 


106  EEPOET  OF  SUEGICAL  CASES  IN  THE  AEMY. 

cation  of  nitric  acid.  Under  siibsequent  applications  of  lint  saturated  with  a  solution  of  chlorate 
of  potassa,  the  abscess  was  doing  very  well;  heallby  granulations  were  being  thrown  out;  fa-cal 
matter  was  discharging  by  the  rectum,  and  the  patient  doing  well,  when  an  untoward  condition 
set  in.  He  became  weaker,  notwithstanding  the  administration  of  stimulants  and  nourishing  diet, 
and  died  October  2,  1865.  Throughout  the  case  the  patient  evinced  the  utmost  heroism.  The 
abscess,  as  far  as  could  be  learned,  was  the  result  of  injuries  received  by  being  knocked  down  and 
kicked  in  Philadelphia  while  on  the  way  to  Camp  Chase.  The  autopsy  revealed  adhesions  between 
the  pleura  pulmoualis  and  pleura  costalis.  The  liver  was  healthy  except  on  the  outward  surface, 
where  there  was  slight  evidence  of  the  abscess  having  burrowed  in  the  hepatic  tissue.  The  kidneys 
and  stomach  were  normal.  The  lungs  were  very  much  surcharged  with  dark  venous  blood.  The 
transverse  colon  was  ulcerated. 

CCCLY. — Report  of  a  Case  of  Contusion  from  a  Bailicay  Accident.    By  G.  S.  EOSE,  Assistant  Sur- 
geon, U.  S.  A. 

Private  John  Holden,  Co.  C.,  29th  Infantry,  age  23,  was  injured  at  Keswick,  Virginia,  Sep- 
tember 28, 18G8,  by  a  railroad  accident.  Being  admitted  on  the  next  day  to  the  post  hospital  at 
Camp  Schofield,  Lynchburgh,  he  stated  that,  while  riding  on  the  top  of  a  box-car,  and  seeing  the 
car  in  front  of  him  rolling  over  the  embankment,  he  sprang  from  the  top,  but  was  unable  to  get 
away  in  time,  and  was  struck  in  the  back  by  the  car  as  it  rolled  over.  He  complained  of  intense 
pain  over  the  sacrum,  extending  between  the  anterior  superior  spinous  process  and  the  right 
tuber  ischii.  The  parts  over  the  sacrum  were  exceedingly  tender  on  pressure,  the  slightest  motion 
or  touch  causing  him  to  scream  with  pain.  I  was  unable  to  elicit  crepitus.  He  could  flex  the  leg 
on  the  thigh  without  pain,  but  was  unable  to  flex  the  thigh  on  the  pelvis.  The  soft  parts  were 
much  ecchymosed,  and  he  had  a  dull,  moving,  continuous  pain,  extending  across  the  whole  front 
of  the  pelvis.  Anodynes,  with  nourishing  diet,  were  given.  The  patient,  making  a  good  recovery, 
was  returned  to  duty  November  2G,  1868. 

CCCLVI. — Note  of  a  Case  of  Contusion  of  tlie  Back.    By  A.  F.  MECHEM,  Surgeon,  U.  S.  A. 

At  Fort  Porter,  New  York,  on  October  5, 1867,  Private  Thomas  Carroll,  Battery  L,  1st  Artillery, 
aged  23  years,  presented  himself  at  surgeon's  call,  stating  that  some  time  during  the  previous  night 
he  had  been  struck  in  the  back  with  the  butt  end  of  a  musket  in  the  hands  of  a  sentiuel.  The 
blow  knocked  him  down,  when  he  was  struck  twice  in  the  splenic  region  with  the  same  weapon. 
On  examination,  a  slight  wound,  such  as  might  have  been  made  by  the  percussion  hammer  of  a 
musket,  was  found  about  an  inch  and  a  half  to  the  left  of  the  articulation  of  the  twelfth  rib  with 
the  twelfth  dorsal  vertebra.  About  two  inches  lower,  at  the  same  distance  from  the  second  lumbar 
vertebra,  was  another  wound  of  the  same  character.  He  was  treated  in  the  post  hospital,  at  Fort 
Porter,  until  October  21, 1867,  when  he  was  returned  to  duty  entirely  cured. 

CCCLVII. — Mention  of  a  Case  of  Contusion  of  the  Back.    By  C.  E.  GBEENLEAF,  Assistant  Sur- 
geon, U.  S.  A. 

August  Burtz,  artificer  of  Co.  H,  2d  Infantry,  aged  38,  was  admitted  to  the  hospital  at  Taylor 
Barracks,  Kentucky,  on  November  7,  1868,  having  fallen  from  a  ladder  to  the  floor,  a  distance  of 
fourteen  feet.  He  complained  of  pain  in  the  bowels  and  inability  to  pass  water,  and  suffered 
considerably  from  shock.  A  stimulant  and  an  anodyne  were  administered.  He  was  improved  on  the 
8th ;  but,  on  the  10th,  was  taken  with  intermittent  fever,  which  yielded  to  quinine  and  iron.  He 
recovered  and  was  returned  to  duty  November  15, 1868. 

CCCLVIII. — Report  of  Case  of  Contusion,  'with  Rupture  of  the  Liver  and  Kidneys.    By  G.  H.  GUNN, 
Assistant  Surgeon,  U.  S.  A. 

Private  Henry  Greene,  Co.  H,  9th  Cavalry,  entered  hospital  at  six  in  the  evening  of  December 
15,  1870,  at  Fort  Quitman,  Texas,  having  been  run  over  by  a  wagon  at  eight  o'clock  the  morning 
of  the  same  day,  while  on  his  way  to  Fort  Quitman  from  Eagle  Springs.  Both  wheels  of  one  side 


LACERATED  AND  CONTUSED  WOUNDS.  1Q7 

were  thought  to  have  passed  over  him,  from  the  right  hip,  over  the  thorax.  The  patient  was 
suffering,  upon  admission,  frotn  shock  and  extreme  depression,  his  extremities  cold,  his  wrist 
almost  pulseless.  But  he  was  perfectly  conscious,  the  action  of  the  heart  was  feeble  but  regular, 
104  to  the  minute ;  respiration,  44.  Any  movement  was  evidently  repressed  and  painful.  No  rales 
upon  auscultation,  some  dullness  over  lower  portion  of  right  lung ;  great  tenderness  over  hepatic 
region,  with  nausea  and  vomiting.  Upon  percussion  over  the  right  hypochondriac  region,  much 
pain  was  experienced.  The  diagnosis  arrived  at  was,  that  there  was  a  rupture  of  the  liver.  Stimu- 
lants and  anodynes  were  ordered,  the  former  continued  every  hour  during  the  night ;  hot  applica- 
tions to  extremities.  Patient  rall-ied  a  little  after  a  few  hours,  but  no  permanent  improvement  was 
observed.  Death  occurred  at  7.30  A.  M.  of  the  following  day,  the  patient  having  passed,  through 
the  night,  a  quantity  of  nearly  pure  blood  from  the  bladder.  A  post-mortem  examination,  ten  hours 
after  death,  revealed  a  rupture  of  the  liver,  through  nearly  the  entire  extent  of  its  antero  posterior 
diameter,  following  the  junction  of  the  right  with  the  left  and  quadrate  lobes,  to  within  one  inch  of 
the  anterior  border  of  the  organ.  Also,  a  fracture  of  the  sternum,  at  the  junction  of  its  upper  and 
middle  third,  fracture  of  the  eighth  rib,  two  inches  in  front  of  its  angle.  The  right  lung  was 
engorged,  with  a  small  puncture  over  the  anterior  aspect  of  its  upper  lobe,  from  the  broken  end  of 
sternum.  A  large  effusion  of  blood  into  the  abdominal  cavity  was  found,  and  a  longitudinal  rup- 
ture of  the  right  kidney,  throughout  nearly  its  entire  extent.  The  bladder  was  normal  and  empty. 

CCCLTX.— Case  of  Rupture  of  the  Spleen,    By  J.  P.  WEEDS,  Surgeon,  U.  S.  A. 

Private  Michael ,  Co.  C,  45th  Infantry,  while  boxing  with  a  comrade  in  the  store  of  the 

post-trader  at  Nashville,  Tennessee,  July  3,  18C9,  received  a  comparatively  light  blow  with  the 
palm  of  the  hand  in  the  left  hypogastric  region.  Ryan  turned  away,  saying  nothing,  and  walked 
on  to  the  veranda,  where,  in  a  few  moments,  he  fainted,  and  was  carried  to  his  company  quarters. 
I  visited  him  eight  or  ten  minutes  after  the  accident,  at  which  time  the  pulse  had  ceased  to  beat  at 
the  carotid ;  the  skiu  was  blanched ;  the  pupil  fully  dilated,  and  respiration,  merely  a  gasp,  repeated 
three  or  four  times  a  minute.  Death  supervened  in  less  than  a  quarter  of  an  hour  after  the  recep- 
tion of  the  blow,  with  symptoms  of  shock  and  haemorrhage.  An  autopsy,  two  hours  after  death, 
revealed  the  abdominal  cavity  filled  with  blood.  This  flowed  from  extensive  fissures  in  the  spleen, 
which  was  enlarged  and  softened,  measured  five  by  seven  inches  in  diameter,  and  was  two  inches 
thick,  weighing  fourteen  ounces.  All  the  other  abdominal  viscera  were  normal ;  there  were  old 
pleuritic  adhesions  of  the  left  side ;  in  all  other  respects,  the  thoracic  viscera  was  in  a  healthy  con- 
dition. The  pathological  specimen,  consisting  of  the  spleen,  is  number  3000,  Section  1,  Army 
Medical  Museum,  and  was  forwarded  with  the  history  of  the  case. 

CCCLX. — Remarks  on  a  Case  of  Contusion  of  the  Abdomen.    By  B.  E.  FRYER,  Surgeon,  U.  S.  A. 

Private  Lewis  Metcalf,  Co.  H,  5th  Infantry,  on  duty  as  teamster  in  the  Quartermaster's 
Department,  was  admitted  into  the  post  hospital  at  Fort  Harker,  Kansas,  August  20,  1870,  just 
after  the  reception  of  a  kick  in  the  abdomen  from  a  mule.  He  was  bordering  on  a  collapsed  state ; 
the  pulse  was  scarcely  perceptible  at  the  wrist,  and  the  surface  was  cold,  with  a  clammy  sweat 
resting  on  it.  No  marks  of  the  kick  were  visible,  though  the  man  stated,  after  reaction  had  fol- 
lowed on  careful  use  of  stimulants,  that  the  blow  was  received  on  the  abdomen  in  the  left  hypo- 
chondriac region.  He  now  complained  of  severe  pain,  which  was  promptly  relieved  by  ten-grain 
doses  of  chloral  hydrate.  On  the  fifth  day  after  the  injury  the  bowels  were  relieved  by  an  enema, 
and  on  August  28th  he  was  able  to  be  about  the  ward.  September  4,  1870 :  Metcalf  was  returned 
to  his  duty  in  the  Quartermaster's  Department,  with  a  request  that,  for  a  time,  some  light  work  be 
assigned  him.  From  this  period  until  the  date  of  readmissiou  into  the  hospital,  (42  days'  interval,) 
he  was  watchman  at  the  quartermaster's  stable,  which  gave  him  nothing  but  the  lightest  duty.  On 
October  loth,  the  man,  complaining  of  being  weak  and  constipated,  was  given  a  mild  aperient, 
marked  "  sick  in  quarters,"  and  directed  to  keep  quiet;  but,  disobeying  this  injunction,  he  got  per- 
mission from  his  commander  to  go  to  the  neighboring  town,  some  three  miles  distant,  where  he  pur- 
chased aud  ate  a  large  quantity  of  pies,  nuts,  &c.,  which,  he  said,  made  him  vomit.  He  reported 


108  EEPOET  OF  SURGICAL  CASES  IN  THE  AEMY. 

the  next  morning  at  sick-call  as  "  feeling  no  better,"  and  was  readmitted  to  the  hospital.  On 
admission,  his  pulse  was  72,  and  rather  feeble;  respiration  somewhat  labored,  but  otherwise  nat- 
ural ;  temperature  normal ;  bowels  still  constipated ;  vomited  several  times ;  no  pain  or  abdominal 
tenderness.  Half-grain  does  of  calomel,  with  one  grain  of  opium,  soon  stopped  vomiting.  Enein- 
ata  were  given  without  avail,  to  move  the  bowels,  though  a  careful  examination  of  the  abdomen 
showed  no  great  accumulation  of  faecal  matter.  Milk  and  beef  essence,  with  small  doses  of  whiskey, 
were  administered  every  hour  to  support  strength,  which  appeared  to  be  rapidly  failing,  but  the 
man  continued,  however,  to  run  down  in  spite  of  the  supporting  treatment  and  faithful  nursing, 
and  died  early  on  the  morning  of  October  19th.  Post-mortem  examination,  eight  hours  after  death ; 
rigor  mortis  well  marked;  muscular  system  well  developed  ;  very  slight  wasting  of  adipose  tissue; 
thoracic  organs  healthy  ;  small  abscess,  about  the  size  of  a  large  hazel-nut,  in  the  lower  and  posterior 
portion  of  the  spleen,  the  pus  being  of  a  dirty  yellowish-brown  hue — the  whole  organ  slightly 
shrunk,  and  somewhat  hardened.  Other  abdominal  organs,  save  a  slight  congestion  of  the  mucous 
coat  of  the  intestines,  normal.  No  febrile  symptoms  exhibited  themselves  after  readmission,  and 
no  positive  indications  of  the  spleen  trouble  were  manifest,  though  it  was  feared,  by  exclusion,  that 
a  lesion  of  the  spleen  existed. 

CCCLXI. — Report  of  a  Case  of  Contusion  of  the  Pelvis.    By  A.  G.  SKINNER,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Thomas  Morgan,  Co.  A,  42d  Infantry,  aged  34,  was  admitted  to  the  hospital  at  Fort 
Niagara,  New  York,  on  October  2,  1867,  the  wheel  of  a  loaded  cart  having  run  over  his  pelvis  on 
the  day  previously.  There  was  swelling,  with  extensive  ecchymosis  over  the  upper  portion  of  the 
sacrum,  and  he  complained  of  much  pain.  The  patient  was  unable  to  walk.  A  stimulating  lotion 
was  applied  to  the  contused  parts,  and  anodynes  were  administered.  A  tumor,  which  formed  over 
the  injured  part,  was  several  times  opened,  and  its  contents  evacuated.  The  patient  suffered  from 
chill  and  fever.  By  November,  his  general  health  had  improved  under  expectant  treatment;  but 
the  wound  was  still  open.  On  December  6th,  he  was  permitted  to  do  light  duty,  the  wound  being 
frequently  examined.  Being  returned  to  hospital  on  the  27th,  the  wound  was  swollen,  inflamed, 
and  freely  discharging  dark,  purulent  matter.  The  swelling  having  subsided  by  January  13,  1868, 
and  the  condition  of  the  wound  remaining  unchanged,  an  incision  three  inches  long  was  made 
down  to  the  diseased  structure,  which  was  found  to  be  a  hard,  cartilaginous  growth,  with  bony 
deposit,  between  which  and  the  periosteum  the  purulent  matter  had  been  lodged,  and  escaped  by 
means  of  an  opening.  On  dissecting  out  this  diseased  growth,  and  touching  the  walls  of  the 
remaining  cavity  with  nitrate  of  silver,  the  wound  was  closed  with  adhesive  strip  and  a  compress. 
But  little  suppuration  followed,  and  on  the  28th,  the  wound  being  nearly  healed,  the  patient  was 
returned  to  duty. 

CCCLXII. — Report  of  a  Case  of  a  Contused  Wound  of  the  Perinwum.    By  JOHN  T.  KING,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Charles  May,  Co.  E,  2d  Infantry,  aged  25  years,  while  intoxicated,  fell  astride  of  a 
board  as  he  was  descending  the  steps  in  the  rear  of  his  company  quarters,  on  February  22,  1870. 
Immediately  after  the  fall  there  was  great  swelling  and  induration  of  the  perinasum,  and  the 
calibre  of  the  urethra  was  encroached  upon  to  such  an  extent  that  the  patient  was  unable  to 
micturate.  On  the  next  day  he  complained  of  severe  pain  behind  the  pubes.  A,11  attempt  was 
made  to  introduce  the  catheter,  which  failed.  On  February  27th  the  bladder  had  become  enor- 
mously distended  with  urine,  and  every  local  symptom  was  aggravated.  There  was  great  hyper- 
gesthesia  of  the  entire  abdomen,  and  considerable  swelling  and  slight  fluctuation  in  the  perinseum. 
There  was  intense  thirst,  quick  pulse,  nausea,  and  headache.  A  second  attempt  was  made  to 
introduce  the  catheter,  but  the  great  pain,  enormous  swelling,  and  spasmodic  contraction,  compli- 
cated with  acute  gonorrhoea,  proved  obstacles  not  readily  overcome.  Still  the  effort  was  persisted 
in  to  relieve  the  bladder  in  this  way  rather  than  resort  to  either  recto-vesical  or  supra-pubic  punc- 
ture. After  considerable  effort  the  catheter  was  introduced  and  about  six  quarts  of  fluid  drawn, 
of  which  it  was  estimated  fully  one-half  was  blood.  On  March  1st  the  swelling  of  the  periuseuin 


LACEEATED  AND  CONTUSED  WOUNDS.  109 

had  not  abated.  On  attempting  to  introduce  the  catheter  the  urethra  contracted  spasmodically. 
Unfortunately,  in  continuing  the  effort  the  wire  was  thrust  through  the  end  of  the  catheter,  which 
punctured  the  walls  of  the  urethra  and  entered  an  abscess.  Whether  this  puncture  with  the  wire 
only  anticipated  what  nature  would  have  done,  has  been  a  question  in  my  mind.  While  I  believe 
that  any  opening  into  the  urethra  was  of  all  things  to  be  feared  and  guarded  against,  as  likely  to 
produce  extravasation  of  urine  and  urinary  fistula},  yet  I  believe  that  the  abscess  would  have  pointed 
there  eventually.  On  March  Gth,  incisions  were  made  into  the  perinseum  to  give  vent  to  the  contents 
of  the  abscess;  the  discharge  was  profuse  and  offensive;  the  abdomen  was  tense,  swollen,  and  very 
tender;  the  pulse  frequent  and  feeble ;  tongue  parched  with  extreme  thirst;  the  appetite  impaired, 
and  the  bowels  constipated.  A  catheter  was  retained  for  several  days,  through  which  the  bladder 
was  frequently  evacuated.  Large  clots  of  blood  passed,  with  considerable  mucus.  Upon  the 
bladder  being  emptied  there  would  be  spasmodic  contraction,  accompanied  by  intense  pain,  which 
was  attributed  to  the  contact  between  the  walls  of  the  bladder  and  the  point  of  the  catheter.  The 
patient  was  taught  to  introduce  the  catheter,  which  he  did  with  comparative  ease.  Occasionally 
the  eye  of  the  catheter  would  become  occluded  with  blood  and  mucus,  so  that  the  contraction  of 
the  bladder  and  the  abdominal  walls  would  force  the  urine  by  the  catheter  and  discharge  it 
through  the  fistulous  openings  in  the  perinaeum.  Warm  fomentations  were  applied  to  the  abdomen 
and  stimulants  given.  Under  the  treatment  adopted  there  was  gradual  abatement  of  the  symp- 
toms, and  a  decided  improvement  in  general  health.  On  March  15th,  the  ha3maturia  had  almost 
disappeared,  but  the  discharge  of  mucus  had  become  more  manifest.  The  urine  was  still  drawn 
through  the  catheter  that  nature  might  heal  the  abnormal  outlets.  On  the  20th,  the  patient 
discharged  urine  with  little  pain  in  ordinary  amount  and  with  scarcely  a  trace  of  mucus.  He 
continued  to  improve,  and  on  March  31st,  two  of  the  fistulous  openings  had  healed,  and  the  only 
remaining  one  looked  healthy  and  was  contracted  very  much.  The  patient  had  recovered  strength, 
though  he  still  retained  the  recumbent  posture. 

CCCLXIII. — Note  of  a  Case  of  Contusion  of  the  Thigh.    By  CARLOS  CARVALLO,  Assistant  Surgeon, 
U.  S.  A. 

Private  Arthur  Calquhoun,  Troop  K,  5th  Cavalry,  aged  22  years,  was  kicked  by  a  horse,  Sep- 
tember 26,  1867,  causing  a  contusion  of  the  right  thigh,  just  above  the  knee.  On  admission  to  the 
post  hospital  at  Sedgwick  Barracks,  Washington,  the  injured  limb  was  swollen  and  tender. 
Plaster  of  Paris  bandage  was  applied.  He  recovered,  and  was  returned  to  duty  October  8, 1867. 

CCCLXIV. — Memorandum  of  a  Contusion  of  the  Knee-Joint.    By  W.   S.  ADAMS,  M.  D.,  Acting 
Assistant  Surgeon. 

Corporal  William  H.  Hoffman,  Troop  A,  5th  Cavalry,  aged  25  years,  was  admitted  to  the  post 
hospital  at  Morganton,  North  Carolina,  October  10,  1867,  Avith  a  contusion  of  the  right  knee-joint, 
caused  by  the  kick  of  a  horse  received  about  October  1st.  The  joint  was  found  swollen  and 
roughened,  with  slight  redness  and  much  heat.  The  patella  was  elevated  at  least  half  an  inch 
above  the  condyles.  He  complained  of  but  little  pain,  nor  had  he  any  well-marked  chill.  The 
limb  was  placed  in  a  straight  splint  and  a  blister  applied  to  the  joint,  to  be  followed  by  tincture  of 
iodine.  On  October  15th  the  patient  was  much  improved;  effusion  apparently  absorbed.  The 
splint  was  removed,  but  rest  enjoined;  and  on  October  25th  he  was  returned  to  duty,  motion  nearly 
perfect. 

CCCLXV. — Note    relative  to   a   Contusion  of  Foot.    By  C.  E.  GREENLEAF,  Assistant  Surgeon, 
U.  S.  A. 

Private  Albert  J.  Furay,  Co.  I,  2d  Infantry,  aged  32  years,  was  admitted  to  the  post  hospital 
at  Taylor  Barracks,  Kentucky,  July  17,  1868,  with  a  contused  wound  of  the  left  foot,  caused  by 
the  falling  upon  it  of  an  iron  safe  which  he  was  assisting  to  move.  Warm  fomentations  were 
applied,  and  on  July  28th,  he  returned  to  duty  entirely  recovered. 


110  REPORT  OP  SURGICAL  CASES  IN  THE  ARMY. 

CONCUSSION  AND  COMPRESSION  OF  THE  BRAIN. — Examples  of  slight  stunning  from 
falls  or  blows  are  of  course  very  common  in  military  practice,  and  the  graver  cases  of 
concussion,  contusion,  laceration,  and  compression  of  the  brain  are  not  infrequent.  The 
Cases  of  fracture  of  the  skull  will  be  reported  in  the  next  section.  Some  of  the  instances 
of  concussion  and  compression  may  be  here  recorded : 

CCCLXVL— Report  of  a  Case  of  Concussion  of  the  Brain.    By  A.  G.  BATES,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  W.  R.  Burroughs,  Co.  I,  40th  Infantry,  at  Fort  Macon,  July  2,  1867,  received  two 
blows  from  a  hammer,  iu  the  hands  of  an  escaping  prisoner,  upon  the  front  and  right  side  of  the 
head,  above  the  temporal  ridge,  producing  severe  concussion  of  the  brain.  He  remained  in  a 
comatose  state  for  several  hours.  After  reaction  took  place  he  was  put  upon  proper  treatment. 
There  being  no  perceptible  fracture  of  the  bones,  the  flesh-wound  was  allowed  to  heal,  which  it  did 
readily.  He  suffered  from  headache,  giddiness,  loss  of  memory,  impaired  vision,  confusion  of 
thought,  and  was  very  dull  of  comprehension.  To  a  casual  observer  his  recovery  would  appear 
complete,  but  the  injury  received  had  left  the  brain  in  such  an  unstable  state  that  it  would  be 
disturbed  by  the  least  excitement,  and  the  man  was  therefore  discharged  on  August  21, 18G7. 

CCCLXVII. — Remarks  on  a  Case  of  Concussion  of  the  Brain.    By  H.  M.  CBONKHITE,  Assistant 
Surgeon,  U.  S.  A. 

Sergeant  Daniel  Isaacs,  Co.  1, 10th  Infantry,  while  attending  a  fandango  at  Rio  Grande  City, 
Texas,  on  the  night  of  December  24,  18G9,  received  a  severe  blow  upon  the  head  with  an  unknown 
weapon,  supposed  to  have  been  a  brick,  in  the  hands  of  a  Mexican,  from  the  effect  of  which  he  lay 
insensible  until  5  o'clock  P.  M.,  December  25,  1809,  at  which  time  he  died.  Upon  post-mortem 
examination  the  following  pathological  conditions  were  exhibited :  In  the  cellular  tissue  of  the 
scalp,  over  the  superior  curved  line  of  the  occipital  bone,  on  the  left  side  of  the  occipital  protuber- 
ance, there  was  extensive  ecchymosis;  on  removing  the  skull-cap  several  ounces  of  efl'used,  coagu- 
lated blood  were  found  between  the  dura  mater,  covering  all  the  posterior  half  of  the  left  hemisphere 
of  the  cerebrum.  On  close  examination  no  fracture  of  the  cranium  could  be  found  in  either  table. 

CCCLXVIII. — Memorandum  of  a  Fatal  Case  of  Compression  of  the  Brain.    By  ELLIOTT  COUES, 
Assistant  Surgeon,  U.  S.  A. 

At  Columbia,  January  14, 18G8,  John  Kelly,  hospital  steward,  aged  24  years,  received,  by  a 
fall,  a  wound  of  the  head,  causing  compression  of  the  brain.  He  was  admitted  to  post  hospital 
on  the  same  day.  Simple  dressings  were  applied.  He  died  January  16,  1868. 

CCCLXIX. — Remarks  on  a  Case  of  Severe  Concussion  of  the  Brain.    By  J.  P.  FOOT,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Patrick  Eagan,  Co.  B,  42d  Infantry,  was  brought  to  hospital  at  Plattsburg,  New  Tork, 
about  6  o'clock  P.  M.,  April  9,  1867,  in  an  unconscious  condition,  and  bleeding  profusely  from  a 
wound  upon  the  head,  the  result  of  a  blow  which  he  had  received  from  a  musket,  in  the  hands  of 
an  intoxicated  soldier.  On  examination,  a  lacerated  wound,  one  inch  in  length  and  one-quarter  of 
an  inch  in  depth,  was  discovered  upon  the  right  orbital  ridge ;  also,  a  slight  tumefaction  in  right 
temporal  region.  Blood  was  oozing  slowly  from  the  nose  and  mouth ;  the  eyes  turned  upward  and 
fixed ;  pupils  contracted  and  insensible  to  light ;  pulse  feeble ;  countenance  pallid ;  and  the  surface 
of  the  body  cold.  The  breath  was  of  a  decidedly  alcoholic  character,  indicating  some  degree  of 
inebriation  coexisting  with  concussion  of  the  brain.  The  case  was  treated  as  concussion  of  the 
brain.  Cold  water  to  the  head,  hot  applications  to  body  and  feet,  and  sinapism  to  spine.  At  11 
o'clock  P.  M.?  patient  exhibited  symptoms  of  a  reaction ;  he  replied  to  questions,  but  rather  con- 


CONCUSSION  AND  COMPEESSION  OP  THE  BEAIN.  HI 

fusedly;  complained  of  great  pain  in  the  head.  He  was  kept  quiet,  and  the  treatment  continued. 
He  slept  a  little  during  the  night,  but  was  restless  at  intervals.  The  next  morning,  April  10th,  the 
patient  appeared  quite  sensible;  pulse  76  and  stronger;  complained  of  severe  frontal  headache; 
skin  dry  and  hot;  no  appetite  and  considerable  thirst.  Continued  cold  water  to  the  head,  and 
gave  four  grains  of  nitrate  of  potass,  every  two  hours.  The  febrile  symptoms  subsided  during  the 
day,  and  patient  slept  during  the  night  without  interruption.  From  this  time  the  patient  rapidly 
improved,  and  on  April  18, 18G7,  was  dismissed  from  the  hospital  and  returned  to  duty. 

CCCLXX. — Note  of  a  Concussion  of  the  Brain.    By  JOHN  E.  TALLON,  M.  D.,  Acting  Assistant 
Surgeon. 

At  Fort  Bayard,  New  Mexico,  September  17,  1869,  Private  John  Fracker,  Co.  B,  3d  Cavalry, 
aged  25,  had  a  fall  from  his  horse,  producing  a  severe  concussion  of  the  brain.  He  was  admitted 
to  the  post  hospital  the  same  day,  and  was  treated  by  cold-water  dressings,  with  stimulants  inter- 
nally. The  patient  was  gradually  recovering  at  the  close  of  the  month,  and  was  returned  to  duty 
some  time  in  October. 

CCCLXXI. — Mention  of  a  Case  of  Concussion  of  the  Brain.    By  JOHN  VANSANT,  Surgeon,  U.  S.  A. 

At  Little  Eock  Arsenal,  Arkansas,  Private  Michael  Mooney,  Co.  D,  28th  Infantry,  aged  19, 
was  admitted  to  post  hospital,  December  29, 18CC,  with  concussion  of  brain.  Eemaiued  in  the  hos- 
pital ;  nearly  well  at  the  end  of  the  month,  and  was  returned  to  duty  in  January,  1807. 

CCCLXXII. — Memorandum  of  a  Fatal  Case  of  Concussion  of  the  Brain  following  a  Blow.    By  D.  W 
BOSLEY,  Assistant  Surgeon,  3d  United  States  Colored  Artillery. 

Private  Isaiah  Williams,  3d  Colored  Heavy  Artillery,  was  admitted  to  the  regimental  hospital, 
October  31, 1865,  suffering  from  a  wound  of  the  scalp  over  the  right  parietal  bone.  The  external 
table  of  the  cranium  was  not  fractured ;  but,  judging  from  the  symptoms  which  followed,  loss  of 
consciousness  and  convulsions,  it  was  supposed  that  the  internal  table  was  fractured  or  depressed. 
Death  resulted  November  15, 1865. 

CCCLXXIII. — Case  of  Traumatic  Apoplexy.    By  L.  Y.  LORING,  Assistant  Surgeon,  U.  S.  A. 

Private  John  W.  Thomas,  Light  Battery  A,  2d  Artillery,  aged  23,  was  brought  to  the  hospital 
at  Fort  Eiley,  Kansas,  on  the  morning  of-  December  20, 1870,  having  been  thrown  from  his  horse 
to  the  frozen  ground  a  few  minutes  before.  There  was  a  contusion  of  the  left  cheek  over  the  malar 
bone,  from  which  there  was  some  haemorrhage;  the  lid  of  the  left  eye  was  bruised  and  congested, 
and  a  very  slight  bruise  of  the  skin  over  the  left  edge  of  the  frontal  protuberance.  The  most 
careful  examination  failed  to  discover  any  fracture  of  the  skull  or  signs  of  injury  other  than  those 
mentioned.  He  was  in  a  semi-conscious  condition  when  admitted,  and  complained  of  the  cut  on 
his  face,  which  he  was  constantly  picking.  He  vomited  several  times.  The  pupils  were  con- 
tracted, breathing  slow  and  labored,  pulse  slow  and  soft.  Compression  of  the  braiu  was  diagnosed 
from  fracture  of  the  skull,  causing  either  some  pressure  of  bone  upon  it  or  rupturing  a  blood  ves- 
sel, causing  extravasation,  accompanied  by  some  concussion  of  the  brain,  from  which  he  was 
slightly  recovering.  The  prognosis  was  unfavorable,  and  operative  interference  out  of  the  ques- 
tion, as  there  was  nothing  at  all  to  indicate  the  seat  of  injury.  He  was  covered  with  warm  bed- 
clothing  and  warmth  applied  to  the  feet,  with  sinapisms  to  the  abdomen,  in  order  to  bring  about 
reaction.  He  grew  rapidly  worse,  becoming  entirely  unconscious  in  the  course  of  twenty  minutes; 
the  pupils  became  dilated  and  the  eyes  fixed  and  insensible.  The  contents  of  the  bladder  were 
evacuated,  but  not  of  the  bowels.  At  6  P.  M.  respiration  became  stertorous  and  sighing,  and  he 
gradually  failed,  dying  at  9  P.  M.,  eleven  hours  alter  the  reception  of  the  injury.  A  p<>.tt->nortem 
examination  was  made  sixteen  hours  after  death.  Rigor  mortis  intense ;  body  well  nourished  and 


112  EEPOET  OF  SURGICAL  CASES  IK  THE  AEMY. 

developed.  In  dissecting  up  the  scalp,  some  congestion  was  found  over  the  temporal  muscle,  as  if 
it  had  been  contused,  but  there  was  nothing  whatever  to  indicate  it  externally.  Upon  removing 
the  calvarium  a  clot  of  blood  weighing  three  ounces  was  discovered  between  the  bone  and  dura 
mater,  over  and  at  the  side  of  the  middle  lobe  of  the  right  hemisphere  of  the  brain ;  there  were 
also  spots  of  extravasation  between  the  dura  mater  and  arachnoid,  at  the  upper  part  of  both  hemi- 
spheres over  the  middle  lobes,  presenting  the  appearance  as  if  encysted.  The  brain  at  the  seat  of 
the  large  clot  presented  the  appearance  of  being  contused  and  disorganized  by  the  pressure  upon 
it;  with  this  exception  the  brain  substance  appeared  normal  throughout.  There  was  a  fracture  of 
the  base  of  the  skull,  beginning  at  the  cribriform  plate  of  the  ethmoid  bone,  extending  posteriorly 
to  the  body  of  the  lesser  wing  of  the  sphenoid  where  it  branched,  one  branch  extending  to  the 
optic  foramen  of  the  left  side,  and  the  other  taking  a  course  indicated  by  the  optic  foramen,  the 
foramen  rotundum,  and  the  foramen  ovale,  and  then  posterior  to  the  foramen  spiuosum  of  the  right 
side,  curving  around  it,  and,  when  at  a  point  one  inch  external  to  it,  again  branched,  one  branch 
extending  forward  through  the  squamous  portion  of  the  temporal  bone  and  across  the  anterior 
inferior  angle  of  the  parietal  into  the  frontal,  ending  at  a  point  one  inch  anterior  to  the  junction  of 
the  lower  with  the  middle  third  of  the  fronto-parietal  suture,  the  other  posteriorly  in  a  line  between 
the  squamous  and  petrous  portion  of  the  temporal  bone  and  then  into  the  parietal  bone  parallel  to 
the  occipito-parietal  suture  and  ending  at  a  point  two  inches  anterior  to  the  posterior  superior 
angle  of  the  right  parietal.  This  fracture  in  its  course  involved  both  tables  of  the  skull,  and 
divided  the  grooves  in  which  run  both  the  anterior  and  posterior  branches  of  the  middle  meuiugeal 
artery.  The  large  clot  formed  at  the  side  of  the  brain  was  caused  by  the  rupture  of  the  anterior 
branch.  It  was  moulded  and  flattened  by  pressure,  and  seemed  as  if  covered  by  a  membrane,  ren- 
dering it  tough.  The  smaller  clots  appeared  to  be  caused  by  the  rupture  of  minute  veins  ramify- 
ing in  the  dura  mater.  The  thoracic  and  abdominal  viscera  were  healthy  throughout,  excepting 
the  spleen,  which  was  considerably  hypertrophied  and  somewhat  indurated.  The  intestines  were 
much  distended  with  semi-fluid  substances. 

CCCLXXIV. — Report  of  a  Case  of  Concmsion  of  the  Spinal  Cord.    By  HENRY  LIPPINCOTT,  Assistant 
Surgeon,  U.  S.  A. 

Surgeon  A.  F.  Mechem,  U.  S.  A.,  was  accidentally  injured  at  Hays  City,  Kansas,  June  21, 
1870,  by  jumping  from  a  railway  train  while  in  motion.  The  fall  caused  partial  concussion  of  the 
spinal  cord,  and  violent  shock  to  the  sympathetic  nervous  system.  When  seen,  shortly  afterwards, 
by  a  medical  officer,  slight  reaction  had  taken  place ;  but  there  was  extreme  hypersesthesia  of  the 
chest,  neck,  and  upper  extremities,  which  were  of  a  cyanotic  hue.  The  cerebral  functions  were 
undisturbed.  The  heart's  action,  almost  suspended  when  first  seen,  came  up  under  the  influence 
of  stimulants.  When  reaction  had  fairly  taken  place,  there  was  violent  arterial  action  at  the  wrist, 
which  was  unaccompanied  by  like  action  in  the  temporal  and  carotid  arteries;  in  fact,  the  action 
of  these  vessels  coincided  neither  in  force  nor  frequency  with  that  of  the  radial  and  nlnar  arteries. 
Nor  was  the  action  of  the  heart,  at  any  time  after  the  pulsations  became  normal,  other  than 
healthy,  although  the  extraordinary  throbbing  at  the  wrist  continued  several  days.  Excepting 
slight  paralysis  of  the  bladder,  there  was  no  loss  of  motor  power.  At  first,  the  terrible  hyperses- 
thesia  of  the  hands  and  arms  inclined  me  to  the  belief  that  there  might  be  a  fracture,  dislocation,  or 
something  of  this  kind,  which,  by  pressure  upon  the  nerves,  might  possibly  account  for  the  symp- 
toms described.  However,  a  careful  examination  proved  that  there  was  neither  fracture  nor 
dislocation,  but  that  the  cause  of  the  symptoms  was  only  to  be  found  in  the  spinal  cord  and  sym- 
pathetic nervous  system.  The  effect  of  the  previous  medication  proving  inefficient,  morphine  was 
administered  hypodermically,  and  afforded  much  relief.  This  was  soon  repeated,  selecting  the 
region  of  the  fourth  dorsal  vertebra  for  the  operation.  The  application  of  cups,  with  hot  applica- 
tions of  lead  and  laudanum,  alternating  with  fomentations  of  hops  and  laudanum  to  the  arms, 
hands,  and  thorax,  assisted  materially  in  mitigating  the  pain  of  the  parts  implicated.  Some  three 
days  subsequent  to  the  reception  of  the  injury,  the  patient  was  conveyed  on  a  litter  to  his  quarters 
at  Fort  Hays.  Arriving  there,  the  use  of  the  morphine  was  in  a  great  measure  dispensed  with, 
Indian  hemp  and  hyoscyamus  being  substituted.  The  hop  fomentations  were  superseded  by  local 


CONCUSSION  OF  THE  BRAIN  OE  SPINAL  COKI).  H3 

applications  of  chloroform  and  camphor,  with  sulphate  of  morphia  and  simple  cerate.  Tonics, 
nourishing  diet,  and  stimulants,  contributed  much  toward  recovery.  There  was  a  decided 
tendency  to  typhoid  depression,  but  this  gave  way  to  proper  measures.  [Surgeon  Mechem's  health 
remained  delicate.  In  January,  1871,  he  availed  of  a  leave  of  absence  of  one  month,  which  was 
extended  six  months  longer,  for  the  benefit  of  his  health.  He  died  at  Pleasantville,  Maryland, 
at  his  father's  home,  July  14,  1871.  The  certificate  of  disability,  forwarded  to  Adjutant  General 
Townsend  with  the  application  for  extension  of  leave  of  absence,  was  signed  by  Acting  Assistant 
Surgeon  T.  B.  Chase,  at  Fort  Hays,  and  clearly  traces  the  shattered  condition  of  Doctor  Mechem's 
health  to  the  accident  he  had  incurred. — ED.] 

The  foregoing  seventy-seven  reports  afford  information  regarding  twenty-nine  cases 
of  incised  wounds,  eighteen  of  punctured  wounds,  twenty-two  of  lacerated  or  contused 
wounds,  and  nine  instances  of  concussion  or  compression  of  the  brain.  Of  the  twenty- 
nine  cases  of  incised  wounds,  eight  were  fatal,  and  two  resulted  in  disabilities  incapacitat- 
ing the  men  for  service.  One  of  these  was  an  interesting  instance  of  a  recovery  from  a 
wound  exposing  the  cavity  of  the  knee-joint.  In  three  of  the  eight  fatal  cases,  the  great 
vessels  of  the  neck  were  divided,  in  two  the  heart  was  wounded,  in  three  the  abdominal 
cavity  was  penetrated,  and  in  one  of  the  latter  the  small  intestine  was  divided  in  five 
places,  and  enterorrhaphy  was  practiced  under  hopeless  conditions,  the  abdomen  being 
filled  with  blood  from  the  divided  mesenteric  artery.  Among  the  nineteen  patients  who 
recovered  and  returned  to  duty,  several  survived  the  protrusion  through  the  abdominal  walls 
of  large  portions  of  the  viscera. 

Of  the  eighteen  reports  on  punctured  wounds,  seven  refer  to  fatal  cases.  One  was 
an  example  of  wound  of  the  aorta,  two  were  stabs  in  the  lungs,  three  involved  the 
abdominal  viscera,  and  one  the  knee-joint.  There  was  an  interesting  instance  of  recovery 
after  puncture  of  the  stomach.  Of  the  twenty-two  cases  of  contused  and  lacerated 
wounds  reported,  four  were  fatal.  They  were  examples  of  lacerations  of  internal  organs 
without  wounds  of  the  integument. 

The  special  reports  of  concussion  or  compression  of  the  brain  or  spinal  cord  related 
to  nine  cases,  five  of  which  had  a  fatal  result. 
15 


114  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 


SIMPLE  AND  COMPOUND  FRACTURES  AND  LUXATIONS. 


There  were  returned,  for  the  period  covered  by  the  reports,  fifteen  hundred  and  ninety- 
nine  cases  of  simple  and  compound  fractures,  and  six  hundred  and  twenty-five  cases  of 
luxations.  Some  cases  in  which  special  reports  were  made  are  cited  here,  and  others  in 
connection  with  the  reports  on  operations. 

CCCLXXV. — Report  of  a  Case  of  Fracture  of  the  Skull.    By  J.  SIMONS,  Surgeon,  U.  S.  A. 

Corporal  George  Adams,  Co.  E,  4th  Artillery,  was  brought  to  hospital  about  two  o'clock  on  the 
morning  of  September  1,  18G9,  by  two  of  his  comrades,  who  stated  that  he  had  been  assaulted  by 
unknown  parties  at  Locust  Point,  about  a  mile  from  FortMcHenry,  Maryland.  Upon  examination, 
an  incised  wound  one  and  a  half  inches  long  was  found  at  the  back  of  the  head,  and  a  small, 
lacerated  wound  on  the  forehead,  above  the  right  eye.  The  man  was  questioned  as  to  how  and  by 
whom  the  wounds  were  inflicted ;  but  he  was  too  much  under  the  influence  of  drink,  and  the  effects 
of  the  injuries  he  had  received,  to  give  intelligible  answers.  He  was  placed  in  bed,  and  his  wounds 
were  dressed  with  cold  applications.  During  the  night  he  was  delirious,  and  had  convulsions, 
from  which  he  passed  into  profound  coma,  with  sterterous  breathing,  in  which  condition  he  remained 
until  his  death,  at  half-past  teu  the  following  morning.  The  autopsy  made  next  day  by  the  coroner, 
in  the  presence  of  a  jury,  revealed  an  extensive  fracture,  about  three  inches  long,  commencing  at 
the  squamous  portion  of  the  temporal  bone,  and  running  in  a  semicircular  line  through  the  posterior 
and  inferior  portion  of  the  parietal  bone,  and  extending  also  into  the  occipital.  Another  small 
fracture,  joining  the  anterior  termination  of  the  first  at  an  acute  angle,  detaching  a  small  piece,  of 
the  temporal  bone.  A  thick  layer  of  extravasated  blood  was  found  covering  a  large  portion  of  the 
right  cerebral  hemisphere,  in  the  neighborhood  of  the  fractures.  It  is  remarkable  that,  with  such 
a  severe  injury  of  the  head,  the  man  was  able  to  walk,  with  the  assistance  of  his  comrades,  the 
distance  of  a  mile  from  the  place  where  he  was  wounded. 

CCCLXXVI. — Abstract  of  a  Report  of  a  Fracture  of  the  Base  of  the  Skull  and  of  the  Fibula.    By 
JOHN  ASHHURST,  Jr.,  M.  D.,  Surgeon  to  the  Episcopal  Hospital. 

Joseph  K.  Alderfer,  a  discharged  soldier,  aged  25  years,  was  thrown  from  a  wagon  in  Philadelphia, 
on  August  31, 1865,  causing  a  fracture  of  the  sphenoid  bone,  arising  in  the  left  greater  wing,  passing 
through  the  olivary  process  and  right  greater  wing,  and  ending  in  the  petrous  portion  of  the  right 
temporal  bone.  The  upper  end  of  the  left  fibula  was  also  comminuted.  He  was  admitted  into  the 
Episcopal  hospital  about  au  hour  after  the  injury.  There  was  a  great  deal  of  ecchyinosis  of  the  left 
orbit.  Blood  flowed  from  the  nose  and  mouth,  and  a  large  quantity  had  been  swallowed  and 
afterwards  vomited.  Pulse,  64;  respiration  somewhat  labored;  right  pupil  slightly  contracted. 
He  was  restless,  but  rational.  The  injured  limb  was  wrapped  in  pillows,  ice  applied  to  the  head, 
and  a  teacupful  of  milk  ordered  every  four  hours.  On  the  following  day  he  was  slightly  delirious, 
pulse  68,  arising  to  112  on  September  2d.  Both  pupils  were  contracted.  Death  resulted  on  Sep- 
tember 3,  1865.  At  the  autopsy,  the  membranes  of  the  brain  were  found  very  much  congested, 
containing  about  four  ounces  of  reddened  serum,  and  there  was  slight  congestion  of  the  brain  and 
lateral  ventricles.* 

*  This  abstract  was  made  by  Hospital  Steward  Sawtelle,  U.  S.  A.,  from  notes  by  Dr.  Bodiue.  A  full  account  of  the 
ease  is  printed  in  the  American  Journal  of  the  Medical  Sciencen,  Vol.  LIT,  p.  72. 


SIMPLE  AND  COMPOUND  FRACTURES.  H5 

CCCLXXVII. — A  Condensed  Account  of  a  Fracture  of  the  Skull,  in  which  Death  occurred  Three  Tears 
subsequently.    From  a  report  by  JOHN  TAYLOR,  M.  D.,  Acting  Assistant  Surgeon. 

James  H.  B ,  a  private  of  Co.  G,  20th  Infantry,  a  robust  man,  but  a  confirmed  inebriate, 

was  admitted  to  hospital  at  New  Orleans,  Louisiana,  on  September  12,  1868,  in  an  epileptic  fit, 
which  lasted  about  twenty  minutes,  and  left  him  in  a  state  of  stupor  for  hours  after.  From  the 
patient's  history,  it  was  ascertained  that  he  had  received  a  blow  on  the  head  some  three  years  pre- 
viously, and  had  been  subject  to  epilepsy  ever  since.  He  was  not  aware  of  suffering  from  other 
serious  disease.  Reference  to  the  hospital  register  of  the  post  showed  that  he  had,  at  various 
times,  been  under  treatment.  His  sufferings,  so  far  as  they  came  under  special  notice,  seemed 
invariably  to  have  been  excited  after  the  excessive  use  of  alcoholic  stimulants.  For  five  days  after 
admission,  the  patient  seemed  better.  The  treatment  consisted  of  bromide  of  potassium  and  a 
nourishing  diet.  On  the  18th  and  19th,  he  became  slightly  feverish  and  complained  of  headache. 
Castor  oil  and  turpentine  were  administered  with  good  effect,  and  ice  applied  to  the  head. 
Although  free  from  fever,  headache  still  continued ;  he  looked  sulky  and  dull,  and  on  the  22d 
there  was  another  epileptic  fit.  On  the  following  day  head  symptoms  with  fever  and  obstinate 
constipation  became  intense.  Mercurial  purgatives  and  a  terebinthinate  enema  failing  to  move 
the  bowels,  the  negative  pole  of  a  battery  was  applied  to  the  tongue  and  the  positive  to  the  anus 
with  the  desired  result.  Forty  ounces  of  blood  was  drawn  from  the  arm,  lowering  the  pulse  from 
120  to  75,  and  ice  was  applied  to  the  shaved  head.  The  symptoms  becoming  worse  on  the  25th, 
blood  was  again  taken  from  the  arm  and  the  temples;  a  mercurial  was  administered;  injections  and 
cold  applications  were  continued,  and  later  in  the  day  a  sinapism  was  applied  to  the  nape  of  the 
neck.  The  patient,  gradually  growing  worse,  sunk  into  a  profound  coma,  and  died  on  the  after- 
noon of  the  27th.  The  antiphlogistic  regimen  was  strictly  observed  from  the  18th  to  the  25th,  but 
on  the  last  two  days  beef  tea  was  given,  both  by  the  mouth  and  rectum.  At  the  autopsy,  fourteen 
hours  afterward,  two  old  cicatrices  were  found  in  the  scalp;  one  over  the  posterior  part  of  the 
parietal  suture,  about  half  an  inch  from  its  occipital  termination,  measuring  about  one  and  a  half 
inches  long;  the  other  was  over  the  left  parietal  eminence,  measuring  about  one  inch  long;  other- 
wise the  scalp  seemed  whole  and  perfect.  The  brain  and  its  membranes  seemed  to  be  in  a  state  of 
general  inflammation;  the  brain,  throughout  its  substance,  showed  a  large  number  of  bloody 
points;  the  gray  matter  was  more  intensified  in  its  color,  and  the  substance  of  the  brain  soft  in 
general.  The  lateral  venticles  contained  a  small  quantity  of  straw-colored  fluid,  and  the  vessels 
in  them  were  in  a  state  of  congestion.  That  portion  of  the  cerebum  immedi- 
ately under  the  first  described  cicatrix  was  found  closely  adherent  to  the  dura 
mater,  and  the  dura  mater  itself,  at  this  point,  although  loosely  connected  to 
the  skull,  was  with  difficulty  removed ;  in  fact  the  knife  had  to  be  used  to  detach 
it  for  about  one  square  inch  from  the  surface  of  the  hemispheres,  indicating  pre- 
vious inflammation  and  adhesion ;  the  Pacchionian  bodies  were  more  numer- 
us  here,  larger,  and  standing  prominently  out  from  the  surface;  immediately 
below  this  point  and  between  the  hemispheres,  a  splinter  of  bone  was  found 
embedded  in  the  falx  cerebri ;  the  approximate  surfaces  of  the  hemispheres  at 
this  spot  were  redder  and  the  minute  vessels  more  injected.  The  pituitary  |^BHJ 
body  was  found  to  be  a  little  larger  than  usual  and  darker  in  color.  From  the  ^^ 
history  of  the  deceased,  and  the  symptoms  during  his  illness,  with  the  appear-  FIO.  is. 
ance  of  the  brain  in  general  after  death,  but  one  conclusion  could  be  arrived  *°,  f"l!C 

.'.Ml.     >I'C.      1,      A.       \1_       .M  . 

at:  That  he  died  of  general  cerebritis,  brought  on  from  drink,  exposure 
to  the  sun,  and  the  irritation  which  appeared  to  be  set  up  by  the  splinter  of  bone  discovered  in  the 
falx-cerebri.     A  portion  of  the  falx  cerebri,  having  a  splinter  of  bone  embedded,  was  forwarded  to 
the  Army  Medical  Museum.    It  is  represented  in  the  wood-cut,  (FiG.  13.) 

CCCLXXVIII. — Note  relative  to  a  Fracture  of  the  Skull.    By  DALLAS  BACHE,  Surgeon,  U.  S.  A. 

At  the  Post  of  San  Antonio,  Texas,  March  16,  1868,  private  John  Banan,  Co.  L,  4th  Cavalry, 
aged  23  years,  received  a  blow  from  a  spade,  causing  a  clean  fracture  in  the  left  occipital  region, 


116  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

about  one  inch  and  a  half  in  length,  with  no  depression  of  the  outer  table.  He  was  admitted  to 
the  post  hospital  March  17,  18(58.  Simple  dressings  were  applied.  Discharged  September  13, 
1868.  Compound  fracture  of  the  skull. 

CCCLXXIX. — Report  of  a  Fracture  of  the  SJcull.    By  FRANCIS  BARNES,  M.  D.,  Acting  Assistant 
Surgeon. 

Prosper  Behan,  colored,  aged  32  years,  was  admitted  to  the  Freeumen's  hospital,  New  Orleans, 
Louisiana,  having  been  beaten  into  a  state  of  insensibility  the  night  previously,  for  the  purpose  of 
robbing  him.  There  were  two  wounds  of  the  head,  one  on  the  right  of  the  median  line,  a  little  over 
one-half  inch,  and  one  over  the  parietal  bone,  one  inch  from  its  frontal  junction.  This  wound  was 
circular  and  ragged,  and  sufficiently  open  to  detect  easily  that  the  outer  table  was  depressed,  and 
to  allow  the  passage  of  a  probe  to  feel  the  fissure  which  surrounded  it.  The  next  day  after 
admission,  the  patient  had  a  slight  epileptic  convulsion,  and  it  was  suggested  that  the  trephine 
should  be  applied  to  his  head.  On  the  night  of  May  3d,  the  patient  had  a  chill,  followed  by  a 
fever,  and  the  next  day  the  plump  appearance  of  his  face  was  gone,  the  skin  shrunken,  and  the  eyes 
sunken.  The  pulse  became  feeble,  and  over  100.  In  the  wound  a  thin  sero-pus  could  be  seen  welling 
through  the  fissure  of  the  fracture  every  time  he  breathed.  On  May  5th,  the  patient  could  not 
lie  down,  and  he  had  difficulty  in  swallowing.  There  was  rigidity  of  the  muscles  of  the  neck  and 
abdomen,  as  well  as  the  chest;  the  body  was  thrown  slightly  backward;  pain  in  right  side  under 
point  of  ribs.  Auscultation  detected  nothing  abnormal  save  the  short  and  hurried  movements  of 
the  walls  of  the  chest,  causing  corresponding  vermicular  murmurs  of  equal  duration  with  them. 
There  was  hernia  of  the  right  side,  which  was  reduced  and  a  truss  applied,  but  he  tore  it  off  as 
often  as  adjusted,  saying  he  wanted  room  to  breathe.  Moderate  doses  of  opium  were  given,  which 
had  such  prompt  effect  in  relieving  the  muscular  rigidity,  that  on  May  (5th,  doubt  was  thrown  on 
the  theory  that  it  was  due  to  tetanus.  Death  resulted  May  !),  1868.  At  the  post-mortem  examina- 
tion, upon  removing  the  calvarium  the  outer  table  was  found  depressed  but  not  detached,  the 
fissure  having  an  oval  form  about  six-eighths  of  an  incli  in  the  short  diameter,  and  seven-eighths 
of  an  inch  in  the  long.  The  inner  table,  at  a  point  corresponding,  was  separated  a  quarter  of  an 
inch  greater,  and  divided  into  four  equal  fragments,  one  of  which  was  completely  detached.  The 
opposite  parietal  bone  had  a  fissured  fracture  running  through  the  temporal  bone,  down  to  the 
floor  of  the  temporal  fossa.  This  fissure  was  nearly  seven  inches  long,  and  extended  to  and  com- 
municated with  the  first  described  fracture.  The  dura  mater  beneath  the  depressed  fracture  had 
a  circle  of  altered  structure,  one-fourth  of  an  inch  greater  than  the  bony  lesion,  being  thickened 
to  this  extent  with  false  membrane,  which  next  the  bone  was  covered  with  a  thin  secretion  of 
serous  pus.  The  sinuses  were  very  full  of  blood,  but  the  other  bloodvessels  of  the  dura  mater  were 
not  unusually  congested.  Upon  removing  the  dura  mater,  the  pia  mater  presented  three  spots  of 
inflammation,  manifested  by  effusion  of  bloody  lymph :  one  under  the  depressed  fracture,  the 
second  corresponding  to  the  fissured  fracture,  and  the  third  in  the  posterior  part  of  the  two 
hemispheres  of  the  cerebrum,  extending  into  the  fissure  between  them.  The  brain  itself  ap- 
peared very  firm  and  healthy.  The  choroid  vessels  were  pale,  and  the  ventricles  had  no  fluid  in 
them.  The  heart  was  healthy,  and  there  was  no  lesion  of  the  substance  of  the  lungs.  The 
pleura>,  however,  had  thin  false  membranes  over  their  whole  extent,  and  there  was  about  a  pint  of 
thin  sero-pus  in  both  cavities.  The  patient  had  a  reducible  inguinal  hernia.  The  organs  and 
peritonaeum  of  the  abdominal  cavity  were  healthy.  The  pathological  specimen,  consisting  of 
the  fissured  calvarium,  was  forwarded  to  the  Army  Medical  Museum,  and  numbered  5461,  of  the 
Surgical  Section. 

CCCLXXX. — Remarks    on   a    Case  of  Fracture  of   the    Skull.      By   E.   P.   VOLLTJM,  Surgeon, 
U.  S.  A. 

Private  James  Buchanan,  Co.  I,  42d  Infantry,  fell  over  the  cliff'  in  front  of  Madison  Barracks, 
New  York,  on  the  night  of  November  6,  1868,  while  in  a  state  of  intoxication,  and  struck  upon  his 
head.  When  found  the  next  morning,  he  was  lying  near  the  water's  edge — dead.  After  washing 


SIMPLE  AND  COMPOUND  KKACTUKES.  117 

the  body,  the  integument  of  the  face  and  neck  was  of  a  decidedly  bright  red  color,  and  a 
number  of  cuts  and  bruises  were  found  on  the  face  and  head,  evidently  produced  by  falling  on 
loose  stones,  and  blood  issued  from  the  right  ear.  An  extensive  clot  was  found  under  the  temporal 
fascia,  and  the  skull  was  fractured  by  a  blow  on  the  lower  border  of  the  parietal  bone,  near  the 
posterior  inferior  angle.  The  fracture  extended  posteriorly  through  the  right  posterior  fossa  of 
the  occipital  bone,  severing  the  lateral  sinus,  and  anteriorly,  through  the  petrous  portion  of  the 
temporal,  great  wing  of  the  sphenoid,  near  the  sella  Turcica,  and  through  the  right  orbital  plate. 
An  immense  blood-clot  covered  the  dura  mater  on  the  right  side. 

CCCLXXXI. — Account  of  a  Fracture  of  the  Skull. — By  J.  V.  D.  MIDDLETON,  Assistant  Surgeon, 
U.  S.  A. 

Brevet  Major  James  ,  4th  Cavalry,  had  been  drinking  hard  for  several  weeks,  and  was 

threatened  with  delirium  tremens,  when  on  the  night  of  March  19,  1870,  about  10  o'clock,  he  went 
to  the  store  of  the  post  trader,  at  Austin,  Texas,  and  finding  three  recruits  there  in  a  state  of 
noisy  intoxication,  ordered  them  to  their  quarters.  They  refused  to  go,  when  a  scuffle  ensued,  and 

Lieutenant was  knocked  down.    While  down  one  of  the  men  struck  him  with  a  cane,  the 

handle  probably  coming  in  contact  with  his  head.     He  was  stunned 

for  a  few  moments,  after  which  he  got  up  and  walked  to  his  quarters, 

two  hundred  yards  distant,  and  in  the  absence  of  the  doctor  sent  for 

the  hospital  steward,  who  examined  the  injury,  and  found  a  wound 

about  an  inch  long.    There  was  considerable  haemorrhage,  which  was 

readily  controlled  by  means  of  a  compress.    The  wound  was  brought 

together  by  adhesive  straps,  and  cold  water  applied.    He  vomited  freely 

immediately  after  getting  back  to  his  quarters.     The  nexttmorning  the 

doctor  saw  him,  but  as  there  were  no  symptoms  directing  his  attention 

to  the  wound,  made  no  examination  of  it.     His  right  hand  was  much 

swollen  from  a  sprain  he  received  in  striking  one  of  the  men,  and  this 

was  all  he  complained  of.     The  symptoms  were  those  of  delirium       i'io.  14.  segment  ««•  r^iit  ^.-meta 

tremens,  and  he  was  treated  accordingly.     On  Sunday,  March  20th,  he     aml  T*"  porti<m8  ,of  8<i"a"'""s "'"' 

occipital  bones,  with  punctured  i'rae- 

was  visited  by  Assistant  Surgeon  J.  V.  D.  Middleton,  U".  S.  A.,  about  ture  at  point  of  parietal  eminence, 
twenty  hours  after  the  reception  of  the  injury.  He  was  extremely  3p«-"3i,  sect, i,  A.M. M. 
restless,  and  looked  upon  every  one  who  came  near  him  with  suspicion,  imagining  many  absurd 
things,  and  wanting  to  get  np  and  go  out.  Pulse  130,  and  full ;  breathing  natural ;  skin  bathed 
in  perspiration ;  tongue  moist  and  tremulous ;  eyes  injected ;  pupils  dilated,  but  responding  to 
light;  hands  tremulous,  and  constantly  picking  at  imaginary  objects.  He  was  ordered  a  drachm 
of  bromide  of  potassium  and  ten  grains  of  capsicum,  with  a  teacupful  of  beef  essence  every  four 
hours,  alternating  so  that  he  took  a  dose  every  two  hours.  His  condition  remained  about  the  same 
except  that  there  was  a  disposition  to  sleep  for  a  few  moments  at  a  time,  and  the  treatment  was 
continued  until  the  morning  of  March  24th,  when  he  had  a  chill,  followed  by  fever  and  profuse 
sweating,  the  paroxysm  lasting  two  hours.  Two  doses  of,  chloroform,  one  drachm  each,  were 
administered  in  mucilage,  one  during  the  day,  the  other  at  bed-time,  with  but  little  effect.  The  beef 
essence  was  kept  up.  also  cold  applications  to  head.  On  March  25th,  having  passed  a  sleepless 
night,  he  was  ordered  one-half  grain  of  morphia,  to  bo  repeated  in  an  hour  if  sleep  was  not  induced. 
Before  the  expiration  of  the  hour  he  fell  into  a  quiet  sleep,  which  continued  until  about  3  o'clock, 
when  it  assumed  a  comatose  character,  which  increased  until  6.15  P.  M.,  when  he  expired.  Autopsy, 
eighteen  hours  after  death,  revealed  a  wound  over  the  right  parietal  eminence ;  ecchymosis  through 
the  temporal  muscle;  the  parietal  bone  was  found  fractured  and  comminuted;  an  oval  piece  of  the 
outer  table  was  driven  in.  On  removing  the  calvaria  the  inner  table  was  found  to  be  depressed ; 
clots  were  found  in  brain  under  wound,  and  a  large  amount  of  bloody  serum  beneath  the  whole  of 
the  dura  mater  and  in  cavities  of  brain.  The  vessels  of  the  brain  were  enlarged  under  the  wound. 
The  specimen  was  forwarded  to  the  Army  Medical  Museum.  [It  is  illustrated  by  the  wood-cut, 
(FIG.  14).  The  interior  view  is  still  more  interesting. — ED.] 


118  EEPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCLXXXIL— Mention  of  a  Case  of  Fracture  of  the  Skull.    By  A.  A.  YEOMANS,  Assistant  Surgeon, 
U.  S.  A. 

Private  Thomas  Charleton,  Co.  F,  16th  Infantry,  died  at  the  post  hospital  at  Vicksbnrg, 
Mississippi,  on  April  G,  1870,  from  compression  of  the  brain,  with  fracture  of  the  base  of  the  skull, 
the  effects  of  a  blow  with  the  stock  of  a  musket.  No  further  particulars  are  recorded. 

CCCLXXXIII. — Remarks  on  a  cane  of  Fracture  of  the  Skull.    By  B.  F.  POPE,  Assistant  Surgeon, 
U.  S.  A. 

George  Clapp,  artificer  of  Battery  H,  3d  Artillery,  aged  37  years,  went  from  Fort  Adams 
to  Newport,  Rhode  Island,  on  November  4,  1807,  in  company  with  a  comrade,  and  while  there 
both  drank  very  freely.  He  was  drunk  when  he  started  to  return  to  the  fort,  and  while  on  the  way 
fell  in  the  road;  his  companion,  who  was  equally  intoxicated,  attempted  to  carry  him,  but  failed, 
and  leaving  him,  dead  drunk  as  he  supposed,  returned  to  the  fort,  but  gave  no  notice  of  the  affair 
until  the  next  morning.  The  case  was  not  reported  to  the  surgeon  in  charge  until  about  9  A.  M. 
When  found  Clapp  was  lying  in  a  stable  near  the  fort ;  he  was  comatose,  breathing  stertorous, 
pupils  dilated,  and  breath  smelling  strongly  of  liquor;  countenance  natural  in  color.  The  head 
was  minutely  examined,  but  no  evidence  of  contusion  could  be  discovered  save  a  slight  ecchymosis 
of  the  left  eye.  He  was  immediately  taken  to  the  post  hospital  at  Fort  Adams,  where  cold  appli- 
cations were  made  to  the  head  and  sinapisms  to  the  feet.  The  pulse  was  full  and  slow,  and  he 
appeared  better  than  when  first  seen  in  the  morning.  Another  minute  examination  was  made,  but 
no  injury  of  the  head  could  be  found;  the  case  was  diagnosed  intense  inebriation.  The  patient 
died  suddenly  at  1.30  P.  M.  without  convulsion.  An  autopsy  was  made  twenty  hours  after  death. 
The  frame  was  large  and  muscular;  the  abdomen  and  thorax  well  developed.  On  removing  the 
integuments  with  the  occipito-frontal  and  temporal  muscles  a  simple  fissured  fracture  of  the  left  tem- 
poral bone  was  discovered,  commencing  about  one  inch  above  the  left  ear  in  the  squamous  portion  of 
the  temporal  bone,  traversing  forward  and  downward  to  the  base  of  the  cranium,  involving  the 
left  greater  wing  of  the  sphenoid  bone.  The  skull-cap  was  removed  and  exposed  a  large  clot  of 
blood,  four  ounces,  occupying  the  left  temporal  fossa,  extravasated  between  the  cranium  and  the 
dura  mater.  The  left  hemisphere  of  the  brain  was  compressed  to  two-thirds  of  its  original  bulk. 
Detached  from  the  inner  table  of  the  temporal  bone  was  found  a  small  spicula  of  bone,  which 
had  wounded  some  of  the  small  arteries  that  ramify  the  dura  mater,  producing  cerebral  haemor- 
rhage and  subsequent  death.  The  lungs,  liver,  and  heart  were  found  healthy.  The  lungs  were 
singularly  free  from  the  carbonaceous  deposit  noticeable  in  adults,  presenting  almost  the  delicate 
pink  color  of  infancy.  The  obscurity  of  the  leading  symptoms  prior  to  death,  complicated  as  they 
were  by  excessive  inebriation,  and  the  absence  of  any  marks  to  lead  one  to  suspect  injury  of  the 
brain,  caused  a  natural  error  in  diagnosis.  In  regard  to  trephining,  it  is  questionable  whether 
(even  could  the  locality  of  the  injury  have  been  discovered)  the  operation  would  have  relieved  the 
brain  from  so  large  a  mass  of  clotted  blood,  since,  even  on  post-mortem  examination,  the  fibrinous 
coagulation  came  away  with  difficulty.  [The  preparation  of  the  fractured  temporal  was  not  for- 
warded to  the  Museum. — ED.] 

CCCLXXXIV. — Remarks  on  a  Case  of  Fracture  of  the  Skull  with  Recovery.   By  JOHN  H.  BAETHOLF, 
Assistant  Surgeon,  U.  S.  A. 

Private  Edward  Cross,  Battery  F,  5th  Artillery,  aged  22  years,  was  kicked  by  a  horse 
at  Camp  Williams,  Virginia,  on  October  22,  1807.  The  wound  was  just  above  the  nasal  emi- 
nence, and  was  two  inches  long;  there  was  a  fracture  of  the  outer  table  of  the  frontal  bone 
with  depression,  and  the  margin  of  the  undepressed  bone  presented  a  serrated  edge.  It  was 
not  certainly  known  whether  there  was  also  depression  of  the  inner  table ;  but  Acting  Assistant 
Surgeon  Hysore,  who  examined  the  wound  at  the  time  of  the  accident,  was  of  the  opinion  from 
the  depth  of  the  depression  on  the  surface  that  the  inner  table  was  also  driven  in.  The  symptoms 
were  dilated  pupils  with  insensibility  for  one  hour,  and  so  far  indicated  depression  ;  but  there  was  no 


SIMPLE  AND  COMPOUND  FRACTURES. 


119 


stertor.  Cold-water  dressings  were  applied,  and  when  he  had  improved  somewhat,  he  was  con- 
veyed to  the  hospital  at  Camp  Grant,  near  Richmond,  Virginia.  After  three  hours  no  cerebral 
symptoms  remained  with  the  exception  of  a  severe  headache.  On  October  23d,  a  creasote  paste 
was  applied  to  exclude  air;  a  clot  filled  the  wound.  The  patient  continued  to  improve.  On 
November  Gth  all  cerebral  symptoms  had  ceased,  and  on  the  17th  Cross  was  returned  to  duty; 
the  wound  had  healed  with  an  irregular  linear  cicatrix. 


By  J.  M.  BEST,  M.  D.,  Acting  Assistant 


CCCLXXXV.  —  Account  of  a  Fatal  Fracture  of  the  Skull. 
Surgeon. 

Private  J.  H.  Danney,  Co.  F,  25th  Infantry,  aged  21  years,  died  at  Von  Schrader  Barracks, 
Paducah,  Kentucky,  on  December  8,  1868,  from  the  effects  of  a  blow  upon  the  head  with  a  club. 
At  the  autopsy,  a  fracture  was  found  extending  from  the  orbit  of  the  left  eye,  running  upward 
nearly  two  inches  through  the  frontal  bone,  then  ranging  backward  in  a  crescentic  shape  through 
the  left  parietal  bone  to  the  occiput  ;  then  transversely  forward  to  the  orbit,  continuing  into  the 
floor  of  the  orbit,  leaving  in  this  space  detached  bone  nearly  two  inches  in  width  and  four  inches 
long,  which  was  taken  out  with  the  fingers.  Upon  opening  the  membranes  within  this  space  a  clot 
of  grumous  blood  was  found,  amounting  to  nearly  three  ounces.  [Specimen  not  forwarded.] 


CCCLXXXVI.  —  Report  of  a  Case  of  Compound  Comminuted  Fracture  of  the  Skull.    By  F.  W. 
ELBEEY,  Assistant  Surgeon,  U.  S.  A. 

Private  James  C.  Dixon,  Troop  H,  5th  Cavalry,  was  injured  at  Fort  McPherson,  Nebraska,  by 
the  falling  of  a  blacksmith  shop,  a  beam  striking  him  on  the  forehead  in  the  median  line,  between 
the  frontal  eminences,  the  blow  producing  a  compound  comminuted  fracture,  which  extended  down 
to  the  nasal  eminence.  In  the  upper  part  of  the  wound  both  tables 
were  involved,  and  the  fragments  much  depressed.  In  the  lower 
part,  the  frontal  sinus  was  laid  open,  but  the  inner  table  only  fissured 
and  not  depressed  ;  the  frontal  bone*  was  also  comminuted  at  its  left 
external  angular  process.  Notwithstanding  the  greatness  of  the 
injury,  neither  symptoms  of  concussion  of  the  brain  nor  compression 
occurred.  He  was  at  once  conveyed  to  the  post  hospital,  where  the 
loose  fragments  were  removed  and  the  depressed  bone  elevated. 
On  the  fourth  day,  considerable  ecchymosis  became  manifest  near 
the  wound  over  the  left  orbital  ridge,  but  no  effusion  of  blood 
appeared  under  the  conjunctiva  of  the  eye.  On  the  eighth  day,  a 
suppurative  fever  was  ushered  in  by  a  severe  chill,  which  subsided  on  the  Gth.  During  its  exist- 
ence, both  pupils  became  dilated  and  irresponsive  to  light,  but  with  its  subsidence  they  returned  to 
a  normal  condition.  On  the  thirty-fourth  day,  absorption  of  the  ecchymosis  had  taken  place,  and 
this  wound,  as  well  as  the  main  one  over  the  forehead,  was  in  a  favorable  condition  for  healing,  the 
granulations  being  healthy,  and  cicatrization  having  begun.  No  symptoms  of  meniugeal  or  brain 
lesion  had  occurred.  His  treatment  consisted  in  absolute  rest,  milk  diet,  cathartics,  water  dress- 
ings for  the  wounds,  and  cold  compresses  for  the  head.  The  pathological  specimen,  consisting  of 
four  fragments  of  cranium  removed  from  over  the  orbital  ridge  at  the  right  angular  process  of  the 
frontal  bone,  was  forwarded  to  the  Army  Medical  Musum,  and  is  represented  by  the  wood-cut 
above.  (FiG.  15.) 


FIG.  is.  FraSm<t8 
tnetme  of  the  frontal. 


a  comminuted 
K&,  sect. 


CCCLXXXVIL—  Account  of  a  Fracture  of  the  Skull.    By  S.  S.  BOYEK,  M.  D.,  Acting  Assistant 
Surgeon. 

Corporal  George  Fairbanks,  Co.  G,  4th  Artillery,  aged  35  years,  was  struck  with  a  shovel 
during  an  affray,  the  blow  knocking  him  senseless,  and  producing  a  simple  fracture  of  the  right 
parietal  bone,  with  slight  depression.  He  was  admitted  to  the  post  hospital  at  Fort  Johnson,  North 
Carolina,  March  17,  1870.  Treatment  consisted  of  cold-water  dressings,  saline  purgatives,  and 
anodynes.  He  recovered  and  was  discharged  July  23,  1870,  by  reason  of  expiration  of  service. 


120  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCLXXXVII1. — Notes  of  a  Fatal  Head  Injury,  with  Fracture  of  the  Inner  Table  only.     By  A.  C. 
GIRARD,  Assistant  Surgeon,  U.  S.  A. 

Private  A.  Grevenberg,  Co.  C,  39th  Infantry,  was  beaten  on  the  head  with  a  club,  by  a  soldier, 
in  a  quarrel.  The  affray  took  place  at  Fort  Pike,  Louisiana,  in  April,  18G8.  Although  stunned 
at  flrst,  he  soon  recovered  his  senses,  and  remained  conscious  about  an  hour.  After  that  time,  he 
commenced  to  be  wandering,  and  gradually  became  violently  delirious.  He  had  antiphlogistic 
treatment.  After  a  protracted  coma  and  muttering  delirium,  he  died  the  next  day,  thirty  hours 
after  injury.  The  autopsy  was  made  twelve  hours  after  death.  There  was  a  large  extravasation 
of  blood  between  the  scalp  and  periosteum.  The  external  lamina  of  the  occipital  bone  was  intact. 
The  internal  lamina  was  splintered  at  its  junction  with  the  parietal  bones;  one  splinter,  sharp  as  a 
needle,  protruding  into  the  torcularHerophili.  The  dura  mater  was  in  a  state  of  hyperaeiuia.  Between 
the  hemispheres,  and  specially  on  the  right  side,  there  was  large  extravasation  of  blood;  in  the 
middle  fossa,  a  clot  the  size  of  a  pigeon's  egg.  The  lateral  ventricles  were  filled  with  bloody  serous 
fluid ;  the  subarachnoidal  interstices  contained  much  serum.  The  right  ventricle  of  the  heart  was 
flabby,  the  heart  filled  with  dark  blood  clots.  Other  organs  in  a  healthy  condition.  In  my  opin- 
ion, death  was  the  consequence  of  the  opening  of  the  venous  sinus  by  the  constant  friction  of  the 
splinter  of  bone,  referred  to,  during  the  pulsation  of  the  brain.  [The  specimen,  unhappily,  not 
forwarded  to  the  Museum. — ED.]  . 

CCCLXXXIX. — Account  of  a  Fatal  Fracture  of  the  Skull.    By  H.  S.  SCHELL,  Assistant  Surgeon, 
U.  S.  A. 

At  Savannah,  Georgia,  September  10,  1866,  William  Hier,  seaman,  aged  18  years,  received  an 
accidental  wound  of  the  head  by  a  fall,  fracturing  the  left  temporal  bone.  He  was  admitted  to  the 
post  hospital  on  the  same  day.  Cold-water  dressings  were  applied,  and  purgatives  given.  He  died 
September  21,  1866,  from  effusion  of  blood  on  the  dura  mater  causing  meningitis. 

CCCXC — Remarks  on  a  Case  of  Fracture  of  the  Skull.    By  J.  T.  AUGUR,  M.  D.,  Acting  Assistant 
Surgeon. 

Lieutenant  Louis  M.  Hughes,  Co.  K,  7th  Infantry,  while  in  search  of  a  man  who  had  stolen 
some  Government  mules,  near  Camp  Miner's  Delight,  Wyoming  Territory,  February  13,  1870,  was 
fatally  injured  by  falling  down  a  miner's  shaft,  thirty-six  feet  deep,  striking  upon  his  head.  When 
taken  out  he  was  profoundly  insensible ;  skin  pale  and  cold  ;  pulse  feeble  and  intermittent ;  and  res- 
piration stertorous.  There  was  a  transverse  wound  eight  inches  long,  situated  about  an  inch  above 
the  juncture  of  the  sagittal  and  lambdoid  sutures.  The  riglit  parietal  bone  was  fractured  and 
depressed,  and  accompanied  with  alarming  haemorrhage  from  the  ears  and  nose.  There  was  also 
a  severe  cut  on  the  forehead  which  extended  to  the  frontal  bone,  and  contusion  and  bruises  of  the 
right  hip  and  hand.  Death  took  place  at  12.20  o'clock  A.  M.,  February  14,  1870. 

CCCXCI. — Memorandum  of  a  Case  of  Compound  Fracture  of  the  Skull.    By  J.  K.  CORSON,  Assistant 
Surgeon,  U.  S.  A. 

Private  Michael  Hurley,  Co.  F,  30th  Infantry,  was  believed  to  have  been  struck  by  a  locomo. 
tive  on  the  Union  Pacific  Railway,  near  Fort  Fred  Steele,  Wyoming  Territory,  on  October  15, 1868, 
his  body  having  been  found  near  the  railroad,  where  he  had  probably  been  lying  since  the  evening 
before.  His  injuries  consisted  of  a  compound  comminuted  fracture  of  the  temporal  bone,  with 
depression,  the  fracture,  evidently,  extending  to  the  base  of  the  skull.  A  number  of  fragments 
were  extracted,  and  the  depressed  bone  was  elevated;  the  wound  was  lightly  dressed,  and  the 
patient  was  kept  lying  on  the  injured  side.  After  pressure  was  removed,  he  was  able  to  speak,  so 
far  as  to  ask  for  water,  but  would  answer  no  questions.  He  was  entirely  pulseless  and  blanched. 
He  had  bled  profusely  before  assistance  arrived,  but  had  no  hemorrhage  afterward.  Stimulants 
were  administered,  and  every  means  was  used  to  bring  on  reaction,  but  without  effect.  He.  died 
October  18. 


SIMPLE  AND  COMPOUND  FRACTURES.  121 

CCCXCII. — Account  of  a  Fatal  Injury  of  the  Head.    By  H.  M.  CRONKHITE,  Assistant  Surgeon, 
U.  S.  A. 

First  Sergeant  Daniel  Isaacs,  Co.  I,  10th  Infantry,  aged  27  years,  received  December  24, 1869, 
a  contusion,  by  a  club  or  brick,  over  the  os  occipitis.  He  was  admitted  to  the  post  hospital  at 
Ringgold  Barracks,  Texas,  on  the  25th,  in  a  comatose  state,  and  died  the  same  day.  Post-mortem 
examination  showed  that  death  was  caused  by  effusion  of  blood  under  the  dura  mater,  covering  all 
the  posterior  half  of  the  left  hemisphere  of  the  cerebrum. 

CCCXCIII. — Remarks  on  a  Case  of  Fracture  of  the  Bane  of  the  tfkull.    By  B.  F.  POPE,  Assistant 
Surgeon,  U.  S.  A. 

Private  Thomas  M.  Johnson,  Battery  B,  3d  Artillery,  at  Fort  Adams,  Rhode  Island,  was  dis- 
covered, on  November  18,  1867,  in  an  insensible  condition  at  the  foot  of  a  stairway  leading  from 
the  outer  parapet  of  the  fort  into  the  main  ditch.  When  last  seen  on  the  previous  evening,  he 
was  hurrying  through  the  darkness  toward  the  fort  to  attend  tattoo  roll-call.  In  his  haste  he 
undoubtedly  mistook  his  way,  and  walked  off  the  parapet,  falling  a  distance  of  some  twenty  feet. 
When  conveyed  to  the  hospital,  he  was  nearly  frozen,  having  lain  in  an  unfrequented  place  some 
eleven  hours,  with  the  thermometer  19°  above  zero.  He  was  in  a  profound  coma ;  breathing  irreg- 
ular and  feeble ;  thoracic  muscles  at  times  convulsed ;  diaphragm  and  abdominal  muscles  appar- 
ently paralyzed  ;  pulse  76,  feeble  and  intermittent;  blood  trickling  from  the  left  ear  and  nose;  the 
right  pupil  dilated  more  than  the  left.  The  only  evidence  of  contusion  that  could  be  discov- 
ered on  the  head  was  a  slight  abrasion  of  the  skin  covering  the  frontal  region.  Fracture  at  the 
base  of  the  skull,  and  probable  compression  at  the  origin  of  the  pneurnogastric  nerve  was 
suspected.  The  patient  was  immediately  placed  in  bed.  The  treatment  consisted  of  warm  appli- 
cations, while  vigorous  friction  was  employed  to  restore  circulation  in  the  extremities.  A  few 
drops  of  brandy  were  administered,  but  on  account  of  almost  complete  aphagia,  and  its  embarass- 
ment  to  the  respiratory  efforts,  the  exhibition  of  stimulants  was  discontinued.  Enemata  of  brandy, 
carbonate  of  ammonia,  and  milk  were  equally  ineffectual.  They  could  not  be  retained  on  account 
of  the  complete  paralysis  of  the  sphincter  ani.  In  about  an  hour  reaction  commenced,  the  pulse 
increasing  in  frequency  and  volume,  but  lost  nothing  of  its  intermitting  character.  As  reaction 
continued,  the  respiration  became  far  more  labored,  and  the  face  a  little  darkened.  His  head  was 
raised  to  relieve  the  pressure  of  blood.  The  symptoms  continued  to  improve  until  1.15  P.  M.,  when 
he  died  without  convulsion,  having  survived  the  injury  probably  about  fifteen  hours.  An  autopsy 
being  held  twenty  hours  after  death  revealed  rigor  mortis  well  marked.  The  left  hip  and  the  fron- 
tal region  were  contused.  There  was  no  discoloration  about  the  eyes.  Blood  had  trickled  from  the 
left  ear  during  the  night,  and  had  formed  somewhat  of  a  clot  upon  the  table.  On  removing  the 
integuments  and  exposing  the  cranium,  a  double-fissured  fracture,  without  depression,  was  dis- 
covered, which  commenced  near  the  left  parietal  eminence,  and  traversed  downward  and  forward 
through  the  squamous  portion  of  the  temporal  bone,  to  the  base  of  the  skull.  The  contents  of  the 
cranium  were  then  exposed.  The  brain  appeared  congested,  the  great  longitudinal  sinus  remark- 
ably so.  The  brain  was  removed,  and  at  its  base  were  discovered  two  ounces  of  clotted  blood. 
The  fissures  were  traced,  one  through  the  greater  wing  of  the  sphenoid  bone  to  the  foramen  lacerum 
anterius.  The  other  involved  the  petrous  portion  of  the  temporal  bone  to  such  an  extent  as  to  per- 
mit of  hemorrhage  from  the  meatus  auditoritis  externus,  which  was  the  earliest  and  most  noticeable 
symptom  in  the  c'ase.  The  internal  table  was  not  splintered  or  depressed.  The  blood  at  the  base 
of  the  brain,  between  the  dura  mater  and  the  skull,  accounted  for  the  marked  derangement  of  both 
the  circulatory  functions,  and  also  for  the  sudden  death  of  the  patient. 

CCCXCIV.— Account  of  a  Linear  Fracture  of  the  Skull.    By  J.  F.  HARTIGAN,  M.  D.,  Hospital 

Steward,  U.  S.  A. 

John,  aged  32,  was  wounded  in  a  mele"e  at  Washington,  July  11,  1809,  by  being  struck 

on  the  head  with  a  cobble-stone.  The  patient  lingered  about  twelve  hours.  An  autopsy,  six  hours 
after  death,  revealed  no  evidence  of  any  external  violence,  with  the  exception  of  a  few  slight 
16 


122  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

scratches  on  the  forehead.  Upon  removing  the  scalp,  however,  there  was  found  a  contused  appear- 
ance of  the  left  temporal  muscle,  under  which  was  an  extensive  fissure  of  the  squamous  portion  of 
the  temporal  bone,  commencing  at  the  point  of  junction  with  the  parietal,  downward  about  three- 
quarters  of  an  inch,  and  forward  and  outward  two  inches,  to  the  temporal  surface  of  the  great 
wing  of  the  sphenoid  bone.  A  smaller  fracture,  involving  only  the  internal  table  at  its  beveled 
edge,  was  also  detected.  Directly  under  the  seat  of  injury  lay  a  large  clot,  weighing  about  six 
ounces,  pressing  upon  the  unruptured  dura  mater — the  result  of  laceration  of  one  of  the  branches 
of  the  middle  meningeal  artery.  The  pathological  specimen  is  numbered  5579,  Surgical  Section, 
Army  Medical  Museum,  and  is  a  good  example  of  linear  fissure. 


CCCXCV. — Memorandum  of  an  Autopsy  of  a  Pensioner  at  the  Soldiers'  Home,  icho  had  his  Skull 
Frachired-by  a  Fall.    From  data  furnished  by  Hospital  Steward  E.  F.  SOHAFHIRT,  U.  S.  A. 

Charles  L.,  a  pensioner,  aged  34  years,  suffering  from  erysipelas  and  caries  of  the  nasal 
bones,  having  committed  some  misdemeanor  while  under  the  influence  of  liquor,  was  confined  to 
the  guard-house.  Being  very  violent,  he  was  supposed  to  have  the  "  horrors."  On  October  29, 
1870,  he  leaped  from  the  window  of  the  guard-house,  and,  striking  on  the  right  side  of  his  head, 
fractured  his  skull.  He  had  other  internal  injuries,  and  survived  the  accident  but  half  an  hour. 
On  examining  the  exterior  of  the  head,  a  great  effusion  of  blood  was  found  under  the  occipito- 
frontalis.  The  orbits  were  distended  with  blood.  It  was  thought  that  a  long-fissured  fracture 
extended  along  the  vault  of  the  skull,  through  the  right  parietal  and  temporal  bones.  Sub- 
sequent examination  proved  this  opinion  to  be  correct.  On 
October  30th,  Hospital  Steward  E.  F.  Schafhirt,  U.  S.  A.,  by 
direction  of  Brevet  Lieutenant  Colonel  C.  H.  Laub,  Surgeon, 
U.  S.  A.,  made  an  autopsy,  and  brought  the  cranium  to  the 
Museum.  There  was  an  extended  linear  fissure  of  the  right 
parietal  and  temporal,  with  fracture  of  the  base  of  the  skull, 
extending  through  the  wing  of  the  sphenoid,  and  radiating. 
There  was  no  extravasation  of  blood  between  the  skull  and 
dura  mater;  but  the  sinuses  and  vessels  of  the  pia  mater 
were  gorged  with  blood.  Near  the  cribriform  plate  of  the 
ethmoid,  the  dura  mater  showed  marks  of  chronic  inflammation, 
having  the  greenish-yellow  fringed  processes  with  adherent 
FIG.  iii.  sin,,,!,.  nmnn-n  fracture  ,-c  n,<  right  cur(]y  pU8  over  a  Sj)ace  about  an  inch  and  a  half  in  diameter. 

parietal  and  temporal.    Spec.  5721,  Sect,  I,  A. 

M.  M.  The  skull  is  specimen  5721;  the  brain  is  specimen  5722,  and 

portions  of  the  dura  mater  5723. 

CCCXCVL— Account  of  a  Fracture  of  the  Skull  by  a   Dumb-Bell.    By   W.  H.  GEORGE,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Michael  Lawrence,  Co.  D,  20th  Infantry,  was  accidentally  wounded,  September  16, 
1870,  by  an  iron  dumb-bell,  which  lacerated  the  forehead  and  slightly  fractured  the  external  plate 
of  the  skull  over  the  frontal  sinus.  He  was  admitted  to  the  post  hospital  at  Fort  Ransom,  Dakota 
Territory,  on  the  following  day.  Simple  dressings  were  applied.  Returned  to  duty  October  9th, 
cured. 

CCCXCVIL— Account  of  a  Fracture  of  the  Skull.    By  D.  STEVENS,  M.  D.,  Acting  Assistant  Sur- 
geon. 

At  Baton  Rouge,  Louisiana,  Sergeant  Frank  Lightner,  Co.  C,  65th  Colored  Troops,  aged  22 
years,  received,  by  explosion  of  the  steamer  City  of  Memphis,  May  31,  1866,  a  compound  commi- 
nuted fracture  of  the  outer  table  of  the  occipital  bone,  near  the  junction  of  the  sagittal  and 
lambdoid  sutures.  He  was  admitted  to  the  post  hospital  July  1,  1866.  He  returned  to  duty 
August  26,  1866. 


SIMPLE  AND  COMPOUND  FRACTUKKS.  123 

CCCXCVIII. — Mention  of  a  Case  of  Compound  Fracture  of  the  Skull.    By  J.  V.  D.  MII>I>I,KTON, 

Assistant  Surgeon,  U.  S.  A. 

Private  William  Mauahan,  Co.  M,  3d  Cavalry,  aged  23  years,  received  near  Prescott,  Arizona 
Territory,  May  14,  1870,  a  compound  fracture  of  the  skull,  caused  by  a  stone  thrown  by  a  com- 
rade. He  was  admitted  to  the  post  hospital  at  Fort  Whipple.  The  external  wound  was  about 
two  inches  in  length,  and  was  located  immediately  over  the  left  frontal  eminence.  The  outer  table 
of  the  skull  was  fractured ;  three  days  after  admission  the  patient  was  taken  with  chills,  and  suf- 
fered for  a  week  with  cold  sweats,  dizziness,  headache,  and  slight  fever,  with  intervals  of  delirium. 
June  26th  chloroform  was  administered,  and  an  incision  about  one  and  a  half  inches  in  length  was 
made  over  the  seat  of  the  fracture,  and  a  piece  of  the  outer  table,  over  one  inch  in  diameter,  was 
removed.  On  June  30th  the  patient  was  still  under  treatment. 

CCCXCIX. — Remarks  on  a  Case  of   Contusion    ivith  Injury  to  the  Skull,  an'l  Brain.     By  S.   M. 
HORTON,  Assistant  Surgeon,  U.  S.  A. 

Private  Charles  Miller,  musician,  27th  Infantry,  was  reported  on  sick  report  of  Omaha  Bar- 
racks, Nebraska,  March  11,  1809,  as  suffering  from  contusion  around  both  eyes,  with  partial 
detachment  of  the  cartilage  of  the  septum,  producing  flattening  of  the  nose — the.  result  of  a  blow 
with  the  fist.  It  was  reported  that  a  good  deal  of  epistaxis  occurred  immediately  on  receiving 
the  injury.  By  the  17th  of  March  he  suffered  from  headache ;  bowels  were  constipated,  and  tbe 
appearance  of  debility  manifested  itself.  Active  treatment  was  resorted  to,  and  the  condition  of 
the  patient  varied  until  death,  which  occurred,  apparently  suddenly,  on  the  night  of  the  1st  of 
April,  1809.  A  post-mortem  examination,  held  the  same  afternoon,  revealed,  upon  removing  the 
skull-cap,  a  small  quantity  of  pus  in  the  foramen  caecum  and  in  the  grooves  for  the  bulbs  of  the 
olfactory  nerves.  The  crista  galli  of  the  ethmoid  was  found  to  be  broken  off  at  its  base,  with  its 
upper  edge  or  point  toward  the  left  side,  and  was  very  easily  lifted  up  by  the  forceps.  Some 
purulent  matter  was  found  in  the  meshes  of  the  pia  mater  and  between  it  and  the  arachnoid  mem- 
brane, on  three-fourths  of  the  entire  under  surface  of  the  brain.  About  one-sixteenth  inch  to  the 
left  of  the  longitudinal  fissure,  at  anterior  end  of  corpus  callosum,  a  longitudinal  slit,  three-eighths 
of  an  inch  long,  with  dark  edges,  was  found  in  all  the  three  membranes.  On  detaching  the  mem- 
branes at  this  point,  a  sinus  was  found  leading  to  an  abscess  in  the  left  anterior  lobe,  which,  when 
examined,  proved  to  be  as  large  as  a  hen's  egg.  It  was  filled  with  pus,  broken  down  brain-matter, 
and,  on  the  outer  wall,  dark  grumous  matter.  On  exploring  this  abscess,  a  communication  was 
found  between  it  and  the  anterior  cornu  of  the  left  ventricle.  On  further  dissection,  I  found  the  left 
ventricle  and  the  right  ventricle,  and  the  third  ventricle,  through  foramen  of  Monroe,  and  fourth 
ventricle  through  aqueduct  of  Sylvius,  all  distended  with  pus  and  broken-up  cerebral  matter  with 
some  serum.  The  lining  membrane  of  the  fourth  ventricle  was  of  a  dusky  red  color.  On  pressing 
up  through  the  nostrils,  nearly  half  an  ounce  of  pus  exuded  from  that  part  of  the  cribriform  plate  of 
the  ethmoid  bone  from  which  the  crista  was  broken  off,  and  flowed  down  over  the  inner  portion 
of  the  base  of  the  skull. 

CCCC. — Remarks  on  a  Case  of  Fracture  of  Hie  Skull  and  of  the  Ribx.    By  A.  W.  WIGGIN,  Assist- 
ant Surgeon,  U.  S.  A. 

Private  Samuel  D.  Bobbins,  Co.  I,  23d  Infantry,  aged  22  years,  was  admitted  to  hospital  at 
Camp  Warner,  Oregon,  on  January  10,  1870,  at  4  o'clock  P.  M.,  suffering  from  injuries  about  the 
head  and  right  side.  He  stated  that  while  driving  a  six-mule  team,  loaded  with  wood,  down  a 
steep  declivity,  his  saddle-mule  stumbled  and  threw  him  over  the  pole.  One  of  the  mules  stepped 
on  his  head  or  kicked  him,  and  two  wheels  of  the  wagon  passed  over  his  body.  An  examination 
revealed  a  fracture  of  the  ninth  and  tenth  ribs  of  the  right  side,  about  three  inches  from  the  ver- 
tebral column,  with  severe  contusion  of  right  side,  as  well  as  minor  contusions  about  the  back  and 
shoulders.  Bloody  serum  was  issuing  from  the  right  ear  and  blood  from  the  left  ear,  as  well  as 
from  the  mouth  and  nose.  The  face  was  much  bruised  and  abraded,  and  the  left  eye  closed  by  a 
flesh-wound,  the  pupil  of  the  right  eye  being  much  dilated  and  irresponsive  to  light.  The  patient 
was  suffering  severely  from  shock,  and  complaining  of  sensations  of  cold  ;  pulse  50,  and  breathing 


124  REPORT  OF  SURGICAL  CASES  IN  THE  AEMY. 

labored.  When  reaction  had  taken  place,  some  four  or  five  hours  after  his  admission  to  hospital, 
the  broken  ribs  were  adjusted  by  applying  strips  of  adhesive  plaster  and  a  broad  bandage  about 
the  chest  and  abdomen.  His  pulse  at  this  time  had  risen  to  110,  and  breathing  easier.  A  small 
quantity  of  serum  and  blood  continued  to  ooze  from  his  ears,  and  ouce  he  vomited  four  or  five 
ounces  of  coagulated  blood.  He  complained  querulously  of  the  pain  in  his  side.  Morphine  was 
cautiously  administered  during  the  night,  but  only  partially  succeeded  in  quieting  his  paiu  and 
fretfulness.  On  the  next  day  he  seemed  easier,  and  was  fully  conscious  most  of  the  time ;  pulse 
11G,  pupils  still  dilated.  There  were  physical  signs  of  engorgement  of  the  lower  lobe  of  the  right 
lung,  and  of  presence  of  fluid  in  the  pleural  cavity,  as  also  of  air  in  the  areolar  tissue  about  the 
chest  and  neck.  During  the  day  the  patient  passed  blood  in  small  quantities  with  his  urine,  and 
vomited  blood  twice;  in  the  evening  the  pulse  was  130,  and  feeble;  patient  unconscious  and 
breathing  labored.  At  11  o'clock  P.  M.  the  pulse  was  150  and  fluttering.  Death  resulted  at  1.30 
o'clock  A. M.,  on  January  12th,  about  thirty-five  hours  after  the  reception  of  the  injury.  An  autopsy 
was  made  fifteen  hours  after  death.  On  removing  the  scalp,  a  fracture  which  had  not  been  previously 
noticed  was  detected,  through  the  squamous  portion  of  the  temporal  bone  without  displacement. 
The  dura  mater  at  the  base  of  the  brain  was  considerably  lacerated,  the  openings  extending  into 
the  ventricles.  An  extensive  fracture  was  discovered  running  obliquely  across  the  base  of  the 
cranium ;  starting  at  the  outer  edge  of  left  orbit,  it  passed  through  the  greater  wing  of  the  sphe- 
noid and  squamous  portions  of  the  temporal  bone  of  the  left  side,  and  then  obliquely  through  the 
body  and  both  lesser  wings  of  the  sphenoid,  and  through  the  whole  length  of  the  petrous  portion 
of  the  temporal  bone  of  the  right  side.  The  fracture  was  considerably  comminuted,  and  six  or 
eight  fragments  of  bone  about  the  left  orbit  were  easily  detached  with  the  fingers.  The  heart  was 
normal ;  the  left  lung  uninjured  and  healthy ;  the  lower  lobe  of  the  right  lung  presented  a  lacerated 
wound  about  two  inches  long,  evidently  produced  by  the  ragged  extremity  of  one  of  the  broken 
ribs  which  had  penetrated  the  pleural  cavity;  there  was  about  eight  ounces  of  blood  in  the  right 
pleural  cavity,  and  a  lacerated  opening  existed  in  the  diaphragm.  An  examination  of  the  abdo- 
men showed  the  cavity  filled  with  blood,  the  intestines  being  bathed  in  it.  Six  or  eight  ounces 
were  removed  from  the  pelvis.  The  right  lobe  of  the  liver  was  congested  and  much  lacerated;  the 
right  kidney  presented  a  slight  bruise  and  a  laceration  an  inch  long.  The  right  supra-renal  vein 
was  torn  across,  and  the  right  renal  vein  wounded  but  not  completely  divided.  No  other  abdomi- 
nal vessels  presented  lesions.  The  ninth,  tenth,  and  eleventh  ribs  were  fractured  about  three 
inches  from  the  vertebrae. 

CCCCI. — Remarks  on  a  Case  of  Fracture  of  the  Skull  with  Concussion  of  the  Brain.    By  C.  S.  DE 
GRAW,  Assistant  Surgeon,  U.  S.  A. 

Private Shields,  Co.  H.,  3d  Infantry,  presented  a  case  of  fracture  of  the  zygomatic  pro- 
cess of  the  temporal  bone  and  of  the  nasal  bones,  complicated  with  concussion  of  the  brain,  of  an 
aggravated  character.  He  was  admitted  to  the  post  hospital  at  Fort  Dodge,  on  November  17, 
1808,  where  it  was  ascertained  that  he  had  been  knocked  down  by  another  soldier,  and  severely 
kicked  and  trampled  upon  about  the  head  and  face.  When  brought  to  the  hospital  there  was 
complete  prostration  of  all  nervous  and  physical  powers.  The  means  taken  to  bring  on  reaction, 
though  pursued  for  an  hour  or  more,  seemed  of  little  or  no  avail.  The  man  remained  iu  the  same 
condition  for  eight  or  ten  hours,  and  shortly  after  midnight,  when  aroused  and  spoken  to,  he 
answered,  but  immediately  relapsed  into  his  former  condition.  On  the  morning  of  the  18th  he 
seemed  somewhat  relieved ;  was  more  easily  aroused,  and,  when  sharply  spoken  to,  would  give 
unintelligible  or  irrelevant  replies.  His  face  was  greatly  distorted  by  swelling,  his  eyes  completely 
closed,  and  there  were  several  cuts  upon  his  forehead  and  face.  Examination  discovered  the  fractures 
mentioned  above.  During  the  day  violent  inflammatory  symptoms,  pointing  to  brain  trouble,  set  in. 
He  became  exceedingly  restless,  tossing  himself  about  so  violently  that  it  became  necessary  to 
hold  him  down  in  bed;  cold  applications  were  made  to  his  head,  sinapism  applied  to  the  back  of 
the  neck,  and  blisters  behind  each  ear.  This  condition  lasted  about  five  days,  when  he  gradually 
became  calmer,  but  his  mental  faculties  were  much  impaired.  He  improved  gradually  during 
December  and  January,  and  in  March,  1869,  he  was  returned  to  duty. 


SIMPLE  AND  COMPOUND  FRACTURES.  125 

CCCCII. — Remarks  on  a  Case  of  Fracture  of  the  Skull.    By  ELLIOTT  COUES,  Assistant  Surgeon, 
U.  S.  A. 

Private  Euiil  Slmkler  fell  from  the  gallery  of  the  church  where  the  troops  are  quartered,  a 
distance  of  about  eighteen  feet,  striking  his  head  on  the  edge  of  a  stair.  Profuse  haemorrhage  of 
chiefly  venous  blood  from  the  left  ear,  and  some  from  the  nose,  with  instantaneous  and  complete 
insensibility.  Was  conveyed  to  the  hospital,  where  I  saw  him  fifteen  minutes  afterward,  in  con- 
dition as  follows:  Entire  insensibility;  temperature  of  blood  normal;  complete  muscular  relaxation. 
Pupils  of  normal  size,  insensible  to  light.  No  pulse  perceptible  at  wrist  or  arm,  though  a  feeble, 
fluttering,  irregular,  and  interrupted  motion  of  the  heart  could  be  felt.  Respirations  about  five  per 
minute,  labored  (but  not  stertorous),  and  amounting  to  little  more  than  gasping.  Haemorrhage 
of  both  venous  and  arterial  blood  still  continued  from  the  ear;  a  well-marked  depression  .of  con- 
siderable depth  and  extent  just  over  the  left  ear ;  none  others  perceptible.  A  trivial  cut  over 
the  left  eye.  Much  ecchymosis  about  the  right  eye.  The  patient  was  in  articulo  mortis,  and  died 
in  about  ten  minutes.  The  pupils,  which  had  been  before  fixed,  dilated  to  a  remarkable  degree 
just  before  death.  Autopsy,  twelve  hours  after  death.  Skull:  On  removing  the  pericranium  and 
left  temporal  muscle,  the  squamous  portion  of  the  temporal  bone  was  found  fractured  and  depressed 
for  one-third  of  an  inch  or  more,  the  posterior  edge  of  the  fracture  comminuted,  and  the  fragments 
driven  in  upon  and  lacerating  the  brain.  A  compound  comminuted  fracture  of  the  petrous  portion 
of  the  os  temporis,  leading  into  the  ineatus  auditorius  externus,  through  which  a  probe  readily 
passed,  and  through  which  the  haemorrhage  had  occurred  (for  the  tympanum  was  intact).  A  very 
extensive  fracture  began  at  the  mastoid  portion  of  the  os  temporis,  and  arched  over  the  side  of  the 
skull  (above,  and  distinct  from  the  depression  of  the  squamous  portion  of  the  os  temporis  above 
mentioned),  involving  parietal  and  frontal  bones  to  the  left  orbit,  at  about  its  middle,  and  thence 
extended  into  the  lett  orbital  plate  of  the  frontal.  This  was  a  clean,  smooth,  fracture,  gaping  one- 
twelfth  of  an  inch.  The  right  orbital  plate  of  frontal  was  also  fractured.  The  cribriform  lamella  of 
ethmoid  fractured  and  comminuted.  Fracture  of  left  spheuoidal  ala.  Brain :  Anterior  lobe  of 
left  hemisphere  lacerated,  from  impact  of  fragments  of  temporal  bone,  the  dura  mater  being  there 
ruptured.  Several  large,  firm,  black  clots  about  the  optic  commissure  and  crura  cerebri.  The  ves- 
sels of  the  pia  mater  all  congested,  and  numerous  minute  clots  from  their  rupture  among  the  cere- 
bral and  cerebellar  convolutions.  A  little  blood  in  the  ventricles,  and  some  clots  in  the  meshes  of 
the  choroid  plexus,  but  no  great  amount  of  serous  effusion.  The  brain  substance  was  studded  more 
thickly  than  usual  with  red  points.  It  was  impossible  to  ascertain  the  exact  amount  or  origin  of 
the  haemorrhage.  It  was  profuse  at  first,  and  continued  in  a  degree  until  death,  and  during  the 
autopsy  it  flowed  freely,  as  soon  as  the  temporal  depression  was  exposed.  I  believe  it  originated 
from  either  the  lateral  or  superior  petrosal  sinus,  and  from  one  of  the  meningeal  arteries.  The 
internal  carotids  were  intact,  as  were  the  superior  and  inferior  longitudinal  sinuses,  as  well  as  those 
about  the  cerebellum.  From  the  indications  afforded  by  the  pupils,  I  presume  the  patient  first 
suffered  chiefly  from  the  concussion,  and  afterward  experienced  the  full  effect  of  the  compression  of 
the  brain. 

CCCCIII. — Remarks  on  a  Case  of  Fracture  of  the  Frontal  Bone. — By  GEORGE  M.  STERNBERG 
Assistant  Surgeon,  U.  S.  A. 

Corporal  William  S ,  Co.  F,  37th  Infantry,  was,  on  March 

2,  1807,  at  work  at  a  pontoon  bridge  across  the  Republican  River, 
drawing  up  a  boat  with  three  men  with  a  windlass.  The  windlass, 
in  some  way,  escaped  from  their  control,  and  while  revolving 
rapidly  the  end  of  the  crank  struck  him  in  the  forehead.  He  re- 
mained about  two  hours  at  the  bridge,  and  then  walked  to  the  post 
hospital  at  Fort  Riley,  Kansas.  About  ten  minutes  after  he  came 
to  the  hospital,  he  had  a  convulsion,  and  was  unconscious  from  that 
time  until  he  died,  March  7, 1867.  Several  fragments  of  bone  were 
removed  by  Assistant  Surgeon  W.  H.  Forwood,  U.  S.  A.,  soon  after 
the  man  arrived  at  the  hospital.  The  specimen  is  figured  in  the 

*  Fin. 17.  Segment  ol  frontal   bone,  giving 

accompanying  WOOd-CUt,  (I  IG.    17.)  an  interior  view  of  a  fracture  by  a  Mow 

froma  windlass.  If/in:  4HU1.  Sect.  I.  A.M.M. 


126  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCCIV. — Memorandum  of  a  Case  of  Fracture  of  the  Cranium.    V.  B.  HUBBARD,  Assistant  Sur- 
geon, U.  S.  Army. 

Private  U :,  U.  S.  Military  Academy,  detachment  of  Cavalry,  was  admitted  to  the  post 

hospital  at  9  o'clock  P.  M.,  December  23,  1870,  in  an  unconscious  state,  bleeding  profusely  from 
the  left  ear.  He  had  falleu  down-stairs  while  intoxicated,  receiving  the  full  force  of  the  blow  upon 
his  head.  There  was  no  laceration,  contusion,  or  swelling  of  the  scalp  to  indicate  the  precise 
locality  of  the  injury.  A  careful  examination  of  the  head  revealed  nothing.  The  soldier  was  so 
jutoxicated  as  to  render  it  difficult  if  not  impossible  to  ascertain  definitely  how  much  of  his 
comatose  condition  was  attributable  to  the  injury  received.  Pulse  70,  full  but  compressible, 
jutermitting  twice  in  the  minute;  respiration  16;  temperature  98°;  pupils  somewhat  dilated,  though 
responding  to  light;  his  breathing  was  of  the  heavy  stertorous  character  usually  present  in  drunk- 
enness. He  was  extremely  restless,  requiring  two  attendants  to  keep  him  in  bed ;  muttering  inces- 
santly and  unintelligibly  during  the  night.  The  flow  of  blood  from  the  ear  was  reduced  shortly 
after  being  admitted  into  hospital  to  an  oozing,  which  continued  until  his  death  ou  the  27th,  the 
fourth  day  after  the  receipt  of  the  injury.  The  blood  was  chiefly  arterial ;  no  serum  could  be 
detected.  Cold  applications  were  made  to  the  head,  and  the  extremities  were  kept  warm  by  hot 
bottles.  Saturday,  24th:  Patient  still  remains  unconscious;  pulse  54,  full,  compressible,  and  inter 
mitting  as  of  the  previous  night ;  pupils  responsive  to  light ;  slightly  but  equally  dilated  ;  tempera 
ture  98°,  respirations  16,  their  character  unchanged ;  restlessness  continues ;  is  constantly  making 
attempts  to  get  out  of  bed,  and  is  only  restrained  by  close  watching  and  the  exercise  of  a  good 
deal  of  physical  force  on  the  part  of  his  attendants ;  muttering  continuous ;  bowels  moved  by  enema ; 
movement  involuntary ;  bladder  evacuated  unconsciously  twice  during  the  day ;  quantity  and  color 
of  urine  normal.  Injections  of  beef  tea  administered  during  the  day,  as  the  patient  was  unable  to 
swallow.  Sunday,  25th :  No  perceptible  change  in  the  condition  of  the  patient ;  pulse,  respirations, 
and  temperature  remain  the  same  as  of  the  day  previous ;  bowels  moved  and  urine  voided  involunta- 
rily, muttering  and  restless  as  before.  Upon  being  slapped  quite  smartly  upon  the  cheek  with  the 
flats  of  the  fingers  with  the  view  to  rouse  him  from  his  comatose  condition,  he  gave  utterance  to 
an  expression  of  disgust  in  a  single  word — the  only  evidence  of  consciousness  given  by  the  patient 
after  the  receipt  of  the  injury.  Injections  of  beef  tea  and  brandy,  largely  diluted,  every  two  hours, 
as  the  patient  was  still  unable  to  swallow.  Monday,  26th,  6  A.  M. :  Patient  still  unconscious ; 
pulse  66 ;  respirations  17 ;  temperature  98°;  restlessness  continues,  patient  rolling  from  side  to 
side,  making  frequent  attempts  to  get  out  of  bed.  12  M. :  Pulse  50;  temperature  100°;  respira- 
tions 10.  4  P.  M.:  No  change  worthy  of  mention  in  the  pulse,  respirations,  or  temperature. 
At  8  P.  M.  reaction  set  in  violently,  pulse  150;  temperature  105°;  respirations  variable,  from  14 
to  19.  From  this  hour  the  patient  sank  rapidly,  pulse  running  up  to  200.  Died  at  5  A.  M.,  Tues- 
day, 27th.  The  decubitus  in  this  case  was  either  dorsal  or  left  lateral;  chiefly  the  latter.  The 
jactitation  was  vhe  most  marked  symptom  throughout.  Post-mortem,  at  2  P.  M.,  27th :  Remov- 
ing the  scalp,  extensive  extravasation  of  blood  was  found,  chiefly  on  the  left  side,  but  no  clots. 
The  fracture  and  depression,  their  character  and  extent,  are  shown  in  the  specimen.*  A  description 
of  them  is  therefore  omitted.  Upon  removing  the  calvarium,  a  clot,  nearly  circular  in  form,  two 
inches  and  one-half  in  diameter,  and  half  an  inch  in  thickness  at  its  centre,  lying  between  the 
dura  mater  and  the  skull,  was  .found  immediately  under  the  seat  of  depression.  Dark  fluid  blood 
mixed  with  serum,  estimated  at  six  ounces,  escaped  upon  removing  the  skull. 

At  a  point  diagonally  opposite  the  seat  of  injury  (the  force  of  the  blow  evidently  coming  from 
behind  and  being  directed  forward  and  upward),  immediately  under  the  right  frontal  protuberance, 
the  surface  of  the  brain  was  found  lacerated  and  contused,  by  contre-coup,  over  a  space  and  to  a 
depth  nearly  equal  in  extent  with  the  dimensions  of  the  clot  mentioned  above. 

"The  specimen  (No.  5919,  Sect.  I,  A.  M.  M.)  is  interesting.  It  is  the  left  side  of  the  cranium,  showing  a  slightly 
depressed  fracture  over  the  parietal  eminence,  with  fissures  extending  to  the  petrous  bone.  At  the  place  of  direc  t  impact 
the  outer  table  is  driven  into  the  diple,  and  is  fissured  by  two  lines,  an  inch  and  a  half  and  an  inch  in  length,  respect- 
ively, crossing  at  right  angles.  The  inner  table  is  very  slightly  depressed  at  this  point.  Extruding  from  this  depres- 
sion to  the  auditory  canal  is  a  broad  fissure  which  passes  through  the  petrous  bone.  Wood -cuts  of  the  specimen  were 
prepared,  but  they  were  unsatisfactory  and  were  discarded. — ED. 


SIMPLE  AND  COMPOUND  FBACTUKES.  127 

At  this  stage  of  the  post-mortem  examination  I  was  called  to  attend  a  ease  of  labor,  which 
detained  me  until  the  forenoon  of  the  next  day,  by  which  time  decomposition  had  set  in  to  such  an 
extent  as  to  render  a  further  examination  of  the  lesions  of  the  brain  nugatory.  The  specimen  is 
No.  5919,  Army  Medical  Museum. 

CCCCV. — Remarks  on  a  Fracture  of  the  Skull  from  Railway  Injury.    By  DE  WITT  C.  PETERS, 
Assistant  Surgeon,  U.  S.  A. 

The  body  of  an  unknown  man,  aged  about  40  years,  was  brought  to  the  Jarvis  Hospital,  Balti- 
more, Maryland,  on  July  7,  18G5,  for  burial.  He  had  been  killed  by  falling  from  a  railroad  car 
while  in  motion.  The  body  was  much  bruised  in  different 
places.  There  was  a  large  and  deep  wound  on  the  right 
side  of  the  head  above  the  external  auditory  meatus,  from 
which  blood  was  escaping.  The  head,  ears,  and  face  were 
much  bruised.  Upon  removing  the  calvaria,  both  tables 
of  the  skull  were  found  fractured  and  driven  in  upon  the 
brain,  compressing  it  at  that  point.  The  fracture  com- 
menced on  the  right  side  in  front  of  the  petrous  portion  of 
tlitj  temporal  bone;  the  lesser  wings  of  the  sphenoid 
bone  and  a  portion  of  the  orbital  plate  of  the  frontal  bone 
were  separated  from  the  frontal  bone  on  the  right  side  and 
extended  across  to  a  similar  point  on  the  left  side.  Clots  of 
blood  were  found  effused  at  the  seat  of  fracture  and  all 
through  different  portions  of  the  brain,  and  effused  blood 
was  found  in  all  the  ventricles.  The  skull  was  forwarded  ,.-1(;. ,,..  skuii  ,.M,.nsiv«iy  fractured.  There  is  die*. 
to  the  Army  Medical  Museum,  and  is  represented  in  the  ad-  tasis  of  the  snt«res  of  the  base  and  right  side.  spn-.. 

3019.  Sect.  I,  A.  M.  M. 

joining  wood-cut. 

CCCCVI. — Remarks  on  a  Case  of  Fracture  of  the  Skull.    By  CHARLES  S.  MERRILL,  M.  D.,  Acting 
Assistant  Surgeon. 

At  Corinth,  Mississippi,  on  the  afternoon  of  April  9,  1868,  Private  Edmund  H.  Wells,  Co.  K, 
34th  Infantry,  was  fatally  injured  while  assisting  in  loading  post-logs  upon  a  wagon,  his 
head  being  caught  laterally  between  a  log  already  loaded  and  another  which  was  being  thrown 
upon  the  wagon.  As  soon  as  his  head  was  released  he  fell  unconscious,  bleeding  from  both  ears, 
nose,  and  mouth.  He  was  brought  to  hospital  with  all  the  symptoms  of  severe  concussion  of  brain, 
rapidly  followed  by  those  of  compression.  Haemorrhage  continued  from  ears,  nose,  and  mouth  ;  deep 
<-<>ma,  stertorous  respiration,  and  dilated  pupils  rapidly  followed,  and  continued  until  April  11, 1868, 
when  death  resulted,  evidently  from  compression  of  the  brain,  dependent  upon  extravasation  of 
blood,  fracture  of  base  of  skull  being  diagnosticated. 

CCCCVII. — Remarks  on  a  Case  of  Fracture  of  the  Skull.    By  J.  H.  BARTHOLF,  Assistant  Surgeon, 
U.  S.  A. 

Private  Charles  Williams,  Co.  F,  5th  Cavalry,  aged  40  years,  was  admitted  to  the  post 
hospital  at  Camp  Grant,  near  Eichmond,  Virginia,  September  28,  18G7,  with  a  compound  fracture 
of  the  outer  table  of  the  skull,  inflicted  by  a  blow  with  the  barrel  of  a  pistol  in  the  hands  of  a 
drunken  sergeant.  The  flesh-wound  was  two  inches  in  length  over  the  left  parietal  region, 
and  the  outer  table  very  slightly  depressed ;  the  patient  had  no  cerebral  symptoms;  cold-water 
dressings  were  applied,  and  quiet  enjoined.  On  October  3d,  the  wound,  which  had  united  by  soft 
adhesions,  reopened.  Simple  cerate  dressings  were  ordered.  The  next  day  the  patient  had  severe 
headache  at  the  back  of  his  head  and  over  his  left  eye ;  his  bowels  were  regular ;  the  wound  gaped 
open  to  the  skull,  discharging  a  small  amount  of  healthy-looking  pus.  On  October  9th  the  wound 
was  granulating  finely,  and  discharging  but  little  pus.  The  patient  continued  to  improve,  and 
was  returned  to  duty  November  10,  1807.  The  wound  had  entirely  healed,  but  the  patient 
suffered  from  occasional  headache. 


128  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

Fractures  of  the  Bones  of  the  Face. — Special  reports  were  made  of  five  cases  of 
fractures  of  the  bones  of  the  face.  Four  of  the  patients  went  to  duty,  and  one,  with  a 
complicated  fracture  of  the  lower  jaw,  was  discharged. 

CCCCVIII. — Account  of  an  Injury  of  the  Head  and  Face,  with  Fracture  of  the  Malar  Bone.    By 
JAMES  P.  KIMBALL,  Assistant  Surgeon,  U.  S.  A. 

Private  E.  Gibson,  Co.  F,  31st  Infantry,  aged  26  years,  while  at  work  in  a  saw-mill,  May  5,  1868, 
11  o'clock  A.  M.,  at  Fort  Buford,  Dakota  Territory,  was  struck  by  a  skid  three  inches  in  diameter, 
suddenly  thrown  up  by  a  heavy  log  falling  upon  one  end  of  it.  The  blow  was  received  upon  the 
left  side  of  the  face  and  head,  fracturing  the  left  malar  bone,  severely  contusing  the  cheek  and 
scalp,  cutting  the  upper  lip  against  the  teeth,  and  causing  concussion  of  the  brain.  When  first 
examined,  fifteen  minutes  after  the  reception  of  the  injury,  he  was  insensible,  the  pulse  was  barely 
perceptible,  the  pupils  were  contracted,  and  the  countenance  qf  a  deathly  pallor.  He  was  imme- 
diately carried  to  the  post  hospital  at  Fort  Buford,  sinapisms  were  applied  to  the  feet,  warmth 
and  friction  to  the  arms  and  legs,  and  ammonia  held  to  the  nostrils.  After  a  vigorous  use  of  these 
measures,  for  nearly  half  an  hour,  the  patient  evinced  signs  of  reanimatiou,  and  soon  after  vomited, 
and  at  the  expiration  of  an  hour  he  was  able  to  speak  and  to  move  the  extremities.  The  pulse 
was  96  per  minute,  soft  and  weak.  Cloths,  wet  in  cold  water,  were  Constantly  applied  to  the 
contused  portions  of  the  head  and  face,  and  perfect  quiet  was  enjoined.  At  5  o'clock  P.  M.  the 
patient  remained  sensible,  and  could  move  without  difficulty.  The  pulse  was  8,j  per  minute,  and 
soft.  He  had  severe  pain  in  the  occiput.  The  left  eye  was  entirely  closed  by  the  swollen  tissues, 
which  were  deeply  ecchymosed.  On  May  6,  1803,  at  8  o'clock  A:  M.,  the  pupils  were  normal, 
responding  readily  to  light.  The  pulse  was  80  per  minute,  soft  but  stronger.  Cloths,  wet  in  a 
mixture  of  zinc,  camphor,  and  water,  were  applied.  At  5  o'clock  P.  M.  the  pain  in  the  head  was 
very  severe.  He  vomited  several  times.during  the  day.  The  pulse  was  85,  and  soft.  A  sinapism 
was  applied  to  the  pit  of  the  stomach.  On  May  7,  1868,  the  pulse  was  78,  full  and  moderately 
strong.  He  urinated  freely.  The  head  and  face  were  kept  wet  with  an  evaporating  lotion  of 
hydrochlorate  of  ammonia  and  water.  On  May  8th  the  pulse  was  72,  and  of  natural  strength. 
The  swelling  of  the  soft  parts  had  diminished.  On  May  llth  the  pulse  was  72.  The  tongue  was 
lightly  coated.  The  swelling  and  ecchymosis  had  diminished.  The  cold  applications  were  dis- 
continued. The  patient  continued  to  improve  under  tonics  and  nourishing  diet,  and  was  able,  on 
May  16th,  to  sit  up.  On  May  20th  the  ecchymosis  had  nearly  gone,  and  the  deformity  of  the  cheek 
was  very  slight.  The  patient  improved  steadily,  and  on  June  2,  1868,  was  free  from  pain  and 
vertigo,  and,  on  June  3d,  he  was  returned  to  duty. 

CCCCIX. — Remarks  on  a  Cane  of  Fracture  of  the  Lower  Jaw.    By  ELLIOTT  COUES,  Assistant 
Surgeon,  U.  S.  A. 

Private  William  Bowers,  Co.  E,  3d  Artillery,  aged  24  years,  received,  on  April  20,  1868,  a 
compound  comminuted  fracture  of  the  lower  jaw,  left  side,  by  a  kick  of  a  horse.  On  the  following 
day  he  was  admitted  to  the  post  hospital  at  Columbia,  South  Carolina.  The  case  was  complicated 
by  extensive  laceration  of  the  soft  parts  over  both  the  upper  and  lower  jaw,  and  probable  slight 
fracture  of  the  alveolar  process  of  the  superior  maxilla.  Union  was  delayed  by  the  successive 
detachment  of  spiculas  requiring  removal.  No  proper  splint  could  be  adopted  to  the  case,  nor 
was  the  fitting  of  one  deemed  advisable,  in  view  of  the  condition  of  the  soft  parts.  A  simple 
bandage  was  used  with  good  results.  [He  was  returned  to  duty  May  6,  1868. — ED.] 

CCCCX. — Note  on  a  Fracture  of  the  Lower  Jaic.    By  J.  V.  D.  MIDDLETON,  Assistant  Surgeon, 
U.  S.  A. 

Private  Robert  Pye,  Troop  B,  4th  Cavalry,  aged  27  years,  received,  on  February  6,  1868,  at 
Camp  Verde,  Texas,  a  compound  fracture  of  the  lower  jaw  from  the  kick  of  a  horse.  He  was 
admitted  to  the  post  hospital,  where  two  pieces  of  bone  were  removed.  Carbolic  acid  and  linseed 
oil.  with  sling  bandages,  were  applied.  The  man  was  returned  to  duty  in  July,  1868. 


SIMPLE  AND  COMPOUND  FRACTURES.  129 

CCCCXI. — Account  of  a  Case  of  Fracture  of  the  Loicer  Jaw.    By  IRVING  C.  ROSSE,  M.  D.,  Act- 
ing Assistant  Surgeon. 

Private  Edward  Sheehy,  Battery  C,  5th  Artillery,  aged  about  30  years,  and  of  fair  condition, 
was  admitted  to  the  hospital  of  the  artillery  school  at  Port  Monroe,  on  October  15,  1870,  with  a 
transverse  fracture  of  the  body  of  the  inferior  maxilla  to  the  right  of  the  symphysis.  He  stated 
that  he  was  kicked  under  the  chin,  a  few  hours  previously,  while  in  an  altercation  with  another 
soldier.  A  suitable  splint  of  pasteboard  having  been  made,  and  immersed  in  hot  water,  was 
moulded  to  the  chin  and  jaw.  This  was  retained  by  a  combination  of  the  four-tailed  bandage  with 
that  of  Gibson.  That  part  of  the  appliance  covering  the  lower  jaw  was  starched,  and  the  bandages 
were  tightened  nearly  every  day.  Quiet  was  enforced,  liquid  nourishment  given,  and  the  patient 
prohibited  from  talking.  This  treatment  maintained  the  parts  in  steady  apposition,  and  the  soldier 
was  returned  to  duty  November  17,  1870. 

