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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![giuia, by a conoidal ball. The popliteal artery near its beginning was completely severed, the missile bruising the femur about the inferior termination of the diaphysis. There was hfemorrhage to syncope on the field, and secondary htemorrhage, and when anj^ one meddled with the wound there was apt to be iLTmorrhage. Inflammation of the knee-joint, (treated by free incisions), gangrene, abscesses of the leg and thigh, anchylosis of the knee-joint, with the leg bent at right angles, erysip- elas repeated and associated with great constitutional disturbance, emaciation, pallor, leucocythjemia, and fatty degeneration, interstitial and proper, of the leg and thigh, were severally declared. At last Irritative fever was decidedly formed, and incurable ulcers on the heel and leg. By my direction Dr. H. McElderry, Acting Assistant Surgeon, U. S. A., performed amputation in the lower third through the diaphysis; forming an ample anterior flap, and a short and somewhat thick i)osterior one, and raising a very long and wide i:>eriosteum flap. This periosteal flap was raised witli tlie greatest ease, too easily in fact, and after the operation was completed, was folded over every part of the cut surface of bone, as were the flaps in the case of Lewis (Case 3). Great prostration followed the operation ; from this he reacted rather slowly, a kind of fever appearing the third day. He was kept under the influence of morphia. After the fourth, day he improved steadily and speedily. At first when the stump was being dressed he complained a great deal. It was dressed first the third day. His blood presented remarkable phenomena of change of the white into red corpuscles (as Dr. McElderry and myself thought), during his cure, whicb will be fully described in a more detailed report of the case. He was discharged the service, at his own request, perfectly well, with the exception of a surface granulating in the cicatrix. On March 14, 1866, he was able to sit all day in a chair and help himself. The end of bone in this case was beautifully rounded.* When a bone is cut in amputations, two conditions, I believe, must result from the action of its distal living bone tissues. First, metamorphosis into such transitional forms as will connect with ordinary fibrous tissue. Second, change of medullary tissue into such transitional tissue and I into bone proper. If, then, we adapt living transitional tissue we substitute the mere action of union the cohesion of homologous formed material, the easiest in nature apparently, for the action of change that reproduces bone out of medullary tissue and forms a connective tissue, certainly by means of the germinal matter that lives in fully formed bone, and that has already performed the work of development and growth. Again it might be reasoned, a priori, that in changes one and two, made, of course, feebly by substance of exhausted (?) formative energy, the least injury of the ( general health and the most trifling local injury are calculated to kill or set the germinal matter free (in the form of pus), and so throw the labor of formation, and, it may be, an added one of separation, upon more i)roximal forms. Thus we have sequestra, thus often osteomyelitis and pytemia. With periosteum over the cut end of a bone, we have a tissue there whose ofBce is to form, to connect, and to resist. So promising have the results of amputations with a periosteal flap been in my hands, that I am constrained, most respectfully, to call your attention again to the subject. This paper was dated Baltimore, April 12, 1866. The suggestions it contains were communicated to several medical officers; but there appear to have been no further ex- periments on the subject, and, indeed, the whole matter of sub-periosteal operations has received little attention in the Army. Dr. McGill used and recommended, for the separation of the periosteum, a rugine no. ea.-Eugine for sub-periosteal operations. [After Oilier.] ■ similar tO that employed bj M. Oilier, and figured in the second volume of his work. * See Catalogue of the Surgical Section of the Army Medical Mnsenra, p/555. t Olukk, Traitii Experimental et Cliuiriue de la Eeg(?n6ratiou des Os. Paris, 18C7, T. II, p. 83, 36 V](https://iiif.wellcomecollection.org/image/b21970695_0297.jp2/full/800%2C/0/default.jpg)
