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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![H. Allison, Co. I, 21st reiiusylvaiiia Cavalry. Those of Gamble aud 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 flaps to cover the cut ends of the bones, to which I called attention by a paper acknowledged by Surgeon George A. Otis, U. S. V., December 20, 1865, Avas 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, 1805, at Farmville, Virginia, in the right foot, a couoidal 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 dead 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 tlap, 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, 1805. There Avas uo tenderness over the sharp cut end of the tibia during the cure. Case 2.—Specimen 455 A. M. ]\r., Private Josiali Gamble, Co. C, 13th West Virginia Volunteers, aged 23 years, was wounded on July 24, 1804, 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 12,1805,1 j-yerformed amputation in junction of lower and 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 extremitj', and from this opening there has been an intermittent discharge until the present time (April, 1806). 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. Tlie end of the tibia is well rounded. The stump is not in the least tender nor tunnd, 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 spi-ained his ankle in July, 1804, while drilling, and 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 tbe 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 hsemorrhage, 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 liis recovery was rapid, and he was transferred on February 20, 1800, to Fort McHenry 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 tbe stump. John H. Allison, Farrier, Co. 1,21st Pennsylvania Cavalry, aged 19 years, was wounded on April 5, 1865, at Amelia Court-House, Vir-](https://iiif.wellcomecollection.org/image/b21970695_0296.jp2/full/800%2C/0/default.jpg)