CCCCXII. — Note  on  a  Fracture  of  the  Loicer  Jaw.    By  J.  H.  BAYNE,  Acting  Assistant  Surgeon. 

Private  Henry  Wimsett,  Co.  I,  4th  Artillery,  was  discharged  March  14, 1808,  from  Fort  Foote, 
Maryland,  on  account  of  compound  comminuted  fracture  of  the  lower  maxillary  bone,  caused  by 
the  wheels  of  a  wagon  passing  over  it.  The  accident  was  followed  by  grave  inflammation,  pro- 
ducing rigidity  of  the  jaw,  and  such  impairment  of  the  power  of  mastication,  that  his  disability 
was  rated  one-half  by  the  pension  examining  surgeon. 


Fractures  of  the  Vertebra. — Brief  mention  is  made  in  the  reports  of  some  instances 
of  compound  fracture  of  the  spine  from  railway  accidents.  Of  simple  fractures  details 
have  been  given  in  two  instances  only. 

CCCCXIII. — Account  of  a  Fracture  of  the  Fourth  Cervical  Vertebra.    By  G.  H.  GUNN,  Assistant 
Surgeon,  U.  S.  A. 

At  Waco,  Texas,  March  5,  1870,  Private  John  Harkey,  Co.  E,  6th  Cavalry,  aged  30  years, 
received,  by  a  fall  through  an  open  door  on  the  second  floor  of  a  building  occupied  as  barracks,  a 
fracture  of  the  fourth  cervical  vertebra.  Complete  paralysis  of  both  motion  and  sensation  of 
the  lower  extremities,  and  most  of  the  trunk  and  upper  extremities  immediately  ensued.  He 
was  admitted  to  hospital  the  same  day.  He  died,  on  the  morning  of  the  7th,  of  acute  myelitis, 
his  intelligence  remaining  unimpaired  throughout.  Treatment  sedative  and  stimulant. 

CCCCX1V. — Abridged  Account  of  a  Fracture  of  the  Fifth  Cervical  Vertebra.    From  reports  furnished 
by  H.  R.  TILTON,  Assistant  Surgeon,  U.  S.  A. 

Private  Emmet  J ,  Co.  A,  5th  Infantry,  aged  19  years,  and  of  splendid  physical  organiza- 
tion, was  in  the  habit  of  bathing  in  the  Arkansas  River,  at  a  place  near  Fort  Lyon,  Colorado 
Territory,  where  the  water  was  ordinarily  from  six  to  eight  feet  deep,  and  so  muddy  as  to  render 
an  object  unseen  at  a  depth  of  six  inches.  On  July  3,  1868,  in  diving  from  the  bank  he  struck  his 
head  against  the  bottom,  which,  being  sandy  and  constantly  shifting,  was  upon  this  particular 
occasion  only  eighteen  inches  below  the  surface.  Becoming  immediately  powerless  from  the  effects 
of  the  concussion,  he  would  have  drowned  had  not  help  been  given.  The  legs  and  arms  being 
paralyzed  he  was  carried  on  a  stretcher  to  the  hospital,  lying  on  his  abdomen.  Upon  admis- 
sion, at  1  o'clock  P.  M.,  the  pulse,  respiration,  and  temperature  were  not  counted,  nevertheless 
they  appeared  normal ;  the  pupils  were  unaffected;  there  was  priapism.  The  power  soon  returned 
to  the  arms,  although  feeble.  The  extremities  were  warm,  and  when  touched  the  sensation  was  more 
17 


130 


REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 


FIG.  19.  Fracture  of  body 
of  fifth  cervical  vertebra. 
Spec.  5724.  Sect.  I, A.  M.  M. 


acute  in  the  left  than  in  the  right  leg.  The  patient  complaining  of  feeling  dead  below  the  neck,  the 
spine  was  carefully  examined.  No  irregularity  was  found,  but  there  was  tenderness  over  the  sixth 
cervical  vertebra.  A  sinapism  was  applied  to  the  nape  of  the  neck,  and  in  an  hour  he  requested 
to  be  turned  over.  At  5  o'clock  P.  M.  the  pulse  was  104 ;  respiration  18 ; 
temperature  105°.  The  patient  was  directed  to  hold  small  pieces  of  ice  in  his 
mouth ;  the  same  was  applied  to  the  upper  portion  of  the  spine,  and  a  saline 
aperient  was  prescribed.  At  9  o'clock,  the  pulse  was  100 ;  respiration  24 ; 
temperature  102°.  The  urine  was  drawn  off  with  a  catheter,  and  the  patient 
was  placed  on  a  water  bed.  On  the  morning  of  July  4th,  the  pulse,  respira- 
tion, and  temperature  were  all  diminished.  The  cold  applications  to  the 
spine  were  continued  in  the  form  of  ice-cold  water;  a  special  diet  was  ordered; 
and  the  catheter  was  used  twice  during  the  day.  At  5  o'clock  the  bowels 
were  moved  involuntarily.  On  July  5th,  there  was  considerable  diminution 
of  the  temperature,  sensation  was  wanting  in  the  lower  extremities,  and 
respiration  was  abdominal.  Tonics,  nutritious  diet,  and  dry  rubbings  were 
prescribed.  On  the  Gth,  sensation  had  partly  returned  in  the  left  leg,  and  the 
breathing  was  better,  there  being  more  movement  of  the  chest.  By  the 
llth,  the  patient  was  able  to  pass  his  urine  without  a  catheter,  but  there 
was  no  improvement  in  the  sensibility  of  the  right  leg.  The  pulse,  respiration,  and  tempera- 
ture had  diminished.  On  the  morning  of  the  loth  he  had  a  chill,  which  recurred  on  the  morn- 
ing of  the  17th,  and  again  in  the  afternoon.  After  this  his  countenance  became  dusky,  and 
there  was  a  rise  in  the  temperature.  He  had  not  perspired  since  the  injury.  On  the  morning  of 
the  18th  the  nrine  became  turbid,  the  patient  complained  of  his  lungs  feeling  like  stone,  and  his 
stomach  was  irritable.  By  the  morning  of  the  20th,  the  pulse  had  become  so  feeble  that  it  could 
not  be  counted,  the  bowels  were  loose,  the  urine  was  ainmoniacal  and  thick  with  mucus,  and  he 
had  an  attack  of  vomiting.  These  symptoms  were  followed  by  increased  respiration  and  a  very 
high  temperature,  (105°.)  The  patient,  at  this  time,  was  again  able  to  pass  his  urine  without  the 
use  of  a  catheter,  but  on  the  21st  this  instrument  was  used  with  difficulty,  owing  to  the  formation 
of  clots  in  the  bladder.  The  patient  also  suffered  from  decubitus,  and  by  July  24th  his  stomach 
became  so  irritable  as  to  retain  scarcely  anything.  On  the  day  following  his  appetite  was  entirely 
gone.  On  the  20th,  the  temperature  was  91.8°.  He  died  at  noon  on  the  28th.  At  the  post-mortem 
the  brain  was  found  perfectly  healthy,  so  far  as  the  unaided  senses  could  determine.  The  spinal 
cord  showed  nothing  abnormal  in  the  dorsal  region,  except  the  fluid  which  escaped.  This  was  filled 

with  transparent,  float- 
ing globules  resembling 
volatile  oil  water.  The 
body  of  the  fifth  cervical 
vertebra  was  fractured, 
and  it  was  ascertained 
that  haemorrhage  had 
compressed  the  cord  at 
and  around  the  seat  of 
fracture.  There  was  no 
displacement  of  the  ver- 
tebra. The  lungs  were 
healthy,  except  the  pos- 
terior portions,  which 
were  hypostatically  con- 
gested. The  liver  was 
slightly  enlarged,  the 
splenic  extremity  of  the 
stomach  congested,  and 
the  kidneys  were  en- 

Fio.  20.  Thermograph  of  a  fatal  case  of  fracture  of  the  fifth  cervical  vertebra.  larged   Rlld    gorged  with 


SIMPLE  AND  COMPOUND  FKACTUKES. 

blood;  the  pelvis  of  the  left  being  filled  with  pus,  (?)  but  upon  careful  examination  no  abscess 
could  be  found.  The  ureters  were  very  dark,  and  one  of  them  contained  a  clot  at  the  entrance 
of  the  bladder.  The  walls  of  the  bladder  were  of  a  dark  purple  color,  inflamed,  and  thickened; 
the  mucus  membrane  being  absent  in  patches.  The.  pathological  specimens,  consisting  of  the  right 
kidney,  the  bladder,  the  urethra,  and  the  cervical  vertebra?  (Fig.  10),  were  contributed  to  the  Army 
Medical  Museum,  and  are  numbered  5724,  5725,  5720, 5727  respectively,  of  the  Surgical  Section. 


FRACTURES  OF  THR  BONES  OF  THE  TRUNK. — But  few  cases  were  reported  in  detail. 
Fractures  of  the  ribs  were  not  infrequent  accidents  ;  while  fractures  of  the  spine  and 
pdvis  were  rare. 

Fractures  of  the  Pdbs. — Special  reports  were  made  of  a  fatal  case,  of  a  case  compli- 
cated by  necrosis,  and  of  a  third  with  fractured  clavicle.* 

CCCCXV. — Report  of  a  Case  in  ichich  the  Ribs  were  Extensively  Fractured.    By  J.  H.  FRANTZ, 
Surgeon,  U.  S.  A. 

James  B ,  a  laborer,  aged  33  years,  was  injured  at  Fort  Sanders,  Wyoming  Territory,  April 

3,  1870,  by  the  passage  over  him  of  the  wheel  of  a  heavily  laden  wagon.  Death  resulted  April  21, 
1870.  The  autopsy  revealed  twelve  fractures  of  the  ribs  of  the  right  side  ;  the  first  to  the  seventh, 
both  inclusive,  were  broken,  with  relation  to  each  other,  nearly  on  a  line  with  the  angles  of  the 
larger  ribs;  while  the  third,  fourth,  fifth,  sixth,  and  seventh  were  again  broken  about  four  inches 
nearer  their  sternal  extremities.  The  cavity  of  the  pleura  was  found  almost  obliterated,  the  vis- 
ceral and  parietal  layers  of  that  membrane  being  adherent  to  each  other.  The  right  lung  contained 
three  or  four  abscesses,  having  tough-lined  membranes,  filled  with  what  seemed  laudable  pus;  the 
remaining  portion  was  broken  down,  disorganized,  and  filled  with  serum  darkly  covered  with  blood. 
[The  specimen,  presented  by  Surgeon  Frantz,  is  a  ligamentous  preparation  of  the  thorax,  and  is 
numbered  5092  in  the  Surgical  Section  of  the  Army  Medical  Museum. — ED.] 

CCCCXVI. — Remarlcs  on  a  Case  of  Contusion,  with  Fracture  of  the  Ribs,  followed  by  Necrosis.    By 
F.  H.  BARBARIN.  Acting  Assistant  Surgeon. 

Corporal  James  Kelly,  Co.  K,  5th  Cavalry,  aged  25  years,  was  injured  April  2, 1807,  while  riding. 
His  horse  fell,  throwing  him  with  his  left  side  upon  a  railroad  track,  and  falling  upon  his  left  leg. 
He  was  taken  upon  sick  report  for  April  3d,  and  treated  for  bruise  of  leg,  no  mention  being  made  of 
pain  of  any  kind  in  the  side.  On  November  10th,  Kelly  was  admitted  into  the  post  hospital  at 
Sedgwick  Barracks,  Washington,  on  account  of  the  injury  to  his  side.  On  December  1st,  there  were 
two  openings,  one  inch  apart,  over  the  anterior  portion  of  the  ninth  rib,  which  were  discharging  pus. 
The  point  of  a  probe  introduced,  discovered  the  bone  denuded  of  periosteum  for  about  one  inch. 
An  incision  was  made  uniting  the  two  openings,  and  flax-seed  poultices  applied,  with  the  hope  that, 
as  he  was  otherwise  in  perfect  health,  the  portion  of  necrosed  bone  would  be  thrown  off.  On  Feb- 
ruary 28,  1808,  chloroform  was  administered,  and  after  making  an  incision  of  some  four  inches  in 
the  course  of  the  rib,  a  piece  of  bone  one  and  a  half  inches  in  length  was  extracted.  Exposing 
the  bone  in  the  operation,  it  was  found  that  in  the  fall  he  had  received,  the  rib  had  been  fractured 
one  and  a  half  inches  from  its  sternal  extremity,  and  had  become  separated  from  its  cartilage. 
After  removing  the  piece,  the  end  of  the  remaining  portion  of  the  rib  was  smoothed,  and  a  small 
portion  of  the  superior  portion  of  the  tenth  rib  found  to  be  diseased  was  also  removed.  On 
November  3d,  the  patient  was  in  fine  condition,  and  the  wound  healing  kindly.  He  was  returned 
to  duty  in  April,  1808. 

"Almost  every  variety  of  fractures  of  the  ribs,  either  united,  with  or  without  deformity,  or  ununited  with  attempt 
at  repair,  are  illustrated  by  specimens  4917,  5027,  5172,  5173,  5174.  5177,  5178,  5180,  5181,  5504,  5506,  of  the  Surgical 
Series,  A.  M.  M.— ED. 


132  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCCXVII. — Memorandum  of   Simple  Fractures  of  the  Ribs  and  Clavicle.    By  J.  P.  ARTHUR, 
M.  D.,  Acting  Assistant  Surgeon. 

Sergeant  Joseph  I.  Allen,  Co.  C,  4th  Cavalry,  aged  27  years,  received  in  a  fall,  December  10, 
1870,  a  fracture  of  the  left  ninth  and  tenth  ribs  and  of  the  clavicle.  He  was  admitted  to  the  post  hos- 
pital at  Fort  Mclntosh,  Texas,  on  the  same  day.  Levis's  apparatus  was  applied.  He  was  returned 
to  duty  in  February,  1871. 


FRACTURES  OF  THE  UPPER  EXTREMITIES. — Of  the  numerous  injuries  of  this  group, 
particulars  of  comparatively  few  cases  were  reported  Several  reports  will  be  quoted 
here,  and  others  may  be  found  in  the  chapter  on  operations,  further  on. 

Fractures  of  the  Clavicle. — There  were  five  special  reports  of  fractures  of  the  collar 
bone,  besides  that  on  page  131.  This  accident,  common  in  military  as  in  civil  practice, 
is  usually  entered  on  the  reports  by  medical  officers  without  any  details.  It  is  desirable 
that  the  cause  and  seat  of  the  fracture,  the  method  of  dressing,  the  duration  of  treatment, 
and  the  degree  of  deformity  left,  should  be  noted  on  the  records. 

CCCCXVIII. — Remarks  on  a  Case  of  Fracture  of  tlie  Clavicle.      By  P.  MIDDLETON,   Assistant 

Surgeon,  U.  S.  A. 

Private  F.  Buruham,  Co.  D,  14th  Infantry,  was  admitted  to  the  hospital  at  Camp  Whipple, 
Arizona  Territory,  February  2,  1808,  with  a  fracture  of  the  middle  third  of  the  left  clavicle,  caused 
by  falling  from  a  mule.  The  apparatus  of  Levis*  was  immediately  applied,  and  continued  until 
February  27th,  when  the  fracture  was  found  to  be  fairly  united,  with  scarcely  any  deformity,  and 
the  apparatus  was  removed  and  a  bandage  to  support  the  arm  was  substituted,  with  instructions 
to  exercise  the  arm  daily.  On  February  29,  1808,  the  patient  was  convalescent. 

CCCCXIX. — Account  of  a  Fracture  of  the  Clavicle.    By  A.  HEGKER,  Surgeon,  U.  S.  A. 

At  Fort  Snelling,  Minnesota,  February  20,  1870,  William  Gohlke,  musician,  '20th  Infantry, 
aged  35  years,,  received,  by  an  accidental  fall,  a  fracture  of  the  left  clavicle.  He  was  admitted  to 
the  post  hospital  the  same  day.  Bandages  were  applied.  He  returned  to  duty  March  21,  1870. 

CCCCXX. — RemarJis  on  a  Case  of  Fracture  of  the  Clavicle.    By  C.  R.  GREENLEAF,  Assistant 
Surgeon,  U.  S.  A. 

Private  F.  Hofner,  Co.  A,  25th  Infantry,  aged  20  years,  was  admitted  to  the  post  hospital  at 
Taylor  Barracks,  Louisville,  Kentucky,  July  27,  1S68,  with  a  fracture  of  the  outer  third  of  the  left 
clavicle,  received  by  falling  a  distance  of  four  feet  upon  his  shoulder,  while  intoxicated.  Fox's 
apparatus  was  applied,  which,  although  it  did  not  secure  complete  reduction,  kept  the  shoulder  and 
arm  fixed.  On  July  31st,  Fox's  apparatus  was  removed,  and  a  figure-of-eight  bandage,  with  axillary 
pad  and  sling  used.  There  was  some  ecchyniosis  over  the  fracture,  which  was  ordered  to  be  rubbed 
with  a  stimulating  liniment.  On  August  21st,  callus  had  formed,  and  the  bandages  were  removed. 
There  was  shortening  of  the  arm,  but  no  great  deformity.  He  was  returned  to  duty  October 
2,  1808. 

CCCCXXI. — Account  of  a  Case  of  Fracture  of  the  Clavicle.    By  IRVING  C.  ROSSE,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  James  Reynolds,  of  Battery  A,  3d  Artillery,  was  taken  on  sick  report  at  Fort  Mon- 
roe, Virginia,  February  10,  1870,  having  sustained  an  oblique  fracture  uear  the  middle  of  the  left 

*  Dr.  Richard  J.  Levis  described  his  apparatus  for  fracture  of  the  clavicle  in  the  Annr'mai  Journal  of  the  Mnin-al 
Sciences,  Vol.  XXAVI,  p.  100.  It  is  also  figured  and  commended  in  Professor  Gross's  System  of  Surgery,  4th  ed.,  1866,  Vol. 
I,  p.  900.  [The  attention  of  medical  officers  is  invited  to  Specimen  5302,  Surgical  Series,  A.  M.  M.,  which  demonstrates 
the  usual  modes  of  distortion  and  deformity  in  nine  united  fractures  of  the  clavicle. — ED.] 


SIMPLE  AND  COMPOUND  FRACTURES.  133 

clavicle,  from  indirect  violence.  There  was  much  displacement,  swelling,  and  suggillation.  The 
indications  for  keeping  the  shoulder  upward,  outward,  and  backward  were  fulfilled  by  placing  a 
wedge-shaped  pad  in  the  axilla,  which  was  held  in  position  by  strings  of  tape  passing  around  the 
shoulder  of  the  opposite  side ;  a  triangular  bandage  was  next  applied,  the  initial  end  being  placed 
on  the  shoulder  of  the  sound  side,  and  a  few  turns  taken  over  it  and  the  elbow.  The  arm  was  then 
fixed  to  the  side  by  several  more  turns  around  the  elbow  and  the  body,  and  the  fore-arm  was  placed 
in  a  sling.  Through  the  patient's  indulgence  in  frolicking,  the  fragments,  after  partial  union,  were 
twice  misplaced.  He  recovered,  and  was  returned  to  duty  May  5,  1870. 

CCCCXXII. — Remarks  on  a  Case  of  Fracture  of  the  Clavicle.    By  J.  P.  KIMBALL,  Assistant  Surgeon, 
U.  S.  A. 

Sergeant  Samuel  Wright,  Co.  C,  13th  Infantry,  was  admitted  to  the  hospital  at  Fort  Buford, 
Dakota  Territory,  October  17,  1869,  with  a  simple  fracture  of  the  left  clavicle,  produced  by  being 
thrown  from  a  horse,  and  falling  upon  his  left  shoulder.  The  fracture  was  oblique,  and  situated 
near  the  outer  end  of  the  middle  third  of  the  clavicle.  The  sternal  fragment  overlapped  the  acro- 
mial  about  one  inch.  The  patient  stated  that  when  about  10  years  of  age  the  same  clavicle  was 
broken  in  the  same  place  by  direct  violence,  but  that  no  subsequent  deformity  resulted.  He  does 
not  remember  to  have  received  any  treatment  at  that  time.  The  present  fracture  was  treated  with 
Hamilton's  apparatus.*  Union  appeared  complete  on  November  9th,  twenty-three  days  after  admis- 
sion, and  the  patient  was  returned  to  duty  November  13th.  The  limb  was  shortened  one-quarter  of 
an  inch,  with  slight  displacement  of  the  outer  end  of  the  inner  fragment  above  the  inner  end  of  the 
outer  fragment. 


Fractures  of  the  Humerus. — Besides  the  gunshot  fractures  and  the  cases  referred 
to  in  the  chapter  on  operations,  special  reports  of  but  two  cases  of  fracture  of  the  arm  were 
forwarded.  Both  were  instances  of  compound  and  comminuted  fractures. 

CCCCXXIII. — Remarks  on  a  Case  of  Compound  Fracture  of  the  Humerus.    By  J.  P.  KIMBALL,  Assist- 
ant Surgeon,  U.  S.  A. 

Private  Anthony  Welsh,  Company  H,  13th  Infantry,  aged  27  years,  was  injured  October  8, 
1869,  about  eight  miles  from  Fort  Buford,  Dakota  Territory,  by  the  passage  of  a  heavy  Army  wagon 
over  his  left  arm,  producing  a  compound  fracture  of  the  humerus  at  its  middle  third.  When  first 
seen  by  the  post  surgeon,  about  an  hour  after  the  accident,  the  lower  fragment  was  found  protrud- 
ing through  the  skin  covering  the  lower  portion  of  the  deltoid  muscle,  having  apparently  been 
thrust  through  after  the  fracture  had  taken  place  by  the  ill-directed  efforts  of  the  persons  about 
him.  The  arm  was  temporarily  put  up  in  splints  made  from  a  cracker-box,  and  the  patient  was 
taken  to  the  post  hospital  at  Fort  Buford.  The  arm  was  severely  bruised,  greatly  swollen,  and  the 
wound  bleeding  moderately.  The  next  morning  the  patient  was  hot  and  feverish ;  pulse  105,  full 
and  strong ;  arm  still  greatly  swollen  and  discolored.  On  October  12th,  the  patient  was  doing 
well;  the  febrile  excitement  had  greatly  diminished ;  the  swelling  and  puffiness  of  the  arm  were 
subsiding,  and  the  wound  suppurating  moderately.  The  patient  continued  to  do  well,  and  on 
November  Gth  the  splints  were  removed ;  the  wound  had  healed,  and  the  union  of  the  fracture  was 
complete ;  there  was  very  slight  false  anchylosis  of  the  elbow.  On  November  21,  1869,  Welsh  was 
returned  to  duty ;  the  anchylosis  of  the  elbow  was  completely  removed ;  there  was  no  shortening 
of  the  arm. 

The  next  report  is  interesting  as  including  an  instance  of  rupture  of  the  liver  without 
breach  of  the  integument. 

"  A  figure  of  "The  Author's  Apparatus"  may  be  found  at  page  199  of  the  third  edition  of  Dr.  F.  H.  Hamilton's 
1'rarlieal  Treatise  on  Fracture*  ainl  Dislocations,  Philadelphia,  I860. 


134  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCCXXIV. — Account  of  a  Fatal  Eaihcay  Injury.     By  ELLIOTT  COUES,   Assistant   Surgeon, 
U.  S.  A. 

Private  Robert  Materne,  Co.  H,  6th  Infantry,  was  injured  at  Columbia,  South  Carolina,  on 
December  30,  1867,  by  a  railroad  accident.  The  case  terminated  fatally  in  about  ten  hours.  The 
right  Immerus  was  fractured  a  little  above  the  joint,  and  drawn  through  the  skin.  Internal  inju- 
ries, however,  were  the  immediate  cause  of  death.  On  examination,  the  liver  was  found  lacerated 
in  three  directions,  being  completely  ruptured  into  three  pieces,  which  were  only  held  together  by 
the  peritoneal  investment.  A  great  quantity  of  coagulated  blood  lay  about  the  parts.  The  lungs 
were  much  contused,  and  many  of  their  smaller  vessels  ruptured.  Singularly  enough,  no  ribs  were 
broken. 


Fracture  of  the  Radim  and  Ulna. — Apart  from  those  cases  of  injuries  of  the 
fore-arm  which  demanded  operations,  details  were  given  of  but  two  fractures  of  the  radius, 
and  one  of  the  ulna. 

CCCCXXV. — Note  of  a  Fracture  of  the  Radim.    By  J.  II.  BARTHOLF,  Assistant  Surgeon,  U.  S.  A. 

Private  Edward  Jamison,  Co.  A,  llth  Infantry,  aged  24  years,  was  admitted  to  the  post 
hospital  at  Camp  Grant,  near  Richmond,  on  December  19,  1867,  with  simple  fracture  of  the  left 
radius  at  the  middle  third,  caused  by  falling  down  a  stairway.  The  fore-arm  was  placed  in  a 
supine  position,  and  straight  board  splints,  somewhat  wider  than  the  fore-arm,  applied,  and  held 
in  place  by  adhesive  straps,  near  the  upper  and  lower  extremities  of  the  splints,  the  sides  being 
left  to  give  a  view  of  the  parts.  The  arm  was  then  put  in  a  sling.  On  February  l()th,  the  splints 
were  removed.  There  was  good  union,  and  free  motion  without  deformity.  A  slight  callus  marked 
the  seat  of  the  fracture.  Patient  was  returned  to  duty  on  February  10,  1868. 

CCCCXXVI.— Note  of  a  Fracture  of  the  Radius.    T.  F.  AZPELL,  Assistant  Surgeon,  U.  S.  A. 

Private  W.  Chapman,  general  service,  was  injured  September  24, 1868,  by  falling  about  seven  feet 
from  the  seat  of  a  wagon  truck,  which  caused  a  simple  fracture  of  the  lower  extremity  of  the  left 
radius.  He  was  admitted  to  the  hospital  at  David's  Island,  on  October  13th ;  the  fractured 
extremities  of  the  radius  being  approximated,  and  the  hand  kept  between  pronation  and  supina- 
tion,  a  wooden  adaptable  splint  was  placed  upon  the  posterior  aspect  of  the  fore-arm ;  a  piece  of 
binder's  board  of  the  proper  size,  well  dampened  and  pliable,  was  placed  upon  the  anterior  portion, 
and  both  kept  in  position  by  a  roller  bandage,  which  was  so  adapted  as  to  draw  the  extremity  ot 
the  fingers  downward,  so  as  to  produce  extension.  Patient  recovered  without  any  bad  symptoms  ; 
the  motion  of  the  fore-arm  and  wrist  was  perfect,  without  any  deformity.  Returned  to  duty. 

CCCCXXVIL— Note  of  a  Simple  Fracture  of  the  Ulna.    By  C.  C.  GRAY,  Surgeon,  U.  S.  A. 

Private  H.  Hampton,  Co.  I,  31st  Infantry,  aged  19  years,  presented  himself  at  surgeon's  call, 
at  Fort  Stevenson,  Dakota,  on  February  10,  1868,  with  a  transverse  fracture  in  the  middle  of  the 
right  ulna,  the  result  of  a  fall  against  a  box,  which  he  had  received  a  few  moments  before.  Pistol- 
shaped  splints,  cut  from  a  shingle  and  padded,  without  an  interosseous  compress  were  applied. 
On  March  7th,  the  splints  were  dispensed  with,  the  limb  being  still  retained  in  a  sling;  occasional 
passive  and  voluntary  motion  was  prescribed.  The  patient  recovered  without  any  deformity  of  the 
limb  whatever,  and  was  returned  to  duty  on  March  21, 1868. 


SIMPLE  AND  COMPOUND  FRACTURES.  135 

Fractures  of  the  Carpal  Phalanges. — A.  single  case  is  specially  reported. 

CCCCXXVIII. — Minute  of  a  Case  of  Compound  Fracture  of  a  Phalanx.    By  E.  F.  BAKER,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Eli  Hubbard,  Co.  K,  15th  Infantry,  aged  19  years,  on  fatigue  duty  at  Cleburne, 
Alabama,  May  27,  1808,  had  his  hand  crushed  by  a  weight,  causing  compound  comminuted  fracture 
of  second  phalanx  of  the  left  middle  finger.  At  the  post  hospital,  the  fractured  ends  of  the  bone 
were  placed  in  opposition,  the  wound  was  closed  with  sutures,  and  kept  in  position  by  compresses 
and  roller  bandages.  The  soldier  was  returned  to  duty  on  June  30,  1808. 


PRACTUEES  OF  THE  LOWER  EXTREMITIES. — In  regard  to  the  numerous  cases  of  this 
category,  special  reports  were  made  in  fourteen  instances,  in  addition  to  the  reports  of 
cases  in  which  operations  were  practiced.  Details  were  given  of  four  examples  of  fracture 
of  the  femur,  one  of  which  was  believed  to  be  intra-capsular,  of  one  fracture  of  the 
patella,  and  of  nine  fractures  of  one  or  both  bones  of  the  leg. 

Fractures  of  the  Femur. — Special  reports  were  made  of  four  cases  treated  by  angular 
splints. 

CCCCXXIX. — Mention  of  a  Fracture  of  the  Femur.    By  E.  F.  BAKER,  M.  D.,  Acting  Assistant 
Surgeon. 

At  Savannah,  Georgia,  in  October,  1808,  Private  John  Carroll,  Co.  F,  12th  Infantry,  while 
laboring  under  an  attack  of  delirium  treinens,  leaped  from  the  second  story  balcony  of  the  post 
hospital  to  the  ground,  causing  a  slightly  oblique  fracture  of  the  right  femur,  a  short  distance 
below  the  great  trochanter.  The  limb  was  placed  in  splints,  and  extension  and  counter-extension 
made  by  means  of  adhesive  strips  applied  to  the  leg,  and  a'  perineal  band.  The  case  progressed 
favorably,  and  in  January,  1869,  Carroll  was  transferred  to  Fort  Pulaski. 

CCCCXXX. — Remarks  on  a  Case  of  Fracture  of  the  Femur.    By  A.  G.  SKINNER,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Thomas  McCann,  Co.  A,  42d  Infantry,  aged  40  years,  was  brought  to  the  hospital  at 
Fort  Niagara,  New  York,  September  23,  1808,  having  fallen  the  earlier  part  of  the  preceding  night, 
while  intoxicated,  and,  being  unaole  to  assist  himself,  had  lain  where  he  fell  until  morning.  On 
examination,  the  left  thigh  was  found  fractured  near  the  small  trochanter,  but  the  swelling  was  so 
immense  that  the  exact  condition  of  the  bone  could  not  then  be  determined.  The  limb  was  nearly 
two  inches  shorter  than  its  fellow,  with  no  eversion  of  the  toes.  The  muscles  of  the  upper  portion 
of  the  thigh  were  in  a  state  of  spasmodic  contraction.  Two  assistants  were  directed  to  make 
extension  and  counter-extension ;  as  not  the  slightest  effect  was  produced  by  this  force,  two  others 
were  directed  to  aid ;  for  ten  minutes  this  force  was  continued  without  effect ;  two  more  men  were 
then  added  to  the  force,  when,  after  a  few  minutes  steady  effort,  the  bone  came  to  its  place  with 
an  audible  crepitus,  resembling  the  sound  heard  in  reducing  luxations.  Iinpactiou  of  fragments 
had  doubtless  occurred  at  the  seat  of  fracture.  The  limb  was  placed  in  an  Amesbury  splint  (the 
only  one  within  reach),  the  thigh  piece  being  lengthened  to  come  firmly  to  the  buttock  ;  adaptation 
splints  were  applied,  and  a  roller  bandage  to  embrace  the  whole  limb.  During  the  day,  the 
patient  recovered  from  his  inebriation,  with  loss  of  appetite  and  sick  stomach  ;  but  complained  ot 
of  very  little  pain.  The  limb  continued  swollen  for  about  a  week,  when  the  swelling  abated, 
and  almost  entirely  disappeared  at  the  end  of  the  second  week.  The  patient  did  not  complain  of 
pain  throughout  the  treatment,  except  from  the  occasional  chafing  of  bandages,  and  being  confined  in 
one  position.  The  dressings  were  removed  at  the  end  of  seven  weeks,  at  which  time  the  bone 


136  EEPOET  OF  SURGICAL  OASES  IN  THE  AEMY. 

seemed  well  united  at  the  seat  of  fracture,  and  tbe  patient  was  able  to  walk  on  crutches.  The 
limb  was  shortened  from  one-half  to  five  eighths  of  an  inch.  McCann  was  returned  to  duty  in 
March,  1869. 

CCOCXXXI.— Abstract  of  a  Report  of  a  Simple  Fracture  of  the  Upper  Third  of  the  Right  Femur.    By 
E.  H.  BOWMAN,  M.  D.,  Acting  Assistant  Surgeon. 

Lieutenant  W.  E.  Sweet,  Co.  A,  24th  Infantry,  being  thrown  from  a  carriage  on  April  5,  1870, 
by  a  mule  team  running  away,  had  his  right  femur  fractured  at  the  upper  part  of  the  middle  third. 
He  was  taken  to  the  post  hospital  at  Fort  Bliss,  Texas,  soon  after  the  accident.  The  treatment 
consisted  in  bringing  the  fractured  bones  in  apposition,  securing  by  splints  and  bandages,  and 
placing  the  limb  on  a  double-inclined  plane.  On  the  twenty-first  day  after  the  injury,  I  was 
discharged  from  attendance  on  the  patient.  The  limb  had  less  than  the  usual  shortening.  Drs. 
Marsh  and  White  pronounced  the  shortening  only  one  inch.  The  case  had  a  favorable  issue,  and 
the  lieutenant  was  returned  to  duty  on  July  11, 1870. 

CCCCXXXII. — Account  of  a  Fracture  of  the  Femur,  supposed  to  be  within  the  Capsule.    By  IKVING 
C.  EOSSE,  M.  D.,  Acting  Assistant  Surgeon. 

About  July,  1870,  my  professional  attention  was  called  to  a  female  child  of  six  years,  an 
inmate  of  the  laundress's  quarters  at  Fort  Monroe,  Virginia,  whom  I  at  first  believed,  from  the 
history  given  by  its  parents,  to  be  suffering  from  infantile  paralysis.  Having  the  patient  stripped, 
my  attention  was  called  by  George  E.  Cooper,  Surgeon,  U.  S.  A.,  to  the  peculiar  everted  position 
of  the  right  foot,  and  the  inability  to  place  it  on  the  floor.  Manipulation  of  the  limb  was  exceed- 
ingly painful,  and  further  examination  revealing  crepitus  in  the  femur,  fracture  within  the  capsule 
was  diagnosed.  A  fracture-bed  was  at  once  improvised;  the  limb  was  placed  on  a  pillow,  and 
extension  produced  by  means  of  a  weight  of  several  pounds  suspended  over  a  pulley  by  a  cord, 
which  was  attached  to  the  leg  by  broad  bands  of  adhesive  plaster.  This  mode  of  extension  not 
being  satisfactory,  and  productive  of  much  discomfort  to  the  little  patient,  I  was  induced  to  aban- 
don it  after  a  few  days  and  to. try  the  anterior  wire  splint  with  suspension.  An  appropriate  one  was 
made  and  applied,  care  being  taken  to  bandage  it  firmly  around  the  body,  and  to  preserve  the 
obliquity  of  the  suspending  cord.  The  remainder  of  the  treatment  was  conducted  on  the  principles 
peculiar  to  fractures  in  general.  Although  this  case  did  not  get  the  attention  I  desired,  owing  to 
the  carelessness  and  indifference  of  the  mother,  yet  recovery,  after  a  reasonable  time,  was  com- 
plete. On  May  10,  1871,  Charles  Smart,  Assistant  Surgeon,  U.  S.  A.,  writes  that  he  found  a 
perceptible  shortening  in  the  limb  of  one-fourth  of  an  inch,  but  not  enough  to  give  any  halt  in  the 
gait. 


Fractures  of  the  Patella. — A  single  case  was  specially  reported.  The  cause  of  injury 
was  not  mentioned,  nor  was  tbe  direction  of  the  fracture  described.  It  is  hoped  that 
hereafter  medical  officers  will  note  such  particulars  in  their  reports.* 

CCCCXXXIII.— Report  of  a  Case  of  Fracture  of  the  Patella.  By  W.  CRAIG,  M,  D.,  Acting  Assistant 
Surgeon. 

Private  George  Johnson,  Co.  A,  40th  Infantry,  aged  24  years,  received  a  fracture  of  the  patella 
of  the  left  leg  on  April  2,  18G7.  He  was  admitted  to  the  post  hospital  at  Fort  Caswell,  North 
Carolina,  on  the  4th.  The  fragments  were  retained  in  close  apposition  by  means  of  adhesive  strips. 
He  was  discharged  June  17,  1808. 

*  Officers  can  consult,  in  the  Army  Medical  Museum,  an  excellent  series  of  fractures  of  the  patella  united  by  bony 
or  by  ligamentous  union.    The  are  numbered  5353,  5354,  5355,  5364,  5413,  5414,  5415,  Surgical  Series.— ED. 


SIMPLE  AND  COMPOUND  FRACTURES.  137 

Fractures  of  the  Leg. — Nine  special  reports  come  under  this  class.     In  four  cases 
the  tibia  and  fibula  were  fractured,  in  five  the  tibia  only. 

CCCCXXXIV.— Remarks  on  a  Case  of  Fracture  of  the  Tibia.    By  G.  S.  ROSE,  Assistant  Surgeon, 
U.  S.  A. 

Private  Ira  V.  Beam,  Co.  B,  29th  Infantry,  aged  26  years,  was  riding  on  a  box-car  on  Septem- 
ber 28,  1868,  when  the  car  rolled  over  an  embankment.  His  leg  was  caught  under  a  large  box  of 
freight  and  crushed,  causing  a  compound  fracture.  He  was  taken  to  the  post  hospital  at  Camp 
Schofield,  Lynchburg,  Virginia.  The  external  wound  was  not  large;  the  soft  parts  were  not  greatly 
destroyed.  The  wound  was  situated  just  over  the  spine  of  the  tibia,  about  its  middle  and  to  the 
inner  side.  The  leg  was  bandaged  and  a  small  splint  applied  along  its  outer  side,  the  wound 
having  been  left  exposed  so  as  to  have  constant  and  ready  application  of  carbolic  acid,  with  which 
the  limb  was  dressed.  The  patient  made  a  good  recovery,  and  on  December  3,  1868,  was  reported 
as  entirely  well,  walking  without  the  aid  of  crutches.  The  limb  was  not  shortened. 

CCCCXKXV. — Mention  of  a  Case  of  Fracture  of  the  Tibia.    By  P.  MEAOIIAM,  Assistant  Surgeon, 
U.  S.  A. 

Private  William  Janke,  Co.  K,  9th  Infantry,  met  with  a  simple  oblique  fracture  in  the  lower 
third  of  the  right  tibia  at  Omaha  Barracks,  Nebraska,  on  January  15,  1871.  The  injury  was 
treated  with  immovable  plaster  splints.  The  patient  made  a  good  recovery.  There  was  but  little 
deformity,  and  no  perceptible  shortening. 

CCCCXXXVL— Note  on  a  Case  of  Fracture  of  the  Tibia.    By  W.  H.  ELBRIDGE,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Thomas  Pomfort,  Co.  H,  5th  Cavalry,  received  on  January  7,  1868,  a  kick  from  a 
horse,  causing  a  fracture  of  the  tibia  four  inches  below  the  knee.  He  was  admitted  to  the  post  hos- 
pital at  Aiken,  South  Carolina,  where  a  fragment  of  the  tibia,  three  quarters  of  an  inch  in  diameter, 
was  removed  by  Assistant  Surgeon  A.  C.  Girard,  U.  S.  A.,  and  Acting  Assistant  Surgeon  T.  M. 
Stuart.  On  March  20th,  Smith's  anterior  splint  was  applied  to  the  limb.  This  man  was  returned 
to  duty  in  September,  1868. 

CCCCXXXVII. — Remarks  on  a  Case  of  Fracture  of  the  Tibia.    By  J.  J.  PUECELL,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Henry  Noyes,  Co.  H,  1st  Artillery,  aged  21  years,  was  admitted  to  the  hospital  at 
Fort  Schuyler,  New  York  Harbor,  on  September  26,  1867,  with  a  simple  fracture  at  the  junction  of 
the  middle  and  lower  thirds  of  the  right  tibia,  caused  by  the  falling  of  a  gun-carriage  upon  it  that 
morning.  The  fracture  was  nearly  transverse,  and  was  set  without  difficulty  and  placed  in  a  frac- 
ture-box, the  ends  remaining  in  apposition.  The  case  progressed  favorably,  and  on  January  21, 
1868,  he  was  returned  to  duty,  at  which  time  he  had  entirely  recovered.  Upon  careful  measure- 
ment no  perceptible  shortening  could  be  discovered,  and  there  was  but  slight  deformity  at  the  seat 
of  fracture. 

CCCCXXXVIII. — Note  relative  to  a  Case  of  Fracture  of  the  Tibia  and  Fibula.    By  J.  SAUNDEIIS, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Thomas  Pumphrey,  Co.  E,  6th  Cavalry,  aged  21  years,  was  admitted  to  the  post  hos- 
pital at  Pilot  Grove,  Texas,  December  15,  1868,  with  a  compound  fracture  of  the  left  tibia  and 
fibula  at  junction  of  middle  and  lower  thirds.  The  tibia  projected  through  the  integument  and 
was  covered  with  mud.  The  limb  was  placed  in  a  Butcher's  box,  and  carbolic  acid  lotions  were 
applied.  On  December  31st  the  case  was  progressing  finely.  He  was  admitted  to  the  hospital  at 
Greenville,  Texas,  convalescent,  on  April  12,  1869;  and  was  discharged  the  service  April  20,  1869, 
his  term  of  service  having  expired. 
18 


138  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCCXXXIX.— Mention  of  a  Case  of  Fracture  of  tlie  Leg.    By  W.  E.  DAY,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  George  Scott,  Co.  M,  3d  Artillery,  aged  21  years,  sustained  June  26, 1869,  a  com- 
pound fracture  of  the  tibia  and  fibula  of  the  right  leg,  by  a  blow  from  a  lever  of  a  capstan.  He 
was  admitted  to  the  post  hospital  at  Fort  Jefferson  the  same  day.  Cold  water  and  simple  dress- 
ings were  applied.  He  was  discharged  from  service  March  5,  1870,  on  surgeon's  certificate  of 
disability,  "  by  reason  of  shortening  of  the  right  leg." 

CCCCXL. — Mention  of  two  Cases  of  Fracture  of  the  Leg,  successfully  treated  by  Smith's  Anterior 
Splint.    By  IKVING  C.  ROSSE,  M.  D.,  Acting  Assistant  Surgeon. 

CASE  1. — On  March  17,  1868,  I  was  requested  to  see  a  Mexican  vaquero  who  had  broken  his 
right  leg  in  attempting  to  lasso  a  wild  ox  near  Point  Isabel,  Texas.  The  animal  had  thrown  the 
horse  by  means  of  a  lariat  made  fast  to  the  saddle,  and  both  bones  of  the  rider's  leg  were  crashed 
by  the  fall.  An  anterior  suspension  wire  splint  was  applied  a  few  hours  after  the  reception  of  the 
injury.  Several  days  subsequently,  the  friends  of  the  patient  desired  to  take  him  to  his  home,  a 
ranche  distant  about  twelve  miles.  Without  seeking  medical  advice  they  caused  him  to  make  this 
journey  on  a  mustang  pony,  the  Rio  Grande  River  being  crossed  on  the  route.  Strange  to  say, 
he  suffered  but  little  inconvenience  from  the  ride,  and  made  a  good  recovery  in  about  six  weeks. 
The  patient  was  a  young  man  accustomed  to  a  diet  of  beef,  beans  (frijoles),  and  maize,  and  pos- 
sessed the  physique  common  to  persons  of  his  vocation. 

CASE  2 — John  Wilson,  aged  about  50  years,  mate  of  the  brig  "Peerless,''  bound  to  Rio  Janiero, 
had  both  bones  of  his  right  leg  broken  by  getting  caught  in  the  cable  whilst  letting  go  anchor 
in  Hampton  Roads  on  April  30, 1869.  He  was  brought  ashore  at  Fort  Monroe,  Virginia,  and 
when  seen  was  much  depressed.  The  fragments  of  bone  were  properly  adjusted,  and  Smith's  ante- 
rior splint  was  applied  to  the  injured  member.  Shortly  afterward  the  patient  was  sent  to  his  home 
in  Baltimore,  from  which  place  he  advised  me  of  his  successful  recovery  and  return  to  his  ordinary 
avocation. 

CCCCXLI.i— JRewarfra  on  a  Case  of  Fracture  of  the  Tibia.    By  JOHN  I.  HXILSE,  M.  D.,  Acting  Assist- 
ant Surgeon. 

Private  Louis  Wilson,  Co.  F,  4th  Cavalry,  on  April  16,  1868,  while  driving  a  quarter- 
master's team,  on  the  road  to  Fort  McKavett,  Texas,  being  intoxicated  and  reeling  to  one  side, 
was  thrown  from  his  seat  by  a  wild  mule,  both  wheels  of  the  wagon  going  over  both  legs,  bruising 
the  left  leg,  and  producing  a  compound  comminuted  fracture  of  the  right  tibia,  just  above  the 
ankle-joint.  He  was  brought  to  Fort  Mason,  Texas,  a  distance  of  sixteen  miles,  in  an  ambulance, 
and  his  injuries  treated  with  simple  dressings,  the  fractured  leg  being  placed  on  a  padded  board, 
having  a  slight  elevation.  Inflammation  soon  subsided,  and  on  the  27th  instant  he  was  returned 
to  his  command,  with  good  prospect  of  complete  recovery,  and  the  following  month  returned  to 
duty. 

Seven  of  these  fractures  of  the  leg  were  compound,  and  two  were  simple.  All  the 
patients  recovered  without  much  deformity  except  two,  who  were  discharged  for  disability. 
Treatment  by  some  form  of  suspensory  apparatus  appears  to  be  generally  preferred  by  the 
medical  officers. 


DISLOCATIONS.  139 

DISLOCATIONS. — Six  hundred  and  twenty-five  cases  of  luxation  of  joints  appear  upon 
the  returns  for  the  period  covered  by  this  report ;  but  special  histories  were  forwarded  in 
a  few  instances  only. 

Dislocations  of  the  Vertebrce. — Histories  of  two  fatal  cases  of  luxation  of  the  cervical 
vertebrae  were  received. 


CCCCXLII. — Memorandum  of  a  Case  of  Luxation  of  the  Atlas  on  the  Axis.    By  J.  K.  WALSH,  M. 
D.,  Acting  Assistant  Surgeon. 

Lieutenant  Justinian  Alman,  Troop  I,  4th  Cavalry,  was  killed  March  17,  1808,  in  a  collision 
between  the  boat  in  which  he  was  returning  to  town  ^Jefferson,  Texas)  and  the  steamboat  J.  M. 
Sharpe.  He  was  struck  by  the  paddles  of  the  wheel  and  carried  under.  His  body  was  once  thrown  to 
the  surface  by  the  eddies  of  the  water,  and  then  sank.  Every  effort  was  made  to  secure  his  remains, 
but  without  avail,  until  the  sixth  day  after  the  disaster,  when  the  body,  in  a  very  advanced  stage 
of  decomposition,  rose  to  the  surface.  The  remains  were  buried  the  following  day,  in  the  Hebrew 
Cemetery,  in  compliance  with  the  wish  of  his  family.  An  autopsy  revealed  a  dislocation  of  the 
atlas  upon  the  second  cervical  vertebra,  with  rupture  of  the  transverse  ligament,  and  the  odontoid 
process  impinging  upon  the  spinal  marrow. 

CCCCXLIIL— Report  on  a  Dislocation  of  the  Fifth  Cervical  Vertebra.    By  C.  C.  GKAY,  Assistant 
Surgeon,  U.  S.  A. 

On  the  morning  of  February  10,  1860,  I  was  called  -to  see  Private  John  P ,  Co.  B,  2d 

Infantry,  who  was  reported  badly  hurt  by  a  fall.  I  found  the  patient,  a  muscular,  powerful,  Ger- 
man, aged  35,  laying  upon  a  table  in  the  company  kitchen  ;  face  pale,  respira- 
tion sighing;  pulse  slow  and  full.  It  appeared  that  about  ten  minutes  before 
he  had  invited  the  bystanders  to  witness  a  gymnastic  feat.  A  few  yards  away 
the  ground  was  thickly  littered  with  short  straw  which  had  been  emptied  from 
bed-sacks.  Starting  toward  this  straw  he  ran  a  few  steps  and  bounding  two  or 
three  feet  into  the  air,  attempted  to  throw  a  somersault  without  touching  hands 
or  head.  Although  accustomed  to  perform  this  exploit,  he  from  some  cause 
failed  upon  this  occasion ;  instead  of  alighting  upon  his  feetj  his  head  struck  the 
earth,  and  he  rolled  over  upon  his  side  and  lay  motionless.  As  he  did  not  arise 
his  comrades  approached  and  found  him  in  the  condition  before  mentioned. 
Upon  examination,  I  found  that  sensation  and  power  of  motion  were  alike 
wanting  from  the  neck  downward.  The  walls  of  the  chest  were  motionless 
and  respiration  was  effected  by  the  diaphragm  alone.  He  was  unable  to  raise 
his  head,  but  moved  it  freely  from  side  to  side.  In  attempting  to  examine  the  FIG  21  Lt)xation  of 
neck,  it  was  necessary  to  lift  the  head  from  the  table,  which  movement  caused  the  fifth  upon  the  fourth 
so  much  distress  that  I  was  obliged  to  desist.  I  however  discovered,  as  ^"Vr^  w*"' 

.  o4y,  oCCt.  1,  A.  .ol.  .II. 

I  thought,  a  slight  but  unusual  depression  immediately  below  the  spinous  pro- 
cess of  the  fourth  or  fifth  cervical  vertebra.  The  patient  was  conveyed  to  the  regimental  hospital 
and  placed  upon  a  hard  mattress,  all  pillows  having  been  removed.  Assistant  Surgeon  S.  H.  Hor- 
ner,  U.  S.  A.,  was  called  in  consultation,  and  we  endeavored  to  ascertain  the  nature  and  extent  of 
the  injury.  By  carefully  supporting  the  head,  the  patient  was  turned  partially  upon  his  side  and  a 
clear  view  of  the  posterior  parts  of  the  neck  obtained.  The  examination  was  very  unsatisfactory, 
for  so  thick  were  the  layers  of  muscle  and  fat  that  the  usual  landmarks,  the  spinous  processes, 
were  confused,  and  we  were  unable  to  arrive  at  a  positive  diagnosis.  It  was  clear,  however,  that 
there  was  an  abnormal  gap  or  depression  between  the  spinous  processes  of  the  fourth  and  fifth  or 
fifth  and  sixth  cervical  vertebra;;  that  pressure  at  this  point  of  depression  gave  slight  pain;  that 
there  was  an  absence  of  crepitus,  and  that  the  movements  of  the  head  upon  the  atlas,  and  of  the 


140  EEPOBT  OF  SURGICAL  CxVSES  IN  THE  ARMY. 

atlas  upon  the  axis,  were  such  as  to  prove  that  these  articulations  were  not  involved.  Respiration 
indicated  that  the  lesion,  whatever  its  nature,  was  below  the  origin  of  the  phrenic  nerve,  while  the 
total  paralysis  of  the  upper  extremities  could  not  be  explained  upon  any  other  theory  than  that  of 
injury  higher  than  the  origin  of  the  brachial  plexus.  It  was  further  agreed  that  \ve  were  not  likely 
to  benefit  the  patient  by  attempting  to  rectify  a  distortion  concerning  the  nature  of  which  we  were 
ignorant.  From  this  time  forth  he  was  accordingly  undisturbed.  My  function  consisted  in  direct- 
ing such  small  attentions  as  were  possible  in  the  case,  and  in  watching  the  process  of  dying.  He 
lay  perfectly  supine,  breathing  by  the  diaphragm,  suffered  no  pain,  and  was  able  to  swallow  small 
quantities  of  fluids.  His  pulse,  which  immediately  after  the  accident  had  been  78,  iu  two  hours  had 
fallen  to  72.  Respiration  20  per  minute.  In  the  evening  about  three  ounces  of  turbid  urine  was 
drawn  oft'  by  the  catheter.  He  sank  gradually,  dying  at  6  A.  M.  on  February  12,  forty-four  hours 
after  the  reception  of  the  injury.  An  autopsy  was  made  five  hours  after  death ;  the  rigor  mortis- 
was  imperfectly  established ;  suggillatiou  general  over  posterior  portions  of  body;  ulceration  had 
already  commenced  over  sacrum.  The  lower  and  back  part  of  the  neck  exhibited  slight  tumefac- 
tion, yet  sufficient  to  obliterate  the  depression  which  had  been  felt  during  life.  The  whole  of  the 
cervical  portion  of  the  spinal  column  was  exposed  by  dissection,  revealing  a  dislocation  backward 
of  the  fifth  vertebra.  Both  the  superior  articulating  processes  of  this  bone  looked  directly  back- 
ward, and  its  bifid  spinous  process  was  astride  of,  and  locked  fast  upon,  the  neck  of  the  spinous 
process  of  the  sixth  cervical  vertebra.  So  perfect  was  this  impaction  or  locking  that  the  spinous 
processes  of  the  fifth  and  sixth  vertebras  could  only  be  felt  as  one  until  after  all  the  soft  tissues 
covering  them  had  been  dissected  away.  The  luxation  was  "symmetrical"  in  respect  to  lateral 
displacement.  Of  course  there  was  a  wide  interval,  one  and  a  half  inches,  between  the  spines  of 
the  fourth  and  fifth  vertebra?,  which  interval  contributed  the  depression  felt  upon  the  first  examina- 
tion of  the  patient.  There  was  no  fracture  of  the  body,  pedicles  or  lamina;  of  the  displaced  bone, 
but  on  the  right  side  a  portion  of  the  anterior  tubercle  of  the  transverse  process  had  snapped  off'. 
The  tip  of  the  left  division  of  the  spinous  process  of  the  third  cervical  vertebra  was  separated, 
possibly  in  the  dissection.  The  subflaviau  and  capsular  ligaments  between  the  fourth  and  fifth 
vertebrae  had  given  way,  as  had  also  the  attachment  of  the  ligamentum  nuchre  to  these  bones. 
The  anterior  and  posterior  common  ligaments  were  not  ruptured.  There  was  a  slight  extravasa- 
tion of  blood  external  to  the  sheath  of  the  spinal  marrow  and  a  considerable  quantity  between  the 
sheath  and  the  cord.  The  upper  and  posterior  edge  of  the  fifth  cervical  vertebra  encroached  to 
such  an  extent  upon  the  spinal  canal,  that  the  cord  at  this  point  was  bent  at  an  abrupt  angle,  and 
its  antero-posterior  diameter  reduced  more  than  half.  The  meninges  of  the  cord  were  not  torn  nor 
was  the  cord  itself  lacerated,  which  may  perhaps  be  accounted  for  by  the  fact  that  the  wide  sepa- 
ration of  the  bones  allowed  it  to  bulge  out  posteriorly  and  thus  escape  fracture.  The  lungs  were 
generally  congested,  the  left  more  than  the  right.  The  posterior  portions  were  especially 
engorged;  crepitation  was  nowhere  entirely  absent.  The  heart  was  slightly  hypertrophied  and  all  of 
its  cavities  empty.  The  cervical  portion  of  the  spinal  column  was  removed  entire;  the  luxation  unre- 
duced. Indeed,  I  failed  in  my  attempt  to  reduce  it,  and  that  after  the  bones  were  removed  from  the 
body  and  were  held  together  by  nothing  save  their  ligamentous  attachments  and  the  interlocking 
mentioned  before.  The  specimen,  a  ligamentous  preparation  of  the  first  six  cervical  vertebra',  was 
forwarded  to  the  Army  Medical  Museum  and  is  represented  in  the  wood-cut.* 


Dislocation  of  the  Clavicle. — One  instance  of  this  rare  accident  is  reported : 

CCCCXLIV. — Remarks  relative  to  a  Subhucation  of  the  Sternal  Extremity  of  the  Clavicle.    By  G. 
McC.  MILLER,  Assistant  Surgeon,  U.  S.  A. 

Sergeant  William  Dow,  Co.  D,  5th  Infantry,  was  thrown  from  a  mule,  while  hunting  antelope, 
near  Fort  Reynolds,  Colorado  Territory,  on  January  3,  18G9,  striking  the  ground  with  the  point 
of  his  right  shoulder.  On  his  return  to  the  fort  I  examined  the  injury,  and  found  a  sublux- 

*  Ur.  Gray  has  already  published  this  abstract  iu  the  American  Journal  of  the  Medical  Science*,  Vol.  LI,  p.  10U. 


DISLOCATIONS.  141 

atiou  forward  of  the  sternal  extremity  of  the  right  clavicle,  the  end  of  the  bone  being  advanced 
about  the  one-sixth  of  an  inch  beyond  its  proper  level.  He  complained  of  pain  at  the  seat  of 
injury,  and  there  was  some  tumefaction,  as  well  as  tenderness  on  pressure.  I  reduced  the  displaced 
bone,  and  applied  Fox's  apparatus  for  fractured  clavicle.  Compresses  were  also  placed  over  the 
seat  of  injury.  The  apparatus,  which  was  made  of  stout  materials,  so  long  as  it  was  worn  and 
kept  moderately  tight,  maintained  the  bone  in  place  admirably  well,  but  when  it  was  removed,  or 
became  slack,  the  bone  was  again  displaced.  He  wore  the  apparatus  until  February  28th,  a  period 
of  two  months,  when  I  removed  it,  and  finding  that  no  improvement  had  taken  place,  I  omitted 
its  further  use,  believing  that  if  an  apparatus  does  no  good  for  two  months  after  the  injury,  a 
reposition  of  the  displaced  bone  is  not  to  be  anticipated.  The  unsuccessful  result  of  treatment  in 
this  case  accords  with  the  experience  of  the  best  surgeons.  Nevertheless,  the  patient  will  most 
probably  have  a  very  useful  arm,  as,  according  to  the  best  authorities,  the  functions  of  the  limb 
in  these  injuries  are  but  slightly  impaired.  The  ultimate  result  will  be  made  known  at  a  future 
time. 

Dislocations  at  the  Shoulder. — Since  the  general  adoption  of  the  methods  of  reduc- 
tion by  manipulations  under  anaesthesia,  cases  of  this  class  have  seldom  presented 
difficulties,  unless  complicated  by  fracture,  or  unless  the  attempt  to  reduce  was  too  long 
postponed.  Though  the  accident  was  common  enough,  especially  in  the  cavalry,  the 
particulars  were  rarely  reported. 

CCCCXLV. — Report  of  a  Case  of  Irreducible  Luxation  of  the  Head  of  the  Humerus.    By  W.  B 
LYON,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Edward  Logan,  Co.  H,  38th  Infantry,  was  admitted  to  the  post  hospital  at  Fort 
Mcltae,  New  Mexico,  on  July  31,  18G8,  having  dislocated  his  right  humerus  into  the  axilla,  by 
falling  from  the  tongue  of  an  Army  wagon  on  July  1st;  at  the  same  time  he  received  severe  flesh 
wounds  on  the  head  and  face  from  mule  kicks.  No  attempt  had  been  made  at  reduction.  On 
August  2d,  he  was  placed  under  chloroform,  and  manipulation  and  extension  employed  for  two 
hours  without  success.  Another  attempt  was  made  on  the  13th  with  pulleys,  and  persisted  in  for 
two  hours,  with  the  same  result.  He  was  discharged  for  disability  November  27, 1808. 

CCCCXLVI. — Note  relative  to  a  Dislocation  at  the  Shoulder-joint.    By  W.  S.  ADAMS,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Thomas  Ford,  5th  Cavalry,  aged  27  years,  while  wrestling  with  a  comrade  at  Mor- 
gantown,  North  Carolina,  on  September  15,  1807,  had  his  left  arm  dislocated,  the  head  of  the 
humerus  being  thrown  downward  and  forward  beneath  the  pectoral  muscles.  The  dislocation  was 
reduced  by  manipulation  (Eeed's  method),  and  the  joint  was  supported  by  a  figure-of-eight  bandage. 
On  October  1st  the  patient  was  returned  to  duty,  with  good  use  of  the  limb. 

Dislocations  at  the  Elbow. — Of  the  nine  varieties  of  luxations  of  the  ulna  and 
radius  upon  the  humerus,  a  special  report  of  one  only  was  given ;  a  case  of  complete 
luxation  backward  of  the  bones  of  the  fore-arm. 

CCCCXLVIL— Extract  from  the  Monthly  Report  from  Downer's  Station,  Kansas,  for  January,  1808. 
By  L.  Y.  LURING,  Assistant  Surgeon,  U.  S.  A. 

The  case  of  dislocation  entered  on  the  report  was  that  of  a  soldier  of  Co.  E,  5th  Infantry,  and 
was  one  of  displacement  of  the  elbow  of  the  right  arm,  in  which  the  ulna  and  radius  were  thrown 
backward  upon  the  posterior  surface  of  the  humerus,  producing  a  characteristic  deformity,  easy 


142  EEPOET  OF  SURGICAL  CASES  IN  THE  ARMY. 

of  diagnosis.  The  luxation  was  caused  by  a  large  stick  of  wood  striking  the  humerus  upon  its 
posterior  and  outer  aspect,  and  thus,  in  reality,  throwing  the  humerus  forward  upon  the  ulna  and 
radius.  The  patient  was  placed  in  a  recumbent  position  upon  the  floor,  and  anaesthetized  by 
means  of  equal  parts  of  chloroform  and  ether.  A  guy  of  strong  material,  having  a  loop,  was 
attached  just  above  the  wrist  of  the  affected  arm,  and  the  loop  was  passed  around  my  neck  and 
shoulders,  thus  increasing  the  power  of  extension.  Counter-extension  was  produced  by  placing 
my  heel  in  the  bend  of  the  arm,  and  thus  also  furnishing  a  fulcrum  over  which  the  forearm  was 
bent,  when  the  bones  began  to  yield  by  extension.  Reduction  by  this  mode  was  soon  accomplished. 
Bandages  carefully  applied  over  splints,  and  the  usual  antiphlogistic  remedies  and  evaporating 
lotions  were  resorted  to.  Passive  motion,  the  swelling  having  diminished,  was  also  resorted  to,  in 
order  to  prevent  anchylosis.  The  man  was  returned  to  duty  in  February,  1808. 

Dislocations  at  the  Wrist. — A  single  special  report  on  this  subject  furnishes  an 
additional  fact  for  those  surgeons  who  do  not  share  Dupuytren's  incredulity  as  to  luxa- 
tions at  the  wrist,  without  concomitant  fracture  of  the  radius. 

CCCCXLVI1I.— On  a  Case  of  Dislocation  of  the  Wrist.    By  D.  F.  DAMOUR,  M.  D.,  Acting  Assistant 

Surgeon. 

Private  Joseph  M.  Choate,  Troop  B,  1st  Cavalry,  aged  23  years,  while  acting  in  the  capacity 
of  teamster,  was  injured  by  falling  from  one  of  the  wheel  mules  while  the  animals  were  stamped- 
ing, dislocating  his  left  wrist.  The  carpus  was  displaced  backward,  and  the  lower  end  of  the 
radius  and  ulna  toward  the  palmar  surface ;  the  pisiform  bone  was  also  displaced.  He  was  admitted 
to  the  hospital  at  Camp  McGarry,  Nevada,  and  the  dislocation  reduced  at  the  time,  and  treated 
by  applying  splints  and  bandages,  which  were  continued  to  October  1,  1867,  without  producing 
the  desired  result.  The  carpal  bones  were  displaced  on  the  dorsal  surface,  on  the  removal  of 
the  splints  and  roller,  the  same  as  before,  and  the  joint  remained  loose  and  flabby.  The  soldier 
was  returned  to  light  duty  on  October  1st,  but,  on  the  7th,  readmitted  to  hospital,  and,  on  November 
17th,  the  splints  and  roller  were  reapplied,  with  a  view  of  giving  support  and  ease  to  the  injured 
parts.  He  was  discharged  from  service  March  20, 18G8,  at  which  time  it  was  believed  he  could  not 
regain  the  use  of  his  left  hand. 

Dislocations  of  the  Metacarpab. — The  rarity  of  luxations  of  the  last  four  meta- 
carpals,  the  cases  observed  by  Bourguet,  Blandin,  and  Roux,  being  cited  by  authors  as 
altogether  exceptional,  adds  to  the  interest  of  the  following  abstract : 

CCCCXLIX. — Mention  of  a  Dislocation  of  the  Second  Metacarpal  Bone.    By  J.  F.  HEAD,  Surgeon, 
U.  S.  A. 

At  West  Point,  New  York,  in  the  beginning  of  April,  1868,  Charles  Conway,  corporal,  Ord- 
nance Department,  was  holding  a  drill  in  his  right  hand  for  another  man  to  strike,  when,  sud- 
denly, the  hammerhead  flew  off,  and  struck  a  glancing  blow  on  the  back  of  his  hand.  Although  the 
hand  was  covered  with  a  thick  buckskin  mitten,  it  was  rendered  helpless  by  the  blow;  and  on 
taking  off  the  mitten,  he  noticed  an  irregularity  in  its  appearance.  I  saw  him  about  half  an  hour 
after  the  accident,  when  there  was,  already,  some  swelling,  but  not  sufficient  to  conceal  a  marked 
depression  on  the  back  of  the  hand,  over  the  carpal  end  of  the  second  metacarpal  bone.  The  bone 
was  felt  running  down  toward  the  palm,  and  with  its  base  on  a  lower  level  than  the  next  bone. 
It  was  fixed  in  this  position,  and  no  crepitus  could  be  detected.  As  there  was,  evidently,  a  dislo- 
cation, I  attempted  to  reduce  it  by  making  extension  from  the  finger,  and  at  the  same  time  pressing, 
with  my  thumb  in  the  palm  of  the  hand,  against  the  base  of  the  metacarpal  bone.  It  almost  imme- 
diately, and  with  a  snap,  returned  to  its  proper  place.  I  then  bandaged  the  hand,  with  a  ball  of 
tow  in  the  palm.  The  swelling  gradually  disappeared,  and  on  April  13,  1868,  the  man  was  returned 
to  duty. 


DISLOCATIONS.  143 

Dislocations  at  (he  Hip. — Of  dislocations  of  the  lower  extremity,  only  one  case 
was  reported  in  detail,  or  by  name.  This  was  a  case  of  luxation  at  the  hip,  in  which  the 
difficulty  of  reduction  was  increased  by  the  inevitable  delay  in  procuring  surgical  aid. 

CCCCL. — Note   relative  to  a   Case  of  Luxation  at  the  Hip.     By  L.  E.  HOLMES,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Edward  Hollen,  Co.  K,  23d  Infantry,  aged  24  years,  was  admitted  to  the  hospital  at 
Camp  Logan,  Oregon,  in  February,  1868.  His  right  hip-joint  was  dislocated  upward  and  back- 
ward on  the  dorsum  of  the  ilium.  The  injury  was  received  while  travelling  on  snow  shoes,  from 
Canon  City  to  Soda  Springs,  February  6, 1868,  and  the  patient  had  been  lying  six  days  in  a  private 
hospital  at  Canon  City.  The  limb  became  slightly  swollen.  On  February  13th,  the  dislocation 
was  reduced  by  pullies,  after  several  unsuccessful  attempts  by  manipulation.  A  splint  was  placed 
upon  the  outside  of  the  limb,  covering  the  joint,  and  bandaged  closely.  Slight  inflammation  of  the 
joint  and  ligaments  followed.  The  patient  was  discharged  the  service  August  17,  1868,  on  account 
of  lameness  of  a  permanent  character. 


144  REPOKT  OP  SURGICAL  CASES  IN  THE  ARMY. 


ARROW  ¥OUIDS. 


The  illustrious  Baron  Percy  was  wont  to  declare*  that  military  surgery  had  its  origin 
in  the  treatment  of  wounds  inflicted  by  darts  and  arrows,  and  used  to  quote  his  favorite 
poetf  in  behalf  of  his  belief,  and  to  cite  Chiron,  and  Machaon's  patients,  Menelaus  and 
Philoctetes,  and  Eurypiles  treated  by  Patroclus.  He  was  even  tempted  to  believe,  with 
Sextus,J  that  the  name  far/>o?,  medicus,  was  derived  from  «?,  which  anciently  signified 
sagitta,  and  that  the  earliest  function  of  our  surgical  predecessors  was  the  extraction 
of  arrows  and  darts.  An  instrument  called  belulcum,  from  /s&«?,  telum,  a  dart,  was 
invented  during  the  long  Peloponnesian  war  (B.  C.  431,  405).  It' was  a  rude  pincers 
or  extracting  forceps,  and  was  used  by  Hippocrates  in  the  many  campaigns  in  which 
he  served.  His  immediate  successor,  Diocles,  invented  a  complicated  instrument  for 
extracting  foreign  bodies,  called  graphiscos,  and  consisting  of  a  canula  with  hooks. ||  It 
was  not  until  the  wars  of  Augustus  that  Heras  of  Cappadocia  designed  the  famous  duck- 
bill forceps,  which,  with  every  conceivable  modification,  has  continued  in  use  to  our  time. 
Celsus  §  instructs  us  that,  in  extracting  arrow-heads,  the  entrance  wound  should  be  dilated, 
the  barb  of  the  arrow-head  crushed  by  strong  pliers,  or  protected  between  the  grooves  of 
a  split  reed,  and  thus  withdrawn  without  laceration  of  the  soft  parts.  Paulus  ^Egineta  ^[ 
also  treated  fully  of  arrow-wounds,  and  described  an  atracton  used  in  his  day  to  remove 
firmly  impacted  arrows.  Albucasis'and  the  Arabian  school  did  little  or  nothing  toward 
advancing  our  knowledge  of  the  means  of  extracting  foreign  bodies.  After  the  fourteenth 
century  the  attention  of  surgeons  was  directed  to  wounds  from  projectiles  impelled  by 
gunpowder.  Yet  the  use  of  bows  and  arrows  in  warfare  continued,  and  we  find  Pard 
treating  of  this  class  of  injuries  with  the  sovereign  good  sense  that  characterized  all  he 
wrote.  As  the  use  of  firerarms  became  prevalent,  the  literature  of  arrow-wounds  became 
meagre,  and  the  subject  is  now  rarely  referred  to  in  systematic  works.  The  considerable 
number  of  cases  reported  by  our  medical  officers  possess  therefore  the  greater  interest. 

Multiple  Arrow- Wounds. — Dr.  Bill,  who  has  printed  an  interesting  essay**  on  this 
subject,  remarking  upon  the  rapidity  with  which  the  American  Indians  discharge  their 
arrows,  states  that  it  is  exceptional  to  meet  with  a  single  wound  ;  that  if  one  arrow  takes 
effect  it  is  immediately  followed  by  two  or  more  others.  Of  the  seven  following  cases, 
six  were  fatal : 

CCCCLL— Report  of  a  Case  of  Three  Wounds  from  Arrows.     By  C.  C.  GRAY,  Surgeon,  U.  S.  A. 

Private  William  Imbler,  Co.  H,  31st  Infantry,  while  a  few  hundred  yards  from  camp,  at  Fort 
Stevenson,  Dakota  Territory,  on  October  10,  1867,  was  severely  wounded  by  Indian  arrows,  one  of 

'  Manuel  du  Chirurgien  d'Arnie'e,  p.  4.  II  See  Andrea  della  Croce,  Lib.  7,  p.  173 ;  Venet.  1574. 

t  Homer,  Iliad,  Book  XI.  §  Celsus,  De  Medicina,  Lib.  VII,  cap.  V. 

t  Sextus,  Advers.  Math.,  Lib.  I,  cap.  2.  1  Paulus  ^giueta,  De  re  Medica,  Lib.  VI,  cap.  88. 

**  Bill,  American  Journal  of  the  Medical  Sciences,  Vol.  XLIV,  p.  365. 


ARROW-WOUNDS.  145 

which  was  extracted  at  the  angle  of  the  jaw,  after  it  had  entered  above  the  left  scapula  and  trans- 
fixed the  left  posterior  triangle  of  the  neck.  A  second  passed  through  the  fleshy  portion  of  the 
right  fore-arm ;  and  a  third  pierced  the  uluar  side  of  the  left  fore-arm  near  the  elbow-joint,  and, 
becoming  twisted  and  wedged  in  the  interosseous  space,  severely  lacerated  the  tissues.  With 
some  difficulty  the  distorted  head  of  this  arrow  was  pushed  downward  and  extracted  near  the 
wrist.  The  wounds  were  treated  with  simple  dressings.  Save  partial  paralysis  of  the  left  hand) 
the  patient  did  well. 

CCCCLII. — Report  of  Death  from  Multiple  Wounds,  most  of  which  were  from  Arrows.    By  W.  II. 
SMITH,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Robert  Nix,  Co.  G,  14th  Infantry,  was  wounded  near  Camp  Lincoln,  Arizona  Territory, 
in  October,  18G8.  He  received  a  gunshot  flesh-wound  in  the  upper  portion  of  left  arm;  a  slight 
cut  from  an  arrow  in  the  left  ear:  two  flesh-wounds  from  arrows,  from  one  of  which  the  hemor- 
rhage was  profuse;  two  arrow  wounds  in  the  right  knee,  the  synovial  membrane  having  been 
penetrated,  but  no  bones  broken;  one  gunshot  wound  in  the  right  elbow,  but  not  through  tin- 
joint;  and  another  through  the  metacarpal  bone  of  the  third  linger  of  the  right  hand.  During 
the  eight  hours  following,  while  being  conveyed  to  camp,  he  became  very  weak  from  loss  of 
blood,  and  riding  part  of  the  time  on  a  horse  with  a  comrade,  and  the  remainder  in  a  Government 
team.  He  suddenly  died  the  next  morning.  Decided  symptoms  of  fatty  degeneration,  with  dilata- 
tion and  hypertrophy  of  heart,  had  been  previously  observed. 

GCCCLIII. — Note  of  a  Case  of  Multiple  Arrow -Wounds.     By  E.  B.  HITZ,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Con  stand  Queswelle,  Co.  E,  13th  Infantry,  aged  20  years,  received  May  24,  1808,  while 
on  herding  duty  about  half  a  mile  from  Camp  Reeve,  Montana  Territory,  seven  arrow-wounds. 
One  arrow  entered  the  cavity,  through  the  eighth  dorsal  vertebra,  and  one  through  the  ninth; 
three  passed  through  the  fore-arm,  one  between  the  fifth  and  sixth  ribs  on  the  right  side,  and  one 
through  the  palmer  surface  of  the  right  hand.  Death  was  apparently  instantaneous. 

CCCCLIV. — Report  of  a  Case  of  Death  from  Arrow -Wounds.    By  G.  L.  POUTER,  Assistant  Sur- 
geon, U.  S.  A. 

Nat.  Crabtree,  a  citizen,  aged  38  years,  while  looking  for  his  cattle,  April  24,  1808,  was  shot 
by  Indians,  receiving  nine  arrow-wounds ;  one  in  the  post  gluteal  region,  oue  in  the  left  lung,  one 
in  the  abdomen,  one  penetrating  the  humerus,  one  in  the  hand,  one  in  the  testicle,  one  in  the  back 
to  the  left  of  the  dorsal  vertebra,  one  in  the  bladder,  and  a  glance-shot  five  inches  long  below  the 
ninth  rib.  He  was  admitted  to  the  post  hospital  at  Camp  Cooke,  Montana  Territory.  Some  of 
the  arrows  had  been  removed  by  his  friends,  and  five,  including  the  one  in  the  gluteal  region, 
which  had  penetrated  ten  and  a  half  inches,  were  taken  out  at  the  post.  The  man  died  a  few 
hours  after  admission  to  hospital. 

CCCCLV. — Report  of  a  Remarkable  Case  of  Arrow-  Wounds.    By  J.  H.  PEABODY,  M.  D.,  Late 
Surgeon,  U.  S.  V. 

Private  George  Osborn,  of  Troop  D,  2d  Nebraska  Cavalry,  was  wounded  by  arrows  in  a  skirm- 
ish with  Indians  near  Pawnee  Reserve,  Nebraska,  on  June  23,  1803.  Eight  arrows  entered  at  dif- 
ferent parts  of  Ins  body,  and  were  all  extracted  except  the  head  of  one,  which  had  entered  at  the 
outer  and  lower  margin  of  the  right  scapula,  and  had  passed  upward  and  inward  through  the  upper 
lobe  of  the  right  lung,  or  trachea.  Haemorrhage  at  this  time  was  so  great  that  all  hope  of  recovery 
was  abandoned.  The  patient,  however,  rallied,  but  continued  to  suffer  great  paiu  upon  swallowing 
or  coughing,  and  occasionally  spit  blood.  In  July,  I860,  more  than  three  years  subsequent  to 
the  receipt  of  the  injury,  he  called  at  the  office  of  Dr.  J.  H.  Peabody,  to  undergo  an  examination, 
with  a  view  of  applying  for  a  pension,  stating  that  his  health  was  much  affected  from  the  presence 
of  the  arrow-head.  He  was  much  emaciated,  and  expressed  himself  tired  of  life.  Upon  probing 
19' 


146  REPORT  OF  SURGICAL  OASES  IN  THE  ARMY. 

through  a  small  fistulons  opening  jnst  above  the  superior  end  of  the  sternum,  the  point  of  the  arrow 
was  found  resting  against  the  bone,  about  an  inch  and  a  half  below,  the  head  lying- flat  against  the 
trachea  and  oesophagus,  with  the  carotid  artery,  jugular  vein,  and  nerves  overlying.  After  some 
little  difficulty,  the  point  of  the  arrow  was  raised  above  the  sternum,  and  it  was  extracted  without 
the  loss  of  an  ounce  of  blood,  the  edge  grating  against  the  sheath  of  the  innominata  artery  during 

the  operation.  The  missile  measured  an  inch  at  the  base,  and 
was  four  inches  long,  (Fie.  22.)  Its  form  is  shown  in  the 
annexed  wood-cut,  nearly,  but  not  accurately,  of  half  the  natural 
size.  The  patient,  appearing  highly  gratified  at  the  result,  rode 
to  his  home.  His  health  underwent  a  remarkable  improvement, 

Fir..  22.  Iron  arrow-head  extracted  from   the  . 

chest,  spec.  5642,  sect,  i,  A.  M.  M.  f'ntl  in  January,  1869,  the  operator  reported  him  perfectly  well. 

CCCCLVI. — Report  of  a  Case  in  which  the  Patient  received  Five  Arrow- Wounds,  <nid  mix  Sculped. 
By  S.  M.  HORTON,  Assistant  Surgeon,  U.  S.  A. 

Private  Patrick  D.  Smith,  of  Co.  II,  18th  Infantry,  was  attacked  about  six  miles  from  Fort 
Philip  Kearney,  Dakota  Territory,  on  the  evening  of  September  26,  1866,  by  three  Indians,  who 
inflicted  five  arrow-wounds,  and  removed  part  of  his  scalp.  On  the  next  morning  he  was  seen  by 
two  physicians.  Two  of  the  arrows  still  remained  in  his  body — one  in  the  right  side  below  the 
region  of  the  kidney;  the  other  had  pierced  the  cartilage,  at  the  junction  of  the  first  rib  with  the 
sternum,  inflicting  a  wound  three  inches  in  depth.  The  arrows  were  extracted,  the  wound  dressed, 
and  the  patient  supported  until  10  o'clock  the  next  morning,  September  28th,  when  he  expired. 
At  the  autopsy  it  was  found  that  the  wound  in  his  chest  had  been  the  cause  of  death.  The  arrow 
had  cut  the  edge  of  the  right  lung,  and  had  inflicted  a  slight  wound,  one-eighth  of  an  inch  in  length, 
in  the  descending  vena  cava.  The  right  lung  and  surrounding  tissues  were  considerably  infiltrated 
with  blood,  and  a  large  amount  of  coagulum  was  found  in  the  cavity  of  the  thorax. 

CCCCLVII. — Account  of  a  Case  of  I<\it«l   Wound*  from  Arrows.     I5y  C.  S.  DK  GRAW,  Assistant 
Surgeon,  U.  S.  A. 

Private  James  Spillman,  Troop  B,  7th  Cavalry,  aged  22  years,  was  wounded  on  the  morning 
of  June  12,  1867,  about  a  mile  from  Fort  Dodge,  Kansas,  by  a  party  of  Kiowa  Indians,  who  made 
a  dash  upon  the  herd  of  horses  he  was  guarding,  and  inflicted  three  arrow-wounds:  The  first  in  the 
right  shoulder;  the  second  in  the  right  side,  the  arrow  glancing  from  a  rib,  and  making  a  wound 
similar  to  a  stitch,  about  three  inches  in  length  ;  and  the  third  through  the  right  lumbar  region, 
penetrating  the  abdominal  cavity  to  a  depth  of  about  eight  inches  or  more.  The  arrow  causing 
the  wound  in  the  side  was  removed  by  cutting  the  arrow  in  two,  and  then  drawing  out  the  parts. 
The  arrow  in  the  lumbar  region  was  removed  with  great  difficulty.  The  wound  being  enlarged, 
two  fingers  were  inserted  on  either  side  of  the  shaft  until  the  base  of  the  iron  head  was  reached, 
the  fingers  thus  inserted  serving  as  a  guide  and  as  a  protection  to  the  parts,  when,  traction  being 
made,  the  arrow  was  withdrawn.  This  latter  wound  proved  mortal,  the  man  dying  the  next  day 
about  3  o'clock,  P.  M.  His  true  name  was  Wise,  of  Washington.  No  post-mortem.  The  two 
arrows  removed  were  contributed  to  the  Army  Medical  Museum,  and  are  numbered  r.<;."U  in  the 
Surgical  Section. 


Arrow-  Wounds  of  the  Head  and  Neck. — Special  reports  of  eight  cases  were  received, 
In  five,  the  cranial  cavity  was  penetrated,  and  four  of  the  patients  perished. 

CCCCLVIII.— Report  of  an  Arrow-  Wound  of  tiie  Skull.    By  C.  C.  GRAY,  Surgeon,  U.  S.  A. 

Private  John  Krumholz,  of  Co.  H,  22d  Infantry,  was  accidentally  wounded  at  Fort  Sully, 
Dakota,  on  June  3,  1869,  by  an  arrow,  which,  entering  at  the  outer  canthus  of  the  left  eye, 
penetrated  the  skull  to  the  extent  of  two  inches,  and  is  supposed  to  have  passed  between  the 


AHKOW-WOUNDS.  147 

skull  and  dura  mater.  Being  admitted  to  hospital -on  the  same  day,  he  was  chloroformed,  and 
an  operation  for  extraction  was  immediately  performed.  This  consisted  in  sawing  nearly  through 
the  skull  with  a  lley's  saw,  inclose  proximity  to  the  arrow.  The  condition  of  the  injured  parts 
was  healthy  at  the  time  of  operation,  and  the  patient's  constitutional  state  was  good.  The  treat- 
ment consisted  in  rest,  low  diet,  elevation  of  the  head,  cold  applications,  and  saline  cathartics. 
Recovery  was  rapid,  and  he  returned  to  duty  on  June  7,  1869. 

CCCCLIX. — Extracts  from  Reports  of  Sick  and   Wounded  at  Fort  McDowell,  Arizona   Territory. 
April  and  May,  1860. .  By  CHARLES  SMAKT,  Assistant  Surgeon,  U.  S.  A. 

Private  Andrew  Snowdon,  Co.  B,  3d  Battalion.  14th  Infantry,  was  one  of  a  party  surprised  by 
Apaches,  March  22,  1866,  while  en  route  from  Maricopa  Wells  to  Fort  Goodwin.  He  was  struck 
on  the  back  of  the  head  by  an  arrow,  which  penetrated  his  skull.  It  is  said  that  he  was  nine 
days  in  traveling  to  Maricopa  Wells  from  the  place  where  he  was  wounded.  On  his  arrival  there 
he  is  stated  to  have  been  weak  and  fatigued,  but  with  his  intelligence  unimpaired.  He  believed 
the  arrow-head  to  be  within  the  cranium,  as  in  pulling  on  the  shaft  after  the  reception  of  the 
injury,  nothing  but  the  shaft  came  away.  On  or  about  the  10th  or  12th  of  April,  he  lost  his 
appetite,  felt  considerable  nausea,  and  appeared  to  those  around  somewhat  dull  and  stupid.  He 
rapidly  grew  worse,  so  that  it  was  considered  advisible  to  send  him  to  the  post  for  treatment.  He 
was  placed  on  a  hay  wagon,  and  made  the  journey  to  Salt  River  on  that  conveyance — a  distance  of 
thirty  miles.  At  this  time  1  was  notified  concerning  the  case,  and  instructed  to  proceed  to  Salt 
J fiver  with  our  ambulance  for  him.  I  found  him  with  a  full  pulse,  slow,  and  somewhat  hard;  his 
mental  faculties  much  clouded ;  hearing  distinctly,  and  giving  answer  to  every  question,  although 
the  answer  seldom  contained  the  information  desired.  He  tried  to  remember  his  name,  but  could 
not.  He  was  troubled  with  a  very  persistent  vomiting.  On  April  19th,  he  was  received  into  the 
post  hospital;  an  active  cathartic  was  administered,  his  head  shaved,  and  cold  dressings  applied- 
During  the  day  his  stupor  increased  to  such  an  extent  that  the  sharpest  tone  failed  to  make  an 
impression  on  him.  His  pulse  50,  full  and  hard  ;  vomiting  much  abated.  On  the  20th,  the  purgative 
was  repeated,  as  it  had  as  yet  been  without  effect.  The  scalp  was  examined,  discovering  a  small 
tumefaction,  in  which  was  an  ill  defined  sense  of  fluctuation,  situated  over  the  parietal  side  of  the 
left  occipito-parietal  suture.  Pressure  exercised  upon  it  caused  the  issue  of  a  small  quantity  of 
serous  matter  from  a  point  in  the  cicatrix  of  the  arrow-wound.  This  was  enlarged,  and  a  probe 
passed  into  it  was  made  to  feel  along  a  fissure  in  the  bone,  when  it  struck  upon  some- 
thing metallic.  The  cranium  was  laid  bare  by -a  crucial  incision,  and  with  considera- 
ble difficulty  a  hoop-iron  arrow-head,  one  and  three-quarter  inches  long,  and  half  an 
inch  in  breadth,  was  withdrawn  from  the  brain.  About  a  drachm  of  pus  followed  it 
in  its  exit.  During  the  procedure  the  patient  lay  quiet,  except  when  at  times,  with- 
out any  assignable  cause,  he  would  burst  into  a  violent  scream.  After  the  operation, 
which  was  not  noticed  previous  to  it,  the  right  side  was  observed  to  be  paralyzed. 
April  21st:  Pulse  as  before.  Insensibility  great.  Paralysis  of  right  side  more 
marked  ;  features  drawn  to  wounded  side.  Has  not  eaten  anything  since  his  admit- 
tance, nor  for  several  days  previous  to  that  time.  Passes  his  urine  when  the  nurse 
solicits  him,  by  the  application  of  the  urinal.  Bowels  unmoved,  a  cathartic  enema 
was  administered.  22d:  Seems  slightly  improved.  Enema  brought  away  nothing, 
but  during  the  afternoon  of  yesterday  he  had  a  large  involuntary  passage.  Has 
eaten  nothing;  swallows  a  mouthful  of  tea  occasionally.  Pulse  50.  24th :  Has  eaten 
nothing— no  improvement— pulse  less  full,  and  more  compressible.  26th:  Yesterday,  FI«. -.M.  iron 

.  arrow  head  ex- 

took  a  few  teaspoonfuls  of  custard.    In  afternoon,  was  feverish  and  delirious.    Enema       lracu,a  from 

administered.    Features  sunken  and  distorted.    27th:  Much  improved.    Has  eaten       thcbrniu.  sp<x. 
considerably  of  a  farinaceous  preparation.    Face  more  regular  in  expression.    Pulse       J^ 
54,  softened.     Answers  questions  readily,  but  not  to  the  purpose.     Cannot  remember 
his  name.     30th:  Steady  improvement.     Has  eaten   well  every  day  since  last  report,      Pulse  CS. 
Hcmiplegiii  unobservable.      Has  remembered  name,  and  at  times  take  an  interest  in  what  is  going 
on  in  the  ward.     Wound  of  operation  healing  kindly. 


148  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

During  the  first  week  of  May  he  continued  to  improve;  caution  concerning  diet  and  an 
occasional  purge  being  all  that  was  considered  necessary.  On  the  7th,  after  eating  heartily  of  some 
soup,  which  I  afterward  learned  to  have  been  "  somewhat  greasy,"  he  became  slightly  feverish,  and 
during  the  succeeding  night  did  not  rest  well.  On  the  8th,  skin  hot ;  pulse  65,  hard,  a  little  head- 
ache, and  occasionally  sickness  at  stomach.  Cold  to  head  ordered,  and  an  enema  administered. 
From  this  time  he  gradually  grew  worse,  complaining  much  of  pain  in  the  head,  and  stiffness  in 
the  back  of  the  neck,  while  on  the  llth  and  12th,  muscular  tremors  were  the  most  prominent 
objective  symptom.  Unconsciousness  set  in  on  the  morning  of  the  13th,  and  he  died  quietly  about 
six  hours  thereafter.  Post-mortem  examination  seven  hours  after  death.  Body  muscular,  rigid,  not 
emaciated.  A  firm  cruciform  cicatrix  on  posterior  and  left  side  of  scalp.  The  centre  of  this  cica. 
trix  adherent  by  firm  fibres  to  bone  beneath.  In  the  bone  almost  corresponding  in  situation  with 
the  centre  of  the  cicatrix,  was  a  slit  half  an  inch  long,  and  one-eighth  of  an  inch  wide,  tilled  in 
with  recently  formed  soft  tissue,  which  broke  down  before  the  handle  of  a  scalpel.  From  the 
upper  end  of  this  slit  a  fissure  one  inch  and  a  half  in  length,  extended  to  the  inter-parietal  suture, 
while  from  its  other  extremity  another  fissure  stretched  in  curved  direction  toward  the  ear  two 
inches.  The  dura  mater  was  adherent  to  the  margin  of  the  slit  in  the  bone,  and  to  the  soft  tissue 
which  filled  it  in  ;  but  external  to  the  membrane  there  was  no  collection  of  matter.  In  the  poste- 
rior lobe  of  the  left  cerebral  hemisphere,  the  track  of  the  arrow-head  was  followed  downward,  forward, 
and  inward,  communicating  with  the  posterior  cornu  of  the  left  ventricle.  The  brain  tissue,  to  the 
extent  of  three-quarters  of  an  inch  around  the  track  as  a  centre,  was  softened  and  disorganized. 
The  track  of  the  arrow-head  was  filled  with  a  thick  pus,  which  had  extended  thence  into  the  ventricle. 
The  right  ventricle  was  also  filled,  as  were  the  sub-araclmoidean  spaces.  No  other  organ  examined. 

CCCCLX. — Memorandum  relative  to  the  Skull  of  a  Mexican  Killed  Inj  an  Arrow.     By  W.  M.  NOT- 
SON,  Assistant  Surgeon,  U.  S.  A. . 

An  unknown  Mexican  was  killed  by  an  arrow- wound  in 
an  Indian  fight,  which  occurred  seventy-five  miles  northwest  of 
Fort  Concho,  Texas,  on  February  1*2,  1808.  The  arrow  perforated 
the  frontal.  When  I  opened  the  skull,  I  found  an  incision 
extending  clear  across  the  opposite  hemisphere,  touching  the  dura 
mater  just  above  the  tentorium.  The  dura  mater  was  stained, 
but  I  could  find  no  mark  on  the  skull.  When  I  made  the  post- 
mortem I  found  the  arrow-head  in  the  brain.  When  the  Mexican 
was  hit  he  seized  the  arrow-shaft  with  both  hands  and  pulled  it 
out,  then  dropped  andof  course  remained  unconscious  until  he  died, 
about  six  hours.  The  specimen  was  forwarded  to  the  Army  Medical 
Museum.  [It  is  figured  in  the  adjacent  wood-cut,  (Fi«.  24.)  The 
I.-ICI.-.M.  Cranium  penetrated  by  an  amrw  arrow-head  has  been  removed  from  the  cavity  of  the  skull  and 

through  the  left  nupercllUry  ruga.   Spec.  . 

5M4,  suet,  i,  A.  ji.  M.  fastened  at  the  point  of  entrance.    Apart  from  the  lesion,  the  skull 

is  a  highly  interesting  specimen. — ED.] 

COCCLXL— Memorandum  of  an  Arroic- Wound  of  the  Face.    By  P.  MIDDLETON,  Assistant  Sur- 
geon, U.  S.  A. 

Private  William  Drum,  Co.  G,  14th  Infantry,  aged  20  years,  was  wounded  in  a  fight  with 
Apache  Indians  on  November  11,  1807.  One  arrow  entered  over  the  malar  bone  of  the  left  side 
of  the  face,  passed  along  the  lower  border  of  the  orbit  to  within  half  an  inch  of  the  nose.  Another 
arrow  entered  through  the  tendon  of  the  latissimus  dorsi  muscle  on  the  right  side,  and  passed 
directly  backward  tn ward  the  spine  under  the  deep  muscles,  penetrating  two  and  a  half  inches. 
He  was  admitted  to  the  post  hospital  at  Fort  Whipple,  Arizona  Territory,  on  the  following  day. 
On  November  K)th,  I  cut  down  upon  the  arrow-head  in  the  side, and  removed  it.  The  parts  healed 
by  the  first  intention,  and  on  December  3,  1807,  the  patient  was  returned  to  duty. 


AKKOW-WOUNDS.  149 

CCCCLXII. — Account  of  an  Arrow-Wound  of  tJic  Scalp  and  of  the  Leg.    By  HENRY  McELDEUiiY, 
Assistant  Surgeon,  U.  S.  A. 

Private  William  Rosback,  Troop  P,  fith  Cavalry,  aged  20  years,  was  wounded  during  the 
night  of  August  29,  1807,  in  an  attack  by  Indians  on  Fort  Belknap,  Texas,  by  two  arrows ;  one 
striking  the  scalp,  the  other  the  outer  aspect  of  the  left  leg  three  inches  below  the  knee-joint. 
Missile  passed  backward  and  inward,  the  spike  lodging.  He  was  admitted  from  company  quarters 
ou  September  1,  to  hospital  at  Camp  Wilson.  Cold-water  dressings  were  applied.  The  arrow- 
head was  excised  posteriorly  in  the  popliteal  space.  Isinglass  plaster  and  fused  nitrate  of  silver 
locally.  He  was  returned  to  duty  on  November  24,  18C7. 

CCCCLXIII. — Report  of  an  Arrow -Wound  of  the  Neck.    By  B.  SEMIG,  Acting  Assistant  Surgeon. 

Private  Thomas  Button,  Co.  K,  32d  Infantry,  aged  23  years,  was  wounded  in  an  attack  by 
Apache  Indians  upon  a  wagon  train  in  the  lower  Senorita  Valley,  Arizona  Territory,  on  May  8, 
1809,  by  an  arrow  which  caused  a  flesh  wound  of  the  posterior  portion  of  the  neck.  He  was 
admitted  on  the  next  day  to  the  post  hospital  at  Camp  Crittenden,  Arizona  Territory.  He 
recovered,  and  was  returned  to  duty  May  17,  1869. 

CCCCLXIV.—  Accounts  of  Two  Fatal  Arrow-Wounds  of  the  Slmll.     By  W.  M.  NOTSON,  Assistant 
Surgeon,  U.  S.  A. 

CASE  1. — J.  C ,  with  two  others,  were  attacked  by  Indians  on  September  1,  1870,  near  the 

Pecos  River,  Texas.    One  man  was  killed,  another  escaped,  and  C received  an  arrow-wound  of 

the  head,  and  three  gunshot  flesh-wounds — one  in  the  arm,  another  in  the  breast,  and  a  third  in  the 

leg.    Seven  days  afterward  he  was  admitted  to  the  post  hospital  at  Fort  Concho,  Texas,  having 

traveled  part  of  the  distance  on  foot  and  the  balance  by 

wagon  and  stage.    When  admitted  his  mental  condition 

was  good,  and  as  clear  and  bright  as  usual.    He  complained 

only  of  weariness  from  his  ride  and  some  slight  soreness 

of  the  gunshot  wounds,  and  spoke  very  lightly  of  the 

scratch  on  the  side  of  his  head.    Water   dressings  were 

applied  to  the  wounds  and  rest  enjoined.    The  gunshot 

Avounds  healed  kindly.    On  the  fourth  day  after  admission, 

the  indications  being  something  more  than  irritative  fever, 

special  diet  was  ordered,  and  aromatic  spirits  of  ammonia 

was  given  in  small  doses.    This  prescription  was  afterward 

replaced  by  an  ordinary  fever  mixture.     On  the  night  of    Flr-23-  Cranimn  with  an an-ow-beaa  imported  in  tii« 

right  sciiiamous  bone.    Spec.  5907,  Sect.  I,  A.  M.  M. 

the  sixth  day  the  cerebral  symptoms  becoming  more  violent, 

hydrate  of  chloral  was  ordered.  On  the  eighth  day  a  saline  cathartic  was  given,  and  an  effort  made 
by  Acting  Assistant  Surgeon  C.  W.  Knight  to  reopen  the  wound  of  the  temple.  This  attempt  proved 
unsuccessful  ou  account  of  the  resistance  of  the  temporal  fascia.  Doubt  as  to  the  cause  of  the 
existing  symptoms  prevented  him  from  making  a  free  incision.  The  treatment  from  this  up  to  the 
fatal  termination  of  the  case,  September  19,  1870,  was  with  counter-irritants,  nutriment,  and 
stimulants.  The  autopsy  revealed  the  site  of  the  injury  of  the  bone  half  an  inch  from  the  external 
incision,  which,  when  first  seen  upon  admission,  was  a  clean  cut  nearly  healed.  Pus  was  found  in 
the  wound,  ventricles,  and  meninges.  The  pathological  specimen,  showing  an  iron  arrow-head  lodged 
in  the  petrous  portion  of  the  right  temporal  bone,  was  contributed  to  the  Army  Medical  Museum, 
and  is  figured  in  the  wood-cut  FIG.  25.  The  following  thermograph  (Fie.  20)  exhibits  the  variations 
of  the  temperature,  as  observed  from  the  seventh  to  the  eighteenth  day  of  disease,  inclusive. 


150 


KEPOUT  OF  SURGICAL  CASES  IN  THE  AKMY. 


Fie.  'Jii.  IhermogTftpb  of  a  Case  of  Arrow-'Wonnd  of  Hr:iin  from  September  7,  1870,  to  Srjiii-nilicr  1-,  1875. 


FIG.  27.    Cranium  with  an  iron  arrow-head  impacted 

in  the  left  temporal  bone.  Spec.  SMS,  Sect,  i,  A. 

M.  M. 


CASE  2.— Private  Martin  W ,  Co.  E,  4th  Cavalry, 

was  killed  by  Indians,  on  September  30,  1870,  twenty 
miles  from  Fort  Coucho,  Texas,  while  on  duty  as  one 
of  the  mail-stage  guard  from  Fort  Chadbourne.  The 
escort  being  attacked  by  a  band  of  Comanches,  this 
soldier  was  wounded  by  an  iron  headed  arrow,  which 
entered  the  sqnamous  portion  of  the  left  temporal  bone, 
and  penetrated  the  left  cerebral  hemisphere  to  a  depth 
of  an  inch  or  more,  causing  intracranial  bleeding  which 
was  speedily  fatal.  In  the  specimen  which  was  for- 
warded to  the  Army  Medical  Museum,  and  which  is 
represented  in  the  accompanying  wood-cut  (FiG.  27) 
the  puncture  of  the  thin  calvaria,  without  Assuring,  is 
well  indicated.  Internally  there  is  no  splintering.  The 
vitrous  table  is  as  cleanly  divided  as  the  outer  table. 


It  was  Dr.  Bill's  belief  (loo.  cit.,  p.  375,)  that  penetrations  of  the  skull  by  arrows  were 
unusually  characterized  by  a  linear  puncture  of  the  outer  table,  corresponding  to  the  size 
of  the  arrow-head,  with  a  crack  usually  extending  from  either  edge,  proportionate  in  length 
to  the  momentum  of  the  arrow,  while  the  inner  table,  struck  by  the  arrow's  point  at  a 
reduced  velocity  was  splintered  and  depresssd.  But  such  is  not  the  testimony  of  the 
specimens  in  the  Army  Medical  Museum.  They  show  both  tables  of  the  calvaria 
punctured  with  little  or  no  fissuring  externally  or  internally.  In  all  of  the  specimens,  the 


ARROW-  WOUNDS. 


arrow-heads  have  been  literally  impacted,  the  vitreous  table  being  penetrated  as  cleanly  as 
the  outer.  This  is  in  such  marked  contrast  to  the  results  of  bayonet  or  sword  thrusts  or 
of  the  impact  of  gunshot  projectiles  as  to  m'erit  notice. 


Arrow -Wounds  of  the  Chest. — Seven  cafes  were  specially  reported.  Among  them 
were  two  remarkable  instances  of  recovery  after  penetration  of  the  plueral  cavity  by 
arrows. 

CCCCLXY. — Note  of  an  Arrow -Wound  of  the  Chest.  By  F.  D  AMOUR,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  George  Duggan,  Troop  K,  8th  Cavalry,  was  wounded  near  Camp  Willow  Grove, 
Arizona  Territory,  November  8,  1807,  by  an  arrow,  which  penetrated  the  posterior  side  of  tlie 
right  chest.  He  died  December  17, 1867.  At  the  autopsy,  the  arrow  was  found  to  have  penetrated 
the  chest  a  little  above  the  diaphragm,  with  which  the  head  of  the  arrow  was  lying  in  contact. 
There  was  also  an  abscess  containing  much  purulent  matter. 

CCCCLXVI. — Mention  of  a  Fatal  Arrow-Wound  of  the  Lung.  By  HENRY  LIPPINCOTT,  Assistant 
Surgeon,  U.  S.  A. 

Private  Benjamin  McCasey,  Troop  H,  7th  Cavalry,  was  wounded  at  the  engagement  of  Washita 
River,  November  27,  18G8,  by  an  arrow  which"  entered  the  left  side  at  the  fourth  intercostal  spare, 
and  passed  backward  and  upward  into  the  lung.  Stimulants  and  opiates  were  administered  with 
cold-water  dressings  to  the  wound.  The  patient  expectorated  a  great  deal  of  blood.  Death 
resulted  on  November  30,  18C8. 

CCCCLXVII. — Account  oj  Two  Cases  of  Arrow -Wounds,  compiled  from  Memoranda  on  the  Monthly 
Report  of  Sick  and  Wounded  at  Fort  C.  H.  Smith,  for  September,  18GG.  By  H.  M.  MATTHEWS, 
M.  D.,  Acting  Assistant  Surgeon. 

CASE  1. — Corporal  Alvin  H.  Stables,  Co.  D,  18th  Infantry,  received  September  20,  18GG,  two 
arrow- wounds  in  addition  to  a  gunshot  wound  of  the  head.  One  arrow  entered  the  left  chest 
posteriorly,  and  transfixed  the  thorax,  the  arrow-point  raising  the  skin  above  the  right  nipple ;  the 
other  arrow  passed  through  the  chest  to  the  left  of  the  median  line.  The  soldier  was  then  scalped 
by  the  Indians,  and  killed. 

CASE  2. — Private  Thomas  Fitzpatrick,  Co.  D,  18th  Infantry,  in  an  engagement  with  Indians 
in  Montana,  was  killed  by  numerous  arrow,  gunshot,  and  contused  wounds.  One  arrow  penetrated 
the  chest  through  the  left  axilla;  another,  entering  under  the  right  nipple,  penetrated  the  vertebral 
column;  a  third  perforated  the  left  elbow-joint;  a  fourth  and  fifth  had  entered  the  thorax  pos- 
teriorly above  and  below  the  scapula.  A  musket  ball  had  passed  through  the  heart,  and  a  second 
through  the  right  knee-joint.  The  skull  was  crushed  in  from  behind  by  a  war  club,  and  there  was 
a  tomahawk  wound  of  the  left  temporal  region. 

CCCCLXVIII. — Report  of  an  Arrow -Wound  oj  the  Lung,  resulting  in  Pleurisy,  andfoUotccd  by 
Recovery.  By  A.  MULLER,  M.  D.,  Acting  Assistant  Surgeon. 

John  Fenske,  a  civilian,  aged  19  years,  came  to  Fort  Ridgely,  Minnesota,  on  the  night  of  August 
20,  1862,  for  surgical  aid  and  protection,  having  been  wounded  on  the  previous  day  by  an  Indian 
arrow,  which  was  shot  a  distance  of  about  twelve  feet,  and  had  entered  the  back  horizontally  between 
the  third  and  fourth  ribs  of  the  left  side,  close  to  the  vertebras  The  arrow,  a  barbed  one, 


152  REPORT  OF  SURGICAL  GASES  IN  THE  ARMY. 

with  the  head  about  three  inches  long,  was  buried  one  inch  below  the  surface  of  the  skin,  and  had 
penetra  ted  the  left  lung.  On  account  of  the  barbs,  it  became  necessary  to  make  a  large  perpendicular 
incision  in  order  to  remove  the  arrow-head,  which  required  for  its  extraction  considerable  pulling,  the 
sharp  edges  having  been  wedged  in  between  the  ribs  with  such  force  as  to  bend  them 
over  on  each  side.  After  its  removal,  there  was  a  considerable  flow  of  blood  for  a  few 
minutes,  probably  from  an  intercostal  artery.  The  bleeding,  however,  was  entirely 
arrested  by  cold-water  applications.  The  wound  having  been  cleansed  and  its  edges 
brought  together  by  a  strip  of  adhesive  plaster,  cold-water  dressings  were  ordered 
and  continued  for  three  days.  A  healthy  suppuration  then  set  in,  and  the  wound 
closed  by  granulation  in  thirteen  days.  It  was  evident  in  this  case  that  the  arrow 
had  penetrated  the  left  lung  through  both  pleurae,  which  diagnosis  was  fully  corrobo- 
rated by  the  objective  as  well  as  subjective  symptoms.  The  patient  complained  of 
severe  pleuritic  pains  (or  stitches)  through  the  whole  of  the  left  lung  at  every  inspi- 
ration. The  respiration  was  greatly  accelerated,  dyspnoea  was  often  very  alarming 
and  palpitations  of  the  heart  very  severe,  obliging  the  patient  to  rest  in  an  upright 
position.  Occasional  bloody  sputa  were  observed,  and  his  pulse  varied,  during  the 
I'm.  as.  Barbed  inflammatory  process,  from  95  to  140.  Auscultation  and  percussion  of  the  thorax 
lira!"1  Fi'oiTa  revealed  an  extensive  effusion  of  fluid  on  the  left  side,  with  subsequent  hepatization 
drawing  by  of  the  upper  lobe  of  the  left  lung  to  the  extent  of  the  palm  of  the  hand.  The 
treatment  was  strictly  antiphlogistic:  Repeated  bleeding,  (five  times  in  two  weeks,) 
cupping  intervening,  (from  six  to  ten  cups  each  time,)  repeated  four  times  in  ten  days,  affording 
the  patient  great  relief  at  each  repetition;  and  application  of  blisters.  Internally  tartar  emetic 
in  progressive  doses,  nitre  and  digitalis,  were  successively  administered,  under  which  treatment, 
aided -by  low  diet,  chiefly  milk,  the  effusion  gradually  disappeared,  and  all  alarming  symptoms 
subsided.  On  the  twelfth  day  of  treatment,  his  pulse  did  not  exceed  eighty,  the  effusion  in 
the  left  pleura  had  entirely  disappeared,  with  the  exception  of  a  small  accumulation  in  the 
lower  left  lobe.  Light  vegetable  tonics,  with  iodide  of  potassium,  were  now  administered,  and 
a  full  and  select  diet  adopted.  The  patient  left  for  home  on  September  30,  1802,  forty -two  days 
after  receiving  the  injury,  having  so  far  recovered  that  only  an  occasional  slight  d.\  spnu?a  re- 
mained. The  percussion  at  this  time  gave  a  clear  tympanitic  sound  in  the  vicinity  of  the  wound, 
followed  by  a  distinct  metallic  sound  to  be  heard  on  auscultation  of  the  parts,  entirely  similar  to 
pneumo-thorax,  which,  in  this  case,  was  believed  to  exist  to  a  circumscribed  extent,  adhesions 
having  formed  along  the  posterior  surface  of  the  left  lung.  He  was  dismissed  with  advice  to  use 
cod-liver  oil.  Dr.  Muller  reports  lately  that  he  had  occasion  to  meet  this  patient  four  years  after- 
ward, and  that  the  remaining  untoward  symptoms,  above  described,  were  considerably  ameliorated. 

CCCGLXIX. — Abstract  from  Reports  of  an  Arrow-  Wound  of  the  Thorax.    By  JOSEPH  KTJGLER, 

Acting  Assistant  Surgeon. 

William  Livingston,  a  private  of  Troop  G,  3d  Cavalry,  was  wounded  by  Indians  while  herding 
horses  at  Fort  Stevens,  Colorado  Territory,  on  October  G,  1800,  an  arrow  having  entered  the  right 
side  of  thorax  between  the  first  and  second  ribs.  It  was  forcibly  extracted  by  the  patient,  who 
stated  that  a  great  gush  of  blood  followed.  After  being  conveyed  in  an  ambulance  over  a  rough 
mountain  road,  he  was  admitted  to  hospital  at  Fort  Garland,  Colorado  Territory,  on  the  12th,  in  a 
very  weak  condition,  and  suffering  frightfully  from  dyspnoea.  An  examination  showed  effusion 
of  blood  into  the  right  pleural  cavity,  and  the  lung  impervious,  owing  to  the  entrance  of  blood 
into  the  bronchii.  Hot  fomentations  were  applied  to  the  wound,  and  stimulants,  afterward 
followed  by  stimulating  expectorants,  were  administered,  under  which  treatment  the  patient  was 
gradually  improving  on  the  last  of  October.  On  the  monthly  report  for  November,  the  patient  is 
borne  as  convalescent.  He  was  able  to  walk  about,  but  there  was  still  a  collection  of  serum  or 
pus  in  right  pleural  cavity,  and  the  respiration  of  that  side  was  merely  bronchial.  The  treatment 
still  consisted  of  stimulating  expectorants,  with  stimulants  and  generous  diet.  In  December,  he  is 
still  reported  convalescent.  The  effusion  in  the  right  pleural  cavity  was  diminishing,  and  un- 
entered more  freely  into  the  lung.  He  was  daily  gaining  strength  and  spirits,  and  little  doubt  was 
entertained  of  his  making  a  good  recovery.  He  was  returned  to  duty  in  February,  1807. 


ARROW- WOUNDS.  153 

CCCGLXX. — Memorandum  of  a  Case  of  Arrow-  Wounds  of  the  Thorax.    By  WILLIAM  M.  NOTSON, 
Assistant  Surgeon,  U.  S.  A. 

"  I  send  to  the  Army  Medical  Museum  a  specimen  of  an  arrow-wound  of 
the  spine.  It  was  taken  from  the  body  of  a  white  man  who  was  killed  by 
Indians  in  1809,  at  an  outpost  near  Fort  Concho,  Texas.  I  found  the  man 
dead.  There  were  extracted  from  his  lungs  and  heart  no  less  than  four 
arrow-heads,  and  a  fifth  was  impacted  at  the  junction  of  the  rib  with  the 
transverse  process  of  the  fourth  dorsal  vertebra.  I  removed  the  fourth 
and  fifth  vertebra'  and  portions  of  the  third  and  sixth,  and  forwarded  them 
to  the  Army  Medical  Museum.  The  specimen  shows  the  arrow-head  impacted 
in  the  right  transverse  process  of  the  fourth  dorsal  vertebra  and  posterior 

extremity  of  the  rib.    The  wound  does  not  intersect  with  the  vertebral  canal.         6e  - 

I  could  learn  no  particulars  of  the  case.    Any  one  of  the  wounds  of  the      the.  fourth  <iorsai  vertebra, 
thorax  would  have  been  fatal."     (FiG.  29.)  "'"'  :"n3' Scct-  '• A M- M 


Arrow-Wound  of  the  Abdomen. — Three  instances  of  penetrating  wounds  of  the 
abdomen  by  arrows  have  been  recorded  among  the  cases  of  multiple  wounds  in  an  earlier 
portion  of  this  section.  Special  reports  were  made  of  six  other  cases  of  this  class.  Of 
the  nine  cases  seven  were  fatal,  and  in  the  two  cases  of  recovery,  there  is  room  for  doubt 
whether  the  arrow-head  penetrated  the  peritonaea!  sac.  The  great  fatality  of  arrow-wounds 
of  the  abdomen  is  well  known,  so  well  known  to  the  Indians  that,  Dr.  Bill  tells  us,  they 
aim  always  at  the  umbilicus.  Dr.  Bill  (loc.  cit.,  p.  385)  mentions  that  Mexicans  are 
accustomed,  when  fighting  Indians,  to  envelope  the  abdomen  as  the  most  vulnerable  part 
in  many  folds  of  a  blanket. 

CCCCLXXI. — Report  of  an  Arrow -Wound  of  the  Abdomen;    By  H.  S.  KILBOUKNE,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Samuel  Brown,  Troop  F,  10th  Cavalry,  was  wounded  near  Canadian  River,  Texas, 
December  2,  18C8,  by  an  arrow,  which  entered  the  abdomen  in  the  left  hypochondriac  region, 
making  a  punctured  wound  three-quarters  of  an  inch  in  length,  through  which  about  eighteen 
inches  of  the  small  intestine  protruded.  The  intestine  was  cut  in  four  places.  The  wounds  in  the 
intestine  were  closed  by  suture,  and  the  protruding  portion  of  the  gut  returned  through  the  wound, 
which  was  enlarged  for  that  purpose.  When  found,  the  man  had  lain  out  all  night,  and  was  in  a 
state  of  collapse.  He  was  carried  along  in  an  ambulance,  but  died  on  the  second  day,  not  having 
rallied  from  the  shock  of  the  injury. 

CCCCLXXII. — Note  of  a  Fatal  Arrow-Wound  involving  the  Liver,  •complicated  by  Gunshot  Injuries. 
By  S.  M.  HORTON,  Assistant  Surgeon,  U.  S.  A. 

Bugler  Edwin  L.  Train,  Troop  D,  2d  Cavalry,  aged  17  years,  was  wounded  at  Fort  Philip 
Kearney,  Dakota  Territory,  June  11,  1867,  in  a  fight  with  Indians.  Ho  received  a  gunshot 
fracture  of  the  right  arm,  a  gunshot  wound  in  the  left  side  of  chest,  and  an  arrow-wound  of  the 
liver.  He  was  admitted  to  the  post  hospital.  Several  fragments  of  bone  were  removed  from  the 
right  arm,  and  the  arrow  was  extracted  by  forcing  it  through  the  body.  He  died  on  June  12,  1807 

CCCCLXXIII.— Mention  of  an  Arrow-  Wound  by  which  the  Body  icas  Transfixed.    By  C.  E.  GODDAKD, 

Surgeon  U.  S.  A. 

John  Locke,  an  employe  of  the  sutler  at  Fort  Rice,  Dakota  Territory,  was  accidentally 
wounded  in  February,  1808,  by  an  arrow,  which  entered  the  back,  three  inches  to  the  right  of  the 
20 


154  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

fifth  lumbar  vertebra,  and  emerged  about  two  inches  to  the  right  of  the  ensiform  cartilage.  During 
the  evening  following,  the  patient  lost  about  eight  ounces  of  blood  externally,  and  a  small  amount 
internally.  He  was  confined  to  his  bed  some  two  weeks,  suffering  from  irritative  fever  and 
circumscribed  peritonitis.  In  four  weeks  he  was  walking  about;  and  by  July  1st,  was  actively 
employed.  The  arrow  was  contributed  to  the  Army  Medical  Museum. 

N 

CCCCLXXIV. — Account  of  an  Arrow- Wound  of  the  Abdomen.     By  J.   P.   KIMBALL,  Assistant 
Surgeon,  U.  S.  A. 

Private  James  W.  Cooper,  Co.  E,  31st  Infantry,  aged  twenty  years,  received,  in  a  light  with 
Indians  near  Fort  Buford,  Dakota  Territory,  August  20,  18C8,  an  arrow-wound  of  the  abdominal 
parietes.  The  missile  entered  over  the  centre  of  the  eighth  rib  of  the  right  side,  and  passed 
downward  and  forward,  to  near  umbilicus.  He  also  received  an  incised  wound  of  the  right  hip.  He 
was  admitted  to  the  post  hospital  on  the  day  of  injury,  complaining  of  excessive  pain.  Chloroform 
was  administered,  and  cutting  down  upon  the  head  of  the  arrow,  immediately  above  the  umbilicus, 
it  was  withdrawn  through  the  incision.  The  patient  reacted  promptly,  and  was  doing  well  until 
September  25th,  when  he  suddenly  experienced  a  severe  pain  in  the  right  hypochondriac  region, 
and  complained  of  a  gurgling  sensation.  He  became  faint,  and  evinced  symptoms  of  internal 
haemorrhage.  Cold  water  was  applied  to  the  abdomen,  and  anodynes  were  administered.  On 
September  30th,  he  was  slowly  improving;  and  on  December  31,1868,  he  was  still  under  treat- 
ment. This  man  was  returned  to  duty  in  February,  ISti'.i. 


CCCCLXXV. — Report  of  an  Arrow-  Wound  of  the  Bad;  and  Kidney.     By  CALVIN  DsWlTT,  Assist- 
ant Surgeon,  U.  S.  A. 

Private  Conrad  Tragesor,  Troop  I,  8th  Cavalry,  was  wounded  in  an  engagement  with  Apache 
Indians,  at  Sunflower  Valley,  Arizona  Territory,  March  9, 1870,  by  an  arrow,  which  entered  the  left 
side,  about  four  inches  from  the  spine,  and  above  the  crest  of  the  ileum,  from  below  upward.  The 
kidney  evidently  was  injured,  as  the  patient  passed  bloody  urine  in  small  quantities,  and  frequently. 
His  face  was  pale,  anxious,  and  expressive  of  great  pain ;  pulse  weak.  He  was  conveyed  in  an 
ambulance  to  Camp  McDowell,  Arizona  Territory,  a  distance  of  thirty  miles,  over  a  rough,  stony, 
and  hilly  road.  Be  died  the  next  day.  At  the  autopsy,  it  was  found  that  the  arrow  had  trans- 
fixed the  kidney,  entering  it  on  the  external  border,  at  the  juncture  of  middle  and  lower  thirds  emerg- 
ing from  the  posterior  surface  near  the  internal  border,  a  few  lines  below  the  pelvis.  A  large  irregular 
piece,  about  one  inch  long,  and  half  an  inch  thick,  was'  torn  from  the  posterior  border  of  the 
kidney  at  the  place  of  entrance,  evidently  by  the  traction  made  in  extracting  the  arrow,  leaving 
the  head  behind.  The  kidney  was  otherwise  normal;  the  abdomen  wa's  filled  with  blood. 

CCCCLXXVI. — Account  of  an  Arroic-Wound  of  the  Pelris  and  Abdomen.    By  JAMES  P.  KIMBALL, 
Assistant  Surgeon,  U.  S.  A. 

To-Kah  K-teu,  or  "he  that  kills  his  enemy,''  an  Indian  scout,  in  a  quarrel  with  a  fellow-scout, 
at  Fort  Buford,  Dakota  Territory,  January  3,  1870,  received  a  penetrating  arrow-wound  of  the 
pelvis  and  abdomen.  The  arrow  entered  midway  between  the  right  ischium  and  the  anus.  The 
shaft  of  the  arrow  having  been  withdrawn  before  he  came  under  surgical  observation,  the  exact 
direction  of  the.  arrow  could  not  be  determined,  but,  as  the  blood  marks  on  the  shaft  showed  that 
it  had  penetrated  about  twelve  inches,  and  the  arrow-head  would  make  at  least  three  inches  more, 
it  is  supposed  that  the  arrow  had  passed  up  through  the  pelvis  into  the  abdomen.  Opiates  were 
administered,  and  light  diet  and  perfect  quiet  enjoined.  The  case  apparently  progressed  favorably 
for  several  days,  when  peritonitis  supervened,  and  death  ensued  January  18,  1870. 


ARROW-WOUNDS.  1 55 

Miscellaneous  Arrow-  Wounds. — None  of  the  forty-eight  cases  of  arrow-wounds  men- 
tioned in  the  nine  following  reports  proved  fatal.  With  one  exception  the  lesions  impli- 
cated the  soft  parts  only.  The  regions  injured  were  the  scalp  or  face,  or  neck  in  three 
instances;  the  parieties  of  the  chest  in  six;  the  long  muscles  of  the  back  in  seven;  the 
abdominal  muscles  in  two ;  the  hip  or  buttocks  in  three;  the  testis  in  one ;  the  shoulder  or 
arm  in  thirteen  ;  the  fore-arm  or  hand  in  six;  the  thigh  or  leg  in  seven.  A  few  cases  of 
extraction  of  arrow-heads,  and  an  instance  of  brachial  aneurism  cured  by  digital  com- 
pression are  noticeable  in  this  series. 

CCCCLXXVII. — Remarks  on  an  Arrow-  Wound  of  the  Back.    By  J.  P.  KIMBALL,  Assistant  Surgeon , 
U.  S.  A. 

Corporal  Edward  Monagban,  Co.  C,  31st  Infantry,  aged  24  years,  was  wounded  in  a  skirmish 
with  Indians  near  Fort  Buford,  Dakota  Territory,  on  November  6, 1807,  by  an  arrow,  which  entered 
just  below  the  inferior  angle  of  the  right  scapula,  and,  passing  around  the  ribs,  caine  so  nearly 
through  in  front,  that  the  position  of  the  head  could  be  clearly  made  out.  He  was  at  once  admit- 
ted to  the  post  hospital.  There  was  no  swelling  or  discoloration,  and  but  little  haemorrhage.  He 
was  somewhat  excited,  having  walked  nearly  two  miles  after  the  reception  of  the  injury.  An 
incision  one  inch  in  length,  and  about  one  incji  in  depth,  was  made  through  the  pectoralis  major 
muscle,  two  inches  above  and  a  little  to  the  outside  of  the  right  nipple.  The  arrow-head  was 
then  removed  through  the  incision,  and  the  shaft  removed  through  the  wound  of  entrance.  Three 
days  later,  the  anterior  wound  was  healing  by  first  intention ;  the  posterior  wound  suppurated 
slightly.  On  November  26,  1867,  both  wounds  had  healed,  and  the  patient  was  returned  to  duty. 

CCCCLXXVIII. — Note  concerning  anArroic-  Wound  of  the  Lumbar  Region.    By  BEDFORD  SHAEPE, 
M.  D.,  Acting  Assistant  Surgeon. 

Captain  E.  M.  Heyl,  Co.  M,  9th  Cavalry,  aged  26  years,  was  admitted  to  the  post  hospital  at 
Fort  McKavett,  Texas,  on  November  28,  1809.  with  an  arrow-wound  of  the  left  lumbar  region, 
midway  between  the  spine  and  umbilicus,  received  in  an  engagement  with  Lipan  Indians,  at  the 
headwaters  of  the  Llano  River,  Texas.  The  wound  had  a  direction  oblique  and  backward.  He 
recovered,  and  returned  to  duty  December  25,  1869. 

CCCCLXXIX. — Report  of  an  Arrow-  Wound  of  the  Arm,  followed  by  Aneurism.    By  J.  N.  McCHAND- 
LESS,  M.  D.,  Acting  Assistant  Surgeon. 

Private  James  Burridge,  Co.  C,  14th  Infantry,  aged  22  years,  was  wounded  near  Bower's 
Ranche,  Arizona  Territory,  November  11,  1867,  by  an  arrow,  which  struck  the  arm  about  two 
inches  above  the  elbow.  Traumatic  aneurism  followed,  and  on  January  3d,  digital  compression 
was  employed,  and  continued  for  twenty-four  hours.  Before  compression,  the  tumor  was  about  the 
size  of  a  pigeon's  egg,  soft  and  pulsating.  One  week  after  the  compression,  it  was  reduced  to  half 
the  size.  On  January  15th,  the  compression  was  repeated  for  twenty-four  hours,  and  on  January 
18th,  the  tumor  was  almost  imperceptible.  The  patient  was  returned  to  duty  January  20,  1868. 

