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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![Henry AVlieaton Rivers and Assistant Surgeon A. G. Sprague, of Rhode Island, and Surgeon M. K. Hogan, U. S. Volunteers, have furnished some additional particulars relative to the case: Case XV.—Priv^ate Richard Gordon, Co. H, 7th Rhode Island Volunteers, a stout and apparently healthy man, of about twenty-eight years of age, was wounded at about eight in tlie morning of the 18th of May, 18S4, in one of the assaults on the lines at Spottsylvania, and was carried on a stretcher, two or tliree miles to the rear, to the Field Hospital of the Third Division of the Ninth Army Corps. A fragment of shell had completely shattered the left thigh, leaving the lower part of the limb attached to the upper by shreds of integument and muscles only. There had been but sliglit primary hsemorrhage. He was conscious and his pulse was perceptible; but he was in extreme collapse. A consultation was held, at which the Surgeon-in-chief of the division, Surgeon P. A. O'Connell, Surgeon James Harris, 7th Rhode Island Volunteers, and others, assisted, and it was determined to give the man the chance of an operation rather than to allow him to die without an effort to save him, and Dr. J. M. Carnochan, a civil surgeon, who had volunteered his services at the hospital, was selected to operate. Chloroform was carefully administered by Surgeon Harris, and Dr. Carnochan, as a preliminary step, tied the femoral artery three-quarters of an inch below Poupart's ligament, and then proceeded to amputate at the hip-joint by a modification of the oblique method of Guthrie. A vertical incision three inches long, commencing an inch above the great trochanter was made, the soft parts being- divided down to the bone. From the lower third of this incision, two oblique incisions, one before and one behind, were made to diverge and then to reunite about two and a half inches below the level of the ischiatic tuberosity. The head of the femur was then disarticulated, and the knife being carried to the inner side of the neck the operation was finished by dividing the soft parts fin that side by a single sweep of the instrument. The operation, including the ligation of the femoral, was completed in two minutes. The patient recovered kindly from the influence of the anfesthetic. He was placed in a shelter tent and took a dose of o]iium. He died ten hours after the operation, no reaction having taken place. Tlie operator, Surgeon C. G. Jewett, 16th Massachusetts Volunteers, has transmitted a very full account of the following case, and vSurgeon Henry F. Lyster, 5th Michigan Volunteers, and Assistant Surgeon J. D. Stewart, 74th New York Volunteers, have communicated facts regarding it: Case XVI.—Private Jacob Barger, Co. B, 26th Pennsylvania Volunteers, aged twenty-two years, of robust constitution and sanguine temperament, was wounded on the morning of May 18, 1864, in the attack of Birney's Division of the Second Army Corps upon the intrenchments before Spottsylvania Court House. He was struck by a fragment of shell, which shattered the femvir from a little above the trochanter minor for nine inches downwards, and tore and mangled the soft parts on the anterior and lateral aspects of the thigh, leaving uninjured a V-shaped portion of integument and subjacent tissue on the antero- internal femoral region, seven inclies wide at the base and ten inches in vertical length. He was carried to the Field Hospital of the Third Division of the Second Corps and was examined about two hours after the reception of the injury. There was no apparent shock, and there had been very little hemorrhage. The pulse was full and calm, and the surface of the bodj^ was of a natural temperature. The senior surgeons of the division concurred in the opinion that this was one of the few cases of extensive gunshot injury of tlie femur in which a successful result might reasonably be anticipated from an amputation at the hip-joint. The patient was desirous that an operation should be practised. He was of a hopeful, buoyant nature, and was sanguine of a favorable issue. Amputation having been decided upon, chloroform was administered by'Surgeon John Wiley, 6tli New Jersey Volunteers, a medical ofiicer of great experience and caution in this duty. Only two drachms of the anaesthetic was used, given from a napkin, with great regard to a due admixture of atmospheric air. Surgeon C. C. Jewett, 16th Massachusetts, performed the amputation, by making a single antero-internal flap. Assistant Surgeon J. T. Calhoun, U. S. Army, and others present on the occasion, have described the admii'able dextei'ity and skill manifested in the operative procedure. The disarticulation was completed in less than forty seconds. Surgeon C. H. Irvine, 72d New York Volunteers, compressed the crural artery at the groin ; Surgeon F. Prentice, 73d New York Volunteers, grasped the flap and secured the cut end of the femoral; Surgeon James Ashe, 70th New York Volunteers, had charge of the limb; Surgeon Evarts, 20th Indiana Volunteers, Surgeon E. A. Whiston, 1st Massachusetts Volunteers, and Assistant Surgeon J. T. Calhoun, U. S. Army, also aided in the operation. Tlie flap, the form and location of which were determined by the wound, was made by cutting from without inwards. Immediately after the head of the bone was freed from the acetabulum a spasmodic catch was heard in the patient's respiration, and an assistant exclaimed: Stop the chloroform! Surgeon Wiley promptly responded: He is not taking any. The next instant an assistant at the wrist reported that the pulse was tailing. The arteries were now rapidly secured. The loss of blood was estimated not to exceed a single ounce. But the patient was insensible, the respira- I'lc. \'l r. Comminution of feidur tion labored, the pulse very slow and feeble. The usual restoratives were employed without effect, bj, a slifcll. Spec.3mo,A.U.M. ^j^^ patient did not rally; he lingered for about two hours, and died a little after noon, May 18,](https://iiif.wellcomecollection.org/image/b21289475_0036.jp2/full/800%2C/0/default.jpg)
