A report on excisions of the head of the femur for gunshot injury.

Date:
1869
Catalogue details

Licence: Public Domain Mark

Credit: A report on excisions of the head of the femur for gunshot injury. Source: Wellcome Collection.

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    Chase, 104th New York Volunteers, proceeded to remove the limb. He performed the double flap operation, sometimes described as B6clard's, transfixing the thigh and forming a large flap in front, disarticulating and then cutting from within outwards to make a posterior flap. The vessels were then rapidly, secured. The patient survived the operation twelve hours. The particulars of the following case have been obtained from the morning report of October 2, 1864, of the Field Hospital of the Second Division, Second Corps, and from a Second Army Corps register: Case.—Private Isaac C. Fulton, Co. I, 4th New York Heavy Artillery, was wounded, on October 1st, 1864, in the trenches before Petersburg, by a fragment of shell, which shattered the upper extremity of his left femur, and lacerated the soft tissues on the outside of the thigh, without, however, implicating any important vessels or nerves. He was immediately carried to the Second Corps field hospital, under the charge of Surgeon F. F. Burmeister, 69th Pennsylvania Volunteers, and a consultation was held, at which it was determined that an amputation at the hip-joint was the only resource that could possi- bly preserve life. The wounded man was, therefore, immediately placed under the influence of chloroform, and Surgeon J. W- Wishart, 140th Pennsylvania Volunteers, did the operation. The ordinary method by antero posterior flaps formed by trans- fixion was employed. The operation was rapidly performed, and but a trifling quantity of blood was lost. The patient sur- vived the shock of the injury and operation but a few hours, and died at City Point, October 1st, 1864. Brevet Lieutenant Colonel J. H. Janeway, Assistant Surgeon U. S. A., has learned that Dr. Hunter McGuire, Surgeon-in-chief of Ewell's Division, performed a primary amputation at the hip after the engagement at Ball's Bluff (?), upon a Union prisoner of war, with a frightful injury of the upper part of the femur, caused by a large projectile, and that the patient succumbed to the combined shock of the injury and operation, soon after the completion of the latter. It is also known that Dr. B. D. Lay, of Paducah, Kentucky, a surgeon in the Confederate service, performed two unsuccessful intermediate amputations for gunshot injury, besides the primary case he has reported in detail.1 These operations were performed on Confederate soldiers in one of the Western campaigns. Dr. B. Rohrer, of Germantown, Pennsylvania, late Surgeon 10th Pennsylvania Reserves, records2 the following case of intermediate amputation at the hip. It is not mentioned in the returns of the Fifth Army Corps Hospital transmitted to this Office: Case.—Frank G , a private in a Texan regiment, was wounded at the battle of Gettysburg. The wound was in the left thigh, caused by a grapeshot, which entered two inches below the trochanter major, shattered the bone up into the neck, and lacerated the soft parts terribly between the place of entrance and the knee. He remained on the battle-field from the 2d until the 4th day of July, with very little attention, until he was brought to the hospital of the Fifth Army Corps. After a consultation with a number of surgeons, and the conclusion being in favor of amputation at the hip, the patient was placed upon the table, and, when fully under the influence of chloroform, I performed the antero-posterior operation, assisted by Joseph A. Philips, Surgeon General of Pennsylvania, and Henry Grimm, Surgeon 12th Pennsylvania Reserve Volunteer Corps. Surgeon Philips controlled the femoral artery, and not over three ounces of blood were lost. Death followed in thirty-six hours. In July, 1867, when a report on the hip-joint amputations of the late war was printed by the War Department, about one-third of the sixty thousand monthly regimental reports of sick and wounded accumulated in this Office had received only a cursory pre- liminary examination. A further search among these reports has discovered memoranda of three more coxo-femoral amputations hitherto unpublished. Two of these were primary cases, in which the operations were, so to speak, compulsory: Case.—Private Elisha WaylaDd, Co. E, 34th Iowa Infantry, had his right thigh almost completely torn off at the hip-joint, at the siege of Vicksburg, July 3d, 1863, by an unexploded shrapnel shell. He was hurriedly conveyed to a field hospital, hut bled very profusely during the short transit, and is represented as almost exsanguinous upon reaching the hospital. His regimental surgeon, Charles W. Davis, 34th Iowa Volunteers, having mastered the haemorrhage, had the patient placed under chloroform, ligated the femoral artery, divided the lacerated soft parts which still connected the mutilated limb with the trunk, and then formed a single large anterior flap, and exarticulated the femur. The patient survived the operation two hours ; and died July 3d, 1863. The next case is one of the very few recorded illustrations of amputations at the hip for gunshot fracture complicated with a wound of the femoral artery: 1 See Circular No. 7, S. G. O, 1867, pp. 27, 78. 2 American Journal of the Medical Sciences, January, 1869, N. S., Vol. LVII, p. 285.