CCCCLXXX.— Mention  of  an  Arrow-Wound  of  the  Hand.    By  J.  B.  GIRABD,  Assistant  Surgeon, 
U.  S.  A. 

Private  Edward  M.  Detterer,  Co.  G,  4th  Infantry,  waS  wounded  at  Smoky  Hill,  Kansas,  July, 
1867,  by  an  arrow,  which  split  the  metacarpal  bone  of  the  right  thumb  down  to  the  trapezium. 
Amputation  at  the  metacarpal  joint  was  performed,  and  the  radial  artery  ligated  above  the  wrist 
on  account  of  haemorrhage.  He  was  discharged  from  service  August  26,  1867. 


156  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CCCCLXXXI. — Account  of  Two  Cases  of  Arrow-Wounds  occurring  near  Bowels  Ranche,  Arizona 
Territory.    By  P.  MIDDLBTON,  Assistant  Surgeon,  U.  S.  A. 

Private  William  Hardwick,  Co.  C,  14th  Infantry,  aged  45  years,  was  wounded  in  an  engage- 
ment with  Indians  on  November  11,  1807,  by  arrows,  in  the  left  thigh  and  right  arm.  One  missile 
penetrated  the  rectus  femoris  muscle  at  the  centre,  and  passed  upward  and  inward  to  the  bone. 
Another  arrow  entered  through  centre  of  belly  of  biceps  muscle,  and  penetrated  to  the  bone.  I 
administered  chloroform,  enlarged  the  wound  of  the  thigh,  and  removed  the  arrow  on  the  field. 
On  the  following  day,  he  was  admitted  to  the  post  hospital  at  Camp  Whipple,  Arizona  Territory. 
On  December  15th,  both  wounds  had  healed,  but  the  patient  had  only  slight  use  of  his  leg.  He 
was,  however,  steadily  improving,  and  on  December  28th,  was  able  to  walk  on  crutches.  lie  was 
returned  to  duty  in  January,  18G8. 

CCCCLXXXII. — Report  of  an  Arrow  Wound  of  the  Thigh.    ByB.  SEMIG,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  James  F.  Tompkins,  Co.  K,  32d  Infantry,  aged  2C  years,  was  wounded  April  20, 1869, 
in  an  attack  by  Apache  Indians  upon  a  wagon-train,  in  the  Santa  Rita  Mountains,  by  an  arrow, 
which  caused  a  flesh-wound  of  the  anterior  portion  of  the  lower  third  of  the  left  thigh.  He 
was  admitted,  on  the  same  day,  to  the  post  hospital  at  Camp  Crittenden,  Arizona  Territory.  He 
recovered,  and  was  returned  to  duty  May  22,  1869. 

CCCCLXXXIII. — Note  relative  to  a  Case  of  Recovery  after  numerous  Wounds  from  Arrows.  By 
W.  S.  TUEMAINE,  Assistant  Surgeon,  U.  S.  A. 

Sergeant  James  Murray.  Co.  B,  3d  Infantry,  aged  34  years,  in  an  attack  by  hostile  Indians  on 
the  Marl  Station  on  Bear  Creek,  Indian  Territory,  May  31,  1870,  received  seven  arrow- wounds ; 
two  on  the  anterior  surface  of  the  right  arm,  one  in  the  right  axilla,  one  on  the  right  side  of  the 
chest  near  the  border  of  the  axilla,  two  on  the  left  arm,  posterior  surface,  near  the  elbow-joint,  and 
one  on  the  left  temple.  He  was  admitted  on  June  1st  to  the  post  hospital  at  Fort  Dodge,  Kansas. 
The  wound  on  the  right  arm,  near  the  deltoid,  discharged,  and  there  was  slight  exfoliation  from  the 
humerus.  He  was  treated  with  simple  dressings,  and  was  returned  to  duty  in  July,  1870. 

CCCCLXXX1V. — Memorandum  relative  to  an  Arrow -Wound  of  the  Testis.  By  A.  H.  SMITH, 
Assistant  Surgeon,  U.  S.  A. 

While  serving  at  Fort  Bliss,  Texas,  in  18G6,  I  had  occasion  to  attend  a  Mexican  herdsman, 

who  had  received  a  wound  in  the  testis  from  an  arrow  shot  by  an 
Apache  Indians.  The  hoop-iron  arrow-head  had  lodged  in  the 
testicle,  and  the  external  wound  had  nearly  healed  over  at  the  time 
1  saw  him,  about  three  months  after  the  reception  of  the  wound. 
It  was  not  difficult,  however,  to  detect  the  position  of  the  foreign 
body  and  to  extract  it.  Upon  its  removal  the  wound  cicatrized 

FIG.  30.  Anew-head  of  Apache  Indians.  .  . . ,     ,  , ,          .  i  r     i  •      i 

spec.  S6ii,  sect,  i,  A.  M.  M.  <Nat,  size.)       finely.     The    specimen   was  transmitted   to  the  Army   Medical 

Museum.     [It  is  figured  in  the  wood-cut,  FIG.  30. — ED.] 

CCCCLXXXV. — Memoranda  of  Forty  Cases  of  Arrow -Wounds.  Condensed  from  reports.  By  D.C. 
PETERS,  Surgeon,  U.  S.  A.;  J.  M.  DICKSON,  M.  D.,  T.  H.  SNOW,  M.  D.,  II.  WKSTERJ.ING, 
M.  D.,  J.  H.  MoMAHON,  M.  D.,  B.  SEMIG,  M.  D.,  Acting  Assistant  Surgeons :  S.  M.  HORTON, 
H.  MCELDERRY,  J.  P.  KIMBALL,  H.  TURNER,  Assistant  Surgeons,  U.  S.  A.,  and  Surgeon  J.  F. 
WEEDS,  U.  S.  A. 

Private  John  Ahern,  Troop  L,  8th  Cavalry ;  Camp  Willow  Grove,  Arizona  Territory,  Novem- 
ber 8,  1867;  slight  arrow- wounds  in  the  back  and  left  shoulder.  He  had  recovered  December  9, 
1867. 

Sergeant  George  Aldrich,  Troop  C,  2d  Cavalry,  aged  3,3  years ;  Peno  Creek,  Dakota  Territory, 
December,  1866;  wound  in  right  lumbar  region  by  an  iron-headed  arrow  ;  treated  in  post  hospital 
at  Fort  Philip  Kearney,  Dakota  Territory,  and  returned  to  duty  December  31,  1866. 


A  U  ROW- WOUNDS.  157 

Private  Joseph  A.  Arkcc,  Troop  I,  3d  Cavalry;  engagement  with  Navajo  Indians  near  Fort 
Sumner,  New  Mexico,  July  9,  1809;  arrow-wound  of  right  shoulder,  passing  through  below  the 
deltoid;  recovered. 

Pa-yan-za,  Indian  scout;  Rocky  Canon,  near  Donner  and  Blitzen  Creek,  Oregon,  March  14, 
18G8;  slight  arrow  flesh-wound  of  the  arm;  transferred  to  Camp  Ilarney,  Oregon;  recovered  and 
returned  to  duty. 

Big  Mack,  Indian  scout;  Rocky  Gailon,  near  Donner  and  Blitzen  Creek,  Oregon,  March  14, 
18G8 ;  slight  arrow  flesh-wound  of  the  arm ;  transferred  to  Camp  Harney,  Oregon ;  duty. 

Private  Frank  Burr,  Troop  D,  3d  Cavalry;  Sierra  Diabola,  Texas,  in  an  engagement  with 
Miscallero  Apaches,  October  18,  1867;  arrow-wound  of  right  fore-arm;  returned  to  duty. 

Private  John  Butler,  Troop  I,  Gth  Cavalry,  aged  26  years;  Paint  Creek,  Texas,  March  6, 1868; 
arrow- wound  of  upper  third  of  left  fore-arm;  treated  in  post  hospital  at  Fort  Griffin,  Texas,  and 
returned  to  duty  on  March  11,  1868. 

Private  Robert  Clinton,  Troop  I,  3d  Cavalry;  engagement  with  Navajo  Indians,  near  Fort 
Sumner,  New  Mexico,  July  9,  1869;  arrow-wound  of  the  back  below  spine  of  the  scapula; 
recovered. 

Private  John  Cooley,  Troop  G,  3d  Cavalry ;  Purgatory  Creek,  Colorado  Territory,  October  3, 
1866 ;  arrow  flesh-wound,  a  few  inches  in  length,  on  left  side  of  the  thorax;  treated  in  post  hospital 
at  Fort  Garland,  Colorado ;  recovered ;  duty. 

Private  John  Craig,  Troop  L,  8th  Cavalry;  Camp  Willow  Grove,  Arizona  Territory,  Novem- 
ber 8, 1867 ;  arrow  perforating  wound  of  the  left  hand ;  transferred  to  Camp  Mojave,  Arizona 
Territory ;  duty. 

Private  Bartholomew  Creeden,  Troop  I,  3d  Cavalry ;  engagement  with  Navajo  Indians,  near 
Fort  Sumner,  New  Mexico,  July  9,  1869 ;  slight  arrow-wound  of  the  left  arm ;  recovered ;  duty. 

Private  James  Daily,  Troop  D,  3d  Cavalry,  Sierra  Diabola,  Texas,  October  17,  1867 ;  arrow 
flesh-wound  through  the  right  thigh  above  the  patella ;  treated  in  post  hospital  at  Fort  Bliss,  Texas, 
and  returned  to  duty  October  26,  1867. 

Williain  Fee,  a  citizen,  aged  22  years;  Crazy  Woman's  Fork,  Dakota,  December  4,  1867 ; 
slight  arrow-wound  of  muscles  of  right  side  of  the  abdomen ;  treated  in  post  hospital  at  Fort 
Philip  Kearney,  and  discharged  December  8,  1867. 

Private  Gottlieb  Harr,  Co.  C,  18th  Infantry,  aged  22  years;  Crazy  Woman's  Fork,  Dakota 
Territory,  December  4,  1867 ;  slight  arrow  flesh-wound  of  the  anterior  surface  of  the  left  thigh ; 
treated  in  post  hospital  at  Fort  Phil  Kearny ;  doing  well;  duty. 

Sergeant  John  F.  Ililmer,  Troop  L,  3d  Cavalry,  aged  24  years  ;  June  24,  1870 ;  arrow-wound 
penetrating  the  right  arm  at  the  inferior  third ;  treated  in  post  hospital  at  Camp  Verde,  Arizona 
Territory ;  returned  to  duty  in  July,  1870. 

Private  Charles  Hoffman,  Troop  I,  Gth  Cavalry,  aged  28  years;  Paint  Creek,  Texas,  March  6, 
1868 ;  arrow-wound  in  upper  third  of  the  left  thigh ;  treated  in  post  hospital  at  Fort  Griffin,  Texas, 
and  returned  to  duty  March  31, 1868. 

Private  George  Johnson,  Troop  L,  8th  Cavalry;  Camp  Willow  Grove,  Arizona  Territory, 
November  8,  1867;  slight  arrow- wound  in  the  chest  over  the  shoulder-blade;  transferred  to  Camp 
Mojave,  Arizona  Territory;  duty. 

Rudolph  Kinten,  citizen,  aged  28  years;  Pinery,  near  Fort  Philip  Kearney,  Dakota  Territory, 
December  18, 1867;  slight  arrow-wounds  of  the  right  leg  and  shoulder;  doing  well  December  20, 
1867 ;  recovered. 

Sergeant  J.  R.  Ludlow,  Troop  G,  7th  Cavalry;  arrow  entered  immediately  behind  the  junction 
of  the  ninth  rib  with  its  cartilage,  and  emerged  about  three  inches  from  the  spinal  column,  same 
side ;  discharged  from  service  at  Fort  Leavenworth,  April  8,  1868. 


158  EEPOET  OF  SURGICAL  CASES  IN  THE  AKMY. 

Private  Edward  Malone,  Troop  L,  8th  Cavalry;  near  Camp  Willow  Grove,  Arizona  Territory, 
November  8,  1867;  slight  arrow  flesh-wound  above  the  hip;  transferred  to  Camp  Mojave,  Ari- 
zona Territory ;  duty. 

Lieutenant  Thomas  J.  March,  7th  Cavalry;  Washita  River,  November  27, 1868;  slight  arrow- 
wound  of  the  left  hand;  recovered;  duty. 

Trumpeter  James  Marshall,  Troop  A,  3d  Cavalry,  aged  21  years ;  June  24,  1870 ;  superficial 
arrow-wound  of  the  right  hip;  treated  in  post  hospital  at  Camp  Verde,  and  returned  to  duty  in 
July,  1870.  . 

Private  Joseph  Miller,  Troop  A,  2d  Cavalry;  Fort  lien o,  Dakota  Territory,  July  19,  1868; 
arrow  entered  over  the  external  edge  of  the  scapula  and  protruded  through  the  bicipital  portion 
of  the  middle  third  of  the  arm,  from  whence  it  was  extracted;  returned  to  duty  in  August,  1868. 

Private  Hugh  Morgan,  Troop  I,  7th  Cavalry;  engagement  with  Indians,  November  27,  1868; 
arrow  flesh-wound  of  the  right  arm;  treated  in  post  hospital  at  Fort  Dodge,  and  returned  to  duly 
in  January,  1869. 

Private  Clarence  G.  Morrell,  Troop  D,  3d  Cavalry;  Sierra  Diabola,  Texas,  October  17,  1867; 
arrow-wounds  of  the  right  groin,  side,  and  back;  treated  in  post  hospital  at  Fort  Bliss,  Texas,  and 
returned  to  duty  on  November  19,  1867. 

Private  Daniel  Morrison,  Troop  G,  7th  Cavalry;  engagement  with  Indians,  November  27, 
1868 ;  arrow- wound  of  the  scalp ;  treated  in  post  hospital  at  Fort  Dodge,  Kansas,  and  returned 
to  duty  in  January,  1869. 

Bugler  John  Murphy,  Troop  M,  7th  Cavalry ;  engagement  with  Indians,  November  14,  1868 ; 
arrow-wound  of  the  right  side ;  treated  in  post  hospital  at  Fort  Dodge,  Kansas,  and  returned  to 
duty  in  March,  1869. 

Private  Charles  Murray,  Troop  F,  10th  Cavalry ;  Beaver  Creek,  Kansas,  August  21,  1867 ; 
slight  arrow-wound  of  the  left  leg ;  treated  in  post  hospital  at  Fort  Hays.  Kansas,  and  returned  to 
duty. 

Corporal  Thomas  O'Brien,  Troop  F,  6th  Cavalry,  aged  21  years;  Fort  Belknap,  Texas,  August 
29,  1867;  slight  arrow-wound  of  the  chest,  two  inches  above  the  nipple;  treated  in  post  hospital  at 
Camp  Wilson,  Texas,  and  returned  to  duty  September  5,  1867. 

Owine,  Indian  scout,  Rocky  Cafion,  near  Donner  and  Blitzen  Creek,  Oregon,  March  14,  1868 ; 
slight  arrow  flesh  wound  of  the  left  arm;  transferred  to  Camp  Harney,  Oregon. 

Sergeant  Francis  Rigby,  Troop  H,  1st  Cavalry  ;  Rocky  Cafion,  near  Donner  and  Blitzen  Creek, 
Oregon,  March  14,  1868;  arrow  passed  through  the  fore-arm,  wilh  cutting  edge  at  right  angles  to 
axis  of  member ;  treated  in  post  hospital  at  Camp  Harney,  Oregon.  By  some  means  the  arrow-head 
had  been  pushed  back  and  became  imbedded  in  the  muscles,  whence  it  was  extracted;  returned  to 
duty  in  April,  1808. 

Private  James  Ryan,  Troop  F,  6th  Cavalry,  aged  29  years;  Paint  Creek,  Texas,  March  6, 1868; 
arrow-wound  of  lip,  treated  in  post  hospital  at  Fort  Griffin,  Texas,  and  returned  to  duty  March 
11,  1868. 

Lieutenant  Gustavus  Schreyer,  Troop  F,  6th  Cavalry,  aged  29  years;  accidental,  September 
20,  1867 ;  slight  arrow-wound  of  the  left  thigh ;  treated  in  post  hospital  at  Camp  Wilson,  Texas, 
and  returned  to  duty  October  22,  1807. 

Corporal  Thomas  Sheppard,  Troop  F,  10th  Cavalry;  Beaver  Creek,  Kansas.  August  21,  1867; 
arrow-wound  of  the  neck ;  treated  in  post  hospital  at  Fort  Hays,  Kansas,  and  returned  to  duty. 

Private  George  Silence,  Troop  A,  3d  Cavalry,  aged  25  years;  June  24,  1870;  penetrating 
arrow-wound  of  the  left  shoulder;  treated  in  post  hospital  at  Camp  Verde,  Arizona  Territory,  and 
returned  to  duty  in  August,  1870. 


ABROW-WOUNDS.  159 

Private  Francis  Stall,  Troop  D,  3d  Cavalry;  Sierra  Diabola,  Texas,  October  18,  18C7;  arrow- 
wound  of  the  right  breast ;  returned  to  duty. 

Private  Henry  Stockford,  Co.  G,  31st  Infantry,  aged  29  years;  Fort  Buford,  Dakota  Territory, 
August  20,  1868;  penetrating  arrow-wound  of  internal  condyle  of  the  left  hummis,  requiring  tin- 
united  streugth  of  two  men  to  extract  it;  returned  to  duty  in  October,  1808. 

Private  William  Wagerle,  Troop  I,  3d  Cavalry;  engagement  with  Navajo  Indians,  July  9, 
18G9;  arrow-wound  of  the  right  chest,  passing  into  the  pleural  cavity;  recovered;  duty. 

Private  Lewis  White,  Troop  C,  9th  Cavalry;  Horse  Head  Hills,  Texas,  September  12,  186S; 
arrow- wound  of  sixth  rib",  left  side,  seven  inches  from  the  spine ;  treated  in  post  hospital  at  Fort 
Davis,  Texas,  and  returned  to  duty  September  20,  1868. 

Private  Michael  Zuch,  Co.  B,  31st  Infantry,  aged  20  years;  Fort  Buford,  Dakota.Territory, 
August  20,  1868;  arrow  flesh-wound  of  the  left  hip;  returned  to  duty  August  23,  1868. 

Nearly  all  of  the  foregoing  instances  of  arrow-wounds  have  been  copied  from  "lists  of 
casualties,"  a  few  from  special  reports.  The  orders  which  enjoin  upon  medical  officers  to 
forward  to  the  Surgeon  General  a  list  of  casualties  within  two  or  three  days  after  every 
engagement  or  skirmish  in  which  they  may  be  on  duty,  have  been  generally,  but  not 
universally,  observed.*  It  is  specially  desirable  that  such  returns  should  be  rendered  with 
the  utmost  regularity  and  promptness,  because  many  of  the  wounded  in  the  field  do  not 
come  under  treatment  in  the  post  hospitals,  and  are  not  accounted  for  on  the  monthly 
and  quarterly  reports.  When  casualties  occur  in  small  scouting  parties,  unaccompanied 
by  a  medical  officer,  the  medical  officer  at  the  nearest  post  should  assume  the  duty  of 
reporting  the  killed  and  wounded  by  name,  with  such  facts  as  can  be  ascertained  regard- 
ing the  nature  and  seat  of  injuries.  The  records  of  this  office  prove  that  he  will  have, 
in  such  cases,  the  cordial  cooperation  of  line  officers  ;  for  many  reports  have  been  received, 
signed  by  lieutenants  or  captains  of  infantry  or  cavalry,  enumerating  the  casualties  in 
their  detachments,  with  the  postscript,  "  I  send  this  as  we  have  no  doctor  along  with  us." 
The  two  following  reports  conform  to  the  instructions  that  have  been  issued  on  this 
subject : 

CCCCLXXXVI.— A  Report  of  Two  Fatal  Cases  of  Arrow-  Wounds.    By  ALFRED  D.  WILSON,  Assist- 
ant Surgeon,  U.  S.  A. 

A  detachment  of  seven  companies  of  the  Fifth  Cavalry  started  from  Fort  Lyons,  Colorado,  on 
May  1,  1869,  for  Sheridan  City,  Kansas.    On  Beaver  Creek,  Indians  were  encountered,  and  a  fight 
ensued.    The  Indians  were  pursued  towards  the  llepublican  Eiver.    When  they  reached  Prairie 
Dog  Creek,  they  dispersed,  and  it  was  impossible  to  follow  them  further.    The  command  then 
retraced  the  route,  and  then  marched  in  a  northwesterly  direction  to  the  Platte  Uiver,  and  then 
westerly  to  Fort  McPhersou,  Nebraska.    There  were  several  casualties  from  gunshot  wounds,  and 
two  soldiers  were  mortally  wounded  by  arrow- wounds  penetrating  the  thorax ;  viz, 
Sergeant  John  Ford,  Troop  B,  5th  Cavalry. 
Private  C.  A.  C.  Stone,  Troop  B,  5th  Cavalry. 

CCCCLXXXVIL— Memorandum  from  a  Report  of  Casualties  in  an  Indian  Engagement.    By  J.  F. 
WEEDS,  Surgeon,  U.  S.  A. 

In  the  eugagemeu  tof  Companies  G  and  1, 3d  Cavalry,  with  a  band  of  Navajoes,  near  Fort  Sum- 
ner,  New  Mexico,  July  9,  1869,  one  soldier  died  from  haemorrhage  from  an  arrow-wound  of  the 

*  See  General  Order*,  No.  355,  A.  G.  O.,  November  4,  ISKi,  Circular  Letter,  S.  G.  O.,  March  23,  1HM,  C'.Yc«/«r  U,;l,  n 
No.  10,  S.  G.  O.,  October  22,  18<>7,  aud  Form  55,  Medical  Defarlnu-iil. 


160 


EEPOET  OF  SUEGICAL  CASES  IN  THE  ARMY. 


bracliial  artery,  and  four  men  were  wounded  so  severely  that  they  were  dismounted,  and,  the  com- 
mand being  forced  to  retreat,  they  were  probably  at  once  killed  by  the  Indians,  as  their  bodies 
were  afterward  found  covered  with  wounds.  These  were — 

Private  John  Devine,  Co.  I,  3d  Cavalry,  bracliial  artery  severed. 

Private  James  Cook,  Co.  I,  3d  Cavalry,  many  wounds. 

Private  William  Kerr,  Co.  I,  3d  Cavalry,  many  wouuds. 

Private  Edward  White,  Co.  I,  3d  Cavalry,  many  wounds. 

Private  John  Lee,  Co.  G,  3d  Cavalry,  many  wouuds. 

In  this  engagement  four  other  soldiers  received  arrow-wounds  of  more  or  less  severity,  and 
were  taken  to  Fort  Sumner,  and  treated  in  the  post  hospital.  All  of  these  cases  terminated 
favorably. 

[These  four  cases  are  included  in  the  preceding  memoranda  of  forty  cases.  I  have  taken  the 
liberty  of  subdividing  the  report  and  classified  return  made  by  Dv.  Weeds.  There  was  no  surgeon 
with  this  command ;  but  the  wounded,  being  taken  to  the  nearest  post,  Dr.  Weeds,  the  post  sur- 
geon, offered  a  good  and  much  needed  example,  by  complying  with  the  spirit  as  well  as  the  letter 
of  the  circular  from  this  office  of  March  23,  18G4,  and  the  instructions  on  Form  55,  Medical  Depart- 
ment, in  forwarding  the  required  Classified  Eeturn  of  Wounds  and  Injuries  and  Eeport  of  Casual- 
ties in  the  absence  of  a  medical  officer  attached  to  the  command. — ED.! 


The  force  with  which  arrows  are  projected  by  the  Indians  is  so  great  that  it  has  been 
estimated  that  the  initial  velocity  of  the  missile  nearly  equals  that  of  a  musket  ball.     At 

a  short  distance,  an  ar- 
row will  perforate  the 
larger  bones  without 
comminuting  them,  or 

F,o.  31.  Section  of  shaft  of  seventh  right  rib  of      ^Using    a    slight    fisSUl'6 

i  ii«          ,1  r*          Fxo. 33.    section  01  the  eleventh  right  rib  of  a 

«  ;T/l1,Vmp  *  only,  resembling  the  ef-    buffalo  li8SU1.ed  by  „,  amnv.    ^  4730,  sect,  i, 

feet  of  a  pistol  ball  fired    A-M-M- 

through  a  pane  of  glass  a  few  yards  off.  This  is  well  illustrated  in  two  preparations 
presented  to  the  Army  Medical  Museum  by  Professor  Joseph  Henry,  in  which  the  dense 
laminated  portions  of  the  shafts  of  ribs  of  the  buffalo  are  transfixed  by  arrows.  These 

are  represented  in  £he  wood-cuts  (Fms.  31,  32  )  The  arrow- 
points  penetrating  the  bones  have  not  produced  the  slightest 
splintering,  and  in  one  case  not  even  fissuring.  The  fissure 
in  the  right  hand  figure  is  much  more  conspicuous  than  in 
the  specimen.  I  have  frequently  been  informed,  by  offi- 
cers who  served  on  the  Plains,  that  it  was  not  infrequent 
for  an  Indian  to  send  an  arrow  fairly  through  the  body  of 
a  horse  or  of  a  buffalo,  provided  the  missile  entered  one  of 
FIG.  33.  section  01  the  left  scapula  of  a  the  intercostal  spaces,  and  did  not  impinge  on  bone  on  the 

buffalo,  transfixed   by  an    arrow.      Kpee,  .,          .  n  ml  -,   . 

4737, sect. i,  A.M.M.'  opposite  side,     lhat  this  statement  is  well  founded  is  rendered 

probable  by  the  evidence  afforded  by  a  preparation  for- 
warded to  the  museum  by  Hospital  Steward  R  Wall,  U.  S.  A.,  of  a  portion  of  the 
left  scapula  of  a  buffalo,  with  an  arrow-head  imbedded  in  it.  The  barbed  iron 
head  of  the  arrow  has  entered  the  venter  of  the  scapula  and  the  point  protrudes 
from  the  dorsum,'  so  that  the  missile  must  have  passed  through  the  thorax.  The  speci- 
men is  from  a  buffalo  killed  near  Port  Sedgwick,  in  1860,  by  a  Cheyenne  Indian. 


ARROW- WOUNDS.  101 

Prom  the  narrative  of  their  explorations  by  Lewis  and  Clarke,  from  Schoolcraft's 
History,  and  from  the  works  of  Mr.  Squier  and  other  writers  on  North  American  ethnology, 
and  the  reports  of  the  Commissioners  on  Indian  Affairs,  many  interesting  particulars  can 
be  gleaned  respecting  the  use  of  the  bow  and  arrow,  but  the  most  important  recent  con- 
tributions to  our  knowledge  of  wounds  by  arrows  have  been  made  by  Surgeon  W.  P. 
Edgar,  U.  S.  A.;  Dr.  T.  C.  Henry;*  Surgeon  B.  A.  Clements,f  U.  S.  A.;  Surgeon  J.  H. 
Bill,!  U.  S.  A;  Assistant  Surgeon  E.  Coues,§  U.  S.  A.;  Professor  0.  A.  Pope,))  Dr.  A. 
Muller,**  and  the  authors  of  the  foregoing  reports. 

In  the  foregoing  reports  of  eighty-three  cases  of  arrow-wounds,  twenty-six,  including 
nearly  all  in  which  the  three  great  cavities,  or  the  larger  bones  or  joints  were  involved, 
proved  fatal.  A  greater  fatality  would  be  represented  had  more  complete  returns  been 
made.ff  In  hostilities  in  the  Indian  country,  military  and  other  exigencies  sometimes 

"  Guoss.    A  System  of  Surgery,  4th  ed.     Philadelphia,  I860.    Vol.  I,  p.  361. 

t  CLKMENTS,  quoted  iii  Hamilton's  Military  Surgery. 

t  HILL,  American  Journal  of  the  Medical  Sciences,  N.  S.    Vol.  XLIV,  p.  365. 

§  COUKS,  The  Medical  and  Surgical  Reporter,  1866.    Vol.  XIV,  p.  321. 

||  POPE,  St  Louis  Medical  and  Surgical  Journal,  January,  1864. 

**  Dr.  Muller  reports  some  unpublished  facts  of  historical  as  well  as  surgical  interest :  "  Dakota  is  the  vernacular 
designation  of  the  Sioux  Indians,  and  the  whole  nation  is  divided  into  seven  principal  tribes  viz.  I.  Mdewakiintomvans; 
(Village  of  the  Spirit  Lake),  about  2,000  souls.  II.  Walipekutes,  (Leaf  Shooters),  about  500  to  600  persons.  HI. 
Wahprtonwans,  (Village  in  tho  Leaves),  about  1,000  to  1,200  souls.  IV.  Sisitonwans,  (Village  in  tho  Marsh),  Sisiton, 
about  2,500  souls.  V.  Yanktonwanua,  (End  Village  Band),  about  4,000  souls.  VI.  Yanktonwans,  (Village  at  tho  End), 
about  2,400  persons.  VII.  Tetonwaiis,  (Village  of  tho  Prairie),  about  12,500  souls.  Prior  to  the  great  Indian  outbreak  in 
Minnesota,  in  August,  1862,  the  three  first-named  bands  occupied  tho  country  east  and  south  of  the  Rod  Wood  Ki  vcr,  on  tho 
Upper  Minnesota  River,  and  were,  therefore,  called  Lower  Sioux;  while  the  four  last-named  lived  further  west,  on 
the  Upper  Minnesota  River,  at  Lac-qui-parlo,  at  and  west  of  Big  Stone  Lake,  or  Lake  Travers,  to  tho  Upper  Missouri 
River,  in  Dakota  Territory,  and  called  "Upper  Sioux,"  where  tho  "  Totons"  still  reside;  while  all  the  rest  of  the  tribe, 
were  driven  from  tho  State  of  Minnesota  in  1862,  and  are  now  scattered  all  over  tho  western  plains,  on  both  shores  of 
tho  Missouri  River.  In  their  warfare  they  use  all  sorts  of  shot-guns,  from  an  old  flint-lock  musket  to  the  best  kind  of 
Kentucky  rifles,  tho  younger  and  poorer  of  them  being  obliged  to  resort  to  bowa  and  arrows  for  tho  chaso  and  for  battles 
The  arrow  shafts  are  prepared  from  hickory,  white  ash,  and  a  willow  which  grows  in  abundance  along  tho  banks  of  all 
the  streams.  Tho  arrows  of  the  same  tribe  are  not  always  made  of  tho  same  size  and  material,  and  are  shaped  by  tho 
savages  according  to  their  prevailing  fancy;  tho  Tetons,  on  tho  Upper  Missouri,  for  instance,  using  both  iron  arrow 
heads  and  also  those  made  out  of  flint.  No  particular  difference  exists  between  tho  war  arrow  and  tho  arrow  for  tho 
chase,  although  most  of  tho  Indians  arc  in  tho  habit  of  painting  tho  shafts  of  their  arrows  prior  to  their  going  on  tho  war 
path,  with  red  and  other  colors.  For  tho  chaso  of  smaller  birds  and  other  animals,  arrows  without  heads  are  used,  a 
knob  of  different  size  being  cut  out  of  tho  wood  tho  arrow  is  made  of  in  place  of  tho  head.  In  order  also  to  prevent 
tho  easy  extraction  of  tho  arrow  head,  tho  war  arrows  are  often  only  glued  to  tho  shaft,  which  glue  becoming  softened 
from  blood,  &c.,  readily  detaches  the  head  from  the  shaft.  Burning  punk  is  also  often  attached  to  the  arrow,  for  tho 
purpose  of  setting  fire  to  houses,  &c.  Tho  iron  heads  arc  prepared  by  tho  Indians,  and  also  furnished  principally  by 
blacksmiths  in  tho  Government  employ.  The  Indians  make  them  out  of  hoop  and  sheet  iron,  tho  shape  and  sharpness 
being  given  by  means  of  a  file,  according  to  convenience.  No  radical  difference  exists  in  tho  arrow  heads  of  different 
tribes.  In  the  same  quiver  of  an  Indian  belonging  to  any  one  tribe,  a  great  variety  of  different  shaped  arrow  heads 
will  bo  found,  which  proves  that  tho  same  tribe  follows  no  special  typo,  but  fashions  them  according  to  any  kind  of  tasto. 
Tho  shallow  groove  which  exists  longitudinally  down  tho  entire  length  of  each  shaft,  has,  to  my  knowledge,  no  particular 
object,  and  tho  feathers  used  on  the  arrows  are  taken  from  almost  any  bird,  such  ones  possessing  gay  colors  being  pre- 
ferred, principally  by  the  Upper  Sioux  (Sisitons)  Indians.  Tho  various  colored  bauds  at  tho  rear  end  of  tho  arrows  aro 
purely  ornamental,  and  have  no  other  significance,  so  far  as  I  could  ascertain. 

tt  I  cannot  find  on  file  in  tho  War  Department  reports  of  tho  casualties  of  the  engagement  in  which  Brevet  Lieutenant 
Colonel  W.  J.  Fetterman,  Eighteenth  Infantry,  and  forty-nine  soldiers,  were  killed,  most  of  them  by  arraw-wounds,  near 
Fort  Philip  Kearney,  December  21,  1866 ;  or  of  General  W.  S.  Hancock's  engagement  with  tho  Cheyennes,  at  Pawneo 
Fork,  on  April  13,  1867;  or  of  Lieutenant  Colonel  G.  A.  Ouster's  attack  on  the  Black  Kettle  Band,  at  Washita,  Novem- 
ber 27, 1868  ;  or  of  Major  E.  A.  Carr's  affair  with  the  Sioux,  at  Beaver  Creek,  October  18, 1868 ;  or  of  Major  A.  W.  Evans's 
fight  with  tho  Comanches,  December  25, 1868;  or  of  tho  encounter  of  Major  E.  A.  Baker,  with  the  Piegans,  at  Mountain. 
Chirf,  Montana,  January  23,  1870.  In  all  of  these  engagements  tho  newspapers  stato  that  arrows,  as  well  as  fire-arms, 
wore  employed  by  tho  Indians. — Ei». 

21 


162  REPORT  OF  SURGICAL  CASES  IN  TETE  ARMY. 

preclude  the  possibility  of  rendering  the  returns  required  of  medical  officers.  For  exam- 
ple, in  several  recent  instances,  the  surgeon's  own  name  would  be  among  those  appearing 
in  the  list  of  killed  or  wounded.  But,  whenever  practicable,  it  is  to  be  desired  that  full 
returns  of  the  casualties  in  these  skirmishes  and  expeditions  should  be  made,  and  that 
medical  officers  should  specify  the  nature  and  seat  of  injuries  minutely.* 

Reference  to  the  reports  here  printed,  and  to  the  papers  that  have  been  cited,  will 
suggest  most  of  the  facts  we  possess  in  connection  with  arrow-wounds  and  their  treatment. 

The  methods  of  extracting  arrows  are  de- 
scribed  in  detail  by  Dr.  Bill,  and  several 
ingenious  expedients  are  described  for  re- 

Fio.  34.  Wire  loop  for  extracting  arrow-heads  em  bedded  in  soft  parts,  .1  i       i     i          i          p  i 

(After  a  drawing  by  Dr.  Bill.)  moving  the  barbed  heads  of  arrows  when 

buried  in  the  soft  parts  or  large  cavities,  or 

when  impacted  in  bone.  In  an  instance  in  which  a  Navajoe  arrow  had  penetrated  the  lung 
for  five  inches,  Dr.  Bill  succeeded  in  removing  it  by  means  of  a  snare,  as  represented  in 
the  preceding  wood-cut;  (FiG.  34),  the  arrow-shaft  being  used  as  a  guide  to  the  wire,  and 

the  great  danger  of  detaching  the 
^_^..^    head  from  the  shaft  being  avoided. 
Where  arrow-heads  are  lodged  in 

FIG.  35.  Wire-twister  recommended  by  Dr.  Bill.    It  sbould  bo  twelve  inches  long.      bone  and  Cannot    be    detached  by 
(From  Dr.  Bill's  paper.)  •>•    i   ,    ,          .•  -111 

slight  traction,  aided  by  a  gentle 

rocking  motion  of  the  shaft,  the  plan  which  Dr.  Bill  advises  is  to  procure  a  piece  of  well- 
annealed  iron  wire,  two  and  a  half  feet  in  length,  to  pass  the  ends  through  the  holes  in  a 
long  suture  wire-twister,  and  secure  them  to  its  handle  (FiG.  35)  leaving  a  loop  at  the 

distal  extremity  (Fio.  36).      The  loop  passed  over  the  feathered 
end  of  the  shaft  is  to  be  thrust  down  to  the  other  extremity  and 
made  to  snare  the  arrow-head,  and,  the  wire  being  tightened,  the 
foreign  body  and  instrument  are  to  be  withdrawn  together.     Dr.  Bill 
suggests  that  two  straightened  catheters  soldered  together  would 
Fir,,  so.  wire  loop  twisted  once    answer  in  place  of  the  wire-twister,  and  the  ecraseur  now  supplied 
with  tfle  armJ  field-instrument  cases  would  probably  prove  a  yet 
more  convenient  and  reliable  implement.     But,  whenever  possible, 
it  will  be  preferable  to  cut  down  upon  the  arrow-head  and  to  remove  it  with  forceps  ; — for 
the  surgeon  should  not  work  in  the  dark. 

The  subject  of  the  treatment  of  arrow-wounds  may  be  passed  over  with  this  brief 
reference  to  the  writings  of  the  medical  officers  whose  observations  of  such  injuries  have 
been  most  extensive.  Further  on  is  an  abstract  of  a  case  of  an  arrow-head  forming  the 
nucleus  of  a  vesical  calculus.  In  accordance  with  the  plan  of  this  report,  it  is  placed 
among  the  operations  for  lithotomy.  The  Army  Medical  Museum  possesses  also  two 
remarkable  specimens  of  the  penetration  of  bone  by  stone  arrow-heads.  Both  appear  to 

*  In  examining  the  reports,  it  is  often  difficult  to  decide  whether  a  contused  wound  that  is  cited,  should  be  classi- 
fied with  the  gunshot,  or  with  other  injuries,  or  to  obtain  any  clow  to  the  cause  of  an  incised  or  punctured  wound.  By 
noting  these  particulars,  medical  ottjcers  will  greatly  facilitate  the  work  of  consolidating  their  reports  and  arranging 
the  statistical  information  contained  in  thorn, 


AKROW-WOUNJDS. 


163 


.  37.  Stono  arrow-head  imbedded  iu 
the  spinous  process  of  a  lumbar  vertebra. 
Spec.  5553,  Sect.  I,  A.  M.  M.  [Natural  size.] 


FIG.  38.  Koverso  view  of  the  foregohij,' 
specimen. 


be  of  great  antiquity      One  was  discovered,,  in  looking  over  a  large  number  of  bones 

exhumed  by  Acting  Assistant 
Surgeon  A.  T.  Comfort,  from 
tumuli  near  Fort  Wads  worth, 
Dakota,  in  the  course  of  his  inter- 
esting explorations  of  the  Indian  - 
mounds,  in  that  vicinity,  in  1869, 
and  consists  of  the  spinous  pro- 
cess of  one  of  the  lumbar  verte- 
bra, in  which  a  small  quartz 
arrow-head  is  encysted.  The 
missile  is  so  overlaid  by  new  osseous  formation,  as  to  prove  that  the  wounded  man 

survived  the  injury  for  many  months  at  least.  Two  views 
of  the  specimen  are  exhibited  in  the  wood-cuts  adjoining, 
(Fias.  37  and  38.)  The  other  preparation  is  a  cranium 
transferred  to  the  Army  Medical  Museum,  by  the  Smith- 
sonian Institution.  It  is  a  skull  of  an  Indian,  of  advanced 
age,  obtained  in  Alameda  County,  California,  by  Dr.  C. 
Yates.  A  long  flint  arrow-head  has  penetrated  the 
cranial  cavity  through  the  left  orbit.  The  lower  maxilla 
is  fractured  almost  vertically  to  the  left  of  the  symphy- 
sis.  The  wood-cut  (Fio.  39),  shows  the  form  of  the 
cranium  and  the  position  in  which  the  flint  was  found 
impacted. 

Stone  arrow-heads  are  still  used  by  many  of  the  North  American  Indians*.  Many 
specimens  collected  in  Arizona,  California,  Utah,  and  Oregon,  have  been  forwarded  to  the 
museum.  It  was  believed  by  the  collectors  that  these,  in  many  instances,  were  poisoned 
arrows.  Repeated  experiments  that  I  have  made  of  inserting  the  points  beneath  the  skin 
of  small  animals,  as  frogs,  birds,  and  mice,  have  had  negative  results,  the  punctures 
healing  readily,  and  the  animals  surviving.  Tho  Indians  may  dip  their  arrow-heads  in 
rattlesnake  venom,  or  the  decayed  livers  of  animals,  as  is  commonly  stated  ;  but  it  is 
more  than  doubtful  if  the  arrows  thereby  become  poisonous.f 

Dr.  Bill  suggests  the  employment  of  archers,  with  regular  troops,  to  pick  off  sentinals 
noiselessly ;  but  he  remains  more  strictly  in  his  province  as  a  medical  officer  in  advising 
a  cuirass  for  soldiers  employed  in  Indian  hostilities. 

*  Lieut,  E.  G.  Bockwith,  3d  Artillery  (Reports  of  Explorations  for  a  Route  for  the  Pacific  Eailroad,  Vol.  II,  p.  43,  of  ad 
Keport),  gives  the  following  description  of  the  manufacture  of  these  stone  arrow-heads  by  the  Pitt  River  Indians  of 
California : 

"  One  of  them  seated  himself  near  rue,  and  made  from  a  fragment  of  quartz,  with  a  simple  piece  of  round  bone,  one 
end  of  which  was  semi-spherical,  with  a  small  crease  in  it  (as  if  worn  by  a  thread)  the  sixteenth  of  an  inch  in  depth,  au 
arrow-head,  which  was  very  sharp  and  piercing,  and  such  as  they  use  on  all  their  arrows.  Tho  skill  and  rapidity  with 
which  it  was  made,  without  a  blow,  but  by  simply  breaking  the  sharp  edges  with  the  creased  bone  by  the  strength  of 
his  hands — for  the  crease  merely  served  to  prevent  the  instrument  from  slipping,  affording  no  leverage — was  remarkable." 

tPAirf:,  cd.  Malgaigne,  p.  183,  and  the  Lyon  edition  of  1652,  p.  287.  Also  BALINGAIX,  Outlines  of  Military  Surgery, 
5th  ed.,  Edinburgh,  1855,  p.  399;  and  Professor  F.  H.  HAMILTON,  M.  D.,  Treatise  on  Military  Surgery,  New  York,  1865,  p. 
525.  There  has  always  been  a  wide-spread  belief  in  the  poisoning  of  arrow-heads.  Every  one  will  recall  the  "  Neo 
venenalis  gratida  sagittas,"  in  Horace,  (Od.  I,  22,  viii.)  Pliny  relates  (Lib.  XVI,  cap.  35,)  of  the  famous  Scythian  bowmen  ; 
"Kcylhu;  Saijitlan  tlmjunt  viperina  same,  et  humano  sanguine,  irremediabile  id  scelus  mortem  illieo  affert  levi  taclu."  Under  the 
articles  "  TOXICUM  "  and  "SA<;ITTA,"  in  the  lexicon  of  Facciolati  and  Forcelliui,  many  references  to  similar  allusions  by 
classical  authors  may  be  found. 


FIG.  39.  Cranium  with  a  stone  arrow-head  in 
tin-  left  orbit.  Spec.  5531,  Sect.  I.  A.  M.  M.,  Eo- 
duced  i-J 


164  KEPOllT  OF  SUHGICAL  CASES  IN  THE  ARMY. 


POISONED  WOUNDS. 


The  examples  of  poisoned  wounds  reported  were  but  few.  No  instances  of  glanders,  or 
malignant  pustule,  or  of  hydrophobia,  or  of  dissection  wounds  occurred,  and  the  instances 
of  serious  results  from  the  stings  or  bites  of  insects,  or  of  venomous  serpents  were  rare. 
Many  specimens  of  so-called  scorpions  and  tarantula?  and  other  arachnids  were  sent  by 
medical  officers  to  the  museum,  and  large  scolopendrse,  with  information  that  they  were 
considered  very  venomous  at  the  posts  at  which  the  officers  were  stationed ;  but  without 
any  sufficient  evidence  that  their  bites  or  stings  had  been  attended  with  any  serious  results. 
SNAKE  BITES. — Five  examples  of  poisoned  wounds  from  bites  by  reptiles  were 
reported.  Only  one  was  fatal,  and  the  fatal  result  in  that  case  was  due  to  secondary 
complications. 

CCCCLXXXVIII. — Memorandum  of  a  Case  of  Snake  Bite.    By  J.  V.  D.  MIDDLETON,  Assistant 
Surgeon,  U.  S.  A. 

Private  Theodore  E.  Turner,  Troop  D,  4th  Cavalry,  aged  29  years,  was  bitten  by  a  rattlesnake 
at  Fort  Concho,  Texas,  June  27,  I860.  The  bite  opening  the  phalangeal  joint  of  the  left  thumb, 
caused  violent  inflammation.  Chronic  inflammation  ensued,  which  resulted  in  the  destruction  of 
the  joint.  On  January  23, 1869,  the  patient  was  admitted  to  the  post  hospital  at  Austin,  Texas, 
at  which  time  the  joint  was  swollen  and  exquisitely  painful  on  the  slightest  motion,  the  anterior 
and  left  lateral  ligament  being  destroyed  by  nlceration.'  The  patient  was  feverish,  unable  to  sleep 
from  pain,  and  desirous  of  having  the  thumb  amputated.  On  the  date  of  admission  the  medical 
officer  in  charge  administered  ether,  and  amputated  the  thumb  above  the  phalangeal  articulation 
by  the  circular  method.  There  was  very  little  haemorrhage  and  that  little  was  suppressed  by 
torsion  of  the  arteries.  The  dressing  was  made  with  adhesive  straps,  carbolic  acid,  and  oil.  The 
pain  eased,  the  appetite  improved,  and  the  patient  slept  well.  The  wound  healed  by  January 
30,  18G9  and  the  man  was  soon  afterward  returned  to  duty. 

CCCCLXXXIX. — Memorandum  of  a  Recovery  from   a  Rattlesnake  Bite.    By  A.  B.  CAMPBELL, 
Assistant  Surgeon,  U.  S.  A. 

A  private  of  the  13th  Infantry  was  bitten  in  the  throat  by  a  rattlesnake  of  large  size.  (Crotalm 
durissus,  LINN.)  near  Camp  Cooke,  Montana  Territory,  in  August,  18C8.  The  wound  was 
immediately  sucked  by  a  comrade.  The  man  reported  at  the  post  hospital  at  Camp  Cooke,  three 
hours  after  the  accident,  which  happened  some  miles  from  camp.  The  only  noticeable  appearance 
was  a  slightly  wild  look  about  the  eyes,  although  the  man  did  not  seem  to  be  the  least  alarmed. 
His  throat  was  bound  up  in  olive  oil,  which  was  rancid,  but  the  only  kind  on  hand.  The  region  of 
wound  was  hard  and  somewhat  painful,  probably  from  being  bruised  by  the  teeth  of  the  man 
sucking  the  wound,  and  remained  so  for  about  three  hours.  There  were  no  further  bad  conse- 
quences from  the  injury,  and  the  patient  was  soon  returned  to  duty.  No  internal  remedy  was 
administered. 


POISONED  WOUNDS.  165 

t 

CCCCXC. — Report  of  a  Case  in  icliicli  a  Bite  from  a  Rattlesnake  proved  Fatal.    By  JULES  LE  CAE- 
PENTIEE,  M.  D.,  Acting  Assistant  Surgeon. 

Private  William  Robinson,  Troop  B,  3d  Cavalry,  aged  37  years,  and  remarkable  for  the  singu- 
larity of  his  conduct,  was  known  in  his  company  as  a  snake-charmer,  having  many  times  handled 
poisonous  snakes  without  being  injured.  On  the  morning  of  July  13, 1869,  he  was  detailed  as 
guard  with  the  herd  at  Fort  Cuminiugs,  New  Mexico,  when,  in  the  presence  of  the  herders,  he 
succeeded  in  catching  a  rattlesnake,  and  proving  his  power  as  a  sorcerer.  The  performance  being 
over,  and  the  snake  killed,  he  caught  sight  of  another  of  the  same  class,  and  tried  to  charm  this  as 
he  had  the  other.  But  hero  his  power  failed.  He  was  bitten  in  the  middle  finger  of  the  right  hand. 
He  was  immediately  admitted  to  the  post  hospital,  complaining  only  of  a  little  smarting  that  might 
be  compared  to  the  pain  following  the  sting  of  a  bee  or  a  wasp.  A  ligature  was  applied  above  the 
wound ;  the  two  injuries  made  by  the  fangs  were  enlarged  with  a  bistoury  ;  ammonia  and  the  actual 
cautery  were  applied^  and  whiskey  ordered  in  large  doses  frequently  repeated.  The  constitution  of 
the  patient  being  broken  down  and  poor,  I  had  doubts,  from  the  beginning,  as  to  his  recovery. 
Vomiting  soon  came  on,  but  was  stopped  without  trouble.  The  swelling  of  the  hand  and  arm 
increased  gradually,  showing  the  particular  livid  and  yellowish  tint  following  the  bites  of  poisonous 
snakes.  A  blister  was  applied  to  the  bitten  finger,  tincture  of  iodine  used,  and  two  ounces  of  whiskey 
given  every  two  hours  until  ebriety  was  induced.  The  pulse,  which  was  very  much  reduced,  at 
first  gained  gradually  under  the  influence  of  stimulants.  Two  grains  of  opium  were  given  at  night ; 
the  patient  slept  well,  and  on  the  next  day  complained  only  of  numbness  in  the  arm.  The  swelling 
had  extended  as  far  as  the  shoulder-joint,  and  the  blood,  which  was  very  fluid,  was  incessantly 
running  from  the  wounds.  Carbolic  acid  and  cerate  were  applied  to  the  arm,  with  stimulants 
internally.  On  the  15th,  his  general  condition  was  good ;  the  swelling  had  somewhat  augmented ; 
there  was  not  so  much  lividity,  but  the  yellowish  hue  had  increased.  On  the  16th,  he  complained  of 
pain  in  the  neck,  on  the  side  of  the  affected  limb,  but  his  general  condition  was  good.  Examining 
his  genitals,  an  iron  ring  six-eighths  of  an  inch  in  diameter  was  discovered,  imbedded  in  the  soft 
tissues  of  the  penis,  constricting  it  to  such  a  degree  as  to  have  produced  an  enormous  enlargement 
of  the  parts.  Upon  inquiry  it  seemed  probable  that  the  ring  had  been  kept  on  the  parts  very  long, 
as  a  preservative  of  chastity ;  but  the  swelling  having  come  on,  under  the  influence  of  the  snake's 
venom,  and  the  patient  having  much  difficulty  in  passing  water,  was  obliged  to  complain.  The  ring 
was  filed  off  with  some  difficulty.  Gangrene  destroyed  the  extremity  of  the  bitten  finger.  From  this 
date  until  the  30th,  his  condition  improved  somewhat.  The  progress  of  the  gangrene  was  stopped, 
and  I  disarticulated  the  injured  finger  at  the  metacarpal  articulation.  Anaesthesia  was  readily 
obtained,  but  the  appearance  of  the  second  stage  was  hardly  perceptible.  I  was  called  early  on  the 
next  morning,  the  patient  having  been  observed  to  be  sinking.  I  found  him  with  stertorous  respir- 
ation, pulse  weak  and  slow,  and  only  partly  conscious.  Electricity  was  applied  to  the  spine,  and 
brandy  and  bromide  of  potassium  were  given ;  but  he  died  about  noon  July  16,  1869.  A  necropsy 
was  made  one  hour  after  death.  There  was  general  softening  of  the  tissues,  particularly  on  the 
affected  side.  The  blood  was  black  and  very  fluid — not  coagulable.  The  ventricles  of  the  brain 
were  filled  with  a  large  amount  of  serum  ;  the  brain  was  somewhat  congested.  The  lungs  were 
healthy,  with  the  exception  of  a  few  crude  tubercles  of  recent  formation  on  the  left  side.  The  right 
ventricle  of  the  heart  was  empty,  and  the  left  filled  with  dark  blood  which  had  coagulated.  The 
liver  and  kidneys  were  healthy,  and  the  gall-bladder  very  much  distended  with  bile.  The  intes- 
tines presented  a  few  livid  patches  on  the  outside. 

CCCCXC1. — Note  relative  to  Two  Poisoned  Wounds.    By  IRVING  C.  EOSSE,  M.  D.,  Acting  Assist- 
ant Surgeon. 

In  May,  1869,  Mr.  E.  C ,  a  butcher,  was  stung  on  the  hand  by  a  scorpion,  at  Point  Isabel, 

Texas.  He  immediately  bound  up  his  hand  in  a  mixture  of  bruised  garlic  and  common  salt,  the 
popular  and  domestic  remedy  for  these  stings  among  the  people  of  that  section  of  country.  When 
seen  a  few  hours  after  the  reception  of  the  injury,  most  of  the  severe  symptoms  had  subsided,  and 
nothing  was  prescribed.  He  made  a  good  recovery. 


166  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

At  the  same  place,  and  about  the  same  time,  a  large  bull-dog  was  bitten  on  the  nose  by  a 
rattlesnake.  A  native  remedy,  probably  of  no  value,  was  also  used  in  this  instance — the  dog's 
nose,  at  and  in  the  vicinity  of  the  wound,  being  severely  pricked  with  sharp  points  of  the  Spanish 
bayonet  (yucca).  A  ludicrous  exaggeration  of  the  animal's  features  ensued  from  the  swelling  of 
the  tissues  about  the  face  and  head ;  he  seemed  surly  and  ill  for  several  days,  but  eventually 
recovered. 

CCCCXCII. — Remarks  on  Tico  Gases  of  Recovery  from  Bites  of  the  Water  Moccasin.    By  R.  D. 
BLACKWOOD,  M.  D.,  Acting  Assistant  Surgeon. 

Private  George  Williams,  2d  Infantry,  was  bitten  at  Patona,  Alabama,  by  a  water  moccasin, 
(Toxicophis  piscivorus,  B.  &  G.)  The  snake  was  four  feet  in  length ;  the  wound  was  on  the  second 
phalanx  of  the  left  index  finger.  The  finger  was  constricted  above  the  wound,  and  free  bleeding  from 
it  encouraged.  Whiskey  was  freely  administered,  three  quarts  (sic)  being  consumed  in  two  hours 
succeeding  the  reception  of  the  injury.  Although  the  patient  is  not  addicted  to  the  use  of  alcoholic 
stimulants,  he  was  not  affected  by  the  large  quantity  employed.  Believing  that  a  sufficient  quan- 
tity of  one  poison  had  been  used  to  neutralize  the  other,  nothing  further  was  done,  and,  except 
depression,  no  ill  effect  followed.  Next  day  the  patient  was  as  well  as  usual.  That  the  reptile  is 
capable  of  producing  poisonous  effects  is  evidenced  by  the  case  of  a  negro  child  of  five  or  six  years 
old,  in  whom  serious  prostration  and  stupor  followed  the  bite  of  a  similar  snake.  The  localeffect 
was  more  marked  than  in  Williams's  case — the  swelling  greater,  and  the  parts  bitten  tinged  of  a 
green  hue,  with  considerable  injection  of  the  conjunctiva.  The  wound  was  over  the  malar  bone. 

Fatal  results  from  the  bites  of  serpents  are  comparatively  infrequent  in  this  country. 
We  are  indebted  to  Dr.  8.  Weir  Mitchell  for  dispelling  many  erroneous  views  on  this 
subject.*  It  would  appear  that  only  some  of  the  larger  crotalidse  are  deadly,  and  even 
they  rarely  inflict  fatal  wounds.  The  adders  and  vipers  and  colubrine  snakes  are  not  hurt- 
ful. It  is  probable  that  only  the  larger  male  rattlesnakes,  during  the  rutting  season,  have 
sufficient  venom  to  destroy  life  in  the  large  mammals.  Dr.  J.  T.  Fayrer,  of  Calcutta,  has 
had  the  kindness  to  supply  me  with  his  work  on  the  Thanatophidia  of  India,  soon  to 
be  published  in  London,  in  which  the  mortality  from  snake-bites  in  Bengal  and  adjacent 
provinces,  including  an  area  "  rather  less  than  half  that  of  the  peninsula  of  Hindostan  " 
was  in  the  year  1869,  not  less  than  ll,416,f  and  it  is  his  belief  that  the  annual  mortality 
in  British  India  from  this  cause  is  not  less  than  20,000.  I  question  whether  so  many 
deaths  have  occurred  on  this  continent,  from  such  cause,  within  the  historical  period. 

*  See  Dr.  Mitchell's  well-known  papers  in  the  Smithsonian  Contrtlmt'tOM  for  1861,  North  American  Medico-Chirurgical 
Review,  March,  1861,  and  in  the  American  Journal  of  the  Medical  Sciences. 

t  FAYREU.    Indian  Medical  Gazette,  January,  1870. 

t  See  also  B.  S.  BAUTON,  Trans.  Am.  Phil.  Society,  Vol.  Ill,  p.  110;  FONTANA,  Trait6  Sur  la  VMn  de  la  viperes,  .J-c., 
(French  trans.,)  Florence,  1781;  RUSSELL,  Account  of  Indian  Serpents,  <$-c.,  cf-c.  PIORKY,  lln-in  Malii-alc,  1826,  p.  26;  IRE- 
LAND, Mcd.-Chir.  Trans.,  Vol.  II,  p.  398 ;  HOME,  Phil.  Trans.,  1830,  p.  75 ;  BOYEH,  Traitd  des  Mai.  Chlr.,  5°  eil.,  T.  I, 
p.  791).  CEI.SUS,  De  Mediclna,  Edinburgh  cd.,  1809,  Lib.  V,  cap.  3.  KEDJ,  Ol>i.  Int.  allc  Fipere,  Firouze,  1664.  Charas, 
Catesby,  Barry. 


BUKNS  AND  SCALDS.  167 


BURNS,  SCALDS,  AND  FEOST  BITES. 


BURNS  AND  SCALDS. — Under  this  head  two  thousand  and  three  cases  were  reported, 
nearly  all  of  trivial  character,  and  special  reports  were  not  made  of  any  particular  cases. 


FKOST  BITES. — Some  cases  of  this  class,  involving  amputations,  will  be  found  among 
the  reports  of  operations.  Others,  in  which  special  reports  were  made,  are  inserted  here. 
Four  of  these  were  fatal. 

CCCCXCIII. — Account  of  a  Fatal  Case  of  Frost  Bite.    By  J.  B.  GIBARD,  Assistant  Surgeon, 
U.  S.  A. 

At  Fort  Fred  Steele,  Wyoming  Territory,  December  9, 1870,  Private  Richard  Bowen,  Co.  A,  13th 
Infantry,  aged  29,  an  habitual  drunkard,  was  detailed  as  a  member  of  a  wood  party  ordered  to  the 
mountains  to  procure  timber.  Previous  to  starting,  he  and  a  comrade  secretly  procured  a  quantity 
of  whiskey,  of  which  they  partook  freely  during  the  day  to  such  an  extent  as  to  become  considerably 
intoxicated.  Toward  evening,  owing  probably  to  their  condition,  they  strayed  from  the  wagon- 
train,  and  lost  their  way.  They  remained  during  the  night  near  a  stream  on  the  bank  of  which 
they  had  built  a  fire,  and  Bowen,  who  during  the  day  had  waded  through  the  stream,  filling  his 
boots  with  water,  found  it  impossible  to  pull  them  off,  the  water  in  them  having  become  frozen. 
The  next  morning  they  returned  to  the  post,  marching  eight  or  ten  miles,  and  were  both  admitted 
to  the  post  hospital.  Bowen's  boots  having  been  cut  off,  his  feet  were  found  frozen  solidly  to  the 
ankle-joints.  Two  nurses  were  immediately  set  to  work  rubbing  the  feet  with  snow,  while  internal 
stimulants  were  administered  to  prevent  collapse.  After  two  hours  of  vigorous  friction  and  cold 
water  pediluvia,  circulation  was  restored  in  the  skiu  and  motion  in  the  joints  of  the  toes  became 
practicable.  The  feet  were  then  wrapped  in  cloths  wet  with  whiskey  and  surrounded  with  several 
layers  of  cotton  wadding  secured  by  bandages.  The  patient  was  put  to  bed  and  morphia  adminis- 
tered. He  passed  a  comfortable  night,  and  the  next  day,  upon  removing  the  dressings,  the  feet 
were  found  in  a  very  satisfactory  condition.  The  toes  were  all  moveable  at  the  patient's  will,  and 
the  soles  alone  looked  dark  and  livid.  He  felt  as  well  as  usual,  complained  of  no  pain,  and  enjoyed  a 
moderate  appetite.  The  application  of  whiskey  to  the  frozen  parts  was  continued,  and  quinine  with 
tincture  of  chloride  of  iron  ordered  three  times  daily.  He  remained  in  nearly  the  same  condition 
till  the  15th,  when  the  alcoholic  lotion  was  replaced  by  lime  water  and  olive  oil  liniment,  on  account 
of  the  removal  of  the  epidermis  from  some  portions  of  the  feet.  On  the  afternoon  of  the  15th  his 
appetite  and  strength  commenced  to  fail.  When  seen  on  the  morning  of  the  IGth  he  was  remark- 
ably weaker  and  his  features  wore  a  typhoid  expression.  His  legs  were  found  cedcmatous  up  to 
the  knees,  and  the  feet  were  less  moveable  than  usual.  Milk  puuch  was  immediately  ordered  three 
times  a  day,  and  beef  tea  at  short  and  regular  intervals.  He  steadily  grew  worse,  and  died  on  the 
morning  of  the  17th. 

CCCCXC1V. — Remarks  on  a  Fatal  Case  of  Frost  Bite.    By  A.  A.  WOODHTILL,  Assistant  Surgeon, 
U.  S.  A. 

Sergeant  William  Earl,  Troop  G,  7th  Cavalry,  of  robust  physique,  and  usually  a  temperate 
man,  visited  the  neighboring  town  of  Las  Anima  while  intoxicated,  after  tattoo,  on  the  night  of 


168  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

December  21st,  1870.  There  ho  grew  much  more  intoxicated,  and,  it  was  understood,  became  involved 
in  a  fracas.  About  or  after  midnight,  he  left,  or  was  turned  from  a  saloon,  and  was  found  in  the 
morning  in  a  wagon  near  by,  in  a  badly-frozen  condition.  The  thermometer  marked  23°  below  the 
zero  of  Fahrenheit  during  the  period  of  his  exposure,  and  against  this  excessive  cold  he  was  not 
specially  protected.  On  admission  to  the  hospital  at  Fort  Lyon,  Colorado  Territory,  about  10 
A.  M.,  lie  was  very  much  prostrated,  and  both  feet  and  the  left  hand  were  frozen.  They  had 
been  rubbed  with  snow,  and  soaked  in  ice-water  before  arriving,  which  treatment  was  continued 
for  more  than  two  hours  in  a  cold  room.  When  first  discovered,  both  feet  were  stated  to  be  stiff 
above  the  ankle.  Moderate  reaction  having  set  in,  he  was  provided  with  food,  and  his  feet  and  hands 
were  enveloped  in  lint  wet  with  olive  oil  and  lime-water.  There  was  a  slight  scalp-wound  on  the 
left  side,  and  he  complained  of  severe  pain  and  soreness  in  the  stomach,  as  if  from  a  blow,  and  of 
pain  in  the  left  shoulder.  An  examination  of  the  shoulder  could  detect  no  injury.  He  was  much 
depressed  in  mind  at  the  extent  of  his  accident  and  at  the  circumstances  under  which  it  was 
received,  and  at  no  time  rallied  so  as  to  be  either  cheerful  or  sanguine.  For  the  first  four  days 
the  patient  did  reasonably  well,  and  in  consequence  of  his  usual  robust  health,  no  more  disastrous 
result  than  the  partial  loss  of  his  hand  and  feet  was  anticipated.  A  little  carbolic  acid  was 
added  to  the  dressing.  About  the  24th,  although  some  sensation  remained,  it  was  evident  he 
would  lose  his  toes,  and  a  line  of  demarkatiou  began  to  show  itself  the  next  day,  near  the 
tarsus  of  the  right  foot,  and  a  little  lower  on  the  left.  Both  heels  were  also  badly  vesicated,  and 
'  amputation  was  deferred  until  it  could  bo  determined  how  deeply  the  slough  would  descend, 
and  especially  the  extent  of  the  injury  to  the  heel.  No  special  treatment  was  adopted,  except 
as  to  the  regulation  of  his  bowels  and  the  use  of  opiates  to  subdue  nocturnal  pains.  All  this 
time  his  comrades  noticed  his  unusual  and  decided  melancholy.  On  the  27th,  perspiration  was 
observed,  but  it  was  ascribed  to  the  artificial  heat  of  the  ward.  On  the  28th,  his  countenance 
changed,  and  he  rapidly  became  worse,  with  some  mental  aberration.  Stimulants  were  ordered 
freely.  It  was  then  iny  intention  to  amputate  the  next  day,  if  possible.  On  the  29th  both 
legs,  especially  the  right,  were  swollen  and  cedeniatous,  and  had  an  erysipelatous  blush,  pit- 
ting deeply  on  pressure,  and  precluding  the  idea  of  the  knife.  Beef  essence  and  strong  milk  punch 
were  freely  and  constantly  given,  and  two  drachms  of  the  tincture  of  the  scsqnichloride  of  iron  were 
ordered  to  be  taken  within  twenty-four  hours.  This  was  steadily  continued  night  and  day  through- 
out the  case.  The  following  is  from  the  clinical  record,  December  29th,  9.30  A.  M. :  Temp.  lOljj-; 
2  o'clock,  P.  M.,  104 ;  pulse  134;  respiration  28;  7  P.  M. :  Temp.  104;  pulse  125;  respiration  32. 
December  30th,  7  A.  M.:  Temp.  102|;  pulse  132;  respiration  32;  2  P.  M.:  Temp.  102J;  pulse 
130 ;  respiration  34 ;  7  P.  M. :  Temp.  104 ;  pulso  122 ;  respiration  35.  During  all  this  time  he  was 
in  a  typhoid  delirium,  and  ho  died  at  1.10  P.  M.  December  31st.  The  right  foot  was  examined 
three  hours  after  death,  with  the  view  of  determining  how  far  a  Syme's  amputation  would  have 
been  justified.  The  flesh  of  the  heels  was  found  softened;  the  ankle  was  firmer  than  was  antici- 
pated, but  a  section  of  the  anterior  tibial,  in  the  lower  part  of  its  course,  showed  it  filled  with  a 
purulent-looking  fluid.  No  further  examination  was  considered  necessary,  the  whole  course  of  the 
symptoms  pointing  so  clearly  to  blood-poisoning. 

CCCCXCV. — Mention  of  Tioo  Cases  of  Frost  Bite  occurring  at  Fort  Abcrcrombie,  Dakota  Territory. 
By  W.  D.  WOLVERTON,  Assistant  Surgeon,  U.  S.  A. 

Private  John  W.  Owens,  Co.  A,  20th  Infantry,  aged  24  years,  was  admitted  to  the  hospital 
January  28, 1870,  with  frost  bite  of  the  right  foot,  which  was  treated  with  carbolic  acid  and  olive 
oil.  lie  was  discharged  from  service  while  in  hospital  by  reason  of  his  term  having  expired. 

Private  Alexander  Brandt,  Co.  I,  20th  Infantry,  aged  21  years,  was  admitted  February  13, 
1870,  with  frost  bite  of  the  large  toe  of  the  right  foot,  which  was  treated  with  carbolic  acid 
and  olive  oil.  When  mortification  appeared,  poultices  were  used ;  after  separation  of  slough,  a 
weak  solution  of  carbolic  acid  and  water.  Ho  was  discharged  from  hospital  on  May  10th,  and  left 
with  his  company  for  Pembina,  the  wound  being  not  quite  healed. 


FBOST  BITES.  169 

CCCCXCVI. — Account  of  Three  Cases  of  Frost  Bite,  occurring  at  Fort  Bipley,  Minnesota.     By 
0.  K.  WINNE,  Assistant  Surgeon,  U.  S.  A. 

On  January  11,  1870,  Private  Thomas  Sweeney,  Co.  G,  20th  Infantry,  aged  22  years,  was 
admitted  to  hospital  with  frost  bite  of  right  ear.  Simple  dressings  were  applied.  He  returned 
to  duty  the  next  day. 

On  January  18,  1870,  Private  Charles  McCoinbs,  Co.  G,  20th  Infantry,  aged  21  years,  was 
admitted  with  frost  bite  of  right  foot.  Simple  dressings  were  applied.  He  returned  to  duty  the 
next  day. 

On  February  18,  1870,  Private  George  W.  Depue,  Co.  G,  20th  Infantry,  aged  19  years,  was 
admitted  with  frost  bite  of  right  hand.  Simple  dressings  were  applied.  He  returned  to  duty 
next  day.  He  was  readmitted  March  8th,  with  frost  bite  of  both  feet  and  legs.  Simple  dressings 
•were  applied.  There  was  excessive  constitutional  depression,  complicated  with  pneumonia.  No 
operation  was  justifiable.  He  died  March  20,  1870. 

CCCCXCVII. — Report  of  Four  Cases  of  Frost  Bite,  occurring  at  Fort  Snelling,  Minnesota .    By  A. 
HEGER,  Surgeon,  U.  S.  A. 

On  January  8, 1870,  Private  James  Smith,  Co.  E,  20th  Infantry,  aged  23  years,  was  admitted  to 
hospital  with  frost  bite  of  heels  and  toes  of  both  feet  and  left  ear,  which  happened  when  absent, 
drunk.  Ice-water  irrigation.  He  returned  to  duty  January  18, 1870. 

On  January  20,  1870,  Private  John  Stack,  Co.  E,  20th  Infantry,  aged  23  years,  was  admitted 
with  frost  bite  of  the  great  toe,  left  foot.  Ice-water  irrigation.  He  returned  to  duty  January  21, 
1870. 

On  January  10, 1870,  Private  William  Hausinan,  Co.  E,  20th  Infantry,  aged  24  years,  was 
admitted  with  frost  bite  of  the  great  toe,  right  foot.  Ice-water  irrigation.  He  returned  to  duty 
January  28, 1870. 

On  January  26,  1870,  Private  William  Flynn,  Co.  E,  20th  Infantry,  aged  24  years,"  was 
admitted  with  frost  bite;  of  left  heel  and  right  great  toe.  Ice-water  irrigation.  He  returned  to 
duty  February  18,  1870. 

CCCCXCVIIL— Note  of  a  Case  of  Death  from  Frost  Bite.    By  P.  C.  DAVIS,  Surgeon,  U.  S.  A. 

Private  Thomas  Kane,  Co.  D,  13th  Infantry,  died  at  Fort  Ellis,  Montana  Territory,  on  January 
20,  1870,  from  the  effects  of  exposure  to  the  cold  on  the  night  of  January  16th,  while  returning 
from  Bozeman,  a  town  three  and  a  half  miles  distant  from  Fort  Ellis.  He  was  found  on  the 
following  morning  lying  on  the  snow,  in  a  comatose  state,  and  immediately  brought  to  the  hospital, 
where,  upon  examination,  it  was  found  that  both  feet  and  legs  were  badly  frozen  nearly  to  the 
knees,  and  that  his  hands  and  part  of  his  arms  were  in  the  same  condition.  All  efforts  to  rouse 
him,  or  procure  reaction,  proved  unavailing.  It  is  supposed  he  was  very  much  intoxicated.  The 
thermometer,  at  7  A.  M.  on  the  morning  he  was  found,  was  33°  F.  below  zero.  The  condition  of 
the  man,  from  the  time  of  his  admission  until  death,  would  not  admit  of  amputation. 

22 


170 


REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 


SURGICAL  OPERATIONS. 


The  reports  for  the  past  five  years  include  minutes  of  numerous  amputations  for 
disease  or  injury,  of  many  excisions  of  the  larger  joints,  of  a  number  of  ligations,  and 
of  other  operations,  such  as  trachiotomy,  lithotomy,  and  the  extirpation  of  tumors.  The 
more  important  abstracts  will  be  recorded  in  full,  and  the  other  reports  will  be  condensed 
in  tabular  shape. 

AMPUTATIONS. 

Two  hundred  and  fifty-one  cases  of  amputations  were  made  the  subjects  of  special 
report ;  viz.,  One  hundred  and  sixty-four  of  the  upper  extremity,  eighty-six  of  the  lower, 
and  one  of  both  upper  and  both  lower  extremities. 

AMPUTATIONS   IN   THE   UPPER   EXTREMITIES. 

Amputations  of  the  Fingers. — Of  114  of  these  operations,  sixty-four  were  on  account 
of  gunshot  wounds,  ten  for  frost-bites,  eight  for  incised  wounds,  two  for  accidents  on  rail- 
ways, and  thirty  for  miscellaneous  accidents.  All  of  the  patients  recovered;  sixty-one 
were  returned  to  duty,  thirty-seven  were  discharged  as  unfit  for  military  duty,  and  six- 
teen recovered,  but  the  ultimate  disposition  made  is  not  yet  ascertained. 


Name. 

Bank. 

Co. 

Eegimeut. 

Nature  of  injury. 

Parts  removed. 

Eemarks. 

1.  Andrew,  Cordey  

Private  

G. 

9th  Cavalry  

Gunshot  wound.. 

Left  index  finger 

Eeturned  to  duty  Mar. 

3,  1871. 

2.  Appleman,  Peter  

Private  

D. 

22d  In  fan  try  

Unknown  

Distal  third  of  first  phalanx  of 

Deserted  May  20,  1870. 

the  right  index  finger. 

3.  Auchenpock,  Marion.  .  . 

Private.... 

L 

37th  Infantry  .  .  . 

Gunshot  wound.  . 

Eight  forefinger,  at  junction  of 

Ecturned  to  duty  Sep- 

first and  second  phalanges. 

tember  24,  1867. 

4.  Banks,  Augustus  

Private  

Ordnance  Corps. 

Fall    

Eight  thumb,  at  metacarpal  joint. 

Eeturned  to  duty  De- 

cember 26,  1868. 

5.  Barclay,  James  

Private  .  .  . 

Ordnance  Corps 

Laceration  hy  cir- 

Third and  fourth  fingers  

Discharged  January  2, 

cular  saw. 

1868. 

6.  Bender,  Eberhardt  

Private  

D. 

3d  Infantry  

Gunshot  wound.. 

Left  index  finger,  and  head  of 

Eeturned  to  duty  in 

metacarpal  bone. 

March,  1869. 

7.  Berry,  Grippen  

Private  

C. 

24th  Infantry  .  .  . 

Gunshot  wound.. 

Left  thumb,  at  metacarpo-pha- 

Eeturned  to  duty  De- 

langeal articulation. 

cember  25,  1869. 

8.  Bischoff,  Franz  

Private  

I. 

37th  Infantry  .  .  . 

Gunshot  wound.. 

Eight   index  finger,   at  second 

Eeturned  to  duty  in 

joint. 

July,  1867. 

9.  Borger,  Philip  

Private  

C. 

9th  Infantry  ..., 

Gunshot  wound.  . 

Left  thumb,  in  continuity  of  first 

Eeturned  to  duty  in 

phalanx. 

August,  1868. 

10.  Bosworth,  Nathaniel  C. 

Private  

B. 

8th  Cavalry  

Gunshot  wound.  . 

Left  index  finger,  at  metacarpo- 

Ei-tnrned  to  duty  July 

phalangeal  joint. 

9,  1867. 

11.  Brady,  James  

Private  

D. 

3d  Cavalry  

Bitten  by  a  com- 

Left forefinger,  one  inch  from 

Eeturned  to  duty  in 

rade. 

ruetacarpo-phalangeal  articu- 

June, 1869. 

lation. 

12.  Brown,  Patrick  

Private  

G. 

4th  Artillery.... 

Incised  wound  .  .  . 

Eight  middle  finger,  at  articula- 

Eeturned to  duty  Sep. 

tion  of  second  and  third  pha- 

tember 15,  1870. 

langes. 

13.  Burnham,  William  

Private  

C. 

10th  Cavalry  

Gunshot  wound.  . 

Second  finger  of  right  hand,  and 

Discharged  January  3, 

two-thirds  of  the  second  met- 

1868. 

acarpal  bone. 

14.  Bush,  Henry  

Private  — 

G. 

7th  Infantry  

Railroad  accident. 

Three  fingers  amputated,   and 

Discharged  from  ser- 

portions of  carpal  and  meta- 

vice August  10,  1867. 

carpal  hones  excised. 

AMPUTATIONS  OF  THE  FINGERS. 


171 


Name. 

Rank. 

Co. 

Regiment. 

Nature  of  injury. 

Parts  removed. 

Remarks. 

15.  Cahil,  Patrick  
16.  Carter,  Monroe  
17.  Clark,  Arthur  
18.  Clone,  Morris  
19.  Cook,  Frank  
20.Cullen,  Martin  
21.  Daily,  John 

Private  
Private  
Private  
Private  
Private  — 
Private  

Jnassigncd 
recruit. 
Private  
Private  

Private.... 
Private  

Private  
Private  
Private  
Private  
Private  — 
Private  
Private.... 
Citizen 

1 
A. 

K. 
G. 
L. 
M. 

H. 
H. 
D. 

D. 
A. 
L 
A. 
G. 
H- 
K. 

13th  Infantry  .  .  . 
21st  TT.  S.  C.  T... 
4th  Infantry  
35th  Infantry  .  .  . 
2d  Artillery  
2d  Cavalry  

9th  Colored  Cav- 
alry. 
Pawnee  Scouts.. 
18th  lu  fan  try  ... 

4th  Artillery  .... 
22d  Infantry  

15th  Infantry  .  .  . 
17th  Infantry  ... 
18th  Infantry  .  .  . 
42d  Infantry  ... 
9th  Cavalry  
4th  Infantry  .  .  . 
14th  Infantry  .  . 

Frost-bite  
Gunshot  wound.. 
Gunshot  wound.. 
Incised  wound... 

Lacerated  wound 
by  circular  saw. 
Frost-bite  

Gunshot  wound  .  . 

Gunshot  wound.. 
Gunshot  wound.. 

Crushed  by  the 
wheel  of  a  cais- 
son. 
Frost-bite 

Second  and  third  phalanges  of 
all  fingers  of  left  hand. 
Eight  little  finger,  through  meta- 
carpo-phalangcal  articulation. 
Fore   and  middle  fingers,  left 
hand. 
Index  finger,  left  hand,  at  meta- 
carpo-phalangeal  articulation. 
All  the  fingers  of  left  hand  

Discharged  from  ser- 
vice May  15,  1868. 

Discharged  Juno   27, 
1868. 
Returned  to  duty  Sep- 
tember 10,  1868. 
Discharged    May   12, 
1870. 
Discharged    April    9, 
1867. 
Returned  to  duty  Au- 
gust 4,  1868. 

Discharged   June  25, 
1870. 

Returned  to  duty  in 
July,  1870. 

Secondary  hjcmor- 
rhage  ;  anchylosis  of 
second  and  third  fin- 
gers ;  returned  to  du- 
ty February,  1870. 
Deserted  September  26, 
1869. 
Returned  to  duty  May 
31,  1868. 
Returned  to  duty  in 
August,  1870. 
Returned  to  duty  Oc- 
tober 20,  1869. 
Returned  to  duty  No- 
vember 20,  1868. 
Transferred   to  Vete- 
ran Reserve  Corps. 
Returned  to  duty  Au- 
gust 20,  1870. 
Recovered. 

Recovered. 

Returned  to  duty  No- 
vember 11,  1870. 
Returned  to  duty  Sep- 
tember 14,  1868. 
Discharged   Juno  17, 
1868. 

Returned  to  duty  Sep- 
tember 25,  1870. 
Discharged  from  ser- 
vice January  10,1870. 

Returned  to  duty  No- 
vember 22,  1870. 
Returned  to  duty 
March  16,  1869. 
Discharged  March  29. 
1869. 

All  the  fingers  of  left  hand  and 
Ihree  first  toes  of  left  foot. 
Left  little  finger,  at  motacarpo- 
phalangeal  articulation. 
Right  index  finger. 
Right  index  finger,  and   head 
of  corresponding  metacarpal 
bone. 
Right  index  finger,  at  second 
phalangeal  articulation. 

Fourth  finger  left  hand,  at  mota- 
carpo-phalangeal  articnlatiou. 

Middle  finger  right  hand,  at  met- 
acarpo-phalangeal  articulation. 

22.  Day,  Barney  
23.  De  Forester,  George  

24.  De  Forrest,  Frank  
23.  Dempsey,  William  

16.  Desmond,  Humphrey  .  . 

Lacerated  wound. 

Bitten  by  a  sol- 
dier. 
Gunshot  wound.. 

Gunshot  wound.  . 
Gunshot  wound.  . 

Necrosis,  follow- 
ing whitlow. 
Bitten  by  a  sol- 
dier. 
Gunshot  wound. 

Gunshot  wound. 
Gunshot  wound. 
Gunshot  wound. 

Crushed  by  wheel 
of  a  truck. 

Gunshot  wound. 
Gunshot  wound. 

Compound    frac- 
ture. 
Frost-bite 

28.  Dooley,  MichaelJ  
29.  Dowdy,  James  
30.  Fisher,  Thomas  
31.  Fletcher,  Thomas  ~W.  . 
32.  Franklin,  A   

Second  finger  and  corresponding 
metacarpal  bone. 
Middle  left  and  ring  fingers  

Right  index  finger  at  first  joint. 
Last  phalanx  of  right  thumb  

33.  Gardner,  Nelson  

Left  index  finger,  and  fractured 
end  of  metacarpal  bone. 
Index,  at  metacarpo-phalangeal 
articulation. 
Second  and  third  phalanges  left 
index. 
Right  index  finger,  at  middle  of 
second  phalanx. 
Right  thumb  at  first  joint,  and 
all  the  fingers,  including  the 
third,  fourth,  and  fifth  meta- 
carpal bones. 
Right  thumb  at  middle  of  second 
phalanx. 
Three  fingers  at  the  second  joint, 
and  thumb  at  carpo-metacarpo 
articulation. 
Right  index  finger,  at  middle  of 
second  phalanx. 

34.  George,  Lewis  J  
35.  Good,  Batton  

Private  
Bugler  
Private... 
Private 

A. 
M 
G. 

7th  Cavalry  
9th  Cavalry  
9th  Cavalry  

36  Hamilton  Frank 

37.  Ilargerty  ,  J  

38.  Harmering,  August  

Private... 
Artificer  . 

Private.  .  . 
Private... 
Private... 

C. 

G. 

E. 
D. 
D. 

7th  Infantry  .  .  . 
8th  Infantry  .  .  . 

17th  Infantry  .  . 
20th  Infantry  .  . 
43d  Infantry  .  .  . 

40.  Hennard,  Jas.  G  
41.  Hickey,  James  
42.  Hogan,  John  

Gunshot  wound. 

Little  finger  of  right  hand,  and 
head  of  metacarpal  bone1. 

172 


EErORT  OF  SURGICAL  CASES  IN  THE  AEMY. 


Name. 

Rank. 

Co. 

Regiment  • 

Nature  of  injury. 

Parts  removed. 

Remarks. 

T 

19th  Infantry 

Left  index  and  second  fingers, 

Recovered. 

44.  Howard,  Charles  

11 

Incised  wound  .  .  . 

through  the  shafts  of  middle 
phalanges. 
Middle,  ring,  and  little  fingers 

Recovered. 

45.  Huntington,  Henry  .  .  . 

Private.  .  . 

G. 

4th  Infantry  
6th  Cavalry 

Gunshot  wound.. 
Supposed  to  have 

of  left  hand,  through  middle 
phalanges. 
Third  and  fourth  fingers  of  right 
hand,  at  metacarpo-phalangeal 
articulation. 
Second  finger  of  the  left  hand 

Discharged  February 
13,  1869. 

resulted  from  in- 
juries   received 
•while  tied  up  hy 
the  wrist. 

27,  1867. 

48.  Keller  Nicholas 

£ 

14th  Infantry 

with  fracture. 

first  joint. 

cember  23,  1870. 

49.  Kold,  John  "W  

Private  

p 

15th  Infantry 

Gunshot  wound.. 

phalanx. 
Middle  finger  of  left  hand 

30,  1870. 

50.  Leopold,  Emil  

Private.... 
Private 

F. 
F 

26th  Infantry... 
20th  Infantry 

Incised  wound... 
Frost-hite 

Second  finger  of  left  hand,  at 
first  phalangefll  joint. 

November,  1868. 
Returned  to  duty  Au- 
gust 12,  1868. 

52.  Lilly,  James  

53.  McAllister,  Alvin  M... 
54.  McCaffrey,  Francis  

Private.... 
Sergeant  .. 
Corporal.  .. 

G. 
G. 
I. 

M 

9th  Cavalry  
17th  Infantry... 
7th  Infantry  

4th  Cavalry 

Gunshot  wound.  . 
Gunshot  wound  .  . 
Gunshot  wound.  . 

third  of  first  phalanges. 
Left  hand  at  carpo-metacarpal  ar- 
ticulation, saving  the  thumb. 
Right  forefinger,  at  metacarpo- 
phalangeal  articulation. 
Left  little  and  ring  fingers  with 
the  metacarpals  at  the  carpo- 
metacarpo-articulations,    and 
middle  finger  at  first  joint; 
also,  right  little  finger. 
Left  little  finger  in  first  pha- 

May, 1870. 
Discharged  December 
16,  1867. 
Returned  to  duty  in 
May,  1867. 
Returned  to  duty  in 
September,  1869. 

56.  McDonald,  Matthew  .  .  . 
57.  McPeake,  Morris  

58.  Mathias,  John  G  
59.  Miller,  William  

fin.Minnr.H    

Private  
Private.... 

Private  
Private  

F. 
A. 

L. 

D. 

F 

23d  Infantry  
15th  Infantry  .  .  . 

4th  Artillery.... 
15th  Infantry  .  .  . 

17tli  Infantry 

Lacerated  wound. 

Caught  by  a  cir- 
cular saw. 

Gunshot  wound.. 
Incised  wound  .  .  . 

lanx. 
First  phalanx  of  right   index 
finger. 
First  phalanx  of  left  thumb,  and 
third  phalanges  of  balance  of 
fingers. 
Ring  finger  at  nngnal  phalanx, 
and  little  finger  at  metacarpal 
articulation  ;  left  hand. 
Right  index  finger,  at  middle 
phalanx. 

August,  1868. 
Recovered. 

Discharged  August  5, 
1867. 

Returned  to  duty  in 
February,  1871. 

Returned  to  duty  in 
September,  1870. 

61.  Mitchel  George 

F 

10th  Cavalry  .. 

tal  extremity  of  first  phalanx, 
and  middle  finger  near  base  of 
second  phalanx. 

62.  Montgomery,  Jesse  
63.  Moore,  John  A. 

Private  

M. 

T 

10th  Cavalry  

8th  Cavalry 

Gunshot  wound.  . 

mi'tacarpal  bone. 
Right  index  finger,  between  first 
and  second  phalanges. 

February,  1868. 
Returned  to  duty  Au- 
gust 14,  1870. 

64.  Moore,  Walter  
65.  Morris,  Patrick  

Private  

H. 

Iff 

41st  Infantry  
2d  Artillery 

Gunshot  wound.. 

lanx. 
Left  little  finger,  above  the  sec- 
ond joint 
Left  little  finger    

1866. 
Recovered. 

Returned  to  duty  Jan- 

66.Mowry, Charles 

Private 

£ 

uary  1,  1867. 

67.  Murphy,  David 

Private 

jj 

finger. 

vcmber  21,  1868. 
Discharged  May  5  1868. 

68.  Myers,  John  

Private 

F 

Two  fingers  of  left  hand  

Discharged  November 

6,  1868. 

AMPUTATIONS  OF  THE  FINGERS. 


173 


Name. 

Bank. 

Co. 

Regiment. 

Nature  of  injury. 

Parts  removed. 

Remarks. 

69  Nice  Charles      

Private.  

G. 

9th  Cavalry  

Gunshot  wound.  . 

Amputation  of  thumb;  second 

Returned  to  duty  in 

metacarpal  bone  of  thumb  ex- 

January, 1868. 

cised. 

70.  Oberficld,  Anthony  

Private.... 

E. 

3d  Artillery  

Lacerated  wound. 

Ungual  phalanx  of  right  middle 

Recovered. 

finger. 

71.  Paris,  Jacob  

Private  

C. 

36thU.S.C.T... 

Gunshot  wound.  . 

Left    thumb,    first   metacarpal 

SenthomeDecember4, 

bone  and  os  trapezium;   also, 

1866,  and  discharged. 

lower  end  of  second  metacar- 

pal bone. 

72.  Parks,  Wallace  

Private  

G. 

9th  Cavalry  

Gunshot  wound.. 

Left  index  finger,  through  first 

Returned  to  duty  in 

third  of  first  phalanx. 

April,  1869. 

73.  Patterson,  Arthur  

Private  

I. 

aid  Infantry  

Gunshot  wound.. 

Left  index  finger,  at  metacarpo- 

Returned  to  duty  in 

phalangeal  joint. 

April,  1869. 

74.  Peak,  Isaiah  

Private  

G. 

38th  Infantry  .  .  . 

Railroad  accident. 

Fourth  and  fifth  fingers  right 

Discharged   June   13, 

hand  at  metacarpo-phalangeal 

1869. 

articulation,  and  middle  finger 

in  continuity  of  second  pha- 

langeal  bone. 

75.  PetermaD  August  .... 

Private  ... 

E. 

18th  Infantry 

Frost-bite 

Last   phalan  ^es   of    third   and 

Returned  to  duty 

fourth  fingers. 

March  3,  1867. 

76.  Platt,  Peter  

Private  

L 

37th  Infantry  .  .  . 

Gunshot  wound.  . 

Eight  forefinger,  at  junction  of 

Returned  to  duty  Sep- 

first and  second  phalanges. 

tember  17,  1867. 

77.  Post  Peter  

Private  

B. 

45th  Infantry  .  .  . 

Gunshot  wound.  . 

Left  ring  finger,  at  metacarpo- 

Returned  to  duty  An. 

phalangeal  articulation. 

gust  6,  1868. 

78.  Rader,  Louis  

Private  

H. 

7th  Cavalry  

Bitten  by  a  com- 

Third finger  of  right  hand,  at 

rade. 

second    phalangeal    articula- 

tion. 

79  Randolph  George  C 

E. 

9th  Infantry  .  

Gunshot  wound.  . 

Littlo.  rin^  and  middle  finders 

Discharged    June    9 

with  their  corresponding  met- 

1870. 

acarpal  bones  ;  left  hand. 

80.  Richards,  William  

Private  

H. 

9th  Cavalry  

Necrosis,  follow- 

Fourth finger  of  left  hand  . 

Returned  to  duty  Oc- 

ing a  bite. 

tober  25,  1870. 

81.  Roberts,  Theodore  

Private  

G. 

22d  Infantry  

Gunshot  wound.  . 

First  and  second  fingers  of  right 

Discharged  March  23, 

hand. 

1868. 

82.  Rose,  Henry   

Private  

C. 

35th  Infantry  .  .  . 

Bitten  by  a  dog  ; 

First  and  second  phalanges,  in- 

Returned to  duty  ilay 

necrosis. 

dex  finger. 

19,  1868. 

83.  Raff,  Michael  

Private  

C. 

35th  Infantry  .  .  . 

Gunshot  wound.  . 

Left  little  finger,  with  metacar- 

Returned to  duty  in 

pal  bone. 

June,  1867. 

84.  Ryan,  William  

Private  

G. 

7th  Infantry  

Gunshot  wound.  . 

Second  phalanx  of  right  index 

finger. 

85.  Schoenhard,  Gottlieb.  .  . 

Private  



Detachm'nt  of  ar- 

Laceration by  cir- 

Littlo finger  left  hand,  at  first 

Recovered. 

tillery  at  West 

cular  saw. 

phalangeal  joint,  ring  finger 

Point- 

through  first  phalanx,  and  in- 

. 

dex  finger  at  metacarpo-pha- 

langeal articulation. 

86.Shelton,  John  W  

Private  

C. 

6th  Cavalry  

Incised  wound... 

Right  forefinger,  at  metacarpo- 

Returned  to  duty 

phalangeal  articulation. 

•     March  18,  1868. 

87.  Simmons,  David  

Private  

H. 

2d  Cavalry 

Gunshot  wound  .  . 

Second  and  third  fingers  right 

Recovered. 

hand,  with  tho  heads  of  the 

metacarpal  bones. 

88.  Smith,  Charles  

Private  

F. 

27th  Infantry... 

Gunshot  wound.. 

Ring  finger  of  right  hand,  at 

Discharged  April  27, 

second  joint. 

1868. 

89.  Smith,  Charles 

(  joriMU'ill 

K. 

31st  Infantry  

Gunshot  wound.  - 

Left  index  fijigor,  in  the  contin- 

Discharged September 

uity  of  the  second  metacarpal 

29,  1868. 

bone. 

90.  Smith,  Joseph  

Private  .  

G. 

3d  Infantry  

Gunshot  wound.  . 

Left  index  finger  and  half  of  cor- 

Returned to  duty  No- 

responding metacarpal  bone. 

vember  7,  1867. 

91.  Stargratt  John 

Bugler 

F. 

7th  Cavalry 

Gunshot  wound,. 

Right  index  finger 

Returned  to  duty  in 

December,  1868. 

92.Stowers,  Isaac  F  

Private  

F. 

llth  Infantry    .. 

Gunshot  wound  .  . 

First  finger  of  right  hand,  at  ar- 

Returned to  duty  in 

ticulation  of  first  and  srcuud 

April,  1870. 

pli.-ilanges. 

93.  Snmiier,  E.  V  

Captain  .  .  . 

D. 

1st  Cavalry  

Gunshot  wound.. 

Right  index  finger  and  first  pha- 

Returned to  duty. 

lanx  of  left  ring  finger. 

174 


EEPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 


Name. 

Rank. 

Co. 

Regiment, 

Nature  of  injury. 

Parts  removed. 

Remarks. 

94.  Taylor,  Joseph  A  

Private.... 

A. 

13th  Infantry  .  .  . 

Gunshot  wound.. 

Second   and    third    phalanges, 

Discharged    June    4, 

third  finger,  left  hand. 

1869. 

95.  Tolliver,  Barnet  

Bugler  — 

K. 

7th  Cavalry  

Incised  wound... 

Ri^ht  thumb,  at  metacarpo-pha- 

Retnrned  to  duty 

langeal  articulation. 

March  11,  1867. 

96.  Turner,  Thomas  

Private  

A. 

9th  Cavalry  

Gunshot  wound.  . 

Returned  to  duty  in 

September,  1867. 

97  "VnnD<xisl)ur*rli  Henry. 

Private 

Ordnance  Corps. 

Second  finger  of  right  hand,  at 

Recovered. 

carpo-metacarpal  articulation. 

98.  Villhouer,  Charles  

Private  — 

D. 

13th  Infantry  .  .  . 

Unknown  

Right  and  left  index  fingers  

Discharged  November 

11,  1867. 

99.  Watson,  Emanuel  

Private  

K. 

25th  Infantry... 

Gunshot  wound.  . 

Loft  thumb,  at  metacarpo-pha- 

Returned  to  duty  in 

laugeal  articulation. 

January,  1871. 

100.  Watson,  Enos  M  ...... 

Private  

H. 

2d  Cavalry  

Gunshot  wound, 

Index  finger  and  part  of  second 

Discharged    January 

followed  by  ca- 

metacarpal bone. 

26,  1869. 

ries. 

101.  Watson,  George  

Private  

L 

10th  Cavalry  

Gunshot  wound.. 

Middle  finger,  right  hand,  with 

Discharged   May    16, 

.    lower  fragment  of  metacarpal 

1869. 

bone. 

102.  Weber,  August  

Private  

D. 

20th  Infantry  .  .  . 

Frost-bite  

First  phalanges  of  ring  and  mid- 

Discharged   July   22, 

dle  fingers  of  right  baud,  and 

1870. 

great  toe  of  right  foot 

103.  Welch,  Michael  

Private  

F. 

4th  Cavalry  

Whitlow  

Left  forefinger 

Returned  to  duty  April 

3,  1869. 

104  Wheeler,  T.  I  

Private  

K. 

4th  Infantry  

Frost-bite  ,  .  . 

First  phalanx  of  forefinger 

Discharged    June    3, 

1868. 

105.  White,  Alfred  

Private  

I. 

9th  Cavalry.... 

Gunshot  wound  .  . 

Right  index  finger,  at  phalango- 

Returned  to  duty  Oc- 

metacarpal joint. 

tober  4,  1867. 

106.  Whitman,  Daniel  

Private  

F. 

17th  Infantry  .  .  . 

Gunshot  wound.. 

Last  phalanx  of  the  right  thumb. 

Returned  to  duty  May 

10,  1868. 

107.  Wiley,  John  

Private  

B. 

7th  Cavalry  

Gunshot  wound.. 

Middle  finger  of  the  right  hand. 

Returned  to  duty  De- 

cember 31,  1868. 

108.  Williams,  John  

Private.... 

A. 

2d  Cavalry  

Gunshot  wound.. 

Index  and  second  fingers,  loft 

Discharged  March  1, 

Jnd. 

1869. 

109.  Williams,  Richard  .  .  . 

Private  

1 

9th  Cavalry  

Bitten  by  a  com- 

t phalanx  of  the  left  little 

rade;  necrosis. 

finger. 

110.  Willis,  John  H  

Private  

C. 

45th  Infantry  .  .  . 

Ulceration  follow 

Left  little  finger,  with  its  meta- 

ing   punctured 

carpal  bone. 

wound. 

111.  Wilson,  Charles  H  

Private  — 

B. 

7th  Cavalry  

Gunshot  wound.. 

Little  finger,  left  hand,  through 

Returned  to  duty  Feb- 

second phalanx. 

ruary  27,  1867. 

112.  Wilson,  George  

Private.... 

H. 

4th  Infantry  

Lacerated  wound 

First,  second,  and  third  fingers 

Discharged  September 

by  circular  saw. 

of  left  hand,  through  middle 

10,  1868. 

of  first  phalanges. 

113.  Wiscwell,  Adelbert  L  . 

Private  

D. 

23d  Infantry  

Larorated  wound 

Ring  finger,  right  hand,  at  meta- 

Discharged March  31, 

by  circular  saw. 

carpal  joint,  and  little  finger 

1869. 

at  first  joint. 

114  Wolf  Albert 

Private. 

M. 

2d  Cavalry  ...... 

Frost-bite 

First  and   second  finders    left 

Disctinrscd    June    8 

hand. 

1867. 

Amputation  at  the  Wrist. — Special  reports  of  two  cases  were  forwarded,  both  neces- 
sitated by  gunshot  wounds  of  the  hand. 


CCCCXCIX. — Account  of  a  Primary  Amputation  at  the  Wrist- Joint  for  Gunshot  Injury.    By  JAMES 
F.  .WEEDS,  Surgeon,  (J.  S.  A. 

Private  Gaw  Jarvis,  Co.  G,  45th  Infantry,  aged  28  years,  was  wounded  November  24,  18G8,  by 
a  conoidal  ball,  which  passed  through  aud  shattered  the  left  hand  completely.  He  was  at  once 
admitted  to  the  post  hospital  at  Nashville,  Tennessee.  There  was  not  much  swelling.  On  the  same 
day,  Acting  Assistant  Surgeon  R.  McGowan  administered  chloroform,  and  performed  a  circular 


AMPUTATIONS  OF  THE  FOEE-AEM.  175 

amputation  at  the  wrist-joint.  After  two  days  hospital  gangrene  ensued.  Nitric  acid  was  applied 
to  the  gangrenous  part,  and  opiates  and  stimulants  were  administered.  On  December  31, 1868,  the 
case  was  still  under  treatment,  and  progressing  very  favorably.  He  was  discharged. 

D. — Mention  of  a  Case  of  Secondary  Amputation  at  tlie  Wrist-Joint.    By  H.  E.  MILLS,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Eeinhold  Shulz,  Co.  B,  43d  Infantry,  aged  23  years,  received  May  12,  1867,  a  gunshot 
wound  of  the  left  hand,  caused  by  the  bursting  of  a  fowling-piece.  He  was  at  once  admitted  into 
the  post  hospital  at  Fort  Wayne,  Michigan.  The  palmar  surface  of  the  hand  was  much  lacerated  ; 
the  index  and  middle  fingers  completely  denuded  of  their  soft  tissues,  and  their  metacarpal  bones  frac- 
tured near  the  carpal  end  ;  the  ball  of  the  thumb  was  badly  lacerated,  and  its.  carpo-metacarpal 
joint  opened.  Assistant  Surgeon  B.  E.  Fryer,  United  States  Army,  administered  chloroform,  and 
removed  the  index  and  middle  fingers  with  their  metacarpal  bones.  One  ligature  was  applied. 
The  patient  reacted  well,  and  the  wound  was  dressed  with  a  solution  of  chloride  of  zinc,  and  left 
open.  About  three  hours  after  the  operation,  haemorrhage  occurred,  which  was  arrested  by  astrin- 
gent lotions.  On  June  30,  1867,  the  parts  were  nearly  well.  On  September  1, 1867,  he  was  admit- 
ted to  the  hospital  at  Fort  Mackinac,  Michigan,  with  three  distinct  fistulous  openings  in  the  hand, 
which  were  discharging  sickly-looking  pus,  more  or  less  freely.  Owing  to  the  great  desire  of  the 
patient  to  save  his  hand,  it  was  decided  to  give  the  experiment  sufficient  time,  for  the  satisfaction 
of  all  concerned.  Alternate  healing  and  reopening  of  the  wound,  accompanied  by  intense  pain  at 
times,  especially  on  any  sudden  change  of  the  weather,  and  a  gradual  decline  of  the  general 
health  of  the  patient  comprised  the  chief  symptoms  in  the  case  until  March  2, 1868,  when  I  decided 
to  remove  the  hand  at  the  radio-carpal  articulation,  which  was  accordingly  performed.  A  small 
interosseous  artery  rendered  three  ligatures  necessary.  The  edges  of  the  flaps  were  nicely  adjusted 
and  united  by  first  intention  throughout  almost" their  entire  extent.  The  ligature  of  the  ulnar 
artery  came  away  the  fourth  or  fifth  day.  On  the  31st  of  March,  the  remaining  ligatures  still 
remained  firmly  attached,  although  traction  had  been  made  daily  since  the  first  week,  with  the 
design  of  removing  them.  With  this  exception,  the  stump  was  perfectly  sound,  and  the  health  of 
the  patient  much  improved.  On  examination  of  the  bones  of  the  hand  and  wrist,  the  articulating 
surfaces  were  found  firmly  adherent,  and  the  whole  a  mass  of  necrosis  and  caries.  This  man  was 
discharged  the.  service  July  6,  1868. 


Amputations  of  the  Fore-arm. — Special  reports  were  made  of  twenty  cases  of  this 
nature,  of  which  nineteen  were  due  to  gunshot  wounds,  and  one  to  railroad  accident. 

DI. — Note  of  a  Case  of  Primary  Amputation  of  the  Fore-arm  for    Gunshot  Injury.     By  H.  A. 
DuBois,  Assistant  Surgeon,  U.  S.  A. 

Private  Casimiro  Alvidrez,  Co.  H,  1st  New  Mexico  Infantry,  was  wounded  July  4, 1866,  at 
Fort  Union,  New  Mexico,  while  firi.ng  a  salute,  by  the  premature  explosion  of  a  gun,  which  greatly 
shattered  the  hand  and  lower  third  of  the  fore-arm.  The  shock  was  profound.  Within  a  half  hour 
after  the  receipt  of  the  injury,  chloroform  was  administered  and  the  fore-arm  amputated  by  skin- 
flap  method.  The  patient  rallied  in  twenty-four  hours.  Chloroform  brought  the  pulse  up,  but  the 
reaction,  after  the  operation,  was  slower  than  it  would  have  beeu  had  the  operation  been  post- 
poned until  reaction  took  place.  During  the  treatment  there  was  haemorrhage  from  the  medullary 
cavity.  The  patient  was  discharged,  with  a  good  stump,  September  8,  1866. 

DII. — Report  of  an  Amputation  of  the  Fore-arm  and  Finger  for  Gunshot  Injury.    By  E.  H.  WHITE, 

Assistant  Surgeon,  U.  S.  A. 

Private  John.  Berger,  Co.  G,  15th  Infantry,  aged  22  years,  was  wounded  at  Mobile,  Ala- 
bama, on  July  4, 1868,  while  acting  as  number  one  in  firing  a  brass  field-piece.  He  had  forced 


176  REPORT  OF  SURGICAL  OASES  IN  THE  ARMY. 

a  blank  cartridge  about  one-third  home,  when  the  vent  was  uncovered,  causing  premature  discharge. 
The  receding  sponge-staff  crushed  the  right  hand,  opened  the  right  wrist-joint,  severed  the  muscles 
of  the  lower  third  of  the  right  fore-arm  on  the  anterior  aspect,  tore  away  the  belly  of  the  deltoid 
muscle,  and  lacerated  three  of  its  fibres  that  arise  from  the  acromion  process,  and  fractured  the 
first  phalanx  of  the  left  index  finger.  There  was  also  a  simple  fracture  of  the  left  radius,  supposed 
to  have  been  caused  by  the  fall  of  the  patient.  The  right  arm  and  fore-arm,  the  right  side  of  face 
and  eye,  and  the  chest,  were  slightly  burned.  He  was  admitted  to  the  post  hospital ;  and  having 
partially  recovered  from  the  shock,  was  chloroformed,  and  the  right  fore-arm  was  amputated  at 
the  junction  of  the  lower  thirds,  and  the  left  index  finger  at  the  metacarpo-phalangeal  articulation, 
both  by  circular  operations.  The  fracture  of  the  left  radius  being  readily  reduced,  Nelatou's  splint 
was  adjusted  to  the  palmar  surface  of  the  hand  and  fore-arm.  The  stump  of  the  right  fore-arm  was 
dressed  with  dry  bandages  and  oakum,  and  healed  by  first  intention,  except  at  the  inner  border, 
where  the  ligatures  applied  to  the  ulnar  and  radial  arteries  required  the  healing  to  be  by  suppura- 
tion and  granulation.  On  August  8,  1868,  the  stump  had  healed. 

DHL — Report  of  a  Primary  Amputation  of  the  Fore-arm  for  Gunshot  Injury.    By  B.  A.  CLEMENTS, 
Surgeon,  U.  S.  A. 

Private  William  Blair,  Battery  K,  1st  Artillery,  aged  18  years,  received,  July  8,  18G7,  by  the 
premature  discharge  of  a  six-pound  rifled  cannon  while  firing  a  salute,  a  compound  comminuted 
fracture  of  the  right  fore-arm  and  hand  with  extensive  laceration  of  the  soft  parts.  He  was,  on 
the  same  day,  admitted  to  the  post  hospital,  Jackson  Barracks,  New  Orleans,  Louisiana,  where  the 
fore-arm  was  amputated  at  the  upper  third,  one  hour  and  a  half  after  reception  of  the  injury,  making 
oval  skin  flaps.  Parts  united  in  almost  their  entire  extent  by  first  intention.  The  progress  of  the  case 
was  retarded  by  an  attack  of  yellow  fever.  September  11, 18C7,  perfect  union  and  sufficient  stump 
left  to  give  effective  support  to  an  artificial  limb.  He  was  discharged  November  27, 1808,  with  a 
pension  of  $15  per  month. 

DIV. — Report  of  a  Primary  Amputation  of  the  Fore-arm  for  Railway  Injury.    By  JonN  T.  KING, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  George  C.  Crawford,  Co.  C,  40th  Infantry,  aged  32  years,  was  injured  at  Goldsborough, 
North  Carolina,  March  29, 1809,  by  the  passage  of  a  railroad  car  over  his  right  hand,  completely 
crushing  it.  Assistant  Surgeon  William  F.  Smith,  United  States  Army,  immediately  administered 
chloroform,  and  amputated  the  lower  third  of  the  fore-arm  by  the  circular  method.  Three  ligatures 
were  used.  On  the  same  day  he  was  admitted  to  the  post  hospital,  from  his  company,  where,  on 
the  31st  of  March,  the  case  was  reported  as  progressing  favorably.  The  patient  was  discharged 
May  15,  1809,  with  a  pension  of  $15  per  month. 

DV. — Report  of  a  Double  Amputation  of  the  Fore-arm.    By  T.  H.  TUKNEK,  Assistant  Surgeon 
U.  S.  A. 

Private  William  Greiter,  Co.  C,  5th  United  States  Infantry,  aged  28  years,  while  firing  a  salute 
at  Fort  Wallace,  Kansas,  July  19,  1868,  was  wounded  by  the  premature  explosion  of  a  cannon, 
which  badly  shattered  and  burned  both  hands  and  fore  arms.  Immediately  after  I  amputated  both 
fore-arms  at  the  middle  third.  Both  stumps  were  well  on  the  twenty-fourth  day  after  the  operation. 
He  was  discharged  May  6, 1869,  and  pensioned  at  $25  per  month. 

DVI. — Account  of  an  Amputation  of  both  Fore-arms  for  Gunshot  Injury.    By  DONALD  JACKSON, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  George  Grey,  Troop  M,  9th  Cavalry,  while  firing  a  national  salute  on  June  29,  1868,  at 
Fort  Clark,  Texas,  was  wounded  by  the  sponge-staff  of  a  field  piece,  which  carried  away  portions 


AMPUTATIONS  OF  THE  FOEE-AEM.  177 

of  both  hands,  tore  several  tendons  from  their  origin,  and  superficially  injured  the  arms  above  the 
elbow-joints.  He  was  at  once  admitted  to  hospital,  and  on  the  next  day  equal  parts  of  ether  and 
chloroform  were  administered,  and  both  fore-arms  amputated  by  the  circular  method,  the  left  four 
inches,  and  the  right  one  and  a  half  inches  above  the  wrist-joint.  The  patient,  at  the  time,  was 
powerfully  narcotized,  opiates  having  been  administered  on  the  previous  night  to  quiet  excessive 
nervous  excitement.  The  pulse  was  120  to  150,  weak  and  irregular.  The  anaesthetic  improved  the 
pulse — was  better  after  the  operation  than  at  the  commencement.  He  continued  under  the  influ- 
ence of  the  opiate,  and  his  condition  was  rather  critical.  On  July  9th,  the  right  stump  had  healed 
and  the  left  was  nearly  well.  On  the  llth  of  July,  tetanus  occurred,  and  death  on  July  15,  1868. 

DVII. — Report  of  an  Amputation  of  the  Fore-arm  for  Gunshot  Injury.    By  HENRY  SPOIIN,  M.  D., 
Acting  Assistant  Surgeon. 

Private  George  E.  Hubbell,  Troop  C,  4th  Cavalry,  aged  21  years,  received  on  February  7,  1870, 
a  gunshot  wound  of  the  left  hand  and  wrist,  by  the  accidental  discharge  of  his  carbine.  On  the 
same  day,  he  was  admitted  to  the  hospital  at  Fort  Mclntosh,  Texas.  The  left  hand  and  wrist 
were  very  much  shattered  and  torn.  Chloroform  and  ether  were  administered,  and  the  left  fore-arm 
amputated  by  the  circular  operation,  four  inches  above  the  wrist.  Simple  dressings  were  applied. 
There  was  very  little  suppuration.  The  patient  was  discharged  the  service  on  May  12,  1870. 

DVIII. — On  an  Amputation  of  the  Fore-arm  for  Gunshot  Injury.    By  W.  D.  WOLVERTON,  Assistant 
Surgeon,  U.  S.  A. 

Private  Adam  Hutton,  Battery  K,  1st  Artillery,  aged  24  years,  while  firing  a  salute  at  New 
Orleans,  June  11, 1808,  had  the  greater  portion  of  his  right  hand  blown  off.  The  parts  were  greatly 
lacerated,  with  slight  haemorrhage.  He  was  admitted  to  the  post  hospital  at  Sedgwick  Barracks, 
on  the  same  day,  where  ether  and  chloroform  were  administered  and  the  fore-arm  amputated,  through 
the  lower  third,  by  the  circular  method.  He  gradually  recovered,  and  was  discharged  the  service 
August  3, 1868,  with  a  stump  completely  healed.  He  is  a  pensioner  at  $15  per  mouth. 

DIX. — Account  of  a  Primary  Amputation  of  the  Fore-arm  for  Gunshot  Injury.    By  E.  H.  BOWMAN, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Doctor  Johnson,  Co.  A,  24th  Infantry,  was  wounded  at  Fort  Bliss,  Texas,  while  firing 
a  national  salute  on  July  4,  1870,  by  the  premature  discharge  of  a  cannon,  which  carried  away  the 
left  hand  up  to  the  carpal  articulation.  On  the  same  day  the  fore-arm  was  amputated  as  close  to  the 
wrist-joint  as  the  condition  of  the  parts  would  admit.  The  stump  was  dressed  with  a  solution  of 
carbolic  acid,  and  healed  kindly.  He  was  discharged  April  30, 1871. 

DX. — Account  of  a  Primary  Amputation  of  the  Fore-arm  for  Gunshot  Injury.    By  JOHN  T.  KING, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Charles  D.  Jones,  Co.  H,  8th  Infantry,  aged  19  years,  was  accidentally  wounded 
December  9,  1866,  by  a  conoidal  ball,  which  entered  the  palmar  surface  of  the  left  hand,  and  passed 
directly  through,  carrying  away  the  fourth,  and  comminuting  the  third  and  fifth  metacarpal  bones. 
The  tompion,  as  well  as  the  ball,  passed  through  the  hand.  The  soft  parts  were  much  lacerated. 
On  the  same  day  he  was  admitted  to  the  post  hospital  at  Charlotte,  North  Carolina,  and  on  the 
16th  chloroform  was  administered,  and  the  left  fore-arm  was  amputated  at  the  lower  third,  by  the 
circular  method.  Simple  dressings  were  used.  On  January  1, 1867,  the  patient  was  doing  well, 
and  the  stump  was  nearly  healed.  [He  was  discharged  on  March  4,  1867.] 
23 


178  EEPOET  OF  SURGICAL  OASES  IN  THE  AEMY. 

DXI. — Account  of  a  Primary  Amputation  of  the  Fore-arm.    By  S.  M.  HOKTON,  Assistant  Sur- 
geon, U.  S.  A. 

Private  Jesse  L.  Judd,  Co.  H,  18th  Infantry,  aged  36  years,  was  wounded  at  Fort  Philip 
Kearney,  Dakota  Territory,  July  24,  1866,  by  the  accidental  discharge  of  a  revolver,  which  frac- 
tured the  lower  end  of  the  left  ulna,  the  unciform  bone,  and  the  third,  fourth,  and  fifth  nieta- 
carpal  bones.  He  was  immediately  admitted  to  the  hospital  of  the  fort.  He  was  iu  a  state  of 
drunkenness  bordering  on  delirium  tremens,  and  there  was  great  haemorrhage  from  the  hand.  On 
the  same  day  equal  parts  of  ether  and  chloroform  were  administered,  and  the  fore-arm  amputated 
three  inches  above  the  wrist-joint,  by  the  flap  operation.  Cold-water  dressings  were  applied,  and 
by  the  20th  of  October,  1866,  the  stump  was  entirely  healed.  [The  patient  was  discharged  June 
6,  1867.] 

DXII. — Remarks  on  a  Primary  Amputation  of  the  Fore-arm  for  Gunshot  Injury.    By  JAMES  SHAW, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Charles  E.  Leonard,  Co.  B,  7th  Infantry,  aged  22  years,  and  of  good  constitution, 
while  firing  a  national  salute  July  4, 1868,  at  Feruandina,  Florida,  was  ramming  home  a  cartridge 
in  a  field-piece,  when  it  exploded,  and  he  was  thrown  some  seven  or  eight  yards  from  its  mouth. 
His  right  fore-arm  was  torn  oil'  six  inches  below  the  elbow -joint,  and  the  soft  parts  of  the  arm  were 
burned  and  lacerated  up  to  the  axilla.  The  thumb  of  the  left  hand  was  also  blown  off,  exposing 
the  end  of  the  carpal  bone.  Being  present  at  the  time,  I  had  him  immediately  carried  into  quarters, 
whereat  once,  after  giving  him  some  brandy  and  w  ater  and  administering  chloroform,  I  controlled  the 
circulation,  thereby  losing  very  little  blood,  and  amputated  the  fore-arm  three  or  four  inches  below 
the  elbow-joint,  by  the  circular  method.  The  soft  parts  were  drawn  across  the  end  of  the  carpal 
bone  left  thumb,  covering  it  very  neatly.  Stimulating  and  nourishingdiet  was  given,  and  cataplasms 
were  applied  to  the  superior  extremities  and  stomach,  and  soothing  lotions  to  the  wounds.  The 
nervous  shock  was  so  severe,  and  the  vital  powers  were  so  entirely  prostrated,  that  all  efforts  in 
establishing  reaction  failed.  During  the  forty-eight  hours  that  he  survived,  he  was  only  able  to 
speak  a  few  words.  He  died  at  10  A.  M.,  July  6,  1868. 

DXIII. — Remarks  on  a  Primary  Amputation  of  the  Fore-arm  for  Gunshot  Injury.    By  BUKTON  RAN- 
DALL, Surgeon,  U.  S.  A. 

Private  Thomas  O'Conner,  Battery  A,  1st  Artillery,  aged  22  years,  while  guard-mounting, 
November  10,  1866,  with  his  left  hand  over  the  muzzle  of  his  gun,  was  wounded  by  its  accidentally 
slipping  and  discharging,  the  ball  producing  a  compound  fracture  of  the  metacarpal  bones  of  the 
first,  second  and  third  fingers  and  thumb,  and  passing  through  the  bones  of  the  carpus,  with  great 
destruction  of  the  bones  and  soft  parts.  The  parts  were  much  burned  and  excessively  inflamed.  He 
was  immediately  admitted  to  the  post  hospital  at  Fort  Trumbull,  Connecticut,  where,  on  the  same 
day,  chloroform  was  administered,  and  the  fore-arm  amputated  just  above  the  wrist,  by  the  circular 
method.  Simple  dressings  were  applied.  The  stump  healed,  and  the  patient  was  discharged  on 
March  13,  1867,  with  a  pension  of  $15  per  mouth. 

DXIV. — Remarks  on  an  Amputation  of  tJie  Fore- Arm  for  Gunshot  Injury.    By  C.  B.  WEIGHT,  Assist- 
ant Surgeon,  U.  S.  A. 

Corporal  William  Pare,  Co.  D,  57th  Infantry,  aged  25  years,  was  wounded  at  Fort  Smith 
Arkansas,  on  February  22, 1866,  by  the  accidental  discharge  of  a  cannon,  while  firing  a  salute  in  honor 
of  Washington's  birthday.  Being,  at  the  time,  in  the  act  of  loading  the  piece,  the  charge  took 
effect  in  the  right  hand,  completely  destroying  it  and  the  integuments  of  the  lower  third  of  the 
fore-arm.  On  the  same  day  the  fore-arm  was  amputated,  by  circular  operation,  at  the  junction  of  the 
upper  thirds.  Water  dressings  were  applied.  Anodynes  at  night,  and  a  light  and  nourishing  diet, 
•were  given.  On  March  31st  the  patient  was  convalescent.  He  was  returned  to  duty  in  October, 
1860. 


AMPUTATIONS  OF  THE  FORE- ARM.  179 

DXV. — Report   of  an   Amputation  of   the  Fore-Arm  for  Gunshot  Injury.     By  C.  E.  GODDARD, 
Assistant  Surgeon,  U.  S.  A. 

Private  Charles  Rhey,  Co.  H,  31st  Infantry,  aged  25  years,  while  firing  a  salute  July  4,  1808, 
at  Fort  Stevenson,  Dakota  Territory,  was  wounded  in  the  right  fore-arm  by  the  premature  discharge 
of  a  cannon.  The  skin  was  burned  by  powder,  and  there  was  more  or  less  contusion.  He  was  at 
at  once  admitted  to  the  hospital,  and  on  the  same  day  chloroform  was  administered,  and  Surgeon 
C.  C.  Gray,  U.  S.  A.,  amputated  about  the  middle  of  the  fore-arm,  by  the  circular  method.  Simple 
dressings  were  applied.  The  patient  recovered  slowly  but  well,  and  was  discharged  September 
29,  1808,  with  a  pension  of  $15  per  month. 

DXVI. — Remarks  on  an  Amputation  of  the  Fore-Ann  for  Gunshot  Injury.    By  H.  A.  DTI  Bois, 

Assistant  Surgeon,  U.  S.  A. 

Private  Juan  Seis,  Co.  D,  1st  New  Mexico  Infantry,  was  wounded  while  herding,  by  the 
discharge  of  a  musket,  which  took  eifectiu  the  fore-arm.  Forty-eight  hours  after  the  reception  of  the 
injury,  he  was  admitted  to  the  post  hospital,  Fort  Union,  New  Mexico.  The  fore-arm  was  hanging 
by  tendons.  On  October  28,  180G,  about  sixty  hours  after  the  receipt  of  the  injury,  chloroform 
was  administered,  and  the  fore-arm  amputated  by-  the  skin-flap  method.  The  patient  rallied  well ; 
the  wound  healed,  and  he  was  discharged  with  a  good  stump  November  9,  1800. 

DXVII. — Account  of  a  Primary  Amputation  of  the  Fore-Arm  for  Gunshot  Injury.    By  J.  J.  MAES- 
TON,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Patrick  Whalen,  Co.  D,  3d  Infantry,  was  wounded  at  Fort  Lamed,  Kansas,  April  10, 
1807,  by  the  accidental  discharge  of  a  Spencer  rifle,  while  in  the  act  of  loading  the  piece.  The  left 
hand  was  badly  shattered,  the  bones  being  fractured,  the  arteries,  muscles,  and  tissues  lacerated, 
and  the  thumb  entirely  carried  away.  Three  hours  after  the  accident  the  left  fore-arm  was 
amputated  at  the  lower  third  by  the  circular  method.  The  tissues  of  the  right  hand,  between  the 
metacarpal  bones  of  the  thumb  and  fore-finger,  were  also  lacerated,  but  the  bones  were  uninjured. 
April  30,  1807 :  The  stump  and  the  wound  of  the  right  hand  had  nearly  healed.  The  patient's 
condition  was  good.  Discharged  May  21,  1807,  with  a  pension  of  $15  per  month. 

DXVIII. — Account  of  an  Intermediate  Amputation  of  the  Fore-Arm  for  Gunshot  Injury.    By  H.  R. 
TILTON,  Assistant  Surgeon,  U.  S.  A. 

Private  Abraham  Wilks,  Troop  B,  10th  Cavalry,  aged  23  years,  was  accidentally  wounded 
November  3,  1808,  by  a  carbine  ball,  which  passed  through  the  left  hand,  from  the  palmar 
to  the  dorsal  aspect,  fracturing  the  second  and  third  metacarpal  bones.  The  third  finger  was 
removed  on  the  same  day.  On  November  10,  1868,  he  was  admitted  to  the  post  hospital,  Fort 
Lyou,  Colorado  Territory.  There  was  diifuse  suppuration  extending  above  the  wrist,  and  secondary 
hemorrhage  from  the  deep  palmar  arch.  The  patient  was  in  great  alarm,  complaining  bitterly  of 
his  wound,  and  desiring  amputation.  On  the  llth,  chloroform  was  administered,  and  the  fore-arm 
amputated  through  the  middle  by  the  circular  method.  Five  ligatures  were  applied,  and  simple 
dressings  were  used.  On  November  17th,  the  first  ligature  was  removed,  and  on  November  29th, 
the  last  one  came  away.  The  posterior  flap  sloughed  to  the  extent  of  half  an  inch,  but  by  using 
adhesive  straps  and  weights,  the  flaps  were  ample.  On  December  27th,  the  stump  reopened  and 
discharged  freely,  but  by  the  5th  of  February,  1809,  it  had  entirely  healed.  He  was  discharged  the 
service  June  18, 1809. 

