A report on amputations at the hip-joint in military surgery / [by George A. Otis].
- Surgeon General of the United States Army
- Date:
- 1867
Licence: Public Domain Mark
Credit: A report on amputations at the hip-joint in military surgery / [by George A. Otis]. Source: Wellcome Collection.
Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)
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![right tliigli, completely divided tlie femoral artery, and comminuted the femur through an extent of eight or nine inches. A surgeon in the trenches put a ligature on the femoral artery, and the wounded man \vas conveyed to the City Hospital, and was plied with cordials. The sufferer had but recently recovered from an attack of illness; the primary Viasmorrhage had been copious, and reaction was very imperfect. A consultation of surgeons decided that amputation at the hip-joint should- be practised, and the wounded man expressed a desire to have the benefit of this for-lorn chance. Surgeon B. D. Lay undertook the operation with great reluctance, fearing that the patient might die under the knife, he was so very feeble. Stimulants were freely administered and morphia; but it was decided that the operation should be done without anfesthetics. The nature of the wound determined the direction of the incisions. There was a rent in the soft parts laying bare the tuberosity of the ischium, and another extending nearly to Poupart's ligament, in which the ligated femoral artery m as hanging. Dr. Lay commenced the operation, in the presence of Surgeons Britts, McDowell, Nidelet, and othei's, by making a clean circular cut through the inner and posterior parts of the thigh, dividing all the soft parts down to the articulation ; a semilunar flap was then obtained from the outer and anterior part by cutting from without inwards; the head of the femur was then disarticulated. Eight ligatures were required. The flap fitted well. The operation was well supported, and the patient said that he felt more comfortable after than before it. However, reaction was never fully established. Dr. Nidelet relates that the patient died upon the table within an hour and a half after the completion of the dressing. Dr. Lay's recollection is that he survived the operation some fourteen or sixteen hpvirs. Special reports from tlie operator, Assistant Surgeon Benjamin Howard, U. S. Army, and Surgeon Thomas M. Flandreau, 146th New York Vokmteers, have furnished tlie particulars of the next case:''' Case XII.—Private James Martin, Co. I, 146th New York Volunteers, aged twenty years, was wounded on the afternoon of July 13, 1863, in one of the reconnoissances of General Lee's position near Williamsport. He was carried to the rear and placed iji a barn by the roadside not far from Williamsport. On the following morning a consultation was held in the case, at which Assistant Surgeons Howard, C. Wagner, and Colton, U S. A., and Drs. Stearns, Lord, Dean, and others nssiste<l. It was found that a conoidal musket ball had passed through the upper ]5art of the left thigh from before backwards, and had struck tlie femur a little below the great trochanter and produced a comminuted fracture. It was believed that the fracture extended into the coxo-femoral articulation, and it was decided that no operative procedure could be advantageously practised except an amputation at the hip-joint. Dr. Howard was invited to operate. Chloroform having been adminis- tered, he removed the limb by a double-flap operation. He desci'ibes the opei'ation as performed by entering the knife about four or five inches below the anterior superior spinous process of the ilium, and causing it to emerge by transfixion an inch and a half to the inside of the course of the femoral vessels. The operation was completed in the ordinary manner of flap amputations. By transfixing at the points described, the mouths of the divided vessels were so near the margin of the anterior flap as to be readily seized immediately after division. Comminuted gunshot and by the external obliquity of the plane of incision, drainage of pus iracture of tlie femur in a „ ... , i i i i- i o j young subject. Spfx. 137.9, was facilitated more than by the ordinary horizontal antero-posterior A. M. M. flaps. It appears that the disai'ticulation was rapidly accomplished, and that very little blood was lost. The shock was great, but the patient is reported to have rallied so far that it was considered safe to move him. On July .11, 1863, he died on the road to Sharpsburg, about forty-eight hours subsequent to the operation. An examination of the pathological specimen from this case, which was forwarded by Assistant Surgeon Howard to the Army Medical Museum, where it is numbered S-ped in€7i 1379, justified the opinion formed before the operation, that an excision of the head of the femur was impracticable; for besides the comminution about the lesse? trochanter and tlie fissures towards the neck, fissures ran down the shaft of the bone for a long distance. Fig. 111. Inc. IV. Posterior view of Spi-cl men 1379, A. M. M. A letter from the operator, Surgeon Albert 0. Gorgas, U. 8. Navy, and a memorandum from Surgeon P. J. Horwitz, Chief of the Bureau of Medicine and Surgery of the Navy Department, have furnished the data from which the abstract of the following case is compiled :^ Case XIII.—Seaman George Cook, aged twenty-one years, an Englishman liy birth, was wounded on February 1, 1864, in an engagement of a gunboat with a battery supported by sharpshooters, at Smithfield, Virginia. A rifle ball grazed his ■ See Circular No. 6, S. G. O., 1865, p. oO, Case C-. -See Circular No. 6, S. G. O., 1865, p. 50, Case 13.](https://iiif.wellcomecollection.org/image/b21289475_0034.jp2/full/800%2C/0/default.jpg)
