Volume 2

The medical and surgical history of the war of the rebellion (1861-65) / prepared, in accordance with the acts of Congress, under the direction of Surgeon General Joseph K. Barnes, United States Army.

  • Joseph K. Barnes
Date:
1875-1879
Catalogue details

Licence: Public Domain Mark

Credit: The medical and surgical history of the war of the rebellion (1861-65) / prepared, in accordance with the acts of Congress, under the direction of Surgeon General Joseph K. Barnes, United States Army. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

    44/1127 (page 26)
    with an apparatus for dislocated hip joint, by Dr. E. D. Hudson, of New York City. Examiner J. K. Reinholdt, February 7, 1871, certified : ‘‘The downward momentum caused the ball to imbed itself securely in the hip joint. * * Parts swollen and tender; wound discharging; more or less injury to great sciatic nerve; limb deficient in temperature; more or less constant pain; confined to bed months at a time,” etc. This pensioner died May 7, 1874, of convulsions superinduced by the results of his wound, his attending physician and others stating that the serious attacks of inflammation, resulting in the formation of abscesses, proved a severe tax upon his vitality and prepared the way for his sudden demise.—Private R. Emerick, Co. D, 82d Pennsylvania, aged 28 years, was wounded at Cold Harbor, June 1, 1864, and admitted to hospital at Alexandria, and subse- quently to Pittsburg. Surgeon J. Bryan, U. S. V., reported that he was transferred to the Veteran Reserve Corps, October 8, 1864, by reason of “a grapeshot wound, dislocating the right femur.” Not a pensioner.—Lieutenant F. Heck, Co. I, 74th' Penn- sylvania, aged 37 years, was wounded in the right thigh at Rappahannock Ford, August 22, 1862, and was discharged from service October 9, 1863. In 1874, the Examining Surgeons report: “ Firm anchylosis, with head of femur thrown out of socket; knee and ankle joints entirely stiff; foot in an extended position, and limb shortened two inches.” Two cases are reported as injuries of the hip joint by large projectiles: Cases 52-53.—Private J. Teeters, Co. A, 84th Pennsylvania, aged 34 years, was wounded at Bull Run, August 30, 1862, and discharged from service March 29, 1863. Assistant Surgeon J. D. McClure, of the regiment, certifying to ‘‘an injury in the right hip joint by a piece of shell, producing paralysis of the whole leg.” This man was a pensioner, but has not been heard from since September 4, 1864.—Private W. S. Gardiner, Co. A, 14th South Carolina; injury to hip joint from bomb; furloughed. The entire subject of traumatic lesions of the hip joint is of such importance that it is deemed proper to adduce or to refer to the previous publication of all the information that can be found on the registers, with the warning that, in many instances, the facts are derived from reports suggestive of superficial examination, and sometimes of diagnoses that must be regarded as little more than conjectures.1 Of the fourteen Fatal Cases in the series of thirty-five shot injuries believed to have been attended with primary lesion of the hip joint without fracture, the details of all are published in Circular 2, S. G. 0., 1869, already cited.2 In the reports of many of these cases it is stated that the character of the lesions was verified by necroscopic examination, and in others it may be inferred that autopsies were made, so that the series is, as a whole, more reliable than the preceding.3 Of the series of forty-nine cases of reported peri-articular shot wounds of the hip joint, fourteen may be classified as examples of secondary traumatic coxitis.4 Seven were 1 VON LANGENBECK (B.) (Uber die Shussverletzungen des Huftgelenlcs, in Archiv fur Klinischt Chirurgie, Berlin, 1874, B. XVI, p. 280) remarks: “It may be taken for granted that a gunshot injury of the hip joint may heal under favorable circumstances without traumatic coxitis beginning. Coxitis may certainly be avoided in simple capsule wounds, which are kept perfectly quiet from the commencement, as well as in gunshot injury of the knee joint, as I have seen the recovery of several cases without any inflammation arising. As, however, in most cases (Pott's) side splint was recommended by the surgeon or adopted by the patient, and as during the last war not a few of the men were subjected to distant transport, and, injury of the hip joint not having been discovered, were allowed to go about, it was difficult in such cases to avoid inflammation. It appears to me that we must admit that in all those cases in which coxitis suddenly appears a considerable time after the injury, recovery is certain under favorable external circumstances without any further trouble occurring.’’ [The translation is the version of JAMES F. WEST, F. R. C. S.] 2 Circular No. 2, S. G. O., 1869, op. cit., pp. 90, 91, 92. The names of the patients, the duration of life after injur}7-, and the names of the reporters are noted: Case 165, W. Blair, survived injury 23 days; extent of injury demonstrated by autopsy; McKee, reporter.—Case 167, A. D. Bradshaw, survived 19 days; verified by autopsy; Burne, reporter.—Case 168, P. Cornell, survived 3 days; WOLFE, reporter.—Case 170, J. W. Falconer, survived 15 days; autopsy; MORONG, reporter.—CASE 171, S. Finnegan, survived 1 day; COLE, reporter.—Case 172, G. Green, survived 14 days; Graham, reporter.—Case 173, F. M. Hate, survived 102 days; IIatchitt, reporter.—Case 174, J. E. Leedy, survived 7 days; Leavitt, reporter.— Case 175, J. McMahon, survived 19 days; Bliss, reporter.—CASE 179, B. F. Pittman, survived 73 days; Janes, reporter.—Case 180, W. R. Reeves, survived 16 days; autopsy; HARRINGTON, reporter.—Case 181, T. Smith, survived 28 days; autopsy; VANDERKIEFT, reporter.—Case 182, R. Taylor, survived 4 days; autopsy; Seabrook, reporter.—Case 183, B. K. Wagoner, survived 265 days; Hatchitt, reporter.—Case 184, of J. Wells, was also reported in Circular 2 as belonging to this group; but the carbine ball inflicting the injury, much deformed, with large bone fragments embedded in it (Specimen 2994, Cat. Surg. Sect., 1866, p. 603), has since been discovered, and the case has been transferred to the category of shot fractures of the neck of the femur. In three cases, in which the patients died within a few days after the infliction of the injury, it is probable that there were grave concom- itant lesions. In those in which they survived two months, three months, and eight months, respectively, there were no autopsies held, and the lesions were not accurately determined. In the eight remaining cases, the patients lived from one to four weeks; the mean was 16 days. 3Billroth (Til.) (Chir. Briefe, u. s. w., Berlin, 1872, p. 238) observes: “I am of opinion, that neither the direct injury of the joint capsule and bone, nor the secondary necrosis, can always be early diagnosticated. In cases resulting favorably, the diagnosis can generally only be made ex post, from the total anchylosis of the hip joint, and in many cases only after the discharging of some necrosed bone. . . Nevertheless I had not imagined the diagnosis to be so difficult; I had thought that there must be, under all circumstances, symptoms of acute coxitis; but I was mistaken therein. . . But gradually we arrive at a correct diagnosis in the majority of these cases from the slow progress after the injury, the copious suppuration, rapid debilitation, and speedy decubitus.” 4 Circular No. 2, S. G. O., 1869, op. cit., pp. 93, 94. The cases of five of the seven patients who partially recovered have been enumerated in the Circular above cited: Case 190, of Capt. H. C. Mason, 20th Massachusetts, is more extensively reported by J. MASON Warren in his excellent Surgical Observations with Cases and Operations, Boston, 1867, p; 565. A fortnight after the accident, acute inflammation of the hip joint came on, and WARREN cut down and removed the ball from directly over the capsule of the joint. He ultimately recovered with stiff joint. The next case, No. 191, A. McGee, will be noticed on the next page. In Case 193, Private S. Schafer, 81st Ohio, was struck in the left hip at Resaca, May 14, 1864, and recovered with a stiff joint, according to Surgeon W. TlIRELKELD, U. S. V., and others. Case 196, Private W. A. Shingledecker, 101st Pennsylvania, Gettysburg, July