DXIX. — Account  of  a  Primary  Amputation  of  the  Fore- Arm  for  Gunshot  Injury.    By  J.  C.  LAMONT, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Horace  Williams,  Troop  L,  9th  Cavalry,  aged  20  years,  was  wounded  December  20, 
1809,  while  firing  a  salute.  In  the  act  of  ramming  a  blank  cartridge  into  a  piece  of.  artillery,  it 
accidentally  Ignited  and  exploded.  The  Soft  tissues  of  the  right  hand)  wrist,  mid  lOtfef  third  of 


180  REPOET  OF  SUEG1CAL  CASES  IN  THE  AEMY. 

the  fore-arm  were  extensively  lacerated,  the  bones  fractured  and  dissevered,  the  blood-vessels  torn, 
and  his  face,  neck,  and  chest  very  severely  burned.  His  vision  was  very  much  injured,  if  not 
destroyed.  On  the  same  day -he  was  admitted  into  the  post  hospital  at  Fort  Duncan.  Texas.  Ether 
was  administered,  and  the  fore-arm  amputated  at  the  junction  of  the  lower  and  middle  thirds,  by 
the  circular  method.  On  December  31st,  the  patient  was  doing  well,  and  there  was  a  probability 
of  a  partial  restoration  of  vision.  He  was  discharged  the  service  April  30,  1870. 

DXX. — Account  of  an  Amputation  of  tlw  Fore-Arm  for  Gunsliot  Injury.    By  A.  A.  YEOMANS, 
Assistant  Surgeon,  U.  S.  A. 

Private  John  Zearambo,  Co.  I,  24th  Infantry,  aged  21  years,  while  firing  a  salute  July  4,  1867, 
received  a  compound  comminuted  fracture  of  the  right  fore-arm.  He  was  at  once  admitted  to  the 
post  hospital  at  Vicksburg,  Mississippi.  The  radius  and  ulna  were  crushed  in  the  middle  and  lower 
thirds,  with  extensive  laceration  of  the  soft  parts.  The  humerus  was  fractured  in  the  middle  third, 
and  there  was  a  severe  contusion  over  the  right  hypochoudrium.  The  patient  was  somewhat 
debilitated  from  an  attack  of  malarial  fever;  hi*  pulse  was  105,  and  rather  weak.  Chloroform  was 
administered,  and  the  fore-arm  amputated  at  the  upper  third.  Haemorrhage  was  slight;  four 
ligatures  were  applied,  and  the  patient  reacted  promptly.  A  few  days  after  the  operation,  the 
stump  became  gangrenous.  Nitric  acid  and  bromine  were  applied,  and  nourishing  diet  given.  In 
a  few  days  the  line  of  demarcation  was  formed,  and  the  slough  thrown  off.  Nitre-muriatic  acid 
was  applied  to  the  ends  of  the  radius  and  ulna,  which  projected  from  the  soft  parts  after  mortification 
had  attacked  the  stump,  but,  as  their  removal  by  that  process  seemed  tedious,  they  were  subsequently 
taken  off  by  the  saw.  Union  took  place  between  the  fragments  of  the  humerus,  and  although  the 
patient  suffered  from  a  severe  attack  of  tetanus,  he  was,  on  September  30,  1807,  doing  well. 
Discharged  July  22, 1868,  and  pensioned  at  $15  per  mouth. 

Amputations  of  the  Arm. — Special  reports  of  twenty-four  cases  of  this  class  were 
received ;  twenty  were  due  to  gun-shot  wounds,  one  to  railroad  accident,  two  to  other 
injuries,  and  one  to  disease.  Five  cases  had  a  fatal  termination. 

DXXI. — Account  of  an  Intermediary  Amputation  of  the  Arm.     By  W.  M.  NOTSON,  Assistant 
Surgeon,  U.  S.  A. 

Private  B.  Bowers,  Co.  E,  llth  Infantry,  aged  21  years,  was  wounded  on  October  13,  1870,  by 
a  couoidal  musket  ball,  in  the  right  hand.  On  the  same  day,  he  was  admitted  to  the  hospital  at 
Fort  Coucho,  Texas ;  and  on  the  14th,  the  third  finger  was  amputated  at  the  carpo  phalangeal 
articulation.  Immediately  succeeding  the  operation,  the  patient  had  an  attack  of  typhoid  pneu- 
monia, during  which  there  was  much  sloughing  of  the  hand  and  fore-arm,  with  haemorrhage.  While 
convalescing  from  the  pulmonary  trouble,  and  a  profuse  haemorrhage  occurring  on  November  7th,  in 
consequence  of  the  extent  of  the  diseased  tissue,  the  arm  was  amputated  in  the  lower  third.  On 
March  31,  1871,  this  man  was  still  under  treatment.  He  was  discharged  the  service  May  24,  1871, 
for  loss  of  arm  from  gunshot  wound  received  in  the  line  of  duty. 

DXXII. — Account  of  an  Amputation  of  the  Arm  and  Fingers  for  Gunshot   Injury.     By  H.  A. 
DuBois,  Assistant  Surgeon,  U.  S.  A. 

Lieutenant  George  W.  Campbell,  3d  Cavalry,  aged  35  years,  was  admitted  into  the  post  hospital 
at  Fort  Uniou,  New  Mexico,  June  8,  1867,  having  been  wounded  by  the  premature  discharge  of  a 
cannon  which  he  was  loading,  in  camp  ou  the  Cimarrou  River,  fifty  miles  from  Fort  Union.  The 
left  hand  was  entirely  blown  off,  the  left  fore-arm  and  lower  half  of  arm  and  the  fingers,  thumb  and 
palm  of  the  right  hand  were  bruised  and  shattered ;  he  was  also  burned  in  both  eyes,  head,  and  face. 
Carrou  oil  was  applied  to  the  burnt  parts,  and  the  arm  was  amputated  four  inches  above  the  elbow 
by  the  circular  method,  which  was  followed  by  a  large  slough  on  lower  surface  of  stump.  First 
phalanges  of  the  middle  and  ring  fingers  were  removed,  and  a  thumb  was  made  by  covering  the 
boue  with  flesh  taken  from  the  palm.  Returned  to  duty  July  1,  1867 ;  wounds  nearly  healed ;  thumb 


AMPUTATIONS  OF  THE  ARM.  181 

very  useful ;  loss  of  vision  of  left  eye.    Patient  is  able  to  write,  and  lias  ridden  over  one  hundred 
miles  in  the  discharge  of  his  duties  as  post  quartermaster.    This  officer  was  retired  July  29, 18C8. 

DXXIII. — Report  of  an  Amputation  of  the  Arm  and  Fore-Arm  for  Gunshot  Injury.    By  J.  T. 
GHISELIN,  Surgeon,  U.  S.  A. 

Private  Michael  Casey,  Battery  A,  2d  Artillery,  aged  23  years,  was  wounded  by  the  prema- 
ture discharge  of  a  field  piece,  October  29,  18GC,  during  review  at  Presidio  of  San  Francisco, 
California.  Both  arms  were  very  much  lacerated.  There  was,  also,  a  lacerated  wound  of  the  left 
breast,  and  fracture  of  the  sixth  rib,  caused  by  a  fragment  of  the  sponge-staff.  He  was  admitted 
to  the  post  hospital  Presidio  of  San  Francisco,  California,  on  the  same  day,  not  much  depressed 
by  his  injury,  and  Assistant  Surgeon  J.  H.  Kinsman,  U.  S.  A.,  immediately  administered  ether 
and  amputated  the  right  fore-arm  at  the  lower  third,  and  the  left  arm  at  the  upper  third,  by  the 
circular  method.  Cold  water  dressings  were  applied.  The  patient  did  well,  and  on  December  31st 
the  stumps  had  nearly  healed.  The  wound  of  chest  remained  open,  but  was  doiug  well.  This 
man  was  discharged  the  service  June  29, 1867,  for  loss  of  both  arms. 

DXXIV. — Remarks  on  a  Primary  Amputation  of  the  Arm.    By  W.   H.  SMITH,  M.   D.,  Acting 
Assistant  Surgeon. 

Private  Patrick  Daley,  Troop  B,  8th  Cavalry,  aged  24  years,  was  wounded  by  Indians  while 
guarding  a  train,  May  6,  1869.  The  ball  entered  the  left  arm  from  the  outside,  shattered  the 
humerus  from  the  elbow-joint  two-thirds  its  length  upward,  and  imbedded  itself  among  the  fragments. 
On  the  same  day  he  was  admitted  to  the  post  hospital,  Camp  Verde,  Arizona  Territory.  He  rallied 
from  the  shock,  his  pulse  was  full  and  soft,  and  his  spirits  good.  Toward  the  next  morning  he 
became  feverish.  He  preferred  amputation  to  any  attempt  to  save  the  arm.  At  10  o'clock  A.  M., 
on  the  7th,  his  arm  being  considerably  swollen  and  inflamed,  chloroform  was  administered,  and  it  was 
amputated  at  the  lower  border  of  the  upper  third  of  humerus.  The  brachial  artery  and  the  muscu- 
lar branch  were  ligated.  The  flaps  were  shaped  so  as  best  to  suit  the  wounds,  and  were  bathed 
with  cold  water  for  an  hour  before  bringing  them  together,  and  securing  them  with  four  sutures 
and  adhesive  plaster.  Nourishing  diet,  stimulants,  tonics,  &c.,  were  prescribed,  and  the  case  pro- 
gressed excellently,  throughout.  Cold-water  dressings  and  poultices  were  applied  as  required  by 
the  condition  of  the  wound.  The  ligatures  came  away  on  the  18th  of  May,  from  the  muscular 
branch,  and  on  the  27th  from  the  brachial  artery.  The  pains  felt  as  if  in  the  lost  arm,  the  nerves 
having  been  severed  above  the  level  of  the  end  of  the  bone.  He  seemed  to  gain  flesh  during  treat- 
ment, and  on  June  9th,  he  was  seen  playing  ball  outside  with  the  remaining  hand.  Stump  excel- 
lent. This  man  was  discharged  the  service  October  o,  1869,  for  loss  of  fore-arm. 

DXXV. — Report  of  an  Amputation  of  the  Arm  and  Fore-Arm  for   Gunshot  Injury.    By  S.  M. 
HOETON,  Assistant  Surgeon,  U.  S.  A. 

Private  William  Denney,  Battery  G,  5th  Artillery,  aged  23  years,  while  firing  a  salute  on  May 
2, 1870,  was  wounded  by  the  premature  explosion  of  a  blank  cartridge  from  a  twelve-pounder  cannon, 
which  shot  away  and  totally  destroyed  the  right  hand,  leaving  a  lacerated  stump,  comminuted  the 
right  hnmerus,  involving  nearly  the  entire  lower  third,  and  produced  a  deep  flesh  wound  of  right  arm 
in  upper  part  of  middle  third,  involving  a  portion  of  the  biceps  muscle ;  the  left  hand  and  wrist  were 
shattered  to  pieces,  and  were  hanging  to  the  fore-arm  by  a  few  shreds  of  skin,  tendon,  and  cellular 
tissue ;  the  lower  portion  of  his  face  and  front  portion  of  the  neck  were  badly  scorched  by  powder. 
The  same  day  ether  and  chloroform  were  administered,  and  the  right  arm  was  amputated  in  the 
upper  third,  near  the  shoulder.  Lateral  flaps  were  made  which  were  retained  in  apposition  by  five 
interrupted  sutures  and  adhesive  strips.  Dry  dressings,  except  lint,  three-fourths  inch  wide,  wrung 
out  of  warm  water,  were  applied  along  the  union  or  junction  of  flaps.  I  also  amputated  the  left 
fore-arm  in  lower  third,  making  anterio-posterior  flaps,  which  were  retained  in  apposition  by  three 
interrupted  sutures  and  adhesive  strips.  Dry  dressings,  except  lint  three-fourths  inch  wide,  wrung 


182  EEPOET  OP  SUEGICAL  CASES  IN  THE  AKMY. 

out  of  warm  water,  were  applied  along  junction  of  flaps.  During  the  operation,  haemorrhage  was 
controlled  by  compression  with  the  thumb  and  fingers  of  an  assistant ;  on  the  right  side  upon  the 
axillary,  and  on  the  left  side  upon  the  brachial  arteries.  The  patient  was  very  healthy  and  robust, 
of  cheerful  disposition,  and  bore  the  loss  of  his  hands  and  arm  with  fortitude  and  patience.  After 
entire  reaction  from  the  shock,  the  constitutional  excitement,  feverishness,  thirst,  &c.,  lasted  for 
three  days.  He  suffered  from  obstinate  constipation  and  retention  of  urine,  for  which  cathartics, 
diuretics,  enemata,  and  hot  poultices  to  abdomen  were  prescribed.  After  the  first  four  days'  use  of 
the  catheter,  all  retention  of  urine  ceased.  He  made  rapid  progress  in  recovery,  the  flaps  uniting 
by  first  intention,  or  without  granulating,  except  along  the  tracks  of  the  ligatures,  and  one  point 
on  the  upper  side  of  the  right  stump.  The  treatment  consisted  principally  of  compresses,  adhe. 
sive  straps,  supports  to  the  flaps,  a  saturated  solution  of  carbolic  acid  and  glycerine  applied  every 
two  or  three  hours  to  the  edges  of  the  flaps,  and  creasote  used  freely  on  the  dressings.  No  cold-water 
dressings  were  used  at  any  time.  At  the  end  of  the  first  week  he  was  sitting  in  a  chair.  -On  the 
eighth  day  after  the  accident  the  flaps  of  the  left  fore-arm  had  sufficiently  united  to  allow  removal 
of  compress  and  adhesive  straps,  and  substitution  of  lint  and  sweet  oil,  which  was  loosely  applied 
to  extremity  of  stump.  By  the  twentieth  day,  the  flaps  of  right  stump  were  firmly  united,  except 
track  of  ligature  on  brachial  artery,  on  which  day  that  ligature  came  away.  On  the  twenty-fourth 
day  the  patient  walked  around  out  of  doors.  On  June  1st  a  small  boil  was  opened  in  right  axilla. 
June  3d,  boil  entirely  healed  up,  and  subsequently  did  not  trouble  him.  Stimulating  and  nourish- 
ing diet  was  used.  The  face  and  neck  have  entirely  healed  without  blemish.  The  stumps  are  firm 
with  good  cushions  for  artificial  limbs,  for  which  application  will  be  made.  This  man  was 
discharged  the  service  December  14,  1870,  on  account  of  loss  of  both  arms. 

DXXVI. — Account  of  an  Amputation  of  the  Arm  for   Necrosis.    By  A.  0.  GIRARD,  Assistant 
Surgeon,  U.  S.  A. 

Private  Patrick  Ford,  Co.  G,  19th  Infantry,  aged  31  years,  suffered  for  eight  months  from 
necrosis  of  radius  and  ulna  of  the  right  arm.  There  was  no  attempt  at  new  formation  of  bone ; 
sequestra?  not  movable.  He  was  admitted  to  the  post  hospital  at  Baton  Kouge,  Louisiana,  on 
November  13,  1869.  Counter  irritants  were  applied,  and  alteratives  and  tonics  administered. 
Scrofula  was  the  source  of  the  disease.  On  February  8th,  with  the  advice  and  assistance  of 
E.  A.  Koerper,  Assistant  Surgeon,  U.  S.  A.,  and  Dr.  W.  Eeyuaud,  of  Baton  Eouge,  I  attempted 
exsection  of  sequestra?  by  trepanation.  I  found,  however,  extensive  destruction  of  both  bones, 
with  no  attempt  at  formation  of  callus.  The  nietaphysis  of  radius  was  almost  entirely  destroyed. 
The  patient  commencing  to  be  reduced  by  pain  and  suppuration,  and  amputation  above  the 
elbow  having  been  decided  on,  he  was  chloroformed,  and  the  limb  was  amputated  by  the  circular 
method.  Three  vessels  were  ligated,  and  the  wound  was  closed  with  the  interrupted  suture.  The 
patient  made  a  rapid  recovery  in  two  weeks,  and  his  general  health  improved  wonderfully. 
He  was  discharged  the  service  March  19,  1870. 

DXXVII. — Note  on  an  Amputation  of  the  Arm  for  Gunshot  Injury.    By  "W.  E.  EAMSEY,  Assistant 
Surgeon,  U.  S.  A. 

Henry  Happe,  Troop  G,  2d  Cavalry,  was  shot  in  the  left  arm  while  on  escort  duty  with  Wells, 
Fargo  &  Co.'s  stage,  August  10, 1867.  He  was  conveyed  to  Fort  Sanders,  Dakota  Territory,  where, 
September  11,  1867,  the  arm  was  amputated  at  the  upper  third  by  the  flap  method.  He  was 
discharged  on  November  1,  1867.  On  the  20th  of  November,  1868,  he  was  examined  for  artificial 
limb,  at  which  time  the  stump  was  iu  a  sound  condition.  The  man  is  a  pensioner  at  $15  per 
mouth. 

DXXVIII. — Report  of  an  Amputation  of  the  Arm  for  Gunshot  Injury.    By  T.  ST.  V.  HUTCHINSON, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Timothy  Houlihan,  Co.  I,  2d  Infantry,  aged  29  years,  was  fired  upon  by  a  patrol  near 
the  camp  of  the  2d  Infantry,  May  27)  1869.  The  ball  entered  directly  above  the  head  of  thtf- 


AMPUTATIONS  OF  THE  AEM. 

radius,  destroyed  the  outer  condyle  of  the  huinerus,  chipped  the  coronoid  process  of  the  ulna,  and 
splintered  the  radius  down  to  the  upper  border  of  the  pronator  quadratus  muscle.  The  whole 
internal  structure  of  the  arm,  on  the  radial  side,  was  torn  and  hanging  from  a  large  gaping  wound 
on  the  anterior  surface  of  the  fore-arm.  Nerves  and  vessels  were  cut  and  torn.  On  the  same  day 
he  was  admitted  to  the  post  hospital  at  Huntsville,  Alabama,  feeble  from  loss  of  blood  and  great 
pain;  pulse  about  80.  Ether  was  at  once  administered,  and  the  arm  was  amputated  at  the  lower 
third  by  the  double-flap  method.  The  haemorrhage  was  about  three  ounces.  Three  ligatures  were 
used.  The  wound  was  allowed  to  glaze  before  closing  the  flaps  with  interrupted  sutures.  Cerate 
dressing  and  a  solution  of  carbolic  acid  were  applied.  Keaction  was  moderate  and  not  delayed. 
The  sutures  were  removed  on  the  third  day.  The  edges  of  the  wound  had  united,  and  had  to  bo 
opened  to  give  free  egress  to  pus.  The  patient  had  no  appetite  for  several  days,  but  it  was 
restored  by  iron  and  quinine,  and  the  case  progressed  favorably.  The  ligatures  came  away  on 
the  eleventh  and  thirteenth  days.  There  was  strong  disposition  of  the  edges  of  the  wound  to 
close,  and  it  was  with  difficulty  that  they  were  kept  so  as  to  allow  a  free  discharge.  On  the  15th 
of  June,  the  patient  was  up  and  about,  and  on  June  30th  the  wound  had  closed,  with  the  exception 
of  a  small  point,  at  one  corner,  which  had  ceased  discharging,  and  was  about  to  heal.  The  patient 
was  in  excellent  health.  He  was  returned  to  duty  July  18,  18C9. 

^ 
DXXIX. — Report  of  a  Primary  Amputation  of  the  Arm  for  Qunsliot  Injury.    By  S.  T.  WEIRICK, 

M.  D.,  Acting  Assistant  Surgeon. ' 

.  Private_  William  Jackson,  Co.  E,  16th  Infantry,  aged  24  years,  at  Macon,  Georgia,  June 
19, 18C8,  while  firing  a  salute  was  wounded,  by  the  premature  discharge  of  a  cannon,  which  blew 
off  his  right  arm.  The  right  hand  and  fore-arm  were  completely  gone,  and  the  parts  badly  contused 
and  burned.  On  the  same  day  he  was  admitted  to  the  hospital  of  the  post,  and  W.  F.  Bowes, 
Acting  Assistant  Surgeon,  amputated  the  arm  at  the  upper  third  of  the  huinerus,  by  the  circular 
method.  On  June  30th  the  case  was  progressing  favorably.  The  patient  was  transferred  to 
hospital  at  Atlanta,  Georgia,  August  Cth,  and  was  discharged  the  service  October  22, 18G9,  for 
loss  of  right  arm. 

DXXX.— Account  of  an  Amputation  of  the  Arm  and  Fore-Arm.    By  W.  J.  PIPER,  M.  D.,  Acting 
Assistant  Surge'on. 

Private  William  Jones,  Co.  A,  20th  Infantry,  aged  21  years,  while  firing  a  salute  February  22, 
1868,  at  Baton  Rouge,  Louisiana,  was  wounded  by  the  premature  explosion  of  the  charge.  The 
left  hand  was  blown  away,  the  radius  and  ulna,  and  the  humerus  at  the  middle  fractured,  and  the 
soft  parts  contused.  The  right  fore-arm  was  comminuted  above  the  carpus,  and  was  attached  only 
by  a  few  tendons.  The  lower  maxilla  was  fractured  on  both  sides  anterior  to  the  angle,  and  the 
anterior  portion  of  the  chest  and  abdomen  burned.  "He  was  at  once  admitted  to  the  post  hospital, 
and  one  hour  after  the  injury  William  Thomson,  Assistant  Surgeon,  U.  S.  A.,  administered  ether 
and  chloroform,  with  embarrassment  on  account  of  oppressed  and  difficult  respiration  from 
displacement  of  the  lower  maxilla  and  bleeding  in  the  mouth,  and  amputated  the  left  arm  at  the 
middle,  and  the  right  fore-arm  at  the  lower  third,  by  the  double  flap  method.  The  patient  rallied 
after  the  operation,  and  took  liquid  food,  stimulants,  &c.  Respiration  was  sibilant  and  labored 
from  obstructions  at  the  glottis.  He  died  February  25,  1868,  at  7  P.  M.,  from  exhaustion,  having 
been  very  restless  and  slightly  delirious  for  twenty-four  hours.  At  the  post-mortem  nothing  worth 
mentioning  was  found.  The  seats  of  fracture  of  the  lower  maxilla  were  examined,  and  the  soft 
parts  found  infiltrated  with  blood,  with  lacerations  extending  into  the  buccal  cavity. 

DXXXI.— Account  of  an  Amputation  of  the  Arm  for   Gunshot  Injury.    By   B.   J.  D.  IE  WIN, 
Surgeon,  U.  S.  A. 

First  Lieutenant  Ransom  Kennicott,  Co.  F,  19th  Infantry,  aged  28  years,  was  accidentally 
wounded,  while  handling  his  gun,  by  a  charge  of  small  bird  shot,  which  passed  through  the  left 


184  EErOET  OF  SUEGICAL  CASES  IN  THE  AEMY. 

arm,  completely  shattering  the  Immerus  and  tearing  the  soft  structures.  Dr.  F.  Halliday,  on 
November  3,  18CG,  near  Lawrence,  Kansas,  amputated  the  arm;  internal  and  external  flaps,  and 
four  ligatures  were  applied.  On  November  lltb  he  was  admitted  to  the  post  hospital  at  Fort 
Leavemvorth,  Kansas.  The  wound  was  without  dressing,  the  flaps  everted  and  insufficient,  and 
the  bone  protruding.  I  immediately  administered  chloroform,  and  excised  one  inch  of  bone, 
revivified  the  flaps,  and  applied  iron  wire  sutures.  The  patient  reacted  well,  and  on  November  28, 
18G6,  when  he  left  on  a  leave  of  absence,  his  wound  was  entirely  healed  up,  with  the  exception  of 
a  small  space  where  the  principal  ligature  protruded.  This  officer  was  retired  November  5, 18C8. 

DXXXIL— Report  of  an  Amputation  of  the  Arm  for  Eailicay  Injury.    By  W.  H.  EENICK,  M.  D., 
Acting  Assistant  Surgeon, 

Private  David  Linton,  Co.  B,  7th  Cavalry,  was  run  over  by  railroad  cars  at  or  near  Willow 
Springs,  Colorado  Territory,  on  the  night  of  August  1,  1870.  The  wheels  passed  obliquely  across 
the  right  arm,  completely  destroying  the  elbow -joint.  Both  bones  of  the  fore-arm  were  crushed, 
and  a  longitudinal  fracture  extended  up  the  shaft  of  the  humcrus,  almost  to  the  junction  of 
the  upper  thirds.  One  hour  after  the  injury,  the  patient  being  chloroformed,  the  arm  was  ampu- 
tated at  the  junction  of  the  upper  thirds,  by  the  circular  operation.  Cold-water  dressings  were 
applied,  and  occasionally  a  solution  of  permanganate  of  potash.  On  August  12th  the  sutures  were 
removed,  the  patient  was  allowed  the  limits  of  the  camp,  and  on  August  17th,  he  was  taken  to  Fort 
Lyon.  On  October  30th,  he  was  sent  to  the  hospital  at  Fort  Leavemvorth,  Kansas,  at  which  date 
one  ligature  yet  remained  in  the  stump ;  his  general  health  was  good.  He  was  discharged  the  ser- 
vice on  December  7, 1870. 

DXXXIII. — Remarks  on  a  Primary  Amputation  of  tlie  Arm  for  Gunshot  Injury.    By  W.  B.  LYON, 
M.  D.,  Acting  Assistant  Surgeon. 

William  McDermith,  a  gold  miner,  aged  32  years,  on  the  evening  of  December  6th,  1870, 
carelessly  grasped  the  muzzle  of  a  shot-gun,  which  discharged  a  large  load  of  number-three  shot 
into  his  left  fore-arm.  The  charge  entered  the  anterior  aspect,  four  inches  above  the  wrist-joint, 
severed  the  belly  of  the  flexor  carpi-ulnaris,  ranged  upward  along  the  course  of  the  ulnar  artery, 
and  produced  a  comminuted  fracture  of  the  condyles  of  the  humerus,  opening  the  elbow-joint,  and 
an  oblique  fracture  of  the  shaft.  The  soft  tissues  of  the  upper  fore-arm  and  lower  fourth  of  the  arm, 
especially  on  the  ulnar  side,  were  so  completely  disorganized  as  to  be  almost  unrecognizable. 
The  ulnar  artery  and  uerve  were  entirely  destroyed,  and  the  radial  artery  was  severed  near  its  source. 
A  few  shot  escaped  through  a  small  exit-wound  posteriorly,  one  inch  and  a  half  above  the  upper 
extremity  of  the  ulna,  and  three  separate  exit-wounds  from  single  shot  were  found  three  inches  above. 
Copious  haemorrhage  occurred  immediately  after  receiving  the  wound,  spontaneously  subsiding 
on  the  patient's  assuming  a  recumbent  position.  He  Avas  admitted  to  the  hospital  at  Fort  McHae, 
New  Mexico,  where,  seventeen  hours  after  the  reception  of  the  wound,  he  was  chloroformed,  and  the 
arm  was  amputated  through  the  middle  third  by  the  circular  operation.  The  stump  was  dressed 
with  a  weak  solution  of  carbolic  acid.  The  wound  united  mainly  by  first  intention,  and  progressed 
favorably  throughout.  The  pathological  specimen,  with  the  history,  was  contributed  to  the  Army 
Medical  Museum,  and  is  numbered  5758  of  the  Surgical  Section. 

DXXXIY. — RemarTcs  on  an  Amputation  of  the  Arm.    By  J.  C.  BAILT,  Surgeon,  U.  S.  A. 

Private  Peter  Mclntyre,  Co.  K,  23d  Infantry,  aged  35  years,  was  wounded  while  on  provost 
guard  duty  in  San  Francisco,  California,  on  October  1,  1870,  by  a  conoidal  musket  ball,  which  was 
fired  by  a  burglar  at  the  distance  of  a  few  feet,  and  which  entered  the  arm  anteriorly,  two  inches 
above  the  elbow-joint,  fracturing  the  humerus,  and  implicating  the  joint,  but  left  the  vessels  unin- 
jured. He  remained  in  the  city  with  but  little  attention  until  the  afternoon  of  the  3d,  when  he  was 
sent  to  the  post  hospital  at  the  Presidio.  On  the  next  day,  the  patient  being  feverish  and  the  arm 


AMPUTATIONS  OF  THE  ARM.  185 

swollen,  inflamed,  and  very  painful,  it  .was  decided  to  operate.  The  patient  having  been  rendered 
insensible  with  •  chloroform,  Assistant  Surgeon  Edwin  Bentley,  U.  S.  A.,  amputated  the  arm 
in  the  upper  third  by  the  antero-posterior-flap  operation.  There  was  considerable  haemorrhage ;  eight 
ligatures  were  applied.  The  patient  recovered  well  from  the  influence  of  the  anaesthetic.  The 
stump  was  dressed  with  a  single  layer  of  lint  saturated  with  glycerine  and  carbolic  acid.  The 
wound  progressed  favorably.  On  December  31,  1870,  the  patient  remained  in  hospital,  the  stump 
not  being  yet  in  a  condition  to  adapt  an  artificial  limb.  At  this  date,  there  was  an  occa- 
sional discharge  of  pus,  with  limited  necrosis,  which,  however,  had  never  been  serious,  and  was 
improving. 

DXXXV. — Report  of  an  Amputation  of  the  Arm  for  Gunshot  Injury.    By  0.  CAUGIIILL,  M.  D., 
Acting  Assistant  Surgeon. 

James  Parker,  Co.  Gr,  28th  Infantry,  aged  32  years,  was  wounded  October  10,  1868,  at 
Gamdeu,  Arkansas,  while  in  the  act  of  escaping  from  the  guard,  by  a  conoidal  ball,  which  entered 
the  right  fore-ann,  one  and  a  half  inches  below  the  elbow-joint,  on  the  anterior  surface,  comminuted 
the  radius  and  ulna,  ruptured  the  nluar,  radial,  and  interosseous  arteries,  and  emerged  in  a  slightly 
oblique  direction  upon  the  opposite  side.  At  8  o'clock  P.  M.,  on  the  same  day,  fifteen  minutes  after 
the  receipt  of  the  wound,  he  was  admitted  into  the  post  hospital,  having  lost  a  large  quantity  of 
blood  previous  to  admission.  The  wound  was  very  large  and  jagged,  and  the  muscles  very  much 
lacerated.  The  large  number  of  loose  fragments  of  bone  which  were  removed,  necessarily  left  the 
fractured  ends  very  widely  separated.  Stimulants  were  given  freely  until  reaction  was  established, 
and  an  opiate  was  given  to  quiet  pain  and  produce  sleep.  The  next  morning,  at  six  o'clock,  the 
parts  being  immensely  swollen,  chloroform  was  administered,  and  the  arm  amputated  just  above 
the  elbow  by  the  circular  method.  Stimulants,  in  combination  with  strong  beef  tea,  were  given 
every  hour.  The  patient  died  fifteen  hours  after  the  operation — evidently  from  the  effect  of  the 
loss  of  blood  sustained  previous  to  his  admission  to  the  hospital.  The  ulna  and  radius  were 
examined  after  death.  Two  inches  or  more  from  each  bone  was  found  missing,  and  the  shafts  of 
both  were  split. 

DXXXVI. — Remarks  on  an  Amputation  of  the  Arm  for  Oun.shot  Injury.    By  P.  MEACHAM,  Assist- 
ant Surgeon,  TJ.  S.  A. 

Hospital  Steward  Lucius  O'Brien,  United  States  Army,  aged  23  years,  was  admitted  to  hospital 
at  Camp  Douglas,  Utah  Territory,  on  July  5,  1808,  having  been  accidentally  shot  through  the  left 
arm  just  above  the  bend  of  the  elbow.  The  artery  was  severed  an  inch  and  a  half  above  the  bifur- 
cation, the  lower  end  of  the  humerus  was  extensively  comminuted,  and  the  soft  parts,  about  two 
inches  in  diameter,  on  the  back  of  the  arm,  were  completely  carried  away.  The  patient  had  lost 
considerable  blood.  Amputation  having  been  decided  on,  the  patient  was  chloroformed,  and  the 
circular  operation  was  done  at  the  lower  third  about  two  hours  after  the  accident.  The  patient 
was  then  placed  in  bed,  being  allowed  tea  and  a  farinaceous  diet.  Simple  cold-water  dressings  were 
applied.  On  the  Gth  he  was  doing  well,  the  same  treatment  being  continued.  On  the  8th  there 
was  considerable  fever,  with  scanty  urine  ;  the  wound  looked  well,  and  suppuration  was  established. 
The  sutures  were  removed ;  beef  tea  was  administered  as  an  additional  article  of  diet,  and  fifteen- 
grain  doses  of  acetate  of  potash  were  administered  every  four  hours,  with  an  anodyne  at  night. 
The  symptoms  of  febrile  disturbance  having  disappeared  ou  the  following  day,  the  potash  was 
discontinued,  and  two-grain  doses  of  quinine  and  iron  were  substituted.  Two  of  the  ligatures  were 
removed  on  August  1st;  the  tonic  was  discontinued,  and  full  diet  allowed.  On  August  24th  the 
last  ligature  was  removed.  One  day  later  he  was  returned  to  duty,  the  stump  having  entirely 
healed.* 

DXXXVII. — Remarks  on  an  Amputation  of  the  Arm  for  an  Injury.    By  W.  H.  LONGWILL,  M.  D., 

Acting  Assistant  Surgeon. 

Private  Dionicio  Eaniires,  Troop  F,  1st  New  Mexico  Cavalry,  was  admitted  to  hospital  at  Fort 
Wingate,  New  Mexico,  on  May  18,  I860,  with  asthma,  and  at  the  same  time  suffering  from  an 

*  In  January,  1869,  O'Brien  was  shot  through  the  heart.     See  Keport  CVIII,  p.  36. 
24 


186  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

injury  of  the  left  wrist-joint,  caused  by  a  log  falling  upon  it.  Tincture  of  iodine  was  applied  to  the 
wrist,  and  a  lotion  of  lead  water  and  laudanum  kept  upon  the  parts.  This  failing  to  reduce  the 
inflammation,  a  poultice  of  linseed  was  applied,  and  openings  were  made  for  the  exit  of  pus.  Tonics 
and  a  generous  diet  were  prescribed ;  but  the  patient  being  of  a  scrofulous  habit,  the  inflammation 
extended  to  the  elbow,  and  pus  having  formed  in  the  joint,  together  with  bad  tendency  of  the 
injury  to  the  wrist,  it  was  deemed  best  to  amputate  at  the  lower  third  of  the  humerus,  which  was 
done  on  August  13th.  Dry  dressings  were  applied,  and  the  stump  healed  kindly,  but  the  asthma 
still  continued,  and  the  patient  subsequently  suffered  from  abscess  of  the  thyroid  gland,  which, 
after  being  opened,  continued  to  discharge  until  September  1, 18G6,  when  it  closed  up.  On  Decem- 
ber 23d,  another  .abscess  formed  in  the  thyroid  gland,  leaving  an  opening  in  the  circoid  cartilage, 
through  which  expiration  and  inspiration  took  place,  and  the  patient  expectorated  a  great  deal  of 
pus.  He  gradually  sank  until  December  27th,  at  3  P.  M.,  when  he  expired.  A  post-mortem  exam- 
ination, sixteen  hours  afterward,  revealed  an  abscess  in  the  thyroid  gland  containing  about  two 
ounces  of  pus ;  the  apices  of  both  lungs  were  filled  with  tubercle  ;  the  right  pleura  was  adherent 
around  the  entire  lung,  and  the  heart  was  hypertrophied. 

DXXXVIII. — Report  of  an  Amputation  of  the  Arm  for  Gunshot  Injury.    By  J.  F.  BOTJGHTER,  M. 
D.,  Acting  Assistant  Surgeon,  U.  S.  A. 

Edward  Randall,  a  trapper,  aged  61  years,  was  accidentally  shot  in  the  right  arm  at  Flandreau, 
on  the  Big  Sioux  River,  on  October  20,  18G8.  He  started  alone  with  a  two-horse  team,  and  without 
assistance  reached  Fort  Dakota,  Dakota  Territory,  on  the  evening  of  the  23d,  much  exhausted,  but 
pulse  good.  Stimulants  were  administered  and  the  patient  was  put  to  bed,  when  upon  examination 
of  the  wound  it  was  found  that  a  round  musket  ball,  weighing  an  ounce,  had  entered  the  middle 
third  of  the  fore-arm  anteriorly,  and,  having  passed  obliquely  upward  and  outward,  had  lodged 
against  the  lower  extremity  of  the  humerus,  producing  an  extensive  comminuted  fracture  which 
extended  into  the  elbow-joint  and  some  distance  up  the  shaft.  The  arm  from  the  hand  to  the  shoul- 
der was  much  swollen.  There  were  incipient  symptoms  of  traumatic  gangrene ;  blebs,  containing 
dark-colored  fluid,  covered  the  hand  and  fore-arm,  a  few  being  scattered  on  the  arm  and  scapular 
region ;  a  dark,  yellowish  blush  extended  to  the  shoulder-joint ;  and  the  muscles  were  much  infil- 
trated. It  was  determined  to  operate  immediately,  and,  at  1  o'clock  the  same  night,  the  arm  was 
amputated  in  the  upper  third,  by  the  lateral  flap  operation.  The  flaps  were  much  infiltrated,  and 
had  an  unhealthy  appearance.  Three  ligatures  were  applied,  the  stump  was  dressed  with  cold- 
water  dressings,  and  an  anodyne  was  administered,  and  repeated  in  an  hour.  The  patient  rested 
well,  and  the  next  morning  breakfasted  on  light  and  stimulating  diet.  A  few  drops  of  chlorinated 
soda  were  added  to  the  cold-water  dressings.  He  slept  well  during  the  next  flight  without  an 
anodyne.  The  following  morning,  his  bowels  not  having  moved  since  the  injury,  cathartics  were 
given.  The  stump,  by  this  time,  was  much  swollen,  and  was  discharging  a  bloody  serum ;  the  shoulder 
was  also  swollen,  blush  extending  over  region  of  scapula.  His  appetite  continued  good.  On  the 
27th,  one  suture  was  removed.  The  edges  of  incision  appeared  to  be  healing  too  rapidly,  preventing 
discharge  of  pus ;  a  poultice  was  applied.  On  the  28th,  the  remaining  sutures  were  removed,  and 
the  stump  was  dressed  with  straps  and  bandages.  On  the  29th  the  patient  complained  of  spasmodic 
twitching  of  muscles  of  stump  with  pain  while  dozing.  On  November  1st,  the  ligatures  came  away, 
and  the  swelling  of  stump  and  shoulder  was  nearly  gonp.  From  this  time  he  improved  rapidly. 
On  the  17th  healthy  granulations  having  sprung  up  in  two  places  of  incision,  nitrate  of  silver  was 
applied ;  and  on  December  7th,  the  stump  being  entirely  healed,  excepting  a  slight  sinus  at  anterior 
edge  of  incision,  the  application  was  repeated,  a  small  tent  was  inserted,  and  the  edges  brought 
together  with  small  adhesive  straps.  On  December  14th  the  arm  was  entirely  healed ;  it  was 
bandaged,  and  a  pad  placed  in  axilla.  On  the  loth  he  left  for  his  home  in  Canada,  which  he  reached 
safely  on  January  6, 1869.  At  this  date,  and  during  the  treatment,  he  complained  of  some  numbness 
in  the  arm.  His  pulse  had  varied  according  to  the  comfort  of  the  stump,  it  having  fallen  after 
dressing  on  the  fourth  day,  from  eighty  to  sixty-four.  The  operator  says  in  his  report  of  the  case, 
that "  the  patient's  age,  his  being  over  three  days  without  any  assistance  (being  obliged  to  take  care 


AMPUTATIONS  OP  THE  ARM.  187 

of  his  own  horse  and  cook  his  own  food  during  that  period),  and  the  very  unfavorable  condition  of  his 
arm,  was  very  much  against  his  recovery.  The  difficulty  of  detecting  the  extent  of  the  fracture  on 
account  of  the  swollen  condition  of  the  arm,  and  the  unhealthy  appearance  of  his  shoulder  at  one 
time,  almost  induced  me  to  amputate  at  the  shoulder-joint ;  and  after  amputating  when  I  did,  I  was 
fearful  of  the  invasion  of  gangrene.  He  made  a  slow  but  good  recovery.  Perhaps  more  of  his 
arm  might  have  been  saved,  as  subsequent  dissection  showed  that  the  fracture  did  not  extend  as 
high  as  was  suspected.  If  it  had  been  taken  off  lower  down,  I  think  extensive  sloughing  would 
have  occurred." 

DXXXIX. — Report  of -an  Amputation  of  the  Arm.    By  T.  F.  AZPBLL,  Assistant  Surgeon,  U.  S.  A. 

Private  Ellis  B.  Robinson,  general-service  recruit,  aged  26  years,  was  wounded  by  the  prema- 
ture discharge  of  a  brass  cannon  at  David's  Island,  New  York  Harbor,  on  Juno  6, 1868,  while 
acting  as  number  one  in  firing  a  salute.  He  was  admitted  to  the  post  hospital,  when,  it  being 
found  that  the  right  humerus,  radius  and  ulna,  and  wrist-joint  were  fractured,  and  that  there  was 
much  contusion,  with  evident  laceration  of  the  vessels,  he  was  at  once  rendered  insensible  with 
two  parts  ether  and  one  chloroform,  and  the  arm  was  amputated  about  four  inches  above  the 
elbow-joint  by  "  the  three-quarter  lateral  flap  operation,  it  being  thought  advisable  not  to  make 
the  flaps  entirely  lateral,  in  order  to  avoid  contused  tissue,  and  give  a  greater  length  of  stump." 
Simple  dressings  were  applied.  The  excessive  pain  continuing  after  the  operation,  an  anodyne  was 
given.  A  nutritious  but  non-stimulating  diet  was  ordered.  The  pain  did  not  cease  until  the  next 
morning,  preventing  sleep.  On  June  8th,  the  bowels  not  having  moved  since  the  injury,  an  injec- 
tion was  given.  On  the  9th,  the  bandages  and  lint  were  removed  for  the  first  time,  and  cold-water 
dressings  were  applied.  About  two  inches  of  the  posterior  portion  of  the  incision  had  united  by 
first  intention ;  considerable  sloughing  had  commenced  on  the  anterior  portion  of  the  flaps,  and 
the  severe  injury  to  the  skin  was  evident  from  the  sphacelated  appearance  of  the  stump  and  the 
discoloration  extending  to  the  axilla  and  chest.  Milk  punch  was  now  added  to  his  diet.  Ou  the 
10th,  the  stump  was  washed  with  a  diluted  solution  of  chlorinated  soda;  and  on  the  llth,  the  silk 
sutures  apparently  increasing  the  tendency  to  slough,  silver  wire  was  substituted.  On  the  12th, 
most  of  the  slough  came  away  on  the  dressing,  showing  a  healthy  granulating  surface.  On  July 
1st,  the  ligature  was  removed,  and  nitrate  of  silver  was  daily  applied,  to  exuberant  granulations, 
until  July  30th,  when  the  stump  had  entirely  healed,  with  ample  covering  to  the  bone.  "  The 
sloughing,  in  this  case,  appeared  to  be  very  materially  diminished,  and  almost  suspended,  by  the 
use  of  the  chlorinated  mixture  and  wire  suture — so  much  so,  that  the  improvement  in  the  condition 
of  the  stump  seemed  evident  in  the  course  of  twenty-four  hours."  In  xVugust,  1868,  the  patient  was 
transferred  to  another  command. 

DXL. — Report  on  an  Amputation  of  the  Arm  and  Fore- Arm.     By  W.  MATTHEWS,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Jacob  Schubach,  Co.  F,  22d  Infantry,  while  firing  a  salute,  July  4, 1870,  at  Fort 
Stevenson,  Dakota  Territory,  was  wounded  by  the  premature  explosion  of  the  cartridge  he  was 
ramming  down  at  the  time.  The  right  fore-arm  was  torn  off,  and  the  remainder  of  the  limb  was 
scorched  and  lacerated  in  the  severest  manner  up  to  the  axilla.  A  portion  of  the  left  hand  was 
also  torn  away,  and  the  remainder  burned  to  the  wrist.  The  right  side  of  the  face,  the  right  eye, 
and  the  entire  chest  were  also  badly  scorched.  On  being  taken  to  the  hospital  and  chloroformed, 
the  arm  was  amputated  in  the  upper  third,  very  close  to  the  shoulder.  There  was  great  difficulty 
in  finding  sufficient  sound  flesh  to  make  a  stump,  and  a  portion  of  the  scorched  tissue  in  the  axilla 
had  to  be  included  in  one  of  the  flaps.  The  left  fore-arm  was  amputated  above  the  wrist.  In  the 
right  arm  suppuration  did  not  commence  until  after  the  fifth  day,  when  carbolic-acid  lotion  was 
applied,  a  small  portion  of  the  axillary  flap  having  become  mortified  before  that  time.  The  opera- 
tion was  followed  by  great  prostration,  and  the  patient's  condition,  for  seven  or  eight  days,  was 
very  doubtful.  July  31 :  He  was  able  to  walk  around,  and  in  excellent  spirits,  and  the  stumps 
were  healing  finely.  On  August  13,  1870,  he  was  transferred  to  Fort  Sully,  Dakota  Territory, 
perfectly  able  to  stand  the  journey. 


188  EEPOET  OF  SUKGICAL  CASES  IN  THE  ARMY. 

DXLI.— Note  relative  to  an  Amputation  of  the  Arm.    By  C.  BACON,  JR.,  Assistant  Surgeon,  U.  S.  A. 

Private  Jean  Shields,  Troop  D,  6th  Cavalry,  aged  22  years,  was  admitted  into  the  post  hospi- 
tal at  Jacksboro,  Texas,  December  13,  I860,  amputation  of  the  left  arm  having  been  performed 
at  the  middle  third,  on  account  of  injury,  at  Sherman,  Texas,  October  15,  I860.  He  was  returned 
to  duty  January  17,  1867. 

DXLII. — Remarks  on  a  Primary  Amputation  of  the  Arm  for  Gunshot  Injury.     By  P.  MIDDLETON, 
Assistant  Surgeon,  U.  S.  A. 

An  Indian  girl,  aged  15  years,  received,  September  11, 1868,  near  Dickenson's  Eanche,  Ari- 
zona Territory,  a  gunshot  wound  of  the  right  arm.  The  lower  part  of  the  humerus  was  shattered, 
and  the  elbow-joint  opened.  On  the  same  day,  in  the  field,  Private  George  W.  Miller,  Company  A,  8th 
Cavalry,  acting  hospital  steward,  without  administering  an  anaesthetic,  amputated  the  humerus 
at  the  lower  third,  by  the  anterior-posterior-flap  method.  Four  ligatures  were  applied.  On  the 
next  day,  she  was  brought  as  a  prisoner  of  war  to  the  post  hospital,  Camp  Whipple,  Arizona 
Territory.  Cold-water  dressings  were  applied,  and  the  patient  did  well.  On  September  29th,  she 
was  convalescent.  On  the  30th,  at  midnight,  two  Indians  approached  the  hospital,  and  recaptured 
the  prisoner. 

DXLIII. — Note  relative  to  a  Primary  Amputation  of  the  Arm  for  Gunshot  Injury.    By  T.  H.  TURNER, 
Assistant  Surgeon,  U.  S.  A. 

Private  George  Washington,  Troop  I,  10th  Cavalry,  received,  January  20,'  1869,  a  gunshot 
comminuted  fracture  of  the  left  elbow-joint.  He  was  immediately  admitted  to  the  post  hospital, 
Fort  Wallace,  Kansas,  and,  on  the  same  day,  Assistant  Surgeon  J.  A.  Fitzgerald,  United  States 
Army,  amputated  the  left  arm  at  the  lower  third  of  the  humerus.  The  patient  was  depressed  at 
the  time  of  the  operation.  Progress  was  good  until  the  third  week,  when  he  commenced  sinking, 
death  supervening  on  the  8th  of  February,  1869. 

DXLIV. — Note  relative  to  an  Amputation  of  the  Arm.     By  T.  CUNTNGHAME,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  David  White,  Co.  G,  41st  Infantry,  aged  23  years,  was  wounded  September  6, 1867, 
by  the  accidental  discharge  of  a  rifle.  The  missile,  a  conoidal  ball,  caused  a  compound  complicated 
and  comminuted  fracture  of  radius,  ulna,  and  humerus  of  one  arm.  He  was  at  once  admitted  to  the 
post  hospital  at  Einggold  Barracks,  Texas,  the  whole  of  the  elbow-joint  being  extensively  pulpifled 
and  lacerated.  Patient  was  suffering  with  intermittent  fever  at  time  of  injury.  Amputation  at 
middle  third  of  arm  was  performed  September  6, 1867.  Death  resulted  September  9, 1867,  from 
nervous  shock. 

Amputations  at  the  /Shoulder-joint. — Of  the  four  special  cases  reported  one  proved 
fatal.  Three  were  due  to  gunshot  wounds  ;  one  to  railway  accident. 

DXLV. — Report  of  a  Successful  Case  of  Primary  Amputation  at  the  Shoulder-Joint  for  Gunshot 
Injury. — By  D.  L.  HTJNTINGTON,  Assistant  Surgeon,  U.  S.  A. 

Manuel  Chavez,  a  Mexican,  aged  24  years,  was  wounded  near  Fort  Cummings,  New  Mexico, 
on  July  3,  1868,  by  the  accidental  discharge  of  an  old  Springfield  musket,  while  drawing  it  out  of 
a  wagon.  The  ball  entered  near  the  internal  edge  of  the  brachialis  anticus  muscle,  about  four 
inches  below  the  head  of  hnmerus,  fractured  the  bone  badly,  and,  passing  out  near  the  posterior 
edge  of  the  deltoid,  injured  the  brachial  artery  and  severed  the  nerve.  On  July  4th,  after  riding 
forty-five  miles  without  water,  he  was  admitted  to  the  hospital  at  Fort  Bayard,  New  Mexico,  tin- 
wound  being  in  a  high  state  of  inflammation.  Morphine  was  given,  and  after  three  hours'  rest  the 
patient  was  rendered  insensible  with  one  part  chloroform  and  four  parts  ether,  and  the  arm  was 
amputated  at  the  shoulder-joint,  with  a  deltoid  and  inner  flap.  Little  or  no  blood  was  lost,  and 


AMPUTATIONS  AT  THE  SHOULDER- JOINT.  189 

the  patient  rallied  well  from  the  effects  of  the  anaesthetic.  Sedatives  were  given  at  bedtime.  On 
July  Gth,  he  had  been  very  restless  during  the  previous  night,  his  skin  was  dry  and  hot,  the  pulse 
one  hundred  and  ten  and  feeble,  and  respiration  twenty-eight ;  there  was  an  offensive  sanious 
discharge  from  the  wound,  and  great  pain.  Stimulants  and  tonics  were  given,  and  the  wound 
was  washed  with  a  lotion  of  carbolic  acid  and  water.  This  treatment  (with  an  injection  on  the 
8th,  which  caused  a  good  flecal  discharge)  was  continued  with  great  improvement  in  the  condition 
of  the  patient ;  and,  on  the  12th,  three  small  ligatures  came  away,  leaving  only  the  brachial,  and 
the  wound  was  rapidly  closing.  On  the  18th,  the  ligature  of  the  brachial  came  away,  and  from 
that  time  he  steadily  improved.  By  August  1st,  the  cicatrix  was  complete  and  firm,  and  a  good 
stump  had  formed.  He  remained  in  hospital  until  near  the  middle  of  August,  when  he  was  sent 
home.  On  examination  of  the  humerus  after  disarticulation,  it  was  found  shattered  into  fragments, 
with  fissures  running  down  the  shaft  and  upward  into  the  cancellated  structure  of  the  head  of  bone. 

DXLVI. — Eeport  of  a  Successful  Secondary  Amputation  at  the  Shoulder-Joint  for  Gunshot  Injury. 
By  CHARLES  SMART,  Assistant  Surgeon,  U.  S.  A. 

Private  James  B.  Farrington,  Co.  K,  32d  Infantry,  aged  36  years,  was  accidently  wounded 
April  27,  1867,  by  the  discharge  of  a  fowling  piece,  six  revolver  bullets  entering  the  left  arm  and 
shoulder,  posteriorly  fracturing  the  left  humerus  and  scapula,  and  severely  injuring  the  soft  parts. 
He  was  admitted  to  the  post  hospital,  at  Camp  Lowell,  Arizona  Territory,  on  the  same  day.  The 
patient  became  exhausted  from  excessive  suppuration  of  wound,  and  the  limb  entirely  useless  on 
account  of  injury  to  nerves.  On  August  27,  1867,  an  excessive  haemorrhage,  supposed  to  be  from 
the-  axillary  artery,  occurred.  Several  unsuccessful  attempts  having  been  made  to  secure  this 
artery,  and  taking  into  consideration  the  uselessness  of  the  arm,  it  was  decided  to  amputate  at  the 
shoulder-joint,  which  was  accordingly  done,  after  rendering  the  patient  insensible  with  chloroform. 
Water  dressings,  nourishing  diet,  and  stimulants  were  used.  He  was  returned  to  duty  March  10, 
1868. 

DXLVII. — Primary  Amputation  at  the  Shoulder- Joint  for  Gunshot  Injury,  having  a  Fatal  Termination. 
By OWENS,  M.  D. 

John  Collins,  Co.  1, 17th  Infantry,  was  admitted  to  the  hospital  at  Camp  Schofield,  Lynchburg, 
Virginia,  about  two  o'clock  on  the  morning  of  September  11,  1869,  with  a  gunshot  comminuted 
fracture  of  the  upper  third  of  the  right  humerus.  It  is  believed  that  the  gun  was  loaded  with  ball 
and  buckshot  or  slugs,  as  fully  one-third  of  the  upper  portion  of  the  bone  was  shattered  to  its  head 
and  the  integuments  for  more  than  that  distance  were  severely  torn,  although,  strange  to  say,  the 
main  artery  was  untouched.  He  had  lost  a  great  amount  of  blood ;  and  this,  together  with  the 
shock  to  his  nervous  system,  precluded  operative  interference  until  reaction.  The  patient  reacted 
very  slowly  ;  and,  at  five  o'clock  in  the  evening,  deeming  it  inadvisable  to  wait  any  longer,  I,  upon 
invitation,  amputated  at  the  shoulder-joint,  by  flap  operation,  with  neatness  and  dispatch.  The 
patient  lost  but  little  blood  ;  but,  some  hours  after,  his  pulse  began  to  fail  rapidly,  death  superven- 
ing at  half  past  six  o'clock  the  next  morning,  thirty  hours  after  being  shot.  The  case  is  reported 
by  the  operator. 

DXLVIII. — Report  of  a  Successful  Primary  Amputation  at  the  Shoulder-Joint  for  Eailway  Injury. 
By  W.  F.  BUCHANAN,  Assistant  Surgeon,  U.  S.  A.  •< 

Private  Alexander  Terry,  Co.  E,  38th  Infantry,  met  with  a  severe  railway  injury  on  the  Union 
Pacific  Road,  a  short  distance  from  Fort  Hays,  Kansas,  for  which  he  was  admitted  to  the  hospital, 
on  October  1C,  1868.  There  was  a  compound  comminuted  fracture  of  the  left  arm,  the  bone  being 
extensively  comminuted  with  both  extremities  fractured  longitudinally.  The  soft  parts  were  much 
lacerated,  the  little  finger  was  torn  off  the  left  hand,  and  the  patient  suffered  much  from  the  shock 
of  injury.  Being  comfortably  arranged  in  bed,  and  precautions  having  been  taken  to  prevent 
haemorrhage  during  the  night,  an  anodyne  was  administered,  and  the  patient  slept  well.  On  the  17th 


190 


EEPOET  OF  SURGICAL  CASES  IK  THE  AEMY. 


he  was  anaesthetized,  when  a  further  examination  of  the  injury  led  to  the  conclusion  that  a  prompt 
removal  at  the  articulation  was  the  best  and  only  chance  of  saving  life.  As  the  subclavian  could 
not  be  properly  conipresed,  owing  to  a  full  development  of  the  chest  and  shoulders,  and  the  absence 
of  proper  assistance,  a  tourniquet  was  applied  over  the  axillary  artery  and  retained  in  situ  by  an 
assistant,  the  screw  being  placed  over  the  superior  border  of  the  scapula  and  retained  in  position  by 
a  tape  passed  around  the  chest.  An  incision,  begun  immediately  below  the  acromion  process,  was 
carried  down  through  the  belly  of  the  deltoid  muscle,  about  three  inches ;  then,  making  a  curve 
around  the  external  extremity  of  the  humerus  to  the  axilla,  a  similar  flap  was  made  on  the  inner 
side,  and  the  bone  was  disarticulated.  The  axillary  artery  was  ligated,  and  after  the  cessation  of 
a  little  venous  oozing,  the  flaps  were  brought  together  by  interrupted  sutures  and  adhesive  strips, 
not  more  than  an  ounce  of  blood  having  been  lost  during  the  operation.  The  patient  reacted 
promptly,  when  a  stimulant,  followed  by  an  anodyne,  was  administered,  and  cold-water  dressings 
were  applied.  He  slept  well,  and  on  the  18th  his  condition  was  fair.  The  remaining  treatment  in 
this  case  was  chiefly  expectant.  By  December  31st  the  patient  had  entirely  recovered  with  a  good 
round  shoulder.  He  was  discharged  April  9, 1867.  The  specimen,  with  the  history,  was  contributed 
to  the  Army  Medical  Museum,  by  the  operator,  and  is  No.  5595,  Surgical  Section. 

AMPUTATION    IN   THE   LOWER   EXTREMITIES — 

Amputations  of  the  Toes. — Special  reports  of  twenty-two  cases  of  this  nature  were 
received.     Eighteen  were  due  to  frost-bites  ;  four  to  injuries. 


Xanio. 

Rank. 

Co. 

Kegiment. 

Nature  of  injury. 

Parts  removed. 

Kemark. 

Civilian  ... 

Frost-bito 

Private 

B 

Frost-bite 

toe,  and  outer  third  of  second 
phalanx  of  left  great  toe. 

April  4,  1868. 

Bell,  John  

TT 

10th  Cavalry 

Frost-bite 

second  toe  of  lett  foot,  and 
first  phalanx  of  great^toc  of 
right  foot. 

F 

13th  Infantry 

phalangcal  articulation. 

ruary  25,  1868. 

Brown,  Samuel  

Private  

K. 

10th  Cavalry  

Frost-bito 

the  continuity  of  the  nieta- 
tarso-phalangeal  articulation. 

Coimell,  Patrick  

Private  

D. 

20th  Infantry... 

mt'tatarsal  bone. 

16,  1869. 
Transferred   to    the    Sol- 

Fisher, John  

Private  

T 

5th  Artillery  

tarsal  bone  of  left  foot,  and 
balance  of  toes  at  metatarso- 
phalangeal  articulation. 

diers'  Homo,  "Washing- 
ton, D.   C.,  October   8, 
1870. 

Gardiner,  James.  A  

Private  
Private 

E. 
ft 

2d  Artillery  
8th  Cavalry 

Frost-bite  

Toes  at  metatarso-phalangeal 
articulation. 

Discharged  April  4,  1868. 

Private 

IT 

6th  Infantry 

tarso-phalangeal  articulation. 

MB 

Honig,  Charles  
Hughes,  Edward  

Private  
Private  

C. 
B 

13th  Infantry  ... 
18th  Infantry 

Frost-bite  
Frost-bite 

toe  ;  also,  both  thumbs  at  sec- 
ond phalangeal  joints,  second 
and  third  phalanges  of  index 
and  middle  fingers,  and  third 
phalanx  of  ring  finger  of  right 
hand,  and  second  and  third 
phalanges  of  first,  second,  and 
ring  fingers,  and  fourth  finger 
at  meta.carpo-phalangeal  joint. 
All  the  toes  of  left  foot  
Great  toe  of  rightfoot  in  n>iilill>- 

Home,  at  Dayton,  Ohio. 

Discharged  August  17,  1867. 
Discharged  October  7,  1867. 

of  first  phalanx,  and  great  toe 
of  loft  foot  at  metatarso-pha- 
langeal articulation. 

AMPUTATIONS  OF  THE  FOOT. 


191 


Name. 

Rank. 

No. 

Regiment. 

Nature  of  injury. 

Parts  removed. 

Remarks. 

soldier. 
Private      . 

•R 

1st  Cavalry      .  .  . 

Frost-bite  

three  toes  of  left  foot  through 
metatarso-phalangeal    articu- 
tion. 

March  6,  1871. 

Private 

TT 

23d  Infantry  

Frost-bite    

little  toe  of  left  foot. 

18C8. 

Private  • 

T) 

33d  Infantry  

Little  toe    " 

1808. 

Private 

F 

14th  Infantry  .  . 

Frost-bite  

24,  1868. 

ends  of  the  metatarsal  bones 
of  the  right  foot. 

12,  1871. 

IT 

22d  Infantry  

ITrost-bite  

30,  1870. 

Private  

F 

2d  Cavalry  

Frost-bite  

1868. 

Sergeant  .. 

F 

1st  Artillery  

Lacerated  wound 

August  11,  1868. 

Private 

TT 

10th  Cavalry 

gust,  1806. 

toe. 

28,1868. 

Amputations  of  the  Foot. — Six  special  cases  were  reported, 
bites,  two  to  gunshot  injuries,  and  one  to  dislocation. 


Three  were  due  to  frost- 


DXLIX. — Account  of  a  Case  In  which  a  Double  Operation  was  Performed  on  the  Feet. 
SCHELL,  Assistant  Surgeon,  U.  S.  A. 


By  H.  S. 


Private  William  Finn,  Troop  D,  2d  Cavalry,  aged  29  years,  while  on  the  march  from  Fort 
Laramie  to  Bridger's  Ferry,  North  Platte  Eiver,  March  26, 18C7,  was  frost-bitten  in  both  feet.  He 
was  admitted  into  the  post  hospital  at  Fort  Laramie,  Dakota  Territory,  on  the  same  day,  the  whole 
of  the  right  foot  in  front  of  the  ankle-joint  and  all  of  the  toes  of  the  left  foot  except  the  last  being 
gangrenous.  On  April  12th  the  patient  was  slightly  feverish,  the  pulse  was  90,  and  the  lower  part 
of  right  leg  and  foot  had  become  swollen  and  congested ;  there  was  a  distinct  line  of  demarca- 
tion extending  vertically  around  the  foot,  from  a  point  about  one-half  inch  in  front  of  tibio-tarsal 
articulation,  and  the  cuticle  was  detached  from  the  plantar  region.  The  left  foot  was  puffy,  and 
there  was  a  line  of  demarcation  a  little  posterior  to  commissures  of  toes.  Chloroform  was  admin- 
istered, and  the  right  foot  amputated  by  PirogofFs  operation  in  the  manner  described  by  Mr. 
Spencer  Wells,  and  all  the  toes  of  the  left  foot  just  behind  the  heads  of  the  metatarsal  bones, 
dorsal  and  palmar  flaps  being  made  from  without  inwards.  Three  ligatures  were  applied  to  right 
foot  and  two  to  left.  Haemorrhage  three  or  four  ounces.  The  induction  of  the  anaesthesia  was 
difficult,  requiring  three-quarters  of  an  hour,  but  was  well  borne  when  induced.  Owing  to  the 
restlessness  of  the  patient  for  the  first  twelve  hours  after  the  operation,  there  was  considerable 
oozing  of  blood  from  the  right  foot,  followed  by  inflammation.  The  stump  and  half  the  leg  were 
wrapped  in  lint  and  kept  constantly  wet  with  lead-water  and  laudanum.  By  April  15th  haemorrhage 
had  ceased.  May  13th,  both  stumps  had  entirely  healed  ;  June  30,  18G7,  right  leg  had  shortened 
about  three-fourths  of  an  inch.  The  patient  was  discharged  September  1, 1867.  His  application 
for  a  pension  was  rejected. 


DL. — Note  relative  to  a  Partial  Amputation  of  the  Foot. 
TJ.  S.  A. 


By  P.  MIDDLETON,  Assistant  Surgeon, 


Private  George  M.  Lockwood,  Troop  C,  3d  Cavalry,  aged  21  years,  was  wounded  at  Fort 
Whipple,  Arizona  Territory,  May  5,  1870,  by  the  accidental  discharge  of  a  Spencer  carbine.    The 


192  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

ball  at  that  range  shattered  the  second  metatarsal  bone  of  the  left  foot.  The  patient  was  admitted 
to  the  hospital  of  the  fort  on  the  same  day,  and,  on  May  ICth,  chloroform  was  administered  and  the 
toe  and  second  metatarsal  bone  amputated.  There  was  but  little  haemorrhage,  and  no  ligatures 
were  applied.  At  the  time  of  the  operation  the  soft  parts  near  the  wound  were  in  a  healthy  condi- 
tion. The  patient  reacted  promptly  from  the  anaesthetic,  and  no  bad  symptoms  followed.  On  June 
30th  the  patient  was  still  under  treatment,  convalescent.  He  was  discharged  January  21,  1871. 

DLL — Account  of  a  Partial  Amputation  of  the  Foot.    By  F.  DAMOUE,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Richard  Melitz,  Troop  B,  1st  Cavalry,  aged  22  years,  while  en  route  to  Camp  McGarry, 
Nevada,  was  frost-bitten  in  both  feet  on  the  20th  of  January,  18G8.  He  arrived  at  his  destination,  and 
was  admitted  to  the  post  hospital  on  the  25th.  On  the  31st,  ether  and  chloroform  were  administered, 
and  a  flap  amputation  of  the  right  foot  performed  through  the  second,  third,  fourth,  and  fifth 
metatarsal  bones,  and  through  the  tarso-metatarsal  articulation  of  the  first.  The  parts  amputated 
were  gangrenous.  The  patient,  at  the  time,  was  feverish,  pulse  110,  skin  dry,  secretion  scant, 
bowels  constipated,  and  appetite  not  very  good.  The  glands  of  the  right  groin  were  swollen  and 
inflamed ;  lithic  acid  was  found  in  the  urine.  On  the  17th  of  February,  part  of  the  left  great  toe 
having  mortified,  an  anaesthetic  was  administered  as  above,  and  it  was  amputated  through  the 
first  phalanx,  with  a  favorable  result.  The  sutures  of  the  flap  of  the  right  foot  gave  way  on 
account  of  the  great  destruction  of  integument  above  the  amputation,  and  therefore  the  healing 
process  was  carried  on  by  granulation.  A  large  portion  of  the  soft  parts  of  the  heel  were  also 
mortified,  and  sloughed  off,  exposing  a  large  part  of  the  os  calcis.  By  the  31st  of  March,  1808,  the 
stump  had  healed  with  good  cushions.  The  ulcer  in  the  heel  had  been  filling  up  by  granulation, 
but  was  not  yet  well.  Discharged  September  26,  1868.  Pension,  $15. 

DLII. — Note  on  a  Partial  Amputation  of  the  Foot.    By  H.  R.  TILTON,  Assistant  Surgeon.  U.  S.  A. 

Private  Frank  Reip,  Troop  B,  7th  Cavalry,  aged  23  years,  while  marching  from  Pueblo  to 
Fort  Lyon,  Colorado  Territory,  January  23  to  27.  1867,  had  his  left  foot  frozen.  He  was  taken 
to  the  post  hospital  at  Fort  Lyou,  Colorado  Territory.  The  injured  parts  were  gangrenous.  On 
February  19th,  I  administered  an  anaesthetic  composed  of  chloroform  and  ether,  and  amputated 
the  foot  through  the  metatarsal  bones.  Simple  dressings  were  applied.  He  recovered,  and  was 
discharged. 

DLIII. — Account  of  an  Amputation  of  the  Foot  for  a  Compound  Dislocation  of  the  AnMe-Jomt.    By 
W.  A.  TOMPKINS,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Leopold  Wiukleman,  Troop  K,  7th  Cavalry,  while  suffering  from  an  attack  of  delirium 
tretnens,  leaped  from  a  third  story  window  of  the  building  used  as  a  hospital  at  Yorkville,  South 
Carolina,  falling  a  distance  of  about  forty  feet,  and  causing  a  compound,  comminuted,  complicated 
fracture  of  the  internal  malleolus,  os  calcis,  and  astragalus  at  the  posterior  part.  The  weather 
being  extremely  warm,  and  the  patient  debilitated  from  excessive  debauchery,  I  decided  to 
amputate  as  the  only  means  of  saving  his  life,  which  decision  was  concurred  in  by  two  medical 
gentlemen  who  assisted  me  in  the  operation.  The  patient  at  present  is  doing  well,  and  will  have 
a  serviceable  limb.  The  specimen  forwarded  to  the  Army  Medical  Museum,  with  the  history,  is 
numbered  5928  of  the  Surgical  Section. 

DLIV. — Note  Relative  to  an  Amputation  of  the  Foot  for  Gunslwt  Injury.    By  J.  W.  WILLIAMS, 
Assistant  Surgeon,  U.  S.  A. 

Jose'  Antonio  Gonzales,  a  citizen,  was  wounded  at  Fort  Dodge,  Kansas,  in  July,  18G5,  by  Indians. 
The  ball  entered  anteriorly,  passed  backward  and  downward,  carried  away  the  cuboid  part  of  the 


AMPUTATIONS  AT  THE  ANKLE-JOINT.  193 

os  calcis,  shattered  the  astragalus,  and  involved  the  joint  to  such  an  extent  as  to  render  amputa- 
tion of  the  foot  necessary,  which  WHS  performed  by  J.  G.  Riddler,  Assistant  Surgeon,  5th  U.  S.  V. 
The  patient  became  very  much  reduced  in  consequence  of  diarrhoea,  which  was  overcome  by  the 
use  of  turpentine  and  laudanum  in  emulsion,  all  other  means  failing.  On  July  31,  1805,  the 
patient  was  doing  well. 

Amputations  at  the  Ankle- Joint. — Of  the  four  cases  of  this  class,  made  subjects  of 
special  reports,  one  proved  fatal. 

DLV. — Remarks  on  a- Case  of  Frost-Bite  in  which  both  Feet  were  removed  by  Pirogo$rs  Method.    By 
JAMES  F.  WEEDS,  Surgeon,  U.  S.  A. 

Daniel  Ferns,  formerly  a  private  of  Co.  K,  7th  Infantry,  aged  45  years,  started  from  Santa 
Fe,  New  Mexico,  about  the  15th  of  January,  180G,  at  midnight,  for  Fort  Craig,  in  a  state  of 
intoxication,  and  carrying  a  canteen  of  whiskey  with  him.  The  night  was  very  cold,  the  thermom- 
eter being  below  zero.  After  .walking  eighteen  mijes,  he  lost  the  road,  and  lay  down,  when  both 
his  feet  were  frozen.  Being  unable  to  bear  transportation,  he  was  treated  in  a  private  family  at 
Algadones,  New  Mexico,  twenty -five  miles  north  of  Albuquerque.  The  feet  were  found  sphacelated, 
the  line  of  demarcation  on  the  right  foot  being  a  little  above  the  scapho-cuneiform  articulation, 
and  the  left  at  the  astragalan-scaphoid  on  the  dorsum  of  the  foot,  and  two  lines  in  front  of  the  cal- 
caneum  cuboid  on  the  plantar  surface.  The  parts  about  the  right  ankle  were  much  swollen,  inflamed, 
and  infiltrated,  and  the  vitality  was  very  low.  There  was  an  ulcer  over  the  external  malleolii.  The 
parts  about  the  left  ankle  were  but  little  swollen  or  inflamed.  The  patient's  constitution  was 
broken  by  many  years  of  intemperance.  The  pulse  was  small  and  weak,  and  120  per  minute ; 
surface  covered  with  cold  perspiration ;  bowels  were  loose,  the  evacuations  being  frequent  and 
watery ;  and  the  appetite  was  poor,  the  patient  having  an  intense  desire  for  whiskey,  and  con- 
stantly calling  for  it.  On  January  27th,  I  amputated  at  the  right  ankle-joint  by  PirogoiPs 
operation ;  and,  on  the  31st,  the  same  operation  was  performed  on  the  left.  The  anaesthetic 
was  chloroform  one  part  and  ether  two  parts.  After  the  operations,  the  constitutional  symp- 
tons  improved ;  the  pulse  fell  to  eighty-five,  and  had  more  volume  and  force ;  the  cold  perspiration 
ceased,  and  the  appetite  improved.  The  wounds  on  both  feet  partly  closed  by  first  intention. 
Inflammation  and  swelling  about  the  left  ankle  greatly  diminished.  He  continued  to  improve 
until  February  10th,  when  mortification  showed  itself  in  both  limbs  without  any  previous  increase 
of  constitutional  symptoms,  and  spread  rapidly  toward  the  body  without  forming  any  line  of 
demarcation.  From  this  time  he  sank  rapidly.  The  treatment  prescribed  was  cold-water  dress- 
ings, the  frequent  and  free  administration  of  stimulants,  nutritious  animal  diet,  and  anodynes  to 
relieve  pain  and  secure  rest.  These  directions  were  not  followed;  the  stimulants  were  irregularly 
administered,  and  the  diet  was  poor  and  insuflicieut.  To  these  causes  the  patient's  death,  which 
occurred  on  February  12, 18GG,  is  attributed.  No  post-mortem. 

DLVI. — Memorandum  relative   to   an  Amputation    of  the  Foot   by  Pirogojfs  Method.      By  J.  E. 
SEMPLE,  Assistant  Surgeon,  U.  S.  A. 

H.  Gr.  Nims,  additional  paymaster,  aged  25  years,  was  admitted  to  the  post  hospital.  Fort 
Vancouver,  Washington  Territory,  December  25,  18G6,  with  a  gunshot  fracture  and  comminution 
of  the  external  and  middle  cuneiform  bones  of  the  right  foot,  the  ball  having  entered  the  lower 
third  of  tibia  externally,  passed  down,  and  lodged  in  the  foot.  The  parts  were  blackened  and  bleed- 
ing. His  general  condition  was  good,  with  the  exception  of  being  exceedingly  nervous.  Ou  Decem- 
ber 28th,  ether  was  administered  and  the  foot  amputated  at  the  ankle-joint,  after  the  method  of 
Pirogoff.  Water  dressings,  and  a  solution  of  morphia  at  night,  were  applied.  He  recovered,  and 
by  the  1st  of  April,  1867,  he  had  been  returned  to  duty,  but  was  mustered  out  July  1, 1867. 

DLVII. — Account  of  an  Amputation  of  the  Foot  by  Cyme's  Method.     By  A.  D.  WILSON,  Assistant 
Surgeon,  U.  S.  A. 

Private  Peter  Vandel,  Co.  A,  3d  Infantry,  aged  31  years,  was  accidentally  wounded,  while  in 
quarters,  November  5, 1867,  by  a  conoidal  musket  ball,  which  entered  just  below  the  inner  malic- 


194  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

olns  of  the  left  foot,  and,  escaping  beneath  the  outer  inalleolus,  shattered  the  os  calcis  and  injured 
the  under  surface  of  the  astragalus.  He  was  admitted  to  post  hospital,  Fort  Dodge,  Kansas,  on 
the  same  day.  The  parts  about  the  wound  were  much  powder-burned.  The  patient  was  of  slight 
frame,  anaemic,  and  suffered  considerably  from  shock  of  injury.  I  amputated  by  Syme's  method  ; 
both  wounds  came  in  the  line  of  the  incision  for  the  operation.  The  flap  when  put  up  showed  a 
linear  wound  one  and  a  quarter  inches  in  extent,  caused  by  wound  of  exit.  A  dressing  of  a  weak 
solution  of  permanganate  of  potash  was  employed.  The  burnt  parts  along  the  wound  of  entrance 
sloughed.  On  November  9th,  in  attempting  to  remove  a  suture,  a  slight  haemorrhage  occurred, 
which  was  checked  by  application  of  cold,  but  recurred  on  the  15th,  when  the  patient  lost  between 
two  and  three  pounds  of  blood.  The  ligatures  would  not  bear  interference  until  long  after  the 
usual  period,  the  last  one  not  being  removed  until  the  thirty-first  day.  Patient  was  much  reduced 
by  the  last  haemorrhage.  December  31, 1867 :  Stump  bears  considerable  pressure ;  there  is  still  a 
slight  discharge  from  it.  [This  man  was  discharged  the  service  September  28,  1868,  for  amputation 
of  foot,] 

\ 

DLVIII. — Report  of  a  Cage  of  Frost-Bite  in  which  both  Feet  were  Removed.    By  J.  H.  PATZKI, 
Assistant  Surgeon,  U.  S.  A. 

First  Lieutenant  Henry  B.  Mellen,  6th  Cavalry,  aged  43  years,  while  travelling  from  Camp. 
Wichita  to  Fort  Richardson,  Texas,  on  horseback,  was  overtaken  by  a  severe  '-norther"  on 
December  20, 1870,  during  which  the  mercury  fell  below  zero.  Having  become  wet  by  his  horse 
falling  with  him  into  the  west  fork  of  Trinity  River,  he  dismounted,  was  overcome  with  the 
cold,  and  remained  in  the  timber  of  the  bottom,  in  a  half  delirious  condition,  until  found  by  a 
hunting  party  of  soldiers  on  the  morning  of  the  22d,  about  twelve  miles  from  Fort  Richardson.  A 
medical  officer  was  at  once  sent  to  his  relief  with  an  ambulance,  and  he  was  conveyed  to  the  post 
hospital  at  Fort  Richardson,  arriving  there  at  one  o'clock  on  the  morning  of  the  23d.  His  hands 
had  escaped  severe  injury,  as  he  had  kept  them  under  his  clothes  in  contact  with  his  skin,  but  both 
his  feet  and  legs,  to  about  five  inches  above  the  ankles,  were  apparently  deprived  of  vitality,  having 
a  white  and  mottled  appearance.  He  was  delirious,  and  had  persistent  vomiting  and  diarrhoea,  and 
was  extremely  prostrated,  the  pulse  being  almost  imperceptible  at  the  wrist.  His  extremities  had 
been  rubbed  with  snow  by  the  soldiers  immediately  on  finding  him.  In  the  hospital,  friction  with 
the  hand  was  continued  until  pulsation  could  be  felt  over  the  dorsalis  pedis  and  posterior  tibialis, 
when  stimulating  lotions  and  artificial  warmth  were  substituted,  but  reaction  did  not  extend  to  the 
toes  of  the  left  nor  below  the  instep  of  the  right  foot,  The  patient  remained  in  a  state  of  profound 
coma  during  the  greater  part  of  December  25th.  The  median-basilic  vein  and  anterior  temporal 
artery  were  opened  without  obtaining  blood  ;  brandy  was  thrown  up  the  rectum.  He  finally  awoke 
in  a  violent  delirium,  which  continued  until  the  28th.  About  this  time  the  toes  became  gangrenous, 
but  the  line  of  demarcation  was  not  fully  established  until  January  4, 1871.  It  ran  on  the  right 
foot  in  a  line  corresponding  to  the  medio-tarsal  articulation,  the  sole  and  heel  being  also 
destroyed.  On  the  left  foot  it  ran  across  the  dorsum,  about  one-half  inch  behind  the  heads  of  the 
metatarsal  bones,  and  across  the  plantar  immediately  behind  the  commissure  of  the  four  smaller 
toes,  but  when  reaching  the  great  toe  it  curved  backward  so  as  to  be  on  a  level  with  its  course 
over  the  dorsum.  Irregular  sloughs  of  varying  depths  ran  along  the  outer  margin  of  the  dorsum, 
and  covered  the  sole  deepest  over  the  bases  of  the  metatarsal  bones,  the  medio-tarsal  articulation, 
and  especially  over  the  heel.  Stimulants  and  nourishing  diet  were  administered.  On  January  13th, 
in  a  consultation  with  Acting  Assistant  Surgeons  R.  Gale  and  B.  B.  Miles,  it  was  decided  that  the 
condition  of  the  patient  permitted  operative  interference.  It  was  resolved  to  remove  the  right  foot 
at  the  ankle-joint,  according  to  Ronx's  method,  the  condition  of  the  heel  not  permitting  Syme's  or 
Pirogoffs  operation.  It  was  rather  embarrassing  to  determine  upon  an  operation  for  the  left  foot, 
the  sloughs  having  separated  except  over  the  heel;  the  sole  was  covered  with  granulations,  forming 
but  a  thin  layer  over  the  bases  of  the  metatarsals  and  over  the  heads  of  the  astragalus  and  calca- 
neum.  This  precluded  Lisfranc's  as  well  as  Chopart's  operation.  A  sufficient  flap  could  be  raised 
from  the  sole  to  cover  the  metatarsal  bones  writh  the  exception  of  the  first.  In  consideration  of  the 
great  usefulness  of  a  portion  of  one  foot,  especially  after  the  loss  of  the  other,  it  was  decided  to 


AMPUTATIONS  AT  THE  ANKLE  JOINT.  195 

amputate  through  the  metatarsus,  with  a  view  of  performing  a  secondary  operation  after  the  soft 
parts  of  the  foot  had  sufficiently  recovered  by  cicatrization.  Ether  having  been  administered,  the 
right  foot  was  disarticulated  by  carrying  an  incision  from  the  insertion  of  the  tendo-Achillis  into 
the  os  calcis,  over  the  external  aspect  of  the  foot  immediately- below  the  external  inalleolus, 
curving  over  the  instep  forward  and  one  inch  in  front  of  the  tibio-tarsal  articulation,  then  down 
to  and  along  the  internal  margin  of  the  foot  to  the  point  of  departure.  This  flap  included  all  the 
healthy  tissues  on  the  inside  of  the  foot.  The  joint  was  opened  from  the  outside  and  the  os  calcis 
separated  from  the  soft  parts,  the  edge  of  the  scalpel  being  kept  close  to  the  bone.  The  malleoli 
and  a  connecting  slice  of  the  tibia  were  removed  with  the  saw ;  four  arteries  were  tied  and  several 
others  twisted;  the  tendons  were  trimmed,  and  sufficient  of  the  posterior  tibial  nerve  to  clear  the 
cicatrix.  The  flap  was  adjusted  with  four  metallic  sutures  and  adhesive  straps,  and  formed  a  good 
cover  for  the  extremities  of  the  bones.  The  left  foot  was  amputated  in  the  usual  manner,  through 
the  metatarsus  at  the  junction  of  the  anterior  and  middle  thirds.  The  flap  which  was  raised  from 
the  sole  was  adjusted  by  straps  and  covered  the  extremities  of  the  metatarsals  well,  with  tho 
exception  of  the  first.  Three  ligatures  were  required.  The  loss  of  blood  was  insignificant.  The 
stumps  were  dressed  with  carbolated  ointment.  The  patient  reacted  feebly,  but  without  vomiting 
or  nausea ;  pulse  125  at  C  o'clock  P.  M.  The  stumps  being  very  painful,  and  to  facilitate  dressing 
and  cleansing,  his  limbs  were  slung  in  Smith's  anterior  splint,  and  suspended  from  the  ceiling, 
which,  in  addition  to  a  rope  with  a  handle  so  suspended  as  to  be  in  his  reach,  enabled  the  patient 
to  shift  his  position  conveniently.  The  suppuration  from  the  left  stump  soon  became  copious ;  the 
flap  of  the  right  had  firmly  cicatrized  on  January  21st,  with  the  exception  of  three-fourths  of  an 
inch  at  its  lower  angle.  The  ligatures  came  away  between  the  seventh  and  eleventh  days.  The 
patient  was  doing  comparatively  well  until  January  23d,  when  the  granulations  of  the  left  foot 
grew  pale,  then  grayish,  as  if  covered  with  a  delicate  film ;  the  pus  became  scanty  and  of  a  grayish 
color,  the  flap  shrinking  and  the  right  stump  secreting  a  small  quantity  of  similar  pus.  The  patient 
was  drowsy,  lost  his  appetite,  had  rigors  in  the  earlier  part  of  the  afternoon  and  profuse  sweats  at 
night.  In  addition  to  the  chalybeates  and  quinine  which  the  patient  had  been  taking,  he  was 
ordered  a  solution  of  chlorinated  soda,  largely  diluted,  during  the  day  and  morphine  followed  by 
hydrate  of  chloral  in  the  evening,  these  latter  drugs  effectively  producing  sleep  and  controlling 
pain,  but  less  so  when  given  separately  than  when  combined.  Irrigation  was  applied  to  the  left 
foot,  with  solution  of  permanganate  of  potassa,  and  the  body  sponged  twice  a  day  with  aromatic 
water.  Nourishing  diet  and  stimulants  were  ordered.  On  February  Gth,  two  small  abscesses  on  tho 
right  stump  were  opened.  On  the  llth  the  patient  complained  of  severe  pain  in  the  right  side  of 
the  chest ;  respiration  shallow  and  frequent ;  a  distinct  sound  of  friction  and  some  subcrepitus 
perceived  over  the  right  lower  lobe.  The  chlorides  were  almost  absent  from  his  urine ;  patient 
greatly  emaciated  and  complexion  sallow.  On  February  14th,  at  2  o'clock  A.  M.,  he  had  a  severe 
chill  lasting  one  hour ;  on  the  19th  the  right  knee  became  tender,  and  on  the  22d  swollen  and 
exquisitly  painful  on  the  slightest  touch ;  this  gradually  improved  under  tho  application  of  tincture 
of  iodine.  The  patient  was  very  weak  and  prostrated,  his  whole  frame  being  harassed  by  severe 
neuralgic  pains.  He  complained  of  much  pain  in  the  right  stump,  where  some  healthy  pus 
discharged  from  the  incisions  made  February  Gth,  but  no  necrosed  bone  could  be  felt  on  probing. 
The  slough  over  the  left  heel  did  not  separate  until  February  2Cth,  leaving  the  heel  bone  denuded 
to  the  extent  of  a  circle  three-fourths  of  an  inch  in  diameter.  On  March  1st,  the  stump  of  the 
right  leg  had  healed,  but  was  somewhat  tender  and  enlarged ;  the  left  foot  was  covered  with 
healthy  granulations,  the  first  metatarsal  bone  being  uncovered  to  the  extent  of  one-fourth  of  an 
inch,  and  necrosed ;  the  flap  over  the  other  metatarsals  had  cicatrized  and  formed  a  good  cover. 
On  March  4th  pastilles  and  small  abscesses  formed  over  the  trunk  and  lower  extremities ;  on  March 
5th  the  cicatricial  tissue  over  shaft  of  fifth  metatarsal  bone  sloughed  and  separated,  on  the  13th 
leaving  the  external  surface  of  this  bone  denuded  to  the  extent  of  one  inch.  The  condition  of  the 
patient  gradually  improved,  and  on  March  28th  it  was  decided  to  remove  the  necrosed  parts  of  the 
heel  and  first  metatarsal  bone.  The  patient  having  been  etherized,  a  disk  of  bone  corresponding 
to  the  point  of  the  heel,  of  the  size  and  thickness  of  a  silver  dollar,  was  removed  with  the  chisel ;  a 
small  abscess  being  discovered  in  the  bone  the  carious  parts  were  scraped  and  gouged  away.  An 
incision  was  next  made  over  the  external  aspect  of  the  first  metatarsal  bone,  and  its  shaft  found  to 


196  EEPOET  OF  SUItGICAL  CASES  IN  THE  AKMY. 

be  carious  to  the  length  of  about  one  inch,  which  was  removed  with  the  bone  forceps.  Patient 
lost  about  one  and  a  half  ounces  of  blood  ;  he  reacted  well,  though  quite  weak.  On  March  31st 
the  left  stump  was  suppurating  profusely,  and  it  was  doubtful  whether  the  attempt  to  save  a 
portion  of  the  foot  would  be  successful.  The  right  stump  looked  -healthy,  with  a  good  and  firm 
cushion  over  the  bones,  without  tenderness,  although  the  abscess  opened  March  18th  still  discharged 
a  few  drops  of  healthy  pus.  His  general  condition  was  somewhat  better  than  before  the  operation, 
but  still  critical.  In  July,  1871,  the  stump  of  the  right  foot  had  healed,  and  the  condition  of  the 
left  was  favorable. 

Amputations  of  the  Ley. — Special  reports  of  twenty-three  cases  of  this  class  were 
received,  of  which  nine  were  due  to  gun-shot  wounds,  seven  to  frost-bites,  three  to  railway 
accidents,  and  four  to  other  injuries.  Five  cases  proved  fatal. 

DLIX. — Account  of  an  Amputation  of  the  Leg.    By  E.  A.  KOERPER,  Assistant  Surgeon,  U.  S.  A. 

Thomas  W.  Aveus,  a  musician  of  the  25th  Infantry  Band,  and  a  strong,  hearty  man,  was 
accidentally  shot  at  Fort  Clark,  Texas,  on  August  20,  1870,  by  a  musket  loaded  with  duck  shot, 
which  carried  away  the  ungual  phalanges  of  the  middle  and  ring  fingers  of  the  right  hand, 
shattered  the  right  tibia  about  three  inches  below  the  proximal  extremity,  wounded  the  anterior 
and  posterior  tibial  arteries,  and  lacerated  the  soft  parts.  The  patient  suffered  considerably  from 
pain  and  arterial  haimorrhage.  On  being  taken  to  the  hospital,  chloroform  was  administered 
within  twenty  minutes  after  the  receipt  of  the  injury,  when  Acting  Assistant  Surgeon  Donald 
Jackson  amputated  three  inches  below  the  knee,  by  the  circular  method,  ligatiug  the  two  principal 
.  arteries,  and  applying  torsion  to  the  smaller  branches.  The  flaps  were  closed  by  five  stitches, 
leaving  an  opening  near  the  lower  angle.  Venous  haemorrhage  continued  a  short  time  afterward. 
The  injured  fingers  were  also  properly  removed,  when  the  man  promptly  recovered  from  the 
anesthesia,  complaining  of  pain  in  the  precordial  region,  which  lasted  but  a  short  time.  After  the 
administration  of  a  stimulant  with  an  anodyne,  a  good  night  was  passed.  On  the  evening  of  the 
27th,  traumatic  fever  ran  high,  and  the  stump  became  swollen  and  painful.  The  treatment  in 
this  case,  which  presented  nothing  remarkably  different  from  other  cases  of  amputation,  consisted 
in  irrigation  to  the  stump,  carbolic  acid  and  warm-water  dressings,  laxatives,  and  anodynes,  when 
indicated,  and  a  light  but  nutritious  diet.  By  September  18th,  the  fingers  had  entirely  healed, 
and  on  October  25th,  the  leg  had  also  healed,  leaving  an  excellent  stump.  On  December  13th,  the 
patient  was  sent  to  quarters ;  and  on  February  4, 1871,  he  was  discharged  the  service. 

DLX — Report  of  an  Amputation  of  the  Leg  for  Pott's  Fracture.     By  G.   S.  HOSE,    Assistant 
Surgeon,  U".  S.  A. 

Private  John  Baker,  Co.  C,  29th  Infantry,  aged  22  years,  convalescent  from  intermittent  fever, 
was  wounded  in  a  railroad  accident  which  occurred  at  Keswick  Station,  Virginia,  on  September  28, 
18G8.  He  was  riding  on  the  top  of  a  box-car,  when,  seeing  that  it  must  go  over  the  embankment, 
he  jumped,  and  alighted  on  his  feet,  causing  fracture  of  the  left  fibula,  with  displacement  of  the 
tibia  from  the  corresponding  surface  of  the  astragalus,  the  fractured  extremity  of  the  fibula  pro- 
jecting nearly  two  inches  from  the  wound.  A  few  moments  after  the  accident,  Assistant  Surgeon 
J.  H.  Patzki,  U.  S.  A.,  in  charge  of  the  detachment,  enlarged  the  wound  and  replaced  the  fractured 
extremities  of  the  bone.  On  the  29th,  he  was  admitted  to  the  post  hospital  at  Camp  Schofield, 
Lynchburg,  Virginia,  where,  on  the  same  day,  the  wound  was  carefully  closed  and  dressed  with 
one  part  carbolic  acid  and  four  parts  linseed  oil,  and  a  small  splint  and  bandage  were  adjusted  to 
the  outer  side  of  the  leg.  He  was  placed  on  special  diet ;  opiates  were  given  at  bedtime,  and 
several  days  after,  quinine  and  whiskey  during  the  day,  on  account  of  his  condition  prior  to  the 
accident.  On  the  30th,  the  leg  being  hot  and  swelled,  the  splints  and  bandages  were  removed,  and 
the  limb  was  placed  in  a  fracture-box.  From  October  1st  to  the  4th,  there  was  a  copious  discharge 
of  unhealthy  pus,  and  on  the  latter  date,  a  good  deal  of  irritative  fever.  On  the  5th,  a  large  abscess, 


AMPUTATIONS  OF  THE  LEG.  197 

• 

pointing  directly  over  the  inner  malleolus,  was  opened ;  the  wound  was  sloughing,  and  the  joint 
was  entirely  open.  Amputation  being  decided  on,  the  patient  partook  freely  of  beef  teii  and  milk 
punch  until  the  night  previous  to  the  operation.  On  the  Cth,  the  directions  having  been  carried 
out,  he  was  readily  brought  under  the  influence  of  chloroform,  and  the  leg  was  amputated  at  the 
junction  of  the  lower  thirds  by  the  half-flap  method.  There  was  considerable  venous  haemorrhage 
but  by  evening  he  was  rallying  well.  Morphine  was  given  immediately  after  the  operation,  and 
was  repeated  at  night.  The  stump  was  dressed  with  liniment  composed  of  carbolic  acid  and  linseed 
oil.  There  was  no  nausea  following  the  operation,  owing,  in  a  great  measure,  it  was  believed,  to 
previous  abstinence  from  solid  food.  Milk  punch  and  beef  tea  were  continued,  the  appetite 
improved,  and  the  case  was  progressing  favorably.  On  the  14th,  the  whole  of  the  inner  half  of  the 
wound  had  closed  by  first  intention ;  there  was,  however,  considerable  suppuration  on  the  outer 
side  of  the  stump,  and  pus  could  be  pressed  from  within  two  inches  of  the  knee-joint,  for  which 
there  appeared  to  be  free  exit.  He  did  not  rest  well  during  the  night,  and,  on  the  next  morning, 
there  was  luemorrhage  from  the  outer  side  of  the  stump,  probably  from  the  anterior  tibial  artery, 
which  was  controlled  by  the  tourniquet.  Persulphate  of  iron  was  also  applied,  the  stump  was 
dressed  with  au  iced  solution  of  acetate  of  lead,  a  compress  and  bandage  secured  over  the  popliteal 
artery,  and  the  leg  elevated ;  an  opiate  was  immediately  given.  An  abscess  beneath  the  fascia 
lata  of  the  thigh  was  opened,  and  bandaged.  Ou  the  morning  of  the  17th,  haemorrhage  recurring, 
was  promptly  arrested,  and  compress  over  the  popliteal  reapplied,  but,  again  occurring  ou  the 
following  morning,  the  patient  was  chloroformed,  and  the  popliteal  artery  was  ligated  at  its  lower 
third.  Two  articular  branches  were  severed  during  the  operation,  requiring  ligatiou.  The  incision 
was  drawn  together  by  four  interrupted  sutures,  and  the  edges  adapted  by  adhesive  plaster.  The 
stump  was  again  dressed  with  carbolic  acid  liniment.  Stimulants,  morphine,  and  tonic  mixtures. 
On  the  21st,  the  stump  began  to  have  a  more  healthy  appearance,  and  on  the  27th,  the  ligature 
came  away,  and  the  incision  was  almost  healed.  The  abscess  of  the  thigh  continued  to  discharge 
several  ounces  of  pus,  but  it  had  a  more  healthy  appearance.  On  November  10th,  the  stump  had 
nearly  healed,  the  abscess  had  closed,  and  the  patient  -was  able  to  sit  up.  He  had  a  severe  chill 
during  the  night,  followed  by  diarrhoea;  pulse  100;  skin  hot  and  dry,  and  tongue  coated.  Quinine 
was  given.  On  the  12th,  the  thigh  was  much  swollen,  and  a  discharge  of  watery  fluid  was  pressed 
from  the  old  opening.  On  the  next  day,  the  swelling  had  abated,  and  the  patient's  appetite  was 
improving.  During  the  month,  one  or  two  small  pieces  of  necrosed  bone  were  removed  from  the 
stump,  which  had  entirely  healed  by  December  1st,  the  patieut  being  able  to  walk  around  on 
crutches.  Discharged  July  21, 1869,  and  pensioned  at  $15  per  mouth. 

DLXI. — Account  of  a  Re-amputation  of  Both  Legs. — Compiled  from  various  Reports. 

Private  Jacob  Bisbing,  Troop  C,  2d  Cavalry,  had  both  feet  frozen  while  on  duty  as  a  mail 
escort  from  Fort  Larainie  to  Fort  Philip  Kearney,  Jauuary  5,  1807.  He  was  admitted  to  post 
hospital  at  Fort  Eeno,  January  6, 1867^  where  both  feet  were  amputated  Jauuary  16, 18C7,  by 
E.  H.  Eeed,  Acting  Assistant  Surgeon.  Owing  to  bad  hygienic  surroundings  the  wounds  healed 
very  slowly,  and  the  patient  suffered  with  conical  and  painful  stumps.  On  July  21, 1867,  both 
feet  were  re-amputated  by  Charles  Mackiu,  jr.,  Assistant  Surgeon,  U.  S.  A.  Bisbiug  was  discharged 
September  28, 1867,  and  pensioned  at  $20  per  mouth. 

DLXII. — Account  of  Several  Amputations,  one  of  which  was  a  Re-amputation  of  the  Leg. 

Private  Charles  O.  F.  Clark,  Co.  G,  1st  Oregon  Volunteers,  had,  on  December  17,  1865,  while 
on  a  march  between  the  mouth  of  the  Kiver  Owyhee  and  the  Malheur  River,  Oregon,  the  lower 
and  upper  extremities  frozen.  He  was  conveyed  to  Camp  Auburn,  where  the  second  and  third 
fingers  of  the  right  hand,  the  left  leg,  and  the  right  foot  were  amputated,  the  latter  by  Chopart's 
operation.  The  end  of  the  second  finger  of  the  left  hand  sloughed  off.  He  was  mustered  out  of 
service  on  April  14,  1866.  On  November  9,  1868,  at  Bellevue  Hospital,  New  York,  Professor 
Hamilton  re-amputated  the  left  leg,  five  inches  below  the  knee.  On  April  5, 1870,  the  patient  was 


1 98  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

furnished  with  artificial  limbs  by  D.  W.  Kolbe,  Philadelphia,  at  which  time  the  stumps  were  of 
normal  size  and  perfectly  healed.    The  man  is  a  pensioner  at  $20  per  month. 

DLXIIL— Account  of  a  Double  Amputation  of  the  Legs.    By  B.  E.  FEYEE,  Surgeon,  U.  S.  A. 

Private  George  Foster,  Troop  C,  10th  Cavalry,  having  lost  his  way  after  a  debauch,  was 
exposed  to  a  severe  snow-storm  on  the  open  prairie,  and  had  both  his  feet  badly  frost-bitten.  He 
was  admitted  to  hospital  at  Fort  Zara,  Kansas,  on  December  9,1868.  Before  admission,  and 
immediately  after  discovery,  he  had  been  injudiciously  taken  to  a  fire.  W.  H.  King,  Assistant 
Surgeon,  U.  S.  A.,  attempted  gradual  reduction  of  temperature,  but,  mortification  ensuing,  he 
administered  chloroform,  and  amputated  the  right  foot  just  above  the  ankle,  by  circular  operation, 
on  December  31, 1868.  At  that  time  the  left  foot  began  to  mortify,  and  was  amputated  on  January 
19, 1869,  in  the  same  manner  as  the  first.  The  patient,  who  had  been  weak  and  emaciated,  rapidly 
improved.  Carbolic  acid,  variously  diluted,  formed  almost  the  only  application  to  the  stumps. 
To  reduce  the  chance  of  secondary  haemorrhage,  as  well  as  to  overcome  the  stretching  of  the 
muscles,  extension  by  means  of  adhesive  strips  and  weight,  as  in  fracture,  was  employed.  On 
January  31,  1869,  the  stumps  looked  well.  He  was  transferred  to  the  hospital  at  Fort  Barker, 
Kansas,  in  the  latter  part  of  the  year,  where  he  stated  that  he  made  a  good  recovery.  By 
December  31,  1869,  the  stumps  had  healed,  and  the  patient's  health  was  excellent.  [Not  on  pension 
rolls.] 

DLXIV. — Report  of  an  Amputation  of  the  Leg.    By  J.  C.  FIELD,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Samuel  Gilbert,  Troop  A,  3d  Cavalry,  aged  20  years,  was  accidentally  wounded  while 
on  post  at  Fort  Smith,  Arkansas,  on  February  19,  1866.  The  ball  entered  the  leg  at  the  internal 
border  of  the  gastrocnemius  muscle,  severed  the  posterior  tibial  artery,  fractured  the  fibula  at  the 
middle  third,  and  emerged  on  the  external  aspect  lower  down.  On  the  22d  he  was  admitted  to 
the  hospital  of  the  post.  On  February  26th,  the  wound  being  in  a  gangrenous  state  throughout 
its  extent,  and  the  patient  in  a  very  low,  auajmic  condition,  I  administered  ether,  and  amputated 
the  leg  at  the  upper  third,  by  circular  operation.  Egg-nog,  quinine,  iron,  and  morphine  were 
prescribed,  and  the  best  nourishment  the  hospital  afforded  was  ordered;  but  death,  from 
exhaustion,  occurred  the  following  day.  A.  post-mortem  examination  disclosed  extensive  sloughing 
of  structure  along  the  entire  course  of  the  ball. 

DLXV. — Remarks  on  an  Amputation  of  the  Leg.    By  B.  J.  D.  IEWIN,  Surgeon,  U.  S.  A. 

Private  Frederick  Hilbrecht,  Co.  C,  43d  Infantry,  aged  51  years,  was  run  over  December  30, 
1867,  by  a  loaded  cart,  which  produced  a  compound  comminuted  fracture  of  the  right  tibia  and 
fibula  in  the  lower  thirds.  On  the  next  day  he  was  admitted  to  the  post  hospital  at  Fort  Wayne, 
Michigan.  By  January  9,  1868,  the  limb  was  much  swollen  to  within  three  inches  of  the  knee, 
and  was  gangrenous,  with  large  phlyctaenae.  A  fragment  of  bone,  denuded  of  periosteum, 
protruded  through  the  slough.  His  health  was  good,  with  the  exception  of  a  slight  cold,  which 
had  troubled  him  some  three  weeks  previously,  and  which  was  attended  with  profuse  muco- 
purnlent  expectoration,  but  without  evidence  of  acute  inflammatory  action.  On  the  latter  date  I 
administered  chloroform,  and  amputated  the  leg  at  the  upper  third,  by  the  antero-posterior  flap 
method.  On  the  fourth  day  after  the  operation  a  ligature  came  away,  and  another  on  the  fifth. 
On  the  ninth  day  he  had  a  severe  attack  of  intermittent  fever.  On  the  eleventh  day  his  bowels 
were  loose,  and  he  had  another  attack  of  intermittent  fever.  On  the  twelfth  day  he  had  involun- 
tary evacuations  of  urine  and  faeces,  with  a  slight  attack  of  intermittent  fever,  and  on  the 
thirteenth  a  severe  attack  of  rheumatism,  affecting  the  whole  left  side  of  his  body.  On  the 
fourteenth  day  he  was  very  feeble  and  greatly  prostrated.  There  was  profuse  expectoration  of 
muco-purulent  matter,  and  evidence  of  softening  of  the  lungs.  The  wound  was  healthy  and 
almost  healed,  with  the  exception  of  slight  oadema  about  the  knee-joint.  He  died  of  inflammation 
of  the  lungs,  January  26, 1868. 


AMPUTATIONS  OF  THE  LEG.  199 

DLXVI. — Report  of  an  Amputation  of  the  Leg  for  Railway  Injury.    By  B.  E.  FRYER,  Surgeon, 
U.  S.  A. 

Otho  Johnson,  a  destitute  civilian,  aged  37  years,  of  good  health  and  habits,  had  his  left  foot 
crushed,  with  fracture  of  the.  metatarsal  bones,  by  a  railroad  car.  On  November  18,  1870,  he  was 
admitted  to  the  hospital  at  Fort  Harker,  Kansas.  An  effort  to  save  the  foot  was  made,  which 
seemed  to  promise  success;  but,  on  November  30th,  being  gangrenous  as  far  as  the  ankle-joint,  the 
patient  was  etherized,  and  the  leg  was  amputated  in  the  lower  third,  lateral  skin  flaps  being  made 
with  the  intention  of  bringing  the  line  of  cicatrization  between  the  tibia  and  fibula.  Four  ligatures 
were  applied.  The  patient  reacted  promptly  from  influence  of  anaesthetic.  Carbolic  acid  dressings 
were  applied.  Union  was  immediate,  save  where  ligatures  were  brought  out  at  flap  angles.  As 
soon  as  the  ligatures  were  removed  the  stump  healed.  On  December  31,  1870,  the  stump  was  full 
and  round,  and  the  line  of  cicatrix  was  so  situated  between  the  tibia  and  fibula  that  it  could  not 
be  pressed  upon  by  them. 

DLXVII. — Remarks  on  an  Amputation  of  the   Leg  for  Frost-Bite.     By   0.  E.  MTJNN,  Assistant 
Surgeon,  U.  S.  A. 

Private  Charles  Kridenoff,  Co.  D,  20th  Infantry,  while  with  a  party  marking  a  railroad, 
February  11, 1870,  was  exposed  in  a  storm  on  the  prairie  for  thirty-six  hours,  and  both  of  his  feet 
were  frost-bitten.  He  was  admitted  into  the  post  hospital  at  Fort  Ransom,  Dakota  Territory,  on 
the  next  day.  The  right  foot  was  gangrenous  to  the  ankle-joint.  On  March  1st  I  administered 
ether,  and  amputated  the  right  leg  at  the  lower  third  by  the  antero-posterior  flap  method.  Three 
ligatures  were  applied.  There  was  but  little  hemorrhage,  and  the  flaps  approximated.  On  March 
12th,  gangrene  having  attacked  the  left  foot,  I  divided  the  metatarsal  bones  in  the  line  of  demarc- 
ation, and  partially  excised  the  os  calcis.  In  the  operation  of  separating  the  sloughing  parts  the 
entire  plantar  surface  was  removed,  no  anaesthetic  being  used.  On  March  31,  1870,  the  patient 
still  remained  under  treatment.  The  stump  of  the  right  leg  was  nearly  cicatrized,  two  ligatures 
still  being  adherent;  that  of  the  left  was  granulating  kindly.  He  was  transferred  to  the  post 
hospital  at  Fort  Abercrombie,  Dakota  Territory,  September  13,  1870,  and  transferred  to  the 
Soldiers'  Home,  at  Washington,  October  8, 1870.  The  maii  has  applied  for  a  pension,  and  the  case 
is  pending. 

DLXVIII. — Report  of  an  Amputation  of  the  Leg  on  account  of  an  Injury.    By  H.  FLETCHER,  M.  D., 
Acting  Assistant  Surgeon. 

Patrick  O'Brien,  Co.  G,  25th  Infantry,  aged  21  years,  while  trimming  a  tree  at  or  near 
Humboldt,  Tennessee,  March  23,  1868,  fell  twenty  feet,  his  whole  weight  coming  upon  his  right 
leg  on  sloping  ground.  The  fibula  was  fractured  two  inches  from  the  lower  extremity,  several 
fragments  of  bone  were  broken  off  of  each  malleolus,  and  the  tibia  projected  two  inches  through 
the  flesh,  rupturing  ligaments  and  veins  and  opening  the  ankle-joint.  He  was  admitted  to  the 
post  hospital  of  the  above  place.  There  being  no  instruments  at  the  post,  Dr.  Thompson,  upon  my 
invitation,  three  hours  after  the  injury,  amputated  the  leg  three  inches  above  the  ankle-joint,  by  the 
circular  method.  A  mixture  of  chloroform  and  etlier  was  the  anajsthetic  used.  On  the  ninth  day, 
the  case  was  progressing  finely.  He  was  discharged  the  service  on  July  12,  18G8,  and  pen- 
sioned, his  disability  being  rated  total.  In  January,  1809,  he  was  furnished  with  an  artificial 
limb,  which  proved  highly  useful.  At  that  date,  the  stump  was  less  than  normal  size,  but  was 
perfectly  healed.  He  is  an  inmate  of  the  Soldiers'  Home,  Dayton,  Ohio. 

DLXIX. — Account  of  an  Amputation  of  the  Leg.    From  the  reports  of  S.  A.  STORROW,  Assistant 
Surgeon,  U.  S.  A.,  and  W.  E.  DAY,  M.  D.,  Acting  Assistant  Surgeon. 

Private  James  Palmer,  Battery  F,  3d  Artillery,  aged  22  years,  while  on  guard  December  24, 
1809,  was  accidentally  wounded  by  a  musket  ball,  which  caused  a  compound  comminuted  fracture 


200  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

of  the  left  tibia  and  fibula,  involving  the  articulations  of  the  foot,  the  dorsal  region  being  severely 
lacerated.  He  also  received  a  slight  bayonet  wound  in  the  left  leg  just  below  the  point  where  the 
ball  entered.  He  was  admitted  to  the  post  hospital  at  Fort  Jefferson,  Florida,  on  the  same  day. 
The  soft  parts  were  considerably  contused  and  lacerated.  Acting  Assistant  Surgeon.  W.  E.  Day, 
on  December  25th,  administered  ether  and  amputated  the  limb  at  the  junction  of  the  middle  and 
lower  thirds  by  a  circular  operation.  At  time  of  operation  patient  was  suffering  from  primary 
haemorrhage  and  nervous  shock.  Seventeen  hours  after  operation  traumatic  tetanus  supervened, 
•which  was  controlled  by  subcutaneous  injections  of  atropiue  and  morphine.  Nourishing  diet  was 
allowed.  Death  resulted  January  11, 1870. 

DLXX.— Mention  of  a  Double  Amputation  of  the  Legs.    By  P.  C.  DAVIS,  Surgeon,  U.  S.  A. 

Private  David  Perigo,  Co.  D,  13th  Infantry,  aged  18  years,  had  both  of  his  feet  frost-bitten  on 
the  night  of  December  21, 1869.  He  was  admitted  into  the  post  hospital  at  Fort  Ellis,  Montana 
Territory,  on  the  next  day.  Snow,  ice- water,  and  simple  cerate  dressings  were  applied.  Gangrene 
supervened,  and  on  January  1,  1870,  Assistant  Surgeon  Clarence  Ewen,  U.  S.  A.,  administered 
ether  and  amputated  the  left  leg  at  the  lower  third,  and,  on  the  next  day,  the  right  leg  at  the  lower 
third.  Stimulants  and  nourishing  diet  were  given.  By  March  31,  1870,  the  patient  was  convales- 
cent. He  was  transferred  to  the  Soldiers'  Home,  Washington,  June  1, 1871. 

DLXXI. — Remarks  on  a  Secondary  Amputation  of  the  Leg.     By  W.  R.  TOMKINS,  M.  D.,  Acting 
Assistant  Surgeon. 

Lieutenant  W.  L.  P ,  5th  Cavalry,  received  on  February  22, 1868,  at  Gallatin,  Tennessee, 

a  compound  comminuted  fracture  of  both  bones  of  the  left  leg,  caused  by  the  bursting  of  an  anvil 
while  firing  a  national  salute.  There  being  no  guns,  a  hole  in  an  anvil  had  been  charged  with 
powder,  another  anvil  placed  upon  the  hole,  and  the  charge  ignited  by  a  hot  iron.  One  of  the 
anvils  bursted  into  a  number  of  pieces,  one  of  which,  weighing  four  and  three-quarter  pounds, 
struck  the  lieu  tenant  on  the  leg,  extensively  lacerating  the  soft  parts.  On  the  morning  of  February 
23d  I  excised  from  six  to  eight  inches  of  the  tibia,  and  placed  the  limb  in  a  fracture-box  with  wheat 
bran,  using  extension  and  counter  extension.  For  sometime  the  case  progressed  favorably;  after- 
ward profuse  suppuration  set  in,  with  unhealthy  granulation  and  a  tendency  to  grangrene,  and  the 
patient  became  debilitated  from  profuse  discharge  of  pus.  On  April  23,  1868,  he  was  again  ether- 
ized, and  Dr.  Paul  F.  Eve  amputated  the  leg  by  the  circular  method.  He  survived  the  operation 
nine  or  ten  hours,  dying  from  shock  of  operation,  April  23,  1868. 

DLXXII. — Account  of  an  Amputation  of  the  Leg  for  Gunshot  Injury.    By  S.  M.  HOBTON,  Assist- 
ant Surgeon,  U.  S.  A. 

James  Scregg,  a  citizen,  aged  29  years,  was  accidentally  wounded  July  24, 1866,  by  the  discharge 
of  his  rifle,  which  fractured  the  bones  of  the  right  ankle-joint.  On  the  same  day  he  was  fetched  a 
distance  of  twenty-five  miles  to  the  post  hospital,  at  Fort  Philip  Kearney,  Dakota  Territory.  On 
admission,  his  pulse  was  rapid  and  weak,  his  ankle-joint  intensely  painful  and  swelled,  and  gangrene 
had  begun  in  the  foot.  I  immediately  administered  equal  parts  of  chloroform  and  ether,  and 
amputated  the  leg  in  the  middle  third  by  a  flap  operation.  Cold-water  dressings  were  applied,  and 
stimulants  given.  The  stump  healed  slowly,  the  skin  refusing  to  cicatrize  entirely  on  account  of 
scabies.  On  November  10, 1866,  he  left  for  his  home,  his  stump  not  entirely  healed,  but  very  firm. 

DLXXIII. — Remarks  on  an  Amputation  of  the  Leg  for   Gunshot  Injury.     By  C.  K.  WINXE, 
Assistant  Surgeon,  U.  S.  A. 

Private  Edwin  Shears,  Co.  G,  20th  Infantry,  aged  23  years,  was  wounded  December  29, 1869, 
by  the  accidental  discharge  of  his  musket.  The  ball  entered  above  and  behind  the  internal 


AMPUTATIONS  OF  THE  LEG..  201 

inalleolus  of  the  left  leg ;  passed  inward,  downward,  and  forward  through  the  limb,  and  extensively 
comminuted  the  tibia,  and  divided  tlie  anterior  tibia!  artery.    He  was  admitted  the  same  day  to 

the  post  hospital,  Fort  Ripley,  Minnesota.  There  was 
constant  and  profuse  haemorrhage,  which  was  controlled 
only  by  the  tourniquet.  On  the  next  day  I  admin- 
istered ether,  and  amputated  the  leg,  by  the  double 
flap  method.  The  patient  recovered,  and  was  dis- 
charged July  12,  1870.  The  pathological  specimen, 

<;.  40.— Gunshot  fracture  of  tho  lower  third  of  the  left          ..i       ,,         ,  •    .  ,    .,      ,     i  j.i 

tibia,  spec.  M; i.  s, , -t.  i,  A.  M.  M.  wlth    the    h^tory,   was    contributed    to    the    Army 

Medical  Museum,  by  the  operator,  and  is  represented 
in  the  adjoining  wood-cut.    The  man  is  a  pensioner  at  $15  per  mouth. 

* 

DLXXIV. — Memorandum  Relative  to  an  Amputation  of  Both  Legs  for  Frost-Bite.    By  D.  E.  HOLMES, 
Acting  Assistant  Surgeon. 

Private  Frederick  Silverhoru,  Troop  F,  8th  Cavalry,  aged  24  years,  while  on  duty  with  his 
team  ten  miles  from  Camp  Logan,  Oregon,  December  28,  1867,  was  frost-bitten  in  both  feet  and 
hands,  and  was  admitted  to  the  hospital  of  the  post  the  same  day.  On  January  1,  1868,  both  legs 
being  considerably  cedematous,  and  the  feet  black  and  mortified  as  far  as  the  ankles,  I  administered 
ether  and  chloroform,  and  amputated  both  legs  four  inches  above  the  ankles,  the  right  by  the 
circular  method  and  the  left  by  the  flap.  The  flaps  at  first  appeared  to  close  up  rapidly,  but 
afterward  opened,  slightly  sloughed  at  the  margin,  and  healed  from  the  bottom  by  granulation. 
Both  stumps  had  healed  by  the  end  of  the  month.  The  hands  were  restored  after  a  few  days' 
treatment.  He  was  discharged  the  service  March  23,  1808,  and  was  pensioned  at  $20  per  month. 

DLXXV. — Note  relative  to  an  Amputation  of  the  Leg  for  a  Sprain.    By  H.   MoL.   CRONKHITE, 
Assistant  Surgeon,  U.  S.  A. 

Private  Albert  Smith,  Co.  E,  26th  Infantry,  aged  23  years,  sprained  his  right  foot,  while  on 
drill,  on  April  28,  1868,  and  on  the  next  day  was  admitted  to  the  post  hospital,  Ringgold  Barracks, 
Texas.  Caries,  involving  all  the  tarsal  bones,  resulted.  By  the  14th  of  November,  1868,  the  ankle 
had  been  for  a  long  time  much  swelled  and  very  painful,  and  there  was  a  fistula  which  discharged 
freely.  The  patient  was  debilitated  from  long  suffering  and  profuse  suppuration.  On  the  latter 
date,  I  administered  chloroform  and  performed  an  antero-posterior  flap  amputation  of  the  leg,  four 
inches  above  the  ankle-joint.  The  wound  was  closed  by  ligatures  and  adhesive  straps.  On  the 
31st  of  December  the  wound  had  healed,  and  his  general  health  was  good.  He  was  discharged 
the  service  May  27,  1860,  and  draws  a  pension  of  $15  per  mouth. 

DLXXVI. — Note  on  an  Amputation  of  Leg  for  Frost-Bite.    From  a  Report  from  the  Penson  Office. 

John  Spyri,  Troop  C,  2d  Cavalry,  was  frost-bitten,  while  on  escort  duty  between  Forts 
Reno  and  Kearney,  Dakota  Territory,  in  the  latter  part  of  January,  1867.  Half  of  the  left  foot  was 
removed  at  the  time,  but  the  case  proving  unsuccessful,  amputation  of  the  lower  third  of  the  leg,  by 
the  circular  method,  was  performed  May  5,  1867.  He  was  discharged  August  26,  1868.  A  year 
and  seven  months  after  he  was  examined  for  an  artificial  limb,  at  which  time  the  stump  was 
perfectly  healed.  He  is  a  pensioner  at  $15  per  month. 

DLXXVII. — Note  on  an  Amputation  of  the  Leg  for  Gunshot  Injury.    By  J.  B.  GIRARD,  Assistant 
Surgeon,  U.  S. A. 

Corporal  James  K.  Thomas,  Troop  A,  2d  Cavalry,  aged  24  years,  was  accidentally  wounded, 
while  scouting  after  Indians,  the  ball  entering  near  the  middle  of  the  calf  of  the  right  leg,  and 
escaping  under  the  malleolus.    He  was  admitted,  on  April  16,  1870,  to  the  post  hospital  at  Fort 
26 


202  BEPOKT  OF  SURGICAL  CASES  IN  THE  ARMY. 

Fred.  Steele,  Wyoming  Territory.  The  fibula  was  found  to  be  fractured.  Conservative  treatment 
was  adopted,  but  no  attempt  at  reunion  followed;  the  tibia,  fibula,  and  astragalus  became  necrosed 
and  the  ankle  joint  anchylosed,  until  the  dorsum  of  the  foot  was  on  a  line  with  the  front  of  the  leg. 
The  patient  became  exhausted  by  long-continued  suppuration,  and  in  January,  1871,  amputation 
became  necessary.  The  operation  was  performed  on  January  5,  1871,  by  removing  the  leg  at  the 
middle  third,  and  taking  a  single  flap  from  the  muscles  of  the  calf.  Lotions  of  carbolic  acid  were 
applied.  The  flap  healed  by  first  intention,  and  on  April  14th  the  patient  was  strong  and  healthy 
and  had  a  good  stump.  He  was  discharged  June  9,  1871. 

DLXXVIII.  —  Note  on  an  Amputation  of  the  Leg  for  Gunshot  Injury.    By  IEA  PERRY,  Assistant 
Surgeon,  9th  U.  S.  C.  T. 

Private  William  White,  Co.  C,  114th  Colored  Infantry,  aged  23  years,  was  accidentally 
wounded  in  camp  by  a  conoidal  ball,  which  entered  and  fractured  the  tibia  just  below  the  inner 
tuberosity,  and,  breaking  the  fibula,  made  its  exit  on  the  outside  of  the  leg,  tearing  the  muscles  and 
integuments  two  by  four  inches.  He  was  admitted  to  the  post  hospital  at  Fort  Brown,  Texas,  on  the 
20th  of  February,  18G6.  The  patient  was  weak  from  the  loss  of  blood.  I  amputated  just  below 
the  attachment  of  the  ligariieutum  patellae,  by  the  flap  method.  The  case  progressed  admirably, 
the  stump  healing  in  good  shape.  Discharged  April  2,  18C7.  The  man  is  a  pensioner  at  $15  per 
month. 

DLXXIX.  —  Note  on  an  Amputation  of  the  Leg  for  Gunshot  Injury.     By  P.  C.  DAVIS,  Surgeon 
U.  S.  A. 

Private  Thomas  Wilkinson,  Battery  C,  3d  Artillery,  aged  22  years,  was  admitted  to  the  post 
hospital,  Fort  McPherson,  Nebraska,  July  15,  1867,  with  a  gunshot  wound  of  the  left  ankle, 
involving  the  joint.  A  musket  ball  had  entered  the  joint  near  the  external  malleolus,  and,  passing 
upward,  escaped  above  the  internal  malleolus.  The  wound  was  much  swelled,  and  very  painful. 
The  patient  suffered  from  loss  of  blood  and  traumatic  irritation.  On  July  19,  1867,  I  administered 
ether,  and  amputated  the  left  leg  at  the  lower  third  by  the  flap  method.  The  hemorrhage  was 
slight,  and  the  patient  reacted  promptly.  The  case  progressed  favorably,  no  treatment  being 
required  but  an  opiate  at  night.  He  was  discharged  from  service  September  28,  1867.  The  stump 
was  completely  healed.  The  man  has  made  application  for  pension,  but  the  case  is  still  pending. 

DLXXX  —  Memorandum  relative  to  an  Amputation  of  the  Leg  on  Account  of  Compound  Dislocation 
of  the  Lower  End  of  the  Tibia.    By  IRA  PERRY,  Assistant  Surgeon,  9th  U.  S.  C.  T. 

William  Wilson,  a  citizen,  aged  30  years,  received,  May  4,  1866,  by  the  upsetting  of  a  stage- 
coach, a  compound  complicated  dislocation  of  the  lower  end  of  the  left  tibia,  inward.  The  internal 
lateral  ligament  was  ruptured,  and  the  ankle-joint  opened  ;  the  external  malleolus  was  fractured, 
and  the  internal  malleolus  broken  square  oif,  with  the  end  off  the  tibia.  He  was  sent  to  the  post 
hospital  at  Fort  Brown,  Texas,  where  the  leg  and  foot  were  placed  in  a  fracture-box.  The  patient 
at  first  objected  to  amputation.  On  the  sixth  day  after  the  injury,  tetanus  appeared.  On  the 
seventh  day,  by  the  advice  of  the  surgeon  in  charge  of  the  hospital,  and  of  the  commanding  medical 
officer  of  the  district  of  the  Ilio  Grande,  I  amputated  the  leg  at  the  upper  third.  The  operation  did 
not  appear  to  benefit.  Slight  spasms  of  limbs  and  some  opisthotonus  followed  ;  his  jaws  remained 
rigid,  and  deglutition  was  difficult.  Warm  poultice  to  the  stump,  and  hot  fomentations  to  the  neck 
and  ears,  were  applied.  Chloroform  was  the  only  remedy  that  had  the  least  effect  in  relieving 
spasm.  He  died  the  next  day,  May  12,  1866. 


DLXXXL—  ^ofe  on  an  Amputation  of  the  Leg  for  Railway  Injury.    By  J.  LUNNEY,  M.  D.,  Acting 
Assistant  Surgeon. 

Arthur,  a  freed  man,  aged  21  years,  September  5,  1866,  in  attempting  to  get  on  a  freight  train 
while  it  was  in  motion,  fell  and  received  a  compound  comminuted  fracture  of  the  right  leg,  a 


AMPUTATIONS  AT  THE  KNEE-JOINT. 


203 


fracture  of  the  right  internal  malleolus,  with  an  external  wound  communicating  with  the  joint, 
a  compound  fracture  of  one  of  the  phalanges  of  each  toe  of  the  right  foot,  except  the  great  toe, 
a  lacerated  wound  of  the  left  side  of  the  face,  extending  from  the  external  angle  of  the  eye  to  the 
ear,  a  lacerated  wound  of  the  scalp  and  of  the  right  ear,  and  several  contusions  and  abrasions  on 
different  parts  of  the  body.  On  the  6th,  he  was  admitted  into  a  temporary  hospital  erected  for 
him  at  the  post  of  Darlington,  South  Carolina,  and  on  the  8th,  chloroform  was  administered  and  the 
limb  amputated  at  the  middle  third  by  the  antero-posterior  flap  method.  There  was  but  little 
haemorrhage,  only  two  ligatures  being  necessary.  At  the  time  of  the  operation,  the  limb  was 
swollen  and  painful;  the  patient  was  feverish;  pulse  120;  and  there  was  concussion  of  the 
brain.  Simple  dressings  were  applied.  The  patient  reacted  promptly.  On  the  30th  of  September, 
the  stump  was  healing  finely,  and  a  complete  recovery  was  soon  expected. 

