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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    In the Seven Weeks' war in Germany, it is probable that this operation was occa- sionally performed; but few cases have been published. Dr. J. Heyfelder mentions three.1 Two of these were early intermediate operations, performed at the Chateau of Hradeck, on July 4th or 5th, 186G, after the battle of Sadowa. Both terminated fatally within forty-eight hours. The third operation was also an early intermediate one, performed at the hospital at Negolisch or Nederlischt, a Bohemian town, by the surgeon in charge, Dr. Wilde. The operation was practised two days after the battle of Sadowa, or Koniggratz, and was promptly fatal. I am informed by Professor P. Pelechin, of the Medico-Chi- rurgical Academy of St. Petersburg, who visited the Prussian and Austrian hospitals during the Seven Weeks' war, that he witnessed this operation on several occasions, but I have been unable to obtain reports of these cases. In January, 1868, Dr. John Ashhurst, jr., performed, at the Episcopal Hospital in Philadelphia, an unsuccessful secondary coxo-femoral amputation for gunshot injury.2 The case was complicated by a fracture of the pelvis, a lesion which should forbid this operation. The following is an abridgment of Dr. Ashhurst's report: Case.—E B ; a woman, 22 years of age, was wounded at Tacony, Pennsylvania, by a conoidal musket ball, at short range, in tlie right hip, August, 1867. The ball entered at the fold of the right buttock, when the woman was in a stooping posture, and shattered the acetabulum and head and neck of the femur, passing out at the groin. The patient was treated on the expectant plan by Dr. W. S. Hendrie until the following December. In January, 1868, large abscesses existing about the hip, discharging through many apertures, the limb being immovable and the seat of severe pain, and the sacrum being occupied by a bed sore, the patient being, moreover, subject to the constant recurrence of an exhausting diarrhoea, and the pulse-rate averaging 150, a consultation of the surgeons of the Episcopal Hospital, at Philadelphia, determined unanimously to recommend ablation of the thigh. On January 14th, 1868, the patient was brought completely under the influence of ether, the circulation was controlled by an aortic tourniquet, and the limb was amputated at the hip by Dr. Ashhurst, jr., by forming, with a short knife, anterior and posterior flaps from without inwards. There was little haemorrhage, no blood whatever being lost from the general circulation, and the patient reacted satisfactorily; but soon after began to sink, and died three hours and a quarter after the completion of the operation, January 14th, 1868. Every step of the operation had been most carefully planned and executed, and the unsuccessful issue was much deplored. The preparation of the injured femur, the head and greater part of the neck being disintegrated, was placed in the Museum of the Episcopal Hospital. It is represented in the adja- cent wood-cut. (Fig. 66.) Twenty-two cases of coxo-femoral amputation are thus added to those 0fF%M~&£m*Fi£l cited in the report published by this Office in 1867. Nine of these Bfa^yi^fromttSeatete - - , . ttt 1 • -. .. of gunshot fracture.— pertain to the surgery ot the American War, and increase that list oi ope- [AfterAshhurst.] rations from fifty-three to sixty-two; seven were cases of earlier date, to be added to the one hundred and eight already cited, and six have been recently reported. But two of these operations, those by Plestelli and McDougall, resulted successfully. This gives a mortality rate of 90.9, corresponding very closely with the results of cases of amputation at the hip for injury heretofore published, and compels the admission that further expe- rience of this operation only confirms the generally received opinion of its formidable fatality. Grouping the one hundred and fifteen amputations at the hip for gunshot injury reported from various campaigns prior to 1862, the sixty-two cases of the American War, and the six cases more recently recorded, the results set forth in the following 1 Rapport sur le Service Sanitaire de I'Armee Prussienne pendant le Guerre de 1866 contre les Saxo-Autrichiens. Gazette Midical de Paris, 1867, p. 541. 3 The American Journal of the Medical Sciences, January, 1869, N. S., Vol. LVII, p. 94.