A report of surgical cases treated in the Army of the United States from 1865 to 1871 / War Department, Surgeon General's Office.
- Date:
- 1871
Licence: Public Domain Mark
Credit: A report of surgical cases treated in the Army of the United States from 1865 to 1871 / War Department, Surgeon General's Office. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![DCCXXXI.—Extract from Reports stiggesting a Modification in tJie Methods of Anqmfation, by preserving the Periosteum to cover the Ends of the Bone, together with Eemarlcs on Amputations at the Knee. By Geoege M. McGill, late Assistant Surgeon, U. S. A. ' % In the winter of 1862-'63, wliile 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 tlie 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 my advice it was frequently adopted in primary operations upon soldiers of the cavalry corps of the army of the Potomac, and by such eminent and worthy men as Surgeon W. H. Eulison, 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, 18G3, 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 paralj'sis and subsequent separation and rejection, such as occurs, as seems probable to me after much observation, when the diaphysis of a bone is jaiTed 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 of 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 sufticient at least to cover the medullary substance. This flap is then carefully raised bj^ 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 fla^) 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, especiallj^ 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 f ** ** ** [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 6,1864, 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](https://iiif.wellcomecollection.org/image/b21970695_0293.jp2/full/800%2C/0/default.jpg)