Amputations  at  the  Knee-joint. — Three  successful  operations  were  reported. 

DLXXXII. — Report  of  Two  Cases  of  Amputation  at  the  Knee-joint  for  Gunshot  Injury.    By  JOHN 
D.  HALL,  Assistant  Surgeon,  U.  S.  A. 

CASE  I. — Private  Thomas  Nipple,  Troop  P,  3d  Cavalry,  was  shot  on  March  31,  1870,  with  a 
Colt's  Army  pistol,  carrying  a  conical  ball  of  a  calibre  four  inches.  The  ball  entered  the  right  leg 
below  and  very  close  to  the  cavity  of  the  knee-joint,  passed  within  the  outer  hamstring  tendon, 
downward  and  inward,  through  the  head  of  the  tibia,  and  made  exit  upon  the  inner  surface  of  the 
tibia.  On  careful  examination,  no  fracture  of  the  bone  could  be  discovered — a  few  small  pieces  and 
spiculce  of  bone  near  the  exit  wound,  and  nothing  more.  I  concluded,  also,  that  the  cavity  of  the 
knee-joint  was  not  opened.  At  9  P.  M.,  nine  hours  after  the  accident,  the  pulse  was  60,  and  the 
patient  comfortable. 


Date. 

Hour. 

Pulse. 

Temperature. 

Date. 

Hour. 

Pulse. 

Temperature. 

April     1st 

9  A.  M. 

76 

April    6th 

9  A.  M. 

72 

<WA 

9  P.  M. 

92 

101| 

9  P.  M. 

80 

"Og 

99? 

April     2d 

9  A.  M. 

84 

100£ 

April    7th 

9  A.  M. 

72 

99 

9  P.  M. 

88 

100* 

9  P.  M. 

76 

99* 

April      3d 

9  A.  M. 

96 

lOOi 

April    8th 

9  A.  M. 

76 

99i 

9  P.  M. 

92 

100 

9  P.  M. 

80 

100J- 

April    4th 

9  A.  M. 

88 

100 

April    9th 

9  A.  M. 

76 

99 

9  P.  M. 

88 

100£ 

9  P.  M. 

76 

99 

April    5th 

9  A.  M. 

84 

100  J. 

April  10th 

9  A.  M. 

76 

99^ 

9  P.  M. 

84 

100J 

9  P.  M. 

84 

100 

And  thus,  until  April  21st,  the  case  proceeded  evenly,  with  pulse  and  temperature  approaching  the 
normal  character.  Durir.g  this  time,  the  wound  seemed  to  be  doing  well,  and  there  were  no 
symptoms  of  inflammation  in  the  neighboring  joint — neither  pain  nor  swelling.  April  21,  9  A.  M.: 
Pulse  76  ;  temperature  98£.  9  P.  M. :  Pulse  120 ;  temperature  103.  Here  was  a  marked  change. 
The  patient  now  complained  of  pain  in  the  right  knee.  On  the  morning  of  April  22d,  his  pulse  was 
108 ;  temperature  101J,  and  in  the  evening  his  pulse  rose  to  134 ;  temperature  105.  The  knee  was 
still  painful  and  somewhat  swollen.  It  was  evident  that  the  knee-joint  had  become  involved.  For 
several  days,  local  applications  were  persistently  applied,  but  increased  swelling  and  signs  of 
suppuration  within  the  joint  began  to  appear.  Soon  after,  hectic  symptoms  began,  and  the  consti- 
tution seemed  failing.  May  3d :  I  amputated  the  limb.  This  was  done  through  the  knee-joint, 
making  a  long  anterior  and  a  short  posterior  flap,  and  sawing  off  about  an  inch  of  the 
condyles,  after  the  manner  of  Mr.  Carden,  of  Worcester.  This  operation  is  also  recommended  by 
Martoe,  of  New  York.  The  anaesthetic  used  in  this  case  was  chloroform.  The  knee-joint  was  full 
of  foetid,  unhealthy  pus,  and  this  extended  also  above  the  joint,  along  the  cellular  planes  of  the 


204  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

thiirb.  On  the  after  treatment,  the  flaps  were  kept  partly  separated,  so  as  to  favor  a  free  exit  of 
pus.  There  was  considerable  retraction,  and  the  period  of  cicatrization  was  much  prolonged. 
Abscesses  forming  above  the  wound,  and  extending  upward  between  the  muscles  of  the  thigh,  gave 
a  good  deal  of  trouble.  These  were  met  by  free  incisions  and  the  injection  of  antiseptic  lotions. 
The  patient's  system  being  reduced,  and  the  season  hot,  careful  nursing  and  supporting  treatment 
were  required  to  carry  him  through  the  long  period  of  cicatrization.  May  31st  (end  of  first  month), 
!)  A.  M.:  Pulse  116;  temperature  9SJ;  9  P.  M.:  Pulse  116;  temperature  98£;  stump  suppurating 
freely;  flaps  somewhat  sloughy  in  the  last  two  weeks.  Antiseptic  lotions  and  carbon  poultices 
applied;  the  flaps  now  look  healthier.  June  30th  (end  of  second  month),  9  A.  M. :  Pulse  112; 
temperature  98.  9P.M.:  Pulse  116;  temperature  99.  The  patient  has  gained  strength  in  the  past 
month ;  stump  healing  up;  suppuration  not  more  than  one  ounce  per  day.  July  31, 1870  (end  of  third, 
month) :  Pulse  and  tongue  and  temperature  normal ;  stump  healed  over ;  patient  walking  about 
with  a  long,  well-rounded  and  apparently  useful  stump.  He  was  transferred  on  May  15,  1871, 
to  join  his  command  at  Tucson,  Arizona  Territory. 

CASE  II. — Private  Louis  Shire,  Troop  P,  3d  Cavalry,  was  shot  by  Apache  Indians  on  October 
6, 1870.  The  ball  entered  the  left  leg  inside  of  and  a  little  above  the  patella,  passed  into  the  centre 
of  the  internal  condyle,  imbedding  itself  there  and  splitting  the  bone  down  into  the  joint.  The 
patient  was  obliged  to  ride  thirty-five  miles  on  horseback,  and  did  not  arrive  at  the  hospital  till 
the  next  afternoon  of  October  7th.  The  knee  was  then  found  to  be  much  swollen  and  very  painful. 
Pulse  112  and  quick ;  skin  hot.  Exploring  the  wound  carefully,  I  could  not  find  the  ball,  but 
concluded  it  had  entered  the  joint  and  lodged  within  or  near  it.  The  patient's  condition  was  much 
depressed  and  irritable.  He  was  greatly  fatigued  by  travel  and  loss  of  sleep,  and  the  knee  was 
already  much  inflamed.  Hence,  I  thought  best  to  defer  amputation  until  a  more  favorable  time. 
On  October  8th  the  pulse  was  110,  the  general  condition  about  the  same,  only  the  pain  and  swelling 
were  increased.  October  9th :  pulse  112;  the  patient  had  slept  pretty  well;  but  his  condition  was 
still  irritable.  On  October  10th,  pulse  100,  knee  and  thigh  less  swollen,  and  there  was  less  general 
irritability.  October  llth:  pulse  102  and  firmer;  general  condition  improved;  less  complaint  of  pain; 
inflammation  in  knee  less  acute.  Amputation  at  11  A.  M.  The  method  adopted  was  by  making 
a  long  flap  anteriorly,  and  a  short  one  posteriorly.  The  condyles  were  sawn  off  about  an  inch ;  the 
ball  was  turned  out  of  its  bed,  and  a  piece  of  bone,  the  size  of  a  hen's  egg,  which  had  been  split 
off  from  the  internal  condyle,  was  removed  by  forceps.  The  anaesthetic  used  was  sulphuric  ether. 
There  was  very  little  haemorrhage,  but  considerable  shock.  At  9  P.  M.,  the  pulse  beat  136; 
the  reaction  was  pretty  good.  October  12th,  9  A.  M.,  pulse  118;  9  P.  M.,  pulse  120;  skin  hot.  In  the 
after  treatment  no  attempt  was  made  to  get  primary  union  of  the  flaps ;  free  outlet  was  given  for 
suppuration;  and  antiseptic  lotions  and  dressings  we/re  freely  used.  There  was  an  early  tendency 
to  sloughing  in  the  anterior  flap ;  carbon  poultices  were  then  applied,  and  the  edges  of  the 
daily  flap  were  touched  with  lunar  caustic.  After  the  separation  of  a  large  slough,  the  edges  being 
cauterized,  the  stump  assumed  a  healthier  appearance.  An  abscess  formed  among  the  muscles  above 
the  knee,  and  became  the  seat  of  a  good  deal  of  suppuration.  This  was  opened  and  daily  injected 
with  antiseptic  lotions  of  chloride  of  zinc  and  Labaraque's  solution  of  chlorinated  soda,  and  it 
gradually  diminished.  On  December  1,  1870,  about  seven  weeks  after  the  operation,  the  stump  was 
almost  entirely  closed  up,  and  the  patient  was  able  to  walk  about  on  crutches.  He,  too,  has  a 
stump  that  will  probably  serve  well  for  locomotion.  On  May  15,  1871,  the  patient  was  transferred 
to  join  his  command  at  Tucson,  Arizona. 

DLXXXIII. — Memorandum  relative  to  an  Amputation  at  the  Knee-Joint.    From  Data  furnished  by 
J.  R.  REILY,  M.  D.,  Acting  Assistant  Surgeon. 

Robert  Realey,  a  lad  of  10  years,  was  struck  on  the  right  instep  by  a  stone  seven  weeks  previous 
to  the  operation  below  mentioned,  when  inflammation  was  at  once  lighted  up,  and  periostitis  rapidly 
extended  up  the  limb,  which  was  much  swollen  and  very  painful  ten  days  after  the  accident.  Fluc- 
tuation being  detected  at  the  internal  malleolus,  an  incision  was  made,  which  gave  exit  to  more 


AMPUTATIONS  OF  THE  THIGH.  205 

i 

than  twelve  ounces  of  pns.  Acute  necrosis  invaded  the  shaft  of  the  tibia,  and  a  fortnight  after  the 
evacuation  of  the  abscess,  Doctor  Reily  held  a  consultation  with  Professor  Johnson  Eliot,  who 
advised  an  exploratory  incision,  with  a  view  of  ascertaining  the  extent  of  the  disease  of  the  tibia. 
On  December  24,  1870,  the  lad  was  etherized,  and  the  bone  being  exposed  by  two  incisions  on  the 
anterior  aspect  of  the  limb,  it  was  found  that  the  bone  was  diseased  to  such  an  extent  that  no 
resection,  nor  even  an  amputation  in  the  continuity,  was  practicable.  It  was  therefore  determined 
to  amputate  at  the  knee-joint.  This  operation  was  performed  by  Dr.  James  K.  Eeily,  assisted  by 
Professor  J.  Eliot  and  Dr.  J.  D.  Barnes.  The  integuments  were  divided  circularly,  two  inches 
below  the  knee-joint,  and  reflected,  the  patella  was  removed,  and  the  leg  disarticulated.  The 
femoral  was  completely  controlled  by  a  tourniquet,  and  there  was  little  or  no  haemorrhage.  The 
condyles  of  the  femur  were  then  sawn  oft',  a  slice  half  an  inch  in  thickness  being  removed.  The 
integument  was  then  brought  together  antero-posteriorly,  and  united  by  wire  sutures.  It  was  only 
necessary  to  ligate  the  popliteal  artery.  The  patient  reacted  promptly  and  progressed  favorably. 
The  pathological  specimen,  with  the  history,  was  contributed  to  the  Army  Medical  Museum  by  the 
operator,  and  is  No.  5T36,  Surgical  Section.  On  January  16, 1871,  the  wound  had  entirely  healed, 
and  the  boy  was  going  about  the  house.  A  few  weeks  subsequently,  he  called  at  this  office.  The 
stump  then  presented  a  very  fair  appearance,  and  the  boy's  health  was  good. 

Amputations  of  the  Thigh. — There  were  reports  of  twenty-six  cases.     Seventeen  fol- 
lowed gunshot-wounds  ;  six,  accidents  ;  three,  diseases.     The  results  were  very  successful. 

DLXXXIV. — Note  on  an  Amputation  of  the  Thigh  for  Gunshot  Injury.    By  CHARLES  SMART,  Assist- 
ant Surgeon,  U.  S.  A. 

George  W.  Albright,  a  citizen,  aged  40  years,  received,  in  a  quarrel,  August  15, 1866,  a  gunshot 
fracture  of  the  right  femur,  lower  third.  The  femur  was  splintered,  longitudinally,  for  six  inches. 
On  the  same  day  he  was  admitted  to  post  hospital,  Camp  McDowell,  Arizona  Territory,  and,  on 
the  next  day,  I  administered  chloroform,  and  amputated  the  thigh  by  the  flap  ^method.  The 
tissues  were  in  a  healthy  condition.  On  the  15th  of  October,  the  flaps  were  firmly  united,  and  on 
November  23,  1866,  he  was  sent  away  from  hospital. 


DLXXXV. — Memorandum  relative  to  a  Secondary  Amputation  of  the  Thigh. 

Private  C.  M.  Bowen,  Co.  A,  27th  Indiana  Volunteers,  had  his  left  femur  fractured  by  a  mus- 
ket ball,  at  the  battle  of  Antietam,  on  September  17, 1862.  He  was  admitted  to  Hospital  No.  1, 
Frederick,  Maryland,  where  Buck's  apparatus  was  applied.  Five  months  subsequently,  he  was 
removed  to  Baltimore.  There  were  numerous  abscesses,  and  the  patient  underwent  two  opera- 
tions for  the  removal  of  necrosed  bone.  On  September  7,  1863,  he  was  discharged  the  service, 

with  the  limb  greatly  deformed.  He  received  a  pension, 
and  was  employed  in  the  Interior  Department.  Owing 
to  recurrence  of  abscesses  he  was  admitted  to  Provi- 
dence Hospital  in  the  autumn  of  1867.  and  on  November 
llth,  the  limb  was  amputated  in  the  middle  third  by 
Dr.  D.  W.  Bliss.  The  wound  healed  well,  and  a  photo- 
FIO.  4i.-Gunshot  fracture  of  the  lower  third  of  left  fe-  graph  was  taken  at  the  Army  Medical  Museum  on  Jau- 

mur,    Spec.  4914,  Sect.  I..  A.  M.  M.  .  .    *      ..         *  .,  , 

uary  9,  1868,  at  which  time  the   stump  was  firm  and 

healthy.  The  specimen,  with  the  history,  was  contributed  by  the  operator  to  the  Army  Medical 
Museum,  and  is  represented  in  the  adjacent  wood-cut.  The  fragments  are  considerably  overlapped, 
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. 


206  KEPOKT  OF  SURGICAL  OASES  IN  THE  ARMY. 

DLXXXVL— Report  of  a  Secondary  Amputation  of  the  Thigh.    By  HARVEY  E.  BROWN,  Assistant 
Surgeon,  U.  S.  A. 

Sergeant  John  Cameron,  Co.  K,  31st  Maine  Volunteers,  aged  26  years,  while  on  picket  before 
Petersburg,  June  18,  18G4,  was  struck  by  a  conoidal  musket  ball,  which  produced  a  flesh-wound 
about  two  inches  above  the  right  knee.  He  was  sent  to  City  Point,  and  thence  to  the  De  Camp 
Hospital,  New  York  Harbor,  where  he  arrived  on  June  2Gth.  Expectant  treatment  was  used.  OH 
August  6th,  he  was  sent  to  the  Cony  Hospital  at  Augusta,  Maine,  and  was  returned  to  duty  on 
September  28,  1864.  No  further  record  of  the  case  can  be  found  until  June  2,  1865,  when  he  was 
discharged  the  service  at  the  post  hospital  at  Augusta ;  but  he  remained  for  treatment  until  July 
31, 1866,  when  the  hospital  was  discontinued.  Prior  to  the  latter  date,  the  knee-joint  had  become 
very  much  enlarged  from  deposit  of  plastic  matter  following  chronic  arthritis.  The  patient  was 
emaciated,  his  appetite  poor,  and  general  condition  bad.  On  July  5, 1866,  being  rendered  insensible 
by  an  anaesthetic  composed  of  one  part  chloroform  and  three  parts  ether,  the  thigh  was  amputated 
at  the  lower  third  by  the  double-flap  operation.  Water  dressings  were  applied.  The  incisions 
healed  by  first  intention ;  the  ligatures  came  away  on  the  eleventh  day.  On  July  27th  the  stump 
had  entirely  healed,  and  the  patient  was  walking  about  on  crutches,  having  gained  several  pounds 
since  the  operation. 

DLXXXVII. — Account  of  Primary  Amputation  of  the  Eight  Thigh  in  the  Lower  Third.    By  IRVING 
C.  ROSSE,  M.  D.,  Acting  Assistant  Surgeon. 

Frank  Cheeseman,  a  large  muscular  mulatto  man,  aged  about  30  years,  and  employed  as  a 
laborer  in  unloading  fixed  ammunition  in  one  of  the  small  buildings  used  for  pyrotechnic  purposes, 
at  Fort  Monroe,  Virginia,  was  seriously  wounded  on  the  afternoon  of  August  3,  1870,  by  several 
fragments  of  shell,  an  explosion  having  occurred  through  the  carelessness  of  a  fellow-laborer.  The 
patient  being  taken  to  hospital  on  a  litter,  I  found  almost  the  whole  of  the  right  leg  torn  to  pieces, 
and  the  knee-joint  implicated ;  the  fourth  and  fifth  metatarsals  of  the  left  foot  were  broken,  a 
fragment  of  shell  remaining  in  the  muscles  of  the  plantar  region,  and  another  fragment  was1 
imbedded  in  the  muscles  of  the  right  fore-arm.  There  were  besides  several  superficial  wounds  on 
the  chest ;  the  patient's  hands,  neck,  and  face  were  badly  burned,  and  he  was  unable  to  see.  The 
amount  of  shock  and  haemorrhage  was  not  great  considering  the  gravity  of  the  injuries,  and  the 
patient  complained  more  of  the  smarting  from  the  burns  than  of  his  other  wounds.  The  burns 
were  dressed  with  carbolized  glycerine  ;  anodynes  with  stimulants  were  administered  ,aud  proper 
means  were  taken  to  bring  about  reaction.  Amputation  having  been  decided  upon,  about  noon  on 
the  following  day  the  usual  preliminaries  were  arranged,  and  Surgeon  George  E.  Cooper,  U.  S.  A., 
chloroformed  the  patient.  The  induction  of  anaesthesia  was  somewhat  slow,  the  pulse  meanwhile 
being  intermittent.  I  amputated  the  thigh  in  the  lower  third,  using  the  circular  operation ;  the 
arteries  were  withdrawn  from  their  sheaths  and  ligated ;  the  cut  surfaces  of  the  stump  were  allowed 
to  glaze,  and  the  wound  was  closed  with  silver-wire  sutures.  Haemorrhage  was  very  slight.  The 
patient,  surviving  the  operation  but  a  short  time,  died  from  the  shock. 

DXXXV1II. — Report  of  an  Intermediary  Amputation  of  the  Thigh.    By  T.  H.  TURNER,  Assistant 
Surgeon,  U.  S.  A. 

Louis  Farley,  of  Major  George  A.  Forsyth's  Independant  Company  of  Scouts,  received  a  gunshot 
fracture  of  the  thigh,  at  the  battle  of  Dry  Forks,  on  the  Republican  River,  Kansas,  September  17, 
1868.  Amputation  was  performed  on  the  tenth  day.  Death  resulted  four  hours  afterward. 

DXXXIX. — Mention  of  a  Primary  Amputation  of  the  Thigh.   By  J.  M.  DICKSON,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  Charles  A.  Fonda,  Co.  D,  23d  Infantry,  received  a  severe  gunshot  wound  of  the  knee- 
joint  in  a  skirmish  near  Lake  Warner,  Oregon,  April  29, 1868.  Amputation  at  the  lower  third  of 
the  thigh  was  performed  on  the  next  day.  He  died  under  the  operation. 


AMPUTATIONS  OF  THE  THIGH.  207 

DXC. — Report  of  a  Case  in  ichich  the  Thigh  and  Leg  were  Amputated  on  account  of  Scorbutus. 

Private  Hugh  Gleason,  Co.  A,  140th  New  York  Volunteers,  was  taken  prisoner  at  Weldon 
Railroad  in  August,  1 86-4,  and  was  confined  at  Salisbury,  North  Carolina,  where,  he  affirms,  on 
account  of  exposure  and  starvation,  he  contracted  scurvy.  When  released,  he  received  a 
furlough  and  went  to  his  home  at  East  Wilson,  Niagara  County,  New  York,  where  he  was  attacked 
with  typhoid  fever.  On  April  15,  1865,  Doctor  A.  M.  Leonard,  of  Lockport,  New  York,  took 
charge  of  the  patient.  He  found  him  suffering  from  scurvy,  which,  resulting  in  gangrene, 
necessitated  the  amputation  of  the  right  thigh  at  the  middle  third  on  April  25th,  and  the  left  leg 
at  the  lower  third  on  June  7,  18G5,  both  by  the  flap  operation.  He  believes  that  the  disease  was 
caused  as  above  stated.  The  patient  was  discharged  on  August  29,  18G5,  and  was  pensioned  for 
total  disability.  On  May  20, 1869,  George  B.  Jewett,  who  furnished  the  patient  with  artificial 
limbs,  reported  the  stumps  sound. 

DXCI. — Report  of  a  Case  of  an  amputation  of  the  Thigh  for  Gunshot   Wound  of  the  Knee-Joint. 
By  J.  M.  LAING,  M.  D.,  Acting  Assistant  Surgeon. 

Sergeant  David  G ,  Troop  M,  7th  Cavalry,  aged  25  years,  while  in  command  of  pay- 
master's escort  proceeding  to  Fort  Lamed,  Kansas,  was  accidentally  wounded  on  November  17, 
1870,  when  twelve  miles  from  destination,  by  a  conoidal  carbine  ball,  which  entered  the  right  leg 
between  the  upper  extremities  of  tibia  and  fibula,  passed  through  the  head  of  tibia,  shattered  the 
patella  to  pieces,  and  emerged  through  the  inner  condyle  of  femur.  The  outer  condyle  was  also 
completely  separted  from  the  shaft,  but  this  is  attributed  to  the  explosive  force  of  the  powder, 
the  muzzle  of  the  piece  having  been  close  to  the  joint  when  fired.  The  carbine  was  lying  in  the 
ambulance,  and,  being  displaced  by  a  jolt,  the  sergeant  stooped  over  to  adjust  it  when  the  accident 
occurred.  Eight  miles  from  destination,  at  11.30  P.  M.,  he  was  visited,  and  the  wound  dressed 
with  lint,  soaked  in  persulphate  of  iron,  and  bandages.  On  the  patient's  arrival  at  the  fort  the 
next  morning  he-  was  chloroformed,  and  the  wounds  were  examined,  when,  no  fracture  of  the 
patella  being  discovered,  and  the  man  being  of  sound  constitution,  it  was  determined  to  try  to 
save  the  limb.  The  wounds  were  thoroughly  syringed-  out  with  a  solution  of  carbolic  acid, 
and  dressed  with  successive  layers  of  lint  soaked  in  carbolic  oil,  and  the  limb  was  laid  in  pillows 
until  the  swelling  should  go  down.  On  November  21st  irritative  fever  had  set  in;  there  was  a 
sanious  discharge  from  the  wound  of  entrance ;  the  parts  contiguous  were  in  a  sloughing  condition, 
and  the  whole  thigh,  up  to  the  buttock,  was  of  a  brownish  color.  Amputation  in  this  condition 
not  being  deemed  advisable,  the  dressings  were  removed,  and  the  whole  limb  was  enveloped  in  a 
yeast  poultice.  In  a  few  days  the  irritative  fever  was  subdued.  The  gangrenous  parts  about  the 
wound  of  entrance  having  separated,  and  pus  beginning  to  form  in  large  quantities  in  the  thigh, 
he  was  put  on  liberal  diet,  and  syringing  with  carbolic  acid  solution,  and  carbolic  oil  dressings 
were  again  resorted  to.  Under  this  treatment  the  patient's  health  improved,  and  there  being  no 
instruments  at  the  post  fit  for  use,  a  note  was  dispatched  on  December  llth  to  W.  S.  Tremaiue, 
Assistant  Surgeon,  U.  S.  A.,  at  Fort  Dodge,  requesting  him  to  come  over  and  bring  his  instruments. 
On  the  afternoon  of  the  13th  haemorrhage  set  in,  but  was  controlled  by  a  tourniquet.  The  next 
morning,  Doctor  Tremaine  having  arrived,  it  was  determined,  on  consultation,  that  amputation 
was  inadmissible  on  account  of  loss  of  blood,  but  that  an  opening  should  be  made  toward  the  back 
of  the  thigh  for  the  readier  evacuation  of  the  matter.  While  examining  the  thigh  for  this  purpose 
hemorrhage,  evidently  from  the  femoral  artery,  recurred ;  and,  as  a  last  resource,  he  was  rendered 
insensible  with  chloroform,  and  the  thigh  was  amputated  at  the  junction  of  the  upper  thirds  by 
lateral  flap  operation.  The  femoral  was  ligated;  bleeding  from  the  other  vessels  was  controlled 
by  torsion.  The  flaps,  after  being  thoroughly  washed  with  strong  solution  of  carbolic  acid,  were 
left  open,  and  a  tourniquet  was  loosely  adjusted.  The  patient  nearly  died  upon  the  table,  and  it 
was  only  after  the  employment  of  artificial  respiration,  and  ammonia  that  he  rallied.  His  pulse 
never  rallied  from  the  shock  of  the  operation,  death  occurring  on  December  16tb,  fifty  hours  after. 
The  extent  of  the  injury  was  not  discovered  until  after  death.  There  having  been  no  displace- 


208  REPORT  OF  SUEGICAL  CASES  IN  THE  ARMY. 

ment  of  the  femur,  nor  of  the  fragments  of  the  patella,  which  were  held  in  position  by  the  ligament, 
the  fracture  of  the  outer  condyle  and  of  the  patella  had  not  been  diagnosed.  The  pathological 
specimen  was  contributed,  with  the  history,  to  the  Army  Medical  Museum  by  the  operator,  and  is 
No.  5782  of  the  surgical  section. 

DXCIL— Account  of  an  Amputation  of  the  Thigh  for  Compound  Fracture.    By  V.  B.  HUBBAED, 
Assistant  Surgeon,  U.  S.  A. 

Private  Maurice  C.  Hickey,  Co.  Cr,   19th  Infantry,  aged  22  years,  received  a  compound 

comminuted  fracture  of  the  right  tibia  and  flbula,  by  the  falling  of  a  flag-staff  upon  the  leg,  while 

assisting  to  raise  the  same,  July  3, 1806,  at  Fort  Gibson,  Choctaw  Nation.    On  the  same  day  he 

was  admitted  to  the  post  hospital.    His  constitution  responded  in  a  very  emphatic  manner  to  so 

powerful  a  source  of  irritation.    The  fever  was  remittent  in  type,  the  febrile  exacerbation  being 

vesperal.    The  evening  pulse  was  150  to  160,  the  morning  pulse  11.0  to  120.    The  exacerbation 

commenced  about  3  P.  M.,  and  ended  about  midnight.    By  the  23d  of  July,  the  parts  were  intensely 

inflamed,  the  inflammation  exteudingto,  and  in  places  reaching  above,  the  knee.    The  limb  enlarged 

to  the  full  capacity  of  the  skin,  which  was  tense  and  shining,  and  hot  to  the  touch.    The  limb  was 

commencing  to  give  out  an  odor  which  awakened  suspicions  of  incipient  hospital  gangrene.    On 

the  latter  date,  chloroform  was  administered,  and  the  thigh  amputated,  by  the  double  flap  method 

at  the  junction  of  the  middle  with  the  lower  third.     Simple  water  dressings  were  applied.    The 

patient  rallied  well  from  the  effects  of  the  operation.    The  constitutional  irritative  fever  left  him 

almost  simultaneously  with  the  source  of  irritation.    Neuralgic  pains,  causing  severe  twitching  of 

the  stump,  referred  to  the  amputated  limb,  continued  seventy-two  hours.    The  weather,  three  weeks 

before  and  three  weeks  after  the  operation,  being  excessively  warm  and  dry,  the  thermometer,  at 

noon,  indicating  100°  F.  in  the  shade,  the  stitches  sloughed  out,  and  the  edges  of  the  flaps  sloughed 

away  sufficiently  to  expose  the  sawn  extremity  of  the  femur,  on  the  fourteenth  day  after  the 

operation.    The  wound  healed,  excepting  the  parts  immediately  around  the  bone,  the  extremity  of 

•which  necrosed.     September  30,  I860,  the  soldier  was  awaiting  his  discharge  from  the  service  on 

surgeon's  certificate  of  disability.    A  second  operation  would  have  been  performed  for  the  removal 

of  the  dead  bone,  had  the  physical  condition  of  the  patient  been  such  as  to  render  it  justifiable  ; 

this,  however,  together  with  the  extreme  heat,  contra-indicated  further  surgical  interference. 

DXCIII. — Account  of  an  Amputation  of  the  Think  for  Compound  Fracture,  by  Vermale's  Operation. 
By  J.  F.  BOUGHTER,  M.  D.,  Acting  Assistant  Surgeon. 

John  Johnson,  a  Norwegian,  aged  39  years,  on  January  19, 1869,  fell  from  a  rock  on  the  Big 
Sioux  River  to  the  ice,  a  large  rock  and  the  tree  he  had  been  cutting  rolling  after  him.  He  was 
found  a  few  hours  afterward,  and  was  taken  to  his  home,  a  dirty,  unventilated  hut,  partially 
under  ground.  On  February  9,  1869,  he  was  admitted  for  treatment  to  the  hospital  at  Fort  Dakota, 
Dakota  Territory,  in  a  very  weak  and  emaciated  condition.  His  diet  had  been  very  meagre. 
Examination  disclosed  a  compound  comminuted  fracture  of  the  right  tibia  and  fibula  extending  to 
the  knee-joint.  Portions  of  the  tibia  protruded  in  several  places,  and,  upon  pressure  with  the 
hand,  the  bones  could  be  felt  crushed  to  small  fragments,  some  of  which  had  been  discharged  from 
the  wounds,  which  were  suppurating  freely,  but  were  not  much  swelled.  There  was,  also,  a 
transverse  fracture  of  the  left  patella,  and  bed-sores  on  the  hip.  Stimulants  were  administered, 
and  the  patient  being  bathed  was  put  to  bed.  On  the  next  day,  beef  essence  and  milk  punch  were 
freely  given,  the  left  leg  was  placed  on  an  inclined  plane,  and  the  fractured  patella  was  brought 
together  with  adhesive  straps.  On  February  llth,  the  right  thigh  was  amputated  by  Vermale's 
operation  (flap)  three  inches  above  the  knee-joint.  The  femoral  and  two  other  arteries  were  tied; 
the  flaps  were  exposed,  and  cold  water  was  poured  over  the  surface  until  glazed ;  then  sutures 
were  introduced  and  the  flaps  were  brought  together.  Morphine  was  given,  cold-water  dressings 
were  applied  to  the  stump,  and  renewed  every  five  minutes.  The  left  leg  was  elevated  and 
extended  in  a  swing.  On  February  12th  a  tonic  and  anodyne  were  given.  On  the  next  da\ . 


AMPUTATIONS  OF  THE  TFIIGII.  209 

his  bowels  not  having  moved  for  fifteen  days,  sulphate  of  magnesia  was  given,  and  being 
continued  until  the  18th  without  effect,  castor  oil  and  turpentine  were  prescribed,  which  gradually 
relieved  the  constipation.  On  the  10th,  the  stump  being  a  little  swelled  and  putty,  a  chlorinated 
linseed  meal  poultice  was  applied,  and  on  the  20th,  warm-water  dressings  were  resorted  to.  From 
the  latter  date  to  March  2d  the  patient  improved  rapidly.  A  very  large  quantity  of  hardened 
faeces,  retaining  the  impress  of  the  sulci  of  large  intestine,  was  discharged.  On  the  latter  date 
the  ligatures  from  the  femoral  and  from  one  of  the  small  arteries  came  away,  and  the  remaining 
one  in  a  day  or  two  afterward.  On  March  31st  the  bandages  and  compresses  were  removed,  and 
the  patient  attempted  to  walk  but  was  compelled  to  desist  on  account  of  pain  in  the  left  knee  ; 
soap  liniment  was  applied  to  the  joint.  The  edges  of  the  patella,  which  were  one-half  inch  apart, 
united  by  ligameutons  union.  No  attention  having  been  given  to  this  wound  previous  to  his 
admission  to  hospital,  bony  union  could  not  be  expected.  There  was  no  swelling  in  the  joint,  and 
it  was  thought  that  anchylosis  would  not  occur.  On  April  18th  he  was  about  to  start  for  home. 
Dissection  of  the  amputated  leg  disclosed  a  stellated  fracture  of  the  head  of  the  tibia,  extending 
into  the  knee-joint,  with  both  bones  crushed  into  about  twenty  fragments. 

DXGIV. — Memorandum  Relative  to  a  Secondary  Amputation  of  the  Thigh. 

Private  Jesse  M.  Jones,  Co.  K,  21st  Indiana  Volunteers,  aged  29  years,  was  wounded  at 

Baton  Rouge,  Louisiana,  August  5. 1802,  by  a  musket 
ball,  which  fractured  the  right  femur,  at  the  junction 
of  the  middle  and  upper  third.  He  was  taken  to  the 
regimental  hospital  the  night  after,  remained  a  day, 
and  was  then  sent,  bv  a  transport  steamer,  to  New 

-(;,m*l,nt  fracture  ,,f  riBl,t  femur  nt  junction ,  of  upper       Orleans      thp    limb    meanwhile    being    Supported    by 
anil  middle  third*.    Spec.  5538,  sect.  I,  A.  M.  M.  • 

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.  The  patient  was  discharged  the  service  April  15,  1863,  and  was  pen- 
sioned, his  disability  being  rated  total  and  temporary.  From  that  date  till  January,  1800,  he 
suffered  much  pain  from  frequent  exfoliations  and  abscesses,  when  he  entered  Providence  Hospital 
at  Washington  ;  and  on  the  23d,  Doctor  D.  W.  Bliss,  late  Surgeon,  U.  S.  V.,  amputated  the  thigh 
in  the  upper  third,  and  afterward  contributed  the  pathological  specimen  to  the  Army  Medical 
Museum.  It  is  represented  in  the  adjoining  wood-cut,  showing  great  deformity  with  exfoliations  on 
posterior  aspect,  and  a  fragment  of  lead  imbedded  in  the  callus.  On  March  9,  1809,  the  patient 
visited  the  Museum,  recovered,  and  his  photograph  was  takeu  to  accompany  the  specimen.  (A 
M.  M.  Card  Photographs,  Vol.  1,  page  27.) 

DXCV. — Account  of  an  Amputation  of  the  Thigh  for  Gunshot  Injury.     By  A.  F.  STEIGERS,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Eobert  Kinnear,  Co.  C,  21st  Infantry,  aged  27  years,  received  an  accidental  gunshot 
fracture  of  the  knee-joint,  with  extensive  laceration  of  the  parts,  and  was  admitted  to  the  hospital 
at  Camp  Verde,  Arizona  Territory,  on  October  4,  1870,  in  an  exhausted  and  almost  pulseless 
condition  from  previous  loss  of  blood.  Operation  was  postponed  until  the  next  day  for  reaction, 
when,  the  knee  being  much  swollen,  Acting  Assistant  Surgeon  J.  T.  Pindell,  after  chloroforming 
the  patient,  amputated  the  thigh  just  above  the  knee,  by  the  lateral-flap  operation.  There  was  little 
haemorrhage ;  the  femoral  artery  and  its  branches  were  ligated  ;  reaction  was  moderate.  Beef-tea 
and  stimulants  by  enema  were  ordered.  Ninety-nine  hours  after  the  reception  of  the  wound,  ho 
died  of  pyaemia. 

DXCVI. — Memorandum  relative  to  an  Amputation  of  the  Thigh  for  Synovitis. 

Private  William  H.  Long,  Co.  B,  84th  Indiana  Volunteers,  sprained  his  left  knee  joint  in  the 
autumn  of  1804.    He  was  mustered  out  of  service  on  June  14, 18G5,  and  pensioned.    On  May  25, 
27 


210  EEPOET  OF  SURGICAL  CASES  IN  THE  AEMY. 

1866,  Pension  Examiner  John  C.  Helm  reported  that  there  was  inflammation  of  the  synovial 
capsule,  which  had  resulted  in  suppuration  and  abscess.  There  were  then  five  or  six  points 
discharging  pus;  the  knee  was  swollen  and  enlarged,  and  there  was  general  cedematous  infiltration 
of  the  whole  limb.  The  patient  was  at  his  home  (Eaton,  Delaware  County,  Indiana),  unable  to 
leave  his  bed,  and  his  disability  was  rated  total  and  permanent.  On  September  26, 1867,  Dr.  Helm 
reported  that  the  leg  was  about  as  before  described,  except  that  it  was  worse,  and  was  wearing 
down  the  patient's  health,  and  that  no  relief  could  be  afforded  except  by  amputation.  In  the  latter 
part  of  May,  1869,  he  was  fitted  with  an  artificial  limb  by  Hiram  A.  Kimball,  who  stated  that  the 
thigh  had  been  amputated  on  February  19,  1868  (amount  of  limb  lost  twenty-four  inches),  by  the 
.flap  operation.  The  stump  was  less  than  normal  size,  but  was  perfectly  healed. 

DXCVII. — Remarks  on  an  Amputation  of  the  Thigh  for  Gunshot  Injury.    By  S.  M.  HORTON,  Assist- 
ant Surgeon,  U.  S.  A. 

Private  Joseph  McKeever,  Co.  E,  27th  Infantry,  aged  28  years,  was  wounded  in  an  engagement 
with  the  Indians  near  Goose  Creek,  Dakota  Territory,  November  4,  1867,  by  a  round  ball,  which 
fractured  and  extensively  comminuted  the  left  femur  in  its  lower  third.  He  was  admitted  to  the 
post  hospital,  Fort  Philip  Kearney,  Dakota  Territory,  on  the  same  day.  The  femur  was  greatly 
comminuted  for  seven  inches.  Extensive  haemorrhage  followed  the  removal  of  a  large  clot  while 
cleansing  the  wound.  The  patient  seemed  to  be  in  good  health,  and  did  not  appear  to  suffer  much 
from  the  wound.  On  November  6th,  I  administered  equal  parts  of  ether  and  chloroform,  and 
amputated  the  thigh  at  the  junction  of  middle  and  lower  thirds  by  a  large  anterior  and  small 
posterior-flap  method.  The  patient  did  well,  and  partook  of  stimulants  freely  until  the  evening  of 
the  7th,  when  his  pulse  became  very  weak.  Death  resulted  on  the  morning  of  November  8,  1867, 
from  nervous  prostration.  The  autopsy  revealed  a  good  attempt  at  the  formation  of  a  fibrinous 
plug  above  the  ligature  of  the  femoral  artery. 

DXCVIII. — Memorandum  relative  to  an  Amputation  of  the  Thigh  for  Gunshot  Injury.    By  W.  H. 
FORWOOD,  Assistant  Surgeon,  U.  S.  A. 

Private  John  Martin,  Troop  H,  7th  Cavalry,  was  wounded  in  quarters  on  March  15, 1867,  by  a 
missile  which  entered  the  left  thigh  anteriorly  at  the  junction  of  the  upper  and  middle  thirds,  passed 
through  the  quadratus  femoris,  semi-membranosus  and  semi-teudinosus  muscles,  and,  injuring  the 
coats  of  the  femoral  vessels,  fractured  the  femur  longitudinally  six  inches.  He  was  admitted  to 
the  post  hospital,  Fort  liiley,  Kansas,  on  the  same  day,  the  injured  parts  being  much  swollen  and 
lacerated,  the  coats  of  the  femoral  vessels  torn,  and  pieces  of  bone  detached  and  driven  into  the 
soft  parts.  The  patient  being  somewhat  intoxicated,  was  much  excited,  and  suffered  great  pain. 
His  general  health  was  good ;  pulse  95.  Chloroform  was  administered,  and  the  left  thigh 
amputated  at  the  junction  of  the  upper  and  middle  thirds  by  the  lateral-flap  method.  There  was 
but  little  haemorrhage;  the  femoral  artery  only  was  tied.  Silk  sutures,  adhesive  straps,  and  cold- 
water  dressings  were  applied.  By  March  31,  1867,  all  symptoms  were  very  favorable,  and  a  good 
result  was  anticipated. 

DXCIX. — Report  of  a  Primary  Amputation  of  the  Thigh  for  Compound  Comminuted  Fracture.    By 
B..  J.  D.  IRWIN,  Surgeon,  U.  S.  A. 

Private  James  McN ,  Company  H,  43d  Infantry,  aged  33  years,  received,  while  intoxicated. 

April  30,  1868,  a  compound  comminuted  fracture  of  the  lower  third  of  the  left  thigh  by  being- 
run  over  by  a  street  car  in  the  city  of  Detroit,  Michigan,  some  three  miles  from  Fort  Wayne. 
He  was  temporarily  attended  by  physicians  in  Detroit,  and  brought  to  the  post  hospital  at  Fort 
Wayne,  May  1,  1868,  about  8  o'clock  A.  M.  The  interior  side  of  the  thigh,  from  within  three  inches 
of  the  groin,  down  to  the  knee,  was  much  lacerated ;  the  bone  was  protruding ;  no  arterial 
haemorrhage  had  taken  place.  There  was  nausea  and  vomiting,  owing  to  the  presence  of  liquor,  of 


AMPUTATIONS  OF  THE  LEG.  211 

which  he  had  partaken  freely.  On  May  1,  1868,  at  3  o'clock,  P.  M.,  being  assisted  by  Dr.  D.  O. 
Farrand,  1  amputated  the  thigh  through  the  upper  portion  of  the  middle  third,  while  the  patient 
was  under  the  influence  of  chloroform.  The  patient  was  weak,  but  cheerful.  Beef-tea  and  brandy 
were  given  every  half  hour.  Twenty  drops  of  chloroform  were  given  internally  one  hour  before 
the  operation.  After  the  amputation,  the  patient  was  quite  weak.  The  muscles  and  all  the  small 
vessels  were  much  bruised  and  mashed,  the  femoral  artery  and  deep  sapheuous  vein  being  the  only 
vessels  requiring  ligatiou.  The  shock  of  the  operation  was  severe,  from  which  he  rallied  slowly. 
The  reaction  was  complete  at  7  o'clock  P.  M. ;  the  pulse  was  small  and  feeble — about  120.  At  10 
o'clock  P.  M.  the  patient  felt  better,  took  beef-tea  and  small  quantities  of  brandy  and  water  every 
half  hour ;  pulse  continued  weak  and  feeble,  at  120.  He  complained  of  much  pain  in  the  lost 
limb.  One-fourth  of  a  grain  of  sulphate  of  morphia  was  given.  He  slept  comfortably  about  two 
hours,  but  sank  gradually,  and  died  from  exhaustion  at  4  o'clock  A.  M.,  May  2, 1868.  The  specimen 
is  No.  5447,  section  I,  A.  M.  M. 

DC. — Remarks  on  an  Amputation  of  the  Thigh  for  Gunshot  Injury.    By  JULES  LE  CARPENTIER, 
M.  D.,  Acting  Assistant  Surgeon. 

Serrapia  Montiel,  a  Mexican,  aged  45  years,  and  of  broken  constitution,  was  fired  upon  by 
two  drunken  soldiers  on  December  31,  1868,  and  was  wounded  by  a  pistol  ball  which  struck  the 
anterior  inner  aspect  of  the  right  thigh  about  the  middle,  passed  downward  and  outward,  producing 
a  transverse  fracture,  with  some  comminution,  at  the  point  of  lesion,  and  a  longitudinal  fracture 
extending  three  and  one-half  inches  up  the  shaft,  and,  dividing  into  about  six  pieces,  scattered 
and  lodged.  On  the  next  day  he  was  conveyed  to  the  post  hospital  at  Fort  Bayard,  New  Mexico. 
The  patient  had  lost  much  blood,  and  stimulants  were  given  to  produce  reaction.  At  2  P.  M.  on 
January  2d,  I  chloroformed  the  patient,  who  did  not  exhibit  any  signs  of  reaction,  but  became  at 
once  insensible,  and  amputated  the  thigh  at  the  junction  of  the  upper  thirds  by  the  antero- 
posterior  flap  operation.  The  haemorrhage  was  abundant,  notwithstanding  the  measures  taken  to 
check  it.  But  three  ligatures  were  required.  While  the  stump  was  being  dressed  with  alcohol 
and  water  the  patient  suddenly  ceased  breathing,  and  the  pulse  could  not  be  felt.  Cold  water 
was  dashed  into  his  face,  and  ammonia  was  applied  to  his  nose,  when  the  respiration  became 
natural.  Stimulants,  an  anodyne,  and  beef-tea  were  given,  but,  as  expected,  he  died  three  hours 
after  the  operation,  of  exhaustion. 

DCI. — Report  of  an  Amputation  of  the  Thigh  for  Gunshot  Injury.    By  A.  J.  GRAY,  M.  D.,  Acting 
Assistant  Surgeon. 

Willis  B.  Morgan,  an  indigent  civilian,  aged  26  years,  asthenic  from  constitutional  syphilis 
and  long-continued  dissipation,  was  accidentally  wounded  on  December  27, 1870,  by  a  round  musket 
ball  which  entered  the  leg  three  inches  below  the  knee-joint,  passed  down  between  the  tibia  and 
fibula,  and  lodged  under  the  external  malleolus,  slightly  fracturing  that  process,  and  opening  the 
ankle-joint.  On  the  next  day  he  was  admitted  to  the  hospital  at  Fort  Bayard,  New  Mexico;  and 
on  the  29th,  the  wound  being  gangrenous,  the  patient  was  rendered  insensible  with  equal  parts  of 
ether  and  chloroform,  and  the  thigh  was  amputated  at  the  lower  fourth  by  circular  operation. 
The  stump  was  dressed  with  cold- water  dressings,  followed  by  warm  fomentation,  and  wine,  beef- 
tea,  and  tonics  were  given.  On  December  31st  the  case  was  progressing  favorably. 

DCII. — Memorandum  relative  to  an  Amputation  of  the  Thigh  for  Synovitlx. 

Henry  Pearce,  Assistant  Surgeon,  150th  New  York  Volunteers,  according  to  the  records  of 
the  Pension  Office,  had  been  suffering  from  synovitis  of  the  left  knee-joint  for  some  years,  when, 
on  October  25,  1863,  the  disease  was  aggravated  by  his  horse  falling  with  him.  He  was  treated 
at  the  hospital  at  Tullahoma,  Tennessee.  His  knee  grew  rapidly  worse,  and  he  walked  with  great 
difficulty.  On  April  7,  1864,  he  was  discharged  the  service,  on  surgeon's  certificate  of  disability.* 

"  Resigned  April  7,  1864.— Official  Army  Keginter  nf  rolunteen.    Part  2,  p.  653. 


212  EEPOET  OF  SUEGICAL  CASES  IN  THE  AEMY. 

Oil  November  23,  1808,  at' Pawling,  Dutchess  County,  New  York,  the  patient's  home,  Doctor 
William  C.  Bennett  amputated  the  left  thigh  iu  the  lower  third  by  the  flap  operation.  Eight 
months  after,  he  was  furnished  with  an  artificial  limb  by  Monroe  and  Gardiner.  At  that  'date  the 
stump  was  perfectly  healed,  but  was  one-third  less  than  normal  size. 

DCIII. — Note  on  an  Amputation  of  the  Thigh. 

Private  Eeese  Furboy,  late  of  Co.  C,  98th  Ohio  Volunteers,  underwent  amputation  of  the  left 
thigh  iu  the  upper  third,  by  flap  operation,  for  "sickness,"  at  his  home  in  Cadiz,  Ohio,  on  October  9, 
1867,  by  Surgeons  Uptegraph  and  Connelly.  On  April  28,  1870,  he  was  furnished  an  artificial 
limb,  by  E.  Clement,  Philadelphia,  which  gave  satisfaction.  At  that  date  the  stump  was  sound, 
but  less  than  normal  size. 

DCIV.— Account  of  a  Secondary  Amputation  of  tlie  Thigh  for  Gunshot  Injury.    By  S.  M.  HORTON, 

Assistant  Surgeon,  U.  S.  A. 

Alfred  Barney,  a  citizen,  aged  20  years,  was  fired  upon  by  Indians  while  sittiiig,  in  company 
with  other  citizens,  by  a  fire,  in  a  small  camp  near  the  stockade  at  Fort  Philip  Kearney,  Dakota 
Territoryj  November  1,  I860,  and  had  his  right  patella  broken  into  five  fragments.  He  was 
admitted  into  the  post  hospital  on  the  next  day,  where  simple  dressings  were  applied,  and  two- 
thirds  of  the  patella  were  removed;  as  the  fragments  loosened  by  suppuration.  By  April,  18G7,  the 
patient  had  become  greatly  emaciated  and  debilitated  from  pain,  exhaustive  suppuration,  hectic  fever 
and  diarrhosa ;  there  was  an  ulcerated  bed-sore  over  the  sacrum  three  and  a  half  inches  in  diameter; 
sinuses  led  from  the  surface  into  the  knee-joint;  and  there  were  abscesses  in  the  middle  and  lower 
htird  of  the  thigh  and  the  leg.  The  entire  limb  became  erysipelatous,  there  was  muscular 
anchylosis  of  the  Lip-joint,  and  on  the  least  motion  of  the  knee-joint  caused  excessive  pain.  The 
patient  would  not  consent  to  an  operation  until  April  25,  1867,  when,  despairing  of  his  life,  he 
allowed  equ.il  parts  of  ether  and  chloroform  to  be  administered  and  the  thigh  to  be  amputated  in 
its  upper  third,  by  short  anterior  and  long  posterior  flap  method.  Light  and  perfectly  dry  dressings 
were  afterward  applied.  The  stump  healed  by  first  intention  at  every  point,  except  in  the  angles 
of  the  flaps,  iu  one  of  Avhich  were  the  ligatures.  On  the  nineteenth  day  after  operation  the  liga- 
tures came  away,  the  stump  was  entirely  healed,  and  the  patient  was  able  to  leave  his  bed.  An 
examination  of  the  amputated  limb  showed  extensive  disorganization  of  the  knee-joint  and 
abscesses  in  the  leg  and  thigh,  which  had  dissected  up  the  muscles  from  the  bones  and  from  each 
other  throughout  the  limb.  The  lower  portion  of  femur  and  tipper  half  of  tibia  and  fibula  showed 
the  entire  surface  denuded  of  periosteum,  and  eroded.  There  was  bony  anchylosis  of  the  knee-joint. 

DCV. — Account  of  an  Amputation  of  the  Thigh  for  Disease  of  the  Knee- Joint.    By  W.  F.  SMITH, 

Assistant  Surgeon,  U.  S.  A. 

Private  Thomas  Eyan,  Troop  A,  5th  Cavalry,  aged  24  years,  was  admitted  to  the  post  hospital 
at  Raleigh,  North  Carolina,  on  May  26,  1866,  with  flbro-cellular  disease  of  the  lower  extremity  of 
the  right  femur,  involving  the  knee-joint,  attributed  to  a  kick  by  a  horse.  On  August  18, 1866,  the 
knee-joint  was  enormously  enlarged,  and  the  skin  was  tense  and  shining.  In  some  spots,  fluctuation 
was  perceptible.  An  immense  sac,  of  what  proved  to  be  disintegrated  blood,  extended  as  far  as 
the  middle  of  the  thigh.  The  patient  was  slightly  worn  from  constant  pain,  but  his  general  health 
was  excellent.  On  this  date,  I  chloroformed  the  patient,  and  amputated,  by  circular  operation,  at 
the  junction  of  the  upper  thirds  of  the  thigh.  The  case  progressed  uninterruptedly  well  for  three 
weeks,  when  the  patient  was  attacked  by  very  severe  bilious  remittent  fever,  which  terminated  in 
death  on  September  17, 1866.  No  autopsy. 

DCVI. — Account  of  an  Amputation  of  the  Thigh  for  Chronic  Inflammation  of  the  Knee-Joint.     By 
A.  S.  EHLE,  M.  D.,  Acting  Assistant  Surgeon. 

Jackson  Washington,  a  freedmau,  aged  22  years,  was  admitted  to  the  hospital  at  Little  Eock, 
Arkansas,  on  January  5,  1867,  with  chronic  inflammation  of  the  right  knee-joint.  There  was  a 


AMPUTATIONS  OF  THE  THIGH.  213 

constant  discharge  from  two  flstulous  openings  on  the  outer  side  of  the  kuee,  communicating  with 
the  joint,  and  the  patient  was  much  emaciated.  Never  having  received  a  blow  or  kick  about  the 
knee,  the  patient  could  assign  no  cause  for  the  disease,  except  that  he  had  been  obliged  to  work  in 
the  water  a  number  of  days  just  previous  to  its  commencement,  about  six  weeks  before  admission  to 
hospital.  Iron  and  quinine  were  immediately  ordered,  under  which  his  appetite  and  general  health 
improved.  On  February  20th,  Surgeon  J.  It.  Smith,  U.  S.  A.,  amputated.the  thigh  at  the  junction 
of  the  lower  thirds  by  the  flap  operation.  During  the  first  day,  the  patient  was  apparently 
recovering  from  the  shock  of  the  operation,  and  it  was  thought  he  would  surely  recover  until  the 
morning  of  the  25th,  when  slight  twitchings  of  the  extremities  were  observed,  which  increased 
in  violence  and  frequency,  death  occurring  at  2  o'clock  on  the -afternoon  of  the  same  day.  The 
pathological  specimen,  with  history,  was  contributed  to  the  Army  Medical  Museum  by  Acting 
Assistant  Surgeon  A.  S.  Ehle,  and  is  No.  4722,  Section  I. 

DC  VII. — Note  relative  to  an  Amputation  of  the  Thigh  for  Gunshot  Injury.    By  J.  B.  GRAND  ALL, 
M.  D.,  Acting  Assistant  Surgeon. 

First  Lieutenant  Ephraim  W ,  5th  Infantry,  aged  30  years,  received,  in  an  engagement  with 

Indians,  sixty  miles  west  from  Fort  Dodge,  Kansas,  September  23,  1867,  a  gunshot  wound  of  left 
thigh,  extensively  fracturing  the  femur.  He  was  on  the  next  day  admitted  to  post  hospital,  Fort 
Dodge,  Kansas,  much  prostrated  from  shock  of  wound  and  transportation.  The  injured  parts  were 
in  good  condition.  On  September  25th,  Assistant  Surgeon  H.  A.  DuBois,  U.  S.  A.,  administered 
chloroform,  and  amputated  with  anterior  and  posterior  skin  flaps  at  junction  of  middle  and  upper 
thirds.  The  patient  bore  the  operation  very  well,  and  improved  rapidly.  [This  officer  was  retired 
April  3,  1869.] 

DC VIII. — Remarks  on  an  Amputation  of  the  Th'ujh  on  Account  of  Injury.    By  W.  SHACKLEFORD, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Daniel  M.  Young,  Co.  F,  23d  Infantry,  was  run  over  by  the  wagon  of  which  he  was 
teamster,  February  29,  1868,  producing  a  compound  fracture  of  the  middle  third  of  the  left  tibia 
and  fibula.  He  was  admitted  to  post  hospital,  Camp  Watson,  Oregon.  The  leg  was  first  put  in  a 
fracture-box,  and  constant  application  of  snow  maintained  until  suppuration  and  displacement  of 
fractured  parts  by  swelling  rendered  this  useless.  By  the  12th  of  March,  the  soft  parts  were  very 
much  inflamed  and  painful,  and  suppuration  extended  to  the  knee-joint.  The  patient  was  much  debil- 
itated from  loss  of  sleep,  anorexia,  and  continued  great  pain.  He  was  very  nervous,  and  his 
digestion  was  much  impaired  by  opium,  given  to  allay  pain.  On  the  latter  date,  chloroform  was 
administered,  and  the  thigh  amputated  just  above  the  knee-joint,  by  the  circular  method.  The 
expended  condition  of  the  patient  and  the  considerable  evolvement  of  the  knee-joint  rendered  a 
more  economical  course  dangerous.  The  patient  immediately  began  to  improve  without  one 
untoward  symptom  ;  his  recovery,  however,  was  delayed  by  a  haemorrhage  from  a  small  artery  on 
the  day  following  the  operation,  and  by  a  fall,  June  31st,  the  whole  weight  of  his  body  striking 
upon  the  stump.  On  the  17th  of  May,  1869,  he  was  examined  for  an  artificial  limb,  and  at  that 
time  the  stump  was  perfectly  healed. 

DCIX. — Memorandum  Relating  to  a  Secondary  Amputation  of  the  Thigh,  in  the  Middle  Third,  for 
Gunshot  Injury. 

Dr.  J.  A.  Freeman,  formerly  of  the  U.  S.  Colored  Troops,  reports  that  he  was  consulted  on 
March  15,  1868,  by  John  H.  Echstrand,  late  a  lieutenant  of  the  same  organization,  relative  to  a 
tumor  near  the  left  popliteal  space.  Ascertaining  the  previous  history  of  the  patient,  it  was  found 
that  he  had  been  wounded  at  Lookout  Mountain,  November  24, 1863,  by  a  fragment  of  shell,  which 
entered  the  left  tibia  externally,  just  below  the  head,  causing  him  to  remain  off  duty  only  a  few 
days.  Again  on  August  30,  1«64,  he  was  wounded  by  guerrillas,  a  pistol  ball  having  fractured  his 


214  KEPOKT  OF  SUKGICAL  CASES  IN  THE  AKMY. 

left  femur.  One-half  the  ball  had  been  extracted,  and  the  femur  had  united  so  that  he  was  able  to 
walk  with  a  cane  in  six  months;  but  he  always  had  pain  in  the  region  of  the  first  wound,  and  in 
September,  1867,  the  difficulty  of  locomotion  increased.  Cutting  down  upon  the  tumor  it  was 
found  to  be  scirrhous,  extending  across  beneath  the  anterior  ligament,  and  continuous  with  the 
synovia!  membranes  of  the  joint,  which  were  increased  to  an  inch  in  thickness.  The  tumor  and 
tiie  tibia  were  found  to  be  softening.  The  patient  was  unsuccessfully  treated  until  July  17,  when 
amputation  of  the  thigh  just  above  the  seat  of  the  fracture  was  performed.  The  wound  was 
dressed  with  carbolic  acid  and  glycerine,  and  healed  by  first  intention,  except  at  the  points  of  exit 
of  the  ligatures.  On  September  18, 1868,  the  operator  reported  his  patient  to  be  "  well  and  hearty, " 
and  transmitted  to  the  Army  Medical  Museum  the  pathological  specimens,  which  are  numbered 
5479  and  5480,  respectively,  of  the  Surgical  Section.  The  first  is  the  lower  half  of  the  left  femur, 
showing  a  well  united  oblique  fracture ;  the  second,  the  proximal  extremity  of  the  tibia,  perforated 
autero-posteriorly,  from  which  the  entire  caucellous  tissue  is  absent. 

Amputations  at  the  Hip- Joint. 

DCX. Report  of  a  Case  of  Secondary  Amputation  at  the  Hip  for  Gunshot  Injury*    By  HENEY  A. 

DuBoiS,  Assistant  Surgeon  U.  S.  A. 

"Antonio  Mutieres,  a  Mexican,  aged  33  years,  employed  by  the  Quartermaster's  Department  as 
a  teamster,  was  received  into  the  post  hospital  at  Fort  Union,  New  Mexico,  on  May  11,  1867.  Early 
that  morning  he  had  had  a  difficulty  with  another  Mexican,  employed  in  the  same  train,  which 
resulted  in  his  drawing  a  pistol  on  his  opponent,  who  instantly  drew  his  revolver  and  fired  at 
Mentieres,  the  ball  taking  effect  in  his  left  hip.  I  saw  the  case  soon  after  the  patient's  admission, 
at  about  eleven  in  the  forenoon,  and  found  the  wound  of  entrance  about  two  inches  beneath 
and  a  little  in  front  of  the  anterior  superior  spinous  process  of  the  ilium.  The  man  was  suttering 
but  little,  and  there  was  scarcely  any  h;emorrhage.:  I  enlarged  the  wound  and  introduced  my 
finger,  and  traced  the  ball  to  the  neck  of  the  femur,  where  it  was  firmly  lodged  in  the  anatomical 
neck  of  the  bone.  With  a  Tiemann's  bullet  forceps,  I,  with  some  trouble,  removed  the  ball  and  a 
small  piece  of  wadding.  It  was  an  ordinary  conical  revolver  ball,  and  was  fired  from  a  distance 
not  exceeding  two  or  three  yards.  The  man  was  kept  perfectly  quiet,  a  cold-water  dressing  applied, 
and  he  was  fed  with  easily  digested  and  nourishing  food.  At  this  time,  and  for  the  period  of  some 
two  weeks,  there  was  no  inflammation  involving  the  joint,  a  smart  blow  on  the  heel  causing  no 
pain.  The  patient  gradually  lost  flesh,  but  suffered  little.  The  discharge  from  the  wound 
consisted  of  ill  formed  pus  having  little  smell,  and  occasionally  streaked  with  blood.  A  few 
small  fragments  of  bone  were  subsequently  exfoliated.  The  patient  slept  but  little,  and  pre- 
spired  much  at  night ;  his  appetite  also  diminished,  and  he  was  evidently  losing  strength 
daily.  To  these  symptoms  the  following  were  afterward  superadded  :  Intense  pain  running  up 
the  side  and  down  the  thigh  to  the  ankle,  much  aggravated  by  the  slightest  movement  or  by  the 
least  pressure  on  the  part.  These  symptoms  increasing,  I  proposed  the  operation  afterward 
performed,  but  could  not  gain  the  patient's  consent  thereto,  he  informing  my  interpreter  that  he 
would  be  up  and  on  his  crutches  in  two  weeks.  I  had,  previous  to  this,  made  up  my  mind  as  to  the 
propriety  of  amputating  at  the  hip,  and  felt  confident  of  ultimately  obtaining  the  patient's  consent 
as  a  relief  from  the  terrible  pain  suffered  in  these  cases.  I  had  rejected  the  operation  of  excision, 
as  in  the  only  case  in  which  I  had  performed  it  t  it  had  caused  a  shock  as  great  to  the  system  as 
I  believed  would  result  from  amputation,  and  though  I  found  any  number  of  authors  who  recom- 
mended excision,  in  preference  to  amputation,  in  this  class  of  cases,  I  found  also  that  they  had,  with 
few  exceptions,  never  tried,  or  seen  it  tried,  in  cases  resulting  from  gunshot  injuries.  Of  the  thirty- 
two  cases  in  which  excision  was  performed  during  the  late  war,  four  only  were  successful,  aud  how 
far  they  succeeded  in  giving  a  useful  limb  is  not  fully  recorded.^  Surgeon  J.  C.  McKee,  who  was 


*  See  a  Report  on  Amputations  at  the  Hip-Joint  in  Military  Surgery,  Circular  No.  7,  S.  G.  O.,  1867,  p.  46 ;  and  American 
Medical  Kecord,  Vol.  II,  p.  266. 

t  See  a  Report  on  Excisions  of  the  Head  of  the  Femur  for  Gunshot  Injury,  Circular  No.  2,  S.  G.  O.,  ISt'.li.  <'a>c  I,  VI,  p.  41». 
{  See  Circular  No.  6,  S.  G.  O.,  1865,  pp.  61-74. 


AMPUTATIONS  AT  THE  HIP- JOINT  215 

visiting  the  post  at  this  time,  examined  the  case  and  advised  amputation  in  preference  to  excision. 
Some  ten  days  after  I  first  proposed  the  operation,  I  obtained  the  patient's  consent,  and  as  I  deemed 
it  advisable,  owing  to  the  rapid  loss  of  strength,  that  the  operation  should  be  performed  as  early 
as  possible,  I  at  once  made  my  arrangments,  and  on  June  22d,  having  obtained  the  assistance 
of  Dr.  Shout,  of  Las  Vegas,  Dr.  Simpson,  of  Moro,  and  of  Hospital  Steward  Enfield,  TJ.  S.  A.,  I 
proceeded  at  half  past  twelve  in  the  afternoon  to  amputate.  I  had  had  previously  constructed 
a  rough  clamp  for  compressing  the  aorta.  The  patient  was  quickly  put  under  the  influence  of  a 
mixture  of  ether  and  chloroform,  removed  to  the  operating  table,  and  all  my  assistants  having 
previously  been  informed  of  their  duties,  the  operation  was  quickly  and  readily  performed,  the 
thigh  being  removed  in,  I  am  told,  fifteen  seconds.  The  clamp  controlled  the  arterial  haemorrhage 
well ;  in- fact,  so  well  that  it  was  extremely  difficult  to  find  and  secure  the  arteries ;  but  the  venous 
haemorrhage  was  more  troublesome.  Some  fifteen  ligatures  were  used  in  all.  Little  blood  was 
lost.  The  acetabulmn  was  found  much  necrosed,  and  the  tissues  a  good  deal  diseased.  The 
diseased  structures,  as  far  as  practicable,  were  removed,  and  a  cerate  cloth  laid  between  the 
flaps,  and  the  patient  then  put  to  bed.  His  condition  during  the  operation  was  on  the 
whole  good.  The  pulse  several  times  became  extremely  feeble,  but  it  quickly  rose  again  under 
slight  stimulation.  The  breathing  was  free.  The  clamp,  which  made  pressure  one  inch  above 
and  to  the  left  side  of  the  umbilicus,  apparently  caused  no  inconvenience,  and  certainly  interfered 
very  little,  if  any,  with  his  regular  breathing.  The  anterior  flap  was  made  long  while  the  posterior 
one  was  extremely  short.  The  patient,  before  taking  the  anaesthetic,  received  hypodermically  one- 
half  a  grain  of  rnorphire  sulph.,  and  on  recovering  from  their  joint  influence  talked  and  seemed  at 
perfect  ease.  He  was  given  small  quantities  of  beef-tea  and  brandy,  and  also  a  little  ammonia,  as 
the  pulse  was  feeble  and  rapid.  He  complained  of  great  thirst,  and  craved  ice,  which  was  given 
to  him  in  small  quantities.  I  hoped  by  these  means  to  bring  about  reaction  and  overcome  the 
profound  shock  under  which  his  system  was  laboring.  His  pulse  gradually  became  more  feeble,  ran 
up  to  160  and  180,  and  became  imperceptible,  and  yet  he  was  living,  talked  much,  and  in  every 
way  perfectly  sensible.  He  complained  of  hunger,  said  he  was  as  hungry  as  a  dog,  and  rejected 
almost  immediately  everything  he  took  into  his  stomach.  In  this  condition  I  resorted  to  hypodermic 
injections  of  tincture  of  opii,  with  the  effect  of  bringing  up  the  pulse  and  quieting  to  some  extent  the 
irritability  of  the  stomach.  In  this  state  he  lingered  about  thirty  hours,  sometimes  almost  entirely 
pulseless ;  but  with  a  warm  skin  and  prespiring  profusely ;  at  other  times  with  a  quick  feeble  pulse, 
sleeping  a  few  moments  at  a  time,  until  half  past  five  in  the  evening  of  the  day  after  the  operation, 
when,  taking  a  piece  of  ice  in  hisruouth,  he  said, "  lam  going,  "and  died  almost  immediately.  Apost- 
mortem  examination  showed  the  flaps  glazed  to  some  extent  but  not  united. .  Wife  sutures,  it  should 
have  been  stated,  were  used  to  close  the  wound,  which  was  done  some  ten  hours  after  the  operation. 
The  acetabulum  and  head  of  the  femur  were  both  extremely  necrosed,  and  the  tissues  much  diseased. 
If  the  operation  did  not  save  the  life,  it  at  least  promoted  the  happy  dying,  the  Euthanasia  which 
Hippocrates  says  the  physician  should  have  as  his  second  object,  considering  the  saving  of  life  his 
first." 


DCXI. — Of  a  Case  of  Re-amputation  at  the  Hip- Joint.    By  GEORGE  A.  OTIS,  Assistant  Surgeon, 
U.  S.  A. 

v 

Private  J.  Fabry,  Co.  K,  4th  Artillery,  aged  38  years,  was  wounded  by  shrapnel,  August  16, 
1864,  at  Deep  Bottom,  Virginia,  his  left  leg  being  shattered,  and  a  portion  of  the  projectile  lodged 
about  the  knee.  His  leg  was  amputated  at  daybreak  the  morning  following,  by  Surgeon  G.  W. 
Jackson,  53d  Pennsylvania  Volunteers,  and  he  was  sent  to  the  hospital  at  City  Point,  and  thence 
to  Philadelphia.  On  August  23d,  the  stump  suppurating  and  sloughing,  an  amputation  through 
the  knee-joint  was  done  by  Acting  Assistant  Surgeons  Atlee  and  Egan.  On  August  28th  a  fuse 
screw  was  extracted  from  the  muscles  of  the  thigh  by  Acting  Assistant  Surgeon  J.  B.  Eoe.  The 
Satterlee  Hospital  Eeport  for  September,  1864,  represents  the  patient  as  weak,  and  with  a  bed-sore 
over  the  sacrum;  necrosis  of  the  femur,  with  more  pain  than  large  doses  of  morphia  would 
alleviate.  On  February  4,  1865,  an  incision  was  made  to  evacuate  an  abscess  that  had  formed  in 


216  REPORT  OF  SURGICAL  CASES  IF  THE  ARMY. 

the  ontcr  part  of  the  thigh.  A  piece  of  cloth  was  removed  from  the  cavity  of  the  abscess.  On 
May  25, 18C5,  this  soldier  was  sent  to  regimental  headquarters  at  Fort  Washington.  Abscesses, 
which  Acting  Assistant  Surgeon  J.  H.  Bayne  endeavored  to  drain  by  setons,  continued  'to"  form 
within  the.  tissues  of  the  stump.  In  October,  1865,  the  patient  received  an  artificial  limb,  but  could 
not  use  it  without  discomfort.  During  the  winter,  the  stump  was  irritable  and  tender.  On 
January  12, 1866,  the  regiment  changing  station,  Fabry  was  discharged  on  surgeon's  certificate  of 
disability,  and  was  received  at  Soldiers'  Home,  January  31,  1866.  The  remnant  of  the  femur  was 
affected  by  osteomyelitis,  and  Surgeon  Laub,  U.  S.  A.,  had  frequent  occasion  to  have  the  stump 
poulticed  and  abscesses  opened.  October  27, 1866,  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  cloacae,  and  discovering  a  sequestrum, 
consisting  of  the  shaft  of  the  femur.  Fabry  was  pensioned,  and  remained  at  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  albuininuria,  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.  When  suffering  from  the  abscesses  in 
his  stump,  Fabry  would  beg  that  an  amputation  should  be  practiced ;  but,  as  soon  as  the  pain  was 
mitigated,  his  resolution  would  fail.  Finally,  he  made  up  his  mind  to  liudergo  the  operation,  and, 
on  May  15, 1870,  I  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  trans- 
fixion. The  accompanying  wood-cut  will 
indicate  the  extent  of  these  osseous  forma 

FIG.  43. — Au  nnusnally  largo  in  rolncrnm,  from  a  case  of  chronic  ostcomy-      tionS.      Fabl'J"  had  a  rather  rapid  COHValCS- 
elitis.    Spec.  5684,  Sect.  I,  A.  M.  M.  ^^  ^.^  abou<.  Qn    cmtches  in    tweuty- 

one  days.  The  cicatrix  remains  at  this  date,  fourteen  months  and  more  after  the  operation,  perfectly 
sound  and  firm,  and  Fabry,  who  remains  as  a  pensioner  at  Soldiers'  Home,  enjoys  good  general 
health.  The  lithograph  opposite  is  accurately  copied  from  a  photograph  of  him,  made  at  the  Army 
Medical  Museum  one  year  after  the  operation. 

Amputation  of  all  four  Limbs. — One  instance  of  this  remarkable  surgical  undertak- 
ing was  reported. 

DCXII. — Report  of  a  Case  of  Recovery  after  all  Four  Limbs  were  Amputated  on  Account  of  Frost- 
Bite.    By  ALFRED  MULLEK,  M.  D.,  Acting  Assistant  Surgeon. 

Benjamin  Franklin,  a  private  of  Troop  H,  2d  Minnesota  Cavalry,  aged  26  years,  left  Fort 
Wadsworth,  Dakota  Territory,  on  December  9,  1865,  on  furlough  to  visit  his  home  in  Faribault 
County,  Minnesota.  After  being  three  days*  out  in  the  stage  from  Fort  Wadsworth  to  Fort 
Ridgely,  Minnesota,  the  party  of  which  he  was  a  member  being  overtaken  by  a  severe  snow-storm, 
which  continued  three  days,  was  obliged  to  leave  the  stage,  on  December  13th,  in  a  snow-drift  on  the 
prairie,  distant  about  one  hundred  and  ten  miles  from  the  place  of  destination.  He  wandered  over 
the  prairie  that  day  and  night,  and  the  following  four  days,  through  the  storm,  freezinghis  limbs,  nose, 
ears,  and  cheeks,  taking  no  food  or  water,  until  found  in  a  dying  condition  by  Indian  scouts,  and 
taken  to  a  station-house  on  the  road,  on  December  17,  1865.  He  was  sent  to  hospital  at  Fort 
Ridgely,  for  treatment,  where  he  arrived  on  the  night  of  the  2ith,  almost  completely  exhausted. 
After  slowly  thawing  the  ice  from  his  clothes,  stockings,  and  boots,  which  had  not  been  removed 
since  December  13th,  it  was  found  that  both  hands  and  fore-arms  were  completely  mortified  by 
freezing  up  to  middle  third,  both  feet  and  legs  as  far  as  theupper  third,  both  knees  over  and  around 
the  patella3,  and  both  alre  and  the  tip  of  the  nose,  all  presenting  a  dark,  bluish  appearance  with 

'The  details  of  the  operation  and  after-treatmont  have  appeared  in  the  American  Journal  of  the  Medical  Scienee", 
Vol.  LXI,  page  141. 


PL  I. 


Circular  N?  3,  S.G.0.1871. 


Ward,  phot. 


OTISS  SUCCESSFUL  RE-AMPUTATION  AT  THE  HIPJOINT. 


AMPUTATION  OF  ALL  FOUR  LIMBS.  217 

some  swelling:,  and  were  fairly  circumscribed.  No  evacuation  of  the  bowels  having  taken  place 
since  December  9th,  and  the  patient  suffering  from  singultusand  constant  pain  in  epigastric,  region 
a  light  cathartic  was  administered,  which,  in  twenty-four  hours,  gave  relief.  A  mild  but  nourishing 
and  stimulating  diet  was  given,  which,  in  a  week's  time,  improved  his  condition.  The  four  frozen 
limbs  were  enveloped  in  cloths  moistened  with  a  solution  of  chloride  of  /inc.  The  frozen  ears  and 
cheeks  healed  in  due  time,  and  presented  nothing  remarkable.  The  gangrenous  parts  of  the  nose 
separated  on  January  G,  1866,  and  soon  healed,  with  the  loss  of  the  tip  of  the  nose  and  parts  of  the 
alse,  leaving  the  septum  somewhat  exposed.  On  January  10th,  the  lines  of  demarcation  on  all  four 
limbs  and  the  patella'  were  distinct  and  deep.  A  most  offensive  smell  was  emitted,  in  spite  of  the 
liberal  use  of  disinfectants  ;  notwithstanding  this  the  patient  obstinately  opposed  operative  inter- 
ference, being  strongly  seconded  by  his  wife.  On  January  13th,  the  patient,  after  a  little  hesitancy, 
consented  to  the  amputation  of  the  arms.  15y  this  time  the  lines  of  demarcation  had  exposed  the 
bones,  and  as  the  patient  refused  the  administration  of  an  anesthetic,  and  his  debilitated  condition 
not  admitting  the  loss  of  blood,  it  was  determined  to  carefully  dissect  as  much  healthy  flesh  from 
the  radius  and  ulna  as  the  line  of  demarcation  would  admit  without  cutting  any  blood-vessels, 
and  then  saw  through  the  bones.  This  was  successfully  done  on  both  fore-arms,  in  middle  third, 
the  patient  losing  very  little  blood,  and  complaining  of  hardly  any  pain.  The  great  relief  afforded 
by  this  operation  so  changed  his  former  aversion  to  being  operated  on,  that  on  the  next  day,  he 
begged  to  have  both  legs  amputated  in  the  same  manner,  which  was  done,  three  days  afterward, 
and  with  the  same  favorable  results.  In  this  case,  the  four  stumps  coidd  not  be  covered  with 
sufficient  skin,  and  much  had  to  be  left  to  self-reparation,  which  took  place  to  an  extraordinary 
extent, -keeping  even  step  with  the  gradual  improvement  of  the  unfortunate's  condition.  The  four 
stumps  healed  over  with  healthy  granulations,  requiring  the  removal  of  only  two  pieces  of  bone, 
one  from  the  right  tibia,  and  one  from  the  left  ulna,  which  separated  on  April  17th  and  ±>d 
respectively.  After  applications  of  diluted  nitric  acid,  the  conical  st  umps  soon  became  covered  with 
a  solid  cicatrix.  Meanwhile,  the  open  sores  over  the  patella*,  on  both  knees,  which  became  as  large 
as  the  palm  of  a  hand,  after  the  separation  of  the  gangrenous  parts,  had  undergone  cicatrization. 
They,  however,  reopened  in  a  fistulous  manner  about  the  middle  of  April,  and  it  was  found  that  in 
both  of  the  patellas  large  sequestra?  had  formed.  A  longitudinal  incision  was  made  over  the  right 
patella,  and  a  large  portion  of  the  front  part  of  this  bone  was  easily  removed.  Another  portion 
was  also  removed  from  the  left  patella,  but  with  more  difficulty.  Both  knees  readily  healed,  leaving 
the  patelhe  anchylosed.  The  patient  was  mustered  out  of  service  with  his  company  on  April 
28,  I860;  but  remained  under  treatment  until  June  10,  1800,  when  he  left  for  his  home,  perfectly 
recovered.  The,  same  year,  Congress  passed  a  special  .act  pensioning  him  for  total  disability.  The 
pathological  specimens,  with  history,  were  contributed  to  the  Army  Medical  Museum  by  the  operator, 
and  arc  numbered  4711,  Surgical  Section  and  consists  of  four  exfoliations.  Dr.  Midler  expresses 
the  belief  that  the  patient  can  never  make  use  of  artificial  limbs. 

Of  the  two  hundred  and  fifty-one  cases  of  amputations  cited  in  the  foregoing  reports, 
twenty-five  resulted  fatally  ;  one  hundred  and  forty-three  were  due  to  gunshot  wounds ; 
eight  to  railway  accidents  ;  nine  to  incised  wounds  ;  forty-five  to  other  injuries  ;  forty-one 
to  frost-bites  ;  and  five  to  diseases.  Setting  aside  the  one  hundred  and  thirty-six 
successful  operations  on  the  fingers  and  toes,  there  remain  one  hundred  and  fifteen  major 
amputations,  with  a  mortality  rate  of  21.7 — a  very  favorable  exhibit.  Sixty-three  of 
these  major  amputations  were  primary,  twenty-seven  were  intermediary,  and  twenty-five 
were  secondary.  The  death  rate  in  these  classes  was,  for  once,  almost  uniform,  being 
primary  22.2,  intermediary  22.2,  secondary  20.  This  circumstance  is  explained  partly  by 
the  small  number  of  cases  analysed,  and  partly  by  the  proportion  of  severe  cases  included 
in  the  primary  class.  Among  the  major  amputations  not  less  than  seventeen  were  multiple 
amputations  :  of  fore-arms,  2  ;  of  arm  and  fore-arm,  4  ;  of  feet,  3  ;  of  legs,  4  ;  of  leg  and 
foot,  2  ;  of  thigh  and  leg,  1  ;  of  four  extremities,  1  ;  with  three  fatal  results  only. 
28 


218 


REPORT  OF  SURGICAL  GASES  IN  THE  ARMY. 


TABTTLAB  STATEMENT  OF  CCL  AMPUTATIONS. 
Results  of  One  hundred  and  Sixty-four  Amputations  in  the  Upper  Extremities. 


REGION. 

M 

O 

9 

Intermediary. 

Secondary. 

Date  of  opera- 
tion unknown. 

Successful. 

"3 

4^ 

s 

Result  unde- 
termined. 

o 

2  ** 
'-5 

114 
2 
20 
24 
4 

75 
2 
IB 

18 
3 

17 

6 

16 

114 
2 
18 
19 
3 

1 

3 

2 
5 
1 

10.0 
20.8 
25.0 

3 
1 

Total    

164 

117 

21 

10 

16 

106 

8 

4.9 

Results  of  Eighty-six  Amputations  in  the  Lower  Extremities. 


REGION. 

QQ 

0 

| 

1 

*£H 

PH 

Intermediary. 

a 

Date  of  opera- 
tion unknown. 

3 

O 

^ 

1 

Result  unde- 
termined. 

it 
o 

a  . 

£ 

<4H      -*^ 

o  a 

0    -3 

;i 

K 

22 

4 

5 

9 

4 

22 

Amputations  of  Foot  

6 

2 

3 

1 

6 

4 

1 

3 

3 

1 

25  0 

23 

8 

11 

4 

18 

5 

21  7 

Amputations  at  Knee-joiiit  

3 

1 

2 

3 

26 

"  10 

5 

11 

16 

10 

38  5 

Amputations  at  Hip-joiut 

2 

2 

1 

1 

50  0 

Total  

86 

25 

28 

29 

4 

69 

17 

19.8 

To  these  two  hundred  and  fifty  cases  must  be  added  the  instance  of  amputation  of 
the  four  extremities  (p.  216).  As  has  been  already  remarked,  the  mortality  rate  was 
unusually  small.  In  looking  over  the  reports,  it  is  impossible  to  avoid  the  conviction  that 
the  medical  officers  greatly  profited  by  the  experience  of  the  War,  and  performed  their 
operations  with  little  regard  for  the  narrow  rules  laid  down  in  the  text-books,  preferring 
to  adapt  their  incisions  to  the  exigencies  of  particular  cases.  The  method  of  making  flaps 
of  the  skin  and  subcutaneous  tissue,  reflecting  them,  and  dividing  the  muscles  circularly, 
which  had  many  advocates  during  the  War,  remains  in  favor. 


219 


EXCISIONS.       • 

Twenty-nine  special  reports  of  cases  of  excision  were  made  ;  five  Were  excisions  of 
the  bones  of  the  head  ;  sixteen  of  the  upper  extremities,  and  eight  of  the  lower  extremities. 
Among  excisions  I  include  operations  for  trephining,  and  for  removal  of  parts  of  the  bones 
of  the  face.  This  classification  must,  I  think,  be  hereafter  adopted,  although  systematic 
authors  have  heretofore  generally  restricted  the  term  "  excisions  "  to  the  removal  of  the 
articular  extremities,  or  of  portions  of  the  shafts  of  the  long  bones. 


EXCISIONS   OF   THE   BONES   OF   THE   HEAD. 

Trephining. — Two  successful  cases  of  this  nature  were  reported. 

DCXIII. — Report  of  a  Compound  Fracture  of  the  Skull,  treated  successfully  by  Trephining.    By  A. 
C.  GIEAKD,  Assistant  Surgeon,  U.  S.  A. 

.  Private  John  Higgins,  Co.  I,  20th  Infantry,  aged  23  years,  was  admitted  to  the  post  hospital 
at  Baton  Rouge,  Louisiana,  March  9, 1869,  with  a  compound  fracture  of  the  skull  from  a  brick-bat. 
At  the  junction  of  the  left  parietal  and  frontal  bones,  near  the  sagittal  suture,  was  a  slight  depres- 
sion of  bone,  of  the  size  of  a  five-dollar  gold  piece ;  the  wound  of  the  scalp  was  two  inches  long, 
and  the  periosteum  was  destroyed.  The  wound  was  cleaned,  and  light  diet  ordered.  On  March 
10th,  fever  set  in  with  violent  headache,  and  the  pupils  became  dilated.  Chloroform  was  admin- 
istered, a  transverse  incision  elongating  the  wound  was  made.  The  bone  was  found  depressed  in 
a  triangular  shape,  the  deepest  depression  being  toward  the  forehead ;  the  skull  was  then  perfo- 
rated with  the  largest  of  drills,  expecting  by  breaking  through  the  communication  between  the 
crack  and  the  hole  with  a  chisel  to  have  sufficient  room  for  elevation.  The  elevator  was  then 
introduced,  but  failed  to  raise  the  depression.  The  smaller  trepan  was  then  applied,  using  the  drill 
hole  for  the  point  of  the  trepan,  and  three-fourths  of  the  depression  were  removed,  exposing  the 
dura  mater.  The  ragged  edges  of  the  hole  were  pared  down,  a  few  splinters  removed,  the  wound 
well  cleaned,  and  the  edges  of  the  scalp  united  by  suture  and  ichthyocolla  plaster.  The  patient  bore 
up  well  under  the  operation,  the  latter  part  of  which  was  performed  after  his  return  to  conscious- 
ness, as  he  had  shown  some  alarming  signs  while  being  put  a  second  time  under  the  influence  of 
chloroform.  Ice  was  applied  to  the  head,  and  calomel  in  small  doses  was  given.  On  March  llth 
the  patient  felt  tolerably  well,  but  still  suffered  some  headache ;  on  the  following  day  there  was 
erysipelatous  swelling  of  the  left  eye ;  no  headache.  March  14th  the  patient  complained  of  want 
of  rest,  and  shooting  pain  through  left  eye.  There  was  a  little  discharge  from  the  wound,  and  the 
incision  began  to  fill  with  granulations.  Thence  steady  improvement  took  place,  and  on  March  30th 
the  wound  had  nearly  closed.  This  man  was  returned  to  duty  in  May,  1869. 

DCXIV. — Report  of  a  Case  of  Fracture  of  the  Skull  treated  by  Trephining.— By  IBA  PERRY,  Assistant 
Surgeon,  9th  Colored  Troops. 

Jesus  Soklaco,  a  Mexican,  while  at  a  drunken  revel  in  Brownsville.  Texas,  June  1, 1866,  was 
struck  with  the  stock  of  a  gun,  which  caused  extensive  contusion  and  fracture  of  the  skull  from  the 
external  angle  of  the  orbit  of  left  eye  toward  the  occiput.  The  fracture  could  be  traced  through 
the  scalp  a  distance  of  six  inches.  About  one  inch  from  the  orbital  angle  was  a  portion  of  bone 
one  and  a  half  by  three-quarters  of  an  inch,  which  was  depressed  one-fourth  of  an  inch,  and  was 
loose.  The  patient  was  admitted  to  the  post  hospital  totally  unconscious,  with  pulse  slow  and  very 
feeble.  The  case  being  considered  hopeless,  water  dressings  only  were  applied;  on  the  third  day, 
the  patient  being  still  alive,  the  trephine  was  applied,  and  fragments  of  bone  elevated  ;  three  days 


220  EEPOET  OF  STJEGICAL  CASES  IN  THE  AEMY. 

later  the  patient  was  slightly  conscious ;  hernia  cerebri  appeared.  Until  the  tenth  day  the  patient 
had  taken  nothing  but  cold  water,  but  now  was  given  some  flour  gruel;  bowels  were  opened  for 
the  first  time  with  lavement  of  soap  and  water.  On  June  15th  the  protruding  brain  began  to 
slough  and  gradually  became  less  prominent.  On  June  21st  copious  hemorrhage,  apparently  from 
middle  meningeal  artery,  occurred,  and  continuing  for  two  hours,  was  controlled  by  pressure.  The 
patient  became  unconscious,  with  stertorous  breathing,  and  signs  of  compression,  but  on  June  25th 
consciousness  returned,  and  'a  gradual  improvement  took  place.  July  17th  the  wound  was  almost 
healed,  and  the  patient  was  removed  from  the  hospital  by  his  friends. 

Excisions  of  the  Bones  of  the  Face. — Three  special  reports  were  received  ;  another 
case  will  be  found  among  the  operations  for  tumors. 

DCXV. Abstract  of  a  Case  in  which  Portions  of  the  Superior  and  Inferior  Maxilla  were  Removed. 

From  a  report  by  JULES  LE  CARPENTIEK,  M.  D., -Acting  Assistant  Surgeon. 

Private  John  Francis,  Troop  E,  3d  Cavalry,  after  escaping  from  the  guard-house  at  Fort 
Bayard,  New  Mexico  (where  he  had  been  confined  by  the  civil  authorities  and  was  awaiting  trial 
for  murder),  went  to  Hot  Springs,  where,  on  April  12,  18G8,  upon  the  approach  of  an  escort, 
he  shot  himself  under  the  mouth  with  a  rifle.  The  patient  denied  all  attempts  at  suicide,  and 
alleged  the  shooting  to  be  accidental.  Soon  after  the  occurrence  he  was  conveyed  to  Bio  Meinbres 
for  better  attendance,  being  very  much  exhausted  and  in  a  doubtful  condition.  The  chin  and  most 
of  the  inferior  maxillary  were  carried  away,  the  superior  maxillaries  were  fractured,  and  the  soft 
parts,  including  the  tongue,  were  badly  lacerated  and  burned.  The  loss  of  voice  was  complete; 
and  the  whole  buccal  cavity,  being  exposed,  presented  a  hideous  appearance.  The  wound  was 
carefully  washed,  and  numerous  small  fragments  of  bone,  impacted  in  the  soft  tissues,  were 
removed.  Simple  dressings  were  applied,  anodynes  and  stimulants  were  prescribed,  and  a 
nourishing  liquid  diet  was  administered  by  means  of  a  syringe,  owing  to  the  patient's  inability  to 
swallow.  On  the  14th  the  patient  was  sent  to  the  post  hospital  at  Fort  Cummings,  New  Mexico. 
An  operation  was  delayed  "for  fear  of  extensive  suppuration,  sloughing  of  some  unseen  fragments 
of  bone,  &c.,  which  would  interfere  very  much  with  cicatrization."  On  the  night  of  the  ICth  the 
patient  suffered  severe  pain.  The  stimulants,  anodynes,  and  nourishing  diet  were  continued,  and 
the  wound  was  frequently  cleansed  with  a  weak  solution  of  carbolic  acid.  Oil  the  l!)th  several 
fragments  of  bone  were  removed,  after  which  the  pain  abated.  On  the  20th  three  of  the  upper 
incisors  fell  out.  On  the  25th  an  operation  was  resolved  upon,  when  the  patient  was,  with 
difficulty,  rendered  insensible  by  chloroform,  his  tongue  having  first  been  secured  by  a  thread 
passed  through  the  tip.  The  stages  in  the  operation  were  as  follow :  1st.  Removal  by  dissection 
of  two  large  pieces  of  the  superior  maxillaries.  2d.  Eemoval  by  dissection  of  a  large  piece  of  the 
inferior  maxillary,  fractured  on  the  right  side,  to  a  level  with  the  coronoid  process.  3d.  On  the 
left  side,  incision  extending  from  the  posterior  part  of  the  coronoid  process  to  the  labial  commissure, 
and  excision  of  the  bone  by  saw  and  pliers  to  a  level  with  that  process.  (This  procedure  was 
preferably  adopted  to  entire  disarticulation  of  the  bone,  in  order  to  leave  some  support  to  the  soft  • 
parts.)  4th.  Paring  the  edges  of  the  wound  and  keeping  them  approximated  by  interrupted 
suture,  after  which  the  deformity  of  the  face  was  not  very  considerable.  The  patient  was  kept 
two  and  a  half  hours  under  the  influence  of  chloroform,  and  seemed  to  stand  it  very  well.  His 
efforts  to  speak  were  somewhat  intelligible.  His  general  condition  was  good,  but  he  suffered  a  good 
deal  from  pain  iu  the  morning,  attended  with  fever  which  exacerbated  toward  the  afternoon.  The 
details  of  the  treatment  up  to  May  15th,  at  which  time  he  was  able  to  walk  round  the  ward,  are 
unimportant,  except  that  the  sutures  gave  way  entirely,  and  that  sticking  plaster  and  appropriate 
bandages  were  substituted.  Attempting  to  escape  on  the  night  of  the  23d,  he  was  confined  in  the 
guard-house;  but  on  the  25th  was  taken  back  to  hospital,  where,  on  the  27th,  a  small  fragment  of 
bone  was  removed  during  the  dressing.  His  condition  was  good;  but  great  difficulty  was 
experienced  in  feeding  him.  After  this  ineffectual  attempt  to  escape  he  declined  rapidly,  owing, 
no  doubt,  to  a  complete  absence  of  any  hope  whatever  for  escaping  trial,  and  he  died  on  June  2, 
18G8,  of  exhaustion. 


EXCISIONS  IN  THE  UPPEE  EXTEEMITIES.  221 

DCXVI. — Report  of  a  Case  in  which  a  Portion  of  the  Maxilla  was  Removed.    By  P.  MIDDLETON, 
Assistant  Surgeon,  U.  S.  A. 

Private  Joseph  Smith,  Troop  I,  8th  Cavalry,  was  shot  by  a  comrade  at  Camp  Whipple, 
Arizona  Territory,  November  17,  1867.  The  missile,  a  conoidal  ball,  entered  over  the  bridge  of 
the  nose,  and  taking  an  oblique  direction,  fractured  the  maxillary  bone  of  the  right  side.  He  was 
admitted  to  post  hospital  in  a  state  of  syncope.  The  excessive  haemorrhage  was  controlled  by 
plugging  the  wound  with  lint  saturated  with  liquor  of  the  persulphate  of  iron.  The  patient  grew 
weak  from  loss  of  blood,  the  face  became  puffy  and  swollen,  and  part  of  the  fractured  bone 
projected  into  the  mouth,  preventing  the  mastication  of  food.  On  November  28th  a  part  of  the 
maxillary  bone  of  the  right  side,  containing  molar  and  bicuspid  teeth,  was  removed.  The  missile 
could'  not  be  found.  Haemorrhage  was  controlled  by  plugging.  The  patient  did  well  until 
December  3d,  when  he  complained  of  pain  in  the  joints  and  back,  also  of  slight  numbness  of  feet 
and  hands.  These  symptoms  increased  until  December  10th,  when  the  anaesthesia  in  both  feet 
and  legs  up  to  the  knee  was  complete.  There  was  also  partial  loss  of  sensation  in  both  hands ; 
the  wound  was  nearly  healed,  appetite  good,  and  secretions  normal.  Under  a  magneto-electric 
treatment,  with  iron,  quinine,  strychnia,  and  iodide  of  potassium  he  gradually  improved,  being 
able  to  walk  on  December  20, 1867.  Sensations  were  almost  normal  again. 

DCXVII. — Note  of  a  Case  in  which  Fragments  of  the  Upper  Jaw  were  Excised.    By  W.  H.  KING, 
Assistant  Surgeon,  U.  S.  A. 

Private  Samuel  Walker,  Co.  D,  3d  Infantry,  aged  28  years,  was  wounded  on  November  13, 
1868,  by  a  conoidal  ball  in  the  right  side  of  the  face.  On  the  same  day  he  was  admitted  to  the 
hospital  at  Fort  Zara,  Kansas,  where  fragments  of  the  upper  jaw  were  excised.  He  was  returned 
to  duty  in  December,  1868. 

EXCISIONS   OF   THE   BONES   OF   THE   UPPER   EXTEEMITIES. 

^Excisions  of  the  Bones  of  the  Hand. — Six  cases  were  reported. 

DCXVIII. — Account  of  an  Excision  of  Metacarpal  Bones,  having  a  Fatal  Result.    By  P.  H.  BROWN, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Jerry  Hewes,  Co.  A,  9th  Colored  Troops,  aged  24  years,  was  wounded  on  September 
1,  1867,  in  the  right  hand.  He  was  admitted  to  the  regimental  hospital  at  Fort  Stockton,  Texas, 
where  an  excision  of  metacarpal  bones,  was  performed.  Pyaemia  supervened,  and  death  occurred 
September  15,  1867. 

DCXIX. — Memorandum  of  a  Case  in  which  a  Portion  of  the  Metacarpal  Bone  and  Phalanx  were 
Excised.    By  E.  H.  BOWMAN,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Thomas  H.  Whipper,  Co.  A,  24th  Infantry,  was  accidentally  wounded  in  the  left  hand 
at  Fort  Bliss,  Texas,  March  19, 1870.  The  missile  passed  through  the  anterior  portion  of  the 
hand,  destroying  the  articulation  of  the  middle  finger,  and  shattering  the  metacarpal  bone  for  one 
and  a  half  inches  above  the  joint.  He  was  admitted  to  post  hospital.  The  injury  was  powder- 
burned,  but  free  from  swelling.  Chloroform  was  administered,  and  one  inch  and  a  half  of 
metacarpal  bone  and  a  portion  of  the  first  phalanx,  making  two  inches  in  all,  were  excised.  Simple 
dressings,  with  application  of  carbolic  acid,  were  used.  The  patient  recovered  rapidly,  aud  was 
returned  to  duty  on  May  16,  1870. 

DCXX.— Account  of  an  Operation  for  Paronychia.    By  BENJAMIN  JAMES,  Hospital  Steward, 
U.  S.  A. 

Sergeant  Charles  Krouse,  Co.  G,  32d  Infantry,  aged  34  years,  was  admitted  to  the  hospital  at 
Camp  Goodman,  Arizona  Territory,  on  January  1,  1869,  with  a  whitlow  011  the  left  thumb.  The 


222  BBPOET  OF  SURGICAL  CASES  IN  THE  ARMY. 

last  phalanx,  being  found  diseased,  was  removed  through  an  incision  one  inch  in  length.    The 
patient  recovered,  and  was  returned  to  duty  on  February  10,  1869. 

DCXXL— Note  Relative  to  an  Excision  of  a  Metacarpal  Bone.    By  H.  F.  LIVINGSTON,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Thomas  Barrett,  Co.  I,  22d  Infantry,  was  admitted  to  hospital  at  camp  near  Crow 
Creek  Agency,  Dakota  Territory,  on  September  22, 1870.  Lacerated  wound  of  fore-finger  of  right 
hand.  Excision  of  metacarpal  bone.  Simple  dressings  were  applied.  He  recovered  and  Avas 
returned  to  duty  November  12,  1870. 

DCXXII. Minute  of  a  Case  in  which  a  Portion  of  the  Metacarpal  Bone  was  excised.    By  S.  M. 

HORTON,  Assistant  Surgeon,  U.  S.  A. 

Private  George  W.  Smith,  Co.  A,  27th  Infantry,  aged  18  years,  on  March  1, 1868,  at  Fort  Philip 
Kearney,  Dakota  Territory,  had  the  ring  finger  of  the  left  hand,  between  the  first  and  second  joints, 
sawed  off  by  a  circular  saw.  The  distal  end  of  the  metacarpal  bone  of  the  same  finger  was  also 
injured,  and  there  was  considerable  laceration.  Assistant  Surgeon  S.  M.  Horton  excised  the  distal 
half  of  the  metacarpal  bone  of  the  ring  finger  of  the  left  hand.  No  anaesthetic  was  used ;  cold- 
water  and  laudanum  dressings  were  applied,  and  the  parts  united  by  granulation  in  ten  days.  The 
man  was  discharged  from  service  May  3, 1868,  on  account  of  expiration  of  term  of  service,  but  he 
remained  in  hospital.  March  31st :  The  hand  is  nearly  healed. 

DCXXIII. — Remarks  on  an  Excision  of  a  Finger-Joint.    By  DONALD  JACKSON,  M.  D.,  Acting 

Assistant  Surgeon. 

Private  Frank  Castle,  Co.  C,  41st  Infantry,  aged  21  years,  while  in  a  brawl  with  other  enlisted 
men  in  quarters  at  Fort  Clark,  Texas,  on  the  night  of  September  8,  1868,  was  wounded  by  a  small 
pistol  ball,  which  entered  the  volar  aspect  of  the  left  index  finger,  and,  passing  through  the  inner 
side,  slightly  injured  the  first  phalanx  near  its  phalangeal  articulation.  Upon  being  admitted  to 
the  hospital,  simple  dressings  were  applied  until  it  became  evident  that  the  articular  extremities 
were  diseased,  when,  on  October  5th,  equal  parts  of  ether  and  chloroform  were  administered,  and 
the  joint  was  excised  after  making  an  incision  on  the  inner  side  of  the  finger.  The  wound  being 
well  cleansed,  was  brought  together  by  a  narrow  bandage.  On  the  8th  the  bandage  was  removed, 
and  simple  dressings  were  applied.  By  the  28th  the  wound  had  entirely  healed,  leaving  the  finger 
shortened  one-half  inch,  and  with  a  false  joint,  in  which  there  was  ample  motion.  On  November 
3, 1868,  the  patient  was  returned  to  duty. 

Excision  of  the  Bones  of  the  Fore-arm. — Only  one  case  of  this  nature  was  reported. 

DCXXIV. — Abstract  of  a  Case  of  Excision  of  the  Radius.    From  the  Report  of  F.  REYNOLDS, 
Assistant  Surgeon,  U.  S.  A. 

Charles  Arnold,  artificer  of  Battery  C,  2d  Artillery,  aged  30  years,  and  of  excellent  constitution 
and  usually  temperate  habits,  was  wounded  at  Fort  Stevens,  Oregon,  on  November  6,  1870,  by  the 
accidental  discharge  of  his  musket,  the  tompion  and  a  coiioidal  ball  having  passed  through  the 
upper  third  of  the  left  fore-arm,  producing  a  comminuted  fracture  of  the  radius,  severing  probably 
the  radial  and  interosseous  arteries,  and  causing  extensive  laceration  and  loss  of  tissue.  A  large 
vessel  was  also  supposed  to  have  been  displaced.  On  admission  to  the  hospital,  there  was  no  pulse 
at  the  wrist,  but  the  temperature  was  normal.  At  first,  it  was  determined  to  remove  the  limb ;  but 
the  temperature  of  the  hand  having  undergone  no  perceptible  change,  and  hoping  that  (lie  collateral 
vessels  would  prove  sufficient  for  its  support,  the  idea  was  abandoned.  Accordingly,  on  the  same 


EXCISIONS  IN  THE  HUMEEUS.  223 

day  (the  patient  being  very  fully  alcoholized),  tho  wound  was  enlarged  two  inches,  the  head  of  the 
radius  excised,  and  splinters  and  the  rough  extremity  of  the  remainder  of  the  bone  removed.  No 
anaesthetic  was  considered  necessary,  and  it  is  believed  by  the  operator  that  its  non-administration 
was  greatly  in  the  patient's  favor.  After  applying  carbolized  oil  dressings,  the  arm  was  placed  in 
a  splint.  Chloral  was  given  at  night,  and  was  continued  as  long  as  necessary.  On  December  31st, 
the  wound  had  almost  healed,  leaving  a  large  and  very  deep  cicatrix.  The  elbow  was  semi-flexed, 
and  the  motions  of  the  fingers,  wrist,  and  elbow  were  impaired,  but  rapidly  improving.  The 
dressings  and  anodyne  fulfilled  all  that  could  be  desired.  The  patient  was  discharged  April  6, 1871. 
Dr.  Eeynolds,  in  his  report,  makes  note  of  "the  very  slight  constitutional  sympathy  accompanying 
so  severe  a  wound."  He  regards  this  as  a  case  for  amputation  in  an  ordinary  subject,  and  thinks 
that  the  favorable  result  is,  in  a  great  measure,  owing  to  the  man's  good  habits  and  exceptionally 
good  constitution.  [He  forwards  the  interesting  specimen  in  the  case,  consisting  of  the  shattered 
upper  third  of  the  radius,  the  battered  musket-ball,  and  the  tompion.  These  are  mounted  together 
in  the  Museum  as  Specimen  5877,  Sect.  I.] 

Excisions  in  the  Shaft  of  the  Humerus. — Seven  successful  cases  of  excisions  of  the 
shaft  of  the  humerus  for  gunshot-wounds  were  reported. 

DCXXV. — Memorandum  relative  to  an  Excision  of  a  Portion  of  the  Humerus. 

Private  John  Haire,  Troop  B,  2d  Cavalry,  was  wounded  in  the  left  arm  at  Fort  McPherson, 
Nebraska  Territory,  on  March  5, 18G7,  by  a  rifle  ball,  which  fractured  and  comminuted  the  humerus 
at  the  middle  third,  necessitating  excision  of  the  bone  to  the  extent  of  about  four  inches.  The 
operation  was  done  by  a  linear  incision  forty-eight  hours  after  the  receipt  of  the  injury,  in  the 
hospital  of  the  post,  by  Surgeon  P.  C.  Davis,  U.  S.  A.  The  patient  was  discharged  August  5, 1867. 
On  September  29, 1809,  Dr.  E.  D.  Hudson,  who  furnished  the  patient  with  an  apparatus,  reports 
the  arm  shortened  two  and  a  half  inches,  and  somewhat  atrophied,  but  well  healed  and  healthy. 
The  functions  of  the  fore-arm  and  hand  were  normal,  but  the  flexion  of  the  limb  was  somewhat 
impeded  by  concretions  in  the  elbow-joint,  which  could  be  easily  broken.  The  arm  was  unreliable, 
owing  to  want  of  leverage.  The  incipient  usefulness  of  the  apparatus,  which  was  applied  two  years 
and  seven  months  after  the  injury,  is  reported  to  be  highly  gratifying  and  efficacious. 

DCXXVI. — Minute  relative  to  an  Excision  of  a  Portion  of  the  Humerus.     By  H.  E.  TH.TON, 
Assistant  Surgeon,  U.  S.  A. 

Private  Edward  McCarthy,  Co.  E,  5th  Infantry,  aged  18  years,  was  accidentally  shot  by  a  guard 
at  Fort  Lyon,  Colorado  Territory.  The  missile,  a  Spencer  rifle  ball,  entered  the  left  shoulder 
posteriorly  at  the  outer  edge  of  the  deltoid,  three  inches  from  the  head  of  the  humerus,  passed 
downward,  fracturing  aud  comminuting  the  shaft  of  the  humerus  into  about  twenty-five  pieces,  and 
escaped  three  inches  above  the  eondyles  at  the  outer  edge  of  the  biceps.  He  was  sent  to  the  post 
hospital ;  chloroform  was  administered ;  an  incision  made  from  the  lower  wound  upward  five  inches 
in  length,  and  four  inches  of  the  shaft  of  the  humerus  was  excised.  Four  stitches  were  introduced 
and  a  felt  bandage  applied.  April  24th  the  wound  had  healed ;  there  was  only  one  inch  aud  a 
half  shortening.  The  periosteum  remaining  after  operation  had  entirely  renewed  the  bone,  and 
on  June  30, 1868,  union  between  the  upper  and  lower  end  of  humerus  was  complete.  The  musciilo- 
spiral  nerve  being  destroyed,  there  is  paralysis  of  extensor  muscles.  He  can  pick  up  any  object 
with  his  fingers,  and  will  soon  be  able  to  carry  his  hand  to  his  head.  He  was  discharged  on  August 
7,  1868. 

DCXXVIL— Account  of  a  Partial  Excision  of  the  Humerus.    Abstract  from  Eeport  of  DONALD 
JACKSON,  M.  D.,  Acting  Assistant  Surgeon. 

Private  Charles  Mitchell,  Troop  C,  4th  Cavalry,  aged  31  years,  of  good  constitution  and  regular 
habits,  was  accidentally  wounded  in  the  line  of  duty  at  Fort  Clark,  Texas,  on  June  2,  1867,  by  the 
explosion  of  his  carbine,  the  bullet  causing  four  different  wounds ;  the  first  entered  the  left  thigh 


224  EEPOET  OF  SUKGICAL  CASES  1$  THE  AEMY. 

posteriorly,  in  the  lower  third,  aud,  passing  through  the  soft  parts,  produced  a  slight  wound  of  the 
left  little  finger ;  next  entered  the  left  fore-arm  on  the  ulnar  side,  one  inch  above  the  wrist-joint, 
and,  passing  upward  and  outward,  emerged  three  inches  above ;  finally  entering  the  left  arm  three 
inches  below  the  axilla  and  just  in  front  of  the  brachial  artery,  it  passed  through  the  bone  upward, 
outward,  and  backward,  causing  extensive  comminution,  and  lodged  in  the  body  of  the  infra-spinatus 
muscle.  After  having  sufficiently  recovered  from  the  shock  of  injury,  the  patient  was  rendered 
insensible  by  equal  parts  of  ether  and  chloroform,  when  a  V-shaped  flap  was  made  having  the 
apex  at  the  insertion  of  the  deltoid.  The  anterior  incision  was  carried  to  the  acromion ;  the 
posterior  three  inches  upward  and  backward  from  the  vertex.  Another  incision,  one  inch  and  a 
half  downward,  was  also  made.  The  soft  parts  were  greatly  lacerated  and  there  was  considerable 
oozing  of  blood.  No  important  artery  was  cut.  One-half  of  the  bone  being  removed,  the  wound 
was  filled  with  cotton  and  tightly  bandaged  to  arrest  bleeding.  A  few  hours  subsequently  an 
anodyne  was  administered,  aud  the  patient  rested  well.  Irrigation  was  applied  to  the  wounds,  the 
discharge  from  which  was  profuse,  and  his  strength  was  sustained  by  generous  diet.  By  the  middle 
of  July,  all  the  wounds  had  healed  favorably,  except  a  small  sinus  through  the  anterior  incision 
communicating  with  inferior  border  and  the  spine  of  the  scapula,  portions  of  which  subsequently 
exfoliated,  and  which  finally  healed  up  completely  by  October  12th.  The  last  phalanx  of  the  little 
finger  was  extruded  through  the  wound,  after  which  it  healed,  leaving  a  small  cicatrix.  The  flexor 
tendons  became  involved  in  the  cicatrix  of  the  wound  of  the  fore-arm,  causing  impaired 
usefulness  of  the  hand.  The  patient  was  discharged  the  service  on  July  1,  1807,  by  reason  of 
expiration  of  enlistment,  no  certificate  of  disability  being  furnished  him.  He  was  finally  discharged 
from  hospital  on  November  10,  1867,  and  on  January  12, 18G8,  was  a  watchman  of  Government 
property  at  San  Antonio,  Texas.  [In  June,  1808,  Mitchell  was  furnished  with  an  artificial  apparatus 
by  Doctor  E.  D.  Hudson.  At  that  date  there  was  no  command  of  arm  or  fore-arm,  and  the  hand 
was  partially  paralyzed.  He  made  an  application  for  pension,  but  the  case  is  still  pending.  Eo.J 

DCXXVIII. — Account  of  an  Excision  of  a  Portion  of  the  Humerus.    By  H.  K.  DUBKANT,  M.  D., 
Acting  Assistant  Surgeon. 

Baranga  Nepomoceno,  a  Mexican,  was  wounded  in  an  attack  made  by  Apache  Indians  on  a 
Government  freight  train,  which  he  was  driving,  on  December  18,  1870,  by  a  ball  which  shattered 
the  left  humerus  in  the  upper  third.  He  was  admitted  to  hospital  at  Camp  Lowell,  Arizona 
Territory,  where,  on  the  26th,  the  parts  being  painful  and  very  much  swollen,  he  was  chloro- 
formed, and  four  inches  of  the  shaft  of  the  humerus,  immediately  below  the  head,  was  excised. 
His  general  condition  at  the  time  of  the  operation  was  very  good.  Cold  water  and  a  solution  of 
permanganate  of  potash  were  applied  to  the  wound,  which  healed  rapidly.  The  patient  experienced 
very  little  constitutional  disturbance.  On  January  21, 1871,  the  patient  was  about  to  leave  the 
hospital  with  a  very  useful  arm.  The  excised  bone,  with  the  history  of  the  case,  was  contributed 
to  the  Army  Medical  Museum  by  the  operator,  and  is  No.  5756,  Surgical  Section. 

DCXXIX. — Remarks  on  a  Case  of  Excision  of  the  Shaft  of  the  Eight  Humerus.     By  S.  M.  HOETON, 
Assistant  Surgeon,  U.  S.  A. 

James  Navity,  a  citizen,  aged  30  years,  was  wounded  in  an  attack  by  Indians  at  Crazy 
Woman's  Fork,  Dakota  Territory,  December  2,  1867,  by  a  conoidal  ball,  which  entered  in  front  and 
lodged  in  back  part  of  right  arm.  He  was,  on  December  7th,  admitted  to  post  hospital  at  Fort  Philip 
Kearney.  Copious  suppuration  from  wounds  of  entrance  and  exit  ensued,  and  the  arm  became 
swollen  from  shoulder  to  elbow.  On  February  6,  1868,  I  administered  equal  parts  of  ether  and 
chloroform ;  made  an  incision  six  inches  long  over  the  seat  of  fracture,  and  excised  six  fragments 
of  the  humerus,  the  largest  one  inch  and  a  half  long  by  one-fourth  of  an  inch  thick.  The  ball, 
very  much  flattened,  was  found  imbedded  in  the  shaft  of  the  humerns,  three  inches  above  the 
fracture,  and  was  also  removed.  The  fragments,  as  also  the  contiguous  ends  of  the  broken 
humerus,  were  found  denuded  of  periosteum. 


EXCISIONS  IN  THE  ITUMEBUS.  225 

The  wound  progressed  favorably,  healthy  callus  formed,  and  the  bone  united  in  four  weeks.  On 
March  31,  18C8,  the  external  wounds  still  suppurated  slightly,  but  the  parts  around  the  fracture 
had  become  indurated. 

DCXXX.  —  Account  of  an  Excision  of  a  Portion  of  Hie  Humerus  and  the  Olecranon  Process  of  Ulna. 
By  H.  A.  BuBois,  Assistant  Surgeon,  U.  S.  A. 

Sergeant  Charles  Brunett,  Co.  D,  3d  Cavalry,  aged  26  years,  was  admitted  to  hospital  at  Fort 
Union,  New  Mexico,  June  7,  1807,  with  a  gunshot  wound  of  the  arm.  The  ball  passed  from 
behind,  forward,  and  upward,  through  the  olecranon  process,  shattering  the  eondyles  of  the 
humeriis  and  the  shaft  for  a  distance  of  three  and  a  half  inches.  On  June  10th,  the  shattered 
portion  of  the  huinerus  and  olecranou  process  were  excised,  and  the  wound  was  closed  with  wire 
sutures.  The  patient  recovered,  and  was  discharged  from  service  September  21,  1807. 

DCXXXI.  —  Account  of  an  Excision  of  a  Portion  of  the   Humerus.     By  W.   F.   BUCHANAN, 
Assistant  Surgeon,  U.  S.  A. 

Private  Frank  Crith,  Co.  G,  38th  Infantry,  aged  22  years,  was  admitted  to  the  hospital 
at  Fort  nays,  Kansas,  August  24,  1808,  for  caries  of  the  humerus.  Having  been 
accidentally  shot  nearly  one  year  previously,  by  a  conoidal  musket  ball,  which 
formed  a  compound  fracture  of  the  right  humerus  in  the  middle  third.*  Subse- 
quent to  the  reception  of  the  injury  he  was  attended  by  the  post  surgeon  at  Fort 
Ilarker,  Kansas,  who,  patient  states,  removed  several  pieces  of  bone,  adjusted  the 
fracture  and  applied  splints.  Pieces  of  bone  were  at  times  removed  while  under 
treatment  at  Fort  Harker.  The  patient's  general  health  was  good,  notwithstanding 
the  occasion.il  exfoliation  of  bone  and  a  discharge  of  sanious  foetid  character,  with 
slight  pain.  On  August  27,  the  patient  was  anesthetized,  and  the  parts  were 
FIG.  44.—  POP-  thoroughly  examined.  Two  or  three  small  sinuses  were  found  leading  to  the  bone, 


of  shnft  of  -which  appeared  to  be  firmly  united  at  the  seat  of  fracture,  but  roughened  on 
excised  fur  gnn-  its  surface.  An  incision  down  to  the  bone  showed  it  to  be  entirely  denuded  of 
shot  wound,  periosteum  in  its  entire  circumference.  Excision  being  determined  upon  the  bone  was 
i*T  iL9M.Se  sawn  through  by  means  of  a  chain  saw,  and  a  portion  of  the  shaft,  three  and  one- 
eighth  inches  in  length,  was  removed.  Very  little  venous  haemorrhage  attended 
the  operation  ;  no  arteries  were  cut.  The  parts  were  well  washed,  and  the  incision  united  by 
the  interrupted  suture.  The  patient  was  removed  to  his  bed  and  the  arm  carefully  placed  in 
position  on  small  pillows,  with  fore-arm  flexed  on  the  chest,  and  cold-water  dressing  instituted. 
A  narrow  strip  of  lint  had  been  left  in  between  the  sutures  to  prevent  discharge  during 
suppuration.  August  29th,  the  arm  was  swollen,  red,  and  painful,  with  appearances  threatening 
erysipelas.  There  was  a  bloody,  dark-colored  discharge,  with  considerable  nervous  irrita- 
bility, and  the  appetite  was  poor.  Patient  was  given  a  nourishing  diet,  with  milk  and  brandy 
punch  occasionally  throughout  the  day  ;  the  pus  was  well  pressed  from  the  arm  by  the 
fingers  on  each  side  from  below  upward,  a  solution  of  chlorinated  soda  was  applied  three  times 
daily,  and  the  water  dressing  continued.  On  September  7th,  the  condition  of  the  arm  was  much 
improved.  Healthy  granulations  and  suppuration,  with  extensive  formation  of  callus,  appeared. 
The  arm  was  adjusted  in  angular  splints  made  of  binder's  boards,  the  fore-arm  being  flexed,  the 
whole  bandaged  firmly,  apertures  being  made  through  the  dressing  for  the  exit  of  the  products  ot 
suppuration,  the  splint  applied  to  anterior  and  internal  surface  of  arm  reaching  close  up  in  the 
axilla  ;  thus  arranged  there  was  a  moderate  degree  of  extension  kept  up  by  the  angle  of  the  splints 
on  the  fore-arm  and  the  internal  splint  in  the  axilla.  September  28th,  callus  had  been  formed  to  the 
entire  extent  of  the  excision,  bony  union  had  taken  place,  and  the  temporary  callus  was  being  absorbed. 
On  October  7th  the  discharge  had  ceased.  The  splints  were  removed,  and  on  October  28th  the 
patient  had  entirely  recovered.  The  arm  was  of  natural  size,  and  the  functions  of  hand  and  arm 
were  well  performed.  He  could  lift  eight  or  ten  pounds,  and  the  arm  was  still  becoming  stronger. 
No  atrophy.  He  was  discharged  June  11,  1809.  The  specimen  is  represented  in  the  adjoining 
wood-cut.  _ 

*  See  Case  CCVI1,  p.  62, 
29 


22G 


REPORT  OF  SUEGICAL  CASES  IN  THE  ARMY. 


Excisions  of  the  Head  of  the  Humerus. — Two  successful  operations  of  this  nature 
were  made  the  subject  of  special  reports. 

DCXXXIL— Account  of  an  Excision  of  the  Head  of  the  Humerus.    By  DONALD  JACKSON,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Joseph  Quimby,  Troop  L,  9th  Cavalry,  aged  27  years,  was,  in  April,  1869,  while  fighting 
the  Indians,  (Pension  Report,)  accidentally  wounded  by  a  carbine  ball,  which 
entered  the  right  shoulder  below  the  acroniion,  passed  obliquely  downward  and 
inward,  shattered  the  upper  third  of  the  humerus,  and  lodged  beneath  the  teres 
major.  He  was  admitted  to  post  hospital  at  Fort  Clark,  Texas,  on  June  26,  18G9, 
being  very  much  exhausted  from  the  effects  of  inflammation,  which  had  existed 
in  the  whole  limb.  On  admission  the  active  stage  of  inflammation  had  subsided ; 
the  wound  suppurated  freely,  and  a  large  abscess,  caused  by  lodgement  of  bullet,  had 
formed  below  the  axilla.  On  June  27th,  chloroform  was  administered,  and  a  vertical 
incision  made,  commencing  at  the  wound  below  the  acromioii,  through  the  deltoid 
to  its  insertion.  The  upper  portion  of  the  humerus,  four  and  a  half  inches  in 
length,  was  then  removed.  The  patient  reacted  promptly,  but  the  shock  of  operation 
was  great,  and  for  four  hours  after  operation  life  was  with  difficulty  sustained  by 
constant  use  of  stimulants.  Herecovered,  and  on  November  13,  18C9,  was  sent  to  his 
company  at  Fort  Duncan,  Texas,  to  be  discharged.  Eight  months  after  injury 
an  apparatus,  which  was  very  useful  to  command  the  arm,  was  furnished  by 
Doctor  E.  D.  Hudson.  At  that  time  the  arm  was  not  shortened,  but  little  reduced 
in  size,  very  healthy,  and  the  wound  well  cicatrized ;  the  functions  of  the  arm  and 
fore-arm  were  normal,  except  lack  of  leverage.  The  man  has  made  application 
for  pension,  but  the  case  is  pending. 


Fin.  45.— Upper 
portion  of  right  ha- 
merns,  excised  for 
gunshot  Tvouud. 
Spec.  5638,  Soct.  I, 
A.  M.  M. 


DCXXXIII. — Account  of  an  Excision  of  a  Portion  of  the  Humcrus.    By  S.  S.  JESSOP,  Assistant 
Surgeon,  U.  S.  A. 

Ordnance  Sergeant  James  T.  Skillin,  aged  50  years,  while  engaged  in  the  line  of  his  duty  at 
Castle  Pinckney,  Charleston  Harbor,  South  Carolina,  July  31,  18G9,  was  shot  by  a  drunken  soldier, 
at  a  distance  of  about  five  feet.  The  missile,  a  conoidal  musket  ball,  fractured  the  first  and  second 
phalanges  of  the  left  fore-finger,  then  entered  about  an  inch  below  the  right  clavicle,  passed 
backward  and  outward  through  the  humerus,  close  to  the  capsule,  emerging  at  the  posterior  and 
outer  aspect  of  the  arm.  He  was  admitted  into  the  post  hospital  of  that  place  on  the  next  day. 
The  orifices  of  entrance  and  exit  were  very  large — the  first  about  three  inches  in  diameter,  the  latter 
somewhat  smaller,  and  irregular  in  shape.  In  the  track  of  the  ball  anterior  to  the  humerus,  were 
fragments  of  clothing;  posterior  to  it,  comminuted  fragments  of  bone.  The  patient,  a  man  of 
unusually  fine  physique  and  very  temperate  habits,  had  rallied  well  from  a  copious  venous 
luvmorrhage.  Pulse  75,  and  tolerably  full.  Eighteen  hours  after  the  reception  of  the  injury,  I 

administered  chloroform,  and  excised  the  head  and  about 
three  and  a  half  inches  of  the  shaft  of  the  humerus,  and 
amputated  the  left  fore-finger  at  the  metacarpo  phalau- 
geal  articulation.  Recovery  was  rapid.  On  Septeinber 
30,  1869,  there  was  a  very  slight  discharge  from  the 
opening  of  the  entrance,  and  from  the  middle  of  the  cut 
made  by  the  operation.  On  the  latter  date,  he  had  good 
use  of  the  fore-arm  and  hand,  but  none  of  the  arm. 
Passive  motion  was  daily  employed.  The  wounds,  during 
most  of  the  treatment,  had  been  washed  and  dressed 

with  a  solution  of  crude  carbolic  acid,  twenty  drops  to  the  pint.  He  was  returned  to  duty 
November  10,  1669.  The  specimens,  with  the  history,  were  contributed  to  the  Army  Medical 
Museum  by  the  operator,  aud  are  numbered  5588  and  5589,  Surgical  Section. 


Flo.  46.— Head  anil  portion  of  shaft  of  hmnerns  excised 
for  gunshot  wound.    Spec.  5588,  Sect.  I,  A.  M.  M. 


EXCISIONS  OF  THE  BONES  OF  THE  FOOT  AND  LEO.         227 

EXCISIONS   OF   THE    BOXES   OF   THE    LOWER   EXTREMITIES. 

^Excisions  of  the  Bones  of  the  Foot, — Two  examples  were  reported. 

DCXXXIV. — Account  of  an  Excision  of  a  Portion  of  the  Os  Galois.    By  W.  B.  DODS,  M.  D., 
Acting  Assistant  Surgeon. 

Private  Charles  Lorenzel,  Co.  A,  1st  Cavalry,  aged  20  years,  was  accidentally  wounded  at 
Camp  Bidwell,  California,  November  3,  1860,  by  a  Spencer  carbine  ball,  which  penetrated  the  heel, 
and  glanced  off  from  the  calcaneum.  He  was  admitted  to  the  post  hospital.  Caries  of  the  heel- 
portion  of  the  calcanenm  supervened,  and  on  February  26,  1867,  the  superior  portion  of  the 
calcaueum  was  excised  through  an  incision  three  inches  in  length.  Simple  dressings  were  applied, 
and  on  March  30,  1867,  the  wound  was  perfectly  healed. 

