A report on excisions of the head of the femur for gunshot injury / War Department, Surgeon General's Office.
- Date:
- 1869
Licence: Public Domain Mark
Credit: A report on excisions of the head of the femur for gunshot injury / 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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![of the injury and the date of operation was two days, the longest was twenty-eight days, the average interval was thirteen and a half days. Five of the patients were youths of eighteen or nineteen years, one was a veteran of sixty years, the majority were in the prime of life, between twenty-five and forty years of age. In the twenty unsuccessful cases, the average duration of life after the operation was twelve and a half days. One patient survived seventy-five days, and apparently succumbed to climatic influences, and not to the effects of the operation. In another case, in which the patient lived twenty days, and died with colliquative diarrhoea, the fatal event was ascribed to malarial disor- ders rather than to the effects of the wound or operation. Three of the cases were com- plicated by fractures of the pelvis. One patient died of profuse venous secondary haemor- rhage, two from frequently recurring capillary bleeding, one from peritonitis, one from diarrhoea, six from pyaemia, and nine from exhaustion. In all of the cases but one, the wounds were inflicted by conoidal musket balls. The details of the first intermediate excision were communicated to the reporter by Surgeon M. Goldsmith, U. S. V. The operation is not recorded on the register of the hos- pital at which it was performed; but the facts communicated by Dr. Goldsmith rendered it possible to identify the case, and to obtain the name and military description of the patient from the hospital register: Case XXXIII.—A soldier of General Buell's army was wounded in a picket skirmish, about seven miles from Nashville, Tennessee, in March, 1862, by a conoidal musket ball, which shattered the neck and trochanters of the femur. He was imme- diately conveyed to Nashville, and placed in the College Hospital, under the care of Surgeon A. H. Thurston, U. S. Volunteers. Surgeon M. Goldsmith, U. S. Volunteers, saw him two days after the reception of the injury, and deemed the case peculiarly well adapted for the operation of excision. The surgeon in charge concurring in this opinion, the patient was anaesthetized, and Dr. Thurston proceeded to excise the head and splintered upper extremity of the femur, through a long straight incision. The operation was accomplished with but little haemorrhage, and although the patient was much prostrated by the shock of the injury and of the operation, he reacted and was in a comfortable condition for several days. But surgical fever and suppu- ration soon set in, and he gradually sank, and died one week after the operation. There can be little doubt that the subject of this operation was Corporal Henry F. Smith, Co. B, 1st Wisconsin Volunteers, who, according to the records of the Nashville Hospital, was admitted for a gunshot wound of the hip, and was the only patient who died from wounds in Dr. Thurston's wards, at the period referred to.* Corporal Smith died on March 15, 1862. The operation was probably done on March 10th.t The particulars of the next case were communicated by the operator, who was serving at the time as a Brigade Surgeon of Volunteers. He remarked that at the period of the operation, pyaemia was destroying almost every [wounded?] soldier in the hospital, those who were subjected to operation and those who were not. An amputation of the great toe was not less fatal than one at the hip: Case XXXIV.—Private D. M. Noe, Co. C, 46th Ohio Volunteers, aged 22 years, was wounded at the battle of Shiloh, Tennessee, April 6th, 1862, by a conoidal musket ball, which shattered the neck of the left femur. The patient was placed on board the hospital transport steamer Lancaster, under the charge of Surgeon George C. Blackman, U. S. Volunteers. On April 16th, 1862, chloroform having been administered, Dr. Blackman made a longitudinal incision four inches in length over the trochanter, and excised the head, neck, and trochanters, together with three inches of the shaft of the femur, the diaphysis being divided by a common amputating saw. The patient reacted well after the operation, and for five days the symptoms progressed favorably. Pyasmia was subsequently developed, and death ensued on April 24th, 1862, eight days after the operation. A special report from the operator, Assistant Surgeon John S. Billings, U. S. A., fur- nishes the materials for the abstract of the next case. Dr. Billings remarked that ampu- * The above account has been submitted to Dr. M. Goldsmith, who states that he thinks that the identification of the case is complete. Surgeon Thurston died during the war. t The report of the Adjutant General of Wisconsin for 1865, p. 33, states that on March 8th, 1862, five companies of the 1st Wisconsin Volunteers were sent out beyond Nashville on picket duty. They were attacked by a cavalry force, and Private Willett Greenly was killed—the first Union soldier killed in Tennessee—while Corporal H. F. Smith and one other were wounded, and were sent to Nashville.](https://iiif.wellcomecollection.org/image/b21971389_0038.jp2/full/800%2C/0/default.jpg)