DCXXXV. — Memorandum  relative  to  an  Excision  of  Portions  of  the  Bones  of  the  Foot.    By  G.  M. 
STERNBERG,  Assistant  Surgeon,  U.  S.  A. 

Private  Julius  Edwards,  Troop  F,  10th  Cavalry,  aged  21  years,  was  accidentally  wounded  by  a 
Spencer  carbine  ball,  at  Fort  Eiley,  Kansas,  January  21,  1868.  The  missile  passed  through  the 
metatarso-phalangeal  articulation  of  the  left  great  toe,  extensively  comminuting  the  bones.  He 
was  admitted  to  the  post  hospital,  and  on  March  1, 1868,  was  rendered  insensible  by  one  part  of 
chloroform  and  two  of  ether,  when  the  phalanx  and  head  of  the  metatarsal  bone  of  the  great  toe 
were  excised  by  a  straight  incision  along  the  dorsum,  and  the  toe-nail  was  removed.  The  periosteum 
was  preserved  as  .far  as  possible,  for  the  reproduction  of  bone.  About  half  of  the  wound  united  by 
first  intention  ;  the  remaining  portion  healed  slowly,  with  profuse  suppuration.  An  abscess  which 
formed  at  the  seat  of  the  original  wound,  was  opened  March  25th,  and  March  31, 1868,  the  wound 
was  nearly  healed.  The  patient  was  returned  to  duty  in  April,  1868. 

Excisions  in  the  Bones  of  the  Leg. — Reports  of  two  cases  were  furnished. 

DCXXXVI. — Account  of  an  Excision  of  a  Portion  of  the  Fibula.    By  JULES  LE  CARPENTIEU, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Waddie  Hostler.  Co.  D,  38th  Infantry,  aged  19  years,  being  apprehended  as  a 
deserter  at  Fort  Bayard,  New  Mexico,  on  July  10, 1868,  was  shot  in  the  left  leg,  a  conoidal  ball 
taking  effect  in  the  middle  third,  fracturing  the  fibula,  splitting  thereon,  and  making  its  exit  by 
two  tracks.  Being  admitted  to  the  hospital  in  a  state  of  collapse,  four  hours  after  the  injury, 
about  an  hour  was  allowed  for  reaction  to  take  place,  when  insensibility  was  produced  by  ether  and 
chloroform,  and  the  wound  thoroughly  examined.  It  was  found  necessary  to  excise  about  three 
and  a  half  inches  of  the  fibula,  which  was  badly  comminuted.  The  peroneal  artery,  which  was 
found  injured  in  several  places  by  splinters,  was  tied  above  and  below  the  wound.  Little  blood 
was  lost  during  the  operation,  and  the  patient  recovered  well  from  the  anaesthesia.  An  anodyne 
was  administered,  and  he  passed  a  good  night.  During  the  day  of  the  llth,  ho  was  restless  and 
somewhat  strange  in  conduct,  refusing  to  take  food  toward  the  evening,  when  the  anodyne  was 
repeated,  and  a  quiet  night  was  passed.  On  the  12th,  pus  appeared  upon  the  lips  of  the  wound ; 
he  again  refused  food,  and  had  a  vacant  look.  About  noon,  a  peculiar  choking  noise  drew  the 
attention  of  the  nurse,  who  found  him  dead.  At  the  autopsy,  twenty-two  hours  after  death,  rigor 
mortis  was  well  marked ;  decomposition  was  going  on  rapidly,  and  the  abdomen  was  distended 
with  flatus.  An  examination  of  the  chest  showed  the  pericardium  distended  and  thickened, 
adherent  in  places  to  ventricles  and  auricles,  and  containing  about  ten  fluid-ounces  of  bloody 
serum ;  heart  rather  large  (weighing  eleven  ounces),  heavily  coated  with  fat,  walls  hypertrophied, 
and  very  soft  and  flaccid,  particularly  those  of  the  right  ventricle ;  fatty  degeneration  well  marked 
of  chordce  tending,  and  the  upper  part  of  the  right  ventricle,  and  adherent  to  the  serous  membrane 
of  the  right  ventricle,  among  the  chordae  tendinaj,  was  a  large  fibrinous  clot,  weighing  nearly  six 
drachms,  attached  to  which  was  an  irregular  rope-like  yellow  cord,  three-eighths  of  an  inch  wide 
and  one-eighth  of  an  inch  thick,  extending  into  the  pulmonary  artery  about  six  inches;  the 


228  EEPOET  OP  SUEGICAL  CASES  IN  THE  AKMY. 

auricula,  ventricular  and  -semi-lunar  valves  of  the  right  side  were  somewhat  thickened  ;  the  walls  of 
the  left  ventricle  showed  fatty  degeneration,  and  were  very  soft,  but  the  valves  were  iu  good  order, 
and  the  auricles  healthy,  but  pale ;  luugs  healthy,  but  marks  of  old  pleuritic  adhesions  existed  on 
the  interior  lobes  of  each  side. 

DCXXXVIL— Minute  of  a  Case  of  Excision  of  a  Portion  of  the  Tibia.    By  W.  M.  AUSTIN,  Assistant 
Surgeon,  U.  S.  A. 

Private  Joseph  Shaw,  Troop  D,  3d  Cavalry,  was  admitted  to  hospital  at  Fort  Bliss  and  Camp 
Coucordia,  Texas,  on  October  25,  1807,  with  a  gunshot  wound  of  the  right  tibia,  which  Avas 
received  in  a  tight  with  Indians,  October  17,  1867.  The  bone  became  necrosed,  and  on  February 
U,  18G8,  the  necrosed  portion  was  excised.  He  recovered,  and  was  returned  to  duty  on  March  (J, 
1808. 

Excisions  at  the  Sip-joint. — It  is  very  gratifying  to  record  two  successes  in  the  three 
excisions  for  gun-shot  injury  of  the  upper  extremity  of  the  femur,  that  have  been 
performed  in  the  army  since  the  War.  The  two  men  referred  too  not  only  recovered,  but 
retained  very  useful  limbs.  Through  the  kindness  of  the  chief  of  the  medical  staff  of 
the  navy,  lam  enabled  also  to  record  a  memorandum*  of  a  successful  case  occurring  in 
the  practice  of  Surgeon  W.  E.  Taylor,  of  the  navy.  Photograph  271,  Surgical  Series,  A. 
M.  M.,  contributed  by  Dr.  Grimm,  the  Director  General  of  the  medical  staff  of  the 
Prussian  army,  represents  a  very  successful  result  of  this  operation,  in  a  soldier  wounded 
in  the  Austro-Prussian  seven-weeks  war.  These  instances  must  place  excision  at  the 
hip  for  gun-shot  injury  among  the  established  operations  of  surgery. 

DCXXXVIII. — Account  of  a  Successful  Case  of  Excision  of  the  Hip-Joint  for  Gunshot  Injury. 
From  detailed  reports. 

Private  Charles  F.  Eead,  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  0,  1808.    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,  illustrating  the   specimen 
contributed  to  the  Army  Medical  Museum   by  the  operator,  J.  E.  Gibson, 
Assistant  Surgeon,  U.  S.  A.,  (FiG.  47.)  The  case  being  fully  detailed  in  Cm-nlur 
No.  2,  S.  G.  O.,  1809,  page  117,  reference  will  only  be  made  to  the  more  salient 
points,  and  to  information  received  since  the  publication  of  that  report.    After 
weeks  of  teinporization,  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  bed-sores,  profuse  suppuration,  an  irritable  diarrhoea,  and  pain  so 
hedrfkftfumur  with    inteuse  as  to  require  the  administration  of  an  anaesthetic  previous  to  dressing 
mi  impacted   musket    the  wound,  the  choice  lay  between  a  lingering  death  or  excision  of  the  head  or 
bail.  spec.  5570,  Sect.    tue  femur  or  the  more  fearful  and  precarious  alternative  of  amputation  at  the 

I,  A.  M.  M. 

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  freely 
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  iu  the  head  of  the 
femur,  a  T-shaped  incision  was  made  over  the  joint,  the  head  of  the  bone  was  turned  out  of  the 
acetabuluin,  and  was  sawn  through  the  neck,  just  within  the  great  trochanter.  The  incisions  were 
closed  with  metallic  sutures,  and  the  limb  was  temporarily  placed  between  splints,  with  a 

*  Surgeon  Taylor,  besides  contributing  to  the  Museum  his  specimen  of  excised  head,  neck,  and  trochanters  of  the  left 
femur,  with  a  couoidal  musket-ball,  lodged  in  the  head,  (Spec.  5884,  Sect.  I,  A.  M.  M.),  forwarded  a  most  interesting 
and  detailed  history  of  the  case,  which  I  would  gladly  reproduce  iu  full,  did  not  Surgeon  (iciieral  Wood,  U.  S.  N., 
prefer  that  it  should  be  inserted  iu  a  volume  of  communications  from  medical  officers  of  the  Navy,  which  he  purposes 
publishing  from  his  Bureau. 


rj  rr 


N"  .'i  S.O.u.  1871 


H     ,  pi,,,! 


Bim.litli 


(ilR.SONS  .SliCCFSSFUL  EXCISION  AT   THfL  HIP. 


EXCISIONS  AT  THE  DIP-JOINT. 


229 


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  earbolized  dressings 
to  the  wound,  the  administration  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.  Notwith- 
standing frequent  displacement  of  the  limb  from  occasional  attacks  of  diarrhoea,  and  the  absence 
of  a  proper  apparatus  to  secure  immobility,  the  performance  of  this  formidable  operation  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.  Oil  May  16, 18G9, 
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,  1809,  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  ligamentous  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  protective  apparatus  and  advised  not  to  use  it  straightway,  but  to  continue 
exercising  the  limb  continuously  for  some  mouths,  thereby  increasing  the  strength  of  the  muscles 
and  ligauieutous  attachments,  and  the  freedom  of  the  newly-formed  joint.  The  next  week  Head 
went  to  New  York,  where  the  proposed  apparatus  was  ingeniously  applied  by  Dr.  E.  D.  Hudson. 
In  the  summer  of  1870,  it  was  reported  that  this  man  could  walk  very  comfortably  with  a  cane 
either  with  or  without  apparatus.  The  appearance  of  the  patient  is  shown  in  the  accompanying 
plate.  In  June,  1871,  three  years  after  the  operation,  the  man  was  in  very  good  health,  and  could 
walk  almost  as  well  as  ever. 


DCXXXIX. — An  Intermediary  Excision  at  the  Hip,  performed  in  18G7. 
Surgeon,  U.  S.  A. 


By  GLOVEK  PERIN, 


Private  Francis  Ahearn,. general  service,  aged  30  years,  was  wounded  at  Newport  Barracks, 
Louisville,  Kentucky,  on  July  31,  1867.  He  was  a  prisoner  in  the 
guardhouse,  and  was  shot  by  a  -  sentinel  while  attempting  to  escape. 
The  ball  entered  behind  and  below  the  prominence  of  the  right  tro- 
chanter  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  ex- 
amined by  Doctor  Perin,  the  surgeon  in  charge.  The  patient  had  been 
an  habitual  drunkard  for  years,  and  had  mania  a  potu  when  shot.  The 
shock  of  the  injury  was  so  grea^thau  an  operation  was  not  considered 
advisable.  It  was  determined  to  adopt  a  supporting  treatment,  and  to 
endeavor  to  build  up  the  general  health,  with  the  view  of  operating 
at  the  first  favorable  moment  when  a  good  result  could  be  reasonably 
anticipated.  On  August  26,  18G7,  the  patient  was  in  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  somewhat 
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 
FIG  48  -shattered  upper  extremity  copious,  and  there  was  extreme  paiu  on  the  slightest  move- 

of    the   right   femur,    excised    tat  *  .  .       7.  .  ,     . 

cari<.«  r.jimvinj:  Sun«hot  fracture,  inent.    There  were  abscesses  about  the  joint  communicating  with  its 

spec.  M89,  sect,  i,  A.  M.  M.  cavity.    Excision  having  been  decided  upon,  I  proceeded  with  the 

operation,  assisted  by  T.  E.  Wilcox,  Assistant  Surgeon,  U.  S.  A.     The  patient  being  endered 

insensible  by  a  mixture  of  chloroform  and  ether,  the  entrance  wound  was  enlarged  by  a  straight 

incision  downward,   three  inches  in  length.      The  head  of  the  bone  was   disarticulated,  and 


230  REPORT  OF   SURGICAL  CASES  IN  THE  ARMY. 

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  recover! ng 
from  the  anaesthetic,  the  patient  complained  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 
preceding  wood-cut,  (FiG.  48.)  Many  of  the  fragments  were  carious.* 

DCXL. — Account  of  a  Case  of  Excision  of  the  Hip-Joint  for  Gunshot  Injury.    Condensed  from 
Detailed  Reports. 

Private  Hubert  Erne,  Co.  D,  4th  Infantry,  aged  48  years,  while  acting  as  one  of  a  corporal's 
guard  escorting  the  mail  wagon  from  Fort  Laramie  to  Fort  Fetterman,  was  wounded  in  an  attack 
on  the  party  by  a  baud  of  Indians  December  2,  1869.  He  was  struck  in  the  left  hip  by  a  musket 
ball,  and  fell  to  the  ground.  His  comrades  placed  him  in  the  mail  wagon  and  returned  as  rapidly 
as  circumstances  would  permit  to  Fort  Laramie,  from  which  they  were  distant  about  thirty-two 
miles.  The  wound  was  received  at  two  in  the  afternoon,  and  the  patient  was  placed  in  bed  in  the 
hospital  by  half  past  seven.  He  had  been  driven  over  a  very  rough  road,  and  was  much  exhausted. 
He  had  lost  considerable  blood,  and  his  feet  and  hands  were  cold,  and  circulation  feeble,  the  pulse 
being  almost  imperceptible,  while  his  face  was  pale  and  covered  with  a  clammy  perspiration.  There 
was  shortening  of  the  left  lower  extremity,  with  eversion  of  the  foot,  and  the  thigh  was  arched  with 
an  anterior  convexity.  The  aperture  of  entrance  of  the  ball  was  one  and  a  half  inches  behind 
and  slightly  above  the  trochanter  major.  The  aperture  of  exit  was  near  the  centre  and  just  below 
Poupart's  ligament,  directly  over  the  femoral  artery.  The  diagnosis  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  was  ordered  to  take  a  half  ounce  of  brandy  every  half  hour,  and  external  applications 
of  heat  were  made  by  hot  blankets,  heated  sad-irons,  and  bottles  of  hot  water.  The  circulation 
was  gradually  restored.  At  midnight  the  patient  had  reacted,  but  complained  of  great  pain  in 
the  middle  of  the  thigh,  and  a  fourth  of  a  grain  of  morphia  was  ordered,  to  be  repeated  every  two 
hours,  if  needed ;  the  stimulant  was  continued.  At  half  past  seven  in  the  morning  of  December 
3,  it  was  found  that  the  patient  had  fully  recovered  from  the  shock,  and  was  comfortable,  with  a 
good  pulse  at  90.  He  had  no  appetite,  and  had  slept  but  little  during  the  night.  There  was  pain 
of  the  thigh  below  the  wound,  but  it  was  not  excessive.  The  temperature  in  the  axilla  was  99.2. 
Cold-water  dressings  were  applied  to  the  wound,  and  milk  punch,  was  given  freely,  with  an  eighth 
of  a  grain  of  sulphate  of  morphia  every  two  hours.  At  1  o'clock,  December  3d,  Post  Surgeon  F. 
Meacham,  Assistant  Surgeon,  U.  S.  A.,  assisted  by  Assistant  Surgeon  J.  B.  Girard,  U.  S.  A., 
who  was  visiting  him,  made  a  thorough  exploration  of  the  injury,  placing  the  patient  under 
chloroform,  and  enlarging  the  entrance  wound  to  admit  the  finger.  It  was  ascertained  that  the 
neck  and  trochanters  were  shattered,  and  the  shaft  of  the  femur  was  splintered  for  a  short 
distance  below.  No  important  vessels  or  nerves  were  injured.  The  patient  was  an  old  soldier ; 
he  had  been  a  hard  drinker,  and  during  the  late  war  had  been  several  times  wounded,  having 
on  one  occasion  suffered  a  gunshot  fracture  of  the  lower  jaw  After  a  careful  consideration  of 
all  the  circumstances,  local  and  constitutional,  it  was  decided  that  excision  of  the  upper  extremity 
of  the  femur  would  afford  the  patient  the  best  chance  of  life,  and  Assistant  Surgeon  Meacham 
immediately  proceeded  with,  the  operation.  He  made  a  curvilinear  incision  seven  inches  in  length, 
commencing  an  inch  and  a  half  above  the  trochanter,  through  the  wound  of  entrance,  and  then 
vertically  parallel  to  the  shaft.  Exposing  the  bone  by  a  rapid  dissection,  the  fragments  of  the 
shaft  and  trochanters  were  first  removed,  and  the  sharp  extremity  of  the  shaft  was  taken  off 

*  See  Circular  No.  2  S.  G.  O.,  1869,  p.  60. 


PI.  IV. 


Circular  N?  3,  S.G.0. 1871 . 


Duty  ram  shaving  the  Variations  of  Temperature  after  an  Excision  at  the  Hip 


J.Bienlifti. 


EXCISIONS  AT  THE  HII>-JOINT.  231 

by  a  chain  saw.  Then,  with  some  difficulty  the  head  of  the  femur  was  cxarticulated,  and  the 
operation  was  completed.  The  exploratory  incisions  and  operation  altogether  occupied  about  an 
hour.  Very  little  blood  was  lost,  and  the  patient  rallied  very  promptly  after  the  operation.  He 
seemed  to  suffer  very  little  from  shock.  The  upper  portion  of  the  wound  was  closed  by  sutures  and 
adhesive  strips.  The  patient  was  placed  in  bed  with  the  limb  in  au  extended  position,  cold-water 
dressings  being  applied  to  the  wound,  and  a  weight  of  four  pounds  being  attached  by  Buck's  method 
to  the  foot  to  keep  up  extension.  The  patient  was  ordered  an  ounce  of  brandy  every  hour  while 
awake,  and  a  quarter  of  a  grain  of  sulphate  of  morphia  every  two  hours.  On  December  4th  the 
patient,  after  a  comfortable  night,  having  slept  well,  complained  only  of  thirst.  His  tongue  was 
dry,  his  pulse  at  90  and  full.  During  the  day  he  had  nutritious  diet,  a  half  ounce  of  brandy  every 
hour  when  awake,  and  two  grains  of  quinine  and  one-eighth  of  a  grain  of  sulphate  of  morphia  every 
four  hours.  The  fragments  of  bone  excised  were  cleaned  and  put  together,  and  transmited  to  the 
Army  Medical  Museum.  They  are  represented  in  the  adjoining  wood-cut. 
On  December  5th,  in  the  early  morning,  there  was  little  change  in  tha  consti- 
tutional 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  substituted  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  continued.  On  the  morning  of  December 
Cth,  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  foot  was  diminished  one  half.  Whiskey  was  substituted  for  the  brandy, 
pin.  49— Excised  head  of  left  which  he  disliked,  and  a  tincture  of  sesquichloride  of  iron  was  given  in  twenty- 
fcmur shattered i>y  a mus-  t|rop  doses  wit]1  two  grains  of  sulphate  of  quiuia  every  four  hours.  One- 

kctliall.  Spec.5658,  Sect.I,  . 

A.  M.  M.  fourth  of  a  gram  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.  Th«  patient  was  allowed  a  small  piece  of 
beefsteak  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  milk  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  eueniata  of  castile  soap  and 
warm  water  were  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  22d,  the  patient  passed  a  very  restless  night.  The  surface  was  hot,  and  pulse  at  100 ; 
the  appetite  was  gone ;  the  abdomen  was  tympanitic.  On  December  23d,  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  going  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. 


232  REPORT  OF  SURGICAL  CASES  IN  THE   ARMY. 

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  t  3  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 
toward  the  cotyloid  cavity.  About  an  ounce  of  pus  was  discharged  daily.  The  limb  was  about 
five  inches  shorter  than  the  other.  On  the  10th  of  April,  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  fair  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  had  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.  Meacham  was  ordered  to  Omaha,  and  the  patient  passed  into  the  hands 
of  Acting  Assistant  Surgeon  L.  S.  Tesson,  who,  on  July  29,  wrote  to  Dr.  Meacham  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  to  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. 
Meacham  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  acetabulum,  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.  By  an  order  dated  A.  G-.  O.,  June  9, 1871,  it  was  provided  that  Private 
Erne  should  be  sent  to  the  Soldiers'  Home.  A  communication  from  Dr.  Meacham,  dated  June  14, 
1871,  states  that  this  man  is  much  better,  and  will  soon  be  able  to  comply  with  the  provisions  of 
the  above  order.  [Private  Erne  was  discharged  the  service  on  surgeon's  certificate  of  disability, 
May  18, 1871.  The  lithograph  opposite  (Plate  III)  is  copied  from  a  photograph  taken  at  Omaha, 
March  30, 1871,  No.  303,  Surg.  Series,  A.  M.  M.— ED.] 

DCXLI. — Account  of  a  Successful  Case  of  Excision  of  the  Sip- Joint  for  Gunsliot  Injury.    Condensed 
from  a  Report  of  W.  E.  TAYLOR,  Surgeon,  U.  S.  Navy. 

Charles  B.  Scott,  a  seaman  of  the  United  States  Navy,  aged  34  years,  of  fair  general  health, 
was  wounded  in  the  line  of  duty  while  an  attack  was  being  made  on  a  piratical  vessel  in  Tecapan 
River,  west  coast  of  Mexico,  June,17,  1870.  A  conoidal  musket  ball,  entering  the  left  nates  midway 
between  the  great  trochauter  and  point  of  coccyx,  fractured  and  comminuted  the  head  and  neck  of 
the  femur,  and  lodged  nearly  in  the  centre  of  its  head.  The  weapon  inflicting  the  wound  was  fired 
from  shore,  a  distance  of  about  eighty  yards,  the  patient  being  at  the  time  in  a  stooping  posture  in 
one  of  the  cutters.  After  a  long  sea  voyage  of  eleven  days,  he  was  admitted,  on  July  12,  1S70, 
from  the  United  States  ship  Mohican  to  the  naval  hospital,  Mare  Island,  California.  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  14,  an  examination  of  the  wound  was  made.  No  amesthetic  was  used,  and  the 
result  was  unsatisfactory.  However,  appearances  led  to  the  belief  that  the  head  and  neck  of  the 
femur  were  extensively  fractured.  Nothing  was  felt  that  was  supposed  to  be  the  ball.  The  joint 
was  not  swollen,  but  was  very  sensitive,  and  there  was  a  scanty,  sanious,  and  foetid  discharge  from 
the  wound.  The  patient's  condition  was  much  better  than  could  be  expected  after  such  a  serious 
injury.  His  appetite  improved ;  there  was  no  hectic ;  he  slept  tolerably  well,  and  his  bowels  were 
regular.  Circumstances  indicating  beyond  a  doubt  the  necessity  of  operative  interference,  it  was 
desirable  to  get  the  patient  in  as  good  condition  as  possible,  whereupon  a  tonic  mixture,  with 


1  I.  ill 


MEACHAMS  SUCCESSFUL  EXCISION  AT  THE  HIP. 


EXCISIONS  AT  THE  HIP-JOINT.  233 

nutritious  diet,  and  an  anodyne,  when  required,  were  ordered,  and  the  wouud  was  dressed  with 
oakum.  On  July  25,  the  patient  seemed  to  be  slowly  sinking,  and  there  being  evidently  no  prospect 
of  recovery  if  treated  on  the  expectant  plan,  the  operation  of  the  excision  of  the  injured  parts  was 
decided  upon,  as  giving  him  the  best  chance  of  life,  especially  as  there  was  no  injury  to  the  large 
vessels  and  nerves,  and  very  little  damage  to  the  soft  parts.  The  patieut,  cheerfully  consenting  to 
the  operation,  was  chloroformed  by  Assistant  Surgeon  A.  M.  Owen,  U.  S.  N.  The  limb  being 
straightened,  a  well-marked  crepitus  was  elicited.  A  straight  and  deep  incision  was  then  made, 
commencing  about  two  inches  above  the  great  trochanter,  and  carried  downward  over  its  centre 
and  along  the  outer  side  of  the  thigh  for  about  eight  inches.  On  exposiiig  the  joint,  the  thigh 
was  well  adducted  and  pushed  upward,  that  the  trochauter  might  be  prominent;  the  muscular 
attachments  were  then  carefully  divided  close  to  the  bone,  which,  being  well  cleared,  was  pushed 
through  the  wound  and  sawn  off  just  below  the  trochauter  minor,  with  an  ordinary  amputating 
saw;  after  which  the  fragments  of  the  neck  and  head,  some  twelve  in  number,  with  the  ball",  were 
easily  removed.  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  and  irritable.  Hydrate  of  chloral  being 
substituted  for  morphia,  he  went  to  sleep  in  a  few  minutes,  and  next  morning  awoke  refreshed  and 
natural,  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  Gth  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  extension  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  bathed  and  rubbed,  after  which  it  was  replaced  in  the  fracture-box,  when  extension 
and  counter-extension  were  made  by  means  of  the  ordinary  perineal  baud  and  a  screw.  This  was 
discontinued  on  the  2Gth,  owing  to  enlargement  of  the  inguinal  glands  and  the  general  malaise  and 
discomfort  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,  bed-sores,  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,  &c.,  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.  He  continued  steadily  to  improve,  and  on  December  27th  went  by 
steamer  to  San  Francisco,  a  distance  of  fifty  miles.  He  returned  in  the  evening,  having  borne  the 
journey  well.  By  January  1,  1871,  the  patient  was  doing  well  in  all  respects.  On  the  20th,  a 
protective  apparatus  was  adjusted  to  the  limb,  which,  at  the  beginning,  proved  highly  useful. 
Photographs  of  the  patient,  both  with  and  without  the  apparatus,  were  taken  on  the  30th.  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.  . 
The  patient  had  gained  about  thirty  pounds  since  the  operation  of  excision,  and  there  was  a 
probability  of  his  being  able,  in  time,  to  walk  quite  well  without  the  aid  of  crutches.  The  above 
"  general  reference"  to  a  very  fully  detailed  case  is  concluded  by  a  quotation  of  Surgeon  Taylor's 
i  -i-marks  :  "This  report  terminates  my  official  connection  with  the  case,  and,  inasmuch  as  the  result 
cannot  yet  be  positively  known,  it  would  perhaps  be  premature  to  make  any  comments,  or  draw 
any  conclusions.  There  is  one  point,  however,  worthy  of  mention,  viz,  that  prior  to  the  operation, 
the  patient  complained  of  severe  and  constant  pain,  which  ceased  immediately  upon  the  removal  of 
30 


234  EEPOET  OF  SUKGICAL  CASES  IN  THE  AKMY. 

the  injured  parts.  This  relief  was  so  marked  that  even  had  the  case  terminated  fatally,  I  think 
operative  interference  was  warranted  with  a  view  to  euthanasia.  It  will  also  be  noticed  that 
treatment  by  extension  and  counter-extension  was  abandoned  after  a  trial  of  a  few  days,  and  I  feel 
quite  certain  that  this  particular  case  did  better  without  it.  The  case  was  admirably  suited  for 
the  operation  of  excision ;  a  better  one  could  not  well  have  been  selected.  There  was  uo  injury  to 
the  vessels  or  nerves,  and  none  to  the  soft  parts,  save  the  small  wound  of  entrance ;  the  pelvic 
walls  were  not  injured ;  there  were  no  abscesses,  and  but  little  swelling  about  the  joint.  The  neck 
and  head  of  the  femur  alone  bore  the  brunt  of  the  injury." 

The  four  cases  above  enumerated,  the  sixty -three  operations  done  during  the  American 
War,  the  twelve  operations  prior  to  that  war,  and  eight  more  cases  recently  published, 
make  an  aggregate  of  eighty-seven  excisions  at  the  hip  for  injury,  with  eight  recoveries,  a 
mortality  rate  of  91.9. 

But  we  have  the  great  satisfaction  of  knowing  that  of  the  survivors  of  this  operation, 
four  can  walk  comparatively  well,  without  assistance.  It  has  occurred  to  me  to  examine 
many  patients  recovered  from  excisions  at  the  hip  for  coxaljia,  but  none  of  them  had  regained 
the  use  of  their  limbs  to  such  an  extrent  as  Hugh  Wright,*  for  whom  Dr.  Mursick  excised 
the  head  and  trochanters  of  the  femur,  shattered  by  a  ball.  The  recovery  of  Dr.  Gibson's 
patient  was  yet  more  perfect,  and  fully  verified  the  prediction  of  Mr.  Blenkins,f  that 
inutility  of  the  limb  would  not  prove  to  be  inevitably  the  result  of  such  operations. 

•  MUKSICK,  New  York  Medical  Journal,  Vol.  I,  p.  424. 

t  BLENKINS,  1.  c.  Additions  to  Cooper,  8tli  ed.,  Vol.  I,  p.  838.    London,  1870. 


LIGATION  OP  ABTEKIES.  235 


LIGATIONS, 


LIGATIONS. — Abstracts  of  twenty-seven  instances  of  ligations  of  the  larger  vessels 
were  furnished.  The  operations  were  required  in  four  cases  of  punctured,,  seven  incised, 
and  four  lacerated  wounds,  in  twelve  cases  of  gunshot  wounds,  and  in  two  cases  of 
aneurism.  Seven  cases  resulted  fatally. 

Ligations  of  Arteries  of  the  Head  and  Neck. — Special  reports  were  made  of  six 
examples  of  ligations  of  these  vessels ;  viz.,  three  of  the  temporal, iOne  of  the  facial,  one — 
a  fatal  case — of  ligation  of  the  thyroid,  and  a  successful  ligation  of  the  common  carotid. 

DCXLII — Note  on  a  Ligation  of  the  Temporal  Artery.    By  H.  S.  SCHELL,  Assistant  Surgeon,  U.  S.  A 

Private  Patrick  Toole,  Troop  H,  2d  Cavalry,  aged  35,  was  kicked  by  a  horse  at  Fort 
Laramie,  Dakota  Territory,  on  November  1C,  1867,  the  effect  of  which  was  a  lacerated  wound  of  the 
scalp  with  punctured  fracture  of  the  frontal  boue.  He  was  taken  to  the  post  hospital,  where  both 
ends  of  the  temporal  artery  were  ligated.  He  recovered,  and  was  returned  to  duty  in  December, 
1867. 

DCXLIII. — Minute  of  a  Case  of  Ligation  of  the  Temporal  Artery.     By  J.  P.  WEEDS,  Assistant 
Surgeon,  U.  S.  A. 

Jacob  Wall,  a  teamster  of  the  Quartermaster's  Department,  aged  32,  was  admitted  to  the 
post  hospital  at  Albuquerque,  New  Mexico,  January  3,  1866,  with  a  lacerated  wound  in  the 
anterior  temporal  region,  caused  by  a  blow  from  the  butt-end  of  a  Colt's  revolver.  The  temporal 
artery  was  severed  and  the  pericranium  exposed.  On  the  same  day  I  ligated  both  ends  of  the 
artery  and  closed  the  wound  with  sutures.  The  patient  recovered  rapidly,  and  was  returned  to 
duty  January  16, 1866. 

DCXLIV. — Note  relative  to  a  Ligation  of  the  Transverse  Facial  Artery.    By  HAKVEY  E.  BKOWN, 
Assistant  Surgeon,  TJ.  S.  A. 

Corporal  Frank  Sachse,  Co.  P.,  17th  Infantry,  aged  27  years,  received  a  lacerated  wound  of 
the  right  cheek,  at  Galveston,  Texas,  on  November  20, 1868,  for  which  he  was  admitted  to  the  post 
hospital.  The  wound  extended  from  angle  of  mouth  transversely  across  the  cheek  two  inches,  the 
transverse  facial  artery  being  severed.  The  artery  was  ligated.  On  November  26th  the  ligature  came 
away;  the  wound  was  closed  by  silver  sutures,  and  healed  by  first  intention.  The  final  result  of 
this  operation  was  favorable,  and  the  patient  was  returned  to  duty  on  November  29,  1868. 

DCXLV. — Minute  of  a  Case  in  which  Haemorrhage  from  the  Temporal  Artery  icas  controlled  by  Ligation. 
By  J.  P.  M.  FOEWOOD,  Actiug  Assistant  Surgeon. 

Hospital  Steward  Charles  Eivers,  Co.  B,  20th  Infantry,  aged  22,  received,  on  March  1, 1868, 
at  Alexandria,  Louisiana,  accidentally,  a  lacerated  wound  of  the  head,  and  was  admitted  to  the 


236  EEPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

post  hospital.  On  March  Gtli,  profuse  hemorrhage  from  the  temporal  artery  occurred.  Styptics 
and  pressure  failed  to  control  it;  acupressure  needles  were  then  inserted,  but  only  checked  the 
haemorrhage  for  twenty-four  hours;  at  the  end  of  that  time  an  incision  was  made,  and  the  bleeding 
vessel  tied.  The  wound  then  healed  rapidly,  and  the  patient  returned  to  duty  in  April,  18G8. 

DCLXVL— Minute  of  a  Case  in  which  the  Thyroid  Artery  was  ligated.    By  HARVEY  E.  BROWN, 
Assistant  Surgeon,  U.  S.  A. 

Private  Joseph  Harnley,  Co.  K,  1st  Infantry,  aged  27  years,  cut  his  throat  with  a  razor,  at 
Jackson  Barracks,  Louisiana,  November  3, 1806.  The  larynx  was  opened,  and  the  superior  thyroid 
artery  severed,  the  incision  extending  from  one  angle  of  the  jaw  to  the  other'.  When  admitted  to 
post  hospital  lie  was  nearly  pulseless.  1  at  once  ligated  the  divided  ends  of  the  thyroid.  The 
patient  did  very  well,  and  seemed  to  improve  until  the  evening  of  November  5th,  when  he  had 
a  choking  fit,  and  died  a  few  minutes  later  of  asphyxia. 

DCXLVII. — Report  of  a  Successful  Case  of  Ligation  of  the  Common  Carotid  Artery.    By  G.  MoC. 
MILLER,  Assistant  Surgeon,  U.  S.  A. 

Private  Patrick  Jordan,  Co.  A,  16th  Infantry,  aged  28,  was  wounded  at  Savannah,  Georgia, 
November  27, 1866,  by  a  conoidal  ball,  which  entered  the  mouth,  and,  knocking  out  four  teeth  in  the 
left  superior  maxilla  (two  incisors,  one  cuspidate,  and  one  bicuspid),  passed  obliquely  over  the 
tongue,  grooving  it  slightly,  fractured  the  right  ramus  of  the  inferior  maxilla  at  the  angle,  then 
passed  into  the  neck  and  lodged  under  the  upper  portion  of  the  right  sterno-mastoid  muscle, 
rather  deeply,  taking  a  position  just  behind  the  external  carotid  artery.  There  was  little  primary 
hemorrhage.  He  was  admitted  to  post  hospital  at  Savannah;  the  neck  was  moderately  swollen, 
and  pus  discharged  from  the  mouth,  but  the  jaw  apparently  was  not  much  comminuted.  On 
December  6th,  profuse  haemorrhage  occurred  through  the  mouth,  probably  from  the  right  external 
carotid  artery  near  its  origin.  The  ball  was  excised  through  an  incision  in  the  direction  of  fibres 
of  the  sterno-mastoid  muscles,  and  liquor  of  the  persulphate  of  iron  was  introduced  into  the  opening. 
The  patient  became  very  weak,  but  the  case  progressed  favorably,  until  the  evening  of  December 
10th,  when  haemorrhage  to  the  amount  of  eight  ounces  recurred  from  the  mouth,  and  also  from  the 
wound  of  incision.  On  December  llth,  I  administered  equal  parts  of  ether  and  chloroform,  and 
ligated  the  right  common  carotid  artery.  Owing  to  the  depth  of  the  artery,  from  tumefaction  and 
infiltration  of  tissues,  it  was  deemed  expedient  to  divide  the  oino-hyoid  muscle,  and  the  ligature  was 
applied  to  the  part  of  the  artery  which  lies  behind  the  muscle.  December  26th,  fifteen  days  after 
the  operation,  the  ligature  came  away;  on  December  31st  the  wound  made  in  the  operation  of 
ligating  the  artery  was  nearly  healed,  but  the  incision  for  removal  of  the  ball  was  still  discharging. 
A  large  amount  of  callus  had  formed  about  the  seat  of  fracture,  and  the  prospect  for  recovery  was 
excellent.  The  case  progressed  favorably,  and  the  patient  was  returned  to  duty  in  January,  1867. 

Ligation  of  Arteries  of  the  Upper  Extremity. — Nine  special  reports  were  made;  one 
relating  to  a  ligation  of  the  brachial,  five  to  ligations  of  the  radial,  and  three  to  ligations 
of  the  interosseous-or  of  the  arteries  of  the  hand.  Two  other  cases  have  been  already 
recorded  in  the  chapter  on  wounds ;  a  ligation  of  the  interosseous  (p.  97),  and  a  ligation 
of  the  radial,  (p.  155.) 

DCXLVIII.— Minute  of  a  Case  in  ichich  the  Brachial  Artery  was  ligated.     By  R.  A.  CHRISTIAN, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  James  McMahon,  Co.  F,  8th  Infantry,  aged  25  years,  was  accidentally  wounded  while  on 
guard,  July  23, 1867,  at  New  Berne,  North  Carolina.  The  missile  entered  at  the  commencement  of 
the  upper  third  of  the  fore-arm,  passed  obliquely  through  the  muscles,  and  out  over  the  radius.  Upon 


LIGATIONS  IN  THE  UPPER  EXTREMITY.  237 

being  admitted  to  hospital  the  arm  was  much  swollen,  and  there  was  considerable  haemorrhage. 
Secondary  haemorrhage  occurred  from  perhaps  both  radial  and  ulnar  artery,  on  July  31st,  when 
the  brachial  artery  was  ligated  in  the  lower  third,  while  the  patient  was  under  the  influence  of 
chloroform.  Recurring  haemorrhage  was  controlled  by  compresses,  which  were  removed  on  the 
third  day  after  the  operation.  The  ligature  came  away  on  August  12th,  and  on  August  19, 1807, 
the  patient  was  doing  well.  He  was  returned  to  duty  in  September,  1867. 

DCXLIX. — Minute  of  a  Case  in  which  a  Branch  of  the  Eadial  Artery  was  ligated.    By  E.  P.VOLLUM, 
Surgeon,  U.  S.  A. 

Private  Frank  Henrietta,  Battery  F,  1st  Artillery,  aged  18  years,  was  accidentally  wounded 
at  Madison  Barracks,  Sackett's  Harbor,  New  York,  October  27,  1869,  by  the  discharge  of  a  shot- 
gun. The  left  hand  was  over  the  muzzle ;  the  load  passed  into  the  palm  and  carried  away  a 
portion  of  the  metacarpal  bones  of  the  little  and  ring  fingers.  He  was  at  once  admitted  to  the  post 
hospital,  where  fragments  of  the  metacarpal  bone  of  the  little  finger  were  removed  from  the  wound, 
and  a  branch  of  the  radial  artery  was  ligated  by  Hospital  Steward  John  S.  Perkins.  The  edges  of 
the  wound  were  brought  together  by  sutures,  and  dry  lint  was  applied.  On  December  30, 1869, 
the  wound  had  nearly  closed.  The  patient  was  returned  to  duty  in  March,  1870. 

DCL. — Minute  of  a  Case  of  Ligation  of  the  Eadial  Artery.     By.  E.  T.  BAKER,  M.  D.,  Acting 
Assistant  Surgeon- 
Private  William  McBride,  Co.  F,  12th  Infantry,  aged  24  years,  received,  on  September  22, 
1868,  an  incised  wound  on  the  dorsal  surface  of  the  right  hand,  severing  the  radial  artery.    He  was 
admitted  to  hospital  at  Oglethorpe  Barracks,  Savannah,  Georgia,  where  both  extremities  of  the 
artery  were  ligated.    On  September  30,  1868,  the  patient  was  doing  well.    He  was  returned  to 
duty  in  October,  1868. 

DCLI. — Minute  of  a  Case  of  Ligation  of  the  Radial  Artery.    By  J.  F.  HEAD,  Surgeon,  TJ.  S.  A. 

Private  James  Quinan,  of  the  cavalry  detachment  at  West  Point,  struck  his  fist  through  a 
window  pane,  and  severed  the  radial  artery,  May  31, 1868.  Assistant  Surgeon  E.  J.  Marsh  enlarged 
the  wound  of  incision  and  tied  both  ends  of  the  artery  with  silk  ligatures.  Considerable  swelling 
followed,  but  the  wound  healed  with  slight  suppuration.  On  June  9th,  the  ligatures  were  removed, 
and  on  June  18th,  the  patient  was  returned  to  duty. 

DCLII. — Minute  of  a  Case  in  ichich  the  Eadial  Artery  was  ligated.    By  E.  T.  BAKEK,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  C.  P.  Ray,  Co.  I,  16th  Infantry,  aged  21  years,  was  wounded  on  January  6,  1868,  near 
Atlanta,  Georgia.  The  ball  passed  between  the  thumb  and  index  finger  of  the  right  hand  and 
severed  the  radial  artery.  He  was  admitted  to  the  post  hospital.  A  tourniquet  applied  to  the 
artery  to  control  the  haemorrhage,  caused  considerable  tumefaction,  and  the  patient  became  debil- 
itated. Secondary  haemorrhage  occurred,  and  on  January  27th,  the  radial  artery  was  ligated  in  its 
lower  third,  while  the  patient  was  under  the  influence  of  chloroform.  The  wound  healed  in  about 
a  week ;  the  hand  remained  weak  and  partially  paralyzed  for  some  time,  but  eventually  recovered 
entirely.  The  patient  returned  to  duty  in  March,  1868. 

DCLIII. — Note  on  a  Ligation  of  the  Eadial  Artery.    By  JOHN  M.  DICKSON,  Assistant  Surgeon, 
U.  S.  A. 

Private  Alonzo  Youngman,  Co.  D,  23d  Infantry,  received  a  severe  gun-shot  wound  of  the  wrist- 
joint,  in  a  skirmish  with  Indians,  at  Lake  Warner,  Oregon,  April  29, 1868.  The  radial  artery  being 


238  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

lacerated  was  ligated  above  and  below  the  seat  of  injury,  and  water  dressings  were  applied  to  the 
wound.    The  patient  returned  to  duty  in  July,  1868. 

DCLIV. — Account  of  a  Wound  of  the  Arm  necessitating  Ligation  of  the  Interosseous  Artery.    By  G. 
M.  STEKNBEEG,  Assistant  Surgeon,  U.  S.  A. 

Private  Wesley  Jess,  Troop  M,  7th  Cavalry,  received,  on  November  21,  1868,  while  on  picket 
at  Camp  Supply,  Indian  Territory,  a  gun-shot  wound  of  middle  of  right  fore-arm.  The  ball  passed 
between  the  radius  and  ulna  without  fracturing  either.  He  was  admitted  to  post  hospital  on  No- 
vember. 23d.  No  haemorrhage  occurred  until  the  fifth  day  after  the  reception  of  injury;  afterward, 
haemorrhage  occurred  about  every  twenty -four  hours,  generally  at  night,  from  a  few  ounces  to  a  pint 
at  a  time.  When  the  dressings  were  removed  the  haemorrhage  would  cease ;  an  operation  was  con- 
sequently delayed  from  day  to  day,  in  the  hope  that  it  would  become  unnecessary.  The  arm  began 
to  swell,  became  painful,  tense  and  glossy,  and  above  the  elbow  to  the  shoulder  swollen  and 
cedematous.  On  December  5th  a  sharp  pointed  bistoury  was  introduced  into  the  wound,  and  a  deep 
incision  about  four  inches  long  was  made  in  the  long  axis  of  the  limb.  A  large  quantity  of  clotted 
blood  was  thrown  out  from  between  the  muscles,  which  had  been  dissected  up  by  it  in  every  direc- 
tion ;  the  interosseous  artery  was  severed  at  the  point  from  which  the  blood  escaped,  and  tied  at 
both  ends.  The  pain  was  immediately  relieved,  the  swelling  of  the  limb  rapidly  disappeared,  and 
healthy  granulation  set  in.  On  December  31st,  the  wound  had  nearly  closed,  and  there  had  been 
no  haemorrhage  simce  the  operation.  The  patient  was  returned  to  duty  in  January,  1869. 

DCLV. — Note  on  a  Ligation  of  the  Superficialis  Volte  Artery.    By  H.  S.  SCHELL,  Assistant  Surgeon, 
TJ.  S.  A. 

Corporal  Cyrus  Reed,  Co.  E,  4th  Infantry,  aged  20  years,  at  Fort  Laramie,  Dakota  Territory, 
September  26,  1867,  accidentally  cut  his  left  wrist,  severing  the  snperflcialis  volae  artery.  He  was 
admitted  to  the  post  hospital,  where  both  ends  of  the  artery  were  tied,  and  three  iron  wire  sutures 
were  applied.  On  September  30th,  the  patient  was  doing  well.  He  returned  to  duty  in  December, 
1867. 

DCLVI. — Memorandum  of  a  Casein  which  the  Superficial  Palmar  Arch  was  ligated.    By  CHRISTIAN 
RAUSHENBEEG-,  Acting  Assistant  Surgeon. 

John  Stanridge,  a  private  of  Co.  B,  16th  Infantry,  accidentally  wounded  himself  with  a  shot-gun 
at  Albany,  Georgia,  on  February  14,  1868.  The  wound  extended  from  the  middle  of  the  palm  of  left 
hand,  seven  inches  above  the  wrist.  The  soft  parts  between  the  ulna  and  radius  were  lacerated 
and  destroyed,  the  wrist-joint  was  opened,  the  superficial  palmar  arch  and  branches  of  the  ulnar 
and  interosseous  arteries  were  wounded,  and  several  carpal  bones  were  fractured.  Considerable 
haemorrhage  was  arrested  by  ligation  of  the  former  and  torsion  of  several  branches  of  the  latter 
arteries ;  five  pieces  of  carpal  bones  of  different  sizes  were  removed,  and  the  edges  of  the  wound 
about  the  wrist  were  brought  as  close  together  as  possible  by  a  twisted  suture.  In  consideration 
of  the  age  and  condition  of  the  patient,  the  importance  of  the  limb  and  its  great  capacity  for 
recovery,  and  the  fact  that  two  large  arteries  of  the  fore-arm  were  not  wounded,  it  was  determined, 
after  consultation  with  another  physician,  not  to  resort  to  primary  amputation,  but  to  make  an 
effort  to  save  the  limb.  Cold  applications,  opiates,  and  saline  purgatives  constituted  the  principal 
treatment  from  the  14th  to  the  19th  of  the  month.  By  the  latter  date  inflammation  had  reached  a 
fearful  degree.  A  large  and  deep  incision  was  made,  and  warm  cataplasms  were  resorted  to,  when 
the  hand,  on  the  evening  of  that  day,  became  cold  and  lifeless.  The  change  in  the  condition  during 
the  night  was  very  great.  The  next  morning  his  pulse  was  soft  and  small,  skin  cool  and  jaundiced, 
and  the  wounded  arm  had  become  gangrenous.  The  state  of  the  pulse  precluding  the  idea  of 
amputation,  local  and  internal  stimulants  were  promptly  but  unsuccessfully  used,  death  occurring 
on  the  evening  of  the  20th. 


LIGATIONS  OF  VESSELS  OF  THE  TRUNK. 


2:)'.) 


legations  of  the  Great  Vessels  of  the  Trunk. — Reports  of  four  cases  come  under  this 
head : 

DCLVII. — Ligation  of  the  AM ominal  Aorta  for  Aneurism.  Compiled  from  reports  by  D.  R.  BROWN, 
M.  D.,  Acting  Assistant  Surgeon,  J.  H.  JANEWAY,  Assistant  Surgeon,  U.  S.  A.,  and  Profes- 
sor H.  McGuiEE,  M.  D. 

Wilson  F ,  a  negro  of  thirty  years,  a  wood-chopper,  was  admitted  to  the  Howard  Grove 

Hospital,  at  Richmond,  Virginia,  March  20,  1SG8.  He  stated  that  a  week,  before,  while  pursuing 
his  ordinary  avocation,  he  felt  something  give  way  in  the  lower  part  of  his 
abdomen,  a  sensation  followed  by  nausea  and  great  pain.  On  admission 
the  tumor  was  small,  but  it  rapidly  increased  and  soon  its  aueurismal 
nature  became  unmistakable.  Drs.  Janeway  and  McGuire  were  invited  to 
examine  the  case.  No  pulsation  could  be  discovered  in  the  left  femoral ; 
but  no  change  in  the  temperature  or  size  of  the  left  leg  was  observed.  His 
general  health  was  good.  The  patient  said  that  the  tumor  gradually 
increased  in  size  and  was  daily  growing  worse.  Rest  in  bed,  with  digitalis, 
iron,  acetate  of 'lead,  and  opiates,  seemed  to  alleviate  the  pain  and  to  dimin- 
ish the  size  of  the  tumor ;  but  the  relief  was  but  temporary.  On  March 
2(!th,  compression  of  the  aorta  was  resorted  to,  but  had  to  be  discontinued 
because  of  the  tenderness  of  the  tumor.  On  March  30th,  at  1  P.  M.,  Dr. 
McGuire,  after  consultation  with  Drs.  Brown  and  Janeway,  Professors 
Joynes,  Wellford,  and  others,  determined  to  cut  down  and  to  ligate  the 
oommon  iliac  above  the  aneurism.  When  the  aneurism  was  exposed  it  was 
found  to  involve  the  whole  of  the  common  iliac,  and  the  aorta  near  its 
bifurcation.  The  sac  was  very  thin.  Dr.  McGuire  now  determined  to  tie  the 
aorta,  when  the  sac  suddenly  ruptured,  although  it  had  been  handled  with 
the  utmost  delicacy,  and  a  profuse  discharge  of  blood  took  place.  The 
aorta  was  instantly  compressed  by  the  finger  an  inch  above  the  tumor,  and 
surrounded  by  an  assistant  with  a  ligature  and  tied.  About  a  pint  ot 
blood  was  removed  from  the  cavity  of  the  abdomen.  The  lips  of  the  wound  were  brought  together. 
Sutures  and  bandages  were  applied.  A  stimulating  enema  was  given.  The  patient  was  put  to  bed, 
and  the  lower  extremities  were  surrounded  by  warm  applications.  In  a  few  moments  the  effects  of 
chloroform  passed  off,  and  slight  reaction  took  place.  He  complained  mtich  of  numbness  of  the 
lower  extremities.  The  temperature  of  the  axilla  never  rose  above  90.  He  died  half  an  hour  after 
midnight,  eleven  and  a  half  hours  after  the  operation.  At  the  autopsy,  the  ligature  was  found  to 
embrace  the  aorta  at  the  origin  of  the  inferior  mesentery  and  included  the  left  ureter.  The  rent  in 
the  sac  was  just  over  the  bifurcation  of  the  aorta.  The  specimen,  figured  by  the  wood-cut  (FiG.  50) 
was  contributed  to  the  Museum  at  Washington.*  It  is  still  better  represented  by  Photograph  222 
of  the  Surgical  Series  of  Photographs,  Vol.  V.,  p.  22.t 


FIG.  50.— Aorta  ligatwl  for  iliac 
aneurism.  Spec.  52u(i,  Suet.  I., 
A.  M.  M. 


DCHVinf-Minute  of  Case  of  TAyation  of  the  External  Iliac. 
U.  S.  A. 


By  B.  E.  FRYER,  Assistant  Surgeon 


Sergeant  Patrick  Fitzpatrick,  Co.  B,  4th  Infantry,  was  admitted  to  post  hospital  at  Fort  Wayne, 
Michigan,  on  May  21, 1807,  with  a  large  aneurism  of  external  iliac  and  femoral  arteries.  The  tumor 
extended  from  about  two  inches  above  Poupart's  ligament  to  eight  inches  below.  The  thigh  was 
nearly  thirty-six  inches  in  circumference.  The  man  had  been  intemperate,  and  had  been  confined 
to  his  bed  for  nearly  three  months  before  his  admission  to  hospital.  On  May  24th,  ether  having  been 
administered,  an  incision  was  made  seven  inches  in  length,  beginning  an  inch  above  the  external 

*  A  detailed  account  of  this  case  may  be  found  in  the  American  Journal  of  the  Medical  Science*,  Vol..  LVf,  i>.  415, 
Oct.,  18(58. 

t  Sir  AsUry  <  '"oiler's  famous  case  of  ligatiou  of  the  aorta  is  recorded  in  the  Surgical  Essaya  of  Cooler  ami  Travers' 
London,  1818,  p.  113. 


240  REPORT  OP  SURGICAL  CASES  IN  THE  AEMY. 

abdominal  ring,  outward,  upward,  and  inward,  toward  and  nearly  on  a  line  with  the  umbilicus. 
The  ligature  was  passed  from  within  out,  about  three  inches  above  Poupart's  ligament,  and  one 
inch  above  the  tumor.  Thirty-six  hours  after  operation  the  stomach  became  excessively  "irritable, 
and  remained  so  for  three  days.  The  patient  vomited  whatever  he  ate.  The  tumor  decreased 
until  June  19th,  when  haemorrhage  to  the  amount  of  twenty-four  ounces  occurred.  On  the  22d 
haemorrhage  recurred,  about  three  ounces  of  blood  being  lost,  and  death  ensued  June  25, 18G7,  from 
exhaustion.  At  the  autopsy,  the  external  iliac  was  found  divided  by  the  ligature  about  three- 
fourths  of  an  inch  below  its  origin,  Jhe  cardiac  extremity  closed  by  a  firm  plug  as  far  up  as  internal 
iliac;  distal  end  remaining  open.  The  sac  of  the  tumor  was  filled  with  a  dark  fluid  and  coagula. 

DCLXIX. Curtailed  Account  of  a  Traumatic  Aneurism,  Succseafully  Treated  by  Ligation  of  the 

External  Iliac  Artery.    By  J.  B.  WHITE,  Acting  Assistant  Surgeon. 

Corporal  Win.  A.Johnson,  Co.  B,  8th  Infantry,  aged  22  years,  was  wounded  at  Goldsborongh, 
North  Carolina,  October  23,  18G9,  by  a  conoidal  ball,  which  entered  right  thigh  on  outer  aspect  of 
junction  of  upper  and  middle  third,  and  lodged  beneath  the  skin  two  inches  higher  up  on  inner 
side.  He  was  admitted  to  the  post  hospital  at  Goldsborough,  where  the  missile  was  extracted  through 
a  counter  opening.  On  November  1st,  he  was  transferred  to  the  post  hospital  at  Raleigh.  The 
wound  had  entirely  healed,  but  an  aneurismal  swelling  could  be  perceived  to  pulsate  very  strongly, 
and  on  auscultation  a  blowing  or  sawing  sound  could  be  heard.  The  thigh  became  swollen  and 
ffidematous,  the  circumference  of  the  affected  limb  being  six  inches  in  excess  of  its  fellow,  and  the 
patient  was  emaciated  from  extreme  pain  and  disquietude.  On  December  IGth,  ether  having 
been  administered,  an  incision  was  made,  commencing  on  a  line  one  inch  on  the  inner  side  of  the 
anterior  superior  spinous  process  of  the  ilium,  running  downward  one  and  a  half  inches  above  and 
parallel  with  Poupart's  ligament,  terminating  a  little  without  the  inner  margin  of  the  abdominal 
ring.  The  parts  were  found  slightly  infiltrated  with  a  light  yellowish  serum.  The  sheath  of  the 
artery  was  reached  without  injury  to  the  peritoneum,  and  without  the  division  of  any  vessel  of 
importance.  The  armed  aneurismal  needle  was  passed  on  the  inner  side  of  the  artery  between  it 
and  the  vein,  and  the  artery  tied  at  least  one  inch  above  the  epigastric  and  circumflex  artery.  The 
muscular  and  iutegumental  lips  were  tacked  together,  and  adhesive  strips .  applied.  The  patient 
rallied  promptly,  but  the  pulsation  in  the  limb  was  entirely  gone.  Warmth  was  applied  to  foot 
and  limb,  and  stimulants  given.  On  December  18th  there  was  slight  oozing  from  wound  of 
operation,  but  the  patient  slept  well,  and  the  size  of  the  leg  was  rapidly  diminishing.  On  Decem- 
ber 28th  ;  the  ligature  came  away,  pus  was  laudable.  December  30th  :  the  wound  was  granulating 
finely,  and  the  patient  in  excellent  spirits.  Early  in  February,  1870,  the  patient  was  placed  upon 
crutches,  and  gradually  regained  the  use  of  the  affected  limb,  which  was  slightly  auchylosed  from 
long  disuse.  He  was  returned  to  his  company  in  April,  1870.  In  May,  1870,  Doctor  White  reports 
his  patient  to  have  entirely  recovered. 

DCLX. — Report  relative  to  a  Case  in  which  the  External  Iliac  Artery  teas  liyated.     By  FRANCIS 
BARNES,  M.  D.,  Acting  Assistant  Surgeon.  * 

Alfred  Sullivan,  aged  26  years,  was  admitted  to  the  Freedmeu's  Hospital,  at  New  Orleans, 
Louisiana,  on  January  16,  1868,  suiferiug  from  two  gunshot  wounds,  one  about  two  inches  below 
Poupart's  ligament,  the  other  about  one  inch  below  the  first  wound.  Both  were  external  to  the 
rectus  femoris.  The  ball  which  caused  the  lower  wound  passed  to  the  inside  of  the  femur,  and 
emerged  at  a  point  opposite  its  entrance ;  the  other  ball  lodged.  When  I  took  charge  of  the  ward, 
the  patient  was  much  emaciated,  pulse  100,  appetite  feeble,  tongue  coated,  and  skin  dry.  He  had 
no  pain,  save  when  his  position  was  disturbed.  All  the  wounds  healed  except  the  upper  one.  A 
non-fluctuating  tumefaction  extended  from  the  middle  third  of  the  thigh  to  Poupart's  ligament, 
and  to  the  gltiteal  muscles.  But  one  position  of  the  limb  could  be  borne,  that  of  flexing  the  leg  upon 
the  thigh  at  right  angles,  and  flexing  the  thigh  upon  the  pelvis,  with  the  limb  rotated  outward. 
The  upper  wound  would  open  every  few  days,  and  discharge  a  quantity  of  grumous  black  blood, 


LIGATIONS  IN  THE  LOWER  EXTREMITY.  241 

or  thin  serum.  These  haemorrhages  were  undoubtedly  venous,  and  it  also  appeared  as  if  the  blood 
were  effused  some  hours  into  the  tissues  of  the  thigh,  be/ore  its  debris  escaped  from  the  wound. 
The  haemorrhages  were  not  alarming  until  a  day  or  two  before  March  22d,  when  they  became  more 
copious,  and  the  patient  sinking  from  their  effects,  it  was  determined  to  lay  open  the  parts  and 
search  for  the  wounded  vessel,  which  was  believed  to  be  the  femoral  vein.  On  March  22d,  a  number 
of  medical  gentlemen  being  present,  the  patient  was  ordered  upon  the  operating  table.  In 
bringing  him  from  his  bed  to  the  table,  on  a  stretcher,  a  most  profuse  arterial  haemorrhage  occurred, 
evidencing  that  the  femoral  artery  had  given  way.  I  compressed  the  artery,  below  Poupart's 
ligament,  with  my  thumb,  while  Dr.  Schuppert  ligated  the  external  iliac  artery  just  above  Poupart's 
ligament.  This  measure  arrested  the  haemorrhage  instantly,  and  it  did  not  recur.  After  the 
ligation,  a  free  incision  was  made  from  the  wound  upward,  in  the  direction  of  the  crest  of  the 
ilium,  and  the  finger  being  used  to  explore  the  cavity,  passed  upward  to  the  crest  of  the  ilium, 
under  the  tensor  vaginae  muscle.  The  finger  could  also  be  passed  in  front  of  the  femur  and 
around  it,  through  openings  in  the  adductor  muscle,  so  as  to  ascertain  the  presence  of  a  large 
cavity  filled  with  coagula  and  serum,  all  of  which  were  washed  out  with  a  syringe.  Death  resulted 
in  a  short  time.  The  post-mortem  examination  revealed  a  cavity  of  the  capacity  of  a  pint,  occasioned 
by  the  tearing  up  of  the  connected  tissues  of  the  muscles  of  the  thigh  from  the  middle  third  to 
gluteal  and  Poupart's  ligament.  The  same  cavity  was  continuous  with  one  made  by  separating  the 
peritoneum  from  the  back  part  of  the  pelvis  in  right  side,  as  far  as  the  bifurcation  of  the  iliac.  The 
external  iliac  had  a  perfectly  formed  thrombus,  extending  to  the  bifurcation.  The  most  interesting 
result  of  the  examination  was  the  demonstration  that  the  ball  must  have  entered  while  the  thigh 
was  flexed  upon  the  pelvis,  passed  in  such  direction  as  to  open  the  hip-joint  and  knock  off  a 
fragment  of  the  cotyloid  rim,  on  its  inner  and  lower  side ;  it  then  passed  through  the  thyroid 
opening  and  lodged  just  behind  the  acetabnlum.  The  cartilages  of  the  head  of  the  femur  and  of 
the  cotyloid  cavity  had  entirely  disappeared,  leaving  the  bones  denuded  and  rough.  The 
ligamentnm  teres  had  disappeared.  From  the  direction  of  the  balls  either  could  have  wounded 
the  femoral  vessels,  or  rather  injured  them  so  that  a  subsequent  slough  caused  them  to  give  away; 
the  femoral  vein  first  by  a  small  opening  and  the  artery  afterward. 

Legations  of  the  Arteries  of  the  Lower  Extremity,. — Eight  special  reports  relate : 
four  to  the  femoral,  one  to  the  external,  and  one  to  the  posterior  circumflex,  one  to  the 
tibial  and  peroneal,  and  one  to  the  arteria  dorsalis  pedis. 

DCLXI. — Account  of  a  Ligation  of  the  Femoral  Artery.    By  W.  B.  BUTCHER,  Acting  Assistant 
Surgeon. 

Corporal  Henry  Cheesely,  Co.  1, 114th  Colored  Troops,  aged  29,  was  accidentally  wounded  at  Port 
Mclntosh,  Texas,  December  18,  I860,  by  a  conoidal  pistol  ball,  which  entered  two  inches  below  Poa- 
part's  ligament,  and  passing  inward,  downward  and  backward,  emerged  upon  the  inner  part  of  the 
thigh,  three  inches  below  point  of  entrance,  injuring  the  femoral  artery  one-half  inch  below  the  pro- 
funda.  Upon  being  admitted  to  hospital  he  was  very  faint  from  excessive  loss  of  blood.  Four  hours 
after  the  reception  of  injury  the  wound  of  entrance  was  enlarged  by  incision,  while  the  patient  was 
under  the  influence  of  ether;  the  tourniquet  was  applied  and  the  femoral  artery  ligated,  above  and 
below  the  seat  of  injury.  The  wound  of  exit  was  then  enlarged  to  favor  drainage.  December  31, 
18GG :  the  patient  was  doing  well,  and  was  returned  to  duty  February  28,  1867. 

DCLXIL— Note  relative  to  a  Ligation  of  the  Femoral  Artery.    By  Surgeon  LEONARD  F.  RUSSELL, 
4th  U.  S.  Veteran  Volunteers. 

Private  David  Jones,  Co.  E,  4th  Infantry,  was  wounded  at  Fort  Sully,  Dakota  Territory,  on 

March  7,  I860,  by  a  soldier  who  made  a  thrust  with  a  large  bread  knife,  which  entered  the  thigh 

transversely  about  three  inches  above  the  inner  condyle  of  the  femur,  and  passing  almost  through, 

severed  the  popliteal  artery  and  vein,  and  nerve.    Haemorrhage  was  controlled  by  compression, 

31 


242  EEPOET  OF  SURGICAL  CASES  IN  THE  ARMY. 

and  it  was  then  deemed  best  not  to  open  the  wound  and  attempt  to  ligate.  On  the  fourth  day, 
some  arterial  hremorrhage  occurring,  it  was  thought  unsafe  to  delay,  and  I  ligated  the  femoral 
at  the  middle  third.  There  had  been  no  warmth  or  circulation  below  the  wound  since  the  injury, 
and,  at  the  time  of  operation,  there  were  strong  indications  of  gangrene.  The  patient  died  on 
March  16,  1S66. 

DCLXIIL— Account  of  a  Ligation  of  the  Femoral  Artery.    By  E.  MCCLELLAN,  Assistant  Surgeon, 
U.  S.  A. 

Private  George  Hastings,  Co.  K,  37th  Infantry,  was  admitted  to  the  hospital  at  Fort  Garland, 
Colorado  Territory,  July  30,  1868,  having  been  accidentally  stabbed  the  same  day,  in  the  upper 
portion  of  the  thigh,  with  a  long,  narrow  hunting-knife,  which  had  been  made  exceedingly  sharp, 
and  which,  passing  the  femoral  artery,  partially  divided  the  profunda  femoris  below  the  origin  of 
the  external  circumflex.  The  haemorrhage  was  excessive.  Some  few  moments  only  elapsed  after 
the  accident,  before  complete  syncope  ensued  with  all  the  characteristic  symptoms.  Pressure 
on  the  femoral  arrested  the  haemorrhage,  but  the  extreme  prostration  prohibited  surgical  inter- 
ference at  the  time,  and  stimulants  and  nourishments  were  administered.  At  10  o'clock  P.  M. 
hemorrhage  again  occurring,  now  from  the  lower  extremity  of  the  artery,  the  wound  was  enlarged 
and  the  artery  secured.  The  patient  was  kept  for  several  days  under  the  influence  of  morphine. 
Slight  pressure  continued  on  the  femoral,  although  not  sufficient  at  any  time  greatly  to  impede 
the  circulation  in  the  limb.  At  no  time  after  the  operation  was  the  circulation  arrested.  On  the 
nineteenth  clay  the  upper  ligature  was  removed,  but  the  lowerone  did  not  come  away  until  the  thirty- 
fourth,  although  steady  and  continual  traction  upon  it  was  made.  The  patient  was  returned  to 
duty  in  October,  1868. 

DCLXIV. — Memorandum  relative  to  a  Ligation  of  the  Femoral  Artery,     By  A.  JUDSON  GEAY, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  John  Neun,  Troop  B,  3d  Cavalry,  aged -26  years,  was  wounded  in  a  drunken  alterca- 
tion at  Fort  Bayard,  New  Mexico,  November  12,  18(!9,  by  a  pistol  ball,  which  entered  the  outer 
aspect  of  right  leg,  three  inches  below  the  knee,  passed  obliquely  downward  and  inward,  between 
tibia  and  fibula,  and  emerged  from  inner  a.spect  of  leg,  six  inches  above  the  ankle-joint.  He  was 
admitted  to  the  post  hospital  on  November  13,  1807.  The  leg  became  inflamed,  and  the  foot  and 
ankle  cedematous.  The  discharge  was  thin  and  bloody.  Haemorrhage  occurred  on  December 
ber  5th,  and  again  on  December  8th,  but  was  easily  controlled  by  pressure.  The  patient  became 
anaemic  from  loss  of  blood,  and  was  anxious  and  desponding.  On  December  10th,  ether  was 
administered,  and  an  incision  four  inches  long  was  made,  commencing  five  inches  below  Poupart's 
ligament,  and  extendiugparallelto,andalittletotheoutsideof,  the  inner  border  of  the  sartorius  muscle. 
The  femoral  artery  was  then  ligated.  The  patient  reacted  promptly.  Three  days  after  the  opera- 
tion aslough  three  by  five  inches,  formed  under  the  leg  just  above  the  ankle,  but  suppurated  healthily. 
The  inflammation  in  the  leg  subsided,  the  ligature  came  away  on  the  27th,  and  on  December  30th 
the  upper  wound  had  entirely  healed,  while  the  others  were  closing  satisfactorily.  He  was  returned 
to  duty  on  February  24,  1870. 

DCLXV. — Minute  of  a  Case  in  which  the  External  Circumflex  Artery  icas   ligated.    By  DONALD 
JACKSON,  M.  D.,  Acting  Assistant  Surgeon. 

Private  John  Davis,  Co.  C,  41st  Infantry,  aged  22  years,  received  on  March  13,  1869,  at  Fort 
Clark,  Texas,  a  punctured  wound  of  thigh.  He  was  admitted  to  the  post  hospital,  where  the  wound 
was  enlarged  and  the  internal  circumflex  artery  ligated,  while  the  patient  was  under  the  influence 
of  ether.  Five  days  later  the  ligature  was  removed,  and  the  wound  was  filling  with  healthy 
granulations.  He  was  returned  to  duty  May  12,  1869. 


LIGATIONS  IN  THE  LOWER  EXTREMITY.  243 

DCLXYI. — Note   relative  to  a  Ligation  of  the  Posterior  Circumflex  Artery.     By  B.  B.  MILES 
M.  D.,  Acting  Assistant  Surgeon. 

Private  Thomas  Quigley,  Co.  G,  17th  Infantry,  aged  21  years,  received  at  Sulphur  Springs, 
Texas,  December  24,  1868,  an  incised  wound  of  left  shoulder,  eight  inches  in  length  from  shoulder 
downwards.  He  was  admitted  to  the  post  hospital.  The  patient  had  fainted  from  loss  of  blood, 
and  the  pulse  was  almost  imperceptible.  I  ligated  the  posterior  circumflex  artery,  and  brought 
the  edges  of  the  wound  together  with  silk  and  adhesive  plaster.  The  wound  healed  rapidly,  and 
was  doing  well  December  31,  1868.  The  patient  was  returned  to  duty  in  February,  1869. 

DCLXVII. — Note  relative  to  a  Ligation  of  the  Peroneal  and  Tibial  Arteries.    By  H.  A.  DuBois, 
Assistant  Surgeon,  U.  S.  A., 

Corporal  Peter  Stone,  Troop  C,  3d  Cavalry,  aged  24  years,  was  admitted  to  the  post  hospital 
at  Fort  Union,  New  Mexico,  June  29, 1867,  with  a  gunshot  wound  in  the  leg.  The  missile,  a  conoidal 
ball,  entered  three  inches  below  the  head  of  tibia,  passed  through  the  gastrocnemius  and  soleus 
muscles,  descended  the  tibialis  posticus  to  two  inches  below  the  outer  malleolus,  and  injured  in  its 
course  the  peroneal,  and  probably  the  posterior  tibial  artery.  An  incision  through  the  gastrocnemius 
and  soleus  muscles  was  made,  and  the  peroneal  and  tibial  arteries  and  all  bleeding  branches  were 
ligated.  The  patient  never  rallied  from  the  shock,  and  died  July  1,  1867,  fifty-two  hours  after  the 
operation.  At  the  post-mortem  examination  the  kidneys  were  found  inflamed,  and  the  unlooked-for 
termination  of  the  case  was  explained  by  the  fact  that  the  patient  had  been  on  a  debauch  at  the 
time  of  his  admission,  and  for  some  weeks  previously. 

DCLXVIII. — Minute  of  a  Case  in  ichich  'the  Dorsalis  Pedis  Artery  was  ligated.    By  E:  T.  CHASE, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  James  Lasby,  Co.  G,  23d  Infantry,  aged  33  years,  while,  on  December  15, 1868,  chopping 
wood  at  Fort  Colville,  Washington  Territory,  cut  his  right  foot  with  a  sharp  axe.  The  flexor 
tendons  of  the  foot,  dorsalis  pedis  artery,  and  the  metatarsal  bone  of  big  toe  were  divided,  causing 
a  gaping  wound  four  inches  in  length.  He  was  admitted  to  the  post  hospital,  where  the  dorsalis 
pedis  artery  was  ligated,  and  the  wound  closed  by  interrupted  suture.  The  wound  failed  to  unite 
by  first  intention,  and  on  December  20,  1868,  the  ligature  was  removed.  The  patient  was  returned 
to  duty  in  March,  1869. 


244  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 


YARIOUS  OPERATIONS. 


Reports  were  made  of  a  few  operations  on  the  eye  and  ear  and  air  passages,  and  of 
examples  of  lithotomy  and  of  the  removal  of  tumors. 

OPERATIONS  ON  THE  EYE  OR  ITS  APPENDAGES. — A.  case  of  extraction  for  cataract, 
one  of  staphyloma,  one  of  ectropion,  and  one  of  extraction  of  a  foreign  body,  were  specially 
reported. 

DCLXIX. — Account  of  an  Operation  for  Ectropion.    By  A.  C.  GIRARD,  Assistant  Surgeon,  U.  S.  A. 

Private  William  Brown,  Co.  E,  20th  Infantry,  was  admitted  to  the  hospital  at  Baton  Rouge, 
Louisiana,  February  22, 1869,  with  ectropion  of  the  right  eye.  The  conjunctiva  of  the  lower  eyelid 
was  largely  everted  and  considerably  swelled  in  consequence  of  a  burn,  involving  the  whole  right 
cheek  and  part  of  the  temporal  region.  There  was  chronic  conjunctivitis  oculi  and  palpebrarum. 
A  V-shaped  piece  was  excised  from  the  external  angle  of  the  eye,  and  the  edges  united  with  twisted 
suture;  the  thickened  conjunctiva  was  excised  with  curved  scissors,  and  parallel  to  lower  eyelid  an 
incision,  one  and  a  half  inches  in  length,  was  made,  td  relieve  tension.  Simple  dressings  were 
applied,  and  occasionally  cauterization,  to  insure  even  granulation.  The  patient  was  discharged 
March  13,  1869,  at  which  date  the  wound  had  not  entirely  healed. 

DCLXX. — Account  of  an  Extirpation  of  the  Eye-ball  for  Staphyloma.     By  G.  M.  STERNBERG, 
Assistant.  Surgeon  U.  S.  A. 

Private  Lewis  Johnson,  Co.  D,  38th  Infantry,  aged  29,  was  admitted  on  June  24,  1867,  to  the 
post  hospital  at  Fort  Riley,  Kansas.  For  six  months  prior  to  admission  the  patient  had  noticed 
that  his  right  eye  was  becoming  prominent,  and  that  he  could  not  see  with  it.  On  admission  there 
was  staphyloma  of  the  sclerotic,  near  the  cornea.  The  whole  eye  continued  to  enlarge  slowly  in 
all  its  diameters,  and  ulceration  at  the  apex  of  the  staphyloma  ensued.  The  patient  suffered  from 
pain  in  the  head  and  eye,  and  had  frequent  attacks  of  temporary  paralysis  of  th6  extremities, 
lasting  from  one  to  three  ho'urs.  On  December  18th,  an  anaesthetic  of  one  part  chloroform  and 
two  parts  ether,  was  administered,  and  the  globe  of  the  right  eye  was  removed.  A  circular  cut 
was  made  through  the  conjunctiva  with  scissors,  hooking  up  .and  cutting  the  muscles  close  to  their 
insertion  in  the  globe;  the  globe  was  dislocated,  and  the  optic  nerve  severed  with  long  scissors. 
A  plug  of  picked  lint  soaked  in  alum  water  was  then  inserted  in  place  of  the  globe.  On  the  third 
day  suppuration  was  established,  and  the  plug  of  lint  removed.  The  pain  in  the  head  and  the 
attacks  of  paralysis  ceased,  and  the  patient  made  an  excellent  recovery.  He  was  discharged  April 
8, 1868. 

DCLXXI — Report  of  a  Case  of  Traumatic  Cataract.    By  HARVEY  E.  BROWN,  Assistant  Surgeon, 
U.  S.  A. 

Private  John  Ehlman,  Battery  A,  First  Artillery,  was  admitted  to  the  post  hospital  at  Fort 
Ontario,  on  June  30,  1870,  on  account  of  a  severe  contusion  of  the  right  eye,  which  had  produced 
so  much  ecchymosis  and  effusion  in  the  lids  that  it  was  impracticable  to  ascertain  the  condition  of 
the  globe  until  July  3d.  It  was  then  found  that  there  was  a  luxation  of  the  crystalline  lens,  with 
extravasation  of  blood  into  the  anterior  chamber,  and  total  loss  of  sight  from  traumatic  cataract. 


OPEBATIONS  ON  THE  EYE  AND  EAR  245 

As  the  tension  was  very  great,  on  consultation  with  Dr.  E.  M.  Curtis,  of  Oswego,  it  was  decided  to 
operate  as  soon  as  possible.  Accordingly,  on  the  16th  of  July,  the  linear  operation  was  performed 
by  Dr.  Curtis,  with  niy  assistance,  the  patient  being  under  the  influence  of  chloric  ether.  It  was 
found,  on  operating,  that  the  iris  was  extensively  injured;  so  much  so  as  to  give  but  little  hope  of 
an  entirely  favorable  result.  The  lens  extracted  was  completely  disorganized.  After  the  operation 
the  sight  decidedly  improved,  though  the  patient  had  to  undergo  quite  a  severe  attack  of  irido- 
choroiditis  after  the  operation.  This  soldier  was  discharged  on  October  10,  1870,  on  surgeon's  cer- 
tificate of  disability,  for  loss  of  sight.  The  accident  occurred  from  a  blow  received  in  a  drunken 
brawl. 

DCLXXII. — A  Case  of  Exit-action  of  a  Foreign  Body  from  the  Anterior  Chamber  of  the  Eight  Eye. 
By  F.  MEACHAM,  Assistant  Surgeon,  U.  S.  A. 

Private  Patrick  Sheridan,  Co.  D,  36th  Infantry,  appeared  at  sick-call  at  Camp  Douglas,  Utah 
Territory,  January  14,  1869,  complaining  of  an  injury  of  the  right  eye.  A  foreign  substance  was 
found  deeply  imbedded  in  the  cornea.  An  attempt  to  remove  it  failed,  as  it  had  passed  entirely 
through,  and  was  suspended  in  the  anterior  chamber  of  the  eye.  Chloroform  was  administered, 
the  wound  of  entrance  was  enlarged,  and  a  piece  of  steel  one-sixteenth  of  an  inch  in  length,  one- 
forty-eighth  of  an  inch  in  width,  and  one-uinety-sixty  of  an  inch  in  thickness  was  removed  from  the 
anterior  surface  of  the  iris.  Prolapse  of  the  iris  occurred  when  irisdectomy  was  performed.  January 
31st  the  wound  of  the  cornea  had  entirely  healed,  with  a  slight  leucoma,  which  somewhat  interfered 
with  the  vision.  The  patient  was  mustered  out  January  22,  1869,  on  account  of  expiration  of  term 
of  service. 

OPERATIONS  ON  THE  EAR. — A  single  special  report  on  this  subject  was  received. 

DCLXXIII. — Account  of  an  Operation  for  the  Removal  of  an  Aural  Polypus.    By  J.  M.  DICKSON, 
Assistant  Surgeon,  U.  S.  A. 

Private  John  Jeffcott,  Co.  B,  9th  Infantry,  of  strumous  diathesis,  was  admitted  to  hospital  at 
Fort  Sedgwick,  Colorado  Territory,  on  July  10,  1870,  with  deafness  of  both  ears,  accompanied  by 
discharge,  a  small  polypus  existing  in  the  meatus  of  the  right  ear.  By  July  24th  the  walls  of  the 
meatus,  &c.,  were  so  thickened  that  a  small  speculum  could  with  difficulty  be  introduced  but  a  short 
distance.  The  Eustachian  tubes  were  pervious.  On  that  date  the  polypus  was  removed,  by  torsion, 
with  forceps,  the  remaining  portions  by  the  application  of  nitrate  of  silver.  The  ensuing  treatment 
consisted  of  astringent  injections,  the  occasional  application  of  a  blister  over  the  mastoid  portion 
of  the  occipital  bone.  Tonics  and  alteratives  were  admiuistered.  On  September  2,  1870,  he  was 
transferred  to  hospital  at  Fort  Eussell,  Wyoming  Territory,  accompanying  his  company.  At  that 
date  his  hearing  was  much  improved. 

OPERATIONS  ON  THE  MOUTH  AND  ITS  DEPENDENCIES. — Interesting  instances  have  been 
reported  of  operations  for  ranula,  polypus,  and  salivary  calculus. 

DCLXXIV. — Remarks  on  a  Case  of  Ranula.     By  IRVING    C.  EOSSE,  M.  D.,  Acting  Assistant 
Surgeon. 

Private  Magenthaler,  Battery  G,  1st  Artillery,  presented  himself  at  sick-call  at  Fort 
Monroe,  Virginia,  on  December  16,  1869,  having  for  some  time  had  a  troublesome  tumor,  involving 
the  right  side  of  the  floor  of  the  mouth.  It  forced  the  tongue  upward  and  backward,  and  interfered 
with  swallowing  and  pronunciation.  There  was  no  perceptible  derangement  of  the  general  health. 
Making  a  small  puncture  in  the  cyst,  a  glairy,  ropy  fluid  escaped;  but  it  was  not  ascertained 
whether  this  was  an  accumulation  in  the  salivary  ducts  or  a  collection  in  an  enlarged  follicle.  The 
cyst  was  thought  to  constitute  that  form  of  atheroma  known  as  cholesteatoma,  or,  more  commonly, 
ranula.  A  seton  was  passed  through  its  walls,  and  a  saturated  solution  of  chlorate  of  potash  was 


246  EEPOET  OF  SUBG1CAL  CASES  IN  THE  AEMT. 


directed  to  be  used  as  a  mouth-wash.    The  seton  was  several  times  renewed  in  the  course  of  treat- 
ment.   The  patient  was  returned  to  duty  December  29,  1809.' 


i  # 


DCLXXV.— Note  relative  to  the  Removal  of  a  Polypus  from  the  Tonsil.    By  G.  M.  STERNBERG, 
Assistant  Surgeon,  U.  S.  A. 

Private  David  Young,  Troop  K,  10th  Cavalry,  aged  22  years,  was  admitted  on  December 
22,  18G7,  to  the  post  hospital  at  Fort  Eiley,  Kansas,  complaining  of  difficulty  in  swallowing.  An 
examination  of  the  pharynx  disclosed  a  fibrous  polypus,  about  one  and  a  half  inches  long,  attached 
to  the  right  tonsil.  Tbe  polypus  was  removed  by  first  seizing  it  with  toothed-forceps,  and  then 
severing  it  from  its  attachments  with  a  blunt-pointed  bistoury.  Very  little  hemorrhage  occurred, 
and,  up  to  December  31st,  no  return  of  polypus  was  noticed.  He  was  returned  to  duty  in  January, 
18G8. 

DCLXXVL— Note  relative  to  a  Salivary  Calculus.    By  CLINTON  WAGNER,  M.  D.,  late  Surgeon, 
U.  S.  A. 

I  transmit  to  the  address  of  the  Surgeon  General  a  salivary  calculus,  which  I  hope  will  be,  on 
account  of  its  extraordinary  size,  an  acceptable  offering  to  the  collections  of  the  Army  Medical 
Museum.  I  removed  the  stone  in  December,  1870,  from  the  sublingual  gland  of  a  laboring  man.  It 
blocked  up  the  orifice  of  the  duct  of  Bartholine  at  its  junction  with  the  Whartonian  duct. 
From  the  man's  statement  I  inferred  that  the  concretion  had  been  about  three  years  in  form- 
ing. The  man  lived  in  Boise"  City,  Idaho.  The  calculus  weighs  about  eight  grains,  or  little 
less.  The  groove  was  made  by  scraping  with  my  knife.  The  powder  scraped  off  did  not 
effervesce  with  hydrochloric  acid.  With  solution  of  molybdate  of  armnonia  it  gave  the 
vary  Va'inii'us.  characteristic  reaction  of  phosphoric  acid,  and  a  white  precipitate  with  oxalate  of  ammo- 
LA.H.H.  nia.  The  concretion  would  seem  to  be  composed  mainly  of  phosphate  of  lime  and  of 
organic  matter.  It  is  figured  of  the  natural  size  in  the  wood-cut.  (FiG.  51.) 

DCLXXVII. — Account  of  a  Plastic  Operation.    By  L.  E.  HOLMES,  Acting  Assistant  Surgeon. 

Private  Andrew  Mussell,  Troop  F,  8th  Cavalry,  aged  22  years,  was  admitted  to  the  post 
hospital  at  Camp  Logan,  Oregon,  on  March  7, 1868.  He  had  lost  a  portion  of  his  nose,  which  had 
been  injured  two  or  three  years  previously.  A  part  of  the  left  wing  of  the  vomer  was  destroyed, 
leaving  a  fistulous  opening  through  the  middle  third  of  the  organ.  On  March  7th  I  performed  the 
rhiuoplastic  operation,  Indian  method.  Considerable  swelling  of  the  flap  and  the  lids  of  both  eyes 
followed  the  operation.  This  was  treated  with  cold  water-dressings.  On  the  fourth  day  the 
stitches  were  removed,  arid  the  root  of  the  flap  was  cut  ou  the  thirtieth  day.  The  flap  was  well 
located,  and  appeared  satisfactory.  The  patient  was  returned  to  duty  on  April  1,  1868. 

OPERATIONS  ON  THE  AIR  PASSAGES. — Eeports  were  furnished  of  five  cases  of  bron- 
chotomy,  and  one  of  paracentesis  of  the  thorax. 

DCLXXVIII — .Report  of  Tico  Operations  of  Tracheotomy,  with  Remarks  on  some  Details  of  the  Opera- 
tion and  After-treatment.    By  BASIL  NORRIS,  Surgeon,  U.  S.  A. 

A  child,  3J  years  old,  son  of  Mr.  Paulson,  in  general  service  at  the  War  Department,  was  seen 
in  consultation  November  9, 1869.  It  had  been  suffering  five  days  from  membraneous  croup ;  was 
extremely  restless,  with  sharp,  ringing,  croupy  cough,  livid  lips,  and  laborious  respiration.  In 
the  afternoon,  at  two  o'clock,  it  was  put  under  the  influence  of  chloroform,  which  was  sprinkled  on 
a  handkerchief  caught  loosely  in  the  hand  and  held  before  the  face ;  it  was  then  placed  upon  a 
table,  the  shoulders  being  raised  on  a  pillow,  and  the  head  allowed  to  fall  back.  An  incision  was 

*  This  man  was  drowned  at  Fort  Monroe,  November  14,  1870. 


OPERATIONS  ON  THE  AIR  PASSAGES.  247 

made  one  and  a  half  inches  long,  "exactly  in  the  median  line,"  through  the  skin  and  superficial 
tissues ;  the  cervical  fascia  was  next  pinched  up  with  a  pair  of  forceps  and  divided  on  a  grooved 
director ;  this  being  done  the  knife  was  laid  aside  and  the  point  of  a  strong  steel  director  iised  to 
separate  the  steruo-hyoid  muscles,  and  clear  a  way  to  the  windpipe  ;  the  lips  of  the  wound  were 
held  apart  by  blunt  hooks ;  the  trachea,  thus  exposed,  was  kept  steady  by  a  teiiacuhun  in  the  hands 
of  an  assistant,  and  opened  with  a  small  scalpel,  inserted  with  the  point  toward  the  cricoid  cartilage 
and  the  edge  upward.  By  the  aid  of  Trousseau's  dilator,  a  double  caimla  was  quickly  introduced, 
and  the  operation  completed.  The  patient  soon  awoke,  breathing  easily ;  it  looked  about  more 
calmly,  and  bore  on  its  face  a  sense  of  relief  and  comfort;  it  lay  at  rest  on  a  bed,  taking  nourish- 
ment and  water,  until  two  o'clock  in  the  morning,  when  it  again  began  to  breathe  witli  difficulty, 
and  died  at  5  o'clock  A.  M. 

A  child,  —  years  old,  son  of  Mr.  Page,  of  Frederick,  Maryland,  was  seized  with  symptoms  of 
membraneous  croup,  January  2, 1870,  while  on  a  visit  to  an  officer  of  the  Army  stationed  in  Wash- 
ington. It  was  six  days  under  treatment  .by  the  usual  remedies,  and,  in  addition,  was  treated  with 
lime  water  atomized  by  the  "hand  apparatus;"  the  patient,  possessed  of  more  intelligence  than  is 
common  to  children  of  that  age,  willingly  inhaled  through  the  mouth-piece  whenever  it  was  pre- 
sented. Tracheotomy,  earlier  advised,  was  not  performed  until  literally  the  last  moment;  the  face 
and  lips  were  congested,  the  hands  and  feet  cold,  and  the  breathing  slow  and  gasping.  While  in 
this  condition,  chloroform  was  administered,  and  the  operation  was  begun  ;  but  before  the  trachea 
could  be  reached,  it  was  remarked  that  the  heart's  action  had  ceased ;  the  operation  was,  neverthe- 
less, continued,  and  the  child  revived  under  artificial  respiration,  maintained  by  pressure  on  the 
abdomen  with  the  hand,  firmly  and  repeatedly  applied.  It  lived  two  days  and  eight  hours ;  was 
able  to  take  beef-tea,  water,  and  milk-punch,  and  preferred  to  help  itself  to  ice  from  a  saucer  placed 
at  the  bedside.  It  finally  succumbed  to  the  constitutional  effect  of  the  disease. 

In  both  these  cases,  some  haemorrhage  occurred  from  a  vein,  which  is  unavoidable  in  dividing 
the  cervical  fascia,  crossing,  as  it  does,  the  line  of  incision,  midway  between  the  cricroid  cartilage 
and  the  sternum ;  though  very  small,  it  was  seen  and  examined  in  the  second  case,  as  it  lay  im- 
mediately upon  the  fascia  when  raised  on  a  grooved  director.  Hemorrhage  from  this  source  soon 
ceased,  and  was  of  so  little  consequence,  that  I  would  not  think  it  worth  while  to  allude  to  it,  had 
I  not  found  it  practicable,  with  this  exception,  to  go  through  all  the  steps  of  the  operation  without 
the  loss  of  more  blood  than  is  caused  by  the  first  incision  through  the  skin.  Keeping  the  canula 
clean,  and  removing  exudation  from  the  trachea  below  the  artificial  opening,  we  ascertained  to  be 
a  very  important  part  of  the  nurse's  duty.  In  the  first  case,  which  lived  fifteen  hours,  a  feather, 
cut  off  at  the  end,  was  used  to  cleanse  the  canula.  In  the  second  case,  which  lived  fifty -eight  hours, 
a  tube  cleaner,  belonging  to  "  Mawsou's  nursing  bottle,"  was  discovered  to  be  the  "  ne  plus  ultra  " 
for  this  purpose,  and  for  clearing  the  trachea  below  the  tube.  It  was  dipped  in  water,  shaken,  and 
introduced  as  far  as  it  would  go,  even  beyond  the  bifurcation  of  the  trachea;  it  was  withdrawn 
loaded  with  thick  mucus,  and  often  with  partial  casts  of  false  membrane.  The  use  of  this  instru- 
ment was  frequently  necessary  to  relieve  the  breathing,  and  it  was  introduced  as  many  times  as  in 
the  judgment  of  the  attendant  the  emergency  required. 

DCLXXIX — . — Report  of  a  Successful  Case  of  Tracheotomy.    By  WILLIAM  M.  NOTSON,  Assistant 
Surgeon,  U.  S.  A. 

Patrick  McMahon,  a  private  of  Co.  H,  llth  Infantry,  aged  23,  was  admitted  to  hospital  at 
Fort  Concho,  Texas,  on  September  12,  1870,  with  a  longitudinal  fracture  at  the  angle  of  the  lower 
jaw,  supposed  to  have  been  caused  by  a  kick  received  in  a  general  fight  in  the  guard-house.  Oil 
the  18th,  the  patient  being  moribund,  with  the  throat,  neck,  and  head  much  swollen,  it  was  decided 
to  perform  tracheotomy,  which  was  done,  at  midnight,  by  Assistant  Surgeon  William  M.  Notson, 
U.  S.  A.,  assisted  by  Acting  Assistant  Surgeons  J.  A.  McCoy  and  C.  W.  Knight.  The  incision 
was  made  below  the  isthmus  of  the  thyroid  gland.  The  constitutional  state  of  the  patient  was 
favorable  from  age,  but  unfavorable  from  the  fact  that  he  had  been  on  a  debauch.  The  tube 
remained  in  the  opening  ten  days.  Light,  liquid  diet  was  allowed,  and  soup  enemata  were  admiuis- 


248  REPORT  OF  SUEGICAL  CASES  IN  THE  AEMY. 

tered.    Cold-water  dressings  were  used.    The  result  was  entirely  successful,  tbe  patient  Laving 
left  the  hospital  cured,  oil  the  expiration  of  his  term  of  enlistment,  November  29, 1870. 

DCLXXX.— Report  of  a  Fatal  Case  of  Laryngotomy.    By  A.  C.  GIKARD,  Assistant  Surgeon,  U.  S.  A. 

Philip  Haxel,  a  private  of  Co.  H,  19th  Infantry,  reported  sick  at  Baton  Rouge,  Louisiana,  on 
March  7, 1870,  and  stated  that  he  was  beaten  on  the  left  temple  with  a  club  some  days  previously 
whilst  in  an  altercation  with  another  soldier.  A  cold-water  dressing  was  applied  to  reduce  the 
swelling,  but  erysipelatous  inflammation  appearing  on  the  9th,  he  was  admitted  to  hospital,  The 
left  cheek  and  temple  were  considerably  swelled.  The  general  health  and  appearance  of  the  patient 
were  good.  An  examination  with  a  probe  revealed  a  comminuted  fracture  of  the  zygoma,  with 
probable  lesion  of  the  skull.  The  pupils  were  natural,  pulse  72,  bowels  confined,  and  tongue  some, 
what  coated.  Absolute  rest  in  bed  was  enjoined,  with  a  nourishing  diet,  and  cold  applications  of 
carbolic  acid  in  solution.  The  administration  of  aperients,  followed  by  a  solution  of  quinine  and 
iron,  with  the  application  of  a  poultice  to  the  wound,  constituted  the  remainder  of  the  treatment 
He  did  well  until  the  evening  of  the  14th,  when  symptoms  of  tetanus  set  in.  After  consultation, 
one-third  of  a  grain  of  the  extract  of  Calabar  bean,  in  solution  of  eighteen  minims  of  water,  was 
injected  in  the  region  of  the  left  deltoid  muscle,  and  an  enema  of  four  ounces  of  brandy  was  admin- 
istered. This  treatment  was  steadily  adhered  to  until  the  evening  of  the  15th,  when  the  patient 
was  in  immediate  danger  of  suffocation.  The  spasms  had  become  more  violent,  there  was  terrible 
orthopno?a  with  cyanosis,  and  small  but  frequent  pulse.  Having  decided  upon  laryngotomy  as  the 
only  means  of  saving  life  in  this  instance,  the  patient  was  laid  on  a  bed  and  held  by  six  men,  chloro- 
form being  inadmissible,  when  Assistant  Surgeon  A.  C.  Girard  opened  the  thyroid  membrane,  after 
having  stopped  bleeding  from  some  small  veins.  Immediately  on  opening  a  large  stream  of  whipped 
•blood  issued  with  great  force  from  the  opening,  apparently  coming  from  the  lungs,  and  continued 
to  gush  forth  at  each  attempt  at  respiration  for  full  fifteen  minutes.  Upon  the  introduction  of  the 
tube  the  air  commenced  to  pass  too  and  fro  with  great  force,  but  the  expectoration  of  blood  con- 
tinued for  one  hour.  When  it  abated  breathing  became  fairly  established,  and  the  patient  felt 
greatly  relieved.  The  Calabar  bean  and  the  stimulating  enemata  were  repeated,  together  with 
hypodermic  injections  of  atropine,  and  of  morphia  with  Calabar  bean,  but  the  patient  got  lower 
and  lower,  and  died  at  noon  on  the  17th.  At  the  autopsy  the  body  was  somewhat  emaciated,  there 
was  considerable  suggillation  of  the  temporal  muscle,  and  the  zygomatic  bone  was  fractured  in 
two  places,  the  fragments  being  loose  but  uudetached.  The  meninges  on  the  left  temple  were 
somewhat  congested.  The  brain  was  normal,  and  the  temporal  bone  intact.  The  larynx  was 
normal.  The  lungs  were  in  a  high  state  of  congestion  and  cedematous.  No  ruptured  blood-vessel 
of  any  size  was  discovered.  The  heart  and  intestines  were  normal. 


DCLXXXI. — Report  of  a  Fatal  Case  of  Laryngotomy.    By  E.  P.  VOLLTIM,  Surgeon  U.  S.  A. 

Patrick  O'Callaghan,  a  private  of  Co.  B,  13th  Infantry,  aged  25,  was  admitted  to  the  post 
hospital  at  Camp  Douglas,  Utah  Territory,  on  December  10,  1870,  suffering  from  oedema  of  the 
glottis  and  tonsillitis.  On  the  next  day  the  patient  becoming  cyanosed,  and  symptoms  of  suffo- 
cation setting  in  about  mid-day,  the  larynx  was  opened  and  a  tube  inserted  by  Surgeon  E.  P. 
Vollurn,  U.  S.  A.  No  anaesthetic  was  used.  After  the  admission  of  air  through  the  tube,  the 
patient  revived  a  little,  and  lived  about  three-quarters  of  an  hour.  At  the  autopsy,  the  cutan- 
eous surface  was  of  a  bluish  color ;  the  tonsils  were  so  tumefied  as  to  completely  overlap  the 
rima  glottidis,  and  the  sub-mucous  tissue  of  the  epiglottis  and  that  surrounding  the  brim  of  the 
rima  glottidis,  as  well  as  that  covering  the  base  of  the  tonsils  and  the  membranous  fold  about  the 
base  of  the  tongue,  were  boggy,  with  cedematous  effusion.  No  abscess  or  pus  was  found  in  the 
vicinity  of  the  tonsils  or  fauces.  The  sub-maxillary  glands  were  greatly  enlarged,  and  the  areolar 
tissue  of  the  neck  was  distended  by  serous  effusion. 


OPERATIONS  ON  THE  CHEST.  241) 

DCLXXXI1.  —  Report  of  a  Case  of  Thoraccniesix.     By  I).  lUniK,  Surgeon,  U.  8.  A. 


At  San  Antonio,  Texas,  May  (i,  18G9,  Richard  Elliott,  private,  Co.  II,  9th  Cavalry,  aged  24, 
received  an  incised  and  punctured  wound  of  the  left  brest  by  a  knife.  He  was  admitted  to  hos- 
pital from  camp  on  May  7th.  Paracentesis  thoracis  on  the  left  side,  was  performed  for  empycma. 
on  June  12th.  He  was  discharged  from  service  March  24,  1870,  because  of  enipyema,  partial  collapse 
of  the  Inng,  and  great  impairment  of  respiratory  power. 

OPERATIONS  ON  THE  CHEST.  —  Instances  of  removal  of  fragments  of  ribs  and  of  "her- 
metically sealing"  wounds,  after  gunshot  injuries  of  the  thorax,  have  been  detailed  on  pp. 
27,  28,  ante,  and  a  case  of  excision  of  a  necrosed  portion  of  rib  is  described  'on  p.  131. 
Reports  were  received  of  two  other  cases  which  may  be  placed  in  this  category. 

DCLXXX1II.  —  Note  of  a  Case  in  which  Fragments  of  the  Ribs  icere  removed,  icith  Remarks  on  the  After 
Treatment.    By  G.  C.  DOUGLAS,  M.  D.  Acting  Assistant  Surgeon. 

George  Christopher,  a  private  of  Troop  L,  Oth  Cavalry,  was  maliciously  shot  by  another  soldier 
at  Fort  Duncan,  Texas,  on   September  19,  1870.    The  missile  causing  the  injury  was  a  conoidal 
ball,  which  fractured  and  comminuted  the  fourth,  fifth,  and  sixtli  rios  of  the  right  side,  and,  in  its 
course,  destroyed  a  portion  of  the  pleura  costalis.    On  being  admitted  to  the  hospital,  numerous 
small  fragments  of  the  ribs,  amounting  in  all  to  quite  a  handful,  were  removed;   the  wound  was 
dressed  with  a  weak   solution  of  carbolic  acid  and  alcohol,  and  adhesive  strips  were  applied  in 
order  to  control  the  movements  of  the  thorax,  but  were  constantly  loosened  by  the  effusion  from 
the  wound.    The  injury  did  well  until  October  IGth,  and  had  nearly  closed,  permitting  the  patient 
to  move  about  the  ward  without  inconvenience  ;  his  general  health  was  excellent.    But  at  that 
date  a  rain  and  wind  storm  prevailed,  and  he  evidently  took  cold,  which  resulted  in  an  attack  of 
pleurisy  of  the  wounded  side,  extending  to  substance  of  lung,  accompanied  with  profuse  hemopty- 
sis and  effusion  into  the  pleural  cavity,  causing  the  wound  to  reopen  when  dependent,  or  when  the 
patient  was  in  the  horizontal  position.    Ou  the  18th  he  commenced  to  respire  through  the  wound, 
the  air  passing  freely  both  in  and  out.    The  discharge  and  expectoration  were  exceedingly  offensive. 
The  patient  sank  rapidly,  being  almost  moribund  by  October  20th.    Stimulants,  beef-tea,  and  other 
articles  of  extra  diet  suitable  to  his  condition  were  administered.    In  addition  to  this,  he  com- 
menced taking,  on  the  20th,  in  as  large  quantities  as  his  appetite  craved,  the  raw,  clear  muscle  of 
fresh  beef,  pounded  to  a  soft  pulp  and  seasoned  to  suit  his  taste.    Relishing  the  beef,  he  ate  freely 
of  it  during  the  twenty-four  hours  of  the  day.    The  liquid  portion  pressed  out  after  pounding  was 
also  given  as  a  change.    The  injured  side  of  thorax  was  protected  with  a  large  plaster  of  simple 
cerate  having  an  opening  over  the  wound.    This  was  covered  with  oakum,  which  was  kept  constantly 
saturated  with  a  strong  solution  of  carbolic  acid,  with  a  view  to  impregnate  the  air  entering  the 
cavity  containing  the  effused  liquid,  and  to  effuse  the  surface  with  the  antiseptic.    The  offensive 
odor  speedily    disappeared,  the  effusion  rapidly  diminished,  and.  by  the  24th   there   was  no 
disagreeable  odor  to  the  discharge.    On  the  27th,  the  discharge  through  the  wound  had  ceased,  the 
wound  was  rapidly  closing,  the  remaining  effusion  into  the  pleural  cavity  was  gradually  absorbing 
and  the  patient  was  well  enough  to  walk  around  the  ward.    The  effect  of  the  raw  beef  and  its 
essence  was  as  immediate  and  marked  as  a  full  dose  of  alcoholic  stimulant,  and  had  the  advantage 
of  being  more  permanent.    To  this  and  the  introduction  of  the  antiseptic  into  the  pleural  cavity,  the 
patient's  recovery  is  attributed. 

DCLXXXIV.—  Account  of  a  Gunshot  Wound  of  the  Chest,  Treated  by  Hie  Method  of  "Hermetically 
Healing."    By  P.  MIDDLETON,  Assistant  Surgeon,  U.  S.  A. 

Private  John  Lee,  Troop  B,8th  Cavalry,  aged  24,  was  shot  in  the  left  breast  at  Camp  Whipple, 
Arizona  Territory,  November  19,  18G7.  The  ball  entered  below  the  left  clavicle,  two  inches  from 
the  sternum,  and",  passing  through  the  chest  and  scapula,  emerged  over  the  infraspinatus  muscle, 
just  below  the  spine  of  the  scapula.  He  was  sent  to  the  post  hospital  in  a  state  of  syncope.  Six 
hours  after  admission,  venous  haemorrhage  occurred  until  the  patient  fainted.  The  wound  was 
32 


250  EEPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

then  hermetically  sealed.   The  patient  reacted,  and  continued  to  do  well  until  December  2d,  when 
pyaemia  supervened,  and  death  occurred  December  8,  1867. 

OPKEATIONS  ox  THE  ABDOMEN.  —  A  number  of  cases  of  paracentesis  are  mentioned 
in  the  reports  and  several  operations  for  hernia,  but  without  names  or  details.  The  reader 
has  not  overlooked  the  cases  of  gunshot  wounds  of  the  abdomen  in  which  balls  were 
removed  (pp.  44,  49  ante),  nor  the  remarkable  instances  of  recovery  after  the  protrusions 
of  the  intestines  from  incised  wounds  (pp.  93,  95).  The  remaining  reports  coming  under 
this  head  relate  to  a  successful  removal  of  a  mass  of  omentum,  operations  for  fistula,  for 
imperforate  anus,  and  for  haemorrhoids. 

DCLXXXV.  _  .Account  of  a  Case  in  which  a  Portion  of  Omentum  was  successfully  removed.    By 
G.  M.  STEKNBERG,  Assistant  Surgeon,  U.  S.  A. 

Brevet  Lieutenant  Colonel  Albert  Barnitz,  captain  7th  Cavalry,  aged  33,  was  wounded  on 
November  27,  1868,  at  the  battle  of  Wichita,  Indian  Territory,  by  a  ball  from  a  Lancaster  rifle, 
which  entered  the  left  side  of  the  abdoinen,  just  below  the  free  margin  of  the  false  ribs,  four  and 
one-half  inches  to  the  left  of  the  umbilicus,  and  emerged  behind,  three  and  one-half  inches  to  the- 
left  of  the  central  line  of  the  vertebral  column.  The  colonel  was  mounted  when  wounded,  and 
killed  the  Indian  who  shot  him  at  the  same  instant  that  he  received  his  wound.  The  Indian  was 
only  about  fifteen  feet  from  him  when  they  exchanged  shots.  After  receiving  the  wound  the 
colonel  rode  about  two  hundred  yards,  dismounted  and  laid  down,  holding  his  horse  until  some  of 
his  company  came  to  him.  About  half  an  hour  afterward  he  was  examined  by  Assistant  Surgeon 
Lippincott,  U.  S.  A.,  who  found  a  mass  of  omeutum  protruding  from  the  anterior  wound,  about 
the  size  of  a  man's  fist.  The  doctor  supposed,  from  the  position  of  the  wound,  that  the  intestine 
must  be  wounded,  and  that  tlie  injury  must  necessarily  prove  fatal.  The  colonel  was  brought  to 
Camp  Supply  in  an  ambulance,  the  distance  being  about  one  hundred  miles,  and  the  country 
exceedingly  rough.  He  arrived  at  this  place  on  December  1st,  at  which  time  I  took  charge  of  his 
case.  He  was  not  able  to  take  any  food  or  stimulus  on  the  way  in,  on  account  of  the  irritability  of 
his  stomach,  which  rejected  everything  except  a  little  water.  I  found  him  very  much  fatigued  by 
the  journey,  but  having  a  good  pulse  and  presenting  no  bad  symptoms.  The  mass  of  omentum 
protruded  from  the  anterior  wound  as  at  first,  completely  closing  it,  and  preventing  any  air  from 
entering  or  fluid  from  escaping.  I  think  that  adhesion  had  already  taken  place  to  a  certain  extent 
between  the  constricted  portion  of  the  omentum  and  the  sides  of  the  wound.  Prom  the  posterior 
wound  there  was  a  very  free  discharge  of  bloody  serum,  which  from  day  to  day  decreased  in 
quantity,  and  gradually  changed  to  a  discharge  of  healthy  pus.  In  a  day  or  two  after  his  arrival 
the  protruding  mass  of  omentum  became  covered  with  florid  granulations  bathed  with  thick  pus. 
Small  quantities  of  beef-tea  and  wine  were  retained  the  day  of  his  arrival  and  larger  amounts 
were  given  from  day  to  day  without  any  return  of  the  vomiting.  No  medi- 
cine has  been  administered  to  this  date,  except  one  grain  of  quinine  three 
times  a  day,  as  a  tonic,  and  two  quarter-grain  doses  of  morphine,  the  first 
two  nights  after  his  arrival,  to  procure  sleep.  There  was  no  movement 
of  the  bowels  from  date  of  injury  until  December  7th,  when  two  copious 
and  natural  passages  occurred.  On  th.e  8th  I  removed  the  protruding  ma*s 
of  omentum.  I  commenced  the  operation  with  a  wire  ecraseur,  but  before 
it  was  completed  the  loop  of  wire  broke  and  I  severed  a  small  portion, 
which  was  not  yet  cut  through,  with  scissors.  A  small  artery  in  the  portion 
cut  by  the  scissors  bled  for  a  few  moments,  but  the  haemorrhage  was  stopped 
by  the  simple  application  of  cold  water.  December  12th  :  the  colonel  is 


_ 

TIG.  52.  Portion  of  excised    ab]e  to  gjt  u]>  an  ]umr  or  two  at  a  time,  has  a  good  appetite,  sleeps  well, 

turn.    Spec.  5524,   Scut.    I, 

A.  M.  M.  and  may  be  considered  out  of  all  danger.     There  has  not  been  a  bad 

symptom  in  the  case  since  the  first  shock  was  recovered  from,  except  the 

irritability  of  the  stomach  while  on  the  way  in.     [The  specimen  was  contributed  to  the  Army  Medical 


OPERATIONS  ON  TUE  ABDOMEN.  251 

Musonm  by  the  operator.    It  is  figured  of  half  the  natural  size  iu  the  foregoing  wood-cut 
(FiG.   52).] 

DCLXXXVI. — Minute  of  an  Operation  for  Impcrf orate  .Rectum.    By  IBVING  0.  ROSSE,  M.  D., 

Acting  Assistant  Surgeon. 

At  Fort  Monroe,  Virginia,  in  August,  1870,  an  operation  for  the  removal  of  a  membranous 
obstruction  in  the  rectum  of  a  newly^-born  male  child  was  performed  by  George  E.  Cooper,  Surgeon, 
U.  S.  A.  An  opening  was  maintained  by  the  daily  introduction  of  a  bougie.  The  natural  passages 
were  restored,  and  rapid  recovery  ensued. 

DCLXXXVII.— Abstracts  of  Reports  of  Operations  for  Fistula  in  Ano.  By  J.  F.  WEEDS,  Surgeon 
U.  S.  A.;  F.  A.  DAVIS  and  E.  H.  BOWMAN,  Acting  Assistant  Surgeons;  and  A.  0.  GIKARU, 
Assistant  Surgeon,  U.  S.  A. 

CASE  1. — Private  Andrew  Cliiford,  Co.  B,  17th  Infantry,  aged  26  years,  was  admitted  to  the 
post  hospital  at  Cheyenne  Agency,  Dakota  Territory,  December  2, 1870,  with  an  anal  fistula  of  two 
years'  standing.  The  external  orifice  was  three  and  a  half  inches  from  the  margin  of  the  anus 
the  internal  orifice  being  just  above  the  sphincter.  The  fistulous  track  was  very  tortuous  and 
sacculated,  it  being  necessary  to  enlarge  the  external  opening  in  order  to  pass  a  probe  through  its 
whole  extent.  On  December  5th,  the  \yhole  of  the  superimposed  structure  was  divided  on  a  grooved 
director,  previously  passed  along  the  fistulous  track.  No  anaesthetic  was  used,  and  there  was  but 
moderate  haemorrhage.  Poultices  of  linseed  meal  and  a  solution  of  carbolic  acid  were  applied,  and 
on  January  1C,  1871,  the  patient  was  returned  to  duty. 

CASE  2. — Private  George  Rogers,  Co.  D,  16th  Infantry,  aged  24  years,  was  admitted  to  post 
hospital  at  Nashville,  December  20,  1870,  with  fistula  in  ano.  The  general  condition  was  favorable. 
Inflammation  had  subsided.  The  sphincter  was  divided  on  the  21st  and  kept  open  by  tents  satu- 
rated with  glycerine  and  carbolic  acid.  The  wound  healed  rapidly,  and  the  man  was  soon  returned 
to  duty. 

CASE  3. — Private  John  A.  Graves,  Co.  A,  24th  Infantry,  was  admitted  to  the  hospital  at  Fort 
Bliss,  Texas,  November  2,  1870,  with  a  fistula  in  ano  of  long  standing.  A  thickened  indurated 
canal  opened  into  the  rectum  above  the  sphincter,  and  externally  near  the  tuberosity  of  the  left 
ischium.  On  November  4, 1870,  the  sphincter  ani  was  divided,  and  tents  of  lint  saturated  with 
liquor  of  the  persulphate  of  iron  were  introduced.  The  patient  recovered  rapidly,  and  was  discharged 
on  account  of  expiration  of  term  of  service. 

CASE  4. — Private  Timothy  Soleven,  Co.  H,  19th  Infantry,  aged  21  years,  was  admitted  to  the 
post  hospital  at  Baton  Rouge,  Louisiana,  June  9, 1869,  with  fistula  in  ano.  There  was  extensive 
suppuration  from  the  perineal  tissues.  On  June  24th,  an  inductor  was  introduced  through  the  fistula 
into  the  rectum  and  the  bridge  divided  with  a  curved  bistouri.  A  tent,  soaked  iu  glycerine,  was 
introduced,  and  the  bowels  were  kept  inactive  by  opium.  Subsequently  the  bowels  were  cleaned 
every  morning  by  injection.  On  June  30th,  the  wound  had  almost  entirely  healed. 

DCLXXXVIII.— Operation  for  Removal  of  Hcemorrliolds.  By  JOHN  H.  BARTHOLF,  Assistant 
Surgeon,  U.  S.  A. 

Private  James  S.  Kehan,  Co.  H,  llth  Infantry,  aged  30  years,  was  admitted  to  the  post  hospital 
at  Camp  Grant,  near  Richmond,  on  August  15,  1867,  with  an  aggravated  form  of  internal  piles, 
which  he  had  suffered  from  for  two  months  prior  to  admission.  The  mass  protruding  was  of  a  size 
equal  to  twice  the  bulk  of  a  black  walnut,  and  bled  profusely  at  every  stool,  of  which  he  had  two  or 


252  EEPOET  OF  SUEGICAL  CASES  IN  THE  AEMY. 

three  daily,  not  from  a  diarrhoea,  but  apparently  from  the  desire  to  defecate  being  excited  by  the 
condition  of  the  parts.  He  had  been  treated  in  quarters  with  astringent  injections  and  suppositories, 
but  without  benefit.  The  protrusion,  which  almost  amounted  to  a  prolapsus  of  the  rectum,  was 
returned  with  difficulty.  Shortly  afterward  I  placed  three  silk  ligatures  well  up  around  three  of 
the  most  prominent  projections,  the  gut  being  first  caused  to  protrude  as  much  as  possible  by  the 
patient  sitting  for  some  time  over  a  vessel  of  hot  water  in  a  squatting  posture  and  using  straining 
and  expulsive  efforts.  The  ligatures  came  away  on  the  tenth  day.  He  made  a  good  recovery, 
having  been  kept  quiet  on  his  back,  and  opiates  administered ;  in  two  weeks  he  was  employed  as  a 
helper  in  the  dispensary,  and  was  returned  to  duty  with  his  company  on  October  2,  1807. 

DCLXXXIX. — Minute  of  an  Operation  for  the  Removal  of  Hemorrhoids.     By  J.  F.  BOUGIITER, 
M.  D.,  Acting  Assistant  Surgeon. 

Private  James  McNally,  Co.  D,  22d  Infantry,  aged  3G  years,  was  admitted  to  the  post  hospital 
at  Fort  Dakota,  with  internal  haemorrhoids,  on  July  3,  1808.  On  July  7th,  ligatures  were  applied 
to  two  large  and  vascular  tumors,  which  were  congested  and  sensitive  to  the  touch.  Recovery 
being  rapid,  the  patient  was  returned  to  duty  July  18th,  and  was  mustered  out  of  service  August 
4, 18G8,  the  haemorrhoids  not  having  returned. 

OPERATIONS  ON  THE  GENITO-URINARY  ORGANS. — Several  successful  and  highly  inter- 
esting operations  for  lithotomy  were  reported,  and  a  number  of  operations  for  stricture, 
and  one  of  supra-pubic  puncture  of  the  bladder  for  retention  of  urine.  The  prevalence 
of  venereal  affections,  unhappily  not  less  common  in  our  own  than  in  other  armies,  caused 
circumcision  or  other  operations  for  phimosis  to  be  not  infrequent. 

DCXC — .Memoranda  of  Fourteen  Cases  of  Phimosis  in  which  Operations  were  performed.  By  B.  A. 
CLEMENTS,  Surgeon,  U.  S.  A.;  C.  SMAKT,  C.  K.  GREENLEAF,  C.  B.  WHITE,  and  HARVEY 
E.  BROWN,  Assistant  Surgeons,  U.  S.  A. ;  and  E.  WOODRUFF,  M.  D.,  B.  F.  SLAUGHTER,  M.  D., 
A.  ANSELL,  M.  D.,  and  E.  McCRAKEN,  M.  D.,  Acting  Assistant  Surgeons. 

CASE  1. — Private  John  Anderson,  Co.  E,  32d  Infantry,  aged  22  years,  was  admitted  to  the 
hospital  at  Camp  Lowell,  Tucson,  Arizona  Territory,  September  27, 1808,  suffering  from  congenital 
phimosis.  On  September  28th  Assistant  Surgeon  Charles  Smart,  U.  S.  A.,  removed  the  prepuce. 
The  patient  had  recovered  October  10,  1808. 

CASE  2. — Private  Henry  Hoffman,  Co.  C,  2d  Infantry,  aged  23  years,  was  admitted  to  the 
hospital  at  Taylor  Barracks,  Louisville,  Kentucky,  November  0,  1808,  with  phimosis,  and  a  large 
mass  of  venereal  warts  on  the  inner  side  of  prepuce.  On  November  7th,  Assistant  Surgeon  Charles 
E.  Greeuleaf  removed  the  prepuce.  December  2,  1808,  the  patient  had  entirely  recovered. 

CASE  3.— Private  Isaac  Taylor,  Co.  I,  2d  Infantry,  aged  22  years,  was  admitted  to  the  hospital 
at  Taylor  Barracks,  Louisville,  Kentucky,  November  0, 1808,  with  gonorrhu-a  and  phimosis.  Acting 
Assistant  Surgeon  Ezra  Woodruff  removed  the  prepuce,  December  2,  18G8.  On  December  31st 
the  patient  had  entirely  recovered. 

CASE  4. — Private  Edward  Burke,  Co.  G,  IGth  Infantry,  was  admitted  to  the  hospital  at  Hum- 
bold  t,  Tennessee,  with  balanitis  and  phimosis.  On  August  20,  1870,  Acting  Assistant  Surgeon 
B.  F.  Slaughter  divided  the  prepuce  from  the  corona  glandis  outward.  Cold-water  dressings  were 
applied,  and  on  September  3,  1870,  the  patient  was  returned  to  duty. 

CASE  5.— Private  John  T.  Talbot,  Co.  G,  25th  Infantry,  was  admitted  to  Jackson  Barracks 
Hospital,  New  Orleans,  June  25,  1809,  with  congenital  phimosis,  aggravated  by  gonorrhcpa.  On 
July  25th,  Surgeon  B.  A.  Clements  operated  by  circumcision.  Owing  to  the  contact  of  irritating 
discharge,  the  parts  healed  slowly  by  granulation.  The  patient  made  an  excellent  recovery,  the 


OPERATIONS  ON  THE  GENiTO  URINARY  ORGANS.  253 

line  of  union  being  less  marked  tliau  would  Lave  been  anticipated  from  the  slow  healing.     He  was 
returned  to  duty  August  30,  1809. 

CASE  G.— Private  John  Harliug,  Co.  G-,  25th  Infantry,  was  admitted  to  the  Jackson  Barracks 
Hospital,  New  Orleans,  May  20,  1869,  with  congenital  phimosis,  aggravated  by  recent  gonon  \ui-.i. 
On  June  2Gth,  Surgeon  B.  A.  Clements  performed  circumcision,  with  slitting  up  of  mucous 
membrane.  Silver  wire  sutures  and  cold-water  dressings  were  applied,  and  the  wound  healed  by 
first  intention  except  at  one  small  point.  The  patient  was  doing  well  June  30,  1809. 

CASE  7. — Private  Edward  P.  Hacketts,  Co.  P,  1st  Infantry,  aged  24  years,  was  admitted  to  the 
Jackson  Barracks  Hospital,  New  Orleans,  January  11,  1809,  with  congenital  phimosis,  aggravated 
by  gonorrhoea.  On  January  15th,  Surgeon  B.  A.  Clements  performed  circumcision.  The  patient 
recovered  entirely  by  March  4,  1809. 

CASE  8. — Private  Michael  Leadthan,  Co.  K,  1st  Infantry,  aged  24  years,  was  admitted  to  the 
hospital  at  Jackson  Barracks,  Louisiana,  February  20,  1807,  with  phimosis  following  venereal 
disease.  On  March  14th,  Assistant  Surgeon  Harvey  E.  Brown,  U.  S.  A.,  performed  circumcision, 
and  divided  the  stricture  along  the  dorsum  of  the  penis.  The  wound  healed  promptly  by  granula- 
tion, and  the  patient  soon  returned  to  duty. 

CASE  9. — Private  James  Clements,  Co.  E,  1st  Infantry,  was  admitted  to  hospital  at  Jackson 
Barracks,  Louisiana,  February  27, 1807,  with  phimosis,  the  result  of  venereal  disease.  Circumcision 
was  performed  on  March  14th,  by  Assistant  Surgeon  C.  B.  White,  U.  S.  A.  The  patient  recovered. 

CASE  10. — Private  Wesley  Thomas,  Troop  G,  9th  Cavalry,  aged  19  years,  was  admitted  to  the 
hospital  at  Fort  Inge,  Texas,  June  3, 1807,  with  phimosis  following  syphilis.  On  June  24tli,  Acting 
Assistant  Surgeon  Aaron  Ausell  removed  the  prepuce.  The  patient  was  returned  to  duty  August 
11,  1807. 

CASE  11. — Private  William  Maunsell,  Co.  F,  1st  Infantry,  was  admitted  to  the  Jackson 
Barracks  Hospital,  New  Orleans,  Louisiana,  with  phimosis  aggravated  by  gonorrhoea.  On  August 
19, 18G7,  Surgeon  B.  A.  Clements,  U.  S.  A.,  removed  the  prepuce.  The  patient  recovered  rapidly. 

CASE  12. — Private  Wilson  Dennis,  Co.  C,  39th  Infantry,  aged  21  years,  was  admitted  to  the 
hospital  at  Fort  Pike,  Louisiana,  February  19,  1809,  with  phimosis.  On  the  same  day  Acting 
Assistant  Surgeon  Robert  McCracken  slit  up  the  prepuce  along  the  dorsum  of  the  penis.  The 
patient  had  recovered  April  1,  1809. 

CASE  13. — Private  William  Jackson,  Co.  K,  39th  Infantry,  aged  27  years,  was  admitted  to  the 
hospital  at  Fort  Pike,  Louisiana,  February  22,  1809,  with  primiary  syphilis.  Phimosis  followed^ 
and  on  March  20th,  Acting  Assistant  Surgeon  Robert  McCracken,  slit  up  the  prepuce  along  the 
dorsum  of  the  penis.  The  man  was  returned  to  duty  March  25,  1809,  almost  well. 

CASE  14. — Private  John  Rice,  Co.  A,  39th  Infantry,  aged  21  years,  was  admitted  to  the  hospital 
at  Fort  Pike,  Louisiana,  March  9,  1809,  with  primary  syphilis.  Phimosis  supervened,  and  on 
March  25th,  Acting  Assistant  Surgeon  liobert  McCrackeu  cut  the  prepuce  along  the  dorsum  of 
the  penis.  On  April  1st,  the  man  had  nearly  recovered. 

DCXCL— Memoranda  relative  to  Two  Cases  in  which  the  Penis  was  amputated.    By  W.  A.  TOMPKINS, 
Acting  Assistant  Surgeon,  and  S.  M.  HORTON,  Assistant  Surgeon,  U.  S.  A. 

CASE  1.— Private  Julius  Citius,  Co.  H,  8th  Infantry,  was  admitted  from  the  guard-house  to  hos- 
pital at  Columbia,  on  October  12,  1870,  for  primary  syphilis  complicated  with  phimosis,  sloughing, 
and  gangrene  of  the  penis.  The  condition  of  the  injured  parts  having  grown  worse,  and  several 
copious  hiumorrhages  occurring,  chloroform  was  administered  on  the  18tli,  and  the  glans  and  two 


254  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

inches  of  the  body  of  penis  were  removed.  The  mucous  membrane  was  then  stitched  at  four  different 
points  to  the  edges  of  the  cutaneous  portion  of  the  wound.  No  contraction  of  the  urinary  canal 
followed,  and  very  little  blood  was  lost.  The  dorsal  artery  was  ligated.  The  patien  t's  constitutional 
condition  at  the  time  of  the  operation  was  fair,  a  generous  diet  and  tonics  having  rapidly  removed 
the  cachexy  present  at  the  date  of  his  admission.  The  after  treatment  consisted  in  the  use  of  a 
catheter,  which  was  retained  four  days  by  tape  straps,  carbolized  dressings,  tonics,  stimulants,  and 
a  nourishing  diet.  The  wound  healed  rapidly,  and  the  patient  gained  twenty-four  pounds  while 
in  the  hospital.  He  passed  his  urine  without  difficulty,  and,  being  convalescent,  joined  his  regiment 
on  December  20,  1870.  The  pathological  specimen,  with  the  above  particulars,  was  contributed  to 
the  Army  Medical  Museum  by  the  operator,  and  is  No.  5737  of  the  Surgical  Section. 

CASE  2. Private  R.  Vogler,  Co.  B,  27th  Infantry,  aged  22  years,  was  admitted  to  the  hospital  at 

Fort  Philip  Kearny,  Dakota  Territory,  July  15, 1867,  with  a  very  large  warty  growth, which  discharged 
an  ichorous,  fetid  pus,  and  involved  the  glans  penis,  the  prepuce,  and  the  anterior  third  of  the 
entire  body  of  that  organ.  On  July  ICth  the  penis  was  amputated  at  the  junction  of  the  middle 
and  posterior  third,  while  the  patient  was  under  the  influence  of  equal  parts  of  ether  and  chloroform. 
The  mucous  membrane  of  the  urethra  was  tacked  by  thread  to  the  skin  at  four  points.  The  stump 
healed  without  a  bad  symptom,  and  the  patient  was  returned  to  duty  on  August  22,  18G7.  Since 
then  he  has  complained  of  partial  closure  of  the  external  orifice,  which  was  relieved  by  gradual 
dilatation,  repeated  every  three  hours  for  one  day. 

DCXCII. — Memorandum  relative  to  an  Operation  for  the  Relief  of  Stricture. — By  JOHN  II.  BARTIIOLF, 
Assistant  Surgeon,  TJ.  S.  A. 

Private  Hugh  Donohue,  Troop  F,  5th  Cavalry,  was  admitted  to  the  post  hospital  at  Camp  Grant, 
Richmond,  with  an  impermeable  stricture  of  the  urethra,  of  fourteen  months  standing,  following 
gonorrhoaa.  It  was  situated  half  an  inch  behind  the  root  of  the  scrotum.  The  urine  came  away 
in  a  very  small  stream,  and  often  in  drops.  The  smallest  instrument  was  absolutely  impassable. 
A  No.  7  catheter  was  passed  down  to  the  stricture  and  cut  down  upon;  the  incision  was  then 
continued  into  the  bladder,  and  the  catheter  passed  directly  afterward  into  the  bladder,  where  it 
was  secured.  The  patient  recovered,  and  was  returned  to  duty  in  May,  1808. 

DCXCIII. — Report  of  an  Operation  for  the  Relief  of  Stricture. — By  F.  L.  TOWN,  Surgeon,  U.  S.  A. 

Private  Timothy  Quill,  Co.  1, 13th  Infantry,  aged  30  years,  was  admitted  to  the  hospital  at  Fort 
Shaw,  Montana  Territory,  May  25, 1808,  with  a  stricture  of  the  spongy  part  of  urethra,  of  long  standing. 
It  was  situated  just  anterior  to  the  scrotum,  and  was  apparently  not  of  great  thickness ;  a  No.  2 
catheter  could  with  difficulty  be  passed.  On  May  25th  chloroform  was  administered,  and  the 
stricture  was  divided  by  the  nrethrotome.  A  full-si/.ed  catheter  was  then  inserted,  and  allowed  to 
remain.  The  incision  healed  rapidly,  and  with  apparently  very  little  contraction  at  the  seat  of 
stricture.  The  patient  was  returned  to  duty,  but  the  stricture  contracted  again,  and  on  March  11, 
1800,  he  was  readmitted  to  the  hospital,  and  the  stricture  again  divided  by  the  urethrotome.  The 
same  treatment  was  observed  as  above,  and  on  March  31st  the  patient  was  able  to  urinate  freely. 

DCXCIV. — Memorandum  relative  to  an  Operation  for  the  Relief  of  Stricture. — By  SAMUEL  S.  JESSOP, 
Assistant  Surgeon,  U.  S.  A. 

Private  J.  E.  Smith,  Ordinance  Corps,  aged  31  years,  was  admitted  to  the  hospital  at  Charleston, 
April  17,  1800,  with  stricture  of  the  urethra,  the  result  of  gonowluea,  contracted  about  seven  years 
previously.  Stricture  occurred  in  two  places,  one  about  two  and  a  half  inches  behind  the  external 
meatus,  the  other  near  the  bulb.  Several  fistula1  existed  ;  there  had  been  urinary  infiltration, 
and  the  scrotum,  with  the  skin  of  the  abdomen,  had  sloughed.  The  patient  was  feeble,  and  suffered 
much  pain  from  the  slightest  movement.  On  May  15th  the  sloughs  had  separated,  and  the  wounds 


OPERATIONS  ON  THE  BLADDER.  255 

were  granulating  finely.  Chloroform  being  administered,  the  anterior  stricture  was  divided  by 
urethrotomy,  ami  the  posterior  by  Syme's  perineal  section.  A  catheter  was  introduced,  and 
nourishing  diet  ordered.  All  the  fistulae  were  closed  and  the  patient  recovered  rapidly. 

DCXCV. — Account  of  an  Operation  for   the  Belief  of  Stricture.     By  E.  P.  VOLLUM,  Surgeon, 
U.  S.  A. 

Private  John  White,  Co.  H,  42d  Infantry,  aged  32  years,  was  admitted  to  the  hospital  at  Madison 
Barracks,  Sackett's  Harbor,  New  York,  March  25,  1808,  with  strictures  of  the  urethra.  The  first 
stricture  extended  from  the  bulb  to  near  the  prostate  gland,  and  the  second  was  at  a  point  about 
three  inches  from  the  head  of  the  penis ;  both  were  impassable  to  the  smallest  bougie.  The 
patient  had  been  twice  injured,  each  injury  being  followed  by  bloody  urine.  Oil  April  10th,  ether 
was  administered  and  the  upper  stricture  divided  by  the  urethrotome.  On  the  following  day 
equal  parts  of  chloroform  and  ether  were  administered,  and  the  lower  stricture  was  divided  by 
perineal  section.  The  patient,  who  had  been  prior  to  the  operation  cachetic  and  debilitated,  sank 
gradually,  and  died  on  April  14,  1808,  from  the  effects  of  the  operation.  At  the  autopsy,  pus  and 
black  ecchymosis  were  found  at  the  site  of  the  divided  strictures.  The  prostate  gland  was  much 
enlarged,  hardened,  and  contained  two  small  abscesses.  The  bladder  was  thickened  to  about  half  an 
inch,  and  its  mucous  lining  eroded,  excepting  some  small  patches  at  the  base,  and  for  about  an  inch 
around  the  neck  ;  the  ureters  were  irregularly  dilated  in  some  places  to  three  times  the  natural 
size;  pelvis  was  dilated  and  contained  a  little  pus;  fat  in  the  pyramids.  The  kidneys  were  white, 
measured  five  and  three-eighths  by  three  and  a  half  inches,  and  weighed  ten  ouuces. 

DCXCVI. — Report  of  a  Case  in  which  a  Foreign  Substance  was  removed  from  the  Urethra  by  Urethrot- 
omy. Bj  J.  H.  BAKTHOLF,  Assistant  Surgeon,  U.  S.  A. 

Private  John  Kline,  Co.  C,  llth  Infantry,  aged  33  years,  was  admitted  to' the  post  hospital  at 
Camp  Grant,  near  Richmond,  on  October  24, 1808.  He  had  for  several  days  previously  had  consid- 
erable difficulty  in  urinating,  the  stream  being  small  and  attended  with  straining  efforts  to  pass  it. 
At  9  A.  M.,  on  the  24th,  as  he  could  not  pass  water  at  all,  he  undertook  to  remedy  the  trouble 
by  passing  a  broom  straw  seven  or  eight  inches  into  the  urethra,  and  on  withdrawing  it  a  portion 
was  broken  off  and  remained.  One  hour  and  a  half  after  the  occurrence  I  removed  it  by  cutting 
down  upon  it,  opening  the  urethra  an  eighth  of  an  inch  in  front  of  the  anterior  border  of  the  scrotum, 
where  the  external  or  anterior  end  of  the  wisp  was  situated  and  could  be  felt.  Making  an  opening 
into  the  urethra  of  the  necessary  size,  the  end  of  the  stem  was  made  to  protrude  and  was  withdrawn. 
Its  length  was  three  and  a  half  inches,  and  its  inner  end  must  therefore  have  been  well  on  toward 
the  bladder.  No  amesthetic  was  used.  On  the  next  day,  being  unable  to  evacuate  his  bladder,  a 
No.  1  flexible  catheter,  without  the  wire,  was  inserted,  ami  the  urine  drawn  off.  The  condition  of 
the  patient  varied  until  December  21st,  when  he  was  detailed  as  hospital  attendant.  Up  to  Decem- 
ber 20th  the  bladder  had  been  evacuated  by  the  aid  of  catheters,  but  the  patient  being  rather  ill  at 
that  date  their  use  was  discontinued.  On  December  31st,  he  is  reported  as  being  well  as  regards 
his  genito-urinary  organs.  The  piece  of  broom  removed  was  forwarded  to  the  Army  Medical 
Museum,  and  is  numbered  5527  of  the  Surgical  Section. 

DCXCVIL— Report  of  a  Case  of  Supra-Pubic  Puncture  of  the  Bladder  for  Retention  of  Urine 
produced  by  Chronic  .Enlargement  of  the  Prostate.  By  A.  W.  WIGGIN,  Assistant  Surgeon, 
U.  S.  A. 

Patrick  Quohn,  aged  59  years,  a  policeman  in  the  cadets'  barracks  at  the  Military  Academy, 
West  Point,  New  York,  had  been  suffering  for  several  years  from  chronic  enlargement  of  the 
prostate  gland,  with  irritable  stricture  at  the  neck  of  the  bladder,  which  required  him  to  void  his 
urine  as  frequently  as  once  in  two  hours,  and  occasionally,  as  a  result  of  a  debauch,  necessitating 
the  introduction  of  a  catheter.  On  August  5,  1809,  having  been  drinking  whiskey  the  evening 
previous,  he  applied  to  an  irregular  practitioner,  who  endeavored  for  two  or  three  hours  to  introduce 
a  very  small-sized  catheter.  I  saw  him  at  3  A.  M.,  August  5th,  There  had  evidently  been  consider- 
able liicmorrliage  from  the  urethra,  and,  on  the  gentle  passage  of  a  No.  7  catheter,  a  good  deal  of 
.soreness  and  tumefaction  were  discovered,  and  blood  flowed  very  readily.  After  trying  with  much 


256  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

can-  ami  gentleness  to  introduce  the  instrument,  I  placed  the  patient  in  a  hot  bath,  afterward 
making  another  ineffectual  attempt  with  the  catheter.  Hot  baths,  with  enemata  of  hot  water, 
wore  continued  during  the  forenoon,  with  occasional  attempts  on  the  part  of  Surgeon  T.  A. 
McParlin,  U.  S.  A.,  and  myself  to  introduce  catheters  of  different  sizes  and  curves,  both  metallic 
and  flexible,'  but  without  success.  At  3  P.  M.,  the  pain  and  anxiety  of  the  patient  had  become 
extreme  ;  pulse  120,  irregular  and  intermittent.  He  had  passed  no  water  for  twenty-four  hours,  a 
condition  of  great  extremity  for  him.  In  view  of  these  facts,  and  the  additional  circumstance  of  the 
chronic  diseased  condition  at  the  neck  of  the  bladder  and  consequent  danger  of  rupture,  it  was  decided 
that  the  only  recourse  was  to  puncture.  The  only  operation  practicable  was  the  supra-pubic,  which 
was  performed  by  Surgeon  McParlin,  the  puncture  being  made  in  the  median  line  about  an  inch 
above  the  os  pubis.  Twenty-six  ounces  of  urine  was  withdrawn,  and  a  canula  left  in  the  wound, 
retained  in  situ  by  a  T  bandage  and  tapes.  Morphine  was  freely  given  to  allay  pain  and  insure 
perfect  quietude.  On  the  next  day  the  canula  had  partially  slipped  out,  and  could  not  be  restored 
to  its  original  position.  The  urine  was  oozing;  the  patient  was  feeble;  pulse  frequent,  irregular, 
and  intermittent.  At  five  A.  M.  of  the  7th,  I  found  the  canula  entirely  out  of  the  wound,  an 
accident  doubtless  attributable  to  the  patient  himself.  There  was  some  evidence  of  absorption  of 
urea;  pulse  quick,  feeble,  and  irregular;  respiration  frequent;  partial  coma.  The  bladder  was 
nearly  as  full  as  before,  and  no  urine  escaping  by  the  puncture.  Another  puncture  was  made  by- 
Surgeon  McParlin  as  near  the  same  spot  as  possible,  the  canula  being  retained  by  adhesive  plaster 
and  tape.  Anodynes  and  nourishing  diet  were  administered.  On  August  8th,  the  urine  escaped 
freely  by  the  canula.  There  was  no  sign  of  extravasation,  and  the  symptoms  of  ursemia  had 
passed  away  ;  pulse  130,  feeble  and  irregular.  .Warm  soap  suds  and  sweet  oil  were  injected  into 
the  urethra,  which  discharged  pus  slightly.  The  patient  slowly  improved  in  appetite  and  general 
health,  the  scrotum  became  slightly  excoriated,  but  this  gave  way  under  the  application  of  a 
carbolic  lotion.  The  same  general  treatment  was  pursued  until  August  13th,  when  a  gum-elastic 
catheter  was  introduced  for  the  first  time  since  the  operation.  This  was  withdrawn  on  the  next 
day,  as  was  also  the  canula,  and  a  No.  7  silver  catheter  inserted  and  fastened  in  the  urethra  by  a 
metallic  ring  around  the  penis  with  tapes  attached.  This  was  found  to  be  unendurable,  and 
unless  pushed  so  far  into  the  bladder  as  to  defeat  its  object,  the  point  was  liable  to  slip  out  of  the 
bladder  into  the  urethra,  particularly  during  a  fit  of  coughing.  The  urine  continued  to  flow  through 
the  wound  without  extravasation,  a  perfect  fistula  having  become  established  by  adhesion  of  the 
walls  of  the  bladder  to  the  abdominal  parietes.  From  August  17th  to  23d,  no  attempt  was  made 
to  retain  a  catheter  in  the  urethra,  the  urine  being  withdrawn  by  the  frequent  introduction  of  a 
gum-elastic  catheter,  while  the  passage  of  the  urine  by  the  fistula  was  not  restricted.  In  a  few  days 
the  patient  acquired  the  habit  of  passing  his  urine  naturally;  the  fistula  gradually  closed,  and  on 
August  24th  the  wound  had  nearly  healed,  the  urine  only  passing  through  it  in  small  quantities  at 
the  commencement  of  an  effort  to  urinate.  He  continued  to  improve,  and,  on  September  25th,  was 
walking  about  apparently  as  well  as  before  the  operation. 

DCXCVIII.  —  Account  of  a  Successful  Lithotomy  Operation  by  the  Lateral  Method,  with  a  Description 
of  the  Specimen.    By  H.  A.  DuBois,  Assistant  Surgeon,  U.  S.  A. 

*  *  On  August  3,  18GG,  I  removed  from  the  person  of  Henry  McJ.,  a  citizen  of  Mora,  New 
Mexico,  by  the  ordinary  lateral  operation,  a  large  vesical  calculus.  The  wound  healed  in  a  short 
time,  and  the  patient  recovered  without  any  incident  of  interest  during  the  after-treatment. 
1  met  him  a  year  subsequently  and  obtained  from  him  the  concretion.  Its  weight,  after  removal 

and  drying,  had  been  three  hundred  grains, 
but  after  being  carried  about  in  the  patient's 
pocket  for  a  year  it  weighed  only  one  hundred 
and  seventy  grains.  I  made  no  complete  analy- 
sis of  the  specimen  owing  to  want  of  time,  but 

found  the  external  lamina  soluble  in  hydro-       FIC.  54.—  scctumuniK-cai- 
.  53._j.:xtc.iuii  view  of  a  vosir:,i    chloric  acid,  and  effervescing  in  the  cold  and    culus 
calculus,  spec.  4803,  Sect  i,  A.  M.  M.      precipitated  with  carbonate  of  soda.    The  specimen  will  be  forwarded 
to  the  Army  Medical  Museum.     [Its  size  and  exterior  surface  is  represented  in  the  adjoining  wood- 


LITHOTOMY. 


257 


cut,  (FiG.  53,)  and  the  appearance  of  the  section  through  the  short  axis  is  shown  in  the  opposite 
wood-cut,  (FiG.  54).  [It  is  of  a  yellowish  white  color,  and  measures  one  inch  and  a  half  in  length, 
one  in  breadth,  and  five  eighths  in  depth.  It  is  compressed  laterally  ;  is  irregularly  ovoid  in  shape' 
and  is  soft  and  friable.  Its  structure,  as  seen  by  the  microscope,  is  amorphous.  After  exposure 
to  heat  it  emitted  the  smell  of  burnt  feathers.  The  nucleus,  of  a  brownish-red  color,  consists  of 
nrate  of  lime,  and  is  of  firmer  consistence  than  the  body  or  crust,  both  of  which  are  made  up  of 
ammonio-magnesian  phosphate  and  organic  matter. — ED.] 

DCXCIX. —  Memorandum  relative  to  a    Vesical  Calculus  successfully  removed  by  Lithotomy.     By 
JOSEPH  E.  SMITH,  Surgeon,  U.  S.  A. 

The  specimen  numbered  5575  of  the  Surgical  Section  was  presented  to  the  Army  Medical 
Museum,  by  Surgeon  Joseph  E.  Smith,  U.  S.  A.,  who  removed  it,  by  the  lateral  operation,  from  a 
boy  of  seven  years,  at  Little  Eock,  Arkansas.  On  March  20,  1871,  Surgeon  Smith  writes :  "  There 
was  no  hemorrhage;  the  incision  in  the  prostate  was  enlarged  by  the  finger,  and  the  stone 
extracted  only  with  considerable  traction.  No  catheter  was  used  after  the  operation,  and  in  a 
short  time  the  urine  passed  by  the  natural  channel.  The  patient  passed  from  under  my  observation 
in  a  few  months,  cured. 

[This  stone,  weighing  five  hundred  and  sixty-one  grains,  and  of  a  dull  white  color,  is  generally 
ovoid  in  shape,  being  compressed  laterally,  and  is  smooth.  It  is  one  inch  and  three-quarters  in  length, 

one  and  three-eighths  in  breadth, 

and  one  in  depth.    A  section  shows 

a    number    of    concentric    layers 

around  a  nucleus.    It  is  compact, 

firm,  and  brittle.    The  microscope 

shows  its  minute  structure  to  be 

amorphous,  and  it  emitted  the  smell 

of  burnt  feathers  when  subjected  to 

heat.     It  consists  probably  of  am- 
monio-magnesian phosphates,  .with 

large  quantity  of  organic  matter. 

The  dimensions  of  the  concretion 
and  its  general  appearance  externally  and  in  section  are  shown  in  the  wood-cuts.    FIGS  .55, 56. — Ed.] 


Fin.  .13.— Section  of  a  urinary  calcnlna. 
Spec.  5575,  Sect.  I,  A.  M.  M.    [Nat.  size.] 


FIG.  50.— Exterior  A  lew  of  the  calculus. 


DCC. — Report  of  a  Successful  Case  of  Lithotomy.    By  E.  J.  JENNINGS,  M.  D.,  Acting  Assist- 
ant Surgeon. 

Leroy  Johnson,  a  mulatto  boy,  aged  about  19  years,  and  weighing  only  eighty  pounds,  was 
admitted  to  the  Freedmcn's  Hospital  at  Little  Eock,  on  August  26, 1867,  with  vesical  calculus, 
having  been  previously  treated  for  the  ordinary  remittent  fever  of  the  country  by  Dr.  E.  V.  Denell, 
who  discovered  a  concretion  in  the  bladder,  and  sent  him  to  the  hospital.  Upon  admission,  he 
stated  that  he  had  of  late  suffered  extreme  pain  in  passing  his  urine,  and  that  fits  frequently, 
occurred  during  the  effort.  A  day  or  so  subsequently  an  opportunity  offered  for  the  post  surgeon 
to  observe  one  of  these  paroxysms,  which  was  intensely  severe,  and  when  it  subsided  left  the  patient 
much  prostrated,  and  bathed  in  a  profuse  perspiration  like  that  of  the  sweating  stage  of  intermittent 
fever.  An  examination  with  a  sound  was  made  in  the  presence  of  several  medical  men,  which 
established,  beyond  a  doubt,  the  existence  of  calculus.  One  of  the  physicians  present  remembered 
having  prescribed  for  this  patient,  ten  years  previously,  for  incontinence  of  urine.  On  September 
3d,  eight  days  after  admission,  the  patient  was  chloroformed,  and  the  bi-lateral  operation  of 
lithotomy  was  performed,  removing  a  stone  weighing  three  and  one-eighth  ounces.  Some  difficulty 
was  experienced  in  the  extraction,  which  was  overcome  by  enlarging  the  primary  incision.  The 
after-treatment  in  this  case  consisted  of  rest — the  patient  lying  supine,  with  a  fold  of  blanket 
drawn  under  his  hips — and  cold-water  dressings  to  the  wound.  On  the  ninth  day  after  the  oper- 
33 


258 


REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 


ation  urine  was  twice  passed  through  the  urethra;  then  followed  an  interval  of  five  days,  during 
which  it  was  passed  through  the  wound.  After  this  it  passed  almost  continuously  by  the  urethra, 
and  the  patient  was  able  to  be  up  aud  about  on  the  twenty-fifth  day.  Several  times  after  this,  how- 
ever, there  occurred,  at  distinct  intervals  of  from  two  to  three  weeks,  a  slight  watery  or  sanguineous 
discharge  from  the  wound,  generally  accompanied  by  more  or  less  gastric  disturbance  and  slight 

fever,  the  correction  of  which,  with  abso- 
lute rest,  usually  caused  this  discharge 
to  disappear.  After  about  six  months, 
everything  of  this  character  ceased. 
Two  years  subsequently  the  patient 
reported  himself  as  enjoying  excellent 
health,  never  having  since  experienced 
the  slightest  inconvenience.  His  phys- 
ical appearance  had  greatly  improved. 

He  had  increased  in  strength  and  en-    ^^^'^ '•^'»»«^«!«talta'- 
ergy,  and  weighed  one  hundred  and  nineteen  pounds.    The  specimen 

was  contributed  to  the  Army  Medical  Museum,  and  is  figured  in  the  adjacent  wood-cuts, 
(FiGS.  57,  58).  It  weighs  two  ounces  and  twenty-seven  grains,  troy ;  but  before  it  was  sawn,  it 
weighed  three  and  one-eighth  ounces. 


FIG.  57,-vesicai  calculus.    Section 

through  the  lo»g  diameter.     Spec.  557-2, 

sect,  i, A.  M.  M. 


DCCI. — Minute  of  a  Successful  Case  of  Lithotomy.    By  W.  F.  SMITH,  Assistant  Surgeon,  U.  S.  A. 

Henry  Morris,  a  mulatto,  aged  twenty-three  years,  had  a  large  vesical  calculus  removed  by 
lithotomy  at  Raleigh,  North  Carolina,  about  the  middle  of  December,  1807.  The  operation  was 
delayed  for  some  time,  owing  to  the  impossibility  of  passing  a  staff'  into  the  urethra,  which 

contracted  violently  at  every  attempt  to  introduce 

one.    Alter  this  excitability  had  been  overcome 

by   a  course  of  training,  which    rendered    the 

passage  of  any  instrument  easy,  the  patient  was 

chloroformed,  aud  the  stone  was  removed  by  the 

lateral  operation,  both  lobes  of  the  prostate  gland 

being  divided  in  consequence  of  its  great  size.    It 

was    partly  attached   to  the    bladder,  and    this 

caused  some  trouble.    The  ha-morrhage,  did  not 

exceed  six  ounces.     The  wound  granulated  finely, 

aud  by  January  23,  18(iS,  the  patient  was  entirely  well  aud  attending  to 

his  ordinary  avocation.  The  stone,  weighing  two  hundred  and  fifty-three 
grains,  is  represented  in  the  adjoining  wood-cuts,  (FiGS.  59, 00,)  and  was  contributed  by  the  operator. 


.  FIG.  5K— \  c Heal  calculus,  ex- 
erior  ^  it-w.  Spec.  4762,  Sect  I, 
A.  M.  M. 


FIG.  60.— Scctioual  view  of  th<> 
calculus. 


DCCII. — Guns  hot  Wound  of  Bladder  and  Rectum,  and  subsequent  Operation  for  Stone  in  the  Bladder 
By  DR.  HUNTER  McGuiRE.* 

Mr.  H.,  aged  23  years,  was  wounded  at  the  battle  of  McDowell,  May  8, 1802.  The  ball  struck 
him  on  the  horizontal  ramus  of  the  left  pubic  bone,  about  an  inch  from  the  sympliysis.  passed 
through  the  bladder  and  rectum,  and  came  out  just  below  the  right  sacro-sciatic  notch,  near 
the  edge  of  the  sacrum.  The  day  after  the  battle  he  was  sent  to  the  general  hospital  at  Staunton, 
where  he  remained,  under  treatment  for  four  months.  For  the  first  month  urine  passed  freely 
through  the  wounds,  made  by  the  'entrance  and  exit  of  the  ball,  and  was  generally  mixed  with  blood 
and  pus.  Fajcal  matter  was  frequently  discharged  through  the  posterior  wouiid.  Some  time  during 
the  third  week  he  passed  several  small  pieces  of  bone  from  the  rectum.  At  the  end  of  the  fifth 
week  the  wound  of  exit  healed,  and  for  the  first  time  since  his  injury  urine  was  discharged  through 


*  See  Richmond  Medical  Journal,  April,  1868,  vol.  V,  p.  279. 


LITHOTOMY. 


259 


the  urethra.  The  water  continued  to  be  discharged  through  the  urethra  and  wound  of  entrance 
for  five  months,  when  the  latter  gradually  closed.  It  opened  again,  however,  in  a  few  weeks,  and 
continued  alternately  to  close  and  open  at  varying  intervals  until  September,  1865,  when  he  came 
to  me.  For  two  months  after  being  wounded  he  was  confined  to  the  bed;  after  this  he  was  able 
to  go  about  with  the  aid  of  crutches.  At  the  end  of  four  months  he  could  walk  slowly  without 
assistance,  and  was  for  a  long  time  engaged  as  clerk  for  the  post  quartermaster  at  Staunton.  In 
September,  1805,  he  applied  to  me  with  symptoms  of  stone  in  the  bladder.  On  sounding  him,  the 
stone  was  readily  discovered,  being  against  the  posterior  wall  of  the  bladder,  and  apparently  fixed 
in  that  situation.  His  general  health  was  very  bad,  in  consequence  of  the  pain  and  continued 
irritation  he  suffered,  and  the  fistulous  opening  in  front  still  remained  discharging  urine  and  pus. 
After  some  days  of  careful  preparatory  treatment,  I  performed  the  lateral  operation,  and  found  the 
stone  attached  to  the  mucous  membrane,  over  and  around  the  old  wound  in  the  posterior  wall  of  the 
bladder.  He  recovered  without  any  untoward  symptoms;  the  fistulous  opening  closing  at  the  same 
time  that  the"  wound  in  the  perinamm  was  healed,  and  he  was  out  of  bed  on  the  fifteenth  day.  I 
heard  from  him  a  few  days  ago,  and  learned  that  the  fistulous  track  had  never  reopened,  and  that 
his  health  and  strength  were  excellent.  The  calculus,  which  was  presented  to  the  Army  Medical 

Museum  byDr.H. 
McGuire,  is  rep- 
resented in  wood- 
cut Nos.  61  and 
C2,  and  consists 
principally  of  the 
triple  phosphates 
of  lime  and  mag- 
nesia, and  weigh- 
ed, immediately 
after  its  removal; 
two  and  a  quarter 

5041,  sect,  i,  A.  M.  M.  ounces;  it  has  for 

its  nucleus  a  piece  of  bone  about  half  an  inch  long. 


Tin.  61.— Exteri 


f  a  urinary  calculus.  Spec. 


Flo.  63— Sectional  view  of  the  calculus. 


DCCIII. — Account  of  an  Operation  for  Lithotomy,  in  ichich  a  Ball  with  a  Phosphatic  Incrustation  was 
Successfully  Removed.    By  J.  L.  FOKWOOD,  M.  D. 

Thomas  Lindsey,  of  Co.  F,  69th  Pennsylvania  Volunteers,  aged  43  years,  was  wounded  at 
Gettysburg,  on  July  2,  1863,  while  in  a  kneeling  posture,  by  a  ball  which,  after  passing  through 
his  canteen,  entered  the  thigh.  On  January  18, 1864,  he  was  discharged  the  service  at  the  Newton 
University  Hospital,  in  Baltimore.  On  his  return  home  to  Chester,  Pennsylvania,  he  suffered 
many  of  the  symptoms  of  stone  in  the  bladder,  for  which  he  was  treated  from  time  to  time,  until 
February,  1866,  when  an  operation  for-  strangulated  hernia,  the  result  of  dyspnoea,  became 
necessary.  On  April  12,  1866,  the  operation  of  lithotomy  was  performed  upon  the  patient,  when, 
most  unexpectedly,  an  irregularly  shaped  ball,  coated  with  a  phosphatic  deposit,  was  removed  from 
the  bladder,  weighing  768  grains.  The  operation  was  successful,  and  at  last  accounts  the  patient 
was  well,  and  living  in  the  vicinity. 


DCCIV.— Memorandum  relative  to  a  Vesical  Calculus,  the  Nucleus  of  which  was  an  Iron  Ball.  Con- 
densed from  Reports  by  A.  N.  DOUGHERTY,  M.  D.,  late  Medical  Director  of  the  Second 
Army  Corps. 

William  Cockcroft,  late  a  private  of  Co.  D,  199th  Pennsylvania  Volunteers,  aged  42  years,  was 
admitted  to  the  New  Jersey  Home  for  Disabled  Soldiers,  on  May  30,  1867,  to  be  treated  for  "shingles" 
(herpes  zoster).  A  week  afterward  he  was  discharged  cured,  without  having  complained  of  any 
urinary  disorder.  In  the  fall  the  patient  returned  to  be  treated  for  painful  micturition,  and  stated 


260 


KEPORT  OF  SUEGICAL  CASES  IN  THE  ARMY. 


that  be  bad  been  wounded  at  Petersburg,  on  April  2,  1865,  by  a  ball,  tbe  cicatrix  of  which  was 
visible  just  above  the  pubis.  A  normal  and  painless  evacuation  occurred  from  both  the  bladder 
and  the  bowels  half  an  hour  after  the  reception  of  the  wound.  Some  days  subsequently  he  was 
taken  to  the  Hampton  Hospital,  at  Fort  Monroe,  where  frequent  and  unavailing  efforts  were  made 
to  find  the  ball.  No  urine  ever  passed  through  the  wound,  but  eight  pieces  of  bone  (probably  of 
the  pubic  bone)  were  removed  at  various  times.  At  this  visit  to  the  "Home"  his  wound  had  healed, 
difficult  micturition  having  occurred  simultaneously.  A  sound  failed  to  reveal  the  presence  of  any 
extraneous  substance  in  the  bladder.  In  a  few  weeks  he  returned  to  say  that  the  wound  had 
reopened,  and  that  in  consequence  he  had  experienced  entire  relief.  Nothing  more  was  heard  from 
him  until  July  13, 1868,  when  he  was  readmitted,  the  wound  having  closed  and  his  old  symptoms 
having  grown  worse.  A  foreign  body  was  now  readily  detected  by  physical  exploration,  and  the 
urine  was  heavily,  loaded  with  pus,  and  at  times  was  bloody.  On  August  31st,  the  patient  was  cut 
for  stone,  and  a  vesical  calculus  removed,  the  nucleus  of  which  was  an  iron  ball.  The  incrustations 
consisted  of  uric  acid  and  tripple  phosphates,  and  the  specimen,  when  recent,  weighed  one  ounce 
and  twenty-three  grains,  avoirdupois.  The  ball  was  part  of  a  shrapnel,*  and  the  incrustations 
were  chiefly  on  one  side,  giving  it  the  shape  of  a  cock's  comb.  The  operation  used  was  the  one 
lately  recommended  by  Sir  William  Fergusson,  and  consisted  in  making  a  superficial  cut,  as  in 
Dupuytren's  bi-lateral  method,  viz,  semicircular,  the  convexity  forward  half  an  inch  in  front  of 
the  amis,  with  the  extremities  of  the  wings  equidistant  between  the  anus  and  the  ischium.  When, 
in  the  dissection,  the  membranous  portion  of  the  urethra  was  reached,  the  cut  was  made  as  in  the 
lateral.  The  incision  described  above  is  said  to  afford  more  ample  room  for  the  fingers  than  the 
usual  lateral  cut.  The  only  untoward  feature  of  this  case  was,  that  although 
the  urine  began  to  flow  wholly  by  the  urethra  as  early  as  the  fifteenth  day, 
there  was,  and  still  was  at  the  date  of  this  report  (December  20,  1868); 
a  fistulous  track  leading  toward  the  bladder,  but  from  which  no  urine 
came.  The  patient  was  healthy-looking,  although  he  stated  that  there  was 
still  some  pus  in  his  urine.  He  had  neither  incontinence  of  urine  nor  irritable 
bladder,  and  was  able  to  retain  his  urine  for  four  or  five  hours.  At  the  above 
date,  he  had  left  the  "Home"  in  order  to  pursue  his  ordinary  avocation. 
The  specimen,  which  is  represented  in  this  wood-cut,  (FiG.  63,)  was  con- 
tributed by  the  operator. 


Fig.  63. — Vesical  calculus, 
of  which  an  iron  Imll  is  the 
nucleus.  Spec.  5521),  Seel.  I, 
A.  M.  M. 


DCOV. — Remarks  on  the  Removal  of  a  Vesical  Calculus,  the  Nucleus  of  which  was  an  Iron  Arrow- 
Head.    By  W.  H.  FORWOOD,  Assistant  Surgeon,  TJ.  S.  A. 

Litimore,  a  wild  Indian,  chief  of  the  Kiowas,  aged  42  years,  applied  to  me  at  Fort  Sill,  Indian 

Territory,  August,  1869,  with  symptoms  of  stone  in  the 
bladder.  The  following  history  was  elicited:  In  the  fall 
of  1862  he  led  a  band  of  Kiowas  against  the  Pawnee 
Indians,  and  was  wounded  in  a  fight  near  Fort  Lamed, 
Kansas.  Being  mounted  and  leaning  over  his  horse,  a 
Pawnee  on  foot  and  within  a  few  paces  drove  an  arrow 
deep  into  his  right  buttock.  The  stick  was  withdrawn 
by  his  companions,  but  the  iron  point  remained  in  his  body. 
He  passed  bloody  urine  immediately  after  the  injury,  but 
the  wound  soon  healed,  and  in  a  few  weeks  he  was  able 
to  hunt  the  buffalo  without  inconvenience.  For  more  than 
six  years  he  continued  at  the  head  of  his  baud,  and 

traveled  on  horseback  from  camp  to  camp,  over  hundreds  of  miles  every  summer.    A  long  time 
after  the  injury  he  began  to  feel  distress  in  micturatiug,  which  steadily  increased  until  he  was 


FIG.  64. — Vesical  calculus  of  which  an  arrow-head  is 
the  nucleus.    Spec.  5931,  I,  A.  M.  M. 


The  projectile  kuown  as  shrapnel  is  a  spherical  case-shot  containing  lead  balls.    The  missile  in  question  is  similar 
to  one  of  the  small  iron  balls  of  a  canister-shot  for  a  howitzer. 


LITHOTOMY.  261 

forced  to  reveal  this  sacred  secret,  as  it  is  regarded  by  these  Indians,  and  to  apply  for  medical 
aid.  His  urine  had  often  been  stopped  for  many  hours,  at  which  time  he  had  learned  to  obtain 
relief  by  elevating  the  hips,  or  lying  in  diifereut  positions.  The  urine  was  loaded  with  blood  and 
mucus,  with  a  few  pus  globules,  and  the  introduction  of  a  sound  indicated  a  large  hard  calculus  in 
the  bladder.  The  Indians  advised  me  of  the  depth  approximately  to  which  the  shaft  had  pene- 
trated and  the  direction  it  took,  and  judging  from  the  situation  of  the  cicatrix  and  all  the  circum- 
stances it  was  apparent  that  the  arrow-head  had  passed  through  the  glutei  muscles"and_the  obturator 
foramen  and  entered  the  cavity  of  the  bladder,  where  it  remained  and  formed  the  nucleus  of  the 
stone.  Stone  in  the  bladder  is  extremely  rare  among  the  wild  Indians,  owing  no  doubt  to  their 
almost  exclusive  meat  diet,  and  the  very  healthy  condition  of  their  digestive  organs,  and  this  fact,  in 
connection  with  the  age  of  the  patient,  and  the  unobstructed  condition  of  his  urethra,  went  very 
far  to  sustain  this  conclusion.  On  August  23d  I  removed  the  stone  without  difficulty  by  the  lateral 
operation  through  the  perinceum.  The  lobe  of  the  prostate  was  enlarged,  which  seemed  to  favor 
the  extent  of  the  incision  beyond  what  would  otherwise  have  been  safe.  The  perimeum  was  deep 
and  the  tuberosities  of  the  ischii  unnaturally  approximated.  The  calculus,  of  the  mixed  ammouiaco- 
magnesian  variety,  was  egg-shapped,  and  weighed  nineteen  drachms.  The  arrow-point  was 
completely  covered  and  imbedded  near  the  centre  of  the  stone.  It  was  of  iron,  and  had  been 
originally  about  two  and  one-half  inches  long,  by  seven-eighths  of  an  inch  at  its  widest  part,  some- 
what reduced  at  the  point  and  edges  by  oxidation.  The  removal  of  the  stone  was  facilitated  by  the 
use  of  two  pairs  of  forceps,  one  with  broad  blades  by  which  I  succeeded  in  bringing  the  small  end  of 
the  stone  to  the  opening  in  the  prostate,  while  the  other,  long  and  narrow,  seized  and  held  it  until  the 
former  were  withdrawn.  In  this  way  the  forceps  did  not  occupy  a  part  of  the  opening  while  the  largo 
end  of  the  stone  was  passing  through  it.  The  capacity  of  the  bladder  was  reduced  and  its  inner  walls 
were  in  a  state  of  chronic  inflammation.  The  patient  quickly  recovered  from  the  eifects  of  the 
chloroform,  and  felt  great  relief  both  in  body  and  mind  after  the  operation,  and  up  to  the  eighth 
day  the  case  did  not  present  a  single  unfavorable  symptom.  The  urine  began  to  pass  by  the 
natural  channel  on  the  third  day,  and  continued  more  or  less  until  on  the  seventh  it  had  nearly 
ceased  to  flow  at  the  wound.  But  the  restless  spirit  of  the  patient's  iriends  could  no  longer  be 
restrained.  Open  hostility  with  the  whites  was  expected  to  begin  at  every  moment,  and  they 
insisted  on  his  removal.  He  needed  purgative  medicine  on  the  eighth  day,  which  they  refused 
to  allow  him  to  take.  They  assumed  entire  charge  of  the  case,  and  the  following  day  started  with 
him  to  their  camps  sixty  miles  away.  Nineteen  days  after  he  is  reported  to  have  died.  But  his 
immediate  relatives  have  since  assured  me  that  his  wound  was  well,  and  that  no  trouble  arose  from 
it.  They  described  his  symptoms  as  those  of  bilious  remitting  fever,  a  severe  epidemic  of  which 
was  prevailing  at  the  time,  and  from  which  several  white  men  and  many  Indians  died  in  that 
vicinity.  The  calculus  was  contributed  to  the  Museum  at  Washington.  A  section  is  represented 
in  the  wood-cut  (Fio.  64)  of  natural  size.  [The  weight  of  the  concretion  is  eight  hundred  and 
fifteen  grains,  and  it  consists  of  an  almost  uniform  deposit  of  triple  phosphates  about  the 
nucleus. — ED.] 

DCCVI. — Report  of  a  Case  in  which  a  Conoidal  Musket  Ball  teas  Successfully  Removed  from  the. 
Bladder  by  Lithotomy.    By  J.  L.  FOEWOOD,  M.  D. 

Edwin  T.  Mason,  a  private  of  Co.  K,  198th  Pennsylvania  Volunteers,  aged  49  years,  was 
wounded  near  Hatcher's  lluu,  Virginia,  on  March  31,  1805.  He  was  sent  to  Lincoln  Hospital  at 
Washington,  from  which  he  was  discharged  per  general  order  on  June  9,  1865.  His  wound 
remained  open,  but  did  not  require  medical  aid.  He  returned  home,  and  followed  his  ordinary 
occupation  up  to  February,  1869.  At  this  date  the  wound  healed  up  and  the  patient  thought 
himself  well ;  but  on  February,  1870,  vesical  trouble,  bloody  urine,  &c.,  appeared.  On  April  16th 
the  operation  of  lithotomy  was  performed,  and  there  was  removed  a  conoidal  musket  ball  weighing 
one  ounce  and  a  quarter,  and  having  two  small  pieces  of  phosphatic  deposit  attached.  On  May 
30th  the  patient  was  up  and  about,  but  the  wound  had  not  entirely  healed.  There  were  no  symptoms 
of  calculus  until  six  weeks  before  the  operation,  notwithstanding  there  seems  but  little  doubt  of 
the  ball  having  been  in  the  bladder  previous  to  that  time. 


2(52  EEPOET  OF  SUKGICAL  CASES  IN  THE  ARMY. 

REMOVAL  OF  TUMORS. — Several  instances  of  the  removal  of  important  tumors,  malig- 
nant or  non-malignant  were  reported-: 
DCC  VII.— Memorandum  of  a  Case  of  ScirrJms.    By  JAMBS  P.  KIMBALL,  Assistant  Surgeon,  U.  S.  A. 

Private  William  Wallace,  Co.  B,  31st  Infantry,  aged  19  years,  was  admitted,  on  February  4, 
1868,  to  the  post  hospital  at  Fort  Buford,  Dakota  Territory,  with  a  scirrhus  in  the  skin  and 
subcutaneous  cellnlar  tissue  immediately  above  the  centre  of  the  forehead.  The  patient  was  slightly 
cachectic,  nervous,  and  debilitated  from  pain  and  want  of  sleep.  On  February  5th,  I  made  a  crucial 
incision  one  and  one-fourth  inches  in  length,  through  the  skin  over  the  centre  of  the  tumor,  reflected 
back  the.  flaps  and  dissected  out  the  tumor,  which  was  of  the  size  of  a  hickory  nut.  No  anaesthetic 
was  used.  The  outer  portion  of  each  incision  united  by  first  intention,  the  centre  filling  up  by 
granulation.  The  patient  was  returned  to  duty  March  5, 18C8.  A  large  scar  remained  unavoidably, 
in  consequence  of  the  skin  over  the  centre  of  the  tumor  having  been  involved  in  the  disease. 

DCC VIII. Note  of  a  Case  of  Extirpation  of  a  Fatty  Tumor.    By  A.  C.  GIRARD,  Assistant  Surgeon, 

U.  S.  A. 

Private  Nicholas  Daly,  Co.  I,  20th  Infantry,  was  admitted  to  the  hospital  at  Baton  Eouge, 
February  22,  1869,  with  a  lipoina  over  the  left  zygomatic  arch.  The  tumor  was  removed  through 
an  incision,  running  obliquely  from  the  corner  of  the  eye  to  the  ear.  Erysipelas  of  the  face  and 
neck  supervened,  but  yielded  to  treatment.  The  wound  of  incision  healed  by  granulation,  and  on 
March  9,  1869,  the  patient  was  returned  to  duty. 

DCCIX. — Note  of  a  Fibrous  Tumor  of  the  Bade.     By  EDWARD  COWLES,  Assistant  Surgeon, 
U.  S.  A. 

Private  Isaac  Spencer,  Co.  H,  117th  Colored  Troops,  aged  56  years,  was  adinited  to  the  post 
hospital  at  Brownsville,  Texas,  April  13, 1867,  with  a  tumor,  four  or  five  inches  in  diameter,  on  the 
left  shoulder,  over  the  spine  of  the  scapula.  On  May  24th,  ether  being  administered,  an  incision,  five 
inches,  was  made,  and  the  tumor  was  removed.  It  did  not  present  the  appearance  of  a  malignant 
growth,  but  was  closely  adherent  to  the  adjacent  parts.  Hemorrhage  was  copious.  The  incision 
was  closed  by  sutures  and  healed  rapidly.  The  patient  had  recovered,  and  was  reported  for  duty 
on  June  24, 1867. 

DCCX. — Memorandum  relative  to  a  Morbid  Growth  on  the  Lip  requiring  Surgical  Interference.    By 
BASIL  NORRIS,  Surgeon,  U.  S.  A. 

A  cancroid  tumor  on  the  lip  of  General  H was  removed  very  satisfactorily  to  him  and 

myself,  by  seizing  it  with  a  pair  of  forceps,  and  enucleating  the  mass  with  a  thin,  sharp  thumb 
lancet,  which  passed  around  and  beneath  it  as  cleanly  as  a  razor.  By  this  means,  in  the  language 
of  Professor  Gross,  "  the  operation  is  best  done,"  when  the  skin  is  not  involved.  The  nest  left  by 
the  tumor  was  covered  over  with  a  piece  of  wet  tissue  paper,  which  was  moistened  by  the  tongue 
of  the  patient,  as  often  as  was  necessary  to  keep  it  in  place.  With  this  dressing  only,  the  wound 
nearly  filled  with  plastic  lymph  in  twenty-four  hours,  and  was  well  in  a  week.  I  inclose  extracts 
of  a  letter  as  a  part  of  the  report: 

***** 

"  NOVEMBER  21, 1870. 

"  MY  DEAR  DOCTOR  :  In  reply  to  your  note  of  the  17th,  I  have  the  pleasure  to  report  that  my 
lip  is  doing  very  well — seems  perfectly  healthful — although,  of  course,  the  circulation  has  been 
interrupted  by  the  cuts  it  has  had,  and  occasionally  it  looks  a  little  blue  and  feels  benumbed.  You 
performed  the  operation  on  the  30th  of  March,  1870.  My  trouble  commenced  as  early  as  the  spring 
of  1865,  when  I  first  noticed  the  skin  of  the  lip  broken  as  from  a  blister.  Two  such  spots  appeared, 
producing  no  other  inconvenience  than  soreness  to  the  touch  and  extreme  sensitiveness  to  salt, 
&c.  As  they  did  not  heal,  I  got  a  physician  to  touch  one  with  caustic,  but  .without  good  effect.  I 


EEMOVAL  OP  TUMOHS. 


203 


then  commenced,  upon  advice  of  different  physicians  and  surgeons,  to  apply  different  remedies, 
caustic  or  emollient,  acid  or  alkaline,  until,  I  think,  the  whole  round  of  acids,  alkalies,  metalloids, 
and  antiseptics  had  each  a  chance.  In  the  spring  of  18G8, 1  determined  to  have  a  surgical  operation 
tried,  and  after  advice  from  two  sources,  one  in  favor  of  a  strong  caustic,  and  the  other  of  the  knife. 
This  required  cutting  through  the  lip  down  to  the  external  mark,  and  removing  quite  a  large  piece 
of  what  was  thought  to  be  diseased  membrane.  At  that  time  the  smaller  place  in  front  and  centre 
of  the  lip,  which  you  afterward  removed,  was  supposed  to  be  curable,  *  *  *  in  March, 
1870, 1  showed  it  to  you,  determined  to  have  it  out  if  you  so  advised,  I  am  glad  to  say  that  you 
did  advise  it."  ****»*» 


DCOXI. — Report  of  a  Case  of  Medullary  Cancer  at  the  Angle  of  the  Lower  Jaw. 
M.  D.,  Acting  Assistant  Surgeon. 


By  J.  E.  REILY, 


Private  Michael  Keilly,  Ordnance  Detachment,  Washington  Arsenal,  aged  27  years,  was 
admitted  into  the  hospital  on  February  5,  1870.  A  large  medullary  carcinoma  involved  the  artic- 
ulation of  the  lower  maxilla  on  the  right  side,  and  had  dislocated  the  condyle  in  its  growth,  and 
had  extended  inward  above  the  palatine  arches,  pushing  down  the  soft  palate,  and  almost  filling 
the  fauces.  The  patient's  pulse,  skin,  and  secretions  were  normal,  at  the  time  of  the  operation  to 
be  described.  His  appetite  was  good ;  but  he  was  unable  to  masticate  or  swallow  solid  food.  On 
March  31,  1870,  the  patient  having  been  placed  under  the  anaesthetic  influence  of  sulphuric  ether, 
an  exploratory  incision,  three  inches  in  length,  was  made,  beginning  immediately  in  front  of  the 
lobe  of  the  right  ear,  and  passing  downward  in  the  direction  of  the  sterno-mastoid  muscle.  It  was 
now  found  necessary  to  make  a  second  incision,  from  the  angle  of  the  jaw  to  the  angle  of  the  mouth, 
the  excision  of  the  right  ramus  of  the  inferior  maxillary  being  necessary  to  remove  the  tumor.  The 
operators  were  Assistant  Surgeon  J.  S.  Billings,  U.  S.  A.;  Assistant  Surgeon  G.  A.  Otis,  U.  S.  A.; 
and  Surgeon  Basil  Norris,  U.  S.  A.  The  patient  continued  in  comfortable  condition  during  the 
evening,  taking  liquid  nourishment  freely,  and  continued  in  good  condition  until  about  four  o'clock 
on  April  1st,  when  symptoms  of  tetanus  set  in,  and,  in  spite  of  the  usual  remedies,  he  sank  rapidly, 
and  died  at  eight  o'clock  in  the  evening,  April  1,  1870. 

[Assistant  Surgeon  Billings  wrote  out  a  more 
extended  account  of  this  operation,  and  yet  a 
third  report  of  the  case  was  received.  Dr. 
lieilly's  official  statement  gives  the  main  facts 
and  dates. 

Dr.  J.  J.  Woodward  had  the  kindness  to 
make  the  drawings  represented  by  the  wood- 
cuts (FiGS.  C5,  G(J),  and  to  furnish  the  following 
memorandum  of  the  microscopical  appearances : 
"  Some  rather  large  fragments  of  the  tumor 
removedfrom  Private  Keilly  having  been  brought 
to  the  Army  Medical  Museum,  on  the  day  of  the 
operation,  were  examined  by  me  while  fresh,  and 


subsequently  sections  stained  with  carmine  were 
prepared  by  Dr.  E.  M.  Schaffer,  and  mounted  in 
Canada  balsam.  These  are  preserved  in  the 
microscopical  section  of  the  museum,  (Nos.  3500 
to  351ii  inclusive).  The  tumor  was  chiefly  com- 
posed of  a  stroma  of  connective  tissue,  with  large 
meshes,  which  were  filled  with  masses  of  small, 
loosely  adherent,  nucleated  cells.  In  the  perma- 


IV..  f>5.— Portion  of  section  of  niciliilhir.v  carcinoma,  dwwteg  connec- 
tive tissue  stroma  with  the  nuclei  of  the  cell  masses  on  either  side 
Spec.  3300,  Sect.  III.  A.  M.  M.,  740. 


nently  mounted  sections  the  position  and  arrangement  of  the  cells  is  indicated  by  that  of  the  oval 
nuclei,  wl.idi  measure  from  ^  to  JTrVo  of  a11  inch  in  lo"S  diameter.  In  the  fresh  preparation 
the  nuclei  appeared  rather  larger,  and  each  was  seen  to  be  contained  in  a  delicate  young  cell. 


264 


BEPORT  OF  SURGICAL  CASES  I1ST  THE  ARMY. 


! 


Some  of  the  fragments  yielded  sections,  in 
which  the  structure  of  the  parotid  gland  could  be 
distinctly  made  out,  the  ultimate  lobules  of  the 
gland  being  pushed  apart  by  a  soft  fibrillated 
connective  tissue,  in  which  numerous  small  cells 
similar  to  those  of  the  rest  of  the  growth 
abounded.  The  same  sections  passed  through 
portions  of  the  masseter  muscle,  the  connective 
tissue  of  which  was  similarly  infiltrated,  the 
bundles  of  fibres,  and,  in  some  instances,  the 
individual  fibres  being  pushed  apart  by  the  new 
formation.  Nos.  3501  and  3502  show  this  con- 
dition of  the  parotid  and  muscle  very  well.  In 
places  the  parotid  lobules  are  perfectly  normal, 
and  their  epithelium  well  shown  in  the  pre- 
parations, but  pushed  apart  by  the  medullary 
infiltration ;  in  other  parts  the  tissue  of  the 
parotid  is  obscured  by  the  new  growth,  and 
appears  to  pass  gradually  into  it.  The  tumor 

,__         is    to   be  regarded    as  a    rapidly  developing 

sio.«i._purtiouof  sa,,,e  B^-imen,  *owi,,g  portion  of  fivemuseuil'  medullary  carcinoma,  involving  the  parotid  and 

fibres,  with  nuclei  of  cancer  cells  in  the  intervening  connective  tissue,  the  adjacent  parts."] 
Spec.  3500,  Sect.  Ill,  A.  M.  M. 

DCCXII. — Account  of  an  Encephaloid  Tumor  at  the  Angle  of  the  Jaw.    From  information  furnished 
by  C.  H.  LAUB,  Surgeon,  U.  S.  A. 

In  December,  1864,  William  P ,  aged  sixty-two  years,  thirty  of  which  were  passed  in  the 

Army  of  the  United  States,  an  inmate  of  the  Soldiers'  Home,  at  Washington,  complained  of  a 
small  indolent  swelling  under  the  left  angle  of  the  lower  jaw.  The  tumor  was  painted  with  tincture 
of  iodine  for  about  three  weeks,  but  its  growth  was  not  arrested.  The  patient  then  left  the  asylum 
to  return  after  an  absence  of  three  months.  During  this  period  the  tumor  increased  rapidly  in  bulk. 
In  October,  1865,  its  attachments  extended  from  the  mastoid  process  of  the  left  temporal  backward 
to  within  half  an  inch  of  the  spinous  process  of  the  upper  cervical  vertebrae,  upward  over  the  occipital 
bones  and  the  rainns  of  the  inferior  maxilla,  and  downward  along  the  sterno-cleido-inastoideus  to 
within  two  inches  of  the  middle  of  the  clavicle,  deflecting  the  trachea  and  oesophagus  to  the  right. 
The  tumor  was  regarded  as  a  malignant  one,  and  in  view  of  the  great  danger  that  its  extirpation 
would  involve  and  the  probability  of  its  recurrence,  operative  interference  was  decided  against, 
The  tumor  enlarged  rapidly,  greatly  impeding  respiration  and  deglutition,  and  there  was  grave 
constitutional  disturbance.  On  October  22,  1865,  the  patient  died.  The  tumor  was  removed. 
post-mortem,  by  Assistant  Surgeon  J.  S.  Billings,  U.  S.  A.  A  microscopical  examination  of  the 
growth,  by  Doctors  Billings  and  Curtis,  proved  it  to  be  of  a  cancerous  nature.  It  is  preserved  in 
the  Surgical  Section  of  the  Army  Medical  Museum  as  ~$o.  4961.  Photograph  102,  Surgical  Series 
A.  M.  M.,  represents  the  appearance  of  the  tumor  a  few  weeks  before  the  fatal  termination. 


DCCXIII. — On  a  Case  of  Scirrlms  of  the  Mamma,  treated  by  Ablation,  and  Internally  by  the  Decoct  ion 
of  Cundurango.    By  BASIL  NORRIS,  Surgeon,  U.  S.  A. 

The  specimen  of  scirrhus  of  the  mamma,  which  I  sent  to  the  Medical  Museum,  was  removed 
September  14,  1869,  from  the  breast  of  a  servant  woman,  42  years  of  age.  Four  years  previously 
she  requested  me  to  examine  a  small  tumor  in  the  right  mamma,  near  the  nipple.  It  was  not  then 
larger  than  a  filbert.  An  elliptical  incision  made  to  include  the  morbid  growth  embraced  one-half 
of  the  gland,  and  a  portion  of  skin  in  the  direction  of  the  axilla.  In  the  endeavor  to  remove 
"every  trace  of  the  disease,"  it  was  necessary  to  dissect  off  the  fascia  from  a  small  space  covering 


REMOVAL  OP  TUMORS.  265 

the  body  of  the  pectoral  is  major,  and  sonic  fibres  of  the  muscle.  The  wound  was  well  sponged  with 
cold  water,  closed  with  silver  sutures,  and  left  to  heal,  as  it  did  very  rapidly,  and  almost  entirely 
by  first  intention.  Relieved  in  mind  and  body,  she  continued  well  and  cheerful  until  the  following 
February,  1870,  when  the  disease  returned.  A  •  small,  hard  tumor  beneath  the  cicatrix  first 
attracted  her  attention,  and  increased  until  May  21st,  when,  having-  attained  its  former  size,  with 
indications  of  approaching  ulceration,  it  was  again  removed.  Three  months  afterward  it  reappeared 
at  several  points  along  the  course  of  the  scar.  She  next  treated  the  tumor  herself,  five  weeks — 
under  the  advice  of  friends  and  with  my  consent — with  poultices  of  crushed  cranberries,  which 
produced  a  peculiar  pustular  eruption,  but  with  neither  appreciable  harm  nor  benefit.  More  recently 
I  prescribed,  and  am  still  using  in  this  case,  with  good  effect  in  relieving  pain,  bromide  of  potassium 
and  acetic  acid,  an  external  remedy,  recommended  by  Mr.  Henry  Osborne,  of  Southampton,  in  a 
communication  to  the  British  Times  and  Medical  Gazette,  republished  in  the  October  number  of  the 
Practitioner  of  1870.  He  says :  "I  have  not  had  an  opportunity  of  trying  the  bromide  of  potassium 
and  acetic  acid  in  many  cases  of  cancer.  I  nevertheless  am  able  to  state  that  those  who  have 
given  it  a  trial  during  the  last  twelve"  mouths  have  derived  the  greatest  relief  from  its  use.  The 
proportion  of  bromide  of  potassium  and  acetic  acid  should  be  in  accordance  with  the  severity  of 
the  pain.  In  one  case  I  ordered  it  to  the  extent  of  three  drachms  of  bromide  of  potassium  to  one 
ounce  of  acetic  acid  and  five  ounces  of  water,  to  be  used  warm  and  kept  constantly  applied  to 
the  breast  by  saturating  a  piece  of  lint  and  covering  it  with  oil  silk.  If  abrasion  of  the  cuticle  or 
a  cicatrix  has  formed,  the  lotion  may  be  more  readily  absorbed,  or  especially  if  ulceration  has  taken 
place;  in  that  case  the  lotion  should  be  diluted  accordingly. 

[Subsequently  Surgeon  Korris  made  the  following  further  report  of  this  case.] 

WASHINGTON,  D.  C.,  June,  1871. 
GENERAL  :  I  have  the  honor  to  report  as  follows  on  the  treatment  of  cancer  by  cundurango,  as 

prescribed  in  the  case  of  Isabella  G ,  aged  43  years.     She  had  been  my  patient  twenty-one 

months,  suffering  from  scirrhus  of  the  right  mamma.  I  removed  the  tumor  on  the  5th  of  September, 
1869,  and  again  on  the  14th  of  May,  1870.  It  reappeared  in  July  following,  and  on  the  24th  of 
April,  1871,  the  day  on  which  she  began  to  use  the  remedy,  it  occupied  a  remaining  small  portion 
of  the  mammary  gland,  and  extended  over  its  original  situation  as  far  as  the  axilla.  The  axillary 
glands  were  involved,  the  arm  and  hand  swollen,  and  the  skin  ulcerated,  forming  three  circular 
sores,  which  discharged  a  thin  offensive  pus  peculiar  to  sloughing  of  this  variety  of  cancer.  She 
complained  of  pain  and  irritable  stomach,  and  was  too  feeble  to  leave  her  apartment.  Observing,  as 
nearly  as  possible,  directions  laid  down  by  Dr.  Casares,  of  Ecuador,  and  contained  in  a  pamphlet 
published  for  information  by  the  Department  of  State,  I  prepared  a  decoction  by  putting  half  an  ounce 
of  crashed  cundurango  with  twelve  ounces  of  water,  and  boiling  it  down  to  six  fluid  ounces.  Of  this, 
one  ounce  was  taken,  morning  and  evening,  until  the  llth  of  May — eighteen  days — when  the  dose 
was  reduced  to  half  an  ounce,  and  continued  to  the  29th  of  May.  Whether  as  coincident,  or  in 
consequence  of  this  treatment,  the  tumor  completely  sloughed  out,  leaving  the  integument  sound 
and  a  surface  granulating  beneath.  Irritability  of  the  stomach,  with  pain  in  swallowing  and  on 
pressure  upon  the  epigastrium,  increased,  and  the  patient,  much  emaciated,  died  on  the  Gth  of  June. 
Post-mortem  examination  revealed  cancer  of  the  stomach  and  spleen ;  a  hard  flat  tumor,  leaf  shaped, 
starting  from  the  point  of  entrance  of  the  resopbagus,  embraced  a  portion  of  the  spleen,  which 
could  only  be  separated  from  the  stomach  by  tearing  the  morbid  growth  common  to  both  organs. 
1  am  indebted  to  Dr.  J.  J.  Woodward,  U.  S.  A.,  for  microscopical  examinations  of  the  tumor  and 
specimen,  and  for  his  note  appended  to  this  report. 
Very  respectfully,  your  obedient  servant, 

BASIL  NORRIS, 

Surgeon,  U,  S.  A, 

General  J.  K.  BARNES, 

Surgeon  General,  U.  8.  Army,  Washington,  D.  C, 

.34 


266 


EEPOET  OF  SURGICAL  CASES  IN  THE  ARMY. 


ARMY  MEDICAL  MUSEUM,  Washington,  D.  C.,  July  21,  1871. 

SIR  :    In  accordance  with  your  request,  I  have  made  a  nriscroscopical  examination  of  the 

several  morbid  growths  in  the  case  of  Isabella  G ,  with  the  general  conclusion  that  the  case 

was  undoubtedly  one  of  scirrhus  carcinoma. 

The  specimens  preserved  at  the  Museum  are  as  follows: 

No.  5598,  Surgical  Section.  The  tumor  first  removed  by  Surgeon  Norris  is  an  oval  mass,  about 
five  inches  long  by  three  broad,  with  a  portion  of  skin  attached  externally.  The  greater  portion 
of  the  piece  is  occupied  by  a  firm  irregular  scirrhus  growth,  which,  after  being  several  months  in 
alcohol,  still  yielded,  on  scraping,  a  creamy  juice  containing  cells  and  nuclei;  on  the  edges  of  the 
mass  is  some  normal  adipose  tissue. 

No.  5921,  Surgical  Section.  The  tumor  removed  by  Surgeon  Norris  at  the  second  operation 
is  a  smaller  mass,  containing  a  similar  but  somewhat  softer  growth.  In  the  skin,  adherent  exter- 
nally, a  portion  of  the  cicatrix  of  the  first  operation  can  be  recognized,  and  from  this  an  irregular 
soft  nodule,  the  size  of  a  walnut,  protrudes. 

No.  1083,  Medical  Section,  is  a  portion  of  the  stomach  and  the  spleen  of  the  same  patient.  In 
thej  greater  curvature  of  the  stomach,  and  not  far  from  the  cardiac  orifice,  is  a  carcinomatous 

thickening  of  the  coats  of  the  organ,  about  half 
an  inch  in  thickness,  occupying  an  area  about 
four  inches  in  diameter.  Externally  the  thick- 
ened patch  was  closely  connected  with  thehilus 
of  the  very  small  spleen  by  a  soft  carciuomatous 
tumor,  about  the  size  of  a  hen's  egg. 

Sections  of  the  first  and  second  tumors  re- 
moved from  the  breast,  of  the  stomach,  and  the 
spleen,  were  prepared  in  the  Microscopical  Sec- 
tion of  the  Museum,  by  Acting  Assistant  Sur- 
geon E.  M.  Schaeffer,  and  having  been  stained 
with  carmine  and  mounted  in  Canada  balsam, 
now  form  a  part  of  the  microscopical  collection. 
Nos.  3513  to  3519,  Microscopical  Section, 
are  from  the  tumor  first  removed  from  the 
breast,  and  show  it  to  consist  of  an  areolar 
stroma  of  soft  connective  tissue,  the  inter- 
spaces of  which  are  stuffed  with  masses  of 
loosely  adherent,  nucleated  cells;  the  nuclei  of 


these  cells  are  oval,  and  measure  from  three  to 
sixten-thousandths  of  an  inch  in  long  diameter ; 


FIG.  67.— Section  of  scirrhus,  magnified  400  diameters,    ."fpec.  3513, 
Sect.  III.,  A.  M.  M.    [Drawn  by  Dr.  Scliaeffer.) 

they  contain  generally  one  or  two  shining  nucleoli.  The  cells  themselves  are  of  an  irregular  form, 
and  various  sizes,  the  smaller  ones  predominating.  The  connective  tissue  stroma  contained  an 
abundance  of  small  nucleated,  connective  tissue  corpuscles,  resembling  those  found  in  most  new 
formations  of  connective  tissue. 

Nos.  3073  to  3076,  Microscopical  Section,  are  from  the  second  breast  tumor,  and  are  very  similar 
to  those  from  the  first;  in  many  places,  however,  the  cell  masses  are  more  voluminous  and  the  con- 
nective tissue  stroma  is  less  prominent. 

Nos.  3003  to  3072,  Microscopical  Section,  are  sections  cut  perpendicularly  to  the  surface,  through 
the  indurated  portion  of  the  stomach.  In  most  places  the  mucous  membrane  and  the  tubular 
glands  are  in  a  condition  not  far  from  normal ;  but  the  submucous  connective  tissue,  the  muscular 
and  peritoneal  coats,  are  transformed  into  a  carcinomatous  mass,  consisting  of  groups  of  cells  with 
large  nuclei  imbedded  in  a  connective  tissue  stroma,  the  general  character  of  the  neoplasm  closely 
approximating  those  of  the  breast  tumors. 

Nos.  3050  to  3602,  Microscopical  Section,  are  sections  of  tumor  between  the  spleen  and  the 
stomach  ;  they  present  the  same  general  characteristics,  but  this  tumor  was  much  softer  than  the 
other  growths,  and  in  the  section  the  stroma  appears  less  pronounced,  and  the  cell  masses  are  more 
voluminous.  In  this  case,  as  in  others  of  multiple  carcinoma,  examined  in  the  Microscopical  Section 


REMOVAL  OF  TUMOKS.  267 

of  the  Museum,  the  general  similarity  of  the.  structural  details  of  the  several  growths  found,  in 
very  different  organs,  deserves  attention. 

The  tumor  between  the  stomach  and  the  spleen  was  evidently  of  recent  origin  and  rapidly 
growing.    Its  relation  to  its  chief  blood-vessels  probably  accounts  for  the  manifest  atrophy  of  the 
spleen,  which  was  only  three  inches  long  by  two  and  a  half  broad. 
Very  respectfully,  your  obedient  servant, 

J.  J.  WOODWARD, 

Assistant  Surgeon  U.  8.  A. 
Surgeon  BASIL  NORRIS,  U.  S.  A. 

DCCXIV. — Remarks  on  the  Removal  of  a  Fibroid  Groicth  from  the  Left  Breast.     By  HENRY 
McELDERRY,  Assistant  Surgeon  U.  S.  A. 

James  Johnston,  Sergeant  Co.  C,  15th  Infantry,  -was  admitted  to  hospital,  August  12, 1868, 
with  a  fibroid  tumor  of  the  left  breast.  The  patient,  a  large  and  a  well-developed  man  of  the 
sanguine  temperament,  stated  that  the  tumor  first  made  its  appearance  during  September,  18C5, 
while  he  was  working  at  his  trade,  boot  and  shoe  making.  His  attention  was  first  called  to  the 
enlargement  by  a  burning  pain  in  the  left  chest ;  and  he  then,  on  examination,  noticed  the  growth. 
From  that  time  until  the  present,  the  tumor  has  gradually  increased  in  size.  He  does  not  experi- 
ence pain  in  the  growth,  except  when  the  chest  becomes  constricted  from,  any  cause.  Has  not 
been  able  to  wear  his  suspender  on  the  left  side,  nor  to  carry  his  knapsack  on  this  account.  Has 
a  sister,  who,  when  about  eight  or  niue  years  old,  had  a  hard  tumor  on  the  right  eyebrow,  which 
was  removed  by  a  surgeon,  and  has  not  since  returned.  The  remainder  of  the  family  are  all 
healthy,  and  have  never  had  any  tumors  of  any  kind. 

August  12, 1808.  The  tumor  is  movable  and  rather  flat ;  measuring  two  inches  and  one  quarter, 
in  length,  and  two  inches  in  width ;  lying  immediately  beneath  the  left  nipple,  superficial  to  the  pec- 
toralis  major  muscle ;  its  diameter  corresponding  with  the  direction  of  the  fibres  of  that  muscle ;  com- 
plains of  pain  when  the  surface  beneath  the  nipple  is  pinched  ;  pinching  the  base  or  sides  of  the 
tumor  gives  no  pain  or  uneasiness.  There  is  no  retraction  of  the  nipple,  nor  lymphatic  involvement ; 
no  enlargement  of  the  subcutaneous  veins ;  general  health  of'  the  patient  excellent.  As  the  patient 
was  anxious  to  have  the  tumor  removed,  its  excision  was  performed  August  12th,  parts  brought 
together  with  interrupted  silken  sutures,  and  ichthiocolla  plaster.  One  grain  of  morphine  was 
given  hypodermically,  after  operation.  August  13th,  slept  well  during  night,  and  complains  of  no 
pain.  Three  compound  cathartic  pills  were  prescribed.  Did  well  until  August  15th,  when  the 
wound  began  to  assume  a  gangrenous  appearance,  and  a  small  quantity  of  foatid,  reddish,  purulent 
fluid  was  discharged.  Sutures  were  removed,  and  the  parts  well  touched  with  liquor  of  perman- 
ganate of  potash,  no  adhesion  having  taken  place.  The  solution  of  permanganate  salts  was 
applied  twice  daily,  until  August  18th,  when  the  gangrenous  appearance  had  entirely  disappeared. 
The  edges  of  the  wound  were  then  brought  together  by  isinglass  plaster.  The  parts  rapidly 
healed,  and  the  patient  was  returned'  to  duty  September  28th,  having  no  pain  in  or  about  the 
cicatrices. 

Miscroscopical  appearance  of  the  juice  of  the  growth,  immediately  after  the  operation; 
numerous  round  nniuucleated  cells,  about  the  size  of  blood  cells,  with  fat  and  blood  cells,  and 
occasionally  fragments  of  fibrous  tissue,  were  the  only  elements  observed  in  the  field  of  the  micro- 
scope. The  growth  appeared,  on  section,  of  a  whitish  color,  tough  and  gristly  feel,  and  had  all  the 
appearance  of  condensed  fibrous  tissue.  Weight,  fifteen  drachms.  It  has  been  preserved  in  proof 
spirit,  for  transmission  to  the  Army  Medical  Museum. 

DCCXV.— Report  of  an  Encysted  Tumor  of  the  Bad:.     By  H.  S.  SCHELL,  Assistant  Surgeon, 
U.  S.  A. 

John  A.  Batt,  a  private  of  Troop  I,  2d  Cavalry,  agsd  54  years,  was 'being  treated  in  quarters  at 
Fort  Laramie,  Dakota  Territory,  for  a  cystic  sebaceous  tumor  situated  between  the  scapuhe.  This 


268 


REPOllT  OF  SURGICAL  CASES  IN  THE  ARMY. 


tumor  liatl  been  opened  on  April  10th,  and  the  contents  discharged.  It  had  filled,  ulcerated,  and 
discharged  three  times  previously,  at  intervals  of  six  months;  but  at  the  time  of  second  operation, 
it  was  a  large,  inflamed,  and  painful  cyst,  five  inches  in  diameter.  On  April  27,  1807,  the  patient's 
constitutional  state  warranting  an  operation  for  removal,  he  took  chloroform,  and  a  crucial  incision 
was  made,  and  the  encysted  mass  was  dissected  from  the  surrounding  tissues.  One  ligature  was 
applied;  the' edges  of  the  incisions  were  approximated  by  iron  wire  sutures  and  adhesive  strips. 
The  edges  of  the  wound  not  uniting,  the  dressing  was  removed  and  the  wound  allowed  to  heal  by 
granulation.  By  May  30,  18G7,  the  wound  had  healed. 

DCCXVI. Memorandum  relative  to  a  Morbid  Growth  removed  from  the  Back  of  the  left  Forearm.    By 

B.  J.  D.  IBWIN,  Surgeon  U.  S.  A. 

Specimen  5501  of  the  Surgical  Section  of  the  Museum  is  a  cystic  tumor,  which  was  removed  at 
Fort  Wayne,  Michigan,  from,  the  dorsal  aspect  of  the  left  wrist  and  fore-arm  of  a  woman,  aged 
about  40  years,  who  had  never  borne  children,  and  whose  usual  occupation  was  that  of  a  seamstress. 
The  operator,  who  contributed  the  specimen,  states  under  date  of  February  22,  1809,  that  some 
four  years  previously  Professor  Van  Buren  had  removed  from  this  patient  a  morbid  growth  from 
the  same  position.  The  disease  having  subsequently  returned,  the  woman  was  advised  to  submit 
to  amputation  of  the  fore-arm.  Upon  consultation  with  two  medical  men,  it  was  decided  to  make 
an  exploratory  incision  with  a  view  to  excision  of  the  radius.  The  incision  showed  the  bone  to  be 
healthy,  and  it  was  deemed  advisable  to  confine  the  operation  to  the  complete  removal  of  the 
diseased  tissues.  The  tumor  extended  about  half  an  inch  over  the  carpal  bones,  and  about  two 
inches  along  the  extensor  tendons  of  the  radius.  [A  microscopical  examination  of  the  tumor  was 
made  by  Assistant  Surgeon  J.  J.  Woodward,  IJ.  S.  A.,  who  furnishes  the  following  memorandum  : 
[Hygroma  pj,oliferum,  of  Virchow  (DieKrankhaften ;  Geschwiilste,  Band  I,  S.  200).]  Ganglion  con- 
taining fibriuous  bodies.  The  walls  of  the  tabulated  cyst  are  composed  of  tough  connective  tissue, 
containing,  however,  many  spindle-shaped  elements  imbedded.  The  little  fibrinous  bodies  of 
granular  matter  are  arranged  in  layers.] 


DCCXVII. — Account  of  a  Morbid  Growth  on  the  Leg,  requiring  Surgical  Interference.     By  A.  C. 
SCHWARTZWELDEE,  late  Surgeon  U.  S.  V. 

Private  Philip ,  Co.  C,  13th  Colored  Infantry,  aged  about  25  years,  fell  through  a  cow- 
catcher, on  a  railroad  track  and  injured  his  left  thigh.  The  accident  put  him 
in  the  hospital  for  two  or  three  weeks,  during  which  time  cups  were  applied 
above  the  knee.  He  was  mustered  out  of  service  in  January,  18GG.  In  Decem- 
ber, 1800,  the  patient  first  noticed  the  appearance  of  a  hard,  painless  tumor,  on 
the  anterior  aspect  of  the  left  fibula,  near  the  middle  third.  The  tumor  was 
first  examined  in  April,  1807,  at  Nashville,  Tennessee.  It  then  occupied  the 
greater  part  of  the  shaft  of  the  fibula,  to  which  it  seemed  firmly  attached,  and 
from  which  it  seemed  to  originate.  Its  contour  was  even  and  smooth,  and  the 
skin  adherent.  Its  most  striking  characters  were  extreme  hardness,  density, 
and  weight.  Anteriorily,  and  just  below  the  head  of  the  fibula,  was  a  soft, 
fluctuating  spot,  of  small  extent.  On  thrusting  a  grooved  needle  into  it,  nothing 
escaped  but  thick,  black  blood.  A  heteroplastic  growth  was  diagnosed,  of  scarcely 
questionable  malignity.  The  patient  was  placed  under  close  observation.  The 
growth  increased  rapidly.  In  two  months  it  doubled  its  size.  An  exploring 
needle  introduced  into  several  places  revealed  osseous  (osteoid)  tissue,  the  hard- 
ness and  apparent  density  of  which  was  remarkable.  The  perimeter  of  the  calf, 
including  the  tumor,  measured  twenty-one  inches  and  a  quarter ;  of  the  sound 
leg,  fourteen.  The  day  after  the  measurement,  June  20,  1807,  the  removal  of 
the  limb  having  been  decided  on,  it  was  amputated  by  Dr.  Schwartzfelder,  just 
above  the  knee-joint.  The  skin  was  still  adherent.  The  gastrocnemius  and 
soleus  muscles  were  spread  out,  and,  with  the  other  muscles  of  the  leg,  formed  a  membranons-like 


FIG.  68.— Osteo-cepha- 
loma  of  tho  left  fibula. 
Spec.  4747,  Sect.  I.,  A.  M. 
M. 


TETANUS.  269 

covering  for  the  tumor.  Near  the  union  of  the  two  former  with  their  common  tendon,  the  muscular 
tissue  was  destroyed  or  converted  into  a  gclatinous-likc  substance.  lu  front,  and  just  below  the 
upper  tibio-flbular  joint,  a  small  sac  was  found,  containing  less  than  an  ounce  of  dark,  grumous 
blood.  The  whole  growth  was  seen  to  be  constituted  of  osseous  spicula,  (osteoid  tissue?)  and 
gelatinous  and  cartilaginous  tissue,  the  latter  greatly  predominating.  On  subjecting  the  growtli 
to  the  microscope,  the  bone  corpuscles  were  clearly  defined,  and  also  others  which  it  was  inclined 
to  range  with  cartilage  cells.  Its  great  succulency,  and  the  fact  that  the  inguinal  glands  of  the  left 
side  were  enlarged,  looked  toward  its  heteroplastic  and  malignant  essence.  On  July  9th  the  patient 
was  doing  well,  and  had  every  prospect  of  recovering  from  the  operation.  He  could  ascribe  no 
cause  whatever  for  the  appearance  of  the  tumor,  except  ths  above-mentioned  injury  to  the  thigh. 
The  marks  occasioned  by  the  cupping  were  still  visible  at  the  time  of  operation.  The  specimen, 
with  the  history,  was  contributed  to  the  Army  Medical  Museum  by  the  operator,  and  some  idea 
of  the  growth  can  be  gathered  from  the  wood-cut  FIG.  68. 

TETANUS. — Six  special  reports  were  made  of  cases  of  alleged  tetanus,  with  tlie  sur- 
prising result  of  four  recoveries  and  two  deaths. 

DCCXVI1I. — Information  relative  to  a  Fatal  Case  of  Traumatic  Tetanus.    By  W.  H.  LONGWILL, 
M.  D.,  Acting  Assistant  Surgeon. 

Edward  Waterfield,  a  private  of  Co.  C,  5th  infantry,  was  admitted  to  hospital  at  Fort 
Wingate,  New  Mexico,  on  November  24,  18G6,  having  been  accidentally  wounded  by  a  musket 
ball,  which  entered  the  right  wrist  anteriorly,  and  passing  through,  emerged  directly  opposite, 
after  comminuting  the  os  magnum  and  the  second  and  third  metacarpal  bones.  A  number 
of  fragments  of  bones  being  removed,  persulphate  of  iron  was  applied  to  stanch  the  haemor- 
rhage. Dry  dressings  were  used  until  November  27th,  when  a  linseed  poultice  was  applied 
in  order  to  remove  the  crust  formed  by  the  styptic.  On  November  30th,  the  crust  was  removed, 
and  the  cataplasm  was  continued;  the  wound  discharging  freely  looked  well,  and  the  patient  was 
in  good  condition.  On  the  morning  of  December  1st,  tetanus  set  in.  Tincture  of  opium,  in  doses 
of  sixty  drops  to  be  taken  every  two  hours,  was  prescribed,  and  a  blister  was  applied  along  the 
spine.  At  7  P.  M.,  a  drastic  purgative  was  administered.  On  December  2d,  the  patient's  bowels 
were  freely  moved,  and  the  blister  had  become  very  painful,  but  no  relief  was  afforded.  He  expe- 
rienced great  difficulty  in  swallowing.  The  tincture  of  opium  was  continued,  but,  at  9  P.  M., 
opisthotonos  occurred,  when  chloroform  was  administered  through  the  remainder  of  the  night  with 
slight  relief.  The  patient  died  at  3  P.  M.,  on  December  3d.  At  the  autopsy,  the  median  nerve 
was  found  swollen  and  inflamed  at  the  seat  of  the  wound,  and  five  or  six  inches  along  its  course. 

DCCXIX.— Eemarlcs  on  a  Case  of  Tetanus  following  a  Burn.     By  A.  A.  YEOMANS,  M.  D.,  Acting 
Assistant  Surgeon. 

Private  D.  A.  McCrum,  Co.  B,  24th  Infantry,  was  severely  burned  by  the  accidental  ignition 
of  a  quantity  of  gun-powder,  at  one  of  the  magazines  at  Vicksburg,  on  December  8,  1867. 
January  6th  he  was  attacked  by  premonitory  symptoms  of  tetanus.  His  jaws  were  firmly  closed 
and  he  was  unable  to  separate  them,  neither  could  they  be  opened  more  than  half  an  inch  by  the 
attendants,  with  the  aid  of  various  appliances.  Pulse  85  and  rather  weak.  Prescribed  half  an 
ounce  of  castor  oil,  to  be  followed  by  one  ounce  of  wine  with  a  raw  egg,  three  times  a  day ;  beef- 
essence  and  brandy,  every  hour,  and  a  grain  dose  of  morphine  at  bed-time.  On  the  7th,  there  was 
increased  immobility  of  the  jaws,  and  occasional  light  spasms.  The  treatment  was  continued ;  and 
in  addition,  an  enema  of  soap,  water,  and  castor-oil  was  administered.  A  blister  was  applied  over 
the  whole  length  of  the  spine,  and  a  drachm  of  bromide  of  potassium  was  given  every  fourth  hour. 
On  the  llth  the  patient  had  severe  spasms,  which,  increasing  in  frequency  and  violence,  assumed 
the  form  known  as  opisthotonos,  and  were  produced  by  the  least  movement  on  the  part  of  the 
patient,  or  by  a  current  of  cold  air.  As  the  bowels  had  not  been  moved  for  two  days,  another 
enema  was  ordered,  and  the  bromide  of  potassium  was  increased  to  half  an  ounce  four  times  a  day 


270  EEPORT  OF  SUBGICAL  CASES  IN  THE  AEMY. 

The  morphine,  wine  and  raw  egg,  brandy,  and  beef-essence  were  continued.  15th:  Spasms 
continue  unchanged  in  severity ;  muscles  of  extremities  rigid ;  pulse  95,  and  diminished  in 
volume.  Treatment  continued;  beef-essence  and  brandy  given  at  shorter  intervals.  18th: 
Patient  improving;  spasms  not  so  severe;  and  there  is  less  rigidity  of  muscle.  For  the  last 
three  days,  he  has  had  paroxsyins  of  spasms,  commencing  at  11  o'clock  A.  M.  Four  grains  of 
quinine  were  ordered  to  be  given  twice  daily,  in  addition  to  previous  treatment.  21st :  Patient 
continues  to  improve.  He  is  now  able  to  separate  his  jaws  about  an  inch,  and  enjoys  his  food, 
still  given  in  a  liquid  form.  Pulse  87  and  increased  in  volume.  Spasms  became  less  frequent,  and 
ceased  entirely  February  3d,  since  which  date  has  had  no  symptoms  of  tetanus.  23d :  He  was 
attacked  by  epilepsy,  of  a  very  severe  grade,  to  which  he  has  been  subject  several  years.  The 
convulsions  continued,  at  intervals  over  half  a  day,  when  finally  checked  by  chloroform.  February 
29th:  Is  now  doing  well,  although  his  hands  are  still  very  sore  from  the  effects  of  the  burn. 
This  man  was  discharged  the  service  June  11,  1868,  at  Vicksburg,  Mississippi,  for  burns. 

DCCXX. — Report  of  a,  Case  of  Tetanus  treated  icith  Calabar  Bean.    By  CHAKLES  SMART,  Assistant 
Surgeon,  U.  S.  A. 

Hugh  Nugent,  bugler  Troop  K,  5th  Cavalry,  on  November  8, 1.809,  at  Washington,  injured  his  left 
fore-arm  by  a  fall  from  his  horse  on  the  curbstone,  causing  a  lacerated  and  slightly  contused  wound 
about  an  inch  and  a  half  below  the  inner  condyle  of  huinerus.  The  joint  was  uninjured.  Cold- 
water  dressings  and  simple  ointment  were  applied  until  November  17th,  when  the  patient  com- 
plained of  stiffness  in  the  muscles  of  the  injured  fore-arin  and  the  back  of  the  neck,  and  that  he 
could  not  separate  his  jaws  as  usual,  which  symptoms  he  ascribed  to  a  cold.  He  was  admitted  to 
the  Sedgwick  Barracks  Hospital,  when  a  hot-air  bath  was  given,  the  wound  dressed  with  bread 
and  milk  poultice,  and  Dover's  powder  administered.  Excepting  the  stiffness  of  neck  and  inability 
to  separate  the  jaws  he  felt  comfortable,  but  had  no  desire  for  food.  Several  attempts  to  swallow 
a,  teaspoonful  of  wine  occasioned  violent  choking  feelings,  and  spasms  of  the  muscles  of  neck. 
At  7  P.  M.,  however,  the  stiffness  of  muscles  of  neck  was  continuous,  and  the  muscles  of  the  spine 
were  implicated.  Every  ten  minutes  an  exacerbation  took  place  lasting  a  few  seconds,  during 
which  the  abdomen  and  chest  were  thrown  forward  and  the  head  back,  while  the  face  became 
flushed,  and  brows  corrugated  and  the  teeth  clenched  and  exposed  by  the  parted  lips ;  pulse  100, 
increasing  during  and  after  exacerbation  to  120.  One-third  of  a  grain  of  extract  of  Calabar  bean 
was  given  in  the  form  of  a  pill.  At  8  o'clock,  as  no  change  was  perceptible,  the  dose  was  repeated, 
and  again  at  9  P.  M.  At  10.30  one-third  of  a  grain  of  the  extract  was  injected  under  the  skin  of 
the  right  fore-arm,  and  one-half  grain  one  hour  later.  The  only  result  was  the  fall  of  the  pulse 
from  100  to  80,  while  the  patient  was  quiet.  Although  he  complained  of  pain  and  stiffness  in  the 
neck  and  back,  no  marked  rigidity  of  the  muscles  in  those  regions  was  observed.  At  1.30  A.  M., 
on  November  18th,  sulphate  of  morphia  was  given,  but  without  manifest  effect.  At  9  A.  M., 
during  an  exacerbation,  spasm  of  the  diaphragm  was  indicated,  more  particularly  at  the  attachments 
to  the  ribs  on  the  right  side.  At  9.30  A.  M.,  half  a  grain  of  the  extract  was  given  per  orem,  and 
repeated  at  11.  No  benefit  was  derived  from  the  administration;  on  .the  contrary,  his  condition 
became  worse,  the  diaphragmatic  spasms  being  continuous,  pulse  100  to  140,  skin  hot  but  moist,  and 
forehead  beaded.  Four  ounces  of  chicken-tea  and  three  ounces  of  wine  were  administered  by 
feeding  bottle  with  a  rubber  teat.  At  4  P.  M.,  two  grains  of  the  grated  kernel  of  the  Calabar  bean 
in  a  drachm  of  water  were  given  by  a  quill,  and  this  was  repeated  at  5.30  At  7  P.  M.  the 
dose  was  increased  to  three  grains  and  repeated  at  9  o'clock,  with  the  effect  of  producing  marked 
contraction  of  the  pupils.  No  change  for  the  better  could  be  discovered.  The  spasms  continued, 
and  the  patient  showed  signs  of  exhaustion.  At  11  P.  M.  four  grains  of  the  grated  kernel,  with 
one  grain  of  sulphate  of  morphia,  were  given,  which  ameliorated  the  sufferings  of  the  patient,  who 
fell  into  a  dose,  which  lasted  till  3  A.  M.,  November  19th.  During  his  sleep,  however,  the  paroxysms 
would  occasionally  return.  On  awakening,  his  face  was  cadaveric,  liis  pupils  contracted  to  one- 
sixteenth  of  an  inch,  but  he  declared  that  he  felt  good.  Wine  being  given,  spasms  were  induced, 
which  lasted  about  thirty  seconds.  The  possibility  of  introducing  nutritives  by  euemata  precluded  by 


TETANUS.  271 

spasms  following  any  attempt  to  lie  on  the  side.  Wine  and  milk  were,  however,  cautiously  continued, 
but  the  further  exhibition  of  the  Calabar  bean  was  discontinued  until  the  pupils  should  show  a 
tendency  toward  enlargement.  The  patient  suffered  no  pain  either  in  right  side,  back,  or  neck,  yet 
every  few  minutes  his  head  was  thrown  back,  and  his  chest  and  abdomen  forward  by  the  action  of 
the  muscles,  while  his  right  hand  clutched  at  the  epigastrium.  The  pupils  showed  no  enlargement. 
He  gradually  failed,  and  died  at  10  A.  M.,  November  19, 1869. 

DCCXXI. — Report  of  a  Case  of  Traumatic  TetaniCs  thought  to  have  been  treated  successfully  with 
Calabar  Bean.  By  DAVID  HEKSHEY,  Acting  Assistant  Surgeon. 

Charles  Holker,  colored,  aged  20  years,  by  occupation  a  deck-hand,  was  admitted  to  the  Frced- 
men's  Hospital,  New  Orleans,  Louisiana,  on  May  24, 1868,  having  about  a  week  previous  to  his  admis- 
sion thrust  a  sliver  of  wood  into  the  sole  of  his  foot.  It  was  immediately  removed  and  the  wound 
healed  readily,  no  unpleasant  symptoms  occurring  until  the  24th.  When  admitted,  spasms  were 
occurring  every  twenty  minutes;  the  jaws  were  firmly  locked,  and  the  muscles  of  the  neck,  chest, 
and  abdomen  were  very  rigid,  with  considerable  opisthotonos.  His  bowels  had  not  moved  for  five 
days.  A  terebinthinate  enema  was  given  with  the  desired  result.  Opium  was  administered  in 
grain  doses  every  two  hours.  He  passed  a  restless  night,  the  spasuis  recurring  with  but  very  slight 
intermission  ;  and  on  the  25th  the  pulse  was  120.  Tincture  of  Calabar  bean  was  given  in  the  dose 
of  five  drops  every  half  hour,  which  was  finally  increased  to  twenty-five  drops.  Very  little  change 
took  place  until  the  30th,  when  all  the  symptoms  became  less  severe;  beef-tea  was  given  freely. 
He  continued  to  improve,  and  on  June  5th  the  pulse  was  52,  full  and  regular,  and  the  spasms 
occurred  but  twice  during  the  day.  Opisthotonos  was  less  marked.  On  the  16th,  having  had  no 
spasms  for  four  days,  the  nse  of  the  bean  was  discontinued.  On  June  20th  he  had  completely 
recovered.  The  quantity  of  extract  of  Calabar  bean  taken  during  the  case  was  three  hundred  and 
forty-two  grains. 

DCCXXII. — Report  of  a  Case  of  Traumatic  Tetanus  belieaed  to  have  been  treated  successfully  by  Large 
Doses  of  Opium  and  the  Inhalation  of  Ether.  By  W.  D.  JAMAISON,  M.  D.  Acting  Assistant 
Surgeon. 

Charles  Wilson,  a  private  of  Co.  B,  llth  Infantry,  aged  21  years,  came  under  notice  for  medical 
treatment  at  Charlottesville,  Virginia,  on  February  25,  1866,  having  chancres  and  bubo.  The  bubo 
had  suppurated  and  was  opened,  giving  exit  to  a  copious  quantity  of  pus.  He  was  doing  well 
until  March  3d,  when,  coming  in  violent  contact  with  the  end  of  a  board,  which  struck  him  over 
the  seat  of  the  bubo,  he  gave  a  scream,  fell  prostrate  on  the  ground,  and  immediately  became 
convulsed.  Upon  being  seen  within  twenty  minutes  from  the  attack,  he  vomited  the  contents  of 
his  stomach,  mingled  with  blood.  From  this  time,  4.30  P.  M.,  till  2  A.  M.  next  morning,  the 
convulsions  followed  each  other  in  rapid  succession,  with  intervals  varying  from  five  to  ten  minutes. 
Opisthotonos  was  marked  in  its  fullest  intensity;  his  speech  was  voluble  but  incoherent,  changing 
at  times  to  a  loud  and  boisterous  tone.  The  pulse  at  no  time  exceeded  86 ;  the  pupils  were 
dilated,  and  did  not  respond  to  the  action  of  light,  or  when  an  object  was  suddenly  brought  near 
the  eye ;  the  countenance  during  the  paroxysms,  was  almost  purple,  the  superficial  vessels  of  the 
face  and  neck  being  much  distended ;  the  muscles  of  deglutition  were  unaffected  throughout, 
and  the  surface  of  the  body  and  the  extremities  were  much  below  the  natural  temperature.  The 
treatment  in  this  case  consisted  of  sinapisms  to  the  hands,  feet,  and  stomach,  followed  by  drachm 
doses  of  laudanum  every  hour,  and  the  free  inhalation  of  ether  on  the  recurrence  of  spasms.  No 
abatement  of  the  spasms  was  preceptible  until  the  next  day  at  2  P.  M.,  a  period  of  ten  hours, 
during  which  time  two  and  a  half  ounces  of  laudanum  and  fourteen  ounces  of  ether  had  been 
expended.  Being  unable  to  make  water,  warm  fomentations  were  applied  over  the  region  of  the 
bladder,  and  bottles  of  hot  water  to  the  feet  and  perinjeum,  which  had  the  desired  effect  an  hour  or 
so  afterward,  the  patient  experiencing  no  further  trouble  in  that  respect.  He  slept  well  and  soundly 
at  night,  but  evinced  no  desire  to  sleep  in  the  day-time.  On  the  fourth  day  the  patient  was  walking 
about,  taking  no  medicine  except  tincture  of  iron,  and  expressed  himself  feeling  "very  well." 


272  REPORT  OF  SURGICAL  GASES  IN  THE  ARMY. 

DCCXXHL— Report  of  a  Case  of  Traumatic  Tetanus  believed  to  have  been  treated  successfully  ir'ith 

Hydrate  of  Chloral    By  D.  BACHE,  Surgeon,  U.  S.  A. 

George  Deems,  a  private  of  Troop  A,  4th  Cavalry,  aged  24  years,  was  admitted  to  the  post  hospital 
at  San  Antonio,  Texas,  July  4,  1870,  with  a  contused  wound  of  the  scalp.  He  had  been  carousing 
the  previous  evening,  and  while  intoxicated  had  been  thrown  from  the  -top  of  a  carriage  which  he 
was  in  the  act  of  mounting.  Simple  dressings  were  applied  to  the  wound.  He  ate  his  breakfast 
as  usual,  but  in  half  an  hour  afterward  complained  of  increasing  stiffness  about  the  lower  jaw,  and 
in  two  hours  it  had  become  firmly  closed  and  general  convulsions  had  set  in,  each  lasting  from  three 
to  five  minutes.  Hydrate  of  chloral  in  twenty-grain  doses  was  administered  every  hour.  Pulse 
102,  temperature  in  axilla  100,  pupils  natural.  Spasms  occurred  upon  the  slightest  touch,  or  upon 
blowing  the  breath  upon  the  face.  On  the  next  day  the  pulse  was  64,  respiration  24,  temperature 
98.  The  bowels  moved  and  urine  passed  freely.  The  pupils  were  somewhat  dilated  equal  and 
sensitive  to  light.  There  was  some  rigidity  of  the  masseter  muscles,  which  were  painful  upon 
touch,  and  hyperresthesia  over  the  entire  length  of  the  spine  ;  greatest  in  the  cervical  region.  The 
case  progressed  very  favorably  until  July  13th,  the  patient  complaining  only  of  occasional  headache. 
He  had  been  moved  during  the  day  to  an  adjoining  bed ;  at  10  P.  M.  he  had  a  general  convulsion, 
and  two  within  the  next  hour ;  the  jaws  closed  firmly,  the  pupils  became  widely  dilated  and  fixed. 
Pulse  full,  intellect  much  confused  after  the  convulsion.  Thirty  grains  of  hydrate  of  chloral  were 
given.  From  this  time  convalescence  was  steadily  progressive,  the  patient  only  requiring  attention 
to  his  diet  and  secretions,  and  all  exposure  to  the  sun  being  prohibited.  He  was  discharged  from 
the  hospital  August  9,  1870,  and  had  no  return  of  convulsion  or  any  form  of  cerebro-spinal 
disturbance. 

DEATH  FROM  CHLOROFORM. — Although  anaesthetics  were  employed  almost  invariably 
in  the  surgical  operations  performed  in  the  Army  during  the  quinquennial  period  considered 
in  this  report,  as  well  as  in  the  reduction  of  luxations  and  fractures,  and  to  a  limited 
extent  in  obstetrical  practice,  there  is  only  a  single  instance  reported  in  which  a  fatal 
result  is  attributed  to  the  use  of  chloroform.  With  what  justice  the  allegation  was  made 
the  reader  can  infer  from  this  report. 

DCCXXIV. — Report  of  a  Death  ascribed  to  the  Effects  of  Chloroform.    By  IRA  PERKY,  Assistant 
Surgeon,  9th  TI.  S.  Colored  Troops. 

Henry  Jeiferson,  a  private  of  Co.  E,  19th  Colored  Troops,  aged  20  years,  was  accidentally  wounded 
by  a  comrade  at  Brownsville,  Texas,  on  August  30, 1SG5.  Two  fragments  of  a  conoidal  musket 
ball  entered  the  outer  aspect  of  thigh,  two  inches  below  the  trochanter  major  and,  fractured  the 
femur.  He  was  admitted  to  post  hospital,  where  spiculae  of  bone  were  removed.  About  September 
15th,  extension  with  pulley  and  weight  was  used,  and  the  limb,  which  was  easily  kept  in  place, 
was  apparently  doing  well.  The  wound  was  kept  open  and  discharged  an  ounce  of  healthy  pus 
daily,  until  October  ICth,  when  pus  was  rusty ;  110  bony  union  had  taken  place.  On  November 
17th,  Acting  Assistant  Surgeon  Raphael  administered  chloroform  and  ether  for  the  purpose  of 
excising  the  ends  of  the  bone.  The  patient  inhaled  two  minutes,  then  began  to  sink ;  pul.se  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  as  soon  as  the  sponge  was  reapplied  the  spasms  returned, 
the  pulse  stopped,  and  death  supervened.  At  the  autopsy,  the  fragments  of  bullet  were  found 
imbedded  in  the  bone  even  with  the  surface.  No  ossific  deposit  was  in  the  fracture  or  close  to  it, 
but  some  above  and  below  its  edge. 

VARIOUS  SURGICAL  AFFECTIONS. — The  reports  are  too  few  for  classification. 

DCCXV. — Account  of  a.  Casein  which  Transfusion  teas  employed.    By  C.  B.  BRAMAN,  M.  D.,  Acting- 
Assistant  Surgeon. 

James  Smith,  a  private  of  Co.  D,  12th  Infantry,  was  admitted  to  post  hospital  at  Petersburg, 
Virginia,  on  November  7,  I860,  suffering  from  thoracic  aneurism,  caused  by  a  strain  experienced 


SURGICAL  DISEASES.  273 

on  November  1st,  while  throwing  heavy  weights  backward  over  his  head.  He  had  been  a  stout, 
robust  man,  but  on  admission  was  completely  pulseless  from  the  loss  of  blood  by  repeated  emesis, 
sufficient  to  fill  a  common  water  bucket  once  and  a  half.  I  transfused  blood  to  the  amount  of  two 
and  a  half  ounces  into  the  median  basilic  vein ;  opium  and  morphine  were  administered  by  the 
mouth,  cutis,  and  rectum  every  hour  for  over  three  days,  in  order  to  subdue  the  cough,  which 
brought  an  renewed  hemorrhages.  An  equivalent  to  sixty-four  groins  of  opium  was  administered 
within  the  first  twenty-four  hours.  Nourishment  was  given  by  enemata  of  whiskey,  quinine,  beef- 
juice,  and  laudanum.  The  patient  gradually  recovered  under  this  treatment,  although  for  several 
days  the  result  was  extremely  doubtful.  He  was  discharged  in  the  latter  part  of  the  month  ;  he 
could  sleep  only  in  a  chair,  not  being  able  to  breathe  in  the  horizontal  posture.  There  was  constant 
cough  and  gnawing  pain  in  sternum  near  third  right  rib,  and  some  hepatization  of  right  lung. 
Aneurismal  fremitus  was  occasionally  perceptible  to  the  ear;  nevertheless  the  patient  was 
gradually  gaining  strength. 

DCCXXVL— Report  of  a  Case  of  Lumbar  Abscess.    By  J.  F.  HEAD,  Surgeon,  U.  S.  A. 

Charles  O- ,  a  private  of  Battery  H,  3d  Artillery,  aged  33  years,  and  unmarried,  served 

in  the  field  during  the  rebellion  with  1st  or  2d  Connecticut  Heavy  Artillery,  and  reenlisted  as  a 
veteran  volunteer  in  18G3.  In  1864  he  suifered  from  typhoid  fever,  for  which  he  was  sent  to  general 
hospital  at  Baltimore,  Maryland,  where  he  was  very  ill  for  some  time.  During  convalescence  he 
felt  pain  in  back,  accompanied  by  swelling,  which  he  attributed  to  long  lying  on  his  back.  An 
abscess  was  opened  in  right  lumbar  region,  and  a  quantity  of  pus,  estimated  by  himself  at  "  more 
than  a  quart,"  was  evacuated.  The  abscess  healed  rapidly,  and,  returning  to  his  regiment,  the  man 
was  mustered  out  in  1865.  In  February,  1866,  he  enlisted  in  the  3d  United  States  Artillery.  He 
was  not  reported  sick,  except  three  days'  diarrho?a  in  August,  1867,  until  November  28,  1867, 
when  he  complained  of  pain  in  the  lumbar  region,  and  was  treated  for  rheumatism,  with  counter- 
irritants,  salts  of  potassa,  and  electricity,  and  returned  to  duty  December  24, 1867.  After  five  days 
duty  returned  to  hospital,  and  was  treated  much  as  before  for  rheumatism.  Returned  to  duty 
January  11,  1868.  Readmitted  March  21st  with  same  symptoms.  Treated  by  tincture  of  iodine 
externally,  dry  cups,  and  tonics.  The  disease  was  recognized  as  lumbar  abscess.  On  April  22d, 
an  incision,  about  midway  between  third  lumbar  vertebra  and  crest  of  right  ilium,  gave  exit  to  less 
than  an  ounce  of  apparently  healthy  pus.  The  opening  healed,  and  he  again  returned  to  duty  on 
June  21st.  On  the  28th  of  April,  it  is  recorded  that  his  weight  has  decreased  from  145  to  121 
pounds.  On  July  4,  1868,  he  reentered  hospital,  which  he  never  left  until  his  death.  The  abscess 
had  reopened,  and  on  July  8th  is  recorded  as  discharging  about  two  ounces  in  twenty-four  hours. 
Nourishing  diet,  wine,  and  quinine  were  prescribed.  The  case  first  came  under  my  observation 
about  July  16,  1868.  The  patient  appeared  to  be  gradually  failing,  the  amount  of  discharge  varying, 
pus  never  offensive,  nor  could  any  denuded  bone  be  detected  by  the  probe.  There  was  never  any 
tenderness  upon  strong  pressure  or  percussion  over  the  spinous  processes  of  vertebrae,  nor  did  the 
nervous  power  of  the  lower  extremities  ever  seem  impaired  during  the  course  of  the  disease.  The 
thighs  were  flexed  upon  the  trunk,  and  attempts  to  extend  them  caused  pain,  which  was  referred 
chiefly  to  the  hip-joint  and  back.  Emaciation  was  marked;  countenance  sunken  and  sallow; 
tongue  moist  and  florid ;  appetite  capricious ;  bowels  generally  regular,  about  one  dejection  in 
forty-eight  hours ;  occasionally  required  a  simple  cathartic.  The  case  progressed  without  note- 
worthy incident  or  variation  until  about  the  middle  of  October,  when  some  swelling,  accompanied 
by  pain,  was  observed  in  left  lumbar  region.  Tincture  of  iodine  applied.  Swelling  increased, 
decided  fluctuation  observed,  and  on  November  2d  an  incision,  under  cover  of  a  rag  soaked  in 
carbolic  acid  and  linseed  oil  one  part  to  seven,  evacuated  about  twenty  ounces  of  abominably 
foetid  pus.  The  opening  was  covered  with  <•  antiseptic  putty,"  after  Lister's  method.  The  discharge 
soon  lost  entirely  its  offensive  smell,  the  quantity  daily  evacuated  decreased  from  eight  ounces  to 
two,  the  original  opening  on  the  right  side  nearly  closed,  and  ceased  to  furnish  any  discharge.  For 
a  time  the  patient  seemed  to  rally  somewhat.  At  about  the  same  time  with  the  appearance  of 
last  named  swelling,  oedema  of  the  feet  was  observed,  which  afterward  extended  to  the  thighs,  and 


274  EEPOET  OF  SURGICAL  CASES  IN  THE  AEMY. 

even  to  the  loins,  and  increased  pretty  steadily  to  the  time  of  his  death.  On  November  23d  began 
to  expectorate  bloody  sputa,  somewhat  darker  than  in  ordinary  pneumonia.  At  first  but  little 
dyspiuBa  and  almost  no  pain  in  chest.  On  24th  complained  of  flight  "  stitch"  in  lower  right  chest. 
On  auscultation  considerable  coarse  rale  in  both  fronts ;  no  fine  crepitus ;  back  not  examined  on 
account  of  difficulty  of  moving  in  bed.  On  28th  and  29th  dyspncsa  much  increased.  On  the  30th, 
he  was  evidently  moribund  at  8  A.  M.,  and  died  at  1.30  P.  M. 

The  treatment  during  the  last  four  months,  in  addition  to  the  local  means  already  mentioned, 
may  be  briefly  summed  upas  consisting  of  a  generous  diet — eggs,  milk,  fresh  meat,  &c.,  ad  libitum 
with  strong  beef-tea,  regularly  administered  when  the  appetite  did  not  induce  him  to  take  sufficient 
nourishment  otherwise;  tonics,  as  quinine,  citrate  of  quinine,  and  iron,  compound  tincture  of  cin- 
chonre,  &c.,  brandy  or  whiskey,  from  four  ounces  to  twelve  ounces  daily,  and  opiates,  when  needed, 
to  relieve  pain  and  procure  sleep. 

Autopsy  nineteen  Jiours  after  death. — Body  greatly  emaciated,  considerable  oedema  of  lower 
extremities.  Cadaveric  rigidity  marked.  Chest  decidedly  resonant  on  percussion  in  both  upper 
fronts,  somewhat  less  so  at  sides.  Abdomen  sunken. 

Thorax. — Lungs  do  not  fully  collapse  on  opening  chest.  Left  pleura  contains  about  fourteen 
ounces  of  straw-colored  serum.  Recent  adhesion  at  left  middle  front  (region  of  nipple),  where 
pleura  costalis  shows  patch  of  arborescent  redness  and  blotches  as  of  ecchymosis,  slight  old  adhe- 
sions at  apex.  Left  lung,  lower  lobe  completely  hepatized.  On  incision  of  lower  part  of  upper 
lobe,  free  exudation  of  muddy,  sanguineo-purulent  fluids  ;  upper  half  of  this  lobe  crepitant.  Right 
pleura,  some  old  adhesions  at  base  (diaphragmatic  portion),  otherwise  normal.  Right  lung,  upper 
and  middle  lobes,  generally  crepitaut.  On  section  abundant  issue  of  frothy  serum.  Lower  lobe 
hepatized,  friable,  particularly  toward  base,  where  it  resembles  softened  spleen.  At  anterior  lower 
margin  apparently  a  clot  of  blood  eifused  in  pulmonary  textures,  but  its  margin  not  well  defined 
from  the  splenifled  tissues  surround.  Pericardium  normal.  Heart  not  examined. 

Abdomen. — Peritoneum  smooth,  moist,  no  effusion  or  adhesions,  no  enlargement  of  mesenteric 
glands.  Intestines  externally  pale,  glossy ;  alimentary  canal  not  opened.  Liver,  spleen,  and  left 
kidney  normal.  Eight  kidney  not  examined.  A  large  abscess  occupies  most  of  situation  of  left 
psoas  inagnus  communicating  with  external  opening  that  made  on  November  2d,  and  with  the 
denuded  bodies  of  second,  third,  and  fourth  lumbar  vertebra.  Posterior  crest  of  ilium  denuded- 
On  right  side  a  section  through  pelvic  fascia  unexpectedly  opened  a  cavity  with  no  apparent  open- 
ing, containing  eight  or  ten  ounces  of  thick,  healthy,  pus,  communicating  with  space  between  last 
lumbar  vertebra  and  sacrum,  from  which  the  intervertebral  substance  had  entirely  disappeared, 
the  opposing  surfaces  of  bone  eroded  and  separated.  Traces  were  found  of  another  sinus,  inde- 
pendent of  the  last  named  abscess,  communicating  with  the  old,  opening  in  right  lumbar  region- 
The  parts  were  so  degenerated,  however,  that  the  anatomical  boundaries  could  not  well  be  made 
out.  [A  section  showing  three  lower  vertebrae,  sacrum,  and  parts  of  ilia  in  situ,  was  forwarded  to 
the  Army  Medical  Museum  with  this  report,  and  is  numbered  5526  of  the  Surgical  Section.] 

DCCXXVII. — Report  of  a  Case  of  Caries  of  the  Pubis,  treated  in  the  Post  Hospital  at  Fort  D.  A. 
Eussell,  Wyoming  Territory.    By  J.  BASIL  GIKARD,  Assistant  Surgeon,  U.  S.  A. 

John  K ,  buglar  Troop  F.  2d  Cavalry,  aged  22  years,  reported  at  sick-call  in  the  latter 

part  of  August,  1868,  complaining  of  pain  on  pressure  and  motion  about  the  region  of  the  right 
groin.  Inspection  of  the  part  showed  no  swelling,  heat,  redness,  or  other  visible  pathological 
change,  and  the  case  being  considered  as  a  sprain  of  the  adductor  muscles,  caused  by  horse-back 
exercise,  the  patient  was  dismissed  with  some  anodyne  liniment  to  rub  the  painful  part.  A  few 
days  after  he  came  again,  stating  the  pain  to  be  worse,  and  judging  from  his  sickly  and  worn-out 
look  that  the  affection  might  be  serious,  he  was  admitted  to  the  hospital  on  August  31st.  On 
admission,  the  symptoms  were  great  pain  in  the  groin,  especially  over  Scarpa's  triangle,  and 
emaciation.  His  appetite  was  good,  pulse  regular,  and  no  fever  present.  The  painful  part  was 
for  a  few  days  painted  with  iodine,  and  an  anodyne  given  at  night  to  produce  sleep.  Ordinary 
.diet  with  beef-tea  was  prescribed.  No  effect  being  produced  by  the  tincture  of  iodine,  it  was 
replaced  by  warm  linseed-meal  poultices,  which  in  their  turn  were  dispensed  with,  and  a  lotion  of 


LIGHTNING-STROKE.  275 

lead-water  and  opium  used.  The  anodyne  liniment  was  also  used  at  times,  and  these  several 
remedies  were  alternately  employed  till  the  patient's  death,  but  with  only  partial  alleviation  of  the 
local  pain.  The  bowels  were  irregular  during  the  whole  length  of  the  disease,  being  sometimes 
confined,  but  much  oftener  very  loose.  In  fact  the  diarrhoea  became  so  violent  that  during  the  last 
two  weeks  the  evacuations  were  repeated  and  involuntary.  It  was  treated  at  first  by  small  doses 
of  chalk  and  .Dover's  powder,  tincture  of  catechu,  opium,  and  acetate  of  lead,  and  when  it  became 
excessive,  tannic  acid  was  given  by  moujfch,  injection,  and  suppository,  while  the  patient  at  the 
same  time  was  taking  large  quantities  of  tincture  of  iron  and  quinine.  Another  complication 
of  the  disease  was  bronchitis  and  pain  over  the  chest,  which  annoyed  the  patient  for  a  long  time,  and 
were  treated  by  cough  mixture  and  the  local  application  of  mustard-plasters  or  linseed  poultices. 
A  few  light  chills  and  some  increase  in  the  rapidity  of  the  pulse  were  noticed  at  times,  caused 
probably  by  the  formation  of  pus.  The  emaciation  progressed  steadily,  although  the  patient's 
appetite  continued  good  to  the  last,  and  beef-tea  and  milk-punch  were  freely  administered  from  an 
early  period.  He  became  completely  bed-ridden,  and  an  indolent  ulcer  opened  itself  over  the  right 
knee,  which  resisted  all  means  of  treatment.  Bed-sores  threatened  to  form  upon  the  sacrum,  but 
were  prevented  by  the  early  application  of  washes  of  alcohol  and  tannin.  One  week  before  death 
an  abscess  showed  itself  in  the  perinreum,  and  having  opened  under  the  action  of  poultices,  a  large 
quantity  of  unhealthy-looking  pus  issued  from  it,  and  continued  to  flow  for  several  days.  Death 
occurred  on  October  26th,  from  exhaustion.  During  the  last  three  days  fecal,  evacuations  had 
been  almost  incessant.  The  patient  was  conscious  to  the  last.  At  an  autopsy,  five  hours  after 
death,  the  body  was  very  rigid,  exceedingly  emaciated,  and  of  a  strangely  dark  hue.  Nothing 
abnormal  was  found  in  the  thoracic  and  abdominal  organs  except  some  hypostatic  congestion  in 
the  lungs.  On  cutting  down  over  the  symphysis  pubis,  a  vast  and  diffuse  abscess  was  opened,  full 
of  a  sanious,  unhealthy  pus.  The  soft  parts  around  the  pubis  and  about  the  perinaeum  were  all 
infiltrated  with  that  fluid,  which  must  have  amounted  at  least  to  a  pint.  The  adductor  muscles  and 
femoral  vessels  and  nerves  of  the  right  thigh  were  destitute  of  connective  tissue  and  bathed  in 
pus,  which  had  burrowed  down  to  the  lower  third  of  the  thigh.  The  right  pubis  was  extensively 
carious,  the  bony  particles  being  so  disintegrated  that,  on  making  the  attempt  to  divide  the 
symphysis,  the  knife  missed  the  joint  and  cut  through  the  bone  without  difficulty.  The  disease  had 
not  proceeded  beyond  the  pnbis,  the  hip-joint,  to  all  appearances,  being  healthy.  The  left  os 
innominatum  was  also  found  in  a  healthy  condition.  [The  pathological  specimen,  consisting  of  the 
right  os  innominatum,  showing  caries  of  the  pubic  portion,  was  forwarded  to  the  Army  Medical 
Museum,  and  is  numbered  5583  of  the  Surgical  Section.] 

DCCXXVIIL— Report  of  the  Removal  of  a  Bunion.    By  WILLIAM  J.  WILSON,  Assistant  Surgeon, 
U.  S.  A. 

Michael  McCormick,  a  corporal  of  Co.  C,  34th  Infantry,  was  admitted  to  the  hospital  at  Holly 
Springs,  Mississippi,  in  March,  1868,  with  a  large  bunion  on  the  outside  of  the  first  metatarso-phal- 
angeal  articulation,  with  which  he  had  been  suffering  for  a  long  time ;  the  toe  was  drawn  iuward  and 
across  and  beneath  the  toes.  The  tendon  of  the  adductor  pollicis  and  the  inner  head  of  the  flexor 
brevis  pollicis  were  divided  subcutaueously,  and  the  toe  straightened  on  a  splint.  On  March  31, 
1868,  the  toe  was  much  straighter  and  not  drawn  across  the  toes  as  before  the  operation.  The 
bunion  itself  was  not  much  reduced  in  size.  The  case  is  reported  by  the  operator. 

LIGHTNING-STROKE. — A  report  of  two  cases  of  recovery  of  soldiers  struck  simultane- 
ously by  lightning,  and  also  a  report  of  a  very  interesting  fatal  case  were  received. 

DCCXXIX.— Report  of  Two  Canes  of  Lightning- Stroke.    By  A.  K.  SMITH,  Surgeon,  U.  S.  A. 

CASE  1  .—Henry  Ward,  a  private  of  Co.  D,  18th  Infantry,  aged  27  years,  was  struck  by  lightning 
July  12,  1870.  He  was  admitted  to  hospital  at  McPherson  Barracks,  Atlanta,  Georgia,  on  the 
following  day.  Stimulating  liniments  and  electricity  were  applied.  He  was  returned  to  duty  July 
31,  1870. 


276  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

CASE  2.— Charles  Zeichler,  a  private  of  Co.  D,  18th  Infantry,  aged  22  years,  was  struck  by  light- 
ning July  12,  1870.  He  was  admitted  to  hospital  at  McPherson  Barracks,  Atlanta,  Georgia,  on 
the  following  day.  Stimulating  liniments  and  electricity  were  applied.  He  was  returned  to  duty 
September  1C,  1870. 

UCCXXX.— Report  of  a  Case  of  Lightning- Stroke.    By  C.  H.  ALDEN,  Surgeon,  U.  S.  A. 

EHas  W ,  a  quartermaster's  employe,  aged  about  GO  years,  was  struck  by  lightning,  near 

Fort  D.  A.  Russell,  Wyoming  Territory,  on  June  24,  1869.  At  the  time  of  this  occurrence  he  was 
on  horseback,  herding  Government  mules,  about  a  mile  east  of  the  post,  and  was  exposed  to  a 
violent  thunder  storm.  The  horse  was  instantly  killed,  but  no  wound  could  be  discovered.  The 
rider  was  shortly  afterward  found  lying  insensible  by  his  side,  and  in  about  fifteen  minutes  was 
brought  to  hospital.  On  admission  he  was  still  insensible,  and  could  not  be  aroused  by  loud  calling ; 
his  eyes  were  closed,  he  was  restless,  and,  tossing  about  his  limbs,  resisted  efforts  to  remove  his 
clothes,  which  were  very  wet.  The  surface  and  extremities  were  cold ;  the  pulse  small.  There 
was  a  superficial  wound  of  the  scalp,  about  two  inches  and  a  half  long,  just  above  and  behind  the 
right  ear,  ranging  upward  and  backward,  but  nearly  vertical,  and  having  the  appearance  of  being 
made  by  the  point  of  some  sharp  instrument.  A  chain  or  series  of  large,  irregular  vesicated  spots 
extended  from  below  the  right  ear  to  the  front  of  the  neck,  and  down  the  chest  and  abdomen  to 
the  penis.  There  was  a  similar  spot  on  the  upper  and  inner  surface  of  left  thigh,  with  slight  super- 
ficial wounds  like  abrasion  on  the  outer  and  middle  surfaces  of  both  thighs.  His  felt  hat  was  very 
much  torn  on  the  right  side,  the  leather  lining  inside  being  burned.  His  shirt  was  somewhat  torn 
in  front,  and  the  pantaloons  were  torn  in  positions  corresponding  to  wounds  on  the  thighs.  On 
applying  heat  to  the  extremities  the  patient  was  wrapt  in  blankets,  and  a  small  quantity  of  whiskey 
administered,  which  was  swallowed  without  difficulty.  In  the  afternoon  the  pulse  grew  somewhat 
fuller  and  the  surface  warmer,  when  slight  vomiting  occurred.  In  the  evening  he  became  more 
restless;  got  up  from  his  bed  and  muttered  a  few  inarticulate  words;  passed  water  in  a  close  stool. 
During  the  night  he  lay  for  the  most  part  quietly,  but  had  occasional  attacks  of  restlessness,  and 
passed  his  faeces  and  urine  in  bed.  On  June  25th  his  condition  was  much  the  same  as  on  the  previ- 
ous evening ;  he  was  generally  quiet,  but  occasionally  grewr  restless ;  pulse  was  somewhat  fuller, 
and  surface  warmer  than  when  admitted,  but  reaction  not  very  decided ;  passed  his  urine  involuntarily, 
and  a  little  watery  fluid  oozed  from  the  right  ear.  Weak  milk-punch  and  beef-tea  were  ordered 
every  two  hours.  Toward  noon  respiration  became  somewhat  blowing,  and  no  change  was  apparent 
in  the  pulse  or  otherwise.  There  was  occasional  restlessness.  Dry  cups  were  ordered  to  the  back 
of  the  neck  and  sinapisms  to  the  extremities.  In  the  afternoon  he  opened^his  eyes,  looking  around 
somewhat  intelligently  for  a  few  moments,  but  did  not  speak,  and  again  became  entirely  unconscious. 
At  7.30  P.  M.  the  pulse  was  72 ;  respiration  30 ;  temperature  97.  At  midnight  he  began  to  swallow 
with  difficulty.  On  June  2Gth,  at  7  A.  M.,  his  condition  was  apparently  unchanged  from  the  last 
evening;  pulse  90;  respiration  30.  The  dry  cups  to  the  nape  of  the  neck  were  ordered  to  be 
repeated.  He  remained  in  the  same  condition  until  he  died  at  12  M.  At  a  post-mortem,  eight  hours 
afterward,  rigor  mortis  was  complete,  having  come  on  about  5  o'clock.  The  wounds  were  found  as 
described  on  admission,  the  scalp  wound  being  very  superficial,  scarcely  extending  through  the  skin, 
and  the  underlying  muscles  somewhat  infiltrated  with  blood,  but  not  decided.  The  periosteum 
and  cranium  were  apparently  intact.  On  removing  the  calvaria  there  appeared  to  be  a  very  slight 
fissure  on  the  inner  surface  corresponding  in  position  to  the  external  wound,  but  so  slight  that  its 
existence  was  almost  doubtful.  Between  the  bone  and  dura  mater  was  a  hard,  black,  circular  clot, 
about  one-fourth  of  an  inch  in  thickness  and  two  inches  in  diameter.  Opposite  the  centre  of  the 
clot  was  a  minute  orifice  in  the  membrane.  The  brain  under  this  clot  was  broken  up  and  mixed 
with  blood  for  about  two  inches  in  diameter,  and  extending  into  the  lateral  ventricles.  The  pia 
mater  was  injected,  and  the  ventricles  filled  with  bloody  serum.  There  was  no  fracture  at  the  base 
of  brain.  The  thoracic  and  abdominal  viscera  exhibited  nothing  abnormal,  excepting  the  heart, 
which  was  loaded  externally  with  fat,  its  cavities  being  quite  empty.  [A  pathological  specimen, 
which  is  numbered  5585  of  the  Surgical  Section,  showing  a  portion  of  the  brain,  temporal  bone,  and 
dura  mater,  was  contributed  to  the  Army  Medical  Museum  along  with  this  report.] 


SURGICAL  ESSAYS.  277 

DCCXXXI. — Extract  from  Reports  suggesting  a  Modification  in  the  Methods  of  Amputation,  by 
preserving  the  Periosteum  to  cover  the  Ends  of  the  Bone,  together  mth  Remarks  on  Amputations  at 
the  Knee.  By  GEORGE  M.  McGiLL,  late  Assistant  Surgeon,  U.  S.  A. 

In  the  winter  of  18G2-'63,  while  on  duty  at  Lincoln  General  Hospital,  Washington,  I  conceived 
that  the  adoption  of  a  periosteal  flap  in  amputations,  such  as  would  cover  the  severed  end  of  the 
bone  and  possibly  unite  with  and  nourish  the  surfaces  recently  cut,  would  be  of  the  greatest  utility 
and  of  easy  performance.  The  idea  was  a  new  one  to  me  at  that  time,  and  to  all  to  whom  I 
presented  it.  But  recently  I  have  observed  the  process  noted  as  an  old  one,  and  have  been  verbally 
informed  to  the  same  effect  by  an  eminent  and  learned  gentleman,  Surgeon  J.  H.  Lidell,  U.  S.  V. 
I  have  practiced  this  operation  in  all  ordinary  amputations  with  excellent  results,  and  with  facility 
from  the  time  I  conceived  it  until  the  present,  and  by  iny  adyice  it  was  frequently  adopted  in 
primary  operations  upon  soldiers  of  the  cavalry  corps  of  the  army  of  the  Potomac,  and  by  such 
emiuent  and  worthy  men  as  Surgeon  W.  H.  Itulison,  9th  New  York  Cavalry,  afterward  unhappily 
killed  while  serving  in  the  Shenandoah  Valley.  In  these  primary  operations  and  in  a  secondary 

operation  performed  in  the  middle  of  the  leg,  by  lateral  flaps,  upon  Lieutenant ,  at 

Gettysburg,  July  8,  1863,  and  more  recently  in  tertiary  operations,  this  procedure  in  the  leg,  so  far 
as  I  am  able  to  ascertain,  has  been  accompanied  by  favorable  results ;  neither  sequestra  nor 
exfoliations  having  formed,  and  the  spine  of  the  tibia  never  having  ulcerated  through.  The 
operation  supposes  no  such  shock  as  destroys  the  vitality  of  the  osseous  tissue  involved,  by  the 
molecular  disturbance  that  gives  rise  to  inflammatory  necrosis  or  by  nuclear  paralysis  and  subsequent 
separation  and  rejection,  such  as  occurs,  as  seems  probable  to  me  after  much  observation,  when 
the  diaphysis  of  a  bone  is  jarred  in  addition  to  being  broken  by  a  missile  of  large  size,  or  by  one 
moving  with  high  velocity  and  striking  obliquely  so  as  to  furnish  a  modified  resultant  force  of 
injury  in  addition  to  the  immediate  destroying  one.  The  operation  is  performed  upon  the  hypothesis 
that  the  osseous  structure  at  the  point  of  division  is  healthy.  After  forming  the  flaps  and  reaching 
the  bone  and  clearing  away  and  retracting  the  muscles,  w  ithout  touching  the  knife  to  the  periosteum, 
taking  half  or  more  of  the  circumference  of  severance  as  the  base,  I  form  by  a  firm,  smooth  cut 
with  a  heavy-bladed  knife,  a  long  anterior  flap  sufficient  at  least  to  cover  the  medullary  substance. 
This  flap  is  then  carefully  raised  by  a  periosteum  knife,  the  operator  running  the  blade  of  this 
instrument  firmly  and  whetting  it,  as  it  were,  against  the  bone,  so  that  the  membrane  is  raised 
intact.  It  will  be  found  that  periosteum  retracts  more  than  skin  ;  this  flap,  for  instance,  retracting 
greatly  upon  and  within  itself.  The  section  of  bone  should  then  be  made  carefully,  accurately, 
and  by  no  means  too  rapidily,  as  the  aim  is  to  preserve  the  life  of  osseous  particles  to  be  touched 
by  the  periosteal  flap's  internal  surface.  The  flap  is  then  allowed  to  fall  of  itself.  I  have  never 
formed  double  flaps,  nor  fixed  the  periosteal  flaps  in  any  manner — proceedings  extremely  easy, 
however.  I  found  the  flaps  I  made  to  fall  readily,  and  to  adhere  to  the  roughened  cut  surface  of 
the  bone.  Of  course,  the  number  of  cases  I  have  had  will  not  justify  generalization,  but  as  these 
cases  number  three  in  which  the  result  was  eminently  good,  I  have  ventured  to  present  a  theory  of 
the  availability  of  a  periosteal  flap  in  amputations,  especially  of  the  leg,  in  which  so  much  inconveni- 
ence has  arisen  from  the  spine  of  the  tibia  even  when  this  spine  has  been  cut  away  in  part.  Why 
does  not  the  substance  of  bone  require  its  natural  cover,  viz.,  periosteum,  to  live  properly,  as  much 

as  muscles  and  other  tissues  require  the  skin  ? 

**  #  *  *  *  *  *  * 

[This  paper  was  dated  Baltimore,  October  30,  1865.     Dr.  McGill's  next  paper  relates 
to  knee-joint  operations,  and  is  dated  January  19,  1866.] 
*  ##  *  #  #*•» 

I  submit  the  following  remarks  upon  three  cases  of  amputation  through  the  knee-joint,  in  all  of 
which  the  patella  was  left,  and  the  proximal  joint  surfaces  interfered  with  as  little  as  possible.  On 
May  6, 18G4,  near  Todd's  Tavern,  Virginia,  in  the  brigade  of  the  first  division  of  cavalry,  commanded 
by  General  Custer,  the  first  sergeant  of  an  independent  New  York  battery,  I  think  the  6th,  was 
struck  by  a  cannon  ball  in  the  left  leg.  Both  bones  were  broken,  and  the  soft  parts  were  extensively 


278  EEPOBT  OF  SURGICAL  CASES  IN  THE  ARMY. 

lacerated.  The  soldier  was  removed  to  the  field  hospital  of  the  brigade,  located  five  hundred  yards 
in  rear  of  the  Hue  of  battle,  at  which  hospital,  very  shortly  after  reception  of  injury,  I  performed 
amputation  through  the  knee-joint.  The  steps  of  this  operation  were  substantially  those  taken  in 
the  second  case.  The  patient  rallied  well,  and  was  carried  to  the  rear  very  shortly.  Since  then  I 
have  not  heard  of  him.  Owing  to  the  press  of  my  duties  at  the  time  I  could  make  no  notes,  and 
these  statements  are  made  from  memory,  twenty  months  after  the  operation.  The  battery  to  which 
this  sergeant  was  attached  was  commanded  by  Captain  Martin. 

[William  H.  Turner,  1st  sergeant,  6th  New  York  Independent  Battery,  died  of  pyaemia  May  27, 
1864,  and  is  doubtless  the  patient  referred  to. — ED.] 

On  August  18,  1864,  in  one  of  our  forts  in  front  of  Petersburg,  Private  Kelly,  Co.  A,  Battalion 
of  U.  S.  Engineers,  Headquarters,  Army  of  the  Potomac,  was  wounded  in  the  left  knee  by  a 
sharpshooter.  The  ball  entered  somewhat  to  the  left  of  the  median  line,  near  the  tuberosity  of  the 
tibia,  and  passing  upward  and  backward  lodged  in  the  face  of  the  external  condyle,  partially 
imbedding  itself  crosswise.  On  consultation  the  same  day  the  man  was  wounded,  with  Surgeon 
Ghiseliu,  U.  S.  A.,  Assistant  Surgeon  J.  R.  Gibson,  U.  S.  A.,  and  Acting  Assistant  Surgeon  Goodrich, 
who  had  charge  of  the  case,  it  was  decided  to  amputate  through. the  knee-joint.  After  the  usual 
preliminaries,  having  taken  a  scalpel  of  medium  size,  taking  position  on  the  right  side  of  the  limb,  I 
introduced  it  opposite  the  termination  of  the  external  condyle,  and  outlined  an  anterior  flap,  the 
lowermost  portion  of  which  was  two  inches  below  the  terminal  insertion  of  the  quadriceps  extensor, 
•with  a  firm  cut  that  divided  the  skin  and  superficial  fascia,  terminating  the  primary  incision  of  the 
anterior  flap  opposite  a  point  of  the  internal  condyle  corresponding  to  the  point  of  the  external  con- 
dyle opposite  which  the  scalpel  had  been  introduced.  From  this  termination  the  scalpel  was  reversed, 
and  the  inner  half  of  the  posterior  flap  formed,  the  depth  of  my  incision  being  such  as  insured  section 
of  the  superficial  fascia  as  well  as  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.  The  angles  of  union  of  the  anterior 
and  lines  of  incision  were  made  very  acute,  so  that  retraction  would  not  tend  to  separate  the  angles 
posterior  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  1  took  care  in  raising  it  to  dissect  so  as  to  inflict  as  little 
injury  as  possible  upon  superficial  fascia.  The  ligament  of  the  patella  was  incised  closely  above  the 
tuberosity  of  the  tibia,  and  the  patella,  with  its  connections,  left  untouched  so  far  as  practicable. 
The  ligaments  remaining  were  then  divided  at  their  insertion,  and  so  cut  through  that  the  semilunar 
cartilages  remained  in  the  stump.  All  the  ligaments  binding  the  head  of  the  tibia  being  thus 
severed  with  a  large  operating  knife,  I  cleared  the  posterior  flap,  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.  But  in  addition,  by  the  method  adopted,  I  found  that  the  fleshy  part 
of  the  posterior-flap  had  been  so  formed  as  to  expose  the  anterior  surface  of  the  deep  posterior 
layer  of  crural  fascia,  and  expose  so  much  of  this  surface  that  it  was  found  that  a  fibrous  sheet 
fitted  upon  the  synovial  surfaces  exposed  by  removal  of  the  tibia.  I  now  cut  away  all  points  and 
strips  of  cartilage  or  fibrous  tissue  accidently  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  were  rotten. 
There  was  a  ball  hole  in  the  anterior  flap,  besides  the  wound  in  the  face  of  the  external  condyle  to 
complicate  the  case.  The  latter  was  oozing  blood  from  its  sides  when  last  observed.  Throughout 
the  operation  injury  to  what  was  left  of  the  synovial  sac  was  avoided.  September  9,  1864 : 
Kelly  is  doing  very  well.  The  ligatures  have  none  of  them  come  away  yet,  and  gentle  traction 
met  with  firm  resistance  this  morning.  He  is  afflicted  with  pains  of  a  darting  lancinating  character, 
which  shift  location.  The  wound  of  entrance  in  the  outer  border  of  the  anterior  flap  has  healed 
rapidly  by  granulation.  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.  So  little 
discharge  takes  place  through  this  sinus  that  it  is  thought  that  the  bed  of  the  ball  has  already 
been  filled  with  callus.  A  peculiar  "  leaden"  feeling  has  been  observed  by  Kelly  about  his  patella. 
He  is  not  able  to  move  this  bone,  but  moves  the  left  thigh  without  pain.  On  September  14th  Kelly 


SURGICAL  ESSAYS.  279 

is  doing  finely,  one  of  the  inside  ligatures,  that  of  an  articular  artery,  has  broken  oft  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  cicatrix  is  somewhat  depressed.  There  is 
still  discharge  from  where  the  ligature  is  broken  off.  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.  I  dread  pulling, 
be  it  ever  so  gentle,  for  the  ligature  thread  is  fine  and  very  rotten.  The  patella  is  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. 
September  27th  :  Kelly  was  sent  away  to  West  Point,  New  York,  this  afternoon  able  to  walk  on 
crutches.  The  only  regret  is  that  knots  of  all  the  ligatures  remain  in  the  stump.  I  have  considered 
it  inexpedient  to  search  for  them.  On  his  way  to  West  Point,  Kelly  was,  as  I  was  informed  by  a 
letter  from  him,  attacked  with  what  he  termed  "  gangrene."  Some  operation  became  necessary, 
and  was,  I  believe,  performed  at  West  Point.  From  what  he  wrote  I  understand  that  this  second 
"operation"  did  not  extend  to  interference  with  bones  or  the  remains  of  the  synovial  sac. 

In  addition  to  the  foregoing  remarks,  I  subjoin  a  history  of  Private  David  D.  Cole,  wounded  in  the 
left  leg  at  Amelia  Court-House,  April  o,  18G5,  and  operated  upon  by  myself  on  August  1,  1865, 
at  this  general  hospital.  The  leg  was  much  swollen,  and  there  was  a  great  deal  of  dead  bone  in  it. 
Patient  was  greatly  weakened  by  discharge,  and  prostrated  by  sympathetic  irritation.  When  the 
operation  was  performed  it  was  evident  that  there  was  no  other  way  to  save  life.  In  operating — 
yielding  to  the  opinion  of  a  gentleman  present  that  the  tumid  and  discolored  tissues  about  certain 
fistulous  orifices,  that  gave  vent  posteriorly  to  discharge  from  about  the  dead  bone,  was  not  capable 
of  living  as  part  of  a  flap — I  made  a  very  long  anterior  flap.  The  angles  of  union  of  the  anterior 
and  posterior  flap  were  too  obtuse,  so  made  in  consequence  of  miscalculating  the  effects  of  retraction 
upon  the  anterior  flap.  In  operating,  moreover,  I  removed  the  semilunar  cartilages,  and  thus  freed 
the  lower  part  of  the  capsule  of  the  joint,  which  was  immediately  drawn  up ;  and  to  this  removal 
is  due  in  great  part  the  extreme  retraction  presented.  There  being,  however,  an  abundance  of  skin- 
flap  to  cover  the  condyles,  I  closed  the  stump  in  the  usual  manner.  At  the  first  dressing,  three 
days  later,  I  removed  the  sutures  at  the  inner  angle  and  along  the  centre  of  the  line  of  coaptation 
wherever  there  was  strain.  The  stump  had  an  indolent  and  weak  look.  Removal  of  sutures  at  the 
inner  angle  of  the  stump  disclosed  a  pearly  surface  of  the  internal  coudyle  and  bright  red  surface 
of  the  lateral  ligament.  The  anterior  flap  exhibited  a  decided  tendency  to  slough.  In  a  few  days 
this  slough  formed,  all  the  sutures  were  removed,  and  the  flaps  carefully  supported  with  adhesive 
strips.  The  angles  opened  widely  after  a  slough  (terminal)  of  an  inch  separated.  But  I  relied  on 
the  vitality  of  the  yet  abundant  integumentary  tissue  in  the  middle  line  of  the  stump.  Without 
further  bad  symtoms  the  case  progressed  favorably,  with  a  copious  formation  of  pus,  however, 
until  the  third  week,  when  a  great  abscess  was  developed  under  the  fascia  lata.  I  do  not  think 
this  abscess  was  in  any  manner  connected  with  the  ascending  anterior  pouch  of  the  synovial  sac. 
After  this,  as  the  abscess  gradually  healed,  so  did  the  stump,  the  general  phenomena  presented  by 
the  patient  being  favorable,  pari  passu.  In  November  the  patient  was  discharged  from  hospital 
perfectly  well.  At  that  time  the  patella  was  drawn  upon  the  supercondyloid  anterior  space  and 
fixed  there,  and  the  synovial  sac  appeared  wholly  obliterated.  The  integumentary  tissue  covering 
the  faces  of  the  condyles  was.  well  nourished,  firmly  attached,  and  capable  of  sustaining  pressure 
with  comfort  to  the  patient.  There  were  no  irregular  nervous  sensations.  The  patient  was  fat, 
and  the  muscles  of  his  left  thigh  were  well  developed.  I  have  received  a  letter  from  him  since, 
in  which  he  informs  me  that  he  has  received  a  proper  artificial  leg  (supplied,  I  believe,  by  Dr. 
Hudson,  of  New  York),  and  has  nothing  to  regret  in  the  manner  in  which  the  operation  was 
performed. 

DCCXXXIL— Second   Paper  on  Periosteal  Flaps.     By  the  late  George  M.  McGill,  Assistant  Sur- 
geon, U.  S.  A. 

I  have  the  honor  to  transmit  (April  12, 186G)  casts  of  the  stumps  of  Private  Josiah  Gamble, 
Co.  C,  13th  Virginia  Infantry ;  private  Church  Lewis,  Co.  B,  llGtli  U.  S.  C.  T.,  and  Private  John 


280  REPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

H.  Allison,  Co.  I,  21st  Pennsylvania  Cavalry.  Those  of  Gamble  and  Lewis,  are  of  amputations  of 
the  right  leg,  and  that  of  Allison  of  an  amputation  of  the  left  thigh,  lower  third.  In  the  operations 
performed  on  these  men,  the  method  of  operation  with  periosteal  Haps  to  cover  the  cut  end^of 
the  bones,  to  which  I  called  attention  by  a  paper  acknowledged  by  Surgeon  George  A.  Otis,  U.  S.  V., 
December  20,  1805,  was  duly  tried.  *  It  has  succeeded  very  well.  Subjoined  is  a  detailed  history 
of  each  case,  also  of  the  case  of  Private  Leonard  Babb,  Co.  B,  5th  New  Hampshire  Volunteers. 

CASE  1. — Leonard  Babb,  Private  Co.  B,  5th  New  Hampshire  Volunteers,  aged  43  years,  was 
wounded  April  7, 18C5,  at  Farmville,  Virginia,  in  the  right  foot,  a  conoidal  ball  entering  the  heel, 
and  making  exit  in  the  instep,  breaking  up  the  tarsal  bones.  He  was  treated  expectantly  until 
August  12, 1865,  when,  no  improvement  being  manifest,  and  much  detad  bone,  abscesses,  and  light 
general  cachexy  being  observed,  and  more  feared,  at  the  man's  desire  amputation  was  performed 
in  the  lower  part  of  the  middle  third  of  the  leg,  by  the  operation  of  Lenoir.  Operating  myself,  I 
was  careful  to  raise  a  long  and  thick  periosteum  flap,  being  particular  in  so  grating  the  knife  on 
the  compact  substances  of  the  tibia  as  to  leave  all  the  transitional  tissue  -possible  attached  to  the 
periosteum.  His  recovery  was  rapid  and  perfect ;  the  stump  was  painless  on  pressure  and  admirably 
suited  for  an  artificial  limb.  He  was  discharged  on  October  5,  18C5.  There  was  no  tenderness 
over  the  sharp  cut^end  of  the  tibia  during  the  cure. 

CASE  2. — Specimen  455  A.  M.  M.,  Private  Josiah  Gamble,  Co.  C,  13th  West  Virginia  Volunteers, 
aged  23  years,  was  wounded  ou  July  24,  18G4,  at  Winchester,  Virginia,  in  the  right  ankle.  There 
being  no  prospect  of  recovery,  and  the  case  becoming  worse  daily,  with  dead  bone,  abscesses,  and 
sympathetic  irritation,  on  October  12, 1865, 1  performed  amputation  in  junction  of  lower  aud  middle 
thirds  of  leg,  operating  by  lateral  flaps,  and  making  a  circular  incisions  of  soft  tissues.  I  raised 
a  flap  of  periosteum,  as  in  case  one,  with  the  greatest  ease.  The  man  recovered  quickly  and  well, 
but  in  removing  the  ligatures  one  of  the  knots  was  broken  off  in  the  stump;  I  believe  that  of  the 
ligature  of  the  anterior  tibial,  drawn  downward  and  inward.  After  it  was  perfectly  healed  the 
cicatrix  opened  near  its  anterior  extremity,  aud  from  this  opening  there  has  been  an  intermittent 
discharge  until  the  present  time  (April,  1866).  Repeated  efforts  have  been  made  to  find  dead 
bone  without  success ;  and  I  think  that  the  knot  of  silk  is  the  cause  of  the  discharge,  and  that 
this  knot  will  finally  be  cast  out.  Gamble  was  transported  to  Fort  McHenry  post  hospital,  on 
February  20,  1866.  The  end  of  the  tibia  is  well  rounded.  The  stump  is  not  in  the  least  tender  nor 
tumid,  and  the  man's  general  health  is  good. 

CASE  3.— Specimen  450  A.  M.  M.,  Private  Church  Lewis,  Co.  B,  116th  U.  S.  C.  T.,  aged  22  years, 
of  tuberculous  diathesis.  Patient  sprained  his  ankle  in  July,  1864,  while  drilling,  aud  there  was 
extensive  disease  of  a  low  type  of  the  bones  and  connective  tissues  generally  of  the  right  ankle. 
1  made  antero-posterior  flaps.  The  posterior  flap  was  formed  in  the  soft  tissues,  after  being  outlined 
by  the  scalpel  in  the  skin  and  superficial  fascia,  by  cutting  from  within  outward  in  the  plane  of 
the  border  of  the  retracted  outlined  skin-flap.  In  this  case  I  made  periosteal  flaps  for  both  tibia 
and  fibula.  The  periosteum  was  lifted  with  the  greatest  ease,  and,  after  the  operation,  was  even 
more  than  sufficient  to  cover  the  ends  of  the  bones.  I  found  it  necessary  to  be  careful  not  to  cut 
the  bones  below  the  folds  of  periosteum.  These  bones  were  very  easily  cut  by  the  saw.  Before 
this  operation  there  was  extensive  irritability,  the  patient  screaming  when  the  foot  was  touched. 
After  it  he  complained  of  great  pain  for  several  days.  The  fourth  day  after  the  operation,  I  was 
compelled  to  open  the  stump  in  the  night  and  religate  the  peroneal  artery,  for  profuse  haemorrhage, 
preceded,  during  the  day,  by  vomiting  and  straining.  The  first  ligature  had  apparently  cut  through 
the  fibrous  coat.  Later  there  was  a  large  abscess  in  the  superficial  fascia  on  the  outer  side  of  the 
leg.  After  the  seventh  day  his  recovery  was  rapid,  and  he  was  transferred  on  February  20,  1866, 
to  Fort  McHeury  post  hospital,  perfectly  well.  His  tibia  was  markedly  rounded  and  the  end  of 
the  stump  well  suited  to  bear  strain. 

CASE  4. — Specimen  403  A.  M.  M.,  is  a  cast  of  the  stump.  John  H.  Allison,  Farrier,  Co.  1, 21st 
Pennsylvania  Cavalry,  aged  19  years,  was  wounded  on  April  5,  1865,  at  Amelia  Court-House,  Vir- 


SUKflKiAL  ESSAYS.  281 

* 

ginia,  by  a  conoidal  ball.  The  popliteal  artery  near  its  beginning  was  completely  severed,  tbc 
missile  bruising  the  femur  about  the  inferior  termination  of  the  diaphysis.  There  was  hemorrhage 
to  syncope  on  the  field,  and  secondary  haemorrhage,  and  when  any  one  meddled  with  the  wound  there 
was  apt  to  be  haemorrhage.  Inflammation  of  the  knee-joint,  (treated  by  free  incisions),  gangrene, 
abscesses  of  the  leg  and  thigh,  anchylosis  of  the  knee-joint,  with  the  leg  bent  at  right  angles,  erysip- 
elas repeated  and  associated  with  great  constitutional  disturbance,  emaciation,  pallor,  leucocy thwinia, 
and  fatty  degeneration,  interstitial  and  proper,  of  the  leg  and  thigh,  were  severally  declared.  At  last 
irritative  fever  was  decidedly  formed,  and  incurable  ulcers  on  the  heel  and  leg.  By  my  direction  Dr. 
H.  McElderry,  Acting  Assistant  Surgeon,  U.  S.  A.,  performed  amputation  in  the  lower  third  through 
the  diaphysis ;  forming  an  ample  anterior  flap,  and  a  short  and  somewhat  thick  posterior  one,  and 
raising  a  very  long  and  wide  periosteum  flap.  This  periosteal  flap  was  raised  with  the  greatest 
ease,  too  easily  in  fact,  and  after  the  operation  was  completed,  was  folded  over  every  part  of  the 
cut  surface  of  bone,  as  were  the  flaps  in  the  case  of  Lewis  (Case  3).  Great  prostration  followed  the 
operation  ;  from  this  he  reacted  rather  slowly,  a  kind  of  fever  appearing  the  third  day.  He  was 
kept  under  the  influence  of  morphia.  After  the  fourth  day  he  improved  steadily  and  speedily.  At 
first  when  the  stump  was  being  dressed  he  complained  a  great  deal.  It  was  dressed  first  the  third 
day.  His  blood  presented  remarkable  phenomena  of  change  of  the  white  into  red  corpuscles  (as 
Dr.  McElderry  and  myself  thought),  during  his  cure,  which  will  be  fully  described  in  a  more  detailed 
report  of  the  case.  He  was  discharged  the  service,  at  his  ow'n  request,  perfectly  well,  with  the 
exception  of  a  surface  granulating  in  the  cicatrix.  On  March  14, 1806,  he  was  able  to  sit  all  day 
in  a  chair  and  help  himself.  The  end  of  bone  in  this  case  was  beautifully  rounded.* 

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  adapt  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  be  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 
pyaemia.  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. 

This  paper  was  dated  Baltimore,  April  12,  1866.  The  suggestions  it  contains  were 
communicated  to  several  medical  officers  ;  but  there  appear  to  have  been  no  further  ex- 
periments on  the  subject,  and,  indeed,  the  whole  matter  of  sub-periosteal  operations  has 
received  little  attention  in  the  Army. 

Dr.  McGill  used  and  recommended,  for 
the  separation  of  the  periosteum,  a  rugine 

FIG.  69.— Engine  for  sub.periosteal  operations.    [After  Oilier.]          similar     to  that  employed  by    M.    Oilier,    and 

figured  in  the  second  volume  of  his  work. 

•  See  Catalogue  of  the  Surgical  Section  of  the  Army  Medical  Museum,  p.  555. 
t  OI.LIKK,  Traitii  Experimental  et  Clinique  de  la  Re-gyration  des  Os.    Paris,  1867,  T.  II,  p.  H.1 
30 


282 


REPORT  OF  SURGICAL  GASES  IN  THE  ARMY. 


REVIEW  AND  CONCLUSION. 


The  one  thousand  and  thirty-seven  cases  recorded  in  the  foregoing  pages,  with  more 
or  less  detail,  are  but  a  small  portion  of  those  entered  under  the  head  of  Class  V  on  the 
monthly  reports  of  sick  and  wounded  for  the  period  embraced  by  this  report.  The 
casualties  thus  entered  numbered  over  sixty  thousand.*  The  following  consolidation 
from  the  numerical  reports  indicates  the  relative  frequency  of  the  different  classes  of 
wounds,  accidents,  and  injuries:  f 

Abstract  of  Woundt,  Accidents,  and  Injuries  reported  on  the  Monthly  Reports  of  Sick  and  Wounded  of  the  United  Statei  Army 
for  the  Period  commencing  July  I,  1865,  and  ending  December  31,  1870. 


d 

1 

( 

CO 

4 

4 

1 

£ 

"0 

g 

g 

1 

T3 

§ 

a  « 

s 

o 

a> 

A 

§ 

S 

p 

Burns  and 

Contusions 

jj 

"S 

o 

g 

o 

Drowning. 

a 
ft 

Dislocatiol 

Simple  fra 

Compound 

1 

§ 

Incised  wo 

Lacerated 

Punctured 

Poisoning. 

Other  acci 
injui 

Homicide. 

Suicide. 

Hanging. 

2,003 

23,651 

152 

193 

13,  731 

635 

1,380 

219 

3,213 

6,774 

3,033 

1,591 

683 

3,683 

68 

84 

2 

It  was  proposed  to  publish  only  a  selection  from  the  histories  of  the  more 
interesting  cases  entered  in  Class  V  of  the  monthly  reports  of  sick  and  wounded,  but 
ultimately  it  was  deemed  expedient  to  print  condensed  abstracts  at  least  of  each  case  of 
which  a  special  report  had  been  forwarded.  All  of  the  evidence  being  thus  presented  to 
them,  it  was  thought  that  medical  officers  would  hereafter  be  enabled  to  determine 
precisely  what  cases  it  would  be  advisable  to  make  the  subject  of  special  reports,  and 
the  extent  and  form  in  which  said  reports  should  be  made.  Many  letters  of  inquiry  on 
these  points  have  been  received  by  this  Division  of  the  Office,  and  it  has  been  difficult 
sometimes  to  answer  them  definitely.  The  gravest  wounds  are  occasionally  devoid  of 
interest  because  of  their  immediate  or  inevitable  fatality ;  while  the  most  trivial  accidents 
may  be  followed  by  formidable  complications,  demanding  the  most  careful  study,  and 
yielding  the  most  instructive  illustrations. 

It  is  very  desirable  that  the  name  and  military  description  should  be  noted  in  all 
cases  entered  under  Class  V  on  the  monthly  report  of  sick  and  wounded,  and  that  the 
patient  should  appear,  by  name,  on  the  report  of  the  following  months,  until  he  is  finally 
accounted  for.  Thus,  it  will  become  practicable  to  identify  always  such  patients,  and 
when  they  are  moved  from  one  post  to  another  to  trace  their  histories.  The  memoranda 
of  grave  cases  can  hardly  be  too  minute,  or  of  trivial  cases  too  concise,  provided  means 
of  identification  of  the  patient  are  afforded.  It  is  hardly  necessary  to  insist  on  the 

*  The  exact  number  is  61,105. 

t  The  period  covered  by  the  consolidation  does  not  precisely  correspond  with  that  considered  in  the  Report ;  hut 
the  ratios  are  the  same.  At  the  beginning  of  the  period  the  Army  numbered  over  150,000  ;  but  it  was  rapidly  reduced 
to  80,000 ;  then  to  54,000,  and  finally  to  30,000,  its  present  nominal  strength. 


CONCLUDING  OBSERVATIONS.  283 

importance  of  the  fullest  description  of  autopsies  and  of  pathological  specimens  forwarded 
to  the  Army  Medical  Museum.  Some  medical  officers  have  performed  creditable  surgical 
operations  on  citizens,  but  have  excluded  such  cases  from  their  reports.  Such  additions 
to  the  surgical  data  of  the  Army  should  be  forwarded  in  supplementary  reports,  otherwise 
the  records  of  the  office  will  imperfectly  represent  the  work  accomplished  by  the  medical 
staff. 

On  page  86,  the  results  of  the  gunshot  wounds  that  were  not  subjected  to  operations 
are  summed  up,  and,  on  page  113,  a  summary  is  given  of  the  results  of  the  incised, 
punctured,  lacerated,  and  contused  wounds,  comprising  some  remarkable  recoveries  after 
visceral  protrusions  and  punctures  of  the  alimentary  canal.  Summaries  of  the  results  of 
simple  and  compound  fractures  and  of  dislocations  have  been  given  in  connection  with 
the  abstracts  of  cases  of  those  injuries  (pp.  114,  143).  Matters  of  interest  respecting 
arrow-wounds  are  comprised  in  the  reports  from  pages  144  to  163.  A  few  abstracts  of 
cases  of  poisoned  wounds,  and  of  burns  and  frost-bites,  close  this  chapter. 

The  chapter  on  surgical  operations,  commencing  (p.  170)  with  a  tabular  statement  of 
the  minor  amputations,  concludes  (p.  218)  with  a  favorable  exhibit  of  the  results  of  the 
major  operations.  Those  at  the  shoulder  and  knee-joint  had  a  larger  measure  of  success 
than  usually  rewards  the  efforts  of  surgeons,  and  the  small  ratio  of  mortality  in  the  thigh 
amputations  (38.5)  is  exceptional.  Two  of  the  amputations  in  the  thigh  were  of  special 
interest  as  performed  for  the  consequences  of  gunshot  fractures  of  the  femur,  inflicted  five 
and  seven  years  previously.  The  pathological  specimens  furnished  from  these  cases,  very 
imperfectly  represented  by  the  wood-cuts  (Fias.  41,  42),  are  very  instructive.  There 
was  a  successful  case  of  amputation  of  the  fore-arms  and  of  the  legs  in  one  patient,  and 
one  of  the  two  exarticulations  at  the  hip  had  a  successful  issue.* 

The  results  of  the  amputations,  according  as  they  were  performed  for  injury  or 
disease,  or  in  the  primary,  intermediary,  or  secondary  stages,  are  summed  up  on  p.  217. 

Under  the  head  of  excisions  are  included  two  examples  of  successful  trephining  in 
depressed  fractures  of  the  skull,  for  symptoms  of  compression,  following  on  the  second  and 
third  days,  respectively,  the  reception  of  blows.  An  excision  of  portions  of  the  upper 
and  lower  maxillaries  resulted  fatally.  Two  other  operations  on  the  facial  bones,  recorded 
in  this  section,  appear  to  have  been  extractions  of  splinters  from  gunshot  fractures  rather 

"  In  a  letter  to  Assistant  Surgeon  General  C.  H.  Crane,  Dr.  J.  Fayrer,  of  Calcutta,  had  the  goodness  to  furnish 
abstracts  of  eight  cases  of  amputations  at  the  hip  occurring  in  his  practice,  kindly  hoping  they  might  be  of  service  in 
the  further  investigation  into  this  important  subject  by  this  office.  Five  of  the  cases  have  already  been  published. 
(Clinical  Surgery  in  India,  pp.  630,  609,  666,  and  Medical  Times  and  Gazette,  1867,  p.  270,  1868,  p.  657.)  The  series  is 
as  follows : 

1.  Bui-man,  aged  30,  primary  amputation  for  gunshot  injury.    Death  from  tetanus. 

2.  Ashgur,  aged  16,  re-amputation.    Recovery. 

3.  Hadji,  aged  36,  re-amputation.    Death  in  four  days. 

4.  Hindoo,  aged  25,  amputation  at  the  hip-joint  for  cancer  at  the  knee.    Death  in  13  days. 

5.  Hindoo,  aged  21,  thigh-amputation  for  injury,  re-amputation  at  the  hip.    Death  in  26  days. 

6.  Hindoo,  aged  55,  primary  amputation  at  the  hip  for  shark-bite.    Death  in  six  hours. 

7.  Bupeer,  aged  20,  cancer  of  right  thigh,  amputation  at  the  hip.    Death  in  five  days. 

8.  Lieutenant  H.,  aged  21,  secondary  amputation  for  gunshot  wound.    Death  in  a  few  hours. 

Dr.  P.  F.  Eve  records  (Richmond  and  Louisville  Medical  Journal,  Vol.  XII,  p.  370)  au  amputation  at  the  hip  for  caries 
and  anchylosis,  terminating  fatally  in  twenty-five  hours. 

Dr.  N.  S.  Lincoln  has  recently  performed  a  successful  re-amputation  at  the  hip,  at  Providence  Hospital,  Washington, 
in  the  case  of  W.  Cotter,  aged  32,  for  necrosis  following  primary  amputation  for  gunshot  fracture  performed  seven  years 
•ago. 


284  EEPOKT  OF  SUKGICAL  CASES  IN  THE  ARMY. 

than  formal  excisions.  Of  six  operations  on  the  bones  of  the  hand,  one  terminated  fatally 
on  account  of  pyaemia.  These  cases  were  reported  as  excisions ;  but  would  probably  be 
more  suitably  described  as  extractions  of  diseased  phalanges,  resections  of  the  ends  of  the 
metacarpals — a  finger  being  shot  off — or  extraction  of  splinters  of  metacarpals  or  phalan- 
ges. These  abstracts  are  followed  by  an  interesting  report  of  a  successful  intermediary 
excision  of  the  upper  portion  of  the  radius  for  gunshot  fracture,  and  this  by  seven  cases 
of  excision  in  the  continuity  of  the  humerus,  three  primary,  two  intermediary,  and  two 
secondary,  all  performed  on  account  of  gunshot  fractures  and  all  terminating  successfully. 
Two  men  recovered  from  excisions  of  head  and  upper  extremity  of  the  humerus,  after 
gunshot  fracture  involving  the  shoulder-joint,  with  the  excellent  results  that  frequently 
follow  this  excellent  operation.  The  excisions  in  the  lower  extremities  were  fewer  in 
number,  but  of  greater  importance.  They  were  all  performed  for  gunshot  injury  ;  one  on 
the  calcaneum,  one  on  the  first  metatarsal,  one  on  the  tibia,  one  on  the  fibula,  and  four  on 
the  hip-joint.  Every  reader  must  be  impressed  and  gratified  by  the  successful  issue  of 
the  excisions  of  the  head  and  trochanter  of  the  femur.  Three  of  the  four  cases  were 
eminently  successful,  and  the  fourth  and  fatal  case  was  practiced  on  a  patient  broken  down 
by  disease  and  intemperate  habits,  and  unlikely  to  bear  even  a  trivial  operation  satis- 
factorily. 

The  twenty-seven  reports  of  ligations  of  the  larger  arterial  trunks  (see  summary  on 
p.  235)  include  one  in  which  the  common  carotid  was  successfully  tied  for  secondary 
haemorrhage  following  a  gunshot-wound  of  the  face  and  neck,  supposed  to  involve  the 
external  carotid  near  its  origin.  That  there  should  not  have  been  recurrent  haemorrhage 
from  the  distal  orifice  in  the  vessel  is  surprising.  A  compulsory  ligation  of  the  aorta  for 
rupture  of  an  aneurism  of  the  common  iliac  is  reported  from  one  of  the  freedmen  hospi- 
tals. One  of  three  ligations  of  the  external  iliac  proved  successful.  Three  of  the  four 
ligations  of  the  femoral  resulted  happily.  The  fatal  case  was  one  in  which  Anel's 
operation  was  performed,  neither  experience  nor  theory  having  convinced  the  operator  that 
tying  the  femoral  in  its  middle  third  would  not  preclude  the  fatal  consequences  of  recurrent 
haemorrhage  from  a  wound  of  the  popliteal.  It  is  almost  incredible,  but  there  are  still 
many  surgeons  who  think  it  unnecessary  to  place  two  ligations  on  wounded  arteries,  but 
are  satisfied  in  securing  the  proximal  extremity  or  in  tying  the  main  trunk  at  a  distance. 
The  reports  indicate  that  acupressure  was  not  employed  to  any  great  extent.  Styptics 
and  tourniquets  were  sometimes  too  freely  substituted  for  more  effective  haemostatics.  An 
interesting  case  of  brachial  aneurism  successfully  treated  by  compression  is  recorded  on  p. 
155. 

The  reports  under  the  head  of  "  Various  Operations  "  comprise  accounts  of  four 
operations  on  the  eye,  and  one  on  the  ear ;  of  four  operations  on  the  face,  including  one  of 
rhinoplasty  and  one  of  extraction  of  a  large  salivary  calculus ;  and  five  cases  of  bron- 
chotomy,  in  three  of  which  the  opening  was  made  in  the  trachea  and  in  two  in  the  larynx. 
One  of  the  two  cases  in  which  the  operation  was  done  for  traumatic  inflammatory  swelling 
occluding  the  air-passages  was  successful.  Three  other  cases,  one  of  oedema  of  the 
glottis  and  two  of  membranous  croup,  terminated  fatally  ;  yet  the  observation  of  the  two 
latter  convinced  the  experienced  surgeon  in  charge  of  them  of  the  propriety  of  trache- 
otomy in  all  hopeless  cases  of  croup. 

The  only  reported  case  of  much  interest  among  the  operations  on  the  abdomen  is  one 


CONCLUDING  OBSERVATIONS.  285 

of  successful  excision  of  a  large  portion  of  extruded  omentum  (p.  250)  ;  but  the  numerical 
returns  indicate  that  there  were  some  important  operations  for  hernia  and  for  imperforate 
rectum  ;  but  no  details  were  reported.  The  rarity  of  strangulated  hernia  in  the  Army 
bears  creditable  testimony  to  the  fidelity  with  which  the  physical  examination  of  recruite 
has  been  conducted. 

The  reports  of  operations  on  the  genito  urinary  organs  commence  with  accounts  of 
fourteen  cases  of  phymosis.  These  show  that  many  of  the  medical  officers  are  of  M. 
Ricord's  opinion  regarding  the  inutility  of  the  prepuce,  and  prefer  circumcision  to  the 
dorsal  incision.  After  notes  of  two  cases  in  which  it  was  deemed  expedient  to  amputate 
the  penis  on  account  of  the  syphilitic  complications  of  the  unhappy  patients,  are  four 
reports  on  -the  surgical  treatment  of  stricture.  Four  cases  were  treated  by  urethrotomy, 
with  a  single  fatal  result.  Reports  of  successful  removal  of  a  foreign  body  of  the  urethra,' 
and  of  suprapubic  puncture  of  the  bladder  for  retention,  are  followed  by  nine  operations 
for  lithotomy  reported  (pp.  256,  261),  which  presented  some  very  interesting  features. 
The  pleasantest  was  that  all  resulted  successfully.  Four  were  performed  by  the  usual  lateral 
method  for  the  removal  of  uric  acid  or  phosphatic  calculi  of  large  size.  Five  were  for  the 
extraction  of  vesical  concretions  having  foreign  bodies  as  nuclei,  the  foreign  bodies  being 
a  fragment  of  the  pubic  bone,  a  cast-iron  ball,  two  leaden  musket-balls,  and  an  iron 
arrow-head.  The  latter  instance  is  perhaps  unique,  and  all  constitute  valuable  additions 
to  the  remarkable  series  in  the  museum,*  of  vesical  concretions  found  around  foreign 
bodies.  Median  lithomony  seems  not  to  have  been  practiced  as  yet  in  the  army. 

The  eleven  reports  on  tumors  comprise,  notes  of  one  lipoma,  one  sebaceous  and  two 
fibroid  tumors,  one  hygroma, 'one  epithelioma,  two  examples  of  scirrhus,  and  three  of 
encephaloma.  There  were  eight  recoveries  from  the  operations,  with  the  prospect  of 
recurrence  in  several  cases.  The  reports  of  Surgeon  .B.  Norris  of  the  treatment  of  a 
case  of  undoubted  medullary  cancer  by  the  drug  called  cundurango,  forwarded  by  the 
minister  resident  at  Ecuador,  does  not  encourage  a  belief  in  any  specific  therapeutic 
property  in  this  new  agent.f 

The  six  reports  on  tetanus  refer  to  two  fatal  cases  and  four  examples  of  recovery 
under  the  use  of  the  Calabar  bean,  ether-inhalation  with  opium,  and  hydrate  of  chloral.  It 
must  be  reluctantly  admitted  that  the  evidence  regarding  the  curative  efficacy  of  these 
drugs,  and  also  to  the  accuracy  of  the  diagnoses,  is  altogeter  insufficient.  Dr.  Smart's 

*  Specimens  88,  1687,  2567,  4712,  and  5,019,  Section  I,  A.  M.  M.,  are  vesical  concretions,  induced  by  gunshot  injuries 
of  the  bladder.  Besides  casts  and  hemp-seed  calculi,  and  other  small  secretions  passed  through  the  urethra,  the  Army 
Medical  Museum  possesses  one  hundred  and  ninety-five  vesical  calculi  removed  by  lithotomy.  As  the  erroneous  impres- 
sion that  the  museum  only  receives  donations  from  medical  officers,  and  only  such  as  pertain  to  military  medicine  and 
snrgery,  are  not  entirely  dispelled,  it  may  bo  well  to  reiterate  that  valuable  pathological  preparations,  from  whatever 
source,  are  welcomed,  the  preparations  carefully  mounted  and  preserved,  the  histories  duly  registered  and  catalogued, 
the  names  of  the  donors  being  always  recorded. 

tThe  correspondence  of  the  minister,  Mr.  E.  Rumsay  Wing,  with  the  State  Department,  relative  to  this  drug,  is 
printed -in  the  National  Medical  Journal,  May,  1871,  p.  23,  and  also  in  pamphlet  form.  Mr.  Wing  furnishes  recommenda- 
tions of  the  drug  by  Drs.  Casaras  and  Eguiguren,  and  it  is  noticeable  that  the  latter  speaks  of  .this  agent  as  one  "  which 
I  alone  possessed  in  Quito."  Mr.  Wing  writes  to  Mr.  Fish  that  cundurango  cures  not  only  cancer,  but  syphilis,  and  he 
judges  from  analogy  that  it  will  also  cure  "  scrofula  and  ulcerous  affections  of  different  types."  There  arc  now  on  file 
at  the  State  Department  three  reports  ou  the  use  of  this  agent  in  soft  cancer,  and  other  evidence  will  soon  be  forthcoming. 
.If  the  verdict  is  that  anticipated  by  pathologists  whoso  powers  of  analogical  reasoning  do  not  permit  them  to  discern 
the  pathological  affinities  of  cancer,  syphilis,  scrofula,  and  indolent  ulcers,  every  one  who  has  aided  in  augmenting  t^8 
misery  of  incurables  in  the  interest  of  commercial  speculation  will  occupy  an  unenviable  position. 


286  KEPOKT  OF  SUKG1CAL  CASES  IN  THE  AEMY. 

carefully  observed  case  (p.  270)  was  instructive  in  relation  to  the  therapeutic  powers  of  the 
Calabar  bean.  In  the  earlier  stages,  he  used  the  extract  and  tincture  without  any 
marked  effect  on  the  pupil  or  upon  the  severity  of  the  paroxysms.  He  then  procured  a 
parcel  of  the  beans  from  the  museum,  and  used  an  infusion  of  the  grated  kernels,  with 
the  uniform  effect  of  contracting  the  pupil  and  reducing  the  frequency  and  severity  of 
the  spasms.  He  assured  me  that  he  believed  that  he  might  have  saved  his  patient  if  he 
could  have  employed  this  remedy  earlier.  In  the  past  few  years,  I  have  had  the  oppor- 
tunity of  examining  the  brain  and  spinal  cord  after  tetanus  in  three  instances  only,  twice 
in  the  human  subject  and  once  in  the  horse.  Only  hypersemia  of  the  membranes  was 
observed.  The  proliferation  of  connective  tissue  in  the  cord  and  medulla,  proposed  as 
the  constant  anatomical  lesion  of  tetanus'  by  some  German  pathologists,  was  nowhere 
detected. 

The  reports  on  a  death  from  chloroform  and  on  a  successful  transfusion  in  thoracic 
aneurism  leave  much  to  be  desired  in  details  of  diagnosis.  Several  reports  on  surgical 
diseases  are  followed  by  accounts  of  three  instances  of  lightning-stroke,  an  interesting 
autopsy  having  been  made  in  the  fatal  case.  Dr.  McGill's  essay  on  osteoplastic  amputa- 
tions concludes  the  series  of  papers. 

I  have  appended  to  the  report  an  index  of  contributors,  an  index  of  patients,  and  a 
table  of  contents,  as  readers  of  some  of  the  former  surgical  reports  have  justly  complained 
of  the  want  of  facilities  for  reference  in  documents  of  such  length.  The  compilation  and 
discussion  of  the  surgical  annals  and  statistics  of  the  war  of  the  rebellion  have  engrossed 
the  time  and  attention  of  this  Division  to  such  an  extent  as  to  preclude  the  possibility  of 
compiling  the  report  with  the  closest  care ;  yet  it  may  be  hoped  that  the  value  of  the 
facts  brought  together,  and  the  interest  of  many  of  the  abstracts  of  cases,  will  compen- 
sate for  all  faults  in  the  report. 

I  am,  General,  very  respectfully,  your  obedient  servant, 

GEORGE  A.  OTIS, 
Assistant  /Surgeon,  U.  iS.  A. 

Brigadier  General  J.  K.  BARNES, 

Surgeon  General,  U.  8.  Army. 


INDEX  OF  REPORTERS. 


ADAMS,  W.  S.,  pp.  29,  109,  141. 
ALDEN,  C.  H.,  pp.  20,  43, 276. 
ALEXANDER,  E.,  pp.  97,  99. 
ALEXANDER,  T.  C.,  p.  8. 
ANSEL,  A.,  pp.  102,  104, 252. 
ARTHUR,  J.  P.,  pp.  57,  132. 
AsHHtntST,  J.,  jr.,  p.  114. 
AT  WOOD,  T.,  p.  45. 
AUGER,  J.  T.,  p.  120. 
AUSTIN,  W.  M.,  pp.  9,  82,  228. 
AXT,  F.,  pp.  80,  82. 
AZPELL,  T.  F.,  pp.  134,  187. 

BACON,  C.,  pp.  26,  28,  188. 

BACIIE,  D.,  pp.  18,  91,  115,249,272. 

BAILEY,  J.  C.,  p.  184. 

BAKEH,  E.  T.,  pp.  135,  237. 

BARTHOLF,J.H.,pp.lO,27,90,98, 101, 118,127,134,251,254,255. 

BARNES,.  F.,  pp.  95,  116,  240. 

BARBARIN,  F.  H.,  p.  131. 

BAYNE,  J.  H.,  p.  129. 

BATES,  H.  G.,  pp.  12, 110. 

BEACH,  S.  S.,  p.  48. 

BENTLY,  E.,  p.  100. 

BERKY,  E.  B.,  pp.  17,  68. 

BENJAMIN,  G.  A.,  p.  30. 


CLEARY,  P.  J.  A.,  pp.  63,  95,  105. 

CLEMENTS,  B.  A.,  pp.  44,  55,  91, 104, 176,352. 

COUES,  E.,  pp.  17,  59, 110,  125,  128,  134. 

CAUGHILL,  C.,  pp.  97, 185. 

CORSON,  J.  K.,  pp.  18,  120. 

COWLES,  E.,  pp.  17,  18,  23,  30,  60,  65,202. 

CRAIG,  W.,  pp.  65,  136. 

CRANDALL,  J.  B.,  pp.  59,  83,  213. 

CREAGHE,  J.  O.  D.,  p.  62. 

CRONKHITE,  H.  M.,  pp.  110, 121,  201. 

CULVER,  J.  J.,  p.  12. 

CUNYNGHAME,  T.,  p.  188. 

DAVIS,  F.  A.,  p.  251. 

DAVIS,  P.  C.,  pp.  169,  200,  202,  223. 

DAMOUR,  F.,  pp.  58, 142,  151,  192. 

DAY,  W.  E.,  pp.  138,  199. 

DEAL,  W.  pp.  10,  42. 

DELANY,  A.,  pp.  21,  37. 

DF.GRAW,  C.  S.,  pp.  27,  67,  76,  91,  124, 146. 

DE  HANNE,  J.  V.,  p.  9. 

DE  WITT,  C.,  pp.  32,  50,  102,  154. 

DICKSON,  J.  M.,  pp.  156,  206,  237,245. 

DOUGHERTY,  A.  N.,  p.  259. 

DOUGHTY,  W.  H.,  p.  93. 

DOUGLAS,  G.  C.,  p.  249. 


ERRATA  ET  CORRIGENDA. 


On  page  18,  nth  line,  for  B.  C.  fryer,  read  B.  E.  Fryer. 
On  page  22,  38th  line,  for  Tarry,  read  Perry. 
On  page  39,  39th  line,  for  186,  read  I860. 
On  page  58, 16th  line,  for  Borrow,  read  Damour. 
On  page  93,  44th  line,  for  hyperdermic,  read  hypodermic. 
On  page  143,  llth  line,  for  pulliei,  read  pulleys. 
On  page  147,  last  line  but  one,  for  take,  read  takes. 
On  page  148,  26th  line,  for  seventy,  read  twenty. 
On  page  149,  in  note  nnder  wood-cut,  for  imparted,  read  im- 
pacted. 


On  page  163, 
On  page  234, 
On  page  234, 
On  page  254, 
On  page  260, 
On  page  267, 
On  page  268, 
On  page  270, 
On  page  271, 
On  page  271 


33d  line,  for  sentinals,  rtad  sentinels. 
loth  line,  for  coxaljia,  read  coxalgia. 
16th  line,  for  extrent,  read  extent. 
12th  line,  for  Kearny,  read  Kearney. 
14th  line,  for  tripple,  read  triple. 
30th  line,  for  uhthiowlla.,  read  ichthyotolla. 
23d  line,  omit  semicolon  after  EraiMnften. 
last  line,  after  enemata,  insert  was. 
7th  line,  for  Tetanw'i,  read  Tetanus. 
23th  line,  for  belteaed,  read  Mierttl. 


c«*ii,  u.  w  .,  p.  no. 


286  KEPORT  OF  SURGICAL  CASES  IN  THE  ARMY. 

carefully  observed  case  (p.  270)  was  instructive  in  relation  to  the  therapeutic  powers  of  the 
Calabar  bean.  In  the  earlier  stages,  he  used  the  extract  and  tincture  without  any 
marked  effect  on  the  pupil  or  upon  the  severity  of  the  paroxysms.  He  then  procured  a 
parcel  of  the  beans  from  the  museum,  and  used  an  infusion  of  the  grated  kernels,  with 
the  uniform  effect  of  contracting  the  pupil  and  reducing  the  frequency  and  severity  of 
the  spasms.  He  assured  me  that  he  believed  that  he  might  have  saved  his  patient  if  he 
could  have  employed  this  remedy  earlier.  In  the  past  few  years,  I  have  had  the  oppor- 
tunity of  examining  the  brain  and  spinal  cord  after  tetanus  in  three  instances  only,  twice 
in  the  human  subject  and  once  in  the  horse.  Only  hypersemia  of  the  membranes  was 
observed.  The  proliferation  of  connective  tissue  in  the  cord  and  medulla,  proposed  as 
the  constant  anatomical  lesion  of  tetanus'  by  some  German  pathologists,  was  nowhere 
detected. 

The  reports  on  a  death  from  chloroform  and  on  a  successful  transfusion  in  thoracic 
aneurism  leave  much  to  be  desired  in  details  of  diagnosis.  Several  reports  on  surgical 
diseases  are  followed  by  accounts  of  three  instances  of  lightning-stroke,  an  interesting 
autopsy  having  been  made  in  the  fatal  case.  Dr.  McGill's  essay  on  osteoplastic  amputa- 
tions concludes  the  series  of  papers. 

I  have  appended  to  the  report  an  index  of  contributors,  an  index  of  patients,  and  a 
table  of  contents,  as  readers  of  some  of  the  former  surgical  reports  have  justly  complained 
of  the  want  of  facilities  for  reference  in  documents  of  such  length.  The  compilation  and 
discussion  of  the  surgical  annals  and  statistics  of  the  war  of  the  rebellion  have  engrossed 
the  time  and  attention  of  this  Division  to  such  an  extent  as  to  preclude  the  possibility  of 
compiling  the  report  with  the  closest  care ;  yet  it  may  be  hoped  that  the  value  of  the 
facts  brought  together,  and  the  interest  of  many  of  the  abstracts  of  cases,  will  compen- 

a  a  f  f\    Tr\T*    nil     TO  nlfci     in     -fK/-\    T»j-M-trvT»4- 


INDEX  OF  REPORTERS. 


ADAMS,  W.  S.,  pp.  29,  109,  141. 
ALDEN,  C.  H.,  pp.20,  43,276. 
ALEXANDER,  E.,  pp.  97,  99. 
ALEXANDER,  T.  C.,  p.  8. 
ANSEL,  A.,  pp.  102,  104, 252. 
ARTHUR,  J.  P.,  pp.  57,  132. 
ASHHURST,  J.,  jr.,  p.  114. 
ATWOOD,  T.,  p.  45. 
AUGER,  J.  T.,  p.  120. 
AUSTIN,  W.  M.,  pp.  9,  82,  228. 
AXT,  F.,  pp.  80,  82. 
AZPELL,  T.F.,  pp.  134,  187. 

BACON,  C.,  pp.  26,  28,  188. 

BACHE,  D.,  pp.  18,  91,  115, 249, 272. 

BAILEY,  J.  C.,  p.  184. 

BAKER,  E.  T.,  pp.  135,  237. 

BARTnoLF,J.H.,pp.lO,27,90,98, 101,118,127,134,251,254,255. 

BARNES,.  F.,  pp.  95,  116,  240. 

BARBARIN,  F.  H.,  p.  131. 

BAYNE,  J.  H.,  p.  129. 

BATES,  H.  G.,  pp.  12, 110. 

BEACH,  S.  S.,  p.  48. 

BENTLY,  E.,  p.  100. 

BERKY,  R.  B.,  pp.  17,  68. 

BENJAMIN,  G.  A.,  p.  30. 

BEST,  J.  M  ,  pp.  82,  119. 

BLACKWOOD,  S.  W.,  p.  96. 

BLACKWOOD,  \V.  R.  D.,  pp.  22,  88, 166. 

BOSLEY,  D.  W.,  p.  111. 

BOUGHTER,  J.  F.,  pp.  67,  186,  208, 252. 

BOWMAN,  E.  H.,  pp.  136,  177,  221, 251. 

BOWES,  M.  F.,  p.  58. 

BOYER,  S.  S.,  p.  119. 

BRADFORD,  F.  G.  H.,  p.  75. 

BRAMAN,  C.  B.,  p.  90, 273. 

BRADLEY,  W.  A.,  p.  14. 

BREWER,  J.  W.,  pp.  73,  76. 

BROWN,  H.  E.,  pp.  47,  206,  235,  236,  244, 252. 

BROWN,  P.  H.,  p.  221. 

BUOWN,  W.  F.,  p.  13. 

BROWN,  D.  R.,  p.  239. 

BROOKE,  J.,  pp.  47,  76. 

BUCHANAN,  W.  F.,  pp.  27,  41,  42,  189,  225. 

BURNS,  R.,  p.  14. 

BUFFINGTON,  A.  L.,  p.  99. 

BUTCHER,  W.  B.,  p.  241. 

BYRNE,  C.  C.,  pp.  6,  34,  100. 

CAMPBELL,  A.  B.,  pp.  73,  164. 
CAMPBELL,  J.,  p.  73. 
CANTRELL,  W.  A.,  pp.  43,  59. 
CARVALLO,  C.,  pp.  12,  13,  33,  73,  103,  109. 
CHRISTIAN,  R.  B.,  p.  236. 
CHANEY,  T.  M.,  p.  61. 
CHASE,  E.  Y.,  p.  243. 


CLEARY,  P.  J.  A.,  pp.  63,  95,  105. 

CLEMENTS,  B.  A.,  pp.  44,  55,  91,  104,  176,252. 

COUES,  E.,  pp.  17,  59, 110,  125,  128,  134. 

CAUGHII.L,  C.,  pp.  97, 185. 

CORSON,  J.  K.,  pp.  18,  120. 

COWLES,  E.,  pp.  17,  18,  23,  30,  60,  65,202. 

CRAIG,  W.,  pp.  65,  136. 

CRANDALL,  J.  B.,  pp.  59,  83,  213. 

CREAGHE,  J.  0.  D.,  p.  62. 

CRONKHITE,  H.  M.,  pp.  110, 121,  201. 

CULVER,  J.  J.,  p.  12. 

CUNYNGHAME,  T.,  p.  188. 

DAVIS,  F.  A.,  p.  251. 

DAVIS,  P.  C.,  pp.  169,  200,  202,  223. 

DAMOUR,  F.,  pp.  58,  142,  151,  192. 

DAY,  W.  E.,  pp.  138, 199. 

DEAL,  W.  pp.  10,  42. 

DELANY,  A.,  pp.  21,  37. 

DEGRAW,  C.  S.,  pp.  27,  67,  76,  91,  124, 146. 

DE  HANNE,  J.  V.,  p.  9. 

DE  WITT,  C.,  pp.  32,  50,  102, 154. 

DICKSON,  J.  M.,  pp.  156,  206,  237,245. 

DOUGHERTY,  A.  N.,  p.  259. 

DOUGHTY,  W.  H.,  p.  93. 

DOUGLAS,  G.  C.,  p.  249. 

DODS,  W.  B:,  p.  227. 

Dow,  S.  A.,  p.  52. 

DuBois,  H.  A.,  pp.  16,  45,  175,  179,  180,  214,  225,  243, 256. 

DURRANT,  H.  K.,  p.  224. 

EHLE,  A.  S.,  p.  212. 
ELBREY,  F.  W.,  pp.  45,  119. 
ELBRIDGE,  W.  H.,  p.  137. 

FIELD,  J.  C.,  p.  198. 

FITCH,  A.  F.,  p.  55. 

FLETCHER,  H.,  p.  199. 

FLINT,  A.  L.,  p.  67. 

FOOTE,  J.  P.,  p.  110. 

FORWOOD,  J.  L.,  pp.  259,  261. 

FORWOOD,  J.  F.  M.,  p.  235. 

FORWOOD,  W.  H.,  p.  210, 260. 

Fox,  E.  C.,  p.  67. 

FRANTZ,  J.  H.,  p.  131. 

FRYER,  B.  E.,  pp.  15, 18, 27,  62, 74,  75, 81, 107,  198, 199, 239. 

FURLEY,  C.  C.,  p.  67. 

GARDNER,  W.  H.,  p.  98. 

GEORGE,  W.  H.,  p.  122. 

GEISDORFF,  F.,  pp.  60,  64. 

GIBSON,  J.  R.,  pp,  25,  29,  32,  40,  228. 

GiRARD.A.C.,  pp.  26, 58, 65, 75, 120, 182.219,244, 248, 251,262. 

GIRARD,  J.  B.,  pp.  70,  72,  101,  155,  167,  201,274. 

GHISELIN,  J.  T.,  p.  181. 

GODDARD,  C.  E.,  pp.  15,  66,  91,  99,  153,  179. 

GOLDSBOROUGH,  L.  W.,  p.  56. 


288 


INDEX  OF  EEPOETERS. 


GRAY,  A.  J.,  pp.  9,  211,  242. 

GRAY,  C.  C.,  pp.  32, 134,  13'J,  144,  146. 

GREANLEAF,  A.  W.,  p.  15. 

GREENLEAF,  C.  R.,  pp.  78, 89,  106, 109,  132,252. 

GWYNTHER,  G.,  p.  83. 

GUNN,  G.  H.,  pp.  7,  11,  65,  67,  74,  102,  106,  129. 

HALL,  J.  D.,  pp.  203,  204. 

HAMILTON,  F.  H.,  p.  197. 

HAMMOND,  J.  F.,  p.  82. 

HARTIGAN,  J.  F.,  p.  121. 

HARVEY,  J.,  p.  46. 

HASSIG,  F.,  p.  50. 

HAYES,  L.  W.,  p.  57. 

HEAD,  J.  F.,  pp.  142,  237,273. 

HEGER,  A.,  pp.  132,  169. 

HEIZMANN,  C.  L.,  p.  21. 

HEXDKICKSON,  W.  T.,  pp.  26,  68. 

HERSHEY,  D.,  pp.  84,271. 

HITZ,  R.  B.,  p.  145. 

HOGG,  A.  J.,  p.  101. 

HOLLY,  F.  M.,  p.  86. 

HOLMES,  L.  E.,  pp.  77,  143,  201,  246. 

HORXER,  S.  H.,  p.  48. 

HOPPER,  W.  H.,  pp.  55,  62,  82,  104. 

HORTON,  S.  M.,  pp.  32,  56,  58,  78,  123,  146,  153,  156,  178, 

181,  200,  210,  212,  222,  224, 253. 
HUBBARD,  V.  B.,  pp.  126,  208. 
HULSE,  J.  I.,  pp.  23,  54,  138.     . 
HUTCHINSON,  T.  S.  V.,  pp.  7, 182. 
HUNTINGTON,  D.  L.,  p.  188. 
HYSON,  W.  T.,  p.  105. 

IRWIN,  B.  J.  D.,  pp.  183,  210,  198,  268. 

JACKSON,  D.,  pp.  29,  35,  90,  176,  222,  223,  226,  242. 

JAMAISON,  W.  D.,  p.  271. 

JANEWAY,  J.  H.,  p.  239. 

JAMES,  B.,  p.  221. 

JAMESON,  G.  A.,  p.  44. 

JENNINGS,  R.  J.,  p.  257. 

JESSOP,  S.  S.,  pp.  40,  57,  226,254. 

JORGENSON,  J.,  p.  100. 

KILBOURNE,  H.  S.,  p.  153. . 

KIMHALL,  J.  !>.,  pp.  66,  128,  133,  154,  155,  156,  262. 

KING,  J.  H.  T.,  p.  36. 

KING,  J.  T.,  pp.  38,  57.  74,  85, 101,  108,  176,  177. 

KING,  W.  H.,  p.  221. 

KIRK,  R.  M.,  p.  12. 

KNIGHT,  C.  W.,  p.  51. 

KNOX,  F.,  p.  90. 

KOERPEU,  E.  A.,  pp,  95,  196. 

KUGLER,  J.,  pp.  79,  152. 

LAING,  J.  M.,  p.  207. 

LAMONT,  J.  C.,  pp.  46,  179. 

LAUB,  C.  H.,  p.  264. 

LE  CARPENTIER,  J.,  pp.  29,  30,  56,  77, 165,  211,  220,  227. 

LIPPINCOTT,  H.,  pp.  8,  21,  112,  151. 

LIVINGSTON,  H.  F.,  p.  222. 

LONGWILL,  W.  H.,  pp.  185,  269. 

LOUING,  L.  Y.,  pp.  55,  111,  141. 

LUNNEY,  J.,  p.  202. 

LYON,  W.  B.,  pp.  141,  184. 

MAGRFDER,  D.  L.,  pp.  36,  51. 


MACKIN,  C.  J.,  p.  197. 
MACFARLINE,  C.,  p.  31. 
MARSTON,  J.  J.,  p.  179. 
MATHEWS,  W.,  pp.  35, 187. 
MATHEWS,  H.  M.,  p.  151, 

McCHANDLESS,  J.  M.,  p.  155. 
McCHESNEY,  C.  E.,  p.  84. 

MCCRACKEN,  R.,  p.  45, 252. 

McCoy,  W.  M.,  p.  56. 

Mcd-ELLAN,  E.,  p.  242. 

McEi-DERRY,  H.,  pp.  20,  38,  66,  149,  156,267. 

McGiLL,  G.  M.,  p.  277. 

McGuiRE,  H.,  p.  239,  258. 

McKEE,  J.  C.,  p.  49. 

MC-LEAN,  D.,  pp.  103,  104. 

McMAHON,  J.  H.,  pp.  9,  102,  156. 

MEACHAM,  F.,  pp.  26,  30,  33,  36,  64,  137,  185,  '245. 

MECIIEM,  A.  F.,  p.  106. 

MERRILL,  C.  S.,  p.  127. 

MEISRITT,  D.,  p.  105. 

MILES,  B.  B.,  pp.  10, 243. 

MILLER,  G.  McC.,  pp.  6,  140,  236. 

MILLS,  H.  R.,  p.  175. 

MIDDLETON,  P.,  pp.  60,  65,  132, 148,  156,  188, 191,  221, 249. 

MIDDLETON,  J.  V.D.,  pp.  62,  80,  117, 123,  128,  164. 

MINEEK,  W.  S.,  p.  48. 

MINOR,  G.  W.  B.,  p.  23. 

MOFFATT,  P.,  pp.  13,  17,  98. 

MCLLER,  A.,  pp.  151,  216. 

MUNN,  C.  E.,  p.  199. 

NF.UMAN,  A.,  p.  44. 

NOTSON,  W.  M.,  pp.  18,  29,  43,  46,  71,  76, 148.  149,  150,  153, 

180,  247. 
NORRIS,  B.,  pp.  246,262,265. 

OTIS,  G.  A.,  p.  215. 
OWENS,  p.  189. 

I'ATZKI,  J.  H.,  pp.  6,  37,  50,  59,  60,  194. 

PEABODY,  J.  H.,  p.  145. 

PERIN,  G.,  p.  229. 

PERRY,  I.,  pp.  22,  38,  202,  219, 272. 

PETERS,  D.  C.,  pp.  32,  127,  150. 

PIPER,  W.  J.,  pp.  35,  183. 

POPE,  B.  F.,  pp.  118,  121. 

PORTER,  G.  L.,  p.  145. 

PORTER,  W.,  p.  66. 

POTTER,  Z.  H.,  p.  14. 

POWELL,  R.,  pp.  60,  88,  99. 

PUKCELL,  J.  B.,  pp.  35,  137. 

RADMORE.  C.  C.,  p.  71. 

RAMSEY,  W.  R.,  pp.  63,  182. 

RANDALL,  B.,  p.  178. 

RAUSHENBERG,  C.,  p.  238. 

RECTOR,  P.,  pp.  28,  64. 

REILY,  J.  R.,  p.  204, 263. 

RENICK,  W.  H.,  p.  184. 

REYNOLDS.  F.,  p.  222. 

RIDGELY,  J.,  pp.  44,  46,  52,  77. 

RIPPARD,  W.  H.,  p.  96. 

ROACH,  M.  A.,  p.  54. 

ROSE,  G.  S.,  pp.  106,  137,  196. 

ROSSE,  I.  C.,  pp.  80,  129,  132,  136,  138,  165,  206,  245,  251. 

ROWE,  C.  H.,  p.  89. 

RrssF.r.L,  L.  F.,  p.  241. 


SANTOINE,  S.,  p.  29. 

SAVAGE,  W.  E.,  p.  74. 

SAUNDERS,  J.,  pp.  43,  137. 

SCHELL,  H.  S.,  pp.  28,  48,  59,  66,  78, 120, 

SCHWARTZWELDER,  A.  C.,  p.  2G8. 

SCOTT,  J.  F.,  p.  53. 

SEMPLE,  J.  E.,  pp.  30,  193. 

SEMIG,  B.,  pp.  149,  156. 

SHACKLEFORD,  W.,  pp,  53,  213. 

SciiAyniRT,\E.  F.,  p.  122. 

SHARPE,  R.,  pp.  9,  35,  46,  47,  68,  78,  155. 

SHAW,  J.,  p.  178. 

SIMONS,  J.,  p.  114. 

SKINNER,  A.  G.,  pp.  108/135. 

SLAUGHTER,  B.  F.,  p.  252. 

SMART,  C.,  pp.  147,  189,  205,  252,270. 

SMITH,  A.  H.,  p.  156. 

SMITH,  A.  K.,  p.^275. 

SMITH,  H.  H.,  p."  43. 

SMITH,  H.  J.,  p.  46. 

SMITH,  J.  R.,  p.  4^  257 

SMITH  O.,  p.  63. 

SMITH,  W.  F.,  pp.  7,  22,  212,  258. 

SMITH,  W.  H.,  pp.  04, 145  m 

SNOW,  T.  H.,  p.  156. 

SPOHN,  H.,  p.  177. 

STEIGERS,  A.  F.,  p.  209. 

STEINMETZ,  W.  R.,  pp.  41,  74. 

f.  M.,  pp.  125,  227,  238,  244,  24 


INDEX  OP  REPORTERS. 


191,  235,  238,  268. 


STORROW,  S.  A.,  p.  199. 
SUHRING,  F.,  p.  47. 

TALLEN,  J.  E.,  p.  in. 
TANSZKY,  R.,pp.  64,  84,  85. 
TAYLOR,  W.  E.,  p.  232. 
TAYLOR,  J.,  p.  115. 
THOMPSON,  D.  D.,  P.  88. 
THOMSON,  W.,  p.  83. 
TIEDMAN,  H.  G.,  P.  61. 

'  R"     '  19 


37 


TOMKINS,  \v.  R.,  p.  200. 
TOMPKWB,  W.  A.,  p.  l!)2j  253 
TONNKR,  J.  A.,  pp.  :J4,  42,  4(i.' 
fowAR,  G.  W.,  p.  63. 
TOWN,  F.L.,p.51,254. 
TRKMAI.VK,  W.  S,  pp.  37,  76,  156. 
TUGGLE,  T.  S.,  p.  61. 
TURNER,  H.  T.,  pp.  156,  176,  183,  206. 

VANSANT,  J.,  p.  m. 

VOLI.UM,  E.  P.,  pp.  lie,  237,  248,  255. 

WAGNER,  C.,  p.  246. 
WALKER,  D.,  p.  7. 
WALSH,  J.  K.,  p.  139. 
WATKINS,  J.  C.,  p.  31. 
WEBB,  J.  p.,  p.  n. 


289 


WEIRICK,  S.  T.,pp.57,  183. 

WEISEL,  D.,  pp.  29,  45. 

WESTERLING,  R.,  p.  156. 

WHITE,  C.  B.,  p.  252. 

WHITE,  J.  B.,  pp.  34,  77,  99,  104,  240. 

WHITE,  R.H.,  pp.  12,  15,  37,  175. 

WHITEHEAD,  W.  E.,  p.  49. 

WIGGIN,  A.  W.,  pp.  ;i3,  123,  255. 

WILLIAMS,  J.  W.,  pp.  23,  57,  59,  64,  89,  102,  192 

WILLIAMS,  F.  A.,  pp,  52,  <)0. 

WILSON,  A.  D.,  pp.  159,  193. 

WILSON,  B.  B.,  p.  61. 

WILSON,  W.  J.,  pp.  36,  75, 375. 

WINNE,  C.  K.,  pp.  19,  169,  200. 

WOLVERTON,  W.  D.,  pp.  32,  91,  168, 177. 

WOODRUFF,  E.,  p.  252. 

WOODHULL,.  A.  A.,  pp.  6,  19,  84, 167. 

WOODWARD,  J.  J.,  pp.,  263,  265. 

WRIGHT,  C.  B.,  p.  178. 

WRIGHT,  J.  p.,  p.  89. 

YEOMANS,  H.  H.,  pp.  8,  59,  118,  180, 269 
YODNG,  C.  W.,  p.  102. 


INDEX  OF  PATIENTS. 


Name. 

Regiment. 

Page 

Name. 

Regiment. 

Page. 

Name. 

Regiment. 

1'a.iic. 

25th  Infantry... 
15th  Infantry  ... 
9th  Cavalry  
4th  Artillery  
31st  Infantry  
8th  Cavalry  
General  service. 
38th  Col.  .Troops 
9th  Cavalry  
Sth  Infantry  
33d  Infantry  
21st  Pa.  Cavalry 
1st  Artillery  
16th  Infantry  .  .  . 
Bis.  Boldier  

55 
37 
95 
114 
36 
156 
229 
41 
20 
30 
38 
280 
S5 
59 
114 
132 
139 
156 
175 
205 
59 
6 

no 

252 
170 
157 
202 
222 
55 
102 
103 
170 
196 
46 
61 
76 
83 
89 
250 
115 
170 
170 
190 
190 
196 
222 
268 
280 
52 
62 
116 
137 
170 
170 
170 
175 
190 
170 
197 
176 
22 
29 

4th  Cavalry  
9th  Cavalry  
3d  Artillery  
8th  Cavalry  
13th  Infantry.  .  . 
llth  Infantry... 
27th  Indiana.  .  .  - 

63 

63 
128 
170 
167 
180 
205 

Chase,  G  

9th  Col.  Troops.. 
40th  Infantry... 
llth  Infantry... 
Kith  Infantry... 
Gen'l  Hel  viee.  .  .  . 
1st  Cavalry  

22,  :!8 
8R 
38 
118 
134 
142 
188 
206 
280 
241 
249 
43 
47 
62 
69 
78 
85 
118 
251 
157 
171 
253 
171 
197 
13 
6 
18 
57 
58 
68 
74 
74 
279 
80 
83 
83 
83 
89 
90 
102 
142 
154 
157 
160 
171 
189 
190 
259 
62,225 
65 
118 
145 
157 
157 
176 
13 
33 
44 
61 
65 
171 
117 

Boats,  C  

Chase,  D.  E  

Adams,  G  
Adams,  G  

Bowers  "W"  '   

Christman,  AV  
Charleton    T 

BoBwortli,  N.  C  

Chapman,  "W  
Choate,  J.  M  

F 

Bowon,  C.  M  

Chavez,  M  

Allen,  C  
Alfonz.P  

Alexander,  W.  S  
Allison  H           

8th  Infantry  
•M  Cavalry  
Civilian  

35 
18 
38 
42 
45 
46 
48 
60 
65 
69 
83 
95 
153 
170 
170 
190 
225 
244 
19 
24 
36 
46 
252 
77 
82 
83 
91 
106 
110 
116 
132 
155 
157 
157 
170 
170 
17 
115 
131 
25 
27 
46 
77 
78 
78 
102 
106 
109 
135 
171 
171 
180 
181 
206 
222 

Cheeseman,  F  
Church  L 

Civilian  
1  Kith  Col.  Troops 
114th  Col.  Troops 
9th  Cavalry  
14th  Infantry... 
44th  Infantry... 
28th  Infantry... 
Cth  Cavalry  
'Jd  Iiil'antry  
10th  Cavalry  
3d  Artillery  
17th  Infantry  .  .  . 

Brown,  A  

Brannan,  J  

7th  Cavalry  
Act.  Ass't  Siurg 
Sth  Cavalry  

Christopher,  G  
Clark,  J  

Allen,  C  

Brown,  T  
Broad   R 

Clements,  G.  A.  H.  .  . 
Clarke  R 

Alderfer,  J.K  
Allen  J  I            

27  th  Infantry  ... 
14th  Infantry... 
10th  Cavalry  
17th  Infantry... 

Clapp  W.  H 

Bryant,  F.  W  

Clinton,  1I.C  

Alman,  J  
Aldrich,  G  
Alvidrez  C 

4th  Cavalry  
3d  Cavalry  
1st  New  Mexico. 

Clay,  H  

Brown,  H.  S  

Clapp,  G  

Clitliird  A 

Allbright  G  W  . 

10th  Cavalry... 
4th  Artillery  
3d  Cavalry  
10th  Cavalry  
3d  Cavalry  

6th  Cavalry  
3d  Infantry  
9th  Cavalry  
32d  Infantry  
22d  Infantry  
3d  Cavalry  

Brown  P 

Clark,  A  

4th  Infantry  
1st  Infantry  
35th  Infantry  .  .  . 

Brady   J            .     . 

Clements,  J  

Brown  S 

Clune,  M  

Bruuett  C  

Clark,  C.  0.  F  

Appleman,  P  
Arkee,  J.  A  

Brown,  W  

Bullis   G 

20th  Jnfantry... 
3<1  Infantry  
10th  Cavalry... 
Ordnance  Corps  - 
Cth  Cavalry  
lOth  Infantry... 
17th  Infantry... 
4th  Cavalry  
114th  Col.  Troops 
Gov't  employe  .  - 
2d  Infantry  
40th  Infantry.. 
42d  Infantry... 
14th  Infantry.. 
14th  Infantry.  . 
3d  Cavalry  
6th  Cavalry.  .  .  . 
10th  Cavalry  
7th  Infantry  
23d  Infantry... 
20th  Infantry.. 

Colby  E.  P  

2d  Infantry  
Uth  Infantry  
!Mh  Cavalry  
21st  Col.  Troops  . 
Sth  Infantry  
Sth  Cavalry  
38th  Infantry  .  .  . 
117th  Col.  Troops 

Butler,  J  
Buel  D  H 

Color,  W  

Arnold  C 

2d  Artillery  
38th  Infantry  .  .  . 
3d  Cavalry  
Sth  Cavalry  
37th  Infantry  .  .  . 
25th  Infantry  .  .  . 
24th  Infantry  .  .  . 
128th  Col.  Troops 
25th  Infantry... 
6th  Cavalry  
6th  Cavalry  
7th  Cavalry  
4th  Cavalry  
Ordnance  Corps. 
Ordnance  Corps. 
Civilian  
7th  Cavalry  
29th  Infantry... 
22d  Infantry  
2d  Cavalry  
Sth  N.  Hainpsh'e 
34th  Infantry... 
Civilian  
Civilian  
29th  Infantry  .  .  . 
3d  Infantry  
24th  Infantry  .  . 
9th  Infantry  .  .  . 
15th  Infantry... 
10th  Cavalry.... 
37th  Infantry... 
2d  Cavalry  
1st  Artillery.  .  . 
33d  Infantry... 
9th  Cavalry... 

Ash  R 

Burke  W 

Atley,  H  
At/wood  G  T     .     ... 

Burke  E 

Burke  P 

Corin,  W  

Burgi  R 

Avens  T.  W  

Cole,  D.  D  

Buckskin  

Sth  Cavalry  
4th  Artillery  
37th  Infantry... 
8th  Cavalry  
2d  Infantry  
llth  Infantry  ... 
9th  Cavalry.  . 

Bailey,  S  

Conroy,  J  

Burroughs,  W.  R  
Buchannan,  J  

Collins  J    

Barry,  W  

Cox  G   

Cody  J 

Burr  F 

Colyer  G 

Banks  A 

Butler,  J  

Ordnance  Corps  . 
31st  Infantry  
3d  Cavalry  
3d  Cavalry  
2d  Artillery  
17th  Infantry  .  .  . 
20th  Infantry  .  .  . 
199th  Pa  .  . 

Barclay,  J  

Cooper  J  "W 

Barrago,  J  
Barry,  D 

Bush.H  

Cooley,  J  
Cook,  J  
Cook  F 

Baker  J 

jj  j  H 

Barrett,  T  
Batt,  J.A  
Babb.L  

Can-,  H  

25th  Infantry., 
llth  Infantry.  . 
Cth  Cavalry  
26th  Infantry.. 
18th  Infantry.. 
Civilian  
10th  Infantry.. 
1st  Artillery  .  .  . 
Sth  Cavalry  
12th  Infantry.. 
13th  Infantry.. 
21st  Col.  Troops 
3d  Cavalry  
2d  Artillery... 
31st  Maine  
41st  Infantry  ... 

Connell  P 

Caldwell  TV 

Behn,  P  

Casey   T 

38th  Infantry  .  .  . 
19th  Infantry... 
Sth  Artillery  

Bently,  W  
Behau,  P  
Beam,  I.  V  

Carriugton,  H.  B.  .  . 
Carnovan,  T  

Cross  E  

Bender,  E  

Craig  J 

Mi  Cavalry  
3d  Cavalry  
40th  Infantry  .  .  . 
1st  Cavalry  
Civilian  
6th  Cavalry  
20th  Pa.  Cavalry. 
4th  Cavalry  
2d  Cavalry  
4th  Cavalry... 

Berry,  G  

Carroll  T 

Berger,  P  

Berger,  J  . 

Calquhoun,  A  

Crawford,  G.  C  
Cuimniugs,  J.  L  
Curry.P  
Curry  B 

Bell,  J  

Cahil  P 

Bischoff,  F  

Carter,  M  

Bisbing,  J  
Blair,  W  

Campbell,  G.W.... 
Casey,  M  

Curry  J             

Cunningham,  B  

Bowen,  J  

Hoyd,  D.  .  . 

Castle,  F... 

INDEX  OF  PATIENTS. 


291 


Name. 

Regiment. 

Pago. 

Name. 

Regiment. 

Page. 

Name. 

Regiment. 

!'•««. 

C             J 

149 
1C5 
9 
14 
16 
58 
53 
83 
50 
91 
119 
157 
171 
171 
262 
181 
242 
45 
253 
69 
105 
155 
160 
160 
171 
171 
171 
171 
171 
181 
272 
119 
17 
26 
88 
32 
38 
40 
66 
68 
69 
104 
140 
171 
171 
254 
148 
20 
43 
48 
61 
69 
149 
151 
84 
110 
167 
86 
213 
227 
244 

230 
61 
206 
82 
119 
189 
215 
239 
76 
151 
1ST 

7th  Infantry  ... 
3d  Cavalry  
18th  Infantry  .  . 
9th  Cavalry  
5th  Artillery... 
2d  Cavalry  
4th  Infantry  .  .  . 
8th  Infantry  .  .  . 
~d  Infantry  
40th  Infantry  ... 
16th  Infantry... 
20th  Infantry  ... 

193 
32 
151 
171 
190 
191 
239 
16 
15 
20 
66 
169 
171 
40 
44 
60 
65 
80 
102 
141 
159 
lt<2 
206 
26 
63 

99 
111 
139 
171 
216 
220 
109 
212 
10 
280 
39 
68 
77 
171 
190 
190 
7 
25 
55 
171 
39 
41 
86 
95 
128 
190 
80 
83 
207 
27 
46 
58 
77 
85 
132 
171 
237 
6 
18 
20 
34 
62 
251 
84 
106 
120 
176 

Grey.G  

3d  Cavalry  
Engineer  liatt'u 

176 
33 
14 

20 
265 
868 
253 
253 

•a 

30 
60 
71 
84 
83 
189 
134 
156 
157 
li.'.i 
171 
171 
171 
171 
182 
823 
836 
242 
248 
39 
76 
99 
159 
171 
821 
237 

H 
180 
157 
171 
808 
219 
9 
17 
11 
12 
43 
88 
106 
858 
109 
133 
143 
157 
271 
171 
178 
172 
183 
190 
287 
57 
63 
84 
HW 
130 
120 
135 
ITS 

n-j 

177 
177 
44 

SM 

C           ,E  

Civilian  

1'iually  J 

Diinicls,  J  
Daniels,  O.  E  

9th  Cavalry  

Fit/.patrick,  T  

G  ,  R,  A. 

Kshcr,  1  
Fishcr.J  
Finn,  W  

Fitzpatrick,  P  

G  —      T 

Davidson   II 

6th  Infantry  
17th  Infantry  .  .  . 
9th  Cavalry  
5th  Cavalry  

G  .Isabella  
G         Philip 

Sen-nut  
13th  Col.  'In-.,.. 
25th  Infantry  .. 
1st  Infantry.  ..  . 
38th  Infantry  .  . 
2d  Artillery.... 
Dili  Cavalry  
Civilian 

Davis,  A  

Davis,  I  
Davis,  J  

Hackotto,  E.  P  
lliirvcy,  H  
Halhcrt,  P  
Hall,C....  
Hallet  

Mammery,  J  

Dardia  T  

10th  Infantry  .  .  . 
25th  Infantry  .  .  . 
3d  Cavalry  
9th  Col.  Cavalry. 
Pawnee  scout  ... 
20th  Infantry  .  .  . 
8th  Cavalry  
41st  Infantry  
5th  Cavalry  
39th  Infantry  .  .  . 
41st  Infantry  
5th  Artillery  
4th  Infantry  
3fl  Cavalry  
20th  Infantry  .  .  . 
18th  Infantry  .  .  . 
4th  Artillery  
22tl  Infantry  
15th  Infantry... 
17th  Infantry  ... 
5th  Artillery.  .  . 

Daily,J  
Daily  J                 .  ... 

Flynu,  W  

Fletcher,  T.  W  
Ford,  J 

4  Hi  Infantry  
45th  Infantry  .  .  . 
19th  Infantry  ... 
Cth  Cavalry  
9th  Cavalry  
9th  Cavalry  
9th  Cavalry  
5th  Cavalry  
5th  Cavalry  
19th  Infantry  .  .  . 
23d  Infantry  .... 
6th  Cavalry  
3Cth  Infantry  .  .  . 
38th  Infantry  ... 
16th  Infantry... 
3d  Cavalry  
2d  Infantry  
14th  Infantry  ... 
3d  Minn.  Cavalry 
3d  Cavalry  
2d  Infantry  
98th  Ohio    

Hall.T  
Hatch,  G.  W  

9th  Cavalry  
Act.  Ass'tSurg.. 
6th  Cavalry  
31st  Infantry.  .. 
14th  Infantry  .  .  . 
18th  Infantry  .  .  . 
20th  Infantry  ... 
9th  Cavalry  

Day,  B  
Dalv,  \V  

Ford,  M 

Daley,  P  

Ford,  A  

Hampton,  H  
Hardwick  W  

Davis,  J  -- 
Dennis,  F.  A  

Foster,  T  

Foray  tli  G  A 

Harr  G 

Dennis,  W  

Foster  J 

llatisman,  W  
Hamilton,  F  

Ford   T 

Dt'liim-y,  J  
Dcttfrer  E.  IT  

Ford,J  

Ford  P 

Harmcring,  A  
Hatzel  J 

7th  Infantry  
8th  Infantry  
2d  Cavalry  

Devine,  J  
Depue,  G.  W  
De  Forrester,  G  
Do  Forrest  F 

Fonda  C.  A      

Happe,  H  1... 

Frey,  G  

1st  Infantry  
37th  Infantry  .  .  . 
19th  Infantry  ... 
38th  Infantry  ... 
1st  N.  M.  Inf  'try. 

Fry  J  

Desmond,  H  

Fracker,  J  
Frank,  J  

Haxel  P  

Herron,  W  

Franklin  A        

4th  Cavalry  
5th  Cavalry  
8th  Infantry  ... 
10th  Cavalry... 
6th  Cavalry  
27th  Infantry  .  .  . 
18th  Infantry  .  .  . 
6th  Infantry  
7th  Infantry  
16th  Infantry  ... 
1st  Artillery     .  . 

Franklin  B 

Herbert  H 

Dixon  J  G 

Francis,  J  

Heyl  E 

9th  Cavalry  
17th  Infantry  ... 
9th  Col.  Troops.  . 
let  Artillery  .... 
9th  Cavalry  
Seaman  .  
3d  Cavalry  
20th  Infantry  ... 
19th  Infantry  ... 
20th  Infantry  .  .  . 
33d  Infantry  
16th  Infantry  .  .  . 
8th  Cavalry  
2d  Infantry  
6th  Cavalry  
25th  Infantry  ... 
29th  Infantry  .  .  . 
2d  Infantry  
5th  Cavalry  
25th  Infantry  .  .  . 
23d  Infantry  
6th  Cavalry  
Colored  

Furboy,  R  

F  ,  R  

llth  Infantry  ... 
13th  West  Va... 
6th  Cavalry  
37th  Infantry  .  .  . 
10th  Cavalry  
Civilian  •-  . 
2d  Artillery  
8th  Cavalry  
40th  Infantry  ... 
38th  Infantry  ... 
2d  Infantry  
7th  Cavalry  
117th  Col.  Troops 
14th  Infantry... 
23d  Infantry  .  .  . 
19th  Infantry  .  .  . 
31st  Infantry  
6th  Infantry  
Civilian  
37th  Infantry  ... 
140th  New  York. 
7th  Cavalry  
4th  Cavalry  
24th  Infantry  ... 
38th  Infantry  .  .  . 
38th  Infantry  .  .  . 
20th  Infantry  .  .  . 
9th  Cavalry  
7th  Cavalry  
5th  Infantry  
41st  Col.  Troops 
25th  Infantry  .  .  . 
26th  Infantry  ... 
19th  Infantry  .  .  . 
24th  Infantry  .  .  . 
7th  Infantry  
9th  Cavalry  
39th  Infantry  .  .  . 
5th  Infanti  v  ... 

Henrietta,  F  

Donnelly  P        

Hight,  H  
Hier.W  
Hilmcr,  J.  F  

Hickey,  J.       

Gallagher,  "W.  B  
Gavin  T 

Garnet,  R  
Gardner,  N  
Gardiner,  J.  A  
Gay  T 

Dotzcl  J 

Hickey,M.C  

Duu^lKTty,  M  

Dow  W 

6th  Cavalry  
5th  Infantry  
42(1  Infantry  
IBth  Infantry  .  .  . 
5th  Cavalry  
14th  Infantry    .  . 
6th  Infantry  
28th  Infantry  .  .  . 

Geddes,  J  

Genniga  W" 

Howard,  J  

Doolry  M.J        .... 

Gerhardt,  J  

'Hood.W.J  
Hoffman,J  
Hohin,  W  

Drum  AV 

Gibbons  W 

Gibbart   F        

Holden,  J  

Hoffman,  H  

D  asset  t  O 

Gill.J  

Gibson  E 

Hoffman,  W.  H  

16th  Infantry  ... 
33d  Infantry  
32d  Infantry  
8th  Cavalry  
3d  Infantry  
42d  Infantry  
7th  Cavalry  
17th  Infantry  ... 

Hofnar,  F  

Gibben  J            ... 

Hollan,  E  

Glascock,  J  

Hotfman,  C  

Holkcr,  C  

Hogan,  J  

42d  Infantry  
19th  Infantry  ... 
5th  Infantry  
2d  Infantry  
13th  Infantry  ... 
38th  Infantry  ... 
8th  Cavalry  
3d  Cavalry  
25th  Infantry  ... 
5  tli  Artillery  
7th  Infantry  
30th  Infantry  .  .  . 
15th  Infantry  .  .  . 
4th  Infantry  
6th  Cavalry  
4th  Cavalry  
1st  Artillery  
17thV.R.C  
Citiuen  

Hoover,  E  

Earl.W  

Howard   C  

Golds  borougb.W.  H. 

Houlihan,  T  

Honig,  C  

10th  Cavalry  
1st  Artillery  
9th  Cavalry  
4th  Infantry  
5th  Infantry  

Hostler,  Vf  

Gohlke,  W  

Huuter.P  

Kllit.tr.  K  

Hnhhard,  T  
Huff.J  

Eustace  P 

Greenland,  G  
Grey,  F  

Huher.W.H  
Hughes,  L.  M  
Hurley,  M  

K'lilt-v   L 

2uth  Infantry  .  .  . 
4th  Artillery  — 
32il  Infantry  
4th  Artillery  
Civilian  
41st  Infantry  
Civilian  

Gray,  J  

Huhhard,  E  
Huntington,  H  
Hughes.W  
Huhbell,  G.E  
Hiitton.  A  

l-'ai  i  ington,  J.  B  
l-"iiltrv  J 

Graves,  "W  
Graves,  J.  A  

Kcnskc,  J  
l,v,.    \v 

(Ircveiiberg,  A  
Civile!-.  W... 

II\  mis,  J  
H  

292 


INDEX  OF  PATIENTS. 


Name. 

Reginirnt. 

Page 

Name. 

Regiment. 

Page. 

Name. 

Regiment. 

Page. 

862 
172 
144 
69 
110 
253 
38 
134 
137 
174 
183 
191 
6 
71 
89 
238 
245 
272 
8 
30 
47 
53 
57 
64 
64 
69 
76 
252 
267 
90 
98 
121 
121 
136 
157 
177 
177 
183 
208 
209 
236 
240 
241 
244 
178 
129 
15 
99 
169 
13 
31 
278 
263 
34 
37 
38 
72 
76 
81 
91 
110 
131 
160 
172 
183 
191 
9 

Krouse,  C  

32d  Infantry  
3d  Infantry  
2d  Cavalry  
35th  Infantry  .  .  . 
7th  Infantry  
6th  Cavalry  
117th  Col.  Troops 
20th  Infantry  .  .  . 
23d  Infantry  
9th  Cavalry  . 
8th  Cavalry  
4th  Cavalry  
35th  Infantry  .  .  . 
Cth  Cavalry  
6th  Cavalry  
40th  Infantry  .  .  . 
40th  Infantry  .  .  . 

292 
37 
274 
12 
66 
69 
69 
122 
243 
25 
249 
29 
29 
39 
66 
<Ci 
104 
160 
172 
172 
253 
178 
45 
259 
260 
66 
122 
l.VJ 
172 
184 
18 
36 
15 
39 
90 
141 
153 
191 
309 
227 
29 
157 
122 
20 
21 
31 
35 
35 
43 
44 
47 
84 
101 
108 
123 
134 
157 
158 
158 
158 
172 
210 
345 
253 
261 
16 
27 
37 
40 
12 
29 
32 
39 
39 

McCarthy,  D  

24th  Infantry  ... 
4th  Cavalry  
1st  Cavalry  
14th  Infantry... 
1st  Cavalry  
20th  Infantry  ... 
17th  Infantry  .  .. 
45th  Infantry  .  .  . 

4tli  Cavalry  

42d  Infantry  
7th  Cavalry  
20th  Infantry... 
17th  Infantry... 
7th  Infantry  
24th  Infantry... 
34th  Infantry..  . 
Citizen  

47 
54 
CO 
82 
83 
90 
90 
100 

<    103 
I    104 
135 
151 
10U 
17-J 
172 
269 
275 
256 
172 
17-J 
172 
184 
184 
191 
191 
210 
210 
223 
23C 
237 
247 
252 
45 
50 
93 
107 
112 

lie 

194 
214 
10 
30 

3u 

67 
69 
83 
104 
123 
158 
172 
172 
172 
223 
7 
358 
10 
21 
48 
48 
57 
58 
58 
62 
69 
101 
103 
108 
111 
155 
158 
158 
158 
172 
172 

Indian  Scout  .. 
31st  Infantry... 
9th  Cavalry  
10th  Infantry  .. 
39th  Infantry  ... 
22d  Infantry  ... 
lltli  Infantry... 
9th  Infantry  ... 
45th  Infantry... 
10th  Infantry  .  .  . 
Civilian  
82(1  Col.  Troops  . 
19th  Col.  Troops. 
6th  Infantry  
7th  Cavalry  
9th  Infantry  
19th  Col.  Troops. 
7th  Cavalry  
4th  Infantry  
35th  Infantry  .  .  . 
23d  Infantry  
1  6th  Infantry  ... 
8th  Cavalry  
36th  Infantry  .  .  . 
10th  Cavalry  
9th  Cavalry  

K         T 

McDougall,  J  

K  ,J  

McCnlla,W  

McWilliams,  J  

Lave  lie,  W  

McMahou.M  
MrManus  

Lather,  J  

McClinchey,  J.  W... 
McCIiuty,  H  

''    .  8' 

Lasby,  J  

McCafferty,  K.  J  .  .  .  . 
McCann,  T  

Lee,  T  

Lee  J 

Jackson,  N.  B  

McCasey,  B  

McCombs,  C  

McAllister,  A  

Leete  \V  F 

McCaffrey.F  

Lewis,  J.  H  

McGrum,  D.  A  

McCormick,  M  

McT  ,H  

Johnston,  "W  
Johnson,  J.  J  

26th  Infantry... 
20th  Infantry... 
1st  Infantry  
7th  Infantry  
7th  Infantry  
60th  Pa 

McCuller.J  

4th  Cavalry  
23d  Infantry  
15th  Infantry... 
Civilian  
23d  Infantry  
23d  Infantry  
33d  Infantry  
27th  Infantr'v... 

McDonald,  M  

McPeake,  M  

Leonard,  C.  E  

McDermith,  W  
Mclntyre,  P  

McDonald,  J  

1 

Indian  Chief  
2d  Cavalry  
65th  Col.  Troops. 
3d  Cavalry  
9th  Cavalry  
7th  Cavalry  
10th  Cavalry  
10th  Infantry... 
Nitli  Infantry... 

McKee,  A  

Jones,      . 

Likarte,  A  

McKeever,  J  

McM  ,J  

43d  Infantry  
5th  Infantry.  .  .  . 
8th  Infantry  

*     ' 

Livingston,  "W  
Lilly  J 

McCarthy,  E  

T                        '       T 

15th  Infantry... 
24th  Infantry  .  .  . 
5th  Cavalry  
3d  Artillery  

McMahou,  J  

Linton,D  

McBride,W  

13th  Infantry... 

McMahon.P  

llthlnfantry.... 
•22(1  Infantry  
!ltli  Cavalry  
14th  Infantry... 
16th  Infantry... 
Oth  Infantry  
Surgeon  U.S.  A. 
1st  Cavalry  

Logan,  T     . 

McNalley.J  
MerrjTveather,  A  ... 
Mcvcr.F  

40th  Infantry  .  .  . 
8th  Cavalry  
24th  Infantry... 
8th  Infantry  .... 
20th  Infantry  .  .  . 
Civilian 

9th  Infantry  
38th  Infantry... 
Civilian 

Merchant,  J  

Metcalf.L  

Mechem,  A.  F  

Lockwood,  G.  M  
Long  AV  H 

3d  Cavalry  
84th  Indiana  
1st  Cavalry  
Kng.  Battalion.. 
7th  Cavalry  
Pensioner  
128th  Col.  Troops 
10th  Cavalry.  .  . 
1st  Artillery  
9th  Cavalry  
9th  Cavalry  
5th  Cavalry  
14th  Mo.  Cav  ... 
16th  Infantry  ... 
3d  Cavalry  
9th  Infantry  
2(1  Infantry  

Melitz.R  

Mellan,  H.  B  

6th  Cavalry  
Civilian  

21st  Indiana  
16th  Infantry  ... 
8th  Infantry  
4th  Infantry  
38th  Infantry  .  .  . 
18th  Infantry... 
5th  Infantry  
7th  Cavalry  
39th  Infantry... 
13th  Infantry  .  .  . 
21st  Infantry  ... 
8th  Cavalry  
U.  S.  Engineers  . 
Ordnance  Corps. 
19th  Infantry  .  .  . 
6th  Cavalry  
7th  Cavalry  
4th  Infantry  
let  Artillery  
5th  Ca  valry  
1st  Infantry  
Hosp'l  Steward. 
5th  Cavalry  
3d  Cavalry  
14t  h  Infantry  ... 
19th  Infantry  ... 

Mentieres,  A  

Luther  M 

Miller,  J  

Cth  Cavalry  
23d  Infantry  
Kith  Offralry... 
41st  Infantry... 
13th  Infantry  ... 
38th  Infantry... 
llth  Infantry  ... 
27th  Infantry  ... 
2<1  Cavalry  
15th  Infantry... 
17th  Infantry... 
10th  Cavalry 

Ludlow,  J.  R  
L  ,C  

Miller  L  

Miller.E  
Minnigan,  C.C  
Mitchell.J  

Judd   J  L 

J         E 

Marks  J 

Michael.C  

Milane.D.G  

Kay  A 

Millcr.C  

Kano  T 

Mason  G  F 

Miller,  J  
Miller,  W  

Martin   S  G- 

Kelly  J 

Man-ion,  T  
Mann,  J  

Miner.H  

Kelly  . 

Mitchel  G 

Keilly,  M  

Mitchell.C  

4th  Cavalry  
2d  Infantry  
Colored  

Kelliier  F 

May.C  

Keiley  M  W 

Cth  Infantry  

9th  Infantry  
34th  Infantry... 
23d  Infantry  
2d  Infantry  
8th  Infantry  
8th  Cavalry  
Civilian 

Keller  J  W 

Kennedy,  C  

Malone,  E  
March  T  J 

8th  Cavalry  
7th  Cavalry  
3d  Cavalry  
4th  Artillery  
7th  Cavalry  
1st  Artillery.... 
1st  Infantry  
198th  Pa 

Morgan,  J.  D  

Kelly  T 

Kelly,  B 

Marshall,  J  
Mathia8j  J.  G  

Kelly,  J 

Monlton,  M  

Kelly  J 

Kerr,  W  
Keller,  N  

Magenthaler  
Maunsell  W 

14th  Infantry.  .. 
38th  Infantry... 
8th  Infantry  
Uth  Infantry  ... 
42(1  Infantry  
28th  Infantry  ... 
31st  Infantry  ... 
7th  Cavalry  
3d  Cavalry  
7th  Cavalry  
10th  Cavalry  
8th  Cavalry... 

Kcnnicott,  E  
Keegan,  J.  

Mason,  E.  T  

Moller  W 

6th  Cavalry  
38th  Infantry  ... 
6th  Infantry  
3d  Cavalry  
Cth  Cavalry  
5th  Cavalry  
1st  Infantry  
1st  Cavalry  
33d  Infautrv  .  .  . 

Mortou.F  

Kimball.J  

35th  Infantry  ... 
3d  Infantry    . 

McDowell  D 

Morgan.T  

King,  T  

McWilliams,  D  
McCoy.T  
MeDonongfa,  J  

McLaughliu,  W  
McCahe  P 

Kinten,  R  
Kinneur,  R 

Civilian  
21st  Infantry  
llth  Infantry... 
31st  Infantry  ... 
15th  Infantry  .  .  . 
22d  Infantrv  .  .  . 

157 

209 
255 
32 
172 
llti 

Monaghan,  E  
Morgan,  II  
Morrell,  C  
Morrison,  D  
Montgomery,  J  
Moore.  J.  A  .  . 

Kline  .T.. 

Kohl,  J.W... 

McCiillough,  W.  W  . 
McLean.  A... 

Krumholz,  J.  .. 

INDEX  OF  PATIENTS. 


293 


Name. 

Regiment. 

Page. 

Name. 

Regiment. 

Page. 

Name. 

Regime  nt. 

P«g«. 

Moore,  "W  

41st  Iiifantry  
2d  Artillery 

172 

172 
172 
211 
211. 
33 
46 
50 
67 
75 
79 
97 
156 
158 
158 
172 
191 
246 
83 
172 
19 
10 
26 
85 
104 
224 
39 
85 
224 
242 
23 
145 
173 
193 
202 
59 
59 
137 
191 
270 
16 
19 
36 
59 
158 
185 
173 
42 
•  52 
178 
191 
248 
26 
64 
76 
16 
85 
88 
11 
75 
145 
54 
67 
158 
168 
273 
30 
34 
84 
101 
157 
173 
173 
173 

Pare,  \V"  

57th  Infantry  .  .  . 
28th  Infantry  .  .  . 

178 
185 
240 

17th  Infantry... 
lith  Cavalry  
3d  Artillery  
Di-t.  Artillery... 
22d  Infantry  
Civilian  

233 

20 
134 
173 
187 
200 
233 
20 
45 
57 
17'J 
12 
76 
82 
134 
129 
12S 
15rt 
173 
175 
188 
191 
200 
204 
228 
245 
28 
74 
99 
158 
173 
201 
226 
851 
41 
9 
23 
64 
273 
69 
70 
73 
75 
83 
84 
84 
91 
97 
146 
169 
173 
,73 
173 
»0l 
2*4 
221 
2~ 
147 
05 
351 

;.i 

219 

-•' 

«• 

lOi 
,46 
201 
51 
12 
26 
29 
43 
56 
68 

Morris  P      

Schwindig.F  

Mo  wry,  C  

20th  Infantry... 
Mexican  

Moutiel.S  

Morgan,  "W.B  

Civilian  
llth  Infantry... 
9th  Cavalry  
6th  Cavalry  
5th  Cavalry  
4th  Cavalry  
7th  Cavalry  
19th  Infantry... 
3d  Infantry  
7th  Cavalry  
10th  Cavalry... 
31st  Infantry  ... 
14th  Infantry... 
8th  Cavalry  
3d  Cavalry  
43d  Infantry  
16th  Infantry... 
39th  Infantry... 
9th  Cavalry  
18th  Infantry..  . 
19th  Infantry  .  .  . 

Peterson,  C.H  

40th  Infantry  .  .  . 
22(1  Infantry  
2-M  Infantry  
38th  Infantry  .  .  . 
18th  Infantry  .  .  . 
13th  Infantry  .  .  . 
Assist't  Surgeon 
150th  N.  T. 
13th  Infantry  .  .  . 
9th  Cavalry  

65 
67 
89 
173 
173 
200 
211 

a 

74 
191 
23 
60 
173 
29 
137 
1(3 
46 
137 
128 
8 
200 
246 
145 
243 
226 
237 
254 
255 
173 
173 
185 
186 
212 
•  237 
9 
67 
68 
69 
132 
192 
204 
238 
228 
179 
253 
14 
50 
102 
103 
158 
173 
235 
22 
39 
251 
67 
123 
149 
173 
173 
165 
51 
173 
59 
60 
107 
168 
173 
212 

Schuback,  J  
Scregg,  J  
Scott  C  B 

Murray,  C  

Fender,  P   . 

Peak  I 

37th  Infantry... 
3d  Cavalry  
8th  Infantry  
IstN.M  
3d  Artillery 

Seobcrgor,  A  
Seyforth,  H.  W  
Seis,J  
Shaw,  R  

Perigo,D  

Murray  T  

Mueller,  G  
Murray,  J  

Phelan,  J  

Phillips  J 

Shields,  J  
Shaw.J  
Shields  
Shechy  E 

10th  Cavalry  
3d  Cavalry  
3d  Infantry  
5th  Artillery  

Phenix  J 

Final  L 

1st  Artillery  
9th  Cavalry  
37th  Infantry  .  .  . 
9th  Cavalry  

Murphy,  M  

Pilot,  J  
Platt,  P 

Shulder  E 

10th  Cavalry.... 
6th  Cavalry  
43d  Infantry  
6th  Cavalry  
1st  Artillery  
20th  Infantry  .  .  . 
3d  Cavalry 

Myers,  J  
Myers,  J  
M            ,  C.  E  

Pochet,  N  .  . 

Shelton  J  "W 

Pomfort,  N  

Shulz  R 

Post  P 

45th  Infantry  .  .  . 
Omaha  Scouts  .  . 
6th  Cavalry  
4th  Cavalry  
24th  Infantry  .  .  . 
5th  Cavalry  

Shields  J 

Nalbrow.D  
Nay  lor,  J  
Navin,  T  

Priest,  "  Little  "  
Pumphrey,  T  
Pye  R 

Shauley,  B  .   .  .  . 

Shears,  E  

Shire  L 

Navarra,  E  

P  ,F    

Shaw  J 

Navitv  J     

P          TV  L 

Sheridan  P 

36th  Infantry  .  .  . 
128th  Col.  Troops 
40th  Infantry  .  .  . 
20th  Infantry  ... 
3d  Cavalry  
2d  Cavalry  
8th  Cavalry  
Ordnance  Corps, 
llth  Infantry  .  .  . 
38th  Infantry  .  .  . 
9th  Cavalry  
38th  Infantry... 
9th  Cavalry  
12th  Infantry  .  .  . 
19th  Infantry... 

Newell,  A  

114th  Col.  Troops 
9th  Cavalry  
Mexican  

P          W 

Neff.W  

13th  Infantry... 
17th  Infantry  .  .  . 
9th  Cavalry  
Cav.  Detachm't. 
13th  Infantry... 

Quigley  T 

Singleton  F 

Neuii,  J  

3d  Cavalry  

Silence,  G  
Simmons,  D  
Silverhorn  ,  F  
Skillin  J  T 

Qtiiuan,  J  

Quill  T 

Nix  K             ... 

14th  Infantry... 
9th  Cavalry  
Add'l  Paymaster 
3d  Cavalry  
37th  Infantry... 
5th  Cavalry  
1st  Artillery.... 
Scout 

Nice  C      

Quohn  P 

Nims  H.  G  

Rader  L 

7th  Cavalry  
9th  Infantry  
IstN.M.Cavalry 

Skehan  J 

Nipple,  T  
Nolan,  T  

Randolph,  G.C  

Slcdge.R  

Smith,  F.  W 

Randall  E 

Smith,  J  

Noyea,H  

Smiths,  G  

Ray  C  P 

16th  Infantry... 
15th  Infantry  .  .  . 
128th  Col.  Troops 
4th  Cavalry  
17th  Infantry.  .. 
3d  Artillery  

Smith  J 

5th  Cavalry  
16th  Infantry... 
7th  Cavalry  
Hosp'l  Steward  . 
28th  Infantry  .  .  . 
6th  Cavalry  
U.S.  A  
3d  Artillery..... 
6th  Cavalry  
6th  Cavalry  
1st  Artillery  
22d  Infantry 

Regan,  M  

Reed  B 

Smith  F 

O'Brien  J  

Smith  E     .       ... 

7th  Infantry  
6th  Cavalry  
19th  Infantry... 
23d  Infantry  
6th  Cavalry  
10th  Cavalry  
Recruit  
25th  Infantry... 
18th  Infantry... 
20th  Infantry... 
27th  Infantry... 
31st  Infantry  
3d  Infantry  
26th  Infantry... 
Ordnance  Corps. 
8th  Cavalry  
•27th  Infantry... 
14th  Infantry... 

O'Brien  M  

Reese  P 

Smith,  W.  S  

O'Brien  L 

Smith    J 

O'Brien,  J  

O'Brien,  T  
O'Brien,  L  
Olwrfleld  A 

Reip.F  
Realey,  R  "... 

Reed  C 

7th  Cavalry  
Civilian  
4th  Infantry  
37th  Infantry  .  .  . 
31st  Infantry  .  .  . 
39th  Infantry  .  .  . 

Smith  G 

Smith,  R  

Smith,  G  
Smith,  J.  B  

0'Callu«han,M  
O'Connor,  D  
O'Connor,  T  

Read  C  F 

Rhoy  C 

Smith,  P.  D  

Smith,  J  

Richards  M  E 

Smith,  C  
Smith.  C  

O'Callaghan  P 

13th  Infantry... 
14th  Infantry.  .. 
27th  Infantry  .  .  . 
14th  Infantry... 
6th  Cavalry  
5th  Cavalry  
2d  Infantry  
24th  Infantry... 
l8tCal.Vet.Vols. 
2d  Neb.  Cavalry. 
15th  Infantry... 
10th  Cavalry  
Indian  Scout  
20th  Infantry  .  .  . 
:i,l  Artillery  .... 
3d  Cavalry  
7th  Cavalry  
24th  Infantry  .  .  . 
29th  Infantry  ... 
Indian  Scout  
36th  Col.  Troops. 
9th  Cavalry  
•23d  Infiuitrv  .  .  . 

Riley  T 

25th  Infantry... 
9th  Cavalry  
19th  Infantry  ... 
1st  Cavalry  
9th  Cavalry  
20th  Infantry  .  .  . 
40th  Infantry  ... 
16th  Infantry  .  .  . 
16th  Infantry... 
9th  Cavalry  
23d  Infantry  
6th  Cavalry  
22d  Infantry  
35th  Infantry  ... 
3d  Cavalry  
4th  Cavalry  
35th  Infantry  .  .  . 
8th  Infantry  
23d  Infantry  
45th  Infantry  ... 
6th  Cavalry  
7th  Infantry  
5th  Cavalry  

Oliver  W  R 

Ridley,  S  
Riley  J 

Smith    J  

Oliver  E 

Smith,  A  
Smith,  J.E  

Oliver  W  R 

Rigby,  F  
Richards,  \V  

O'Neil.H  

O'Xral,  W  
O'Neil  J 

Smith,  J  
Smith,  G.  W  

Rodgers,W  

Southwood,  J  

40th  Infantry... 
19th  Infantry... 
13th  Infantry... 
Mrxii-au  
KlthCol.  Troops 
lllth  CoL  Troops 
4th  Veteran  Veil. 
7th  Cavalry  
2d  Cavalry  
19th  Kansas  
4th  Cavalry.  
14th  Infantry  ... 
'JM\  Infantry... 
4th  Cavalry  
3f(h  Infantry... 
10th  Cavalry... 

Soleven,  T  

Ross  F         

Soohen,  J  

O'  Shan  ghn  easy,  T  ... 
Overton,  G  
Owino    

Robbins  S  D 

Soldaco,  J  

Rosback,  W  
Roberts,!  

Springer,  D.  K  

Payne,  J.  A  

Robinson,  W  
Russell  "W 

Spyri,  J  

Staiubrook,  J  

Ruff.H  
Ryan,  D  

Paine  I 

Stone,\V.R  
Stewart,  T  

Ryan,  J  
Ryau.M  
Ryan,  J  
Ryan.W  
Rvan.T... 

Stcm.G  

Paris  J 

Stnvan,  E  

Parks,  W  

Stewart.  F  
Slant.-  n     C  

294 


INDEX  OF  PATIENTS. 


Name. 

Kegiinent. 

Page. 

Name. 

Regiment. 

Page. 

Name. 

Regiment. 

Page. 

10th  Cavalry  
6th  Cavalry  
18th  Infantry... 

69 
69 
151 
159 
159 
159 
169 
173 
173 
238 
243 
35 
61 
105 
173 
240 
16 
136 
196 
125 
252 
68 
68 
74 
252 
174 
189 
23 
32 

(1,M 

G9 
73 
96 
253 
111 
201 
42 
7 
41 
73 
100 
154 
156 
174 
235 
64 
64 
153 
154 
84 
278 
164 
174 
91 
34 
56 

96 
98 
98 
107 
126 
127 
136 
138 
141 
148 
153 
156 
159 
164 

LM 

Whalen,  P  3d  Infantry  

179 

188 
202 
255 
221 
17 
15 
39 
39 
57 
69 
78 
79 

an 

85 
85 
100 
111 
127 
129 
138 
138 
174 
174 
174 
174 
174 
174 
174 
166 
179 
179 
192 
•M-> 
202 
28 
174 
21 
133 
54 
150 
213 
276 
7 
25 
•JO,  -  1 
213 
•-'4(1 
237 
276 
100 
180 
.49 
159 

White,  D  

41st  Infantry  
114th  Col.  Troops. 
42d  Infantry  
24th  Infantry  ... 
20th  Infantry  .  .  . 
U.S.  Infantry... 

Stables,  A.  H  

White,  W  

45th  Infantry... 
U.  S.  Mil.  Acad'y 

White,  J  

31st  Infantry  
5th  Cavalry  
20th  Infantry.  .  . 
7th  Cavalry  
llth  Infantry.  .. 
16th  Infantry... 
3d  Cavalry  
20th  Infantry... 
1st  Cavalry  
45th  Infantry... 
1st  Cavalry  
Freedman  ...  — 
3d  Cavalry  
24th  Infantry... 
20th  Infantry... 
37th  Infantry... 
25th  Infantry... 
10th  Cavalry  
10th  Cavalry  
24th  Infantry... 
2d  Infantry  
13th.  Infantry... 
36th  Infantry... 
7th  Cavalry  
3d  Cavalry  
10th  Cavalry  
9th  Cavalry  
10th  Cavalry  
84th  Col.  Troops. 
9th  Cavalry  
2d  Artillery  

U                   

Whippor,  T.  H  

Stone,  C.A.C  

Wicks.C  

Unknown  
Unknown  

Female  child  
Mexican  
5th  Infantry  

Wilson,  D  

Wilmare.S  

116th  Col.  Troops. 
Gth  Cavalry  
116thCol.Troops 
10th  Cavalry  
24th  Infantry  .  .  . 
3d  Cavalry  
llth  Infantry  ... 
5th  Cavalry  
18th  Iiifiiiitrv  ... 

Stowers,  I.F  

Wiuterbottom,  W... 
Willinarc,  S  

Stone,P  

Wilson,  J  

Unknown  

Mex'n  herdsman 
3d  Cavalry  
13th  Infantry... 

Williams  
Willis,  C  
Wilsoii.C  

Sumner,  J  

Unknown  

Unknown  Indian... 

Wiliuot,  J  
Wilson,  William  

Sullivan,  A  
Swords,  E  
Sweet  W   E 

Van  del  P 

3d  Infantry 

193 
174 
35 
59 
174 
49 
254 
56 
60 
75 
262 
269 
275 
77 
99 
159 
174 
174 
174 
188 
212 
'.-21 
235 
8 
12 
13 
39 
39 
69 
75 
82 
127 
133 
174 
174 
159 
160 
174 
174 
174 

Williams,  G  

18th  Infantry  ... 
3d  Col.  H.  Art... 
5th  Cavalry  
4th  Artillery  
Srumall  
4th  Cavalry  
7th  Cavalry  
2d  Cavalry  
9th  Cavalry  
45th  Infantry  .  .  . 
7th  Cavalry  
4th  Infantry  
•2M  Infantry..'.. 
2d  Infantry  
10th  Cavalry  
9th  Cavalry  
7th  Cavalry.  .  .  . 
3d  Artillery.... 
Civilian 

Van  Doesburgh,  H.. 
Vane  J  T 

Ordnance  Corps. 
23d  Infantry  
18th  Infantry... 
13th  Infantry... 
Civilian  . 

Williams,  I  

Winisctt,  II  

Talbot  J  T 

Villhouer.C  

Wilson,  J  
Wilson,  L  
Wiley,  J  
Williams,  J  
Williams,  R  
Willis,  J.  H  

V         F.H       . 

Tusker,  L  
Taylor,  H.  E  

Vogler,  E    ... 

27th  Infantry... 
18th  Col.  Troops. 
6th  Cavalry  
38th  Infantry... 
31st  Infantry  ... 
5th  Infantry  
18th  Infantry... 
1st  Cavalry  
23d  Infantry  

Waffler,  L,  ...  . 

AV  allure  W 

Wilson,  C.H  

Thompson,  J.  A  
Thompson,  C.  E  

Wilson  G 

Ward  H 

AVisrwell  A.  L 

Walcott,  D.  W  
Waltsh.J  

Williams  G 

Thompson  W 

Wilks.A  
Williams,  H  

Wagerle,  W  

Watson  E 

25th  Infantry... 
2d  Cavalry  
10th  Cavalry  
9th  Cavalry  
Civilian  
3d  Infantry  

Winkleman,  L  
Wilkinson,  T  
Wilson,  W  

Thomas,  W  

Watson,  E.  M  
"Watson  G 

"Washington  G 

Wolf,  G  

18th  Infantry  .  .  . 
2d  Cavalry  
7th  Cavalry  
13th  Infantry  .  . 
2d  Cavalry  
4th  Cavalry  
5th  Infantry  
Civilian.  ..  .  
1st  Oreg.  Cavalry 
3d  Cavalry  
9th  Cavalry  
23d  Infantry  .  .  . 
10th  Cavalry... 
23d  Infantry... 
18th  Infantry  .  .  . 
21st  Infantry  
24  th  Infantry  ... 
37th  Infantry  .  . 
31st  Infantry... 

Tindolph,  J  
looker,  F  

TolHver   J 

1st  Artillery.... 
6th  Cavalry  
24th  Infantry... 
42d  Infantry  
19th  Infantry... 
Indian  Scout  
32d  Infantry  
7th  Cavalry  
2d  Cavalry  
16th  Infantry 

Washington,  J  
Walker  S 

Wolf,  A  
Wright,  J.  A  
Wright,  S  

Wall,  J  .  . 

Tooher  T    .    

Welch,  J  
Weaver,  "W  

3d  Cavalry  
9th  Cavalry  
llth  Infantry... 
16th  Infantry... 
1st  Cal.  Cavalry. 
6th  Cavalry  
3d  Infantry  
23d  Infantry... 
34th  Infantry... 
13th  Infantry... 
20th  Infantry... 
4th  Cavalry  
9th  Cavalry  
3d  Cavalry  
4th  Infantry  
9th  Cavalry  
17th  Infantry  .  .  . 

W  ,P  
W        ,M  

Tobin,  J  

To-kah-k-len  .  . 

Weiss,  G  

W  ,E  
W  ,E  
X 

Weicler,  F  

Tolliver  B 

Webb  J 

Toole,  P  

Tracey   J 

Welsh  M 

Teaton,  F  
Young,  G.  W  

Yimn<r  D.  M 

Welber  A 

Trowell   T 

128th  Col.  Troops 
2d  Cavalry  
8th  Cavalry  
9th  Cavalry  
6th  N.T.  Battery 
4th  Cavalry  

Welsh  J 

Train,  E.  L  
Tra^csor,  C 

Wells  E  H 

Young,  D  

Welsh  A 

Turner,  J  
Turner,  W.  II  

Weber  A 

Zeiebler,  C  

Welch  M  

Turner,  T  

While  L 

Turner  T 

White,  E  
Wheeler  T  J 

Tynes  W 

16th  Infantry... 
40th  Infantry... 

Zuch  M 

T         Louis 

White  A 

Whitman  1) 

TABLE    OF    CONTENTS. 


Pago. 

Circular  No.  3,  Surgeon  General's  Office,  1871  ................................................................  3 

Preliminary  observations  ......................................  5 

Gunshot  wounds  of  the  head  ...............................................................................  6 

Gunshot  wounds  of  the  face  ................................................................................  10 

Gunshot  wounds  of  the  neck  .................................................................  -JO 

Gunshot  wounds  of  the  chest  ................................................................................  25 

Gunshot  wounds  of  the  chest  involving  spine  ..............................  ...................................  36 

Gunshot  wounds  of  the  abdomen  ............................................................................  39 

Gunshot  woun.ds  involving  thorax  and  abdomen  .............................................................  40 

Gunshot  wounds  of  the  stomach  .............................................................................  42 

Gunshot  wounds  of  the  small  intestine  .......................................................................  42 

Gunshot  flesh-wounds  of  the  abdomen  .......................................................................  4C 

Gunshot  wounds  of  the  large  intestine  .......................................................................  48 

Gunshot  wounds  of  the  liver,  spleen,  and  gall-bladder  ........................................................  49 

Gunshot  wounds  of  the  pelvis  ...................................  ............................................  53 

Gunshot  wounds  of  the  genito-urinary  organs  ................................................................  56 

Gunshot  wounds  of  the  trunk  ...............................................................................  57 

Gunshot  wounds  of  the  upper  extremities  ....................................................................  58 

Gunshot  wounds  of  the  arm  ...........................................  •.  .....................................  61 

Gunshot  wounds  of  the  elbow  ...............................................................................  62 

Gunshot  wounds  of  the  fore-arm  .............................................................................  63 

Gunshot  wounds  of  the  hand  ................................................................................  65 

Gunshot  flesh-wounds  of  the  upper  extremities  ...............................................................  68 

Gunshot  wounds  of  the  lower  extremities  ....................................................................  70 

Gunshot  flesh-wounds  of  the  lower  extremities  ...............................................................  74 

Gunshot  wounds  of  the  knee-joint  ...........................................................................  79 

Gunshot  wounds  of  the  leg  ....................................  -  .............................................  80 

Gunshot  wounds  of  the  foot  ................................................................................. 

Analytical  review  of  cases  of  gunshot  wounds  .  ............................................................... 

Incised  and  punctured  wounds  and  contusions  ............................................................... 

Punctured  wounds  .......................................................................................... 

Lacerated  and  contused  wounds  ............................................................................. 

Concussion  and  compression  of  the  brain  ..................................................................... 

Simple  and  compound  fractures  and  luxations  ..............................   ................................. 

Fractures  of  the  skull  ....................................................................................... 

Fractures  of  the  bones  of  the  face  .........................  ................................................... 

Fractures  of  the  vertebra)  .................................................................................. 

Ill 
Fractures  of  the  bones  of  the  trunk  .......................................................................... 

132 
Fractures  of  the  upper  extremities  ............................................................. 

133 
Fractures  of  the  humerus  ...................................................................... 

134 
Fractures  of  the  radius  and  ulna  .............................................................. 

135 
Fractures  of  the  lower  extremities  ................................................................ 


Fractures  of  the  patella 


296  TABLE  OF  CONTENTS. 

J'a£o. 

Fractures  of  the  lej* 137 

Dislocations 139 

Dislocations  at  the  clavicle 140 

Dislocations  at  the  shoulder-joint 141 

Dislocations  at  the  elbow-joint 141 

Dislocations  at  the  wrist-joint 142 

Dislocations  at  the  hip-joint 142 

Arrow  wounds - 144 

Arrow  wounds  of  the  head  and  neck 146 

Arrow  wounds  of  the  chest 151 

Arrow  wounds  of  the  abdomen 153 

Poisoned  wounds 164 

Burns,  scalds,  and  frost-bites 167 

Amputations  in  the  upper  extremities 170 

Amputations  in  the  lower  extremities 190 

Excisions 219 

legations 235 

Various  operations 244 

Operations  on  the  eye,  ear,  and  mouth 245 

Operations  on  the  chest 249 

Operations  on  the  abdomen 250 

Operations  on  the  genito-urinary  organs 252 

Cases  of  lithotomy 256 

Removal  of  tumors 262 

McGill  on  osteoplastic  amputations 277 

Concluding  observations 282 

Index  of  reporters 287 

Index  of  patients 290 


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